Subject-Specific Modeling of Implant Placement for Type I Thyroplasty Surgery

Type I thyroplasty is widely used to improve voice production in patients affected by unilateral vocal fold paralysis. Almost two-thirds of laryngologists report using Silastic® implants to medialize the vocal fold, with implant size, shape, and location determined experientially. However, post-surgical complications arising from this procedure (extrusion, migration, resizing) necessitate revision in 4.5-16% of patients. To improve initial surgical outcomes, we have developed a subject-specific modeling tool, PhonoSim, which uses model reconstruction from MRI scans to predict the optimal implantation location. Eleven vocal fold sample sides from eight larynges of New Zealand white rabbits were randomized to two groups: PhonoSim informed (n = 6), and control (no model guidance, n = 5). Larynges were scanned ex vivo in the abducted configuration using a vertical-bore 11.7 T microimaging system, and images were used for subject-specific modeling. The PhonoSim tool simulated vocal fold adduction for multiple implant location placements to evaluate vocal fold adduction at the medial surface. The best implant placement coordinates were output for the 6 samples in the PhonoSim group. Control placements were determined by the same surgeon based on anatomical landmarks. Post-surgical MRI scans were performed for all samples to evaluate medialization in implanted vocal folds. Results show that PhonoSim-guided implantation achieved higher vocal fold medialization relative to controls (28 to 55% vs. - 29 to 39% respectively, in the glottal area reduction), suggesting that this tool has the potential to improve outcomes and revision rates for type I thyroplasty.

Factors That Influence Health-Promoting Behaviors in Cancer Caregivers

OBJECTIVES

To describe cancer caregivers' participation in health-promoting behaviors and to identify factors influencing participation.

SAMPLE & SETTING

129 informal cancer caregivers at the National Institutes of Health Clinical Center.

METHODS & VARIABLES

Cross-sectional survey methodology using Health-Promoting Lifestyle Profile-II (HPLP-II), PROMIS® Global Physical Health, NIH Toolbox Stress and Self-Efficacy, Caregiver Reaction Assessment, and Family Care Inventory Mutuality subscale.

RESULTS

Caregivers reported the highest HPLP-II subscale scores for spirituality and interpersonal relationships and the lowest for physical activity. Caregivers who were older, with lower body mass indices, in better physical health, and with higher self-efficacy and mutuality participated in more health-promoting behaviors. Sixty percent of the caregivers reported that they exercised less since becoming a caregiver, and 47% reported that their diet was worse.

IMPLICATIONS FOR NURSING

Future research is needed to examine novel interventions to increase health-promoting activities in cancer caregivers, and these interventions might be strengthened by including components that focus on increasing self-efficacy and/or improving the strength of the relationship between the caregiver and care recipient.

331 The Role of Prophylactic and Therapeutic Fasciotomy in Acute Limb Presentations

Introduction

Acute compartment syndrome is a surgical emergency that can be of traumatic or non-traumatic nature. Missed or delayed diagnosis can cause significant morbidity. The aim of this systematic review was to assess outcomes following prophylactic and therapeutic fasciotomies performed for acute limb presentations.

Method

This systematic review was undertaken following a predefined protocol registered with PROSPERO, in accordance with PRISMA guidelines. Searches of MEDLINE and Embase databases retrieved 623 articles; 19 articles were included in the study. A qualitative synthesis was performed due to heterogeneity between the studies.

Results

Overall mortality rates of 0–19 % were reported for traumatic causes and 24.5–27% for non-traumatic causes. In general, comparative studies reported lower amputation rates (0–21.7% vs 6.6–50%) and neurological deficit rates in the prophylactic versus therapeutic fasciotomy arms (8.8–18% vs 12.5–42%). Complication rates of up to 42% and 35% were reported in traumatic and non-traumatic cases respectively, which included wound infection, nerve injury and ischaemic contractures.

Conclusions

Prophylactic fasciotomies appear to have superior outcomes than therapeutic ones. There is insufficient evidence for a specific time cut-off for the performance of therapeutic fasciotomies; retrospective analysis of outcomes via a fasciotomy registry may help to guide future practice.

