bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonlinear analysis of dynamic stability for the thin cylindrical shells of supercavitating vehicles
Authors: An Hai , Zhou Ling , Wei Xing , An Weiguang
Published: January 2017

The dynamic stability of supercavitating vehicles under periodic axial loading is investigated in this article. The supercavitating vehicle is simulated as a long and thin cylindrical shell subjected to periodic axial loading and simply supported boundary conditions. The nonlinear transverse vibration differential equation is obtained in terms of nonlinear geometric equations, physical equations, and balance equations of cylindrical shells. Mathieu equation with periodic coefficients and nonlinear term is derived by employing Galerkin variational method and Bolotin method. The analytical expressions of the steady-state amplitudes of vibrations in the first- and second-order instable regions are obtained by solving nonlinear Mathieu equation derived in this article. Numerical results are presented to analyze the influence of the sailing speed, ratio of loads, the frequency of axial loads, and the mode of vibration on parametric resonance curves and to show the nonlinear parametric resonance curves incline toward the side where it is greater than the excitation frequency, which significantly extends the range of the exciting region. The presented results indicate the enlargement of the exciting region will cause shrinkage of the safe frequency range of external loads and decrease in dynamic stability of supercavitating vehicle.
Experimental determination of rupture pressure and stress of adventitia of human middle cerebral arteries
Authors: Piechna Adam , Lombarski Leszek , Ciszek Bogdan , Cieslicki Krzysztof
Published: January 2017

Background

Intracranial arterial dissections might be attributed to the particular biomechanical properties of their specific layers. Also, knowledge of adventitia properties would be crucial in the context of intracranial balloon angioplasty.

Aims

The purpose of this work was to determine the rupture pressure of separated adventitia and compare it to intact cerebral arterial segments.

Methods

Brain specimens were harvested from 14 autopsy subjects (age range from 23 to 86 years). Pressure-inflation tests were conducted on proximal segments of middle cerebral arteries and separated adventitia layers from contralateral arteries to assess the rupture pressure values.

Results

The averaged rupture pressure of adventitia layers was 1.41 SD 0.25 atm (1072 SD 190 mmHg), whereas for intact arterial segments it was 2.32 SD 0.70 atm (1763 SD 532 mmHg) and diminished with age according to nonlinear regression trends. The difference beetween the aformentioned rupture pressures was positively correlated with rupture pressure of intact arterial segments ( R2 = 0.88; p < 0.001).

Conclusions

The obtained experimental results indicate a leading role of adventitia in building arterial strength under supraphysiological pressure conditions. The greater the rupture pressure of complete cerebral arteries, the smaller the contribution of adventitia in overall wall resistance.
Management of acute central retinal artery occlusion: Intravenous thrombolysis is feasible and safe
Authors: Préterre Cécile , Godeneche Gaelle , Vandamme Xavier , Ronzière Thomas , Lamy Matthias , Breuilly Christophe , Urbanczyk Cédric , Wolff Valérie , Lebranchu Pierre , Sevin-Allouet Mathieu , Guillon Benoit
Published: January 2017

Background

Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units.

Methods

We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion. The feasibility was assessed by the ratio of patients that had received intravenous alteplase within 6 h after central retinal artery occlusion onset among those who had been admitted to the same hospital for acute central retinal artery occlusion. All adverse events were documented.

Results

Thirty patients were included. Visual acuity before treatment was limited to “hand motion”, or worse, in 90% of the cases. The mean onset-to-needle time was 273 min. The individuals treated with intravenous alteplase for central retinal artery occlusion represented 10.2% of all of the patients hospitalized for central retinal artery occlusion in 2013 and 2014. We observed one occurrence of major bleeding, a symptomatic intracerebral hemorrhage.

Conclusion

When applied early on, intravenous thrombolysis appears to be feasible and safe, provided that contraindications are given due consideration. Whether intravenous thrombolysis is more effective than conservative therapy remains to be determined. In order to conduct a well-designed prospective randomized control trial, an organized network should be in place.
Survival analysis using primary care electronic health record data: A systematic review of the literature
Authors: Hodgkins Adam Jose , Bonney Andrew , Mullan Judy , Mayne Darren John , Barnett Stephen
Published: January 2017

Purpose:

An emerging body of research involves observational studies in which survival analysis is applied to data obtained from primary care electronic health records (EHRs). This systematic review of these studies examined the utility of using this approach.

Method:

An electronic literature search of the Scopus, PubMed, Web of Science, CINAHL, and Cochrane databases was conducted. Search terms and exclusion criteria were chosen to select studies where survival analysis was applied to the data extracted wholly from EHRs used in primary care medical practice.

Results:

A total of 46 studies that met the inclusion criteria for the systematic review were examined. All were published within the past decade (2005–2014) with a majority ( n = 26, 57%) being published between 2012 and 2014. Even though citation rates varied from nil to 628, over half ( n = 27, 59%) of the studies were cited 10 times or more. The median number of subjects was 18,042 with five studies including over 1,000,000 patients. Of the included studies, 35 (76%) were published in specialty journals and 11 (24%) in general medical journals. The many conditions studied largely corresponded well with conditions important to general practice.

