Periprosthetic joint infections in femoral neck fracture patients treated with hemiarthroplasty – should we use antibiotic-loaded bone cement?

BACKGROUND Hemiarthroplasty is the most common treatment in elderly patients with displaced intra-capsular femoral neck fracture (FNF). Prosthetic joint infection (PJI) is one of the most feared and frequent complications post-surgery because of the frail health status of these patients and the need for fast track surgery. Therefore, priorities should lie in effective preventive strategies to mitigate this burden. AIM To determine how much the implementation of the routine use of antibiotic-loaded bone cement (ALBC) as a relatively easy-to-apply amendment to the surgical practice reduces the infection rate in our hemiarthroplasty cohort. METHODS We retrospectively assessed all demographic, health status and treatment-related data of our FNF patients undergoing cemented hemiarthroplasty in the period from 2011 to 2017; 241 patients were further analyzed after exclusion of patients with cancer-related sequelae and those who died before the end of the 1-year observation period. The PJI rate as diagnosed on basis of the Musculoskeletal Infection Society (MSIS) criteria 2011 was determined for each included patient and compared in function of the bone cement used for hip stem fixation. Patients were split into a group receiving a plain bone cement in the period from January 2011 to June 2013 (non-ALBC group) and into a group receiving an ALBC in the period July 2013 to December 2017 (ALBC group). Data analysis was performed with statistical software. We further calculated the cost-efficacy of the implementation of routine use of ALBC in the second group balancing the in-hospital infection related treatment costs with the extra costs of use of ALBC. RESULTS In total 241 FNF patients who received cemented hemiarthroplasty in the period from January 2011 to January 2017 were eligible for inclusion in this retrospective study. There were 8 PJI cases identified in the ALBC group among n = 94 patients, whereas 28 PJI cases were observed in the non-ALBC group among n = 147 patients. The statistical analysis showed an infection risk reduction of 55.3% (in particular due to the avoidance of chronic delayed infections) in the ALBC group (95%CI: 6.2%-78.7%; P = 0.0025). The cost-evaluation analysis demonstrated a considerable cost saving of 3.500 € per patient, related to the implementation of routine use of ALBC in this group. CONCLUSION Use of ALBC is a potent infection preventive factor in FNF patients receiving cemented hemiarthroplasties. It was further found to be highly cost-effective.post-print314 K

Molecular and Antigenic Characterization of the Leishmania (Viannia) panamensis Kinetoplastid Membrane Protein-11

The kinetoplastid membrane protein 11 (KMP-11) has been recently described in Leishmania (Leishmania) donovani as a major component of the promastigote membrane. Two oligonucleotide primers were synthesized to PCR-amplify the entire coding region of New World Leishmania species. The Leishmania (Viannia) panamensis amplification product was cloned, sequenced and the putative amino acid sequence determined. A remarkably high degree of sequence homology was observed with the corresponding molecule of L. (L) donovani and L. (L) infantum (97% and 96%, respectively). Southern blot analysis showed that the KMP-11 locus is conformed by three copies of the gene. The L. (V) panamensis ORF was subsequently cloned in a high expression vector and the recombinant protein was induced and purified from Escherichia coli cultures. Immunoblot analysis showed that 80%, 77% and 100% sera from cutaneous, mucocutaneous and visceral leishmaniasis patients, respectively, recognized the recombinant KMP-11 protein. In a similar assay, 86% of asymptomatic Leishmania-infected individuals showed IgG antibodies against the rKMP-11. We propose that KMP-11 could be used as a serologic marker for infection and disease caused by Leishmania in America

Caracterización de dos proteínas metacíclicas de leishmania y su relación con la virulencia

<p class="MsoNormal"><span style="font-size: 8.5pt; font-family: Arial">Los parásitos de Leishmania durante su crecimiento tanto in vivo como in vitro se diferencian desde un estado no infectivo o poco infectivo hasta uno más infectivo. Este proceso de diferenciación está acompañado de cambios en la expresión de algunas moléculas. Entre las moléculas mejor estudiadas que experimentan modificaciones tanto cualitativas como cuantitativas en la expresión, durante este proceso de diferenciación, se encuentra un glicoconjugado de superficie denominado Lipofosfoglicano (Turco y Descoteaux, 1992) y una glicoproteína de superficie con actividad proteasa, denominada gp63 (Kweider, et al.1987). Posteriormente, empleando técnicas de hibridización substractiva, se han identificado los genes, Meta-1 (Nourbakhsh, et al., 1996) y Mat-1 (Brodin et al., 1992) los cuales se expresan preferencialmente o exclusivamente en el promastigote metacíclico infectivo. Poco se conoce sobre la función de estos dos genes en el ciclo de vida de Leishmania. Experimentos de gene-knockout para tratar de elucidar un posible papel del gen Meta-1 mostraron que no puede ser reemplazado dado que los dobles mutantes no fueron viables, sugiriendo el papel esencial de esta proteína, en promastigotes. Sin embargo, sobreexpresión de la proteína Meta-1 en promastigotes de L. amazonensis generó parásitos mas virulentos que los parásitos silvestres (Uliana et al., 1999).</span></p> <p class="MsoNormal"><span style="font-size: 8.5pt; font-family: Arial">En este estudio se describe la caracterización molecular de estos dos genes metacíclicos en Leishmania infantum. Además, se evaluará el papel de la proteína Meta-1 en la virulencia de Leishmania empleando la técnica de RNA antisentido. Para esto se clonará en orientación reversa el ORF de meta-1 junto con el 3’ UTR, amplificados por PCR a partir de un clon cósmido aislado de una librería de DNA genómico de L. infantum. Esta técnica ha sido empleada en Leishmania para evaluar función génica con buenos resultados (Chen, et al., 2000).</span></p&gt

