Highly Porous Acetabular Cup and Augment Constructs in Complex Revision Total Hip Arthroplasty: What Predicts 10-Year Implant Survivorship?

BACKGROUND: Porous tantalum acetabular cup and augment constructs have demonstrated favorable outcomes up to 5 years postsurgery despite severe bone loss during revision total hip arthroplasty (THA). Prior literature lacks long-term studies with substantial case numbers. This study aims to assess long-term clinical and radiographic outcomes 10 years postsurgery in patients undergoing revision THA with porous tantalum acetabular cup-augment constructs and determine factors associated with long-term survivorship. METHODS: Between 2000 and 2012, 157 revision THAs were performed in cases with major acetabular defects (mainly Paprosky type IIIA and IIIB) utilizing porous tantalum cup-augment constructs. Pelvic discontinuity was noted intraoperatively in 17 hips (11%). Postoperative radiographs were evaluated at regular intervals for implant stability and radiolucent lines. There were 49 patients who had complete radiographic follow-up at 10 years or longer postsurgery. RESULTS: The 10-year survivorship free of revision of the cup-augment construct for aseptic loosening was 93%, free of any acetabular construct revision was 91%, free of any hip rerevision was 77%, and free of any reoperation was 75%. Pelvic discontinuity was associated with increased risk of reoperation (hazard ratio [HR] = 2.8), any hip rerevision (HR = 3.2), any cup-augment construct revision (HR = 11.8), and aseptic construct revision (HR = 10.0). Of unrevised cases with radiographs at 10 years, 4 hips showed radiographic loosening. Mean Harris hip scores improved from 47 preoperatively to 79 at 10 years. CONCLUSIONS: Porous tantalum acetabular cup-augment constructs used in revision THA with severe acetabular bone loss provide excellent implant survivorship at 10 years when the acetabulum is intact. Due to lower survivorship of cup-augment constructs in cases of pelvic discontinuity, additional construct fixation or stabilization methods are recommended, when a discontinuity is present. LEVEL OF EVIDENCE: IV.

Ultrasound Demonstrates Potential in Identifying Proximal Femoral Morphology Before and After Cam Resection: A Cadaveric Study.

PURPOSE: (1) To compare alpha angles measured on fluoroscopy with those measured on ultrasound pre- and postosteoplasty and (2) to determine whether ultrasound can adequately assess cam deformity correction. METHODS: Twelve full-body specimens (20 hips) were analyzed. Images using fluoroscopy and ultrasound were captured of the operative hip with the hip in 6 consistent positions: 3 views in hip extension (neutral [N], 30° internal rotation [IR], and 30° external rotation [ER]) and 3 views in hip flexion of 50° (neutral [F-N], 40° external rotation [F-ER40], and 60° external rotation [F-ER60]). A curved-array ultrasound transducer probe was used with the transducer placed in line with the femoral neck to evaluate the proximal femoral morphology. An open femoral osteoplasty using an anterior approach was performed. Fluoroscopy and ultrasound were again used to capture images with the hip in the same 6 positions. Bland-Altman plots were used to determine whether fluoroscopic and ultrasound alpha angles agreed at each position. Independent t-tests were used to compare the alpha angles between the 2 modalities at each position, and paired t-tests were used to compare preoperative and postoperative alpha angles at each position. RESULTS: No significant differences between the alpha angle on fluoroscopy and ultrasound at all 6 positions were appreciated preosteoplasty. The mean preoperative alpha angle on ultrasound in each position was as follows: N (55.4° ± 5.9° vs 43.0° ± 2.1°), IR (55.1° ± 5.3° vs 43.9° ± 5.5°), ER (58.6° ± 5.6° vs 42.8° ± 3.0°), F-N (53.9° ± 5.5° vs 41.6° ± 3.3°), F-ER40 (55.5° ± 4.6° vs 41.5° ± 2.7°), and F-ER60 (57.9° ± 6.5° vs 41.2° ± 4.2°). The mean preoperative and postoperative alpha angle on fluoroscopy in each position were as follows: N (56.0 ± 12.8° vs 43.1 ± 2.1°), IR (54.1 ± 13.4° vs 41.9 ± 2.9°), ER (61.2 ± 11.0° vs 44.2 ± 1.9°), F-N (57.9 ± 10.6° vs 44.0 ± 2.3°), F-ER40 (59 ± 8.2° vs 42 ± 2.2°), and F-ER60 (55 ± 7.6° vs 41.1 ± 2.6°). Postosteoplasty, there was no significant difference between the mean alpha angle on fluoroscopy versus ultrasound in any position except F-N (44.0 ± 2.3 vs 41.6 ± 3.3, P = .015). Bland-Altman plots showed a high level of agreement between alpha angle values on fluoroscopy and ultrasound at all positions pre- and postosteoplasty. There was a significant reduction in alpha angle measured on ultrasound and fluoroscopy at each position following osteoplasty. There were no significant differences in the delta of the pre- and postosteoplasty alpha angle measurements between fluoroscopy and ultrasound. CONCLUSIONS: Ultrasound is a useful tool for assessing a cam deformity in patients with femoroacetabular impingement syndrome and for determining adequate resection of a cam deformity intraoperatively. CLINICAL RELEVANCE: Due to the inherent limitations and risks of the fluoroscopy, it is worth evaluating other nonionizing imaging modalities. Ultrasound has potential to be an accessible, cost-effective, and safe imaging modality that lacks radiation and is commonly used for intra-articular hip injections and dynamic examination of the hip.

