Effect of Mitomycin C in the prevention of tendon adhesion after surgery and the effect of biomechanical stretching on tendon histology

Objective: In this study, optimal dose to reduce tendon adhesion, by using the dose-dependent fibroblast proliferation inhibition effect of Mit-C, and the level, which the tendon histologies are affected, using biomechanical stretching, is investigated. Methods: 56 chicken flexor tendons were used in this study. A total of 9 groups were formed. Mit-C were applied between the tendon and the sheath; 0.9% NaCl for surgical control groups (groupII, groupIII), 0.1mg/ml Mit-C (groupIV, groupVII), 0.2mg/ml Mit-C (groupV, groupVIII) 0.5 mg/ml Mit-C (groupVI, groupIX). Macroscopic, microscopic, synovial sheath thickness and active fibroblast count were compared between the groups that underwent biomechanical stretching (groups III,V,VII,IX) and groups without biomechanical stretching (groups I,II,IV,VI,VIII). Results: After the macroscopic and microscopic examination, it was observed that the groups with the most adhesion were surgical control groups. The best results from the experimental groups were seen in group VIII, but the results of the groups were similar. When active fibroblast count was examined, it was seen that group VIII had the least active fibroblast count. Conclusion: According to the results of the evaluation, Mit-C, by inhibiting fibroblast proliferation and decreasing synovial sheath thickness, decreased adhesion formation. At the same time, it was concluded that the optimal dose for adhesion prevention was 0.2mg/ml, biomechanical stretching affected tendon histology and the drug was suitable for clinical studies

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Ultrasonic testing to measure the stress statement of steel parts

This paper presents an efficient method for stress measurement propagation. Pulse-echo method are used as stress measurement method on railway wheels. Hard service conditions and brake failures can lead to dangerous stress on the railway wheels. Stress measurements so important for wheels. Especially wheel expose to severe drag braking conditions in freight service. Residual stresses can significantly reduce the engineering properties and fatigue life of materials such as railway components. The paper presents results of stress state investigation of ER7 steel. Finally, the article briefly discusses how to adopt the pulse-echo method to railway wheels. Reducing cost of residual stress measurement investigated

Triple pelvic osteotomy for the treatment of symptomatic acetabular dysplasia in adolescents and adults: A review of 42 hips.

We treated 42 hips with symptomatic acetabular dysplasia using triple pelvic osteotomy. The mean age of the patients was 20.7 years (12–47). The median follow-up was 50.3 months. The average Harris hip score improved from 74 to 92 points. Significant improvement from the preoperative to the latest follow-up evaluation was seen radiologically with reference to the center-edge angle, the anterior center-edge angle, the acetabular index and the femoral head extrusion index. Shenton’s line was intact in 9 hips before the operation and it was intact in 40 hips at the latest follow-up. The cross-over sign was present in 15 hips before the operation and it was present in one hip after the operation. In 12 hips the severity of osteoarthritis had improved at the latest follow-up. The results of this study demonstrated that triple pelvic osteotomy provides improved radiographic results and good symptomatic relief in acetabular dysplasia

İntraartiküler propolis ekstraktının erişkin sıçanlarda deneysel osteoartrit tedavisinde etkinliği

