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Prosthetic joint infections (PJIs) can be challenging to eradicate and have high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been linked to a greater rate of reoperation.There has been increasing investigation of the use of next-generation sequencing (NGS) technology such as metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction (PCR) has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJIs when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further toward routine clinical practice.Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJIs are diagnosed, managed, and drastically improve outcomes from this currently devastating complication.

We assessed acetabular erosion, hip function, quality of life (QoL), pain, deep infection, mortality, re-operation and dislocation rates in patients with displaced femoral neck fractures (dFNFs) treated with unipolar versus bipolar hemiarthroplasty at different postoperative time points.Relevant Randomized Controlled Trials (RCTs) were identified, following comprehensive literature research in Medline, Cochrane Central and Scopus databases, from conception until August 31th, 2021 and analyzed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Database research retrieved 120 studies; sixteen met eligibility criteria, providing 1813 (1814 hips) evaluable patients. Acetabular erosion was significantly higher for unipolar group at 6 and 12 months (p = 0.02 and p = 0.01 respectively). Patients in the bipolar group presented significantly better hip function at 12 and 24 months (p = 0.02 and p = 0.04 respectively). Postoperative pain was significantly less in the bipolar group at 12, 24 and 48 months (p = 0.01). No statistically significant differences were found regarding the postoperative rates of deep infection, mortality, re-operation and dislocation.This study showed that patients with dFNFs treated with bipolar hemiarthroplasty have lower acetabular erosion rates at 6 and 12 months postoperatively, better hip function at 12 and 24 months, better QoL and less pain, when compared with unipolar. No statistically significant difference could be established regarding deep infection, mortality, re-operation and dislocation rates.

Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide range of causes must be considered in the deferential diagnosis. Ischiofemoral impingement (IFI) is a pathological condition defined by hip pain associated with narrowing of the ischiofemoral (IF) space. We report the case of an adolescent patient with non-traumatic quadratus femoris (QF) tear secondary to an occult IFI syndrome. To the best of our knowledge, this is the first such case reported in the literature. Case Report: A 15-year-old girl reported persisting hip pain for a month following increased physical activity. The symptoms had started a couple of days following a weekend of increased activity due to her participating in a dancing contest. Physical examination and imaging studies (standard anterior pelvis radiograph and MRI-scan) failed to reveal any pathology apart from an area of diffused edema in the IF space. Standard hematology and biochemistry laboratory tests were all within normal range. Conservative treatment for 6 months with rest and modification of physical activities failed. A new MRI scan showed partial edema resolution and marked reduction in the IF and QF spaces (12 mm and 8 mm, respectively), thus suggesting IFI, which, in turn, led to a partial rupture of the QF. The patient underwent a local infiltration of the QF with betamethasone sodium phosphate and betamethasone acetate (6+6 mg/2 ml) under CT guidance, which led to the complete resolution of all her symptoms. She remains symptoms free for 24 months. Conclusion: IFI is a rather uncommon condition in the developing skeleton. As in adults, in adolescents as well, MRI is the study of choice in cases of IFI, since it shows QF pathology and allows measurement of the IF and QF spaces, assisting physicians in establishing the right diagnosis. However, the coexistence of a QF hematoma and/or edema, may temper with the initial MRI measurements and render the diagnosis of the primary condition rat

Introduction: Slipped capital femoral epiphysis (SCFE) is a rather uncommon fracture, occurring usually in adolescence, during a period of rapid growth. Various pathogenetic risk factors contributing to its development have been identified. We present the case of a 10-month-old male infant who developed SCFE in his left hip following an epileptic seizure. To the best of our knowledge, this is the first such case report in the English literature. Case Report: A 10-month-old male infant, with a known medical history of epileptic encephalopathy, was referred to the accident and emergency department of our hospital. The parents of the youngster reported inability of the child to move his left lower limb and inconsolable crying following several epileptic seizures. A radiograph revealed the existence of SCFE in the left hip. The fracture was reduced (with gentle closed traction under general anesthesia) and a hip spicacast was applied. It was removed at 8 weeks. Physical examination at this stage revealed a painless hip with a full range of motion. Painless hip range of motion was retained during all follow-up visits throughout the next 22 months. Amagnetic resonance imaging scan at 2 years post-reduction showed normal shape and size of the affected femoral head, with no signs of physeal arrest and/or avascular necrosis. Conclusion: This unique case of a 10-month-old infant who developed SCFE following an epileptic seizure shows that this rare fracture may occur even in very young children. Although it is not currently indicated for the treatment of the vast majority of patients with SCFE, closed reduction and immobilization in a hip spicacast may be considered as an alternative treatment option in carefully selected patients.