545 Actigraphic sleep parameters and anxiety symptoms among community-dwelling older adults

Introduction

A number of cross-sectional studies have found that elevated levels of anxiety are associated with poor sleep among healthy older adults, but most have used self-reported sleep measures. We investigated the longitudinal association between objectively measured sleep (by wrist actigraphy) and subsequent change in anxiety symptoms in this population.

Methods

We studied 555 community-dwelling older adults (mean age 72.52±7.35, 77.48% white, 53.15% women) in the National Social Health and Aging Project (NSHAP) study who completed 3 nights of wrist actigraphy at wave 2 (2010–2011) and the Hospital Anxiety and Depression Scale at waves 2 and 3 (2015–2016). Actigraphic sleep parameters were averaged across nights and included: total sleep time (TST; minutes), percent sleep (%), wake after sleep onset (WASO; minutes), and sleep fragmentation. Change in anxiety was calculated as the difference between anxiety scores at wave 3 and wave 2.

Results

After adjusting for age, race, sex, education, body mass index, number of medical conditions, depression symptoms, and anxiety scores at wave 2, we found no significant associations between any actigraphic sleep parameter and subsequent change in anxiety symptoms (all p ≥ 0.390). Additional analyses revealed no significant cross-sectional associations at wave 2 (p ≥ 0.390).

Conclusion

We found no evidence for an association between actigraphic sleep and anxiety symptoms, or change in anxiety symptoms, in community-dwelling older adults. Additional studies using clinical anxiety disorder diagnoses are needed to evaluate the extent to which objectively measured sleep disturbance predicts clinically significant anxiety in older adults.

Support (if any)

American Academy of Sleep Medicine Foundation (#223-BS-19).

Factors influencing loneliness in cancer caregivers: A longitudinal study

OBJECTIVE

To describe levels of loneliness in cancer caregivers over a 6 month time period, and to examine factors that influence changes in loneliness in caregivers over time.

METHODS

Prospective, repeated measures design was utilized to examine levels of loneliness and factors that influence loneliness in 129 family caregivers of individuals undergoing cancer treatment at three time points over a 6 month period. Measures included: PROMIS global health and sleep disturbance; NIH Toolbox loneliness, self-efficacy and perceived stress; Family Care Inventory mutuality scale; and Caregiver Reaction Assessment.

RESULTS

Approximately one third (30.2%, n = 39) of the caregivers had high levels of loneliness, and levels of loneliness did not change over the three time points (P = .985). For any given time point, caregivers who were not married (P = .008), not working (P = .027), with worse mental health (P = .015), more perceived-stress (P < .0001), and more caregiver burden (P = .003) reported higher levels of loneliness.

CONCLUSION

This study provides guidance for clinicians attempting to identify at-risk caregivers by confirming the findings of previous research that caregivers with higher burden, stress and in poor mental health are at increased risk for loneliness. This study provides preliminary evidence that continuing to work during the caregiving trajectory may be beneficial to caregivers by reducing levels of loneliness. Future research is needed to confirm these findings and to examine novel interventions to reduce loneliness in cancer caregivers.

Size-dependent influence of NOx on the growth rates of organic aerosol particles

Atmospheric new-particle formation (NPF) affects climate by contributing to a large fraction of the cloud condensation nuclei (CCN). Highly oxygenated organic molecules (HOMs) drive the early particle growth and therefore substantially influence the survival of newly formed particles to CCN. Nitrogen oxide (NOx) is known to suppress the NPF driven by HOMs, but the underlying mechanism remains largely unclear. Here, we examine the response of particle growth to the changes of HOM formation caused by NOx. We show that NOx suppresses particle growth in general, but the suppression is rather nonuniform and size dependent, which can be quantitatively explained by the shifted HOM volatility after adding NOx. By illustrating how NOx affects the early growth of new particles, a critical step of CCN formation, our results help provide a refined assessment of the potential climatic effects caused by the diverse changes of NOx level in forest regions around the globe.

