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Telerobotic surgery could improve access to specialty procedures such as cardiac catheter ablation in rural and underserved regions in the United States and worldwide. Advancements in telecommunications, internet infrastructure, and surgical robotics are lowering the technical hurdles for this future healthcare delivery paradigm. Nonetheless, important questions remain regarding the safe implementation of telerobotic surgery in rural community hospital settings.

A woman with scleroderma, a disease that causes tissues and organs to harden, describes how she has lived since 1984 with the disease, even though she could have died within three years. She had one complicated pregnancy and two fairly normal pregnancies.

Adoption of contrast-enhanced US by interventional radiologists can enhance not only procedure guidance but also preprocedure patient evaluation and assessment of treatment response across a wide spectrum of oncologic, vascular, and nonvascular procedures.

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants linked to harmful health effects. Currently employed PFAS destruction methods are energy-intensive and often produce shorter-chain and recalcitrant partially fluorinated byproducts. We report the mineralization of five fluorotelomer compounds via a base-mediated degradation using NaOH and mild temperatures (120 °C) in a mixture of DMSO:H2O (8:1 v/v). The studied fluorotelomers have varying polar head groups–carboxylic acids, sulfonic acids, alcohols, and phosphonic acids, which are the most common polar head groups used in commercial and industrial applications. The degradation intermediates and byproducts were characterized using 1H, 13C, and 19F NMR spectroscopy. Density functional theory computations at the M06-2X/6-311 + G(2d,p)-SMD-(DMSO) level were consistent with the observed intermediates and guided an overall mechanistic hypothesis. Degradation of each fluorotelomer occurs through a similar process, in which the nonfluorinated carbons and the first fluorinated carbon are cleaved from the remaining perfluoroalkyl fragment, which degrades through previously identified pathways. These findings provide important insight into PFAS degradation processes and suggest that PFAS containing at least one C–H bond within or adjacent to its fluoroalkyl chain can be degraded under these mild conditions. Many PFAS in current use as well as recalcitrant fluorinated byproducts generated from other PFAS degradation methods are candidates for this approach.

AbstractThe complete list of pairs of non-isomorphic finite simple groups having the same order is well known. In particular, for p> 3, PSL2(ℤ/p) is the “only” simple group of order It's less well known that Frobenius proved this uniqueness result in 1902. This note presents a version of Frobenius’ argument that might be used in an undergraduate honors algebra course. It also includes a short modern proof, aimed at the same audience, of the much earlier result that PSL2(ℤ/p) is simple for p> 3, a result stated by Galois in 1832.

Purpose The placement of a peripherally inserted central catheter (PICC) for neonatal or pediatric patients may at times be technically challenging. We describe an alternate method of placing a PICC in neonatal and pediatric patients with difficult venous access.Methods An Amplatz gooseneck snare is advanced from the femoral vein to the basilic vein, as a target for puncture and guidewire positioning, allowing PIcc placement. Between 1999 and 2006, 44 PICCs were placed in the manner described. The medical records were reviewed allowing for up to 7 yrs of patient follow-up.Results Ninety-five percent of PICCs were successfully placed using the snare technique. Two placements were aborted and two procedural complications occurred. The review revealed no evidence of osteomyelitis, nerve injury, deep venous thrombosis or leg length discrepancy.Conclusion this technique offers an alternate method for PICC placement in neonatal and pediatric patients when conventional methods are unsuccessful. The technique avoids the need for intermediate to long-term jugular, subclavian or femoral vein access.

Introduction:Telerobotic operation in which a remote surgeon performs an operation over distance has long held the promise of providing a more equitable distribution of healthcare in rural and underserved regions of the world. One of the technological limitations that has hampered the adoption of telerobotic surgery is the need for a broadband connection to transmit high-resolution video of the operative field.Hypothesis:We hypothesized that we could develop a low-bandwidth system for telerobotic cardiac catheter ablation that deploys a virtual reality (VR)-based surgical guidance system to allow remote operation without the need for high-resolution video transmission.Methods:We assembled a portable pre-clinical telerobotic catheter ablation system from commercial-grade components by 3rdparty vendors. Raw sensor data from the catheter ablation system requiring a bitrate of less than 100kb/sec was streamed in real-time over distance using a standard internet connection. We used a proprietary service (DOPL Technologies, Seattle, WA) and an Oculus Quest (Oculus, Inc. Menlo Park, CA) to generate a shared, virtual operative field and operating room environment. No video data was transmitted. The Institutional Animal Care and Use Committee of the University of Washington (Seattle, WA) approved the study performed on a 14-week (27 kg) Yorkshire pig. The operator was located 6 miles from the OR at the time of the operation.Results:A successful proof of concept telerobotic cardiac catheter ablation in an animal model was performed without video transmission. The remote surgeon applied radiofrequency energy lesions in the animal’s cavotricuspid isthmus region. The visual depiction of the operative environment was successfully constructed in virtual reality from sensor data generated from the animal subject and surgical instruments. The remote operator conducted the ablation while interacting in a shared virtual OR environment with members of the surgical team present in the physical operating room and three remote observers.Conclusions:Telerobotic cardiac catheter ablation is feasible without video transmission. This approach could reduce network bandwidth requirements for telerobotic operations in rural areas.

