Meropenem-loaded Cement Is Effective in Preventing Gram-negative Osteomyelitis in an Animal Model.

BACKGROUND: Low-dose antibiotic-loaded acrylic cement is routinely used for preventing skeletal infection or reimplantation in patients with periprosthetic joint infections. However, few reports about the selection of antibiotics in acrylic cement for antigram-negative bacteria have been proposed. QUESTIONS/PURPOSES: (1) Does the addition of antibiotics (tobramycin, meropenem, piperacillin, ceftazidime, ciprofloxacin, and aztreonam) to acrylic cement adversely affect compressive strength before and after elution? (2) Which antibiotics have the highest cumulative release within 28 days? (3) Which antibiotics showed antimicrobial activity within 28 days? (4) Does meropenem-loaded cement improve body weight, temperature, and other inflammatory markers compared with control unloaded cement? METHODS: This is an in vitro study that assessed the mechanical strength, antibiotic elution, and antibacterial properties of antibiotic-loaded cement, combined with an animal study in a rat model that evaluated key endpoints from the animal study. In the in vitro study, we added 2 g of tobramycin (TOB), meropenem (MEM), piperacillin (PIP), ceftazidime (CAZ), ciprofloxacin (CIP), and aztreonam (ATM) to 40 g of acrylic cement. The compressive strength, elution, and in vitro antibacterial properties of the antibiotic-loaded cement were detected. Thirty male rats were randomly divided into two groups: CON (antibiotic-unloaded cement) and MEM (meropenem-loaded cement, which had the most stable antibacterial properties of the six tested antibiotic-loaded cements in vitro within 28 days). The right tibia of all rats underwent arthroplasty and was implanted with the cement, followed by inoculation with Pseudomonas aeruginosa in the knee. General status, serum biomarkers, radiology, microbiological assay, and histopathological tests were assessed over 14 days postoperatively. RESULTS: The compressive strength of all tested antibiotic cement combinations exceeded the 70 MPa threshold (the requirement established in ISO 5833). The cumulative release proportions of the raw antibiotic in cement were 1182.8 ± 37.9 µg (TOB), 355.6 ± 16.2 µg (MEM), 721.2 ± 40.3 µg (PIP), 477.4 ± 37.1 µg (CAZ), 146.5 ± 11.3 µg (CIP), and 372.1 ± 14.5 µg (ATM) within 28 days. Over a 28-day period, meropenem cement demonstrated antimicrobial activities against the four tested gram-negative bacteria ( Escherichia coli , P. aeruginosa , Klebsiella pneumoniae , and Proteus vulgaris ). Ciprofloxacin cement inhibited E. coli growth, ceftazidime and aztreonam cement inhibited K. pneumonia growth, and tobramycin cement inhibited P. aeruginosa . Only meropenem demonstrated antimicrobial activity against all gram-negative bacteria on agar diffusion bioassay. Rats treated with meropenem cement showed improved body weight (control: 280.1 ± 4.2 g, MEM: 288.5 ± 6.6 g, mean difference 8.4 [95% CI 4.3 to 12.6]; p < 0.001), improved knee width (control: 13.5 ± 0.3 mm, MEM: 11.8± 0.4 mm, mean difference 1.7 [95% CI 1.4 to 2.0]; p < 0.001), decreased inflammatory marker (control: 316.7 ± 45.0 mm, MEM: 116.5 ± 21.8 mm, mean difference 200.2 [95% CI 162.3 to 238.2]; p < 0.001), decreased radiographic scores (control: 17.7 ± 2.0 mm, MEM: 10.7± 1.3 mm, mean difference 7.0 [95% CI 5.4 to 8.6]; p < 0.001), improved bone volume/total volume (control: 8.7 ± 3.0 mm, MEM: 28.5 ± 5 .5 mm, mean difference 19.8 [95% CI 13.3 to 26.2]; p < 0.001), decreased Rissing scale scores of the knee gross pathology (control: 3.3 ± 0.5, MEM: 1.1 ± 0.7, mean difference 2.2 [95% CI 1.7 to 2.7]; p < 0.001), decreased Petty scale scores of knee synovium (control: 2.9 ± 0.4 mm, MEM: 0.7 ± 0.7 mm, mean difference 2.1 [95% CI 1.7 to 2.5]; p < 0.001), and decreased bacterial counts of the bone and soft tissues and negative bacterial cultures of cement (p < 0.001, p < 0.001, p < 0.001, p < 0.001, respectively). CONCLUSION: In this current study, MEM cement had the most stable in vitro antimicrobial activities, effective in vivo activity while having acceptable mechanical and elution characteristics, and it may be an effective prophylaxis against skeletal infection caused by gram-negative bacteria. CLINICAL RELEVANCE: Meropenem-loaded acrylic cement is a potentially effective prevention measure for skeletal infection caused by gram-negative bacteria; however, more related clinical research is needed to further evaluate the safety and efficacy.

