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Tay HW, Tay KS. Future directions for early detection of fracture related infections. J Orthop 2024; 55:64-68. [PMID: 38655538 PMCID: PMC11035015 DOI: 10.1016/j.jor.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Fracture related infection (FRI) refers to pathogens infecting a fracture site and hence impeding fracture healing. It is a significant complication that carries substantial disease burden and socio-economic costs, but has had limited scientific development. Hence, this paper will review the existing strategies for early detection of FRI, in the form of serum markers, molecular diagnostics and imaging modalities, and further discuss potential future directions for improved detection of FRI. Existing Strategies for Diagnosis of FRI The Anti-infection Global Expert Committee (AIGEC) developed a consensus definition for FRI in 2017, which includes confirmatory and suggestive criteria for diagnosis of FRI. Existing strategies for diagnosis include clinical, laboratory, histopathological, microbiological and radiological investigations. Future Directions for Early Detection of FRI With increasing recognition of FRI, early detection is crucial for early treatment to be enforced. We have identified potential areas for future development in diagnostics for early detection of FRI, which are discussed in this manuscript. They include inflammatory cytokines, serum calcium levels, platelet count, improved management of histopathological and microbiological specimens, metagenomics, wound biomarkers, gut microbiota analysis, and novel imaging technologies.
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Affiliation(s)
- Hui Wen Tay
- Singapore General Hospital Department of Orthopaedic Surgery, Singapore
| | - Kae Sian Tay
- Singapore General Hospital Department of Orthopaedic Surgery, Singapore
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Becker K, Sharma I, Slaven JE, Mosley AL, Doud EH, Malek S, Natoli RM. Proteomic Analyses of Plasma From Patients With Fracture-Related Infection Reveals Systemic Activation of the Complement and Coagulation Cascades. J Orthop Trauma 2024; 38:e111-e119. [PMID: 38117580 PMCID: PMC10922838 DOI: 10.1097/bot.0000000000002752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/16/2023] [Indexed: 12/22/2023]
Abstract
OBJECTIVES The objective of this study was to compare plasma proteomes of patients with confirmed fracture-related infections (FRIs) matched to noninfected controls using liquid chromatography-mass spectrometry. METHODS DESIGN This was a prospective case-control study. SETTING The study was conducted at a single, academic, Level 1 trauma center. PATIENT SELECTION CRITERIA Patients meeting confirmatory FRI criteria were matched to controls without infection based on fracture region, age, and time after surgery from June 2019 to January 2022. Tandem mass tag liquid chromatography-mass spectrometry analysis of patient plasma samples was performed. OUTCOME MEASURES AND COMPARISONS Protein abundance ratios in plasma for patients with FRI compared with those for matched controls without infection were calculated. RESULTS Twenty-seven patients meeting confirmatory FRI criteria were matched to 27 controls. Abundance ratios for more than 1000 proteins were measured in the 54 plasma samples. Seventy-three proteins were found to be increased or decreased in patients with FRI compared with those in matched controls (unadjusted t test P < 0.05). Thirty-two of these proteins were found in all 54 patient samples and underwent subsequent principal component analysis to reduce the dimensionality of the large proteomics dataset. A 3-component principal component analysis accounted for 45.7% of the variation in the dataset and had 88.9% specificity for the diagnosis of FRI. STRING protein-protein interaction network analysis of these 3 PCs revealed activation of the complement and coagulation cascades through the Reactome pathway database (false discovery rates <0.05). CONCLUSIONS Proteomic analyses of plasma from patients with FRI demonstrate systemic activation of the complement and coagulation cascades. Further investigation along these lines may help to better understand the systemic response to FRI and improve diagnostic strategies using proteomics. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin Becker
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - Ishani Sharma
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
| | - James E Slaven
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Amber L Mosley
- Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
- Center for Proteome Analysis, Indiana University School of Medicine, Indianapolis, IN; and
| | - Emma H Doud
- Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
- Center for Proteome Analysis, Indiana University School of Medicine, Indianapolis, IN; and
| | - Sarah Malek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
| | - Roman M Natoli
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN
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Hu X, Chen J, Zheng X, Li J, Zhou M. Establishment and application of TSDPSO-SVM model combined with multi-dimensional feature fusion method in the identification of fracture-related infection. Sci Rep 2023; 13:19632. [PMID: 37949929 PMCID: PMC10638378 DOI: 10.1038/s41598-023-46526-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023] Open
Abstract
