Ovipositional responses of tortricid moths to sugars, salts and neem oil.

Oviposition is essential in the life history of insects and is mainly mediated by chemical and tactile cues present on the plant surface. Oviposition deterrents or stimulants can modify insect oviposition and be employed in pest control. Relatively few gustatory oviposition stimuli have been described for tortricid moths. In this study the effect of NaCl, KCl, sucrose, fructose and neem oil on the number of eggs laid by Cydia pomonella (L.), Grapholita molesta (Busck) and Lobesia botrana (Dennis & Schifermüller) was tested in laboratory arenas containing filter papers loaded with 3 doses of a given stimulus and solvent control. In general, salts increased oviposition at the mid dose (102 M) and sugars reduced it at the highest dose (103 mM), but these effects depended on the species. Neem oil dramatically reduced the number of eggs laid as the dose increased, but the lowest neem oil dose (0.1% v/v) increased L. botrana oviposition relative to solvent control. Our study shows that ubiquitous plant chemicals modify tortricid moth oviposition under laboratory conditions, and that neem oil is a strong oviposition deterrent. The oviposition arena developed in this study is a convenient tool to test the effect of tastants on the oviposition behavior of tortricid moths.

Sequential repeated tibial tubercle osteotomy in a two-stage exchange strategy: a superior approach to treating a chronically infected knee arthroplasty?

PURPOSE: Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a tibial tubercle osteotomy (TTO) in a two-stage exchange protocol for knee PJI treatment. METHODS: Retrospective cohort study examining patients managed with two-stage arthroplasty due to chronic knee PJI (2010-2019). Performance and timing of the TTO were collected. Primary end-point was infection control with a minimum FU of 12 months and according to internationally accepted criteria. Correlation between TTO timing and reinfection rate was reviewed. RESULTS: Fifty-two cases were finally included. Overall success (average follow-up: 46.2 months) was 90.4%. Treatment success was significantly higher among cases addressed using TTO during the second stage (97.1% vs. 76.5%, p value 0.03). Only 4.8% of the patients relapsed after performing a sequential repeated TTO, that is, during both first and second stages, compared to 23.1% cases in which TTO was not done (p value 0.28). No complications were observed among patients in the TTO group with a significant decrease in soft tissue necrosis (p: 0.052). CONCLUSION: Sequential repeated tibial tubercle osteotomy during a two-stage strategy is a reasonable option and offers high rates of infection control in complex cases of knee PJI with a low rate of complications.

Gustatory function of sensilla chaetica on the labial palps and antennae of three tortricid moths (Lepidoptera: Tortricidae).

In adult Lepidoptera the labial palps are best known for their role in CO2 detection, but they can also bear sensilla chaetica which function is unknown. The number and distribution of sensilla chaetica in labial palps was studied using a bright field microscope. To determine if these sensilla have a gustatory function, we performed single sensillum electrophysiology recordings from palp and antennal sensilla of adult moths of Cydia pomonella (L.), Grapholita molesta (Busck) and Lobesia botrana (Denis and Shieffermüller). Each sensillum was stimulated with 3 doses of one of four test stimulus (sucrose, fructose, KCl and NaCl). Overall, responses (spikes/s-1) increased with dose, and were higher in the palps than in the antennae, and higher to sugars than to salts. With sugars the response increased with concentration in the palp but not in the antenna. With salts there was a drop in response at the intermediate concentration. The number and position of sensilla chaetica on labial palps was variable among individuals. Sensilla were located in the most exposed areas of the palp. Differences in sensilla distribution were detected between species. Such differences among species and between palps and antenna suggest that taste sensilla on the palps have an unforeseen role in adaptation.

Different Population Phenologies of Grapholita molesta (Busck) in Two Hosts and Two Nearby Regions in the NE of Spain.

