Programmable Droplet Microfluidics Based on Machine Learning and Acoustic Manipulation.

Typical microfluidic devices are application-specific and have to be carefully designed to implement the necessary functionalities for the targeted application. Programmable microfluidic chips try to overcome this by offering reconfigurable functionalities, allowing the same chip to be used in multiple different applications. In this work, we demonstrate a programmable microfluidic chip for the two-dimensional manipulation of droplets, based on ultrasonic bulk acoustic waves and a closed-loop machine-learning-based control algorithm. The algorithm has no prior knowledge of the acoustic fields but learns to control the droplets on the fly. The manipulation is based on switching the frequency of a single ultrasonic transducer. Using this method, we demonstrate 2D transportation and merging of water droplets in oil and oil droplets in water, and we performed the chemistry that underlies the basis of a colorimetric glucose assay. We show that we can manipulate drops with volumes ranging from ∼200 pL up to ∼30 nL with our setup. We also demonstrate that our method is robust, by changing the system parameters and showing that the machine learning algorithm can still complete the manipulation tasks. In short, our method uses ultrasonics to flexibly manipulate droplets, enabling programmable droplet microfluidic devices.

Possible Association of Pulmonary Atresia with In-Utero Coxsackievirus B Exposure.

Gestational viral infection has been associated with congenital heart disease (CHD). Few studies, however, have studied the potential role of gestational Coxsackievirus B (CVB) exposure in the pathogenesis of CHD. We prospectively enrolled women with pregnancies affected by CHD to explore possible associations with in utero CVB exposure. Serum samples were obtained from 122 women referred for fetal echocardiography between 2006 and 2018. We quantified CVB IgG and IgM levels, with titers ≥ 15.0 U/mL considered positive and measured neutralizing antibodies for three CVB serotypes: CVB1, CVB3, and CVB4. Using data from the national enterovirus surveillance system, we compared the annual exposure rates for each serotype in our cohort to infections reported across the United States. 98 pregnancies with no genetic defects were included. Overall, 29.6% (29/98) had positive IgG and 4.1% (4/98) of women had positive CVB IgM titers. To explore first-trimester CVB exposure, we focused exclusively on the 26 women with positive IgG and negative IgM titers. 61.5% (16/26) had neutralizing antibodies against a single serotype and 38.5% (10/26) against multiple CVB serotypes. CVB4 neutralizing antibodies were the most common (65.4%, 17/26), followed by CVB3 (53.9%, 14/26) and CVB1 (30.8%, 8/26). Among these, 30.8% of babies presented pulmonary valve anomalies: 19.2% (5/26) pulmonary atresia, and 11.5% (3/26) pulmonary stenosis. 23.1% (6/26) of babies had coronary sinusoids. CVB exposure in our cohort mirrored that of reported infections in the United States. Our results suggest a possible association between gestational CVB exposure and specific CHD, particularly pulmonary valve anomalies and coronary sinusoids.

Comparative evaluation of high-flow nasal cannula oxygenation vs nasal intermittent ventilation in postoperative paediatric patients operated for acyanotic congenital cardiac defects.

Background: This study aimed to compare high-flow nasal cannula (HFNC) oxygenation vs nasal intermittent ventilation (NIV) oxygenation for respiratory care after extubation in postoperative paediatric cardiac patients. Methods: This study was a randomised controlled trial. One hundred twenty-one paediatric patients with acyanotic congenital heart disease undergoing corrective cardiac surgery on cardiopulmonary bypass were included in the study. Patients were randomised to receive either HFNC (AIRVO) or NIV (RAM Cannula) postextubation. Arterial blood gas was analysed at different time points perioperatively. Results: Patients in both the groups were matched with respect to diagnosis and demographic profiles. Baseline hemodynamic and respiratory parameters were also similar in both the groups. Patients in HFNC/AIRVO group did not show improved carbon dioxide (CO2) washout but showed improved pO2 and pO2/FiO2 ratio immediate postextubation. Reintubation rate and other intensive care unit (ICU) complications were similar in both the groups. Conclusion: Postcardiopulmonary bypass respiratory complications in paediatric patients with congenital acyanotic heart disease can be minimised with newer oxygen therapy devices such as AIRVO (HFNC) or RAM cannula (NIV). In comparison between these two, AIRVO did not show improved CO2 washout over RAM cannula; however, it did provide better oxygenation as measured by pO2 in arterial blood and pO2/FiO2 ratio immediate postextubation. Also, long-term results such as duration of mechanical ventilation and ICU stay were not affected by the choice of device.

