The radiographic outcome after plating for pubic symphysis diastasis: does it matter clinically?

INTRODUCTION: Open reduction and internal fixation with plates is the most widespread surgery in traumatic pubic symphysis diastasis. However, implant failure or recurrent diastasis was commonly observed during follow-up. The aim of our study was to evaluate the radiologic findings and clinical outcomes. MATERIALS AND METHODS: Sixty-five patients with traumatic pubic symphysis diastasis treated with plating between 2008 and 2019 were retrospectively reviewed. The exclusion criteria were a history of malignancy and age under 20 years. Radiographic outcomes were determined by radiograph findings, including pubic symphysis distance (PSD) and implant failure. Clinical outcomes were assessed according to the Majeed score at the final follow-up. RESULTS: Twenty-eight patients were finally included. Nine patients (32%) experienced implant failure, including four (14%) with screw loosening and five (18%) with plate breakage. Only one patient underwent revision surgery. Postoperatively, a significant increase in PSD was observed at 3 months and 6 months. Postoperative PSD was not significantly different between patients with single plating and double plating, but it was significantly greater in the implant-failure group than in the non-failure group. The Majeed score was similar between patients with single plating and double plating or between the implant-failure group and the non-failure group. Body mass index, number of plates, age, and initial injured PSD were not significantly different between the implant-failure group and the non-failure group. Only a significant male predominance was observed in the implant-failure group. CONCLUSION: A gradual increase in the symphysis distance and a high possibility of implant failure may be the distinguishing features of traumatic pubic symphysis diastasis fixation. The postoperative symphyseal distance achieved stability after 6 months, even after implant failure. Radiographic outcomes, such as increased symphysis distance, screw loosening, and plate breakage, did not affect clinical functional outcomes.

Functional outcomes following fixation of a marginal distal radius fracture with two commonly used volar locking plates: a retrospective cohort study.

INTRODUCTION: The volar locking plate has been widely used for unstable distal radius fractures to provide early recovery of wrist function. Volar plate prominence to the watershed line has been reported to be related to flexor tendon irritation, and avoid implant prominence in this area was suggested. On the other hand, marginal distal radius fracture patterns required the plate to cross the watershed line, making conflict over plate positioning on marginal distal radius fractures. This study compared functional outcomes in patients with marginal distal radius fractures treated with two different implants. MATERIALS AND METHODS: A retrospective study was conducted, all patients who received a Synthes 2.4 mm LCP or an Acumed Acu-Loc VLP between January 2015 and December 2018 were reviewed. The marginal distal radius fracture pattern was the most distal horizontal fracture line within 10 mm of the lunate fossa's joint line. The primary outcomes including patient-reported pain scores, range of motion, and grip strength were assessed. Secondary outcomes included patient-based subjective satisfaction scores of the injured wrist and hand function. The Mayo Wrist Score and the requirement for a secondary procedure related to hardware complications were also recorded. RESULTS: Forty-two patients met our inclusion criteria. Twenty-one patients were treated with the Synthes 2.4 mm LCP, and 21 patients with the Acumed Acu-Loc VLP. The primary outcome revealed that post-operative range of motion (P = 0.016) and grip strengths (P = 0.014) were significantly improved in the Acu-Loc VLP group. The MAYO wrist score in the Acu-Loc VLP group was also significantly better (P = 0.006). CONCLUSIONS: Despite advances in implant designs, flexor tendon irritation or rupture is still a complication following distal radius's volar plating. We believe the Acumed Acu-Loc VLP design provided better functional outcomes than the Synthes 2.4 mm LCP if appropriately and carefully placed into its designed-for position. This positioning results in promising patient satisfaction when treating marginal distal radius fractures.

[Analysis of the Effects of Femoral Nerve Block on Pain Level and Knee Mobility in Patients With Total Knee Replacement].