Conclusion:

Survival analysis applied to primary care electronic medical data is a research approach that has been frequently used in recent times. The utility of this approach was demonstrated by the ability to produce research with large numbers of subjects, across a wide range of conditions and with the potential of a high impact. Importantly, primary care data were thus available to inform primary care practice.
Hypoglycemia and Clinical Outcomes in Hospitalized Patients With Diabetes: Does Association With Adverse Outcomes Remain When Number of Glucose Tests Performed Is Accounted For?
Authors: Jones Gregory C. , Timmons Joseph G. , Cunningham Scott G. , Cleland Stephen J. , Sainsbury Christopher A. R.
Published: January 2017

Background:

Hypoglycemia is associated with increased length of stay in hospital patients, but previous studies have not considered the confounding effect of increased hypoglycemia detection associated with increased capillary blood glucose (CBG) measurement in prolonged admissions. We aimed to determine the effect of recorded hypoglycemia on length of stay of hospital inpatients (LOS) when this mathematical association is subtracted.

Methods:

CBG data were analyzed for inpatients within our health board area (01/2009-01/2015). A simulated CBG data set was generated for each patient with an identical sampling frequency to the measured CBG data set. The mathematical component of increased LOS was determined using the simulated data set. Subtraction of this confounding mathematical association was used to provide measurement of the true clinical association between recorded hypoglycemia (CBG < 4 mmol [< 72mg/dl]) and LOS.

Results:

A total of 196 962 admissions of 52 475 individuals with known diabetes were analyzed. 68 809 admissions of 29 551 individuals had >4 CBG measurements made and were included in analysis. After subtraction of the mathematical association of increased sample number, the clinical effect of recorded hypoglycemia is reduced—but persists—compared to previous studies. 1-2 days with recorded hypoglycemia has a relatively minor effect on LOS. LOS increases rapidly if there are ≥3 days with recorded hypoglycemia, with an increase of 0.75 days LOS per additional day with hypoglycemia.

Conclusions:

This technique increases accuracy of economic modeling of the impact of hypoglycemia on health care systems. This could assist study of the impact of hypoglycemia on other outcomes by factoring for bias of increased sample numbers.
Patients’ Preferences for Insulin Injection Devices
Authors: Pfützner Andreas
Published: January 2017

In this issue, Pohlmeier et al report on a device assessment study in insulin-naïve patients with type 2 diabetes, to investigate the ease of use/learning and patient preference of the new prefilled U300 insulin glargine injection pen. Human factor studies are required by regulatory agencies and should ensure the proper use of the device in the context of the provided instructions. The patients found the device easy to learn/use and had a stable treatment satisfaction despite introduction of injection treatment. The lack of a control arm, the short duration, and the small sample size make it difficult to translate these results into clinical practice. It is encouraging to know, however, that the new pen is accepted by one of the intended patient populations.
Inside the Rating Scores: A Multilevel Analysis of the Factors Influencing Customer Satisfaction in the Hotel Industry
Authors: Radojevic Tijana , Stanisic Nemanja , Stanic Nenad
Published: January 2017

In this study, we conducted a multilevel analysis of factors affecting customer satisfaction in the global hotel industry. The survey data collected from TripAdvisor.com included customer reviews relating to 13,410 hotels located in 80 major global urban tourism destinations. We examined multiple relevant factors at each of the following five levels of analysis: (a) service encounter, (b) visitor, (c) visitor’s nationality, (d) hotel, and (e) destination. The results show that hotel attributes and the personal characteristics of visitors most powerfully influence customer satisfaction. However, the purpose of the trip, the characteristics of the destination, and the visitor’s nationality are also found to play an important role in hotel evaluation. By integrating multiple levels of analysis into a single statistical model, multilevel modeling framework enables researchers and professionals to see the “big picture” of factors affecting customer satisfaction in the contemporary hotel industry.
Engaging patients as partners in research: Factors associated with awareness, interest, and engagement as research partners
Authors: Hearld Kristine R , Hearld Larry R , Hall Allyson G
Published: January 2017

Objectives:

There is growing interest in engaging patients in healthcare research, which raises important questions about the factors that may promote such engagement. The purpose of this study was to examine the association between patient characteristics and three aspects of patient engagement in the medical research process: awareness, interest, and actual participation.

Methods:

Cross-sectional, bivariate analyses were employed using the 2014 Health Information National Trends Survey.

Results:

Analyses suggest modest levels of interest among respondents engaging as patient partners in the research process (37.7% of respondents), low level of awareness of what patient engagement in research was (15.3% of respondents), and a very low level of actual participation (2.7% of respondents). Respondents of higher socioeconomic status and with more positive patient attitudes regarding their health and healthcare were more likely to be interested in research. In comparison, relatively few patient characteristics were significantly associated with patient awareness and actual participation in research.

