Suicide Attempt in a Poststroke Patient After Undergoing Deep Brain Stimulation: A Case Report.

Deep brain stimulation (DBS) is a type of therapy involving electrical stimulation of the brain and is primarily used to treat movement disorders. While perhaps beneficial, DBS has also been shown to have some potential major side effects, including increased risk for depression and suicide. In the present article, we report a case of a suicide attempt in a depressed patient two months after undergoing DBS for treatment of acute dystonia the patient had suffered from a prior ischemic stroke. This manuscript serves as a reminder of the negative ramifications that can be associated with DBS and why we should be cautious in providing DBS to patients who are either currently depressed or have a history of depression.

Beta-blocker adjunct therapy as a prospective anti-metastatic with cardio-oncologic regulation.

The prevailing treatment stratagem in cancer therapy still challenges the dilemma of a probable metastatic spread following an initial diagnosis. Including an anti-metastatic agent demands a significant focus to overrule the incidence of treatment failures. Adrenergic stimulation underlying the metastatic spread paved the way for beta blockers as a breakthrough in repurposing as an anti-metastatic agent. However, the current treatment approach fails to fully harness the versatile potential of the drug in inhibiting probable metastasis. The beta blockers were seen to show a myriad of grip over the pro-metastatic and prognostic parameters of the patient. Novel interventions in immune therapy, onco-hypertension, surgery-induced stress, induction of apoptosis and angiogenesis inhibition have been used as evidence to interpret our objective of discussing the potential adjuvant role of the drug in the existing anti-cancer regimens. Adding weight to the relative incidence of onco-hypertension as an unavoidable side effect from chemotherapy, the slot for an anti-hypertensive agent is necessitated, and we try to suggest beta-blockers to fill this position. However, pointing out the paucity in the clinical study, we aim to review the current status of beta blockers under this interest to state how the drug should be included as a drug of choice in every patient undergoing cancer treatment.

Receiver operating characteristic curve analysis of arteriovenous dialysis access flow using ultrasound.

BACKGROUNDS: Despite numerous studies investigating the use of ultrasound (US) in assessing arteriovenous fistulas (AVF), there are no universally agreed threshold flow velocities in diagnosing significantly abnormal flow that are useful in predicting thrombotic flow-related dysfunction. This study evaluates a predictive model using receiver operating characteristic curve (ROC) analyses to establish threshold velocities. METHODS: Five hundred and eleven US scans were analysed. ROC curves were used to determine the optimal threshold time average mean velocity (TAMV), peak systolic velocity (PSV) and end diastolic velocity (EDV) of the brachial artery supplying the AVF in determining the need for intervention or thrombosis within 3 months of the scans. Estimated flow volume (FV) ROC was used as an evaluative comparison. RESULTS: There were 356 negative and 155 positive scan results in relation to the need for intervention or thrombosis. Empirical flow velocity parameters of TAMV, EDV and PSV were analysed using ROC curves, yielding an area under the curve (AUC) of 0.95, 0.92 and 0.86, respectively. FV ROC analysis yields a comparative AUC of 0.90. A TAMV cut-off at 48.6 cm/s yielded the highest AUC. Subgroup analysis yielded an optimal TAMV cut-off of 45 cm/s for forearm and 49 cm/s for arm AVF. The EDV was also highly predictive of outcomes. PSV has the lowest accuracy. CONCLUSION: The TAMV of inflow brachial artery to AVF is highly predictive of outcomes of thrombotic flow-related dysfunction. Our study confirms TAMV cut-offs of 45 cm/s for forearm and 49 cm/s for arm AVF. These results require prospective validation.

Ultrasensitive Detection and In Situ Imaging of Analytes on Graphene Oxide Analogues Using Enhanced Raman Spectroscopy.

We demonstrate how algorithm-improved confocal Raman microscopy (ai-CRM), in combination with chemical enhancement by two-dimensional substrates, can be used as an ultrasensitive detection method for rhodamine (R6G) molecules adsorbed from aqueous solutions. After developing a protocol for laser-induced reduction of graphene oxide, followed by noninvasive Raman imaging, a limit of detection (LOD) of 5 × 10-10 M R6G was achieved using ai-CRM. An equivalent subnanomolar LOD was also achieved on another graphene oxide analogue -UV/ozone-oxidized graphene. These record-breaking detection capabilities also enabled us to study the adsorption kinetics and image the spatial distribution of the adsorbed R6G. These findings indicate a strong potential for algorithm-improved graphene-enhanced Raman spectroscopy as a facile method for detecting, imaging, and quantifying trace amounts of adsorbing molecules on a variety of 2D substrates.

