Multidisciplinary Diagnostic Algorithm for Evaluation of Patients Presenting with a Prosthetic Problem in the Hip or Knee:A Prospective Study

The predominant indications for revision surgery after total hip (THA) or knee arthroplasty (TKA) are an aseptic failure (AF) and prosthetic joint infection (PJI). Accurate diagnosis is crucial. Therefore, we evaluated prospectively a multidisciplinary diagnostic algorithm including multi-modal radionucleid imaging (RNI) and extended microbiological diagnostics. If the surgeon suspected PJI or AF, revision surgery was performed with multiple samples obtained in parallel for special culture procedures and later molecular analyses. Alternatively, if the underlying cause was not evident, RNI was scheduled comprising 99Tc—HDP SPECT/CT, 111In-labeled white blood cells combined with 99Tc-nanocoll bone marrow SPECT/CT, and 18F-FDG PET/CT. A multidisciplinary clinical team made a recommendation on the indication for a diagnostic procedure guided by RNI images or revision surgery. A total of 156 patients with 163 arthroplasties were included. Fifty-five patients underwent RNI. In all, 118 revision surgeries were performed in 112 patients: 71 on the indication of AF and 41 revision of PJI. Thirty-four patients were concluded with chronic pain, and revision surgery refrained. The effective median follow-up period was 13 months. A structured approach offered by the algorithm was useful for the clinician in the evaluation of patients with a failing TKA or THA. Surgical revision was possibly obviated in approximately 20% of patients where an explanation or cause of failure was not found. The algorithm served as an effective tool

Differential contributions of specimen types, culturing, and 16S rRNA sequencing in diagnosis of prosthetic joint infections

ABSTRACT Prosthetic joint failure is mainly caused by infection, aseptic failure (AF), and mechanical problems. Infection detection has been improved with modified culture methods and molecular diagnostics. However, comparisons between modified and conventional microbiology methods are difficult due to variations in specimen sampling. In this prospective, multidisciplinary study of hip or knee prosthetic failures, we assessed the contributions of different specimen types, extended culture incubations, and 16S rRNA sequencing for diagnosing prosthetic joint infections (PJI). Project specimens included joint fluid (JF), bone biopsy specimens (BB), soft-tissue biopsy specimens (STB), and swabs (SW) from the prosthesis, collected in situ , and sonication fluid collected from prosthetic components (PC). Specimens were cultured for 6 (conventional) or 14 days, and 16S rRNA sequencing was performed at study completion. Of the 156 patients enrolled, 111 underwent 114 surgical revisions (cases) due to indications of either PJI ( n = 43) or AF ( n = 71). Conventional tissue biopsy cultures confirmed PJI in 28/43 (65%) cases and refuted AF in 3/71 (4%) cases; one case was not evaluable. Based on these results, minor diagnostic adjustments were made. Fourteen-day cultures of JF, STB, and PC specimens confirmed PJI in 39/42 (93%) cases, and 16S rRNA sequencing confirmed PJI in 33/42 (83%) cases. One PJI case was confirmed with 16S rRNA sequencing alone and five with cultures of project specimens alone. These findings indicated that JF, STB, and PC specimen cultures qualified as an optimal diagnostic set. The contribution of sequencing to diagnosis of PJI may depend on patient selection; this hypothesis requires further investigation. </jats:p

Data from: Species distribution models of the Spotted Wing Drosophila (Drosophila suzukii, Diptera: Drosophilidae) in its native and invasive range reveal an ecological niche shift

