Osteomyelitis: Diagnosis and Treatment.

Osteomyelitis is an inflammatory condition of bone secondary to an infectious process. Osteomyelitis is usually clinically diagnosed with support from imaging and laboratory findings. Bone biopsy and microbial cultures offer definitive diagnosis. Plain film radiography should be performed as initial imaging, but sensitivity is low in the early stages of disease. Magnetic resonance imaging with and without contrast media has a higher sensitivity for identifying areas of bone necrosis in later stages. Staging based on major and minor risk factors can help stratify patients for surgical treatment. Antibiotics are the primary treatment option and should be tailored based on culture results and individual patient factors. Surgical bony debridement is often needed, and further surgical intervention may be warranted in high-risk patients or those with extensive disease. Diabetes mellitus and cardiovascular disease increase the overall risk of acute and chronic osteomyelitis.

PURL: Can viscous fiber lower glycemic markers in type 2 diabetes?

The first meta-analysis to focus on viscous dietary fiber in T2D suggests a potential role for this supplement in improving glycemic control.

PURL: Is it better to take that antihypertensive at night?

A large RCT in a primary care setting comparing bedtime to upon-waking administration of antihypertensives answers the question.

PURL: Best timing for measuring orthostatic vital signs?

We typically take a blood pressure within 3 minutes of a patient rising from a supine to a standing position. But is that too long?

PURL: Supplemental oxygen: More isn't always better.

A recent study says that in certain populations, supplemental oxygen above certain levels can increase mortality.

Erratum: A better approach to the diagnosis of PE.

The author list for the June 2019 PURL ("A better approach to the diagnosis of PE." J Fam Pract. 2019;68:286,287,295) should have read: Andrew H. Slattengren, DO; Shailendra Prasad, MBBS, MPH; David C. Bury, DO; Michael M. Dickman, DO; Nick Bennett, DO; Ashley Smith, MD; Robert Oh, MD, MPH, FAAFP; Robert Marshall, MD, MPH, MISHM, FAAFP.

PURL: A better approach to the diagnosis of PE.

A simple diagnostic algorithm is all that's needed to safely and effectively reduce our reliance on CT pulmonary angiography to diagnose PE.

Fungicidal activity of AKWATON and in vitro assessment of its toxic effects on animal cells.

Acquired superficial fungal infections are among the most common infections. It is necessary to create new effective and non-toxic disinfectants. AKWATON is a new disinfectant of the polymeric guanidine family. Its fungicidal activity against Trichophyton mentagrophytes and its in vitro toxicity assessment were determined in this study. The MIC, minimum fungicidal concentration (MFC) and time required for its fungicidal activity at the MFC were evaluated using the official methods of analysis of the Association of Official Analytical Chemists, with modifications as recommended by the Canadian General Standards Board. The toxic effects of AKWATON and of four commercial disinfectants were evaluated on rat pancreatic (C2C12) and muscle (RnM5F) cells, using the trypan blue and MTT [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] methods. The MIC, MFC and time required for the fungicidal activity of AKWATON at the MFC were 0.025 % (w/v), 0.045 % (w/v) and 2.5 min, respectively. Cell cultures and the different tests carried out showed that the AKWATON-based disinfectant killed fewer cells than the commercial disinfectants, sparing 80 % of C2C12 cells and 65 % of RnM5F cells, whilst some of the well-known disinfectants currently on the market killed 85-100 % of cells. This study demonstrates that AKWATON has great potential as an odourless, colourless, non-corrosive and safe disinfectant for use in hospitals, the agriculture industry, farming and household facilities.

Akwaton, polyhexamethylene-guanidine hydrochloride-based sporicidal disinfectant: a novel tool to fight bacterial spores and nosocomial infections.

Bacterial spores are of continuing interest to the food and medical industries. In efforts to eliminate bacterial spore contamination, a number of sporicidal agents have been developed. Most of these compounds must be used carefully in very specific circumstances as they are toxic to humans. The sporicidal activity of Akwaton, a polyhexamethylene-guanidine hydrochloride (PHMGH)-based disinfectant, was tested against Bacillus subtilis spores. PHMGH is a colourless, odourless, non-corrosive and non-irritating antimicrobial biocide of the guanidine family. Spores suspended in distilled water and spores placed on solid surfaces (stainless steel and glass) were used to determine the log(10) reduction after exposure to varying concentrations of Akwaton. The minimum sporostatic concentration, the minimum sporicidal concentration and the time required for sporicidal activity corresponded to 0.06% (w/v), 0.08 % (w/v) and 8.5 min, respectively. Disinfectant concentrations of 0.24 % (w/v) and 0.44 % (w/v) killed all spores suspended in distilled water within 3 min and 90 s, respectively. The sporicidal activity against suspended spores was linearly dependent with respect to the concentration of PHMGH and contact time (y(3 min) = 40x-1.6 and y(90 s) = 20x-0.8 thus y(3 min) = 2y(90 s)). Spores placed on surfaces were more resistant to the effect of the disinfectant and the positive linear correlation between the sporicidal activity and concentration was not observed. The concentration required to kill all spores placed on a surface (stainless steel or glass) corresponded to 0.52 % (w/v) for 90 s of contact and 0.36 % (w/v) for 3 min. This study demonstrated that PHMGH is an effective sporicidal disinfectant with great potential for use in hospitals, laboratories, food industries and households.

