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It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L/D-lactide copolymer 96: 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years (minimum 1 year) showed that the improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. The lack of implant fractures and intramedullary osteolysis were advantages of the PLDLA implant. The bioresorbable PLDLA interposition implant may offer an alternative tool for tailored reconstruction of rheumatoid metacarpophalangeal joints. [ABSTRACT FROM PUBLISHER]

Background: Prosthetic joint infection (PJI) treatment decisions are traditionally based on treatment algorithms. There is, however, a lack of evidence to support the choice of these treatment algorithms. Therefore, we aimed to assess the one-year survival after PJI revision and compared different surgical strategies in a single-center setting., Methods: Revisions of the hip due to PJI performed at our institution between January 2008 and September 2021 with at least one-year of follow-up were identified. In total, 134 debridement, antibiotics, and implant retentions (DAIRs), 114 one-stage revisions, and 121 two-stage revisions were performed. Infections were classified as early, acute hematogenous, and chronic. Survival was calculated using the Kaplan-Meier method and cumulative incidence function. Predictors of outcomes were examined with Fine-Gray regressions and Cox proportional hazards regressions. Subdistribution hazard ratios and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated., Results: At one-year follow-up, 26.6% (CI 22.2 to 31.2%) of the patients had undergone reoperation and 7.9% (CI 5.4 to 10.9%) had died. The risk for reoperation was highest after DAIR (36.6%, CI 28.5 to 44.7%) and lowest after one-stage revision (20.2%, CI 13.4 to 28%). Within the early infections, the one-stage revision almost halved the risk of reoperation (HR 0.51, CI 0.31 to 0.84) with no added mortality risk (HR 1.05, CI 0.5 to 2.2), when compared to DAIR., Conclusion: By utilizing 1-stage revision over DAIR in early infections, it might be possible to improve the prognosis by decreasing the risk of reoperation without increasing mortality. However, as the patient selection is undeniably difficult, more research is warranted., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Prosthetic joint infection (PJI) is one of the most devastating complications after total knee arthroplasty (TKA), and comorbidities increase the risk. We examined whether a temporal change has occurred in the demographics, especially regarding comorbidities, of patients who have PJI and were treated at our institution over a 13-year study period. In addition, we assessed the surgical methods used and the microbiology of the PJIs., Methods: Revisions (n = 384, 377 patients) due to PJI of the knee performed at our institution between 2008 and September 2021 were identified. All included PJIs fulfilled the 2013 International Consensus Meeting diagnostic criteria. The surgeries were categorized into one of the following categories: debridement, antibiotics, and retention (DAIR), 1-stage revision, and 2-stage revision. Infections were classified as early, acute hematogenous, and chronic., Results: No changes in the median age of the patients nor comorbidity burden were observed during the study period. However, the proportion of 2-stage revisions decreased remarkably from 57.6% in 2008 to 2009 to 6.3% in 2020 to 2021. A DAIR was the most used treatment strategy, but the proportion of 1-stage revisions increased the most. In 2008 to 2009, 12.1% of the revisions were 1-stage, but in 2020 to 2021, the proportion was 43.8%. The most common pathogen was Staphylococcus aureus (27.8%)., Conclusion: The comorbidity burden remained at the same level with no trends. A DAIR was the most used strategy, but the proportion of 1-stage revisions rose to almost the same level. The incidence of PJI varied between the years, but remained relatively low., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: The focus in the reporting of results after total knee replacement (TKR) has changed from surgeon/radiologist-based scores to patient-reported outcome measures (PROMs). The questionnaires used in subjective outcome are often originally published in English and need to be validated in different languages. The aim of our study was to investigate the feasibility, validity, reliability, and responsiveness of the Finnish language version of the Oxford Knee Score (OKS-S) questionnaire., Methods: The original OKS questionnaire was translated using a forward/backward protocol. The OKS-S questionnaire was sent to 225 patients who were scheduled to undergo TKR surgery. The assessment was repeated 1 year after the index operation. Half of the patients also received the RAND-36 questionnaire with the OKS-S questionnaire and the other half the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. 30 patients twice received the OKS-S questionnaire preoperatively for the test-retest assessment., Results: Feasibility was acceptable with a response rate of 96% in both pre- and postoperative assessments. Correlation between OKS-S questionnaire and all domains of the KOOS questionnaire and the physical domains in the RAND-36 questionnaire was high, and confirmed both good criterion and convergent validity. Content validity was good since no ceiling or floor effect was observed. In the test-retest assessment, all but 2 patients were within the 95% limits of agreement. Responsiveness was large according to effect sizes., Conclusions: Our data suggests that the OKS-S questionnaire is suitable for the assessment of both the preoperative status and the outcome of TKR in Finnish speaking patients.

