bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing patterns in marriage choice and related health risk in the Pakistani heritage community in Bradford UK: a qualitative study.
Authors: Small Neil , Razaq Rifat , Sharma Vishal , Cunningham Alice , Khurshid Zuneera , Islam Shahid
Published: November 2024

Background Children born to blood relations (consanguineous parents), primarily cousins, have higher mortality and morbidity than children born to non-consanguineous parents. Consanguinity is low in the UK but high in some communities, including the Pakistani heritage community in Bradford. There has been a marked decrease in consanguinity in the last decade and that is likely to result in reductions in excess mortality and morbidity. Methods Drawing on patterns of child health reported by the Born in Bradford study, augmented with a summary of the literature on motivations for choosing consanguineous unions and on the shifting characteristics of those who make this choice, questions about marriage choice and knowledge of allied health risk were devised. They were explored in four focus groups with self-identified members of the Pakistani heritage community. Groups were divided by age and gender. Discussions were analysed using Thematic Analysis. Results There was agreement that rates of consanguinity were declining. Older group members were concerned this might indicate a shift away from tradition and damage community cohesion. Younger participants were positive about the benefits of a shift towards individual choice. They felt this could be achieved without damaging community strengths. Reasons for the fall in numbers were attributed to changes within the community, including higher numbers of people staying in education beyond school. External factors, including new immigration rules, were also considered. There was not a consensus about health risks, some older respondents were sceptical of links between marriage choice and child health and concerned about how health risks were communicated. All were concerned that marriage choice should not be used to demonise this community. Conclusion A commitment to sustaining community cohesion is shared by all groups. Younger people think this can be achieved despite falls in consanguinity. There are continuing challenges in communicating health risk.
The genome sequence of Trimmer's Mining Bee, Andrena trimmerana (Kirby, 1802)
Authors: Baker Ellen , Crowley Liam M. , Falk Steven ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life Management, Samples and Laboratory team,   Wellcome Sanger Institute Scientific Operations: Sequencing Operations,   Wellcome Sanger Institute Tree of Life Core Informatics team,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: November 2024

We present a genome assembly from afemale specimen of Andrena trimmerana (Trimmer’s Mining Bee; Arthropoda; Insecta; Hymenoptera; Andrenidae). The genome sequence has a total length of 399.10 megabases. Most of the assembly (86.18%) is scaffolded into 5 chromosomal pseudomolecules. The mitochondrial genome has also been assembled and is 19.77 kilobases in length. Gene annotation of this assembly on Ensembl identified 10,570 protein-coding genes.
APPROACHES FOR THE TREATMENT OF COMPLICATIONS FOLLOWING WAR INJURIES IN UKRAINIAN PATIENTS
Authors: Pidgaiska Olga , Goumenos Stavros , Dos Santos Maria Virginia , Trampuz Andrej , Stöckle Ulrich , Meller Sebastian
Published: November 2024

Introduction

Since the expanded war in Ukraine in 2022, explosives, mines, debris, blast waves, and other factors have predominantly caused injuries during artillery or rocket attacks. These injuries, such as those from shelling shrapnel, involve high-energy penetrating agents, resulting in extensive necrosis and notable characteristics like soft tissue defects and multiple fragmentary fractures with bone tissue defects and a high rate of infection complications caused by multi resistant gram-negative (MRGN) pathogens.

Material and Methods

We conducted a prospective study at our center between March 2022 and December 2023. Out of the 56 patients from Ukraine, 21 met the inclusion criteria who had severe war injuries were included in the study. Each of these patients presented with multiple injuries to both bones and soft tissues, having initially undergone treatment in Ukraine involving multiple surgeries. The diagnosis of infection was established based on the EBJIS criteria. Prior to our treatment patients had undergone multiple revision surgeries, including debridement, biopsies, implant and fixator replacement. Additionally, soft tissue management required previously VAC therapy and flap reconstruction for successful treatment.

Results

All 21 infections manifested as bone infections (11; 52%), followed by implant-associated infections (5; 24%), soft tissue infections (4; 19%), and septic arthritis (1; 5%). In all patients, the infection was polymicrobial, caused by 3- and 4-MRGN pathogens, as Klebsiella pneumonia 4MRGN, Proteus mirabilis 4MRGN, Enterobacter cloacae 4MRGN etc. Upon admission, all patients carried a diagnosis and exhibited signs indicative of chronic infection. 19 (90.5%) patients required complex antibiotic regimens combined with multiple wound revisions and debridements, changes of fixators and combination of systemic and local antibiotic therapy. In 6 patients (28%) high dosages of local antibiotics such as gentamycin, vancomycin and meropenem were incorporated into a carrier of bio-absorbable calcium sulfate, calcium sulfate/hydroxyapatite which were introduced into the hip joint, femoral canal or bone defect for dead space management during the surgery. When local antibiotics were administered at intervals, the microbiology results at implantation showed negative results. 2 (9%) patients had new infections (different site, different pathogens), 1 (4.8%) is still under the treatment. In 17 (81%) patients infection complications were treated successfully with no recurrence of infection.

