Citations

We implemented a three-dimensional solver for simulating the ultrasound radiation force induced shear wave motion in viscoelastic media using a mapped Chebyshev pseudospectral method. The solver used a body force field that is simulated by the Field II program as the excitation. Then, a velocity-stress formulation was used to calculate the shear wave motion. We used a Voigt model to describe tissue viscoelasticity, and the viscosity is introduced by memory variables and auxiliary differential equations. The top boundary of the domain had a fixed boundary condition to mimic the interaction between an ultrasound probe and the tissue surface. All other sides of the domain were surrounded by perfectly matched layers to minimize the reflections. Time stepping was implemented with the LSODE integrator with variable step sizes. Results show that the waveform of the simulated shear wave is close to experimental observations and equivalent FEM simulations. We used a Fourier-based method to estimate the phase velocities of the shear waves between 100–1000 Hz and a nonlinear regression to estimate the Voigt model parameters. The reconstructions matched within 10% error compared with the true values.

Low frequency harmonic force excitation can be used for both imaging and tissue characterization. This type of excitation can be achieved via intersecting two beams that slightly differ in frequency. One requirement of this technique is creating focused intersecting beams using available hardware. Previous studies have suggested different configurations for creating harmonic radiation force using linear arrays. However, these methods rely on identical frequency response assumption across all elements of the aperture. In practice, this assumption can be easily violated, especially if the transmit frequencies are not around the center frequency of the probe. When using electronic steering and focusing at different locations, this can result in a non-uniform radiation force pattern due to frequency changes in the sub-aperture. When used for vibro-acoustography, this manifests as vertical streaks in the final image that can severely degrade the quality of the image. We present a novel technique that minimizes element transmit frequency switching which in turn results in a more uniform excitation intensity. The results of applying this aperture configuration for vibro-acoustography imaging of breast phantoms with hard inclusions show significant improvements over previous methods. [This work was supported by NIH Grant R01 EB17213.]

Direct numerical solutions of the three-dimensional time-dependent Navier-Stokes equation are presented for the evolution of three-dimensional finite-amplitude disturbances in the Stokes boundary layer. The basic flow is driven harmonically in time and the disturbances represent a departure from the basic state of the fluid. For fixed value of the fluid viscosity, instability is shown to be a function of the amplitude of oscillation of the basic flow, excitation frequency, and the channel wall geometry. Special attention is given to pressure gradient and surface wave driven flows. Conditions for instability and transition are outlined.

Treatment of condylar fractures is variable and controversial. Treatment options for management of condylar fractures include surgical and nonsurgical methods, and if a nonsurgical method is as effective as a surgical method, the former is preferred. Although plain film radiographs and functional outcomes attained through nonsurgical treatment are well established in literature, evidence of the remodeling process through detailed, high-quality imaging is lacking. The purpose of this case series is to describe and illustrate two adults and one pediatric patient with significantly displaced condylar fractures treated nonsurgically with excellent clinical results. It is unique for such patients to have pre- and posttreatment computed tomography scans with high-quality three-dimensional reconstruction as in the case of two adults and to have 3.5-year posttrauma radiographs and 14.5-year follow-up as in the case of the pediatric patient. As such, this report is useful in visually presenting three examples of repositioning and reformation of the temporomandibular joint structures in displaced condylar fractures in a postmenarche 14-year-old female patient, a 21-year-old male patient, and an 18-month-old male patient.

Background: Electronic health records (EHRs) provide a clinical view of patient health. EHR data are becoming available in large data sets and enabling research that will transform the landscape of healthcare research. Methods are needed to incorporate wellbeing dimensions and strengths in large data sets. The purpose of this study was to examine the potential alignment of the Wellbeing Model with a clinical interface terminology standard, the Omaha System, for documenting wellbeing assessments. Objective: To map the Omaha System and Wellbeing Model for use in a clinical EHR wellbeing assessment and to evaluate the feasibility of describing strengths and needs of seniors generated through this assessment. Methods: The Wellbeing Model and Omaha System were mapped using concept mapping techniques. Based on this mapping, a wellbeing assessment was developed and implemented within a clinical EHR. Strengths indicators and signs/symptoms data for 5 seniors living in a residential community were abstracted from wellbeing assessments and analyzed using standard descriptive statistics and pattern visualization techniques. Results: Initial mapping agreement was 93.5%, with differences resolved by consensus. Wellbeing data analysis showed seniors had an average of 34.8 (range=22–49) strengths indicators for 22.8 concepts. They had an average of 6.4 (range=4–8) signs/symptoms for an average of 3.2 (range=2–5) concepts. The ratio of strengths indicators to signs/symptoms was 6:1 (range 2.8–9.6). Problem concepts with more signs/symptoms had fewer strengths. Conclusion: Together, the Wellbeing Model and the Omaha System have potential to enable a whole-person perspective and enhance the potential for a wellbeing perspective in big data research in healthcare.

