We report our experience using a biodegradable calcium sulphate antibiotic carrier containing tobramycin in the surgical management of patients with chronic osteomyelitis. The patients were reviewed ...to determine the rate of recurrent infection, the filling of bony defects, and any problems with wound healing. A total of 193 patients (195 cases) with a mean age of 46.1 years (16.1 to 82.0) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 12 type I, 1 type II, 144 type III and 38 type IV cases. The mean follow-up was 3.7 years (1.3 to 7.1) with recurrent infection occurring in 18 cases (9.2%) at a mean of 10.3 months post-operatively (1 to 25.0). After further treatment the infection resolved in 191 cases (97.9%). Prolonged wound ooze (longer than two weeks post-operatively) occurred in 30 cases (15.4%) in which there were no recurrent infection. Radiographic assessment at final follow-up showed no filling of the defect with bone in 67 (36.6%), partial filling in 108 (59.0%) and complete filling in eight (4.4%). A fracture occurred in nine (4.6%) of the treated osteomyelitic segments at a mean of 1.9 years (0.4 to 4.9) after operation. We conclude that Osteoset T is helpful in the management of patients with chronic osteomyelitis, but the filling of the defect in bone is variable. Prolonged wound ooze is usually self-limiting and not associated with recurrent infection.
The recent consensus definition for the diagnosis of fracture-related infection (FRI) includes the identification of indistinguishable microorganisms in at least 2 surgical deep-tissue specimens as a ...confirmatory criterion. However, this cut-off, and the total number of specimens from a patient with suspected FRI that should be sent for microbiological testing, have not been validated. We endeavored to estimate the accuracy of different numbers of specimens and diagnostic cut-offs for microbiological testing of deep-tissue specimens in patients undergoing surgical treatment for possible FRI.
A total of 513 surgical procedures in 385 patients with suspected FRI were included. A minimum of 2 surgical deep-tissue specimens were submitted for microbiological testing; 5 or more specimens were analyzed in 345 procedures (67%). FRI was defined by the presence of any confirmatory criteria other than microbiology. Resampling was utilized to model the sensitivity and specificity of diagnostic cut-offs for the number of surgical specimens yielding indistinguishable microorganisms and for the total number of specimens. The likelihood of detecting all clinically relevant microorganisms was also assessed.
A diagnostic cut-off of at least 2 of 5 specimens with indistinguishable microorganisms identified by culture was 68% sensitive (95% confidence interval CI, 62% to 74%) and 87% specific (95% CI, 81% to 94%) for the diagnosis of FRI. Two out of 3 specimens were 60% sensitive (95% CI, 55% to 66%) and 92% specific (95% CI, 88% to 96%). Submitting only 3 deep-tissue specimens risked missing clinically relevant microorganisms in at least 1 in 10 cases.
The present study was the first to validate microbiological criteria for the diagnosis of FRI, supporting the current confirmatory diagnostic criteria for FRI. Analysis of at least 5 deep-tissue specimens in patients with possible FRI is recommended.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
An appeal to the novel “Poor Lisa” by Nikolay Karamzin in an extensive cultural and historical context provides an opportunity to pose a question on the transmission of culture, its “vertical” ...dimension. This makes it possible to distinguish between the characters according to their cultural types: Liza is a person of “soil”, endowed with ancestors’ sacred knowledge, while Erast is a man of «culture» out of touch with the ground. In this regard, it proves to be relevant not so much the social inequality of the characters, as noted by the researchers, as their different worldview, attitude to nature, love, etc. Parallel with the Russian folklore tradition, lyrics, where the concept of «love» is represented through the lexemes «sweetheart», «soul», «heart» are also challenging in this respect. It is to this archaic knowledge, the heritage of centuries, that Liza, the main character, is attached. Separation from love, a broken heart in this context is equivalent to the loss of life. Based on such representations, Liza’s act is considered from a different angle: death is the only possible outcome for the heroine, for her heart life. In the typological aspect, it is fruitful to refer to Montaigne’s Essays, to his statements on heart life, which is to a great extent consistent with the life of nature. At that time, Montaigne’s philosophy was well known to Russian literary figures.
The methodological basis of the study includes structural-typological, comparative, and system-complex (culturological) research methods, ensuring a comprehensive approach to the analysis of the artistic text and making it possible to show the national space in Karamzin’s novel. The results may be interesting to both philologists and cultural scientists, and can also be used in courses on the history of Russian literature.
