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Table 31.

Laboratory Diagnosis of Osteomyelitis

Abbreviations: KOH, potassium hydroxide; NAAT, nucleic acid amplification test; RT, room temperature.

osteomyelitis occurs most often in patients with sickle cell trait or disease.

osteomyelitis occurs most often in pediatric patients, not infrequently in the setting of pneumococcal bacteremia.

spp will be recovered in standard aerobic bacterial cultures; however, the laboratory should be notified when spp is considered to be a potential cause of osteomyelitis so that cultures are examined only in a biological safety cabinet. Concomitant serologic testing is recommended.

Hematogenous osteomyelitis caused by and other spp occurs most often in injection drug users. is the most common bacterial cause of calcaneal osteomyelitis in individuals who develop this infection after stepping on nails while wearing sneakers.

The most common site of osteomyelitis due to is the vertebral bodies. also represents one of the most common causes of clavicular osteomyelitis. Commercial NAATs are not US Food and Drug Administration–approved for nonrespiratory sites, so a laboratory-developed/validated test must be used if NAATs are requested.

Chronic endodontic infections such as apical abscesses may extend into surrounding bone, resulting in osteomyelitis of the maxilla or mandible. These infections are caused by the aerobic and anaerobic bacterial flora of the oral cavity and may be either monomicrobial or polymicrobial. spp is a recognized pathogen in this setting; when spp is suspected, specimens should be transported to the laboratory under anaerobic conditions and cultures incubated for 10–14 days.

Mycetoma is a chronic soft tissue infection of the extremities which can also extend into contiguous bone and connective tissue. It occurs most often in tropical and subtropical climates and may be characterized by the development of draining sinuses. Etiologic agents are derived from the soil. Sinus tract drainage material, when present, may be representative of the etiology of underlying osteomyelitis. In addition to the stains and cultures noted in the table, sinus drainage should also be examined grossly and microscopically for the presence of “sulfur granules” characteristic of this disease. Furthermore, the laboratory should be notified of the possibility of spp as a pathogen so that appropriate media (eg, Middlebrook agar, Sabouraud dextrose agar, buffered charcoal yeast extract) can be inoculated which facilitate recovery of this organism.

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Table 31.

Laboratory Diagnosis of Osteomyelitis

Abbreviations: KOH, potassium hydroxide; NAAT, nucleic acid amplification test; RT, room temperature.

osteomyelitis occurs most often in patients with sickle cell trait or disease.

osteomyelitis occurs most often in pediatric patients, not infrequently in the setting of pneumococcal bacteremia.

spp will be recovered in standard aerobic bacterial cultures; however, the laboratory should be notified when spp is considered to be a potential cause of osteomyelitis so that cultures are examined only in a biological safety cabinet. Concomitant serologic testing is recommended.

Hematogenous osteomyelitis caused by and other spp occurs most often in injection drug users. is the most common bacterial cause of calcaneal osteomyelitis in individuals who develop this infection after stepping on nails while wearing sneakers.

The most common site of osteomyelitis due to is the vertebral bodies. also represents one of the most common causes of clavicular osteomyelitis. Commercial NAATs are not US Food and Drug Administration–approved for nonrespiratory sites, so a laboratory-developed/validated test must be used if NAATs are requested.

Chronic endodontic infections such as apical abscesses may extend into surrounding bone, resulting in osteomyelitis of the maxilla or mandible. These infections are caused by the aerobic and anaerobic bacterial flora of the oral cavity and may be either monomicrobial or polymicrobial. spp is a recognized pathogen in this setting; when spp is suspected, specimens should be transported to the laboratory under anaerobic conditions and cultures incubated for 10–14 days.

