Surgical Site Infection Prophylaxis and Wound Management in Spine Surgery

Surgical site infection (SSI) is a potentially devastating complication of spinal surgery that increases patient morbidity and healthcare costs. SSIs have complex and multifactorial etiologies; therefore, there are numerous opportunities for prevention and risk mitigation. The aim of this narrative review was to describe the incidence, risk factors, and outcomes of SSIs in spine surgery with an emphasis on postoperative wound care. We list and describe the preoperative, intraoperative, and postoperative evidence-based interventions that can be applied to potentially prevent SSI after spinal surgery.

Trends in intensity-modulated radiation therapy use for rectal cancer in the neoadjuvant setting: a National Cancer Database analysis

PURPOSE: Traditionally, three-dimensional conformal radiation therapy (3D-CRT) is used for neoadjuvant chemoradiation in locally advanced rectal cancer. Intensity-modulated radiation therapy (IMRT) was later developed for more conformal dose distribution, with the potential for reduced toxicity across many disease sites. We sought to use the National Cancer Database (NCDB) to examine trends and predictors for IMRT use in rectal cancer. MATERIALS AND METHODS: We queried the NCDB from 2004 to 2015 for patients with rectal adenocarcinoma treated with neoadjuvant concurrent chemoradiation to standard doses followed by surgical resection. Odds ratios were used to determine predictors of IMRT use. Univariable and multivariable Cox regressions were used to determine potential predictors of overall survival (OS). Propensity matching was used to account for any indication bias. RESULTS: Among 21,490 eligible patients, 3,131 were treated with IMRT. IMRT use increased from 1% in 2004 to 22% in 2014. Predictors for IMRT use included increased N stage, higher comorbidity score, more recent year, treatment at an academic facility, increased income, and higher educational level. On propensity-adjusted, multivariable analysis, male gender, increased distance to facility, higher comorbidity score, IMRT technique, government insurance, African-American race, and non-metro location were predictive of worse OS. Of note, the complete response rate at time of surgery was 28% with non-IMRT and 21% with IMRT. CONCLUSION: IMRT use has steadily increased in the treatment of rectal cancer, but still remains only a fraction of overall treatment technique, more often reserved for higher disease burden.

Localization of sulphonylurea receptor proteins SUR2A and SUR2B and/or SUR1 in rat kidney

To further explore precise expression and localization of sulphonylurea receptor isoforms SUR2A and SUR2B [SUR1] in rat kidney, total RNA was isolated from the kidney tissue using the TRIzol kit. Three different primer sets designed against SUR isoforms were used in reverse transcriptase reactions. Western blotting was done on membrane fractions obtained from kidney tissues using the primary antisera for SUR2A and SUR2B [SUR1]. Paraformaldehyde fixed kidney sections were immunostained with SUR2A and SUR2B [SUR1] primary antisera. Sections were developed with DAB as a chromogen. RT-PCR results demonstrated mRNA consistent with SUR1 isoform to be the only identifiable transcript. Western blotting could not identify any protein consistent with SUR2A or SUR2B [SUR1] but recognized instead a smaller 55kD protein of unknown identity. Immunohistochemistry demonstrated a differential staining pattern whereby SUR2A was localized to the mesangial cells, intra- and extrarenal blood vessels and smooth muscles. In contrast, SUR2B [SUR1] was localized only to distal nephron epithelia. Intense immunoreactivity was localized to the thick ascending limb and as well as in the outer and inner medullary collecting ducts, both. Our results demonstrate differential and highly localized expression pattern of sulphonylurea receptor proteins SUR2A and 2B [SUR1] in rat kidney with implications for drug design

[Effect of the V364D mutation in membrane endocytosis of ROMK2 [Kir1.1b]]

Recent studies suggest that endocytosis of ROMK channels is important for regulation of K+ secretion in cortical collecting ducts. In this study the effect of V364D mutation is examined on the membrane turnover and stability of ROMK2 channel when expressing in Xenopus laevis oocytes. In this experimental study oocytes were isolated by standard protocols using collagenase [Type 1A]. Mutations of the cytoplasmic termini of ROMK2 were constructed using the quikchange approach for site-directed mutagensis. Xenopus oocytes were injected with cRNA encoding ROMK2 or V364D mutant three days prior to treatment with BFA solution [time 0]. Brefeldin A [BFA] was added to the OR3 medium [+BFA] at concentrations of 5-25 M [inhibit insertion of new proteins into the cell membrane] or ethanol as BFA vehicle [-BFA]. Two-electrode voltage clamp [TEVC] was used to measure oocyte ROMK-dependent currents and membrane potential. Data was analysed using Student's t-tests or ANOVA as appropriate. Incubation of oocytes expressing ROMK2 channels in both 5microM and 25 microM BFA caused a reduction in the normalized steady state currents. The effect of BFA was dose dependent. In oocytes expressing the V364D mutant, there was no decay in current at any time point during incubation with BFA at either 5 M or 25 M. The fractional current for ROMK2 at 48h following treatment of oocytes with BFA was 0.24 0.05 [n=16] which was significantly different to V364D mutant [1.17 0.09]. These results show that the V364D mutation increases the general stability of ROMK and renderes the protein resistant to endocytosis, consistent with the idea that there is an interaction between the C-terminal of ROMK2 and components of the endocytotic pathway. A functional PDZ domain [the S-E-V] plays a key role in determining stability of ROMK

A case of factor V deficiency presenting as menorrhagia

@#Factor V deficiency is a rare hereditary disorder. We report a patient with factor V deficiency who presented with menorrhagia and pelvic haematoma. The Haematology Department at the Royal Brisbane Hospital performed the definitive factor assays leading to the diagnosis. The challenges of her management were obtaining adequate supplies of factor V and her socioeconomic circumstances. The main future challenge will be the supervision of her pregnancies.