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Objective: Infections from penetrating brain injuries (PBI) lead to higher morbidity and mortality rates. The results of this research will be evaluated to develop institutional guideline for antibiotic prophylaxis in this patient population. The objective was to characterize the prophylactic antibiotic usage for patients presenting with PBI., Patients and Methods: This retrospective chart review included patients with a PBI identified through the institution's trauma center registry between December 2015 and July 2018. The primary outcome was the proportion of patients that received prophylactic antibiotics. Secondary outcomes included antibiotic administration timing, selection and duration of antibiotic regimens, infection rates and patient outcomes., Results: The study population included 33 patients, with 82 % males and an average age of 32 years. The most common mechanism of injury was a gunshot wound (94 %). Of the 33 patients, 24 (73 %) received at least one dose of prophylactic antibiotics. The median time to antibiotic administration was 52.8 min (IQR, 18-120), while the median duration of prophylaxis was 24 h (IQR, 7-84). The most common antibiotic regimen was a single cefazolin dose, with the next most common regimen included scheduled ceftriaxone and metronidazole. Overall, there were no documented central nervous system or skin and soft tissue infections during the initial admission, while 4 patients (12 %) were treated for pneumonia. Survivors (67 %) had a median hospital length of stay of 5.8 days., Conclusion: The median duration of prophylaxis was shorter than the current data suggesting antibiotics for 5 days; however, there were no documented central nervous system infections, which is less than previously reported in the literature., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Porous tantalum components are widely used for complex acetabular reconstructions in revision hip arthroplasty. Multiple other metal alloys such as titanium-aluminum-vanadium or cobalt-chromium-molybdenum are principally used in artificial joint setups. We report a case of tantalum component failure being both cause and effect of a multiple metal exposure. Our aims were to assess and to characterize associated particle exposure and biological consequences. Metal level quantification revealed substantial in vivo exposure to particulate and dissociated tantalum, zirconium, chromium, cobalt, molybdenum, titanium, aluminum and vanadium in periprosthetic compartments. Aside from micron-sized particles, nanoparticles of a broad size range and elemental composition were obtained. Histological exams verified a spectrum of necrotic changes in the periprosthetic tissues. In the presented case tantalum release was accompanied by concomitance of particles originating from other utilized metals. We conclude that an overall in vivo exposure assessment is mandatory for realistic appraisal of metal toxicity and associated risks., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Malnutrition is a common problem in maintenance hemodialysis patients and is associated with increased mortality and morbidity. Interventions such as oral or intravenous nutritional supplements have often failed to improve nutritional status. We studied the effect of a daily dialysis program on nutritional parameters., Methods: Eight patients treated with standard hemodialysis (SHD) 4 to 5 hours three times per week were converted to daily hemodialysis (DHD) 2 to 2.5 hours six times per week. Serum albumin, prealbumin, and total cholesterol were evaluated every three months. Anthropometry and dietary evaluation were performed every six months., Results: Serum albumin rose from 39.0 +/- 2.6 to 42.0 +/- 3.1 and 43.0 +/- 2.6 g/L, prealbumin from 0.36 +/- 0.04 to 0.41 +/- 0.05 and 0.42 +/- 0.1 g/L, total cholesterol from 1.7 +/- 0.4 to 1.9 +/- 0.4 and 1.8 +/-0.3 g/L at baseline and at 6 and 12 months, respectively, after switching patients to DHD. Daily protein intake increased from 1.29 +/- 0.20 g/kg/day to 1.48 +/- 0.60 and 1.90 +/- 0.70 (P < 0.05). These changes were accompanied by a dry body weight increase of 2.4 +/- 1.6 kg (P < 0.005) at month 6 and 4.2 +/- 2.8 kg at one year (P < 0.05). Lean body mass increased from 47.7 +/- 4.9 kg to 49.1 +/- 5.9 (P < 0.05) and 50.5 +/- 6.2 (P < 0.05)., Conclusions: Daily hemodialysis appears to be a suitable method to improve nutritional status in maintenance dialysis patients.

