Septic Arthritis: Diagnosis and Treatment.

Septic arthritis must be considered and promptly diagnosed in any patient presenting with acute atraumatic joint pain, swelling, and fever. Risk factors for septic arthritis include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, hip or knee prosthesis, skin infection, and immunosuppressive medication use. A delay in diagnosis and treatment can result in permanent morbidity and mortality. Physical examination findings and serum markers, including erythrocyte sedimentation rate and C-reactive protein, are helpful in the diagnosis but are nonspecific. Synovial fluid studies are required to confirm the diagnosis. History and Gram stain aid in determining initial antibiotic selection. Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, other bacteria, viruses, fungi, and mycobacterium can cause the disease. After synovial fluid has been obtained, empiric antibiotic therapy should be initiated if there is clinical concern for septic arthritis. Oral antibiotics can be given in most cases because they are not inferior to intravenous therapy. Total duration of therapy ranges from two to six weeks; however, certain infections require longer courses. Consideration for microorganisms such as Neisseria gonorrhoeae, Borrelia burgdorferi, and fungal infections should be based on history findings and laboratory results.

Flavin monooxygenase 3, the host hepatic enzyme in the metaorganismal trimethylamine N-oxide-generating pathway, modulates platelet responsiveness and thrombosis risk.

Essentials Microbe-dependent production of trimethylamine N-oxide (TMAO) contributes to thrombosis risk. The impact of host flavin monooxygenase 3 (FMO3) modulation on platelet function is unknown. Genetic manipulation of FMO3 in mice alters systemic TMAO levels and thrombosis potential. Genetic manipulation of FMO3 is associated with alteration of gut microbial community structure. SUMMARY: Background Gut microbes play a critical role in the production of trimethylamine N-oxide (TMAO), an atherogenic metabolite that impacts platelet responsiveness and thrombosis potential. Involving both microbe and host enzymatic machinery, TMAO generation utilizes a metaorganismal pathway, beginning with ingestion of trimethylamine (TMA)-containing dietary nutrients such as choline, phosphatidylcholine and carnitine, which are abundant in a Western diet. Gut microbial TMA lyases use these nutrients as substrates to produce TMA, which upon delivery to the liver via the portal circulation, is converted into TMAO by host hepatic flavin monooxygenases (FMOs). Gut microbial production of TMA is rate limiting in the metaorganismal TMAO pathway because hepatic FMO activity is typically in excess. Objectives FMO3 is the major FMO responsible for host generation of TMAO; however, a role for FMO3 in altering platelet responsiveness and thrombosis potential in vivo has not yet been explored. Methods The impact of FMO3 suppression (antisense oligonucleotide-targeting) and overexpression (as transgene) on plasma TMAO levels, platelet responsiveness and thrombosis potential was examined using a murine FeCl3 -induced carotid artery injury model. Cecal microbial composition was examined using 16S analyses. Results Modulation of FMO3 directly impacts systemic TMAO levels, platelet responsiveness and rate of thrombus formation in vivo. Microbial composition analyses reveal taxa whose proportions are associated with both plasma TMAO levels and in vivo thrombosis potential. Conclusions The present studies demonstrate that host hepatic FMO3, the terminal step in the metaorganismal TMAO pathway, participates in diet-dependent and gut microbiota-dependent changes in both platelet responsiveness and thrombosis potential in vivo.

7-Methoxybenzofuran-4-carboxamides as PDE 4 inhibitors: a potential treatment for asthma.

The synthesis and pharmacological profile of a novel series of 7-methoxybenzofuran-4-carboxamides is described. Some of these compounds were found to be potent inhibitors of phosphodiesterase type 4 (PDE4).

Effect of surface treatment on unalloyed titanium implants: spectroscopic analyses.

Surgical implant finishing and sterilization procedures were investigated to determine surface characteristics of unalloyed titanium (Ti). All specimens initially were cleaned with phosphoric acid and divided into five groups for comparisons of different surface treatments (C = cleaned as above, no further treatment; CP = C and passivated in nitric acid; CPS = CP and dry-heat sterilized; CPSS = CPS and resterilized; CS = C and dry-heat sterilized). Auger (AES), X-ray photoelectron (XPS), and Raman spectroscopic methods were used to examine surface compositions. The surface oxides formed by all treatments primarily were TiO2, with some Ti2O3 and possibly TiO. Significant concentrations of carbonaceous substances also were observed. The cleaning procedure alone resulted in residual phosphorus, primarily as phosphate groups along with some hydrogen phosphates. A higher percentage of physisorbed water appeared to be associated with the phosphorus. Passivation (with HNO3) alone removed phosphorus from the surface; specimens sterilized without prior passivation showed the thickest oxide and phosphorus profiles, suggesting that passivation alters the oxide characteristics either directly by altering the oxide structure or indirectly by removing moieties that alter the oxide. Raman spectroscopy showed no crystalline order in the oxide. Carbon, oxygen, phosphorus, and nitrogen presence were found to correlate with previously determined surface energy.

Atmospheric radioactive isotopes at orbital altitudes.

The radioactive isotope 7Be was discovered on the forward-facing side of the LDEF satellite in amounts far exceeding that expected from direct cosmic ray activation of the spacecraft material. This prompted an examination of the production of cosmogenic isotopes in the atmosphere and of the processes by which they may be transported to orbital altitudes and adsorbed by a spacecraft. 7Be is only one of several atmospheric cosmogenic isotopes that might be detectable at orbital altitudes and that might prove to be as useful as tracers of atmospheric circulation processes in the mesosphere and thermosphere as they have been in the lower layers of the atmosphere.

