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Attributes of oblong horizontal tubes within the semi-preparative counter-current chromatography bobbin.
PURPOSE To assess fiberoptic endoscopic evaluation of swallowing (FEES) findings in individuals with cricopharyngeal bar (CPB) and Zenker's diverticulum (ZD). METHODS In this retrospective chart review spanning from 2010-2018, individuals diagnosed with CPB or ZD and undergoing FEES were identified. Patient demographics, radiographic studies, and treatments were recorded, and findings were compared between CPB, ZD of  less then  3 cm, and ZD ≥ 3 cm. RESULTS Sixty-one individuals consisting of 48 patients with ZD and 13 patients with CPB met inclusion criteria. Post-swallow hypopharyngeal reflux (PSHR) of undigested food bolus, present with or without Valsalva maneuver, was noted in 23%, 84%, and 75% of patients with CPB, ZD  less then  3 cm, and ZD ≥ 3 cm, respectively. The sensitivity and specificity of the finding for those with ZD were 81% and 83%, respectively. Of patients with ZD, reflux resolved in all but six individuals after surgery. Four of these patients underwent revision surgery with the reflux subsequently resolving, and two patients with persistent reflux were asymptomatic and did not desire further treatment. CONCLUSIONS PSHR is a good tool to identify the presence of a ZD and is less helpful to identify a CPB. Elimination of PSHR is a good tool to determine treatment success in patients with ZD and CPB. LEVEL OF EVIDENCE IV.PURPOSE To report the outcomes of parathyroid gland (PG) identification and autotransplantation (autoT) during thyroidectomy. METHODS Consecutive total thyroidectomy cases performed by a single surgeon using extracapsular dissection technique were considered. PGs were not intentionally sought during dissection. PG location, number identified and autoT were prospectively recorded and correlated to postoperative outcomes. read more RESULTS In all, 265 cases were included. The mean number of PGs identified per case was 2.7. The number of PGs identified had no correlation to postoperative hypocalcemia. However, independent risk factors for hypocalcemia were female sex, bilateral central compartment neck dissection (CND) and autoT > 1 PG; and for permanent hypoparathyroidism were female sex and bilateral CND. AutoT did not protect against permanent hypoparathyroidism. CONCLUSION The number of PGs identified during the course of a standard extracapsular dissection technique had no correlation to postoperative hypocalcemia. Whenever possible, avoiding bilateral CND and careful techniques to preserve PGs in an in situ and viable state, to obviate the necessity for autoT, are recommended.Mercury (Hg) is a potent neurotoxin that biomagnifies within food webs. Adverse effects have been documented for avian species related to exposure of elevated Hg levels. High elevation, boreal forests generally receive higher atmospheric Hg deposition and regional studies have subsequently identified elevated blood Hg concentrations in songbird species inhabiting these montane habitats. The overall goal of this study was to investigate spatial and seasonal Hg exposure patterns in songbird species along an elevational gradient on Whiteface Mountain in the Adirondack Park of New York State. Songbird blood samples were collected from June-July in 2009 and 2010 along an elevational gradient at 13 study plots (450-1400 m) with a focus on Catharus thrushes, including the hermit thrush, Swainson's thrush, and Bicknell's thrush. The main results of this study documented (1) an overall linear pattern of increasing blood Hg concentrations with increasing elevation, with additional analysis suggesting a nonlinear elevational pattern of increasing blood Hg concentrations to 1075 m, followed by decreasing concentrations thereafter, for all Catharus thrush species across the elevational gradient; and (2) an overall nonlinear seasonal pattern of increasing, followed by decreasing blood Hg concentrations across target species. Avian exposure patterns appear driven by elevated atmospheric Hg deposition and increased methylmercury bioavailability within high elevation habitats as compared with low elevation forests. Seasonal patterns are likely influenced by a combination of complex and dynamic variables related to dietary selection and annual molting cycles. Considering that few high elevation analyses have been conducted within the context of regional songbird research, this project complements the results from similar studies and highlights the need for further monitoring efforts to investigate environmental Hg contamination within avian communities.BACKGROUND Frameless neuronavigation allows neurosurgeons to visualize and relate the position of surgical instruments to intracranial pathologies based on preoperative tomographic imaging. However, neuronavigation can often be inaccurate. Multiple factors have been proposed as potential causes, and new technologies are needed to overcome these challenges. OBJECTIVE To evaluate the accuracy of neuronavigation systems compared to near-infrared (NIR) fluorescence imaging using Second Window Indocyanine Green, a novel technique, and to determine factors that lead to neuronavigation errors. METHODS A retrospective analysis was conducted on 56 patients who underwent primary resections of intracranial tumors. Patients received 5 mg/kg ICG approximately 24 h preoperatively. Intraoperatively, neuronavigation was used to plan craniotomies to place the tumors in the center. After craniotomy, NIR imaging visualized tumor-specific NIR signals. The accuracy of neuronavigation and NIR fluorescence imaging for delineating the tumor boundary prior to durotomy was compared. RESULTS The neuronavigation centers and NIR centers were 23.0 ± 7.7 % and 2.6 ± 1.1 % deviated from the tumor centers, respectively, relative to the craniotomy sizes. In 12 cases, significant changes were made to the planned durotomy based on NIR imaging. Patient position was a significant predictor of neuronavigation inaccuracy on both