Unlabelled: Twenty-five years of experience with out-center hemodialysis., Background: Out-center hemodialysis (HD) offers patients a better quality of life, a greater independence, and a better rehabilitation opportunity. A lower mortality than with other modalities of dialysis has been reported. In addition, in France the charges paid depend on the modality of dialysis, out-center HD being the less expensive, and savings are also accomplished through fewer patient transports, which are additionally reimbursed. We present a 25-year experience of out-center HD., Methods: We retrospectively studied the clinical records of 471 patients treated between 1974 and 1997 in a single nonprofit organization operating regional home HD (H-HD) and facilities for self-care HD (SC-HD). Survival results were analyzed according to: (a) causes of end-stage renal disease, (b) age at the start of HD, (c) period of start of HD, (d) modality of HD (H-HD, SC-HD), and (e) a subgroup of 174 patients defined at risk because they were contraindicated for transplantation., Results: The mean age at the start of HD increased from 31.2 +/- 9.7 (mean +/- SD) years in 1974 to 52.6 +/- 13.5 years in 1997. Causes of the end of treatment were: (a) transplantation (63%), (b) transfer (20%), and (c) death (17%). The overall survival was 90% at 5 years, 77% at 10 years, 62% at 15 years, and 45% at 20 years, and, for the group at risk, 78%, 62%, 46%, and 31%, respectively. Cox proportional hazard analyses showed that risk factors were older age, diabetes, and renal vascular diseases., Conclusion: If adequate choice is given, out-center HD offers a reliable and safe modality of dialysis with better survival results than survival in full-care in-center HD. In addition, out-center HD ensures a striking financial benefit as compared with the higher costs if the same patients were treated with full-care in-center HD. These modalities should be encouraged for all HD patients who are able to be treated by out-center modalities.

Undecalcified sections of doubly tetracycline-labeled transiliac bone biopsy specimens obtained from ten hemodialyzed patients before and 10 to 16 months after parathyroidectomy (PTX) were analyzed. Before parathyroidectomy (total PTX with autotransplant in six patients and subtotal PTX in four patients), all the patients demonstrated histological evidence of hyperparathyroidism with increased resorption parameters. A high bone formation rate (BFR) was noted in all patients but one who had both an increase in the osteoid seam thickness and a low calcification rate characteristic of osteomalacia. A significant correlation was found between immunoreactive parathyroid hormone (iPTH) levels and BFR at the tissue and at the basic multicellular unit (BMU) levels. Parathyroidectomy was associated with a dramatic drop in resorption surfaces and osteoclast number as well as in bone formation rate at the tissue, BMU, and cell-levels. After PTX, the bone formation rate at the tissue level was low or in the lower range of normal values in six patients. The thickness index of osteoid seams was significantly reduced and no evidence of osteomalacia was present even in the six patients showing bone aluminum deposits after PTX. One of the three patients, who had an iPTH level within the normal range after PTX, showed an osteoid excess associated with a low bone formation rate. These date demonstrate that increased PTH secretion is an important factor of bone formation in dialyzed patients and that excessive reduction of the PTH secretion leads to an inactive bone.

Direct measurement methods (or the forecast related to indirect measurements) of the maximal oxygen uptake are reviewed. 15 patients suffering from renal failure, performed a total of 28 exercises. One can draw the conclusion that the maximum VO2 is inferior in these subjects to the values usually determined in normal healthy subjects of the same age. This decrease can be significantly correlated with the haematocrit. Comparison between direct measurement methods of the maximal oxygen uptake and indirect methods allowing its forecast from the heart rate, shows that only direct methods are to be used in these patients.

Eluates from uremic sera were obtained by chromatography on sephadex G 25. They were assayed on lymphocytes cultured in the presence of various stimulants. Lymphocyte proliferation induced by mitogens or allogeneic cells was markedly inhibited in the presence of medium size molecules (MM), or of larger molecules (MW greater than 5000).

