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Introduction: Depressive risk is higher for mothers of infants with chronic medical conditions. The present study examined maternal depressive risk and associations with parent and child outcomes among mothers of young children who were randomized to either prenatal or postnatal surgical closure for myelomeningocele. Methods: Using the Management of Myelomeningocele Study database, maternal depressive risk was examined at 3 time points as follows: prior to birth, 12 months, and 30 months post birth. Separate multivariate analyses examined associations among change in depressive risk (between baseline and 30 months), parenting stress, and child outcomes at 30 months. Results: Mean scores were in the minimal depressive risk range at all the time points. Post birth depressive risk did not differ by prenatal versus postnatal surgery. Mean change scores reflected a decrease in depressive risk during the first 30 months. Only 1.1–4.5% of mothers reported depressive risk in the moderate to severe range across time points. Increased depressive risk during the first 30 months was associated with increased parenting stress scores and slightly lower child cognitive scores at 30 months. Conclusion: Most mothers reported minimal depressive risk that decreased over time, regardless of whether their infant underwent prenatal or postnatal surgery. Only a small percentage of mothers endorsed moderate to severe depressive risk, but an increase in depressive risk over time was associated with higher parental stress and slightly lower child cognitive development.

We present a new adduct of carbon dioxide with dihydrogenphosphide, that may be prepared either by direct reaction of NaPH2 with carbon dioxide or by hydrolysis of the phosphaethynolate ion (PCO- ). In this hydrolysis transformation, a new mechanism is proposed for the electrophilic reactivity of the phosphaethynolate ion. Protonation to form phosphine carboxylic acid (PH2 COOH) and functionalization to form esters is shown to increase the strength of the P-C interaction, allowing for comparisons to be drawn between this species and the analogous carbamic (NH2 COOH) and carbonic acids (H2 CO3 ). Functionalization of the oxygen atom is found to stabilize the phosphine carboxylate while also allowing solubility in organic solvents whereas phosphorus functionalization is shown to facilitate decarboxylation. Substituent migration occurs in some cases.

Background The subnasal lip lift is a surgical technique that elevates the “lip line” (interface between vertical maxillary incisor height and upper lip) to achieve a more youthful aesthetic. Objectives The authors sought to offer the first ever definition, to their knowledge, of 3-dimensional (3D) changes to the upper lip due to subnasal lip lift. Methods A lip lift procedure was performed (on cadaveric samples) in a sequential manner from 2.5- to 5.0-mm intervals (n = 13). 3D photographs were taken with the VECTRA H1 system (Canfield Scientific, Fairfield, NJ), and 3D analysis was performed including vermillion height and width, philtral height, sagittal lip projection, vermillion surface area, and incisor show. A subset of samples (n = 9) underwent a modification of the technique by undermining the upper lip subcutaneous tissue off the underlying muscular fascia. Results Vermillion surface area (baseline range, 1.45-5.52 cm2) increased by an average of 20.5% and 43.1% with 2.5-mm and 5.0-mm lip lift, respectively. Anterior projection of the vermillion increased in all cases by an average of 2.13 and 4.07 mm at 2.5 and 5.0 mm, respectively. Philtral height decreased in all cases by an average of 3.37 and 7.23 mm at 2.5 and 5.0 mm, whereas incisal show increased on average of 1.9 and 4.09 mm, respectively. Conclusions This study is the first to our knowledge to define the 3D morphometric changes to the upper lip following subnasal lip lift. Quantifying these changes aids the surgeon in preoperative planning and guiding patient expectations.

Objectives To describe the h-index as a measure of scientific output. Methods The formula for this index is based on (1) the number of papers published by an author and (2) the number of citations per paper. The h-index can be used to evaluate performance by individuals or by groups of scientists working in university departments or research institutes. Results While the h-index is both objective and quantitative, it has some deficiencies. It does not take into account first or last author publications, numbers of coauthors, or self-citations. Numerous alternative indices have been proposed to better reflect scientists' contributions in their fields. Conclusions Pathologists and clinical laboratory scientists should be familiar with the h-index, as it may be used in decisions about professional advancement.

Calcium pyrophosphate deposition (CPPD) disease is a crystal arthropathy primarily affecting peripheral joints, most commonly the wrist and the knees. However, CPPD in the cervical spine is a rare entity. This report describes a case of CPPD of the cervical spine which presents with symptoms of neck pain and brachalgia. A 62-year-old woman presented with left-sided upper limb and neck pain. MRI scanning revealed a low signal abnormality within the C6 and C7 vertebrae, and the possibility of lymphoma was raised. The patient was recalled for gadolinium-enhanced scans which showed perivertebral and marrow enhancement. Fine-needle aspirate histology initially suggested a spindle cell tumour or lymphoma. However, CT-guided biopsy showed positively birefringent crystals, confirming CPPD. CPPD of the spine is a rare differential of nerve impingement in the cervical spine when MRI scanning perivertebral signal enhancement. Furthermore, CPPD of the spine can mimic malignancy.