Conclusion:

Although it is promising that people are interested in being engaged in research, the results suggest that there is work to be done to raise awareness of these engagement opportunities. Likewise, the gap between awareness and participation highlights opportunities to identify why patients may be reluctant to participate even when they are aware of research opportunities.
Education for Sustainable Development in Higher Education Institutions
Authors: Tapia-Fonllem César , Fraijo-Sing Blanca , Corral-Verdugo Víctor , Ortiz Valdez Anais
Published: January 2017

The role that higher education plays in the promotion of sustainable development outstands in the declarations on Education for Sustainable Development (ESD), besides being a research priority in higher education. However, few studies exist that evaluate sustainable lifestyles among university students. The aim of this study was to analyze the mission and vision, processes and actions undertaken to promote sustainability in higher education institutions, and to compare the pro-sustainability orientation (PSO) reported by 360 students coursing first or last semesters at college. The study was intended to evaluate the influence that four higher education institutions in Sonora, Mexico, have on students’ PSO. Results of the study indicate that a coherent PSO factor emerges from the interrelations among pro-environmental dispositional and behavioral variables reported by students. However, university programs and actions do not produce statistically significant differences between freshmen and senior students. Possible reasons explaining the lack of positive influence of those universities on students’ PSO are discussed.
A Space Apart
Authors: Lynch Lisa
Published: January 2017

This article examines how the preschool child is enabled to withdraw from the peer group and create a private, individual space within the institutional collective. The question under consideration is, “What factors are necessary to enable a child to create and maintain a withdrawal space in the preschool?” Data were collected through ethnographic fieldwork at two Montessori schools in the south of Sweden. Analysis of the results reveals that a child is enabled through a combination of two elements: a level of opportunity to create a space and a level of defense of a created space. These two factors are dependent on the teachers’ ability to correctly identify space creation, alongside their desire for the child’s space creation effort to be successful.
Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child
Authors: Basheer Nuha , Mneimneh Sirin , Rajab Mariam
Published: January 2017

Rhabdomyolysis is an acute life-threatening condition that can occur in childhood secondary to many causes. The authors report the case of a 3-year-old male child who presented with acute rhabdomyolysis. The peak plasma creatine kinase level was extremely high. The 2 main causes of rhabdomyolysis in childhood are viral myositis and trauma, which can sometimes lead to acute renal failure. The highest creatine kinase levels reported in the literature so far was a 6-digit level in 2014 case report. In this study, the authors report the case of a 7-digit creatine kinase level in a child secondary to viral myositis who did not require renal dialysis.
Who Works Here? Contingent Labor, Nonfamily Labor, and Immigrant Labor on U.S. Dairy Farms
Authors: Schewe Rebecca L. , White Bernadette
Published: January 2017

Using a survey of dairy farmers in Michigan, Pennsylvania, and Florida, this study examines labor patterns on U.S. dairy farms by analyzing employment of nonfamily and immigrant labor, as well as labor precarity and contingency. We build upon and connect two divergent theoretical frames: first, the contradictory class location of family farmers, and second, the neoliberal rise of precarious and contingent labor. We move beyond the family/nonfamily farm binary often found in examinations of the class location of family farmers, including the interplay of family and nonfamily labor, demonstrating that farm size is an equally important component of labor relations to farm ownership structure. Farms’ labor relations more accurately exist on a continuum between “family” and “industrial” that reflects both ownership structure and farm size. Extending the study of precarious and contingent labor into the agricultural sector, we suggest that high rates of overtime work may be a unique form of labor precarity in agriculture, not just part-time work. Scholars must acknowledge that labor precarity and contingency may take different forms across diverse sectors.
The Home Rule Advantage: Motives and Outcomes of Local Anti-fracking Mobilization
Authors: Buday Amanda
Published: January 2017

The professionalization of environmental advocacy in the United States has pushed grassroots environmental activists to the margins of federal and state policy arenas. Frequently, individuals or communities who will be directly affected by environmental policy decisions are excluded from participating in policy discussions. Unable to compete with professionalized, national environmental organizations for legislative influence, informal, grassroots environmentalists are compelled to test out new models of organizing that leverage political power outside of institutionally sanctioned venues. This article examines the motives and outcomes of a grassroots social movement to prohibit unconventional shale development (“fracking”) through exercising home rule authorities in rural Southern Illinois. In Illinois, grassroots anti-fracking activists initially collaborated with a statewide coalition of environmental organizations lobbying for a moratorium on fracking in the state. I examine how conflict between coalition partners pushed grassroots anti-fracking activists to adopt new, localized models of organizing to achieve their policy goals. In these local efforts, I find that the same structural features of grassroots groups that enable strategic innovation also prevent the dispersion of authority in informal groups, ultimately undermining their creative capacity.
Lysophosphatidic acid converts monocytes into macrophages in both mice and humans
Authors: Ray Rashmi , Rai Vivek
Published: January 2017

Key Points

LPA converts monocytes into macrophages. LPA mediates macrophage formation via Akt/mTor pathway; PPARγ is a master regulator of LPA-derived macrophages.
Long non-coding RNA TUG1 is involved in cell growth and chemoresistance of small cell lung cancer by regulating LIMK2b via EZH2
Authors: Niu Yuchun , Ma Feng , Huang Weimei , Fang Shun , Li Man , Wei Ting , Guo Linlang
Published: January 2017

Background

Taurine upregulated gene1 (TUG1) as a 7.1-kb lncRNA, has been shown to play an oncogenic role in various cancers. However, the biological functions of lncRNA TUG1 in small cell lung cancer (SCLC) remain unknown. The aim of this study is to explore the roles of TUG1 in cell growth and chemoresistance of SCLC and its possible molecular mechanism.