First diastereoselective synthesis of methyl caffeoyl- and feruloyl-muco-quinates.

We report on a diastereoselective synthesis of six derivatives of caffeoyl- and feruloyl-muco-quinic acids. All the muco-quinic acid derivatives were obtained in excellent yield in five steps starting from quinic acid, caffeic acid and ferulic acid. Allyl ether protection of trans-hydroxy cinnamic acids was here introduced to chlorogenic acids synthesis. We show that muco-quinic acid derivatives, which are formally diastereoisomers of chlorogenic acids, can be readily distinguished by their tandem mass spectra.

An easy and effective demonstration of enzyme stereospecificity and equilibrium thermodynamics.

Enzyme stereospecificity and equilibrium thermodynamics can be demonstrated using the coupling of two amino acid derivatives by Thermoase C160. This protease will catalyze peptide bond formation between Z-L-AspOH and L-PheOMe to form the Aspartame precursor Z-L-Asp-L-PheOMe. Reaction completion manifests itself by precipitation of the product. As the product has almost zero solubility, the equilibrium favors condensation and thus a normally hydrolytic enzyme catalyzes the opposite reaction. Neither Z-D-AspOH with L-PheOMe nor Z-L-AspOH with D-PheOMe produces any visible product.

Trilacunary A-beta-Keggin tungstogermanates and -silicates functionalized with phenyltin(IV) electrophiles.

The first organic derivative of a beta-Keggin tungstogermanate, the monomeric Keggin anion [{(C(6)H(5))Sn(OH)}(3)(A-beta-GeW(9)O(34))](4-) (1), was the only species isolated from the reaction of (C(6)H(5))SnCl(3) with Na(10)[A-beta-GeW(9)O(34)] in water, whereas the Si-analogue [{(C(6)H(5))Sn(OH)}(3)(A-beta-SiW(9)O(34))](4-) (2) and two dimeric tungstosilicates, the unprecedented species [{(C(6)H(5))Sn(A-beta-H(3)SiW(9)Sn(2)O(37))}(2)O(2)](8-) (3) and the known sandwich-type polyanion [{(C(6)H(5))Sn(OH)}(3)(A-beta-H(3)SiW(9)O(34))(2)](8-) (4), were isolated starting from [A-beta-SiW(9)O(34)](10-). The novel polyanion 3 can be described as the product of a double Sn-C hydrolysis followed by condensation of two subunits of 2 through double Sn-O-Sn bridge formation. Solid-state characterization has been carried out by infrared spectroscopy, thermogravimetry and single-crystal X-ray diffraction, representing the first structural analysis for 4. A full solution multinuclear NMR ((1)H, (13)C, (117)Sn, and (183)W) and solid-state (117)Sn CP-MAS NMR study enabled full characterization of 1. A weak 1-dimensional polyanion association through (Sn)O-HO(t) hydrogen contacts involving one of the protonated bridging O atoms of the (C(6)H(5))(3)Sn(3)O(12) corner-shared triad is observed for 1 by X-ray diffraction, resulting in a local C(s) pseudosymmetry for the Sn centers detected by solid-state (117)Sn NMR spectroscopy.

Heteropoly-13-palladates(II) [Pd(II)(13)(As(V)Ph)(8)O(32)](6-) and [Pd(II)(13)Se(IV)(8)O(32)](6-).

Two discrete anionic palladium(II)-oxo clusters have been prepared: [Pd(13)(As(V)Ph)(8)O(32)](6-) (1) and [Pd(13)Se(IV)(8)O(32)](6-) (2) were synthesized in one-pot self-assembly reactions of Pd(OAc)(2) with PhAsO(3)H(2) and SeO(2) and characterized by single-crystal X-ray analysis, IR, thermogravimetric analysis, elemental analysis, magnetic and electron paramagnetic resonance measurements, and electrochemistry.