Natural attenuation of organic contaminants in groundwater can give rise to a series of complex biogeochemical reactions that release secondary contaminants to groundwater. In a crude oil contaminated aquifer, biodegradation of petroleum hydrocarbons is coupled with the reduction of ferric iron (Fe(III)) hydroxides in aquifer sediments. As a result, naturally occurring arsenic (As) adsorbed to Fe(III) hydroxides in the aquifer sediment is mobilized from sediment into groundwater. However, Fe(III) in sediment of other zones of the aquifer has the capacity to attenuate dissolved As via resorption. In order to better evaluate how long-term biodegradation coupled with Fe-reduction and As mobilization can redistribute As mass in contaminated aquifer, we quantified mass partitioning of Fe and As in the aquifer based on field observation data. Results show that Fe and As are spatially correlated in both groundwater and aquifer sediments. Mass partitioning calculations demonstrate that 99.9% of Fe and 99.5% of As are associated with aquifer sediment. The sediments act as both sources and sinks for As, depending on the redox conditions in the aquifer. Calculations reveal that at least 78% of the original As in sediment near the oil has been mobilized into groundwater over the 35-year lifespan of the plume. However, the calculations also show that only a small percentage of As (∼0.5%) remains in groundwater, due to resorption onto sediment. At the leading edge of the plume, where groundwater is suboxic, sediments sequester Fe and As, causing As to accumulate to concentrations 5.6 times greater than background concentrations. Current As sinks can serve as future sources of As as the plume evolves over time. The mass balance approach used in this study can be applied to As cycling in other aquifers where groundwater As results from biodegradation of an organic carbon point source coupled with Fe reduction.

To determine the prevalence and identify risk factors of autism spectrum disorders (ASDs) and neurodevelopmental delays in giant omphalocele (GO) survivors.The study cohort consists of 47 GO survivors enrolled in our follow-up program between 07/2004 and 12/2015. All patients underwent assessments at 2 years of age or older. Outcomes were assessed by either the Bayley Scales of Infant Development II (prior 2006) or III (after 2006), or the Wechsler Preschool and Primary Scale of Intelligence (children older than 4 years). ASD diagnosis was made based on the Diagnostic and Statistical Manual of Mental Disorders IV (prior to 2014) or 5 criteria.The prevalence of ASD in GO children is 16 times higher than the general population (P = 0.0002). ASD patients were more likely to be diagnosed with neurodevelopmental and neurofunctional delays, language disorders, and genetic abnormalities (P 0.01). While 53.2% of GO children scored within the average range for all developmental domains, 19.1% scored within the mildly delayed and 27.7% in the severe delayed range in at least one domain. Prolonged respiratory support, pulmonary hypertension, gastroesophageal reflux disease, feeding problems, prolonged hospitalization, abnormal BAER hearing screen, presence of delayed motor coordination, and hypotonicity were associated with delayed scores (P 0.05).There is a significant rate of ASD in GO survivors. Neurodevelopmental delays, language delays, and genetic abnormalities were strongly associated with ASD. Neurological impairments were present in nearly half of GO children. Surrogate markers of disease severity were associated with below average neurodevelopmental scores. Level of evidence Level IV.

This paper describes some of the more common patterns in neurobehavioral deficits and their underlying neuroanatomical basis in myelomeningocele (MMC). Patients with MMC can face a lifetime of specific organ system dysfunction, chief among them spinal cord malformations, orthopedic issues, hydrocephalus, and urological disabilities. In addition, patients can experience specific patterns of neurobehavioral difficulties due to the changes in neuroanatomy associated with the open spinal defect. Although there is variability in these patterns, some trends have been described among MMC patients. It is thought that early recognition of these potential neurobehavioral deficits by treating neurosurgeons and other members of the treatment team could lead to earlier intervention and positively impact the overall outcome for patients. Neurodevelopmental and neurobehavioral follow-up assessments are recommended to help guide planning for relevant treatments or accommodations.

Purpose: Training in clinical dosimetry is an important component of radiation therapy,dosimetry, and medical physics training programs. Based on our in‐house treatment planning system, PLanUNC, we are developing and assessing a web‐based dosimetry teaching tool to augment existing training programs. Methods: We surveyed radiation therapy program directors to assess the need for clinical dosimetry training tools. Based on survey results, we are developing a web‐based dosimetry‐training tool consisting of 10 modules containing didactic content based on the ASRT curriculum, student assessment, and hands‐on treatment planning exercises. External content specialists reviewed the self‐paced modules for accuracy and content validity. Two external dosimetry students were observed as they completed three sections, and were interviewed in‐depth to evaluate the modules. This qualitative analysis combined features of usability testing with formative evaluation of instructional products. We revised the modules based on these data. Our next phase, quantitative evaluation, will assess the effectiveness of the modules, the quality of the interactivity and the degree of student engagement when completing the modules. Results: Sixty‐four percent of program directors indicated they had insufficient local resources for dosimetry training, and over 90% indicated interest in web‐based training tools as teaching supplements. External evaluators indicated module content was appropriate and accurate. Students indicated the modules were easy to use with clear and understandable content. They were engaged when using the modules and motivated by the interactive components. They placed value on the exercises and the feedback they received. Conclusions: Inter‐institutional evaluation improves the quality and generalizability of instructional modules. Carefully designed online learning modules are viewed as effective teaching tools by dosimetry students. The clinical dosimetry teaching tool will be made accessible to therapy and dosimetry training programs worldwide. This work is supported by NCI grant 5R25‐CA134307

Trace elements are added to poultry feed to control infection and improve weight gain. However, the fate of these trace elements in poultry litter is poorly understood. Because poultry litter is applied as fertilizer in many agricultural regions, evaluation of the environmental processes that influence the mobility of litter-derived trace elements is critical for predicting if trace elements are retained in soil or released to water. This study examined the effect of dissolved organic carbon (DOC) in poultry litter leachate on the fate and transport of litter-derived elements (As, Cu, P and Zn) using laboratory column experiments with soil collected from the Delmarva Peninsula (Mid-Atlantic, USA), a region of intense poultry production. Results of the experiments showed that DOC enhanced the mobility of all of the studied elements. However, despite the increased mobility, 60-70% of Zn, As and P mass was retained within the soil. In contrast, almost all of the Cu was mobilized in the litter leachate experiments, with very little retention in soil. Overall, our results demonstrate that the mobility of As, Cu, Zn and P in soils which receive poultry litter application is strongly influenced by both litter leachate composition, specifically organic acids, and adsorption to soil. Results have implications for understanding fate and transport of trace elements released from litter application to soil water and groundwater, which can affect both human health and the environment.

