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Lipophilic aggregation using adamantanes is a widely exploited molecular property in medicinal and materials chemistry. Adamantanes are traditionally installed to molecular units via covalent bonds. However, the noncovalent installation of adamantanes has been relatively underexplored and presents the potential to bring properties associated with adamantanes to molecules without affecting their intrinsic properties (e.g., pharmacophores). Here, we systematically study a series of adamantanecarboxylic acids with varying substitution levels of methyl groups and their cocrystals with bipyridines. Specifically, single-crystal X-ray diffraction shows that while the directionality of single-component adamantanes is notably sensitive to changes in methyl substitution, hydrogen-bonded cocrystals with bipyridines show consistent and robust packing due to π-stacking predominance. Our observations are supported by Hirshfeld surface and energy framework analyses. The applicability of cocrystal formation of adamantanes bearing carboxylic acids was used to generate the first cocrystals of adapalene, an adamantane-bearing retinoid used for treating acne vulgaris. We envisage our study to inspire noncovalent (i.e., cocrystal) installation of adamantanes to generate lipophilic aggregation in multicomponent systems.

Court Applied the "Virtual Identity" Standard to Jokes In a copyright infringement action over jokes aired on the late-night television talk show Conan, the district court of California held that [...]

By now, most US businesses and organizations have heard of General Data Protection Regulation, or GDPR. This EU regulation is drawing attention in the United States because it expands the [...]

As the number of patients with diabetes continues to grow, complications of diabetes have likewise increased. Specifically, diabetic foot ulcers have become a massive burden to both the diabetic patient population and national healthcare systems. Diabetic foot ulcers occur due to nerve damage as a result of extensive hyperglycemia. This nerve damage can allow the progression of ulceration, thus providing a window of opportunity for various pathogens to invade the surrounding tissue. Extensive infection of the ulcer tissue can lead to infection of nearby bone, which may require both surgical and antimicrobial intervention for proper wound healing. The aim of this review was to describe the etiology, pathological progressions, and the advancement of ideologies pertaining to treatment options for diabetic foot ulcers.

SummaryCalculus and combinatorics overlap, in that power series can be used to study combinatorially defined sequences. In this paper, we use exponential generating functions to study a curious refinement of the Euler numbers, which count the number of “up-down” permutations of length n.

Background: Rescue from a disabled submarine may result in substantial risk for severe decompression sickness (DCS) among survivors. Oxygen prebreathe (OPB) before rapid decompression has been shown to significantly reduce risk or delay onset for severe DCS in animals. However, the duration of this benefit remains unknown and might even be lost if a delay between the prebreathe period to initiation of recompression therapy allows for nitrogen reaccumulation. Methods: We hypothesized that the benefit of OPB would be lost following subsequent periods of air interruption in a 70-kg swine saturation model. Following OPB of 45 or 60 min with varying periods (30, 45, 60 min) of air interruption, 61 swine exposed to 2.7 ATA for 22 h were rapidly decompressed. Swine without OPB served as negative controls and swine treated with 45 min of OPB without air interruption served as positive controls. Results: Comparing experimental groups for Type II DCS incidence showed OPB120/60 being the only experimental group (11%) statistically different than the negative control group OPB0 (80%). Log rank tests comparing Type II DCS free survival only showed statistically significant differences for OPB45/60 compared to positive control group OPB45, while, more importantly, demonstrating a significant difference for OPB120/60 compared to that approximated for OPB45, indicating a significant reversal of the air interruption effects with longer OPB on Type II DCS disease free survival. Discussion: Based on these findings we concluded that the protective effects of OPB against severe DCS are reduced with increasing periods of air interruption. [ABSTRACT FROM AUTHOR]

ABSTRACTThe epidemiology of Acinetobacter baumanniiemerging in combat casualties is poorly understood. We analyzed 65 (54 nonreplicate) Acinetobacterisolates from 48 patients (46 hospitalized and 2 outpatient trainees entering the military) from October 2004 to October 2005 for genotypic similarities, time-space relatedness, and antibiotic susceptibility. Clinical and surveillance cultures were compared by amplified fragment length polymorphism (AFLP) genomic fingerprinting to each other and to strains of a reference database. Antibiotic susceptibility was determined, and multiplex PCR was performed for OXA-23-like, -24-like, -51-like, and -58-like carbapenemases. Records were reviewed for overlapping hospital stays of the most frequent genotypes, and risk ratios were calculated for any association of genotype with severity of Acute Physiology and Chronic Health Evaluation II (APACHE II) score or injury severity score (ISS) and previous antibiotic use. Nineteen genotypes were identified; two predominated, one consistent with an emerging novel international clone and the other unique to our database. Both predominant genotypes were carbapenem resistant, were present at another hospital before patients' admission to our facility, and were associated with higher APACHE II scores, higher ISSs, and previous carbapenem antibiotics in comparison with other genotypes. One predominated in wound and respiratory isolates, and the other predominated in wound and skin surveillance samples. Several other genotypes were identified as European clones I to III. Acinetobactergenotypes from recruits upon entry to the military, unlike those in hospitalized patients, did not include carbapenem-resistant genotypes. Acinetobacterspecies isolated from battlefield casualties are diverse, including genotypes belonging to European clones I to III. Two carbapenem-resistant genotypes were epidemic, one of which appeared to belong to a novel international clone.

