Quantum interferometry and pathway selectivity in the nonlinear response of photosynthetic excitons.

We propose a time-frequency resolved spectroscopic technique which employs nonlinear interferometers to study exciton-exciton scattering in molecular aggregates. A higher degree of control over the contributing Liouville pathways is obtained as compared to classical light. We show how the nonlinear response can be isolated from the orders-of-magnitude stronger linear background by either phase matching or polarization filtering. Both arise due to averaging the signal over a large number of noninteracting, randomly oriented molecules. We apply our technique to the Frenkel exciton model which excludes charge separation for the photosystem II reaction center. We show how the sum of the entangled photon frequencies can be used to select two-exciton resonances, while their delay times reveal the single-exciton levels involved in the optical process.

Prolonged consumption of grass pea (64 g/Cu/day) along with millets and other cereals causes no neurolathyrism.

Objective: To assess the safe limit of L. sativus (grass pea) consumption along with cereals and millets.Methods: A community-based cross-sectional study was undertaken in three districts (Bilaspur, Durg and Raipur) of Chhattisgarh state. A total of 1500 households (HHs) were surveyed. A total of 360 split grass pea (SGP) samples were collected from all three districts for ?-ODAP analysis. Clinical examination was carried out for symptoms of neurolathyrism. Diet survey was done on 5769 HHs by 24hr recall method. Mean intake of different foods and nutrients were calculated. Based on food frequency questionnaire, HHs were separated into daily consumers of SGP along with its quantity consumed and that never consumed SGP.Results: The study revealed that 30 daily consuming and 89 never consuming HHs, in all the three districts. Daily SGP was consumed at an average of 64 g/Cu/day along with millets, cereals and vegetables. Whereas among the never consumers of SGP, mean intake of vegetables was higher than recommended intakes in addition to pulses. The average ?-ODAP content in SGP was 0.630 g%. The nutritional status of children <5 years and the adults was not significantly different between the daily SGP consumers and never consumers. Households in all the three districts, who consumed the SGP recipes, followed the method of washing, boiling, draining the excess water and cooking the pulse.Discussion: There were no adverse effects observed among daily consumers of grass pea (64 g/CU/day) along with millets, cereals and vegetables.

Bronchial rupture following endobronchial blocker placement: a case report of a rare, unfortunate complication.

BACKGROUND: Lung separation may be achieved through the use of double lumen tubes or endobronchial blockers. The use of lung separation techniques carries the risk of airway injuries which range from minor complications like postoperative hoarseness and sore throat to rare and potentially devastating tracheobronchial mucosal injuries like bronchus perforation or rupture. With few case reports to date, bronchial rupture with the use of endobronchial blockers is indeed an overlooked complication. CASE PRESENTATION: A 78-year-old male patient with a left upper lobe lung adenocarcinoma underwent a left upper lobectomy with a Fuji Uniblocker® as the lung separation device. Despite an atraumatic insertion and endobronchial blocker balloon volume within manufacturer specifications, an intraoperative air leak developed, and the patient was found to have sustained a left mainstem bronchus rupture which was successfully repaired and the patient extubated uneventfully. Unfortunately, the patient passed on in-hospital from sepsis and other complications. CONCLUSION: Bronchial rupture is a serious complication of endobronchial blocker use that can carry significant morbidity, and due care should be exercised in its use and placement. Bronchoscopy should be used during insertion, and the volume and pressure of the balloon kept to the minimum required to prevent air leak. Bronchial injury should be considered as a differential in the presence of an unexplained air leak.

Rescue extracorporeal membrane oxygenation for massive anterior mediastinal masses.

The management of massive anterior mediastinal masses (AMM) is challenging. With the burgeoning role of extracorporeal membrane oxygenation support (ECMO) beyond the confines of salvage therapy, more trained clinicians are adopting it as a bridge for high-risk procedures or situations where temporary respiratory or cardiac support is required. We report our experience with using ECMO in the management of massive AMM in this case series of three patients sharing their clinical details and the lessons learned from them.

The next big thing for silicon nanostructures - CO2 photocatalysis.

