Identificación y sensibilidad antibiótica directas desde el hemocultivo positivo para bacilos gram negativos. Rendimiento comparativo de los sistemas Vitek 2C y Phoenix / Direct identification and susceptibility testing from positive blood cultures. A head-to-head performance comparison between Vitek 2C and Phoenix systems / Identificação e sensibilidade antibiótica diretas a partir da hemocultura positiva para bacilos gram negativos. Desempenho comparativo dos sistemas Vitek 2C e Phoenix

Resumen El objetivo de este estudio fue comparar los resultados de las pruebas de identificación y sensibilidad antimicrobiana obtenidos por los sistemas Vitek 2C (bioMérieux, Francia) y Phoenix (Becton Dickinson, EE.UU.) directamente a partir de hemocultivos positivos. Se realizó un estudio observacional prospectivo en el Hospital Naval Pedro Mallo de Buenos Aires, Argentina, que incluyó 70 bacteriemias monomicrobianas por gram negativos. Se obtuvo una identificación correcta por Vitek® 2C y por Phoenix del 100% y 97% respectivamente [p: no significativa (NS)]. La concordancia categórica para todos los antimicrobianos fue 97,1% y 98,1% (p: NS) con Vitek 2C y con Phoenix respectivamente. El tiempo medio para obtener un resultado fue de 10,19 h y 13,8 h (p: NS), respectivamente. Vitek 2C y Phoenix son herramientas importantes, rápidas y confiables para la identificación y las pruebas de sensibilidad realizadas directamente a partir de hemocultivos positivos.

Abstract The aim of this study was to compare the results of identification and antimicrobial susceptibility tests obtained by the Vitek 2C (bioMérieux, France) and Phoenix (Becton Dickinson, USA) systems directly from positive blood cultures. A prospective observational study was performed at the Pedro Mallo Navy Hospital in Buenos Aires, Argentina, which included 70 monomicrobial bacteremias by gram negative rods. Correct identification by Vitek® 2C and Phoenix was 100% and 97%, respectively [p: not significant (NS)]. Categorical agreement for all antimicrobials was 97.1% and 98.1% (p: NS) with Vitek 2C and Phoenix, respectively. The mean time to result was 10.19 h and 13.8 h (p: NS), respectively. Vitek 2C and Phoenix are important, rapid and reliable tools for identification and susceptibility testing when performed directly from positive blood cultures.

Resumo O objetivo deste estudo foi comparar os resultados dos testes de identificação e de suscetibilidade antimicrobiana obtidos pelos sistemas Vitek 2C (bioMérieux, França) e Phoenix (Becton Dickinson, EUA) diretamente a partir de culturas de sangue positivas. Foi realizado um estudo observacional prospectivo no Hospital Naval Pedro Mallo em Buenos Aires, Argentina, incluindo 70 bacteriemias monomicrobianas devido a gram negativos. A identificação correcta por Vitek® 2C e Phoenix obtida foi de 100% e 97% respectivamente [p: não significativo (NS)]. O acordo categórico para todos os antimicrobianos foi de 97,1% e 98,1% (p: NS) com Vitek 2C e Phoenix respectivamente. O tempo médio para obter o resultado foi de 10,19 h e 13,8 h (p: NS), respectivamente. Vitek 2C e Phoenix são ferramentas importantes, rápidas e fiáveis para a identificação e testes de sensibilidade realizados diretamente a partir de hemoculturas positivas.

The Performance of Graduation from Traditional Growing Rods with Apical Control Technique in Patients with Congenital Early-Onset Scoliosis / 罕见病研究

  Objective  Different from other etiologies of early-onset scoliosis (EOS), congenital early-onset scoliosis (CEOS) is mainly linked to vertebral anomalies, such as formation failures and segmentation failures at the apex segments. So far, there is little research on CEOS patients who have completed traditional growing rods (TGR) treatment, and the initial outcomes of TGR with or without apical control technique (ACT) are different. Therefore, we compared the "final" results of CEOS patients who completed TGR treatment with or without ACT.  Methods  We conducted a retrospective study of CEOS patients who completed TGR treatment from 2007—2020. They either had final fusion or were followed up after reaching skeletal maturity. We split the patients into two groups based on whether they had ACT with TGR or not. The ACT-TGR group had apical vertebrectomy/hemivertebrectomy with short fusion and TGR. The TGR-only group had only TGR. We looked at their demographic features, radiographic measurements, and complications.  Results  This study enrolled 46 CEOS patients, of which 13 patients were in the ACT-TGR group and 33 patients in the TGR group. The ACT-TGR group had a longer distraction interval (1.17 years vs. 0.75 years). The ACT-TGR group had a larger preoperative main curve [87.00(63.50, 98.00)], but the residual curve degrees were comparable between the two groups at the last follow-up (P=0.354). At the last follow-up, the T1-12 and T1-S1 heights were similar between the two groups. The ACT-TGR group had a lower number of implant-related complications per patient (0.77 vs. 1.48). Three patients in the ACT-TGR group underwent final fusion, while 17 patients in the TGR group underwent final fusion (P=0.060).  Conclusions  Both ACT-TGR and traditional TGR coud effectively correct deformity and preserve spinal growth in CEOS patients. ACT-TGR had a better corrective effect on patients with severe deformity and did not have a significant impact on spinal height. For patients with acceptable correction, spontaneous fusion and without implant failure, retaining the implant and continuing observation could be a strategy for graduating from growing rod treatment.

