All-Order Full-Coulomb Quantum Spectral Line-Shape Calculations.

Understanding how atoms interact with hot dense matter is essential for astrophysical and laboratory plasmas. Interactions in high-density plasmas broaden spectral lines, providing a rare window into interactions that govern, for example, radiation transport in stars. However, up to now, spectral line-shape theories employed at least one of three common approximations: second-order Taylor treatment of broadening operator, dipole-only interactions between atom and plasma, and classical treatment of perturbing electrons. In this Letter, we remove all three approximations simultaneously for the first time and test the importance for two applications: neutral hydrogen and highly ionized magnesium and oxygen. We found 15%-50% change in the spectral line widths, which are sufficient to impact applications including white-dwarf mass determination, stellar-opacity research, and laboratory plasma diagnostics.

Effect of Electron Capture on Spectral Line Broadening in Hot Dense Plasmas.

Accurate calculation of spectral line broadening is important for many hot, dense plasma applications. However, calculated line widths have significantly underestimated measured widths for Δn=0 lines of Li-like ions, which is known as the isolated-line problem. In this Letter, scrutinization of the line-width derivation reveals that the commonly used expression neglects a potentially important contribution from electron-capture. Line-width calculations including this process are performed with two independent codes, both of which removed the discrepancies at temperatures below 10 eV. The revised calculations also suggest the remaining discrepancy scales more strongly with electron temperature than the atomic number as was previously suggested.

A novel treatment for supraglottic stenosis secondary to immunoglobulin G4-related disease.

Although immunoglobulin G4-related disease (IgG4-RD) has a predilection for the head and neck region, laryngeal pathology is rare. We report a case of supraglottic stenosis due to IgG4-RD together with a novel treatment strategy of employing a laryngeal stent. A 69-year-old man was referred with longstanding dyspnoea and worsening inspiratory stridor. Despite two supraglottic dilations over a 12-month period, his stenosis recurred and symptoms persisted. Serum investigations revealed elevated IgG4 levels (2.390g/l), with IgG4 infiltrate in laryngeal biopsies. The patient underwent endoscopic balloon dilation, intralesional Depo-Medrone® injection, CO2 laser therapy and insertion of a laryngeal stent to prevent re-stenosis. Rituximab and prednisolone were commenced postoperatively and the stent was removed at 6weeks. No stenosis recurrence was visualised over a further 12-month follow-up period. Sixteen cases of laryngeal lesions with confirmed IgG4 infiltrate in biopsies have been reported in the worldwide literature to date. Based on a literature review and our experience, we recommend that similar laryngeal pathologies undergo early IgG4 serological testing and biopsy immunohistochemistry. Prompt diagnostic confirmation may prevent unnecessary surgical interventions and optimise immunosuppression. Furthermore, the use of a laryngeal stent following laryngeal surgery may help reduce stenotic recurrence and promote healing.

Effect of the first wave of COVID-19 on Poison Control Centre activities in 21 European countries: an EAPCCT initiative.

