Electron Paramagnetic Resonance Spectra of Pentagonal Bipyramidal Gadolinium Complexes

Gadolinium is a special case in spectroscopy because of the near isotropic nature of the 4f⁷ configuration of the +3 oxidation state. Gd³⁺ complexes have been studied in several symmetries to understand the underlying mechanisms of the ground state splitting. The abundance of information in Gd³⁺ spectra can be used as a probe for properties of the other rare earth ions in the same complexes. In this work, the zero-field splitting (ZFS) of a series of Gd³⁺ pentagonal bipyramidal complexes of the form [GdX₁X₂(L_eq)₅]ⁿ⁺ [n = 1, X = axial ligands: Cl^-, ^-O^tBu, ^-OArF₅ or n = 3, X = ^tBuPO(NHⁱPr)₂, L_eq = equatorial ligand: Py, THF or H₂O] with near fivefold symmetry axes along X¹-Gd-X² was investigated. The ZFS parameters were determined by fitting of room-temperature continuous wave electron paramagnetic resonance (EPR) spectra (at X-, K-, and Q-band) to a spin Hamiltonian incorporating extended Stevens operators compatible with C₅ symmetry. Examination of the acquired parameters led to the conclusion that the ZFS is dominated by the B₂⁰ term and that the magnitude of B₂⁰ is almost entirely dependent on, and inversely proportional to, the donor strength of the axial ligands. Surveying the continuous shape measure and the X¹-Gd-X² angle of the complexes showed that there is some correlation between the proximity of each complex to D_5h symmetry and the magnitude of the B₆⁵ parameter, but that the deformation of the X¹-Gd-X² angle is more significant than other distortions. Finally, the magnitude of B₂⁰ was found to be inversely proportional to the thermal barrier for the reversal of the magnetic moment (U_eff) of the corresponding isostructural Dy³⁺ complexes.

Novel unconventional radiotherapy techniques: Current status and future perspectives - Report from the 2nd international radiation oncology online seminar

•Improvement of therapeutic ratio by novel unconventional radiotherapy approaches.•Immunomodulation using high-dose spatially fractionated radiotherapy.•Boosting radiation anti-tumor effects by adding an immune-mediated cell killing.

Oral SYK/JAK Inhibitor Gusacitinib for the Treatment of Chronic Hand Eczema: Results of a Randomized Phase 2 Study

BACKGROUND

Gusacitinib is an oral inhibitor of Janus and Spleen tyrosine kinases.

METHODS

The efficacy and safety of gusacitinib were evaluated in a double-blind, placebo-controlled, multicenter, Phase 2 study in 97 Chronic Hand Eczema (CHE) patients randomized (1:1:1) to placebo or gusacitinib (40 or 80 mg) for 12 weeks (Part A). Then, in Part B (through week 32), patients received gusacitinib.

RESULTS

At Week 16, patients receiving 80 mg gusacitinib showed a 69.5% (p<0.005) decrease in modified Total Lesion Symptom Score (mTLSS) versus 49.0% for 40 mg (p=0.132), and 33.5% for placebo. Significant improvement in Physician's Global Assessment (PGA) was seen in 31.3% patients receiving 80 mg versus 6.3% placebo (p<0.05). A 73.3% decrease in the hand eczema severity index (HECSI) versus placebo (21.7%) occurred in patients receiving 80 mg (p<0.001). Patients receiving 80 mg experienced significant decrease in hand pain (p<0.05). As early as Week 2, significant reductions over placebo in mTLSS (p<0.005), PGA (p = 0.04), and HECSI (p<0.01) were observed (80 mg gusacitinib). Adverse events included upper respiratory infection (URI), headache, nausea, and nasopharyngitis.

CONCLUSION

Gusacitinib showed rapid improvement in CHE patients and was well tolerated warranting further investigations.

Mechanistic insight into the protective and pathogenic immune-responses against SARS-CoV-2

COVID-19 is a severe respiratory illness that has emerged as a devasting health problem worldwide. The disease outcome is heterogeneous, which is most likely dependent on the immunity of an individual. Asymptomatic and mildly/moderate symptomatic (non-severe) patients likely develop an effective early immune response and clear the virus. However, severe symptoms dominate due to a failure in the generation of an effective and specific early immune response against SARS-CoV-2. Moreover, a late surge in pathogenic inflammation involves dysregulated innate and adaptive immune responses leading to local and systemic tissue damage and the emergence of severe disease symptoms. In this review, we describe the potential mechanisms of protective and pathogenic immune responses in "mild/moderate" and "severe" symptomatic SARS-CoV-2 infected people, respectively, and discuss the immune components that are currently targeted for therapeutic intervention.