Silicene is a relatively new member of the growing family of two-dimensional single-element materials. Both top-down and bottom-up approaches provide access to silicene, the former via vapor deposition on a substrate and the latter via exfoliation of the layered CaSi2 precursor. Most top-down research has been concerned with understanding the various electronic, optical, magnetic, mechanical, electrical, thermal transport and gas-adsorption properties of silicene. By contrast, the focus on bottom-up silicene has primarily been on its synthesis, structure and chemical properties as they relate to its function and utility. Herein, emphasis is placed on the bottom-up strategy because of its scalability and the ease of subsequent silicene modification, with both qualities being important prerequisites for heterogeneous catalysis applications. In this context, synthetic freestanding silicene exists as single sheets or multilayer assemblies, depending on the CaSi2 exfoliation synthesis conditions. The structure of a sheet comprises three connected chair-configuration silicon 6-rings. This connectivity creates buckled sheets in which the hybridization around the unsaturated silicon atoms is sp2-sp3. By adjusting the CaSi2 exfoliation synthesis conditions, either layered silane (Si6H6) or siloxene (Si6H3(OH)3) nanosheets can be obtained. In our studies, we have explored the nucleation and growth of different transition metal nanoparticles on and within the layer spaces of these nanosheets, and explored their thermochemical and photochemical reactivity in CO2 hydrogenation reactions. An overview of these findings, related works and a new-and-optimized catalyst are provided in this article.

Thyrotoxic periodic paralysis: A retrospective, observational study from India.

Background & objectives: Thyrotoxic periodic paralysis (TPP) is an endocrine emergency presenting with acute-onset flaccid paralysis in a patient having thyrotoxicosis accompanied by hypokalaemia. This study was conducted to evaluate the clinical profile of patients with TPP presenting to three centres in India. Methods: This retrospective, observational study was conducted at three tertiary care Armed Forces medical centres, located at Lucknow, Kolkata and Delhi. The history, clinical features, treatment details and outcomes were evaluated. Results: Of the 244 patients with thyrotoxicosis, 15 were diagnosed with TPP and included in the study. These 15 patients (14 male and 1 female) had 32 episodes of TPP which were analyzed. The mean age was 30.2±6.2 yr (range: 21-39), and overt thyrotoxicosis was seen in all patients except one who had subclinical hyperthyroidism. Graves' disease was the most common cause of thyrotoxicosis (13/15) and the remaining two patients had subacute thyroiditis and gestational thyrotoxicosis. Hypokalaemia (serum potassium <3.5 mmol/l) was seen in 12 patients, and the mean serum potassium was 3.2±0.9 mmol/l (range: 2.1-4.9). All patients had flaccid weakness, predominantly involving the lower limb with no bulbar, respiratory or cranial nerve involvement. The average duration of paralysis was 10.6±5.7 h (range: 3-28 h). Interpretation & conclusions: Our study demonstrated an early age of presentation and presence of clinical and biochemical thyrotoxicosis in majority of patients with TPP. Hypokalaemia may not always be evident in patients with TPP.

The good, the bad, and the ugly facets of insulin resistance.

Insulin is a potent anabolic hormone, and binding to its receptor activates downstream intracellular signaling pathways that regulate the nutrient metabolism, fluid homeostasis, growth, ionic transport, maintenance of vascular tone, and other functions. Insulin resistance (IR) is a condition characterized by subnormal cellular response to physiological levels of insulin. The IR is divided into three types (prereceptor, receptor, and postreceptor) based on the site of pathology. Beta cells attempt to overcome the IR by increasing the release of insulin, leading to hyperinsulinemia. IR is the predisposing factor for many metabolic and cardiovascular disorders. From the evolutionary perspective, the presence of IR offers a survival advantage in the face of starvation or stress. In this brief review, we discuss the different facets of insulin resistance and appraise the readers about the hitherto neglected beneficial advantages.

Spontaneous Light Emission from Molecular Junctions: Theoretical Analysis of Upconversion Signal.

