Confocal microscopy 3D imaging and bioreactivity of La Palma volcanic ash particles.

In September 2021 an eruption began of Cumbre Vieja, La Palma (Spain) that lasted 3 months. Previous studies have shown that volcanic ash particles can be associated with adverse effects on human health however, the reasons for this are unclear. Particle shape has been shown to contribute to cellular uptake in prostate cancer cells. Hence we aimed to study 3D structure, elemental composition and effects on cultured lung cells of particles collected from the La Palma volcanic eruption. 3D imaging of PM10 sized and below particles was performed using a LEXT OLS4100 confocal microscope (Olympus Corporation, Japan). A Zeiss EVO 50 (Carl Zeiss AG, Germany) Scanning Electron Microscope (SEM) was used to assess elemental composition. In addition, volcanic particle concentration dose response for pneumococcal adhesion to A549 human alveolar epithelial cells was investigated. Confocal microscopy showed that some PM10 and below sized particles had sharp or angular 3D appearance. SEM x-ray analysis indicated silicate particles with calcium, aluminium and iron. We observed increased colony forming units indicating increased Pneumococcal adhesion due to exposure of cells to volcanic particles. Thus in addition to the toxic nature of some volcanic particles, we suggest that the observed sharp surface particle features may help to explain adverse health effects associated with volcanic eruptions.

Recognising and managing eating disorders in the emergency department.

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.

Recognising and managing eating disorders in the emergency department.

Compared with other mental health conditions or psychiatric presentations, such as self-harm, which may be seen in emergency departments, eating disorders can seem relatively rare. However, they have the highest mortality across the spectrum of mental health, with high rates of medical complications and risk, ranging from hypoglycaemia and electrolyte disturbances to cardiac abnormalities. People with eating disorders may not disclose their diagnosis when they see healthcare professionals. This can be due to denial of the condition itself, a wish to avoid treatment for a condition which may be valued, or because of the stigma attached to mental health. As a result their diagnosis can be easily missed by healthcare professionals and thus the prevalence is underappreciated. This article presents eating disorders to emergency and acute medicine practitioners from a new perspective using the combined emergency, psychiatric, nutrition and psychology lens. It focuses on the most serious acute pathology which can develop from the more common presentations; highlights indicators of hidden disease; discusses screening; suggests key acute management considerations and explores the challenge of mental capacity in a group of high-risk patients who, with the right treatment, can make a good recovery.

Management of Haemarthrosis in Patients On Oral Anticoagulants.

Aims: Our aim was to investigate the management of patients who were admitted to hospital with an acute haemarthrosis whilst taking oral anticoagulants, and highlight the outcomes of different management strategies. Methods: A retrospective review was performed of all orthopaedic admissions over a 42-month period (January 2015-July 2018) to the Orthopaedic Department of a London District General Hospital. All patients admitted with a spontaneous joint haemarthrosis and concomitant use of oral anticoagulants was identified. Anonymised data was placed on a secure trust database. Findings: A total of 31 patients were included. 22 patients (71%) had their anticoagulant temporarily held during admission. 9 patients (32%) had their anticoagulation reversed with 10 mg of vitamin K. 5 patients had their haemarthrosis aspirated either on admission or during their hospital stay. The overall mean length of stay in patients with a haemarthrosis was 7.0 days. The mean length of stay in patients who had their anticoagulation held was 8.6 days. In contrast, patients who continued taking their anticoagulation were found to have an average length of stay of 2.3 days. No patients suffered a thrombotic event in the 60 days following discharge. No adverse events were recorded following joint aspiration. Conclusion: There is currently no consensus on the management of haemarthrosis in patients on oral anticoagulants. Continuing the anticoagulants did not increase length of hospital stay. Further research may focus on assessing the effect of management adjuncts on patient outcomes and their cost effectiveness to aid the development of local and/or national guidelines.

Confocal microscopy 3D imaging of diesel particulate matter.

