Mineralogical and geochemical study of rodingites and associated serpentinized peridotite, Eastern Desert of Egypt, Arabian-Nubian Shield

We studied rodingite and rodingite-like rocks within a serpentinized ultramafic sequence and ophiolitic mélange at Um Rashid, in the Eastern Desert of Egypt. The Um Rashid ophiolite is strongly deformed, metamorphosed, and altered by serpentinization, carbonatization, listvenitization, rodingitization and silicification. The textures, whole-rock chemistry, and composition of fresh primary mineral relics show that the serpentinite protoliths were strongly melt-depleted harzburgite and minor dunite, typical of a supra-subduction zone fore-arc setting. The light-colored rocks replacing gabbro are divided on the basis of field relations, mineral assemblages and geochemical characteristics into typical rodingite and rodingite-like rock. Typical rodingite, found as blocks with chloritite blackwall rims within ophiolitic mélange, contains garnet, vesuvianite, diopside and chlorite with minor prehnite and opaque minerals. Rodingite-like rock, found as dykes in serpentinite, consists of hercynite, preiswerkite, margarite, corundum, prehnite, ferropargasite, albite, andesine, clinozoisite and diaspore. Some rodingite-like rock samples preserve relict gabbroic minerals and texture, whereas typical rodingite is fully replaced. Rodingite is highly enriched in CaO, Fe₂O₃, MgO, and compatible trace elements, whereas rodingite-like rock is strongly enriched in Al₂O₃ and incompatible trace elements. Based on geochemistry and petrographic evidence, both types of rodingitic rocks likely developed from mafic protoliths in immediate proximity to serpentinite but were affected by interaction with different fluids, most likely at different times. Typical rodingite development likely accompanied serpentinization and shows mineral assemblages characteristic of low-Si, high-Ca fluid infiltration at about 300 °C. Rodingite-like rock, on the other hand, likely developed from seawater infiltration

Mineralogical and geochemical study of rodingites and associated serpentinized peridotite, Eastern Desert of Egypt, Arabian-Nubian Shield

We studied rodingite and rodingite-like rocks within a serpentinized ultramafic sequence and ophiolitic mélange at Um Rashid, in the Eastern Desert of Egypt. The Um Rashid ophiolite is strongly deformed, metamorphosed, and altered by serpentinization, carbonatization, listvenitization, rodingitization and silicification. The textures, whole-rock chemistry, and composition of fresh primary mineral relics show that the serpentinite protoliths were strongly melt-depleted harzburgite and minor dunite, typical of a supra-subduction zone fore-arc setting. The light-colored rocks replacing gabbro are divided on the basis of field relations, mineral assemblages and geochemical characteristics into typical rodingite and rodingite-like rock. Typical rodingite, found as blocks with chloritite blackwall rims within ophiolitic mélange, contains garnet, vesuvianite, diopside and chlorite with minor prehnite and opaque minerals. Rodingite-like rock, found as dykes in serpentinite, consists of hercynite, preiswerkite, margarite, corundum, prehnite, ferropargasite, albite, andesine, clinozoisite and diaspore. Some rodingite-like rock samples preserve relict gabbroic minerals and texture, whereas typical rodingite is fully replaced. Rodingite is highly enriched in CaO, Fe₂O₃, MgO, and compatible trace elements, whereas rodingite-like rock is strongly enriched in Al₂O₃ and incompatible trace elements. Based on geochemistry and petrographic evidence, both types of rodingitic rocks likely developed from mafic protoliths in immediate proximity to serpentinite but were affected by interaction with different fluids, most likely at different times. Typical rodingite development likely accompanied serpentinization and shows mineral assemblages characteristic of low-Si, high-Ca fluid infiltration at about 300 °C. Rodingite-like rock, on the other hand, likely developed from seawater infiltration

Treatment selection of early stage non-small cell lung cancer: The role of the patient in clinical decision making

Background: The objective of this study is to investigate the role and experience of early stage non-small cell lung cancer (NSCLC) patient in decision making process concerning treatment selection in the current clinical practice. Methods: Stage I-II NSCLC patients (surgery 55 patients, SBRT 29 patients, median age 68) were included in this prospective study and completed a questionnaire that explored: (1) perceived patient knowledge of the advantages and disadvantages of the treatment options, (2) experience with current clinical decision making, and (3) the information that the patient reported to have received from their treating physician. This was assessed by multiple-choice, 1-5 Likert Scale, and open questions. The Decisional Conflict Scale was used to assess the decisional conflict. Health related quality of life (HRQoL) was measured with SF-36 questionnaire. Results: In 19% of patients, there was self-reported perceived lack of knowledge about the advantages and disadvantages of the treatment options. Seventy-four percent of patients felt that they were sufficiently involved in decision-making by their physician, and 81% found it important to be involved in decision making. Forty percent experienced decisional conflict, and one-in-five patients to such an extent that it made them feel unsure about the decision. Subscores with regard to feeling uninformed and on uncertainty, contributed the most to decisional conflict, as 36% felt uninformed and 17% of patients were not satisfied with their decision. HRQoL was not influenced by patient experience with decision-making or patient preferences for shared decision making. Conclusions: Dutch early-stage NSCLC patients find it important to be involved in treatment decision making. Yet a substantial proportion experiences decisional conflict and feels uninformed. Better patient information and/or involvement in treatment-decision-making is needed in order to improve patient knowledge and hopefully reduce decisional conflict

Atud Gabbro-Diorite Complex: Glimpse of the Cryogenian Mixing, Assimilation, Storage, and Homogenization Zone beneath the Eastern Desert of Egypt

