OmpR regulation of the uropathogenic Escherichia coli fimB gene in an acidic/high osmolality environment.

Uropathogenic Escherichia coli (UPEC) causes more than 90 % of all human urinary tract infections through type 1 piliated UPEC cells binding to bladder epithelial cells. The FimB and FimE site-specific recombinases orient the fimS element containing the fimA structural gene promoter. Regulation of fimB and fimE depends on environmental pH and osmolality.

SU-E-I-89: Applying Image Gently and Image Wisely in Nuclear Medicine.

Purpose: To demonstrate how principles and recommendations of the Image Gently® and Image Wisely™ campaigns can be clinically implemented.

Methods: Implementation of Image Gently® and Image Wisely™ guidelines was a quality and safety improvement project for our Nuclear Medicine department in 2011. Pediatric administered radiopharmaceutical doses were compared to recommended doses in the North American Consensus Guidelines for AdministeredRadiopharmaceutical Activities in Children and Adolescents and the European Association of Nuclear Medicine Paediatric Dose Card.

Immune modulation during latent herpesvirus infection.

Nearly all human beings, by the time they reach adolescence, are infected with multiple herpesviruses. At any given time, this family of viruses accounts for 35-40 billion human infections worldwide, making herpesviruses among the most prevalent pathogens known to exist. Compared to most other viruses, herpesviruses are also unique in that infection lasts the life of the host.

Expansion of the Midwestern focus for human granulocytic anaplasmosis into the region surrounding La Crosse, Wisconsin.

Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis (HGA), shares the same enzootic life cycle as Borrelia burgdorferi, the causative agent of Lyme disease. Although La Crosse, WI, is a well-recognized Lyme disease focus with an abundance of Ixodes scapularis vector ticks and the first documentation of HGA occurred in patients from northwestern Wisconsin, local transmission of A. phagocytophilum has not to date been documented.

Rapid decline of OspC borreliacidal antibodies following treatment of patients with early Lyme disease.

We determined whether the levels of OspC borreliacidal antibodies declined following treatment of early Lyme disease and whether the OspC7 peptide enzyme-linked immunosorbent assay (ELISA) could be used as an alternative test for detecting the response. Serum samples were collected from 37 subjects at the onset of illness and 2 and 6 months after treatment with doxycycline. The ELISA detected IgM and IgG OspC7 antibodies within 2 months in 18 (49%) and 5 (14%) sera, respectively.

The need for surgical revision after isolated cheilectomy for hallux rigidus: a systematic review.

Isolated cheilectomy has been proposed for treatment of hallux rigidus due to the perceived safety, efficacy, and ability to revise with repeat cheilectomy, implant or interpositional arthroplasty, or arthrodesis. A systematic review was undertaken to better understand the need for surgical revision after isolated cheilectomy for hallux rigidus. Studies were eligible for inclusion only if they involved consecutively enrolled patients undergoing isolated cheilectomy or involved revision surgery of the first metatarsophalangeal joint after isolated cheilectomy, evaluated patients at mean follow-up > or = 12 months' duration, and included details of complications.

Contagious rhythm: infectious diseases of 20th century musicians.

Infectious diseases have led to illness and death for many famous musicians, from the classical period to the rock 'n' roll era. By the 20th century, as public health improved and orchestral composers began living more settled lives, infections among American and European musicians became less prominent. By mid-century, however, seminal jazz musicians famously pursued lifestyles characterized by drug and alcohol abuse.

Bacterial skin contamination before and after surgical preparation of the foot, ankle, and lower leg in patients with diabetes and intact skin versus patients with diabetes and ulceration: a prospective controlled therapeutic study.

Eradication of bacterial flora from the foot, especially the nailfolds and toe webspaces, through surgical preparation remains a challenge. All previous studies have involved healthy patients undergoing elective foot and ankle surgery or healthy volunteers. However, the patient with diabetes is considered an immunocompromised host with decreased ability to combat invasive bacterial infections.

Use of optical mapping to sort uropathogenic Escherichia coli strains into distinct subgroups.

Optical maps were generated for 33 uropathogenic Escherichia coli (UPEC) isolates. For individual genomes, the NcoI restriction fragments aligned into a unique chromosome map for each individual isolate, which was then compared with the in silico restriction maps of all of the sequenced E. coli and Shigella strains.

Outcome following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus: a systematic review.

Autogenous soft tissue interpositional arthroplasty has been proposed as an alternative to arthrodesis and other forms of arthroplasty for treatment of end-stage hallux rigidus because of the perceived safety and efficacy. The author undertook a systematic review of electronic databases and other relevant sources to identify material relating to the outcomes following autogenous soft tissue interpositional arthroplasty for end-stage hallux rigidus. Information from peer-reviewed journals, as well as from non-peer-reviewed publications, abstracts and posters, textbooks, and unpublished works, were also considered.

Social determinants of smoking among Hmong Americans residing in Wisconsin.

