Abstract Objectives: To determine: 1) the natural incidence of sacral inlet angle differences between S1 and S2 and 2) implications for iliosacral screw placement with a technique to improve the ...accuracy of the intraoperative fluoroscopic inlet for S1 and S2. Design: Combined retrospective and prospective cohort reviews. Setting: Regional Level 1 trauma center. Patients/Participants: After exclusion criteria, 300 patients with uninjured pelvic rings to determine the natural incidence of S1 – S2 angle differences and 33 patients treated with iliosacral screws over the study period. Intervention: None in the retrospective cohort. In the prospective cohort all patients underwent fluoroscopically assisted iliosacral screw fixation. Main Outcome Measurements: Radiographic determination of S1 – S2 angle differences above 10 degrees in a natural population for the retrospective cohort. In the prospective, operative cohort the outcome of interest was the safety of iliosacral screws in S1 and S2 as determined on intraoperative fluoroscopy and postoperative CT scan. Results: In the retrospective cohort, 180/300 (60.0%) had S1 – S2 inlet angle differences above 10 degrees. In the operative cohort, 19/33 (57.6%) had S1 – S2 inlet angle differences above 10 degrees. Of the iliosacral screws in S1 and S2 placed using the described imaging technique, all (69/69, 100%) were safe. Conclusions: A normal population determined that differences in the inlet angle between S1 and S2 are common. An operative cohort was treated using preoperative CT-based planning to define different intraoperative fluoroscopic inlet views for S1 and S2, if a larger difference existed. Using this technique, 69/69 (100%) of iliosacral screws were either intraosseous or juxtacortical and safe. Level of Evidence: Level V. See Instructions for Authors for a complete description of levels of evidence.
Background
Many healthcare facilities and providers prohibit blenderized tube feeding (BTF) for patients who request it due to concerns of high microbial load. The current project compared microbial ...loads of a standard ready‐to‐feed polymeric commercial formula (CF), a BTF made using baby food (BTF‐BF), and a BTF prepared from blending whole food (BTF‐WF), following food safety standards expected of U.S. hospitals.
Methods
Three tube‐feeding formulas (CF, BTF‐BF, BTF‐WF) were prepared in a U.S. hospital and delivered in vitro to an unoccupied patient room. Samples were collected at zero hour, 2 hours, and 4 hours and compared for growth of aerobic microorganisms, Staphylococus aureus, coliforms, and Escherichia coli. The experiment was conducted in triplicate, 1 week apart.
Results
No S. aureus or coliform/E. coli were detected at any time point following preparation, and total bacterial count was well below acceptable limits. All 3 feeding formulas at zero hour, 2 hours, and 4 hours for each of the 3 sampling dates were acceptable for human consumption.
Conclusion
Judicious BTF recipe selection and adherence to safe food handling provide a safe feeding substrate equivalent to CF in the hospital setting. Due to increased use and interest in BTF by patients and their caregivers, healthcare facilities may need to reexamine their policies prohibiting BTF use.
Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and ...outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children's Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL.
Core/shell quantum dots (QDs) are of high scientific and technological importance as these nanomaterials have found a number of valuable applications. In this paper, we have investigated the ...dependence of optical activity and photoluminescence upon CdS shell thickness in a range of core–shell structured CdSe/CdS QDs capped with chiral ligands. For our study, five samples of CdSe/CdS were synthesized utilizing successive ion layer adsorption and reaction to vary the thickness of the CdS shell from 0.5 to 2 nm, upon a 2.8 nm diameter CdSe core. Following this, a ligand exchange of the original aliphatic ligands with l- and d-cysteine was carried out, inducing a chiroptical response in these nanostructures. The samples were then characterized using circular dichroism, photoluminescent spectroscopy, and fluorescence lifetime spectroscopy. It has been found that the induced chiroptical response was inversely proportional to the CdS shell thickness and showed a distinct evolution in signal, whereas the photoluminescence of our samples showed a direct relationship to shell thickness. In addition, a detailed study of the influence of annealing time on the optical activity and photoluminescence quantum yield was performed. From our work, we have been able to clearly illustrate the approach and strategies that must be used when designing optimal photoluminescent optically active CdSe/CdS core–shell QDs.
