bluuebunny/crossref_metadata_2025 huggingface dataset:
Hybridization of Alkali Basaltic Magmas: a Case Study of the Ogol Lavas from the Laetoli Area, Crater Highlands (Tanzania)
Authors: Zaitsev Anatoly N , Arzamastsev Andrei A , Marks Michael A W , Braunger Simon , Wenzel Thomas , Spratt John , Salge Tobias , Markl Gregor
Published: April 2021

The southern part of the eastern branch of the East African Rift is characterized by extensive volcanic activity since the late Miocene. In the Crater Highlands, part of the North Tanzanian Divergence zone, effusive and pyroclastic rocks reflect nephelinitic and basaltic compositions that formed between 4·6 and 0·8 Ma. The former are best represented by the Sadiman volcano (4·6–4·0 Ma) and the latter occur in the giant Ngorongoro crater (2·3–2·0 Ma), the Lemagarut volcano (2·4–2·2 Ma) and as a small volcanic field in the Laetoli area (2·3 Ma), where basaltic rocks known as Ogol lavas were erupted through fissures and several cinder cones. Compositionally, they are alkaline basalts with 46·0–47·9 wt% SiO2, 3·0–4·3 wt% of Na2O + K2O, Mg# of 61 to 55, and high Cr and Ni content (450–975 and 165–222 ppm respectively). Detailed textural and compositional analysis of the major minerals (olivine, clinopyroxene, plagioclase and spinel-group minerals) reveals the heterogeneity of the rocks. The primary mineral assemblage that crystallized from the Ogol magmas comprises macro- and microcrysts of olivine (Fo89·5–84·2), Cr-bearing diopside to augite, magnesiochromite–chromitess, magnetite–ulvöspinelss, andesine–oligoclasess and fluorapatite, with glass of phonolitic composition in the groundmass. All samples contain appreciable proportions of xenocrystic minerals of macro- and microcryst size, with large variations in both concentration and mineral populations between samples. Xenocrysts include olivine with reverse zonation (Fo84·1–72·5), rounded and embayed clinopyroxene cores of variable composition, anhedral Cr-free magnetite–ulvöspinelss and embayed oligoclase. These xenocrysts as well as variations in major and trace element contents, 87Sr/86Sr(i) (0·70377–0·70470) and 143Nd/144Nd(i) (0·51246–0·51261) ratios provide evidence of multi-stage magma mixing and mingling between Ogol and adjacent Lemagarut volcano basaltic melts with only very minor contamination by Precambrian granite–gneisses. Elevated alkalinity of Ogol lavas, which positively correlates with isotope ratios, and the presence of xenocrystic green core clinopyroxene, perovskite, schorlomite and titanite indicate additional mixing and mingling with evolved nephelinitic magmas and/or assimilation of nephelinitic Laetolil tuffs or foidolitic rocks related to the Sadiman volcano. Owing to their heterogeneity, estimates on the crystallization conditions for the Ogol rocks are difficult. Nevertheless, clinopyroxene–liquid thermobarometry indicates crystallization temperatures of around 1150–1220 °C and records upper-crustal depths of 3–12 km (1–4 kbar). Despite the fact that Ogol basalts are hybrid rocks that formed under open-system conditions with well-documented mixing and mingling processes, they seem to be the best examples closest to primary basaltic melts within the Crater Highlands.
P007 Service evaluation of the nurse-led telephone advice line in the wake of COVID-19: a report of audit and staff satisfaction
Authors: Day Julia , Ball Janet , Down Jayne , Sengupta Raj
Published: April 2021

Background/Aims 

The Rheumatology nurse advice line (NAL) at the Royal National Hospital for Rheumatic Diseases (RNHRD, Bath) provides a vital service for direct patient access to specialist advice via a designated voicemail system. Increasing numbers and difficulty connecting call returns have increased staff workload, reduced efficiency and impacted on staff satisfaction. An audit was therefore undertaken to evaluate service use and efficiency, paired with formal assessment of staff satisfaction in order to identify areas for improvement.

Methods 

The total number of monthly calls through the NAL during 2020 were counted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call being logged, returned and concluded. The number of clinicians and attempts required to contact the patient was noted. An anonymised staff satisfaction questionnaire was completed by NAL nurses and administrators. Data was analysed using Excel.

Results 

An average 653 calls per month (range 340-894) came through the NAL between January and September 2020. 97 consecutive patient contacts were audited from August 2020. Multiple attempts were required to successfully return the call in 19.6% of cases (n = 19/97). Of those, 68.4% (n = 13/19) of calls needed ≥ 2 nurses to contact the patient. In general, the first attempt to return the call was prompt (average 7.6 hours, range 0.1-27.7). However, the time to conclude the call from the patient’s first call log ranged from 0.1 - 142.6 hours (average 12.7 hours) with increased time associated with difficulties contacting the patient or when further advice was required from a Rheumatology doctor (18.5%, n = 18/97).

Staff surveys revealed 67% of staff felt that the NAL is a good service to offer patients. However, 67% of staff did not feel the NAL in its current format was easy to manage. Specific comments included that the lack of rota'd responsibility, unpredictable workload and time inefficiencies were barriers to managing the service.

Conclusion 

From this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns is inefficient and contributes to staff dissatisfaction. This data has driven change for service improvement. To improve efficiency, calls will be answered live by an administrator during working hours and patients given a call-back time. A doctor will be named as a single point of contact for the nurses to seek additional advice and a nurse rota will designate responsibility for NAL calls to reduce work-load uncertainty. Follow up service evaluation will include staff and patient satisfaction questionnaires, and repeat audit, with consideration of ways to support frequent service users.

