Concussion management application for amateur sports

Concussion management has become one of the most popular topics in sports medicine. Significant resources are being invested in developing protocols for professional sport associations such as the NFL and FIFA. These protocols are often expensive and require substantial resources to implement. The problem, however, runs much deeper than just professional sports. Currently there exists little infrastructure to effectively manage concussion in amateur settings such as high school, club and university sport. A more holistic approach is required to ensure that the same standard of concussion management is being implemented across the board, regardless of the available medical and financial resources. An application was developed that will allow for easily accessible baseline testing and access to a player's concussion history from anywhere in the world. The application will be used to monitor players from the day they start playing sport until they potentially become professional sport players.

Prediction of protein functional residues from sequence by probability density estimation

MOTIVATION

The prediction of ligand-binding residues or catalytically active residues of a protein may give important hints that can guide further genetic or biochemical studies. Existing sequence-based prediction methods mostly rank residue positions by evolutionary conservation calculated from a multiple sequence alignment of homologs. A problem hampering more wide-spread application of these methods is the low per-residue precision, which at 20% sensitivity is around 35% for ligand-binding residues and 20% for catalytic residues.

RESULTS

We combine information from the conservation at each site, its amino acid distribution, as well as its predicted secondary structure (ss) and relative solvent accessibility (rsa). First, we measure conservation by how much the amino acid distribution at each site differs from the distribution expected for the predicted ss and rsa states. Second, we include the conservation of neighboring residues in a weighted linear score by analytically optimizing the signal-to-noise ratio of the total score. Third, we use conditional probability density estimation to calculate the probability of each site to be functional given its conservation, the observed amino acid distribution, and the predicted ss and rsa states. We have constructed two large data sets, one based on the Catalytic Site Atlas and the other on PDB SITE records, to benchmark methods for predicting functional residues. The new method FRcons predicts ligand-binding and catalytic residues with higher precision than alternative methods over the entire sensitivity range, reaching 50% and 40% precision at 20% sensitivity, respectively.

AVAILABILITY

Server: http://frpred.tuebingen.mpg.de. Data sets: ftp://ftp.tuebingen.mpg.de/pub/protevo/FRpred/.

Citrate sensing by the C4-dicarboxylate/citrate sensor kinase DcuS of Escherichia coli: binding site and conversion of DcuS to a C4-dicarboxylate- or citrate-specific sensor

The histidine protein kinase DcuS of Escherichia coli senses C(4)-dicarboxylates and citrate by a periplasmic domain. The closely related sensor kinase CitA binds citrate, but no C(4)-dicarboxylates, by a homologous periplasmic domain. CitA is known to bind the three carboxylate and the hydroxyl groups of citrate by sites C1, C2, C3, and H. DcuS requires the same sites for C(4)-dicarboxylate sensing, but only C2 and C3 are highly conserved. It is shown here that sensing of citrate by DcuS required the same sites. Binding of citrate to DcuS, therefore, was similar to binding of C(4)-dicarboxylates but different from that of citrate binding in CitA. DcuS could be converted to a C(4)-dicarboxylate-specific sensor (DcuS(DC)) by mutating residues of sites C1 and C3 or of some DcuS-subtype specific residues. Mutations around site C1 aimed at increasing the size and accessibility of the site converted DcuS to a citrate-specific sensor (DcuS(Cit)). DcuS(DC) and DcuS(Cit) had complementary effector specificities and responded either to C(4)-dicarboxylates or to citrate and mesaconate. The results imply that DcuS binds citrate (similar to the C(4)-dicarboxylates) via the C(4)-dicarboxylate part of the molecule. Sites C2 and C3 are essential for binding of two carboxylic groups of citrate or of C(4)-dicarboxylates; sites C1 and H are required for other essential purposes.

