The effect of intraparenchymal blood patching on the rate of pneumothorax in patients undergoing percutaneous CT-guided core biopsy of the lung.

PURPOSE: To assess the effect of intraparenchymal blood patching (IBP) as well as tumor- and operator-related risk factors on the rate of pneumothoraxes after percutaneous CT-guided core needle biopsy of the lung. MATERIALS AND METHODS: We performed a retrospective analysis of 868 CT-guided lung biopsies that were conducted at our institution between 2003 and 2018, of which 419 (48%) received an IBP. Outcome variable included the rates of pneumothorax and chest tube placement, as well as lesion size (<3 cm versus ≥3 cm long axis diameter), lesion depth (≤2 cm, >2-4 cm, >4-5 cm and >5 cm distance to the pleura), location within the lungs (upper lobe, lower lobe, middle lobe), needle caliber (13 G, 15 G, 17 G, 19 G), number of samples taken (1-3 versus ≥4 samples), and experience of the performing physician. RESULTS: The rate of pneumothorax was significantly (p < 0.05) lower in the group with IBP (10.7%) compared to the group without IBP (15.4%). The number of post-interventional chest tube placements was also lower in the IBP group (3.1% vs. 5.8%) but not statistically significant. The lesion size correlated negatively with the rate of pneumothoraxes, whereas in both groups (±IBP) lesions ≥ 3 cm showed a significantly lower rate of pneumothorax (p < 0.05). With increasing lesion depth, the pneumothorax rate increased with (p < 0.01) and without (p < 0.001) IBP. The rate of pneumothorax was significantly lower (p < 0.05) for 17 G needles with IBP, but not for other calibers. For biopsies in the lower lobe, the pneumothorax rate reduced significantly (p < 0.001) with IBP. In case of ≥4 tissue samples, the pneumothorax rate was significantly lower with IBP (p < 0.01). For experienced operators, the overall pneumothorax rate was significantly lower compared to less experienced operators (p < 0001). CONCLUSIONS: IBP significantly reduces the rate of pneumothorax following CT-guided lung biopsies in particular for lesions located deeper in the lungs, when ≥4 samples are taken, when samples are taken by less-experienced operators, and when sampling from the lower lobes.

Exercise, manual therapy, and use of booster sessions in physical therapy for knee osteoarthritis: a multi-center, factorial randomized clinical trial.

OBJECTIVE: (1) Do treatment effects differ between participants receiving manual therapy (MT) with exercise compared to subjects who don't, (2) are treatment effects sustained better when participants receive booster sessions compared to those who don't over a one year period in subjects with knee osteoarthritis (KOA)? DESIGN: Multi-center, 2 × 2 factorial randomized clinical trial. 300 participants with knee OA were randomized to four groups: exercise-no boosters (Ex), exercise-with boosters (Ex+B), manual therapy+exercise-no boosters (MT+Ex), manual therapy+exercise-with boosters (MT+Ex+B). The primary outcome was the Western Ontario and McMaster osteoarthritis index (WOMAC) at 1 year. Secondary outcomes included knee pain, physical performance tests, and proportions of participants meeting treatment responder criteria. RESULTS: There were no differences between groups on the WOMAC at 1 year or on any performance-based measures. Secondary analyses indicated a) better scores on the WOMAC and greater odds of being a treatment responder at 9 weeks for participants receiving MT, b) greater odds of being a treatment responder at 1 year for participants receiving boosters. Exploratory interaction analysis suggested knee pain decreases for participants receiving boosters and increases for participants not receiving boosters from 9 weeks to 1 year. CONCLUSIONS: MT or use of boosters with exercise did not result in additive improvement in the primary outcome at 1 year. Secondary outcomes suggest MT may have some short term benefit, and booster sessions may improve responder status and knee pain at 1 year. However, the role of booster sessions remains unclear in sustaining treatment effects and warrants further study. CLINICAL TRIALS: gov (NCT01314183).

[Nutritional laminitis--preventive measures for the obese horse]. / Fütterungsbedingte Rehe--Rezidivprophylaxe beim übergewichtigen Pferd.

Nutrition-induced laminitis is often caused by i) fermentation of large amounts of carbohydrates in the hindgut (usually fructans from grass or starch from cereals), which cause the release and absorption of microbial toxins and ii) insulin resistance induced by being overweight (equine metabolic syndrome). Both causes can act together. Overweight horses with a history of laminitis need to reduce body weight to prevent further incidences of laminitis. Weight reduction occurs normally on a diet of late-cut hay, a hay-straw mixture (maximally one third straw to prevent constipation) or grass seed straw all at 1-1.2% of ideal body weight. However, this roughage allowance does not satisfy the need of horses to chew, for which it requires at least 1.5% of ideal body weight. This may lead to behavioural issues, such as allophagia and aggression, and in extreme cases, stereotypic behaviour. Starch concentrates should not be replaced with high fat concentrates. Used saw dust is recommended for bedding. The intake of grass from a pasture has to be considerably and efficiently reduced. If the horse is extremely prone to laminitis or if stable management is unreliable, abstention from grazing is recommended. Any supplements need to be low in energy, and should supply minerals and vitamins which are deficient in the diet. Some additional protein or amino acids may be beneficial. Regular exercise, such as a daily 30-minute speedy trot, improves insulin sensitivity. Exercise increases energy expenditure to a certain extent, allowing a slight increase in the roughage supply, thus alleviating the conflict between energy reduction and fulfilling the need to chew. Weight loss should be 0.5-1% of body weight per week, while at a higher rate there is a potential risk of hyperlipemia. The effectiveness of the reducing diet should be monitored regularly, either by weighing or measuring body, neck or girth circumference (aiming for a reduction of 1-2 cm per week).

