Impact of therapeutic choices on outcome of osteomyelitis caused by MRSA

Fifty-four patients with chronic osteomyelitis sustained by methicillin-resistant staphylococcus were treated with daptomycin, linezolid, or teicoplanin and observed over time. Median time to CRP normalization was 7 weeks for daptomycin, 8 weeks for linezolid, and 12 weeks for teicoplanin (X2 =14.1; p < 0.001). Cure rate (intention to treat analysis) was 83% for the cases receiving teicoplanin, 77% for those receiving linezolid and 92% for those receiving daptomycin. We conclude that daptomycin and linezolid have to be considered at least equivalent to teicoplanin for the treatment of MRSA osteomyelitis

Structural and Functional Similarities between Osmotin from Nicotiana Tabacum Seeds and Human Adiponectin

Osmotin, a plant protein, specifically binds a seven transmembrane domain receptor-like protein to exert its biological activity via a RAS2/cAMP signaling pathway. The receptor protein is encoded in the gene ORE20/PHO36 and the mammalian homolog of PHO36 is a receptor for the human hormone adiponectin (ADIPOR1). Moreover it is known that the osmotin domain I can be overlapped to the β-barrel domain of adiponectin. Therefore, these observations and some already existing structural and biological data open a window on a possible use of the osmotin or of its derivative as adiponectin agonist. We have modelled the three-dimensional structure of the adiponectin trimer (ADIPOQ), and two ADIPOR1 and PHO36 receptors. Moreover, we have also modelled the following complexes: ADIPOQ/ADIPOR1, osmotin/PHO36 and osmotin/ADIPOR1. We have then shown the structural determinants of these interactions and their physico-chemical features and analyzed the related interaction residues involved in the formation of the complexes. The stability of the modelled structures and their complexes was always evaluated and controlled by molecular dynamics. On the basis of these results a 9 residues osmotin peptide was selected and its interaction with ADIPOR1 and PHO36 was modelled and analysed in term of energetic stability by molecular dynamics. To confirm in vivo the molecular modelling data, osmotin has been purified from nicotiana tabacum seeds and its nine residues peptide synthesized. We have used cultured human synovial fibroblasts that respond to adiponectin by increasing the expression of IL-6, TNF-alpha and IL-1beta via ADIPOR1. The biological effect on fibroblasts of osmotin and its peptide derivative has been found similar to that of adiponectin confirming the results found in silico

Functional outcome and short-term mortality after surgery for hip fractures

Introduction Hip fractures are associated with significant disability and mortality. We conducted a prospective study to investigate the mortality rate and functional ability in patients who underwent surgery for hip fracture over a one-year period. Materials and methods One-hundred patients (72 females and 28 males; mean age, 78.2 years (range 32–102) surgically treated for hip fracture were prospectively followed-up for 1 year. Fifty-five and 45 patients sustained a trochanteric fracture or a fracture of the femoral neck, respectively. Daily-life activities (ADL scale), cognitive impairment (MMSE Scale), comorbidity (CIRS scale), functional status, and personal mobility were prospectively evaluated 4 months and 1 year after the operation by telephonic interviews with the patient, his/her relatives, or primary care providers. Mortality data was also recorded. Possible outcome predictors were evaluated by regression analysis. Results The overall mortality rate at 1 year was 19 percent. Male sex, comorbidity, and a poor pre-fracture functional status were significant predictors of mortality. ADL scale and personal mobility significantly improved between 4-month and 1-year follow-up controls. Forty-five percent of patients without preoperative walking limitations dropped out their walking aids 1-year postoperatively. Patients with trochanteric fracture treated with hip prosthesis showed greater and faster postoperative functional improvement with respect to patients treated by gamma nail. Discussion Current results represent the first report of a wider ongoing prospective study aimed to evaluate possible outcome predictors of hip fractures to be used to improve and personalize the surgical treatment. The preoperative functional status and comorbidities are major determinants of 4-month and 1-year postoperative mortality and ability of subjects. Conclusions Our preliminary findings demonstrate the role of surgery in promoting the functional improvement of patients who sustained hip fracture

La sonicazione di spacers in cemento antibiotato come metodica diagnostica complementare nelle infezioni protesiche

I batteri responsabili di infezione delle protesi articolari sono spesso produttori di biofilm, una struttura extracellulare aderente agli impianti ortopedici che rende i microrganismi stessi difficilmente isolabili con le comuni metodologie colturali e resistenti alle terapie antibiotiche. L'utilizzo di colture di un bagno ultrasonico degli spaziatori in cemento antibiotati espiantati nel corso di una revisione protesica in due stadi può agevolare il rendimento diagnostico delle comuni metodologie analitiche microbiologiche