Grapholita molesta is an important pest of stone and pome fruits. In commercial orchards, integrated pest management programs use pheromone traps to monitor the population dynamics of G. molesta and adjust treatments. Phenology models can be used to forecast the population phenology of pests and to help optimise the time point at which to spray the orchards with insecticides. In the present study, the adult population phenologies of G. molesta in two provinces of north-east Spain were studied, as well as their fit to the phenology model most used in both provinces. Weekly captures of adults in pheromone traps through the season were recorded over 5 y in a large number of commercial orchards, and these data were used to determine the number of generations of G. molesta in each province. The results show significant differences between provinces in the generation time, being 97 degree days (DD) shorter in the Lleida province than in the Girona province. In Girona province, four generations were registered, while five were detected in Lleida. As a result of the differences found, the phenology model was not able to predict precisely the population dynamics in the Girona province.

Simultaneous bilateral dual mobility total hip arthroplasty dislocation in a patient with hepatic encephalopathy: A case report.

INTRODUCTION AND IMPORTANCE: Dislocation is a severe complication after total hip arthroplasty (THA). It is one of the most common reasons for failure and revision surgery. This is the first case of a documented simultaneous bilateral dual mobility (DM) THA dislocation. CASE PRESENTATION: A forty-nine-year-old man presented with bilateral hip pain, immobility and deformity. X-ray images demonstrated simultaneous bilateral posterior THA dislocation. Previously, the patient had presented atraumatic dislocations recurrently. When he was thoroughly re-interrogated, he complained of uncontrolled and generalized muscle contractions, which were compatible with myoclonus due to hepatic encephalopathy (HE). Multidisciplinary treatment was performed satisfactorily to control myoclonus symptomatology and to prevent dislocation. CLINICAL DISCUSSION: Patient's most important risk factor was a neuromuscular disorder, which we initially gave little notice and undervalued. HE is a serious but reversible syndrome, observed in patients with liver dysfunction. It leads to a wide spectrum of neuropsychiatric abnormalities. Management is based on prevention of episodes, avoiding the underlying triggers. Due to the high risk for dislocation of our patient, we decided to use DM cups bilaterally. This system has demonstrated lower rates of dislocation. CONCLUSION: This case report reminds us that a careful evaluation through meticulous history and physical examination are mandatory when faced with recurrent instability. Furthermore, prevention of dislocation is vastly preferable to treating this challenging complication. High-risk patients should be identified, and appropriate surgical approach, technique and implants have to be collectively used to reach a strategy that mitigates and ideally prevents dislocation.

Reconstruction of infected post-traumatic bone defects of the distal femur with the CompressⓇ implant. Preliminary results of a staged non-biological strategy.

INTRODUCTION: Infected post-traumatic distal femur defects remain a therapeutic challenge. Non-biological reconstruction offers an option for avoiding complex biological knee arthrodesis procedures. The CompressⓇ implant is an alternative to the traditional distal femur stemmed megaprosthesis. The aim of this study is to analyse the first patients treated with a distal femur CompressⓇ prosthesis to manage massive infected post-traumatic defects of the distal femur with joint involvement. METHODS: We retrospectively reviewed all patients with massive infected defects of the distal femur where this implant was used in a two-stage strategy, together with an antibacterial coating hydrogel (DACⓇ). The specific protocol, microbiological data, clinical and radiological results, complications, functional results and prosthesis survivorship were determined. Follow-up was for a minimum of 12 months, or until implant removal. RESULTS: Ten patients (11 CompressⓇ implants) with a mean age of 52 years (range 35-73) were included. On average, patients had undergone 4.4 previous surgical procedures before index surgery. The mean bone defect was 14 cm (range 8-21). After a median follow-up of 27 months (range 12-50 months) no patient had presented with recurrence of the infection, and limb salvage was achieved in all cases. Two patients suffered aseptic loosening which required revision of the femoral component. The short-term survivorship of the implant in our series was 81.8% at 4 years, with all failures occurring in the first 7 months. After this 7-month time threshold, we encountered no further loosening. Regarding functional outcomes, patients had a mean knee ROM of -4/86, expressed high overall satisfaction with the procedure according to the SAPS scale, and had an average LEFS of 52.5% (40-72.5%). CONCLUSION: Non-biological reconstruction of the distal femur with the CompressⓇ implant is a valid option in selected patients with massive infected defects with joint involvement. Survivorship was high, with all loosening occurring in the first months after surgery-representing a failure in the osseointegration of the implant.

