Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets.MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS).ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria.ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.     

经皮肾穿气压弹道碎石联合体外冲击波碎石治疗上尿路结石

目的 探讨提高上尿路结石碎石成功率的微创治疗方法。方法 采用经皮肾穿微造瘘输尿管镜气压弹道碎石，术中放置双J管，术后配合体外冲击波碎石术(ESWL)治疗上尿路结石48例。结果 结石总排净率为89．1％，结石最小排净率79．2％，无严重并发症发生。结论 该方法结石排净率高，创伤较小，手术并发症少，是上尿路结石较为理想的微创治疗方法。     

输尿管镜治疗输尿管结石185例

目的探讨输尿管镜气压弹道碎石治疗输尿管结石的效果。方法2004年2月～2005年3月，我们对185例输尿管结石（其中伴肾绞痛96例）采用输尿管镜取石或气压弹道碎石进行总结和分析。结果失败12例，其中6例改开放手术，6例术后3d行体外冲击波碎石。一次碎石成功率93．5％（173／185），其中上段结石为75．0％（24／32），中段为95．8％（46／48），下段为98．1％（103／105）。肾绞痛者成功率为100％（96／96）。术中输尿管损伤率2．9％（5／173），其中3例（1．7％）中转开放手术。术后肾绞痛1例。全组随访6～12个月，平均10．2月，无复发。结论输尿管镜气压弹道碎石安全有效，并发症少，是治疗输尿管中下段结石的首选方法，尤其对肾绞痛者疗效更好。     

Pallidotomy in Parkinson's disease improves single-joint, repetitive, ballistic movements, but fails to modify multijoint, repetitive, gestural movements.

We studied 12 non-demented PD patients in on state before and 3 months after posteroventral pallidotomy (PVP), in order to evaluate the effects of surgery upon an unconstrained, multijoint skilled movement as well as a single joint, repetitive, ballistic movement. A Selspot II System was used for three-dimensional data acquisition, processing and reconstruction of limb trajectories. Specific wrist kinematic features of spatial accuracy (linearity and planarity), temporal attributes (acceleration and velocity), spatiotemporal relationships (velocity-curvature coupling), and joint kinematic variables (relationships between wrist and elbow velocities and relative arm angle amplitudes) for each cycle of movement were graphically and numerically analysed. QMC was applied to single joint, repetitive, ballistic movements. QMC significantly improved after PVP (P < 0.0006). However, wrist as well as joint kinematic variables of the gestural movements failed to change significantly after PVP. The lack of improvement of the kinematic abnormalities of the gestural movement in PD patients would indicate that they are unrelated to the basic motor deficit; most likely they are the result of a disruption of a complex of sensorimotor integration processes due to abnormal parieto-frontal basal ganglia interaction.     

Feedback and feedforward adaptation to visuomotor delay during reaching and slicing movements

It has been suggested that the brain and in particular the cerebellum and motor cortex adapt to represent the environment during reaching movements under various visuomotor perturbations. It is well known that significant delay is present in neural conductance and processing; however, the possible representation of delay and adaptation to delayed visual feedback has been largely overlooked. Here we investigated the control of reaching movements in human subjects during an imposed visuomotor delay in a virtual reality environment. In the first experiment, when visual feedback was unexpectedly delayed, the hand movement overshot the end‐point target, indicating a vision‐based feedback control. Over the ensuing trials, movements gradually adapted and became accurate. When the delay was removed unexpectedly, movements systematically undershot the target, demonstrating that adaptation occurred within the vision‐based feedback control mechanism. In a second experiment designed to broaden our understanding of the underlying mechanisms, we revealed similar after‐effects for rhythmic reversal (out‐and‐back) movements. We present a computational model accounting for these results based on two adapted forward models, each tuned for a specific modality delay (proprioception or vision), and a third feedforward controller. The computational model, along with the experimental results, refutes delay representation in a pure forward vision‐based predictor and suggests that adaptation occurred in the forward vision‐based predictor, and concurrently in the state‐based feedforward controller. Understanding how the brain compensates for conductance and processing delays is essential for understanding certain impairments concerning these neural delays as well as for the development of brain–machine interfaces.     

EFFECTS OF BICYCLE HELMET LAWS ON CHILDREN'S INJURIES

In recent years, many states and localities in the USA have enacted bicycle helmet laws. We estimate the effects of these laws on injuries requiring emergency department treatment. Using hospital‐level panel data and triple difference models, we find helmet laws are associated with reductions in bicycle‐related head injuries among children. However, laws also are associated with decreases in non‐head cycling injuries, as well as increases in head injuries from other wheeled sports. Thus, the observed reduction in bicycle‐related head injuries may be due to reductions in bicycle riding induced by the laws. Copyright © 2013 John Wiley & Sons, Ltd.     

气压弹道式体外冲击波联合玻璃酸钠治疗膝关节骨性关节炎的疗效观察

目的探讨气压弹道式体外冲击波联合玻璃酸钠治疗膝关节骨性关节炎的临床疗效。方法选择确诊膝关节骨性关节炎患者100例,随机分为单纯玻璃酸钠组(对照组)与冲击波联合玻璃酸钠组(联合组),分别给予单纯玻璃酸钠及冲击波联合玻璃酸钠膝关节腔内注射,每周1次,连续5次为一个疗程。观察治疗前及治疗后2、4、8、12和24周的VAS评分、Lysholm膝关节功能评分,评估患膝的功能改善状况及治疗有效率。结果治疗后联合组与对照组VAS评分均较治疗前下降(P<0.05),联合组下降更明显(P<0.05);膝关节功能评分两组均较治疗前升高(P<0.05),联合组升高更显著(P<0.05);联合组总有效率为96%,对照组为84%,两组比较差异有统计学意义(P<0.05)。结论冲击波联合玻璃酸钠治疗膝关节骨性关节炎临床疗效显著、安全性高,简单易行,值得临床推广。     

Are self‐reported risk‐taking behavior and helmet use associated with injury causes among skiers and snowboarders?

Over the last 10 years, ski helmet use has steadily increased worldwide. According to the “risk compensation theory,” however, studies found that up to one third of skiers and snowboarders self‐reported to engage in more risk taking when wearing a ski helmet. Therefore, to evaluate whether self‐reported risk taking and ski helmet use affect accident causes on ski slopes, more than 2000 injured skiers and snowboarders were interviewed during the 2011/2012 winter season about accident causes and potential intrinsic and extrinsic risk factors. Chi‐square tests revealed that ski helmet use did not significantly differ between self‐reported risky and cautious people (81% vs 83%). Multivariate regression analysis revealed younger age groups [odds ratios (ORs) 1.8–1.9, P < 005], male sex (OR 2.4, P < 0.001), Austrian nationality (2.2, P < 0.001), higher skill level (1.7, P < 0.001), and off‐slope skiing (OR 2.2, P = 0.060) to be predictive for a risky behavior on ski slopes. Neither the use of skis or snowboards nor accident causes were significantly associated with a riskier behavior on ski slopes. In conclusion, self‐reported risk‐taking behavior and ski helmet use seem not to be associated with accident causes leading to an injury among recreational skiers and snowboarders.