Different approaches in treatment of infected non-unions

Introduction: We present the case of a 60 years old patient involved in a car accident with trochanteric fracture and open type I comminutive 1/3 proximal right tibial fracture. For the treatment of trochanteric fracture DHS (dynamic hip screw) was used and for the tibial fracture we opted for plate and screws. Due to the absence of complete bone consolidation, the plate was removed and another surgery using intramedullar nail and plate for the tibial tuberosity was performed. Unfortunately patient did not follow the hygienic conditions as a consequence he contacted an infection which led to septic non-union. To treat this new situation the device was removed and an Ilizarov frame was used. This technique allowed radical resection of the infected bone. For lengthening procedures, a percutaneous “corticotomy” was used in which the accessible cortices of tibia were cut, avoiding as much as possible penetration of medullary canal. The wires were tensioned up to 130 kg to provide adequate stiffness for bone segment stability and correction of axial, translational and rotational deformities. Even with this lengthy period of fixing wear (1.5 months for each cm of lengthening), the Ilizarov procedure was very helpful for this patient who needed extensive resection of bone and reconstruction to achieve stability. Methods: The treatment option was DHS for trochanteric fracture and plate and screws for tibial fracture. Patient developed non-union at the level of tibial metaphysic as a consequence the plate was removed. After the procedure we opted for intramedullary nail for tibial fracture and plate for tibial tuberosity. However the patient did not fallow the postoperative indications as a result he developed septic non-union. Due to the infected non-union we opted for the Ilizarov technique. Results: This technique was very effective in treatment of septic non-union, which needed large excision of bone. The patient recovered completely and regained the mobility of his leg. Conclusion: The Ilizarov procedure benefits patients who need extensive resection of bone and reconstruction to achieve stability. Disadvantages include the time required to achieve a solid union (six weeks for each centimeter of lengthening) and the high incidence of associated complications (minor pin track infection, residual equinus contracture, a nerve palsy or unexpected sequel that can compromise the final results)

Active surveillance of adverse events after immunization (AEFI) from the Local Health Unit of Ferrara, Italy

IntroductionVaccine vigilance implies the collection, evaluation, analysis and communication of adverse events following immunization (AEFI) and is a useful tool for vaccine monitoring allowing, even after approval and marketing, to check its safety/tolerability. The multiregional project "Active surveillance of adverse vaccine reactions", joined by the AUSL of Ferrara, is aimed at making parents of children, who have undergone at least one vaccination provided by the regional vaccination calendar in the first 24 months of life, aware of the reporting of any AEFI via mobile phone-SMS.MethodsAn analysis of the project data, collected in the period March 2018 - May 2019, was carried out, to evaluate the effectiveness of the reporting tool and the type and frequency of AEFI. Anonymized data were analyzed by number, gender, distribution by age, type of vaccine, adverse event, severity and outcome.ResultsA total of 1494 consents and 983 SMS messages were obtained from parents.The vaccine doses carried out were 1,984 (28.3% hexavalent, 28% PCV13, 17% anti-rotavirus, 14.3% Men-B). Almost all (99.5%) AEFI were classified as "not serious".Based on the Organ System Class (SOC), most reports are related to "General Disorders and Administration Site Conditions" (52.3%), followed by "Psychiatric Disorders" (26.5%) and "Metabolic and nutrition disorders" (12.5%).ConclusionsThe reported AEFI are in line with the ones reported in the literature.Reporting via SMS is a valid vaccine surveillance tool contributing to the qualitative and quantitative improvement of the information transmitted

Risk factors for infections caused by carbapenem-resistant Enterobacterales: an international matched case-control-control study (EURECA)

Cases were patients with complicated urinary tract infection (cUTI), complicated intraabdominal (cIAI), pneumonia or bacteraemia from other sources (BSI-OS) due to CRE; control groups were patients with infection caused by carbapenem-susceptible Enterobacterales (CSE), and by non-infected patients, respectively. Matching criteria included type of infection for CSE group, ward and duration of hospital admission. Conditional logistic regression was used to identify risk factors. Findings Overall, 235 CRE case patients, 235 CSE controls and 705 non-infected controls were included. The CRE infections were cUTI (133, 56.7%), pneumonia (44, 18.7%), cIAI and BSI-OS (29, 12.3% each). Carbapenemase genes were found in 228 isolates: OXA-48/like, 112 (47.6%), KPC, 84 (35.7%), and metallo-beta-lactamases, 44 (18.7%); 13 produced two. The risk factors for CRE infection in both type of controls were (adjusted OR for CSE controls; 95% CI; p value) previous colonisation/infection by CRE (6.94; 2.74-15.53; <0.001), urinary catheter (1.78; 1.03-3.07; 0.038) and exposure to broad spectrum antibiotics, as categorical (2.20; 1.25-3.88; 0.006) and time-dependent (1.04 per day; 1.00-1.07; 0.014); chronic renal failure (2.81; 1.40-5.64; 0.004) and admission from home (0.44; 0.23-0.85; 0.014) were significant only for CSE controls. Subgroup analyses provided similar results. Interpretation The main risk factors for CRE infections in hospitals with high incidence included previous coloni-zation, urinary catheter and exposure to broad spectrum antibiotics

2015/16 seasonal vaccine effectiveness against hospitalisation with influenza a(H1N1)pdm09 and B among elderly people in Europe: Results from the I-MOVE+ project

