Partial Exchange Research Articles

Limb salvage surgery of primary and metastatic bone tumors of the lower extremity: Functional outcomes and survivorship of modular endoprosthetic reconstruction.

The study was aimed to determine the survivorship and functional outcomes of modular endoprosthetic reconstruction in the management of primary and metastatic bone tumors of the lower limbs and to investigate the rate and causes of implant failure. A total of 84 limbs of 82 patients (49 male, 33 female; mean age=48 years, age range=13-78 years) with a minimum follow-up of 12 months in whom resection and modular endoprosthetic reconstructions were performed for primary or metastatic bone tumors of the lower extremity were retrospectively reviewed and included in the study. The mean follow-up was 43 (range=13-119) months. Functional status was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system at the final follow-up. Implant survival was defined as the time from implantation until partial or complete exchange of the prosthesis secondary to mechanical or nonmechanical causes or amputation. The effects of the anatomical site on functional scores and implant survival were statistically analyzed. Additionally, the effects of diagnosis and adjuvant treatments on functional scores, implant survival, and failure rates were investigated. At the time of the study, 55 patients were still alive with a mean follow-up of 48 (range=15-119) months. The mean MSTS scores resulting from the final follow-up of all patients and of those surviving were 87.9% (range=16%-100%) and 86.8% (range=16%-100%), respectively. Overall implant survival was 95.2%, 89.2%, 87%, and 87% at 1, 2, 3, and 4 years, respectively. Statistically, both functional scores and implant survival analysis in different anatomical sites were found similar. In 15 of the patients (17.8%), endoprosthetic reconstructions had failed. The causes of failure were soft tissue failure (dislocation) in 5 patients, infection in 5, structural/mechanical failure in 2, local recurrence in two, and aseptic loosening in one. The diagnosis and receiving preoperative and/or postoperative adjuvant treatment did not affect functional scores, implant survival or failure rates. The results of this study have shown that modular endoprosthetic replacement can provide satisfactory functional results and a durable mid-term limb salvage option in the management of patients with primary and metastatic bone tumors of the lower limbs. Level IV, Therapeutic Study.

Partial exchange of ozone by electron beam irradiation shows better viscosity control and less oxidation in cellulose upgrade scenarios

Electron beam irradiation (EBI) is an alternative treatment for intrinsic viscosity (IV) control in cellulose pulps, but has never been integrated in full bleaching sequences for comparison to conventional methods. Both eucalyptus kraft (EK) paper pulp and beech sulfite (BS) dissolving pulp were subjected to totally chlorine free (TCF) bleaching sequences comprising either EBI, ozone, or both for IV control. Additionally, effects of EBI on hexenuronic acid (HexA) and xylan were investigated. IV was adjusted to 450–500 mL g−1 and properties including carbonyl content, kappa, brightness, alkali-resistance and sugar composition were compared. Pulps produced with EBI had a higher alkali-resistance, uniformity and less cellulose oxidation. However, the degree of bleaching (DoB) was low without the use of ozone. HexA content in a birch pulp was halved by EBI. Isolated xylans were more resistant to irradiation than cellulose with little decrease of molar masses and moderate oxidation.

Consensus-Based Estimation for Type-2 Fuzzy Time-Delay Systems Under Deception Attacks and Partial Information Exchange

This paper addresses the problem of consensus-based state estimation for interval type-2 Takagi–Sugeno (T–S) fuzzy time-delay systems over a wireless sensor network under deception attacks, partial information exchange and switching sensor-network topologies. The switching-topology-dependent estimators are constructed using interval type-2 fuzzy models considering the cases where the premise variables are available and unavailable. By means of the mode-dependent dwell time approach, sufficient conditions are established such that the estimation error system is exponentially and ultimately bounded. In addition, a fuzzy Lyapunov functional is utilized to derive the existence conditions of estimators for the case that the premise variable are unavailable. Two illustrative examples are provided to verify the effectiveness of the proposed method.

Does the retention of osseointegrated prosthetic implants during the surgical management of chronic infections following reverse total shoulder arthroplasty (RTSA) influence functional outcomes without impacting the efficacy of the infection treatment?

