[Diagnosis of periprosthetic hip infections]. / Diagnostik der infizierten Hüftendoprothese.

The diagnosis of periprosthetic infection requires a clear definition itself and structured procedure concerning anamnesis, clinical examination, laboratory findings, puncture and imaging diagnostics. The clinical presentation may vary considerable due to the time of their occurrence as early, delayed, or late infection. Recognition of risk factors and knowledge of differential diagnoses facilitate and confirm the diagnosis. The synovial fluid is assessed with regard to leukocyte count, protein content, and glucose. Intraoperative tissue specimen sampling has to be performed correctly; the histopathological and microbiological studies must be assessed using specific criteria. The examination and classification of periprosthetic membranes make discrimination of the causal pathological mechanism possible, especially distinction between septic and aseptic loosening. In this manner statements with regard to etiology and prosthesis durability are possible. Different causative microorganisms appear postoperatively at specific times. Pathogens that grow as biofilms are of great significance, as they may compound diagnosis and therapy. Early infections are often caused by virulent microorganisms (S. aureus) with acute onset. Delayed (low grade) infections are usually caused by less virulent microorganisms, such as S. epidermidis or coagulase-negative staphylococci. Many diagnostic imaging methods have been used in the assessment of periprosthetic infection: plain radiographs, arthrography, ultrasonography, computed tomography, and magnetic resonance imaging. Nuclear medicine with bone scintigraphy or positron-emission tomography enhance diagnostic capabilities. Cultures of samples obtained by sonication of prostheses are more sensitive than conventional periprosthetic tissue culture. Multiplex PCR of sonication fluid is a promising test for diagnosis of periprosthetic joint infection. The promising diagnostic accuracy for interleukin-6 and procalcitonin has yet not been affirmed.

Economic weights for maternal traits of sows, including sow longevity.

The objective of this study was to develop a transparent, comprehensive, and flexible model for each trait for the formulation of breeding objectives for sow traits in swine breeding programs. Economic values were derived from submodels considering a typical Australian pig production system. Differences in timing and expressions of traits were accounted for to derive economic weights that were compared on the basis of their relative size after multiplication by their corresponding genetic standard deviation to account for differences in scale and genetic variability present for each trait. The number of piglets born alive had the greatest contribution (27.1%) to a subindex containing only maternal traits, followed by daily gain (maternal; 22.0%) and sow mature weight (15.0%). Other traits considered in the maternal breeding objective were preweaning survival (11.8%), sow longevity (12.5%), gilt age at puberty (8.7%), and piglet survival at birth (3.1%). The economic weights for number of piglets born alive and preweaning piglet survival were found to be highly dependent on the definition of scale of enterprise, with each economic value increasing by approximately 100% when it was assumed that the value of extra output per sow could be captured, rather than assuming a consequent reduction in the number of sows to maintain a constant level of output from a farm enterprise. In the context of a full maternal line index that must account also for the expression of direct genetic traits by the growing piglet progeny of sows, the maternal traits contributed approximately half of the variation in the overall breeding objective. Deployment of more comprehensive maternal line indexes incorporating the new maternal traits described would lead to more balanced selection outcomes and improved survival of pigs. Future work could facilitate evaluation of the economic impacts of desired-gains indexes, which could further improve animal welfare through improved sow and piglet survival. The results justify further development of selection criteria and breeding value prediction systems for a wider range of maternal traits relevant to pig production systems.

Economic weights for performance and survival traits of growing pigs.

