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Wu H, Wang X, Shen J, Wei Z, Wang S, Xu T, Luo F, Xie Z. Clinical characteristics and outcomes associated with culture-negative status in limb osteomyelitis patients. Bone Joint J 2024; 106-B:720-727. [PMID: 38945537 DOI: 10.1302/0301-620x.106b7.bjj-2023-0778.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Aims This study aimed to investigate the clinical characteristics and outcomes associated with culture-negative limb osteomyelitis patients. Methods A total of 1,047 limb osteomyelitis patients aged 18 years or older who underwent debridement and intraoperative culture at our clinic centre from 1 January 2011 to 31 December 2020 were included. Patient characteristics, infection eradication, and complications were analyzed between culture-negative and culture-positive cohorts. Results Of these patients, 264 (25.2%) had negative cultures. Patients with a culture-negative compared with a culture-positive status were more likely to have the following characteristics: younger age (≤ 40 years) (113/264 (42.8%) vs 257/783 (32.8%); p = 0.004), a haematogenous aetiology (75/264 (28.4%) vs 150/783 (19.2%); p = 0.002), Cierny-Mader host A (79/264 (29.9%) vs 142/783 (18.1%); p < 0.001), antibiotic use before sampling (34/264 (12.9%) vs 41/783 (5.2%); p<0.001), fewer taken samples (n<3) (48/264 (18.2%) vs 60/783 (7.7%); p<0.001), and less frequent presentation with a sinus (156/264 (59.1%) vs 665/783 (84.9%); p < 0.001). After initial treatments of first-debridement and antimicrobial, infection eradication was inferior in culture-positive osteomyelitis patients, with a 2.24-fold increase (odds ratio 2.24 (95% confidence interval 1.42 to 3.52)) in the redebridement rate following multivariate analysis. No statistically significant differences were found in long-term recurrence and complications within the two-year follow-up. Conclusion We identified several factors being associated with the culture-negative result in osteomyelitis patients. In addition, the data also indicate that culture negativity is a positive prognostic factor in early infection eradication. These results constitute the basis of optimizing clinical management and patient consultations.
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Affiliation(s)
- Hongri Wu
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
- Department of Orthopaedics, Navy 905th Hospital, Navy Medical University, Shanghai, China
| | - Xiaohua Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jie Shen
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhiyuan Wei
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Shulin Wang
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Tianming Xu
- Department of Orthopaedics, Navy 905th Hospital, Navy Medical University, Shanghai, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
| | - Zhao Xie
- Department of Orthopaedics, Southwest Hospital, Army Medical University, Chongqing, China
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Zhang Q, Wei JH, Fu X, Liu X, Li XY, Liu W, Liu ZL, Duan XQ, Zheng B. Can we trust computers to assess the cognition of stroke patients? A systematic review. Front Neurol 2023; 14:1180664. [PMID: 37305744 PMCID: PMC10248476 DOI: 10.3389/fneur.2023.1180664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To summarize the classification of computerized cognitive assessment (CCA) tools for assessing stroke patients, to clarify their benefits and limitations, and to reveal strategies for future studies on CCA tools. Methods A literature review was performed using PubMed, Embase, Scopus, JAMA Network, Cochrane Library and PsycINFO databases from January 1st, 2010, to August 1st, 2022. Two authors independently screened the literature following the same criteria, evaluated the study quality, and collected data from the articles. Results A total of 8,697 papers were acquired from the six databases. A total of 74 potentially eligible articles were selected for review. Of these, 29 articles were not relevant to this research, 3 were reviews, 2 were not written in English, and 1 was on an ongoing trial. By screening the references of the reviews, 3 additional articles were included in this study. Thus, a total of 42 articles met the criteria for the review. In terms of the CCA tools analyzed in these studies, they included five types: virtual reality (VR)-based, robot-based, telephone-based, smartphone-based, and computer-based cognitive assessments. Patients' stages of the disease ranged from the subacute phase and rehabilitation phase to the community phase. A total of 27 studies supported the effectiveness of CCA tools, while 22 out of 42 articles mentioned their benefits and 32 revealed areas for future improvement of CCA tools. Conclusions Although the use of CCA tools for assessing the cognition of post-stroke patients is becoming popular, there are still some limitations and challenges of using such tools in stroke survivors. More evidence is thus needed to verify the value and specific role of these tools in assessing the cognitive impairment of stroke patients.