Copper Oxide Microtufts on Natural Fractals for Efficient Water Harvesting.

Hierarchical surfaces that aid in the droplet nucleation, growth, and removal is highly desirable for fog and moisture harvesting applications. Taking inspiration from the unique architecture of leaf skeletons, we present a multiscale surface capable of rapidly nucleating, growing, and directional transport of the water droplets. Copper oxide microtufts were fabricated onto the Ficus religiosa leaf skeletons via electroplating and chemical oxidation techniques. The fabricated surfaces with microtufts had high wettability and very good fog harvesting ability. CuO surfaces tend to become hydrophobic over time because of the adsorption of the airborne species. The surfaces were efficient in fog harvesting even when the hydrophobic coating is present. The overall water collection efficiencies were determined, and the role of the microtufts, fractal structures, and the orientation of leaf veins was investigated. Compared to the planar control surfaces, the noncoated and hydrophobic layer-coated copper oxide microtufts on the leaf skeletons displayed a significant increase in the fog harvesting efficiency. For superhydrophilic skeleton surfaces, the water collection rate was also observed to slightly vary with the vein orientation. The CuO microtufts along with high surface area fractals allowed an effective and sustainable way to capture and transport water. The study is expected to provide valuable insights into the design and fabrication of sustainable and efficient fog harvesting systems.

Vangl2-regulated polarisation of second heart field-derived cells is required for outflow tract lengthening during cardiac development.

Planar cell polarity (PCP) is the mechanism by which cells orient themselves in the plane of an epithelium or during directed cell migration, and is regulated by a highly conserved signalling pathway. Mutations in the PCP gene Vangl2, as well as in other key components of the pathway, cause a spectrum of cardiac outflow tract defects. However, it is unclear why cells within the mesodermal heart tissue require PCP signalling. Using a new conditionally floxed allele we show that Vangl2 is required solely within the second heart field (SHF) to direct normal outflow tract lengthening, a process that is required for septation and normal alignment of the aorta and pulmonary trunk with the ventricular chambers. Analysis of a range of markers of polarised epithelial tissues showed that in the normal heart, undifferentiated SHF cells move from the dorsal pericardial wall into the distal outflow tract where they acquire an epithelial phenotype, before moving proximally where they differentiate into cardiomyocytes. Thus there is a transition zone in the distal outflow tract where SHF cells become more polarised, turn off progenitor markers and start to differentiate to cardiomyocytes. Membrane-bound Vangl2 marks the proximal extent of this transition zone and in the absence of Vangl2, the SHF-derived cells are abnormally polarised and disorganised. The consequent thickening, rather than lengthening, of the outflow wall leads to a shortened outflow tract. Premature down regulation of the SHF-progenitor marker Isl1 in the mutants, and accompanied premature differentiation to cardiomyocytes, suggests that the organisation of the cells within the transition zone is important for maintaining the undifferentiated phenotype. Thus, Vangl2-regulated polarisation and subsequent acquisition of an epithelial phenotype is essential to lengthen the tubular outflow vessel, a process that is essential for on-going cardiac morphogenesis.

Management of Unusual Rotation of Maxillary Central Incisor with Impacted Mesiodens: Case Report.

Supernumerary teeth are frequently found in the maxillary anterior region, largely in permanent dentition (rare in deciduous dentition). Shape of the supernumerary teeth may vary from conical, tueberculate, supplemental to odontome. Mesiodens is a conical type of supernumerary teeth located in the maxillary central incisor region and is generally unerupted. Presence of mesiodens may result in rotation, uneruption, or malalignment of adjacent maxillary incisors. In this article, we present a case report of unusual rotation of maxillary central incisor with impacted mesiodens.

Correction of Scissor's Bite with Modified Transpalatal Arch.

Compromised occlusion because ofscissor' bite can eventually lead to temporomandibular disorders and severe consequences. Wany devices and orthodontic techniques have been proposed for the correction of this defect. Treatment of scissor's bite with the help of cross. elastics between maxillary and mandibular molars may lead to extrusion of molars resulting in increased vertical dimension. Here, we are going to present management of two cases of scissor's bite with the help of modified transpalatal arch.

Effect of Oral Appliance for Snoring and Obstructive Sleep Apnea.

