Evaluating the antimicrobial efficacy of long-lasting hand sanitizers on skin.

BACKGROUND: The microbicidal efficacy of hand sanitizer formulations is usually measured through standardized quantitative suspension tests and fingerpad tests; these cannot evaluate long-lasting formulations or are impractical due to biological risks, high cost, or time required for testing. With increased numbers of long-lasting microbicidal activity claims of commercially available hand sanitizers, alternative testing strategies are required. AIM: To explore the use of a standardized ex-vivo pig skin model to reproducibly measure long-lasting efficacy of an alcohol-free hand sanitizer formulation. METHODS: The microbicidal efficacy of an alcohol-free hand sanitizer was tested against Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, and the enveloped virus SARS-CoV-2 with quantitative suspension tests (EN13727 and EN14476) with a contact time of 5 min. The product was then tested over a 6 h period using an ex-vivo pig skin model with a modified version of PAS 2424 to simulate the impact of skin abrasion. FINDINGS: Quantitative suspension tests yielded a >5 log10 reduction for all organisms tested within a 5 min contact time. Pig skin tests showed reduced but consistent efficacy at all time points and indicated no significant impact of abrasion on efficacy. CONCLUSION: The use of the ex-vivo pig skin model provides a potentially viable and convenient model system to test long-lasting hand sanitizer formulations, providing a path for sustainable hand sanitizer formulation claims of activity on skin.

Bone infection: a clinical priority for clinicians, scientists and educators.

Bone infection has received increasing attention in recent years as one of the main outstanding clinical problems in orthopaedic-trauma surgery that has not been successfully addressed. In fact, infection may develop across a spectrum of patient types regardless of the level of perioperative management, including antibiotic prophylaxis. Some of the main unknown factors that may be involved, and the main targets for future intervention, include more accurate and less invasive diagnostic options, more thorough and accurate debridement protocols, and more potent and targeted antimicrobials. The underlying biology dominates the clinical management of bone infections, with features such as biofilm formation, osteolysis and vascularisation being particularly influential. Based on the persistence of this problem, an improved understanding of the basic biology is deemed necessary to enable innovation in the field. Furthermore, from the clinical side, better evidence, documentation and outreach will be required to translate these innovations to the patient. This review presents the findings and progress of the AO Trauma Clinical Priority Program on the topic of bone infection.

The effect of intestinal microbiota dysbiosis on growth and detection of carbapenemase-producing Enterobacterales within an in vitro gut model.

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) can colonize the gut and are of major clinical concern. Identification of CPE colonization is problematic; there is no gold-standard detection method, and the effects of antibiotic exposure and microbiota dysbiosis on detection are unknown. AIM: Based on a national survey we selected four CPE screening assays in common use. We used a clinically reflective in vitro model of human gut microbiota to investigate the performance of each test to detect three different CPE strains under different, clinically relevant antibiotic exposures. METHODS: Twelve gut models were seeded with a pooled faecal slurry and exposed to CPE either before, after, concomitant with, or in the absence of piperacillin-tazobactam (358 mg/L, 3 × daily, seven days). Total Enterobacterales and CPE populations were enumerated daily. Regular screening for CPE was performed using Cepheid Xpert® Carba-R molecular test, and with Brilliance™ CRE, Colorex™ mSuperCARBA and CHROMID® CARBA SMART agars. FINDINGS: Detection of CPE when the microbiota are intact is problematic. Antibiotic exposure disrupts microbiota populations and allows CPE proliferation, increasing detection. The performances of assays varied, particularly with respect to different CPE strains. The Cepheid assay performed better than the three agar methods for detecting a low level of CPE within an intact microbiota, although performance of all screening methods was comparable when CPE populations increased in a disrupted microbiota. CONCLUSION: CPE strains differed in their dynamics of colonization in an in vitro gut model and in their subsequent response to antibiotic exposure. This affected detection by molecular and screening methods, which has implications for the sensitivity of CPE screening in healthcare settings.

A murine femoral ostectomy model with hardware exchange to assess antibiotic-impregnated spacers for implant-associated osteomyelitis.