Introduction: Submarine disaster survivors can be transferred from a disabled submarine at a pressure of 40 meters of seawater (msw) to a new rescue vehicle; however, they face an inherently risky surface interval before recompression and an enormous decompression obligation due to a high likelihood of saturation. The goal was to design a safe decompression protocol using oxygen breathing and a trial-and-error methodology. We hypothesized that depth, timing, and duration of oxygen breathing during decompression from saturation play a role to mitigate decompression outcomes. Methods: Yorkshire swine (67-75 kg), compressed to 40 msw for 22 h, underwent one of three accelerated decompression profiles: 1)13.3 h staged air decompression to 18 msw, followed by 1 h oxygen breathing, then dropout; 2) direct decompression to 18 msw followed by 1 h oxygen breathing then dropout; and 3) 1 h oxygen prebreathe at 40 msw followed by 1 h mixed gas breathing at 26 msw, 1 h oxygen breathing at 18 msw, and 1 h ascent breathing oxygen. Animals underwent 2-h observation for signs of DCS. Results: Profile 1(14.3 h total) resulted in no deaths, no Type II DCS, and 20% Type I DCS. Profile 2 (2.1 h total) resulted in 13% death, 50% Type II DCS, and 75% Type I DCS. Profile 3 (4.5 h total) resulted in 14% death, 21% Type II DCS, and 57% Type I DCS. No oxygen associated seizures occurred. Discussion: Profile 1 performed best, shortening decompression with no death or severe DCS, yet it may still exceed emergency operational utility in an actual submarine rescue. [ABSTRACT FROM AUTHOR]

Extrapulmonary manifestations of Mycoplasma pneumoniae are well described, including a subset of central nervous system (CNS)-associated syndromes. In pediatric populations, frequencies of CNS sequelae occur in 0.1% to 7% of patients. Neurologic illness associated with M. pneumoniae, such as meningitis, encephalitis, polyradiculitis, Guillain-Barre, and stroke have been reported; however, the incidence of M. pneumoniae-associated organic brain syndrome is rare. We present the case of a 20-year-old midshipman with acute psychosis following resolution of M. pneumoniae pneumonia and review 6 other adult cases found in the literature. M. pneumoniae remains one of the most common causes of respiratory illnesses in the military recruit setting and therefore should always be suspected as an organic cause of mental status changes in young persons such as recruits, cadets, and midshipmen particularly with antecedent respiratory illnesses.

Maxillofacial injuries constitute 16% of all war-related injuries. This review focuses on data available from military and civilian studies to provide evidence-based recommendations for the modification of infections associated with combat-related injuries to the head and neck. The major emphasis of this review is on the study of subsequent infection, perioperative antimicrobial prophylaxis, debridement of devitalized tissue, optimal time to wound closure to achieve a water tight seal, wound irrigation with removal of debris and gross contaminants, fracture fixation, and removal of ocular foreign bodies with intravitreal antibiotics. Further studies are needed in combat-related injuries to the head and neck in military personnel to provide the highest evidence-based medicine recommendations.

Management of combat-related trauma is derived from skills and data collected in past conflicts and civilian trauma, and from information and experience obtained during ongoing conflicts. The best methods to prevent infections associated with injuries observed in military combat are not fully established. Current methods to prevent infections in these types of injuries are derived primarily from controlled trials of elective surgery and civilian trauma as well as retrospective studies of civilian and military trauma interventions. The following guidelines integrate available evidence and expert opinion, from within and outside of the US military medical community, to provide guidance to US military health care providers (deployed and in permanent medical treatment facilities) in the diagnosis, treatment, and prevention of infections in those individuals wounded in combat. These guidelines may be applicable to noncombat traumatic injuries under certain circumstances. Early wound cleansing and surgical debridement, antibiotics, bony stabilization, and maintenance of infection control measures are the essential components to diminish or prevent these infections. Future research should be directed at ideal treatment strategies for prevention of combat-related injury infections, including investigation of unique infection control techniques, more rapid diagnostic strategies for infection, and better defining the role of antimicrobial agents, including the appropriate spectrum of activity and duration.

