RESUMO
A protracted outbreak of New Delhi metallo-ß-lactamase (NDM)-producing carbapenem-resistant Klebsiella pneumoniae started in Tuscany, Italy, in November 2018 and continued in 2020 and through 2021. To understand the regional emergence and transmission dynamics over time, we collected and sequenced the genomes of 117 extensively drug-resistant, NDM-producing K. pneumoniae isolates cultured over a 20-mo period from 76 patients at several healthcare facilities in southeast Tuscany. All isolates belonged to high-risk clone ST-147 and were typically nonsusceptible to all first-line antibiotics. Albeit sporadic, resistances to colistin, tigecycline, and fosfomycin were also observed as a result of repeated, independent mutations. Genomic analysis revealed that ST-147 isolates circulating in Tuscany were monophyletic and highly genetically related (including a network of 42 patients from the same hospital and sharing nearly identical isolates), and shared a recent ancestor with clinical isolates from the Middle East. While the blaNDM-1 gene was carried by an IncFIB-type plasmid, our investigations revealed that the ST-147 lineage from Italy also acquired a hybrid IncFIB/IncHIB-type plasmid carrying the 16S methyltransferase armA gene as well as key virulence biomarkers often found in hypervirulent isolates. This plasmid shared extensive homologies with mosaic plasmids circulating globally including from ST-11 and ST-307 convergent lineages. Phenotypically, the carriage of this hybrid plasmid resulted in increased siderophore production but did not confer virulence to the level of an archetypical, hypervirulent K. pneumoniae in a subcutaneous model of infection with immunocompetent CD1 mice. Our findings highlight the importance of performing genomic surveillance to identify emerging threats.
Assuntos
Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Animais , Antibacterianos , Proteínas de Bactérias/genética , Biomarcadores , Carbapenêmicos , Colistina , Biologia Computacional/métodos , Infecção Hospitalar/epidemiologia , Humanos , Itália/epidemiologia , Estimativa de Kaplan-Meier , Funções Verossimilhança , Camundongos , Testes de Sensibilidade Microbiana , Preparações Farmacêuticas , Plasmídeos , Polimorfismo de Nucleotídeo Único , beta-Lactamases/genéticaRESUMO
In 2003-2023, amid 5,436 Acinetobacter baumannii isolates collected globally through the Multidrug-Resistant Organism Repository and Surveillance Network, 97 were ST19PAS, 34 of which carbapenem-resistant. Strains (n = 32) sampled after 2019 harboured either bla OXA-23, bla OXA-72, and/or bla NDM-5. Phylogenetic analysis of the 97 isolates and 11 publicly available ST19 genomes revealed three sub-lineages of carbapenemase-producing isolates from mainly Ukraine and Georgia, including an epidemic clone carrying all three carbapenemase genes. Infection control and global surveillance of carbapenem-resistant A. baumannii remain important.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Proteínas de Bactérias , Testes de Sensibilidade Microbiana , beta-Lactamases , beta-Lactamases/genética , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/enzimologia , Humanos , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/epidemiologia , Proteínas de Bactérias/genética , Ucrânia/epidemiologia , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Filogenia , Farmacorresistência Bacteriana Múltipla/genética , República da Geórgia/epidemiologia , Tipagem de Sequências MultilocusRESUMO
PURPOSE: Conservative treatment remains the standard approach for first-time patellar dislocations. While risk factors for patellofemoral instability, a common paediatric injury, are well-established in adults, data concerning the progression of paediatric recurrent patellar dislocation remain scarce. A reproducible method was developed to quantitatively assess the patellofemoral morphology and anatomic risk factors in paediatric patients using magnetic resonance imaging (MRI) and machine learning analysis. METHODS: Data were analyzed from a retrospective review (2005-2022) of paediatric patients diagnosed with acute lateral patellar dislocation (54 patients) who underwent MRI and were compared with an age-based control group (54 patients). Patellofemoral, tibial, tibiofemoral and patellar height parameters were measured. Differences between groups were analyzed with respect to MRI parameters. The potential diagnostic utility of the parameters was assessed via machine learning and genetic algorithm analyses. RESULTS: Significant differences were observed between the two groups in six patellofemoral morphological parameters. Regarding patellar height morphological parameters, all methods exhibited significant between-group differences. Among the tibia and tibiofemoral morphological parameters, only the tibial tubercle-trochlear groove distance exhibited significant differences between the two groups. No sex-related differences were present. Significant variations were observed in patellar height parameters, particularly in the Koshino-Sugimoto (KS) index, which had the highest area under the curve (AUC: 0.87). Using genetic algorithms and logistic regression, our model excelled with seven key independent variables. CONCLUSION: KS index and Wiberg index had the strongest association with lateral patellar dislocation. An optimized logistic regression model achieved an AUC of 0.934. Such performance is considered clinically relevant, indicating the model's effectiveness for the intended application. LEVEL OF EVIDENCE: Level â ¢.