Spontaneous light emission from a current-carrying molecular junction is analyzed. There are two leading processes, fluorescence and electroluminescence, as defined using Liouville space diagrams within the perturbative method, that contribute to the light emission from junctions. This allows us to identify a general mechanism that explains the origin of the so-called upconversion electroluminescence (UCEL) signal, which has been observed in a variety of molecular junctions [Umera et al. Chem. Phys. Lett. 2007, 448, 232; Dong et al. Nat. Photonics 2010, 4, 50]. Here, we show that a double-peak signal, one at energy less than the applied bias and the other at higher energy (UCEL), is generated due to overlap between two processes: one is electron transfer to create the required excited state, and the other is radiative relaxation of the excited state. The lifetimes induced by the lead interactions play a crucial role in determining the required overlap between these processes. Our analysis shows that, unlike the higher-energy signal, the lower-energy peak is sensitive to the applied bias and does not correspond to any optical resonance in the junction. The signal at higher energy is enhanced as the temperature is increased. We demonstrate our findings using nonperturbative analytic results for a model system.

Comparative Evaluation of Foveal Avascular Zone on Two Optical Coherence Tomography Angiography Devices.

SIGNIFICANCE: This study compares foveal avascular zone (FAZ) geometry in healthy eyes as imaged by two commercially available optical coherence tomography angiography (OCTA) devices. Foveal avascular zone measurements are repeatable and reproducible with each OCTA device, but interdevice agreement was poor. We provide conversion factors between devices. PURPOSE: The purpose of this study was to perform comparative evaluation of FAZ geometry in healthy eyes as imaged by two commercially available OCTA devices. METHODS: Ninety-six eyes of 48 healthy subjects were imaged prospectively on each of two OCTA devices (DRI-OCT [Topcon Corporation, Tokyo, Japan]; Cirrus 5000 [Carl Zeiss Meditec Inc., Dublin, CA]). The FAZ was evaluated in the superficial capillary plexus layer of 6 × 6-mm foveal scans by two masked observers. Intraobserver and interobserver agreement was determined using intraclass correlation by using linear mixed models and Bland-Altman plots. K-means clustering was used to provide conversion values between two devices. Foveal avascular zone acircularity was calculated using scans from each device and compared. RESULTS: The intraobserver repeatability for DRI-OCT was 0.95 (95% confidence interval [CI], 0.90 to 0.98) for observer A and 0.92 (95% CI, 0.83 to 0.96) for observer B. Intraobserver repeatability for Cirrus 5000 was 0.988 (95% CI, 0.972 to 0.995) for observer A and 0.993 (95% CI, 0.983 to 0.997) for observer B. The interobserver variability between observers A and B for DRI-OCT was 0.87 (0.73 to 0.94) and for Cirrus 5000 was 0.984 (95% CI, 0.964 to 0.993). Poor interdevice agreement (0.205 [95% CI, -0.202 to 0.554]) was noted, and conversion formulas were devised to convert FAZ area measurements from one device to another. No significant correlation was found when comparing FAZ acircularity indices between devices (P = .39). CONCLUSIONS: Repeatable and reproducible FAZ area measurements were obtained with each respective OCTA device, but interdevice agreement was poor, yet quantifiable and systematic with calculable conversion factors between devices.

Comprehensive Genome Scale Phylogenetic Study Provides New Insights on the Global Expansion of Chikungunya Virus.

Since the India and Indian Ocean outbreaks of 2005 and 2006, the global distribution of chikungunya virus (CHIKV) and the locations of epidemics have dramatically shifted. First, the Indian Ocean lineage (IOL) caused sustained epidemics in India and has radiated to many other countries. Second, the Asian lineage has caused frequent outbreaks in the Pacific islands and in 2013 was introduced into the Caribbean, followed by rapid spread to nearly all of the neotropics. Further, CHIKV epidemics, as well as exported cases, have been reported in central Africa after a long period of perceived silence. To understand these changes and to anticipate the future of the virus, the exact distribution, genetic diversity, transmission routes, and future epidemic potential of CHIKV require further assessment. To do so, we conducted the most comprehensive phylogenetic analysis to date, examined CHIKV evolution and transmission, and explored distinct genetic factors associated with the emergence of the East/Central/South African (ECSA) lineage, the IOL, and the Asian lineage. Our results reveal contrasting evolutionary patterns among the lineages, with growing genetic diversities observed in each, and suggest that CHIKV will continue to be a major public health threat with the potential for further emergence and spread. IMPORTANCE: Chikungunya fever is a reemerging infectious disease that is transmitted by Aedes mosquitoes and causes severe health and economic burdens in affected populations. Since the unprecedented Indian Ocean and Indian subcontinent outbreaks of 2005 and 2006, CHIKV has further expanded its geographic range, including to the Americas in 2013. Its evolution and transmission during and following these epidemics, as well as the recent evolution and spread of other lineages, require optimal assessment. Using newly obtained genome sequences, we provide a comprehensive update of the global distribution of CHIKV genetic diversity and analyze factors associated with recent outbreaks. These results provide a solid foundation for future evolutionary studies of CHIKV that can elucidate emergence mechanisms and also may help to predict future epidemics.

