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There is a reduction in the expression of glucose transporters to the cell interior, especially GLUT-4, resulting in increased expression of the peroxisome proliferator-activated receptor-α (PPAR-α), which in turn induces an increase in fatty acid degradation enzymes and an increase in insulin resistance. In this process, free fatty acids are employed over glucose. PPAR-α activation due to the increase in fatty acids leads to increased expression of the mitochondrial uncoupling protein UCP3. Resulting in less efficient ATP production. The excess of fatty acids also saturates the β-oxidation, producing an excess of ceramides, diacylglycerol and reactive oxygen species (ROS), which are accumulated in the cytoplasm increasing lipotoxicity. Moreover, the excess glucose generates polyols and hexosamine, which activate pro-oxidant and proinflammatory pathways and generate advanced glycation end products (AGE), thereby increasing the glucotoxicity.</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The arrows indicate the metabolic changes.</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Abbreviations: ATP/O2, adenosine triphosphate/oxygen ratio; β-ox, beta-oxidation, ETC, electron transport chain; G6P, glucose 6 phosphate; TAG, triacylglycerides; TCA, tricarboxylic acid.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Lorenzo-Almorós, J.M. Cepeda-Rodrigo, Ó. Lorenzo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Lorenzo-Almorós" ] 1 => array:2 [ "nombre" => "J.M." "apellidos" => "Cepeda-Rodrigo" ] 2 => array:2 [ "nombre" => "Ó." "apellidos" => "Lorenzo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520300254" "doi" => "10.1016/j.rce.2019.10.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520300254?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742030103X?idApp=WRCEE" "url" => "/22548874/0000022200000002/v1_202202020644/S225488742030103X/v1_202202020644/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Medicine in Images</span>" "titulo" => "Ostesyntesis-associated infection by <span class="elsevierStyleItalic">S. aureus</span> and the role of PET/CT in the diagnosis of septic complications" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "112" "paginaFinal" => "113" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "R. Roa-Chamorro, A. Godoy-Montijano, A. Moral-Ruiz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "R." "apellidos" => "Roa-Chamorro" "email" => array:1 [ 0 => "ricardoroa@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Godoy-Montijano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "A." "apellidos" => "Moral-Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección de material de osteosíntesis por <span class="elsevierStyleItalic">S. aureus</span> y la utilidad del PET/TC en el diagnóstico de las complicaciones sépticas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1274 "Ancho" => 3340 "Tamanyo" => 289904 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 55-year-old man had HT, DM2, a dual-chamber pacemaker for syncope due to complete AV block, osteosynthesis of the dorsal and lumbar spine (D11-L2), and arthrodesis due to Charcot neuropathic foot with collapse in the Lisfranc joint area in 2017.</p><p id="par0010" class="elsevierStylePara elsevierViewall">He was admitted for an infection associated with osteosynthesis material, which consisted of a nail for arthrodesis in the foot. Methicillin-sensitive <span class="elsevierStyleItalic">Staphylococcus aureus</span> was isolated. During the hospitalization, he started having lumbar pain that was highly localized to the L4-L5 area without fever or other clinical symptoms. Of note on the blood test was a sustained elevation of CRP (peak of 272 mg/L).</p><p id="par0015" class="elsevierStylePara elsevierViewall">In light of a suspicion of infectious spondylodiscitis, an <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan was requested. It showed increased metabolic uptake in the L4-L5 area suggestive of the pathology with a SUVmax of 4.1 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B) and no involvement of the lumbar osteosynthesis material. There was increased uptake in the left supraclavicular fossa around the pacemaker, with a SUVmax of 3.2, and along the path of the pacemaker lead, with a SUVmax of 2.9 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and C).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The suspicion of infectious endocarditis was confirmed with a transesophageal echocardiogram in which a mobile mass measuring 15 × 8 mm was observed in the atrial face of the tricuspid valve posterior leaflet compatible with vegetation/infectious endocarditis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Initially treated with cloxacillin and daptomycin, the patient was operated on; the pacemaker system was removed and a new dual-chamber pacemaker was implanted. <span class="elsevierStyleItalic">S. aureus</span> was isolated in a culture of the extracted system.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We believe that he presented with <span class="elsevierStyleItalic">S. aureus</span> bacteremia whose initial focal point was infection of the left foot arthrodesis. This led to the onset of infectious endocarditis and later vertebral septic embolism. The <span class="elsevierStyleSup">18</span>F-FDG PET/CT scan played a key role in the diagnosis, as it provided additional information with respect to other imaging tests, detecting hidden focal points of inflammation and infection.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-11-21" "fechaAceptado" => "2020-01-16" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Roa-Chamorro R, Godoy-Montijano A, Moral-Ruiz A. Infección de material de osteosíntesis por <span class="elsevierStyleItalic">S. aureus</span> y la utilidad del PET/TC en el diagnóstico de las complicaciones sépticas. Rev Clin Esp. 2022;222:112–113.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1274 "Ancho" => 3340 "Tamanyo" => 289904 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022200000002/v1_202202020644/S225488742100120X/v1_202202020644/en/main.assets" "Apartado" => array:4 [ "identificador" => "71811" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Medicine in images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022200000002/v1_202202020644/S225488742100120X/v1_202202020644/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742100120X?idApp=WRCEE" ]
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Medicine in Images
Ostesyntesis-associated infection by S. aureus and the role of PET/CT in the diagnosis of septic complications
Infección de material de osteosíntesis por S. aureus y la utilidad del PET/TC en el diagnóstico de las complicaciones sépticas