Mycetoma is a chronic soft tissue infection of the extremities which can also extend into contiguous bone and connective tissue. It occurs most often in tropical and subtropical climates and may be characterized by the development of draining sinuses. Etiologic agents are derived from the soil. Sinus tract drainage material, when present, may be representative of the etiology of underlying osteomyelitis. In addition to the stains and cultures noted in the table, sinus drainage should also be examined grossly and microscopically for the presence of “sulfur granules” characteristic of this disease. Furthermore, the laboratory should be notified of the possibility of spp as a pathogen so that appropriate media (eg, Middlebrook agar, Sabouraud dextrose agar, buffered charcoal yeast extract) can be inoculated which facilitate recovery of this organism.

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In osteomyelitis occurring after a contaminated open fracture, the organisms listed above may be found, with enterococci, fungi, and NTM alternatively being involved; microorganisms may derive from patient skin, contaminated soil, and/or the healthcare environment.

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WATCH US successfully launches ground-based interceptor in California
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The U.S. has "successfully intercepted" an intercontinental ballistic missile during the first test of its ground-based intercept system, the U.S. Missile Defense Agency said Tuesday.

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The test occurred just days after the North Korean regime launched its ninth missile this year. U.S. officials say today's test had been planned for years.

The ground-based interceptor launched from Vandenberg Air Force Base in California shortly after 3:30 p.m. ET. A little more than one hour later, the Pentagon confirmed that it had successfully collided with an ICBM-class target over the Pacific Ocean.

Published: February 5, 2018 Updated: February 7, 2018

Chromosomes, the coiled strands of DNA that reside in the cell nucleus, are the main repository of genetic information within cells. When chromosomes don’t form correctly during cell division, the result can be a misspelling or glitch in the genetic code, potentially allowing cells to proliferate continuously – a hallmark of cancer. Most cancer cells contain more than one kind of chromosomal abnormality.

One type of abnormality is called a chromosomal rearrangement. This occurs when a portion of a chromosome breaks off and reattaches at the wrong location. This can result in “hybrid genes,” which consist of genes fused together at the points of breakage and reattachment. Researchers have identified more than 200 hybrid genes, many of which involve genes linked to cancer. Chromosomal rearrangements also can affect sections of DNA that control gene activity, causing genes involved in cell division to go into hyperdrive, or even disabling genes that normally rein in cell growth.

Incorrect copying of chromosomes can lead to other problems as well. Genes that should be present may be deleted or deactivated. If such genes are tumor-suppressor genes, whose job is to keep cell division in check, their absence or idleness can remove critical restraints on growth. The opposite problem – a surplus or over activity of some genes – can be equally hazardous if the affected genes help promote cell growth and division.

Chromosomal abnormalities can also hobble genes involved in repairing damaged DNA. If damage occurs in a gene that normally drives or constrains cell growth, DNA-repair genes are often able to fix the problem so growth doesn’t veer out of control. But if the repair genes themselves don’t work properly, there may be little to prevent this loss of control.

Chromosomes.

Under a microscope, one of the most striking features of cancer cells is that they often have the wrong number of chromosomes in their nuclei, a condition known as aneuploidy. The role of aneuploidy in cancer isn’t clear, but some researchers have suggested that, by increasing the diversity of cell types within tumors, aneuploidy may help cancer cells acquire gene mutations that help them survive, grow, and multiply. One paper from 2015 called aneuploidy in cancer a “jackpot of chaos.”

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Researchers led by Dana-Farber’s David Pellman, MD, have shown that aneuploidy can generate not only abnormal chromosome number but also massive chromosome rearrangement. This sudden, isolated shuffling of genetic material, known as chromothripsis, is a major driver of the abnormal genomic architecture of cancer – occurring in 65 percent of pancreatic cancers, for example.

In a 2015 paper , Pellman and his colleagues, including Dana-Farber’s Matthew Meyerson, MD, PhD, and Cheng-Zhong Zhang, PhD, now at Harvard Medical School, demonstrated how chromothripsis can occur. Using live video images of single cells and technology for sequencing the genomes of those cells – a technique called “Look-Seq” – they traced chromothripsis to a glitch in cell division that can cause one of the newly formed daughter cells to be short one chromosome, while the other daughter cell inherits an extra one.

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