Sugar phosphate-mediated inhibition of peptidoglycan precursor synthesis.

Antibiotic tolerance, the widespread ability of diverse pathogenic bacteria to sustain viability in the presence of typically bactericidal antibiotics for extended time periods, is an understudied steppingstone towards antibiotic resistance. The Gram-negative pathogen , the causative agent of cholera, is highly tolerant to β-lactam antibiotics. We previously found that the disruption of glycolysis, via deletion of (, glucose-6-phosphate isomerase), resulted in significant cell wall damage and increased sensitivity towards β-lactam antibiotics.

Epidemiological Trends and Outcomes of Unicompartmental Knee Arthroplasty Among 104 Million Patients in the United States.

Background: Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) for localized osteoarthritis. Recent advancements in UKA implant design and expanding patient criteria may have increased its utilization. However, few studies have examined the use of UKA in the United States.

Engineering tumor-colonizing E. coli Nissle 1917 for detection and treatment of colorectal neoplasia.

Bioengineered probiotics enable new opportunities to improve colorectal cancer (CRC) screening, prevention and treatment. Here, first, we demonstrate selective colonization of colorectal adenomas after oral delivery of probiotic E. coli Nissle 1917 (EcN) to a genetically-engineered murine model of CRC predisposition and orthotopic models of CRC.

Colorectal cancer detection and treatment with engineered probiotics.

Bioengineered probiotics enable new opportunities to improve colorectal cancer (CRC) screening, prevention and treatment strategies. Here, we demonstrate the phenomenon of selective, long-term colonization of colorectal adenomas after oral delivery of probiotic Nissle 1917 (EcN) to a genetically-engineered murine model of CRC predisposition. We show that, after oral administration, adenomas can be monitored over time by recovering EcN from stool.

Smith-Petersen Versus Watson-Jones Approach Does Not Affect Quality of Open Reduction of Femoral Neck Fracture.

Objective: To compare immediate quality of open reduction of femoral neck fractures by alternative surgical approaches.

Design: Retrospective cohort study.

Setting: Twelve Level 1 North American trauma centers.

Open Reduction Is Associated With Greater Hazard of Early Reoperation After Internal Fixation of Displaced Femoral Neck Fractures in Adults 18-65 Years.

Objectives: To determine (1) which factors are associated with the choice to perform an open reduction and (2) by adjusting for these factors, if the choice of reduction method is associated with reoperation.

Design: Retrospective cohort study with radiograph and chart review.

Setting: Twelve Level 1 North American trauma centers.

The Quality of Diagnostic Studies in Periprosthetic Joint Infections: Can We Do Better?

Background: The diagnosis of periprosthetic joint infections (PJIs) continues to be a subject of extensive debate. This is in part due to the lack of a single "gold standard" test, and the marked heterogeneity in the design of studies evaluating the accuracy of different diagnostic modalities. The goal of this review is to critically analyze the evidence cited by the proceedings of the 2013 International Consensus Meeting (ICM) on PJI with regards to the diagnosis of PJI.

Emergency Department Visits Within Thirty Days of Discharge After Primary Total Hip Arthroplasty: A Hidden Quality Measure.

Background: Thirty-day hospital readmissions following total hip arthroplasty (THA) have received increasing scrutiny by policy makers and hospitals. Emergency department (ED) visits may not necessarily result in an inpatient readmission but can be a measure of performance and can incur costs to the health system. The purpose of this study is to describe the following: (1) the frequency and subsequent disposition; (2) patient characteristics; (3) reasons; and (4) potential risk factors for ED visits that did not result in a readmission within 30 days of discharge after THA.

The Diagnostic Utility of Synovial Fluid Markers in Periprosthetic Joint Infection: A Systematic Review and Meta-analysis.

Introduction: This study is a systematic review of all reported synovial fluid markers for the diagnosis of periprosthetic joint infection and a meta-analysis of the most frequently reported markers to identify those of greatest diagnostic utility.