This project examined the impact of long-term poultry litter application on the chemical signatures of As, Cu, Zn, and P in stream sediments of the Broadkill River watershed within the Delmarva Peninsula, a region of intense poultry production. Thirty-seven sediment samples were collected from Broadkill River drainage systems and analyzed for litter-derived elements (As, Cu, Zn, P) and basic soil parameters such as particle size distribution, organic matter, and soluble salts. Results showed that concentrations of elements in stream sediments are approximately log-normally distributed. Spatial variability in concentrations of elements was evident, with most elements increasing in concentration and enrichment from upgradient headwaters to downgradient reaches draining predominantly agricultural areas. Results of correlation analyses showed positive significant correlation among elements; elements were also positively correlated with percent clay and silt in the sediment. Using GIS maps with overlays of hydrology and land use activities, statistical correlations between As, Cu, Zn, and P enrichment factors and land use were examined. Results showed statistically significant relationships between As, Mn, and Zn enrichment factors and residential areas within the watershed, but did not show a statistically significant relationship between element enrichment factors and agricultural land use. Factors that complicate this type of landscape-scale study include the presence of poultry processing plants, impoundments, changes in land use over time, and the influence of tides, all of which can have direct and indirect influences on element mobility.

A 29-year-old man presented with a 1-week history of fever, night sweats, reduced appetite, and left upper abdominal pain exacerbated by inspiration. He reported no weight loss, cough, dyspnea, nausea, diarrhea, rash, mouth ulcers, arthralgias, or ocular or urinary symptoms.

Manganese(IV,V)-hydroxo and oxo complexes are often implicated in both catalytic oxygenation and water oxidation reactions. Much of the research in this area is designed to structurally and/or functionally mimic enzymes. On the other hand, the tendency of such mimics to decompose under strong oxidizing conditions makes the use of molecular inorganic oxide clusters an enticing alternative for practical applications. In this context it is important to understand the reactivity of conceivable reactive intermediates in such an oxide-based chemical environment. Herein, a polyfluoroxometalate (PFOM) monosubstituted with manganese, [NaH2(Mn-L)W17F6O55]q–, has allowed the isolation of a series of compounds, Mn(II, III, IV and V), within the PFOM framework. Magnetic susceptibility measurements show that all the compounds are high spin. XPS and XANES measurements confirmed the assigned oxidation states. EXAFS measurements indicate that Mn(II)PFOM and Mn(III)PFOM have terminal aqua ligands and Mn(V)PFOM has a termin...

BACKGROUND Literature cautions against applying lidocaine 15%/prilocaine 5% over an area larger than 300 cm2. The area of the face, neck, and chest is 400 cm2 or greater. OBJECTIVE To investigate the safety of lidocaine 15%/prilocaine 5% topical anesthetic ointment used as anesthesia for intense pulsed light (IPL) treatment. METHODS AND MATERIALS Lidocaine 15%/prilocaine 5% ointment was applied to the face only (n=10) for 30 ± 15 minutes or to the face, neck, and chest (n=10) for a total of 60 ± 15 minutes before IPL. Blood lidocaine and prilocaine levels were measured. Adverse events were recorded. RESULTS For the entire cohort, blood was drawn 25.6 ± 6.6 minutes after IPL was completed. In the face only group, the mean lidocaine level was 0.122 ± 0.125 μg/mL, and the mean prilocaine level was 0.048 ± 0.029 μg/mL. In the face, neck, and chest group, the mean lidocaine level was 0.272 ± 0.208 μg/mL, and the mean prilocaine level was 0.087 ± 0.060 μg/mL. No adverse events related to systemic toxicity were observed or reported to the nurse. At the 24-hour follow-up, no subject reported symptoms of systemic toxicity after leaving the clinic. CONCLUSION Under the conditions of this study, topical lidocaine 15%/prilocaine 5% produces low levels of systemic absorption. The authors have indicated no significant interest with commercial supporters.

Sudden sensorineural hearing loss is usually unilateral and can be associated with tinnitus and vertigo. In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. A careful examination is needed to exclude life threatening or treatable causes such as vascular events and malignant diseases, and patients should be referred urgently for further assessment. About half of patients completely recover, usually in about 2 weeks. Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management.

In the past few years, the term Web 2.0 has become a descriptor for the increased functionality of Web sites, including those with medical content. Most physicians do not know what Web 2.0 means or how it can impact their work lives. This review provides some background on the evolution of Web 2.0 and describes how its features are being incorporated into medical Web sites. Some potential applications of Web 2.0 in pathology and laboratory medicine are discussed, as are the issues that must be considered when adopting this new technology.

The authors present a case of late postoperative infection after augmentation gluteoplasty in a 32-year-old pregnant woman. The case is unique in that it is the first documented example of a gluteal implant infection in a pregnant woman and because the infection was not preceded by trauma to the anatomic region.