[Implications of EET in renal ischemia/reperfusion by regulating NLRP3 expression and pyroptosis]

Objective: To investigate the mechanism of epoxyeicosatrienoic acids (EET) on renal ischemia/reperfusion (I/R). Methods: Thirty 10-week male C57BL6 mice were randomly divided into five groups: sham goup, I/R group, I/R with EET group, I/R with toll-like receptor 4 (TLR4) inhibitor (TAK242) group, I/R with EET and TAK242 group. Blood urea nitrogen (BUN) and serum creatinine (Scr) as well as renal pathological changes were observed 24 h after reperfusion. The protein expression of NOD-like receptor pyrin domain containing 3 (NLRP3), cysteinyl aspartate specific proteinase 1 (caspase-1), interleukin-1β (IL-1β), TLR4 and myeloid differentiation factor 88 (MyD88) were evaluated using Western blot. Results: Severe renal tubular epithelial cell injury and decreased renal function [BUN:(10.37±0.53) vs (6.70±0.82)mmol/L, t=9.17, P<0.001; Scr: (83.67±3.88) vs (32.50±3.51)μmol/L, t=23.96, P<0.001] occurred in I/R group. Compared to the sham group, the relative expression of NLRP3 (1.54±0.10 vs 0.71±0.05, t=13.14, P<0.001), caspase-1 (2.35±0.05 vs 0.62±0.02, t=73.77, P<0.001), IL-1β (3.11±0.11 vs 1.26±0.05, t=35.97, P<0.001), TLR4 (1.58±0.03 vs 0.39±0.01, t=86.00, P<0.001), MyD88 (0.94±0.02 vs 0.26±0.01, t=72.61, P<0.001) were significantly increased. Mice pretreated with EET analog featured lower kidney damage and diminished levels of above proteins than I/R group (all P<0.001). Besides, the co-administration of TAK242 and EET analog could even markedly reduced the expression levels of each proteins than those in I/R group and I/R with EET group (all P<0.001). Conclusion: EET exerts a protective effect on attenuating renal I/R injury possibly through inhibiting TLR4 pathway to regulate the activation of NLRP3-induced pyroptosis.

Computed tomography-guided iodine-125 interstitial implantation as an alternative treatment option for lung cancer

PURPOSE

The aim was to evaluate the safety, feasibility and efficacy of computed tomography (CT)-guided percutaneous interstitial brachytherapy using radioactive iodine-125 ( 125 I) seeds for the treatment of lung cancer.

MATERIALS AND METHODS

Included in this study were 45 male and 35 female patients aged 52-85 years (mean 72-year) who were diagnosed with lung cancer. Of the 80 cases of lung cancer, 38 were pathologically confirmed as squamous cell carcinoma, 29 as adenocarcinoma, 2 as small cell lung cancer, and 11 as metastatic lung cancer. Percutaneous interstitial implantation of radioactive 125 I seeds was performed under CT guidance. The treatment planning system was used to reconstruct three-dimensional images of the tumor to determine the quantity and distribution of 125 I seeds to be implanted. Under CT guidance, 125 I seeds were embedded into the tumor, with the matched peripheral dose set at 100-130 Gy. Follow-up CT scan was done in 2-month to explore the treatment efficacy.

RESULTS

The procedure was successful in all patients. No major procedure-associated death occurred. The duration of follow-up was 6-month. Complete response (CR) was seen in 38 cases (47.5%), partial response (PR) in 27 cases (33.75%), stable disease (SD) in 10 cases (12.5%), and progressive disease in 5 cases (6.25%), with a local control rate (CR + PR + SD) of 93.75%. The 2-, 4- and 6-month overall response rate (CR + PR) was 78%, 83% and 81%, respectively.

CONCLUSION

Implantation of CT-guided 125 I seeds is a safe and effective alternative option for the treatment of lung cancer.

Optimizing the high-resolution manometry (HRM) study protocol

BACKGROUND

Intolerance of the esophageal manometry catheter may prolong high-resolution manometry (HRM) studies and increase patient distress. We assessed the impact of obtaining the landmark phase at the end of the study when the patient has acclimatized to the HRM catheter.

