Endophthalmitis caused by staphylococcus epidermidis: in vitro antibiotic susceptibilities and clinical outcomes.

BACKGROUND AND OBJECTIVE: To investigate the antibiotic sensitivities and clinical outcomes of eyes with endophthalmitis caused by methicillin-sensitive versus methicillin-resistant Staphylococcus epidermidis (MSSE/MRSE). PATIENTS AND METHODS: A retrospective, consecutive case series of all patients with endophthalmitis caused by S. epidermidis from January 1, 1996, through July 1, 2004, was conducted. The antibiotic sensitivities and clinical outcomes were obtained from the corresponding medical records. RESULTS: The study included 86 eyes of 86 patients with S. epidermidis endophthalmitis (34 MSSE and 52 MRSE). Endophthalmitis categories included cataract surgery (58), glaucoma surgery (12), trauma (7), vitrectomy (4), penetrating keratoplasty (4), and corneal suture ulcer (1). In vitro testing revealed that all MSSE and MRSE isolates were sensitive to vancomycin, 67% of MSSE isolates and 67% of MRSE isolates were sensitive to gatifloxacin, and 73% of MSSE isolates and 67% of MRSE isolates were sensitive to moxifloxacin (overall 68% sensitive). All eyes were treated with intravitreal vancomycin and either ceftazidime or amikacin. Visual acuity improved to a median of 20/80 at 3 months and 20/60 at 1 year. I CONCLUSIONS: In the current study, all MSSE and MRSE isolates were sensitive to vancomycin and 68% were sensitive to the fourth-generation fluoroquinolones. There were no significant differences in visual acuity outcomes of endophthalmitis caused by MSSE versus MRSE isolates.     

Cutaneous matastasis from sino-nasal malignant melanoma — a rare case report

To report a case of disseminated cutaneous metastasis from malignant melanoma of sino-nasal region. A 53-year-old man from rural parts of West Bengal presented with progressive nasal obstruction. CT scanning was done to know the extent of the mass and punch biopsy from the mass was performed. Malignant melanoma of sino-nasal region was diagnosed and chemotherapy was started. The patient developed cutaneous deposits after two cycles of chemotherapy. The patient developed cutaneous deposits during the course of chemotherapy. Excision biopsy from cutaneous deposits revealed malignant melanoma. A rare case of diffuse cutaneous metastasis of malignant melanoma is presented here along with review of literature.     

Trocheliophorin: A novel rearranged sesquiterpenoid from the Indian Ocean soft coral Sarcophyton trocheliophorum

A novel rearranged sesquiterpenoid, trocheliophorin (1) has been isolated from the soft coral Sarcophyton trocheliophorum besides the known compounds, sarcophytin, methyl arachidonate, and two polyhydroxy steroids (24S)-24-methylcholestane-3beta,5alpha,6beta,25-tetrol-25-monoacetate and (24S)-24-methylcholestane-3beta,5alpha,6beta,25-tetrol. The structure of the new sesquiterpenoid was elucidated by a study of its spectral data.     

Meckel diverticulum: ten-year experience in adults

OBJECTIVES: Meckel diverticulum, a congenital gastrointestinal anomaly, is well studied in pediatrics, but less so in the adult population. At the Charleston Area Medical Center (CAMC), in addition to the removal of Meckel diverticula in symptomatic patients, diverticula are commonly removed when found incidentally during other procedures. We present our experience over the past ten years with this condition, unusual in the adult population. METHODS: From 1992 to 2002 at the Charleston Area Medical Center, Meckel diverticula were removed from 47 patients older than 18 years of age. We reviewed the age, sex, indication for removal, pathologic findings, and perioperative complications of these cases. RESULTS: Diverticula were removed most often from female patients (31 female, 66%; 16 male, 34%). The removal of the diverticulum was incidental in 35 patients (74.5%) and symptomatic in 12 (25.5% percent). Symptomatic patients presented with: obstruction (n = 4), acute bleeding (n = 1) and diverticulitis (n = 7). Female patients were significantly less likely than male patients to be symptomatic (4 of 31, 13% among females, and 8 of 16, 50% among males; P < 0.05). Heterotopic mucosa was identified in six patients, two of whom were symptomatic at the time of removal. Gastric mucosa was found in all six of the diverticula with ectopic mucosa, although one of the six had a mixed gastric and pancreatic cell population. One asymptomatic patient had a malignancy identified as a 1.5 cm carcinoid with no evidence of metastatic disease. An adenomyoma was found incidentally in one patient upon pathologic evaluation. Hospital complications that could possibly be attributed to removal of diverticula included two wound infections and two anastomotic leaks requiring exploration (8.5% morbidity). Complications were experienced by two asymptomatic females, one asymptomatic male, and a symptomatic male. There were no mortalities. CONCLUSIONS: Meckel diverticulum is found infrequently in the adult population. Adults rarely become symptomatic, but symptoms that do arise are associated with significant morbidity. Complications directly attributable to diverticulum removal are uncommon; however, those that do occur are often life threatening. Therefore, incidental removal of asymptomatic diverticula, particularly in women, is not recommended.     

