Infected hip prosthesis in patient with suspected Covid-19 infection

Background

Infections following arthroplasty are one of the major risks during this type of surgery. Moreover, the outbreak of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus Disease 2), has developed into an unprecedented pandemic, posing enormous pressure on health-care providers around the world.

Case presentation

Four and half years after right hip arthroplasty, the patient came back to our attention with pain at the same hip. The instrumental examinations showed signs of cup detachment. After carefully analyzing the case, we decided to perform a sterile aspiration of the hip in the operating room under C-arm fluoroscopy. Microbiological examinations showed positivity for E. coli. The patient underwent surgery by which the prosthesis was removed and a spacer was implanted. A therapy with Cefotaxim 2 g three times a day for 6 weeks was then set, and then a total arthroplasty was performed. During this period, the COVID-19 pandemic occurred and therefore the patient received nasal-throat swabbing two times, and both yielded negative results. However, 1 week after the final surgery, his respiratory conditions deteriorated and chest X-ray and CT scan showed images of ground-glass opacification patterns (GGO). Due to the clinical symptoms and the characteristic images of the instrumental examinations, the patient was transferred to an observation ward. Thereafter, two more swab tests gave negative results. The patient was then transferred to the ward for patients with typical symptoms of COVID-19 but with negative swab tests for 2 weeks and was subsequently discharged home.

Conclusion

The purpose of this case report was to point out the correct treatment of a PJI after the outbreak of COVID-19. Despite the ongoing COVID-19 pandemic, the guidelines in the case of periprosthetic hip infection further confirmed the correct management of the patient.

Effects of ultrasound and selenium on human neurons in vitro

As the effects of ultrasound on human brain functions might bear therapeutic potential, in this study, we examined the effects of diagnostic, i.e. non-thermal, ultrasound, on morphology, networking, and metabolic activity of SH- SY5Y human neurons in culture, as well as on the expression of GAP-43, Hsp90 and VEGF proteins, with and without selenium in the culture medium. The rationale for studying selenium lays in the observation that selenium improves functional neurologic outcome in traumatic brain injury and, therefore, analysis of the interactions between ultrasound and selenium may be of clinical interest. In the presence of selenium, ultrasound increased the overall number and length of elongations arising from the neuron bodies, thus reflecting an increase in the complexity of neuronal networks and circuits. The expression of GAP-43, Hsp90 and VEGF and metabolic activity of SH-SY5Y neurons, studied as markers of cell damage, were not affected by ultrasound or selenium. This study suggests that ultrasound may modulate neuronal networking in vitro without inducing cellular or molecular damage and highlights the potential role of selenium in the ultrasound-elicited cellular responses.

Morphological analysis of neurons: Automatic identification of elongations

Our study is focused on the development of a new method for the automatic analysis of cell images. We focused on neurons (cells line SH-SY5Y) treated/untreated with ultrasound and stained with Haematoxylin-Eosin. The aim of the algorithm is the automatic detection of the cell body as well as the determination of the number and the length of neuron elongations. Starting point of the algorithm was the convolution of an image with a bank of rotating Gaussian kernels and the construction of a module map. Then several strategies were implemented to detect cell bodies and to detect and extract data about cell elongations. We have also realized a graphical user interface allowing the loading, saving and processing of images. Results show that this method is able to properly and efficiently detect cell contours and elongations. The automated evaluation is in strong agreement with manual evaluation performed by an expert operator, with an average error of 11% with most parameter combinations. This tool constitutes an important support in biological research activities, where operators need to analyze a large number of images to investigate about cell morphology before and after a treatment.

Applicability of a new robotic walking aid in a patient with cerebral palsy. Case report

BACKGROUND

Gait training with the help of assistive technological devices is an innovative field of research in neurological rehabilitation. Most of the available gait training devices do not allow free movement in the environment, which would be the most suitable natural and motivating condition for training children with neurological gait impairment.

AIM

To evaluate the potential applicability of a new robotic walking aid as a tool for gait training in non-ambulatory children with Cerebral Palsy.

