Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023

BackgroundThe war in Ukraine led to migration of Ukrainian people. Early 2022, several European national surveillance systems detected multidrug-resistant (MDR) bacteria related to Ukrainian patients.AimTo investigate the genomic epidemiology of New Delhi metallo-β-lactamase (NDM)-producing Providencia stuartii from Ukrainian patients among European countries.MethodsWhole-genome sequencing of 66 isolates sampled in 2022-2023 in 10 European countries enabled whole-genome multilocus sequence typing (wgMLST), identification of resistance genes, replicons, and plasmid reconstructions. Five blaNDM-1-carrying-P. stuartii isolates underwent antimicrobial susceptibility testing (AST). Transferability to Escherichia coli of a blaNDM-1-carrying plasmid from a patient strain was assessed. Epidemiological characteristics of patients with NDM-producing P. stuartii were gathered by questionnaire.ResultswgMLST of the 66 isolates revealed two genetic clusters unrelated to Ukraine and three linked to Ukrainian patients. Of these three, two comprised blaNDM-1-carrying-P. stuartii and the third blaNDM-5-carrying-P. stuartii. The blaNDM-1 clusters (PstCluster-001, n = 22 isolates; PstCluster-002, n = 8 isolates) comprised strains from seven and four countries, respectively. The blaNDM-5 cluster (PstCluster-003) included 13 isolates from six countries. PstCluster-001 and PstCluster-002 isolates carried an MDR plasmid harbouring blaNDM-1,blaOXA-10, blaCMY-16, rmtC and armA, which was transferrable in vitro and, for some Ukrainian patients, shared by other Enterobacterales. AST revealed PstCluster-001 isolates to be extensively drug-resistant (XDR), but susceptible to cefiderocol and aztreonam-avibactam. Patients with data on age (n = 41) were 19-74 years old; of 49 with information on sex, 38 were male.ConclusionXDR P. stuartii were introduced into European countries, requiring increased awareness and precautions when treating patients from conflict-affected areas.</p

Between-Limb Symmetry during Double-Leg Vertical Hop Landing in Males an Average of Two Years after ACL Reconstruction is Highly Correlated with Postoperative Physiotherapy Supervision Duration

This study investigates whether double-leg and single-leg vertical hops (VH) landing between-limb symmetry in males, an average of two years after anterior cruciate ligament (ACL) reconstruction (ACLR), is associated with postoperative physiotherapy supervision duration. Thirty-eight healthy controls and thirty-eight males after primary unilateral ACLR, with the use of ipsilateral semitendinosus and gracilis tendon autograft, on average two years before, underwent bilateral peak vertical ground reaction force (vGRF) measurements during double-leg and single-leg VH landing, using two force plates. The vGRF was normalized to the body mass (vGRF BM). The vGRF BM limb symmetry index (LSI) was calculated. Tests for dependent and independent samples and linear Pearson&#8217;s correlation coefficient (r) calculations were performed. There were significant between-leg differences in the double-leg (p &lt; 0.001) vGRF BM values. The longer the postoperative physiotherapy supervision duration was, the higher the double-leg VH LSI values (r = 0.727; p &lt; 0.001). There was also a significant but weak positive association between the single-leg VH landing LSI value and the physiotherapy supervision duration (r = 0.333; p = 0.041). Between-limb symmetry during double-leg VH landing in males, an average of two years after ACLR, was correlated with postoperative physiotherapy supervision duration. Fully supervised postoperative physiotherapy for a minimum of six months is more effective for improving VH landing limb symmetry in patients after ACLR

Evaluation of loading symmetry of the lower limbs during vertical hops landing in men, on average 2 years after the anterior cruciate ligament reconstruction and supervised postoperative physiotherapy, lasting less than 6 months

