Total Resolution Research Articles

Clinical manifestations, management, and outcomes of primary silent sinus syndrome: a systematic review.

Silent sinus syndrome (SSS) is a rare disorder of the maxillary sinus, which may present with orbital symptoms. Most reports of silent sinus syndrome are limited to small series or case reports. This systematic review comprehensively characterizes the various clinical presentations, management, treatment, and outcomes in patients with SSS. A systematic literature search of the PubMed, Cochrane, Web of Science, and Scopus databases. Inclusion criteria were studies describing the presentation, management, or treatment of SSS or chronic maxillary atelectasis. One hundred fifty-three articles were included in the final review (n=558 patients). Mean age at diagnosis was 38.8 ± 14.1 years, with a relatively even distribution among sexes. Enophthalmos and/or hypoglobus were the most frequent symptoms, along with diplopia, headache, or facial pressure/pain. Most patients (87%) underwent functional endoscopic sinus surgery (FESS), and 23.5% received orbital floor reconstruction. Post-treatment, patients had significant reductions in enophthalmos (2.67 ± 1.39 vs. 0.33 ± 0.75 mm) and hypoglobus (2.22 ± 1.43 vs. 0.23 ± 0.62 mm). Most patients (83.2%) achieved partial or total resolution of clinical symptoms. SSS has a variable clinical presentation, with enophthalmos and hypoglobus being most common. FESS with or without orbital reconstruction are effective treatments to address the underlying pathology and structural deficits.

Partially reversible bilateral Lenticular fork sign and acute Parkinsonism in diabetic uremic syndrome (P5-11.005)

<h3>Objective:</h3> Not applicable <h3>Background:</h3> Diabetic uremic syndrome is a concept that has been increasingly recognized since it was proposed in 2003. It differs from uremic encephalopathy. Hereby, we describe the first case of North African Arab descent with end-stage renal disease and diabetes who developed acute Parkinsonism with bilateral lenticular fork sign and uremia that partially resolved after extensive dialysis therapy. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> <h3>Case Description:</h3> 65 years old man with end-stage renal disease on peritoneal dialysis and newly diagnosed diabetes millets presented with a 3-day history of unsteady gait, generalized weakness, mild dysarthria, mild dysphagia, drowsiness, and changes in concentration. Examination revealed a mask face, dysphagia, absent gag reflex, dysphonia, generalized motor weakness more prominent in lower limbs, bradykinesia, absent knee reflexes, and myoclonic jerks. Laboratory studies showed urea 25 mmol/L, Creatinin 922 umol/L, arterial pH 7.25, and normal lactate. The lumbar puncture study was unremarkable. CT head showed swollen hypodense bilateral lentiform nuclei with a hypodense rim delineating the basal ganglia and giving the appearance of a lentiform fork sign. MRI showed bilateral T2 and FLAIR putamen and globus pallidus hyperintensity and significant lactate peak in the bilateral basal ganglia on MR spectroscopy. EMG study was evident of axonal polyneuropathy. IVIG course was commenced, and motor weakness improved. The peritoneal dialysis was intensified, and later treatment was switched to hemodialysis. Acidemia resolved, and uremia significantly improved. Two weeks post-admission, the fork sign on MRI significantly regressed, and the patient’s Parkinsonian symptoms partially improved. <h3>Conclusions:</h3> Development of acute or subacute extrapyramidal movement disorder in end-stage renal disease associated with diabetes should promote the possibility of diabetic uremic syndrome with bilateral basal ganglia lesions forming fork sign appearance that occurs early on brain imaging. Usually, extensive dialysis, preferable hemodialysis, leads to a total resolution of brain imaging and partial resolution of clinical findings. <b>Disclosure:</b> Dr. Nofal has nothing to disclose. Dr. Noorain has nothing to disclose. Dr. Safan has nothing to disclose. Dr. Adeli has nothing to disclose. Dr. Sokrab has nothing to disclose.