Clinicopathological features of cystic neutrophilic granulomatous mastitis / 中华普通外科杂志

Objective:To investigate the etiology, clinical manifestations, clinicopathological features of cystic neutrophil granulomatous mastitis (CNGM).Methods:From Jan 2019 to Dec 2020, 95 CNGM cases diagnosed by biopsy pathology at Chongqing Hospital of Traditional Chinese Medicine and Chongqing Liangping District Hospitol of Traditional Chinese Medicine were reviewed.Results:There were 95 female patients, aged 21 to 50 years, with a median age of 32 years. Laboratory examination showed that 56% (53/95) cases had elevated rheumatoid antibody level, 27 % (26/95) had increased level of serum thyroid antibody, 15% (14/95) had elevated antineutrophil antibody, 35% (33/95) had increased ESR, 38% (36/95) had increased C-reactive protein. The positive rate of Gram-stained bacilli was 82% (78/95). Histology: pyogenic granuloma with lobule of breast as the center, the center of granuloma was cystic vacuole.Immunohistochemistry showed that the inflammatory cells in and around granuloma were mainly CD3 + cells, and CD4 + cells were more than CD8 + cells. Conclusions:The cystic neutrophilie granulo matous mastitis is a rare type of idiopathic granulomatous mastitis. The diagnosis of CNGM is dependent on its specific pathological features.

Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients

ABSTRACT Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia. Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis. Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7-4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1-7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2-6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8-15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2-4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %. Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.

Actinomyces naeslundii causing pulmonary endobronchial Actinomycosis – A case report

Actinomyces naeslundii is a commensal flora of the oral cavity and is generally considered as an avirulent saprophytic bacterium in immunocompetent patients. It can become an opportunistic anaerobic pathogen in oral cavity in patients with poor oral hygiene or tooth extraction and can cause periodontal disease. Pulmonary Actinomycosis is a rare manifestation and may be suspected in middle-aged male patients with cough and hemoptysis showing radiological findings of a peripheral mass or chronic consolidation in whom repeated aerobic cultures have yielded negative results. Here, we report isolation of A. naeslundii from the bronchoalveolar lavage sample from an immunocompetent patient who presented with chronic nonresolving pneumonia of 6 months duration.

Comparison of the Effects of Magnetically Controlled Growing Rod and Tradiotinal Growing Rod Techniques on the Sagittal Plane in the Treatment of Early-Onset Scoliosis

OBJECTIVE: Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS). METHODS: Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients’ demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period. RESULTS: Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8–15) and 4.8 (3–7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1–S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group. CONCLUSION: There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Comparison of the Effects of Magnetically Controlled Growing Rod and Tradiotinal Growing Rod Techniques on the Sagittal Plane in the Treatment of Early-Onset Scoliosis

OBJECTIVE: Comparing the effects of magnetically controlled growing rod (MCGR) and traditional growing rod (TGR) techniques on the sagittal plane in the treatment of early-onset scoliosis (EOS).METHODS: Twelve patients were operated using dual MCGR technique in one center, while 15 patients were operated using dual TGR technique for EOS in another center. Patients’ demographic characteristics, complications and radiological measurements such as cobb angle, thoracic kyphosis, lumbar lordosis, T1–S1 range (mm), proximal junctional angle, distal junctional angle, sagittal balance, coronal balance, pelvic incidence, sacral slope and pelvic tilt were assessed and compared in preoperative, postoperative and last follow-up period.RESULTS: Age and sex distributions were similar in both groups. The mean number of lengthening in the MCGR group was 12 (8–15) and 4.8 (3–7) in the TGR group. Two techniques were shown to be effective in controlling the curvature and in the increase of T1–S1 distance. In TGR group, four patients had rod fractures, six patients had screw pull-out and four patients had an infection, whereas three patients had screw pull-out and one patient had infection complications in the MCGR group.CONCLUSION: There was no significant difference between the two groups in terms of cobb angle, coronal and sagittal balance and sagittal pelvic parameters. MCGR can cause hypokyphosis and proximal junctional kyphosis in a minimum 2-year follow-up period. The implant-related complications were less in the MCGR group. However, larger case groups and longer follow-up periods are required for the better understanding of the superiority of one method on other in terms of complications.

