Aircraft observations in a tropical supercluster over the equatorial Indian Ocean during MISO-BOB field campaign.

The Monsoon Intra-Seasonal Oscillations in the Bay of Bengal (MISO-BOB) field campaign was conducted in the Indian Ocean during the 2018 and 2019 summer monsoon seasons. WC-130J aircraft of the 53rd Weather Reconnaissance Squadron of the US Air Force participated in the campaign in June 2018. The dropsonde observations across a tropical supercluster showed zonal wind variations in association with the structure of the convectively coupled Kelvin wave (CCKW). Within the supercluster, easterlies (westerlies) were observed in the upper (lower) troposphere; this transformation occurred just below the 0[Formula: see text] C level. The cold pool had an easterly component throughout, and it was coldest (by 2.5[Formula: see text] C) at the center of the supercluster, deepest ([Formula: see text] [Formula: see text]) at its rear/western end, and shallowest ([Formula: see text] 300 m) at the front/eastern end. The level of free convection (LFC) at the front end was at [Formula: see text] altitude. At the eastern flank of the supercluster, zonal convergence in the lower troposphere occurred between 500-1500 m levels above the surface between the westerlies within the supercluster and opposing ambient easterlies. Thus, the uplifting of conditionally unstable air parcels above LFC to the east of the supercluster was likely to occur due to this convergence rather than the cold pool influence. Conversely, the western flank of the supercluster had low-level zonal divergence. These observations support the notion of 'self-similarity' among the mesoscale convective systems and large-scale waves.

Protocol optimization of a targeted sequencing panel for genomic profiling of bronchoalveolar lavage fluid in lung cancer.

INTRODUCTION: We investigated a commercially available sequencing panel to study the effect of sequencing depth, variant calling strategy, and targeted sequencing region on identifying tumor-derived variants in cell-free bronchoalveolar lavage (cfBAL) DNA compared with plasma cfDNA. METHODS: Sequencing was performed at low or high coverage using two filtering algorithms to identify tumor variants on two panels targeting 77 and 197 genes respectively. RESULTS: One hundred and four sequencing files from 40 matched DNA samples of cfBAL, plasma, germline leukocytes, and archival tumor specimens in 10 patients with early-stage lung cancer were analyzed. By low-coverage sequencing, tumor-derived cfBAL variants were detected in 5/10 patients (50%) compared with 2/10 (20%) for plasma. High-coverage sequencing did not affect the number of tumor-derived variants detected in either biospecimen type. Accounting for germline mutations eliminated false-positive plasma calls regardless of coverage (0/10 patients with tumor-derived variants identified) and increased the number of cfBAL calls (5/10 patients with tumor-derived variants identified). These results were not affected by the number of targeted genes.

Seasonal temperature variability observed at abyssal depths in the Arabian Sea.

The abyssal ocean is generally considered an aseasonal environment decoupled from the variabilities observed at and just below the ocean's surface. Herein, we describe the first in-situ timeseries record of seasonal warming and cooling in the Arabian Sea at a depth of 4000 m. The seasonal cycle was observed over the nearly four-year-long record (from November 2018 to March 2022). The abyssal seasonal temperature cycle also exhibited noticeable interannual variability. We investigate whether or not surface processes influence the near-seabed temperature through deep meridional overturning circulation modulated by the Indian monsoon or by Rossby wave propagation. We also consider if bottom water circulation variability and discharge of the dense Persian Gulf and Red Sea Water may contribute to the observed seasonality.

Assessing ROSE for adequacy of EBUS-TBNA compared with a direct-to-cell block approach as a response to the COVID-19 pandemic.

INTRODUCTION: Rapid on-site evaluation (ROSE) has been used during the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure as standard practice. Because of the COVID-19 (coronavirus disease 2019) pandemic, our institute had had to discontinue ROSE and adopt a direct-to-cell block approach. In the present study, we aimed to determine whether this change has had significant effects on the cytopathology quality. MATERIALS AND METHODS: A total of 1903 EBUS-TBNA cases from 734 patients were collected (1097 cases with ROSE for 452 patients; 806 cases without ROSE but with direct-to-cell block for 282 patients). The clinical and cytology data were analyzed using SAS, version 9.4, software to render calculated standardized residuals and a fitted multivariate generalized linear model. RESULTS: On average, a biopsy from a patient with ROSE was 0.936 (=exp -0.066) times less likely to be reported as satisfactory compared with a biopsy from a patient without ROSE, although the difference was not statistically significant (P = 0.785). The inadequacy rate of EBUS-TBNA was 6.4% higher on average for cases with ROSE compared with a direct-to-cell block approach. However, this difference was also not statistically significant. The proportions of biopsies reported as diagnostic for malignancy and other were significantly different between the ROSE and no-ROSE groups with a standardized residual of 1.80 (P = 0.036) and -2.27 (P = 0.012), respectively. CONCLUSIONS: Discontinuing ROSE and using a direct-to-cell block approach had no negative effects on cytopathology quality. This practice can be considered acceptable during the COVID-19 pandemic when social distancing and the shortage of staff and supplies have resulted in challenges to delivering quality care to cancer patients whose treatment cannot be postponed.

A prospective observational cohort study to evaluate patients' experience during sequential cataract surgery under monitored anesthesia care and topical anesthesia.

