Obesity and diabetes are major risk factors for epicardial adipose tissue inflammation

BACKGROUND. Epicardial adipose tissue (EAT) directly overlies the myocardium, with changes in its morphology and volume associated with myriad cardiovascular and metabolic diseases. However, EAT's immune structure and cellular characterization remain incompletely described. We aimed to define the immune phenotype of EAT in humans and compare such profiles across lean, obese, and diabetic patients. METHODS. We recruited 152 patients undergoing open-chest coronary artery bypass grafting (CABG), valve repair/replacement (VR) surgery, or combined CABG/VR. Patients' clinical and biochemical data and EAT, subcutaneous adipose tissue (SAT), and preoperative blood samples were collected. Immune cell profiling was evaluated by flow cytometry and complemented by gene expression studies of immune mediators. Bulk RNA-Seq was performed in EAT across metabolic profiles to assess whole-transcriptome changes observed in lean, obese, and diabetic groups. RESULTS. Flow cytometry analysis demonstrated EAT was highly enriched in adaptive immune (T and B) cells. Although overweight/obese and diabetic patients had similar EAT cellular profiles to lean control patients, the EAT exhibited significantly (P ≤ 0.01) raised expression of immune mediators, including IL-1, IL-6, TNF-α, and IFN-γ. These changes were not observed in SAT or blood. Neither underlying coronary artery disease nor the presence of hypertension significantly altered the immune profiles observed. Bulk RNA-Seq demonstrated significant alterations in metabolic and inflammatory pathways in the EAT of overweight/obese patients compared with lean controls. CONCLUSION. Adaptive immune cells are the predominant immune cell constituent in human EAT and SAT. The presence of underlying cardiometabolic conditions, specifically obesity and diabetes, rather than cardiac disease phenotype appears to alter the inflammatory profile of EAT. Obese states markedly alter EAT metabolic and inflammatory signaling genes, underlining the impact of obesity on the EAT transcriptome profile

Research priorities in regional anaesthesia: an international Delphi study

Background: Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. Methods: We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as ‘definitely’ include in any round, it was accepted. Indicative questions rated as ‘definitely’ or ‘probably’ by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. Results: There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven ‘highest priority’ research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. Conclusions: We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas

Carbon nanotube micro-contactors on ohmic substrates for on-chip microelectromechanical probing applications at wafer level

CNTs can have the ability to act as compliant small-scale springs or as shock resistance micro-contactors. This work investigates the performance of vertically-aligned CNTs (VA-CNTs) as micro-contactors in electromechanical testing applications for testing at wafer-level chip-scale-packaging (WLCSP) and wafer-level-packaging (WLP). Fabricated on ohmic substrates, 500-μm-tall CNT-metal composite contact structures are electromechanically characterized. The probe design and architecture are scalable, allowing for the assembly of thousands of probes in short manufacturing times, with easy pitch control. We discuss the effects of the metallization morphology and thickness on the compliance and electromechanical response of the metal-CNT composite contacts. Pd-metallized CNT contactors show up to 25 μm of compliance, with contact resistance as low as 460 mΩ (3.6 kΩ/μm) and network resistivity of 1.8 × 10−5 Ω cm, after 2500 touchdowns, with 50 μm of over-travel; they form reproducible and repeatable contacts, with less than 5% contact resistance degradation. Failure mechanisms are studied in-situ and after cyclic testing and show that, for top-cap-and-side metallized contacts, the CNT-metal shell provides stiffness to the probe structure in the elastic region, whilst reducing the contact resistance. The stable low resistance achieved, the high repeatability and endurance of the manufactured probes make CNT micro-contacts a viable candidate for WLP and WLCSP testing

A Deep Learning-Based Intelligent Garbage Detection System Using an Unmanned Aerial Vehicle

A population explosion has resulted in garbage generation on a large scale. The process of proper and automatic garbage collection is a challenging and tedious task for developing countries. This paper proposes a deep learning-based intelligent garbage detection system using an Unmanned Aerial Vehicle (UAV). The main aim of this paper is to provide a low-cost, accurate and easy-to-use solution for handling the garbage effectively. It also helps municipal corporations to detect the garbage areas in remote locations automatically. This automation was derived using two Convolutional Neural Network (CNN) models and images of solid waste were captured by the drone. Both models were trained on the collected image dataset at different learning rates, optimizers and epochs. This research uses symmetry during the sampling of garbage images. Homogeneity regarding resizing of images is generated due to the application of symmetry to extract their characteristics. The performance of two CNN models was evaluated with the state-of-the-art models using different performance evaluation metrics such as precision, recall, F1-score, and accuracy. The CNN1 model achieved better performance for automatic solid waste detection with 94% accuracy

The practice of regional anesthesia during the COVID-19 pandemic: an international survey of members of three regional anesthesia societies = Pratique de l’anesthésie régionale pendant la pandémie de COVID-19 : un sondage international auprès des membres de trois sociétés d’anesthésie régionale

Purpose To determine: the preferences and attitudes of members of regional anesthesia societies during the COVID-19 pandemic. Methods: We distributed an electronic survey to members of the American Society of Regional Anesthesia and Pain Medicine, Regional Anaesthesia-UK, and the European Society of Regional Anaesthesia & Pain Therapy. A questionnaire consisting of 19 questions was developed by a panel of experienced regional anesthesiologists and distributed by email to the participants. The survey covered the following domains: participant information, practice settings, preference for the type of anesthetic technique, the use of personal protective equipment, and oxygen therapy. Results: The survey was completed by 729 participants from 73 different countries, with a response rate of 20.1% (729/3,630) for the number of emails opened and 8.5% (729/8,572) for the number of emails sent. Most respondents (87.7%) identified as anesthesia staff (faculty or consultant) and practiced obstetric and non-obstetric anesthesia (55.3%). The practice of regional anesthesia either expanded or remained the same, with only 2% of respondents decreasing their use compared with the pre-pandemic period. The top reasons for an increase in the use of regional anesthesia was to reduce the need for an aerosol-generating medical procedure and to reduce the risk of possible complications to patients. The most common reason for decreased use of regional anesthesia was the risk of urgent conversion to general anesthesia. Approximately 70% of the responders used airborne precautions when providing care to a patient under regional anesthesia. The most common oxygen delivery method was nasal prongs (cannula) with a surgical mask layered over it (61%). Conclusions: Given the perceived benefits of regional over general anesthesia, approximately half of the members of three regional anesthesia societies seem to have expanded their use of regional anesthesia techniques during the initial surge of the COVID-19 pandemic