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Introduction Herbal medicine and other forms of complementary and alternative medicine (CAM) are used to treat symptoms of psychiatric disorders in the United States, including anxiety and mood problems. In Traditional Tibetan Medicine anxiety and depression are commonly treated with an herbal compound known as Agar-35. Objective The objective of this pilot study was to explore whether Agar-35 tea would improve anxiety, affect, stress, and rumination. Methods Undergraduate psychology students ( N =14) were randomized to drink either Agar-35 tea ( n =6) or placebo tea ( n =8) for 7 nights. Results The results indicated that Agar-35 significantly reduced participants' negative affect compared to placebo, U = 6.0, p = .019, effect size, r = .63. Further, Agar-35 also reduced anxiety (trending toward significance), U = 10.0, p = .071, effect size, r = .48. Conclusion In accordance with its use in Tibetan Medicine, these preliminary findings suggest that Agar-35 may benefit aspects of psychological health.

Background Long segment tracheobronchial stenosis is a rare congenital anomaly that can also occur in combination with abnormal bronchial arborization. Long segment tracheal reconstruction in the setting of a supernumerary bridging bronchus has been reported; however, these repairs can be particularly complex. We present our experience using the bridging bronchus to augment long segment tracheal stenosis with a side-to-side tracheobronchoplasty. Methods Four patients with complex long segment tracheobronchial stenosis involving a bronchus suis (right upper lobe bronchus) and a bridging bronchus presented with refractory respiratory distress requiring urgent tracheal reconstruction. Patient 1 was initially managed with modified slide tracheoplasty and tracheostomy. Patients 2, 3, and 4 were managed with single-stage procedures. All patients underwent definitive long segment tracheobronchoplasty consisting of a side-to-side anastomosis between the bridging bronchus and the right upper lobe bronchus. Results Age at surgery was 569, 69, 24, and 142 days, respectively. Weight at surgery was 9.3, 4.3, 2.7, and 5.9 kg. All patients were weaned from mechanical ventilation at 84, 13, 47, and 8 days after side-to-side tracheobronchoplasty. All patients were alive and free from tracheostomy at follow-up of 6.7, 3.8, 2.7, and 0.5 years. Conclusions Side-to-side tracheal reconstruction is feasible in severe cases of long segment tracheal stenosis with a right upper lobe bronchus and a bridging bronchus. This technique can be successfully applied in high-risk patients and in the neonatal period and can provide excellent midterm results.

IMPORTANCE: Although almost equal numbers of male and female medical students enter into ophthalmology residency programs, whether they have similar surgical experiences during training is unclear. OBJECTIVE: To determine differences for cataract surgery and total procedural volume between male and female residents during ophthalmology residency. DESIGN, SETTING, PARTICIPANTS: This retrospective, longitudinal analysis of resident case logs from 24 US ophthalmology residency programs spanned July 2005 to June 2017. A total of 1271 residents were included. Data were analyzed from August 12, 2017, through April 4, 2018. MAIN OUTCOMES AND MEASURES: Variables analyzed included mean volumes of cataract surgery and total procedures, resident gender, and maternity or paternity leave status. RESULTS: Among the 1271 residents included in the analysis (815 men [64.1%]), being female was associated with performing fewer cataract operations and total procedures. Male residents performed a mean (SD) of 176.7 (66.2) cataract operations, and female residents performed a mean (SD) of 161.7 (56.2) (mean difference, −15.0 [95% CI, −22.2 to −7.8]; P

The role of radiofrequency energy (RFE) devices has been minimally studied in hip arthroscopy. The purpose of this study was to determine the role of RFE devices in hip arthroscopy through a systematic review of the literature. We searched the PubMed database using the following Medical Subject Heading terms: hip arthroscopy, hip radiofrequency, thermal capsulorrhaphy, thermal chondroplasty and radiofrequency debridement. Two authors independently reviewed the literature and included articles based on predetermined inclusion criteria. We excluded review, technique and experimental articles. After title and abstract review, we selected 293 articles for full-text review. Ten articles met the inclusion and exclusion criteria. For the included articles, a total of 305 hips underwent arthroscopy with concomitant RFE treatment at a mean age of 25.7 years. Eight articles presented patient-reported outcome (PRO) instruments, one study did not report an outcome instrument but utilized an evaluation of postoperative range of motion (ROM) and 1 year magnetic resonance image (MRI) and computed tomography (CT) imaging. The remaining article measured only the ROM pre- and postoperatively. Only one of the articles reviewed reported complications. Current evidence on the safety and indications for use of RFE devices in hip arthroscopy is insufficient. The literature shows mixed results regarding its use in hip arthroscopy. Although the use of thermal energy is not without risk, if used judiciously and appropriate precautions are taken to avoid damage to adjacent tissues, those devices can be useful for the treatment of certain intra-articular hip pathologies arthroscopically.

