Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the ...creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care Research Group (PNCRG). Our objective is to describe the creation of an international, peer-reviewed, online PNCC educational series targeting medical trainees and faculty. More than 1600 members of departments such as pediatrics, pediatric critical care, and child neurology hailing from 75 countries across six continents have participated in this series over a 10-month period. We created an online educational channel in PNCC with over 2500 views to date and over 130 followers. This framework could serve as a roadmap for other institutions and specialties seeking to address the ongoing problems of textbook obsolescence relating to the rapid acceleration in knowledge acquisition, as well as those seeking to create new educational content that offers opportunities for an interactive, global audience. Through the creation of a virtual community of practice, we have created an international forum for pediatric healthcare providers to share and learn specialized expertise and best practices to advance global pediatric health.
Objective
To determine the accuracy of MR imaging for the evaluation of the subscapularis tendon as well as define imaging findings that will increase accuracy.
Materials and methods
Retrospective ...review of the MR and operative (OR) reports of 286 patients was conducted and reviewed for the presence/degree (partial (PT)/full-thickness (FT)) of tearing; only PT articular tears were included. The presence of a supraspinatus tear and time interval between surgery and MRI were also documented. All of the PT tears called on MRI were also reviewed to see if there was a statistically significant association between certain imaging characteristics and the presence of a tear in surgery. Statistical analysis included 95 % confidence intervals, Fisher’s exact, and exact Mann–Whitney tests.
Results
A total of 244 patients were included in the study with a total of 25 subscapularis tears, 16 PT and nine FT, and 219 intact tendons in arthroscopy; 20/25 tears and 200 intact tendons were diagnosed correctly on MRI, resulting in sensitivity of 80 %, specificity of 91 %, accuracy of 90 %, positive predictive value of 51 %, and negative predictive value of 98 %. There was a significant association between the presence of a PT tear during arthroscopy and fluid-like signal within the tendon on more than one imaging plane (
p
< 0.001) with an accuracy of 90 %.
Conclusions
This study reflects a musculoskeletal radiology section’s experience with the diagnosis of subscapularis tendon pathology, demonstrating that MRI could be used to accurately evaluate the subscapularis tendon. An understanding of certain imaging pitfalls and the presence of fluid-like signal on multiple imaging planes should increase the diagnostic accuracy of the radiologist evaluating the subscapularis tendon for the presence of a tear.
Published reports from France and Norway suggest a frequent incidence of anaphylaxis to rocuronium and have raised concerns about its safety. We hypothesized that the Food and Drug Administration ...Adverse Event Reporting System could be used to confirm whether there has been an unusual incidence of anaphylactic events for rocuronium in the United States (U.S.) and whether the reporting patterns differ within and outside of the U.S.. We queried the Food and Drug Administration Adverse Event Reporting System for 1999 through the first quarter of 2002 for all adverse events for the drugs rocuronium and vecuronium and then searched on the terms considered to represent possible anaphylaxis using proprietary software. We compared the frequency of these terms in data both for rocuronium and vecuronium. We then assessed the occurrence of reports of anaphylaxis-related terms in reports from the U.S. compared with reports originating outside of the U.S.. For rocuronium, the database contained 311 reports, 166 domestic and 145 from foreign sources. Fifty percent of the foreign reports contained an anaphylaxis term versus 20% of the domestic reports (P < 0.001). For vecuronium, the comparable figures were 17% and 19% (not significant) and the total number of reports was 243. The incidence of the reports containing anaphylaxis terms did not differ between vecuronium and rocuronium in the U.S. but were significantly different for foreign reports (P < 0.001). These data confirm that U.S. anesthesia providers have not observed a significant difference in anaphylactic reactions between the two commonly used intermediate-acting muscle relaxants and suggest that frequency of reports of anaphylaxis may be significantly influenced by the area from which the reports originate.
α-Conotoxins are disulfide-rich peptides that target nicotinic acetylcholine receptors. Recently we identified several α-conotoxins that also modulate voltage-gated calcium channels by acting as G ...protein-coupled GABA(B) receptor (GABA(B)R) agonists. These α-conotoxins are promising drug leads for the treatment of chronic pain. To elucidate the diversity of α-conotoxins that act through this mechanism, we synthesized and characterized a set of peptides with homology to α-conotoxins known to inhibit high voltage-activated calcium channels via GABA(B)R activation. Remarkably, all disulfide isomers of the active α-conotoxins Pu1.2 and Pn1.2, and the previously studied Vc1.1 showed similar levels of biological activity. Structure determination by NMR spectroscopy helped us identify a simplified biologically active eight residue peptide motif containing a single disulfide bond that is an excellent lead molecule for developing a new generation of analgesic peptide drugs.
Periacetabular resections for primary malignancies and metastatic disease require reconstruction to restore weightbearing along anatomic axes. Without reconstruction, patients are unable to ambulate ...independently, and are left with a disfigured pelvis and shortened limb. The current authors describe a reconstruction technique using Steinmann pins augmented with methylmethacrylate reconstruction, and autoclaved autografting, in combination with total hip arthroplasty, after resection of primary sarcomas of the pelvis. For this study, the results of 15 patients at two institutions who had surgery by the same surgeons were retrospectively reviewed. The patients had primary malignant tumors of the pelvis, and had limb-sparing resections between 1985 and 2000. Three measures of outcome were evaluated: survival, function, and pain. The surgical method uses Steinmann pins with bone cement to fill in areas of bone loss that cannot be reconstructed with autoclaved autograft. A constrained polyethylene acetabular component is cemented into this bed. Twelve patients had chondrosarcoma and one patient had osteosarcoma. The remaining two patients had alveolar sarcoma of soft parts. Six patients died of disease. Seven patients were alive with no evidence of disease, and two were alive with disease at the most recent followup. Early return to ambulation without assistive devices occurred in nine of 15 patients. The functional outcome of this technique compares favorably with others reported. Sixty percent of patients ambulated independently without assistive devices, compared with 0% to 10% in other studies reviewed. The time required for independent gait is similar to recovery from a total hip arthroplasty. Moreover, this method minimized leg length discrepancy, while also producing a favorable cosmetic result.
