Surgical Management of Massive Labial Edema in a Gravid Preeclamptic Diabetic

Background. Massive labial edema is a rare complication during pregnancy that can jeopardize vaginal delivery, as well as leading to maternal and fetal morbidity. It can be related to systemic pathologies, but has been commonly associated with preeclampsia and diabetes. This increased and sometimes longstanding pressure may result in a “labial compartment syndrome� leading to microvascular damage and tissue necrosis if not resolved in a timely fashion. Case. Massive labial edema was treated first conservatively and then surgically in a gravid diabetic patient with severe preeclampsia. Immediately after Cesarean section, the labial compartment syndrome was relieved surgically and resolved rapidly. Conclusion. When conservative attempts at management of labial edema fail, or rapid resolution is critical to maternal and fetal outcome, surgical alternatives should be considered

Locus of Control in Athletic Training

Purpose: Locus of control (LOC) is the level of control an individual feels they have over the outcomes in their life; work locus of control (WLOC) is the control someone feels over their work. Both LOC and WLOC can be internally or externally affected and influence athletic trainers’ ability to change their clinical circumstances. The purpose of this study was to explore athletic trainers’ LOC and WLOC. Method: Cross-sectional web-based survey. Two validated surveys were used to measure locus of control and work locus of control in athletic trainers along with the collection of 8 demographic variables. Results: Of the 213 participants, athletic trainers expressed an external LOC (n=108, 50.7%) in their personal lives while reporting an internal WLOC (n=197, 92.5). Conclusion: Participants demonstrated external LOC and internal WLOC. Future investigations should examine LOC and WLOC with work conditions like burnout and job satisfaction to understand barriers faced in the workplace by athletic trainer

Calf pre-weaning traits and immunoglobulin response to bovine viral diarrhea virus vaccination

Calfhood vaccination for bovine viral diarrhea virus (BVDV) is a relatively new concept, and protocols are evolving. Our objective was to determine effects of BVDV type I vaccination protocol, calf behavior (chute score, and chute exit velocity), and gender on calf gain and immunoglobulin (Ig) response. Crossbred calves (n = 64) were randomly allotted to one of two vaccination protocols. In protocol 1, calves were vaccinated at 60 d of age (d 0) and at weaning (d 147). Calves assigned to protocol 2 were vaccinated against BVDV type I at 21 d prior to (d 126) and at weaning (d 147). Blood samples were collected from half of the calves in each protocol group on d 0 (60 days of age), d 21, d 126 (21 days prior to weaning), and d 147 (at weaning); serum was harvested and Ig titers were determined. Titers for BVDV type I were transformed (log base 2) and analyzed using a mixed model procedure. Calves vaccinated at d 0 and weaning had larger (P \u3c 0.0001) titers than calves vaccinated at d 126 and weaning (7.5 ± 0.36 and 5.1 ± 0.36, respectively). Mean BVDV titers were larger (P \u3c 0.0001) on d 147 when compared with d 126, d 21, and d 0 (8.3 ± 0.39, 5.1 ± 0.40, 5.9 ± 0.39 and 5.7 ± 0.39, respectively). A treatment × day interaction (P \u3c 0.0001) also affected BVDV titers. However, BVDV titers were not affected (P \u3e 0.05) by calf gender, chute score, or chute exit velocity. Weaning weight and pre-weaning average daily gain (ADG) were not related to BVDV type I titers. This study indicated that vaccinating beef calves against BVDV was effective in triggering an Ig response. Furthermore, our results suggest that calves should be vaccinated against BVDV type I at 60 d of age for greater disease resistance

Transcriptional networks specifying homeostatic and inflammatory programs of gene expression in human aortic endothelial cells.

Endothelial cells (ECs) are critical determinants of vascular homeostasis and inflammation, but transcriptional mechanisms specifying their identities and functional states remain poorly understood. Here, we report a genome-wide assessment of regulatory landscapes of primary human aortic endothelial cells (HAECs) under basal and activated conditions, enabling inference of transcription factor networks that direct homeostatic and pro-inflammatory programs. We demonstrate that 43% of detected enhancers are EC-specific and contain SNPs associated to cardiovascular disease and hypertension. We provide evidence that AP1, ETS, and GATA transcription factors play key roles in HAEC transcription by co-binding enhancers associated with EC-specific genes. We further demonstrate that exposure of HAECs to oxidized phospholipids or pro-inflammatory cytokines results in signal-specific alterations in enhancer landscapes and associate with coordinated binding of CEBPD, IRF1, and NFκB. Collectively, these findings identify cis-regulatory elements and corresponding trans-acting factors that contribute to EC identity and their specific responses to pro-inflammatory stimuli

Flight Dynamics Aspects of a Large Civil Tiltrotor Simulation Using Translational Rate Command

An in-depth analysis of a Large Civil Tiltrotor simulation with a Translational Rate Command control law that uses automatic nacelle deflections for longitudinal velocity control and lateral cyclic for lateral velocity control is presented. Results from piloted real-time simulation experiments and offline time and frequency domain analyses are used to investigate the fundamental flight dynamic and control mechanisms of the control law. The baseline Translational Rate Command conferred handling qualities improvements over an attitude command attitude hold control law but in some scenarios there was a tendency to enter PIO. Nacelle actuator rate limiting strongly influenced the PIO tendency and reducing the rate limits degraded the handling qualities further. Counterintuitively, increasing rate limits also led to a worsening of the handling qualities ratings. This led to the identification of a nacelle rate to rotor longitudinal flapping coupling effect that induced undesired pitching motions proportional to the allowable amount of nacelle rate. A modification that applied a counteracting amount of longitudinal cyclic proportional to the nacelle rate significantly improved the handling qualities. The lateral axis of the Translational Rate Command conferred Level 1 handling qualities in a Lateral Reposition maneuver. Analysis of the influence of the modeling fidelity on the lateral flapping angles is presented. It is showed that the linear modeling approximation is likely to have under-predicted the side-force and therefore under-predicted the lateral flapping at velocities above 15 ft/s. However, at lower velocities, and therefore more weakly influenced by the side force modeling, the accelerations that the control law commands also significantly influenced the peak levels of lateral flapping achieved

