Sternoclavicular Septic Arthritis: A Case Report.

We report a case of a 47-year-old male who presented with concerns for a "mass" on the right side of his chest and low-grade fevers for the last month. The patient was found to have an induration, erythema, and warmth at the right sternoclavicular joint, with tenderness to palpation and pain in the movement of the right arm. The patient was found to have septic arthritis of the sternoclavicular joint based on CT imaging. Sternoclavicular joint septic arthritis is a rare diagnosis and accounts for very few diagnosed septic joints. Most patients have some sort of risk factors, such as diabetes, immunosuppression, rheumatoid arthritis, or intravenous drug use. The most common pathogen is Staphylococcus aureus. Our patient did not consent to joint aspiration for a definitive diagnosis of the causative organism and was therefore empirically treated for S. aureus with trimethoprim-sulfamethoxazole. The patient also did not consent to any surgical management. Septic arthritis has been successfully treated with antibiotic therapy alone in the past, and in conjunction with the patient's choices, this was the treatment plan that was chosen for the patient. The patient responded to antibiotic therapy and followed up with a thoracic surgery clinic outpatient. This case depicts the importance of retaining a high index of suspicion for a rare diagnosis in the emergency department (ED). This case also depicts the successful treatment of sternoclavicular septic arthritis with outpatient oral trimethoprim-sulfamethoxazole, which, to the best of our knowledge, has not been done previously.

Comparisons of Schansitherium tafeli with Samotherium boissieri (Giraffidae, Mammalia) from the Late Miocene of Gansu Province, China.

We are describing and figuring for the first time skulls of Schansitherium tafeli, which are abundant in the Gansu area of China from the Late Miocene. They were animals about the size of Samotherium with shorter necks that had two pairs of ossicones that merge at the base, which is unlike Samotherium. The anterior ossicones consist of anterior lineations, which may represent growth lines. They were likely mixed feeders similar to Samotherium. Schansitherium is tentatively placed in a very close position to Samotherium. Samotherium and Schansitherium represent a pair of morphologically very similar species that likely coexisted similarly to pairs of modern species, where the main difference is in the ossicones. Pairs of ruminants in Africa, for example, exist today that differ mostly in their horn shape but otherwise are similar in size, shape, and diet. The absence of Schansitherium from Europe is interesting, however, as Samotherium is found in both locations. While is it challenging to interpret neck length and ossicone shape in terms of function in combat, we offer our hypothesis as to how the two species differed in their fighting techniques.

Fatty liver promotes fibrosis in monkeys consuming high fructose.

OBJECTIVE: Nonalcoholic fatty liver diseases (NAFLD) are related to development of liver fibrosis which currently has few therapeutic options. Rodent models of NAFLD inadequately model the fibrotic aspects of the disease and fail to demonstrate the spectrum of cardiometabolic diseases without genetic manipulation. This study aimed to document a monkey model of fatty liver and fibrosis, which naturally develop cardiometabolic disease pathophysiologies. METHODS: Twenty-seven cynomolgus monkeys (Macaca fascicularis) fed diets either low or high in simple carbohydrates, supplied as fructose [control and high-fructose diet (HRr)], on low-fat, cholesterol-free background were studied. The HFr was consumed for up to 7 years, and liver tissue was histologically evaluated for fat and fibrosis extent. RESULTS: The HFr diet increased steatosis, and its extent was related to duration of fructose exposure. Lipid droplet size also increased with HFr duration; however, compared with control, the lipid droplets were smaller on average. Fibrosis extent was significantly greater with fructose feeding and was predicted by fructose exposure, extent of fatty liver, and age. CONCLUSIONS: These data are the first to demonstrate that high-carbohydrate diets alone can generate both liver fat and fibrosis and thus allow further study of mechanisms and therapeutic options in the translational animal model.