Ampicillin/sulbactam versus cefazolin plus aminoglycosides for antimicrobial prophylaxis in management of Gustilo type IIIA open fractures: A retrospective cohort study.

BACKGROUND: The antibiotic regimens for prophylaxis in the management of open fractures remain controversial. Although the use of aminoglycosides is widely accepted for treatment of Gustilo type III open fractures, aminoglycosides are often avoided in patients with risk factors. This study aimed to compare efficacy and safety of two regimens, cephazolin plus aminoglycoside (amikacin or gentamicin) and ampicillin/sulbactam (ABPC/SBT), in patients with Gustilo type IIIA open fractures. METHODS: A total of 95 Gustilo type IIIA fractures in 90 patients were retrospectively reviewed in this study. The cohort was categorized into two groups that were treated in accordance with the institutional prescribed regimen in different periods: (1) cefazolin plus aminoglycoside (January 1, 2014-September 30, 2017) and (2) ABPC/SBT monotherapy (October 1, 2017-September 30, 2020). Cefazolin was used at 1-2 g every 8 h, aminoglycoside (amikacin or gentamicin) was used daily depending on body weight, and ABPC/SBT was used at 3 g every 8 h The antibiotic administration was continued within 3 days or until successful soft tissue coverage was achieved. The infection rate and the incidence of acute kidney injury (AKI) in both groups were assessed. RESULTS: ABPC/SBT was used in 34 patients (36 fractures), and 56 patients (59 fractures) received cefazolin plus aminoglycoside for antibiotic prophylaxis. Infection developed in 2 of 36 fractures in ABPC/SBT group and 4 of 59 fractures in the cefazolin plus aminoglycoside group (p > 0.99). The average serum creatinine levels on admission, baseline, and peak during the hospital stay were not significantly different between the two groups. One case of AKI was identified in each group, indicating that incidence rate of AKI was not significantly different between the two groups. CONCLUSION: We demonstrated the non-inferiority of ABPC/SBT therapy over cefazolin plus aminoglycoside regimen for type IIIA open fractures. The ABPC/SBT regimen may be an alternative option for managing Gustilo type IIIA open fractures. Further prospective studies with larger samples are needed to verify these results.

Continuous Local Antibiotics Perfusion Therapy for Acute Deep Infections after Open Fractures.

Unresolved bone and soft tissue infections remain a great hindrance to fracture management worldwide, both economically and functionally for the patient. For this purpose, the benefits of local antibiotic administration besides systemic therapy have been elucidated. We present a retrospective descriptive analysis of six patients (4 males and 2 females) with acute deep infections after open fractures managed using the continuous local antibiotic perfusion (CLAP) therapy. After sufficient debridement, gentamicin solution concentrated at 1,200 µg/mL was continuously infused (2 mL/h) for 7-12 days by syringe pump through an inlet tube placed on the infected area. The antibiotics injected into the infected area were both collected and perfused by negative pressure using a negative-pressure wound therapy system. After an average of 9.5 days of CLAP therapy, symptoms of infection disappeared, and the bacterial culture was negative. There were no cases of recurrence during the follow-up period, and no complications, such as acute renal failure, ototoxicity, allergic or hypersensitivity reactions, and impaired fracture healing, were observed. All six cases were successfully managed with the CLAP therapy without any serious side effects. CLAP therapy may be a potential treatment option for acute deep infections after open fractures.

Selective Synthesis and Photoluminescence Study of Pyrazolopyridopyridazine Diones and N-Aminopyrazolopyrrolopyridine Diones.

The newly designed luminol structures of pyrazolopyridopyridazine diones and N-aminopyrazolopyrrolopyridine diones were synthesized from versatile 1,3-diaryfuropyrazolopyridine-6,8-diones, 1,3-diarylpyrazolopyrrolopyridine-6,8-diones, or 1,3-diaryl-7-methylpyrazolopyrrolopyridine-6,8-diones with hydrazine monohydrate. Photoluminescent and solvatofluorism properties containing UV-Vis absorption, emission spectra, and quantum yield (Φf) study of pyrazolopyridopyridazine diones and N-aminopyrazolopyrrolopyridine diones were also studied. Generally, most of pyrazolopyrrolopyridine-6,8-diones 6 exhibited the significant fluorescence intensity and the substituent effect when compared with N-aminopyrazolopyrrolopyridine diones, particularly for 6c and 6j with a m-chloro group. Additionally, the fluorescence intensity of 6j was significantly promoted due to the suitable conjugation conformation. Based on the quantum yield (Φf) study, the value of compound 6j (0.140) with planar structural skeletal was similar to that of standard luminol (1, 0.175).