Extremely low neonicotinoid doses alter navigation of pest insects along pheromone plumes.

The prevailing use of neonicotinoids in pest control has adverse effects on non-target organisms, like honeybees. However, relatively few studies have explored the effect of sublethal neonicotinoid levels on olfactory responses of pest insects, and thus their potential impact on semiochemical surveillance and control methods, such as monitoring or mating disruption. We recently reported that sublethal doses of the neonicotinoid thiacloprid (TIA) had dramatic effects on sex pheromone release in three tortricid moth species. We present now effects of TIA on pheromone detection and, for the first time, navigational responses of pest insects to pheromone sources. TIA delayed and reduced the percentage of males responding in the wind tunnel without analogous alteration of electrophysiological antennal responses. During navigation along an odor plume, treated males exhibited markedly slower flights and, in general, described narrower flight tracks, with an increased susceptibility to wind-induced drift. All these effects increased in a dose-dependent manner starting at LC0.001 - which would kill just 10 out of 106 individuals - and revealed an especially pronounced sensitivity in one of the species, Grapholita molesta. Our results suggest that minimal neonicotinoid quantities alter chemical communication, and thus could affect the efficacy of semiochemical pest management methods.

Acute periprosthetic joint infection due to Fusobacterium nucleatum in a non-immunocompromised patient. Failure using a Debridement, Antibiotics + Implant retention approach.

Fusobacterium nucleatum is an obligately anaerobic gram-negative rod, a component of the microbiome of the oropharynx and the gastrointestinal and urogenital tracts, causing an array of human infections which often include periodontal pathologies. As far as we know, there are no previous publications about acute periprosthetic joint infection due to Fusobacterium sp.; we report the first case in the medical literature of an aggressive, acute knee prosthetic infection due to F. nucleatum in a non-immunocompromised patient, unsuccessfully treated with a DAIR approach (Debridement + Antibiotics + Implant Retention).

Use of modular megaprosthesis in managing chronic end-stage periprosthetic hip and knee infections: Is there an increase in relapse rate?

BACKGROUND: Bone loss is a common problem in periprosthetic joint infection (PJI) scenarios. Modular megaprosthesis (MP) could offer a limb salvage solution in such situations. Concerns about risk of infection relapse, reinfection and implant longevity exist regarding MP use in cases of chronic PJI, rather than standard implants. We therefore sought to analyze our results with MP use in chronic PJI cases. METHODS: We performed a retrospective analysis of 29 MP patients. Inclusion criteria were the use of this type of modular megaimplant for reconstruction of segmental bone defects in chronically infected lower-extremity arthroplasties (hip or knee) and a minimum follow-up of 18 months. We evaluated the primary outcome of infection control or recurrence. The MPs were classified into 3 groups, according the bone segment replaced (proximal femur, distal femur or total femur). We further analyzed complications, pain, patient satisfaction and functional results. RESULTS: Mean age was 75 years; mean follow-up was 48 months (range 18-82). The most frequently involved pathogens were coagulase-negative staphylococci (62%). Polymicrobial infection was detected in 7 patients. Twenty-eight patients were managed with a two-stage approach. The infection-free rate at the end of follow-up was 82.8% (24 of 29 patients). Aside from infection relapse, the most frequent complication was dislocation. Final-point survival rate was 91.2% (CI 68.1-97.8). Clinical outcome data and satisfaction results were acceptable. CONCLUSION: According our data, MP is a useful tool in treating end-stage PJI cases, achieving acceptable eradication, satisfaction and implant survivorship rates.

Outcome of oscillating saw open osteotomy in two-stage lower extremity bone transport with monolateral frame.