DESIGN

Single case study

SETTING

Outpatient regimen

POPULATION

A 11-years-old child unable to stand and walk independently as a result of spastic tetraplegic cerebral palsy (CP).

METHODS

The experimental device was a newly actuated version of a dynamic combined walking and standing aid (NF-Walker®) available in the market which was modified by means of two pneumatic artificial muscles driven by a foot-switch inserted in the shoes. The child was tested at baseline (while maintaining the standing position aided by the non-actuated NF-Walker®) and in the experimental condition (while using the actuated robotic aid). The outcome measures were: 2-minute walking test, 10-metre walking test, respiratory and heart parameters, energy cost of locomotion.

RESULTS

At baseline, the child was unable to perform any autonomous form of locomotion. When assisted by the actuated aid (i.e. during the experimental condition), the child was successful in moving around in his environment. His performance was 19.63 m in the 2-minute walking test and 64 s in the 10-metre walking test. Respiratory and heart parameters were higher than healthy age-matched children both at baseline and in the experimental condition. The energy cost of gait, which was not valuable in the baseline condition, was significantly higher than normality during the experimental condition.

CONCLUSION

The new robotic walking aid may help children suffering from CP with severe impairment of gait to move around in their environment.

CLINICAL REHABILITATION IMPACT

This new robotic walking device may have a potential impact in stimulating the development and in training of gait in children with neurological gait impairment. Future studies are warranted in order to test this hypothesis.

In-plane illuminated metallic annular aperture array for sensing application

We propose here an application to sensing of annular aperture arrays (AAA). We theoretically investigate the optical properties of the reflective AAA device when illuminated in-plane. The cavity presents almost perfect absorption due to the waveguide mode resonance with strong field localization in the aperture. Additionally, the reflective cavity is modeled to be available for on-chip sensing with a theoretically expected sensitivity of 764 nm/RIU(refractive index unit).

The new potential invader Linopherus canariensis (Polychaeta: Amphinomidae) in a Mediterranean coastal lake: colonization dynamics and morphological remarks

The newly introduced polychaete Linopherus canariensis Langerhans, 1881 was found in the Lake of Faro (NE Sicily), during a study comparing the macrobenthos in artificial modules with a neighboring sandy bottom assemblage. Of a total of 4465 specimens, almost 6% showed morphological variation related to branchial turfs and mean body size. The sandy bottom exhibited an average density of 41.86 ind L⁻¹ and a wet biomass of 30.35 mg L⁻¹, whereas the artificial substratum reached levels of 205.29 ind L⁻¹ and 318.44 mg L⁻¹. The highest estimated immigration rate was 3.7 ind L⁻¹d⁻¹ (5.8 mg L⁻¹ d⁻¹). In the artificial microhabitat, 0.4% of the population showed mid-anterior fragmentation, with anterior- (2%), mid- (< 1%) and posterior- (1%) regenerating lineages, which contributed significantly to the dispersion ability of this species. L. canariensis was a selective micro-deposit feeder, even under conditions of reduced sediments. Linopherus was found to be a new potential invader of stressed environments that is probably tied to the import of oysters.

Expression of SPANX proteins in normal prostatic tissue and in prostate cancer

The sperm protein associated with the nucleus in the X chromosome (SPANX) gene family encodes for proteins that are not only expressed in germ cells, but also in a number of tumors. In addition, SPANX genes map in an interval of the X chromosome (namely, Xq27), which has been found to be associated with familial prostate cancer by linkage analysis. The aim of this study was therefore to evaluate SPANX protein expression in normal prostate tissues and in prostate carcinoma. For this purpose, formalin-fixed and paraffin-embedded sections obtained from 15 normal (at autopsy) donors and 12 men with prostate cancer were analyzed by immunohistochemistry. About 40% of both normal and tumor prostate samples resulted SPANX positive. Signals were exclusively within the nucleus in normal prostate cells, whereas both nuclear and cytoplasmic positivity was observed in tumor cells. In conclusion, these findings showed that SPANX genes are expressed in both normal and tumor prostate gland, but the latter showed a peculiar cytoplasmic staining positivity. This suggests a possible association between SPANX over expression and prostate cancer development. Additional studies are needed to corroborate this hypothesis.