Disclosure 

J. Day: None. J. Ball: None. J. Down: None. R. Sengupta: None. V. Flower: None.
P018 Multi-disciplinary team management of haemophagocytic lymphohistiocytosis: improving patient outcomes in a central London teaching hospital
Authors: Ludwig Dalia R , Manson Jessica , Jones Alexis , Mackenzie Strachan , Mccann Naina
Published: April 2021

Background/Aims 

Haemophagocytic lymphohistiocytosis (HLH) is a syndrome characterised by the presence of severe uncontrolled systemic inflammation due the overproduction of inflammatory cytokines and macrophage activation. The majority of adult patients have secondary HLH, triggered by either infection, haematological malignancy or rheumatic disease. Early recognition and initiation of definitive treatment is of vital importance as HLH leads to multi-organ failure and death if left untreated, with mortality of up to 80% in some cohorts.

Methods 

Under-recognition of the disease and vast differences in the management of patients with HLH between specialities have been common problems. To address this, a Rheumatology-led HLH multi-disciplinary team (MDT) meeting was established at University College London Hospital (UCLH) in 2018. The MDT includes physicians from Rheumatology, Infectious Disease, Haematology, Intensive Care, Nephrology and Neurology and feeds into the national HLH group HASC - HLH Across Specialty Collaboration. The MDT is now held bimonthly, discussing between 2 and 4 cases each meeting. The MDT functions as a decision-making tool, while providing consensus on patient management, including collaboration on how to access urgent HLH-directed treatments such as Anakinra for secondary care centres without access. It also serves as a unique learning opportunity for trainees from different disciplines.

Results 

Since the introduction of the MDT the number of patients diagnosed with HLH at ULCH has increased from an average of 6 per year in 2014-2016 to 12 per year in 2018-2020. In the last two years we have seen improved survival from years 2017/18 to 2019/20 (Table 1); survival was approximately 30% in 2017 and 75% in 2019. P018 Table 1:Outcomes of patients diagnosed with HLH (using ICD codes D761 and D762) at University College London Hospital since 2005.YEARALIVEDECEASED200511200601201021201111201220201334201442201525201641201737201839201993202095

Conclusion 

We believe that the HLH MDT has directly contributed to these improvements by encouraging earlier recognition and subspeciality collaboration. We encourage other sites to adopt a multi-disciplinary approach to managing patients with HLH to promote awareness of the condition and improve patient outcomes.

Disclosure 

D.R. Ludwig: None. J. Manson: None. A. Jones: None. S. Mackenzie: None. N. Mccann: None.
P020 A new complex musculoskeletal clinic combining rheumatology and sport and exercise medicine services
Authors: Navarajasegaran Joshua A , Betts Jill , Baldock James , Soni Anushka , Smith Ralph
Published: April 2021

Background/Aims 

Sport and Exercise Medicine (SEM) can play a key role to help manage the increasing demands on NHS Rheumatology and Musculoskeletal services. The ‘Complex MSK clinic’ has been developed as a combined consultant-led service staffed by Rheumatologists and Sport and Exercise Medicine (SEM) physicians at the Oxford University Hospitals. Patients referred from primary care to the rheumatology services were allocated to this clinic via an internal triage process. The aim of this project was to identify the spectrum of diagnoses and the epidemiological characteristics of patients seen in the clinic to help develop patient pathways, optimise patient care, and to showcase this collaborative approach

Methods 

A retrospective analysis of the electronic patient record (EPR) of 194 consecutive patients attending the Complex MSK Clinic between 1 October and 30 November 2019 was performed. Patient age, reason for referral, length of time to appointment, prior investigations and treatment were all recorded, as were the primary/secondary diagnoses made, investigations requested, treatment provided and follow up arrangements. 16 patients had missing data or did not attend their appointment, leaving 178 patients that were included in the analysis.

Results 

Mean age at appointment was 49 (range 17-90). 86.5% of all referrals were made by Oxfordshire GPs , with the main reason for referral being diagnostic uncertainty (78%). Almost 1 in 4 patients were given a primary diagnosis of osteoarthritis (23.6%), of which 64.3% involved the hands. Other prominent diagnoses included chronic pain syndrome/fibromyalgia (20.2%), mechanical pain (15.7%), and inflammatory arthritis or spondyloarthritis (14.0%). The most common further management was referral to physiotherapy services (46.1%), with 23.6% of patients offered additional medication and 11.2% a therapeutic injection. 104 (58%) patients were discharged after their first appointment, with 52 (29%) followed up in the complex MSK service and only 22 (12%) referred to another specialist clinic.

Conclusion 

This report illustrates the spectrum of diagnoses seen within this unique service, highlighting a role for both Rheumatology and SEM within the same clinic. The low onward referral rate demonstrates appropriate triage and an efficient approach that is appropriate for this cohort of patients. It could reduce overall costs and patient journeys. Further work is required to streamline patient pathways, evaluate patient satisfaction and to determine whether the clinic is cost-effective and improves patient pathways.

