Antibiotic-impregnated calcium phosphate cement as part of a comprehensive treatment for patients with established orthopaedic infection.

BACKGROUND: The treatment of established orthopaedic infection is challenging. While the main focus of treatment is wide surgical debridement, systemic and local antibiotic administration are important adjuvant therapies. Several reports have described the clinical use of antibiotic-impregnated calcium phosphate cement (CPC) to provide local antibiotic therapy for bone infections. However, these were all individual case reports, and no case series have been reported. We report a case series treated by a single surgeon using antibiotic-impregnated CPC as part of a comprehensive treatment plan in patients with established orthopaedic infection. METHODS: We enrolled 13 consecutive patients with osteomyelitis (n = 6) or infected non-union (n = 7). Implantation of antibiotic-impregnated CPC was performed to provide local antibiotic therapy as part of a comprehensive treatment plan that also included wide surgical debridement, systemic antibiotic therapy, and subsequent second-stage reconstruction surgery. We investigated the rate of successful infection eradication and systemic/local complications. The concentration of antibiotics in the surgical drainage fluids, blood, and recovered CPC (via elution into a phosphate-buffered saline bath) were measured. RESULTS: The mean follow-up period after surgery was 50.4 (range, 27-73) months. There were no cases of infection recurrence during follow-up. No systemic toxicity or local complications from the implantation of antibiotic-impregnated CPC were observed. The vancomycin concentration in the fluid from surgical drainage (n = 6) was 527.1 ± 363.9 µg/mL on postoperative day 1 and 224.5 ± 198.4 µg/mL on postoperative day 2. In patients who did not receive systemic vancomycin therapy (n = 3), the maximum serum vancomycin level was <0.8 µg/mL. In vitro vancomycin elution was observed from the CPC that was surgically retrieved (n = 2). CONCLUSIONS: Implantation of antibiotic-impregnated CPC is an option to provide local antibiotic therapy as part of a comprehensive treatment plan.

In vitro effects of bisphenol A on developing hypothalamic neurons.

Estradiol plays an essential role in sexual differentiation of the rodent hypothalamus. Endocrine disruptors with estrogenic activity such as bisphenol A (BPA) are reported to disturb sexual differentiation of the hypothalamus. The purpose of the present study was to examine in vitro effects of BPA on developing hypothalamic neurons by focusing on a presynaptic protein synapsin I and microtubule-associated protein 2 (MAP2). In cultured hypothalamic cells from fetal rats, treatment with BPA enhanced both dendritic and synaptic development, as evidenced by increases in the area of dot-like staining of synapsin I and MAP2-positive area. An estrogen receptor (ER) antagonist, ICI 182,780, only partially blocked BPA-induced increase in the synapsin I-area, while it suppressed the MAP2-area increased by BPA. A specific ERK inhibitor, U0126, reduced the synapsin I-area without affecting the MAP2-area. BPA significantly decreased protein levels of synapsin I phosphorylated at Ser-9 and Ser-603. These findings indicate that BPA-inducing effects on dendritic and synaptic development are mediated by different molecular pathways.

Effects of estrogen on synapsin I distribution in developing hypothalamic neurons.

Estradiol (17beta-estradiol, E(2)) plays an essential role in sexual differentiation of the rodent brain. The purpose of the present study was to investigate the effects of E(2) on developing hypothalamic neurons by focusing on a presynaptic protein, synapsin I. We applied E(2) to cultured hypothalamic cells removed from fetal rats and investigated resultant effects upon synapsin I. Our immunocytochemical study revealed that administration of E(2) increased the dendritic area ('MAP2-area') and synaptic area detected as dot-like staining of synapsin I ('synapsin I-area'). However, immunoblotting and real-time PCR showed that E(2) did not increase both protein and mRNA expression levels of synapsin I. Studies with cyclohexamide (CHX), membrane impermeable E(2) (E(2)-BSA), and an estrogen receptor (ER) antagonist ICI 182,780 indicated that E(2) affected the synapsin I-area mainly via a non-genomic pathway mediated by membrane ER. Immunoblotting showed that E(2) suppressed phosphorylation of synapsin I at residues Ser-9, Ser-553, and Ser-603. On the other hand, E(2) did not affect phosphorylation of synapsin I at Ser-62, Ser-67 and Ser-549. The present study suggests that E(2) affects localization of synapsin I in hypothalamic neurons by altering site-specific phosphorylation of synapsin I, which is likely mediated by membrane ER.