Wstęp. Celem pracy była ocena symetrii obciążania kończyn dolnych w fazie lądowania skoków u mężczyzn średnio dwa lata po rekonstrukcji więzadła krzyżowego przedniego (ACL) stawu kolanowego i nadzorowanej pooperacyjnej fizjoterapii trwającej krócej niż sześć miesięcy. Materiał i metody. Badany materiał stanowiło 15 mężczyzn, średnio 112,60±43,88 tygodni od rekonstrukcji ACL (Grupa ACLR) oraz 15 mężczyzn bez uszkodzeń narządu ruchu w przeszłości (Grupa kontrolna). Średni czas trwania pooperacyjnej nadzorowanej fizjoterapii w Grupie ACLR wyniósł 14,67±5,30 tygodni. W obu badanych grupach, przy wykorzystaniu dwóch platform tensometrycznych, wykonano obustronnie pomiar składowej pionowej sił reakcji podłoża (vGRF) w fazie lądowania skoków obunóż i jednonóż. Uzyskane wyniki znormalizowano do masy ciała badanego (vGRF [BM]) oraz obliczono wskaźnik symetrii kończyn (LSI). Wyniki. W Grupie ACLR wartości vGRF [BM] uzyskane w kończynie operowanej były istotnie statystycznie niższe niż w kończynie nieoperowanej w fazie lądowania skoków obunóż (p=0,001) i jednonóż (p=0,045). Wartości LSI vGRF [BM] w fazie lądowania skoków obunóż były istotnie statystycznie gorsze w Grupie ACLR niż w Grupie kontrolnej (p<0,001). W fazie lądowania skoków jednonóż, wartości LSI nie różniły się pomiędzy badanymi grupami. Wnioski. U mężczyzn, średnio dwa lata po rekonstrukcji ACL stawu kolanowego, zaobserwowano istotne zaburzenia symetrii obciążania kończyn dolnych w fazie lądowania skoków. Badani mężczyźni znacznie bardziej w fazie lądowania obciążali kończynę nieoperowaną niż kończynę operowaną. Asymetria występowała w większym stopniu w czasie skoków obunóż niż podczas skoków jednonóż. Ze względu na niewielką liczebność próby, badania należy traktować jako pilotażowe.Background. The aim of the study was to assess the symmetry of load exerted on the lower limbs during the landing phase of hops in males after anterior cruciate ligament (ACL) reconstruction (ACLR) and the controlled postoperative physiotherapy procedure, lasting less than six months. Material and methods. The sample included 15 males, on average 112.60±43.88 weeks after ACL reconstruction (ACLR group) and 15 males with no history of injuries within the musculoskeletal system (control group). The mean duration of the postoperative supervised physiotherapeutic procedure was 14.67±5.30 in ACLR group. In both groups, the ground reaction force compound (vGRF) was measured bilaterally during the landing phase of single and double leg hops. The obtained results were normalized to the patient’s body mass (vGRF [BM]) and the leg symmetry index (LSI) was calculated. Results. In ACLR group, the vGRF [BM] values obtained for the operated leg were statistically significantly lower than those obtained for the uninvolved leg in the landing phase of double leg hops (p=0.001) and single leg hops (p=0.045). The LSI vGRF [BM] values, obtained during the landing phase of double leg hops, were significantly worse in the ACLR group than in the control group (p<0.001). In the landing phase of single leg hops, no between group differences were found in LSI values. Conclusions. Significant disorders in lower limb load symmetry were observed in male patients during the landing phase, on average two years after ACLR. The studied patients exerted a significantly more substantial load on the uninvolved leg as compared with the operated leg. A higher asymmetry was noted during double leg hops as compared with single leg hops. Due to the small sample size, the study should be regarded as a pilot research

The giant cell tumour of the proximal phalanx of the thumb treated by a 2-stage operation

We present a 29-year-old woman who was treated for a giant-cell tumour of her thumb. Surgical treatment was performed in two stages. In the first stage, the tumour was removed and the first metacarpal and distal phalanges were fixed by an external fixator. In the second stage of reconstruction of the thumb, a cortico-cancellous bone graft from the iliac crest, an external fixator and double arthrodesis were used. This two-stage procedure provides the possibility for confirming the diagnosis and appropriate treatment choice and minimizes the risk of recurrence. Keywords: Bone tumours, Giant cell tumour, Thum

Safety and efficacy of two ilioiliac tension band plates osteosynthesis of fragility fractures of the pelvis

