Preventing Iatrogenic Injury to the Vertebral Artery in Cervical Spine Surgery: A Case Report.

SUMMARY OF BACKGROUND DATA: Iatrogenic injury of the vertebral artery (VA) in the context of surgical approaches to the cervical spine has been cited as a relatively rare complication with varying degrees of severity ranging from minimal injury to acute stroke and can result in death. It is estimated that ~50% of cases of iatrogenic VA injury are preventable after postoperatively examining a patient's preoperative imaging. Despite the low incidence (<2%) of this complication, the potential associated morbidity demonstrates the importance of meticulous preoperative vascular consideration. OBJECTIVE: This study aims to emphasize the importance of preoperative vascular screening during anterior cervical access planning visualized through a rare case of a VA aberration in a 47-year-old patient. STUDY DESIGN: This study is designed as a retrospective case report. METHODS: A thorough chart review was performed for this subject including all prior medical records, imaging studies, imaging reports, operative notes, and communication records. RESULTS: The subject was found to have a history of patent foramen ovale (PFO) repair with a rare vertebral artery malformation described as a medial transposition of the vertebral artery out of the vertebral artery foramen between C3 and C4. CONCLUSIONS: Consideration of cervical anatomy, particularly the VA, is key to minimizing the risk of adverse surgical outcomes in both anterior and posterior approaches to the cervical spine. During the workup process, the patient's primary care providers, radiologists, and surgeons should be aware of the potential variations of the VA with particular attention given to the course of the VA on MR imaging. LEVEL OF EVIDENCE: Level IV.

Role of Biplane Double-Supported Screw Fixation (BDSF) in Management of Fracture Neck Femur and Its Comparison with Conventional CC Screw Fixation.

Background: The aim of this study is to evaluate comparative biomechanical fixation provided with the BDSF method with the conventional CC screw fixation for treatment of femoral neck fractures with three parallel cannulated screws. Methods: This is a prospective cohort study. There were two teams of surgeons out of which one team operated the patients with BDSF technique and second with conventional CC screw fixation technique; thus, the patients were randomly distributed into two groups. Patients were included in the study as per the following inclusion and exclusion criteria. Results: Union was achieved in 15 (83.33%) patients managed by conventional CC screw technique, while union was achieved in 11 (91.67%) patients managed by BDSF technique in the present study. The average Harris hip score in present study was 90 score in patients managed by BDSF technique, while the average Harris hip score in present study was 80 score in patients managed by BDSF technique. Conclusion: Both BDSF and conventional CC screw fixation are good fixation methods for fracture neck of femur. But functional outcome and fracture union rates are better with BDSF Technique. Although, there are some minor problems noted in BDSF technique such as outer cortical fracture at the entry point of beam screw and opening up of anterior cortex of oblique fracture patterns. Thus, BDSF method provides reliable fixation in which early mobilization and partial weight bearing of the patient may be allowed.

Enriching Surface-Accessible CO2 in the Zero-Gap Anion-Exchange-Membrane-Based CO2 Electrolyzer.

Zero-gap anion exchange membrane (AEM)-based CO2 electrolysis is a promising technology for CO production, however, their performance at elevated current densities still suffers from the low local CO2 concentration due to heavy CO2 neutralization. Herein, via modulating the CO2 feed mode and quantitative analyzing CO2 utilization with the aid of mass transport modeling, we develop a descriptor denoted as the surface-accessible CO2 concentration ([CO2 ]SA ), which enables us to indicate the transient state of the local [CO2 ]/[OH- ] ratio and helps define the limits of CO2 -to-CO conversion. To enrich the [CO2 ]SA , we developed three general strategies: (1) increasing catalyst layer thickness, (2) elevating CO2 pressure, and (3) applying a pulsed electrochemical (PE) method. Notably, an optimized PE method allows to keep the [CO2 ]SA at a high level by utilizing the dynamic balance period of CO2 neutralization. A maximum jCO of 368±28 mA cmgeo -2 was achieved using a commercial silver catalyst.

