High-speed feedback based wavefront shaping for spatiotemporal enhancement of incoherent light through dynamic scattering media.

Feedback-based wavefront shaping is a promising and versatile technique for enhancing the contrast of a target signal for both coherent and incoherent light through a highly scattering medium. However, this technique can fail for a dynamic sample with a short correlation time. So far, most proposed methods for high-speed wavefront shaping can only directly enhance the intensity of coherent light but not incoherent light. Here we try to fill this gap to directly enhance incoherent light with high speed, such as fluorescence, which is essential in extending wavefront shaping to biomedical applications. For this purpose, we develop a technique based on a single acousto-optic deflector (AOD) with field-programmable gate array (FPGA) acceleration for spatiotemporal focusing within milliseconds. With the digital time gating of the feedback signal, spatiotemporal focusing of laser light with high contrast can be formed behind dynamic scattering media in milliseconds resulting in fluorescence enhancement. Furthermore, FPGA-based wavefront shaping is shown to effectively enhance fluorescence directly behind dynamic samples with short correlation times.

Sequency encoding single pixel spectroscopy based on Hadamard transform.

Single pixel spectroscopy based on Hadamard transform (SPS-HT) has been applied widely because of its capability of wavelength multiplexing and associated advantage in signal-to-noise ratio. In this paper, we propose a sequency encoding single pixel spectroscopy (SESPS) based on two-dimensional (2D) masks for concurrent coding of all Hadamard coefficients instead of one-dimensional (1D) Hadamard masks (only coding one coefficient at a time) widely used in the traditional SPS-HT. Moreover, each Hadamard coefficient is coded along the time dimension with a different sequency value such that the alternating current (AC) measurements of the time-domain signal can be used to reconstruct all Hadamard coefficients simultaneously, which reduces the influence of noise and dramatically speeds up data acquisition. We demonstrate that the SESPS with 32 spectral channels can accelerate spectral measurements from white light sources and fluorescence particles by around 14 times and 70 times, respectively, compared to measurements using a commercial spectrometer when the relative root mean square error (RMSE) is around 3% or smaller. The acceleration factors can be boosted by an extra 4 times when only eight spectral channels are used to achieve a compression ratio of 4:1, in which the relative RMSEs change only marginally. Compared to our previous SPS-HT, this new scheme can increase the speed by three orders of magnitude. This technique is expected to be useful in applications requiring high-speed spectral measurements such as the spectral flow cytometry and on-site medical diagnosis using fluorescence or Raman spectroscopy.

Diabetes self-management during the COVID-19 pandemic and its associations with COVID-19 anxiety syndrome, depression and health anxiety.

INTRODUCTION: The effects of the COVID-19 pandemic on mental health have been profound. Mental health and diabetes self-care are inter-related. We examined whether COVID-19 anxiety, depressive symptoms and health anxiety were associated with domains of diabetes self-management and investigated whether greater COVID-19 anxiety syndrome would independently contribute to suboptimal diabetes self-care. RESEARCH DESIGN AND METHODS: Surveys were sent to people attending diabetes clinics of three London hospitals. Participants completed the Diabetes Self-Management Questionnaire (DSMQ), the COVID-19 Anxiety Syndrome Scale (C-19 ASS), which measures perseveration and avoidant maladaptive coping behaviour, assessed with measures of co-existent depressive symptoms and anxiety, controlling for age, gender and social deprivation. Clinical data, including pre- and post-lockdown HbA1c measures, were obtained from hospital records for 369 respondents, a response rate of 12.8%. RESULTS: Depressive symptom scores were high. Both pre-existing health anxiety and depressive symptoms were independently linked to improvable measures of diabetes care, as was lower socio-economic rank. However, avoidant COVID-19 anxiety responses were independently associated with higher diabetes self-care scores. HbA1c levels improved modestly over the year of UK lockdown in this cohort. CONCLUSION: During the height of lockdown, avoidant coping behaviours characteristic of the COVID-19 anxiety syndrome may in fact work to improve diabetes self-care, at least in the short term. We recommend screening for depressive symptoms and being aware of the significant minority of people with COVID-19 anxiety syndrome who may now find it difficult to re-engage with face-to-face clinic opportunities.

