Objective comparison of a sit to stand test to the walk test for the identification of unilateral lameness caused by cranial cruciate ligament disease in dogs.

OBJECTIVE: The purpose of this study was to evaluate a sit to stand test with the walk test for the identification of unilateral cranial cruciate ligament rupture in dogs. MATERIALS AND METHODS: Peak vertical force and vertical impulse were measured on a pressure-sensitive walkway, during a sit to stand test and walk test, and in 10 dogs with unilateral cranial cruciate ligament rupture and 18 non-lame dogs. Data collected were used to calculate symmetry indices (SI) of ipsilateral and contralateral hindlimbs (HL), diagonal limb pairs (DLP) and ipsilateral limb pairs (ILP). RESULTS: The symmetry indices of peak vertical force of HL during the walk test and sit to stand test were 100% and 90% sensitive for discriminating lame and non-lame dogs respectively. The symmetry indices of vertical impulse of HLs during the walk test and sit to stand test were 100% and 50% sensitive for discriminating lame and non-lame dogs respectively. Analysis of ipsilateral and diagonal limb pairs did not improve the discrimination in either test. The time taken to collect data from the sit to stand test data was shorter than for the walk test. CLINICAL SIGNIFICANCE: Whilst the sit to stand test required a shorter time for collection of data than the walk test, it did not accurately identify all dogs with lameness associated with CCLR, and thus has relatively limited clinical utility in its tested form.

Transurethral ureteric embolization for locally advanced cervical cancer with uretero-vaginal fistula - A case report.

INTRODUCTION: Targeted radiotherapy, surgery, and localised disease progression can all result in fistulous tract formation in patients with a pelvic malignancy, in particular cervical or endometrial cancer. This report discusses a novel technique for palliative management of ureterovaginal fistulas in end-stage disease. PRESENTATION OF CASE REPORT: We report the case of a 37 year old female with metastatic cervical squamous cell carcinoma previously treated with chemoradiation who presented with progressive disease and secondary development of a symptomatic ureterovaginal fistula. DISCUSSION: This case report discusses the causes and sequalae of uretero-vaginal fistula formation, the role of the interventional radiology with regards to palliative intervention, and potential patient factors that can affect performance of such procedures. CONCLUSION: Interventional radiology plays an important role in palliative and symptomatic management of end stage malignant disease. Ureteric embolisation via a retrograde transurethral approach by way of an existing stent is a novel approach to access making the procedure easier for both the patient and radiologist.

"Uroptysis!" - A case report of xanthogranulomatous pyelonephritis with nephrobronchial fistulation.

INTRODUCTION AND IMPORTANCE: Xanthogranulomatous pyelonephritis (XGP) is an uncommon complication of chronic urinary tract infection, classically secondary to a chronic obstructive uropathy, resulting in destruction of renal parenchyma and a non-functioning kidney (Jha and Aeddula, 2022 [1]). This is rarely associated with nephrobronchial fistulation, with few published case reports in the literature to date. CASE PRESENTATION: We present the rare case of a 42-year-old female who was admitted to an Irish tertiary urology centre with abdominal pain, elevated inflammatory markers and an obstructive uropathy on initial imaging, with a new diagnosis of XGP. Initial management was with targeted intravenous antimicrobial therapy, percutaneous nephrostomy and perinephric drain insertion. The subsequent discovery of a nephrobronchial fistula later complicated the case, warranting plan for interval nephrectomy and fistula repair following prolonged medical management. We discuss the initial presentation, workup and image-guided approach to management. CLINICAL DISCUSSION: XGP is an uncommon sequela of chronic renal suppurative infection, and is usually associated with long-standing ureteric obstruction secondary to a staghorn calculus. Nephrobronchial fistulation is a rare complication of XGP, highlighting the significance of this case discussion. CONCLUSION: XGP should be considered in cases of suspected chronic pyelonephritis and may rarely lead to nephrobronchial fistulation. In cases of known XGP and pleural empyema, nephrobronchial fistulation should be considered as part of the differential diagnosis.