BACKGROUND: Public health emergencies often affect Poison Control Centre (PCC) operations. We examined possible effects of the coronavirus disease 2019 (COVID-19) pandemic on call volume, call characteristics, and workload in European PCCs. METHOD: All 65 individual European PCCs were requested to supply data on the number of calls and call characteristics (caller, age groups, reason and specific exposures) from March to June in 2018, 2019, and 2020 (Part 1). Number of calls with specific characteristics was normalised to all calls. Calls (N) and call characteristics (%) were compared between 2020 and 2018/2019 (average), within PCCs/countries and grouped. Correlation between call volume and COVID-19 cases per PCC/country was examined. All PCCs received a survey on workload (Part 2). Parts 1 and 2 were independent. RESULTS: For Part 1, 36 PCCs (21 countries) supplied 26 datasheets. PCCs in the UK and in France merged data and supplied one datasheet each with national data. Summed data showed an increase of 4.5% in call volume from 228.794 in 2018/2019 (average) to 239.170 in 2020 (p < 0.001). Within PCCs/countries, calls significantly increased for 54% of PCCs/countries (N = 14/26) and decreased for 19% (N = 5/26), three of which (N = 3/5) only serve medical professionals. Correlation between call volume and COVID-19 cases was (non-significant) positive (Rho >0.7) in 5/26 PCCs/countries (19%), and negative in 6/26 (23%). Call characteristics (median proportion of grouped data in 2018/2019 vs. 2020) changed: fewer medical professionals called (40 vs. 34%, p < 0.001), calls on intentional exposures decreased (20 vs. 17%, p < 0.012), as did calls on patients between 13 and 17 years (5 vs. 4%, p < 0.05). Calls on specific exposures increased; disinfectants from 1.9 to 5.2%, and cleaning products from 4.4 to 5.7% (p < 0.001). For Part 2, 38 PCCs (24 countries) filled the survey on workload (number/length of shifts and time on PCC duties), which increased in 23/38 PCCs (61%), while 10/38 (26%) worked with fewer employees. CONCLUSIONS: Obtaining aggregated European PCC data proved challenging but showed an increase in overall call volume and workload during the first COVID-19 wave. Call characteristics changed including fewer calls from professionals and more calls on specific exposures. Within single PCCs/countries a variety of effects was observed.

A prospective audit of early stoma complications in colorectal cancer treatment throughout the Greater Manchester and Cheshire colorectal cancer network.

AIM: The study aimed to identify the incidence of early stoma problems after surgery for colorectal cancer to identify predisposing factors and to assess the effect on discharge from hospital and the greater need for community stoma care. METHOD: A prospective study of 192 patients was carried out over a six-month period in the 13 units of the Greater Manchester and Cheshire Cancer Network. Stoma problems were categorized into fistula, leakage, pancaking, necrosis, retraction, separation, stenosis, skin problems, parastomal hernia, suboptimal stoma site and need for resiting or refashioning. Differences in incidence between units (anonymized) were analysed, and the effect of stoma complications on length of hospital stay and the need for additional community stoma care was determined. RESULTS: One hundred and ninety-two patients with stomas were included, of which 52 (27.1%) were identified as being problematic (range 0-66.7% between units). Significant risk factors included stoma type (colostomy) (P < 0.05), short stoma length (P = 0.006), higher BMI (P = 0.043), emergency surgery (P = 0.002) and lack of preoperative site marking (P < 0.001). Problematic stomas were associated with longer hospital stay (P < 0.001) and increased community care (P < 0.001). CONCLUSION: Stoma type, stoma length, body mass index, emergency surgery and lack of preoperative marking were significant risk factors. Overall complication rates compare favourably with other studies.

A rise in facial nerve palsies during the coronavirus disease 2019 pandemic.

OBJECTIVE: An increase in spontaneous lower motor neuron facial nerve (VIIth cranial nerve) palsies was seen during the severe acute respiratory syndrome coronavirus 2 outbreak in our emergency clinic. This led us to perform a single-centre cohort review. METHODS: A retrospective review was conducted of VIIth cranial nerve palsies from January to June 2020 and the findings were compared to those cases reviewed in the previous year. The severe acute respiratory syndrome coronavirus 2 incidence of the cohort was compared with that of the Liverpool population. RESULTS: Our VIIth cranial nerve palsy incidence in the 2020 period was 3.5 per cent (30 out of 852), 2.7 higher than last year's rate of 1.3 per cent (14 out of 1081), which was a statistically significant difference (p < 0.01). Two of the 17 patients in our cohort tested positive for severe acute respiratory syndrome coronavirus 2 (11.8 per cent), contrasting with Liverpool's severe acute respiratory syndrome coronavirus 2 incidence (0.5 per cent). CONCLUSION: Severe acute respiratory syndrome coronavirus 2 may be responsible for an increased number of facial nerve palsies; it is important for clinicians to be aware that this may being an initial presentation of the disease.

Patient satisfaction from ENT telephone consultations during the coronavirus disease 2019 pandemic.

