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Background Emphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis. Case presentation This is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock. Conclusions Our case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

IntroductionThe Royal College of Psychiatrists’ (RCPsych) Leadership and Management Fellow Scheme was established to develop and support a new cohort of medical leaders within psychiatry. Sponsored and mentored by a trainee's local education provider, the scheme combines a high-impact national leadership and management training programme, with a novel in-programme apprenticeship model, where Fellows gain local leadership experience.MethodAn internal review team conducted a mixed-methods evaluation of feedback from Fellows and Mentors on the scheme’s structure, delivery, provision of individual leadership development and the impact fellows had on their teams and the organisations within which they were embedded.ResultsWith a response rate of 67% (n=20) from Fellows and 30% (n=7) from Mentors, a clear benefit from the scheme was observed, alongside opportunities for improvement. Strengths of the scheme included the bespoke in-programme design, mentoring from a senior medical leader, networking opportunities, and experiential learning through local leadership experience, which additionally promoted medical engagement within organisations. Opportunities for improvement included strengthening existing offers, particularly mentoring relationships and enhancing the network established between fellows.ConclusionsA bespoke, uniprofessional and in-programme leadership and management fellow scheme can play an important role in the development of future medical leaders within psychiatry.

A 21-year-old woman presented with abdominal pain and constipation and was found to have hypertension with renal failure. Imaging showed an obstructive mass.

The delivery of RNA genes has great potential in a range of therapeutic applications. A couple of main limitations for RNA-based therapies include its vulnerability to ribonuclease (RNase) digestion, and its transient and low expression levels due to its lack of amplification. Accordingly, a gene delivery platform that includes self-amplifying mRNA inside a protective capsid allowing for cell targeting and uptake could represent a major step forward in mRNA-based gene therapy.The self-amplifying nature of viral-encoded RNA-dependent RNA polymerases (RdRp) of Nodamura virus holds promise in the development of a platform for self-amplifying RNA gene delivery. To protect and assist in uptake of mRNA encoding an RdRp coupled to a gene of interest, plant virus-like-particles (VLPs) are a strong candidate. Cowpea chlorotic mottle virus (CCMV) capsid protein has been shown to be able to package in vitro heterologous mRNAs, and also to make the genes available to mammalian cells. To better characterize the uptake and amplification in mammalian cells of RdRp-associated genes (also called a replicon, because of its self-amplifying nature), both when naked or encapsidated, reporter genes such as enhanced yellow fluorescent protein (EYFP) or luciferase were used.In collaboration with the German pharmaceutical company Boehringer Ingelheim (B-I), evaluation of possible efficacy of this platform for a cancer vaccine was explored by incorporation of a model antigen (Ovalbumin epitope, SIINFEKL) sequence into the RNA1 of Nodamura virus. From in vitro studies involving incubation of OVA-replicon-VLPs, we observed that CCMV VLPs can be taken up by dendritic cells, where replication then occurs to promote increased production of antigen. Flow cytometry analysis revealed increased expression of maturation markers, and assaying the dendritic cell content by qPCR showed a significant number of SIINFEKL epitope-containing RNA. After these OVA-replicon-VLPs are injected into mice, a population of SIINFEKL-specific CD8+ (cytotoxic) T cells results.

According to a memo by City Manager John Deardoff, the FAA established Runway Protection Zones in the early 1990s not to protect aircraft or pilots but to protect the public from potential accidents during take-off and landing. The house is a three-bedroom, two-bathroom ranch-style house built in 1999.