The Role of One-Stage Exchange for Prosthetic Joint Infection

Purpose of Review

In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy.

Recent Findings

Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years. More review articles and opinion pieces have been written. Reinfection rates in these recent studies range from 0 to 65%, but a meta-analysis and systematic review of all studies showed a reinfection rate of 7.6% (95% CI 3.4–13.1) and 8.8% (95% CI 7.2–10.6) for single-stage and two-stage revisions respectively. There is emerging evidence to support single-stage revision in the setting of significant bony deficiency and atypical PJIs such as fungal infections.

Summary

Prospective randomised studies are recruiting and are necessary to guide the direction of single-stage revision selection criteria. The onus of surgical excellence in mechanical removal of implants, necrotic tissue, and biofilms lies with the arthroplasty surgeon and must remain the cornerstone of treatment. Single-stage revision may be considered the first-line treatment for all PJIs unless the organism is unknown, the patient is systemically septic, or there is a poor tissue envelope.

     

“Salt mummification” — atypical method of embalming a corpse

International Journal of Legal Medicine - It is extremely rare for table salt to be used to preserve a dead body in criminal cases. In the case presented here, after the death of his 85-year-old...     

High Martensitic Steel after Welding with Micro-Jet Cooling in Microstructural and Mechanical Investigations

Modern means of transport will play a significant role in the smart city. In the automotive industry, high-strength steels such as Docol are employed more often. This kind of material is relatively not very well weldable. The main reason is related to the Heat Affect Zone, the region in which cracks occur. Another disadvantage is connected with differences in values of ultimate strength of parent and weld material. The differences can be diminished using the correct welding process, which employs nickel and molybdenum electrode wires at much lower sulfur content. The weld metal deposit contains mainly martensite and bainite with coarse ferrite, while the parent material contains mainly martensite and rather fine ferrite. New technology, micro-jet cooling after the joining process enables to obtain the microstructure of weld metal deposit at acceptable parameters. Welding with micro-jet cooling could be treated as a very promising welding Docol steels process with high industrial application. Results of non-destructive inspections on macro samples corresponded with further destructive test results (tensile strength, hardness, fatigue, metallographic structure analyses). This article aims to verify fatigue behavior of Docol 1200 M steel after welding supported by the cooling using the micro-jet technique. For the first time, micro-jet cooling was used to weld this kind of steel to check the mechanical properties of the joint, especially to determine the fatigue limit. This study is formulated as follows: investigating fatigue resistance of the Docol 1200 M weld manufactured at the cooling process with micro-jets. The joints were produced in the MAG (Metal Active Gas) technology modified by micro-jet cooling. The results collected in the fatigue test were processed in the form of the Wöhler’s S–N diagram following the fatigue limit of the weld examined. All data have indicated the possibility of obtaining a new method of welded joints with high fatigue limit minimum of 480 MPa. It could be important to achieve a tensile strength of 700 MPa while maintaining the best relative elongation at the level of the base material.     

Proper interpretation of non-differential misclassification effects: expectations vs observations

BACKGROUND: Many investigators write as if non-differential exposure misclassification inevitably leads to a reduction in the strength of an estimated exposure-disease association. Unfortunately, non-differentiality alone is insufficient to guarantee bias towards the null. Furthermore, because bias refers to the average estimate across study repetitions rather than the result of a single study, bias towards the null is insufficient to guarantee that an observed estimate will be an underestimate. Thus, as noted before, exposure misclassification can spuriously increase the observed strength of an association even when the misclassification process is non-differential and the bias it produced is towards the null. METHODS: We present additional results on this topic, including a simulation study of how often an observed relative risk is an overestimate of the true relative risk when the bias is towards the null. RESULTS: The frequency of overestimation depends on many factors: the value of the true relative risk, exposure prevalence, baseline (unexposed) risk, misclassification rates, and other factors that influence bias and random error. CONCLUSIONS: Non-differentiality of exposure misclassification does not justify claims that the observed estimate must be an underestimate; further conditions must hold to get bias towards the null, and even when they do hold the observed estimate may by chance be an overestimate.     

Middle ear schwannoma--case report

Schwannoma is one of the common benign middle ear space tumors. The tumors may present with facial nerve paresis or palsy, otologic symptoms and/or parotid mass middle ear schwannomas may originate from the nerves of the tympanic caviti or by extensions from outside the middle ear space. Schwannomas of the facial nerve can occur along any segment, but they frequently involve the geniculate ganglion and extend proximally or distally from there. MRI and CT imaging characteristics are similar to those of vestibular schwannomas. We present the clinical and radiologic features of a middle-space schwannoma originating from facial nerve. The patient underwent middle ear exploration and mastoidectomy. The tumor was of facial nerve origin and was separated from middle ear. The pathologic diagnosis was schwannoma.     

The relative sensitivity of four benthic invertebrates to metals in spiked-sediment exposures and application to contaminated field sediment

The relative sensitivity of four benthic invertebrates (Hyalella azteca, Chironomus riparius, Hexagenia spp., and Tubifex tubifex) was determined for Cd, Cu, and Ni in water-only and in spiked-sediment exposures. Survival (median lethal concentrations [LC50s] and the concentrations estimated to be lethal to 25% of test organisms [LC25s]), and endpoints for growth and reproduction (mean inhibitory concentrations [IC25s]) were compared. The sensitivities differed depending on the species and metal, although some trends emerged. In water-only exposures, H. azteca is the most sensitive species to cadmium and nickel, with mean LC50s of 0.013 and 3.6 mg/L, respectively; C. riparius is the most sensitive species to copper, with a mean LC50 of 0.043 mg/L. In the spiked-sediment exposures, the order in decreasing sensitivity to copper is Hyalella = Hexagenia < Chironomus < Tubifex for survival and growth/reproduction. For cadmium, the order in decreasing sensitivity is Hyalella = Chironomus < Hexagenia < Tubifex, and for nickel is Hyalella < Hexagenia < Chironomus < Tubifex. Chironomus riparius and Hexagenia spp. survival can be used to distinguish between toxicity caused by different metals. Species test responses in field-collected sediment(Collingwood Harbour, ON, Canada) were examined in an attempt to determine the causative agent of toxicity throughout, using the established species sensitivities. Sediment toxicity was categorized first by comparing species responses to those established for a reference database. Test responses in the field-collected sediment do not support causality by Cu, a suspected toxicant based on comparison of sediment chemistry with sediment quality guidelines.