Sugar phosphate-mediated inhibition of peptidoglycan precursor synthesis.

Antibiotic tolerance, the widespread ability of diverse pathogenic bacteria to sustain viability in the presence of typically bactericidal antibiotics for extended time periods, is an understudied steppingstone towards antibiotic resistance. The Gram-negative pathogen , the causative agent of cholera, is highly tolerant to β-lactam antibiotics. We previously found that the disruption of glycolysis, via deletion of (, glucose-6-phosphate isomerase), resulted in significant cell wall damage and increased sensitivity towards β-lactam antibiotics.

ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey.

Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury).

Rigorous treatment of pairwise and many-body electrostatic interactions among dielectric spheres at the Debye-Hückel level.

Electrostatic interactions among colloidal particles are often described using the venerable (two-particle) Derjaguin-Landau-Verwey-Overbeek (DLVO) approximation and its various modifications. However, until the recent development of a many-body theory exact at the Debye-Hückel level (Yu in Phys Rev E 102:052404, 2020), it was difficult to assess the errors of such approximations and impossible to assess the role of many-body effects. By applying the exact Debye-Hückel level theory, we quantify the errors inherent to DLVO and the additional errors associated with replacing many-particle interactions by the sum of pairwise interactions (even when the latter are calculated exactly).

A Rare Case of Porocarcinoma and Trichoblastoma Arising in a Nevus Sebaceus of Jadassohn.

Nevus sebaceus of Jadassohn, or "organoid nevus," is a common, benign hamartoma of the skin consisting of epithelial and adnexal components. Its natural history and association with neoplastic growths is well documented. The majority of concomitant neoplasms are benign-trichoblastoma and syringocystadenoma papilliferum are most frequently discovered-but malignant tumors have been described.

Indications and Outcomes of Mohs Micrographic Surgery Using a Multidisciplinary Approach: A Decade of Experience.

Background: Traditional approaches of staged outpatient Mohs Micrographic Surgery (MMS) in nonmelanoma skin cancer (NMSC) followed by reconstruction is not possible in a subset of patients.

Objective: Assess the indications and outcomes of a multidisciplinary approach MMS.

Methods And Materials: Retrospective, single-surgeon, single Mohs specialist, university-based tertiary care referral practice, including all MMS performed in the operating room setting with concurrent reconstruction in patients from 2008 to 2018 with minimum follow-up of 6 months.

Pomalidomide, bortezomib, and dexamethasone for patients with relapsed or refractory multiple myeloma previously treated with lenalidomide (OPTIMISMM): a randomised, open-label, phase 3 trial.

Background: As lenalidomide becomes increasingly established for upfront treatment of multiple myeloma, patients refractory to this drug represent a population with an unmet need. The combination of pomalidomide, bortezomib, and dexamethasone has shown promising results in phase 1/2 trials of patients with relapsed or refractory multiple myeloma. We aimed to assess the efficacy and safety of this triplet regimen in patients with relapsed or refractory multiple myeloma who previously received lenalidomide.

Oral Hedgehog Pathway Inhibition as a Means for Ocular Salvage in Locally Advanced Intraorbital Basal Cell Carcinoma.

Background: Basal cell cancer is the most common cutaneous malignancy. It rarely presents with locally advanced or metastatic disease. Rare presentations such as intraorbital invasion remain a difficult clinical problem with significant potential morbidity.

Improving series convergence: the simple pendulum and beyond.

A simple and easy to implement method for improving the convergence of a power series is presented. We observe that the most obvious or analytically convenient point about which to make a series expansion is not always the most computationally efficient. Series convergence can be dramatically improved by choosing the center of the series expansion to be at or near the average value at which the series is to be evaluated.

The Collaborative Payer Provider Model Enhances Primary Care, Producing Triple Aim Plus One Outcomes: A Cohort Study.

Rising health care costs are threatening the fiscal solvency of patients, employers, payers, and governments. The Collaborative Payer Provider Model (CPPM) addresses this challenge by reinventing the role of the payer into a full-service collaborative ally of the physician. From 2010 through 2014, a Medicare Advantage plan prospectively deployed the CPPM, averaging 30,561 members with costs that were 73.

Desmoplastic Melanoma of the Head and Neck: Incidence and Survival, 1992-2013.

Objective To describe the epidemiological characteristics and survival of desmoplastic melanoma of the head and neck (DMHN) and discuss the factors influencing survival variation among DMHN, DM of other sites (DMnHN), and conventional melanoma of the head and neck (CMHN). Study Design Retrospective cohort study. Setting Surveillance, Epidemiology, and End Results (SEER) database (years 1992-2013).

Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Technology: A Clinical and Radiographic Analysis of 50 Patients.

Objective: Interbody cage implantation during minimally invasive surgery for transforaminal lumbar interbody fusion (MIS TLIF) presents challenges. Expandable cages when collapsed facilitate insertion; subsequent expansion in situ optimizes endplate contact. This report describes clinical and radiographic outcomes of MIS TLIF with an expandable cage.

Can dielectric spheres accurately model atomic-scale interactions?

We calculate the polarization portion of electrostatic interactions at the atomic scale using quantum mechanical methods such as density functional theories (DFT) and the coupled cluster approach, and using classical methods such as a surface charge method and a polarizable force field. The agreement among various methods is investigated. Using the coupled clusters method CCSD(T) with large basis sets as the reference, we find that for systems comprising two to six atoms and ions in S-states the classical surface charge method performs much better than commonly used DFT methods with moderate basis sets such as B3LYP/6-31G(d,p).

