Debridement, antibiotics and implant retention (DAIR): An effective treatment option for early prosthetic joint infections.

INTRODUCTION: Debridement, antibiotics and implant retention (DAIR) is an attractive treatment option for prosthetic joint infections (PJIs). However, reported success rates and predictors of DAIR failure vary widely. The primary aim of this study is to report the outcome of DAIR in patients with hip and knee PJIs receiving short course of antibiotic therapy. The secondary aim is to identify risk factors for DAIR failure. METHODS: We performed a retrospective analysis of prospectively collected data of all hip and knee PJIs consecutively diagnosed at Quadrante Orthopedic Center, an Italian orthopedic hospital highly specialized in prosthetic surgery, from January 1, 2013 to January 1, 2019, and we analyzed those treated with DAIR. RESULTS: Forty-seven PJIs occurred after 5102 arthroplasty procedures. Twenty-one patients (45%) aged 71 years were treated with DAIR for hip (62%) and knee (38%) PJIs. These were classified as early PJIs in 76% cases, delayed in 19% and late in 5%. Median time from PJI-related symptoms onset to implant revision surgery was 12 days (IQR, 7-20 days). The median duration of antibiotic treatment after surgery was 63 days (IQR, 53-84 days). Sixteen (76%) patients were cured after a median follow-up of 2197 days (IQR, 815-2342 days), while 5 (24%) experienced failure. At multivariate analysis, delayed/late PJIs were significantly associated with failure (OR = 12.51; 95% CI 1.21-129.63, p = 0.03). CONCLUSIONS: DAIR represents an effective strategy for the treatment of early PJIs in spite of short course of antibiotic therapy.

Josephson effect in MgB(2) break junctions.

We present the first observation of the dc and ac Josephson effect in MgB(2) break junctions. The junctions, obtained at 4.2 K in high-quality, high-density polycrystalline metallic MgB(2) samples, show a nonhysteretic dc Josephson effect. By irradiating the junctions with microwaves we observe clear Shapiro steps spaced by the ideal Delta V value. The temperature dependence of the dc Josephson current and the dependence of the height of the steps on the microwave power are obtained. These results directly prove the existence of pairs with charge 2e in MgB(2) and give evidence of the superconductor-normal metal-superconductor weak link character of these junctions.

[Primary extranodal non-Hodgkin's lymphoma of muscle tissue]. / Linfoma non-Hodgkin extranodale primitivo del tessuto muscolare.

Primary muscular involvement is extremely rare in non-Hodgkin's lymphomas. To our knowledge few cases are reported in literature and all of them concern patients with unifocal muscular lymphoid masses usually growing in one of the extremities. Our case-report, instead, regards a 78 years-old woman presenting primary multifocal muscular involvement by extranodal non-Hodgkin's lymphoma (right upper and lower limbs affected at the same time). Therefore, in contrast with the therapeutic approach suggested by other Authors in such neoplasms (radiotherapy or combined radio-chemotherapy), we preferred to administer only chemotherapy. The treatment led to a complete regression of all lymphoid masses. By now the woman is healthy and disease-free as confirmed at the one-year haematological follow-up.

[Occurrence of primary hypothyroidism in alpha-interferon treatment]. / Insorgenza di ipotiroidismo primitivo in corso di terapia con alfa-interferone.

In recent years recombinant alpha interferon (IFN) has been widely used in the treatment of neoplastic and infectious diseases. Induced autoimmune disorders and thyroid impairment are getting increasing relevance in the field of side-effects complicating long-term alpha-interferon courses. We monitored thyroid function in 35 patients receiving alpha-IFN therapy for different diseases (chronic hepatitis, essential thrombocytemia, multiple myeloma, chronic myeloid leukemia, essential polycytemia, essential crioglobulinemia and hairy-cell leukemia). All of them were euthyroid and negative for anti-thyroid serum antibodies before treatment. Six months later, 6 patients (17%) developed primary hypothyroidism with elevated antithyroid antibodies in 5 cases; 1 continuing to be negative. None of our patients developed hyperthyroidism. Overall, "indirect-autoimmune" and "direct non autoimmune" mechanisms are considered possible and/or combined pathogenetic moments of thyroid disfunction during alpha-IFN therapy. Thyroid complications mainly occur when latent impairment of immune system exists. Thyroid circulating hormones levels and autoimmunity screening should be performed in all patients before starting and during long-term alpha-IFN treatment.

[Impaired glucose tolerance in obesity in children and adolescents]. / Ridotta tolleranza glucidica nell'obesità infanto-giovanile.

The incidence of impaired glucose tolerance (IGT) in obese juvenile has not yet been well defined. Glycemic and insulin responses to OGTT were evaluated in 398 obese juveniles (and 70 healthy control subjects) to investigate possible correlations with age, body mass index (BMI) and obesity duration. Subjects were subdivided into two groups according to OGTT results: obese with normal glucose tolerance (OB-NGT) and obese with impaired glucose tolerance (OB-IGT). IGT was found in 11% of subjects but no correlations were observed in relation to age, BMI and obesity duration. There was no difference in the glycemic response to OGTT in terms of the biological parameters examined. Insulin plasma levels were twice as high in OB-NGT in comparison to control subjects and OB-NGT. Basal insulinemia increased with BMI in OB-IGT but not in OB-NGT.

High-accuracy picosecond characterization of gain-switched laser diodes.

A unique combination of the time-correlated photon-counting technique and single-photon avalanche diode detectors gives an accurate characterization of gain-switched semiconductor lasers with picosecond resolution. The high sensitivity and the clean shape of the time response reveal even small features (reflections and relaxation oscillations), making a true optimization of the laser-diode operation possible. The technique outperforms the standard characterization with ultrafast p-i-n photodiodes and a sampling oscilloscope. In addition, compared with other methods, it has favorable features that greatly simplify the measurement.

High-resolution and high-sensitivity optical-time-domain reflectometer.

We demonstrate a photon-counting optical-time-domain reflectometer (OTDR) operating at a wavelength of 0.85 microm at room temperature with high sensitivity (3 x 10(-15) W) at high resolution (1.5 cm, 150 psec). Measurements of splice losses and Rayleigh scattering losses less then 0.1 dB with centimeter resolution are demonstrated to be possible with such an OTDR.