RESUMEN
BACKGROUND: Open fractures are challenging due to susceptibility to Staphylococcus aureus infections. This study examines the impact of Vancomycin-Loaded Calcium Sulfate (VLCS) and negative pressure wound therapy (NPWT) on macrophage behavior in enhancing healing and infection resistance. Both VLCS and NPWT were evaluated individually and in combination to determine their effects on macrophage polarization and infection resistance in open fractures. METHODS: Through single-cell RNA sequencing, genomic expressions in macrophages from open fracture patients treated with VLCS and NPWT were compared to a control group. The analysis focused on MBD2 gene changes related to macrophage polarization. RESULTS: Remarkable modifications in MBD2 expression in the treatment group indicate a shift towards M2 macrophage polarization. Additionally, the combined treatment group exhibited greater improvements in infection resistance and healing compared to the individual treatments. This shift suggests a healing-promoting atmosphere with improved infection resilience. CONCLUSIONS: VLCS and NPWT demonstrate the ability to alter macrophage behavior toward M2 polarization, which is crucial for infection prevention in open fractures. The synergistic effect of their combined use shows even greater promise in enhancing outcomes in orthopedic trauma care.
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Sulfato de Calcio , Fracturas Abiertas , Macrófagos , Terapia de Presión Negativa para Heridas , Vancomicina , Sulfato de Calcio/administración & dosificación , Sulfato de Calcio/uso terapéutico , Terapia de Presión Negativa para Heridas/métodos , Humanos , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico , Fracturas Abiertas/terapia , Masculino , Femenino , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Persona de Mediana Edad , Infecciones Estafilocócicas/prevención & control , Adulto , Cicatrización de Heridas/efectos de los fármacos , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Infection after implant-based breast reconstruction remains challenging, with infection rates up to 24%. Best clinical practice indicates prophylactic oral antibiotics are ineffective at preventing infection. Absorbable antibiotic beads have been routinely used in other surgical subspecialties such as orthopedic and vascular procedures for continuous local antibiotic delivery to the surgical site when implants are placed. Biodegradable calcium sulfate antibiotic beads have been shown to normalize incidence of infection when used prophylactically for a high-risk prepectoral patient population. The purpose of this study is to evaluate the effect of prophylactic biodegradable antibiotic beads when used non-selectively for all prepectoral immediate tissue expander (TE) reconstruction. Patients who underwent mastectomy and immediate prepectoral TE reconstruction on the same day between 2018 and 2024 were reviewed. Patients were divided into two groups: those who received antibiotic beads (Group 1) and those who did not (Group 2). Absorbable calcium-sulfate beads were reconstituted with 1 g vancomycin and 240 mg gentamicin. There were 33 patients (63 TEs) in Group 1 and 330 patients (545 TEs) in Group 2. TE loss was present in 1.5% (1/65 TEs) Group 1 compared to 9.4% (51/545 TEs) in Group 2 (p = 0.032). The mean follow-up time was 178 days (range 93-266 days). Prophylactic biodegradable antibiotic beads used during immediate tissue expander reconstruction decreased implant loss rate. There was one occurrence of SSI in the antibiotic bead group. Antibiotic beads may potentially decrease complications in immediate TE reconstruction when used non-selectively for all patients.
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Implantes Absorbibles , Antibacterianos , Profilaxis Antibiótica , Gentamicinas , Humanos , Femenino , Persona de Mediana Edad , Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Gentamicinas/administración & dosificación , Estudios Retrospectivos , Implantes de Mama/efectos adversos , Mastectomía , Sulfato de Calcio/administración & dosificación , Implantación de Mama/métodos , Implantación de Mama/efectos adversos , Vancomicina/administración & dosificación , Adulto , Neoplasias de la Mama/cirugía , Infección de la Herida Quirúrgica/prevención & control , Dispositivos de Expansión Tisular , Expansión de Tejido/métodos , Expansión de Tejido/instrumentación , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Relacionadas con Prótesis/etiología , Mamoplastia/métodosRESUMEN
BACKGROUND: Tooth extraction procedures often lead to bone resorption, which can have adverse effects on the dimensions of the alveolar ridge. Research has shown that socket preservation techniques using bone graft substitutes can effectively minimize early bone loss in such cases. α-calcium sulfate hemihydrate (α-CSH) has garnered significant attention as a potential bone graft material due to its favorable properties, including osteoconductivity, angiogenic potential, and biocompatibility. Considering these facts, we developed a preliminary protocol for applying α-CSH in addressing alveolar bone loss following tooth extraction. OBJECTIVE: This research's general objective is to evaluate the feasibility and initial effectiveness of α-CSH as bone-inducing graft material for socket preservation after tooth extraction. METHODS: This preliminary clinical trial will involve 30 fresh extraction sockets from individuals aged 18-35 years. The participants will be divided into 2 groups: one group will receive α-CSH graft material after tooth extraction for socket preservation, while the other group will not receive any graft material. Throughout the study, the participants will be closely monitored for safety measures, which will include clinical examinations, radiographic imaging, and blood tests. Radiographic imaging will be used extensively to assist the progress of bone formation. RESULTS: The study commenced enrollment in August 2022 and is scheduled to conclude post assessments and analyses by the end of 2023. The results of the study are anticipated to be accessible in late 2024. CONCLUSIONS: This clinical study represents the initial investigation in humans to assess the feasibility and efficacy of α-CSH in alveolar bone regeneration. We hypothesize that the inclusion of α-CSH can greatly expedite the process of bone formation within fresh sockets, resulting in a swift restoration of bone height without the disadvantages associated with harvesting autogenous bone graft. TRIAL REGISTRATION: Indonesia Registry Center INA-D02FAHP; https://tinyurl.com/2jnf6n3s. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49922.
