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Background and purposeTwo-thirds of lymphatic malformations in children are found in the head and neck. Although conventionally managed through surgical resection, percutaneous sclerotherapy has gained popularity. No reproducible grading system has been designed to compare sclerotherapy outcomes on the basis of radiologic findings. We propose an MR imaging-based grading scale to assess the response to sclerotherapy and present an evaluation of its interrater reliability.Materials and methodsA grading system was developed to stratify treatment outcomes on the basis of interval changes observed on MR imaging. By means of this system, 56 consecutive cases from our institution with formally diagnosed head and neck lymphatic malformations treated by sclerotherapy were retrospectively graded. Each patient underwent pre- and posttreatment MR imaging. Each study was evaluated by 3 experienced neuroradiologists. Interrater reliability was assessed using the Krippendorff α statistic, intraclass coefficient, and 2-way Spearman ρ correlation.ResultsThe overall Krippendorff α statistic was 0.93 (95% CI, 0.89-0.95), denoting excellent agreement among raters. Intraclass coefficients with respect to consistency and absolute agreements were both 0.97 (95% CI, 0.96-0.98), illustrating low variability. Every combination of individual rater pairs demonstrated statistically significant (P < .01) linear Spearman ρ correlations, with values ranging from 0.90 to 0.95.ConclusionsThe proposed radiographic grading scale demonstrates excellent interrater reliability. Adoption of this new scale can standardize reported outcomes following sclerotherapy for head and neck lymphatic malformation and may aid in the investigation of future questions regarding optimal management of these lesions.

Degradation of marine ecosystems is an increasing problem and extends beyond nearshore coastal waters with significant human development. However, measuring ecosystem damage and decreased ecosystem function can be difficult. Marine mammals have often been recommended as indicators for evaluating ecosystem health. Between March 2010 and July 2014, a significant cetacean unusual mortality event occurred across the northern Gulf of Mexico, where multiple demographically independent populations of common bottlenose dolphins Tursiops truncatus occur adjacent to one another. Some populations are fairly small and restricted to small habitat areas, while other populations have higher abundances and cover broader geographic ranges. An integral component to determining the impact of this event on these populations is identifying what percentage of each population the stranded animals comprise. We applied genetic assignment test methods to stranded dolphins from southeastern Louisiana to determine the proportion of dead dolphins that came from the local estuarine population versus the population found in adjacent coastal waters. Forty-one microsatellite loci were genotyped in 156 live dolphins sampled to represent the 2 potential stocks of origin and in 131 dead stranded dolphins of unknown origin. Both classical assignment tests and genetic stock identification methods indicated that approximately 6 to 7% of the sampled stranded dolphins originated from the Western Coastal Stock and the remainder from the smaller, estuarine stock in Barataria Bay, Louisiana.

The potential for stranded dolphins to serve as a tool for monitoring free-ranging populations would be enhanced if their stocks of origin were known. We used stable isotopes of carbon, nitrogen, and sulfur from skin to assign stranded bottlenose dolphins Tursiops truncatus to different habitats, as a proxy for stocks (demographically independent populations), following the Deepwater Horizon oil spill. Model results from biopsy samples collected from dolphins from known habitats (n = 205) resulted in an 80.5% probability of correct assignment. These results were applied to data from stranded dolphins (n = 217), resulting in predicted assignment probabilities of 0.473, 0.172, and 0.355 to Estuarine, Barrier Island (BI), and Coastal stocks, respectively. Differences were found west and east of the Mississippi River, with more Coastal dolphins stranding in western Louisiana and more Estuarine dolphins stranding in Mississippi. Within the Estuarine East Stock, 2 groups were identified, one predominantly associated with Mississippi and Alabama estuaries and another with western Florida. δ15N values were higher in stranded samples for both Estuarine and BI stocks, potentially indicating nutritional stress. High probabilities of correct assignment of the biopsy samples indicate predictable variation in stable isotopes and fidelity to habitat. The power of δ34S to discriminate habitats relative to salinity was essential. Stable isotopes may provide guidance regarding where additional testing is warranted to confirm demographic independence and aid in determining the source habitat of stranded dolphins, thus increasing the value of biological data collected from stranded individuals.

