Sarcoidosis presenting as granulomatous myositis in a 16-year-old adolescent

BACKGROUND: Sarcoidosis is a multi-system disease characterized by the presence of non-caseating epithelioid granulomas in affected tissues, including skeletal muscle. These organized collections of immune cells have important pathophysiologic action including cytokine production leading to inflammation as well as enzymatic conversion of cholecalciferol to calcitriol via 1-α hydroxylase. There are limited reports of isolated granulomatous myositis causing hypercalcemia in pediatric patients. Our patient uniquely presented with symptoms from hypercalcemia and renal insufficiency caused by an overwhelming burden of granulomatous myositis in her lower extremities, but was otherwise asymptomatic. CASE PRESENTATION: A 16 year old Caucasian female presented with protracted symptoms of fatigue, nausea and prominent weight loss with laboratory evidence of hypercalcemia and renal insufficiency. She lacked clinical and physical findings of arthritis, weakness, rash, uveitis, fever, lymphadenopathy or respiratory symptoms. After extensive negative investigations, re-examination yielded subtle soft tissue changes in her lower extremities, with striking MRI findings of extensive myositis without correlative weakness or serum enzyme elevation. Biopsy showed the presence of non-caseating epithelioid granulomas and calcium oxalate crystals. The patient responded well to prednisone and methotrexate but relapsed with weaning of steroids. She reachieved remission with addition of adalimumab. CONCLUSIONS: Sarcoidosis should be considered in patients presenting with symptomatic hypercalcemia with no apparent causes and negative routine workup. The absences of decreased muscle strength or elevated muscle enzymes do not preclude the diagnosis of granulomatous myositis

A preliminary evaluation of a new control-knob design for electronic equipment

Two experiments were carried out using five subjects to compare performance using standard and flush fitting rotary controls for electronic equipment. It vas found that the flush knob could be rotated more quickly through several revolutions, but a given setting accuracy was achieved less quickly using this flush knob. Some of the more general advantages and disadvantages of the flush knob are outlined. It should be noted that the primary objective of this study was to provide the participants with some experience in carrying out Human Factors studies and the time allowed was not such as to permit a comprehensive evaluation of the new knob design

Comparison of water-sensitive paper, Kromekote and Mylar collectors for droplet deposition with a visible fluorescent dye solution

The study was conducted at the University of Nebraska Pesticide Application and Tech-nology Laboratory in North Platte, Nebraska in July 2015. Two application volume rates (100 and 200 l · ha−1) and three nozzle types (XR, AIXR, TTI) were selected at two flow rates (0.8 and 1.6 l · min−1) and at a single application speed of 7.7 km · h−1. Each collec-tor type [Mylar washed (MW), Mylar image analysis (MIA), water-sensitive paper (WSP), and Kromekote (KK)] was arranged in a randomized complete block design. Each nozzle treatment was replicated twice, providing six cards of each collector type for each nozzle treatment. A water + 0.4% v/v Rhodamine WT spray solution was applied, given the fluo-rescent and visible qualities of Rhodamine, which allows it to be applied over all the collec-tor types. MW had the highest coverage at 18.3% across nozzle type, followed by WSP at 18%, KK at 12% and lastly by MIA at 4%. MW resulted in a 58% increase in coverage, WSP in a 56% increase, and KK only an increase of 39% when the volume rate was doubled from 100 l · ha−1 to 200 l · ha−1 across nozzle type. MW coverage was similar to KK for half of the nozzles (XR 11002, XR 11004, AIXR 11002). Droplet number density fixed effects were all significant for nozzle type and collector type (p \u3c 0.001) as was the interaction of nozzle type and collector type (p \u3c 0.001). Results from this study suggest a strong correlation to data produced with WSP and MW collectors, as there was full agreement between both types except for the TTI 11004. Using both collector types in the same study would allow for a visual understanding of the distribution of the spray, while also giving an idea of the concentration of that distribution

Novel, Anti-hTNF-α Variable New Antigen Receptor Formats with Enhanced Neutralising Potency and Multifunctionality, Generated for Therapeutic Development

ACKNOWLEDGMENTS The authors wish to acknowledge the funding support for this work from MSD/Scottish Universities Life Sciences Alliance (SULSA), Scottish Enterprise, the Biotechnology and Biological Sciences Research Council (BBSRC), and the University of Aberdeen. FUNDING Grateful for support from Biotechnology and Biological Sciences Research Council (BB/K010905/1), Scottish Enterprise [VNAR_001 (2012)], Scottish Universities Life Sciences Alliance/ MSD (MSD01_A_Porter-Teismann), and the College of Life Sciences and Medicine, University of Aberdeen (Fee bursary to OU).Peer reviewedPublisher PD

Avirulent Strains of Toxoplasma Gondii Infect Macrophages by Active Invasion from the Phagosome

Unlike most intracellular pathogens that gain access into host cells through endocytic pathways, Toxoplasma gondii initiates infection at the cell surface by active penetration through a moving junction and subsequent formation of a parasitophorous vacuole. Here, we describe a noncanonical pathway for T. gondii infection of macrophages, in which parasites are initially internalized through phagocytosis, and then actively invade from within a phagosomal compartment to form a parasitophorous vacuole. This phagosome to vacuole invasion (PTVI) pathway may represent an intermediary link between the endocytic and the penetrative routes for host cell entry by intracellular pathogens. The PTVI pathway is preferentially used by avirulent strains of T. gondii and confers an infectious advantage over virulent strains for macrophage tropism

Outcomes of elective induction of labour compared with expectant management: population based study

Objective To determine neonatal outcomes (perinatal mortality and special care unit admission) and maternal outcomes (mode of delivery, delivery complications) of elective induction of labour compared with expectant management