Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery.

Study designA literature review.ObjectivesAn evaluation of the contaminants prevalent on implants used for surgery and the aseptic methods being employed against them.MethodsPubMed was searched for articles published between 2000 and 2017 for studies evaluating the contaminants present on spine implants, and associated pre- and intraoperative implant processing and handling methodology suggested to avoid them. Systematic reviews, observational studies, bench-top studies, and expert opinions were included.ResultsEleven studies were identified whose major focus was the asepsis of implants to reduce the incidence of surgical site infection incidences during surgery. These studies measured the colony forming units of bacteria on sterilized implants and/or gloves from the surgeon, scrub nurse, and assistants, as well as reductions of surgical site infection rates in spine surgery due to changes in implant handling techniques. Additionally, the search included assessments of endotoxins and carbohydrates present on reprocessed implants. The suggested changes to surgical practice based on these studies included handling implants with only fresh gloves, keeping implants covered until the immediate time of use, reducing operating room traffic, avoiding reprocessing of implants (ie, providing terminally sterilized implants), and avoiding touching the implants altogether.ConclusionsBoth reprocessing (preoperative) and handling (intraoperative) of implants seem to lead to contamination of sterilized implants. Using a terminally sterilized device may mitigate reprocessing (preoperative implant prophylaxis), whereas the use of fresh gloves for handling each implant and/or a permanent shielding technique (intraoperative implant prophylaxis) could potentially avoid recontamination at the theatre

A unique modular implant system enhances load sharing in anterior cervical interbody fusion: a finite element study

BACKGROUND: The efficacy of dynamic anterior cervical plates is somewhat controversial. Screws in static-plate designs have a smaller diameter and can cut through bone under load. While not ideal, this unintended loosening can help mitigate stress shielding. Stand-alone interbody devices with integral fixation have large endplate contact areas that may inhibit or prevent loosening of the fixation. This study investigates the load sharing ability of a novel dynamic plate design in preventing the stress shielding of the graft material compared to the non-dynamic devices. METHODS: An experimentally validated intact C5-C6 finite element model was modified to simulate discectomy and accommodate implant-graft assembly. Four implant iterations were modeled; InterPlate titanium device with dynamic surface features (springs), InterPlate titanium non-dynamic device, InterPlate titanium design having a fully enclosed graft chamber, and the InterPlate design in unfilled PEEK having a fully enclosed graft chamber. All the models were fixed at the inferior-most surface of C6 and the axial displacement required to completely embed the dynamic surface features was applied to the model. RESULTS: InterPlate device with dynamic surface features induced higher graft stresses compared to the other design iterations resulting in uniform load sharing. The distribution of these graft stresses were more uniform for the InterPlate dynamic design. CONCLUSIONS: These results indicate that the dynamic design decreases the stress shielding by increasing and more uniformly distributing the graft stress. Fully enclosed graft chambers increase stress shielding. Lower implant material modulus of elasticity does not reduce stress shielding significantly

Role of serum interleukin-6 in deciding therapy for multidrug resistant oral lichen planus

Background: Oral lichen planus (OLP) is a T cell mediated immune response. T cells locally present in the involved tissues release cytokines like interleukin-6 (IL-6), which contributes to pathogenesis of OLP. Also IL-6 has been associated with multidrug resistance protein (MRP) expression by keratinocytes. Correspondingly, upregulation of MRP was found in OLP. We conducted this study to evaluate the effects of various drugs on serum IL-6 in OLP; and correlation of these effects with the nature of clinical response and resistance pattern seen in OLP lesions with various therapeutic modalities. Thus we evaluated the role of serum IL-6 in deciding therapy for multidrug resistant OLP. Material and Methods: Serum IL-6 was evaluated in 42 erosive OLP (EOLP) patients and 10 normal mucosa and 10 oral squamous cell carcinoma cases using ELISA technique. OLP patients were randomly divided into 3 groups of 14 patients each and were subjected to Pimecrolimus local application, oral Mycophenolate Mofetil (MMF) and Methotrexate (MTX) alongwith Pimecrolimus local application. IL-6 levels were evaluated before and after treatment. Results: Serum IL-6 levels were raised above 3pg/ml in 26.19% erosive OLP (EOLP) cases (mean- 3.72±8.14). EOLP (5%) cases with IL-6 levels above 5pg/ml were resistant in MTX group. However significant decrease in serum IL-6 corresponding with the clinical resolution was seen in MMF group. Conclusions: Significantly raised IL-6 levels in EOLP reflect the chronic inflammatory nature of the disease. As serum IL-6 levels significantly decreased in MMF group, correspondingly no resistance to treatment was noted. However with MTX there was no significant decrease in IL-6 and resistance to treatment was noted in some, especially plaque type lesions. Thus IL-6 can be a possible biomarker in deciding the best possible therapy for treatment resistant OLP