BACKGROUND: Osteoarthritis is a common cause of inactivity and reduced quality of life in the elderly. Total knee replacement (TKR) surgery, a last-stage treatment option for osteoarthritis, often results in postoperative pain that influences knee flexion and the ability to perform prescribed rehabilitation exercises. PURPOSE: This study was designed to examine the effectiveness of single femoral nerve block (FNB) on pain level and knee mobility in patients with TKR. METHODS: A quasi-experimental, two-group, longitudinal study was designed. The participants were distributed into the FNB group (n = 86) and non-FNB group (n = 86). The outcome measurements included pain scale (Numerical Rating Scale) score and knee continuous passive motion knee flexion angle. The five assessments and followed-up times were as follows: admission day (T0) and post-surgery day 1, 2, 3, and 4. RESULTS: The results of the generalized estimating equations model showed that the pain level in the FNB group was significantly lower than in the non-FNB group, (p < .001). In terms of analgesics demand from post-surgery day 1 to day 4, the FNB group exhibited a significantly lower demand than the non-FNB group (p < .01). In addition, significant differences in the continuous passive motion rehabilitation exercise angle were found between the two groups from post-surgery day 1 through day 4 (p < .05). Finally, significant differences in knee flexion angles between the two groups were observed between hospital admission and discharge (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study support the positive effects of the femoral nerve block intervention on patients who receive total knee replacement surgery. The results were significant in terms of pain relief and knee mobility recovery. This intervention should be made available for use in the clinical care of TKR patients.

Development of a Fast Raman-Assisted Antibiotic Susceptibility Test (FRAST) for the Antibiotic Resistance Analysis of Clinical Urine and Blood Samples.

Human health is at great risk due to the spreading of antimicrobial resistance (AMR). The lengthy procedure of conventional antimicrobial susceptibility testing (AST) usually requires a few days. We developed a fast Raman-assisted antibiotic susceptibility test (FRAST), which detects single bacterial metabolic activity in the presence of antibiotics, using Raman single-cell spectroscopy. It was found that single-cell Raman spectra (SCRS) would show a clear and distinguishable Raman band at the "silent zone" (2000-2300 cm-1), due to the active incorporation of deuterium from heavy water (D2O) by antibiotic-resistant bacteria. This pilot study has compared the FRAST and the conventional AST for six clinical standard quality controls (four Gram-negative and two Gram-positive bacteria strains) in response to 38 antibiotics. In total, 3200 treatments have been carried out and approximately 64 000 SCRS have been acquired for FRAST analysis. The result showed an overall agreement of 88.0% between the FRAST and the conventional AST assay. The gram-staining classification based on the linear discriminant analysis (LDA) model of SCRS was developed, seamlessly coupling with the FRAST to further reduce the turnaround time. We applied the FRAST to real clinical analysis for nine urinary infectious samples and three sepsis samples. The results were consistent with MALDI-TOF identification and the conventional AST. Under the optimal conditions, the "sample to report" of the FRAST could be reduced to 3 h for urine samples and 21 h for sepsis samples. The FRAST provides fast and reliable susceptibility tests, which could speed up microbiological analysis for clinical practice and facilitate antibiotic stewardship.

Clinical results of using minimally invasive long plate osteosynthesis versus conventional approach for extensive comminuted metadiaphyseal fractures of the radius.

INTRODUCTION: The minimally invasive plate osteosynthesis (MIPO) technique has been introduced recently. The extensive comminuted fractures of the distal radial metaphysis with diaphyseal involvement are probably good indications for MIPO technique because of less extensive dissection and soft-tissue stripping. The purpose of this retrospective study was to compare the clinical results of MIPO technique to those of conventional open reduction in extensive metadiaphyseal fractures of distal radius. MATERIALS AND METHODS: Of 34 patients treated for comminuted metadiaphyseal fractures of the distal radius between June 2006 and May 2012, all the patients had extra-articular fractures. Twenty-one patients underwent MIPO technique and 13 underwent conventional open reduction with long periarticular locking plates system (Zimmer). Six patients in the MIPO group and three in the conventional group who had concomitant distal ulnar fractures or distal radioulnar joint (DRUJ) injury underwent plate osteosynthesis or Kirschner-wire fixation before radial fixation. Perioperative parameters and union time were recorded. Radiologic assessment, Mayo Wrist Score, and satisfaction scale were evaluated at the final follow-up. RESULTS: All fractures united without secondary procedures. Radiologic assessment, Mayo wrist score, and time to union showed no significant difference between the two groups, but the MIPO group had significantly smaller incision wound, higher satisfaction scale, and shorter operative time than did the conventional group. CONCLUSIONS: MIPO is capable of achieving functional results as good as those of conventional open reduction, with a higher satisfaction scale, smaller incision, and shorter operative time. When MIPO intervention is planned, concurrent distal ulnar fracture or DRUJ injury should be repaired first, thus facilitating subsequent indirect reduction. For treating intra-articular fractures, anatomical reduction of the articular surface is more important, and the MIPO technique described here is not recommended.