Disclosure 

J.A. Navarajasegaran: None. J. Betts: None. J. Baldock: None. A. Soni: None. R. Smith: None.
P114 Effect of vitamin D on parathyroid hormone, serum calcium and bone mineral density in patients with primary hyperparathyroidism being managed conservatively
Authors: Khalid Mahrukh , Deshani Vismay , Jadoon Khalid
Published: April 2021

Background/Aims 

Vitamin D deficiency is associated with more severe presentation of primary hyperparathyroidism (PTHP) with high parathyroid hormone (PTH) levels and reduced bone mineral density (BMD). We analyzed data to determine if vitamin D levels had any impact on PTH, serum calcium and BMD at diagnosis and 3 years, in patients being managed conservatively.

Methods 

Retrospective analysis of patients presenting with PHPT. Based on vitamin D level at diagnosis, patients were divided into two groups; vitamin D sufficient (≥ 50 nmol/L) and vitamin D insufficient (≤ 50 nmol/L). The two groups were compared for age, serum calcium and PTH levels at diagnosis and after mean follow up of 3 years. BMD at forearm and neck of femur (NOF) was only analyzed in the two groups at diagnosis, due to lack of 3 year’s data.

Results 

There were a total of 93 patients, 17 males, mean age 70; range 38-90. Mean vitamin D level was 73.39 nmol/L in sufficient group (n = 42) and 34.48 nmol/L in insufficient group (n = 40), (difference between means -38.91, 95% confidence interval -45.49 to -32.33, p < 0.0001). There was no significant difference in age, serum calcium and PTH at the time of diagnosis. After three years, there was no significant difference in vitamin D levels between the two groups (mean vitamin D 72.17 nmol/L in sufficient group and 61.48 nmol/L in insufficient group). Despite rise in vitamin D level in insufficient group, no significant change was observed in this group in PTH and serum calcium levels. BMD was lower at both sites in vitamin D sufficient group and difference was statistically significant at NOF. Data were analyzed using unpaired t test and presented as mean ± SEM.

Conclusion 

50% of patients presenting with PHPT were vitamin D insufficient at diagnosis. Vitamin D was adequately replaced so that at 3 years there was no significant difference in vitamin D status in the two groups. Serum calcium and PTH were no different in the two groups at diagnosis and at three years, despite rise in vitamin D levels in the insufficient group. Interestingly, BMD was lower at forearm and neck of femur in those with sufficient vitamin D levels and the difference was statistically significant at neck of femur. Our data show that vitamin D insufficiency does not have any significant impact on PTH and calcium levels and that vitamin D replacement is safe in PHPT and does not impact serum calcium and PTH levels in the short term. Lower BMD in those with adequate vitamin D levels is difficult to explain and needs further research.

Disclosure 

M. Khalid: None. V. Deshani: None. K. Jadoon: None.
P139 Disease modifying treatment: the end of a golden age
Authors: Stanway James , Walker David
Published: April 2021

Background/Aims 

The role of gold changed from first line DMARD to use in cases where other options were limited, either due to contraindication or ineligibility for biologics. In Autumn 2019, IM gold was withdrawn by the manufacturer due to supply issues, without consultation of the Rheumatology community. As such, a group of patients with difficult to manage disease have lost a key DMARD. We aimed to assess the impact of the withdrawal of gold on the management of IA within Northumbria Healthcare Trust.

Methods 

Retrospective case note review.

Results 

We identified 37 patients on gold as of Autumn 2019; 16 for seropositive RA; 4 for PsA; 16 for seronegative RA and 1 for axial spondyloarthritis. 28 were taking gold monotherapy, with 3 receiving regular glucocorticoid in addition. Eight were taking gold in combination with a csDMARD and one in combination with rituximab. Data are currently available for 30 patients regarding the circumstances of gold initiation. Of these, all had received at least one alternative csDMARD which was either inefficacious or intolerable. Reasons for avoiding biologics were not documented in all cases; concerns regarding frequent chest infections were common and documented as a clear contraindication in 5. Follow up has been impacted by COVID-19; only 19 patients have had follow up within the last 6 months, 7 have not been followed up since gold cessation. Fourteen (37.8%) have commenced an alternative DMARD. Six of these have commenced a high cost drug; rituximab (3), adalimumab (2) or tofacitinib (1). Five have commenced hydroxychloroquine (with one subsequently switching to leflunomide),2 methotrexate and 1 minocycline. Seropositive RA and PsA patients are more likely to have commenced an alternative DMARD, 8/16 and 2/4 respectively; compared to 4/16 with seronegative RA. Of 23 patients who have not commenced alternative DMARDs, 17 have been reviewed following gold cessation; 3 were felt to need additional treatment; 1 has been deferred due to COVID-19 and 2 did not meet criteria for biologic treatment when assessed in early 2020 and subsequent follow up has been delayed. Fourteen patients were felt not to need an additional DMARD, although 1 required an increase in methotrexate and 6 continued co-prescribed DMARDs at the usual dose.

Conclusion 

The majority of patients have not required additional treatment although for some patients this may reflect the fact that the COVID-19 pandemic has significantly restricted routine follow up. This unusual case of forced DMARD cessation highlights the fact that drug free remission is possible and the ongoing need for immunosuppression should be reviewed. This also raised the ethical question of weather it is right to cease the production of medication which for some patients may be the only effective treatment option.

Disclosure 

J. Stanway: None. D. Walker: None.
P161 A comparative study of childhood-onset SLE with adult-onset patients: a single centre study
Authors: Morton Neil T , Rutter-Locher Zoe , Durrani Maumar , Sangle Shirish , Wilkinson Nick , D'Cruz David
Published: April 2021

Background/Aims 

Childhood-onset SLE (cSLE) was once associated with significant mortality but 5-year survival rates have now improved significantly. We retrospectively compared the clinical features and outcomes of cSLE patients with an adult-onset SLE (aSLE) group.