Development of a sealed MRPC with high time resolution

Multi-gap Resistive Plate Chambers (MRPC) are used in the Solenoidal Large Intensity Device (SoLID) at Jefferson Lab (JLab) to identify kaons. SoLID requires 20 ps for the total time resolution. In this paper, a sealed MRPC (sMRPC) prototype with 4 stacks and 7 uniform gas gaps is designed to reach a good time resolution. At the same time, sMRPC can lower the airflow through the chamber to reduce the greenhouse pollution. Both analog signal discrimination & TDC electronic system and waveform sampling electronic system are used for the readout of the signal. In cosmic tests, we compared the time resolution of these electronic readout methods and measured the efficiency of the sealed MRPC. The preliminary result shows that the MRPC prototype has an efficiency higher than 95%. The sealed MRPC prototype using waveform sampling system, has a time resolution of 40 ps, while a 54 ps time resolution is obtained using analog signal discrimination & TDC electronic system.

Resonant inelastic X-ray scattering endstation at the 1C beamline of Pohang Light Source II.

An endstation for resonant inelastic X-ray scattering (RIXS), dedicated to operations in the hard X-ray regime, has been constructed at the 1C beamline of Pohang Light Source II. At the Ir L3-edge, a total energy resolution of 34.2 meV was achieved, close to the theoretical estimation of 34.0 meV, which considers factors such as the incident energy bandpass, intrinsic analyzer resolution, geometrical broadening of the spectrometer, finite beam-size effect and Johann aberration. The performance of the RIXS instrument is demonstrated by measuring the RIXS spectra of Sr2IrO4. The endstation can be easily reconfigured to measure energy-integrated intensities with very low background for diffuse scattering and diffraction experiments.

Therapeutic efficacy evaluation of the reference drug ursodeoxycholic acid and its analogues in the biliary sludge dissolution: a meta-analysis

Aim. To compare the therapeutic efficacy of the reference drug ursodoxycholic acid (UDCA) for Russian Federation (Ursofalk) and generic UDCA preparations of other manufacturers in the solution of biliary sludge (BS).&#x0D; Materials and methods. The search for studies was carried out in the electronic databases MEDLINE/PubMed, EMBASE, Cochrane, Russian Science Citation Index (RSCI) until February 2022. Inclusion criteria for the meta-analysis were controlled trials, trials using the reference drug for RF Ursofalk in one of the groups, diagnosis and subsequent assessment of the dynamics of resolution of BS according to transabdominal ultrasound, the absence of simultaneous use of other therapy that could affect therapeutic outcomes, a documented endpoint, which reflects the percentage of the total resolution of the BS in each of the compared groups.&#x0D; Results. The final analysis included 6 studies involving 671 patients with BS (324 with Ursophalc, 347 with other UDCA). When using any UDCA preparations, the generalized frequency of BS dissolution within 3 months was 52.010% (95% confidence interval CI 36.55467.272; I2=94.07%), and after 6 months 78.204% (95% CI 67.84087.024; I2=86.90%). When using the RF reference drug Ursofalk, the generalized frequency of dissolution of BS during 3 months of therapy was 64.826% (95% CI 49.24278.941; I2=87.53%), while when using other UDCA drugs it was 39.187% (95% CI 17.52063.390; I2=95.24%). Ursofalk was more effective than other UDCA preparations (odds ratio OR 3.183; 95% CI 1.495-6.777; I2=74.52%). A similar trend persisted when evaluating the effectiveness of a 6-month course of therapy (OR 4.614; 95% CI 2.8817.388; I2=26.41%). Thus, the generalized frequency of dissolution of BS in the Ursofalk groups was 88.381% (95% CI 80.89094.198; I2=64.98%), and for other UDCA drugs 65.978% (95% CI 60.12571.491; I2=43.22%).&#x0D; Conclusion. This meta-analysis demonstrated that the reference drug UDCA for RF (Ursofalk) is more effective than generic UDCA drugs from other manufacturers in diluting BS.

Interface Fluid Syndrome After Descemet Membrane Endothelial Keratoplasty in Patients With History of LASIK.

