Skeletal injuries after cesarean section - a rare differential diagnosis of child abuse.

Birth-related fractures are an important differential diagnosis of child abuse in early infancy. While fractures associated to vaginal deliveries are well known, cesarean section is not necessarily known to cause such injuries. Nevertheless neonatal fractures have been described after cesarean sections. To give an overview over the frequency and typical locations of such fractures, the appearance of symptoms and the timespan until diagnosis, a literature research was conducted via Google scholar and Pubmed, using the key words "cesarean section" and "fractures". Birth-related fractures after cesarean sections are rare but can occur, with the long bones being particularly affected. Therefore, birth injuries should always be considered in the forensic medical assessment of fractures in early infancy, even after cesarean section. To enable a differentiation between birth trauma and physical abuse, birth and operation records should be checked for surgical manoeuvres, possible difficulties during the procedure or other risk factors. Birth-related fractures are usually detected early; in rare cases, the diagnosis is made only weeks after birth.

Multi-decadal geochemical evolution of drainage from underground coal mines in the Appalachian basin, USA.

Coal mine drainage (CMD) in Appalachia is a widespread source of dissolved metals, SO4, and acidity that can degrade aquatic habitats and water supplies for decades following mine closure and flooding. In the bituminous coalfield of Pennsylvania, the Irwin Coal Basin (ICB) contains a series of partly to completely flooded, abandoned underground mines separated by leaky barriers within the Pittsburgh coal seam. CMD originated throughout the basin from minepool aquifers that formed after mine closures dating from 1910 to 1957. Historical and recent water quality data for eight CMD sites across the ICB, plus mineralogy and cation-exchange capacity of overburden lithologies, were analyzed to quantify important reactants and evaluate spatial and temporal water-quality trends. As overburden thickness and residence time increase along a ~ 50-km flowpath northeast to southwest in the basin, CMD becomes more alkaline, and Na concentrations increase. Since the 1970s, all eight ICB discharges have become less acidic, with exponential decreases in acidity, SO4, and Fe concentrations; only two CMD remain net-acidic (acidic pH at equilibrium). Exponential decay models that include a steady-state asymptote consistent with background groundwater chemistry and siderite equilibrium describe the early-stage, rapid contaminant concentration decay immediately after the "first flush" (initial flooding) and the progressive evolution toward late-stage background conditions. A geochemical evolution PHREEQC model indicates that spatial and temporal trends in pH, net-acidity, SO4, Fe, and major cations could be explained by the continuous dilution of first flush water by ambient groundwater combined with sustained water-mineral reactions involving pyrite and carbonates (calcite, dolomite, siderite) plus cation-exchange by clays (illite, chlorite, mixed-layer illite/smectite). These data and model results indicate that 1) cation-exchange reactions enhance calcite dissolution and alkalinity production, resulting in the evolution of CMD to Na-SO4-HCO3 type waters, and 2) siderite equilibrium could maintain dissolved Fe >16 mg/L over the next 40 years.

Lower limb reconstruction involving osteosynthesis material: A retrospective study on propeller flaps outcomes.

INTRODUCTION: Reconstruction of soft tissue defects in lower limb fractures requiring internal fixation remains a challenging scenario with the optimal surgical treatment still debated. This study aims to recommend, and eventually redefine, surgical indications for propeller flaps reconstruction in the distal lower limb, with a particular focus on the presence or not of metalwork. METHODS: A retrospective study of lower limb soft tissue reconstructions performed between January 2015 and July 2018 was carried out including all patients treated with a propeller perforator flap (PPF) with at least 6-month follow-up. Patients were further divided in 2 groups depending on the presence of metalwork fixation beneath the flap (F group, propeller on Framework; NF group, propeller with No-Framework). RESULTS: 21 patients were retained (F group, 11 patients; NF group, 10 patients). There were no significant differences between the two groups in age, BMI, ASA scores, comorbidities or defect size. There was a statistically significant difference between the groups (p<0.05) in the cumulative hospital stay with a mean cumulative hospital stay of 22 ± 9 days in the F group and 12 ± 8 days in NF group. Failures were higher where PPF were used to cover hardware material, with 3 patients requiring a major secondary procedure in F group versus 1 patient in NF group. CONCLUSION: The presence of underlying metalwork significantly reduced the margin for small, day-case revision procedures such as flap readvancement or STSG. This study emphasizes clinical intuition that whilst PPF are a useful and elegant tool in lower limb reconstruction, their use should be limited when underlying metalwork is present.

