Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial.

OBJECTIVES: Wound complications are reported in up to 10% hip and knee arthroplasties and there is a proven association between wound complications and deep prosthetic infections. In this randomised controlled trial (RCT) we explore the potential benefits of a portable, single use, incisional negative pressure wound therapy dressing (iNPWTd) on wound exudate, length of stay (LOS), wound complications, dressing changes and cost-effectiveness following total hip and knee arthroplasties. METHODS: A total of 220 patients undergoing elective primary total hip and knee arthroplasties were recruited into in a non-blinded RCT. For the final analysis there were 102 patients in the study group and 107 in the control group. RESULTS: An improvement was seen in the study (iNPWTd) group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced (p = 0.007). Overall LOS reduction (0.9 days, 95% confidence interval (CI) -0.2 to 2.5) was not significant (p = 0.07) but there was a significant reduction in patients with extreme values of LOS in the iNPWTd group (Moses test, p = 0.003). There was a significantly reduced number of dressing changes (mean difference 1.7, 95% CI 0.8 to 2.5, p = 0.002), and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (8.4% control; 2.0% iNPWTd, p = 0.06). CONCLUSIONS: Based on the results of this RCT incisional negative pressure wound therapy dressings have a beneficial role in patients undergoing primary hip and knee arthroplasty to achieve predictable length of stay, especially to eliminate excessive hospital stay, and minimise wound complications.Cite this article: S. L. Karlakki, A. K. Hamad, C. Whittall, N. M. Graham, R. D. Banerjee, J. H. Kuiper. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res 2016;5:328-337. DOI: 10.1302/2046-3758.58.BJR-2016-0022.R1

Genotypic variation in phosphorus efficiency between wheat cultivars grown under greenhouse and field conditions

Phosphorus (P) efficiency (relative growth), which is described as the ratio of shoot dry matter or grain yield at deficient P supply to that obtained under adequate P supply, was compared in 25 winter wheat cultivars grown under greenhouse and field conditions with low and adequate P levels in a P-deficient calcareous soil. Adequate P supply resulted in significant increases in shoot dry weight and grain yield under both experimental conditions. In the greenhouse experiment, the increases in shoot dry weight under adequate P supply (80 mg kg(-1)) were from 0% (cv: C-1252) to 34% (cv: Dagdas). Under field conditions, the cultivars showed much greater variation in their response to adequate P supply (60 kg ha(-1)): the increases in shoot dry weight and grain yield with adequate P supply were between -2% (cv: Sivas-111/33) and 25% (cv: Kirac-66) for shoot dry matter production at the heading stage and between 0% (cv: Kirkpinar-79) and 76% (cv: Kate A-1) for grain yield at maturity. Almost all cultivars behaved totally different in their response to P deficiency under greenhouse and field conditions. Phosphorus efficiency ratios (relative growth) under greenhouse conditions did not correlate with the P efficiency ratios under field conditions. In general, durum wheat cultivars were found to be more P efficient compared with bread wheat cultivars. The results of this study indicated that there is wide variation in tolerance to P deficiency among wheat cultivars that can be exploited in breeding new wheat cultivars for high P deficiency tolerance. The results also demonstrated that P efficiency was expressed differently among the wheat cultivars when grown under greenhouse and field conditions and, therefore, special attention should be paid to growth conditions in screening wheat for P efficiency

Human Female Genital Tract Infection by the Obligate Intracellular Bacterium Chlamydia trachomatis Elicits Robust Type 2 Immunity

While Chlamydia trachomatis infections are frequently asymptomatic, mechanisms that regulate host response to this intracellular Gram-negative bacterium remain undefined. This investigation thus used peripheral blood mononuclear cells and endometrial tissue from women with or without Chlamydia genital tract infection to better define this response. Initial genome-wide microarray analysis revealed highly elevated expression of matrix metalloproteinase 10 and other molecules characteristic of Type 2 immunity (e.g., fibrosis and wound repair) in Chlamydia-infected tissue. This result was corroborated in flow cytometry and immunohistochemistry studies that showed extant upper genital tract Chlamydia infection was associated with increased co-expression of CD200 receptor and CD206 (markers of alternative macrophage activation) by endometrial macrophages as well as increased expression of GATA-3 (the transcription factor regulating TH2 differentiation) by endometrial CD4+ T cells. Also among women with genital tract Chlamydia infection, peripheral CD3+ CD4+ and CD3+ CD4- cells that proliferated in response to ex vivo stimulation with inactivated chlamydial antigen secreted significantly more interleukin (IL)-4 than tumor necrosis factor, interferon-γ, or IL-17; findings that repeated in T cells isolated from these same women 1 and 4 months after infection had been eradicated. Our results thus newly reveal that genital infection by an obligate intracellular bacterium induces polarization towards Type 2 immunity, including Chlamydia-specific TH2 development. Based on these findings, we now speculate that Type 2 immunity was selected by evolution as the host response to C. trachomatis in the human female genital tract to control infection and minimize immunopathological damage to vital reproductive structures. © 2013 Vicetti Miguel et al