Urea-Functionalized Silver Catalyst toward Efficient and Robust CO2 Electrolysis with Relieved Reliance on Alkali Cations.

We report a new strategy to improve the reactivity and durability of a membrane electrode assembly (MEA)-type electrolyzer for CO2 electrolysis to CO by modifying the silver catalyst layer with urea. Our experimental and theoretical results show that mixing urea with the silver catalyst can promote electrochemical CO2 reduction (CO2R), relieve limitations of alkali cation transport from the anolyte, and mitigate salt precipitation in the gas diffusion electrode in long-term stability tests. In a 10 mM KHCO3 anolyte, the urea-modified Ag catalyst achieved CO selectivity 1.3 times better with energy efficiency 2.8-fold better than an untreated Ag catalyst, and operated stably at 100 mA cm-2 with a faradaic efficiency for CO above 85% for 200 h. Our work provides an alternative approach to fabricating catalyst interfaces in MEAs by modifying the catalyst structure and the local reaction environment for critical electrochemical applications such as CO2 electrolysis and fuel cells.

A case report and first-person account of an individual at risk for psychosis who improved during the COVID-19 pandemic.

Background: The COVID-19 pandemic is expected to increase stress and mental health symptoms. We present the case of a young man at risk for psychosis who has paradoxically shown symptomatic and functional improvement as a result of circumstances produced by COVID-19. These changes were unexpected given the client's persistent mental health struggles in the year leading up to the COVID-19 outbreak in the United States and the expectation of an exacerbation of psychotic-like symptoms. Methods: This report is based on clinical assessments and the client's first-person account during the height of the pandemic when stay at home orders were in place. Results: During the pandemic, the client demonstrated increased agency by taking on more responsibility at home and obtaining part-time employment. He showed improvement in his mood and relationships with others, had less symptom-related distress, and significantly reduced his cannabis use. The client interpreted these improvements in terms of changing his mindset toward more adaptive thoughts and engaging in healthy coping skills such as praying, reading, and healthy eating. Conclusions: This case highlights the importance of fostering agency in clients during a time of crisis and ensuring that clinicians be aware of potential biases about mental health symptom exacerbation.

Multi-objective optimization of thermophysical properties of multiwalled carbon nanotubes based nanofluids.

The experimental determination of thermophysical properties of nanofluid (NF) is time-consuming and costly, leading to the use of soft computing methods such as response surface methodology (RSM) and artificial neural network (ANN) to estimate these properties. The present study involves modelling and optimization of thermal conductivity and viscosity of NF, which comprises multi-walled carbon nanotubes (MWCNTs) and thermal oil. The modelling is performed to predict the thermal conductivity and viscosity of NF by using Response Surface Methodology (RSM) and Artificial Neural Network (ANN). Both models were tested and validated, which showed promising results. In addition, a detailed optimization study was conducted to investigate the optimum thermal conductivity and viscosity by varying temperature and NF weight per cent. Four case studies were explored using different objective functions based on NF application in various industries. The first case study aimed to maximize thermal conductivity (0.15985 W/m oC) while minimizing viscosity (0.03501 Pa s) obtained at 57.86 °C and 0.85 NF wt%. The goal of the second case study was to minimize thermal conductivity (0.13949 W/m °C) and viscosity (0.02526 Pa s) obtained at 55.88 °C and 0.15 NF wt%. The third case study targeted maximizing thermal conductivity (0.15797 W/m °C) and viscosity (0.07611 Pa s), and the optimum temperature and NF wt% were 30.64 °C and 0.0.85,' respectively. The last case study explored the minimum thermal conductivity (0.13735) and maximum viscosity (0.05263 Pa s) obtained at 30.64 °C and 0.15 NF wt%.

Lipid emulsion for the treatment of acute organophosphate poisoning: an Open-Label randomized trial.