Methods: A search of six databases was conducted to identify all studies evaluating the utility of synovial fluid markers in the diagnosis of periprosthetic joint infection. Two observers assessed methodologic quality and extracted data independently.

The Use of Transcutaneous Electrical Nerve Stimulation After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial.

Introduction: Multimodal pain management is used after total knee arthroplasty (TKA) to reduce opioid intake. Transcutaneous electrical nerve stimulation (TENS) has generated much interest as a non-pharmacologic, patient-controlled therapy. The aims of this study were to evaluate the efficacy of TENS in reducing opioid intake and improving recovery after TKA.

The Reamer-Irrigator-Aspirator System: A Review.

The reamer-irrigator-aspirator (RIA) system has been recently developed to decrease the incidence of osseous thermal necrosis and fat embolism associated with intramedullary reaming of long bones in trauma cases. This is achieved by continuous irrigation and suction. Recently, the use of RIA has been expanded to harvest bone graft and debride the medullary canal of long bones in cases of osteomyelitis and intramedullary tumors.

Neer Award 2015: Analysis of cytokine profiles in the diagnosis of periprosthetic joint infections of the shoulder.

Background: Periprosthetic joint infection (PJI) after shoulder arthroplasty can present a diagnostic and therapeutic challenge. This study evaluated the diagnostic utility of broader synovial fluid cytokine analysis for identifying PJI in patients undergoing revision shoulder arthroplasty.

Methods: Synovial fluid levels of 9 cytokines (interleukin [IL] 6, granulocyte-macrophage colony-stimulating factor, IL-1β, IL-12, IL-2, IL-8, interferon-γ, IL-10, and tumor necrosis factor-α) were measured in 75 cases of revision shoulder arthroplasty with a multiplex immunoassay.

Synovial Cytokines and the MSIS Criteria Are Not Useful for Determining Infection Resolution After Periprosthetic Joint Infection Explantation.

Background: Diagnosing periprosthetic joint infection (PJI) requires a combination of clinical and laboratory parameters, which may be expensive and difficult to interpret. Synovial fluid cytokines have been shown to accurately differentiate septic from aseptic failed total knee (TKA) and hip (THA) arthroplasties. However, after first-stage explantation, there is still no reliable test to rule out PJI before a second-stage reimplantation procedure.

α-Defensin Accuracy to Diagnose Periprosthetic Joint Infection-Best Available Test?

Background: The purpose of this study was to test the accuracy of a single synovial fluid biomarker, α-defensin, in diagnosing periprosthetic joint infection in revision total hip and revision total knee arthroplasty.

Methods: A total of 102 patients comprising 116 revision total hip arthroplasty and revision total knee arthroplasty procedures performed between May 2013 and March 2014 were prospectively evaluated. Cases were categorized as infected or notinfected using Musculoskeletal Infection Society criteria.

Chronic Suppression of Periprosthetic Joint Infections with Oral Antibiotics Increases Infection-Free Survivorship.

Background: The clinical benefit of chronic suppression with oral antibiotics as a salvage treatment for periprosthetic joint infection is unclear. The purpose of this study was to compare infection-free prosthetic survival rates between patients who received chronic oral antibiotics and those who did not following irrigation and debridement with polyethylene exchange or two-stage revision for periprosthetic joint infection.

Methods: We reviewed the records on all irrigation and debridement procedures with polyethylene exchange and two-stage revisions performed at our institution from 1996 to 2010 for hip or knee periprosthetic joint infection.

Early Versus Late Culture Growth of Propionibacterium acnes in Revision Shoulder Arthroplasty.

Background: Propionibacterium acnes is recognized as a pathogenic organism associated with periprosthetic joint infection following shoulder arthroplasty. The goal of our study was to determine the relationship between the time to P. acnes growth in culture and the likelihood of a culture result being a true positive versus a false positive based on the proportion of positive cultures and other perioperative findings in cases of revision shoulder arthroplasty.

Bone Mesenchymal Stem Cells with Growth Factors Successfully Treat Nonunions and Delayed Unions.

