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We present a determination of the isovector, $P$-wave $\pi\pi$ scattering phase shift obtained by extrapolating recent lattice QCD results from the Hadron Spectrum Collaboration using $m_\pi =236$ MeV. The finite volume spectra are described using extensions of L\"uscher's method to determine the infinite volume Unitarized Chiral Perturbation Theory scattering amplitude. We exploit the pion mass dependence of this effective theory to obtain the scattering amplitude at $m_\pi= 140$ MeV. The scattering phase shift is found to be in good agreement with experiment up to center of mass energies of 1.2 GeV. The analytic continuation of the scattering amplitude to the complex plane yields a $\rho$-resonance pole at $E_\rho= \left[755(2)(1)(^{20}_{02})-\frac{i}{2}\,129(3)(1)(^{7}_{1})\right]~{\rm MeV}$. The techniques presented illustrate a possible pathway towards connecting lattice QCD observables of few-body, strongly interacting systems to experimentally accessible quantities., Comment: 8 pages, 6 figures, equivalent to published version, added two appendices and a figure

Background Middle-third clavicle fractures represent 2% to 4% of all skeletal trauma in the United States. Treatment options include intramedullary (IM) as well as plate and screw (PS) constructs. The purpose of this study was to analyze the biomechanical stability of a specific IM system compared with nonlocking PS fixation under low-threshold physiologic load. Methods Twenty fourth-generation Sawbones (Pacific Research Laboratories, Vashon, WA, USA) with a simulated middle-third fracture pattern were repaired with either an IM device (n = 10) or superiorly positioned nonlocking PS construct (n = 10). Loads were modeled to simulate physiologic load. Combined axial compression and torsion forces were sequentially increased until failure. Data were analyzed on the basis of loss of rotational stability using 3 criteria: early (10°), clinical (30°), and terminal (120°). Results No significant difference was noted between constructs in early loss of rotational stability (P > .05). The PS group was significantly more rotationally stable than the IM group on the basis of clinical and terminal criteria (P Conclusions When tested under physiologic load, fixation failure occurred from loss of rotational stability. No statistical difference was seen between groups under early physiologic loads. However, during load to failure, the PS group was statistically more rotationally stable than the IM group. Given the clavicle's function as a bony strut for the upper extremity and the biomechanical results demonstrated, rotational stability should be carefully considered during surgical planning and postoperative advancement of activity in patients undergoing operative fixation of middle-third clavicle fractures. Level of evidence Basic Science Study; Biomechanics

Optical coherence tomographic angiography (OCTA) is a novel technology capable of imaging retinal vasculature three-dimensionally at capillary scale without the need to inject any extrinsic dye contrast. However, projection artifacts cause superficial retinal vascular patterns to be duplicated in deeper layers, thus interfering with the clean visualization of some retinal plexuses and vascular pathologies. Projection-resolved OCTA (PR-OCTA) uses post-processing algorithms to reduce projection artifacts. With PR-OCTA, it is now possible to resolve up to 4 distinct retinal vascular plexuses in the living human eye. The technology also allows us to detect and distinguish between various retinal and optic nerve diseases. For example, optic nerve diseases such as glaucoma primarily reduces the capillary density in the superficial vascular complex, which comprises the nerve fiber layer plexus and the ganglion cell layer plexus. Outer retinal diseases such as retinitis pigmentosa primarily reduce the capillary density in the deep vascular complex, which comprises the intermediate capillary plexus and the deep capillary plexus. Retinal vascular diseases such as diabetic retinopathy and vein occlusion affect all plexuses, but with different patterns of capillary loss and vascular malformations. PR-OCTA is also useful in distinguishing various types of choroidal neovascularization and monitoring their response to anti-angiogenic medications. In retinal angiomatous proliferation and macular telangiectasia type 2, PR-OCTA can trace the pathologic vascular extension into deeper layers as the disease progress through stages. Plexus-specific visualization and measurement of retinal vascular changes are improving our ability to diagnose, stage, monitor, and assess treatment response in a wide variety of optic nerve and retinal diseases. These applications will be further enhanced with the continuing improvement of the speed and resolution of the OCT platforms, as well as the development of software algorithms to reduce artifacts, improve image quality, and make quantitative measurements.

PURPOSE: Ultrasound is the imaging method of choice in gynecology. The quality and diagnostic accuracy of ultrasound depends on the skills of the individual performing the scan. Evaluation of ultrasound practice has received limited attention. METHODS: A video recording device was connected to an ultrasound machine in gynecology clinics in a teaching hospital. To minimize the observer effect, all staff were notified through email in advance. Data were collected over a 3-week period. Anonymous recordings of both patients and user were compared with current guidelines, and practice was categorized as: compliant, partially compliant, or non-compliant. RESULTS: Observations (n = 43) were categorized and the results described as percentage frequencies (%). Image optimization was compliant in 23.3% of recorded observations, 11.6% was partially compliant, and 65.1% was noncompliant. The study also found that global examination on gynecology was 20.9% compliant, 18.6% partially compliant, and 60.47% noncompliant. Images were annotated in appropriately 41.9% of instances, and 25.6% of end-users examined bladder, vagina, and cervix when indicated. CONCLUSION: The pilot evaluation showed that ultrasound practice among end-users did not reflect current guidelines, suggesting a need for improvement. Accuracy and performance of ultrasound examination remains highly operator-dependent although video evaluation can be an effective tool for assessing such skills.