Staged Bilateral Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Index Surgery Patient Reported Outcome Measures Predict Contralateral Surgery Results at 2 Years.

PURPOSE: To determine whether (1) patient-reported outcome (PRO) scores after index hip arthroscopy correlate with PRO scores for the contralateral hip in patients undergoing staged bilateral hip arthroscopy and (2) patients who achieved minimal clinically important difference (MCID) or patient-acceptable symptom state (PASS) for the index hip were more likely to achieve MCID or PASS for the contralateral hip. METHODS: Patients who underwent staged bilateral hip arthroscopy for femoroacetabular impingement syndrome were retrospectively reviewed. PRO scores were prospectively collected at preoperative and 1- and 2-year timepoints. Odds ratios for achievement of MCID and PASS for the contralateral hip given achievement for the index hip were calculated. Improvements from before surgery to 2 years after surgery were correlated between both hips. RESULTS: A total of 143 patients (286 hips) were included in the final analysis. Average time between surgeries was 8.5 months (range, 0.7-57.2). Both hips demonstrated significant improvement (P < .05 for all) in all PROs at 2 years. Achievement of MCID in Hip Outcome Score Activities of Daily Living (HOS-ADL) at the 1-year timepoint for the index hip was predictive of achievement of MCID in HOS-ADL at 2 years for the contralateral hip. Achievement of PASS in all PROs at the 1-year timepoint for the index hip were predictive of achievement of PASS in the equivalent outcome score at the 2-year mark for the contralateral hip. Achievement of MCID or PASS at the 2-year timepoint for the index hip was predictive of achievement of the equivalent outcome at the 2-year timepoint for the contralateral hip. The strongest correlation between improvement in PRO scores for the index and contralateral hips was noted in patients who underwent staged hip arthroscopy within less than 3 months. CONCLUSION: Patients experience significant clinical benefit in both hips after staged bilateral hip arthroscopy. Results from the initial hip arthroscopy at either 1- or 2-year follow-up can be used to predict outcomes on the contralateral side; however, there is a higher degree of predictive value using 2-year results. Average correlations between 2-year PROs on the index and contralateral hips were moderate to strong, regardless of the time between surgeries. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Genomic Diversity of Campylobacter lari Group Isolates from Europe and Australia in a One Health Context.