METHODS

366 patients (mean age 55.4 ± 0.8 years, 62.0% female) undergoing esophageal HRM over a 1-year period were studied. The standard protocol consisted of the landmark phase, 10 5 mL water swallows 20-30 s apart, and multiple rapid swallows where 4-6 2 mL swallows were administered in rapid succession. The modified protocol consisted of the landmark phase at the end of the study after test swallows. Study duration, technical characteristics, indications, and motor findings were compared between standard and modified protocols.

KEY RESULTS

Of the 366 patients, 89.6% underwent the standard protocol (study duration 12.9 ± 0.3 min). In 10.4% with poor catheter tolerance undergoing the modified protocol, study duration was significantly longer (15.6 ± 1.0 min, p = 0.004) despite similar duration of study maneuvers. Only elevated upper esophageal sphincter basal pressures at the beginning of the study segregated modified protocol patients. The 95th percentile time to landmark phase in the standard protocol patients was 6.1 min; as many as 31.4% of modified protocol patients could not obtain their first study maneuver within this period (p = 0.0003). Interpretation was not impacted by shifting the landmark phase to the end of the study.

CONCLUSIONS & INFERENCES

Modification of the HRM study protocol with the landmark phase obtained at the end of the study optimizes study duration without compromising quality.

Streuung von Ionen. III. Regenbogeneffekt bei der Streuung von H+ an N2 , CO, CO2 , SF6, H2 und CH4 sowie von H2 + an Ar und Kr

Differential scattering cross sections of H+ on various molecules and of H2 + on Ar and Kr were measured at various energies between 5 eV and 40 eV. Several rainbows could be resolved for the systems H+-N2, H+-CO, H+-CO2 and H+-SF6 . In the case of H+-H2 , secondary rainbows could be traced at higher energies (30 eV). Only the primary rainbow was observed for H+-CH4 . The H2 +-Ar and H2 +-Kr systems also yielded rainbow structures. Broad additional maxima appeared at large angles for H2 +-Kr which were atttributed to the crossing of potential curves. The rapid oscillations could not be observed. The measured differential cross sections for the systems H+-N2 , CO, CO2, SF6 and H2 were fitted by a procedure described in part I using a simple Morse potential. The equilibrium distances rm were estimated from the relation rm = 0.7-rg (rg: gaskinetic radius of the molecule) which was found to hold approximately for the H+-noble gas systems.

The following potential depths e were obtained: 4.15 eV for N2-H+; 4.70 eV for CO-H+; 5.10 eV for CO2-H+; 3.66 eV for SF6-H+; 4.04 eV for H2-H+. These values are averages because of the anisotropy of the potentials. The potential depth for the H+-H2 system is little smaller than the theoretical value of 4.56 eV. This is attributed to nontriangular configurations in the scattering process. The scattering experiments with the system H4-CH4 were evaluated classically, ε (H+-CH4) was found to be 3.8 eV only. The large difference to the theoretical value ε = 5.45 eV is explained by the inadiabacity of the scattering process with respect to the movement of the H atoms in methane.

ε (Ar-H2 +) and ε (KrH2 +) were found to be (1.3 ± 0.2 ) eV and (1.1 ± 0.2 ) eV, respectively. Energy level diagram are dicussed for the ion-molecule reactions Ar+ (Kr+) + H2 → ArH+ (KrH+) + H including the ArH2 + and KrH2 + intermediate states. They show that most of the reaction energy becomes free in the approach of the reactants Ar++H2. This effect is less pronounced for the Kr+ (2P1/2)+H2-reaction and even a small threshold energy exists for the Kr+ (2P3/2)+H2-reaction. reaction

Streuung von Ionen. II. Regenbogeneffekt bei der elastischen Streuung von Protonen an Helium, Neon, Krypton, Xenon und von He+ an Helium

Differential scattering cross sections of H+ on various noble gases and of He+ on He were measured at various energies between 3 eV-80 eV. The rainbow structure and the superimposed rapid oscillations were resolved. Differential cross sections were calculated in WKB approximation and compared with experimentally obtained cross sections. Agreement was obtained by using the modified Morse potential:

U = exp{2 G1 G2(1 -ρ)} -2 exp{G1 G2(1-ρ)} , G2 = 1 for ρ>1,

whit ρ=r/rm, and U=V/ε. G2 ≠ 1 for ρ ≧1,

The fitting procedure discussed in part I was applied in order to obtain the parameters ε,rm, G1 and G2. Calculations with the modified Lennard-Jones potential described in part I gave the same values for ε and rm .