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Sulfato de Calcio , Estudios de Factibilidad , Extracción Dental , Alveolo Dental , Adolescente , Adulto , Femenino , Humanos , Masculino , Adulto Joven , Pérdida de Hueso Alveolar/prevención & control , Pérdida de Hueso Alveolar/cirugía , Sustitutos de Huesos/uso terapéutico , Sulfato de Calcio/uso terapéutico , Sulfato de Calcio/administración & dosificación , Proyectos Piloto , Extracción Dental/efectos adversos , Extracción Dental/métodos , Alveolo Dental/cirugía , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Flue Gas Desulfurization (FGD) gypsum is a byproduct of the coal-fired power plant process commonly used to remove sulfur dioxide emissions from the flue gas. FGD gypsum has numerous industrial, agricultural, and environmental applications. This study aimed to explore a novel approach involving the use of FGD gypsum combined with different litter treatments as bedding for broiler production. It focused on performance metrics, including adjusted feed conversion ratio (AFCR) and average body weight (BW), foot pad dermatitis (FPD), and fear response over 5 consecutive flocks. A total of 1,800 one-day-old Ross 708 chicks were randomly assigned to 24 pens (75 birds/pen), divided into 6 treatment groups (4 pens/treatment), with 5 replications and raised until 42 d old (d). Treatments were gypsum that was decaked (D), rotovated (E), and rotovated then windrowed (F) between flocks. Control treatments using pine shavings were decaked (A), rotovated (B), and windrowed postrotovating (C). AFCR, average BW, and mortality were used as a measure of production. Foot pad dermatitis scores were taken on d42 using a scale of 0 (absence), 1 (mild), and 2 (severe). Response to observer and human approach test were used to measure fear response. Data were analyzed as a 2-way ANOVA (Proc Glimmix) for the main effects of bedding type and litter treatment. Means were identified using Tukey's HSD. No effect of bedding type or litter treatment was found for AFCR, BW, or mortality. FPD scores 2 and 1, were higher with pine shavings than gypsum (P = 0.01 and P = 0.01, respectively). While FPD scores 0 were higher for gypsum than the pine shaving (P = 0.01). No difference in fear response was found among birds raised on any of the gypsum litter treatments and any of the pine shaving litter treatments. Overall, the use of gypsum as bedding results in equivalent production and fear response to pine shavings, while increasing FPD quality when compared to pine shaving.
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Sulfato de Calcio , Pollos , Miedo , Enfermedades del Pie , Vivienda para Animales , Enfermedades de las Aves de Corral , Animales , Pollos/fisiología , Sulfato de Calcio/química , Sulfato de Calcio/administración & dosificación , Sulfato de Calcio/farmacología , Enfermedades del Pie/veterinaria , Pisos y Cubiertas de Piso , Distribución Aleatoria , Masculino , Crianza de Animales Domésticos/métodos , Dermatitis/veterinariaRESUMEN
BACKGROUND: Neuromuscular and syndromic (NMS) scoliosis patients are at higher risk of acute surgical site infections (SSIs). Despite following POSNA's endorsed consensus-based guidelines for SSI prevention, our institutional rates of acute SSI have varied dramatically. This variability drove simultaneous strategies to lower SSI rates: the creation of a preoperative Medical Optimization Clinic (MOC) and use of antibiotic-impregnated (Abx-I) calcium sulfate beads. METHODS: Patients undergoing index PSF at a single institution between 2016 and 2022 were retrospectively reviewed. Patients with ≥ 2 risk factors were included: (1) BMI < 18.5 or > 25; (2) incontinence; (3) instrumentation to pelvis; (4) non-verbal; (5) GMFCS IV/V. SSI was defined as deep infection within 90 days. We compared patients who attended MOC and received Abx-I (MOC + Abx-I) to those receiving neither intervention (control) nor a single intervention. RESULTS: 282 patients were included. The overall infection rate was 4.26%. Higher GMFCS (p = 0.0147), non-verbal status (p = 0.0048), and longer fusions (p = 0.0298) were independently associated with infection rate. Despite the MOC + Abx-I group having larger Cobb angles (88° ± 26°), higher GMFCS levels (4.5 ± 0.9), ASA class (3 ± 0.4), and more frequent instrumentation to the pelvis (85%), they had the lowest infection rate (2.13%) when compared to the control (4.2%) or single intervention groups (5.7%, 4.6%) (p = 0.9). CONCLUSION: The study examined the modern infection rate of NMS patients following the implementation of two interventions: MOC and Abx-I. Despite having higher risk factors (curves (88°), GMFCS level (4.5), ASA class (3), higher % instrumentation to the pelvis (85%)), the patients treated with both interventions demonstrated the lowest infection rate (2.13%).