Removal of forearm plate leads to a high risk of refracture: decision regarding implant removal after fixation of the forearm and analysis of risk factors of refracture.

INTRODUCTION: Plate fixation is the gold standard for the treatment of forearm fractures at present, and whether or not to remove the implant after bone union remains controversial. This study demonstrated some cases of refracture in adult forearm fractures after bone union and discussed the risk factors for decision-making regarding implant removal. METHODS: We reviewed patients with forearm diaphyseal fractures (including the radius, ulna, or both bones) who received open reduction and internal fixation (ORIF) from January 2008 to May 2011 in our institute. Fracture type was classified according to the AO/OTA system. All patients were fixed with a 3.5-mm dynamic compression plate. The patients were divided into two main groups: group A received implant removal after bone union, and group B retained the implant. RESULTS: There were 122 patients (170 bones) included in this study (40 females and 82 males). In group A, 7/51 patients (8/62 bones; 12.9 %) had refracture. As classified by the AO/OTA classification, one patient was classified as type A1, one patient as type A2, two patients as type A3, and three patients as type B3. All patients suffered refracture without high-energy trauma. In group B, the refracture rate was 2.77 %, and all were caused by high-energy trauma. Patients with refracture had a shorter time interval between ORIF and implant removal. The possible risk factors of refracture in this study included a wedge bone defect on plain film, implant removal performed after less than 18 months, and AO/OTA type B fracture. CONCLUSION: The incidence of refracture was significantly lower in the group that retained the implant. Routine implant removal after bone union in adult forearm fractures is not recommended due to the higher refracture rate.

Free non-vascularized fibular strut bone graft for treatment of post-traumatic lower extremity large bone loss.

Post-traumatic large bone defects of more than 4 cm occur sometimes in open lower extremity fractures. Management of this kind trauma can be a challenge to orthopedic surgeons. We have managed this kind of bone defect by the use of free non-vascularized fibular strut bone grafts (FNVFG) harvested subperiosteally and held by screw fixation of the strut ends to the ends of the bone defect. Ten patients, eight males and two females, with a mean age of 44 years (range 26-76 years) underwent this procedure. The length of defect was 7.0 cm on average (ranging from 4 to 8 cm). Ten grafts (100%) united at both ends within an average of 6 months (range 5-9 months). Nine patients walked independently, and one patient walked with a stick. FNVFG is a simple procedure and a reliable method to bridge huge bone loss due to open fractures of lower extremities successfully in selected cases.

Quantification of the Safe Zone of the First to Third Sacral Segments for Transiliac-Transsacral Screw Fixation in Normal and Dysmorphic Sacra.