Based on complementary metal-oxide semiconductor (CMOS) technology a neurosensor chip with passive palladium electrodes was developed. The CMOS technology allows a high reproducibility of the sensors as well as miniaturization and the on-chip integration of electronics. Networks of primary neurones were taken from murine foetal spinal cord (day 14) and frontal cortex (day 15) tissues and cultured on the silicon surface in a chamber volume of 200 microl with 7 mm diameter. Measurements were performed between days 15 and 59 in vitro. Signals were recorded from both types of cultures. To test the capability of the system to detect pharmacologically induced activity changes two established neuromodulators were applied. The GABA(A)-receptor blocker bicuculline was applied to both tissue cultures, the glycine-receptor blocker strychnine to spinal cord cultures. Four network frequency parameters were analysed: spike rate (SR), burst rate (BR), frequency in bursts (FiB) and peak frequency in bursts (PFiB). Significant changes of spike rate and burst rate were measured with spinal cord cultures after bicuculline application. Significant changes of frequency in bursts and peak frequency in bursts were observed with frontal cortex cultures after bicuculline application. Significant changes of spike rate and frequency in bursts were recorded with spinal cord cultures after strychnine application. These results were compared with results achieved in the same laboratory by using glass-microelectrode arrays (MEAs). This comparison showed for spinal cord similar native spike and burst rate, but higher mean frequency and peak frequency in bursts, whereas frontal cortex activity had higher spike and burst rate and peak frequency in bursts. Application of bicuculline or strychnine to spinal cord networks showed stronger effects on MEAs, whereas with frontal cortex networks the modulation of activity was similar after application of bicuculline.

Recent debate concerning the modification of safe drinking water standards for arsenic (As) has led to increased awareness of the risks As poses to both humans and the environment. However, few studies have examined the effects of As on the diversity and composition of aquatic assemblages in streams. Benthic macroinvertebrate surveys, chemical analysis of water column and sediment, and laboratory toxicity tests were conducted to assess effects of an abandoned As mine on a headwater stream, and to determine the primary component of toxicity. The average 48-hr LC50 value for Daphnia magna was 4316 microg As/L, and the average 96-hr LC50 value for Lepidostoma spp. was 2138 microg As/L. Reproduction was significantly reduced for D. magna at concentrationsor =312 microg As/L in water column laboratory bioassays, and for treatments in bioassays with sediments containing elevated As (or =2630 mg/kg). These results support the findings of the in-stream benthic macroinvertebrate survey as the density and percent Ephemeroptera + Plecoptera, + Trichoptera (EPT) were substantially lower at sites downstream of the mine compared to upstream reference sites. Results of bioassays comparing the toxicity of As-contaminated site water and upstream reference water spiked with As salts suggest that As is the primary component of toxicity impacting the stream. Measured As concentrations at downstream sites were above the recommended Criterion Maximum Concentration of 340 microg As/L and Criterion Continuous Concentration of 150 microg As/L for protection of aquatic life published by the United States Environmental Protection Agency. At the study site, elevated As concentrations likely prevent recruitment of benthic macroinvertebrates and recovery of the perturbed headwater stream.

Background Several studies have attempted to define the dimensions of an aesthetically pleasing eyebrow. However, these dimensions represent the views of plastic surgeons and cosmetologists, not necessarily the general public. We hypothesized that many patients who present to their plastic surgeon for periorbital rejuvenation actually want their eyebrows to be in a more natural position than was represented in the studies we surveyed. Objective A study was designed to define the dimensions of an aesthetically pleasing eyebrow from the perspective of the general public. This was achieved by surveying individuals in our local community. Methods One hundred individuals were surveyed and asked to rank 27 photographs (including photographs of pre- and postoperative patients and of models) on a scale of 1 to 10 and grade each photograph as either “attractive” or “unattractive”. Each survey taker provided extensive background information. The photographs receiving the highest number of points and “attractive” grades were then analyzed for eyebrow dimensions. The following distances were measured: medial canthus (MC) to medial eyebrow (ME), lateral limbus (LL) to lateral eyebrow (LE), and eyebrow arch position (EAP) to eye width (EW). Ratios were determined using the EW for comparison. We also evaluated the EAP in relation to the LL. Results The eyebrow dimensions (mean ± SD) of the most highly ranked female photographs were as follows: MC-ME:EW ratio 0.573 ± 0.126, LL-LE:EW ratio 0.668 ± 0.083, and EAP:EW 0.703 ± 0.1. The eyebrow dimensions (mean ± SD) of the most highly ranked male photographs were as follows: MC-ME:EW ratio 0.547 ± 0.177, LL-LE:EW ratio 0.58 ± 0.171, and EAP:EW 0.63 ± 0.175. The EAP in relation to the LL was found to be 0.925 ± 0.884 cm lateral to the LL in women, and 1.05 ± 1.04 cm lateral to the LL in men. Conclusions Previously published dimensions of an aesthetically pleasing eyebrow, as defined by plastic surgeons and cosmetologists, differ from dimensions currently defined as attractive by the general public in our study.

Context.—Most proficiency testing materials (PTM) contain an artificial matrix that may cause immunoassays to perform differently with this material than with clinical samples. We hypothesized that matrix effects would be reduced by using fresh frozen serum (FFS). Objective.—To compare the performance of an FFS pool to standard PTM for measurement of α-fetoprotein, carcinoembryonic antigen, human chorionic gonadotropin (hCG), and prostate-specific antigen (PSA). Design.—One FFS specimen and 4 different admixtures of PTM were distributed in the 2003 College of American Pathologists K/KN-A (for α-fetoprotein, carcinoembryonic antigen, hCG, and total and free PSA) and C-C (hCG only) Surveys. Participants.—The number of laboratories that participated in the surveys varied from a low of 288 (free PSA, K/KN-A Survey) to a high of 2659 (hCG, C-C Survey). Main Outcome Measures.—Method imprecision and method bias were compared between the FFS specimen and the standard PTM specimen with the closest value. Method imprecision was determined by calculating the coefficients of variation for each method and for all methods combined. Bias was defined as the proportional difference between peer-group mean and the median of all method means. Results.—The FFS specimen gave significantly higher imprecision than PTM for the analytes α-fetoprotein, carcinoembryonic antigen, total PSA, and free PSA. For hCG, no substantial imprecision differences were observed in both surveys. Bias was significantly greater for the α-fetoprotein, carcinoembryonic antigen, and total PSA assays and significantly lower for the hCG and free PSA assays when comparing the FFS with the PTM. Conclusions.—Fresh frozen serum did not provide consistently lower imprecision or bias than standard PTM in a survey of commonly ordered tumor markers.