The aim of this study was to evaluate the visual, pachymetric, tomographic, and biomicroscopic findings in a series of cases with laser in situ keratomileusis (LASIK) flap interface fluid syndrome (IFS) after Descemet membrane endothelial keratoplasty (DMEK). Six cases were included in this study; all patients had a history of LASIK and underwent DMEK for the treatment of bullous keratopathy. After uneventful surgery, all patients presented with corneal edema and IFS under the LASIK flap, which was demonstrated with anterior segment optical coherence tomography (AS-OCT). Visual acuity, clinical findings, pachymetry, endothelial cell count, and AS-OCT were documented during the management of these cases. IFS appears 2.33 days (±1.03) after DMEK. One case improved with conservative treatment. In 5 cases, the LASIK flap was lifted, the fluid was drained, and the flap was replaced. The mean best-corrected visual acuity after fluid drainage was 0.44 logMAR (range 0.18-1.0) and mean central corneal thickness was 538 μm ± 160. Total resolution of the IFS was achieved at 14.5 days (range 4-30) after DMEK. AS-OCT showed resolution of the flap interface in 5 of 6 cases, while 1 patient required second DMEK due to reaccumulation of the interface fluid. IFS can occur after DMEK in patients with previous LASIK. AS-OCT is a valuable tool for monitoring these cases preoperatively and postoperatively. Early surgical management is often needed to achieve resolution.

The Emerging Role of Photobiomodulation in COVID-19 Therapy Part II

Purpose: To empirically confirm the utility of photobiomodulation (PBM) in the treatment of acute and long COVID-19 guided by a mechanistic analysis of the photochemical effects of pulsed light on SARS-CoV-2 infections and disease progression. Background: COVID-19 comprises a coronavirus severe inflammatory disease infecting tissue populated by ACE-2 receptors of the upper and lower respiratory tract and AEC causing an overexpression of pro-inflammatory cytokines. Once in the lungs, viremic spread and cytokine profusion progresses into multi-organ hyperinflammation of visceral epithelium, vascular endothelium, and neurons of the CNS, PNS, ANS, and brain with long-term sequelae. In response to an oxidative state, red and NIR PBM down-regulates proinflammatory cytokines, activating M2 macrophages and Th2 helper cells to increase anti-inflammatory immune response in accordance with a biphasic dose response. Published reports confirm efficacious therapy of COVID-19 using conformal LED pads or scanned lasers. Results: A series of two acute COVID case studies comprising 69 ambulatory (stage 1-to-5) and five stage-6 hospitalized patients confirm the efficacious impact of whole-organ deep-tissue PBM using algorithmically-pulsed conformal LED pad optical delivery methods. Together, acute symptomatic recovery from two 64-84 min PBM sessions occurred within three days for 62/62 patients. Full recovery occurred within four sessions for all PBM patients (all but two cases resolved within one week). Prophylactic benefits were recorded in 17/17 asymptomatic-to-mild (stage 0-1) patients exposed to viral shedding of infected family members. PBM of long COVID outcomes include total resolution of dyspnea, ability to maintain SpO2 above 97% without oxygen supplementation, relief from digestive distress, elimination of brain fog, improved memory recall, restored executive function, and symptomatically managing emotional deficits. Total whole-organ PBM treatments to date comprise approximately three-hundred fifty cases comprising 60% acute COVID-19, 20% metabolic and respiratory long COVID, and 20% neurological long COVID. Unresolved cases totaling 0.25% include two cases of severe long COVID anxiety and nosophobia where PBM was found to deliver only short-term palliative relief. Conclusion: Ongoing results increasingly support the application of whole-organ deep tissue PBM in the treatment of acute and long COVID-19. Both conformal LED pads and scanning lasers demonstrate favorable outcomes. LED pads deliver higher fluences than scanned lasers in the same session times. Further studies of the prophylactic benefits of PBM are indicated.

Early propranolol treatment of infantile hemangiomas improves outcome

BackgroundInfantile hemangiomas (IH) are the most common soft tissue tumors of childhood. Although most of these tumors are not worrisome, some IH may be life or function-threatening, can lead to permanent disfigurement, or have associated structural congenital anomalies, requiring early recognition and referral to specialists for treatment consideration. Since 2008, oral propranolol has been widely considered to be the first-line treatment for IH. ObjectivesTo evaluate aesthetic and functional outcome in propranolol-treated infantile hemangiomas according to the age of treatment onset. MethodsRetrospective, observational study of infantile hemangioma patients under 4 years of age at the time of diagnosis, treated with oral propranolol. Evaluated parameters included: pre and post-treatment morphologic/aesthetic aspects of the hemangioma, total resolution rate, degree of functional compromise of affected areas and its evolution. Two independent pediatric dermatologists evaluated all cases reviewing clinical data from medical records and comparing clinical photographs taken at initiation and at the end of treatment of each patient. Data were analyzed with STATA 13.0 program. ResultsThe cohort included 138 patients, with a female predominance. The median age at therapy onset was 3 months. The morphological/aesthetic improvement rate was 99% (95% CI 96‒99), the total resolution rate was 48% (95% CI 44‒60) and the functional improvement rate reached 100%. When comparing total resolution outcome versus age when treatment started, the improvement was larger in younger patients (3.5 vs. 4.9 months, p = 0.01). When comparing the total resolution rate in those younger or older than 3 months at treatment initiation, the percentage of total resolution in the younger group was 57% vs. 40% in the older one (p = 0.05). Study limitationsRetrospective design; patients photographs were the sole indicators used to measure regression rates. Visual assessment is subjective. ConclusionThe present results strongly suggest that early (before 3 months of age) initiation of treatment of infantile hemangiomas with propranolol results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution.