Putting the tritone paradox into context: insights from neural population decoding and human psychophysics.

The context in which a stimulus occurs can influence its perception. We study contextual effects in audition using the tritone paradox, where a pair of complex (Shepard) tones separated by half an octave can be perceived as ascending or descending. While ambiguous in isolation, they are heard with a clear upward or downward change in pitch, when preceded by spectrally matched biasing sequences. We presented these biased Shepard pairs to awake ferrets and obtained neuronal responses from primary auditory cortex. Using dimensionality reduction from the neural population response, we decode the perceived pitch for each tone. The bias sequence is found to reliably shift the perceived pitch of the tones away from its central frequency. Using human psychophysics, we provide evidence that this shift in pitch is present in active human perception as well. These results are incompatible with the standard absolute distance decoder for Shepard tones, which would have predicted the bias to attract the tones. We propose a relative decoder that takes the stimulus history into account and is consistent with the present and other data sets.

Diagnosis and treatment of ocular coccidioidomycosis in a female captive chimpanzee (Pan troglodytes): a case study.

We report here the first documented case of ocular coccidioidomycosis in a chimpanzee (Pan troglodytes). In 1996, a 12-year-old female chimpanzee was undergoing treatment with an experimental triazole, BayR3783, for coccidioidomycosis when she was diagnosed with severe conjunctivitis in the right eye. Subsequent development of a coccidioidal granuloma of the ventral conjunctiva and anterior uvea was noted over the next several months, distorting the lens, iris, pupil, and sclera and progressing to uveitis. Treatment with BayR3783 and subconjunctival injections of triamcinolone were successful in reducing the ocular mass, but extensive damage was done to the lens and cornea. This case study provides an interesting comparison to ocular coccidioidomycosis cases observed in both humans and canines.

Recent developments in the separation of inorganic and small organic ions by capillary electrophoresis.

Which method should I use for ion analysis, ion chromatography (IC) or capillary electrophoresis (CE)? In terms of actual theoretical plates CE has a clear-cut advantage. The separation ability of IC is adequate for many sample types, and many separation scientists feel that IC offers greater reliability and confidence than CE. However, IC is a more mature technique and there has been more time to solve problems such as peak tailing and to improve reproducibility. The two techniques should be viewed as complementary. A number of recent developments in ion analysis by CE are discussed. These include some simple ways to control electroosmotic flow and improve reproducibility, separation of isotopes, improved methods of indirect photometric detection, a new contactless conductivity detector, separation of ions at low pH, and in solutions of high salt content. Progress in a new technique called IC-CE will be described in which a soluble ion-exchange polymer is added to the capillary electrolyte to separate anions based on differences in both electrophoretic mobility and ion-exchange interactions.

Translating biomolecular recognition into nanomechanics.

We report the specific transduction, via surface stress changes, of DNA hybridization and receptor-ligand binding into a direct nanomechanical response of microfabricated cantilevers. Cantilevers in an array were functionalized with a selection of biomolecules. The differential deflection of the cantilevers was found to provide a true molecular recognition signal despite large nonspecific responses of individual cantilevers. Hybridization of complementary oligonucleotides shows that a single base mismatch between two 12-mer oligonucleotides is clearly detectable. Similar experiments on protein A-immunoglobulin interactions demonstrate the wide-ranging applicability of nanomechanical transduction to detect biomolecular recognition.

Dual streams of auditory afferents target multiple domains in the primate prefrontal cortex.

'What' and 'where' visual streams define ventrolateral object and dorsolateral spatial processing domains in the prefrontal cortex of nonhuman primates. We looked for similar streams for auditory-prefrontal connections in rhesus macaques by combining microelectrode recording with anatomical tract-tracing. Injection of multiple tracers into physiologically mapped regions AL, ML and CL of the auditory belt cortex revealed that anterior belt cortex was reciprocally connected with the frontal pole (area 10), rostral principal sulcus (area 46) and ventral prefrontal regions (areas 12 and 45), whereas the caudal belt was mainly connected with the caudal principal sulcus (area 46) and frontal eye fields (area 8a). Thus separate auditory streams originate in caudal and rostral auditory cortex and target spatial and non-spatial domains of the frontal lobe, respectively.

Degradability of forage proteins by in situ and in vitro enzymatic methods.

