Phaeohyphomycosis fungal infections in solid organ transplant recipients: clinical presentation, pathology, and treatment.

BACKGROUND: Dematiaceous, or dark-pigmented, fungi are known to cause infections such as phaeohyphomycosis, chromoblastomycosis, and mycetoma. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We present a retrospective chart review of 27 SOTR who developed phaeohyphomycosis infections post transplant from 1988 to 2009. METHODS: Cases were reviewed for fungal species isolated, date and source of culture, immunosuppressive and fungal therapy used, and outcome. The majority of isolates obtained were from the skin and soft tissue, with 3 pulmonary and brain abscesses. RESULTS: The time from transplantation to onset of infection ranged from 2 months to 11 years. The species isolated were Exophiala (11), Ochroconis (3), Alternaria (2), Phoma (2), Wangiella (1), Cladosporium (1), Aureobasidium (1), Chaetomium (1), Coniothyrium (1), and non-sporulating fungi (2). An additional 4 patients had infections confirmed by pathology, but no cultures were done. Most of the affected skin lesions were surgically debrided and treated with itraconazole; 2 patients were treated with voriconazole and 2 with amphotericin D. Death from fungal disease occurred only in patients with pulmonary and brain abscesses. CONCLUSIONS: As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.

Parallel And Divergent Morphological Adaptations Underlying The Evolution of Jumping Ability in Ants.

Jumping is a rapid locomotory mode widespread in terrestrial organisms. However, it is a rare specialization in ants. Forward jumping has been reported within four distantly related ant genera: Gigantiops, Harpegnathos, Myrmecia, and Odontomachus. The temporal engagement of legs/body parts during jump, however, varies across these genera. It is unknown what morphological adaptations underlie such behaviors and whether jumping in ants is solely driven directly by muscle contraction or additionally relies on elastic recoil mechanism. We investigated the morphological adaptations for jumping behavior by comparing differences in the locomotory musculature between jumping and non-jumping relatives using X-ray micro-CT and 3D morphometrics. We found that the size-specific volumes of the trochanter depressor muscle (scm6) of the middle and hind legs are 3-5 times larger in jumping ants, and that one coxal remotor muscle (scm2) is reduced in volume in the middle and/or hind legs. Notably, the enlargement in the volume of other muscle groups is directly linked to the legs or body parts engaged during the jump. Furthermore, a direct comparison of the muscle architecture revealed two significant differences between jumping vs. non-jumping ants: First, the relative Physiological Cross-Sectional Area (PCSA) of the trochanter depressor muscles of all three legs were larger in jumping ants, except in the front legs of Odontomachus rixosus and Myrmecia nigrocincta; second, the relative muscle fiber length was shorter in jumping ants compared to non-jumping counterparts, except in the front legs of O. rixosus and M. nigrocincta. These results suggest that the difference in relative muscle volume in jumping ants is largely invested in the area (PCSA), and not in fiber length. There was no clear difference in the pennation angle between jumping and non-jumping ants. Additionally, we report that the hind leg length relative to body length was longer in jumping ants. Based on direct comparison of the observed vs. possible work and power output during jumps, we surmise that direct muscle contractions suffice to explain jumping performance in three species, except for O. rixosus, where the lack of data on jumping performance prevents us from drawing definitive conclusions for this particular species. We suggest that increased investment in jumping-relevant musculature is a primary morphological adaptation that separates jumping from non-jumping ants. These results elucidate the common and idiosyncratic morphological changes underlying this rare adaptation in ants. まとぅみ (Okinawan language-Uchinaaguchi) (Japanese) РЕЗЮМЕ (Kazakh) ZUSAMMENFASSUNG (German).

Alterations of single molecule fluorescence lifetimes in near-field optical microscopy.

Fluorescence lifetimes of single Rhodamine 6G molecules on silica surfaces were measured with pulsed laser excitation, time-correlated single photon counting, and near-field scanning optical microscopy (NSOM). The fluorescence lifetime varies with the position of a molecule relative to a near-field probe. Qualitative features of lifetime decreases are consistent with molecular excited state quenching effects near metal surfaces. The technique of NSOM provides a means of altering the environment of a single fluorescent molecule and its decay kinetics in a repeatable fashion.