Lateral hip pain along with tenderness of the greater trochanter has been associated with greater trochanteric pain syndrome. Radiographically, this has been associated with gluteus medius pathology on magnetic resonance imaging. This has led some surgeons to conclude that abductor pathology is a primary cause of lateral hip pain. Failure of conservative treatment in the setting of gluteus medius pathology may lead to surgical intervention. In some patients a focal tear of the gluteus medius cannot be visualized and likely represents more diffuse tendinopathy. In these patients we propose micropuncture of the greater trochanter. Similar procedures have shown effectiveness in the elbow and shoulder by eliciting a healing response. Our experience suggests that trochanteric micropuncture at the insertion of the gluteus medius tendon can be effectively performed endoscopically for gluteus medius tendinopathy.

Background: Leukemic infiltration of the optic nerve is relatively rare. While previously described in acute leukemia, the infiltration in our case represents central nervous system (CNS) metastasis of Burkitt-type lymphoma that developed as a complication of solid-organ transplantation, resulting in a bilateral infiltrative optic neuropathy with sequential, bilateral central retinal artery occlusion (CRAO) and devastating vision loss. Methods: The medical record, serial ophthalmic examination findings, clinical course, and imaging including magnetic resonance imaging (MRI), fundus photographs, and fluorescein angiography of a single patient were retrospectively reviewed. Results: MRI demonstrated multifocal cortical and leptomeningeal CNS involvement, including the left optic nerve. Serial fundus examination/photography and fluorescein angiography showed that despite urgent whole-brain irradiation and systemic chemotherapy, CNS disease progressed to bilateral optic nerve infiltration and CRAO with no light perception vision in both eyes. Conclusion: CRAO can occur as a devastating and irreversible complication of lymphoproliferative optic nerve infiltration.

Severe tracheobronchomalacia significantly complicates the postoperative course of infants and children with congenital heart disease, tracheoesophageal fistula, and tracheal stenosis. We have found that traditional approaches, including aortopexy, have been inconsistent in preventing acute life threatening events (ALTEs). In order to directly support the anterior tracheal wall, we have adopted the use of direct anterior tracheal suspension (ATS).Twenty-one children, median age 5 months (35 days to 11 years) and weight 5.0 (2.3 to 28.0) kg have undergone anterior tracheal suspension for severe tracheobronchomalacia through median sternotomy; 15 for inability to ventilate despite mechanical respiratory support, 3 for intermittent ALTEs without mechanical respiratory support, and 3 for recurrent respiratory admissions. Nine procedures were performed as isolated ATS and 12 procedures were combined with at least 1 of the following: repair of ventricular septal defect; vascular ring; atrioventricular canal; tracheal reconstruction or arterial-pexy. Level of respiratory support was graded at preoperative (preop), discharge, and follow-up, and respiratory clinical status was graded at preop and follow-up. Median follow-up was 30.0 months (2.0 to 57.0 months).There was no mortality. Both level of respiratory support and the clinical status improved at all time points studied compared with preoperative score (p0.001) after ATS. Whether ATS was performed in isolation or combined with other procedures did not impact these findings.Anterior tracheal suspension is feasible and appears effective in dramatically improving respiratory clinical status. Tracheal suspension is applicable to a wide range of anatomic variants. Additional study is needed to characterize long-term functional outcomes.

Caution, alkyl acyl azides can rapidly decompose with heat to release large amounts of nitrogen. Care should be taken during handling: do not attempt to convert neat and avoid handling neat.

The primary purpose of this review article is to discuss the role of diagnostic, corticosteroid, hyaluronic acid (HA) and platelet rich plasma (PRP) in the treatment of osteoarthritis (OA) and femoroacetabular impingement (FIA). These treatments play an important biological role in the non-operative management of these conditions. Two independent reviewers performed an search of PubMed for articles that contained at least one of the following search terms pertaining to intra-articular hip injection-local anaesthetic, diagnostic, ultrasound, fluoroscopic, image guided, corticosteroid, HA, PRP, OA, labral tears and FAI. Seventy-two full text articles were suitable for inclusion. There were 18 articles addressing the efficacy of diagnostic intra-articular hip injections. With respect to efficacy in OA there were 25 articles pertaining to efficacy of corticosteroid, 22 of HA and 4 of PRP. There were three articles addressing the efficacy of biologics in FAI. Diagnostic intra-articular hip injections are sensitive and specific for differentiating between intra-articular, extra-articular and spinal causes of hip symptoms. Ultrasound and fluoroscopy improves the precision of intra-articular positioning of diagnostic injections. Corticosteroids are more effective than HA and PRP in alleviating pain from hip OA. A higher dose of corticosteroids produces a longer benefit but volume of injection has no significant effect. Intra-articular corticosteroids do not increase infection rates of subsequent arthroplasty. There is currently limited evidence to warrant the routine use of therapeutic injections in the management of labral tears and FIA.