IntroductionThe gold standard (GS) for treating chronic infections following reverse total shoulder arthroplasty (RTSA) is a complete exchange of the prosthesis carried out in one or two stages. This surgical procedure, which may damage the bone stock, can result in poor functional outcomes due to intraoperative complications. The purpose of this study was to compare the GS to a surgical technique that retained osseointegrated implants: the partial one-stage exchange. HypothesisPartial one-stage exchange was effective in treating chronic infections after RTSA (no recurrent infection) and resulted in better functional outcomes than the GS. Materials and methodsThis retrospective single-center study included 18 patients with chronic infection after a primary RTSA. Two treatments were compared in a non-randomized fashion. The first included 11 patients who underwent a partial one-stage exchange with implant retention in case of macroscopic osseointegration. The second included seven patients who were treated with the GS: six patients with a complete one-stage exchange and one patient with a two-stage surgical approach. The absence of recurrent infection and functional outcomes were assessed after a minimum of two years. ResultsThere were no statistically significant differences in treatment efficacy between the two strategies: 91% vs. 100%, respectively. The partial one-stage exchange resulted in a significantly improved shoulder function compared to the GS with postoperative Constant scores of 55±14.58 vs. 44±14.45, respectively (p=.03). In the partial one-stage exchange group, there was a significantly improved shoulder function with a preoperative Constant score of 40 [28–55]±9.04 preoperatively vs. 55 [25–75]±14.58 postoperatively (p=.01). The GS treatment did not significantly improve the postoperative function (p=.09). DiscussionPartial one-stage exchange does not compromise treatment efficacy of chronic infections after RTSA. This technique resulted in better shoulder function than a conventional GS-type management. A study with greater statistical power is required. Level of evidenceIII; clinical series, retrospective, single-center.

The Influence of Exchange Rate, Inflation, For the Results of the Development Assets of Islamic Banks

This study aims to determine how much influence the exchange rate, inflation, for the results of partial and simultaneous influence on the development of the assets of islamic banks in Indonesia. This study using the technique of regression analysis of panel data, i.e. using data pooling cross section and time series, where this research was conducted by using test specifications model common effect and fixed effect using the test chow test and hausman. The population and sample of this research is financial statement quarter 10 sharia commercial banks and sharia business units that exist in Indonesia. The Model chosen in this study is the Fixed Effect Model (FEM). The results showed that the partial variable exchange rate and inflation have a positive but not significant to the development of the assets of islamic banks, while the variable for the result and significant positive effect on the development of the assets of islamic banks. While simultaneously the variables of exchange rate, inflation, and for the results and significant positive effect on the growth of assets of islamic banks.

Metal Cation Valency Dependence in Morphology Evolution of Cu2-x S Nanodisk Seeds and Their Pseudomorphic Cation Exchanges.

A crucial parameter in the design of semiconductor nanoparticles (NPs) with controllable optical, magnetic, electronic, and catalytic properties is the morphology. Herein, we demonstrate the potential of additive metal cations with variable valency to direct the morphology evolution of copper-deficient Cu2-x S nanoparticles in the process of seed-mediated growth. In particular, the djurleite Cu1.94 S seed could evolve from disk into tetradecahedron in the presence of tin(IV) cations, whereas they merely formed sharp hexagonal nanodisks with tin(II) cations. In addition to djurleite Cu1.94 S, the tin(IV) cations could be generalized to direct the growth of roxbyite Cu1.8 S and covellite CuS nanodisk seeds into tetradecahedra. We further perform pseudomorphic cation exchanges of Cu1.94 S tetradecahedra with Zn2+ and Cd2+ to produce polyhedral zinc sulfide (ZnS) and cadmium sulfide (CdS) NPs. Moreover, we achieve Cu1.8 S/ZnS and Cu1.94 S/CdS tetradecahedral heterostructures via partial cation exchange, which are otherwise inaccessible by traditional synthetic approaches.