RESUMO
Background and Objectives: Reducing opioid exposure in common pediatric surgeries is of paramount importance. This study aimed to assess the efficacy of regional nerve blocks in reducing opioid exposure while preserving high success rates. Materials and Methods: We conducted a retrospective matched cohort study (1:1) including patients with elbow fractures < 12 years old who underwent treatment with percutaneous pinning. Patients were divided into general-anesthesia (GA) and GA-followed-by-supraclavicular-brachial-plexus-block (GA-SCB) groups. The primary outcome was the number of patients administered postoperative rescue opioids. The secondary outcomes included intraoperative and postoperative opioid administration, the time to first request for rescue analgesia, pain scores, block success rate, block performing time, and block-related complications. Results: In a total of 478 patients, 363 underwent percutaneous pinning, and 86 were cohort-matched (GA: n = 43, GA-SCB: n = 43). On the first postoperative day, 34 (79.0%) patients in the GA group were administered postoperative rescue opioids, compared with 12 (27.9%) in the GA-SCB group (p < 0.001). All the patients in the GA-SCB group were opioid-free during the intraoperative period. No SCB-associated complications were observed. Total opioid consumption was significantly lower in the GA-SCB group than in the GA group until the first postoperative day (GA vs. GA-SCB, 3.2 ± 3.0 mg vs. 0.9 ± 1.8 mg, p < 0.001). Conclusions: SCB application in pediatric patients who underwent elbow fracture surgery significantly reduced opioid exposure and had a high success rate when performed using ultrasound guidance by an expert. Furthermore, the complication risk and surgical delay were minimal.
Assuntos
Bloqueio do Plexo Braquial , Fraturas do Cotovelo , Humanos , Criança , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Estudos de Coortes , Dor Pós-Operatória/tratamento farmacológicoRESUMO
BACKGROUND: To evaluate whether insertion of self-biodegradable stent into the pylorus to prevent delayed-gastric emptying after pylorus-preserving gastrectomy is feasible and safe through porcine experiment. METHODS: Self-biodegradable dumbbell-shaped pyloric stents were designed from absorbable suture materials: poly(glycolide-co-caprolactone) (PGCL) or poly-p-dioxanone (PPDO). After gastrotomy on ten pigs, each stent was inserted: two shams, four PGCL stents, and four PPDO stents. Body weight (Bwt), body temperature (BT), complete blood cell (CBC) count, and plain X-ray were evaluated. On postoperative day (POD) 13, euthanasia was performed for histologic evaluation. RESULTS: Operation was successfully performed in all ten pigs. Without tagging suture, both stents migrated before POD 3. The migration was delayed up to POD 13, when the tagging sutures (-t) were applied between stent and stomach wall. Self-degradation of PGCL started from POD 3, and stents were completely excreted from the abdomen by POD 8. Although PPDO were also weakened as self-degradation progressed, its shape was maintained in gastrointestinal tract for 13 days. Unexpected sudden death occurred in the pig with PPDO-t2 on POD 10, which is more likely due to acute volvulus rather than stent-related complication. There was no significant difference between three groups in terms of Bwt, BT, CBC, and histology (sham vs. PGCL vs. PPDO, all p > 0.05). CONCLUSION: The concept of biodegradable stents made of absorbent suture material seems feasible in porcine experiment. Among them, PGCL which has shown rapid absorption, appears to be a more suitable material for transient pyloric absorbable stent when considering safety aspect.