To date, diesel particulate matter (DPM) has been described as aggregates of spherule particles with a smooth appearing surface. We have used a new colour confocal microscope imaging method to study the 3D shape of diesel particulate matter (DPM); we observed that the particles can have sharp jagged appearing edges and consistent with these findings, 2D light microscopy demonstrated that DPM adheres to human lung epithelial cells. Importantly, the slide preparation and confocal microscopy method applied avoids possible alteration to the particles' surfaces and enables colour 3D visualisation of the particles. From twenty-one PM10 particles, the mean (standard deviation) major axis length was 5.6 (2.25) µm with corresponding values for the minor axis length of 3.8 (1.25) µm. These new findings may help explain why air pollution particulate matter (PM) has the ability to infiltrate human airway cells, potentially leading to respiratory tract, cardiovascular and neurological disease.

The acute Charcot foot in diabetics: Diagnosis and management.

Acute Charcot foot is a diagnostic challenge.The exact pathophysiology is not fully understood.Acute Charcot foot is often present with a history of trauma or cellulitis which does not respond to antibiotics.The condition is best managed within a multidisciplinary team.The mainstay of the treatment is mechanical off-loading and total contact casting.Surgery is reserved for select cases. Cite this article: EFORT Open Rev 2018;3:568-573. DOI: 10.1302/2058-5241.3.180003.

A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy.

PURPOSE: To determine whether platelet-rich plasma (PRP) injections are associated with improved pain and function scores when compared with corticosteroid injections for plantar fasciopathy. METHODS: A systematic review of published literature was performed for studies comparing PRP injections and corticosteroid injections for plantar fasciopathy. Studies were assessed using the Cochrane Risk of Bias Tool and the Newcastle Ottawa Scale (NOS). The primary endpoint was pain and function score at three and six month follow-up. Sensitivity analysis was performed for high quality studies and randomised studies. RESULTS: Ten studies totalling 517 patients were included. Seven studies were randomised. All studies included patients who had failed conservative measures and excluded patients with systemic illness and other causes of foot pain. Studies reported outcomes using the visual analogue score (VAS) and American Orthopaedic Foot and Ankle Score (AOFAS). At 3-month follow-up, PRP injections were associated with improved VAS scores (standard mean difference [SMD], -0.66; 95% CI, -1.3 to -0.02; p = 0.04) and AOFAS scores (SMD, 1.87; 95% CI, 0.16-3.58; p = 0.03). At 6-month follow-up, there was no difference in VAS score (SMD, -0.66; 95% CI, -1.65 to 0.3; p = 0.17) or AOFAS scores (SMD, 1.69; 95% CI, -1.06 to 4.45; p = 0.23). No studies reported adverse event rates or cost analysis. There was no difference in pain or function score at one, six- or 12-month follow-up. Sensitivity analyses of high-quality studies showed no differences between the PRP and steroid group at any of the follow-up points. CONCLUSIONS: PRP injections are associated with improved pain and function scores at three month follow-up when compared with corticosteroid injections. Information regarding relative adverse event rates and cost implications is lacking. Further, large-scale, high-quality, randomised controlled trials with blinding of outcome assessment and longer follow-up are required.

High resolution 3D confocal microscope imaging of volcanic ash particles.

We present initial results from a novel high resolution confocal microscopy study of the 3D surface structure of volcanic ash particles from two recent explosive basaltic eruptions, Eyjafjallajökull (2010) and Grimsvötn (2011), in Iceland. The majority of particles imaged are less than 100µm in size and include PM10s, known to be harmful to humans if inhaled. Previous studies have mainly used 2D microscopy to examine volcanic particles. The aim of this study was to test the potential of 3D laser scanning confocal microscopy as a reliable analysis tool for these materials and if so to what degree high resolution surface and volume data could be obtained that would further aid in their classification. First results obtained using an Olympus LEXT scanning confocal microscope with a ×50 and ×100 objective lens are highly encouraging. They reveal a range of discrete particle types characterised by sharp or concave edges consistent with explosive formation and sudden rupture of magma. Initial surface area/volume ratios are given that may prove useful in subsequent modelling of damage to aircraft engines and human tissue where inhalation has occurred.

