Developing a Comprehensive List of Criteria to Evaluate the Characteristics and Quality of eHealth Smartphone Apps: Systematic Review

BACKGROUND

The field of eHealth is growing rapidly and chaotically. Health care professionals need guidance on reviewing and assessing health-related smartphone apps to propose appropriate ones to their patients. However, to date, no framework or evaluation tool fulfills this purpose.

OBJECTIVE

Before developing a tool to help health care professionals assess and recommend apps to their patients, we aimed to create an overview of published criteria to describe and evaluate health apps.

METHODS

We conducted a systematic review to identify existing criteria for eHealth smartphone app evaluation. Relevant databases and trial registers were queried for articles. Articles were included that (1) described tools, guidelines, dimensions, or criteria to evaluate apps, (2) were available in full text, and (3) were written in English, French, German, Italian, Portuguese, or Spanish. We proposed a conceptual framework for app evaluation based on the dimensions reported in the selected articles. This was revised iteratively in discussion rounds with international stakeholders. The conceptual framework was used to synthesize the reported evaluation criteria. The list of criteria was discussed and refined by the research team.

RESULTS

Screening of 1258 articles yielded 128 (10.17%) that met the inclusion criteria. Of these 128 articles, 30 (23.4%) reported the use of self-developed criteria and described their development processes incompletely. Although 43 evaluation instruments were used only once, 6 were used in multiple studies. Most articles (83/128, 64.8%) did not report following theoretical guidelines; those that did noted 37 theoretical frameworks. On the basis of the selected articles, we proposed a conceptual framework to explore 6 app evaluation dimensions: context, stakeholder involvement, features and requirements, development processes, implementation, and evaluation. After standardizing the definitions, we identified 205 distinct criteria. Through consensus, the research team relabeled 12 of these and added 11 more-mainly related to ethical, legal, and social aspects-resulting in 216 evaluation criteria. No criteria had to be moved between dimensions.

CONCLUSIONS

This study provides a comprehensive overview of criteria currently used in clinical practice to describe and evaluate apps. This is necessary as no reviewed criteria sets were inclusive, and none included consistent definitions and terminology. Although the resulting overview is impractical for use in clinical practice in its current form, it confirms the need to craft it into a purpose-built, theory-driven tool. Therefore, in a subsequent step, based on our current criteria set, we plan to construct an app evaluation tool with 2 parts: a short section (including 1-3 questions/dimension) to quickly disqualify clearly unsuitable apps and a longer one to investigate more likely candidates in closer detail. We will use a Delphi consensus-building process and develop a user manual to prepare for this undertaking.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021227064; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227064.

Correction: Selective area growth of GaN nanowires and nanofins by molecular beam epitaxy on heteroepitaxial diamond (001) substrates

[This corrects the article DOI: 10.1039/D1NA00221J.].

AB1353 VESSEL AFFECTION AND THE INFLUENCE OF GLUCOCORTICOIDS ON 18F-FLUORODEOXYGLUCOSE POSITRON EMISSION TOMOGRAPHY/COMPUTED TOMOGRAPHY IN GIANT CELL ARTERITIS

Background

18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) represents one of the standard imaging modalities in the detection of giant cell arteritis (GCA). Detailed data regarding the vessel involvement in GCA are not available.

Objectives

The aim of this study was to quantify arterial vessel involvement at the onset of GCA by 18F-FDG PET/CT and to verify the influence of glucocorticoid treatment on the diagnostic performance of 18F-FDG PET/CT.

Methods

This study included 60 patients (44 women and 16 men, mean age 72.8 ± 8.8 years) at the onset of GCA. All patients received a PET/CT. 44 patients were glucocorticoid naïve. 16 patient were treated with glucocorticoid (prednisone median dose 60 mg) 3.5 ± 4.4 days before the 18F-FDG PET/CT was performed. All 18F-FDG PET/CT scans were scored regarding the active inflammation of the large arteries.

Results

The most affected arteries were the aorta ascendens (72 %), followed by truncus brachiocephalicus (62 %), acrus aortae (60 %), aorta descendens (60 %), left and right arteria sublcavia (60 % and 58 %). The aorta and their outgoing arteries presented an involvement in 39 GCA patients (89 %). A singular affection of the aorta was shown in 9 patients (20 %). glucocorticoid naïve patients (89 %) showed affected arteries more frequently than glucocorticoid treated patients (38 %).

Conclusion

The study showed that the thoracic aorta (in particular aorta ascendens) is the most involved vascular segment in GCA. The use of glucocorticoids was associated with a marked decrease of vascular inflammation. Consequently, the imaging of the thoracic aorta should be included in the diagnostic procedure of GCA. 18F-FDG PET/CT should be performed without glucocorticoid treatment, if the clinical situation allowed this proceeding.

