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A hybrid surgical approach was utilized to address cor triatriatum sinister in a 10-month-old castrated male domestic shorthair cat. Prior to surgery, open-mouth breathing occurred with exertion. The procedure was guided by transesophageal echocardiography and fluoroscopy. A minithoracotomy was performed, and the left atrial membrane was accessed via an introducer placed through the left ventricular apex. Sequential balloon dilations were performed, and the mean transmembrane gradient under anesthesia was reduced from 16 mmHg to 2.23 mmHg. Four months after surgery, the transmembrane mean gradient remained lower than prior to intervention. The cat tolerated surgery well and remains free of clinical signs nine months after surgery. [ABSTRACT FROM AUTHOR]

Phytohemagglutinin (PHA) is commonly used to evaluate cell-mediated immunocompetence. In chickens, PHA is typically injected intradermally (i.d.) into the skin (e.g., wing web, wattle, or footpad), and the tissue swelling response is monitored, whereby the extent of tissue swelling positively relates to the individual's cell-mediated immune system capabilities. Although i.d. injected PHA was shown to stimulate mononuclear cell and basophil infiltration to the site of injection, reports on temporal, qualitative, and quantitative aspects of the local cutaneous PHA response are limited. The objective of this study was to use the growing feather (GF) as a cutaneous test site to assess and monitor the type and relative amounts of leukocytes present in the pulp of PHAinjected GF. For this study, male, non-vaccinated Lightbrown Leghorn chickens reared at the Arkansas Experiment Station Poultry Health Laboratory were used. At 9 wk of age, the dermis of 20 18-day-old regenerating GF was injected with 10 μL of either PBS diluent or 300 μg/mL PHA-P (5 chickens per treatment). GF were collected from each chicken before (zero) and at 0.25, 1, 2, 3, 4, 5, and 7 d post injection. At each time point, one GF was collected for immunofluorescent staining of pulp cell suspensions and leukocyte population analysis by flow cytometry, and another GF for histological analysis. Histological analysis confirmed participation of granulocytes and mononuclear cells, primarily lymphocytes, in the cutaneous PHA response. As revealed by flow cytometric cell population analysis, T cells, especially CD4+ T cells, constituted the major portion of the mononuclear cell infiltrate. Levels of CD4+ T cells were greatly elevated in PHA-injected GF within 6 h and remained elevated throughout the 7-day examination period. γδ T cells, CD8+ T cells, and B cells also infiltrated in response to PHA although at lower levels and with different time-course patterns from CD4+ T cells. The dominant presence of CD4+ T cells at the site of PHA injection further affirms this polyclonal response as an indicator of cell-mediated immunity. [ABSTRACT FROM AUTHOR]

Abstract: Aluminum is traditionally used as the primary fuel in nanocomposite energetic systems due to its abundance and high energy release. However, thermodynamically boron releases more energy on both a mass and volumetric basis. Kinetic limitations can explain why boron rarely achieves its full potential in practical combustion applications, and thus has not replaced aluminum as the primary fuel in energetic systems. In particular, the existence of the naturally formed boron oxide (B2O3) shell is believed to play a major role in retarding the reactivity by acting as a liquid barrier if it cannot be efficiently removed. In this paper we demonstrate from constant-volume combustion experiments that nanoboron can be used to enhance the reactivity of nanoaluminum-based Metastable Intermolecular Composites (MICs) when the boron is of the fuel. It was also observed that an enhancement was not achieved when micronboron (700 nm) was used. Thermodynamic calculations showed that the aluminum reaction with CuO was sufficient to raise the temperature above in those mixtures which showed an enhancement. This is above both the boiling point of B2O3 (2338 K) and the melting point of boron (2350 K). A heat transfer model investigates the heating time of boron for temperatures (the region where the enhancement is achieved), and includes three heating times; sensible heating, evaporation of the B2O3 oxide shell, and the melting of pure boron. The model predicts the removal of the B2O3 oxide shell is fast for both the nano- and micronboron, and thus its removal alone cannot explain why nanoboron leads to enhancement while micronboron does not. The major difference in heating times between the nano- and micronboron is the melting time of the boron, with the micronboron taking a significantly longer time to melt than nanoboron. Since the oxide shell removal time is fast for both the nano- and micronboron, and since the enhancement is only achieved when the primary reaction (Al/CuO) can raise the temperature above 2350 K, we conclude that the melting of boron is also necessary for fast reaction in such formulations. Nanoboron can very quickly be heated relative to micronboron, and on a timescale consistent with the timescale of the Al/CuO reaction, thus allowing it to participate more efficiently in the combustion. The results indicate that sufficiently small boron can enhance the reactivity of a nanoaluminum-based MIC when added as the minor component (<50% by mole) of the fuel. [Copyright &y& Elsevier]