Assuntos
Piloro , Neoplasias Gástricas , Humanos , Animais , Suínos , Piloro/cirurgia , Piloro/patologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Estudos de Viabilidade , Gastrectomia/métodos , Stents , Abdome/patologiaRESUMO
Mesenchymal stem cells (MSCs) have been widely applied to the regeneration of damaged tissue and the modulation of immune response. The purity of MSC preparation and the delivery of MSCs to a target region are critical factors for success in therapeutic application. In order to define the molecular identity of an MSC, the gene expression pattern of a human bone marrow-derived mesenchymal stem cell (hBMSC) was compared with that of a human embryonic fibroblast (hEF) by competitive hybridization of a microarray. A total of 270 and 173 genes were two-fold up- and down-regulated with FDR < 0.05 in the hBMSC compared to the hEF, respectively. The overexpressed genes in the hBMSC over the hEF, including transcription factors, were enriched for biological processes such as axial pattern formation, face morphogenesis and skeletal system development, which could be expected from the differentiation potential of MSCs. CD70 and CD339 were identified as additional CD markers that were up-regulated in the hBMSC over the hEF. The differential expression of CD70 and CD339 might be exploited to distinguish hEF and hBMSC. CMKLR1, a chemokine receptor, was up-regulated in the hBMSC compared to the hEF. RARRES2, a CMKLR1 ligand, stimulated specific migration of the hBMSC, but not of the hEF. RARRES2 manifested as ~two-fold less effective than SDF-1α in the directional migration of the hBMSC. The expression of CMKLR1 was decreased upon the osteoblastic differentiation of the hBMSC. However, the RARRES2-loaded 10% HA-silk scaffold did not recruit endogenous cells to the scaffold in vivo. The RARRES2−CMKLR1 axis could be employed in recruiting systemically delivered or endogenous MSCs to a specific target lesion.
RESUMO
BACKGROUND: Congenital femoral deficiency (CFD) is a rare condition that affects the morphology of the hip and surrounding soft tissues. Bony deformity and distorted muscular anatomy are well known, but no studies have described the relationship of the femoral neurovascular (NV) bundle to surgically relevant anatomic landmarks. The authors compared the location of the femoral NV bundle on the affected side in patients with CFD with the unaffected side. The authors hypothesized that the bundle on the pathologic side would be in an abnormal position relative to the unaffected side. METHODS: Thirty-three patients diagnosed with unilateral CFD who had undergone preoperative magnetic resonance imaging of the pelvis were included in our study. The authors identified the femoral NV bundle on the axial cuts and measured its distance from the anterior superior iliac spine (ASIS), anterior inferior iliac spine (AIIS), and lesser trochanter (LT). Anatomic percent change and absolute measurements were then compared and correlated with associated boney deformities and the Paley classification. RESULTS: The distance from the femoral NV bundle to the ASIS, AIIS, and LT was significantly different compared with the unaffected side. The AIIS absolute distance and AIIS percent change significantly correlated with the neck-shaft angle of the proximal femur. CONCLUSIONS: In patients with CFD, the femoral NV bundle seems to be further from the LT and closer to the AIIS on the affected side when compared with the unaffected side. magnetic resonance imaging may be helpful to understand the course of the femoral NV bundle before reconstruction in patients with CFD; however, the authors recommend identification of the femoral NV bundle before transection of the proximal rectus femoris tendon to provide safe surgical care. LEVEL OF EVIDENCE: Level IV-case-control study of diagnostic studies.
