Six months after Maria: A post-hurricane examination of mental health and associated risk factors in older Puerto Ricans.

Following Hurricanes Irma and Maria in September 2017, there were elevated rates of depression and suicide in Puerto Rico. This study evaluates mental health in older and elderly Puerto Ricans 6 months after the hurricanes and suggests strategies for improving future psychosocial responses. Patients attending clinics were evaluated for depression (Patient Health Questionnaire [PHQ-9]) and suicide risk (Ask Suicide-Screening Questions [ASQ]) and were surveyed about their perceived safety, designated as a proxy for anxiety. Used in conjunction, PHQ-9 and ASQ were found to identify a greater proportion of individuals experiencing adverse mental health effects than if each instrument was used in isolation. Patients were also surveyed about time to water and electricity restoration, and it was found that prolonged time to water restoration was associated with increased prevalence and severity of depression and decreased perceived safety. Based on collected patient data (n = 523), using multiple mental health screening tools for diagnosis, improving perceptions of home safety or anxiety, and prioritizing water restoration may reduce mental health sequelae in the elderly and enhance the effect of psychosocial responses following disasters.

Gene expression profiling in Helicobacter-induced MALT lymphoma with reference to antigen drive and protective immunization.

We have previously shown that long-term infection of BALB/c mice with gastric Helicobacter species results in the development of histopathological lesions that resemble those seen in patients diagnosed with gastric mucosa associated lymphoid tissue (MALT) lymphoma. This paper describes analysis of this disease at the molecular level through the use of microarray technology and immunohistochemical staining. We were able to monitor the genetic changes in the gastric mucosa characterized by distinct transcriptional signatures and correlate these with histological changes as the infection progressed from a chronic inflammatory infiltrate through to MALT lymphoma. This model system also enabled us to further dissect the role of antigen presentation and prophylactic immunization in the disease process. Antimicrobial therapy to eradicate the antigen correlated with significant reduction in pathology and major changes in the gene expression profile. Subsequent reintroduction of the antigen resulted in rapid tumor development which correlated with an increase in aggressively proliferating cells and changes in the cellular composition of the tumor. The response in vaccinated animals showed that the protected animals exhibited a strikingly different transcriptional profile compared to those of non-protected or control mice, indicating that the vaccination targeted the appropriate site leaving a long-lasting signature. The genes which were most significantly up-regulated included a number of adipocyte-specific factors, such as fat-cell specific cytokines and adipocyte surface markers. This study allowed for us to highlight the significance of antigen presentation in this disease and to hypothesis mechanisms associated with protective immunity.

Urea, fluorofamide, and omeprazole treatments alter helicobacter colonization in the mouse gastric mucosa.

BACKGROUND: Helicobacter pylori is a causative agent of gastric and duodenal ulcers and gastric cancer. Its urease enzyme allows survival in acid conditions and drives bacterial intracellular metabolism. We aimed to investigate the role of urease in determining the intragastric distribution of Helicobacter species in vivo. MATERIALS AND METHODS: The C57BL/6 mouse model of gastritis was used for infection with Helicobacter felis (CS1) or H. pylori (SS1). Urease-modulating compounds urea and/or fluorofamide (urease inhibitor) were administered to mice over 7 days. Concurrent gastric acid inhibition by omeprazole was also examined. Bacterial distribution in the antrum, body, antrum/body, and body/cardia transitional zones was graded "blindly" by histologic evaluation. Bacterial colony counts on corresponding tissue were also conducted. RESULTS: Urease inhibition by fluorofamide decreased H. pylori survival in most gastric regions (p < .05); however, there were no marked changes to H. felis colonization after this treatment. There was a consistent trend for decreased antral colonization, and an increase in antrum/body transitional zone and body colonization with excess 5% or 6% (w/v) urea treatment. Significant reductions of both Helicobacter species were observed with the co-treatment of urea and fluorofamide (p < .05). Collateral treatment with omeprazole did not alter H. pylori colonization patterns caused by urea/fluorofamide. CONCLUSIONS: Urease perturbations affect colonization patterns of Helicobacter species. Combined urea and fluorofamide treatment reduced the density of both Helicobacter species in our infection model.

Mucispirillum schaedleri gen. nov., sp. nov., a spiral-shaped bacterium colonizing the mucus layer of the gastrointestinal tract of laboratory rodents.

