CEFAZOLIN PROPHYLACTIC EFFICACY ON PROSTHETIC JOINT INFECTION AFTER PRIMARY HIP ARTHROPLASTY.

Objective: Perioperative deep prosthetic joint infection (PJI) is a serious postoperative complication of total hip arthroplasty (THA). We aimed to compare the efficacy of cefazolin administered within 24 and 48 h of primary THA for PJI prophylaxis. Methods: In this retrospective study, 720 patients were divided into two groups depending on whether cefazolin was administered as a single injection of 2 g twice daily within 24 (24-h group) or 48 h of surgery and the following day (48-h group). Sex, age at surgery, body mass index, co-existing diseases, blood test data, and PJI risk factors were evaluated. Results: The 24- and 48-h groups included 364 and 356 patients, respectively. Diabetes mellitus was the most common risk factor for PJI in both groups. The corresponding incidence of perioperative deep PJI following primary THA was 0.55% and 0.28% in the 24- and 48-h groups, respectively. There was no significant difference in patient background characteristics between the groups. Conclusions: Cefazolin administration within 24 h of primary THA may be appropriate for perioperative deep PJI. Level of Evidence II; Retrospective study .

Objetivo: A infecção de prótese articular (IPA) perioperatória profunda é uma grave complicação pós-operatória da artroplastia total de quadril (ATQ). Este estudo buscou comparar a eficácia da cefazolina administrada dentro de 24 e 48 horas após ATQ para profilaxia de IPA. Métodos: Neste estudo retrospectivo, 720 pacientes foram divididos em dois grupos, que receberam cefazolina em uma injeção de 2g duas vezes por dia nas primeiras 24 e 48 horas (grupos de 24 e 48 horas), respectivamente. Foram avaliados sexo, idade na data da cirurgia, índice de massa corporal, comorbidades, testes sanguíneos e fatores de risco para IPA. Resultados: Os grupos de 24 e 48 horas incluíram, respectivamente, 364 e 356 pacientes. O fator de risco para IPA mais comum nos dois grupos foi o diabetes mellitus. A incidência de IPA perioperatória profunda após ATQ foi, respectivamente, de 0,55% e 0,28% nos grupos de 24 e 48 horas. Não houve diferença significativa nas características gerais dos pacientes entre os dois grupos. Conclusão: A administração de cefazolina dentro de 24 horas após ATQ primária pode ser adequada para IPA perioperatória profunda. Nível de Evidência II; Estudo retrospectivo .

Effects of Calcium Polystyrene Sulfonate Formulation Change from Dry Syrup to Oral Solution in Patients with Chronic Kidney Disease.

Calcium polystyrene sulfonate, a cation exchange resin preparation, is used to treat hyperkalaemia. The effects of switching from dry syrup to oral solution forms have been rarely evaluated. We investigated changes in serum potassium levels, incidence of adverse events, and patients' perception and satisfaction associated with the change in calcium polystyrene sulfonate dosage forms from dry syrup to oral solution in chronic kidney disease patients. The study population was comprised of 24 patients. The chronic kidney disease cause, glomerular filtration rate category, and albuminuria category was G4 in 10 cases (41.7%) and G5 in 8 cases (33.3%). No significant difference was observed between groups before and after the change in dosage form. Contrastingly, the ease of intake (P=0.0047), taste (P=0.0056), and satisfaction (P<0.001) indicated positive significant improvements. Changing the calcium polystyrene sulfonate dosage form from dry syrup to oral solution in patients with chronic kidney disease improved patient satisfaction while maintaining efficacy and safety. For patients in whom weight gain is not a problem, we recommend changing the dosage form from dry syrup to oral solution for calcium polystyrene sulfonate.

Safety of linezolid, rifampicin, and clindamycin combination therapy in patients with prosthetic joint infection.

We investigated adverse events in patients with prosthetic joint infections receiving combination therapy with linezolid, rifampicin, and clindamycin for ≥ 7 days. Twenty-two patients were evaluated. The combination therapy was administered for 15.5 (7-29) days at dosages of 1200, 450, and 450-1200 mg/day for linezolid, rifampicin, and clindamycin, respectively. Adverse events (gastrointestinal, eye, and skin disorders; liver damage; myelosuppression; hyponatremia, and others) were recorded. The incidence rates of leukopenia, neutropenia, anemia, thrombocytopenia, and hyponatremia were 36.4%, 31.8%, 40.9%, 18.2%, and 18.2%, respectively. Common Terminology Criteria for Adverse Events version 5.0 Grade 3 neutropenia, anemia, and hyponatremia were observed. The incidence rate of myelosuppression was higher following combination therapy compared with that previously reported following single-drug administration. All patients were discharged after the infection was under control. It is important to monitor these adverse events during combination therapy with the aforementioned agents; these conditions may be relieved by discontinuing linezolid.