univariate and multivariate analysis, with the prone position having significantly higher inaccuracy (29.2 ± 8.1 %) compared to the supine (16.2 ± 8.1 %, p value  less then  0.001) or the lateral (17.9 ± 5.1 %, p value = 0.003) positions. CONCLUSION Patient position significantly affects neuronavigation accuracy. Intraoperative NIR fluorescence imaging before durotomy offers an opportunity to readjust the neuronavigation image space to better align with the patient space.PURPOSE Despite recent advances in antimicrobial treatments, tuberculosis (TB) remains a major global health threat. Mycobacterium tuberculosis proliferates in macrophages, preventing apoptosis by inducing anti-apoptotic proteins leading to necrosis of the infected cells. Necrosis then leads to increased tissue destruction, reducing the penetration of antimicrobials and immune cells to the areas where they are needed most. Pro-apoptotic drugs could be used as host-directed therapies in TB to improve antimicrobial treatments and patient outcomes. PROCEDURE We evaluated [18F]-ICMT-11, a caspase-3/7-specific positron emission tomography (PET) radiotracer, in macrophage cell cultures and in an animal model of pulmonary TB that closely resembles human disease. RESULTS Cells infected with M. tuberculosis and treated with cisplatin accumulated [18F]-ICMT-11 at significantly higher levels compared with that of controls, which correlated with levels of caspase-3/7 activity. Infected mice treated with cisplatin with increased caspase-3/7 activity also had a higher [18F]-ICMT-11 PET signal compared with that of untreated infected animals. CONCLUSIONS [18F]-ICMT-11 PET could be used as a noninvasive approach to measure intralesional pro-apoptotic responses in situ in pulmonary TB models and support the development of pro-apoptotic host-directed therapies for TB.The aim of this study was to evaluate the impact of pregestational diabetes mellitus (DM) on fetal cardiac function two-dimensional parameters using spectral and tissue Doppler. Pregnant women between 20 and 36 + 6 weeks gestation were divided into three groups controls, type I DM, and type II DM. The right ventricle (RV) and left ventricle (LV) annular velocity peaks were measured using spectral (E, A) and tissue (E', A', S') Doppler. The myocardial performance index was calculated as (isovolumetric contraction time [ICT] + isovolumetric relaxation time [IRT])/ejection time using tissue (MPI') and the spectral Doppler (MPI). A general linear model, with fetal heart rate as a covariant, was used to evaluate the effect of DM on the fetal heart function assessment parameters. To assess the association of type I and II DM with adverse perinatal outcomes, Fisher's exact test was used. A receiver operating characteristic curve was used to determine the best cutoff for fetal cardiac function assessment parameters t01). Tissue Doppler and MPI parameters can be useful to detect subclinical cardiac dysfunction in the fetal heart of pregestational DM pregnant women.Caseous Mitral Annular Calcification (CMAC) is seen in 0.6% of Mitral annular Calcification (MAC) and carries an increased risk for ischemic stroke. The typical location is Posterior Mitral Annular area and arises as degeneration of MAC. Typical Echocardiographic features along with Cardiac MRI and CT imaging features are diagnostic.Understanding how sexual behaviors cluster in distinct population subgroups along the life course is critical for effective targeting and tailoring of HIV prevention messaging and intervention activities. We examined interrelatedness of sexual behaviors and variation between men and women across a wide age range in a rural South African setting with a high HIV burden. Data come from the Ha Nakekela population-based survey of people aged 15-85-plus drawn from the Agincourt Health and Socio-Demographic Surveillance System. We used latent class analysis of six sexual behavior indicators to identify distinct subgroup sexual behavior clusters. We then examined associations between class membership and sociodemographic and other behavioral risk factors and assessed the accuracy of a reduced set of sexual behavior indicators to classify individuals into latent classes. We identified three sexual behavior classes (1) single with consistent protective behaviors; (2) risky behaviors; and (3) in union with lack of protective behaviors. Patterns of sexual behaviors varied by gender. Class membership was also associated with age, HIV status, nationality, and alcohol use. With only two sexual behavior indicators (union status and multiple sexual partners), individuals were accurately assigned to their most likely predicted class. There were distinct multidimensional sexual behavior clusters in population subgroups that varied by sex, age, and HIV status. In this population, only two brief questions were needed to classify individuals into risk classes. Replication in other situations is needed to confirm these findings.PURPOSE Gliomas are primary brain tumors with a life-limiting course of disease, and the last weeks of life are often characterized by neurological deficits that affect communication and personality. End-of-life treatment in this patient group therefore requires specific approaches. To date, little data is available on patients' and caregivers' needs and experiences in the last phase of the disease. METHODS In this observational study, relatives of patients treated at the University Hospital Zurich, Switzerland and deceased 2015-2017 due to glioma progression were contacted to complete a structured questionnaire assessing caregivers experience within the last weeks of the disease. RESULTS The survey was sent to 120 relatives of deceased patients with a glioma (WHO grades II-IV) (median patient age 62 years; 73.8% male). Forty-three questionnaires were returned (37.7%). Approximately half of the patients were taken care of at home in the last 4 weeks of the disease, mainly with the assistance of in-home nursing care, of which eventually 14 patients (63.
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