Anterior femoral notching (AFN) may be associated with a higher risk for supracondylar periprosthetic fracture (sPPF) after total knee arthroplasty (TKA), although studies have yielded inconclusive results. We aimed to systematically investigate and meta-analyze the best available evidence regarding the association between AFN and the risk of sPPF after TKA. A comprehensive search of PubMed, Scopus, Mendeley, Google Scholar and Cochrane databases was performed, from conception to February 29, 2020. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). I2-index was employed for heterogeneity. Newcastle–Ottawa scale was implemented for quality assessment of the included studies. Nine studies fulfilled the eligibility criteria, including a total of 3264 patients subjected to TKA. Among them, there were 150 patients who sustained a sPPF. Overall, patients exposed to AFN (AFN group) demonstrated an increased risk for sPPF compared to those not exposed (control group) (OR 3.91, 95% CI 1.22–12.58, p = 0.02; I2 68.52%). Subgroup analysis based on AFN depth with a cut-off value of 3 mm further clarified this association. Patients with AFN ≥ 3mm were at higher risk for sPPF compared to patients with AFN < 3 mm and control group (OR 4.85, 95% CI 2.08–11.33, p = 0.00; I2 0.0%). On the contrary, fracture risk was not significant for patients with AFN

Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as a predisposing factor for the development of degenerative full-thickness rotator cuff tears (DRCT) or primary glenohumeral osteoarthritis (PGOA). A systematic review of the Pubmed, Scopus, Mendeley, ScienceDirect and the Cochrane Central Register of Controlled Trials online databases was performed for literature regarding CSA and its association with DRCT and PGOA. In order to evaluate solely the relationship between CSA as a predisposing factor for the development of the aforementioned degenerative shoulder diseases (DSDs), we precluded any study in which traumatic cases were not clearly excluded. Our search strategy identified 289 studies in total, nine of which were eligible for inclusion based on our pre-established criteria. Quality assessment contacted using the Newcastle Ottawa Scale for case-control studies. There were a total of 998 patients with DRCT and 285 patients with PGOA. The control groups consisted of a total of 538 patients. The mean CSA ranged from 33.9° to 41.01° for the DRCT group, from 27.3° to 29.8° for the PGOA group and from 30.2° to 37.28° for the control group. All studies reported statistically significant differences between the DRCT and PGOA groups and the respective control groups. Our study results showed that there is moderate evidence in the literature supporting an intrinsic role of CSA in the development of DSDs. Level of evidence: IV. Systematic review of diagnostic studies, Level II-IV.

Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.

Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI, an intraneural ganglion cyst of the common peroneal nerve was diagnosed. Patient was treated with surgical decompression of the cyst, followed by ligation and complete resection of the articular branch, as well as disarticulation of the superior tibiofibular joint. At a twelve-month follow-up, the patient showed significant functional recovery. This is, to the best of our knowledge, the first case of intraneural ganglion cyst manifested with an acute complete foot drop without a clear prior traumatic event. We underline the need for a high index of suspicion when dealing with cases of acute peroneal palsy without any accompanying symptoms.