Effect of partial exchange of lactose with fat in milk replacer on ad libitum feed intake and performance in dairy calves

Compared with Holstein whole milk, commercial milk replacers (MR) for calves deliver relatively high levels of lactose and low levels of fat, and protein levels are rather comparable, resulting in a lower energy density and energy-to-protein ratio of the diet. Thus, the objective of this study was to determine the effects of partially exchanging lactose with fat in MR on voluntary feed intake, growth performance, and feeding behavior. Thirty-two male Holstein calves (2.1 ± 0.16 d of age, 46.4 ± 0.77 kg of body weight; BW) were assigned to 16 blocks of 2 calves per block based on arrival date and serum IgG. Within each block, calves were randomly assigned to 2 treatments: a high-lactose MR (HL; 17% fat; 44% lactose), or a high-fat MR (HF; 23% fat; 37% lactose). Lactose was exchanged by fat on a weight per weight basis, resulting in a 6% difference in metabolizable energy density per kilogram of MR. The experiment was divided into 3 phases: preweaning (P1; 0-35 d), weaning (P2; 36-56 d), and postweaning (P3; 57-84 d). For the first 2 wk of P1, calves were individually housed, fed their respective MR ad libitum through teat buckets, and provided access to water. At 14.2 ± 0.5 d of age, calves were group-housed (4 blocks/pen, 8 calves) and housed in group pens for the remainder of the study. In the group pens, calves were fed ad libitum MR, starter feed, chopped wheat straw, and water via automated feeders. During P2, calves were gradually weaned until complete milk withdrawal by 57 d and then monitored until 84 d (P3). Measurements included daily intakes and feeding behavior (rewarded and unrewarded visits), weekly BW and body measurements, and biweekly blood samples. Increasing fat content at the expense of lactose decreased MR intake during P1 by 15% (HL = 1.32 ± 0.04; HF = 1.17 ± 0.04 kg of dry matter per day), whereas total starter intake was not affected by MR composition. Once MR was restricted during P2, HL calves were reported to have more unrewarded visits to the automatic milk feeder than HF calves (11.9 ± 0.95 vs. 8.4 ± 1.03 visits/d, respectively). Crude protein intake was higher for HL calves during P1 (352.1 ± 11.2 vs. 319.6 ± 11.6 g/d), which was attributed to the higher intake of MR during that period, and metabolizable energy intake and protein-to-energy ratio remained comparable between treatments. Plasma cholesterol and nonesterified fatty acids levels were higher in HF calves as a consequence of the diet. Nevertheless, final BW (84 d) did not differ between treatments. Overall, calves fed ad libitum seemed to regulate their intake of MR based on its energy density, without significant effects on solid feed intake and overall growth.

Defect Structure, Transport Properties, and Chemical Expansion in Ba0.95La0.05FeO3– δ

This work systematically investigates the oxygen nonstoichiometry, defect structure and mass/charge transport properties of Ba0.95La0.05FeO3−δ (BLF). Thermogravimetric measurement and coulometric titration were performed to determine change in oxygen nonstoichiometry (δ) with oxygen partial pressure () in 10−17 ≤ (/atm) ≤ 0.21 and 850 ≤ (T/°C)≤900 range. The δ−−T plot showed “S-type” shape with a crossover plateau around δ ≈ 0.475. Defect modelling was used to explain the nonstoichiometry data and partial molar thermodynamic quantities for oxygen were determined. The DC 4-probe conductivity measurement was performed which showed a typical semiconductor-to-metal transition with temperature around the conductivity maxima at 450 °C. Electrical conductivity relaxation (ECR) measurement was performed to extract partial ionic conductivity, chemical diffusivity and surface exchange kinetics of oxygen ion by using Nernst-Einstein equation and Fick’s law. Isothermal chemical expansion was measured by dilatometry measurement in the range of 10−2 ≤ (/atm) ≤ 0.21 and 850 ≤ (T/°C) ≤ 950.

Reversible Diels–Alder Reactions with a Fluorescent Dye on the Surface of Magnetite Nanoparticles

Diels–Alder reactions on the surface of nanoparticles allow a thermoreversible functionalization of the nanosized building blocks. We report the synthesis of well-defined magnetite nanoparticles by thermal decomposition reaction and their functionalization with maleimide groups. Attachment of these dienophiles was realized by the synthesis of organophosphonate coupling agents and a partial ligand exchange of the original carboxylic acid groups. The functionalized iron oxide particles allow a covalent surface attachment of a furfuryl-functionalized rhodamine B dye by a Diels–Alder reaction at 60 °C. The resulting particles showed the typical fluorescence of rhodamine B. The dye can be cleaved off the particle surface by a retro-Diels–Alder reaction. The study showed that organic functions can be thermoreversibly attached onto inorganic nanoparticles.

Transformations of Ionic Nanocrystals via Full and Partial Ion Exchange Reactions.