Conclusion

War injuries result in complex bone and soft-tissue infections caused by 3-, 4-MRGN pathogens. Addressing this challenge necessitates multidisciplinary approach with multiple, thorough surgical debridements, effective local, and systemic antimicrobial therapy. As for the outlook we can see potential in local antibiotic carriers.
NANOSCALE ZINC-SUBSTITUTED HYDROXYAPATITE: A BONE GRAFTING BIOMATERIAL WITH ENHANCED ANTIBACTERIAL PROPERTIES
Authors: Wali Rofida , Miller Cheryl , Harrison Caroline , Stafford Graham , Hatton Paul
Published: November 2024

Introduction

In specific conditions, infection may lead to bone loss and is difficult to treat1. Current clinical approaches rely on the introduction of antibiotics. While these may be effective, there are concerns regarding the rise of antimicrobial resistance. There is therefore interest in the development of antimicrobial bone graft substitutes for dental and trauma surgery.

Aim & Objectives

The incorporation of zinc into biomaterials has been shown to confer broad spectrum antimicrobial activity, but this has not yet been applied to the development of a commercial bone graft substitute. The aim of this research was therefore to prepare and characterise a series of zinc-substituted nanoscale hydroxyapatite (nHA) materials, including evaluation of antimicrobial activity.

Method

Zinc (Zn) substituted nHA materials were prepared (0, 5, 10, 15 & 20 mol.% Zn) using a wet chemical precipitation method with a rapid mixing(2). The reaction was carried out using zinc hydroxide at pH 10. The suspension formed was washed and dried into both powder & paste forms. The resultant powders were characterized using transmission electron microscopy (TEM) and X-ray diffraction (XRD). The antimicrobial activity was evaluated against Staphylococcus aureus (S8650 strain - isolated from an osteomyelitis case), by two techniques. The Miles and Misra method was applied to determine the number of colony-forming units (CFUs) in bacterial suspensions incubated with pastes. Secondly, a biofilm initialization method was used to evaluate the capacity of the materials to prevent biofilm formation. One-way analysis of variance (ANOVA) was used for the statistical analysis and results with p-value < 0.05 were considered statistically significant.

Results

XRD indicated the formation of pure hydroxyapatite with up to 10 mol.% Zn without any side products. However, when Zn was increased to 15 & 20 mol %, zinc oxide (ZnO) peaks were detected. The TEM showed nanoscale needle-like particles when Zn was increased compared to nHA particles. Regarding the antibacterial activity, ZnHA pastes at all concentrations caused a significant reduction in bacterial CFUs in a dose-dependent manner (50, 100 & 200 mg). Additionally, even the lowest zinc substitution (5 mol.%) significantly reduced biofilm formation.

Conclusion

The results demonstrated a novel method to produce a Zn-substituted nHA that showed antimicrobial activity against a pathogen isolated from a bone infection.
WHAT DO WE REALLY KNOW ABOUT HAND DISINFECTION PERFORMANCE DURING PATIENT CARE ON SURGICAL WARDS?
Authors: Otchwemah Robin , Sons Dominik , Herbrand Swetlana , Stolte Marieke , Hamid Adnan , Mattner Frauke
Published: November 2024

Aim

Hand-disinfection (HD) is the most effective infection-prevention-measure. HD-performance of health care professionals (HCP) is usually evaluated by compliance observations (CO). The Hawthorne effect (HE) (HCP behave differently under observation) is considered to systematically increase HD-compliance-rates during CO. However, little is known about the specifications of the HE in health care settings. We hypothesized that, due to hand-hygiene`s known impact on patient safety and infection-prevention, the HE does not affect HD performance during direct patient care in patient-rooms.

Method

We conducted a prospective observational trial on an 18-bed surgical intensive care unit (ICU), a 12-bed surgical intermediate care unit (IMC) and a 36-bed surgical normal ward (NW) in a university hospital in Germany. Dispensers of hand sanitizers were equipped with an electronic monitoring system (EMS) (GWA Hygiene, Germany), which recorded the number of HDs per patient hour (HD/PH) and time and location of hand-disinfections. Locations were categorized as follows: 1. Patient rooms (PR); 2. Utility- and waste-disposal-rooms (UWR) and 3. Other rooms (hallways, kitchen, toilets etc.) (OR). Additionally trained infection-control-staff performed hand-hygiene CO according to WHO's Five Moments. The HD/PH during CO was compared to the HD/PH during the same time-periods without CO. Additionally the ratio between HD/PD-change during CO and mean-HD/PD of each ward during the study-period was determined in percentages. Descriptive and analytical statistics were calculated using R. P-values ≤ 0.05 were regarded as significant.

Results

587.128 HD were electronically recorded during the study-period (February 2022 to May 2023) and CO took place on 72 days. We recorded a significant increase of HD/PH during CO on all three wards in PRs (ICU: 21%, p<0.001; IMC: 11%, p=0.029; NW: 49%, p=0.047). Furthermore we detected a significant increase of HD/PH during CO on ICU (10%, p<0.001) and IMC (11%, p=0.033) in ORs. CO did not significantly affect HD/PH in ORs on NW and in UWR on all three wards.

Conclusions

In our setting, the number of hand-disinfections per patient-hour was significantly increased during compliance-observations especially in patient-rooms, where hand-hygiene is most crucial for infection-prevention. This indicates a lower everyday compliance to WHO`s hand-hygiene indications during patient care than determined by compliance-observations.

Acknowledgments

Paul-Hartmann AG financially supported this study.
PREVENTING PERIPROSTHETIC JOINT INFECTION: A NOVEL ANTIMICROBIAL SOL-GEL APPROACH
Authors: Boyce Sarah , Nichol Tim , Smith Thomas , Le Maitre Christine
Published: November 2024

Aim

Periprosthetic joint infections follow 1-3% of arthroplasty surgeries, with the biofilm nature of these infections presenting a significant treatment challenge1. Prevention strategies include antibiotic-loaded bone cement; however, increases in cementless procedures means there is an urgent need for alternative local antimicrobial delivery methods2. A novel, ultrathin, silica-based sol-gel technology is evaluated in this research as an anti-infective coating for orthopaedic prosthetic devices, providing local antibiotic release following surgery.