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Antibacterianos , Sulfato de Calcio , Escoliosis , Infección de la Herida Quirúrgica , Humanos , Escoliosis/cirugía , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/epidemiología , Femenino , Masculino , Antibacterianos/administración & dosificación , Estudios Retrospectivos , Niño , Adolescente , Sulfato de Calcio/administración & dosificación , Factores de Riesgo , Fusión Vertebral/métodos , Fusión Vertebral/efectos adversos , Cuidados Preoperatorios/métodos , Profilaxis Antibiótica/métodosRESUMEN
Non-unions continue to present a challenge to trauma surgeons, as current treatment options are limited, duration of treatment is long, and the outcome often unsatisfactory. Additionally, standard treatment with autologous bone grafts is associated with comorbidity at the donor site. Therefore, alternatives to autologous bone grafts and further therapeutic strategies to improve on the outcome and reduce cost for care providers are desirable. In this study in Sprague-Dawley rats we employed a recently established sequential defect model, which provides a platform to test new potential therapeutic strategies on non-unions while gaining mechanistic insight into their actions. The effects of a combinatorial treatment of a bone graft substitute (HACaS+G) implantation and systemic PTH administration was assessed by µ-CT, histological analysis, and bio-mechanical testing and compared to monotreatment and controls. Although neither PTH alone nor the combination of a bone graft substitute and PTH led to the formation of a stable union, our data demonstrate a clear osteoinductive and osteoconductive effect of the bone graft substitute. Additionally, PTH administration was shown to induce vascularization, both as a single adjuvant treatment and in combination with the bone graft substitute. Thus, systemic PTH administration is a potential synergistic co-treatment to bone graft substitutes.
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Sustitutos de Huesos/administración & dosificación , Fracturas no Consolidadas/terapia , Neovascularización Fisiológica/efectos de los fármacos , Hormona Paratiroidea/administración & dosificación , Animales , Antígenos CD/metabolismo , Antígenos de Diferenciación Mielomonocítica/metabolismo , Regeneración Ósea/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Sustitutos de Huesos/farmacología , Trasplante Óseo , Sulfato de Calcio/administración & dosificación , Sulfato de Calcio/farmacología , Terapia Combinada , Combinación de Medicamentos , Durapatita/administración & dosificación , Durapatita/farmacología , Fracturas del Fémur/terapia , Gentamicinas/administración & dosificación , Gentamicinas/farmacología , Receptores de Lipopolisacáridos/metabolismo , Ratas , Ratas Sprague-DawleyRESUMEN
This study evaluated the biocompatibility and biological performance of novel additive-manufactured bioabsorbable iron-based porous suture anchors (iron_SAs). Two types of bioabsorbable iron_SAs, with double- and triple-helical structures (iron_SA_2_helix and iron_SA_3_helix, respectively), were compared with the synthetic polymer-based bioabsorbable suture anchor (polymer_SAs). An in vitro mechanical test, MTT assay, and scanning electron microscope (SEM) analysis were performed. An in vivo animal study was also performed. The three types of suture anchors were randomly implanted in the outer cortex of the lateral femoral condyle. The ultimate in vitro pullout strength of the iron_SA_3_helix group was significantly higher than the iron_SA_2_helix and polymer_SA groups. The MTT assay findings demonstrated no significant cytotoxicity, and the SEM analysis showed cells attachment on implant surface. The ultimate failure load of the iron_SA_3_helix group was significantly higher than that of the polymer_SA group. The micro-CT analysis indicated the iron_SA_3_helix group showed a higher bone volume fraction (BV/TV) after surgery. Moreover, both iron SAs underwent degradation with time. Iron_SAs with triple-helical threads and a porous structure demonstrated better mechanical strength and high biocompatibility after short-term implantation. The combined advantages of the mechanical superiority of the iron metal and the possibility of absorption after implantation make the iron_SA a suitable candidate for further development.
