A lucid interval in a victim of abusive head trauma with multiple parenchymal lacerations.

Abusive head trauma (AHT) is a leading cause of abusive deaths in children under age one. AHT can include intracranial hemorrhages, hypoxic ischemic injury, or parenchymal lacerations. Most infants with parenchymal lacerations present with acute neurological symptoms.

Predictive and diagnostic measures for kernicterus spectrum disorder: a prospective cohort study.

Background: Kernicterus spectrum disorder (KSD) resulting from neonatal hyperbilirubinemia remains a common cause of cerebral palsy worldwide. This 12-month prospective cohort study followed neonates with hyperbilirubinemia to determine which clinical measures best predict KSD.

Methods: The study enrolled neonates ≥35 weeks gestation with total serum bilirubin (TSB) ≥ 20 mg/dl admitted to Aminu Kano Hospital, Nigeria.

Developing a User-Centered Digital Clinical Decision Support App for Evidence-Based Medication Recommendations for Type 2 Diabetes Mellitus: Prototype User Testing and Validation Study.

Background: Closing the gap between care recommended by evidence-based guidelines and care delivered in practice is an ongoing challenge across systems and delivery models. Clinical decision support systems (CDSSs) are widely deployed to augment clinicians in their complex decision-making processes. Despite published success stories, the poor usability of many CDSSs has contributed to fragmented workflows and alert fatigue.

Randomized prospective evaluation of genome sequencing versus standard-of-care as a first molecular diagnostic test.

Purpose: To evaluate the diagnostic yield and clinical relevance of clinical genome sequencing (cGS) as a first genetic test for patients with suspected monogenic disorders.

Methods: We conducted a prospective randomized study with pediatric and adult patients recruited from genetics clinics at Massachusetts General Hospital who were undergoing planned genetic testing. Participants were randomized into two groups: standard-of-care genetic testing (SOC) only or SOC and cGS.

Integrating neuroimaging biomarkers into the multicentre, high-dose erythropoietin for asphyxia and encephalopathy (HEAL) trial: rationale, protocol and harmonisation.

Introduction: MRI and MR spectroscopy (MRS) provide early biomarkers of brain injury and treatment response in neonates with hypoxic-ischaemic encephalopathy). Still, there are challenges to incorporating neuroimaging biomarkers into multisite randomised controlled trials. In this paper, we provide the rationale for incorporating MRI and MRS biomarkers into the multisite, phase III high-dose erythropoietin for asphyxia and encephalopathy (HEAL) Trial, the MRI/S protocol and describe the strategies used for harmonisation across multiple MRI platforms.

Tracking the Pliensbachian-Toarcian Karoo firewalkers: Trackways of quadruped and biped dinosaurs and mammaliaforms.

The Karoo igneous rocks represent one of the largest continental flood basalt events (by volume) on Earth, and are not normally associated with fossils remains. However, these Pliensbachian-Toarcian lava flows contain sandstone interbeds that are particularly common in the lower part of the volcanic succession and are occasionally fossiliferous. On a sandstone interbed in the northern main Karoo Basin, we discovered twenty-five tridactyl and tetradactyl vertebrate tracks comprising five trackways.

Coregistration of multimodal imaging is associated with favourable two-year seizure outcome after paediatric epilepsy surgery.

Multimodal coregistration uses multiple image datasets coregistered to an anatomical reference (i.e. MRI), allowing multiple studies to be viewed together.

The utilization of video-conference shared medical appointments in rural diabetes care.

Aim: To explore whether Video-Shared Medical Appointments (video-SMA), where group education and medication titration were provided remotely through video-conferencing technology would improve diabetes outcomes in remote rural settings.

Methods: We conducted a pilot where a team of a clinical pharmacist and a nurse practitioner from Honolulu VA hospital remotely delivered video-SMA in diabetes to Guam. Patients with diabetes and HbA1c ≥7% were enrolled into the study during 2013-2014.

Sodium nitrite protects against kidney injury induced by brain death and improves post-transplant function.

Renal injury induced by brain death is characterized by ischemia and inflammation, and limiting it is a therapeutic goal that could improve outcomes in kidney transplantation. Brain death resulted in decreased circulating nitrite levels and increased infiltrating inflammatory cell infiltration into the kidney. Since nitrite stimulates nitric oxide signaling in ischemic tissues, we tested whether nitrite therapy was beneficial in a rat model of brain death followed by kidney transplantation.

3T magnetic resonance imaging accurately depicts radiofrequency ablation zones in a blood-perfused bovine liver model.

Purpose: To determine if noncontrast T1-weighted (T1W) images from 3T magnetic resonance (MR) imaging accurately depict radiofrequency (RF) ablation zones as determined macroscopically and microscopically in a blood-perfused bovine liver model.

Materials And Methods: Three-dimensional (3D) gradient-recalled echo (GRE) T1W images were obtained on a 3T MR imaging scanner after RF ablations (n = 14) of in vitro blood-perfused bovine livers. The resulting central hypointense and peripheral hyperintense signal regions were measured and compared with the inner tan and outer red zones of the gross specimen.

In vitro blood-perfused bovine liver model: a physiologic model for evaluation of the performance of radiofrequency ablation devices.

Purpose: To describe an in vitro blood-perfused bovine liver model for the testing of radiofrequency (RF) ablation devices and compare the performance of a specific RF ablation device in the model relative to three other biologic models.