BACKGROUND: Telephone consultations have rapidly increased in the out-patient setting because of the coronavirus pandemic. A quality improvement project was implemented to improve patient satisfaction of telephone consultations in our unit. METHODS: This was a prospective complete-cycle project. Patient satisfaction questionnaires were sent to patients following telephone consultations in ENT clinics. Based on a literature review and initial results, clinicians were encouraged to follow a structured consultation format. A second questionnaire survey was conducted following its implementation. RESULTS: One hundred patient questionnaires were collected during the survey (April and June 2020). There was significant improvement over the two surveys in terms of satisfaction scores (p = 0.026), along with a significantly increased preference for telephone consultations over face-to-face consultations (p = 0.021). CONCLUSION: This study showed significant improvement in patient satisfaction and an increased telephone consultation preference through the use of a structured consultation model. The potential benefits in terms of infection control and impact on out-patient workload may see telephone consultations persist in the post-coronavirus era.

Relationship of amyloid beta and neurofibrillary tau deposition in Neurodegeneration in Aging Down Syndrome (NiAD) study at baseline.

IMPORTANCE: Adults with Down syndrome (DS) are at high-risk of revealing Alzheimer's disease (AD) pathology, in part due to the triplication of chromosome 21 encoding the amyloid precursor protein. Adults with DS are uniformly affected by AD pathology by their 30's and have a 70% to 80% chance of clinical dementia by their 60's. Our previous studies have assessed longitudinal changes in amyloid beta (Aß) accumulation in DS. OBJECTIVE: The goal of the present study was to assess the presence of brain tau using [18F]AV-1451 positron emission tomography (PET) in DS and to assess the relationship of brain tau pathology to Aß using Pittsburgh Compound B (PiB)-PET. DESIGN: Cohort study. SETTING: Multi-center study. PARTICIPANTS: Participants consisted of a sample of individuals with DS and sibling controls recruited from the community; exclusion criteria included contraindications for magnetic resonance imaging (MRI) and/or a medical or psychiatric condition that impaired cognitive functioning. EXPOSURES: PET brain scans to assess Aß ([11C]PiB) and tau ([18F]AV-1451) burden. MAIN OUTCOMES AND MEASURES: Multiple linear regression models (adjusted for chronological age, sex and performance site) were used to examine associations between regional [18F]AV-1451 standard uptake value ratio (SUVR) (based on regions associated with Braak stages 1-6) and global [11C]PiB SUVR (as both a continuous and dichotomous variable). RESULTS: A cohort of 156 participants (mean age = 39.05, SD(8.4)) were examined. These results revealed a significant relationship between in vivo Aß and tau pathology in DS. As a dichotomous variable, [18F]AV-1451 retention was higher in each Braak region in PiB(+) participants. We also found, based on our statistical models, starting with the Braak 3 region of interest (ROI), an acceleration of [18F]AV-1451 SUVR deposition with [11C]PiB SUVR increases.

A cost comparison of photodynamic therapy and metallic stents in the palliation of oesophageal cancer.

BACKGROUND: There is currently little information on the cost effectiveness of photodynamic laser therapy (PDT) compared with other palliative treatments for oesophageal cancer. AIM: To compare the cost of oesophageal cancer palliation associated with PDT with those of another standard option, self-expanding metallic stents. METHODS: A cost comparison study using prospectively and retrospectively collected data was conducted. Data was collected from 25 patients who had received PDT between 1999 and 2003. Costs were compared with data from patients who received a metallic stent between 1998 and 2000. Costs were estimated using routine costs for the year 2002-2003. RESULTS: Patients receiving PDT or oesophageal stents were similar in terms of age, gender and tumour presentation. Patients receiving PDT had slightly shorter duration of symptoms, less metastatic spread but similar dysphagia scores to those in the oesophageal stent group. Costs of initial PDT treatment were significantly higher than those associated with stent placement (PDT mean costs £2068.48 versus stent mean costs £1086.76; cost difference £981.72 (95% CI: £844.47-1118.96)). This higher cost persisted throughout future re-interventions and hospital episodes. Patients receiving PDT survived longer however (132.5 (70.5-250 days) (medium IQR)) than those receiving a stent 105 (31-172.5 days), thus the mean cost per day's survival was equivalent between the two treatments. There was no impact of PDT on patients' quality of life at 6 weeks post-treatment. CONCLUSIONS: Although initially more expensive than metallic stents, a longer survival results in PDT being as cost effective as stenting in oesophageal palliation. A larger, randomised controlled trial is required combining both economic evaluation and quality of life measurement to fully establish the best palliative treatment in this disease.

