Meeting Report on the International Conference of ECMO-Life Support for Pakistan in 21st Century held May 11-12, 2017, Lahore

Extracorporeal membrane oxygenation support (ECMO) is indicated in severe heart or lung failure with 80 percent or more risk of mortality. In experienced centers, overall survival to discharge ranges from 40 percent in cardiac arrest with extracorporeal cardiopulmonary resuscitation (ECPR) to 70 percent for respiratory failure in adults. Overall survival in children is about 80 percent and newborns with severe lung injury can recover to normal function following prolonged ECMO support, thus, re-defining irreversible lung injury. In the future, ECMO will be automatically controlled with care out of the Intensive care units (ICU) or at home. The International Conference of ECMO-Life Support for Pakistan in 21st Century which was recently held in Lahore, Pakistan on May 11 - 12, 2017. It was to bring together the best of cardiothoracic and vascular surgeons, heart failure cardiologist, adult and pediatric intensivists, pulmonologists, anaesthetists, cardiovascular nurses, postgraduate trainees, para-medical staff, perfusionists, ambulance cardiac first responders and cardiovascular scientists for thought provoking evidence based discussions on the direction and flow of ECMO technology for Pakistan and the Developing World in the next decade. The aim of this conference was to share knowledge on ECMO technologies, advancements and their impact on the health capacity building

New results on structure of low beta confinement Polywell cusps simulated by comsol multiphysics

AbstractThe Inertial electrostatic confinement (IEC) is one of the ways for fusion approaches. It is one of the various methods which can be used to confine hot fusion plasma. The advantage of IEC is that the IEC experiments could be done in smaller size facilities than ITER or NIF, costing less money and moving forward faster. In IEC fusion, we need to trap adequate electrons to confine the desired ion density which is needed for a fusion reactor. Polywell is a device which uses the magnetic cusp system and traps the required amount of electrons for fusion reactions. The purpose of this device is to create a virtual cathode in order to achieve nuclear fusion using inertial electrostatic confinement (Miley and Krupakar Murali, 2014). In this paper, we have simulated the low beta Polywell. Then, we examined the effects of coil spacing, coils current, electron injection energy on confinement time

Complement protein levels in plasma astrocyte-derived exosomes are abnormal in conversion from mild cognitive impairment to Alzheimer's disease dementia.

IntroductionLevels of complement proteins (CPs) in plasma astrocyte-derived exosomes (ADEs) that are abnormal in Alzheimer's disease (AD) have not been assessed in mild cognitive impairment (MCI).MethodsParticipants (n = 20 per group) had either MCI converting to dementia within 3 years (MCIC), MCI remaining stable over 3 years (MCIS), Alzheimer's disease, or were controls. CPs of ADEs isolated from plasmas by anti-human glutamine aspartate transporter antibody absorption were quantified by ELISAs.ResultsADE levels of C1q and C4b of the classical pathway, factor D and fragment Bb of the alternative pathway, and C5b, C3b, and C5b-C9 of both pathways were significantly higher in patients with MCIC than those with MCIS. ADE levels of inhibitory CPs decay-accelerating factor, CD46, CD59, and type 1 complement receptor were significantly lower in patients with MCIC than those with MCIS.DiscussionADE CPs are components of neurotoxic neuroinflammation that may be predictive biomarkers of MCI conversion to Alzheimer's disease

Generation of picosecond pulses directly from a 100 W, burst-mode, doping-managed Yb-doped fiber amplifier

Cataloged from PDF version of article.Burst-mode laser systems offer increased effectiveness in material processing while requiring lower individual pulse energies. Fiber amplifiers operating in this regime generate low powers in the order of 1 W. We present a Yb-doped fiber amplifier, utilizing doping management, that scales the average power up to 100 W. The laser system produces bursts at 1 MHz, where each burst comprises 10 pulses with 10 mu J energy per pulse and is separated in time by 10 ns. The high-burst repetition rate allows substantial simplification of the setup over previous demonstrations of burst-mode operation in fiber lasers. The total energy in each burst is 100 mu J and the average power achieved within the burst is 1 kW. The pulse evolution in the final stage of amplification is initiated as self-similar amplification, which is quickly altered as the pulse spectrum exceeds the gain bandwidth. By prechirping the pulses launched into the amplifier, 17 ps long pulses are generated without using external pulse compression. The peak power of the pulses is similar to 0.6 MW. (C) 2014 Optical Society of Americ

Effect of tissue inhomogeneities on dosimetric accuracy of conformal radiotherapy of prostate cancer using Monte Carlo simulation