With exception of the system H+ -Xe, a single set of parameters could describe the rainbow structure and the fine structure at all ion energies. The values for ε and rm agree fairly well with ab-initio calculations. The reduced potentials have about the same shape, G1 being between 2.7 and 2.2, G2 being between 0.8 and 0.9.

In the case of H+ -Xe, ε increases significantly with decreasing proton energy, while G1 and G2 have only slightly to be changed. The potential well is narrower than for the other systems mentioned above. These effects are attributed to the crossing of the potential curves of the systems H+ -Xe and H-Xe+ .

Chemische Reaktionskinematik

The velocity spectra and cross sections of reactions of the type X*+D2 → XD++D (X+=Ar+, N2 +, CO+) have been found to be independent of the temperature of the target gas ( — 190° to 20°C). The additional forward scattering (as compared to spectator stripping) of the product ion at high energies cannot be explained by the thermal motion of the D2 molecules. A recoil stripping mechanism is proposed. At low energies, an intermediate XD2* is postulated that lives shorter than half a period of rotation and is forward scattered but quickly equilibrates the excess energy among the vibrational degrees of freedom. The reactions of Ar+ and N2 + with CD4 can well be understood by the stripping model over a wide range of energy. At low energies, no preferential forward scattering of the product ion is found as in the corresponding reactions with D2. The strongly unsymmetric broadening of the product ion band together with a small shift to lower velocities indicate a strong interaction of the incident ion with the CD3 group at low energies. The formation of an intermediate complex XCD4 + which isotropically decays is expected at energies of a few tenth of one eV. Direct measurements at such low primary ion energies have not yet been possible.

A novel mutation causing nephronophthisis in the Lewis polycystic kidney rat localises to a conserved RCC1 domain in Nek8

Background

Nephronophthisis (NPHP) as a cause of cystic kidney disease is the most common genetic cause of progressive renal failure in children and young adults. NPHP is characterized by abnormal and/or loss of function of proteins associated with primary cilia. Previously, we characterized an autosomal recessive phenotype of cystic kidney disease in the Lewis Polycystic Kidney (LPK) rat.

Results

In this study, quantitative trait locus analysis was used to define a ~1.6Mbp region on rat chromosome 10q25 harbouring the lpk mutation. Targeted genome capture and next-generation sequencing of this region identified a non-synonymous mutation R650C in the NIMA (never in mitosis gene a)- related kinase 8 ( Nek8) gene. This is a novel Nek8 mutation that occurs within the regulator of chromosome condensation 1 (RCC1)-like region of the protein. Specifically, the R650C substitution is located within a G[QRC]LG repeat motif of the predicted seven bladed beta-propeller structure of the RCC1 domain. The rat Nek8 gene is located in a region syntenic to portions of human chromosome 17 and mouse 11. Scanning electron microscopy confirmed abnormally long cilia on LPK kidney epithelial cells, and fluorescence immunohistochemistry for Nek8 protein revealed altered cilia localisation.

Conclusions

When assessed relative to other Nek8 NPHP mutations, our results indicate the whole propeller structure of the RCC1 domain is important, as the different mutations cause comparable phenotypes. This study establishes the LPK rat as a novel model system for NPHP and further consolidates the link between cystic kidney disease and cilia proteins.

Development of an in situ magnetoelastic magneto-optical Kerr effect magnetometer

Reported here is the development and implementation of an integrated in situ magnetoelastic measurement setup with a MOKE magnetometer, repositionable electromagnet, and sample transfer/straining device. The former were used within a molecular beam epitaxial vacuum growth chamber. Consequently the magnetostriction constants for both Cr capped and uncapped Fe/GaAs(100) films were acquired without film oxidization occurring. Samples were bent in a four point bending geometry to produce a quantifiable tensile mechanical strain on the films during magnetoelastic measurements. In addition, a laser measurement system was developed to confirm the induced strain in the samples.