Amaç: Eklem kıkırdağının kendini tamir edebilme yeteneği oldukça sınırlıdır. Dejeneratif osteoartrit (OA), eklemde özellikle eklem kıkırdağı ve subkondral kemikte ilerleyici dejenerasyonla karakterizedir. Bazı sitokinler, matriks metalloproteinazlarının (MMP) ve kondrosit kaynaklı katabolik maddelerin salınımını artırarak kıkırdak harabiyetini hızlandırırlar. Bal arıları tarafından üretilen propolis sitokinler ve MMP üzerinde etkiye sahiptir . Bu çalışma; intraartiküler propolis uygulanmasının deneysel osteoartrit üzerine etkilerini araştırmayı amaçlamaktadır. Yöntemler: Çalışmada kullanılan 21 adet Spraque Dawley cinsi dişi sıçan sadece artrotomi yapılan (A), artrotomi ve intraartiküler propolis uygulanan (P) ve artrotomi ve intraartiküler serum fizyolojik uygulanan (SF) olmak üzere üç gruba ayrıldı. P grubuna artrotomi sonrası 3. haftadan itibaren toplam üç hafta, haftada bir kez olacak şekilde 0.5 mg/ml konsantrasyondaki propolisten 0.1 ml intraartiküler verildi. SF grubuna ise P grubuyla aynı zamanlarda serum fizyolojik verildi. 6. hafta sonunda bütün sıçanlar servikal dislokasyon yoluyla sakrifiye edildi ve alınan diz eklemleri Safranin O-Fast Green ile boyanarak Mankin Skorlamasına göre histolojik olarak değerlendirildi. Bulgular: Yapılan histolojik skorlamada gruplardaki ortalama skorlar;A grubunda 0.57; SF grubunda 10.1 ve P grubunda ise 5.57 puan olarak hesaplanmıştır. A grubunda; eklem yüzeyi kıkırdak yapısının, boyanmasının ve hücrelerinin genel olarak normal olduğu görüldü. SF grubunda, kıkırdak yüzeyinde yarıklar; hücrelerinde ve matriks boyanmasında ciddi bozukluk mevcut olduğu gözlendi. P grubunda ise boyanmada azalma ve hücrelerde gruplaşmalar görülse de eklem yüzeyi SF grubuna göre daha düzgündü. Sonuç: İntraartikülerpropolisekstraktı uygulamasının deneysel OA oluşumunu azaltıcı etkisi olabilir

Giant cell tumor of the metacarpal bone in children: free osteoarticular metatarsal transfer: case report

WOS: 000345916500017PubMed: 25243983We present a successful total resection of metacarpal bone and nonvascularized joint transfer in a giant cell tumor of the fourth metacarpal bone in a 13-year-old girl. At the 6-year follow-up, a good functional outcome was achieved, with 85 degrees range of motion of the metacarpophalangeal joint and no clinical or radiographic evidence of tumor recurrence and no signs of degeneration of the joint. (C) 2014 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

Evaluation of the Relationship Between Histopathological Tissue Diagnosis and Endometrial Thickness in Cases with Postmenopausal Bleeding

OBJECTIVE: The investigation of the relationship between the endometrial sampling results and the endometrial thicknesses measured by transvaginal ultrasonography (TV-USG) in patients with postmenopausal bleeding. STUDY DESIGN: The results of 235 cases, where endometrial sampling has been made due to postmenopausal bleeding at the Diyarbakır Maternity and Pediatric Hospital between January 2013 and December 2013, have been evaluated retrospectively. RESULTS: In the findings, the mean age is 57.83±8.06 years and the mean parity is 7.73±3.26. In 126 of the findings (53.6%), the endometrial thickness in TV-USG is <5 mm (group 1), and in 109 (46.4%) the endometrial thickness in TV-USG is ≥5 mm (group 2). It has been observed that 53 (22.6%) of the cases have been diagnosed with atrophic endometrium, 43 (18.3%) with endometrial polyp, 34 (14.5%) with deficient material, 28 (11.9%) with secretory endometrium, 19 (8.1%) with proliferative endometrium, 16 (6.8%) with simple endometrial hyperplasia, 12 (5.1%) with irregular proliferative endometrium, 7 (3%) with complex endometrial hyperplasia, 3 (1.3%) with endometrial adenocarcinoma and 3 (1.3%) with endometritis. In Group 1, any abnormal histopathological (endometrial polyp, hyperplasia and adenocarcinoma) findings have not been identified. CONCLUSION: In cases with postmenopausal bleeding, endometrial sampling is important. Endometrial thickness measurement with TV-USG, which is a non-invasive technique, should be used as the first step in the evaluation of the cases. It appears that high parity ratios reduce the endometrium cancer risk