Members of the Campylobacter lari group are causative agents of human gastroenteritis and are frequently found in shellfish, marine waters, shorebirds, and marine mammals. Within a One Health context, we used comparative genomics to characterize isolates from a diverse range of sources and geographical locations within Europe and Australia and assess possible transmission of food, animal, and environmental isolates to the human host. A total of 158 C. lari isolates from Australia, Denmark, France, and Germany, which included 82 isolates from human stool and blood, 12 from food, 14 from domestic animal, 19 from waterbirds, and 31 from the environment were analyzed. Genome-wide analysis of the genetic diversity, virulence, and antimicrobial resistance (AMR) traits was carried-out. Most of the isolates belonged to C. lari subsp. lari (Cll; 98, 62.0%), while C. lari subsp. concheus and C. lari urease-positive thermotolerant Campylobacter (UPTC) were represented by 12 (7.6%) and 15 (9.5%) isolates, respectively. Furthermore, 33 (20.9%) isolates were not assigned a subspecies and were thus attributed to distant Campylobacter spp. clades. Whole-genome sequence-derived multilocus sequence typing (MLST) and core-genome MLST (cgMLST) analyses revealed a high genetic diversity with 97 sequence types (STs), including 60 novel STs and 14 cgMLST clusters (≤10 allele differences), respectively. The most prevalent STs were ST-21, ST-70, ST-24, and ST-58 (accounting for 13.3%, 4.4%, 3.8%, and 3.2% of isolates, respectively). A high prevalence of the 125 examined virulence-related loci (from 76.8 to 98.4% per isolate) was observed, especially in Cll isolates, suggesting a probable human pathogenicity of these strains. IMPORTANCE Currently, relatedness between bacterial isolates impacting human health is easily monitored by molecular typing methods. These approaches rely on discrete loci or whole-genome sequence (WGS) analyses. Campylobacter lari is an emergent human pathogen isolated from diverse ecological niches, including fecal material from humans and animals, aquatic environments, and seafood. The presence of C. lari in such diverse sources underlines the importance of adopting an integrated One Health approach in studying C. lari population structure for conducting epidemiological risk assessment. This retrospective study presents a comparative genomics analysis of C. lari isolates retrieved from two different continents (Europe and Australia) and from different sources (human, domestic animals, waterbirds, food, and environment). It was designed to improve knowledge regarding C. lari ecology and pathogenicity, important for developing effective surveillance and disease prevention strategies.

Management Strategies for Prevention of Campylobacter Infections Through the Poultry Food Chain: A European Perspective.

Numerous studies point out that at present, a complete elimination of Campylobacter species in the poultry food chain is not feasible. Thus, the current aim should be to establish control measures and intervention strategies to minimize the occurrence of Campylobacter spp. in livestock (esp. poultry flocks) and to reduce the quantitative Campylobacter burden along the food chain in animals and subsequently in foods. The most effective measures to mitigate Campylobacter focus on the primary production stage. Nevertheless, measures applied during slaughter and processing complement the general meat hygiene approaches by reducing fecal contamination during slaughtering and processing and as a consequence help to reduce Campylobacter in poultry meat. Such intervention measures at slaughter and processing level would include general hygienic improvements, technological innovations and/or decontamination measures that are applied at single slaughter or processing steps. In particular, approaches that do not focus on a single intervention measure would need to be based on a thorough process of evaluation, and potential combinatory effects have to be modeled and tested. Finally, the education of all stakeholders (including retailers, food handlers and consumers) is required and will help to increase awareness for the presence of foodborne pathogens in raw meat and meat products and can thus aid in the development of the required good kitchen hygiene.

Human Campylobacteriosis-A Serious Infectious Threat in a One Health Perspective.

Zoonotic Campylobacter species-mainly C. jejuni and C. coli-are major causes of food-borne bacterial infectious gastroenteritis worldwide. Symptoms of intestinal campylobacteriosis include abdominal pain, diarrhea and fever. The clinical course of enteritis is generally self-limiting, but some infected individuals develop severe post-infectious sequelae including autoimmune disorders affecting the nervous system, the joints and the intestinal tract. Moreover, in immunocompromised individuals, systemic spread of the pathogens may trigger diseases of the circulatory system and septicemia. The socioeconomic costs associated with Campylobacter infections have been calculated to several billion dollars annually. Poultry meat products represent major sources of human infections. Thus, a "One World-One Health" approach with collective efforts of public health authorities, veterinarians, clinicians, researchers and politicians is required to reduce the burden of campylobacteriosis. Innovative intervention regimes for the prevention of Campylobacter contaminations along the food chain include improvements of information distribution to strengthen hygiene measures for agricultural remediation. Given that elimination of Campylobacter from the food production chains is not feasible, novel intervention strategies fortify both the reduction of pathogen contamination in food production and the treatment of the associated diseases in humans. This review summarizes some current trends in the combat of Campylobacter infections including the combination of public health and veterinary preventive approaches with consumer education. The "One World-One Health" perspective is completed by clinical aspects and molecular concepts of human campylobacteriosis offering innovative treatment options supported by novel murine infection models that are based on the essential role of innate immune activation by bacterial endotoxins.