Assessment of a joint farmer-veterinarian discussion about biosecurity using novel social interaction analyses

Veterinarians are trusted by farmers and play an important role in assisting them to implement biosecurity. More research is needed that particularly focuses on the impact of joint farmer-veterinarian discussions to further understand the role of communication in altering biosecurity behaviours. The aim of this study was to analyse joint dairy cattle farmer-veterinarian discussions about the adoption of on-farm biosecurity using novel social interaction methodologies. Farmer and veterinarian stakeholders were invited to take part in a face-to-face meeting. Introductory presentations were given, followed by separate facilitated veterinarian and farmer discussions. All stakeholders were brought together for a final facilitated group discussion which was audio recorded. Corresponding transcripts from the recordings were analysed via thematic and conversation analyses. Conversation analysis assessments such as turn taking, repair, sequence organisation, overlap and asymmetry were employed to investigate the nature of the conversation. Thematic analysis identified the negative repercussions of conflicting information or ineffective communication surrounding biosecurity implementation. The type of, and importance of, the relationship farmers had with veterinarians and other stakeholders was highlighted. The need to provide personalised biosecurity protocols on farms was identified. Four key factors were identified via conversation analyses. These included: 1) how the conversation facilitated agreement, 2) how the conversation allowed the farmer and veterinarian participants to learn from one another in real time, 3) how the discussion enabled participants to expand upon points they were making, and 4) how participants were able to obtain a greater understanding of the other participants’ opinions, even without total resolution. Debate around the effective implementation of biosecurity measures on farms, explored using novel techniques, demonstrated the potential for utilising a discussive approach between veterinarians and farmers to lead to solutions not previously considered. Because of the nature of the discussion, conversation analysis resulted in an informative approach to encapsulating the nuanced dialogue between stakeholders, highlighting the potential of this analysis framework.

Acute gastric twist after laparoscopic sleeve gastrectomy: A case series.

Laparoscopic sleeve gastrectomy (LSG) has become the most performed bariatric procedure. Like any surgical intervention, LSG is not free from complications. One of the rarest complications is gastric sleeve stenosis, caused by either stricture or axial rotation of the stomach (twisted gastric tube). There is no consensus on the management of such a complication due to several underlying mechanisms and different timings of presentation. Between July 1, 2021 and December 31, 2021, we encountered three cases of acute gastric twist following LSG, and all of them required surgical intervention. All data (imaging results, operative reports and videos, discharge summaries, etc.) were retrospectively collected and analyzed after obtaining patients' informed consent. We report three cases of acute gastric twist post-sleeve gastrectomy, diagnosed by different imaging modalities which showed localized distal gastric twist. All patients underwent exploratory laparoscopy which confirmed gastric sleeve twist. Gastropexy by fixation of the gastric tube to the transverse mesocolon was done in the first case which presented a localized partial distal twist, and a gastro-jejunal anastomosis proximal to the gastric twist was performed in the two other cases to bypass the obstruction. All of them had excellent postoperative results and a total symptomatic resolution. We considered gastric tube fixation to the transverse mesocolon as a feasible option when the twist is local and partial. We also presented a new surgical modality to treat local complete distal gastric twist by a single gastro-jejunal latero-lateral anastomosis proximal to the twist, which seems safe and effective. The best method to treat such a complication is to prevent it by giving special attention to the different technical aspects of LSG.

