Failure of surgical treatment in 115 infected total hip arthroplasties - analysis of a 12-year prosthetic joint cohort study (1999-2010)

Infection of total hip arthroplasties (THA) leads to significant long-termmorbidity and high healthcare costs. We evaluated the differentreasons for treatment failure using different surgical modalities in a12-year prosthetic joint infection cohort study.Method: All patients hospitalized at our institution with infected THAwere included either retrospectively (1999-2007) or prospectively(2008-2010). THA infection was defined as growth of the same microorganismin ≥2 tissue or synovial fluid culture, visible purulence, sinustract or acute inflammation on tissue histopathology. Outcome analysiswas performed at outpatient visits, followed by contacting patients,their relatives and/or treating physicians afterwards.Results: During the study period, 117 patients with THA were identified.We exclude 2 patients due to missing data. The median age was69 years (range, 33-102 years); 42% were women. THA was mainlyperformed for osteoarthritis (n = 84), followed by trauma (n = 22),necrosis (n = 4), dysplasia (n = 2), rheumatoid arthritis (n = 1), osteosarcoma(n = 1) and tuberculosis (n = 1). 28 infections occurred early(≤3 months), 25 delayed (3-24 months) and 63 late (≥24 months aftersurgery). Infected THA were treated with (i) two-stage exchange in59 patients (51%, cure rate: 93%), (ii) one-stage exchange in 5 (4.3%,cure rate: 100%), (iii) debridement with change of mobile parts in18 (17%, cure rate: 83%), (iv) debridement without change of mobileparts in 17 (14%, cure rate: 53% ), (v) Girdlestone in 13 (11%, curerate: 100%), and (vi) two-stage exchange followed by removal in 3(2.6%). Patients were followed for a mean of 3.9 years (range, 0.1 to 9years), 7 patients died unrelated to the infected THA. 15 patients (13%)needed additional operations, 1 for mechanical reasons (dislocationof spacer) and 14 for persistent infection: 11 treated with debridementand retention (8 without change and 3 with change of mobile parts)and 3 with two-stage exchange. The mean number of surgery was 2.2(range, 1 to 5). The infection was finally eradicated in all patients, butthe functional outcome remained unsatisfactory in 20% (persistentpain or impaired mobility due to spacer or Girdlestone situation).Conclusions: Non-respect of current treatment concept leads totreatment failure with subsequent operations. Precise analysis of eachtreatment failures can be used for improving the treatment algorithmleading to better results.

Spatial correlations and cross sections of clusters in the A + B -> 0 reaction

We consider the distribution of cross sections of clusters and the density-density correlation functions for the A+B¿0 reaction. We solve the reaction-diffusion equations numerically for random initial distributions of reactants. When both reactant species have the same diffusion coefficients the distribution of cross sections and the correlation functions scale with the diffusion length and obey superuniversal laws (independent of dimension). For different diffusion coefficients the correlation functions still scale, but the scaling functions depend on the dimension and on the diffusion coefficients. Furthermore, we display explicitly the peculiarities of the cluster-size distribution in one dimension.

Carbono orgânico total, biomassa microbiana e atividade enzimática do solo de áreas agrícolas, florestais e pastagem no médio Vale do Paraíba do Sul (RJ)

Características do solo, como o carbono orgânico total (COT), a biomassa microbiana e a atividade enzimática, são influenciadas por diversos fatores e têm sido apontadas como indicadores adequados de alterações provocadas por diferentes sistemas de uso e manejo do solo. O objetivo deste trabalho foi avaliar o COT, a biomassa microbiana e a atividade enzimática de um Cambissolo Háplico Tb distrófico típico de áreas agrícolas, florestais e de pastagem, no Médio Vale do Paraíba do Sul (RJ). Os sistemas avaliados foram: agricultura anual (AgAn); agricultura perene (AgP); pasto; floresta secundária em estádio inicial de sucessão (FSEI); floresta secundária em estádio médio de sucessão (FSEM); e floresta secundária em estádio avançado de sucessão (FSEA). Foram coletadas amostras de terra na camada de 0-5 cm, em duas épocas distintas (úmida e seca), e analisados o COT e as propriedades biológicas: C da biomassa microbiana - CBM; N da biomassa microbiana - NBM; respiração basal - RB; quociente metabólico - qCO2; quociente microbiano - qMIC; e atividade das enzimas arilsulfatase, β-glicosidase e fosfatase ácida. As áreas agrícolas apresentaram redução no COT e nas propriedades biológicas (atividade enzimática e carbono e nitrogênio da biomassa microbiana) do solo quando comparadas ao pasto e às áreas florestais. Com as análises de componentes principais, foi possível separar os sistemas agrícolas e os sistemas florestais e de pasto. Observou-se que, em ambas as épocas, a FSEM e o pasto estiveram associados ao COT e à maioria das variáveis biológicas, ao contrário dos sistemas agrícolas.