Spectral Analysis of the September 2017 Solar Energetic Particle Events.

An interval of exceptional solar activity was registered in early September 2017, late in the decay phase of solar cycle 24, involving the complex Active Region 12673 as it rotated across the western hemisphere with respect to Earth. A large number of eruptions occurred between 4 and 10 September, including four associated with X-class flares. The X9.3 flare on 6 September and the X8.2 flare on 10 September are currently the two largest during cycle 24. Both were accompanied by fast coronal mass ejections and gave rise to solar energetic particle (SEP) events measured by near-Earth spacecraft. In particular, the partially occulted solar event on 10 September triggered a ground-level enhancement (GLE), the second GLE of cycle 24. A further, much less energetic SEP event was recorded on 4 September. In this work we analyze observations by the Advanced Composition Explorer (ACE) and the Geostationary Operational Environmental Satellites (GOES), estimating the SEP event-integrated spectra above 300 keV and carrying out a detailed study of the spectral shape temporal evolution. Derived spectra are characterized by a low-energy break at few/tens of MeV; the 10 September event spectrum, extending up to ~1 GeV, exhibits an additional rollover at several hundred MeV. We discuss the spectral interpretation in the scenario of shock acceleration and in terms of other important external influences related to interplanetary transport and magnetic connectivity, taking advantage of multipoint observations from the Solar Terrestrial Relations Observatory. Spectral results are also compared with those obtained for the 17 May 2012 GLE event.

Technical description of laparoscopic Morgagni hernia repair with primary closure and onlay composite mesh placement.

INTRODUCTION: Morgagni hernias rarely present in adult life and, thus, little data exist on the optimal method of surgical repair. The laparoscopic approach has grown in popularity since the first reported case in 1992. This article showcases a method for laparoscopic repair of Morgagni hernias using both primary closure and mesh reinforcement. OPERATIVE APPROACH: There were three obese women who presented in adulthood with cardiopulmonary symptoms; in all cases, the symptoms were attributable to local compressive effects of large Morgagni hernias. All three hernias were repaired laparoscopically, first by approximating the diaphragm to the fascia of the anterior abdominal wall, followed by insertion of a composite mesh, tacked to the diaphragm, to buttress the closure. All patients had excellent outcomes with symptom resolution. DISCUSSION: This case series describes a method of laparoscopic Morgagni hernia repair using primary closure reinforced with a mesh, with excellent postoperative outcomes. Others have described thoracic or open approaches. The authors feel that the method described herein is likely to reduce recurrence in a patient population who are often overweight or obese and, thus, have a high risk of this complication. Furthermore, we discuss all reported laparoscopic repair cases in the literature and highlight the paucity of evidence on the optimal approach.

Use of a Modified Matrix Band Technique to Restore Subgingival Root Caries.

Given the increasing incidence of root caries in the elderly population, clinicians frequently must isolate and restore subgingival preparations. This article demonstrates a technique utilizing a modified Tofflemire matrix band that creates a preparation free of crevicular fluid and blood for restoration with resin-modified glass ionomer cement.

Vanutide Cridificar (ACC-001) and QS-21 Adjuvant in Individuals with Early Alzheimer's Disease: Amyloid Imaging Positron Emission Tomography and Safety Results from a Phase 2 Study.

