Conservative Treatment of Empyema Formation Following Intrathoracic Rib Fixation With Antibiotics and Tissue Plasminogen Activator/Dornase.

Rib plating is a recommended intervention for patients with multiple rib fractures or flail chest to improve shortness of breath, significantly reduce pain, and shorten the length of hospital stay. Here, we report a unique and extremely rare finding in a patient with empyema following intrathoracic rib fixation. A 32-year-old male with a history of alcohol use disorder presented to the emergency department trauma bay after a motor vehicle accident. Computed tomography (CT) showed right hemopneumothorax and fourth to ninth rib fractures with displacement. The right fifth and sixth ribs were then plated using a titanium RibFix bridge, implanted intrathoracically along the posterior surface of the ribs. On postoperative day 11, the patient developed an empyema and a CT-guided drainage catheter was placed into the collection. The patient was given a 3-day course of tissue plasminogen activator (tPA) and DNase for the treatment of his empyema. On postoperative day 15, a repeat CT scan demonstrated significant improvement in the empyema with evidence of abscess resolution. Antibiotics were discontinued after a total of 7 days and the patient was discharged on postoperative day 20. This case report contributes information to the management of complications in intrathoracic rib fixation.

Emerging liver infection of Veillonella parvula associated with acute respiratory distress syndrome: a case report.

Introduction: Veillonella parvula is a bacteria that can be found in normal oral and gastrointestinal flora. Veillonella infection is rare in immunocompetent patients but is known to cause periorbital cellulitis, endocarditis, osteomyelitis and bacteremia; however, its association with acute respiratory distress syndrome (ARDS) has not been previously documented. Case presentation: A 36-year-old female with no known history who presented with right-sided chest, flank and upper abdominal pain after a motor vehicle accident. Computed tomography showed multiple right rib fractures, small right pneumothorax, and a grade 4 liver laceration with active extravasation of the posterior aspect of the right liver lobe. Over the hospital course, the patient developed ARDS and was intubated for hypoxemia. A right posterior liver abscess was percutaneously drained, with a copious amount of air and ~30 ml turbid fluid aspirated. Cultures from the liver abscess grew Veillonella parvula. She was treated with Micafungin, Levofloxacin, and Metronidazole for the hepatic abscess, and was discharged home with outpatient follow-up. Discussion: The authors present one of the first reported cases of a V. parvula infected liver abscess associated with ARDS in an immunocompetent patient. Conclusion: These clinical findings are unique due to the nature of our patient's ARDS onset and the dearth of similar cases in the literature. The favorable outcome of our patient was due to a multidisciplinary and early identification of a V. parvula hepatic abscess. The authors' findings contribute to the future management of V. parvula and a greater understanding of its disseminating effects and presentation in immunocompetent patients.

Long Segment Colon Degloving From Blunt Abdominal Trauma.

It is extremely rare for blunt abdominal trauma to result in serious injuries to hollow organs. Degloving injuries of the colon are one of the rarest injuries following blunt abdominal trauma. Intestinal degloving is often seen following rapid deceleration, changes in velocity, crushes and motor vehicle collisions (MVCs). Victims with intestinal degloving injuries can experience vague symptoms despite the severity of the lesion. We present the case of a 21-year-old male with insulin-dependent type 1 diabetes who was involved in a high-speed MVC. He sustained second- and third-degree burns to the extremities, right carotid artery dissection, and multiple fractures to the mandible, pelvis and forearm. Free fluid was also noted in the pelvis prompting an emergent exploratory laparotomy. In the operating room, he was found to have a cecal serosal injury involving more than 50% of the circumference and a sigmoid and descending colon degloving injury of 50 cm. The injured segments were resected, and primary anastomoses were created. Degloving of the colon is extremely rare and the sigmoid is one of the more frequently documented locations of injury. Our case contributes to the limited literature available pertaining to the treatment of evolution of these severe colon injuries.

Transcriptomic Effects on the Mouse Heart Following 30 Days on the International Space Station.

Efforts to understand the impact of spaceflight on the human body stem from growing interest in long-term space travel. Multiple organ systems are affected by microgravity and radiation, including the cardiovascular system. Previous transcriptomic studies have sought to reveal the changes in gene expression after spaceflight. However, little is known about the impact of long-term spaceflight on the mouse heart in vivo. This study focuses on the transcriptomic changes in the hearts of female C57BL/6J mice flown on the International Space Station (ISS) for 30 days. RNA was isolated from the hearts of three flight and three comparable ground control mice and RNA sequencing was performed. Our analyses showed that 1147 transcripts were significantly regulated after spaceflight. The MAPK, PI3K-Akt, and GPCR signaling pathways were predicted to be activated. Transcripts related to cytoskeleton breakdown and organization were upregulated, but no significant change in the expression of extracellular matrix (ECM) components or oxidative stress pathway-associated transcripts occurred. Our results indicate an absence of cellular senescence, and a significant upregulation of transcripts associated with the cell cycle. Transcripts related to cellular maintenance and survival were most affected by spaceflight, suggesting that cardiovascular transcriptome initiates an adaptive response to long-term spaceflight.

FGF21 promotes thermogenic gene expression as an autocrine factor in adipocytes.

The contribution of adipose-derived FGF21 to energy homeostasis is unclear. Here we show that browning of inguinal white adipose tissue (iWAT) by ß-adrenergic agonists requires autocrine FGF21 signaling. Adipose-specific deletion of the FGF21 co-receptor ß-Klotho renders mice unresponsive to ß-adrenergic stimulation. In contrast, mice with liver-specific ablation of FGF21, which eliminates circulating FGF21, remain sensitive to ß-adrenergic browning of iWAT. Concordantly, transgenic overexpression of FGF21 in adipocytes promotes browning in a ß-Klotho-dependent manner without increasing circulating FGF21. Mechanistically, we show that ß-adrenergic stimulation of thermogenic gene expression requires FGF21 in adipocytes to promote phosphorylation of phospholipase C-γ and mobilization of intracellular calcium. Moreover, we find that the ß-adrenergic-dependent increase in circulating FGF21 occurs through an indirect mechanism in which fatty acids released by adipocyte lipolysis subsequently activate hepatic PPARα to increase FGF21 expression. These studies identify FGF21 as a cell-autonomous autocrine regulator of adipose tissue function.