Localized Immunomodulation with PD-L1 Results in Sustained Survival and Function of Allogeneic Islets without Chronic Immunosuppression.

Allogeneic islet transplantation is limited by adverse effects of chronic immunosuppression used to control rejection. The programmed cell death 1 pathway as an important immune checkpoint has the potential to obviate the need for chronic immunosuppression. We generated an oligomeric form of programmed cell death 1 ligand chimeric with core streptavidin (SA-PDL1) that inhibited the T effector cell response to alloantigens and converted T conventional cells into CD4+Foxp3+ T regulatory cells. The SA-PDL1 protein was effectively displayed on the surface of biotinylated mouse islets without a negative impact islet viability and insulin secretion. Transplantation of SA-PDL1-engineered islet grafts with a short course of rapamycin regimen resulted in sustained graft survival and function in >90% of allogeneic recipients over a 100-d observation period. Long-term survival was associated with increased levels of intragraft transcripts for innate and adaptive immune regulatory factors, including IDO-1, arginase-1, Foxp3, TGF-ß, IL-10, and decreased levels of proinflammatory T-bet, IL-1ß, TNF-α, and IFN-γ as assessed on day 3 posttransplantation. T cells of long-term graft recipients generated a proliferative response to donor Ags at a similar magnitude to T cells of naive animals, suggestive of the localized nature of tolerance. Immunohistochemical analyses showed intense peri-islet infiltration of T regulatory cells in long-term grafts and systemic depletion of this cell population resulted in prompt rejection. The transient display of SA-PDL1 protein on the surface of islets serves as a practical means of localized immunomodulation that accomplishes sustained graft survival in the absence of chronic immunosuppression with potential clinical implications.

Paediatric facial paralysis: An overview and insights into management.

The aim of this article is to provide an overview on paediatric facial paralysis, looking into aetiology, epidemiology, assessment and investigation and subsequent treatment options available. Facial paralysis describes the inability to activate the muscles of fascial expression. Overall, it affects 2.7 per 100 000 children under 10 years old and 10.1 per 100 000 children over 10 years old each year. There are many causes of facial paralysis and the outcomes and necessary treatments vary depending on the cause. The mainstays of medical management are corticosteroids and facial therapy; however, when the facial palsy persists, facial deformity surgery is an option to improve the facial symmetry, protect vision and recreate dynamic movement.

Pediatric Microsurgery in the Reconstruction of Complex Posttraumatic Foot and Ankle Defects: A Long-Term Follow-Up with a Comprehensive Review of the Literature.

BACKGROUND: Lower limb reconstruction is a well-recognized challenge to the trauma or plastic surgeon. Although techniques and outcomes in the adult population are well documented, they are less so in the pediatric population. Here, we present our experience in the management of posttraumatic foot and ankle defects with free tissue transfer in children. METHODS: We performed a retrospective analysis of 40 pediatric patients between the ages of 3 and 16 from 2008 to 2016 who underwent foot and ankle soft tissue reconstruction. Any patient who underwent reconstruction for any reason other than trauma was excluded. Data were collected on operative time, free tissue transfer type, use of vein grafts, length of hospital stay, and postoperative morbidity. Also, a comprehensive systematic literature review was completed according to the PRISMA protocol for all previous reports of foot and ankle reconstruction in the young age group with free tissue transfer. RESULTS: Of our 40 patients, 23 were males and 12 females, free tissue transfer was used to reconstruct primarily the dorsum (71%), heel (11%), medial (9%), and lateral (3%) aspect of the foot. The anterior tibial artery was the predominant recipient vessel for anastomosis (77%). Mean inpatient stay was 9 days and our complication rate was 20%, primarily of superficial infection treated with antibiotic therapy. The review of the literature articles is completely analyzed in detail. CONCLUSION: The need for durable coverage of exposed joints, tendons, fractures, or hardware makes the free flap particularly well suited to trauma reconstruction of the foot and ankle. The lack of underlying vascular disease in this patient group allows for low complication rates. Our study evidences the safety and positive long-term outcomes of free tissue transfer for the reconstruction of huge sized-soft tissue defects of the foot and ankle in children.

