Mycoplasma and Ureaplasma Donor-Derived Infection and Hyperammonemia Syndrome in 4 Solid Organ Transplant Recipients From a Single Donor.

Hyperammonemia syndrome (HS) is a life-threatening condition occurring in solid organ transplant patients, affecting primarily lung recipients, and is associated with Mycoplasma hominis and/or Ureaplasma spp infection. The organ donor was a young man who died of hypoxic brain injury and had urethral discharge antemortem. The donor and 4 solid organ transplant recipients had infection with M hominis and/or Ureaplasma spp. The lung and heart recipients both developed altered conscious state and HS associated with M hominis and Ureaplasma spp infections. Despite treatment with antibiotics and ammonia scavengers, both the lung and heart recipients died at day +102 and day +254, respectively. After diagnosis in the thoracic recipients, screening samples from the liver recipient and 1 kidney recipient were culture positive for M hominis with or without Ureaplasma spp. Neither the liver nor kidney recipients developed HS. Our case series demonstrates the unique finding of M hominis and Ureaplasma spp dissemination from an immunocompetent donor across 4 different organ recipients. Phylogenetic whole genome sequencing analysis demonstrated that M hominis samples from recipients and donor were closely related, suggesting donor-derived infection. Screening of lung donors and/or recipients for Mycoplasma and Ureaplasma spp is recommended, as well as prompt treatment with antimicrobials to prevent morbidity.

Industrial PLC Network Modeling and Parameter Identification Using Sensitivity Analysis and Mean Field Variational Inference.

A multiple input multiple output (MIMO) power line communication (PLC) model for industrial facilities was developed that uses the physics of a bottom-up model but can be calibrated like top-down models. The PLC model considers 4-conductor cables (three-phase conductors and a ground conductor) and has several load types, including motor loads. The model is calibrated to data using mean field variational inference with a sensitivity analysis to reduce the parameter space. The results show that the inference method can accurately identify many of the model parameters, and the model is accurate even when the network is modified.

Chronic haemothorax: an important cause of pleural effusion.

We describe a case of chronic exudative pleural effusion in a patient initially referred with anorexia, weight loss, and past history of breast cancer, following multiple presentations with chest pain and dyspnoea. Detailed history included past blunt thoracic trauma with pleural effusion drainage and anticoagulation for atrial fibrillation (AF). This case highlights several learning points for physicians around the management of thoracic trauma, anticoagulation for AF, and chronic haemothorax as an uncommon but important cause of exudative pleural effusion.

Surgical Correction of Haglund's Triad Using a Central Tendon-Splitting Approach: A Retrospective Outcomes Study.

We evaluated the surgical outcomes of Haglund's triad using a central tendon-splitting approach, with Achilles tendon partial detachment and debridement, excision of the retrocalcaneal bursa, resection of Haglund's prominence, and reattachment of the Achilles tendon. The medical records of 22 patients (22 heels) who had undergone surgical correction of Haglund's triad from January 2010 to December 2015 were reviewed retrospectively. The visual analog scale pain score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical and mental component scores were prospectively collected preoperatively, 6 months postoperatively, and at the last visit. The scores of a subjective question involving satisfaction were prospectively collected at the last visit. Possible risk factors were also evaluated. We reviewed the data from 12 females and 10 males, with the mean age of 59.2 ± 7.3 years and a mean follow-up duration of 15.1 ± 4.6 months. Significant improvement was found in the mean visual analog scale pain score, average American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale score, and 36-item Short-Form Health Survey physical component scale score. The overall satisfaction rate was 77.3% (17 of 22). Postoperative complications included 2 cases of delayed wound healing and 1 case of sensation loss over the heel wound. No Achilles tendon rupture or wound infection developed. Gender and body mass index did not affect the surgical outcomes. The surgical technique we used for Haglund's triad provided effective pain relief, function improvement, and overall enhancement of patients' health condition. More research is required to further evaluate the outcomes of our surgical approach to treat Haglund's triad and the possible risk factors.

Results of operative correction of grade IIB tibialis posterior tendon dysfunction.

