Infectious profiles in civilian gunshot associated long bone fractures.

PURPOSE: There is a paucity of literature on infections in civilian gunshot associated with long bone fractures with the reported rates ranging from 0-15.7%.This study aimed to investigate the rates of infection associated with long bone fractures caused by civilian gunshots. The specific objectives were to determine if certain extremities were at a higher risk for infection and to identify the types of bacteria present in these infections by analyzing culture isolates. METHODS: We conducted a retrospective review of consecutive patients aged 18-64 who sustained gunshot-associated long bone fractures at an urban Level I trauma centre from 2010 to 2017. Patient selection was based done through a institutional trauma centre database using international classification of diseases (ICD) 9 and 10 codes. We included patients who underwent surgical treatment, specifically fracture fixation, at our institution and excluded patients with fractures involving the pelvis, spine, foot, and hand. A total of 384 gunshot-associated long bone fractures in 347 patients were identified for analysis. Relevant patient-, injury-, and treatment-related variables were extracted from clinical records and radiographic reviews. Outcomes of interest included bony union, repeat operative procedures, and the development of deep infection. RESULTS: 347 patients with 384 long bone fractures were included. 32 fractures in 32 patients developed an infection for an incidence of 9.3% of patients and 8.3% of fractures. Gram-positive bacteria were present in 23/32 (72.0%) culture isolates, gram-negative bacteria in 10/32 (31.3%) culture isolates, and six infections were polymicrobial. Staphylococcus 16/32 (50.0%) and Enterobacter 6/32 (18.8%) species were the most common isolates. Of the Staphylococcus species, 5/16 (31.3%) were MRSA. Lower extremity fractures had a greater risk for infection compared to the upper extremity (11.7% vs 3.7% p < 0.01) and fractures that developed an infection had a larger average zone of comminution (63.9 mm vs 48.5 mm p < 0.05). CONCLUSION: This study investigated the rates of infection associated with long bone fractures caused by civilian gunshots. The overall infection rate observed in our series aligns with existing literature. Gram-positive bacteria were the predominant isolates, with a notable incidence of MRSA in our patient population, highlighting the need for considering empiric coverage. Additionally, gram-negative organisms were found in a significant proportion of infections, and a notable percentage of infections were polymicrobial. Our findings emphasize the importance of carefully assessing highly comminuted lower extremity fractures and implementing appropriate antibiotic coverage and operative debridement for patients with gunshot-related long bone fractures. While current prophylaxis algorithms for open fractures lack specific inclusion of gunshot wounds, we propose incorporating these injuries to reduce the incidence of infections associated with such fractures.

Nanostructured Catalyst Layer Allowing Production of Ultralow Loading Electrodes for Polymer Electrolyte Membrane Fuel Cells with Superior Performance.

This study introduces a simple method to produce ultralow loading catalyst-coated membrane electrodes, with an integrated carbon "nanoporous layer", for use in polymer electrolyte membrane fuel cells or other electrochemical devices. This approach allows fabrication of electrodes with loadings down to 5.2 µgPt cm-2 on the anode and cathode (total 10.4 µgPt cm-2, Pt3Zn/C catalyst) in a controlled, uniform, and reproducible manner. These layers achieve high utilization of the catalyst as measured through electrochemical surface area and mass specific activities. Electrodes composed of Pt/C, PtNi/C, Pt3Co/C, and Pt3Zn/C catalysts containing 5.2-7.1 µgPt cm-2 have been fabricated and tested. These electrodes showed an impressive performance of 111 ± 8 A mgPt-1 at 0.65 V on Pt3Co/C with a power density of 31 ± 2 kW gPt,total-1, about double that of the best previous literature electrodes under the same operating conditions. The performance appears apparently mass transport free and dominated by electrokinetics over a very wide potential range, and thus, these are ideal systems to study oxygen electrokinetics within the fuel cell environment. The improved performance is associated with reduced "contact resistance" and more specifically a reduction in the resistance to lateral current flow in the catalyst layer. Analytical expressions for the effect illuminate approaches to improve electrode design for electrochemical devices in which catalyst utilization is key.

Dynamics of Droplets Impacting on Aerogel, Liquid Infused, and Liquid-Like Solid Surfaces.