The Comparative Accuracy of BISAP and PANC3 Scoring System for the Disease Severity and Outcome in Acute Pancreatitis in Tertiary Care Hospital from North India

Background Acute pancreatitis has local and systemic manifestations, so it's important to assess the severity by various scoring system. Among them bed side index for severity of acute pancreatitis and pancreatitis three score have been considered to be more predictive and easier. Objective To determine the comparative prognostic value of bed side index for severity of acute pancreatitis and pancreatitis 3 score and its correlation with the outcome. Method A prospective observational study was conducted on 50 cases of acute pancreatitis. The patients were assessed clinically, radiologically and biochemically and were categorised into mild, moderate and severe category as per Atlanta Classification. Bed side index for severity of acute pancreatitis and pancreatitis 3 score was calculated at the time of admission and followed till the time of discharge or they had mortality. Result Receiver operating characteristic curve, showed bed side Index for severity of acute pancreatitis score had sensitivity (66.67%), specificity (84.09%), diagnostic accuracy (84%) while pancreatitis 3 score had sensitivity (50%), specificity (81.82%), diagnostic accuracy (80%) for the severity of acute pancreatitis. Bed side index for severity of acute pancreatitis had sensitivity (100%), specificity (66.67%) and Pancreatitis 3 score had sensitivity (66.67%), specificity (80.85%) for predicting the mortality in acute pancreatitis. Conclusion Bed side index for severity of acute pancreatitis and pancreatitis 3 score are both simple, bedside tool for assessing the severity and mortality but bed side index for severity of acute pancreatitis score had better sensitivity, specificity for assessing the severity and mortality as compared to pancreatitis three score.

Secular equilibrium assessment in a CaWO4 target crystal from the dark matter experiment CRESST using Bayesian likelihood normalisation

CRESST is a leading direct detection sub-GeVc^-2 dark matter experiment. During its second phase, cryogenic bolometers were used to detect nuclear recoils off the CaWO₄ target crystal nuclei. The previously established electromagnetic background model relies on Secular Equilibrium (SE) assumptions. In this work, a validation of SE is attempted by comparing two likelihood-based normalisation results using a recently developed spectral template normalisation method based on Bayesian likelihood. Albeit we find deviations from SE in some cases we conclude that these deviations are artefacts of the fit and that the assumptions of SE is physically meaningful.

The value of cardiopulmonary exercise testing and stress echocardiography in the prediction of all-cause mortality in adults with end-stage renal disease

We aimed to assess the prognostic utility of different parameters routinely assessed from cardiopulmonary exercise testing (CPET) and exercise echocardiography in adults with end-stage renal disease (ESRD). Forty-two ESRD (37 male) individuals (age: 58 ± 13 years, height: 169.30 ± 8.30 cm, weight: 81 ± 15 kg, body surface area: 1.92 ± 0.20 m²) underwent a maximal/symptom limited CPET, with a full cross-sectional echocardiogram performed at baseline and peak exercise. All participants were prospectively followed over a 10-year period, with all-cause mortality as the primary endpoint. After the follow-up period, a total of 19 participants (45%) died. Left atrial size (4.70 ± 0.70 vs. 3.65 ± 0.50 cm, P < 0.001) and anteroseptal wall thickness (1.28 ± 0.40 vs. 1.06 ± 0.02 cm, P = 0.002) were significantly greater in those that died, while peak heart rate was significantly lower (108 ± 12 vs. 128 ± 14 bpm, P < 0.001). The prevalence of myocardial ischaemia (13 vs. 8 participants, P = 0.03) was significantly greater, while peak VO₂ (9.80 ± 2.10 vs. 15.90 ± 4.30 ml·kg^-1·min^-1, P < 0.001) was significantly lower in those that died. Following multivariate cox regression, myocardial ischaemia (Hazard Ratio 3.08; 95% Confidence Interval 1.09-8.70; P = 0.03) and peak VO₂ (HR 0.73; 95% CI 0.64-0.84; P < 0.001) were significant independent predictors of 10-year all-cause mortality. This is the first study to establish peak VO₂ as powerful marker of all-cause mortality when assessed with clinical, resting and stress echocardiography parameters in people with ESRD over a 10-year follow up period. This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with ESRD. HIGHLIGHTSWe aimed to assess the prognostic utility of cardiopulmonary exercise testing (CPET) and exercise echocardiography in end-stage renal disease (ESRD) with 10-year mortality.Peak aerobic capacity and the presence of ischaemic heart disease were independently associated with all-cause mortality.This observation indicates that, in clinical practice, CPET and exercise echocardiography may serve as valuable tools for the risk stratification of individuals with end-stage renal disease.

