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Fungal and bacterial commensal organisms play a complex role in the health of the human host. Expansion of commensal ecology after birth is a critical period in human immune development. However, the initial fungal colonization of the primordial gut remains undescribed. To investigate primordial fungal ecology, we performed amplicon sequencing and culture-based techniques of first-pass meconium, which forms in the intestine prior to birth, from a prospective observational cohort of term and preterm newborns. Here, we describe fungal ecologies in the primordial gut that develop complexity with advancing gestational age at birth. Our findings suggest homeostasis of fungal commensals may represent an important aspect of human biology present even before birth. Unlike bacterial communities that gradually develop complexity, the domination of the fungal communities of some preterm infants by Saccromycetes, specifically Candida, may suggest a pathologic association with preterm birth.—Willis, K. A., Purvis, J. H., Myers, E. D., Aziz, M. M., Karabayir, I., Gomes, C. K., Peters, B. M., Akbilgic, O., Talati, A. J., Pierre, J. F. Fungi form interkingdom microbial communities in the primordial human gut that develop with gestational age.

Participation in eight common types of recreational activities leads annually to more than 2 million medically treated musculoskeletal injuries in children aged 5 to 14 years. Many of these injuries could have been prevented if current safety guidelines and protective equipment had been used. Studies have demonstrated the value of safety education programs in preventing injuries. Parents consider their child's physician an important source of safety education, and orthopaedic surgeons have a unique opportunity to provide injury prevention counseling. The American Academy of Orthopaedic Surgeons recognizes the importance of injury prevention and has developed advocacy programs that are readily available to physicians and the public. Individual orthopaedists should be involved in injury prevention through patient education, research, community programs, and regulatory efforts that promote safe play for children.

STUDY DESIGN Case Series and Review of the Literature. OBJECTIVE To report on cases of spinal cord injury from loss of fixation of upper thoracic pedicle screws. SUMMARY OF BACKGROUND DATA Despite generally low rates of intraoperative neurological injury from pedicle screws, there is 1 reported case of T2 pedicle screw pullout causing spinal cord injury. METHODS A review of the literature and an informal poll of 2 professional societies searching for cases in which thoracic pedicle screws migrated postoperatively into the spinal canal was performed. RESULTS Three patients had failure of spinal instrumentation with the most cephalad pedicle screws (T2, T4 and T4) plowing into the spinal canal, causing direct trauma to the spinal cord with resulting clinical and neurological injury. Failure of fixation occurred at 1 month, 1 year, and 2 years after index procedure. In 2 patients, neurological injury was severe enough that they became nonambulatory; the third patient had rapidly progressive leg weakness. In each case, there were only 1 or 2 pedicle screws at the top of the construct, and a span of 6 to 7 vertebrae without rigid fixation below this. One similar case was found in the literature. CONCLUSIONS Spinal instrumentation with only 1 to 2 pedicle screws at the top of the construct, and a span of >5 vertebrae below these screws without rigid fixation may be at risk for implant failure and catastrophic spinal cord injury. In the rare instance in which only 1 to 2 pedicle screws can be placed at the cephalad half of long spinal constructs, one may consider using hooks that would fail posteriorly and may present less risk to the spinal cord.

The federally supported state climatologist program ended in 1972. Thereafter, most states supported these endeavors in coordination with the National Climatic Data Center, but the current state programs vary widely. One of the functions of state climate programs that evolved since 1972 is acting as a liaison between the National Weather Service and various state agencies. This role is most apparent and controversial in coordinating state and local government response to severe weather and extreme climate anomalies such as drought, flood, winter storms, and tropical cyclones. The activities of the climate office in South Carolina during Hurricane Hugo in September 1989 and the October 1990 floods reveal how these interactions occur in one state that mandated these activities. The state climate office had to react to shifting weather conditions and to variable political conditions that affect public organizations. The climate office in South Carolina acts to interpret weather information, develop ...