Graphs with large total angular resolution

The total angular resolution of a straight-line drawing is the minimum angle between two edges of the drawing. It combines two properties contributing to the readability of a drawing: the angular resolution, which is the minimum angle between incident edges, and the crossing resolution, which is the minimum angle between crossing edges. We consider the total angular resolution of a graph, which is the maximum total angular resolution of a straight-line drawing of this graph.We prove tight bounds for the number of edges for graphs for some values of the total angular resolution up to a finite number of well specified exceptions of constant size. In addition, we show that deciding whether a graph has total angular resolution at least 60∘ is NP-hard. Further we present some special graphs and their total angular resolution.

Design of Ultrahigh Energy Resolution RIXS Beamline at NanoTerasu

The optical design of the ultrahigh-resolution RIXS beamline, which is currently developed at NanoTerasu in Japan, is described. The main goal of this beamline is to perform ultrahigh-resolution RIXS measurements with a total energy resolution of <10 meV at 250–1000 eV with E/ΔE>150,000 for both beamline and RIXS spectrometer. To achieve the ultra-high resolution, a 2D-RIXS spectrometer using energy-dispersive X-ray is employed to compensate for lower throughput at higher energy resolution, and the optics of the beamline is optimized for the 2D-RIXS spectrometer. A vertically dispersing in-focus variable-included-angle varied-line-spacing plane grating monochromator is employed for the beamline, with an entrance slit to ensure the ultrahigh resolution. First and second mirrors focus X-ray on entrance slits vertically and horizontally, respectively, and the divergent X-ray is irradiated onto the grating. For the 2D-RIXS spectrometer, there is no exit slit, and the vertically energy-dispersed X-ray is irradiated directly onto a sample. In front of the sample, X-ray is horizontally refocused by a Wolter type-I mirror. The expected horizontal focus size at the sample is ~0.7 μm. The expected photon flux is ~1×1011 photons/s at 500–1000 eV with a virtual slit width of 2 μm required for E/ΔE>150,000. The height of the dispersed X-ray available in the 2D-RIXS spectrometer is ~120 μm, which allows the use of a remarkably high flux of ~6×1012 photons/s, and the beamline will serve as an ultrahigh-resolution and high-efficiency RIXS facility.

Intravitreal Fluocinolone Acetonide Implant (FAc, 0.19mg, ILUVIEN®) in the Treatment of Patients with Recurrent Cystoid Macular Edema After Pars Plana Vitrectomy.

Postoperative cystoid macular edema (PCME) is a complication of several ocular procedures, including pars plana vitrectomy (PPV), due to the activation of the inflammatory cascade. The purpose of this case series is to evaluate the effectiveness and safety of fluocinolone acetonide intravitreal implant (FAc, 0.2μg/day; ILUVIEN®) in the treatment of refractory PCME after successful PPV. This retrospective observational case series includes consecutive eyes of patients with recurrent PCME after PPV and treated with a single FAc implant at Centro Hospitalar Universitário de São João, Porto, Portugal. Previous treatments, best-corrected visual acuity (BCVA, ETDRS letters), central macular thickness (CMT, μm), intraocular pressure (IOP, mmHg), and IOP-lowering medication needed were recorded at baseline and during follow-up. Total macular edema resolution was defined as CMT less than 300μm or a reduction of greater than 20%, and partial macular edema resolution was defined as a reduction of greater than 10%. Nine eyes from nine patients were included. Before FAc implant, all eyes received intravitreal short-action corticosteroids (triamcinolone and dexamethasone implant), with a good response but relapse 1-5months later. At baseline, BCVA was 55.0 ± 10.6 letters, CMT was 514.9 ± 165.6μm, and IOP was 15.4 ± 2.4mmHg with four eyes under IOP-lowering medication. After FAc implant, all eyes achieved edema resolution (eight total and one partial) with a peak gain of 17.2 letters and a maximum decrease of 208.2μm in CMT. During follow-up (44.0 ± 14.8months), 66.7% of the eyes kept their macula dry and three showed recurrence after 11, 14, and 28months, respectively. The maximum IOP registered was 17.0 ± 6.0mmHg. IOP-lowering regimen was increased in one eye and two additional eyes started hypotensive drops. FAc implant can be considered a therapeutic alternative in PCME refractory to other therapies in vitrectomized eyes, reducing the need for repeated treatments.

A hybrid coded-aperture and Compton camera based on cerium-doped Gd3Al2Ga3O12 scintillators coupled with multi-pixel photon counter arrays.

