Isolated brachial artery aneurysm: a rare presentation of paediatric Behçet's disease.

Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.

Incidence and risk predictors analysis of adverse donor reactions in whole blood donation.

OBJECTIVE: Adverse donor reactions in normal healthy blood donors is not unusual. However, these unpleasant effects have a negative impact on donor retention. Adverse event due to blood donation is multifactorial in origin. Therefore, the objective of this study was to determine the frequency and type of adverse donor reactions during or after blood donation. More importantly, this study also aimed at analyzing important risk predictors of adverse donor reaction. MATERIAL AND METHODS: This was a retrospective study conducted from May 2017 to April 2019 in the department of Transfusion Medicine at a tertiary care center in eastern India. Data were stored in Microsoft excel 2016 by using a standardized format as per ISBT criteria and analyzed with software "R, version 3.5.3" to find out the various independent precipitating factor. RESULTS: Overall, 107 donors (0.98%) experienced adverse events with 10,814 whole blood donations. The first time, females, younger age donors (18-30 years), and donors with a mean arterial blood pressure of less than 90mm of Hg were the most important independent risk factors predicting the possibility of adverse donor reaction. Donors' weight, hemoglobin, and the type of donation had not affected the frequency of adverse events. CONCLUSION: Analysis of adverse donor reactions helps in selecting the blood donors who are at risk of donor reactions. Our study highlights the importance of proper predonation screening especially in terms of assessment of mean blood pressure, along with identification of first time and female blood donors in order to reduce untoward donor reaction.

Investigation of the genotoxic effects of fluoride on a bone tissue model.

Fluorides are thought to be a major cause of osteocarcinogenesis, due to their widespread industrial use, ability to accumulate in bone tissue, and genotoxic and probable carcinogenic properties. In vitro experiments investigating the genotoxic potential of fluorides in bone tissue models can provide valuable indirect information on their involvement in osteocarcinogenesis. Here, we investigated whether sodium fluoride (NaF) has the ability to induce DNA damage and chromosomal abnormalities in human osteosarcoma cells after 48 and 72 h of exposure. The cell cultures were treated with NaF in concentrations of 0, 20, 100 and 200 µg/ml. The level of DNA damage was assessed by the comet assay, and the frequency of chromosomal abnormalities by a micronucleus test. A significant increase in DNA damage indicators was noted in the samples treated with fluoride concentrations of 100 and 200 µg/ml, after 48 and 72 h of exposure. The micronucleus test revealed a dose-dependent increase in cells with micronuclei, nucleoplasmic bridges and nuclear protrusions. Increasing the concentration of NaF led to an increase in the prevalence of cytogenetic indicators after both treatment durations. This demonstrated ability of fluorine to exert genotoxic effects on bone cells indirectly indicates the possible importance of fluoride in the aetiology of osteosarcoma.

Deep venous thrombosis manifestation of common femoral vein leiomyoma.

Deep vein thrombosis is a common clinical condition, with well-known risk factors. An unusual case of venous leiomyoma manifesting as a deep vein thrombosis in the left femoral vein of a 55-year-old man was managed successfully at our institution with anticoagulation, en-bloc excision and reconstruction of the femoral vein with spiral vein graft.

CT based measurement of anatomical dimensions of femur and its relevance in nail designs for proximal femoral fractures.

INTRODUCTION: The purpose of this study was to obtain computed tomography (CT) based measurements of femoral dimensions in adults, to identify its relevance with intramedullary nails used in the management of proximal femur fractures and to suggest a best fitting implant dimensions to our population. To best of our knowledge our study would be first to compile different CT based dimension in single study. METHODS: In our retrospective study of 50 femurs, CT based femoral dimensions measured in standardized cuts and compared with previous studies and commonly available proximal femur intramedullary devices. RESULTS: 68.4 was the mean age in our study, neck shaft angle (NSA) was 127.2±5.20, anteversion 11.2±7.40, endosteal isthmus diameter was 11.9 ± 1.7 mm, anterior radius of curvature (ROC) was 116.8 ± 20 mm, horizontal femoral offset 37.5 ± 4.6 mm, medio-lateral angle 7.8±1.60, with good inter and intra observer correlation. Femoral length and neck width was positively correlated to head diameter, horizontal femoral offset with medio-lateral (ML) angle. One of the 50 femur studied had the parameters in the range of available implant and could match appropriately. CONCLUSION: CT based dimensions in our population is different from other population. Based on this study, a design modification of nails used in present day management of proximal femur fractures has been recommended.

