Catastrophic failure of an uncemented acetabular component due to high wear and osteolysis: An analysis of 154 Omnifit prostheses with mean 6-year follow-up

Background The purposes of this study were (1) to evaluate the wear pattern of the hydroxyapatite-coated "Dual Radius" Omnifit cup, (2) to investigate whether wear is correlated to any demographic or prosthesis-related factors, and (3) to describe micromotion of both the cup and the stem. Patients and methods 154 hips were implanted between 1990 and 1996 and followed for an average of 6 years. Wear was measured according to the "Charnley-duo" method and, in 79 hips, with radiostereometry (RSA). RSA was also used to evaluate micromotion. We analyzed the femoral heads using scanning electron microscopy, energy dispersive X-ray spectroscopy and an atomic force microscope. Result 66 cups were revised and had a mean annual wear of 0.32 mm compared to 0.12 mm in hips not revised. Osteolytic processes were observed in 35 hips but at revision osteolysis was present in 51 cases. 43/66 sockets were loose. Micromotion evaluated by RSA, weight, age, side, size of cup, screws, polyethylene thickness or shelf-life of the polyethylene did not correlate to wear, whereas male gender did. Interpretation It is still unclear why about half of our cases had an abnormal wear rate. Annual wear exceeding 0.2 mm is prognostic of late failure and should be considered a warning sign

An instrument for measuring health-related quality of life in patients with Deep Venous Thrombosis (DVT): development and validation of Deep Venous Thrombosis Quality of Life (DVTQOL) questionnaire

BACKGROUND: Few studies have evaluated patient-reported outcomes in connection with a primary event of deep venous thrombosis, partly due to a lack of disease-specific measures. The aim here was to develop a disease-specific health-related quality of life (HRQL) measure, the deep venous thrombosis quality of life questionnaire (DVTQOL), for patients with recent exposition and treatment of proximal deep venous thrombosis. METHODS: A total of 121 consecutive outpatients (50 % males; mean age 61.2 ± 14 years) treated with warfarin (Waran(®)) for symptomatic proximal deep venous thrombosis were included in the study. Patients completed the SF-36, EQ-5D and the pilot version of the DVTQOL. RESULTS: Items having: high ceiling and floor effect, items with lower factor loadings than 0.50 and items loading in several factors were removed from the pilot version of DVTQOL. In addition, overlapping and redundant items identified by the Rasch analysis were excluded. The final DVTQOL questionnaire consists of 29 items composing six dimensions depicting problems with: emotional distress; symptoms (e.g. pain, swollen ankles, cramp, bruising); limitation in physical activity; hassle with coagulation monitoring; sleep disturbance; and dietary problems. The internal consistency reliability was high (alpha value ranged from 0.79 to 0.93). The relevant domains of the SF-36 and EQ-5D significantly correlated with DVTQOL, thereby confirming its construct validity. CONCLUSIONS: The DVTQOL is a short and user-friendly instrument with good reliability and validity. Its test-retest reliability and responsiveness to change in clinical trials, however, must be explored

Deactivation of a Vanadium-Based SCR Catalyst Used in a Biogas-Powered Euro VI Heavy-Duty Engine Installation

We have investigated how the exhaust gases from a heavy-duty Euro VI engine, powered with biogas impact a vanadium-based selective catalytic reduction (SCR) catalyst in terms of performance. A full Euro VI emission control system was used and the accumulation of catalyst poisons from the combustion was investigated for the up-stream particulate filter as well as the SCR catalyst. The NO(x)reduction performance in terms of standard, fast and NO2-rich SCR was evaluated before and after exposure to exhaust from a biogas-powered engine for 900 h. The SCR catalyst retains a significant part of its activity towards NO(x)reduction after exposure to biogas exhaust, likely due to capture of catalyst poisons on the up-stream components where the deactivation of the oxidation catalyst is especially profound. At lower temperatures some deactivation of the first part of the SCR catalyst was observed which could be explained by a considerably higher surface V4+/V(5+)ratio for this sample compared to the other samples. The higher value indicates that the reoxidation of V(4+)to V(5+)is partially hindered, blocking the redox cycle for parts of the active sites

Accuracy in local staging of prostate cancer by adding a three-dimensional T2-weighted sequence with radial reconstructions in magnetic resonance imaging.