A modified constraint-induced movement therapy (CIT) program improves paretic arm use and function in children with cerebral palsy

AIM

Constraint-induced movement therapy (CIT) is a rehabilitation intervention put forward by Taub and colleagues for sensorimotor disorders in children with hemiparesis, comprising consisting of the restraint of the unaffected arm and concurrent intensive training of the affected arm for six hours/day for two weeks. The aim of this study was to evaluate the effectiveness of a modified CIT program (mCIT) characterized by restraining the unaffected hand with a cotton mitten during daily activities and a reduced intensity training program for two h/week for five weeks.

METHODS

Ten children (age: 1-9 years) with hemiparetic cerebral palsy were enrolled in a randomized, cross-over study in which the effects of a mCIT and a conventional physiotherapy program were compared. The amount of use and the functional performance of the affected arm were evaluated by means of two specifically devised tests (Use and Function Test). A further test evaluated functional performance during bimanual tasks. These measures showed a good inter-rater and inter-session reliability. All tests were administered before, at the end and four weeks after treatment.

RESULTS

Significant differences between the two therapeutic approaches were evidenced in both affected arm use (P=0.008) and function (P=0.018). These improvements maintained at the follow-up (Use Test P=0.07; paretic arm function P=0.012). Bimanual function performance showed a trend towards improvement in both post-treatment and follow-up testing. The conventional physiotherapy group did not show any improvement in any outcome measure.

CONCLUSIONS

The mCIT program proposed in the present study showed to be a promising rehabilitative procedure in children with congenital arm paresis after cerebral palsy.

Rehabilitation of limb apraxia improves daily life activities in patients with stroke

We randomly assigned 33 patients with left hemisphere stroke, limb apraxia, and aphasia to an apraxia or a control (aphasia) treatment group. Before and after each treatment, patients underwent a comprehensive neuropsychological testing battery and a caregiver evaluation of patient's activities of daily life (ADL) independence. Apraxia severity was related with ADL independence. Control (aphasia) treatment improved patients' language and intelligence performance. Apraxia treatment specifically improved praxic function and ADL.

Early and delayed orthotic treatment in congenital metatarsus varus: effectiveness of two types of orthoses

AIM

The aim of this study was to evaluate the effectiveness of early or delayed orthotic treatment of congenital metatarsus varus and evaluate the efficacy of static vs dynamic anti-varus orthosis.

METHODS

Twenty-five children (14 males, 11 females), of 81.3 days of age (range 1-189) (41 feet affected) were selected among 88 patients referred to our rehabilitation department for foot deformity. Children were assigned to 1 of 2 groups (dynamic or static orthosis) according to a simple randomization scheme. Patients were evaluated at diagnosis (T1), at the end of treatment (T2) and at a follow-up performed at least 2 years after the end of treatment (T3). Primary outcome was measured using the Bleck scale. The IOWA functional rating system questionnaire was performed at follow up evaluation.

RESULTS

The Bleck scale showed that both static and dynamic orthoses were effective and that the best results were achieved with early treatment. The IOWA questionnaire showed that no child had residual deformities that interfered with daily activities. Nonetheless, the dynamic orthosis group had better scores in 4 sub-items related to parental satisfaction, foot function, heel position, and foot passive motion.

CONCLUSIONS

Both static and dynamic orthoses are useful for correction of congenital metatarsus varus. Optimal results are achieved with early treatment.

