Cluster-randomized crossover trial of chlorhexidine-alcohol versus iodine-alcohol for prevention of surgical-site infection (SKINFECT trial).

Background: Surgical-site infection (SSI) is a serious surgical complication that can be prevented by preoperative skin disinfection. In Western European countries, preoperative disinfection is commonly performed with either chlorhexidine or iodine in an alcohol-based solution. This study aimed to investigate whether there is superiority of chlorhexidine-alcohol over iodine-alcohol for preventing SSI. Methods: This prospective cluster-randomized crossover trial was conducted in five teaching hospitals. All patients who underwent breast, vascular, colorectal, gallbladder or orthopaedic surgery between July 2013 and June 2015 were included. SSI data were reported routinely to the Dutch National Nosocomial Surveillance Network (PREZIES). Participating hospitals were assigned randomly to perform preoperative skin disinfection using either chlorhexidine-alcohol (0·5 per cent/70 per cent) or iodine-alcohol (1 per cent/70 per cent) for the first 3 months of the study; every 3 months thereafter, they switched to using the other antiseptic agent, for a total of 2 years. The primary endpoint was the development of SSI. Results: A total of 3665 patients were included; 1835 and 1830 of these patients received preoperative skin disinfection with chlorhexidine-alcohol or iodine-alcohol respectively. The overall incidence of SSI was 3·8 per cent among patients in the chlorhexidine-alcohol group and 4·0 per cent among those in the iodine-alcohol group (odds ratio 0·96, 95 per cent c.i. 0·69 to 1·35). Conclusion: Preoperative skin disinfection with chlorhexidine-alcohol is similar to that for iodine-alcohol with respect to reducing the risk of developing an SSI.

Antecedentes: La infección del sitio quirúrgico (surgical site infection, SSI) es una complicación quirúrgica grave que se puede prevenir mediante una desinfección cutánea preoperatoria. En los países de Europa occidental, la desinfección preoperatoria se realiza habitualmente usando clorhexidina o yodo en una solución a base de alcohol. Nuestro objetivo fue investigar si la clorhexidina alcohólica es superior al yodo con alcohol para prevenir la SSI. Métodos: Este ensayo prospectivo aleatorizado por conglomerados y de grupos cruzados se realizó en cinco hospitales docentes. Se incluyeron todos los pacientes que se sometieron a cirugía mamaria, vascular, colorrectal, biliar y ortopédica entre julio de 2013 y junio de 2015. Los datos de SSI se presentaron de manera rutinaria a la Red Nacional Holandesa de Vigilancia Nosocomial (PREZIES). Los hospitales participantes fueron asignados al azar para realizar una desinfección cutánea preoperatoria con clorhexidina alcohólica (0,5%/70%) o yodo con alcohol (1%/70%) durante los primeros tres meses del estudio; cada 3 meses a partir de entonces, cambiaron a usar el otro agente antiséptico, durante un total de 2 años. El criterio de valoración principal fue el desarrollo de SSI. Resultados: Se incluyeron un total de 3.665 pacientes; 1.835 y 1.830 de estos pacientes recibieron desinfección cutánea preoperatoria con clorhexidina alcohólica o yodo con alcohol, respectivamente. La incidencia global de SSI fue del 3,8% entre los pacientes en el grupo de clorhexidina alcohólica y del 4,0% entre los pacientes en el grupo de yodo con alcohol (razón de oportunidades, odds ratio, OR 0,96; i.c. del 95%: 0,69­1,35). Conclusión: La desinfección cutánea preoperatoria con clorhexidina alcohólica es similar al yodo con alcohol con respecto a la reducción del riesgo de desarrollar una SSI.

Make it spin: individual trapping of sperm for analysis and recovery using micro-contact printing.

