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Bacterial contamination of war wounds occurs either at the time of injury or during the course of therapy. Characterization of the bacteria recovered at the time of initial trauma could influence the selection of empiric antimicrobial agents used to prevent infection. In the spring of 2004, U.S. military casualties who presented to the 31st Combat Support Hospital in Baghdad, Iraq, with acute traumatic injuries resulting in open wounds underwent aerobic culture of their wounds to identify the bacteria colonizing the wounds. Forty-nine casualties with 61 separate wounds were evaluated. Wounds were located predominantly in the upper and lower extremities and were primarily from improvised explosive devices or mortars. Thirty wounds (49%) had bacteria recovered on culture, with 40 bacteria identified. Eighteen casualties (20 wounds) had undergone field medical therapy (irrigation and/or antimicrobial treatment); six of these had nine bacterial isolates on culture. Of the 41 wounds from 31 patients who had received no previous therapy, 24 grew 31 bacteria. Gram-positive bacteria (93%), mostly skin-commensal bacteria, were the predominant organisms identified. Only three Gram-negative bacteria were detected, none of which were characterized as broadly resistant to antimicrobial agents. The only resistant bacteria recovered were two isolates of methicillin-resistant Staphylococcus aureus (MRSA). Our assessment of war wound bacterioly soon after injury reveals a predominance of Gram-positive organisms of low virulence and pathogenicity. The presence of MRSA in wounds likely reflects the increasing incidence of community-acquired MRSA bacteria. These data suggest that the use of broad-spectrum antibiotics with efficacy against more resistant, Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter spp., is unnecessary in early wound management. [ABSTRACT FROM AUTHOR]

Background: Hyperpigmentation is a common cosmetic concern that significantly impacts self-esteem. A skincare regimen has been developed to improve the appearance, tone, texture, and luminosity of subjects with facial hyperpigmentation (Even Up ® Hyperpigmentation Regimen; Colorescience, Inc., Carlsbad, CA)., Aims: The objective of this open-label trial was to assess the efficacy and tolerability of this regimen for treating facial hyperpigmentation., Patients/methods: Subjects with moderate-to-severe facial hyperpigmentation (N = 33) were randomized to those not using prescription, advanced or physician-dispensed skin care products (Group A, n = 23) and those currently using prescription, advanced or physician-dispensed skincare products for facial hyperpigmentation (Group B, n = 10). Both groups were provided three skincare products comprising the hyperpigmentation regimen and instructions for use. Subjects were evaluated at baseline and Weeks 2, 4, 8 and 12., Results: The overall median (range) baseline MASI score at baseline was 9.0 (2, 31), decreasing by 0.0 (-7, 0) points at Week 2 (p = 0.002), 0.6 (-8, 0) points at Week 4 (p < 0.0001), 1.5 (-16, 0) points by Week 8 (p < 0.0001) and 2.4 (-20, 0) points at Week 12 (p < 0.0001). At Week 12, the overall median improvement in MASI score was 26% and higher for Group B (32% vs. 22%). By Week 2, subjects reported lighter, less noticeable brown spots (76%), brighter, more luminous skin (88%), more even skin tone (67%), and healthier look and feel (85%). Improvements continued throughout the study. No adverse events were observed or reported., Conclusions: This regimen addresses facial hyperpigmentation and protects skin against the damaging effects of ultraviolet and high energy visible light (HEV). It is safe to use on all skin types and tones., (© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

We retrospectively evaluated predictors of conversion to multiple sclerosis (MS) in 357 children with isolated optic neuritis (ON) as a first demyelinating event who had a median follow-up of 4.0 years. Multiple Cox proportional-hazards regressions revealed abnormal cranial magnet resonance imaging (cMRI; hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 3.39-10.39, p < 0.001), presence of cerebrospinal fluid immunoglobulin G oligoclonal bands (OCB; HR = 3.69, 95% CI = 2.32-5.86, p < 0.001), and age (HR = 1.08 per year of age, 95% CI = 1.02-1.13, p = 0.003) as independent predictors of conversion, whereas sex and laterality (unilateral vs bilateral) had no influence. Combined cMRI and OCB positivity indicated a 26.84-fold higher HR for developing MS compared to double negativity (95% CI = 12.26-58.74, p < 0.001). Accordingly, cerebrospinal fluid analysis may supplement cMRI to determine the risk of MS in children with isolated ON., (© 2015 American Neurological Association.)

