[Livestock-Associated Methicillin-Resistant Staphylococcus aureus: Epidemiological Data from an Orthopaedic Department in North-West Germany]. / Livestock-assoziierter Methicillin-resistenter Staphylococcus aureus ­ Erhebung einer orthopädischen Fachklinik im Hochrisikogebiet Nord-West.

Background MRSA represents a considerable health threat to orthopaedic patients. Throughout the last decade, livestock-associated MRSA emerged increasingly in livestock all over Europe. LA-MRSA broke the species barrier, colonizing and causing infections in humans. Nevertheless, to date there are no studies concerning livestock-associated MRSA and orthopaedic patients. Therefore, we aimed to investigate the prevalence of LA-MRSA in a regional orthopaedic department localized in an area with high-density livestock. Patients and Methods 1544 persons were enrolled in this prospective study. Nasal swabs and questionnaires were collected in patients admitted to the orthopaedic hospital. Nasal carriage was assessed by using selective MRSA agars. MRSA-positive samples were spa typed. Results Overall, the prevalence of MRSA carriage was 3.3%, nearly all spa types were indicative for LA-MRSA. 91% of all LA-MRSA carriers had contact to livestock during the last 6 months before testing. Conclusion Livestock-associated MRSA emerged rapidly over the last few years and will contribute substantially to MRSA infection rates in orthopaedic hospitals. Livestock-associated patients must be screened before admission in order to control infectious complications.

The Importance of Bone Mineral Density in Hip Arthroplasty: Results of a Survey Asking Orthopaedic Surgeons about Their Opinions and Attitudes Concerning Osteoporosis and Hip Arthroplasty.

Objective. In patients scheduled to undergo total joint arthroplasty of the hip, the bone quality around the joint affects the safety of prosthetic implantation. Bone strength is clinically assessed by measuring bone mineral density (BMD); therefore we asked if BMD is important to orthopaedic surgeons performing hip arthroplasty. Methods. In a 14-question survey, we asked about treatment patterns with respect to BMD, osteoporosis work-up, and treatment for patients with low BMD scheduled to undergo hip arthroplasty. Results. 72% of all asked orthopaedics reported to use cementless implants as a standard in hip arthroplasty. Over 60% reported that low BMD is a reason to reconsider operation strategies, but only 4% performed BMD measurement preoperatively. 26% would change their treatment strategy in case of a BMD (T-Score) between -1.5 and -2 and 40% in case of a T-score between -2 and -2.5, and 29% would change their intraoperative strategy if a T-score smaller than -2.5 was measured. Conclusion. The majority of orthopaedic surgeons who responded to the survey reported that they do not perform routine measurement of BMD before arthroplasty. However, most surgeons commented that low bone mineral density will influence their surgical plan and the implant design.

Risk factors for pelvic insufficiency fractures and outcome after conservative therapy.