Circadian consequences of social organization in the ant species Camponotus compressus

The locomotor activity rhythm of different castes of the ant species Camponotus compressus was monitored individually under laboratory light/dark (LD) cycles, and under continuous darkness (DD). The colony of this ant species comprises two sexual castes, the queens and the males, and three worker castes, namely the major, media, and minor workers. The virgin males and virgin queens display rhythmic activity patterns, but the mated queens were arrhythmic while laying eggs, with the rhythmicity resuming soon after egg-laying. Under the LD regime, major workers showed nocturnal patterns, while about 75% of the media workers displayed nocturnal patterns and about 25% showed diurnal patterns. Under the DD regime, most major workers exhibited circadian rhythm of activity with a single steady state, whereas media workers displayed two types of activity patterns, with activity patterns changing after 6-9 days in DD (turn-arounds). The pre-turn-around τ of the ants that showed nocturnal activity patterns during LD entrainment was <24 h after release into DD, which then became >24 h, after 6-9 days. On the other hand, the pre-turn-around τ of those ants that exhibited diurnal patterns during LD entrainment was first >24 h after release into DD, and then became <24 h, after 6-9 days. The activity of the minor workers neither entrained to LD cycles nor showed any sign of free-run in DD. It appears that the circadian clocks of the ant species C. compressus are flexible, and may perhaps depend upon the tasks assigned to them in the colony

Convalescent plasma a tool to treat or a reason to retreat in COVID-19 infection: a systematic review and meta-analysis

For management of Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, different therapeutic approaches are being given for mitigating symptoms that reduce hospital and intensive care unit (ICU) stay and decreasing the mortality. Convalescent plasma therapy is among one of the therapeutic approaches and to determine its effect on COVID-19, we aggregated patient outcome data from 8 randomized clinical trials (RCT). Studies published between 01 January 2020 to 28 February 2021 were identified via a thorough systematic search of PubMed, Embase, Medline and preprint platforms MedRxiv databases and data was analysed for its efficacy. Random-effects analyses of RCT demonstrated that COVID-19 patients who received convalescent plasma therapy along with standard of care showed a similar mortality rate when compared to patients receiving only standard of care treatments. Additional data showed that these data doesn’t provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized COVID-19 patients

Open reduction of carpometacarpal fracture dislocations: a case report

Dislocations of the carpometacarpal (CMC) joints are uncommon injuries. Up to 70% of carpometacarpal dislocations are missed or misdiagnosed. Post traumatic dislocation of carpal and CMC joint results most commonly due to high energy trauma. A 24 year old male with right hand dominant presented 5 days after in emergency room with alleged history of fall from 4 feet height on right hand with wrist in extension. On clinical examination revealed marked swelling over dorsum of right hand with wound over volar aspect of hand. There was minimal movement of fingers due to pain. There was no finger paresthesia. CRT was normal. Radiography revealed a volar dislocation of 2nd to 5th CMC joint with intra-articular fracture of base of proximal phalanx of the thumb. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at 6 months of follow-up

In-vitro scolicidal activity of Mallotus philippinensis (Lam.) Muell Arg. fruit glandular hair extract against hydatid cyst Echinococcus granulosus