To analyze therapeutic and clinical efficacy of mandibular advancement device (MAD) on snoring and obstructive sleep apnea (OSA). Thirty patients with OSA were recruited on the basis ofpolysomnography with an Apnea and Hypopnea Index (AHI) greater than 5 but less than 30. Repeat polysomnography was performed in follow up with the appliance in place. MAD used in the study is Medical Dental Sleep Appliance (MDSA). It is a titratable appliance. With the appliance in position, the mandible was advanced to an extent that did not exceed 70% of maximum protrusion capacity; Vertical opening did not exceed on an average 3-4 mm beyond freeway space. Comparison of pre AHI scores (diagnostic PSG) with post AHI scores (PSG with OA in-situ) showed a decrease from Mean +/- SD 26.2367 +/- 6.53 to 13.7111 +/- 627. A highly significant (p < 0.001) improvement in AHI was observed. Pre and post ESS score showed a mean decrease from 14.2333 +/- 5.00 to 6.1481 +/- 2.46 MDSA is effective in reducing apnea hypopnea index scores and improving oxygen saturation level.

Unveiling the Success of Awake Insertion of Supraglottic Airway Device for Ventilation in the Bronchoscopic Management of Tracheal Stenosis.

Tracheal and subglottic stenoses are inflammatory conditions that can arise from a variety of potential etiologies, most commonly as a result of iatrogenic airway injury due to endotracheal intubation. Significant stenosis requires management by endoscopy or surgical resection. We describe a case of recurrent subglottic cuff stenosis with an episode of sudden desaturation in a 25-year-old female. The management involved balloon dilatation, laser ablation, and topical mitomycin C application through a flexible fiberoptic bronchoscope. Ensuring safe gas exchange during bronchoscopy was a priority, and this was achieved by maintaining ventilation with a supraglottic airway device, which was inserted in an awake patient after adequate tropicalization of the oral cavity. The intervention successfully helped in the management of stenosis and also addressed the complication of sudden complete airway collapse due to sedation.

VATS thoracic duct clipping in post-CABG with chylothorax.

Post-coronary artery bypass graft (CABG) surgery, chylothorax is a rare, but a serious, complication. We report a case of 49-year-old female who underwent CABG, and developed pleural effusion on post-operative day 2 which was milky in nature. Chylothorax was confirmed based on the biochemical analysis of the pleural fluid. As the medical line of management failed, video-assisted thoracoscopic surgery (VATS) was done and thoracic duct clipped on the right side. Close to the proximal portion of the left internal thoracic artery, disrupted tributaries of thoracic duct were noted and clipped. Rarity of the case and management is highlighted.

Multiple subtypes of coxsackievirus group B can cause congenital heart disease.

BACKGROUND: Different serotypes of coxsackievirus B (CVB), which is the most common cause of viral myocarditis, target cardiomyocytes through Coxsackie and Adenovirus Receptor and Decay-Accelerating Factor. Both receptors are expressed in the fetal heart. We hypothesized that infection with different serotypes of CVB during early pregnancy plays a role in pathogenesis of congenital heart defect (CHD). METHODS: In this study, we use a murine model to infect with CVB1, CVB4, and combination of CVB3 + CVB4 during a critical period in gestation. We examined offspring of pregnant mice for fetal death and heart defects following viral infection. RESULT: Fetuses from uninfected control dams showed normal heart development, while maternal CVB infection precipitates CHD: majorly ventricular septal defects (VSD) and non-compaction of ventricular myocardium (NC), with some infrequent cases of double outlet right ventricle, left ventricle wall rupture, right ventricle hypertrophy, and thickened/dysplastic semilunar valves. Infection of pregnant dams with CVB1 leads to 44% VSD and 41.2% NC cases, while with CVB4 leads to 31.7% VSD and 13.3% NC cases. Co-infection with CVB3 + CVB4 increases fetal pathology to 51.3% VSD and 41% NC cases. Infection can also result in fetal death, with higher incidences with CVB3 + CVB4 with 46.2% cases, compared to 33.3% by CVB1 and 21.7% by CVB4. Male fetuses were more susceptible to all phenotypes. CONCLUSION: Our report shows that prenatal CVB infections can lead to pathogenesis of certain heart defects in mouse model, particularly exacerbated with co-infections. This data confirms a link between prenatal CVB infection and CHD development and highlights it is not unique to just one serotype of CVB.

Effect of orthodontic retraction force on thick and thin gingival biotypes in different grades of gingival recession and alveolar bone quality: A finite element analysis.