Modulation of nicotine-evoked [3H]dopamine release from rat striatal synaptosomes by voltage-sensitive calcium channel ligands.

The calcium channel subtypes mediating nicotine-evoked [3H]dopamine release from rat striatal synaptosomes were probed with L-, N-, and P-type calcium channel ligands. Responses to nicotine were blocked by the peptides omega-conotoxin GVIA and omega-agatoxin IVA. The affinity constants for these compounds were consistent with their actions at N- and P-type channels, respectively. Together, these channels mediate at least 90% of the calcium-dependent response to nicotine. The L-type antagonists nifedipine, verapamil, and nicardipine were also effective blockers of nicotine-evoked release with maximal effects of 80-100% inhibition. However, these effects occurred at concentrations 2-3 orders of magnitude higher than those necessary to block L-type channels. Moreover, Bay K8644, an L-type agonist, also blocked nicotine-evoked release. Together, these findings argue strongly against the involvement of L-type channels.

Ecological land classification as a basic theme for the management of wildlands in Tennessee: A start.

The Tennessee Wildlife Resources Agency (TWRA) owns and/or cooperatively manages nearly 247 000 ha scattered across the state. To aid the management of this diversity of soils, landforms, and plant communities, TWRA has selected a flexible, ecological land classification system developed for the Interior Uplands in southeastern United States. Landtypes are the most detailed unit of the 5-level hierarchy. To date, four wildlife management areas and one state wetland have been mapped and entered into the agency s Geographic Information System (GIS). These five tracts are in the Upper Coastal Plain of west Tennessee, in the Western and Eastern Highland Rim regions of middle Tennessee, and in the Cumberland Mountains of east Tennessee. The history, physiography, geology, soils, topography, and vegetation of each area are discussed. After forest cover type and age information is merged with the landtypes, wildlife habitat modelling will commence.

Investigating the HLA component in rheumatoid arthritis: an additive (dominant) mode of inheritance is rejected, a recessive mode is preferred.

We examined the mode of inheritance of rheumatoid arthritis (RA) and estimated the genetic contribution of the HLA-linked locus to the development of RA using data from 111 multiplex families (54 London, 57 Cleveland), and 43 randomly ascertained patients (Seattle). HLA-DR4 was present in 78 multiplex probands (70%); a further 16 probands who were negative for DR4 were positive for DR1. Both DR4 and DR1 were significantly in excess when compared to control population frequencies (P less than 0.001); an additional finding was an excess of DR7, although the numbers of probands with DR7 were small. Despite the well-established HLA association with RA, neither recessive nor additive (dominant) modes of inheritance, nor any intermediate models have been ruled out using affected sib-pair and antigen genotype frequency among patients (AGFAP) methods. However, in our study the AGFAP data for HLA-DR4 and DR1 were close to recessive expectations (P = ns) while an additive (dominant) mode of inheritance was rejected (P less than 0.001). The same results were obtained by an independent method which considered HLA-DR transmission from affected parents to their affected children. The affected sib-pair haplotype sharing method showed deviation from random expectations but did not allow discrimination between recessive and additive (dominant) modes. The effect of the HLA-linked locus on familiarity accounted for only a 1.61-fold increased risk to sibs over the population prevalence, compared to an observed value of 3.90. This indicated that there could be at least one other non-HLA locus predisposing to RA with a weight that is slightly greater than that of HLA.

Gonococcal infections of penile prostheses.

The first two known cases of Neisseria gonorrhoeae infection of a penile implant are reported. The literature regarding periprosthetic infections is reviewed, and the mode of transmission of the gonococcal organism to the corpora is discussed.

The measured radiation environment within Spacelabs 1 and 2 and comparison with predictions.

To measure the radiation environment in the Spacelab (SL) module and on the pallet, a set of passive and active radiation detectors was flown as part of the Verification Flight Instrumentation (VFI). SL 1 carried 4 passive and 2 active detector packages which, with the data from the 26 passive detectors of Experiment INS006, provided a comprehensive survey of the radiation environment within the spacecraft. SL 2 carried 2 passive VFI units on the pallet. Thermoluminescent dosimeters (TLDs) measured the low linear energy transfer (LET) dose component; the HZE fluence and LET spectra were mapped with CR-39 track detectors; thermal and epithermal neutrons were measured with the use of fission foils; metal samples analyzed by gamma ray spectroscopy measured low levels of several activation lines. The TLDs registered from 97 to 143 mrad in the SL 1 module. Dose equivalents of 330 +/- 70 mrem in the SL 1 module and 537 +/- 37 mrem on the SL 2 pallet were measured. The active units in the SL 1 module each contained an integrating tissue-equivalent ion chamber and two differently-shielded xenon-filled proportional counters. The ion chambers accumulated 125 and 128 mrads for the mission with 17 and 12 mrads accumulated during passages through the South Atlantic Anomaly (SAA). The proportional counter rates (approximately 1 cps at sea level) were approximately 100 cps in the middle of the SAA (mostly protons), approximately 35 cps at large geomagnetic latitudes (cosmic rays) and approximately 100 cps in the South Horn of the electron belts (mostly bremsstrahlung). Detailed results of the measurements and comparison with calculated values are described.