Current status survey of the extramural hospital management of venous thromboembolism after total hip and knee arthroplasty in China.

BACKGROUND: Venous thromboembolism (VTE) is a potentially fatal complication after arthroplasty. Numerous prophylactic strategies and studies to reduce VTEs have focused on the duration of the hospital stay and on few extramural hospitals. This study aimed to investigate extramural hospital management of VTE after total hip/knee arthroplasty (THA/TKA) in China with a novel survey tool. METHODS: A total of 180 patients undergoing arthroplasty, including 68 THA patients and 112 TKA patients, were enrolled in this study. All patients received anticoagulant treatment management. A survey querying VTE management and adherence, such as therapy information, understanding of anticoagulation, satisfaction with the ability of medical staff, and satisfaction with health care costs, was administered by a questionnaire (TKA/THA Patients' Experience with Anticoagulation in the Post-discharge Period) for quality improvement. RESULTS: The average age of the patients was 65.27 ± 13.62 years. All patients knew their follow-up times. 85 % of them were suggested that re-examine at the next 14 days, and the others at the next 28 days. All patients continued to visit the orthopaedic clinic after discharge without choosing other types of outpatient services, such as an anticoagulant clinic or home visit with a nurse/pharmacist or remote evaluation by telephone. A total of 96.6 % of all patients used new oral anticoagulants, and the most common treatment duration was 2-4 weeks (93.3 %). 48 % informed their physicians that they were taking anticoagulation medications when they visited ophthalmology, dentistry, dermatology, and other departments. The overall rate of satisfaction with anticoagulation management was 81.67 %, and 6.67 % of patients were not unsatisfied with their medical expenses. Patient compliance decreased with increasing follow-up time. Continuous follow-ups after discharge significantly improved patient compliance. CONCLUSIONS: These results elucidate how we can improve the quality of anticoagulation. Continuous follow-up appointments for 30 days after discharge, especially for individuals over 65 years old, significantly improved patient satisfaction and reduced the incidence of VTE and medical costs.

Transcriptome Reveals Roles of Lignin-Modifying Enzymes and Abscisic Acid in the Symbiosis of Mycena and Gastrodia elata.

Gastrodia elata is a well-known medicinal and heterotrophic orchid. Its germination, limited by the impermeability of seed coat lignin and inhibition by abscisic acid (ABA), is triggered by symbiosis with fungi such as Mycena spp. However, the molecular mechanisms of lignin degradation by Mycena and ABA biosynthesis and signaling in G. elata remain unclear. In order to gain insights into these two processes, this study analyzed the transcriptomes of these organisms during their dynamic symbiosis. Among the 25 lignin-modifying enzyme genes in Mycena, two ligninolytic class II peroxidases and two laccases were significantly upregulated, most likely enabling Mycena hyphae to break through the lignin seed coats of G. elata. Genes related to reduced virulence and loss of pathogenicity in Mycena accounted for more than half of annotated genes, presumably contributing to symbiosis. After coculture, upregulated genes outnumbered downregulated genes in G. elata seeds, suggesting slightly increased biological activity, while Mycena hyphae had fewer upregulated than downregulated genes, indicating decreased biological activity. ABA biosynthesis in G. elata was reduced by the downregulated expression of 9-cis-epoxycarotenoid dioxygenase (NCED-2), and ABA signaling was blocked by the downregulated expression of a receptor protein (PYL12-like). This is the first report to describe the role of NCED-2 and PYL12-like in breaking G. elata seed dormancy by reducing the synthesis and blocking the signaling of the germination inhibitor ABA. This study provides a theoretical basis for screening germination fungi to identify effective symbionts and for reducing ABA inhibition of G. elata seed germination.