Cefazolin prophylactic efficacy on prosthetic joint infection after primary hip arthroplasty / Eficácia profilática da cefazolina sobre a infecção protética articular após artroplastia primária de quadril

ABSTRACT Objective Perioperative deep prosthetic joint infection (PJI) is a serious postoperative complication of total hip arthroplasty (THA). We aimed to compare the efficacy of cefazolin administered within 24 and 48 h of primary THA for PJI prophylaxis. Methods In this retrospective study, 720 patients were divided into two groups depending on whether cefazolin was administered as a single injection of 2 g twice daily within 24 (24-h group) or 48 h of surgery and the following day (48-h group). Sex, age at surgery, body mass index, co-existing diseases, blood test data, and PJI risk factors were evaluated. Results The 24- and 48-h groups included 364 and 356 patients, respectively. Diabetes mellitus was the most common risk factor for PJI in both groups. The corresponding incidence of perioperative deep PJI following primary THA was 0.55% and 0.28% in the 24- and 48-h groups, respectively. There was no significant difference in patient background characteristics between the groups. Conclusions Cefazolin administration within 24 h of primary THA may be appropriate for perioperative deep PJI. Level of Evidence II; Retrospective study.

RESUMO Objetivo A infecção de prótese articular (IPA) perioperatória profunda é uma grave complicação pós-operatória da artroplastia total de quadril (ATQ). Este estudo buscou comparar a eficácia da cefazolina administrada dentro de 24 e 48 horas após ATQ para profilaxia de IPA. Métodos Neste estudo retrospectivo, 720 pacientes foram divididos em dois grupos, que receberam cefazolina em uma injeção de 2g duas vezes por dia nas primeiras 24 e 48 horas (grupos de 24 e 48 horas), respectivamente. Foram avaliados sexo, idade na data da cirurgia, índice de massa corporal, comorbidades, testes sanguíneos e fatores de risco para IPA. Resultados Os grupos de 24 e 48 horas incluíram, respectivamente, 364 e 356 pacientes. O fator de risco para IPA mais comum nos dois grupos foi o diabetes mellitus. A incidência de IPA perioperatória profunda após ATQ foi, respectivamente, de 0,55% e 0,28% nos grupos de 24 e 48 horas. Não houve diferença significativa nas características gerais dos pacientes entre os dois grupos. Conclusão A administração de cefazolina dentro de 24 horas após ATQ primária pode ser adequada para IPA perioperatória profunda. Nível de Evidência II; Estudo retrospectivo.

Efficacy and safety of tedizolid in a patient with linezolid-induced neutropenia: A case report.

Linezolid is used to treat prosthetic joint infection after total hip arthroplasty. Here, we present a case of linezolid-induced severe neutropenia, which improved after switching to tedizolid. Grade 3 neutropenia developed 5 days after linezolid injection (1,200 mg/day) and 33 days after oral administration of the same dose. However, during the 70 days of treatment with tedizolid, grade 3 neutropenia did not occur, and C-reactive protein levels remained in the normal range. No grade ≥ 1 thrombocytopenia or bleeding event occurred during the course of tedizolid treatment. Tedizolid may be an alternative drug for patients who develop linezolid-induced neutropenia.

Am80 induces neuronal differentiation via increased tropomyosin-related kinase B expression in a human neuroblastoma SH-SY5Y cell line.

Am80, a synthetic retinoid, has been used in differentiation therapy for acute promyelocytic leukemia (APL). All-trans retinoic acid (ATRA) as one of natural retinoid has been also used to treat APL. ATRA treatment causes neuronal differentiation by inducing tropomyosin-related kinase B (TrkB) expression and increasing the sensitivity to brain-derived neurotrophic factor (BDNF), a TrkB ligand. In the present study, we investigated the effects of Am80 on neuronal differentiation, BDNF sensitivity and TrkB expression in human neuroblastoma SH-SY5Y cells. Treatment with Am80 induced morphological differentiation of neurite outgrowth and increased the expression of GAP43 mRNA, a neuronal differentiation marker. Additionally, TrkB protein was also increased, and exogenous BDNF stimulation after treatment with Am80 induced greater neurite outgrowth than without BDNF treatment. These results suggest that Am80 induced neuronal differentiation by increasing TrkB expression and BDNF sensitivity.

Association between lipid accumulation and the cannabinoid system in Huh7 cells expressing HCV genes.

Evidence from clinical and laboratory studies has accumulated indicating that the activation of the cannabinoid system is crucial for steatosis, especially in non-alcoholic fatty liver disease. However, the association between hepatitis C virus (HCV) infection and the cannabinoid system has not been well investigated and it is unclear whether steatosis in chronic hepatitis C develops via activation of the endocannabinoid/cannabinoid receptor signaling pathway. In this study, we examined the expression of a cannabinoid receptor (CB1) and the lipid accumulation in the hepatic Huh7 cell line, expressing HCV genes. We utilized Huh7/Rep-Feo-1b cells stably expressing HCV non-structural proteins (NS) 3, NS4, NS5A, and NS5B, as well as Tet-On Core-2 cells, in which the HCV core protein expression is inducible. Significantly higher levels of stored triglycerides were found in Huh7/Rep-Feo-1b cells compared to Huh7 cells. Also, triglyceride accumulation and CB1 receptor expression were down-regulated in Huh7/Rep-Feo-1b cells after HCV reduction by IFNα. Moreover, lipid accumulation appeared to increase after CB1 agonist treatment, while it decreased after CB1 antagonist treatment, although significant differences were not found compared to untreated cells. In Tet-On Core-2 cells, induction of HCV core protein expression did not affect CB1 expression or triglyceride accumulation. The results of this study in cultured cells suggest that HCV infection may activate the cannabinoid system and precede steatosis, but the core protein by itself may not have any effect on the cannabinoid system.