The exhaust emissions of three cars using different biofuels were explored at a temperature of -7 °C. The biofuels studied contained both low- and high-concentration ethanol blends, isobutanol, and biohydrocarbons. A multipoint fuel injection car (MPFI), direct-injection spark-ignition car (DISI), and flex-fuel car (FFV) represented three different spark-ignition-car technologies. At -7 °C, substantial emissions were observed for the three cars, and differences were found among ethanol, isobutanol, and biohydrocarbons as fuel components. For example, E85 resulted in high acetaldehyde, formaldehyde, ethanol, ethene, and acetylene emissions when compared to E30 or lower ethanol concentrations. Isobutanol-containing fuel showed elevated butyraldehyde, methacrolein, and isobutanol emissions. The highest particulate matter (PM) emissions, associated polyaromatic hydrocarbon (PAH) and indirect mutagenicity emissions were detected with the DISI car. Oxygenated fuels reduced PM emissions and associated priority PAH emissions in the DISI car. PM and PAH emissions from the MPFI and FFV cars were generally low. A combination of 10% ethanol and biohydrocarbon components did not change emissions significantly when compared to ethanol-only-containing E10 gasoline. Therefore, a combination of ethanol or isobutanol with biohydrocarbon components offers an option to reach high gasoline bioenergy content for E10-compatible cars.

Objectives: Recent studies have suggested a decreased need for orthopaedic surgery in patients with rheumatoid arthritis (RA). We analysed trends in total knee replacement (TKR) in RA using TKR in osteoarthritis (OA) as a point of reference., Methods: Data on TKRs from the Finnish Arthroplasty Register and population data from Statistics Finland were used to analyse the trends in TKRs among patients aged ≥ 40 years with primary osteoarthritis (OA) or RA in Finland for the period from 1980 to 2010., Results: During 1980-2010, the overall incidence of TKRs increased 20-fold from 14.2 to 305.3 operations per 10(5) person-years. After peaking in 1992, the annual incidence of TKRs for RA decreased gradually from 19.6 to 10.8 per 10(5) [incidence rate ratio (IRR) 0.97, p < 0.001]. The decrease was more pronounced in women and the older (≥ 60 years) age group. The mean age at the time of TKR among patients with RA increased over time, converging with that of patients with OA., Conclusion: There is a clear decrease in the annual incidence of TKRs in RA, while among OA patients the incidence is increasing steadily. Furthermore, patients with RA seem to receive their TKRs at an older age. Both of these findings suggest improving long-term outcome in RA.

It was hypothesized that the bioresorbable interposition implant might offer a viable alternative to conventional silicone implant arthroplasty in rheumatoid metacarpophalangeal joint destruction. A randomized clinical study was performed to compare a stemless poly-L/D-lactide copolymer 96 : 4 (PLDLA) implant with the Swanson silicone implant. Results in 52 patients (53 hands and 175 joints) at a mean follow-up of 2 years (minimum 1 year) showed that the improvement in clinical assessments was comparable in both groups, except for better maintenance of palmar alignment in the Swanson group. The lack of implant fractures and intramedullary osteolysis were advantages of the PLDLA implant. The bioresorbable PLDLA interposition implant may offer an alternative tool for tailored reconstruction of rheumatoid metacarpophalangeal joints.