Cimetidine for kidney transplantation: experimental observations.

H2-histamine receptor antagonists may augment delayed hypersensitivity. The effect of cimetidine, a H2-histamine receptor antagonist, was assessed in renal allografts in dogs. The animals in the control group (I) (n = 5) received a renal transplant and moderate immunosuppression with azathioprine and prednisone. The dogs in the experimental group (II) (n = 8) were given cimetidine in two doses (300/150 mg, twice daily). Group III (n = 4) dogs were not operated upon and received all drugs in full dosage in order to test any direct toxic effect on normal kidneys. Biweekly gastric analysis, hemoglobin, white blood count, and daily serum creatinine were monitored. The dogs in group II that received the higher dose of cimetidine rejected the transplant earlier (mean survival, 20.4 days) than the dogs in the control group (mean survival, 37.8 days). No direct toxic effect from the drug was demonstrated in the control nontransplanted group. Cimetidine in high doses suppressed both basal and host stimulation secretion of gastric acid. In summary, the finding of increased rejection episodes and diminished survival after kidney transplantation in moderately immunosuppressed dogs that received cimetidine indicates that the use of this drug in transplantation is probably not safe until more is known about the immunological mechanisms involved in this situation.

Steady-state measurement of NO and CO lung diffusing capacity on moderate exercise in men.

Using a rapidly responding nitric oxide (NO) analyzer, we measured the steady-state NO diffusing capacity (DL(NO)) from end-tidal NO. The diffusing capacity of the alveolar capillary membrane and pulmonary capillary blood volume were calculated from the steady-state diffusing capacity for CO (measured simultaneously) and the specific transfer conductance of blood per milliliter for NO and for CO. Nine men were studied bicycling at an average O(2) consumption of 1.3 +/- 0.2 l/min (mean +/- SD). DL(NO) was 202.7 +/- 71.2 ml. min(-1). Torr(-1) and steady-state diffusing capacity for CO, calculated from end-tidal (assumed alveolar) CO(2), mixed expired CO(2), and mixed expired CO, was 46.9 +/- 12.8 ml. min(-1). Torr(-1). NO dead space = (VT x FE(NO) - VT x FA(NO))/(FI(NO) - FA(NO)) = 209 +/- 88 ml, where VT is tidal volume and FE(NO), FI(NO), and FA(NO) are mixed exhaled, inhaled, and alveolar NO concentrations, respectively. We used the Bohr equation to estimate CO(2) dead space from mixed exhaled and end-tidal (assumed alveolar) CO(2) = 430 +/- 136 ml. Predicted anatomic dead space = 199 +/- 22 ml. Membrane diffusing capacity was 333 and 166 ml. min(-1). Torr(-1) for NO and CO, respectively, and pulmonary capillary blood volume was 140 ml. Inhalation of repeated breaths of NO over 80 s did not alter DL(NO) at the concentrations used.

A comparison of external velour and double velour Dacron grafts in the canine thoracic aorta.

Six external velour (Bionit C. R. Bard, Inc.; Billerica, MA) and 11 double velour (Microvel Meadox Medicals, Inc.; Oakland, NJ) warp-knit Dacron grafts with lengths of 6 cm and diameters of 8 mm were implanted in the canine upper descending thoracic aorta for 56 days. Differences were observed: four of 11 double velour grafts developed major perigraft hematomas, while none of the external velour grafts exhibited this complication. Healing of the external velour grafts was virtually complete (average full wall healing and endothelial-like cell coverage of 97.0%, SD 5.9%) in contrast to the seven (of 11) double velour grafts that were free of perigraft hematoma (average full wall healing and endothelial-like cell coverage of 40.9%, SD 20.9%).

Total parenteral nutrition in renal transplantation. Experimental observations.

