Fenestrate what you can't snorkel?

Background: Although challenging proximal necks have limited the utility of standard endovascular aneurysm repair (EVAR) devices, sophisticated endovascular techniques have evolved in recent years for the repair of juxtarenal abdominal aortic aneurysms (AAAs). Among these techniques, snorkel or chimney EVAR (sn-EVAR) and fenestrated EVAR (f-EVAR) have emerged as options for repairing anatomic high-risk AAAs. Unfortunately, in the United States, except in the context of a clinical trial or physician-sponsored device exemption, limited long-term data exist on the treatment of juxta- and suprarenal AAAs with either sn-EVAR or f-EVAR.

A preparation guide for surgical resident and student rotations to underserved regions.

Interest in global health among surgical residents and medical students is growing. There are numerous opportunities worldwide for both short- and long-term experiences. In order to maximize the learning potential, the authors present a practical guide for residents and students to prepare for a surgical visit, elective, rotation, or mission to an underserved region.

Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies: report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict.

Limb amputations are frequently performed as a result of trauma inflicted during conflict or disasters. As demonstrated during the 2010 earthquake in Haiti, coordinating care of these patients in austere settings is complex. During the 2011 Humanitarian Action Summit, consensus statements were developed for international organizations providing care to limb amputation patients during disasters or humanitarian emergencies.

Antigen-independent differentiation and maintenance of effector-like resident memory T cells in tissues.

Differentiation and maintenance of recirculating effector memory CD8 T cells (T(EM)) depends on prolonged cognate Ag stimulation. Whether similar pathways of differentiation exist for recently identified tissue-resident effector memory T cells (T(RM)), which contribute to rapid local protection upon pathogen re-exposure, is unknown. Memory CD8αβ(+) T cells within small intestine epithelium are well-characterized examples of T(RM), and they maintain a long-lived effector-like phenotype that is highly suggestive of persistent Ag stimulation.

Best practice guidelines on surgical response in disasters and humanitarian emergencies: report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space.

The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management.

Delayed hypogastric artery pseudoaneurysm following blunt trauma without evidence of pelvic fracture.

Arterial pelvic bleeding caused by bony fragments is a common finding in patients with pelvic fractures after blunt trauma (Durkin et al., Am J Surg 2006;192:211-23). However, arterial injury in the absence of bony fracture is extremely rare, and in the event that it does occur, is immediately discovered on cross-sectional imaging.

Clinical characteristics, comorbidities, and response to treatment of veterans with obstructive sleep apnea, Cincinnati Veterans Affairs Medical Center, 2005-2007.

Introduction: Obstructive sleep apnea (OSA) is a common disorder that is associated with significant morbidity. Veterans may be at an elevated risk for OSA because of increased prevalence of factors associated with the development and progression of OSA. The objective of this study was to determine the clinical characteristics, comorbidities, polysomnographic findings, and response to treatment of veterans with OSA.

The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses.

The International Classification of Sleep Disorders, Second Edition (ICSD-2) distinguishes 5 subtypes of central sleep apnea syndromes (CSAS) in adults. Review of the literature suggests that there are two basic mechanisms that trigger central respiratory events: (1) post-hyperventilation central apnea, which may be triggered by a variety of clinical conditions, and (2) central apnea secondary to hypoventilation, which has been described with opioid use. The preponderance of evidence on the treatment of CSAS supports the use of continuous positive airway pressure (CPAP).

The Featherstone laboratory pH cycling model: a prospective, multi-site validation exercise.

Purpose: To demonstrate the robustness of the Featherstone pH cycling model when tested in three independent laboratories and to evaluate the use of "non-inferiority" testing at those laboratories.

Methods: The fundamental principles for the Featherstone laboratory pH cycling model to be an appropriate alternative to animal testing is that it must demonstrate equivalent accuracy to the "Gold Standard" (rat caries model) by: (1) providing a meaningful representation of the caries process; (2) demonstrating a proportionate response to fluoride dose (or concentration); (3) being able to show that clinically proven formulations perform similarly relative to the controls; and (4) differentiating products that have attenuated fluoride activity.

Results: This cross-validation study confirmed the ability of the three independent laboratories to discriminate between various concentrations of fluoride-containing dentifrice formulations, demonstrated that clinically proven formulas perform as expected and identified an attenuated fluoride formulation (NaF/CaCO3 dentifrice - 1100 ppm NaF) as inferior compared to the 1100 ppm F (NaF/silica) positive control.

Psychophysical and cerebral responses to heat stimulation in patients with central pain, painless central sensory loss, and in healthy persons.

Patients with central pain (CP) typically have chronic pain within an area of reduced pain and temperature sensation, suggesting an impairment of endogenous pain modulation mechanisms. We tested the hypothesis that some brain structures normally activated by cutaneous heat stimulation would be hyperresponsive among patients with CP but not among patients with a central nervous system lesion causing a loss of heat or nociceptive sensation with no pain (NP). We used H(2)(15)O positron emission tomography to measure, in 15 healthy control participants, 10 NP patients, and 10 CP patients, increases in regional cerebral blood flow among volumes of interest (VOI) from the resting (no stimulus) condition during bilateral contact heat stimulation at heat detection, heat pain threshold, and heat pain tolerance levels.

Population pharmacokinetics of recombinant factor VIII: the relationships of pharmacokinetics to age and body weight.

