Massive neonatal adrenal enlargement due to cytomegaly, persistence of the transient cortex, and hyperplasia of the permanent cortex: findings in Cushing syndrome associated with hemihypertrophy.

Described in this article is the massive enlargement of both adrenal glands in 3 newborns-2 girls and 1 boy. Two had hemihypertrophy and other congenital abnormalities but no identified genetic mutation; the third had genetically proven Beckwith-Wiedemann syndrome. Two had severe Cushing syndrome, the third had hypercortisolemia but no clinical Cushing syndrome.

An analysis of shoulder outcomes scores in 275 consecutive patients: disease-specific correlation across multiple shoulder conditions.

Objectives: To determine the outcomes scores of military patients who initially present with a variety of shoulder conditions, identify which scores demonstrate the highest correlation per diagnosis, and determine if a difference exists for patients who went onto surgery.

Methods: Two-hundred and seventy five consecutive patients with mean age of 36.5 +/- 12.

Outcomes of a clinic-based pediatric constraint-induced movement therapy program.

A single-group pre- and post-test design was used to evaluate functional outcomes of a constraint-induced movement therapy (CIMT) protocol implemented in an outpatient therapy center. The participants were 29 children with hemiplegia, ages 1.6-19.

Improved auscultation skills in paramedic students using a modified stethoscope.

Background: The Ventriloscope® (Lecat's SimplySim, Tallmadge, OH) is a modified stethoscope used as a simulation training device for auscultation.

Objective: To test the effectiveness of the Ventriloscope as a training device in teaching heart and lung auscultatory findings to paramedic students.

Methods: A prospective, single-hospital study conducted in a paramedic-teaching program.

Arrhythmia discrimination using hemoglobin spectroscopy in humans.

Background: Inappropriate therapies are frequently delivered by implantable cardioverter-defibrillators (ICDs). We have investigated muscle perfusion as a means of augmenting arrhythmia discrimination by using implanted near-infrared spectroscopy.

Objective: To evaluate hemodynamic stability by monitoring muscle perfusion from within the ICD pocket, in fresh tissue and inside the scar capsule on preexisting ICD generators, during induced cardiac arrhythmias, in humans.

Structure-based design of supercharged, highly thermoresistant antibodies.

Mutation of surface residues to charged amino acids increases resistance to aggregation and can enable reversible unfolding. We have developed a protocol using the Rosetta computational design package that "supercharges" proteins while considering the energetic implications of each mutation. Using a homology model, a single-chain variable fragment antibody was designed that has a markedly enhanced resistance to thermal inactivation and displays an unanticipated ≈30-fold improvement in affinity.

NIST gravimetrically prepared atmospheric level methane in dry air standards suite.

The Gas Metrology Group at the National Institute of Standards and Technology was tasked, by a congressional climate change act, to support the atmospheric measurement community through standards development of key greenhouse gases. This paper discusses the development of a methane (CH(4)) primary standard gas mixture (PSM) suite to support CH(4) measurement needs over a large amount-of-substance fraction range 0.3-20,000 μmol mol(-1), but with emphasis at the atmospheric level 300-4000 nmol mol(-1).

Saving lives following the expansion of centralized remote telemetry monitoring.

Continuous monitoring of patients throughout the hospital is a desirable method to ensure the continuity of quality care. Hospitals looking to improve the manner in which they maintain such continuity without compromising efficiency must explore the benefits of implementing monitoring technology to its fullest potential. This case study chronicles the journey of a level-one trauma hospital during the expansion of remote wireless telemetry monitoring and the telemetry technician role.

Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies.

Objectives: To determine whether methylene blue dye significantly improves the sensitivity of the saline load test for detection of a traumatic arthrotomy of the knee.

Design: Randomized, prospective.

Setting: Orthopaedic department, tertiary care medical center.

Llama-derived single domain antibodies specific for Abrus agglutinin.

Llama derived single domain antibodies (sdAb), the recombinantly expressed variable heavy domains from the unique heavy-chain only antibodies of camelids, were isolated from a library derived from llamas immunized with a commercial abrin toxoid preparation. Abrin is a potent toxin similar to ricin in structure, sequence and mechanism of action. The selected sdAb were evaluated for their ability to bind to commercial abrin as well as abrax (a recombinant abrin A-chain), purified abrin fractions, Abrus agglutinin (a protein related to abrin but with lower toxicity), ricin, and unrelated proteins.

A large family with Carney complex caused by the S147G PRKAR1A mutation shows a unique spectrum of disease including adrenocortical cancer.

Context: Most tumors in Carney complex (CNC) are benign, including primary pigmented nodular adrenocortical disease (PPNAD), the main endocrine tumor in CNC. Adrenocortical cancer (AC) has never been observed in the syndrome. Herein, we describe a large Azorean family with CNC caused by a point mutation in the PRKAR1A gene coding for type 1-α (RIα) regulatory subunit of the cAMP-dependent protein kinase A, in which the index patient presented with AC.

Recombination and positive selection identified in complete genome sequences of Japanese encephalitis virus.

The mosquito-borne Japanese encephalitis virus (JEV) causes encephalitis in man but not in pigs. Complete genomes of a human, mosquito and pig isolate from outbreaks in 1982 and 1985 in Thailand were sequenced with the aim of identifying determinants of virulence that may explain the differences in outcomes of JEV infection between pigs and man. Phylogenetic analysis revealed that five of these isolates belonged to genotype I, but the 1982 mosquito isolate belonged to genotype III.

Community-academic partnerships: how can communities benefit?