ConspectusElaborate chemical synthesis methods allow the production of various types of inorganic nanocrystals (NCs) with uniform shape and size distributions. Many single-step synthesis approaches, such as the reduction of metal ions, the decomposition of metal complexes, double replacement reactions, and hydrolysis, have been adapted to promote the generation of monodisperse metal and ionic NCs. However, the question has become, how can we synthesize NCs with thermodynamically metastable phases or very complex structures? The transformation of already-synthesized NCs via elemental substitutions, such as ion exchange reactions for ionic NCs and galvanic replacement reactions for metal NCs, can overcome the difficulties facing conventional one-step syntheses. In particular, NC ion exchange reactions have been studied with numerous combinations of foreign ions and ionic NCs with various shapes. They have been investigated extensively because the reactions proceed under relatively mild conditions thanks to the large surface-to-volume ratio of the NCs relative to their bulk form. The functionality of the resulting ionic NCs, including semiconducting and plasmonic properties, can be easily tuned in a wide range, from the visible to near-infrared. Because anions generally have much larger ionic radii than cations within the frameworks of NCs, the cation exchange reactions proceed much faster than the anion exchange reactions. For ionic NCs above a critical size, the anion framework remains intact, and the original shape of the parent NCs is retained throughout the cation exchange reaction. In contrast, the anion exchange reaction often provides the new NCs with unique structures, such as hollow or anisotropically phase-segregated assemblies.This Account focuses on the full and partial ion exchange reactions involving ionic NCs, which have been thoroughly investigated by our group and others while highlighting important aspects such as the preservation of appearance and dimensions. First, we discuss how each type of ion exchange reaction progresses to understand the morphologies and crystal structures of their final products. This discussion is supported by emphasizing important examples, which help to explore the formation of NCs with thermodynamically metastable phases and complex structures, and other significant features of the ion exchange reactions leading to structure-specific functions. As a special case, we examine how the shape-dependent anionic framework (surface anion sublattice and stacking pattern) of polyhedral Cu2O NCs determines the crystalline structure of the anion-exchanged products of hollow CuxS NCs. In addition, we review the characteristic anion exchange behavior of metal halide perovskite NCs observed in our laboratory and other laboratories. Finally, a general outline of the transformation of NCs via ion exchange reactions and future prospects in this field are provided.

Realization of arbitrary two-qubit quantum gates based on chiral Majorana fermions* *Project supported by the National Key R&D Program of China (Grant No. 2017YFA0303301), the National Natural Science Foundation of China (Grant No. 11921005), the Strategic Priority Research Program of Chinese Academy of Sciences (Grant No. XDB28000000), and Beijing Municipal Science & Technology Commission, China (Grant No. Z191100007219013).

Quantum computers are in hot-spot with the potential to handle more complex problems than classical computers can. Realizing the quantum computation requires the universal quantum gate set {T, H, CNOT} so as to perform any unitary transformation with arbitrary accuracy. Here we first briefly review the Majorana fermions and then propose the realization of arbitrary two-qubit quantum gates based on chiral Majorana fermions. Elementary cells consist of a quantum anomalous Hall insulator surrounded by a topological superconductor with electric gates and quantum-dot structures, which enable the braiding operation and the partial exchange operation. After defining a qubit by four chiral Majorana fermions, the single-qubit T and H quantum gates are realized via one partial exchange operation and three braiding operations, respectively. The entangled CNOT quantum gate is performed by braiding six chiral Majorana fermions. Besides, we design a powerful device with which arbitrary two-qubit quantum gates can be realized and take the quantum Fourier transform as an example to show that several quantum operations can be performed with this space-limited device. Thus, our proposal could inspire further utilization of mobile chiral Majorana edge states for faster quantum computation.

Lithium storage performance of α-Ni(OH)2 regulated by partial interlayer anion exchange

