Bio-net dataset: AI-based diagnostic solutions using peripheral blood smear images.

Peripheral blood smear examination is one of the basic steps in the evaluation of different blood cells. It is a confirmatory step after an automated complete blood count analysis. Manual microscopy is time-consuming and requires professional laboratory expertise. Therefore, the turn-around time for peripheral smear in a health care center is approximately 3-4 hours. To avoid the traditional method of manual counting under the microscope a computerized automation of peripheral blood smear examination has been adopted, which is a challenging task in medical diagnostics. In recent times, deep learning techniques have overcome the challenges associated with human microscopic evaluation of peripheral smears and this has led to reduced cost and precise diagnosis. However, their application can be significantly improved by the availability of annotated datasets. This study presents a large customized annotated blood cell dataset (named the Bio-Net dataset from healthy individuals) and blood cell detection and counting in the peripheral blood smear images. A mini-version of the dataset for specialized WBC-based image processing tasks is also equipped to classify the healthy and mature WBCs in their respective classes. An object detection algorithm called You Only Look Once (YOLO) with a refashion disposition has been trained on the novel dataset to automatically detect and classify blood cells into RBCs, WBCs, and platelets and compare the results with other publicly available datasets to highlight the versatility. In short the introduction of the Bio-Net dataset and AI-powered detection and counting offers a significant potential for advancement in biomedical research for analyzing and understanding biological data.

A highly efficient broadband multi-functional metaplate.

Due to the considerable potential of ultra-compact and highly integrated meta-optics, multi-functional metasurfaces have attracted great attention. The mergence of nanoimprinting and holography is one of the fascinating study areas for image display and information masking in meta-devices. However, existing methods rely on layering and enclosing, where many resonators combine various functions effectively at the expense of efficiency, design complication, and complex fabrication. To overcome these limitations, a novel technique for a tri-operational metasurface has been suggested by merging PB phase-based helicity-multiplexing and Malus's law of intensity modulation. To the best of our knowledge, this technique resolves the extreme-mapping issue in a single-sized scheme without increasing the complexity of the nanostructures. For proof of concept, a multi-functional metasurface built of single-sized zinc sulfide (ZnS) nanobricks is developed to demonstrate the viability of simultaneous control of near and far-field operations. The proposed metasurface successfully verifies the implementation of a multi-functional design strategy with conventional single-resonator geometry by reproducing two high-fidelity images in the far field and projecting one nanoimprinting image in the near field. This makes the proposed information multiplexing technique a potential candidate for many high-end and multi-fold optical storage, information-switching, and anti-counterfeiting applications.

Broad-Band Polarization-Insensitive Metasurface Holography with a Single-Phase Map.

The remarkable potential of metasurface holography promises revolutionary advancements for imaging, chip-integrated augmented/virtual reality (AR/VR) technology, and flat optical displays. The choice of constituent element geometry constrains many potential applications purveyed through polarization-independent optical response. The limited capabilities and degree of freedoms in commonly used meta-atoms restrict the design flexibility to break the conventional trade-off between polarization-insensitivity and bandwidth. Here, we propose a geometric phase-enabled novel design strategy to break this conventional trade-off. The proposed strategy ensures the realization of broad-band polarization-insensitivity through a simplified design procedure. An identical output wavefront manipulation is achieved by adjusting the phase delay freedom of geometric phase engineering under different incident polarization conditions. For proof of concept, a metahologram device is fabricated by an optimized complementary metal-oxide-semiconductor (CMOS)-compatible material of hydrogenated amorphous silicon (a-Si:H). This metahologram device reproduces the required hologram with high image fidelity and efficiency under different polarization scenarios of white light incidence. Due to the simple design strategy, low computational cost, and easy fabrication, the proposed technique can be an excellent candidate for realizing polarization-insensitive metahologram devices.

Aorto-iliac peripheral artery disease.

Aorto-iliac disease is a common manifestation of atherosclerosis. Individuals with this condition are at heightened cardiovascular risk, and may have limb symptoms ranging from claudication to limb-threatening ischemia. A regimen of medical therapy, risk factor modification, and exercise is first line therapy. Revascularization is reserved for individuals with lifestyle-limiting claudication despite conservative therapy and in those with chronic limb-threatening ischemia. Multiple endovascular therapies are now available that enable even the most complex aorto-iliac lesions to be approached and treated with safe and durable results.

TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Clinical Trial.

OBJECTIVES: This study was a sham-controlled, double-blind, randomized clinical trial to examine the effect of chronic low level tragus stimulation (LLTS) in patients with paroxysmal AF. BACKGROUND: Low-level transcutaneous electrical stimulation of the auricular branch of the vagus nerve at the tragus (LLTS) acutely suppresses atrial fibrillation (AF) in humans, but the chronic effect remains unknown. METHODS: LLTS (20 Hz, 1 mA below the discomfort threshold) was delivered using an ear clip attached to the tragus (active arm) (n = 26) or the ear lobe (sham control arm) (n = 27) for 1 h daily over 6 months. AF burden over 2-week periods was assessed by noninvasive continuous electrocardiogram monitoring at baseline, 3 months, and 6 months. Five-minute electrocardiography and serum were obtained at each visit to measure heart rate variability and inflammatory cytokines, respectively. RESULTS: Baseline characteristics were balanced between the 2 groups. Adherence to the stimulation protocol (≤4 sessions lost per month) was 75% in the active arm and 83% in the control arm (p > 0.05). At 6 months, the median AF burden was 85% lower in the active arm compared with the control arm (ratio of medians: 0.15; 95% confidence interval: 0.03 to 0.65; p = 0.011). Tumor necrosis factor-alpha was significantly decreased by 23% in the active group relative to the control group (ratio of medians: 0.77; 95% confidence interval: 0.63 to 0.94; p = 0.0093). Frequency domain indices of heart rate variability were significantly altered with active versus control stimulation (p < 0.01). No device-related side effects were observed. CONCLUSIONS: Chronic, intermittent LLTS resulted in lower AF burden than did sham control stimulation, supporting its use to treat paroxysmal AF in selected patients. (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation [TREAT-AF]; NCT02548754).

