Indications and clinical outcome in pediatric tracheostomy:Lessons learned

Objective: Indications for tracheostomy have changed over the last decades and clinical outcome varies depending on the indication for tracheostomy. By gaining more insight in the characteristics and outcome of the tracheostomized pediatric population, clinical care can be improved and a better individual prognosis can be given. Therefore, we studied the outcome of our pediatric tracheostomy population in relation to the primary indication over the last 16 years. Methods: We retrospectively included children younger than 18 years of age with a tracheostomy tube in the Erasmus Medical Center, Sophia children's hospital. The primary indication for tracheostomy, gender, age at tracheostomy, age at decannulation, comorbidity, mortality, closure of a persisting tracheocutaneous fistula after decannulation, surgery prior to decannulation and the use of polysomnography were recorded and analyzed. Results: Our research group consisted of 225 children. Reasons for a tracheostomy were first divided in two major diagnostic groups: 1) airway obstruction group (subgroups: laryngotracheal obstruction and craniofacial anomalies) and 2) pulmonary support group (subgroups: cardio-pulmonary diseases and neurological diseases). Children in the airway obstruction group were younger when receiving a tracheostomy (3.0 months vs. 31.0 months, p &lt; 0.05), they were tracheostomy dependent for a longer time (median 21.5 months vs. 2.0 months, p &lt; 0.05) and they required surgery more often (74.5% vs. 8.3%, p &lt; 0.05) than the children in the pulmonary support group. The decannulation rate of children with a laryngotracheal obstruction is high (74.8%), but low in all other subgroups (craniofacial anomalies; 38.5%, cardio-pulmonary diseases; 34.6% and neurological diseases; 52.9%). Significantly more children (36.7%) died in the pulmonary support group due to underlying comorbidity, mainly in the cardio-pulmonary diseases subgroup. Surgery for a persisting tracheocutaneous fistula was performed in 34 (37.8%) children, with a significant relationship between the duration of the tracheostomy and the persistence of a tracheocutaneous fistula. No cannula related death occurred during this study period. Conclusion: Main indications for a tracheostomy were airway obstruction and pulmonary support. Children in the airway obstruction group were younger when receiving a tracheostomy and they were tracheostomy dependent for a longer period. Within the airway obstruction group, the decannulation rate for children with laryngotracheal stenosis was high, but low for children with craniofacial anomalies. In the pulmonary support group, the decannulation rate was low and the mortality rate was high. Surgery for a persisting tracheocutaneous fistula was frequently needed.</p

Edge Enhancement Optimization in Flexible Endoscopic Images to the Perception of Ear, Nose and Throat Professionals

Objectives: Digital endoscopes are connected to a video processor that applies various operations to process the image. One of those operations is edge enhancement that sharpens the image. The purpose of this study was to (1) quantify the level of edge enhancement, (2) measure the effect on sharpness and image noise, and (3) study the influence of edge enhancement on image quality perceived by ENT professionals. Methods: Three digital flexible endoscopic systems were included. The level of edge enhancement and the influence on sharpness and noise were measured in vitro, while systematically varying the levels of edge enhancement. In vivo images were captured at identical levels of one healthy larynx. Each series of in vivo images was presented to 39 ENT professionals according to a forced pairwise comparison test, to select the image with the best image quality for diagnostic purposes. The numbers of votes were converted to a psychometric scale of just noticeable differences (JND) according to the Thurstone V model. Results: The maximum level of edge enhancement varied per endoscopic system and ranged from 0.8 to 1.2. Edge enhancement increased sharpness and noise. Images with edge enhancement were unanimously preferred to images without edge enhancement. The quality difference with respect to zero edge enhancement reaches an optimum at levels between 0.7 and 0.9.Conclusion: Edge enhancement has a major impact on sharpness, noise, and the resulting perceived image quality. We conclude that ENT professionals benefit from this video processing and should verify if their equipment is optimally configured. Level of Evidence: N/A Laryngoscope, 2023.</p

Solid-state reference electrodes based on carbon nanotubes and polyacrylate membranes

