Experiences of people with non-traumatic spinal cord injuries returning home after inpatient rehabilitation

PURPOSE

The aim of this study was to explore the experience of people with non-traumatic spinal cord injuries who have recently returned home from inpatient rehabilitation.

METHODS

Semi-structured interviews were conducted with seven adults with non-traumatic spinal cord injuries who had been discharged from inpatient rehabilitation from an Australian rehabilitation hospital, within the last two years.

RESULTS

Three themes were identified: the practicalities of coming home; adjusting to "my altered home life"; pursuing recovery. When people felt prepared by their rehabilitation service, and had appropriate support from others, they had a more positive adjustment experience, although not one without challenges. Due to less independence and inability to participate in meaningful life roles, participants experienced a sense of lost or changed identity. Maintaining hope for physical recovery was very important and motivated participants to actively engage in rehabilitation efforts.

CONCLUSIONS

This study adds to the knowledge regarding the lived experience of people with non-traumatic spinal cord injury transitioning from rehabilitation to home. Facilitators for successful rehabilitation discharge included ensuring community services contacted patients immediately after they left hospital, and providing support for carers. Health care workers can positively influence the adjustment process of people with NTSCI by facilitating re-engagement in meaningful roles.IMPLICATIONS FOR REHABILITATIONThe transition home from inpatient rehabilitation after non-traumatic spinal cord injury (NTSCI) is facilitated by early discharge planning and follow-up from services after discharge.Establishing routines helped participants adjust to their new circumstances.The emotional and practical support of carers is vital for successful adjustment to living in the community with an NTSCI.Health care workers can positively influence the adjustment process of people with NTSCI by facilitating their re-engagement in meaningful roles.

Musculoskeletal Injury in Referees That Officiate Over Ladies Gaelic Football and Camogie

Aim Ladies Gaelic football and Camogie are leading female sports in Ireland. Referees are essential to the game, however, no research has examined injury in referees that officiate over female Gaelic games to date. Therefore, this study aims to retrospectively examine the musculoskeletal injury profile and injury prevention practices of referees that officiate over female Gaelic games. Methods A retrospective anonymous questionnaire examined injuries that occurred in the previous 12 months in currently active Ladies Gaelic football and Camogie referees (n=170). Incidence and repeat incidence proportions were calculated along with descriptive statistics. Results In 2019, 42.9% (n=73) of referees sampled sustained an injury with 27.4% (n=20) sustaining two or more. Injuries primarily occurred to the lower extremity (79.6%,n=78), particularly the lower leg (20.4%,n=20) and knee (18.4%,18). Muscle strains and cramps (55.1%,n=54) were most frequent and injuries predominantly occurred during games (71.4%,n=70). Referees largely completed a warm-up but just 30.6% (n=52) conducted a cool-down. Over half had undertaken injury prevention education but only 37.6% (n=64) incorporated injury prevention elements into their training. Conclusion Just over two in five referees that officiate female Gaelic games became injured in the previous year, however their utilisation of injury prevention strategies, beyond completing a warm-up, is lacking. Thus, a referee specific injury prevention programme should be developed and if found to be effective, incorporated into a comprehensive injury prevention strategy by the governing bodies.

Capacitive monitoring system for real-time respiratory motion monitoring during radiation therapy

Summary

This work introduces a novel capacitive‐sensing technology capable of detecting respiratory motion with high temporal frequency (200 Hz). The system does not require contact with the patient and has the capacity to sense motion through clothing or plastic immobilization devices.

Abstract

Purpose

This work presents and evaluates a novel capacitive monitoring system (CMS) technology for continuous detection of respiratory motion during radiation therapy. This modular system provides real‐time motion monitoring without any contact with the patient, ionizing radiation, or surrogates such as reflective markers on the skin.

Materials and methods

The novel prototype features an array of capacitive detectors that are sensitive to the position of the body and capable of high temporal frequency readout. Performance of this system was investigated in comparison to the RPM infrared (IR) monitoring system (Varian Medical Systems). The prototype included three (5 cm × 10 cm) capacitive copper sensors in one plane, located at a distance of 8–10 cm from the volunteer. Capacitive measurements were acquired for central and lateral‐to‐central locations during chest free‐breathing and abdominal breathing. The RPM IR data were acquired with the reflector block at corresponding positions simultaneously. The system was also tested during deep inspiration and expiration breath‐hold maneuvers.