The 2018 Ocular Oncogenesis and Oncology Conference was held through a partnership of the Association for Research in Vision and Ophthalmology (ARVO) and the Champalimaud Foundation. Twenty-one experts from international ocular oncology centers, from the Champalimaud Clinical Centre and the Champalimaud Foundation Cancer Research Program, and from patient advocacy organizations, delivered lectures on subjects that ranged from global ocular oncology, to basic research in mechanisms of ocular malignancy, to clinical research in ocular cancers, and to anticipated future developments in the area. The scientific program of the conference covered a broad range of ocular tumors-including uveal melanoma, retinoblastoma, ocular surface tumors, and adnexal and intraocular lymphomas-and pathogenesis and management were deliberated in the context of the broader systemic cancer discipline. In considering the latest basic and clinical research developments in ocular oncogenesis and oncology, and providing the opportunity for cross-talk between ocular cancer biologists, systemic cancer biologists, ocular oncologists, systemic oncologists, patients, and patient advocates, the forum generated new knowledge and novel insights for the field. This report summarizes the content of the invited talks at the 2018 ARVO-Champalimaud Foundation Ocular Oncogenesis and Oncology Conference.

We present new Hubble Space Telescope (HST) ultraviolet and ground-based optical observations of the hot, metal-rich white dwarf GD 394. Extreme-ultraviolet (EUV) observations in 1992-1996 revealed a 1.15d periodicity with a 25 percent amplitude, hypothesised to be due to metals in a surface accretion spot. We obtained phase-resolved HST/Space Telescope Imaging Spectrograph (STIS) high-resolution far-ultraviolet (FUV) spectra of GD 394 that sample the entire period, along with a large body of supplementary data. We find no evidence for an accretion spot, with the flux, accretion rate and radial velocity of GD 394 constant over the observed timescales at ultraviolet and optical wavelengths. We speculate that the spot may have no longer been present when our observations were obtained, or that the EUV variability is being caused by an otherwise undetected evaporating planet. The atmospheric parameters obtained from separate fits to optical and ultraviolet spectra are inconsistent, as is found for multiple hot white dwarfs. We also detect non-photospheric, high-excitation absorption lines of multiple volatile elements, which could be evidence for a hot plasma cocoon surrounding the white dwarf., Accepted for publication in MNRAS

Purpose: To report a case of orbital cellular epithelioid hemangioma (EH) in which FOSB and CAMTA1 immunostains were used to detect a cytogenetic rearrangement as an adjunctive tool in diagnosis. Methods: Case report. Results: A patient with a history of prior ligation of a presumed orbital varix presented with recurrent proptosis. Imaging revealed a highly vascular right orbital mass. Microscopic examination revealed a circumscribed neoplasm composed of plump epithelioid endothelial cells with copious mildly eosinophilic cytoplasm and relatively uniform vesicular nuclei. To aid in diagnosis, immunostains for FOSB and CAMTA1 were performed to detect corresponding cytogenetic rearrangements. The presence of multifocal nuclear positivity for FOSB, indicating FOSB genetic rearrangement, and negativity for CAMTA1 were considered reassuring features against a diagnosis of a malignant epithelioid hemangioendothelioma (EHE), supporting a diagnosis of benign cellular EH. Conclusions: This case report demonstrates that the use of immunohistochemical stains to detect cytogenetic rearrangements may aid in the distinction between benign EH and malignant EHE. It also reminds providers of the clinical and histopathologic features of this lesion, which occurs rarely in the orbit, and helps clarify the evolving nomenclature surrounding epithelioid hemangioma.

Mastitis in a single quarter can cause high somatic cell counts (SCC), clinical mastitis, and death in dairy cows. Currently, management of these mastitic quarters presents a problem for the dairy industry. Casein hydrolysate (CH) is an intramammary (IMM) infusion treatment reported to induce mammary involution. The primary objectives of this study were to investigate whether IMM CH treatment of single high SCC quarters, followed by cessation of quarter milk production for the remainder of lactation, was effective in reducing cow–level SCC and whether that quarter resumed milk production following calving. Three treatment groups were used: CH, non-hydrolyzed casein (NHC), and cessation of milking only (negative; N). Treatments were assigned in a 2:2:1 ratio for 40 cows enrolled in the study; 27 cows completed the entire protocol. Following IMM infusion and involution of the single mastitic quarter, decreases in cow–level SCC (-966,000/ml) and milk production (-11 lb (5 kg), -14%) with 3 remaining lactating quarters were significant for all 28 cows combined. Cows treated with CH (n=17) had a significant decrease in cow– level SCC (-1,150,000/ml) during remaining lactation. All treated quarters returned to milk production after calving, and their proportion of total–cow milk production (24%) was not different than before treatment (28%). After calving, treated quarters’ decrease in SCC was significant for CH (-2,763,000/ml; n=14) and N (–5,324,000/ml; n=5). Of 16 quarters with positive milk culture before treatment that completed the protocol, 88% (14/16) were cured (no isolation of the same bacteria for 3 weeks following calving). A new intramammary infection (IMI) was detected in 67% (18/27) of previously treated quarters post-calving. Infusing single mastitic quarters with casein hydrolysate to induce involution for the remainder of lactation may be a promising alternative to current methods.