A novel potentiometric solid-state reference electrode containing single-walled carbon nanotubes as the transducer layer between a polyacrylate membrane and the conductor is reported here. Single-walled carbon nanotubes act as an efficient transducer of the constant potentiometric signal originating from the reference membrane containing the Ag/AgCl/Cl− ions system, and they are needed to obtain a stable reference potentiometric signal. Furthermore, we have taken advantage of the light insensitivity of single-walled carbon nanotubes to improve the analytical performance characteristics of previously reported solid-state reference electrodes. Four different polyacrylate polymers have been selected in order to identify the most efficient reservoir for the Ag/AgCl system. Finally, two different arrangements have been assessed: (1) a solid-state reference electrode using photo-polymerised n-butyl acrylate polymer and (2) a thermo-polymerised methyl methacrylate:n-butyl acrylate (1:10) polymer. The sensitivity to various salts, pH and light, as well as time of response and stability, has been tested: the best results were obtained using single-walled carbon nanotubes and photo-polymerised n-butyl acrylate polymer. Water transport plays an important role in the potentiometric performance of acrylate membranes, so a new screening test method has been developed to qualitatively assess the difference in water percolation between the polyacrylic membranes studied. The results presented here open the way for the true miniaturisation of potentiometric systems using the excellent properties of single-walled carbon nanotubes

The Objective Measurement and Subjective Perception of Flexible ENT Endoscopes' Image Quality

ENT-flexible endoscopes are an important tool for ear, nose and throat (ENT) professionals to examine the upper airway. Although image quality has improved significantly in the past decade, there is no generally accepted approach to measure this objectively. Sharpness, visual noise and color fidelity are aspects of image quality that can objectively be measured. The purpose of this study was to explore the relationship between these quality metrics and the subjective perception of image quality by ENT-professionals. The image quality of six different flexible endoscopes was assessed objectively and subjectively. Objective measurements were obtained using the Rez Checker Target Nano Matte and comprised sharpness (MTF50), visual noise and color fidelity (CIE Delta E 2000). Subjective image quality ranking was obtained by presenting images of a single larynx to 30 ENT-professionals in a forced pairwise comparison and asking them to select the image with the best image quality. Differences in image quality between endoscopes are reliably detected by objective measurement and subjective assessment. A strong positive correlation was found between sharpness and subjective ranking (p < 0.005). Visual noise and color fidelity may be relevant, but did not correlate with the subjective assessment and were probably overshadowed by the strong correlation between sharpness and subjective ranking in the data. The authors found that number of pixels on screen to display the registered image differs per type of endoscope, however more pixels do not necessarily imply a sharper image. The authors will continue their investigation of image quality metrics and their relation to diagnostic accuracy which can provide feedback on design and manufacturing optimization to the industry. (C) 2022 Society for Imaging Science and Technology

Tuning the Electrochemical Property of the Ultrafine Metal-oxide Nanoclusters by Iron Phthalocyanine as Efficient Catalysts for Energy Storage and Conversion

Nanoclusters (NCs) have been demonstrated of outstanding performance in electrochemical energy storage and conversion technologies due to their strong quantum confinement effects and strong interaction with supports. Here, we developed a class of ultrafine metal-oxide (MOx, M = Fe, Co and Ni) NCs incorporated with iron phthalocyanine (FePc), MOx/FePc-G, supported on graphene as high-performance catalysts for oxygen reduction reaction (ORR), oxygen evolution reaction (OER), and carbon dioxide reduction (CO2RR). The high activities for ORR and OER are attributed to the electron donation and accepting ability of the highly redox active of FePc-G that could tune the properties of MOx. The FeOx/FePc-G exhibits an extremely positive half-wave potential (E1/2) of 0.888 and 0.610 V for ORR in alkaline and neutral conditions, respectively, which is around 60 mV more positive than that of Pt/C. And NiOx/FePc-G shows similar OER activity with the state-of-the-art catalysts, Ir/C, and better performance than NiFeO NCs supported on graphene. Remarkably, the CoOx/FePc-G and NiOx/FePc-G show high activity and selectivity to reduce CO2 into CO with a low onset potential of −0.22 V (overpotential is 0.11 V)

Tuning the Electrochemical Property of the Ultrafine Metal‐oxide Nanoclusters by Iron Phthalocyanine as Efficient Catalysts for Energy Storage and Conversion