Disclosure of Interests

Leander Malich: None declared, Falk Gühne: None declared, Tobias Hoffmann: None declared, Ansgar Malich: None declared, Peter Oelzner: None declared, Gunter Wolf: None declared, Martin Freesmeyer: None declared, Alexander Pfeil Grant/research support from: This study is a part of the Investigator Initiated study Retrospective analysis of clinical and imaging parameters to predict flair in patients with giant cell arteritis.” which is supported by Chugai Pharma Germany GmbH, Lyoner Straße 15, 60528 Frankfurth am Main.

AB1374 INTERSTITIAL LUNG DISEASE IN ASYMPTOMATIC PATIENTS AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES

Background

Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD, but the clinical manifestations and severity can vary from subclinical abnormality to dyspnoea, respiratory failure, and death.

Objectives

The objective of the following study is to evaluate the frequency and type of ILD in asymptomatic patients at the onset of IRD.

Methods

The study represents a sub-analysis of a case-control study performed earlier, and includes 126 patients with a newly diagnosed IRD. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). The patients were evaluated for respiratory symptoms (cough, sputum, dyspnea) and sclerosiphonia. If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. The sub-analysis includes 20 patients with asymptomatic ILD at the onset of IRD.

Results

The asymptomatic ILD group consists out of 75 % female (n = 15) and 25 % male (n = 5) patients, with median age of 51.8 years (SD ± 17.1 years). In comparison, asymptomatic ILD patients are significant younger (t(27.4) = 2.36, p = 0.026), but the distribution of gender is similar. The mean values in different pulmonary function parameter are: FVC: 89.9% ± 19.3%; DLCO: 69.9% ± 21.2%; FEV1: 87.9% ± 21.4%; TLC: 91.0% ± 16.5% and TLCO: 82.1% ± 20.6% (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). The observed CT patterns are pure ground glass opacities (GGO) (50%, n = 10), non-specific interstitial pneumonia (NSIP) (25%, n = 5), granuloma/proliferations (15%, n = 3), usual interstitial pneumonia (UIP) (5%, n = 1) and lymphocytic interstitial pneumonia (LIP) (5%, n = 1). The distribution of CT pattern was not significant to the symptomatic ILD group (χ2(6) = 10.224, p = 0.116).

Conclusion

The study highlighted that also clinical asymptomatic patients have ILD in IRD at the onset of the IRD. Frequently, a reduced DLCO is detectable in PFT as a sign of early lung involvement, so this represents a potential screening parameter. Moreover, asymptomatic patients are often younger than symptomatic patients. No significant difference was found in CT pattern, but further research is needed as the number of patients is quite small.

Disclosure of Interests

None declared

Cryoballoon-ablation of atrial fibrillation in patients with heart failure and preserved ejection fraction

Funding Acknowledgements

Type of funding sources: Public Institution(s). Main funding source(s): Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK)

Background

Co-existence of atrial fibrillation (AF) and heart failure with preserved ejection fraction (HFpEF) is common and severely affects morbidity and prognosis.

Purpose

This study evaluates outcome after cryoballoon-ablation for AF in HFpEF compared to patients without heart failure employing multiple diagnostic modalities.

Methods

A total of 102 patients scheduled for cryoablation of AF with LVEF≥50% were prospectively enrolled. Baseline evaluation included echocardiography, stress echocardiography, six-minute-walk-test, biomarker measurements and quality of life assessment (SF-36). HFpEF was diagnosed according to current guidelines and confirmed applying the HFA-PEFF-Score. Procedural parameters as well as clinical, functional and echocardiographic endpoints at follow-up ≥12 months after AF-ablation were compared between patients with and without HFpEF.

Results

Patients with HFpEF (n=24) were older (median: 73.5 years [Q25: 66.5 years; Q75: 75.8 years] vs. 64.5 years [Q25: 55.0 years; Q75: 71.3 years], P&lt;0.001) and more often female (83.3% vs. 28.2%). They were characterized by more pronounced AF-related symptoms (median EHRA-score: 3.0 [Q25:3.0; Q75:3.0] vs. 2.0 [Q25: 2.0; Q75: 3.0], P&lt;0.001), reduced distance in six-minute-walk-test (median 487.5m [Q25: 378.1m; Q75: 517.8m] vs. 539.0m [Q25: 489.3m; Q75:589.1 m], P&lt;0.001), and higher mean left atrial (LA)-pressure measured at the needle tip at transseptal puncture (14.0mmHg [Q25: 10.3mmHg; Q75: 21.5mmHg] vs. 10.0 mmHg [Q25: 8.0mmHg; Q75: 13.3mmHg], P=0.008). Procedural parameters were comparable between the two subgroups. Rates of AF-recurrence, repeat AF-ablation and AF-related re-hospitalization were increased in HFpEF (Figure 1A-C), which was confirmed after adjusting for intergroup differences in sex and age distribution by multiple regression analysis. There was no improvement of heart failure-related symptoms and persistent elevation of cardiac biomarkers, even in HFpEF-patients with successful restoration of sinus rhythm at follow-up (Figure 2A-C). Echocardiographic follow-up showed progression of adverse LA-remodeling (LA-volume index at baseline: 35.8ml/m2 [Q25: 32.2ml/m2; Q75: 41.9ml/m2] vs. 12-month follow-up: 40.5ml/m2 [Q25: 36.0ml/m2; Q75: 51.4ml/m2], P=0.017) and no improvement in diastolic function in HFpEF (E/e’ at baseline: 9.7 [Q25: 7.8; Q75: 12.1] vs 12-month follow-up: 10.2 [Q25: 8.4; Q75: 11.8], P=0.874), in particular in patients with HFpEF and AF-recurrence. Quality of life improved in patients without HFpEF in both physical and mental summary scales, however, no beneficial effect was seen in HFpEF.

