Treatment outcomes of patients with Cutibacterium acnes-positive cultures during total joint replacement revision surgery: a minimum 2-year follow-up.

INTRODUCTION: Periprosthetic joint infection (PJI) is a devastating complication following total joint replacement (TJR). Cutibacterium acnes (C. acnes) is a low virulent skin commensal, commonly found during TJR revision surgery for "aseptic" causes. The purpose of the present study was to report the treatment outcomes of patients with C. acnes contamination or infection in the presence of a TJR treated with a revision surgery ± implant exchange ± prolonged (≥ 8 weeks) postoperative antibiotics. METHODS: Medical records of patients with at least one positive C. acnes culture in intraoperative tissue samples or sonication fluid from a TJR revision surgery between January 2005 and December 2014 were retrospectively evaluated. The primary endpoint was infection eradication according to Delphi criteria. The diagnostic accuracy of preoperative TJR aspiration regarding the diagnosis of C. acnes PJI was also investigated. RESULTS: A total of 52 TJR (28 shoulders, 17 hips, 7 knees) in 52 patients (35 males, 17 females) with an average age of 63 ± 11 (33-86) years were included. At an average follow-up of 67 ± 33 (24-127) months, the infection eradication of C. acnes PJI was 97% regardless of the surgical treatment or administration of prolonged postoperative antibiotics. The incidence of unsuspected C. acnes PJI was 28.8%. The sensitivity and specificity of preoperative joint aspiration in detecting C. acnes PJI were 59% and 88%, whereas the PPV and NNV were 83% and 67%, respectively. CONCLUSION: Infection eradication of C. acnes PJI was very high at a minimum follow-up of 24 months, suggesting that C. acnes PJI could be adequately treated with a combination of revision surgery and prolonged postoperative antibiotics. The preoperative diagnosis of C. acnes PJI might be challenging with more than one-quarter of patients presenting without suspicion of C. acnes PJI. The appropriate treatment of patients with a single positive culture remains still unclear. A negative TJR aspiration should not rule out a C. acnes PJI, especially in the presence of clinical correlates of infection. LEVEL OF EVIDENCE: Retrospective case-control study, Level III. IRB APPROVAL: Kantonale Ethikkommission Zürich, BASEC Nr.:2017-00567.

A cross-cultural comparison of sleep patterns between typically developing children and children with ASD living in Saudi Arabia and the United Kingdom.

BACKGROUND: Sleep is crucial for child development, especially for children with ASD. While it is known that children with ASD experience more severe sleep problems and that these problems tend to persist compared to their typically developing counterparts, these findings tend to come from only Western countries. A cross-cultural study is important to understand if the prevailing understanding of sleep in children with ASD can be extended to different cultural backgrounds. AIM: A cross-cultural study is conducted, involving typically developing children and children with ASD aged 5-12 across two countries: Saudi Arabia and the United Kingdom. METHODS AND PROCEDURES: Using a combination of questionnaires measuring ASD severity (CARS-2), sleep quality (CSHQ), sociodemographic and lifestyle variables and sleep diaries, 244 children were sampled using a mixture of snowball and convenience sampling methods. OUTCOMES AND RESULTS: Children with ASD experience more sleep problems compared to typically developing children in Saudi Arabia, and these problems similarly persist across time. Specifically, it was found that children with ASD in Saudi Arabia experience greater sleep onset latency and a greater number of night awakenings. Additionally, across the ASD groups, it was found that children from Saudi Arabia generally experienced poorer sleep than children in the United Kingdom in terms of shorter sleep duration, although children in the United Kingdom tended to report more instances of sleep anxiety and parasomnias. CONCLUSIONS AND IMPLICATIONS: Several reasons such as parental education about sleep hygiene, cultural influences and social hours were put forward as potential explanations for cross-cultural differences. Findings served to emphasise the importance of culturally-appropriate interventions and public education regarding child sleep.

Sleep-disordered breathing and cognitive functioning in preschool children with and without Down syndrome.

