Is High Flow Nasal Oxygenation a Game Changer in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A pilot study

Objectives: A pilot observational study was done to compare High Flow Nasal Oxygen (HFNO) and supraglottic airway device (SAD) technique in patients undergoing endobronchial ultrasound (EBUS) and transbronchial needle aspiration procedures (TBNA) with an objective to evaluate the efficacy of HFNO  in oncological patients. Methods:  The study was conducted in a tertiary cancer center in Muscat, Sultanate of Oman from May 2022 to March 2023.  Consecutive patients undergoing EBUS TBNA under moderate sedation were quasi-randomized into HFNO and SAD groups. The episodes and duration of hypoxia and the lowest level of oxygen saturation were the primary outcome measured. Results: A total of twenty-four patients were taken into the study of which 10 were in the HFNO group and 14 were in the SAD group with an equal number of males and females.  The duration of the procedure in both the groups was similar (45±20 mins in HFNO vs 44±17 in the SAD group). Mean lowest oxygen saturation in the HFNO group was (93.5%±4), which was statistically significant in comparison to the SAD group (90±6). In both groups, the maximum hypoxia occurred during the early phase of the procedure. However, both the groups were similar for the cumulative duration of hypotension (140 secs in HFNO vs 55 secs in SAD) and bradycardia (25 secs in HFNO vs. 40 secs in SAD). Conclusion: HFNO can be a good alternative to the SAD and could be used safely and efficiently in the cohort of population in patients undergoing EBUS TBNA. Keywords: High flow nasal oxygenation; Endobronchial Ultrasound-guided Transbronchial Needle Aspiration; Supraglottic airway devices

Adversarial training with cycle consistency for unsupervised super-resolution in endomicroscopy

In recent years, endomicroscopy has become increasingly used for diagnostic purposes and interventional guidance. It can provide intraoperative aids for real-time tissue characterization and can help to perform visual investigations aimed for example to discover epithelial cancers. Due to physical constraints on the acquisition process, endomicroscopy images, still today have a low number of informative pixels which hampers their quality. Post-processing techniques, such as Super-Resolution (SR), are a potential solution to increase the quality of these images. SR techniques are often supervised, requiring aligned pairs of low-resolution (LR) and high-resolution (HR) images patches to train a model. However, in our domain, the lack of HR images hinders the collection of such pairs and makes supervised training unsuitable. For this reason, we propose an unsupervised SR framework based on an adversarial deep neural network with a physically-inspired cycle consistency, designed to impose some acquisition properties on the super-resolved images. Our framework can exploit HR images, regardless of the domain where they are coming from, to transfer the quality of the HR images to the initial LR images. This property can be particularly useful in all situations where pairs of LR/HR are not available during the training. Our quantitative analysis, validated using a database of 238 endomicroscopy video sequences from 143 patients, shows the ability of the pipeline to produce convincing super-resolved images. A Mean Opinion Score (MOS) study also confirms this quantitative image quality assessment

Determination of topological edge quantum numbers of fractional quantum Hall phases by thermal conductance measurements

To determine the topological quantum numbers of fractional quantum Hall (FQH) states hosting counter-propagating (CP) downstream (Nd) and upstream (Nu) edge modes, it is pivotal to study quantized transport both in the presence and absence of edge mode equilibration. While reaching the non-equilibrated regime is challenging for charge transport, we target here the thermal Hall conductance GQ, which is purely governed by edge quantum numbers Nd and Nu. Our experimental setup is realized with a\ua0hexagonal boron nitride (hBN) encapsulated graphite gated single\ua0layer graphene device. For temperatures up to 35 mK, our measured GQ at ν = 2/3 and 3/5 (with CP modes) match the quantized values of non-equilibrated regime (Nd + Nu)κ0T, where κ0T is a quanta of GQ. With increasing temperature, GQ decreases and eventually takes the value of\ua0the equilibrated regime ∣Nd - Nu∣κ0T. By contrast, at ν = 1/3 and 2/5 (without CP modes), GQ remains robustly quantized at Ndκ0T independent of the temperature. Thus, measuring the quantized values of GQ\ua0in two regimes, we determine the edge quantum numbers, which opens a new route for finding the topological order of exotic non-Abelian FQH states

Theory of dynamic crack branching in brittle materials

The problem of dynamic symmetric branching of an initial single brittle crack propagating at a given speed under plane loading conditions is studied within a continuum mechanics approach. Griffith's energy criterion and the principle of local symmetry are used to determine the cracks paths. The bifurcation is predicted at a given critical speed and at a specific branching angle: both correlated very well with experiments. The curvature of the subsequent branches is also studied: the sign of $T$, with $T$ being the non singular stress at the initial crack tip, separates branches paths that diverge from or converge to the initial path, a feature that may be tested in future experiments. The model rests on a scenario of crack branching with some reasonable assumptions based on general considerations and in exact dynamic results for anti-plane branching. It is argued that it is possible to use a static analysis of the crack bifurcation for plane loading as a good approximation to the dynamical case. The results are interesting since they explain within a continuum mechanics approach the main features of the branching instabilities of fast cracks in brittle materials, i.e. critical speeds, branching angle and the geometry of subsequent branches paths.Comment: 41 pages, 15 figures. Accepted to International Journal of Fractur