Assessment of Femoral Torsion on Magnetic Resonance Imaging is More Reliable Using Axial-Oblique Sequences Compared With Standard Axial Slices in Patients With Femoroacetabular Impingement Syndrome.

PURPOSE: To determine the agreeability of femoral torsion measurements on axial and oblique axial magnetic resonance imaging (MRI) sequences in patients with femoroacetabular impingement syndrome (FAIS). METHODS: Patients who underwent primary hip arthroscopy for FAIS between January 2012 to January 2019 were identified. Inclusion criteria were all patients with an MRI scan containing the pelvis and knee imaging. MRI-based measurements of femoral torsion were performed on axial and oblique-axial slices by 2 raters, and inter-rater and intrarater reliability was assessed. Bland Altman plots were constructed to evaluate the agreeability between femoral torsion measurements performed using axial and oblique-axial slices. Bivariate correlation analyses were performed to assess the relationship between measurement methods on each respective scan. A linear regression was performed between measurements performed using axial and oblique-axial sequences. RESULTS: A total of 164 patients were included. The mean true-axial and oblique axial femoral torsion were 12.2° ± 9.9° and 11.1° ± 9.2°, respectively. The intrarater reliability for axial and oblique-axial measurements were 0.993 and 0.997, respectively. The inter-rater reliability for axial and oblique-axial measurements were 0.925 and 0.965, respectively. The number of differences within the limits of agreement for axial and oblique-axial femoral torsion measurements was 58.54%. On Pearson correlation analysis, strong positive correlations were found between oblique-axial measurements at multiple time points (r = 0.994, P < .001), as well as axial measurements at multiple time points (r = 0.986, P < .001). A strong positive correlation was found between axial and oblique-axial measurements (r = 0.894, P < .001). A significant regression equation indicated that for each additional increase in axial femoral torsion, the oblique-axial femoral torsion increased 0.837 (95% confidence interval 0.772-0.901). CONCLUSIONS: Femoral torsion values measured on oblique-axial sequences are smaller than on true-axial sequences. Femoral torsion measurements on axial and oblique-axial MRI sequences exhibit poor agreement. Oblique-axial sequences demonstrated greater measurement consistency at multiple timepoints. When evaluating torsional measurements, it is important to delineate which axial sequence was used, especially in patients with suspected severe femoral antetorsion. Standardization of MRI femoral version protocols within one's practice can ensure more consistent decision-making, especially in patients with suspected femoral antetorsion. LEVEL OF EVIDENCE: Retrospective cohort, level III.

Multicenter Outcomes After Primary Hip Arthroscopy: A Comparative Analysis of Two-Year Outcomes After Labral Repair, Segmental Labral Reconstruction, or Circumferential Labral Reconstruction.

PURPOSE: (1) To report minimum 2-year follow-up patient-reported outcome measures in patients undergoing labral repair (LR), segmental labral reconstruction (SLR), or circumferential labral reconstruction (CLR) in the primary setting; and (2) to compare minimum 2-year follow-up patient-reported outcome measures among these groups. METHODS: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. Inclusion criteria were patients undergoing hip arthroscopy for treatment of labral tear and femoroacetabular impingement syndrome between January 2014 and October 2017, and completion of minimum 2-year postoperative outcome scores. Exclusion criteria were patients undergoing revision hip surgery, labral treatment limited to debridement, lateral center-edge angle <20°, osteoarthritis (Tönnis grade > 1), slipped capital femoral epiphysis, workers compensation status, and patients undergoing concomitant gluteus medius and/or minimus repair. Labral reconstruction patients were matched (1:3) with labral repair patients on age, sex, and body mass index. The labral reconstruction group was further stratified into SLR, and CLR groups. Patient demographic characteristics and clinical outcomes including Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool, and visual analog scale for pain were analyzed, as well as achievement of the minimal clinical improvement difference (MCID). A P-value less than .05 indicated statistical significance. RESULTS: A total of 416 patients were included (LR, n = 312; SLR, n = 53; CLR, n = 51). The age, body mass index, and sex of the matched cohort were 42.3 ± 11.2 years, 24.7 ± 3.7, and 55.0% female. At a minimum of 2-year after hip arthroscopic surgery, no differences were found in preoperative, postoperative, or the delta visual analog scale for pain, modified Harris Hip Score, Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, or international Hip Outcome Tool. Subsequently, the proportion of patients achieving the MCID and the PASS at latest follow-up were analyzed. This analysis revealed that no significant differences in the rate of MCID or PASS achievement for any outcome measure existed based on labral treatment. CONCLUSIONS: In this multicenter study on labral treatment in the primary setting, patients undergoing LR, SLR, and CLR demonstrated no difference in preoperative or postoperative scores, nor the proportion of patients achieving clinically significant outcome improvement. LEVEL OF EVIDENCE: III; therapeutic outcome study with controls.

