Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study.

PURPOSE: The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery. METHODS: Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort. RESULTS: 2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205-0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32-5.42, p = 0.01). Age (OR: 1.06, CI95 1.01-1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05-1.17, p < 0.01) had little effect on the risk of PJI. CONCLUSION: Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.

Excellent overall and chronic graft-versus-host-disease-free event-free survival in Fanconi anaemia patients undergoing matched related- and unrelated-donor bone marrow transplantation using alemtuzumab-Flu-Cy: the UK experience.

Haematopoietic stem cell transplantation (HSCT) remains the only curative option in Fanconi anaemia (FA). We analysed the outcome of children transplanted for FA between 1999 and 2018 in the UK. A total of 94 transplants were performed in 82 patients. Among the donors, 51·2% were matched related donors (MRD) while the remainder were alternative donors. Most patients received a fludarabine-cyclophosphamide (Flu-Cy)-based conditioning regimen (86·6%) and in vivo T-cell depletion with alemtuzumab (69·5%). Five-year overall survival (OS) was 85·4% [70·4-93.2] with MRD, 95·7% [72·9-99.4] with matched unrelated donors (MUD), 44·4% [6·6-78.5] with mismatched unrelated donors (MMUD) and 44·4% [13·6-71.9] with mismatched related donors (MMRD) (P < 0·001). Other factors significantly impacting OS were pre-transplant bone marrow status, source of stem cells, cytomegalovirus (CMV) serostatus, preparation with Flu-Cy, use of total body irradiation (TBI) and alemtuzumab as serotherapy. In multivariate analysis, absence of myelodysplastic syndrome (MDS) or leukaemia, bone marrow as source of stem cells, cytomegalovirus (CMV) other than +/- (Recipient/Donor) and Flu-Cy were protective factors for five-year OS. Five-year chronic graft-versus-host-disease (cGVHD)-free event-free survival was 75·4% with the same risk factors except for CMV serostatus. Five-year non-relapse mortality was 13·8% [7·3-22.3]. Only five patients (6·1%) developed grade II-IV acute GVHD and two patients chronic GVHD. These data confirm the excellent outcome of matched related or unrelated HSCT in children with FA.

Interferometric Constraints on Spacelike Coherent Rotational Fluctuations.

Precision measurements are reported of the cross-spectrum of rotationally induced differential position displacements in a pair of colocated 39 m long, high-power Michelson interferometers. One arm of each interferometer is bent 90° near its midpoint to obtain sensitivity to rotations about an axis normal to the plane of the instrument. The instrument achieves quantum-limited sensing of spatially correlated signals in a broad frequency band extending beyond the 3.9-MHz inverse light travel time of the apparatus. For stationary signals with bandwidth Δf>10 kHz, the sensitivity to rotation-induced strain h of classical or exotic origin surpasses CSD_{δh}

Simulation and calibration of a compact millimeter-wavelength Fourier transform spectrometer.

This paper presents the simulation and calibration of a Fourier transform spectrometer (FTS) developed to measure the spectrum of radiation sources between 50 GHz and 330 GHz, such as the cosmic microwave background. The recorded signal is modified from the ideal by properties of the interferometer and the detection system. We have developed a ray-trace-based simulation with which we can model these effects. The model can be verified with measurements and used to understand the instrument's systematic effects and to design new optimized configurations. The optimization comprises parameters of the design, such as large étendu, maximal spectral resolution, compact size, operational simplicity, and light weight, that conflict and need to be balanced. The numerical simulation consists of two parts: time-stream signal analysis and a ray-trace-based simulation that includes polarization and path length calculations and can account for the effects of beam loss and change of focus as the delay-generating mirror travels on its path. The simulation can study the coherence level and frequency resolution of the FTS instrument. While not exercised in this study, the simulation also can be used to study the effect of mirror figure and polarizer non-idealities, walk-off rays in the beam due to the large étendu, as well as misalignment of optical elements. We then present the comparison between simulations of a spectrally unresolved source and measurements by the FTS.

[COVID pandemic in accommodation facilities for dependent elderly]. / Pandémie de Covid dans les Ehpad.

During the coronavirus outbreak, accommodation facilities for dependent elderly (Ehpad) had to adapt quickly to an unknown and dangerous situation for residents, putting all the resources of these places to the test. Caregivers faced clinical and organizational emergencies with the coordinating doctors and nurse, going through different individual and collective phases. The directors, who are legally responsible for Ehpad, had to make room for the "we", anticipate, apprehend and evaluate the crisis but also deal with paradoxical recommendations.

Compact millimeter-wavelength Fourier-transform spectrometer.

We have constructed a Fourier-transform spectrometer (FTS) operating between 50 GHz and 330 GHz with minimum volume (355×260×64 mm) and weight (5.9 kg) while maximizing optical throughput (100 mm2 sr) and optimizing the spectral resolution (4 GHz). This FTS is designed as a polarizing Martin-Puplett interferometer with unobstructed input and output in which both input polarizations undergo interference. The instrument construction is simple with mirrors milled on the box walls and one motorized stage as the single moving element. We characterize the performance of the FTS, compare the measurements to an optical simulation, and discuss features that relate to details of the FTS design. The simulation is also used to determine the tolerance of optical alignments for the required specifications. We detail the FTS mechanical design and provide the control software as well as the analysis code online.