A pesticide runoff model for simulating runoff losses of pesticides from agricultural lands

An integrated modeling system was developed to predict runoff losses of pesticides from agricultural lands. The system is an integration of a mathematical model, a database system, and a geographic information system. Information on soil type, land use, land slope, watershed boundaries, precipitation, pesticide usage, as well as physical and chemical properties of pesticides have been input to a GIS, managed through a database, and used for further modeling studies. The modeling outputs were in turn put into the database, such that runoff patterns along with pesticides losses could be further simulated by using a database management system. The final results could then be visualized through GIS. The developed modeling system was applied to the Kintore Creek Watershed, Ontario, Canada, for simulating losses of atrazine from agricultural lands. A water quality monitoring project was carried out from 1988 to 1992 in the watershed to detect conditions of surface water pollution due to the use of pesticides. The modeling outputs were verified through the monitoring data, demonstrating reasonable prediction accuracy. The result indicated that the model provides an effective means for forecasting pesticide runoff from agriculture lands.

Pediatric thoracic trauma

OBJECTIVE

A retrospective analysis of the medical records of children up to 12 years of age inclusive, who sustained thoracic injuries during a 6-year period.

METHODS

Ninety-one children were treated at King Fahad National Guard Hospital, Riyadh from January 1993 through December 1998. The clinical data included age, sex, mechanism of injury, associated injuries, pediatric trauma score, treatment and mortality.

RESULTS

Eighty-seven children (96%) had injuries from blunt trauma and 4 from penetrating injuries. Of the blunt trauma cases, 82 children sustained motor vehicle accident related injuries, 62 as pedestrians and 20 as passengers. Penetrating thoracic injuries occurred in 4 children: 1 stab wound and 3 gunshots. The most frequent thoracic injuries were pulmonary contusion (70), pneumothorax (32), fractured rib (20) and fractured clavicle (18). Extrathoracic injuries included head (45), abdominal (41) and skeletal (26). Thoracotomy was required in only 1 child, laparotomy being necessary in 9 children for intraabdominal injuries. Tube thoracostomy was required in 33 children. Nine children died from motor vehicle accident related fatal head and neck injuries, 8 as pedestrians all with a pediatric trauma score < or = 6.

CONCLUSION

Thoracic injuries in children below 12 years of age are usually from motor vehicle accident related blunt trauma. Pulmonary contusion and pneumothorax are the most common thoracic injuries. Most thoracic injuries can be managed either conservatively or by tube thoracostomy. Thoracic trauma in children is an indicator of multisystem injury with head injury being the most common cause of mortality.

Comparison of zafirlukast (Accolate) absorption after oral and colonic administration in humans

PURPOSE

This study characterized the gastrointestinal (GI) absorption of zafirlukast after oral and colonic administration in humans.

METHODS

Five healthy subjects received zafirlukast solution (40 mg) orally and via an oroenteric tube into the colon in a randomized, crossover fashion. Two additional subjects were dosed into the distal ileum. Serial blood samples were obtained and plasma concentrations were quantitated by HPLC.

RESULTS

Mean +/- SD pharmacokinetic parameters after oral vs. colonic administration were: AUC infinity of 2076 +/- 548 vs. 602 +/- 373 ng x h/mL, respectively, and Cmax of 697 +/- 314 vs. 194 +/- 316 ng/mL, respectively. Mean colon:oral AUCalpha and Cmax were 0.29 and 0.30, respectively. Median tmax values were 2.0 and 1.35 hr after oral and colonic administration. First-order absorption rate constants (Ka and Kac) were estimated from a two-compartment model with first-order elimination. Kac:Ka was <0.5 in 4 of the 5 subjects dosed in the colon.

CONCLUSIONS

Zafirlukast was absorbed at multiple sites in the GI tract. The rate and extent of zafirlukast absorption was less after colonic than oral administration. Zafirlukast was significantly absorbed in the distal ileum. This study demonstrated that gamma scintigraphy, digital radiography, and fluoroscopy can be used to track the movement and confirm the location of the oroenteric tube in the GI tract.

