Inter‐serotype reassortment among epizootic haemorrhagic disease viruses in the United States

First described in 1955 in New Jersey, epizootic haemorrhagic disease (EHD) causes a severe clinical disease in wild and domestic ruminants worldwide. Epizootic haemorrhagic disease outbreaks occur in deer populations each year from summer to late autumn. The etiological agent is EHD virus (EHDV) which is a double‐stranded segmented icosahedral RNA virus. EHD virus utilizes point mutations and reassortment strategies to maintain viral fitness during infection. In 2018, EHDV serotype 2 was predominantly detected in deer in Illinois. Whole genome sequencing was conducted for two 2018 EHDV2 isolates (IL41747 and IL42218) and the sequence analyses indicated that IL42218 was a reassortant between different serotypes whereas IL41747 was a genetically stable strain. Our data suggest that multiple strains contribute to outbreaks each year.     

A systematic approach to reconstruction of neglected tears of the patellar tendon. A case report

Neglected tears of the patellar tendon due to loss of active extension remain a difficult therapeutic endeavor. The goals in the approach to this diagnosis include restoration of both structural and functional integrity of the extensor mechanism. A procedure has been developed utilizing Z-shortening of the patellar tendon, Z-lengthening of the quadriceps tendon, and the semitendinosis gracilis as a biologic splint. This technique allows establishment of preoperative goals, including restoration of the muscle-tendon complex in its anatomic position, restoration of quadriceps function, preservation of vascularity of the reconstructed tendon, and splinting of the patellar tendon. This reconstruction allows early mobilization and rehabilitation.     

A randomized multicenter study to determine the efficacy of activity restriction for preterm labor management in patients testing negative for fetal fibronectin.

OBJECTIVE: To assess the impact of activity restriction (AR) on the incidence of preterm birth in women treated for preterm labor testing negative for fetal fibronectin (fFN). STUDY DESIGN: Women who were diagnosed with preterm labor and tocolyzed with magnesium sulfate were concurrently screened with fFN for the purpose of subsequent management. Included were consenting patients with negative fFN, gestational age 23 0/7-33 6/7 weeks, cervical dilation < or =3 cm, and minimal vaginal bleeding. Patients were randomized to AR or no AR. Primary study outcome was incidence of preterm delivery and interval from randomization to delivery. RESULTS: A total of 73 women with negative fFN were randomized (36 with AR, 37 without AR). The overall preterm birth rate was 40%, with 44.4% of patients with AR and 35.1% of patients without AR delivering preterm, p=0.478. CONCLUSION: Maternal AR did not impact pregnancy outcome. The incidence of preterm birth in symptomatic women testing fFN negative was higher than previously reported.     

Islet cell carcinomas of the pancreas: a twenty-year experience

Unlike its lethal exocrine counterpart, islet cell carcinoma of the pancreas is an indolent neuroendocrine neoplasm. The majority of these tumors are hormonally active. When functioning, a number of clinical syndromes (for example, hyperinsulinism, Zollinger-Ellison and Cushing's syndromes) may be evident. Fifty-eight patients surgically treated between 1965 and 1984 were retrospectively analyzed. The purpose of this study was to determine the distribution of functioning versus nonfunctioning tumors and the response to type of therapy. Mean postoperative follow-up was 7.4 years. Survival and prognostic indices were calculated by the Kaplan-Meier method and compared with log-rank tests. Of the group, 54% had functioning and 46% nonfunctioning tumors. Gastrinomas were the most common functioning tumors encountered (19%). Of interest was the finding that nonfunctioning tumors increased steadily during the last 15 years of the study (25% to 65%). Curative resections were performed in 15 (26%) and noncurative procedures in 43 patients (74%), with an overall operative mortality rate of 3%. Symptomatic improvement was achieved in 90% (curative) and 51% (noncurative). Survival at 3 years was 87% and 66% for the curative and noncurative groups, respectively (p less than 0.1), with an overall 5-year survival of 42%. The absence of hepatic metastases was a major predictor of survival at 3 years (82% vs 56%, p less than 0.05). Survival was statistically better at 3 years in those patients with gastrinomas compared with patients with nonfunctioning tumors (91% vs 58%, p less than 0.05). Although surgical cure is rare, significant long-term palliation may be achieved in a large percentage of patients with an aggressive surgical approach, occasional total gastrectomy, combination chemotherapy, H2 blockade, when indicated, and, most recently, with the new long-acting analogue of somatostatin.     

Tear buffering in contact lens wearers

The buffering capacity of tears collected from contact lens wearers was compared to that from non-contact lens wearers. Three groups of subjects were investigated: 6 subjects not wearing contact lenses, 3 subjects wearing rigid contact lenses, and 3 subjects wearing hydrogel contact lenses. Each of the 12 subjects provided, on 6 separate occasions, 100 microliters of tears. The pH of the tears was measured with a closed chamber, temperature stabilized micro-electrode system firstly on collection and then after titration with acid and base. In all, 28 titration steps across the acid-base spectrum were completed for each subject's tears on each occasion. These tear pH responses to acid-base challenge were compared to that of unbuffered distilled water for the same titration procedure. There was no statistically significant effect of contact lens wear on tear buffering capacity, but considerable inter-subject variability was noted.     

Developmental effects of multiple looks in speech sound discrimination.

PURPOSE: The change/no-change procedure (J. E. Sussman & A. E. Carney, 1989), which assesses speech discrimination, has been used under the assumption that the number of stimulus presentations does not influence performance. Motivated by the tenets of the multiple looks hypothesis (N. F. Viemeister & G. H. Wakefield, 1991), work by R. F. Holt and A. E. Carney (2005) called this assumption into question (at least for adults): Nonsense syllable discrimination improved with more stimulus presentations. This study investigates the nature of developmental differences and the effects of multiple stimulus presentations in the change/no-change procedure. METHOD: Thirty normal-hearing children, ages 4.0-5.9 years, were tested on 3 consonant-vowel contrasts at various signal-to-noise ratios using combinations of 2 and 4 standard and comparison stimulus repetitions. RESULTS: Although performance fell below that which is predicted by the multiple looks hypothesis in most conditions, discrimination was enhanced with more stimulus repetitions for 1 speech contrast. The relative influence of standard and comparison stimulus repetitions varied across the speech contrasts in a manner different from that of adults. CONCLUSION: Despite providing no additional sensory information, multiple stimulus repetitions enhanced children's discrimination of 1 set of nonsense syllables. The results have implications for models of developmental speech perception and assessing speech discrimination in children.     

Indicated and non-indicated preterm delivery in twin gestations: impact on neonatal outcome and cost.

OBJECTIVE: To identify the etiology and impact of preterm delivery in twin gestations. STUDY DESIGN: Twin gestations delivered at 33.0 to 36.9 weeks were identified in a perinatal database, and categorized by indication for delivery. Deliveries were identified as indicated, or non-indicated (discretionary). Neonatal outcomes were measured by birth weight, length of stay, NICU admission, and ventilator utilization. Data were divided and analyzed by indicated or discretionary delivery, and gestational age at delivery. RESULTS: Analyzed were 3252 twin gestations (6504 infants), with 78% having indicated delivery. Of the 22% with discretionary delivery, nearly 40% required NICU admission. With each advancing week of gestation, there was a significant decrease in incidence of NICU admission and nursery days. CONCLUSION: The majority of preterm deliveries were indicated, though 22% were discretionary. It is vital to consider neonatal morbidity and costs related to gestational age when choosing discretionary delivery.