Modes of failure following locking plate fixation of the distal radius: a thematic analysis of 517 fractures.

Anterior locking plate fixation of the distal radius is a common procedure with reliable results. Failure of fixation is sometimes seen. The aim of the present study was to identify the reasons for failure. In total, 517 cases met the study inclusion criteria. Of them, 23 cases had failure of fixation (4.4%). Failure analysis generated qualitative data. Subsequent thematic analysis identified the primary mode of failure and contributing factors. Primary modes were identified as failure to support all key fracture fragments (n = 20), wrong choice of implant (n = 1), failure of union (n = 1) and poor bone quality (n = 1). Contributing factors were errors in plate positioning, fracture reduction, implant selection and screw configuration, as well as fracture pattern complexity and poor bone quality. Most failed fixations had a primary mode and two or three contributing factors. Overall anterior plating is reliable with a low rate of surgical failure. Knowledge of failure modes will aid operative planning and prevent failure.Level of evidence: V.

Impingement-related osteolysis in Motec total wrist arthroplasty: an explant analysis and review of the literature.

We present five cases of osteolysis in the Motec total wrist prosthesis, three around the radial implant, one around the metacarpal implant and one around both. Three of these were progressive and required revision, and biomechanical explant analyses of these revised prostheses were performed. Ex vivo testing of the contact points of the Motec implants was also performed at maximum extension. Here, impingement occurs between the metacarpal screw and the dorsal rim of the cup (non-articulating surfaces) with the short-necked prosthesis, leading to metacarpal screw damage, titanium debris formation and osteolysis. An analysis of three previously published cases suggests that this may have been the likely mode of failure in those cases. This complication is preventable by avoiding use of the short-neck prosthesis.Level of evidence: IV.

Learning curves in Motec total wrist arthroplasty: an international cohort study.

We examined the learning curve of Motec total wrist arthroplasty (TWA) of six experienced surgeons in their first 30 cases. Three times more complications/revisions were encountered in the first half of the study compared with the second half. Motec TWA surgery should be concentrated in a smaller number of centres performing higher volumes.

Complication rates and modes of short and medium-term failure in Motec total wrist arthroplasty: an international cohort study.

The aim of this study was to analyse the short- and medium-term complications of the Motec total wrist arthroplasty (TWA). Identifying exact modes of failure and their causes should allow surgeons to avoid or mitigate these risks in the future. Retrospective analysis of prospectively collected data from six hand surgeons at five international centres provided details of 171 Motec TWAs. The mean follow-up was 5.8 years (range 18 months to 12 years). There were 33 (19%) complications within our cohort, with a revision rate of 8.2% (14 revisions). There was no difference in complication rates between metal-on-metal and metal-on-polymer articulations. Failure of osseointegration was the most common complication. Problems with soft tissue balancing, implant impingement related osteolysis, bony impingement and metacarpal fracture were found to be other preventable causes of failure in this series. Elimination of these preventable complications will improve survival rates for this implant.Level of evidence: IV.

Developing textile sustainability education in the curriculum: pedagogical approaches to material innovation in fashion.

The textile industry needs to adopt environmentally sustainable approaches to address ecologically damaging practices. Whilst driven by initiatives such as Textiles 2030, it is current students who will carry this agenda forward. This project investigated pedagogical approaches to develop sustainable textiles for the fashion design curriculum. Pilot studies, using bacterial cellulose (BC) as a material for millinery, revealed members of the public were prepared to experiment with this novel material, and BC was compatible with traditional hat-making techniques. A further study challenged secondary school students, based on an experiential learning model, to grow their own BC biofilm, exploring this as a sustainable apparel fabric. Initial attitudes of reluctance developed into acceptance once engaged in the practical activity. This study illustrates that with appropriate communication and education strategies, the principles of sustainability in fashion, and the acceptability of novel materials, can be engendered in different audiences.

Hands on Biofilm! Utilizing a public audience in a citizen science project to assess yield variability when culturing kombucha pellicle.