BACKGROUND: ACC-001 is an investigational therapeutic vaccine designed to elicit antibodies against the N-terminal peptide 1-7 of the amyloid-beta peptide, believed to be important in the pathogenesis of Alzheimer's disease. OBJECTIVES: To evaluate safety, immunogenicity, impact on brain amyloid, and other exploratory endpoints in participants receiving ACC-001. DESIGN: Randomized, phase 2, interventional study. TRIAL REGISTRATION: Clinicaltrials.gov ID NCT01227564. PARTICIPANTS: Individuals with early Alzheimer's disease (Mini-Mental State Examination scores ≥25, a global Clinical Dementia Rating of 0.5, and evidence of elevated baseline brain amyloid burden). INTERVENTION: Participants were randomized to ACC-001 3 µg or 10 µg with QS-21 adjuvant (50 µg), or placebo. MEASUREMENTS: The primary endpoint was change in brain amyloid burden by 18F-florbetapir positron emission tomography in composite cortical standard uptake value ratio. RESULTS: A total of 63 participants were randomized and 51 completed the study. At week 104, no significant differences were observed in 18F-florbetapir positron emission tomography composite cortical standard uptake value ratio between either ACC-001 dose compared with placebo. In both ACC-001 + QS-21 treatment groups, following the initial immunization, the anti-amyloid-beta geometric mean titers increased after each subsequent vaccination and then declined, with less apparent decline after the later compared with earlier immunizations. The majority of treatment-emergent adverse events in the ACC-001 + QS-21 groups were injection site reactions, which occurred at a greater rate in active treatment groups than in the placebo group. No amyloid-related imaging abnormalities of edema or effusion were reported. CONCLUSION: No statistically significant differences were observed between groups in the change from baseline brain amyloid burden despite apparently robust systemically measured anti-amyloid-beta antibody response at both dose levels. Insufficient antibody titers, poor quality immune response, short duration of treatment, or small sample size may have resulted in these findings. The safety and tolerability profile was acceptable.

Occupational radiation dose to eyes from interventional radiology procedures in light of the new eye lens dose limit from the International Commission on Radiological Protection.

OBJECTIVE: In 2011, the International Commission on Radiological Protection (ICRP) recommended a substantial reduction in the equivalent dose limit for the lens of the eye, in line with a reduced threshold of absorbed dose for radiation-induced cataracts. This is of particular relevance in interventional radiology (IR) where it is well established that staff doses can be significant, however, there is a lack of data on IR eye doses in terms of Hp(3). Hp(3) is the personal dose equivalent at a depth of 3 mm in soft tissue and is used for measuring lens dose. We aimed to obtain a reliable estimate of eye dose to IR operators. METHODS: Lens doses were measured for four interventional radiologists over a 3-month period using dosemeters specifically designed to measure Hp(3). RESULTS: Based on their typical workloads, two of the four interventional radiologists would exceed the new ICRP dose limit with annual estimated doses of 31 and 45 mSv to their left eye. These results are for an "unprotected" eye, and for IR staff who routinely wear lead glasses, the dose beneath the glasses is likely to be significantly lower. Staff eye dose normalized to patient kerma-area product and eye dose per procedure have been included in the analysis. CONCLUSION: Eye doses to IR operators have been established using a dedicated Hp(3) dosemeter. Estimated annual doses have the potential to exceed the new ICRP limit. ADVANCES IN KNOWLEDGE: We have estimated lens dose to interventional radiologists in terms of Hp(3) for the first time in an Irish hospital setting.

A profile of elderly fallers referred for physiotherapy in the emergency department of a Dublin teaching hospital.

Ireland has an ageing population and the elderly are over-represented in Emergency Departments (ED)--a quarter of these presentations resulting from falls. A prospective study design was employed using a convenience sample to profile elderly fallers referred for physiotherapy in ED. Forty-subjects were assessed over 14 weeks. Mean age was 84.88 years (s.d. 7.3) and 31 (77.5%) were female. All demonstrated slow walking speed and 26 (65%) demonstrated poor grip strength. A quarter of subjects reported fear of falling and 30 (75%) were classified as frail. Elderly fallers in ED are a frail group of socially vulnerable patients who demonstrate a risk of further falls. Osteoporosis had been diagnosed in 9 (22.5%) subjects--a low prevalence compared with international research, but 25 (62.5%) subjects had never had a DEXA scan. The prevalence of frailty in the sample of elderly fallers in this study was very high (75%).

Unilateral synostosis of the zygo-maticotemporal suture associated with mandibular coronoid process impingement in a dog.

