Skin preparation before hip replacement in emergency setting versus elective scheduled arthroplasty: Bacteriological comparative analysis

SummaryIntroductionHip arthroplasty needs to be performed in an emergency setting after intracapsular femur neck fracture, whereas pain makes preoperative skin preparation of the limb difficult and it may therefore be incomplete. To date no study has analyzed the patient's skin bacteriological status in these surgical conditions.HypothesisThe skin's bacterial flora is quantitatively and qualitatively different in the trauma context compared to an elective scheduled arthroplasty for chronic hip disease.Materials and methodsTwo groups of patients, undergoing hip arthroplasty and having the same preparation at the time of surgery but different skin preparation procedures the day before and the day of surgery, were prospectively compared: 30 patients operated on in an emergency setting for fracture (group A) had no skin preparation and 32 patients operated on in scheduled surgery (group B). Group A had no skin disinfection before going into surgery, whereas group B followed a predefined protocol the day before surgery. Skin samples were taken on gelose at three different stages of skin preparation at the time of surgery (before and after detersive cleaning, and at the end of the surgery) and on two sites (inguinal and greater trochanter). The bacteriological analysis took place after 48hours of incubation.ResultsBefore detersive cleaning, group A had 3.6times more bacteria than group B in the trochanter region and 2.7times more in the inguinal area. After detersive cleaning, the contamination rate in the trochanter area was similar in both groups (group A: 10%; group B: 12.5%), but different in the inguinal region (group A: 33%; group B: 3%; P=0.002). At the end of the surgery, no difference was identified. Coagulase-negative Staphylococcus and Bacillus cereus accounted for 44% and 37%, respectively, of the bacteria isolated. In addition, the frequency of pathogenic non-saprotrophic bacteria was higher in group A (38%) compared to group B (6%). At a mean follow-up of 9.7months (range: 8–11months), no infection of the surgical site was identified.ConclusionThe dermal flora is more abundant and different when the patient is managed in an emergency context. Although effective in the trochanter area, cutaneous detersive cleaning in the operating room is insufficient in the inguinal area and the frequency of pathogenic bacteria warrants identical rigor in preoperative preparation in all situations.Level of evidenceIII. Prospective case – control study

First observation of CO at 345 GHz in the atmosphere of Saturn with the JCMT. New constaints on its origin

International audienceWe have performed the first observation of the CO(3-2) spectral line in the atmosphere of Saturn with the James Clerk Maxwell Telescope. We have used a transport model of the atmosphere of Saturn to constrain the origin of the observed CO. The CO line is best-fit when the CO is located at pressures less than (15± 2) mbar with a mixing ratio of (2.5±0.6)×10-8 implying an external origin. By modelling the transport in Saturn's atmosphere, we find that a cometary impact origin with an impact 200-350 years ago is more likely than continuous deposition by interplanetary dust particles (IDP) or local sources (rings/satellites). This result would confirm that comet impacts are relatively frequent and efficient providers of CO to the atmospheres of the outer planets. However, a diffuse and/or local source cannot be rejected, because we did not account for photochemistry of oxygen compounds. Finally, we have derived an upper limit of 1×10-9 on the tropospheric CO mixing ratio

Scientific rationale of a Saturn probe mission

We describe the main scientific goals to be addressed by future in situ exploration of Saturn

Optical sideband generation up to room temperature with mid-infrared quantum cascade lasers

Room temperature sideband generation on an optical carrier is demonstrated using midinfrared quantum cascade lasers. This is achieved via an enhancement of the nonlinear susceptibility via resonant interband and intersubband excitations, compensating the large phase-mismatch

First results on Martian carbon monoxide from Herschel/HIFI observations

We report on the initial analysis of Herschel/HIFI carbon monoxide (CO) observations of the Martian atmosphere performed between 11 and 16 April 2010. We selected the (7-6) rotational transitions of the isotopes ^{13}CO at 771 GHz and C^{18}O at 768 GHz in order to retrieve the mean vertical profile of temperature and the mean volume mixing ratio of carbon monoxide. The derived temperature profile agrees within less than 5 K with general circulation model (GCM) predictions up to an altitude of 45 km, however, show about 12-15 K lower values at 60 km. The CO mixing ratio was determined as 980 \pm 150 ppm, in agreement with the 900 ppm derived from Herschel/SPIRE observations in November 2009.Comment: Accepted for publication in Astronomy and Astrophysics (special issue on HIFI first results); minor changes to match published versio

High order optical sideband generation with Terahertz quantum cascade lasers

Optical sidebands are generated by difference frequency mixing between a resonant bandgap near-infrared beam and a terahertz (THz) wave. This is realized within the cavity of a THz quantum cascade laser using resonantly enhanced non-linearities. Multiple order optical sidebands and conversion efficiencies up to 0.1% are shown