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Affiliation(s)
- Qi Zhang
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | | | - Xue Fu
- Changchun University of Chinese Medicine, Changchun, China
| | - Xin Liu
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xin-Yi Li
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Wei Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Xiao-Qin Duan
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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Commons RJ, Charles J, Cheney J, Lynar SA, Malone M, Raby E. Australian guideline on management of diabetes-related foot infection: part of the 2021 Australian evidence-based guidelines for diabetes-related foot disease. J Foot Ankle Res 2022; 15:47. [PMID: 35676695 PMCID: PMC9178854 DOI: 10.1186/s13047-022-00545-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes-related foot infections cause substantial morbidity and mortality, both globally and in Australia. There is a need for up-to-date evidence-based guidelines to ensure optimal management of patients with diabetes-related foot infections. We aimed to identify and adapt high quality international guidelines to the Australian context to become the new Australian evidence-based guideline for people with a diabetes-related foot infection. METHODS Following Australian National Health and Medical Research Council (NHMRC) procedures we identified the 2019 International Working Group on the Diabetic Foot (IWGDF) guidelines as suitable for adaptation to the Australian context. Guidelines were screened, assessed and judged by an expert panel for the Australian context using the guideline adaptation frameworks ADAPTE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Judgements led to recommendations being adopted, adapted or excluded, with additional consideration regarding their implementation, monitoring and future research for the Australian context. Clinical pathways were then developed to assist implementation. RESULTS Of 36 original diabetes-related foot infection IWGDF sub-recommendations, 31 were adopted, four were adapted and one was excluded. Adaption was primarily undertaken due to differences or clarification of the sub-recommendations' intended population. One sub-recommendation was excluded due to substantial differences in judgements between the panel and IWGDF and unacceptable heterogeneity of the target population. Therefore, we developed 35 evidence-based sub-recommendations for the Australian context that should guide best practice diagnosis and management of people with diabetes-related foot infection in Australia. Additionally, we incorporated these sub-recommendations into two clinical pathways to assist Australian health professionals to implement these evidence-based sub-recommendations into clinical practice. The six guidelines and the full protocol can be found at: https://www.diabetesfeetaustralia.org/new-guidelines/ . CONCLUSIONS A new national guideline for the diagnosis and management of people with diabetes-related foot infections were successfully developed for the Australian context. In combination with simplified clinical pathway tools they provide an evidence-based framework to ensure best management of individuals with diabetes-related foot infections across Australia and highlight considerations for implementation and monitoring.
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Affiliation(s)
- Robert J Commons
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia. .,Internal Medical Services, Ballarat Health Services, Ballarat, Australia.
| | - James Charles
- First Peoples Health Unit, Faculty of Health Griffith University, Gold Coast, Australia
| | | | - Sarah A Lynar
- Global Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.,Infectious Diseases Unit, Royal Darwin Hospital, Darwin, Australia
| | - Matthew Malone
- South West Sydney Limb Preservation and Wound Research, South Western Sydney LHD, Liverpool, Sydney, Australia.,Infectious Diseases and Microbiology, School of Medicine Western Sydney University, Campbelltown Campus, Sydney, Australia
| | - Edward Raby
- Infectious Diseases Department, Royal Perth Hospital, Perth, Australia.,Department of Microbiology, Fiona Stanley Hospital Network, PathWest Laboratory Medicine, Murdoch, Australia
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Gariani K, Lebowitz D, Kressmann B, Gariani J, Uçkay I. X-Ray Versus Magnetic Resonance Imaging in Diabetic Foot Osteomyelitis: A Clinical Comparison. Curr Diabetes Rev 2021; 17:373-377. [PMID: 32729421 DOI: 10.2174/1573399816999200729124134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Radiographic imaging is an important diagnostic tool in diabetic foot osteomyelitis (DFO). It is unknown whether DFO cases diagnosed with conventional X-ray versus positive Magnetic Resonance Imaging (MRI) differ regarding epidemiology and treatment outcome. Theoretically, signs of inflammation on MRI without bone lesions might be easier to treat. METHODS Our clinical pathway for diabetic foot infections discourages the use of MRI for the diagnosis of DFO. We compared the epidemiology and therapy of non-amputated DFO with positive features on conventional X-ray, MRI, or both. Radiology specialists interpreted the images. The intraoperative aspect of bone during amputation and the results of bone cultures were considered the gold standard for DFO diagnosis. RESULTS We prospectively followed 390 DFO episodes in 186 adult patients for a median of 2.9 years and performed 318 conventional X-rays (median costs 100 Swiss Francs; 100 US$) and 47 (47/390; 12%) MRI scans (median 800 Swiss Francs; 800 US $). Among them, 18 episodes were associated with positive MRI findings but lacked bone lesions on X-ray. After debridement, the median duration of systemic antibiotics was 28 days for MRI-only episodes and 30 days for X-ray-positive cases (Wilcoxonranksum- test; p=0.26). The corresponding median numbers of surgical debridements were 1 and 1; and recurrence was witnessed in 25% and 28%, respectively. In multivariate logistic regression analysis, MRI-only episodes did not alter the remission rate (odds ratio 0.5, 95%CI 0.1-5.2). CONCLUSION According to our clinical pathway, DFO episodes with positive MRI findings only did not differ epidemiologically from the remaining DFO cases and did not influence the choice of therapy nor remission rate.