[Clinical Features and Treatment Strategy of Vertebral Artery Injury Associated with Cervical Spine Trauma].

OBJECTIVE: Vertebral artery injury(VAI)associated with cervical spine trauma has the potential to cause catastrophic vertebrobasilar stroke. However, there are no well-defined treatment recommendations for VAI. The purpose of this study was to identify an effective treatment strategy for VAI following cervical spine trauma. METHODS: Ninety-seven patients with blunt cervical spine trauma were treated at Hyogo Prefectural Kakogawa Medical Center between January 2013 and September 2017. Of these patients, 49 underwent computed tomographic angiography or magnetic resonance angiography for evaluation of the vertebral artery. Eighteen patients(36.7%)had a diagnosis of VAI. We retrospectively analyzed the clinical features, treatment, and outcomes in these 18 patients. RESULTS: Seven patients(38.9%)had bilateral VAI, 16(88.9%)had cervical dislocation, and 2(11.1%)had transverse process fractures extending into the transverse foramen. Surgical reduction was performed in 14 patients. Five patients with either bilateral or unilateral occlusion underwent parent artery occlusion before reduction. There were no complications after this procedure. Two patients with bilateral VAI had a stroke before treatment. There were no infarctions in the distribution of the vertebrobasilar artery after intervention. The perioperative stroke rate was relatively good, and almost all Glasgow Outcome Scale scores were related to the degree of spinal cord injury. CONCLUSIONS: Aggressive screening for VAI is important in patients with cervical spine trauma in order to ensure adequate treatment. Although the treatment strategy described here could yield good results, it may require modification according to the needs of the individual patient.

One-Flask Synthesis of Pyrazolo[3,4-d]pyrimidines from 5-Aminopyrazoles and Mechanistic Study.

A novel one-flask synthetic method was developed in which 5-aminopyrazoles were reacted with N,N-substituted amides in the presence of PBr3. Hexamethyldisilazane was then added to perform heterocyclization to produce the corresponding pyrazolo[3,4-d]pyrimidines in suitable yields. These one-flask reactions thus involved Vilsmeier amidination, imination reactions, and the sequential intermolecular heterocyclization. To study the reaction mechanism, a series of 4-formyl-1,3-diphenyl-1H-pyrazol-5-yl-N,N-disubstituted formamidines, which were conceived as the chemical equivalent of 4-(iminomethyl)-1,3-diphenyl-1H-pyrazol-5-yl-formamidine, were prepared and successfully converted into pyrazolo[3,4-d]pyrimidines. The experiments demonstrated that the reaction intermediates were the chemical equivalents of 4-(iminomethyl)-1,3-diphenyl-1H-pyrazol-5-yl)formamidines. The rate of the reaction could be described as being proportional to the reactivity of amine reactants during intermolecular heterocyclization, especially when hexamethyldisilazane was used.

Comparative inhibition of tetrameric carbonyl reductase activity in pig heart cytosol by alkyl 4-pyridyl ketones.

CONTEXT AND OBJECTIVE: The present study is to elucidate the comparative inhibition of tetrameric carbonyl reductase (TCBR) activity by alkyl 4-pyridyl ketones, and to characterize its substrate-binding domain. MATERIALS AND METHODS: The inhibitory effects of alkyl 4-pyridyl ketones on the stereoselective reduction of 4-benzoylpyridine (4-BP) catalyzed by TCBR were examined in the cytosolic fraction of pig heart. RESULTS: Of alkyl 4-pyridyl ketones, 4-hexanoylpyridine, which has a straight-chain alkyl group of five carbon atoms, inhibited most potently TCBR activity and was a competitive inhibitor. Furthermore, cyclohexyl pentyl ketone, which is substituted by cyclohexyl group instead of phenyl group of hexanophenone, had much lower ability to be reduced than hexanophenone. DISCUSSION AND CONCLUSION: These results suggest that in addition to a hydrophobic cleft corresponding to a straight-chain alkyl group of five carbon atoms, a hydrophobic pocket with affinity for an aromatic group is located in the substrate-binding domain of TCBR.