Method

Reduction in clinically relevant microbial activity and biofilm reduction by antimicrobial sol-gel coatings, containing a selection of antibiotics, were assessed via disc diffusion and microdilution culture assays using the Calgary biofilm device3. Proliferation, morphology, collagen, and calcium production by primary bovine osteoblasts cultured upon antibiotic sol-gel surfaces were examined, and cytotoxicity evaluated using Alamar blue staining and lactate dehydrogenase assays. Concentrations of silica, calcium and phosphorus compounds within the cell layer cultured on sol-gel coatings and concentrations eluted into media, were quantified using ICP-OES. Furthermore, cellular phenotype was assessed using alkaline phosphatase activity with time in culture.

Results

Low antibiotic concentrations within sol-gel had an inhibitory effect on clinically relevant biofilm growth, for example 0.8 mg ml-1 tobramycin inhibited clinically isolated S. aureus (MRSA) growth with an 8-log reduction in viable colony forming units. There was no significant difference in metabolic activity between untreated and sol-gel exposed primary bovine osteoblasts in elution-based assays. Reduction (2-fold) in metabolic activity in direct contact assays after 48 hours exposure was likely to be due to increased osteoinduction, whereas no impact upon cell proliferation were observed (p=0.92 at 14 days culture). The morphology of primary osteoblasts was unaffected by culture on sol-gel coatings and collagen production was maintained. Calcium containing nodule production within bovine osteoblastic cells was increased 16-fold after 14 days culture upon sol-gel.

Conclusions

The ultrathin sol-gel coating showed low cytotoxicity, strong biofilm reducing activity and antimicrobial activity, which was comparable to antibiotics alone, demonstrating that sol-gel delivery of antibiotics could provide local antimicrobial effects to inhibit PJI growth without the need for bone cement. Future work will develop and evaluate sol-gel performance in an ex vivo explant bone infection model which will reduce the need for animal experimentation.
PROGNOSTIC VALUE OF THREE DIFFERENT CLASSIFICATION SYSTEMS FOR PERIPROSTHETIC JOINT INFECTIONS
Authors: Seixas João , Altoé Laís Simonato , Santos Ana Cláudia , Ribau Ana , Abreu Miguel , Carvalho André , Pereira Filipa , Soares Daniel , Sousa Ricardo
Published: November 2024

Aim

Determine therapeutic and prognostic value of three different prosthetic joint infections (PJI) staging systems – JS-Bach, McPherson and PJI-TNM.

Method

Retrospective analysis of patients who received surgery for PJI between 2011 and 2022 at one single institution, including DAIR, 1-stage revision and 2-stage revision. We applied three staging systems - JS-Bach, McPherson, PJI-TNM – and categorize the results into A (less severe), B (intermediate) and C (most severe). Demographic data and comorbidities, anatomic location, type of treatment, recurrency of infection, final outcome and antibiogram were analyzed.

Results

186 patients were included, 112 (60%) were woman. Median age was 70 years old. 51% were submitted to DAIR, 10% to 1-stage revision and 39% to 2-stage revision. Recurrence of infection was found on 27% of patients after initial treatment. 10% died with complication related to PJI. Final status at last follow-up showed 96% of cases were ultimately free of infection at last follow-up. JS-BACH was associated with recurrence. All three staging systems were associated with final outcome.

Conclusions

Despite all existing knowledge around risk factors for treatment failure of PJI, there is still a lack of a generally accepted classification system to accurately predict patient outcome.

JS-BACH, McPherson and PJI-TNM are three different proposed classifications developed to predict clinical outcomes. To the best of our knowledge there are no studies directly comparing their performance.

We retrospectively evaluated our cohort and found that all three correlated with final patient outcome but JS-BACH was the only who significantly correlated with infection recurrence after initial treatment.
ARE CURRENT DEFINITIONS RELIABLE IN THE PREOPERATIVE DIAGNOSIS OF SHOULDER PERIPROSTHETIC JOINT INFECTION? COMPARING THE EBJIS AND THE 2018 ICM SHOULDER DEFINITION
Authors: Barros Bianca Sousa , Costa Bárbara , Ribau Ana , Vale João , Sousa Ricardo
Published: November 2024

Aim

Accurate diagnosis is key in correctly managing prosthetic joint infection(PJI). Shoulder PJI definition and diagnosis is challenging. Current PJI definitions, based overwhelmingly in hip/knee research, may not accurately diagnose shoulder PJI. Our aim is to compare the preoperative performance of two PJI definitions comparing it to definitive postoperative classification.

Method

This is a retrospective study of patients who have undergone total shoulder revision surgery for infection between 2005 and 2022.

Cases were classified using two different PJI definitions: a)the European Bone and Joint Infection Society (EBJIS) and; 2)the 2018 International Consensus Meeting(ICM) PJI specific shoulder definition.

Preoperative classification was based on clinical features, inflammatory markers and synovial fluid leukocyte count and definitive classification also considered microbiology and histology results.

Results

Preoperative and definitive PJI classification status of the 21 patients included were evaluated and is summarized in table 1. The shoulder specific 2018 ICM definition showed the highest agreement between preoperative and definitive classification (76.2%, k=0.153, p=0.006) compared to EBJIS (52.4%, k=0.205, p=0.006). In all cases, the classification was changed because of positive intraoperative microbiology (at least two identical isolates).