Results

Capacitive monitoring system data demonstrate close agreement with the RPM status quo at all locations examined. Cross‐correlation analysis on RPM and CMS data showed an average absolute lag of 0.07 s (range: 0.03–0.23 s) for DIBH and DEBH data and 0.15 s (range: 0–0.43 s) for free‐breathing. Amplitude difference between the normalized CMS and RPM signal during chest and abdominal breathing was within 0.15 for 94.3% of the data points after synchronization. CMS performance was not affected when the subject was clothed.

Conclusion

This novel technology permits sensing of both free‐breathing and breath‐hold respiratory motion. It provides data comparable to the RPM system but without the need for an IR tracking camera in the treatment room or use of reflective markers on the patient.

Describing a Process for Creating a Patient Visible Quality Educational Display to Increase Patient Engagement in Radiation Oncology Throughout the Canadian Maritimes Provinces

Here, we report the process for creating a patient visible quality educational display to highlight the collaborative quality working practices of Radiation Oncology clinicians and staff in the main Radiotherapy Centers throughout three Canadian provinces. These processes are often not visible to patients yet they speak directly to the standards of care delivered at these centers. The Canadian Partnership for Quality Radiotherapy (CPQR) Quality Assurance Guidelines for Canadian Radiation Treatment Programs guided this process. The display slides created were approved by the local Radiation Oncology departmental leadership for each participating medical center as well as patient focus groups and revised with feedback from both perspectives. Of 27 patients/families who evaluated the resulting educational patient display, 70% expressed high engagement in the information presented, and 81% felt the display will be of interest to patients receiving radiotherapy treatment. Patients/families surveyed reported that the displayed content made them feel more informed and more comfortable with their treatments. Survey data from this project indicates that increasing transparency and deepening patient education about the quality working practices behind radiotherapy treatments has the potential to empower patients receiving radiotherapy and increase their confidence in the care they are receiving.

Is stiffness related to athletic groin pain?

Athletic groin pain (AGP) is a common injury prevalent in field sports. One biomechanical measure that may be of importance for injury risk is stiffness. To date, [corrected] however, stiffness has not been examined in AGP. The primary aim was to determine whether AGP affects vertical and joint stiffness and if so, whether successful rehabilitation is associated with a change in stiffness. Sixty-five male patients with AGP and fifty male controls were recruited to this study. Assessment included a biomechanical examination of stiffness during a lateral hurdle hop test. Subjects with AGP were tested pre- and post-rehabilitation, while controls were tested once. AGP subjects were cleared for return to play in a median time of 9.14 weeks (5.14-29.0). Stiffness was significantly different at pre-rehabilitation in comparison with controls for three [corrected] of the ten stiffness values examined: ankle plantar flexor, knee extensor, hip abductor, and vertical stiffness (P <  .05, D = 0.38-0.81). [corrected]. Despite clearance for return to play, of these four variables, only hip abductor stiffness changed significantly from pre- to post-rehabilitation (P = .05, D = 0.36) [corrected] to become non-significantly different to the uninjured group (P = .23, D = 0.23). [corrected]. These findings suggest that hip abductor stiffness may represent a target for AGP rehabilitation. Conversely, given the clearance for return to play, the lower sagittal plane and vertical stiffness in the AGP group in comparison with the uninjured controls likely represents either a compensatory mechanism to reduce the risk of further injury or a consequence of neuromuscular detraining.

Clinical interventions to reduce stillbirths in sub-Saharan Africa: a mathematical model to estimate the potential reduction of stillbirths associated with specific obstetric conditions

OBJECTIVE

Stillbirths are among the most common adverse pregnancy outcomes, with 98% occurring in low-income countries. More than one-third occur in sub-Saharan Africa (SSA). However, the medical conditions causing stillbirths and interventions to reduce stillbirths from these conditions are not well documented. We estimated the reductions in stillbirths possible with combinations of interventions.

