Chronic osteomyelitis: what the surgeon needs to know

Chronic osteomyelitis represents a progressive inflammatory process caused by pathogens, resulting in bone destruction and sequestrum formation. It may present with periods of quiescence of variable duration, whereas its occurrence, type, severity and prognosis is multifactorial. The ‘gold standard’ for the diagnosis of chronic osteomyelitis is the presence of positive bone cultures and histopathologic examination of the bone. Its management remains challenging to the treating physician, with a multidisciplinary approach involving radiologists, microbiologists with expertise in infectious diseases, orthopaedic surgeons and plastic surgeons. Treatment should be tailored to each patient according the severity and duration of symptoms, as well as to the clinical and radiological response to treatment. A combined antimicrobial and surgical treatment should be considered in all cases, including appropriate dead space management and subsequent reconstruction. Relapse can occur, even following an apparently successful treatment, which has a major impact on the quality of life of patients and is a substantial financial burden to any healthcare system

Femoral non-union above a fused knee: Successful treatment with exchange nailing and intramedullary delivery of bone morphogenetic protein

Bone healing is a complex and well-orchestrated physiological process, in which bone repairs and regenerates regaining its original biomechanical and biochemical properties. It is estimated that 5 to 10% of all fractures are complicated by delayed union or non-union. Progression to non-union is thought to be multifactorial, even though the exact biological sequence remains obscure. Treatment should aim to addressing deficiencies in both the mechanical and biological components, along with eliminating co-factors that could negatively affect the locally induced fracture healing response. We report a case of a 78-year-old patient who presented with a distal femoral non-union above a previously fused knee, which was successfully managed with exchange nailing and intramedullary delivery of recombinant human bone morphogenetic protein-7 (rhBMP-7)

Geographical Origin Prediction of Folk Music Recordings from the United Kingdom

Field recordings from ethnomusicological research since the beginning of the 20th century are available today in large digitised music archives. The application of music information retrieval and data mining technologies can aid large-scale data processing leading to a better understanding of the history of cultural exchange. In this paper we focus on folk and traditional music from the United Kingdom and study the correlation between spatial origins and musical characteristics. In particular, we investigate whether the geographical location of music recordings can be predicted solely from the content of the audio signal. We build a neural network that takes as input a feature vector capturing musical aspects of the audio signal and predicts the latitude and longitude of the origins of the music recording. We explore the performance of the model for different sets of features and compare the prediction accuracy between geographical regions of the UK. Our model predicts the geographical coordinates of music recordings with an average error of less than 120 km. The model can be used in a similar manner to identify the origins of recordings in large unlabelled music collections and reveal patterns of similarity in music from around the world

Inflammatory Profile and Osteogenic Potential of Fracture Haematoma in Humans

Fracture haematoma forms immediately after fracture and is considered essential for the bone healing process. Its molecular composition has been briefly investigated with our current understanding being based on animal studies. This study aims to analyse the inflammatory cytokine content of fracture haematoma in humans and determine its effect on osteoprogenitor cells. Twenty-three patients were recruited following informed consent. Peripheral blood, fracture haematoma and bone were collected. A Luminex assay on the levels of 34 cytokines was performed and autologous peripheral blood samples served as control. Mesenchymal Stem Cells (MSCs) were isolated following collagenase digestion and functional assays were performed. Gene expression analysis of 84 key osteogenic molecules was performed. Thirty-three inflammatory cytokines were found to be significantly raised in fracture haematoma when compared to peripheral serum (p < 0.05). Amongst the most raised molecules were IL-8, IL-11 and MMP1, -2 and -3. Fracture haematoma did not significantly affect MSC proliferation, but ALP activity and calcium deposition were significantly increased in the MSCs undergoing osteogenic differentiation. Medium supplementations with fracture haematoma resulted in a statistically significant upregulation of osteogenic genes including the EGF, FGF2 and VEGFA. This seems to be the pathway involved in the osteogenic effect of fracture haematoma on bone cells. In conclusion, fracture haematoma is found to be a medium rich in inflammatory and immunomodulatory mediators. At the same time, it contains high levels of anti-inflammatory molecules, regulates osteoclastogenesis, induces angiogenesis and the production of the extracellular matrix. It appears that fracture haematoma does not affect osteoprogenitor cells proliferation as previously thought, but induces an osteogenic phenotype