The mucosal gene expression in rectosigmoid mucosa (RSM) in irritable bowel syndrome with diarrhea (IBS-D) is unknown. Our objectives were, first, to study mRNA expression [by RT2 PCR of 19 genes pertaining to tight junctions, immune activation, intestinal ion transport and bile acid (BA) homeostasis] in RSM in IBS-D patients ( n = 47) and healthy controls ( n = 17) and study expression of a selected protein (PDZD3) in 10 IBS-D patients and 4 healthy controls; second, to assess RSM mRNA expression according to genotype and fecal BA excretion (high ≥2,337 μmol/48 h); and third, to determine whether genotype or mucosal mRNA expression is associated with colonic transit or BA parameters. Fold changes were corrected for false detection rate for 19 genes studied ( P < 0.00263). In RSM in IBS-D patients compared with controls, mRNA expression of GUC2AB, PDZD3, and PR2Y4 was increased, whereas CLDN1 and FN1 were decreased. One immune-related gene was upregulated (C4BP4) and one downregulated (CCL20). There was increased expression of a selected ion transport protein (PDZD3) on immunohistochemistry and Western blot in IBS-D compared with controls ( P = 0.02). There were no significant differences in mucosal mRNA in 20 IBS-D patients with high compared with 27 IBS-D patients with normal BA excretion. GPBAR1 ( P < 0.05) was associated with colonic transit. We concluded that mucosal ion transport mRNA (for several genes and PDZD3 protein) is upregulated and barrier protein mRNA downregulated in IBS-D compared with healthy controls, independent of genotype. There are no differences in gene expression in IBS-D with high compared with normal fecal BA excretion.

Significance The skin and intestinal barrier are controlled by signaling scissors, termed ADAM17 (a disintegrin and metalloprotease 17), that reside in the membrane on the surface of cells. The main purpose of these signaling scissors is to liberate growth factors from their membrane anchor, allowing them to activate their receptors, including the epidermal growth factor receptor (EGFR). The ADAM17/EGFR signaling axis is tightly regulated, yet little is known about the underlying mechanism. Here we use genetic, cell biological, and biochemical approaches to identify two membrane proteins termed iRhoms 1 and 2 (inactive Rhomboid-like proteins) as crucial upstream regulators of ADAM17-dependent EGFR signaling. This uncovers the iRhoms as attractive novel targets to treat ADAM17/EGFR-dependent diseases such as cancer.

BACKGROUNDPostmenopausal women with breast cancer receiving aromatase inhibitors are at an increased risk of bone loss. The current study was undertaken to determine whether upfront versus delayed treatment with zoledronic acid (ZA) impacted bone loss. This report described the 5‐year follow‐up results.METHODSA total of 551 postmenopausal women with breast cancer who completed tamoxifen treatment and were undergoing daily letrozole treatment were randomized to either upfront (274 patients) or delayed (277 patients) ZA at a dose of 4 mg intravenously every 6 months. In the patients on the delayed treatment arm, ZA was initiated for a postbaseline bone mineral density T‐score of <‐2.0 or fracture.RESULTSThe incidence of a 5% decrease in the total lumbar spine bone mineral density at 5 years was 10.2% in the upfront treatment arm versus 41.2% in the delayed treatment arm (P<.0001). A total of 41 patients in the delayed treatment arm were eventually started on ZA. With the exception of increased NCI Common Toxicity Criteria (CTC) grade 1/2 elevated creatinine and fever in the patients treated on the upfront arm and cerebrovascular ischemia among those in the delayed treatment arm, there were no significant differences observed between arms with respect to the most common adverse events of arthralgia and back pain. Osteoporosis occurred less frequently in the upfront treatment arm (2 vs 8 cumulative cases), although this difference was not found to be statistically significant. Bone fractures occurred in 24 patients in the upfront treatment arm versus 25 patients in the delayed treatment arm.CONCLUSIONSImmediate treatment with ZA prevented bone loss compared with delayed treatment in postmenopausal women receiving letrozole and these differences were maintained at 5 years. The incidence of osteoporosis or fractures was not found to be significantly different between treatment arms. Cancer 2015;121:2537–2543. © 2015 American Cancer Society.