Attogram detection limit for aqueous dye samples by laser-induced fluorescence.

A modified flow cytometer has been used to detect attogram quantities of aqueous rhodamine 6G by laser-induced fluorescence analysis. A detection limit of 28 attograms (35,000 molecules) was obtained, nearly two orders of magnitude better than earlier measurements. The detection limit in concentration units was 1.4 x 10(-13) mole per liter. During the 1-second measurement period, the total volume sampled was 0.42 microliter. On average, only half a rhodamine 6G molecule was present in the 6-picoliter probed volume.

Current practice: postoperative and return to play trends after ACL reconstruction by fellowship-trained sports surgeons.

PURPOSE: Advances in anterior cruciate ligament (ACL) reconstruction have allowed for many progressions in postoperative management. However, there is no standardized protocol for immediate postoperative management or return to play. Our objective was to evaluate current trends in immediate postoperative and return to sport practices after ACL reconstruction. LEVEL OF EVIDENCE: Cross sectional study, Level IV. METHODS: Surveys were obtained from four large sports fellowship alumni networks. Demographics included years of practice and ACLs performed per year. Postoperative questions included weight bearing status, brace use and continuous passive motion (CPM) use. Return to play included time for return, brace use and metrics used for clearance to sport. RESULTS: A total of 143 surveys were completed (32% response rate). Average years in practice were 15.1 years. Average ACL reconstructions performed per year was 20-50 in 44% and 50-100 in 29%. 26% used CPM in all patients, 8% if concomitant meniscal repair and 66% never. Bracing after surgery was used in 84% and 48% after return to play. Return to play was allowed at 6-9 months in 67% and overall 94% from 6 to 12 months. No consensus on return to play metrics was used, with the hop test being most important followed by specific time point after surgery. CONCLUSION: Immediate weight bearing after surgery is commonplace with intermittent CPM use. Bracing is common postoperatively and half the time with return to play. Return to play is typically allowed after at least 6 months with no consensus on return to sport metrics. Years after fellowship and ACLs performed yearly had no correlation with postoperative practices.

The utility of botulinum toxin A in the repair of distal biceps tendon ruptures.

PURPOSE: The purpose of our study is to report the outcomes and complications in patients who underwent distal biceps tendon repair with the use of Botulinum toxin A (BoNT-A) as an adjunct to surgery. METHODS: A retrospective review of 14 patients who underwent 15 distal biceps tendon repairs was performed. All repaired tendons had their correlating muscle bellies injected intraoperatively with a mixture of 100U of BoNT-A and 10 ml of normal saline. Each patient was evaluated for surgical and post-operative complications and followed with Disabilities of the Arm, Shoulder and Hand (DASH) Disability Scores. RESULTS: The cohort was exclusively male, 14/14 (100%). The mean age at procedure was 52.1 years (range: 29-65 years). Types of injuries repaired included: 12 acute biceps tendon ruptures, one chronic partial (> 50% of tendon) biceps tear, and two chronic biceps ruptures. Average final follow-up was 32.9 months (SD: 19.6; range: 7.07-61.72). Average time to repair of chronic injury was 5.75 months (range: 2-12 months). There were no intraoperative complications, and all patients were discharged home on the day of surgery. Average DASH score at latest follow-up was 4.9 (range: 0.0-12.5). All patients had return of function of paralyzed muscle prior to final follow-up. One patient required an incision and drainage for a deep infection 1 week post-operatively, without any further complications. Another patient required operative removal of heterotopic ossification located around the tendon fixation site, which was the result of a superficial infection treated with antibiotics 2 weeks post-operatively. This patient later healed with improvement in supination/pronation range-of-motion and no further complications. CONCLUSIONS: Injection of BoNT-A is safe and effective to protect distal biceps tendon repair during the early phases of bone-tendon healing. CLINICAL RELEVANCE: BoNT-A may is safe and effective to protect distal biceps tendon repair. The utility of BoNT-A as an adjunct to surgical repair may be applicable to acute or chronic tears as well as repairs in the non-compliant patient without decreases in functional scores after return of function of the biceps muscle. LEVEL OF EVIDENCE: Level 4.

