Periprosthetic joint infection increases the risk of one-year mortality.

BACKGROUND: Periprosthetic joint infection continues to potentially complicate an otherwise successful joint replacement. The treatment of this infection often requires multiple surgical procedures associated with increased complications and morbidity. This study examined the relationship between periprosthetic joint infection and mortality and aimed to determine the effect of periprosthetic joint infection on mortality and any predictors of mortality in patients with periprosthetic joint infection. METHODS: Four hundred and thirty-six patients with at least one surgical intervention secondary to confirmed periprosthetic joint infection were compared with 2342 patients undergoing revision arthroplasty for aseptic failure. The incidence of mortality at thirty days, ninety days, one year, two years, and five years after surgery was assessed. Multivariate analysis was used to assess periprosthetic joint infection as an independent predictor of mortality. In the periprosthetic joint infection population, variables investigated as potential risk factors for mortality were evaluated. RESULTS: Mortality was significantly greater (p \u3c 0.001) in patients with periprosthetic joint infection compared with those undergoing aseptic revision arthroplasty at ninety days (3.7% versus 0.8%), one year (10.6% versus 2.0%), two years (13.6% versus 3.9%), and five years (25.9% versus 12.9%). After controlling for age, sex, ethnicity, number of procedures, involved joint, body mass index, and Charlson Comorbidity Index, revision arthroplasty for periprosthetic joint infection was associated with a fivefold increase in mortality compared with revision arthroplasty for aseptic failures. In the periprosthetic joint infection population, independent predictors of mortality included increasing age, higher Charlson Comorbidity Index, history of stroke, polymicrobial infections, and cardiac disease. CONCLUSIONS: Although it is well known that periprosthetic joint infection is a devastating complication that severely limits joint function and is consistently difficult to eradicate, surgeons must also be cognizant of the systemic impact of periprosthetic joint infection and its major influence on fatal outcome in patients

Detection of Uniaxial Fatigue Stress under Magnetic Flux Leakage Signals using Morlet Wavelet

This paper demonstrates the application of continuous wavelet transform technique for magnetic flux leakage signal generated during a uniaxial fatigue test. This is a consideration as the magnetic signal is weak and susceptible to being influenced by an external magnetic field. The magnetic flux leakage signal response of API steel grade X65 is determined using Metal Magnetic Memory under cyclic load conditions ranging from 50% to 85% of the UTS. To facilitate further signal analysis, the magnetic flux gradient, the dH(y)/dx signal were converted from a length base into time series in this study. Magnetic flux leakage readings indicated a maximum UTS load of 56.5 (A/m)/mm at 85%, where a higher load resulted in a higher reading and the signal contained Morlet wavelet coefficient energy of 1.02×106 µe2/Hz. As increasing percentages of UTS loads were applied, the signal analysis revealed an increasing linear trend in the dH(y)/dx and wavelet coefficient energy. The analysis revealed a strong correlation between the wavelet coefficient energy and the dH(y)/dx amplitude, as indicated by the coefficient of determination (R2) value of 0.8572. Hence, this technique can provide critical information about magnetic flux leakage signals that can be used to detect high stress concentration zones

Use of Ultrasound-Assisted, Catheter-Directed Thrombolysis in a Patient With High-Risk Pulmonary Embolism

High-risk pulmonary embolism (PE) is a complex clinical entity associated with high mortality rates. Ultrasound-assisted, catheter-directed thrombolysis, typically used for intermediate-risk PE, may be a viable treatment approach for high-risk PE, particularly in patients at increased risk for major bleeding. This report describes a case in which ultrasound-assisted, catheter-directed thrombolysis was successfully used to treat high-risk PE in a female patient with extensive peritoneal metastases from gastric adenocarcinoma. Other examples from the literature, in which ultrasound-assisted, catheter-directed thrombolysis was used to treat high-risk PE, are also provided

Operative Environment

Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.2 The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense capacity of the host including local and systemic defense mechanisms. The last group contains environmental determinants of exposure such as size, time, and location of the surgical wound that can provide an opportunity for the bacteria to enter the surgical wound, overcome the local defense system, sustain their presence, and replicate and initiate local as well as systemic inflammatory reactions of the host. The use of iodine impregnated skin incise drapes shows decreased skin bacterial counts but no correlation has been established with SSI. However, no recommendations regarding the use of skin barriers can be made (see this Workgroup, Question 27)

The Influence of Abacavir and Other Antiretroviral Agents on Virological Response to HCV Therapy Among Antiretroviral-Treated HIV-Infected Patients.