Conclusion

Patients with HFpEF constitute a distinct subgroup with an elevated risk for arrhythmia recurrence after cryoablation of AF. Functional hallmarks and heart-failure related symptoms of HFpEF persisted in our cohort, irrespective of rhythm-status at follow-up. Future research is needed to optimize tailored treatment strategies in HFpEF.

Detection of atmospheric nuclear explosions: the infrasound component of the International Monitoring System

The infrasound component of the International Monitoring System (IMS') for Comprehensive Nuclear-Test-Ban Treaty verification will consist of 60 array stations distributed as uniformly as possible over the surface of the globe. This network will be far larger and more sensitive than any other previously operated infrasound network. In this paper, we discuss the design and performance characteristics of this monitoring network and the current status of the site survey and installation programs. A brief review of significant developments in infrasound monitoring technology in the last few years is also presented along with a summary of the various areas where data from this unique global network is likely to be of value to the scientific community.

Selective area growth of GaN nanowires and nanofins by molecular beam epitaxy on heteroepitaxial diamond (001) substrates

GaN-on-diamond is a promising route towards reliable high-power transistor devices with outstanding performances due to better heat management, replacing common GaN-on-SiC technologies. Nevertheless, the implementation of GaN-on-diamond remains challenging. In this work, the selective area growth of GaN nanostructures on cost-efficient, large-scale available heteroepitaxial diamond (001) substrates by means of plasma-assisted molecular beam epitaxy is investigated. Additionally, we discuss the influence of an AlN buffer on the morphology of the GaN nanostructures. The nanowires and nanofins are characterized by a very high selectivity and controllable dimensions. Low temperature photoluminescence measurements are used to evaluate their structural quality. The growth of two GaN crystal domains, which are in-plane rotated against each other by 30°, is observed. The favoring of a certain domain is determined by the off-cut direction of the diamond substrates. By X-ray diffraction we show that the GaN nanostructures grow perpendicular to the diamond surface on off-cut diamond (001) substrates, which is in contrast to the growth on diamond (111), where the nanostructures are aligned with the substrate lattice. Polarity-selective wet chemical etching and Kelvin probe force microscopy reveal that the GaN nanostructures grow solely in the Ga-polar direction. This is a major advantage compared to the growth on diamond (111) and enables the application of GaN nanostructures on cost-efficient diamond for high-power/high-frequency applications.

AB0796 THE EVALUATION OF LUNG DIAGNOSTIC PROCEDURE AT THE ONSET OF INFLAMMATORY RHEUMATIC DISEASES WITH INTERSTITIAL LUNG DISEASE

Background:

Interstitial lung disease (ILD) in inflammatory rheumatic diseases (IRD) is associated with increased mortality. Moreover, the lung is one of the most effected organs on IRD. Consequently, screening methods were required to the detect ILD in IRD.

Objectives:

The objective of the following study is to evaluate the diagnostic value of lung function test, chest x-ray and HR-CT of the lung in the detection of ILD at the onset of IRD.

Methods:

The study is designed as a case-control study and includes 126 patients with a newly diagnosed IRD. It was matched by gender, age and the performance of lung function test and chest x-ray. The sensitivity and specificity were verified by crosstabs and receiver operating characteristic (ROC) curve analysis. The study cohort was divided in two groups (ILD group: n = 63 and control group: n = 63). If possible, all patients received a lung function test and optional a chest x-ray. Patients with pathological findings in the screening tests (chest x-ray or reduced diffusing capacity for carbon monoxide (DLCO) < 80 %) maintained a high-resolution computer tomography (HR-CT) of the lung. Additionally, an immunological bronchioalveolar lavage was performed in the ILD group as gold standard for the detection of ILD.

Results:

The DLCO (< 80 %) revealed a sensitivity of 83.6 % and specificity of 45.8 % for the detection of ILD. Other examined parameter of lung function test showed no sufficient sensitivity as screening test (FVC = Forced Vital Capacity, FEV1 = Forced Expiratory Volume in 1 second, TLC = Total Lung Capacity, TLCO = Transfer factor of the Lung for carbon monoxide). Also, a combination of different parameter did not increase the sensitivity. The sensitivity and specificity of chest x-ray for the verification of ILD was 64.2 % versus 73.6 %. The combination of DLCO (< 80 %) and chest x-ray showed a sensitivity with 95.2 % and specificity with 38.7 %. The highest sensitivity (95.2 %) and specificity (77.4 %) was observed for the combination of DLCO (< 80 %) and HR-CT of the lung.