Hierarchical flower-like α-Ni(OH)2 with interlayer NO3− is prepared via a homogeneous precipitation method. To optimize the lithium storage performance of the α-Ni(OH)2 sample, the interlayer NO3− is partially exchanged by Cl−, SO42−, CO32−, PO43−, and OH−, respectively. The results demonstrate that the α-Ni(OH)2 samples exchanged by SO42−, CO32−, Cl−, and OH− exhibit improved rate capability and enhanced pseudocapacitive behavior. The α-Ni(OH)2 with interlayer NO3− and the ones exchanged by SO42− and Cl− suffer from poor cyclic stability after 50 cycles at a current density of 1.0 A g−1. In contrast, the α-Ni(OH)2 samples exchanged by CO32−, PO43−, and OH− exhibit much-enhanced cyclic stability compared to the α-Ni(OH)2 with interlayer NO3−. The α-Ni(OH)2 with interlayer NO3− and the ones exchanged by SO42− and Cl− deliver capacities of 265, 197, and 341 mA h g−1, respectively, after 500 cycles at a current density of 1.0 A g−1, while the α-Ni(OH)2 samples exchanged by CO32−, PO43−, and OH− maintain reversible capacities of 980, 1172, and 879 mA h g−1, respectively, after 500 cycles at a current density of 1.0 A g−1. This work provides a new avenue for the rational design and performance optimization of α-Ni(OH)2 as an anode material for lithium-ion batteries.

Observations on 24-hour ex situ normothermic liver perfusion

In human liver transplantation, normothermic machine perfusion is being applied with increasing frequency, though little has been published regarding its extended application (≥24h). Purpose: Perfuse livers 24h to optimize technique of extended ex situ liver perfusion in a pre-clinical model. Method: Following donor exsanguination, pig livers (N=12) are recovered and connected to the NMP device (Devocean-Liver2000, Devocean Medical Instruments, Ltd., Guangdong, China) via the portal vein, hepatic artery, and common bile duct. The caval vein is left open; perfusate flows from graft to receptacle, where it is recovered, reoxygenated, reheated, and returned to the hepatic artery as pulsatile flow and portal vein as continuous flow. Perfusion commences with blood mixed with calcium and antibiotics. Parenteral nutrition, insulin, heparin, multivitamins, and trace elements are infused continuously. Hemodynamic, gasometric, and biochemical parameters are serially monitored, as are bile production and composition. In 6/12 livers, partial exchange of perfusate with fresh whole blood was performed at 12h. Results: All livers were perfused for 24h. After 1h, hemodynamic parameters remained stable, without need for exogenous vasoactive substances. In the perfusate, glucose and lactate levels decreased progressively. Transaminase levels remained relatively stable, while urea levels increased progressively, even in spite of partial perfusate exchange in 6/12 cases. Bile production was constant. In bile, glucose levels declined to undetectable, while pH, bicarbonate, and sodium increased progressively. Conclusions: This strategy of NMP adequately maintains livers for 24h, though longer perfusions might require addition of dialysis to avoid effects of increasing urea.

How the Solid/Liquid Ratio Affects the Cation Exchange Process and Porosity in the Case of Dioctahedral Smectite: Structural Analysis?

The performance of a clay mineral geomembrane used in the context of a geological barrier for industrial and radioactive waste confinement must pass through the understanding of its hydrous response as well as the limits of the cation exchange process which are closely related to the solid/liquid ratio constraint. The Na-rich montmorillonite is used, as starting material, to evaluate the link between the applied external constraint (variable solid/liquid ratio) and the structural response of the material. The geochemical constraint is realized at the laboratory scale, and the possible effects are investigated in the cases of Ba2+ and Ni2+ heavy metal cations. The structural analysis is achieved using the XRD profile modeling approach to quantify the interlayer space (IS) deformation. The quantitative XRD analysis, which consists of the comparison of experimental 001 reflections with the calculated ones deduced from structural models, allowed us to determine the optimal structural parameters describing IS configuration along the [Formula: see text] axis. The obtained result showed an interstratified hydration character, for both studied exchangeable cations, regardless of the solid/liquid ratio being described probably by a partial cation exchange process. The theoretical mixed layer structure (MLS) suggests the coexistence of more one cristallite species saturated by more than one exchangeable cations, indicating a partial saturation of all exchangeable sites. The optimum structural parameter values, from the theoretical model, allowed us to follow the evolution of several intrinsic properties versus the applied constraint strength. The variable solid/liquid ratio effect on the material porosity is examined by the BET-specific surface area and BJH pore size distribution (PSD) analyses. The adsorption measurement outcomes confirm XRD results concerning mainly the link between several intrinsic clay properties and the constraint strength.

Nucleophilic iodonium interactions (NIIs) in 2-coordinate iodine(I) and silver(I) complexes.