We conducted a multicentre test-negative caseâ\u80\u93control study in 27 hospitals of 11 European countries to measure 2015/16 influenza vaccine effectiveness (IVE) against hospitalised influenza A(H1N1)pdm09 and B among people aged â\u89¥ 65 years. Patients swabbed within 7 days after onset of symptoms compatible with severe acute respiratory infection were included. Information on demographics, vaccination and underlying conditions was collected. Using logistic regression, we measured IVE adjusted for potential confounders. We included 355 influenza A(H1N1)pdm09 cases, 110 influenza B cases, and 1,274 controls. Adjusted IVE against influenza A(H1N1)pdm09 was 42% (95% confidence interval (CI): 22 to 57). It was 59% (95% CI: 23 to 78), 48% (95% CI: 5 to 71), 43% (95% CI: 8 to 65) and 39% (95% CI: 7 to 60) in patients with diabetes mellitus, cancer, lung and heart disease, respectively. Adjusted IVE against influenza B was 52% (95% CI: 24 to 70). It was 62% (95% CI: 5 to 85), 60% (95% CI: 18 to 80) and 36% (95% CI: -23 to 67) in patients with diabetes mellitus, lung and heart disease, respectively. 2015/16 IVE estimates against hospitalised influenza in elderly people was moderate against influenza A(H1N1)pdm09 and B, including among those with diabetes mellitus, cancer, lung or heart diseases

Development Trends of Production Systems through the Integration of Lean Management and Industry 4.0

The integration of efficient production and management systems with the new Industry 4.0 concept represents a challenge for any company wishing to adapt its processes in order to increase performance, both at the operational and the organizational levels, through digitization and connectivity. This research proposes an analysis of Lean tools and Industry 4.0 technologies for compatibility in order to provide a framework model for development and integration in industrial applications. Through a systematic review of the literature, this paper contributes to the development of the current vision regarding the implementation and integration of the two “paradigms” of production. An analysis of the current key production strategies was performed through a new conceptual approach from the perspective of correlating the Lean management system, a system that has been stable in recent decades, with the innovative technologies of Industry 4.0. The applicative character of the research consisted of the optimization by simulation of a flexible production system in which the two concepts were integrated. The results showed that the implementation of Lean in the field of flexible manufacturing, correlated with the integration of Industry 4.0 techniques, such as digital twin and simulation, led to improved production processes by fast and flexible reconfiguration, with the two concepts being interdependent

Reduction of Cracks in Marble Appeared at Hydro-Abrasive Jet Cutting Using Taguchi Method

The appearance of cracks in brittle materials in general and in marble, in particular, is a problem in the hydro-abrasive jet cutting process. In this paper is presented a method to reduce the appearance of cracks when cutting with a hydro-abrasive jet of marble by using statistical analysis. The Taguchi method was used, establishing the main parameters that influence the process. Research design was based on performing experiments by modifying the parameters that influence the process. In this way, it has been shown that the stochastic effects resulting from the marble structure can be reduced. A careful study was made of the behavior of marble under the action of the hydro-abrasive jet, and of the behavior of the whole process in the processing of brittle materials. Results of experiments confirmed the hypothesis that statistical analysis is a procedure that can lead to a decrease in the number of cracks in processing. The measurement was performed with precise instruments and analyzed with recognized software and according to the results obtained, the reduction of the number of cracks is achieved through use of low pressure, a minimum stand-off distance and a small tube diameter. In this way, the paper presents a new and effective tool for optimizing the cutting with a hydro-abrasive jet of marble

Analysis of bearings behaviour with cylindrical rollers with variable center of gravity

This paper consists in analysis of the contact stress and deformations appeared to the cylindrical rollers with variable center of gravity who equips large bearings, with finite elements method. Also it proposed an innovative model of lubrication system mounts in the hollow cylindrical rollers of the large bearings where it is stored the lubricant who is driven to the raceways through holes fitted with closing/opening systems made in the cover, controlled by a command system, monitoring and control, equipped with temperature sensors and wireless command. Elimination of lubricant, in stages, leads to changes in position of center of gravity of roller, thus to change its behavior in functioning. Comparison of deformations occurred in cylindrical rollers, solid, with hollowness, and with variable center of gravity, allow favorable conclusions, on the implementation of the proposed lubrication system

Development Trends of Production Systems through the Integration of Lean Management and Industry 4.0

The integration of efficient production and management systems with the new Industry 4.0 concept represents a challenge for any company wishing to adapt its processes in order to increase performance, both at the operational and the organizational levels, through digitization and connectivity. This research proposes an analysis of Lean tools and Industry 4.0 technologies for compatibility in order to provide a framework model for development and integration in industrial applications. Through a systematic review of the literature, this paper contributes to the development of the current vision regarding the implementation and integration of the two &ldquo;paradigms&rdquo; of production. An analysis of the current key production strategies was performed through a new conceptual approach from the perspective of correlating the Lean management system, a system that has been stable in recent decades, with the innovative technologies of Industry 4.0. The applicative character of the research consisted of the optimization by simulation of a flexible production system in which the two concepts were integrated. The results showed that the implementation of Lean in the field of flexible manufacturing, correlated with the integration of Industry 4.0 techniques, such as digital twin and simulation, led to improved production processes by fast and flexible reconfiguration, with the two concepts being interdependent

Analysis of bearings behaviour with cylindrical rollers with variable center of gravity

This paper consists in analysis of the contact stress and deformations appeared to the cylindrical rollers with variable center of gravity who equips large bearings, with finite elements method. Also it proposed an innovative model of lubrication system mounts in the hollow cylindrical rollers of the large bearings where it is stored the lubricant who is driven to the raceways through holes fitted with closing/opening systems made in the cover, controlled by a command system, monitoring and control, equipped with temperature sensors and wireless command. Elimination of lubricant, in stages, leads to changes in position of center of gravity of roller, thus to change its behavior in functioning. Comparison of deformations occurred in cylindrical rollers, solid, with hollowness, and with variable center of gravity, allow favorable conclusions, on the implementation of the proposed lubrication system