The study retrospectively determined the efficacy and safety of fixation of the pelvis (FFP) fragility fractures type IV using two tension band ilioiliac locking compression plates. Forty-one patients with FFP were treated in 2017–2020. 16 patients with FFP type IV, unable to walk weight-bearing, were treated by fixation using two tension band ilioiliac locking compression plates without fixing the anterior ring. Preoperatively and one year postoperatively, the functional outcome and performance were assessed using Pelvic Discomfort Index (PDI) and Timed Up and Go (TUG) test. Pre- and postoperative hemoglobin level was evaluated. Operation time and intra-and postoperative complications were documented. One year postoperatively, an X-ray was taken. The arithmetic mean (x) and standard deviations (±) of quantitative variables were calculated. T-test for dependent samples was used for pre-and postoperative results comparison. The PDI improved (p < 0.001) from x = 81.42 ± 4.04 to x = 36.19 ± 15.58. Preoperatively none of the patients was able to perform the TUG test. Postoperatively, the result exceeded x = 13.13 ± 3.99 s. The operation lasted x = 42.80 ± 8.90 min. Hemoglobin decreased (p < 0.001) from 11.63 ± 1.11 to 9.07 ± 1.21 g/dL. No complications nor fixation loosening were noted. The study support fixation using two tension band ilioiliac locking compression plates as an efficient and safe treatment of the FFP type IV

Peak torque angle of anterior cruciate ligament-reconstructed knee flexor muscles in patients with semitendinosus and gracilis autograft is shifted towards extension regardless of the postoperative duration of supervised physiotherapy.

BACKGROUND:The observational cohort study investigated whether the flexor muscles peak torque (PT) angle shifting towards extension observed in the involved knee in patients after anterior cruciate ligament reconstruction (ACLR) using semitendinosus and gracilis tendon (STGR) autograft is associated with the postoperative physiotherapy supervision duration. METHODS:From 230 ACL-reconstructed males, we identified patients after ACLR utilizing STGR autograft and divided them into those who completed supervised physiotherapy <6 months (Group I; n = 77) and those who completed supervised physiotherapy ≥6 months (Group II; n = 66). The mean follow-up time was 6.84 ± 1.47 months. The ACL-reconstructed patients were compared to 98 controls (Group III). Bilateral knee flexor muscle PT measurements were performed. The relative PT at 180°/s (RPT), PT angle at 180°/s, and range of motion at 180°/s were analysed. The RPT limb symmetry index (LSI) was calculated. Tests for dependent samples, one-way analysis of variance, post hoc test, and linear Pearson's correlation coefficient (r) calculations were performed. RESULTS:The shift towards extension was noted when comparing the ACL-reconstructed limb to the uninvolved limb (Group I, p ≤ 0.001; Group II, p ≤ 0.001) and to Group III (p ≤ 0.001), but it was not correlated with physiotherapy supervision duration (r = -0.037, p = 0.662). In ACL-reconstructed patients, there was a moderate association of supervision duration and knee flexor LSI (r = 0.587, p < 0.001). CONCLUSIONS:The ACL-reconstructed knee flexors PT angle shift towards extension was observed regardless of the duration of postoperative physiotherapy supervision. However, the analysis revealed that the duration of supervised physiotherapy positively influenced the RPT and LSI in patients after the ACLR

The Effect of Longer versus Shorter Duration of Supervised Physiotherapy after ACL Reconstruction on the Vertical Jump Landing Limb Symmetry

The study investigated the vertical jump landing limb symmetry after ACLR between a group of patients receiving a longer supervised physiotherapeutic procedure and following a shorter supervised physiotherapy. Group I (n=20) and Group II (n=15) were males averagely 30 weeks after ACLR. The time since ACLR in both groups (Group I, 27.95 ± 8.26 weeks; Group II, 32.47 ± 7.74 weeks) was insignificant, although the duration of supervised physiotherapy between the two groups (Group I, 27.9 ± 8.26 weeks; Group II, 11.28 ± 8.20 weeks) significantly differenced. Group III (n=20) were controls. Two-legged and one-legged vertical jumps landing vertical ground reaction force (VGRF) were bilaterally measured in all groups using force plates. The intragroup comparison of two-legged jump landing VGRF revealed p=0.01 between the involved and uninvolved limbs in Group II. The intergroup comparison revealed p≤0.001 in the two-legged vertical jump between Groups II and III, and I and II. The one-legged limb symmetry was comparable in studied groups. In the group following shorter supervised physiotherapy, the two-legged landing limb symmetry was on a worse level than in the group of patients receiving fully supervised procedure and healthy individuals. A fully supervised postoperative physiotherapy is more effective for improving two-legged vertical jump landing limb symmetry

