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Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients. - Critical ultrasound journal
It is important to detect splenomegaly as it can have important diagnostic implications. Previous studies, however, have shown that the traditional physical examination is limited in its ability to rule in or rule out splenomegaly.To determine if performing point-of-care ultrasonography (POCUS) in addition to the traditional physical examination improves the sensitivity and specificity for diagnosing splenomegaly.This was a prospective trial of diagnostic accuracy. Physical and sonographic examinations for splenomegaly were performed by students, residents and attending physicians enrolled in an ultrasound training course. Participants received less than 1Â h training for ultrasound diagnosis of splenomegaly. The findings were compared to radiographic interpretation of gold standard studies.Hospitalized adult patients at an academic medical center without severe abdominal pain or recent surgery who had abdominal CT, MRI or ultrasound performed within previous 48Â h.Thirty-nine subjects were enrolled. Five patients had splenomegaly (12.5Â %). The physical examination for splenomegaly had a sensitivity of 40Â % (95Â % CI 12-77Â %) and specificity of 88Â % (95Â % CI 74-95Â %) while physical examination plus POCUS had a sensitivity of 100Â % (95Â % CI 57-100Â %) and specificity of 74Â % (95Â % CI 57-85Â %). Physical examination alone for splenomegaly had an LR+ of 3.4 (95Â % CI 0.83-14) and LR- of 0.68 (95Â % CI 0.33-1.41); for physical exam plus POCUS the LR+Â was 3.8 (2.16-6.62) and LR- was 0.Point-of-care ultrasonography significantly improves examiners' sensitivity in diagnosing splenomegaly.
An Analysis of Research from Faculty at U.S. Adult Reconstruction Fellowships. - The Journal of arthroplasty
We reviewed all articles published in three major orthopaedic journals from January 2010 to December 2014. Any article focusing on adult reconstruction of the hip or knee was reviewed for first and last authorship, institution, and level of evidence. Three institutions had authored work from arthroplasty faculty that fell within the top five most published institutions in all three journals, while one institution ranked first in all three journals. 43 of 67 (64.2%) reconstruction fellowships had at least one publication included in this study. The majority of the adult reconstruction literature published by faculty at U.S. reconstruction fellowships stems from a few academic centers with the ten most prolific institutions accounting for 65.9% of all U.S. fellowship publications.Copyright Â© 2015. Published by Elsevier Inc.
Modeling human perception of orientation in altered gravity. - Frontiers in systems neuroscience
Altered gravity environments, such as those experienced by astronauts, impact spatial orientation perception, and can lead to spatial disorientation and sensorimotor impairment. To more fully understand and quantify the impact of altered gravity on orientation perception, several mathematical models have been proposed. The utricular shear, tangent, and the idiotropic vector models aim to predict static perception of tilt in hyper-gravity. Predictions from these prior models are compared to the available data, but are found to systematically err from the perceptions experimentally observed. Alternatively, we propose a modified utricular shear model for static tilt perception in hyper-gravity. Previous dynamic models of vestibular function and orientation perception are limited to 1 G. Specifically, they fail to predict the characteristic overestimation of roll tilt observed in hyper-gravity environments. To address this, we have proposed a modification to a previous observer-type canal-otolith interaction model based upon the hypothesis that the central nervous system (CNS) treats otolith stimulation in the utricular plane differently than stimulation out of the utricular plane. Here we evaluate our modified utricular shear and modified observer models in four altered gravity motion paradigms: (a) static roll tilt in hyper-gravity, (b) static pitch tilt in hyper-gravity, (c) static roll tilt in hypo-gravity, and (d) static pitch tilt in hypo-gravity. The modified models match available data in each of the conditions considered. Our static modified utricular shear model and dynamic modified observer model may be used to help quantitatively predict astronaut perception of orientation in altered gravity environments.
Glomus tumour: a rare differential for subungual lesions. - BMJ case reports
A 21-year-old, usually fit and well man, presented with a 10-year history of intermittent, paroxysmal pain and temperature sensitivity to his right thumb. He felt this was associated with a subungual lesion present on the same digit. He was diagnosed as having a glomus tumour and was referred to the hand surgeons for surgical excision.2015 BMJ Publishing Group Ltd.
Evaluation of a porcine collagen matrix used to augment keratinized tissue and increase soft tissue thickness around existing dental implants. - The International journal of periodontics & restorative dentistry
Implant-supported prostheses often present with mucogingival deficiencies that may cause esthetic or hygienic issues. These issues may present as limited or no keratinized tissue, irregular soft tissue contour or concavity, and gray "showthrough" of the implant abutment and root forms. An interpositional soft tissue graft substitute that generates keratinized tissue and increases soft tissue thickness would be beneficial, as it would reduce donor site morbidity and be available in unlimited, off-the-shelf supply. Thirty patients were assessed as part of a multicenter, practice-based evaluation of the material. A xenogeneic collagen matrix was placed as an interpositional graft on the buccal aspect of implant sites; sites were reassessed at 6 months posttreatment. Results indicated that the collagen matrix increased tissue thickness and keratinized tissue around existing dental implants.
Comparison of a self-inflating bulb syringe and a colorimetric CO2 indicator with capnography and radiography to detect the misdirection of naso/orogastric tubes into the airway of critically ill adult patients. - Chest
The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults.A prospective, observational study was performed in humans, evaluating both the self-inflating bulb syringe (SIBS) and a colorimetric CO2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a "standard" (ie, end tidal CO2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement).On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS.The SIBS and the colorimetric CO2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.