PURPOSE: The prevalence of osteoporosis has continuously increased over the past decades and it is set to increase substantially as life expectancy rises steadily. Fragility or osteoporotic fractures of the pelvis often occur after low energy falls e.g. from standing, however, some patients present with assumed insufficiency fractures of the pelvis without a previous trauma. Osteoporotic fractures impose a tremendous economic burden and these fractures deserve attention as they lead to a decrease in mobility with an increase in dependency and are associated with a high rate of mortality. To date, little is known about potential risk factors for pelvic insufficiency fractures. Furthermore, information on clinical outcome is scarce. In view of this rather limited knowledge, we aimed to identify potential risk factors for pelvic insufficiency fractures and to collect information on their short- and long-term outcomes. METHODS: Files of all consecutive patients admitted between January 2010 and December 2013 for a pelvic insufficiency fracture were enrolled in this study. Pelvic fractures that occurred on tumorous bone or after high-energy trauma were excluded. Fractures of the pelvis included all pelvic bones except the coccyx. For all patients, we recorded clinical and biological parameters available from their medical history. For comparison, the same biological and clinical parameters were evaluated in an age matched control group of 1083 patients aged over 70 who were admitted to our orthopaedic department to undergo knee or hip arthroplasty. The statistical analyses used or Fisher test for percentages comparison, 2-tailed t-tests and Mann Whitney for mean comparison. To determine what factors are predictors and what factors are confounders of pelvic insufficiency fractures, multivariate linear regression analysis using the fracture as a continuous variable was performed. RESULTS: Ninety-three patients with a pelvic insufficiency fracture were identified. Following the Rommens and Hofmann classification for fragility fractures of the pelvis (FFP), 51 were FFP Type Ia, 26 were FFP Type IIb lesions and 26 were FFP Type IIc. Osteoporosis was found to be significantly associated with pelvic insufficiency fractures (p=0.003), as was hypertension (p=0.036), diabetes (p=0.021), vitamin D deficiency (p=0.004), hypocalcaemia (p=0.002) and nicotine abuse (p=0.0012) after adjustment for possible confounders in the multivariate linear regression analysis. Comparing the autonomous state before and after pelvic fracture, a high loss of autonomy was observed. Patients needing daily assistance nearly doubled their number. Overall mortality was high (20%). CONCLUSIONS: In conclusion, this study showed multiple risk factors for pelvic insufficiency fractures. Some, like vitamin D deficiency, can benefit easy preventive measures. Outcome of conservative therapy is poor, with loss of social and physical independence and autonomy. The mortality rate is high. Efforts should be made in preventing pelvic insufficiency fractures. All patients should be treated for the severe osteoporosis being associated with these fracture type.

Phase I clinical study of vascular targeting fluorescent cationic liposomes in head and neck cancer.

The aim of this first-time-in-human non-randomized dose-escalating prospective phase I clinical trial was to analyze safety of two doses of fluorescent rhodamine-labeled cationic liposomes (LDF01) in head and neck squamous cell carcinoma (HNSCC). Patients had resectable UICC stadium I-IV A HNSCCs. LDF01 was administered before tumor resection under general anesthesia as an intravenous infusion with effective lipid doses of 0.5 or 2 mg/kg b.w., respectively. In addition to clinical monitoring for safety assessment, tumor biopsies were taken during the surgical procedure for fluorescence histological analysis. Eight patients were assigned to the two dose groups. During safety follow-up no clinically relevant adverse events occurred. Fluorescence histology revealed some evidence of favorable selectivity of LDF01 for tumor microvessels in the high-dose group. LDF01 is safe applied as infusion at both tested dose levels. Furthermore, LDF01 can be detected in the vicinity of tumor cells and could be assigned to the microvessel target in individual HNSSC cases. Detailed analysis of targeting properties of LDF01 has to be performed in upcoming clinical phase II trials.

Liposomal transfection of squamous carcinoma cells of the head and neck with IL-2 and B7 plasmids inducing an autologous immune response in vitro.

New treatment strategies need to be developed to face the increasing incidence and mortality of squamous cell carcinoma of the head and neck (SCCHN), as the overall survival rate remains poor, with minor therapeutic progress having been achieved over the past forty years. One major goal could be to restore a damaged immune system by intratumoral injection of IL-2-genes that permanently provide non-toxic IL-2-protein concentrations at the tumor site, sufficient to activate cellular immunity in vivo. We showed that the transfection of SCCHN cell lines with IL-2-plasmids, encapsulated in DOTMA/Col, in vitro resulted in the synthesis of bioactive IL-2-protein for up to 30 days by the tumor cells themselves. The transcription of secondary cytokines (IL-6, IL-8, GM-CSF, TNF-alpha) and the expression of immunomodulatory surface molecules (MHC Class II, ICAM1) were enhanced. The IL-2-modified tumor cells were effectively lysed by autologous peripheral blood lymphocytes (PBLs). The immune response was enhanced by B7.1-gene-cotransfection and/or preactivation of PBLs with exogenous IL-2. We demonstrated that in vitro liposome-mediated IL-2-gene-transfection of SCCHN cells is an effective method to stimulate an autologous immune response and is, therefore, promising for clinical application.