BACKGROUND: It remains unclear if certain antiretroviral medications, particularly abacavir, compromise response to HCV therapy. Such data could inform the selection of appropriate antiretrovirals in HIV/HCV-coinfected patients. The aim of this study was to determine if use of abacavir, as well as other antiretrovirals, was associated with reduced response to pegylated interferon (PEG-IFN) plus ribavirin. METHODS: A cohort study was performed among antiretroviral-treated HIV/HCV-coinfected patients initiating PEG-IFN plus ribavirin between January 2001 and June 2007 at six sites in the United States. Abacavir and other antiretrovirals represented exposures of interest. Study outcomes included an early virological response (\u3e or =2 log IU/ml decrease in HCV viral load at 12 weeks) and sustained virological response (undetectable HCV viral load 24 weeks after treatment discontinuation). RESULTS: Among 212 patients, 74 (35%) received abacavir. For patients infected with HCV genotype 1 or 4, no differences were observed between abacavir users and non-users in early virological response (26 [40%] versus 53 [44%]; adjusted odds ratio [OR] 1.00; 95% confidence interval [CI] 0.50-2.00) or sustained virological response (8 [13%] versus 13 [12%]; adjusted OR 1.34; 95% CI 0.50-3.62). Among genotype 2 and 3 patients, rates of early virological response (7 [78%] versus 16 [89%]; OR 0.44; 95% CI 0.05-3.76) and sustained virological response (3 [33%] versus 8 [44%]; OR 0.63; 95% CI 0.12-3.32) were also similar between abacavir users and non-users. No association was found between other antiretrovirals and a lack of early or sustained response. CONCLUSIONS: Use of abacavir or other antiretroviral medications was not associated with reduced early or sustained virological response rates

Observing the simulation behaviour of Magnesium alloy metal sandwich panel under cyclic loadings

This study aims to investigate the delamination effect of a metal sandwich panel using a four-point bending simulation under continual spectrum loading. The most recent core designs of the sandwich panel have a cavity that can increase vulnerability in terms of bonding strength under constant cyclic loading. The sandwich panel is simulated under constant cyclic loading using different core design configurations, which are rounded dimple, hemispherical dimple, and smooth surface core design. There are two types of conditions used; no pre-stress and pre-stress loads with variable stress ratios based on Gerber stress life theory. Results showed that dimple core design enhanced mechanical behaviour and fatigue life performance about 33% and 5%, respectively, compared to the sandwich panel with a smooth surface core design. It is highlighted that modification on the surface of core design could be beneficial to enhance the bonding strength performance of sandwich panels and prevent early delamination under extreme conditions such as constant cyclic loading. This study is beneficial to enhance the bonding strength for sandwich panels against extreme conditions such as high impact load and continuous cyclic load

Improving the Accuracy of Hydrodynamic Simulations in Data Scarce Environments Using Bayesian Model Averaging: A Case Study of the Inner Niger Delta, Mali, West Africa

In this paper, the study area was the Inner Niger Delta (IND) in Mali, West Africa. The IND is threatened by climate change, increasing irrigation, and dam operations. 2D hydrodynamic modelling was used to simulate water levels, discharge, and inundation extent in the IND. Three different digital elevation models (DEM) (SRTM, MERIT, and a DEM derived from satellite images were used as a source of elevation data. Six different models were created, with different sources of elevation data and different downstream boundary conditions. Given that the performance of the models varies according to the location in the IND, the variable under consideration and the performance criteria, Bayesian Model Averaging (BMA) was used to assess the relative performance of each of the six models. The BMA weights, along with deterministic performance measures, such as the Nash Sutcliffe coefficient (NS) and the Pearson’s correlation coefficient (r), provide quantitative evidence as to which model is the best when simulating a particular hydraulic variable at a particular location. After the models were combined with BMA, both discharge and water levels could be simulated with reasonable precision (NS > 0.8). The results of this work can contribute to the more efficient management of water resources in the IND

