Carotid Cavernous Fistula as a Rare and Late Complication of Maxillofacial Injury: A Brief Clinical Study.

Carotid- Cavernous Fistula (CCF) represents an aberrant vascular communication at the skull base between the high-flow carotid arterial system and the low-flow venous channels within the cavernous sinuses of the sphenoid bone. Benjamin Travers, in the year 1809, described this condition as "pulsating exophthalmos". This case is a presentation of a carotid cavernous fistula in an operated case of maxillofacial injury as a late complication. The individual presented with a nonresolving proptosis and chemosis for the past 9 weeks. This presentation enumerates how the diagnosis was made, though being a rare complication and how it was promptly managed that resulted in a remarkable resolution of signs and symptoms.

Oral Plasmablastic Lymphoma: A Rare Manifestation of HIV-Related Neoplasm-A Brief Clinical Study.

Plasmablastic lymphoma (PBL) is an uncommon and aggressive large B-cell lymphoma commonly diagnosed in human immunodeficiency virus-positive patients. Though the oral cavity is a common site for PBL, this condition is not commonly reported in the literature as an oral manifestation. Most oral PBLs presented as an asymptomatic swelling, frequently associated with ulcerations and bleeding. No standard treatment is yet advocated for oral PBL. Five-year survival rate was recorded not more than 33.5%. This presentation emphasizes on oral manifestation of plasmablastic lymphoma (PBL) as a rare entity, which was provisionally diagnosed for carcinoma (CA) oral cavity. A simple presentation of ulcerated growth in the upper jaw was excised for histopathologic evaluation. Subsequently, it turned out to be a rare oral manifestation of HIV-related lymphoma. It is imperative to understand simple oral presentation as a manifestation of an underlying systemic condition. With this interest, this case presentation is published with a literature review.

De Haas-van Alphen spectroscopy and magnetic breakdown in moiré graphene.

Quantum oscillations originating from the quantization of electron cyclotron orbits provide sensitive diagnostics of electron bands and interactions. We report on nanoscale imaging of the thermodynamic magnetization oscillations caused by the de Haas-van Alphen effect in moiré graphene. Scanning by means of superconducting quantum interference device (SQUID)-on-tip in Bernal bilayer graphene crystal axis-aligned to hexagonal boron nitride reveals large magnetization oscillations with amplitudes reaching 500 Bohr magneton per electron in weak magnetic fields, unexpectedly low frequencies, and high sensitivity to superlattice filling fraction. The oscillations allow us to reconstruct the complex band structure, revealing narrow moiré bands with multiple overlapping Fermi surfaces separated by unusually small momentum gaps. We identified sets of oscillations that violate the textbook Onsager Fermi surface sum rule, signaling formation of broad-band particle-hole superposition states induced by coherent magnetic breakdown.

Scanning SQUID-on-tip microscope in a top-loading cryogen-free dilution refrigerator.

The scanning superconducting quantum interference device (SQUID) fabricated on the tip of a sharp quartz pipette (SQUID-on-tip) has emerged as a versatile tool for the nanoscale imaging of magnetic, thermal, and transport properties of microscopic devices of quantum materials. We present the design and performance of a scanning SQUID-on-tip microscope in a top-loading probe of a cryogen-free dilution refrigerator. The microscope is enclosed in a custom-made vacuum-tight cell mounted at the bottom of the probe and is suspended by springs to suppress vibrations caused by the pulse tube cryocooler. Two capillaries allow for the in situ control of helium exchange gas pressure in the cell that is required for thermal imaging. A nanoscale heater is used to create local temperature gradients in the sample, which enables quantitative characterization of relative vibrations between the tip and the sample. The spectrum of the vibrations shows distinct resonant peaks with a maximal power density of about 27 nm/Hz1/2 in the in-plane direction. The performance of the SQUID-on-tip microscope is demonstrated by magnetic imaging of the MnBi2Te4 magnetic topological insulator, magnetization and current distribution imaging in a SrRuO3 ferromagnetic oxide thin film, and thermal imaging of dissipation in graphene.

Triplet-Triplet Annihilation Upconversion in a Porphyrinic Molecular Container.