MECP2 (methyl CpG binding protein 2) duplication causes syndromic intellectual disability. Patients often suffer from life-threatening infections, suggesting an additional immunodeficiency. We describe for the first time the detailed infectious and immunological phenotype of MECP2 duplication syndrome. 17/27 analyzed patients suffered from pneumonia, 5/27 from at least one episode of sepsis. Encapsulated bacteria (S.pneumoniae, H.influenzae) were frequently isolated. T-cell immunity showed no gross abnormalities in 14/14 patients and IFNy-secretion upon ConA-stimulation was not decreased in 6/7 patients. In 6/21 patients IgG2-deficiency was detected - in 4/21 patients accompanied by IgA-deficiency, 10/21 patients showed low antibody titers against pneumococci. Supra-normal IgG1-levels were detected in 11/21 patients and supra-normal IgG3-levels were seen in 8/21 patients - in 6 of the patients as combined elevation of IgG1 and IgG3. Three of the four patients with IgA/IgG2-deficiency developed multiple severe infections. Upon infections pronounced acute-phase responses were common: 7/10 patients showed CRP values above 200 mg/l. Our data for the first time show systematically that increased susceptibility to infections in MECP2 duplication syndrome is associated with IgA/IgG2-deficiency, low antibody titers against pneumococci and elevated acute-phase responses. So patients with MECP2 duplication syndrome and low IgA/IgG2 may benefit from prophylactic substitution of sIgA and IgG.

Deficiency of apoprotein A-V (apoA-V) can cause hypertriglyceridemia. In an 11 months old boy presenting with a severe hypertriglyceridemia, a formerly unknown 24 nucleotide deletion in exon 2 of the APOA5 gene was detected. The homozygous mutation results in an eight amino acid loss in the signal peptide sequence (c.16&#95;39del; p.Ala6&#95;Ala13del). Screening of control persons proved that this deletion is a rare mutation. Hypertriglyceridemia in the patient was only found at the time when he was breast fed, while after weaning, triglyceride levels were close to normal. Under both dietary conditions, apoA-V protein was undetectable in plasma while post-heparin plasma lipoprotein lipase activity was normal. Expression analysis of normal and mutated protein by Western blot and immunofluorescence in apoA-V deficient primary hepatocytes revealed that, due to changes in the signal peptide, mutated apoA-V was intracellularly missorted to lipid droplets and not secreted. Wild type apoA-V, instead, was not targeted to lipid droplets but transported via endosomal compartments to the plasma membrane for secretion. It is concluded that the c.16&#95;39del mutation in the APOA5 gene leads to hepatic missorting and impaired secretion, which consequently results in undetectable apoA-V plasma levels. The absence of apoA-V in plasma leads under conditions of fat-rich diets to severe chylomicronemia, suggestive for a modulatory role of apoA-V for lipoprotein lipase mediated intravascular triglyceride lipolysis., (Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.)