Microbial biomass and activity in litter during the initial development of pure and mixed plantations of Eucalyptus grandis and Acacia mangium

Studies on microbial activity and biomass in forestry plantations often overlook the role of litter, typically focusing instead on soil nutrient contents to explain plant and microorganism development. However, since the litter is a significant source of recycled nutrients that affect nutrient dynamics in the soil, litter composition may be more strongly correlated with forest growth and development than soil nutrient contents. This study aimed to test this hypothesis by examining correlations between soil C, N, and P; litter C, N, P, lignin content, and polyphenol content; and microbial biomass and activity in pure and mixed second-rotation plantations of Eucalyptus grandis and Acacia mangium before and after senescent leaf drop. The numbers of cultivable fungi and bacteria were also estimated. All properties were correlated with litter C, N, P, lignin and polyphenols, and with soil C and N. We found higher microbial activity (CO2 evolution) in litter than in soil. In the E. grandis monoculture before senescent leaf drop, microbial biomass C was 46 % higher in litter than in soil. After leaf drop, this difference decreased to 16 %. In A. mangium plantations, however, microbial biomass C was lower in litter than in soil both before and after leaf drop. Microbial biomass N of litter was approximately 94 % greater than that of the soil in summer and winter in all plantations. The number of cultivable fungi and bacteria increased after leaf drop, especially so in the litter. Fungi were also more abundant in the E. grandis litter. In general, the A. mangium monoculture was associated with higher levels of litter lignin and N, especially after leaf drop. In contrast, the polyphenol and C levels in E. grandis monoculture litter were higher after leaf drop. These properties were negatively correlated with total soil C and N. Litter in the mixed stands had lower C:N and C:P ratios and higher N, P, and C levels in the microbial biomass. This suggests more effective nutrient cycling in mixed plantations in the long term, greater stimulation of microbial activity in litter and soil, and a more sustainable system in general.

Boson-boson mixtures and triplet correlations

The hypernetted-chain formalism for boson-boson mixtures described by an extended Jastrow correlated wave function is derived, taking into account elementary diagrams and triplet correlations. The energy of an ideal boson 3He-4He mixture is computed for low values of the 3He concentration. The zero-3He-concentration limit provides a 3He chemical potential in good agreement with the experimental value, when a McMillan two-body correlation factor and the Lennard-Jones potential are adopted. If the Euler equations for the two-body correlation factors are solved in presence of triplet correlations, the agreement is again improved. At the experimental 4He equilibrium density, the 3He chemical potential turns out to be -2.58 K, to be compared with the experimental value, -2.79 K.

Enhanced electron-electron correlations in nanometric epitaxial SrRuO3 epitaxial films

Epitaxial and fully strained SrRuO3 thin films have been grown on SrTiO3(100). At initial stages the growth mode is three-dimensional- (3D-)like, leading to a finger-shaped structure aligned with the substrate steps and that eventually evolves into a 2D step-flow growth. We study the impact that the defect structure associated with this unique growth mode transition has on the electronic properties of the films. Detailed analysis of the transport properties of nanometric films reveals that microstructural disorder promotes a shortening of the carrier mean free path. Remarkably enough, at low temperatures, this results in a reinforcement of quantum corrections to the conductivity as predicted by recent models of disordered, strongly correlated electronic systems. This finding may provide a simple explanation for the commonly observed¿in conducting oxides-resistivity minima at low temperature. Simultaneously, the ferromagnetic transition occurring at about 140 K, becomes broader as film thickness decreases down to nanometric range. The relevance of these results for the understanding of the electronic properties of disordered electronic systems and for the technological applications of SrRuO3¿and other ferromagnetic and metallic oxides¿is stressed.

