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Shales are the most common sedimentary rocks in hydrocarbon environments often forming the source rock and trapping rock for a reservoir. Due to the platey nature of the constituent grains, shales are commonly anisotropic. In this paper we calculate seismic waveforms for highly anisotropic shales using Maslov asymptotic theory (MAT). This theory is an extension of classical ray theory which provides valid waveforms in regions of caustics (wavefront folding) where ray theory amplitudes are unstable. Asymptotic ray theory (ART) is based on the Fermat or geometrical ray which connects the source and receiver. In contrast, the Maslov solution integrates the contributions from neighbouring non-Fermat rays. Raypaths, travel-times, amplitudes and synthetic seismograms are presented for three highly anisotropic shales using a very simple 1D model comprised of an anisotropic shale overlying an isotropic shale. The ART waveforms fail to account for complex waveform effects due to triplications. In comparison, the MAT waveforms predict nonsingular amplitudes at wavefront cusps and it predicts the diffracted signals from these cusps. A Maslov solution which integrates ray contributions over a single slowness component will break down when rays focus in 3D (at a point rather than along a line). One of the tested shales shows such a point caustic and integration over 2 slowness components is required to remove the amplitude singularity. Finally, we examine the effects of wavefront triplications on Alford rotations which are used to estimate shear-wave splitting. In such cases, the rotation successfully finds the fast shear-wave polarization, but it can be unreliable in its estimate of the time separation. Les argiles sont les roches sédimentaires les plus répandues dans l'environnement des hydrocarbures, et forment souvent la roche mère et la roche des pièges pétrolifères. En raison de la structure en plaques des grains, les argiles sont généralement anisotropes. Dans le présent article, nous calculons les formes d'onde sismiques pour des argiles fortement anisotropes en employant la théorie asymptotique de Maslov (MAT). Cette théorie est une extension de la théorie classique des rayons qui fournit des formes d'onde valides dans les zones des caustiques (repliement du front d'onde), là où les amplitudes de la théorie des rayons sont instables. La théorie asymptotique des rayons (ART) est basée sur le rayon géométrique ou rayon de Fermat qui relie la source au récepteur. Par contre, la solution de Maslov intègre les données sur des rayons contigüs qui ne sont pas des rayons de Fermat. Les rayons, les temps de propagation, les amplitudes et les sismogrammes synthétiques sont présentés pour trois argiles fortement anisotropes en utilisant un modèle 1D très simple composé d'une argile anisotrope sus-jacente à une argile isotrope. Les formes d'onde ART ne réussissent pas à rendre compte des effets de formes d'onde complexes dues à la triplication. En comparaison, les formes d'onde MAT prévoient les amplitudes régulières aux sommets du front d'onde et les signaux diffractés à partir de ces sommets. Une solution de Maslov qui intègre les contributions des rayons sur une composante unique de lenteur se détériorera si les rayons se focalisent en 3D (sur un point plutôt que le long d'une ligne). Une des argiles testées exhibe cette caustique, et l'intégration sur deux composantes de lenteur est nécessaire pour éliminer la singularisation en amplitude. Nous examinons enfin les effets des triplications du front d'onde sur les rotations de Alford qui sont utilisées pour évaluer la biréfringence des ondes transversales. Dans de tels cas, la rotation trouve avec succés la polarisation de l'onde transversale rapide, mais elle peut s'avérer peu fiable pour l'estimation de l'écart de temps d'arrivée entre les deux ondes transversales.

Hand osteomyelitis is a complex condition to diagnose and treat, with an opportunity to improve care through organization of existing evidence. The literature was systematically searched for series of hand osteomyelitis between 1990 and 2022 for evidence regarding diagnosis and treatment, to formulate recommendations. Twenty-one series reported at least 5 cases of hand osteomyelitis in adults, with a total of 666 cases. Surgical debridement is central to treatment and oral antibiotics are sufficient for individuals without diabetes, renal or vascular disease, after debridement and resolution of associated sepsis. A 4- to 6-week duration of antibiotic therapy according to organism sensitivities is recommended, or a 2-week course after amputation. Delayed presentation is common and if over 6 months is associated with high amputation rates. Hand osteomyelitis with renal failure is associated with systemic complications. Reconstruction options include antibiotic-eluting spacers, osteosynthesis or arthrodesis, vascularized bone or adipose, regional soft tissue coverage and silicone implant arthroplasty. Level of Evidence: IV., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: The diagnosis of hand osteomyelitis requires correlation of clinical, radiological, and microbiological findings. The role of serum inflammatory markers in diagnosing and prognosticating hand osteomyelitis remains uncertain. We sought to determine the utility of inflammatory markers in the diagnosis and follow-up of hand osteomyelitis, and their ability to predict outcomes, particularly amputation., Methods: We retrospectively reviewed 146 patients diagnosed with hand osteomyelitis and with serum inflammatory marker levels measured after the onset of symptoms and within 14 days either side of diagnosis. Blood results at first presentation including white cell count (WCC), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and C-reactive protein (CRP) were reviewed, and associations with amputations assessed. Follow-up markers taken at 15 to 60 days from diagnosis were analyzed where available., Results: Mean WCC and CRP at diagnosis were 9.2 (SD: 4.6) and 30.2 (SD: 42.4) respectively, compared with 8.2 (SD: 3.9) and 30.2 (SD: 42.4) at follow-up. At diagnosis, sensitivity of CRP was 74%, and WCC was 31%. Each marker had a low positive predictive value for amputation at diagnosis (<29%). A rise in CRP between diagnosis and follow-up was associated with an increased risk of amputation compared with a fall in CRP. The finding that WCC and CRP were both normal at diagnosis had a high negative predictive value against amputation (96%)., Conclusion: C-reactive protein has a higher sensitivity than WCC, NLR, and PLR when used as a diagnostic adjunct in hand osteomyelitis. White cell count and CRP both within reference ranges at diagnosis was highly negatively predictive against amputation.

