Identifying microplastic litter with Laser Induced Breakdown Spectroscopy: A first approach

The broad diversity of microplastic litter requires a selection of analytical techniques to reliably determine the particle's chemical composition. This study demonstrates that Laser Induced Breakdown Spectroscopy (LIBS) can identify microplastic particles based on their spectral fingerprints. By studying the spectral features of polymer reference spectra, microplastic litter can be distinguished from non-plastic materials. The results show that LIBS can be used as a fast in-situ technique for pre-characterization of the microparticle's material and is a possible tool for environmental studies on microplastics.

Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

Background

Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.

Methods

Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.

Results

The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment.

Conclusions

PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01316-5.

P–587 Highly purified human menopausal gonadotrophin (HP-hMG, Menopur) as a ready-to-use solution for injection in pre-filled pen is bioequivalent to HP-hMG powder for reconstitution

Study question

Are serum FSH levels after single subcutaneous dosing of HP-hMG in a liquid formulation and a powder formulation bioequivalent?

Summary answer

The 90% CIs for the geometric mean ratios of serum FSH AUCt and Cmax were both within 0.8000–1.2500, thus the two formulations are bioequivalent.

What is known already

For several decades, HP-hMG (Menopur) has been used for the treatment of infertility; its efficacy and safety compared to other gonadotropins have been consistently demonstrated in several prospective, randomised controlled trials and meta-analyses (Deeks et al 2018; Bordewijk et al 2019). Menopur powder for reconstitution is available in multidose and single dose formulations. Up to 3 single dose vials (each containing 75 IU) may be dissolved into 1 mL solvent for administration. Recently, and for the first time, Menopur has been successfully formulated in a stable, ready-to-use solution for injection, which may be administered by a pre-filled pen.

Study design, size, duration

This was a randomised, two-way crossover, single dose, bioequivalence trial comparing Menopur liquid injected by pre-filled pen, with Menopur powder injected by conventional syringe and needle. The primary endpoints were AUCt and Cmax of baseline-adjusted FSH. Pituitary-suppressed, healthy women were randomised to receive one treatment sequence including a single subcutaneous injection of 450 IU Menopur liquid (600 IU/0.96 mL) and of 450 IU Menopur powder by two subcutaneous injections of 225 IU in 1 mL.

Participants/materials, setting, methods

Blood samples were collected pre- and post-dose, until 9 days after each injection. The PK parameters of FSH and hCG were assessed by noncompartmental methods with adjustment for endogenous pre-dose levels. Highly sensitive and specific electrochemiluminescence immunoassays were used for quantification and the LLOQ of the FSH and hCG assays were 1.47 mIU/mL and 0.5 mIU/mL, respectively, and the total validated CV was within 5% for both assays.

Main results and the role of chance

In total, 76 women were randomised and 56 completed the trial. The main reason for discontinuation was insufficient pituitary suppression prior to the second administration of HP-hMG. The mean FSH and hCG serum concentration-time profiles were comparable between the two HP-hMG formulations. The geometric mean ratios and 90% confidence intervals of FSH for HP-hMG liquid versus HP-hMG powder were 1.12 [1.0562; 1.1889] for AUCt and 1.17 [1.0946; 1.2490] for Cmax, showing that the two formulations were bioequivalent. Maximal serum FSH concentrations were reached at 18.19 h for HP-HMG liquid and 15.55 h for HP-hMG powder. In addition to FSH, the PK parameters for hCG were compared between the two HP-hMG formulations. The geometric mean ratios and 90% confidence intervals for HP-hMG liquid versus HP-hMG powder were 0.93 [0.86; 1.01] for AUCt and 0.94 [0.86; 1.02] for Cmax. There was no difference between the two groups in the incidence or severity of adverse events, and both preparations were well tolerated. Mild injection site reactions were less common after administration of HP-hMG liquid by a single injection compared to HP-hMG powder by two injections and were mostly related to pain and erythema after drug administration.

Limitations, reasons for caution

This bioequivalence study is based on the comparison of single dose administrations in healthy female volunteers of reproductive age.

Wider implications of the findings: The new HP-hMG solution for injection in a pre-filled pen will deliver the efficacy and safety of Menopur in a convenient delivery device.

