Postmortem findings in bone cement implantation syndrome-related deaths.

Several mechanisms have been postulated as potentially involved in life-threatening complications during cemented surgery. In this study, we evaluated the role of anaphylaxis and pulmonary fat embolism in the pathophysiology of bone cement implantation syndrome in a series of fatal cases that underwent medicolegal investigations. Postmortem findings in these cases were compared with those obtained from individuals who died after other injuries and/or interventions and in which activated mast cells and pulmonary fat embolism were involved in the pathogenesis of death. Fifty subjects were selected including 6 individuals who had undergone cemented total hip arthroplasty and died intraoperatively, 32 subjects who died shortly after being involved in traffic accidents, 8 individuals who died shortly after the injection of contrast material, and 4 subjects who had undergone orthopedic surgery and died postoperatively. Massive pulmonary fat embolism was determined to be the cause of death in all the 6 subjects who died intraoperatively as well as the main cause of death in traffic-road victims with rapid respiratory function deterioration. Mast cell activation was identified exclusively in the group of subjects who died shortly after contrast material administration. Massive pulmonary fat embolism appears to be the most important factor responsible for severe cardiorespiratory function deterioration during cemented arthroplasty. Cardiac comorbidities can also significantly influence the severity of intraoperative complications, thus corroborating the hypothesis of a multifactorial model in the pathogenesis of bone cement implantation syndrome.

Activity of polymethylmethacrylate (PMMA) bone cement loaded with daptomycin, vancomycin and gentamicin against Staphylococcus epidermidis biofilms

Background: Local antibiotics may significantly improve the treatmentoutcome in bone infection without systemic toxicity. For impregnationof polymethylmethacrylate (PMMA), gentamicin, vancomycin and/orclindamycin are currently used. A new lipopeptid antibiotic,daptomycin, is a promising candidate for local treatment due to itsspectrum against staphylococci and enterococci (including multiresistantstrains), and concentration-dependent rapid bactericidalactivity. We investigated activity of antibiotic-loaded PMMA againstStaphylococcus epidermidis biofilms using an ultra-sensitive bacterialheat detection method (microcalorimetry).Methods: Staphylococcus epidermidis (strain RP62A, susceptibleto daptomycin, vancomycin and gentamicin) at concentration 106bacteria/ml was incubated with 2 g-PMMA block (Palacos, HeraeusMedical, Hanau, Germany) in 25 ml tryptic soy broth (TSB)supplemented with calcium. PMMA blocks were preloaded withdaptomycin, vancomycin and gentamicin each at 2 g/40 mg (= 100 mg/block) PMMA. After 72 h-incubation at 35 °C under static conditions,PMMA blocks were rinsed in phosphate-buffered solution (PBS) 5times and transferred in 4 ml-microcalorimetry ampoule filled with 1 mlTSB. Bacterial heat production, which is proportional to the quantityof biofilm on PMMA surface, was measured by isothermalmicrocalorimetry. The detection time was calculated as the time untilthe heat flow reached 20 microwatt.Results: Biomechanical properties did not differ between antibioticloadedand non-loaded PMMA blocks. The mean detection time (±standard deviation) of bacterial heat was 6.5 ± 0.4 h for PMMA withoutantibiotics (negative control), 13.5 ± 4.6 h for PMMA with daptomycin,14.0 ± 4.1 h for PMMA with vancomycin and 5.0 ± 0.4 h for PMMAwith gentamicin.Conclusion: Our data indicates that antibiotics at 2 g/40 mg PMMAdid not change the biomechanical properties of bone cement. Daptomycinand vancomycin were more active than gentamicin against S.epidermidis biofilms when all tested at 2 g/40 mg PMMA. In the nextstep, higher concentrations of daptomycin and their elution kineticneeds to be determined to optimize its antibiofilm activity before usingin the clinical setting.

Antibiotic cement nail for the treatment of posttraumatic intramedullary infections of the tibia: Midterm results in 10 cases.