Cyclization-carbonylation-cyclization coupling reaction of propargyl ureas with palladium(II)-bisoxazoline catalyst.

The cyclization-carbonylation-cyclization coupling reaction (CCC-coupling reaction) of propargyl ureas catalyzed by Pd(II)(box) complexes afforded symmetrical ketones bearing two 2-amino-2-oxazoline groups in good to moderate yields.

Synthesis and antiproliferative evaluation of 3,5-disubstituted 1,2,4-triazoles containing flurophenyl and trifluoromethanephenyl moieties.

An efficient 1,3-dipolar cycloaddition method was performed for the synthesis of a series of monofluoro- and trifluoromethane-3,5-disubstituted 1,2,4-triazoles. This efficient cycloaddition method was to react hydrazonoyl hydrochlorides with a series of aldehydes in the presence of NEt(3) as catalytic basic agent to provide the corresponding product in 28-94%. Their growth inhibitory results against cancer cells indicated that some of the fluorine- and trifluoromethane-containing compounds could effectively inhibit the growth of NCI-H226 and T-cell leukemia (Jurkat) cells. Among the compounds, trifluoromethane-containing 1,2,4-triazoles possessed the five-membered ring groups on the C-5 position of the triazolic ring, including cyclopentyl, 3-furyl, 3-thienyl, and 2-pyrrolyl, possessed the significant inhibitory activity for NCI-H226 cancer cells.

Synthesis and antiproliferative evaluation of N,N-disubstituted-N'-[1-aryl-1H-pyrazol-5-yl]-methnimidamides.

A series of N,N-disubstituted-N'-[1-aryl-1H-pyrazol-5-yl]-methnimidamides was synthesized by a newly developed microwave reaction and their antiproliferative activities were evaluated. Microwave irradiation of 5-amino-1,3-disubstituted pyrazoles with various amide solvents in the presence of POCl(3) provided the corresponding 2a-2k, 3a-3c, and 4a-4f in good to excellent yields. The obtained methnimidamides were tested against NCI-H661, NPC-TW01, and Jurkat cancer cell lines and the results indicated that compounds 2d and 2e were the most potent with IC(50) values in low micromolar range.

Lumbar facet joint infection associated with epidural and paraspinal abscess: a case report with review of the literature.

A case of lumbar facet joint infection associated with epidural and paraspinal abscess is presented. A 57-year-old man was hospitalized with severe low back pain that radiated into the bilateral buttocks and legs. The patient had a temperature of 37.3 degrees C, and the biochemical inflammatory parameters were elevated. Initially on admission, we administered antibiotics intravenously. However, pain increased, fever elevated gradually, and bladder-bowel disturbance appeared. Magnetic resonance imaging (MRI) showed effusion in the widened facet joint, paraspinal muscles, and epidural space, which compressed the theca severely. We performed an immediate surgical debridement combined with thorough antibiotic therapy and achieved excellent results. MRI was useful for precise diagnosis and operative planning.

Proprioceptive recovery of patients with cervical myelopathy after surgical decompression.