Background and purpose: The human body is composed of various inhomogenous tissues with a variety of physical and radiological properties. These inhomogeneities could change isodose distributions, increase the probability of geometric errors, and eventually lead to missing of the target irradiation or incorrect isodose coverage in conformal radiation therapy (CRT) due to the uncertainties resulted from the effect of such inhomogeneties on isodose curves. In this study, the effect of inhomogeneities on dosimetric accuracy of the CRT of prostate was investigated using Monte Carlo simulation method. Materials and methods: An anthropomorphic pelvis phantom was used in two modes representing a homogeneous and heterogeneous phantom. Three dimensional (3D) CRT planning composed of five fields were performed on the CT images of the phantoms using the CorPLAN treatment planning system (TPS) of a 2100C/D Varian linac. Delivery of 3DCRT was also simulated by EGSnrc Monte Carlo code for the same conditions used in the CorPLAN TPS. The dose distributions resulted from the MC simulations were compared with those of the CorPLAN TPS for both of the phantoms based on the �dose difference (DD) percentages� and �distance to agreement (DTA)� parameters. Results: Findings indicated that the heterogeneity leads to an overdose estimation at the target location up to 2.8 and 4.4 for the 6 and 18 MV energies, respectively by the CorPLAN TPS compared with the MC simulation data. The average DD and DTA for the homogeneous phantom were 2.7-3.4mm and 1.6-2.3 mm while for the inhomogeneous phantom they were 5.5-3.7 mm and 6.0-2.5 mm at the 6 and 18 MV energies, respectively. Conclusion: Our results indicates that the accuracy of the dosimetry parameters estimated by the CorPLAN TPS at 18 MV is more than that of 6 MV energy. But, the heterogeneity deteriorates more the accuracy level of such dosimetry parameters estimated by this commercial TPS at 18 MV energy. � 2016, Mazandaran University of Medical Sciences. All rights reserved

Recovering the state sequence of hidden Markov models using mean-field approximations

Inferring the sequence of states from observations is one of the most fundamental problems in Hidden Markov Models. In statistical physics language, this problem is equivalent to computing the marginals of a one-dimensional model with a random external field. While this task can be accomplished through transfer matrix methods, it becomes quickly intractable when the underlying state space is large. This paper develops several low-complexity approximate algorithms to address this inference problem when the state space becomes large. The new algorithms are based on various mean-field approximations of the transfer matrix. Their performances are studied in detail on a simple realistic model for DNA pyrosequencing.Comment: 43 pages, 41 figure

Doping management for high-power fiber lasers: 100 W, few-picosecond pulse generation from an all-fiber-integrated amplifier

Cataloged from PDF version of article.Thermal effects, which limit the average power, can be minimized by using low-doped, longer gain fibers, whereas the presence of nonlinear effects requires use of high-doped, shorter fibers to maximize the peak power. We propose the use of varying doping levels along the gain fiber to circumvent these opposing requirements. By analogy to dispersion management and nonlinearity management, we refer to this scheme as doping management. As a practical first implementation, we report on the development of a fiber laser-amplifier system, the last stage of which has a hybrid gain fiber composed of high-doped and low-doped Yb fibers. The amplifier generates 100 W at 100 MHz with pulse energy of 1 mu J. The seed source is a passively mode-locked fiber oscillator operating in the all-normal-dispersion regime. The amplifier comprises three stages, which are all-fiber-integrated, delivering 13 ps pulses at full power. By optionally placing a grating compressor after the first stage amplifier, chirp of the seed pulses can be controlled, which allows an extra degree of freedom in the interplay between dispersion and self-phase modulation. This way, the laser delivers 4.5 ps pulses with similar to 200 kW peak power directly from fiber, without using external pulse compression. (C) 2012 Optical Society of Americ

Iatrogenic insertion of impression mould into middle ear and mastoid and its retrieval after 9 years: a case report

The magnitude of hearing loss in Pakistan is enormous. One in twelve children of Pakistan suffers from some form of hearing impairment. Many of them are unable to afford surgical procedures and resort to the use of cheap hearing aids fitted by untrained individuals or people lacking the required expertise. This predisposes the patients to significant complications during a process that is otherwise considered safe. We report the case of a child, where the process of making the mould for a hearing aid led to the perforation of the tympanic membrane and pouring of mould material into the middle ear, necessitating surgical intervention. During initial surgery it was thought that all mould had been removed from the middle ear but 9 years later this child underwent cochlear implantation at the same center and remaining part of ear mould was discovered from mastoid cavity

Sphenopalatine-sphenopalatine anastomosis: a unique cause of intractable epistaxis, safely treated with microcatheter embolization: a case report

Epistaxis is the most common emergency presenting to the ENT surgeon. Here we present a case of epistaxis arising from the sphenopalatine artery in a patient who had previously had the ipsilateral external carotid artery ligated due to previous epistaxis. On investigation the epistaxis was determined to arise from an anastamosis with the contralateral sphenopalatine artery. The anatomy was demonstrated with angiography and the epistaxis treated using microcatheter embolization. Anatomical variation can be a cause for failure of ligation as a permanent treatment for epistaxis. Embolization is used less frequently for epistaxis control due to concerns about the risks involved, but it can be a valuable treatment option in intractable epistaxis following a failure of arterial ligation