Circular External Fixation as a New Offloading Standard of Treatment in Charcot Neuro-Osteoarthropathy Complicated by Midfoot Osteomyelitis: A Pilot, Prospective Case-Control Study.

After surgical treatment of Charcot neuro-osteoarthropathy (CNO) complicated by plantar ulcer and midtarsal osteomyelitis, offloading is mandatory to protect the surgical site. Total contact casting is, to date, the standard-of-care to offload the foot during the postoperative period. We have compared the application of external circular fixator, to the standard of care, with regard to surgical wound healing and time to healing. During the time period from January 2020 to December 2021, 71 consecutive patients admitted to our unit with diabetes and CNO complicated by plantar ulceration and midtarsal osteomyelitis were enrolled in our study. All patients were classified as stage 2, according to the Frykberg & Sanders classification. Wifi wound stage was W2 I0 FI2 in 43 of 71 patients (60.6%) and W2 I2 FI2 in 28 of 71 patients (39.4%). In cases where critical limb ischemia occurred, we performed an endovascular procedure to obtain patency in at least one of the tibial arteries. Localization of osteomyelitis was carried out with magnetic resonance imaging studies, and the degree of deformity was assessed using plain X-ray or computed tomography. A localized ostectomy through the ulceration was carried out with a fasciocutaneous flap to cover the surgical site. In 36 patients, an external circular fixator was applied intraoperatively (exfix+ group); the remaining 35 patients received fiberglass cast in the postoperative period (exfix- group). Complete healing of the surgical site was achieved in 36 of 36 patients in the exfix+ arm and in 22 of 35 in the exfix- arm (P < .02). Time to healing was 68 ± 28 days in exfix+ and 102 ± 88 days in exfix- (P = .05). Circular external frames should be considered as an effective offloading device that enhances the healing rate and reduces time to healing after surgical treatment of midfoot osteomyelitis in subjects affected by CNO.

Advances in treatment of diabetic foot ulcers

Diabetic foot is a major health problem all over the world. Approximately 15% of the 200 million people with diabetes worldwide will develop a foot ulcer during their lifetime. Major amputation is a feared complication of diabetes. Many patients who undergo an amputation have a history of ulceration. More than 60% of non-traumatic amputations in the western world are carried out in diabetes patients. Major amputations increase morbidity and mortality and reduce the patient’s quality of life. An important prelude to diabetic foot treatment is the differing diagnosis of neuropathic and neuroischemic foot. Treatment of a neuropathic plantar ulcer must correct pathological plantar distribution of pressures. Surgical treatment of deformities, with or without ulcerations, is an effective therapy. Charcot neuroarthropathy is a particular complication of neuropathy wich may lead to fragmentation or destruction of joints and bones. Additionally, in the diabetic population peripheral vascular disease (PVD) is the main risk factor for amputation. If PVD is not diagnosed, treatment of the ulcer cannot be successful. In diabetic patients PVD is distal, but often fully involves the femoral, popliteal and tibial vessels. It can be successfully treated with either open surgical or endovascular procedures. Finally, infection is a serious complication of diabetic foot. Phlegmon or necrotizing fascitis are not only limb-threatening problems, but also life-threatening ones. In this case emergency surgery is mandatory (AU)

In vitro synergistic antibacterial action of certain combinations of gentamicin and essential oils.

The aim of this study was to verify the existence of synergistic antibacterial effect between four essential oils (Aniba rosaeodora, Melaleuca alternifolia, Origanum vulgare, and Pelargonium graveolens) individually combined with the antibacterial drug Gentamicin. We investigated the effectiveness in vitro of the association of essential oil/Gentamicin, against fifteen different strains of Gram positive and Gram negative bacteria. The antibacterial effects of these oils in combination with Gentamicin were evaluated by using the MHB microdilution method, while gas chromatography (GC) and GC/Mass spectrometry were used to analyze the chemical composition of the oils. A synergistic interaction was observed against all tested strains with the associations between the essential oils Aniba rosaeodora/Gentamicin and Pelargonium graveolens/Gentamicin. In particular a very strong synergistic interaction was observed against Acinetobacter baumannii ATCC 19606 (FIC index = 0.11). In contrast, the essential oils Origanum vulgare and Melaleuca alternifolia in association with Gentamicin were less effective on bacterial species growth. In vitro interaction can improve the antimicrobial effectiveness of the Gentamicin and may contribute to reduce its dose correlated to side effects.

