Many Common Pathogens are Present in the Operative Room Air During Surgery.

BACKGROUND: The main objective of this study was to assess the sanitary measures of operating theaters using next-generation sequencing. METHODS: Air was sampled from the operating room for the whole duration of 10 surgical days of "clean" (no infection cases) procedures (6 hip/knee arthroplasty and 4 spine cases). Controls consisted of samples at the beginning of the day (1 hour before the surgery started) and at the end of the day after terminal cleaning. One additional control sample, consisting of a culture swab that was opened and exposed to the air for 5 seconds, was collected at each time point. All samples were sent for next-generation sequencing analysis (16S rRNA sequencing) for bacterial identification. RESULTS: Overall, 306 samples were collected (159 controls and 147 experimental). Microbial DNA was detected in only 1 control sample, while 18 (12.2%) experimental samples were positive for microbial DNA. The most common organisms retrieved were Escherichia coli (6/18, 30%), Cutibacterium acnes (3/18, 15%), and Pseudomonas aeruginosa (2/18, 11.1%). There was no difference in positive samples between arthroplasty and spine cases (P > .05). CONCLUSION: Microbial organisms are not uncommonly present in the operating room air during hip and knee arthroplasties and spine procedures.

Dual-Mobility Implants and Constrained Liners in Revision Total Hip Arthroplasty.

BACKGROUND: Instability remains the most common complication after revision total hip arthroplasty (THA). The purpose of this study was to determine whether there was a difference in aseptic revision rates and survivorship between dual-mobility (DM) and constrained liners (CL) in revision THA. METHODS: We reviewed a consecutive series of 2432 revision THA patients from 2008 to 2019 at our institution and identified all patients who received either a CL or DM bearing. We compared demographics, comorbidities, indications, dislocations, and aseptic failure rates between the two groups. Bivariate and multivariate regression analyses were used to determine risk factors for failure, and a Kaplan-Meier survivorship analysis was performed with an aseptic re-revision as the endpoint. RESULTS: Of the 191 patients, 139 (72%) received a DM bearing, and 52 (28%) had a CL. At a mean follow-up of 14.3 months, there was no statistically significant difference in rates of dislocation (10.4% vs 14.0%, P = .667), aseptic revision (30.9% vs 46.2%, P = .073), or time to revision (3.78 vs 6 months, P = .565) between the two groups. The multivariate analysis revealed CL had no difference in aseptic re-revision rates when compared with DM (odds ratio 1.47, 95% confidence interval 0.84-2.52, P = .177). The survivorship analysis found no difference in aseptic failure between the groups at 12 months (P = .059). CONCLUSION: Both CL and DM bearings have high aseptic failure rates at intermediate term follow-up after revision THA. CL did show a higher risk of failure than DM bearings, but it was not statistically significant with the numbers available for this study. Further prospective studies are needed to determine the optimal treatment for recurrent instability.

Lumbar Total Disc Replacement: Current Usage.

Low back pain is the leading cause of disability worldwide in industrialized nations. The pathology underlying chronic low back pain is associated with numerous factors. Lumbar degenerative disc disease is a potential major source of low back pain. There are numerous treatment modalities and options. Nonsurgical treatment options exist in the form of pain management through a combination of anti-inflammatory medications and steroid injections, physical therapy and lifestyle modifications. This article reviews the history and current trends in use for lumbar toral disc arthroplasty for degenerative disc disease treatment. Furthermore, indications, contraindications, and complications management are discussed.

Intradural extramedullary capillary hemangioma of the cauda equina: case report of a rare spinal tumor.

INTRODUCTION: Intradural extramedullary capillary hemangiomas of the cauda equina are exceedingly rare, with only 20 previous cases reported. In the adult population, these tumors are rare and can arise in the central and peripheral nervous systems from the dura or spinal nerve roots. Intradural capillary hemangiomas of the cauda equina can yield symptoms such as lower extremity weakness, pain, and bladder and bowel dysfunction. The clinical symptomology and surgical management of this rare spinal lesion are reviewed in this case report. CASE PRESENTATION: A 50-year-old male presented with progressive bilateral lower extremity weakness for 2 years, with recent bladder and bowel dysfunction. On physical exam, strength was symmetrically impaired in both lower extremities. Pre-operative magnetic resonance imaging (MRI) of the lumbar spine demonstrated a gadolinium-enhanced intradural lesion at the L4 level. Laminectomy was performed and the lesion was resected. Histopathological analysis determined that the tumor demonstrated features consistent with a capillary hemangioma. DISCUSSION: Clinically, patients with capillary hemangiomas of the cauda equina present with space-occupying compressive deficits, including progressive low back and lower extremity pain, motor deficits, paresthesias, sensory loss, and bowel and bladder dysfunction. Acute presentation can transpire following a hemorrhagic episode, although this is more associated with cavernous rather than capillary hemangiomas. Our patient demonstrated non-acute, progressive weakness, and late-onset bladder and bowel dysfunction. This report demonstrates that this rare lesion should be included in the differential diagnosis of cauda equina lesions.

Spinal ganglion cyst presenting with radiculopathy: diagnostic challenges and differential.

INTRODUCTION: Ganglion cysts are benign soft tissue lesions, usually arising from periarticular connective tissue. These are very rarely reported in the spine, but when seen can cause radiculopathy or myelopathy. CASE PRESENTATION: A 68-year-old female patient presented with worsening radiculopathy and right foot drop and imaging noted a right L5-S1 foraminal mass. The lesion was gross totally resected. Histological analysis revealed myxoid degeneration and inflammation, without a synovial lining, consistent with ganglion cyst. DISCUSSION: While uncommon, intra-foraminal ganglion cysts can be distinguished from synovial cysts through imaging and histology and are typically amenable to surgical resection. Greater knowledge and insight about differentiating ganglion versus synovial cyst may prevent resection of facet joints and prevent a fusion procedure.

Thermal stability and structure of glyceraldehyde-3-phosphate dehydrogenase from the coral Acropora millepora.

Corals are vulnerable to increasing ocean temperatures. It is known that elevated temperatures lead to the breakdown of an essential mutualistic relationship with photosynthetic algae. The molecular mechanisms of this temperature-dependent loss of symbiosis are less well understood. Here, the thermal stability of a critical metabolic enzyme, glyceraldehyde-3-phosphate dehydrogenase, from the stony coral Acropora millepora was found to increase significantly in the presence of its cofactor NAD+. Determination of the structure of the cofactor-enzyme complex (PDB ID 6PX2) revealed variable NAD+ occupancy across the four monomers of the tetrameric enzyme. The structure of the fully occupied monomers was compared to those with partial cofactor occupancy, identifying regions of difference that may account for the increased thermal stability.