Microbiology findings showed coagulase negative staphylococci, Staphyloccocus aureus and Cutibacterium acnes to be the most frequent. Four patients had polymicrobial infections.

Conclusions

Both the EBJIS 2021 and 2018 ICM definitions have low accuracy in predicting shoulder PJI preoperatively. Clearly further studies with larger cohorts are in dire need focusing specifically on shoulder revision arthroplasty to improve on existing definitions. Caution is advised while extrapolating of criteria/thresholds recommended for hip/knee joints.

For any tables or figures, please contact the authors directly.
ULTRASOUND-GUIDED SYNOVIAL BIOPSY FOR THE PREOPERATIVE DIAGNOSIS OF PERIPROSTHETIC JOINT INFECTION
Authors: Stoddart Catriona , Hennessy Conor , Ashworth Jonathon , Vaz James , Alvand Abtin , Kendrick Benjamin , Palmer Antony , Partington Karen
Published: November 2024

Aim

Prosthetic joint infection (PJI) is assessed using clinical history and examination, imaging studies and laboratory investigations which inform diagnostic tools such as that proposed by the European Bone and Joint Infection Society to determine the probability of infection. Infection is often confirmed by microbiology culture and histology from intraoperative samples, but ideally a diagnosis of infection is made preoperatively to guide management decisions.

At our institution, a tertiary referral centre for PJI, ultrasound (US)-guided synovial biopsy is routinely used as an adjunct to preoperative joint aspiration. Our aim was to evaluate the sensitivity and specificity of microbiology and histology results from US-guided synovial biopsy samples when compared to intraoperative samples.

Method

In this retrospective study we analysed all prosthetic hip and knee US-guided biopsies performed at our institution over a 5 year period between 2018 and 2022. Microbiology and histology results from preoperative biopsy samples were individually compared to microbiology and histology findings from intraoperative samples.

Results

381 biopsies were performed; 281 knee, 100 hip. US-guided biopsy results showed strong positive predictive values (PPVs) in hip biopsies (microbiology PPV (79.3%), histology PPV (85.7%)) and knee biopsies (microbiology PPV (77%), histology PPV (85%)). Biopsies showed low sensitivity in predicting intraoperative findings (hip microbiology sensitivity (62%), hip histology sensitivity (31%), knee microbiology sensitivity (70%), knee histology sensitivity (21%). Biopsies showed high specificity for knee (microbiology specificity (89%), histology specificity (97%)) and hip (microbiology specificity (73%), histology specificity (91%)).

Conclusions

This study demonstrates that US-guided biopsy is a valuable diagnostic aid for PJI with high specificities and PPVs. Furthermore US-biopsy is valuable when there is limited fluid for aspiration.
SYNOVIAL FLUID NMR-BASED METABOLOMICS IN SEPTIC AND ASEPTIC REVISION TOTAL KNEE ARTHROPLASTY: IMPLICATIONS ON DIAGNOSIS AND TREATMENT
Authors: Mozella Alan , Leal Ana Carolina , Cobra Hugo , Costa Gilson
Published: November 2024

Aim

Evaluate the metabolites composition of the synovial fluid from patients with PJI or aseptic failure of total knee arthroplasties.

Method

The synovial fluids from 21 patients scheduled for revision total knee arthroplasty (11 with the diagnosis of PJI and 10 with aseptic failures) were analyzed using 1D 1H NMR spectroscopy. Univariate and multivariate statistical analyses were used to identify metabolites that were differentially abundant between those groups.

Results

A total of 28 metabolites were identified and five of them found to be differentially abundant between infected and non-infected synovial fluids. Lactate, acetate and 3-hydroxybutyrate were found to be in a higher concentration, and glucose and creatine were found reduced in the synovial fluid from PJI patients.

Conclusions

Synovial fluid from patients with PJI exhibit a distinct metabolic profile, possibly reflecting metabolic adaptation that occurs in the infected periprosthetic microenvironment. Further research and studies are warranted to gain a broader insight into the metabolic pathways engaged by both pathogen and immune cells in the context of a PJI.
DYNAMIC DISTRIBUTION OF SYSTEMICALLY ADMINISTERED ANTIBIOTICS IN ORTHOPAEDICALLY RELEVANT TARGET TISSUES AND SETTINGS
Authors: Nielsen Maria Bech Damsgaard , Jørgensen Andrea René , Stilling Maiken , Mikkelsen Mads Kristian Duborg , Jørgensen Nis , Bue Mats
Published: November 2024

Aim

Efficacious antibiotic treatment is crucial for managing and preventing orthopedic infections due to their complexity and associated risk of treatment failure. Previous reviews on antibiotic target tissue concentrations have primarily focused on static measurements, which may not accurately reflect the dynamic pharmacokinetic/pharmacodynamic (PK/PD) changes encountered in clinical settings.

This review aimed to summarize the current literature on antibiotic distribution in orthopedically relevant tissues and settings using dynamic sampling methods.

Method

In accordance with PRISMA guidelines, a literature search was conducted with a scientific librarian's assistance. PubMed and Embase databases were systematically searched using relevant MeSH terms, entries, and keywords. English-published studies between 2004 and 2023 involving systemic antibiotic administration and dynamic measurements were included. 4467 titles were identified. After title and abstract screening, 77 eligible studies remained.