The Spotted Wing Drosophila (Drosophila suzukii) is native to Southeast Asia. Since its first detection in 2008 in Europe and North America, it has been a pest to the fruit production industry as it feeds and oviposits on ripening fruit. Here we aim to model the potential geographical distribution of D. suzukii. We performed an extensive literature review to map the current records. In total 517 documented occurrences (96 native and 421 invasive) was identified spanning 52 countries. Next, we constructed three species distribution models (SDMs) based on occurrence records in: 1) the native range (SDMnative), 2) the invasive range in Europe (SDMEurope) and 3) a global model of all records (SDMglobal). The models aimed to investigate, whether this species will be able to occupy additional ecological niches beyond its native range and expand its current geographic distribution both globally and in Europe. The SDMs were generated using Maximum Entropy algorithms (Maxent) based on present occurrence records and bioclimatic variables (WorldClim). Predictions of habitat suitability vary greatly depending on origins of occurrence records. According to all models, precipitation and low temperatures were key limiting factors for the distribution of D. suzukii, which suggests that this species requires a humid environment with mild winters in order to establish a permanent population in its invasive range. Several regions in the invasive range, not presently occupied by this species, were predicted highly suitable, especially in northern Europe, suggesting that D. suzukii is not occupying its full fundamental niche yet. Synthesis and applications. Based on these models of potential geographic distribution of the Spotted Wing Drosophila (Drosophila suzukii), we show a shift in the ecological niche in D. suzukii populations, emphasizing the importance of using presence and local environmental data. Further investigation regarding new occurrences is recommended to secure optimal pest management. Despite a continuing expansion, many countries still lack proper surveillance schemes, and we urge policy makers to initiate appropriate management programs

Occurrence records of Drosophila suzukii

Microsoft Excel spreadsheet with two worksheets (tabs). First sheet: Information about all 517 occurrence records used in the study, as obtained through extensive literature review and through mining online databases, e.g. Taxodros (http://www.taxodros.uzh.ch) and European and Mediterranean Plant Protection Organization (EPPO - https://www.eppo.int). Columns describe: country, state or region (if applicable), latitude, longitude, the year of the first observation at the specific site (if available), status, and references. Regarding the status we distinguish between: widespread, present, restricted distribution, and few occurrences similar to the EPPO and the National Plant Protection Organizations (NPPOs) of the International Plant Protection Convention (IPPC: https://www.ippc.int/en/news/tag/nppo/). In most information sources, GPS coordinates of occurrences were given, but in the cases where direct coordinates could not be obtained, the GPS coordinates were identified from geographic sites, e.g. cities, lakes, etc. outlined in the studies. Some recent occurrences were only listed as a rather imprecise geographic location such as a country in some databases (e.g. Toxodros). In all cases, the original literature was mined for precise information on the distributions of individual occurrences. Second sheet: Reference list of all occurrence dat

Data from: Species distribution models of the Spotted Wing Drosophila (Drosophila suzukii, Diptera: Drosophilidae) in its native and invasive range reveal an ecological niche shift

The Spotted Wing Drosophila (Drosophila suzukii) is native to Southeast Asia. Since its first detection in 2008 in Europe and North America, it has been a pest to the fruit production industry as it feeds and oviposits on ripening fruit. Here we aim to model the potential geographical distribution of D. suzukii. We performed an extensive literature review to map the current records. In total, 517 documented occurrences (96 native and 421 invasive) were identified spanning 52 countries. Next, we constructed three species distribution models (SDMs) based on occurrence records in: 1) the native range (SDMnative), 2) the invasive range in Europe (SDMEurope) and 3) a global model of all records (SDMglobal). The models aimed to investigate, whether this species will be able to occupy additional ecological niches beyond its native range and expand its current geographic distribution both globally and in Europe. The SDMs were generated using Maximum Entropy algorithms (Maxent) based on present occurrence records and bioclimatic variables (WorldClim). Predictions of habitat suitability vary greatly depending on the origins of occurrence records. According to all models, precipitation and low temperatures were key limiting factors for the distribution of D. suzukii, which suggests that this species requires a humid environment with mild winters in order to establish a permanent population in its invasive range. Several regions in the invasive range, not presently occupied by this species, were predicted highly suitable, especially in northern Europe, suggesting that D. suzukii is not occupying its full fundamental niche yet. Synthesis and applications. Based on these models of potential geographic distribution of the Spotted Wing Drosophila (Drosophila suzukii), we show a shift in the ecological niche in D. suzukii populations, emphasizing the importance of using presence and local environmental data. Further investigation regarding new occurrences is recommended to secure optimal pest management. Despite a continuing expansion, many countries still lack proper surveillance schemes, and we urge policymakers to initiate appropriate management programs