INTRODUCTION: Many organophosphate (OP) pesticides are lipid-soluble; therefore, intravenous lipid emulsion (ILE) has been evaluated as a possible treatment for acute poisoning. A single bolus dose of 100 ml of 20% ILE was found safe in a pilot observational study. This randomized trial aimed to assess the effectiveness and safety of an extended dose of ILE in acute OP poisoning. METHODS: This was an investigator-initiated, parallel-group, open-label, randomized controlled trial conducted at PGIMER, Chandigarh (India), from January 2019 to June 2020, in patients aged above 13 years with acute OP poisoning. The primary efficacy outcome was to study the change in atropine dose requirement (total and over the first 24 h) for cholinergic crisis after giving an initial bolus dose of 100 ml of 20% ILE followed by an infusion of 100 ml of 20% ILE over 6 h in addition to the standard care. The secondary efficacy outcomes were to detect the effects on hemodynamic variables, length of hospital stay, and duration of mechanical ventilation required. The incidence of adverse events was evaluated. RESULTS: A total of 45 patients were assigned to receive either ILE (intervention group, n = 23) or normal saline (control group, n = 22) in addition to standard treatment. Baseline variables in both groups were comparable. The median dose of atropine (in mg) in the first 24 h and at complete resolution in the ILE group were similar to the control group (124.0 versus 141.8, p-value 0.916; and 150.8 versus 175.0, p-value 0.935). Hemodynamic variables (systolic and diastolic blood pressures, mean arterial pressure, and pulse rate) over 24, 48, and 72 h of treatment, length of hospital stay, and duration of mechanical ventilation were also unaffected by ILE. Case fatality was 4 and not statistically different between intervention and control groups (1 versus 3, p-value 0.346). There was no excessive fever, dyspnea, elevation of serum amylase, or pancreatitis from ILE. CONCLUSION: ILE has no apparent benefit in acute OP poisoning. However, an extended dose appears safe for the indication.

ANN Assisted-IoT Enabled COVID-19 Patient Monitoring.

COVID-19 is an extremely dangerous disease because of its highly infectious nature. In order to provide a quick and immediate identification of infection, a proper and immediate clinical support is needed. Researchers have proposed various Machine Learning and smart IoT based schemes for categorizing the COVID-19 patients. Artificial Neural Networks (ANN) that are inspired by the biological concept of neurons are generally used in various applications including healthcare systems. The ANN scheme provides a viable solution in the decision making process for managing the healthcare information. This manuscript endeavours to illustrate the applicability and suitability of ANN by categorizing the status of COVID-19 patients' health into infected (IN), uninfected (UI), exposed (EP) and susceptible (ST). In order to do so, Bayesian and back propagation algorithms have been used to generate the results. Further, viterbi algorithm is used to improve the accuracy of the proposed system. The proposed mechanism is validated over various accuracy and classification parameters against conventional Random Tree (RT), Fuzzy C Means (FCM) and REPTree (RPT) methods.

NERO: a biomedical named-entity (recognition) ontology with a large, annotated corpus reveals meaningful associations through text embedding.

Machine reading (MR) is essential for unlocking valuable knowledge contained in millions of existing biomedical documents. Over the last two decades1,2, the most dramatic advances in MR have followed in the wake of critical corpus development3. Large, well-annotated corpora have been associated with punctuated advances in MR methodology and automated knowledge extraction systems in the same way that ImageNet4 was fundamental for developing machine vision techniques. This study contributes six components to an advanced, named entity analysis tool for biomedicine: (a) a new, Named Entity Recognition Ontology (NERO) developed specifically for describing textual entities in biomedical texts, which accounts for diverse levels of ambiguity, bridging the scientific sublanguages of molecular biology, genetics, biochemistry, and medicine; (b) detailed guidelines for human experts annotating hundreds of named entity classes; (c) pictographs for all named entities, to simplify the burden of annotation for curators; (d) an original, annotated corpus comprising 35,865 sentences, which encapsulate 190,679 named entities and 43,438 events connecting two or more entities; (e) validated, off-the-shelf, named entity recognition (NER) automated extraction, and; (f) embedding models that demonstrate the promise of biomedical associations embedded within this corpus.

