[Endoscopic release of the carpal tunnel using the Agee technique modified by Neumann]

OBJECTIVE

Decompression of the median nerve by complete endoscopic release of the transverse carpal ligament (TCL) and the distal antebrachial fascia. Minimization of surgical trauma results in decreased postoperative morbidity and earlier return to work and daily activities.

INDICATIONS

Symptomatic carpal tunnel syndrome.

CONTRAINDICATIONS

Revision surgery after open or endoscopic procedure, rheumatic diseases.

SURGICAL TECHNIQUE

Small transverse incision at the ulnar border of the palmaris longus tendon, and proximal to the distal wrist flexion crease. Exposure and incision of the antebrachial fascia, dilatation of the carpal tunnel and dissection of synovial tissue from the undersurface of the TCL. With the wrist in extension, the endoscopic blade assembly with integrated camera is inserted into the canal. Exposure of TCL and short incision in the middle portion. Gradually, dissection of the distal portion of the TCL then completion by retraction of the blade distally to proximally.

POSTOPERATIVE MANAGEMENT

Slightly compressive dressing, selfcare on day 1 after procedure.

RESULTS

More than 25 years of experience, more than 8000 treated patients, and 3 documented cases with intraoperative lesions of the median nerve requiring revision. High acceptance and patient satisfaction in AQS1 patient-reported surveillance.

MR Imaging and Clinical Characteristics of Diffuse Glioneuronal Tumor with Oligodendroglioma-like Features and Nuclear Clusters

BACKGROUND AND PURPOSE

Diffuse glioneuronal tumor with oligodendroglioma-like features and nuclear clusters (DGONC) is a new, molecularly defined glioneuronal CNS tumor type. The objective of the present study was to describe MR imaging and clinical characteristics of patients with DGONC.

MATERIALS AND METHODS

Preoperative MR images of 9 patients with DGONC (median age at diagnosis, 9.9 years; range, 4.2-21.8 years) were reviewed.

RESULTS

All tumors were located superficially in the frontal/temporal lobes and sharply delineated, displaying little mass effect. Near the circle of Willis, the tumors encompassed the arteries. All except one demonstrated characteristics of low-to-intermediate aggressiveness with high-to-intermediate T2WI and ADC signals and bone remodeling. Most tumors (n = 7) showed a homogeneous ground-glass aspect on T2-weighted and FLAIR images. On the basis of the original histopathologic diagnosis, 6 patients received postsurgical chemo-/radiotherapy, 2 were irradiated after surgery, and 1 patient underwent tumor resection only. At a median follow-up of 61 months (range, 10-154 months), 6 patients were alive in a first complete remission and 2 with stable disease 10 and 21 months after diagnosis. The only patient with progressive disease was lost to follow-up. Five-year overall and event-free survival was 100% and 86±13%, respectively.

CONCLUSIONS

This case series presents radiomorphologic characteristics highly predictive of DGONC that contrast with the typical aspects of the original histopathologic diagnoses. This presentation underlines the definition of DGONC as a separate entity, from a clinical perspective. Complete resection may be favorable for long-term disease control in patients with DGONC. The efficacy of nonsurgical treatment modalities should be evaluated in larger series.

Influence of assisted outpatient living in people with intellectual disabilities on individual quality of life and resilience – design of a doctoral thesis

Introduction

The research field of disability and mental health is politically and socially relevant, because the psychological well-being of people with intellectual disabilities has often been trivialized in therapy and legislation. Since the pursuit of mental health is coming into focus due to removal of stigma and emerging awareness, people with disabilities must have equal opportunities to choose their place of residence and get suitable psychosocial support.

Objectives

Our aim is to investigate the influence of assisted outpatient treatment (AOT) on the quality of life and resilience of people with intellectual disabilities who are living self-determined.

Methods

A participatory mixed-methods design is chosen as it enables the greatest possible standardization and allows a high flexibility. The project will be divided into three parts: A systematic literature search to gain knowledge about the field and to estimate the sample size, a pre-post-comparison of the WHOQOL-BREF to evaluate AOT in terms of self-perceived quality of life and a focus-group of handicapped people to reflect the study results with attention on resilience.

Results

To foster the doctoral thesis, several questions can be discussed: 1) How is the relation of disability and mental health to be described? 2) What might be the pros and cons of self-determined living? 3) Which steps need to be taken to implement AOT more often?

