Thirty day low-dose versus regular-dose aspirin for venous thromboembolism prophylaxis in primary total joint arthroplasty.

BACKGROUND: The optimal dosing of aspirin (ASA) monotherapy for prophylaxis after total joint arthroplasty is debatable. The objective of this study was to compare two ASA regimens with regards to symptomatic deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding, and infection 90 days after primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). METHODS: We retrospectively identified 625 primary THA and TKA surgeries in 483 patients who received ASA for 4 weeks post-op. 301 patients received 325 mg once daily (QD) and 324 patients received 81 mg twice daily (BID). Patients were excluded if they were minors, had a prior venous thromboembolism (VTE), had ASA allergy, or received other VTE prophylaxis drugs. RESULTS: There was a significant difference in rate of bleeding and suture reactions between the two groups. Bleeding was 7.6% for 325 mg QD and 2.5% for 81 mg BID (p = .0029 Χ2, p = .004 on multivariate logistic regression analysis). Suture reactions were 3.3% for 325 mg QD and 1.2% for 81 mg BID (p = .010 Χ2, p = .027 on multivariate logistic regression analysis). Rates of VTE, symptomatic DVT, and PE were not significantly different. The incidence of VTE was 2.7% for 325 mg QD and 1.5% for 81 mg BID (p = .4056). Symptomatic DVT rates were 1.6% for 325 mg QD and 0.9% for 81 mg BID (p = .4139). Deep infection was 1.0% for 325 mg QD and 0.31% for 81 mg BID (p = .3564). CONCLUSION: Low-dose ASA in patients with limited comorbidities undergoing primary THA and TKA is associated with significant lower rates of bleeding and suture reactions than high dose ASA. Low-dose ASA was not inferior to higher dose ASA for the prevention of VTE, wound complications, and infection 90 days postoperatively.

The response of Escherichia coli to the alkylating agents chloroacetaldehyde and styrene oxide.

DNA damage is ubiquitous and can arise from endogenous or exogenous sources. DNA-damaging alkylating agents are present in environmental toxicants as well as in cancer chemotherapy drugs and are a constant threat, which can lead to mutations or cell death. All organisms have multiple DNA repair and DNA damage tolerance pathways to resist the potentially negative effects of exposure to alkylating agents. In bacteria, many of the genes in these pathways are regulated as part of the SOS reponse or the adaptive response. In this work, we probed the cellular responses to the alkylating agents chloroacetaldehyde (CAA), which is a metabolite of 1,2-dichloroethane used to produce polyvinyl chloride, and styrene oxide (SO), a major metabolite of styrene used in the production of polystyrene and other polymers. Vinyl chloride and styrene are produced on an industrial scale of billions of kilograms annually and thus have a high potential for environmental exposure. To identify stress response genes in E. coli that are responsible for tolerance to the reactive metabolites CAA and SO, we used libraries of transcriptional reporters and gene deletion strains. In response to both alkylating agents, genes associated with several different stress pathways were upregulated, including protein, membrane, and oxidative stress, as well as DNA damage. E. coli strains lacking genes involved in base excision repair and nucleotide excision repair were sensitive to SO, whereas strains lacking recA and the SOS gene ybfE were sensitive to both alkylating agents tested. This work indicates the varied systems involved in cellular responses to alkylating agents, and highlights the specific DNA repair genes involved in the responses.

Review of Sympathetic Blocks: Anatomy, Sonoanatomy, Evidence, and Techniques.

The autonomic nervous system is composed of the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is implicated in situations involving emergent action by the body and additionally plays a role in mediating pain states and pathologies in the body. Painful conditions thought to have a sympathetically mediated component may respond to blockade of the corresponding sympathetic fibers. The paravertebral sympathetic chain has been targeted for various painful conditions. Although initially injected using landmark-based techniques, fluoroscopy and more recently ultrasound imaging have allowed greater visualization and facilitated injections of these structures. In addition to treating painful conditions, sympathetic blockade has been used to improve perfusion, treat angina, and even suppress posttraumatic stress disorder symptoms. This review explores the anatomy, sonoanatomy, and evidence supporting these injections and focuses on ultrasound-guided/assisted technique for the performance of these blocks.

Otolaryngology education in family medicine and communication sciences training.

OBJECTIVES: To characterize the extent and format of otolaryngology instruction during family medicine and communication disorders training and to determine the comfort level of graduate trainees to assess specific hearing disorders. DESIGN: Online surveys were sent to program directors in the fields of family medicine, audiology, and speech pathology. Directors were asked to delineate methods of teaching otolaryngology-related material and to define how often otolaryngologists were involved in their curricula. They were also asked to rate their graduate trainees' ability to manage 3 clinical scenarios involving pediatric hearing impairment. PARTICIPANTS: A total of 682 surveys were sent using e-mail addresses from the American Medical Association and the Council of Academic Programs in Communication Sciences and Disorders. RESULTS: Response rates were 20% for family medicine programs and 30% for each of the communication science disciplines. Virtually all respondent family medicine programs have dedicated instruction in otolaryngology, typically in the form of a clinical rotation (98%). Ninety-five percent of audiology programs involve an otolaryngologist in teaching compared with 55% of speech pathology programs. Otolaryngology-related diagnostic examination skills are taught by most programs in all 3 disciplines; confirmation of skills acquisition, however, is lacking. Directors rated the competence of their trainees to manage hearing disorders at an average of 3.4 for audiology, 2.7 for speech pathology, and 2.6 for family medicine graduates on a 4-point scale. CONCLUSIONS: Respondent directors from all 3 disciplines make a concerted effort to teach otolaryngology-related topics. A greater emphasis on those otolaryngology disorders requiring multidisciplinary care appears necessary, as does more formal instruction in and competency evaluation of diagnostic examination skills.

Immunoglobulin A defines secretions from salivary tissue in post-Sistrunk procedure drainage.

OBJECTIVES: This was a pilot study to establish a protein difference between thyroglossal duct cyst fluid relative to oral saliva, in order to differentiate patients with residual thyroglossal cyst from those with salivary fistula in the case of post-Sistrunk procedure incisional drainage. Past immunohistochemistry studies on archived tissue blocks from post-Sistrunk procedure patients have shown MUC5AC to have elevated concentrations in thyroglossal duct relative to salivary tissue; secretory immunoglobulin A (IgA) was also chosen as a candidate protein based on previously published reports of its increased concentration in saliva relative to respiratory secretions. DESIGN: Diagnostic tests were assessed. Thyroglossal duct cyst fluid and oral saliva were obtained from 12 patients. Enzyme-linked immunosorbent assay (ELISA) was then performed on the samples to identify the presence of MUC5AC and IgA. SETTING: Tertiary care hospital. SUBJECTS: Patient fluid samples were taken immediately postoperatively for patients undergoing Sistrunk procedure at one institution. Presence of thyroglossal duct cyst was confirmed in all cases by pathology. RESULTS: Seven of 12 thyroglossal duct cyst fluid samples were shown to have elevated absorbance with ELISA for MUC5AC. In experiments for IgA, 10 of the 12 saliva samples had elevated absorbance compared with thyroglossal duct fluid samples obtained from the same patient. CONCLUSIONS: IgA is an accurate identifier of saliva compared with thyroglossal duct fluid in secreted samples obtained from the same patient.