Propionibacterium avidum infection following breast reduction: high morbidity from a low-virulence pathogen

Propionibacterium avidum is a common inhabitant of sebaceous glands, traditionally considered to be of low virulence and generally found on implanted foreign material. We report a rare case of P. avidum breast abscess, causing severe morbidity following breast reduction surgery. A 36-year-old woman presented with a non-painful wound discharge 3 weeks postoperatively, and was treated conservatively. She was readmitted 7 weeks postoperatively with a red and tender breast. A purulent discharging abscess was drained under ultrasound guidance. A 2-week intravenous course of amoxicillin-clavulanic acid, followed by oral replacement for a month resulted effective. Serial ultrasound imaging was useful in treatment decision-making. The infective potential of P. avidum may be underappreciated. Proximity of sutures to the axilla, tobacco smoking and the potential for resorbable sutures to host bacteria may predispose to infection, and should raise the clinician's awareness

Nuclear lines revealing the injection of cosmic rays in supernova remnants

At high energies, the hadronic origin of gamma rays from supernova remnants is still debated. Assuming the observed gamma-rays from the Wolf-Rayet supernova remnant Cas A are due to accelerated protons and ions, we predict the nuclear de-excitation line emission arising from interactions with the heavy elements in the supernova ejecta. This illustrative example highlights the importance of MeV gamma ray observations of the hadronic fingerprint of cosmic rays. The lines could be observed in the MeV band with a future space mission such as GRIPS which has been proposed to ESA as an all-sky survey mission with gamma-ray, X-ray and near-infrared telescopes. In MeV gamma rays, its sensitivity will improve by a factor of 40 compared with previous missions.Comment: 25th Texas Symposium on Relativistic Astrophysics (TEXAS 2010), Proceedings of Scienc

Multilevel upper body movement control during gait in children with cerebral palsy

Upper body movements during walking provide information about balance control and gait stability. Typically developing (TD) children normally present a progressive decrease of accelerations from the pelvis to the head, whereas children with cerebral palsy (CP) exhibit a general increase of upper body accelerations. However, the literature describing how they are transmitted from the pelvis to the head is lacking. This study proposes a multilevel motion sensor approach to characterize upper body accelerations and how they propagate from pelvis to head in children with CP, comparing with their TD peers. Two age-and gender-matched groups of 20 children performed a 10m walking test at self-selected speed while wearing three magneto-inertial sensors located at pelvis, sternum, and head levels. The root mean square value of the accelerations at each level was computed in a local anatomical frame and its variation from lower to upper levels was described using attenuation coefficients. Between-group differences were assessed performing an ANCOVA, while the mutual dependence between acceleration components and the relationship between biomechanical parameters and typical clinical scores were investigated using Regression Analysis and Spearman's Correlation, respectively (alpha = 0.05). New insights were obtained on how the CP group managed the transmission of accelerations through the upper body. Despite a significant reduction of the acceleration from pelvis to sternum, children with CP do not compensate for large accelerations, which are greater than in TD children. Furthermore, those with CP showed negative sternum-to-head attenuations, in agreement with the documented rigidity of the head-trunk system observed in this population. In addition, the estimated parameters proved to correlate with the scores used in daily clinical practice. The proposed multilevel approach was fruitful in highlighting CP-TD gait differences, supported the in-field quantitative gait assessment in children with CP and might prove beneficial to designing innovative intervention protocols based on pelvis stabilization

User Guide for Luminescence Sampling in Archaeological and Geological Context

Luminescence dating provides a direct age estimate of the time of last exposure of quartz or feldspar minerals to light or heat and has been successfully applied to deposits, rock surfaces, and fired materials in a number of archaeological and geological settings. Sampling strategies are diverse and can be customized depending on local circumstances, although all sediment samples need to include a light-safe sample and material for dose-rate determination. The accuracy and precision of luminescence dating results are directly related to the type and quality of the material sampled and sample collection methods in the field. Selection of target material for dating should include considerations of adequacy of resetting of the luminescence signal (optical and thermal bleaching), the ability to characterize the radioactive environment surrounding the sample (dose rate), and the lack of evidence for post-depositional mixing (bioturbation in soils and sediment). Sample strategies for collection of samples from sedimentary settings and fired materials are discussed. This paper should be used as a guide for luminescence sampling and is meant to provide essential background information on how to properly collect samples and on the types of materials suitable for luminescence dating. La datación por luminiscencia proporciona una estimación directa de la edad del último momento en el que el cuarzo o los minerales de feldespato se expusieron a la luz o al calor y que se ha aplicado exitosamente a depósitos, superficies rocosas y materiales expuestos al fuego en distintos contextos arqueológicos y geológicos. Las estrategias de muestreo son diversas y pueden ser individualizadas dependiendo de las circunstancias locales, aunque todas las muestras de sedimentos deben incluir una muestra segura que no haya sido expuesta a la luz y material para calcular la tasa de la dosis. La exactitud y precisión de los resultados de la datación por luminiscencia están directamente relacionadas con el tipo y la calidad de los materiales muestreados y los métodos de recolección de muestras en el campo. La elección del material de estudio para su datación debe incluir las siguientes consideraciones en torno a la idoneidad de poder reposicionar la señal de luminiscencia (blanqueador óptico y térmico), la capacidad de caracterizar el ambiente radiactivo que rodea la muestra (la tasa de la dosis) y el que no exista evidencia de una alteración posdeposicional (bioperturbación en suelos y sedimentos). Se discuten las estrategias de muestreo para la recolección de muestras de contextos sedimentarios y de materiales expuestos al fuego. Este artículo debe utilizarse como una guía para el muestreo por luminiscencia y tiene la intención de proveer información básica de cómo recolectar muestras y sobre los tipos de materiales apropiados para la datación por luminiscencia