A156 OUTCOMES FOLLOWING ENDOSCOPIC RESECTION OF GASTRIC NEUROENDOCRINE TUMOURS FROM A TERTIARY-CARE ACADEMIC CENTRE

Background

Gastric neuroendocrine tumours (G-NET) are rare cancers derived from neuroendocrine cells of the stomach. A steady increase in the incidence of these tumours has been observed. Current treatment and surveillance strategies are guided by various tumour characteristics including size, grade, and depth of invasion. There exists conflicting evidence, however, on the rates of recurrence from positive resection margins following primary endoscopic resection. Thus, it remains uncertain whether complete endoscopic resection (R0) of these indolent tumours is clinically significant and whether follow-up endoscopic or surgical intervention is justified.

Purpose

Our aim is to characterize current management patterns and clinical outcomes in patients undergoing endoscopic resection of G-NETs.

Method

We conducted a retrospective, single-centre cohort study at The Centre for Advanced Therapeutic Endoscopy and Endoscopic Oncology at St. Michael’s Hospital, Toronto, Ontario. Consecutive patients over the age of 18 who underwent endoscopic resection of histologically proven G-NETs between 2011 and 2020 were included. Data on patient, endoscopic, and tumour characteristics were collected through electronic chart review. Descriptive statistics were conducted for data analysis.

Result(s)

A total of 155 foregut neuroendocrine tumours were endoscopically resected during the study period, of which 108 were identified as G-NETs. 95.3% were classified as Type I. Mean tumour size was 8.93 ± 5.27 mm. Cap-assisted EMR was performed most frequently (n=51), followed by conventional EMR (n=35). ESD was performed in eight cases. Seven intra-procedural perforations occurred, of which all were closed endoscopically. One patient experienced post-procedural perforation requiring ICU and surgery. Positive resection margins (R1) were found in 25% of cases (n=27), of which 78% were assessed at surveillance endoscopy 1 (SE1). Six patients with R1 margins were referred for surgical evaluation and four were lost to follow-up. 78% of all resected G-NETs were followed at SE1 with a median interval of 196 days (range, 23 to 3373). SE1 recurrence rate at the primary resection site was 14% (n=12), of which two were from routine scar biopsies in the absence of endoscopically identifiable recurrence. All visible recurrences at these sites (n=10) were managed with repeat endoscopic resection. Patient and tumour characteristics in the evaluation of G-NET recurrence are presented in Table I.

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Conclusion(s)

G-NET recurrence occurs in less than 15% of patients at surveillance endoscopy following endoscopic resection in spite of a predictably higher R1 resection rate. Patient, endoscopic, and tumour factors including method of resection and margin status do not appear to impact the development of early recurrence. Given the indolent nature of these tumours, patients with positive resection margins can be followed conservatively. Further investigation is warranted to determine the optimal duration and surveillance strategy for these patients.

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None

Disclosure of Interest

None Declared

A155 OUTCOMES FOLLOWING ENDOSCOPIC RESECTION OF DUODENAL NEUROENDOCRINE TUMOURS FROM A TERTIARY-CARE ACADEMIC CENTRE

Background

Duodenal neuroendocrine tumours (D-NET) are rare cancers derived from neuroendocrine cells of the duodenum. A steady increase in the incidence of these tumours has been observed. Current treatment and surveillance strategies are guided by various tumour characteristics including size, grade, and depth of invasion. There exists conflicting evidence, however, on the rates of recurrence after positive resection margins following endoscopic resection. Thus, it remains uncertain whether complete endoscopic resection (R0) of these indolent tumours is clinically significant and whether follow-up endoscopic or surgical intervention is justified.