Small animal simultaneous PET/MRI: initial experiences in a 9.4 T microMRI

We developed a non-magnetic positron-emission tomography (PET) device based on the rat conscious animal PET that operates in a small-animal magnetic resonance imaging (MRI) scanner, thereby enabling us to carry out simultaneous PET/MRI studies. The PET detector comprises 12 detector blocks, each being a 4 × 8 array of lutetium oxyorthosilicate crystals (2.22 × 2.22 × 5 mm(3)) coupled to a matching non-magnetic avalanche photodiode array. The detector blocks, housed in a plastic case, form a 38 mm inner diameter ring with an 18 mm axial extent. Custom-built MRI coils fit inside the positron-emission tomography (PET) device, operating in transceiver mode. The PET insert is integrated with a Bruker 9.4 T 210 mm clear-bore diameter MRI scanner. We acquired simultaneous PET/MR images of phantoms, of in vivo rat brain, and of cardiac-gated mouse heart using [(11)C]raclopride and 2-deoxy-2-[(18)F]fluoro-D-glucose PET radiotracers. There was minor interference between the PET electronics and the MRI during simultaneous operation, and small effects on the signal-to-noise ratio in the MR images in the presence of the PET, but no noticeable visual artifacts. Gradient echo and high-duty-cycle spin echo radio frequency (RF) pulses resulted in a 7% and a 28% loss in PET counts, respectively, due to high PET counts during the RF pulses that had to be gated out. The calibration of the activity concentration of PET data during MR pulsing is reproducible within less than 6%. Our initial results demonstrate the feasibility of performing simultaneous PET and MRI studies in adult rats and mice using the same PET insert in a small-bore 9.4 T MRI.     

Decoupling of stretch reflex and background muscle activity during anticipatory postural adjustments in humans

We studied the evolution of stretch reflexes in relation to background electromyographic (EMG) activity in the soleus muscle preceding the onset of voluntary arm raise movements. Our objective was to investigate if changes in reflex EMG and muscle activity occur simultaneously and are similarly scaled in amplitude. Ten human subjects stood with each foot on pedals able to exert short dorsiflexor pulses during stance. Subjects were asked to product consistent voluntary arm raise movements to a target upon a visual cue. In ¼ of trials, no pulse perturbations were given, but in the remaining ¾’s of all trials pulses were given randomly during a 600-ms period, from 400 ms before until 200 ms after the onset of the movements. Perturbation trials were sorted into 20-ms bins post hoc, and the amplitude of the reflex EMG component was calculated and compared to the EMG activity obtained when no pulses were given. Results showed that despite exhibiting similar profiles over time, the background EMG consistently inhibited before the reflex EMG did. However, times of reactivation (rebound) were variable across subjects, with background EMG activating before reflex for some subjects and vice versa for others. The minimum values of inhibition, time of inhibition and time of rebound for background and reflex EMG measures did not show significant linear correlations when all subjects’ data were considered. These results suggest that reflex and background EMG components of anticipatory postural adjustments evolve differently in time and amplitude. This has implications for the independent control of reflexes and voluntary muscle activity.     

Query-by-example surgical activity detection

Purpose

Easy acquisition of surgical data opens many opportunities to automate skill evaluation and teaching. Current technology to search tool motion data for surgical activity segments of interest is limited by the need for manual pre-processing, which can be prohibitive at scale. We developed a content-based information retrieval method, query-by-example (QBE), to automatically detect activity segments within surgical data recordings of long duration that match a query.

Methods

The example segment of interest (query) and the surgical data recording (target trial) are time series of kinematics. Our approach includes an unsupervised feature learning module using a stacked denoising autoencoder (SDAE), two scoring modules based on asymmetric subsequence dynamic time warping (AS-DTW) and template matching, respectively, and a detection module. A distance matrix of the query against the trial is computed using the SDAE features, followed by AS-DTW combined with template scoring, to generate a ranked list of candidate subsequences (substrings). To evaluate the quality of the ranked list against the ground-truth, thresholding conventional DTW distances and bipartite matching are applied. We computed the recall, precision, F1-score, and a Jaccard index-based score on three experimental setups. We evaluated our QBE method using a suture throw maneuver as the query, on two tool motion datasets (JIGSAWS and MISTIC-SL) captured in a training laboratory.

Results

We observed a recall of 93, 90 and 87 % and a precision of 93, 91, and 88 % with same surgeon same trial (SSST), same surgeon different trial (SSDT) and different surgeon (DS) experiment setups on JIGSAWS, and a recall of 87, 81 and 75 % and a precision of 72, 61, and 53 % with SSST, SSDT and DS experiment setups on MISTIC-SL, respectively.

Conclusion

We developed a novel, content-based information retrieval method to automatically detect multiple instances of an activity within long surgical recordings. Our method demonstrated adequate recall across different complexity datasets and experimental conditions.