Minimum 2-Year Experience with Magnetically Controlled Growing Rods for the Treatment of Early-Onset Scoliosis: A Systematic Review

Magnetically controlled growing rods have been used to treat early-onset scoliosis for the last 9 years; however, few studies have been published, with only short-term follow-up. The aim of the present study is to systematically review the outcomes of magnetically controlled growing rods in the treatment of early-onset scoliosis with a minimum of 2-year follow-up. Studies were included if patients with early-onset scoliosis (scoliosis diagnosed before 10 years of age) underwent implantation of magnetically controlled growing rods with a minimum of 2-year follow-up. The literature review and data extraction followed the established preferred reporting items for systematic review and meta-analysis guidelines. Data of distraction frequency, number of distractions, distracted length, Cobb angle, kyphosis, T1–T12 length, and T1–S1 length preoperatively, postoperatively, and at final follow-up were collected. Data regarding complications and unplanned reoperations were also extracted. The mean values of these parameters were calculated, or pooled meta-analysis was performed if available. Ten articles were included in this systematic review, with a total of 116 patients and a follow-up period between 23 and 61 months. The mean preoperative Cobb angle and kyphosis angle were 60.1° and 38.0°, respectively, and improved to 35.4° and 26.1° postoperatively. At final follow-up, the Cobb and kyphosis angles were maintained at 36.9° and 36.0°, respectively. The average preoperative T1–T12 and T1–S1 lengths were 180.6 mm and 293.6 mm, respectively, and increased to 198.3 mm and 320.3 mm postoperatively. T1–T12 and T1–S1 lengths were 212.3 mm and 339.3 mm at final follow-up, respectively. The overall rate of patients with complications was 48% (95% confidence interval [CI], 0.38–0.58) and unplanned reoperation 44% (95% CI, 0.33–0.55) after sensitivity analysis. The current evidence from different countries with a minimum of a 2-year follow-up suggests that magnetically controlled growing rods are an effective technique to treat pediatric scoliosis and promote spine growth. However, nearly half of patients still developed complications or required unplanned reoperations.

Leclercia adecarboxylata, a rare cause of soft tissue infections in immunocompromised patients, case report and review of the literature / Leclercia adecarboxylata, una causa rara de infección de tejidos blandos en pacientes inmunocomprometidos, reporte de caso y revisión de la literatura

Leclercia adecarboxylata is a member of the Enterobacteriaceae family that has been isolated from several environmental and animal specimens, however it rarely causes diseases in human beings. It has natural resistance to several antibiotics, and has shown the ability to harbor and produce enzymes capable of hydrolyzing most of the antibiotics used in daily clinical practice, making its treatment a challenge when a strain with such characteristics causes disease. Here we report the first known case of infection by Leclercia adecarboxylata after a trauma with plant material, in a 69-year-old male patient, with poorly controlled Diabetes Mellitus type 2.

Leclercia adecarboxylata es un miembro de la familia Enterobacteriaceae que ha sido aislada tanto de muestras de animales como medioambientales, sin embargo raramente produce enfermedad en seres humanos. Tiene resistencia natural a varios antibióticos y se ha encontrado que tiene enzimas capaces de hidrolizar la mayoría de los antibióticos utilizados en la práctica clínica, lo cual hace un verdadero tratar una infección por este microorganismo en humanos. Aquí reportamos el primer caso de infección por Leclercia adecarboxylata luego de un trauma con material vegetal, en un paciente de 69 años y con una diabetes tipo 2, mal controlada.

Outcome of traditional growing rods for correction of apical vertebra rotation in early-onset scoliosis / 中华外科杂志

Objective@#To evaluate the correction result of traditional dual growing rods on apical vertebral rotation.@*Methods@#This study recruited 19 early-onset scoliosis patients (6 boys and 13 girls) who had received traditional dual growing rods treatment at Department of Spine Surgery, Nanjing Drum Tower Hospital from January 2009 to July 2015. The age at initial surgery was (5.7±1.7)years(range, 3 to 9 years). Measurements of primary curve magnitude, height of T1-S1, apical vertebral translation(AVR), apical vertebral body-rib ratio, apical vertebral rotation, thoracic rotation and rib hump were compared between pre-operatively, post-operatively, and at latest follow-up, through a paired-t test. Pearson correlation test was used for correlation analysis between parameters.@*Results@#All patients had a follow-up of (49.5±12.8)months(range, 24 to 71 months). A total of 111 operative procedures were performed, among which there were 92 lengthening procedures, averagely 4.8 lengthening procedures per patient. The average interval for each lengthening procedure was 10 months. The Cobb angle of primary curve was notably decreased from (66.5±13.2)° to (35.2±10.9)°(t=24.013, P<0.01), and no significant correction loss was found at the latest follow-up ((36.7±10.7)°)(t=-1.324, P=0.202). In addition, significant correction of AVR, thoracic rotation, apical vertebral translation, apical vertebra body-rib ratio, and rib hump were noted after initial surgery. Whereas, these parameters significant increased during follow-up(all P <0.05) except for thoracic rotation. Pearson correlation analysis showed that the increase of AVR during follow-up significantly correlated with change of apical vertebra translation, apical vertebral body-rib ratio, and rib hump(r=0.652, 0.814, 0.695; all P<0.05).@*Conclusions@#Significant correction of AVR can be achieved after initial surgery in early-onset scoliosis patients treated with traditional dual growing rods. However, such a technique can hardly prevent the deterioration of AVR during follow-up.