A strategy for the facile alpha-amination of carboxylic acid menthyl esters is described. The resulting diastereomers, readily separable, can be individually carried on to each enantiomer of the FMOC alpha-amino acid. A variety of unnatural side chains were compatible with this approach. The menthyl ester was easily removed from the FMOC alpha-amino acid without racemization.

To perform a proper labral repair, most surgeons use anchors to secure the labrum to the acetabular bone. We aim to describe a technique for labral repair with a knotless tensionable suture anchor. This technique uses a looped suture configuration, allowing selective tensioning of the repair to maintain the anatomic suction seal of the hip. The use of this technique is easily reproducible and reduces the surgical time compared with previous techniques.

The labrum of the hip is recognized as being important to the stability of the hip and a major cause of hip pain. Damage to the labrum may result in increased joint stress and articular damage. Labral damage is often treated through various methods, among them simple stitch repair, base refixation, and debridement. Labral reconstruction becomes necessary when the labrum is too damaged to salvage, which renders labral repair improbable and labral debridement ineffective. In contrast to other methods that have been described for this treatment, our technique uses a semitendinosus allograft as a graft source, allowing for arthroscopic hip labral reconstruction. This technique has many advantages and is easily reproducible. It has shown promising results in patients with labral damage. The purpose of this article is to detail the step-by-step surgical technique of labral reconstruction using a semitendinosus allograft, in addition to the indications, pearls, and pitfalls of the technique.

Atraumatic instability or microinstability of the hip is a recognized cause of groin pain and hip instability. Risk factors include female sex, ligamentous laxity, and borderline dysplasia. Arthroscopically, the joint may distract easily, and there may be associated ligamentum teres tears and laxity of the capsule on manual probing. The use of arthroscopic capsular plication in this cohort of patients has shown good to excellent results. Biomechanically, a capsular plication aims to create an imbrication and inferior shift of the capsule to augment the screw-home mechanism of the capsuloligamentous structures and thereby improve stability in extension and external rotation. The purpose of this article is to detail the step-by-step surgical technique of arthroscopic capsular plication, in addition to the indications, pearls, and pitfalls of the technique.

Previous studies assessed elite athletes' return to sport (RTS) after hip arthroscopy, but few investigated a cohort including athletes from all levels of sport. This study compared athletes who returned to sport to those who did not, based on four patient-reported outcome (PRO) scores, including the Hip Outcome Score-Sports Specific Subscale (HOS-SSS). Between September 2008 and April 2012, hip arthroscopies were performed on 157 patients (168 hips) who reported playing a sport preoperatively and indicated their level of sports activity post-operatively. Two-year follow-up was available for 148 (94%) amateur and professional athletes with a total of 158 hips. Of these 60 cases (65 hips) did not return to sports (NRTS) and were in the NRTS group. The remaining 88 cases (93 hips) constituted the RTS group. The modified Harris Hip Score, Non-Arthric Hip Score, Hip Outcome-Activities of Daily Living (HOS-ADL), and HOS-SSS were used to assess outcomes. The HOS-SSS was used to assess specific sport-related movement. Both groups demonstrated significant improvement at 2 years post-operatively in visual analog score and four PRO scores (P

Microfracture is a marrow-stimulation technique in which damaged cartilage is drilled or punched, perforating the subchondral bone and generating a blood clot within the defect that matures into fibrocartilage. Microfracture for the treatment of small cartilage defects of the hip has shown good results. Arthroscopic procedures are less invasive than open procedures and have a reduced incidence of complications such as infection or avascular necrosis of the femoral head. Furthermore, arthroscopic procedures allow for a shorter recovery time, resulting in not only lower overall treatment costs but also higher patient satisfaction. Medial and parafoveal cartilage defects of the femoral head can be challenging to effectively microfracture using standard arthroscopy portals because of the acute angles required for instrument manipulation. This report describes a technique for microfracturing these challenging areas of the femoral head using a 2.7-mm K-wire and drilling in a transtrochanteric direction using arthroscopic and imaging guidance to target the area of chondral damage.