On machine learning-based techniques for future sustainable and resilient energy systems

Permanently increasing penetration of converter-interfaced generation and renewable energy sources (RESs) makes modern electrical power systems more vulnerable to low probability and high impact events, such as extreme weather, which could lead to severe contingencies, even blackouts. These contingencies can be further propagated to neighboring energy systems over coupling components/technologies and consequently negatively influence the entire multi-energy system (MES) (such as gas, heating and electricity) operation and its resilience. In recent years, machine learning-based techniques (MLBTs) have been intensively applied to solve various power system problems, including system planning, or security and reliability assessment. This paper aims to review MES resilience quantification methods and the application of MLBTs to assess the resilience level of future sustainable energy systems. The open research questions are identified and discussed, whereas the future research directions are identified

Learning a feature space for similarity in world music

In this study we investigate computational methods for assessing music similarity in world music styles. We use state-of-the-art audio features to describe musical content in world music recordings. Our music collection is a subset of the Smithsonian Folkways Recordings with audio examples from 31 countries from around the world. Using supervised and unsupervised dimensionality reduction techniques we learn feature representations for music similarity. We evaluate how well music styles separate in this learned space with a classification experiment. We obtained moderate performance classifying the recordings by country. Analysis of misclassifications revealed cases of geographical or cultural proximity. We further evaluate the learned space by detecting outliers, i.e. identifying recordings that stand out in the collection. We use a data mining technique based on Mahalanobis distances to detect outliers and perform a listening experiment in the ‘odd one out’ style to evaluate our findings. We are able to detect, amongst others, recordings of non-musical content as outliers as well as music with distinct timbral and harmonic content. The listening experiment reveals moderate agreement between subjects’ ratings and our outlier estimation

Safety of Epidural Corticosteroid Injections

Background and Objective Epidural corticosteroid injections (ESIs) have been used for several decades and now represent the most common intervention performed for the management of back pain with a radicular component. However, several reports have presented devastating complications and adverse effects, which fuelled concerns over the risk versus clinical effectiveness. The authors offer a comprehensive review of the available literature and analyse the data derived from studies and case reports. Methods Studies were identified by searching PubMed MEDLINE, Ovid MEDLINE, EMBASE, Scopus, Google Scholar and the Cochrane Library to retrieve all available relevant articles. Publications from the last 20 years (September 1994 to September 2014) were considered for further analysis. Studies selected were English-language original articles publishing results on complications related to the technique used for cervical and lumbar ESIs. The studies had to specify the approach used for injection. All studies that did not fulfil these eligibility criteria were excluded from further analysis. Results Overall, the available literature supports the view that serious complications following injections of corticosteroid suspensions into the cervical and lumbar epidural space are uncommon, but if they occur they can be devastating. Conclusions The true incidence of such complications remains unclear. Direct vascular injury and/or administration of injectates intra-arterially represent a major concern and could account for the vast majority of the adverse events reported. Accurate placement of the needle, use of a non-particulate corticosteroid, live fluoroscopy, digital subtraction angiography, and familiarisation of the operator with contrast patterns on fluoroscopy should minimise these risks. The available literature has several limitations including incomplete documentation, unreported data and inherent bias. Large registries and well-structured observational studies are needed to determine the true incidence of adverse events and address the safety concerns

Combined caesarean section and open reduction internal fixation for the treatment of an acetabular fracture in late pregnancy

Lesson In this case, we opted for dual surgery combining caesarean section and internal fixation of acetabular fracture in late pregnancy, which allowed safe foetal delivery, fracture repair and early ambulation of the mother. In similar cases, this method could be potentially considered in the armamentarium of treatment options, aiming to facilitating prompt motherhood input and early hospital discharge, as well as minimising the risk of post-traumatic arthritis of the hip