The pellicle biofilm generated during the Kombucha tea fermentation process has, when dried, textile-like properties that may have real-life applications. However, pellicle yield can vary depending on inoculation and incubation conditions, which affects research investigations on the properties of the pellicle. To generate data on variability to help define optimum pellicle growth conditions, as part of a public engagement event about biofilm, a citizen science activity was hosted whereby visitors to a science festival were invited to select incubation conditions and inoculate different media with liquid or solid (pellicle). More than 220 samples were inoculated (in excess of 1200 visitors, mainly in family groups). The most popular incubation conditions were coconut water or tea medium, 30°C/room temperature and liquid inoculum. The most productive/reproducible in terms of yield and variability were tea medium, 30°C, and liquid inoculum, which reflect some of the conditions most used in the domestic setting for kombucha culture. The event provided both useful research data and generated public interest in a research area of which many will have been unaware. Interest in the results of the activity, available several weeks after the activity, was sustained using email contact and FlickR for the dissemination of images and data.

Hands On Biofilm! A multidisciplinary public engagement event using kombucha tea pellicle as an accessible example of biofilm.

Public engagement with science has become increasingly important for the scientific community. There are many documented public engagement events that focus on aspects of microbiology, but relatively few utilise biofilms as a topic, despite their importance. Kombucha tea pellicles are easy to grow biofilms, facilitating their use within the public domain as examples of these complex communities. The aim of this work was to deliver a public engagement event that introduced visitors to general concepts about biofilm, and applications around sustainability, using kombucha. The event encouraged visitors to: build a biofilm using model clay; inoculate kombucha tea cultures using different incubation conditions, as part of a citizen science experiment to assess impact on pellicle biofilm yield; create garments and drapes on mini-mannequins using dried kombucha pellicle fabric, and demonstrate the range and importance of fermented foods (including kombucha tea), and 'good bacteria'. Quantitative and qualitative indicators of engagement were built into the activities. More than 1200 visitors, mainly in family groups, visited the event over a 4-h period. Knowledge of biofilms was low at the beginning of the event. Participation in all activities was high. Indicators of quantitative engagement were impressive, but it was difficult to obtain qualitative evidence other than observations from the delivery team (nineteen members) because of the intensity of the event and volume of visitors. The event was clearly successful in terms of fulfilment of aims, audience engagement and enthusiasm: the embedded evaluations helped to evidence the impact and reach of the event, enabling confidence in dissemination of good practice in the enhancement of public understanding of the importance of biofilm in general, and kombucha in particular.

Reproducibility of Bacterial Cellulose Nanofibers Over Sub-Cultured Generations for the Development of Novel Textiles.

The textile industry is in crisis and under pressure to minimize the environmental impact on its practices. Bacterial cellulose (BC), a naturally occurring form of cellulose, displays properties superior to those of its cotton plant counterpart, such as enhanced purity, crystallinity, tensile strength, and water retention and is thus suitable for an array of textile applications. It is synthesized from a variety of microorganisms but is produced in most abundance by Komagataeibacter xylinus. K. xylinus is available as a type strain culture and exists in the microbial consortium commonly known as Kombucha. Whilst existing literature studies have described the effectiveness of both K. xylinus isolates and Kombucha in the production of BC, this study investigated the change in microbial communities across several generations of sub-culturing and the impact of these communities on BC yield. Using Kombucha and the single isolate strain K. xylinus as inocula in Hestrin and Schramm liquid growth media, BC pellicles were propagated. The resulting pellicles and residual liquid media were used to further inoculate fresh liquid media, and this process was repeated over three generations. For each generation, the thickness of the pellicles and their appearance under SEM were recorded. 16S rRNA sequencing was conducted on both pellicles and liquid media samples to assess changes in communities. The results indicated that the genus Komagataeibacter was the most abundant species in all samples. Cultures seeded with Kombucha yielded thicker cellulose pellicles than those seeded with K. xylinus, but all the pellicles had similar nanofibrillar structures, with a mix of liquid and pellicle inocula producing the best yield of BC after three generations of sub-culturing. Therefore, Kombucha starter cultures produce BC pellicles which are more reproducible across generations than those created from pure isolates of K. xylinus and could provide a reproducible sustainable model for generating textile materials.

How Do We Determine the Efficacy of an Antibacterial Surface? A Review of Standardised Antibacterial Material Testing Methods.