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Implantes Absorbibles , Materiales Biocompatibles , Anclas para Sutura , Alanina Transaminasa/sangre , Animales , Materiales Biocompatibles/química , Materiales Biocompatibles/toxicidad , Fenómenos Biomecánicos , Nitrógeno de la Urea Sanguínea , Fosfatos de Calcio/química , Fosfatos de Calcio/toxicidad , Sulfato de Calcio/administración & dosificación , Sulfato de Calcio/química , Sulfato de Calcio/toxicidad , Creatinina/sangre , Diseño de Equipo , Fémur/diagnóstico por imagen , Fémur/ultraestructura , Hierro , Rayos Láser , Ensayo de Materiales , Microscopía Electrónica de Rastreo , Estructura Molecular , Oseointegración , Polímeros/química , Polímeros/toxicidad , Porosidad , Conejos , Distribución Aleatoria , Resistencia a la Tracción , Vísceras , Microtomografía por Rayos XRESUMEN
Yearling Angus bulls (n = 36) were assigned one of three diets: 1) 60 % concentrate as corn (CON, 0.2 % S, 13.4 % CP; n = 12); 2) 60 % dried corn distiller's grains plus solubles (60DDGS 0.5 % S, 22.0 % CP; n = 12); 3) CON diet + equivalent sulfur of 60DDGS as CaSO4 (SULF, 0.5 % S, 13.9 % CP; n = 12) to evaluate effects of feeding 60 % DDGS or sulfur as CaSO4 on mineral and metabolite concentrations in serum and seminal plasma. Treatment × day interactions (P < 0.03) were observed for serum Cu, Se, and Mo. For Cu at d 112, lesser (P < 0.01) concentrations were observed in bulls fed the 60DDGS compared to SULF and CON diets. There were greater (P < 0.01) concentrations of Se at d 112 in bulls fed 60DDGS than CON and SULF diets. Concentrations of Mo were greater at d 56 and 112 (P < 0.01) in bulls fed CON compared to SULF and 60DDGS diets. In seminal plasma, there were treatment × day interactions (P < 0.02) for Cu and Mo. For Cu, at d 112, there was a lesser (P < 0.01) concentration in the bulls fed SULF compared to CON and 60DDGS diets. For Mo, there was a greater (P < 0.01) concentration in bulls fed the CON than 60DDGS and SULF diets at d 56 and 112. Changes in mineral and metabolite concentrations may have effects on bull reproductive performance when there is a relatively greater dietary sulfur content.
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Alimentación Animal/análisis , Sulfato de Calcio/administración & dosificación , Bovinos , Dieta/veterinaria , Minerales/sangre , Semen/química , Aminoácidos/química , Aminoácidos/metabolismo , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Sulfato de Calcio/farmacología , Suplementos Dietéticos , Glucosa/química , Glucosa/metabolismo , Masculino , Minerales/metabolismo , Urea/metabolismo , Zea maysRESUMEN
OBJECTIVE: To report the outcomes and complications associated with antibiotic-impregnated calcium sulfate beads for prevention and treatment of orthopedic-related surgical site infection (SSI) in companion animals. STUDY DESIGN: Retrospective case series. ANIMALS: Client-owned cats (n = 2) and dogs (n = 14). METHODS: Medical records of 16 cases in which implantation of antibiotic-impregnated calcium sulfate beads was performed for the prevention or treatment of SSI were reviewed. Information collected included signalment, prior surgery, reason for bead placement, antibiotics used, bacterial culture results, and clinical outcomes. RESULTS: Surgical site infection resolved in six of 10 animals treated therapeutically and did not occur in six of six animals treated prophylactically. Susceptibility of the causative bacteria to the antibiotic implanted was confirmed in five of six cases with resolved SSI treated therapeutically but in only one of four cases with unresolved SSI treated therapeutically. Complications directly related to bead placement were evident in only one case in which beads extruded from external skeletal fixator pin tracts 7 days after implantation. At final follow-up, 11 of 12 animals without SSI had satisfactory limb use and no clinical, cytologic, or radiographic evidence of infection. CONCLUSION: Implantation was well tolerated. Resolution of SSI was inconsistent; however, when bacteria were susceptible to the antibiotic implanted, SSI resolved in all but one case. CLINICAL SIGNIFICANCE: Antibiotic-impregnated calcium sulfate beads could be considered for prevention or treatment of orthopedic SSI in small animals. A prospective clinical study is required to obtain additional information, including the value of preoperative bacterial culture.
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Antibacterianos/uso terapéutico , Sulfato de Calcio/uso terapéutico , Enfermedades de los Gatos/prevención & control , Enfermedades de los Perros/prevención & control , Microesferas , Infección de la Herida Quirúrgica/veterinaria , Animales , Antibacterianos/administración & dosificación , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/veterinaria , Sulfato de Calcio/administración & dosificación , Gatos , Perros , Femenino , Masculino , Procedimientos Ortopédicos/veterinaria , Estudios Retrospectivos , Infección de la Herida Quirúrgica/prevención & controlRESUMEN
Prepackaged natural cheese shreds are a growing consumer category. Anticake agents are applied to commercial cheese shreds to assist with shelf life and ease of use. The objective of this study was to investigate consumer perception of 3 anticake agents applied at various levels to Cheddar cheese shreds. Three common anticake agents (80% potato starch/20% cellulose blend, 100% potato starch, or potato starch/corn starch/calcium sulfate blend) were applied to duplicate lots of Cheddar cheese shreds at 1, 2, 3, 4, and 5% (wt/wt). Control Cheddar cheese shreds with no anticake were also included. Sensory properties (appearance, flavor, texture, and hot texture) were documented using a trained sensory panel (n = 8), and 3 consumer acceptance tests were also conducted. In test 1, consumers (n = 110) visually evaluated liking of cold shred appearance. In test 2, consumers (n = 100) evaluated melted shreds on a flour tortilla for overall liking and appearance, flavor, and texture liking. In test 3, consumers (n = 49) participated in a home usage test. Two-way ANOVA (anticake × anticake application rate) was used to interpret the collected data from each test. Visual appearance of shreds was the primary attribute influenced by anticake application and anticake agent. Trained panel evaluation demonstrated that the 100% potato starch anticake had minimal effects on visual appearance. The other 2 agents (80% potato starch/20% cellulose blend and potato starch/corn starch/calcium sulfate blend) showed increases in visible powder at >3% (wt/wt). Consistent with results from trained panelists, higher application rates decreased consumer appearance and color liking for Cheddar shreds with 80% potato starch/20% cellulose and potato starch/corn starch/calcium sulfate blends at >2 or 3% (wt/wt), respectively. Appearance liking of melted shreds decreased with increased anticake application percent but decreased the most for 100% potato starch anticake at greater than 1% (wt/wt) application. Overall liking, flavor liking, and texture liking attributes for melted shreds were negatively affected at >3% (wt/wt) application regardless of anticake agent used. In general, anticake agents can be applied to Cheddar cheese shreds at up to 3% (wt/wt) with minimal effect on consumer perception.