Immune checkpoint CD47 molecule engineered islets mitigate instant blood-mediated inflammatory reaction and show improved engraftment following intraportal transplantation.

Instant blood-mediated inflammatory reaction (IBMIR) causes significant destruction of islets transplanted intraportally. Myeloid cells are a major culprit of IBMIR. Given the critical role of CD47 as a negative checkpoint for myeloid cells, we hypothesized that the presence of CD47 on islets will minimize graft loss by mitigating IBMIR. We herein report the generation of a chimeric construct, SA-CD47, encompassing the extracellular domain of CD47 modified to include core streptavidin (SA). SA-CD47 protein was expressed in insect cells and efficiently displayed on biotin-modified mouse islet surface without a negative impact on their viability and function. Rat cells engineered with SA-CD47 were refractory to phagocytosis by mouse macrophages. SA-CD47-engineered islets showed intact structure and minimal infiltration by CD11b+ granulocytes/macrophages as compared with SA-engineered controls in an in vitro loop assay mitigating IBMIR. In a syngeneic marginal mass model of intraportal transplantation, SA-CD47-engineered islets showed better engraftment and function as compared with the SA-control group (87.5% vs 14.3%). Engraftment was associated with low levels of intrahepatic inflammatory cells and mediators of islet destruction, including high-mobility group box-1, tissue factor, and IL-1ß. These findings support the use of CD47 as an innate immune checkpoint to mitigate IBMIR for enhanced islet engraftment with translational potential.

G-quadruplex oligonucleotide AS1411 as a cancer-targeting agent: Uses and mechanisms.

BACKGROUND: AS1411 is a 26-mer G-rich DNA oligonucleotide that forms a variety of G-quadruplex structures. It was identified based on its cancer-selective antiproliferative activity and subsequently determined to be an aptamer to nucleolin, a multifunctional protein that preferentially binds quadruplex nucleic acids and which is present at high levels on the surface of cancer cells. AS1411 has exceptionally efficient cellular internalization compared to non-quadruplex DNA sequences. SCOPE OF REVIEW: Recent developments related to AS1411 will be examined, with a focus on its use for targeted delivery of therapeutic and imaging agents. MAJOR CONCLUSIONS: Numerous research groups have used AS1411 as a targeting agent to deliver nanoparticles, oligonucleotides, and small molecules into cancer cells. Studies in animal models have demonstrated that AS1411-linked materials can accumulate selectively in tumors following systemic administration. The mechanism underlying the cancer-targeting ability of AS1411 is not completely understood, but recent studies suggest a model that involves: (1) initial uptake by macropinocytosis, a form of endocytosis prevalent in cancer cells; (2) stimulation of macropinocytosis by a nucleolin-dependent mechanism resulting in further uptake; and (3) disruption of nucleolin-mediated trafficking and efflux leading to cargoes becoming trapped inside cancer cells. SIGNIFICANCE: Human trials have indicated that AS1411 is safe and can induce durable remissions in a few patients, but new strategies are needed to maximize its clinical impact. A better understanding of the mechanisms by which AS1411 targets and kills cancer cells may hasten the development of promising technologies using AS1411-linked nanoparticles or conjugates for cancer-targeted therapy and imaging. This article is part of a Special Issue entitled "G-quadruplex" Guest Editor: Dr. Concetta Giancola and Dr. Daniela Montesarchio.

