Scedosporium prolificans Septic Arthritis

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did not show sustained response to antibiotics or a radiocarpal joint steroid injection given by other providers. On initial examination, she was afebrile with dorsal wrist swelling. There was no erythema, but wrist mobility was limited. She had tenderness throughout the wrist, but no fluctuance or drainage. All initial laboratory work was normal. Right wrist X-ray showed severe osteopenia with some mild evidence of cortical erosion. Despite the normal laboratory values, her presenting findings of swelling, radiographic erosions, and immunocompromised state prompted concern for atypical septic arthritis. The patient subsequently underwent wrist exploration for tissue and culture harvest. In addition to extensive wrist synovectomy, the proximal pole of the scaphoid, lunate, triquetrum, capitate, hamate, and metacarpal bases all showed evidence of necrosis that required debridement. One week later, her fluid aspirate and bone cultures unexpectedly grew an unidentified fungal species, and she was taken back to the operating room for further debridement and placement of a voriconazole-impregnated cement spacer. The culture grew pan-resistant Scedosporium prolificans, and based on recommendations from Rheumatology and Infectious Disease, the patient was started on a 6-week course of intravenous micafungin, and immunosuppressive medications were stopped. She returned to the operating room for debridement and serial treatments with polyhexamethylene biguanide (PHMB) irrigation until intraoperative tissue cultures showed no growth. PHMB is an antiseptic medication that has been described as a local adjunct to the treatment of resistant fungal infections.2–4 After successful eradication of her infection, she underwent wrist reconstruction and fusion with a double-barrel free fibula osteocutaneous flap. She is now 18 months out from her reconstruction, has healed uneventfully, and has a functional, painless upper extremity

Preliminary investigation of a polyethylene glycol hydrogel "nerve glue"

<p>Abstract</p> <p>Background</p> <p>Polyethylene glycol (PEG) hydrogel is a biocompatible semi-adherent gel like substance that can potentially augment nerve repair much like a fibrin sealant. Potential advantages of this substance include fast preparation and set up time, as well as adhesion inhibiting properties. The purpose of this study was to perform an initial evaluation of PEG hydrogel in this application.</p> <p>Methods</p> <p>The sciatic nerves of 29 rats were transected and repaired using two 10-0 nylon sutures and either PEG hydrogel or fibrin glue. After 10 weeks, contraction forces of the reinnervated muscles were evaluated and histological assessment of scar tissue performed.</p> <p>Results</p> <p>Muscle strength testing revealed the average ratio of experimental to control sides for the fibrin glue group was 0.75 and for the PEG hydrogel group was 0.72 (no significant difference). Longitudinal sections through the nerve repair site showed no significant difference in nerve diameter but did demonstrate a significant reduction in scar thickness in the PEG hydrogel group (p < 0.01).</p> <p>Conclusion</p> <p>Though further study is necessary to fully evaluate, PEG hydrogel results in less scar tissue formation and equivalent muscle recovery as fibrin sealant when applied as a nerve glue in a rodent sciatic nerve repair model.</p

Bring your own heritage: final project report.

Public libraries have traditionally played a role in the acquisition and curation of local studies collections, and cultural heritage is recognised as a core area of activity for libraries aiming to increase patron numbers (Danish Agency for Libraries and Media, 2010). Developments in digital technologies present libraries with new opportunities to enhance this area of strength and expertise. For example, crowdsourcing, gaming and laser scanning could be used to increase engagement and to enable more people to both access and contribute to these collections (Laing and Scott, 2011; Nicholson, 2013; Czarnecki, 2010). Libraries are increasingly becoming spaces where knowledge is created and shared, and many are making use of collaborative and social technologies to encourage this (Paulus, 2011). Our project was conducted in partnership with Moray Council in Elgin, in the Northeast of Scotland. It has a rich history dating back to the 12th century - but, like many areas, it is facing challenges. The library service in the local authority area of Moray has been threatened with cuts, with four local branches earmarked for closure (BBC, 2013). The main aim of this research was to investigate the opportunities and challenges for libraries to develop their role as facilitators of community heritage curation through the development of IT utilities, such as laser scanning and gaming

Tracking evaporative cooling of a mesoscopic atomic quantum gas in real time

The fluctuations in thermodynamic and transport properties in many-body systems gain importance as the number of constituent particles is reduced. Ultracold atomic gases provide a clean setting for the study of mesoscopic systems; however, the detection of temporal fluctuations is hindered by the typically destructive detection, precluding repeated precise measurements on the same sample. Here, we overcome this hindrance by utilizing the enhanced light--matter coupling in an optical cavity to perform a minimally invasive continuous measurement and track the time evolution of the atom number in a quasi two-dimensional atomic gas during evaporation from a tilted trapping potential. We demonstrate sufficient measurement precision to detect atom number fluctuations well below the level set by Poissonian statistics. Furthermore, we characterize the non-linearity of the evaporation process and the inherent fluctuations of the transport of atoms out of the trapping volume through two-time correlations of the atom number. Our results establish coupled atom--cavity systems as a novel testbed for observing thermodynamics and transport phenomena in mesosopic cold atomic gases and, generally, pave the way for measuring multi-time correlation functions of ultracold quantum gases.Comment: Significantly extended discussion of Fig. 4. Accepted for publication in Phys. Rev.