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Queso/análisis , Comportamiento del Consumidor , Aditivos Alimentarios/administración & dosificación , Manipulación de Alimentos/métodos , Análisis de Varianza , Animales , Sulfato de Calcio/administración & dosificación , Color , Aromatizantes , Humanos , Sensación , Solanum tuberosum/química , Almidón/administración & dosificación , Zea mays/químicaRESUMEN
BACKGROUND: The purpose of this study was to evaluate the clinical and radiologic outcome of chronic hematogenous osteomyelitis (CHOM) in children, treated with single-stage debridement and dead space management using antibiotic impregnated calcium sulphate pellets. METHODS: The authors retrospectively evaluated a consecutive series of 34 patients who presented with CHOM from 2011 to 2017. In each case, CHOM was classified according to the Beit CURE classification. Following thorough surgical debridement, the resulting dead space in the bone was filled with the antibiotic impregnated beads before primary closure. RESULTS: Of the 31 patients available for follow up, effective regeneration of bone was confirmed in all cases, with radiographic bone healing typically observed at around 12 weeks. None of the children required reoperation for infection and none had recurrence of infection at the time of final review. The beads were completely absorbed within 3 months. No systemic adverse reactions to the local delivery of antibiotics were observed in this study. CONCLUSIONS: The authors found that single-stage debridement in conjunction with antibiotic impregnated calcium sulphate was an effective means of treating CHOM in children, with effective eradication of infection in every case. LEVEL OF EVIDENCE: Level IV-Retrospective case series. See instructions for authors for a complete description of levels of evidence.
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Antibacterianos/uso terapéutico , Sulfato de Calcio/uso terapéutico , Desbridamiento , Osteomielitis/tratamiento farmacológico , Antibacterianos/administración & dosificación , Sulfato de Calcio/administración & dosificación , Niño , Preescolar , Composición de Medicamentos , Femenino , Humanos , Lactante , Masculino , Osteomielitis/sangre , Osteomielitis/diagnóstico por imagen , Estudios Retrospectivos , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
SUMMARY: In single-stage hernia repair in the setting of contaminated fields there is a high rate of infection following mesh repair. New strategies to decrease infection in this challenging patient population are needed. Stimulan calcium sulfate antibiotic beads (CSAB) are a biodegradable material that deliver high concentrations of antibiotics locally to a site of insertion. Their use in the prevention of infection has not been described in hernia graft implantation. Here we describe our use of CSAB in a series of 11 patients with modified Ventral Hernia Working Group class III and Centers for Disease Control and Prevention class II-IV wounds undergoing single-stage incisional ventral hernia repair. We found that implantation of CSAB in single-stage hernia repair in the setting of contaminated fields was feasible with low systemic antibiotic levels. Further research should be undertaken to investigate the efficacy of this novel tool in hernia repair.
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Antibacterianos/administración & dosificación , Sulfato de Calcio/administración & dosificación , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Infección de la Herida Quirúrgica/prevención & control , Anciano , Animales , Estudios de Factibilidad , Femenino , Gentamicinas/administración & dosificación , Herniorrafia/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiología , Porcinos , Andamios del Tejido , Resultado del Tratamiento , Vancomicina/administración & dosificaciónRESUMEN
BACKGROUND: Ventricular assist devices driveline infections are common, recalcitrant, and carry high morbidity and mortality. Herein, we reported a patient with driveline infection that was successfully treated with a combination of systemic antibiotics, surgical debridement, and instillation of absorbable antibiotic beads to the wound bed. METHODS AND RESULTS: A 39-year-old man with nonischemic cardiomyopathy underwent insertion of a continuous flow left ventricular assist device. Four years postoperatively, the patient presented with clinical, laboratory, and radiologic signs of driveline tract infection. He underwent extensive surgical debridement, installation of absorbable antibiotic beads that consisted of calcium sulfate, vancomycin, and tobramycin, into the wound bed, and systemic antibiotics. The patient was free of infection 9 month postoperatively. CONCLUSION: Absorbable calcium sulfate antibiotic beads may serve as a beneficial adjunct to surgical debridement and systemic antibiotics for the treatment of ventricular assist device driveline infection, and merit further investigation.