Heterocyclic Bismuth(III) Dithiocarbamato Complexes as Single-Source Precursors for the Synthesis of Anisotropic Bi2 S3 Nanoparticles.

New complexes catena-(µ2 -nitrato-O,O')bis(piperidinedithiocarbamato)bismuth(III) (1) and tetrakis(µ-nitrato)tetrakis[bis(tetrahydroquinolinedithiocarbamato)bismuth(III)] (2) were synthesised and characterised by elemental analysis, FTIR spectroscopy and thermogravimetric analysis. The single-crystal X-ray structures of 1 and 2 were determined. The coordination numbers of the Bi(III) ion are 8 for 1 and ≥6 for 2 when the experimental electron density for the nominal 6s(2) lone pair of electrons is included. Both complexes were used as single-source precursors for the synthesis of dodecylamine-, hexadecylamine-, oleylamine and tri-n-octylphosphine oxide-capped Bi2 S3 nanoparticles at different temperatures. UV/Vis spectra showed a blueshift in the absorbance band edge characteristic of a quantum size effect. High-quality, crystalline, long and short Bi2 S3 nanorods were obtained depending on the thermolysis temperature, which was varied from 190 to 270 °C. A general trend of increasing particle breadth with increasing reaction temperature and increasing length of the carbon chain of the amine (capping agent) was observed. Powder XRD patterns revealed the orthorhombic crystal structure of Bi2 S3 .

Synthesis of Nanoparticulate Alloys of the Composition Cu2Zn(1-x)Fe(x)SnS4: Structural, Optical, and Magnetic Properties.

Nanoparticles of the semiconductor Cu2Zn(1-x)Fe(x)SnS4 with different mole fractions of iron (x(Fe)) were synthesized by the decomposition of molecular precursors in oleylamine. The composition, structure, optical, and magnetic properties of the nanoparticles are reported. The parent (Cu2ZnSnS4) zinc material is usually reported as kesteritic and the corresponding iron phase as stannitic; with different site occupancies and tetragonalities. In the small ca. 8-10 nm particles prepared, the smooth variation in lattice parameters and other measured properties suggest that the phase change, with composition, may be absent. SQUID magnetometry suggests that the iron containing samples are ferromagnetic at 5 K and paramagnetic at 300 K.

The training and certification of surgical oncologists globally.

BACKGROUND: The global cancer burden (GCB) is expected to rise significantly during the next few decades with most of the new cancers and cancer-related deaths afflicting the low- to middle-income countries. The ability to tackle this rising GCB requires the presence of an adequately trained surgical oncology workforce, which is dependent on credible training pathways and sustainable certification pipelines. The purpose of this article is to review briefly the training patterns and certification requirements for surgical oncologists globally by sampling representative countries across all regions of the world. METHODS: A thorough literature search was conducted using multiple websites of credible national/global organizations as well as the websites of individual countries. Countries from select regions in the world were included (based on the World Health Organization regions and Human Development Index) in the analysis to determine the prevalent trends in the training of surgical oncologists globally. RESULTS: Several trends and significant differences were noted in the training patterns of surgical oncologists globally. The presence or absence of domestic surgical oncology fellowships had an inverse correlation to the income level of the country. Countries without domestic fellowships usually relied on high-income foreign destinations for their training. CONCLUSIONS: The results of the analysis demonstrated significant variability in training of surgical oncologists globally. Despite the diversity, we noticed some general trends based on which some recommendations were put forth for increasing the global surgical oncology workforce.

Integrated approach for prioritizing watersheds for management: a study of lidder catchment of kashmir himalayas.