Methods 

We retrospectively studied data from 30 patients from our cSLE patients (onset before age 16) compared with 65 aSLE randomly selected in a 2:1 ratio, from our Lupus clinic patients fulfilling the 1997 ACR SLE criteria. Data regarding ethnicity, age of onset, family history, serology, complications, medications and outcomes were recorded.

Results 

Of cSLE patients 24 were female and 6 male (F:M ratio 4:1), with 16 patients (53%) Afro-Caribbean, 8 Caucasian, 5 Asian and 1 of mixed ethnicity. In the aSLE group, 60 patients were female and 5 male (ratio 9:1), with 29 (44%) Afro-Caribbean, 13 Asian, 21 Caucasian and 2 of mixed ethnicity. Median age at disease onset was 14 years (10-16) in cSLE and 29 years (17-50) in aSLE. A positive family history of SLE was seen in 37% (11/30) of cSLE patients compared to 11% (7/65) of aSLE [p = 0.003]. There was no difference in family history of other autoimmune rheumatic diseases (10% vs 14% [p = 0.57]).

Table 1 shows frequency of different autoantibodies, with anti-dsDNA and anti-cardiolipin antibodies significantly more frequent in the cSLE group [p = 0.017, p = 0.016 respectively]. Lupus nephritis appears to be more common in cSLE but not significantly (80% renal involvement vs 69% aSLE).There was no difference between involvement of chest, haematological, VTE or APS. Standard of care treatment was used in both groups, including oral prednisolone (>80% patients), anti-malarial and immunosuppressive medications. Renal flares were significantly more frequent in cSLE (23% vs 8%, [p = 0.027]). Of those deceased, only 1 was directly due to SLE. P161 Table 1:Serological markercSLE (n = 30)aSLE (n = 65)Number of patients%Number of patients%ANA2790%6498%dsDNA23*77%33*51%ENA1447%3655%RNP827%2335%Anti-Ro1033%2132%Anti-Sm827%1218%C1Q14**64%19**63%ACL17*57%20*31%LAC930%1828%RF517%69%Comparison of serological markers.*p < 0.05 (Chi-square used).**10 patients’ data missing.

Conclusion 

More cSLE patients had a positive SLE family history and had higher anti-dsDNA antibody positivity compared to aSLE. Renal involvement was observed more commonly in cSLE than aSLE patients but was not statistically significant. Our results suggest that the cSLE cohort have a higher prevalence of specific lupus serology and a positive family history of SLE which may point towards more aggressive disease.

Disclosure 

N.T. Morton: None. Z. Rutter-Locher: None. M. Durrani: None. S. Sangle: None. N. Wilkinson: None. D. D'Cruz: None.
Early Detection of the Root-Knot Nematode Meloidogyne hapla Through Developing a Robust Quantitative PCR Approach Compliant with the Minimum Information for Publication of Quantitative Real-Time PCR Experiments Guidelines
Authors: Tavoillot Johannes , Mateille Thierry , Ali Nadine , Chappé Anne-Marie , Martin Jean-François
Published: April 2021

Root-knot nematodes (RKNs) are major threats to crops through attacking the roots, which induces an abnormal development of the plant. Meloidogyne hapla is of particular concern, as it is currently expanding its distribution area and displays a wide host range. Effective plant protection against this RKN requires early detection, as even a single individual can cause severe economic losses on susceptible crops. Molecular tools are of particular value for this purpose, and among them, quantitative PCR (qPCR) presents many advantages (i.e., sensitivity, specificity, and rapidity of diagnosis at a reduced cost). Although a few studies have already been proposed for detecting M. hapla through this technique, they lack experimental details and performance testing, suffer from low taxonomic resolution, and/or require expensive hydrolysis probes. Here, we propose a qPCR detection method that uses SYBR Green with developed primers amplifying a fragment of the cytochrome oxidase I mitochondrial region. The method was developed and evaluated following the minimum information for publication of quantitative real-time PCR experiments (MIQE) guidelines to ensure its quality (i.e., sensitivity, specificity, repeatability, reproducibility, and robustness). The results demonstrate that the newly developed method fulfills its goals, as it proved specific to M. hapla and allowed for a reproductible detection level as low as 1.25 equivalent of a juvenile individual. All criteria associated with the MIQE guidelines were also met, so the method is of general use for the reliable early detection of M. hapla.
Cannabis Legalization and Adolescent Use of Electronic Vapor Products, Cannabis, and Cigarettes
Authors: Bhatia Devika , Hinckley Jesse , Mikulich Susan , Sakai Joseph
Published: April 2021

Objectives:

Cannabis legalization may have unintended consequences, such as effects on prevalence of adolescent use of other substances. We hypothesize that in states that have legalized recreational cannabis (RCL states), electronic vapor product use (“vaping”), cannabis, and cigarette use among adolescents is more prevalent than in states that have only legalized medical cannabis (MCL states) and states that have neither legalized recreational nor medical cannabis (NL states).

Methods:

Data are from the Center for Disease Control's 2017 Youth Risk Behavior Surveillance Survey (n = 107,665), a nationally representative survey of US high school students. We categorized student responses by cannabis legalization status of the state in which they lived at time of survey, then tested associations between cannabis legalization status and adolescent vaping, cannabis, and cigarette use, using logistic regressions.