We investigated influences of the thermal environment on patterns of body temperature (Tb), activity, and use of burrows during the active season in a population of free-living arctic ground squirrels (Spermophilus parryii). Arctic ground squirrels normally exhibited a daily 58C range in Tb, and had higher Tb when above ground than when in burrows (P , 0.0001). This difference decreased as standard operative temperature (Tes; an index of environmental heat load) increased. Ground squirrels entered burrows more frequently on warmer compared to average or cooler days and when Tb exceeded 398C. On cool days with heavy precipitation, ground squirrels remained almost exclusively below ground, and peaks in Tb were associated with brief aboveground forays. Time on the surface was maximal (about 80% between 0500 and 2200 h) at Tes ¼ 17‐338C and decreased proportionately with decreasing Tes from 178 Ct o� 28C. Forty-six percent of variation in timing of presence above ground could be explained by a series of thermal and nonthermal variables related to environmental heat transfer. This suggests that diurnal activity patterns in this arctic environment with 24-h daylight result from a strategy that minimizes thermoregulatory costs.

Informed by different ontologies, rival research traditions in comparative education forward divergent epistemological platforms, types of analyses and conclusions for the comparative education community. This article examines two studies of educational designs in socialist states-- Joseph Farrell's study of Allende's Chile and Jonathon Jansen's study of Mugabe's Zimbabwe--both of which share remarkably similar conclusions, despite their disparate geo-cultural contexts, as well as divergent research methodologies. Through a comparative analysis of the religio-political conflicts highlighted in each study's conclusion, as well as the research methodologies utilised by each comparativist, this article suggests that rival research traditions can not only arrive at similar conclusions, but offer one another complementary, though divergent, ontologies, which together offer a more complete and fuller picture of the reality or realities being studied.

Recalcitrant osteitis pubis presents a challenging problem for orthopaedic surgeons. Various surgical interventions have been described for treatment, including opening-wedge resection, symphysiodesis, and curettage. We propose that endoscopic pubic symphysectomy offers an effective method of treating such a challenging problem. This article describes in detail the technique used to perform endoscopic pubic symphysectomy, and a companion video demonstrating the procedure is included. Our experience suggests that removal of the interpubic fibrocartilaginous lamina and resection of approximately 1 cm of bone can successfully eliminate all sources of pain and dysfunction caused by the recalcitrant osteitis pubis.

Society׳s reliance upon chemicals over the last few decades has led to their increased production, application and release into the environment. Determination of chemical persistence is crucial for risk assessment and management of chemicals. Current established OECD biodegradation guidelines enable testing of chemicals under laboratory conditions but with an incomplete consideration of factors that can impact on chemical persistence in the environment. The suite of OECD biodegradation tests do not characterise microbial inoculum and often provide little insight into pathways of degradation. The present review considers limitations with the current OECD biodegradation tests and highlights novel scientific approaches to chemical fate studies. We demonstrate how the incorporation of molecular microbial ecology methods (i.e., ‘omics’) may improve the underlying mechanistic understanding of biodegradation processes, and enable better extrapolation of data from laboratory based test systems to the relevant environment, which would potentially improve chemical risk assessment and decision making. We outline future challenges for relevant stakeholders to modernise OECD biodegradation tests and put the ‘bio’ back into biodegradation.

IMPORTANCE The clinical course and outcomes of pediatric vocal fold immobility (VFI) vary widely in the literature, and follow-up in these patients varies accordingly. A better understanding of the natural history of pediatric VFI is crucial to improved management. OBJECTIVE To characterize the natural history of pediatric VFI, including symptoms and rates of resolution and surgical intervention. DESIGN, SETTING, AND PARTICIPANTS Retrospective review at an academically affiliated private pediatric otolaryngology practice in a metropolitan area of all patients seen between July 15, 2001, and September 1, 2012, with a diagnosis of complete or partial VFI. After elimination of 92 incomplete or duplicate files, 404 patient records were reviewed for demographic characteristics, etiologies, symptoms, follow-up, resolution, and interventions. Follow-up records were available for 362 patients (89.6%). MAIN OUTCOMES AND MEASURES Resolution of VFI confirmed by repeated laryngoscopy, length of follow-up, and surgical intervention rates. RESULTS Among the 404 patients, left VFI was present in 66.8%, right VFI in 7.9%, and bilateral VFI in 25.3%. Median (range) age at presentation was 2.9 (0-528.1) months. Major etiological categories included cardiac surgery in 68.8%, idiopathic immobility in 21.0%, and neurologic disease in 7.4%. At presentation, 61.4%experienced dysphonia, 54.0%respiratory symptoms, and 49.5%dysphagia. Tracheotomy was performed in 25.7%and gastrostomy in 40.8%. Median (range) duration of follow-up among the 89.6%of patients with follow-up was 17.2 (0.2-173.5) months. Resolution evidenced by laryngoscopy was found in 28.0%, with a median (range) time to resolution of 4.3 (0.4-38.7) months. In patients without laryngoscopic resolution, median follow-up was 26.0 months, and 28.9% reported symptomatic resolution. CONCLUSIONS AND RELEVANCE The natural history of pediatric VFI involves substantial morbidity, with lasting symptoms and considerable rates of surgical intervention. In this large database, the majority of patients did not experience resolution. This suggests a need for more regimented follow-up in these patients, a recommendation for which is proposed here.