Implant-associated osteomyelitis is a chronic infection that complicates orthopaedic surgeries. Once infected, 50 % of patients suffer treatment failure, resulting in high healthcare costs. While various small animal models have been developed to investigate the efficacy of prophylactic and therapeutic treatments, the minute scale of murine-model bone and hardware has been prohibitive for evaluating interventions with a complete implant exchange in the setting of an infected critical defect. To address this, the aim of the present study was to develop a murine femur model in which an initial mid-diaphyseal infection was established by surgical implantation of a titanium screw contaminated with bioluminescent Staphylococcus aureus (Xen36). 7 d after the infection was established, an ostectomy was performed to remove the middle segment (3 mm flanking the infected screw hole) and a bone-cement spacer, with or without impregnated gentamicin, was secured with a plate and screws to fix the septic segmental defect. Longitudinal bioluminescent imaging revealed a significant decrease in Xen36 growth following one-stage revision, with the antibiotic-impregnated spacer treated systemically with vancomycin (p < 0.05). This result was corroborated by a significant decrease in colony forming units (CFU) recovered from spacer, bone, soft tissue and hardware 12 d post-operative (p < 0.05). However, ~ 105 CFU/g Xen36 still persisted within the bone despite a clinical therapeutic regimen. Therefore, the model enables the investigation of new therapeutic strategies to improve upon the current standard of care in a mouse model of implant-associated osteomyelitis that employs reconstruction of a critical defect.

Psychometric properties and validation of the Spanish versions of the overall anxiety and depression severity and impairment scales.

BACKGROUND: Anxiety and depressive disorders are the most frequent disorders for which patients seek care in public health settings in Spain. This study aimed at validating the Overall Anxiety Severity and Impairment Scale (OASIS) and the Overall Depression Severity and Impairment Scale (ODSIS), which are brief screening scales for anxiety and depression consisting of only five items each. METHODS: The study was conducted in a Spanish clinical sample receiving outpatient mental health treatment (N = 339). A subsample of participants (n = 219) was assessed before and after receiving a course of cognitive-behavioral treatment. RESULTS: The results revealed excellent internal consistency estimates (Cronbach's alpha for the OASIS and the ODSIS was 0.87 and 0.94, respectively), along with promising convergent and discriminant validity and test-criterion relationships (i.e., moderate correlation with other measures of depression and anxiety, as well as with neuroticism, quality of life, adjustment, and negative affect). A one-dimensional structure was obtained for the OASIS and the ODSIS. The ROC analyses indicated an area under the curve of 0.83 for the OASIS and the ODSIS when predicting moderate-to-severe anxiety and depression, respectively. Good sensitivity to therapeutic change was also evidence and the analysis of the sensitivity as a function of 1-specificity area suggested a cutoff value of 10 for both scales. LIMITATIONS: Inter-rater reliability of diagnoses with the ADIS-IV interview could not be investigated and the results obtained may not be generalizable to other samples and health settings. CONCLUSIONS: The availability of these two short and psychometrically sound measures should make screening of anxiety and depressive symptoms in routine care more feasible.

Strain as a Function of Time in Extrinsic Wrist Ligaments Tensioned Through External Fixation.

BACKGROUND: The objective of this study is to determine the time-dependent dissipation of extrinsic wrist ligament tension following the application external fixation with axial distraction of the wrist in a cadaveric model. METHODS: Six paired fresh-frozen cadaveric specimens underwent mechanical testing simulating external fixation with 1 arm of each pair osteotomized to simulate a distal radius fracture. The change in tension was then recorded over 24 hours. RESULTS: The rate of stress relaxation decreased with time. The average loss in tension in the control arms and osteotomized arms was 55% and 59%, respectively, over a 24-hour period. There was no statistically significant difference in the stress relaxation behavior between the 2 groups. CONCLUSION: This study further supports the recommendation that comminuted distal radius fractures treated with an external fixator should have Kirschner wire augmentation or other additional means of fixation to help maintain fracture length and alignment. The results of this study call in to question the efficacy of ligamentotaxis alone through external fixation as the sole means of maintaining reduction of displaced, unstable distal radius fractures.

Cationic disulfide-functionalized worm gels.

The recent development of polymerization-induced self-assembly (PISA) has facilitated the rational synthesis of a range of diblock copolymer worms, which hitherto could only be prepared via traditional post-polymerization processing in dilute solution. Herein we explore a new synthetic route to aqueous dispersions of cationic disulfide-functionalized worm gels. This is achieved via the PISA synthesis of poly[(glycerol monomethacrylate-stat-glycidyl methacrylate)]-block-poly(2-hydroxypropyl methacrylate) (P(GMA-stat-GlyMA)-PHPMA) block copolymer worms via reversible addition-fragmentation chain transfer (RAFT) aqueous dispersion polymerization of HPMA. A water-soluble reagent, cystamine, is then reacted with the pendent epoxy groups located within the P(GMA-stat-GlyMA) stabilizer chains to introduce disulfide functionality, while simultaneously conferring cationic character via formation of secondary amine groups. Moreover, systematic variation of the cystamine/epoxy molar ratio enables either chemically cross-linked worm gels or physical (linear) primary amine-functionalized disulfide-based worm gels to be obtained. These new worm gels were characterized using gel permeation chromatography, 1H NMR spectroscopy, transmission electron microscopy, dynamic light scattering, aqueous electrophoresis and rheology. In principle, such hydrogels may offer enhanced mucoadhesive properties.

