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Background: Antibiotic-loaded spacers are often used during two-stage exchange for periprosthetic joint infections (PJIs) both for its mechanical properties and as a means of local antibiotic delivery. Purpose: The main goal of this study is to compare the efficacy of different options of antibiotic(s) in spacers concerning the rate of positive cultures at the second stage. Patients and Methods: We retrospectively evaluated two-stage exchange procedures for infected hip or knee arthroplasty performed between 2012 and 2018 in which adequate (at least four deep tissue samples) culture results in both stages were available. The type of spacer and antibiotics used, in addition to several other patient, infection and treatment-related variables, were registered and correlated to microbiological findings in the second stage. Results: Fifty-eight cases were included with a 19.0 % (11/58) overall rate of positive cultures during reimplantation. With a mean follow-up of 46 months, failure rate was significantly higher at 63.6 % (7/11) in cases with positive cultures at reimplantation compared to 4.3 % (2/47) for those with negative cultures during reimplantation (p< 0.001). The need for additional surgeries was also significantly higher (odds ratio (OR) 122.67, confidence interval (CI) 95 % 11.30–1331.32, p< 0.001). Multivariable analysis revealed antibiotics in the spacers were the main independent prognostic risk factor associated with positive cultures at the second stage with an advantage for combined antibiotics. Monotherapy is associated with failure with an OR of 16.99. Longer time between surgeries did not have statistical significance (p= 0.05), and previous surgical treatment for PJI, presence of difficult-to-treat microorganism(s), duration of systemic antibiotic therapy or even treatment within a dedicated septic team were not shown to be independent risk factors. Among combined antibiotic spacers, there were no significant differences between the rate of positive cultures during the second stage, comparing commercially available vancomycin/gentamicin spacers to hand-mixed vancomycin/meropenem manufactured spacers (8.3 % [2/24] vs. 15.0 % [3/20], p= 0.68). Conclusions: Results show that combined antibiotic therapy spacers are advantageous when compared to gentamicin monotherapy as they produce significantly lower rates of subsequent positive cultures during the second stage. Hand-mixed high-dose vancomycin/meropenem spacers seem to perform just as well as prefabricated commercially available vancomycin/gentamicin options. Level of Evidence: Therapeutic level III.

The potential alkali-silica reactivity (ASR) of volcanic aggregates, especially basalts, remains a source of debate in the scientific community. When evaluating the potentially deleterious character of this type of aggregate, different laboratory testing methods may produce contradictory data; this is particularly evident when using the accelerated mortar bar test (AMBT). In order to better understand such discrepancies, this study applied several methods of characterizing potential aggregate alkali reactivity, including the accelerated mortar bar test (AMBT), petrographic characterization, and the concrete prism test (CPT). Moreover, this study assessed volcanic aggregate samples from sites around the world, including the Azores, Brazil, Canada, the Canary and Hawaiian Islands, Iceland, Japan, Mozambique, New Zealand, Norway, and Turkey. The results obtained contribute to accurately assessing the potential alkali reactivity of volcanic aggregates and enhance the understanding of their different behaviours.

To create an international recommendation concerning the release of alkalis, test method AAR-8 was developed within the scope of RILEM TC 258-AAA activities. The first round robin test was performed using five aggregate types, and further investigation was conducted as RRT2, leading to the final version of the AAR-8 recommendation. Five aggregates with different mineralogies and origins were immersed in specific volumes of NaOH or KOH solutions with excess calcium hydroxide maintained 38 °C and 60 °C respectively. Samples of the immersion test solution were removed at intervals of 2, 6, 13, 26, and 52 weeks by pipetting and chemically analyzed for NaOH or KOH test solutions. The amount of alkali released was expressed in grams of Na2O, K2O, and Na2Oe per kilogram of the respective aggregate. The results obtained are presented. Based on the data, several changes to the original version of the test method are proposed.

Introduction: Debridement, antibiotics and implant retention (DAIR) is known to be effective in treating acute periprosthetic joint infection (PJI). However, deciding to perform additional surgery in the early postoperative period may be challenging as there is the concern of adding morbidity and clinical presentation is often subtle. We mean to assess the impact of early DAIR on final functional outcome.Methods: A case-control comparison was performed between patients that underwent DAIR for suspected PJI between 2010-2016 and controls randomly selected (1:2 ratio) from a list of primary joint replacements. Patients were matched for anatomic site, age, gender, American Society of Anesthesiologists (ASA) classification, body mass index and follow-up time. The outcome of surgical treatment and complications were assessed and Hip disability and Osteoarthritis Outcome Score (HOOS) or Knee injury and Osteoarthritis Outcome Score (KOOS) were performed.Results: Thirty-eight cases were included at a mean follow-up of 42 months. Infection was not confirmed in one patient. There was one infection related-death and three other cases of treatment failure that required a two-stage revision. Overall success rate was 89.2%. There were no significant patient reported differences regarding final functional outcome between both groups: pain 91±6 vs. 87±13; other symptoms 90±8 vs. 90±9; activities of day living 86±8 vs. 85±14; sport 63±13 vs. 57±16; quality of life 78±17 vs. 76±16.Discussion: These findings support that DAIR for suspected acute PJI is safe, effective and causes no impact on final functional results. Thus, a low threshold for assuming infection and subsequent DAIR may safely be adopted in the early postoperative period.