First Measurements of High Frequency Cross-Spectra from a Pair of Large Michelson Interferometers.

Measurements are reported of the cross-correlation of spectra of differential position signals from the Fermilab Holometer, a pair of colocated 39 m long, high power Michelson interferometers with flat broadband frequency response in the MHz range. The instrument obtains sensitivity to high frequency correlated signals far exceeding any previous measurement in a broad frequency band extending beyond the 3.8 MHz inverse light-crossing time of the apparatus. The dominant but uncorrelated shot noise is averaged down over 2×10^{8} independent spectral measurements with 381 Hz frequency resolution to obtain 2.1×10^{-20}m/sqrt[Hz] sensitivity to stationary signals. For signal bandwidths Δf>11 kHz, the sensitivity to strain h or shear power spectral density of classical or exotic origin surpasses a milestone PSD_{δh}

Clinical practice and barriers among Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction: A survey of pre-operative rehabilitation to return to sport.

OBJECTIVES: To investigate current clinical practice of Swiss physiotherapists treating patients with anterior cruciate ligament reconstruction (ACLR) from pre-operative rehabilitation until return to sport (RTS). We assessed optimisation strategies in daily practice and the perceived barriers to these optimisations, and evaluated whether there was a relevant difference in clinical practice for physiotherapists with post-graduate certification in sports physiotherapy or deep clinical experience and those without such experience. DESIGN: Cross-sectional survey. SETTING: Online survey platform. PARTICIPANTS: Swiss physiotherapists. MAIN OUTCOME MEASURES: The survey comprised six sections: participant information, pre-operative rehabilitation, post-operative rehabilitation, RTS, re-injury prevention, and optimisation strategies and barriers. RESULTS: A minority of physiotherapists treated ACLR patients pre-operatively. Overall, 91% included quadriceps open kinetic chain exercise in their treatment, 37% used patient-reported outcomes measures (PROMs) and 39% considered psychological criteria when making decisions about RTS. Most physiotherapists (67%) felt limited due to the time available, the number of prescriptions and the tariffication system. CONCLUSION: This study highlights areas within ACLR rehabilitation practice in Switzerland that could be improve. Improvements in understanding of the barriers to implementation of best evidence in practice and a redefinition of the clinical process around ACLR rehabilitation in Switzerland are necessary.

Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses-Results of a Prospective Cohort Study.

This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients' general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts.

Coverage-dependent adsorption geometry of octithiophene on Au(111).

The adsorption behavior of α-octithiophene (8T) on the Au(111) surface as a function of 8T coverage has been studied with low-temperature scanning tunneling microscopy, high resolution electron energy loss spectroscopy as well as with angle-resolved two-photon photoemission and ultraviolet photoemission spectroscopy. In the sub-monolayer regime 8T adopts a flat-lying adsorption geometry. Upon reaching the monolayer coverage the orientation of 8T molecules changes towards a tilted configuration, with the long molecular axis parallel to the surface plane, facilitating attractive intermolecular π-π-interactions. The photoemission intensity from the highest occupied molecular orbitals (HOMO and HOMO - 1) possesses a strong dependence on the adsorption geometry due to the direction of the involved transition dipole moment for the respective photoemission process. The change in molecular orientation as a function of coverage in the first molecular layer mirrors the delicate balance between intermolecular and molecule/substrate interactions. Fine tuning of these interactions opens up the possibility to control the molecular structure and accordingly the desirable functionality.

The impact of evidence: evolving therapy for acute ischemic stroke in a large healthcare system.

BACKGROUND: With a recent surge of clinical trials, the treatment of ischemic stroke has undergone dramatic changes. OBJECTIVE: To evaluate the impact of evidence and a revamped stroke protocol on a large healthcare system. METHODS: A retrospective review of 69 patients with ischemic stroke treated with intra-arterial therapy was carried out. Cohort 1 included patients treated before implementation of a new stroke protocol, and cohort 2 after implementation. Angiographic outcome was graded using the Thrombolysis in Cerebral Infarction (TICI) score. Clinical outcomes were assessed using the National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). RESULTS: Primary outcomes comparing cohorts demonstrated decreased arrival-to-puncture time (cohort 2: 104 vs cohort 1: 181 min, p<0.001), similar TICI 2b/3 rates (86.5% vs 81.3%, p=0.5530), and similar percentage of patients with discharge mRS 0-2 (18.9% vs 21.9%, p=0.7740). Notable secondary outcomes for cohort 2 included decreased puncture-to-first pass time (34 vs 53 min, p <0.001), increased TICI 3 rates (37.8% vs 18.8%, p=0.0290), a trend toward greater improvements in NIHSS on postoperative day 1 (6.8 vs 2.6, p=0.0980) and discharge (9.5 vs 6.7, p=0.1130), and a trend toward increased percentage of patients discharged with mRS 0-3 (48.6% vs 34.4%, p=0.3280 NS). There were similar rates of symptomatic intracerebral hemorrhage (10.8% vs 9.4%, p=0.9570) and death (10.8% vs 15.6%, p=0.5530). CONCLUSIONS: An interdisciplinary and rapid response to the emergence of strong clinical evidence can result in dramatic changes in a large healthcare system.

