Fusobacterium nucleatum prosthetic hip infection: Case report and review of the literature of unusual anaerobic prosthetic joint infection.

The anaerobic Gram-negative rod Fusobacterium nucleatum is an oral commensal and periodontal pathogen that has been associated with a wide variety of infections, yet it is extremely rare to be associated with prosthetic joint infection. After an exhaustive literature review, only two cases of prosthetic joint infection by F. nucleatum have been previously reported. To our knowledge, the case we report on here is the first combined with periprosthetic abscess and related with hemochromatosis. We therefore sought to provide a comprehensive literature review of case reports or series of less commonly encountered anaerobic microorganisms isolated from prosthetic joint infections.

Edad al momento del trasplante: ¿Quiénes tienen riesgo de mala evolución ? / Age at transplantation: who are at risk of a poor outcome ?

Introducción: Si bien la sobrevida de paciente e injerto en niños con trasplante renal (TxR) ha mejorado, algunos sugieren que la edad al TxR es predictora de malos resultados, y los mayores tendrían peor evolución. Objetivo: Definir sobrevida de paciente e injerto según edad al TxR, y factores pronósticos de fracaso en aquellos con peor evolución. Material y métodos: Cohorte retrospectivo de todos los pacientes con TxR en el Hospital Garrahan desde el 01-01-2002 hasta el 01-03-2016. Resultados: de 431 pacientes, 44, (10%) tenían < 6a, 179 (42%)> 6 y <12 y 208 (48%) ≥12 años. La sobrevida del paciente a 8 años fue 97%, 99% y 95% (p=0,2), y la del injerto de: 86%, 69% y 30% respectivamente (p=<0,001). En los ≥ de 12 años, con peor evolución, se incluyeron al análisis univariado como factores de riesgo de pérdida de injerto: GSFS como causa de IRC : HR: 9,4; (p<0,001), Rechazo Agudo (RA) temprano: HR: 8,1; (p<0,001), RA tardío: HR: 4,3; (p<0.001), DGF: HR: 4,1; (p<0,001), No adherencia: HR: 2,3; (p=0,02), Edad de DC > 35a: HR: 1,95 (p=0,1), Tiempo en diálisis: HR: 1,1 (p=0,1), Número de incompatibilidades HLAB y HLADR: HR: 0,8 (p=0,3), Tiempo de Isquemia : 0,9 (p=0,5), Sexo del receptor: HR:0,8 (p=0,6), Donante Cadavérico: HR: 1,2; (p=0,6), 2do TxR : HR: 1,2; (p=0,7). En análisis multivariado: RA tardío: HR: 12,9 (p<0,001), GSFS como causa de IRC: HR: 12,5 (p<0,001), RA temprano: HR: 9 (p<0,001), y DGF: HR: 4,9 (p<0,001). Conclusión: la sobrevida del injerto en adolescentes es inferior. Merecen atención, la prevención de la no adherencia asociada a rechazo, el paciente con GSFS y el retardo de la función pos TxR (AU)

Introduction: Although patient and graft survival of children with a kidney transplantation (KTx) has improved, it has been suggested that older age at KTx is a predictive factor of poor outcome. Aim: To evaluate patient and graft survival according to age at KTx and define predictive factors in those with a poor outcome. Material and methods: A retrospective cohort study was conducted in all patients who underwent KTx at Garrahan Hopital between 01-01-2002 and 01-03-2016. Results: Of 431 patients, 44 (10%) were <6yr, 179 (42%) >6yr, and <12yr, and 208 (48%) ≥12yr. Eight-year patient survival was 97%, 99%, and 95% (p=0.2) and graft survival was 86%, 69%, and 30% (p=<0.001), respectively. In children ≥12 yr, with a worse outcome, the following risk factors of graft loss were included in univariate analysis: FSGS-related CFR: HR: 9.4; (p<0.001), early acute rejection (AR): HR: 8.1; (p<0.001), late AR: HR: 4.3; (p<0.001), DGF: HR: 4.1; (p<0.001), non-adherence: HR: 2.3; (p=0.02), age of deceased donor >35yr: HR: 1.95 (p=0.1), time on dialysis: HR: 1.1 (p=0.1), number of HLA-B and HLA-DR mismatches: HR: 0.8 (p=0.3), cold ischemia time: 0.9 (p=0.5), recipient sex: HR:0.8 (p=0.6), deceased donor: HR: 1.2; (p=0.6), second KTx: HR: 1.2; (p=0.7; and in multivariate analysis: late AR: HR: 12.9 (p<0.001), FSGS-related CFR: HR: 12.5 (p<0.001), early AR: HR: 9 (p<0.001), and DGF: HR: 4.9 (p<0.001). Conclusion: Graft survival is lower in adolescents. Prevention of rejection associated with non-adherence, FSGS, and post-KTx DGF should be taken into account (AU)

Self-Reported bruxism and associated factors in Israeli adolescents.

