Streptococcus intermedius: unusual presentation and complication of lung abscess

We report a case of a 54-year-old immunocompetent male who had lung abscess secondary to Streptococcus intermedius that led to discitis by contiguous spread of infection. He initially presented with constant chest pain for 6 weeks that radiated to lower back, with no fever, chills or weight loss. He denied smoking cigarettes, alcohol use or any illicit drug. On investigation, a mass was identified on the posterior medial aspect of the right lower lobe with direct infiltration into right side of the T5–T6 vertebral bodies. Histopathology identified organising pneumonia with abscess. Tissue cultures showed S. intermedius, and were negative for other microorganisms. This case highlights a rare presentation of S. intermedius discitis by contiguous spread of infection from posterior right lower lobe lung abscess. S. intermedius usually occurs in older patients with pulmonary infections complicated with pleural effusion or lung abscess, but can present in young patients with no clear symptoms of lung infection, like our patient.

A Novel Method for the Preparation of Fibrous CeO2–ZrO2–Y2O3 Compacts for Thermochemical Cycles

Zirconium-Yttrium-co-doped ceria (Ce0.85Zr0.13Y0.02O1.99) compacts consisting of fibers with diameters in the range of 8–10 µm have been successfully prepared by direct infiltration of commercial YSZ fibers with a cerium oxide matrix and subsequent sintering. The resulting chemically homogeneous fiber-compacts are sinter-resistant up to 1923 K and retain a high porosity of around 58 vol% and a permeability of 1.6–3.3 × 10−10 m² at a pressure gradient of 100–500 kPa. The fiber-compacts show a high potential for the application in thermochemical redox cycling due its fast redox kinetics. The first evaluation of redox kinetics shows that the relaxation time of oxidation is five times faster than that of dense samples of the same composition. The improved gas exchange due to the high porosity also allows higher reduction rates, which enable higher hydrogen yields in thermochemical water-splitting redox cycles. The presented cost-effective fiber-compact preparation method is considered very promising for manufacturing large-scale functional components for solar-thermal high-temperature reactors.

Hydrogeological Criteria to Improve the Sponge City Strategy of China

China is facing frequent waterlogging and an increasing water scarcity that mirrors the fast urban and economic expansion of the last 4 decades. To mitigate these issues, the government promulgated the “Sponge City” strategy; a concept rooted in practices in western countries aimed at collecting and reusing 65–90% of urban rainfall. The application consists of absorbent infrastructures such as green roofs and rain gardens combined with the pre-existing urban environment. However, due to climate heterogeneities and the different urbanization contexts in China, these goals may seem overly ambitious in many areas of the country. Compact urbanization, together with heavy rainfall concentrated in short events, puts dramatic stresses on these infrastructures. At the same time, overdesigned infrastructures are expensive and may not be practical to retrofit in existing urban areas. In this paper, the role of urban aquifers as natural Sponge City elements are investigated throughout China. The method of implementation is inexpensive and easy to apply, favoring the direct infiltration to the subsoil after the conversion of the urban surfaces from impervious to permeable. Infiltration to urban aquifers alleviates the pressure on sewers, urban streams, as well as waste-water treatment plants. Considering urban aquifers with different hydraulic characteristics, water table dynamics after large infiltration events from rainfall are simulated via numerical analysis. Hydrogeological and geomorphological analyses are carried out to individuate criteria for the mapping of high absorbance areas at the regional and local scales. A Sponge City approach involving the urban aquifers can represent a winning formula for the success of this ambitious but compelling plan.

Pressing and Infiltration of Metal Matrix Nanocomposites

The ability to produce metal matrix nanocomposites via pressing and infiltration was validated. Al/TiC nanocomposite was used as the model material. Pressing the powder in a die yielded cylindrical specimens with a green density of 1.98 ± 0.05 g/cm3, which was increased to only 2.11 ± 0.12 g/cm3 by sintering. Direct infiltration of the pressed specimens at 1050 °C for 3.5 h yielded specimens with a density of 3.07 ± 0.08 g/cm3, an open porosity of 3.06 ± 1.40%, and an areal void fraction of 8.09 ± 2.67%. The TiC nanoparticles were verified to be well dispersed using energy-dispersive X-ray spectroscopy. The measured hardness of 64 ± 3 HRA makes it a promising material for structural applications in industries such as aerospace and automotive.