Materials And Methods: Fresh bovine livers were used to create three in vitro models: blood-perfused, Krebs-Henseleit (KH) solution-perfused, and nonperfused. The perfused models were connected to a heart-lung machine via the portal vein and perfused with heparinized autologous blood or KH solution under physiologic conditions.

Combination radiofrequency ablation and intravenous radiolabeled liposomal Doxorubicin: imaging and quantification of increased drug delivery to tumors.

Purpose: To identify, with noninvasive imaging, the zone of radiopharmaceutical uptake after combination therapy with radiofrequency (RF) ablation and intravenous administration of technetium 99m ((99m)Tc) liposomal doxorubicin in a small-animal tumor model, and to quantify and correlate the uptake by using imaging and tissue counting of intratumoral doxorubicin accumulation.

Materials And Methods: This study was approved by the animal care committee. Two phases of animal experiments were performed.

Short communication: Effect of estrogen supplemented at dry-off on temporal changes in concentrations of lactose in blood plasma of Holstein cows.

The objective was to determine the effect of supplemental estrogen (estradiol cypionate, ECP) at dry-off on temporal changes in concentrations of lactose in blood plasma of Holstein cows as an indicator of rate of mammary involution. Thirty-two Holstein cows (8/group) were assigned randomly to 4 treatment groups: 30-d dry, 30-d dry + ECP, 60-d dry, and 60-d dry + ECP. A single injection (7.

Supplementing Holstein cows with low doses of bovine somatotropin prepartum and postpartum reduces calving-related diseases.

The objective of this study was to evaluate whether supplementing Holstein cows with bovine somatotropin (bST; 142.8 mg/14 d), beginning at 21 d (+/-3 d) before expected calving and continuing through 42 d in milk (+/-3 d), affected the incidence rates of retained fetal membranes (RFM), metritis (MET), clinical mastitis (MAS), digestive problems (DIG), ketosis (KET), milk fever (MF), displaced abomasum (DA, left or right), lameness (LAM), or number of sick cows during the first 60 d in milk. Data for multiparous Holstein cows from 3 separate trials were merged for analyses (n = 437).

Management of sternoclavicular joint infections.

Surgically managed infections of the sternoclavicular joint have rarely been reported, but general and thoracic surgeons may be consulted to manage such infections. Patients who have demonstrated resistance to antibiotic therapy or have infection extending beyond the joint capsule are best managed by surgical resection.

Percutaneous radiofrequency ablation of hepatic tumors against the diaphragm: frequency of diaphragmatic injury.

Purpose: To retrospectively determine the frequency of diaphragmatic injury when percutaneous hepatic radiofrequency (RF) ablation is performed adjacent to the diaphragm.

Materials And Methods: Institutional Review Board approval was obtained for our HIPAA-compliant study. Informed consent for the ablation procedure and for use of related data for future research was obtained from each patient.

Milk production from Holstein half udders after concurrent thirty- and seventy-day dry periods.

The objective of this study was to use a within-cow, half-udder model to compare the effect of cessation of milk removal from mammary quarters within respective half udders at either 30 or 70 d before expected calving date (ECD) on the ability of the half udders to subsequently produce milk. Pregnant Holstein cows were assigned to control (n = 14) or treatment (TRT, n = 26) groups. All mammary quarters in the udder of cows in the control group had 70-d (68 +/- 9 d) dry periods, whereas in each cow of the TRT group, 1 randomly selected half udder was dried at 70 d before ECD and the other half udder continued to be milked twice daily until dried at 30 d before ECD.

Thermal ablation for hepatocellular carcinoma.

Thermal ablation, as a form of minimally invasive therapy for hepatocellular carcinoma (HCC), has become an important treatment modality. Because of the limitations of surgery, the techniques of thermal ablation have become standard therapies for HCC in some situations. This article reviews 4 thermal ablation techniques-radiofrequency (RF) ablation, microwave ablation, laser ablation, and cryoablation.

Pregnancy and bovine somatotropin in nonlactating dairy cows: I. Ovarian, conceptus, and insulin-like growth factor system responses.

Nonlactating dairy cows were used to examine effects of bovine somatotropin (bST) on components of the insulin-like growth factor (IGF) system. Estrus was synchronized in cows with a Presynch + Ovsynch protocol and timed AI (TAI; n = 55) or not TAI (cycling, C; n = 23) on d 0 (time of synchronized ovulation). On d 0 and 11, cows received bST (500 mg) or no bST, and were sacrificed on d 17.

Low doses of bovine somatotropin during the transition period and early lactation improves milk yield, efficiency of production, and other physiological responses of Holstein cows.

The objectives of this experiment were to determine whether low doses of bovine somatotropin (bST) during the transition period and early lactation period improved dry matter intake (DMI), body weight (BW), or body condition score (BCS); provoked positive changes in concentrations of somatotropin, insulin, insulin-like growth factor-I (IGF-I), glucose, nonesterified fatty acids, and Ca; or improved milk yield (MY) response without obvious adverse effects on health status. Eighty-four multiparous Holstein cows completed treatments arranged in a 2 x 3 x 2 factorial design that included prepartum and postpartum bST, dry period (30 d dry, 30 d dry + estradiol cypionate, and 60 d dry), and prepartum anionic or cationic diets. Biweekly injections of bST began at 21 +/- 3 d before expected calving date through 42 +/- 2 d postpartum (control = 0 vs.