Introduction: Prosthetic infection is a devastating complication of arthroplasty and carries significant economic burden. The objective of this study was to analyze the economic impact of prosthetic hip and knee infection in Portuguese National Health System.Material and Methods: Case-control study carried out from January 2014 to December 2015. The mean costs of primary arthroplasties and prosthetic revision surgeries for non-infectious reasons were compared with the costs of prosthetic infections treated with debridement and preservation of the prosthesis or with two-stage exchange arthroplasty.The reimbursement for these cases was also evaluated and compared with its real costs.Results:A total of 715 primary arthroplasties, 35 aseptic revisions, 16 surgical debridements and 15 revisions for infectious reasons were evaluated. The cost of primary arthroplasties was 3,230€ in the hips and 3,618€ in the knees. The cost of aseptic revision was 6,089€ in the hips and 7,985€ in the knees. In the cases treated with debridement and implant retention the cost was 5,528€ in the hips and 4,009€ in the knees. In cases of infections treated with a two-stage revision the cost was 11,415€ and 13,793€ for hips and knees, respectively.Conclusion: As far as we know this is the first study that analyzes the economic impact of prosthetic infection in the Portuguese context. Although direct compensation for treating infected cases is much lower than calculated costs, infected cases push the overall hospital case-mix-index upwards thus increasing financial compensation for the entire cohort of treated patients. This knowledge will allow for more informed decisions about health policies in the future.

The purpose of this work was to investigate the influence of the hot pressing variables, namely pressure, time and temperature, on the microstructure, density and hardness in a sterling silver alloy. Powders were hot pressed under different combinations of pressures (25MPa, 35MPa and 45MPa), times (10 min, 30 min and 60 min) and temperatures (250 ºC, 300 ºC, 400 ºC, 500 ºC and 700 ºC). The microstructures of hot pressed compacts were analyzed by the means of SEM/EDS and optical microscopy. The density and hardness of specimens were assessed. The microstructure of all specimens consisted in Cu-rich precipitates of different sizes dispersed in a Ag-rich matrix. Of the variables that were examined, only temperature produced significant (p

Debido a las preocupaciones ambientales y sanitarias, se están desarrollando aleaciones alternativas para soldadura sin plomo. Entre ellas se ha estudiado el sistema Sn-Zn-Al, que revela propiedades prometedoras. En este trabajo se evalúa la presencia de bismuto, en el rango de 0 a 8 % en peso, en relación con las interacciones químicas entre soldadura y substrato y con las fases de equilibrio presentes en la superficie de contacto. Se han estudiado las fases formadas en la superficie de contacto entre el substrato de cobre y una soldadura fundida sin plomo en función del tiempo de mantenimiento y de la composición de la aleación. Se ha evaluado el efecto del contenido en bismuto sobre las temperaturas de transformación de una aleación de base Sn-9Zn-1Al mediante Calorimetría de Barrido Diferencial (DSC). Se ha determinado el rango de solidificación para cada aleación, lo que es una característica importante en relación con la aplicación de estos materiales en la industria de la electrónica. Se ha llevado a cabo la identificación de las fases de equilibrio y su composición química mediante microscopía electrónica de barrido (SEM/EDS). También se han evaluado los perfiles de la composición química y el espesor de la interfase de reacción.

Wave propagation problems can be solved using a variety of methods. However, in many cases, the joint use of different numerical procedures to model different parts of the problem may be advisable and strategies to perform the coupling between them must be developed. Many works have been published on this subject, addressing the case of electromagnetic, acoustic, or elastic waves and making use of different strategies to perform this coupling. Both direct and iterative approaches can be used, and they may exhibit specific advantages and disadvantages. This work focuses on the use of iterative coupling schemes for the analysis of wave propagation problems, presenting an overview of the application of iterative procedures to perform the coupling between different methods. Both frequency- and time-domain analyses are addressed, and problems involving acoustic, mechanical, and electromagnetic wave propagation problems are illustrated.

Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is the only curative therapy for many hematologic malignancies, whereby the Graft-versus-Leukemia (GVL) effect plays a pivotal role in controlling relapse. However, the success of GVL is hindered by Graft-versus-Host Disease (GVHD), where donor T cells attack healthy tissues in the recipient. The ability of natural regulatory T cells (Treg) to suppress immune responses has been exploited as a therapeutical option against GVHD. Still, it is crucial to evaluate if the ability of Treg to suppress GVHD does not compromise the benefits of GVL. Initial studies in animal models suggest that Treg can attenuate GVHD while preserving GVL, but results vary according to tumor type. Human trials using Treg as GVHD prophylaxis or treatment show promising results, emphasizing the importance of infusion timing and Treg/Tcon ratios. In this review, we discuss strategies that can be used aiming to enhance GVL post-Treg infusion and the proposed mechanisms for the maintenance of the GVL effect upon the adoptive Treg transfer. In order to optimize the therapeutic outcomes of Treg administration in allo-HSCT, future efforts should focus on refining Treg sources for infusion and evaluating their specificity for antigens mediating GVHD while preserving GVL responses.