BACKGROUND: The evidence supporting the use of magnetic resonance imaging (MRI) in prostate cancer detection has been established, but its accuracy in local staging is questioned. PURPOSE: To investigate the additional value of multi-planar radial reconstructions of a three-dimensional (3D) T2-weighted (T2W) MRI sequence, intercepting the prostate capsule perpendicularly, for improving local staging of prostate cancer. MATERIAL AND METHODS: Preoperative, bi-parametric prostate MRI examinations in 94 patients operated between June 2014 and January 2015 where retrospectively reviewed by two experienced abdominal radiologists. Each patient was presented in two separate sets including diffusion-weighted imaging, without and with the 3D T2W set that included radial reconstructions. Each set was read at least two months apart. Extraprostatic tumor extension (EPE) was assessed according to a 5-point grading scale. Sensitivity and specificity for EPE was calculated and presented as receiver operating characteristics (ROC) with area under the curve (AUC), using histology from whole-mount prostate specimen as gold standard. Inter-rater agreement was calculated for the two different reading modes using Cohen's kappa. RESULTS: The AUC for detection of EPE for Readers 1 and 2 in the two-dimensional (2D) set was 0.70 and 0.68, respectively, and for the 2D + 3D set 0.62 and 0.65, respectively. Inter-rater agreement (Reader 1 vs. Reader 2) on EPE using Cohen's kappa for the 2D and 2D + 3D set, respectively, was 0.42 and 0.17 (i.e. moderate and poor agreement, respectively). CONCLUSION: The addition of 3D T2W MRI with radial reconstructions did not improve local staging in prostate cancer

Deactivation of a Pd/Pt Bimetallic Oxidation Catalyst Used in a Biogas-Powered Euro VI Heavy-Duty Engine Installation

The reduction of anthropogenic greenhouse gas emissions is crucial to avoid further warming of the planet. We investigated how effluent gases from a biogas powered Euro VI heavy-duty engine impact the performance of a bimetallic (palladium and platinum) oxidation catalyst. Using synthetic gas mixtures, the oxidation of NO, CO, and CH4\ua0before and after exposure to biogas exhaust for 900 h was studied. The catalyst lost most of its activity for methane oxidation, and the activity loss was most severe for the inlet part of the aged catalyst. Here, a clear sintering of Pt and Pd was observed, and higher concentrations of catalyst poisons such as sulfur and phosphorus were detected. The sintering and poisoning resulted in less available active sites and hence lower activity for methane oxidation

The G428A nonsense mutation in FUT2 provides strong but not absolute protection against symptomatic GII.4 Norovirus infection.

In November 2004, 116 individuals in an elderly nursing home in El Grao de Castellón, Spain were symptomatically infected with genogroup II.4 (GII.4) norovirus. The global attack rate was 54.2%. Genotyping of 34 symptomatic individuals regarding the FUT2 gene revealed that one patient was, surprisingly, a non-secretor, hence indicating secretor-independent infection. Lewis genotyping revealed that Lewis-positive and negative individuals were susceptible to symptomatic norovirus infection indicating that Lewis status did not predict susceptibility. Saliva based ELISA assays were used to determine binding of the outbreak virus to saliva samples. Saliva from a secretor-negative individual bound the authentic outbreak GII.4 Valencia/2004/Es virus, but did not in contrast to secretor-positive saliva bind VLP of other strains including the GII.4 Dijon strain. Amino acid comparison of antigenic A and B sites located on the external loops of the P2 domain revealed distinct differences between the Valencia/2004/Es and Dijon strains. All three aa in each antigenic site as well as 10/11 recently identified evolutionary hot spots, were unique in the Valencia/2004/Es strain compared to the Dijon strain. To the best of our knowledge, this is the first example of symptomatic GII.4 norovirus infection of a Le(a+b-) individual homozygous for the G428A nonsense mutation in FUT2. Taken together, our study provides new insights into the host genetic susceptibility to norovirus infections and evolution of the globally dominating GII.4 viruses.Original Publication: Beatrice Carlsson, Elin Kindberg, Javier Buesa, Gustaf E Rydell, Marta Fos Lidón, Rebeca Montava, Reem Abu Mallouh, Ammi Grahn, Jesús Rodríguez-Díaz, Juan Bellido, Alberto Arnedo, Göran Larson and Lennart Svensson, The G428A nonsense mutation in FUT2 provides strong but not absolute protection against symptomatic GII.4 Norovirus infection., 2009, PLoS ONE, (4), 5, e5593. http://dx.doi.org/10.1371/journal.pone.0005593 Licensed under Creative Common