The Himalayan watersheds are susceptible to various forms of degradation due to their sensitive and fragile ecological disposition coupled with increasing anthropogenic disturbances. Owing to the paucity of appropriate technology and financial resources, the prioritization of watersheds has become an inevitable process for effective planning and management of natural resources. Lidder catchment constitutes a segment of the western Himalayas with an area of 1,159.38 km(2). The study is based on integrated analysis of remote sensing, geographic information system, field study, and socioeconomic data. Multicriteria evaluation of geophysical, land-use and land-cover (LULC) change, and socioeconomic indicators is carried out to prioritize watersheds for natural resource conservation and management. Knowledge-based weights and ranks are normalized, and weighted linear combination technique is adopted to determine final priority value. The watersheds are classified into four priority zones (very high priority, high priority, medium priority, and low priority) on the basis of quartiles of the priority value, thus indicating their ecological status in terms of degradation caused by anthropogenic disturbances. The correlation between priority ranks of individual indicators and integrated indicators is drawn. The results reveal that socioeconomic indicators are the most important drivers of LULC change and environmental degradation in the catchment. Moreover, the magnitude and intensity of anthropogenic impact is not uniform in different watersheds of Lidder catchment. Therefore, any conservation and management strategy must be formulated on the basis of watershed prioritization.

Chest X-ray: an unfair screening tool.

BACKGROUND: Chest radiography is considered as the sole screening tool for chest pathologies as prerequisite for overseas employment during their medical examinations. The aim was to evaluate the role of CXR as a screening tool in the diagnosis of different lung pathologies in general and TB in particular. METHODS: In this descriptive case series, reports of 63,648 Pakistani candidates, who took chest X-rays during medical screening for employment abroad under the rules of Gulf Coordination Council (GCC), were analysed. The reports were collected over a three year period (2008-2011). All the candidates were apparently healthy males of ages ranging between 18-50 years with average age of 27.4 years. RESULTS: Out of 63,648 candidates examined over a three year period, 1368 (2.15%) were declared unfit on the basis of CXR. There were 359 cases of calcified granulomas, 318 of costophrenic angle obliteration, 174 of apical scaring; 144 of pulmonary scars, 123 of fibrocalcific lesion, 82 of soft shadows in lung, 51 of nodular lung shadows, 42 of lymphadenopathy, 30 of pleural effusion, 26 of interstitial lung shadow and 19 of calcification. A closer scrutiny of these cases revealed that over 90% of the CXRs of the candidates declared as having lung pathologies displayed scars rather than active disease. CONCLUSION: A normal CXR by itself, neither categorically rules out problems in the chest nor does any finding in it confirm some disease. Unfitness on the basis of CXR alone, unless substantiated by further investigation, is questionable to say the least.

In Situ synthesis of self-assembled gold nanoparticles on glass or silicon substrates through reactive inkjet printing.

A facile and low cost method for the synthesis of self-assembled nanoparticles (NPs) with minimal size variation and chemical waste by using reactive inkjet printing was developed. Gold NPs with diameters as small as (8±2) nm can be made at low temperature (120 °C). The size of the resulting NPs can be readily controlled through the concentration of the gold precursor and oleylamine ink. The pure gold composition of the synthesized NPs was confirmed by energy-dispersive X-ray spectroscopy (EDXS) analysis. High-resolution SEM (HRSEM) and TEM (HRTEM), and X-ray diffraction revealed their size and face-centered cubic (fcc) crystal structure, respectively. Owing to the high density of the NP film, UV/Vis spectroscopy showed a red shift in the intrinsic plasmonic resonance peak. We envision the extension of this approach to the synthesis of other nanomaterials and the production of tailored functional nanomaterials and devices.

Development of Magnesium Aluminate (MgAl2O4) Nanoparticles for refractory crucible application.