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Affiliation(s)
- Karim Gariani
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Dan Lebowitz
- Division of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benjamin Kressmann
- Clinical Pathway of Diabetic Foot Infections, University of Geneva Hospitals and Medical School, 1211 Geneva, Switzerland
| | - Joanna Gariani
- Department of Radiology, Geneva University Hospitals, Geneva, Switzerland
| | - Ilker Uçkay
- Clinical Pathway of Diabetic Foot Infections, University of Geneva Hospitals and Medical School, 1211 Geneva, Switzerland
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Crisologo PA, Davis KE, Ahn J, Farrar D, Van Asten S, La Fontaine J, Lavery LA. The infected diabetic foot: Can serum biomarkers predict osteomyelitis after hospital discharge for diabetic foot infections? Wound Repair Regen 2020; 28:617-622. [PMID: 32698253 DOI: 10.1111/wrr.12836] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/06/2020] [Accepted: 05/12/2020] [Indexed: 12/16/2022]
Abstract
The aim of this study is to evaluate serum biomarkers to monitor high-risk patients for reinfection of bone. Thirty-five patients were prospectively enrolled with moderate to severe diabetic foot infections with suspicion of osteomyelitis. Bone samples were obtained for culture and histology. Clinical characteristics and outcomes of patients were compared using χ2 square test. Biomarkers (white blood cell count, erythrocyte sedimentation rate, c-reactive protein, procalcitonin, interleukin-6, interleukin-8, and monocyte chemoattractant protein 1) were assessed at baseline, 3, and 6 weeks after treatment initiation and evaluated for correlation with reinfection of bone. After 6 weeks of antibiotic treatment, ESR at 73.5 mm/h (sensitivity 62.5%, specificity 100%, area under the receiver operating characteristic (AUROC) 0.7839, 95% CI 0.54-1.00, P < .01) and IL-8 at 15.09 mg/dL (sensitivity 42.9%, specificity 92.0% AUROC 0.6286, 95% CI 0.36-0.90, P = .0496) were associated with reinfection of bone. An increase in IL-8 from week 0 to 6 >0.95 mg/dL was associated with reinfection (sensitivity 71%, specificity 72% AUROC 0.7057, 95% CI 0.49-0.92, P = .04). An ESR change from week 0-6 of -16.5% (sensitivity 71.4%, specificity 86.4% AUROC 0.7403, 95% CI 0.48-1.00, P = .02), CRP (-)74.4% (sensitivity 66.7%, specificity 91.3% AUROC 0.7174, 95% CI 0.40-1.00, P = .04), IL-6 (-)49.9% (sensitivity 71.4%, specificity 76% AUROC 0.7371, 95% CI 0.47-1.00, P = .04), and IL-8 29% (sensitivity 85.7%, specificity 56.0% AUROC of 0.7343, 95% CI 0.54-0.93, P = .048) were associated with increased risk of reinfection. Pilot data suggest that serum biomarkers (ESR, IL8 and IL6, MCP-1) may be correlated with developing osteomyelitis and could be used to monitor high-risk patients for reinfection.
