Predictors of successful neonatal intubation in inexperienced operators: a secondary, non-randomised analysis of the SHINE trial.

OBJECTIVE: Neonatal endotracheal intubation is a lifesaving but technically difficult procedure, particularly for inexperienced operators. This secondary analysis in a subgroup of inexperienced operators of the Stabilization with nasal High flow during Intubation of NEonates randomised trial aimed to identify the factors associated with successful intubation on the first attempt without physiological stability of the infant. METHODS: In this secondary analysis, demographic factors were compared between infants intubated by inexperienced operators and those intubated by experienced operators. Following this, for inexperienced operators only, predictors of successful intubation without physiological instability were analysed. RESULTS: A total of 251 intubations in 202 infants were included in the primary intention-to-treat analysis of the main trial. Inexperienced operators were more likely to perform intubations in larger and more mature infants in the neonatal intensive care unit where premedications were used. When intubations were performed by inexperienced operators, the use of nasal high flow therapy (nHF) and a higher starting fraction of inspired oxygen were associated with a higher rate of safe, successful intubation on the first attempt. There was a weaker association between premedication use and first attempt success. CONCLUSIONS: In inexperienced operators, this secondary, non-randomised analysis suggests that the use of nHF and premedications, and matching the operator to the infant and setting, may be important to optimise neonatal intubation success. TRIAL REGISTRATION NUMBER: ACTRN12618001498280.

How Low Back Pain is Managed-A Mixed-Methods Study in 32 Countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series.

BACKGROUND: The Lancet Low Back Pain (LBP) Series highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs and (2) how that care is delivered. DESIGN: An online mixed-methods study. METHODS: A Consortium for LBP in LMICs (n = 65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with 5 years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using inductive and deductive coding and developed a thematic framework. RESULTS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women, 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and people with lived experience (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The thematic framework comprised 8 themes: (1) self-management is ubiquitous, (2) medicines are the cornerstone, (3) traditional therapies have a place, (4) society plays an important role, (5) imaging use is very common, (6) reliance on passive approaches, (7) social determinants influence LBP care pathway, and (8) health systems are ill-prepared to address LBP burden. CONCLUSION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. J Orthop Sports Phys Ther 2024;54(8):560-572. Epub 11 April 2024. doi:10.2519/jospt.2024.12406.

Fin-Bayes: A Multi-Objective Bayesian Optimization Framework for Soft Robotic Fingers.

Computational design is a critical tool to realize the full potential of Soft Robotics, maximizing their inherent benefits of high performance, flexibility, robustness, and safe interaction. Practically, computational design entails a rapid iterative search process over a parameterized design space, with assessment using (frequently) computational modeling and (more rarely) physical experimentation. Bayesian approaches work well for these expensive-to-analyze systems and can lead to efficient exploration of design space than comparative algorithms. However, such computational design typically entails weaknesses related to a lack of fidelity in assessment, a lack of sufficient iterations, and/or optimizing to a singular objective function. Our work directly addresses these shortcomings. First, we harness a sophisticated nonlinear Finite Element Modeling suite that explicitly considers geometry, material, and contact nonlinearity to perform rapid accurate characterization. We validate this through extensive physical testing using an automated test rig and printed robotic fingers, providing far more experimental data than that reported in the literature. Second, we explore a significantly larger design space than comparative approaches, with more free variables and more opportunity to discover novel, high performance designs. Finally, we use a multiobjective Bayesian optimizer that allows for the identification of promising trade-offs between two critical objectives, compliance and contact force. We test our framework on optimizing Fin Ray grippers, which are ubiquitous throughout research and industry due to their passive compliance and durability. Results demonstrate the benefits of our approach, allowing for the optimization and identification of promising gripper designs within an extensive design space, which are then 3D printed and usable in reality.

Cerebral Oxygenation during Neonatal Intubation with Nasal High Flow: A Sub-Study of the SHINE Randomized Trial.

