Synovial calprotectin in prosthetic joint infection. A systematic review and meta-analysis of the literature.

INTRODUCTION: Calprotectin is a protein endowed with antimicrobial properties, rendering it a distinctive marker for infection. Two methods are currently available for the assay of calprotectin: the enzyme-linked immunosorbent assay (ELISA) and the lateral flow test (LFT). We aimed to assess the diagnostic accuracy of synovial fluid calprotectin and to compare the accuracy of the laboratory-based test and the qualitative assessment for the diagnosis of hip and knee prosthetic infection. MATERIALS AND METHODS: We searched (from inception to November 2023) MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane for studies on calprotectin in the diagnosis of periprosthetic joint infection (PJI). Sensitivity, specificity, positive and negative likelihood ratio (LR), and diagnostic odds ratio were analyzed. The receiver-operating curve for each method was calculated. RESULTS: We included 14 articles in our meta-analysis, including 902 patients who underwent total hip and knee arthroplasties revision; 331 (37%) had a joint infection according to MSIS, MSIS-modified criteria, ICM 2018 and EBJIS 2021. Considering the false-positive result rate of 6% and false-negative result rate of 7%, pooled sensitivity and specificity were 0.92 (95% CI 0.89-0.94) and 0.93 (0.91-0.95), respectively. The area under the curve (AUC) was 0.93 (95% CI 0.91-0.94). No statistical differences in terms of sensitivity and specificity were found between ELISA and LFT. The pooled sensitivity and specificity of the two calprotectin assessment methods were: LFT 0.90 (95% CI 0.869-0.935) and 0.92 (95% CI 0.894-0.941), respectively; ELISA 0.96 (95% CI 0.914-0.986) and 0.97 (95% CI 0.934-0.988), respectively. The diagnostic odds ratio of the ELISA was superior to that of the LFT (906.6667, 95% CI 271.2686-3030.3712 versus 113.8886, 95% CI 70.4001-184.2414; p < 0.001). The AUC for ELISA and LFT was 0.968 (95% CI 0.944-0.984) and 0.915 (95% CI 0.895-0.933), respectively. CONCLUSIONS: Detection of synovial calprotectin is an accurate test for diagnosis of hip and knee prosthetic infections. The diagnostic accuracy of the two calprotectin assessment methods is almost comparable. The LFT is a valid, rapid, and more available diagnostic tool, particularly to rule out PJI.

Role of bariatric surgery in reducing periprosthetic joint infections in total knee arthroplasty. A systematic review and meta-analysis.

BACKGROUND: Obesity represents an epidemic of rising numbers worldwide year after year. In the Orthopedic field, obesity is one of the major causes leading to osteoarthritis needing Total Joint Arthroplasty (TJA). Still, contextually, it represents one of the most significant risk factors for joint replacement complications and failures. So, bariatric Surgery (BS) is becoming a valuable option for weight control and mitigating obesity-related risk factors. This review of the literature and meta-analysis aims to evaluate periprosthetic joint infections (PJI) and surgical site infections (SSI) rates in patients who underwent TKA after BS compared to obese patients without BS. METHODS: Systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines up to October 2023. We included longitudinal studies comparing obese patients who underwent total knee arthroplasty after bariatric surgery (study group) and obese patients who underwent TKA (control group). The surgical site infection and Periprosthetic joint infection rate were compared among groups using a meta-analytical approach. RESULTS: The online database and references investigation identified one hundred and twenty-five studies. PJI rate differed significantly among groups, (z = -21.8928, p < 0.0001), with a lower risk in the BS group (z = -10.3114, p < 0.0001), for SSI, instead, not statistically significance were recorded (z = -0.6784, p = 0.4975). CONCLUSIONS: The current Literature suggests that Bariatric Surgery can reduce infectious complications in TKA, leading to better outcomes and less related costs treating of knee osteoarthritis in obese patients.

Major phenolic and volatile compounds and their influence on sensorial aspects in stem-contact fermentation winemaking of Primitivo red wines.

In red winemaking de-stemming is crucial since the stems contain polymeric phenolic compounds responsible for the astringency of wine. Wine such as Primitivo has low phenolic constituents and tannins and stems affect aroma, taste body and olfactory characteristics. The aim of the study was to evaluate the effects of presence of stems during fermentation on polyphenolic, volatile compounds and sensory characteristics of wine. Primitivo grapes vinified in presence of different percentage of stems: 100 % de-stemmed (D100), 75 % de-stemmed (D75) and 50 % de-stemmed (D50). Results confirmed that the wines vinified in presence of stems were higher in tannins, flavans, to vanillin and proanthocyanidins, colour intensity with lower anthocyanins. The presence of stems during fermentation conferred more structure and flavour to wines. They facilitated must aeration thus promoting synthesis of higher alcohols and ethyl esters by yeast. In particular, a higher content of hexan-1-ol, hex-3-en-1-ol and 2-phenyl ethanol in D50 and D75 gave the wines that suggest green grass, herb and floral. Wine from D75 seemed to be better than D50 in terms of volatile compounds as well as fruity, floral and balsamic components preserved, without any unpleasant taste of long chain fatty acids found in D50.

Prognostic value of biophysical profile score in post-date pregnancy.

OBJECTIVES: This study was undertaken to assess the ability of each individual biophysical profile score variable and combination of variables, to predict fetal distress or imminent labor in the post data pregnancy. MATERIALS AND METHODS: From June 1992 to August 1993, Biophysical Profile Scoring (BPS) was performed on 182 pregnant women. Thirty one patients delivered between 42 and 43 weeks of gestation, while the other 151 pregnant women delivered between 38 and 41+6 days. Monitoring procedures were based on the evaluation of fetal heart rates by Non Stress Test and four ultrasound parameters: Fetal Tone; Gross Body Movements; Fetal breathing movements; Evaluation of amniotic fluid volume. RESULTS: In this analysis the BPS showed a high specificity (82.7%) with a negative predictive value of 100%. The mean value of the last BPS among the 151 term patients was significantly higher if compared with the 31 post term pregnant women (6.73 and 6.12 respectively with p < 0.05). The predictive value of Fetal Breathing Movements (FBM) for the onset of imminent labor was confirmed. CONCLUSION: BPS, as measured in this study, has proved to be a very accurate method of determination of fetal well-being. Although these results will be further verified by other studies, BPS should come into general use to help reach the correct diagnosis and treatment of post date pregnancy.

[Cervicofacial neuroendocrine Merkel cell carcinoma: radiotherapy]. / Carcinoma neuroendocrino di Merkel del distretto cervico-facciale: radioterapia.

The Authors report a case of Merkel cell carcinoma of the cervicofacial district, particular due to its clinical and evolutive characteristics. The Merkel cell carcinoma was first identified by Toker in 1972 and is also known as a primary neuroendocrine the or trabecular carcinoma of the skin. The Merkel cell carcinoma is a rare aggressive skin cancer most frequently localized in the cervicofacial district. Although in earlier reports on the clinical history of these tumors primary emphasis was placed on their local aggressive behaviour, it has recently become evident that these neoplasms have a marked propensity for early dissemination. Distant metastases are often responsible for disease-related mortality. Merkel cell carcinoma have classically been managed with surgery alone or surgery followed by radiation therapy. Treatment of Merkel cell carcinoma with radiation therapy alone has usually been reserved for advanced unresectable tumors.