Little is known about the epidemiological characteristics of sleep and awake bruxism (SB and AB) in adolescents. The aims of the study were: to assess the prevalence rates of self-reported SB and AB in Israeli adolescents; to determine the associations between SB/AB and several demographical, exogenous and psychosocial factors in Israeli adolescents; and to investigate the possible concordance between SB and AB. The study made use of a questionnaire. The study population included 1000 students from different high schools in the centre of Israel. Prevalence of self-reported SB and AB in the Israeli adolescents studied was 9·2% and 19·2%, respectively. No gender difference was found regarding the prevalence of SB and AB. Multiple variable regression analysis revealed that the following predicting variables were related to SB: temporomandibular joint sounds (P = 0·002) and feeling stressed (P = 0·001). The following predicting variables were related to AB: age (P = 0·018), temporomandibular joint sounds (P = 0·002), oro-facial pain (P = 0·006), and feeling stressed (P = 0·002) or sad (P = 0·006). A significant association was found between SB and AB; that is, an individual reporting SB had a higher probability of reporting AB compared with an individual who did not report SB (odds ratio = 5·099). Chewing gum was the most common parafunction reported by adolescents. The results of this study demonstrate that self-reports of AB and SB are common in the Israeli adolescents population studied and are not related to gender. The significant correlation found between SB and AB may be a confounding bias that affects proper diagnosis of bruxism through self-reported questionnaires only.

Spontaneous resolution of acute rejection and tolerance induction with IL-2 fusion protein in vascularized composite allotransplantation.

Vascularized composite allotransplantation (VCA) has emerged as a treatment option for treating nonlife-threatening conditions. Therefore, in order to make VCA a safe reconstruction option, there is a need to minimize immunosuppression, develop tolerance-inducing strategies and elucidate the mechanisms of VCA rejection and tolerance. In this study we explored the effects of hIL-2/Fc (a long-lasting human IL-2 fusion protein), in combination with antilymphocyte serum (ALS) and short-term cyclosporine A (CsA), on graft survival, regulatory T cell (Treg) proliferation and tolerance induction in a rat hind-limb transplant model. We demonstrate that hIL-2/Fc therapy tips the immune balance, increasing Treg proliferation and suppressing effector T cells, and permits VCA tolerance as demonstrated by long-term allograft survival and donor-antigen acceptance. Moreover, we observe two distinct types of acute rejection (AR), progressive and reversible, within hIL-2/Fc plus ALS and CsA treated recipients. Our study shows differential gene expression profiles of FoxP3 versus GzmB, Prf1 or interferon-γ in these two types of AR, with reversible rejection demonstrating higher Treg to Teff gene expression. This correlation of gene expression profile at the first clinical sign of AR with VCA outcomes can provide the basis for further inquiry into the mechanistic aspects of VCA rejection and future drug targets.

Periarticular regional analgesia in total knee arthroplasty: a review of the neuroanatomy and injection technique.

Postoperative pain control after total knee arthroplasty may be insufficient, resulting in insomnia, antalgic ambulation, and difficulty with rehabilitation. Current strategies, including the use of femoral nerve catheters, may control pain but have been associated with falls, motor blockade, and quadriceps inhibition. Periarticular infiltration using the appropriate technique and knowledge of intraarticular knee anatomy may increase pain control and maximize rehabilitation.

Patients' understanding of how genotype variation affects benefits of tamoxifen therapy for breast cancer.