Results:

Students in RCL states were significantly more likely to report current vaping behaviors compared to NL students [odds ratios (OR's) 2.07–2.21]. Students in cannabis-legal states were significantly more likely to report ever or currently using cannabis compared to NL students (OR's 1.27–1.40). MCL students were significantly less likely to report current cigarette smoking (OR = 0.86) compared to NL students.

Conclusions:

Adolescents in cannabis-legal states were more likely to report vaping and cannabis use compared to adolescents in NL states. Public health officials, policymakers, and clinicians should consider the associations between cannabis legalization and adolescent vaping, cigarette, and cannabis use patterns.
Full Arthroscopic Eden-Hybinette Procedure Using 2 Cortical Suture Buttons for the Reconstruction of Anteroinferior Glenoid Defects
Authors: Valenti Philippe , Martinez-Catalan Natalia , Werthel Jean-David , Kazum Efi
Published: April 2021

Therapeutic management of recurrent anterior shoulder instability with an anterior glenoid defect and a Hill-Sachs lesion requires a bone graft to restore the width of the glenoid. The Latarjet procedure is the most popular technique but an iliac crest bone graft is preferred when the coracoid process is dysplastic or too short or after failure of Latarjet or Bristow-Latarjet. The purpose of this manuscript is to describe a full arthroscopic Eden-Hybinette-guided technique with 2 cortical suture buttons for bone graft fixation. This procedure allows reconstruction of severe glenoid bone defects and treatment of concomitant capsulolabral lesions and humeral bone loss, while preserving the subscapularis muscle. In addition, the use of 2 cortical buttons for bone graft fixation simplify graft transport and positioning, provides good control of the rotation, improving healing of the iliac crest bone graft to the anterior glenoid rim.
The role of socioeconomic status in the relationship between social support and burden among cancer caregivers
Authors: Nikbakht Nasrabadi Alireza , Pahlevan Sharif Saeed , Allen Kelly A. , Naghavi Navaz , Sharif Nia Hamid , Salisu Waliu Jawula , Yaghoobzadeh Ameneh
Published: April 2021

While much research has focused on the direct impact of socioeconomic status on cancer patients, what is not clear is the impact of socioeconomic status on social support and the burden of care for caregivers. In this study, a cross-sectional method, using a convenience sampling approach, was adopted to collect the data of 191 caregivers of cancer patients who were referred to the oncology clinic and cancer institute of hospitals affiliated with Tehran University of Medical Sciences, Iran. The participants completed a questionnaire on basic demographics, the short version of the Burden Scale for Family Caregivers, and Zimet Multidimensional Perceived Social Support. A maximum likelihood exploratory factor analysis with oblique rotation to assess the factor structure of the constructs and the measurement model was conducted. The two-factor model consisting of 22 items explained 65.116% of the variance. There was a significant negative relationship between social support and burden (b = −0.771, P < 0.001) and also between economic status and burden (b = −0.308, P < 0.01). Moreover, there was a significant positive association between the interaction of social support and economic status and burden (b = 0.138, P < 0.05). More specifically, the negative relationship between social support and burden was statistically stronger for participants with weak economic status (b = −0.663, P < 0.001) than those with good economic status (b = −0.356, P < 0.01). Social support and an individual’s economic status are essential determinants of caregiver burden. Further studies are recommended to better inform the precise support needed by caregivers to enhance their quality of life, and ultimately, that of the patients under their care.
The Effect of 3 Positions Given to Preterm Infants During Heelstick Procedure on Pain and Durations of Crying and Procedure
Authors: Erkut Zeynep , Mutlu Birsen , Çakıcı Meltem
Published: April 2021

The purpose of this randomized controlled study was to determine the effect of 3 positions given to preterm infant during heelstick procedure on the pain and durations of crying and procedure. The sample of the study consisted of 90 preterm infants (30 in each group). The heelstick procedure was video recorded. Data from the pain scores, durations of crying, and procedure were collected watching the video recordings. It was determined that the pain mean score of the infants in the control group (supine on the crib) (5.50 ± 2.13) was statistically significantly higher than that of the infants in the positions of upright (3.00 ± 2.17) and supine on the lap (3.20 ± 2.46) (P < .01), and there was no difference between the positions of upright and supine on the lap (P > .05). Giving the positions of upright or supine on the lap during heelstick is effective in reducing pain, shortening the duration of crying, and calming down the infant. Heelstick in the position of upright on the lap shortened the procedure duration and allowed the infants to be subjected to less painful procedure. It is recommended for nurses to take the preterm infants on their laps during heel lancing and give them the upright position, in particular.
Clinical Significance of Middle Cerebellar Peduncle Ischemia After Translabyrinthine Vestibular Schwannoma Resection
Authors: Maxwell Anne K. , Muelleman Thomas , Barnard Zachary , Slattery William H. , Mehta Gautam U. , Lekovic Gregory P.
Published: April 2021

Objective:

To assess clinical symptoms, signs, and radiographic evolution of middle cerebellar peduncle (MCP) diffusion restriction (DR) abnormalities following vestibular schwannoma (VS) resection.

Study Design:

Retrospective chart and imaging review.

Setting:

Tertiary-referral neurotology and neurosurgery practice.

Patients:

All consecutive patients who underwent translabyrinthine VS resection over a 2-year period (August 2017–May 2019).