The objective of this paper was to derive economic weights for performance and survival traits of growing pigs including feed conversion ratio (FCR), daily feed intake (DFI), ADG, postweaning survival of the growing pig (SG), and carcass fat depth at the P2 site (CFD). An independent model was developed for each trait to derive economic values directly based on a typical Australian production system. This flexible approach may be used to customize economic values for different production systems and alternative trait combinations in breeding objectives. Discounted genetic expressions were used as a means of taking into account differences in frequency and timing of expression of traits to obtain economic weights. Economic values for SG were derived based on a cost-saving and a lost-revenue approach. The correct formulation of the economic value of ADG depends on how feed cost is included in the breeding objective. If FCR is defined as a breeding objective trait, then savings in feed costs through earlier slaughter should not be counted in the economic value of ADG. In contrast, if DFI is included in the breeding objective instead of FCR, then feed-cost savings through earlier slaughter need to be attributed to the economic value for ADG, as a benefit from faster ADG. The paper also demonstrates that economic weightings in indexes for FCR can potentially be overestimated by 70% when it is assumed that DFI or FCR records taken from a limited duration test period reflect the corresponding trait over the full lifetime of the growing pig destined for slaughter. Postweaning survival of the growing pig was the most important breeding objective trait of growing pigs. The relative importance of each breeding objective trait in a sire-line index based on the genetic SD of each trait was 44.5, 27.0, 17.4, and 11.1% for SG, FCR, ADG, and CFD, respectively. Further studies to better clarify the extent of genetic variation that exists in SG under nucleus-farm and commercial-farm conditions are warranted, given the high economic importance of this survival trait of growing pigs.

[Autologous bone-marrow stem-cell transplantation for induction of arteriogenesis for limb salvage in critical limb ischaemia]. / Extremitätenerhalt durch autologe Knochenmarksstammzelltransplantation zur Induktion der Arteriogenese bei kritischer, nicht-revaskularisierbarer Extremitätenischämie.

BACKGROUND: Bone marrow cell transplantation has been shown to induce angiogenesis and thus improve ischaemic artery disease. This study evaluates the effects of intramuscular bone marrow cell transplantation in patients with limb-threatening critical limb ischaemia with a very high risk for major amputation. METHODS AND RESULTS: After failed or impossible operative and / or interventional revascularisation and after unsuccessful maximum conservative therapy, 51 patients with impending major amputation due to severe critical limb ischaemia had autologous bone marrow cells (BMC) transplant-ed into the ischaemic leg. Patients 1-12 received Ficoll-isolated bone marrow mononuclear cells (total cell number 1.1 +/- 1.1 x 10(9)), patients 13-51 received point of care isolated bone marrow total nucleated cells (3.0 +/- 1.7 x 10(9)). Limb salvage was 59 % at 6 months and 53 % at last follow-up (mean: 411 +/- 261 days, range: 175-1186 days). Perfusion measured with the ankle-brachial-index (ABI) and transcutaneous oxygen tension (tcpO2) at baseline and after 6 months increased in -patients with consecutive limb salvage (ABI 0.33 +/- 0.18 to 0.46 +/- 0.15, tcpO2 12 +/- 12 to 25 +/- 15 mmHg) and did not change in patients eventually undergoing major amputation. No differences in clinical outcome between the isolation methods were seen. Clinically most important, patients with limb salvage improved from a mean Rutherford category of 4.9 at baseline to 3.3 at 6 months (p = 0.0001). Analgesics consumption was reduced by 62 %. -Total walking distance improved in non-amputees from zero to 40 metres. Three severe peri-procedural adverse events resolved without sequelae, and no unexpected long-term adverse events occurred. CONCLUSIONS: In no-option patients with end-stage critical limb ischaemia due to peripheral -artery disease, bone marrow cell transplantation is a safe procedure which can improve leg perfusion sufficiently to reduce major amputations and permit durable limb salvage.

Design and rationale of a randomized, double-blind, placebo-controlled phase III study for autologous bone marrow cell transplantation in critical limb ischemia: the BONe Marrow Outcomes Trial in Critical Limb Ischemia (BONMOT-CLI).