Assuntos
Artéria Femoral/diagnóstico por imagem , Nervo Femoral/diagnóstico por imagem , Veia Femoral/diagnóstico por imagem , Fêmur/anormalidades , Articulação do Quadril/anormalidades , Pontos de Referência Anatômicos , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Fêmur/irrigação sanguínea , Fêmur/diagnóstico por imagem , Fêmur/inervação , Articulação do Quadril/irrigação sanguínea , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/inervação , Humanos , Ílio/diagnóstico por imagem , Lactente , Masculino , Pelve/diagnóstico por imagem , Músculo Quadríceps/cirurgia , Estudos Retrospectivos , Tendões/cirurgiaRESUMO
Over the past two decades, Acinetobacter baumannii has emerged as a leading cause of nosocomial infections worldwide. Of particular concern are panresistant strains, leading the World Health Organization (WHO) to designate carbapenem-resistant A. baumannii as a priority 1 (critical) pathogen for research and development of new antibiotics. A key component in supporting this effort is accessibility to diverse and clinically relevant strains for testing. Here, we describe a panel of 100 diverse A. baumannii strains for use in this endeavor. Whole-genome sequencing was performed on 3,505 A. baumannii isolates housed at the Multidrug-Resistant Organism Repository and Surveillance Network. Isolates were cultured from clinical samples at health care facilities around the world between 2001 and 2017. Core-genome multilocus sequence typing and high-resolution single nucleotide polymorphism (SNP)-based phylogenetic analyses were used to select a final panel of 100 strains that captured the genetic diversity of the collection. Comprehensive antibiotic susceptibility testing was also performed on all 100 isolates using 14 clinically relevant antibiotics. The final 100-strain diversity panel contained representative strains from 70 different traditional Pasteur scheme multilocus sequence types, including major epidemic clones. This diversity was also reflected in antibiotic susceptibility and antimicrobial resistance (AMR) gene content, with phenotypes ranging from pansensitive to panresistant, and over 100 distinct AMR gene alleles identified from 32 gene families. This panel provides the most diverse and comprehensive set of A. baumannii strains for use in developing solutions for combating antibiotic resistance. The panel and all available metadata, including genome sequences, will be available to industry and academic institutions and federal and other laboratories free of charge.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Infecção Hospitalar , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/genética , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Humanos , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Filogenia , PesquisaRESUMO
PURPOSE: Knee joint morphology is a known contributor to anterior cruciate ligament (ACL) injury, and the shape of the distal femur condyle is one of the associated factors. However, the relationship between femoral trochlear morphology and ACL injury is unclear, especially in pediatric patients. Therefore, the present study aimed to evaluate the effect of femoral trochlear morphology on ACL injury in pediatric patients and investigate the possibility of gender differences. METHODS: In total, 116 skeletally immature children aged 3-18 years with primary ACL injuries were matched with a control group of 116 skeletally immature children. Lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, and sulcus angle were evaluated using magnetic resonance imaging (MRI). Differences between patient groups and gender were investigated. Receiver-operating characteristic (ROC) curves were constructed to obtain the sensitivity and specificity of all parameters. RESULTS: A significant difference was observed in the sulcus angle and trochlear inclination between the ACL injury and control groups (p < 0.05). No significant difference was observed between the ACL injury and control groups with respect to the anatomic patellar instability risk factors. All parameters showed an area under the curve of 0.6 in the ROC analysis, indicative of failure of the diagnostic test. CONCLUSIONS: There was a significant association between femoral trochlear morphology and increased risk of ACL injury in pediatric patients. No gender difference was found except in the trochlear depth. It was showed that the difference in trochlear morphology should be considered between normal children and pediatric patients with ACL injury to increase the awareness regarding ACL injuries. LEVEL OF EVIDENCE: III.