Triplet-triplet annihilation-based molecular photon upconversion (TTA-UC) is a photophysical phenomenon that can yield high-energy emitting photons from low-energy incident light. TTA-UC is believed to fuse two triplet excitons into a singlet exciton through several consecutive energy-conversion processes. When organic aromatic dyes─i.e., sensitizers and annihilators─are used in TTA-UC, intermolecular distances, as well as relative orientations between the two chromophores, are important in an attempt to attain high upconversion efficiencies. Herein, we demonstrate a host-guest strategy─e.g., a cage-like molecular container incorporating two porphyrinic sensitizers and encapsulating two perylene emitters inside its cavity─to harness photon upconversion. Central to this design is tailoring the cavity size (9.6-10.4 Å) of the molecular container so that it can host two annihilators with a suitable [π···π] distance (3.2-3.5 Å). The formation of a complex with a host:guest ratio of 1:2 between a porphyrinic molecular container and perylene was confirmed by NMR spectroscopy, mass spectrometry, and isothermal titration calorimetry (ITC) as well as by DFT calculations. We have obtained TTA-UC yielding blue emission at 470 nm when the complex is excited with low-energy photons. This proof-of-concept demonstrates that TTA-UC can take place in one supermolecule by bringing together the sensitizers and annihilators. Our investigations open up some new opportunities for addressing several issues associated with supramolecular photon upconversion, such as sample concentrations, molecular aggregation, and penetration depths, which have relevance to biological imaging applications.

Divinylanthracene-Containing Tetracationic Organic Cyclophane with Near-Infrared Photoluminescence.

Near-infrared (NIR) light is known to have outstanding optical penetration in biological tissues and to be non-invasive to cells compared with visible light. These characteristics make NIR-specific light optimal for numerous biological applications, such as the sensing of biomolecules or in theranostics. Over the years, significant progress has been achieved in the synthesis of fluorescent cyclophanes for sensing, bioimaging, and making optoelectronic materials. The preparation of NIR-emissive porphyrin-free cyclophanes is, however, still challenging. In an attempt for fluorescence emissions to reach into the NIR spectral region, employing organic tetracationic cyclophanes, we have inserted two 9,10-divinylanthracene units between two of the pyridinium units in cyclobis(paraquat-p-phenylene). Steady-state absorption, fluorescence, and transient-absorption spectroscopies reveal the deep-red and NIR photoluminescence of this cyclophane. This tetracationic cyclophane is highly soluble in water and has been employed successfully as a probe for live-cell imaging in a breast cancer cell line (MCF-7).

An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network.

OBJECTIVE: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network. SETTING: A 780-bed, tertiary-level, public teaching hospital in northern India. METHODS: After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash. RESULTS: Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified. CONCLUSIONS: Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

Surgical Challenges in the Management of Post COVID-19 Midface Mucormycosis (PCoMM): An Institutional Protocol.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has posed another serious threat, mucormycosis infection, affecting the maxilla and orbitocerebral region. This condition has not spared world population from its merciless claws. This article addresses the challenges faced by the maxillofacial surgeons in setting the protocols from preoperative diagnosis, surgical management to postoperative care, including short-term and long-term rehabilitation. To manage this relentlessly progressing condition, a multispecialty team approach is to be activated in diagnosing, managing, and rehabilitating the patients. PURPOSE: The purpose of this clinical study is to document and analyze the clinical and demographic data, presentation of the lesion, the diagnostic methods followed for early clinical detection, and management of post COVID-19 midface mucormycosis. The article also discusses postoperative medical management and prosthetic rehabilitation. RESULTS: Most of the mucormycosis cases reporting to our center were treated and recovered patients of Severe Acute Respiratory Syndrome Coronavirus 2 infection. Thirty-four (n=34) case were operated for post COVID-19 midface mucormycosis between October 2020 and December 2021. Male to Female ratio is 1:42. The average age of the patients was 57.5 years. Maximum patients were in fifth and sixth decade of life. Maxilla was the involved bone. Treatment was primarily surgical debridement to extended or radical maxillectomy. All patients were treated with Liposomal Amphotericin B and tab posaconazole for 3 to 4 weeks depending upon the age, weight, and physiological state of the patients to attain an optimal cumulative load. Three patients succumbed to illness postoperatively (n=3, 1.02%). Average duration of hospital stay was 47 days. The average review period was 5.1 months.

Congenital Granular Cell Tumour - Case Report and Review of Literature.

