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Introduction The purpose of this study was to develop a multi-institutional registry to characterize the demographics, management, and outcomes of a contemporary cohort of children undergoing congenital lung malformation (CLM) resection. Methods After central reliance IRB approval, a web-based, secure database was created to capture retrospective cohort data on pathologically-confirmed CLMs performed between 2009 and 2015 within a multi-institutional research collaborative. Results Eleven children's hospitals contributed 506 patients. Among 344 prenatally diagnosed lesions, the congenital pulmonary airway malformation volume ratio was measured in 49.1%, and fetal MRI was performed in 34.3%. One hundred thirty-four (26.7%) children had respiratory symptoms at birth. Fifty-eight (11.6%) underwent neonatal resection, 322 (64.1%) had surgery at 1–12 months, and 122 (24.3%) had operations after 12 months. The median age at resection was 6.7 months (interquartile range, 3.6–11.4). Among 230 elective lobectomies performed in asymptomatic patients, thoracoscopy was successfully utilized in 102 (44.3%), but there was substantial variation across centers. The most common lesions were congenital pulmonary airway malformation (n = 234, 47.3%) and intralobar bronchopulmonary sequestration (n = 106, 21.4%). Conclusion This multicenter cohort study on operative CLMs highlights marked disease heterogeneity and substantial practice variation in preoperative evaluation and operative management. Future registry studies are planned to help establish evidence-based guidelines to optimize the care of these patients. Level of evidence Level II.

Study Design A controlled laboratory study, with a single-blind, block-randomization crossover design. Objectives To compare the electrically elicited knee extensor torque produced by 3 clinically available waveforms: 2500-Hz burst-modulated alternating current (BMAC), 1000-Hz BMAC, and 1000-Hz burst-modulated biphasic square-wave pulsed current (BMBPC). Background Neuromuscular electrical stimulation (NMES) is the therapeutic use of electrical current to strengthen muscle. Muscle torque produced by NMES is limited by discomfort. Methods The knee extensor maximal volitional isometric torque (KEMVIT) of 33 able-bodied participants (18 female) was measured and used to normalize the electrically elicited knee extensor torque to produce a percent of KEMVIT (%KEMVIT). Electrically elicited isometric knee extensor torque was measured in response to each of the waveforms at the participants' maximum tolerance. Results The average maximum tolerated stimulation produced 32.0 ± 16.7 %KEMVIT with 2500-Hz BMAC, 38.2 ± 18.4 %KEMVIT with 1000-Hz BMAC, and 42.2 ± 17.1 %KEMVIT with 1000-Hz BMBPC. Tukey honest significant difference (HSD) post hoc testing revealed a statistically significant difference between 2500-Hz BMAC and 1000-Hz BMAC (P = .046), and between 2500-Hz BMAC and 1000-Hz BMBPC (P.001). No statistically significant difference was found between 1000-Hz BMAC and 1000-Hz BMBPC (P = .267). Conclusion For eliciting maximum knee extensor muscle torque, 1000-Hz BMBPC and 1000-Hz BMAC were similarly effective, and 2500-Hz BMAC was less effective. J Orthop Sports Phys Ther 2018;48(3):217-224. Epub 19 Dec 2017. doi:10.2519/jospt.2018.7601.

Background and Purpose: The effect of knee angle on electrically elicited quadriceps muscle torque has not been established. The goal of this study was to determine which knee angle allowed for the production of the greatest knee extensor maximal voluntary isometric torque (KEMVIT), the greatest electrically elicited torque, and the highest percent of KEMVIT from the knee extensor muscles. Case Description: Eighteen participants were secured in a force dynamometer with the knee positioned at 30°, 60°, and 90° flexion. Participants performed KEMVITs followed by electrically elicited contractions to their maximum tolerance. Outcomes: The mean ± SD of the peak KEMVITs was 123.7 ± 35.7 Nm, 222.6 ± 67.1 Nm, and 248.2 ± 81.1 Nm at 30°, 60°, and 90°, respectively. Significantly greater KEMVITs were produced at 60° and 90° than at 30° (p < 0.001). The mean ± SD of the maximally tolerated electrically elicited torques was 71.8 ± 18.8 Nm, 170.9 ± 70.4 Nm, and 134.6 ± 72.6 Nm at 30°, 60°, and 90°, respectively. Significantly higher torques were tolerated at 60° than at 30° (p < 0.001) and 90° (p = 0.018). The mean ± SD of the percent KEMVITs was 59.7 ± 11.7%, 78.2 ± 23.8%, and 52.6 ± 18.7% at 30°, 60°, and 90°, respectively. Significantly greater percent KEMVITs were produced at 60° than at 30° (p = 0.001) and 90° (p < 0.001). Discussion: Electrically elicited quadriceps torque production is greater at 60° as compared to 30° and 90° knee flexion.

