Refractory shoulder injury related to vaccine administration: correlation with culture presence of Cutibacterium acnes.

Background: Shoulder pain following intramuscular administration of vaccine is common. However, a small number of patients experience prolonged pain and dysfunction atypical to normal transient postvaccination shoulder pain. Shoulder Injury Related to Vaccine Administration (SIRVA) remains incompletely understood, whether a robust immune response to vaccine antigen or inappropriate injection technique with needle placement in synovial or bursal tissue, or some combination of the two. Symptoms overlap with those of Cutibacterium acnes (C. acnes) infection but the relationship between the two, if any, has not been evaluated. Methods: Clinical case files were reviewed for 3 cases of SIRVA with positive cultures for C. acnes were reviewed. Presentation, treatment, and clinical outcomes were compared. Results: In all cases, patients were thin (body mass index < 23), females, who had high injection placement of a vaccine, all patients had positive magnetic resonance imaging findings of increased signal in the subacromial bursa, and/or greater tuberosity. All patients underwent arthroscopic débridement and culture harvest and cultures were positive for C. acnes. A combination of oral and intravenous antibiotics was used, and all patients demonstrated clinical improvement from the preoperative state. Discussion: This case series presents 3 patients with refractory SIRVA who ultimately underwent arthroscopic irrigation and débridement with culture biopsy. Each case had culture results positive for C. acnes and all responded, at least partially, to arthroscopic débridement and intravenous antibiotic therapy. The purpose of this manuscript is to raise awareness of potential coexistence of SIRVA and C. acnes which may be of assistance to surgeons treating refractory cases of SIRVA.

"Triple Package" Modified SpeedBridge Rotator Cuff Repair Technique.

Treatment of full-thickness rotator cuff repairs vary in surgical technique depending on many factors including tear geometry, delamination of soft tissue, tissue quality, and rotator cuff retraction. The described technique presents a reproducible method of addressing tear patterns where the tear may be larger laterally, but the medial footprint exposure is small. This can be addressed with a single medial anchor combined with a knotless lateral-row technique to provide compression for small tears or two medial row anchors for moderate to large tears. In this modification of the standard knotless double row (SpeedBridge) technique, 2 medial row anchors are used, with 1 augmented with additional fiber tape and an additional lateral row anchor to create a triangular repair construct, increasing the size and stability of the footprint of the lateral row.

3D microcarrier system for efficient differentiation of human pluripotent stem cells into hematopoietic cells without feeders and serum [corrected].

BACKGROUND: Human embryonic stem cells (hESCs) have been derived and maintained on mouse embryonic fibroblast feeders to keep their undifferentiated status. To realize their clinical potential, a feeder-free and scalable system for large scale production of hESCs and their differentiated derivatives is required. MATERIALS & METHODS: hESCs were cultured and passaged on serum/feeder-free 3D microcarriers for five passages. For embryoid body (EB) formation and hemangioblast differentiation, the medium for 3D microcarriers was directly switched to EB medium. RESULTS: hESCs on 3D microcarriers maintained pluripotency and formed EBs, which were ten-times more efficient than hESCs cultured under 2D feeder-free conditions (0.11 ± 0.03 EB cells/hESC input 2D vs 1.19 ± 0.32 EB cells/hESC input 3D). After replating, EB cells from 3D culture readily developed into hemangioblasts with the potential to differentiate into hematopoietic and endothelial cells. Furthermore, this 3D system can also be adapted to human induced pluripotent stem cells, which generate functional hemangioblasts with high efficiency. CONCLUSION: This 3D serum- and stromal-free microcarrier system is important for future clinical applications, with the potential of developing to a GMP-compatible scalable system.

Environmental health resilience.