INTRODUCTION: Bone transport techniques have been widely used to solve massive bone defects due to trauma, osteomyelitis or bone tumors. The technique of bone interruption to achieve better new bone formation is a subject of debate. Low-energy osteotomy (LEO) techniques have been proposed as the gold standard. Some authors reject open osteotomy with an oscillating saw (OOS osteotomy), based on the danger of bone tissue thermal necrosis and periosteal damage. To date, however, there is no strong clinical evidence to discourage this high-energy (HEO) bone interruption technique. METHODS: The aim of this study was to determine outcomes in using OOS osteotomy in a series of patients, where monolateral-frame bone transport has been used to resolve segmental bone defects of the lower extremity. The minimum accepted follow-up was 1 year. The primary endpoints were radiographic evidence of regenerated bone quality (Li classification) and final outcome (Cattaneo clinical system assessment). Further, we analyzed associated complications, and compared results with other published series. We hypothesized that OOS osteotomy produces results no less favorable than those achieved with other, low-energy techniques. RESULTS: A total of 54 patients, with an average bone defect of 8.58cm (CI95% 7.01-10.16), were enrolled in the study. In terms of regeneration quality, 84% of the regenerated segment shapes were associated with good outcomes; only 16% exhibited a shape (hypotrophic) predictive of a poor outcome. Regarding functional assessment, following the Cattaneo system, we found a total of 90% good or excellent results. Finally, the Bone Healing Index (BHI) in our series averaged 21.09 days per cm. The main complication observed was pin-track infection, occurring in 45% of the cases. CONCLUSION: According our data, the superiority of an LEO technique over HEO techniques is yet to be confirmed; it appears that any open osteotomy is effective, performed well and in a proper clinical setting, and that many factors other than choice of osteotomy technique must play important roles.

Necrotising fasciitis of the extremities: implementation of new management technologies.

INTRODUCTION: Necrotising fasciitis (NF) is potentially life-threatening soft-tissue infection. Early diagnosis and aggressive surgical debridement are critical to decrease mortality and morbidity. The impacts of new management technologies such as hydro-bisturi-assisted debridement (HAD) and negative pressure wound therapy (NPWT) are not yet clear with respect to treatment of NF. The objective of this study was to describe laboratory (including LRINEC score), clinical and microbiological factors, treatment methods and outcomes related to managing necrotising fasciitis, focusing on the implementation of new treatment methods in our centre. METHODS: From June 2010 to June 2014, adult patients diagnosed with necrotising fasciitis affecting an upper or lower limb that were admitted to our hospital, a referral tertiary care centre, were eligible to participate in this study. Demographic data, clinical features, location of infection, Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score on the day of admission, microbiology and laboratory results, use of HAD, wound management using NPWT, and patient outcomes were retrospectively analysed. A univariate risk factor analysis was performed, in an attempt to define prognostic factors for mortality. RESULTS: A total of 20 patients satisfied the inclusion criteria. Type II NF (Group A ß-haemolytic streptococci) was found in 8 cases (40%). The average LRINEC score on the day of admission was 6. The lower extremity was affected in 60% of the cases. All patients were treated operatively, with 2.5 interventions on average. Hydro-bisturi was used in the first debridement in 40% of the cases (8 out 20). In 75% of the studied cases, Negative Pressure Wound Therapy (NPWT) was the technique selected for surgical wound management. The global mortality rate was 30%. On univariate analysis, the only factors significantly associated with mortality were high levels of creatinin (p=0.033) and low blood glucose levels (p=0.012). Finally, four amputations were observed in this series. CONCLUSION: We confirm that necrotising fasciitis (NF) of the extremities, despite new advancements in treatment and critical care management, is still a potentially life-threatening soft-tissue infection (30% mortality). New, advanced wound management modalities have been heavily used in management of necrotising fasciitis, but these have not had significant impacts on morbidity and mortality rates.

Increased infection risk after hip hemiarthroplasty in institutionalized patients with proximal femur fracture.