Background: While the gold standard of treatment of nonunion is open autologous bone grafting, studies have shown that injecting bone marrow aspirate concentrates (BMAC) is effective in treating tibial nonunions with fracture gaps less than 5 mm.

Questions/purposes: We aim to demonstrate that combining BMAC with osteoinductive agents can effectively treat delayed or nonunion regardless of fracture gap size, nonunion site, or osteoinductive agent used.

Methods: In this non-randomized retrospective-prospective cohort study, 49 patients with tibial nonunion met the inclusion criteria and underwent BMAC injection with demineralized bone matrix (DBM) and/or recombinant human bone morphogenic protein-2 (rhBMP-2).

α-Defensin as a predictor of periprosthetic shoulder infection.

Background: Diagnosis of periprosthetic joint infection (PJI) in revision shoulder arthroplasty can be challenging because of the indolent nature of the common offending organisms. The purpose of this study was to evaluate the diagnostic utility of synovial fluid α-defensin levels in identifying PJI of the shoulder.

Methods: Thirty patients evaluated for painful shoulder arthroplasty were prospectively enrolled and underwent revision surgery (n = 33 cases).

Synovial fluid interleukin-6 as a predictor of periprosthetic shoulder infection.

Background: Diagnosis of periprosthetic joint infection (PJI) in patients undergoing revision shoulder arthroplasty is challenging because of the low virulence of the most common infecting organisms. The goal of this study was to evaluate the diagnostic utility of measuring synovial fluid interleukin-6 (IL-6) levels for identifying PJI of the shoulder.

Methods: Thirty-two consecutive patients evaluated for pain at the site of a shoulder arthroplasty were prospectively enrolled from November 2012 to September 2013 and underwent revision surgery (thirty-five procedures during which samples were obtained for synovial fluid IL-6 analysis).

Allogenic blood transfusion following total hip arthroplasty: results from the nationwide inpatient sample, 2000 to 2009.

Background: The large-scale utilization of allogenic blood transfusion and its associated outcomes have been described in critically ill patients and those undergoing high-risk cardiac surgery but not in patients undergoing elective total hip arthroplasty. The objective of this study was to determine the trends in utilization and outcomes of allogenic blood transfusion in patients undergoing primary total hip arthroplasty in the United States from 2000 to 2009.

Methods: An observational cohort of 2,087,423 patients who underwent primary total hip arthroplasty from 2000 to 2009 was identified in the Nationwide Inpatient Sample.

Unexpected positive intraoperative cultures in aseptic revision arthroplasty.

Unexpected positive intraoperative cultures (UPIC) in presumed aseptic revision arthroplasty can be difficult to interpret. The purpose of this retrospective study was to compare the incidence of subsequent periprosthetic joint infection (PJI) in patients who received antibiotic therapy according to an institutional protocol with those who did not and whether they meet Musculoskeletal Infection Society (MSIS) criteria for PJI. In patients who were treated with antibiotic according to institutional criteria, the incidence of PJI after revision was higher in those who did not meet MSIS criteria (22%) than in those that met MSIS criteria (14%; P > 0.

Glycopeptides versus β-lactams for the prevention of surgical site infections in cardiovascular and orthopedic surgery: a meta-analysis.

Objective: To compare the efficacy of glycopeptides and β-lactams in preventing surgical site infections (SSIs) in cardiac, vascular, and orthopedic surgery.

Background: The cost-effectiveness of switching from β-lactams to glycopeptides for preoperative antibiotic prophylaxis has been controversial. β-Lactams are generally recommended in clean surgical procedures, but they are ineffective against resistant gram-positive bacteria.

Serum inflammatory markers for periprosthetic knee infection in obese versus non-obese patients.

Accurate diagnosis of periprosthetic joint infection (PJI) is challenging. Most infection diagnosis criteria define elevated serum C-reactive protein (CRP) as >1.0mg/dL and erythrocyte sedimentation rate (ESR) as >30mm/hour.