George Dewey Purvis Jr. MD, died at his home in Jackson, Mississippi on July 2, 2011 (Fig. 1). He is survived by his wife Janet, four sons and daughters-in-law, 10 grandchildren, and four great-grandchildren. Fig. 1 George Dewey Purvis Jr. MD. (Photograph published with courtesy of JM Purvis MD.) As a young boy, he had a severe infection develop in his leg and was transferred to Memphis, Tennessee, for treatment at the Campbell Clinic (Fig. 2). His experience and the care he received at Campbell Clinic influenced his desire to become an orthopaedic surgeon. He graduated from the University of Tennessee School of Medicine and trained in surgery at the Universities of Iowa and Michigan before returning to Campbell Clinic as a fellow in orthopaedics in 1947. In 1950, George returned to Jackson, Mississippi, and entered solo practice. He and others later formed the Central Orthopaedic Clinic, where he practiced until 1990. Fig. 2 A young George Purvis was treated at Campbell Clinic in Memphis for a severe leg infection. (Photograph published with courtesy of JM Purvis MD.) George was an active member of numerous professional organizations and held many leadership positions, including the presidencies of the Association of Bone and Joint Surgeons in 1976, the Mississippi Orthopaedic Society, and the Mid-America Orthopaedic Association. He was the first surgeon from Mississippi to join the American Orthopaedic Association. He also was a member of the Board of Councilors of the American Academy of Orthopaedic Surgeons. George also contributed his time and services to the Mississippi Crippled Children’s Service and the State Hospital at Whitfield. In his spare time, he enjoyed spending time with his family and friends, and golf, bridge, travel, and photography. Although he was a “high-tech” orthopaedic surgeon during his career, he will be remembered for his warm and caring personality by his patients and peers.

Fifty-nine consecutive patients presenting within 6 hours of the onset of symptoms of an acute myocardial infarction were treated with 150 mg of soluble aspirin orally, and either 70 or 100 mg of alteplase divided into 2 intravenous bolus injections separated by 30 minutes. Dosage regimens were either 20 followed by 50 mg (group A), 50 followed by 20 mg (group B), or 50 followed by 50 mg (group C). Coronary angiography 60 minutes after the first bolus showed infarct-related coronary artery patency (Thrombolysis in Myocardial Infarction score 2 or 3) in 13 of 16 (81%) patients in group A, 12 of 17 (71%) in group B, and 10 of 11 (91%) in group C (overall patency rate at 60 minutes: 35 of 44 [80%] patients; 95% confidence interval 68 to 91%). At 90 minutes, patency rates were 15 of 20 (75%) patients in both groups A and B, and 18 of 19 (95%) in group C (overall patency rate 48 of 59 [81%] patients; 95% confidence interval 72 to 91%). Residual thrombus was identified with the 90-minute angiogram in 7 patients in group A, 5 in group B, and 3 in group C. Although there was no statistically significant difference in patency between the 3 dosage regimens at either 60 or 90 minutes there was a trend toward increased patency and more complete thrombolysis at 90 minutes in group C. No episodes of bradyarrhythmia, hypotension or cerebrovascular bleeding were observed after double bolus therapy. There were 7 episodes (12%) of reocclusion, and 3 deaths (5%) within 1-month follow-up. Double bolus alteplase therapy is a convenient and highly effective method of promoting early coronary artery patency.

Playground safety recently has received increasing attention from parents and municipalities. Orthopaedic surgeons treat a large number of the more than 350,000 injuries per year sustained on the play areas of this country's school, home, and community play areas. A parent brings a child to the playground for fun, healthy exercise, and imaginative play. Unfortunately, most parents may not be aware of recommended injury prevention methods. Data from the Consumer Product Safety Commission and other epidemiologic studies document frequency, identify at-risk activities and equipment, give direction for additional research, and guide regulations. It is appropriate for the medical community to lead in this safety effort and to contribute to additional research and advocacy efforts.

The evidence linking magnesium disorders with the pathogenesis and treatment of various cardiovascular diseases will be reviewed.

Publisher Summary This chapter examines the preliminary report on adrenal medullary grafting from the American Association of Neurological Surgeons Graft Project. This data is preliminary and subject to alteration as further data is accumulated and analyzed. It is not part of a controlled study but is the collection of clinical experience of the participants. Therefore, the data has been cautiously analyzed relative to the experience being described. The data is discussed in the chapter in various subgroups and not as a single unit or net result. It would be inappropriate to describe an overall complication rate, because the patient selection criteria, surgical procedure, and evaluation criteria vary with each center. In the chapter, rather than discussing an overall complication rate, complication rates are discussed for various types of patient characteristics and surgical procedures. The data are meant to provide a framework to evaluate the current state of the art of transplantation and provide insight into the direction for future studies.

