Arthroplasty-center related retrospective analysis of risk factors for Periprosthetic Joint Infection after primary and after revision Total Hip Arthroplasty.

BACKGROUND: Periprosthetic Joint Infection (PJI) poses a great challenge to patients, surgeons and health care systems. Comorbid diseases and patient-related risk factors are poorly understood. OBJECTIVE: The purpose of this study was to evaluate patient-related risk factors for PJI after primary and after revision Total Hip Arthroplasty (THA). METHODS: In the present study, data was collected from 566 patients who underwent primary or revision THA between July 2011 and June 2012 in an established arthroplasty center (Endocert certified endoprosthesis center, EPZmax). The effects of demographic data and comorbid diseases on revision operations within 18 months following THA were analyzed using descriptive and explorative statistics. RESULTS: It was shown, that alcohol abuse, depression, preoperative ESBL (Extended Spectrum ß-Lactamase bacteria) infection, elevated preoperative serum-CRP (C-reactive protein), extended operation-time, extended length of hospital-stay, intraoperative complications, perioperative urinary tract infections and postoperative antibiotic therapy are significantly related to PJI in primary THA. CONCLUSIONS: Comorbid diseases seem to influence outcome after THA. They are important for predicting revision operations and implant survival. In severe high-risk cases, they can lead to perform the operation under precaution or to avoid performing the operation entirely. This should reduce PJI occurrences in future.

Phenotype-genotype correlations in hemophilia A carriers are consistent with the binary role of the phase between F8 and X-chromosome inactivation.

BACKGROUND: The recessive X-linked disorder hemophilia A (HA) is rarely expressed in female carriers, most of whom express about half of normal factor VIII activity ( FVIII: C). OBJECTIVE: To propose an integrative assessment model for the binary role of the phase between the mutated F8 and the active X-chromosome (Xa) in FVIII: C in HA carriers. METHODS: We studied 67 females at risk of severe HA, comprising five symptomatic females ( FVIII: C < 1.5 IU dL(-1) ) and 14 controls. A correlation study between FVIII: C (observed vs. expected) and X-chromosome inactivation (XCI) patterns (XIPs; androgen receptor gene [AR] system) in blood leukocyte DNA was performed in carriers, by comparison of a model correlating FVIII: C and XIP with arbitrary models devoid of biological significance, and with FVIII: C levels in non-carriers (mean model) as a proxy from background data dispersion not influenced by XIP. RESULTS: We provide proof-of-concept example from a family presenting with extremely skewed XIPs in which the severe HA phenotype appeared in a heterozygous carrier of a crossover between AR and F8 loci that phased the mutated F8 with the maternally inherited Xa. Furthermore, four cases of severe HA affected women who had a combination of a heterozygous F8 mutation and extremely skewed XIPs in leukocytes or oral mucosa are presented. Correlation analyses between FVIII: C levels and XIPs in carriers (n = 38) but not in non-carriers (n = 20) showed highly significant differences between the proposed correlation model and models without biological significance. The data support a binary influence of XCI, either increasing or decreasing the FVIII: C, subject to the underlying phase set between the F8 mutation and XCI. CONCLUSIONS: Our evidence suggests that the phase between XCI and mutated F8 acts as a molecular switch conditioning FVIII: C levels and HA expression in carriers.

Bimolecular photoreduction of aromatic sulfoxides.

Photolysis of aromatic sulfoxides in the presence of alkoxides in alcoholic solvents provides a photochemical route to the corresponding sulfides. Other electron donors also give sulfide with various degrees of success. The reaction could also be carried out using carbazoles as sensitizers, and quantitative yields could be obtained using N-methylcarbazole in methanol. Evidence points toward a hydroxysulfuranyl radical as the key intermediate, and solvent effects point to heterolysis, rather than homolysis, as the step that breaks the S-O bond.

Oral antibiotic therapy for skeletal infections of children. II. Therapy of osteomyelitis and suppurative arthritis.

Antimicrobial regimens consisting of a brief initial period of parenteral therapy followed by oral therapy were investigated in infants and children with suppurative bone and joint disease. There were 30 patients with acute hematogenous disease (19 osteomyelitis; three osteoarthritis; eight arthritis) and five with subacute or chronic osteomyelitis. Disease was due to Staphylococcus aureus in 26, Hemophilus influenzae in five, streptococci in three, and S. aureus plus Streptococcus pyogenes in one patient. Pus was removed by surgical drainage or needle aspiration. Oral therapy was monitored by assay of antibiotic concentration and bactericidal activity in serum. Adjustments in dosage were made when necessary to assure a peak serum bactericidal titer of at least 1:8. One patient progressed to chronic osteomyelitis but all other patients with acute disease responded well. Oral therapy provides increased patient comfort and decreases the risk of nosocomial infection associated with prolonged intravenous therapy. It should be carried out only under carefully monitored conditions in hospital to assure compliance and adequacy of serum bactericidal activity.

Antibiotic concentrations in pus and bone of children with osteomyelitis.

Pharmacologic data are presented on 39 children treated for osteomyelitis with one of the following antibiotics: methicillin, dicloxacillin, cephaloridine, or cefazolin. The concentrations of drug in pus and bone were correlated with serum concentrations, with the susceptibilities of Staphylococcus aureus strains isolated from the patients, and with the degree of drug protein-binding. The penetration of the antibiotics into pus and bone was similar for the two penicillins and for the two cephalosporins despite the disparate protein-binding affinities of these drugs. The agents attained concentrations in tissues that were at least several fold, and often more than tenfold, greater than the MIC and MBC values of the S. aureus stains. These data provide a basis for selection of antimicrobial agents for treatment of osteomyelitis.

Otitis media in children less than 12 weeks of age.

Cases of otitis media in infants under 12 weeks of age were reviewed to delineate the frequency, clinical features, and etiologic agents involved. Tympanocentesis was performed in 42 infants, 0 to 5 weeks of age, and in 17, from 6 to 11 weeks of age. The most common symptoms were irritability/lethargy (69%), fever (52%), cough (36%), vomiting (21%), diarrhea (20%), tachypnea (20%), and anorexia (18%). Associated illnesses were present in 33 (54%) of the patients, the most common being pneumonia (9), bronchiolitis (7), meningitis (6), conjunctivitis (4), and omphalitis (4). No peripartum infections or severe perinatal problems were found. Common respiratory pathogens were the predominant etiologic organisms, but coliform organisms were identified in 18% of the infants under 6 weeks of age. Cultures were sterile or grew organisms of questionable pathogenicity ("nonpathogens") in 39% of specimens. Since the signs and symptoms of otitis media in children less than 12 weeks of age are nonspecific and frequently associated with other major illnesses, the physician caring for these infants needs to be more aware of this disease and the therapeutic problems it presents.