Results of Magnetically Controlled Growing Rods for Early Onset Scoliosis / 대한정형외과학회잡지

PURPOSE: To evaluate the first results of surgical treatment using newly developed magnetically controlled growing rods (MCGR) for early onset scoliosis (EOS). MATERIALS AND METHODS: From January 2013 to January 2017, 5 patients, who underwent surgical treatment with MCGR for EOS and were followed for more than one year, were analyzed retrospectively. The demographic and radiology data, including age at surgery, diagnosis, number of lengthening, Cobb angle, T1–S1 length, T1–T12 length, and complications, were analyzed. RESULTS: The mean age of the patients was 6.0±2.7 years old. The subjects were 3 males and 2 females: 2 with neuromuscular scoliosis, 1 with syndromic scoliosis, 1 with idiopathic scoliosis, and 1 with congenital scoliosis. The mean number of lengthening was 9.8±2.9 times and the follow-up was 21.6±5.7 months. The Cobb angle improved from 82.0°±28.5° to 48.3°±28.8° at the last follow-up. The T1–S1 length increased from 283.1±72.7 mm to 342.6±86.3 mm at the last follow-up. The T1–T12 length increased from 163.1±50.5 mm to 202.3±65.5 mm at the last follow-up. One screw loosening complication was encountered and there were no neurological complications. CONCLUSION: The treatment using MCGR for EOS is effective and useful.

Dual Growing Rod Treatment for Progressive Pediatric Spinal Deformity

STUDY DESIGN: Retrospective study. OBJECTIVES: To evaluate the outcomes of dual growing rod treatment over a follow-up period of at least 2 years in patients with progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The dual growing rod treatment is safe and effective in curve correction and maintenance in patients with progressive pediatric spinal deformity. MATERIALS AND METHODS: Between 2009 to 2017, 14 patients who underwent dual growing rod treatment were followed up for more than 2 years. We analyzed their demographic and radiologic data, including age at surgery, sex, diagnosis, instrumented levels, number of total operations, number of lengthening procedures, interval of lengthening, Cobb angle, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, and complications. RESULTS: The mean age of the patients was 11.0±2.9 years old. There were 10 male and 4 female patients, including 8 cases of neuromuscular scoliosis, 3 cases of idiopathic scoliosis, 2 cases of spondyloepiphyseal dysplasia, and 1 case of congenital scoliosis. The mean follow-up period was 42.4±14.0 months. The total number of operations was 6.6±2.6. The average number of lengthening procedures was 4.3±2.3 at an interval of 6.9±2.1 months. The Cobb angle improved from 60.4°±27.9° to 33.5°±19.7° after the initial treatment and 29.1°±16.4° after the last follow-up or final fusion. The T1-S1 length increased from 328.2±57.5 mm to 388.0±64.9 mm after the initial treatment and 424.9±64.4 mm after the last follow-up or final spinal fusion. The average growth rate was 11.5 mm/year. Six patients experienced 11 complications, of which 4 were Implant-related, and 7 were Infections. CONCLUSIONS: The dual growing rod technique is an effective and relatively safe treatment in patients with progressive pediatric spinal deformity.

The effectiveness of 3D printed titanium alloy trabecular reconstruction rod for the treatment of early osteonecrosis of femoral head / 天津医药

Objective To evaluate the safety of 3D printed titanium alloy trabecular reconstruction rod, bone grafts and its clinical efficacy. Methods Sixty patients with osteonecrosis of femoral head (ONFH) stageⅡ(ACROⅡ) were randomly divided into experimental group (titanium rod group) and control group (tantalum rod group). Patients were followed up at 6, 12 and 24 months after the operation. Harris score and visual analogue scale (VAS) were used to evaluate the postoperative function. Changes of X-ray were observed before and after operation. The imaging evaluation was analyzed after 24 months. Results The Harris score was decreased in titanium rod group compared with that of tantalum rod group at six-month. There were no significant differences in Harris scores for other time points between two groups. Repeated measures analysis of variance showed that there was a significant difference in time effect. The X-ray staging results changed gradually before and after operation in two groups, stage Ⅲand stage Ⅳgradually increased with time. There was progress in ONFH after operation in two groups. No infection or rejection was found in the two groups. There were higher improvement rates of stageⅡA and stageⅡB. There were no significant differences in improvement rate and hip preservation rate between two groups. The transparent lines disappeared in the positive and lateral X-ray films 6 months after the operation. No new transparent lines were found. The bone enhancement was not found in two groups of patients during follow-up period. No stress occlusion and bone trabecular bone enhancement were observed in two groups. Conclusion Titanium rods are satisfactory for the treatment of femoral head necrosis in the early stage of ACRO Ⅱ, which is not recommended for the treatment of relatively large ACROⅡC stage of necrotic area.