Abstract Measurement of body core temperature (Tcore) is paramount to determining the thermoregulatory strain of athletes. However, standard measurement procedures of Tcore are not practical for extended use outside the laboratory environment. Therefore, determining the factors that predict Tcore during a self‐paced run is crucial for creating more effective strategies to minimize the heat‐induced impairment of endurance performance and reduce the occurrence of exertional heatstroke. The aim of this study was to identify the factors predicting Tcore values attained at the end of a 10 km time trial (end‐Tcore) under environmental heat stress. Initially, we extracted data obtained from 75 recordings of recreationally trained men and women. Next, we ran hierarchical multiple linear regression analyses to understand the predictive power of the following variables: wet‐bulb globe temperature, average running speed, initial Tcore, body mass, differences between Tcore and skin temperature (Tskin), sweat rate, maximal oxygen uptake, heart rate and change in body mass. Our data indicated that Tcore increased continuously during exercise, attaining 39.6 ± 0.5°C (mean ± SD) after 53.9 ± 7.5 min of treadmill running. This end‐Tcore value was primarily predicted by heart rate, sweat rate, differences between Tcore and Tskin, wet‐bulb globe temperature, initial Tcore, running speed and maximal oxygen uptake, in this order of importance (β power values corresponded to 0.462, −0.395, 0.393, 0.327, 0.277, 0.244 and 0.228, respectively). In conclusion, several factors predict Tcore in athletes subjected to self‐paced running under environmental heat stress. Moreover, considering the conditions investigated, heart rate and sweat rate, two practical (non‐invasive) variables, have the highest predictive power.

The ability of companies to react to changes imposed by the market can be aided by to information acquisition and knowledge generation. Big data technologies, crowdsourcing, and Online Social Networks (OSN) are used for knowledge generation. These technologies have assumed a significant position in agribusiness in recent decades. This work investigates how social network analysis can promote agribusiness to provide a basis for future applications and evaluations. We adopted a hybrid systematic mapping to conduct the investigation. Two hundred twenty-three works that propose solutions for agribusiness were found and categorized. Results showed the most used OSN is Twitter and revealed an increase in the number of studies in this area. The information obtained indicates how social media monitoring can complement traditional decision-making methods in managing and regulating agricultural systems. However, more studies in agribusiness using data analysis tools on social networks are required, considering the importance of social networks on marketing strategies. Based on our results, we discuss some challenges and research directions.

Several cases of alkali-silica reaction involving granitic aggregates have been diagnosed in damaged concrete structures in Portugal. Nonetheless, this kind of rock is usually regarded as slow/late reactive or even non-reactive to alkalis. Granitic rocks are widely exploited in Northern and Central Portugal, representing almost half of the produced aggregates in this country. Project IMPROVE rose from the need to accurately diagnose the potential reactivity of granites to alkalis. The study involved about forty granites collected from different regions in Portugal, from which the results of eight samples are being presented in this paper. The tests carried out include the petrographic analyses of the aggregates and mortar and concrete expansion tests. It was concluded that the content of microcrystalline quartz correlates better with the results of AAR-4.1 than with the other expansion tests.

Background: The access to pediatric rheumatology (PR) services in Portugal is not well described. The primary objective of this study was to identify barriers to PR referrals and explore alternative referral patterns among family doctors and pediatricians. Methods: A web-based survey was emailed to family doctors and pediatricians practicing in Portugal to investigate issues related to access to PR care. Descriptive and comparative analyses were performed. Results: A total of 292 responses were obtained, with 24.7% from pediatricians and 75.3% from family doctors. Only 12% claimed to have received specific education on PR. Nearly 70% worked within one hour of a PR center. Twenty-eight percent had referred a patient to PR at least once, and 9.3% considered referring to PR at least once but ultimately did not. Many referred patients to other specialties, primarily pediatrics, adult rheumatology, and pediatric orthopedics. Pediatricians encountered a greater variety of rheumatic diseases. Fifty-five percent had no opinion on the support provided by PR centers, while 24% found it sufficient. Having specific training in PR, being a pediatrician, and being a specialist were associated with higher referral rates to PR. Discrepancies in regional access to PR were documented. The most highly rated measure for improving PR referrals was promoting education. Conclusion: The main barriers to PR referrals in Portugal are primarily the lack of education in PR, along with uneven national coverage and greater distances to some PR centers. Pediatricians appear to have better education, more experience, and higher referral rates to PR. The current alternatives for referral are pediatrics, adult rheumatology, and pediatric orthopedics. Addressing educational fragmentation was the most significant and rewarding inconsistency to overcome. [ABSTRACT FROM AUTHOR]