INTRODUCTION: Nasal high flow (nHF) improves the likelihood of successful neonatal intubation on the first attempt without physiological instability. The effect of nHF on cerebral oxygenation is unknown. The aim of this study was to compare cerebral oxygenation during endotracheal intubation in neonates receiving nHF and those receiving standard care. METHODS: A sub-study of a multicentre randomized trial of nHF during neonatal endotracheal intubation. A subset of infants had near-infrared spectroscopy (NIRS) monitoring. Eligible infants were randomly assigned to nHF or standard care during the first intubation attempt. NIRS sensors provided continuous regional cerebral oxygen saturation (rScO2) monitoring. The procedure was video recorded, and peripheral oxygen saturation and rScO2 data were extracted at 2-second intervals. The primary outcome was the average difference in rScO2 from baseline during the first intubation attempt. Secondary outcomes included average rScO2 and rate of change of rScO2. RESULTS: Nineteen intubations were analyzed (11 nHF; 8 standard care). Median (interquartile range [IQR]) postmenstrual age was 27 (26.5-29) weeks, and weight was 828 (716-1,135) g. Median change in rScO2 from baseline was -1.5% (-5.3 to 0.0) in the nHF group and -9.4% (-19.6 to -4.5) in the standard care group. rScO2 fell more slowly in infants managed with nHF compared with standard care: median (IQR) rScO2 change -0.08 (-0.13 to 0.00) % per second and -0.36 (-0.66 to -0.22) % per second, respectively. CONCLUSIONS: In this small sub-study, regional cerebral oxygen saturation was more stable in neonates who received nHF during intubation compared with standard care.

One-Shot 3D-Printed Multimaterial Soft Robotic Jamming Grippers.

Soft gripping provides the potential for high performance in challenging tasks through morphological computing; however, design explorations are limited by a combination of a difficulty in generating useful models and use of laborious fabrication techniques. We focus on a class of grippers based on granular jamming that are particularly difficult to model and introduce a "one shot" technique that exploits multimaterial three-dimensional (3D) printing to create entire grippers, including membrane and grains, in a single print run. This technique fully supports the de facto physical generate-and-test methodology used for this class of grippers, as entire design iterations can be fitted onto a single print bed and fabricated from Computer-Aided Design (CAD) files in a matter of hours. Initial results demonstrate the approach by rapidly prototyping in materio solutions for two challenging problems in unconventional design spaces; a twisting gripper that uses programmed deformations to reliably pick a coin, and a multifunctional legged robot paw that offers the ability for compliant locomotion over rough terrains, as well as being able to pick objects in cluttered natural environments. The technique also allows us to easily characterize the design space of multimaterial printed jamming grippers and provide some useful design rules. The simplicity of our technique encourages and facilitates creativity and innovation. As such, we see our approach as an enabling tool to make informed principled forays into unconventional design spaces and support the creation of a new breed of novel soft actuators.

Protocol for a randomised controlled trial comparing two CPAP levels to prevent extubation failure in extremely preterm infants.

INTRODUCTION: Respiratory distress syndrome is a complication of prematurity and extremely preterm infants born before 28 weeks' gestation often require endotracheal intubation and mechanical ventilation. In this high-risk population, mechanical ventilation is associated with lung injury and contributes to bronchopulmonary dysplasia. Therefore, clinicians attempt to extubate infants as quickly and use non-invasive respiratory support such as nasal continuous positive airway pressure (CPAP) to facilitate the transition. However, approximately 60% of extremely preterm infants experience 'extubation failure' and require reintubation. While CPAP pressures of 5-8 cm H2O are commonly used, the optimal CPAP pressure is unknown, and higher pressures may be beneficial in avoiding extubation failure. Our trial is the Extubation CPAP Level Assessment Trial (ÉCLAT). The aim of this trial is to compare higher CPAP pressures 9-11 cm H2O with a current standard pressures of 6-8 cmH2O on extubation failure in extremely preterm infants. METHODS AND ANALYSIS: 200 extremely preterm infants will be recruited prior to their first extubation from mechanical ventilation to CPAP. This is a parallel group randomised controlled trial. Infants will be randomised to one of two set CPAP pressures: CPAP 10 cmH2O (intervention) or CPAP 7 cmH2O (control). The primary outcome will be extubation failure (reintubation) within 7 days. Statistical analysis will follow standard methods for randomised trials on an intention to treat basis. For the primary outcome, this will be by intention to treat, adjusted for the prerandomisation strata (GA and centre). We will use the appropriate parametric and non-parametric statistical tests. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Monash Health Human Research Ethics Committees. Amendments to the trial protocol will be submitted for approval. The findings of this study will be written into a clinical trial report manuscript and disseminated via peer-reviewed journals (on-line or in press) and presented at national and international conferences.Trial registration numberACTRN12618001638224; pre-results.