DESIGN

We developed a computerised model to estimate the impact of various interventions on stillbirths caused by the most common conditions. The model considered the location of obstetric care (home, clinic or hospital) and each intervention's efficacy, penetration and utilisation. Maternal transfers were also considered.

SETTING AND POPULATION

Pregnancies in SSA in 2012.

METHODS

For each condition, we created a series of scenarios involving different combinations of interventions and modelled their impact on stillbirth rates.

MAIN OUTCOME MEASURES

Stillbirths associated with various maternal and fetal conditions and the percentage reduction with various interventions.

RESULTS

Eight to ten maternal and fetal conditions were responsible for most stillbirths, but none for more than 15%. The most common conditions causing stillbirths in SSA include obstructed labour and uterine rupture, fetal distress and umbilical cord complications, fetal growth restriction, pre-eclampsia/eclampsia, and placental abruption/placenta praevia. Syphilis and malaria contribute smaller numbers. Reducing stillbirths requires appropriate diagnosis and management of each condition, usually including hospital care for monitoring and delivery, often by caesarean section. Maternal syphilis and malaria were the only conditions for which outpatient management alone reduced stillbirth.

CONCLUSIONS

Most stillbirths in low-income countries occur at term and during labour and therefore are preventable by appropriate obstetric care. Management focused on the maternal and fetal conditions that cause stillbirths is necessary to achieve stillbirth rates approaching those found in high-income countries.

TWEETABLE ABSTRACT

Reducing stillbirth incidence requires appropriate management of each causative condition and often caesarean delivery.

Intrapatient study comparing 3D printed bolus versus standard vinyl gel sheet bolus for postmastectomy chest wall radiation therapy

PURPOSE

This patient study evaluated the use of 3-dimensional (3D) printed bolus for chest wall radiation therapy compared with standard sheet bolus with regard to accuracy of fit, surface dose measured in vivo, and efficiency of patient setup. By alternating bolus type over the course of therapy, each patient served as her own control.

METHODS AND MATERIALS

For 16 patients undergoing chest wall radiation therapy, a custom 5.0 mm thick bolus was designed based on the treatment planning computed tomography scan and 3D printed using polylactic acid. Cone beam computed tomography scanning was used to image and quantify the accuracy of fit of the 2 bolus types with regard to air gaps between the bolus and skin. As a quality assurance measure for the 3D printed bolus, optically stimulated luminescent dosimetry provided in vivo comparison of surface dose at 7 points on the chest wall. Durations of patient setup and image guidance were recorded and compared.

RESULTS

In 13 of 16 patients, the bolus was printed without user intervention, and the median print time was 12.6 hours. The accuracy of fit of the bolus to the chest wall was improved significantly relative to standard sheet bolus, with the frequency of air gaps 5 mm or greater reduced from 30% to 13% (P < .001) and maximum air gap dimension diminished from 0.5 ± 0.3 to 0.3 ± 0.3 mm on average. Surface dose was within 3% for both standard sheet and 3D printed bolus. On average, the use of 3D printed bolus reduced the setup time from 104 to 76 seconds.

CONCLUSIONS

This study demonstrates 3D printed bolus in postmastectomy radiation therapy improves fit of the bolus and reduces patient setup time marginally compared with standard vinyl gel sheet bolus. The time savings on patient setup must be weighed against the considerable time needed for the 3D printing process.

Effects of high inclusion of soybean meal and a phytase superdose on growth performance of weaned pigs housed under the rigors of commercial conditions