Мониторинг этиологической структуры возбудителей у пациентов с гнойными ранами

РАНЕВАЯ ИНФЕКЦИЯ /МИКРОБ /ЭТИОЛСТАФИЛОКОККИ /ПАТОГЕНSTAPHYLOCOCCUS /ПАТОГЕНЭНТЕРОБАКТЕРИИ /ПАТОГЕНENTEROBACTERIACEAE /ПАТОГЕНКОЛИФОРМНЫЕ БАЦИЛЛЫ /ПАТОГЕНПАРАКОЛОБАКТЕРИИ /ПАТОГЕНПСЕВДОМОНАДЫ /ПАТОГЕНГИДРОГЕНОМОНАДЫ /ПАТОГЕНХЛОРОБАКТЕРИИ /ПАТОГЕНКЛЕБСИЕЛЛЫ /ПАТОГЕНАКИНЕТОБАКТЕРИИ /ПАТОГЕНACINETOBACTER /ПАТОГЕНHERELLEA /ПАТОГЕНMIMA /ПАТОГЕНБАКТЕРИИ АНАЭРОБНЫЕ /ПАТОГЕНЦель исследования – изучить изменения в этиологической структуре возбудителей у пациентов с гнойными ранами. Материал и методы. На базе бактериологической лаборатории в 2006-2007 годах и в 2019-2020 годах обследованы бактериологическими методами 92 и 99 пациентов с гнойными ранами различных локализаций, соответственно. Пациенты проходили стационарное лечение в отделении гнойной хирургии УЗ "Витебская областная клиническая больница". Определение видовой принадлежности производилось в автоматическом режиме на биохимическом анализаторе АТВ Expression "bioMerieux" с использованием тест-систем: ID 32 STAPH – для стафилококков, ID 32 E – для энтеробактерий, ID 32 GN – для грамотрицательных палочек, rapid ID 32 A – для анаэробов и разработанных нами тест-систем "ИД-ЭНТЕР", "ИД-АНА" для энтеробактерий и анаэробных возбудителей, соответственно. Результаты. В результате проведенных исследований установлено, что на 13,96% (р<0,05) уменьшилась роль рода Staphylococcus, на 6,19% (р<0,05) Streptococcus pyogenes. На 12,25% (р<0,05) увеличилась доля Klebsiella pneumoniae, на 15,58% (р<0,05) – Acinetobacter baumannii. В микробном пейзаже начали появляться новые ассоциации: S.aureus + A.baumannii – 14,71% (р<0,05), представитель семейства Enterobacteriaceae + A.baumannii – 11,76% (р<0,05). Заключение. За 13 лет произошли существенные изменения в этиологической структуре экзогенных микроорганизмов у пациентов с гнойными ранами. На фоне снижения роли грамположительной флоры отмечается достоверное увеличение доли грамотрицательных проблемных возбудителей, таких как K.pneumoniae и A.baumannii. Полученные результаты необходимо учитывать при проведении антибиотикотерапии у пациентов с гнойными ранами.Objectives. To study changes in the etiological structure of pathogens in patients with purulent wounds. Material and methods. On the basis of the bacteriological laboratory, in 2006-2007 and in 2019-2020, 92 and 99 patients with purulent wounds of various locations, respectively, were examined by bacteriological methods. Patients underwent inpatient treatment at the department of purulent surgery at the Vitebsk Regional Clinical Hospital. Microflora was identified on an automated biochemical analyzer ATB Expression "bioMerieux" using test-systems: ID 32 STAPH – for staphylococci, ID 32 E – for enterobacteria, ID 32 GN – for gram-negative bacilli, rapid ID 32 A – for anaerobes and the "ID-ENTER", "ID-ANA" test-systems, developed by us for identification of enterobacteria and anaerobes, respectively. Results. As a result of the conducted investigations it has been found, that the role of the genus Staphylococcus decreased by 13.96% (p<0.05), and that of S.pyogenes decreased by 6.19% (p<0.05). The proportion of K.pneumoniae increased by 12.25% (p <0.05), and that of A.baumannii increased by 15.58% (p<0.05). New associations began to appear in the microbial landscape: S.aureus + A.baumannii – 14.71% (p<0.05), a representative of the family Enterobacteriaceae + A.baumannii – 11.76% (p<0.05). Conclusions. Over 13 years, significant changes have occurred in the etiological structure of exogenous microorganisms in patients with purulent wounds. Against the background of a decreasing role of gram-positive flora, a significant increase in the proportion of gram-negative problem pathogens, such as K.pneumoniae and A.baumannii, is observed. The obtained results must be taken into account, when providing antibiotic therapy in patients with purulent wounds