Objective: To examine the results of a treatment algorithm incorporating an EUA performed intraoperatively after fixation of the femoral head through a Smith Petersen approach to determine need for ...posterior wall or capsule repair. Methods: Design : Retrospective review Setting: Two Level 1 trauma centers Patient Selection Criteria: All acute, traumatic femoral head fractures from posterior hip dislocations treated at participating centers over a 5-year period from 2017-2022. Injuries were classified according to the Pipkin system. Outcome Measures and Comparisons: The primary outcome was the result of intraoperative EUA performed after femoral head fixation to determine the need for Kocher-Langenbeck exposure for posterior wall and/or capsule fixation. The secondary outcomes included rates of avascular necrosis, heterotopic bone formation, late instability, and conversion to total hip arthroplasty. Results: Studied were 63 males and 22 females with mean age 32.5 (range 18-71). 79 of 85 (92.9%) patients had a stable EUA after fixation of the femoral head through a Smith-Petersen approach. Six (6/85, 7.1%) underwent an additional Kocher-Langenbeck approach for posterior wall or capsule fixation. This included 1 Pipkin I, 1 Pipkin II, and 4 Pipkin IV injuries. Of the Pipkin IV injuries, 51/55 (92.7%) had stable EUA and did not require fixation of their posterior wall. This included 7 patients with wall involvement >20%. Five patients were excluded because of planned fixation of their posterior wall based on preoperative imaging. Of patients with at least 6 months follow up, 16 of 65 (26.4%) developed radiographic evidence of AVN and 21 of 65 (32.3%) evidence of heterotopic bone formation. Seven out of 65 (10.8%) were converted to total hip arthroplasty over the study period. When comparing patients with a single exposure with those with additional KL exposure, they did not vary in their rate of AVN (27.1% vs. 0.0%, P=0.3228), HO formation (30.5% vs. 50.0%, P=0.3788), or conversion to total hip arthroplasty (10.2% vs. 16.7%, P=0.510). Conclusions: This study found residual posterior hip instability after femoral head fixation in patients with and without posterior wall fractures after posterior dislocations. The results of this study support use of an EUA after femoral head fixation to identify residual posterior hip instability in all femoral head fractures from posterior hip dislocations, regardless of Pipkin type. Use of the Smith-Petersen exposure remains a viable surgical option and may be improved with incorporation of an EUA after femoral head fixation. For Pipkin IV injuries with posterior wall fractures with indeterminate stability, an EUA accurately identifies residual instability. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Stick balancing on the fingertip is a complex voluntary motor task that requires the stabilization of an unstable system. For seated expert stick balancers, the time delay is 0.23 s, the shortest ...stick that can be balanced for 240 s is 0.32 m and there is a ° dead zone for the estimation of the vertical displacement angle in the saggital plane. These observations motivate a switching-type, pendulum–cart model for balance control which uses an internal model to compensate for the time delay by predicting the sensory consequences of the stick's movements. Numerical simulations using the semi-discretization method suggest that the feedback gains are tuned near the edge of stability. For these choices of the feedback gains, the cost function which takes into account the position of the fingertip and the corrective forces is minimized. Thus, expert stick balancers optimize control with a combination of quick manoeuvrability and minimum energy expenditures.
The whale shark (Rhincodon typus) has by far the largest body size of any elasmobranch (shark or ray) species. Therefore, it is also the largest extant species of the paraphyletic assemblage commonly ...referred to as fishes. As both a phenotypic extreme and a member of the group Chondrichthyes - the sister group to the remaining gnathostomes, which includes all tetrapods and therefore also humans - its genome is of substantial comparative interest. Whale sharks are also listed as an endangered species on the International Union for Conservation of Nature's Red List of threatened species and are of growing popularity as both a target of ecotourism and as a charismatic conservation ambassador for the pelagic ecosystem. A genome map for this species would aid in defining effective conservation units and understanding global population structure.
We characterised the nuclear genome of the whale shark using next generation sequencing (454, Illumina) and de novo assembly and annotation methods, based on material collected from the Georgia Aquarium. The data set consisted of 878,654,233 reads, which yielded a draft assembly of 1,213,200 contigs and 997,976 scaffolds. The estimated genome size was 3.44Gb. As expected, the proteome of the whale shark was most closely related to the only other complete genome of a cartilaginous fish, the holocephalan elephant shark. The whale shark contained a novel Toll-like-receptor (TLR) protein with sequence similarity to both the TLR4 and TLR13 proteins of mammals and TLR21 of teleosts. The data are publicly available on GenBank, FigShare, and from the NCBI Short Read Archive under accession number SRP044374.
This represents the first shotgun elasmobranch genome and will aid studies of molecular systematics, biogeography, genetic differentiation, and conservation genetics in this and other shark species, as well as providing comparative data for studies of evolutionary biology and immunology across the jawed vertebrate lineages.
Objective:No widely accepted clinical guidelines, and scant directly applicable pragmatic research, are available to guide the prescription of psychiatric medications in “low-threshold” outpatient ...settings, such as street outreach, urgent care, and crisis care, as well as walk-in, shelter, and bridge and transition clinics. Providers frequently prescribe medications in these settings without patients’ having firm psychiatric diagnoses and without medical records to guide clinical decision making. Persons who receive medications in these settings often seek help voluntarily and intermittently for mental illness symptoms. However, because of structural and individual factors, such patients may not engage in longitudinal outpatient psychiatric care. The authors reviewed the literature on psychiatric medication prescribing in low-threshold settings and offer clinical considerations for such prescribing.Methods:The authors conducted a rapid literature review (N=2,215 abstracts), which was augmented with up-to-date clinical prescribing literature, the authors’ collective clinical experience, and DSM-5 section II diagnostic criteria to provide considerations for prescribing medications in low-threshold settings.Results:For individuals for whom diagnostic uncertainty is prominent, a symptom-based diagnostic and treatment approach may be best suited to weigh the risks and benefits of medication use in low-threshold settings. Practical considerations for treating patients with clinical presentations of psychosis and trauma, as well as mood, anxiety, and substance use disorders, in low-threshold settings are discussed.Conclusions:An urgent need exists to invest in pragmatic research and guideline development to delineate best-practice prescribing in low-threshold settings.
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