Objective: This study examined correlates of tobacco use among Hmong people residing in Wisconsin.

Methods: Surveys of youth (ages 12-17) and adults (ages > or =18), available in English and Hmong, were distributed in 14 communities through Hmong Mutual Assistance Associations and analyzed centrally. Surveys assessed daily and ever use of tobacco, as well as other sociodemographic characteristics.

Local recurrence of invasive micropapillary breast cancer after MammoSite brachytherapy: a case report and literature review.

Controversy exists over the optimal patient selection criteria for accelerated partial-breast irradiation (APBI), which has been introduced as an alternative to whole-breast irradiation. The goal is to select patients with the lowest risk for tumor spread outside of the original lumpectomy bed targeted by the local internal radiation dose. Therefore, patients with more aggressive types of breast cancer might not be ideal candidates for partial breast irradiation.

Telephone-based management of lactation mastitis.

Objective: To evaluate the quality of care for mastitis managed by telephone without an office or emergency room visit.

Study Design: A word search of electronic medical records allowed for identification of patients managed with a mastitis clinical practice guideline. Comparisons of outcomes were made to a group of patients who received care in the clinic, urgent care or emergency room.

A case of neonatal compartment syndrome: importance of early diagnosis in a rare and debilitating condition.

Neonatal compartment syndrome (NCS) is a rare condition that is often initially misdiagnosed because its skin lesions mimic several other more common diseases of the newborn. It has not been described in the pediatric literature thus far. Early diagnosis along with fasciotomy may be limb and function-sparing, but only in certain cases, because the exact time and duration of the initial insult and the full extent of damage at presentation is unknown in many cases.

The demise of primary care: a diatribe from the trenches.

Medical school graduates are avoiding primary care. The very aspects that once attracted students have been subverted. The breadth of practice that was once appealing has become the breadth of heavy-handed scrutiny, as politicians and business leaders have demanded quality--simplistically defined as dogmatic adherence to a standard.

Compound heterozygosity for MSH6 mutations in a pediatric lymphoma patient.

An 8-year-old male with lymphoblastic lymphoma was noted to have multiple café-au-lait macules and possible Lisch nodules. Work-up revealed the child as compound heterozygous for mutations in the DNA mismatch repair gene, MSH6. This case emphasizes many clinical issues regarding individuals with biallelic mismatch repair mutations, a rare and easily missed hereditary predisposition to childhood cancer.

Emergency cesarean section and the 30-minute rule: definitions.

We explored the role that lack of a standard definition and heterogeneity in patient selection criteria in the literature might have on the apparent inability to routinely begin an emergency cesarean section in less than 30 minutes. A review of the literature on emergency cesarean delivery was performed. Although there are some similarities in definitions and the criteria used for patient selection in multiple studies, the variability in the definitions could be responsible for some of the apparent timeliness performance deficiency in the literature.

Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective.

Background: Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries.

Methods: Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours.

Detection of borreliacidal antibodies by flow cytometry.

Lyme disease is a multisystem disorder that usually begins with a skin lesion called erythema migrans and with constitutional symptoms. If the disease is left untreated or treated inappropriately, dissemination of the organism can lead to more severe sequelae, including nervous system disorders or arthritis. Vaccinations with B.

Cutaneous metastasis of invasive ductal carcinoma of the breast to an infusaport site.

Cutaneous metastasis of a primary internal malignancy is a relatively common phenomenon, occurring in up to 10% of patients with noncutaneous cancer. Cutaneous metastasis can occur via direct extension, hematologic or lymphatic dissemination, or surgical implantation. The most common internal malignancy associated with the development of cutaneous metastases in females is breast cancer.

Significantly improved accuracy of diagnosis of early Lyme disease by peptide enzyme-linked immunosorbent assay based on the borreliacidal antibody epitope of Borrelia burgdorferi OspC.

Highly specific borreliacidal antibodies are induced by infection with Borrelia burgdorferi, and the immunodominant response during early Lyme disease is specific for an epitope within the 7 amino acids nearest the C terminus of OspC. We evaluated the ability of an enzyme-linked immunosorbent assay (ELISA) based on a synthetic peptide (OspC7) that matched the region to detect the response and compared the sensitivity during early Lyme disease to that for an FDA-approved Western blot. When the optical density value was adjusted to 98% specificity based on the results from testing normal or uncharacterized sera (n = 236) or sera from patients with blood factors or illnesses that commonly produce antibodies that cross-react with B.

Hemostasis in minimally invasive liver surgery.

Two cases are reviewed here that highlight the utility of minimally invasive surgery (MIS) techniques in major surgery procedures involving the liver. They also demonstrate specific operative procedures once thought beyond the scope of the MIS surgeon, but they are now standard in expert hands. Improved methods for attaining hemostasis is one of the key reasons surgeons are able to accomplish these increasingly difficult procedures via minimally invasive techniques.