Two studies were conducted to determine whether soybean meal (SBM) use in nursery pig diets can be increased by superdosing with phytase. In Exp. 1, 2,550 pigs (BW of 5.54 ± 0.09 kg) were used to evaluate the optimal level of phytase in low- or high-SBM diets. Two SBM levels (low and high) and 4 phytase doses (0, 1,250, 2,500, and 3,750 phytase units [FTU]/kg) were combined to create 8 dietary treatments in a 2 × 4 factorial arrangement. Pigs were fed a 3-phase feeding program, with each period being 10, 10, and 22 d, respectively. Inclusion of low and high SBM was 15.0 and 25.0%, respectively, for Phase 1; 19.0 and 29.0%, respectively, for Phase 2; and 32.5% for the common Phase 3 diet. Pigs fed diets with high SBM had improved G:F for Phase 1 and 2 and overall ( < 0.01) compared with low-SBM diets. Phytase quadratically improved G:F during Phase 3 and overall ( < 0.05), with the optimum phytase dose being 2,500 FTU/kg. High-SBM diets tended ( = 0.09) to decrease stool firmness (determined daily from d 1 to 10) only on d 2. In Exp. 2, 2,112 pigs (BW of 5.99 ± 0.10 kg) were used to evaluate the impact of high levels of SBM and phytase on performance, stool firmness, mortality, and morbidity in weaned pigs originating from a porcine reproductive and respiratory syndrome (PRRS) virus-positive sow farm. Pigs were fed a 3-phase feeding program as in Exp. 1. Three levels of SBM (low, medium, or high) and 2 phytase levels (600 or 2,600 FTU) were combined to create 6 dietary treatments in a 3 × 2 factorial arrangement. Inclusion of SBM was 15.0, 22.5, and 30.0% for Phase 1 and 20.0, 27.5, and 35.0% for Phase 2 for low, medium, and high SBM, respectively, and 29.0% for the common Phase 3 diet. Inclusion of SBM did not affect growth performance. The percentage of pigs removed for medical treatment linearly declined with increasing SBM levels ( = 0.04). High-SBM diets tended ( < 0.10) to decrease stool firmness during d 4 and 5 and high phytase tended ( < 0.10) to improve stool firmness on d 2 and 4. Analyzed PRRS titers in saliva samples collected on d 20 and 42 confirmed the PRRS status of the pigs; however, viral load was not impacted by dietary treatments ( ≥ 0.11). Results indicate that SBM levels in early nursery diets can be increased without decreasing growth performance and may be favorable in pigs originating from PRRS-positive sow farms by reducing costs of medical treatments. Supplementation of phytase at superdose levels can improve growth performance independently from the level of SBM in the diet.

Clinical applications of 3-dimensional printing in radiation therapy

Three-dimensional (3D) printing is suitable for the fabrication of complex radiotherapy bolus. Although investigated from dosimetric and feasibility standpoints, there are few reports to date of its use for actual patient treatment. This study illustrates the versatile applications of 3D printing in clinical radiation oncology through a selection of patient cases, namely, to create bolus for photon and modulated electron radiotherapy (MERT), as well as applicators for surface high-dose rate (HDR) brachytherapy. Photon boluses were 3D-printed to treat a recurrent squamous cell carcinoma (SCC) of the nasal septum and a basal cell carcinoma (BCC) of the posterior pinna. For a patient with a mycosis fungoides involving the upper face, a 3D-printed MERT bolus was used. To treat an SCC of the nose, a 3D-printed applicator for surface brachytherapy was made. The structures' fit to the anatomy and the radiotherapy treatment plans were assessed. Based on the treatment planning computed tomography (CT), the size of the largest air gap at the interface of the 3D-printed structure was 3 mm for the SCC of the nasal septum, 3 mm for the BCC of the pinna, 2 mm for the mycosis fungoides of the face, and 2 mm for the SCC of the nose. Acceptable treatment plans were obtained for the SCC of the nasal septum (95% isodose to 99.8% of planning target volume [PTV]), the BCC of the pinna (95% isodose to 97.7% of PTV), and the mycosis fungoides of the face (90% isodose to 92.5% of PTV). For the latter, compared with a plan with a uniform thickness bolus, the one featuring the MERT bolus achieved relative sparing of all the organs at risk (OARs) distal to the target volume, while maintaining similar target volume coverage. The surface brachytherapy plan for the SCC of the nose had adequate coverage (95% isodose to 95.6% of clinical target volume [CTV]), but a relatively high dose to the left eye, owing to its proximity to the tumor. 3D printing can be implemented effectively in the clinical setting to create highly conformal bolus for photon and MERT, as well as applicators for surface brachytherapy.