Hydrogen-rich water prepared by hydrogen rods:an experimental study / 军事医学

Objective To verify the efficiency and stability of hydrogen-rich water preparation with hydrogen-rich rods. Methods ①Seven firenew hydrogen-rich rods were separately placed in seven plastic bottles, each filled with distilled water and soaked for 6 h, before the hydrogen concentration of the water was measured.This process was repeated 10 times.②After the hydrogen-rich rods with the strongest and weakest hydrogen product capacity were removed, the remaining 5 hydrogen-rich rods were placed separately into 5 plastic bottles filled with distilled water,put in a water bath pot at 20,40 and 60℃, respectively, and kept for 2, 4, 6, 8 and 10 h, respectively.Then, the hydrogen concentration, oxidation-reduction potential(ORP),and dissolved oxygen concentration(DO) were measured at various time points.③In order to determine the hydrogen emission rate from the hydrogen-rich water, the hydrogen-rich rods were constantly kept in some samples and the others were removed.All the sample bottle caps were kept open during the experimental process, and the hydrogen concentration was measured at such time points as 0, 10 and 30 min, 1, 2, 5, 12, 24, 30, 48 and 72 h, respectively.Results ①The hydrogen-rich rods used in this study could well meet the requirements.②When the environment temperature was kept constant, the hydrogen concentration of the water was increased with the soaking time of the hydrogen-rich rods, and the ORP of the water was reduced.However, the DO of the water was decreased with the rise of the environment temperature.③When the hydrogen-rich water was kept in opened plastic bottles with a 25 mm oral diameter, the hydrogen concentration of the samples with the hydrogen-rich rods reserved was almost about 0.50 ppm until 72 h, and that of the others was reduced to almost 0 ppm.Conclusion Our results demonstrate that the hydrogen-rich rods test is a simple and effective method for preparing hydrogen-rich water, which will be an valuable and useful method for using hydrogen-rich water in health promotion and prevention of chronic diseases.

Gram-negative enteric rods associated to early implant failure and peri-implantitis: case report and systematic literature review / Bacilos entéricos gram-negativos asociados a fracaso temprano de implantes y peri-implantitis: reporte de un caso y revisión sistemática de literatura

The microbiota associated with failed implants includes Pseudomonas and Gram-negative enteric rods. The present study reports a case of Escherichia coli associated to early implant failed that was resistant in vitro to doxycycline, amoxicillin, metronidazole, and clindamycin, but was susceptible in vitro to ciprofloxacin and aminoglycosides. The literature concerning the prevalence of the opportunistic microorganisms in early implant failure and peri-implantitis patients, and the usual treatment of these patients harboring Pseudomonas and enteric rods was also revised.

La microbiota asociada con los implantes fallidos incluye Pseudomonas y bacilos entéricos Gram-negativos. En el presente estudio se informa acerca de un caso de Escherichia coli asociada a un fallo temprano del implante resistente in vitro a la doxiciclina, amoxicilina, metronidazol y clindamicina, pero susceptible in vitro a ciprofloxacina y aminoglucósidos. Se realizó una revisión de la literatura sobre la prevalencia de los microorganismos oportunistas en pacientes con insuficiencia temprana del implante y periimplantitis, y el tratamiento habitual de estos pacientes portadores de Pseudomonas y bacilos entéricos.

Indução do padrão citoplasmático em forma de "bastões e anéis" através do tratamento da hepatite C: relato de caso / Induction of cytoplasmic pattern in the form of "rods and rings" through the treatment of hepatitis C: a case report

Paciente do sexo feminino, queixando-se de astenia e dor em hipogastro, foi admitida no pronto-socorro do Hospital Universitário do Oeste do Paraná (HUOP). Durante a anamnese relatou tratamento de infecção crônica pelo vírus da hepatite C (VHC) com inteferon peguilado e ribavirina. Dentre os exames laboratoriais solicitados, a pesquisa de autoanticorpos contra antígenos celulares (PAAC-HEp-2), conhecido tradicionalmente como fator antinúcleo (FAN), apresentou fluorescência em forma de bastões e/ou anéis no citoplasma das células. Esse padrão é caracterizado por bastões de 3-10 µm e anéis com 2-5 µm de diâmetro espalhados através do citoplasma da célula. Portanto, esse novo padrão tem sido designado como "bastões e anéis" (traduzido do inglês: Rods and Rings, RR). O alvo antigênico dessa reação foi identificado como inosina-5'-monofosfato desidrogenase tipo 2 (IMPDH2) que é uma enzima chave na síntese de nucleotídeos púricos. A enzima IMPDH2 agregada ou modificada em forma de RR nos pacientes tratados com ribavirina pode tornar-se antigênica e induzir uma resposta autoimune. É possível que o interferon alfa estimule a ocorrência de reatividade anti-RR aparentemente induzida pela ribavirina. Até o momento não se sabe por que o padrão RR em células HEp-2 ocorrem apenas em uma fração de pacientes portadores do VHC. Os dados apresentados em trabalhos anteriores possibilitam afirmar que esses anticorpos associados ao padrão RR estão fortemente relacionados com o tratamento da hepatite C. Além disso, pode-se afirmar que a ocorrência de reatividade anti-RR é promovida pela terapia combinada com interferon alfa e ribavirina.