Reporting of Postoperative Pain Management Protocols in Randomized Clinical Trials of Mandibular Fracture Repair: A Systematic Review.

Importance: The control of pain associated with mandibular fractures is an important treatment outcome that affects function, adherence to treatment regimens, and patient comfort and satisfaction.

Objective: To explore the pain management protocols reported in studies of mandibular fractures, including the reporting of quality-of-life measures.

Evidence Review: PubMed/MEDLINE, EMBASE, Cochrane CENTRAL, and clinicaltrials.

Pomalidomide alone or in combination with dexamethasone in Japanese patients with refractory or relapsed and refractory multiple myeloma.

This phase 1, open-label, dose-escalation study investigated the tolerated dose (recommended dose), safety, efficacy, and pharmacokinetics of pomalidomide alone or pomalidomide plus low-dose dexamethasone in Japanese patients with refractory or relapsed and refractory multiple myeloma. Twelve patients were enrolled. Patients received pomalidomide 2 mg (Cohort 1) or 4 mg (Cohort 2) orally on day 1 and days 3-21 of a 28-day cycle.

Evidence-Based Facial Fracture Management.

With demands for an evidence-based approach to patient care, the management of facial fractures will come under increasing scrutiny because there is an overall deficiency in higher level clinical evidence. This article reviews the management of facial fractures, focusing on an evidence-based approach. It focuses on select areas of facial trauma in which there is controversy and presents randomized studies and meta-analysis to help define best practice.

Validation and analysis of a multi-site MIS Prospective Registry through sub-analysis of an MIS TLIF Subgroup.

Study Design: Retrospective analysis of multi-site, prospectively collected database.

Objective: To assess the validity and utility of a prospective spine registry by sub-analysis of patients treated with MIS TLIF.

Background: The MIS registry is a large-scale, multi-center series of prospectively collected clinical information on outcomes, complications, and adverse events for minimally invasive spine procedures for the treatment of degenerative lumbar conditions.

A multicenter phase 2 study of pomalidomide plus dexamethasone in patients with relapsed and refractory multiple myeloma: the Japanese MM-011 trial.

Background: The immunomodulatory agent pomalidomide in combination with low-dose dexamethasone has demonstrated efficacy and safety for the treatment of relapsed and refractory multiple myeloma (RRMM) in phase 2 and 3 trials. However, these trials enrolled very few Asian patients.

Methods: This phase 2 study investigated pomalidomide plus low-dose dexamethasone in 36 Japanese patients with RRMM after ≥2 prior therapies.

Electrical interactions in the cell: Asymmetric screening in a watery antiverse.

The problem of electrostatics in biomolecular systems presents an excellent opportunity for cross-disciplinary science and a context in which fundamental physics is called for to answer complex questions. Due to the large density in biological cells of charged biomacromolecules such as protein factors and DNA, it is challenging to understand quantitatively the electric forces in these systems. Two questions are especially puzzling.

Utility of computed tomography scans in predicting need for surgery in nasal injuries.

In many centers, computed tomography (CT) scan is preferred over plain film radiographs in the setting of acute nasal injury because CT scan is thought to be more sensitive in predicting nasal bone fracture. However, the usefulness of CT scans in predicting the need for surgery in acute nasal injury has not been well-studied. We conducted a retrospective review of 232 patients with known nasal bone fracture and found very similar rates of surgery in patients with a diagnosis of nasal fracture by CT scan as by nasal radiographs (41 and 37%, respectively).

Further development of the response scales of the Acquired Brain Injury Challenge Assessment (ABI-CA).

Primary Objective: To revise the scaling of the response sets of the Acquired Brain Injury Challenge Assessment (ABI-CA) through expert input and determination of empirically based cut-points.

Research Design: A measurement development study with a content validity focus.

Methods: Response option wording was revised through consultation with six physiotherapists with paediatric ABI expertise.

Simple electrostatic model applicable to biomolecular recognition.

An exact, analytic solution for a simple electrostatic model applicable to biomolecular recognition is presented. In the model, a layer of high-dielectric constant material (representative of the solvent, water), whose thickness may vary separates two regions of low-dielectric constant material (representative of proteins, DNA, RNA, or similar materials), in each of which is embedded a point charge. For identical charges, the presence of the screening layer always lowers the energy compared to the case of point charges in an infinite medium of low-dielectric constant.

Rigorous treatment of electrostatics for spatially varying dielectrics based on energy minimization.

An energy minimization formulation of electrostatics that allows computation of the electrostatic energy and forces to any desired accuracy in a system with arbitrary dielectric properties is presented. An integral equation for the scalar charge density is derived from an energy functional of the polarization vector field. This energy functional represents the true energy of the system even in nonequilibrium states.

Early tracheotomy in elderly patients results in less ventilator-associated pneumonia.

Objectives: To determine if the timing of tracheotomy in elderly patients results in less ventilator associated-pneumonia, mortality, and morbidity.

Study Design: Historical cohort study.

Subjects And Methods: This study included 158 ICU patients aged >65 who underwent tracheotomy from March 2003 to June 2007.

Adaptive management: a paradigm for remediation of public facilities following a terrorist attack.

Terrorist actions are aimed at maximizing harm (health, psychological, economical, and political) through the combined physical impacts of the act and fear. Immediate and effective response to a terrorist act is critical to limit human and environmental harm, effectively restore facility function, and maintain public confidence. Though there have been terrorist attacks in public facilities that we have learned from, overall our experiences in restoration of public facilities following a terrorist attack are limited.