Biological risk factors for suicidal behaviors: a meta-analysis.

Prior studies have proposed a wide range of potential biological risk factors for future suicidal behaviors. Although strong evidence exists for biological correlates of suicidal behaviors, it remains unclear if these correlates are also risk factors for suicidal behaviors. We performed a meta-analysis to integrate the existing literature on biological risk factors for suicidal behaviors and to determine their statistical significance. We conducted a systematic search of PubMed, PsycInfo and Google Scholar for studies that used a biological factor to predict either suicide attempt or death by suicide. Inclusion criteria included studies with at least one longitudinal analysis using a biological factor to predict either of these outcomes in any population through 2015. From an initial screen of 2541 studies we identified 94 cases. Random effects models were used for both meta-analyses and meta-regression. The combined effect of biological factors produced statistically significant but relatively weak prediction of suicide attempts (weighted mean odds ratio (wOR)=1.41; CI: 1.09-1.81) and suicide death (wOR=1.28; CI: 1.13-1.45). After accounting for publication bias, prediction was nonsignificant for both suicide attempts and suicide death. Only two factors remained significant after accounting for publication bias-cytokines (wOR=2.87; CI: 1.40-5.93) and low levels of fish oil nutrients (wOR=1.09; CI: 1.01-1.19). Our meta-analysis revealed that currently known biological factors are weak predictors of future suicidal behaviors. This conclusion should be interpreted within the context of the limitations of the existing literature, including long follow-up intervals and a lack of tests of interactions with other risk factors. Future studies addressing these limitations may more effectively test for potential biological risk factors.

Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies.

BACKGROUND: A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. METHOD: We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. RESULTS: The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76-2.43] for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. CONCLUSIONS: Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.

Hydrogen peroxide vapour decontamination of surfaces artificially contaminated with norovirus surrogate feline calicivirus.

BACKGROUND: Noroviruses are a leading cause of gastrointestinal disease and are of particular concern in healthcare settings such as hospitals. As the virus is reported to be environmentally stable, effective decontamination following an outbreak is required to prevent recurrent outbreaks. AIM: To investigate the use of hydrogen peroxide vapour to decontaminate a number of surfaces that had been artificially contaminated with feline calicivirus (FCV), a surrogate for norovirus. The surfaces tested were representative of those found in hospital wards. METHODS: FCV was used to contaminate materials representative of a hospital setting (stainless steel, glass, vinyl flooring, ceramic tile and PVC plastic cornering). The carriers were exposed to 30% (w/w) hydrogen peroxide vapour at 5-min intervals over 20 min, after which postexposure viral titres were measured. FINDINGS: Hydrogen peroxide vapour reduced the viral titre by 4 log(10) on all surfaces tested within 20 min of exposure. The reduction in viral titre took longest to achieve on stainless steel (20 min), and the quickest effect was seen on vinyl flooring (10 min). For glass, plastic and ceramic tile surfaces, the desired reduction in viral titre was seen within 15 min of exposure. Hydrogen peroxide vapour allows for large-scale decontamination of areas following outbreaks of infectious organisms. CONCLUSION: Hydrogen peroxide vapour is effective against FCV and is active on a range of surfaces. Therefore, it may represent a suitable decontamination system for use following a hospital outbreak of norovirus.

Detection of rare paternal chloroplast inheritance in controlled crosses of the endangered sunflower Helianthus verticillatus.

A variety of questions in population and evolutionary biology are studied using chloroplast DNA (cpDNA). The presumed maternal inheritance in angiosperms allows for certain assumptions and calculations to be made when studying plant hybridization, phylogeography, molecular systematics and seed dispersal. Further, the placement of transgenes in the chloroplast to lessen the probability of 'escape' to weedy relatives has been proposed since such genes would not move through pollen. In many studies, however, strict maternal inheritance is assumed but not tested directly, and some studies may have sample sizes too small to be able to detect rare paternal leakage. Here, we study the inheritance of cpDNA simple sequence repeats in 323 offspring derived from greenhouse crosses of the rare sunflower Helianthus verticillatus Small. We found evidence for rare chloroplast paternal leakage and heteroplasmy in 1.86% of the offspring. We address the question of whether one can extrapolate the mode of chloroplast transmission within a genus by comparing our results to the findings of another sunflower species study. The findings of occasional paternal transmission of the chloroplast genome are discussed in the framework of using these markers in studies of population and evolutionary biology both in Helianthus and other angiosperms.

