Rank-Ordered List of Cost-effective Strategies for Preventing Prosthetic Joint Infection in Total Joint Arthroplasty in an Academic US Hospital.

Although the overall rate of prosthetic joint infection (PJI) is low, it remains a major complication associated with total joint arthroplasty (TJA). PJI represents a significant economic burden to the health care system that is projected to increase commensurate with increasing joint replacement volumes. This review provides a rank-ordered list of cost-effective strategies that are performable intraoperatively and have data supporting their efficacy at preventing PJI after TJA. This study may be helpful in assisting surgeons, ambulatory surgery center owners, and hospital acquisition committees to make reasonable and cost-conscious decisions in the face of changing reimbursement. [Orthopedics. 2023;46(6):327-332.].

Demystifying spasticity in primary care.

OBJECTIVE: To raise awareness of spasticity in primary care and clarify how to identify, diagnose, and manage it effectively and efficiently in patients with pre-existing neurologic conditions. SOURCES OF INFORMATION: PubMed was searched for articles published from 1970 to May 2018 using the terms spasticity, spasticity in physical disability, spasticity in mobility impairment, and spasticity with family medicine or primary care. Other relevant guidelines and resources were reviewed and used. MAIN MESSAGE: Spasticity is a common secondary complication in conditions such as spinal cord injury, multiple sclerosis, stroke, cerebral palsy, and other neuromuscular physical disabilities and can have a negative effect on health and quality of life. Factors such as inconsistent definition, poorly understood mechanism, and relatively low prevalence make spasticity seem like a daunting condition to manage. Furthermore, its variable presentation and effect on a patient's quality of life, and its range of treatments with varying levels of evidence, can make treatment challenging in primary care and in other clinical settings. Family physicians play an important role in recognizing and inquiring about spasticity and its changes, triggers, and effects on function. Ruling out reversible causes is important. Many management strategies can be instituted by family physicians. CONCLUSION: Managing spasticity might be unfamiliar to many practitioners. It is important for physicians to understand spasticity and the potential treatment options available to improve quality of life. The current review provides concise information on the clinical relevance of spasticity in primary care and how to assess and manage it effectively and efficiently in those with chronic neurologic conditions.

Démythifier la spasticité en première ligne.

OBJECTIF: Sensibiliser les généralistes à la spasticité en première ligne et éclaircir comment la dépister, poser un diagnostic et prendre en charge efficacement les patients atteints d'affections neurologiques préexistantes. SOURCES DE L'INFORMATION: Une recherche d'articles publiés entre 1970 et mai 2018 a été effectuée dans PubMed à l'aide des mots-clés anglais spasticity, spasticity in physical disability, spasticity in mobility impairment et spasticity with family medicine or primary care. D'autres lignes directrices et ressources pertinentes ont été examinées et utilisées. MESSAGE PRINCIPAL: La spasticité est une complication secondaire courante d'affections telles que le traumatisme de la moelle épinière, la sclérose en plaques, l'AVC, la paralysie cérébrale et autres déficiences physiques neuromusculaires; elle aurait des effets négatifs sur la santé et la qualité de vie. Certains facteurs, tels que la définition variable, les mécanismes non élucidés et la prévalence relativement faible, contribuent à la nature intimidante du traitement de la spasticité. En outre, son tableau clinique et ses effets variables sur la qualité de vie, ainsi que la gamme de traitements étayés par divers niveaux de données probantes, compliquent le traitement en première ligne et dans d'autres contextes cliniques. Les médecins de famille jouent un rôle de premier plan pour reconnaître la spasticité et s'informer de ses variations, de ses déclencheurs et de ses effets sur les capacités fonctionnelles. Il importe d'éliminer les causes réversibles. Les médecins de famille peuvent appliquer de nombreuses stratégies de prise en charge. CONCLUSION: Beaucoup de praticiens sont mal à l'aise avec la prise en charge de la spasticité. Les médecins doivent comprendre la spasticité et les options thérapeutiques potentielles qui pourraient améliorer la qualité de vie. Cette revue présente des renseignements concis sur la pertinence clinique de la spasticité en première ligne et sur la façon de la prendre en charge efficacement chez les personnes atteintes d'affections neurologiques chroniques.

