Favourable outcomes of repeat one-stage exchange for periprosthetic joint infection of the hip

Aims One-stage exchange for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) is gaining popularity. The outcome for a repeat one-stage revision THA after a failed one-stage exchange for infection remains unknown. The aim of this study was to report the infection-free and all-cause revision-free survival of repeat one-stage exchange, and to investigate the association between the Musculoskeletal Infection Society (MSIS) staging system and further infection-related failure. Methods We retrospectively reviewed all repeat one-stage revision THAs performed after failed one-stage exchange THA for infection between January 2008 and December 2016. The final cohort included 32 patients. The mean follow-up after repeat one-stage exchange was 5.3 years (1.2 to 13.0). The patients with a further infection-related failure and/or all-cause revision were reported, and Kaplan-Meier survival for these endpoints determined. Patients were categorized according to the MSIS system, and its association with further infection was analyzed. Results A total of eight repeat septic revisions (25%) developed a further infection-related failure, and the five-year infection-free survival was 81% (95% confidence interval (CI) 57 to 92). Nine (28%) underwent a further all-cause revision and the five-year all-cause revision-free survival was 74% (95% CI 52 to 88). Neither the MSIS classification of the host status (p = 0.423) nor the limb status (p = 0.366) was significantly associated with further infection-related failure. Conclusion Repeat one-stage exchange for PJI in THA is associated with a favourable five-year infection-free and all-cause revision-free survival. Notably, the rate of infection control is encouraging when compared with the reported rates after repeat two-stage exchange. The results can be used to counsel patients and help clinicians make informed decisions about treatment. With the available number of patients, further infection-related failure was not associated with the MSIS host or limb status. Cite this article: Bone Joint J 2022;104-B(1):27–33.

MDITRE: scalable and interpretable machine learning for predicting host status from temporal microbiome dynamics

Longitudinal microbiome datasets are being generated with increasing regularity, and there is broad recognition that these studies are critical for unlocking the mechanisms through which the microbiome impacts human health and disease. Yet, there is a dearth of computational tools for analyzing microbiome time-series data. To address this gap, we developed an open-source software package, MDITRE, which implements a new highly efficient method leveraging deep-learning technologies to derive human-interpretable rules that predict host status from longitudinal microbiome data. Using semi-synthetic and a large compendium of publicly available 16S rRNA amplicon and metagenomics sequencing datasets, we demonstrate that in almost all cases, MDITRE performs on par or better than popular uninterpretable machine learning methods, and orders-of-magnitude faster than the prior interpretable technique. MDITRE also provides a graphical user interface, which we show through use cases can readily derive biologically meaningful interpretations linking patterns of microbiome changes over time with host phenotypes.

Immunological evaluation of patients with orthopedic infections: taking the Cierny–Mader classification to the next level

Introduction: Cierny–Mader osteomyelitis classification is used to label A, B, or C hosts based on comorbidities. This study's purpose was to define the “true” host status of patients with orthopedic infection using serologic markers to quantify the competence of their immune system while actively infected. Methods: Retrospective chart review identified patients at a single-surgeon practice who were diagnosed with orthopedic infection between September 2013 and March 2020 and had immunological laboratory results. All patients were A or B hosts who underwent surgery to eradicate infection. Medical history, physical examination, and Cierny–Mader classification were recorded. Laboratory results included complement total, C3, C4, immunoglobulin G (IgG), immunoglobulin M (IgM), immunoglobulin A (IgA), immunoglobulin E (IgE), rheumatoid factor, and antineutrophil cytoplasmic antibodies (ANCA) panel. Clinically significant results were defined as flagged abnormal. Normal complement levels and normal IgG levels were considered abnormal when infection was present. Results: Of 105 patients, 99 (94 %) had documented lab abnormalities. Clinically significant abnormalities were found in 33 of 34 (97 %) type-A hosts and 66 of 71 (93 %) type-B hosts. Eleven of 105 (10.5 %) patients were formally diagnosed with primary immunodeficiency by a hematologist. IgG deficiency, of either low or normal value, in the face of infection comprised 91 % (30 of 34) type-A hosts and 86 % (56 of 71) type-B hosts. Six (5.7 %) patients received IgG replacement therapy. Twenty-eight patients had abnormal total complement levels (low or normal): 7.4 % (2 of 34) A hosts and 40 % (26 of 71) B hosts (p=0.002). B hosts had statistically significantly lower complement levels and significantly more no-growth cultures (p<0.03). Thirteen of 14 patients with recurrent infections had low or normal IgG levels. IgM was significantly lower between reinfected patients and those without reinfection (p=0.0005). Conclusions: Adding immunologic evaluation to the Cierny–Mader classification more accurately determines patients' true host status and better quantifies risk and outcome with respect to orthopedic infection. Immunologically deficient A hosts should be quantified as B hosts. IgG deficiencies may be addressed when deemed appropriate by the consulting hematologist/immunologist. Patients with recurrent infections had significantly lower IgM levels than their nonrecurrent infection counterparts.