Yields, plant characteristics, total N and fibre composition of timothy cultivars grown at two latitudes

Selostus: Timoteilajikkeiden sadot, kasvuominaisuudet sekä typpi- ja kuitupitoisuus kahdella leveysasteella

Revisiting the S-index for soil physical quality and its use in Brazil

The S-index was introduced in 2004 in a publication by A.R. Dexter. S was proposed as an indicator of soil physical quality. A critical value delimiting soils with rich and poor physical quality was proposed. At present, Brazil is world leader in citations of Dexter's publication. In this publication the S-theory is mathematically revisited and extended. It is shown that S is mathematically correlated to bulk density and total porosity. As an absolute indicator, the value of S alone has proven to be incapable of predicting soil physical quality. The critical value does not always hold under boundary conditions described in the literature. This is to be expected because S is a static parameter, therefore implicitly unable to describe dynamic processes. As a relative indicator of soil physical quality, the S-index has no additional value over bulk density or total porosity. Therefore, in the opinion of the author, the fact that bulk density or total porosity are much more easily determined than the water retention curve for obtaining S disqualifies S as an advantageous indicator of relative soil physical quality. Among the several equations available for the fitting of water retention curves, the Groenevelt-Grant equation is preferable for use with S since one of its parameters and S are linearly correlated. Since efforts in soil physics research have the purpose of describing dynamic processes, it is the author's opinion that these efforts should shift towards mechanistic soil physics as opposed to the search for empirical correlations like S which, at present, represents far more than its reasonable share of soil physics in Brazil.

Patient-perceived health-related quality of life during recovery after total hip arthroplasty – a 6-month follow-up study

Potilaiden käsitys terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana – kuuden kuukauden seurantatutkimus Tässä kaksivaiheisessa seurantatutkimuksessa tarkasteltiin potilaiden käsitystä terveyteen liittyvästä elämänlaadusta lonkan tekonivelleikkauksen jälkeisenä toipumisaikana. Tutkimuksen ensimmäisessä vaiheessa tarkoituksena oli sekä kuvailla potilaiden kokemuksia potilaana olosta, saamastaan hoidosta ja terveyspalveluorganisaatiosta että analysoida aikaisempien tutkimusten perusteella leikkauksen tuloksia potilaan kannalta. Toisessa vaiheessa tarkoituksena oli arvioida potilaiden kokemaa elämänlaatua leikkauksen jälkeen, ja sitä vaikuttivatko primaaritulokset (fyysinen toimintakyky, kipu, ahdistus) tai taloudelliset seuraukset (potilaiden itsensämaksamat kustannukset, palvelujen käyttö) terveyteen liittyvään elämänlaatuun. Tutkimuksen tavoitteena oli löytää mahdolliset kriittiset ajankohdat tai tekijät, jotka saattavat hidastaa toipumista ja siten huonontaa potilaiden elämänlaatua. Tätä tietoa voidaan käyttää hoitotyössä kun suunnitellaan sopivaa hoitoa ja tukea toipumisajalle. Tutkimuksen ensimmäisessä vaiheessa primaarileikkaukseen tulevat potilaat (n = 17) kuvailivat teemahaastatteluissa kokemuksiaan kahdesti leikkauksen jälkeen. Haastatteluaineisto analysoitiin induktiivisella sisällönanalyysilla. Lisäksi 17 tutkimusartikkelista analysoitiin deduktiivisella sisällönanalyysilla leikkauksen tuloksia potilaalle, tuloksiin vaikuttavia tekijöitä ja käytetyt tutkimusmetodit. Toisessa vaiheessa primaari- tai revisioleikkaukseen tulevat potilaat (n = 100) arvioivat leikkauksen tuloksia kuuden kuukauden ajan leikkauksen jälkeen: terveyteen liittyvää elämänlaatua, primaarituloksia ja taloudellisia seurauksia. Aineisto kerättiin erilaisilla mittareilla: Sickness Impact Profile, Finnish Version, Stait-Trait Anxiety Inventory, ja Numeric Rating Scale. Lisäksi käytettiin tätä tutkimusta varten tehtyjä kyselylomakkeita: Fyysinen toimintakyky-mittari, Palvelujen käyttö-mittari ja Kustannusmittari. Tutkimuksen toiseen vaiheen tulokset analysoitiin tilastollisilla menetelmillä. Potilaiden terveyteen liittyvä elämänlaatu parani ja kipu lievittyi leikkauksen jälkeen ja fyysinen toimintakyky lisääntyi toipumisaikana. Positiivisista muutoksista huolimatta potilaat kokivat ahdistusta samassa määrin kuin ennen leikkaustakin. Palvelujen käyttö vaihteli toipumisajan kuluessa ja potilaiden maksamissa kustannuksissa oli suuria vaihteluita. Fyysisen toimintakyvyn lisääntyminen ja kivun lieveneminen paransivat terveyteen liittyvää elämänlaatua. Sen sijaan huonompi elämänlaatu toipumisaikana oli yhteydessä suurempaan palvelujen käyttöön, kun taas kustannuksilla ei ollut yhteyttä elämänlaatuun. Potilaiden ominaispiirteet tulisi ottaa enemmän huomioon suunniteltaessa sopivaa leikkauksenjälkeistä hoitoa ja tukea. Potilaat tarvitsevat yksilöllisiä ohjeita, sillä monet taustatekijät (esim. ikä, sukupuoli, preoperatiivinen kipu, siviilisääty, ja leikkaustyyppi) vaikuttavat toipumiseen.