The mammalian gastrointestinal tract is covered by a layer of mucus that can harbour a range of bacterial species specifically adapted to colonize this ecological niche. Examination of 110 bacterial isolates cultivated from the gastrointestinal tract of 23 mice revealed the presence of a subgroup of 30 isolates that did not correspond genetically with genera commonly associated with this site, i.e. members of the epsilon-Proteobacteria such as Helicobacter and Campylobacter species. Instead this group of isolates was found to lie within the phylum Deferribacteres, a completely distinct lineage in the domain Bacteria. There was a high level of consensus in results obtained from the phenotypic and genotypic characterization of a number of the isolates, which showed they were distinct from other members of the Deferribacteres. As such, they are proposed to constitute a new genus and species, Mucispirillum schaedleri gen. nov., sp. nov. These organisms are anaerobic, Gram-negative, spiral-shaped rods with bipolar flagella. The type strain is HRI I17(T) (= ATCC BAA-1009(T) = ACM 5223(T)).

Description of 'Candidatus Helicobacter heilmannii' based on DNA sequence analysis of 16S rRNA and urease genes.

While Helicobacter pylori is accepted as the major bacterial agent of gastric disease in humans, some patients and many animals are infected with a larger, tightly helical-shaped bacterium previously referred to as 'Helicobacter heilmannii' or 'Gastrospirillum hominis'. Taxonomic classification of these bacteria has been hampered by the inability to cultivate them in vitro and by the inadequate discriminatory power of 16S rRNA gene sequence analysis. This study describes the detection and phylogenetic analysis of 26 different gastrospirillum isolates from humans and animals, which incorporates sequence data based on the 16S rRNA and urease genes. Fifteen gastrospirilla detected in humans, primates and pigs clustered with 'Candidatus Helicobacter suis', thus expanding the host range for this organism. By comparison, based on 16S rRNA data, the remaining 11 gastrospirilla could not be differentiated from Helicobacter felis, Helicobacter bizzozeronii and Helicobacter salomonis. However, urease gene sequence analysis allowed for the discrimination of this latter group into four discrete clusters, three of which contained the above recognized species. The fourth cluster contained isolates from human and feline hosts, and should provisionally be considered a unique bacterial species, for which the name 'Candidatus Helicobacter heilmannii' is proposed.

Chronic Helicobacter pylori infection with Sydney strain 1 and a newly identified mouse-adapted strain (Sydney strain 2000) in C57BL/6 and BALB/c mice.

The mouse model of Helicobacter pylori-induced disease using Sydney strain 1 (SS1) has been used extensively in Helicobacter research. Herein we describe the isolation and characterization of a new mouse-colonizing strain for use in comparative studies. One strain capable of persistent mouse colonization was isolated from a total of 110 clinical isolates and is named here SS2000 (Sydney strain 2000). Genome typing revealed a number of differences between SS1 and SS2000 as well as between them and the respective original clinical isolates. In particular, SS2000 lacked the entire cag pathogenicity island, while SS1 contained all 27 genes of the island. C57BL/6 and BALB/c mice were infected with SS1 or SS2000 or were treated with broth medium (controls). After 6 months host-specific effects were evident, including lower colonization levels in the BALB/c animals. Few pathological differences were observed between SS1- and SS2000-infected animals. However, by 15 months postinfection, SS1-infected C57BL/6 mice had developed more severe gastritis than the SS2000-infected animals. In contrast SS2000-infected BALB/c mice showed increased accumulation of mucosa-associated lymphoid tissue compared to those infected with SS1. This improved comparative model of H. pylori-induced disease allowed dissection of both host and strain effects and thus will prove useful in further studies.

Gastric transitional zones, areas where Helicobacter treatment fails: results of a treatment trial using the Sydney strain mouse model.

Current combination therapies cure Helicobacter pylori infection in 75 to 85% of cases. However, many treatment failures are not explained by antibiotic resistance. Our goal was to explore treatment failures under in vivo conditions by using the H. pylori Sydney strain (SS1) mouse model. Mice infected with H. pylori (SS1) were treated with monotherapies or combination therapies used in human trials. Bacterial levels and distribution of organisms within the stomach were assessed 24 h after treatment to determine clearance and location of treatment failures and 29 days after treatment to determine cure rates. Except for treatment with metronidazole, mono- and dual therapies did not cure infection but resulted in decreases in bacterial levels and differences in distribution within the stomach. In cases of treatment failure when clarithromycin was used, omeprazole and dual therapy with omeprazole and amoxicillin resulted in organisms being cleared from the antrum, but organisms remained in the antrum-body transitional zone. The triple therapies of OMC and bismuth subcitrate, metronidazole, and tetracycline were successful in eradicating infection. Except for metronidazole monotherapy and triple therapy with OAC, there was good correlation between the Sydney strain mouse model and humans with respect to the success of antimicrobial therapy. The antrum-body transitional zone was identified as a sanctuary site in treatment failure. This could result from antimicrobial agents not functioning effectively at this site or bacteria in this location expressing products that protect them against antimicrobial agents. This is the first demonstration of a possible sanctuary site as a reason for failure of therapy.