Conclusions

The topic is relevant in the public health sector and the results could help to sensitize professionals and the general society regarding to participation in everyday life. The recommendations developed may serve to implement comparable forms of housing.

Disclosure

No significant relationships.

AB1402 FACILITATORS AND BARRIERS OF VACCINE UPTAKE IN PATIENTS WITH CHRONIC INFLAMMATORY RHEUMATIC DISEASE: A SCOPING REVIEW

Background

Patients with chronic inflammatory rheumatic diseases (CIRD) remain underrepresented in receiving vaccinations despite being disproportionately affected by infectious complications.

Objectives

To systematically review the literature regarding vaccination willingness and vaccination hesitancy in CIRD patients with focus on the perspective of patients and physicians.

Methods

A scoping review was conducted in PUBMED, EMBASE and the Cochrane Library through 2021. Study selection was performed by two independent reviewers, data were extracted using a standardized form and risk of bias was assessed using instruments from the McMaster University. Identified barriers and hurdles were synthesized by categorizing them into the WHO’s Measuring Behavioural and Social Drivers of Vaccination (BeSD) conceptual model.

Results

The search yielded 1,644 hits, of which 30 were included (cross-sectional studies (n=27) based on interviews and 3 intervention studies). The majority of studies reported barriers to influenza and pneumococcal vaccination (n=11), or influenza vaccination only (n=9) from the patients perspective. Two studies assessed the attitudes towards COVID-19 vaccinations. Only one study assessed the view of rheumatologists. Patients mainly mentioned behavioral and social factors that negatively influence their willingness to be vaccinated while physicians see deficits in the organization and lack of time as a major barrier. Coverage of domains matched to the BeSD model suggests a lack of awareness of infection risk by both patients and physicians (Figure 1).

Figure 1.

Coverage of domains matched to the WHO BeSD Model

Conclusion

The view of vaccination in CIRD patients diverges between patients and rheumatologists. Our results show that in-depth counseling on vaccines is important for patients, whereas physicians need support in implementing specific immunization recommendations. The themes identified provide a starting point for future interventions to improve vaccine rates in CIRD patients.

Disclosure of Interests

None declared

Decision-analytic modeling for health economic evaluation in child and adolescent psychiatry using inpatient equivalent treatment - design of a doctoral thesis

Introduction

Despite the high prevalence of psychiatric disorders among children and adolescents, services are often accessed too late or not at all. Inpatient-equivalent treatment can be a good option here, as it can counteract structural barriers by enabling treatment from home. Although national and international studies highlight the benefits, this form of treatment is offered by only a few psychiatric facilities.

Objectives

The aim is to provide a decision-making aid for the introduction of outreach treatments with regard to cost-effectiveness. Based on this, the question will be answered whether telemedicine can be an option for the distribution of rare (human) resources.

Methods

1) Based on a systematic review, the best available evidence will serve for deriving hypotheses and providing assumptions for the decision-making model. 2) Decision analytic modeling will be used to determine the cost-effectiveness of inpatient-equivalent treatment compared to conservative inpatient treatment. 3) An additional systematic review will provide information on the use of telemedicine in inpatient equivalent treatment.

Results

The following questions need to be discussed: 1)Is there an indication for all psychiatric diseases and age groups? 2) Are there ethical considerations that need to be taken into account, especially in the use of telemedicine? What incentives need to be set for psychiatrists to opt for inpatient-equivalent treatment?

Conclusions

The results of the study may help to raise awareness of inpatient equivalent treatment among decision-makers. Furthermore, fears could be reduced, since admission to a psychiatric facility can mean a stigmatizing intervention in the lives of young patients.

Disclosure

No significant relationships.

Image quality improvement for optical imaging interferometric microscopy

Imaging interferometric microscopy (IIM) is an optical microscopy resolution enhancement technique involving combining multiple sub-images to increase resolution. Several image reconstruction challenges can degrade the image quality including the frequency, phase deviations between sub-images, and maintenance of a uniform frequency response across the entire space. This work proposes methods to address these issues. The methods are first compared in simulation using a Manhattan structure of 260-nm critical dimension with 2-µm-pitch calibration grating on the sides. The proposed correction methods are then applied to the experimental results and found to be effective in improving the image quality of IIM.

Vaginal birth after Cesarean section and levator ani avulsion: a case-control study

OBJECTIVE

The aim of this study was to explore the risk of levator ani muscle (LAM) avulsion and enlargement of the levator hiatus following vaginal birth after Cesarean section (VBAC) in comparison with vaginal delivery in primiparous women.