Association of MHC Class I chain-related A (MIC-A) gene polymorphism with Type I diabetes

AIMS/HYPOTHESIS

A distinct family of MHC genes has been identified in the class III region and denominated MHC Class I chain-related genes (MIC). The MIC-A gene is located between the TNFA and the HLA-B genes. The aim of our study was to test the association of the polymorphism of the MIC-A gene with Type I (insulin-dependent) diabetes mellitus and evaluate the interaction between MIC-A and TNFA, HLA-B, HLA-DR and HLA-DQ gene polymorphism.

METHODS

Type I diabetic (n =95) and healthy (n = 98) Italian subjects were typed for exon 5 of MIC-A and for HLA-DRB1, HLA-DQA1, HLA-DQB1 and TNFA alleles. All subjects were also typed for the presence of HLA-B8 or HLA-B15.

RESULTS

The frequency of MIC-A5 was increased in diabetic subjects (53 % vs 15 %) (OR = 6.1) (corrected p, p(c) < 0.0005). Among HLA class II haplotypes, both HLA-DRB1*03-DQA1*0501-DQB1*0201 (DR3-DQ2) and DRB1*04-DQA1*0301-DQB1*0302 (DR4-DQ8) ("at-risk class II haplotypes") were positively associated with diabetes (OR = 6.7 and 6.0, respectively) (p(c) < 0.003). Also HLA-B8 was more frequent among Type I diabetic subjects than among healthy control subjects (OR = 2.8, p = 0.01). None of the TNFA alleles were statistically significantly associated with Type I diabetes. The MIC-A5 exon was negatively associated with age at clinical onset of diabetes (p = 0.012). Thus, 68 % diabetic subjects younger than 25 years and 29 % older than 25 years were carrying this allele. Both MIC-A5 and the at-risk class II haplotypes were independently associated with Type I diabetes and the combined association of the two markers had the highest relative risk (OR = 172). In subjects younger than 25 years, the OR of MIC-A5 was as high as 21.7 and was more than twofold that of at-risk class II haplotypes (OR = 9.5). The MIC-A5 exon was not in linkage disequilibrium with any of the HLA-class I, class II or TNFA alleles studied.

CONCLUSIONS/INTERPRETATION

The MIC-A gene polymorphism is associated with genetic risk for Type I diabetes and the combination of MIC-A5 and at-risk class II haplotypes is now to be seen as the strongest genetic marker for this disease.

Autoantibodies against recombinant human steroidogenic enzymes 21-hydroxylase, side-chain cleavage and 17alpha-hydroxylase in Addison's disease and autoimmune polyendocrine syndrome type III

OBJECTIVE

To evaluate the frequency of autoantibodies (Ab) against 21 hydroxylase (21OH), side-chain cleavage (SCC) and 17alpha-hydroxylase (17OH), in Addison's disease (AD) and autoimmune polyendocrine syndrome type III (APSIII).

DESIGN AND METHODS

We used radiobinding assays and in vitro translated recombinant human (35)S-21OH, (35)S-SCC or (35)S-17OH and studied serum samples from 29 AD (18 idiopathic, 11 granulomatous) and 18 APSIII (autoimmune thyroid disease plus type 1 diabetes mellitus, without AD) patients. Results were compared with those of adrenocortical autoantibodies obtained with indirect immunofluorescence (ACA-IIF).

RESULTS

ACA-IIF were detected in 15/18 (83%) idiopathic and in 1/11 (9%) granulomatous AD subjects. 21OHAb were found in 14/18 (78%) idiopathic and in the same (9%) granulomatous AD subject. A significant positive correlation was shown between ACA-IIF and 21OHAb levels (r(2)=0.56, P<0.02). The concordance rate between the two assays was 83% (24/29) in AD patients. SCCAb were found in 5/18 (28%) idiopathic (4 of whom were also positive for 21OHAb) and in the same (9%) granulomatous AD subject. 17OHAb were found in only 2/18 (11%) idiopathic and none of the granulomatous AD patients. Two APSIII patients were positive for ACA-IIF, but only one was positive for 21OHAb and SCCAb. 17OHAb were found in another two APSIII patients.

