Background: There have been few case reports of patellar tendon rupture in patients with underlying systemic lupus erythematosus (SLE). Objectives: We present a unique case to discuss the importance of recognizing patellar tendon rupture in the emergency department (ED). Case Report: An 18-year-old man with SLE presented to the ED with pain, swelling, and inability to extend his left knee after a fall. Physical examination demonstrated a palpable defect over the patellar tendon, and plain radiographs showed patella alta. Patellar tendon rupture was diagnosed, and the patient underwent open surgical repair. Conclusion: In low-energy patellar tendon rupture, the effects of the pathophysiology and the treatment for SLE, which includes systemic corticosteroids, are currently unclear. However, it is important to establish prompt diagnosis and appropriate treatment in the ED to maximize recovery and minimize long-term disability.

Recent 2H nuclear magnetic resonance (NMR) studies on retinal in rhodopsin indicate a discrepancy in parameters for methyl rotation activation compared to previous molecular dynamics (MD) simulations [1,2]. Here we report ab initio quantum mechanical (QM) calculations of retinal potential energy surfaces that enable comparison to the results of 2H NMR relaxation measurements [3,4]. Rotational dynamics of the retinal ligand were assessed via C5-, C9-, and C13-methyl dihedral scans in retinal model compounds that correspond to 2H NMR data and allow us to validate the methyl dihedral contribution to the retinal force field [1,2].

We have performed quantum mechanical calculations for retinal model compounds to establish the rotational energy barriers for the C5-, C9-, and C13-methyl groups known to play an essential role in rhodopsin activation. Intraretinal steric interactions as well as electronic effects lower the rotational barriers of both the C9- and C13-methyl groups, consistent with experimental (2)H NMR data. Each retinal methyl group has a unique rotational behavior which must be treated individually. These results are highly relevant for the parameterization of molecular mechanics force fields which form the basis of molecular dynamics simulations of retinal proteins such as rhodopsin.

BACKGROUND:Insulin glargine is a relatively new medication in the treatment of diabetes mellitus, and there have only been six case reports of overdoses in the literature with this specific insulin.OBJECTIVES:We present a unique case of insulin glargine overdose that presented with persistent hypoglycemia and required prolonged in-hospital treatment.CASE REPORT:A 51-year-old woman with insulin-dependent diabetes and a history of suicide attempts by medication overdose presented to the Emergency Department the morning after she had self-administered 2700 units of her insulin glargine in an attempted suicide. She was treated with continuous intravenous dextrose infusion with liberal oral intake, and continued to have recurrent hypoglycemic episodes 96 h into her hospital stay. She was discharged on hospital day 5 after psychiatric clearance without any permanent complications.CONCLUSIONS:A single massive overdose of insulin glargine can present with prolonged hypoglycemia. Emergency physicians should have a low threshold for initiating continuous dextrose infusions and admitting these patients for frequent blood glucose and serum electrolyte monitoring, preferably in an intensive care setting.

The purpose of this study was to investigate the effects of various cold immersion durations on maximal grip strength and the subsequent recovery of grip strength. Sixteen healthy men between 20 and 42 years of age participated in this study. Maximal isometric grip strength was measured before, immediately after, and 5, 10, and 15 minutes after cold immersion. Subjects submerged their dominant elbow, forearm, and hand in a cold water whirlpool at 10 degrees C for 5, 10, 15, or 20 minutes. There was a significant decrease in isometric grip strength when the forearm was immersed in 10 degrees C water for durations between 5 and 20 minutes and no recovery of this strength loss for a period of 15 minutes following removal from the cold immersion (p = 0.0001). These findings suggest that clinicians should be aware of the alterations in isometric muscle strength that result from utilizing the temperature and time frames of cold application used in this study.

An efficient contact search for dynamic explicit finite element (FE) simulations with several moving bodies is essential to avoid unacceptable costs. The time spent for contact algorithms is mainly determined by the cost of the search phase. We present a variant of the position code algorithm for efficient global contact search. Instead of a row-wise ordering we propose a numbering that follows a space filling curve. An analysis proves that the new ordering is more efficient in case of long surface segments. The two variants of the position code algorithm and another widely used algorithm, which is based on a hierarchical ordering, are implemented in an industrial FE code and applied to problems in fastening and demolition technology. Experimental results show that the presented method is well suited for all types of meshes and meets the great demands on efficiency for the mentioned field while the other algorithms show disadvantages in some cases.

This article describes the first (to our knowledge) tetracycline-inducible regulatory system that demonstrates that the tetracycline repressor (tetR) alone, rather than tetR-mammalian cell transcription factor fusion derivatives, can function as a potent trans-modulator to regulate gene expression in mammalian cells. With proper positioning of tetracycline operators downstream of the TATA element and of human epidermal growth factor (hEGF) as a reporter, we show that gene expression from the tetracycline operator-bearing hCMV major immediate-early enhancer-promoter (pcmvtetO) can be regulated by tetR over three orders of magnitude in response to tetracycline when (1) the reporter was cotransfected with tetR-expressing plasmid in transient expression assays, and (2) the reporter unit was stably integrated into the chromosome of a tetR-expressing cell line. This level of tetR-mediated inducible gene regulation is significantly higher than that of other repression-based mammalian cell transcription switch systems. In an in vivo porcine wound model, close to 60-fold tetR-mediated regulatory effects were detected and it was reversed when tetracycline was administered. Collectively, this study provides a direct implementation of this tetracycline-inducible regulatory switch for controlling gene expression in vitro, in vivo, and in gene therapy.