METHODS

In this two-center observational case-control study, we identified all women who had a term VBAC for their second delivery at the Departments of Obstetrics and Gynecology at the Faculty of Medicine in Pilsen and the 1^st Faculty of Medicine in Prague, Charles University, Czech Republic, between 2012 and 2016. Women with a repeat VBAC, preterm birth or stillbirth were excluded from the study. As a control group, we enrolled a cohort of primiparous women who delivered vaginally during the study period. To increase our control sample, we also invited all primiparous women who delivered vaginally in both participating units between May and June 2019 to participate. All participants were invited for a four-dimensional pelvic floor ultrasound scan to assess LAM trauma. LAM avulsion and the area of the levator hiatus were assessed offline from the stored pelvic floor volumes obtained at rest, during maximum contraction and during Valsalva maneuver. The laterality of the avulsion was also noted. The cohorts were then compared using the χ² test and Wilcoxon's two-sample test according to the normality of the distribution. P < 0.05 was considered statistically significant. Multivariate regression analysis, controlling for age and body mass index (BMI), was also performed.

RESULTS

A total of 356 women had a VBAC for their second delivery during the study period. Of these, 152 (42.7%) attended the ultrasound examination and full data were available for statistical analysis for 141 women. The control group comprised 113 primiparous women. A significant difference was observed between the VBAC group and the control group in age (32.7 vs 30.1 years; P < 0.05), BMI (28.4 vs 27.4 kg/m² ; P < 0.05) and duration of the first and second stages of labor (293.1 vs 345.9 min; P < 0.05 and 27.6 vs 35.3 min; P < 0.05, respectively) at the time of the index birth. The LAM avulsion rate was significantly higher in the VBAC compared with the control group (32.6% vs 18.6%; P = 0.01). The difference between the groups was observed predominantly in the rate of unilateral avulsion and remained significant after controlling for age and BMI (adjusted odds ratio 2.061 (95% CI, 1.103-3.852)). There was no statistically significant difference in the area of the levator hiatus at rest (12.0 vs 12.6 cm² ; P = 0.28) or on maximum Valsalva maneuver (18.6 vs 18.7 cm² ; P = 0.55) between the VBAC and control groups. The incidence of levator hiatal ballooning was comparable between the groups (17.7% and 18.6%; P = 0.86).

CONCLUSIONS

VBAC is associated with a significantly higher rate of LAM avulsion than is vaginal birth in nulliparous women. The difference was significant even after controlling for age and BMI. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Blood glucose response after oral lactulose intake in type 2 diabetic individuals

BACKGROUND

Lactulose is approved for the symptomatic treatment of constipation, a gastrointestinal (GI) complication common in individuals with diabetes. Lactulose products contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose for the treatment of mild constipation. A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.

AIM

To evaluate the blood glucose profile after oral lactulose intake in mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.

METHODS

This prospective, double-blind, randomized, controlled, single-center trial was conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects with T2DM. Eligible subjects were randomized and assigned to one of six treatment sequences, each consisting of four treatments stratified by sex using an incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose (crystal and liquid formulation), water as negative control or 30 g glucose as positive control. Capillary blood glucose concentrations were measured over a period of 180 min post dose. The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period [AUC_{baseline_c (0-180 min)}]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters included GI tolerability, which was assessed at 180 min and 24 h post dose, and adverse events occurring up to 24 h post dose.

RESULTS

In 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The primary endpoint [AUC_{baseline_c (0-180 min)}] was not significantly different between lactulose and water regardless of lactulose dose and formulation. Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level. A minor increase in maximum blood glucose was observed after the 30 g dose, liquid lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, respectively (all P < 0.0001). No differences in blood glucose response were observed between the different lactulose formulations. As expected, lactulose increased the number of bowel movements and was generally well tolerated. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.

CONCLUSION

Blood glucose AUC_{baseline_c (0-180 min)} levels in mildly constipated, non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations.