Osteoporosis is common throughout the world. Complications include fragility fractures. In this paper I will describe the condition as it relates to athletes young and old. It will be seen that osteoporosis may result from poorly managed sporting activities at the same time it may be ameliorated by exercise in those susceptible to the disorder. I will discuss the epidemiology, the protective effect of exercise, the therapeutic benefits of sport and exercise in the older population with fragility fractures, the effects of weight limited sport and the severe risks to those who diet and exercise intensely at the same time. I will cover the range of diagnostic investigations including imaging and non-radiological techniques and focus on advice to the coach and athlete to maintain bone health throughout an athletic and sporting lifetime.

OBJECTIVE: To evaluate the projection-resolved (PR) optical coherence tomography angiography (OCTA) algorithm in detecting plexus-specific vascular abnormalities in retinal pathologies. DESIGN: Cross-sectional observational clinical study PARTICIPANTS: Patients diagnosed with retinal vascular diseases and healthy volunteers. METHODS: Eyes were imaged using an OCT system operating at 840 nm and employing the split-spectrum amplitude decorrelation algorithm. A novel algorithm suppressed projection artifacts inherent to OCTA. The volumetric scans were segmented and visualized on different plexuses. MAIN OUTCOME MEASURES: Qualitative observation of vascular abnormalities on both cross-sectional and en face PR-OCTA images. RESULTS: Eight illustrative cases are reported. In cases of diabetic retinopathy, retinal vessel occlusion, and retinitis pigmentosa, PR-OCTA detected retinal nonperfusion regions within deeper retinal plexuses not visualized by conventional OCTA. In age-related macular degeneration, cross-sectional PR-OCTA permitted the classification of choroidal neovascularization, and, in a case of retinal angiomatous proliferation, identified a vertical vessel contiguous with the deep capillary plexus. In macular telangiectasia, PR-OCTA detected a diving perifoveal vein and delineated subretinal neovascularization. CONCLUSIONS: Application of PR-OCTA promises to improve sensitive, accurate evaluation of individual vascular plexuses in multiple retinal diseases.

A stored energy based methodology for calculating the driving force for crack growth is introduced which can capture the highly local microstructural sensitivity. This has been implemented in the context of crystal plasticity finite element simulations with explicit representation of the crack with the eXtended Finite Element Method (XFEM), with non-local approaches for both stored energy and J-integral calculation. The model is shown to have good agreement with discrete dislocation plasticity (DDP) models in terms of the crack-tip dislocation configurational energy, and with experimental observations of long and very short (microstructurally-sensitive) cracks for both fracture toughness and crack growth rate data. The method is shown to capture the microstructural sensitivity, in contrast with the widely used J-Integral method. By modelling different crack lengths, the diminution of the microstructural sensitivity with increasing crack length is quantified and a critical length defined above which the microstructural sensitivity is insignificant.

We present the first determination of $\rho \pi$ scattering, incorporating dynamically-coupled partial-waves, using lattice QCD, a first-principles numerical approach to QCD. Considering the case of isospin-2 $\rho \pi$, we calculate partial-wave amplitudes with $J \le 3$ and determine the degree of dynamical mixing between the coupled $S$ and $D$-wave channels with $J^P=1^+$. The analysis makes use of the relationship between scattering amplitudes and the discrete spectrum of states in the finite volume lattice. Constraints on the scattering amplitudes are provided by over one hundred energy levels computed on two lattice volumes at various overall momenta and in several irreducible representations of the relevant symmetry groups. The spectra follow from variational analyses of matrices of correlations functions computed with large bases of meson-meson operators. Calculations are performed with degenerate light and strange quarks tuned to the physical strange quark mass so that $m_\pi \sim 700$ MeV, ensuring that the $\rho$ is stable against strong decay. This work demonstrates the successful application of techniques, opening the door to calculations of scattering processes that incorporate the effects of dynamically-coupled partial-waves, including those involving resonances or bound states., Comment: Minor changes to match the published version