Female patient, complaining of weakness and pain in hypogastric, was admitted to the emergency department of the University Hospital of the West of Paraná (HUOP). During the interview reported treatment of chronic infection with hepatitis C virus (HCV) with peginterferon and ribavirin. Among the laboratory tests ordered, the search for self-antibodies against cellular antigens, traditionally known as antinuclear factor, showed fluorescence shaped like rods and/or rings in the cytoplasm of cells. This study attempts to clarify the relationship between this pattern not yet completely understood and the clinical picture of the patient. This pattern is characterized by 3–10 µm rods or rings with 2–5 µm in diameter scattered throughout the cytoplasm of the cell. Therefore, this new standard has been designated as "rods and rings" (RR). The antigenic target of this reaction was identified as inosine-5'-monophosphate dehydrogenase type 2 (IMPDH2) which is a key enzyme in the synthesis of purine nucleotides. The IMPDH2 enzyme aggregated or modified shaped RR in those patients treated with ribavirin may become antigenic and induce an autoimmune response. It is possible that interferon alpha stimulates the occurrence of anti-RR reactivity apparently induced by ribavirin. So far it is not known why the standard RR in HEp2 cells occurs only in a fraction of patients with HCV. Previous studies presented in this paper allow affirming that these antibodies associated with the standard RR are strongly related to hepatitis C. Moreover, it can be stated that the occurrence of anti-RR reactivity is promoted by combination therapy with interferon and ribavirin.

Morphology and ultrastructure of the freshwater rotifer Brachionus bidentatus (Monogononta: Brachionidae) using scanning and transmission electron microscopy / Morfología y ultraestructura del rotífero de agua dulce Brachionus bidentatus (Monogononta: Brachionidae), utilizando microscopía electrónica de barrido y transmisión

The study of sexual reproductive behavior supported by ultrastructural evidence is important in rotifers to describe differences among potential cryptic species. In this research, the morphology of the rotifer Brachionus bidentatus is described at the ultrastructural level, using electronic microscopy, together with a brief description and discussion of its sexual reproductive behavior. The characteristics of the (a) male,(b) the female, (c) the sexual egg or cyst, (d) the partenogenic egg, (e) the no-fecundated sexual egg (male egg), and (f) the trophi, were described. Another part of this research is dedicated to the ultrastructure of the sex cells of the male rotifer B. bidentatus. Samples were obtained from La Punta pond in Cosio, Aguascalientes, Mexico (22°08’ N - 102°24’ W), and a culture was maintained in the laboratory. Fifty organisms, from different stages of the rotifer Brachionus bidentatus, were fixed in Formol at 4% and then prepared; besides, for the trophi, 25 female rotifer Brachionus bidentatus were prepared for observation in a JEOL 5900 LV scanning electronic microscope. In addition, for the observation of male sex cells, 500 males of Brachionus bidentatus were isolated, fixed and observed in a JEOL 1010 transmission microscope. Females of B. bidentatus in laboratory cultures had a lifespan of five days (mean±one SD=4.69±0.48; N=13), and produced 4.5+3.67 (N=6) parthenogenetic eggs during such lifespan. In the case of non-fertilized sexual eggs, they produced up to 18 eggs (mean±one SD=13±4.93; N=7). Sexual females produced a single cyst on average (mean±one SD=1±0; N=20). For the sexual cycle, the time of copulation between male and female ranged from 10 to 40 seconds (mean±one SD=17.33±10.55, N=7). The spermatozoa are composed of a celular body and a flagellum, the size of the body is of 300nm while the flagellum measures 1 700nm. The rods have a double membrane. Their mean length is almost 2.45µm±0.74, N=6; and their mean wide is 0.773µm±0.241, N=11. The evidence on the specific ultrastructural characteristics of the rotifer B. bidentatus is notorious, even more in the male and in the cyst cell. Regarding the ultrastructure of the spermatozoa and the rods, compared to other species they only differ in size, despite their structural resemblance. Our study of the ultraestructure of this species adds useful information that along with molecular data will help clarify the taxonomy of brachionid rotifers. Rev. Biol. Trop. 61 (4): 1737-1745. Epub 2013 December 01.