Time to desaturation in preterm infants undergoing endotracheal intubation.

BACKGROUND: Neonatal endotracheal intubation is often associated with physiological instability. The Neonatal Resuscitation Program recommends a time-based limit (30 s) for intubation attempts in the delivery room, but there are limited physiological data to support recommendations in the neonatal intensive care unit (NICU). We aimed to determine the time to desaturation after ceasing spontaneous or assisted breathing in preterm infants undergoing elective endotracheal intubation in the NICU. METHODS: Observational study at The Royal Women's Hospital, Melbourne. A secondary analysis was performed of video recordings of neonates ≤32 weeks' postmenstrual age undergoing elective intubation. Infants received premedication including atropine, a sedative and muscle relaxant. Apnoeic oxygenation time (AOT) was defined as the time from the last positive pressure or spontaneous breath until desaturation (SpO2 <90%). RESULTS: Seventy-eight infants were included. The median (IQR) gestational age at birth was 27 (26-29) weeks and birth weight 946 (773-1216) g. All but five neonates desaturated to SpO2 <90% (73/78, 94%). The median (IQR) AOT was 22 (14-32) s. The median (IQR) time from ceasing positive pressure ventilation to desaturation <80% was 35 (24-44) s and to desaturation <60% was 56 (42-68) s. No episodes of bradycardia were seen. CONCLUSIONS: This is the first study to report AOT in preterm infants. During intubation of preterm infants in the NICU, desaturation occurs quickly after cessation of positive pressure ventilation. These data are important for the development of clinical guidelines for neonatal intubation. TRIAL REGISTRATION NUMBER: ACTRN12614000709640.

The Importance of Binomial Nomenclature for the Identification of Pollen Aeroallergens.

The diagnosis and treatment of atopic disorders associated with specific aerobiological triggers require basic botanical training. However, the identification of specific pollen can often be confounded by broad naming conventions that range from categorized colloquial to scientific names based on either higher taxonomic levels or, in some cases, binomial nomenclature. Physicians specializing in allergy often lack a comprehensive understanding with respect to plant taxonomy and botanical nomenclature that are critical skills required for clinical practice and research programs evaluating pollen and airborne fungal spores. In addition, binomial and current family designation and synonyms, including author citation are often misused, causing a misinterpretation of existing plants species or pollen types. It is critical that the correct botanical name is linked to a validated specimen and scientific naming conventions are used where possible by the clinician and researcher. In relation to pollen identification, we propose that clinicians and researchers should provide the currently accepted binomial nomenclature, offer relevant synonyms, and use the Angiosperm Phylogeny Group names.

Supraglottic airway devices for administration of surfactant to newborn infants with respiratory distress syndrome: a narrative review.

Surfactant is an effective treatment for respiratory distress syndrome, being particularly important for infants in whom continuous positive airway pressure (CPAP) provides insufficient support. Supraglottic airway devices present an attractive option for surfactant delivery, particularly as an alternative to methods dependent on direct laryngoscopy, a procedural skill that is both difficult to learn and in which to maintain competence. Published studies provide encouraging data that surfactant administration by supraglottic airway device can be performed with a high rate of success and may reduce the need for subsequent intubation compared with either continued CPAP or surfactant administration via endotracheal tube. However, existing randomised controlled trials (RCTs) are heterogeneous in design and include just over 350 infants in total. To date, all RCT evidence has been generated in tertiary units, whereas the greatest potential for benefit from the use of these devices is likely to be in non-tertiary settings. Future research should investigate choice and utility of device in addition to safety and effectiveness of procedure. Importantly, studies conducted in non-tertiary settings should evaluate feasibility, meaningful clinical outcomes and the impact that this approach might have on infants and their families. Supraglottic airway devices may represent a simple and effective mode of surfactant administration that can be widely used by a variety of clinicians. However, further well-designed RCTs are required to determine their role, safety and effectiveness in both tertiary and non-tertiary settings before introduction into routine clinical practice.