Methods

The expression of TUG1 in thirty-three cases of SCLC tissues and SCLC cell line were examined by quantitative RT-PCR (qRT-PCR). The functional roles of TUG1 in SCLC were demonstrated by CCK8 assay, colony formation assay, wound healing assay and transwell assay, flow cytometry analysis and in vivo study through siRNA or shRNA mediated knockdown. Western blot assays were used to evaluate gene and protein expression in cell lines. Chromatin immunoprecipitation (ChIP) and RNA binding protein immunoprecipitation (RIP) were performed to confirm the molecular mechanism of TUG1 involved in cell growth and chemoresistance of small cell lung cancer.

Results

We found that TUG1 was overexpressed in SCLC tissues, and its expression was correlated with the clinical stage and the shorter survival time of SCLC patients. Moreover, downregulation of TUG1 expression could impair cell proliferation and increased cell sensitivity to anticancer drugs both in vitro and in vivo. We also discovered that TUG1 knockdown significantly promoted cell apoptosis and cell cycle arrest, and inhibited cell migration and invasion in vitro . We further demonstrated that TUG1 can regulate the expression of LIMK2b (a splice variant of LIM-kinase 2) via binding with enhancer of zeste homolog 2 (EZH2), and then promoted cell growth and chemoresistance of SCLC.

Conclusions

Together, these results suggested that TUG1 mediates cell growth and chemoresistance of SCLC by regulating LIMK2b via EZH2.
Activity-based Twitter sampling for content-based and user-centric prediction models
Authors: Aghababaei Somayyeh , Makrehchi Masoud
Published: January 2017

Increasingly more applications rely on crowd-sourced data from social media. Some of these applications are concerned with real-time data streams, while others are more focused on acquiring temporal footprints from historical data. Nevertheless, determining the subset of “credible” users is crucial. While the majority of sampling approaches focus on individual static networks, dynamic user activity over time is usually not considered, which may result in activity gaps in the collected data. Models based on noisy and missing data can significantly degrade in performance. In this study, we demonstrate how to sample Twitter users in order to produce more credible data for temporal prediction models. We present an activity-based sampling approach where users are selected based on their historical activities in Twitter. The predictability of the collected content from activity-based and random sampling is compared in a content-based and user-centric temporal model. The results indicate the importance of an activity-oriented sampling method for the acquisition of more credible content for temporal models.
Broad AOX expression in a genetically tractable mouse model does not disturb normal physiology
Authors: Szibor Marten , Dhandapani Praveen K. , Dufour Eric , Holmström Kira M. , Zhuang Yuan , Salwig Isabelle , Wittig Ilka , Heidler Juliana , Gizatullina Zemfira , Gainutdinov Timur , Consortium German Mouse Clinic , Fuchs Helmut , Gailus-Durner Valérie , de Angelis Martin Hrabě , Nandania Jatin , Velagapudi Vidya , Wietelmann Astrid , Rustin Pierre , Gellerich Frank N. , Jacobs Howard T. , Braun Thomas
Published: January 2017

Plants and many lower organisms, but not mammals, express alternative oxidases (AOX) that branch the mitochondrial respiratory chain, transferring electrons directly from ubiquinol to oxygen without proton pumping. Thus, they maintain electron flow under conditions when the classical respiratory chain is impaired, limiting excess production of oxygen radicals and supporting redox and metabolic homeostasis. AOX from Ciona intestinalis has been used to study and mitigate mitochondrial impairments in mammalian cell-lines, Drosophila disease models and, most recently, in the mouse, where multiple, lentivector-AOX transgenes conferred substantial expression in specific tissues. Here we describe a genetically tractable mouse model in which Ciona AOX has been targeted to the Rosa26 locus for ubiquitous expression. The AOXRosa26 mouse exhibited only subtle phenotypic effects on respiratory complex formation, oxygen consumption or the global metabolome, and showed an essentially normal physiology. AOX conferred robust resistance to inhibitors of the respiratory chain in organello, whilst animals exposed to a systemically applied LD50 dose of cyanide did not succumb. The AOXRosa26 mouse is a useful tool to investigate respiratory control mechanisms and to decipher mitochondrial disease aetiology in vivo.
Genetic polymorphisms in the serotonin receptor 7 (HTR7) gene are associated with cortisol levels in African American young adults
Authors: Swanson Grace , Miller Stephanie , Alyahyawi Areej , Wilson Bradford , Saadatmand Forough , Lee Clarence , Dunston Georgia , Abbas Muneer
Published: January 2017

Introduction: Serotonin is a neurohormone involved in biological processes, such as behavior and immune function. Chronic psychosocial stressors may cause serotonin release resulting in immune system dysregulation, as evidenced by increased or far decreased levels of cortisol, a blood biomarker of stress and immune function. We hypothesize that genetic polymorphisms in the HTR7 gene are associated with both hypo- and hyper-cortisolism. Methods: The study population included 602 African American subjects between 18-34 years of age, living in Washington, D.C. Five single nucleotide polymorphisms (SNPs) in HTR7, rs2420367, rs12412496, rs2185706, rs7089533, and rs7093602 were genotyped by restriction fragment length polymorphism or the TaqMan assay. Statistical analysis, using the program SNPstat, was performed to determine their associations with cortisol measured in the study population. Results: While an increased risk of hypocortisolism was found to be associated with rs2420367, rs2185706, and rs7093602 in a gender specific manner, no genotypes could be associated with hypercortisolism. Inversely, a decreased risk of hypocortisolism was found with the haplotype CGGCC (p=0.033), which remained significant in males. When adjusting for gender, females associated with the haplotype AGACC. Hypercortisolism was also associated with a decreased risk for the haplotypes AAACC (p=0.042) and AAGTT (p=0.001). Discussion: Based on these results, genetic variation in the HTR7 gene may contribute to both stress and inflammation, and will provide a new glimpse into stress-related inflammation psychophysiology.
Conservation of gene essentiality in Apicomplexa and its application for prioritization of anti-malarial drug targets
Authors: Singh Gajinder Pal
Published: January 2017