Cardiac injury in organophosphate poisoning after acute ingestion.

INTRODUCTION: Sparse data and conflicting evidence exist on the prevalence and prognosis of organophosphate (OP)-related cardiac toxicity. We aimed to characterize the cardiac abnormalities of OP after an acute cholinergic crisis in adults without previous cardiovascular conditions. PATIENTS AND METHODS: We did a prospective observational study in a tertiary-care hospital of north India (Postgraduate Institute of Medical Education and Research, Chandigarh) in 74 patients aged ≥ 13 years admitted with acute OP poisoning after self-ingestion. A systemic evaluation, including clinical characteristics, electrocardiography, and echocardiography, was performed to estimate the prevalence and prognosis of cardiac injury. A rate-corrected QT interval was calculated using Bazett's method, and >440 milliseconds was used to define prolongation. RESULTS: Chlorpyrifos was the most commonly ingested OP (n = 29). The patients had a similar occurrence of hypotension (n = 10) and hypertension (n = 9) at admission, and electrocardiography demonstrated sinus tachycardia in 38 (51.3%) and sinus bradycardia in one case. During the hospital stay, 3 out of 74 patients had a prolonged rate-corrected QT interval (457, 468, and 461 milliseconds), and one patient developed supraventricular tachycardia. Eight (10.8%) patients developed the intermediate syndrome, and six (8.1%) died. None of the hemodynamic or electrocardiographic abnormalities was associated with in-hospital mortality or intermediate syndrome development on univariant analysis. Baseline echocardiography at hospital discharge was performed in 27 patients (admitted during 2018) and normal in all except mild tricuspid regurgitation in one. At a 6-month follow-up, 23 cases were available for cardiovascular screening (including echocardiography) and had a normal evaluation. CONCLUSION: Cardiac toxicity is uncommon after acute OP self-ingestion and lacks prognostic significance.

Cobalt Electrochemical Recovery from Lithium Cobalt Oxides in Deep Eutectic Choline Chloride+Urea Solvents.

Electrochemical recovery of the cobalt in deep eutectic solvent shows its promise in recycling and recovery of valuable elements from the spent lithium-ion battery due to its high selectivity and minimal environmental impacts. This work unveiled the roles of the substrates, applied potentials, and operating temperatures on the performance of cobalt electrochemical recovery in a deep eutectic choline chloride+urea solvent. The solvent contains cobalt and lithium ions extracted from lithium cobalt oxides - 3an essential lithium-ion battery cathode material. Our results highlight that the substrate predetermines the cobalt recovery modes via substrate-cobalt interactions, which could be predicted by the cobalt surface segregation energies and crystallographic misfits. We also show that a moderate cathode potential under -1.0 V vs. silver quasi-reference electrode at 94-104 °C is essential to ensure a selective cobalt recovery at an optimal rate. We also found that the stainless-steel mesh is an optimal substrate for cobalt recovery due to its relatively high selectivity, fast recovery rate, and easy cobalt collection. Our work provides new insights on metal recovery in deep eutectic solvents and offers a new avenue to control the metal electrodeposition modes via modulation of substrate compositions and crystal structures.

Understanding the Effects of Anion Interactions with Ag Electrodes on Electrochemical CO2 Reduction in Choline Halide Electrolytes.

