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The glycome describes the complete repertoire of glycoconjugates composed of carbohydrate chains, or glycans, that are covalently linked to lipid or protein molecules. Glycoconjugates are formed through a process called glycosylation and can differ in their glycan sequences, the connections between them and their length. Glycoconjugate synthesis is a dynamic process that depends on the local milieu of enzymes, sugar precursors and organelle structures as well as the cell types involved and cellular signals. Studies of rare genetic disorders that affect glycosylation first highlighted the biological importance of the glycome, and technological advances have improved our understanding of its heterogeneity and complexity. Researchers can now routinely assess how the secreted and cell-surface glycomes reflect overall cellular status in health and disease. In fact, changes in glycosylation can modulate inflammatory responses, enable viral immune escape, promote cancer cell metastasis or regulate apoptosis; the composition of the glycome also affects kidney function in health and disease. New insights into the structure and function of the glycome can now be applied to therapy development and could improve our ability to fine-tune immunological responses and inflammation, optimize the performance of therapeutic antibodies and boost immune responses to cancer. These examples illustrate the potential of the emerging field of 'glycomedicine'.

Background: How the relative volume of an epidural abscess on MRI affects outcomes with antibiotics alone has limited literature. The purpose of this study was to identify which infected epidural collections will reabsorb with antibiotics alone. Specifically, what is the critical size and enhancement on contrast MRIs to require a drainage procedure?, Materials and Methods: A retrospective review of all spinal osteomyelitis patients from 2001-2012 was performed. Inclusion criteria included appropriate initial imaging, lab results, no drainage procedures of collections, and no treatment prior to admission at an outside institution. Large size epidural abscess was defined as abscesses with a volume greater than 1400 mm3. Clearance and mortality rates were evaluated., Results: The cohort consisted of 128 patients including 76 men and 52 women who had a mean age of 62 years (range, 21 to 90 years) and had a mean follow-up of 38 months (range, 24 to 72 months). Patients with a large epidural abscess had a greater clearance rate of the infection and decreased mortality rate when treated with surgery or drainage compared to patients treated with antibiotics alone [clearance: p=0.048; mortality: p=0.048]. Those small epidural abscesses had similar clearance and mortality rates when treated with surgery or drainage compared to antibiotics alone [clearance: p=0.75; mortality: p=0.13]. Patients with non-enhancing epidural abscesses had similar clearance rates-but increased mortality rates-when treated with antibiotics alone compared to surgery or drainage [clearance: p>0.9; mortality: p=0.03]. Those with enhancing epidural collections had similar clearance and mortality rates when treated with antibiotics alone compared to surgery or drainage [clearance: p=0.08, mortality: p=0.10]., Conclusion: Large epidural infected collections require surgery or a percutaneous drainage procedure. Clearance rates are higher and mortality rates are lower compared to non-operative management in these instances. Neurologically intact patients with a small epidural collection can be treated with antibiotics alone with good expected outcomes.

Introduction: Obtaining blood or tissue cultures prior to administration of antibiotics has been the standard of care in the treatment of osteomyelitis of the spine. A delay in diagnosis of vertebral osteomyelitis is the primary culprit for the inaccuracy of blood cultures and biopsies. The purpose of this study was to evaluate the outcomes of spinal osteomyelitis in patients where the infecting organism was identified through cultures in contrast to cases where the cultures continued to be negative., Materials and Methods: We retrospectively reviewed the database of spinal osteomyelitis cases presented at a high-volume institution from 2001-2011. This resulted in 91 patients (51 men and 40 women) who had a mean age of 59 years with a mean follow-up of four years. Delay in diagnosis was defined as greater than 2.5 months from first ER visit for non-specific back pain to diagnosis of osteomyelitis without antibiotic treatment in the interim. Nineteen patients had a delay in diagnosis (DD) and 72 were diagnosed early (ED). Outcomes evaluated include clearance of infection, clinical outcomes measured by Oswestry disability index scores (ODIs), and the efficacy of blood cultures and biopsies., Results: The ED group had a higher odds ratio of osteomyelitis clearance compared to the delay in diagnosis group and this trended toward significance [p=0.08]. The mean improvements in ODIs were significantly greater in the ED group compared to the DD group. Positive blood cultures were more positive when drawn within one month compared to after one month [p=.001]. Percutaneous biopsy cultures were more positive when drawn within 2.5 months compared to after 2.5 months [p=.025]. Open biopsy cultures were more positive when drawn within 4.5 months compared to after that [p<0.001]., Discussion: We found that delayed diagnosis may negatively affect the treatment outcome as evidenced by the greater improvements in ODI scores among those diagnosed early. Although we were unable to show a difference in clearance between early and delayed diagnosis, it is quite possible that larger cohorts may have shown this given the trend toward significance., Conclusion: Hence, an early diagnosis has improved vertebral osteomyelitis clearance and clinical outcomes, and blood cultures and biopsies may have a low yield if delayed.