CONCLUSIONS

Measurement of 21OHAb should be the first step in immune assessment of patients with AD and individuals at risk for adrenal autoimmunity, in addition to ACA-IIF. Due to their low prevalence in AD, measurement of SCCAb and 17OHAb should be indicated only for 21OHAb negative patients and/or for those with premature ovarian failure, regardless of ACA-IIF results.

Autoantibody recognition of COOH-terminal epitopes of GAD65 marks the risk for insulin requirement in adult-onset diabetes mellitus

Some type 2 diabetic subjects develop secondary failure to sulphonylurea treatment and require insulin therapy. To test the diagnostic sensitivity and specificity of epitopes of GAD65 autoantibodies (GAD65Ab) for insulin requirement, in patients with latent autoimmune diabetes of the adult, we studied 569 adult subjects with a clinical diagnosis of type 2 diabetes mellitus. All the patients had been initially treated with hypoglycemic agents and/or diet for at least 1 yr. The presence of GAD65Ab (61/569, 10.7%) depended on insulin therapy (P<0.0001), low BMI (P<0.0001), and low basal C-peptide (P = 0.01). The majority of GAD65Ab-positive subjects (47/61, 77%) had antibodies directed to both middle (GAD65-MAb) and COOH-terminal (GAD65-CAb) epitopes. However, GAD65-CAb were more frequent in insulin-treated subjects (92% of GAD65Ab+ individuals) than in subjects treated with hypoglycemic agents and/or diet (18.2% of GAD65Ab+ individuals), while the exclusive presence of GAD65-MAb was more frequent in subjects treated with hypoglycemic agents and/or diet (81.8% vs. 8%) (P<0.0001). The presence of GAD65-CAb had a diagnostic specificity for insulin requirement as high as 99.4% (compared with 96.9% of GAD65Ab as measured in the traditional radiobinding assay) and identified a subgroup of patients with low BMI, low basal C-peptide values, and a need for insulin therapy. Subjects carrying only GAD65-MAb were phenotypically indistinguishable from GAD65Ab-negative patients. Patients positive for GAD65-M+CAb, but not those positive for GAD65-MAb only, showed an increased risk for thyroid autoimmunity, as revealed by the presence of thyroid peroxidase autoantibodies. Our study demonstrates that the use of epitope-specific antibody assays improves the diagnostic specificity of GAD65Ab, and that the presence of GAD65Ab binding to COOH-terminal epitopes is strongly associated with a need for insulin requirement.

[An interlaboratory study of the use of PapNet in the quality control of cervico-vaginal cytology]

In this feasibility study of the utilization of the PapNet System (Neuromedical Systems, Suffern, NY) for computer-assisted cervical/vaginal cytology diagnosis, a random sample of 329 negative smears and a series of 68 positive smears reported as such by the Caltagirone laboratory, underwent PapNet review at the Imola laboratory. False-positive (FP) cases (smears originally classified as ASCUS, LGSIL, AGUS, e HGSIL and interpreted as negative on PapNet) and false-negative (FN) cases (reverse discrepancies) were further and conventionally re-evaluated by the staff of the originating laboratory. On PapNet review, there were 16/68 FP cases (23.5%) e 20/329 FN cases (6.1%) with a FP:FN rate ratio of 3.8 (95% confidence interval, 2.2-6.3). At final re-examination of these diagnostic errors, most FP cases (14/16) were confirmed as such whereas the FN cases significantly decreased from 20 to 9, with a final rate of 2.7%. As a consequence, the ratio of the FP rate (14/68) to the FN rate (9/329) rose to 7.5 (4.1-12.6). The study suggests one potential approach to the preliminary utilization of PapNet by those laboratories that are interested in this technology. The results are in accordance with those of the previous PapNet review studies which have generally shown a greater frequency of FP cases compared with FN cases.