Context.—There are 2 general types of assays measuring MUC1 gene–derived glycoprotein: assays for cancer antigen (CA) 15-3, which are sandwich assays, and assays for CA 27.29, which are competitive assays. These 2 types of assays measure slightly different parts of this tandem-repeat molecule. Across-method assay differences hinder the exchange of patient test values among integrated health care networks and among countries. Objective.—This report evaluates the method differences among these assays to determine if the differences between these assays are mainly related to variations in calibration or differences in analyte specificity. Design.—Data from 22 College of American Pathologists survey challenges were analyzed to compare 10 commercial assay methods for these 2 related analytes. In addition, data from 58 patient samples were analyzed to compare 3 of these assays. Results.—The linear correlation coefficients comparing the within-method medians of these proficiency test distributions were very high (>0.99) for all of the methods; however, the regression slopes varied from 0.836 to 1.095. The regression slopes for the patient specimens varied similarly, but the correlation coefficients were lower. Conclusions.—This study indicates that many of the test value differences for these measurements are due to differences in assay calibration rather than differences in the specificity of the assay measurement systems. Survey test data potentially could be used to help harmonize these assay differences.

Background: Although many techniques of reduction mammaplasty are currently in use, a prospective study quantitating the sensation of the nipple-areolar complex (NAC) after the performance of specific techniques has not been performed. Objective: The purpose of this study was to quantitate the postoperative sensation of the NAC after reduction mammaplasty and to compare the results on the basis of the orientation of the vascularized pedicle. Methods: We tested 42 patients divided into 4 groups: medial pedicle (9 patients), inferior pedicle (8 patients), free nipple transfer (8 patients), and a control group (17 patients). The specific mammaplasty technique chosen was based on the preoperative assessment and the estimated volume of resection. A Wise pattern approach was used in all cases. NAC sensation was quantified with the use of the Pressure Specified Sensory Device (Sensory Management Services LLC, Baltimore, MD). Results: We detected no significant difference in the volume of reduction between the free nipple group and the medial pedicle group (P =.14). NAC sensation in the free nipple transfer group was significantly lower than either of the pedicle techniques and control group in all areas of testing (P < 0.001), whereas the medial and inferior pedicle groups had no significant sensory differences in NAC sensation (P < 0.001). Conclusions: The medial pedicle technique is safe and reliable and can be used for large-volume reduction mammaplasty to optimize sensation of the NAC.

Purpose: To expand the dosimetric comparison of CyberKnife and Elekta Versa HD regarding their capability to perform SBRT in lung cases by including radiobiological measures, which can estimate the clinical impact of the observed differences. Methods: This study analyzes treatment data of 10 patients, who were treated with SBRT on Elekta Versa HD and replanned using CyberKnife. The original structure sets from the RayStation treatment plans were transferred to MultiPlan and were used for planning, with the exception of the PTV. Special attention was given to the following structures during optimization in MultiPlan: PTV (expanded off GTV instead of ITV), ipsilateral and contralateral lungs, and chest wall. For each patient, the same dosimetric constraints were applied to both plans. The dose volume histograms (DVH) of the targets and organs at risk (OAR) were computed and used to compare the dosimetric differences between the two modalities. Additionally, the tumor control probability (TCP), normal tissue complication probability (NTCP) and complication-free tumor control probability (P+) radiobiological indices were calculated and compared. Results: The dosimetric indices show a negligible differences (Versa – CK) for the PTV (mean dose difference of 1.7 Gy and average minimum dose difference of −0.3 Gy). For the OARs, the average differences in mean and maximum doses, which varied between 0.4 to 1.7 Gy and 1.1 to 4.7Gy, respectively. The average differences in the radiobiological indices were also similar TCP = 0.3±0.6%, Composite NTCP = 2.4±2.9%, and P+ = −.1±3.3%, respectively. Conclusion: Both modalities managed to meet the same dosimetric goals equally well. The similarities between the dosimetric and radiobiological indices indicate that the two treatment modalities are comparable. A larger patient cohort involving patients of different complexities would give a better insight for this comparison.

The highly reactive species [(α2-P2W17O61Co) 2O]14- containing a nearly linear Co—O—Co moiety is prepared by oxidation of [α2-P2W17O61Co II(H2O)]8- and characterized by single crystal XRD, 31 NMR, Raman, and UV/VIS spectroscopy, and DFT calculations.

2-butoxyethanol (2BE) is a solvent commonly incorporated into household and industrial cleaning products. Its ingestion causes rapid central nervous system depression, hypotension, and metabolic acidosis attributable to metabolism of the parent compound to butoxyacetic acid (BAA) by alcohol dehydrogenase. Lactic acidosis is also reported to develop in some cases. Published treatment strategies include the use of ethanol infusion, ethanol with concomitant dialysis, dialysis alone, and fomepizole.We present an unusual case of a coingestion of ethanol and 150-250 mL of pure 2BE, which resulted in rapid obtundation, severe airway edema, hypotension, and prolonged acidosis despite the coingestion of ethanol and the administration of a loading dose of fomepizole. Continuous veno-venous hemodialysis was employed to treat the acidosis. Ingestion was confirmed by gas chromatography and mass spectrometric determinaiton of 2BE and BAA. The patient recovered without sequelae.Alcohol dehydrogenase inhibitors may not be adequate to prevent acidosis in significant ingestions to 2BE and extracorporeal treatments may be necessary.