Purpose The exact effect of vitamin D supplementation, either as monotherapy or in combination with protein, on musculoskeletal health in patients with sarcopenia is currently unknown. This study aimed to determine the effect of vitamin D alone or with protein supplementation on muscle strength, mass, and performance in this population. Methods A comprehensive search was conducted in Medline, Cochrane Central and Scopus databases, up to March 31st, 2020. Data were expressed as standardized mean difference (SMD) with 95 % confidence intervals (CI). I2 index was employed for heterogeneity. Results The initial search identified 1164 studies, eight of which met the eligibility criteria for qualitative and quantitative analysis, yielding a total of 776 patients. Vitamin D (100–1600 IU/day) plus protein (10–44 g/day) supplementation exhibited a beneficial effect on muscle strength, as demonstrated by an improvement in handgrip strength (SMD 0.38 ± 0.07, 95 % CI 0.18–0.47, p = 0.04; I2 76.2 %) and a decrease in the sit-to-stand time (SMD 0.25 ± 0.09, 95 % CI 0.06–0.43, p = 0.007; I2 0%) compared with placebo. However, the effect on muscle mass, assessed by skeletal muscle index, was marginally non-significant (SMD 0.25 ± 0.13, 95 % CI -0.006–0.51, p = 0.05; I2 0%). No effect on appendicular skeletal muscle mass or muscle performance (assessed by walking speed) was observed with vitamin D plus protein. Conclusions Vitamin D supplementation, combined with protein, improves muscle strength in patients with sarcopenia, but has no effect on muscle mass or performance.

Diaphragm dysfunction develops during severe sepsis as a consequence of hemodynamic, metabolic, and intrinsic abnormalities. Similarly, 12 hours of controlled mechanical ventilation also promotes diaphragm dysfunction. Importantly, patients with sepsis are often treated with mechanical ventilation for several days. It is unknown if controlled mechanical ventilation exacerbates sepsis-induced diaphragm dysfunction, and this forms the basis for these experiments. We investigate the effects of 12-hour controlled mechanical ventilation on contractile function, fiber dimension, cytokine production, proteolysis, autophagy, and oxidative stress in the diaphragm of septic rats.Randomized controlled experiment.Animal research laboratory.Adult male Wistar rats.Treatment with a single intraperitoneal injection of either saline or Escherichia coli lipopolysaccharide (5 mg/kg). After 12 hours, the saline-treated animals (controlled mechanical ventilation) and half of the septic animals (lipopolysaccharide + controlled mechanical ventilation) were submitted to 12 hours of controlled mechanical ventilation while the remaining septic animals (lipopolysaccharide) were breathing spontaneously for 12 hours. They were compared to a control group. All animals were studied 24 hours after saline or lipopolysaccharide administration.Twenty-four hours after saline or lipopolysaccharide administration, diaphragm contractility was measured in vitro. We also measured diaphragm muscle fiber dimensions from stained cross sections, and inflammatory cytokines were determined by proteome array. Activities of calpain, caspase-3, and proteasome, expression of 20S-proteasome α subunits, E2 conjugases, E3 ligases, and autophagy were measured with immunoblotting and quantitative polymerase chain reaction. Lipopolysaccharide and/or controlled mechanical ventilation independently decreased diaphragm contractility and fiber dimensions and increased diaphragm interleukin-6 production, protein ubiquitination, expression of Atrogin-1 and Murf-1, calpain and caspase-3 activities, autophagy, and protein oxidation. Compared with lipopolysaccharide alone, lipopolysaccharide + controlled mechanical ventilation worsened diaphragm contractile dysfunction, augmented diaphragm interleukin-6 levels, autophagy, and protein oxidation, but exerted no exacerbating effects on diaphragm fiber dimensions, calpain, caspase-3, or proteasome activation.Twelve hours of controlled mechanical ventilation potentiates sepsis-induced diaphragm dysfunction, possibly due to increased proinflammatory cytokine production and autophagy and worsening of oxidative stress.