Diode-pumped high-efficiency high-brightness Q-switched ND:YAG slab laser

A high-efficiency diode-pumped Q-switched Nd:YAG oscillator designed for future spaceborne applications has been demonstrated and characterized. The laser is based on a side-pumped slab geometry and uses an unstable resonator with a radially variable-reflectivity output coupler. The laser provides an output pulse energy of 100 mJ at a 100-Hz repetition rate, with a near-diffraction-limited beam and an overall electrical optical efficiency exceeding 6%.

Metanephric adenoma of the kidney: histologic, immunohistochemical and DNA content analysis study. A case report

Metanephric adenoma is an uncommon and distinct clinicopathologic entity, recently described among benign epithelial kidney tumors. The authors report a case of a metanephric adenoma in a 70-year-old man. Because of its benign clinical course, it is important to distinguish metanephric adenoma from renal cell carcinomas and adult Wilms' tumor for which it is usually mistaken. Clinical, pathologic features and diagnostic problems of the case are discussed.

[Male breast cancer. Histochemical and flow cytometry analysis of 6 cases]

The authors studied immunohistochemical and flow cytometric parameters of 6 male breast carcinomas. All patients were ER positive and frequency of aneuplody was 66%. Diploid tumors showed low proliferative activity and S-phase fraction < 3%.

A system for automated procedure documentation

Quantitative information regarding competency in performing procedures is invaluable in attesting to a house officer's abilities when assessments need to be made. Thus, the means by which procedures, proficiency, and experience can be recorded and organized in an automated fashion need not be any further away than the nearest micro-computer. The procedure documenting system (PDS) automates the documenting of procedures and quantitative information pertaining to these procedures, and shortens the time demanded of the house officer to document procedures from a mean of 5.5 to 1.9 min. This paper is a description of the work done to automate the recording of procedures performed by housestaff at a teaching hospital and the acceptance by housestaff. This computer program takes the specific information and places it into a specialized database so that house officers can have detailed documentation attesting to their proficiency in various procedures. In addition, the program director can access the database to document the quantity of procedures to which an individual house officer has attained competence.

[Urinary cytology of transitional-cell carcinoma]

The authors report on their experience about urinary cytology in 1991. They studied 100 patients with cytology and histology, carried by cystoscopy and cold-mapping biopsy, trying to have notice about cytological value and proficiency.

[Effects of nimodipine on mental deterioration in subjects with chronic cerebrovascular pathology]

In order to assess the efficacy of Nimodipine against a polymorphous pathology, such as chronic cerebrovascular insufficiency, the authors studied 96 subjects affected by chronic cerebrovascular diseases aged between 65 and 85 years old. The various symptoms were evaluated individually using tests and subjects were then divided into two groups on the basis of overall results. All subjects were followed for six months and then reassessed using the above-mentioned tests at the end of the study. From results obtained, it appears that Nimodipine is a useful tool for controlling the most common symptoms associated with mental deterioration in subjects affected by chronic cerebrovascular disorders.

Handpiece with variable spot size for carbon dioxide laser surgery

A variable-spot-size handpiece, with sliding control mechanism for focusing and defocusing, has been designed for use in CO2 laser operations, to provide the surgeon with increased precision in cutting and ablation of tissue with improved hemostasis.

A statistical comparison of the emotional status of hospitalized versus nonhospitalized subjects: a pilot study

It has been suggested that the health care system might be best assessed by the patient's own attitudes concerning the quality of service rendered (Wood, 1974). The purpose of this study is to analyze the psychosocial quality of the health service/hospital system in the greater Iowa City, Iowa area, and the relative emotional stability of hospitalized patients in several local hospitals. Specifically, a survey of 20 questions has been developed to assess (1) patient's attitudes and psychosocial outlook, (2) patient's self-perception. (3) situation generated feelings and (4) family/support group generated feelings. The comparative results of this experiment may indicate (1) the overall emotional status of hospitalized patients relative to non-hospitalized individuals and (2) the general psychosocial effectiveness of the hospital system (in the greater Iowa City. Iowa area). This information may be useful to both the medical/allied-health student and the inexperienced clinician, relative to various preconceived notions concerning the emotional state of hospitalized patients, in general.