In this article, we describe the development of a high throughput platform to spatially manipulate viable sperm for motility measurements and recovery of the best single sperm for fertilization purposes. Micro-contact printing was used to pattern islands of adhesive proteins (fibronectin) separated by sperm repellent species (Pluronic acid F-127) on commercially available polystyrene substrates. Following washing, arrays of viable single sperm were captured onto the islands demonstrating for the first time that sperm can be trapped by micro-contact printing with patterning efficiency of 90% while retaining 100% viability. These were then subjected to motility analysis whilst remaining spatially confined to the islands. Single sperm motility was assessed (n = 37) by software analysis measuring the number of rotations per second (degrees s⁻¹). The assignment of array coordinates allows the more active single sperm to be easily identified and recovered by a simple micromanipulator pipette aspiration step with automated possibility for assisted reproductive technologies or further quality correlation analysis. Taken together, we show for the first time a technique to simultaneously screen thousands of viable single sperm for motility assessment while retaining the ability for single species recovery for enhanced fertilization purposes.

Risk of infection and sepsis in severely injured patients related to single nucleotide polymorphisms in the lectin pathway.

BACKGROUND: Infectious complications remain a serious threat to patients with multiple trauma. Susceptibility and response to infection is, in part, heritable. The lectin pathway plays a major role in innate immunity. The aim of this study was to assess whether single nucleotide polymorphisms (SNPs) in three key genes within the lectin pathway affect susceptibility to infectious complications in severely injured patients. METHODS: A prospective cohort of severely injured patients admitted to a level I trauma centre between January 2008 and April 2011 were genotyped for SNPs in MBL2 (mannose-binding lectin 2), MASP2 (MBL-associated serine protease 2) and FCN2 (ficolin 2). Association of genotype with prevalence of positive culture findings and infection was tested by χ(2) and logistic regression analysis. RESULTS: A total of 219 patients were included, of whom 112 (51·1 per cent) developed a positive culture from sputum, wounds, blood or urine. A systemic inflammatory response syndrome (SIRS) developed in 139 patients (63·5 per cent), sepsis in 79 (36·1 per cent) and septic shock in 37 (16·9 per cent). Patients with a MBL2 exon 1 variant allele were more prone to positive wound cultures (odds ratio (OR) 2·51, 95 per cent confidence interval 1·12 to 5·62; P = 0·025). A MASP2 Y371D DD genotype predisposed to SIRS (OR 4·78, 1·06 to 21·59; P = 0·042) and septic shock (OR 2·53, 1·12 to 4·33; P = 0·003). A FCN2 A258S AS genotype predisposed to positive wound cultures (OR 3·37, 1·45 to 7·85; P = 0·005) and septic shock (OR 2·18, 1·30 to 4·78; P = 0·011). CONCLUSION: Severely injured patients with SNPs in MBL2, MASP2 Y371D and FCN2 A258S of the lectin pathway of complement activation are significantly more susceptible to positive culture findings, and to infectious complications, SIRS and septic shock than patients with a wildtype genotype.

[Use of root-end filling materials in a surgical apical endodontic treatment in the Netherlands]. / Gebruik van vulmaterialen bij een chirurgische apicale endodontische behandeling in Nederland.

The material to be used for closing the root canal when carrying out a retrograde surgical apical endodontic treatment continues to be a subject of discussion. The aim of the present study was to inventory which materials are being used for this purpose at this moment by Dutch O&MF surgeons. All practicing Dutch OM&F surgeons (n = 195) were sent a questionnaire. The response rate was 77%. The results showed that at this moment intermediate restoration material (IRM) is the retrograde filling material most widely used by the Dutch O&MF surgeons (47.6%) in cases of surgical apical endodontic treatment. Amalgam, with 35%, was second, especially due to its plasticity and convenience. The choice of material is just as often determined by tradition, personal preference, individual experience or scientific results. There seems to be no relationship between the dental surgeon's number of years of experience and the type of retro grade filling material which he or she uses.

[A tooth located in a mandibular fracture line. Treatment by oral- and maxillofacial surgeons in The Netherlands]. / Mandibulafracturen met een gebitselement in de fractuurlijn. Behandelbeleid van kaakchirurgen in Nederland.