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Antibacterianos/administración & dosificación , Cardiomiopatías/terapia , Quimioterapia Adyuvante/métodos , Corazón Auxiliar/efectos adversos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Infecciones Relacionadas con Prótesis/etiología , Adulto , Sulfato de Calcio/administración & dosificación , Cefadroxilo/administración & dosificación , Cefazolina/administración & dosificación , Desbridamiento , Formas de Dosificación , Quimioterapia Combinada , Humanos , Masculino , Infecciones Relacionadas con Prótesis/microbiología , Staphylococcus aureus , Tobramicina/administración & dosificación , Resultado del Tratamiento , Vancomicina/administración & dosificaciónRESUMEN
Unicameral bone cyst (UBC) is a benign fluid-filled lesion, mainly located in the metaphyses of long bones in children and adolescents. Elastic stable intramedullary nail (ESIN) is adopted in our institute for UBCs since 2010, and bone grafting was performed simultaneously. This study aims to evaluate the efficacy of ESIN decompression combined with different bone graft materials.All patients with the diagnoses of UBCs of the humerus, treated with ESINs and bone grafting between January 2010 and June 2018, were analyzed retrospectively. The bone grafting included injectable calcium sulfate, a mixture of the autologous iliac bone and allogeneic bone. All patients were categorized into 2 groups: ICS (injectable calcium sulfate) group and MIX (a mixture of the autologous iliac bone and allogeneic bone, ratio: 1:3) group. All the information was collected from the Hospital Database.In all, 17 patients (8.8â±â2.3-year-old, male 8, female 9) in the ICS group and 19 patients (8.9â±â1.9-year-old, male 10, female 9) in the MIX group were included in this study. Patients in both groups were followed up for more than 2 years (average, 3.4â±â1.3 years). No recurrence was observed in either group. There was no significant difference between the two groups concerning the patient's demographic parameters, including sex, age, and affected side. All patients in both groups displayed excellent and good shoulder function, and there was no significant difference between the 2 groups (Pâ=â.29). As for the Capanna classification, there was no significant difference between these 2 groups (Pâ=â.78).Intramedullary nailing has the advantage of a minimally invasive procedure, immediate stability, and continuous decompression. ICS showed similar results as a mixture of the autologous iliac bone and allogeneic bone.
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Quistes Óseos/cirugía , Trasplante Óseo/métodos , Fijación Intramedular de Fracturas/instrumentación , Trasplante Homólogo/métodos , Quistes Óseos/complicaciones , Clavos Ortopédicos , Sulfato de Calcio/administración & dosificación , Niño , Descompresión Quirúrgica/métodos , Femenino , Fracturas Espontáneas/etiología , Fracturas Espontáneas/prevención & control , Humanos , Húmero/lesiones , Húmero/patología , Húmero/cirugía , Ilion/trasplante , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Background and purpose - The successful eradication of calcaneus infection with limb salvage remains a challenge. We describe the outcomes of cortical bone windowing followed by eggshell-like debridement and implantation of antibiotic-loaded calcium sulphate (CS) for localized (Cierny-Mader type III) calcaneal osteomyelitis (CO).Patients and methods - We report a retrospective study of 34 patients. Infection followed trauma or orthopedic surgery in 30 patients and hematogenous spread in 4 patients. 31 patients had a sinus tract, accompanied by a soft tissue defect in 3 patients. All patients received cortical bone windowing, debridement, multiple sampling, local implantation of vancomycin- and gentamicin-loaded CS, skin closure or flap coverage, and culture-specific systematic antibiotic treatment in a single-stage procedure. Patients were followed up for a median of 26 months.Results - Infection was eradicated in 29 patients after the single-stage surgery, and all of the 5 recurrent infections were cleared by repeated surgery without amputation. Other adverse events included 11 patients with aseptic wound leakage and 1 unrelated death. Compared with those before surgery, the median postoperative scores of the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot scale (65 vs. 86 vs. 89) and the visual analog scale (VAS) for pain (6 vs. 3 vs. 1) improved at the 1-year and 2-year follow-up.Interpretation - This single-stage protocol, cortical bone windowing, and eggshell-like debridement combined with local implantation of antibiotic-loaded CS is effective in treating type III CO. However, the incidence of aseptic wound leakage is high.
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Antibacterianos/administración & dosificación , Calcáneo/cirugía , Sulfato de Calcio/administración & dosificación , Desbridamiento/métodos , Osteomielitis/cirugía , Vehículos Farmacéuticos/administración & dosificación , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Calcáneo/patología , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/tratamiento farmacológico , Osteomielitis/patología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Local antibiotic delivery systems with differing chemical and mechanical properties have been developed to assist in the management of osteomyelitis. We investigated the bone conductive and resorptive capabilities of a calcium phosphate-calcium sulfate (CaP/CaS) composite compared with commercially available polymethylmethacrylate (PMMA). In addition, we compared the in vivo preventative and treatment efficacies of both biomaterials in a proven osteomyelitis model. METHODS: Sixty-four, male Sprague-Dawley rats were inoculated with 10 µl of 1.5 x 108 CFU/ml of Staphylococcus aureus in a surgically drilled defect in the right proximal tibia. Infected animals were randomly allocated into prevention and treatment groups with 32 rats each. In the prevention group, the defect was filled with a plug containing either PMMA or CaP/CaS immediately after the inoculation. In the treatment group, the infected defects were irrigated, debrided, and filled with either a PMMA or CaP/CaS plug. Both CaP/CaS and PMMA were impregnated with 10% weight of vancomycin. Rats were sacrificed 6 weeks after cement insertion. Infection was detected by bacterial culture and histological analysis. Bone formation in the defect was assessed with micro-computed tomography and histology. RESULTS: No bacteria were detected in any group. Both the prevention and treatment groups using CaP/CaS had significantly more bone volume fraction, bone area, and cartilage area than the PMMA groups. CONCLUSIONS: When loaded with 10% of vancomycin, CaP/CaS and PMMA have the same efficacy for treatment and prevention of osteomyelitis. CaP/CaS enhances bone defect healing through improved bone remodeling in our osteomyelitis rat model.