Trial registration number

NA

Feasibility of sentinel lymph node detection by near-infrared endoscopy in squamous cell carcinoma of the oral cavity: a pilot study

OBJECTIVE

Near-Infrared (NIR) fluorescence imaging is a novel technique for intraoperative sentinel lymph node (SLN) identification. It has demonstrated promising results in several surgical specialties. The study aims to evaluate the feasibility of identifying the SLN by indocyanine green (ICG) enhanced NIR endoscopy in squamous cell carcinoma of the oral cavity (OCSCC).

PATIENTS AND METHODS

Seven patients with (cT1-3 N0) OCSCC were included. We injected 1-1.25 ml of ICG (5 mg/ml) at four to five points around the primary. After the elevation of a platysma flap and posterior retraction of the sternocleidomastoid muscle, fluorescence images were taken via IMAGE1 STM NIR/ICG system to define the SLN(s). We sampled fluorescence marked SLN(s) stratified to lymph node levels, followed by level-specified elective neck dissection.

RESULTS

The detection of at least one unilateral or bilateral SLN (range 1-5) was possible in every case. The fluorescence signal occurred, on average, 5.0 ± 2.2 minutes after injection. A total of 22 SLN could be identified. Among 331 histologically examined lymph nodes we could detect one micrometastasis, which was correctly defined as SLN (1/22). There were no false-negative findings. No adverse reactions to ICG occurred.

CONCLUSIONS

Our first results are indicating the concept of SLN concerning OCSCC after the application of real-time NIR fluorescence endoscopy. However, this has to be verified by more extended studies.

[Young Respiratory Physicians in Germany - Current Situation and Future Perspectives]

BACKGROUND

 Demographic changes in the society and among doctors, as well as changing attitudes towards and norms of how living should be structured are creating challenges regarding the organization of work environment in the hospital. In addition, organization of medical training is increasingly being influenced by economic considerations as well as a high level of medical specialization. We asked young respiratory physicians how they assessed their current situation with respect to quality of medical training and organization of their work environment.

METHODS

 From September to November 2019, we performed an online survey adressing young respiratory physicians in Germany. Participants were recruited via three emails (baseline and reminders after 2 and 6 weeks) sent by the German Respiratory Society (DGP) and the German Union of Pulmonologists (BdP). The questionnaire consisted of a maximum of 62 questions. Apart from own questions that had been aligned with other questionnaires from similar surveys in other medical specialties, we also assessed the effort-reward ratio (ER ratio) based on the short version of the effort-reward imbalance questionnaire (16 questions).

RESULTS

 We recuited n = 224 participants (33.8 ± 4.5 years, 5.4 ± 2.9 years of medical training, 54.4 % female , 86.8 % with German nationality). A little under half of the interviewees (n = 103, 46 %) reported to be very or generally satisfied with their working conditions, while n = 60 (27 %) were unsure. The main reasons for not being satisfied were long working hours and high work-load, as well as a lack of streamlining the work environment in the hospital to the specific needs of doctors. Despite the fact that many participants were satisfied, a large majority (n = 166, 88.2 %) depicted an unfavorable effort-reward ratio imbalance (adjusted mean 1.89 ± 2.18).

CONCLUSION

 Compared to many other European countries and internationally, the German healthcare system offers high-quality patient care and a well-equipped work environment. Increasing demands in the health care sector, however, are leading to a gratification crisis that not only harms the health and work performance of doctors but is also leading to reduced attractiveness of the job that might possibly lead to the search for new fields of activity or migration. Respiratory medicine is a discipline of growing interest and motivating young doctors to secure the promotion of this discipline is increasingly important. Factors harming the growth of this discipline should be immediately addressed. The results of this survey might help leaders in the field to restructure the work environment and medical education according to the actual needs.

Simultaneous application of ultrasound and sialendoscopy: experience in the management of stenosis and other non-sialolithiasis-related salivary gland disorders

OBJECTIVE

To assess the value of the simultaneous application of ultrasound and sialendoscopy (US+SE) in several salivary gland diseases not caused either by sialolithiasis or by tumours.

PATIENTS AND METHODS

US+SE are routinely used in patients with inflammatory, obstructive, and other non-tumorous major salivary gland diseases. In patients in whom US and SE as single investigation tools were not conclusive or not useful in the management of several non-sialolithiasis-related conditions (stenoses, ductal anomalies, ductal trauma, space-occupying paraductal lesions), both methods were used simultaneously for diagnosis and treatment.