Structural and fuctional analysis of two leishmania proteinsselectivelyexpressed in the metacyclic parasite stage with respect to virulence and infectivity

IP 1115-05-041-99the genus leishmania and shows a tendency to from dimers uponprotein expression / Marcel marin, Carlos;En: Leishmania molecular biology / Tropical health in thenewmillenium. (1 : 2000 agos. 20-25 : Cartagena de;Indias, Colombia). -- Medellin : PECET, 2000. -- ; 28 cm.;Muskus, Juan F. Alzate, Christof Berberich. -- En: Short communication. --no. 86 (2000); p. 431-435. -- The;metacyclic stage expressed meta-1 gene is conserved between oldand new world leishmania species / Christof;Berberich, Marcel Marin, Carlos Muskus. -- En: Mem inst oswaldocruz. -- Vol. 93, no. 6 (nov.- dic. 1998); p.;819-821. -- Metaciclogenesis: un proceso fundamental en labiologia de leishmania / Carlos Mokus, Marcel Marin;Villa. -- En: Biomedica. -- no. 22 (2002); p. 167-177. --Meta-1y mat-1,proteinas metaciclicas en;leishmania: clonacion, expresion y caracterizacion inmunologica/ Marcel Marin, Carlos Muskus, Christof;Berberich. -- En: Iatreia. -- Vol. 13, no. 2 (jun. 2000);p. 5-3120. ISSN:01210793. -- Caracterizacion de dos;proteinas metaciclicas de leishmania y su relacion con lavirulencia / Carlos Muskus, Marcel Marin, Christof;Berberich. -- En: Iatreia. -- Vol. 13 no.2 (jun. 2000); p.-53120. ISSN: 01210793.-- PONENCIA(S) EN CONGRESO:;Expression, localization and antigenic analysis of the metacyclic / MuskusCarlos, Marin Marcel, Alzate Juan;F., Berberich Christof. -- En: Organized by: hellenic pasteurinstitute turkisch siciety of parasitology;university of Crete / World dleish 2. (2001 may. : UniversityofCrete); -- Creta : On behalf of 20-24. -- The;metacyclic stage expressed genes meta-1 and mat-1 are conservedbetween old and new world leishmania species;and are antigenic components of the parasite / Christof Berberich, Marin Marcel, Mukus Carlos. -- En: Clone,;cure and control tropical health for the 21 st century / European congresson tropical medicine. (2 : 1998;sep.14 - 18 : University of Antioquia). -- Colombia : Federationof european sicieties for tropical medicine;1998. -- ; 28 cm. -- Meta-1 and mat-1 metacyclic proteinsin leishmania: cloning, expression and immunologic;characterization / Marin Marcel, Muskus Carlos, BerberichChristof. -- En:Leishmania molecular biology /;Tropical health in the new millenium. (1 : 2000 agos. 20-20,208333333333333Cartagena deIndias, Colombia). -- Medellin :;ARTICULO(S) EN REVISTA: The gene encoding the metacyclogenesisassociatedtranscript mat-1 is conserved in;PECET, 2000. -- ; 28 cm. -- Molecular characterization ofthemetacyclic stage protein meta-1 in leishmania;infantum / Carlos Muskus, Marcel Marin, Christof Bereberich. --En: Leishmania molecular biology / Tropical;health in the new millenium. (1 : 2000 agos. 20-25 : Cartagenade Indias,Colombia). -- Medellin : PECET,;2000. -- ; 28 cm. -- The gene encoding the metacyclogenesis associated transcript mat-1 is conserved in the;genus leishmania and shows tendency to form dimers in vitro /Muskus Carlos, Alzate juan F., Berberich C. -

Caracterización estructural y funcional de la proteína meta-cíclica, Meta-1 de Leishmania

<p>Los promastigotes de Leishmania se diferencian desde un estadio no<br />infectivo hasta un estadio metacíclico e infectivo y esta diferenciación se correlaciona con la expresión incrementada de un número de genes (1). Entre estos genes está el Meta-1, el cual fue inicialmente descrito en L. major (2) . Este gen es de copia única y codifica para una proteína de 11.5 Kda (3) cuya función es aún desconocida. En este trabajo se describe una caracterización de este gen y los resultados preliminares enfocados hacia la caracterización funcional de la proteína.</p><p> </p><p> </p&gt

RESEARCH NOTE - The Metacyclic Stage-expressed Meta-1 Gene is Conserved between Old and New World Leishmania Species

Leishmaniasis is an endemic disease in large parts of the world including Central and South America. The most prevalent species in Colombia belong to the complex Leishmania (Viannia) braziliensis and are responsible for the majority of cases of cutaneous, mucocutaneous and dissiminated cutaneous leishmaniasis. Cases of visceral leishmaniasis in Colombia, in contrast, are always caused by L. (Leishmania) infantum/chagasi