INTRODUCTION: To evaluate the effect of orthodontic retraction force on thick and thin gingival biotypes of anterior teeth having grade I and II gingival recession with D1 and D2 alveolar bone densities by assessing the displacement of teeth and deformation in gingival tissue, along with evaluating the amount of equivalent stress on teeth and gingiva in finite element model. MATERIALS AND METHOD: Based on cone-beam computed tomography datasets, eight models (LC01-LC08) of maxilla with appliance assembly were created. A retraction load of 150 gm was applied on each model during the finite element analysis (FEA), and then values of teeth displacement, gingival deformation, and von Mises stress were evaluated. RESULT: All the models with D1 bone density (LC01-04) were showing gingival deformation, whereas models with D2 bone quality (LC05-08) give no significant outcome. The amount of von Mises stress for teeth and gingival tissue in each model was the same for both central and lateral incisors. CONCLUSION: All the models having D1 bone quality showed greater gingival deformation after applying retraction force, whereas in models with D2 bone density, deformation was not significant. Changes in gingival tissue are brought about by orthodontic treatment, which also helps to correct the periodontal defects; however, bone density plays a significant role in improving gingival recession.

Orthodontic-surgical management of severe skeletal class iii malocclusion: A case report.

Skeletal Class III malocclusion possess a difficult challenge to treat for clinicians. They are multifactorial and include genetic and environmental factors. Early intervention of Class III needs orthopedic correction, whereas, in adults, orthodontic camouflage can be done to treat mild cases while severe skeletal discrepancies demand orthognathic surgery along with orthodontic therapy. In this case report, a case of mandibular prognathism with Bilateral Sagittal Split Osteotomy (BSSO) setback was presented.

In vitro biocompatibility of polylactide and polybutylene succinate blends for urethral tissue engineering.

Surgical treatment of urothelial defects with autologous genital or extragenital tissue grafts is susceptible to complications. Tissue engineering utilizing novel biomaterials and cells such as human urothelial cells (hUC) for epithelial regeneration and adipose stromal cells (hASC) for smooth muscle restoration might offer new treatment options for urothelial defects. Previously, polylactide (PLA) has been studied for urethral tissue engineering, however, as such, it is too stiff and rigid for the application. Blending it with ductile polybutylene succinate (PBSu) could provide suitable mechanical properties for the application. Our aim was to study the morphology, viability and proliferation of hUC and hASC when cultured on 100/0 PLA/PBSu, 75/25 PLA/PBSu blend, 50/50 PLA/PBSu blend, and 0/100 PLA/PBSu discs. The results showed that the hUCs were viable and proliferated on all the studied materials. The hUCs stained pancytokeratin at 7 and 14 days, suggesting maintenance of the urothelial phenotype. The hASCs retained their viability and morphology and proliferated on all the other discs, except on PLA. On the PLA, the hASCs formed large aggregates with each other rather than attached to the material. The early smooth muscle cell markers SM22α and α-SMA were stained in hASC at 7 and 14 day time points on all PBSu-containing materials, indicating that hASCs maintain their smooth muscle differentiation potential also on PBSu. As a conclusion, PBSu is a highly potential biomaterial for urothelial tissue engineering since it supports growth and phenotypic maintenance of hUC and smooth muscle differentiation of hASC.

Evaluation of surface-modified orthodontic wires by different concentration and dipping duration of titanium oxide (TiO2) nanoparticles.

OBJECTIVE: To evaluate in-vitro surface characteristics and frictional properties of orthodontic stainless steel and beta-titanium archwires after surface modification with different concentrations and coating time of titanium oxide (TiO2) nanoparticles by Sol-gel dip coating method. MATERIALS AND METHODS: The experiment was carried out with 4 different concentrations (1:2, 1:4, 1:6, and 1:8) and three different dipping durations (24 hours, 48 hours, and 72 hours) over ten main test groups of SS and TMA archwires with uncoated wires acting as control in both dry and wet conditions. Phase analysis and surface characterization of TiO2 was analyzed by X-ray Diffractometry, surface evaluation with the help of scanning electron microscopy (SEM), and frictional characteristics were evaluated. RESULTS: Among all the concentrations 1:6 ratio with 48 hours of dipping duration showed better surface characteristics. A statistically significant difference in frictional coefficient was observed in both SS and TMA wires than their respective controls (p = 0.001). Intragroup comparison among SS and TMA groups showed that groups with 1:6 ratio and 48 hours dipping duration had least frictional coefficient in both dry and wet conditions (p = 0.001). Intergroup comparison between SS and TMA showed that SS group had significantly reduced friction than TMA (p = 0.001) except in few groups. CONCLUSION: TiO2 nanoparticle with a concentration ratio of 1:6 and 48 hours dipping duration is recommended for surface modification of orthodontic archwires.

