Illegal tattoos complicated by Staphylococcus infections: a north Carolina wound care and medical center experience.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a major source of morbidity in Hamlet, NC; in 2011, there were 58 emergency room visits resulting from MRSA infections, leading to 31 admissions to Sandhills Regional Medical Center (Hamlet, NC). The situation is complicated by illegal tattoo artists offering less-expensive artwork, as their bargain prices often involve stinting on sterile technique. Three patients with infected tattoos were seen at Sandhills Center for Wound Healing and Hyperbaric Medicine (Hamlet, NC) with a range of tissue damage requiring different treatment plans. Closer scrutiny of tattoo ink and use of preservatives could prevent accidental or deliberate contamination, and reduce the risk of tattoo infection. .

The genome sequence of Caenorhabditis briggsae: a platform for comparative genomics.

The soil nematodes Caenorhabditis briggsae and Caenorhabditis elegans diverged from a common ancestor roughly 100 million years ago and yet are almost indistinguishable by eye. They have the same chromosome number and genome sizes, and they occupy the same ecological niche. To explore the basis for this striking conservation of structure and function, we have sequenced the C. briggsae genome to a high-quality draft stage and compared it to the finished C. elegans sequence. We predict approximately 19,500 protein-coding genes in the C. briggsae genome, roughly the same as in C. elegans. Of these, 12,200 have clear C. elegans orthologs, a further 6,500 have one or more clearly detectable C. elegans homologs, and approximately 800 C. briggsae genes have no detectable matches in C. elegans. Almost all of the noncoding RNAs (ncRNAs) known are shared between the two species. The two genomes exhibit extensive colinearity, and the rate of divergence appears to be higher in the chromosomal arms than in the centers. Operons, a distinctive feature of C. elegans, are highly conserved in C. briggsae, with the arrangement of genes being preserved in 96% of cases. The difference in size between the C. briggsae (estimated at approximately 104 Mbp) and C. elegans (100.3 Mbp) genomes is almost entirely due to repetitive sequence, which accounts for 22.4% of the C. briggsae genome in contrast to 16.5% of the C. elegans genome. Few, if any, repeat families are shared, suggesting that most were acquired after the two species diverged or are undergoing rapid evolution. Coclustering the C. elegans and C. briggsae proteins reveals 2,169 protein families of two or more members. Most of these are shared between the two species, but some appear to be expanding or contracting, and there seem to be as many as several hundred novel C. briggsae gene families. The C. briggsae draft sequence will greatly improve the annotation of the C. elegans genome. Based on similarity to C. briggsae, we found strong evidence for 1,300 new C. elegans genes. In addition, comparisons of the two genomes will help to understand the evolutionary forces that mold nematode genomes.

Femoral Vein Cannulation in the Treatment of Osteomyelitis.

OBJECTIVE: The main objective was to investigate the feasibil- ity of using the femoral vein for long-term venous access. This was accomplished in the course of treating osteomyelitis patients, using a combination of long-term (6 weeks), outpatient, intravenous (IV) an- tibiotics administered through a femoral central line. This was com- bined subsequently with the use of hyperbaric oxygen (HBO) therapy. Using the femoral vein for central venous access means there is no risk of creating an iatrogenic pneumothorax, which would prohibit the subsequent use of HBO therapy. In addition, the propitious nature of the groin skin flora, Propionibacteriaceae, seems less inclined to par- ticipate in biofilm production, the root cause of central line infections. METHODS: The femoral central lines were all inserted in the operating room (OR) and handled like a regular outpatient surgery with a me- ticulous skin prep completed by experienced OR nurses. Experienced technicians assisted with the surgery. After insertion, the lines were then specially secured to prevent sliding. Vancomycin was adminis- tered preoperatively. RESULTS: Surprisingly, femoral lines placed in this way remained free of infection for up to 70 days. Eight patients with Wagner stage 2 ulcers and underlying osteomyelitis were treated with a course of 6 weeks of vancomycin, followed by HBO therapy. A cure rate of 75% was achieved. CONCLUSION: Femoral vein cannulation for antibi- otic administration is safe and effective in treating patients with osteo- myelitis. The lines should be placed in the OR with the help of skilled personnel. Femoral cannulation avoids the risk of pneumothorax, and the lines can be used for up to 70 days. By avoiding pneumothorax, the patients remain candidates for HBO therapy.

Sacral decubitus after cervical spine injury: a case report and suggestions for avoiding such wounds.