Molecular Acoustic Angiography: A New Technique for High-resolution Superharmonic Ultrasound Molecular Imaging

Ultrasound molecular imaging utilizes targeted microbubbles to bind to vascular targets such as integrins, selectins, and other extracellular binding domains. After binding, these microbubbles are typically imaged using low pressures and multi-pulse imaging sequences. In this article, we present an alternative approach for molecular imaging using ultrasound which relies on superharmonic signals produced by microbubble contrast agents. Bound bubbles were insonified near resonance using a low frequency (4 MHz) and superharmonic echoes were received at high frequencies (25–30 MHz). While this approach was observed to produce declining image intensity during repeated imaging in both in vitro and in vivo experiments due to bubble destruction, the feasibility of superharmonic molecular imaging was demonstrated for transmit pressures which are sufficiently high to induce shell disruption in bound microbubbles. This approach was validated using microbubbles targeted to the αvβ3 integrin in a rat fibrosarcoma model (n=5), and combined with superharmonic images of free microbubbles to produce high contrast, high resolution 3D volumes of both microvascular anatomy and molecular targeting. Image intensity over repeated scans and the effect of microbubble diameter were also assessed in vivo, indicating that larger microbubbles yield increased persistence in image intensity. Using ultrasound-based acoustic angiography images rather than conventional B-mode ultrasound to provide the underlying anatomical information facilitates anatomical localization of molecular markers. Quantitative analysis of relationships between microvasculature and targeting information indicated that most targeting occurred within 50 µm of a resolvable vessel (>100 µm diameter). The combined information provided by these scans may present new opportunities for analyzing relationships between microvascular anatomy and vascular targets, subject only to limitations of the current mechanically-scanned system and microbubble persistence to repeated imaging at moderate mechanical indices

Physicians’ Knowledge and Beliefs Regarding Athletic Trainers

Purpose: The relationship between athletic trainers (ATs) and physicians is a legal obligation and collaboration to improve patient outcomes. The objective of this study was to examine the knowledge of physicians regarding the educational preparation, legal obligations, and scope of practice for ATs and how it relates to previous experiences with ATs. Additionally physicians’ perceptions of Interprofessional Collaboration (IPC) were studied. Methods: 169 physicians medical doctors (MD)=133/169, 78.7%, doctor of osteopathy (DO)=36/169, 21%) completed a 36-question web-based survey, which included a validated IPC scale. Results: Respondents with experience working with an AT scored significantly higher (P \u3c 0.01) on the knowledge assessment, where physicians currently working with an AT scored higher (5.4/8) than those who previously worked with an AT (4.2/8) and those who had never worked with an AT (3.3/8). Additionally, physicians with previous exposure to an AT as an athlete had significantly higher knowledge scores than those without exposure (P \u3c 0.01). Two areas of weakness in IPC from the physician’s perspective included sharing of important information (2.48/4) and importance of work as compared to others on the team (2.38/4). Conclusions: Physicians who have a current working relationship with an AT and those that had access to an AT as an athlete demonstrated significantly higher knowledge about an AT’s academic preparation, legal obligations, and scope of practice. Moreover, physicians currently working with an AT report positive interprofessional collaborations

An Investigation of Large Tilt-Rotor Hover and Low Speed Handling Qualities

A piloted simulation experiment conducted on the NASA-Ames Vertical Motion Simulator evaluated the hover and low speed handling qualities of a large tilt-rotor concept, with particular emphasis on longitudinal and lateral position control. Ten experimental test pilots evaluated different combinations of Attitude Command-Attitude Hold (ACAH) and Translational Rate Command (TRC) response types, nacelle conversion actuator authority limits and inceptor choices. Pilots performed evaluations in revised versions of the ADS-33 Hover, Lateral Reposition and Depart/Abort MTEs and moderate turbulence conditions. Level 2 handling qualities ratings were primarily recorded using ACAH response type in all three of the evaluation maneuvers. The baseline TRC conferred Level 1 handling qualities in the Hover MTE, but there was a tendency to enter into a PIO associated with nacelle actuator rate limiting when employing large, aggressive control inputs. Interestingly, increasing rate limits also led to a reduction in the handling qualities ratings. This led to the identification of a nacelle rate to rotor longitudinal flapping coupling effect that induced undesired, pitching motions proportional to the allowable amount of nacelle rate. A modification that counteracted this effect significantly improved the handling qualities. Evaluation of the different response type variants showed that inclusion of TRC response could provide Level 1 handling qualities in the Lateral Reposition maneuver by reducing coupled pitch and heave off axis responses that otherwise manifest with ACAH. Finally, evaluations in the Depart/Abort maneuver showed that uncertainty about commanded nacelle position and ensuing aircraft response, when manually controlling the nacelle, demanded high levels of attention from the pilot. Additional requirements to maintain pitch attitude within 5 deg compounded the necessary workload