Enzyme supplementation to improve the nutritional value of fibrous feed ingredients in swine diets fed in dry or liquid form

This study evaluated the effect of xylanase supplementation (with or without), feeding method (dry or liquid), and feedstuff (corn distiller's dried grains with solubles [DDGS] or wheat middlings) on apparent total tract digestibility (ATTD) and apparent ileal digestibility (AID) of GE and nutrients, intestinal morphology, ileal and cecal pH, and VFA concentrations. Sixty-four growing pigs (25.87 ± 0.38kg initial BW) were blocked by BW and sex and randomly assigned to 8 dietary treatments. Within each feedstuff, diets were fed either liquid or dry, without or with xylanase (24,000 birch xylan units/kg feed), for 16 d. Diets contained 3.32 and 3.19 Mcal/kg ME for DDGS- and wheat middlings-based diets, respectively. Pigs were fed restricted at 3 times maintenance ME requirements. Liquid diets were prepared by steeping DDGS or wheat middlings with water (1:3, wt/vol) with or without xylanase for 24 h followed by mixing with a basal ingredient mixture and water to achieve a final ratio of 1:2.5 (wt/vol). During steeping of wheat middlings, some fiber degradation occurred. When xylanase was added in dry wheat middlings diets, AID of GE ( < 0.10) and NDF ( < 0.05) increased compared with dry wheat middlings diets without xylanase (64.50 vs. 54.67% and 52.88 vs. 31.69%, respectively), but supplementation of xylanase did not impact AID of GE and NDF when liquid wheat middlings diets were fed. Xylanase in liquid DDGS diets increased ( < 0.05) the AID of NDF compared with liquid DDGS diets without xylanase, but xylanase did not affect AID of NDF in dry DDGS diets. Xylanase in wheat middlings diets improved ( < 0.05) ATTD of GE and N compared with wheat middlings diets without xylanase (80.37 vs. 78.07% and 80.23 vs. 77.94%, respectively). However, there was no effect of xylanase in DDGS diets. Pigs fed DDGS diets had greater concentrations of butyrate in the cecum ( = 0.001) than pigs fed wheat middlings diets (27.6 vs. 20.4 mmol/L). Pigs fed DDGS diets with xylanase had deeper crypts ( < 0.05) in the jejunum than pigs fed DDGS diets without xylanase (98.20 vs. 86.16 μm), but xylanase had no effect in pigs fed wheat middlings diets. Results suggest that liquid feeding and xylanase supplementation had limited potential to enhance nutrient digestibility in pigs fed DDGS-based diets. However, xylanase supplementation in dry wheat middlings-based diets improved the AID of NDF and ATTD of GE and N, but liquid feeding as pretreatment did not further enhance the nutritional value of wheat middlings-based diets.

Athletic groin pain (part 2): a prospective cohort study on the biomechanical evaluation of change of direction identifies three clusters of movement patterns

Background

Athletic groin pain (AGP) is prevalent in sports involving repeated accelerations, decelerations, kicking and change-of-direction movements. Clinical and radiological examinations lack the ability to assess pathomechanics of AGP, but three-dimensional biomechanical movement analysis may be an important innovation.

Aim

The primary aim was to describe and analyse movements used by patients with AGP during a maximum effort change-of-direction task. The secondary aim was to determine if specific anatomical diagnoses were related to a distinct movement strategy.

Methods

322 athletes with a current symptom of chronic AGP participated. Structured and standardised clinical assessments and radiological examinations were performed on all participants. Additionally, each participant performed multiple repetitions of a planned maximum effort change-of-direction task during which whole body kinematics were recorded. Kinematic and kinetic data were examined using continuous waveform analysis techniques in combination with a subgroup design that used gap statistic and hierarchical clustering.

Results

Three subgroups (clusters) were identified. Kinematic and kinetic measures of the clusters differed strongly in patterns observed in thorax, pelvis, hip, knee and ankle. Cluster 1 (40%) was characterised by increased ankle eversion, external rotation and knee internal rotation and greater knee work. Cluster 2 (15%) was characterised by increased hip flexion, pelvis contralateral drop, thorax tilt and increased hip work. Cluster 3 (45%) was characterised by high ankle dorsiflexion, thorax contralateral drop, ankle work and prolonged ground contact time. No correlation was observed between movement clusters and clinically palpated location of the participant's pain.