Cataract surgery is the most common ambulatory surgery at our outpatient surgery center. Several studies have shown that patients with bilateral cataracts may experience different levels of anxiety, pain, and awareness during the first and second cataract extraction.A prospective observational cohort study was conducted at The Ohio State University Wexner Medical Center Eye and Ear Institute in order to compare anxiety, general comfort, awareness, and pain levels in patients undergoing sequential cataract surgeries. Likert and numerical rating scale were used to assess the outcomes. Patients receiving monitored anesthesia care and topical anesthesia were included.A total of 198 patients were enrolled in this study, 116 patients (59%) were female and 157 patients (78%) were Caucasians with a median age of 67 years among participants. Patients with rating "no anxiety" or feeling "somewhat anxious" were significantly higher during surgery 2 (P =< .001). Most of the patients felt "extremely comfortable" during surgery 1 when compared to surgery 2 (54% vs 42.9%; P = .08). No significant differences were found between surgeries regarding intraoperative awareness (P = .16). Overall, patients experienced mild pain during both procedures (92.4% in surgery 1 compared to 90.4% in surgery 2; P = .55). During the postoperative visit, 54% of the patients associated surgery 2 with less anxiety levels, 53% with no differences in general comfort, 60% felt more aware, and 59% had no differences in pain levels.Previous exposure to surgery could have been associated with a significant reduction in anxiety levels reported during surgery 2. Non-pharmacological strategies aiming to reduce perioperative anxiety may be considered an alternative or additional approach to premedication in patients undergoing consecutive cataract surgeries.

Primary bronchial Ewing sarcoma.

INTRODUCTION: Primary bronchial Ewing sarcoma (ES) is a rare endobronchial tumor. PRESENTATION OF CASE: A 65-year-old male presented with six-month history of progressive shortness of breath. Flexible bronchoscopy showed an endobronchial polypoid tumor in the left main stem bronchus about 2 cm from the carina. The tumor was resected by a left bronchial sleeve resection using a right postero-lateral thoracotomy approach. Pathology showed complete tumor resection with negative margins. The morphological and immune-phenotypical features of the resected specimen were compatible with ES. He had an uneventful post-operative recovery. He did not receive adjuvant radiation or chemotherapy and remains disease free at 9 months follow up. DISCUSSION: A review of the literature identified six other cases of primary bronchial ES. In addition, there were three reported cases of primary ES involving the trachea and thirteen involving the lung parenchyma. Bronchial ES appeared to have a relatively better prognosis than ES involving the trachea or the lung. Our case demonstrates that primary bronchial ES may be treated safely with limited resection, lung preservation and without the need for adjuvant therapy if negative margins can be achieved. CONCLUSION: Sleeve resection without adjuvant therapy may be a safe treatment option for primary bronchial ES.

Endobronchial neurogenic tumor: A combination of traumatic neuroma and neurofibroma.

Traumatic neuromas are uncommon and benign lesions arising from a peripheral nerve injury during surgery. Here we describe a case with histopathologic features of both a traumatic neuroma and neurofibroma in a patient without integumentary physical exam findings nor prior surgical history. A 54 year old male was admitted for surgical debridement of a foot ulcer. During pre-operative evaluation and review of imaging multiple CT scans revealed a stable, 4 mm endobronchial lesion in the left lower lobe. Given history of nicotine abuse, bronchoscopy was performed. Bronchoscopy showed a pearly, polypoid lesion. Histopathological results showed strong positivity for S-100 protein and spindle cell proliferation. Repeat CT chest showed no new lesions in the bronchial tree. The rarity of this case is noted not only by the limited number of bronchial neurogenic tumors, but the combined features in this case of a traumatic neuroma and neurofibroma which has not been described.

Management of pain with diclofenac after femtosecond-assisted laser in situ keratomileusis.

PURPOSE: To evaluate the safety and efficacy of topical diclofenac sodium 0.1% after femtosecond laser-assisted laser in situ keratomileusis (LASIK). SETTING: W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA. DESIGN: Clinical trial. METHODS: Pain was assessed in patients treated with topical diclofenac sodium 0.1% or artificial tears immediately after LASIK using a numeric pain scale and a combined picture-numeric pain scale 0, 2, 4, 12, and 24 hours postoperatively. Visual outcomes and complications were noted up to 24 hours. RESULTS: The study enrolled 100 eyes of 50 patients. Patients treated with diclofenac 0.1% reported less pain than the control group on both pain scales 2, 4, 12, and 24 hours after surgery, with the maximum benefit at 4 hours (P=.02). Fewer patients in the diclofenac group (76.0%) than in the control group (91.3%) used oral pain and/or anxiolytic medications during the first 24 hours after surgery (P=.25). Ninety-eight eyes had an uncorrected distance visual acuity of 20/40 or better. Mild peripheral diffuse lamellar keratitis accounted for the majority of perioperative complications (n = 15). CONCLUSION: Pain after femtosecond laser-assisted LASIK was mild and was reduced with a single dose of topical diclofenac sodium 0.1% given immediately after surgery.

Comment on "Eddy/wind interactions stimulate extraordinary mid-ocean plankton blooms".

McGillicuddy et al. (Reports, 18 May 2007, p. 1021) proposed that eddy/wind interactions enhance the vertical nutrient flux in mode-water eddies, thus feeding large mid-ocean plankton blooms. We argue that the supply of nutrients to ocean eddies is most likely affected by submesoscale processes that act along the periphery of eddies and can induce vertical velocities several times larger than those due to eddy/wind interactions.