Στην παρούσα εργασία εξετάζονται τα αποτελέσματα της οικονομίας της Ευρωπαϊκής Ένωσης στη δομή των επιχειρήσεων των χωρών-μελών. Δίνεται ιδιαίτερη έμφαση στο κομμάτι στο πως συλλέχθηκαν τα δεδομένα και το πώς ταξινομούνται ώστε να έχουμε επαρκή και αξιόπιστα αποτελέσματα στην περιγραφή των δεδομένων μας. Προκειμένου να μελετήσουμε τη δομή των Ευρωπαϊκών επιχειρήσεων, χρησιμοποιήσαμε δεδομένα ανά κλάδο δραστηριότητας και ανά Ευρωπαϊκή περιφέρεια που συλλέξαμε από τη eurostat για τα έτη 1997-2007. Οι επιχειρήσεις ανάλογα με τον τομέα που δραστηριοποιούνται έχουν καταταχθεί σε γενικότερους κλάδους σύμφωνα με την επίσημη στατιστική κατηγοριοποίηση της οικονομικής δραστηριότητας στην Ευρωπαϊκή κοινότητα κατά “NACE”. Οι κλάδοι των επιχειρήσεων που περιλαμβάνει το δείγμα μας είναι οι ακόλουθοι: D. Manufacturing (Κατασκευή σε βιομηχανίες), C. Mining and quarrying (Ορυκτός Πλούτος), E. Electricity, gas and water supply(Ηλεκτρισμός, παροχή αερίου και νερού), F. Construction (Οικοδομικές κατασκευές), G. Distributive trades(Διανεμητικό Εμπόριο), H. Hotels and Restaurants (Ξενοδοχεία και εστιατόρια), I. Transport, Storage and Communication (Μεταφορές και Αποθηκευτικός χώρος) και K. Real estate, renting and business activities(Κτηματομεσιτικές υπηρεσίες ενοικιάσεις και άλλες επιχειρηματικές δραστηριότητες). Για τις επιχειρήσεις (local units) του δείγματος εκτός από τον κλάδο και τη χώρα προέλευσης υπάρχει διαθέσιμη πληροφορία και για τον αριθμό των ατόμων που εργάζονται ως προσωπικό (workforce). Στη συνέχεια μετά από τη συλλογή των δεδομένων, αφού απορρίψαμε τις ελλείπουσες μεταβλητές (missing values), προχωρήσαμε σε περιγραφική ανάλυση των διάφορων κλάδων της οικονομικής δραστηριότητας σε επίπεδο χωρών ώστε να εξακριβώσουμε σε ποια χώρα εμφανίζουν την μεγαλύτερη συχνότητα, καθώς και την κατανομή του εργατικού δυναμικού και την κατανομή των διάφορων κλάδων σε χρονικό διάστημα δεκαετίας (1997-2007). Αυτή η ανάλυση έγινε σε επίπεδο τριετίας ώστε να εξάγουμε όσο το δυνατόν σαφέστερα αποτελέσματα. Η εξαγωγή όλων των παραπάνω συμπερασμάτων έγινε με τη βοήθεια του λογισμικού spss –το πιο εξειδικευμένο στατιστικό πρόγραμμα για επεξεργασία μεγάλου αριθμού μεταβλητών από τα εκάστοτε δείγματα. Ιδιαίτερη έμφαση πέρα από την αρχική ταξινόμηση των δεδομένων δώσαμε στο πως χειριστήκαμε τις missing values ώστε να δώσουμε όσο το δυνατόν πιο ακριβή και αξιόπιστα αποτελέσματα για την περιγραφική ανάλυση που θα ακολουθήσει. In this work we present the structural business statistics of European area during a decade (1997-2007) of all countries –states of European Union. We used data from all structures of business activities and from each European state during the last decade. We collected the data from the official site of Eurostat. Businesses according to the sector that are activating have been categorized at more general units in compliance with the official statistical categorization of European business activities at European Community as "NACE". Our sample includes this sectors of businesses : D. Manufacturing, C. Mining and quarrying, E. Electricity, gas and water supply, F. Construction, G. Distributive trades, H. Hotels and Restaurants, I. Transport, Storage and Communication K. Real estate, renting and business activities. For all local units we have information about their sectors and the country that exist. We also have important information about the workforce that each sector includes. Then we selected the data and we rejected the missing values of the sample in order to conduct perigraphical statistical analysis for these sizes. We examined the frequency of each business structure in order to conclude at which country each sector has the larger frequency. We also examined the workforce distribution at each country during the last decade (1997-2007). All the conclusions are extracted with the use of specific statistical software-named spss –the most specific software for the collection and usage of data that are extracted from large samples. In this project we tried to be very careful at how we are going ro handle the missing values. And this happened in order to have the most accurate results as we could.