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Fosfatos de Calcio/administración & dosificación , Sulfato de Calcio/administración & dosificación , Osteomielitis/tratamiento farmacológico , Polimetil Metacrilato/administración & dosificación , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/administración & dosificación , Animales , Materiales Biocompatibles/administración & dosificación , Materiales Biocompatibles/farmacología , Fosfatos de Calcio/farmacología , Sulfato de Calcio/farmacología , Modelos Animales de Enfermedad , Humanos , Masculino , Osteogénesis/efectos de los fármacos , Osteomielitis/diagnóstico por imagen , Osteomielitis/microbiología , Osteomielitis/prevención & control , Polimetil Metacrilato/farmacología , Distribución Aleatoria , Ratas , Ratas Sprague-Dawley , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico por imagen , Infecciones Estafilocócicas/prevención & control , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Resultado del Tratamiento , Vancomicina/química , Vancomicina/farmacología , Microtomografía por Rayos XRESUMEN
BACKGROUND: Large segmental bone defects can be repaired using the Masquelet technique in conjunction with autologous cancellous bone (ACB). However, ACB harvesting is severely restricted. α-calcium sulfate hemihydrate (α-CSH) is an outstanding bone substitute due to its easy availability, excellent biocompatibility, biodegradability, and osteoconductivity. However, the resorption rate of α-CSH is too fast to match the rate of new bone formation. The objective of this study was to investigate the bone repair capacity of the Masquelet technique in conjunction with isolated α-CSH or an α-CSH/ACB mix in a rabbit critical-sized defect model. METHODS: The rabbits (n = 28) were randomized into four groups: sham, isolated α-CSH, α-CSH/ACB mix, and isolated ACB group. A 15-mm critical-sized defect was established in the left radius, followed by filling with polymethyl methacrylate spacer. Six weeks after the first operation, the spacers were removed and the membranous tubes were grafted with isolated α-CSH, isolated ACB, α-CSH/ACB mix, or none. Twelve weeks later, the outcomes were evaluated by manual assessment, radiography, and spiral-CT. The histopathological and morphological changes were examined by H&E staining. The levels of alkaline phosphatase and osteocalcin were analyzed by immunohistochemistry and immunofluorescence staining. RESULTS: Our results suggest that the bone repair capacity of the α-CSH/ACB mix group was similar to the isolated ACB group, while the isolated α-CSH group was significantly decreased compared to the isolated ACB group. CONCLUSION: These results highlighted a promising strategy in the healing of large segmental bone defect with the Masquelet technique in conjunction with an α-CSH/ACB mix (1:1, w/w) as they possessed the combined effects of sufficient supply and low resorption.
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Sustitutos de Huesos/administración & dosificación , Sulfato de Calcio/administración & dosificación , Procedimientos de Cirugía Plástica/métodos , Radio (Anatomía)/lesiones , Radio (Anatomía)/cirugía , Animales , Masculino , Conejos , Radio (Anatomía)/diagnóstico por imagenRESUMEN
BACKGROUND: Managing with diabetic foot osteomyelitis (DFO) is challenging. Even after infective bone resection and thorough debridement, DFO is still difficult to cure and has a high recurrence rate. This retrospective study aims to compare the outcomes of two treatment methods, infected bone resection combined with adjuvant antibiotic-impregnated calcium sulfate and infected bone resection alone, for the treatment of diabetic foot osteomyelitis. METHODS: Between 2015 to 2017, 48 limbs (46 patients) with DFO met the criteria were included for assessment. 20 limbs (18 patients) were included in the calcium sulfate group (the CS group) in which vancomycin and/or gentamicin-impregnated calcium sulfate was used as an adjuvant after infected bone resection while 28 limbs (28 patients) as the control group were undergone infected bone resection only. Systemic antibiotics, postoperative wound care and offloading were continued to be applied following surgery in both groups. The time to healing, healing rate, recurrence rate and amputation rate were compared between the two groups. RESULTS: In total, 90% (18/20) limbs in the CS group as compared to 78.6% (22/28) infected limbs in the control group went to heal (P = 0.513). The Mean time to healing was 13.3 weeks in the CS group and 11.2 weeks in control group (P = 0.132). Osteomyelitis recurrence rate was 0% (0/18) in the CS group and 36.4% (8/22) in the control group (P = 0.014). Postoperative leakage in calcium sulfate group was 30.0% (6/20) with a mean duration of 8.5 weeks. Amputation rate in the control group was 7.1% (2/28) compared to 0% (0/20) in the CS group (P = 0.153). CONCLUSIONS: Antibiotic-impregnated calcium sulfate as an adjuvant prevents the recurrence of DFO but cannot improve the healing rate, reduce the postoperative amputation rate or shorten the time to healing. Prolonged postoperative leakage as the most common complication can be managed with regular dressing. LEVEL OF EVIDENCE: III, Retrospective Comparative Study.