Variação diurno-noturna do potencial mátrico e gradiente de potencial total da água no solo

O potencial mátrico em solos não saturados é um importante componente do potencial total e, portanto, deve ser medido da melhor forma possível. Este trabalho teve por objetivo avaliar a influência da temperatura do solo sobre o potencial mátrico e o gradiente de potencial total, durante a redistribuição da água num Latossolo Vermelho-Amarelo, em Piracicaba, SP, a partir de dados coletados por tensiometria. Em uma parcela circular de 3 m de diâmetro, foram instalados 10 tensiômetros com transdutor de tensão, modelo SWT3 da Delta-T, nas profundidades de 0,10; 0,15; 0,20; 0,25; 0,30; 0,35; 0,40; 0,45; 0,50; e 0,55 m, com os quais foram obtidos os potenciais mátricos para essas profundidades e o gradiente de potencial total, (ΔΦm/Δz)+1, para a profundidade de 0,25 m, com Δz de 0,1; 0,2; e 0,3 m, utilizando os tensiômetros instalados nas profundidades de 0,20 e 0,30; 0,15 e 0,35; e 0,10 e 0,40 m para ΔΦm, respectivamente. Na mesma parcela, foram também instalados termopares tipo T na superfície e nas profundidades 0,025; 0,050; e 0,075 m de solo. Ambas as leituras dos tensiômetros e termopares foram armazenadas em um Datalogger, Modelo DL2, da Delta-T, a idênticos intervalos de tempo. As avaliações detectaram oscilações na leitura do potencial mátrico da água no solo ao longo do dia e nos efeitos diferenciados nos tensiômetros instalados em profundidades diferentes, ocasionando oscilações também no gradiente de potencial total da água no solo. Os melhores horários para a realização das leituras dos tensiômetros são nas primeiras sete horas do dia ou após às 18 h.

Einfluss von L-Carnitin-supplementierter total parenteraler Ernährung (TPE) auf die postoperative Fett- und Stickstoff-Utilisation [Effect of L-carnitine supplemented total parenteral nutrition on postoperative lipid and nitrogen utilization].