Single-molecule detection as an approach to rapid DNA sequencing.

Current sequencing technologies are insufficient to cope with large-scale projects such as sequencing the human genome and genomes of model organisms. In addition, as genetic lesions associated with specific human diseases are identified, DNA sequencing will be used increasingly for clinical applications. Thus, new approaches are needed to combine high-throughput with accuracy for both research and diagnostic purposes. A novel technology based on detection of individual fluorescent nucleotides in a flowing sample stream is under development.

A computer program for the localization of small areas in roentgenological images.

A method and associated algorithm are presented which allow a simple and accurate determination to be made of the location of small symmetric areas presented in roentgenological images. The method utilizes an operator to visually spot object positions but eliminates the need for critical positoning accuracy on the operator's part. The rapidity of measurement allows results to be evaluated on-line. Parameters associated with the algorithm have been analyzed, and methods to facilitate an optimum choice for any particular experimental setup are presented.

The capability of fluoroscopic systems for the production of computerized axial tomograms.

Previous work in our laboratories and at other institutions has shown that fluoroscopic images recorded on a video disc can be used successfully for producing computerized-axial-tomograms. The work described in this paper gives a quantitative analysis of the capabilities of such imaging systems, in conjunction with a particular method of data processing, for detecting and imaging changes in object absorptivity. Relations between the degree of contrast or absorptivity and object size required by this type of system can be inferred from the data.

Simple method for the generation of organ and vessel contours from roentgenographic or fluoroscopic images.

A simple method is described for outlining or contouring any area defined by a change in film density or fluoroscopic screen intensity. The entire process, except for the positioning of an electronic window, is accomplished using a small computer having appropriate software. The electronic window is operator positioned over the area to be processed. The only requirement is that the window be alrge enough to encompass the total area to be considered.

Computerized system for the measurement of gallstone volume, in vivo.

Instrumentation and methodology for the determination of gallstone volume from standard roentgenographic views have been developed. Evaluation of size is made by using video viewing, an operator-set electronic window, intercept registers, and the programming of a PDP/8E for handling the data. The programming makes corrections for geometric factors arising from anatomical variations, corrections for variations in technique, roentgenographic magnification, and provides for the use of several roentgenographic views. The precision of the measuring (video) technique is approximately 0.5 mm as measured on the roentgenogram. Estimates and test data indicate that this system should be capable of an absolute accuracy within 10% of the true volume.

Tumor localization and beam monitoring--electrofluorotomography.

Methodology and instrumentation are presented which are potentially capable of presenting fluoroscopically derived transverse axial body sections for use in radiation-oncology treatment planning and beam monitoring. These combine the methods of Takahashi for generating transverse axial tomograms with electronic radiography, electrofluorotomography, and a contouring program for extracting body and tumor contours in a digital format. The system will also be capable of assuring both initial and day-to-day beam alignment.

High-speed DNA sequencing: an approach based upon fluorescence detection of single molecules.

We are developing a laser based technique for the rapid sequencing of large fragments (approximately 40 kb) of DNA based upon the detection of single, fluorescently tagged nucleotides cleaved from a single DNA fragment. We have demonstrated significant progress on several of the important steps of this technique. The projected rate of sequencing is several hundred bases per second which is orders of magnitude faster than existing methods. Once developed, this technology could be utilized by investigators for rapid sequencing of genetic material from virtually any source.

The dermatologist in military operations.

The military dermatologist has a specific and significant role in military operations--in time of war as well as in peace. Many dermatologists are unfamiliar with the impact that our specialty and cutaneous disease has upon the ability of the military to fulfill the missions, duties, and responsibilities assigned by our government. This article highlights a few of the recent or ongoing types of military operations in which our specialty plays a prominent part.