New anti-malarial drugs are needed to address the challenge of artemisinin resistance and to achieve malaria elimination and eradication. Target-based screening of inhibitors is a major approach for drug discovery, but its application to malaria has been limited by the availability of few validated drug targets in Plasmodium. Here we utilize the recently available large-scale gene essentiality data in Plasmodium berghei and a related apicomplexan pathogen, Toxoplasma gondii, to identify potential anti-malarial drug targets. We find significant conservation of gene essentiality in the two apicomplexan parasites. The conservation of essentiality could be used to prioritize enzymes that are essential across the two parasites and show no or low sequence similarity to human proteins. Novel essential genes in Plasmodium could be predicted based on their essentiality in T. gondii. Essential genes in Plasmodium showed higher expression, evolutionary conservation and association with specific functional classes. We expect that the availability of a large number of novel potential drug targets would significantly accelerate anti-malarial drug discovery.
Necrotizing Soft Tissue Infection
Authors: Witt Chance , Dissanaike Sharmila
Published: January 2017

This image showed the picture of a very heavy woman who initially had an NSTI of the right leg which was extensively debrided and skin grafted and healed well, then presented 2 months later with a new NSTI of the left leg.
Mild Traumatic Brain Injury
Authors: Phy Michael
Published: January 2017

-
The Supreme Court Decision on Obama Care Part 1
Authors: Berdine Gilbert
Published: January 2017

-
Skin Metastasis in a patient with Small-Cell Lung Cancer
Authors: Ussavarungsi Kamonpun , Kim Minji , Tijani Lukman
Published: January 2017

A 64-year-old woman presented with abdominal pain and back pain. Physical examinationrevealed a subcutaneous nodule in the anterior abdominal wall. An ultrasoundguidedbiopsy revealed small cell lung carcinoma (SCLC), and additional workuprevealed extensive stage small cell lung carcinoma with involvement of the left lung andthe abdominal viscera. The patient underwent chemotherapy with a good initial response.Lung carcinoma infrequently metastasizes to the skin. However, these lesions,when present, have important prognostic implications since these patients typicallyrespond poorly to chemotherapy and have a mean survival of about five months. Carefulskin evaluation is essential in the evaluation of patients with possible bronchogeniccarcinoma.
Sulfa Allergy and Therapeutic Decisions
Authors: Fuhrmann Kristen K , Dumrongmongcolgul Nat
Published: January 2017

-
Kartagener's syndrome
Authors: Berdine Gilbert
Published: January 2017

-
Imaging in Haboob Lung Syndrome
Authors: Panikkath Ragesh , Mulkey Zachary , Jumper Cynthia
Published: January 2017

-
Double Jeopardy : Acute myocardial infarction complicated by cardiogenic shock and contrast mediated anaphylactoid reaction
Authors: Nguyen Ha-uyen Thi , Civitello Andrew B , Cevik Cihan , Simpson Leo
Published: January 2017

A 63 year-old woman who developed a severe anaphylactoidreaction to iodinated contrast in the setting of emergent percutaneous intervention(PCI) for a large anterior wall ST elevation myocardial infarction (STEMI) resulting incardiogenic shock followed by cardiopulmonary arrest necessitating placement of the patient on the arterio-venous extra corporeal membrane oxygenation (ECMO). While anaphylactoid/anaphylactic reactions to radiocontrast agents have been well documentedin literature, the development of an anaphylactoid reaction secondary to radiocontrastmedia in the setting of an ST elevation myocardial infarction (STEMI) and resultingin cardiogenic shock has never been reported. We discuss naphylactoidreactions to contrast media occurs by non-immunologic (i.e. non IgE ) mechanisms. Premedication does not abate or prevent all types of iodinated contrastmediated reactions. However, studies have shown that premedication is effective fora cutaneous reaction to iodinated contrast media (ICM). Due to the relative excellentsafety profiles of the premedication, physicians should continue to use them prior to asuspected ICM reaction.
Tracheal Stenosis
Authors: Perez Colbert , Paone Ralph , Alalawi Raed
Published: January 2017

-
Acute Kidney Injury and Rhabdomyolysis as an Initial Presentation of Hashimoto’s Thyroiditis
Authors: Swaminath Deephak , Limsuwat Chok , Islam Ebtesam
Published: January 2017