Results

The studies covered clinical and pre-clinical studies on both healthy and infected tissue. Dynamic measurements were obtained from various tissues including bone, intervertebral discs, joints, muscles, and subcutaneous tissue. Microdialysis was the predominant sampling method (98.70%, 76/77). Antibiotics like cefuroxime, linezolid, and vancomycin were extensively studied. Fluoroquinolones, tetracyclines, and most beta-lactams typically presented good tissue penetration in relation to relevant PK/PD-targets. In contrast, glycopeptides, macrolides, and flucloxacillin exhibited poorer penetration.

Conclusions

This review provides valuable insights of antibiotic distribution in orthopedically relevant target tissues and settings, which may help improve dosing recommendations and treatment outcomes. Our findings are limited to the investigated dosing regimens and administration methods and depend on the chosen PK/PD target. Many antibiotics still require further research to address the significant knowledge gaps, such as the lack of dynamic evaluations for certain antibiotic types and further investigation across various orthopedic settings and tissues.
A LONGER DURATION OF INTRAVENOUS ANTIBIOTIC TREATMENT FOR PATIENTS WITH EARLY PERIPROSTHETIC JOINT INFECTION DOES NOT IMPROVE IMPLANT SURVIVAL
Authors: Meijer Janneke , Soriano Alex , Zijlstra Wierd , ten Have Bas , Tarabichi Saad , Jutte Paul , Parvizi Javad , Wouthuyzen-Bakker Marjan
Published: November 2024

Introduction

In recent years, many studies demonstrated the efficacy of an early switch to oral antibiotics after surgical treatment in orthopaedic related infections. However, large analyses on periprosthetic joint infections (PJIs) are lacking.

Material and Methods

We conducted a retrospective observational multicenter study in patients diagnosed with an early postoperative PJI (i.e less than 3 months after the index arthroplasty) treated with debridement, antibiotics and implant retention (DAIR). Patients from Europe and the USA were included. These two cohorts served as a quasi-randomised trial since an early oral antibiotic switch is routine practice in Europe versus a long duration of intravenous (IV) antibiotic treatment in the USA. Failure was defined as the clinical need for: i) a second DAIR, ii) implant removal, iii) suppressive antibiotic treatment or iv) infection related death.

Results

A total of 668 patients were included. 277 received IV antibiotics for <14 days, 232 were given IV antibiotics between 14 - 27 days and 159 received IV antibiotics for >27 days. The overall 1-year failure rate within the 3 groups was 41.5%, 44.4% and 42.1%, respectively (P 0.80), and mainly comprised the need for a second DAIR. The results did not change when analyzing patients with or without obesity, the causative microorganism or the type of oral antibiotics.

Conclusion

In early postoperative PJIs, a longer duration of IV antibiotic treatment is not associated with a lower failure rate of a DAIR procedure.
INVESTIGATING OSTEOLYSIS IN OSTEOMYELITIS: WHAT TO BELIEVE?
Authors: Peterlin Anton Alexander , Gottlieb Hans , Birch Julie Melsted , Jensen Louise Kruse
Published: November 2024

Aim

The osteolytic process of osteomyelitis is, according to textbooks, caused by increased osteoclast activity due to RANKL production by osteoblasts. However, recent findings contradict this theory. Therefore, the aim was to investigate, in a porcine osteomyelitis model, how osteolysis is affected by massive inflammation and RANKL blocking, respectively. In parallel, patients with chronic osteomyelitis, diabetes, foot osteomyelitis, and fracture related infections (FRI) were included for advanced histological analysis of osteolysis.

Methods

In pigs, a tibial implant cavity was created and inoculated with 104 CFU of Staphylococcus aureus: Group A (n=7). Group B (n=7); + 1cm3 spongostan into the cavity. Group C (n=4); + systemic Denosumab treatment. Spongostan was used as an avascular material to support bacterial growth and thus increase the inflammatory response. Denosumab treatment was administrated to suppress osteoclast activity by RANKL inhibition (as in osteoporotic patients). The volume of osteolysis was accessed by CT scans. Immunohistochemistry with antibodies towards Cathepsin K was used to identify osteoclasts within the bone lesions. Briefly, the number of Cathepsin K positive cells, i.e., both precursors and bone resorbing osteoclasts, respectively, were counted in 10 high power fields (400x). In total, 50 bone infection patients were included (Herlev Hospital). From each patient five parried samples were taken for histology and microbiology, respectively. Histopathology, CT osteolysis volume estimation, and molecular expression of osteoclasts and inflammatory markers are ongoing. One FRI patient was osteoporotic and treated with Denosumab for 6 years.

Results

All pigs were confirmed infected in the implant cavity. The volume (2.41 ± 1.29cm3) of osteolysis was significantly increased in the spongostan group in comparison to Group A (1.24 ± 0.59 cm3) (p=0.04). Thereby, the spongostan group had bacteria deeper into the bone from the inoculation point. Sufficient Denosumab treatment, i.e. reduced serum Ca was seen in 3 pigs. None of the Denosumab treated pigs showed reduced osteolysis in comparison to Group A (1.42 ± 0.63 cm3). The Cathepsin K score of Group C was 17 (15-23 IQR) of precursor osteoclasts and 2 (0-2 IQR) of osteoclasts in Howship lacunae. The Denosumab treated patient showed substantial osteolysis and histological analysis confirmed acute inflammatory.