The nutritional support of the transplant recipient as a means of improving the allograft response after transplantation has not been investigated. This experimental study was designed in an attempt to define the role of malnutrition and total parenteral nutrition (TPN) on the rejection of canine renal allografts. Twenty-three mongrel dogs (18-23 kg) received kidney transplants from unrelated donors. All animals were minimally immunosuppressed with azathioprine (5.0-2.5 mg/K/day). Daily serum creatinines, biweekly complete blood counts, serum protein, and total iron binding capacity (TIBC) were determined. Postmortem examination was performed on all animals. Four groups of animals were compared: Group I (n = 5) served as a control and was maintained postoperatively on a regular balanced diet (RBD). Group II (n = 6) and Group IV (n = 6) were gradually malnourished prior to operation by diet leading to 12 to 22 per cent loss of weight, decreased albumin (2.0-2.6 mg/dl) and decreased TIBC (greater than 30%). After transplantation, Group II was maintained on 50 per cent RBD, and in Group IV, TPN was started two days prior to transplantation. The rejection times were 6.2 +/- 1.2, 9.5 +/- 3.5, 12.0 +/- 3.9, and 9.1 +/- 4.1 (mean +/- SD) days, respectively, for Group I through IV. TPN was not detrimental or beneficial to the allograft response of canine kidneys. Malnutrition, however, delayed significantly (P less than 0.005) the appearance of rejection after transplantation. Our findings appear to suggest that TPN could be safely used prior to and after transplantation if indicated, since it does not significantly alter the dog allogenic response following transplantation.

Influence on healing in the canine thoracic aorta of three substances used to close the interstices of macroporous Dacron grafts.

The influence on healing of three materials for closure of interstices in a macroporous Dacron arterial prosthesis were evaluated by 56-day implantation in the canine descending thoracic aorta. The materials studied were: the nondenatured fibrin deposited as a result of a 4-step preclot with autogeneic blood (n = 6), heat-coagulated autogeneic blood deposited by autoclaving the blood-soaked prosthesis (n = 6), and cross-linked human albumin (n = 6). Healing of autogeneic fibrin was superior with little difference between the other two materials.

Role of posttransplant kidney biopsy after hypothermic pulsatile perfusion.

Biopsies were obtained from 24 perfused cadaver kidneys. The histologic findings were correlated with short- and long-term kidney function after transplantation. There was no correlation between structural findings present immediately after perfusion and transplantation and short- or long-term kidney function. Thus, we believe that one-hour posttransplant kidney biopsy does not have a role in assessing recently perfused and transplanted kidneys.

A clinical comparison of Dacron patch closure of small-caliber carotids compared with primary closure of large-caliber carotids after endarterectomy.

The objective was to study results of carotid endarterectomies performed between 1975 and 1991, comparing primary closure to Dacron patch closure. This was a retrospective study. Data from patient follow-up by physical examination, chart review, and Duplex study were used. Scan data were obtained in 92 of the primary cases, at a mean of 5 years postoperatively, and in 63 of the patch cases, at a mean of 4.1 years postoperatively. During this period, 269 endarterectomies were closed primarily and 101 were closed with a knitted Dacron patch. Twenty patients in the primary group and nine patients with patch closure were lost to follow-up, which extended for up to 12.5 years, with a mean of 4.7 +/- 3.6 years. No acute closures, infections or aneurysms developed in either group. Perioperative stroke incidence was 4.1 per cent for primary closure and 3.0 per cent for the patch group (P > 0.05). Late stenosis occurred in 17.3 per cent of the primary group and 11.1 per cent of the patch closure group (P > 0.05). Five-year survival was 76.2 per cent in the primary group, compared with 79.2 per cent for patch closure. Late stroke incidence was 2.8 per cent in the primary group and 3.3 per cent in the patch closure group. Results of smaller (< or = 3.5 mm) carotid arteries closed with knitted Dacron patches are equivalent to those of larger carotid arteries closed primarily.

The prevalence and patterns of dental caries in Labrador Inuit youth.