Teaching Outbreak Investigations with an Interactive Blended Learning Approach.

Public health is a central but often neglected component of veterinary education. German veterinary public health (VPH) education includes substantial theory-focused lectures, but practical case studies are often missing. To change this, we combined the advantages of case-based teaching and blended learning to teach these topics in a more practical and interactive way. Blended learning describes the combination of online and classroom-based teaching. With it, we created an interdisciplinary module for outbreak investigations and zoonoses, based on the epidemiology, food safety, and microbiology disciplines. We implemented this module within the veterinary curriculum of the seventh semester (in the clinical phase of the studies). In this study, we investigated the acceptance of this interdisciplinary approach and established a framework for the creation of interactive outbreak investigation cases that can serve as a basis for further cases. Over a period of 3 years, we created three interactive online cases and one interactive in-class case and observed the student-reported evaluation of the blended learning concept and self-assessed learning outcomes. Results show that 80% (75-89) of students evaluated the chosen combination of case-based and blended learning for interdisciplinary teaching positively and therefore accepted it well. Additionally, 76% (70-98) of students evaluated their self-assessed learning outcomes positively. Our results suggest that teaching VPH through interdisciplinary cases in a blended learning approach can increase the quality of teaching VPH topics. Moreover, it provides a framework to incorporate realistic interdisciplinary VPH cases into the curriculum.

Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications.

Hip arthroscopy for the treatment of femoroacetabular impingement syndrome requires access to the central compartment of the hip, which is more easily obtained with hip distraction. However, surgeons must balance improved surgical access with the risks of postoperative complications. Hip joint venting describes the disruption of the suction seal by introducing a large-gauge needle into the joint space and injecting air or fluid into the joint. Joint venting performed before initiating axial traction may reduce the force required to obtain central compartment access while mitigating postoperative complications.

Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs.

PURPOSE: To quantitatively evaluate computer vision interface (CVI)-guided femoroplasty in the arthroscopic treatment of femoroacetabular impingement syndrome and compare those results with traditional unguided resections. METHODS: Consecutive patients undergoing hip arthroscopy for femoroacetabular impingement syndrome between July 2019 and October 2019 were evaluated. Cases with CVI were identified along with controls, consisting of patients from the same study period who underwent surgery without the CVI and were balanced for age, sex, laterality, and preoperative alpha angles. Alpha angles were measured on pre- and postoperative clinic radiographs, as well as intraoperatively for the CVI group. Cam resections were quantified by measuring pre- and postresection alpha angles and compared between groups. The correlation between CVI views and office-based radiographs was assessed, and the 3 CVI views that best correlated with each of the 3 standard clinic radiographs were evaluated for accuracy and performance in detection of cam deformity with alpha angle ≥48° with the clinic-based films as the reference. RESULTS: A total of 49 patients (51 hips) (average age, 28.7; 33 female patients) in the CVI group, and 51 patients (51 hips) (average age: 29.9; 35 female patients) in the control group. There were no significant differences between groups with respect to age, sex, laterality, or preoperative alpha angle (all P > .05). Significant alpha angle reduction occurred on all intraoperative and postoperative clinic views (all P < .01). The CVI views that best correlated with the clinic radiographs were 11:45 with the anteroposterior (ρ = 0.588, P = .0025), 12:30 with the Dunn lateral (ρ = 0.632, P = .0009), and 1:45 with the false-profile (ρ = 0.575, P = .0033). Greater reliability was observed with 12:30/Dunn (accuracy = 83.33%, P < .0001; sensitivity = 77.14%; specificity = 87.76%) and 1:45/false-profile (accuracy = 82.35%, P = .0051; sensitivity = 81.82%; specificity = 82.61%) than with 11:45/anteroposterior (accuracy = 69.15%, P = .0077; sensitivity = 56.10%; specificity = 79.25%). CONCLUSIONS: CVI-guided cam resection results in successful resection of proximal femur cam lesions and represents a femoroplasty templating method that does not require preoperative computed tomography imaging or additional invasive intraoperative referencing modules. The accuracy and adequacy of this resection was validated by comparison with routine clinic radiographs. LEVEL OF EVIDENCE: Therapeutic Level III: retrospective comparative analysis.