Fracture-related infection (FRI) is one of the most common and intractable complications in orthopedic trauma surgery. This complication can impose severe psychological burdens and socio-economic impacts on patients. Although the definition of FRI has been proposed recently by an expert group, the diagnostic criteria for FRI are not yet standardized. A total of 4761 FRI patients and 4761 fracture patients (Non-FRI) were included in the study. The feature set of patients included imaging characteristics, demographic information, clinical symptoms, microbiological findings, and serum inflammatory markers, which were reduced by the Principal Component Analysis. To optimize the Support Vector Machine (SVM) model, the Traction Switching Delay Particle Swarm Optimization (TSDPSO) algorithm, a recognition method was proposed. Moreover, five machine learning models, including TSDPSO-SVM, were employed to distinguish FRI from Non-FRI. The Area under the Curve of TSDPSO-SVM was 0.91, at least 5% higher than that of other models. Compared with the Random Forest, Backpropagation Neural Network (BP), SVM and eXtreme Gradient Boosting (XGBoost), TSDPSO-SVM demonstrated remarkable accuracy in the test set ([Formula: see text]). The recall of TSDPSO-SVM was 98.32%, indicating a significant improvement ([Formula: see text]). Compared with BP and SVM, TSDPSO-SVM exhibited significantly superior specificity, false positive rate and precision ([Formula: see text]. The five models yielded consistent results in the training and testing of FRI patients across different age groups. TSDPSO-SVM is validated to have the maximum overall prediction ability and can effectively distinguish between FRI and Non-FRI. For the early diagnosis of FRI, TSDPSO-SVM may provide a reference basis for clinicians, especially those with insufficient experience. These results also lay a foundation for the intelligent diagnosis of FRI. Furthermore, these findings exhibit the application potential of this model in the diagnosis and classification of other diseases.
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Affiliation(s)
- Xiaofeng Hu
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, No. 34, Lot 34, Changfu Street, Qinhuai District, Nanjing, Jiangsu Province, China
| | - Jianmin Chen
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, No. 34, Lot 34, Changfu Street, Qinhuai District, Nanjing, Jiangsu Province, China.
| | - Xiaofei Zheng
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, No. 34, Lot 34, Changfu Street, Qinhuai District, Nanjing, Jiangsu Province, China
| | - Jianmei Li
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, No. 34, Lot 34, Changfu Street, Qinhuai District, Nanjing, Jiangsu Province, China
| | - Mingwei Zhou
- Department of Orthopaedics, Jinling Hospital, School of Medicine, Nanjing University, No. 34, Lot 34, Changfu Street, Qinhuai District, Nanjing, Jiangsu Province, China
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Chaszczewska-Markowska M, Górna K, Bogunia-Kubik K, Brzecka A, Kosacka M. The Influence of Comorbidities on Chemokine and Cytokine Profile in Obstructive Sleep Apnea Patients: Preliminary Results. J Clin Med 2023; 12:jcm12030801. [PMID: 36769452 PMCID: PMC9918226 DOI: 10.3390/jcm12030801] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/14/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is frequently associated with a chronic inflammatory state and cardiovascular/metabolic complications. The aim of this study was to evaluate the influence of certain comorbidities on a panel of 45 chemokines and cytokines in OSA patients with special regard to their possible association with cardiovascular diseases. MATERIAL AND METHODS This cross-sectional study was performed on 61 newly diagnosed OSA patients. For the measurement of the plasma concentration of chemokines and cytokines, the magnetic bead-based multiplex assay for the Luminex® platform was used. RESULTS In the patients with concomitant COPD, there were increased levels of pro-inflammatory cytokines (CCL11, CD-40 ligand) and decreased anti-inflammatory cytokine (IL-10), while in diabetes, there were increased levels of pro-inflammatory cytokines (IL-6, TRIAL). Obesity was associated with increased levels of both pro-inflammatory (IL-13) and anti-inflammatory (IL-1RA) cytokines. Hypertension was associated with increased levels of both pro-inflammatory (CCL3) and anti-inflammatory (IL-10) cytokines. Increased daytime pCO2, low mean nocturnal SaO2, and the oxygen desaturation index were associated with increased levels of pro-inflammatory cytokines (CXCL1, PDGF-AB, TNF-α, and IL-15). CONCLUSIONS In OSA patients with concomitant diabetes and COPD, elevated levels of certain pro-inflammatory and decreased levels of certain anti-inflammatory cytokines may favor the persistence of a chronic inflammatory state with further consequences. Nocturnal hypoxemia, frequent episodes of desaturation, and increased daytime pCO2 are factors contributing to the chronic inflammatory state in OSA patients.
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Affiliation(s)
- Monika Chaszczewska-Markowska
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Katarzyna Górna
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
- Correspondence:
| | - Katarzyna Bogunia-Kubik
- Laboratory of Clinical Immunogenetics and Pharmacogenetics, Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, 50-422 Wroclaw, Poland
| | - Anna Brzecka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
| | - Monika Kosacka
- Department of Pulmonology and Lung Oncology, Wroclaw Medical University, 53-439 Wroclaw, Poland
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