Animal models of Helicobacter pylori infection and disease.

The acceptance of Helicobacter pylori as a major human pathogen has necessitated the development of animal models to help elucidate the pathogenic mechanisms of this bacterium and aid in the development of improved strategies for the treatment of gastric disease. Appropriate models, utilising a range of animal species, have been developed to examine factors such as the influence of host responses and bacterial factors in disease development and the success of new therapeutic regimens, including vaccination, to cure infection.

[Management and treatment results for acute slipped capital femoral epiphysis]. / Therapieregime und Ergebnisse bei der Epiphyseolysis capitis femoris juvenilis acuta.

The priorities in treating an acute slip are to avoid avascular necrosis and chondrolysis. Other aims in the unstable situation are to prevent further slip and to correct deformity. We reviewed the management of 16 unstable slips after nearly 9 years. Fifteen patients underwent reduction and stabilization with K wires within 24 h of the onset of severe symptoms. Only one patient in this group developed avascular necrosis (6.6%) and in no case was chondrolysis seen. No correlation was noted between slip magnitude and the development of avascular necrosis. Therefore, we recommend in cases of unstable slips early reduction and stabilization to reduce the risk of avascular necrosis and chondrolysis.

[Significance and results of subcapital osteotomy in severe slipped capital femoral epiphysis]. / Stellenwert und Ergebnisse der subkapitalen Osteotomie bei der Epiphyseolysis capitis femoris lenta mit hochgradigem Abrutsch der Epiphyse.

Today treatment with in situ fixation for mild slips in chronic SCFE is undisputed. However, it is far more difficult to give a definite recommendation in cases where a severe dorsal slip of >70 degrees has already occurred. With this position of the femoral head, a severe functional deficit combined with an early onset of osteoarthritis has to be expected. With these severe slips we prefer the subcapital osteotomy, a technique which results in an almost normal anatomical alignment of femoral head and acetabulum. In the literature, this procedure is subject to controversy because of the relatively high incidence of avascular necrosis and chondrolysis. In our own small collective of five patients, we did not observe these complications in the postoperative follow-up and the clinical results were excellent. After 8.5 years the Iowa score was a mean of 91.8 points. Only one patient showed radiological signs of grade I osteoarthritis; the follow-up interval was, however, relatively short.

[Results of treating slipped capital femoral epiphysis by pinning in situ]. / Therapieergebnisse der In- situ-Spickung bei der Epiphyseolysis capitis femoris juvenilis lenta.

The primary aim in treatment of chronic SCFE consists of immediate stabilization of the epiphysis to prevent further slipping. For mild degrees of slipping (<30 degrees ), pinning in situ is the treatment of choice. With slips between 30 and 50 degrees, the decision should be based on individual factors (age, functional limitation of the hip joint) whether pinning in situ is sufficient or whether an additional intertrochanteric osteotomy according to Imhäuser should be performed.The choice of implant should ensure a safe and stable connection between the epiphysis and the femoral neck without resulting in a substantial impairment of growth of the femoral neck due to premature closure of the growth plate. Since 1982 we have used K wires for in situ pinning of the affected hip as well as for prophylactic pinning of the nonaffected hip with a low complication rate. In a clinical and radiological study, 65 patients with a chronic slip of less than 50 degrees could be assessed after in situ pinning. Almost 75% were pain-free after a follow-up interval of 9.8 years, and 92% achieved a good or very good result according to the criteria of the Iowa hip score, the mean score being 95.1 points. According to the radiological score of Schulitz, five patients (7.7%) demonstrated a grade I osteoarthritis. One patient showed a partial necrosis of the femoral head; chondrolysis was not observed.

Mid-term results of the cementless CLS stem. A 7- to 11-year follow-up study.