Education And Small Business Growth: A Gender Perspective Of Two Divergent Provinces In South Africa

The article attempts to identify whether the level of education and gender has an impact on the business growth of SMMEs in a developing economy. The study furthermore looks at the contribution made by the SMME sector from a spatial perspective. The Western Cape is seen as a more affluent province and a bigger contributor to the country’s GDP as opposed to KwaZulu-Natal, which comprises of the former province of Natal and the Zululand homelands. Entrepreneurship can be considered as one of the means of creating an enabling environment conducive to reducing poverty, stimulating economic growth, and creating employment opportunities, particularly in a South African context. Hence, activities in the SMME sector are often considered to be the bedrock of an economy and a key driver of growth and development. This holds most true for women assuming the role of entrepreneur, especially in developing countries. This study aims to explore and test this delicate relationship between women entrepreneurs and SMME sustainability, and to conduct empirical investigations into high-density SMME operations in two South African provinces. Survey data were collected from SMME owners/managers in the Western Cape and KwaZulu-Natal provinces of South Africa. In building on previous academic literature on SMME sustainability and women in business, various measures are developed and tested for reliability and validity. The study is cross-sectional in design, making use of trained fieldworkers to administer face-to-face surveys to a diverse set of SMMEs. A structured questionnaire was used to collect data from 465 owners/managers in the two provinces. The findings show (i) a positive relationship between a business owner’s/manager’s level of education and business growth, (ii) no correlation between a business owner’s/manager’s education and employment, and (iii) no relationship between gender and business growth. The findings of the study can benefit the South African Government in directing policy, SMME owners, educators and women in business by increasing awareness of the nature of sustainable SMMEs, and the effect of operational skills, gender and education on the development thereof. This study focuses on the growing sector of women in business and the impact of education in SMMEs linked toward business sustainability. A contribution is made toward theory development through empirical research

Follistatin protein enhances satellite cell counts in reinnervated muscle

Background Muscle recovery following peripheral nerve repair is sup-optimal. Follistatin (FST), a potent muscle stimulant, enhances muscle size and satellite cell counts following reinnervation when administered as recombinant FST DNA via viral vectors. Local administration of recombinant FST protein, if effective, would be more clinically translatable but has yet to be investigated following muscle reinnervation. Objective  The aim of this study is to assess the effect of direct delivery of recombinant FST protein on muscle recovery following muscle reinnervation. Materials and Methods  In total, 72 Sprague-Dawley rats underwent temporary (3 or 6 months) denervation or sham denervation. After reinnervation, rats received FST protein (isoform FS-288) or sham treatment via a subcutaneous osmotic pump delivery system. Outcome measures included muscle force, muscle histomorphology, and FST protein quantification. Results  Follistatin treatment resulted in smaller muscles after 3 months denervation ( p  = 0.019) and reduced force after 3 months sham denervation ( p  < 0.001). Conversely, after 6 months of denervation, FST treatment trended toward increased force output ( p  = 0.066). Follistatin increased satellite cell counts after denervation ( p  < 0.001) but reduced satellite cell counts after sham denervation ( p  = 0.037). Conclusion  Follistatin had mixed effects on muscle weight and force. Direct FST protein delivery enhanced satellite cell counts following reinnervation. The positive effect on the satellite cell population is intriguing and warrants further investigation

Designer TGFβ Superfamily Ligands with Diversified Functionality

Transforming Growth Factor – beta (TGFβ) superfamily ligands, including Activins, Growth and Differentiation Factors (GDFs), and Bone Morphogenetic Proteins (BMPs), are excellent targets for protein-based therapeutics because of their pervasiveness in numerous developmental and cellular processes. We developed a strategy termed RASCH (Random Assembly of Segmental Chimera and Heteromer), to engineer chemically-refoldable TGFβ superfamily ligands with unique signaling properties. One of these engineered ligands, AB208, created from Activin-βA and BMP-2 sequences, exhibits the refolding characteristics of BMP-2 while possessing Activin-like signaling attributes. Further, we find several additional ligands, AB204, AB211, and AB215, which initiate the intracellular Smad1-mediated signaling pathways more strongly than BMP-2 but show no sensitivity to the natural BMP antagonist Noggin unlike natural BMP-2. In another design, incorporation of a short N-terminal segment from BMP-2 was sufficient to enable chemical refolding of BMP-9, without which was never produced nor refolded. Our studies show that the RASCH strategy enables us to expand the functional repertoire of TGFβ superfamily ligands through development of novel chimeric TGFβ ligands with diverse biological and clinical values

The accuracy of clinical symptoms and signs for the diagnosis of serious bacterial infection in young febrile children: prospective cohort study of 15 781 febrile illnesses

Objectives To evaluate current processes by which young children presenting with a febrile illness but suspected of having serious bacterial infection are diagnosed and treated, and to develop and test a multivariable model to distinguish serious bacterial infections from self limiting non-bacterial illnesses

What can rheumatologists learn from translational cancer therapy?

It is well established that an intimate connection exists between inflammation and neoplasia. Indeed, particular chronic infections and autoimmune processes giving rise to prolonged site-specific inflammation are known to increase the probability of the development of specific cancers. Molecular characterisation of these processes has revealed profound similarities in the specific molecules involved in persistence of inflammation and in both the primary induction of neoplastic processes and in specification of the preferred anatomic sites of metastatic spread. The therapeutic importance of these findings is underscored by the remarkable success in the treatment of autoimmune pathology using medications initially developed for use in oncology and this arena is one of considerable therapeutic promise for rheumatologists