Thoraco-lumbar osteoporotic compression fractures have a higher incidence of continued collapse with development of deformity and progression to vertebra plana when untreated and even after vertebral augmentation (VA) or balloon kyphoplasty (BKP). Even when there is the restoration of height and improvement in angulation, multiple long-term follow-up series have repeatedly documented that over time, many patients lose the initial height correction and in a smaller group the vertebral body re-collapses leading to the development of progressive deformity with an increased risk for adjacent level fractures. At first, larger balloons and more cement were used to try and avoid these problems, but it did not reduce the risk of adjacent fractures. Several procedures were developed to place various types of intervertebral implants combined with bone cement to maintain the initial height correction. Initial studies with these implants showed a reduction in adjacent level fractures but the systems did not proceed to market. The SpineJack R (SJ) system (Stryker Corp, Kalamazoo, MI), consisting of bilateral expandable titanium implants supplemented with bone cement, was first used approximately 10 years ago in Europe and recently gained FDA approval in the United States. This system provides more symmetric and balanced lateral and anterior support and is effective with lesser amounts of bone cement compared to BKP. Follow-up studies have documented that there is equal or better pain control, with better long-term results based both on maintaining vertebral height restoration and deformity correction. Most importantly, statistically it clearly reduces the risk of adjacent level fractures by at least 60%. The biomechanical effects of intravertebral implants for osteoporotic fractures in regard to the risk of adjacent level fractures and preliminary experience with the use of the SJ is reviewed.

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Objectives:The Tei index is a useful Doppler index of combined systolic and diastolic function, calculated as isovolumic relaxation time plus isovolumic contraction time divided by ejection time. This study was focused on comparing the Tei index between normal fetus and fetuses of diabetic mothers (DMs). Methods: A prospective study was performed in a total of 68 fetuses. The study group underwent 2-dimensional/Doppler echocardiographic measurement of their Tei index. They included total 28 fetuses of diabetic mothers (DMs) (32-38 weeks of gestation). In this group, 18 fetuses were appropriate for gestational age (AGA), 6 fetuses were large for gestational age (LGA) and 4 fetuses were small for gestational age (SGA). Control group included total 40 fetuses (22-38 weeks of gestation). . These values were significantly higher than the control (P < 0.001 for both ventricles). Conclusions:LGA fetuses from DMs who have an increased value of the Tei index may have abnormal myocardial performance. Tei index is a simple and useful parameter for the assessment of fetal both ventricular myocardial performance and is able to reflect fetal cardiac function. Objectives: Structural cardiac derangement in fetuses of diabetic women is widely recognized, though few studies have assessed cardiac functional impairment in this group. We examined fetal cardiac structure and function in pregestational (PG) and gestational diabetic (GDM) pregnancies compared to non-diabetic pregnancies using echocardiography. Methods: Women undergoing fetal echo at the University of Kentucky were recruited for this prospective longitudinal cohort study. Eighteen PG diabetics, 18 GDM, and 13 non-diabetic controls were enrolled. Fetal echo was performed at 24-28 weeks and repeated at 35 weeks. Cardiac structure, systolic and diastolic function were assessed. Differences in groups were analyzed with t-test and Fisher's exact test. Results: Right ventricular (RV) minor axis and tricuspid valve (TV) annulus were larger in fetuses of GDM women compared to nondiabetics at first echo: 11 ± 2.3 versus 9 ± 2.4 mm (P = 0.024), 8.5 ± 1.6 versus 7.1 ± 1.3 mm (P = 0.014), respectively. In addition, TV early ventricular filling velocity (E) was higher in GDM fetuses (42 ± 6.0 cm/s) compared to controls (38 ± 6.2 cm/s, P = 0.05). These differences were no longer present in the late third trimester. At second echo, mitral valve early/atrial filling velocity ratio (E/A) was increased in GDM fetuses (0.82 ± 0.18) compared to controls (0.64 ± 0.11, P = 0.029). There was also a trend toward decreased fetal ventricular myocardial performance index (MPI) in GDM and PG diabetics compared to controls (P = 0.087 and 0.075, respectively). Conclusions: Midtrimester echo findings represent mild RV dilation in the GDM group; the elevated TV E-wave suggests minor diastolic dysfunction as a contributing factor. Although the RV changes resolved by late pregnancy, there is evidence of changes in left ventricular function at that time in the GDM group. The trend of decreased MPI in the...

The purpose of this investigation was to explore the presumed relationship between the days of hospitalisation and microorganisms identified by endotracheal aspirate cultures in relation to adequate empirical treatment strategies of pneumonia in the intensive care unit (ICU). All potentially pathogenic microorganisms identified by (surveillance) cultures of endotracheal aspirates obtained in the ICUs of two Dutch teaching hospitals in 2007 and 2012 were retrospectively collected and analysed. Antibiotic susceptibilities to 11 antibiotics were calculated for several time points (days or weeks) after hospital admission and expressed per patient-day. In total, 4184 potentially pathogenic microorganisms identified in 782 patients were analysed. Prevalence of the classic early-onset pneumonia-causing microorganisms decreased from 55 % on the first four days to 34 % on days 4–6 after hospital admission (p < 0.0001). Susceptibility to amoxicillin/clavulanic acid was below 70 % on all days. Except for days 0 and 12, susceptibility to ceftriaxone was below 80 %. The overall susceptibility to piperacillin/tazobactam was 1518/1973 (77 %) in 2007 vs. 727/1008 (67 %) in 2012 (p < 0.0001). After day 8 of hospital admission, susceptibility to piperacillin/tazobactam therapy was below 80 % in 2012. After one week of hospital admission, susceptibilities to antibiotics were lower in the hospital that included that antibiotic in the local empirical treatment protocols as compared to the hospitals in which that antibiotic was not or infrequently included: 90/434 (21 %) vs. 117/398 (29 %); p = 0.004 for amoxicillin/clavulanic acid and 203/433 (47 %) vs. 253/398 (64 %); p < 0.001 for ceftriaxone. No cut-off in the number of days after hospital admission could be identified to distinguish early-onset from late-onset pneumonia. Consequently, the choice of empirical antibiotics should probably not be based on the time of onset.Electronic supplementary materialThe online version of this article (doi:10.1007/s10096-015-2482-y) contains supplementary material, which is available to authorized users.