Case Presentation for Compartment Syndrome of Tibial Nerve

CASE HISTORY: The patient is an active 60-year-old male who was seen in the emergency room following an injury to the right lower extremity due to heavy impact with the ground during a lacrosse tournament. He stated that he felt a sharp pain in the knee and that he could not run the next day. His pain continued to get worse and he began feeling sharp pins and needles on plantar surface. The patient was put on Xarelto (an anticoagulant) for the next six months and continued to consult with different doctors to further evaluate the progression of the injury. The swelling and pain eventually resolved but the pins and needles on the plantar aspect of the foot was persistent. PHYSICAL EXAM: Examination of the right lower extremity showed right thigh girth at the vastus medialis obliques to be 46 cm in comparison to 48 cm at the left thigh. The girth of the right calf was 1 cm smaller than the left calf at 40 cm. Manual testing found that strength and reflexes remained throughout the extremity, except for a notable loss of toe flexion strength. Ankle inversion was 3/5 on the right and 5/5 on the left. The tibialis posterior tendon was not palpable on the right. A dull pinprick assessment found that sensation was absent on the plantar surface of the right foot. These results indicated that there was a considerable loss of right flexor digitorum and right flexor hallucis strength, with a decrease in tibialis posterior function. DIFFERENTIAL DIAGNOSES: Deep vein thrombosis; popliteal artery entrapment; fibula or tibia fracture; ischemic necrosis or gangrene; stress fracture, medial tibial stress syndrome. TESTS & RESULTS: Patient had an MRI of the right lower extremity performed, which found diffused edema involving the deep posterior compartment, especially within the posterior tibialis muscle below the knee and flexor digitorum longus muscle. With further exams, minimal edema was found in the medial head of the gastrocnemius. Prominence of the deep compartment veins of the right lower extremity along the neurovascular bundle extending through the course of the tibial nerve and posterior tibial artery was also discovered. Postsurgical changes from a right ACL reconstruction, severe lateral compartment degenerative changes with loss of articular cartilage and osteophytes were found as well. FINAL DIAGNOSIS: Compartment Syndrome of Right Tibial Nerve. DISCUSSION: Compartment syndrome occurs when the tissue pressure inside of a compartment exceeds perfusion pressure from the local arterial supply. This pressure can build up due to bleeding, edema, or soft tissue damage in a closed muscle compartment. Acute trauma and overuse syndrome are the most common causes of compartment syndrome. Men are ten times more likely to develop compartment syndrome in the lower extremities than women. Males younger than 35 years of age who are involved in a high energy trauma possess the highest risk. OUTCOME OF THE CASE: The most recent MRI showed an improvement of diffuse edema involving the deep posterior compartment of the right lower leg with minimal persistent edema within the tibialis posterior muscle. Right knee joint degenerative changes continued to progress, especially in the lateral compartment. Given this long injury-span, the active patient was given a chance to do exercise therapy in a whirlpool. He was also prescribed Capsaicin cream. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: The patient was given a physical therapy order for 1-2 times per week. He will also receive transcutaneous electrical nerve stimulation for 20 minutes to stimulate the tibial nerve, an electromyography to evaluate the health of motor units, and an ultrasonogram of the tibial nerve during his follow-up visit in 4 weeks

9G4 Autoreactivity Is Increased in HIV-Infected Patients and Correlates with HIV Broadly Neutralizing Serum Activity