Are metacognitive processes associated with posttraumatic stress symptom severity following acquired brain injury?

PURPOSE: Although posttraumatic stress disorder (PTSD) after acquired brain injury (ABI) is relatively common, its causal mechanisms remain speculative and little research has considered psychological perspectives. The current study aimed to examine whether metacognitive variables were associated with posttraumatic stress symptom (PTSS) severity in individuals with an ABI. METHODS: Participants who had a traumatic brain injury (n = 47) or subarachnoid haemorrhage (n = 93) completed questionnaires related to demographic, clinical, social support and metacognitive variables. Correlation analyses and a hierarchical multiple regression analysis, with total PTSS severity used as the outcome variable, were conducted. RESULTS: Results demonstrated that metacognitive factors were correlated with PTSS severity and were able to explain an additional and significant amount of variance in PTSS severity within the regression analysis. CONCLUSIONS: The results provide preliminary support that metacognitive variables are associated with PTSS after ABI. Clinical implications within rehabilitative settings are discussed, as well as theoretical and research implications in the context of the study's limitations. IMPLICATIONS FOR REHABILITATION: Posttraumatic stress disorder (PTSD) can impede quality of life after brain injury. Clinical, social and metacognitive processes all influence the development of PTSD after brain injury and should be considered within rehabilitative care plans. Rehabilitative care plans should incorporate interventions for PTSD when appropriate, and metacognitive interventions could prove beneficial.

Psychosocial and psychological factors associated with post-traumatic stress disorder following traumatic brain injury in adult civilian populations: a systematic review.

PRIMARY OBJECTIVE: Increasing support exists for the development of post-traumatic stress disorder (PTSD) after traumatic brain injury (TBI). Despite the psychological nature of PTSD, previous reviews have mainly focused on the injury-related and neurological characteristics of its presentation in TBI. Consequently, this review systematically examined the psychological and psychosocial variables associated with PTSD symptoms after TBI in civilian adults. METHODS: Detailed searching retrieved 28 relevant articles which met the inclusion criteria. Each article underwent a thorough quality assessment procedure and data were extracted relevant to the review's aims. RESULTS: Results highlighted several psychological and psychosocial variables associated with PTSD after TBI, including historical factors and those which become relevant after the traumatic event. Furthermore, the results indicated that some factors were not associated with PTSD after TBI, despite a relationship existing with PTSD in the general population. The findings of the quality assessment were utilized throughout the formation of results. CONCLUSIONS: The review highlights the importance of addressing psychological and psychosocial factors within the assessment and treatment of PTSD after TBI. The limitations of the research are highlighted and the clinical and research implications discussed.

Ten year results of the collum femoris preserving total hip replacement: a prospective cohort study of seventy five patients.

PURPOSE: The collum femoris preserving (CFP) uncemented prosthesis has a bone-preserving, high subcapital neck resection and a short anatomical stem. The ideal arthroplasty option in the younger, active patient is a subject of some debate. We evaluated midterm outcomes of the CFP in this patient population. METHODS: A prospective, consecutive cohort of 75 CFP total hip replacement (THR) patients with a mean age of 52 years was followed for a mean of 9.3 years. Patients were assessed using the Harris Hip Score (HHS). Pain was assessed using a visual analogue scale (VAS) and activity levels using the University of California, Los Angeles (UCLA) score. Radiographs were evaluated for evidence of loosening. Survivorship was calculated with an endpoint of revision for aseptic loosening or radiographic evidence of loosening. RESULTS: Mean HHS improved from a mean of 50 pre-operatively to 91 (p < 0.001) postoperatively. Mean pain score was 1, mean patient satisfaction was 9 and mean UCLA score was 6. Two acetabular components were revised for aseptic loosening; no stem required revision. Radiographically, no cases had evidence of loosening. Survivorship was 96.8 % for the acetabular component and 100 % for the stem at ten years. Three patients died from unrelated causes, and five were lost to follow-up. CONCLUSIONS: Bone-preserving hip replacement has increased in popularity as hip replacement in younger and more active individuals increases. The CFP prosthesis has excellent midterm clinical function and survival and provides high levels of satisfaction in young patients.

