Hierarchical organization of macromolecules through self-assembly is a prominent feature in biological systems. Synthetic fabrication of such structures provides new materials with emergent functions. Here we report the fabrication of self-assembled superstructures through co-engineering of recombinant proteins and nanoparticles. These structures feature an unprecedented level of multi-layered hierarchical organization of the components: individual proteins and nanoparticles co-assemble to form discrete assemblies that collapse to form granules, which then further self-organize to generate superstructures of hundreds of nanometer size. The components within these superstructures are dynamic and spatially reorganize in response to environmental influences. The precise control over the molecular organization of building blocks imparted by this protein-nanoparticle co-engineering strategy provides a new strategy for creating hierarchical hybrid materials.

Mycobacterium gordonae is a slow-growing acid-fast bacilli mycobacterium with low pathogenic potential. Patients with this infection are treated with antimycobacterial agents such as ethambutol, clarithromycin, and rifampin. We present a rare side effect of ethambutol causing peripheral neuropathy, along with regression of this upon discontinuation of the inciting medication. A 78-year-old male with a past medical history of lumbar degenerative disc disease and lumbosacral radiculopathy presented to the clinic with three weeks of progressively worsening rhinorrhea, nasal congestion, and productive cough with yellow sputum. After a bronchoalveolar lavage (BAL) and a chest computed tomography (CT) scan, he was diagnosed with an M. gordonae infection. He was started on a 12-month triple regimen of rifampin, clarithromycin, and highdose ethambutol. During the first three months of antibiotic therapy, the patient began to have symptoms of gastrointestinal upset and worsening numbness in bilateral lower extremities, especially at night. Because he was unable to tolerate these adverse effects, the patient stopped taking these medications three months into his 12-month course. Upon stopping the antimycobacterial therapy, the patient's neuropathy began to return to baseline. Based on imaging, electromyography (EMG), nerve conduction studies (NCS), and a literature search of antimycobacterial medicines, we concluded that the high dose of ethambutol is the most likely cause of this patient's peripheral neuropathy. An important takeaway is that while ethambutol is a well-known cause of optic neuritis, it may also lead to peripheral neuropathy, which may regress upon discontinuation of the medication.

» Pathology of the long head of the biceps tendon is a common source of shoulder pain and often occurs in combination with other shoulder disorders.» Nonsurgical management, including rest and activity modification, use of nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections, is usually the first line of treatment.» Patients with symptoms that are refractory to nonsurgical management are indicated for biceps tenotomy or various tenodesis procedures.» Although several studies have reported a higher incidence of “Popeye” deformity, muscle cramping, and pain in the bicipital groove postoperatively with tenotomy compared with tenodesis, there are no substantial differences in functional scores or patient satisfaction between the 2 techniques.» To date, both tenotomy and tenodesis have been shown to be effective options in the management of long head of the biceps tendinopathy, and there are advantages to each procedure.

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