New developments in anti-biofilm intervention towards effective management of orthopedic device related infections (ODRI's).

Orthopedic device related infections (ODRI's) represent a difficult to treat situation owing to their biofilm based nature. Biofilm infections once established are difficult to eradicate even with an aggressive treatment regimen due to their recalcitrance towards antibiotics and immune attack. The involvement of antibiotic resistant pathogens as the etiological agent further worsens the overall clinical picture, pressing on the need to look into alternative treatment strategies. The present review highlightes the microbiological challenges associated with treatment of ODRI's due to biofilm formation on the implant surface. Further, it details the newer anti-infective modalities that work either by preventing biofilm formation and/or through effective disruption of the mature biofilms formed on the medical implant. The study, therefore aims to provide a comprehensive insight into the newer anti-biofilm interventions (non-antibiotic approaches) and a better understanding of their mechanism of action essential for improved management of orthopedic implant infections.

Ambient carbon monoxide and increased risk of daily hospital outpatient visits for respiratory diseases in Dongguan, China.

BACKGROUND: The toxicity of high-concentration carbon monoxide (CO) on human health has previously been documented. However, the epidemiological evidence on the association between acute exposure to ambient CO and respiratory diseases is relatively lacking and controversial. OBJECTIVES: To examine the short-term association between ambient CO and hospital outpatient visits for respiratory diseases in Dongguan, China. METHODS: The number of daily hospital outpatient visits for respiratory diseases, and air pollution and meteorological data were collected from January 2013 to August 2017. A generalized additive model with a quasi-Poisson link was used to estimate the association between ambient CO concentration and the total number of hospital outpatient visits for all respiratory diseases and those for asthma, bronchiectasis, chronic obstructive pulmonary disease (COPD) and pneumonia. We further analyzed the effect of ambient CO by gender and age. RESULTS: Over the study period, a 24-h mean concentration of ambient CO of 0.88 mg/m3 (below the limit for CO in China) and a total of 89,484 hospital outpatient visits for respiratory diseases were recorded. Ambient CO was found to increase the risk for asthma, bronchiectasis, pneumonia and the total number of respiratory diseases. The per interquartile range (IQR) increase in ambient CO at lag03 day corresponded to a 5.62% (95% confidence interval (CI): 3.24%, 8.05%), 8.86% (95% CI: 4.89%, 12.98%), 6.67% (95% CI: 0.87%, 12.81%) and 7.20% (95% CI: 2.35%, 12.29%) increased risk in outpatient visits for all respiratory diseases, asthma, bronchiectasis and pneumonia, respectively. Each association was partially weakened after adjusting for co-pollutants. The effect of ambient CO on respiratory diseases appeared to be greater for females and the elderly. CONCLUSIONS: Short-term exposure to ambient CO was associated with increased risk of outpatient visits for respiratory diseases. Our analysis may help to understand the health effects of low-levels of CO and provide evidence for the creation of air quality standards.

Adipose tissue-derived stem cells inhibit hypertrophic scar (HS) fibrosis via p38/MAPK pathway.

OBJECTIVE: The current study was designed to investigate the effects and underlying mechanisms of adipose tissue-derived stem cells (ADSCs) on hypertrophic scar (HS) fibrosis. METHOD: Real-time quantitative polymerase chain reaction (qRT-PCR) and Western blot analysis were performed to detect the expression of collagen I (Col1), collagen III (Col3), and α-smooth muscle actin (α-SMA) after fibroblasts and cultured HS tissues were treated with ADSC medium. All data were analyzed by using SPSS17.0 software. Statistical analysis was performed by Student t tests. RESULTS: The in vitro study showed that ADSC medium decreased the expression of Col1, Col3, and α-SMA. In addition, the protein level of p-p38 was downregulated by ADSC medium treatment in a concentration dependent manner. CONCLUSION: The current study demonstrated that ADSC could decrease collagen deposition and scar formation in in vitro experiments. The regulation of the p38/MAPK signaling pathway might play an important role in the process.

Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years: A case series.

No surgical procedure perfectly treats advanced Kienböck disease. Although vascularized os pisiform transferring (VOPT) is one of the main therapeutic approaches, reports on long-term follow-up and case series for this technique are scarce.We collected postoperative results in 11 patients with advanced Kienböck disease who underwent VOPT between 1986 and 2001 in our Hospital. Follow-up durations ranged from 15 to 26 years.At the last follow-up, excellent and good results were found in 81.8% according to the Modified Green and O'Brien score. Postoperative imaging revealed significantly reduced pisiform bone; carpal height ratio and Nattrass index were decreased, while the radioscaphoid angle was increscent, compared with preoperative and mid-term follow-up results.The favorable long-term results demonstrated that VOPT is a dependable and durable procedure for the treatment of advanced Kienböck disease, with pain relief and functional improvement despite some radiographic findings such as wrist osteoarthritis occurrence.

