Risk of septic knee following retrograde intramedullary nailing of open and closed femur fractures

<p>Abstract</p> <p>Background</p> <p>One potential complication of retrograde femoral nailing in the treatment of femur fractures is the risk of septic knee. This risk theoretically increases in open fractures as a contaminated fracture site has the potential to seed the instrumentation being passed in and out of the sterile intraarticular starting point. There are few studies examining this potential complication in a relatively commonly practiced technique.</p> <p>Methods</p> <p>All patients who received a retrograde femoral nail for femur fracture between September 1996 and November 2006 at a Level 1 trauma center were retrospectively reviewed. This yielded 143 closed fractures, 38 open fractures and 4 closed fractures with an ipsilateral traumatic knee arthrotomy. Patient follow-up records were reviewed for documentation of septic knee via operative notes, wound culture or knee aspirate data, or the administration of antibiotics for suspected septic knee.</p> <p>Results</p> <p>No evidence of septic knee was found in the 185 fractures examined in the dataset. Utilizing the Wilson confidence interval, the rate of septic knee based on our population was no greater than 2%, with that of the open fracture group alone being 9%.</p> <p>Conclusions</p> <p>Based on these results and review of the literature, the risk of septic knee in retrograde femoral nailing of both open and closed femoral shaft fractures appears low but potentially not insignificant.</p> <p>Funding</p> <p>There was no outside source of funding from either industry or other organization for this study.</p

Comparison of family health history in surveys vs electronic health record data mapped to the observational medical outcomes partnership data model in the All of Us Research Program

OBJECTIVE: Family health history is important to clinical care and precision medicine. Prior studies show gaps in data collected from patient surveys and electronic health records (EHRs). The All of Us Research Program collects family history from participants via surveys and EHRs. This Demonstration Project aims to evaluate availability of family health history information within the publicly available data from All of Us and to characterize the data from both sources. MATERIALS AND METHODS: Surveys were completed by participants on an electronic portal. EHR data was mapped to the Observational Medical Outcomes Partnership data model. We used descriptive statistics to perform exploratory analysis of the data, including evaluating a list of medically actionable genetic disorders. We performed a subanalysis on participants who had both survey and EHR data. RESULTS: There were 54 872 participants with family history data. Of those, 26% had EHR data only, 63% had survey only, and 10.5% had data from both sources. There were 35 217 participants with reported family history of a medically actionable genetic disorder (9% from EHR only, 89% from surveys, and 2% from both). In the subanalysis, we found inconsistencies between the surveys and EHRs. More details came from surveys. When both mentioned a similar disease, the source of truth was unclear. CONCLUSIONS: Compiling data from both surveys and EHR can provide a more comprehensive source for family health history, but informatics challenges and opportunities exist. Access to more complete understanding of a person\u27s family health history may provide opportunities for precision medicine

Severity of Giardia infection associated with post-infectious fatigue and abdominal symptoms two years after

<p>Abstract</p> <p>Background</p> <p>A high rate of post-infectious fatigue and abdominal symptoms two years after a waterborne outbreak of giardiasis in Bergen, Norway in 2004 has previously been reported. The aim of this report was to identify risk factors associated with such manifestations.</p> <p>Methods</p> <p>All laboratory confirmed cases of giardiasis (n = 1262) during the outbreak in Bergen in 2004 received a postal questionnaire two years after. Degree of post-infectious abdominal symptoms and fatigue, as well as previous abdominal problems, was recorded. In the statistical analyses number of treatment courses, treatment refractory infection, delayed education and sick leave were used as indices of protracted and severe <it>Giardia </it>infection. Age, gender, previous abdominal problems and symptoms during infection were also analysed as possible risk factors. Simple and multiple ordinal logistic regression models were used for the analyses.</p> <p>Results</p> <p>The response rate was 81% (1017/1262), 64% were women and median age was 31 years (range 3-93), compared to 61% women and 30 years (range 2-93) among all 1262 cases. Factors in multiple regression analysis significantly associated with abdominal symptoms two years after infection were: More than one treatment course, treatment refractory infection, delayed education, bloating and female gender. Abdominal problems prior to <it>Giardia </it>infection were not associated with post-infectious abdominal symptoms. More than one treatment course, delayed education, sick leave more than 2 weeks, and malaise at the time of infection, were significantly associated with fatigue in the multiple regression analysis, as were increasing age and previous abdominal problems.</p> <p>Conclusion</p> <p>Protracted and severe <it>giardiasis </it>seemed to be a risk factor for post-infectious fatigue and abdominal symptoms two years after clearing the <it>Giardia </it>infection.</p

CHEMICAL CONTROL OF ANDROSPORE MORPHOGENESIS IN OEDOGONIUM DONNELLII (CHLOROPHYTA, OEDOGONIALES)1

ABSTRACT Under the influence of the pheromone, “circein,” produced by an oogonial mother cell of Oedogonium donnellii Wolle, the androspore of the same species progresses through several behavioral changes and a series of developmental stages which result in the formation of a sperm‐producing dwarf male thallus. When subjected instead to an environment with an increased nitrate or ammonium ion concentration [0.02 M KNO3 or 0.01 M (NH)2SO4], an androspore undergoes a series of developmental changes which result in the formation of a vegetative male thallus indistinguishable from the one which originally released it. If exposed to neither circein nor increased nitrate/ammonium ion concentration, the androspore enters a cycle of swimming androspore: cyst: swimming androspore. Thus, three separate paths are open to the androspore depending on its environment: (1) development into a dwarf male thallus under the influence of female‐produced pheromone, circein, (2) development into a vegetative thallus under the influence of increased nitrate/ammonium ion concentration, and (3) periodic regeneration through an encystment cycle in an unaltered environment. Treatments with transcriptional and translational inhibitors indicate that androspore development into either a dwarf male or a vegetative thallus requires several different phases of de novo synthesis of RXA and protein stimulated by circein or by nitrate ion

Net Global Warming Potential of Spring Wheat Cropping Systems in a Semiarid Region

Investigations of global warming potential (GWP) of semiarid cropping systems are needed to ascertain agriculture’s contributions to climate regulation services. This study sought to determine net GWP for three semiarid cropping systems under no-tillage management in the northern Great Plains of North America: spring wheat (Triticum aestivum L.)—fallow (SW-F), continuous spring wheat (CSW) and spring wheat—safflower (Carthamus tinctorius L.)—rye (Secale cereale L.) (SW-S-R). Management records, coupled with published carbon dioxide (CO2) emission estimates, were used to determine emissions from production inputs and field operations. Static chamber methodology was used to measure soil-atmosphere methane (CH4) and nitrous oxide (N2O) fluxes over a 3-year period and changes in profile soil organic carbon (SOC) stocks were determined over 18 years. Carbon dioxide emissions associated with production inputs and field operations were greatest for CSW, intermediate for SW-S-R and lowest for SW-F. All cropping systems were minor CH4 sinks (≤0.5 kg CH4-C ha−1 yr−1) and moderate N2O sources (1.0 to 2.8 kg N2O-N ha−1 yr−1). No differences in SOC stocks were observed among cropping systems (P = 0.78), nor did SOC stocks change significantly from baseline conditions (P = 0.82). Summing across factors, net GWP was positive for SW-F and CSW, implying net greenhouse gas (GHG) emission to the atmosphere, while net GWP for SW-S-R was negative, implying net GHG uptake. Net GWP, however, did not differ among cropping systems (P = 0.17). Management practices that concurrently improve N use efficiency and increase SOC stocks are needed for semiarid cropping systems to be net GHG sinks