Annotated bibliography of selected themes on New Zealand rugby literature 1967-2003

<p>New Zealand has always prided itself as being the premier rugby nation. Rugby has been a major influence that has shaped the way we see ourselves. It is more than simply our national sport. Rugby has been a mirror reflecting the state of our society, our national character. Currently New Zealand rugby is experiencing a relative lean time and in any time of hardship it is common to look back and reflect on the good times while also analysing the not so good times. During the period 1998-2002 the success of the national rugby team had waned, no Bledisloe Cup which had previously been considered a given, no World Cup since 1987 and narrow last minute losses and it has been suggested by writers, supporters, talk back callers and former players that players may have attained a state of softness, greed and lack of initiative, removing them from the environment which supposedly made them strong and which they are meant to represent. The unexpected defeat by France at the semi final stage of the 1999 World Cup and the loss of sub-host status for the 2003 World Cup dealt hammer blows to its confidence in the New Zealand game and those running it. Those in charge were found guilty and vilified. In the first stage of this national enquiry the team was accused of cowardice and capitulation to the enemy. Rugby journalists and former greats described the All Blacks as spineless, clueless, leaderless, gutless, panic stricken, lacking in skills and perhaps worst of all soft up front. Embittered kiwi fans wanted a cruel and protracted revenge for what they seemed to regard as a personal betrayal. Either through gross incompetence or dereliction of duty (All Black coach) Hart had let them down (Thomas 2003, 79). These suggestions began a series of debates that continue to this day. However upon closer examination it appears that some of these concerns have been articulated before, particularly in times of disappointments and defeat. Even in times of great success there have still been voices that cry out for change or re-evaluation. Overreaction to a rugby defeat has been a common reaction within New Zealand society as we reflect inwards and feel the need to apportion blame. The increased commercialisation that led to the success of the World Cup in 1987, the return from isolation of South Africa in 1992, the dramatic entry of professionalism in 1995 and the harsh reality of player drain are just a few issues that have enlivened or (depending on your standpoint) threatened the standing of our national sport. Some rugby literature seeks to help illuminate and understand how rugby came to be an important nation builder with reference to Imperialism and making our way in the Commonwealth. The 1905 Originals intensified the belief of colonial physical and mental superiority. Other themes that have shaped our history have been race relations, rugby violence and its rationalization of its place in rugby, the pre-eminence of the rugby hard man and how these perceptions have changed through the era of amateurism to the age of professionalism. Many of these themes are intertwined and have influenced the style in which we have played, which in turn have influenced how we perceive ourselves through rugby, and how the rest of the world sees us through rugby.</p>

Annotated bibliography of selected themes on New Zealand rugby literature 1967-2003