Ceramics are the oxides of metals and nonmetals with excellent compressive strength. Ceramics usually exhibit inert behavior at high temperatures. Magnesium aluminate (MgAl2O4), a member of the ceramic family, possesses a high working temperature up to 2000°C, low thermal conductivity, high strength even at elevated temperatures, and good corrosion resistance. Moreover, Magnesium Aluminate Nanoparticles (MANPs) can be used in the making of refractory crucible applications. This study focuses on the thermal behavior of Magnesium Aluminate Nanoparticles (MANPs) and their application in the making of refractory crucibles. The molten salt method is used to obtain MANPs. The presence of MANPs is seen by XRD peaks ranging from 66° to 67°. The determination of the smallest crystallite size of the sample is achieved by utilizing the Scherrer formula and is found to be 15.3 nm. The SEM micrographs provided further information, indicating an average particle size of 91.2 nm. At 600°C, DSC curves show that only 0.05 W/g heat flows into the material, and the TGA curve shows only 3% weight loss, which is prominent for thermal insulation applications. To investigate the thermal properties, crucibles of pure MANPs and the different compositions of MANPs and pure alumina are prepared. During the sintering, cracks appear on the crucible of pure magnesium aluminate. To explore the reason for crack development, tablets of MgAl2O4 are made and sintered at 1150°C. Ceramography shows the crack-free surfaces of all the tablets. Results confirm the thermal stability of MANPs at high temperatures and their suitability for melting crucible applications.

Mild Hyperthermia Enhanced Liposomal Doxorubicin Delivery and CD8+ T cell Infiltration in Triple Negative Breast Cancer.

Mild hyperthermia (MHTh) is often used in combination with chemotherapy and radiotherapy for cancer treatment. In the current study, the effect of MHTh on the enhanced uptake of the FDA-approved chemotherapy drug, liposomal doxorubicin (dox) in syngeneic 4T1 tumors was investigated. Doxorubicin has inherent fluorescence properties having an emission signal at 590 nm upon excitation with a 480 nm laser. A group of mice administered with doxorubicin (dox) were exposed to MHTh (42 °C) for 30 minutes whereas control group given dox did not receive MHTh. Ex vivo optical imaging of harvested tumors confirmed higher uptake of dox in treated versus the control untreated tumors. Confocal microscopy of tumor sections indicates higher fluorescent intensity due to increased accumulation of dox in MHTh-treated compared to untreated tumors. We examined the effect of MHTh to enhance CD8 tumor infiltration, production of interferon-γ (IFN-γ) and expression of programmed death ligand-1 (PD-L1). mRNA in situ hybridization was performed to test for transcripts of CD8, IFN-γ and PD-L1. Results showed that higher expression of CD8 mRNA was observed in MHTh-administered tumors versus untreated cohorts. The signal for IFN-γ and PD-L1 in both groups were not significantly different. Taken together, our findings imply that MHTh can improve tumor uptake of dox. Importantly, our data suggests that MHTh can boost CD8+ T cell infiltration.

Public health and the undergraduate medical curriculum: are we preparing physicians for the 21st century?

OBJECTIVE: To investigate the adequacy of the undergraduate medical curriculum in Pakistan to address primary healthcare and public health needs of the community at national level. METHODS: The cross-sectional study used standardised pilot-tested instruments from January 12 to July 14, 2010. Stratified purposive sampling technique was employed to include public and private-sector medical colleges in the study. A total of 174 faculty members were interviewed at 11 medical colleges. Data entry and analysis was done using SPSS 17.0. RESULTS: Of the 174 faculty members, 93 (53%) were male. The age of the respondents ranged between 26 and 68 years (Mean: 43 +/- 9 years). Of the participants, 64 (37%) had worked in a primary healthcare facility at some point in their career. Various aspects of maternal, newborn and child health are not covered by the medical curriculum as reported by the faculty members. CONCLUSION: There is disconnection between academia, primary healthcare providers, policymakers and the regulators. The primary healthcare providers have inadequate representation in the curriculum design. There is a need to re-direct financial resources, medical education, and medical practitioners with a focus on addressing the needs of the rural areas.

A synthesis on utilization of waste glass and fly ash in cold bitumen emulsion mixtures.