The overall objective of these two studies was to evaluate the efficacy of using the proteolytic enzyme from Streptomyces griseus to estimate concentrations of ruminally degradable protein (RDP) in a wide array of forages. In the first study, alfalfa and prairie hays that previously had been evaluated in vivo for RDP were incubated in a replicated 3 x 3 factorial combination of enzyme concentrations (6.6, 0.66, and 0.066 activity units/ml of incubation medium) and incubation times (2, 4, and 48 h). Two treatment combinations (6.6 activity units for 4 h and 0.066 activity units for 48 h) yielded respective RDP estimates for alfalfa and prairie hay that were close to the known in vivo values. In the second study, 20 diverse forages were evaluated for RDP by using the in situ technique. These forages also were evaluated for RDP with the two enzyme concentrations identified in the first study, but incubation times were expanded to include 1, 2, 3, 4, and 5 h at the high concentration and 24, 30, 36, 42, 48, and 54 h at the low concentration. At the high enzyme concentration, r2 statistics from linear regressions of enzymatic estimates of RDP on corresponding estimates obtained by the in situ procedure were high (r2 > or = 0.898) at all incubation times; in addition, slopes (range = 0.88 to 1.00) and intercepts (range = -9.4 to 3.5%) approached unity and 0, respectively. At the lower enzyme concentration, r2 statistics were still good (> 0.81), but slopes (0.59 to 0.67) and intercepts (18.5 to 21.9%) for all incubation times did not meet the respective goals of unity and 0.

Evaluation of the potential of supplements to substitute for low-quality, tallgrass-prairie forage.

Thirteen ruminally fistulated steers (260 +/- 15 kg) were used in an incomplete Latin square with 13 treatments and four periods to evaluate the potential for different supplements to substitute for intake of low-quality, tallgrass-prairie forage. Steers were given ad libitum access to forage and received either no supplement (control = CTL) or one of four supplements, each fed at three different levels of intake. Supplements included 1) moderate CP (17.5%) concentrate (MCP-CON), 2) high CP (32.7%) concentrate (HCP-CON), 3) long-stem alfalfa hay (LSAH; 17.2% CP), and 4) alfalfa pellets (AP; 16.3% CP). Concentrates were mixtures of sorghum grain and soybean meal. Supplements were fed to supply .05, .10, and .15% BW of CP/d. Forage intake and digestible DMI were increased (P < .01) for supplemented steers compared with CTL (22 and 96%, respectively). Steers receiving increasing MCP-CON exhibited a quadratic (P = .03) forage intake response. Offering MCP-CON higher than .10% BW of CP/d (approximately .59% BW of DM) resulted in a substitution rate of -.56 g of forage/g of supplement. Although effects were not significant for steers receiving LSAH, the decline in forage intake at the high level of supplementation (-.48 g of forage/g of supplement) was similar in magnitude to that for MCP-CON. Forage intake increased linearly (P < .01) across supplementation levels for HCP-CON and AP supplements. Passage rates were faster (P < .01) for supplemented steers. However, passage rates for HCP-CON and AP groups increased linearly (P < .01) with increasing supplement, whereas they declined at the highest supplementation rate for MCP-CON and LSAH (quadratic, P < or = .05). Most fermentation variables displayed positive responses to supplementation per se and to increasing amount of supplements offered. In conclusion, although supplementation effectively enhances the use of low-quality forage, supplement type may affect the likelihood of observing substitution effects.

A possible neuronal basis for representation of acoustic scenes in auditory cortex of the big brown bat.

Behavioural studies and field observations demonstrate that echolocating bats simultaneously perceive range, direction and shape of multiple objects in the environment as acoustic images derived from echoes. Cortical echo delay-tuned neurons contribute to the perception of object range, because focal inactivation of these neurons disrupts behavioural discrimination of range. We report here that response properties of delay-tuned neurons in the cortical tonotopic area of the bat, Eptesicus, transform the sequential arrival times of echoes with different delays into a concurrent, accumulating neural representation of multiple objects at different ranges. The sharpness of delay tuning systematically increases at each best delay in a subpopulation of these neurons while responses to echoes at different delays are accumulated. The resulting concurrent, multiresolution representation of echo delay corresponds to neural implementation of a common representation of images used in computational vision and may provide the basis for representing acoustic images of multiple objects as acoustic 'scenes'.

Estimation of the bioavailability of iron.

Eight laboratories conducted a test for the estimation of the bioavailability of iron from 4 sources, using depleted male albino rats. Ferrous sulfate was used as the reference standard. Ferric orthophosphate was found to have a relative biological value of 11 (range 6-22), an old sample of hydrogen-reduced iron 27 (range 15-41), and ferric citrate 96 (range 75-125). Good results were obtained with a simplified basal diet prepared without ingredients that had previously contributed variable quantities of iron. There was no apparent advantage in using the change in hemoglobin during the repletion period instead of the final homoglobin value as the criterion of response to iron supplements. Several statistical treatments of the data yielded similar conclusions regarding relative biological values of the iron sources.