Next-generation sequencing-based clinical metagenomics identifies Prevotella pleuritidis in a diabetic adolescent with large parapneumonic effusion and negative growth of pleural fluid culture: a case report.

We report a 12-year-old diabetic boy with a right-sided parapneumonic effusion and pneumonia who failed initial empirical antibiotics. Prevotella pleuritidis was identified from the pleural fluid using next-generation sequencing-based clinical metagenomics with cultures of pleural fluid and blood resulting negative. The patient responded well to intravenous meropenem followed by oral metronidazole.

Association between multiple respiratory viral infections and pediatric intensive care unit admission among infants with bronchiolitis.

BACKGROUND: It is unclear whether multiple respiratory viral infections are associated with more severe bronchiolitis requiring pediatric intensive care unit (PICU) admission. We aimed to identify the association between multiple respiratory viral infections and PICU admission among infants with bronchiolitis. METHODS: We performed a 1:1 case-control study enrolling previously healthy full-term infants (≤12 months) with bronchiolitis admitted to the PICU as cases and those to the general pediatric ward as controls from 2015 to 2017. Multiplex polymerase chain reaction (PCR) was used for detection of the respiratory viruses. We summarized the characteristics of infants admitted to the PICU and the general pediatric unit. Multivariable logistic regression analysis was used to fit the association between multiple respiratory viral infections (≥2 strains) and PICU admission. RESULTS: A total of 135 infants admitted to the PICU were compared with 135 randomly selected control infants admitted to the general pediatric unit. The PICU patients were younger (median: 2.2 months, interquartile range: 1.3-4.2) than the general ward patients (median: 3.2 months, interquartile range: 1.6-6.4). Respiratory syncytial virus (74.1%), rhinovirus (28.9%), and coronavirus (5.9%) were the most common viruses for bronchiolitis requiring PICU admission. Patients with bronchiolitis admitted to the PICU tended to have multiple viral infections compared with patients on the general ward (23.0% vs. 10.4%, P<0.001). In the multivariable logistic regression analysis, bronchiolitis with multiple viral infections was associated with higher odds of PICU admission (adjusted odds ratio: 2.56, 95% confidence interval: 1.17-5.57, P=0.02). CONCLUSION: Infants with multiviral bronchiolitis have higher odds of PICU admission compared with those with a single or nondetectable viral infection.

The fabrication and testing of electrospun silica nanofiber membranes for the detection of proteins.

In this study, we fabricated electrospun silica nanofiber membranes and investigated their use in biomolecular sensing. The diameter, porosity and surface-to-volume ratio of nanofiber membranes were investigated under different fabrication conditions. Using this type of nanofiber membrane, enzyme-linked immunosorbent assay (ELISA) was performed, and the results were compared with those obtained with conventional ELISA using polystyrene well plates. The minimum detectable concentration was determined as 0.19 ng ml(-1) (1.6 pM), which is 32 times lower than that of conventional ELISA. In addition, the detection time for all processes for the nanofiber membrane was reduced to 1 h, compared with 1 day for conventional ELISA. The increased sensitivity, faster reaction time, and affordability of the nanofiber membrane make it well suited for bio-chip use.

Ultrasonographic and cytologic findings of metastatic cancer in the thyroid gland.

BACKGROUND AND PURPOSE: Cancer metastasizing to the thyroid is not uncommon. Prompt diagnosis and aggressive treatment appear to contribute to better prognosis in some patients. The aim of this study was to determine the clinical manifestations, ultrasonographic and cytologic findings, and outcomes in patients with metastatic thyroid cancer. METHODS: We retrospectively reviewed the medical records, including clinical courses, ultrasonographic and cytologic findings, and outcomes, of 14 patients with metastatic thyroid cancer. RESULTS: There were various primary sites of cancer in our study population, with adenocarcinoma the most common. The sonographic images in five of 12 patients who underwent sonography showed diffusely heterogeneous hypoechoic abnormalities, while the remaining seven patients had nodular lesions. The cytologic appearances of metastatic lesions in the thyroid were characteristic of the primary malignancies. CONCLUSIONS: Most cancer metastatic to the thyroid presented as advanced metastases of primary malignancies. The sonographic appearance alone was not the ideal discriminator, and fine needle aspiration cytology helped define the diagnosis and management strategy.

Model system for plant cell biology: GFP imaging in living onion epidermal cells.