Conclusions

We identified three distinct movement strategies among athletes with long-standing groin pain during a maximum effort change-of-direction task These movement strategies were not related to clinical assessment findings but highlighted targets for rehabilitation in response to possible propagative mechanisms.

Trial registration number

NCT02437942, pre results.

Epidemiology of Injury in Gaelic Handball

The initial step in developing injury prevention strategies is to establish the epidemiology of injury. However there has been no published research on injury in Gaelic handball. This study describes the epidemiology of injury in 75 Gaelic handball players utilising a retrospective questionnaire. 88% of participants reported one or more injuries. Injuries to the upper limb were prevalent (52.9%), followed by the lower limb (30.3%). The shoulder (17.6%), finger (10.5%) and ankle (9.8%) were the primary sites of injury. Injuries occurred most frequently in December (9.7%), January (9.7%), February (9.7%) and November (8.7%). Injuries predominantly occurred during games (82.4%). Injuries were primarily severe (54.7%), with 14.6% of participants admitted to hospital due to injury. Given that this is the only study on Gaelic handball to date, prospective epidemiological studies and further research on injury prevention strategies are necessary.

The Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT) Taxonomy

PURPOSE

Incident investigation, reporting, and learning are core elements of quality improvement in radiation treatment. This report describes the development of a Canadian National System for Incident Reporting in Radiation Treatment (NSIR-RT), focusing especially on the taxonomy.

METHODS AND MATERIALS

The NSIR-RT was developed to provide a framework in Canada for reporting and analyzing radiation treatment incidents. A key objective was to assure compatibility with other international reporting systems to facilitate future information exchange. The Canadian community was engaged at every step of the development process through Delphi consensus building and inter-user agreement testing to promote awareness of the system and motivate broad-based utilization across the country.

RESULTS

The final taxonomy was comprised of 6 data groups (impact, discovery, patient, details, treatment delivery, and investigation) and 33 data categories with predefined menu options. There was a high level agreement within the Canadian community about the final suite of data categories, and broad alignment of these categories with the World Health Organization and other American and European radiation treatment incident classifications.

CONCLUSIONS

The Canadian NSIR-RT taxonomy will be implemented as an online, web-based reporting and analysis system. It is expected that the taxonomy will evolve and mature over time to meet the changing needs of the Canadian radiation treatment community and support radiation treatment incident learning on a global scale.

The Quest for Quality: Principles to Guide Medical Radiation Technology Practice

Quality is a ubiquitous term in medical radiation technology; technologists, programs, and organizations emphasize the importance of "quality care," yet the concept of what is encompassed by the term, how it is built and measured, and who is the judge of whether it has been achieved, are often left undefined. This article will present theoretical definitions of quality, considering the value of professional, patient, and organization perspectives. Foundational quality principles and frameworks will be explored to highlight tools necessary to engage in "quality-related" activities and research at the individual, institutional, and systems level. Being equipped with an understanding of the work of Deming, the underpinnings of the lean strategy and the idea of continuous quality improvement will support technologists in contributing to evidence-based, high-quality, and safe practice. Building on these basics, concepts of complexity and standardization will be explored as they relate to achieving and maintaining quality given changing practice, focusing on personalized medicine, technological innovation, and best practice guidelines. Means to measure and evaluate quality will be presented, emphasizing the need for a structured approach. Using the work of the Canadian Partnership for Quality Radiotherapy as an example, key quality-related considerations, such as incident reporting, organizational structure, and quality culture will be discussed, with specific attention to roles within the team. When appropriately defined, measured, and evaluated, the quest for quality has the potential to improve safety and mitigate risk. Engaging technologists to assume strong roles in providing the highest quality of care will contribute positively at the level of the individual patient, the organization, and the system.