Background and Procedure: Pharmacological surrogate parameters are considered a useful tool in estimating the treatment intensity of asparaginase (ASNase) preparations. When a pegylated ASNase (single infusion of 2,500 IU/m(2) polyethylene glycol (PEG)-ASNase, Oncaspar) was introduced into the treatment protocols of the German Cooperative Acute Lymphoblastic Leukaemia (COALL) study group, this was accompanied by a drug monitoring programme measuring serum ASNase activity and asparagine (ASN) concentrations in the cerebrospinal fluid (CSF) in 70 children., Results: Four hundred fifty-nine serum samples from 67 evaluable patients showed medians of ASNase activity of 1,189.5, 824.5, 310.5, 41 and 4 U/l on day 7 +/- 1, 14 +/- 1, 21 +/- 1, 28 +/- 1 and 35 +/- 1 respectively. One hundred eighty-four samples from 59 patients were evaluable for ASN concentrations in the CSF. The medians of ASN concentration were <0.2, 0.2, 0.9 and 3.2 microM on day 14 +/- 1, 21 +/- 1, 28 +/- 1 and 35 +/- 1 respectively. When relating CSF ASN levels to the serum ASNase activity measured on the same day, a median of 1.2 microM CSF ASN was associated with values of serum ASNase activity between > or =2.5 and <100 U/l. Serum ASNase activity values > or =100 U/l were associated with a median CSF ASN of <0.2 microM, with 13/27 samples being incompletely depleted., Conclusions: The treatment intensity achieved with PEG ASNase in the present study appears to be acceptable based on the surrogate of serum ASNase activity. However, the pharmacological objective of ASNase treatment, that is, complete CSF ASN depletion with an ASNase activity >100 U/l, was not ensured. Nevertheless, one must also be aware that the minimum ASN concentration required for leukaemic cell growth is yet to be established.

Unlabelled: Polyethylene glycol conjugated asparaginase (PEG-ASNase) can be substituted in cases of hypersensitivity to native Escherichia coli asparaginase. We measured asparagine (asn) levels in plasma after a single dose of 2,500 IU/m(2) i.v. PEG-ASNase (Oncaspar) in consolidation treatment of ALL and compared those with data from the previous protocol COALL-05-92. This protocol was similar to COALL-06-97, except that children had been given 45,000 IU/m(2) C-ASNase instead of PEG-ASNase., Patients and Methods: Between May 2000 and December 2001 seventy-one children (38 boys, 33 girls) with newly diagnosed ALL treated according to the multicenter protocol COALL-06-97 were investigated in this study. Four hundred and seventy-four plasma samples (71 patients) were analysed by ion exchange chromatography after column derivatization with o-phthaldialdehyde. For comparison data (350 plasma samples) from 51 patients treated according to the protocol COALL-05-92 were available. The same method for detection of asn in plasma was used., Results: The median asparagine level in plasma after 2,500 IU/m(2) PEG-ASNase i.v. was below the limit of detection for at least 5 weeks in 81 % of the patients. When divided into high risk (HR) and low risk (LR) group, HR patients who had previously received one dose more of C-ASNase showed a markedly shorter depletion than the LR patients compatible with a higher risk of antibody formation and consequent silent inactivation after a higher number of exposures to ASNase. In the previous protocol COALL-05-92 median asn levels in plasma after 45,000 IU/m(2) native C-ASNase i.v. were below the limit of detection for at least 5 weeks in 65 % of the patients., Conclusions: 2,500 IU/m(2) PEG-ASNase led to an equally long depletion of asn in plasma as did 45,000 IU/m(2) native C-ASNase i.v. used in COALL-05-92.

Background: Acupuncture alleviates acute and chronic shoulder pain. Yet it has not been determined whether acupuncture is useful following musculoskeletal surgery., Hypothesis: Compared to sham acupuncture, arthroscopic acromioplasty subjects who received real acupuncture would manifest significantly better recovery as demonstrated by: UCLA shoulder scale, improved range of motion, diminished pain, decreased need and duration of analgesic use, and enhanced patient satisfaction., Methods: Forty arthroscopic acromioplasty patients were randomized to real or sham acupuncture. UCLA shoulder scale scores, pain intensity, analgesic use, range of motion, and quality of life were monitored for four months. Data were analyzed with the general linear model ANOVA for repeated measures., Results: Thirty-five subjects completed the study. Real acupuncture subjects scored significantly better on UCLA shoulder scale (p<0.000); pain intensity (p<0.022); self-reported analgesic use (p<0.008); angles of abduction (p<0.046); and in six of eight health status questionnaire components., Conclusions: Following arthroscopic acromioplasty, real acupuncture compared to sham acupuncture offered significantly greater improvement via: (1) lower pain level, (2) less analgesic use, (3) range of motion, and (4) patient satisfaction.