Replumbing the Bengal Basin: A Shift in Recharge Driven by Groundwater Irrigation Revealed by Stable Water Isotopes

Groundwater supports agriculture and provides domestic water for over 250 million people in the Bengal Basin. Our analysis of stable water isotope ratios in rain, surface, and groundwater shows that the proportion of groundwater recharge originating from stagnant surface water bodies has increased by about 50% over the last seventy years while the relative contribution from direct infiltration of rain has decreased. This regional shift in the source of groundwater shows how the simultaneous expansion of irrigated rice, excavated ponds and groundwater pumping has changed the hydrologic system by cycling evaporated standing water through the subsurface. Analysis of water isotope data also reveals that most recharge from standing water enters during the latter part of the dry season (February-April), while most rainwater recharge occurs in the early months of the monsoon (June-August) before aquifers fill to capacity and reject additional recharge of rainwater.

Groundwater Origin and Quality Appraisal through a Combined Geochemical and Isotopic Approach in the Great Algiers District (Algeria)

The assessment of the origin of water that is allocated both for people and for irrigation in the eastern part of the Mitidja plain was carried out making use of geochemical and isotopic tools (18O, 2H and 3H). Both hydrochemical and isotopic information gathered for eastern Mitidja alluvial aquifer were used for the sake of assessing the mechanisms controlling groundwater chemistry. This allowed one to identify: (i) the natural or the anthropogenic processes that control groundwater quality, (ii) the origin of groundwater and when its recharge occurs. The work involved sampling campaigns, in situ measurements, and analyses of ions, heavy metals and water isotope content. Results showed a fair overall chemical quality of waters, since the assessment of water quality using water quality index (WQI) revealed that 90 % of the groundwater samples are good. Mitidja’s groundwaters fall into the Cl−SO4−Ca water type, that is mainly induced by water-rock interactions (dissolution of evaporites). The concentrations in Fe, Mn, Ni and Cd for some of the samples were found higher than the prescribed limits recommended by the World Health Organization. Isotopes indicate that groundwater is young since it originates from direct infiltration of precipitation that is mostly induced by Mediterranean atmospheric disturbances.

The History of the Discovery of Ectopic Epithelial Cells in Lower Peritoneal Organs: The So-Called Mucosal Invasion

Through microscopy, early researchers identified the epithelium on the inner surfaces of the uterus, cervix and Fallopian tubes. The identification of ectopic epithelium was gradual, starting from the gross pathology study of unusual cystic lesions. Towards the end of the nineteenth century, attention focused on the epithelium as a critical component. The term ‘adenomyoma’ was coined around eighteen eighty to designate the majority of mucosa-containing lesions. Several theories were advanced to explain its aetiology. In the main, lesions were considered to arise from invasion from uterine epithelium; implantation of endometrium through retrograde menstruation; hematogenous or lymphatic spread; or from embryonic remnants. Although initially widely rejected, around 1920, an almost unanimous consensus formed on the endometrial nature of epithelial invasions. During the following years, adenomyosis and endometriosis came to be used to distinguished lesions within or outside the uterus. Adenomyosis was attributed to direct infiltration of uterine mucosa into the myometrium, and endometriosis to the implantation of endometrial cells and stroma into the peritoneal cavity through retrograde menstruation. Around the same time, ovarian lesions, initially described as ovarian hematomas or chocolate cysts, were regarded as a form of endometriosis. Three variants of endometriosis were thus described: superficial peritoneal, deep nodular and ovarian endometriomas. Ectopic epithelium has long been recognised as having similarities to tubal, or cervical epithelium. Lesions containing mixed epithelium are often termed Müllerianosis. This article demonstrates the stepwise evolution of knowledge, the role of the pioneers and the difficulties that needed to be overcome. It also demonstrates the value of collaboration and the inter-connected nature of the scientific endeavour.