[Research progress in influence of bony structure of glenohumeral joint on shoulder joint stability].

OBJECTIVE: To review the progress in influence of bony structure of glenohumeral joint on the shoulder joint stability. METHODS: Recent literature, concerning the influence factors of the shoulder joint stability and the action of bony structure of the glenohumeral joint in the stability of shoulder joint, was extensively reviewed and summarized. RESULTS: The specific factors which the bony structure of the glenohumeral joint influences the stability of the shoulder joint are the conformity index, the shape of the glenohumeral joint, version angle, inclination angle, and head shaft angle, etc. CONCLUSION: Although the predecessor's research experience and clinical reports have preliminarily determined the relationship between the bony structure of the glenohumeral joint and the stability of the shoulder joint, it is necessary to further study in various aspects (including anatomy, biomechanics, and clinical practice).

[Biomechanical evaluation of anterior instability of shoulder joint after glenoid osseous defect].

OBJECTIVE: To evaluate the role of glenoid osseous structure on anterior stability of shoulder so as to provide the biomechanical basis for clinical treatment. METHODS: Ten fresh shoulder joint-bone specimens were collected from 10 adult males cadavers donated voluntarily, including 4 left sides and 6 right sides. The displacements of the specimens were measured at 0 degrees and 90 degrees abduction of shoulder joint by giving 50 N posterior-anterior load under the conditions as follows: intact shoulder joint, glenoid lip defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect. RESULTS: For intact shoulder joint, glenoid lip defect, 10% of osseous defect, 20% of osseous defect, and repairing osseous defect, the displacements were (10.73 +/- 2.93), (11.43 +/- 3.98), (13.58 +/- 4.86), (18.53 +/- 3.07), and (12.77 +/- 3.13) mm, respectively at 0 degrees abduction of shoulder joint; the displacements were (8.41 +/- 2.10), (8.55 +/- 2.28), (9.06 +/- 2.67), (12.49 +/- 2.32), and (8.55 +/- 2.15) mm, respectively at 90 degrees abduction of shoulder joint. There was no significant difference between intact shoulder joint and others (P > 0.05) except between intact shoulder joint and 20% of osseous defect (P < 0.05). CONCLUSION: When shoulder glenoid lip defects or the glenoid osseous defect is less than 20%, the shoulder stability does not decrease obviously, indicating articular ligament complex is not damaged or is repaired. When glenoid osseous defect is more than 20%, the shoulder stability decreases obviously even if articular ligament complex is not damaged or is repaired. Simultaneous repair of glenoid osseous defect and articular ligament complex can recover the anterior stability of the shoulder.

[Clinical results of open arthrolysis by elevated lateral and medial collateral ligament-musculature complex from supracondylar ridge of humerus in treatment of post-traumatic elbow stiffness].

OBJECTIVE: To evaluate the results of open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus in treatment of post-traumatic elbow stiffness. METHODS: From March 2003 to December 2007, 33 patients with post-traumatic elbow stiffness were treated with open arthrolysis by elevated the lateral and medial collateral ligament-musculature complex from the supracondylar ridge of the humerus. There were 23 males and 10 females, aged 17-70 years old (mean 41.8 years old). According to Morrey, 15 cases were extremely serious (less than 30 degrees extension-flexion arc) and 18 cases were serious (30-60 degrees extension-flexion arc). The range of motion of the elbow stiffness was (32.5 +/- 28.9) degrees and the Mayo score was 51.9 +/-13.1 before operation. All initial fractures were healed according to clinical examination and X-rays films. All patients present with a post-traumatic elbow stiffness and the average period from initial trauma to elbow arthrolysis was 16.9 months (2-72 months). RESULTS: Wound infection occurred in 1 patient and cured after dressing change and anti-infectious treatment. The wounds healed by first intension in 32 cases. No patient showed sign of elbow instability and debilitating pain. All patients were followed up 6 months to 5 years (mean 3.3 years). At last follow up, the Mayo score was 82.3 +/- 14.4 and the range of motion of elbow stiffness was (108.8 +/- 36.0) degrees; showing significant differences when compared with preoperation (P < 0.05). According to Mayo evaluation, the results were excellent in 11 cases, good in 18 cases, fair in 2 cases, and poor in 2 cases, the excellent and good rate was 87.88%. Thirty-one patients achieve satisfactory results. Two patients were not satisfied with the result, but the satisfactory results were achieved by a second arthrolysis. CONCLUSION: Open elbow arthrolysis and postoperative rehabilitation for patients with elbow stiffness can improve joint function and ensure the stability of elbows.