The myopathy associated with hypothyroidism is usually mild and causes myalgia,stiffness, fatigability, and muscle weakness. Severe forms of myopathy, such as rhabdomyolysiswith acute kidney injury (AKI), have rarely been reported in hypothyroidpatients. We describe a young patient who presented with generalized body aches,cramps, and abdominal pain with vomiting after physical exercise. His laboratory studiesdemonstrated that he had rhabdomyolysis and AKI secondary to hypothyroidism;both resolved with thyroid hormone replacement. Hypothyroidism should be consideredin the differential diagnosis of rhabdomyolysis when common causes are excluded.
The Supreme Court Decision on Obama Care part II
Authors: Berdine Gilbert
Published: January 2017

-
Bullous Lung disease
Authors: Berdine Gilbert , Nantsupawat Nopakoon
Published: January 2017

-
Sweet Seizures – Epilepsia Partialis Continua
Authors: Panikkath Ragesh , Lado Joaquin Abeal
Published: January 2017

Epilepsia partialis continua (EPC) refers to focal and recurrent seizures that happenevery few seconds to minutes for extended periods of time. The most common causesof these seizures are stroke, Rasmussen’s encephalitis (in children), and viral encephalitis.Metabolic disorders, like hyperglycemic hyperosmolar state (HHS), infrequentlycause EPC. Correction of the HHS stops the EPC and eliminates the need for antiepilepticdrugs. Synaptic transmission in the central nervous system requires normal glucoseconcentrations. Hyperglycemia can lower the seizure threshold, and this possiblyexplains the development of seizures in patients with HHS.
The role of telomere shortening in the development and progression of COPD
Authors: Amiri Hoda Mojazi , Cooper Jason P , Nugent Kenneth
Published: January 2017

The prevalence and incidence of COPD increase with age in all populations studied. These associations suggest that normal aging could contribute to the pathogenesis of COPD. Telomeres are DNA structures at the end of chromosomes which protect DNA from degradation and unneeded recombination events. Telomere length decreases with age. At a critical length cells undergo senescence which results in changes in cell morphology, gene activity, and cytokine production. Senescent cells eventually undergo programmed cell death (apoptosis) and drop out of tissue structures. Telomeres from lung tissue and circulating leukocytes are shorter in patients with COPD. Lung biopsy specimens indicate that patients with COPD have increased numbers of apoptotic epithelial and endothelial cells. This information suggests that normal aging or accelerated aging or senescence induced by oxidant injury and/or inflammation contributes to the development of COPD. Longitudinal studies suggest that patients with shorter telomere have increased all cause and cancer mortality. Therefore, telomere attrition is associated with important consequences in these patients. In addition, animal studies suggest that patients with shorter telomeres are at increased risk of developing COPD. These observations raise the possibility that drugs designed to increase telomere length or to prevent telomere attrition might slow the progression of COPD. However, very careful studies with animal models of COPD and of malignancy are needed to determine benefits and to make certain that this genetic manipulation does not increase the risk of malignancy.
Aeromonas veronii septicemia in an immunocompetent patient
Authors: McKenzie Paula , Sotello David , Hailemariam Yared , Desai Vipul , Temple Brian
Published: January 2017

We present a 29-year-old healthy man who fell into an industrial auger, sustaining acrushed, open pelvic injury, multiple comminuted fractures of the right leg, and traumaticamputation of his left foot. Blood and wound cultures were positive for Aeromonasspp and vancomycin resistant Enterococcus. Treatment included cefepime, levofloxacin,daptomycin, and metronidazole. Aeromonas veronii is a Gram negative bacillus usuallyfound in fresh and brackish water in warm climates. It can cause severe skin andsoft tissue infections, typically after injured tissue is exposed to contaminated water.Aeromonas septicemia is uncommon and is usually associated with underlying diseases,such as malignancy, cirrhosis, diabetes, or immunosuppression. It rarely occurs in ahealthy host.
Azygos vein cannulation: recognition is vital for preventing complications
Authors: Panikkath Ragesh , Lim Sian Yik , Panikkath Deepa
Published: January 2017

Inadvertent cannulation of the azygos vein can occur during central vein cannulations,especially from the left side. This can cause several complications, including rupture ofthe azygos vein. This complication is unlikely from the more commonly used right internaljugular vein access, although that approach is not free of complications. An abruptcurve at the tip of the central venous catheter showing venous wave forms and highoxygen saturations suggest azygos vein cannulation. Azygos vein cannulations may bemore common in patients with heart failure in which the vein is dilated.
Ceftaroline in the treatment of methicillin-resistant and daptomycin-non-susceptible Staphylococcus aureus bacteremia and infective endocarditis in end-stage renal disease
Authors: Fuhrmann Kristen , Winn Richard , McKenzie Paula , Bashir Mamoun
Published: January 2017

As bacteria evolve and become resistant to preferred antibiotics, we often have toresort to alternative, second-line agents for treatment. This case highlights a growingtrend being observed among methicillin-resistant Staphylococcus aureus (MRSA)isolates, in which the minimum inhibitory concentration breakpoints start to increaseand traditional therapy fails. When clinicians are faced with a difficult to treat infectionand constrained by declining renal function, drug allergies, or clinical scenario, it maybe prudent to use therapy that is supported by only in vitro data, animal models, andstrong case reports. Combining knowledge of the drug’s kinetic properties, mechanismof action, safety, and adverse effect profile, and literature to support its use helpedguide our decision in treating a patient with persistent MRSA bacteremia and infectiveendocarditis.
Exercise duration during pulmonary rehabilitation: an index of efficacy
Authors: Amiri Hoda Mojazi , McClellan Ryan , Limsuwat Chok , Nugent Kenneth
Published: January 2017