BACKGROUND: CYP2D6 is a critical enzyme in the metabolism of tamoxifen and potentially a key determinant in breast cancer outcomes. Our study examined patients' beliefs about how the CYP2D6 genotype would affect their prognoses. METHODS: Women enrolled in a pharmacogenomic clinical trial and on tamoxifen for prevention or treatment of breast cancer underwent CYP2D6 genotyping (EM = extensive, IM = intermediate, PM = poor metabolizing alleles). The informed consent said that the purpose of the trial was to examine effects of dose adjustment based on genotype, but that clinical benefits were uncertain. Our embedded sub-study surveyed 320 patients prior to receiving their genotypes. We experimentally manipulated 6 vignettes to describe hypothetical tamoxifen treatment (no or yes) and hypothetical genotype (EM, IM or PM). For each vignette, women gave their perceived recurrence risk (RR; 0-100%). RESULTS: Women believed that genotype would not affect their RR if they did not take tamoxifen (p = 0.06). However, women believed that if prescribed tamoxifen, genotype would affect their RR (22% if EM, 30% if IM and 40% if PM, p < 0.001). CONCLUSION: Women believed that extensive tamoxifen metabolizers had better prognoses, despite study materials stating uncertainty about any benefit. The rapidly changing nature of genomic science calls for caution when communicating clinical utility.

Masticatory muscle disorders diagnostic criteria: the American Academy of Orofacial Pain versus the research diagnostic criteria/temporomandibular disorders (RDC/TMD).

In this study, relevant cases were retrospectively reviewed to identify patients who were diagnosed as suffering from myofascial pain only according to the research diagnostic criteria/temporomandibular disorders (RDC/TMD) criteria, in order to examine whether or not they could fulfil the American Academy of Orofacial Pain (AAOP) diagnostic criteria for TMD-related masticatory muscle disorders. One hundred and twenty-seven patients, diagnosed according to the RDC/TMD criteria as having myofascial pain with or without limited jaw opening only, were allocated to two groups according to their answers to the RDC/TMD 'jaw disability checklist'. The two groups were compared for Axis I and II data taken from the RDC/TMD questionnaire. Thirty-eight of the patients (29·9%) did not associate their symptoms with jaw functions (e.g. chewing and yawning). This group was characterised by increased range of motion (ROM) and older average age. The AAOP diagnostic criteria for TMD require pain on function in all subtypes of TMD-related muscle disorders. An association between pain and jaw function is common and research is needed to determine whether this should be categorised differently to muscle pain unrelated to jaw function. There may well be different pathophysiological mechanisms and consequently different management strategies for these two pain conditions.

Bruxism, oral parafunctions, anamnestic and clinical findings of temporomandibular disorders in children.

The reported prevalence of temporomandibular disorders (TMD) present during childhood and adolescence ranges between 7% and 68%. The range of the reported prevalence of sleep bruxism in children is also wide. The purpose of the current study was threefold: (i) determine the prevalence of oral parafunctions, sleep bruxism and of anamnestic and clinical findings of TMD among Israeli children with primary or mixed dentition; (ii) to establish whether the parafunctional activities are associated with anamnestic and clinical findings of TMD in this population and (iii) to examine the possible impact of stressful life events on the prevalence of bruxism, oral parafunctions, and anamnestic and clinical findings of TMD in children. A total of 244 children (183 girls and 61 boys) aged 5-12 years were included in the study. Each participant underwent a full TMD examination. Parents, in collaboration with their children, completed a questionnaire on TMD symptoms, oral parafunctions and stressful life events in their children's life. Most participants (78·8%) reported at least one oral habit. Of these, only 'jaw play' was associated with TMD anamnestic and clinical findings. Stressful life events were associated only with the performance of multiple oral habits. These findings indicate that the performance of oral parafunctions is commonplace during childhood, with younger children exhibiting fewer oral parafunctions than adolescents. Stressful life events are related with an increase in the performance of multiple oral parafunctions in children but the later are not necessarily associated with anamnestic and clinical findings of TMD in the paediatric population.

The copia retrotransposon and horizontal transfer in Drosophila willistoni.

The copia element is a retrotransposon that is hypothesized to have been horizontally transferred from Drosophila melanogaster to some populations of Drosophila willistoni in Florida. Here we have used PCR and Southern blots to screen for sequences similar to copia element in South American populations of D. willistoni, as well as in strains previously shown to be carriers of the element. We have not found the canonical copia element in any of these populations. Unlike the P element, which invaded the D. melanogaster genome from D. willistoni and quickly spread worldwide, the canonical copia element appears to have transferred in the opposite direction and has not spread. This may be explained by differences in the requirements for transposition and in the host control of transposition.

Observation of eta' decays to pi+pi-pi0 and pi+pi-e+e-.