<p>New Zealand has always prided itself as being the premier rugby nation. Rugby has been a major influence that has shaped the way we see ourselves. It is more than simply our national sport. Rugby has been a mirror reflecting the state of our society, our national character. Currently New Zealand rugby is experiencing a relative lean time and in any time of hardship it is common to look back and reflect on the good times while also analysing the not so good times. During the period 1998-2002 the success of the national rugby team had waned, no Bledisloe Cup which had previously been considered a given, no World Cup since 1987 and narrow last minute losses and it has been suggested by writers, supporters, talk back callers and former players that players may have attained a state of softness, greed and lack of initiative, removing them from the environment which supposedly made them strong and which they are meant to represent. The unexpected defeat by France at the semi final stage of the 1999 World Cup and the loss of sub-host status for the 2003 World Cup dealt hammer blows to its confidence in the New Zealand game and those running it. Those in charge were found guilty and vilified. In the first stage of this national enquiry the team was accused of cowardice and capitulation to the enemy. Rugby journalists and former greats described the All Blacks as spineless, clueless, leaderless, gutless, panic stricken, lacking in skills and perhaps worst of all soft up front. Embittered kiwi fans wanted a cruel and protracted revenge for what they seemed to regard as a personal betrayal. Either through gross incompetence or dereliction of duty (All Black coach) Hart had let them down (Thomas 2003, 79). These suggestions began a series of debates that continue to this day. However upon closer examination it appears that some of these concerns have been articulated before, particularly in times of disappointments and defeat. Even in times of great success there have still been voices that cry out for change or re-evaluation. Overreaction to a rugby defeat has been a common reaction within New Zealand society as we reflect inwards and feel the need to apportion blame. The increased commercialisation that led to the success of the World Cup in 1987, the return from isolation of South Africa in 1992, the dramatic entry of professionalism in 1995 and the harsh reality of player drain are just a few issues that have enlivened or (depending on your standpoint) threatened the standing of our national sport. Some rugby literature seeks to help illuminate and understand how rugby came to be an important nation builder with reference to Imperialism and making our way in the Commonwealth. The 1905 Originals intensified the belief of colonial physical and mental superiority. Other themes that have shaped our history have been race relations, rugby violence and its rationalization of its place in rugby, the pre-eminence of the rugby hard man and how these perceptions have changed through the era of amateurism to the age of professionalism. Many of these themes are intertwined and have influenced the style in which we have played, which in turn have influenced how we perceive ourselves through rugby, and how the rest of the world sees us through rugby.</p>

Irrigation and Rootstocks to Manage Northern Root-Knot Nematode During Wine Grape Vineyard Establishment

Vineyard replanting in Washington state can be negatively impacted by the plant-parasitic nematode Meloidogyne hapla. Chemically-focused nematode management programs do not offer long-term suppression, however, this may be achieved through the adoption of cultural approaches such as rootstocks and irrigation. Nematode-resistant rootstocks are used extensively in other regions, but many have not been tested against M. hapla. Vineyards in eastern Washington are irrigated, so manipulating available soil water may also impact nematode development. In 2017, two field trials were established in eastern Washington to evaluate the effects of: 1) late-summer water limitation on M. hapla population development, and 2) host status of 1103 Paulsen, 3309 Couderc and Matador rootstocks for M. hapla. The efficacy of these cultural management approaches was evaluated under three initial M. hapla densities (0, 50, and 250 M. hapla J2 per 250 g soil) in both trials. Reducing irrigation to manage M. hapla infestation of grape roots was ineffective and may cause harm to the vines by inducing too much water stress. Conversely, rootstocks effectively reduced population densities of M. hapla. Overall, rootstocks show the most promise as a cultural tool to manage M. hapla during the establishment phase in Washington vineyards.

Host suitability of summer cover crops to Meloidogyne arenaria, M. enterolobii, M. incognita and M. javanica

Summary Cover crops can be a useful tool for managing plant-parasitic nematodes provided they are poor or non-hosts for the target nematode species. A glasshouse experiment was done to determine the host status of four common cover crops in Florida, sunn hemp, cowpea, sorghum sudangrass and sunflower, to pure populations of four common tropical root-knot nematode (RKN) species Meloidogyne javanica (Mj), M. incognita (Mi), M. enterolobii (Me) and M. arenaria (Ma). Tomato was included as a susceptible control. Eight weeks after nematode inoculation (WAI), tomato showed the highest root gall damage for all tested RKN species, with gall indices (GI) between 7 (Ma) and 8.5 (Me) and reproduction factor (RF) ranging from 20 (Ma) to 50 (Mj). No visible root galls were observed for any of the RKN species on sunn hemp and sorghum sudangrass at 8 WAI. However, Mj and Mi were able to reproduce slightly on sorghum sudangrass (RF = 0.02 and 0.79, respectively). Sunflower and cowpea were infected by all four tested RKN species, but host suitability varied. Sunflower root galling ranged from 1.1 (Me) to 4.5 (Mj) and RF = 3.2 (Me) to 28.7 (Mj), while cowpea root galling ranged from 0.6 (Mi) to 5.1 (Me) and RF = 0.8 (Mi) to 67.3 (Mj). Sunn hemp and, to a lesser extent, sorghum sudangrass were poor hosts to all four tested RKN species. Sunflower was a good host to all RKN species, but root gall damage and RF were lowest for Me. Cowpea was a good host to Mj, Me and Ma, but a poor host to Mi. Our results confirm and stress the importance of RKN species identification when selecting cover crops as an RKN management strategy.