Chirped-grating spectrometer-on-a-chip

We demonstrate an on-chip spectrometer readily integrable with CMOS electronics. The structure is comprised of a SiO₂/Si₃N₄/SiO₂ waveguide atop a silicon substrate. A transversely chirped grating is fabricated, in a single-step optical lithography process, on a portion of the waveguide to provide angle and wavelength dependent coupling to the guided mode. The spectral and angular information is encoded in the spatial dependence of the grating period. A uniform pitch grating area, separated from the collection area by an unpatterned propagation region, provides the out-coupling to a CMOS detector array. A resolution of 0.3 nm at 633 nm with a spectral coverage tunable across the visible and NIR (to ∼ 1 µm limited by the Si photodetector) by changing the angle of incidence, is demonstrated without the need for any signal processing deconvolution. This on-chip spectrometer concept will cost effectively enable a broad range of applications that are beyond the reach of current integrated spectroscopic technologies.

Save the children by treating their mothers (PriVileG-M-study) - study protocol: a sequentially randomized controlled trial of individualized psychotherapy and telemedicine to reduce mental stress in pregnant women and young mothers and to improve Child's health

BACKGROUND

As early as pregnancy, maternal mental stress impinges on the child's development and health. Thus, this may cause enhanced risk for premature birth, lowered fetal growth, and lower fetal birth weight as well as enhanced levels of the stress hormone cortisol and lowered levels of the bonding hormone oxytocin. Maternal stress further reduces maternal sensitivity for the child's needs which impairs the mother-child-interaction and bonding. Therefore, prevention and intervention studies on mental stress are necessary, beginning prenatally and applying rigorous research methodology, such as randomized controlled trials, to ensure high validity.

METHODS

A randomized controlled trial is used to assess the impact of psychotherapy and telemedicine on maternal mental stress and the child's mental and physical health. Mentally stressed pregnant women are randomized to an intervention (IG) and a not intervened control group. The IG receives an individualized psychotherapy starting prenatal and lasting for 10 months. Afterwards, a second randomization is used to investigate whether the use of telemedicine can stabilize the therapeutic effects. Using ecological momentary assessments and video recordings, the transfer into daily life, maternal sensitivity and mother-child-bonding are assessed. Psycho-biologically, the synchronicity of cortisol and oxytocin levels between mother and child are assessed as well as the peptidome of the colostrum and breast milk, which are assumed to be essential for the adaptation to the extra-uterine environment. All assessments are compared to an additional control group of healthy women. Finally, the results of the study will lead to the development of a qualification measure for health professionals to detect mental stress, to treat it with low-level interventions and to refer those women with high stress levels to mental health professionals.

DISCUSSION

The study aims to prevent the transgenerational transfer of psychiatric and somatic disorders from the mother to her child. The effects of the psychotherapy will be stabilized through telemedicine and long-term impacts on the child's and mothers' mental health are enhanced. The combination of psychotherapy, telemedicine and methodologies of ecological momentary assessment, video recording and bio banking are new in content-related and methodological manner.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00017065. Registered 02 May 2019. World Health Organization, Universal Trial Number: U1111-1230-9826. Registered 01 April 2019.

Time and laser ranging: a window of opportunity for geodesy, navigation and metrology

Recent progress in the domain of time and frequency (T/F) standards requires important improvements of existing time distribution links. Among these, the accuracy of time transfer is actually an important part of the concerns in order to establish and maintain time & space references from ground and/or space facilities. Several time transfers by laser link projects have been carried out over the past 10 years with numerous scientific and metrological objectives. Satellite Laser ranging (SLR) has proven to be a fundamental tool, offering a straightforward, conceptually simple, highly accurate and unambiguous observable. Depending on the mission, LR is used to transmit time over two-way or one-way distances from 500 to several millions of km. The following missions and their objectives employed this technique: European Laser Timing (ELT) at 450 km, Time Transfer by Laser Link (T2L2) at 1,336 km, Laser Time Transfer (LTT) at 36,000 km, Lunar Reconnaissance Orbiter (LRO) at 350,000 km, and MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) at tens of million km. This article describes the synergy between SLR and T/F technologies developed on the ground and in space and as well as the state of the art of their exploitation. The performance and sources of limitation of such space missions are analyzed. It shows that current and future challenges lie in the improvement of the time accuracy and stability of the time for ground geodetic observatories. The role of the next generation of SLR systems is emphasized both in space and at ground level, from the point of view of GGOS and valuable exploitation of the synergy between time synchronization, ranging and data transfer.

Time spent on self-management by people with diabetes: results from the population-based KORA survey in Germany

AIMS

Time needed for health-related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self-management and associated factors was analysed using cross-sectional data from people with diagnosed diabetes enrolled in a population-based study.