Sacral decubitus ulcers after cervical spine injuries are particularly debilitating wounds. An illustrative case is presented here and strategies are proposed that may help reduce the incidence of this type of wound. These include early involvement in the patient's care by a wound prevention specialist and the incorporation of a cholera cot design into the spinal transport board with a hole to completely offload the sacral tissue and permit the drainage of stool. Because intermittent visual inspection of skin is probably inadequate to detect the first sign of impending complications, there is a need for technology to objectively assess the status of skin's integrity so a computer program could automatically adjust the pressure on the patient's skin and alert the doctor. Sophisticated equipment that measures mattress pressure on skin is now widely available; sensors of this type could be situated on top of a quilt of miniature air bags (ie, smart cubes) so that individual computer-controlled areas of the quilt could be deflated to offload pressure as required. In the future, probes capable of measuring CO2 production, electrical resistance, or even polarization spectroscopy might be interspersed among the cubes so that ongoing skin viability and integrity could also be monitored. Finally, if the middle model, which proposes that pressure damage starts deep in the middle of the tissue overlying the sacrum before spreading to the skin, proves to be correct and the ground zero for some decubitus really is in the sacral fat, then even more advanced monitoring will be required such as implantable biosensors, and treatment plans might require hyperbaric oxygen or even preemptive liposuction of necrotic fat.

A 75-year-old female with ulceration of breast skin.

An elderly female presented to a North Carolina wound care center (Sandhills Center for Wound Healing and Hyperbaric Medicine, Hamlet, NC) with ulcerative lesions of both breasts. After a thorough investigation, an Internet search yielded a list of possible causes, of which candidiasis exacerbated by friction seemed the most likely diagnosis. However, a biopsy diagnosed bullous pemphigoid. This reinforces the point that a biopsy of an unusual lesion is a valuable diagnostic tool to investigate suspected malignancy, wounds in unusual locations or with unusual appearance, and wounds not responding to treatment.

Ribozyme-catalyzed transcription of an active ribozyme.

A critical event in the origin of life is thought to have been the emergence of an RNA molecule capable of replicating a primordial RNA "genome." Here we describe the evolution and engineering of an RNA polymerase ribozyme capable of synthesizing RNAs of up to 95 nucleotides in length. To overcome its sequence dependence, we recombined traits evolved separately in different ribozyme lineages. This yielded a more general polymerase ribozyme that was able to synthesize a wider spectrum of RNA sequences, as we demonstrate by the accurate synthesis of an enzymatically active RNA, a hammerhead endonuclease ribozyme. This recapitulates a central aspect of an RNA-based genetic system: the RNA-catalyzed synthesis of an active ribozyme from an RNA template.

Ice as a protocellular medium for RNA replication.

A crucial transition in the origin of life was the emergence of an informational polymer capable of self-replication and its compartmentalization within protocellular structures. We show that the physicochemical properties of ice, a simple medium widespread on a temperate early Earth, could have mediated this transition prior to the advent of membraneous protocells. Ice not only promotes the activity of an RNA polymerase ribozyme but also protects it from hydrolytic degradation, enabling the synthesis of exceptionally long replication products. Ice furthermore relieves the dependence of RNA replication on prebiotically implausible substrate concentrations, while providing quasicellular compartmentalization within the intricate microstructure of the eutectic phase. Eutectic ice phases had previously been shown to promote the de novo synthesis of nucleotide precursors, as well as the condensation of activated nucleotides into random RNA oligomers. Our results support a wider role for ice as a predisposed environment, promoting all the steps from prebiotic synthesis to the emergence of RNA self-replication and precellular Darwinian evolution.

Genomics in C. elegans: so many genes, such a little worm.

The Caenorhabditis elegans genome sequence is now complete, fully contiguous telomere to telomere and totaling 100,291,840 bp. The sequence has catalyzed the collection of systematic data sets and analyses, including a curated set of 19,735 protein-coding genes--with >90% directly supported by experimental evidence--and >1300 noncoding RNA genes. High-throughput efforts are under way to complete the gene sets, along with studies to characterize gene expression, function, and regulation on a genome-wide scale. The success of the worm project has had a profound effect on genome sequencing and on genomics more broadly. We now have a solid platform on which to build toward the lofty goal of a true molecular understanding of worm biology with all its implications including those for human health.

Dispersal of NK homeobox gene clusters in amphioxus and humans.

The Drosophila melanogaster genome has six physically clustered NK-related homeobox genes in just 180 kb. Here we show that the NK homeobox gene cluster was an ancient feature of bilaterian animal genomes, but has been secondarily split in chordate ancestry. The NK homeobox gene clusters of amphioxus and vertebrates are each split and dispersed at two equivalent intergenic positions. From the ancestral NK gene cluster, only the Tlx-Lbx and NK3-NK4 linkages have been retained in chordates. This evolutionary pattern is in marked contrast to the Hox and ParaHox gene clusters, which are compact in amphioxus and vertebrates, but have been disrupted in Drosophila.

Initial sequencing and comparative analysis of the mouse genome.

The sequence of the mouse genome is a key informational tool for understanding the contents of the human genome and a key experimental tool for biomedical research. Here, we report the results of an international collaboration to produce a high-quality draft sequence of the mouse genome. We also present an initial comparative analysis of the mouse and human genomes, describing some of the insights that can be gleaned from the two sequences. We discuss topics including the analysis of the evolutionary forces shaping the size, structure and sequence of the genomes; the conservation of large-scale synteny across most of the genomes; the much lower extent of sequence orthology covering less than half of the genomes; the proportions of the genomes under selection; the number of protein-coding genes; the expansion of gene families related to reproduction and immunity; the evolution of proteins; and the identification of intraspecies polymorphism.