Mycobacterium colombiense belongs to the M. avium complex (MAC), a type of slow growing mycobacterium (1) which infects humans, both immunocompetent and incompetent patients. CASE REPORTWe wish to report a case of an apparently immunocompetent 17-year-old boy with disseminated cutaneous infection caused by M. colombiense. The patient presented with deep asymptomatic erythematous nodules on his face and extremities for 4 months without any preceding history of trauma or surgery. Some of the nodules on his extremities developed into discharging ulcers, others featured slightly scaly erythematous infiltrated plaques (Fig. 1). Two months earlier, he was admitted to a local hospital on account of irregular bowel movements and an occasional slight pain in the right lower quadrant. He was diagnosed with intestinal tuberculosis according to clinical features and biopsy of the intestinal mucosa, which indicated infectious granuloma. The patient received anti-tuberculosis chemotherapy for 2 weeks but ceased taking the drugs because of severe drug-induced liver hepatitis. The past medical history of the patient only revealed chronic hepatitis B with normal liver function. Routine blood test showed mild anaemia with haemoglobin of 101 g/l. Blood culture, purified protein derivative and human immunodeficiency virus antibody tests were negative.Systemic examinations of chest X-ray, type-B ultrasonography and CT scan indicated no abnormal lesions.A skin biopsy of a nodule on the patient's left leg displayed deep dermis showing nodular lesions with clear boundaries, collagen oedema, mucinous degeneration, blood vessel hyperplasia, infiltrated histiocytes and the absence of caseation necrosis, without special manifestation. Moderate growth of smooth, creamy, yolk yellow colonies was observed after 3 weeks of incubation only at 32 and 37°C on Löwenstein-Jensen (L-J) medium ( Fig. 2A). Ziehl-Neelsen staining confirmed that the cultured organisms were acid-fast bacilli (AFB) (Fig. 2B). Pigment production testing showed that the isolated AFB was non-chromogenic. Fungal and other standard bacterial cultures were negative. Sequence analysis of 16S rDNA genes showed 99% similarity with M. colombiense strain CIP108962, and hsp65 genes indicated 99% homology with M. colombiense strain InDRE 9m. Gene sequences were analysed using the BLAST V2.0 software available at http://www.ncbi.nlm.nih.gov/ BLAST/. Gene sequencing results indicated that the strain was most similar to M. colombiense.As indicated by drug susceptibility analysis, we administered an oral regimen of clarithromycin (500 mg/ day), rifabutin (750 mg/day) and moxifloxacin (300 mg/day). After 3 months of therapy, the patient's skin lesions greatly improved. However, his bowel symptoms did not completely improve and he continues to receive antibiotics. Fig. 1. Clinical manifestations. Several deep erythemas, reddish nodules on his extremities and face. On the surface of some nodules there were discharging ulcers and crusts. Some erythema with slight scales were also observed. A ...
The aim of this study was to investigate the clinical effect of AO miniplate screw internal fixation and Kirschner wire (KW) in the treatment of metacarpal fractures. We retrospectively analyzed the clinical data of 590 metacarpal fracture patients admitted to our hospital from March 2016 to March 2019. Among them, 290 patients were treated with KWs; 300 were treated with AO microplate internal fixation. The clinical, radiological results, time of surgery, and complications were observed and compared between the 2 groups. The imaging characteristics and preoperative fracture types of the 2 groups were similar and comparable ( P > .05). The operation time, length of hospital stay, and fracture healing time of AO group were shorter than those of KW group, and the differences were statistically significant (41.22 ± 7.23 vs 25.64 ± 6.29; 7.13 ± 2.38 vs 5.26 ± 1.71; 67.43 ± 22.01 vs 52.57 ± 17.46, P < .05). In addition, the incidence of postoperative complications in AO group was lower than that in KW group (8.3% vs 15.2%, P < .05). In terms of surgical knuckle extension, flexion, and total mobility (compared with the uninjured hand), patients in the AO plate group were significantly improved compared with patients in the KW group, and the difference was statistically significant (4 vs 10 degree; 19 vs 10 degree; 14 vs 29 degree, P < .05); The average degree of finger rotation deformity in AO plate group was significantly lower than that in KW group (1 vs 6 degree, P < .05). In terms of grip strength (compared with the healthy hand), the average grip strength of AO plate group was significantly higher than that of KW group (93% vs 83%, P < .05). Patients in the OA plate group had a lower Disabilities of the Arm, Shoulder and Hand score ( P < .05). Compared with KW fixation, AO mini-plate and screw fixation for the metacarpal fracture has a better effect, which can effectively shorten the operation time and reduce the trauma to patients. It can provide patients with better stability and realize the early movement of the palm, promote fracture healing and joint function recovery; it can reduce the incidence of postoperative complications, which has certain safety. In addition, it can effectively reduce the risk of poor finger rotation.