The objective of this study was to evaluate the effect of allogeneic tissue engineered cartilage implants on healing of osteochondral defects. Rabbit chondrocytes were cultured in monolayer, then seeded onto biodegradable, three-dimensional polyglycolic acid meshes. Cartilage constructs were cultured hydrodynamically to yield tissue with relatively more (mature) or less (immature) hyalinelike cartilage, as compared with adult rabbit articular cartilage. Osteochondral defects in the patellar grooves of both stifle joints either were left untreated or implanted with allogeneic tissue engineered cartilage. Histologic samples from in and around the defect sites were examined 3, 6, 9, and 12, and 24 months after surgery. By 9 months after surgery, defects sites treated with cartilage implants contained significantly greater amounts of hyalinelike cartilage with high levels of proteoglycan, and had a smooth, nonfibrillated articular surface as compared to untreated defects. In contrast, the repair tissue formed in untreated defects had fibrillated articular surfaces, significant amounts of fibrocartilage, and negligible proteoglycan. These differences between treated and untreated defects persisted through 24 months after surgery. The results of this study suggest that the treatment of osteochondral lesions with allogenic tissue engineered cartilage implants may lead to superior repair tissue than that found in untreated osteochondral lesions.

Confocal laser scanning microscopy represents a suitable technique to study the localization of cellular components in three dimension. The authors used this technique to analyse cellular events related to mechanical stimulation of integrin receptors on the cell surface. By performing optical sections the distribution of integrin receptors on the apical surface of an osteoblastic cell was determined. Concerning intracellular compartimentalization of signal transduction events, it was demonstrated that mechanical stimulation of integrins induced their linkage to the cytoskeleton. Cytoskeletally associated proteins like vinculin and talin accumulated in the vicinity of the site where the mechanical stress was applied to integrins on the cell surface. Optical sections revealed that clustering of these proteins proceeded to the base of the cell with gradually decreasing extent. In summary, it was demonstrated that the local distribution of cellular components is an important factor in mechanically induced signal transduction.

A native North American family with acute intermittent porphyria was investigated by molecular methods to locate the causative mutation and identify carriers of the mutant allele. All 15 exons of the porphobilinogen deaminase gene were screened by single-strand conformation polymorphism analysis, and a unique banding pattern was observed in exon 14. Sequencing revealed a one base-pair insertion in this exon that shifts the reading frame of the mRNA, and generates a premature stop codon. Family members were tested for the mutation by amplification of exon 14 followed by digestion with the restriction enzyme NlaIII. The activity of erythrocyte porphobilinogen deaminase was measured in 36 family members. The results agreed with mutational analysis in 32 cases. However, four individuals who were not gene carriers had low enzyme activity, and in the absence of molecular genetic data would have been incorrectly diagnosed. This is the first study to identify the molecular basis of acute intermittent porphyria in native North Americans.

Objectives Determine the prevalence of drug use in injured drivers and identify associated demographic factors and crash characteristics. Design Prospective cross-sectional study. Setting Seven trauma centres in British Columbia, Canada (2010–2012). Participants Automobile drivers who had blood obtained within 6 h of a crash. Main outcome measures We analysed blood for cannabis, alcohol and other impairing drugs using liquid chromatography/mass spectrometry (LCMS). Results 1097 drivers met inclusion criteria. 60% were aged 20–50 years, 63.2% were male and 29.0% were admitted to hospital. We found alcohol in 17.8% (15.6% to 20.1%) of drivers. Cannabis was the second most common recreational drug: cannabis metabolites were present in 12.6% (10.7% to 14.7%) of drivers and we detected Δ-9-tetrahydrocannabinol (Δ-9-THC) in 7.3% (5.9% to 9.0%), indicating recent use. Males and drivers aged under 30 years were most likely to use cannabis. We detected cocaine in 2.8% (2.0% to 4.0%) of drivers and amphetamines in 1.2% (0.7% to 2.0%). We also found medications including benzodiazepines (4.0% (2.9% to 5.3%)), antidepressants (6.5% (5.2% to 8.1%)) and diphenhydramine (4.7% (3.5% to 6.2%)). Drivers aged over 50 years and those requiring hospital admission were most likely to have used medications. Overall, 40.1% (37.2% to 43.0%) of drivers tested positive for alcohol or at least one impairing drug and 12.7% (10.7% to 14.7%) tested positive for more than one substance. Conclusions Alcohol, cannabis and a broad range of other impairing drugs are commonly detected in injured drivers. Alcohol is well known to cause crashes, but further research is needed to determine the impact of other drug use, including drug–alcohol and drug–drug combinations, on crash risk. In particular, more work is needed to understand the role of medications in causing crashes to guide driver education programmes and improve public safety.

The purpose of this study was to determine the lowest dose of Photofrin (P) that would produce a 3:1 or greater ratio between atherosclerotic (AS) and control arterial walls. Aortoiliac AS was created in 24 Yucatan miniswine by a combination of balloon endothelial injury and 2% cholesterol and 15% lard diet for 7 weeks. Arteriography was then performed to demonstrate AS lesions. Following this, swine were given intravenously P in one of the following single dosages: 2.5, 1.0 or 0.5 mg/kg. Twenty-four hours later, swine were sacrificed and aortoiliac and control carotid artery segments removed and photographed with ultraviolet light to differentiate fluorescent from nonfluorescent areas. Arterial specimens were submitted for histologic analysis and chemical extraction for determination of fluorescence using a spectrofluorometer. Tissue concentration (ng/g tissue) of P from AS vessels were: Group I, 130.4 +/- 82.7; Group II, 10.0 +/- 1.2; and Group III, 9.1 +/- 0.6, respectively (P < 0.05). Ratios of P concentration in AS: control vessels were: Group I, 8.1 +/- 13.7; Group II, 1.1 +/- 0.2; and Group III, 0.9 +/- 0.1, respectively (P < 0.05). These results demonstrated that a P dose of 2.5 mg/kg provided at least a 3:1 ratio between AS: control artery wall.