Immune response profiling of primary monocytes and oral keratinocytes to different Tannerella forsythia strains and their cell surface mutants.

The oral pathogen Tannerella forsythia possesses a unique surface (S-) layer with a complex O-glycan containing a bacterial sialic acid mimic in the form of either pseudaminic acid or legionaminic acid at its terminal position. We hypothesize that different T. forsythia strains employ these stereoisomeric sugar acids for interacting with the immune system and resident host tissues in the periodontium. Here, we show how T. forsythia strains ATCC 43037 and UB4 displaying pseudaminic acid and legionaminic acid, respectively, and selected cell surface mutants of these strains modulate the immune response in monocytes and human oral keratinocytes (HOK) using a multiplex immunoassay. When challenged with T. forsythia, monocytes secrete proinflammatory cytokines, chemokines and vascular endothelial growth factor (VEGF) with the release of interleukin-1ß (IL-1ß) and IL-7 being differentially regulated by the two T. forsythia wild-type strains. Truncation of the bacteria's O-glycan leads to significant reduction of IL-1ß and regulates macrophage inflammatory protein-1. HOK infected with T. forsythia produce IL-1Ra, chemokines and VEGF. Although the two wild-type strains elicit preferential immune responses for IL-8, both truncation of the O-glycan and deletion of the S-layer result in significantly increased release of IL-8, granulocyte-macrophage colony-stimulating factor and monocyte chemoattractant protein-1. Through immunofluorescence and confocal laser scanning microscopy of infected HOK we additionally show that T. forsythia is highly invasive and tends to localize to the perinuclear region. This indicates, that the T. forsythia S-layer and attached sugars, particularly pseudaminic acid in ATCC 43037, contribute to dampening the response of epithelial tissues to initial infection and hence play a pivotal role in orchestrating the bacterium's virulence.

Biochemistry of S-layers.

During evolution prokaryotes have developed different envelope structures exterior to the cell wall proper. Among these surface components are regularly arranged S-layers and capsules. The structural characterization and the detailed chemical analysis of these surface molecules is a prerequisite to understand their biosynthesis and functional role(s) at the molecular level. Of particular interest are the glycosylated S-layer proteins which belong to the first prokaryotic glycoproteins ever described. Their characterization was performed on strains belonging to the thermophilic Bacillaceae and included structural studies and experiments to learn about the pathways for the glycan biosynthesis of S-layer glycoproteins. As an example for non-glycosylated S-layer proteins those of Lactobacillus helveticus strains are described in detail. Recently, a novel type of bacterial glycoconjugate was observed in the cell envelope of the extremely halophilic archaeon Natronococcus occultus which consists of a glycosylated polyglutamyl polymer. Beside the conventional biochemical techniques for the analysis new sophisticated instrumental methods such as X-ray photoelectron spectroscopy and matrix-assisted laser desorption ionization or electrospray ionization mass spectrometry have been introduced for the analysis of the protein and glycan portions of these cell surface macromolecules.

Facial discrimination and emotional recognition in schizophrenia and affective disorders.

Current research demonstrates that patients with schizophrenia display deficits in a broad range of interpersonal skills. To investigate the ability of patients with schizophrenia and major depression and normal controls to process facial stimuli, four tasks were constructed from 21 photographs of faces representing standardized poses of fundamental emotions. Two tasks were designed to investigate facial identity matching independent of emotion expressed, and two tasks were designed to test emotion recognition and emotion labeling, respectively. Results indicate that while depressed patients differed from controls only on the emotion-labeling task, those with schizophrenia showed deficits on all four tasks when compared with controls and did worse than patients with depression on the emotion tasks. The findings suggest that patients with schizophrenia are impaired on a broader range of facial perception skills than those with depression, when compared with controls.

Somatic symptoms in primary affective disorder. Presence and relationship to the classification of depression.