Manganese oxides, as a highly active oxidation catalyst, are expected to have great potential for replacing platinum group material (PGM) in volatile organic compound (VOC) degradation. Manganese sulfate and manganese chloride are usually adopted as raw materials for catalyst preparation, and Cl − and SO 4 2− adsorbed on the catalyst might affect the catalytic activities. In this study, sphere-like Mn 2 O 3 was prepared from different manganese sources with a simple carbonate precipitation method, which was further used to systematically study the potential poisoning effect of residual trace species on the catalytic activity of toluene oxidation. The fully washed samples all show excellent toluene oxidation activity at the beginning; however, both chlorideand sulfate-derived samples exhibited unexpected severe inactivation after the thermal aging treatment, and the light-off temperature (T 90 ) of toluene oxidation increased by more than 116 and 252 °C, while this value is only 65 and 40 °C over nitrate-and acetatederived Mn 2 O 3 , respectively. The characterization results of ICP-OES and XPS demonstrated that the incorporated traced sulfur and chloride species existing in fresh samples were difficult to wash away completely, which has little influence on the catalytic performance of fresh samples but will greatly affect their anti-sintering behavior. During the thermal aging process, doped sulfur gradually forms uniformly dispersed sulfate that will cover on the catalyst surface, where the transports of reactants and the supplementary lattice oxygen would be restrained significantly.
The authors present the first, to the best of their knowledge, reported case of cutaneous infection caused by Mycobacterium parascrofulaceum. A 42-year-old woman presented with asymptomatic reddish papules, nodules, plaques, and patches on the right side of her face and on her forehead that had persisted for 5 years, with the lesions gradually increasing in size over that time. No previous intervening medical treatment had been applied. No history or evidence of immunosuppression was found. A skin biopsy was performed for routine histological examination. Samples of lesioned skin were inoculated on Löwenstein-Jensen medium to determine the presence of acid-fast bacilli. Ziehl-Neelsen staining was used to confirm the presence of the organism. In vitro drug susceptibility testing was conducted using the microtiter plate method. Mycobacterium was identified by polymerase chain reaction-restriction fragment length polymorphism analysis and sequencing of the hsp65 and 16S rDNA genes. Cultures for aerobic and anaerobic bacteria, as well as fungus, were also conducted. Routine histopathology revealed granulomatous changes without caseation. Ziehl-Neelsen staining showed that the organisms in both the lesions and the cultures were acid-fast bacilli. The cultured colonies were grown in Löwenstein-Jensen medium and incubated at two different temperatures (32°C and 37°C) for 2-3 weeks, developing pigmentation both in the dark and in the light. In vitro drug susceptibility tests showed that the organism was sensitive to clarithromycin and moxifloxacin. Polymerase chain reaction-restriction fragment length polymorphism analysis and sequencing of the hsp65 and 16S rDNA genes confirmed that the isolated organisms were M. parascrofulaceum. Fungal and other standard bacterial cultures were negative. In conclusion, identification and diagnosis of nontuberculous mycobacteria should be performed promptly to obtain better prognoses. Empirical treatments may be feasible, and drug susceptibility tests are important.
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