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.

Tolerance of ocular iontophoresis in healthy volunteers.

To evaluate ocular tolerance, healthy volunteers were iontophoresed transclerally using novel OcuPhor trade mark hydrogel drug delivery applicators filled with balanced salt solution. In this three-period crossover study in 24 male and female subjects, 16 subjects received 0 mA and two of the following DC currents: 0.1, 0.5., 1.0, 2.0, 3.0, or 4.0 mA for 20 min; 6 subjects received 3 mA for 20 min and 1.5 mA for 40 min (both equivalent to 60 mAmin total charge). Safety and tolerance were determined by subjective VAS and objective ophthalmic assessments. Subjects were evaluated before and up to 22 hr after dosing. The applicators were well-tolerated and no clinically significant changes in symptomology or in ophthalmic assessments were seen following exposure to 0-3.0 mA for 20 min or 1.5 mA for 40 min. At 4.0 mA 2 of 4 subjects reported a burning sensation under the applicator during dosing which resolved by 22 hr post-dose; superficial changes in fluorescein staining were observed at 1 hr, but not at 22 hr. The OcuPhor trade mark system has promise for noninvasive drug delivery to the eye.     

Relationship between pregnancy outcomes and maternal vitamin D and calcium intake: A cross-sectional study.

Poor maternal vitamin D status affects fetal and infant skeletal growth. The aim of the present study was to determine the association between newborn outcomes and maternal calcium and vitamin D intakes. Four hundred and forty-nine pregnant women, healthy at the point of delivery, and their newborns were enrolled in the study, which was performed in three university hospitals in Tehran in March 2004. Maternal anthropometric data and energy, protein, calcium and vitamin D intakes were collected, and newborn outcomes (weight, length, head circumference and 1-min Apgar score) were determined. Almost two-thirds of the mothers (64.3%) took no supplements during pregnancy. Only one-third of the mothers (33.8%) had adequate intakes of calcium and vitamin D (from supplements and foods) compared with the Recommended Dietary Allowances. Mean length at birth and 1-min Apgar score were higher in newborns whose mothers had adequate calcium and vitamin D intake than in newborns whose mothers had inadequate intake (p = 0.03 and p = 0.04, respectively). Significant correlations were found between adequate maternal calcium and vitamin D intake and both appropriate birth weight and 1-min Apgar score of newborns and weight gain of mothers during pregnancy. Informing mothers of the critical importance of consuming adequate amounts of calcium and vitamin D seems necessary.     

Adenosine deaminase and purine nucleoside phosphorylase activity in spleen cells of aged mice

The activities of two enzymes of purine metabolism, adenosine deaminase (ADA) and purine nucleoside phosphorylase (PNP), were determined in spleen lymphocytes from mice of various ages. We found that in the older animals, which have depressed responses to concanavalin A and phytohemagglutinin, there is a decrease in the activity of PNP but normal activity of ADA. The decline of PNP activity was seen at 7.5 months of age and appears to be concurrent with a decline in T-cell function. These results suggest that a decrease in PNP activity may be a contributing factor in the immunodeficient state of the aged.     

Association of Opioid Use Disorder With 2016 Presidential Voting Patterns: Cross-sectional Study in New York State at Census Tract Level

BackgroundOpioid overdose-related deaths have increased dramatically in recent years. Combating the opioid epidemic requires better understanding of the epidemiology of opioid poisoning (OP) and opioid use disorder (OUD).ObjectiveWe aimed to discover geospatial patterns in nonmedical opioid use and its correlations with demographic features related to despair and economic hardship, most notably the US presidential voting patterns in 2016 at census tract level in New York State.MethodsThis cross-sectional analysis used data from New York Statewide Planning and Research Cooperative System claims data and the presidential voting results of 2016 in New York State from the Harvard Election Data Archive. We included 63,958 patients who had at least one OUD diagnosis between 2010 and 2016 and 36,004 patients with at least one OP diagnosis between 2012 and 2016. Geospatial mappings were created to compare areas of New York in OUD rates and presidential voting patterns. A multiple regression model examines the extent that certain factors explain OUD rate variation.ResultsSeveral areas shared similar patterns of OUD rates and Republican vote: census tracts in western New York, central New York, and Suffolk County. The correlation between OUD rates and the Republican vote was .38 (P<.001). The regression model with census tract level of demographic and socioeconomic factors explains 30% of the variance in OUD rates, with disability and Republican vote as the most significant predictors.ConclusionsAt the census tract level, OUD rates were positively correlated with Republican support in the 2016 presidential election, disability, unemployment, and unmarried status. Socioeconomic and demographic despair-related features explain a large portion of the association between the Republican vote and OUD. Together, these findings underscore the importance of socioeconomic interventions in combating the opioid epidemic.     

Motion discrimination of single targets: comparison of preliminary findings in normal subjects and patients with glaucoma

Background: Luminance, global motion and flicker sensitivities are affected in patients with primary open-angle glaucoma. Although no theoretical model has been put forward to explain the observed reduction in sensitivity in this patient group, these findings have often been attributed to diffuse and selective loss of large optic nerve fibres. Methods: Movement processing was investigated using an optical projection system that generates smooth, continuous motion with control of speed, displacement and motion direction. Motion-displacement and direction-discrimination thresholds were measured in eight normal subjects and in three patients with diagnosed glaucoma. At each speed tested, targets were presented for a range of displacements and thresholds were extracted after probit analysis. The measurements were carried out both foveally and at 19° in the periphery and provided the data necessary to develop and optimise a model of motion perception based on multiple time delays for the correlation of signals that map progressively more distant parts of the visual field. Results: Our preliminary findings show that direction discrimination can be at chance level even for large displacements when motion is detected 80% of the time. Model simulations show that specific changes in the spatial sampling interval and the speed of transmission of the motion signals involved can cause the observed reduction in motion sensitivity and direction discrimination in patients with glaucoma. Conclusions: A model for motion detection and direction discrimination of single targets has been proposed to account for the measured functional relationship between motion displacement thresholds and target speed in normal subjects. Tested patients with glaucoma show reduced motion sensitivity and poor discrimination of motion direction. The type of degraded performance observed experimentally in glaucoma patients is also predicted by the model. Such predictions require specific changes in model parameters that may be indicative of changes in the retina caused by the disease.     

Intrathoracic kidney: A rare presentation of ectopic kidney

The thoracic kidney is the rarest form of renal ectopia. Furthermore, it is usually asymptomatic and discovered incidentally. It is seen as a mass in the posterior mediastinum or juxta-diaphragmatic on chest radiography. A computed tomography scan or magnetic resonance imaging is usually needed for a definitive diagnosis. The thoracic kidney typically exits the retroperitoneal space through the foramen of Bochdalek.     

Bench-to-bedside review: Rapid molecular diagnostics for bloodstream infection - a new frontier?

ABSTRACT: Among critically ill patients, the diagnosis of bloodstream infection poses a major challenge. Current standard bacterial identification based on blood culture platforms is intrinsically time-consuming and slow. The continuous evolvement of molecular techniques has the potential of providing a faster, more sensitive and direct identification of causative pathogens without prior need for cultivation. This may ultimately impact clinical decision-making and antimicrobial treatment. This review summarises the currently available technologies, their strengths and limitations and the obstacles that have to be overcome in order to develop a satisfactory bedside point-of-care diagnostic tool for detection of bloodstream infection.