Comparison of the pharmacokinetics (PK) of a coagulation factor between groups of patients can be biased by differences in study protocols, in particular between blood sampling schedules. This could affect clinical dose tailoring, especially in children. The aim of this study was to describe the relationships of the PK of factor VIII (FVIII) with age and body weight by a population PK model.

Reproductive experience modifies the effects of estrogen receptor alpha activity on anxiety-like behavior and corticotropin releasing hormone mRNA expression.

Previous studies have demonstrated that prior reproductive experience can influence anxiety-like behaviors, although neural mechanisms underlying this shift remain unknown. Studies in virgin females suggest that activation of the two estrogen receptor subtypes, ERα and ERβ, have differing effects on anxiety. Specifically, ERβ activation has been shown to reduce anxiety-like behaviors, while ERα activation has no significant effect.

Elective global surgery rotations for residents: a call for cooperation and consortium.

Background: International elective experiences are becoming an increasingly important component of American general surgery education. In 2011, the Residency Review Committee (RRC) approved these electives for credit toward graduation requirements. Previous surveys of general surgery program directors have established strong interest in these electives but have not assessed the feasibility of creating a national and international database aimed at educational standardization.

Development and implementation of an introductory endovascular training course for medical students.

Background: Endovascular simulation has been promoted as an educational tool for trainees to practice procedures in a safe environment and improve basic technical skills. We sought to determine whether an established endovascular training course for medical students could increase technical proficiency, enhance interest in vascular surgery, and be implemented at another academic institution.

Methods: At Center A, medical students participated in an eight-week elective course with a structured curriculum comprised of weekly mentored simulator sessions and didactic teachings.

Readiness for practice: the senior practicum experience.

Nursing students must be prepared to enter the practice environment ready to competently care for patients. The purpose of this study was to examine factors hypothesized to influence senior nursing students' perceptions of readiness for practice and to determine their level of comfort performing skills independently. This study also validates an investigator-developed instrument, the Casey-Fink Readiness for Practice Survey.

Endovascular repair of bilateral iliac artery aneurysms in a patient with Loeys-Dietz syndrome.

Background: Loeys-Dietz syndrome (LDS) is a rare congenital connective tissue disorder (CTD) caused by mutations in the gene encoding for transforming growth factor-β receptors I and II. This recently described syndrome is characterized by aortic aneurysms and dissections, arterial tortuosity, and spontaneous organ perforation. The technical feasibility of endovascular interventions, particularly endovascular aneurysm repair (EVAR), in CTDs is relatively unknown.

Wristbands as aids to reduce misidentification: an ethnographically guided task analysis.

Objective: Wristbands are recommended in the UK as a means of verifying patient identity but have been little studied. We aimed to document how wristbands are used in practice.

Design: and participants Task analysis of wristband application and use, drawing on qualitative analysis of workplace observation of, and interviews with, clinical and non-clinical staff.

Acute phenylalanine/tyrosine depletion reduces motivation to smoke cigarettes across stages of addiction.

The neurobiology of tobacco use is poorly understood, possibly in part because the relevant mechanisms might differ depending on past nicotine exposure and degree of addiction. In the present study we investigated whether these factors might affect the role of dopamine (DA). Using the acute phenylalanine/tyrosine depletion method (APTD), DA synthesis was transiently decreased in three groups of abstinent smokers (n=47): (1) early low-frequency smokers, who had smoked a maximum of five cigarettes per day for less than one year, (2) stable low-frequency smokers smoking at the same level as early low-frequency smokers for at least 3 years, and (3) stable high-frequency smokers, who smoked a minimum of 10 or more cigarettes per day for at least 5 years.

Daily, monthly, seasonal, and annual ammonia emissions from Southern High Plains cattle feedyards.

Ammonia emitted from beef cattle feedyards adds excess reactive N to the environment, contributes to degraded air quality as a precursor to secondary particulate matter, and represents a significant loss of N from beef cattle feedyards. We used open path laser spectroscopy and an inverse dispersion model to quantify daily, monthly, seasonal, and annual NH emissions during 2 yr from two commercial cattle feedyards in the Panhandle High Plains of Texas. Annual patterns of NH fluxes correlated with air temperature, with the greatest fluxes (>100 kg ha d) during the summer and the lowest fluxes (<15 kg ha d) during the winter.

Anticaries potential of commercial fluoride rinses as determined by fluoridation and remineralization efficiency.

Objective: The objective of this work was to compare the anticaries potential of several currently marketed fluoride-containing mouthrinse products using two in vitro approaches: 1) fluoride uptake studies of demineralized human enamel samples after exposure to rinse products; and 2) microhardness studies of sound enamel samples after exposure to the rinse products and demineralizing agents.

Methods: Four currently marketed rinse products, formulated at 100 ppm F, were evaluated in fluoride uptake studies relative to a negative (water) rinse control (Study 1). The same rinse products were evaluated in microhardness studies (Study 2) against a positive control, ACT Anticavity rinse, which is formulated with 225 ppm F and carries the ADA Seal of Acceptance as an effective anticavity mouthrinse.

Creating an assistive technology clinic: the experience of the Johns Hopkins AT clinic for patients with ALS.

For persons with Amyotrophic Lateral Sclerosis (ALS), comprehensive multidisciplinary care can effectively improve overall quality of life from diagnosis to end of life [16]. Considering the rapidly progressive loss in overall function experienced by persons with ALS, it is essential to provide comprehensive multidisciplinary care, including Assistive Technology (AT) services, in an effective and efficient manner. AT is an important adjunctive therapy for people with neurological disability.