Mandibular fractures are among the most common facial bone injuries. Approximately 50% of the fractures occur in teeth bearing areas. Consequently, the likelihood that a tooth will be in the fracture line is substantial. A review of the literature reveals that there is not a clear guideline for preserving or removing a tooth in a mandibular fracture line. By means of a questionnaire, information was collected about how dental surgeons in The Netherlands deal with this problem. The research sample consisted of 194 active oral and maxillofacial surgeons in The Netherlands in 2005. One hundred and two surgeons responded (52.6%). The response rate was sufficient to allow for reliable deductions and statistical analysis. The results of the questionnaire showed that the respondents were in agreement. Generally, the respondents strove to preserve a tooth in the mandibular fracture line. The respondent's treatment of a mandibular fracture was in agreement with the state of the art as presented in the current literature. The respondent's choice of treatment did not depend on age, gender, university clinic at which the respondent was trained to be a dental surgeon, year of registration as a specialist, place of work and position. According to the respondents, the dentist's role in the aftercare of a mandibular fracture is treatment of the teeth injuries, follow-up of the posttraumatic oral self care, and regularly testing the vitality of the teeth in and around the mandibular fracture line.

[Diagnostic image (324). A man with a necrotic finger]. / Diagnose in beeld (324). Een man met een necrotische vinger.

A 35-year-old man presented with progressive infected necrosis of the second digit of his right hand, caused by exposure to hydrogenfluoride.

[Osteomyelitis of the jaws]. / Osteomyelitis van de kaak.

In the western world osteomyelitis of the jaws is not frequently encountered these days. In order to establish the actual incidence a survey was conducted, based on the number of patients treated for osteomyelitis of the jaw at a Dutch university medical centre between 1996 and 2001. 44 patients were identified. Their symptoms, afflicted areas and specific types of osteomyelitis were recorded, and compared to the literature. The incidence of osteomyelitis at the university medical centre was found to be in line with other, similar medical centres in the western world (approximately 3-4 per 100.000 annually). However, since recent data from comparable centres are either of limited use or altogether lacking, no firm conclusions could be drawn. Although there appears to be a slight increase in incidence in recent years, there is no hard evidence to support this.

[Diagnostic image (169). A man with a painful swelling on the hand]. / Diagnose in beeld (269). Een man met een pijnlijke zwelling op de handrug. Symptomatische carpale exostose.

A 29-year-old man presented with a painful swelling on his right hand, which was caused by a carpal boss on the second and third carpometacarpal joint.

[Diagnostic image (240). A neonate with a swollen, red and painful mamma]. / Diagnose in beeld (240). Een neonatus met een gezwollen, rode en pijnlijke mamma.

In a 5-week-old girl suppurative mastitis was observed caused by Staphylococcus aureus.

[Diagnostic image (225). A woman with extensive necrosis of the abdominal skin]. / Diagnose in beeld (225). Een vrouw met uitgebreide necrose van de buikhuid.

In a 6o-year-old woman suffering from end-stage renal disease and diabetes, progressive ulceration of the abdominal skin and subcutaneous soft tissues occurred due to calciphylaxis.

[Diagnostic image (226). A man with a painful upper arm]. / Diagnose in beeld (226). Een man met een pijnlijke bovenarm.

A 55-year-old man suffered a distal avulsion of the brachial biceps tendon.

Peritoneal benign cystic mesothelioma: a case report and review of the literature.

Peritoneal benign cystic mesothelioma is a rare tumour of unknown aetiology. It usually presents with mild abdominal pain and a solid tumour on physical examination. The differential diagnosis with solid abdominal tumours is difficult. Computed tomography, magnetic resonance imaging as well as aspiration cytology are useful in suggesting the pre-operative diagnosis. We present one case report and discuss this entity.

Latex laboratory-gloves: an unexpected pitfall in amphibian toxicity assays with tadpoles.

This study examined the unexpected toxic effects of protective latex laboratory gloves on developing amphibians. Mortality after exposure to rinsing water from the outside of the gloves was observed in Xenopus laevis and Rana temporaria, with R. temporaria being more sensitive. This phenomenon was further confirmed using the microtiter-version of the Microtox-Assay, an in vitro assay for general toxicity. Latex gloves from the specific brand used in the experiment, in which the toxicity to tadpoles was observed for the first time, showed the highest toxicity of all materials and brands tested. Due to the high responsiveness of amphibian tadpoles to latex-glove contaminated rinsing water, special care is necessary when cleaning aquaria during toxicological experiments with amphibians as otherwise results may be biased.