The abundance of wolf spiders (Lycosidae) was measured across woodland-pasture boundaries in the wheat-belt of New South Wales, Australia, to determine the nature and magnitude of any edge effect. Spiders were collected by spotlighting along sample plots in woodlands located at distances of 5, 20, 35 and 200 m from the edge, and along sample plots in paddocks located at distances of 5 and 20 m from the edge. The wolf spider assemblage changed significantly across the edge, but the difference could be accounted for only by a change between the woodland and the paddock and not by any changes within the woodland at different distances from the edge. Ground cover (wolf spider microhabitat) changed significantly between the paddock and the woodland, but there were no consistent differences in microhabitat with distance from edge within either paddocks or woodlands. There was a significant correlation between an ordination of sites based on spider species abundance and an ordination based on microhabitat variables, suggesting that the wolf spider assemblage was responding to differences in microhabitat. Fine-scale selection of microhabitat by most wolf spider species was non-random, with most species preferring locations with grass cover, rather than more open locations. The present study indicates that wolf spiders are mostly unaffected by edge conditions at the woodland-paddock boundary. Accordingly, small and/or linear remnants with high edge-to-area ratios may constitute suitable faunal habitat for wolf spiders and perhaps other terrestrial arthropod species, despite the fact that this configuration is unsuitable for many vertebrate species.

We conducted a retrospective study to determine the treatment outcomes of 6 patients who had either unilateral or bilateral elongated styloid processes and symptoms consistent with Eagle syndrome. Five of these patients had undergone transcervical resection of the styloid process, with relief of symptoms over the follow-up period (mean: 8 mo). Two of the 5 patients experienced a transient weakness in the marginal mandibular nerve, and both recovered completely. The transcervical surgical approach to resection in patients with elongated styloid processes and Eagle syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.

Tropomyosin-related kinases (Trk) are tyrosine kinase receptors implicated in tumor proliferation, invasion, and survival signaling across a number of tumors, making them potentially attractive targets for the treatment of cancer. AZD7451 is a potent and selective inhibitor of Trk kinases currently undergoing a Phase I dose escalation in glioblastoma multiforme at the National Cancer Institute. A key part of early clinical testing for AZD7451 involves demonstrating that pharmacokinetic half-life and clinical exposures of AZD7451 are sufficient to inhibit Trk receptors in preclinical models. To address this need, an ultra sensitive analytical method was developed to measure the AZD7451 profile in human plasma. A liquid-liquid extraction recovered >80% of AZD7451 before quantitative analysis by ultra HPLC-MS/MS. A Varian Polaris® C18-A column and a mass transition of m/z 383.5→340.5 (m/z 389.6→342.0 for the internal standard [2H6]-AZD7451) was used, and a dynamic calibration range of 0.5–1000 ng/mL was established, which provided a sensitive (

Characterization of the prostate cancer transcriptome and genome has identified chromosomal rearrangements and copy number gains and losses, including ETS gene family fusions, PTEN loss and androgen receptor (AR) amplification, which drive prostate cancer development and progression to lethal, metastatic castration-resistant prostate cancer (CRPC). However, less is known about the role of mutations. Here we sequenced the exomes of 50 lethal, heavily pre-treated metastatic CRPCs obtained at rapid autopsy (including three different foci from the same patient) and 11 treatment-naive, high-grade localized prostate cancers. We identified low overall mutation rates even in heavily treated CRPCs (2.00 per megabase) and confirmed the monoclonal origin of lethal CRPC. Integrating exome copy number analysis identified disruptions of CHD1 that define a subtype of ETS gene family fusion-negative prostate cancer. Similarly, we demonstrate that ETS2, which is deleted in approximately one-third of CRPCs (commonly through TMPRSS2:ERG fusions), is also deregulated through mutation. Furthermore, we identified recurrent mutations in multiple chromatin- and histone-modifying genes, including MLL2 (mutated in 8.6% of prostate cancers), and demonstrate interaction of the MLL complex with the AR, which is required for AR-mediated signalling. We also identified novel recurrent mutations in the AR collaborating factor FOXA1, which is mutated in 5 of 147 (3.4%) prostate cancers (both untreated localized prostate cancer and CRPC), and showed that mutated FOXA1 represses androgen signalling and increases tumour growth. Proteins that physically interact with the AR, such as the ERG gene fusion product, FOXA1, MLL2, UTX (also known as KDM6A) and ASXL1 were found to be mutated in CRPC. In summary, we describe the mutational landscape of a heavily treated metastatic cancer, identify novel mechanisms of AR signalling deregulated in prostate cancer, and prioritize candidates for future study.