Between 1986 and 1990, 335 primary total hip arthroplasty (THA) were performed using the cementless CLS stem. The mean age at surgery was 55.3 years. The retrospective study was performed at an average follow-up time of 8.9 years. A total of 232 patients (69.3%) underwent clinical and radiological examination, 33 patients (9.9%) were interviewed by telephone, and 9 stems (2.7%) had been replaced meanwhile. The mean Harris hip score was 91.7 points, and the mean Merle D'Aubigne score was 16.8 points. One stem had subsided during the first postoperative year. Ectopic ossifications classified as Brooker III were noted in 5.7%, with no Brooker IV being seen. Radiolucent lines were found in 43.5%, and 11% showed enlargement with time. Focal osteolyses were present in 36%, of which 24% progressed with time. At the latest follow-up, we did not find any stem loosening clinically or radiologically.

[Long-term results with the cement-free Spotorno CLS shaft]. / Langzeitergebnisse mit dem zementfreien CLS-Schaft von Spotorno.

This retrospective study reviews 298 sequential cementless CLS Spotorno stems, which achieved their primary fixation and bony in- or ongrowth predominantly in the metaphyseal region. The minimum follow-up was 10 years and the average follow-up 11.7 years (range 10-14). The mean age at surgery was 55.2 years (range 32.2-68.9). Of the patients, 76.2% (227 stems) were followed up: 172 patients (57.7%) underwent clinical and radiological examination and 52 patients (55 stems, 18.5%) were interviewed by telephone. Of 298 stems, 13 (4.4%) had been replaced in the mean time, only 6 stems (2.0%) because of an aseptic loosening. The evaluation included both clinical (Merle d'Aubigne and Harris hip score) and radiographic parameters (plain X-rays). The mean Merle d'Aubigne score was 16.7 points, and the mean Harris hip score was 94.3 points. Radiolucent lines were detected in 33.7%; 5.8% showed enlargement within the last 3 years. Focal osteolyses were present in 30.8% of patients; 2.9% had progressed within the last 3 years. At follow-up, one patient presented with new clinical and radiological evidence of aseptic stem loosening. The current study showed an aseptic loosening of the CLS stem in 2.3%, a good osseointegration and good functional score results in more than 90%. The primary fixation and bony in- or ongrowth predominantly in the metaphyseal region seems to achieve good clinical results. Wear is the main reason for the osteolytic changes. Frequent clinical and radiological follow-up is important to detect bone reactions and loosening of the stem.

[Mannheim concept of preoperative autologous blood donation and perioperative autologous blood transfusion in hip endoprosthesis surgery]. / Mannheimer Konzept der präoperativen Eigenblutspende und perioperativen Autotransfusion in der Hüftendoprothetik.

PURPOSE: To investigate the efficiency of preoperative autologous deposit and intra- and postoperative cell salvage (CS) to reduce homologous transfusion in hip arthroplasty and revision hip arthroplasty. METHODS: In a retrospective study, the data of 1402 patients scheduled for hip arthroplasty and for revision hip arthroplasty were analysed. RESULTS: 767 women and 635 men, age 62.9 +/- 9.8 years (x +/- s) were included in the study. 1270 were scheduled for hip arthroplasty, 132 for revision hip arthroplasty. Of the autologous donors, 51 patients predeposited four units, 1020 patients three, 204 patients two, 39 patients one unit. 88 patients who had not enrolled in the autologous donation program but received CS served as a control group. Blood loss in autologous donors amounted to 1620 (220-5620) ml in hip arthroplasty and 2830 (950-7910) ml in revision arthroplasty. CS was employed in part of the cases in arthroplasty and in all revision operations. 470 (0-2200) ml and 705 (0-2200) were retransfused. In hip arthroplasty 227 of 1182 patients (19.2%) received homologous blood. Homologous transfusion in patients with coxarthrosis due to acetabular protrusio, avascular necrosis of the femoral head and hip dysplasia showed a trend to higher values. Patients who had donated 3 units and received CS required homologous transfusion in 12.4% of the cases. CS reduced the homolgous transfusion rate significantly if the preoperative hemoglobin concentration was < or = 12 g/dl. A group of autologous donors receiving CS was matched with patients receiving CS only. 12 of 76 (15.8%) vs. 45 of 76 (59.2%) required homologous transfusion. In revision hip arthroplasty 58 of 132 patients (43.9%) required homologous blood. CONCLUSIONS: Preoperative deposit reduces homologous transfusion requirements considerably in hip surgery. Under the conditions studied CS should be employed in hip arthroplasty in addition to preoperative deposit if the preoperative hemoglobin concentration falls below 12 g/dl. In revision arthroplasty, 4 or more autologous units should be predeposited and CS should be used regularly.

[A new standard method for experimental for measuring cement coat strength in endoprosthesis implantation]. / Eine neue Standardmethode zur experimentellen Vermessung der Zementmantelstärke in der Endoprothetik.