Using psi(2S)-->pi;{+}pi;{-}J/psi, J/psi-->gammaeta;{'} events acquired with the CLEO-c detector at the CESR e;{+}e;{-} collider, we make the first observations of the decays eta;{'}-->pi;{+}pi;{-}pi;{0} and eta;{'}-->pi;{+}pi;{-}e;{+}e;{-}, measuring absolute branching fractions (37_{-9};{+11}+/-4)x10;{-4} and (25_{-9};{+12}+/-5)x10;{-4}, respectively. For eta;{'}-->pi;{+}pi;{-}pi;{0}, this result probes the mechanism of isospin violation and the roles of pi;{0}/eta/eta;{'}-mixing and final state rescattering in strong decays. We also set upper limits on branching fractions for eta;{'} decays to pi;{+}pi;{-}micro;{+}micro;{-}, 2(pi;{+}pi;{-}), pi;{+}pi;{-}2pi;{0}, 2(pi;{+}pi;{-})pi;{0}, 3(pi;{+}pi;{-}), and invisible final states.

Successful management of spontaneous Clostridium septicum myonecrosis.

Spontaneous Clostridium septicum myonecrosis, or gas gangrene, is an extremely rare soft tissue infection associated with malignancy and immunosuppression. Even with appropriate treatment the mortality rate approaches 100%. We present the case of a patient who presented with fulminant Clostridium septicum sepsis and myonecrosis who was successfully treated and made a full recovery within two weeks of the initial episode.

[Laser Doppler flowmetry in differential diagnosis of organic erectile dysfunction].

The aim of this study was to investigate penile microcirculation in patients with erectile dysfunction. Laser doppler flowmetry was performed in 67 patients (mean age 43.9 +/- 1.53 years) with organic erectile dysfunction and in 20 men without erectile dysfunction. It was found that in patients with arteriogenic erectile dysfunction blood flow parameters were subnormal including flux motions. The occlusive test revealed reduced postocclusive reactive hyperemia in patients with arteriogenic erectile dysfunction. Patients with neurogenic erectile dysfunction have signs of sympathetic denervation of microcirculation and decreased respiratory response.

Determination of the strong phase in D0-->K+pi- using quantum-correlated measurements.

We exploit the quantum coherence between pair-produced D0 and D[over]0 in psi(3770) decays to study charm mixing, which is characterized by the parameters x and y, and to make a first determination of the relative strong phase delta between D0-->K+pi- and D[over]0-->K+pi-. Using 281 pb(-1) of e+e- collision data collected with the CLEO-c detector at Ecm=3.77 GeV, as well as branching fraction input and time-integrated measurements of RM identical with (x2 + y2)/2 and RWS identical with Gamma(D0-->K+pi-)/Gamma(D[over]0-->K+pi-) from other experiments, we find cosdelta=1.03(-0.17)(+0.31)+/-0.06, where the uncertainties are statistical and systematic, respectively. By further including other mixing parameter measurements, we obtain an alternate measurement of cosdelta=1.10+/-0.35+/-0.07, as well as x sindelta=(4.4(-1.8)(+2.7)+/-2.9)x10(-3) and delta=(22(-12-11)(+11+9)) degrees .

Absolute measurement of hadronic branching fractions of the Ds+ meson.

The branching fractions of D(s)(+/-) meson decays serve to normalize many measurements of processes involving charm quarks. Using 298 pb(-1) of e(+)e(-) collisions recorded at a center of mass energy of 4.17 GeV, we determine absolute branching fractions for eight D(s)(+/-) decays with a double tag technique. In particular we determine the branching fraction B(D(s)(+)-->K(-)K(+}pi(+))=(5.50+/-0.23+/-0.16)%, where the uncertainties are statistical and systematic, respectively. We also provide partial branching fractions for kinematic subsets of the K(-)K(+)pi(+) decay mode.

First observation of the decay Ds+-->pn.

Using e+e--->Ds*-Ds+ data collected near the peak Ds production energy, Ecm=4170 MeV, with the CLEO-c detector, we present the first observation of the decay Ds+-->pn. We measure a branching fraction B(Ds+-->pn)=(1.30+/-0.36(-0.16)+0.12)x10(-3). This is the first observation of a charmed meson decaying into a baryon-antibaryon final state.

Comparison of the effects of unfractionated heparin and the low-molecular-weight heparins dalteparin and enoxaparin on spontaneous platelet aggregation and adenosine diphosphate activity in platelets during the third trimester of pregnancy.