A total of 179 non-spore-forming bacteria aerobically growing on Nutrient Agar, Plate Count Agar or in specific enrichment conditions for salmonella, campylobacteria, listeria, yersinia or staphylococci, were isolated from 16 untreated paper mill pulps. After phenotypical screening the isolates were characterised by automated ribotyping and partial sequencing of the 16S rRNA gene. They could be divided into seven taxonomical classes representing 63 taxa (species): actinobacteria (11 species), bacilli (7), flavobacteria (3) alphaproteobacteria (10), betaproteobacteria (5), gammaproteobacteria (25) and sphingobacteria (2). Most of the gammaproteobacteria were enterobacteria, mainly species of the genera Enterobacter (7 species, 7 samples/3 mills) and Klebsiella (5 species, 6 samples/3 mills). Other commonly occurring bacteria were most closely related to Microbacterium barkeri (7 samples/3 mills), Cloacibacterium normanense (6 samples/2 mills), Pseudoxanthomonas taiwanensis (5 samples/2 mills) and Sphingobacterium composti (5 samples/1 mill). Sporadic isolates of Listeria innocua, L. monocytogenes, Enterococcus casseliflavus and Staphylococcus warneri were detected, from which only L. monocytogenes is considered to be a food pathogen. No isolates of the genera Campylobacter, Salmonella or Yersinia were detected. The detected bacteria may be harmful in process control, but the load of food pathogens with recycled fibres to paper machines is insignificant. Faecal contamination of the pulp samples was not indicated.

Revision metacarpophalangeal arthroplasty after silicone implant arthroplasty is frequently complicated by severe bone loss, osteolysis and diaphyseal perforations. Impacted, morselised allografts are frequently used to treat bone loss in revision surgery. A new method of treatment using bioreconstructive poly-L/D-lactic acid (PLDLA) joint scaffold and allograft bone packing, after complete removal of the original silicone implants, allows recovery of bony deficiencies, correction of malalignment and improves function of the hand. This article presents the one-year results of a prospective, non-randomised clinical and radiographic follow-up study of 21 patients with 52 revision metacarpophalangeal arthroplasties using the PLDLA implants and allograft bone packing.

Objective: Leg length discrepancy and excessive knee valgus are potential complications of juvenile chronic arthritis of the knee. The aim of the present study was to evaluate retrospectively the safety and efficacy of temporary stapling of the knee epiphyses in management of valgus deformities of the knee in children with JCA., Methods: Medical data of the patients with temporary epiphyseodesis due to knee valgus deformity (KVD) were studied. 177 knees in 112 patients were found with sufficient data for evaluation. Patient documents and radiographs of these patients were evaluated., Results: Mean age at the time of operation was 8 years (range: 2 - 17) in 19 males and 93 females. The patients are predominantly affected by aggressive polyarticular disease. Preoperative mean valgus angle was 11 degrees (IQR: 9, 14) and at staple removal 4 degrees (IQR: 2, 5). In 120 of 177 knees (68% [95% CI: 61 - 74], p < 0.001) the physiological angle (3-8 degrees) was reached. Median time of stapling was 10 months (IQR: 8, 13). Five reversible and one irreversible (3% [95% CI: 2 to 7]) major complications were documented among the 177 stapled knees., Conclusion: Temporary epiphyseal stapling enables flexible correction of KVD in children with JCA. Low complication rate encourages the use of the method. Prompt follow-up is, however, important in avoing excess over-correction to varus.

Objective: The aim of the present study was to evaluate retrospectively the long-term efficacy of temporary stapling of the knee epiphyses over four decades of use in children with JCA., Methods: Medical data of the patients with temporary epiphyseodesis due to leg length discrepancy (LLD) were studied. Seventeen knees in 17 patients were found with sufficient follow-up data for evaluation. Patient documents and radiographs of these patients were evaluated., Results: The mean age at the time of the operation was 11 years (range: 6-15) in 3 males and 14 females. The preoperative mean LLD was 21 mm (SD 8) and at staple removal 4 mm (SD 10). The difference was -17 mm (95% CI: -10 to -23). Statistically the result remained the same during the follow-up. Two reversible complications were documented among the 17 stapled knees. In five (29%) cases the correction was affected by re-occurrence of LLD quickly after removal of the staples., Conclusion: In this study with 17 patients and a wide range of follow-up times we found that the good correction of LLD achieved by stapling is usually permanent.