A decrease in the incidence of bovine mastitis, the costliest disease in the dairy industry, can be facilitated through genetic marker-assisted selective breeding programs. Identification of genomic variants associated with mastitis resistance is an ongoing endeavor for which genome-wide association studies (GWAS) using high-density arrays provide a valuable tool. We identified single nucleotide polymorphisms (SNPs) in Holstein dairy cattle associated with mastitis resistance in a GWAS by using a high-density SNP array. Mastitis-resistant (15) and mastitis-susceptible (28) phenotypic extremes were identified from 224 lactating dairy cows on commercial dairy farm located in Utah based on multiple criteria of mastitis resistance over an 8-month period. Twenty-seven quantitative trait loci (QTLs) for mastitis resistance were identified based on 117 SNPs suggestive of genome-wide significance for mastitis resistance (p ≤ 1 × 10−4), including 10 novel QTLs. Seventeen QTLs overlapped previously reported QTLs of traits relevant to mastitis, including four QTLs for teat length. One QTL includes the RAS guanyl-releasing protein 1 gene (RASGRP1), a candidate gene for mastitis resistance. This GWAS identifies 117 candidate SNPs and 27 QTLs for mastitis resistance using a selective genotyping approach, including 10 novel QTLs. Based on overlap with previously identified QTLs, teat length appears to be an important trait in mastitis resistance. RASGRP1, overlapped by one QTL, is a candidate gene for mastitis resistance.

Importance Diabetic retinopathy (DR) is a leading cause of vision loss that is managed primarily through qualitative clinical examination of the retina. Optical coherence tomography angiography (OCTA) may offer an objective and quantitative method of evaluating DR. Objective To quantify capillary nonperfusion in 3 vascular plexuses in the macula of eyes patients with diabetes of various retinopathy severity using projection-resolved OCTA (PR-OCTA). Design, Setting, and Participants Cross-sectional study at a tertiary academic center comprising 1 eye each from healthy control individuals and patients with diabetes at different severity stages of retinopathy. Data were acquired and analyzed between January 2015 and December 2017. Main Outcomes and Measures Foveal avascular zone area, extrafoveal avascular area (EAA), and the sensitivity of detecting levels of retinopathy. Results The study included 39 control individuals (20 women [51%]; mean [SD] age, 43.41 [19.37] years); 16 patients with diabetes without retinopathy (8 women [50%]; mean [SD] age, 56.50 [12.43] years); 23 patients with mild to moderate nonproliferative DR (18 women [78%] ; mean [SD] age, 62.48 [10.55] years); and 32 patients with severe nonproliferative DR or proliferative DR (12 women [38%]; mean age, 53.41 [14.05] years). Mean (SD) foveal avascular zone area was 0.203 (0.103) mm2for control individuals, 0.192 (0.084) mm2for patients with diabetes without retinopathy, 0.243 [0.079] mm2for mild to moderate nonproliferative DR, and 0.359 (0.275) mm2for severe nonproliferative DR or proliferative DR. Mean (SD) EAA in whole inner retinal slab in these groups, respectively, were 0.020 (0.031) mm2, 0.034 (0.047) mm2, 0.038 (0.040) mm2, and 0.237 (0.235) mm2. The mean (SD) sum of EAA from 3 segmented plexuses in each of the respective groups were 0.103 (0.169) mm2, 0.213 (0.242) mm2, 0.451 (0.243) mm2, and 1.325 (1.140) mm2. With specificity fixed at 95%, using EAA in inner retinal slab, the sensitivity of detecting patients with diabetes from healthy control individuals was 28% (95% CI, 18%-40%), 31% for patients with DR (95% CI, 19%-45%), and 47% for patients with severe DR (95% CI, 29%-65%) from whole inner retinal EAA. With the sum of EAA from 3 individual plexuses, the sensitivities were 69% (95% CI, 57%-80%), 82% (95% CI, 70%-91%), and 97% (95% CI, 85%-100%), respectively. Avascular areas were not associated with signal strength index. The commercial vessel density from the 2-plexus scheme distinguished the groups with lower sensitivity and were dependent on SSI. Conclusions and Relevance Automatically quantified avascular areas from a 3-layer segmentation scheme using PR-OCTA distinguished levels of retinopathy with a greater sensitivity than avascular areas from unsegmented inner retinal slab or measurements from a commercially available vessel density in 2-layer scheme. Additional studies are needed to investigate the applicability of nonperfusion parameters in clinical settings.

Pectoralis major rupture is an uncommon injury often treated surgically, requiring anatomic knowledge of the tendon insertion. This study defines the pectoralis major tendon insertion footprint and a novel anatomic relationship. Twelve cadaver shoulders were evaluated andmeasured using a standard surgical ruler to demonstrate the normal anatomic footprint. Measurements were taken from the anterior medial margin of the articular surface of the humeral head to the superior margin of the pectoralis major insertion and its relation to the latissimus dorsi tendon insertion. The average length and width of the pectoralis major insertion were 73.3 ± 10.0 mm and 3.3 ± 0.54 mm, respectively, consistent with previous publications. On average, the superior margin of the pectoralis tendon was within 1 mm of the latissimus dorsi insertion and 41.2 ± 9.27 mm from the articular margin. These points form a new anatomic reference of the latissimus dorsi, providing an intraoperative reference point when performing pectoralis major muscle tendon repair. (Journal of Surgical Orthopaedic Advances 27(1):39-41, 2018).