Clinical and functional evaluation of anterior crucial ligament reconstruction by internal bracing technique in adolescents

Wstęp. Uszkodzenia więzadła krzyżowego przedniego (WKP) stanowią ok. 50% urazów więzadłowych stawu kolanowego. Niewielki potencjał do pierwotnego biologicznego gojenia się WKP sprawia, że obecnie najczęściej stosowaną metodą leczenia jest zabieg rekonstrukcji z użyciem przeszczepu. Najnowsze badania pokazują, że alternatywą do pełnego leczenia rekonstrukcyjnego, zwłaszcza w przypadkach częściowego uszkodzenia, może być technika wzmacniania uszkodzonego więzadła za pomocą taśm syntetycznych określana jako internal bracing. Celem pracy była ocena możliwości wykorzystania taśmy syntetycznej FiberTape w częściowych uszkodzeniach więzadła krzyżowego przedniego u młodzieży. Materiał i metody. Badanie miało charakter retrospektywnych badań kohortowych. Analizie poddano 16 osób, leczonych w latach 2015-2016, z powodu częściowego uszkodzenia więzadła krzyżowego przedniego (uszkodzenie pęczka przednio-przyśrodkowego). W badaniu ortopedycznym oceniano zakres ruchu stawu kolanowego i wykonywano testy: Lachmana, szuflady przedniej i Pivot-Shift. Przednie przemieszczenie piszczeli oceniano za pomocą rolimetru. Badanie uzupełniono o ocenę subiektywną na podstawie skal IKDC 2000 i Lysholma. Okres obserwacji minimum 2 letni Wyniki. U wszystkich pacjentów uzyskano stabilność przednią stawu kolanowego w ocenie subiektywnej i obiektywnej, ocenianych przy użyciu testów Lachmana, szuflady przedniej, Pivot-Shifta oraz rolimetru. Zakres ruchomości wynosił 0-0-138,35±6,75. Wyniki subiektywne wynosiły w skali Lysholma 92,6±7,08 pkt, w skali IKDC 2000 95,79±5,42 Wnioski. Wzmocnienie za pomocą taśmy syntetycznej więzadła krzyżowego przedniego w częściowych uszkodzeniach pozwala uzyskać stabilność stawu kolanowego. Wyniki oceny subiektywnej odpowiadają wynikom w ocenie funkcjonalnej.Background. Damage to the anterior cruciate ligament (ACL) constitutes approximately 50% of ligamentous injuries of the knee joint. The large number of these injuries and the low potential for the primary biological healing of ACL are the reasons why the most frequently used method nowadays is a reconstruction using a transplant. Recent research shows that the technique of strengthening a damaged ligament with synthetic tapes (internal bracing) may be the alternative to reconstructive treatment, especially in cases of partial ACL damage. The aim of the study was to evaluate the possibility of using the synthetic FiberTape in partial lesions of the anterior cruciate ligament in adolescents. Material and methods. The study was a retrospective cohort study. The analysis involved 16 people treated in 2015-2016 due to partial lesion of anterior cruciate ligament (ACL) involving anteromedial bundle damage. The orthopedic examination evaluated the range of knee joint motion with the use of the Lachman Test, the Anterior Drawer Test and the Pivot-Shift Test. The forward dislocation of the tibia was evaluated by means of a Rolimeter. The surgery was supplemented with a subjective assessment based on the IKDC 2000 and the Lysholm scoring scales. The follow up was carried out after 2 years Results. The analysis of postoperative results showed that the knee joint regained anterior stability in subjective and objective assessments, with the use of the Lachman test, the Anterior Drawer test, the Pivot-Shift Test and the Rolimeter, in all the patients. The range of postoperative mobility of the knee joint was 0-0-138.35 ± 6.75 degrees. The subjective results were respectively: 92.6 ± 7.08 points on the Lysholm scale, 95,79 ± 5,42 points on the IKDC 2000 scale Conclusions. Internal bracing of the anterior cruciate ligament is an effective treatment approach for instability of the knee joint. The results of the subjective assessment correspond to the results of the functional assessment

Differences in Accuracy and Radiation Dose in Placement of Iliosacral Screws: Comparison between 3D and 2D Fluoroscopy