Interactions of electrolyte ions at electrocatalyst surfaces influence the selectivity of electrochemical CO2 reduction (CO2 R) to chemical feedstocks like CO. We investigated the effects of anion type in aqueous choline halide solutions (ChCl, ChBr, and ChI) on the selectivity of CO2 R to CO over an Ag foil cathode. Using an H-type cell, we observed that halide-specific adsorption at the Ag surface limits CO faradaic efficiency (FECO ) at potentials more positive than -1.0 V vs. reversible hydrogen electrode (RHE). At these conditions, FECO increased from I- 90 %) in ChCl (at -0.75±0.06 Vvs. RHE) and ChI (at -0.78±0.17 V vs. RHE) could be achieved at a current density of 150 mA cm-2 in a continuous flow-cell electrolyser with Ag nanoparticles on a commercial gas diffusion electrode. This study provides new insights to understand the interactions of anions with catalysts and offers a new method to modify electrocatalyst surfaces.

Negative symptoms and speech pauses in youths at clinical high risk for psychosis.

Aberrant pauses are characteristic of schizophrenia and are robustly associated with its negative symptoms. Here, we found that pause behavior was associated with negative symptoms in individuals at clinical high risk (CHR) for psychosis, and with measures of syntactic complexity-phrase length and usage of determiners that introduce clauses-that we previously showed in this same CHR cohort to help comprise a classifier that predicted psychosis. These findings suggest a common impairment in discourse planning and verbal self-monitoring that affects both speech and language, and which is detected in clinical ratings of negative symptoms.

Privacy-Enhanced Data Fusion for COVID-19 Applications in Intelligent Internet of Medical Things.

With the worldwide large-scale outbreak of COVID-19, the Internet of Medical Things (IoMT), as a new type of Internet of Things (IoT)-based intelligent medical system, is being used for COVID-19 prevention and detection. However, since the widespread use of IoMT will generate a large amount of sensitive information related to patients, it is becoming more and more important yet challenging to ensure data security and privacy of COVID-19 applications in IoMT. The leakage of private information during IoMT data fusion process will cause serious problems and affect people's willingness to contribute data in IoMT. To address these challenges, this article proposes a new privacy-enhanced data fusion strategy (PDFS). The proposed PDFS consists of four important components, i.e., sensitive task classification, task completion assessment, incentive mechanism-based task contract design, and homomorphic encryption-based data fusion. The extensive simulation experiments demonstrate that PDFS can achieve high task classification accuracy, task completion rate, task data reliability and task participation rate, and low average error rate, while improving the privacy protection for data fusion under COVID-19 application environments based on IoMT.

Modulated Sn Oxidation States over a Cu2O-Derived Substrate for Selective Electrochemical CO2 Reduction.

Pursuing high catalytic selectivity is challenging but paramount for an efficient and low-cost CO2 electrochemical reduction (CO2R). In this work, we demonstrate a significant correlation between the selectivity of CO2R to formate and the duration of tin (Sn) electrodeposition over a cuprous oxide (Cu2O)-derived substrate. A Sn electrodeposition time of 120 s led to a cathode with a formate Faradaic efficiency of around 81% at -1.1 V vs reversible hydrogen electrode (RHE), which was more than 37% higher than those of the Sn foil and the sample treated for 684 s. This result highlights the significant role of the interface between deposited Sn and the cuprous-derived substrate in determining the selectivity of CO2R. High-resolution X-ray photoelectron spectra revealed that the residual cuprous species at the Cu/Sn interfaces could stabilize Sn species in oxidation states of 2+ and 4+, a mixture of which is essential for a selective formate conversion. Such modulation effects likely arise from the moderate electronegativity of the cuprous species that is lower than that of Sn2+ but higher than that of Sn4+. Our work highlights the significant role of the substrate in the selectivity of the deposited catalyst and provides a new avenue to advance selective electrodes for CO2 electrochemical reduction.

Catalyst-Electrolyte Interactions in Aqueous Reline Solutions for Highly Selective Electrochemical CO2 Reduction.

Invited for this month's cover is the group of Tom Rufford at the University of Queensland. The image shows how choline chloride and urea in a reline solution interact with the surface of a silver cathode to enhance the selectivity of electrochemical CO2 reduction to CO. The Full Paper itself is available at 10.1002/cssc.201902433.