A 13-month-old dog was investigated for the complaint of open-mouth locked jaw. There were not any previous episodes of trauma witnessed. Computed tomographic evaluation revealed unilateral zygomatico-temporal synostosis and associated craniofacial asymmetry, with impingement of the mandibular coronoid process resulting in unilateral temporomandibular joint subluxation. Closed reduction of the subluxation was not maintained. Partial zygomatico-temporal suturectomy resulted in resolution of the clinical signs. To the author's knowledge, isolated zygomaticotemporal syno-stosis with associated temporomandibular subluxation has not been reported in the dog.

Successful catheter directed thrombolysis of IVC and renal vein occlusive thrombus.

Thrombus formation is a recognised complication of IVC filter placement, however IVC and bilateral renal vein occlusion secondary to thrombus is much less common. We present a case of infrahepatic caval and bilateral renal vein occlusion secondary to thrombosis of a suprarenal IVC filter. With progressive clinical deterioration and failure of conservative medical management the patient underwent successful mechanical disruption and catheter directed thrombolysis.

A collision in 2009 as the origin of the debris trail of asteroid P/2010 A2.

The peculiar object P/2010 A2 was discovered in January 2010 and given a cometary designation because of the presence of a trail of material, although there was no central condensation or coma. The appearance of this object, in an asteroidal orbit (small eccentricity and inclination) in the inner main asteroid belt attracted attention as a potential new member of the recently recognized class of main-belt comets. If confirmed, this new object would expand the range in heliocentric distance over which main-belt comets are found. Here we report observations of P/2010 A2 by the Rosetta spacecraft. We conclude that the trail arose from a single event, rather than a period of cometary activity, in agreement with independent results. The trail is made up of relatively large particles of millimetre to centimetre size that remain close to the parent asteroid. The shape of the trail can be explained by an initial impact ejecting large clumps of debris that disintegrated and dispersed almost immediately. We determine that this was an asteroid collision that occurred around 10 February 2009.

Characterization of photoreceptor cell types in the little brown bat Myotis lucifugus (Vespertilionidae).

We report the expression of three visual opsins in the retina of the little brown bat (Myotis lucifugus, Vespertilionidae). Gene sequences for a rod-specific opsin and two cone-specific opsins were cloned from cDNA derived from bat eyes. Comparative sequence analyses indicate that the two cone opsins correspond to an ultraviolet short-wavelength opsin (SWS1) and a long-wavelength opsin (LWS). Immunocytochemistry using antisera to visual opsins revealed that the little brown bat retina contains two types of cone photoreceptors within a rod-dominated background. However, unlike other mammalian photoreceptors, M. lucifugus cones and rods are morphologically indistinguishable by light microscopy. Both photoreceptor types have a thin, elongated outer segment. Using microspectrophotometry we classified the absorption spectrum for the ubiquitous rods. Similar to other mammals, bat rhodopsin has an absorption peak near 500 nm. Although we were unable to confirm a spectral range, cellular and molecular analyses indicate that M. lucifugus expresses two types of cone visual pigments located within the photoreceptor layer. This study provides important insights into the visual capacity of a nocturnal microchiropteran species.

Cell contact, prostaglandin E(2) and transforming growth factor beta 1 play non-redundant roles in human mesenchymal stem cell induction of CD4+CD25(High) forkhead box P3+ regulatory T cells.

Adult human mesenchymal stromal or stem cells (MSC) can differentiate into a variety of cell types and are candidate cellular therapeutics in regenerative medicine. Surprisingly, these cells also display multiple potent immunomodulatory capabilities, including allosuppression, making allogeneic cell therapy a possibility. The exact mechanisms involved in regulatory T cell induction by allogeneic human MSC was examined, using purified CD4+ populations and well-characterized bone marrow-derived adult human MSC. Allogeneic MSC were shown to induce forkhead box P3 (FoxP3)+ and CD25+ mRNA and protein expression in CD4+ T cells. This phenomenon required direct contact between MSC and purified T cells, although cell contact was not required for MSC induction of FoxP3 expression in an unseparated mononuclear cell population. In addition, through use of antagonists and neutralizing antibodies, MSC-derived prostaglandins and transforming growth factor (TGF)-beta1 were shown to have a non-redundant role in the induction of CD4+CD25+FoxP3+ T cells. Purified CD4+CD25+ T cells induced by MSC co-culture expressed TGF-beta1 and were able to suppress alloantigen-driven proliferative responses in mixed lymphocyte reaction. These data clarify the mechanisms of human MSC-mediated allosuppression, supporting a sequential process of regulatory T cell induction involving direct MSC contact with CD4+ cells followed by both prostaglandin E(2) and TGF-beta1 expression. Overall, this study provides a rational basis for ongoing clinical studies involving allogeneic MSC.