METHODS

Mean total time spent on self-management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two-part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values.

RESULTS

Some 86% of participants reported spending time on self-management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self-management-activities. People with insulin or oral anti-hyperglycaemic drug treatment, better diabetes education, HbA_1c 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self-management activities. For example, people without anti-hyperglycaemic medication invested 66 min/week in self-management, whereas those taking insulin and oral anti-hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85-10.18).

CONCLUSIONS

Time spent on self-management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self-management activities should be routinely considered because it may affect diabetes self-care and quality of life.

Direct-current current transformer for the measurement of an electric propulsion ion beam

An important task in the development of electric propulsion devices is ground-based testing. In order to characterize electric thrusters, their generated ion beams are regarded as figures of merit and have to be well-known and understood. We present an approach to measure DC ion beam currents generated by electric thrusters by means of an inductive direct-current current transformer. In contrast to commonly used devices like Faraday cups, this device can measure the beam current non-intrusively by means of magnetic field coupling rather than charge collection. This paper shows the development of a prototype sensor which can measure currents in the typical range for electric thrusters with high resolution and satisfactory accuracy. A detailed SPICE model to assist during hardware development is also introduced and verified by test case measurements. The prototype has been tested and validated with a radio-frequency ion thruster. Its readout shows very good agreement with the output of an analytical model which computes a Gaussian-shaped ion beam in the far-field based on experimental input data.

Nachruf Prof. Dr. med. Joachim Heermann

Am 20.07.2018 ist Herr Prof. Dr. med. Joachim Heermann nach langer Krankheit im Kreise seiner großen Familie in Essen verstorben. Mit Joachim Heermann verliert die HNO-Gesellschaft eine außergewöhnliche Persönlichkeit, einen Pionier der Mikrochirurgie des Ohres und der Nase und einen menschlichen innovativen Geist.

Maternal depression during pregnancy and cord blood DNA methylation: findings from the Avon Longitudinal Study of Parents and Children

Up to 13% of women may experience symptoms of depression during pregnancy or in the postpartum period. Depression during pregnancy has been associated with an increased risk of adverse neurodevelopmental outcomes in the child and epigenetic mechanisms could be one of the biological pathways to explain this association. In 844 mother-child pairs from the Avon Longitudinal Study of Parents and Children, we carried out an epigenome-wide association study (EWAS) to investigate associations between prospectively collected data on maternal depression ascertained by the Edinburgh Postnatal Depression Scale in pregnancy and DNA methylation in the cord blood of newborn offspring. In individual site analysis, we identified two CpG sites associated with maternal depression in the middle part of pregnancy. In our regional analysis, we identified 39 differentially methylated regions (DMRs). Seven DMRs were associated with depression at any time point during pregnancy, 7 associated with depression in mid-pregnancy, 23 were associated with depression in late pregnancy, and 2 DMRs were associated with depression throughout pregnancy. Several of these map to genes associated with psychiatric disease and brain development. We attempted replication in The Generation R Study and could not replicate our results. Although our findings in ALSPAC suggest that maternal depression could be associated with cord blood DNA methylation the results should be viewed as preliminary and hypothesis generating until further replicated in a larger sample.

[Medical care of patients with spasticity following stroke : Evaluation of the treatment situation in Germany with focus on the use of botulinum toxin]

BACKGROUND

Upper limb spasticity is a common complication following stroke. Cohort studies found 19% of post-stroke patients had upper limb spasticity at 3 months and 38% of patients at 12 months. For focal spasticity, intramuscular injections of botulinum toxin are indicated. In Germany, it is assumed that patients with the described indication are undersupplied with botulinum toxin.

OBJECTIVE

The aim of the present study is to evaluate the medical care of patients with upper limb spasticity post-stroke with the focus on the use of botulinum toxin as one treatment option.

METHODS

A standardized questionnaire was developed and a postal survey of a representative national random sample of 800 neurologists to capture the actual medical care situation.

RESULTS

The response rate amounted to 37% (n = 292). 59% of the neurologists surveyed had never used botulinum toxin. In total, 87% of neurologists noticed barriers regarding the use of botulinum toxin, where the amount of the doctor's remuneration in 40% and the lack of reimbursement of costs in off-label use in 60% were the most commonly used answers. The achievement of an advanced training in using botulinum toxin was also stated as a general obstacle for resident neurologists.

