Risk factors of postoperative urinary retention following total hip and knee arthroplasty.

Aims: The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following total hip and knee arthroplasty (total joint replacement (TJR)) and to evaluate the risk factors and complications associated with POUR. Methods: Two authors conducted searches in PubMed, Embase, Web of Science, and Scopus on TJR and urinary retention. Eligible studies that reported the rate of POUR and associated risk factors for patients undergoing TJR were included in the analysis. Patient demographic details, medical comorbidities, and postoperative outcomes and complications were separately analyzed. The effect estimates for continuous and categorical data were reported as standardized mean differences (SMDs) and odds ratios (ORs) with 95% CIs, respectively. Results: A total of 31 studies were included in the systematic review. Of these, 29 studies entered our meta-analysis, which included 3,273 patients diagnosed with POUR and 11,583 patients without POUR following TJR. The pooled incidence of POUR was 28.06%. Demographic risk factors included male sex (OR 1.81, 95% CI 1.26 to 2.59), increasing age (SMD 0.16, 95% CI 0.04 to 0.27), and American Society of Anesthesiologists grade 3 to 4 (OR 1.39, 95% CI 1.10 to 1.77). Patients with a history of benign prostatic hyperplasia (OR 1.99, 95% CI 1.41 to 2.83) and retention (OR 3.10, 95% CI 1.58 to 6.06) were more likely to develop POUR. Surgery-related risk factors included spinal anaesthesia (OR 1.44, 95% CI 1.19 to 1.74) and postoperative epidural analgesia (OR 2.82, 95% CI 1.65 to 4.82). Total hip arthroplasty was associated with higher odds of POUR compared to total knee arthroplasty (OR 1.10, 95% CI 1.02 to 1.20). Postoperatively, POUR was associated with a longer length of stay (SMD 0.21, 95% CI 0.02 to 0.39). Conclusion: Our meta-analysis demonstrated key risk variables for POUR following TJR, which may assist in identifying at-risk patients and direct patient-centered pathways to minimize this postoperative complication.

Evaluation of biosynthesized silver nanoparticles effects on expression levels of virulence and biofilm-related genes of multidrug-resistant Klebsiella pneumoniae isolates.

The emergence of multidrug-resistant (MDR) strains of Klebsiella pneumoniae is associated with high morbidity and mortality due to limited treatment options. This study attempts to biologically synthesize silver nanoparticles (AgNPs) and investigate their effect on expression levels of virulence and biofilm-related genes in clinically isolated K. pneumoniae. In this study, biofilm formation ability, antibiotic resistance pattern, extended-spectrum ß-lactamases (ESBLs), and carbapenemases production were investigated for 200 clinical isolates of K. pneumoniae using phenotypic methods. Polymerase chain reaction (PCR) was used to detect virulence and biofilm-related genes, ESBL-encoding genes, and carbapenem resistance genes. AgNPs were synthesized using the bio-reduction method. The antibacterial effects of AgNPs were investigated by microdilution broth. In addition, the cytotoxic effect of AgNPs on L929 fibroblast cell lines was determined. The effects of AgNPs on K. pneumoniae virulence and biofilm-related genes (fimH, rmpA, and mrkA) were determined using quantitative real-time PCR. Thirty percent of the isolates produced a strong biofilm. The highest and lowest levels of resistance were observed against amoxicillin/clavulanic acid (95.4%) and tigecycline (96%), respectively. About 31% of isolates were considered positive for carbapenemases, and 75% of the isolates produced an ESBLs enzyme. Different frequencies of mentioned genes were observed. The synthesized AgNPs had a spherical morphology and varied in size. AgNPs inhibited the growth of MDR K. pneumoniae at 128 µg/ml. In addition, AgNPs downregulated the expression of fimH, rmpA, and mrkA genes by 10, 7, and 14-fold, respectively (p < 0.05), also exerted no cytotoxic effect on L929 fibroblast cell lines. It was revealed that AgNPs lead to a decrease in expression levels of virulence and biofilm-related genes; therefore, it was concluded that AgNPs had an excellent antibacterial effect on MDR K. pneumoniae.

Numerical modeling of a hybrid hollow-core fiber for enhanced mid-infrared guidance.

We propose a novel design of hollow-core fiber for enhanced light guidance in the mid-infrared. The structure combines an arrangement of non-touching antiresonant elements in the air core with a multilayer glass/polymer structure in the fiber's cladding. Through numerical modeling, we demonstrate that the combination of antiresonant/inhibited-coupling and photonic bandgap guidance mechanisms can decrease the optical loss of a tubular antiresonant fiber by more than one order of magnitude. More specifically, our simulations demonstrate losses of the HE11 mode in the few dB/km level, which can be tuned through mid-infrared wavelengths (5 µm-10.6 µm) by carefully optimizing the structural parameters of both structures. We also show that the hybrid hollow-core fiber design is more robust to bend-induced loss than an equivalent tubular antiresonant fiber or a Bragg/OmniGuide fiber. As a result, if successfully fabricated, the hybrid hollow-core fiber will offer low-loss, high beam-quality, effectively single-mode operation, and low bending losses, potentially solving many of the problems that affect all known mid-infrared fiber types.