Effects of oral exposure to polychlorinated biphenyls (PCBs) on the development and metamorphosis of two amphibian species (Xenopus laevis and Rana temporaria).

This study examined the effects of polychlorinated biphenyls (PCBs) on development of families of amphibians using the African clawed frog (Xenopus laevis) and the European common frog (Rana temporaria). Amphibians were orally exposed to the technical PCB-mixture Clophen A50 or to the non-ortho-3,3',4,4',5-CB congener (PCB 126) either for a 10-day period or until metamorphosis. Occurrence and rate of malformations, mortality, period until metamorphosis and thyroid hormone levels were measured. Mortality increased in a dose-dependent manner, as did the rates of malformation. Time until metamorphic transformation was prolonged and the weight of froglets was increased. Although not statistically significant, thyroid hormone levels were also lowered. PHAHs such as PCBs may affect important aspects of amphibian fitness and may influence amphibian reproductive success.

Delayed effects of pre- and early-life time exposure to polychlorinated biphenyls on tadpoles of two amphibian species (Xenopus laevis and Rana temporaria).

This study examined the effects of polychlorinated biphenyls (PCBs) on the development of amphibians using Xenopus laevis and Rana temporaria as experimental animals. Amphibians were exposed at different life stages and via different routes to the technical mixtures Clophen A50 and Aroclor 1254 or to a non-ortho PCB congener (PCB 126). The effects of PCB exposure in amphibians, such as mortality, number and pattern of malformations, or body weight at the end of successful metamorphosis of tadpoles, depends on the route, the point of time of exposure during the complex life cycle of amphibians, and the length of the observation period. Retinoid concentrations were significantly altered in PCB dosed embryos. Presently used early-life time test systems such as the FETAX assay may underestimate toxic effects of compounds with long term response such as PCBs on amphibians.

Short-term outcome of kidney transplants from non-heart-beating donors after preservation by machine perfusion.

In this study, the short-term outcome of renal transplants from non-heart-beating donors (NHBD) preserved by machine perfusion (MP) is evaluated and compared to preservation by cold storage (CS). Twenty-two NHBD kidneys were procured during 1993 and 1994 after in situ perfusion with histidine-tryptophan ketoglutarate and preserved by continuous perfusion using University of Wisconsin organ preservation solution for MP as a perfusate. Between 1980 and 1992, 57 NHBD kidneys were procured and preserved by CS. Donors in the MP group sustained increased first warm ischemia times (WIT1) (P < 0.1) and recipients in the MP group suffered longer anastomosis time, worse HLA-DR mismatch, and more initial use of cyclosporin as immunosuppressant; all these factors are known to be deleterious to short-term outcome. Despite these unfavorable conditions, delayed function (DF) rate was decreased in the MP group, although not significantly. However, when considering only kidneys with WIT1 > or = 45 min, short-term outcome was significantly better in the MP group (P < 0.05). We conclude that MP is superior for the preservation of NHBD kidneys, especially after prolonged warm ischemia.

Long-term results following digital flexor tenosynovectomy in rheumatoid arthritis.

A retrospective review of flexor tenosynovectomy for rheumatoid flexor tenosynovitis in the palm and digit was performed. Fifteen patients (61 fingers) were reviewed for at least 1 year (average, 4 years) after surgery. An average of 2.2 cm improvement in active flexion (pulp to distal palmar crease) was observed. A significant difference in preoperative and postoperative results was found. Sixty-seven percent of digits were classified as having excellent or good results, 21% fair results, and 12% poor results. The clinical recurrence rate was 31% and the reoperation rate was 15%. Only minimal complications from the extended surgical approach were observed. Debulking the fibro-osseous canal by excising a slip of flexor digitorum superficialis was associated with a reduction in the recurrence and reoperation rates.