Transiliac-transsacral screw fixation is widely used to stabilize unstable posterior pelvic ring injuries. Preoperative radiographic assessment of the safe osseous corridor is necessary because the safe space of sacrum is narrower for transiliac-transsacral screw placement than for traditional iliosacral screw placement. However, the radiographic assessment has rarely been studied in the Taiwanese population. We retrospectively analyzed 100 patients with pelvic computed tomography images and divided them into normal and dysmorphic pelvis groups. To determine the safe osseous space, we recorded cross-section area, cross-sectional diameter of the safe zone (CS-szD), and safe zone width on axial view (Ax-szW) in the S1 to S3 segments. The prevalence of dysmorphic pelvis was 48% among all patients. In the S1 segment, no differences were found in the cross-section area and CS-szD been the two groups. However, the Ax-szW was significantly smaller in the dysmorphic pelvis group. In the S2 segment, the cross-section area, CS-szD, and Ax-szW were all significantly larger in the dysmorphic pelvis group. In the S3 segment, the cross-section area and CS-szD of the normal pelvis group were both significantly smaller. No differences were found in the Ax-szW between the two groups. Based on our findings in a Taiwanese population, S1 was the most suitable segment for transiliac-transsacral screw fixation in a normal pelvis, whereas S2, followed by S3, was most suitable in a dysmorphic pelvis. This study offers surgeons information on identifying the optimal sacral segment for transiliac-transsacral screw placement for each pelvic morphology. [Orthopedics. 2024;47(1):e13-e18.].

Is Staged Surgery Always Necessary for Schatzker Type IV-VI Tibial Plateau Fractures? A Comparison Study.

AIMS: This study aims to compare the outcomes of immediate (followed by closed-incision negative-pressure therapy use) versus delayed ORIF in patients with Schatzker type IV-VI TPFs. PATIENTS AND METHODS: A prospective study of patients undergoing ORIF between January 2018 and December 2019 was performed. The inclusion criteria were patients (>18 years) with a closed fracture sent to the emergency room (ER) within 24 h of injury. All the patients underwent preoperative image evaluation. Two senior orthopedic trauma surgeons evaluated the soft tissue condition in the ER by 5P's of the compartment syndrome, judging the timing of the operation of definitive ORIF. Group 1 (n = 16) received delayed ORIF. Group 2 (n = 16) received immediate ORIF and ciNPT use. Patient follow-up occurred after 2 and 6 weeks and 3, 6, and 12 months after surgery. The assessments included the time to definitive fixation, the length of hospital stay, the time to bone union, surgical site complications, and reoperation within 12 months. A universal goniometer was used to measure the postoperative 3 m, 6 m, and 12 m ROM. RESULTS: The patient demographics were similar between the groups (p > 0.05). Group 2 displayed significantly a shorter time to definitive fixation (5.94 ± 2.02 vs. 0.61 ± 0.28, p < 0.0001) and hospital stay (14.90 ± 8/78 vs. 10.30 ± 6.78, p = 0.0016). No significant difference was observed in the time to bone union, surgical site complication incidence, and reoperation rates (p > 0.05). Flexion and flexion-extension knee ROM were demonstrated to be significantly improved in Group 2, 3, 6, and 12 months postoperatively (p < 0.0001). CONCLUSIONS: In this study, early ORIF and ciNPT use resulted in a shorter hospital length of stay, a reduced time to early active motion of the knee, and improved knee ROM. These results suggest that early ORIF with ciNPT for Schatzker type IV-VI TPFs is safe and effective in some patients. However, further research to confirm these findings across larger and more diverse populations is needed.

Comparison of primary total hip arthroplasty with limited open reduction and internal fixation vs open reduction and internal fixation for geriatric acetabular fractures: a systematic review and meta-analysis.

Purpose: Comminuted fractures with poor bone quality in the elderly are associated with poor outcomes. An alternative to open reduction and internal fixation (ORIF) alone, primary or acute total hip arthroplasty (aTHA), allows early mobilization with full weight bearing. In this study, we aim to analyze whether treatment of aTHA with/withtout ORIF (limited ORIF) vs ORIF alone yields better intra-operative results, functional outcomes, and less complications. Methods: PubMed, Cochrane, Embase, and Scopus databases were searched in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Random-effects model and 95% confidence intervals were used. The outcomes of interest were surgery time, blood loss, length of hospital stay, Harris hip score (HHS), 36-Item Short Form Survey (SF-36), complication rate, surgical site infection rate, heterotopic ossification rate, reoperation rate, and mortality rate. Results: Ten observational studies with a total of 642 patients (415 ORIF alone and 227 aTHA with/without ORIF) were included in the systematic review. Compared to ORIF alone, aTHA with limited ORIF provided higher HHS (P = 0.029), better physical function (P = 0.008), better physical component summary (P = 0.001), better mental component summary (P = 0.043) in postoperative 1-year SF-36, lesser complication rate (P = 0.001), and lesser reoperation rate (P = 0.000), but however greater bodily pain (P = 0.001) in acetabular fractured elderlies. Conclusions: Acute THA with limited ORIF is favorable alternative to ORIF technique alone. It provided better HHS, physical, and mental component summary in SF-36 and yielded lower complication and reoperation rate compare to ORIF alone.