BACKGROUND: Sleep affects children's cognitive development, preparedness for school and future academic outcomes. People with Down syndrome (DS) are particularly at risk for sleep-disordered breathing (SDB). To our knowledge, the association between SDB and cognition in preschoolers with DS is unknown. METHODS: We assessed sleep by using cardiorespiratory polygraphy in 22 typically developing (TD) preschoolers and 22 with DS. Cognition was assessed by using the Mullen Scales of Early Learning and behaviour by using the Strengths and Difficulties Questionnaire (SDQ). The MacArthur Communicative Development Inventory (MCDI) measured language level. We predicted that sleep problems would be associated with lower cognitive and behavioural functioning. RESULTS: In TD children, longer sleep duration was associated with higher scores on MCDI expressive language and fewer emotional symptoms such as fear and unhappiness on the SDQ, whilst SDB was associated with increased conduct problems and less prosocial behaviour on the SDQ. Conversely, for children with DS, SDB was associated with increased language understanding and use of actions and gestures on the MCDI. CONCLUSIONS: The findings in the TD group support our hypotheses. We recommend that sleep problems are screened for and treated as even mild SDB may prompt poorer cognition and behaviour. For children with DS, we expect that multiple factors in this complex syndrome mask or mediate the association between sleep and cognitive development and tighter controls are necessary to uncover effects of sleep. We propose longitudinal studies as a necessary tool to assess the precise impact of sleep on cognitive development in accounting for individual differences in DS.

Side-to-side variation in normal femoral morphology: 3D CT analysis of 122 femurs.

BACKGROUND: The contralateral femur is often used as reference for reconstruction in unilateral hip joint pathology. The objective of this study was to quantify the side-to-side variation in proximal femur. We hypothesized that significant side-to-side differences exist between left and right femur with implications for preoperative planning and leg length discrepancy following hip arthroplasty. MATERIALS AND METHODS: CT-based 3D femoral models were reconstructed for 122 paired femurs in 61 young healthy subjects (46.9±6.8 years) with no history of hip pathology. Side-to-side differences of several femoral morphologic parameters, including femoral head diameter, femoral anteversion, horizontal offset and femoral head center location, were compared and correlated with demographic factors using multiple linear regression. RESULTS: Significant side-to-side differences (P<0.01) were found in femoral anteversion (4.3±3.8°; range: 0.2° to 17.3°), horizontal offset (2.5±2.1mm; range: 0.1 to 10.3mm), and femoral head center location (7.1±3.8mm; range: 0.5 to 19.4mm). The difference in femoral anteversion was strongly correlated with the difference in neck diameter (R(2)=0.79), whereas the difference in horizontal femoral offset was highly correlated with the head diameter difference (R(2)=0.72). Femoral head center difference was correlated with the femoral anteversion, horizontal offset and neck-shaft-angle difference (R(2)=0.82). DISCUSSION: Relying on the anatomic landmarks of the contralateral femur during hip arthroplasty may not necessarily result in restoration of native anatomy and leg-length. Knowledge of the baseline side-to-side asymmetry could provide a range of error that would be tolerable following hip reconstruction. LEVEL OF EVIDENCE: Level IV. TYPE OF STUDY: Retrospective observational study.

Atypical development of configural face recognition in children with autism, Down syndrome and Williams syndrome.

BACKGROUND: Configural processing in face recognition is a sensitivity to the spacing between facial features. It has been argued both that its presence represents a high level of expertise in face recognition, and also that it is a developmentally vulnerable process. METHOD: We report a cross-syndrome investigation of the development of configural face recognition in school-aged children with autism, Down syndrome and Williams syndrome compared with a typically developing comparison group. Cross-sectional trajectory analyses were used to compare configural and featural face recognition utilising the 'Jane faces' task. Trajectories were constructed linking featural and configural performance either to chronological age or to different measures of mental age (receptive vocabulary, visuospatial construction), as well as the Benton face recognition task. RESULTS: An emergent inversion effect across age for detecting configural but not featural changes in faces was established as the marker of typical development. Children from clinical groups displayed atypical profiles that differed across all groups. CONCLUSION: We discuss the implications for the nature of face processing within the respective developmental disorders, and how the cross-sectional syndrome comparison informs the constraints that shape the typical development of face recognition.