Conclusion:

The study highlighted that a reduced DLCO in lung function test is associated with a lung involvement in IRD. DLCO represented a potential screening parameter for lung manifestation in IRD. Especially patients with suspected vasculitis should receive an additional chest x-ray. Based on the high sensitivity of DLCO in combination with chest x-ray or HR-CT for the detection of ILD in IRD, all patients with a reduced DLCO (< 80%) should obtained an imaging of the lung.

Disclosure of Interests:

None declared

OP0075 EVALUATION OF A VIRTUAL REALITY TEACHING CONCEPT FOR MEDICAL STUDENTS DURING THE SARS-COV-2 PANDEMIC

Background:

The ongoing COVID-19 pandemic has disrupted face-to-face teaching of medical students and forced efforts in finding alternative approaches. In order to help maintain high-quality education, a new virtual reality (VR)-based concept for training medical students in rheumatic and musculoskeletal diseases (RMD) has been developed. This VR training concept is based on the integration of real patient data with two- and three-dimensional visualized pathological joints from X-ray and computed tomography generated images.

Objectives:

To evaluate the practicability and acceptance of the VR training application in the digital curricular education of medical students during the COVID-19 pandemic.

Methods:

A short refresher lecture on rheumatic diseases (duration 60 minutes) was followed by presenting the VR training concept to the students. The VR training concept included the demonstration of three virtual patients with early rheumatoid arthritis, rheumatoid arthritis psoriatic arthritis regarding the symptoms, current medical problems, disease patterns at the imaging (conventional radiographs and high-resolution computed tomography) and therapy options. The practicability and acceptance of the VR was evaluated by medical students using a survey.

Results:

The study encompassed 237 medical students (163 female, 73 male, one diverse, age range 20 to 40 years). 72 % of the participants rated the virtual teaching as good or very good. 87 % presented an expanded knowledge for rheumatoid arthritis and psoriatic arthritis through the VR. Moreover, 91 % reported that the lecture provided a deeper understanding of RMD. Furthermore, 60 % of the students asked for additional courses by VR.

Conclusion:

The study highlighted the usefulness of innovative VR tools for teaching medical students digitally about RMD. VR applications can be a complementary educational modality for medical students, especially during the COVID-19 pandemic, to provide students with the best possible clinical experience while ensuring that patient, student, and staff safety is not compromised.

Figure 1.

A Screen view of virtual reality included three virtual patients with early rheumatoid arthritis (RA), RA, and psoriatic arthritis (PsA) and B demonstration of structural damage in RA and PsA using hand X-ray and high-resolution quantitative computed tomography images.

Disclosure of Interests:

Alexander Pfeil Speakers bureau: Lilly Pharma Deutschland GmbH, Franz Marcus: None declared, Tobias Hoffmann: None declared, Philipp Klemm Consultant of: Lilly Pharma Deutschland GmbH, Peter Oelzner: None declared, Ulf Müller-Ladner Consultant of: Lilly Pharma Deutschland GmbH, Axel Hueber Consultant of: Lilly Pharma Deutschland GmbH, Uwe Lange: None declared, Gunter Wolf: None declared, Georg Schett: None declared, David Simon Consultant of: Lilly Pharma Deutschland GmbH, Arnd Kleyer Consultant of: Lilly Pharma Deutschland GmbH

Study of enteric pathogens among children in the tropics and effects of prolonged storage of stool samples

The study was performed to compare real-time PCR after nucleic acid extraction directly from stool samples as well as from samples stored and transported on Whatman papers or flocked swabs at ambient temperature in the tropics. In addition, the possible suitability for a clear determination of likely aetiological relevance of PCR-based pathogen detections based on cycle threshold (Ct) values was assessed. From 632 Tanzanian children <5 years of age with and without gastrointestinal symptoms, 466 samples were subjected to nucleic acid extraction and real-time PCR for gastrointestinal viral, bacterial and protozoan pathogens. Equal or even higher frequencies of pathogen detections from Whatman papers or flocked swabs were achieved compared with nucleic acid extraction directly from stool samples. Comparison of the Ct values showed no significant difference according to the nucleic acid extraction strategy. Also, the Ct values did not allow a decision whether a detected pathogen was associated with gastrointestinal symptoms.