Rationale: Congenital orofacial swellings in neonates are mainly limited to vascular malformations and neuroectodermal benign tumours. Congenital granular cell tumour (CGCT) is a rare condition affecting neonates with a prevalence rate of 6 in 1 million. Our report provides a brief review of diagnosis and management. Patient Concern: A 4-day-old female neonate was brought in with the chief complaint of a single, lobulated mass protruding from the right side of the oral cavity. The inability to achieve lip seal and suckling resulting in feeding problems was the primary concern. Diagnosis and Treatment: Surgical excision of the lesion was carried out under general anaesthesia. Resected mass was confirmed to be a CGCT upon histopathological evaluation. Outcome: One-year follow-up showed satisfactory healing with no evidence of recurrence. Take-away Lesson: Ultrasonography and other imaging modalities help in differentiating it from vascular malformations. Simple surgical excision suffices to treat the condition.

Melanotic Neuroectodermal Tumour of Infancy - A Case Report and Review of Literature.

Rationale: Melanotic neuroectodermal tumour of infancy (MNTI) is universally described as a rare, benign, pigmented lesion which most frequently involves the maxilla. Its origin is well established to be in the neural crest cells. Due to the high recurrence rate and aggressive behaviour mimicking malignancy, it poses a great challenge in their diagnosis, treatment planning, and prognosis. Patient Concern: Two-year-old female with no known comorbidities was brought in with the chief complaint of a growing swelling in the upper lip region. Diagnosis and Treatment: She was taken up for resection of the tumour under general anaesthesia. The specimen was subjected to histological and immunological examination confirming the diagnosis of MNTI. Outcome: The postoperative period was uneventful. After regular follow-up, the patient showed satisfactory healing with no signs of recurrence. Take-Away Lessons: Based on our experience, we feel that the diagnosis of MNTI is mainly clinical. Early conservative surgical excision and regular follow-up provide an excellent result with good prognosis.

Modeling Oxidation of AlCoCrFeNi High-Entropy Alloy Using Stochastic Cellular Automata.

Together with the thermodynamics and kinetics, the complex microstructure of high-entropy alloys (HEAs) exerts a significant influence on the associated oxidation mechanisms in these concentrated solid solutions. To describe the surface oxidation in AlCoCrFeNi HEA, we employed a stochastic cellular automata model that replicates the mesoscale structures that form. The model benefits from diffusion coefficients of the principal elements through the native oxides predicted by using molecular simulations. Through our examination of the oxidation behavior as a function of the alloy composition, we corroborated that the oxide scale growth is a function of the complex chemistry and resultant microstructures. The effect of heat treatment on these alloys is also simulated by using reconstructed experimental micrographs. When they are in a single-crystal structure, no segregation is noted for α-Al2O3 and Cr2O3, which are the primary scale-forming oxides. However, a coexistent separation between Al2O3 and Cr2O3 oxide scales with the Al-Ni- and Cr-Fe-rich regions is predicted when phase-separated microstructures are incorporated into the model.

Fluorescent cyclophanes and their applications.

With the serendipitous discovery of crown ethers by Pedersen more than half a century ago and the subsequent introduction of host-guest chemistry and supramolecular chemistry by Cram and Lehn, respectively, followed by the design and synthesis of wholly synthetic cyclophanes-in particular, fluorescent cyclophanes, having rich structural characteristics and functions-have been the focus of considerable research activity during the past few decades. Cyclophanes with remarkable emissive properties have been investigated continuously over the years and employed in numerous applications across the field of science and technology. In this Review, we feature the recent developments in the chemistry of fluorescent cyclophanes, along with their design and synthesis. Their host-guest chemistry and applications related to their structure and properties are highlighted.

Helically Chiral Hybrid Cyclodextrin Metal-Organic Framework Exhibiting Circularly Polarized Luminescence.

Three achiral polycyclic aromatic fluorophores─namely, 1-pyrenecarboxylic acid, 9-anthracenecarboxylic acid, and perylene-3,9-dicarboxylic acid─were chosen based on their desired properties before being incorporated into the construction of a K+-carrying gamma-cyclodextrin (γ-CD)-based metal-organic framework (CD-MOF-1) and γ-CD-containing hybrid frameworks (CD-HFs). Among these fluorophores, only the pyrene-carrying one shows significant noncovalent bonding interactions with γ-CD in solution. This fluorophore is encapsulated in a CD-HF with a trigonal superstructure instead of the common cubic CD-MOF-1 found in the case of the other two fluorophores. Single-crystal X-ray diffraction analysis of the trigonal CD-HF reveals a π-stacked chiral positioning of the pyrene-carrying fluorophore inside the (γ-CD)2 tunnels and held uniformly around an enantiomorphous 32 screw axis along the c direction in the solid-state structure. This helix-like structure demonstrates an additional level of chirality over and above the point-chiral stereogenic centers of γ-CD and the axial chirality associated with the self-assembled π-stacked fluorophores. These arrangements result in specifically generated photophysical and chiroptical properties, such as the controlled emergence of circularly polarized luminescence (CPL) emission. In this manner, a complete understanding of the mechanism of chirality transfer from a chiral host (CD-HF) to an encapsulated achiral fluorophore has been achieved, an attribute which is often missing in the development of materials with CPL.

