Identification of the various dematiaceous fungi responsible for black grain

Identification of the various dematiaceous fungi responsible for black-grain mycetoma remains difficult with standard mycologic procedures and can be delayed up to 12 weeks. Phenotypic and biochemical methods cannot distinguish E jeanselmei from E oligosperma. In addition, E spinifera may be confused with E jeanselmei due to similar early colony morphologic characteristics. Sequencing of the rDNA ITS1-5.8S-ITS2 gene has proven to be a useful molecular tool for reliable and rapid identification of most black-grain mycetoma agents.
Subcutaneous phaeohyphomycosis can occur in both immunocompetent and immunosuppressed patients, the latter being at greater risk of treatment failure and subsequent dissemination of the infection. Owing to the rarity of this infection, there are no clinical trials to guide the management of subcutaneous phaeohyphomycosis caused by E jeanselmei. The optimal antifungal agent in the treatment of E jeanselmei is still unknown. Historically, itraconazole and voriconazole have demonstrated the most consistent in vitro activity against Exophiala species. Severe infections due to E jeanselmei, including pneumonia, fungemia, central bcr-abl inhibitor infection, endocarditis, and peritonitis, have been reported in immunocompromised patients. Antifungal therapy is recommended until all signs and symptoms of infection have resolved. In Taiwan, three reported cases of subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei were identified in the literature, and all three involved immunocompromised patients. Two cases were treated successfully with itraconazole plus either debridement or cryotherapy. Our case showed that surgical excision alone was sufficient to treat and cure subcutaneous phaeohyphomycosis caused by E jeanselmei in an immunocompetent host. Although cryotherapy seems effective for treatment of subcutaneous phaeohyphomycosis, it is unknown whether cryotherapy alone is a sufficient treatment in immunocompetent hosts.
In summary, E jeanselmei should be suspected in immunocompetent patients presenting with chronic subcutaneous lesions. The diagnosis can be made by histopathologic and microbiologic evaluation of tissue and exudate. Surgical excision alone appears to be an efficacious therapy in immunocompetent hosts.

Introduction
Hereditary periodic (recurrent) fever syndromes are a group of autoinflammatory diseases characterized by recurrent episodes of unprovoked inflammation without high-titer autoantibodies or autoreactive T cells. Seven diseases exhibit Mendelian patterns of inheritance with identified single gene defects. They include familial Mediterranean fever (FMF), tumor necrosis factor receptor-associated periodic syndrome (TRAPS), pyogenic sterile arthritis, pyoderma gangrenosum and acne (PAPA), hypergammaglobulinemia D with periodic fever syndrome (HIDS) and three overlapping conditions, the cryopyrinopathies, with common cryopyrin abnormalities: familial cold autoinflammatory syndrome (FCAS); Muckle-Wells syndrome (MWS); and neonatal-onset multisystem inflammatory disease (NOMID), also known as chronic infantile neurologic cutaneous articular syndrome (CINCA). Hereditary periodic fevers are characterized by recurrent flares of systemic inflammation presenting as sudden episodes of fever associated with a dramatic elevation of acute phase reactants and a number of clinical manifestations, such as rash, serositis (peritonitis, pleuritis), lymphadenopathy, and arthritis. Disease flares are usually separated by symptom-free intervals of variable duration, characterized by complete well-being, normal growth, and complete normalization of acute phase reactants. The clinical spectrum of these disorders is also extremely variable.
TRAPS is characterized by periodic fever (duration of more than 1 week), migratory cutaneous rash, conjunctivitis, periorbital edema, lymphadenopathy, abdominal pain, myalgia, arthralgia, and serositis. It is an autosomal dominant disease that is related to heterozygous mutations in the tumor necrosis factor (TNF) receptor super family 1A (TNFRSF1A) gene encoding TNF receptor type 1 (TNFR1). Levels of acute-phase reactants are elevated during attacks and also during asymptomatic periods. TRAPS is the second most common disease among hereditary periodic fever syndromes following FMF. Although people of any ethnicity may be affected, there have been few reports to date with regards to patients from Asia. Here, we presented the case of a 14-year-old Asian girl with recurrent fever and abdominal pain for 2 years who was finally diagnosed with TRAPS, and had good response to etanercept, an anti-TNF-α agent.

For sound attenuation in gases the Stokes

For sound attenuation in gases, the Stokes–Kirchhoff attenuation coefficient is used:where is the dynamic and is the volumetric viscosity of the gas, is the heat conductivity, and and are its isochoric and isobaric heat capacities, respectively.
For an extended emitter, such as a line, rectangle, circle, sphere or cylinder, the emitter surface has to be discretized into n point sources. The total electrical input power has to be distributed between all these point sources in relation to their surfaces. Using a discretized version of the Kirchhoff–Helmholtz integral, the complex amplitudes of all n point sources will superposed at the observation point r. The absolute value of this superposition yields the sound pressure amplitude at the observation point. Thus, we obtain for the sound pressure amplitude at some point r in a gas:
Now let us focus on the influence of the thermal inertia of the electrically conductive film on the generated sound pressure. According to Eq. (2), the amount of thermal bcr-abl inhibitor flowing into the gas depends on the thermal effusivity of the gas , on the substrate and also on the frequency dependent thermal inertia () of the electrically conductive film (see Eq. (5)). In particular at high frequencies , the influence of thermal inertia of the conducting film will become increasingly important. In addition, an increase in the film thickness , its density or in its heat capacity will result in an additional reduction of the amount of thermal energy flowing into the adjacent gas. Consequently, this process will also reduce the generated sound pressure.
Table 1 gives an overview of densities and specific heat capacities of some materials that can be used as electrically conductive films. The product of density and specific heat capacity gives a relative thickness-independent value of the thermal capacitance.
As one can see in Table 1, carbon has a thermal capacitance smaller than metallic materials. Thus theoretically carbon-based materials such as graphene and CNTs suit best to be used as TA-emitters. However, in practice, as e.g. Wei et al. [19] and Harrer [26] experimentally demonstrated these materials are insufficiently robust to generate durable sound pressure levels of more than 140dB due to their low thermal, chemical and mechanical stabilities.
For example, thermo-acoustic generation of a 1kPa sound pressure at 100kHz and in 3cm distance from a 1×1cm2 large TA-emitter requires a periodic heating of the electrically conductive film up to 1000°C (calculated using EDF-model). Carbon based materials like carbon nanotubes or graphene oxidize in air at temperatures over 350°C [27] and burn up already at 560°C [19]. Therefore, TA-emitters consisting of carbon are unsuitable for high-performance airborne ultrasound generation.
Metallic coatings such as titanium, aluminum or gold provide much better thermal and chemical stability in air compared to carbon-based materials, but unfortunately these materials are not the best choice for high-frequency ultrasound generation due to their relatively high thermal capacitances (see Table 1).
As one can see from Table 1, the thermal capacitance of ITO almost equals that of carbon. However, ITO is much harder (6–7 Mohs), thermally and chemically more stable in air (up to 1800°C) than carbon and is already an oxide. Hence we can conclude that ITO as an electrically conductive film best meets the requirements of a thermo-acoustic airborne ultrasound emitter in terms of its mechanical, thermal and chemical stability combined with a relatively low thermal capacitance.

Experiment
Therefore, we prepared five TA-emitter samples consisting of ITO (In2O3/SnO2, 90/10) coatings of various thicknesses (as electrically conductive films) on Herasil2 glass (SiO2 glass) [28] substrates. We have chosen to use a SiO2 glass as a substrate since its density, heat conductivity and thermal capacity of this material is well known.