OBJECTIVES: This study was undertaken to examine the prevalence of dental caries in Inuit (Eskimo) youth aged 5-22 years. METHODS: Both tooth-oriented indices and child-oriented caries patterns were recorded in a field study conducted in 1991 in Nain and Hopedale, Northern Labrador. Seventy-eight percent (N = 347) of all school-children in these two locations were examined by a single examiner. RESULTS: Three percent of the population were caries free and 88 percent of those with caries experience had untreated dental decay. The mean combined dmft and DMFT per child for all ages was 6.85, while the mean combined dmfs and DMFS was 15.72. About 38 percent of subjects had pit and fissure caries; 2 percent had hypoplastic lesions; 4 percent had faciolingual caries; 31 percent had molar-approximal caries and 22 percent had faciolingual and molar-approximal caries, the most destructive caries pattern. About 68 percent of the 5-6-year-olds and 26 percent of the 15-22-year-olds experienced the most destructive pattern of decay in their primary and permanent dentitions, respectively. CONCLUSIONS: Preventive measures should start well before the age of 5 years. Describing caries patterns according to the dentition type complemented the traditional indices.

Use of arm veins for lower extremity arterial bypass--results, anatomical features and technical considerations.

Forty lower limb bypasses using arm veins were performed on 37 patients. The indications for surgery were limb threat in 50% of cases, graft failure in 33%, aneurysms in 10% and claudication in 7%. Saphenous veins were absent because of prior use in 73% of cases, and because they were unsuitable in 27%. A single vein was used in 48%, 2 veins in 40% and 3 veins in 12% of cases. Seventy-four per cent of cases had a single-vessel run-off below the distal anastomosis. Eighty-two per cent of the distal anastomoses were to infrapopliteal arteries. The primary and secondary rates of these 40 bypasses at a mean follow-up of 14 months (range 1-40 months) were 74% and 90%, respectively. Limb salvage was 94%. Peri-operative morbidity and mortality were 23% and 3%, respectively. The anatomical and technical aspects of harvesting arm veins are critical to the success of this procedure and will be emphasised. We have found arm veins to be a durable source of accessible autogenous grafts for lower limb revascularisation in the absence of suitable saphenous veins.

Intussusception of the appendix secondary to mucinous cystadenoma: A rare cause of abdominal pain.

A 35-year-old woman was seen as an outpatient with a 3-month history of pain in the right iliac fossa. A CT scan of her abdomen revealed the presence of a mucocele of the appendix. Intra-operatively, an appendico-appendicular intussusception was found. Histology confirmed the presence of a mucinous cystadenoma with the presence of acellular mucin on the serosal surface of the appendix. This association has rarely been described in the literature. Prompt surgical intervention is advocated to prevent the subsequent development of pseudomyxoma peritonei. We present a case of intussusception of the appendix with a mucinous cystadenoma as its lead point.

The pharmacokinetics and safety of porfimer after repeated administration 30-45 days apart to patients undergoing photodynamic therapy.

BACKGROUND: Porfimer is an intravenous (i.v.) injectable photosensitizing agent used in the photodynamic treatment of tumours and of high-grade dysplasia in Barrett's oesophagus. AIM: To assess the pharmacokinetics as well as the safety profiles of porfimer after a first and a second dose administered 30-45 days apart in patients undergoing photodynamic therapy. METHODS: Nineteen patients (16 with cholangiocarcinoma) were enrolled. Porfimer sodium was administered by i.v. injection over 3-5 min. Blood samples were collected prior to starting i.v. drug injection and postdose at different time points after the first and second administrations. RESULTS: Porfimer exposure values after the second administration were statistically higher than those observed after the first administration, suggesting a slight accumulation of porfimer following repeated administration. The apparent mean elimination half-life of porfimer increased from 410 h after the first administration to 725 h after the second administration. The safety profiles of porfimer after a first and a second administration were similar and did not raise additional concern. Eight patients experienced nine serious adverse events. Only photosensitivity was deemed study-drug related. CONCLUSION: Porfimer appears to display a safe and tolerable profile when used in patients requiring a second photodynamic therapy within 45 days.