Potential diagnosis of COVID-19 from chest X-ray and CT findings using semi-supervised learning.

COVID-19 is an infectious disease, which has adversely affected public health and the economy across the world. On account of the highly infectious nature of the disease, rapid automated diagnosis of COVID-19 is urgently needed. A few recent findings suggest that chest X-rays and CT scans can be used by machine learning for the diagnosis of COVID-19. Herein, we employed semi-supervised learning (SSL) approaches to detect COVID-19 cases accurately by analyzing digital chest X-rays and CT scans. On a relatively small COVID-19 radiography dataset, which contains only 219 COVID-19 positive images, 1341 normal and 1345 viral pneumonia images, our algorithm, COVIDCon, which takes advantage of data augmentation, consistency regularization, and multicontrastive learning, attains 97.07% average class prediction accuracy, with 1000 labeled images, which is 7.65% better than the next best SSL method, virtual adversarial training. COVIDCon performs even better on a larger COVID-19 CT Scan dataset that contains 82,767 images. It achieved an excellent accuracy of 99.13%, at 20,000 labels, which is 6.45% better than the next best pseudo-labeling approach. COVIDCon outperforms other state-of-the-art algorithms at every label that we have investigated. These results demonstrate COVIDCon as the benchmark SSL algorithm for potential diagnosis of COVID-19 from chest X-rays and CT-Scans. Furthermore, COVIDCon performs exceptionally well in identifying COVID-19 positive cases from a completely unseen repository with a confirmed COVID-19 case history. COVIDCon, may provide a fast, accurate, and reliable method for screening COVID-19 patients.

Photon Upconversion in a Glowing Metal-Organic Framework.

The interaction of low-energy light with matter that leads to the production of high-energy light is known as photon upconversion. This phenomenon is of importance because of its potential applications in optoelectronics, energy harvesting, and the biomedical arena. Herein, we report a pillared-paddlewheel metal-organic framework (MOF), constructed from a tetrakis(4-carboxyphenyl)porphyrin sensitizer and a dipyridyl thiazolothiazole annihilator, designed for efficient triplet-triplet annihilation upconversion (TTA-UC). Single-crystal X-ray diffraction studies reveal that the Zn-metalated sensitizers are coordinated to Zn2 nodes in a paddlewheel fashion, forming 2D sheets, to which are linked annihilators, such that each sensitizer is connected to five of them. The precise arrangements of sensitizers with respect to annihilators, and the high annihilator-to-sensitizer ratio, facilitate Dexter energy transfer. This level of organization in an extended structure leads to a high TTA-UC efficiency of 1.95% (theoretical maximum = 50%) at an excitation power density of 25 mW cm-2.

Cyclodextrin Metal-Organic Frameworks and Their Applications.