Conclusions

Application of spongostan, i.e., bacterial host optimization and massive inflammation promotes osteolysis and local bacterial dissemination. Osteoclast blocking with Denosumab showed no impact on osteolysis. Elucidation of the pathophysiology causing bone loss in osteomyelitis is fundamental. However, the widely accepted osteoclast-based theory might not be the only relevant.
ROUTINE SONICATION LEADS TO CLINICALLY RELEVANT IMPROVEMENT OF PERIPROSTHETIC JOINT INFECTION DIAGNOSIS
Authors: Zouitni Anas , van Oldenrijk Jakob , Bos Koen , Croughs Peter D. , Yusuf Erlangga , Veltman Wout
Published: November 2024

Aim

Periprosthetic joint infection (PJI) is a serious complication after joint arthroplasty. Diagnosing PJI can be challenging as preoperative screening and conventional cultures may be inconclusive. Sonication fluid culturing stands out as a valuable adjunct technique to improve microbiological PJI diagnosis. This study aims to determine the clinical relevance of routinely using sonication for all septic and aseptic revisions.

Method

All patients who underwent (partial) hip or knee revision arthroplasty for all causes between 2012 and 2021 at our institution were retrospectively reviewed. Based on the European Bone and Joint Society PJI criteria, we categorized them into three groups: infection confirmed, infection likely, and infection unlikely. We analyzed the clinical, laboratory, and radiological screening that could confirm or refute suspicion of PJI. We analyzed microbiology cultures and the most frequently detected microorganisms. Sensitivity and specificity were calculated for synovial fluid cultures (preoperative), tissue cultures, and sonication fluid cultures. We determined the clinical relevance of sonication as the percentage of patients for whom sonication confirmed (microbiological) PJI diagnosis.

Results

429 patients who underwent (partial) revision of hip (246 patients) or knee (183 patients) arthroplasty were included. Sensitivity and specificity were 69% and 99% for preoperative synovial fluid cultures, 76% and 92% for intraoperative tissue cultures, and 80% and 89% for sonication fluid cultures, respectively. Sonication fluid cultures improved tissue culture sensitivity and specificity to 83% and 99%, respectively. In 12 (11%) out of 110 PJIs, sonication fluid cultures were decisive for confirming the causative pathogen. This was applicable to acute and chronic infections. In 29 (9%) out of 319 aseptic cases, a negative sonication fluid culture could confirm contamination of tissue cultures.

Conclusions

Routine sonication fluid cultures enhanced the sensitivity and specificity of PJI diagnostics. In 11% of PJI cases, causative pathogens were confirmed by sonication fluid culture results. Routine sonication may be helpful in confirming contamination of synovial fluid cultures and tissue cultures. Routine sonication fluid culture should be performed in all revision arthroplasties.
ACCURACY OF DIFFERENT TEST METHODS FOR DIAGNOSING LOW-GRADE PERIPROSTHETIC JOINT INFECTIONS
Authors: Luger Markus , Böhler Christoph , Staats Kevin , Windhager Reinhard , Sigmund Irene Katharina
Published: November 2024

Aim

Diagnosing low-grade periprosthetic joint infections (PJI) can be very challenging due to low-virulent microorganisms capable of forming biofilm. Clinical signs can be subtle and may be similar to those of aseptic failure. To minimize morbidity and mortality and to preserve quality of life, accurate diagnosis is essential. The aim of this study was to assess the performance of various diagnostic tests in diagnosing low-grade PJI.

Methods

Patients undergoing revision surgery after total hip and knee arthroplasty were included in this retrospective cohort study. A standardized diagnostic workup was performed using the components of the 2021 European Bone and Joint Infection Society (EBJIS) definition of PJI. For statistical analyses, the respective test was excluded from the infection definition to eliminate incorporation bias. Receiver-operating-characteristic curves were used to calculate the diagnostic performance of each test, and their area-under-the-curves (AUC) were compared using the z-test.

Results

422 patients undergoing revision surgery after total hip and knee arthroplasty were included in this study. 208 cases (49.3%) were diagnosed as septic. Of those, 60 infections (28.8%) were defined as low-grade PJI (symptoms >4 weeks and caused by low-virulent microorganisms (e. g. coagulase-negative staphylococci, Cutibacterium spp., enterococci and Actinomyces)). Performances of the different test methods are listed in Table 1. Synovial fluid (SF) - WBC (white blood cell count) >3000G/L (0.902), SF - %PMN (percentage of polymorphonuclear neutrophils) > 65% (0.959), histology (0.948), and frozen section (0.925) showed the best AUCs.

Conclusion

The confirmatory criteria according to the EBJIS definition showed almost ideal performances in ruling-in PJI (>99% specificity). Histology and synovial fluid cell count (SF-WBC and SF-%PMN) showed excellent accuracies for diagnosing low-grade PJI. However, a reduced immune reaction in these cases may necessitate lower cut-off values. Intraoperative frozen section may be valuable in cases with inconclusive preoperative diagnosis.

For any tables or figures, please contact the authors directly.
THE BURDEN OF BROAD-SPECTRUM ANTIBIOTIC USE IN ORTHOPAEDIC INFECTION: SYSTEMIC ANTIBIOTIC PRESCRIBING IN THE SOLARIO TRIAL
Authors: Dudareva Maria , Lama Shristi , Miyazaki Keiko , Scarborough Claire , Wijendra Asanka , Tissingh Elizabeth , Kumin Michelle , Scarborough Matthew , McNally Martin
Published: November 2024

Aim

The SOLARIO trial is a randomised controlled non-inferiority trial of antibiotic strategy for bone and joint infection. SOLARIO compares short or long post-operative systemic antibiotic duration, for patients with confirmed infections, who had local antibiotics implanted and no infected metalwork retained when undergoing surgery.