AbstractObjectiveTo investigate new scolicidal agent from natural resources to cope with the side effects associated with synthetic drugs in Echinococcosis.MethodsThe scolicidal potential of methanolic fruit powder extract (10 and 20 mg/mL) of Mallotus philippinensis (M. philippinensis) was investigated. Viability of protoscoleces was confirmed by trypan blue exclusion method, where mortality was observed at concentration of 10 and 20 mg/mL in 60 min treatment against Echinococcus granulosus (E. granulosus), under in-vitro conditions with reference to the known standard drug Praziquantel®.ResultsAt concentration 10 and 20 mg/mL, the mortality rate was observed 97% and 99% respectively for 60 min treatment; while up to 93% mortality was observed with 20 mg/mL for only 10 min treatment. The concentration above 20 mg/mL for above 2 h showed 100% mortality, irrespective of further incubation.ConclusionsAs compared with the standard anti-parasitic drug Praziquantel our extract has significant scolicidal activity with almost no associated side effects

A new lumbar fixation device alternative to pedicle-based stabilization for lumbar spine: In vitro cadaver investigation

Context: To evaluate the stability provided by a new bilateral fixation technique using an in vitro investigation for posterior lumbar segmental instrumentation. Design: Experimental cadaver study. In this study, we propose an alternative technique for a posterior lumbar fixation technique called “inferior-oblique transdiscal fixation” (IOTF). Setting: Study performed at Engineering Center for Orthopedic Research Exellence (ECORE) in Toledo University-Ohio. Participants: Six human lumbar cadaveric specimen used in this study. Interventions: In this study, we propose an alternative technique for a posterior lumbar fixation technique called “inferior-oblique transdiscal fixation” (IOTF). As a novel contribution to the classical technique, the entry point of the screw is the supero-lateral point of the intersecting line drawn between the corpus and the pedicle of the upper vertebra. This approach enables the fixation of two adjacent vertebrae using a single screw on each side without utilizing connecting rods. Outcome Measures: Flexion (Flex), extension (Ext), right and left lateral bending (LB & RB), and right and left axial rotation (LR & RR), and the position data were captured at each load step using the Optotrak motion measurement system and compared for IOTF and posterior transpedicular stabilization. Results: The Posterior stabilization system (PSS) and IOTF significantly reduced the ROM of L4-L5 segment compared to intact segment’s ROM. During axial rotation (AR) IOTF fused index segment more than PSS. Besides this, addition of transforaminal lumbar interbody fusion (TLIF) cage improved the stabilization of IOTF system during flexion, extension and lateral bending. Whereas, PSS yielded better fusion results during extension compared to IOTF with and without interbody fusion cages. Conclusions: We hypothesized that the new posterior bilateral system would significantly decrease motion compared to the intact spine. This cadaver study showed that the proposed new posterior fusion technique IOTF fused the index segment in a similar fashion to the classical pedicle screw fusion technique.National Science Foundation (NSF)University of Toledo, Toledo, O

Do design variations in the artificial disc influence cervical spine biomechanics? A finite element investigation

Various ball and socket-type designs of cervical artificial discs are in use or under investigation. Many artificial disc designs claim to restore the normal kinematics of the cervical spine. What differentiates one type of design from another design is currently not well understood. In this study, authors examined various clinically relevant parameters using a finite element model of C3–C7 cervical spine to study the effects of variations of ball and socket disc designs. Four variations of ball and socket-type artificial disc were placed at the C5–C6 level in an experimentally validated finite element model. Biomechanical effects of the shape (oval vs. spherical ball) and location (inferior vs. superior ball) were studied in detail. Range of motion, facet loading, implant stresses and capsule ligament strains were computed to investigate the influence of disc designs on resulting biomechanics. Motions at the implant level tended to increase following disc replacement. No major kinematic differences were observed among the disc designs tested. However, implant stresses were substantially higher in the spherical designs when compared to the oval designs. For both spherical and oval designs, the facet loads were lower for the designs with an inferior ball component. The capsule ligament strains were lower for the oval design with an inferior ball component. Overall, the oval design with an inferior ball component, produced motion, facet loads, implant stresses and capsule ligament strains closest to the intact spine, which may be key to long-term implant survival