BACKGROUND: The prevalence of tibialis posterior tendon dysfunction (PTTD) is estimated to be as high as 3% to 4% in Western populations, and it is one of the most commonly misdiagnosed conditions of the foot and ankle. METHODS: Clinical and radiological outcomes were assessed in grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening. The clinical and radiological findings recorded were the SF-36 score on physical function and mental health, midfoot and hindfoot American Orthopaedic Foot and Ankle Society (AOFAS) clinical scores, the midfoot and visual analog pain scores, as well as the radiological measurements of the hindfoot calcaneal pitch, talo-first metatarsal angle, and medial cuneiform height. The time points of assessment were preoperatively, 6 months postoperatively, and 24 months postoperatively by an examiner different from the operating surgeon. RESULTS: The SF-36 score on physical function (mean difference of 8.7 and 8.2, respectively), AOFAS midfoot score (mean difference of 29.6 and 15.3, respectively), AOFAS ankle-hindfoot score (mean difference of 23.2 and 14.3, respectively), midfoot visual analog pain score (mean difference of 4.0 and 1.2), and the ankle and hindfoot visual analog score (mean difference of 3.6 and 1.6) all had significant reduction from the preoperative to the 24-month postoperative time point (P < .001). Radiologically, there was also correction of the deformity associated with PTTD. The hindfoot calcaneal pitch was corrected from 8.4 degrees to 18.7 degrees. The talo-first metatarsal angle was corrected from 14.0 degrees to 1.3 degrees, and the medial cuneiform height was corrected from 10.3 mm to 20.4 mm at 24 months postoperatively. CONCLUSION: Grade IIB PTTD treated with a medializing calcaneal osteotomy, lateral column lengthening, flexor digitorum longus transfer, and tendo-Achilles lengthening demonstrated statistical significant improvement in hindfoot and midfoot AOFAS scores, SF-36 physical function scores, as well as visual analog scores. The complications were minimal. We advocate the combination of these procedures as being successful for the treatment of grade IIB PTTD. Longer term follow-up is needed to determine if these improvements plateau, improve, or deteriorate. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Effect of the DentalVibe injection system on pain during local anesthesia injections in adolescent patients.

PURPOSE: The purpose of this study was to compare the pain rating scale measurements from an exposure group (injections with the aid of DentalVibe Injection Comfort System) and control group (traditional injection without the aid of the DentalVibe) in adolescent patients using self-reported pain during administration of local anesthetic injections. METHODS: This was a randomized, controlled study. Subjects consisted of 36 10- to 17-year-old patients who required local anesthesia for dental treatment on both sides of the maxilla or mandible. All subjects received a conventional injection (control) and an injection using DentalVibe (experimental). A pain rating for each injection was obtained from subjects using the Wong-Baker FACES Pain Rating Scale. RESULTS: Statistical analysis using a Wilcoxon signed rank test found a significant reduction in pain ratings for injections with the DentalVibe when compared to control injections. There was a positive correlation between the pain rating for control injection and the difference between the two types of injection, indicating that subjects who reported a higher pain score with the control injection had a greater reduction when DentalVibe was used. CONCLUSION: When compared to a conventional approach, DentalVibe significantly lowered self-reported pain during local anesthesia injection for adolescent subjects in this study.

Evaluation of the dose calculation accuracy in intensity-modulated radiation therapy for mesothelioma, focusing on low doses to the contralateral lung.

This study compares Monte Carlo (MC) with conventional treatment planning system (TPS) calculations. The EGS4nrc MC code, BEAMnrc, was commissioned to simulate a Varian 21Ex Linac. The accuracy of the simulations, including points blocked by the jaws, was evaluated by comparing MC with ion chamber and MOSFET measurements. Eight mesothelioma IMRT cases were planned using Eclipse (pencil beam and superposition convolution algorithms). Dose distributions were recalculated using BEAMnrc/DOSxyz, and compared with TPS. MC agreed with experimental results for IMRT fields within 3% (96% of points). For regions blocked by the jaws, average agreement between MC and experiment was better than 5% up to 20 cm from isocenter. The pencil beam algorithm underestimated lung MLD, V20, and V5, compared with MC, by a mean (range) of 16% (11-22%), 9.0% (2.4-30.1%), and 11.8% (2-30%), respectively. The superposition convolution algorithm gave better agreement of 8.5% (0-17%), 4% (0-12%) and 0% (-6-6%). Mean dose to the targets was better than +/- 5% in all cases. In conclusion, there is excellent correlation between TPS and MC calculations for the target doses. The pencil beam algorithm and superposition convolution algorithms both underestimate lung dose parameters, but the superposition convolution dose offers improvements in dose calculation accuracy for these patients.