Leclercia Adecarboxylata and Pseudomonas Oryzihabitans Infection after Achilles Tendon Repair: A Case Report and Literature Review.

Leclercia adecarboxylata and Pseudomonas oryzihabitans are two bacteria rarely seen in human infections. We present an unusual case of a patient who developed a localized infection with these bacteria after repair of a ruptured Achilles tendon. We also present a review of the literature regarding infection with these bacteria within the lower extremity.

Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections.

Central line-associated bloodstream infections (CLABSIs) account for one-third of all hospital-acquired infections and can cost the health care system between $21,000 and $100,000 per infection. A dedicated vascular access team (VAT) can help develop, implement, and standardize policies and procedures for central line usage that address insertion, maintenance, and removal as well as educate nursing staff and physicians. This article presents how 1 hospital developed a VAT and implemented evidence-based guidelines. Central line utilization decreased by 45.2%, and CLABSI incidence decreased by 90%. The results of the study demonstrated that a reduced utilization of central lines minimized the risk of patients developing a CLABSI.

Condensation of the isoprenoid and amino precursors in the biosynthesis of domoic acid.

Understanding how environmental signals regulate production of domoic acid in blooms of Pseudo-nitzschia spp. at a molecular level requires description of the biochemical pathway to this kainoid neurotoxin. Precursor feeding studies have suggested domoic acid arises from the condensation of the C(10) isoprenoid geranyl diphosphate with glutamate, but the specific reactions leading to domoic acid from these precursors remain undescribed. Here, we develop a method to derivatize domoic acid with propyl chloroformate that enables gas chromatography-mass spectrometry (GC-MS) analysis to measure incorporation of stable isotopes into domoic acid generated in cultures incubated with isotopically-labeled substrates. We apply this method to demonstrate that both (2)H from [1-(2)H(2)]geraniol are incorporated into domoic acid, suggesting that the condensation of geranyl diphosphate with an amino group occurs by nucleophilic substitution of the diphosphate rather than by oxidation of geraniol to the aldehyde before reaction with an amino group to form an imine. Ultimately, these and similar studies will facilitate the identification of DA biosynthetic enzymes and genes which will enable the study of how environmental factors regulate DA biosynthesis at the molecular level.

Results of modified lapidus arthrodesis procedure using medial eminence as an interpositional autograft.

The Lapidus procedure has received wide acceptance as a valuable operation for correcting moderate to severe hallux valgus, especially in the presence of hypermobility. However, shortening of the first ray inherently occurs as the first metatarsocuneiform joint cartilage and subchondral bone are resected in preparation for arthrodesis. The purpose of this study was to radiographically compare the degree of shortening of the first ray with and without the use of the first metatarsal medial eminence as an interpositional autograft at the site of metatarsocuneiform fusion. Preoperative and postoperative radiographs were measured in 35 consecutive patients who underwent 37 modified Lapidus procedures for hallux valgus repair. In group A, 20 surgeries were performed without use of the interpositional autograft, and served as the control. In group B, 14 surgeries were performed using the medial eminence as an interpositional autograft. The mean amount of first ray shortening was 5.3 ± 1.66 mm in group A and 2.69 ± 1.56 mm in group B, and this difference was statistically significant (P < .001). All patients progressed to complete union, and the median follow-up was 6 months (range, 4-60). Based on these results, the use of the medial eminence as an interpositional autograft in conjunction with Lapidus arthrodesis resulted in a 49.2% reduction in the amount of shortening of the first ray and proved to be a useful source of readily available bone graft.