New flow cytometric technologies for the 21st century.

The envelope that defines the limits within which flow cytometry was developed is being rapidly expanded. For example: detection sensitivity has been extended to single molecules, the size range of "particle" analysis now extends from DNA fragments to plankton (1,000.+ microns), cell and chromosome sorting rates are being increased dramatically by using inactivation procedures (50,000 per second versus 2,000 per second), rapid kinetic flow cytometry enables real-time analysis of molecular assembly and cell function in the sub-second time domain, the lifetime of a fluorochrome bound to a single cell can be measured with nsec precision, and classical karyotype information (cell to cell heterogeneity) can be determined in a flow based system. These frontiers have greatly expanded the range of new and exciting flow cytometric based biomedical applications. New enabling technologies have provided the means to measure DNA cleavage by the structure-specific nuclease, human Flap Endonuclease (FEN-1), in the 300 msec time frame. Phase sensitive measurements and fluorescence lifetime are proving to be major advances for understanding molecular environments that change with, for example, the process of apoptosis. The ability to detect single fluorescent molecules has been applied to the analysis of DNA fragments obtained from enzymatic digestion of lambda DNA. This technology is being used to rapidly and very accurately size DNA fragments for the human genome project. Optical chromosome selection is a faster, better, less complex approach to chromosome sorting. This method is based on the induction of specific damage to the DNA of selected chromosomes. Lastly, the miniaturization of a single cell fractionator has made it possible to perform single cell flow cytogenetics.

Multi-spot paper chromatograms of sodium orthophosphate.

The formation of two zones on paper chromatograms was investigated by chromatographing orthophosphoric acid and the primary, secondary and tertiary sodium salts, using pyridine-ethyl acetate/water as mobile phase. Movement of the species from the origin depends on washing the paper with acid and suggests an exchange of protons for sodium as a prerequisite condition. Washing with EDTA does not alter this requirement. Zone movement and multi-spot formation require that the forming solvent contain at least 5% of water (v/v). Between this value and saturation, increasing water content enhances zone disengagement. A solute spot of a sodium salt exchanges with the protons to produce a fast-migrating protonated phosphate species. If the solute sample has a sodium content less than the amount of exchangeable protons, a single fast spot is produced ; if the concentration exceeds this capacity, a second slower spot results.

Characteristics of child sexual abuse treatment programs.

Within the professional community, a vast number of sexual abuse treatment programs have emerged to meet the needs of victims and their families. Significant variations among these programs can be observed due to differences in philosophy, system context, client focus, problem definition, and the treatment strategy adopted. Unfortunately, little comparative information is available regarding the operation of different programs and, more importantly, their relative treatment effectiveness. This article presents the findings from a nationwide survey of 553 sexual abuse treatment programs. The survey focused on program context, client, and service characteristics. Overall it was found that most programs are affiliated with a larger public or private agency, focus on treating victims, and rely on a combination of individual, family, dyad, and group therapy approaches.

Cutaneous herpes simplex virus, type I, in association with Staphylococcus aureus in an infant.

A 9-month-old infant was diagnosed as having impetigo of the central face. Her clinical condition deteriorated despite treatment with intravenous antibiotics. Viral and bacterial cultures grew herpes simplex virus type I and Staphylococcus aureus, respectively. The patient's condition improved rapidly with antiviral treatment in combination with antibiotics. Recognition of the possibility of a combined viral and bacterial infection is important so that adequate treatment is not delayed.

Rickettsialpox-like illness in a traveler.

A patient presented after a trip to South Africa with a febrile illness and rash that was consistent with either rickettsialpox or mild boutonneuse fever. The clinical, laboratory, and geographic overlap of these diseases makes differentiation difficult in certain situations. Several different rickettsial infections may cause an eschar and a rash that may be papulovesicular. From a clinical perspective, distinguishing these diseases is not critically important as long as therapy with tetracycline is implemented. More precise identification of the etiologic agent could be required in certain military situations because the preventive measures employed for some of these diseases may be significantly different.