Campylobacteriose ­ eine zoonotische Infektionskrankheit.

Campylobacter jejuni represents an important zoonotic pathogen that is causing foodborne enteric infections. In the human gut, C. jejuni bacteria induce intestinal campylobacteriosis which can develop into systemic post-infectious sequelae such as Guillain-Barré syndrome or rheumatoid arthritis. Here, we review the pathobiology and molecular mechanisms of C. jejuni infections as well as promising strategies to combat campylobacteriosis within the "One World - One Health" approach.

Characterization of Arcobacter spp. isolated from retail seafood in Germany.

Arcobacter species are considered emerging zoonotic pathogens associated with human gastroenteritis. They were already isolated from a wide range of habitats and hosts worldwide. However, information about the prevalence of Arcobacter in retail seafood products is still scarce. This study aimed to evaluate the presence of Arcobacter in retail seafood and characterize Arcobacter isolates derived from these matrices. In total, seven species of Arcobacter were isolated from 56 of 318 (17.6%) seafood samples, including bivalves (mussels, clams and razor clams), shrimps and cephalopods (squids and octopuses). The highest prevalence was detected in cephalopods (27.4%), followed by bivalves (18%) and lowest in shrimps (8.5%). PCRs of 10 putative virulence genes demonstrated higher prevalences of these genes among A. butzleri, compared to other species, such as A. cryaerophilus, A. aquimarinus and A. venerupis. Further, high genetic diversity could be determined by ERIC-PCR. Our study indicates the potential transmission of Arcobacter to humans by consuming uncooked or undercooked seafood.

Contamination of chicken meat with extended-spectrum beta-lactamase producing- Klebsiella pneumoniae and Escherichia coli during scalding and defeathering of broiler carcasses.

Extended-spectrum beta-lactamase- (ESBL-) producing Klebsiella (K.) pneumoniae and Escherichia (E.) coli are of critical importance in human and veterinary medicine. Animal food products, especially broiler chickens, are discussed as a possible source for the exposure of humans with antibiotic resistant bacteria. Although the occurrence and vertical transmission of ESBL-/AmpC-producing Enterobacteriaceae in the broiler production has been reported before, detailed investigations concerning the dissemination along the slaughter processing line are missing. In this study, we investigated cross-contamination with ESBL-producing Enterobacteriaceae during the processing of two different broiler flocks in one slaughterhouse. The ESBL-status during the fattening period of the flocks was determined and environmental samples from the slaughterhouse were taken before processing of the respective flocks. These isolates were compared to those found in samples from the carcasses after processing using whole genome sequencing. Phylogenetic analyses of seven ESBL-producing K. pneumoniae and 14 E. coli revealed close relationships between isolates from scalding water and the defeathering machine, respectively, which were collected before the processing of the broiler flocks, to those isolates found in samples from skin and filet of the respective flock carcasses. In conclusion, using high resolution molecular data we found evidence for the cross-contamination of carcasses with ESBL-producing Enterobacteriaceae during scalding and defeathering in the slaughterhouse.