The generation of waste materials is a global concern and attempts are being made to utilize these wastes in the construction industry. The development of road infrastructure everywhere is going at a fast pace which increases the environmental degradation, fossil fuel consumption, global warming, and depletion of natural materials because of hot mix asphalt (HMA) usage. The detrimental effects of generation of waste in large quantities at a global scale and virgin material/energy consumption in HMA construction are of prime concern and need to be addressed. The construction/maintenance of pavement must be environmentally, economically, and socially sustainable. Use of cold bitumen emulsion mixtures (CBEMs), a type of cold mix asphalt (CMA), is a way forward for development of sustainable road infrastructure. The incorporation of wastes in CMA can be a sustainable solution to problems linked to waste generation and development of flexible pavements with HMA. This work summarizes the staging evaluation of CBEMs incorporated with waste glass (WG) and fly ash (FA) utilizing mechanical characteristics, water sensitivity and environmental impact, critical gaps in the literature, and recommendations to address those gaps. A detailed analysis on CBEMs using WG as a replacement of fine aggregate showed comparable stability/stiffness and multifold resistance to rutting than HMA. Fly ash filler in CBEMs reported extraordinary increase in stability, stiffness, rutting resistance, and water sensitivity than reference CBEM/HMA. The focus of the research area should continue on the exploration of waste materials for use in CBEMs to achieve a better environment for society and to promote sustainability in the pavement industry.

An Unusual Case of Bleeding: Acquired Hemophilia A.

Acquired hemophilia A (AHA) is a bleeding disorder, autoimmune in nature, in which the body produces IgG antibody inhibitors that attack coagulation factor VIII, causing deficiency. It is largely seen in the elderly, but most cases are idiopathic. Cases of acquired hemophilia A can occur in the presence of neutrophilia, infection, acute physiological stress, medication effect, tissue necrosis, various inflammatory disorders, and/or malignancy, which presents a formidable challenge with clinical workup. This case illustrates the potential for a masked bleeding disorder in a complex elderly male patient and the value of a thorough history-taking and workup. Although rare, acquired hemophilia recognition is essential for appropriate therapies to be started as early as possible and for cases to not easily be confused for another bleeding disorder in an acute care setting after ruling out other acute/common causes of similarly presenting symptoms.

A Unique Case of Atrial Fibrillation Secondary to Squamous Cell Lung Carcinoma.

Atrial fibrillation (AF) is widely considered to be the most prevalent cardiac arrhythmia with an incidence of roughly 1%-2% in the United States alone. The incidence of AF has been known to increase with advancing age and thus presents a significant burden on healthcare systems across the globe. AF arises as a result of several mechanisms including structural changes that occur in the heart over time. Here, we present a case in which a 63-year-old male with no past medical history except heavy tobacco use presented to the emergency department complaining of shortness of breath. He also endorsed having palpations and a productive cough for several weeks prior to presenting to the emergency department. An EKG revealed AF with a rapid ventricular response. His chest x-ray revealed an irregular opacification of the left lung; however, a chest computed tomography unveiled a left hilar mass extending to the left upper lobe. The mass was causing obstruction of the left upper lobe and encasement of the left main pulmonary artery and left atrium. This case highlights a rare etiology of AF. While many causes of AF have been elucidated, including hypertension and valvular heart disease, a much lesser-known cause includes lung carcinoma resulting in a mass effect on the heart. Representing almost 19% of all cancer deaths, lung cancer is the leading cause of cancer death. Although lung cancer screenings are recommended for certain populations, the majority of lung cancer cases present at an advanced stage, limiting treatment options. Our patient presents a unique case involving a lung mass causing AF due to the mass effect on the left heart. Although the patient had other risk factors for AF including advanced age and cigarette smoking, we propose that due to the anatomical location of his lung mass, his AF was a consequence of the squamous cell carcinoma of the lung. Although the mortality for lung cancer remains high, new treatments, including pembrolizumab, have the potential to drastically alter the way these cancers are treated.