Antibody binding to neuronal surface in movement disorders associated with lupus and antiphospholipid antibodies

AIM

Systemic lupus erythematosus is a multi-organ autoimmune disorder associated with autoantibodies of complex diversity. Antiphospholipid antibodies (aPL), which are commonly associated with lupus, create a pro-thrombotic tendency, but are also associated with non-thrombotic neurological features. Movement disorders are rare neuropsychiatric complications of lupus and antiphospholipid syndrome, and autoimmune and thromboembolic disease mechanisms have been proposed.

METHOD

We describe the clinical features, investigation findings, treatment, and outcome of six paediatric participants with movement disorders associated with lupus and/or aPL (six females, median age 13 y, range 8-15). To examine the autoantibody hypothesis, we used a neuronal cell line with dopaminergic characteristics and measured serum antibody binding to neuronal cell-surface antigens using flow cytometry. For comparison with the six participants, we used serum from healthy individuals (n=12, six females, median age 11 y, range 9-13) and children with other neurological diseases (n=13, seven females, median age 7 y, range 2-15).

RESULTS

Of the six participants, two had lupus only, two had lupus with aPL, and two had aPL only. The movement disorder was chorea in four and parkinsonism in two. All four participants with chorea had aPL and movement disorder relapses. The two participants with parkinsonism did not have aPL, but had a progressive course until rituximab or plasma exchange resulted in neuropsychiatric remission. All six participants demonstrated elevated serum antibody binding to neuronal cell-surface antigens compared with healthy individuals and those with other neurological diseases.

INTERPRETATION

This report supports the association of chorea with aPL, but suggests a different autoimmune mechanism operates in lupus parkinsonism. The presence of antibody binding to neuronal cell-surface antigens supports a possible direct action of autoantibodies on neurons in patients with movement disorders associated with lupus and aPL.

Antibody binding to neuronal surface in Sydenham chorea, but not in PANDAS or Tourette syndrome

OBJECTIVE

To test the hypothesis that Sydenham chorea (SC) immunoglobulin G (IgG) autoantibodies bind to specific neuronal surface proteins, whereas IgG from patients with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) or Tourette syndrome (TS) do not bind to neuronal surface proteins.

METHODS

We used live differentiated SH-SY5Y cells, which have neuronal and dopaminergic characteristics. Using flow cytometry, we measured serum IgG cell surface binding in patients with SC (n = 11), PANDAS (n = 12), and TS (n = 11), and compared the findings to healthy controls (n = 11) and other neurologic controls (n = 11). In order to determine the specificity of binding to neuronal antigens, we also used a non-neuronal cell line, HEK 293.

RESULTS

The mean IgG cell surface binding was significantly higher in the SC group compared to all other groups (p < 0.001). By contrast, there was no difference between the PANDAS or TS groups and the controls. Using the non-neuronal HEK-293 cells, there was no significant difference in IgG cell surface binding between any groups.

CONCLUSIONS

Serum autoantibodies that bind to neuronal cell surface antigens are present in SC, but not in PANDAS or TS. These findings strengthen the hypothesis that SC is due to a pathogenic autoantibody, but weaken the autoantibody hypothesis in PANDAS and TS.

Hepatic encephalopathy as an unusual late complication of transjugular intrahepatic portosystemic shunt insertion for non-cirrhotic portal hypertension caused by nodular regenerative hyperplasia in an HIV-positive patient on highly active antiretroviral therapy

Transjugular intrahepatic portosystemic shunt (TIPS) is an artificially created conduit between the portal and systemic vascular system in the liver performed percutaneously via radiological guidance. It is used mainly in conditions causing portal hypertension and its resulting complications. It reduces portal pressure by diverting portal blood flow into the systemic circulation. Hepatic encephalopathy is the most common complication following TIPS insertion and tends to present fairly early. We describe a case of hepatic encephalopathy as an unusual late complication of TIPS insertion (first presenting six years after) for non-cirrhotic portal hypertension caused by nodular regenerative hyperplasia in an HIV-positive patient on highly active antiretroviral therapy.