BACKGROUND: Critical limb ischemia (CLI) is the end-stage of peripheral artery disease. Only about two thirds of patients with CLI can be revascularised, one third progresses to leg amputation with high associated morbidity and mortality. Therapeutic angiogenesis with bone marrow cells has shown promising improvement in less severe stages of peripheral ischemia. Our study evaluates the therapeutic value of bone marrow cell induced angiogenesis and arteriogenesis in severe, limb-threatening ischemia. PATIENTS AND METHODS: the BONe Marrow Outcome Trial in Critical Limb Ischemia (BONMOT-CLI) is a investigator-initiated, double-blinded, 1:1 randomized, placebo-controlled multi-centre study at 4 sites in Germany. Only patients with no option for revascularisation or after failed revascularisation will be included. A total of 90 patients is to be included. One arm with 45 subjects will be treated with a concentrate of autologous bone marrow cells which will be injected at 40 sites into the ischemic limb. In the placebo arm, study subjects will undergo a sham bone marrow punction and 40 saline injections. At three months, a combined primary endpoint of major amputation or persisting critical limb ischemia (no clinical or perfusion improvement) will be evaluated. Secondary endpoints are death, changes in perfusion, quality of life, walking distance, minor amputations, wound healing, collateral density and cancer incidence. Post-study follow-up is up to two years. CONCLUSIONS: The results of this first randomized placebo-controlled trial for autologous bone marrow cell therapy in CLI will clarify the value of this new therapeutic modality in a patient population with no other alternatives except major amputation.

[Post-discharge surgical wound infection: what is to be done?]. / Nach der Klinikentlassung. OP-Wunde infiziert--was tun?

Infection of the laparotomy wound cannot always be prevented--for a variety of reasons including patient-related, disease-related and surgery-related factors. Of importance is the early detection of a wound infection--with confirmation or exclusion of underlying pathology (e.g. anastomotic leakage)--before sepsis develops. As a rule, a laparotomy wound infection can be adequately controlled by re-opening, debridement and moist management. Innovative dressing techniques involving vacuum sealing and suction accelerate healing.

Adult Amblyomma hebraeum burdens and heartwater endemic stability in cattle.

Several conclusions of importance to studies on the epidemiology of heartwater were drawn from an investigation in which the numbers of adult Amblyomma hebraeum ticks, to which a closed herd of Hereford cattle were exposed over a period of 6 1/2 years, were manipulated. With a tick Cowdria ruminantium infection rate of 3-5%, an endemically stable situation was created by dipping the herd only when an average of 10 adult male and female A. hebraeum ticks were counted on 10 animals. When the average was increased to 15 during the calving period, 97% of calves acquired a tick-mediated immunity at the age of 6 months. Because only adult ticks confined to the hindquarters are counted, this procedure is recommended as a feasible and practical guideline to stock owners wishing to determine a dipping programme that would ensure endemic stability. The indirect fluorescent antibody test gave a true reflection of the infection rate through ticks in calves 3-6 months old, but not in older animals that had been re-infected more than once. This is because on one hand antibody may persist for 2 years after withdrawal from tick exposure and on the other the artificial re-infection of cattle with a tick acquired immunity is not always followed by a rise in antibody titres and may even result in seronegativity. Four cows infected and re-infected through ticks, remained immune to challenge for 2 years after withdrawal from tick exposure. Within the confines of one farm 3 isolates of C. ruminantium that differed in pathogenicity and immunogenicity were recovered from ticks. One of these isolates was almost non-pathogenic to cattle.

The immunization of calves against heartwater: subsequent immunity both in the absence and presence of natural tick challenge.

Cattle, vaccinated as calves with Cowdria ruminantium-infected tick stabilate, were challenged 6, 12 and 24 months later. In the absence of tick challenge, vaccination of calves induced a partial immunity against subsequent challenge at 12 and 24 months. In animals exposed to ticks, the resistance was no better than that of control, unvaccinated cattle. When they were challenged at 6 months of age there was no difference between vaccinated and unvaccinated calves, either in the absence or presence of tick challenge, and all the animals manifested a high degree of natural resistance. This study therefore suggests that the value of vaccinating Afrikander-cross calves in heartwater endemic areas should be further investigated. The indirect fluorescent antibody (IFA) test proved to be a valuable means of monitoring the serological response of vaccinated animals and detecting the sero-conversion of animals exposed to tick infection. On one hand, there was good correlation between the febrile reaction and the results of the IFA test on the sera of vaccinated and control cattle challenged with the heartwater agent, in that all sero-positive animals were resistant to challenge. On the other hand, though, a considerable percentage of the animals that were serologically negative were also resistant to challenge.