Adipose-Derived Stem Cells Prevent Anastomotic Leak: A Porcine Ischemic Esophagectomy Model.

Introduction: Esophagectomy is a lifesaving procedure plagued by an anastomotic leak rate of 11%-35%. Ischemia is widely accepted to be the most significant risk factor for anastomotic leak. We hypothesized that the injection of adipose-derived stem cells (ASCs) into an ischemic esophagogastric anastomosis would prevent leakage.

Experimental recreationist noise alters behavior and space use of wildlife.

Providing outdoor recreational opportunities to people and protecting wildlife are dual goals of many land managers. However, recreation is associated with negative effects on wildlife, ranging from increased stress hormones to shifts in habitat use to lowered reproductive success. Noise from recreational activities can be far reaching and have similar negative effects on wildlife, yet the impacts of these auditory encounters are less studied and are often unobservable.

Treatment of Abdominal Aortic Aneurysm Utilizing Adipose-Derived Mesenchymal Stem Cells in a Porcine Model.

Introduction: The current treatment paradigm of abdominal aortic aneurysms (AAA) focuses on observing patients until their disease reaches certain thresholds for intervention, with no preceding treatment available. There is an opportunity to develop novel therapies to prevent further aneurysmal growth and decrease the risk of a highly morbid rupture. We used a porcine model of aortic dilation to assess the ability of human adipose-derived mesenchymal stem cells (MSCs) to attenuate aortic dilation.

Effect of Online Training Modules and Virtual Patients on First-Year Physician Assistant Students' Confidence Levels.

Purpose: Pilot study assessing impact of virtual patients (VPs) and online modules on first-year physician assistant (PA) student confidence in documentation performance.

Methods: Five VP cases (head, eyes, ears, nose, and throat; musculoskeletal; abdominal; neurological; and comprehensive history and physical examination) and one module (cardiac sounds) were implemented to complement the core PA curriculum.

Results: A VP-based protocol significantly improved student confidence for taking a history, performing a physical examination, and undertaking clinical reasoning as well as providing overall documentation confidence.

Hepatitis B Vaccination, Screening, and Linkage to Care: Best Practice Advice From the American College of Physicians and the Centers for Disease Control and Prevention.

Background: Vaccination, screening, and linkage to care can reduce the burden of chronic hepatitis B virus (HBV) infection. However, recommendations vary among organizations, and their implementation has been suboptimal. The American College of Physicians' High Value Care Task Force and the Centers for Disease Control and Prevention developed this article to present best practice statements for hepatitis B vaccination, screening, and linkage to care.

High-Fidelity Simulation Use in Preparation of Physician Assistant Students for Neonatal and Obstetric Care.

Purpose: The study attempts to determine whether a simulation experience would increase physician assistant (PA) students' comfort level in caring for obstetric patients and assessing a neonate with an Apgar score.

Methods: First-year PA students who are in the didactic phase of their education were asked to complete a questionnaire before and after a hybrid simulation scenario, in which they aided in estimating cervical dilation, delivering a neonate, and assessing the Apgar score of a neonate. The simulation included high-fidelity simulation for 2 portions of the experience and task-trainer simulation for the remaining portion of the experience.

Impact of PhD training on scholarship in a neurosurgical career.

Object: The purpose of this study was to report the prevalence of neurosurgeons with both medical degrees (MDs) and doctorates (PhDs) at top-ranked US academic institutions and to assess whether the additional doctorate education is associated with substantive career involvement in academia as well as greater success in procuring National Institutes of Health (NIH) research funding compared with an MD-only degree.

Methods: The authors reviewed the training of neurosurgeons across the top 10 neurosurgery departments chosen according to academic impact (h index) to examine whether MD-PhD training correlated significantly with career outcomes in academia.

Results: Six hundred thirteen neurosurgery graduates and residents between the years 1990 and 2012 were identified for inclusion in this analysis.

Evaluation of multiple variables predicting the likelihood of passage and failure of PANCE.

Purpose: A significant positive correlation between the Physician Assistant National Certifying Examination (PANCE) and the PAEA Physician Assistant Clinical Knowledge Rating and Assessment Tool (PACKRAT) has been found in previous studies. This study's goal was to improve prediction of PANCE failure using other predictive measures, alone and in combination, with the PACKRAT.

Methods: Correlation and discriminate and regression analyses were conducted on 3 years of data (2007-2009) collected from Chatham University PA Studies graduates, with convergent results.

Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study.

Purpose: To determine the frequency of preoperative computed tomography (CT) in the evaluation of patients suspected of having appendicitis at one institution during the past 10 years and to determine whether changes in CT utilization were associated with changes in the negative appendectomy rate.

Materials And Methods: Institutional review board approval was obtained, and a waiver of informed consent was granted for this HIPAA-compliant study. A surgical database search yielded medical record numbers of 925 patients (526 [ 56.

Contrast material administration protocols for 64-MDCT angiography: altering volume and rate and use of a saline chaser to better match the imaging window--physiologic phantom study.

Objective: The purpose of our study was to evaluate the effect of varying volumes and rates of contrast material, use of a saline chaser, and cardiac output on aortic enhancement characteristics in MDCT angiography (MDCTA) using a physiologic phantom.