The induction of a broadly neutralizing antibody (BNAb) response against HIV-1 would be a desirable feature of a protective vaccine. Vaccine strategies thus far have failed to elicit broadly neutralizing antibody responses; however a minority of HIV-infected patients do develop circulating BNAbs, from which several potent broadly neutralizing monoclonal antibodies (mAbs) have been isolated. The findings that several BNmAbs exhibit autoreactivity and that autoreactive serum antibodies are observed in some HIV patients have advanced the possibility that enforcement of self-tolerance may contribute to the rarity of BNAbs. To examine the possible breakdown of tolerance in HIV patients, we utilized the 9G4 anti-idiotype antibody system, enabling resolution of both autoreactive VH4-34 gene-expressing B cells and serum antibodies. Compared with healthy controls, HIV patients had significantly elevated 9G4+ serum IgG antibody concentrations and frequencies of 9G4+ B cells, a finding characteristic of systemic lupus erythematosus (SLE) patients, both of which positively correlated with HIV viral load. Compared to the global 9G4−IgD− memory B cell population, the 9G4+IgD− memory fraction in HIV patients was dominated by isotype switched IgG+ B cells, but had a more prominent bias toward “IgM only" memory. HIV envelope reactivity was observed both in the 9G4+ serum antibody and 9G4+ B cell population. 9G4+ IgG serum antibody levels positively correlated (r = 0.403, p = 0.0019) with the serum HIV BNAbs. Interestingly, other serum autoantibodies commonly found in SLE (anti-dsDNA, ANA, anti-CL) did not correlate with serum HIV BNAbs. 9G4-associated autoreactivity is preferentially expanded in chronic HIV infection as compared to other SLE autoreactivities. Therefore, the 9G4 system provides an effective tool to examine autoreactivity in HIV patients. Our results suggest that the development of HIV BNAbs is not merely a consequence of a general breakdown in tolerance, but rather a more intricate expansion of selective autoreactive B cells and antibodies

Homing endonuclease I-TevIII: dimerization as a means to a double-strand break

Homing endonucleases are unusual enzymes, capable of recognizing lengthy DNA sequences and cleaving site-specifically within genomes. Many homing endonucleases are encoded within group I introns, and such enzymes promote the mobility reactions of these introns. Phage T4 has three group I introns, within the td, nrdB and nrdD genes. The td and nrdD introns are mobile, whereas the nrdB intron is not. Phage RB3 is a close relative of T4 and has a lengthier nrdB intron. Here, we describe I-TevIII, the H–N–H endonuclease encoded by the RB3 nrdB intron. In contrast to previous reports, we demonstrate that this intron is mobile, and that this mobility is dependent on I-TevIII, which generates 2-nt 3′ extensions. The enzyme has a distinct catalytic domain, which contains the H–N–H motif, and DNA-binding domain, which contains two zinc fingers required for interaction with the DNA substrate. Most importantly, I-TevIII, unlike the H–N–H endonucleases described so far, makes a double-strand break on the DNA homing site by acting as a dimer. Through deletion analysis, the dimerization interface was mapped to the DNA-binding domain. The unusual propensity of I-TevIII to dimerize to achieve cleavage of both DNA strands underscores the versatility of the H–N–H enzyme family

Biomolecular insights into North African-related ancestry, mobility and diet in eleventh-century Al-Andalus.

Funder: Helmholtz Zentrum München – German Research Center for Environmental HealthFunder: Leverhulme TrustHistorical records document medieval immigration from North Africa to Iberia to create Islamic al-Andalus. Here, we present a low-coverage genome of an eleventh century CE man buried in an Islamic necropolis in Segorbe, near Valencia, Spain. Uniparental lineages indicate North African ancestry, but at the autosomal level he displays a mosaic of North African and European-like ancestries, distinct from any present-day population. Altogether, the genome-wide evidence, stable isotope results and the age of the burial indicate that his ancestry was ultimately a result of admixture between recently arrived Amazigh people (Berbers) and the population inhabiting the Peninsula prior to the Islamic conquest. We detect differences between our sample and a previously published group of contemporary individuals from Valencia, exemplifying how detailed, small-scale aDNA studies can illuminate fine-grained regional and temporal differences. His genome demonstrates how ancient DNA studies can capture portraits of past genetic variation that have been erased by later demographic shifts-in this case, most likely the seventeenth century CE expulsion of formerly Islamic communities as tolerance dissipated following the Reconquista by the Catholic kingdoms of the north

Racial Differences in Depression Trajectories among Older Women: Socioeconomic, Family, and Health Influences

Abstract available at publisher's website