To assess potential impacts of the Deepwater Horizon oil spill in April 2010, we conducted boat-based photo-identification surveys for common bottlenose dolphins Tursiops truncatus in Barataria Bay, Louisiana, USA (~230 km2, located 167 km WNW of the spill center). Crews logged 838 h of survey effort along pre-defined routes on 10 occasions between late June 2010 and early May 2014. We applied a previously unpublished spatial version of the robust design capture-recapture model to estimate survival and density. This model used photo locations to estimate density in the absence of study area boundaries and to separate mortality from permanent emigration. To estimate abundance, we applied density estimates to saltwater (salinity > ~8 ppt) areas of the bay where telemetry data suggested that dolphins reside. Annual dolphin survival varied between 0.80 and 0.85 (95% CIs varied from 0.77 to 0.90) over 3 yr following the Deepwater Horizon spill. In 2 non-oiled bays (in Florida and North Carolina), historic survival averages approximately 0.95. From June to November 2010, abundance increased from 1300 (95% CI ± ~130) to 3100 (95% CI ± ~400), then declined and remained between ~1600 and ~2400 individuals until spring 2013. In fall 2013 and spring 2014, abundance increased again to approximately 3100 individuals. Dolphin abundance prior to the spill was unknown, but we hypothesize that some dolphins moved out of the sampled area, probably northward into marshes, prior to initiation of our surveys in late June 2010, and later immigrated back into the sampled area.

Paul Verrills,1 Chantelle Sinclair,2 Adele Barnard2 1Metro Pain Group, 2Monash Clinical Research, Monash House, Clayton, Victoria, Australia Abstract: Spinal cord stimulation (SCS) applications and technologies are fast advancing. New SCS technologies are being used increasingly in the clinical environment, but often there is a lag period between the clinical application and the publishing of high-quality evidence on safety and efficacy. Recent developments will undoubtedly expand the applicability of SCS, allowing more effective and individualized treatment for patients, and may have the potential to salvage patients who have previously failed neuromodulation. Already, high-level evidence exists for the safety, efficacy, and cost-effectiveness (Level I–II) of traditional SCS therapies in the treatment of chronic refractory low back with predominant limb pain (regardless of surgical history). More than half of all patients with chronic painful conditions experience sustained and significant levels of pain reduction following SCS treatment. Although only limited evidence exists for burst stimulation, there is now Level I evidence for both dorsal root ganglion SCS and high-frequency SCS that demonstrates compelling results compared with traditional therapies. The body of evidence built on traditional SCS research may be redundant, with newer iterations of SCS therapies such as dorsal root ganglion SCS, high-frequency SCS, and burst SCS. A number of variables have been identified that can affect SCS efficacy: implanter experience, appropriate patient selection, etiologies of patient pain, existence of comorbidities, including psychiatric illness, smoking status, and delay to SCS implant following pain onset. Overall, scientific literature demonstrates SCS to be a safe, effective, and drug-free treatment option for many chronic pain etiologies. Keywords: spinal cord stimulator, neuromodulation, chronic pain, low back pain

Microorganisms produce secondary metabolites with a remarkable range of bioactive properties. The constantly increasing amount of published genomic data provides the opportunity for efficient identification of biosynthetic gene clusters by genome mining. On the other hand, for many natural products with resolved structures, the encoding biosynthetic gene clusters have not been identified yet. Of those secondary metabolites, the scaffolds of nonribosomal peptides and polyketides (type I modular) can be predicted due to their building block-like assembly. SeMPI v2 provides a comprehensive prediction pipeline, which includes the screening of the scaffold in publicly available natural compound databases. The screening algorithm was designed to detect homologous structures even for partial, incomplete clusters. The pipeline allows linking of gene clusters to known natural products and therefore also provides a metric to estimate the novelty of the cluster if a matching scaffold cannot be found. Whereas currently available tools attempt to provide comprehensive information about a wide range of gene clusters, SeMPI v2 aims to focus on precise predictions. Therefore, the cluster detection algorithm, including building block generation and domain substrate prediction, was thoroughly refined and benchmarked, to provide high-quality scaffold predictions. In a benchmark based on 559 gene clusters, SeMPI v2 achieved comparable or better results than antiSMASH v5. Additionally, the SeMPI v2 web server provides features that can help to further investigate a submitted gene cluster, such as the incorporation of a genome browser, and the possibility to modify a predicted scaffold in a workbench before the database screening.