The pharmacokinetics of two pyridinol carbamate formulations were studied after a single oral administration in 10 healthy volunteers. An open one-compartment model described the evolution of plasma concentrations as a function of time. Pyridinol carbamate was rapidly absorbed (mean lag time from 0.36 to 0.38 hr). Its elimination half-life ranged from 3.3 to 7.9 hr. The two formulations were bioequivalent.

The drug, pentosan-poly-sulfoester (PPS), has an anticomplementary activity (ACA) on human serum both in vitro and in vivo, as judged by a reduction in total hemolytic complement activity (CH 50). In vitro, this ACA is very potent, immediate and temperature independent. In vivo this ACA obtained with a IV dose of 100 mg per 8 hours eg 300 mg/24 h, increases with the duration of treatment (mean time:30 days), suggesting a cumulative effect. Eleven patients with glomerulonephritis (GN) received such a treatment (8 with acute post-streptococcal GN and 3 with mesangio-proliferative GN). In patients with already marked hypocomplementemia, the ACA is difficult to establish, while in patients with normal complement activity or moderate hypocomplementemia, the decrease of CH 50 level in serum is obvious. There was no significant change inthe serum level of C3, C4, properdin factor B as measured by radial immunodiffusion technique. The clinical course of these GN was apparently not affected by this treatment. Neverthless, the in vivo ACA of PPS is firmly established and we can speculate that this functional depletion in complement may prevent or decrease the liberation of humoral mediators of inflammation.

In 63 patients with chronic renal insufficiency treated with intermittent dialysis plasma beta2m concentrations were shown to be stable and increased 8 to 60 times over normal values. The excretion of beta2m is achieved either through residual diuresis (up to 150 mg/24 h) or by filtration through high permeability membranes of the dialyser. In the absence of extra-renal catabolism of beta2m it is suggested that the rate of beta2m synthesis differs markedly among patients. beta2m it self does not to seem to contribute to the toxic manifestations of chronic renal insufficiency.

In vitro, the drug pentosan-poly-sulfoester (PPS) changes the electrophoretic migration of different proteins from the complement and properdin systems, such as native C3 (beta 1C globulin), C3c (beta-1A globulin), C3d (alpha-2D globulin), C1s inactivator (ClsINA), Clq and properdin factor B (B). Their more anodal migration is the consequence of a molecular alteration and persists after prolonged dialysis. These structural changes, yet undefined, explain the loss of functional activity of these proteins, and the anticomplementary activity of this drug. Moreover, PPS is able to block the alternate pathway activation by its action on properdin factor B (C3 proactivator). In fact, in presence of PPS, the activators of the properdin systems such as C3 nephritic factor are inactive. These altered mobilities are also responsible for the overestimation in the antigenic concentration of B (+ 45%), C4 (+27%) and C3/C3c (+ 14%), found in human serum containing 50 mg/ml of PPS. PPS has an original action upon the complement and properdin systems, which allows its clinical use as a potent inhibitor of the humoral mediators of inflammation.

The drug, pentosan-poly-sulfoester (PPS), is a potent in vitro inhibitor of the human complement hemolytic activity. This CH 50 inhibition represents a real anticomplementary activity (ACA), because this drug has no effect on sensitized sheep red blood cells (EA). The inhibition curve of human serum CH 50, by PPS is sigmoidal. The 50% inhibition is obtained for a 1: 650 dilution of PPS, which corresponds to a concentration of 0.08 mg/ml in normal human serum. Hemolytic titrations of C1, C4, C2, C3, and C5 showed a complete inhibition of C4, C2 and C3, and a partial inhibition of C1 (C1q, C1r, C1s, Ca++) and C5, by this drug. The mechanism of such functional inactivation of the different complement components is not yet elucidated.