The incidence and severity of somatic symptoms were determined in 132 patients with major depressive disorder and 80 normal controls. The role of somatic symptoms was analyzed in relation to the unipolar-bipolar division, Research Diagnostic Criteria (RDC) subtypes, hypersomnia, and appetite increase. The data suggest that the rate and level of somatic symptoms increased with the severity of depression and age, only appetite loss differentiated unipolar from bipolar patients, and the classic somatic symptoms of depression were present in most RDC subtypes and not exclusively associated with the "endogenous" subtype. Hypersomnia or increased appetite identified two overlapping depressive subgroups; patients in both groups were young and characterized by high interpersonal sensitivity. Hypersomniac depressed patients were less anxious and agitated; patients with increased appetite were more hostile and showed a greater decrease in libido than age-matched and sex-matched patients with neither symptom.

Bacteremia in patients undergoing oral procedures. Study following parenteral antimicrobial prophylaxis as recommended by the American Heart Association, 1977.

The type and rate of bacteremia following dental extractions, dental cleaning, or other dental/oral surgical procedures were studied in 124 patients with valvular heart disease following parenteral antibiotic prophylaxis (penicillin G potassium with or without streptomycin sulfate, or vancomycin hydrochloride) as recommended by the American Heart Association in 1977. Generally, under penicillin G prophylaxis with or without streptomycin, detection of bacteremia in blood culture media containing no penicillinase was low (14.7% to 16.1% at five minutes and 3.1% to 9.0% at 30 minutes after the procedure). The number and types of organisms recovered from patients who received penicillin prophylaxis alone or with streptomycin were similar. Anaerobes were recovered twice as frequently as aerobes. Polymicrobial bacteremia was rare and only one patient had streptococci detected in the blood culture. Addition of penicillinase to one blood culture medium, however, and comparing it with a similar medium without penicillinase was accompanied with a sixfold greater recovery from patients of both aerobic and anaerobic bacteria, including six patients with streptococcal bacteremia. Vancomycin prophylaxis was accompanied with bacteremia in only one patient.

Characterization of an α-l-fucosidase from the periodontal pathogen Tannerella forsythia.

The periodontal pathogen Tannerella forsythia expresses several glycosidases which are linked to specific growth requirements and are involved in the invasion of host tissues. α-l-Fucosyl residues are exposed on various host glycoconjugates and, thus, the α-l-fucosidases predicted in the T. forsythia ATCC 43037 genome could potentially serve roles in host-pathogen interactions. We describe the molecular cloning and characterization of the putative fucosidase TfFuc1 (encoded by the bfo_2737 = Tffuc1 gene), previously reported to be present in an outer membrane preparation. In terms of sequence, this 51-kDa protein is a member of the glycosyl hydrolase family GH29. Using an artificial substrate, p-nitrophenyl-α-fucose (KM 670 µM), the enzyme was determined to have a pH optimum of 9.0 and to be competitively inhibited by fucose and deoxyfuconojirimycin. TfFuc1 was shown here to be a unique α(1,2)-fucosidase that also possesses α(1,6) specificity on small unbranched substrates. It is active on mucin after sialidase-catalyzed removal of terminal sialic acid residues and also removes fucose from blood group H. Following knock-out of the Tffuc1 gene and analyzing biofilm formation and cell invasion/adhesion of the mutant in comparison to the wild-type, it is most likely that the enzyme does not act extracellularly. Biochemically interesting as the first fucosidase in T. forsythia to be characterized, the biological role of TfFuc1 may well be in the metabolism of short oligosaccharides in the periplasm, thereby indirectly contributing to the virulence of this organism. TfFuc1 is the first glycosyl hydrolase in the GH29 family reported to be a specific α(1,2)-fucosidase.

Outer membrane vesicles of Tannerella forsythia: biogenesis, composition, and virulence.