The problem of modeling reinforced concrete structures with bar finite elements using a nonlinear material that allows to consider the direct reinforcement is studied. An approach to the creation of ...a computational model of a reinforced concrete column is proposed, the peculiarity of which is to specify reinforcing bars at the appropriate integration points of the cross-section. As a material of reinforced concrete bar elements, a nonlinear material based on Eurocode-2 is used, which can model the nonlinear behavior of both concrete and reinforcement for different integration points. Numerical experiments were carried out using the LS-DYNA software package. The results of the calculation of the bar reinforced concrete column are compared with the data for the column modeled using solid finite elements with direct reinforcement. In addition, a comparative analysis of the studied column with the results of full-scale tests is performed. Studies have shown good convergence of stresses, strains, and displacements, as well as the coincidence of the value of the ultimate breaking load and the similar nature of the destruction of the reinforced concrete column.
Abstract Vaccination against Plasmodium falciparum malaria could reduce the worldwide burden of this disease, and decrease its high mortality in children. Replication-defective recombinant adenovirus ...vectors carrying P. falciparum epitopes may be useful as part of a vaccine that raises cellular immunity to the pre-erythrocytic stage of malaria infection. However, existing immunity to the adenovirus vector results in antibody-mediated neutralization of the vaccine vector, and reduced vaccine immunogenicity. Our aim was to examine a population of children who are at risk from P. falciparum malaria for neutralizing immunity to replication-deficient recombinant chimpanzee adenovirus 63 vector (AdC63), compared to human adenovirus 5 vector (AdHu5). We measured 50% and 90% vector neutralization titers in 200 individual sera, taken from a cohort of children from Kenya, using a secreted alkaline phosphatase neutralization assay. We found that 23% of the children (aged 1–6 years) had high-titer neutralizing antibodies to AdHu5, and 4% had high-titer neutralizing antibodies to AdC63. Immunity to both vectors was age-dependent. Low-level neutralization of AdC63 was significantly less frequent than AdHu5 neutralization at the 90% neutralization level. We conclude that AdC63 may be a useful vector as part of a prime-boost malaria vaccine in children.
The paper is dedicated to the issue of the apophatic component of artistic culture associated with Thanatos that is developed in the literature oeuvre of Aleksandr Grin. Setting Grin’s short story ...The Mystery of Foreseen Death as the research object, this texts seeks to provide insight into the image of death and the examination of its spiritual and material manifestations that reflected the logocentric approach that was then popular among the Russian thinkers. To pursue this aim, the methodology of this study should allow identifying the ontological perspective of Grin’s story. Thus, the methodological foundations embrace the onto-hermeneutic approach to the analysis of literary work. In revealing the ontological dimension of the story much attention is paid to the ethos of life and death, the protagonist’s artistic imaginative experience of reality. In the story under study death is ambivalent: it is bodily, anthropological, as indicated by the repetitive image of neck on the execution block. At the same time, it is apophatic, as indicated by the darkened end of the story, the bewilderment of skeptical scientists that arose because of the main event of the story, namely the protagonist’s execution. In this regard, it appears to be effective to consider the anthroposophical thought of Rudolf Steiner that was absorbed by a large part of Russian intelligentsia at the beginning of the 20th century. This doctrine stresses the reflections on a person’s experience of death in reality. The imaginative aspect of anthroposophism was developed by Grin’s close friend, a neighbor in Crimean Cimmeria, Maximilian Voloshin, a disciple of the teachings of Steiner. The conclusions that can be drawn from the study are as follows: Grin’s story presents a detailed imaginative death experience, which makes it possible to raise the issue of it being part of the broader anthroposophical teaching. The Mystery of Foreseen Death indirectly expresses the Steinerian ideas and at the same time it fits into the framework of the Russian apophatic artistic tradition. The article also raises the issue of the apophatic component of Russian artistic culture, the thanatological experience of which can help in overcoming crisis situations nowadays. The findings of the research, in this way, can have an effect on better understanding in several fields: in literature studies (philology), in the history of Russian literature, in cultural studies and in philosophy.
The meaning of proper names always attracted the scientists of different humanitarian spheres. The researchers of literary texts also paid much attention to the names of characters since special ...semantics is hidden in such names. In this article we deal with M. D. Chulkov’s novel written in the 18th century. Here the linguistic and cultural analysis of the names in the novel “The Comely Cook or A Dissolute Woman’s Progress” has been made. The parallels with the Russian folklore tradition help to highlight the mythopoeic implied sense of this work.