Establishing scald prevention measures in UK maternity units from takeaway drinks.

AIM: To identify policies on the consumption of hot drinks by patients and visitors on all perinatal and postnatal wards in the United Kingdom, and to seek the opinions of members of the wider burns MDT as to whether standardised patient education or regulation of hot drinks around newborn babies is required. METHODS: All maternity units with postnatal wards across the United Kingdom were surveyed to establish availability of hot drinks on site and whether these were permitted on postnatal wards around infants. An online questionnaire was distributed to members of the British Burn Association to ascertain opinions on hot drinks policies. RESULTS: Hot takeaway drinks were permitted around newborn infants in 194 of surveyed postnatal wards and were only banned by two units. The online survey received 49 responses from different members of the British Burn Association. Thirty responders (61%) supported a takeaway hot drink ban, while those against the policy would alternatively encourage patient education, dedicated drinking areas and introduction of safety measures. CONCLUSIONS: Almost every postnatal unit in the UK has access to hot drink retailers on site allowing parents and visitors to bring them into close contact with babies. With varying local regulations, this poses potentially serious consequences during feeding or carrying. We propose a standardised antenatal education be made available, together with standardised designated areas on wards for parents and visitors to consume hot drinks away from infants.

The value of peer support for self-management of diabetes among veterans in the Empowering Patients In Chronic care intervention.

AIM: To examine the value of peer support in the self-management of diabetes among veterans in an integrated health care system. METHODS: We conducted semi-structured in-depth interviews with veterans and clinicians 6 months after their participation in Empowering Patients in Chronic Care (EPIC), a group-based diabetes intervention with a peer-support component. Interviews elicited clinicians' narratives of how peer support unfolded in the groups and veterans' experiences of giving and receiving support from their peers. Data analysis was guided by principles of framework analysis using Heisler's peer-support model. RESULTS: Findings support Heisler's peer-support model and provide evidence supporting professional-led group visits with peer exchange. Clinicians and veterans endorsed informational and emotional support received in EPIC groups. Clinicians often referred to EPIC as an open forum or a support group where veterans could both give and receive help. Veterans noted the benefits of shared problem-solving and the support they received. Clinicians and veterans perceived the peer-support component of EPIC as facilitating increased empowerment in terms of self-efficacy, increased perceived social support and increased understanding of self-care. Ultimately, many veterans acknowledged that their participation in EPIC facilitated improved health-related quality of life, improved health behaviours and improved chronic disease control. CONCLUSIONS: Findings emphasize the value of peer support in managing chronic illness. Peer-support programmes may address veterans' unique challenges and have the potential to improve physical and mental health.

Enhanced all-optical cavity-tuning using graphene.

All-optical tuning of the resonance of an optical cavity is used to realise optical signal-processing including modulation, switching, and signal-routing. The tuning of optical resonance is dictated by the two primary effects induced by optical absorption: charge-carrier-generation and heat-generation. Since these two effects shift the resonance in opposite directions in a pure silicon-on-insulator (SOI) micro-ring resonator as well as in a graphene-on-SOI system, the efficiency and the dynamic range of all-optical resonance-tuning is limited. In this work, in a graphene-oxide-silicon waveguide system, we demonstrate an exceptional resonance-tuning-efficiency of 300 p m/m W (0.055 π/m W), with a large dynamic range of 1.2 n m (0.22 π) from linear resonance to optical bistability. The dynamics of the resonance-tuning indicates that the superior resonance-tuning is due to large linear-absorption-induced thermo-optic effect. Competing free-carrier dispersion is suppressed as a result of the large separation between graphene and the silicon core. This work reveals new ways to improve the performance of graphene-on-waveguide systems in all-optical cavity-tuning, low-frequency all-optical modulation, and switching.

