Oversizing the tibial component in TKAs: incidence, consequences and risk factors

International audienc

Mediolateral oversizing influences pain, function, and flexion after TKA

PURPOSE: Manufacturers of total knee arthroplasty (TKA) have introduced narrower femurs to improve bone-implant fit. However, few studies have reported the clinical consequences of mediolateral oversizing. Our hypothesis was that component oversizing negatively influences the results after TKA. METHODS: One hundred and twelve prospectively followed patients with 114 consecutive TKA (64 females and 50 males) were retrospectively assessed. The mean age of the patients was 72 years (range, 56 to 85 years). The dimensions of the femur and tibia were measured on a preoperative CT-scan and were compared with those of the implanted TKA. The influence of size variation on the clinical outcomes 1 year after surgery was assessed. RESULTS: Mediolateral overhang was observed in at least one area in 66 % of the femurs (84 % in females and 54 % in males) and 61 % of the tibia (81 % in females and 40 % in males). Twenty-two patients presented no overhang in any area and 16 had overhang in all studied zones. The increase in the Pain and KOOS scores were 43 ± 21 and 36 ± 18 in the patients without overhang and 31 ± 19 and 25 ± 13 in patients with overhang (p = 0.033; p = 0.032). Knee flexion was 127° ± 7 and 121° ± 11, respectively. Regression and latent class analysis showed a significant negative correlation between overall oversizing and overall outcome. CONCLUSIONS: This study confirms that oversizing may lead to worse clinical results in TKA. The clinical consequences are that surgeons should pay attention not to oversize implants during implantation nd that oversizing should be ruled out in case of so called unexplained pain. LEVEL OF EVIDENCE: IV. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00167-013-2443-x) contains supplementary material, which is available to authorized users

Production, caractérisation, conditionnement et distribution de préparations de référence d'hormones équines et camelines : LH, FSH et CG équines et LH, FSH, GH et PRL camelines

National audienc

Production, caractérisation, conditionnement et distribution de préparations de référence d'hormones équines et camelines : LH, FSH et CG équines et LH, FSH, GH et PRL camelines

National audienc

Evaluation of MALDI-TOF mass spectrometry for the identification of medically-important yeasts in the clinical laboratories of Dijon and Lille hospitals

EA MERSInternational audienceConventional identification (CI) of yeasts is based on morphological, biochemical and/or immunological methods. Matrix-assisted laser desorption/ionization - time of flight (MALDI-TOF or MT-MS) mass spectrometry has been proposed as a new method for the identification of microorganisms. This prospective study compared the performance of MT-MS and CI for the identification of yeasts isolated from clinical samples. Sequencing of the internal transcribed spacer (ITS) regions of ribosomal DNA was used as the reference method in the analysis of a total of 1207 yeast isolates. Concordance between MT-MS and CI was observed for 1105 isolates (91.5%), while 74 isolates (6.1%) were misidentified. Molecular identification revealed that 73 of these 74 isolates were identified correctly by MT-MS and CI correctly identified the last one. Concordance between the two techniques was excellent for the medically-important species (98-100%), including the identification of closely-related species (Candida albicans/C. dubliniensis; C. inconspicua/C. norvegensis; C. parapsilosis/C. metapsilosis/C. orthopsilosis). Only 2.3% of isolates belonging to C. famata, C. lambica and C. magnoliae or to Geotrichum spp. and Trichosporon spp. were not identified by MT-MS. This investigation highlights the potential of MT-MS-based yeast identification as a reliable, time and cost-efficient alternative to CI

A clonal lineage of fusarium oxysporum circulates in the tap water of different french hospitals