In this study, we propose a hybrid coded-aperture and Compton camera based on cerium-doped Gd3Al2Ga3O12 (GAGG:Ce) scintillator arrays coupled with Multi-Pixel Photon Counter (MPPC) arrays. The sensitive detector of the gamma camera consists of a single GAGG:Ce crystal coupled with a single-chip MPPC unit module. An impedance bridge circuit and a 64-channel data acquisition system were employed to record the code-aperture events and Compton coincidence events. After the calibration of position and energy, the total energy resolution for 662keV gamma-rays from 137Cs was 6.6%. The hybrid camera had the characteristics of mechanical collimation and electronic collimation at the same time. In the code aperture mode, the reconstructed images were obtained by direct deconvolution and maximum likelihood expectation maximization (MLEM) methods. In the Compton imaging mode, the energy-dependent method was applied to order the sequence of Compton scatter events. The simple back-projection algorithm and list-mode MLEM algorithm were adopted for image reconstruction. Practical performances demonstrated that the angular resolutions in two modes were measured as 5.2° and 11.4°, respectively. In addition, the hybrid camera had a desirable imaging capability in a wide energy range (32 keV-2.6MeV) and a wide field of view (∼210° in the horizontal direction). As for the sensitivity, the camera had a commercially available sensitivity level of localizing a 137Cs point source, producing ∼0.026 µSv/h in 5min. Furthermore, the function of distinction for different radiation sources was preliminarily realized.

Efficacy of a Digital Personalized Elimination Diet for the Self-Management of Irritable Bowel Syndrome and Comorbid Irritable Bowel Syndrome and Inflammatory Bowel Disease.

Most patients with irritable bowel syndrome (IBS) and dual-diagnosis IBS and inflammatory bowel disease (IBD) report that symptoms originate from or are exacerbated by trigger foods. Despite patient interest and need, there is no consensus on what diet is optimal. Popular diets have notable limitations including cost, length, implementation complexity, and lack of personalization. This pilot study evaluated the feasibility, desirability, and effect on gastrointestinal symptoms of a digitally delivered personalized elimination diet for patients with IBS and comorbid IBS/IBD, powered by machine learning. Participants were recruited online and were provided access to a digital personalized nutrition tool for 9 weeks (N = 37; IBS only = 16, Crohn's disease and IBS = 9, and ulcerative colitis and IBS = 12). Significant symptom improvement was seen for 81% of participants at study midpoint and persisted for 70% at end point, measured by the relevant symptom severity score (IBS symptom severity score, Patient Simple Clinical Colitis Activity Index, or Mobile Health Index for Crohn's disease). Clinically significant symptom improvement was observed in 78% of participants at midpoint and 62% at end point. Twenty-five participants (67.6%) achieved total symptomatic resolution by the end of study. Patient-reported quality of life improved for 89% of participants. Ninety-five percentage daily engagement, 95% retention, 89% adherence and 92% satisfaction with the program were reported. Dietary elimination can improve symptoms and quality of life in patients with IBS and comorbid IBS/IBD. Digital technology can personalize dietary interventions and improve adherence. Randomized controlled trials are warranted.