[Radicality of maxillary sinus surgery and size of the maxillary sinus ostium]

Until the 1990s, radical sinus surgery was considered a standard procedure for maxillary sinus diseases, but it is no longer favored due to the high morbidity. Today, functional endoscopic sinus surgery (FESS) is considered the gold standard in sinus surgery. Modifications of surgical approaches also allow access to regions of the maxillary sinus that were previously difficult to reach. Depending on anatomy and pathology, different methods for widening the maxillary ostium can be selected. In type I sinusotomy, the natural ostium is widened dorsally by a maximum of 1 cm. Sinusotomy type II involves widening the natural ostium up to a maximum diameter of 2 cm. In sinusotomy type III, the natural ostium is widened dorsally to the posterior wall of the maxillary sinus and caudally to the base of the inferior turbinate. Beside the prelacrimal approach, more invasive approaches are the medial maxillectomy, in which the dorsal part of the inferior turbinate and the adjacent medial wall of the maxillary sinus is resected, as well as its modifications "mega antrostomy" and "extended maxillary antrostomy." Correct selection of the size of the maxillary sinus window is prerequisite for successful treatment and long-term postoperative success. Isolated purulent maxillary sinusitis can usually be treated by a type I sinusotomy. Sinusotomy type II addresses nasal polyps with involvement of the mucosa of the ostium, recurrent stenosis after previous surgery, chronic maxillary sinusitis due to cystic fibrosis, and purulent maxillary sinusitis with involvement of other adjacent sinuses. Sinusotomy type III is required for choanal polyps with attachment to the floor of the maxillary sinus, for extensive polyposis and fungal sinusitis, and for inverted papilloma. Particularly for (recurrent) disease and extensive interventions in the maxillary sinus, medial maxillectomy or a modification thereof may be required.

Are German family practitioners and psychiatrists sufficiently trained to diagnose and treat patients with alcohol problems?

Background

Harmful alcohol consumption in Germany is a serious public health problem: About 7.7 million adults in Germany can be classified as risky alcohol consumers, about 74,000 deaths per year are related to alcohol consumption, and about 1.8 million adults in Germany (18–64 years) are classified as alcohol dependent. A treatment rate of 9% of all alcohol dependent patients in Germany implies a lack of supply and misuse of medical care. The aim of the study was to examine whether family practitioners (FPs) and psychiatrists have sufficient skills to diagnose and treat patients with alcohol problems.

Methods

A total of 6324 FPs and psychiatrists in the states of Saxony and Rhineland-Palatinate in Germany were invited to participate in this survey. Nine hundred seventy-four participants (90.3%/FPs) could be included in the statistical analysis (response rate: 14.3%/FPs, 21.6%/psychiatrists). Data was analysed descriptively and logistical regressions were used to identify predictors for physicians’ ability to feel adequately trained to diagnose and treat patients with alcohol problems.

Results

In comparison to psychiatrists, less FPs reported feeling sufficiently trained to counsel patients with alcohol problems (81.5% vs. 44.8%). Regression analysis revealed that FPs who felt not adequately trained had less experience with patients with alcohol dependence (OR 7.4), had attended fewer hours on alcohol addiction in continuing medical education (OR 4.8), and were more likely to be female (OR 1.9). A minimum of 10 h of training was associated with improved self-assessed competence.

Conclusion

Harmful drinking is a serious public health problem, and patients with alcohol dependence represent a large and demanding patient group in primary health care setting. Our study shows that the lack of training is a severe barrier in the work with this patient group in the primary care setting.

[Analysis of referral diagnoses to the rheumatology department]

BACKGROUND

The initial presentation of patients with symptoms indicative of a rheumatic disease is in most cases not directly to a rheumatologist. This study evaluated the following questions: I. Which medical specialists refer patients to a department of rheumatology? II. Evaluation of the accordance of the presumptive referral diagnosis and the final diagnosis by a rheumatologist.

METHODS

A total of 947 patients (279 men and 668 women) who initially presented to a university hospital for rheumatological diagnostics were included in the study. The referring medical specialist fields were identified. Furthermore, a kappa analysis was performed to evaluate the accordance of the presumptive referral diagnosis and the final diagnosis generated after a rheumatological evaluation of the patients.

RESULTS

Of the referrals 73% were initiated by general practitioners or internists functioning as general practitioners. The other referrers were 5% specialists in internal medicine (excluding rheumatology), 4% orthopedic/trauma surgeons, 1% other surgeons and 4% other specialist fields. A rheumatological diagnosis was made in 58% of the patients and rheumatological inflammatory joint diseases (26%), collagenosis (14%) and vasculitides (5%) were the most frequently diagnoses. The accordance of the presumptive diagnosis of the general practitioners and the final diagnosis after rheumatological evaluation was a kappa coefficient of κ = 0.304. Lower kappa values were evaluated for orthopedic surgeons (κ = 0.277) and other specialists (κ = 0.200).

CONCLUSION

The referrals to a rheumatology institution were frequently initiated by general practitioners and internists functioning as general practitioners. In this context the presumptive diagnosis of general practitioners showed a low accordance with the final rheumatological diagnosis. In contrast, a detailed presumptive diagnosis is desirable for optimal use of the limited resources for rheumatological care.