We analysed gabbroic and dioritic rocks from the Atud igneous complex in the Eastern Desert of Egypt to understand better the formation of juvenile continental crust of the Arabian–Nubian Shield. Our results show that the rocks are the same age (U–Pb zircon ages of 694.5 ± 2.1 Ma for two diorites and 695.3 ± 3.4 Ma for one gabbronorite). These are partial melts of the mantle and related fractionates (εNd₆₉₀ = +4.2 to +7.3, ⁸⁷Sr/⁸⁶Sr_i = 0.70246–0.70268, zircon δ¹⁸O ∼ +5‰). Trace element patterns indicate that Atud magmas formed above a subduction zone as part of a large and long-lived (c. 60 myr) convergent margin. Atud complex igneous rocks belong to a larger metagabbro–epidiorite–diorite complex that formed as a deep crustal mush into which new pulses of mafic magma were periodically emplaced, incorporated and evolved. The petrological evolution can be explained by fractional crystallization of mafic magma plus variable plagioclase accumulation in a mid- to lower crustal MASH zone. The Atud igneous complex shows that mantle partial melting and fractional crystallization and plagioclase accumulation were important for Cryogenian crust formation in this part of the Arabian–Nubian Shield

Timing of pulmonary valve replacement in patients with corrected Fallot to prevent QRS prolongation

OBJECTIVES: Timing of pulmonary valve replacement (PVR) remains one of the most heavily debated topics in congenital cardiac surgery. We aimed to analyse the temporal evolution of QRS duration before and after PVR. METHODS: We included 158 consecutive patients who underwent PVR after previous correction with transannular patch. All 3549 available serial standard 12-lead surface QRS measurements of 158 (100%) patients were analysed with linear mixed-effect modelling. RESULTS: PVR was perfo

Pulmonary metastasectomy versus continued active monitoring in colorectal cancer (PulMiCC): a multicentre randomised clinical trial

BACKGROUND: Lung metastasectomy in the treatment of advanced colorectal cancer has been widely adopted without good evidence of survival or palliative benefit. We aimed to test its effectiveness in a randomised controlled trial (RCT). METHODS: Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metastases to a multicentre, two-arm RCT comparing active monitoring with or without metastasectomy. Other local or systemic treatments were decided by the local team. Randomisation was remote and stratified by site with minimisation for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, the number of metastases, and carcinoembryonic antigen level. The central Trial Management Group were blind to patient allocation until completion of the analysis. Analysis was on intention to treat with a margin for non-inferiority of 10%. RESULTS: Between December 2010 and December 2016, 65 participants were randomised. Characteristics were well-matched in the two arms and similar to those in reported studies: age 35 to 86 years (interquartile range (IQR) 60 to 74); primary resection IQR 16 to 35 months previously; stage at resection T1, 2 or 3 in 3, 8 and 46; N1 or N2 in 31 and 26; unknown in 8. Lung metastases 1 to 5 (median 2); 16/65 had previous liver metastases; carcinoembryonic antigen normal in 55/65. There were no other interventions in the first 6 months, no crossovers from control to treatment, and no treatment-related deaths or major adverse events. The Hazard ratio for death within 5 years, comparing metastasectomy with control, was 0.82 (95%CI 0.43, 1.56). CONCLUSIONS: Because of poor and worsening recruitment, the study was stopped. The small number of participants in the trial (N = 65) precludes a conclusive answer to the research question given the large overlap in the confidence intervals in the proportions still alive at all time points. A widely held belief is that the 5-year absolute survival benefit with metastasectomy is about 35%: 40% after metastasectomy compared to < 5% in controls. The estimated survival in this study was 38% (23-62%) for metastasectomy patients and 29% (16-52%) in the well-matched controls. That is the new and important finding of this RCT. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT01106261. Registered on 19 April 2010

Male-Female Differences in Acute Type B Aortic Dissection

BACKGROUND: Acute type B aortic dissection is a cardiovascular emergency with considerable mortality and morbidity risk. Male–female differences have been observed in cardiovascular disease; however, literature on type B aortic dissection is scarce. METHODS AND RESULTS: A retrospective cohort study was conducted including all consecutive patients with acute type B aortic dissection between 2007 and 2017 in 4 tertiary hospitals using patient files and questionnaires for late morbidity. In total, 384 patients were included with a follow-up of 6.1 (range, 0.02–14.8) years, of which 41% (n=156) were female. Women presented at an older age than men (67 [interquartile range (IQR), 57–73] versus 62 [IQR, 52–71]; P=0.015). Prior abdominal aortic aneurysm (6% versus 15%; P=0.009), distally extending dissections (71 versus 85%; P=0.001), and clinical malperfusion (18% versus 32%; P=0.002) were less frequently observed in women. Absolute maximal descending aortic diameters were smaller in women (36 [IQR: 33–40] mm versus 39 [IQR, 36–43] mm; P<0.001), while indexed for body surface area diameters were larger in women (20 [IQR, 18–23] mm/m2 versus 19 [IQR, 17–21] mm/m2). No male–female differences were found in treatment choice; however, indications for invasive treatment were different (P<0.001). Early mortality rate was 9.6% in women and 11.8% in men (P=0.60). The 5-year survival was 83% (95% CI, 77–89) for women and 84% (95% CI, 79–89) for men (P=0.90). No male–female differences were observed in late (re)interventions. CONCLUSIONS: No male–female differences were found in management, early or late death, and morbidity in patients presenting with acute type B aortic dissection, despite distinct clinical profiles at presentation. More details on the impact of age and type of intervention are warranted in future studies