The generality of nucleophilic iodonium interactions (NIIs) has been demonstrated by preparing a range of silver(i) and iodonium (I+) complexes and studying their 15N NMR chemical shifts, with the first example of a NII-complex involving a 2-coordinate silver(i) complex being confirmed by X-ray crystallography, and its nucleophilicity studied by DFT calculations.

Delayed Cord Clamping in Infants of Diabetic Mothers: Laboratory and Clinical Outcomes

AbstractThe aim of this study was to compare the effects of delayed cord clamping (DCC) and early cord clamping (ECC) on venous hematocrit (htc) and clinical outcomes in infants of diabetic mothers (IDMs). This prospective randomized study included 157 term IDMs. The umbilical cords of these infants were clamped at least 60 seconds in group I (DCC group, n = 79) and as soon as possible after birth in group II (ECC group, n = 78). The two groups were compared regarding neonatal venous htc levels, hypoglycemia rates, jaundice requiring phototherapy, respiratory distress, and admission to the neonatal intensive care unit (NICU). Hematocrit levels were significantly higher in the DCC group, both at 6 and 24 hours postnatally (p = 0.039 and 0.01), respectively. Polycythemia frequency was higher in DCC than the ECC group, but no patient in either group needed partial exchange transfusion (PET). Rates of jaundice were significantly higher in the DCC group (p = 0.028), but there was no significant difference between the two groups regarding jaundice requiring phototherapy (p = 0.681). There were no differences between the groups regarding hypoglycemia rates, need for glucose infusion, or respiratory distress. The incidence of admission to NICU was lower in the DCC group (p = 0.005). Early clamping was a significant predictor for increased risk of NICU admission. DCC increased polycythemia and jaundice rates but did not increase the need for PET or phototherapy. Also, DCC reduced the severity of respiratory distress and the subsequent need for NICU admission.

DMPC-Based Coordinated Voltage Control for Integrated Hybrid Energy System

High penetration and fluctuation of renewable energy resources are threatening the voltage security of the integrated hybrid energy system (IHES). This article focuses on providing a fully distributed method to ensure the voltage security and information privacy of the IHES. First, a multiagent system based control scheme is presented, in which the upper level agent is responsible for the voltage security of the whole system, and the local dynamic performance of each distributed energy resource (DER) unit is formulated in the lower level unit agent. Second, a distributed model predictive control (DMPC) based coordinated voltage control method is proposed, by which only partial information exchange is needed in the interaction. Furthermore, the diverse requirements on voltage quality of each microgrid in the IHES are considered in this article and it provides a novel paradigm in this field compared with the traditional methods. To study the stability of the resultant DMPC, the Nash equilibrium is achieved and theoretically proved to ensure the convergence of the proposed method. Finally, the validity of the proposed method is verified by virtue of the simulation and experimental test results.

Increasing Resistance to Reserve Antibiotics: The Experience of a Tertiary Level Neonatal Intensive Care Unit.

Blood stream infections are considered as a major cause of morbidity and mortality in neonates. Recent trend shows increasing resistance to commonly used antibiotics. The aim of this study is to find the antibiotic susceptibility pattern of various bacteria from blood samples in neonates and associated risk factors. All consecutive cases of intramural neonatal sepsis were enrolled for >12 months. Before starting or changing antibiotic, blood sample under all aseptic precautions was taken for culture. Clinical and demographic details were recorded to analyze risk factors for sepsis. Antibiotic sensitivity tests were done as per CLSI 2019 guidelines. Of the 898 participants, 107 showed culture positivity. Klebsiella pneumoniae (25.2%) and Coagulase-negative Staphylococcus (23.3%). The blood culture positivity rate was 11.9%. Approximately 79% of isolates were multidrug-resistant: extended-spectrum beta-lactamase 90%, carbapenemase-resistant Enterobacteriaceae 27.7% and MRSA 43%. The risk factors found to be associated with sepsis were period of gestation ≤37 weeks, meconium-stained liquor, birth weight <1500 g, mechanical ventilation, partial exchange transfusion, duration of antibiotics for >10 days and duration of both NICU stay and hospital stay for >10 days. The case fatality rate (CFR) was more due to K. pneumoniae (19.2%) and the relative risk of death was 2.53 in culture-positive cases with an attributable risk of 60% and the population attributable risk of 15.4%. Increase in antibiotic resistance organisms can lead to an increase in the neonatal CFR, so regular surveillance is needed.