PMON281 PERSISTENT VIRILIZATION AND VASOMOTOR SYMPTOMS IN A TRANSMAN 5-YEARS POST TESTOSTERONE WITHDRAWAL

Abstract Introduction Polycystic ovarian syndrome (PCOS) is one of the most common reproductive abnormalities, characterized by irregular menses, hirsutism, and polycystic ovaries (PCO). In cisgender females is associated with insulin resistance and increased risk of metabolic and CV disease. Management of PCOS in transmen has not been established. Case Presentation Twenty-three-year-old transman referred for evaluation of heat intolerance, upper body flushing, sweating, and nausea. Symptoms were severe, non-responsive to lifestyle modifications. He denied change in size of hats, rings or shoes, no easy bruising, no muscular weakness but increased facial hair even after 5-year testosterone withdrawal. He had a normal puberty, menses, breast growth and distribution of fat for assigned female at birth. Testosterone gender affirming care started at age 14 to age 18 but discontinued secondary to irritability and rage. Progesterone and etonogestrel implant were used without success of suppression of menses, requiring hysterectomy with retention of ovaries, to relieve gender dysphoria (GD), in addition to gender affirming bilateral mastectomy. Physical exam is notable for normal vital signs, weight 111 Kg, BMI 33, +male pattern alopecia, terminal facial hair, full beard, acne, supraclavicular fat deposition, and pink thin abdominal stria. Total testosterone and DHEA were elevated at 58.7 ng/dl (13.84-53.35 ng/dL) and 501 ug/dl (18-391 ug/dL) respectively; random estradiol 63 pg/ml; SHBG, LH, FSH, TSH, free T4, T3, IGF1, prolactin, 24-hour urine cortisol and 5-HIAA were normal. Repeat labs were similar, and free testosterone was 26 pg/ml (1-18 pg/mL). Pelvic US showed multi follicular ovaries. A trial of low dose oral estradiol resulted in total resolution of symptomatology. Discussion PCOS was diagnosed based on hirsutism and PCO. He was not bothered by virilization; testosterone was declined as his GD was relieved by gender affirming surgical interventions. We hypothesize that mood disturbances may have been secondary to high endogenous and exogenous androgen levels, as symptomatology resolved upon testosterone withdrawal. We postulate that climacteric symptoms relieved by low dose estradiol may have been the result of an alteration in hormonal feedback. Decreased feedback of testosterone to the hypothalamus has been described during antiandrogen therapy for prostate cancer, as the cause of hot flashes and nausea. Our patient did not have low androgen levels; however, it is possible that drastic fluctuations in androgens, caused "relative hypogonadal" status resulting in his symptomatology. There are no clear guidelines on evaluation and treatment of PCOS in transmen; as virilization is usually not bothersome, however more research is needed on the metabolic effects and CV risk in this population. Our case emphasizes the importance of obtaining baseline hormonal levels before initiation of hormonal affirming care. Transmen are to be screened for PCOS and work up of unexplained hirsutism pursued to treat metabolic and CV risk factors aggressively. Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

New trapezoid-shaped Frisch-grid ionization chamber for low-energy particle measurements

A new trapezoid-shaped Frisch-grid ionization chamber (TFG-IC) has been built as a part of a varDelta {E}-E telescope system for the detection and identification of charged particles at energies down to a few MeV. To study the effect of the drift electric field uniformity, two types of sealed windows, namely a pair of SSA (split-strip aluminized mylar film) and a pair of DSA (double-sided aluminized mylar film) sealed windows have been investigated. The detector’s performances were studied using a standard ^{241}Am source at different gas pressures, and the total energy-deposit resolution achieved is about 1.1%(FWHM). The varDelta {E}-E telescope, which was composed of TFG-IC and a DSSSD (double-sided silicon strip detector), has been tested using a three-component alpha source and the ^{241}Am source under laboratory conditions. The results show that the energy resolution with the SSA sealed windows which provide uniform drift electric field has a smaller fluctuation than that with the DSA ones; the fluctuations are about 1% and 4% for the former and the latter, respectively. Simulations using the COMSOL software also confirmed the electric-field distortion at the edge of the detector with the DSA windows. A correlation curve between energy resolution and energy deposit of charged particles at various gas pressures and for two gas species is derived for TFG-IC with the SSA sealed windows using the measurement with the ^{241}Am source. Incorporating the above results, we performed Monte Carlo simulations to evaluate the particle-identification capability of the telescope. The results show that the telescope can be extended to the identification of low-energy particles.

Evaluation of Oral Therapy Based on Ferric Sodium EDTA, in Combination With Vitamin C, Folic Acid, Copper Gluconate, Zinc Gluconate and Selenomethionine, in Iron-Deficiency Anemia: A Real-Life Study