Tropical forest soil characteristics in rehabilitated forests of Malaysia

The coordinated efforts of rehabilitating forests, either for its natural resources or for environmental reasons, has always been a priority especially in tropical regions that experience high levels of weathering. This book summarizes significant studies on soil properties of selected forest reserves and cultivated lands around Malaysia. The research on forest soils covered in these studies are largely on the forest reserves of Chikus, Tapah Hill and Kinta forest in Perak, Malaysia. Some soil properties evaluation was also carried out in different land usage areas in Bintulu, Sarawak. The last chapter is on research about using valuable tropical forest trees to remediate contaminated forest soil through phytoremediation. The book comprises of extensive information on the interpretation of results of soil analyses; the interpretation is done in a simple and easy to understand manner. This book is ideal for any student, researcher or member of the public that wants to know more about the nature of forest soils

Suboptimal clinical response to ciprofloxacin in patients with enteric fever due to Salmonella spp. with reduced fluoroquinolone susceptibility: a case series

BACKGROUND: Salmonella spp. with reduced susceptibility to fluoroquinolones have higher than usual MICs to these agents but are still considered "susceptible" by NCCLS criteria. Delayed treatment response to fluoroquinolones has been noted, especially in cases of enteric fever due to such strains. We reviewed the ciprofloxacin susceptibility and clinical outcome of our recent enteric fever cases. METHODS: Salmonella enterica Serotype Typhi (S. Typhi) and Serotype Paratyphi (S. Paratyphi) blood culture isolates (1998–2002) were tested against nalidixic acid by disk diffusion (DD) and agar dilution (AD) and to ciprofloxacin by AD using NCCLS methods and interpretive criteria. Reduced fluoroquinolone susceptibility was defined as a ciprofloxacin MIC of 0.125–1.0 mg/L. The clinical records of patients treated with ciprofloxacin for isolates with reduced fluoroquinolone susceptibility were reviewed. RESULTS: Seven of 21 (33%) S. Typhi and S. Paratyphi isolates had reduced susceptibility to fluoroquinolones (MIC range 0.125–0.5 mg/L). All 7 were nalidixic acid resistant by DD (no zone) and by AD (MIC 128- >512 mg/L). The other 14 isolates were nalidixic acid susceptible and fully susceptible to ciprofloxacin (MIC range 0.015–0.03 mg/L). Five of the 7 cases were treated initially with oral ciprofloxacin. One patient remained febrile on IV ciprofloxacin until cefotaxime was added, with fever recurrence when cefotaxime was discontinued. Two continued on oral or IV ciprofloxacin alone but had prolonged fevers of 9–10 days duration, one was switched to IV beta-lactam therapy after remaining febrile for 3 days on oral/IV ciprofloxacin and one was treated successfully with oral ciprofloxacin. Four of the 5 required hospitalization. CONCLUSIONS: Our cases provide further evidence that reduced fluoroquinolone susceptibility of S. Typhi and S. Paratyphi is clinically significant. Laboratories should test extra-intestinal Salmonella spp. for reduced fluoroquinolone susceptibility

Probabilistic-Based Analysis for Damaging Features of Fatigue Strain Loadings

This paper presents the behaviour of fatigue damage extraction in fatigue strain histories of automotive components using the probabilistic approach. This is a consideration for the evaluation of fatigue damage extraction in automotive components under service loading that is vital in a reliability analysis. For the purpose of research work, two strain signals data are collected from a car coil spring during a road test. The fatigue strain signals are then extracted using the wavelet transform in order to extract the high amplitude segments that contribute to the fatigue damage. At this stage, the low amplitude segments are removed because of their minimal contribution to the fatigue damage. The fatigue damage based on all extracted segments is calculated using some significant strain-life models. Subsequently, the statistics-based Weibull distribution is applied to evaluate the fatigue damage extraction. It has been found that about 70% of the probability of failure occurs in the 1.0 x 10-5 to 1.0 x 10-4 damage range for both signals, while 90% of the probability of failure occurs in the 1.0 x 10-4 to 1.0 x 10-3 damage range. Lastly, it is suggested that the fatigue damage can be determined by the Weibull distribution analysi