INTRODUCTION: This is a single, level 1 trauma centre, prospective consecutive patient series with intramedullary infection in the presence of unstable tibial fracture treated using the Kirschner wire-reinforced, antibiotic cement nail. PATIENTS AND METHODS: A total of 10 consecutive patients (eight males and two females) with a mean age of 42 years (range, 20-59) suffering from infection after intramedullary nailing for tibial fracture, admitted during a period of 4 years, were included. An antibiotic cement-coated nail, handmade at the time of surgery, was implanted in all patients. This was followed by a standardised 6-week treatment protocol, extraction of the nail and definitive fixation. RESULTS: At 6 years of follow-up, infection eradication and bony union were possible in all of the patients. No further infection treatment was necessary; however, all of our patients underwent additional procedures (mean: four additional procedures per patient) for cosmetic or other non-infectious reasons (bone grafting, muscle flaps, etc.). CONCLUSIONS: The antibiotic cement-coated nail seems to be an effective treatment for intramedullary infections of the fractured tibia.

Investgiation into Improved Pavement Curing Materials and Techniques: Part 1 - Phases I and II, April 2002

Concrete curing is closely related to cement hydration, microstructure development, and concrete performance. Application of a liquid membrane-forming curing compound is among the most widely used curing methods for concrete pavements and bridge decks. Curing compounds are economical, easy to apply, and maintenance free. However, limited research has been done to investigate the effectiveness of different curing compounds and their application technologies. No reliable standard testing method is available to evaluate the effectiveness of curing, especially of the field concrete curing. The present research investigates the effects of curing compound materials and application technologies on concrete properties, especially on the properties of surface concrete. This report presents a literature review of curing technology, with an emphasis on curing compounds, and the experimental results from the first part of this research—lab investigation. In the lab investigation, three curing compounds were selected and applied to mortar specimens at three different times after casting. Two application methods, single- and double-layer applications, were employed. Moisture content, conductivity, sorptivity, and degree of hydration were measured at different depths of the specimens. Flexural and compressive strength of the specimens were also tested. Statistical analysis was conducted to examine the relationships between these material properties. The research results indicate that application of a curing compound significantly increased moisture content and degree of cement hydration and reduced sorptivity of the near-surface-area concrete. For given concrete materials and mix proportions, optimal application time of curing compounds depended primarily upon the weather condition. If a sufficient amount of a high-efficiency-index curing compound was uniformly applied, no double-layer application was necessary. Among all test methods applied, the sorptivity test is the most sensitive one to provide good indication for the subtle changes in microstructure of the near-surface-area concrete caused by different curing materials and application methods. Sorptivity measurement has a close relation with moisture content and degree of hydration. The research results have established a baseline for and provided insight into the further development of testing procedures for evaluation of curing compounds in field. Recommendations are provided for further field study.

Estudo da Influência da Granulometria das Areias no Desempenho de Rebocos de Cimento Portland Normal

Os agregados para a indústria da construção civil são as matérias-primas mais consumidas no mundo, pelo que o estudo e conhecimento das suas características e consequente influência sobre as propriedades das argamassas assumem uma considerável importância. A escolha do tipo de areia e a sua composição granulométrica têm uma grande influência no comportamento das argamassas. Utilização de areias com diferentes constituições granulométricas constitui uma forma de introduzir consideráveis alterações nas características das argamassas. Torna-se então importante compreender de que modo, a variação deste simples factor, pode influenciar as características desejadas para as argamassas utilizadas no revestimento.

Activity of bone cement loaded with daptomycin alone or in combination with gentamicin or PEG600 against Staphylococcus epidermidis biofilms.

Daptomycin is a promising candidate for local treatment of bone infection due to its activity against multi-resistant staphylococci. We investigated the activity of antibiotic-loaded PMMA against Staphylococcus epidermidis biofilms using an ultra-sensitive method bacterial heat detection method (microcalorimetry). PMMA cylinders loaded with daptomycin alone or in combination with gentamicin or PEG600, vancomycin and gentamicin were incubated with S. epidermidis-RP62A in tryptic soy broth (TSB) for 72h. Cylinders were thereafter washed and transferred in microcalorimetry ampoules pre-filled with TSB. Bacterial heat production, proportional to the quantity of biofilm on the PMMA, was measured by isothermal microcalorimetry at 37°C. Heat detection time was considered time to reach 20μW. Experiments were performed in duplicate. The heat detection time was 5.7-7.0h for PMMA without antibiotics. When loaded with 5% of daptomycin, vancomycin or gentamicin, detection times were 5.6-16.4h, 16.8-35.7h and 4.7-6.2h, respectively. No heat was detected when 5% gentamicin or 0.5% PEG600 was added to the daptomycin-loaded PMMA. The study showed that vancomycin was superior to daptomycin and gentamicin in inhbiting staphylococcal adherence in vitro. However, PMMA loaded with daptomycin combined with gentamicin or PEG600 completely inhibited S. epidermidis-biofilm formation. PMMA loaded with these combinations may represent effective strategies for local treatment in the presence of multi-resistant staphylococci.