Catalyst-Electrolyte Interactions in Aqueous Reline Solutions for Highly Selective Electrochemical CO2 Reduction.

Achieving high product selectivities is one challenge that limits viability of electrochemical CO2 reduction (CO2 R) to chemical feedstocks. Here, it was demonstrated how interactions between Ag foil cathodes and reline (choline chloride + urea) led to highly selective CO2 R to CO with a faradaic efficiency of (96±8) % in 50 wt % aqueous reline at -0.884 V vs. the reversible hydrogen electrode (RHE), which is a 1.5-fold improvement over CO2 R in KHCO3 . In reline the Ag foil was roughened by (i) dissolution of oxide layers followed by (ii) electrodeposition of Ag nanoparticles back on cathode. This surface restructuring exposed low-coordinated Ag atoms, and subsequent adsorption of choline ions and urea at the catalyst surface limited proton availability in the double layer and stabilized key intermediates such as *COOH. These approaches could potentially be extended to other electrocatalytic metals and lower-viscosity deep eutectic solvents to achieve higher-current-density CO2 R in continuous-flow cell electrolyzers.

Pelvic Mass Lesions in Females: Tissue Characterization Capability of MRI.

INTRODUCTION: Magnetic Resonance Imaging (MRI) of adult female pelvis is a well-established tool in the evaluation of utero-ovarian lesions and is often used to supplement ultrasonography. The need for diagnostic surgical intervention has largely been eclipsed with the advent of MRI, which has become the imaging modality of choice for characterization of pelvic masses. AIM: To assess the role of MRI in female pelvic mass lesions and to exploit the tissue characterization capability of MRI. MATERIALS AND METHODS: A prospective observational study was done on all patients referred to Department of Radiodiagnosis, Krishna Hospital, Karad, for MRI pelvis with clinically suspected uterine and adnexal masses or with indeterminate diagnosis on ultrasonography. Study was conducted between September 2014 to August 2016 with a sample size of 100 patients. All patients were scanned using 1.5 Tesla Seimens Avanto (Tim+Dot) scanner with Body matrix coil Tim. Histopathology was taken as gold standard. Results on continuous measurements were presented on Mean±SD (Min-Max) and results on categorical measurements were presented in Number (%). RESULTS: Among 100 cases, on MRI, the maximum number of patients was having uterine lesions (48) followed by ovarian lesions (40), inconclusive adnexal/ovarian lesions (6), adnexal lesions (4). Two patients had normal findings. This correlated well with histopathology results, which showed the maximum number of patients were having uterine lesions (48) followed by ovarian lesions (41), adnexal lesions (5). Normal findings were observed in two patients. CONCLUSION: Due to excellent depiction of pelvic anatomy, non-invasiveness and absence of ionizing radiation, MRI is an excellent tool for assessment of utero-ovarian disorders, for detecting and characterization of various diseases, and staging patients with carcinomas where accurate diagnosis will make an impact on their surgical and medical management planning.

Bilateral obturator hernia diagnosed by computed tomography: a case report with review of the literature.

Obturator hernia is a rare form of abdominal hernia and a diagnostic challenge. It is commonly seen in elderly thin females. Its diagnosis is often delayed with resultant increased morbidity and mortality due to bowel ischemia/gangrene. It is mistakenly diagnosed as femoral or inguinal hernia on USG. Computed tomography is diagnostic and is a valuable tool for preoperative diagnosis. This report presents a case of 70-year-old thin female presenting with intestinal obstruction due to left sided obstructed obturator hernia. USG showed small bowel obstruction and an obstructed left sided femoral hernia. CT scan of abdomen and pelvis with inguinal and upper thigh region disclosed left sided obturator hernia. It also detected clinically occult right sided obturator hernia. Early diagnosis and surgical treatment contribute greatly in reducing the morbidity and mortality rate.