External Electrons Directly Stimulate Escherichia coli for Enhancing Biological Hydrogen Production.

External electric field has the potential to influence metabolic processes such as biological hydrogen production in microorganisms. Based on this concept, we designed and constructed an electroactive hybrid system for microbial biohydrogen production under an electric field comprised of polydopamine (PDA)-modified Escherichia coli (E. coli) and Ni foam (NF). In this system, electrons generated from NF directly migrate into E. coli cells to promote highly efficient biocatalytic hydrogen production. Compared to that generated in the absence of electric field stimulation, biohydrogen production by the PDA-modified E. coli-based system is significantly enhanced. This investigation has demonstrated the mechanism for electron transfer in a biohybrid system and gives insight into precise basis for the enhancement of hydrogen production by using the multifield coupling technology.

Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis.

OBJECTIVE: This study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis. PATIENTS AND METHODS: We retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12-63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76cm (range, 2.7-15.7cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity). RESULTS: The mean follow-up after removal of the apparatus was 25.26 months (range, 14-51 months). The mean finite fixator time was 10.15 months (range, 8-14 months) in group A versus 17.21 months (range, 11-24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)]. CONCLUSIONS: In the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.

[Influence of autoclave sterilization on dimensional stability and detail reproduction of 5 additional silicone impression materials].

OBJECTIVE: To evaluate the dimensional stability and detail reproduction of five additional silicone impression materials after autoclave sterilization. METHODS: Impressions were made on the ISO 4823 standard mold containing several marking lines, in five kinds of additional silicone. All the impressions were sterilized by high temperature and pressure (135 °C, 212.8 kPa) for 25 min. Linear measurements of pre-sterilization and post-sterilization were made with a measuring microscope. Statistical analysis utilized single-factor analysis with pair-wise comparison of mean values when appropriate. Hypothesis testing was conducted at alpha = 0.05. RESULTS: No significant difference was found between the pre-sterilization and post-sterilization conditions for all locations, and all the absolute valuse of linear rate of change less than 8%. All the sterilization by the autoclave did not affect the surfuce detail reproduction of the 5 impression materials. CONCLUSIONS: The dimensional stability and detail reproduction of the five additional silicone impression materials in the study was unaffected by autoclave sterilization.

[In vivo model to evaluate the accuracy of complete-tooth spectrophotometer for dental clinics].

OBJECTIVE: To test ΔE between measured value and right value from the Crystaleye complete-tooth spectrophotometer, and to evaluate the accuracy rate of the spectrophotometer. METHODS: Twenty prosthodontists participated in the study. Each of them used Vita 3D-Master shadeguide to do the shade matching, and used Crystaleye complete-tooth spectrophotometer (before and after the test training) tested the middle of eight fixed tabs from shadeguide in the dark box. The results of shade matching and spectrophotometer were recorded. The accuracy rate of shade matching and the spectrophotometer before and after training were calculated. RESULTS: The average accuracy rate of shade matching was 49%. The average accuracy rate of the spectrophotometer before and after training was 83% and 99%. CONCLUSIONS: The accuracy of the spectrophotometer was significant higher than that in shade matching, and training can improve the accuracy rate.

[The influence of toothguide training box on shade matching veracity].

PURPOSE: The aim of the study was to evaluate the influence of toothguide training box(TTB) on shade matching veracity, and compare the differences of influence on shade matching veracity of tabs of shadeguide and on that of tabs out of shadeguide. METHODS: 31 graduated students who had 1 to 5-year clinical experience without color blindness were trained by TTB once a week for 3 weeks. Elapsed time and scores from the training system were recorded each time. And everyone was tested by 29 tabs of Vita 3D-Master shadeguide and 7 tabs out of Vita 3D-Master shadeguide before the first training as the base line and tested again after the last training as the test after training. SPSS 10.0 software package was used for analysis. The variances of scores and elapsed time were analyzed by ANOVA, and the differences of veracity between tabs of shadeguide and that of tabs out of shadeguide by Wilcoxon signed ranks test. RESULTS: The scores of the tests were rising via training. There was significant difference (P<0.01) between the first (900.29+/-51.68) and the third training (933.81+/-32.94). The elapsed time was turning shorter via training. There is significant difference (P<0.01) between the first [(46.29+/-13.29)min] and the second training [(32.68+/-8.81)min], and also between the first and the third training (30.00+/-7.07)min. The veracity of test after training was higher than the veracity of base line. A significant difference (P<0.01) of shade matching veracity was demonstrated between base line and test after training in both tabs of shadeguide (60.37%+/-18.33%,46.08%+/-22.04%) and the total (37.10%+/-11.58%,28.34%+/-11.73%), but that difference in tabs out of shadeguide (13.82+/-14.98%,10.60%+/-11.65%) was not significant(P>0.01). CONCLUSION: TTB can improve the shade matching ability of prosthodontists, but has limited influence on the shade matching ability of tabs out of shadeguide.