Bronchobiliary fistula: a case report

Fewer than 20 cases of bronchobiliary fistula have been reported in the literature. In this report a newborn female infant was referred for investigation of gastroesophageal reflux. Upper gastrointestinal endoscopy and 24-hour pH monitoring revealed severe reflux. A fundoplication was carried out. In the immediate postoperative period bile was noticed coming from the endotracheal tube. Bronchoscopy revealed an abnormal opening just to the left of the carina. Fistulography and HIDA scanning confirmed the presence of a bronchobiliary fistula. A right thoracotomy was used to divide the fistula. The child made an uncomplicated recovery. Pathological examination of the excised specimen demonstrated tissue most consistent with an esophageal origin.

Gastroschisis: a simple technique for staged silo closure

In conjunction with the Neonatology Department at Loma Linda University Children's Hospital, a new protocol has evolved for the management of infants with gastroschisis, which obviates both risks associated with primary and staged silo closure. After stabilization of the infant in the neonatal intensive care unit, under sterile conditions, a 5- or 7-cm SILASTIC silo with a spring-loaded ring is placed over the exposed viscera, under the fascial defect. No sutures are required. A fentanyl drip is given, and the bowel is gradually reduced over the next few days. The transparent material of the silo allows for continuous monitoring of the condition of the bowel. Second-stage closure in the operating room is performed using a purse-string suture in the fascia to create a pseudoumbilicus. From October 1992 to April 1994 the authors managed 10 infants using this protocol. The results are compared with those of infants with gastroschisis treated at the same institution between August 1982 and June 1993. Outcome parameters to be compared include time until closure, time on ventilation, days of total parenteral nutrition, time until start of oral feeding, time until toleration of full-volume oral feeding, and time until discharge. The authors conclude that silo closure in the neonatal intensive care unit is simple, quick, and effective. It eliminates multiple trips to the operating room, allows the natural accommodation of the bowel into the abdominal cavity with little edema and minimal vascular compromise, and has become the authors' treatment of choice for infants with gastroschisis.

Pediatric laparoscopic splenectomy

Laparoscopic surgery is becoming widely accepted as an alternative to conventional procedures. It is becoming more and more evident that laparoscopic techniques can be applied successfully to pediatric patients. Advantages of these techniques include less postoperative pain, decreased ileus, fewer pulmonary complications, and shorter hospital stays. Elective splenectomy for hematologic disease or for staging of Hodgkin's lymphoma also appears to be amenable to laparoscopic techniques. This report details 12 consecutive splenectomies successfully performed laparoscopically since July 1993. No case required conversion to laparotomy. Each case was reviewed with respect to operative time, estimated blood loss, identification of accessory spleens, time until full oral intake, analgesia requirements, and length of stay. Factors contributing to morbidity such as ileus, pulmonary complications, and would infections were evaluated. Documentation was also reviewed for late sequelae such as intestinal obstruction and incisional hernias. These patients were compared with 20 consecutively treated patients who underwent open splenectomy in the period immediately preceding the use of laparoscopic splenectomy. Laparoscopic splenectomy, in the authors' experience, is a safe alternative to open splenectomy, has few complications, is cost effective, and has been well accepted by patients and families.

Esophagotomy for incarcerated esophageal foreign bodies

Less than 1% of esophageal foreign bodies are irretrievable by endoscopic techniques. Incarcerated esophageal foreign bodies require esophagotomy for removal. A retrospective study was conducted to determine the incidence, predisposing factors, and optimal treatment of incarcerated esophageal foreign bodies. Four of 815 patients (0.5%) with esophageal foreign bodies required esophagotomy for foreign body removal. Two predisposing factors for incarceration were identified, and these factors were related to patient age. Two infants had neglected esophageal foreign bodies that partially migrated through the esophageal wall. In two adults, foreign body size and sharpness were responsible for incarceration. One cervical and three thoracic esophagotomies were done. One thoracic esophagotomy suture line dehiscence occurred. Occult foreign body pressure necrosis may be a factor in esophagotomy suture line leakage. Care is required in esophagotomy closure. Principles established for repair of esophageal perforations are also applicable to esophagotomy closure.