This study presents the results of four Ligamentum Teres (LT) reconstruction procedures for hip instability with an average of 21.4 months follow-up (range 16.4-27.8). The indication for reconstruction was patients who complained of hip instability (hip giving way on gait or activities of daily living) on a background of a connective tissue disorder and generalized ligamentous laxity. The following data were recorded: age, sex, body mass index, hip range of motion, impingement signs, acetabular coverage (lateral center edge angle and acetabular inclination), acetabular retroversion (ischial spine sign and a crossover sign), femoral alpha angles and femoral neck shaft angles. Four patient recorded outcomes (PROs) were collected at 3 months, 12 months and 24 months. Three patients were female. Three out of four procedures had an improvement in PROs. One patient with bilateral procedures had an improvement in PROs on one side at 1 year but a failure of the graft on the contralateral side. There were no complications reported with the technique. LT reconstruction and concomitant capsular plication in this case series is associated with an improvement in outcomes in three out of four of the patients with hip instability associated with a full thickness tear of the LT and who presented with hip instability on a background of generalized ligamentous laxity and a connective tissue disorder. However, the physical examination, radiographic and intra-operative findings which may help predict who would benefit from LT reconstruction require further investigation.

A convergent synthesis of the C31-C52 bis-tetrahydropyran core of the natural product amphidinol 3 is reported. A common intermediate was synthesized from D-tartaric acid utilizing an asymmetric glycolate alkylation/ring-closing metathesis sequence to construct the THP rings. Differential elaboration of the common intermediate allowed the synthesis of two distinct coupling partners which were joined through a modified Horner-Wadsworth-Emmons olefination to provide the bis-tetrahydropyran core.

The mass transfer rates and equilibrium partitioning behaviour of 14 diverse organochlorine pesticides (OCP) between water and polyethylene (PE) passive samplers, cut from custom made PE sheets and commercial polyethylene plastic bags, were quantified. Overall mass transfer coefficients, k(O), estimated PE membrane diffusion coefficients, D(PE), and PE-water partitioning coefficients, K(PE-water,) are reported. In addition, the partitioning of three polycyclic aromatic hydrocarbons (PAHs) from water to PE is quantified and compared with literature values. K(PE-water) values agreed mostly within a factor of two for both passive samplers and also with literature values for the reference PAHs. As PE is expected to exhibit similar sorption behaviour to long-chain alkanes, PE-water partitioning coefficients were compared to hexadecane-water partitioning coefficients estimated with the SPARC online calculator, COSMOtherm and a polyparameter linear free energy relationship based on the Abraham approach. The best correlation for all compounds tested was with COSMOtherm estimated hexadecane-water partitioning coefficients.

We conducted a retrospective study to determine the treatment outcomes of 6 patients who had either unilateral or bilateral elongated styloid processes and symptoms consistent with Eagle syndrome. Five of these patients had undergone transcervical resection of the styloid process, with relief of symptoms over the follow-up period (mean: 8 mo). Two of the 5 patients experienced a transient weakness in the marginal mandibular nerve, and both recovered completely. The transcervical surgical approach to resection in patients with elongated styloid processes and Eagle syndrome appears to be safe and effective, although the risk for transient marginal mandibular nerve weakness is notable.