The ability to visualize organelle localization and dynamics is very useful in studying cellular physiological events. Until recently, this has been accomplished using a variety of staining methods. However, staining can give inaccurate information due to nonspecific staining, diffusion of the stain or through toxic effects. The ability to target green fluorescent protein (GFP) to various organelles allows for specific labeling of organelles in vivo. The disadvantages of GFP thus far have been the time and money involved in developing stable transformants or maintaining cell cultures for transient expression. In this paper, we present a rapid transient expression system using onion epidermal peels. We have localized GFP to various cellular compartments (including the cell wall) to illustrate the utility of this method and to visualize dynamics of these compartments. The onion epidermis has large, living, transparent cells in a monolayer, making them ideal for visualizing GFP. This method is easy and inexpensive, and it allows for testing of new GFP fusion proteins in a living tissue to determine deleterious effects and the ability to express before stable transformants are attempted.

Synthesis and cytotoxic evaluation of substituted sulfonyl-N-hydroxyguanidine derivatives as potential antitumor agents.

A series of sulfonyl-N-hydroxyguanidine derivatives was designed and synthesized for cytotoxic evaluation as potential anticancer agents on the basis of the lead compound LY-181984. Replacement of the ureido moiety of the lead compound with hydroxyguanidine provided a stable cytotoxic agent. The conformation of sulfonyl-N-hydroxyguanidine derivatives, such as N-(4-chlorophenyl)-N'-[(benzo[2,1,3]thiadiazol-4-yl)sulfonyl]-N"- hydroxyguanidine (4g), investigated utilizing HMBC NMR, theoretical calculations, and X-ray crystallography, indicated stacking of the two aromatic rings. The derivatives were evaluated for in vitro cytoxicity against five human tumor cell lines, including HepG2, TSGH 8302, COLO 205, KB, and MOLT-4. The cytotoxic activities of the derived compounds against the human tumor cell lines were equal to or greater than that of the lead compound. N-(4-Chlorophenyl)-N'-[[3,5-dichloro-4-(4-nitrophenoxy)phenyl]sulfonyl]- N"- hydroxyguanidine (4n) and N-(4-chlorophenyl)-N'-[[3,5-dichloro-4-(2-chloro-4-nitrophenoxy)phenyl] sulfonyl]-N"-hydroxyguanidine (4o) exhibited the greatest growth inhibition of solid tumor cell lines. Compound 4o was found to possess antitumor activity against murine K1735/M2 melanoma xenografts.

STARDUST: finessing expensive cometary sample returns.

The STARDUST Discovery mission will collect samples of cometary coma and interstellar dust and return them to Earth. Five years after launch in February 1999, coma dust in the 1- to 100-micrometers size range will be captured by impact into ultra-low-density silica aerogel during a 6 kms-1 flyby of Comet Wild 2. The returned samples will be investigated at laboratories where the most critical information on these primitive materials is retained. The Jet Propulsion Laboratory will provide project management with Lockheed Martin Astronauts as the spacecraft industrial partner. STARDUST management will aggressively and innovatively achieve cost control through the use of Total Quality Management principles, the chief of which will be organization in a Project Engineering and Integration Team that "flattens" the traditional hierarchical structure by including all project elements from the beginning, in a concurrent engineering framework focusing on evolving Integrated Mission Capability.

Exploratory investigations of hypervelocity intact capture spectroscopy.

The ability to capture hypervelocity projectiles intact opens a new technique available for hypervelocity research. A determination of the reactions taking place between the projectile and the capture medium during the process of intact capture is extremely important to an understanding of the intact capture phenomenon, to improving the capture technique, and to developing a theory describing the phenomenon. The intact capture of hypervelocity projectiles by underdense media generates spectra, characteristic of the material species of projectile and capture medium involved. Initial exploratory results into real-time characterization of hypervelocity intact capture techniques by spectroscopy include ultra-violet and visible spectra obtained by use of reflecting gratings, transmitting gratings, and prisms, and recorded by photographic and electronic means. Spectrometry proved to be a valuable real-time diagnostic tool for hypervelocity intact capture events, offering understanding of the interactions of the projectile and the capture medium during the initial period and providing information not obtainable by other characterizations. Preliminary results and analyses of spectra produced by the intact capture of hypervelocity aluminum spheres in polyethylene (PE), polystyrene (PS), and polyurethane (PU) foams are presented. Included are tentative emission species identifications, as well as gray body temperatures produced in the intact capture process.

Effect of void-size distribution on the Hugoniot state at low shock pressures.