In answer to the question of how academic institutions will meet medical education needs and public health challenges of the 21st century, a strong, vibrant, and sustained community partnership has been developed to teach public health, address community public health needs, and develop health policy to sustain these improvements, all with a practical approach. In this paper, the partnership between the University of Vermont College of Medicine and various community agencies is described from the perspective of how the community can benefit from educational efforts in public health. Particular focus is given to the community-academic partnership model in public health, a strong and sustained partnership between the University of Vermont College of Medicine and the United Way of Chittenden County Volunteer Center that began in 2004.

Planning and incorporating public health preparedness into the medical curriculum.

As part of a 2010 conference entitled "Patients and Populations: Public Health in Medical Education," faculty from four U.S. medical schools (Case Western Reserve University, Harvard Medical School, the University of Colorado School of Medicine, and the University of Vermont College of Medicine), collaborated on a workshop to help other medical educators develop scenario-based learning experiences as practical, engaging, and effective mechanisms for teaching public health principles to medical school students.

Virilizing ovarian stromal tumor in a young woman with Carney complex.

A woman with Carney complex presented at the age of 22 years with abdominal pain and hirsutism. As a baby, she had undergone excision of a right eyelid lesion, and at age 14 years she had undergone removal of a left lower eyelid nodule that subsequently recurred. Investigation revealed an elevated level of serum testosterone and a 2-cm left ovarian tumor.

Pancreatic ductal and acinar cell neoplasms in Carney complex: a possible new association.

Context: Carney complex (CNC) is a rare disease inherited as an autosomal dominant trait, associated with various tumors, and caused most frequently by inactivation of the PRKAR1A gene.

Objectives: In our recent investigation of a large cohort of CNC patients, we identified several cases of pancreatic neoplasms. This possible association and PRKAR1A's possible involvement in pancreatic tumor have not been reported previously.

Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks.

The extent of analgesia provided by transversus abdominis plane blocks depends upon the site of injection and pattern of spread within the plane. There are currently a number of ultrasound-guided approaches in use, including an anterior oblique-subcostal approach, a mid-axillary approach and a more recently proposed posterior approach. We wished to determine whether the site of injection of local anaesthetic into the transversus abdominis plane affects the spread of the local anaesthetic within that plane, by studying the spread of a local anaesthetic and contrast solution in four groups of volunteers.

Primary bimorphic adrenocortical disease: cause of hypercortisolism in McCune-Albright syndrome.

McCune-Albright syndrome (polyostotic fibrous dysplasia, café-au-lait skin spots, and precocious puberty) is a genetically mosaic disorder with populations of mutant and normal cells in affected organs. Cushing syndrome, a rare feature of the condition, usually affects infants and is the result of corticotropin-independent primary bilateral adrenal disease, usually interpreted as nodular adrenocortical hyperplasia. In this study of 9 patients with Cushing syndrome and McCune-Albright syndrome, light microscopy revealed a characteristic bimorphic pattern of diffuse and nodular hyperplasia and a distinctive form of cortical atrophy with apparent zona glomerulosa hyperplasia in 8 patients, all very young.

Human Mre11/human Rad50/Nbs1 and DNA ligase IIIalpha/XRCC1 protein complexes act together in an alternative nonhomologous end joining pathway.

Recent studies have implicated a poorly defined alternative pathway of nonhomologous end joining (alt-NHEJ) in the generation of large deletions and chromosomal translocations that are frequently observed in cancer cells. Here, we describe an interaction between two factors, hMre11/hRad50/Nbs1 (MRN) and DNA ligase IIIα/XRCC1, that have been linked with alt-NHEJ. Expression of DNA ligase IIIα and the association between MRN and DNA ligase IIIα/XRCC1 are altered in cell lines defective in the major NHEJ pathway.

Laser dispersion and ignition of metal fuel particles.

The development of a laser-shock technique for dispersing Al metal fuel particles at velocities approaching those expected in a detonating explosive is discussed. The technique is described in detail by quantifying how air drag affects the temporal variation of the velocity of the dispersed particle plume. The effect of particle size is incorporated by examining various poly-dispersed commercial Al powders at different dispersion velocities (390-630 m/s).

Primary schwannoma of the bone: a clinicopathologic and radiologic study of 17 cases.

Primary schwannoma of the bone, defined as arising within the medullary cavity and radiologically mimicking more common primary bone tumors, is rare. We present 17 tumors, 13 conventional schwannomas, and 4 melanotic type. Collectively, they represented <1% of all primary bone tumors seen at Mayo Clinic over a 33-year period.

Human biodistribution and dosimetry of the PET radioligand [¹¹C]flumazenil (FMZ).

Purpose: We measure the whole-body distribution of IV injected [¹¹C]Flumazenil (FMZ) as a function of time in adult subjects and determine the absorbed radiation doses.

Procedures: After injection with 770 MBq of [¹¹C]FMZ (nominal), each of six subjects underwent nine consecutive whole body PET scans. Twelve source organs were identified using PET attenuation and emission images.

PET/CT artifacts.

There are several artifacts encountered in positron emission tomography/computed tomographic (PET/CT) imaging, including attenuation correction (AC) artifacts associated with using CT for AC. Several artifacts can mimic a 2-deoxy-2-[18F] fluoro-d-glucose (FDG) avid malignant lesions and therefore recognition of these artifacts is clinically relevant. Our goal was to identify and characterize these artifacts and also discuss some protocol variables that may affect image quality in PET/CT.

Evaluation of a modified prescription form to address prescribing errors.

Purpose: The impact of a modified paper prescription form on the occurrence of prescribing errors was evaluated.

Methods: Rural primary care providers practicing in the United States who wrote paper prescriptions in English were eligible for study participation. The prescribers agreed to use only the prescription pads provided to them during the study.