Transplantation of potentially therapeutic cells into the subretinal space is a promising prospective therapy for the treatment of retinal degenerative diseases including age-related macular degeneration (AMD). In rodent models with photoreceptor degeneration, subretinal transplantation of cell suspensions has repeatedly been demonstrated to rescue behaviorally measured vision, maintain electrophysiological responses from the retina and the brain, and slow the degeneration of rod and cone photoreceptors for extended periods. These studies have led to the initiation of a number of FDA-approved clinical trials for application of cell-based therapy for AMD and other retinal degenerative diseases. However, translation from rodent models directly into human clinical trials skips an important intermediary preclinical step that is needed to address critical issues for intraocular cell transplantation. These include determination of the most appropriate and least problematic surgical approach, the application of treatment in an eye with similar size and structure including the presence of a macula, and a thorough understanding of the immunological considerations regarding graft survival and the consequences of grafted cell rejection. This chapter will review these and related issues and will document current efforts to address these concerns.

We present the first lattice QCD study of coupled isoscalar $\pi\pi,K\overline{K},\eta\eta$ $S$- and $D$-wave scattering extracted from discrete finite-volume spectra computed on lattices which have a value of the quark mass corresponding to $m_\pi\sim391$ MeV. In the $J^P=0^+$ sector we find analogues of the experimental $\sigma$ and $f_0(980)$ states, where the $\sigma$ appears as a stable bound-state below $\pi\pi$ threshold, and, similar to what is seen in experiment, the $f_0(980)$ manifests itself as a dip in the $\pi\pi$ cross section in the vicinity of the $K\overline{K}$ threshold. For $J^P=2^+$ we find two states resembling the $f_2(1270)$ and $f_2'(1525)$, observed as narrow peaks, with the lighter state dominantly decaying to $\pi\pi$ and the heavier state to $K\overline{K}$. The presence of all these states is determined rigorously by finding the pole singularity content of scattering amplitudes, and their couplings to decay channels are established using the residues of the poles.

OBJECTIVE: To study peripapillary retinal capillary circulation in eyes treated with I-125 plaque brachytherapy for uveal melanoma using optical coherence tomography angiography (OCTA). DESIGN: Cross-sectional study of 10 subjects imaged with OCTA prior to uveal melanoma treatment and 15 subjects imaged after development of radiation retinopathy and/or optic neuropathy. PARTICIPANTS: Following IRB approval, subjects were enrolled from an academic ocular oncology clinical practice. All subjects had uveal melanoma in one eye and treatment with I-125 plaque brachytherapy was planned or had previously taken place. Patients with low vision at baseline and uncontrolled hypertension were excluded. In the post-treatment group, seven subjects were male and eight were female; age range 38 to 81 years. Visual acuities in the irradiated eyes ranged from 20/20 to counting fingers. Visual acuities in the untreated fellow eyes were 20/25 or better. METHODS: Peripapillary retinal capillary circulation was measured by OCTA (Optovue, Inc). 4.5×4.5 mm optic disc scans were obtained. 10 subjects were imaged prior to brachytherapy treatment and 15 subjects were imaged after development of clinically apparent radiation retinopathy and/or radiation optic neuropathy post-brachytherapy. MAIN OUTCOME MEASURES: The relationship of the peripapillary retinal capillary density (PPCD) as measured by OCTA to the calculated dose to the optic nerve (D50, the dose to 50% of the disc) and the LogMAR vision was evaluated. RESULTS: No significant difference was seen in the PPCD as measured by OCTA when comparing the eye with melanoma to the fellow eye prior to brachytherapy; however the PPCD was significantly lower in treated eyes (52.9% +/− 22.4%) than in fellow eyes that did not receive radiation (73.3% +/− 13.7%, p = 0.004). There was an inverse linear correlation between D50 and the PPCD (Pearson’s; r= −0.528, P=0.043) and between visual acuity and the PPCD (Pearson’s; r= −0.564, P=0.028). CONCLUSIONS: Among patients with clinically apparent radiation retinopathy and/or radiation optic neuropathy, PPCD was lower in the treated eye and correlated with the radiation dose to the optic nerve and the visual acuity. OCTA provides a measure of capillary changes following radiation, and may serve as a quantitative endpoint to address visual prognosis.

Acromioclavicular separations are common injuries. Low-grade separations are typically managed with nonoperative treatment. However, surgical treatment is recommended for high-grade separations, as well as for chronic low-grade separations that remain symptomatic. Multiple fixation techniques have been described over the past several decades, including Kirschner wires, hook plates, and coracoclavicular screws. More recently, a single-tunnel suture-graft repair and an anatomic reconstruction reproducing both the conoid and trapezoid ligaments have been described. All described techniques have reported complications, including implant migration, need for implant removal, clavicle or coracoid fracture, and loss of reduction. As a result, there is no single optimal method of operative fixation. We describe our technique for an arthroscopically assisted anatomic coracoclavicular repair using a 6-strand suture tape and cortical button construct.