Trace elements used in animal feed additives can be introduced to aquatic environments through application of manures from animal feeding operations to agricultural land as fertilizer. The use of poultry feed additives containing arsenic (As) is of particular concern in the Shenandoah River watershed (Virginia, USA), an agricultural landscape with a high density of poultry operations. This study investigated the relationship between watershed characteristics of Shenandoah River tributaries and trace element concentrations in streambed sediment and tissue of resident mollusks, including: Asian clams (Corbicula fluminea), which are commonly used biomonitors, and pleurocerid snails (Leptoxis carinata), which are generally understudied. Results failed to support the primary hypothesis of a predictive relationship between watershed densities of poultry operations and As concentrations in sediment and mollusk tissue. However, there were statistical relationships between land use in tributary watersheds and other trace elements in sediment (Cu, Mn, Pb, Zn) and tissue (Cd, Hg, Pb). Principal components analysis of the sediment data suggested a possible geologic source of As at some sites. Tissue concentrations of As were significantly higher in snails than in clams, but clams accumulated higher concentrations of other trace elements (Cd, Cr, Hg, Pb, Se). Snails may be useful biomonitors of environmental As, but appear to be less suitable than clams for studies of landscape sources of other trace elements.

As the 100th anniversary of the Flexner report nears, medical student education is being reviewed at many levels. One area of concern, expressed in recent reports from some national health care organizations, is the adequacy of training in the discipline of laboratory medicine (also termed clinical pathology). The Academy of Clinical Laboratory Physicians and Scientists appointed an ad hoc committee to review this topic and to develop a suggested curriculum, which was subsequently forwarded to the entire membership for review. The proposed medical student laboratory medicine curriculum defines goals and objectives for training, provides guidelines for instructional methods, and gives examples of how outcomes can be assessed. This curriculum is presented as a potentially helpful outline for use by medical school faculty and curriculum committees.

A PDA (personal digital assistant) program containing information on 193 laboratory tests was provided to students during the 8-week core clerkship in internal medicine. Students used the program at their own discretion. The number of times each test was accessed during the clerkship was recorded by the program's database. Ten tests were accessed by more than 40% of the students: serum enzymes (lactate dehydrogenase, amylase, alkaline phosphatase, creatine kinase, and gamma-glutamyl transferase), electrolytes (sodium and potassium), renal function tests (urea and creatinine), and a plasma protein (albumin). The most frequently looked up test category was the CBC, followed by liver-related tests, plasma proteins, electrolytes, and autoantibodies. Students at the 2 hospitals where the clerkship was offered had similar test lookup patterns. We conclude that students seek information about laboratory tests that are frequently ordered and directly relevant to the diagnosis and management of their patients.

Purpose: The dose-dependent nature of radiation therapy (RT)-induced lung injury following hypo-fractionated stereotactic RT is unclear. We herein report preliminary results of a prospective study assessing the magnitude of RT-induced reductions in regional lung perfusion following hypo-fractionated stereotactic RT. Methods: Four patients undergoing hypo-fractionated stereotactic lung RT (SBRT: 12 Gy x 4 fractions or 10 Gy x 5 fractions) had a pre-treatment SPECT (single-photon emission computed tomography) perfusion scan providing a 3D map of regional lung perfusion. Scans were repeated 3–6 months post-treatment. Pre- and post SPECT scans were registered to the planning CT scan (and hence the 3D dose data). Changes in regional perfusion (counts per cc on the pre-post scans) were computed in regions of the lung exposed to different doses of radiation (in 5 Gy intervals), thus defining a dose-response function. SPECT scans were internally normalized to the regions receiving

Purpose: TomoTherapy treatment has unique challenges in handling intrafractional motion compared to conventional LINAC. This study is aimed to gain a realistic and quantitative understanding of motion impact on TomoTherapy SBRT treatment of lung and prostate cancer patients. Methods: A 4D dose engine utilizing GPUs and including motion during treatment was developed for the efficient simulation of TomoTherapy delivered dosimetry. Two clinical CyberKnife lung cases with respiratory motion tracking and two prostate cases with a slower non-periodical organ motion treated by LINAC plus Calypso tracking were used in the study. For each disease site, one selected case has an average motion (6mm); the other has a large motion (10mm for lung and 15mm for prostate). SBRT of lung and prostate cases were re-planned on TomoTherapy with 12 Gyx4 fractions and 7Gyx5 fractions, respectively, all with 95% PTV coverage. Each case was planned with 4 jaw settings: 1) conventional 1cm static, 2) 2.5cm static, 3) 2.5cm dynamic, and 4) 5cm dynamic. The intrafractional rigid motion of the target was applied in the dose calculation of individual fractions of each plan and total dose was accumulated from multiple fractions. Results: For 1cm static jaw plans with motions applied, PTV coverage is related to motion type and amplitude. For SBRT patients with average motion (6mm), the PTV coverage remains > 95% for lung case and 74% for prostate case. For cases with large motion, PTV coverage drops to 61% for lung SBRT and 49% for prostate SBRT. Plans with other jaws improve uniformity of moving target, but still suffer from poor PTV coverage (< 70%). Conclusion: TomoTherapy lung SBRT is less motion-impacted when average amplitude of respiratory-induced intrafractional motion is present (6mm). When motion is large and/or non-periodic (prostate), all studied plans lead to significantly decreased target coverage in actual delivered dosimetry.