Competing Interests: The authors declare no conflict of interest.

We present 210 patients with hand osteomyelitis in 246 rays over 12 years, including detailed analysis of 29 patients in this cohort with digital artery calcification evident on plain X-ray. Overall 71 patients had diabetes mellitus and/or end-stage renal failure, including 28 of 29 patients with calcification. In the calcification group, 17 patients had ipsilateral arteriovenous fistulae, five had steal syndrome and 15 had digital ulceration or skin necrosis. Compared with 181 controls, patients with calcification had more affected bones, polymicrobial infections, surgical procedures, phalanges and digits amputated and had higher mortality at 1 year (12 of 29) and 5 years (20 of 29), as a result of comorbidities. Absence of calcification in 43 patients with diabetes and/or end-stage renal failure was associated with better outcomes on all the above parameters. Early amputation to maximize disease-free survival may be appropriate for patients with hand osteomyelitis and arterial calcification. Level of evidence: IV.

Competing Interests: The authors declare no conflict of interest.

The cytogenetically cryptic t(5;11)(q35;p15) leading to the NUP98-NSD1 fusion is a rare but recurrent gene rearrangement recently reported to identify a group of young AML patients with poor prognosis. We used reverse transcription polymerase chain reaction (PCR) to screen retrospectively diagnostic samples from 54 unselected pediatric AML patients and designed a real time quantitative PCR assay to track individual patient response to treatment. Four positive cases (7%) were identified; three arising de novo and one therapy related AML. All had intermediate risk cytogenetic markers and a concurrent FLT3-ITD but lacked NPM1 and CEBPA mutations. The patients had a poor response to therapy and all proceeded to hematopoietic stem cell transplant. These data lend support to the adoption of screening for NUP98-NSD1 in pediatric AML without otherwise favorable genetic markers. The role of quantitative PCR is also highlighted as a potential tool for managing NUP98-NSD1 positive patients post-treatment., (Copyright © 2013 Wiley Periodicals, Inc.)

We have investigated the phenotypic and bioassay characteristics of bone marrow mesenchymal stromal cells (MSCs) differentiated along a Schwann cell lineage using glial growth factor. Expression of the Schwann cell markers S100, P75, and GFAP was determined by immunocytochemical staining and Western blotting. The levels of the stem cell markers Stro-1 and alkaline phosphatase and the neural progenitor marker nestin were also examined throughout the differentiation process. The phenotypic properties of cells differentiated at different passages were also compared. In addition to a phenotypic characterization, the functional ability of differentiated MSCs has been investigated employing a co-culture bioassay with dissociated primary sensory neurons. Following differentiation, MSCs underwent morphological changes similar to those of cultured Schwann cells and stained positively for all three Schwann cell markers. Quantitative Western blot analysis showed that the levels of S100 and P75 protein were significantly elevated upon differentiation. Differentiated MSCs were also found to enhance neurite outgrowth in co-culture with sensory neurons to a level equivalent or superior to that produced by Schwann cells. These findings support the assertion that MSCs can be differentiated into cells that are Schwann cell-like in terms of both phenotype and function., ((c) 2006 Wiley-Liss, Inc.)

Objectives: A rapid random amplification of polymorphic DNA (RAPD) technique was developed to distinguish between strains of coagulase-negative staphylococci (CoNS) involved in central venous catheter (CVC)-related bloodstream infection. Its performance was compared with that of pulsed-field gel electrophoresis (PFGE)., Methods: Patients at the University Hospital Birmingham NHS Foundation Trust, U.K. who underwent stem cell transplantation and were diagnosed with CVC-related bloodstream infection due to CoNS whilst on the bone marrow transplant unit were studied. Isolates of CoNS were genotyped by PFGE and RAPD, the latter employing a single primer and a simple DNA extraction method., Results: Both RAPD and PFGE were highly discriminatory (Simpson's diversity index, 0.96 and 0.99, respectively). Within the 49 isolates obtained from blood cultures of 33 patients, 20 distinct strains were identified by PFGE and 25 by RAPD. Of the 25 strains identified by RAPD, nine clusters of CoNS contained isolates from multiple patients, suggesting limited nosocomial spread. However, there was no significant association between time of inpatient stay and infection due to any particular strain., Conclusion: The RAPD technique presented allows CoNS strains to be genotyped with high discrimination within 4h, facilitating real-time epidemiological investigations. In this study, no single strain of CoNS was associated with a significant number of CVC-related bloodstream infections.