Droplets impacting superhydrophobic surfaces have been extensively studied due to their compelling scientific insights and important industrial applications. In these cases, the commonly reported impact regime was that of complete rebound. This impact regime strongly depends on the nature of the superhydrophobic surface. Here, we report the dynamics of droplets impacting three hydrophobic slippery surfaces, which have fundamental differences in normal liquid adhesion and lateral static and kinetic liquid friction. For an air cushion-like (super)hydrophobic solid surface (Aerogel) with low adhesion and low static and low kinetic friction, complete rebound can start at a very low Weber (We) number (∼1). For slippery liquid-infused porous (SLIP) surfaces with high adhesion and low static and low kinetic friction, complete rebound only occurs at a much higher We number (>5). For a slippery omniphobic covalently attached liquid-like (SOCAL) solid surface, with high adhesion and low static friction similar to SLIPS but higher kinetic friction, complete rebound was not observed, even for a We as high as 200. Furthermore, the droplet ejection volume after impacting the Aerogel surface is 100% across the whole range of We numbers tested compared to other surfaces. In contrast, droplet ejection for SLIPs was only observed consistently when the We was above 5-10. For SOCAL, 100% (or near 100%) ejection volume was not observed even at the highest We number tested here (∼200). This suggests that droplets impacting our (super)hydrophobic Aerogel and SLIPS lose less kinetic energy. These insights into the differences between normal adhesion and lateral friction properties can be used to inform the selection of surface properties to achieve the most desirable droplet impact characteristics to fulfill a wide range of applications, such as deicing, inkjet printing, and microelectronics.

Slippery Liquid-Like Solid Surfaces with Promising Antibiofilm Performance under Both Static and Flow Conditions.

Biofilms are central to some of the most urgent global challenges across diverse fields of application, from medicine to industries to the environment, and exert considerable economic and social impact. A fundamental assumption in anti-biofilms has been that the coating on a substrate surface is solid. The invention of slippery liquid-infused porous surfaces─a continuously wet lubricating coating retained on a solid surface by capillary forces─has led to this being challenged. However, in situations where flow occurs, shear stress may deplete the lubricant and affect the anti-biofilm performance. Here, we report on the use of slippery omniphobic covalently attached liquid (SOCAL) surfaces, which provide a surface coating with short (ca. 4 nm) non-cross-linked polydimethylsiloxane (PDMS) chains retaining liquid-surface properties, as an antibiofilm strategy stable under shear stress from flow. This surface reduced biofilm formation of the key biofilm-forming pathogens Staphylococcus epidermidis and Pseudomonas aeruginosa by three-four orders of magnitude compared to the widely used medical implant material PDMS after 7 days under static and dynamic culture conditions. Throughout the entire dynamic culture period of P. aeruginosa, SOCAL significantly outperformed a typical antibiofilm slippery surface [i.e., swollen PDMS in silicone oil (S-PDMS)]. We have revealed that significant oil loss occurred after 2-7 day flow for S-PDMS, which correlated to increased contact angle hysteresis (CAH), indicating a degradation of the slippery surface properties, and biofilm formation, while SOCAL has stable CAH and sustainable antibiofilm performance after 7 day flow. The significance of this correlation is to provide a useful easy-to-measure physical parameter as an indicator for long-term antibiofilm performance. This biofilm-resistant liquid-like solid surface offers a new antibiofilm strategy for applications in medical devices and other areas where biofilm development is problematic.

Antiwetting and Antifouling Performances of Different Lubricant-Infused Slippery Surfaces.

