Objectives
To demonstrate the efficacy and cost‐effectiveness of acute extracorporeal shockwave lithotripsy (ESWL) for ureteric stones we present our experience of ESWL in 530 ureteric stone cases, ...in the largest UK series we are aware of to date. ESWL is underutilised in ureteric stone management. The Getting It Right First Time (GIRFT) report showed just four units nationally treated >10% of acute ureteric stones with ESWL. Despite guideline recommendations as a first‐line treatment option, few large volume studies have been published.
Patients and Methods
Retrospective review of prospectively collected data between December 2012 and February 2020 was performed. Data relating to patient demographics, stone characteristics, skin‐to‐stone distance, and treatment failure were collected. Cost analysis was conducted by the Trust’s surgical financial manager. Multivariable analyses were performed to assess for predictors of ESWL success.
Results
A success rate of 68% (95% confidence interval 64%–72%) at 6 weeks was observed (n = 530). The median (interquartile range) number of treatment sessions was 2 (1, 2). Stone diameter was observed to be a predictor of ESWL success. The small number of stones treated of >13 mm or >1250 HU had an ~50% chance of successful treatment. Acute ureteric ESWL was less costly than acute ureterorenoscopy, consistent with findings from previous NHS studies.
Conclusion
Acute ESWL is a safe, reliable, and financially viable treatment option for a wider spectrum of patients than reflected in international guidelines based on our large, heterogenous series. In the coronavirus disease 2019 (COVID‐19) era, with theatre access reduced and concerns over aerosol generating procedures, acute ESWL remains an attractive first‐line treatment option.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Defining the conditions that lead to the rupture of a magma chamber is essential to forecast eruptions. So far, models simulating magma chamber dynamics have neglected the effects of elastic thermal ...expansion in the host rocks surrounding a new injection of magma, focusing instead primarily on elastic-plastic deformation and more recently, on visco-elastic deformation. Here we fill this gap by building a suite of elastic thermo-mechanical models to determine the stress field around a variably heated crustal magma chamber. We first consider linear elastic mechanical models with only the effect of magma pressure. We then present purely thermal models simulating heat distribution around a heated chamber. Finally, we present coupled linear elastic thermo-mechanical models that highlight the influence of temperature on the distribution of crustal stresses. Results show that thermal expansion–induced stresses generate two competing consequences: (1) they increase the level of shear stress around the magma chamber and (2) they partially suppress the level of tensile stress generated by the magmatic pressure. These competing effects influence the short-timescale conditions required for the failure of immature magmatic systems and hence the nucleation of dikes which may ultimately feed eruptions during unrest. Therefore, soon after a new magmatic recharge event, the contribution of temperature increase in the host rocks, following the new influx of magma into a crustal magma chamber, should be considered.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The biogeochemical cycle of zinc (Zn) in the South Atlantic, at 40°S, was investigated as part of the UK GEOTRACES program. To date there is little understanding of the supply of Zn, an essential ...requirement for phytoplankton growth, to this highly productive region. Vertical Zn profiles displayed nutrient‐like distributions with distinct gradients associated with the water masses present. Surface Zn concentrations are among the lowest reported for the world's oceans (< 50 pM). A strong Zn‐Si linear relationship was observed (Zn (nM) = 0.065 Si (μM), r2 = 0.97, n = 460). Our results suggest that the use of a global Zn‐Si relationship would lead to an underestimation of dissolved Zn in deeper waters of the South Atlantic. By utilizing Si* and a new tracer Zn* our data indicate that the preferential removal of Zn in the Southern Ocean prevented a direct return path for dissolved Zn to the surface waters of the South Atlantic at 40°S and potentially the thermocline waters of the South Atlantic subtropical gyre. The importance of Zn for phytoplankton growth was evaluated using the Zn‐soluble reactive phosphorus (SRP) relationship. We hypothesize that the low Zn concentrations in the South Atlantic may select for phytoplankton cells with a lower Zn requirement. In addition, a much deeper kink at ~ 500m in the Zn:SRP ratio was observed compared to other oceanic regions.
Key Points
Dissolved zinc biogeochemical cycle investigated in the South Atlantic Ocean
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FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Abstract Targeted delivery of potent, toxic chemotherapy drugs, such as cisplatin, is a significant area of research in cancer treatment. In this study, cisplatin was successfully encapsulated with ...high efficiency (> 70%) in poly (lactic-co-glycolic acid) polymeric nanoparticles by using electrohydrodynamic atomization (EHDA) where applied voltage and solution flow rate as well as the concentration of cisplatin and polymer were varied to control the size of the particles. Thus, nanoparticles were produced with three different drug:polymer ratios (2.5, 5 and 10 wt% cisplatin). It was shown that smaller nanoparticles were produced with 10 wt% cisplatin. Furthermore, these demonstrated the best sustained release (smallest burst release). By fitting the experimental data with various kinetic models it was concluded that the release is dependent upon the particle morphology and the drug concentration. Thus, these particles have significant potential for cisplatin delivery with controlled dosage and release period that are crucial chemotherapy parameters.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Highlights • SEBT and LOS scores were inversely related. • Both may be valid but measure different points on the balance continuum. • Care is needed when choosing balance tests.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
The availability of iron (Fe) and phosphorus (P) has been shown
to be a key factor regulating rates of nitrogen fixation in the western
subtropical Pacific. However, the relative importance of Fe and ...P at finer spatial
scales between the northern South China Sea (NSCS) and the western boundary
of the North Pacific is poorly constrained. Furthermore, nutrient limitation
of specific diazotroph types has not yet been assessed. Here we investigated
these unknowns by (i) carrying out measurements of finer-scale spatial
variabilities in N2 fixation rates and diazotroph nifH gene abundances
throughout these regions and (ii) conducting eight additional Fe and
phosphate addition bioassay experiments where both changes in N2
fixation rates and the nifH gene abundances of specific diazotrophs were
measured. Overall, nitrogen fixation rates and nifH gene abundances were lower
in the NSCS than around the Luzon Strait and the western North Pacific. The
nutrient addition bioassay experiments demonstrated that N2 fixation
rates in the central NSCS were co-limited by Fe and P, whereas at the
western boundary of the North Pacific they were P-limited. Changes in the
abundances of nifH in response to nutrient addition varied in how well they
correlated with changes in N2 fixation rates, and in six out of eight
experiments the largest responses in nifH gene abundances were dominated by
either Trichodesmium or UCYN-B (unicellular diazotrophic cyanobacteria group B). In general, nutrient addition had a relatively restricted
impact on the composition of the six phylotypes that we surveyed apart from
on UCYN-B. This unicellular cyanobacterium group showed increased
contribution to the total nifH gene abundance following P addition at sites
where N2 fixation rates were P-limited. Our study provides
comprehensive evidence of nutrient controls on N2 fixation biogeography
in the margin of the western North Pacific. Future research that more
accurately constrains nutrient supply rates to this region would be
beneficial for resolving what controls diazotroph community structure.
