Plasma Microbial Cell-Free DNA Sequencing from over 15,000 Patients Identified a Broad Spectrum of Pathogens.

Microbial cell-free DNA (mcfDNA) sequencing is an emerging infectious disease diagnostic tool which enables unbiased pathogen detection and quantification from plasma. The Karius Test, a commercial mcfDNA sequencing assay developed by and available since 2017 from Karius, Inc. (Redwood City, CA), detects and quantifies mcfDNA as molecules/μL in plasma.

Assessment of Splinting Quality: A Prospective Study Comparing Different Practitioners.

Background: Splinting is routinely performed in the emergency department (ED), and follow-up visits of improperly placed splints are commonplace in orthopaedic clinics. As open reduction and internal fixation (ORIF) of fractures has become the preferred treatment for many injuries, orthopaedic surgeons and emergency physicians have received less instruction on splinting technique. Limited literature exists regarding error/complication rates of splint application.

Analytical and clinical validation of a microbial cell-free DNA sequencing test for infectious disease.

Thousands of pathogens are known to infect humans, but only a fraction are readily identifiable using current diagnostic methods. Microbial cell-free DNA sequencing offers the potential to non-invasively identify a wide range of infections throughout the body, but the challenges of clinical-grade metagenomic testing must be addressed. Here we describe the analytical and clinical validation of a next-generation sequencing test that identifies and quantifies microbial cell-free DNA in plasma from 1,250 clinically relevant bacteria, DNA viruses, fungi and eukaryotic parasites.

Discrete-to-continuum modelling of weakly interacting incommensurate two-dimensional lattices.

In this paper, we derive a continuum variational model for a two-dimensional deformable lattice of atoms interacting with a two-dimensional rigid lattice. The starting point is a discrete atomistic model for the two lattices which are assumed to have slightly different lattice parameters and, possibly, a small relative rotation. This is a prototypical example of a three-dimensional system consisting of a graphene sheet suspended over a substrate.

Discrete-to-continuum modeling of weakly interacting incommensurate chains.

In this paper we use a formal discrete-to-continuum procedure to derive a continuum variational model for two chains of atoms with slightly incommensurate lattices. The chains represent a cross section of a three-dimensional system consisting of a graphene sheet suspended over a substrate. The continuum model recovers both qualitatively and quantitatively the behavior observed in the corresponding discrete model.

Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients.

Objective: This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population.

Study Design: Retrospective case review.

Setting: Tertiary care center.

Validation of a Clinical-Grade Assay to Measure Donor-Derived Cell-Free DNA in Solid Organ Transplant Recipients.

The use of circulating cell-free DNA (cfDNA) as a biomarker in transplant recipients offers advantages over invasive tissue biopsy as a quantitative measure for detection of transplant rejection and immunosuppression optimization. However, the fraction of donor-derived cfDNA (dd-cfDNA) in transplant recipient plasma is low and challenging to quantify. Previously reported methods to measure dd-cfDNA require donor and recipient genotyping, which is impractical in clinical settings and adds cost.

Cost Analysis of Hemiarthroplasty Versus Reverse Shoulder Arthroplasty for Fractures.

Complex proximal humerus fractures in older patients can be treated with hemiarthroplasty (HA) or reverse shoulder arthroplasty (RSA), with both providing good pain relief and function. This study compared the costs, complications, and outcomes of HA vs RSA after proximal humerus fracture in older patients. Patients 65 years or older who were admitted between January 2007 and August 2011 with a 3- or 4-part proximal humerus fracture and treated with HA or RSA were identified.

An anatomical study of the entry point in the greater trochanter for intramedullary nailing.

Malpositioning of the trochanteric entry point during the introduction of an intramedullary nail may cause iatrogenic fracture or malreduction. Although the optimal point of insertion in the coronal plane has been well described, positioning in the sagittal plane is poorly defined. The paired femora from 374 cadavers were placed both in the anatomical position and in internal rotation to neutralise femoral anteversion.

Timing of orthopaedic surgery in multiple trauma patients: development of a protocol for early appropriate care.

Objectives: The purpose was to define which clinical conditions warrant delay of definitive fixation for pelvis, femur, acetabulum, and spine fractures. A model was developed to predict the complications.

Design: Statistical modeling based on retrospective database.

Modeling the response of a biofilm to silver-based antimicrobial.

Biofilms are found within the lungs of patients with chronic pulmonary infections, in particular patients with cystic fibrosis, and are the major cause of morbidity and mortality for these patients. The work presented here is part of a large interdisciplinary effort to develop an effective drug delivery system and treatment strategy to kill biofilms growing in the lung. The treatment strategy exploits silver-based antimicrobials, in particular, silver carbene complexes (SCC).

Do patients with multiple system injury benefit from early fixation of unstable axial fractures? The effects of timing of surgery on initial hospital course.

Objectives: We hypothesized that early definitive management (within 24 hours of injury) of mechanically unstable fractures of the pelvis, acetabulum, femur and spine would reduce complications and shorten length of stay.

Design: Retrospective review.

Setting: Level 1 trauma center.

A comparison of human performance in figural and navigational versions of the traveling salesman problem.

Performance on a typical pen-and-paper (figural) version of the Traveling Salesman Problem was compared to performance on a room-sized navigational version of the same task. Nine configurations were designed to examine the use of the nearest-neighbor (NN), cluster approach, and convex-hull strategies. Performance decreased with an increasing number of nodes internal to the hull, and improved when the NN strategy produced the optimal path.