Low-molecular-weight heparins (LMWHs) have demonstrable pharmacokinetic, pharmacodynamic and safety advantages over unfractionated heparin (UH) in routine clinical use and are now the preferred agents in routine anticoagulant therapy. However, the utility and impact of the LMWH compared with that of UH has not been studied extensively in human pregnancy, wherein the prophylaxis against venous thromboembolism is imperative. Human pregnancy is a hypercoagulable state with an increase in spontaneous platelet aggregation (SPA) in vivo. We evaluated and compared the effects of UH and the LMWHs dalteparin and enoxaparin (10 U/ml) on SPA in citrated whole blood with an ultraflow platelet counter in pregnancy and also investigated the role of adenosine diphosphate (ADP) in heparin-induced platelet aggregation in the third trimester of pregnant women (aged 28 +/- 3 years, gestational age 34 +/- 5 weeks) and in healthy, age-matched nonpregnant women. Pregnant women showed a significantly increased SPA of 37% 6 5% compared with 16% 6 3% in nonpregnant women (p < 0.01). UH exerted a significantly greater proaggregatory effect on SPA compared with that of LMWHs or saline (p < 0.0002; ANOVA). The maximum values of SPA were as follows: UH, 69% +/- 5%; dalteparin, 46% +/- 5%; and enoxaparin, 54% +/- 3%. There was no difference between SPA induced by LMWHs and saline or between enoxaparin and dalteparin. At 480 s, there was no difference in SPA induced by LMWH between pregnant and nonpregnant women, but UH substantially and specifically increased SPA in pregnant women compared with that in nonpregnant women (p < 0.01). This heparin-induced platelet activation and thrombocytopenic response was reversed by apyrase grade II (ADP scavenger) that also inhibited SPA in pregnancy to a level similar to that of nonpregnant women (p < 0.0002; ANOVA). These results indicate that the LMWHs dalteparin and enoxaparin cause significantly less platelet aggregation in whole blood in pregnancy and in the nonpregnant state when compared with UH. The proaggregatory platelet effects of UH is substantially enhanced in pregnancy, a property not shared by LMWHs. The reversal of the heparin-induced platelet activation by apyrase grade II suggests that the mechanism is, at least in part, mediated by copious ADP release from platelets or red cells by heparin but not LMWHs.

Study of exclusive charmless semileptonic B decays and |Vub|.

We study semileptonic B decay to the exclusive charmless states pi, rho/omega, eta, and eta;{'} using the 16 fb(-1) CLEO Upsilon(4S) data sample. We find B(B0-->pi-l+nu)=(1.37+/-0.15stat+/-0.11sys)x10(-4) and B(B0-->rho-l+nu)=(2.93+/-0.37stat+/-0.37sys)x10(-4) and find evidence for B+-->eta'l+nu, with B(B+-->eta'l+nu)=(2.66+/-0.80stat+/-0.56sys)x10(-4). From our B-->pilnu rate for q2>16 GeV2 and lattice QCD, we find |Vub|=(3.6+/0.4stat+/0.2syst-0.4thy+0.6)x10(-3) [corrected]

Experimental limits on weak annihilation contributions to decays.

We present the first experimental limits on high-q2 contributions to charmless semileptonic decays of the form expected from the weak annihilation (WA) decay mechanism. Such contributions could bias determinations of /Vub/ from inclusive measurements of B-->Xulupsilon. Using a wide range of models based on available theoretical input we set a limit of GammaWA/Gammab-->u<7.4% (90% confidence level) on the WA fraction, and assess the impact on previous inclusive determinations of /Vub/.

New measurements of Cabibbo-suppressed decays of mesons with the CLEO-c detector.

Using of data collected with the CLEO-c detector, we report on first observations and measurements of Cabibbo-suppressed decays of D mesons in the following six decay modes: pi+ pi- pi0 pi0, pi+ pi+ pi- pi- pi0, pi+ pi0 pi0, pi+ pi+ pi- pi0, eta pi0, and omega pi+ pi-. Improved branching fraction measurements in eight other multipion decay modes are also presented. The measured D --> pi pi rates allow us to extract the ratio of isospin amplitudes A(DeltaI = (3/2) / A(DeltaI = (1/2)) = 0.420 +/- 0.014(stat) +/- 0.016(syst) and the strong phase shift of delta1 = (86.4 +/- 2.8 +/- 3.3) degrees, which is quite large and now more precisely determined.