Degenerative cervical myelopathy: Diagnosis and management in primary care.

OBJECTIVE: To raise awareness about degenerative cervical myelopathy (DCM) and to help family physicians identify, diagnose, and manage DCM more effectively. SOURCES OF INFORMATION: A PubMed search was conducted for articles published between 1970 and October 2017, using the terms cervical myelopathy and degenerative spinal cord injury with family medicine or primary care. MAIN MESSAGE: Owing to limited knowledge of DCM in primary care, along with the large variability of the disease, the diagnosis of DCM is often missed or delayed. The natural course of DCM presents as a stepwise decline, with symptoms ranging from muscle weakness to complete paralysis. All individuals with signs and symptoms should be referred to a spine surgeon for consideration of surgery; those with mild DCM might be offered conservative treatment but should receive a surgical evaluation and opinion nonetheless. Asymptomatic patients with evidence of cord compression on magnetic resonance imaging might need to be referred for assessment; however, surgery is not advised. It is critical to closely monitor asymptomatic individuals or those with mild DCM for neurologic deterioration. CONCLUSION: Degenerative cervical myelopathy is the most common cause of spinal cord dysfunction in adults. This review helps streamline its diagnosis in primary care, allowing for improved chances of early diagnosis and prevention of further neurologic decline among patients.

Myélopathie cervicale dégénérative: Diagnostic et prise en charge en première ligne.

OBJECTIF: Sensibiliser les médecins de famille à la myélopathie cervicale dégénérative (MCD) afin de les aider à dépister, à diagnostiquer et à traiter la maladie de façon plus efficace. SOURCES DE L'INFORMATION: Une recherche d'articles publiés entre 1970 et octobre 2017 a été effectuée sur PubMed à l'aide des mots-clés anglais cervical myelopathy et degenerative spinal cord injury avec family medicine ou primary care. MESSAGE PRINCIPAL: Le diagnostic de MCD reste souvent omis ou retardé en première ligne en raison du peu de connaissances sur la maladie, de même que de la grande variabilité de ses manifestations. L'évolution naturelle de la MCD accuse un déclin par paliers, les symptômes allant d'une faiblesse musculaire à la paralysie complète. Toutes les personnes qui présentent des signes et des symptômes doivent être recommandées en chirurgie de la colonne vertébrale aux fins d'évaluation; les personnes dont le cas est léger peuvent recevoir un traitement prudent, mais doivent quand même recevoir une évaluation et une opinion chirurgicales. Les patients asymptomatiques qui présentent des signes de compression de la moelle épinière à l'imagerie par résonance magnétique devraient être recommandés aux fins d'évaluation; mais la chirurgie leur est déconseillée. Il est essentiel de surveiller de près les personnes asymptomatiques ou celles atteintes d'un cas léger de MCD afin de détecter toute détérioration neurologique. CONCLUSION: La myélopathie cervicale dégénérative est la cause la plus fréquente de dysfonctionnement de la moelle épinière chez les adultes. Cette révision aide à clarifier le diagnostic en première ligne, ce qui améliore les chances de poser un diagnostic précoce et de prévenir tout déclin neurologique supplémentaire chez les patients.

Differential effects of transcranial direct current stimulation on antiphase and inphase motor tasks: A pilot study.

Ageing is associated with a decline in motor function that critically interferes with activities of daily living involving manual dexterity. Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that has been shown to enhance manual dexterity in healthy aging adults. The supplementary motor area (SMA) is involved in motor preparation and bimanual control; therefore, bihemispheric tDCS incorporating the SMA may preferentially enhance bimanual motor movements in healthy older adults. The aim of the current study was to determine if tDCS incorporating SMA could improve manual dexterity in older adults. Twenty-four adults, aged 67-84 participated in this double-blind, randomized, cross over design, pilot study. One group of participants (n = 17) were randomized to receive stimulation or sham on their first visit and received the contrary on their second visit, seven days later. A second group of participants (n = 10) received three consecutive days of tDCS while performing a motor task. Participants performed unimanual and bimanual hand movements while receiving 2 mA of tDCS. The total time for participants to complete three trials of each task was recorded. No significant differences in performance times were observed between single or tri session tDCS and sham conditions. However, tDCS had opposing effects on the motor consolidation of anti-phase and in-phase bimanual tasks. During the tri session paradigm, older adults improved performance learning of antiphase bimanual movements more quickly than inphase bimanual movements, suggesting a different mechanism of action of these two movements.