Human manual control performance in hyper-gravity. - Experimental brain research
Hyper-gravity provides a unique environment to study how misperceptions impact control of orientation relative to gravity. Previous studies have found that static and dynamic roll tilts are perceptually overestimated in hyper-gravity. The current investigation quantifies how this influences control of orientation. We utilized a long-radius centrifuge to study manual control performance in hyper-gravity. In the dark, subjects were tasked with nulling out a pseudo-random roll disturbance on the cab of the centrifuge using a rotational hand controller to command their roll rate in order to remain perceptually upright. The task was performed in 1, 1.5, and 2 G's of net gravito-inertial acceleration. Initial performance, in terms of root-mean-square deviation from upright, degraded in hyper-gravity relative to 1 G performance levels. In 1.5 G, initial performance degraded by 26 % and in 2 G, by 45 %. With practice, however, performance in hyper-gravity improved to near the 1 G performance level over several minutes. Finally, pre-exposure to one hyper-gravity level reduced initial performance decrements in a different, novel, hyper-gravity level. Perceptual overestimation of roll tilts in hyper-gravity leads to manual control performance errors, which are reduced both with practice and with pre-exposure to alternate hyper-gravity stimuli.
Human perceptual overestimation of whole body roll tilt in hypergravity. - Journal of neurophysiology
Hypergravity provides a unique environment to study human perception of orientation. We utilized a long-radius centrifuge to study perception of both static and dynamic whole body roll tilt in hypergravity, across a range of angles, frequencies, and net gravito-inertial levels (referred to as G levels). While studies of static tilt perception in hypergravity have been published, this is the first to measure dynamic tilt perception (i.e., with time-varying canal stimulation) in hypergravity using a continuous matching task. In complete darkness, subjects reported their orientation perception using a haptic task, whereby they attempted to align a hand-held bar with their perceived horizontal. Static roll tilt was overestimated in hypergravity, with more overestimation at larger angles and higher G levels, across the conditions tested (overestimated by âˆ¼35% per additional G level, P < 0.001). As our primary contribution, we show that dynamic roll tilt was also consistently overestimated in hypergravity (P < 0.001) at all angles and frequencies tested, again with more overestimation at higher G levels. The overestimation was similar to that for static tilts at low angular velocities but decreased at higher angular velocities (P = 0.006), consistent with semicircular canal sensory integration. To match our findings, we propose a modification to a previous Observer-type canal-otolith interaction model. Specifically, our data were better modeled by including the hypothesis that the central nervous system treats otolith stimulation in the utricular plane differently than stimulation out of the utricular plane. This modified model was able to simulate quantitatively both the static and the dynamic roll tilt overestimation in hypergravity measured experimentally.Copyright Â© 2015 the American Physiological Society.
Mercury exposure as a function of fish consumption in two Asian communities in coastal Virginia, USA. - Archives of environmental contamination and toxicology
Fish consumption and associated mercury exposure were explored for two Asian-dominated church communities in coastal Virginia and compared with that of two non-Asian church communities. Seafood-consumption rates for the Chinese (36.9Â g/person/day) and Vietnamese (52.7Â g/person/day) church communities were greater than the general United States fish-consumption rate (12.8Â g/person/day). Correspondingly, hair mercury concentrations for people from the Chinese (0.52Â Âµg/g) and the Vietnamese church (1.46Â Âµg/g) were greater than the overall level for United States women (0.20Â Âµg/g) but lower than the published World Health Organization exposure threshold (14Â Âµg/g). A conventional regression model indicated a positive relationship between seafood consumption rates and hair mercury concentrations suggesting the importance of mercury exposure through seafood consumption. The annual-average daily methylmercury intake rate for the studied communities calculated by Monte Carlo simulations followed the sequence: Vietnamese communityÂ >Â Chinese communityÂ >Â non-Asian communities. Regardless, their daily methylmercury intake rates were all lower than the United States Environmental Protection Agency reference dose of 0.1Â Âµg/kg body weight-day. In conclusion, fish-consumption patterns differed among communities, which resulted in different levels of mercury exposure. The greater seafood and mercury ingestion rates of studied Asian groups compared with non-Asian groups suggest the need for specific seafood consumption advice for ethnic communities in the United States. Otherwise the health benefits from fish consumption could be perceived as trivial compared with the ill-defined risk of mercury exposure.
The Use of Therapeutic Drug Monitoring in Complex Antituberculous and Antiretroviral Drug Dosing in HIV/Tuberculosis-Coinfected Patients. - Journal of the International Association of Providers of AIDS Care
We report 2 cases coinfected with HIV and tuberculosis (HIV/TB), requiring drug dose adjustments guided by therapeutic drug monitoring (TDM) and/or serum drug concentrations.Over the course of the 9-months of TB treatment, drugs that required increased doses due to low concentrations included efavirenz (800 mg), rifampin (900 mg), and isoniazid (450 mg). Higher drug doses were well tolerated until the end of treatment.Over the 12-month course of TB therapy, drugs that required increased doses due to incomplete and/or delayed absorption were rifampin (1500 mg), moxifloxacin (800 mg), and ethambutol (1600 mg). Higher drug doses were well tolerated until the end of treatment. Due to delayed/incomplete drug absorption and weight gain during therapy, higher antituberculous doses may be required in patients coinfected with HIV/TB. A daily dose of efavirenz 800 mg was well tolerated in both patients (weight over 70 kg). Managing patients coinfected with HIV/TB is complex, and, therefore, TDM of drug concentrations can help guide clinical decision making.Â© The Author(s) 2014.
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1196 South De Anza Blvd San Jose, CA 95129
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