Combat casualty care has made significant advances in recent years, including administration of blood products in far-forward locations. However, recent studies have shown blood transfusion to be a significant risk factor for infection and increased resource utilization in critically injured patients. We therefore sought to investigate the incidence of blood transfusion and its association with infection and resource utilization in combat casualties. Prospective data were collected and retrospectively reviewed on 210 critically injured patients admitted to the USNS Comfort over a 7-week period during the 2003 assault phase of Operation Iraqi Freedom. Patients were stratified by age, gender, and injury severity score (ISS). Multivariate regression analyses were used to assess blood transfusion and hematocrit (HCT) as independent risk factors for infection and intensive care unit (ICU) admission controlling for age, gender, and ISS. The study cohort had a mean age of 30 ± 2 years, a mean ISS of 14 ± 3, 84 per cent were male, and 88 per cent sustained penetrating trauma. Blood transfusion was required in 44 per cent (n = 93) of the study cohort. Transfused patients had a higher ISS (18 ± 4 vs. 10 ± 3, P < 0.01), a higher pulse rate (105 ± 4 vs. 93 ± 3, P < 0.0001), and a lower admission HCT (27 ± 1 vs. 33 ± 2, P < 0.0001) compared with patients not transfused. Patients receiving blood transfusion had an increased infection rate (69% vs. 18%, P < 0.0001), ICU admission rate (52% vs. 21%, P < 0.0001), and ICU length of stay (6.7 ± 2.1 days vs. 1.4 ± 0.5 days, P < 0.0001) compared with nontransfused patients. However, there was no significant difference in mortality between transfused and nontransfused patients. Multivariate binomial regression analysis identified blood transfusion and HCT as independent risk factors for infection (P < 0.01) and blood transfusion as an independent risk factor for ICU admission (P < 0.05). Combat casualties have a high incidence of blood transfusion. Blood transfusion is an independent risk factor for infection and increased resource utilization. Therefore, consideration should be given to the use of alternative blood substitutes and recombinant human erythropoietin in the treatment and management of combat casualties.

Conditioned avoidance response (CAR) tests were used to determine the effects of perinatal exposure to three neuroleptic drugs and an antineoplastic agent in mice. In one experiment, mice were given sc injections of haloperidol at 1.25 mg/kg. or trifluoperazine at 12.5 mg/kg. for 2 wk, starting when they were 4 d old. In additional groups, nursing dams were given haloperidol at 5 mg/kg. or trifluoperazine at 25 mg/kg. for 2 wk during lactation. CAR tests were begun when offspring were 40 d of age. No statistically significant evidence of impairment in the learning ability of any group was found. In a second experiment, hybrid male mice were treated with a single ip injection of triflupromazine at 50 mg/kg or triethylenemelamine at 0.2 mg/kg and were mated 2, 4, and 6 wk after dosing. The male offspring were tested for learning ability at 40 d of age. No statistically significant differences in CAR values were observed in offspring of triflupromazine-treated males. CAR values of offspring of triethylenemelamine-treated males mated 4 wk after dosing were significantly higher than those of controls.

Buccal smears were analyzed for X chromatin in 1,000 newborn infants. The mean percentage of X chromatin in the 506 female infants was 39.5 (range 19–61) and in the 494 males 0.13 (range 0–3.0). Evaluation of the data comparing the percentage of X chromatin with Caucasian and noncaucasian infants, the weight of the newborn, and the gestation time, indicated no significant differences within the male or female populations. A longitudinal study on 25 female infants for the first 4 days postpartum indicated a significant increase in the percentage of X chromatin in females.

Pseudomonas aeruginosais a motile, aerobic, gram-negative rod that has become a leading infectious agent among patients who were hospitalized and immunocompromised. We report a case of preseptal periorbital cellulitis due to pseudomonas with focal skin necrosis (ecthyma gangrenosum) in a patient with severe immunocompromise. Ecthyma gangrenosum is known to be associated with sepsis and death but is rarely reported as a complication of preseptal cellulitis.

Macrocytosis occurs with HIV therapies containing zidovudine (AZT) and stavudine (d4T) and may help assess adherence. Occurrence in antiretroviral therapy regimens without these agents or when they are added to multidrug antiretroviral therapy is unknown. We retrospectively evaluated change in mean corpuscular volume for 590 patients at 90 days after initiating therapy. Zidovudine and stavudine caused significant increases in mean corpuscular volume similar to previous studies, whereas didanosine (ddI) did not. Addition of a protease inhibitor and or lamivudine did not significantly change the mean corpuscular volume.

The article reports on an agreement between the European Commission and the U.S. Department of Commerce to a draft "Privacy Shield" which enables organizations to transfers personal from European Union (EU) member states to the U.S. It mentions that the draft will be enforced by the U.S. Federal Trade Commission (FTC). It discusses privacy principles under a EU directive such as lawful processing and accountability.