Purpose

Our aim is to characterize endoscopic management and clinical outcomes in patients undergoing endoscopic resection of D-NETs.

Method

We conducted a retrospective, single-centre cohort study at The Centre for Advanced Therapeutic Endoscopy and Endoscopic Oncology at St. Michael’s Hospital, Toronto, Ontario. Consecutive patients over the age of 18 who underwent endoscopic resection of histologically proven D-NETs between 2011 and 2020 were included. Data on patient, endoscopic, and tumour characteristics were collected through electronic chart review. Descriptive statistics were conducted for data analysis.

Result(s)

A total of 155 foregut neuroendocrine tumours (NET) were endoscopically resected amongst 96 patients during the study period. 47 of these were histologically identified as D-NETs. Mean tumour size was 9.88 ± 6.86 mm. Conventional endoscopic mucosal resection (EMR) was performed most frequently (55%, n=26/47), followed by cap-assisted EMR (30%, n=14/47). Hybrid endoscopic submucosal dissection (ESD)/EMR was performed in one case. A total of two intra-procedural perforations occurred, both of which were successfully closed endoscopically. One patient with a peri-ampullary D-NET experienced significant intra-procedural bleeding requiring Hemospray® and subsequent endotracheal intubation resulting in a brief hospitalization. 57% of all resected D-NETs were followed at surveillance endoscopy 1 (SE1) at a median interval of 199 days (range, 84 to 830). Positive resection margins (R1) were found in 26 cases (55%), of which 16 were assessed at SE1 while nine were lost to follow-up. One patient with R1 margins was electively treated with APC at SE1. Tumour recurrence at SE1 occurred in only two patients.

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Conclusion(s)

D-NET recurrence is found in less than 5% of patients at surveillance endoscopy following endoscopic resection in spite of a high R1 resection rate. Given this indolent nature of these tumours, our study suggests that patients with positive resection margins can be followed conservatively with surveillance endoscopy. Further investigation is warranted to determine the optimal duration and surveillance strategy for these patients.

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CAG

Disclosure of Interest

None Declared

A166 RISK STRATIFICATION OF EARLY RE-HOSPITALIZATION IN PERSONS WITH INFLAMMATORY BOWEL DISEASES USING MULTIVARIABLE MODELS

Background

Hospitalization for persons with inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), is a significant contributor to morbidity and health care costs in Canada. Recognition of individuals at high risk of re-hospitalization could help inform targeted outpatient interventions that mitigate this risk.

Purpose

The aim of our study is to derive prediction models of risk of early (90-day) re-hospitalization among persons with IBD.

Method

We conducted a retrospective cohort study of all adult persons with IBD admitted to The Ottawa Hospital, Canada, for an acute IBD-related indication between April 2009 - March 2016. Demographic, clinical, and health services variables were obtained through chart review. Persons were linked to population-based health administrative datasets to identify historical and future IBD-related hospitalizations across the greater Ottawa region. Multivariable logistic regression models of 90-day re-hospitalization in persons with CD and UC were derived, and candidate predictors that demonstrated an independent association with the outcome at a p-value of 0.1 were retained. Bootstrap internal validation (200 iterations) was performed on the final models. Model performance and calibration were evaluated using the optimism-corrected c-statistic value and Hosmer-Lemeshow goodness of fit test, respectively. Adjusted odds ratios are reported with 95% confidence intervals (CI). Optimal probability cut points for re-hospitalization were selected to optimize sensitivity, specificity, and the J (Youden’s) index.

Result(s)

There were 524 CD and 248 UC hospitalizations during the study period. Of these, 57 (10.9%) CD and 27 (10.9%) UC hospitalizations were associated with re-hospitalization within 90 days of discharge. Forty-two candidate predictors were tested among CD hospitalizations, and 35 were tested among UC hospitalizations. Four variables were retained in each of the final models. Model performance and calibration for each variable are described in Table 1. The optimal range of probability cut points allowed for a sensitivity/positive predictive value (PPV)/false positive rate (FPR) of 0.72/0.23/0.29 (maximum J-index of 0.43) in the model for CD, and 0.78/0.33/0.19 (maximum J-index of 0.59) in the model for UC, respectively.