El estudio del comportamiento reproductivo sexual apoyado en evidencias ultraestructurales en rotíferos, es importante para describir diferencias entre especies potencialmente crípticas. En este trabajo se describe a nivel ultraestructural la morfología del rotífero Brachionus bidentatus, usando microscopía electrónica, junto con una breve descripción y discusión de su comportamiento sexual reproductivo. Se presentan las características del: (a) macho, (b) hembra, (c) huevo partenogenético, (d) huevo sexual no fecundado, (e) trofos. También se muestra un apartado sobre la ultra estructura de las células sexuales de rotíferos macho B. bidentatus. Para el estudio se utilizó una cepa proveniente del bordo La Punta (22°08’ N - 102°24’ W), ubicado en Cosió, estado de Aguascalientes, México y se cultivaron en el laboratorio. Para el procesamiento de las muestras se tomaron 50 organismos fijados en Formol al 4%, de los diferentes estadios del rotífero Brachionus bidentatus, mientras que para el trofos se tomaron 25 organismos hembra del rotífero Brachionis bidentatus y se prepararon para observarse en un microscopio electrónico de barrido JEOL 5900 LV, mientras que para las observaciones de las células sexuales del macho se aislaron 500 organismos machos del rotífero Brachionus bidentatus, se fijaron e incluyeron en resina epóxica (EPON) para su observación en un microscopio electrónico de transmisión JEOL 1010 operado a 80kv. Los análisis obtenidos de hembras de B. bidentatus en cultivos de laboratorio demuestran un ciclo de vida de cinco días (4.69±0.48; N=13), y una producción de 4.5±3.67 (N=6) huevos partenogenéticos. En el caso de los huevos no fertilizados, la hembra produce más de 18 huevos (13±4.93; N=7). Para los huevos sexuales solo se produce uno solo por hembra (1±0; N=20). En el ciclo sexual, los tiempos de copula entre el macho y la hembra están en el rango de 10 a 40 segundos (17.33±10.55, N=7). Los espermatozoides se componen de un cuerpo celular y un flagelo, el tamaño del cuerpo celular es de 300nm mientras que el flagelo mide 1 700nm. Los bastones presentan una doble membrana y su tamaño a lo largo va de 2.45µm±0.74; N=6 mientras que el ancho es de 0.773µm±0.241; N=11. La evidencia sobre las características específicas ultraestructurales del rotífero B. bidentatus son notorias, más aun en el macho y en el quiste. En cuanto a la ultraestructura de los espermatozoides y los bastones respecto a otras especies sólo difieren en su tamaño, a pesar de las similitudes estructurales las estructuras de los bastones se evidencian con mayor claridad y dan más evidencias sobre su funcionalidad. Nuestro estudio de la ultraesturctura de esta especie añade información útil que junto con un análisis molecular ayudarán a clarificar la taxonomía de rotíferos brachionidos.

Results of Dual Growing Rods Treatment for Progressive Pediatric Spinal Deformity

STUDY DESIGN: A prospective study. OBJECTIVES: To report the results of new designed dual growing rods system for progressive pediatric spinal deformity. SUMMARY OF LITERATURE REVIEW: The current expandable spinal implant system appears effective in controlling progressive pediatric spinal deformity, allowing for spinal growth. However, there was no report concerning the growing rod in Korea. MATERIALS AND METHODS: Between 2010 and 2011, seven pediatric patients, who had a minimum of 1year follow-up, had undergone surgery for spinal deformity correction with a dual growing rods technique. We analyzed the demographic and radiologic data, including height, weight, age at surgery, diagnosis, number of lengthening, Cobb's angle of the major curve, thoracic kyphosis angle, lumbar lordosis angle, T1-S1 length, instrumented segment length, and complications, from the preoperative period to the last follow up period. RESULTS: Four male and three female patients with 5 neuromuscular scoliosis, 1 idiopathic juvenile osteoporosis and 1 spondyloepiphyseal dysplasia had underwent corrective surgery with dual growing rods. The mean age at the initial surgery was 11.6 years (7-13.8). The mean follow-up duration was 19.3 months (12-24), and the mean lengthening procedure time was 2.8 (2-4) for every patient. Cobb's angle of scoliosis curve was corrected from preoperative 80.2degrees(55-136) to 37.6degrees (15-81) on the last follow-up. Thoracic kyphosis angle and lumbar lordosis angle were changed from preoperative 48.7degrees(12-101) and 38.3degrees(9-72) to 44.5degrees(12-75) and 18.8degrees(1-46) on the last follow-up, respectively. Growth length during the follow-up period was measured as instrumented segment is 46 mm (33-59) and T1-S1 segment is 82 mm (66-98). Complications, such as breakage of rod in 3 cases and soft tissue infection in 1 case, occurred during the follow-up period. CONCLUSIONS: New designed dual growing rods system for pediatric patients with progressive spinal deformity is an effective and relatively safe method because of adequate correction and acceptable rate of complications.

Microorganismos inusuales en placa subgingival de pacientes con periodontitis crónica / Unusual microorganisms in subgingival plaque of patients with chronic periodontitis

Fundamento: en ambientes subgingivales de pacientes con periodontitis crónica se han encontrado microorganismos inusuales que incluyen bacilos entéricos gramnegativos y levaduras. En estos pacientes la terapia mecánica o antimicrobiana puede ser ineficiente para tratar o controlar la enfermedad periodontal. La característica que comparten los microorganismos inusuales es la de ser patógenos oportunistas, ya que aprovechan las condiciones de inmunodepresión para originar o agravar una enfermedad. Objetivo: presentar la prevalencia de microorganismos inusuales en placa subgingival de pacientes con periodontitis crónica en una población colombiana. Método: se evaluaron 76 pacientes sistémicamente sanos que asistieron a las clínicas odontológicas de la Facultad de Odontología de la Universidad de Antioquia. Las muestras subgingivales se procesaron mediante cultivo. Resultados: se observaron bacilos entéricos gramnegativos en 20 (26.31 %) pacientes y levaduras en 10 (13.2 %). Conclusiones: estos hallazgos tienen implicaciones terapéuticas importantes que deben tenerse en cuenta para el manejo de los pacientes con enfermedades periodontales.

