Broad-spectrum Antibiotic Prophylaxis in Tumor and Infected Orthopedic Surgery - the prospective-randomized, microbiologist-blinded, stratified, superiority Trials - BAPTIST trials

Background: The perioperative antibiotic prophylaxis with 1st or 2nd-generation cephalosporins is evidence-based in orthopedic surgery. There are, however, situations with a high risk of prophylaxis-resistant surgical site infections (SSI). Methods: We perform a superiority randomized-controlled trial with a 10% margin and a power of 90% in favor of the broad-spectrum prophylaxis. We will randomize orthopedic interventions with a high risk for SSI (open fractures, surgery under therapeutic antibiotics, tumor surgery, spine surgery with ASA-Score ≥ 3 points) in a prospective-alternating scheme (1:1, standard prophylaxis with mostly cefuroxime versus a broad-spectrum prophylaxis of a combined single-shot of vancomycin 1 g & gentamicin 5 mg/kg parenterally). The primary outcomes are "remission" at 6 weeks; or at 1 year for surgeries with implant. Secondary outcomes are the risk for prophylaxis-resistant SSI pathogens, revision surgery for any reason, change of antibiotic therapy, adverse events and the incidence of non-SSI infections within 6 weeks (e.g. urine infections). With event-free surgeries to 95% in the broad-spectrum versus 85% in the standard arm, we need 2 x 207 orthopedic surgeries among all groups. Discussion: In selected patients with a high risk for prophylaxis-resistant SSI, a broad-spectrum combination might prevent SSIs better than the standard prophylaxis. Trial registration: ClinicalTrial.gov NCT05502380. Registered on 12 August 2022. Protocol version: 2 (3 June 2022

Arthroscopic observation was useful to detect loosening of the femoral component of unicompartmental knee arthroplasty in a recurrent hemoarthrosis

A case of recurrent hemarthrosis of the knee after a mobile-bearing unicompartmental knee arthroplasty (UKA; Oxford UKA) is described. A 58-year-old man met with a road traffic accident 10 months after UKA. He developed anteromedial pain and hemarthrosis of the knee joint 1 month after the accident, which required multiple aspirations. Physical examination showed no instability. Plain radiograph revealed no signs of loosening. All laboratory data, including bleeding and coagulation times, were within normal limits. Diagnostic arthroscopy demonstrated loosening of the femoral component. Any intraarticular pathology other than nonspecific synovitis was ruled out. The loose femoral component and polyethylene meniscal bearing were revised. Since then, hemarthrosis has not recurred

Magnetic resonance imaging studies of spontaneous capillary water imbibition in aerated gypsum

International audienceIn this paper we investigate both capillary water imbibition and the sorptivity of aerated gypsum plaster, and how these sorption characteristics are related to the pore structure of the material. These characteristics are examined by monitoring mass change using the conventional gravimetric method and by obtaining water content profiles using nondestructive magnetic resonance imaging (MRI) techniques during capillary imbibition of water. Here, three different gypsum samples are investigated: one non-aerated reference gypsum sample and two aerated gypsum samples produced with different volumetric air fractions. The capillary water absorption into the reference sample follows t 1/2 kinetics (Fickian diffusion), where t is the time of ingress. However, in the aerated gypsum samples there are deviations from t 1/2 kinetics. The MRI results show unambiguously that two wetting fronts advance through the aerated structure ; an observation that cannot be made from the gravimetric data alone. The water content profiles of the aerated gypsum samples are therefore analysed by treating them as the sum of two separate absorption processes using Sharp Front (SF) analysis. The capillary water absorption properties of this material are well described as a parallel combination of fast absorption into fine matrix pores and slow absorption into a modified structure of matrix pores inter-connected to air voids introduced into the slurry by aeration. PACS 47.56.+r. flows through porous media PACS 47.55.nb. capillary and thermocapillary flow

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure.

Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual's health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them. Methods: Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed. Results: Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants' economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system. Conclusions: This study, the first of its kind in the UK, indicated that participants' health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK

When East Meets West: International Change and Its Effects on Domestic Cultural Institutions

Domestic governments increasingly face the pressure to follow policy developments occurring at the international or supranational level. Yet international laws and policies need to be “translated” to suit domestic political institutions and newly adopted policies may challenge or contradict preexisting domestic policies, institutions, and interests. To explore the domestic impact of international institutional developments, we studied the United Nations Educational, Scientific, and Cultural Organization (UNESCO) Convention for the Safeguarding of Intangible Cultural Heritage and its adoption in four countries (Japan, China, France, and Germany). Using historical institutionalism, this comparative case study sheds light on the effects of the Convention on cultural governance systems in two supposedly different “camps” within the UNESCO: the East and the West. The study argues that it is the interaction and entangled relationship of exogenous and endogenous factors over time, particularly the timing and sequence in which they constrain and facilitate change, which shape actors’ preferences and institutional development at both levels