Background: The optimal program for pulmonary rehabilitation likely varies from patient to patient and depends on individual limiting factors. We wanted to determine the typical exercise duration in our patients to use as a basis for modifying individual rehabilitation components. Methods: We retrospectively reviewed the medical records of patients who completed the pulmonary rehabilitation program at University Medical Center in Lubbock, TX. We collected demographic, pulmonary function, and 6-minute walk test information. Patients exercised with treadmills, arm ergometers, recumbent stair steppers, and recumbent bicycles; we recorded the initial and follow-up modality duration at four week intervals. Results: This study included 119 patients with a mean age of 68.8 ± 10.1 years. Most patients (95) had COPD. The mean FEV1 was 1.3 ± 0.7 L 9 (47.2 ± 19.7 % predicted). The baseline gait speed was 41 ± 15 meters per minute. The initial total exercise duration was 30.5 ± 7.0 minutes. These times increased to 41.2 ± 8.8, 44.6 ± 10.7 and 47.0 ± 12.0 minutes at 4, 8 and 12 weeks of rehabilitation. Conclusions: Most patients increased their total exercise duration to 40 minutes. This goal can identify patients who are not making progress and need alternative strategies and patients who have made good progress and might benefit from additional training, such as lower extremity strength exercises.
Contamination of Unused, Nonsterile Gloves in the Critical Care Setting: A Comparison of Bacterial Glove Contamination in Medical, Surgical and Burn Intensive Care Units
Authors: Hall Matthew , Trivedi Urvish , Rumbaugh Kendra , Dissanaike Sharmila
Published: January 2017

Objective: To assess the rate and burden of bacterial contamination on unused, nonsterile gloves found in glove boxes in three different specialty intensive care units (ICUs).Design: Descriptive, cross-sectional studySetting: A burn, trauma/surgical, and medical ICU in a 412-bed tertiary care hospital.Subjects: Convenience sample of 90 non-sterile vinyl exam glove pairsMethods: Thirty occupied rooms in each ICU were utilized for collection of glove pair samples. Gloves from opened glove boxes placed in wall-mounted racks for use by healthcare staff were donned by one investigator in a routine, aseptic fashion. The surfaces of both gloves were swabbed, plated onto a contact agar plate and incubated for 48 hours. Resulting colony forming units (CFUs) were counted and recorded for each glove pair sample.Results: Bacterial contaminants were cultured from 73 of 90 (81.1%) glove pairs sampled across all ICUs. Contamination rates of glove samples from the BICU, SICU and MICU were 66.7%, 86.7% and 90.0% respectively. The differences in contamination rate among units was statistically significant (p=0.044). The average contamination burden was 5.83 CFU per glove pair and was not significantly different among units.Conclusions: Despite differences in infection control practices and the composition of pathologies managed in each ICU, the average bioburden of gloves left exposed in the environment was not significantly different. Further research is needed to assess for an association of glove bioburden with nosocomial infection rates and the effects of different infection control practices on the reduction of glove bioburdens.
Miliary Tuberculosis in a Healthy Adult
Authors: Denega Tatiana , Griffith David
Published: January 2017

Miliary tuberculosis (TB) is a consequence of mycobacterial dissemination. In theearly stages it can be a challenging diagnosis due to the systemic but non-specificsymptoms and subtle and gradual imaging changes. The dissemination of wall componentsof Mycobacterium tuberculosis can induce a severe inflammatory response withgeneralized endothelial cell damage, leading to fatal complications, such as disseminatedintravascular coagulation (DIC) and acute respiratory distress syndrome (ARDS).We report a 34-year-old woman with no known medical disorders. She was diagnosedwith miliary TB at the late stage of infection which presented with a fulminant clinicalcourse, including DIC and multi-organ failure. The autopsy revealed multiple foci ofinfection in the kidneys, spleen, meninges, lungs, and vertebral bodies. Disseminationof TB to extrapulmonary organs is a diagnostic challenge when the onset precedes pulmonarysymptoms, thereby eluding clinical suspicion and a rapid diagnosis. The durationfrom the onset of symptoms and laboratory abnormalities can be key predictors forthe development of late stage complications. The poor prognosis of military TB canbe mitigated by the early detection and rapid initiation of appropriate antituberculousmedications.
Mediastinal mass: an unusual presentation of coccidioidomycosis
Authors: Umer Imran , Ahmed Yasir
Published: January 2017

Coccidioidomycosis is an endemic fungal disease, found mainly in the southwesternUnited States, northwestern Mexico, and some areas of Brazil and Argentina. Clinicalmanifestations vary depending upon both the extent of infection and the immune statusof the host. Pneumonia is the most common clinical presentation, and it rarely involvesthe central nervous system, skin, and bones. Patients with coccidioidomycosis usuallyrespond well to therapy if diagnosed and treated promptly. Here we report a rare caseof coccidioidomycosis infection in an immunocompromised host who presented with amediastinal mass.
The Diagnosis of Acute Pulmonary Embolism
Authors: Islam Ebtesam , Test Victor J.
Published: January 2017

