Effectiveness of antimicrobial-coated sutures for the prevention of surgical site infection: a review of the literature

OBJECTIVE:Surgical site infections (SSIs) are the third most common hospital-acquired infections and account for 14% to 16% of all such infections, and suture material may play a role in SSI rate. Given this risk of infection, sutures with antimicrobial activity have been developed. Both in vitro and in vivo experiments have shown that triclosan-coated sutures (TCS) are effective in the prevention of SSIs. Our aim is to analyze currently available RCTs, comparing the effect of antimicrobial-coated suture (ACS) with uncoated suture on the occurrence of SSIs following surgical procedures, we highlighted major contributions of most significant studies and evaluate the current "state of the art" on antimicrobial-coated sutures.MATERIALS AND METHODS: We reviewed 15 RCTs comparing antimicrobial-coated sutures with conventional sutures and assessing the clinical effectiveness of antimicrobial sutures to decrease the risk for SSIs. We focused our attention on each variable in all the analyzed study. RESULTS:Our selected RCTs, produced controversial results: 7 RCTs demonstrated a significant benefit, on the contrary, 8 RCTs presented a comparison in which there was no difference.CONCLUSIONS:On the basis of our selected trial results and the heterogeneous findings of our 7 selected meta-analyses, we conclude that even though the question of whether TCSs could reduce the occurrence of SSI remains still open, the antimicrobial suture was effective in decreasing the risk for postoperative SSIs in a broad population of patients undergoing surgery. Alternative substances are becoming clinically relevant, such as Chlorhexidine (CHX) coated sutures and only 6 in vivo scientific studies evaluated them. In vivo studies, large and comparative clinical research trials are necessary to validate the efficacy of CHX-coated sutures thus allowing their use in clinical practice

Evaluation of the progression of visual field damage in patients suffering from early manifest glaucoma

Abstract BACKGROUND: This retrospective study aimed to determine how often a perimetric examination should be carried out in order to identify visual field (VF) changes in patients with relatively early manifestation glaucoma. MATERIALS AND METHODS: Patients included had a relatively recent manifestation of primary open-angle glaucoma. Patients with a minimum follow-up of 5 years and a minimum of seven VF tests were included. Statistical analysis was performed to verify the trend of variations in mean defect (MD) over time (PeriData). The results were subjected to a t-test for a comparative analysis of progression of VF changes over time. The annual rate of progression provided by PeriData considering all the VFs analyzed was compared with that obtained on half of the VF examinations during the same follow-up period. An analysis of the MD trend over time was also carried out in relationship to the number of VF tests done and by dividing the sample into a high-frequency group (more than eight VFs) and a low-frequency group (fewer than eight VFs) in the follow-up period. RESULTS: A total of 96 eyes of 96 patients were included, and overall 846 VFs were examined. The paired t-test performed comparing the MD index of all the VFs against half of them did not show statistical significance (P=0.537). The high-frequency group comprised 39 eyes (average VF 11.05±1.91, average time interval 0.76 years) while the low-frequency group comprised 57 eyes (average VF 6.95±0.6, average time interval 1.21 years). The analysis of the MD trend in the high-frequency patients showed significance (P=0.017); the low-frequency group did not show statistical significance (P=0.08). CONCLUSION: The number of VFs in a determined time interval was not significant. However, a greater frequency of tests provides a predictive evaluation of the rate of progression of early manifestation open-angle glaucoma

Ganglion cell complex analysis in glaucoma patients: what can it tell us?

Glaucoma is a group of optic neuropathies characterized by a progressive degeneration of retina ganglion cells (RGCs) and their axons that precedes functional changes detected on the visual field. The macular ganglion cell complex (GCC), available in commercial Fourier-domain optical coherence tomography, allows the quantification of the innermost retinal layers that are potentially involved in the glaucomatous damage, including the retinal nerve fiber (RNFL), ganglion cell and inner plexiform layers. The average GCC thickness and its related parameters represent a reliable biomarker in detecting preperimetric glaucomatous damage. The most accurate GCC parameters are represented by average and inferior GCC thicknesses, and they can be associated with progressive visual field loss. Although the diagnostic accuracy increases with more severe glaucomatous damage and higher signal strength values, it is not affected by increasing axial length, resulting in a more accurate discrimination of glaucomatous damage in myopic eyes with respect to the traditional RNFL thickness. The analysis of the structure-function relationship revealed a good agreement between the loss in retinal sensitivity and GCC thickness. The use of a 10-2° visual field grid, adjusted for the anatomical RGCs displacement, describes more accurately the relationship between RGCs thickness and visual field sensitivity loss

Quantification of a distributive fluvial system; the Salt Wash DFS of the Morrison Formation, SW USA

Peer reviewedPostprin

Iginio Tansini revisited

The origin of the muscolocutaneous latissimus dorsi flap dates back to 1906 when Igino Tansini, an Italian surgeon, described a procedure to reconstruct the mastectomy defect. After a detailed study of Tansini's original description and drawings, new insights about the pedicle of its compound flap have been found, showing that it has the same pedicle of the scapular flap. In the end, Tansini's flap should be more correctly considered as a compound musculocutaneous scapular flap

Controls on the apex location of large deltas

Acknowledgements and Funding We would like to acknowledge the sponsors of the Fluvial Systems Research Group consortium BP, BG, Chevron, ConocoPhillips and Total. We would like to thank A. Felicia for image generation and database management.Peer reviewedPublisher PD

CVEM-BEM Coupling with Decoupled Orders for 2D Exterior Poisson Problems

For the solution of 2D exterior Dirichlet Poisson problems, we propose the coupling of a Curved Virtual Element Method (CVEM) with a Boundary Element Method (BEM), by using decoupled approximation orders. We provide optimal convergence error estimates, in the energy and in the weaker L-2-norm, in which the CVEM and BEM contributions to the error are separated. This allows for taking advantage of the high order flexibility of the CVEM to retrieve an accurate discrete solution by using a low order BEM. The numerical results confirm the a priori estimates and show the effectiveness of the proposed approach

A vigorous activity cycle mimicking a planetary system in HD200466

Stellar activity can be a source of radial velocity (RV) noise and can reproduce periodic RV variations similar to those produced by an exoplanet. We present the vigorous activity cycle in the primary of the visual binary HD200466, a system made of two almost identical solar-type stars with an apparent separation of 4.6 arcsec at a distance of 44+/-2 pc. High precision RV over more than a decade, adaptive optics (AO) images, and abundances have been obtained for both components. A linear trend in the RV is found for the secondary. We assumed that it is due to the binary orbit and once coupled with the astrometric data, it strongly constrains the orbital solution of the binary at high eccentricities (e~0.85) and quite small periastron of ~21 AU. If this orbital motion is subtracted from the primary radial velocity curve, a highly significant (false alarm probability <0.1%) period of about 1300 d is obtained, suggesting in a first analysis the presence of a giant planet, but it turned out to be due to the stellar activity cycle. Since our spectra do not include the Ca~II resonance lines, we measured a chromospheric activity indicator based on the Halpha line to study the correlation between activity cycles and long-term activity variations. While the bisector analysis of the line profile does not show a clear indication of activity, the correlation between the Halpha line indicator and the RV measurements identify the presence of a strong activity cycle.Comment: Accepted on Astronomy and Astrophysics Main Journal 2014, 16 pages, 18 figure