Human and canine leishmaniasis in asymptomatic and symptomatic population in Northwestern Greece.

The occurrence of human and canine Mediterranean visceral leishmaniasis (MVL) in Northwestern Greece was investigated during an 8-year survey (1994-2001). A total of 1200 blood sera samples, collected from asymptomatic human population, and 1200 blood sera samples from asymptomatic dogs were screened for Leishmania infantum antibodies using the indirect immunofluorescence test (IFA). Also during the survey 111 human subjects and 350 canines were referred as clinically suspect cases for MVL. Significant differences (p = 0.001) were found between the prevalence of MVL in symptomatic and asymptomatic human populations (12.6 and 0.5%, respectively), but a more modest difference was observed between symptomatic and asymptomatic canines (45.4 and 24.4%, respectively). From the results, it appears that Greece has a high background of canine leishmaniasis, which is likely to be a risk factor for the emergence of human MVL.

Efforts to understand the molecular basis of hypertension through drug:membrane interactions.

Biological membranes play an essential role in the drug action. They constitute the first barrier for drugs to exert their biological action. AT1 antagonists are amphiphilic molecules and are hypothesized to act on AT1 receptor through incorporation (first step) and lateral diffusion through membrane bilayers (second step). Various biophysical methods along with Molecular Modelling were applied in order to explore the plausible two step proposed mechanism of action for this class of antihypertensive drugs.

Electrophysiological recording of tendon reflexes in cervical myelopathy.

Twenty-six patients with unequivocal, clinically and radiologically confirmed cervical myelopathy were investigated electrophysiogically using needle electromyography (EMG), motor and sensory conduction velocity, F-wave latency and the electromyographic recording of the tendon reflexes (TR) of the biceps brachii, brachioradialis and triceps brachii muscles. Normal latency and amplitude values of the reflex evoked compound muscle potentials (T-wave) were calculated from 74 healthy volunteers. Pathological TR were found in 73.1% of the patients, while EMG--which was the next more effective method--was positive in 38.5% of the cases. Eight pathologically delayed T-waves were recorded from muscles with clinically normal or even exaggerated reflexes. TR recording appears to be a useful method in the assessment of segmental functional disturbance in cervical myelopathy.

Bacterial strains isolated from eggs and their resistance to currently used antibiotics: is there a health hazard for consumers?

In order to study the putative transfer of antibiotic resistance from poultry to humans, hens' eggs were examined for the presence of various pathogens. Staphylococcus, Enterobacter, Escherichia, Proteus and Pseudomonas spp. were the most frequently isolated genera. Sensitivity tests, performed with the Kirby-Bauer technique, showed the presence of resistant strains of Staphylococcus aureus (to penicillin-G, tetracycline, erythromycin, clindamycin, cefalosporins, oxacillin, gentamycin, chloramphenicol and tobramycin), Enterococcus faecalis (to ampicillin, ciprofloxacin, clindamycin, gentamycin and tetracyclin), Escherichia coli (to tetracycline, erythromycin, ampicillin and cefalosporins), Enterobacter cloacae (to ampicillin, amoxycillin plus clavunalic acid, erythromycin and tetracycline), Pseudomonas stutzeri (to erythromycin and chlorampenicol) and Citrobacter freundii (to ampicillin, amoxycillin plus clavunalic acid, cefalosporins and co-trimoxazole).

Genetic analysis of human immunodeficiency virus type 1 strains from patients in Cyprus: identification of a new subtype designated subtype I.

DNA sequences encoding the C2 to V3 region of envelope glycoprotein gp120 of human immunodeficiency virus type 1 (HIV-1) were amplified by PCR from uncultured peripheral blood mononuclear cells obtained from 24 of 25 HIV-1-seropositive patients from Cyprus. By using a heteroduplex mobility assay (HMA), all amplified products were studied genetically and compared with 16 previously characterized HIV-1 strains belonging to subtypes A through F. HMA results revealed that HIV-1 gp120 sequences from 15 of our patients were of subtype B of HIV-1, whereas one isolate was of subtype C. However, gp120 sequences from eight patients had no obvious similarities to the known subtypes as defined by HMA. DNA sequencing and phylogenetic analyses of molecular clones confirmed the HMA results and placed the eight undefined HIV-1 isolates into three distinct genetic clusters. On the basis of branch topology and lengths of the phylogenetic tree, we conclude that one group consisting of three clones from two patients represents a new HIV-1 env subtype, which we have termed subtype I. The remaining two sequence clusters, consisting of five sequences from four patients and two sequences from two other patients, are distally related to subtypes A and F. These data demonstrate the extensive heterogeneity of HIV-1 in Cyprus, including the presence of new subtype.