This analysis compared systemic antibiotic use in the short (intervention) and long (standard of care) arms of the trial, in the 12 months after index surgery.

Method

Data was collected prospectively from study randomisation, within 7 days of index surgery. All systemic antibiotics prescribed for the index infection were recorded, from health records and patient recall, at randomisation, 6 weeks, 3-6 months and 12 months after study entry. Start and end dates for each antibiotic were recorded.

Results

251 patients were randomised to short systemic antibiotics (up to 7 post-operative days) and 249 patients, to long systemic antibiotics. 5 participants in the short group and 2 participants in the long group withdrew from study follow-up.

Complete data for all systemic antibiotics taken in the 12 months following surgery, were available for 237 participants in the short group and 236 participants in the long group. 80 participants across both groups were noted as having deviated from their assigned treatment strategy. Both groups received empiric antibiotics, predominantly vancomycin and meropenem, for up to 7 days after surgery.

Considering each prescribed antibiotic as a separate duration (even when administered concurrently), participants assigned to standard care received a mean of 74.9 antibiotic-days. Participants assigned to short systemic antibiotics received a mean of 27.5 antibiotic-days in the 12 months after surgery. The most commonly prescribed antibiotics in both treatment groups were vancomycin and meropenem: these antibiotics accounted for 7.1 days prescribed per participant in the long group, and 6.3 days in the short group (p=0.37). Reasons for post-randomisation antibiotic prescribing in the short treatment group included later planned surgery, identification of bacteria requiring additional systemic antibiotics, and treatment of superficial wound infections.

WHO AWaRe classification ‘watch’ and ‘reserve’ group antibiotics, such as ciprofloxacin, rifampicin, vancomycin and meropenem, accounted for 39.4 antibiotic-days per long group participant, and 16.5 antibiotic-days per short group participant.

Conclusions

Considering the combined duration of all systemic antibiotics prescribed over 12 months, including those co-administered, participants in the short arm of the SOLARIO trial received considerably fewer days of all antibiotic classes, and particularly those antibiotics restricted in the WHO AWaRe classification (2021).
LOCAL ANTIBIOTIC THERAPY WITH AMINOGLYCOSIDE ALONE OR IN COMBINATION WITH VANCOMYCIN IN THE MANAGEMENT OF BONE INFECTION
Authors: Unsworth Annalise , McNally Martin , Scarborough Matthew , Young Bernadette
Published: November 2024

Aim

Local antibiotics, delivered to the site of infection, achieve high tissue concentrations and are used as an adjunct to systemic therapy. Local gentamicin provides levels well above the minimum inhibitory concentration and may be sufficient on its own, however, the efficacy of single or combination local antibiotics has not been studied. This retrospective study evaluated the effect of combination aminoglycoside and vancomycin local antibiotic treatment compared to aminoglycoside alone in the surgical management of bone infection.

Method

We studied patients with microbiologically confirmed osteomyelitis and fracture-related infection, who had implantation of antibiotic carriers as part of their surgical management. Data including patient demographics, type of surgery, microbiological characteristics, BACH score, duration of antibiotic treatment and clinical outcomes were collected. Failure of therapy was a composite of recurrence of infection, continued or new antimicrobial therapy, or reoperation with suspected or confirmed infection at one year after index surgery.

Results

There were 266 patients who met the inclusion criteria. Nine patients died before the outcome endpoint at 12 months and five patients were lost to follow up so were excluded. 252 patients were included in the final analysis and were well matched with regard to demographics, BACH score and microbiology. 113 patients had treatment with aminoglycoside alone and 139 patients had combination aminoglycoside and vancomycin.

There was no difference in the failure rate between groups; 10/113 (8.8%) in the aminoglycoside alone and 12/139 (8.6%) in the combination group, p = 0.934. There was no difference for reoperation, ongoing suppressive antibiotic use, or clinical suspicion of infection. Multivariate analysis showed that there was no added benefit of combination therapy (OR 1.54: 95%CI 0.59-4.04, p=0.38). BACH score and low BMI were associated with increased risk of failure (BACH OR 3.49: 95%CI 1.13-10.76, p=0.03; Low BMI OR 0.91: 95%CI 0.84-0.99, p-0.037).

The form of the carrier material (pellets or injectable paste) had no effect on failure rate (p=0.434). Aminoglycoside resistance (confirmed and presumed) occurred in 39/113 (34.5%) of the aminoglycoside only group and 36/139 (25.9%) of the combination group (p=0.137). The presence of aminoglycoside resistance had no effect on failure rate (OR 0.39: 95%CI 0.05-3.01, p=0.37).

Conclusions

Clinical outcome was not improved by the addition of vancomycin to aminoglycoside alone as local therapy for the management of osteomyelitis and FRI. Laboratory measured resistance, using currently accepted breakpoints, may not be relevant in local therapy.
The roadmap to collapse: whatever the last summers have been like for you, one thing is clear: you are currently experiencing the coolest period of your lives
Authors: Spangenberg Joachim H.
Published: November 2024

The following trend projection is based on the state of scientific knowledge of summer 2024, and the policy assumptions are optimistic for 2030. Still the outlook is dystopic – readers are invited to identify intervention and bifurcation points for the better, but in line with the state of science.
US-China Relations in Retrospect: Revisiting the Debate of Realists, Liberals, and Constructivists
Authors: Fong Brian C.H.
Published: November 2024