Elevated liver enzymes and cardiovascular mortality: a systematic review and dose-response meta-analysis of more than one million participants.

Gamma glutamyl transferase (GGT), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (ALP) are commonly used liver function markers. We performed a dose-response meta-analysis to investigate the association between liver enzymes and cardiovascular disease (CVD) mortality in prospective cohort studies. We conducted a systematic search up to April 2018 in Medline/PubMed, Scopus, Cochrane, and Embase databases. Combined hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using a random-effects model as described by DerSimonian and Laird. Dose-response analysis was also carried out. Twenty-three studies with 1 067 922 participants reported association between GGT and CVD mortality and were included in our analysis. Pooled results showed a significant association between GGT and risk of CVD mortality (HR: 1.62; 95% CI: 1.47-1.78, P=0.001, P-heterogeneity=0.001) and it was HR: 0.87; 95% CI: 0.73-1.07; P=0.221, P-heterogeneity=0.028, for ALT. There was a direct association between baseline levels of ALP and AST/ALT ratio with CVD mortality (HR: 1.45; 95% CI: 1.11-1.89; P=0.005, P-heterogeneity=0.026, and HR: 2.20; 95% CI: 1.60-3.04; P=0.001, P-heterogeneity=0.540, respectively). Pooled results did not show any significant association between AST and the risk of CVD mortality (HR: 1.20; 95% CI: 0.83-1.73; P=0.313, P-heterogeneity=0.024). Moreover, there was a significant nonlinear association between GGT and ALP levels and the risk of CVD mortality (P=0.008 and 0.016, respectively). Our dose-response meta-analysis revealed a direct relationship between GGT and ALP levels and the risk of CVD mortality. High levels of GGT, ALP and AST/ALT were associated with an increased CVD mortality rate.

Evaluation of completeness of case ascertainment in Swiss cancer registration.

This is the first comprehensive evaluation of completeness of case ascertainment in Swiss cancer registration. There is currently no method available that is considered to be the gold standard. Apart from simple measures such as the proportion of cases where registration was initiated by a death certificate and the proportion of diagnoses on the basis of histology or cytology/haematology, we applied two dedicated approaches: (i) the semiquantitative method of comparing the mortality to incidence rate ratio with relative survival (MI-Surv method) and (ii) the Flow method, which provides a quantitative estimate for the completeness depending on time since diagnosis. All 10 Swiss cancer registries in operation since at least 2006 and providing the required parameters were included. Simple and dedicated methods showed high completeness across all cancer registries and for most cancer types tested, with the notable exception of lymphoid leukaemia.

Prevalence of Enterotoxin Genes and Antibacterial Susceptibility Pattern of Staphylococcus aureus Strains Isolated from Animal Originated Foods in West of Iran.

OBJECTIVES: The aims of our study were to evaluate the prevalence of Staphylococcus aureus (S. aureus) strains in food samples of animal origin, examine their antibacterial susceptibility pattern, and to detect staphylococcal enterotoxin (SEs) genes and the mecA gene in isolated S. aureus strains using the polymerase chain reaction (PCR). . METHODS: A total of 1050 food samples including 671 raw milk and dairy products and 379 raw meats were collected between September 2013 and June 2014 in Hamadan, Iran. Food samples were analyzed for S. aureus identification. The antibiotic susceptibility pattern of all isolates was determined using the disk agar diffusion method followed by detecting mecA resistance gene using PCR. In addition, harboring of SE genes were determined using a multiplex PCR assay targeting nine genes. . RESULTS: A total of 98 (9.3%) S. aureus strains were isolated from 1050 food samples. Of the 98 isolates examined, the most frequent resistance was observed to erythromycin (30.6%), followed by tetracycline (29.6%), gentamicin (27.6%), clindamycin (26.5%), ciprofloxacin and rifampin (24.5%), trimethoprim-sulfamethoxazole (14.3%), and cefoxitin (5.1%). All cefoxitin resistant isolates were positive for mecA. The prevalence of SEs was 77.6% (n=76). Among the genes that code classic enterotoxins, sea was the most frequent and was carried by 25.5% of isolates, followed by see in 18.4%, sed in 11.2%, sec in 5.1%, and seb in 4.1% of isolates. Among the detected enterotoxins, seg was the predominantly identified enterotoxin gene in isolates with prevalence of 35.7%. The seh gene with prevalence of 1% and sei gene with 3.1% were other detected enterotoxins with low frequencies. . CONCLUSION: The high prevalence of SE genes detected indicates a potential risk for causing animal-originated food poisoning. The increasing prevalence of community-acquired MRSA and its emerging antibiotic resistance in foods is a serious problem for public health.