HighlightsUranyl acetate/tungsten double stains are proposed for imaging lipid rich nanoparticle in TEM.Combined with methylcellulose embedment, the technique enhances membrane contrast.The technique works for liposomes, nanodiscs and bicelles.The double staining should improve quantification of lipid rich nanoparticles.

Background: There is no global consensus on the optimal management of bone metastases (BMs) in neuroendocrine neoplasms (NENs). Objectives: To review current management and outcomes of patients with BMs in NENs, in order to identify areas for improvement. Methods: A retrospective study of all patients with NENs, except Grade 3 lung NENs (April 2002 to March 2018) was conducted. Baseline characteristics, nature of BMs, treatment received and overall survival (OS) were evaluated. Statistical analyses were performed using SPSS version 23.0/STATA v12. Results: Of 1,212 patients, 85 (7%) had BMs; median age 58 years. The majority had a gastro-entero-pancreatic primary (49%, n = 42) followed by lung (25%, n = 21), unknown primary (20%, n = 17), and "others" (6%, n = 5). Two-thirds (n = 57) had G1-2 neuroendocrine tumours, and 41% (n = 35) had functional tumours. Overall, 28% (n = 24) presented with synchronous BMs at first NEN diagnosis, and 55% (n = 47) developed BMs at the same time as other distant metastases. For the subpopulation of patients in whom BMs developed metachronously to other distant metastases (45%, n = 38), median time to development of BMs was 14.0 months. BMs were "widespread" in 61% (n = 52). Although only 22% (n = 19) reported symptoms at initial diagnosis of BMs, most (78%) developed symptoms at some time during the follow-up period (pain/hypercalcaemia 64%, skeletal-related events 20%). BMs were mainly managed with analgesia (44%, n = 37). Radiotherapy and bisphosphonates were used in 34% (n = 29) and 22% (n = 19) respectively. Surgery was rarely performed (2%, n = 2). Median OS from identification of BMs was 31.0, and 18.9 months from development of BMs-related symptoms. Conclusions: In this cohort study, most patients with BMs developed symptoms. The utility of radiotherapy and/or bisphosphonates should be prospectively and systematically explored further for its potential impact on patients' quality of life and survival outcomes.

Neurogenic pulmonary oedema (NPO) is a rare clinical syndrome of pulmonary oedema occurring secondary to an insult of the central nervous system (CNS). The exact aetiology of this disorder is unknown. NPO can be fatal and poor awareness and identification of this entity, particularly in terms of misdiagnosis as primary pulmonary or cardiac disease, can result in suboptimal management and outcomes. We describe the presentation and management of a 68-year-old woman with an acute left lateral medullary stroke complicated by pulmonary oedema. The likely aetiology is discussed, and important learning points are highlighted.

The requirements for informed consent were modified in 2015 following the UK Supreme Court judgment of Montgomery v Lanarkshire Health Board. This marked a decisive shift from the traditional paternalistic ‘doctor knows best' model towards a more patient-centred approach. This study examines the current standard of consent for septoplasty and whether it complies with the law. We also report whether the ‘reasonable patient’ and surgeon agree about which risks should be discussed during the consent process. Ten complications were identified as common or serious via a literature search. Using questionnaires, 21 Ears, Nose and Throat surgeons were asked which of these they routinely discussed, and 103 patients were asked how seriously they regarded those complications. Results were compared using the Test of Proportions. Most surgeons routinely discuss all risks except negative change in sense of smell and numbness of upper incisors. The ‘reasonable patient’ regarded these two complications as serious or very serious. However, less than 70% of surgeons mentioned them. A significant proportion of Ears, Nose and Throat surgeons do not routinely mention all the risks that the ‘reasonable patient' would want to know about before undergoing a septoplasty. This may result in more clinical negligence claims, as managing a patient's reasonable expectations is an important factor.

