Antibiotic-loaded bone cement reduces risk of infections in primary total knee arthroplasty? A systematic review.

PURPOSE: Antibiotic-loaded bone cement has been widely used for the treatment of infected knee replacement, but its routine use in primary TKA remains controversial. The aim of this systematic review was to analyze the literature about the antimicrobial efficacy and safety of antibiotic-loaded bone cement for its prophylactic use in primary TKA. METHODS: A detailed and systematic search of the Pubmed, Medline, Cochrane Reviews and Google Scholar databases had been performed using the keyword "total knee arthroplasty" "total knee replacement" "total knee prosthesis" and "antibiotic-loaded bone cement" with no limit regarding the year of publication. We used modified Coleman scoring methodology (mCMS) to identify scientifically sound articles in a reproducible format. The review was limited to the English-language articles. RESULTS: Six articles met inclusion criteria. In total, 6318 arthroplasties were included in our study. 3217 of these arthroplasties received antibiotic-loaded bone cement and 3101 arthroplasties served as the control. There was no statistical difference between the two groups in terms of the incidence of deep or superficial surgical site infection. The average mCMS score was 67.6, indicating good methodological quality in the included studies. CONCLUSIONS: Present review did not reveal any significant difference in terms of rate of deep or superficial surgical site infection in patients receiving antibiotic-loaded bone cement compared with the control (plain bone cement) during primary TKA. The clinical relevance of this study was that the use of antibiotic-loaded bone cement did not significantly reduce the risk of infection in primary TKA. LEVEL OF EVIDENCE: III.

Quantification of sewer leakage by a continuous tracer method.

Water authorities interested in the evaluation of the structural state of a sewer must quantify leakage to plan strategic intervention. However, the quantification of the exfiltration and the localisation of structural damage are challenging tasks that usually require expensive and time-consuming inspections. Herein, we report one of the first applications of the QUEST-C method to quantify the exfiltration in a continuously operating sewer by dosing two chemical tracers, sodium bromide (NaBr) and lithium chloride (LiCl). The method was applied at the catchment scale in a 14-year-old sewer in Rome, Italy. Preliminary laboratory tests, field measurements, and numerical simulations showed that reliable results require the QUEST-C method to be applied to sewers without lateral inflows, during periods of quasi-steady flow, and that the travel time of the NaBr tracer is minimised. Three sewer reaches were tested and the estimated exfiltration, as a fraction of the dry weather flow (DWF), increased from 0.128 in the agricultural area to 0.208 in the urban area. Although our estimates are at the lower end of the range given in the literature (0.01-0.56 DWF), the exfiltration was not negligible, and interventions should focus on the sewers in urban areas. This illustrates the capability of the QUEST-C method to guide strategic intervention at low cost and without an interruption of sewer operation. However, careful interpretation of the results is recommended for sewers with many lateral inflows, where leakage may be overestimated.

Parallel conduction of the phase I preventive and therapeutic trials based on the Tat vaccine candidate.

The native HIV-1 Tat protein was chosen as vaccine candidate for phase I clinical trials in both uninfected (ClinicalTrials.gov identifier: NCT00529698) and infected volunteers (ClinicalTrials.gov identifier: NCT00505401). The rationale was based on the role of Tat in the natural infection and AIDS pathogenesis, on the association of Tat-specific immune responses with the asymptomatic stage and slow-progression rate as well as on its sequence conservation among HIV clades (http://www.hiv1tat-vaccines.info/). The parallel conduction in the same clinical centers of randomized, double blind, placebo-controlled phase I studies both in healthy, immunologically competent adults and in HIV-infected, clinically asymptomatic, individuals represents a unique occasion to compare the vaccine-induced immune response in both the preventive and therapeutic setting. In both studies, the same lot of the native Tat protein was administered 5 times, every four weeks, subcute (SC) with alum adjuvant or intradermic (ID), in the absence of adjuvant, at 7.5 microg, 15 microg or 30 microg doses, respectively. The primary and secondary endpoints of these studies were the safety and immunogenicity of the vaccine candidate, respectively. The study lasted 52 weeks and monitoring was conducted for on additional 3 years. The results of both studies indicated that the Tat vaccine is safe and well tolerated both locally and systemically and it is highly immunogenic at all the dosages and by both routes of administration. Vaccination with Tat induced a balanced immune response in uninfected and infected individuals. In particular, therapeutic immunization induced functional antibodies and partially reverted the marked Th1 polarization of anti-Tat immunity seen in natural infection, and elicited a more balanced Th1/Th2 immune response. Further, the number of CD4 T cells correlated positively with anti-Tat antibody titers. Based on these results, a phase II study is ongoing in infected drug-treated individuals (http://www.hiv1tat-vaccines.info/).

Quantification of sewer system infiltration using delta(18)O hydrograph separation.