Tannerella forsythia is the only 'red-complex' bacterium covered by an S-layer, which has been shown to affect virulence. Here, outer membrane vesicles (OMVs) enriched with putative glycoproteins are described as a new addition to the virulence repertoire of T. forsythia. Investigations of this bacterium are hampered by its fastidious growth requirements and the recently discovered mismatch of the available genome sequence (92A2 = ATCC BAA-2717) and the widely used T. forsythia strain (ATCC 43037). T. forsythia was grown anaerobically in serum-free medium and biogenesis of OMVs was analyzed by electron and atomic force microscopy. This revealed OMVs with a mean diameter of ~100 nm budding off from the outer membrane while retaining the S-layer. An LC-ESI-TOF/TOF proteomic analysis of OMVs from three independent biological replicates identified 175 proteins. Of these, 14 exhibited a C-terminal outer membrane translocation signal that directs them to the cell/vesicle surface, 61 and 53 were localized to the outer membrane and periplasm, respectively, 22 were predicted to be extracellular, and 39 to originate from the cytoplasm. Eighty proteins contained the Bacteroidales O-glycosylation motif, 18 of which were confirmed as glycoproteins. Release of pro-inflammatory mediators from the human monocytic cell line U937 and periodontal ligament fibroblasts upon stimulation with OMVs followed a concentration-dependent increase that was more pronounced in the presence of soluble CD14 in conditioned media. The inflammatory response was significantly higher than that caused by whole T. forsythia cells. Our study represents the first characterization of T. forsythia OMVs, their proteomic composition and immunogenic potential.

Frontal and parietal electroencephalogram asymmetry in depressed and nondepressed subjects.

High vs. low scorers on the Beck Depression Inventory (BDI) were compared on measures of resting EEG activation asymmetry from frontal and parietal brain regions. Depressed subjects showed greater relative right frontal activation compared with nondepressed subjects. Parietal asymmetry did not distinguish between the groups. These data support the hypothesis of right hemisphere hyperactivation in the frontal region of depressed individuals and are consistent with the growing body of literature which suggests that the left and right frontal regions may be differentially specialized for particular positive and negative affects.

Migraine headaches and depression.

After taking the lifetime migraine headache histories of 116 patients with major depressive disorder, the authors compared the prevalence of migraine headaches in these depressed patients with the prevalence of migraine reported in four community surveys. There was a trend for the depressed men to experience a higher prevalence of migraine than men in the general population, but the depressed women had a migraine prevalence similar to that of women in the general population. No differences on multiple variables of depressive illness were found between depressed patients with a history of migraine and those with none.

Glycobiology of surface layer proteins.

Over the last two decades, a significant change of perception has taken place regarding prokaryotic glycoproteins. For many years, protein glycosylation was assumed to be limited to eukaryotes; but now, a wealth of information on structure, function, biosynthesis and molecular biology of prokaryotic glycoproteins has accumulated, with surface layer (S-layer) glycoproteins being one of the best studied examples. With the designation of Archaea as a second prokaryotic domain of life, the occurrence of glycosylated S-layer proteins had been considered a taxonomic criterion for differentiation between Bacteria and Archaea. Extensive structural investigations, however, have demonstrated that S-layer glycoproteins are present in both domains. Among Gram-positive bacteria, S-layer glycoproteins have been identified only in bacilli. In Gram-negative organisms, their presence is still not fully investigated; presently, there is no indication for their existence in this class of bacteria. Extensive biochemical studies of the S-layer glycoprotein from Halobacterium halobium have, at least in part, unravelled the glycosylation pathway in Archaea; molecular biological analyses of these pathways have not been performed, so far. Significant observations concern the occurrence of unusual linkage regions both in archaeal and bacterial S-layer glycoproteins. Regarding S-layer glycoproteins of bacteria, first genetic data have shed some light into the molecular organization of the glycosylation machinery in this domain. In addition to basic S-layer glycoprotein research, the biotechnological application potential of these molecules has been explored. With the development of straightforward molecular biological methods, fascinating possibilities for the expression of prokaryotic glycoproteins will become available. S-layer glycoprotein research has opened up opportunities for the production of recombinant glycosylation enzymes and tailor-made S-layer glycoproteins in large quantities, which are commercially not yet available. These bacterial systems may provide economic technologies for the production of biotechnologically and medically important glycan structures in the future.

Catatonia associated with glutethimide withdrawal.

Catatonia is a syndrome that is often considered as a subtype of schizophrenia, although studies have shown that it is most often associated with affective disorders. There are also many medical causes of catatonia. A case is presented in which glutethimide withdrawal seems the most likely explanation for catatonic symptoms.

Retinal blood flow derived from dye dilution curves: Televised fluorescein angiography.