Incidence of parathyroid disorders in Indian adult male population: A 25-year follow-up study.

CONTEXT AND OBJECTIVE: Detailed information on the epidemiology of parathyroid disorders in India is lacking. Most of the available data pertain to primary hyperparathyroidism (PHPT) rather than the overall burden of parathyroid disorders. We studied the incidence of parathyroid disorders in a cohort of service personnel followed for a long duration. DESIGN, SETTING AND PATIENTS: The data for this retrospective, descriptive epidemiological study were derived from the electronic medical records (EMR) of health care personnel enrolled between 1990 and 2015. Subjects were recruited between the ages of 17 and 20 years in good health, and the data pertaining to parathyroid disorders were derived from the EMR. MAIN OUTCOMES MEASURES: We calculated the incidence rates per person-years of parathyroid disorders using appropriate statistical methods. RESULTS: Our analysis includes 51 217 participants (median age 33, range 17-54 years) with a mean follow-up of 12.5 years. Yearly evaluation of the data gave cumulative follow-up duration of 613 925 person-years. PHPT was diagnosed in 37 patients and hypoparathyroidism in 16 patients, giving incidence rates of 6 and 2.6 per 100 000 person-years, respectively. Only one patient was diagnosed with pseudohypoparathyroidism (0.16 per 100 000 person-years). Of the 37 patients with PHPT, 16 (43%) developed postsurgical hypoparathyroidism. CONCLUSIONS: Our cohort had a low incidence of PHPT when compared to Western populations. Long-term epidemiological studies are essential to identify the demographic trends of metabolic bone disorders in India.

Diagnostic hepatic haemodynamic techniques: safety and radiation exposure.

BACKGROUND & AIMS: Hepatic venous pressure gradient (HVPG) and transjugular liver biopsy (TJLB) are increasingly used in the management of patients with liver disease. We aimed to describe the safety profile of these procedures, providing data on the intra- and periprocedure complications, radiation exposure and amount of iodinated contrast material used. METHODS: In 106 consecutive patients undergoing HVPG and TJLB data on fluoroscopy time (FT), absorbed radiation dose, equivalent effective dose (mSv) and volume of iodinated contrast material (ICM) were prospectively collected and reviewed, together with clinical and laboratory data. Incidence and severity of procedure-related complications were assessed. In 28 hospitalised patients, creatinine values after 72 hours of the procedure were reviewed to identify contrast-induced nephropathy (CIN). RESULTS: Median effective radiation dose was 5.4 mSv (IQR 10 mSv). A total 28.3% of patients exceeded an effective exposure of 10 mSv and 9.4% exceeded 20 mSv. Only age and BMI correlated with radiation dose (R = .327, P=.001 and R = .410, P<.0001 respectively), and only BMI remained independently associated with an exposure over 20 mSv. Procedure-related complications occurred in eight patients (7.5%), and were minor in six cases. Median ICM volume was 12.5 mL. 6/28 patients met the diagnostic criteria for CIN. CONCLUSIONS: Hepatic venous pressure gradient and Transjugular liver biopsy show a good safety profile and radiation exposure associated with these procedures is in most of the cases low. In hepatic haemodynamic procedures, efforts should be made to reduce the radiation dose in patients with overweight/obesity and to use the minimal possible ICM volume in patients with acute-on-chronic liver failure.

Semi-automated quantification of hard exudates in colour fundus photographs diagnosed with diabetic retinopathy.