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Affiliation(s)
- Peter Andrew Crisologo
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kathryn E Davis
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Junho Ahn
- The University of Texas Southwestern Medical School, Dallas, Texas
| | - David Farrar
- Department of Immunology and Molecular Biology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Suzanne Van Asten
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Javier La Fontaine
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lawrence A Lavery
- Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Infections of Deep Hand and Wrist Compartments. Microorganisms 2020; 8:microorganisms8060838. [PMID: 32503146 PMCID: PMC7356554 DOI: 10.3390/microorganisms8060838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/20/2022] Open
Abstract
The human hand is the most exposed part of the body to highest risk for injuries, loss of the skin integrity, and to the inoculation of bacteria, most commonly Staphylococcus aureus, Streptococcus β-haemolytic, and gram-negative. In case of an infection, the mobile anatomical structures and the synovial membranes in close proximity to each other may spread the pus towards deep spaces and compartments. Mild early infections without an abscess formation may respond to antibiotics, but at more advanced stage, erythema, swelling, stiffness, and severe pain may ensue. Abscess formation will cause debilitating pain, fever, systemic symptoms, and even sepsis. Necrotizing infections may threaten not only the limb, but also patient’s life. Therefore, an initially “trivial” hand injury should never be neglected, as it might turn into a deep space infection, which must be treated immediately with drainage, wound debridement, and i.v. antibiotics. Delay in diagnosis and inadequate initial management might rapidly lead to abscess formation, destruction of the gliding surfaces and the normal anatomy, and irreparable functional deterioration.
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Fu L, Jin P, Hu Y, Lu H, Su L. KR‑12‑a6 promotes the osteogenic differentiation of human bone marrow mesenchymal stem cells via BMP/SMAD signaling. Mol Med Rep 2020; 21:61-68. [PMID: 31939626 PMCID: PMC6896396 DOI: 10.3892/mmr.2019.10843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/05/2019] [Indexed: 12/23/2022] Open
Abstract
Considering the increased resistance to antibiotics in the clinic and the ideal antibacterial properties of KR‑12, the effects of KR‑12‑a6, an important analogue of KR‑12, on the osteogenic differentiation of human bone marrow mesenchymal stem cells (hBMSCs) were investigated. Osteogenic differentiation‑associated experiments were conducted in hBMSCs, and KR‑12‑a6 was used as an additional stimulating factor during osteogenic induction. Quantitative analysis of alkaline phosphatase (ALP) and alizarin red staining, and reverse transcription‑quantitative PCR analysis of the expression of osteogenesis‑associated genes were performed to determine the effects of KR‑12‑a6 on the osteogenic differentiation of hBMSCs. LDN‑212854 was selected to selectively suppress BMP/SMAD signaling. Western blotting was performed to investigate the underlying mechanisms. The intensity of ALP and alizarin red staining gradually increased with increasing KR‑12‑a6 concentrations. KR‑12‑a6 induced the strongest staining at 40 µg/ml, whereas 60 µg/ml and 80 µg/ml concentrations did not further increase the intensity of staining. The mRNA expression levels of RUNX2 and ALP increased in a dose‑dependent manner as early as 3 days post‑KR‑12‑a6 treatment. The mRNA expression of COL1A1, BSP and BMP2 exhibited significant upregulation from day 7 post‑KR‑12‑a6 treatment. In contrast, the mRNA levels of OSX, OCN and OPN were enhanced dramatically at day 14 following KR‑12‑a6 stimulation. Additionally, KR‑12‑a6 significantly promoted the phosphorylation of Smad1/5. Furthermore, LDN‑212854 suppressed the activation of Smad1/5 and inhibited the upregulation of several osteogenic differentiation‑associated genes in KR‑12‑a6‑treated hBMSCs. KR‑12‑a6 promoted the osteogenic differentiation of hBMSCs via BMP/SMAD signaling.
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Affiliation(s)
- Lanqing Fu
- Department of Orthopedics, Jingzhou Central Hospital, Tongji Medical College of Huazhong University of Science and Technology, Jingzhou, Hubei 434020, P.R. China
| | - Peicheng Jin
- Department of Orthopedics, Xiangyang No. 1 People's Hospital, Affiliated Hospital of Hubei University of Medicine, Xiangyang, Hubei 441000, P.R. China
| | - Yajun Hu
- Department of Gynecology and Obstetrics, Jingzhou Central Hospital, Tongji Medical College of Huazhong University of Science and Technology, Jingzhou, Hubei 434020, P.R. China
| | - Hougen Lu
- Department of Orthopedics, Jingzhou Central Hospital, Tongji Medical College of Huazhong University of Science and Technology, Jingzhou, Hubei 434020, P.R. China
| | - Linlin Su
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
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