The infiltration of parasitical water into two sewer systems in Rome (Italy) was quantified during a dry weather period. Infiltration was estimated using the hydrograph separation method with two water components and delta(18)O as a conservative tracer. The two water components were groundwater, the possible source of parasitical water within the sewer, and drinking water discharged into the sewer system. This method was applied at an urban catchment scale in order to test the effective water-tightness of two different sewer networks. The sampling strategy was based on an uncertainty analysis and the errors have been propagated using Monte Carlo random sampling. Our field applications showed that the method can be applied easily and quickly, but the error in the estimated infiltration rate can be up to 20%. The estimated infiltration into the recent sewer in Torraccia is 14% and can be considered negligible given the precision of the method, while the old sewer in Infernetto has an estimated infiltration of 50%.

Neurocognitive impairment influences quality of life in HIV-infected patients receiving HAART.

The objective of the study was to determine the association of neurocognitive impairment with health-related quality of life (HRQoL) in patients receiving highly active antiretroviral therapy (HAART). Seventy subjects were cross-sectionally analysed with a standardized neuropsychological test battery and a questionnaire including an Italian translation of the MOS-HIV Health Survey. The presence of neurocognitive impairment was significantly associated with lower HRQoL scores: pain (P = 0.03), physical functioning (P = 0.01), role functioning (P = 0.01), social functioning (P = 0.029), mental health (P = 0.001), energy (P = 0.036), health distress (P = 0.002), cognitive functioning (P = 0.05), current health perception (P <0.001), physical health summary score (PHS) (P = 0.005), mental health summary score (MHS) (P = 0.002). Years of education (odds ratio [OR] 0.79; 95% confidence interval [CI] 0.65-0.96), PHS (OR 0.71; 95% CI 0.54-0.95) and MHS (OR 0.67; 95% CI 0.51-0.88) were also associated with cognitive impairment. Neurocognitive impairment in patients receiving HAART was associated with reduced HRQoL. Identifying cognitive impairment may provide motivation for additional treatment to help patients to compensate for deficits in functioning.

Changes in neurocognitive performance in a cohort of patients treated with HAART for 3 years.

OBJECTIVES: To describe changes in HIV-associated neurocognitive impairment in patients treated with highly active antiretroviral therapy (HAART) for at least 3 years. METHODS: Prospective, observational study of comprehensive neuropsychologic (NP) testing, neurologic examination, and laboratory measures before HAART and after 6, 15 and 45 months of HAART, on 28 consecutive patients seen in our department since April 1996. RESULTS: At baseline, 16 patients were neurocognitively impaired and 12 were not. Among the 16 impaired patients, 5 patients failed to meet the criteria for impairment after 6 months and 9 patients after both 15 and 45 months of HAART, respectively. Statistically significant improvements ( p < or =.01) were seen in two of six measures exploring the concentration and speed of mental processing, two of three measures exploring mental flexibility, in one of five measures exploring memory, and in two of two measures exploring fine motor functions. Unimpaired study subjects performed better than impaired ones in 10 of 17 measures at baseline, in eight of 17 after 6 months, in six of 17 after 15 months, and in seven of 17 after 45 months of HAART. CONCLUSIONS: During the course of HAART, patients experienced a positive and sustained improvement in their neurocognitive performance. However, the presence of 7 of 16 (43.7%) patients with neurocognitive impairment, and the persistence of statistically significant differences in the neurocognitive performance between impaired and unimpaired patients after more than 3 years of HAART, suggests that ongoing HIV-related neurologic damage can occur even during potent antiretroviral treatment.

[Knowledge and attitudes regarding family clinics on the part of women who use or do not use them]. / Conoscenza ed immagine del consultorio familiare da parte di donne utenti e non utenti.

Thanks to large civil participation and to the women's movement in 1975 a law has been approved that institutes family health clinics. This law is dedicated in particular to health and general services for women and to family planning. The Hygiene Department of University of Perugia has studied during this time: the family health clinics (FHC) activity in order to determine how well it is meeting the institutional aims. The knowledge and the attitudes of women with respect their use of FHC which have been projected onto the community. Health Education has a very important role because it is quite often basis for acceptance of FHC by women. The identification of all aspects of cultural resistance is very important. To this point a research project has been completed. The focal point of this research concerns women and their ability to profit from available information, as well as their attitudes and evaluation of the FCH. This study has been using a representative sample of Umbrian women, aged 16-50 ys old, at March 1987; the sampling method was of two stage. On the whole 1647 observations have been made by means of a mail questionnaire. The responders were very low (about 25%), so the results obtained must be considered with extreme caution. Generally there is a positive opinion on family health clinic: women are linked to a service of the community. They express satisfaction with the service. They express opinions on both positive and negative aspects. Even if the first approach is generally determined by a gynecological visit, the users redefine the service in a less ambulatory manner and into a more consultative one. In fact, users consider the FHC as a reference for women's problems. They underline the lack of sexual and health consulting service. There is demand for counseling for infancy problems, sterility, health education and sexual education. Even the non-users have a sufficiently clear idea of the family health clinics. Non-users view the FHC as a service for women's problems as well as relationship problems.