The Outcome of Using Closed Suction Wound Drains in Patients Undergoing Lumbar Spine Surgery: A Systematic Review

Study Design Systematic review. Objective Determine whether closed suction wound drains decrease the incidence of postoperative complications compared with no drain use in patients undergoing spine surgery for lumbar degenerative conditions. Methods Electronic databases and reference lists of key articles were searched up through January 22, 2015, to identify studies comparing the use of closed suction wound drains with no drains in spine surgery for lumbar degenerative conditions. Outcomes assessed included the cumulative incidence of epidural hematoma, superficial and deep wound infection, and postoperative blood transfusion. The overall strength of evidence across studies was based on precepts outlined by the Grades of Recommendation Assessment, Development and Evaluation Working Group. Results Five heterogeneous studies, three randomized controlled trials, and two cohort studies form the evidence basis for this report. There was no difference in the incidence of hematoma, superficial wound infection, or deep infection in patients with compared with patients without closed suction wound drains after lumbar surgery. The upper bounds of the 95% confidence interval for hematoma ranged from 1.1 to 16.7%; for superficial infection, 1.0 to 7.3%; and for deep infection, 1.0 to 7.1%. One observational study reported a 3.5-fold increase in the risk of blood transfusion in patients with a drain. The overall strength of evidence for these findings is considered low or insufficient. Conclusions Conclusions from this systematic review are limited by the quality of included studies that assessed the use of closed suction wound drains in lumbar spine surgeries for degenerative conditions. We believe that spine surgeons should not routinely rely on closed suction wound drains in lumbar spine surgery until a higher level of evidence becomes available to support its use.

Design and production of 3D printed bolus for electron radiation therapy

This is a proof‐of‐concept study demonstrating the capacity for modulated electron radiation therapy (MERT) dose distributions using 3D printed bolus. Previous reports have involved bolus design using an electron pencil beam model and fabrication using a milling machine. In this study, an in‐house algorithm is presented that optimizes the dose distribution with regard to dose coverage, conformity, and homogeneity within the planning target volume (PTV). The algorithm takes advantage of a commercial electron Monte Carlo dose calculation and uses the calculated result as input. Distances along ray lines from the distal side of 90% isodose line to distal surface of the PTV are used to estimate the bolus thickness. Inhomogeneities within the calculation volume are accounted for using the coefficient of equivalent thickness method. Several regional modulation operators are applied to improve the dose coverage and uniformity. The process is iterated (usually twice) until an acceptable MERT plan is realized, and the final bolus is printed using solid polylactic acid. The method is evaluated with regular geometric phantoms, anthropomorphic phantoms, and a clinical rhabdomyosarcoma pediatric case. In all cases the dose conformity are improved compared to that with uniform bolus. For geometric phantoms with air or bone inhomogeneities, the dose homogeneity is markedly improved. The actual printed boluses conform well to the surface of complex anthropomorphic phantoms. The correspondence of the dose distribution between the calculated synthetic bolus and the actual manufactured bolus is shown. For the rhabdomyosarcoma patient, the MERT plan yields a reduction of mean dose by 38.2% in left kidney relative to uniform bolus. MERT using 3D printed bolus appears to be a practical, low‐cost approach to generating optimized bolus for electron therapy. The method is effective in improving conformity of the prescription isodose surface and in sparing immediately adjacent normal tissues.

PACS number: 81.40.Wx

Virus and Antibody Diagnostics for Swine Samples of the Dominican Republic Collected in Regions Near the Border to Haiti

The Dominican Republic (DR) and Haiti share the island of Hispaniola, and reportable transboundary animal diseases have been introduced between the two countries historically. Outbreaks of severe teschovirus encephalomyelitis in pigs began occurring in Haiti in February 2009, and a field and laboratort study in April 2010 indicated that the teschovirus disease is prevalent in many regions in Haiti including areas near the border with DR and that other viral disease agents, including CSF virus (CSFV), porcine circovirus type 2 (PCV-2), porcine reproductive and respiratory syndrome virus (PRRSV), and swine influenza virus (SIV), are present in the swine population in these regions. The purpose of this study was to evaluate the introduction of teschovirus encephalomyelitis from Haiti to DR and to identify the other viral disease agents present in the swine population in regions of DR near the border with Haiti. Six of 7 brains and 6 of 7 spinal cords collected from pigs with central nervous system (CNS) signs were positive in reverse transcription-polymerase chain reaction for PTV. Genome sequencing on the Dominican PTV and phylogenetic analysis on the polyprotein of PTV strains indicate that the sequence of the Dominican PTV is 99.1% identical to the Haitian isolate and closely related to other PTV-1 strains in the world. Among 109 serum samples tested, 65 (59.6%) were positive for antibodies to PCV-2, and 51 (46.8%) were positive for antibodies to CSFV. Fifty-four of the 109 serum samples were tested for antibodies to other agents. Among the 54 samples, 20 (37.0%) were seropositive to PTV-1, 17 (31.5%) tested seropositive to SIV H3N2, 12 (22.2%) were seropositive to SIV H1N1, and 1 (1.9%) was seropositive to PRRSV.