Diabetic retinopathy is a microangiopathy that causes capillary occlusion, vascular hyperpermeability, and neovascularization in the retinal vasculature.1 Detailed clinical examination for grading disease severity for risk of progression and vision loss is the standard of care2, but ophthalmic angiography has played a critical role in understanding and care of the disease. Early Treatment of Diabetic Retinopathy Study (ETDRS) examined the fluorescein angiographic features of the posterior pole of patients with non-proliferative diabetic retinopathy and correlated the specific features with their risk of disease progression. 3,4 Fluorescein angiography (FA) is also used to identify retinal neovascularization (RNV) in situations where clinical examination cannot detect RNV or distinguish from other anomalous appearing vessels on the retinal surface. While angiography provides valuable additional information compared to clinical examination or fundus photography, it is not part of the routine diabetic eye examination. FA requires venipuncture and intravenous injection of a dye that has a moderate risk of nausea and a rare but well documented risk of anaphylaxis and death. 5 Also, a standard protocol FA acquires images over 10 minutes with repeated exposure to a very bright light source, 6 which can cause significant discomfort for patients. Optical coherence tomography (OCT) angiography, a novel imaging technique that uses decorrelation between resampled images to detect flow to construct 2- and 3-dimensional images of blood flow within the eye, offers an alternative angiographic technique without some of the drawbacks of FA. Our group has developed the split-spectrum amplitude decorrelation algorithm (SSADA) for efficiently detecting flow signals for angiography. 7 Applying this algorithm, an OCT angiogram in areas up to 6 × 6 mm area can be acquired in 3.5 seconds without intravenous injection. This study describes features of diabetic retinopathy as seen on OCT angiography.

We present a detailed study of the metal-polluted DB white dwarf SDSS J0845+2257 (Ton 345). Using high-resolution Hubble Space Telescope/Cosmic Origins Spectrograph and Very Large Telescope spectroscopy, we have detected hydrogen and 11 metals in the atmosphere of the white dwarf. The origin of these metals is almost certainly the circumstellar disc of dusty and gaseous debris from a tidally disrupted planetesimal, accreting at a rate of 1.6 × 1010 g s−1. Studying the chemical abundances of the accreted material demonstrates that the planetesimal had a composition similar to the Earth, dominated by rocky silicates and metallic iron, with a low water content. The mass of metals within the convection zone of the white dwarf corresponds to an asteroid of at least ∼130–170 km in diameter, although the presence of ongoing accretion from the debris disc implies that the planetesimal was probably larger than this. While a previous abundance study of the accreted material has shown an anomalously high mass fraction of carbon (15 per cent) compared to the bulk Earth, our independent analysis results in a carbon abundance of just 2.5 per cent. Enhanced abundances of core material (Fe, Ni) suggest that the accreted object may have lost a portion of its mantle, possibly due to stellar wind stripping in the asymptotic giant branch. Time series spectroscopy reveals variable emission from the orbiting gaseous disc, demonstrating that the evolved planetary system at SDSS J0845+2257 is dynamically active.

Purpose The purpose of this study was to determine the incidence of meniscal injury, specifically medial meniscal injury, in US Army soldiers undergoing revision anterior cruciate ligament (ACL) reconstruction. Methods A retrospective review was performed of all patients who underwent revision ACL reconstruction from 2002 to 2011 at our institution. A complete chart review was performed to identify the prevalence of meniscal pathology identified at the time of revision ACL surgery. Patient demographic data and meniscal injury patterns were analyzed. Results Sixty-seven patients were identified, with a mean age of 28 years. The mean time to revision reconstruction was 67 months. Most patients (64.1%) reported a distinct reinjury. Reinjury was reported as the cause for revision ACL reconstruction in 43 patients. In this subgroup the mean time from reinjury to revision surgery was 13.9 months. Meniscal pathology was identified in 50 patients (74.6%). Medial meniscal tears were noted in 38 patients (56.7%), a rate significantly greater than that previously described ( P = .008). Lateral meniscal tears were noted in 26 patients (38.8%), which was similar to previously published data ( P = .52). Conclusions The prevalence of meniscal injury at the time of revision ACL reconstruction in active-duty US Army soldiers is nearly identical to that of previously published data looking at a civilian population (74.6% v 74%) in the Multicenter ACL Revision Study (MARS) cohort. However, the incidence of medial meniscal injury was greater in the active-duty population than in the civilian population (56.7% v 40%). The observed increase in the prevalence of medial meniscal pathology is likely multifactorial, relating to the unique demands on young military athletes in both combat and training environments, rate of reinjury, and various delays to treatment after reinjury. Level of Evidence Level IV, therapeutic case series.

Two infants were referred for progressive orbital proptosis. MRI in both cases demonstrated a homogenous mass in the orbit adherent to and isointense with a rectus muscle. Histopathology in both cases demonstrated a bland proliferation of spindle cells with entrapped skeletal muscle. Immunochemistry demonstrated that the abnormal tissue was of skeletal muscle origin, consistent with rhabdomyomatous mesenchymal hamartoma (RMH). Observation was elected due to the reported benign nature of RMH. In contrast to RMH of the cutaneous tissues that typically follows a benign course, RMH of the orbit may present with rapid growth.