Background: subgingival environment of patients with chronic periodontitis have been found unusual microorganisms including Gram-negative enteric bacilli and yeasts. Mechanical or antimicrobial therapy in these patients may be inefficient to treat or to control periodontal disease. The common feature unusual microorganisms share is to be opportunistic pathogens, taking advantage of immunosuppression conditions to cause or aggravate the disease. Objective: to present the prevalence of unusual microorganisms in subgingival plaque of patients with chronic periodontitis in a Colombian population. Method: 76 systemically healthy patients who were presented in the dental clinic at the Dental School of Antioquia University were evaluated. Subgingival samples were processed by cultivation. Results: enteric Gram-negative bacilli in 20 patients and yeasts in 10 were observed. Conclusions: these findings have important therapeutic implications that must be taken into account for patients management with periodontal diseases.

Administración sistémica adjunta de moxifloxacina versus ciprofloxacina másmetronidazol en el tratamiento de periodontitis crónica con presencia de bacilos entéricos Gram negativos: I. efectos clínicos y microbiológicos / Adjunctive systemic administration of moxifloxacin versus ciprofloxacin plus metronidazole in the treatment of chronic periodontitis harboring gram-negative enteric rods: I microbiological and clinical effects

Introducción: los hallazgos clínicos preliminares indican que las lesiones periodontales asociadas a bacilos entéricos Gram negativos no responden al tratamiento convencional. Los objetivos del presente estudio fueron evaluar y comparar los efectos clínicos ymicrobiológicos del raspaje y alisado radicular (RAR) combinado con la administración sistémica de moxifloxacina (MOX) o ciprofloxacinamas metronidazol (CIPRO + MET), en el tratamiento de sujetos con periodontitis crónica. Métodos: en este ensayo clínico participaron 76 pacientes, divididos en dos grupos. Los sujetos se trataron con RAR más MOX (Grupo MOX; n = 38) o RAR más CIPRO + MET (GrupoCIPRO + MET; n = 38). Los datos clínicos y microbiológicos se registraron a nivel base, y a los 3 y 6 meses después del tratamiento. Loscambios significativos en los parámetros clínicos y microbiológicos, intra e inter grupos, se midieron utilizando las pruebas de Mann-Whitney y Wilcoxon, respectivamente. Resultados: después de seis meses, los dos grupos de tratamiento presentaron una reducción significativa en la profundidad de sondaje y en el sangrado al sondaje, además de una ganancia en la inserción clínica (P < 0,05). Se observó disminución estadísticamente significativa de la proporción de sitios > 6 mm. No se identificaron entéricos ni Aggregatibacter actinomycetemcomitansen ninguno de los grupos, después de la terapia. Conclusiones: este estudio proporciona evidencia del beneficio adjunto de MOX o CIPROMET al RAR, en pacientes con periodontitis crónica que presentan entéricos. Sin embargo, MOX puede ser el antibiótico de elección envista de los pocos efectos adversos ocasionados y debido a su dosificación solo una vez al día.

Introduction: preliminary clinical findings indicate that periodontal lesions associated with Gram-negative enteric rods do not respond to conventional treatment modalities. The aim of the present study was to evaluate and compare the clinical and microbiologicaleffects of scaling and root planing (SRP) combined with systemic administration of moxifloxacin (MOX) or ciprofloxacin plus metronidazole (CIPRO + MET) in the treatment of chronic periodontitis. Methods: seventy-six patients participated in this randomized clinical trial, and they were divided into two groups. Subjects were treated with SRP plus adjunctive MOX (MOX group; n = 38) or SRP plus adjunctive CIPRO + MET (CIPRO + MET GROUP; n = 38). Clinical and microbiological data were recorded at baseline and at 3 and 6 months after treatment. The significant changes in clinical and microbiological parameters between and within the groups were measured using theMann-Whitney test and Wilcoxon’s rank test respectively. Results: after six months, both treatment groups showed a significant reduction in probing depth and bleeding on probing (P < 0.05) and better clinical attachment. A statistically significant reduction of the proportionof sites > 6 mm was also observed. Gram-negative enteric rods and Aggregatibacter actinomycetemcomitans were not identified in either group six months after baseline. Conclusions: this study provides evidence of the benefit of using MOX or CIPRO+MET as adjunct to SRP in patients with chronic periodontitis harboring Gram-negative enteric rods. However, MOX may be the antibiotic of choice in view of itsfew adverse effects and single dose treatment per day.