Iron deficiency (ID) and iron-deficiency anemia (IDA) are still frequent conditions in several patients’ settings. Oral iron supplementation is one of available treatments of IDA, representing a convenient strategy since is cost-saving, effective and does not require intravenous (IV) access. However, often traditional oral iron therapies, mainly based on ferrous sulphate, are poorly tolerated, and with low iron absorption, causing gastrointestinal adverse events and limiting adherence to treatment and efficacy. The aim of this study is to evaluate the efficacy and safety of a new oral iron supplementation based on Ferric Sodium EDTA, in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel forte®) for IDA treatment in real-life clinical practice. Patients (N=103) were allocated to treatment with this new formulation at dosage of 1 tab/day, containing 30 mg of iron for 72 days. Patients were evaluated at basal conditions (T0), after 24 and 72 days of therapy (T1 and T2, respectively), collecting blood parameters of hemoglobin (Hb) and sideremia, evaluated as primary objective. The secondary outcomes were symptoms improvement (evaluated through a 4-points score) and safety profile of oral therapy. Treatment with Ferric Sodium EDTA in combination with vitamin C, folic acid, copper gluconate, zinc gluconate and selenomethionine (Ferachel Forte®) showed improvements statistically significant (P &lt; 0.001) of Hb and sideremia levels both at time T1 and T2. Symptoms evaluation showed an almost total resolution of symptomatology after only 72 days of therapy, and treatment was safe and well tolerated. In conclusion, this study confirmed the efficacy and the safety of the new oral iron formulation evaluated, for IDA patients in real-life clinical practice.

Novel design of phase demodulation scheme for fiber optic interferometric sensors in the advanced undergraduate laboratory

Phase modulation depth (PMD) is crucial for the phase demodulation scheme of fiber optic interferometric sensors. The novel design of phase generated carrier differential-cross-multiplying (PGC-DCM) demodulation schemes allows undergraduates to understand the operation principle of the sensors and explore the connection between the PMD and the system performance. The system mainly consists of a laser, a fiber Michelson interferometer (FMI), a data acquisition card and a host computer. The simulation signal is first applied on the sensing arm of the FMI by a piezoelectric transducer and induces the phase difference shift between the two arms. Next the signal-to-noise ratios (SNRs) of the demodulated signals from the PGC-DCM algorithms under different PMD values are tested and an optimum PMD value is found. Thus, a proportion integral differential (PID) module is designed and integrated with the demodulation algorithm to calibrate the PMD to the optimum value. An ellipse fitting algorithm (EFA) is used to estimate the real-time PMD of the system that is then fed into the PID module. The amplitude of the laser modulation signal is controlled by the PID module, which is proportional to the PMD. Moreover, the response linearity, dynamic range, total harmonic distortion and phase resolution of the system are investigated.

S3196 Wilson Disease in a U.S. Navy Pilot: Delayed Diagnosis With Drastic Career Implications

Introduction: Wilson disease is an autosomal recessive genetic disorder of the intracellular copper transport ATP7B leading to impaired copper excretion and subsequent accumulation in the liver, brain and cornea. Index symptoms vary widely and include neurologic and psychiatric abnormalities. The wide array of subtle symptoms often lead to significant delays in diagnosis and thus prognostic implications for patients diagnosed with this rare disease. In the Armed Forces, the diagnosis and clinical sequelae can have drastic career implications especially when neurologic sequelae are resistant to treatment. Case Description/Methods: A 28 year old US Navy pilot male presented to behavioral health clinic with complaint of depressed mood. He was diagnosed with major depressive disorder which was resistant to traditional treatment for over a year. He developed fasciculations of his neck and arms which was associated with initiation of an SSRI. When he had difficulty landing an aircraft due these progressive symptoms, he was deemed incapable of flight. He later required admission for suicidal ideations. He had several concerning incidents occur including driving over a median and through several red lights. Neurology was consulted and examination showed hyperkinetic movements of his extremities with head and voice tremors. Lab work revealed ALT 52 and AST 48 and later, a ceruloplasmin of 6.7. A slit lamp exam was performed revealing Kayser-Fleischer rings. MRI brain showed abnormal T2 signal within the basal ganglia and midbrain consistent with copper deposition. MRI liver was consistent with cirrhosis. A liver biopsy confirmed the diagnosis of Wilson disease with cirrhosis. He was started on trientene and zinc for chelation and his mood markedly improved. However, his neurologic abnormalities have persisted despite ongoing therapy for over 4 years, permanently ending his piloting career. Discussion: Our case highlights the importance of careful clinical consideration in patients presenting with psychiatric complaints. We aim to highlight this patient’s response to therapy, and lack thereof, as the range of patient response can be quite broad. The majority of patient’s have significant or even total resolution of symptoms. Our patient had significant improvement in depression after chelation therapy but his neurologic symptoms did not recover. Regrettably, the patient’s Navy pilot career was brought to an early close given the severity of his symptoms and lack of response and thus, inability to perform as an aviator.