A television system was used to record retinal fluorescein dilution curves. In pigs, fluorescein was injected intravenously (IV), into the left ventricle (ILV), and ILV during bilateral carotid occlusion (ILVco). Dye dilution curves from points on a retinal-artery-vein pair, from two points on a single artery, and from two points on a single vein were recorded by a storage oscilloscope, using two photodetectors positioned over the television image of the vessels. Dye curves were less dispersed following ILV than following IV injections, and were irregular following ILVco injection. The dye appearance time was shortest after injection with ILV and progressively longer with ILVco and IV. The artery-vein mean transit time was greatest during carotid occlusion. Retinal blood flow in a venous segment was calculated to be 0.149 +/- 0.037 mi/min. This value was reproducible following both IV and ILV injections but could not be obtained following ILVco due to irregularity of the curves. It was in the same range as that found (0.095 +/- 0.011 ml/min), using the radioactively labeled microsphere technique. The system was subsequently tested in humans and was found to give reproducible dye curves. The usefulness of the system as a clinical tool is presently being explored.

Fluphenazine pharmacokinetics and therapeutic response.

We conducted a double-blind study of therapeutic outcome versus mean steady-state levels in 29 newly admitted schizophrenic and schizoaffective patients who were treated with a constant dose of fluphenazine HCI over a 2-week period. both an upper and lower end of the therapeutic window were suggested by three nonresponders whose plasma levels were above 2.8 ng per ml and by two nonresponders and one partial responder whose plasma levels were below 0.2 ng per ml. The mean terminal half-life of fluphenazine (+ or - SD) was 16.4 + or - 13.3 h. We found that concomitant use of benztropn mesylate during the initial 4 weeks of fluphenazine treatment did not significantly alter fluphenazine plasma levels.

Are S-layer glycoproteins and lipopolysaccharides related?

Several glycan structures of S-layer glycoproteins of gram-positive eubacteria were compared with the principal structural organization of O-antigens of lipopolysaccharides of gram-negative eubacteria. Further, activated intermediates of the biosynthetic pathway of S-layer glycans were compared with activated intermediates of the route of assembly of lipopolysaccharide O-antigens. As a result, at least structural similarities between both types of molecules have been clearly observed. More detailed studies of the assembly of S-layer glycans are required to unambiguously demonstrate the extent to which the biosynthetic pathways of both molecules are related.

Important issues in the drug treatment of schizophrenia.

The large body of research demonstrating the effectiveness of antipsychotic drugs in the treatment of acute schizophrenia is selectively reviewed. Research evidence relevant to the following issues is assessed; indications for selective treatment; characteristics of drug responders and nonresponders; indications for high dosage phenothiazine treatment; indications for maintenance therapy; benefits and risks of antipsychotic drugs. Recommendations are made concerning areas of psychopharmacologic research that require further development.

Nocardial endophthalmitis: report of two cases studied histopathologically.

We report two cases of nocardial endophthalmitis. Case 1 is a 66-year-old man whose left eye was enucleated about one month after onset of decreased vision. Ophthalmoscopic examination disclosed multiple choroidal masses. Six weeks before the onset of ocular manifestations he had undergone a prolonged carotid endarterectomy with intraoperative complications. The source of the ocular infection was probably exogenous. Case 2 is a 49-year-old woman who had systemic sclerosis (scleroderma) with severe pulmonary insufficiency. She had received moderate doses of corticosteroids. Seventeen months after initiation of therapy she developed ocular manifestations leading to enucleation of the eye one month later. Histopathologically, the enucleated eyes in both cases showed numerous branching, Gram-positive, filamentous organisms involving mainly the plane of Bruch's membrane and the subretinal space. The nosological and microbiological aspects of nocardiosis are reviewed.

Are some symptoms of depression age dependent?

177 depressed patients were examined to see whether age was associated with the presence of specific symptoms or symptom clusters. 14 of the 39 tested variables were significantly associated with age. Patients age > or = 40 were more likely to have terminal insomnia, agitation, diurnal variation with lower mood in the morning and the RDC subtype diagnoses endogenous, incapacitated or agitated. Patients age < or = 39 were more likely to have hypersomnia, increased appetite, weight gain, decreased libido, headaches, diurnal variation with worsening of mood in the afternoon and a mood characterized as sad not anxious.