Cyclodextrin-based metal-organic frameworks (CD-MOFs), derived from γ-cyclodextrin (γ-CD) and alkali metal cations, constitute a class of porous, renewable, and edible MOFs that can be synthesized from a naturally occurring carbohydrate on a large scale. γ-CD is a C8-symmetrical cyclic oligosaccharide composed of eight asymmetric α-1,4-linked d-glucopyranosyl residues that possesses a bucket-shaped cavity with an inner diameter of ∼1 nm and a depth of ∼0.8 nm. Upon combination of 1 equiv of γ-CD with 8 equiv of potassium hydroxide in an aqueous solution, followed by vapor diffusion of MeOH (or EtOH) into this solution during several days, CD-MOF-1 is obtained as cubic crystals. This carbohydrate-based MOF, which was discovered serendipitously in 2010, was the first highly crystalline CD-MOF to be obtained. X-ray crystallography of a single crystal reveals that it adopts the space group I432 with unit cell dimensions of approximately 31 × 31 × 31 Å3. Other CD-MOFs, namely, CD-MOF-2 and CD-MOF-3, can be obtained when potassium ions are replaced by rubidium and cesium ions, respectively. CD-MOFs comprise extended body-centered frameworks of (γ-CD)6 cubic units, which contain spherical pores that reside at the center of the cubes, interconnected by alkali metal cations, forming both cylindrical and triangular channels.During the past decade, CD-MOFs have emerged as a useful class of multifunctional materials based on porous frameworks with extended structures displaying robust crystallinity, permanent porosity, and excellent biocompatibility. The family of CD-MOFs has been joined by a growing collection of metal nodes involving alkali metal cations (Li+, Na+, K+, Rb+, Cs+) and γ-CD as well as its derivatives. As a result of the ability of their extended porous frameworks to absorb guest molecules, including gases, drugs, metal-based nanoclusters, and nanoparticles, CD-MOFs have potential applications in areas as disparate as templating syntheses of metal-based nanoparticles and gels, adsorption and separation, trapping highly reactive intermediates, catalyst supports, sensing, electrical memory, and drug delivery.In this Account, we tell the story of CD-MOFs, a scientific discovery made in our research laboratory at Northwestern University, and the opportunities to use these environmentally friendly porous materials across different fields of science and technology. The story includes representative synthetic protocols for the preparation of CD-MOFs, along with an overview of their structural features, functionalization, and chemical modification aimed at increasing their stabilities in aqueous environments, and finally, a summary of their applications. The examples we will discuss, however, are only illustrative, and there is a significant body of additional findings emanating from our laboratory and others, especially in the realm of developing new synthetic strategies, tuning the framework stabilities, and exploring the guest inclusion and emergent properties of CD-MOFs. We refer readers to the original communications, papers, and reviews cited herein. We hope that, in the telling of the story of CD-MOFs, this Account may promote new scientific discoveries and further development of CD-MOF-based technologies in the future.

Oral amyloidosis: A case report and diagnostic algorithm.

Background: Amyloidosis is a distressing and infrequent condition caused by accumulation of abnormally folded proteins as aggregates in the extracellular tissue spaces of the body, leading to destruction of organ structure and function. Presentation of Oral Amyloidosis is generally a rare phenomenon, tongue being the most common site to manifest the disease process. Accurate recognition of the amyloid protein and its sub typing is absolutely critical for clinical management and to assess prognosis such as to avoid misdiagnosis and unwanted, potentially harmful treatment. Case Report: We report a case of 84 year old male patient with an enlarged tongue, who presented with burning sensation and a facial violaceous papules with no other known systemic findings. Incisional biopsy revealed amorphous deposits confirmed for amyloid by congo red stain and Immunohistochemistry. Conclusion: The suspicion of Amyloidosis should always be kept in mind whenever a solitary enlargement of the tongue is noticed. Close follow-up and an entire panel of investigations is mandatory, both to manage recurrences and to monitor the possible advancement of the disease into a full blown systemic form.

MultiCon: A Semi-Supervised Approach for Predicting Drug Function from Chemical Structure Analysis.

Semi-supervised learning has proved its efficacy in utilizing extensive unlabeled data to alleviate the use of a large amount of supervised data and improve model performance. Despite its tremendous potential, semi-supervised learning has yet to be implemented in the field of drug discovery. Empirical testing of drugs and their classification is costly and time-consuming. In contrast, predicting therapeutic applications of drugs from their structural formulas using semi-supervised learning would reduce costs and time significantly. Herein, we employ a new multicontrastive-based semi-supervised learning algorithm-MultiCon-for classifying drugs into 12 categories, according to therapeutic applications, on the basis of image analyses of their structural formulas. By rational use of data balancing, online augmentations of the drug image data during training, and the combined use of multicontrastive loss with consistency regularization, MultiCon achieves better class prediction accuracies when compared with the state-of-the-art machine learning methods across a variety of existing semi-supervised learning benchmarks. In particular, it performs exceptionally well with a limited number of labeled examples. For instance, with just 5000 labeled drugs in a PubChem (D3) data set, MultiCon achieved a class prediction accuracy of 97.74%.

Partly deepithelialised palatal graft for the treatment of deep-wide palatal recession defect: simplified protocol with 18-month follow-up.

Advances in periodontal plastic surgical procedures have led to achieve predictable root coverage outcomes for the recession defects. However, little has been reported and emphasised over management of palatal recession defects. The root coverage surgical procedures used for coverage of palatal recession defect are technically challenging in terms of accessibility and graft coverage. The purpose of this report is to describe a surgical technique used to manage deep-wide palatal recession defect. The technique uses partly deepithelialised palatal graft that is designed to approximately fit the defect site. This is employed for prolonged protection of the underlying healing process. This case report is unique in terms of treatment of deep (9.0 mm), wide (6.0 mm) palatal recession defect and its long-term follow-up for 18 months.