Resilience has been described as positive adaptation despite significant adversity. While the evidence cited as determinant of resilience varies across studies, most researchers consider adolescents and young adults who perform well in school; maintain a job; exhibit hope and optimism; engage in positive, nurturing, long-term relationships; and do not have evidence of psychopathology to indeed be resilient. A significant number of children, adolescents, and adults exposed to childhood abuse, poverty, and other substantial stressors exhibit these characteristics. The factors that predict resilience and the role of the primary care nurse practitioner (NP) in fostering positive adaptation are explored in this paper. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Oncology Nursing is the property of Churchill Livingstone, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of European Journal of Oncology Nursing is the property of Churchill Livingstone, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Presents information on a study that measured the concentration and speciation of mercury (Hg) in the surface and deep ocean waters of the South and equatorial Atlantic. Information on the methylated Hg species; Methods; Results and discussion of the study.

Aims The increasing use of highly conformal radiation techniques to treat meningioma confers a greater need for accurate targeting. Several groups have shown that positron emission tomography/computed tomography (PET/CT) information alters meningioma targets contoured by single observers, but whether this translates into improved accuracy has not been defined. As magnetic resonance imaging (MRI) is the cornerstone of meningioma target contouring, simultaneous PET/MRI may be superior to PET/CT. We assessed whether 68 Ga DOTATATE PET imaging (from PET/CT and PET/MRI) reduced interobserver variability (IOV) in meningioma target volume contouring. Materials and methods Ten patients with meningioma underwent simultaneous 68 Ga DOTATATE PET/MRI followed by PET/CT. They were selected as it was anticipated that target volume definition in their cases would be particularly challenging. Three radiation oncologists contoured target volumes according to an agreed protocol: gross tumour volume (GTV) and clinical target volume (CTV) on CT/MRI alone, CT/MRI+PET(CT) and CT/MRI+PET(MRI). GTV/CTV Kouwenhoven conformity levels (KCL), regions of contour variation and qualitative differences between PET(CT) and PET(MRI) were evaluated. Results There was substantial IOV in contouring. GTV mean KCL: CT/MRI 0.34, CT/MRI+PET(CT) 0.38, CT/MRI+PET(MRI) 0.39 ( P = 0.06). CTV mean KCL: CT/MRI 0.31, CT/MRI+PET(CT) 0.35, CT/MRI+PET(MRI) 0.35 ( P = 0.04 for all groups; P > 0.05 for individual pairs). One observer consistently contoured largest and one smallest. Observers rarely decreased volumes in relation to PET. Most IOV occurred in bone followed by dural tail, postoperative bed and venous sinuses. Tumour edges were qualitatively clearer on PET(MRI) versus PET(CT), but this did not affect contouring. Conclusion IOV in contouring challenging meningioma cases was large and only slightly improved with the addition of 68 Ga DOTATATE PET. Simultaneous PET/MRI for meningioma contouring is feasible, but did not improve IOV versus PET/CT. Whether volumes can be safely reduced according to PET requires evaluation. [ABSTRACT FROM AUTHOR]