RESULTS

US+SE were used simultaneously in 44 patients for 56 indications. Stenosis was managed in 36 cases (81.8%) and in thirty-eight of the indications (67.9%) with simultaneous US+SE. The successful opening was achieved in 23 (63.9%), conservative and/or ablative treatment was indicated in 13 (36.1%), and further imaging was indicated in two (5.5%) of these cases. Post-traumatic or postinfectious complications were managed in 12 (27.3%) of all cases, and isolated ductal anomalies and paraductal space-occupying lesions were assessed in three cases (8.3%) each. In all instances, simultaneous US+SE clearly improved the management in diagnosis and/or therapy.

CONCLUSIONS

Simultaneous application of US+SE provided additional information that proved to be valuable for diagnosis, planning, and treatment in several non-sialolithiasis-related conditions such as stenoses, ductal anomalies, ductal trauma, and space-occupying paraductal lesions.

Is extracapsular dissection for pleomorphic adenoma rather a euphemism for enucleation that jeopardises the intactness of the capsule?

The aim of this study was to compare several surgical modalities with respect to the incidence of positive margins and focal capsular exposure of pleomorphic adenoma of the parotid gland. The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2006 and 2020 were retrospectively evaluated (n = 845). The lesion was removed by extracapsular dissection in 577 cases (68%) and facial nerve dissection in 268 (32%). Our analysis did not reveal a statistically significant difference between the examined modalities regarding positive margins (p=0.648) or capsular exposure (p=0.112). Recurrences were detected in 7/845 cases (0.82%) with a mean (range) follow-up time of 82.3 (6-183) months. The choice of surgical method does not seem to have a significant effect on the incidence of positive margins, or on the capsular exposure of a pleomorphic adenoma.

Pyrene-Terminated Tin Sulfide Clusters: Optical Properties and Deposition on a Metal Surface

Herein, we present the synthesis of two pyrene-functionalized clusters, [(Rpyr Sn)4 S6 ]⋅2 CH2 Cl2 (4) and [(Rpyr Sn)4 Sn2 S10 ]⋅n CH2 Cl2 (n=4, 5 a; n=2, 5 b; Rpyr =CMe2 CH2 C(Me)N-NC(H)C16 H9 ), both of which form in reactions of the organotin sulfide cluster [(RN Sn)4 S6 ] (C; RN =CMe2 CH2 C(Me)N-NH2 ) with the well-known fluorescent dye 1-pyrenecarboxaldehyde (B). In contrast, reactions using an organotin sulfide cluster with another core structure, [(RN Sn)3 S4 Cl] (A), leads to formation of small molecular fragments, [(Rpyr Cl2 Sn)2 S] (1), (pyren-1-ylmethylene)hydrazine (2), and 1,2-bis(pyren-1-ylmethylene)hydrazine (3). Besides synthesis and structures of the new compounds, we report the influence of the inorganic core on the optical properties of the dye, which was analyzed exemplarily for compound 5 a via absorption and fluorescence spectroscopy. This cluster was also used for exploring the potential of such non-volatile clusters for deposition on a metal surface under vacuum conditions.

Visualization of the structure of native human pulmonary mucus

Human respiratory mucus lining the airway epithelium forms a challenging barrier to inhalation therapeutics. Therefore, structural elucidation of hydrated mucus is essential for an efficient drug delivery development. The structure of mucus has been primarily investigated by conventional electron microscopy techniques, which operate under vacuum conditions and require sample preparation steps that might alter the structure of mucus. In this study we investigated the impact of dehydration on mucus and analyzed the structure of mucus in its hydrated state. Cryo-scanning electron microscopy (Cryo-SEM) analysis of mucus showed, that during the process of sublimation, non-porous structure of mucus is transformed into a porous network. Similarly, images acquired by environmental scanning electron microscopy (ESEM), revealed a non-porous structure of hydrated mucus, while further observation at decreasing pressure demonstrated the strong influence of dehydration on mucus structure. We could successfully visualize the structural organization of the major gel forming mucin MUC5B in its hydrated state by employing stimulated emission depletion (STED) microscopy, which allowed resolving the nano-scale patterns of mucin macromolecules within the essentially pore-free mucus structure. The general structural organization of mucus components was addressed by confocal laser scanning microscopy (CLSM), which revealed the heterogeneous and composite structure of mucus. These results provide a novel view on the native structure of mucus and will affect drug delivery development.