The capacity of the Earth's environment to support increasing and expanding human populations has been questioned at least for hundreds of years, but never more than in the mid to late 20th Century and early 21st Century. Global human population now exceeds seven billion and continues to increase at an unprecedented rate. Estimates of future (2050) human populations on Earth range from a low of about 7.4 billion to a high of 10.6 billion ("United Nations World Population to 2300", 2004 accessed at http://www.un.org/esa/population/publications/longrange2/WorldPop2300final.pdf). Current human populations already place an extreme burden on global environmental resources, including air, water and food quality as well as increasing challenges related to human waste management and disease prevention, control and treatment. In fact, some have proposed that humans have entered the "anthropocene", an age in which the global environment is dominated by human activities (http://www.sciencedaily.com/releases/2012/11/121101131609.htm). Climate change and expanding human populations contribute to increased risk of transmission of infectious and non-infectious disease. Developing nations with huge human populations such as China and India are benefitting from increased economic globalization, allowing for increased availability of personal luxuries such as automobiles, which in turn results in increased pollution and further depletion of natural resources such as global oil reserves. Increasing availability to global resources also may contribute to global conflict over environmental resources such as oil, water and food. In the United States, 2013 was the hottest year on record. Average global temperatures are also on the rise, with Australia being another prime example. Globally, 2012 was the tenth hottest year on record since data collection began in 1880 (http://www.ncdc.noaa.gov/sotc/global/2012/13). Many people are now starting to question the ability of human populations to continue to grow, and perhaps even for humans continue to exist on the planet without significant changes in the way that we interact with our global environment. Others point out that dire predictions of the fragility of humanity have been made for thousands of years and that humans have continued to survive and even grow in spite of these challenges.

In vivo imaging and computational analysis of the aortic root. Application in clinical research and design of transcatheter aortic valve systems.

Valvular heart disease is a major cause of morbidity and mortality in developing and industrialized countries. For patients with advanced symptomatic disease, surgical open-heart valve replacement is an effective treatment, supported by long-term outcome data. More recently, less-invasive transcatheter approaches for valve replacement/implantation have been developed for patients that are not considered surgical candidates. An understanding of valvular and paravalvular anatomy and biomechanics is pivotal for the optimization of interventional valve procedures. Advanced imaging is increasingly used not only for clinical guidance but also for the design and further improvement of transcatheter valve systems. Computed tomography is particularly attractive because it acquires high-resolution volumetric data sets of the root including the leaflets and coronary artery ostia, with sufficient temporal resolution for multi-phasic analysis. These volumetric data sets allow subsequent 3-D and 4-D display, reconstruction in unlimited planes, and mathematical modeling. Computer modeling, specifically finite element analysis, of devices intended for implantation in the aortic root, allows for structural analysis of devices and modeling of the interaction between the device and cardiovascular anatomy. This paper will provide an overview of computer modeling of the aortic root and describe FEA approaches that could be applied to TAVI and have an impact on clinical practice and device design.

Evaluation of pulverized trommel fines for use as a soil amendment.

Pulverized trommel fines collected from the City of Chicago's municipal solid waste were applied as a soil amendment over a 2-year period to evaluate: (1) their effects on soil quality by measuring soil elemental concentrations, pH, organic matter and cation exchange capacity; (2) their potential for pathogen transfer. A secondary objective was to examine crop growth, yield and productivity. Total and fecal coliform, Enterococci, Escherichia coli, Staphylococci and Salmonella were below minimum detection limits in trommel fines. Trommel fines contained 894.5+/-171.4 mg/kg Pb, and when applied at a rate equivalent to 9.95 mt/ha dry wt, resulted in a soil Pb concentration increase of 18.80 mg/kg, thereby limiting lifetime trommel fine application to 15.9 years before reaching the 300 ppm IEPA (USEPA) regulatory limit. Trommel fines were subjected to a shake extraction procedure and resulting leachate Pb samples were 88.7% below the IEPA (USEPA) regulatory limit (5 mg/l). For the first year, corn yield was significantly higher on soil amended with trommel fines than soil amended with inorganic nitrogen fertilizer. During the second year, soybean yield was significantly lower on soil amended with trommel fines than on soil amended with inorganic fertilizer due to lower plant population. Results of this study suggest that trommel fines can be land applied as a soil amendment if best management practices are followed.

