DNA Sequencing to Evaluate Nail Pathogens: An Investigation into Bacteria and Fungi.

BACKGROUND: It is well established and accepted that fungi are a major contributing factor in nail dystrophy. It has also been recognized that bacteria play a crucial role in onycholysis. However, the bacteria and fungi that can be grown on culture media in the laboratory are only a small fraction of the total diversity that exists in nature. Contemporary studies have revealed that fungi and bacteria often form physically and metabolically interdependent consortia that harbor properties and pathogenicity distinct from those of their individual components. Metagenomic DNA "shotgun" sequencing has proved useful in determining microbial etiology in clinical samples, effective for not only bacteria but also fungi, archaea, and viruses. METHODS: Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture. The nail plate and surrounding areas were disinfected with an ethyl alcohol swab before nail sampling. Samples from 16 patients were analyzed for suspected onychomycosis with DNA sequencing, searching a database of 25,000 known pathogens. These results were compared with 15 real-time polymerase chain reaction screening assays and eight fungal cultures sampled with the same methods. RESULTS: The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi. CONCLUSIONS: Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples. Further work is required to fully investigate its relevance to nail pathology and treatment.

The ABCESS System for Chronic Wound Management: A New Acronym for Lower Extremity Wound Management.

The authors propose a new acronym to promote teaching and learning evidence-based care for wounds of the lower extremity, maximizing healing potential, and assuring the ability to adapt to everchanging new technologies. ABCESS is a comprehensive framework for the assessment of a patient with a lower extremity wound. Wound care clinicians benefit from a system that is broad enough to include new guidelines and technologies as they appear. The TIME/DIME model has been used for many years to assist clinicians in thorough wound bed management. In order to expand the model to be able to address all aspects of lower extremity wound healing, ABCESS was developed. TIME has recently also been expanded to TIMERS in an attempt to address this. The ABCESS acronym was originally developed at the Temple University School of Podiatric Medicine to use as a teaching tool and organizational aid for students of wound healing. Each letter was used as a framework to aid the wound care clinician in performing a complete assessment of the patient with chronic wounds of the lower extremity: All of the patient, including a complete history, physical assessment, and systemic disease overview (with nutrition) to assess the physical aspects of the patient presenting with a wound; wound Bed management to include Bioload, Biofilm, cellular assessment of Biomarkers using polymerase chain reaction/DNA analysis, and wound Biopsy; Circulation to include arterial, venous, and lymphatic circulation; Edema, Exudate, and Erythema management focusing on dressing and compression choices; Skin protection and treatment to include wound edge, periwound skin, and offloading management; Social, Societal, and Spiritual factors, including assessment of the immediate social environment, the wider societal limiting factors, and personal, spiritual, and psychological issues affecting this patient's wound care.

Comparative Evaluation of Radiographic Parameters of Foot Pronation in Two Different Conditions versus Barefoot.

BACKGROUND: To date, there is conflicting evidence that high-end "motion control" running shoes can correct and control rearfoot pronation. Many methods have been used to evaluate the efficacy of motion control footwear in reducing hindfoot pronation during gait, including stop-motion photography, three-dimensional camera kinematic analysis, and three-dimensional bone modeling using computed tomography. Until now, there have been no radiographic studies that examined the effect of motion control running shoes on the static posture of the foot. Murley et al devised a reliable system that correlated noninvasive clinical examinations to radiographic values that correspond to foot pronation. The aim of this prospective investigation was to determine whether motion control running shoes are able to produce a significant difference in pronation through a radiographic study, using the angular relationships as described by Murley et al, in two different shoe conditions as compared to the barefoot condition in female subjects. METHODS: This prospective study screened 28 female subjects ranging in age from 22 to 27 years on the basis of arch height index. The 24 subjects with a standing arch height index less than 0.370 were invited to participate in the study. Unilateral weightbearing dorsoplantar and lateral foot radiographs were taken in barefoot, neutral shoe, and motion control shoe conditions. Calcaneal inclination angle, calcaneal-first metatarsal (CFMA) angle, talonavicular coverage angle (TNCA), and talus-second metatarsal angle were measured in each condition by two independent observers using the Opal-Ortho PACS software package and then averaged. Angles were compared to barefoot baseline values using paired t tests. RESULTS: The motion control running shoe produced average decreases of 2.64% in CFMA, 12.62% in TNCA, 5.3% in talus-second metatarsal angle and an average increase of 1.3% in calcaneal inclination angle. Statistically significant ( P > .05) improvements in CFMA were noted in both the motion control ( P < .000) and neutral shoe conditions ( P < .000) when compared to barefoot, whereas TNCA improved only in the motion control shoe condition as compared to barefoot ( P = .003). CONCLUSIONS: This investigation found evidence that the particular models of motion control running shoes studied could correct foot pronation in the transverse and sagittal planes in stance. Motion control running shoes improved CFMA and TNCA from the barefoot condition and were more effective in correcting pronation compared with neutral running shoes in this radiographic study simulating static foot posture in stance.