Materials that confer antimicrobial activity, be that by innate property, leaching of biocides or design features (e.g., non-adhesive materials) continue to gain popularity to combat the increasing and varied threats from microorganisms, e.g., replacing inert surfaces in hospitals with copper. To understand how efficacious these materials are at controlling microorganisms, data is usually collected via a standardised test method. However, standardised test methods vary, and often the characteristics and methodological choices can make it difficult to infer that any perceived antimicrobial activity demonstrated in the laboratory can be confidently assumed to an end-use setting. This review provides a critical analysis of standardised methodology used in academia and industry, and demonstrates how many key methodological choices (e.g., temperature, humidity/moisture, airflow, surface topography) may impact efficacy assessment, highlighting the need to carefully consider intended antimicrobial end-use of any product.

Analysis of university student responses to the pandemic in a formal microbiology assessment.

During the coronavirus pandemic, second-year students on the B.Sc. molecular biology and genetics degree at Istanbul Technical University sat an open-ended online exam for a microbiology course in which one of the compulsory questions asked how the course had helped them during the first phase of the pandemic (April-July 2020). Fifty of 69 students gave consent for their (anonymous) responses to be analysed in order to discern any key ways in which their knowledge had been applied. The aim of the study was to investigate whether taking an advanced microbiology course increases understanding of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic and has a positive impact on student behaviours with respect to public health practices. Findings were divided into four major themes: course content (information), application of course content to behavioural change (practice), professionalism and their 'audience' whilst at home in lockdown (family and friends). Social distancing, wearing face masks, and hand and surface hygiene were described as important behaviours, with this practice informed by their basic microbiology knowledge. This paper describes a scenario where rote assessment can be used to assess wider scientific literacy with respect to application in society, providing students with an opportunity to incorporate and apply their learning into real-life situations, whilst tutors can assess constructivist learning, conceptual understanding and impact on student behaviour.

Phenotypic and Genotypic Characterization of Novel Polyvalent Bacteriophages With Potent In Vitro Activity Against an International Collection of Genetically Diverse Staphylococcus aureus.

Phage therapy recently passed a key milestone with success of the first regulated clinical trial using systemic administration. In this single-arm non-comparative safety study, phages were administered intravenously to patients with invasive Staphylococcus aureus infections with no adverse reactions reported. Here, we examined features of 78 lytic S. aureus phages, most of which were propagated using a S. carnosus host modified to be broadly susceptible to staphylococcal phage infection. Use of this host eliminates the threat of contamination with staphylococcal prophage - the main vector of S. aureus horizontal gene transfer. We determined the host range of these phages against an international collection of 185 S. aureus isolates with 56 different multilocus sequence types that included multiple representatives of all epidemic MRSA and MSSA clonal complexes. Forty of our 78 phages were able to infect > 90% of study isolates, 15 were able to infect > 95%, and two could infect all 184 clinical isolates, but not a phage-resistant mutant generated in a previous study. We selected the 10 phages with the widest host range for in vitro characterization by planktonic culture time-kill analysis against four isolates:- modified S. carnosus strain TM300H, methicillin-sensitive isolates D329 and 15981, and MRSA isolate 252. Six of these 10 phages were able to rapidly kill, reducing cell numbers of at least three isolates. The four best-performing phages, in this assay, were further shown to be highly effective in reducing 48 h biofilms on polystyrene formed by eight ST22 and eight ST36 MRSA isolates. Genomes of 22 of the widest host-range phages showed they belonged to the Twortvirinae subfamily of the order Caudovirales in three main groups corresponding to Silviavirus, and two distinct groups of Kayvirus. These genomes assembled as single-linear dsDNAs with an average length of 140 kb and a GC content of c. 30%. Phages that could infect > 96% of S. aureus isolates were found in all three groups, and these have great potential as therapeutic candidates if, in future studies, they can be formulated to maximize their efficacy and eliminate emergence of phage resistance by using appropriate combinations.

Biofilm associated genotypes of multiple antibiotic resistant Pseudomonas aeruginosa.