Organo-ruthenium supported heteropolytungstates: synthesis, structure, electrochemistry, and oxidation catalysis.

The reaction of [Ru(arene)Cl(2)](2) (arene = benzene, p-cymene) with [X(2)W(22)O(74)(OH)(2)](12-) (X = Sb(III), Bi(III)) in buffer medium resulted in four organo-ruthenium supported heteropolytungstates, [Sb(2)W(20)O(70)(RuC(6)H(6))(2)](10-) (1), [Bi(2)W(20)O(70)(RuC(6)H(6))(2)](10-) (2), [Sb(2)W(20)O(70)(RuC(10)H(14))(2)](10-) (3), and [Bi(2)W(20)O(70)(RuC(10)H(14))(2)](10-) (4), which have been characterized in solution by multinuclear ((183)W, (13)C, (1)H) NMR, UV-vis spectroscopy, electrochemistry, and in the solid state by single-crystal X-ray diffraction, IR spectroscopy, thermogravimetric analysis, and elemental analysis. Polyanions 1, 2, and 4 crystallize in the triclinic system, space group P1 with the following unit cell parameters: K(5)Na(5)[Sb(2)W(20)O(70)(RuC(6)H(6))(2)] x 22 H(2)O (KNa-1), a = 12.1625(2) A, b = 13.1677(2) A, c = 16.0141(3) A, alpha = 78.9201(7) degrees, beta = 74.4442(8) degrees, gamma = 78.9019(8) degrees, and Z = 1; Cs(2)Na(8)[Bi(2)W(20)O(70)(RuC(6)H(6))(2)] x 30 H(2)O (CsNa-2), a = 11.6353(7) A, b = 13.3638(7) A, c = 16.7067(8) A, alpha = 79.568(2) degrees, beta = 71.103(2) degrees, gamma = 80.331(2) degrees, and Z = 1; Na(10)[Bi(2)W(20)O(70)(RuC(10)H(14))(2)].35H(2)O (Na-4), a = 15.7376(12) A, b = 15.9806(13) A, c = 24.2909(19) A, alpha = 92.109(4) degrees, beta = 101.354(4) degrees, gamma = 97.365(3) degrees, and Z = 2. Polyanions 1-4 consist of two (L)Ru(2+) (L = benzene or p-cymene) units linked to a [X(2)W(20)O(70)](14-) (X = Sb(III), Bi(III)) fragment via Ru-O(W) bonds resulting in an assembly with idealized C(2h) symmetry. Polyanions 1-4 are stable in solution as indicated by the expected (183)W, (13)C, and (1)H NMR spectra. The electrochemistry of 1-4 is described by considering the reduction and the oxidation processes. The nature of the arene in Ru(arene) has practically no influence on the formal potentials of the W-centers, which are more sensitive to the Sb or Bi hetero atoms. The results suggest that the respective Sb- and Bi derivatives have very different pK(a) values, with the reduced form of 1 being the most basic, thus permitting the observation of two well-developed voltammetric waves at pH 6. In contrast, the identity of the arene influences the oxidation processes, thus permitting to distinguish them. A strong electrocatalytic water oxidation peak is observed that is more positive than the one corresponding to the Ru(arene) oxidation process. Also a stepwise oxidation of the Ru(benzene) group could be observed at pH 3. The catalytic efficiency, on the other hand, of 1-4 toward the oxidation of n-hexadecane and p-xylene illustrated the effect of ruthenium substitution on the polyanion catalytic performance.

Copper-, cobalt-, and manganese-containing 17-tungsto-2-germanates.

The sandwich-type tungstogermanates [Cu(3)(H(2)O)(B-beta-GeW(9)O(33)(OH))(B-beta-GeW(8)O(30)(OH))](12-) (1), [Co(H(2)O)(2){Co(3)(B-beta-GeW(9)O(33)(OH))(B-beta-GeW(8)O(30)(OH))}(2)](22-) (2), and [Mn(H(2)O)(2){Mn(3)(H(2)O)(B-beta-GeW(9)O(33)(OH))(B-beta-GeW(8)O(30)(OH))}(2)](22-) (3) were synthesized and characterized by single-crystal X-ray diffraction, elemental analysis, thermogravimetric analysis, and infrared spectroscopy. Polyanion 1 is composed of two nonequivalent Keggin units, (B-beta-GeW(8)O(31)) and (B-beta-GeW(9)O(34)), linked to each other via three copper(II) ions in such a way that there is a plane of symmetry passing through both Ge atoms and the unique Cu atom, resulting in a sandwich-type structure with C(s) symmetry. On the other hand, the monomeric building blocks of 2 and 3 contain the same Keggin fragments as 1, but linked through three octahedrally coordinated Co(2+) or Mn(2+) ions. The major difference between complex 1 and complexes 2 and 3 is that the latter all lack a plane of symmetry due to a different orientation of the rotated triad. Magnetic measurements indicated antiferromagnetic exchange interactions between the three Cu(2+) ions in 1 and between the three Mn(2+) ions in 3. On the other hand, polyanion 2 possesses ferromagnetic interaction of the Co(2+) ions. The best least-squares fit values for 2 are J(z) = 7.9 cm(-1), J(z) = 3.1 cm(-1), J(y) = 2.4 cm(-1), g(z) = 6.77 cm(-1), and g(xy) = 4.15 (R = 2.6 x 10(-2)).