Abstract: At the turn of the millennium, Western scholars heatedly debated the impact of China's rise on US-China relations and the wider great power relations. On the one hand, optimists, including economic liberals, democratic peace liberals, institutional liberals, constructivists, and defensive realists, advanced an optimistic view, arguing that US-China relations would be productive and peaceful. On the other hand, pessimists, including power transition realists and offensive realists, advanced a pessimistic view, arguing for a growing US-China rivalry, with the former anticipating a great power war and the latter predicting an intense great power competition. By reviewing these perspectives against the changing patterns of US-China relations from the 2000s to the present, this study reflects the relative importance of system-level forces vis-à-vis unit-level forces in accounting for the dynamics of great power relations.
Why Did Kim Jong-un Delete Unification? Issues and Implications of North Korea's Position on 'Hostile Relations Between Two States'
Authors: Kim Kap-sik
Published: November 2024

Abstract: In 2024, North Korea deleted 'unification strategy' from its national strategy and declared its pursuit of a policy toward South Korea founded on the recognition of two states coexisting on the Korean Peninsula, thus disregarding South Korea as a counterpart for reconciliation and unification. This fundamental policy shift toward South Korea is based on an aggressive perception of the current political situation, and appears to be a mid-to-long term strategic level decision. Since the failure of the US-North Korea summit meeting in Hanoi in 2019, North Korea appears to be cultivating a new identity for itself as a self-reliant 'nuclear power' in order to gain superiority over South Korea, pressure the United States, and gain recognition as a nuclear state from the international community. Pyongyang seeks superiority over Seoul by contrasting North Korea's 'great power identity' as an independent socialist country with South Korea's 'colonial identity' as a capitalist colony of the United States. This fundamental policy shift will inevitably affect South Korea's overall national strategy, including Seoul's diplomatic, security, and unification strategies.
Hide and Seek: Elmer Belt, Agnes, and the Battle over Castration in Transsexual Surgery, 1953–1962
Authors: Chiang Howard
Published: November 2024

summary: In the 1950s, the idea of sex change increasingly assumed the mainstay of public interest. As psychiatrists and psychologists developed new understandings of gender, the role of surgeons is often overlooked in the early history of sex reassignment. This article explores the work of one such doctor, Elmer Belt, a urologist based in Los Angeles. Between 1953 and 1962, Belt operated on twenty-nine male-to-female patients in the face of ethical and material obstacles. Working closely with Harry Benjamin, Belt developed a surgical technique that transplanted the testes inside the abdomen rather than involving full castration. He became involved in the famous case of Agnes Torres, on which other high-profile scientists based their invention of such seminal concepts as "passing" and "gender identity." Belt's utilization of Agnes as exemplary evidence to support his technique illustrates how and why testicular retention remained a heated topic in the development of transsexual science.
The Subjective Apparatus: First-Person Films and the Fundamental Subjectivity of Virtual Reality
Authors: Bédard Philippe
Published: November 2024

abstract: This article focuses on a short-lived trend in virtual reality (VR) films: putting viewers in the shoes of a character. While this narrative strategy has gone largely out of fashion in recent years due to the evolution of VR technologies, studying it highlights the intersections of technological affordances, design strategies, and user experience at a crucial point in the emergence of a new medium. My central argument is that these first-person VR films resulted from a key technical feature of VR head-mounted displays (HMD), understood here as more than simply a new kind of screen; it is a new (subjective) apparatus.
Cine-mapping: Charting the Use of Scripted Spaces in Screen Tourism
Authors: Burke Liam , Balanzategui Jessica , Lomax Tara
Published: November 2024

abstract: Since the turn of the twenty-first century, creative industries, government agencies, and tourism bodies have gradually recognized screen tourism's economic potential. From film location apps to theme park–like "movie sets," these stakeholders have used scripted spaces to commodify fan tourism practices. This article introduces cine-mapping as a new analytical framework to chart how film and television narratives are plotted onto real-world spaces. Using three prominent screen tourism examples—Middle-earth, Star Wars , and Game of Thrones —the analysis explores how cine-mapping strategies have enabled destination stakeholders to extend screen franchises in an experience economy and the impact on these remapped places.
"What Goes on in the Windshield": Rear-Projection and On-Screen Automobility
Authors: Stock Michael
Published: November 2024

abstract: This article examines the history and role of rear-projection in the representation of automobility in classic American cinema. In use for nearly four decades, rear-projection was crucial in the presentation of traveling sequences in classic cinema—whether by car, truck, boat, plane, or other fantastic contraption. To date, there are only a handful of scholarly articles about rear-projection, many of which dismiss or deride this conspicuous artifact of the studio system. While at first glance the use of rear-projection in driving sequences seems artificial and "an emblem of a bygone era" (as Laura Mulvey describes), at the same time, viewing this technique through a phenomenological lens reveals that it is very true to our own experience of automobility each time we get into the car.
Art and Politics: Prometheus Bound and the Delphic Festivals
Authors: Ballengee Jennifer
Published: November 2024

ABSTRACT: This essay explores Aeschylus’ tragedy Prometheus Bound within the context of its performance at the 1927 and 1930 Delphic Festivals organized by Eva and Angelos Sikelianos. The Sikelianoses hoped that the enduring ruins and natural landscape of Delphi would provide a foundation for their spiritual project— though the engagement of the Greek government put those goals in tension with political demands. At a time when a sense of autochthony or origin continues to invigorate political struggles over geographic landscapes, this essay provides a timely meditation upon the limits of landscape to be mapped to a spiritual or political project.