Am80 induces neuronal differentiation in a human neuroblastoma NH-12 cell line.

Retinoids including natural vitamin A, its derivatives and synthetic compounds work as transcription factors through the retinoic acid receptors (RAR, RXR). All-trans retinoic acid (ATRA), a family of retinoids, is an internal ligand of RAR and well known as a useful differentiation inducer to treat acute promyelocytic leukemia (APL). ATRA therapy is now established as an initial treatment for APL. Recently, to improve therapeutic potency and reduce adverse effects of ATRA, a novel synthetic selective agonist for RARalpha and beta, Am80, was developed and applied to APL treatment. In this study, we tested whether Am80 was capable of inducing neuronal differentiation in a human neuroblastoma cell line, NH-12 and compared the differentiation effects between Am80 and ATRA. Morphological studies demonstrated that Am80 induced more potent neurite outgrowth and also proved lesser cell toxicity than ATRA. Am80 up-regulated the expression of tropomyosin-related kinase B as well as ATRA. Moreover, Am80 increased the expression of the neuronal marker, growth-associated protein 43. These findings suggest that Am80 induces neuronal differentiation to a greater extent than ATRA and thus may help establishing therapeutic strategies against neuronal degenerative disorders such as Parkinson's disease.

Telmisartan but not candesartan affects adiponectin expression in vivo and in vitro.

To examine the effects of telmisartan on peroxisome proliferator-activated receptor gamma activation, we compared the effects of telmisartan with those of candesartan on adipocytokines and glucose and lipid metabolism in vivo and in vitro. In vivo, 56 patients with both type 2 diabetes and hypertension were enrolled and randomized to receive either telmisartan (40 mg) or candesartan (8 mg) for 3 months. Serum adiponectin, HbA1c levels, lipid profiles and blood pressure were recorded at the beginning and 3 months later. In vitro, differentiated 3T3-L1 adipocytes were treated with telmisartan, candesartan, pioglitazone or vehicle for 24 h, and then adiponectin mRNA and protein levels were measured. The results showed that most of the metabolic parameters, including the lipid profiles, did not change significantly during the study in either group. However, the changes in serum adiponectin and plasma glucose over 3 months were significantly greater in the telmisartan group than in the candesartan group. In vitro, although the protein level of adiponectin was not significantly elevated, the mRNA expression of adiponectin was elevated 1.5-fold by telmisartan in 3T3-L1 adipocytes. Our findings suggest that telmisartan may have beneficial effects in type 2 diabetes beyond its antihypertensive effect.

Switching from premixed human insulin to premixed insulin lispro: a prospective study comparing the effects on glucose control and quality of life.

AIM: To evaluate the clinical effects of switching from premixed human insulin to a premixed rapid-acting insulin analogue in type 2 diabetic patients. RESEARCH DESIGN AND METHODS: Thirty patients, who were treated with a twice-daily injection of premixed human insulin, were enrolled and randomized to (i) 50/50 premixed insulin lispro twice-daily at the same daily dose as premixed human insulin (analogue mix group), or (ii) continued premixed human insulin (control group). The doses of insulin were adjusted every month by registered diabetologists to achieve adequate blood glucose levels. At the beginning of the study, and again 4 months later, HbA1c and blood glucose levels were measured, and the amount of insulin required and BMI were recorded in both groups. Insulin therapy-related quality of life (ITR-QOL) and the diabetes treatment satisfaction questionnaire (DTSQ) were also assessed in the analogue mix group at the beginning of the study and again 4 months later. RESULTS: Although HbA1c levels did not change significantly over the duration of the study in the control group (7.33 +/- 0.58 vs 7.29 +/- 0.65%), HbA1c did improve significantly in the analogue mix group (7.59 +/- 0.44 vs 7.24 +/- 0.49%; p<0.05). The dose of insulin required in the analogue mix group did not change significantly (0.37 +/- 0.11 vs 0.38 +/- 0.14 U/kg/day), but increased in the control group from 0.34 +/- 0.15 to 0.37 +/- 0.16 U/kg/day (p<0.05). The switch to the premixed insulin analogue did not affect ITR-QOL and DTSQ scores. CONCLUSIONS: This study showed that switching from premixed human insulin to 50/50 premixed insulin lispro improved blood glucose control without compromising QOL. This finding suggests that a premixed rapid-acting insulin analogue is more effective than human insulin for Japanese type 2 diabetic patients.