22-Isopolytungstate fragment [H2W22O74]14- coordinated to lanthanide ions.

The novel polyanions [Ln(2)(H(2)O)(10)W(22)O(71)(OH)(2)](8-) (Ln = La (1), Ce (2), Tb (3), Dy (4), Ho (5), Er (6), Tm (7), Yb (8), Lu (9), Y (10)) have been synthesized by reaction of WO(4)(2-) and lanthanide ions in acidic aqueous medium. The low symmetry (C(i)) polyanion family [Ln(2)(H(2)O)(10)W(22)O(71)(OH)(2)](8-) consists of the isopolyanion [H(2)W(22)O(74)](14-) and two {Ln(H(2)O)(5)}(3+) supporting units. The [H(2)W(22)O(74)](14-) cluster, which consists of two undecatungstate {W(11)} fragments, acts as a tridentate ligand to two Ln(3+) ions. Polyanions 1-10 are isostructural, and the coordination number of the lanthanide ions correlates with their sizes. All compounds have been fully characterized in the solid state by Fourier transform infrared spectroscopy, single-crystal X-ray diffraction, thermogravimetric analysis, and elemental analysis. Single-crystal X-ray diffraction analyses show that 1-10 crystallize as sodium salts in the triclinic space group P1.

Large cation-anion materials based on trinuclear ruthenium(III) salts of Keggin and Wells-Dawson anions having water-filled channels.

Reaction of the trinuclear ruthenium(III) cation [Ru(3)O(OOCCH(3))(6)(CH(3)OH)(3)](+) with the Keggin-type [alpha-GeW(11)O(39)](8-), [alpha-SiW(11)O(39)](8-), and [alpha-SiMo(12)O(40)](4-) and the Wells-Dawson-type [alpha-P(2)W(18)O(62)](6-) polyanions in an aqueous, acidic medium resulted in plenary polyoxometalate-based materials K(2)Na[Ru(3)O(OOCCH(3))(6)(H(2)O)(3)][alpha-GeW(12)O(40)].10H(2)O (1), K(3)[Ru(3)O(OOCCH(3))(6)(H(2)O)(3)][alpha-SiW(12)O(40)].18H(2)O (2), K(3)[Ru(3)O(OOCCH(3))(6)(H(2)O)(3)][alpha-SiMo(12)O(40)].7H(2)O (3), and K(2)Na[Ru(3)O(OOCCH(3))(6)(H(2)O)(3)](3)[alpha-P(2)W(18)O(62)].26H(2)O (4), respectively. All four materials, 1-4, crystallize as sodium and/or potassium salts in the monoclinic space group P2(1)/n. Compounds 1-4 were characterized by IR, thermogravimetric analysis, and single-crystal/powder X-ray diffraction (XRD). The isolated solid-state frameworks, composed of cocrystallized trinuclear ruthenium cations and polyanions, exhibit nanosized voids filled with crystal waters. These water molecules can be removed reversibly upon heating under a vacuum, and powder XRD measurements demonstrated that the crystallinity of the compound was preserved. Sorption studies on ethanol and methanol were also performed.

Organoantimony-containing polyoxometalate: [{PhSbOH}3(A-alpha-PW9O34)2]9-.

The dimeric, sandwich-type tungstophosphate [{PhSbOH}(3)(A-alpha-PW(9)O(34))(2)](9-) (1) has idealized D(3h) symmetry and represents the first organoantimony-containing polyoxometalate. Polyanion 1 was synthesized in an aqueous, acidic medium via three different routes and was fully characterized in the solid state by X-ray diffraction, IR, and thermogravimetric analysis and in solution by multinuclear NMR ((1)H, (13)C, (31)P, and (183)W).