"Fragment Width Ratio" as a Predictor of Nonunion for Femoral Shaft Fracture With Third Fragments.

Previous studies have reported that large fracture fragment with displacement might cause nonunion of femoral shaft fractures. We therefore intended to delineate significant risk factors for developing a nonunion predisposed by a major fracture fragment. We analyzed 61 patients who were operated on using interlocking nails for femoral shaft fractures from 2009 to 2018. We classified patients with modified Radiographic Union Scale for Tibia fractures scores of less than 11 or needing reoperations by 1 year postoperatively as nonunion. We thereafter measured parameters of the displaced fracture fragment and fracture site to identify the significant difference between the union and non-union groups. We also applied the receiver operating characteristic curve to demonstrate a threshold value for the fragment width (FW) ratio. Among 61 patients with complete follow-up, no significant difference was found regarding length, displacement, and angulation of fragments between patients with and without union. Except for higher mean FW (P=.03) and the FW ratio (P=.01) in patients with nonunion, the logistic regression analysis demonstrated that FW ratio significantly affected union (P=.018; odds ratio, 0.21; 95% CI, 0.001-0.522). Although a fracture fragment greater than 4 cm with displacement greater than 2 cm was reported to significantly cause nonunions, our study showed that an FW ratio greater than 0.55 instead of fragment size or displacement was predictive for the occurrence of nonunion adjoining to the fracture site. Fixation of the third fracture fragment should not be ignored for preventing a nonunion. More attention should be paid to achieve a better fixation for a major fracture fragment with an FW ratio greater than 0.55 to avoid the development of non-union following the use of interlocking nail for femoral shaft fracture. [Orthopedics. 2023;46(3):169-174.].

Using Trident distal radial locking plate to fix the fracture of distal radius volar rim.

BACKGROUND: The volar locking plates have been widely used in a variety of distal radius fractures, but they still have several limitations when dealing with small fragments located around the watershed line with widely reported complications. The volar rim fragments play a critical role in radiocarpal joint stability and failing to secure the volar rim fragment usually results in carpal instability, subluxation, or even dislocation. This study investigates clinical outcomes in the use of a novel implant, the Trident distal radial (TDR) locking plate to treat distal radius fracture with the intermedium column edge (lunate fossa volar rim) fragment involvement. METHODS: A retrospective study of 25 patients was conducted, all patients had intermedium column fractures with lunate fossa volar rim involvement and treat with the TDR between January 2016 and December 2019. The clinical assessment outcomes included VAS Pain, PRWE, and DASH scores. Objective measurements included ROM of the injured wrist and grip strength. Final radiographs were used to evaluate radial inclination, volar tilt, ulnar variance, and distal radioulnar joint instability. Secondary operations related to hardware complications were also recorded. RESULTS: The outcome revealed that the mean VAS Pain Score was 1.3, mean DASH score was 10.5, and mean PRWE score was 9.3. Objective measurements revealed good ROM recovery and an 89% gripping strength recovery compared with contralateral hand. Radiographic measurements revealed good maintenance of volar tilt, radial inclination, and mean ulnar variance. There were no complications related to the implant and all fracture sites were union. CONCLUSION: We believe that the TDR provided more stable fixation among distal radial fractures that predominantly involved the intermedial column and volar rim fragment, and allowing early rehabilitation. We could obtain excellent results in the wrist ROM, gripping power, and Pain Score (VAS).