Clinical categories of patients and encounter rates in primary health care – a three-year study in defined populations

BACKGROUND: The objective was to estimate the proportion of inhabitants with a diagnosis-registered encounter with a general practitioner, and to elucidate annual variations of clinical categories of patients in terms of their individual comorbidity. METHODS: A three-year retrospective study of encounter data from electronic patient records, with an annual-based application of the Johns Hopkins Adjusted Clinical Groups (ACG) system. Data were retrieved from every patient with a diagnosis-registered encounter with a GP during the period 2001–2003 at 13 publicly managed primary health care centres in Blekinge county, southeastern Sweden, with about 150000 inhabitants. Main outcome measures: Proportions of inhabitants with a diagnosis-registered encounter, and ranges of the annual proportions of categories of patients according to ACGs. RESULTS: The proportion of inhabitants with a diagnosis-registered encounter ranged from about 64.0% to 90.6% for the primary health care centres, and averaged about 76.5% for all inhabitants. In a three-year perspective the average range of categories of patients was about 0.4% on the county level, and about 0.9% on the primary health care centre level. About one third of the patients each year had a constellation of two or more types of morbidity. CONCLUSION: About three fourths of all inhabitants had one or more diagnosis-registered encounters with a general practitioner during the three-year period. The annual variation of categories of patients according to ACGs was small on both the county and the primary health care centre level. The ACG system seems useful for demonstrating and predicting various aspects of clinical categories of patients in Swedish primary health care

The importance of comorbidity in analysing patient costs in Swedish primary care

BACKGROUND: The objective was to explore the usefulness of the morbidity risk adjustment system Adjusted Clinical Groups(® )(ACG), in comparison with age and gender, in explaining and estimating patient costs on an individual level in Swedish primary health care. Data were retrieved from two primary health care centres in southeastern Sweden. METHODS: A cross-sectional observational study. Data from electronic patient registers from the two centres were retrieved for 2001 and 2002, and patients were grouped into ACGs, expressing the individual combination of diagnoses and thus the comorbidity. Costs per patient were calculated for both years in both centres. Cost data from one centre were used to create ACG weights. These weights were then applied to patients at the other centre. Correlations between individual patient costs, age, gender and ACG weights were studied. Multiple linear regression analyses were performed in order to explain and estimate patient costs. RESULTS: The variation in individual patient costs was substantial within age groups as well as within ACG weight groups. About 37.7% of the individual patient costs could be explained by ACG weights, and age and gender added about 0.8%. The individual patient costs in 2001 estimated 22.0% of patient costs in 2002, whereas ACG weights estimated 14.3%. CONCLUSION: ACGs was an important factor in explaining and estimating individual patient costs in primary health care. Costs were explained to only a minor extent by age and gender. However, the usefulness of the ACG system appears to be sensitive to the accuracy of classification and coding of diagnoses by physicians