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Antibacterianos/administración & dosificación , Sustitutos de Huesos/administración & dosificación , Pie Diabético/terapia , Osteomielitis/terapia , Osteotomía/métodos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Amputación Quirúrgica/estadística & datos numéricos , Sustitutos de Huesos/química , Sulfato de Calcio/administración & dosificación , Terapia Combinada , Pie Diabético/complicaciones , Femenino , Pie , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/etiología , Osteotomía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Cicatrización de Heridas/efectos de los fármacosRESUMEN
The addition of fat and calcium sulfate to diets fed to ruminants has resulted in a reduction in methane production, but the effects on energy balance have not been studied. A study using indirect calorimetry and 16 multiparous (8 Holstein and 8 Jersey; 78 ± 15 d in milk; mean ± standard deviation) lactating dairy cows was conducted to determine how mitigating methane production by adding corn oil or calcium sulfate to diets containing reduced-fat distillers grains affects energy and nitrogen balance. A replicated 4 × 4 Latin square design with 35-d periods (28 d of adaption and 4 d of collections) was used to compare 4 different dietary treatments. Treatments were composed of a control (CON) diet, which did not contain reduced-fat distillers grain and solubles (DDGS), and treatment diets containing 20% (dry matter basis) DDGS (DG), 20% DDGS with 1.38% (dry matter basis) added corn oil (CO), and 20% DDGS with 0.93% (dry matter basis) added calcium sulfate (CaS). Compared with CON, dry matter intake was not affected by treatment, averaging 29.6 ± 0.67 kg/d. Milk production was increased for diets containing DDGS compared with CON (26.3 vs. 27.8 ± 0.47 kg/d for CON vs. DDGS, respectively), likely supported by increased energy intake. Compared with CON, energy-corrected milk was greater in DG and CO (30.1 vs. 31.4, 31.7, and 31.0 ± 0.67 kg/d for CON, DG, CO, and CaS, respectively). Compared with CON, the addition of calcium sulfate and corn oil to diets containing DDGS reduced methane production per kg of dry matter intake (22.3, 19.9, and 19.6 ± 0.75 L/kg per d for CON, CO, and CaS, respectively). Similarly, methane production per kilogram of energy-corrected milk was reduced with the addition of calcium sulfate and corn oil to diets containing DDGS (14.2, 12.5, and 12.4 ± 0.50 L/kg per d for CON, CO, and CaS, respectively). Compared with CON and CaS, the intake of digestible energy was greater for DG and CO treatments (57.7, 62.1, 62.0, and 59.0 ± 1.38 Mcal/d for CON, DG, CO, and CaS, respectively). Intake of metabolizable energy was greater in all treatments containing DDGS compared with CON (50.5 vs. 54.0 ± 1.08 Mcal/d for CON vs. DDGS, respectively). Net balance (milk plus tissue energy) per unit of dry matter was greater in CO (containing DDGS and oil) than CON (1.55 vs. 1.35 ± 0.06 Mcal/kg for CO vs. CON, respectively). Tissue energy was greater in DG and CO compared with CON (6.08, 7.04, and 3.16 ± 0.99 Mcal/d for DG, CO, and CON, respectively. Results of this study suggest that the addition of oil and calcium sulfate to diets containing DDGS may be a viable option to reduce methane production and in the case of oil also improve net energy balance in lactating dairy cows.
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Sulfato de Calcio/metabolismo , Bovinos/fisiología , Aceite de Maíz/metabolismo , Metabolismo Energético , Metano/metabolismo , Nitrógeno/análisis , Alimentación Animal/análisis , Animales , Sulfato de Calcio/administración & dosificación , Aceite de Maíz/administración & dosificación , Industria Lechera , Dieta/veterinaria , Suplementos Dietéticos/análisis , Ingestión de Energía , Femenino , Distribución AleatoriaRESUMEN
OBJECTIVE: To present our technique and early results using the Masquelet technique. DESIGN: Retrospective cohort study. PATIENTS/PARTICIPANTS: Thirteen patients with 14 open fractures of the femur and tibia were included between November 2013 and December 2014. INTERVENTION: A Masquelet technique was used to manage the open fractures. MAIN OUTCOME MEASURE: Infection and union rate. RESULTS: The mean follow-up was 17 months. The mean bone defect was 56.6 mm. Eight fractures (57.1%) progressed to union at an average of 42.1 weeks. Infection developed in 3 fractures (21.4%). Overall, the induced membrane technique was abandoned in 5 (35.7%) cases. CONCLUSIONS: The induced membrane technique showed a substantial rate of failure in the acute trauma setting in the lower limb. In the absence of sound published evidence, the authors now use the technique in selected cases only. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.