Intervention:

Translabyrinthine craniotomy for VS resection.

Main Outcome Measures:

Magnetic resonance imaging (MRI) obtained on postoperative day 1 were reviewed for DR within the pons and cerebellum, with 3 months follow-up MRI to assess for evolution of these vascular changes.

Results:

Of the 31 patients who met inclusion criteria, MRI demonstrated MCP DR consistent with acute ischemia in 29% (9/31). Of those, two showed corresponding T2 signal abnormalities on follow up MRI consistent with cerebrovascular accident (CVA) within the MCP. Both had severe gait ataxia and dysmetria requiring acute rehabilitation admission and significantly larger tumors (p = 0.02). The remaining seven were asymptomatic, and DR abnormality resolved without lasting radiographic changes. Brainstem compression was present in 100% of patients with postoperative MCP DR (mean MCP ipsilateral:contralateral ratio 0.59 ± 0.19), and 68.1% of those without (mean MCP ratio 0.71 ± 0.25), a difference that was not statistically significant (p = 0.14). In the two patients with CVA, MCP asymmetry persisted, whereas the asymmetry resolved in all others.

Conclusions:

Asymptomatic acute MCP ischemia discovered incidentally does not require intervention. However, when the ischemic area is large and patients are symptomatic, especially if an acute rehabilitation admission is required, surgeons should suspect true CVA.
Evidence of Cochlear Synaptopathy and the Effect of Systemic Steroid in Acute Idiopathic Tinnitus With Normal Hearing
Authors: Park Euyhyun , Song Insik , Jeong Yong Jun , Im Gi Jung , Jung Hak Hyun , Choi June , Rah Yoon Chan
Published: April 2021

Objective:

To evaluate the electrophysiologic evidence of cochlear synaptopathy and the effects of systemic steroids in acute idiopathic tinnitus with normal hearing.

Study Design:

Retrospective review of medical data.

Setting:

Tertiary referral center.

Patients:

Fifty-nine patients who experienced acute-onset idiopathic tinnitus (within 12 weeks) with normal hearing and the same number of age- and pure-tone threshold-matched control groups.

Intervention:

Electrophysiologic studies of the auditory pathway, oral steroids, and ginkgo biloba.

Main Outcome Measures:

Pure-tone thresholds, wave I and wave V amplitudes of the auditory brainstem response (ABR), tinnitus handicap inventory (THI), and visual analog scale (VAS).

Results:

Significantly reduced ABR wave I amplitude and wave I/wave V ratio were found in the tinnitus group compared with the no tinnitus group. Age and pure-tone threshold were significantly correlated with reduced wave I amplitude and small wave I/wave V ratio. The THI and VAS scores were decreased at 3 and 12 weeks after steroid administration; however, overall changes in THI and VAS scores were not significantly different between the steroid and ginkgo biloba groups.

Conclusion:

Potential cochlear synaptopathy was suspected in the early stage of acute idiopathic tinnitus, even in patients with normal hearing. Age and hearing threshold were potentially associated with the development of cochlear synaptopathy. Low-dose oral steroids and ginkgo biloba induced early subjective relief of tinnitus, which maintained up to 12 weeks, however, those changes did not differ between groups.
Metal Versus Plastic Stents for Pancreatic Fluid Collection Drainage
Authors: Zhou Xianzhu , Lin Han , Su Xiaoju , Zhang Pingping , Fu Chunting , Kong Xiangyu , Jin Zhendong , Li Zhaoshen , Du Yiqi , Zhu Huiyun
Published: April 2021

Objectives:

The therapeutic efficacy of metal stents (MSs) for pancreatic fluid collections (PFCs) is invariably controversial. Here, we conducted a meta-analysis to summarize the results of efficacy of MSs and plastic stents (PSs) in PFC drainage.

Subjects and Methods:

We performed a literature search of PubMed/MEDLINE, EMBASE, and COCHRANE for all of the published studies regarding the use of MSs and PSs for endoscopic transmural drainage of PFCs from January, 1 2015 to June 1, 2020. We extracted data from 9 studies (1359 patients) that met the inclusion criteria. The main outcome measures were the rates of treatment success, including technique success and clinical success (CS), adverse events, recurrence, procedure time, and length of hospital stay (LOS).

Results:

There was no difference in overall technique success between patients treated with MSs and PSs for PFCs. However, MSs showed a higher CS rate 92% versus 82% (P<0.01) and a lower overall adverse event rate 20% versus 31% (P<0.01) than PSs. The recurrence rate of PFCs using MSs also had significant advantages over PSs 3% versus 10% (P<0.01) and MSs needed a shorter procedure time than PSs (26.73 vs. 45.40 min, P<0.01). In comparing direct endoscopic necrosectomy use and LOS, there was no difference between MSs and PSs.

Conclusions:

Bringing together the results of the current study, endoscopic ultrasound-guided drainage of PFCs using MSs may be superior to PSs in terms of CS, adverse events rates and recurrence rate, with similar LOS and direct endoscopic necrosectomy use.
The Benefit of a Couple-Based Intervention Among Women in Active Cancer Treatment on Sexual Concerns
Authors: Jonsdottir Jona Ingibjorg , Vilhjalmsson Runar , Svavarsdottir Erla Kolbrun
Published: April 2021

Background

Sexuality-related problems are common in women with cancer, threatening their sexual well-being and intimate relationships. Evidence-based interventions addressing the full range of sexual concerns among women in active cancer treatment are scarce.