Comparison of a static gravity screen-roll press combination separator to a PAM-assisted gravity belt thickener system for swine waste slurry solids separation.

Liquid effluent resulting from solids separation from raw swine slurry (RS) using a static gravity screen-roll press separator (SE) and a polyacrylamide (PAM) flocculant-assisted gravity belt thickener system (BE1 and 2, with BE2 designating an added belt thickening of SE) were compared. Effluent pH was 7.6-7.7. Dissolved oxygen was less than 0.01 mg/l in RS and SE and 0.50 mg/l in BE1 and 2. Solids dry weight and total phosphorus concentrations were reduced significantly (p0.05) in SE (17-27%) and in BE1 and 2 (92-96%), relative to RS. Phosphorus concentration reductions were higher than those previously found. Settleable and suspended solids, total nitrogen and chemical oxygen demand were significantly reduced in BE1 and 2 (63-99%). No significant differences (p>0.05) were found between BE1 and 2. Results indicated that the gravity belt thickener system was more efficient at solids separation than the screen-roll press system.

Solids, organic load and nutrient concentration reductions in swine waste slurry using a polyacrylamide (PAM)-aided solids flocculation treatment.

Increased swine production results in concentration of wastes generated within a limited geographical area, which may lead to land application rates exceeding the local or regional assimilatory capacity. This may result in pollutant transfer through surface water or soil-groundwater systems, environmental degradation, and/or odor concerns. Existing swine waste pit storage and lagoon treatment technologies may be inadequate to store or treat waste prior to land application without these concerns resulting. Efficient swine waste solids separation may reduce environmental health concerns and generate a value-added bioresource (solids). This study evaluated the efficiency of a polyacrylamide (PAM) flocculant-aided solids separation treatment to reduce pollution indicator concentrations in raw (untreated) swine waste slurry. Swine waste slurry solids separation efficiency through gravity settling (sedimentation) was evaluated before and after the addition of a proprietary polymeric (PAM) flocculant. Results indicated that polymer amendments at concentrations of 62.5-750 mg/l improved slurry solids separation efficiency and significantly reduced concentrations of other associated aquatic pollution indicators in a majority of analyses conducted (33 of 50 total analyses conducted). Results also suggested that PAM-aided solids separation from swine waste slurry might facilitate further treatment and/or disposal and therefore reduce associated environmental degradation potential.

Removal of N, P, BOD5, and coliform in pilot-scale constructed wetland systems.

Pilot-scale surface-flow (SF), subsurface-flow (SSF), and floating aquatic plant (FAP) constructed wetland system designs were installed and evaluated to determine the effectiveness of constructed wetlands to treat tertiary effluent wastewater in a Midwestern U.S. climate (central Illinois). Average ammonia-nitrogen (N) concentrations decreased approximately 50% in the SSF system design, suggesting that this design had the highest nitrification rate. Nitrate-N concentrations decreased by over 60% in the FAP system design, possibly due to dissimilatory reduction or plant uptake. Total phosphorus (P) concentration reductions of 25 to 40% were observed in all three system designs. Five-day biochemical oxygen demand (BOD5) and dissolved oxygen (DO) results suggested that biodegradation was highest in the SSF system design and lowest in the FAP system design. Greater than 90% concentration reductions of total coliform and E. coli recovered were also observed following treatment in all three system designs. The FAP system design appeared to yield the highest concentration reduction efficiency for E. coli, possibly due to increased sunlight and related bacteriocidal ultraviolet light exposure. Ongoing experiments will test regularly for a variety of vegetative, water quality, and biological conditions for longer time periods in order to gain a better understanding of the pilot constructed wetland system design kinetics.