Epidemiological analysis, serological prevalence and genotypic analysis of foot-and-mouth disease in Nigeria 2008-2009

The epidemiological situation of foot-and-mouth disease virus (FMDV) is uncertain in Nigeria, where the disease is endemic, and the majority of outbreaks are unreported. Control measures for FMD in Nigeria are not being implemented due to the absence of locally produced vaccines and an official ban on vaccine importation. This study summarizes the findings of a 3-year study aimed at quantifying the seroprevalence of FMD, its distribution in susceptible species and the genetic diversity of FMDV isolated from the Plateau State of Nigeria. A 29% FMD prevalence was estimated using 3ABC enzyme-linked immunosorbent assay (3ABC ELISA). Farms with suspected FMD nearby, with contact with wildlife, that used drugs or FMD vaccines or with >100 animals, and animals of large ruminant species and in pastures other than nomadic grazing were significantly (P < 0.05) associated with FMD. Antibodies against five FMDV serotypes, (A, O, SAT1, SAT2 and SAT3) were detected by the virus neutralization test (VNT) at various titres (<100->800) from all tested sera from most parts of the region. This is probably the first report of the presence of FMDV SAT3 in Nigeria. Further studies to investigate the potential probable presence and prevalence of SAT 3 virus in Nigeria are required. Tissue samples collected from clinical animals were positive for FMDV. Virus isolates were sequenced and confirmed as serotype A. All of the isolates showed marked genetic homogeneity with >99% genetic identity in the VP1 region and were most closely related to a previously described virus collected from Cameroon in 2000. This study provides knowledge on the epidemiological situation of FMD in Plateau State, Nigeria, and will probably help to develop effective control and preventive strategies for the disease in Nigeria and other countries in the West African subregion.

PI3K and MAPKs regulate neutrophil migration toward the airways in heaves

BACKGROUND

Neutrophils accumulate in the airways of horses with heaves. They likely play an important role in the disease pathogenesis. Understanding the pathways regulating their migration may help identifying new therapeutic targets.

HYPOTHESIS

MAPK and PI3K pathways are involved in neutrophil migration toward the airway lumen in heaves.

ANIMALS

Twelve heaves-affected horses and 4 healthy horses.

METHODS

Migratory activity of bronchoalveolar lavage fluids (BALF) from horses with heaves and healthy horses was compared by means of a Boyden chamber. Involvement of MAPK and PI3K pathways in neutrophil migration was investigated by pretreating neutrophils with inhibitors of p38 MAPK, JNK, MEK1/2, and PI3K. The capacity of a p38 MAPK inhibitor at decreasing neutrophil chemotaxis toward the airways was also evaluated in vivo.

RESULTS

BALF from symptomatic heaves-affected horses induced a greater degree of chemokinesis (P = .0004) than BALF from healthy horses. Although all pathways tested were involved in neutrophil migration, inhibition of PI3K was most potent in vitro. An inhibitor of p38 MAPK administered before challenge in horses with heaves did not alter BALF chemokinetic properties. BALF neutrophil percentage and BALF migratory activity were positively correlated after 14 and 35 days of antigen challenge in healthy (P = .05; R(2) = 0.82) and heaves-affected horses (P = .03; R(2) = 0.76), respectively.

CONCLUSIONS AND CLINICAL IMPORTANCE

MAPK and PI3K pathways regulate neutrophil migration induced by BALF of horses with heaves. Inhibition of multiple pathways might be required to completely abolish BALF-induced neutrophil migratory activity and possibly inflammation in heaves.