BackgroundSurgical-site infections due to intraoperative contamination are chiefly ascribable to airborne particles carrying microorganisms. The purpose of this study is to identify the actions that increase the number of airborne particles in the operating room.MethodsTwo surgeons and two surgical nurses performed three patterns of physical movements to mimic intraoperative actions, such as preparing the instrument table, gowning and donning/doffing gloves, and preparing for total knee arthroplasty. The generation and behavior of airborne particles were filmed using a fine particle visualization system, and the number of airborne particles in 2.83 m3 of air was counted using a laser particle counter. Each action was repeated five times, and the particle measurements were evaluated through one-way analysis of variance multiple comparison tests followed by Tukey–Kramer and Bonferroni–Dunn multiple comparison tests for post hoc analysis. Statistical significance was defined as a P value ≤ .01.ResultsA large number of airborne particles were observed while unfolding the surgical gown, removing gloves, and putting the arms through the sleeves of the gown. Although numerous airborne particles were observed while applying the stockinet and putting on large drapes for preparation of total knee arthroplasty, fewer particles (0.3–2.0 μm in size) were detected at the level of the operating table under laminar airflow compared to actions performed in a non-ventilated preoperative room (P < .01).ConclusionsThe results of this study suggest that surgical staff should avoid unnecessary actions that produce a large number of airborne particles near a sterile area and that laminar airflow has the potential to reduce the incidence of bacterial contamination.

Background The purpose of this study was to compare radiological features between high tibial osteotomy (HTO) and tibial condylar valgus osteotomy (TCVO), in order to define the radiological indication criteria for TCVO. Methods Thirty-two cases involving 35 knees that had undergone HTO and the same number that had undergone TCVO for knee osteoarthritis were retrospectively evaluated. Characteristics of both groups did not differ significantly. Lower limb alignment, bone morphology, joint congruity, and joint instability were measured in standing full-length leg and knee radiographs obtained before and after surgery. Results Radiological features in the TCVO group included greater frequencies of advanced knee OA grade, varus lower limb malalignment, depression of the medial tibial plateau, and varus-valgus joint instability compared to the HTO group before surgery. However, tibial morphology, alignment of the lower limb, and joint instability improved to comparable levels after surgery in both groups. Conclusions TCVO appears preferable in cases with advanced knee OA, destroyed or inclined medial tibial plateau, widened and subluxated lateral joint, and high varus-valgus joint instability.

Background: Bacterial contamination by airborne particles is one of the most important factors in the pathogenesis of surgical-site infections. Aim: This study aimed to identify the generation and behaviour of airborne particles around the feet of surgical staff while walking in and out of an operating theatre. Methods: Two physicians and two nurses walked in and out of a bio-clean theatre under laminar airflow, either individually or as a group. The generation and behaviour of airborne particles was filmed using a fine-particle visualization system, and the number of airborne particles per 2.83 m 3 of air was counted using a laser particle counter. Each action was repeated five times, and particle counts were evaluated statistically. Findings: Airborne particles were generated from the floor and by the shoes and gown hems of the participants, whether walking individually or as a group. Numerous airborne particles were generated by the group, and significantly more particles, especially those measuring 0.3e0.5 mm, were carried up to the level of the operating table by the group than by individuals (P<0.01). Conclusions: The results of this study provide a clearer picture of the dispersion and distribution of airborne particles around the feet of staff walking in and out of an operating theatre. The findings suggest that to reduce the incidence of bacterial contamination and risk of surgical site infections, surgical staff should walk calmly and independently, if possible, near sterile areas.

Summary The annual incidence of new hip fractures increased from 2005 to 2014 in Nagasaki and females were much more affected. High-risk factors were identified as age ≥ 80 years, winter, indoors, living room, Monday, and early morning. Seven days after admission, most patients remained hospitalized and had been treated surgically. Introduction Hip fractures are major osteoporotic fractures that reduce quality of life. In Japan, the incidence of hip fractures increased steadily from 1986 to 2014 and the number of hip fractures could be 7.3–21.3 million by 2050. This study aimed to determine the incidence of hip fractures from 2005 to 2014 in Nagasaki Prefecture and to analyze the characteristics of and risk factors for hip fracture. Methods Hip fractures that occurred in Nagasaki Prefecture between 2005 and 2014 were analyzed using emergency transportation records. Fracture type, age, sex, location in which fracture occurred, and risk factors for hip fracture were clarified. Results The total number of new hip fractures among individuals ≥ 35 years old was 17,395 (mean age, 82.6 years old) and the annual incidence per 100,000 population increased from 147.9 in 2005 to 235.0 in 2014. Females (79.6%) were much more commonly affected than males (20.4%) and cervical fractures were more common than trochanteric fractures in all age groups. Hip fracture tended to be associated with age ≥ 80 years, winter rather than summer, indoors rather than outdoors, and living room rather than the bathroom or toilet. Other high-risk factors were Monday as day of the week, and early morning as the time of day. Seven days after admission, 97.3% of patients were hospitalized and 78.1% of hip fractures had been treated surgically. Conclusion Information on actual situations and valid preventive measures relevant to hip fracture are urgently needed.

Abstract. Using dispersed and primarily cultured cells of rat pituitary glands, thyrotrophin (TSH) release by TSH-releasing hormone (TRH) and an analogue, γ - butyrolactone - γ-carbonyl - l - histidyl - l - prolinamide (DN-1417) which is more potent than TRH on central nervous system behavioural paradigms, was examined under conditions of static incubation and superfusion. Static incubations of the cells with different concentrations of DN-1417 (10−7–10−4 m) and TRH (10−10–10−6 m) resulted in a dose-related increase of TSH release and the response to both peptides, in logarithmic doses, was in parallel. The potency of DN-1417 related to TSH release was 0.14–0.26% that of TRH. Maximal TSH release induced by DN-1417 (10−5 m) was slightly but significantly greater than that by TRH (10−7 m) In the presence of 3-isobutyl-1-methylxanthine, the TSH response to either of the peptides was augmented, and the difference in the maximal TSH release by either peptide became insignificant, suggesting that TRH as well as DN-1417 act through the same mechanism of mediation by the cyclic nucleotides. In the superfusion study, a biphasic profile of TSH release was observed during a continuous exposure (100 min) to maximal doses of either the analogue or TRH. The biphasic release of TSH was thought to be specific to TRH action because high K+ produced a different profile of the release. These results indicate that the potency of DN-1417 in TSH release is considerably lower than that of TRH, and also suggest that the direct action of DN-1417 on TSH release is qualitatively similar to that of TRH.