DISCUSSION

Due to a response rate of 37% for the postal survey a selection bias cannot be excluded. Although botulinum toxin is recommended in the national treatment guidelines, many neurologists do not use botulinum toxin. The reasons can be seen from the barriers described.

Observer variability and sensitivity of radiographic diagnosis of canine medial coronoid disease

Objective: Medial coronoid disease (MCD) is a very common form of elbow joint disease and it’s radiographic diagnosis can be challenging since it is frequently based on the detection of rather subtle primary or secondary changes than on a large primary lesion. We hypothesized that accuracy of radiographic diagnosis of MCD is highly dependent on training and experience level. Methods: Radiographs of 102 canine elbows were evaluated for MCD by four observers with different levels of training and experience. All elbows underwent CT scans and arthroscopy. Sensitivity and specificity of radiographic and CT interpretation was determined using arthroscopy as a gold standard. Interobserver and intraobserver agreement (reliability and repeatability) were assessed by using Cohen’s Kappa (κ) statistic. Results: The sensitivity (92.4–96.7%) of the two experienced observers was almost comparable to that of CT (100%) and significantly higher than that of the two less experienced observers (77.2–80.4%). Reliability of the radiographic diagnosis of MCD was better between observers with higher experience level (κ = 0.74) than between observers of lower or different experience levels (κ =0.07–0.42). Repeatability was better in experienced (κ = 0.73–0.88) than in less experienced observers (κ = 0.31–0.42). Conclusion: Our results confirm that training and experience play important roles in reaching high sensitivity, reliability and repeatability for the radiographic diagnosis of MCD. Clinical relevance: Although radiography is inferior to CT in imaging of the medial coronoid process itself, sensitivity of radiographic diagnosis MCD can be significantly improved with observer experience almost reaching that of CT. Therefore, it is advised that radiographic screening for MCD should be performed by specialists experienced in the radiographic evaluation of elbow joint disease.

Fetal and neonatal alloimmune thrombocytopenia

OBJECTIVE

This article shows our experience with fetal and neonatal alloimmune thrombocytopenia (FNAIT) on a particular patient and the difficulties we faced during the hospitalization.

DESIGN

Case report.

SETTING

Department of Obsterics and Gynecology 1st Faculty of Medicine, Charles University and General Faculty Hospital in Prague.

METHODS

Our experience with FNAIT therapy.

RESULTS

According to literature is recommended to use IVIG for FNAIT treatment. Women, who were treated by IVIG have better results, in comparison with women, who had no treatment at all. Our case is not confirming this statement, because first pregnancy of our patient terminated by IUFD, on the other hand second pregnancy was successful and she delivered healthy child.

CONCLUSION

FNAIT is relatively rare disease, but if it appears, it can be dangerous for a fetus or for a new-born baby. In the worst case FNAIT can result in intracranial bleeding or prenatal death. There are limited preventive steps and available therapy produces uncertain results. The only partially accepted treatment substance is IVIG (intravenous immunoglobulins). Unfortunately, this therapy is very expensive and not accepted by some experts. This article shows our experience with FNAIT on a particular patient and the difficulties we faced during the hospitalization.

Solution nuclear magnetic resonance spectroscopy on a nanostructured diamond chip

Sensors using nitrogen-vacancy centers in diamond are a promising tool for small-volume nuclear magnetic resonance (NMR) spectroscopy, but the limited sensitivity remains a challenge. Here we show nearly two orders of magnitude improvement in concentration sensitivity over previous nitrogen-vacancy and picoliter NMR studies. We demonstrate NMR spectroscopy of picoliter-volume solutions using a nanostructured diamond chip with dense, high-aspect-ratio nanogratings, enhancing the surface area by 15 times. The nanograting sidewalls are doped with nitrogen-vacancies located a few nanometers from the diamond surface to detect the NMR spectrum of roughly 1 pl of fluid lying within adjacent nanograting grooves. We perform ¹H and ¹⁹F nuclear magnetic resonance spectroscopy at room temperature in magnetic fields below 50 mT. Using a solution of CsF in glycerol, we determine that 4 ± 2 × 10^{12 19}F spins in a 1 pl volume can be detected with a signal-to-noise ratio of 3 in 1 s of integration.

Nitrogen vacancy (NV) centres in diamond can be used for NMR spectroscopy, but increased sensitivity is needed to avoid long measurement times. Kehayias et al. present a nanostructured diamond grating with a high density of NV centres, enabling NMR spectroscopy of picoliter-volume solutions.