Infraorbital cutaneous angiosarcoma: a diagnostic and therapeutic dilemma

Background A cutaneous angiosarcoma is a rare malignant tumour of vascular endothelial cells with aggressive clinical behaviour and poor prognosis. Diagnosis is often delayed due to its variable and often benign clinical appearance. Case presentation This case presents a 64-year-old man with a six-month-history of a recurrent diffuse and erythematous painless swelling below the left eye. Several resections with intraoperatively negative resection margins followed, but positive margins were repeatedly detected later on permanent sections. Histopathologic examination of the specimen diagnosed a cutaneous angiosarcoma. Neither, finally achieved negative margins on permanent sections, nor a following chemotherapy could prevent the recurrence of the disease after five months and the patient's dead 21 months after the first diagnosis. Conclusion The case elucidates the current diagnostic and therapeutic dilemma of this entity, which shows an unfavourable clinical course in spite of multimodal therapy

Personal Drug Selection: Problem-Based Learning in Pharmacology: Experience from a Medical School in Nepal

BACKGROUND: At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. METHOD: The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS) acted as a facilitator. The responses were recorded and analyzed qualitatively. RESULTS: The overall student opinion was positive. Around 25% (3 respondents) of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. CONCLUSIONS: Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training can be considered

The Drosophila melanogaster Seminal Fluid Protease “Seminase” Regulates Proteolytic and Post-Mating Reproductive Processes

Proteases and protease inhibitors have been identified in the ejaculates of animal taxa ranging from invertebrates to mammals and form a major protein class among Drosophila melanogaster seminal fluid proteins (SFPs). Other than a single protease cascade in mammals that regulates seminal clot liquefaction, no proteolytic cascades (i.e. pathways with at least two proteases acting in sequence) have been identified in seminal fluids. In Drosophila, SFPs are transferred to females during mating and, together with sperm, are necessary for the many post-mating responses elicited in females. Though several SFPs are proteolytically cleaved either during or after mating, virtually nothing is known about the proteases involved in these cleavage events or the physiological consequences of proteolytic activity in the seminal fluid on the female. Here, we present evidence that a protease cascade acts in the seminal fluid of Drosophila during and after mating. Using RNAi to knock down expression of the SFP CG10586, a predicted serine protease, we show that it acts upstream of the SFP CG11864, a predicted astacin protease, to process SFPs involved in ovulation and sperm entry into storage. We also show that knockdown of CG10586 leads to lower levels of egg laying, higher rates of sexual receptivity to subsequent males, and abnormal sperm usage patterns, processes that are independent of CG11864. The long-term phenotypes of females mated to CG10586 knockdown males are similar to those of females that fail to store sex peptide, an important elicitor of long-term post-mating responses, and indicate a role for CG10586 in regulating sex peptide. These results point to an important role for proteolysis among insect SFPs and suggest that protease cascades may be a mechanism for precise temporal regulation of multiple post-mating responses in females

Bidirectional lipid droplet velocities are controlled by differential binding strengths of HCV Core DII protein

Host cell lipid droplets (LD) are essential in the hepatitis C virus (HCV) life cycle and are targeted by the viral capsid core protein. Core-coated LDs accumulate in the perinuclear region and facilitate viral particle assembly, but it is unclear how mobility of these LDs is directed by core. Herein we used two-photon fluorescence, differential interference contrast imaging, and coherent anti-Stokes Raman scattering microscopies, to reveal novel core-mediated changes to LD dynamics. Expression of core protein’s lipid binding domain II (DII-core) induced slower LD speeds, but did not affect directionality of movement on microtubules. Modulating the LD binding strength of DII-core further impacted LD mobility, revealing the temporal effects of LD-bound DII-core. These results for DII-core coated LDs support a model for core-mediated LD localization that involves core slowing down the rate of movement of LDs until localization at the perinuclear region is accomplished where LD movement ceases. The guided localization of LDs by HCV core protein not only is essential to the viral life cycle but also poses an interesting target for the development of antiviral strategies against HCV

Characterisation of different polymorphs of tris(8-hydroxyquinolinato)aluminium(III) using solid-state NMR and DFT calculations

<p>Abstract</p> <p>Background</p> <p>Organic light emitting devices (OLED) are becoming important and characterisation of them, in terms of structure, charge distribution, and intermolecular interactions, is important. Tris(8-hydroxyquinolinato)-aluminium(III), known as Alq₃, an organomettalic complex has become a reference material of great importance in OLED. It is important to elucidate the structural details of Alq₃in its various isomeric and solvated forms. Solid-state nuclear magnetic resonance (NMR) is a useful tool for this which can also complement the information obtained with X-ray diffraction studies.</p> <p>Results</p> <p>We report here ²⁷Al one-dimensional (1D) and two-dimensional (2D) multiple-quantum magic-angle spinning (MQMAS) NMR studies of the meridional (<it>α</it>-phase) and the facial (<it>δ</it>-phase) isomeric forms of Alq₃. Quadrupolar parameters are estimated from the 1D spectra under MAS and anisotropic slices of the 2D spectra and also calculated using DFT (density functional theory) quantum-chemical calculations. We have also studied solvated phase of Alq₃containing ethanol in its lattice. We show that both the XRD patterns and the quadrupolar parameters of the solvated phase are different from both the <it>α</it>-phase and the <it>δ</it>-phase, although the fluorescence emission shows no substantial difference between the <it>α</it>-phase and the solvated phase. Moreover, we have shown that after the removal of ethanol from the matrix the solvated Alq₃has similar XRD patterns and quadrupolar parameters to that of the <it>α</it>-phase.</p> <p>Conclusion</p> <p>The 2D MQMAS experiments have shown that all the different modifications of Alq₃have ²⁷Al in single unique crystallographic site. The quadrupolar parameters predicted using the DFT calculation under the isodensity polarisable continuum model resemble closely the experimentally obtained values. The solvated phase of Alq₃containing ethanol has structural difference from the <it>α</it>-phase of Alq₃(containing meridional isomer) from the solid-state NMR studies. Solid-state NMR can hence be used as an effective complementary tool to XRD for characterisation and structural elucidation.</p