Direct Inpatient Medical Costs of Operative Treatment of Periprosthetic Hip and Knee Infections Are Twofold Higher Than Those of Aseptic Revisions.

Periprosthetic joint infections (PJIs) following total hip arthroplasty (THA) and total knee arthroplasty (TKA) are associated with substantial morbidity. A better understanding of the costs of PJI treatment can inform prevention, treatment, and reimbursement strategies. The purpose of the present study was to describe direct inpatient medical costs associated with the treatment of hip and knee PJI. At a single tertiary care institution, 176 hips and 266 knees that underwent 2-stage revisions for the treatment of PJI from 2009 to 2015 were compared with 1,611 hips and 1,276 knees that underwent revisions for aseptic indications. In addition, 84 hips and 137 knees that underwent irrigation and debridement (I&D) with partial component exchange were compared with 39 hips and 138 knees that underwent partial component exchange for aseptic indications. Line-item details of services billed during hospitalization were retrieved, and standardized direct medical costs were calculated in 2018 inflation-adjusted dollars. The mean direct medical cost of 2-stage revision THA performed for the treatment of PJI was significantly higher than that of aseptic revision THA ($58,369 compared with $22,846, p < 0.001). Similarly, the cost of 2-stage revision TKA performed for the treatment of PJI was significantly higher than that of aseptic revision TKA ($56,900 compared with $24,630, p < 0.001). Even when the total costs of aseptic revisions were doubled for a representative comparison with 2-stage procedures, the costs of PJI procedures were 15% to 28% higher than those of the doubled costs of aseptic revisions (p < 0.001). The mean direct medical cost of I&D procedures for PJI was about twofold higher than of partial component exchange for aseptic indications. The direct medical costs of operative treatment of PJI following THA and TKA are twofold higher than the costs of similar aseptic revisions. The high economic burden of PJI warrants efforts to reduce the incidence of PJI. Reimbursement schemes should account for the high costs of treating PJI in order to ensure sustainable patient care. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Intraocular mitomycin C use in the treatment and prophylaxis of proliferative vitreoretinopathy in severe traumatic retinal detachments.

To evaluate the anatomic and visual outcomes of a new intraocular mitomycin c (MMC) application technique in the treatment of severe traumatic retinal detachment (RD) with advance proliferative vitreoretinopathy (PVR). The records of 15 eyes of 14 patients who underwent vitreoretinal surgery and intraoperative MMC application were reviewed retrospectively. After performing complicated vitreoretinal surgical procedures (Pars plana vitrectomy, PVR membrane stripping, large retinotomy/retinectomies and intraocular foreign body removal if found etc. . .) retina was attached with perfluorocarbon liquid (PFCL) and partial fluid-air exchange. Endolaser was performed. PFCL was removed to the posterior borders of retinochoroidal wounds, breaks or retinectomy sites. The remaining PFCL was enough to cover and prevent MMC contact with the posterior vital structures including optic disc, macula and underlying RPE and major vascular arcades. Ciliary epithelium and other anterior segment structures were protected from MMC contact with the use of air in the rest of the eye. Then, a 10 µg/mL concentrated MMC solution was carefully injected above the PFCL bubble until it covered PVR or potential areas of PVR development and removed after 60 s. Finally, the remaining PFCL was removed and all eyes were filled with silicone oil. The patients were followed at least 6 months after silicone oil removal. Visual and anatomic outcomes were determined during follow-up period. The mean follow-up time was 19.6 ± 6 months (range 12-27 months). About 100% retinal attachment was achieved with one vitreoretinal surgery during the follow-up period. PVR was not detected around the retinal breaks or retinotomy sites in any eye. Limited macular epiretinal membrane was detected in two eyes and subsequently peeled during silicone oil removal. Preoperative visual acuities were hand motions in seven eyes and light perception in eight eyes. Nine of 15 eyes had a visual acuity of ⩾0.1 during the follow-up period. The mean preoperative visual acuity was logMAR 2.16 ± 0.15 and postoperative visual acuity was 0.80 ± 0.50 (p = 0.001). There were no additional complications related to intraoperative MMC use during follow-up period. Temporary intraocular MMC use in vitreoretinal surgery yielded good anatomic and visual outcomes after the treatment of traumatic RDs with PVR or those with high risk of PVR development. Furthermore, MMC application appeared to prevent further PVR development after vitreoretinal surgery.