Intraoperative fluoroscopy alone versus routine post-operative X-rays in identifying return to theatre after fracture fixation.

BACKGROUND: Post-operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post-operative imaging in identifying patients that require a return to theatre following the use of IF. METHODS: A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post-operative imaging were identified and complications requiring a return to theatre were obtained. Non-trauma patients and those who did not have IF were excluded. RESULTS: A total of 1319 patients had IF. Of these patients, 1131 patients had post-operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post-operative imaging. The calculated number of X-rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post-operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. CONCLUSION: The use of post-operative radiographs can identify significant complications despite the use of IF in trauma patients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.

In-situ observation of reactive wettability alteration using algorithm-improved confocal Raman microscopy.

HYPOTHESIS: The wettability of complex fluids on surfaces usually depends on the adsorption of solutes to any of the constituting interfaces. Controlling such interfacial processes by varying the composition of a phase enables the design of smart responsive systems. Our goal is to demonstrate that 3D Confocal Raman Microscopy (CRM) can reveal the mechanistic details of such processes by allowing to simultaneously monitor the contact angle variation and redistribution of the chemical species involved. EXPERIMENTS: Motivated by the enhanced oil recovery process of low salinity water flooding, we studied the response of picolitre oil drops on mineral substrates upon varying the ambient brine salinity. The substrates were pre-coated with thin layers of deuterated-stearic acid (surfactant) that display salinity-dependent stability. FINDINGS: 3D CRM imaging using a recently proposed faster 'ai' (algorithm-improved) mode reveals that the surfactant layer is stable at high salinities, leading to preferential oil wetting. Upon reducing the ambient brine salinity, this layer decomposes and the investigated surfaces of mica and - somewhat less pronounced - silica become more water wet. Eventually, the surfactant is found to partly dissolve in the oil and partly precipitate at the oil-water interface. We anticipate that ai-3D-CRM will prove useful to holistically study similar systems displaying reactive wetting.

Evaporation mediated translation and encapsulation of an aqueous droplet atop a viscoelastic liquid film.

HYPOTHESIS: Viscoelastic liquids could be used as potential substrates in the microfluidics paradigm. The theoretical and experimental investigation of an evaporating aqueous droplet, over a viscoelastic liquid substrate, could provide a fundamental perspective of the complex interplay amongst capillarity, viscosity, and elasticity, resulting in a wide array of intriguing dynamics, which could be important in several microscale processes. EXPERIMENTS: The evaporation dynamics of a water droplet atop an un-crosslinked polydimethylsiloxane film (polymeric liquid substrate) are examined using an optical goniometer and a laser scanning confocal microscopy, to discern the interfaces. The recorded videos were analyzed to estimate the contact angles, velocities, and other parameters of relevance. FINDINGS: The viscoelasticity of the film, in conjunction with evaporation, triggered a self-propulsion in the droplet, leading to crumpling of the polymeric film, and finally culminating in the encapsulation of the water drop by the polymer. The evaporation caused a dynamic variation in both the radius and contact angle of the droplet. The physics of the hitherto unreported phenomena is explained via the development of a semi-analytical model, considering all the relevant forces. We postulate that this symbiotic and self-sustained dynamics would pave the path towards the comprehension of micro-swimmers and surface encapsulation, to name a few.

Accuracy of a smartwatch based single-lead electrocardiogram device in detection of atrial fibrillation.