Materials And Methods: Volumes of 75, 100, and 125 mL of iopamidol, 370 mg I/mL, were administered at rates of 4, 6, and 8 mL/s. The effect of a saline chaser (50 mL of normal saline, 8 mL/s) was evaluated for each volume and rate combination.

Bidimensional measurements in brain tumors: assessment of interobserver variability.

Objective: Bidimensional tumor measurements indicating a greater than 25% increase in tumor size are generally accepted as indicating tumor progression. We hypothesized that use of digital images and a homogeneous reader population would have lower interobserver variability than in previous studies.

Subjects And Methods: Eight board-certified radiologists measured tumor diameters in three planes in two consecutive MRI examinations of 22 patients with contrast-enhancing high-grade brain tumors.

Capsaicin-sensitive sensory nerve fibers contribute to the generation and maintenance of skeletal fracture pain.

Although skeletal pain can have a marked impact on a patient's functional status and quality of life, relatively little is known about the specific populations of peripheral nerve fibers that drive non-malignant bone pain. In the present report, neonatal male Sprague-Dawley rats were treated with capsaicin or vehicle and femoral fracture was produced when the animals were young adults (15-16 weeks old). Capsaicin treatment, but not vehicle, resulted in a significant (>70%) depletion in the density of calcitonin-gene related peptide positive (CGRP(+)) sensory nerve fibers, but not 200 kDa neurofilament H positive (NF200(+)) sensory nerve fibers in the periosteum.

Effect of automatic tube current modulation on radiation dose and image quality for low tube voltage multidetector row CT angiography: phantom study.

Rationale And Objectives: To evaluate the effect of automatic tube current modulation on radiation dose and image quality for low tube voltage computed tomography (CT) angiography.

Materials And Methods: An anthropomorphic phantom was scanned with a 64-section CT scanner using following tube voltages: 140 kVp (Protocol A), 120 kVp (Protocol B), 100 kVp (Protocol C), and 80 kVp (Protocol D). To achieve similar noise, combined z-axis and xy-axes automatic tube current modulation was applied.

Pediatric MDCT: towards assessing the diagnostic influence of dose reduction on the detection of small lung nodules.

Rationale And Objectives: The purpose of this study was to evaluate the effect of reduced tube current (dose) on lung nodule detection in pediatric multidetector array computed tomography (MDCT).

Materials And Methods: The study included normal clinical chest MDCT images of 13 patients (aged 1-7 years) scanned at tube currents of 70 to 180 mA. Calibrated noise addition software was used to simulate cases as they would have been acquired at 70 mA (the lowest original tube current), 35 mA (50% reduction), and 17.

Hypervascular liver tumors: low tube voltage, high tube current multidetector CT during late hepatic arterial phase for detection--initial clinical experience.

Purpose: To intraindividually compare a low tube voltage (80 kVp), high tube current computed tomographic (CT) technique with a standard CT protocol (140 kVp) in terms of image quality, radiation dose, and detection of malignant hypervascular liver tumors during the late hepatic arterial phase.

Materials And Methods: This prospective single-center HIPAA-compliant study had institutional review board approval, and written informed consent was obtained. Forty-eight patients (31 men, 17 women; age range, 35-77 years) with 60 malignant hypervascular liver tumors (mean diameter, 20.

Three-dimensional simulation of lung nodules for paediatric multidetector array CT.

The purpose of this study was to develop and validate a technique for three-dimensional (3D) modelling of small lung nodules on paediatric multidetector array computed tomography (MDCT) images. Clinical images were selected from 21 patients (<18 years old) who underwent MDCT examinations. Sixteen of the patients had one or more real lung nodules with diameters between 2.

Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial.

The authors report interim clinical results from an ongoing NIH-sponsored trial to evaluate digital chest tomosynthesis for improving detectability of small lung nodules. Twenty-one patients undergoing computed tomography (CT) to follow up lung nodules were consented and enrolled to receive an additional digital PA chest radiograph and digital tomosynthesis exam. Tomosynthesis was performed with a commercial CsI/a-Si flat-panel detector and a custom-built tube mover.

Object detectability at increased ambient lighting conditions.

Under typical dark conditions encountered in diagnostic reading rooms, a reader's pupils will contract and dilate as the visual focus intermittently shifts between the high luminance display and the darker background wall, resulting in increased visual fatigue and the degradation of diagnostic performance. A controlled increase of ambient lighting may, however, reduce the severity of these pupillary adjustments by minimizing the difference between the luminance level to which the eyes adapt while viewing an image (L(adp)) and the luminance level of diffusely reflected light from the area surrounding the display (L(s)). Although ambient lighting in reading rooms has conventionally been kept at a minimum to maintain the perceived contrast of film images, proper Digital Imaging and Communications in Medicine (DICOM) calibration of modern medical-grade liquid crystal displays can compensate for minor lighting increases with very little loss of image contrast.

Effect of echo time pair selection on quantitative analysis for adrenal tumor characterization with in-phase and opposed-phase MR imaging: initial experience.

Purpose: To determine the effect of two pairs of echo times (TEs) for in-phase (IP) and opposed-phase (OP) 3.0-T magnetic resonance (MR) imaging on (a) quantitative analysis prospectively in a phantom study and (b) diagnostic accuracy retrospectively in a clinical study of adrenal tumors, with use of various reference standards in the clinical study.

Materials And Methods: A fat-saline phantom was used to perform IP and OP 3.