Is there any place for the variable angle proximal femoral plate? A case matched cohort study against the Dynamic Hip Screw system.

INTRODUCTION: The Variable angle Martin Plate (MP) is designed to offer patient-specific adaption for the treatment of intertrochanteric hip fractures. Its proposed benefits include optimization of lag screw placement, plate shaft congruence and reduced risk of failure. Often its use has been criticized as representing a poor reduction of the fracture. The purpose of this study was to assess for a poorer quality of reduction, and compare functional outcomes and mortality, using a MP to that of a fixed angle Dynamic Hip Screw (DHS) in a matched cohort of patients. METHODS: A retrospective review of a prospective fracture database system was undertaken between 1st January 2004 to 31st December 2013. MP patients were matched to a cohort of DHS patients. Outcomes measure were a quality of procedure score(QPS), 1-year mortality rates, reoperation rates, and Barthel Index functional outcome. Minimum follow up was 12 months. RESULTS: A total of 77 Martin Plate patients were identified and case matched. The mean pre- and post-op Neck Shaft Angle (NSA) in the MPs was significantly different (132.97±7.78 Vs 126±8.62; p<0.0001). Conversely, the mean pre op DHS NSA and the mean post op NSA was not (p=0.397). Mean Tip-Apex Distance (TAD) was significantly different between groups; MP mean 26.51±9.09mm vs DHS 23.50±8.14mm (p=0.023). The QPS consisted of 4 variables. A significant inverse relationship between QPS and the incidence of construct related complications exists. TAD>25mm, and a change in AP NSA of >5°conveyed the greatest risk of complications. No difference occurred in complications, nor 12-month mortality. CONCLUSIONS: No statistical difference was found in the quality of reduction between MP and DHS in this group of matched patients. QPS demonstrated a significant inverse correlation with implant-related complications. No significant difference was noted in the incidence of complications, Barthel Index functional scores, or 12-month mortality between implants. A rationale exists regarding the use of MPs, particularly in patients with varus NSA. However, planning and adequate reduction are essential regardless of implant choice.

The in vitro activity of daptomycin against Staphylococcus aureus and Enterococcus species.

OBJECTIVE: The purpose of this study was to examine the in vitro activity of daptomycin using an optimal calcium (Ca2+) concentration (50 mg/L) against a diverse collection of enterococcal and Staphylococcus aureus clinical isolates, including glycopeptide-resistant enterococci (GRE) and methicillin-resistant S. aureus (MRSA). METHODS: The activity of daptomycin was compared with the activities of seven other agents against 1483 enterococcal and S. aureus clinical isolates, including 303 GRE and 193 methicillin-resistant S. aureus (MRSA) strains. Susceptibility testing was performed by the NCCLS broth microdilution method, with one exception: Mueller-Hinton (MH) broth was supplemented to a physiological level of 50 mg/L Ca2+ when testing daptomycin. Daptomycin zone diameters were determined by disc diffusion with MH agar plates containing Ca2+ 50 mg/L. RESULTS: All staphylococcal isolates tested, and the majority of enterococcal isolates (96.5%), would be considered susceptible to daptomycin if the breakpoint previously proposed of or = 20 mm, and all of the enterococcal isolates had daptomycin zone diameters > or = 17 mm. CONCLUSIONS: Overall, daptomycin showed potent activity against S. aureus and enterococcal isolates, comparable to quinupristin-dalfopristin and linezolid.

Quantitative reflectometry--IV, determination of copper in nickel-plating solutions.

The determination of copper in nickel-plating solutions with commercial test-strips has been investigated. The rate of colour development, which is normally slow in the presence of high concentrations of foreign ions, has been speeded up by flushing sample solutions over the strips, rather than by immersion. Relative precision is 2.7-12% over the concentration range 2-25 ppm of copper. The accuracy of the reflectance method compares favourably with that of atomic-absorption spectrophotometry and is better than that of a visual colorimetric procedure involving dithizone.

Quantitative reflectometry-III: determination of protein in aqueous media.

The determination of protein in aqueous media by using commercial and laboratory-prepared test-strips has been investigated. Adsorption indicators of the Bromophenol Blue type form the basis of the colour-forming reaction, which is selective for natural protein. The relative precision of reflectance measurements is 1.7-5.7% over the concentration range 0.5-10 mg ml , for bovine serum albumin. The method would be suitable for the rapid determination of protein in urine and other body fluids.

Quantitative reflectometry-II Precision and interferences.

A detailed assessment of the precision of direct reflectance measurements has been made, using commercially available test-strips for nickel. The overall relative precision is 3.2-4.6% for the concentration range 10-100 ppm. The effect of interfering ions has been studied and the mechanism of interference discussed in terms of diffusion. Non-commercial test-strips have been prepared and compared with the commercial product.

Quantitative reflectometry-I Principles and scope.

The technique of quantitative reflectometry is critically investigated, the model being the quantitative determination of nickel in aqueous media. Direct reflectance measurements can be made on commercially available nickel test-strips which develop a pink or red colour in the presence of nickel ions. Relative precisions at the 10 and 50 ppm levels are 2.3-3.6%.

Improved synthesis of 8-mercaptoquinoline and its derivatives.

A rapid and simple synthesis of 8-mercaptoquinoline and some of its derivatives is described. High yields are easily obtained.