Nanoclusters (NCs) have been demonstrated of outstanding performance in electrochemical energy storage and conversion technologies due to their strong quantum confinement effects and strong interaction with supports. Here, we developed a class of ultrafine metal-oxide (MOx, M = Fe, Co and Ni) NCs incorporated with iron phthalocyanine (FePc), MOx/FePc-G, supported on graphene as high-performance catalysts for oxygen reduction reaction (ORR), oxygen evolution reaction (OER), and carbon dioxide reduction (CO2RR). The high activities for ORR and OER are attributed to the electron donation and accepting ability of the highly redox active of FePc-G that could tune the properties of MOx. The FeOx/FePc-G exhibits an extremely positive half-wave potential (E1/2) of 0.888 and 0.610 V for ORR in alkaline and neutral conditions, respectively, which is around 60 mV more positive than that of Pt/C. And NiOx/FePc-G shows similar OER activity with the state-of-the-art catalysts, Ir/C, and better performance than NiFeO NCs supported on graphene. Remarkably, the CoOx/FePc-G and NiOx/FePc-G show high activity and selectivity to reduce CO2 into CO with a low onset potential of −0.22 V (overpotential is 0.11 V)

Design and synthesis of porous ZnTiO<inf>3</inf>/TiO<inf>2</inf> nanocages with heterojunctions for enhanced photocatalytic H<inf>2</inf> production

Despite the tremendous potential applications of hollow micro/nanostructures, their composition has been limited to mainly single chemical compounds. Inspired by recent innovations in the areas of metal organic frameworks (MOFs) and nanocoating, here, we report the rational synthesis of mesoporous ZnTiO3/TiO2 hollow polyhedra (MZTHP) obtained by hydrothermal treatment of zeolitic imidazolate framework-8 (ZIF-8)@TiO2 core-shell polyhedral particles. The subsequent calcination of these particles caused phase transformation from TiO2 to ZnTiO3 and eventually induced the formation of Zn2TiO4. In addition, the fabrication of these hollow structures revealed a way for the preparation of hollow polyhedral photocatalysts with Pt nanoparticles deposited onto their external surface (PHS-1) or encapsulated inside their hollow structures (PHS-2). Importantly, these two types of Pt-decorated nanoparticles are shown to exhibit an improved yet distinctly different performance for photocatalytic hydrogen production, highlighting that the photocatalytic activity correlates with the Pt location and dispersion

Edge Enhancement Optimization in Flexible Endoscopic Images to the Perception of Ear, Nose and Throat Professionals

Objectives: Digital endoscopes are connected to a video processor that applies various operations to process the image. One of those operations is edge enhancement that sharpens the image. The purpose of this study was to (1) quantify the level of edge enhancement, (2) measure the effect on sharpness and image noise, and (3) study the influence of edge enhancement on image quality perceived by ENT professionals. Methods: Three digital flexible endoscopic systems were included. The level of edge enhancement and the influence on sharpness and noise were measured in vitro, while systematically varying the levels of edge enhancement. In vivo images were captured at identical levels of one healthy larynx. Each series of in vivo images was presented to 39 ENT professionals according to a forced pairwise comparison test, to select the image with the best image quality for diagnostic purposes. The numbers of votes were converted to a psychometric scale of just noticeable differences (JND) according to the Thurstone V model. Results: The maximum level of edge enhancement varied per endoscopic system and ranged from 0.8 to 1.2. Edge enhancement increased sharpness and noise. Images with edge enhancement were unanimously preferred to images without edge enhancement. The quality difference with respect to zero edge enhancement reaches an optimum at levels between 0.7 and 0.9. Conclusion: Edge enhancement has a major impact on sharpness, noise, and the resulting perceived image quality. We conclude that ENT professionals benefit from this video processing and should verify if their equipment is optimally configured. Level of Evidence: N/A Laryngoscope, 2023.ImPhys/Computational ImagingImPhys/Rieger grou

Design and synthesis of porous ZnTiO3/TiO2 nanocages with heterojunctions for enhanced photocatalytic H2 production

Despite the tremendous potential applications of hollow micro/nanostructures, their composition has been limited to mainly single chemical compounds. Inspired by recent innovations in the areas of metal organic frameworks (MOFs) and nanocoating, here, we report the rational synthesis of mesoporous ZnTiO 3 /TiO 2 hollow polyhedra (MZTHP) obtained by hydrothermal treatment of zeolitic imidazolate framework-8 (ZIF-8)@TiO 2 core-shell polyhedral particles. The subsequent calcination of these particles caused phase transformation from TiO 2 to ZnTiO 3 and eventually induced the formation of Zn 2 TiO 4 . In addition, the fabrication of these hollow structures revealed a way for the preparation of hollow polyhedral photocatalysts with Pt nanoparticles deposited onto their external surface (PHS-1) or encapsulated inside their hollow structures (PHS-2). Importantly, these two types of Pt-decorated nanoparticles are shown to exhibit an improved yet distinctly different performance for photocatalytic hydrogen production, highlighting that the photocatalytic activity correlates with the Pt location and dispersion