This paper reviews the most current literature on the diagnosis of pulmonary thromboembolism.  The epidemiology and symptomology of this disorder, including common symptoms such as fever, chest pain, dyspnea, edema, and syncope, are reviewed.  The utility of basic and easily available testing, such as electrocardiography and chest radiography, is evaluated. The literature on determining the pretest probability of venous thromboembolism with scoring systems, such as the Wells Score, the Geneva Scoring System, and the Pulmonary Embolism Rule Out Criteria, is appraised.  As the evaluation of pulmonary embolism has evolved, multiple imaging techniques has been developed and studied.  Ultrasonography, computed tomography with angiography, magnetic resonance angiography, ventilation perfusion lung scanning, and SPECT ventilation-perfusion lung imaging are discussed.  In conclusion, the diagnosis of pulmonary embolism remains complicated.  Clinical suspicion and stratification should guide a diagnostic strategy for the comprehensive evaluation and diagnosis of patients with this disorder.
Amiodarone pulmonary toxicity: a report on two cases
Authors: Zedan Ahmed , Mukarram Osama , Burns Charles E. , Ahmed Yasir
Published: January 2017

Amiodarone is an iodine-containing antiarrhythmic drug commonly used for the treatment of ventricular and supraventricular arrhythmias. Amiodarone toxicity has several clinical presentations and affects multiple organs. One well-known serious side effect of amiodarone is pulmonary toxicity which can be acute, sub-acute, or chronic. Amiodarone pulmonary toxicity may present a diagnostic dilemma, particularly when clinical suspicion of pulmonary infection is high. Here we report two cases of amiodarone lung toxicity that were diagnosed in an early stage and improved after the discontinuation of amiodarone.
Nutrition in the intensive care unit
Authors: Hansen Chase C. , Dissanaike Sharmila
Published: January 2017

Nutrition has evolved into an integral part of modern critical care for both medical and surgical patients. Multiple international societies now issue evidence-based guidelines to help clinician optimize their patients’ Nutrition. However, adherence to these guidelines throughout the country is poor, and education in nutrition is still lagging in medical school.  The authors also highlight four key areas where evidence-based recommendations exist – timing of initiation of enteral feeding, calculating and meeting total daily requirements, use of gastric residual volumes to guide delivery, and interuption of feeding for procedures – but are currently often not followed.  Reasons for this lack of adherence are explored, and potential solutions discussed.
Vancomycin-induced Severe asymptomatic Immune Thrombocytopenia; a rare cause
Authors: Ahmed Yasir , Sartin Christopher , Umer Imran , Mukarram Osama , Borra Renuka
Published: January 2017

Drug-induced immune thrombocytopenia is a challenging clinical problem that is often overlooked. Vancomycin is a rare cause of immune-mediated thrombocytopenia that can cause severe life-threatening bleeding in an acutely ill patient. The diagnosis requires a temporal relationship with the drug, exclusion of other common causes, and testing for vancomycin-induced platelet antibodies. Here we present a rare case of very severe but asymptomatic vancomycin-induced immune thrombocytopenia that resolved after discontinuation of vancomycin.
Shortness of breath caused by a tracheal web
Authors: Jafar Nagham , Islam Ebtesam , Alalawi Raed
Published: January 2017

Tracheal webs are rare anomalies that can be either congenital or acquired due to prolonged or traumatic endotracheal intubation. Patients with tracheal webs present with shortness of breath especially during exertion, stridor, and recurrent chest infections. They are often misdiagnosed and treated as bronchial asthma with only minimal relief of symptoms with bronchodilators. This condition can also present as a cause of difficult endotracheal intubations. CT scans of the chest can be used to screen for airway anomalies; bronchoscopy is both diagnostic and therapeutic. Here we present a 34-year-old woman with a tracheal web who had been on treatment for refractory asthma for many years with only partial relief of her symptoms.
Successful treatment of post-intubation tracheal stenosis with balloon dilation, argon plasma coagulation, electrocautery and application of mitomycin C
Authors: Fuller Audra , Sigler Mark , Kambali Shrinivas , Alalawi Raed
Published: January 2017

Tracheal stenosis is an uncommon but known complication of endotracheal intubation and tracheostomy. Surgery is currently the definitive treatment for tracheal stenosis but carries a significantly higher risk for adverse events as it often involves complex procedures.  Here we present our experience using topical application of mitomycin C, along with various bronchoscopic interventions, as a treatment for tracheal stenosis. The patients in our series developed tracheal stenosis post-intubation or post-tracheostomy. Each patient in our series underwent the same basic procedures involving rigid bronchoscopy and balloon dilation, ablation of granulation tissue with cryotherapy and argon plasma coagulation, and finally application of topical mitomycin C. Our experience with these four cases shows a good initial success rate with topical mitomycin C application for the treatment of tracheal stenosis. Most patients required a repeat intervention a few weeks later. Our results suggest that success with topical mitomycin C is more likely in post-intubation rather than post-tracheostomy tracheal stenosis. Bronchoscopic therapy and topical application of mitomycin C may work better as a bridge to definitive surgery rather than as a stand-alone therapy.
Writing Effective Paragraphs
Authors: Messuri Kristin
Published: January 2017

Taking a methodical approach to constructing paragraphs can improve clarity and organization in medical writing. This article describes a typical model for paragraph structure, explains the significance of coherence and cohesion, and recommends revision strategies.