STUDY DESIGN: A prospective observational study. OBJECTIVES: To determine whether proprioceptive deficit recovers after surgery and whether proprioceptive evaluation can predict functional outcome in cervical myelopathy patients. SUMMARY OF BACKGROUND DATA: Proprioceptive sensation plays an important role in smooth, coordinated movement of the limbs. Information about proprioception ascends through the dorsal columns in the spinal cord. In severe compressive myelopathy, proprioceptive ability would be reduced and could be improved after surgical decompression. However, there have been few studies concerning proprioceptive impairment in cervical myelopathy. MATERIALS AND METHODS: The study group included 26 cervical myelopathy patients who underwent posterior surgical decompression. Knee proprioception was assessed by joint position sense, which was evaluated by measuring the error angle when the subjects tried to reproduce the predetermined angle by extension and by flexion. Proprioceptive deficit in the study group was evaluated, compared with age-matched normal subjects. Postoperative recovery and correlation to functional status was analyzed in the study group. The Japanese Orthopedic Association (JOA) scores were used for functional evaluation. RESULTS: The error angles were significantly higher in the study group than those in the control group before surgery. All patients in the study group finally had improvement of the error angles by a year after surgery. The average of error angles in the study group was improved 2 weeks after surgery; however, no changes were observed later. There was significant correlation between the improvement rate of the error angles 2 weeks after surgery and that of the JOA scores 2 years after surgery. There were 9 patients who had worsened proprioception 2 weeks after surgery either by extension or by flexion, all of whom had poor functional outcome. CONCLUSIONS: Knee proprioception was impaired in cervical myelopathy and recovered after surgical posterior decompression. Proprioceptive improvement at 2 weeks correlates with the degree of improvement in JOA scores at 2 years after surgery.

Impaired joint proprioception in patients with cervical myelopathy.

STUDY DESIGN: Prospective clinical study. OBJECTIVES: To evaluate impairment of proprioception quantitatively in patients with cervical myelopathy. SUMMARY OF BACKGROUND DATA: Sensory information regarding proprioception ascends through the posterior columns in the spinal cord. Damage to these columns causes proprioceptive loss in patients with spondylotic myelopathy. Nevertheless, there have been few studies regarding proprioception in patients with myelopathy. METHODS: The authors evaluated knee proprioception in 54 cervical myelopathy patients and compared results with those of 54 age-matched healthy volunteers. Knee proprioception was assessed by joint position sense, represented by the error angles when patients reproduced predetermined angles of knee flexion. RESULTS: The average absolute angle error of right and left knee with the predetermined position of 30 degrees of knee flexion was 2.5 +/- 1.8 (mean +/- standard deviation) and 1.8 +/- 1.2 degrees and with the predetermined 60 degrees of flexion, 4.7 +/- 2.8 and 2.8 +/- 1.4 degrees in the myelopathy and control groups, respectively. The average absolute angular errors in the myelopathy group were significantly higher than those in the control group for each predetermined knee position (P < 0.01). CONCLUSIONS: Proprioceptive ability is impaired in patients with cervical myelopathy. Position sense can be assessed by measuring the angular error when reproducing criterion positions, and the results may reflect the severity of cervical myelopathy. Thus, the present method of measuring proprioception is easy to perform and useful for quantitative assessment of the severity of cervical myelopathy.

An expanding cervical synovial cyst causing acute cervical radiculopathy.

Synovial cysts of the cervical spine occur infrequently in the spinal canal and are most often associated with degenerative facet joints. Despite the prevalence of degenerative spinal disease, symptomatic synovial cysts are extremely uncommon. We report a rare case that showed an exacerbation of a cervical radiculopathy due to an acute expansion of the synovial cyst. Magnetic resonance (MR) images originally revealed a small cystic extradural lesion when the patient presented with neck pain and slightly numbness in the right hand. The patient's complaints subsequently subsided after administration of pain killers. However, 2 weeks after this, the patient experienced a spontaneous, sudden, severe radiating pain into the right arm without any accompanying cervical injury. MR images showed that the cyst had become markedly increased in size in the intervening 4 weeks and compressed the spinal cord laterally. Because the arm pain was so severe and neurologic examinations revealed the paralysis of the C8 nerve root, the synovial cyst was excised surgically and a good clinical outcome achieved. Thus, even if symptoms are mild and the size of the synovial cyst is small, acute expansion of the cyst might be rarely observed and careful management, including surgical consideration, is needed.

Avulsion fracture of the posterior oblique ligament associated with acute tear of the medial collateral ligament.

The term posterior oblique ligament was proposed in 1973 but the specific anatomy of this region has been controversial. It has been concluded that the posterior oblique ligament is separated from the medial collateral ligament, each with distinctly different bony attachment points. In this article, we report a posterior oblique ligament avulsion fracture associated with a medial collateral ligament rupture.