Leveraging single-cell Raman spectroscopy and single-cell sorting for the detection and identification of yeast infections.

Invasive fungal infection serves as a great threat to human health. Discrimination between fungal and bacterial infections at the earliest stage is vital for effective clinic practice; however, traditional culture-dependent microscopic diagnosis of fungal infection usually requires several days, meanwhile, culture-independent immunological and molecular methods are limited by the detectable type of pathogens and the issues with high false-positive rates. In this study, we proposed a novel culture-independent phenotyping method based on single-cell Raman spectroscopy for the rapid discrimination between fungal and bacterial infections. Three Raman biomarkers, including cytochrome c, peptidoglycan, and nucleic acid, were identified through hierarchical clustering analysis of Raman spectra across 12 types of most common yeast and bacterial pathogens. Compared to those of bacterial pathogens, the single cells of yeast pathogens demonstrated significantly stronger Raman peaks for cytochrome c, but weaker signals for peptidoglycan and nucleic acid. A two-step protocol combining the three biomarkers was established and able to differentiate fungal infections from bacterial infections with an overall accuracy of 94.9%. Our approach was also used to detect ten raw urinary tract infection samples. Successful identification of fungi was achieved within half an hour after sample obtainment. We further demonstrated the accurate fungal species taxonomy achieved with Raman-assisted cell ejection. Our findings demonstrate that Raman-based fungal identification is a novel, facile, reliable, and with a breadth of coverage approach, that has a great potential to be adopted in routine clinical practice to reduce the turn-around time of invasive fungal disease (IFD) diagnostics.

Monoarticular septic arthritis in a patient with juvenile rheumatoid arthritis under etanercept treatment.

A 7-year-old girl with polyarticular type juvenile rheumatoid arthritis (JRA) presented with acute onset of right hip pain with limited range of motion and fever within the past two days. She had received etanercept for more than one year. Percutaneous arthrocentesis was performed and showed a white blood cell count of 84150/µL in the synovial fluid, although the culture showed negative results. The fever and right hip pain completely resolved after antibiotic treatment. Herein, we report the first case of septic monoarthritis of JRA under etanercept treatment.

Combining a transosseous cerclage wire after patellar tendon reattachment to treat patella distal pole fracture did not improve functional outcome.

This study aims to investigate whether an augmented wire in the treatment of patella distal pole fracture could improve knee range of motion (ROM) and radiographic features. Thirty-five consecutive patients with patellar distal pole fracture were analyzed from January 2014 to July 2019. The treatment is divided into two groups according to the presence or absence of augmented wire. Knee ROM, bone union, extension lag, and patellar height were compared between these two groups as the clinical and radiological outcomes. There was no significant difference in mean knee ROM (110° vs. 108°, p = 0.79), proportion of patella baja or bone union. More extension lag was noted in the augmentation group (5/20, 25%) than in the tendon reattachment group (1/15, 6.7%) with no statistically significant difference. In the augmentation group, four cases (20%) would need to remove the fixator due to irritation or broken hardware. Maintaining the patella length by preserving the distal pole and repairing the torn retinaculum allowed early motion to avoid knee stiffness safely without augmentation wire, which doesn't improve knee ROM. The patellar tendon reattachment alone could achieve a great recovery and prevent the need for a second surgery due to broken wire or irritation.

Single Cell Raman Spectroscopy Deuterium Isotope Probing for Rapid Antimicrobial Susceptibility Test of Elizabethkingia spp.

Nosocomial infection by multi-drug resistance Elizabethkingia spp. is an emerging concern with severe clinical consequences, particularly in immunocompromised individuals and infants. Efficient control of this infection requires quick and reliable methods to determine the appropriate drugs for treatment. In this study, a total of 31 Elizabethkingia spp., including two standard strains (ATCC 13253 and FMS-007) and 29 clinical isolates obtained from hospitals in China were subjected to single cell Raman spectroscopy analysis coupled with deuterium probing (single cell Raman-DIP). The results demonstrated that single cell Raman-DIP could determine antimicrobial susceptibility of Elizabethkingia spp. in 4 h, only one third of the time required by standard broth microdilution method. The method could be integrated into current clinical protocol for sepsis and halve the report time. The study also confirmed that minocycline and levofloxacin are the first-line antimicrobials for Elizabethkingia spp. infection.