Assuntos
Lesões do Ligamento Cruzado Anterior/patologia , Fêmur/anatomia & histologia , Adolescente , Determinação da Idade pelo Esqueleto , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/patologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Imageamento por Ressonância Magnética , Masculino , Fatores de Risco , Sensibilidade e Especificidade , Fatores SexuaisRESUMO
PURPOSE: Revision of unicompartmental knee arthroplasty (UKA) to total knee arthroplasty (TKA) is technically demanding but can be performed with computer navigation system guidance. The purpose of this study was (1) to compare the outcomes of revision of UKA to TKA to those of primary TKA and (2) to describe a surgical technique for the revision of UKA to TKA using a navigation system. METHODS: From May 2011 to April 2014, a total of 298 knees underwent primary navigation-assisted TKA (group 1), and navigation-assisted UKA revision to TKA was performed in 15 patients (group 2). One to three propensity score matching was performed to compare the two groups after a minimum of three years of follow-up. Radiographic and clinical outcomes in addition to radiolucent lines were evaluated during follow-up. RESULTS: In group 1, there was one case that required metal block augmentation with the long stem under the tibial plate due to severe bone loss, while in other cases, short stems were used, and cement and autogenous bone grafts were used to fill bone defects due to minimal bone loss. Pre- and post-operative outcomes were significantly improved in both groups (p < 0.001). There were no statistical differences between groups in pre- and post-operative outcomes except post-operative Knee Society Function Score (KSFS) (p = 0.008). There were no radiolucent lines in the tibia or femur in either group during follow-up. CONCLUSIONS: With the use of an appropriate surgical technique, navigation-assisted revision of UKA to TKA can yield clinical and radiologic outcomes comparable to those of primary navigation-assisted TKA. LEVEL OF EVIDENCE: Level IV.
Assuntos
Artroplastia do Joelho , Articulação do Joelho/cirurgia , Idoso , Placas Ósseas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Tíbia/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: The aims of this study were to evaluate the recovery of physical function and to investigate whether there are factors that adversely affect functional recovery after cosmetic bilateral lengthening of the tibia. METHODS: One hundred twenty-five healthy individuals who had undergone bilateral cosmetic tibia lengthening by the lengthening and then nail (LATN) method, lengthening over intramedullary nail (LON) method or intramedullary skeletal kinetic distractor (ISKD) were included in the study. Functional outcomes were evaluated using the Sports Activity Rating Scale (SARS), International Knee Documentation Committee (IKDC) Subjective Knee Form and patient self-reported ability scores. RESULTS: SARS and IKDC scores decreased at post-operative one year and improved significantly at post-operative two years. SARS and IKDC scores recovered similarly to pre-operative levels. Average patient self-reported ability scores at post-operative two years were 94.6 and 89.9 for daily living and light sports, respectively. However, the average score for moderate-to-strenuous sports was 68.1 and 39 patients (31.2%) recorded below average score for the moderate-to-strenuous sports. CONCLUSIONS: Patients who had undergone bilateral cosmetic tibial lengthening may expect almost full recovery of daily and light sports activities at post-operativetwo years. However, several patients may feel some limitation in moderate-to-strenuous sports activities.
Assuntos
Alongamento Ósseo/métodos , Tíbia/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Alongamento Ósseo/efeitos adversos , Alongamento Ósseo/instrumentação , Pinos Ortopédicos , Técnicas Cosméticas/instrumentação , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Resultado do Tratamento , Adulto JovemRESUMO
Whole-genome sequencing (WGS) of historical Pseudomonas aeruginosa clinical isolates identified a chromosomal copy of mcr-5 within a Tn3-like transposon in P. aeruginosa MRSN 12280. The isolate was nonsusceptible to colistin by broth microdilution, and genome analysis revealed no mutations known to confer colistin resistance. To the best of our knowledge, this is the first report of mcr in colistin-nonsusceptible P. aeruginosa.
Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Pseudomonas aeruginosa/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/genéticaRESUMO
BACKGROUND: Quadriceps tendon-patellar bone (QTPB) autograft is an excellent graft option with good clinical outcome. Use of QTPB autografts have increased because they minimize donor-site morbidity including anterior knee pain, while providing adequate mechanical strength. Although, there were many clinical results about allografts that used in anterior cruciate ligament (ACL) reconstruction, it have never been reported about the clinical outcome of ACL reconstruction with QTPB allograft. The purpose of this study is to evaluate the clinical outcome of ACL reconstruction with QTPB allograft and to compare with QTPB autograft. We hypothesized that ACL reconstruction with QTPB allograft had good functional outcomes and stability and no significant difference compared to the ACL reconstruction with QTPB autograft. METHODS: From February 2009 to January 2014, 213 cases who received ACL reconstruction with QTPB grafts were included. Forty-five patients who received ACL reconstruction with QTPB allograft were individually matched in age, sex, direction of the injured knee and body mass index (BMI) to a control group of 45 patients who received QTPB autograft. Clinical results were evaluated using International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner scale, Knee injury and Osteoarthritis Outcome Score (KOOS) and ligament laxity. An average follow-up time was 31.2 months. RESULTS: The functional scores and ligament laxity improved from initial to the last visit in those with ACL reconstruction with QTPB allograft (p < 0.05). No significant statistical difference was found in clinical outcomes and complications including re-rupture between the QTPB allograft and autograft groups (p > 0.05). Laxity using anterior drawer test, Lachman test and KT-2000 showed no significant difference. No significant difference was found between the two groups in quadriceps peak extension torque, except at 60° per second at 6 months. CONCLUSION: QTPB allograft achieved good clinical outcome with no difference compared with QTPB autograft. QTPB allograft for ACL reconstruction is promising alternative to selected and compliant patients. Long-term follow-up needs to further evaluate the clinical outcomes and complications including re-rupture rate.