Objectives: Previous studies have assessed elite athletes’ level of return to sport, but few have investigated a general hip arthroscopy cohort. The study purpose was to compare patient-reported outcomes (PRO) scores and ability to perform sports-related movements between a group of patients that returned to sport (RTS) and a group that did not return to sports (NRTS). Methods: Between September 2008 and April 2012, 1343 patients underwent hip arthroscopy, of which, 157 patients (168 hips) reported playing a sport before surgery and also indicated their postoperative involvement in sports. Of these, 148 patients (158 hips, 94%) had two-year follow-up. Four PROs were used. The Hip Outcome Score - Sports Specific Subscale (HOS-SSS) was the primary measure to assess return to sports and ability to perform sport-related movements. Results: In the overall cohort of 148 amateur and professional athletes (158 hips) who underwent hip arthroscopies, 25 (17%) did not return to sports due to hip-related issues. An additional 32 patients (22%) did not return to sports due to non-hip-related issues, while three patients did not return sports for unidentified reasons. These 60 patients (65 hips) were considered the NRTS group. The remaining 88 patients (93 hips) were defined as the RTS group. Average ages for the RTS and NRTS groups were 30.7 and 30.4 years, respectively. Both groups demonstrated significant improvements from preoperative to postoperative scores based on all PRO measures. While there was no significant difference between groups for HOS-SSS scores preoperatively, the RTS group had significantly higher HOS-SSS scores at one year and two years post-surgery. Postoperatively, patients in the RTS group had significantly better ability to: run one mile, jump, land from a jump, stop quickly and perform cutting/lateral movements (p20 at two years post-surgery were 2.3 times as likely to return to sport as those with HOS-SSS < 20. Conclusion: In a mixed group of hip arthroscopy athletes, 84% returned to sport or discontinued participation due to non-hip related issues. Patients who returned to sport demonstrated significantly higher HOS-SSS scores and abilities to perform several sport-related movements. movements.

Objectives: The purpose of this study was to evaluate clinical outcomes, pain, and patient satisfaction following all hip arthroscopies performed by a single surgeon at a high volume referral center with a mean 2-year follow-up. Methods: During the study period, February 2008 to June 2012, data were collected on all patients undergoing hip arthroscopy. All patients were assessed pre- and post-operatively with 4 patient-reported outcome (PRO) measures: the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), and Hip Outcome Score-Sport Specific Subscales (HOS-SSS). Pain was estimated on the visual analog scale (VAS). Patient satisfaction was measured on a scale from 0 to 10. The number of patients who underwent revision arthroscopy, total hip arthroplasty, or a resurfacing procedure during the study period is also reported for primary and revision hip arthroscopies. Results: One thousand and thirty eight patients underwent hip arthroscopy during the study period. The score improvement from preoperative to 2-year follow-up was 60.9 to 77.6 for mHHS, 62.8 to 78.9 for HOS-ADL, 40.0 to 63.43 for HOS-SSS, 57.4 to 76.2 for NAHS. VAS decreased from 5.86 preoperatively to 3.15 postoperatively. All scores demonstrated statistically significant improvement (pConclusion: Hip arthroscopy for all indications results in improved clinical outcomes, decreased pain, and high satisfaction at a mean 2-year follow-up. Patients should be counseled regarding the potential progression of degenerative change leading to arthroplasty, and the potential for revision surgery.

Received 29 March 2005; revised 26 July 2005; accepted 22 September 2005; published 6 December 2005. [1] Wind throw, as evidenced by a tree bole with an attached root plate, is an indicator of forest disturbance, and can often be used as direct evidence of surface winds during a single storm event. We assess tree-fall patterns resulting from the 1982 Cyclone Bernie event in the North Island, New Zealand, and apply these findings to interpretation of a pre–Last Glacial Maximum (LGM) tree-fall site to determine if the subfossil tree-fall pattern could have been caused by a single extropical cyclone. There is insufficient evidence to recommend that a single extropical storm event could have caused the forest destruction observed at our pre-LGM tree-fall site, and therefore multiple possibilities for enhanced wind flow that could have caused tree throw are possible.