Significantly reduced ice coverage in Greenland and West Antarctica during the warmer-than-present Pliocene could account for ∼10 m of global mean sea level rise. Any sea level increase beyond this would require contributions from the East Antarctic Ice Sheet (EAIS). Previous studies have presented low-resolution geochemical evidence from the geological record, suggesting repeated ice advance and retreat in low-lying areas of the EAIS such as the Wilkes Subglacial Basin. However, the rates and mechanisms of retreat events are less well constrained. Here we present orbitally-resolved marine detrital sediment provenance data, paired with ice-rafted debris and productivity proxies, during three time intervals from the middle to late Pliocene at IODP Site U1361A, offshore of the Wilkes Subglacial Basin. Our new data reveal that Pliocene shifts in sediment provenance were paralleled by increases in marine productivity, while the onset of such changes was marked by peaks in ice-rafted debris mass accumulation rates. The coincidence of sediment provenance and marine productivity change argues against a switch in sediment delivery between ice streams, and instead suggests that deglacial warming triggered increased rates of iceberg calving, followed by inland retreat of the ice margin. Timescales from the onset of deglaciation to an inland retreated ice margin within the Wilkes Subglacial Basin are on the order of several thousand years. This geological evidence corroborates retreat rates determined from ice sheet modeling, and a contribution of ∼3 to 4 m of equivalent sea level rise from one of the most vulnerable areas of the East Antarctic Ice Sheet during interglacial intervals throughout the middle to late Pliocene., Provenance analysis was supported by a Kristian Gerhard Jebsen PhD Scholarship and NERC UK IODP grants (NE/H025162/1 and NE/H014144/1). Biogenic silica data was supported by a Royal Society of New Zealand Marsden FastStart grant (#UOO-1315) and a University of Otago PhD Scholarship. Support for sedimentology analysis was provided by the Royal Society of New Zealand Rutherford Discovery Fellowship (RDF-13-VUW-003). XRF work was supported by the Ministry of Science and Innovation Grant CTM2014-60451-C2-1-P co-financed by the European Regional Development Fund (FEDER). Samples were provided by the Integrated Ocean Drilling Program. The authors acknowledge two anonymous reviewers whose thoughtful comments helped improve the manuscript.

Transplantation of potentially therapeutic cells into the subretinal space is a promising prospective therapy for the treatment of retinal degenerative diseases including age-related macular degeneration (AMD). In rodent models with photoreceptor degeneration, subretinal transplantation of cell suspensions has repeatedly been demonstrated to rescue behaviorally measured vision, maintain electrophysiological responses from the retina and the brain, and slow the degeneration of rod and cone photoreceptors for extended periods. These studies have led to the initiation of a number of FDA-approved clinical trials for application of cell-based therapy for AMD and other retinal degenerative diseases. However, translation from rodent models directly into human clinical trials skips an important intermediary preclinical step that is needed to address critical issues for intraocular cell transplantation. These include determination of the most appropriate and least problematic surgical approach, the application of treatment in an eye with similar size and structure including the presence of a macula, and a thorough understanding of the immunological considerations regarding graft survival and the consequences of grafted cell rejection. This chapter will review these and related issues and will document current efforts to address these concerns.

Case: Three years after a total knee arthroplasty, the patient presented with persistent pain and an enlarging intra-articular periprosthetic mass. Attempts at nonoperative treatment and arthroscopic debridement were unsuccessful. A biopsy revealed a large, intermediate-grade chondrosarcoma involving the joint space. The patient was treated with an above-the-knee amputation, but eventually died as a result of widespread metastatic disease. Conclusion: To our knowledge, this is the first reported case of chondrosarcoma involving the joint space that was diagnosed after total knee arthroplasty. This case demonstrates the need for increased awareness when there are suspicious clinical findings and the importance of diagnosing and/or treating tumors prior to or shortly after total joint arthroplasty.

This chapter provides sufficient information on in situ soil vapor stripping to give managers and regulators a clear idea of the range of applicability of the technique. It purposes to describe the studies that must be done to determine if soil vapor stripping is suitable for any given site. Site investigations normally break down into the following steps: a site history review; the preliminary site screening; detailed characterization of the site; contaminant assessment; and pilot testing. The chapter concerns the development of a phased approach to evaluation and implementation of vacuum extraction on a site-specific basis, and the mathematical models for implementing an approach. W. L. Crow et al. described data from soil vacuum extraction experiments carried out at a petroleum fuels terminal at which a gasoline spill had taken place. They concluded that the technique removes hydrocarbon vapors from the vadose zone effectively and is also useful in augmenting conventional methods for recovering spilled hydrocarbons from shallow aquifers.

Proximal humerus fracture after pectoralis major tendon repair has been recently reported. Although this complication is rare, it may be possible to decrease such risk using newer techniques for myotenodesis. This study was designed to evaluate various unicortical stress risers created at the proximal humeral metadiaphysis during myotenodesis for repair of pectoralis major ruptures. A simulated pectoralis major myotenodesis was performed using fourth-generation Sawbones (N=30). Using previously described anatomic landmarks for the tendinous insertion, 3 repair techniques were compared: bone trough, tenodesis screws, and suture anchors (N=10 each). Combined compression and torsional load was sequentially increased until failure. Linear and rotational displacement data were collected. The average number of cycles before reaching terminal failure was 383 for the bone trough group, 658 for the tenodesis group, and 832 for the suture anchor group. Both the tenodesis and the suture anchor groups were significantly more resistant to fracture than the bone trough group ( P P Orthopedics. 2017; 40(5):e801–e805.]