Gas flow in preterm infants treated with bubble CPAP: an observational study.

OBJECTIVE: To measure the nasal gas flow in infants treated with bubble continuous positive airway pressure (CPAP) and compare it with commonly used flows during nasal high flow (nHF) treatment. DESIGN: This is a prospective, single-centre study. Bubble CPAP pressure was measured at the nasal prongs. Set gas flow was reduced until bubbling in the water chamber just ceased. Set gas flow without bubbling then approximated flow entering the infant's nose ('delivered flow'). SETTING: Neonatal intensive care at The Royal Women's Hospital, Melbourne, Australia. PATIENTS: Clinically stable preterm infants receiving bubble CPAP therapy. MAIN OUTCOME MEASURE: Delivered flow (L/min) when bubbling stopped at a range of clinically set CPAP pressures (cm H2O). RESULTS: Forty-four infants were studied, with a mean (SD) gestational age at birth of 28.4 (2.2) weeks and birth weight of 1154 (419) g. At the time of the study, infants had a median (IQR) age of 4.5 (2-12) days and a mean (SD) weight of 1205 (407) g. Delivered flow ranged from 0.5 to 9.0 L/min, and increased with higher set CPAP pressures (median 3.5 L/min at CPAP 5 cm H2O vs 6.3 L/min at CPAP 8 cm H2O) and heavier weights (median 3.5 L/min in infants <1000 g vs 6.5 L/min for infants >1500 g). CONCLUSIONS: Nasal gas flows during bubble CPAP in preterm infants are similar to flows used during nHF and increase with higher set bubble CPAP pressures and in larger infants. Trial registration number ACTRN12619000197134.

Feeding Arsenic-Containing Rice Bran to Growing Pigs: Growth Performance, Arsenic Tissue Distribution, and Arsenic Excretion.

This research was conducted to study the growth performance, arsenic (As) tissue distribution, and As excretion of pigs fed As-containing rice bran. Twenty gilts (26.3 kg) were randomly assigned to 3 dietary treatments (n = 6 or 7) with Diets I, II, and III containing 0, 36.7, and 73.5% rice bran and 0, 306, and 612 ppb As, respectively. Pigs were fed for 6 weeks, and their growth performance and daily activities were examined. Fecal, blood, and hair samples were collected immediately before and after the 6-weeks. At the end of the 6-weeks, pigs were slaughtered; the liver, kidney, muscle, and urine samples were collected. No pig showed any unhealthy signs throughout the trial. The average daily feed intake, average daily gain, and final body weight of Diet III pigs were lower (p ≤ 0.001) than Diet I pigs. The gain to feed ratios were not different among the treatments. The fecal, hair, kidney, and urinary As concentrations of both Diets II and III pigs were higher than Diet I pigs. The hair As concentration of Diet III pigs was higher than Diet II pigs, but no difference was found in the fecal, urinary, kidney, or muscle As concentrations between Diets II and III pigs. The blood and muscle As concentrations were below 10 ppb. These results suggest that 73.5% dietary rice bran inclusion compromised growth performance, whereas the 36.7% inclusion did not. The fecal As data imply that dietary As was poorly absorbed by the gastrointestinal tract. The tissue As data indicate that the absorbed As was rapidly cleared from the blood with some retained in various organs and others eliminated via urine. The hair As concentration was much higher than that of liver and kidney. The muscle As data suggest that the pork produced from the pigs fed a typical As-containing rice bran as used in this study is safe for human consumption.

A multicentre, randomised trial of stabilisation with nasal high flow during neonatal endotracheal intubation (the SHINE trial): a study protocol.

