Immiscible metallic melts in the deep Earth: clues from moissanite (SiC) in volcanic rocks.

The occurrence of moissanite (SiC), as xenocrysts in mantle-derived basaltic and kimberlitic rocks sheds light on the interplay between carbon, hydrogen and oxygen in the lithospheric and sublithospheric mantle. SiC is stable only at ƒO2 < ΔIW-6, while the lithospheric mantle and related melts commonly are considered to be much more oxidized. SiC grains from both basaltic volcanoclastic rocks and kimberlites contain metallic inclusions whose shapes suggest they were entrapped as melts. The inclusions consist of Si0 + Fe3Si7 ± FeSi2Ti ± CaSi2Al2 ± FeSi2Al3 ± CaSi2, and some of the phases show euhedral shapes toward Si0. Crystallographically-oriented cavities are common in SiC, suggesting the former presence of volatile phase(s), and the volatiles extracted from crushed SiC grains contain H2 + CH4 ± CO2 ± CO. Our observations suggest that SiC crystalized from metallic melts (Si-Fe-Ti-C ± Al ± Ca), with dissolved H2 + CH4 ± CO2 ± CO derived from the sublithospheric mantle and concentrated around interfaces such as the lithosphere-asthenosphere and crust-mantle boundaries. When mafic/ultramafic magmas are continuously fluxed with H2 + CH4 they can be progressively reduced, to a point where silicide melts become immiscible, and crystallize phases such as SiC. The occurrence of SiC in explosive volcanic rocks from different tectonic settings indicates that the delivery of H2 + CH4 from depth may commonly accompany explosive volcanism and modify the redox condition of some lithospheric mantle volumes. The heterogeneity of redox states further influences geochemical reactions such as melting and geophysical properties such as seismic velocity and the viscosity of mantle rocks.

Functional Outcomes for Nonoperatively Treated Proximal Fifth Metatarsal Fractures.

Fractures of the proximal fifth metatarsal are relatively common and can be treated with a variety of treatment modalities. The goals of the current study were to answer the following questions: (1) Is there a difference in functional outcomes with different nonoperative treatment modalities for avulsion and Jones fractures? (2) What is the long-term functional impairment? This study included 53 patients who were treated for proximal fifth metatarsal fracture at 1 university health care system between 2004 and 2013. Treatment methods included shoe modification, cast, and boot. Patients completed a telephone questionnaire that included selected questions from the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS). Treatment groups were stratified as shoe modification or immobilization, and the results of the MODEMS survey were compared. At most recent follow-up, no significant difference was found between the 2 patient groups (P=.062) for self-reported effects of the injury on work and quality of life. No significant difference was found for frequency of use of pain medication (P=.157), patient satisfaction with current symptoms (P=.633), ambulatory status (P=.281), or pain level with strenuous activity (P=.772). Obese patients were more likely to have severe pain with strenuous activity (P=.015). Most (87%) patients were able to ambulate without the need for assistive devices. Of the study patients, 79% could wear dress shoes, excluding high heels, comfortably. The findings showed that patients who were treated with a variety of nonoperative methods for closed proximal fifth metatarsal fracture had acceptable functional outcomes, regardless of treatment method. [Orthopedics. 2017; 40(6):e1030-e1035.].

Treatment with tobramycin solution for inhalation reduces hospitalizations in young CF subjects with mild lung disease.

Our objective was to study the effect of tobramycin solution for inhalation (TSI; TOBI, Chiron Corp.) on lung function decline rate in 400 young persons with cystic fibrosis (CF) and mild lung disease. Effects on hospitalization, antibiotic use, school days missed, and nutritional status also were determined. This was an open-label, randomized (stratified by sex and age group, i.e., 6-10 and 11-15 years), parallel-group, multicenter study. Routine subject management (control group) was compared to routine management plus 28 days of twice-daily TSI inhalation, followed by 28 days off the drug (TSI group) for 56 weeks. Primary efficacy endpoints included rate of lung function decline (as measured by forced expiratory volume in 1 sec; FEV(1)), hospitalization, and concomitant antibiotic use. Safety was assessed by analysis of treatment-emergent adverse events. Only 184 of 400 planned subjects were recruited and randomized (93 to the TSI group, and 91 to the control group). Enrollment was ended after 2 years because of difficult recruitment. An interim safety review showed a 2.42-fold risk of respiratory hospitalization for control group subjects (P = 0.020), and the study was terminated. Sixty-three subjects (34.2%) completed the entire study (30 in the TSI group, or 32.3%; and 33 in the control group, or 36.3%). Significantly fewer TSI subjects were hospitalized for worsening of respiratory symptoms (11.0% vs. 25.6%; P = 0.011), and fewer TSI subjects were hospitalized overall (16.5% vs. 27.8%; P = 0.065). Fewer TSI subjects received antibiotics other than the study drug (78.0% vs. 95.6%), and significantly fewer received oral antibiotics (76.9% vs. 91.1%; P = 0.009). No other safety or adverse event differences were observed. In conclusion, significant reductions in respiratory hospitalizations, concomitant antibiotic use, and a trend towards improvement in percent predicted forced expiratory flow (FEF(25-75)) provide evidence of a clinical benefit of TSI use in young persons with CF and mild lung disease. An effect on lung function decline rate could not be evaluated as planned, due to inadequate enrollment and early study termination.