Time-dependent surgical instrument contamination begins earlier in the uncovered table than in the covered table

Purpose: Time-dependent surgical instrument contamination and the effect of covering during arthroplasty have not been investigated. This study aimed to evaluate time-dependent contamination of surgical instruments and the effect of covering on contamination as well as to perform bacterial typing of contaminated samples. The hypothesis was that covering the surgical instruments would decrease contamination rates. Methods: Sixty patients who underwent total knee arthroplasty were randomized and divided into two groups: surgical instruments covered with a sterile towel or surgical instruments left uncovered. K-wires were used to extract microbiological samples. The K-wires were placed in a liquid culture medium at 0, 15, 30, 60, 90, and 120 min. After 24-h incubation period, samples from liquid cultures were cultured on blood agar using swabs. Samples with growth after 48 h were considered contaminated. Microscopic, staining, and biochemical properties were used for bacterial typing. Results: Bacterial growth started after 30 and 60 min in the uncovered and covered groups, respectively. An increase in the number of K-wires contaminated with time was detected. At least 10,000 CFU/mL bacterial load was observed in the culture samples. Contamination was more significant in the uncovered group. A statistically significant difference in contamination was found between the uncovered and covered groups at 30-, 60-, 90-, and 120 min (p = 0.035, p = 0.012, p = 0.024, and p = 0.037, respectively). The most common bacteria on the contaminated instruments were coagulase-negative Staphylococci (60.4%), Staphylococcus aureus (22.9%), and Streptococcus agalactia (16.7%), respectively. Conclusion: The risk of contamination increases with time. However, it may decrease if surgical instruments are covered. In the clinical practice, empiric antibiotic regimens based on the type of identified microorganisms in this study may be developed for postoperative periprosthetic joint infection prophylaxis. Level of evidence: Prognostic, Level II. © 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA)

Comparative effectiveness of Glycyrrhiza glabra vs. omeprazole and misoprostol for the treatment of aspirin-induced gastric ulcers

The aim of the study was to evaluate the comparative effectiveness of Glycyrrhiza glabra (liquorice) root decoction vs. omeprazole and misoprostol for the treatment of aspirin-induced gastric ulcers in rats. Animals were randomly assigned first to the "prophylaxis" and "treatment" groups and then to the test and the control groups. Liquorice decoction (25 ml/kg; i.g.); omeprazole (2.3 mg/kg; i.p.) and misoprostol (50 mu g/kg; i.g.) were administered for 3 consecutive days 30 min before aspirin (200 mg/kg, i.g.) administration, in the prophylaxis group. In the treatment group, aspirin (200 mg/kg, i.g.) was administered for 3 consecutive days, and then other drugs were administered at the same doses as the prophylaxis group daily for 4 weeks. According to histopathologic evaluation, misoprostol showed significant protection; however, liquorice decoction and omeprazole failed to protect. In the treatment group histopathological examinations showed no significant difference among liquorice decoction, misoprostol and omeprazole regarding aspirin-induced ulcer treatment; ulcers in all treatment groups were completely cured. The results of this study suggest that Glycyrrhiza glabra can be used for the treatment of NSAID-induced ulcers as an inexpensive alternative to misoprostol and omeprazole

Reference intervals for growth arrest-specific 6 protein in adults

The objective of this study was to establish reference intervals for growth arrest-specific 6 (GAS6), a vitamin K-dependent protein, in human adult plasma according to the Guideline of Clinical and Laboratory Standards Institute (CLSI) C28-A3. Blood samples were collected from 308 healthy volunteers aged 18-72 (157 female, 151 male). A non-parametric approach was used to calculate the reference interval. The plasma GAS6 reference interval was determined, with 90% confidence interval: the lower limit (2.5 percentile) was 2.5 (1.9-3.1) g/L and the upper limit (97.5 percentile)=18.8 (18.0-22.3) g/L. Harris-Boyd's test did not suggest partitioning by age or gender: medians for males [7.8 (5.8-10.7) g/L] and females [9.9 (7.1-13.5) g/L]. Three age-subgroups were tested: 18-29 years (n=168); 30-44 years (n=73); 45-72 years (n=67). The intra- and inter-assay variations were 12.6% (mean, 5.2 +/- 0.7g/L) and 14.0% (mean, 9.2 +/- 1.3g/L), respectively. The mean recovery was 104%. This study reports plasma GAS6 reference intervals established first according to the guideline of CLSI C28-A3