Temperature dissociation of liquids in reusable thermoplastic containers-An eco-friendly scald risk?

Recent global concern regarding the impact of plastic waste on the environment has resulted in efforts to utilise reusable drink containers. Research is lacking regarding temperature dissociation of drinks in reusable thermoplastic cups. This study aimed to compare the cooling time of two common hot drinks sold at a UK retailer, in the three vessels they are sold; ceramic, disposable paper (with and without lid) and reusable thermoplastic cups (with and without lid). All temperatures were collated from 250 ml volumes of black Americano coffee or café latte in the three different containers. The cooling time was measured every sixty seconds using a standardised digital thermocouple thermometer until a threshold liquid temperature of 43 °C was reached. All experiments were performed in triplicate and temperatures converted to a dimensionless logarithmic scale prior to statistical analysis. Cooling time was significantly slower for lidded cups irrespective of material. Unlidded thermoplastic cups significantly slowed cooling times for both black Americano coffee and café latte compared to ceramic and unlidded disposable paper cups. The growing trend in reusable cups does not in itself pose an increased risk of scald injury. However, we consider that the potentially increased ambulatory behaviour associated with using a lidded rather than unlidded cup may increase scald risk. We propose that further consumer guidance should be disseminated regarding the use of any lidded takeaway container to prevent scalds in both adults and children.

Gate Tunable Cooperativity between Vibrational Modes.

Coupling between a mechanical resonator and optical cavities, microwave resonators, or other mechanical resonators have been used to observe interesting effects from sideband cooling to coherent manipulation of phonons. Here we demonstrate strong coupling between different vibrational modes of MoS2 drum resonators at room temperature. We observe intermodal as well as intramodal coupling. Cooperativity, a measure of coupling between the two modes, can be tuned by more than an order of magnitude by changing the direct current gate bias. The large measured cooperativity of about 900 at room temperature indicates that the phonon population can be coherently transferred between the modes for more than 500 cycles. This coherent oscillation is of great interest in studying quantum effects in macroscopic objects.

Acquired diaphragmatic hernia in a preterm low birth weight neonate.

Iatrogenic diaphragmatic hernia is rare in children and we report a preterm low birth weight neonate with a presumably acquired diaphragmatic hernia due to trauma caused by treatment following pneumothorax.

The effect of strain on effective Duffing nonlinearity in the CVD-MoS2 resonator.

We demonstrate all electrical measurements on NEMS devices fabricated using CVD grown monolayer MoS2. The as-grown monolayer film of MoS2 on top of the SiO2/Si wafer is processed to fabricate arrays and individual NEMS devices without the complex pick and transfer techniques associated with graphene. The electromechanical properties of the devices are on par with those fabricated using the exfoliation method. The frequency response of these devices is then used as a probe to estimate the linear thermal expansion coefficient of the material and evaluate the effect of strain on the effective Duffing nonlinearity in the devices.

Carbon-nanotube-on-waveguide thermo-optic tuners.

We demonstrate on-waveguide thermo-optic tuners based on solution-processed metallic carbon nanotubes (CNTs) on silicon-on-insulator (SOI) and silicon nitride (SiN) microring resonators operating around 1550 nm. On SOI microring resonators using planarized wire waveguides, a thermo-optic power efficiency of 29 mW/FSR and a thermal transient of 1.3 µs are achieved. The heater is shown to be more power-efficient than conventional metal heaters and has lower thermal transient than both metal heaters and graphene-based heaters. On SiN microring resonators using rib waveguides, improvement in power efficiency with an increase in coverage of CNTs is demonstrated, indicating localized heating using the CNTs; this is favorable for low thermal cross-talk. An optimal power efficiency of 142 mW/FSR and a thermal transient of 5.8 µs are achieved.

Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: A retrospective analysis of integrated registry and pharmacy claims data.

While guidelines support metformin as a therapeutic option for diabetic patients with mild-to-moderate renal insufficiency, the frequency and outcomes of metformin use in kidney transplant recipients are not well described. We integrated national U.S. transplant registry data with records from a large pharmaceutical claims clearinghouse (2008-2015). Associations (adjusted hazard ratio, 95% LCL aHR95% UCL ) of diabetes regimens (with and excluding metformin) in the first year post-transplant with patient and graft survival over the subsequent year were quantified by multivariate Cox regression, adjusted for recipient, donor, and transplant factors and propensity for metformin use. Among 14 144 recipients with pretransplant type 2 diabetes mellitus, 4.7% filled metformin in the first year post-transplant; most also received diabetes comedications. Compared to those who received insulin-based regimens without metformin, patients who received metformin were more likely to be female, have higher estimated glomerular filtration rates, and have undergone transplant more recently. Metformin-based regimens were associated with significantly lower adjusted all-cause (aHR 0.18 0.410.91 ), malignancy-related (aHR 0.45 0.450.99 ), and infection-related (aHR 0.12 0.320.85 ) mortality, and nonsignificant trends toward lower cardiovascular mortality, graft failure, and acute rejection. No evidence of increased adverse graft or patient outcomes was noted. Use of metformin-based diabetes treatment regimens may be safe in carefully selected kidney transplant recipients.

The impact of direct-acting antiviral agents on liver and kidney transplant costs and outcomes.

Direct-acting antiviral medications (DAAs) have revolutionized care for hepatitis C positive (HCV+) liver (LT) and kidney (KT) transplant recipients. Scientific Registry of Transplant Recipients registry data were integrated with national pharmaceutical claims (2007-2016) to identify HCV treatments before January 2014 (pre-DAA) and after (post-DAA), stratified by donor (D) and recipient (R) serostatus and payer. Pre-DAA, 18% of HCV+ LT recipients were treated within 3 years and without differences by donor serostatus or payer. Post-DAA, only 6% of D-/R+ recipients, 19.8% of D+/R+ recipients with public insurance, and 11.3% with private insurance were treated within 3 years (P < .0001). LT recipients treated for HCV pre-DAA experienced higher rates of graft loss (adjusted hazard ratio [aHR] 1.34 1.852.10 , P < .0001) and death (aHR 1.47 1.681.91 , P < .0001). Post-DAA, HCV treatment was not associated with death (aHR 0.34 0.671.32 , P = .25) or graft failure (aHR 0.32 0.641.26 , P = .20) in D+R+ LT recipients. Treatment increased in D+R+ KT recipients (5.5% pre-DAA vs 12.9% post-DAA), but did not differ by payer status. DAAs reduced the risk of death after D+/R+ KT by 57% (0.19 0.430.95 , P = .04) and graft loss by 46% (0.27 0.541.07 , P = .08). HCV treatment with DAAs appears to improve HCV+ LT and KT outcomes; however, access to these medications appears limited in both LT and KT recipients.

Prescription opioid use before and after kidney transplant: Implications for posttransplant outcomes.

Evolving literature suggests that the epidemic of prescription opioid use affects the transplant population. We examined a novel database wherein national U.S. transplant registry records were linked to a large pharmaceutical claims warehouse (2007-2015) to characterize prescription opioid use before and after kidney transplant, and associations (adjusted hazard ratio, 95%LCL aHR95%UCL ) with death and graft loss. Among 75 430 eligible patients, 43.1% filled opioids in the year before transplant. Use was more common among recipients who were women, white, unemployed, publicly insured, and with longer pretransplant dialysis. Of those with the highest level of pretransplant opioid use, 60% continued high-level use posttransplant. Pretransplant opioid use had graded associations with one-year posttransplant outcomes; the highest-level use predicted 46% increased risk of death (aHR 1.28 1.461.66 ) and 28% increased risk of all-cause graft failure (aHR 1.17 1.281.41 ). Effects of high-level opioid use in the first year after transplant were stronger, predicting twice the risk of death (aHR 1.93 2.242.60 ) and 68% higher all-cause graft failure risk (aHR 1.50 1.681.89 ) over the subsequent year; increased risk persisted over five years. While associations may, in part, reflect underlying conditions or behaviors, opioid use history is relevant in assessing and providing care to transplant candidates and recipients.