[Differential diagnosis and treatment of pituitary adenomas]

Pituitary adenomas are among the most common primary brain tumors. These tumors can produce all hormones of the anterior pituitary and thus cause endocrine diseases. Compression of the pituitary gland, the surrounding cranial nerves, or brain structures can lead to hypopituitarism, cranial nerve deficits, or diverse neurological symptoms. Visual impairment, typically with bitemporal hemianopsia, is the most common cardinal symptom. The diagnostic workup requires broad interdisciplinary cooperation. With the exception of prolactinoma, the treatment of choice for symptomatic pituitary adenoma is transnasal transsphenoidal resection. For prolactinoma, dopamine agonistic therapy is the primary treatment. Adequate hormone replacement therapy is essential in cases of hypopituitarism. Long-term follow-up is a vital part of the treatment concept.

Effect of Periodontal Treatment on HbA1c among Patients with Prediabetes

Evidence is limited regarding whether periodontal treatment improves hemoglobin A1c (HbA1c) among people with prediabetes and periodontal disease, and it is unknown whether improvement of metabolic status persists >3 mo. In an exploratory post hoc analysis of the multicenter randomized controlled trial “Antibiotika und Parodontitis” (Antibiotics and Periodontitis)—a prospective, stratified, double-blind study—we assessed whether nonsurgical periodontal treatment with or without an adjunctive systemic antibiotic treatment affects HbA1c and high-sensitivity C-reactive protein (hsCRP) levels among periodontitis patients with normal HbA1c (≤5.7%, n = 218), prediabetes (5.7% < HbA1c < 6.5%, n = 101), or unknown diabetes (HbA1c ≥ 6.5%, n = 8) over a period of 27.5 mo. Nonsurgical periodontal treatment reduced mean pocket probing depth by >1 mm in both groups. In the normal HbA1c group, HbA1c values remained unchanged at 5.0% (95% CI, 4.9% to 6.1%) during the observation period. Among periodontitis patients with prediabetes, HbA1c decreased from 5.9% (95% CI, 5.9% to 6.0%) to 5.4% (95% CI, 5.3% to 5.5%) at 15.5 mo and increased to 5.6% (95% CI, 5.4% to 5.7%) after 27.5 mo. At 27.5 mo, 46% of periodontitis patients with prediabetes had normal HbA1c levels, whereas 47.9% remained unchanged and 6.3% progressed to diabetes. Median hsCRP values were reduced in the normal HbA1c and prediabetes groups from 1.2 and 1.4 mg/L to 0.7 and 0.7 mg/L, respectively. Nonsurgical periodontal treatment may improve blood glucose values among periodontitis patients with prediabetes (ClinicalTrials.gov NCT00707369).

GaN Nanowire Arrays for Efficient Optical Read-Out and Optoelectronic Control of NV Centers in Diamond

Solid-state quantum emitters embedded in a semiconductor crystal environment are potentially scalable platforms for quantum optical networks operated at room temperature. Prominent representatives are nitrogen-vacancy (NV) centers in diamond showing coherent entanglement and interference with each other. However, these emitters suffer from inefficient optical outcoupling from the diamond and from fluctuations of their charge state. Here, we demonstrate the implementation of regular n-type gallium nitride nanowire arrays on diamond as photonic waveguides to tailor the emission direction of surface-near NV centers and to electrically control their charge state in a p-i-n nanodiode. We show that the electrical excitation of single NV centers in such a diode can efficiently replace optical pumping. By the engineering of the array parameters, we find an optical read-out efficiency enhanced by a factor of 10 and predict a lateral NV-NV coupling 3 orders of magnitude stronger through evanescently coupled nanowire antennas compared to planar diamond not covered by nanowires, which opens up new possibilities for large-scale on-chip quantum-computing applications.

Clinical features and outcome of acquired haemophilia A

We have performed a monocenter study on 29 consecutive patients with acquired haemophilia A who were referred for diagnosis and treatment to the Düsseldorf Haemophilia Comprehensive Care Center between March 2001 and February 2010. Patients, methods: 18 men (age: 44–86 years) and 11 women (age: 20–83 years). For laboratory evaluation, a standardized staged protocol of aPTT, FVIII : C activity and concentration, mixing studies with patient and normal plasma, and quantification of inhibitor titers (Bethesda assay) was used. Diagnostic work-up included elaborate examinations for any underlying disease. Results: In 18 (62%) of the 29 patients with acquired haemophilia A, an underlying disorder was identified, including 9 patients with respiratory diseases (31%), 7 patients with autoimmune disorders (24%), one with malignancy, and one with postpartum state, while in 11 patients (38%) acquired haemophilia A remained idiopathic. Haemotherapy of bleeding, suppression or elimination of the inhibitor, and induction of immunotolerance to endogenous FVIII:C were performed according to a treatment algorithm. Predefined clinical endpoints were control of bleeding, eradication of the inhibitor, complete or partial remission (CR, PR), relapse, or early death (≤30 days). Of the 29 patients in total, 22 individuals achieved CR (76%), three had PR, one relapsed, and three died within 30 days (one of acute myocardial infarction while on anti-haemorrhagic treatment, one of sepsis while on immunosuppression due to active acquired haemophilia A, one of lung bleeding in association with pre-existing pulmonary sarcoidosis). Conclusion: This monocenter study demonstrates that control of life-threatening bleeding, eradication of the inhibitor, and induction of tolerance to endogenous FVIII have significantly improved the clinical outcome of acquired haemophilia A. Our data also suggest a shift in underlying disorders associated with acquired haemophilia A, whereby, in comparison to published studies, a relative increase in the proportion of patients with respiratory diseases is present.