Objective

The aim of this study was to evaluate the benefits of a novel couple-based intervention focusing on sexual concerns among women undergoing cancer treatment, including a subgroup of women with breast cancer. A secondary aim was to assess changes in illness intrusiveness in daily life.

Methods

A quasi-experimental single-group pre-post follow-up design was used. The study was initially planned as a randomized controlled trial with waitlist control group receiving delayed intervention. However, substantial differences were observed in clinical and demographic variables between the treatment group and control group, resulting in using a single-group pre-post follow-up design. The intervention consists of 3 advanced nurse-led, face-to-face couple-based sessions supported by access to web-based information.

Results

Women in active cancer treatment participated in the study (n = 60) together with their partners (n = 60). The main results showed significant differences between time points in the outcome measures for concerns related to the sexual adverse effects of cancer treatment (T1 vs T2, and T2 vs T3), sexual concerns related to the women’s partners (T1 vs T2), and for concerns related to communication with healthcare providers about sexuality-related issues (T1 vs T2). No significant changes were found over time with respect to illness interference on the intimacy or instrumental subscales.

Conclusions

The results demonstrated that the approach of 3 couple-based therapeutic conversations is beneficial in reducing sexual concerns among women in active cancer treatment.

Implications for Practice

Advanced nurse practitioners can develop and offer brief psychoeducational support that is helpful in reducing sexual concerns among women in active cancer treatment.
Endoscopic Thyroidectomy With Level Vb Dissection Via a Chest-breast Approach: Technical Updates for Selective Lateral Neck Dissection
Authors: Huo Jinlong , Guo Youming , Hu Xiaochi , Chen Xin , Liu Wei , Luo Libo , Shen Shuang , Qu Rui
Published: April 2021

Objective:

To determine the feasibility of endoscopic thyroidectomy with level Vb dissection using a chest-breast approach.

Methods:

Lateral neck level Vb dissection by endoscopic surgery using a chest-breast approach was performed as an update to the previously reported endoscopic selective lateral neck dissection. The demographic data, surgical outcomes, and adverse events were analyzed.

Results:

A total of 12 cases were performed successfully, and no patient was converted to the open procedure. The sex ratio was 16/2 (female/male). The average age and primary lesion diameter were 36.3±5.8 years old, and 1.97±0.58 cm, respectively. The average total and lateral lymph nodes dissection time of duration was 154.6±17.0 and 276.3±19.2 minutes, respectively. The lymph node ratio (mean number of metastasis/total number of dissected nodes) at levels II, III+IV, VI, and Vb were 1.6±1.4/6.8±2.0, 5.8±2.4/14.4±3.6, 3.2±1.1/6.5±1.9, and 0.8±0.9/5.8±1.6, respectively. One of 12 patients had lymphatic leakage and 2 of 12 patients had transient hypocalcemia. There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve injury, skin bruise on neck, infection, asphyxia/dyspnea, large blood vessel injury or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the 2 groups during a short follow-up period.

Conclusions:

It is feasible to perform endoscopic thyroidectomy with level Vb dissection using a chest-breast approach. Such strategy represents another option for selective papillary thyroid carcinoma patients with levels II, III, IV, and Vb lymph node metastasis.
The Management of Indirect Inguinal Hernia Sac in Laparoscopic Inguinal Hernia Repair: A Systemic Review of Literature
Authors: Li Junsheng , Bao Pingqian , Shao Xiangyu , Cheng Tao
Published: April 2021

Background:

The aim of this study is to investigate the current management strategy of indirect hernia sac during laparoscopic inguinal hernia repair.

Objectives:

The aim was to evaluate the various indirect hernia sac management strategies when performing laparoscopic inguinal hernia repair.

Data Sources:

Major databases (PubMed, Embase, Springer, and Cochrane Library).

Review Methods:

MeSH and free-text searching include “laparoscopic inguinal hernia” “TAPP,” “TEP,” “inguinal hernia,” “indirect inguinal hernia sac,” “distal sac,” “sac transection,” “sac ligation,” and “sac reduction.”

Results:

The present study enrolled 7 trials, 4 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (odds ratio=2.74, 95% confidence interval: 1.41-4.31), and there was no statistical difference in the incidence of postoperative pain, operative time, hernia recurrence, and time to return to normal activity between the sac transection and sac reduction groups. Two studies reported the application of adjuncts in the management of distal sac during laparoscopic large inguinoscrotal hernia repair. The seroma formation could be reduced by adjuncts of fixing the distal hernia sac to posterior abdominal wall with either suture or tacks.

Conclusion:

Indirect sac transection during laparoscopic indirect inguinal hernia repair is associated with a higher incidence of postoperative seroma. Additional adjuncts to the divided distal hernia sac, including distal sac fixation with either suture or tacks, are effective methods to prevent postoperative seroma.
Simulating digital micromirror devices for patterning coherent excitation light in structured illumination microscopy
Authors: Lachetta Mario , Sandmeyer Hauke , Sandmeyer Alice , Esch Jan Schulte am , Huser Thomas , Müller Marcel
Published: April 2021