The purpose of this study was to evaluate the clinical presentation and operative outcomes of patients with congenital lobar emphysema (CLE) within a large multicenter research consortium.After central reliance IRB-approval, a retrospective cohort study was performed on all operatively managed lung malformations at eleven participating children's hospitals (2009-2015).Fifty-three (10.5%) children with pathology-confirmed CLE were identified among 506 lung malformations. A lung mass was detected prenatally in 13 (24.5%) compared to 331 (73.1%) in non-CLE cases (p 0.0001). Thirty-two (60.4%) CLE patients presented with respiratory symptoms at birth compared to 102 (22.7%) in non-CLE (p 0.0001). The most common locations for CLE were the left upper (n = 24, 45.3%), right middle (n = 16, 30.2%), and right upper (n = 10, 18.9%) lobes. Eighteen (34.0%) had resection as neonates, 30 (56.6%) had surgery at 1-12 months of age, and five (9.4%) had resections after 12 months. Six (11.3%) underwent thoracoscopic excision. Median hospital length of stay was 5.0 days (interquartile range, 4.0-13.0).Among lung malformations, CLE is associated with several unique features, including a low prenatal detection rate, a predilection for the upper/middle lobes, and infrequent utilization of thoracoscopy. Although respiratory distress at birth is common, CLE often presents clinically in a delayed and more insidious fashion.Level III.

Osteoarthritis (OA) is a degenerative joint disease with a high prevalence in dogs. Mesenchymal stem cells have been used to treat humans, dogs, and horses with OA. This report describes a prospective, randomized, blinded, and placebo-controlled clinical efficacy study of intraarticular allogeneic adipose stem cells for the treatment of dogs with osteoarthritis. Health assessments and measurements of pain and activity impairment were performed at baseline and at selected time points through day 60. The primary outcome variable was the owner Client-Specific Outcome Measurement (CSOM) and secondary measures included veterinary pain on manipulation, veterinary global score, and owner global score. The dogs were treated with either a saline placebo or a single dose of allogeneic adipose-derived mesenchymal stem cells in either one or two joints. Seventy-four dogs were statistically analyzed for efficacy outcomes. Success in the primary outcome variable, CSOM, was statistically improved in the treated dogs compared to the placebo dogs (79.2% versus 55.4%, p=0.029). The veterinary pain on manipulation score (92.8% versus 50.2%, p=0.017) and the veterinary global score (86.9% versus 30.8%, p= 0.009) were both statistically improved in treated dogs compared to placebo. There was no detected significant difference between treated and placebo dogs in the incidence of adverse events or negative health findings. Allogeneic adipose-derived stem cell treatment was shown to be efficacious compared to placebo. This large study of dogs also provides valuable animal clinical safety and efficacy outcome data to our colleagues developing human stem cell therapy.

Single-blind, block-randomization crossover design.To compare the knee extensor muscle torque production elicited with 2500-Hz burst-modulated alternating current (BMAC) and with a monophasic pulsed current (MPC) at the maximum tolerated stimulation intensity.Neuromuscular electrical stimulation (NMES) is often used for strengthening the quadriceps following knee surgery. Strength gains are dependent on muscle torque production, which is primarily limited by discomfort. Burst-modulated alternating current stimulation is a clinically popular waveform for NMES. Prior research has established that MPC with a relatively long pulse duration is effective for high muscle torque production.Participants in this study were 20 adults with no history of knee injury. A crossover design was used to randomize the order in which each participant's dominant or nondominant lower extremity received NMES and the waveform (MPC or BMAC) this limb received. Stimulation intensity was incrementally increased until participants reached their maximum tolerance. The torque produced was converted to a percentage of each participant's maximum volitional isometric contraction of the respective limb.A general linear model for a 2-treatment, 2-period crossover design was utilized to analyze the results. The mean ± SD electrically induced percent maximum volitional isometric contraction at maximal participant tolerance was 49.5% ± 19.6% for MPC and 29.8% ± 12.4% for BMAC. This difference was statistically significant (P = .002) after accounting for treatment order and limb, which had no effect on torque production.Neuromuscular stimulation using MPC may be more efficacious than using BMAC to achieve a high torque output in patients with quadriceps weakness.

Forests in northern Michigan will be affected directly and indirectly by a changing climate during the next 100 years. This assessment evaluates the vulnerability of forest ecosystems in Michigan's eastern Upper Peninsula and northern Lower Peninsula to a range of future climates. Information on current forest conditions, observed climate trends, projected climate changes, and impacts to forest ecosystems was considered in order to draw conclusions on climate change vulnerability. Upland spruce-fir forests were determined to be the most vulnerable, whereas oak associations and barrens were determined to be less vulnerable to projected changes in climate. Projected changes in climate and the associated ecosystem impacts and vulnerabilities will have important implications for economically valuable timber species, forest-dependent wildlife and plants, recreation, and long-range planning.