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Objective: Previous work indicated that E‐selectin mediates transient interactions between leukocytes and cytokine‐activated endothelium in vitro. Here we examine the role of E‐selectin in blood leukocyte interactions with microvascular endothelium in vivo.

Rationale and Objectives.: Many perceptual studies have shown that the detection of large, low-contrast targets is better either in color or in contrast-reversing presentations than in standard gray scale. We determined the value of several new display techniques for viewing liver computed tomography (CT) scans. Methods.: Eight observers (four radiologists and four nonradiologists) viewed sets of 100 liver CT images (50 with lesions and 50 without) under five display conditions on a Macintosh computer: (1) color (equiluminant color contrast); (2) color-luminance (combined luminance and chromatic contrast); (3) flicker (luminance contrast that reversed polarity at 2 Hz); (4) contour (shaded intensity mapping); and (5) control (conventional gray scale). Receiver operating characteristic (ROC) techniques were used for analysis. Results.: The measured ROC curve areas for the different viewing conditions were as follows: control = 0.77 +/- 0.01 (mean +/- standard error of the mean); color = 0.78 +/- 0.01; color-luminance = 0.82 +/- 0.01; flicker = 0.78 +/- 0.01; and contour = 0.76 +/- 0.01. The percentage of lesions correctly located ranged from 0.82 (color-luminance) to 0.75 (flicker). Performance under the color-luminance condition was significantly better than in the control condition (p = .01), whereas the other experimental conditions were not significantly different from the control condition (p > .21). Conclusion.: The use of mixed color and luminance displays may have perceptual advantages for radiologists and can improve performance over that of gray-scale viewing.

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Metastasizing cancer cells can invade the extracellular matrix using plasma membrane protrusions, termed invadopodia, that contact and dissolve the matrix. Various membrane associated proteases localized on the invadopodial membranes are responsible for the extracellular matrix degradation. Work from our laboratory shows that secreted proteases including Gelatinase A, and high molecular weight integral membrane proteases are associated with cell surface invadopodia. Three cell types, including chicken embryonic cells transformed by Rous sarcoma virus, human malignant melanoma cell line LOX, and human breast carcinoma cell line MDA-MB-231, retain the invasive phenotypein vitro, express invadopodia, degrade and enter into a fibronectin-rich collagenous matrix. We suggest that invadopodium-associated proteases are ideal targets for the diagnosis and treatment of cancer as their presence in association with primary tumors may signal increased metastatic potential. An approach toward the development of new prognostic markers for breast malignancy involved production of monoclonal antibodies directed against membrane proteases in a mixture of glycoproteins. Double immunofluorescent technique using a known invadopodium marker is designed to select specific monoclonal antibodies colocalizing at the invasion front, on invadopodia of cancer cells. Membrane protease accessibility at the cell surface can therefore be exploited for therapeutic advances by the development of specific antibodies and inhibitors that block their activities, and by the use of monoclonal antibodies to target cytotoxic molecules to micrometastases. Also, this same accessibility may potentially be used to detect surface proteases on micrometastases or to detect components shed by micrometastases in serum.

Relates how management consultant Sharon Monsky dealt with her scleroderma. Battle against physical suffering; Founding of the Scleroderma Research Foundation; Goals for the foundation. INSET: Where to find help..

Two letters to the editor are presented in response to articles "Champions: Rosa Gatti," in the February 25-March 3, 2013 issue, and "Three reasons why ceiling for rights fees is nowhere in sight," in the February 25-March 3, 2013 issue.