Design, Synthesis, and Application of Carbon Dots With Synergistic Antibacterial Activity.

The diversity of bacteria and their ability to acquire drug resistance lead to many challenges in traditional antibacterial methods. Photothermal therapies that convert light energy into localized physical heat to kill target microorganisms do not induce resistance and provide an alternative for antibacterial treatment. However, many photothermal materials cannot specifically target bacteria, which can lead to thermal damage to normal tissues, thus seriously affecting their biological applications. Here, we designed and synthesized bacteria-affinitive photothermal carbon dots (BAPTCDs) targeting MurD ligase that catalyzes the synthesis of peptidoglycan (PG) in bacteria. BAPTCDs presented specific recognition ability and excellent photothermal properties. BAPTCDs can bind to bacteria very tightly due to their chiral structure and inhibit enzyme activity by competing with D-glutamic acid to bind to MurD ligases, thus inhibiting the synthesis of bacterial walls. It also improves the accuracy of bacteria treatment by laser irradiation. Through the synergy of biochemical and physical effects, the material offers outstanding antibacterial effects and potentially contributes to tackling the spread of antibiotic resistance and facilitation of antibiotic stewardship.

Stain-free Gram staining classification of pathogens via single-cell Raman spectroscopy combined with machine learning.

Gram staining (GS) is one of the routine microbiological operations to classify bacteria based on the cell wall structure. Accurate GS classification of pathogens is of great significance since it helps correct administration of antimicrobial treatment. The laborious procedure and low sensitivity results related to conventional GS have resulted in reluctance among clinicians. In this study, we integrate confocal Raman spectroscopy and machine learning techniques to distinguish Gram-negative (GN) or Gram-positive (GP) bacteria. A single-cell Raman database including seven most common clinical pathogens (three GP strains and four GN strains) was constructed. Machine learning algorithms including the support-vector machine (SVM), k-nearest neighbors' algorithm (k-NN), gradient boosting machine (GBM), linear discriminant analysis (LDA), and t-distributed stochastic neighbor embedding (t-SNE) were trained to achieve the binary classification for GS. With such a relatively small database, the SVM model achieved the highest accuracy of 98.1%. The molecular signatures of GN and GP embedded in their Raman fingerprints were identified with hierarchical cluster analysis (HCA). The results indicated that Raman peaks for peptidoglycan and teichoic acid were the most significant factors that contributed to accurate classification. The Raman machine learning approach could greatly enhance the diagnosis of pathogenic infections.

Single pulley double-strand anchor suture fixation of the coronoid process in terrible triad of the elbow injury.

BACKGROUND: Terrible triad of the elbow injury is difficult to manage, and the role of the coronoid process in instability is very important. We describe a simple, modified suture technique to fix a coronoid process fragment using suture anchor fixation. METHODS: Eight patients (three female and five male) with coronoid process injuries with the fragment involving <50% of the total height (Regan-Morrey type I/II) in terrible triad of elbow injury were included. Patients were treated operatively via a lateral Kocher's approach, and coronoid process fractures were repaired with a single pulley double-strand suture technique. Structures were addressed in a sequential fashion-the coronoid process, radial head, lateral ulnar collateral ligament. RESULTS: All patients were treated with the single pulley double-strand anchor suture technique and the coronoid process fragment was found to be in good contact with the original avulsion site using the method. The final Mayo Elbow Performance Score was excellent (> 90) in six patients and good (between 85 and 89) in two patients after operation 6 months. CONCLUSION: The single pulley double-strand suture tie method using a suture anchor is a less invasive and simpler fixation method for the repair of coronoid process fractures in patients with terrible triad of the elbow injuries and results in good outcomes.