In patients undergoing hip hemiarthroplasty (HHA) secondary to proximal femur fracture, acute periprosthetic joint infection (PJI) is one of the most important complications. We have detected an increased risk of PJI in chronic institutionalized patients (CIPs), and a higher number of early postoperative infections are caused by Gram-negative bacteria (GNB), not covered by the current prophylaxis (cefazolin in noninstitutionalized patients (NIPs) and cotrimoxazole in CIPs). We sought to compare infection characteristics between NIPs and CIPs, analyzing predisposing factors, causative pathogens, and antibiotic prophylaxis-related microbiological characteristics. We performed a retrospective review of our prospective institutional database to identify all patients consecutively admitted for HHA to treat proximal femur fracture at our centre between 2011 and 2013. PJI was diagnosed in 21 of 381 (5.51%) patients, with 10 of 105 (9.52%) in the CIP group and 11 of 276 (3.99%) in the NIP group, and statistical significance was achieved. GNB accounted for PJI in 14 (66.67%) patients. We detected a single case of methicillin-resistant Staphylococcus aureus (MRSA) infection in the NIP group. We confirm a higher risk of acute PJI among institutionalized patients, commonly caused by Gram-negative microorganisms, which are not covered by the current prophylaxis. New prophylactic strategies should be investigated in order to reduce this problem.

Mid-Term Outcomes and Complications with Cementless Distal Locking Hip Revision Stem with Hydroxyapatite Coating for Proximal Bone Defects and Fractures.

We revised the first 100 revision total hip arthroplasties using a cementless distal locking revision stem conducted in our referral centre. Average follow-up was 9.2 years (range: 5.5-12 years). Harris Hip Score improved from 42.5 to 81.6, and none had thigh pain at last follow-up. No significant stress shielding, osteolysis, or radiologic loosening was found. All patients showed radiological evidence of secondary implant osseointegration. Overall survival was 97% with three patients being revised: two stem ruptures and one subsidence. We could trace these complications to technical errors. These findings suggest that a diaphyseal fixation of the revision stem with distal locking can provide the needed primary axial and rotational stability of the prosthesis. This would allow further bony ingrowth, enhanced by the hydroxyapatite coating.

Case report: first report of a prosthetic joint infection caused by Facklamia hominis.

Facklamia spp. are gram-positive cocci first described in 1997. They are α-hemolytic, facultative anaerobes, catalase-negative cocci, resembling viridians streptococci on 5% sheep blood agar. Facklamia hominis is, by far, the most common species of the 6 so far described, and it is thought that its natural habitat is the female genital tract. Four previous human infections with Facklamia spp. have been documented. We report the first case of a chronic prosthetic joint infection caused by F. hominis and its successful treatment by a 2-stage exchange procedure to eradicate the infection. This is also the first osteoarticular infection reported. The clinical implications are discussed.

Isolated medial foot compartment syndrome after ankle sprain.

Foot compartment syndrome is a serious potential complication of foot crush injury, fractures, surgery, and vascular injury. An acute compartment syndrome isolated to the medial compartment of the foot after suffering an ankle sprain is a rare complication. We report the case of a 31-year-old man who developed a medial foot compartment syndrome after suffering a deltoid ligament rupture at ankle while playing football. The patient underwent a medial compartment fasciotomy with resolution of symptoms. Compartment syndromes of the foot are rare and have been reported to occur after severe trauma. But, there are some reports in the literature of acute exertional compartment syndrome. In our case, the compartment syndrome appeared after an ankle sprain without vascular injuries associated.

Outcome after knee arthrodesis for failed septic total knee replacement using a monolateral external fixator.