[Comparison of shade matching accuracy of tabs of shadeguide and tabs out of shadeguide].

OBJECTIVE: To compare the shade matching accuracy between tabs of shade guide and tabs out of shade guide by prosthodontists. METHODS: Sixty-two graduate students who had 1 to 5 years clinical experience without color blindness were included in this study. Twenty-nine tabs from Vita 3D-Master shadeguide and 7 tabs out of Vita 3D-Master shade guide but from Vita Bleachedguide 3D-Master were taken as the targets of shade matching and observed under the standard light. Subjects' shade matching accuracy on tabs of shadeguide and tabs out of shadeguide was recorded. Frequency of right match was analyzed using Monte Carlo exact probability-test. Wilcoxin test was used to analyze the difference between each group on ranked data of value, chroma and hue. RESULTS: The shade matching accuracy of tabs of shade guide [45.9% (199/434)] was significantly higher than that of tabs out of shade guide [9.0% (39/434)]. There was significant difference between the two kinds of tabs of ranked data of value [0.2 (0.1 - 0.3), 0.4 (0.4 - 0.5)] and chroma [0.2 (0.1 - 0.4), 0.5 (0.4 - 0.6), P < 0.01, but there was no significant difference in hue data [0.3 (0.1 - 0.4), 0.3 (0.1 - 0.4)]. CONCLUSIONS: The shade matching ability of prosthodontists on tabs out of shade guide is lower than that on tabs of shadeguide. To fulfill clinical need, more training is necessary.

[Application and comparison of two shade guide training systems].

OBJECTIVES: To evaluate the effect of shade guide training box and shade guide training software on shade matching ability of observers when used separately. To find out the difference between two training plans when the two training methods were used in combination, and to provide information on shade matching training system. METHODS: Sixty-two postgraduate dental students who specialized in prosthodontics with 1 to 5 year clinical experience were enrolled in this study. At base line, each participant were asked to match 7 standard shade tabs which have been randomly chosen from Vita 3D-Master shade guide and 7 intermediate shade tabs from Vita bleached guide 3D-Master. Then the subjects were allocated to 2 groups [Toothguide Training Box (TTB) group and Toothguide Training (TT) group] according to the baseline data. Participants in group TTB received training session once a week for 3 weeks, while those in group TT received TT training session once a week for 3 weeks. All participants took a middle term shade-matching test. Then the two groups exchange the training methods and repeat the whole process, a final test was given to each participant. The elapsed time and number of accurate shade matching were recorded for each training session. Wilcoxon signed ranks test and ANOVA were used in data analysis. RESULTS: There were no significant differences in the number of accurate shade matching (standard shade tab and the sum) between group TTB (4.4 +/- 1.3 and 5.3 +/- 1.6) and TT (4.0 +/- 1.4 and 4.9 +/- 1.5) in the middle term test with higher value found in group TTB. In the final test, the number of accurate shade matching (standard shade tab and the sum) in group TT (4.9 +/- 0.8 and 6.4 +/- 0.8) was higher than that in group TTB (4.7 +/- 1.1 and 5.8 +/- 0.9), but significant difference was found only when the sum number of accurate shade matching was compared between the two groups (P < 0.05). There was no significant difference between data from middle term test and from final test in group TTB; while in group TT, the number of accurate shade matching in the final test was significantly increased compared with that in the middle term test (P < 0.05). CONCLUSIONS: When used in combination, TT training followed by TTB training is recommended.