A clinical diagnosis of urinary bladder (extra-adrenal) phaeochromocytoma.

Urinary bladder (extra-adrenal) pheochromocytoma is a catecholamine-producing tumor that arises from chromaffin cells in the extra-adrenal paraganglion system of the urinary bladder. The symptoms and signs result from the release of epinephrine and/or non-epinephrine, which is more prominent during micturition. The most serious consequences of the disease are paroxysmal hypertension during micturition and malignant degeneration. Thus, proper treatment is mandatory.

Distribution of Clostridium perfringens in different aquatic environments in Greece.

Clostridium perfringens and especially its spores, which are more tolerant to various physiochemical effects than the other fecal indicator bacteria, could serve as a useful indicator in ecosystems with stress factors. In order to determine the numbers of Clostridium perfringens in waters of rural North-West Greece, we utilised a new medium, lactose-sulfite (LS) broth, suggested for rapid enumeration and identification of Clostridium perfringens without the necessity for further confirmatory tests. Membrane filtration equipment was used on site. All samples were alternatively passed through two membrane filters, one (20-25 microns pore size) was used for retention of the abundant phytoplankton and the other (porosity 0.45 micron) for Clostridium perfringens. Membranes were placed into the first tube of 10-fold dilutions from 10(1) to 10(4) and incubated aerobically in a water-bath at 46 degrees C for 24 h. The numbers of Clostridium perfringens revealed fluctuations depending on the sampling site. It was significantly more common in the vicinity of industrial or domestic activities. LS broth not only allows the detection of small numbers of Clostridium perfringens but also permits rapid detection within 24 h. We propose the medium and the procedures described in this paper as a reliable technique for estimation of Clostridium perfringens as indicator of fecal contamination in waters.

Survival of Salmonella enteritidis during the manufacture of feta cheese made of pasteurized ewe's milk.

The behaviour of Salmonella enteritidis during the Feta cheese making process was investigated. Two lots of pasteurized whole ewe's milk were inoculated to contain 10(6) cfu/ml of S. enteritidis (strain AS1 and AS2) and were processed into Feta cheese following standard procedures. All samples were examined for S. enteritidis both quantitatively and qualitatively, while moisture, fat, water activity and pH were also measured. S. enteritidis was enumerated in duplicate samples by surface plating on SS agar. Selected salmonella-like colonies were identified biochemically and serologically. The enumerations have shown that S. enteritidis was initially entrapped in the curd. Then the growth of S. enteritidis gradually decreased and no Salmonellae were quantitatively enumerated after the 23rd day. However S. enteritidis was detected qualitatively in samples taken until the 38th day.

Behavior of Salmonella enteritidis During the Manufacture, Ripening, and Storage of Feta Cheese Made from Unpasteurized Ewe's Milk.

The ability of Salmonella enteritidis to grow during the Feta cheese-making process and to survive during ripening and storage of the cheese was investigated. Unpasteurized whole ewe's milk was inoculated to contain 106-107 CFU/ml of S. enteritidis and was processed into Feta cheese following standard procedures. All samples were examined for S. enteritidis both quantitatively and qualitatively, while moisture, fat, water activity, and pH values were also measured. S. enteritidis was enumerated in duplicate samples by surface plating on SS agar. Selected Salmonella colonies were identified biochemically and serologically. The enumerations have shown that S. enteritidis was entrapped in curd with the population increasing to a maximum during the First 48 h. Thereafter, the growth of S. enteritidis was inhibited and surviving cells persisted in the curd for up to 20 d.