A Case Study of Eukaryogenesis: The Evolution of Photoreception by Photolyase/Cryptochrome Proteins

Eukaryogenesis, the origin of the eukaryotes, is still poorly understood. Herein, we show how a detailed all-kingdom phylogenetic analysis overlaid with a map of key biochemical features can provide valuable clues. The photolyase/cryptochrome family of proteins are well known to repair DNA in response to potentially harmful effects of sunlight and to entrain circadian rhythms. Phylogenetic analysis of photolyase/cryptochrome protein sequences from a wide range of prokaryotes and eukaryotes points to a number of horizontal gene transfer events between ancestral bacteria and ancestral eukaryotes. Previous experimental research has characterised patterns of tryptophan residues in these proteins that are important for photoreception, specifically a tryptophan dyad, a canonical tryptophan triad, an alternative tryptophan triad, a tryptophan tetrad and an alternative tetrad. Our results suggest that the spread of the different triad and tetrad motifs across the kingdoms of life accompanied the putative horizontal gene transfers and is consistent with multiple bacterial contributions to eukaryogenesis

Homeosis in a scorpion supports a telopodal origin of pectines and components of the book lungs

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated

Casting Light on Dark Matter

The prospects for detecting a candidate supersymmetric dark matter particle at the LHC are reviewed, and compared with the prospects for direct and indirect searches for astrophysical dark matter. The discussion is based on a frequentist analysis of the preferred regions of the Minimal supersymmetric extension of the Standard Model with universal soft supersymmetry breaking (the CMSSM). LHC searches may have good chances to observe supersymmetry in the near future - and so may direct searches for astrophysical dark matter particles, whereas indirect searches may require greater sensitivity, at least within the CMSSM.Comment: 16 pages, 13 figures, contribution to the proceedings of the LEAP 2011 Conferenc

The Formation of Orthogonal Balanced Experiment Designs Based on Special Block Matrix Operations on the Example of the Mathematical Modeling of the Pneumatic Gravity Seed Separator

The article describes solving the task of building a mathematical model of the pneumatic gravity seed separator by organizing an effective scheme for conducting (plan) experiments with a sufficiently large number of levels of factors and, simultaneously, a small number of experiments. The construction of a planning matrix, which has specified properties, provides a fairly high level of experimental research efficiency. For this purpose, proposed an algorithm for constructing a balanced orthogonal plan of the mn experiment, optimal by the criterion of D-efficiency. The point of the algorithm is to build a special balanced matrix by performing an operation of the Kronecker product in relation to some basis matrix and the subsequent implementation of block summation matrices. Based on the proposed algorithm, was constructed a balanced matrix of an experiment plan by 55 types, consisting of 25 experiments. On the grounds of the offered algorithm, implemented the experiment and constructed a mathematical model. Based on the mathematical model, was determined the optimal values of the parameters of the pneumatic gravity seed separator. The optimal values of the parameters found on the basis of a mathematical model are confirmed experimentally

The failure of suicide prevention in primary care: family and GP perspectives - a qualitative study

Background Although Primary care is crucial for suicide prevention, clinicians tend to report completed suicides in their care as non-preventable. We aimed to examine systemic inadequacies in suicide prevention from the perspectives of bereaved family members and GPs.Methods Qualitative study of 72 relatives or close friends bereaved by suicide and 19 General Practitioners who have experienced the suicide of patients.Results Relatives highlight failures in detecting symptoms and behavioral changes and the inability of GPs to understand the needs of patients and their social contexts. A perceived overreliance on anti-depressant treatment is a major source of criticism by family members. GPs tend to lack confidence in the recognition and management of suicidal patients, and report structural inadequacies in service provision.Conclusions Mental health and primary care services must find innovative and ethical ways to involve families in the decision-making process for patients at risk of suicide

Axion Protection from Flavor

The QCD axion fails to solve the strong CP problem unless all explicit PQ violating, Planck-suppressed, dimension n<10 operators are forbidden or have exponentially small coefficients. We show that all theories with a QCD axion contain an irreducible source of explicit PQ violation which is proportional to the determinant of the Yukawa interaction matrix of colored fermions. Generically, this contribution is of low operator dimension and will drastically destabilize the axion potential, so its suppression is a necessary condition for solving the strong CP problem. We propose a mechanism whereby the PQ symmetry is kept exact up to n=12 with the help of the very same flavor symmetries which generate the hierarchical quark masses and mixings of the SM. This "axion flavor protection" is straightforwardly realized in theories which employ radiative fermion mass generation and grand unification. A universal feature of this construction is that the heavy quark Yukawa couplings are generated at the PQ breaking scale.Comment: 16 pages, 2 figure