Guide to Cement-Based Integrated Pavement Solutions, August 2011

This guide provides a clear, concise, and cohesive presentation of cement-bound materials options for 10 specific engineering pavement applications: new concrete pavements, concrete overlays, previous concrete, precast pavements, roller-compacted concrete, cement-treated base, full-depth reclamation with cement, cement-modified soils, recycled concrete aggregates, and repair and restoration. Each application is presented as a method for meeting specific design and construction objectives that today’s pavement practitioners must accomplish. The benefits, considerations, brief description, and summary of materials, design, and construction requirements, as well as a list of sustainable attributes, are provided for every solution. This guide is intended to be short, simple, and easy to understand. It was designed so that the most up-to-date and relevant information is easily extractable. It is not intended to be used as a design guide for any of the applications identified herein. Recommendations for additional information that can provide such details are given at the end of each solution discussion. The intended audience is practitioners, including engineers and managers who face decisions regarding what materials to specify in the pavement systems they design or manage. The audience also includes city and county engineers, along with the A/E firms that often represent them, and state DOT engineers at all levels who are seeking alternatives in this era of changing markets.

Workshop on Nanotechnology for Cement and Concrete, September 5, 2007

This document summarizes the discussions and findings of a workshop held in Arlington, VA, on September 5, 2007. The objective of the meeting was to provide national direction on areas of priority interest and collaboration between industry and public agencies specifically for applications of nanotechnology to cement and concrete.

Deicer Scaling Resistance of Concrete Mixtures Containing Slag Cement Phase 2: Evaluation of Different Laboratory Scaling Test Methods, TPF-5(100), 2012

With the use of supplementary cementing materials (SCMs) in concrete mixtures, salt scaling tests such as ASTM C672 have been found to be overly aggressive and do correlate well with field scaling performance. The reasons for this are thought to be because at high replacement levels, SCM mixtures can take longer to set and to develop their properties: neither of these factors is taken into account in the standard laboratory finishing and curing procedures. As a result, these variables were studied as well as a modified scaling test, based on the Quebec BNQ scaling test that had shown promise in other research. The experimental research focused on the evaluation of three scaling resistance tests, including the ASTM C672 test with normal curing as well as an accelerated curing regime used by VDOT for ASTM C1202 rapid chloride permeability tests and now included as an option in ASTM C1202. As well, several variations on the proposed draft ASTM WK9367 deicer scaling resistance test, based on the Quebec Ministry of Transportation BNQ test method, were evaluated for concretes containing varying amounts of slag cement. A total of 16 concrete mixtures were studied using both high alkali cement and low alkali cement, Grade 100 slag and Grade 120 slag with 0, 20, 35 and 50 percent slag replacement by mass of total cementing materials. Vinsol resin was used as the primary air entrainer and Micro Air® was used in two replicate mixes for comparison. Based on the results of this study, a draft alternative test method to ASTM C762 is proposed.