Down-regulation of BRCA1 in chronic pancreatitis and sporadic pancreatic adenocarcinoma.

PURPOSE: BRCA1 and BRCA2 are considered to be breast cancer susceptibility genes that may also contribute to pancreatic cancer development because family studies revealed mutation carriers to have an increased risk of developing pancreatic cancer. However, as demonstrated for breast and ovarian cancer, inactivation of BRCA in sporadic diseases is based on alteration in gene expression or functional alteration. EXPERIMENTAL DESIGN: To study a potential correlation of BRCA1 and BRCA2 to chronic pancreatitis and development of sporadic pancreatic adenocarcinoma, we have analyzed the expression of these genes by quantitative PCR and performed immunohistochemical analyses in normal pancreatic tissues, chronic pancreatitis, and pancreatic cancer specimens. RESULTS: BRCA1 expression was down-regulated in chronic alcoholic pancreatitis, in particular on the RNA level. Furthermore, our data indicate suppressed BRCA1 expression in pancreatic cancer on both the RNA and protein levels. Quantitative analysis of BRCA1 protein expression demonstrated regular staining in 50% of tumor specimens tested and reduced staining in 50% of tumor specimens tested. Correlation with the clinical outcome revealed a significantly better 1-year overall survival for patients with BRCA1-regular as compared with BRCA1-reduced or BRCA1-absent tumors. In contrast, no substantial differences in BRCA2 expression were found in chronic pancreatitis and pancreatic cancer samples. CONCLUSIONS: Our data demonstrate alteration of BRCA1 expression in chronic pancreatitis and sporadic pancreatic adenocarcinoma. We, for the first time, provide evidence for a role of BRCA1 in pancreatic carcinogenesis of noninherited tumors and for clinical outcome.

Imine derivatives on Au(111): evidence for "inverted" thermal isomerization.

Molecules that undergo reversible isomerization between trans and cis states, typically upon illumination with light at appropriate wavelengths, represent an important class of molecular switches. In this combined scanning tunneling microscopy (STM) and high-resolution electron energy loss spectroscopy (HREELS) study, we report on self-assembled arrays of imine derivatives on a Au(111) surface. Most of the molecules are found in the trans state after deposition at room temperature, but many of them change their conformation upon heating, which we assign to switching to the cis state. As for many molecular switches, the trans isomer is the energetically more stable compound in solution, resulting in thermal cis to trans relaxation upon sufficient heating. On the surface, however, the number of cis isomers increases with temperature, pointing toward an "inverted" thermal isomerization behavior. The reason for this surface-mediated effect could be a stronger coupling, as compared to the trans state, of the central imine part of the molecule to the gold surface, which is sterically only possible in the cis state.

Primordial gravitational waves and cosmology.

The observation of primordial gravitational waves could provide a new and unique window on the earliest moments in the history of the universe and on possible new physics at energies many orders of magnitude beyond those accessible at particle accelerators. Such waves might be detectable soon, in current or planned satellite experiments that will probe for characteristic imprints in the polarization of the cosmic microwave background, or later with direct space-based interferometers. A positive detection could provide definitive evidence for inflation in the early universe and would constrain new physics from the grand unification scale to the Planck scale.

Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes.

OBJECTIVE: To investigate the results of surgical treatment on athletes presenting with chronic symphysis syndrome (lower abdominal, groin, and adductor pain). DESIGN: Retrospective nonrandomized study. SETTING: Swiss Olympic Medical Center associated with Institute of Sports Sciences. PATIENTS: Twenty-four athletes who were treated for chronic symphysis syndrome, a combination of abdominal, groin, and adductor pain, were evaluated for an average of 6.6 years after surgery. All athletes were males, with a mean age of 25.8 years. The average duration of chronic symptoms was 17 months. INTERVENTIONS: Of patients, 20 underwent spreading of the lateral border of the sheath of the rectus abdominis muscle together with an epimysial adductor release, and 4 had only the reconstruction of the rectus abdominis muscle. MAIN OUTCOME MEASURES: Subjective (questionnaire) and objective (clinical examination) follow-up data using point scores were obtained at a mean of 6.6 years posttreatment. RESULTS: The mean point score in the subjective overall rating was 10.2 (maximum 12) and in the objective rating was 12.0 (maximum 13). Of athletes, 21 were very content, 2 were content, and 1 was not content. Full sports activity was noted in 23 of 24 athletes. CONCLUSIONS: Surgical treatment of chronic symphysis syndrome is successful and can salvage the career of athletes.