Application of Viable Cryopreserved Human Placental Membrane Grafts in the Treatment of Wounds of Diverse Etiologies: A Case Series.

There is evidence in the literature that viable cryopreserved human placental membrane (vCHPM) grafts are effective in treating diabetic foot ulcers and venous leg ulcers. OBJECTIVE: This case series presents 3 cases of chronic ulcerations - 1 arterial ulcer (AU), 1 pressure ulcer (PU), and 1 recurrence of a pyoderma gangrenosum ulcer (PGU) - that had failed previous courses of standard wound care and were subsequently treated with vCHPM to determine if the treatment is an effective modality for treating wounds of these etiologies. MATERIALS AND METHODS: This retrospective review describes 3 cases in which patients with chronic wounds that had failed standard of care treatments for more than 4 weeks were subsequently treated with weekly applications of vCHPM. Each wound area was recorded and photographed on a weekly basis and wound area reduction also was charted weekly. RESULTS: The PU and AU both reached full closure in 4 and 5 weeks, respectively, without complication. The patient with the PGU achieved 64% closure after 9 applications of vCHPM. CONCLUSIONS: Viable CHPM is an effective treatment modality for wounds of diverse etiologies and shows better results than have been previously published with standard of care. In patients with PGUs, medical optimization and close management of comorbidities is essential in achieving optimal results.

Musculoskeletal Effects of Pregnancy on the Lower ExtremityA Literature Review.

Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.

Spectroscopic and biological activity studies of the chromium-binding peptide EEEEGDD.

While trivalent chromium has been shown at high doses to have pharmacological effects improving insulin resistance in rodent models of insulin resistance, the mechanism of action of chromium at a molecular level is not known. The chromium-binding and transport agent low-molecular-weight chromium-binding substance (LMWCr) has been proposed to be the biologically active form of chromium. LMWCr has recently been shown to be comprised of a heptapeptide of the sequence EEEEDGG. The binding of Cr(3+) to this heptapeptide has been examined. Mass spectrometric and a variety of spectroscopic studies have shown that multiple chromic ions bind to the peptide in an octahedral fashion through carboxylate groups and potentially small anionic ligands such as oxide and hydroxide. A complex of Cr and the peptide when administered intravenously to mice is able to decrease area under the curve in intravenous glucose tolerance tests. It can also restore insulin-stimulated glucose uptake in myotubes rendered insulin resistant by treating them with a high-glucose media.

Spatial mapping of lipids at cellular resolution in embryos of cotton.

Advances in mass spectrometry (MS) have made comprehensive lipidomics analysis of complex tissues relatively commonplace. These compositional analyses, although able to resolve hundreds of molecular species of lipids in single extracts, lose the original cellular context from which these lipids are derived. Recently, high-resolution MS of individual lipid droplets from seed tissues indicated organelle-to-organelle variation in lipid composition, suggesting that heterogeneity of lipid distributions at the cellular level may be prevalent. Here, we employed matrix-assisted laser desorption/ionization-MS imaging (MALDI-MSI) approaches to visualize lipid species directly in seed tissues of upland cotton (Gossypium hirsutum). MS imaging of cryosections of mature cotton embryos revealed a distinct, heterogeneous distribution of molecular species of triacylglycerols and phosphatidylcholines, the major storage and membrane lipid classes in cotton embryos. Other lipids were imaged, including phosphatidylethanolamines, phosphatidic acids, sterols, and gossypol, indicating the broad range of metabolites and applications for this chemical visualization approach. We conclude that comprehensive lipidomics images generated by MALDI-MSI report accurate, relative amounts of lipid species in plant tissues and reveal previously unseen differences in spatial distributions providing for a new level of understanding in cellular biochemistry.