Flexor digitorum longus tendon harvest length utilising a limited operative exposure: A cadaveric study.

BACKGROUND: Flexor digitorum longus (FDL) is a commonly used donor tendon for transfer to substitute for a dysfunctional tibialis posterior in the management of adult acquired flatfoot deformity. The tendon transfer is attached to the navicular bone via a drill hole. Interference-fit screws are an alternative means of securing a transferred tendon allowing for a shorter length of graft and less extensive dissection. The aim of this cadaveric study was to investigate the length of FDL tendon harvest required for transfer and to determine if this length of tendon can be obtained without formal dissection to the Knot of Henry. METHODS AND RESULTS: The FDL tendon was exposed in 8 cadaveric specimens via a medial hindfoot incision. The tendon was divided proximal to the Knot of Henry. The lengths of the skin incisions and the length of the FDL tendon harvest were measured. No specialist tendon harvesting instruments were used. The average length of the skin incision was 9.0cm (95% confidence intervals 8.0-10.0cm). The average length of the harvested FDL tendon was 6.7cm (95% confidence intervals 6.4-7.0cm). CONCLUSION: This study demonstrates that the FDL tendon can be safely and adequately harvested via a limited exposure. The average length of FDL tendon harvest via this approach compares favourably with other descriptions of approaches. This shorter graft length is more than adequate, allowing at least 2cm for fixation by interference screw to a tunnel in the navicular bone.

Clients' perspectives of rehabilitation in one acquired brain injury residential rehabilitation unit: a thematic analysis.

PRIMARY OBJECTIVE: To examine clients' perspectives on residential rehabilitation for acquired brain injury (ABI). RESEARCH DESIGN: Qualitative semi-structured interviews. METHOD: Seven individuals who resided in a single residential rehabilitation unit for ABI were interviewed and thematic analysis was used to identify themes in their responses. MAIN OUTCOMES AND RESULTS: The analysis identified four themes: rebuilding self-belief, reflecting participants' sense of independence and confidence in their ability; recognition of personal identity, including a number of personal traits; acceptance and change, incorporating coming to terms with their ABI and identifying change; and a sense of community atmosphere, reflecting clients' perception of their own role and relationships with others. CONCLUSION: The results provide in-depth qualitative understanding of how clients' perceived their experience within a residential rehabilitation unit for ABI. Implications of the results are discussed, including the identification of potential beneficial talking therapies for clients within this setting.

The synergistic effect of autograft and BMP-7 in the treatment of atrophic nonunions.

UNLABELLED: Combining autologous bone graft and recombinant human bone morphogenetic protein-7 (BMP-7) to treat long-bone fracture aseptic atrophic nonunions theoretically could promote bone healing at higher rates than each of these grafting agents separately. We retrospectively reviewed prospectively collected data on patient general characteristics, clinical outcomes, and complications over 3 years to determine the healing rates and the incidence of complications and adverse events of this "graft expansion rationale." There were 45 patients (32 male) with a median age of 43 years (range, 19-76 years). Minimum followup was 12 months (mean, 24.5 months; range, 12-65 months). There were seven humeral, 19 femoral, and 19 tibial nonunions. The median number of prior operations was two (range, 1-7). All fractures united. Clinical and radiographic union occurred within a median of 5 months (range, 3-14 months) and 6 months (range, 4-16 months), respectively. Thirty-nine (87%) patients returned to their preinjury occupation at a mean of 4.2 months (range, 3-6 months). The median visual analog scale pain score was 0.9 (range, 0-2.8; maximum 10), and the median functional score was 86 (range, 67-95; maximum 100) at the final followup. BMP-7 as a bone-stimulating agent combined with conventional autograft resulted in a nonunion healing rate of 100% in these 45 patients. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.