Nanoparticle deposition onto biofilms.

We develop a mathematical model of nanoparticles depositing onto and penetrating into a biofilm grown in a parallel-plate flow cell. We carry out deposition experiments in a flow cell to support the modeling. The modeling and the experiments are motivated by the potential use of polymer nanoparticles as part of a treatment strategy for killing biofilms infecting the deep passages in the lungs.

In vitro antimicrobial studies of silver carbene complexes: activity of free and nanoparticle carbene formulations against clinical isolates of pathogenic bacteria.

Objectives: Silver carbenes may represent novel, broad-spectrum antimicrobial agents that have low toxicity while providing varying chemistry for targeted applications. Here, the bactericidal activity of four silver carbene complexes (SCCs) with different formulations, including nanoparticles (NPs) and micelles, was tested against a panel of clinical strains of bacteria and fungi that are the causative agents of many skin and soft tissue, respiratory, wound, blood, and nosocomial infections.

Methods: MIC, MBC and multidose experiments were conducted against a broad range of bacteria and fungi.

Early appropriate care: definitive stabilization of femoral fractures within 24 hours of injury is safe in most patients with multiple injuries.

Background: Type and timing of treatment of femur fractures is controversial. Although reported as safe and effective in many reports, others have suggested that early definitive stabilization may cause complications, particularly in patients with chest and head injuries. Damage control orthopedics was proposed as an alternative in unstable patients.

Validation of a multimarker model for assessing risk of type 2 diabetes from a five-year prospective study of 6784 Danish people (Inter99).

Background: Improved identification of subjects at high risk for development of type 2 diabetes would allow preventive interventions to be targeted toward individuals most likely to benefit. In previous research, predictive biomarkers were identified and used to develop multivariate models to assess an individual's risk of developing diabetes. Here we describe the training and validation of the PreDx Diabetes Risk Score (DRS) model in a clinical laboratory setting using baseline serum samples from subjects in the Inter99 cohort, a population-based primary prevention study of cardiovascular disease.

Clavicular anatomy and the applicability of precontoured plates.

Background: Plate fixation of clavicular fractures is technically difficult because of the complex anatomy of the bone, with an S-shaped curvature and a cephalad-to-caudad bow. The purpose of the present study was to characterize variations in clavicular anatomy and to determine the clinical applicability of an anatomic precontoured clavicular plate designed for fracture fixation.

Methods: One hundred pairs of clavicles were analyzed.

Three-dimensional analysis of pelvic volume in an unstable pelvic fracture.

Background: A model was developed to predict changes in pelvic volume associated with increasing pubic diastasis in unstable pelvic fractures.

Methods: Intact and postfracture pelvic volumes were calculated in 10 cadavers using computerized axial tomography (CT). The true pelvis was assumed to be either a sphere, a cylinder, or a hemi-elliptical sphere.

Concomitant fractures of the acetabulum and spine: a retrospective review of over 300 patients.

Background: The incidence and spectrum of concomitant acetabulum and spine trauma has not been clearly defined.

Methods: We retrospectively reviewed 307 acetabulum fracture patients over 5 years, and evaluated this cohort for concomitant spine injuries. Patient and injury demographics, spine and neurologic injury and delay in diagnosis were examined.

Treatment of compartment syndrome: transverse fasciotomy as an adjunct to longitudinal dermatofasciotomy: an in vitro study.

Objective: This study describes a previously unpublished technique for compartment release that combines adjunctive transverse fasciotomies with a limited longitudinal dermatofasciotomy and compares its efficacy with a standard extensile longitudinal dermatofasciotomy.

Design: Limited 10-cm longitudinal dermatofasciotomies were performed bilaterally on 14 cadaveric specimens (28 legs). Next, we performed transverse fasciotomies on 1 limb and performed extensions of the longitudinal incision on the contralateral limb.

Infection with GB virus C and reduced mortality among HIV-infected patients.

Background: The flavivirus GB virus C (GBV-C, also designated hepatitis G virus) was identified in a search for hepatitis viruses, but no disease is currently known to be associated with it. We investigated the relation between coinfection with GBV-C and the long-term outcome in patients infected with the human immunodeficiency virus (HIV).

Methods: A total of 197 HIV-positive patients were followed prospectively beginning in 1993 or 1994.

Infant cerebral ventricle volume: a comparison of 3-D ultrasound and magnetic resonance imaging.

Enlargement of the cerebral lateral ventricles is observed in several neuropsychiatric disorders with origins in early brain development. Lateral ventricle size is also predictive of poor neurodevelopmental outcome in premature infants. Three-dimensional (3-D) ultrasound (US) offers an improved methodology for the study of lateral ventricle volume in neonates and infants.

Blood flow changes to the femoral head after acetabular fracture or dislocation in the acute injury and perioperative periods.

Objectives: Acute blood flow to the femoral head has been postulated to be affected negatively by traumatic acetabular fracture or dislocation. To the best of our knowledge, a prospective study that has examined acute changes in blood flow to the femoral head with respect to the timing of reduction and the effect of open reduction and internal fixation after acetabular fracture or dislocations has not been performed.

Design And Setting: From June 1994 to February 1996, fifty-four consecutive patients with hip dislocations with or without fractures of the acetabulum were entered into this investigation.