[Comparison between oral fluid samples and pooled serum samples for the detection of antibodies against Porcine Reproductive and Respiratory Syndrome Virus in weaning pig herds]

INTRODUCTION

Monitoring of Porcine Reproductive and Respiratory Syndrome Virus (PRRSV) in pig farms is performed usually by testing for antibodies against PRRSV in serum samples. A new method is the detection of PRRSV antibodies in porcine saliva. In this study serum samples and saliva were collected in nine farms suspicious for PRRSV and tested for the presence of PRRSV antibodies. In total 220 serum and 41 saliva samples were taken from pigs at the age of 8 weeks (± 1 week). One saliva and one pooled serum sample (1:5) were tested from each pen. In total 11 (Cut-off 0.4/0.3) or 14 (Cut-off 0.2) serum samples and 23 saliva out of 41 pens were positive for PRRSV antibodies. Cohen`s Kappa testing showed a moderate agreement (κ = 0.446). Saliva samples compared to pooled serum samples were very sensitive, the specificity was 60 and 67, respectively.

Intraductal lithotripsy in sialolithiasis with two different Ho:YAG lasers: presetting parameters, effectiveness, success rates

OBJECTIVE

To compare two different Ho:YAG laser systems in relation to the preset parameters and their effectiveness for intraductal fragmentation of the salivary stones.

PATIENTS AND METHODS

We made a retrospective study in two tertiary referral centers (Department of ENT, Head and Neck Surgery, University of Erlangen-Nuremberg, Germany and the MacKay Memorial Hospital, Taipei, Taiwan). Patients with a diagnosis of sialolithiasis were treated in Erlangen and Taipei. The Erlangen patients were treated using the Calculase II™ Ho:YAG laser (Karl Storz, Tuttlingen, Germany) at 4 Hz, 1.2 J (4.8 W) and the MacKay patients were treated using the VersaPulse® PowerSuite™ Ho:YAG laser (Lumenis Ltd., Yokneam, Israel) at 6 Hz, 0.5 J (3 W).

RESULTS

A total of 12 patients with 12 stones were treated in Erlangen and 54 with 75 stones in Taipei. The submandibular stones were present in 50% and 86.7% of cases, respectively. The complete fragmentation was achieved in all of the treated stones in both groups; 100% and 92.6% of the patients were stone-free, 100% and 94.4% of the patients became symptom-free, respectively. 33% of the Erlangen patients had multimodal treatments. The glands were preserved in all cases in both centers.

CONCLUSIONS

The Ho:YAG laser proved to be effective in the treatment of sialolithiasis. Stone size, location, and involved gland were important additional parameters. Our experience and the literature results show that the laser presetting with a frequency of 3-6 Hz, an energy level of 0.5-1.2 J, and effective power of between 3 and 4.8 W is sufficient to achieve maximum success without any increased risk for complications.

Primary parotid gland lymphoma: pitfalls in the use of ultrasound imaging by a great pretender

The aim of this study was to highlight several misleading imaging and clinical aspects of parotid gland lymphoma, taking our personal experience and relevant literature reports into consideration. The records of all patients diagnosed with lymphoma in the parotid gland between 2005 and 2017 were examined retrospectively. Sixty-seven patients were included in this study. The mean age was 61.4 years. The most frequent histological entities were marginal zone B-cell lymphoma (31.3%) and follicular lymphoma (28.4%). The tumour was stage I in 35 cases (52.2%), stage II in 13 cases (19.4%), stage III in 11 cases (16.4%), and stage IV in eight cases (11.9%). B symptoms were seen in only three patients (4.5%). The diagnosis was made after parotidectomy in 51 cases (76.1%), by core needle biopsy in 14 cases (20.9%), and by means of open biopsy in the remaining two cases (3.0%). Parotid gland lymphoma represents a diagnostically challenging, multifaceted entity that can easily mimic both benign and malignant conditions. This entity should be included in the differential diagnosis of almost all types of parotid lesion, as it seems to play the role of a great pretender.

Quantification of microplastics: Which parameters are essential for a reliable inter-study comparison?