1H MR spectroscopy of the motor cortex immediately following transcranial direct current stimulation at 7 Tesla.

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that may modulate cortical excitability, metabolite concentration, and human behaviour. The supplementary motor area (SMA) has been largely ignored as a potential target for tDCS neurorehabilitation but is an important region in motor compensation after brain injury with strong efferent connections to the primary motor cortex (M1). The objective of this work was to measure tissue metabolite changes in the human motor cortex immediately following tDCS. We hypothesized that bihemispheric tDCS would change levels of metabolites involved in neuromodulation including N-acetylaspartate (NAA), glutamate (Glu), and creatine (tCr). In this single-blind, randomized, cross-over study, fifteen healthy adults aged 21-60 participated in two 7T MRI sessions, to identify changes in metabolite concentrations by magnetic resonance spectroscopy. Immediately after 20 minutes of tDCS, there were no significant changes in metabolite levels or metabolite ratios comparing tDCS to sham. However there was a trend toward increased NAA/tCr concentration (p = 0.08) in M1 under the stimulating cathode. There was a strong, positive correlation between the change in the absolute concentration of NAA and the change in the absolute concentration of tCr (p<0.001) suggesting an effect of tDCS. Both NAA and creatine are important markers of neurometabolism. Our findings provide novel insight into the modulation of neural metabolites in the motor cortex immediately following application of bihemispheric tDCS.

Motor network recovery in patients with chronic spinal cord compression: a longitudinal study following decompression surgery.

OBJECTIVE The authors used functional MRI to assess cortical reorganization of the motor network after chronic spinal cord compression and to characterize the plasticity that occurs following surgical intervention. METHODS A 3-T MRI scanner was used to acquire functional images of the brain in 22 patients with reversible cervical spinal cord compression and 10 control subjects. Controls performed a finger-tapping task on 3 different occasions (baseline, 6-week follow-up, and 6-month follow-up), whereas patients performed the identical task before surgery and again 6 weeks and 6 months after spinal decompression surgery. RESULTS After surgical intervention, an increased percentage blood oxygen level-dependent signal and volume of activation was observed within the contralateral and ipsilateral motor network. The volume of activation of the contralateral primary motor cortex was associated with functional measures both at baseline (r = 0.55, p < 0.01) and 6 months after surgery (r = 0.55, p < 0.01). The percentage blood oxygen level-dependent signal of the ipsilateral supplementary motor area 6 months after surgery was associated with increased function 6 months after surgery (r = 0.48, p < 0.01). CONCLUSIONS Plasticity of the contralateral and ipsilateral motor network plays complementary roles in maintaining neurological function in patients with spinal cord compression and may be critical in the recovery phase following surgery.

Using Perovskite Nanoparticles as Halide Reservoirs in Catalysis and as Spectrochemical Probes of Ions in Solution.

The ability of cesium lead halide (CsPbX3; X = Cl(-), Br(-), I(-)) perovskite nanoparticles (P-NPs) to participate in halide exchange reactions, to catalyze Finkelstein organohalide substitution reactions, and to colorimetrically monitor chemical reactions and detect anions in real time is described. With the use of tetraoctylammonium halide salts as a starting point, halide exchange with the P-NPs was performed to calibrate reactivity, stability, and extent of ion exchange. The exchange of CsPbI3 with Cl(-) or Br(-) causes a significant blue-shift in absorption and photoluminescence, whereas reacting I(-) with CsPbBr3 causes a red-shift of similar magnitudes. With the high local halide concentrations and the facile nature of halide exchange in mind, we then explored the ability of P-NPs to catalyze organohalide exchange in Finkelstein like reactions. Results indicate that the P-NPs serve as excellent halide reservoirs for substitution of organohalides in nonpolar media, leading to not only different organohalide products, but also a complementary color change over the course of the reaction, which can be used to monitor kinetics in a precise manner. The merits of using P-NP as spectrochemical probes for real time assaying is then expanded to other anions which can react with, or result in unique, classes of perovskites.