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Conclusion(s)

Demographic, clinical, and health services variables at the time of discharge have the potential to help identify persons with IBD at risk of early re-hospitalization, thereby permitting targeted outpatient intervention. Application of the models to our reference cohorts would earmark 1/3 or less of patients for early post-discharge intervention, with the potential to benefit more than 70% of patients destined for early re-hospitalization. Although the PPVs of our models were low, the models incorrectly predicted early re-hospitalization in less than 30% of patients. We are in process of externally validating these models in other jurisdictions across Ontario to test their generalizability.

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None

Disclosure of Interest

None Declared

Ossification of Superior Transverse Scapular Ligament - Incidence, Embryology and Association with Suprascapular Neuropathy

Introduction

Suprascapular notch is present at superior border of scapula just medial to coracoid process. This is covered by superior transverse scapular ligament (STSL). Suprascapular nerve passes below this ligament while suprascapular vessels pass above it. STSL ossification is a rare finding with variable incidences in different population groups.

Materials and Methods

We observed 60 dry bony scapulae, 30 prosected formalin fixed upper limbs with scapula and 10 embalmed cadavers for the presence of ossified STSL.

Results

There were complete ossification of STSL in two dried bony specimens of sacpula.

Conclusion

Ossified STSL may be the causative factor for suprascapular neuropathy. The mainstay of management in cases of neuropathy or compression of suprascapular nerve is release of suprascapular ligament by either open or arthroscopic surgical approach. So, it is extremely important to know this type of variation to minimize any damage to related structure and plan the management accordingly.

Management of idiopathic granulomatous mastitis: a prospective study

INTRODUCTION

Idiopathic granulomatous mastitis (IGM) is an evolving problem with varied presentation. No definite treatment guidelines are available at present that may reduce rate of recurrence. Current evidence suggests a ductal pathology behind IGM, which leads to periductal mastitis, leakage and sinus/fistula formation. Thus, excision of the sinus/fistulous tract with en-bloc wide local excision (WLE) of the lesion could be curative. The objective of this study was to look for the basic aetiology of IGM and evaluate the effectiveness of WLE with total or partial duct excision as a curative approach.

METHODS

An institutional prospective comparative study was conducted over 4 years (2015-2019), in which 59 cases of IGM were randomly divided into three groups. After necessary investigations, patients in group A received steroid therapy, those in group B received WLE and patients in group C received WLE with total or partial duct excision as the mode of treatment. Postoperative follow-up was between 6 months and 3 years.

RESULTS

Histopathological examination (HPE) was found to be the most suitable diagnostic procedure. Patients in group B showed the highest rate of recurrence (73.6%), followed by group A (35.0%) and group C (5.0%). Patients in group C had a significantly lower chance of recurrence compared with both group A and group B (p < 0.05). HPE reports of excised ducts from patients in group C showed ductal disruption and leakage along with periductal granuloma in 70% of cases.

CONCLUSIONS

The presence of duct granuloma indicates the association of ductal pathology in IGM. IGM is therefore a disease of the mammary ducts and en-bloc duct excision is curative in non-responding cases.

Outcomes of complex colorectal polyps managed by multi-disciplinary team strategies-a multi-centre observational study

PURPOSE

Team management strategies for complex colorectal polyps are recommended by professional guidelines. Multi-disciplinary meetings are used across the UK with limited information regarding their impact. The aim of this multi-centre observational study was to assess procedures and outcomes of patients managed using these approaches.

METHOD

This was a retrospective, observational study of patients managed by six UK sites. Information was collected regarding procedures and outcomes including length of stay, adverse events, readmissions and cancers.

RESULTS

Two thousand one hundred ninety-two complex polyps in 2109 patients were analysed with increasing referrals annually. Most presented symptomatically and the mean polyp size was 32.1 mm. Primary interventions included endoscopic therapy (75.6%), conservative management (8.3%), colonic resection (8.1%), trans-anal surgery (6.8%) or combined procedures (1.1%). The number of primary colonic resections decreased over the study period without a reciprocal increase in secondary procedures or recurrence. Secondary procedures were required in 7.8%. The median length of stay for endoscopic procedures was 0 days with 77.5% completed as day cases. Median length of stay was 5 days for colonic resections. Overall adverse event and 30-day readmission rates were 9.0% and 3.3% respectively. Malignancy was identified in 8.8%. Benign polyp recurrence occurred in 13.1% with a median follow up of 30.4 months. Screening detected lesions were more likely to undergo bowel resection. Colonic resection was associated with longer stays, higher adverse events and more cancers on final histology.

