Longer Operative Time Results in a Higher Rate of Subsequent Periprosthetic Joint Infection in Patients Undergoing Primary Joint Arthroplasty

Background

Whether prolonged operative time is an independent risk factor for subsequent surgical site infection (SSI) and periprosthetic joint infection (PJI) following total joint arthroplasty (TJA) remains a clinically significant and underexplored issue. The aim of this study is to investigate the association between operative time and the risk of subsequent SSI and PJI in patients undergoing primary TJA.

Technical Note: A comparison of a novel direct ophthalmoscope, the OptyseTM, to conventional direct ophthalmoscopes

Despite the current popularity of binocular indirect ophthalmoscopy, direct ophthalmoscopes are still commonly used by clinicians for fundus examination. They are considered to be expensive, however, and it has been suggested that this cost can prevent their use by healthcare professionals in developing countries. The Optyse Lens Free Ophthalmoscope is a novel direct ophthalmoscope, without a lens focus system, that allows for comparatively inexpensive manufacture and supply. We compared the clarity of view with the Optyse to that with standard direct ophthalmoscopes, over a sequential cohort of patients with a variety of refractive errors and ocular conditions. The grade of clarity of view with the Optyse Lens Free Ophthalmoscope was less than conventional ophthalmoscopes (Wilcoxon signed rank test, p < 0.0001). This grade of clarity of view was not associated with the ametropia of the ophthalmoscopic observation (Spearman r < or = 0.03, p > or = 0.28) but was with the presence of cataracts (chi2 test, p < 0.0001) with both the Optyse and the conventional ophthalmoscopes. Despite its limitations, the retinal view with Optyse was often within acceptable clinical limits suggesting that this relatively inexpensive ophthalmoscope may have a place when cost prohibits any other type of ophthalmoscope use.     

Benign lymphoepithelial lesion of the parotid gland in intravenous drug users

Fifteen partial parotid salivary gland resection specimens interpreted as benign lymphoepithelial lesion (BLL) were accessioned by our surgical pathology service between January 1983 and December 1986. Twelve of the specimens were removed from 11 prison inmates referred to our hospital, a patient subgroup constituting the source of only 2% of surgical pathology specimens in general. All prison inmates with BLL had a history of intravenous drug use, had developed unexplained lymphadenopathy concurrently with the parotid gland enlargement, and had suspected human immunodeficiency virus (HIV) infection (serologically confirmed in two). Histopathologic features of the parotid gland specimens included atypical follicular hyperplasia and follicular involution, resembling lymph node changes of HIV infection. The clinical and pathologic findings in these cases suggest an association between HIV infection and BLL, and support a previously proposed mechanism for the development of BLL through progressive enlargement of intraparotid lymph nodes.     

Regional Variation and Use of Exception Letters for Cadaveric Liver Allocation in Children with Chronic Liver Disease

The Pediatric End-Stage Liver Disease (PELD) score was designed to reduce subjectivity in liver allocation and to advantage patients with a higher probability of waiting list mortality. The aims of this study were to determine the impact of PELD implementation for children with chronic liver disease and to assess whether PELD met its goal of standardization of liver allocation for children. This study used data reported to the United Network for Organ Sharing (UNOS) registry for children with chronic liver disease receiving primary cadaveric liver transplant between January 2000 and December 2001 (pre-PELD) and March 2002 and July 2003 (PELD). PELD reduced the percentage of children transplanted while in an intensive care unit and as status 1. A calculated PELD score was used for allocation in only 52% of recipients. Thirty percent were status 1 at transplant and PELD scores granted by exception were used for allocation in 18% of patients. There was regional variation in PELD score at allocation and use of exception scores with a significant relationship between PELD score and percentage of exception cases. Regional variation suggests that PELD has not resulted in standardization of listing practices in pediatric liver transplantation.     

T-cell signature cytokines distinguish pulmonary sarcoidosis from pulmonary tuberculosis

Sarcoidosis is a systemic inflammatory disorder characterized by tissue infiltration due to mononuclear phagocytes and lymphocytes and associated noncaseating granuloma formation. Pulmonary sarcoidosis (PS) shares a number of clinical, radiological, and histopathological characteristics with that of pulmonary tuberculosis (PTB). Due to this, clinicians face issues in differentiating between PS and PTB in a substantial number of cases. There is a lack of any specific biomarker that can diagnose PS distinctively from PTB. We compared T-cell-based signature cytokines in patients with PS and PTB. In this study, we proposed a serum biomarker panel consisting of cytokines from cells: T helper (Th) 1 [interferon-gamma (IFN-γ); tumor necrosis factor-alpha (TNF-α)], Th9 [interleukin (IL)-9], Th17 [IL-17], and T regulatory (Treg) [IL-10; transforming growth factor-beta (TGF-β)]. We performed the principal component analysis that demonstrated that our serum cytokine panel has a significant predictive ability to differentiate PS from PTB. Our results could aid clinicians to improve the diagnostic workflow for patients with PS in TB endemic settings where the diagnosis between PS and PTB is often ambiguous.     

Effects of trifluralin on carp: biochemical and histological evaluation.

Acute and subacute toxicity of the herbicide trifluralin on fish was investigated in laboratory toxicity tests with carp. Median lethal concentrations were determined in acute tests. The 96-h LC50 value was 0.045 (0.036-0.051)mg/L. Fish were exposed to subacute concentrations of the herbicide (0.005, 0.01, and 0.02 mg/L trifluralin) in the 14-day toxicity tests and the effects on the relative growth rate, some biochemical parameters [alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanin aminotransferase (ALT) activities in serum, gills, liver, and kidney], gills, liver, and kidney structure were studied. A decrease in relative growth rate was found. An increase of functional enzyme activities in blood serum and the organs examined, particularly in the highest concentration of trifluralin indicated changes in the vital organs, was confirmed by histological analysis. The most severe changes (although mostly reversible) were found in the gills and kidney of the fish examined.