Is There an Association Between Preoperative Expectations and Patient-Reported Outcome After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

PURPOSE: To determine the relationship between preoperative patient expectation and postoperative satisfaction and overall patient-reported outcome (PRO) of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. METHODS: Patients who underwent hip arthroscopy for femoroacetabular impingement syndrome completed the validated Hip Preservation Surgery Expectations Survey (21 questions; 0-100 range), as well as multiple PROs before surgery. High expectation was defined as an expectation score greater than 1 standard deviation above the mean. Patients with osteoarthritis, dysplasia, and those having undergone previous hip surgery were excluded. At 1 year postoperatively, patient visual analog scale (VAS) satisfaction, VAS pain, and PROs were assessed. Univariable and multivariate analyses were performed. RESULTS: One-hundred fifty-three subjects (mean age 34.4 ± 12.6 years, female: 114 [71.3%], body mass index: 25.9 ± 5.3 kg/m2) participated. The mean expectation score was 84.5 ± 12.3. Significant correlations between high expectation scores (>96.7) and achieving the minimal clinical important difference (MCID) for modified Harris Hip Score (mHHS; r = 0.339; P = .043) and patient acceptable symptomatic state (PASS) for Hip Outcome Score-Activities of Daily Living Subscale (HOS-ADL; r = 0.207; P = .032) were observed. There were no significant correlations between high expectation scores and preoperative or postoperative PROs or patient satisfaction scores. χ2 analysis demonstrated patients with greater expectations had increased rates of reaching MCID mHHS (92.3% vs 74.7%; P = .08), PASS mHHS (85.7% vs 69.7%; P = .046), and PASS HOS-ADL (93.8% vs 67.4%; P = .031). CONCLUSIONS: High preoperative expectation is associated with increased rates of MCID/PASS achievement on mHHS and increased rate of PASS achievement on HOS-ADL. Preoperative expectations did not have an impact on Hip Outcome Score-Sports Subscale; however, patients with high preoperative expectations also have a high baseline Hip Outcome Score-Sports Subscale. In addition, preoperative expectations are not associated with postoperative VAS satisfaction scores. LEVEL OF EVIDENCE: III; non-randomized cohort, therapeutic.

MLST genotypes of Campylobacter jejuni isolated from broiler products, dairy cattle and human campylobacteriosis cases in Lithuania.

BACKGROUND: Campylobacter (C.) jejuni is the leading cause of human campylobacteriosis worldwide. We performed a molecular epidemiological study to investigate the genetic relationship among C. jejuni strains isolated from human diarrhoeal patients, broiler products and dairy cattle in Lithuania. METHODS: The C. jejuni isolates from human clinical cases, dairy cattle and broiler products were genotyped using multilocus sequence typing (MLST). Allele numbers for each housekeeping gene, sequence type (ST), and clonal complex (CC) were assigned by submitting the DNA sequences to the C. jejuni MLST database ( http://pubmlst.org/campylobacter ). Based on the obtained sequence data of the housekeeping genes a phylogenetic analysis of the strains was performed and a minimum spanning tree (MST) was calculated. RESULTS: Among the 262 C. jejuni strains (consisting of 43 strains isolated from dairy cattle, 102 strains isolated from broiler products and 117 clinical human C. jejuni strains), 82 different MLST sequence types and 22 clonal complexes were identified. Clonal complexes CC21 and CC353 predominated among the C. jejuni strains. On ST-level, five sequence types (ST-5, ST-21, ST-50, ST-464 and ST-6410) were dominating and these five STs accounted for 35.9% (n = 94) of our isolates. In addition, 51 (19.5%) C. jejuni strains representing 27 (32.9%) STs were reported for the first time in the PubMLST database ( http://pubmlst.org/campylobacter ). The highest Czekanowski index or proportional similarity index (PSI) was calculated for C. jejuni strains isolated from human campylobacteriosis cases and broiler products (PSI = 0.32) suggesting a strong link between broiler strains and human cases. The PSI of dairy cattle and human samples was lower (PSI = 0.11), suggesting a weaker link between bovine strains and human cases. The calculated Simpson's index of all C. jejuni isolates showed a high genetic diversity (D = 0.96). CONCLUSION: Our results suggest that broiler products are the most important source of human campylobacteriosis in Lithuania. The study provides information on MLST type distribution and genetic relatedness of C. jejuni strains from humans, broiler products and dairy cattle in Lithuania for the first time, enabling a better understanding of the transmission pathways of C. jejuni in this country.

VIM-1 carbapenemase-producing Escherichia coli isolated from retail seafood, Germany 2016.