Drug-induced inhibition of phosphorylation of STAT5 overrides drug resistance in neoplastic mast cells

Systemic mastocytosis (SM) is a mast cell (MC) neoplasm with complex pathology and a variable clinical course. In aggressive SM (ASM) and MC leukemia (MCL) responses to conventional drugs are poor and the prognosis is dismal. R763 is a multi-kinase inhibitor that blocks the activity of Aurora-kinase-A/B, ABL1, AKT and FLT3. We examined the effects of R763 on proliferation and survival of neoplastic MC. R763 produced dose-dependent inhibition of proliferation in the human MC lines HMC-1.1 (IC₅₀ 5-50 nM), HMC-1.2 (IC₅₀ 1-10 nM), ROSA^{KIT WT} (IC₅₀ 1-10 nM), ROSA^{KIT D816V} (IC₅₀ 50-500 nM) and MCPV-1.1 (IC₅₀ 100-1000 nM). Moreover, R763 induced growth inhibition in primary neoplastic MC in patients with ASM and MCL. Growth-inhibitory effects of R763 were accompanied by signs of apoptosis and a G2/M cell cycle arrest. R763 also inhibited phosphorylation of KIT, BTK, AKT and STAT5 in neoplastic MC. The most sensitive target appeared to be STAT5. In fact, tyrosine phosphorylation of STAT5 was inhibited by R763 at 10 nM. At this low concentration, R763 produced synergistic growth-inhibitory effects on neoplastic MC when combined with midostaurin or dasatinib. Together, R763 is a novel promising multi-kinase inhibitor that blocks STAT5 activation and thereby overrides drug-resistance in neoplastic MC.

Bacillus Calmette-Guérin vaccination at birth and in vitro cytokine responses to non-specific stimulation. A randomized clinical trial

Several studies have shown increased in vitro cytokine responses to non-related pathogens after Bacillus Calmette-Guérin (BCG) vaccination. A total of 158 infants (80 BCG administered within 7 days of birth; 78 controls) were bled 4 days post-randomization, and at age 3 and 13 months. Geometric mean concentrations of IL-1β, TNF-α, IL-6 (24 h stimulation) and IFN-γ, IL-10, IL-17, IL-22 (96 h stimulation) in response to in vitro stimulation with RPMI, LPS, PHA, Escherichia coli, Streptococcus pneumoniae, Candida albicans and BCG were compared among BCG vaccinated children and controls. BCG vaccination did not affect in vitro cytokine production, except IFN-γ and IL-22 response to BCG. Stratifying for 'age at randomization' we found a potentiating effect of BCG on cytokine production (TNF-α, IL-6, IL-10) in the 4 days post randomization stimulations, among children who were vaccinated at age 2-7 days versus age 0-1 days. BCG vaccination did not potentiate cytokine production to non-BCG antigens. At 4 days post randomization, BCG was associated with higher cytokine production in the later randomized children.

Influence of cooling face masks on nasal air conditioning and nasal geometry

INTRODUCTION

Nasal geometries and temperature of the nasal mucosa are the primary factors affecting nasal air conditioning. Data on intranasal air conditioning after provoking the trigeminal nerve with a cold stimulus simulating the effects of an arctic condition is still missing. The objective was to investigate the influence of skin cooling face masks on nasal air conditioning, mucosal temperature and nasal geometry.

METHODS

Standardized in vivo measurements of intranasal air temperature, humidity and mucosal temperature were performed in 55 healthy subjects at defined detection sites before and after wearing a cooling face mask. Measurements of skin temperature, rhinomanometry and acoustic rhinometry were accomplished.

RESULTS

After wearing the face mask the facial skin temperature was significantly reduced. Intranasal air temperature did not change. Absolute humidity and mucosal temperature increased significantly. The acoustic rhinometric results showed a significant increase of the volumes and the cross-sectional areas. There was no change in nasal airflow.

CONCLUSIONS

Nasal mucosal temperature, humidity of inhaled air, and volume of the anterior nose increased after application of a cold face mask. The response is mediated by the trigeminal nerve. Increased mucosal temperatures as well as changes in nasal geometries seem to guarantee sufficient steady intranasal nasal air conditioning.