INTRODUCTION: Neonatal endotracheal intubation is an essential but potentially destabilising procedure. With an increased focus on avoiding mechanical ventilation, particularly in preterm infants, there are fewer opportunities for clinicians to gain proficiency in this important emergency skill. Rates of successful intubation at the first attempt are relatively low, and adverse event rates are high, when compared with intubations in paediatric and adult populations. Interventions to improve operator success and patient stability during neonatal endotracheal intubations are needed. Using nasal high flow therapy extends the safe apnoea time of adults undergoing upper airway surgery and during endotracheal intubation. This technique is untested in neonates. METHODS AND ANALYSIS: The Stabilisation with nasal High flow during Intubation of NEonates (SHINE) trial is a multicentre, randomised controlled trial comparing the use of nasal high flow during neonatal intubation with standard care (no nasal high flow). Intubations are randomised individually, and stratified by site, use of premedications, and postmenstrual age (<28 weeks' gestation; ≥28 weeks' gestation). The primary outcome is the incidence of successful intubation on the first attempt without physiological instability of the infant. Physiological instability is defined as an absolute decrease in peripheral oxygen saturation >20% from preintubation baseline and/or bradycardia (<100 beats per minute). ETHICS AND DISSEMINATION: The SHINE trial received ethical approval from the Human Research Ethics Committees of The Royal Women's Hospital, Melbourne, Australia and Monash Health, Melbourne, Australia. The trial is currently recruiting in these two sites. The findings of this study will be disseminated via peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER: ACTRN12618001498280.

Active RAC1 Promotes Tumorigenic Phenotypes and Therapy Resistance in Solid Tumors.

Acting as molecular switches, all three members of the Guanosine triphosphate (GTP)-ase-family, Ras-related C3 botulinum toxin substrate (RAC), Rho, and Cdc42 contribute to various processes of oncogenic transformations in several solid tumors. We have reviewed the distribution of patterns regarding the frequency of Ras-related C3 botulinum toxin substrate 1 (RAC1)-alteration(s) and their modes of actions in various cancers. The RAC1 hyperactivation/copy-number gain is one of the frequently observed features in various solid tumors. We argued that RAC1 plays a critical role in the progression of tumors and the development of resistance to various therapeutic modalities applied in the clinic. With this perspective, here we interrogated multiple functions of RAC1 in solid tumors pertaining to the progression of tumors and the development of resistance with a special emphasis on different tumor cell phenotypes, including the inhibition of apoptosis and increase in the proliferation, epithelial-to-mesenchymal transition (EMT), stemness, pro-angiogenic, and metastatic phenotypes. Our review focuses on the role of RAC1 in adult solid-tumors and summarizes the contextual mechanisms of RAC1 involvement in the development of resistance to cancer therapies.

Evaluation of production parameters and health of dairy cows treated with pegbovigrastim in the transition period.

The aim of this study was to evaluate the effects of pegbovigrastim injection (Imrestor, Elanco Animal Health, Greenfield, IN) on production parameters and postpartum disease occurrence (retained placenta, metritis, displaced abomasum, and clinical mastitis) in dairy cows. Study cows (n = 270) were blocked by parity group (multiparous or primiparous) and randomly assigned to control (CON, n = 144) or pegbovigrastim treatment (IMR, n = 126). Ten ± 4 days before expected calving and again at calving, IMR cows received 2.7 mL of Imrestor and CON cows received 2.7 mL of 0.9 % saline. Milk yield, fat, protein, lactose, solids nonfat (SNF) percent, and somatic cell count (SCC), body condition, hygiene, and lameness were evaluated weekly. Animals were evaluated for metritis twice weekly through rectal temperature, palpation, and uterine discharge evaluation until 30 days in milk. Farm personnel recorded other postpartum diseases. The MIXED procedure of SAS was used to evaluate milk composition and milk yields were analyzed as repeated measures in time with block, treatment, calving month, and lactation week included in mixed models. The GLIMMIX procedure was used to evaluate mastitis and metritis occurrence. Variables entered a model if P ≤ 0.10 when screened individually. Variables with P ≤ 0.10 were kept in the final model. Milk yield, fat, protein, lactose, SNF, and log of SCC were not significantly affected by treatment. Clinical mastitis occurrence did not differ between treatments, but only 17 cases were detected. Compared to CON, IMR treated cows had increased clinical metritis incidence, and were 2.46 times more likely to develop the disease. No difference was observed on puerperal metritis ocurrence. Cows given pegbovigrastim injections had increased odds of developing clinical signs of metritis, but no negative effects on milk production or composition were observed.

Severe lung disease characterized by lymphocytic bronchiolitis, alveolar ductitis, and emphysema (BADE) in industrial machine-manufacturing workers.