Beneficial Effects of Selected Additives on Asphalt Cement Mixes, HR-278, 1987

Effects of polyolefins, neoprene, styrene-butadiene-styrene (SBS) block copolymers, styrene-butadiene rubber (SBR) latex, and hydrated lime on two asphalt cements were evaluated. Physical and chemical tests were performed on a total of 16 binder blends. Asphalt concrete mixes were prepared and tested with these modified binders and two aggregates (crushed limestone and gravel), each at three asphalt content levels. Properties evaluated on the modified binders (original and thin-film oven aged) included: viscosity at 25 deg C, 60 deg C and 135 deg C with capillary tube and cone-plate viscometer, penetration at 5 deg C and 25 deg C, softening point, force ductility, and elastic recovery at 10 deg C, dropping ball test, tensile strength, and toughness and tenacity tests at 25 deg C. From these the penetration index, the viscosity-temperature susceptibility, the penetration-viscosity number, the critical low-temperature, long loading-time stiffness, and the cracking temperature were calculated. In addition, the binders were studied with x-ray diffraction, reflected fluorescence microscopy, and high-performance liquid chromatography techniques. Engineering properties evaluated on the 72 asphalt concrete mixes containing additives included: Marshall stability and flow, Marshall stiffness, voids properties, resilient modulus, indirect tensile strength, permanent deformation (creep), and effects of moisture by vacuum-saturation and Lottman treatments. Pavement sections of varied asphalt concrete thicknesses and containing different additives were compared to control mixes in terms of structural responses and pavement lives for different subgrades. Although all of the additives tested improved at least one aspect of the binder/mixture properties, no additive was found to improve all the relevant binder/mixture properties at the same time. On the basis of overall considerations, the optimum beneficial effects can be expected when the additives are used in conjunction with softer grade asphalts.

Asphalt Cement Concrete Pavement Recycling Cass and Montgomery Counties, HR-1018, 1986

This demonstration project consisted of three adjacent highway resurfacing projects using asphalt cement concrete removed from an Interstate highway which had become severely rutted. The salvaged asphaltic concrete was later crushed and hauled to a plant site where it was combined with virgin materials to resurface the three projects. Only two of the projects were used for performance evaluation as the third project was in an interchange area including ramps and was otherwise too short. It was concluded that recycling was cost effective and a high quality surface can be constructed using recycled asphalt cement concrete.

Asphalt Cement Concrete Longitudinal Joint Adhesive Crafco PN 34524 (Iowa DOT New Product C-98-7), HR-2084, 2000

The joint between two lanes of asphalt pavement is often the first area of a roadway which shows signs of deterioration and requires maintenance. As the final lift of hot asphalt is being placed in a construction project, it is being forced p against the adjoining lane of cold asphalt, forming the longitudinal joint. The mating of the two lanes, to form a high quality seal, is often not fully successful and later results in premature stripping or raveling as water enters the unsealed joint. The application of a hot poured rubberized asphaltic joint sealant along the joint face in the final stage of construction should help to form a watertight joint seal. A new product, especially formulated for the longitudinal joint in asphalt pavements was proposed to improve joint sealing. The following describes the experimental application of the new product, Crafco, PN 34524.

Asphalt Rubber Cement Concrete Webster County, HR-555, Construction Report, 1993

Discarded tires have become a major disposal problem in the U.S. Different techniques of recycling these discarded tires have been tried. The state of Iowa is currently evaluating the use of discarded tires ground into crumb rubber and blending it with asphalt to make asphalt rubber cement (ARC}. This was the sixth project this process has been used in. This project is located on US 169 from the east junction of IA 175 west and north to US 20. Only the binder course was placed this year with the surface course to be let at a later date. There are four test sections, two sections with conventional mixtures and two with ARC mixtures.

Polymerized Asphalt Cement, HR-533, 1989

In 1986, a 0.34 mile experimental section of polymerized asphalt cement (PAC30) concrete was placed in the westbound driving lane of Interstate 80 in western Iowa. It was used in a 2" asphalt concrete inlay using 20% recycled asphalt pavement. The virgin aggregate included 41% crushed gravel, 25% crushed quartzite and 14% natural sand. The evaluation of the project was severely limited when a 1987 reconstruction project extended into the experimental section leaving only 395 feet. Rut depths under a 4-foot gage were taken for a period of two years. No significant rutting occurred in the experimental polymerized section. The frequency of transverse cracking in the polymerized AC section was the same as that of the comparative AC-20 section. The asphalt paving mixture made with polymerized AC cost 120% of the cost of the conventional mix.

Evaluation of Type I Cement Fast Track Concrete, MLR-87-6, 1988

There are projects where opening the pavement to traffic in less than the 5 to 7 days is needed, but an 8 to 12 hour opening time is not necessary. The study examined fast track concrete with Type I cement and admixtures. The variables studied were: (1) cure temperature, (2) cement brand, (3) accelerators, and (4) water reducers. A standard water reducer and curing blankets appear to be effective at producing a 24 hour to 36 hour opening strength. An accelerator and/or high range water reducer may produce opening strength in 12 to 24 hours. Calcium chloride was most effective at achieving high-early strength.