During episodes of trauma carnitine-free total parenteral nutrition (TPN) may result in a reduction of the total body carnitine pool, leading to a diminished rate of fat oxidation. Sixteen patients undergoing esophagectomy were equally and randomly divided and received isonitrogenous (0.2 gN/kg.day) and isocaloric (35 kcal/kg.day TPN over 11 days without and with L-carnitine supplementation (12 mg/kg.day). Compared with healthy controls, the total body carnitine pool was significantly reduced in both groups prior to the operation. Without supplementation carnitine concentrations were maintained, while daily provision of carnitine resulted in an elevation of total carnitine mainly due to an increase of the free fraction. Without supplementation the cumulative urinary carnitine losses were 11.5 +/- 6.3 mmol corresponding to 15.5% +/- 8.5% of the estimated total body carnitine pool. Patients receiving carnitine revealed a positive carnitine balance in the immediate postoperative phase, 11.1% +/- 19.0% of the infused carnitine being retained. After 11 days of treatment comparable values for respiratory quotient, plasma triglycerides, free fatty acids, ketone bodies, and cumulative nitrogen balance were observed. It is concluded that in the patient population studied here carnitine supplementation during postoperative TPN did not improve fat oxidation or nitrogen balance.

Statistical dynamics of dislocation systems: The influence of dislocation-dislocation correlations.

During plastic deformation of crystalline materials, the collective dynamics of interacting dislocations gives rise to various patterning phenomena. A crucial and still open question is whether the long range dislocation-dislocation interactions which do not have an intrinsic range can lead to spatial patterns which may exhibit well-defined characteristic scales. It is demonstrated for a general model of two-dimensional dislocation systems that spontaneously emerging dislocation pair correlations introduce a length scale which is proportional to the mean dislocation spacing. General properties of the pair correlation functions are derived, and explicit calculations are performed for a simple special case, viz pair correlations in single-glide dislocation dynamics. It is shown that in this case the dislocation system exhibits a patterning instability leading to the formation of walls normal to the glide plane. The results are discussed in terms of their general implications for dislocation patterning.

Frações oxidáveis do carbono orgânico total e macrofauna edáfica em sistema de integração lavoura-pecuária

O crescente nível de degradação das terras tem promovido a adoção de manejos agrícolas que busque aliar a produção agropecuária à conservação do solo. Entre esses, a prática da Integração Lavoura-Pecuária (ILP) tem intensificado-se no Centro-Oeste brasileiro. Com o objetivo de avaliar o efeito em longo prazo do sistema ILP e da sazonalidade, sob a comunidade da macrofauna edáfica e das frações oxidáveis do carbono orgânico total (COT) em áreas de cultivo e Cerradão, foi desenvolvido na Fazenda Cabeceira no município de Maracaju, MS, um estudo em que se mensurou a influência da ILP sobre as frações oxidáveis do COT e sobre a macrofauna edáfica. O sistema ILP está sendo utilizado nessa área desde 2003; o solo foi identificado como Latossolo Vermelho, localizado em área de relevo plano. As áreas amostradas possuem o seguinte histórico: soja/milho + braquiária/algodão/ aveia + pastagem/soja/formação da pastagem/pastagem; as amostragens foram realizadas na época seca, em que as culturas presentes eram pasto, milho+braquiária e algodão; e na chuvosa, com milho+braquiária, algodão e soja. Assim, as áreas nas duas épocas de avaliação foram: pasto/milho, milho+braquiária/ algodão, algodão/soja e uma área nativa de Cerradão. A amostragem foi realizada nas profundidades de 0-10, 10-20 e 20-30 cm, sendo feitas as seguintes determinações: análise da macrofauna edáfica, fracionamento granulométrico da matéria orgânica do solo (MOS) e frações oxidáveis do COT. As áreas não apresentavam delineamento experimental, sendo este um estudo de observação. Os dados foram comparados pelo teste de Kruskal Wallis a 5 % e por meio da análise de redundância. A compartimentalização da MOS pode ser utilizada para a avaliação da qualidade do manejo, sendo os compartimentos mais sensíveis as frações F1 e F2 de frações oxidáveis, pois são mais lábeis no solo, já as frações F3 e F4 são as mais recalcitrantes. Isoptera (cupim) pode estar atuando como agente humificador da matéria orgânica na área de Cerradão, contribuindo para maiores teores de F3 e F4, em relação à F1 e F2 na época seca. Esse padrão somente foi verificado na área de Cerradão, visto que nas áreas de produção, Isoptera é controlado pelo manejo. A falta desse inseto no sistema ILP pode estar reduzindo a estabilização da MOS nas frações F3 e F4.