BACKGROUND: A cluster of severe lung disease occurred at a manufacturing facility making industrial machines. We aimed to describe disease features and workplace exposures. METHODS: Clinical, functional, radiologic, and histopathologic features were characterized. Airborne concentrations of thoracic aerosol, metalworking fluid, endotoxin, metals, and volatile organic compounds were measured. Facility airflow was assessed using tracer gas. Process fluids were examined using culture, polymerase chain reaction, and 16S ribosomal RNA sequencing. RESULTS: Five previously healthy male never-smokers, ages 27 to 50, developed chest symptoms from 1995 to 2012 while working in the facility's production areas. Patients had an insidious onset of cough, wheeze, and exertional dyspnea; airflow obstruction (mean FEV1 = 44% predicted) and reduced diffusing capacity (mean = 53% predicted); and radiologic centrilobular emphysema. Lung tissue demonstrated a unique pattern of bronchiolitis and alveolar ductitis with B-cell follicles lacking germinal centers, and significant emphysema for never-smokers. All had chronic dyspnea, three had a progressive functional decline, and one underwent lung transplantation. Patients reported no unusual nonoccupational exposures. No cases were identified among nonproduction workers or in the community. Endotoxin concentrations were elevated in two air samples; otherwise, exposures were below occupational limits. Air flowed from areas where machining occurred to other production areas. Metalworking fluid primarily grew Pseudomonas pseudoalcaligenes and lacked mycobacterial DNA, but 16S analysis revealed more complex bacterial communities. CONCLUSION: This cluster indicates a previously unrecognized occupational lung disease of yet uncertain etiology that should be considered in manufacturing workers (particularly never-smokers) with airflow obstruction and centrilobular emphysema. Investigation of additional cases in other settings could clarify the cause and guide prevention.

Outcomes following antenatal identification of hydrops fetalis: a single-centre experience from 2001 to 2012.

OBJECTIVE: To describe the aetiologies and outcomes of pregnancies complicated by hydrops fetalis (HF). STUDY DESIGN: Case series of all pregnancies complicated by HF managed at The Royal Women's Hospital (RWH), Melbourne, Australia, between 2001 and 2012. Multiple pregnancies, and cases where antenatal care was not provided at RWH were excluded. Cases were identified from neonatal and obstetric databases. Data were extracted from maternal and neonatal case files, electronic pathology and radiology reports, and obstetric and neonatal databases. RESULTS: Over 12 years, 131 fetuses with HF with a median (IQR) gestational age (GA) at diagnosis of 24 (20-30) weeks were included in the analysis. There were 65 liveborn infants with a median (IQR) GA at birth of 33 (31-37) weeks and a median (IQR) birthweight Z-score of 1.4 (0.4-2.2). Overall survival from diagnosis was 27% (36/131) increasing to 55% (36/65) if born alive. CONCLUSIONS: The perinatal mortality risk for fetuses and newborn infants with HF is high with important differences dependent on underlying diagnosis and the time at which counselling is provided. Clinicians need to be aware of the outcomes of both fetuses and neonates with this condition.

Indirect Immunodetection of Fungal Fragments by Field Emission Scanning Electron Microscopy.

Submicronic fungal fragments have been observed in in vitro aerosolization experiments. The occurrence of these particles has therefore been suggested to contribute to respiratory health problems observed in mold-contaminated indoor environments. However, the role of submicronic fragments in exacerbating adverse health effects has remained unclear due to limitations associated with detection methods. In the present study, we report the development of an indirect immunodetection assay that utilizes chicken polyclonal antibodies developed against spores from Aspergillus versicolor and high-resolution field emission scanning electron microscopy (FESEM). Immunolabeling was performed with A. versicolor fragments immobilized and fixed onto poly-l-lysine-coated polycarbonate filters. Ninety percent of submicronic fragments and 1- to 2-µm fragments, compared to 100% of >2-µm fragments generated from pure freeze-dried mycelial fragments of A. versicolor, were positively labeled. In proof-of-concept experiments, air samples collected from moldy indoor environments were evaluated using the immunolabeling technique. Our results indicated that 13% of the total collected particles were derived from fungi. This fraction comprises 79% of the fragments that were detected by immunolabeling and 21% of the spore particles that were morphologically identified. The methods reported in this study enable the enumeration of fungal particles, including submicronic fragments, in a complex heterogeneous environmental sample.