Patients, physicians, and the general public have increasingly greater access and exposure to orthopaedic information from a wide variety of sources. Some information is biased or commercial, while other information is evidence-based and accurate. The dividing lines may not always be clear to medical professionals or to consumers. This symposium considers the accuracy, availability, and influence of information that is available to patients on the Internet and observes the role of direct marketing to the public by the orthopaedic industry and pharmaceutical companies. Media coverage of orthopaedic topics, including what the media looks for in press releases, how the media interprets and presents the material provided to them, and how the public is impacted by such coverage, is also discussed. Furthermore, the validity of orthopaedic industry advertisements directed to physicians, as well as the role of industry in driving the focus of non-peer-reviewed publications and podium presentations, is considered. The Internet, radio, television, and print media have overwhelmed the American public with medical information. When it is incorrect or misleading, patients become victims of medical misinformation. The consequences can be considerable and have negatively affected many doctor-patient relationships. As an example, a patient may read a nonvalidated infomercial in a magazine while on an airplane flight and develop erroneous opinions about diagnoses or treatments. A subsequent visit to a qualified physician may then be made difficult for the patient by conflicting opinions, the need for potentially awkward re-education, and by considerable skepticism. In contrast, a patient who has previously obtained accurate and understandable medical information can be an active participant in shared decision-making with a physician. A frequent source of medical information, the Internet, may be as likely to help as it is to hurt. Beredjiklian et al. described the case of carpal tunnel syndrome1. The authors looked …

Artificial intelligence (AI) is an emerging technology with great potential, particularly in manufacturing. But, has this technology matured to the point where its application can have a favorable financial impact? To answer this, existing AI technology is examined and evaluated for how well it can be applied to computer-aided manufacturing (CAM). Areas well suited to current AI CAM tools are identified. Following this analysis is a proposed autonomous manufacturing system that employs AI technology. A methodology for evaluating the fiscal soundness of this system is proposed and demonstrated.

A survey of smoking habits of medical students was done using basic medical science graduate students at the same institution as a comparison group. Smoking status was not significantly related to sex, race, or academic classification. Knowledge of adverse health consequences of smoking was related to time spent in medical school and to whether or not the respondent smoked (ie. probable denial of knowledge of the adverse consequences among smokers). The respondent's smoking status was significantly related to familial and peer group smoking status and to peer group attitude. The most common reason given by quitters was "the media influence." The nonsmoker most frequently never began the habit because of fear of health consequences. Because of the finding that a small percentage of medical students still are not convinced of the dangers of smoking, it was suggested that increased educational emphasis on these dangers be included in the medical curriculum.

Following separation of the seminiferous tubules from the interstitial cells in the rat testis, the amount of cytochrome P-450 and the activities of the cytochrome P-450-dependent enzymes, the 17alpha-hydroxylase and the C17-C20 lyase, were measured in the microsomes of the separated fractions. The amount of cytochrome P-450-dependent enzymes recovered in the microsomal fraction of the interstitial cells ranged from 71 to 86% of the whole testis. However, in some experiments lower recoveries of the activities of the enzymes were attributed to the breakdown of cytochrome P-450 to cytochrome P-420. In all cases, less than 10% of the testicular cytochrome P-450 and the cytochrome P-450-dependent steroidogenic enzymes were found in the tubular microsomes. Moreover, the specific activities of the 17 alpha-hydroxylase and the C17-C20 lyase were found to be 10 to 30 times higher in the interstitial tissue than in the seminiferous tubules of the rat testis. From these results, we have concluded that cytochrome P-450 and the activities of the cytochrome P-450-dependent enzymes in the rat testis are predominantly, if not sole, located in the interstitial cells.