OBJECTIVE: The AliveCor KardiaBand (KB) is an Food and Drug Administration-approved smartwatch-based cardiac rhythm monitor that records a lead-Intelligent ECG (iECG). Despite the appeal of wearable integrated ECG devices, there is a paucity of data evaluating their accuracy in diagnosing atrial fibrillation (AF). We evaluated whether a smartwatch-based device for AF detection is an accurate tool for diagnosing AF when compared with 12-lead ECG. METHODS: A prospective, multi-centre, validation study was conducted in an inpatient hospital setting. The KB paired with a smartwatch, generated an automated diagnosis of AF or sinus rhythm (SR). This was compared with a 12-lead ECG performed immediately after iECG tracing. Where an unclassified or no-analysis tracing was generated, repeat iECG was performed. RESULTS: 439 ECGs (iECGs (n=239) and 12-lead ECG (n=200)) were recorded in 200 patients (AF: n=38; SR: n=162) from three tertiary centres. Sensitivity and specificity using KB was 94.4% and 81.9% respectively, with a positive predictive value of 54.8% and negative predictive value of 98.4%. Agreement between 12-lead ECG and KB diagnosis was moderate when unclassified tracings were included (κ=0.60, 95% CI 0.47 to 0.72). Combining the automated device diagnosis with blinded electrophysiologists (EP) interpretation of unclassified tracings improved overall agreement (EP1: κ=0.76, 95% CI 0.65 to 0.87; EP2: κ=0.74, 95% CI 0.63 to 0.86). CONCLUSION: The KB demonstrated moderate diagnostic accuracy when compared with a 12-lead ECG. Combining the automated device diagnosis with EP interpretation of unclassified tracings yielded improved accuracy. However, even with future improvements in automated algorithms, physician involvement will likely remain an essential component when exploring the utility of these devices for arrhythmia screening. CLINICAL TRIAL REGISTRATION: URL: https://www.anzctr.org.au/ Unique identifier: ACTRN12616001374459.

Algorithm-improved high-speed and non-invasive confocal Raman imaging of 2D materials.

Confocal Raman microscopy is important for characterizing 2D materials, but its low throughput significantly hinders its applications. For metastable materials such as graphene oxide (GO), the low throughput is aggravated by the requirement of extremely low laser dose to avoid sample damage. Here we introduce algorithm-improved confocal Raman microscopy (ai-CRM), which increases the Raman scanning rate by one to two orders of magnitude with respect to state-of-the-art works for a variety of 2D materials. Meanwhile, GO can be imaged at a laser dose that is two to three orders of magnitude lower than previously reported, such that laser-induced variations of the material properties can be avoided. ai-CRM also enables fast and spatially resolved quantitative analysis, and is readily extended to 3D mapping of composite materials. Since ai-CRM is based on general mathematical principles, it is cost-effective, facile to implement and universally applicable to other hyperspectral imaging methods.

Modified positioning of a smartphone based single-lead electrocardiogram device improves detection of atrial flutter.

INTRODUCTION: The AliveCor Kardia Mobile (AKM) is a handheld, smartphone based cardiac rhythm monitor that records a lead-I electrocardiogram (ECG). Despite being efficacious for detection of atrial fibrillation (AF), it is unclear whether atrial flutter (AFL) may be misdiagnosed as sinus rhythm due to regular R-R intervals. We hypothesised that generating lead-II tracings through repositioning of the AKM may improve visualisation of flutter waves and clinician diagnosis of AFL compared to traditional lead-I tracings. MATERIALS AND METHODS: A prospective, multi-centre, validation study was conducted comparing standard lead-I AKM positioning with lead-II in AFL. A mixed cohort of lead I tracings from patients in AF and sinus rhythm were also included. Two independent electrophysiologists (EP) analysed all ECGs blinded to the automated device diagnosis. RESULTS: Fifty patients were recruited, 11 in atrial flutter, 14 in atrial fibrillation, and 25 in sinus rhythm. Lead-I AFL sensitivity was 27.3% for both EP's which individually improved to 72.7% and 54.6% in lead-II. AKM appropriately diagnosed lead-I AFL as unclassified in 18.2% of cases, compared to 54.5% in lead-II. Overall clinician agreement (AF, SR and AFL) was modest utilising AFL lead-I (EP1: κ = 0.71, EP2: κ = 0.73, p < 0.001), which improved with lead-II tracings (EP1: κ = 0.87, EP2: κ = 0.83, both p < 0.001). CONCLUSION: Repositioning of the AKM device improves clinician diagnosis of atrial flutter. A lead-II tracing may be considered in high-risk patients to improve detection of atrial flutter.