The article deals with comparative analysis of the works by N. V. Gogol and E. T. A. Hoffman. The study object is two texts: “The Night Before Christmas” by the writer from Russia and “A New Year’s ...Eve Adventure” by the romantic writer from Germany. The topic being analyzed is spatial models and relations thereof in the writers’ poetics. Special attention here is drawn to folklore tradition as in folk art a clear differentiation of various types of space can be observed. The parallels with Chinese fairy tales are drawn here where a literary technique of an animated portrait appeared to be relevant to the artistic world of the authors in question. Great importance is attached to archetypal structures associated with the feminine principle (the images of Oksana and Julia). Historico-literary and typological methods of the work analysis are used.
This study quantified changes in the microbiology of osteomyelitis over a ten year period from a single centre within the UK with regard to infection with multi-drug resistant (MDR) bacteria and ...susceptibility of antimicrobial regimens.
Patients with chronic osteomyelitis undergoing definitive surgery from 2013–2017 were inluded (n = 223). Microbiology was compared to patients in a cohort from 2001–2004, using the same diagnostic criteria, and same deep tissue sampling technique (n = 157). Clinical features associated with MDR bacterial infection were analysed using logistic regression.
Both cohorts had similar baseline characteristics. Despite a similar proportion of Staphylococcus aureus in both cohorts, the rate of methicillin resistant Staphylococcus aureus (MRSA) infection was lower in 2013–2017 compared to 2001–2004 (11.4% vs 30.8% of Staphylococcus aureus, p = 0.007). However, the proportion of MDR infections was similar in both cohorts (15.2% versus 17.2%). Metalwork was associated with MDR infection (unadjusted OR 5.0; 95% CI: 1.15 to 22.0). There was no change in resistance to glycopeptide / meropenem combination treatment (2.2% vs 2.5%, p > 0.9).
In this centre, rates of MRSA osteomyelitis have fallen by two thirds, over the past 10 years, in line with the reducing rate of MRSA bacteraemia nationally. A history of metalwork may predict MDR infection. A glycopeptide with an anti-pseudomonal carbapenem remains the post-operative empiric systemic regimen of choice. Resistance patterns support the use of a glycopeptide with an aminoglycoside in local antibiotic therapy.
The aim of this study was to evaluate the diagnostic value of preoperative serum CRP, white blood cell count (WBC), percentage of neutrophils (%N), and neutrophil to lymphocyte ratio (NLR) when using ...the fracture-related infection (FRI) consensus definition.
A cohort of 106 patients having surgery for suspected septic nonunion after failed fracture fixation were studied. Blood samples were collected preoperatively, and the concentration of serum CRP, WBC, and differential cell count were analyzed. The areas under the curve (AUCs) of diagnostic tests were compared using the z-test. Regression trees were constructed and internally cross-validated to derive a simple diagnostic decision tree.
Using the FRI consensus definition, 46 patients (43%) were identified as infected. Sensitivity, specificity, and AUC of CRP were 67% (95% confidence interval (CI) 52% to 80%), 61% (95% CI 47% to 74%), and 0.64 (95% CI 0.54 to 0.74); of WBC count were 17% (95% CI 9% to 31%), 95% (95% CI 86% to 99%), and 0.57 (95% CI 0.50 to 0.62); of %N 13% (95% CI 6% to 26%), 87% (95% CI 76% to 93%), and 0.50 (95% CI 0.43 to 0.56); and of NLR 28% (95% CI 17% to 43%), 80% (95% CI 68% to 88%), and 0.54 (95% CI 0.46 to 0.63), respectively. A better performance of serum CRP was shown in comparison to the leucocyte count (p = 0.006), %N (p < 0.001), and NLR (p = 0.001). A statistically lower serum CRP level was shown in patients with an infection caused by a low virulence microorganism in comparison to high virulence bacteria (p = 0.008). We found that a simple decision tree approach using only low serum neutrophils (< 3.615 × 10
/l) and low CRP (< 2.45 mg/l) may allow better identification of aseptic cases.
The evaluated serum inflammatory markers showed limited diagnostic value in the preoperative diagnosis of FRI when using the uniform FRI Consensus Definition. Therefore, they should remain as suggestive criteria in diagnosing FRI. Although CRP showed a higher performance in comparison to the other serum markers, it is insufficiently accurate to diagnose a septic nonunion, especially when caused by low virulence microorganisms. Cite this article:
2020;102-B(7):904-911.
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