In most theoretical and experimental investigations into the shock response of underdense solid media, the influence of the medium's mesostructure on the resulting pressure and degree of compaction has not been taken into account. In typical cases examined, shock pressures are well in excess of 1 GPa and this approach is clearly justified. However, at low pressures, calculations show that the distribution of void sizes can affect the final state achieved upon shocking the medium from a given initial porosity. This paper analyzes the response of porous aluminum to low pressure shocking and demonstrates a dependence of the final shocked state on the distribution of void sizes.

Intact capture of hypervelocity projectiles.

The ability to capture projectiles intact at hypervelocities opens new applications in science and technology that would either not be possible or would be very costly by other means. This capability has been demonstrated in the laboratory for aluminum projectiles of 1.6 mm diameter, captured at 6 km/s, in one unmelted piece, and retaining up to 95% of the original mass. Furthermore, capture was accomplished passively using microcellular underdense polymer foam. Another advantage of capturing projectiles in an underdense medium is the ability of such a medium to preserve a record of the projectile's original velocity components of speed and direction. A survey of these experimental results is described in terms of a dozen parameters which characterize the amount of capture and the effect on the projectile due to different capture media.

Percutaneous cannulated screw coracoclavicular fixation for acute acromioclavicular dislocations.

In 1941, Bosworth introduced a new method of repairing acute complete acromioclavicular dislocations in which a noncannulated coracoclavicular lag-screw was inserted by a blind technique. The author reintroduces the percutaneous coracoclavicular fixation concept. A cannulated screw was specially designed, and the technique of percutaneous insertion under fluoroscopic image control was developed. Fifty-three acromioclavicular dislocations were treated by this method. There were 40 Type III, five Type IV, and three Type V dislocations with distal clavicle fractures in conjunction with complete coracoclavicular ligament tears. Technical failures, which occurred in 17 of 53 patients (32%) included: failed percutaneous insertion in two; early screw pullout in three; late screw pullout in four; subluxation after screw removal in six; and malreduction of Type IV dislocation in two. There was no screw breakage or evidence of migration. Serous drainage occurred in two patients.

Postdecompression lumbar instability.

In the last two decades, the concept of spinal stenosis and its treatment by surgical decompression has been widely accepted. Complications such as olisthy, disc rupture, facet fracture, and intractable back pain began to appear postoperatively, suggesting instability as their cause. A retrospective study of 344 patients treated surgically for lumbar stenosis revealed a 17% reoperation rate for complications resulting from obvious or suspected instability. Sixteen cases of postdecompression olisthy, 14 cases of fresh disc herniation, and 27 cases of intractable back pain required further surgery. Preoperative indicators of potential instability are degenerated discs as evidenced by traction spurs or diminished disc height, olisthy, and scoliosis or asymmetrically narrowed discs. Total facetectomy and pars excision at surgery destabilize the spine and must be added to the preoperative risk factors for instability. Calcified annulus, capsule and ligamentum flavum, or complete disc resorption may offer some protection from postoperative instability. The level of instability may be preselected by the proximity to the intercrestal line. It is recommended that during surgical decompression for spinal stenosis, the posterior elements be spared as much as possible to avoid instability after surgery. Factors suggesting instability noted preoperatively or decompression which produces instability suggest that fusion should be combined with decompression. Spinal fusion is the treatment for postoperative instability.

Congenital distal femoral focal deficiency: report of a unique case.

An 8-year-old Chinese boy with congenital leg length discrepancy is believed to be the first reported case of unequivocal distal femoral focal deficiency. A pseudarthrosis is present between the normal appearing distal femoral epiphysis and the lower end of the femoral diaphysis. The patient's family history is negative for congenital limb deficiency, psuedarthrosis and neurofibromatosis. There is no history of trauma or infection. Congenital lack of distal femoral physis in this case is analogous to Aitken's Classification Type B proximal femoral focal deficiency.

Embryogenesis and prenatal development of congenital vertebral anomalies and their classification.

Vertebral anomalies were studied in 144 patients. The specific anatomic defects were defined by serial roentgenograms: anterior approaches were used in 42 operations and posterior approaches in 74 operations. Growth features of the spine were examined histologically in 15 embryos and fetuses ranging in length from 6 to 120 mm. After an extensive review of the literature on normal human spine embryology and fetal development, and after defining the specific vertebral anatomic defects and their pathogenesis, some new concepts of congenital vertebral anomalies formation are proposed. Old concepts are found to be inadequate in light of our current knowledge of embryogenesis. The authors' new and all-inclusive classification of congenital vertebral anomalies is based on specific defects, pathogenesis, and time for origin in embryonic or fetal development.