CONCLUSION

Multi-disciplinary team management of complex polyps is safe and effective. Standardisation of organisation and quality monitoring is needed to continue positive effects on outcomes and services.

Venoms classification and therapeutic uses: a narrative review

The mere glimpse of venomous animals has always terrified humans because of the devastating effects of their venoms. However, researchers across the globe have isolated therapeutically active ingredients from these venoms and continue to explore them for drug leads. These efforts lead to the discovery of therapeutic molecules that the US-FDA has approved to treat different diseases, such as hypertension (Captopril), chronic pain (Ziconotide), and diabetes (Exenatide). The main active constituents of most venoms are proteins and peptides, which gained more attention because of advancements in biotechnology and drug delivery. The utilization of newer screening approaches improved our understanding of the pharmacological complexity of venom constituents and facilitated the development of novel therapeutics. Currently, with many venom-derived peptides undergoing different phases of clinical trials, more are in pre-clinical drug development phases. This review highlights the various sources of venoms, their pharmacological actions, and the current developments in venom-based therapeutics.

Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer

The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of patients with endometrial cancer was published in 2022. It was therefore decided, by both the ESMO and the Indian Society of Medical and Paediatric Oncology (ISMPO), to convene a virtual meeting in July 2022 to adapt the ESMO 2022 guidelines to take into account the variations in the management of endometrial cancer in Asia. These guidelines represent the consensus opinion of a panel of Asian experts representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). Voting was based on scientific evidence and was conducted independently of the current treatment practices and treatment access constraints in the different Asian countries, which were discussed when appropriate. The aim of this guideline manuscript is to provide guidance for the optimisation and harmonisation of the management of patients with endometrial cancer across the different regions of Asia, drawing on the evidence provided by Western and Asian trials whilst respecting the variations in clinical presentation, diagnostic practices including molecular profiling and disparities in access to therapeutic options, including drug approvals and reimbursement strategies.

Towards an automated data cleaning with deep learning in CRESST

The CRESST experiment employs cryogenic calorimeters for the sensitive measurement of nuclear recoils induced by dark matter particles. The recorded signals need to undergo a careful cleaning process to avoid wrongly reconstructed recoil energies caused by pile-up and read-out artefacts. We frame this process as a time series classification task and propose to automate it with neural networks. With a data set of over one million labeled records from 68 detectors, recorded between 2013 and 2019 by CRESST, we test the capability of four commonly used neural network architectures to learn the data cleaning task. Our best performing model achieves a balanced accuracy of 0.932 on our test set. We show on an exemplary detector that about half of the wrongly predicted events are in fact wrongly labeled events, and a large share of the remaining ones have a context-dependent ground truth. We furthermore evaluate the recall and selectivity of our classifiers with simulated data. The results confirm that the trained classifiers are well suited for the data cleaning task.

A retrospective comparison between laparoscopic and open ureteroneocystostomy for management of benign lower ureteral strictures: An experience in tertiary care centre of Eastern India

OBJECTIVES

The objective is to discover the etiopathogenesis of benign lower ureteric stricture in Eastern India and compare the outcome of open versus laparoscopic ureteroneocystostomy.

MATERIALS AND METHODS

Retrospectively 52 patients who underwent laparoscopic (n = 28) or open ureteroneocystostomy (n = 24) for lower ureteral stricture between January 2018and December 2021 were included. The demography, aetiology, radiologic imaging, intraoperative & postoperative outcomes and follow-up data were collected and analysed.

RESULTS

The mean duration of follow up was 14.3 months. Lower ureteric stricture were common in females. The most common cause of the stricture was iatrogenic injury (42%). Other causes were tuberculosis, post-endourological surgery, obstructing mega ureter, endometriosis and idiopathic. Laparoscopic surgery had longer mean operative time (228 vs 171 min), less blood loss (166 vs 246 ml), lower VAS score (6.1 vs 7.22) and less need of post-operative analgesia (1.86 vs 2.36 days). The hospital stay (5.36 vs 6.77 days) and post-operative complications (none vs 3) were also significantly lower in laparoscopic group. Open surgery and laparoscopic surgery had success rate of 100% and 96.6% each.