Carbapenems belong to the group of last resort antibiotics in human medicine. Therefore, the emergence of growing numbers of carbapenemase-producing bacteria in food-producing animals or the environment is worrying and an important concern for the public health sector. In the present study, a set of 45 Enterobacteriaceae isolated from German retail seafood (clams and shrimps), sampled in 2016, were investigated by real-time PCR for the presence of carbapenemase-producing bacteria. One Escherichia coli (ST10), isolated from a Venus clam (Ruditapes philippinarum) harvested in the Mediterranean Sea (Italy), contained the carbapenemase gene blaVIM-1 as part of the variable region of a class I integron. Whole-genome sequencing indicated that the integron was embedded in a Tn3-like transposon that also contained the fluoroquinolone resistance gene qnrS1. Additional resistance genes such as the extended-spectrum beta-lactamase blaSHV-12 and the AmpC gene blaACC-1 were also present in this isolate. Except blaACC-1, all resistance genes were located on an IncY plasmid. These results confirm previous observations that carbapenemase-producing bacteria have reached the food chain and are of increasing concern for public health.

Changes in global gene expression of Vibrio parahaemolyticus induced by cold- and heat-stress.

BACKGROUND: Vibrio (V.) parahaemolyticus causes seafood-borne gastro-intestinal bacterial infections in humans worldwide. It is widely found in marine environments and is isolated frequently from seawater, estuarine waters, sediments and raw or insufficiently cooked seafood. Throughout the food chain, V. parahaemolyticus encounters different temperature conditions that might alter metabolism and pathogenicity of the bacterium. In this study, we performed gene expression profiling of V. parahaemolyticus RIMD 2210633 after exposure to 4, 15, 20, 37 and 42 °C to describe the cold and heat shock response. METHODS: Gene expression profiles of V. parahaemolyticus RIMD 2210633 after exposure to 4, 15, 20, 37 and 42 °C were investigated via microarray. Gene expression values and RT-qPCR experiments were compared by plotting the log2 values. Moreover, volcano plots of microarray data were calculated to visualize the distribution of differentially expressed genes at individual temperatures and to assess hybridization qualities and comparability of data. Finally, enriched terms were searched in annotations as well as functional-related gene categories using the Database for Annotation, Visualization and Integrated Discovery. RESULTS: Analysis of 37 °C normalised transcriptomics data resulted in differential expression of 19 genes at 20 °C, 193 genes at 4 °C, 625 genes at 42 °C and 638 genes at 15 °C. Thus, the largest number of significantly expressed genes was observed at 15 and 42 °C with 13.3 and 13%, respectively. Genes of many functional categories were highly regulated even at lower temperatures. Virulence associated genes (tdh1, tdh2, toxR, toxS, vopC, T6SS-1, T6SS-2) remained mostly unaffected by heat or cold stress. CONCLUSION: Along with folding and temperature shock depending systems, an overall temperature-dependent regulation of expression could be shown. Particularly the energy metabolism was affected by changed temperatures. Whole-genome gene expression studies of food related pathogens such as V. parahaemolyticus reveal how these pathogens react to stress impacts to predict its behaviour under conditions like storage and transport.

Arcobacter butzleri induces a pro-inflammatory response in THP-1 derived macrophages and has limited ability for intracellular survival.

Recent case reports have identified Arcobacter (A.) butzleri to be another emerging pathogen of the family Campylobacteraceae causing foodborne diseases. However, little is known about its interaction with the human immune system. As macrophages act as first defense against bacterial infections, we studied for the first time the impact of A. butzleri on human macrophages using THP-1 derived macrophages as an in vitro infection model. Our investigations considered the inflammatory response, intracellular survival and activation of caspases as potential virulence mechanisms employed by A. butzleri. Induction of IL-1α, IL-1ß, IL-6, IL-8, IL-12ß and TNFα demonstrated a pro-inflammatory response of infected macrophages towards A. butzleri. gentamycin protection assays revealed the ability of A. butzleri strains to survive and resist the hostile environment of phagocytic immune cells for up to 22 h. Moreover, initial activation of intitiator- (CASP8) as well as effector caspases (CASP3/7) was observed without the onset of DNA damage, suggesting a potential counter regulation. Intriguingly, we recognized distinct strain specific differences in invasion and survival capabilities. This suggests the existence of isolate dependent phenotype variations and different virulence potentials as known for other intestinal pathogens such as Salmonella enterica ssp.