One-Stage Coverage of Leg Region Defects with STSG Combined with VAC Dressing Improves Early Patient Mobilisation and Graft Take: A Comparative Study

Lower limb skin defects are very common and can result from a wide range of aetiologies. Split thickness skin graft (STSG) is a widely used method to address these problems. The role of postoperative dressing is primary as it permits one to apply a uniform pressure over the grafted area and promote adherence. Focusing on lower limb reconstruction, our clinical study compares the application of V.A.C. (Vacuum Assisted Closure) Therapy vs. conventional dressing in the immediate postoperative period following skin grafting. We included in the study all patients who received skin grafts on the leg region between January 2015 and December 2018, despite the aetiology of the defect. Only reconstructions with complete preoperative and postoperative follow-up data were included in the study. Patients were divided into two groups depending on if they received a traditional compressive dressing or a VAC dressing in the immediate postoperative period. We could retain 92 patients, 23 in the No VAC group and 69 in the VAC group. The patients included in the VAC group showed a statistically significant higher rate of graft take together with a lower immobilisation time (p < 0.05). Moreover, a lower rate of postoperative infection was recorded in the VAC group. This study represents the largest in the literature to report in detail surgical outcomes comparing the use of VAC therapy vs. conventional dressing after STSG in the postoperative management of lower limb reconstruction using skin grafts. VAC therapy was used to secure the grafts in the leg region, increasing the early graft take rate while at the same time improving patient mobilisation

Nuclear de-excitation line spectrum of Cassiopeia A

The supernova remnant Cassiopeia A is a prime candidate for accelerating cosmic ray protons and ions. Gamma rays have been observed at GeV and TeV energies, which indicates hadronic interactions, but they could also be caused by inverse-Compton scattering of low-energy photons by accelerated electrons. We seek to predict the flux of nuclear de-excitation lines from Cas A through lower-energy cosmic rays and to compare it with COMPTEL measurements. Assuming a hadronic origin of the high-energy emission, we extrapolate the cosmic ray spectrum down to energies of 10 MeV, taking into account an equilibrium power-law momentum spectrum with a constant slope. We then calculate the nuclear line spectrum of Cassiopeia A, considering the most prominent chemical elements in the MeV band and their abundances as determined by X-ray spectroscopy. We show that the predicted line spectrum is close to the level of the COMPTEL sensitivity and agrees with conservative upper limits.Comment: 4 pages, 1 figure, accepted for publication by A&

How many chronic myeloid leukemia patients who started a frontline second-generation tyrosine kinase inhibitor have to switch to a second-line treatment? A retrospective analysis from the monitoring registries of the italian medicines agency (AIFA)

The frequency of patients who switch to a second-line therapy from a frontline second-generation (2gen) tyrosine kinase inhibitor (TKI) such as dasatinib and nilotinib, is still substantially unknown. We retrospectively investigated a large series of chronic phase chronic myeloid leukemia (CP-CML) patients initially treated with 2gen TKIs monitored through the Italian Medicines Agency (AIFA Agenzia Italiana del farmaco) registries. Overall, 2420 patients were analyzed over a period of 6 years. One hundred and fifty-seven patients (16.3%) treated with dasatinib and 164 treated with nilotinib (11.3%) have switched to another drug, with an overall frequency of 13.2%. In the dasatinib cohort, 39.4% of patients changed treatment for failure and 36.3% for intolerance as compared to 45.7% and 27.4% respectively in the nilotinib cohort. Overall, the median time to switch due to resistance was 293 days, whereas it was 317 days in case of intolerance. Resistance was observed mainly in younger male patients with high-risk features, while intolerance was not related to any baseline parameter. After resistance/intolerance to nilotinib, the majority of patients switched to dasatinib (53.8%) whereas in case of frontline dasatinib to ponatinib (43.2%). To the best of our knowledge these data provide the first report on the frequency of discontinuation of frontline 2gen TKIs and on the main causes and pattern of choice to a second-line therapy in the real-life setting

Crucial Physical Dependencies of the Core-Collapse Supernova Mechanism

We explore with self-consistent 2D F{\sc{ornax}} simulations the dependence of the outcome of collapse on many-body corrections to neutrino-nucleon cross sections, the nucleon-nucleon bremsstrahlung rate, electron capture on heavy nuclei, pre-collapse seed perturbations, and inelastic neutrino-electron and neutrino-nucleon scattering. Importantly, proximity to criticality amplifies the role of even small changes in the neutrino-matter couplings, and such changes can together add to produce outsized effects. When close to the critical condition the cumulative result of a few small effects (including seeds) that individually have only modest consequence can convert an anemic into a robust explosion, or even a dud into a blast. Such sensitivity is not seen in one dimension and may explain the apparent heterogeneity in the outcomes of detailed simulations performed internationally. A natural conclusion is that the different groups collectively are closer to a realistic understanding of the mechanism of core-collapse supernovae than might have seemed apparent.Comment: 25 pages; 10 figure