PURPOSE: To evaluate the pain level and patient satisfaction as well as the fusion and infection eradication rates after knee arthrodesis using a monolateral external fixator for failed septic total knee replacement (TKR). METHODS: Records of 10 male and 11 female consecutive patients aged 70 to 88 (mean, 81) years who underwent knee arthrodesis using a monolateral external fixator for failed septic TKR were retrospectively reviewed. Each patient had undergone a mean of 3.4 (range, 1-15) procedures. The infection eradication rate, fusion rate, time to achieve fusion, pain level, patient satisfaction, and health-related quality of life were evaluated. RESULTS: Infection was eradicated in 18 (86%) of the 21 patients, whereas fusion was achieved in 17 (81%) of the 21 patients after a mean of 10.3 (range, 4-16) months. Those who did and did not achieve fusion differed significantly in terms of the mean pain score (2.3 vs. 6.4, p=0.031). Compared with age-matched Spanish general population, patients aged >75 years fared significantly worse in terms of the mean physical summary component score (40.7 vs. 34.9, p=0.001). Among those who achieved fusion, 82% were very or somewhat satisfied; none was very dissatisfied. Among those who did not achieve fusion, 75% were very or somewhat dissatisfied. CONCLUSION: Knee arthrodesis using a monolateral external fixator for failed septic TKR achieved high fusion and infection eradication rates, despite the extended time needed. When fusion is achieved, patients had good pain relief and satisfaction.

Antibiotic-impregnated cement spacer as a definitive treatment for post-arthroscopy shoulder destructive osteomyelitis: case report and review of literature.

Arthroscopic revision of rotator cuff lesions is an increasingly popular procedure with a relatively safe profile. However, associated deep articular infection has been described, with potentially destructive joint sequelae. When occurring, it poses the double challenge of eradicating the infectious agent while preserving the articulation and its function. Experience remains scarce and is mostly based on case reports and small series. These also rely on the evidence from the better-described lower extremity joint infections. Through a complex case, the following report addresses this exceptional situation and offers an unusual solution, taking into consideration the peculiarities of the shoulder joint. With the consent of the patient, a single-stage resection arthroplasty with the implantation of an antibiotic-impregnated cement spacer was performed as a long-lasting-if not definite-treatment. After 4 years, the patient maintains excellent function with no radiological signs of wear or loosening.

Two-stage knee arthrodesis using a cemented modular tumour replacement system for recalcitrant septic proximal tibial non-union: a case report.

Knee arthrodesis is an alternative to amputation for treating recalcitrant septic non-union of the proximal tibia with bone loss, soft-tissue compromise, and knee-joint involvement. Nonetheless, arthrodesis is difficult to achieve if bone loss is massive, and the septic environment can result in failed bone fusion. We report on a 77-year-old man with massive bone loss secondary to recalcitrant septic non-union who underwent radical bone resection, followed by knee arthrodesis using a cemented modular intercalary megaprosthesis in conjunction with a microvascularised flap in 2 stages.

Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: a technique for preoperative isolation of the infecting organism.

PURPOSE: Preoperative identification of the infecting micro-organism is of paramount importance in the treatment protocol for chronic periprosthetic joint infections, as it enables selection of the most appropriate antibiotic treatment. Preoperative joint aspiration, the most commonly used sampling technique, has proven to have a broad range of sensitivity values and the frequency of dry aspirations has not been well assessed. In such dry-tap cases a biopsy sample could be an option. The purpose of this study was to assess the diagnostic accuracy of percutaneous interface biopsy (PIB) in isolating the infecting organism in cases of chronic Periprosthetic Joint Infection (PJI) and dry-tap event. The basic technique is to harvest and culture a sample from the periprosthetic interface membrane by a percutaneous technique in the preoperative period. METHODS: A retrospective study was done involving 24 consecutive patients suspected of PJI and where no fluid was obtained from the joint. Culture results from a percutaneous interface biopsy (PIB) were compared with intraoperative tissue cultures at the time of revision surgery. In all cases, a two-stage replacement was done. RESULTS: The sensitivity was 88.2%; specificity was 100%. Positive predictive value was 100%, while negative predictive value was 77.9%. Accuracy was 91.6%. No technique-related complication was observed. CONCLUSION: We conclude that PIB is a useful test for preoperative isolation of the infecting organism and could play a role in cases with dry-tap joint aspirations.