Inconsistencies in microplastic quantification are a problem in current microplastic research, leading to difficulties in inter-study comparability. This study proposes a guideline for consistent quantification of microplastic distributions. It contains specific recommendations on how to quantify common microplastic particle parameters, such as size or shape. These recommendations are based on how reliably a parameter can be measured and its importance for inter-study comparability. Furthermore, our study proposes a multidimensional vector approach, where one vector contains the information for the microplastic distribution in one sample. In this way geometric and statistical means can be used to quantitatively compare different studies. In particular, in combination with our proposed quantification procedure, a meaningful comparison of microplastic distributions across different studies becomes possible. Ultimately, this allows comparable long-term and global scale assessments, as well as the development of modeling approaches.

Dataset for the reporting of urinary tract carcinoma-biopsy and transurethral resection specimen: recommendations from the International Collaboration on Cancer Reporting (ICCR)

The International Collaboration on Cancer Reporting (ICCR) is an alliance of major pathology organisations in Australasia, Canada, Europe, United Kingdom, and United States of America that develops internationally standardised, evidence-based datasets for the pathology reporting of cancer specimens. This dataset was developed by a multidisciplinary panel of international experts based on previously published ICCR guidelines for the production of cancer datasets. It is composed of Required (core) and Recommended (noncore) elements identified on the basis of literature review and expert consensus. The document also includes an explanatory commentary explaining the rationale behind the categorization of individual data items and provides guidance on how these should be collected and reported. The dataset includes nine required and six recommended elements for the reporting of cancers of the urinary tract in biopsy and transurethral resection (TUR) specimens. The required elements include specimen site, operative procedure, histological tumor type, subtype/variant of urothelial carcinoma, tumor grade, extent of invasion, status of muscularis propria, noninvasive carcinoma, and lymphovascular invasion (LVI). The recommended elements include clinical information, block identification key, extent of T1 disease, associated epithelial lesions, coexistent pathology, and ancillary studies. The dataset provides a structured template for globally harmonized collection of pathology data required for management of patients diagnosed with cancer of the urinary tract in biopsy and TUR specimens. It is expected that this will facilitate international collaboration, reduce duplication of effort in updating current national/institutional datasets, and be particularly useful for countries that have not developed their own datasets.

Effect of fluoride mouthrinses and stannous ions on the erosion protective properties of the in situ pellicle

The particular feature of this study is the investigation of effects of pure fluoride- or stannous ions based mouthrinses on the erosion protective properties and the ultrastructure of the in situ pellicle (12 volunteers). Experimental solutions were prepared either from 500 ppm NaF, SMFP, AmF or SnF₂ or 1563 ppm SnCl₂, respectively. After 1 min of in situ pellicle formation on bovine enamel slabs, rinses with one of the preparations were performed for 1 min and intraoral specimens’ exposure was continued for 28 min. Native enamel slabs and rinses with bidestilled water served as controls. After oral exposure, slabs were incubated in HCl (pH 2; 2.3; 3) for 120 s and kinetics of calcium- and phosphate release were measured photometrically; representative samples were analysed by TEM and EDX. All mouthrinses reduced mineral loss compared to the native 30-min pellicle. The effect was pH-dependent and significant at all pH values only for the tin-containing mouthrinses. No significant differences were observed between the SnF₂- and the SnCl₂-containing solutions. TEM/EDX confirmed ultrastructural pellicle modifications. SnF₂ appears to be the most effective type of fluoride to prevent erosive enamel demineralisation. The observed effects primarily have to be attributed to the stannous ions’ content.

The killer cell lectin-like receptor B1 (KLRB1) 503T>C polymorphism (rs1135816) and acute rejection after liver transplantation

The killer cell lectin-like receptor B1 (KLRB1) gene encodes for CD161 expressed by different subsets of leukocytes involved in the development of acute liver transplant rejection. The single nucleotide polymorphism (SNP) 503T>C (rs1135816) in the KLRB1 gene represents a missense mutation modifying functional properties of CD161. The aim of our study is to determine whether the SNP 503T>C is associated with acute liver transplant rejection. We genotyped the SNP for 163 liver recipients without acute rejection, 125 recipients with a single acute rejection, and 53 recipients with multiple acute rejections. The genotype frequencies within the groups did not show any significant difference. Our data suggest that the SNP 503T>C has no impact on the susceptibility of acute liver transplant rejection.