In this study, culture of samples obtained by sonication of prostheses was more sensitive than conventional periprosthetic-tissue culture for the microbiologic diagnosis of prosthetic hip and knee infection, especially in patients who had received antimicrobial therapy within 14 days before surgery.

The familial melanoma gene (INK4a/MTS1/CDKN2) encodes potent tumor suppressor activity. Although mice null for the ink4a homolog develop a cancer-prone condition, a pathogenetic link to melanoma susceptibility has yet to be established. Here we report that mice with melanocyte-specific expression of activated H-ras G12V on an ink4a-deficient background develop spontaneous cutaneous melanomas after a short latency and with high penetrance. Consistent loss of the wild-type ink4a allele was observed in tumors arising in ink4a heterozygous transgenic mice. No homozygous deletion of the neighboring ink4b gene was detected. Moreover, as in human melanomas, the p53 gene remained in a wild-type configuration with no observed mutation or allelic loss. These results show that loss of ink4a and activation of Ras can cooperate to accelerate the development of melanoma and provide the first in vivo experimental evidence for a causal relationship between ink4a deficiency and the pathogenesis of melanoma. In addition, this mouse model affords a system in which to identify and analyze pathways involved in tumor progression against the backdrop of genetic alterations encountered in human melanomas.

We recently described a sonication technique for the diagnosis of prosthetic knee and hip infections. We compared periprosthetic tissue culture to implant sonication followed by sonicate fluid culture for the diagnosis of prosthetic shoulder infection. One hundred thirty-six patients undergoing arthroplasty revision or resection were studied; 33 had definite prosthetic shoulder infections and 2 had probable prosthetic shoulder infections. Sonicate fluid culture was more sensitive than periprosthetic tissue culture for the detection of definite prosthetic shoulder infection (66.7 and 54.5%, respectively; P ‫؍‬ 0.046). The specificities were similar (98.0% and 95.1%, respectively; P ‫؍‬ 0.26). Propionibacterium acnes was the commonest species detected among culture-positive definite prosthetic shoulder infection cases by periprosthetic tissue culture (38.9%) and sonicate fluid culture (40.9%). All subjects from whom P. acnes was isolated from sonicate fluid were male. We conclude that sonicate fluid culture is useful for the diagnosis of prosthetic shoulder infection.

Patients with hypopigmented mycosis fungoides (HMF) present at a younger age than those with classic MF. Our goal was to describe the clinical presentation, histopathologic features and long-term outcome in patients who developed HMF before the age of 21. It was observed that among 69 pediatric patients diagnosed with MF between 1992 and 2010, 50 had HMF. Thirty-five patients had clinical follow-up. There were 37 males and 32 females with a mean age of 13.6 years. Most patients were African American or Hispanic and presented with multiple hypopigmented patches. All biopsies showed epidermotropism of T-lymphocytes, whereas fibroplasia and lichenoid infiltrate were variable. All specimens tested were CD8+. Treatment modalities included topical steroids, narrow band ultraviolet B and psoralen and ultraviolet A. HMF patients were followed for <1-12 years. Most children responded to treatment, but recurrence rates were high. One patient progressed to plaque/tumor stage. Others did not progress; however, many were lost to follow-up. We present a large cohort of children with HMF and report on the features of disease and progression. A major difference in histology of HMF was lack of fibroplasia and lichenoid infiltrate, probably because of presentation in the early patch stage. Most patients have a waxing-and-waning course and relapse after discontinuation of therapy, requiring repetitive treatment.

PEEK cages and rhBMP-2 when used in spinal fusion give consistently good fusion rates. However, the early role of BMP in the resorptive phase may cause loosening, cage migration, and subsidence.

Aim Species' responses to climate change are likely to depend on their ability to overcome abiotic constraints as well as on the suite of species with which they interact. Responses to past climate change leave genetic signatures of range expansions and shifts, allowing inferences to be made about species' distributions in the past, which can improve our ability to predict the future. We tested a hypothesis of ongoing range shifting associated with climate change and involving interactions of two species inferred to exclude each other via competition.Location New Zealand.Methods The distributions of two tree weta species (Hemideina crassidens and H. thoracica) were mapped using locality records. We inferred the likely modern distribution of each species in the absence of congeneric competitors with the software Maxent. Range interaction between the two species on an elevational gradient was quantified by transect sampling. Patterns of genetic diversity were investigated using mitochondrial DNA, and hypotheses of range shifts were tested with population genetic metrics. ResultsThe realized ranges of H. thoracica and H. crassidens were narrower than their potential ranges, probably due to competitive interactions. Upper and lower elevational limits on Mount Taranaki over 15 years revealed expansion up the mountain for H. thoracica and a matching contraction of the low elevation limits of the range of H. crassidens. The observed nucleotide diversity in H. thoracica was consistent with a species that persisted in northern areas during Pleistocene glacial periods, from where it expanded at warmer times. In contrast, a two-tailed distribution of nucleotide diversity in H. crassidens was as expected for a species that expanded northwards during glacials and southwards during interglacials.Main conclusions Range shifts resulting from climate change involve complex species interactions. Competition among related species is an important factor limiting realized ranges. In New Zealand, H. thoracica is likely to continue to displace H. crassidens as human-induced global warming proceeds.

Daptomycin is released from PMMA in vivo at a rate similar to that of vancomycin. Systemic daptomycin is as active as vancomycin in a rat model of chronic MRSA experimental osteomyelitis.

These cases confirm the characteristic clinical and histopathologic findings of 'persistent papules and plaques of Still's disease' and show the potential for this eruption in both the adult and juvenile age groups.