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DPN+ is incorporated intact into isolated rat liver mitochondria by an energy-linked process. No difference in incorporation could be seen when DPN+ labeled in either the nicotinamide or the adenine portion of the molecule was used. Incorporation is not dependent on endogenous phosphate and proceeds equally well in a State 4 or a State 3 system. The uptake of DPN+ by mitochondria is also stimulated by oligomycin and can be supported by ATP in the presence of antimycin A. This latter reaction is inhibited by both oligomycin and 2,4-dinitrophenol.

A soluble (microsomal) preparation of tyrosinase was obtained from frog skin (Rana pipiens) by pretreatment of strips of dorsal skin with trypsin. The relatively high activity of the enzyme towards tyrosine compared with that against dopa and other catechols would indicate that the enzyme is predominantly of the nature of a monophenolase. The rate of oxidation of D-tyrosine is about one-third that obtained with L-tyrosine. The activity of the enzyme (measured by oxygen consumption of the system) with dialyzed preparations could be increased up to fivefold by the addition of cupric ions. The enzyme is inhibited in the presence of copper-binding agents such as diethyldithiocarbamate. Highly purified specimens of intermedin had no effect on the production or turnover of tyrosinase in the frog skin, nor was there any effect on the tyrosinoxidase. There was little difference in the activity of the tyrosinase in light- or dark-adapted frogs, or in frogs which had received a series of injections of intermedin. The tyrosinase activity of the skin is subject to a large seasonal variation. The activity is about ten times greater during the period September to November than in the earlier period of the year.

An electron microscopic examination of the rat adrenal cortex reveals changes in the abundance and structure of the mitochondria of the zona fasciculata after hypophysectomy, which are time-dependent and lead to the production of giant (diameter > 1.5μ) mitochondria. These changes were measured in low power fields involving a total thin section area of 850μ2 at 4, 7, 11, and 14 days after hypophysectomy. Following hypophysectomy, the number of mitochondria decreases, the volume of lipid droplets increases, the ratio of the surface area of the outer mitochondrial membrane to the mitochondrial volume decreases (indicative of increased size), and the percent of small mitochondria increases. The volume of giant mitochondria, comprising 8% of the total mitochondrial volume in control animals, increases to 65% of the total 7 days after hypophysectomy and to 82% 14 days after hypophysectomy. It has been found that administration of ACTH causes the gradual reversal of these effects of hypophysectomy over a period of 9 days. Mitochondrial partitions, clearly associated with the inner membrane, were observed after hypophysectomy and during ACTH-induced recovery. The evidence suggests that ACTH controls the process of growth and division of the mitochondria. The retarded growth of mitochondria in the absence of ACTH is associated with fusion of existing mitochondria to form giant mitochondria.

Studies on the role of cytochrome P-450 in mouse, rat, and chick testis microsomes showed that this CO-binding hemoprotein is involved in the activity of the 17α-hydroxylase. A 70–80% inhibition by CO of the 17α-hydroxylase activity was detected in rat and chick testis microsomes. In the mouse testis, the level of the enzyme activity is ten times greater than that of the rat. This partly explains why an acceleration of NADPH oxidation by progesterone can be observed in mouse but not in rat testis microsomes. In rat testis microsomes, type I binding spectra of cytochrome P-450 was observed with pregnenolone, progesterone, 17-hydroxyprogesterone, androstenedione, and testosterone. The apparent K s values for progesterone and 17-hydroxyprogesterone were 0.50 and 1.00 μ m , respectively. When NADPH is used to measure cytochrome P-450 levels in rat testis microsomes, CO formation resulting from a stimulation in lipid peroxidation by phosphate or Fe 2+ was sufficient to bind with 50% of the total amount of cytochrome P-450. Substitution of phosphate by Tris reduced the amount of lipid peroxidation to minimal levels. On a comparable basis, no CO formation was observed in avian testis microsomes. An increase in the testicular levels of cytochrome P-450 resulted upon the administration of HCG and cyclic-AMP to 1-day-old chicks. The lack of stimulation of the cytochrome P-450 levels by progesterone and pregnenolone suggest that the hormonal stimulation of the P-450 levels is not due to substrate induction.

A practicable solution of the Penman formula for potential evapotranspiration by use of graphs is presented. For ease in computation, three graphs are used. These graphs, designed for Columbia, S.C., can be adapted for any location by relabeling or correcting two of the families of curves.

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