Psoriasis is a chronic, immune-mediated inflammatory disease with prominent cutaneous features, although the limited number of medications approved for pediatric psoriasis makes treating this ...population difficult. This review provides an overview of the challenges associated with diagnosing and treating pediatric psoriasis as well as the approved and off-label treatments for children and infants with psoriasis.
Articles relevant to pediatric psoriasis were identified using a series of PubMed searches. Topics relevant to pediatric psoriasis were explored, including disease characteristics, epidemiology, treatment efficacy and safety, and access to care. Publications previously known to the authors were also included.
Clinical features of psoriasis can be challenging to identify clinically, and patients face challenges gaining access to treatment. Most medications that have been approved for adult psoriasis lack data and labeling to support safe and effective use in pediatric patients, and therefore access is limited. A growing number of clinical trials using biologic agents for pediatric psoriasis aim to broaden available treatment options but may also raise unique concerns associated with the use of these medications in children.
Pediatric psoriasis is underrecognized and often undertreated. Clinicians must balance relative risks and potential benefits when developing a treatment strategy for these patients.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
We report the distributions and stoichiometry of dissolved zinc (dZn) and
cobalt (dCo) in sub-tropical and sub-Antarctic waters of the south-eastern
Atlantic Ocean during austral spring 2010 and ...summer 2011/2012. In
sub-tropical surface waters, mixed-layer dZn and dCo concentrations during
early spring were 1.60 ± 2.58 nM and 30 ± 11 pM, respectively,
compared with summer values of 0.14 ± 0.08 nM and 24 ± 6 pM. The
elevated spring dZn concentrations resulted from an apparent offshore
transport of elevated dZn at depths between 20–55 m, derived from
the Agulhas Bank. In contrast, open-ocean sub-Antarctic surface waters
displayed largely consistent inter-seasonal mixed-layer dZn and dCo
concentrations of 0.10 ± 0.07 nM and 11 ± 5 pM, respectively.
Trace metal stoichiometry, calculated from concentration inventories,
suggests a greater overall removal for dZn relative to dCo in the upper water
column of the south-eastern Atlantic, with inter-seasonally decreasing dZn / dCo
inventory ratios of 19–5 and 13–7 mol mol−1 for
sub-tropical surface water and sub-Antarctic surface water, respectively. In
this paper, we investigate how the seasonal influences of external input and
phytoplankton succession may relate to the distribution of dZn and dCo and
variation in dZn / dCo stoichiometry across these two distinct ecological
regimes in the south-eastern Atlantic.
To describe the underlying principles used to develop a web-based algorithm that incorporated intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment for diabetic macular edema ...(DME) in a Diabetic Retinopathy Clinical Research Network (DRCR.net) randomized clinical trial.
Discussion of treatment protocol for DME.
Subjects with vision loss resulting from DME involving the center of the macula.
The DRCR.net created an algorithm incorporating anti-VEGF injections in a comparative effectiveness randomized clinical trial evaluating intravitreal ranibizumab with prompt or deferred (≥24 weeks) focal/grid laser treatment in eyes with vision loss resulting from center-involved DME. Results confirmed that intravitreal ranibizumab with prompt or deferred laser provides superior visual acuity outcomes compared with prompt laser alone through at least 2 years. Duplication of this algorithm may not be practical for clinical practice. To share their opinion on how ophthalmologists might emulate the study protocol, participating DRCR.net investigators developed guidelines based on the algorithm's underlying rationale.
Clinical guidelines based on a DRCR.net protocol.
The treatment protocol required real-time feedback from a web-based data entry system for intravitreal injections, focal/grid laser treatment, and follow-up intervals. Guidance from this system indicated whether treatment was required or given at investigator discretion and when follow-up should be scheduled. Clinical treatment guidelines, based on the underlying clinical rationale of the DRCR.net protocol, include repeating treatment monthly as long as there is improvement in edema compared with the previous month or until the retina is no longer thickened. If thickening recurs or worsens after discontinuing treatment, treatment is resumed.
Duplication of the approach used in the DRCR.net randomized clinical trial to treat DME involving the center of the macula with intravitreal ranibizumab may not be practical in clinical practice, but likely can be emulated based on an understanding of the underlying rationale for the study protocol. Inherent differences between a web-based treatment algorithm and a clinical approach may lead to differences in outcomes that are impossible to predict. The closer the clinical approach is to the algorithm used in the study, the more likely the outcomes will be similar to those published.
Proprietary or commercial disclosure may be found after the references.
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