Atypical fibroxanthoma, lentigo maligna melanoma and squamous cell carcinoma arising in the site of a thermal burn treated with skin grafts.

We report the first case of atypical fibroxanthoma, lentigo maligna melanoma and squamous cell carcinoma that developed in the site of a thermal burn that had previously been treated with multiple skin grafts.There is a controversy over the question of an increased risk of skin cancer in scars from burns and the various factors which may contribute to this.

Discovery of localized regions of excess 10-TeV cosmic rays.

The 7 year data set of the Milagro TeV observatory contains 2.2 x 10(11) events of which most are due to hadronic cosmic rays. These data are searched for evidence of intermediate scale structure. Excess emission on angular scales of approximately 10 degrees has been found in two localized regions of unknown origin with greater than 12sigma significance. Both regions are inconsistent with pure gamma-ray emission with high confidence. One of the regions has a different energy spectrum than the isotropic cosmic-ray flux at a level of 4.6sigma, and it is consistent with hard spectrum protons with an exponential cutoff, with the most significant excess at approximately 10 TeV. Potential causes of these excesses are explored, but no compelling explanations are found.

Growth hormone secretagogue MK-677: no clinical effect on AD progression in a randomized trial.

BACKGROUND: In animals, insulin-like growth factor-1 (IGF-1) increases clearance of beta-amyloid, a pathologic hallmark of Alzheimer disease (AD), from the CNS. Serum IGF-1 level decreases with age, and shows a further decrease in AD. We examined whether the growth hormone secretagogue MK-677 (ibutamoren mesylate), a potent inducer of IGF-1 secretion, slows the rate of progression of symptoms in patients with AD. METHODS: A double-blind, multicenter study was conducted in which 563 patients with mild to moderate AD were randomized to receive MK-677 25 mg or placebo daily for 12 months. Efficacy measures were mean change from baseline at month 12 on the Clinician's Interview Based Impression of Change with caregiver input (CIBIC-plus), the cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-Cog), Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL), and the Clinical Dementia Rating-sum of boxes (CDR-sob). RESULTS: A total of 416 patients completed treatment and assessments at 12 months. Administration of MK-677 25 mg resulted in a 60.1% increase in serum IGF-1 levels at 6 weeks and a 72.9% increase at 12 months. In mixed-effects models that included treatment, time (month), randomization strata (baseline MMSE score < or =20 vs >20), and interaction of treatment-by-time, there were no significant differences between the treatment groups on the CIBIC-plus or the mean change from baseline scores on the ADAS-Cog, ADCS-ADL, or CDR-sob scores over 12 months. CONCLUSION: Despite evidence of target engagement as indicated by an increase in serum insulin-like growth factor-1, the human growth hormone secretagogue MK-677 25 mg was ineffective at slowing the rate of progression of Alzheimer disease.

Management of a massive pulmonary embolism in a pregnant patient with mechanical fragmentation followed by delayed catheter-directed thrombolysis in the early postpartum period.

There are limited data available on the management of massive pulmonary embolism in pregnancy. The use of systemic thrombolysis has been reported, but there are few documented cases on the use of mechanical fragmentation or catheter-directed thrombolysis. Systemic thrombolysis in pregnancy increases the risk of major hemorrhage and there are reports of massive subchorionic hematomas following its use. We describe the use of mechanical fragmentation and optional retrievable inferior vena cava (IVC) filter insertion in a 38-week pregnant woman followed by delayed pharmacological catheter-directed thrombolysis during the early postpartum period to successfully treat a massive pulmonary embolism.