Temporary epiphyseal stapling is a flexible method for correction of leg length discrepancy. Due to a high risk of premature epiphyseal plate closure and other complications reported in previous studies, the technique has not been in wide use. In this study a retrospective analysis of 71 knees in patients with juvenile idiopathic arthritis was performed to determine the safety and effectiveness of the method. Only seven minor reversible complications were encountered, and the authors found the method suitable even for immunologically compromised patients.

The safety of refrigerated processed foods of extended durability (REPFEDs) with respect to nonproteolytic Clostridium botulinum is under continuous evaluation. In the present study, mild (P7.0(85.0) values 0 to 2 min [P, pasteurization value; z-value 7.0 degrees C; reference temperature 85.0 degrees C]) and increased (P7.0(85.0) values 67 to 515 min) heat treatments were evaluated in relation to survival of nonproteolytic C. botulinum type B spores in sous vide processed ground beef and pork cubes. The use of two concentrations of nisin in inhibition of growth and toxin production by nonproteolytic C. botulinum in the same products was also evaluated. A total of 96 samples were heat processed and analyzed for C. botulinum by BoNT/B gene-specific polmerase chain reaction and for botulinum toxin by a mouse bioassay after storage of 14 to 28 days at 4 and 8 degrees C. Predictably, after mild processing all samples of both products showed botulinal growth, and one ground beef sample became toxic at 8 degrees C. The increased heat processing, equivalent to 67 min at 85 degrees C. resulted in growth but not toxin production of C. botulinum in one ground beef sample in 21 days at 8 degrees C: in the pork cube samples no growth was detected. The increased heating of both products resulted in higher sensory quality than the milder heat treatment. Nisin did not inhibit the growth of nonproteolytic C. botulinum in either product; growth was detected in both products at 4 and 8 degrees C, and ground beef became toxic with all nisin levels within 21 to 28 days at 8 degrees C. Aerobic and lactic acid bacterial counts were reduced by the addition of nisin at 4 degrees C. The study demonstrates that the mild processing temperatures commonly employed in sous vide technology do not eliminate nonproteolytic C. botulinum type B spores. The intensity of each heat treatment needs to be carefully evaluated individually for each product to ensure product safety in relation to nonproteolytic C. botulinum.

Etanercept, a tumor necrosis factor receptor p75 Fc fusion protein (TNFR:Fc; Enbrel), has preliminarily been shown to be effective in the management of methotrexate-resistant polyarticular juvenile idiopathic arthritis (JIA). Reported side-effects have been minor, for example injection site reactions and upper respiratory tract infections, not necessitating discontinuation of the medication (1, 2). We report on 2 patients who developed an urticaria-like rash with prurigo appearing bilaterally on the extensor surfaces of the elbows subsequent to etanercept injections.

Sixteen different types of sous vide-processed products were evaluated for safety with respect to nonproteolytic group II Clostridium botulinum by using challenge tests with low (2. 0-log-CFU/kg) and high (5.3-log-CFU/kg) inocula and two currently available predictive microbiological models, Food MicroModel (FMM) and Pathogen Modeling Program (PMP). After thermal processing, the products were stored at 4 and 8 degrees C and examined for the presence of botulinal spores and neurotoxin on the sell-by date and 7 days after the sell-by date. Most of the thermal processes were found to be inadequate for eliminating spores, even in low-inoculum samples. Only 2 of the 16 products were found to be negative for botulinal spores and neurotoxin at both sampling times. Two products at the high inoculum level showed toxigenesis during storage at 8 degrees C, one of them at the sell-by date. The predictions generated by both the FMM thermal death model and the FMM and PMP growth models were found to be inconsistent with the observed results in a majority of the challenges. The inaccurate predictions were caused by the limited number and range of the controlling factors in the models. Based on this study, it was concluded that the safety of sous vide products needs to be carefully evaluated product by product. Time-temperature combinations used in thermal treatments should be reevaluated to increase the efficiency of processing, and the use of additional antibotulinal hurdles, such as biopreservatives, should be assessed.