Assuntos
Aloenxertos/transplante , Reconstrução do Ligamento Cruzado Anterior/métodos , Patela/transplante , Músculo Quadríceps/transplante , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
PURPOSE: The purpose of this study was to find a prognostic factor of medial meniscus posterior root tear (MMPRT) for surgical decision making. METHODS: Eighty-eight patients who were diagnosed as acute or subacute MMPRT without severe degeneration of the meniscus were treated conservatively for 3 months. Fifty-seven patients with MMPRT showed good response to conservative treatment (group 1), while the remaining 31 patients who failed to conservative treatment (group 2) received arthroscopic meniscus repair. Their demographic characteristics and radiographic features including hip-knee-ankle angle, joint line convergence angle, Kellgren-Lawrence grade in plain radiographs, meniscus extrusion (ME) ratio (ME-medial femoral condyle ratio, ME-medial tibial plateau ratio, ME-meniscus width ratio), the location of bony edema, and cartilage lesions in MRI were compared. Receiver operating characteristic (ROC) curve analysis was also performed to determine the cut-off values of risk factors. RESULTS: The degree of ME-medial femoral condyle and medial tibia plateau ratio of group 2 was significantly higher than group 1 (0.08 and 0.07 vs. 0.1 and 0.09, respectively, both p < 0.001). No significant (n.s.) difference in other variables was found between the two groups. On ROC curve analysis, ME-medial femoral condyle ratio was confirmed as the most reliable prognostic factor of conservative treatment for MMPRT (area under ROC = 0.8). CONCLUSION: The large meniscus extrusion ratio was the most reliable poor prognostic factor of conservative treatment for MMPRT. Therefore, for MMPRT patients with large meniscus extrusion, early surgical repair could be considered as the primary treatment option. LEVEL OF EVIDENCE: III.
Assuntos
Tratamento Conservador , Lesões do Menisco Tibial/terapia , Adulto , Idoso , Artroscopia , Tomada de Decisão Clínica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Lesões do Menisco Tibial/diagnóstico , Lesões do Menisco Tibial/patologia , Lesões do Menisco Tibial/cirurgiaRESUMO
PURPOSE: The aim of this study was to investigate gait speed changes 2 years after bilateral total knee arthroplasty (TKA) and identify kinetic and kinematic factors associated with such changes by comparing patients with age- and sex-matched controls. METHODS: The study group included 34 female patients with end-stage knee osteoarthritis (OA) who underwent bilateral TKA and 42 age- and sex-matched controls without knee pain or OA. Standard TKA was performed on all arthritic patients with placement of posterior stabilized fixed-bearing implants. Kinetic and kinematic parameters were evaluated using a commercial optoelectric gait analysis system. Gait speed, kinetic and kinematic changes and determinants of speed were assessed via principal component analysis and multiple regression analysis. RESULTS: The average gait speed of an arthritic patient was 90.2 ± 18.4 cm/s and improved to 96.0 ± 12.3 cm/s after TKA (p = 0.032). However, the speed remained slower than that of controls (111.2 ± 8.2 cm/s, p < 0.001). With regard to kinetics, the peak knee extension moment (KEM) generated by the quadriceps was unchanged after TKA and weaker than that of controls (p < 0.001). The proportions of KEM contributing to the total sagittal moment were also smaller in the pre-/post-operative groups than in the control group (13-14% vs. 19%). On the other hand, the ankle plantar flexion moment (APFM) was increased after TKA (p = 0.007) and its proportion of the total sagittal moment was greater than in controls (46% vs. 42%). With regard to kinematics, knee range of motion (ROM) improved after TKA (p = 0.025), but was smaller than that of controls (p < 0.001). In controls, gait speed was determined principally by hip and knee joint moments. However, in the TKA group, speed was determined by the knee ROM and APFM. CONCLUSIONS: Despite showing improvement, the gait speed of TKA patients remained slower than that of controls. Slow gait speed after bilateral TKA was associated with suboptimal improvement of knee biomechanics. Quadriceps strengthening exercises and the achievement of greater ROM during gait are advised for the further improvement of gait speed. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.