A variant of Poland's syndrome

A case of Poland's syndrome--the association of congenital thoracic abnormalities with ipsilateral syndactyly--in a newborn infant is described. The infant demonstrated unusual manifestations of the syndrome: there was extension of the liver through the chest, and there was absence of a whole arm rather than hypoplasia and syndactyly. The authors describe the investigation and treatment of this infant, and they discuss the diversity of findings in Poland's syndrome.

Routine omission of nasogastric intubation after gastrointestinal surgery

The need for routine nasogastric-tube decompression after gastrointestinal surgery has been challenged repeatedly for several years. To determine whether nasogastric intubation can be omitted routinely, 101 consecutive patients who underwent gastrointestinal surgery were managed prospectively without nasogastric tubes. Excluded were patients with complete bowel obstruction and those who required prolonged endotracheal intubation. These patients were compared with 101 retrospective controls who had nasogastric decompression routinely. There were four protocol violations in the prospective group (nasogastric tubes were left in place postoperatively) and one in the retrospective group (no nasogastric tube postoperatively), leaving 97 and 100 patients, respectively, for follow-up. The mean duration of hospitalization in comparable patients was 10.6 days in patients without decompression and 11.9 days in those with routine decompression. Subsequent nasogastric-tube insertion was required in nine patients who did not undergo routine decompression, compared with two patients who had routine decompression. There were no statistically significant differences in the rates of anastomotic leaks, wound disruptions and pulmonary or other complications between the two groups. The authors conclude that nasogastric decompression can be safely omitted as a routine part of postoperative care after gastrointestinal surgery.

Characteristics of participants in a large group awareness training

A study was conducted to assess the psychosocial characteristics of individuals who become involved in large group awareness training (LGAT) programs. Prospective participants in The Forum, which has been classified as an LGAT, were compared with nonparticipating peers and with available normative samples on measures of well-being, negative life events, social support, and philosophical orientation. Results revealed that prospective participants were significantly more distressed than peer and normative samples of community residents and had a higher level of impact of recent negative life events compared with peer (but not normative) samples. Prospective participants also held preparticipation values more similar to those espoused by the LGAT than peer or normative samples, and the three groups failed to be distinguished by their levels of social support. The implications of the findings are considered for understanding participation in LGATs and other self-change promoting activities.

Pulmonary sequestration and congenital cystic adenomatoid malformation in an infant

Pulmonary sequestration and congenital cystic adenomatoid malformation (CCAM) are individually well known but infrequent congenital malformations of the lung. We report a rare case of pulmonary sequestration and CCAM occurring concurrently in the same infant.

The effect of oral oxyphenbutazone (Tandearil) on tumor growth and the level of the seromucoid fraction in rats bearing Walker 256 carcinoma

The effect of the oral administration of oxyphenbutazone (Tandearil) on tumor growth and the levels of the seromucoid protein and seromucoid-bound carbohydrates of rats bearing Walker 256 has been studied. Oxyphenbutazone was administered at two dose levels, namely 60 mg/kg per day and 100 mg/kg per day. The anticipated elevation of seromucoid protein and seromucoid-bound carbohydrates was observed in untreated tumor-bearing rats. Oxyphenbutazone treatment suppressed the initial response of seromucoid protein and seromucoid-bound carbohydrate in tumor-bearing rats such that no significant elevation occurred over levels recorded for untreated nontumor-bearing rats for the first 8 days following transplantation. After 8 days the levels of seromucoid protein and seromucoid-bound carbohydrate were elevated in treated tumor-bearing animals as compared with untreated nontumor-bearing controls although the magnitude of the elevation was significantly less than that observed in untreated tumor-bearing animals.Oxyphenbutazone at an oral dose of 100 mg/kg per day proved toxic to the adult male rat. Toxicity was manifested by weight loss and occasionally by a fatal hemorrhagic gastritis.Tumors regressed in oxyphenbutazone-treated animals, and survival times of animals treated with oxyphenbutazone at 60 mg/kg per day exceeded those of comparable untreated tumor-bearing animals. In addition, treated animals were free of apparent malignant disease at the completion of the study.