BACKGROUND: Hard exudates (HEs) are the classical sign of diabetic retinopathy (DR) which is one of the leading causes of blindness, especially in developing countries. Accordingly, disease screening involves examining HEs qualitatively using fundus camera. However, for monitoring the treatment response, quantification of HEs becomes crucial and hence clinicians now seek to measure the area of HEs in the digital colour fundus (CF) photographs. Against this backdrop, we proposed an algorithm to quantify HEs using CF images and compare with previously reported technique using ImageJ. METHODS: CF photographs of 30 eyes (20 patients) with diabetic macular edema were obtained. A robust semi-automated algorithm was developed to quantify area covered by HEs. In particular, the proposed algorithm, a two pronged methodology, involved performing top-hat filtering, second order statistical filtering, and thresholding of the colour fundus images. Subsequently, two masked observers performed HEs measurements using previously reported ImageJ-based protocol and compared with those obtained through proposed method. Intra and inter-observer grading was performed for determining percentage area of HEs identified by the individual algorithm. RESULTS: Of the 30 subjects, 21 were males and 9 were females with a mean age of the 50.25 ± 7.80 years (range 33-66 years). The correlation between the two measurements of semi-automated and ImageJ were 0.99 and 0.99 respectively. Previously reported method detected only 0-30% of the HEs area in 9 images, 30-60% in 12 images and 60-90% in remaining images, and more than 90% in none. In contrast, proposed method, detected 60-90% of the HEs area in 13 images and 90-100% in remaining 17 images. CONCLUSION: Proposed method semi-automated algorithm achieved acceptable accuracy, qualitatively and quantitatively, on a heterogeneous dataset. Further, quantitative analysis performed based on intra- and inter-observer grading showed that proposed methodology detects HEs more accurately than previously reported ImageJ-based technique. In particular, we proposed algorithm detect faint HEs also as opposed to the earlier method.

State-of-the-Art: a Review of Cardiovascular Effects of Testosterone Replacement Therapy in Adult Males.

PURPOSE OF REVIEW: According to an Endocrine Society Clinical Practice Guideline published in June 2010, testosterone replacement therapy (TRT) should be administered only to men who are hypogonadal with documented low testosterone level on two morning measurements. This recommendation was based on previous studies that did not show an increased risk in cardiovascular events with TRT. In contrast, recent studies did show an increased risk which prompted the FDA to investigate further. RECENT FINDINGS: Multiple studies suggested an increased risk in cardiovascular events among groups of men prescribed TRT. There is recent evidence that TRT can be associated with higher cardiovascular risks, while these risks are still not well established, and more well-designed trials are needed. Physicians should always be cautious when prescribing TRT to their patients. Potential risks should be discussed with each patient, and TRT requires regular monitoring to help minimize side effects.

Imaging the Canaliculops With Ultrasound Biomicroscopy and Anterior Segment Ocular Coherence Tomography.

Canaliculops is a noninflammatory and noninfectious ectasia of the canaliculus with serous fluid accumulation. Currently, the etiology is uncertain. To the best of the authors' knowledge only 6 confirmed cases have been published earlier; however, the imaging features were not described. The authors report the ultrasound biomicroscopic and ocular coherence tomography features of a histopathologically proven canaliculops.

Mortality audit of medical patients at armed forces hospitals.

The mortality statistics of the medical patients at our tertiary care hospitals are sparse and lacking. We studied the mortality characteristics of the patients admitted to medical wards and intensive care unit at two hospitals based on the available fatal documents. Our objectives include analysis of the cause of death, duration of stay and presence of sepsis. The deceased (103 males, 47 females) had a mean age of 64.6 ± 15.5 yrs and mean duration of stay 7.1 ± 12.3 days. Infections and sepsis syndrome (33%), respiratory (17%), neurological (15%) and cardiovascular disorders (10%) were the top four causes of the mortality. Comorbid ailments were present in 71% of the deceased and the ventilator was used in 39% of them prior to the death. Age of the patients did not show any correlation with the duration of hospital stay (P = 0.8322). Infections and sepsis syndrome are the major reasons of death in medical patients. Mortality audit helps in identifying the prevalent causes of death in the hospital.