On-chip optical transduction scheme for graphene nano-electro-mechanical systems in silicon-photonic platform.

We present a scheme for on-chip optical transduction of strain and displacement of graphene-based nano-electro-mechanical systems (NEMS). A detailed numerical study on the feasibility of three silicon-photonic integrated circuit configurations is presented: the Mach-Zehnder interferometer (MZI), the micro-ring resonator, and the ring-loaded MZI. An index sensing based technique using an MZI loaded with a ring resonator with a moderate Q-factor of 2400 can yield a sensitivity of 28 fm/Hz and 6.5×10-6%/Hz for displacement and strain, respectively. Though any phase-sensitive integrated-photonic device could be used for optical transduction, here we show that optimal sensitivity is achievable by combining resonance with phase sensitivity.

Parametric amplification in MoS2 drum resonator.

Parametric amplification is widely used in diverse areas from optics to electronic circuits to enhance low level signals by varying relevant system parameters. Parametric amplification has also been performed in several micro-nano resonators including nano-electromechanical system (NEMS) resonators based on a two-dimensional (2D) material. Here, we report the enhancement of mechanical response in a MoS2 drum resonator using degenerate parametric amplification. We use parametric pumping to modulate the spring constant of the MoS2 resonator and achieve a 10 dB amplitude gain. We also demonstrate quality factor enhancement in the resonator with parametric amplification. We investigate the effect of cubic nonlinearity on parametric amplification and show that it limits the gain of the mechanical resonator. Amplifying ultra-small displacements at room temperature and understanding the limitations of the amplification in these devices is key for using these devices for practical applications.

Under-utilization of pacemaker therapy for sinus node dysfunction - Real world data from South Asia.

OBJECTIVE: Chronic symptomatic sinus node dysfunction (SND), the most common bradyarrhythmia, can be effectively managed by permanent cardiac pacing. Yet the care pathway and barriers to adoption of pacing therapy are not well understood - particularly in low volume implanting countries. The IMPROVE Brady study is a quality improvement initiative being conducted at centers in South Asia, Latin America, and Russia. We assessed the rates of SND diagnosis and pacemaker treatment for SND in the South Asia cohort. METHODS: The prospective study enrolled patients with heart rate of ≤50 beats per minute presenting with symptoms including syncope, dizziness, and/or dyspnea from ten centers in India and Bangladesh. Patients were followed to identify the proportion diagnosed with SND and subsequently treated with pacemaker therapy. RESULTS: A total of 508 patients meeting criteria were enrolled and followed on average for 8.3±8.0months. Patients were on average 58 years of age, 77% were male, and 91% had completed at least primary education. An SND diagnosis was made in 368 (72%) of patients, with the majority (80%) of diagnoses occurring within 1 month of enrollment. Of the patients with an SND diagnosis, 63 (17%) were treated with a pacemaker. Reasons for not receiving treatment were: subject refusal or deferred decision (45%), unaffordability (34%), physician determined - not-indicated (20%), and other (1%). Older age, female gender, history of hypertension, lower resting heart rate, and syncopal or pre-syncopal symptoms were associated with a higher probability of implant. CONCLUSIONS: In a care pathway assessment for the diagnosis and treatment of symptomatic SND in South Asia only 1 in 6 patients received pacemaker indicated therapy, largely due to patient refusal and physician decision. Phase II of the study will be aimed to improve this treatment rate.