Pituitary Sarcoidosis in a Pediatric Patient Successfully Treated With Adalimumab and Methotrexate

Neurosarcoidosis is a rare phenomenon in the pediatric population, with only a few cases reported in the literature worldwide. While hypothalamo-pituitary involvement is known to occur, direct infiltration of the pituitary gland and isolated anterior pituitary dysfunction without diabetes insipidus is seldom observed. A high index of suspicion is required for diagnosis of neurosarcoidosis, and treatment can be challenging due to lack of standardized guidelines. We present the case of a 17-year-old female with known sarcoidosis of the lacrimal glands, who developed severe headache and neurologic symptoms secondary to granulomatous infiltration of the pituitary gland and infundibulum due to neurosarcoidosis. She was successfully treated with corticosteroids, methotrexate, and adalimumab, with complete radiologic resolution. This is the first documented pediatric case of neurosarcoidosis with radiologic granulomatous infiltration of the pituitary gland, manifesting as partial anterior hypopituitarism, in the form of central hypothyroidism, without diabetes insipidus.

Hydrogeochemical and Isotopic (δ2H-δ18O) Investigations of Hydrologic Dynamics of the Southern Urucuia Aquifer System, Brazil

The integration of hydrogeochemical and isotopic data (δ2H-δ18O) allowed the reconstruction of the hydrological dynamics of Southern Urucuia Aquifer System. This system is a combination of aquifers that are responsible for the perennity of the rivers during the rainy recession. In this study, water samples were collected from three sources: rainfall, rivers and pumping wells. The hydrogeochemical data lead to subdivide the aquifers in three main types: regional unconfined, confined, and unconfined with deep water level. The unconfined aquifer with deep water level originates from an groundwater flow deflection in the westernmost portion of the study area. The occurrence of silicified and fractured levels divide the aquifer types and represents a mixing and interfaced zone, allowing a leakage between aquifers and a great variability of hydrogeochemical facies. The hydrogeochemical evolution occurs by local, intermediate and regional flow systems. The buildup of dissolved solids is the major controlling mechanism of the groundwater composition represented by the systematic changes of anion species from HCO3 to SO4 to Cl, and cationic exchange between Ca and Na. The discharge occurs through the baseflow of rivers, which have hybrid composition between regional unconfined and confined aquifer from Na-Ca-Cl to Na-Cl. The analysis of stable isotopes shows that the surface water and groundwater are located in the same range of values, which indicates a connection between the reservoirs. During the rainy season, the regional unconfined isotopic composition becomes similar to the precipitation isotopic composition, with the main recharge occurring mostly by direct infiltration of rainwater. However, there is a modification of this composition in the dry season due to strong isotopic enrichment caused by the evaporation process. The seasonal variation in the isotopic composition represents a continuous cycle. In other words, as the rainy season approaches, the atmospheric air column becomes increasingly saturated with water vapor, what results in a considerably diminishment of evaporation.

A New Treatment for Local Adiposity with Ascorbic Acid and Ascorbyl-Palmitate Solution: Clinical and Histological Study

Background Localized adiposity (AL) is the accumulation of subcutaneous adipose tissue, placed in definite anatomic areas, building up an alteration of the body silhouette. The aim of the present clinical and histological study is to assess the effectiveness of an injectable solution containing sodium salt of ascorbic acid 0.24% and surfactant agent at 0.020% ascorbyl-palmitate (SAP) for treating local adiposity. Methods Eighty healthy female adult patients were selected, suffering from local adiposity in the abdominal region. The patients underwent a cycle of 6 sessions, with biweekly treatments, without the addition of any active ingredient. Direct infiltration of pharmacologically active SAP solutions into the adipose tissue with a long needle, very similar to the needles used for spinal anesthesia, was performed. This procedure is quick and painless (does not require any anesthesia) with moderate infiltration speed. Results All the patients treated showed good results with good satisfaction of the circumferential reductions. Before treatment: Waist (cm) 78.8 ± 10.6 and hip 93.6 ± 9.0 with WHR 0.84 ± 0.07. After treatment: Waist (cm) 70.8 ± 9.6 and hip 92.6 ± 8.0 with WHR 0.76 ± 0.06. Indeed, signs of adipocyte apoptosis were observed in subcutaneous skin after injection of SAP. Conclusion The results showed in the present study suggest that the SAP utilized induces apoptosis of adipocytes and could be of use as a safe and effective method with which to eliminate subcutaneous abdominal fat. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.