Assuntos
Artroplastia do Joelho/efeitos adversos , Marcha/fisiologia , Articulação do Joelho/fisiopatologia , Joelho/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Velocidade de Caminhada/fisiologia , Idoso , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Feminino , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Treatment of unstable intertrochanteric fracture in elderly patients remains challenging. The purpose of this prospective study is to determine clinical and radiological results of cementless bipolar hemiarthroplasty using a fully porous-coated stem in osteoporotic elderly patients with unstable intertrochanteric fractures with follow-up over 5 years. METHODS: From January 2010 to December 2011, we performed 123 cementless bipolar hemiarthroplasties using fully porous-coated stem to treat unstable intertrochanteric fractures in elderly patients with osteoporosis. Clinical and radiographic evaluations were performed. RESULTS: Fifty-three patients died and 14 patients were lost during the follow-up period. Mean follow-up period was 61.8 months postoperatively. Their mean Harris hip score was 77 points (range 36-100). None of these hips had loosening of the stem or osteolysis. Postoperative complications included nonunion of greater trochanter in 2 hips and dislocation in 2 hips. Two patients were reoperated due to periprosthetic fracture. One patient underwent implant revision due to periprosthetic infection. Thirty-one patients maintained walking activities similar to those before fracture. With follow-up period of 83 months, cumulative survival rates were 97.3% and 99.1% with reoperation for any reason and femoral stem revision as endpoint, respectively. CONCLUSION: Cementless bipolar hemiarthroplasty using a fully porous-coated stem is a useful surgical treatment option for unstable intertrochanteric fracture in elderly patients with osteoporosis.
Assuntos
Artroplastia de Quadril/métodos , Hemiartroplastia/instrumentação , Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Prótese de Quadril , Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/mortalidade , Feminino , Fêmur/cirurgia , Hemiartroplastia/mortalidade , Humanos , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteólise/cirurgia , Osteoporose/cirurgia , Porosidade , Complicações Pós-Operatórias/cirurgia , Período Pós-Operatório , Estudos Prospectivos , Desenho de Prótese , Radiografia , Reoperação , Resultado do Tratamento , CaminhadaRESUMO
The emergence of a transferable colistin resistance gene (mcr-1) is of global concern. The insertion sequence ISApl1 is a key component in the mobilization of this gene, but its role remains poorly understood. Six Escherichia coli isolates were cultured from the same patient over the course of 1 month in Germany and the United States after a brief hospitalization in Bahrain for an unconnected illness. Four carried mcr-1 as determined by real-time PCR, but two were negative. Two additional mcr-1-negative E. coli isolates were collected during follow-up surveillance 9 months later. All isolates were analyzed by whole-genome sequencing (WGS). WGS revealed that the six initial isolates were composed of two distinct strains: an initial ST-617 E. coli strain harboring mcr-1 and a second, unrelated, mcr-1-negative ST-32 E. coli strain that emerged 2 weeks after hospitalization. Follow-up swabs taken 9 months later were negative for the ST-617 strain, but the mcr-1-negative ST-32 strain was still present. mcr-1 was associated with a single copy of ISApl1, located on a 64.5-kb IncI2 plasmid that shared >95% homology with other mcr-1 IncI2 plasmids. ISApl1 copy numbers ranged from 2 for the first isolate to 6 for the final isolate, but ISApl1 movement was independent of mcr-1 Some movement was accompanied by gene disruption, including the loss of genes encoding proteins involved in stress responses, arginine catabolism, and l-arabinose utilization. These data represent the first comprehensive analysis of ISApl1 movement in serial clinical isolates and reveal that, under certain conditions, ISApl1 is a highly active IS element whose movement may be detrimental to the host cell.
Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Elementos de DNA Transponíveis/genética , Proteínas de Escherichia coli/genética , Escherichia coli , Sequência de Bases , DNA Girase/genética , DNA Topoisomerase IV/genética , Farmacorresistência Bacteriana/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Genoma Bacteriano/genética , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNA , beta-Lactamases/genéticaRESUMO
OBJECTIVE: To determine the functional relevance of diffusion tensor imaging (DTI) metrics and conventional MRI (signal intensity change in T2, compression ratio) by measuring the correlation of these parameters with clinical outcome measured by the modified Japanese Orthopedic Association (mJOA) score. MATERIALS AND METHODS: A total of 20 cervical myelopathy (CM) patients participated in this prospective cohort study. The severities of CM were assessed using the mJOA score. Conventional MRIs (T2-weighted images) measuring the signal changes of spinal cords and the degree of compression at the lesion level and DTI metrics [fractional anisotropy (FA), apparent diffusion coefficient (ADC)] at each lesion and below each lesion (C7/T1) level were acquired using a 3-T Achieva MRI. These parameters were correlated with the mJOA scores to determine the functional relevance. RESULTS: Ninety percent of CM patients showed signal changes and 30 % of patients noted a more than 40% canal compression ratio in conventional MRIs at the lesion level; however, these findings were not correlated with the mJOA score (p < 0.05). In contrast, FA values on DTI showed high sensitivity to CM (100%), which was well correlated with the mJOA score (p = 0.034, r = 0.475) below the lesion level (C7/T1). CONCLUSIONS: This study showed a meaningful symptomatic correlation between mJOA scores and FA values below the lesion levels in CM patients. It could give us more understanding of the pathological changes in spinal cords matched with various clinical findings in CM patients than the results from conventional MRI.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Compressão da Medula Espinal/diagnóstico por imagem , Estenose Espinal/diagnóstico por imagem , Anisotropia , Vértebras Cervicais/patologia , Imagem de Tensor de Difusão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Compressão da Medula Espinal/patologia , Estenose Espinal/patologiaRESUMO
16S rRNA methyltransferases confer resistance to most aminoglycosides, but discriminating their activity from that of aminoglycoside-modifying enzymes (AMEs) is challenging using phenotypic methods. We demonstrate that arbekacin, an aminoglycoside refractory to most AMEs, can rapidly detect 16S methyltransferase activity in Enterobacteriaceae with high specificity using the standard disk susceptibility test.
Assuntos
Anti-Infecciosos/metabolismo , Dibecacina/análogos & derivados , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão/métodos , Farmacorresistência Bacteriana , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/enzimologia , tRNA Metiltransferases/análise , Dibecacina/metabolismo , Genótipo , Humanos , Fenótipo , RNA Ribossômico 16S/metabolismo , tRNA Metiltransferases/genéticaRESUMO
BACKGROUND: Phalangeal neck fractures in children are difficult to treat conservatively because of the difficulty in maintaining reduction, obtaining satisfactory follow-up x-rays, and the limited remodeling potential. The purpose of this study was to present the results after using buddy taping with a short-arm splint for phalangeal neck fracture in children and to compare with operative treatment. METHODS: Thirty-seven patients below 12 years old who had phalangeal neck fractures were included. Nineteen patients were underwent conservative treatment and 18 patients were underwent operative fixation with Kirschner wires. Clinical outcome and radiographs between groups were compared. RESULTS: There were no significant differences between conservative group and operative group in the sagittal angulation, coronal angulation, and translation at immediately after reduction, at the 6-week, and final follow-up examination. CONCLUSION: Buddy taping with a short-arm splint for treating phalangeal neck fractures had acceptable outcomes compared to that with surgical correction.