The effects of cultivation conditions, winter storage, peeling method, browning prevention chemicals replacing sodium bisulfite, and packing methods on the sensory, nutritional and microbiological quality of pre-peeled potato were examined. Two different cultivation lots of the potato variety Van Gogh were used. Cultivation and harvesting conditions and peeling method were the most important facts reducing the sensory quality, especially the appearance, of prepeeled and sliced potatoes. Cooking and baking of potatoes decreased the appearance defects detected in raw potatoes. The levels of vitamin C in packaged samples decreased during winter storage. Cooking for 10 min and keeping potatoes at 60 degrees C for 1 h after cooking also decreased the content of vitamin C. In potato samples immediately after treatments aerobic bacteria were present at levels of 400 to 2,950 CFU/g and lactic acid bacteria at levels of 8 to 16 CFU/g. The number of aerobic bacteria did not increase during storage, and the number of lactic acid bacteria increased at the most to 90 CFU/g. Peeling, washing and packaging methods, cultivation conditions, and winter storage did not have important effects on the number of microbes present.

In order to study the purity of recycled fibre-based materials, products containing recycled fibre as well as recycled pulp were examined with regard to their chemical impurities, toxicity and microbiological quality. The study was carried out to clarify both qualitatively and quantitatively the variations in microbiological quality. The levels of several classes of chemical substances were analysed and semi-volatile and volatile substances identified. The toxicity and mutagenicity of virgin fibre and recycled fibre materials were screened using the Photobacter toxicity test and the Ames Salmonella mutagenicity test. Preliminary chemical characterization of the mutagens was carried out. Identification of the compounds found in the mutagenic fractions was performed by gas chromatography/mass spectrometry (GC/MS). The concentration of various substances analysed was found to be low, although the variety of substances present appeared to be very broad. Preliminary chemical characterization revealed that some samples contained compounds known to have mutagenic or other toxic activity. Also, the recycled fibre pulps contained large amounts of various microbes, the microbial load consisting mainly of aerobic spore-forming bacteria. The paper-making process was found to clearly have reduced the total microbial counts.

The broad-spectrum antibacterial activity exhibited by three Pediococcus strains isolated from beer was preliminarily characterized. Factors affecting the production rate of bacterial inhibitors were screened and the effects of simultaneous cultivation of Lactococcus and Pediococcus on the production of inhibitory substances were studied. The antibacterial activity against a range of Gram-negative test organisms was not affected by catalase or proteolytic enzymes and was extremely thermotolerant. Production of the inhibitors was maximal between pH 6 and pH 7. A growth medium containing unhopped end-fermented wort was beneficial for the production of inhibitors, particularly by the Pediococcus damnosus strain, and anaerobic growth conditions were preferable. The antagonistic activity against the Gram-negative test organism Salmonella infantis could be demonstrated after an incubation period of only 2 d if the Pediococcus and Lactococcus strains were incubated simultaneously as a mixed population.

Samples of indoor air were collected from an office room (88 m3) both before smoking and during experimental smoking of 96 cigarettes by 10 persons within 6 h. The particulates were collected on glass-fibre filters and the vapour-phase compounds on XAD-2 resin. The samples were extracted with acetone and analysed quantitatively for polycyclic aromatic compounds and qualitatively with GC-MS. The extracts of filters and XAD-2 resins were fractionated into neutral/acidic and 2 basic (strong and weak bases) fractions; all these fractions were tested with the sister-chromatid exchange (SCE) assay in Chinese hamster ovary (CHO) cells and with the Salmonella/microsome test (strain TA98). Total concentrations of PAC were 205 ng/m3 in the background sample and 1207 ng/m3 after contamination by cigarette smoking. The total PAC concentrations were 4-6 times higher in the vapour phase than in the particulate phase. The fractions of the particulate samples collected before smoking showed mainly marginal genotoxic activity, whereas after smoking their genotoxicity increased dramatically. The fractions of the vapour phase samples were not genotoxic before smoking, but after smoking the neutral/acidic and strong basic fractions induced responses in both assays. The SCE assay was more sensitive towards the vapour-phase mutagens of environmental tobacco smoke (ETS). The relative responses of the two basic fractions, whereas the fraction containing neutral and acidic compounds was the most potent in the SCE assay. In the Salmonella test, the mutagenic activity was mainly detected with metabolic activation, while the induction of SCE in CHO cells was also seen without an exogenous metabolic activation system.