Polarity Control of Heteroepitaxial GaN Nanowires on Diamond

Group III-nitride materials such as GaN nanowires are characterized by a spontaneous polarization within the crystal. The sign of the resulting sheet charge at the top and bottom facet of a GaN nanowire is determined by the orientation of the wurtzite bilayer of the different atomic species, called N and Ga polarity. We investigate the polarity distribution of heteroepitaxial GaN nanowires on different substrates and demonstrate polarity control of GaN nanowires on diamond. Kelvin Probe Force Microscopy is used to determine the polarity of individual selective area-grown and self-assembled nanowires over a large scale. At standard growth conditions, mixed polarity occurs for selective GaN nanowires on various substrates, namely on silicon, on sapphire and on diamond. To obtain control over the growth orientation on diamond, the substrate surface is modified by nitrogen and oxygen plasma exposure prior to growth, and the growth parameters are adjusted simultaneously. We find that the surface chemistry and the substrate temperature are the decisive factors for obtaining control of up to 93% for both polarity types, whereas the growth mode, namely selective area or self-assembled growth, does not influence the polarity distribution significantly. The experimental results are discussed by a model based on the interfacial bonds between the GaN nanowires, the termination layer, and the substrate.

Intervention decision-making processes and information preferences of parents of children with autism spectrum disorders

BACKGROUND

When a child is diagnosed with autism, parents are faced with the task of choosing from many different intervention options. To find information about the options available, parents turn to a number of different sources. This study explores parents' (n = 23) intervention decision-making processes and information preferences following the diagnosis of ASD for their child.

METHODS

Qualitative thematic analysis of verbatim transcripts from interviews and focus groups involving parents of children with an autism diagnosis was undertaken.

RESULTS

Analysis of the results revealed that there are concurrent emotional and pragmatic intervention 'journeys' undertaken by parents post diagnosis, which encompass the primary themes of: (1) information sources used, (2) parents' information preferences and (3) factors influencing intervention decision making. Parents described a journey from the point of diagnosis that involved seeking information on ASD interventions from multiple sources, with the Internet being the primary source. They were overwhelmed by the sheer volume of information available, and their preferences for information varied according to their stage in the journey post diagnosis. Parents had a 'trial and error' approach to choosing ASD interventions, with confidence increasing as they became more familiar with their child's condition, and had opportunities to explore numerous information sources about their child's diagnosis. While confidence increased over time, consideration of the effectiveness or evidence supporting interventions remained largely absent throughout the journey.

CONCLUSION

This study highlights the need for parents of children with ASD to be supported to make informed intervention decisions, particularly with consideration for research evidence.

Secondary brown carbon formation via the dicarbonyl imine pathway: nitrogen heterocycle formation and synergistic effects

We observe nitrogen heterocycles to be common secondary brown carbon chromophores formed by dicarbonylsviathe imine pathway, and synergistic effects in mixed dicarbonyl reaction systems.

Increasing the visibility of thin NITINOL vascular implants

New implants for vascular therapy like flow diverters are made of tiny braided wires. The radio opacity of these wires is poor, which makes assessment of implant expansion and exact positioning difficult. Additional markers only allow the estimation of the current device position, but they also induce artefacts that impair the assessment during the intervention and in follow-up examination. A new strategy to increase implant visibility is the braiding of composite wires with a radiopaque core along the whole implant. This paper shows some useful combinations of these new wires on a phantom study with five vascular implants.

DPP4 inhibitors increase differentially the expression of surfactant proteins in Fischer 344 rats

AIM

Intact surface active agent (surfactant) composed of surfactant-associated proteins (SPs) and lipids is necessary for respiration and prevents alveoli from collapsing. CD26, a transmembrane glycoprotein exerting dipeptidyl peptidase activity (DPP4), highly expressed in lung parenchyma, is involved in inflammatory processes. A pharmacological inhibition of DPP4 influenced not only the inflammation but also elevated the SPs. Thus, DPP4 inhibitors may be a novel drug for treatment of diseases with surfactant deficiency. Therefore, we tested firstly the hypothesis that DPP4 inhibitors increase the expression of SPs in healthy rats.

METHODS

SP mRNA and protein expression were determined different times after nebulization of aerosolized DPP4 inhibitors [L-isoleucine-thiazolidide (L-Ile-Thia), L-valine-pyrrolidide (L-Val-Pyrr)], budesonide, saline or stereoisomers.

RESULTS

Compared with negative controls (1) L-Ile-Thia as well as budesonide led to a significant higher and L-Val-Pyrr had the tendency to a significant higher expression of SP-A mRNA 6 h after nebulization, (2) the expression of SP-D mRNA increased significantly 6 h after nebulization with L-Ile-Thia and 3 and 6 h after nebulization with Val-pyrr, (3) SP-B mRNA levels showed significantly higher values 3 and 6 h after nebulization with L-Val-Pyrr, (4) protein levels of SP-A, SP-B and SP-C were elevated significantly 6 h after nebulization with L-Val-Pyrr as well as with budesonide, and (5) phospholipids were also increased in response to DPP4 inhibition; the minimal surface tension was comparable.

CONCLUSION

DPP4 inhibition influence differently the expression of surfactant proteins in healthy rats and may be suitable to elevate surfactant synthesis in different diseases accompanied with surfactant deficiencies.