Digital micromirror devices (DMDs) are spatial light modulators that employ the electro-mechanical movement of miniaturized mirrors to steer and thus modulate the light reflected off a mirror array. Their wide availability, low cost and high speed make them a popular choice both in consumer electronics such as video projectors, and scientific applications such as microscopy. High-end fluorescence microscopy systems typically employ laser light sources, which by their nature provide coherent excitation light. In super-resolution microscopy applications that use light modulation, most notably structured illumination microscopy (SIM), the coherent nature of the excitation light becomes a requirement to achieve optimal interference pattern contrast. The universal combination of DMDs and coherent light sources, especially when working with multiple different wavelengths, is unfortunately not straight forward. The substructure of the tilted micromirror array gives rise to ablazed grating,which has to be understood and which must be taken into account when designing a DMD-based illumination system. Here, we present a set of simulation frameworks that explore the use of DMDs in conjunction with coherent light sources, motivated by their application in SIM, but which are generalizable to other light patterning applications. This framework provides all the tools to explore and compute DMD-based diffraction effects and to simulate possible system alignment configurations computationally, which simplifies the system design process and provides guidance for setting up DMD-based microscopes.

This article is part of the Theo Murphy meeting ‘Super-resolution structured illumination microscopy (part 1)’.
GPU-accelerated real-time reconstruction in Python of three-dimensional datasets from structured illumination microscopy with hexagonal patterns
Authors: Gong Hai , Guo Wenjun , Neil Mark A. A.
Published: April 2021

We present a structured illumination microscopy system that projects a hexagonal pattern by the interference among three coherent beams, suitable for implementation in a light-sheet geometry. Seven images acquired as the illumination pattern is shifted laterally can be processed to produce a super-resolved image that surpasses the diffraction-limited resolution by a factor of over 2 in an exemplar light-sheet arrangement. Three methods of processing data are discussed depending on whether the raw images are available in groups of seven, individually in a stream or as a larger batch representing a three-dimensional stack. We show that imaging axially moving samples can introduce artefacts, visible as fine structures in the processed images. However, these artefacts are easily removed by a filtering operation carried out as part of the batch processing algorithm for three-dimensional stacks. The reconstruction algorithms implemented in Python include specific optimizations for calculation on a graphics processing unit and we demonstrate its operation on experimental data of static objects and on simulated data of moving objects. We show that the software can process over 239 input raw frames per second at 512 × 512 pixels, generating over 34 super-resolved frames per second at 1024 × 1024 pixels.

This article is part of the Theo Murphy meeting issue ‘Super-resolution structured illumination microscopy (part 1)’.
Super-resolution fluorescence microscopy by line-scanning with an unmodified two-photon microscope
Authors: Pilger Christian , Pospíšil Jakub , Müller Marcel , Ruoff Martin , Schütte Martin , Spiecker Heinrich , Huser Thomas
Published: April 2021

Fluorescence-based microscopy as one of the standard tools in biomedical research benefits more and more from super-resolution methods, which offer enhanced spatial resolution allowing insights into new biological processes. A typical drawback of using these methods is the need for new, complex optical set-ups. This becomes even more significant when using two-photon fluorescence excitation, which offers deep tissue imaging and excellent z-sectioning. We show that the generation of striped-illumination patterns in two-photon laser scanning microscopy can readily be exploited for achieving optical super-resolution and contrast enhancement using open-source image reconstruction software. The special appeal of this approach is that even in the case of a commercial two-photon laser scanning microscope no optomechanical modifications are required to achieve this modality. Modifying the scanning software with a custom-written macro to address the scanning mirrors in combination with rapid intensity switching by an electro-optic modulator is sufficient to accomplish the acquisition of two-photon striped-illumination patterns on an sCMOS camera. We demonstrate and analyse the resulting resolution improvement by applying different recently published image resolution evaluation procedures to the reconstructed filtered widefield and super-resolved images.

This article is part of the Theo Murphy meeting issue ‘Super-resolution structured illumination microscopy (part 1)'.
Answers to fundamental questions in superresolution microscopy
Authors: Heintzmann Rainer
Published: April 2021

This article presents answers to the questions on superresolution and structured illumination microscopy (SIM) as raised in the editorial of this collection of articles (
https://doi.org/10.1098/rsta.2020.0143
). These answers are based on my personal views on superresolution in light microscopy, supported by reasoning. Discussed are the definition of superresolution, Abbe's resolution limit and the classification of superresolution methods into nonlinear-, prior knowledge- and near-field-based superresolution. A further focus is put on the capabilities and technical aspects of present and future SIM methods.

This article is part of the Theo Murphy meeting issue ‘Super-resolution structured illumination microscopy (part 1)’.
Inactivation of SARS-CoV-2 on surfaces and in solution with Virusend (TX-10), a novel disinfectant
Authors: Anderson Enyia R. , Hughes Grant L. , Patterson Edward I.
Published: April 2021

Until an effective vaccine against SARS-CoV-2 is available on a widespread scale, the control of the COVID-19 pandemic is reliant upon effective pandemic control measures. The ability of SARS-CoV-2 to remain viable on surfaces and in aerosols, means indirect contact transmission can occur and there is an opportunity to reduce transmission using effective disinfectants in public and communal spaces. Virusend (TX-10), a novel disinfectant, has been developed as a highly effective disinfectant against a range of microbial agents. Here we investigate the ability of Virusend to inactivate SARS-CoV-2. Using surface and solution inactivation assays, we show that Virusend is able to reduce SARS-CoV-2 viral titre by 4 log10 p.f.u. ml−1 within 1 min of contact. Ensuring disinfectants are highly effective against SARS-CoV-2 is important in eliminating environmental sources of the virus to control the COVID-19 pandemic.