1,720,973 research outputs found
Debridement, antibiotic pearls, and retention of the implant in the treatment of infected total hip arthroplasty
No full textIn this article the authors describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining a total hip arthroplasty (THA) undergoing acute periprosthetic joint infection (PJI). This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration by using calcium sulphate antibiotic-added beads. The combination of 3 different surgical techniques (tumour-like synovectomy, Argon Beam application and chlorhexidine gluconate brushing) might enhance the disruption and removal of the bacterial biofilm which is the main responsible of antibiotics and antibodies resistance. The timing of the diagnosis (6 weeks from the original surgery or 1 week from clinical symptoms appearance in the case of an hematogenous infection) and the preoperative isolation of the germ are fundamental in order to obtain a satisfactory outcome. A 12-week course of postoperative antibiotic therapy (6 weeks I.V. and 6 weeks oral) complete the postoperative protocol used by the authors. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous PJI
Debridement, antibiotic, pearls, irrigation and retention of the implant and other local strategies on hip periprosthetic joint infections
No full textPeriprosthetic joint infections (PJI) represent a catastrophic consequence following total joint arthroplasty, due to a very high morbidity and mortality. If chronic infections are regularly treated with single-stage or dual-stage explant, there is no consensus in the literature on which is the best approach to treat acute infections. This article proposes a new surgical technique to treat PJI in an acute setting, characterized by identification or isolation of the micro-organism. Debridement, antibiotic pearls, retention of the implant constitute a new, multimodal, surgical approach to PJI after total hip arthroplasty (THA). The authors also reviewed the literature on alternative strategies currently utilized to treat PJI following THA: debridement, antibiotics, implant retention, hydrogels, nanoparticles with bactericidal effects, antimicrobial peptides, all represent effective and promising strategies to prevent explant of the components. Nevertheless, more basic science studies and advancements in surgical techniques and technology applications are still needed before retention of a previously infected implant will become standard of care
No clinical differences at the 2-year follow-up between single radius and J-curve medial pivot total knee arthroplasty in the treatment of neutral or varus knees
No full textPurpose: Modern total knee arthroplasty (TKA) systems are designed to reproduce the normal knee kinematics and improve patient outcome. The authors compared two different third-generation medial pivot TKA implants, having a single-radius or a J-curve design in their sagittal plane, hypothesizing no clinical differences. Methods: Two cohorts of 50 patients who underwent primary TKA were first preoperatively matched by sex, deformity, body mass index (BMI), Oxford Knee Score (OKS), Knee society score (KSS) and range of motion (ROM) and then statistically analyzed at a minimum follow-up (FU) of 2 years. An identical surgical technique, which aimed to reproduce a slightly tighter medial than lateral compartment, was used in all knees. Results: At a minimum follow-up of 2 years (range 24–34 months) there were no statistically significant differences in OKS and KSS between the two implant groups. The final ROM differed statistically between the two groups: the average maximum active flexion was 123° in the J-curve femoral design group with an adapted “medially-congruent” polyethylene insert, and 116° in the single radius femoral design with a medial “ball-in-socket” articulation. Conclusion: No clinical and radiological differences were found when the two cohorts of patients were compared. This study showed that the implant design played a minor role in the final outcome as opposed to a precise surgical technique. Level of evidence: Retrospective case-control study, Level III
Does D-Dimer really help in the diagnosis of chronic periprosthetic joint infections (PJI)? A case-control study
No full textIntroduction
The differential diagnosis between aseptic and septic total joint arthroplasty (TJA) revision is fundamental in order to be successful in the surgical treatment. Several serum biomarkers have been proposed as gold standards in the diagnosis of Periprosthetic Joint Infections (PJI). The aim of the current study was (1) to evaluate serum levels of D-dimer in a retrospective series of PJIs diagnosed by traditional methods and (2) to compare the D-dimer performance as a diagnostic test with other well established PJI biomarkers in a case-control study.
Materials and methods
A total of 159 TJA revisions were included in the study database: 55 implants in 55 patients met the inclusion criteria. The final study group included 33 aseptic and 22 septic (with micro-organism isolation) TJA revisions; these two groups were not statistically different in terms of demographics. All patients were preoperatively tested with the following serologic tests: erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), fibrinogen, D-dimer and white blood cell (WBC) count. A standard univariate logistic analysis was performed in order to investigate the association between chronic PJI and the serologic tests.
Results
A gram-positive microorganism was isolated in 15 patients whereas a gram-negative microorganism was isolated in 7 patients. Univariate analysis showed that high D-dimer, ESR or fibrinogen were not associated with a PJI occurrence, whereas high CRP and WBC count >10.000 cells/mm3 were significantly elevated in chronic PJI patients. A multivariate analysis confirmed that leukocytosis was a significant predictor of PJI.
Conclusions
This study showed that D-dimer had a low sensitivity and specificity in diagnosing chronic PJI, especially when evaluated as a single diagnostic biomarker
Epidemiology of injuries in the 2014 MotoGP World Championship: The "Clinica Mobile" experience
No full textBackground: The MotoGP World Championship is the worldwide premier class of motorcycle road racing, divided in three competition classes: MotoGP, Moto2 and Moto3. Material and methods: This study investigates the incidence, pattern, relative risk, and external factors affecting injuries recorded by the "Clinica Mobile" Medical Team during the 2014 season. A total of 101 elite motorcycle competitors were followed during the entire season. A general encounter-related database has been created: the data included age, experience, date of injury, injury diagnosis, mechanism of injury, protective gear used and total time lost of participation. Results: One hundred and ninety-one injuries were recorded during the study timeframe: 28 were major injuries (14.6% of total encounters). The most common major injuries were fractures (9.9%), followed by joint dislocations. The overall injury rate in the MotoGP group was 4.14 per 1000 practice kilometers and 3.8 per 1000 race kilometers and the death rate was zero. Moto2 and Moto3 riders showed a higher injury risk than MotoGP riders. Conclusions: This study showed that, in the MotoGP World Championship, both deaths and serious injuries are rare but improvement of safety rules for practice sessions and the development of more effective safety gear are keys to further reduce the incidence of those accidents
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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