BACKGROUND: Pseudomonas aeruginosa is a ubiquitous environmental microorganism and also a common cause of infection. Its ability to survive in many different environments and persistently colonize humans is linked to its presence in biofilms formed on indwelling device surfaces. Biofilm promotes adhesion to, and survival on surfaces, protects from desiccation and the actions of antibiotics and disinfectants. RESULTS: We examined the genetic basis for biofilm production on polystyrene at room (22 °C) and body temperature (37 °C) within 280 P. aeruginosa. 193 isolates (69 %) produced more biofilm at 22 °C than at 37 °C. Using GWAS and pan-GWAS, we found a number of accessory genes significantly associated with greater biofilm production at 22 °C. Many of these are present on a 165 kb region containing genes for heavy metal resistance (arsenic, copper, mercury and cadmium), transcriptional regulators and methytransferases. We also discovered multiple core genome SNPs in the A-type flagellin gene and Type II secretion system gene xpsD. Analysis of biofilm production of isolates of the MDR ST111 and ST235 lineages on stainless-steel revealed several accessory genes associated with enhanced biofilm production. These include a putative translocase with homology to a Helicobacter pylori type IV secretion system protein, a TA system II toxin gene and the alginate biosynthesis gene algA, several transcriptional regulators and methytransferases as well as core SNPs in genes involved in quorum sensing and protein translocation. CONCLUSIONS: Using genetic association approaches we discovered a number of accessory genes and core-genome SNPs that were associated with enhanced early biofilm formation at 22 °C compared to 37 °C. These included a 165 kb genomic island containing multiple heavy metal resistance genes, transcriptional regulators and methyltransferases. We hypothesize that this genomic island may be associated with overall genotypes that are environmentally adapted to survive at lower temperatures. Further work to examine their importance in, for example gene-knockout studies, are required to confirm their relevance. GWAS and pan-GWAS approaches have great potential as a first step in examining the genetic basis of novel bacterial phenotypes.

Giving intravenous iron to patients with symptomatic heart failure is safe and cost effective.

AIMS/BACKGROUND: Heart failure affects approximately 1 million people in the UK, adversely affecting quality of life, functional capacity and cognitive health. Iron deficiency complicates heart failure in approximately 50% of patients. Giving intravenous ferric carboxymaltose has been shown to improve quality of life in patients with heart failure (New York Heart Association class and Kansas City Cardiomyopathy Questionnaire). METHODS: A quality improvement project was designed to assess the feasibility, safety and cost implications of establishing an intravenous iron service in the authors' centre. RESULTS: Between July and December 2019 61 patients who were screened met the inclusion criteria and were administered intravenous ferric carboxymaltose. There were statistically significant improvements in ferritin levels (83.3 ug/litre to 433 ug/litre; P<0.0001), transferrin saturation (18% to 30% P<0.0001) and haemoglobin levels (126 g/litre to 135 g/litre; P<0.01). No demonstrable changes in New York Heart Association class or quality of life scores were noted. The overall financial impact for the trust was income generation of £14 665, a net income of £240 per patient. CONCLUSIONS: Intravenous iron replacement with ferric carboxymaltose is safe and cost effective, and should be considered in eligible iron-deficient patients with symptomatic heart failure. Integration with another day case intravenous service represented the most logistically simple and economically viable method of service delivery.

Risk Factors for Nonunion After First Metatarsophalangeal Joint Arthrodesis With a Dorsal Locking Plate and Compression Screw Construct: Correction of Hallux Valgus Is Key.

First metatarsophalangeal joint (MTPJ) arthrodesis is currently the gold standard technique for advanced hallux rigidus. This retrospective study aimed to identify the risk factors for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. Between April 2014 and April 2019, 165 consecutive patients (28 men and 137 women; mean age, 60 (range, 28-84) years) who underwent 178 primary first MTPJ arthrodeses were retrospectively reviewed. All arthrodeses were performed using either a dorsal locking plate with an integrated compression screw (Anchorage CP plate, Stryker, n = 97) or a dorsal locking plate (Anchorage V2 plate, Stryker, n = 81) with a separate compression screw (4 mm cannulated ACE screw). Union was defined as bone bridging across the fusion site on at least 2 of the 3 standard foot radiographs (anteroposterior, lateral, oblique) and no MTPJ movement or pain during clinical examination. Potential risk factors for nonunion were analyzed with the use of univariate and multivariate analyses. The overall nonunion rate was 6.2% (11 of 178 cases). The risk factors identified in the univariate analysis included preoperative hallux valgus deformity, postoperative residual hallux valgus deformity, and diabetes (p < .05). Multivariate analysis confirmed that postoperative residual hallux valgus deformity (odds ratio 6.5; p= .015) and diabetes (odds ratio 7.4; p = .019) are independent risk factors for nonunion after first MTPJ arthrodesis. Diabetes is the most important independent risk factor for nonunion after first MTPJ arthrodesis with a dorsal locking plate and compression screw construct. A residual postoperative hallux valgus deformity is associated with a significantly increased risk for nonunion. It is therefore crucial to correct the hallux valgus deformity to a hallux valgus angle of less than 20°.