The distribution of bone cement around an endoprosthesis influences its stability over the long term. We have developed a new method for the experimental measurement of the cement mantle thickness of an endoprosthesis. The use of this computer-aided procedure is described in a hip prosthesis. Transverse sections of a human femur containing a cemented stem were prepared, recorded with a CCD camera and the images fed into a computer. The image-processing software differentiated the metal and bone cement on the basis of the different colours. Radial lines were drawn from the calculated centre of gravity of the stem, and the cement thickness was measured automatically along these lines. In our experiment, the accuracy of the method was 0.2 mm. This method of measuring the thickness of the cement mantle is accurate, rapid and practical.

[Simulator for migration processes and wear in the artificial hip acetabulum for radiologic measurement]. / Simulator für Wanderungsvorgänge und Abrieb bei künstlichen Hüftpfannen zur radiologischen Vermessung.

For assessing migration of cups, standard X-rays or stereo radiological images (SRI) are available. In addition, software is also available for measurements. The accuracies of the various systems are established statistically, in part combined with phantoms, and compared. To date, no known phantom is available for the simulation of acetabular cup migration with account being taken of the position of the pelvis in the X-ray beam. Such an appliance covering 8 different parameters has now been developed, the cup can be moved horizontally, vertically and in the loading direction. Angular accuracy is +/- 0.5 degree, and wear of a magnitude of 0.25 mm can be simulated. Two degree elevation of the pelvis, left or right, can be simulated. The position of the pelvis around the horizontal axis permits continuous variation. This appliance can simulate migratory movements of the acetabular cup within a pelvis, and wear within the cup. In addition, the spatial position of the pelvis can be varied. The X-ray images can be used to investigate the accuracy of evaluation strategies.

[Osseontegration of trial implants of carbon fiber reinforced plastics]. / Knöchernes Einwachsverhalten von Probekörpern aus kohlefaserverstärktem Kunststoff.

PROBLEM: To what extent are carbon fibre-reinforced plastics (CFRP) suitable as an osseous integration surface for implants? METHOD: CFRP test implants having a plexus-structured, rhombus-structured, and plexus-structured, hydroxyapatite surface were implanted in the femura of mini-plgs. Exposure time lasted 12 weeks. The implants were subjected to a macroradiological, a histological-histomorphometrical, and a fluorescence-microscopical evaluation. RESULTS: One half of the uncoated, plexus-structured implants were not osteointegrated, the other half displayed an osteointegration rate of 11.8% in the spongy area and 29.8% in the cortex layer. The HA-coated test implants showed an osteointegration of 29.5% in the spongiosa and 56.8% in the cortex layer. The rhombus-structured test implants had an osteointegration of 29.2% (spongiosa) and 46.2% (cortex layer). CONCLUSION: Compared to the osteointegration of metallic, especially titanium surfaces the CFRP surfaces tested by us fared worse, especially the uncoated, plexus-structured surfaces. For this reason we view very critically the use of carbon-fibre reinforced plastics together with the surfaces tested by us as osteointegrating surfaces.

[Guidelines in orthopedics. Alliance of German Orthopedists. University Clinic of Orthopedics, Heidelberg]. / Leitlinien in der Orthopädie. Ein erster Schritt.

Guidelines are systematically developed statements of the actual knowledge in order to assist doctors and patients by the decision of appropriate health care. Since 1998 the DGOT has published 22 well structured guidelines, 20 guidelines are under construction. The AWMF as the coordinator of guideline constructing of all scientific medical societies has published 629 guidelines since 1995. The publication of guidelines of the DGOT and the BVO is the first step for dissemination, next steps should be implementation und evaluation. Then it will be evident whether change in medical practice will occur.

Simulator trials to determine the wear of the combination aluminium oxide ceramic-carbon fibre reinforced plastic (CFRP) used as an insert in a hip socket.

Hip simulator trials were conducted to determine the initial wear between alumina femoral heads and carbon fibre reinforced plastic (CFRP, CAPROMAN) insert in a titanium socket. A force of 2500 N and a frequency of 0.857 H were applied. Using surface and sphericity measurement techniques, the amount of wear was determined. After 500,000 cycles, the centre of the head had moved by 10 microm into the insert, and the average radius increased by 2 microm. After 1 million cycles, the additional changes were less than 1 microm. Based on an examination of retrieved implants (wear rate: 6.1 microm/year) and based on the simulator results, the combination alumina-CFRP inserts could be approved for total hip replacement.