Autologous adipose-derived mesenchymal stem cell (AD-MSC) therapy involves harvesting fat from the patient, isolating the stem and regenerative cells, and administering the cells back to the patient. Autologous AD-MSC therapy in veterinary regenerative medicine has been commercially available since 2003. Previously reported results from a blinded, controlled trial in dogs with chronic osteoarthritis of the coxofemoral (hip) joint demonstrated efficacy of a single intraarticular injection of autologous AD-MSC therapy. The primary objective of the current study was to evaluate the effectiveness of this therapy in dogs with chronic osteoarthritis of the humeroradial (elbow) joints and to determine the duration of effect. Fourteen dogs were recruited. Veterinarians assessed each dog for lameness, pain on manipulation, range of motion, and functional disability using a numeric rating scale at baseline and specified intervals up to 180 days after treatment. Statistically significant improvement in outcome measures was demonstrated.

Autologous stem cell therapy in the field of regenerative veterinary medicine involves harvesting tissue, such as fat, from the patient, isolating the stem and regenerative cells, and administering the cells back to the patient. Autologous adipose-derived stem cell therapy has been commercially available since 2003, and the current study evaluated such therapy in dogs with chronic osteoarthritis of the hip. Dogs treated with adipose-derived stem cell therapy had significantly improved scores for lameness and the compiled scores for lameness, pain, and range of motion compared with control dogs. This is the first randomized, blinded, placebo-controlled clinical trial reporting on the effectiveness of stem cell therapy in dogs.

The level of neonatal and perinatal care that is provided has been improving over the past few decades. This improved care has resulted in better outcomes of extreme premature babies. To examine the effect of the improved quality of care we performed a study on infants that were admitted to our NICU. Seventy-one infants born at a gestational age of 28 weeks or less were admitted to the St. Vincent's Medical Center Level III NICU. Twenty-four of these infants (33.8%) died and forty-seven (66.2%) survived. The mean gestational age of all the admissions was 25.7 weeks. Of the infants who died the mean age was 24.9 weeks, while those survived had an average gestational age of 26.5 weeks. Thirty-four of the infants who survived (72.3%)were followed to assess their neuro-developmental outcome. Most of these infants required ventilatory support for RDS/BPD. The ventilatory days ranged from 2 to 74 days and the length of stay ranged from 53 to 128 days. The incidence of IVH in the infants who were followed was 14.8%. Of the 34 infants, three had a grade II bleed and two had a grade III bleed; two of these required a VP shunt for hydrocephalous. The incidence of ROP in the 34 infants followed was 70%; 12 of them had stage II and 12 had stage III. Of the 12 babies who had stage III ROP, 5 of them required cryotherapy. For developmental assessment the Bayley Test and the neurological examination was performed at 18 months corrective age. This revealed that 7 infants (20%) had a significant delayed performance, 5 infants (14.7%) had mildly delayed performance, and another 5 infants (14.7%) had minimum motor function impairment. The development of the remaining infants has been as expected given their age. As a whole, the incidence of the problems mentioned above has decreased over the years to the levels stated. As the rapid progress in medical care is resulting in increased survival of very low birth weight infants, long term follow-up of these babies is warranted to assess their developmental outcome.

The objective of our study is to reassess the need of routine cranial ultrasound to rule out intraventricular bleed in all neonates with birthweights less than 1500 grams and gestational age less than 32 weeks. For this, we studied 134 babies with birthweights of 500-1500 grams, born between January, 1993 and December, 1994, at St. Vincent Medical Center Level III NICU. Of these, 105 (78.4%) babies survived. Subsequently, we studied 99(94.3%) of the babies who survived using cranial ultrasounds to rule out intraventricular bleed. Of the babies studied, only 12 (12.12%) developed intraventricular bleeding - 6 of them were Grade I and 6 were Grade III. The gestational age of these 12 babies varied from 24 weeks to 30 weeks with a mean gestational age of 26.6 weeks. The birth weight ranged from 605 to 1415 grams with a mean of 961 grams. All babies with bleeding had a significant Respiratory Distress Syndrome, required ventilatory support (required CPAP, IMV or HFV) and developed Broncho-Pulmonary Dysplasia. Three of these babies developed Patent Ductus Arteriosis and required treatment with indomethasin. One infant also had Group-B Streptococcus sepsis. The rest of the infants who had no significant illnesses (transient tachypnea or mild RDS and required oxyhood, etc.) did not develop any bleeding. Therefore, we feel that very low birth weight infants with mild or no illness do not need to be routinely screened for intracranial bleeding. However, further studies need to be done to support these results.

The substitution of digital representations for analog images provides access to methods for digital storage and transmission and enables the use of a variety of digital image processing techniques, including enhancement and computer assisted screening and diagnosis. Lossy compression can further improve the efficiency of transmission and storage and can facilitate subsequent image processing. Both digitization (or digital acquisition) and lossy compression alter an image from its traditional form, and hence it becomes important that any such alteration be shown to improve or at least not damage the utility of the image in a screening or diagnostic application. One approach to demonstrating in a quantifiable manner that a specific image mode is at least equal to another is by clinical experiment simulating ordinary practice and suitable statistical analysis. In this paper we describe a general protocol for performing such a verification and present preliminary results of a specific experiment designed to show that 12 bpp digital mammograms compressed in a lossy fashion to 0.015 bpp using an embedded wavelet coding scheme result in no significant differences from the analog or digital originals.