Visible light photocatalytic bismuth oxide coatings are effective at suppressing aquatic cyanobacteria and degrading free-floating genomic DNA.

Access to safe drinking water free from microbial pollution is an issue of global concern. The use of photocatalytic thin films in water treatment has focused on titanium dioxide, which requires UV-activation, proving a potential barrier to upscaling and implementation in the real world. Visible-light-activated photocatalytic thin films, such as bismuth oxide, have recently been shown to have antimicrobial properties. However, more understanding of the photocatalytic effect on the microbial population in water is required. Glass beads coated with bismuth oxide were incubated with either Microcystis aeruginosa, Anabaena sp. or free-floating genomic DNA. The presence of bismuth oxide-coated glass beads was able to rapidly stop a population of cyanobacteria from increasing. The coated beads were also able to degrade genomic DNA. Leachate from the beads showed no increase in toxicity against human liver cells. This data demonstrates the efficacy of bismuth oxide-coated glass beads for controlling potentially dangerous cyanobacterial populations, whilst potentially reducing the amount of free-floating genomic DNA (an essential issue in the face of antimicrobial resistance) - all of which should be essential considerations in emerging water treatment technologies.

Development of a rapid method for assessing the efficacy of antibacterial photocatalytic coatings.

Visible-light activated photocatalytic coatings may represent an attractive antimicrobial solution in domains such as food, beverage, pharmaceutical, biomedical and wastewater remediation. However, testing methods to determine the antibacterial effects of photocatalytic coatings are limited and require specialist expertise. This paper describes the development of a method that enables rapid screening of coatings for photocatalytic-antibacterial activity. Relying on the ability of viable microorganisms to reduce the dye resazurin from a blue to a pink colour, the method relates the time taken to detect this colour change with number of viable microorganisms. The antibacterial activity of two photocatalytic materials (bismuth oxide and titanium dioxide) were screened against two pathogenic organisms (Escherichia coli and Klebsiella pneumoniae) that represent potential target microorganisms using traditional testing and enumeration techniques (BS ISO 27447:2009) and the novel rapid method. Bismuth oxide showed excellent antibacterial activity under ambient visible light against E. coli, but was less effective against K. pneumoniae. The rapid method showed excellent agreement with existing tests in terms of number of viable cells recovered. Due to advantages such as low cost, high throughput, and less reliance on microbiological expertise, this method is recommended for researchers seeking an inexpensive first-stage screen for putative photocatalytic-antibacterial coatings.

Management of gunshot wound-related hip injuries: A systematic review of the current literature.

PURPOSE: To propose a gunshot wound-related hip injury algorithm and improve patient outcomes. METHODS: Multiple online databases were queried to identify studies reporting on management of gunshot-wound hip injury. RESULTS: Of 47 papers included, 5 and 14 studies recommended surgical intervention for the treatment of low- and high-velocity gunshot wounds, respectively, and 1 paper advocated the use of prophylactic antibiotics in the treatment of high-velocity injuries. All remaining papers had mixed and conflicting results. CONCLUSION: Various therapeutic strategies have been used for the management of gunshot wound-related hip injuries but further prospective studies are necessary to determine the optimal therapeutic modality.

Osteoporosis and Spine Surgery: A Critical Analysis Review.

Despite being part of the aging process, early and adequate management of osteoporosis mitigates adverse outcomes associated with low bone mineral density. Although the health-care burden of osteoporosis is on the rise, screening and management of osteoporosis are not yet an integral part of preoperative patient evaluation in spine surgery. Patients with osteoporosis should undergo multidisciplinary evaluation and management, including lifestyle modifications and initiation of multiple therapeutic modalities. Integrating osteoporosis in preoperative optimization and surgical planning for patients undergoing spine surgery has the potential to mitigate osteoporosis-related postoperative complications.