Percutaneous iliosacral screw fixation is a widely accepted method of stabilizing the posterior pelvic ring. Recently developed tools such as 3D-navigated fluoroscopy and computed navigation seem to prevent a surgeon from conducting screw misplacement. The study aimed to comparatively assess the introduction of sacroiliac screw placement using 2D and 3D fluoroscopy in terms of accuracy and radiation exposure. Iliosacral screws were introduced in 37 patients using 2D (group N1) and in 36 patients using 3D fluoroscopy (group N2) techniques. Overall, 61 and 56 screws were introduced in groups N1 and N2, respectively. Screw placement accuracy was assessed using postoperative computed tomography and Smith’s scale. Intraoperative radiation exposure was also assessed. No differences were noted between groups in terms of screw positioning accuracy and radiation dose. Both 2D and 3D fluoroscopy provide good visualization for safely placing percutaneous iliosacral joint screws. Using 3D fluoroscopy-based navigation in comparison with 2D fluoroscopy is not advantageous

Diagnostics and treatment of the distal biceps tendon rupture – current state of knowledge

Uszkodzenie przyczepu dalszego ścięgna mięśnia dwugłowego ramienia jest urazem występującym wyjątkowo rzadko, co może negatywnie wpływać na szybkość jego diagnostyki oraz wybór odpowiedniego leczenia. W przypadku całkowitego zerwania ścięgna, diagnostyka opiera się przede wszystkim na badaniu klinicznym, uzupełnionym o badanie ultrasonograficzne. Badanie rezonansem magnetycznym jest z kolei wykorzystywane u pacjentów z podejrzeniem częściowego uszkodzenia ścięgna. Standardową metodą leczenia uszkodzeń jest operacyjna anatomiczna reinsercja uszkodzonego ścięgna do guzowatości kości promieniowej. Leczenie nieoperacyjne stosowane jest zazwyczaj u pacjentów w starszym wieku, o niskim poziomie aktywności fizycznej, a także u pacjentów z przeciwwskazaniami do leczenia operacyjnego. Niemniej jednak, wybór techniki operacyjnej, a także wybór odpowiedniej metody mocowania pozostaje tematem kontrowersyjnym. Wśród technik operacyjnych wyróżnia się pojedynczy lub podwójny dostęp operacyjny. Najczęściej do mocowania ścięgna wykorzystywane są kotwice lub guzik korowy (ang. cotical button). Stosowane dostępy operacyjne oraz każda z wykorzystywanych metod mocowania ścięgna jest obarczona ryzykiem powikłań pooperacyjnych, które dodatkowo zwiększa się w przypadku opóźnionego leczenia operacyjnego. W związku z tym, że uszkodzenia dalszego ścięgna mięśnia dwugłowego ramienia występują bardzo rzadko, a nieprawidłowa diagnostyka uszkodzenia i opóźnienie wdrożenia odpowiedniego leczenia operacyjnego może poważnie zaburzyć funkcję kończyny górnej, a także zwiększa ryzyko wystąpienia pooperacyjnych powikłań, właściwe byłoby zalecanie leczenia tego typu uszkodzeń w ośrodkach referencyjnych.Damage to distal biceps tendon attachment is an exceptionally rare type of injury and therefore it can delay diagnostics and the choice of appropriate treatment. In the case of complete tendon rupture, diagnostics is mainly based on clinical examination and ultrasonography (USG). Magnetic resonance imaging (MRI), in turn, is applied in patients with suspected partial tendon damage. Standard treatment involves surgical anatomic reinsertion of the ruptured tendon to the radial tuberosity. Non-surgical treatment is usually applied in older patients with low levels of physical activity and in patients with contraindications to surgical treatment. Nevertheless, the choice of surgical technique as well as the choice of a proper approach of fixation are still controversial. Surgical techniques include single or double port access surgery. Most often the tendon is fixed using suture anchors or a cortical button. The access surgeries and each of the applied tendon fixation technique entail the risk of postoperative complications which increases when surgical treatment is delayed. Since damage to distal biceps tendon are extremely rare and improper diagnostics of damage and delayed surgical treatment can significantly impair the function of the involved upper limb, increasing the risk of postoperative complications, it seems reasonable to treat this type of damage in reference centers