Background: Suture anchors are widely used for labral reconstruction surgery. However, there has been some concern over the development of osteolysis around the anchor. This has been reported for both biocomposite and all-suture anchors, but they have not been compared directly in vivo. Purpose: To compare the bone response to 2 common suture anchors: a traditional biocomposite push-fit anchor and an all-suture anchor. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Included in this study were 17 patients with a total of 37 unique suture anchors. Magnetic resonance imaging scans were performed at 3 weeks and 6 months postoperatively. A total of 38 senior radiologists and shoulder surgeons evaluated the images using a previously validated system for grading the bone response around suture anchors. The mean difference in grading at 3 weeks and 6 months was calculated using unpaired t tests, and the interrater reliability was evaluated with an intraclass correlation coefficient (ICC). Results: At 3 weeks, there was no statistically significant difference in the degree of osteolysis surrounding each suture anchor type ( P = .258), with little bone response. However, on the 6-month scans, there was a significantly lower level of osteolysis seen in the all-suture anchors compared with the biocomposite anchors ( P = .040). Interrater reliability was excellent, with an ICC value of 0.975 (95% CI, 0.962-0.985). Conclusion: All-suture anchors cause significantly less osteolysis in glenoid bone at 6 months compared with biocomposite anchors.

Objective This study aimed to evaluate the readability and quality of current online information on Bell's palsy. Method A Google search using the terms ‘Bell's palsy’ and ‘facial palsy’ was performed separately. The first three pages of results were analysed. Readability was assessed using Flesch Reading Ease Score, Flesch–Kincaid Grade Level, the Gunning-Fog Index and the Simple Measure of Gobbledygook. Quality was assessed using the Discern tool. Spearman's correlation between quality and readability was calculated. Results A total of 31 websites met the inclusion criteria. The mean Flesch Reading Ease Score, Flesch–Kincaid Grade Level, the Gunning Fox Index and the Simple Measure of Gobbledygook scores were 52.45 (95 per cent confidence interval = 47.01–57.86), 10.50 (95 per cent confidence interval = 9.42–11.58), 12.76 (95 per cent confidence interval = 11.68–13.85) and 9.36 (95 per cent confidence interval = 8.52–10.20), respectively. The average Discern score was 44 (95 per cent confidence interval = 40.88–47.12). A negligible correlation was noted between the Discern and Flesch Reading Ease Score (rs = −0.05, p = 0.80). Conclusion Online information on Bell's palsy is generally of fair quality but is written above the recommended reading age guidance in the UK.

Introduction The aim of this study was to assess the readability and quality of online information on functional endoscopic sinus surgery (FESS). Methods The term ‘functional endoscopic sinus surgery’ was entered into the Google, Bing and Yahoo search engines. The first 30 websites for each search engine were screened. Readability was assessed using the Flesch–Kincaid Reading Ease Score (FRES), Flesch–Kincaid Grade (FKG), Simple Measure of Gobbledygook (SMOG) Index, and Gunning Fog Index (GFI). Quality was assessed using the DISCERN instrument. Spearman’s correlation between quality and readability was calculated. Results Thirty-three websites met the inclusion criteria. The mean and standard deviations for the FRES, FKG, SMOG, GFI, and DISCERN scores were 49 (13.1), 10.9 (2.5), 10.2 (1.9), 13.6 (2.4), and 51.1 (12.8), respectively. A positive correlation was noted between the FRES and DISCERN (R=0.357, p=0.041). Conclusions Online information on FESS is generally written above the recommended reading levels and of fair quality.

Objective This study aimed to explore the current practices of the UK rhinology consultant body in regard to cocaine screening in nasal reconstructive surgery. Method A 12-question online survey was distributed to rhinology consultants (October 2021 to February 2022) currently practising in the UK. Results A total of 55 consultants responded. Fifty-three per cent asked patients about cocaine use prior to consideration of surgery, and 45 per cent performed cocaine testing prior to consideration of surgery. Of these, the majority employed urine testing alone (60 per cent), with hair testing being less common as a single screening modality (4 per cent). Sixteen per cent opted for both urine and hair testing. The most common reasons for not performing cocaine testing included patient history or clinical examination that was not suggestive of cocaine use (44 per cent), lack of formal guidelines (33 per cent) and lack of testing availability (27 per cent). Sixty-four per cent were in favour of a national policy for cocaine screening. Conclusion There is marked variation in cocaine screening practices for nasal reconstructive surgery among UK rhinologists.