Radiotherapy (RT) is a mainstay of management of head and neck cancer (HNC) but is associated with high rates of severe toxicity. Currently there is a lack of objective criteria that can predict premature RT termination or delayed RT treatment completion. This study aims to evaluate objective criteria that can be used to identify patients who are less likely to tolerate an extended course of RT treatment. A RT completion scoring system was developed based on patient characteristics (Table 1), which was used to assign patients with a total score. For validation of the scoring, patients with HNC treated with curative intent with RT at our tertiary care center from 2017 to 2023 were reviewed from a large departmental database (IRB approved). Patients were included if they had a diagnosis of primary HNC and were prescribed curative RT, either as primary treatment or post-operatively. Individual variables were scored and a total score was calculated for each patient. Early termination (ET) was defined as any non-completion of full radiation course. Prolonged treatment (PT) was defined as any radiation course >50 days. Chi-squares test / Fisher's exact test was used for categorical data. Univariable logistic regression was used for continuous data. Significance level was 0.05 for all tests unless otherwise specified. Data analysis was performed using SAS Version 9.4. Of 301 patients included, 182 (60%) were male and 119 (40%) were female. Median age was 66.9 years (range 20.3-96.0 years). 267 (89%) were treated with IMRT and 34 (11%) with SBRT. 150 (50%) had primary cancer in the oral cavity, 53 (18%) in the salivary glands, 45 (14%) in the oropharynx, 53 (18%) in the nasal cavity, sinuses, nasopharynx, larynx, hypopharynx and thyroid. 40 patients (13.3%) had PT and 14 (4.7%) had ET. For each unit increase in total score, there was significant increased risk of ET/PT (p value 0.002; odds ratio 1.17, 95% CI = 1.06-1.28). On multivariable analysis considering these covariates, patients with ECOG score 2-4 had higher risk of ET/PT than patients with ECOG score of 0-1 (odds ratio 3.63, 95% CI = 1.74-7.54, p value <0.001). Patients receiving >30 fractions had higher risk of ET/PT than those receiving <5 fractions (odds ratio 5.60, 95% CI = 1.09-28.71, p value = 0.039). Patients receiving concurrent chemotherapy had higher risk of ET/PT than patients receiving no systemic therapy (odds ratio 2.16, 95% CI = 1.08-4.34, p value = 0.030). This novel radiation treatment score predicted ET/PT in RT treatment of HNC. Total score, ECOG score, total fractions and associated therapy were significantly associated with ET/PT. We plan to validate this score prospectively in patients with HNC being treated with RT. [ABSTRACT FROM AUTHOR]

This is especially the case in liver surgery, and given the complex surgical anatomy of the liver, this mental exercise can be challenging for surgical trainees. The objective of this study is to determine whether a 3D model of pre-operative axial imaging improves the surgical trainee's assessment of liver lesions and aids in surgical planning. [Extracted from the article]

OBJECTIVE: Caring is closely associated with reduced malpractice litigation, adherence to treatment and even symptom relief. Caring also is included in pay for performance formulas as well as widely utilized for quality improvement purposes. Our objective in this prospective qualitative study was to define caring behaviors associated with three challenging encounters: discussing the transition from curative to palliative care, delivering bad news (cancer), and discussing a medical error (misplaced test result). The purpose was to lay the groundwork for the creation of a 'patient-centered' caring attitude checklist that could help the healthcare provider understand and ultimately enhance the patient's experience of care. METHODS: Groups of randomly selected lay people, henceforth referred to as patients: (1) engaged in 'think aloud' exercises to help create a 15-item caring behavior checklist; (2) used the checklist to rate videotapes of simulated challenging encounters conducted by twenty primary care physicians (total of 600 ratings sets); and (3) participated in 12 separate 1.5h focus groups discussing the caring (and non-caring) behaviors exhibited in videotapes of the highest and lowest rated encounters. RESULTS: Thirteen behaviors emerged as focal for describing a doctor's caring attitude but with disagreement as to whether specific examples of these behaviors were 'caring' or 'uncaring.' For example, although the concept of empathic inquiry was considered important by most patients, the physician question, 'Is there someone you can call or talk with' (about a cancer diagnosis) was interpreted by one patient as 'very caring' while another was 'impressed with how uncaring' the statement appeared. CONCLUSION: At the conceptual level there is a set of behaviors that represent caring, however, the manifestation of these behaviors is 'in the eye of the beholder.' The most important element of caring may not be the set of behaviors but a set of underlying abilities that include taking the patient's perspective and reflecting on the patient's responses. PRACTICE IMPLICATIONS: Medical education must focus on the underlying abilities of caring. [ABSTRACT FROM AUTHOR]

The objective of this study was to document temporal trends in bulk tank somatic cell count (SCC) and total bacterial counts (TBC) in Irish dairy herds during the years 1994 to 2004. Three milk processors participated in the study, providing data on 2,754,270 individual bulk tank SCC and 2,056,992 individual bulk tank TBC records from 9,113 herds. Somatic cell counts decreased during the years 1994 to 2000, followed by an annual increase thereafter of more than 2,000 cells/mL. A tendency existed for TBC to decrease over time. Across all years, bulk tank SCC were the lowest in April and highest in November; TBC were the lowest in May and highest in December. The significant seasonal pattern observed in herd SCC and TBC was an artifact of seasonal calving in Ireland. In general, herds selling more milk had lower bulk tank SCC and TBC. Herds having the highest SCC (i.e., >450,000 cells/mL) and the lowest SCC (i.e., ≤150,000 cells/mL) both contributed substantially to the mean SCC of the milk pool collected by the milk processors. Derived transition matrices showed that between adjacent years, herds had the greatest probability of remaining in the same annual mean SCC or TBC category. [ABSTRACT FROM AUTHOR]