The concept of slippery lubricant-infused surfaces has shown promising potential in antifouling for controlling detrimental biofilm growth. In this study, nontoxic silicone oil was either impregnated into porous surface nanostructures, referred to as liquid-infused surfaces (LIS), or diffused into a polydimethylsiloxane (PDMS) matrix, referred to as a swollen PDMS (S-PDMS), making two kinds of slippery surfaces. The slippery lubricant layers have extremely low contact angle hysteresis, and both slippery surfaces showed superior antiwetting performances with droplets bouncing off or rolling transiently after impacting the surfaces. We further demonstrated that water droplets can remove dust from the slippery surfaces, thus showing a "cleaning effect". Moreover, "coffee-ring" effects were inhibited on these slippery surfaces after droplet evaporation, and deposits could be easily removed. The clinically biofilm-forming species P. aeruginosa (as a model system) was used to further evaluate the antifouling potential of the slippery surfaces. The dried biofilm stains could still be easily removed from the slippery surfaces. Additionally, both slippery surfaces prevented around 90% of bacterial biofilm growth after 6 days compared to the unmodified control PDMS surfaces. This investigation also extended across another clinical pathogen, S. epidermidis, and showed similar results. The antiwetting and antifouling analysis in this study will facilitate the development of more efficient slippery platforms for controlling biofouling.

A quick and versatile one step metal-organic chemical deposition method for supported Pt and Pt-alloy catalysts.

A simple, modified Metal-Organic Chemical Deposition (MOCD) method for Pt, PtRu and PtCo nanoparticle deposition onto a variety of support materials, including C, SiC, B4C, LaB6, TiB2, TiN and a ceramic/carbon nanofiber, is described. Pt deposition using Pt(acac)2 as a precursor is shown to occur via a mixed solid/liquid/vapour precursor phase which results in a high Pt yield of 90-92% on the support material. Pt and Pt alloy nanoparticles range 1.5-6.2 nm, and are well dispersed on all support materials, in a one-step method, with a total catalyst preparation time of ∼10 hours (2.4-4× quicker than conventional methods). The MOCD preparation method includes moderate temperatures of 350 °C in a tubular furnace with an inert gas supply at 2 bar, a high pressure (2-4 bar) compared to typical MOCVD methods (∼0.02-10 mbar). Pt/C catalysts with Pt loadings of 20, 40 and 60 wt% were synthesised, physically characterised, electrochemically characterised and compared to commercial Pt/C catalysts. TEM, XRD and ex situ EXAFS show similar Pt particle sizes and Pt particle shape identifiers, namely the ratio of the third to first Pt coordination numbers modelled from ex situ EXAFS, between the MOCD prepared catalysts and commercial catalysts. Moreover, electrochemical characterisation of the Pt/C MOCD catalysts obtained ORR mass activities with a maximum of 428 A gPt -1 at 0.9 V, which has similar mass activities to the commercial catalysts (80-160% compared to the commercial Pt/C catalysts).

Anatomic Knowledge and Perceptions of the Adequacy of Anatomic Education Among Applicants to Orthopaedic Residency.

BACKGROUND: The time dedicated to the study of human anatomy within medical school curriculums has been substantially reduced. The effect of this on the knowledge of incoming orthopaedic trainees is unknown. The current study aimed to evaluate both the subjective perceptions and objective anatomic knowledge of fourth-year medical students applying for orthopaedic residency. METHODS: A multicenter prospective study was performed that assessed 224 students during the course of their interview day for an orthopaedic residency. Participants provided demographic data and a subjective assessment of the quality of their anatomic education, and completed either an upper or lower extremity anatomic examination. Mean total scores and subscores for various anatomic regions and concepts were calculated. RESULTS: Students on average rated the adequacy of their anatomic education as 6.5 on a 10-point scale. Similarly, they rated the level of importance their medical school placed on anatomic education as 6.2 on a 10-point scale. Almost 90% rated the time dedicated to anatomy as good or fair. Of six possible methods for learning anatomy, dissection was rated the highest.On objective examinations, the mean score for correct answers was 44.2%. This improved to 56.4% when correct and acceptable answers were considered. Regardless of anatomic regions or concepts evaluated, percent correct scores did not reach 50%. There were no significant correlations between performance on the anatomic examinations and either prior academic performance measures or the student's subjective assessment of their anatomic education. CONCLUSIONS: Current students applying into orthopaedic residency do not appear to be adequately prepared with the prerequisite anatomic knowledge. These deficits must be explicitly addressed during residency training to produce competent, safe orthopaedic surgeons.

Dipeptidyl nitrile inhibitors of Cathepsin L.

A series of potent Cathepsin L inhibitors with good selectivity with respect to other cysteine Cathepsins is described and SAR is discussed with reference to the crystal structure of a protein-ligand complex.