Context.—As part of a College of American Pathologists (CAP) proficiency testing survey, a comparison is made between human chorionic gonadotropin (hCG) results from an actual patient pool and a similarly targeted artificial sample. The goal is to gain insight into the possible source(s) of bias attributable to the proficiency testing material (PTM) with a view toward creating more appropriate survey materials.Objective.—To compare hCG and related variants in a pool of fresh frozen sera (FFS) with that found in PTM.Design.—The 2003 CAP K/KN-A Survey included a FFS specimen along with admixtures of PTM. The FFS (K-02) and 1 PTM admixture (K-01) had similar mean hCG values. Five hCG-related analytes were measured on these 2 samples by a reference laboratory.Participants.—Approximately 1800 clinical laboratories and diagnostic test kit manufacturers participated in the K/ KN-A Survey.Main Outcome Measures.—Method imprecision (coefficient of variation) and method bias (relative difference between peer group mean and all-method median) were computed for the 2 samples. Differences were evaluated with respect to hCG-related analytes levels.Results.—All-method hCG results were 12.9 mIU/mL (12.9 IU/L) for the PTM material and 21.6 mIU/mL (21.6 IU/L) for the FFS material. Method biases for 14 manufacturers were greater for PTM than for FFS (−40% to +35% and −16% to +23%). Twelve of 14 methods had higher coefficients of variation on PTM. Total hCG and free β hCG measurements by the reference laboratory were 14.1 mIU/ mL (14.1 IU/L) for the PTM material and 18.5 mIU/mL (18.5 U/L) for the FFS material (FFS), and 2.4 (PTM) and 0.7 (FFS) mIU/mL (2.4 and 0.7 IU/L), respectively. On a molar basis, free β represented 17% and 4% of the total hCG, respectively. Levels of hyperglycosylated hCG, nicked hCG, and β core fragment were not measurable in either sample.Conclusions.—It is unlikely that the hCG added to the PTM is the source of the increased bias and variability. The main difference is a 3-fold increase in free β found in the PTM, but methods previously found to strongly react with free β were not systematically elevated. The biases between manufacturers found for the FFS specimen are likely attributable to calibration differences.

Objectives: Acute intermittent porphyria (AIP) is caused by mutations in the porphobilinogen deaminase (PBGD) gene that disrupt the function of the enzyme. Many mutations that lead to decreased PBGD activity have been described. An Arg to Trp substitution at codon 173 (CGG→TGG in exon 10) and designated R173W, which leads to a CRIM-negative phenotype, has been reported in Swedish, Finnish, Scottish, and South African kindreds, and in a Nova Scotian proband with fatal AIP. In this work, we investigated the presence of this mutation in a Nova Scotian patient population presenting with AIP. Design and Methods: Single-strand conformation polymorphism analysis and DNA sequencing by TA cloning and Sanger’s dideoxy chain termination method, were used to confirm the maternal transmission of this mutation to the proband. The mutation also eliminates an NciI (also MspI) endonuclease restriction site, which allows for detection of the mutant allele by polymerase chain reaction amplification and restriction enzyme digestion. Results: The family of the Nova Scotian proband and four other AIP kindreds showed the presence of the same mutation. These five families are descendants of German, Swiss, and French immigrants historically known as the “Foreign Protestants,” who were recruited to Nova Scotia in the 1750s. Conclusion: In all these families, descent from one couple that settled in Nova Scotia in 1751 has been identified by genealogy research, consistent with a founder effect within this population. This is the first identified mutation in PBGD causing AIP that has been linked to a founder effect in descendants of an immigrant population to North America, and which could be traced to such a distant background, similar to the South African variegate porphyria mutation.

Purpose: Microbeam radiation therapy(MRT) is a promising experimental treatment modality produced by large synchrotron facilities. Using carbon‐nanotube (CNT)field emission based x‐ray generation as an enabling technology, we propose a compact MRT small animal irradiator. We report on a Monte Carlo feasibility study of the proposed device.Methods: A prototype 160 kVp CNTMRTdevice was simulated using EGSnrc‐based codes. Dosimetry for 100‐micron thick planar beams at 160 mm SSD was calculated in a 30 mm diameter cylindrical water target. In contrast to single source synchrotron MRT systems, the proposed CNT‐MRT system has multiple linear x‐ray sources were arranged in a ring surrounding the target. The planar dosimetry from the MRT was simulated by using 12–24 equally spaced identical linear x‐ray source segments. Dosimetry for the full MRT array was generated by combining circular planar dose distributions in parallel planes separated by 150–1000 microns. The resulting configurations were analyzed for isocentric dose rate, dose to normal tissue, and peak‐to‐valley ratio. Results: The peak‐to‐valley dose ratio varied from 10 to 100 as the spacing between adjacent parallel microbeams was increased from 150 to 1000 microns. The dose rate at the center of the phantom was calculated to be 700 Gy/A/min per linear source segment. An expected maximum current per source segment of 1 A (due to anode heating) projects a maximum dose rate of 280 Gy/sec at isocenter for a 24‐source segment configuration. The dose rate falls by 80% within 5 mm of the edge of the target area in the center of the phantom, providing significant normal tissue sparing compared with single‐direction MRT techniques. Conclusions:Monte Carlo simulations show that it is feasible for the proposed MRTdevice to produce the dose rate and peak‐to‐valley characteristics needed to conduct MRT research. This work is supported by NCI grant 1U54CA151652