Mutational analysis of the HIV-1 LTR as a promoter of negative sense transcription.

The HIV-1 gene promoter is a bi-directional promoter of transcription. We report the characterization of the negative sense promoter (NSP) by analysis of the effect on negative sense transcription of a series of LTR U3 region substitution mutants. Mutations in the region nt -58 to -183 (positive sense transcription initiation nt +1) reduced transcription to <15% of wild type NSP activity. This region, essential for NSP activity, was designated the core basal promoter. Over expression of NF-kappaB RelA(p65) and LEF-1 increased negative sense expression, as did over expression of H-ras oncogene, consistent with the presence of cognate sequence motifs for NF-kappaB, LEF-1 and RBF. We were also able to confirm that the NSP is a TATA-less promoter inhibited by HIV-1 Tat. Based on our findings, we propose a model for the interaction between the NSP and PSP, and the role of Tat in regulating the interaction.

A multi-centre study of Osseotite implants supporting mandibular restorations: a 3-year report.

This multi-centre study evaluated the performance of the Osseotite implant in the mandibular arch. Osseotite implants (n = 688) were placed in 172 patients; 43.5% were placed in the anterior mandible and 66.5% in the posterior mandible. Fifteen per cent of the implants were placed in soft bone, 56.9% in normal bone and 28.1% in dense bone. During placement, 49.9% of the implants were identified as having a tight fit, 48.6% a firm fit and 1.5% a loose fit. About one-third of the implants (32.4%) were short (10 mm in length or less). After 36 months, only 5 implants had been lost, for a cumulative survival rate of 99.3%. The 3-year results of this study indicate a high degree of predictability with placement of Osseotite implants in the mandibular arch.

Effect of 4-vinylcyclohexene on micronucleus formation in the bone marrow of rats and mice.

This study was conducted to evaluate the potential of 4-vinylcyclohexene (VCH) to induce micronuclei in the bone marrow of mice and rats. Male and female Crl:CD BR (Sprague-Dawley) rats and B6C3F1/CrBR mice were exposed to VCH 6 hr/day for 2 days or for 13 weeks. In the 2-day study, mice were exposed by inhalation to 0, 250, 500, or 1000 ppm, and rats were exposed to 0, 500, 1000, or 2000 ppm. In the 13-week study, mice were exposed to 0, 50, 250, or 1000 ppm, and rats were exposed to 0, 250, 1000, or 1500 ppm. In each study, a separate group of mice was exposed to 1000 ppm 1,3-butadiene (BD) so that a comparison could be made between the two compounds. Likewise, cyclophosphamide was also included for rats as a positive control. Bone marrow was collected from VCH-exposed animals approximately 24 h and 48 h after the final exposure. There were no statistically significant increases in micronucleatedpolychromatic erythrocytes (MN-PCEs) among VCH-treated mice and rats at any dose level or sampling interval at either 2-days or 13-weeks. Also, no statistically significant differences in the polychromatic erythrocytes (PCE) to normochromatic erythrocytes (NCE) ratios were observed in any of the VCH-treated mice and rats compared to air-exposed animals. As expected, both the butadiene-treated mice and the cyclophosphamide-treated rats showed significantly more MN-PCEs than the control animals.

Pharmacological characterization of bradykinin B1 and B2 receptors in IMR-90 and INT-407 human cell lines using a microphysiometer.