Dear SirSituational judgment tests (SJTs) are becoming prevalent in medical selection. Within medicine, they are now used internationally in undergraduate selection, in-course assessment and postgr...

Introduction The key elements of a lecture that promote retention and understanding of material have been extensively described, although both the understanding and use of these principles by lecturers is a significant time and resource investment. Lecturers in healthcare are a broad group of people, many of which have other commitments and may lack prior formal teaching experience. Perspective This commentary describes an essential version of the cognitive theories of learning and presents an assimilated and reduced version of these theories in the form of the acronym ‘MAKE’ (make it memorable, add value, keep audience interest, entertain) to enable the more rapid development of memorable lectures and reduce the time required to improve them. Implications There is a fine line between a lecture that engages and inspires the audience and one that is unimaginative and poorly planned. All lecturers should be encouraged to use simple evidence-based methods to improve engagement, retention and student satisfaction. The easy to understand and share nature of the “MAKE” acronym could help achieve these aims.

Purpose To describe histopathologic features of an eye with retinal angiomatous proliferation (RAP) secondary to age-related macular degeneration treated with serial ranibizumab injections and to correlate these findings with spectral domain optical coherence tomography. Methods Histopathologic features from serial sections through the globe of a 93-year-old man with age-related macular degeneration were studied and compared with spectral domain optical coherence tomography images obtained 7 weeks before his death. Results The pathologic correlate of ranibizumab-treated RAP was a circumscribed, branching paucicellular vascular complex extending from the inner plexiform layer to Bruch membrane. The histopathologic findings corresponded to an area of hyperreflectivity on spectral domain optical coherence tomography imaging, substantiating the reported tomographic appearance of RAP lesions. A frank anastomosis with choroidal or retinal vasculature was not seen in this treated RAP lesion. There was a lack of retinal pigment epithelium underlying the lesion in an area of retinal pigment epithelium detachment. The elastic portion of Bruch membrane appeared intact. Treatment with ranibizumab over an extended period of time may have been associated with a loss of cellularity of the RAP lesion. Conclusion In a patient with ARMD extensively treated with ranibizumab, color fundus photography, fluorescein angiography and SD-OCT images of RAP correlated histopathologically with a paucicellular intraretinal vascular complex.

PURPOSE To report a case of local transmission of invasive lobular carcinoma from a donor to a recipient in a keratolimbal allograft after cessation of systemic immunosuppressive therapy. METHODS This is a case report including the clinicopathologic findings. Sections of the donor breast tumor and recipient conjunctival lesions were stained with hematoxylin and eosin. Immunohistochemical studies were performed using pancytokeratin, CK7, CK20, CAM 5.2, CD138, TTF1, estrogen receptor, progesterone receptor, GATA-3, GCDFP-15, and mammaglobin. Polymerase chain reaction-based DNA profiling of tumor cells was performed. RESULTS Histopathologic examination revealed an infiltrate of atypical cells with large hyperchromatic nuclei consistent with carcinoma. Immunohistochemical analysis showed pancytokeratin, CK7, CAM 5.2, GATA-3, and estrogen receptor positivity and progesterone receptor absence, consistent with the previously determined phenotype of the donor's breast carcinoma. Results of polymerase chain reaction analysis were also consistent with the donor's tumor. After reduced dosing of tacrolimus and mycophenolate mofetil, 2 limbal tumors occurred in the recipient. The immunosuppressive treatment had been stopped completely before the appearance of the third lesion. The recipient had no history of malignancy, and she had routine screenings for breast cancer. CONCLUSIONS We report a case of donor-derived breast carcinoma in a keratolimbal allograft recipient. The grafted tissue harbored donor-derived tumor cells for more than 4 years after surgery even after systemic immunosuppression was discontinued. Although no similar reports of tumor transfer could be found in the literature, this case suggests the need for increased stringency in donor selection and heightened surveillance for such tumor transmission.

This paper investigates the impact of video streaming quality on bandwidth consumption during the transfer of video data from a humanoid robot `NAO' to computing devices, used to perform face recognition tasks, and to the cloud. It presents the results of profiling the network performance of connecting NAO with an edge controller, and discusses the effect of using different qualities of video streaming on the consumed up-link bandwidth. This study considers the limitation of the up-link bandwidth in the Wi-Fi network. It compares the performances of Wi-Fi and Ethernet connections between the NAO robot and a computer. In addition, it examines the accuracy of the face recognition tasks using various streaming scenarios, such as colored video and black & white video. It investigates real-time video streaming using a wide range of frame rates, and video qualities, and their impact on the bandwidth, and accuracy of face identification. The results of our investigations are used to determine the acceptable video quality, frame rate, buffering and bandwidth that would give optimal results in face recognition using NAO robot, and enable efficient data transfer to the cloud.