International audienceFusarium oxysporum is typically a soilborne fungus but can also be found in aquatic environments. In hospitals, water distribution systems may be reservoirs for the fungi responsible for nosocomial infections. F. oxysporum was previously detected in the water distribution systems of five French hospitals. Sixty-eight isolates from water representative of all hospital units that were previously sampled and characterized by translation elongation factor 1 alpha sequence typing were subjected to microsatellite analysis and full-length ribosomal intergenic spacer (IGS) sequence typing. All but three isolates shared common microsatellite loci and a common two-locus sequence type (ST). This ST has an international geographical distribution in both the water networks of hospitals and among clinical isolates. The ST dominant in water was not detected among 300 isolates of F. oxysporum that originated from surrounding soils. Further characterization of 15 isolates by vegetative compatibility testing allowed us to conclude that a clonal lineage of F. oxysporum circulates in the tap water of the different hospitals. IMPORTANCEWe demonstrated that a clonal lineage of Fusarium oxysporum inhabits the water distribution systems of several French hospitals. This clonal lineage, which appears to be particularly adapted to water networks, represents a potential risk for human infection and raises questions about its worldwide distribution

Volunteers, religious communities and users representatives as an alternative for visiting hospitalized patients: The importance of an infection control training.

BackgroundDuring the COVID-19 pandemic, the suspension of relatives' visits was a common measure in healthcare facilities to prevent the spread of the virus among patients. This measure caused significant adverse consequences for hospitalized patients. Volunteers' intervention was an alternative but could also lead to cross transmission events.Aimsin order to secure their intervention with patients, we implemented an infection control training to evaluate and to improve the knowledge of volunteers about infection control measures.MethodWe performed a before-after study in a group of five tertiary referral teaching hospitals in the suburbs of Paris. A total of 226 volunteers from three groups (religious representatives, civilian volunteers and users' representatives) were included. Basic theoretical and practical knowledge about infection control, hand hygiene, and glove and mask use were evaluated just before and immediately after a three-hour training program. The contribution of the characteristics of the volunteers to the results was studied.FindingsThe initial conformity rate for theoretical and practical infection control measures ranged from 53% to 68%, depending on the participants' activity status and education level. Some critical shortcomings in hand hygiene as well as mask and glove wearing putatively endangered the patients and volunteers. Surprisingly, serious gaps were also identified among volunteers who experienced care activities. Regardless of their origin, the program significantly improved both their theoretical and practical knowledge (pConclusionsTo become a secure alternative to relatives' visits, volunteers' interventions must be preceded by the assessment of their theoretical knowledge and practical skills in infection control. Additional study, including practice audit, must confirm the implementation of the acquired knowledge in the real-life

Épidémiologie de populations de Fusarium oxysporum et F. dimerum en milieu hospitaliers à Dijon et Nancy

National audienceFusarium oxysporum et F. dimerum sont des champignons d'origine tellurique présents dans de nombreux écosystèmes terrestres mais ils ont été récemment détectés dans les systèmes de distribution d'eau de bâtiments hospitaliers1. Une enquête épidémiologique incluant divers bâtiments hospitaliers sur différents sites, des complexes non-hospitaliers et des maisons individuelles a été menée pendant deux ans dans deux villes françaises, Dijon et Nancy. Les champignons ont été détectés seulement dans les canalisations de bâtiments hospitaliers et n'ont pas été détectés dans celles des autres immeubles ni dans l'eau du réseau urbain. Cette distribution surprenante s'explique par une combinaison de trois facteurs principaux: i) la complexité du système de distribution d'eau d'un ensemble de bâtiments rénovés régulièrement; cette complexité comprend la diversité des matériaux utilisés pour les tuyaux et l'existence de bras morts dans lesquels l'eau stagne; ii) l'application d'un procédé de désinfection qui crée des vides écologiques et rend des ressources trophiques et spatiales disponibles pour les champignons opportunistes; iii) le potentiel réel de souches de F. oxysporum et F. dimerum pour s'adapter et exploiter le milieu aquatique urbain. La très faible diversité génétique (intergenic spacer IGS et facteurs d'élongation (EF)) entre les différents isolats de F. oxysporum d'une part et de F. dimerum d'autre part suggère pour chacune de ces 2 espèces telluriques l'existence d'une population unique spécialisée dans la colonisation et l'exploitation des ressources fournies par les canalisations d'eau de bâtiments hospitaliers, phénomène analogue à celui observé aux États-Unis2. Le risque de fusariose causé par ces formes invasives et opportunistes particulières doit être pris au sérieux pour éviter toute contamination des patients immunodéprimés