1. In the present study, we used a microphysiometer to measure bradykinin-induced acidification responses in IMR-90, a human lung fibroblast cell line, and INT-407, a human colonic epithelial cell line. Furthermore, we investigated the effect of 24 h exposure of transforming growth factor (TGF)-alpha on the bradykinin response in INT-407 cells. 2. Bradykinin (0.1-100 nmol/L) was potent in producing acidification responses in IMR-90 cells (pEC50 8.79+/-0.13; Hill slope 0.96+/-0.04) and INT-407 cells (pEC50 8.90+/-0.04; Hill slope 1.00+/-0.07). These responses were competitively antagonized by the bradykinin B2 receptor antagonist icatibant in both IMR-90 cells (apparent pKB = 8.54+/-0.15; Hill slope = 1.09+/-0.13 and 1.66+/-0.26 in the absence and presence of 10 nmol/L icatibant, respectively) and INT-407 cells (pKB = 8.12+/-0.07 (3, 10 and 30 nmol/L icatibant); Hill slope = 1.06+/-0.04). However, the bradykinin B1 receptor antagonist des-Arg9Leu8-bradykinin (3 micromol/L) had no effect on the bradykinin responses. 3. The non-peptide bradykinin B2 receptor antagonist FR173657 selectively antagonized bradykinin-induced acidification responses in INT-407 cells in a competitive manner (pKB = 8.76+/-0.10; Hill slope = 0.92+/-0.05) at lower concentrations (1 and 3 nmol/L) but in an insurmountable manner at higher concentrations (10 nmol/L; Hill slope = 1.04+/-0.09). This compound, at concentrations of 10 and 100 nmol/L (Hill slope = 1.38+/-0.15), also proved to be an insurmountable antagonist in IMR-90 cells. 4. The bradykinin B1 receptor selective agonist Lys0des-Arg10-bradykinin (0.1 nmol/L to 0.1 micromol/L) failed to produce acidification responses in IMR-90 cells, even after 24 h pre-incubation with bacterial lipopolysaccharide (0.1 microg/mL). 5. A 24 h pre-incubation of INT-407 cells with TGF-alpha (1, 10 and 100 ng/mL) caused a significant concentration-dependent decrease in maximal bradykinin response without affecting the pEC50. 6. In addition to this study being the first to use a microphysiometer to characterize bradykinin B2 receptors in cultured IMR-90 human lung fibroblast cells and INT-407 human colonic epithelial cells, we also showed that pre-incubation of INT-407 cells with TGF-alpha caused a significant decrease in maximal acidification response mediated by bradykinin B2 receptors.

Lipopolysaccharide decreases bradykinin receptor-induced acidification responses in cultured bovine aortic endothelial cells.

The effects of bacterial lipopolysaccharide (Escherichia coli 0127-B8) on bradykinin receptor function in bovine aortic endothelial cells were investigated using a microphysiometer. Bradykinin and Lys(0)-desArg(10)-bradykinin produced concentration-dependent acidification responses with pEC(50) values of 8.87+/-0.20 and 9.78+/-0.08, respectively. These responses were competitively and selectively antagonised by the bradykinin B(2) receptor antagonist, icatibant and the bradykinin B(1) receptor antagonist, desArg(9)-Leu(8)-bradykinin, respectively. The non-peptide bradykinin B(2) receptor antagonist, FR173657 (0.3 and 3 nM), selectively antagonised bradykinin-induced acidification responses, causing rightward shifts of the concentration-response curves to bradykinin, but at the same time, significantly decreasing the maximum response. A preincubation with lipopolysaccharide (0.01 and 0.1 microg/ml) for 24 h caused a significant concentration-dependent decrease in maximal response to bradykinin (27.2+/-1.9 and 9.7+/-0.4% of control) and the bradykinin B(1) receptor agonist, Lys(0)-desArg(10)-bradykinin (59.0+/-7.14 and 25.3+/-7.8% of control), without affecting the EC(50). These results suggest that bradykinin B(1) receptors are constitutively expressed in cultured bovine aortic endothelial cells and that the microphysiometer provides a rapid, sensitive technique to characterise bradykinin receptors and investigate their regulation by cytokines. Interactions between bradykinin receptors and lipopolysaccharide may play a part in the cascade of deleterious effects that occur during septic shock.

The effect of hypotensive anesthesia on blood loss and operative time during Le Fort I osteotomies.

PURPOSE: The purpose of this prospective study was to compare the quality of the surgical field, blood loss, and operative time with either hypotensive or normotensive anesthesia during Le Fort I osteotomies. PATIENTS AND METHODS: Twenty-three patients were randomized into normotensive or hypotensive anesthesia treatment groups. The quality of the surgical field was assessed intraoperatively by direct observation and again postoperatively using video imaging. A standardized rating scale was applied at specific intervals by surgeons blinded to the anesthetic technique. The surgical time was measured on the videotape, and blood loss was measured by volumetric and gravimetric techniques. RESULTS: There was a statistically significant correlation (P < .0001) between the surgeon's perception of the quality of the surgical field and the blood pressure. There was also a statistically significant reduction (P < .01) in blood loss when using hypotensive anesthesia. However, there was no statistically significant reduction (P = .44) in operative time when using hypotensive anesthesia. CONCLUSIONS: It was concluded that hypotensive anesthesia is valuable in reducing blood loss and improving the quality of the surgical field during Le Fort I osteotomies, allowing for easier, more deliberate, and careful dissection. However, it does not reduce operative time.