This clinical study determined the feasibility of a sealed resin composite restoration to arrest dental caries using a minimal tooth preparation: a bevel in enamel only without removal of the carious lesion. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) that had no "extension for prevention". The CompS/C restorations were also compared with the traditional (unsealed) amalgam restorations (AGU) with the "extension for prevention" outline form. Caries progress, as determined by standardized radiographs, revealed that after 5 years caries remained arrested under the CompS/C restorations; the marginal integrity was similar for the CompS/C and the AGS groups, and exhibited highly significant superiority to the AGU restorations (Chi square, P less than = 0.00004). Complete sealant retention over the amalgam restorations (AGS group) was less than over the composite restorations (CompS/C), and conversely, partial sealant retention was higher for the AGS group. Sealants also appeared to protect the posterior composite restorations against wear.

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries without the removal of the carious lesion and without the traditional cavity preparation. The minimal tooth preparation (a bevel in enamel) usually did not require any anesthetic injection and conserved tooth structure. These ultraconservative sealed composite restorations placed over caries (CompS/C) have been compared with ultraconservative sealed amalgam restorations (AGS) and with the traditional outline form (unsealed) amalgam restorations (AGU). This clinical study has shown that: (1) caries can be arrested by the CompS/C restoration for a period of three years; (2) the marginal integrity of the AGS restorations showed a definite trend toward improvement as compared to the AGU restorations; and (3) complete sealant retention over posterior restorations was similar in both the CompS/C and the AGS groups during the first two years; however, at Year 3 complete sealant retention was 16 percent higher in the CompS/C than in the AGS group.

The overall objective of this clinical study was to determine the feasibility of using a sealed composite restoration to arrest caries. This objective was to be achieved using minimal tooth preparation for Class I lesions, without the traditional Class I cavity preparation and without the removal of the carious lesion. The minimal tooth preparation consisted of no [corrected] removal of the carious lesion, bevel in enamel only, and usually not requiring any anesthetic injection. These ultra-conservative sealed composite restorations placed over caries (CompS/C) were compared with ultra-conservative sealed amalgam restorations (AGS) and with the traditional (unsealed) amalgam restorations (AGU). This study showed that: 1) caries is arrested under the CompS/C restoration for a period of 4 years; 2) sealant retention is similar in both the CompS/C and the AGS groups; 3) the marginal integrity of the AGS restorations is markedly superior to that of the AGU restorations; and 4) sealant appears to prevent wear of posterior composite restorations.

Type C botulism was determined to be the cause of an epizootic among waterfowl and shorebirds in a phosphate mine settling pond in northern Florida during May and June of 1979. Several hundred birds, the most common of which were American coots (Fulica americana), wood ducks (Aix sponsa), common gallinules (Gallinula chloropus), and northern shovelers (Anas clypeata), were afflicted over about a three-week period. A second smaller outbreak occurred in the same pond in early December of 1979. This is apparently the first time that botulism has been reported in waterbirds of Florida.

This study evaluated the microleakage of various restorative materials placed in root surfaces. A minimum of 20 freshly extracted single-rooted teeth were used for each combination of restorative materials. Four preparations were made on the root surface and each restored with a different material. After thermocycling in dye, the root was cut transversely in several sections through the restoration, and microscopically examined to record the microleakage at the interface between restorative materials and tooth. Results indicated that fewer composite resin specimens allowed microleakage into dentin as compared with either amalgam or glass ionomer materials.