1. Responses to adenosine, R-PIA and ovalbumen were examined in guinea-pig isolated superfused tracheal spirals to determine the effects of passive sensitization by overnight incubation in serum from ovalbumen (OA)-sensitized or non-sensitized guinea-pigs. 2. Tissues incubated with serum from non-sensitized and OA-sensitized guinea-pigs contracted (0.07+/-0.02 and 0.04+/-0.01 g, respectively) to adenosine (300 micro M) whereas non-incubated or Krebs-incubated tissues produced no contractions to adenosine or ovalbumen (10 micro g). Ovalbumen caused substantial contractions (0.40+/-0.09 g) after OA-sensitized serum incubation and significantly (P0.05) smaller contractions (0.08+/-0.03 g) after non-sensitized serum incubation. Tracheae from guinea-pigs actively sensitized to ovalbumen 14-21 days beforehand also contracted to adenosine, R-PIA (3 micro M) and ovalbumen. 3. The A(1)/A(2) adenosine receptor antagonist, 8-phenyltheophylline (8-PT, 3 micro M), failed to antagonize these contractions, suggesting that A(1)/A(2) adenosine receptors were not involved. 4. Unlike adenosine, R-PIA (3 micro M) produced contractions in non-incubated (0.23+/-0.04 g) or Krebs-incubated (0.15+/-0.04 g) tracheae, as well as after passive and active sensitization. None of these responses were blocked by 8-PT. 5. The A(3) receptor agonist, IB-MECA, in the presence of 8-PT produced small contractions in passively sensitized tracheae (10 micro M, 0.02+/-0.003 g) and, in larger doses (100 micro M and 1 mM), contracted actively sensitized tracheae. 6. In actively sensitized trachea, the A(3) receptor antagonist, MRS-1220 (100 nM), significantly (P0.05) attenuated adenosine contractions in the presence of 8-PT from 0.23+/-0.07 g to 0.07+/-0.03 g. 7. These results show that passive, like active sensitization, reveals bronchoconstrictions to adenosine of isolated tracheae. The insensitivity to 8-PT blockade, the antagonism by MRS-1220, and the fact that the A(3) receptor agonist, IB-MECA, mimics this response, suggest involvement of A(3) receptors. R-PIA, however, has a different profile of adenosine receptor activity.

POSTOPERATIVE neurologic or neuropsychologic deficits, or both, remain a common cause of disability after otherwise successful cardiac surgery. However, not all deficits are caused by gaseous or atheromatous emboli.

PURPOSE: It has been suggested that the pupillary light reaction is relatively preserved in the affected eyes of patients with Leber hereditary optic neuropathy (LHON). To test the hypothesis that visual-pupillomotor dissociation exists in LHON, we performed a retrospective study to evaluate the magnitude of the relative afferent pupillary defect (RAPD) in patients who had experienced monocular visual loss. We also compared the size of the measured RAPD with the size of the RAPD that would be expected on the basis of documented visual field loss. METHODS: We identified a cohort of patients with LHON and monocular visual loss, whose pupillary reactions had been quantified using neutral density filters. From a review of the case records, we determined whether an RAPD was present, as well as the magnitude of the documented RAPDs. We also calculated the expected size of the RAPD for each patient, using previously established templates that correlated the size of the RAPD with the degree of visual field loss. RESULTS: An RAPD was identified in all 10 patients in this study. There was no significant difference between the size of the measured and predicted RAPD, nor did the size of the RAPD correlate with visual acuity or the time interval between the onset of visual loss and evaluation. CONCLUSION: The results of this study do not support the hypothesis that visual-pupillomotor dissociation is a common feature of LHON.

Objectives To evaluate the pathologic conditions, preoperative evaluation, treatment, and clinical outcomes associated with sphenoid sinus disease. Design Retrospective study. Setting Tertiary university-based referral center. Patients All patients with isolated sphenoid sinus disease managed surgically or in which surgery was considered a primary treatment option. Main Outcome Measures Demographic data, presenting signs and symptoms, endoscopic and imaging findings, surgical management, surgical pathology, and clinical outcomes were investigated in patients presenting with sphenoid sinus disease to the Medical College of Wisconsin, Milwaukee, between January 1, 1991, and December 31, 2001. Results The study population included 17 women and 12 men with a mean age of 52.3 years (range, 15-82 years). The most common presenting symptom was headache (20 patients [69%]). Imaging evaluation included computed tomography and/or magnetic resonance imaging studies in all cases. Sphenoid sinus abnormality was variable and included sinusitis (11 patients [38%]), tumor (7 [24%]), mucocele (5 [17%]), fungal process (3 [10%]), and cerebrospinal fluid fistula (3 [10%]). Twenty-one cases (72%) were managed endoscopically and 4 (14%) were managed with a transseptal approach. One patient (3%) underwent combined extracranial-endoscopic transnasal approach, while another (3%) underwent a midface degloving approach. The remaining 2 patients (7%) did not undergo surgical intervention. Conclusions Given the high prevalence of noninflammatory lesions within the sphenoid sinus, thorough preoperative evaluation is imperative. Initially, this should include nasal endoscopy and computed tomography to help define the location, extent, and character of the lesion. In some cases, magnetic resonance imaging may help further define the nature and extent of a lesion. Angiography should be considered if a vascular lesion is suspected. The clinical and imaging findings should all be taken into consideration when the surgical approach is planned.

Immunocompromised patients are known to be at risk for varicella-zoster virus reactivation, often in atypical manners. We describe a 30-year-old man with simultaneous involvement of the retina, optic chiasm, and optic nerve with varicella-zoster virus who had a bitemporal visual field defect.