Left Atrial Size May Predict Blood Pressure Improvement After Ganglionated Plexi Ablation in Addition to Pulmonary Vein Isolation.

BACKGROUND: Hypertension (HTN) and atrial fibrillation (AF) commonly co-exist. An improvement in control of HTN in a subset of patients undergoing AF ablation was previously demonstrated by our group. In the present study, we aimed to assess whether left atrial (LA) size based on transthoracic echocardiography may predict the patients who demonstratebetter HTN improvement after ganglionated plexus ablation (GPA) in addition to pulmonary vein isolation (PVI). METHODS: This was a retrospective chart review of patients with AF and HTN who underwent GPA+PVI. Patients were divided into 2 groupsbased on LA size: Patients with normal LA size and patients with LA enlargement. Systolic blood pressure (SBP) levelswere compared at baseline, and 3, 6, and 12 months post-ablation. The primary endpoints of the study weremean systolic blood pressure change compared between groups from baseline to 12-months, as well as the absolute difference in systolic blood pressure at 12 months follow-up.Medical therapy for HTN was also assessed before the procedure, and at 12 months post-procedure. RESULTS: 53 patients (37 with LA enlargement, 16 with normal LA size) met inclusion criteria. At 12 months follow-up, SBP was 136.46 ± 22.38 mmHg in patients with LA enlargementand 118.25 ± 9.81 mmHg in patients with normal LA size (estimated difference of 19.04 ± 6.98 mmHg, p = 0.01). Patients with normal LA size were on significantly fewer anti-hypertensive agents at 12 months (2.33 ± 1.49 vs. 1.44 ± 1.21, p < 0.05). CONCLUSIONS: In patients undergoing PVI+GP ablation, normal LA size may predict HTN improvement at 12 months post-procedure. Normal LA size may identify hypertensive AF patients for whom autonomic modulation could be an effective therapy.

"Tear Drops in the Duodenum": Uncommon Cause of Iron Deficiency Anemia in Adults.

A 64-year-old man presented to the internal medicine resident clinic with fatigue and abdominal pain of six-month duration. He did not have diarrhea, hematemesis, melena, or hematochezia. Physical examination was unremarkable. Laboratory findings were consistent with iron deficiency anemia. Upper and lower gastrointestinal (GI) endoscopies revealed normal findings. Duodenal biopsy showed trophozoites (tear-drop-shaped) morphologically consistent with Giardia duodenalis. He was prescribed metronidazole and iron replacement therapy, with a resultant improvement in symptoms as well as lab values at the four-month follow-up visit.

Metastatic Pleural Effusion: An Unusual Presentation of Urothelial Bladder Carcinoma.

Pleural effusions are frequently encountered in clinical practice. In the United States, malignancy is the third leading cause of pleural effusion after heart failure and pneumonia. The most common cause of malignant pleural effusion (MPE) is lung cancer, followed by breast cancer, lymphoma, and mesothelioma. Genitourinary cancers rarely metastasize to the pleura. Although several atypical patterns of thoracic metastasis from genitourinary cancers have been described in the literature, genitourinary cancers rarely give rise to MPEs. We describe a case where the workup of a unilateral pleural effusion led to the diagnosis of high-grade urothelial bladder carcinoma.

Obesity is associated with incident atrial fibrillation independent of gender: A meta-analysis.

BACKGROUND: The prevalence of obesity is increasing among the general population. Obesity is associated with increased risk of several cardiovascular conditions, which in turn may increase the risk for atrial fibrillation (AF). We performed a meta-analysis of cohort studies that examined the effect of obesity on the incidence of AF. In addition, we examined the effect of obesity on the incidence of AF stratified by gender. METHODS AND RESULTS: We searched the MEDLINE and EMBASE databases for studies evaluating the effect of obesity on AF. Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random effects model. Sixteen trials involving 587,372 subjects were included in the analysis. Obesity was defined as body mass index >30 kg/m2 . AF during follow-up developed in 5,751 of 91,031 (6.3%) obese subjects and in 15,346 of 496,341 (3.1%) nonobese subjects (RR = 1.51, 95% CI 1.35 to 1.68; P < 0.00001). Based on the pooled estimate across the studies, the effect of obesity on incident AF was similar in men (RR = 1.41, 95% 1.24 to 1.62; P < 0.00001) and women (RR = 1.53, 95% CI 1.19 to 1.97; P < 0.00001). CONCLUSION: Obesity is associated with an increased risk of new-onset AF in susceptible individuals. This effect appears to be consistent in both genders. Further studies are warranted to examine the impact of weight loss interventions on the risk of developing AF.