CONCLUSIONS

Iatrogenic injury are the most common cause of ureteric stricture followed by tuberculosis. Laparoscopic approach is a feasible option in treatment of lower ureteric stricture as it offer comparable outcome to open procedure while offering the advantage of a minimal invasive technique. Stricture secondary to iatrogenic injury poses a different challenge due to presence of hard dense fibrosis. This is a complex reconstructive procedure and has a steep learning curve and demands high level of laparoscopic skill.

Cross-cultural Adaptation and Psychometric Properties of Nepali Version of Developmental Coordination Disorder Questionnaire

Background Revised developmental coordination disorder questionnaire (DCDQ'07) is the best available population-based screening tool to identify developmental coordination disorder and being a parent reported tool, it needs to be available in Nepali language for its application in Nepali population. Objective The objective of this study was to cross-culturally adapt developmental coordination disorder questionnaire into Nepali (DCDQ-NP). The psychometric properties of Nepali version of Developmental coordination disorder questionnaire were established. Method The adaptation was done following Beaton's guideline and the psychometric properties was studied in the community sample of 165 parents of school going children of 5-15 years. Fifty parents were asked to refill the questionnaire after the two weeks period. The study determines internal consistency, test retest reliability, floor and ceiling effect and construct validity. Result Significant cultural adaptation was required to obtain relevant Nepali version. The Nepali version of Developmental coordination disorder questionnaire demonstrates high internal consistency (α = 0.912), excellent test-retest reliability (IC = 0.901) and the floor and ceiling effect were acceptable. Principal component analysis showed three factor structure accounting 62% of variance. Conclusion The developmental coordination disorder questionnaire into Nepali were successfully translated and culturally adapted preserving its original concept. It showed good psychometric properties in a Nepali population. The adapted questionnaire shall be of significance in carry out further research in developmental coordination disorder in Nepal.

Elongational behaviour of electrostatically stabilised and concentrated CNF and CNC hydrogels: Experiments and modelling

TEMPO-oxidized cellulose nanofibril (CNF) hydrogels or cellulose nanocrystal (CNC) hydrogels can now be obtained at high concentrations (>10 wt%) and used to fabricate biobased materials and structures. Thus, it is required to control and model their rheology in process-induced multiaxial flow conditions using 3D tensorial models. For that purpose, it is necessary to investigate their elongational rheology. Thus, concentrated TEMPO-oxidized CNF and CNC hydrogels were subjected to monotonic and cyclic lubricated compression tests. These tests revealed for the first time that the complex compression rheology of these two electrostatically stabilised hydrogels combines viscoelasticity and viscoplasticity. The effect of their nanofibre content and aspect ratio on their compression response was clearly emphasised and discussed. The ability of a non-linear elasto-viscoplastic model to reproduce the experiments was assessed. Even if some discrepancies were observed at low or high strain rates, the model was consistent with the experiments.

Enhancing diversity, equity, inclusion, and accessibility in eosinophilic gastrointestinal disease research: the consortium for eosinophilic gastrointestinal disease researchers' journey

In response to the social inequities that exist in health care, the NIH-funded Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) recently formed a diversity committee to examine systemic racism and implicit bias in the care and research of eosinophilic gastrointestinal diseases (EGIDs). Herein, we describe our process, highlighting milestones and issues addressed since the committee's inception, which we hope will inspire other researchers to enhance diversity, equity, inclusion, and accessibility (DEIA) in their fields. Our journey began by establishing mission and vision statements to define the purpose of the committee. Regular discussion of diversity-related topics was incorporated into existing meetings and web-based materials were shared. This was followed by educational initiatives, including establishing a library of relevant publications and a speaker series to address DEIA topics. We then established a research agenda focused on the following actionable items: (1) to define what is known about the demographics of EGIDs by systematic review of population-based studies; (2) to develop a practical tool for reporting participant demographics to reduce bias in EGID literature; (3) to examine health disparities in the care of individuals with eosinophilic esophagitis who present to the emergency department with an esophageal food impaction; (4) to examine how access to a gastroenterologist affects the conclusions of published research examining the prevalence of pediatric eosinophilic esophagitis; and (5) to develop a model for examining the dimensions of diversity, and provide a framework for CEGIR's ongoing projects and data capture. In addition to promoting consciousness of DEIA, this initiative has fostered inclusivity among CEGIR members and will continue to inspire positive changes in EGID care and research.