Behavior maintained under a differential-reinforcement-of-low-rate (DRL) 72-s operant schedule, which reinforces responses with interresponse times greater than 72
s, exhibits a rather unique ...sensitivity to antidepressant drugs. Antidepressants from a number of pharmacological classes, including tricyclic antidepressants, selective serotonin or norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, as well as a number of atypical antidepressants and putative antidepressants, reduce response rate and increase reinforcement rate of rats under this schedule. These effects are observed acutely but persist or are augmented with repeated treatment. By contrast, drugs from a number of other psychotherapeutic classes do not, in general, produce similar effects. This includes anxiolytic, sedative, stimulant, opioid, antihistaminic, and anticholinergic drugs, which can produce false positive results in some preclinical tests for antidepressant efficacy. There are conflicting data regarding the utility of DRL behavior for discriminating the effects of antidepressant and antipsychotic drugs. This results in part from methodological differences among studies, but likely also reflects the overlap between the neuropharmacological and clinical effects of some antipsychotic and antidepressant drugs. DRL behavior also has proven useful for identifying neurochemical and neuroanatomical mediators of antidepressant effects on behavior. Consistent with clinical data, it appears that activation of noradrenergic or serotonergic systems provides for parallel means of producing antidepressant-like effects on DRL behavior. Finally, the results of studies using DRL behavior highlight important roles for central beta-1 adrenergic receptors, as well as 5-HT1A, 5-HT1B, 5-HT2A, and 5-HT2C receptors, in the mediation of antidepressant-like behavioral effects.
This study examined social-emotional functioning in children with Gilles de la Tourette's
syndrome (TS) alone and children with TS and Attention Deficit Hyperactivity Disorder
(ADHD). In addition, ...the contribution of family functioning to social competence was
examined. Children with a clinical diagnosis of TS were recruited from the Yale Child Study
Center TS specialty clinic. Unaffected control children were recruited through newspaper
advertisements and announcements within the university and at area schools. The final
sample consisted of 72 children (45 boys and 27 girls) between the ages of 8 and 14. Sixteen
children met DMS-III-R criteria for TS, 33 children met criteria for TS and ADHD, and 23
children had no psychiatric diagnoses. Children with TS and ADHD evidenced more
externalizing and internalizing behavior problems and poorer social adaptation than
children with TS only or unaffected controls. Children with TS only were not significantly
different from unaffected controls on most measures of externalizing behaviors and social
adaptation but did exhibit more internalizing symptoms. Tic symptom severity was not
associated with social, behavioral, or emotional functioning among children with TS, even
after stratifying by medication status. However, ADHD diagnosis, obsessional symptom
severity, and family functioning were significantly associated with social and emotional
adjustment among TS children. Moreover, family functioning was associated with social and
emotional adjustment even after controlling for TS and ADHD diagnostic status. These
findings demonstrate that much of the social and behavioral dysfunction in children with TS
is ADHD-specific and children with TS alone have a very different social-emotional profile
than do those with TS plus ADHD. Finally, social-emotional adjustment in children with TS
is best understood within the family context.
Left atrial invasion by pulmonary adenocarcinoma McLaughlin, Anne Marie; Meaney, James F.; Keane, Joseph ...
European journal of cardio-thoracic surgery,
05/2007, Letnik:
31, Številka:
5
Journal Article
Strong lenses are extremely useful probes of the distribution of matter on galaxy and cluster scales at cosmological distances, but are rare and difficult to find. The number of currently known ...lenses is on the order of 1,000. We wish to use crowdsourcing to carry out a lens search targeting massive galaxies selected from over 442 square degrees of photometric data from the Hyper Suprime-Cam (HSC) survey. We selected a sample of \(\sim300,000\) galaxies with photometric redshifts in the range \(0.2 < z_{phot} < 1.2\) and photometrically inferred stellar masses \(\log{M_*} > 11.2\). We crowdsourced lens finding on this sample of galaxies on the Zooniverse platform, as part of the Space Warps project. The sample was complemented by a large set of simulated lenses and visually selected non-lenses, for training purposes. Nearly 6,000 citizen volunteers participated in the experiment. In parallel, we used YattaLens, an automated lens finding algorithm, to look for lenses in the same sample of galaxies. Based on a statistical analysis of classification data from the volunteers, we selected a sample of the most promising \(\sim1,500\) candidates which we then visually inspected: half of them turned out to be possible (grade C) lenses or better. Including lenses found by YattaLens or serendipitously noticed in the discussion section of the Space Warps website, we were able to find 14 definite lenses, 129 probable lenses and 581 possible lenses. YattaLens found half the number of lenses discovered via crowdsourcing. Crowdsourcing is able to produce samples of lens candidates with high completeness and purity, compared to currently available automated algorithms. A hybrid approach, in which the visual inspection of samples of lens candidates pre-selected by discovery algorithms and/or coupled to machine learning is crowdsourced, will be a viable option for lens finding in the 2020s.
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