Viability of nerve grafts preserved in different storage medium: ultrastructural features

We investigated the ultrastructural organization of transplanted autologous grafts after storage in two different solutions. Male Wistar rats were divided into groups to obtain normal tibial nerves, freshly transplanted nerves, and nerves stored in Wisconsin/Belzer or Collins solution for 24 or 72 hours at 4 °C and transplanted (W1, W3, C1, C3). After storage or transplantation, the specimens were processed for ultrastructural analysis. All grafts showed alterations in collagen fiber organization in the endoneurial space compared to normal nerves. These fibers were more loosely organized among nerve fibers, a finding that was significantly more marked in group C3 compared to groups W1 and W3. Important alterations were also observed in the myelin sheath structure of grafts stored in the two media. These changes were characterized by separation of the lipid lamellae, clearly visible in larger diameter nerve fibers. These findings were more marked and frequent in the C1 and C3 groups compared to the W1 and W3 groups. Ultrastructural analysis showed better preservation of Schwann cells and other elements that support axonal regeneration for grafts stored in Wisconsin/Belzer solution. These results support ongoing studies for the formulation of storage solutions that permit the creation of nerve banks for heterologous transplantation.

[Hospital anxiety and depression]. / Ansia e depressione nelle ospedalizzazioni.

OBJECTIVE: The study investigate the presence of depressive disorders in patient who are taken in general hospital, to prevent and reduce the risk of developing a psychological pathology (anxious-depressive symptoms). METHODS: We used two tests: 1. General Health Questionnaire (GHQ-12) by Goldberg, a self-report questionnaire, consisting of 12 items, used to estimate the probability of detecting non-psychotic mental disorders and problems in every day's activity. 2. Personal Health Questionnaire (PHQ), a self-report questionnaire, consisting of 10 items. It is a new tool for detecting individuals with ICD-10 depressive disorders, used to estimate the probability to individuate the presence of major depression symptoms, and minor depression symptoms. Tests have been administered to 140 subjects (males' experimental group, 32 subjects; males' control group, 20 subjects; females' experimental group 58 subjects; females' control group, 30 subjects) from eight departments of university hospital, medical faculty, and social services. RESULTS: It can be noted that with GHQ-12, the presence of non-psychotic mental disorders does not come out: just the females' group, experimental and control, shows some problems with insomnia and stress. On the other hand, with PHQ, the presence of no great entity depressive symptoms comes out for all groups. In the experimental groups the quantity of depressive symptoms is greater than in the control groups. CONCLUSIONS: We have find the presence of a number of depressive symptoms into a hospitalized population. It is known that detecting such symptoms is important for protection and care of depressive disorders in hospitalized and non-hospitalized populations.

MitBASE: a comprehensive and integrated mitochondrial DNA database.

MitBASE is an integrated and comprehensive database of mitochondrial DNA data which collects all available information from different organisms and from intraspecie variants and mutants. Research institutions from different countries are involved, each in charge of developing, collecting and annotating data for the organisms they are specialised in. The design of the actual structure of the database and its implementation in a user-friendly format are the care of the European Bioinformatics Institute. The database can be accessed on the Web at the following address: http://www.ebi.ac. uk/htbin/Mitbase/mitbase.pl. The impact of this project is intended for both basic and applied research. The study of mitochondrial genetic diseases and mitochondrial DNA intraspecie diversity are key topics in several biotechnological fields. The database has been funded within the EU Biotechnology programme.

Vertebrate MitBASE: a specialised database on vertebrate mitochondrial DNA sequences.

Vertebrate MitBASE is a specialized database where all the vertebrate mitochondrial DNA entries from primary databases are collected, revised and integrated with new information emerging from the literature. Variant sequences are also analyzed, aligned and linked to reference sequences. Data related to the same species and fragment can be viewed over the WWW. The database has a flexible interface and a retrieval system to help non-expert users and contains information not currently available in the primary databases. Vertebrate MitBASE is now available through the MitBASE home page at URL: http://www.ebi.ac.uk/htbin/Mitbase/mitb ase.pl. This work is part of a larger project, MitBASE which is a network of databases covering the full panorama of knowledge on mitochondrial DNA from protists to human sequences.