Assessment of gingival biotype in different facial patterns: A cross-sectional study.

Objective: The aim of the present study is to evaluate the relationship of gingival biotype in different malocclusions. Methods: A total of 157 periodontally healthy subjects (88 males and 69 females) were enrolled in this cross-sectional study. The study participants were divided into three groups of skeletal class I, class II, and class III. The probe transparency method was used to determine the quality and gingival tissue into thick and thin biotype. Results: There was significant difference in gingival biotype among different skeletal malocclusion with high prevalence of thin gingival biotype in class I subjects and more prevalence of thick biotype in class II and class III individuals (P-value: 0.022). Pairwise comparison of gingival biotype in class I versus class II showed significant difference (P-value: 0.032); however in class I versus class III and class II versus class III, the test result was nonsignificant. The overall frequency of thin gingival biotype was significantly less in female subjects with respect to males (P-value: 0.025). Conclusion: A significant relationship is present between skeletal malocclusion and quality of gingival biotype. The prevalence of thick gingival biotype is found more in females as compared to male individuals. The thin gingival biotype is more commonly seen in skeletal class I than class II and class III.

A Real-World Perspective of Co-amoxiclav Prescription Pattern With Probiotics for Pediatric Patients With Respiratory Tract Infections: Results of Quantitative and Qualitative Approach in Indian Outpatient Settings.

BACKGROUND: Probiotics are co-prescribed with co-amoxiclav to prevent antibiotic-associated diarrhea (AAD). The study assesses the co-prescription pattern of probiotics with co-amoxiclav in pediatric patients with respiratory tract infections (RTIs). METHODS: This was a mixed methods research study with a retrospective study and a prospective survey. The retrospective part included a multicenter, observational, real-world study utilizing patients' electronic medical records for three years (2018-2020) from seven outpatient pediatric clinics and hospitals. The qualitative evaluation was performed with a predefined questionnaire. RESULTS: The patients having RTIs (N=984) were prescribed Clamp® (46.7%), CAA (23.8%), and CAM (29.5%). The mean age of the patients was 4.05 years, with 59.25% males and most patients having upper RTIs. Co-amoxiclav was prescribed twice daily for one to 15 days. A significantly lesser number of probiotic co-prescriptions were observed with Clamp® (19.57%) than with CAA (38.46%) and CAM (29.31%) at baseline (p<0.001). Similar findings were observed for follow-up visits one and two. Saccharomyces boulardii, Bacillus clausii,and lactic acid bacillus were the most commonly co-prescribed probiotics. The qualitative evaluation indicated that most clinicians were aware of the co-amoxiclav-related gastrointestinal side effects and the benefits of probiotics in preventing them. CONCLUSION: The frequency of co-prescriptions of probiotics with Clamp® among pediatric patients with RTIs was significantly less, potentially indicating better gastrointestinal tolerability.

Comparative analysis of proficiencies of various textures and geometric features in breast mass classification using k-nearest neighbor.

This paper introduces a comparative analysis of the proficiencies of various textures and geometric features in the diagnosis of breast masses on mammograms. An improved machine learning-based framework was developed for this study. The proposed system was tested using 106 full field digital mammography images from the INbreast dataset, containing a total of 115 breast mass lesions. The proficiencies of individual and various combinations of computed textures and geometric features were investigated by evaluating their contributions towards attaining higher classification accuracies. Four state-of-the-art filter-based feature selection algorithms (Relief-F, Pearson correlation coefficient, neighborhood component analysis, and term variance) were employed to select the top 20 most discriminative features. The Relief-F algorithm outperformed other feature selection algorithms in terms of classification results by reporting 85.2% accuracy, 82.0% sensitivity, and 88.0% specificity. A set of nine most discriminative features were then selected, out of the earlier mentioned 20 features obtained using Relief-F, as a result of further simulations. The classification performances of six state-of-the-art machine learning classifiers, namely k-nearest neighbor (k-NN), support vector machine, decision tree, Naive Bayes, random forest, and ensemble tree, were investigated, and the obtained results revealed that the best classification results (accuracy = 90.4%, sensitivity = 92.0%, specificity = 88.0%) were obtained for the k-NN classifier with the number of neighbors having k = 5 and squared inverse distance weight. The key findings include the identification of the nine most discriminative features, that is, FD26 (Fourier Descriptor), Euler number, solidity, mean, FD14, FD13, periodicity, skewness, and contrast out of a pool of 125 texture and geometric features. The proposed results revealed that the selected nine features can be used for the classification of breast masses in mammograms.