Interrater Agreement of Bosniak Classification Version 2019 and Version 2005 for Cystic Renal Masses at CT and MRI.

Background The Bosniak classification system for cystic renal masses was updated in 2019 in part to improve agreement compared with the 2005 version. Purpose To compare and investigate interrater agreement of Bosniak version 2019 and Bosniak version 2005 at CT and MRI. Materials and Methods In this retrospective single-center study, a blinded eight-reader assessment was performed in which 195 renal masses prospectively considered Bosniak IIF-IV (95 at CT, 100 at MRI, from 2006 to 2019 with version 2005) were re-evaluated with Bosniak versions 2019 and 2005. Radiologists (four faculty members, four residents) who were blinded to the initial clinical reading and histopathologic findings assessed all feature components and reported the overall Bosniak class for each system independently. Agreement was assessed with Gwet agreement coefficients. Uni- and multivariable linear regression models were developed to identify predictors of dispersion in the final Bosniak class assignment that could inform system refinement. Results A total of 185 patients were included (mean age, 63 years ± 13 [standard deviation]; 118 men). Overall interrater agreement was similar between Bosniak version 2019 and version 2005 (Gwet agreement coefficient: 0.51 [95% CI: 0.45, 0.57] vs 0.46 [95% CI: 0.42, 0.51]). This was true for experts (0.54 vs 0.49) and novices (0.50 vs 0.47) and at CT (0.56 vs 0.51) and MRI (0.52 vs 0.43). Nine percent of masses prospectively considered cystic using Bosniak version 2005 criteria were considered solid using version 2019 criteria. In general, masses were more commonly classified in lower categories when radiologists used Bosniak version 2019 criteria compared with version 2005 criteria. The sole predictor of dispersion in Bosniak version 2019 class assignment was dispersion in septa or wall quality (ie, smooth vs irregular thickening vs nodule; 72% [MRI] and 60% [CT] overall model variance explained; multivariable P < .001). Conclusion Overall interrater agreement was similar between Bosniak version 2019 and version 2005; disagreements in septa or wall quality were common and strongly predictive of variation in Bosniak class assignment. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Eberhardt in this issue.

Efficient second-harmonic and terahertz generation from single BiB3O6crystal using nanosecond and femtosecond lasers.

The paper reports the efficient UV and terahertz generation from a 1.29 mm thick and Type I, θ=28.9∘ cut BiB3O6 (bismuth triborate, BIBO) crystal using femtosecond and nanoseconds laser pulses. We have employed 800 nm wavelength pulses of 50 and 140 fs obtained from a Ti:sapphire laser amplifier and oscillators at 1 kHz and 80 MHz repetition rates, respectively. The conversion efficiency of second-harmonic generation (SHG) was ∼50% while that obtained for terahertz (THz) generations was of the order of 1.85×10-5%. In addition, LDS-698 dye laser radiation tunable between 650-700 nm was also used as a source for SHG between the 325-350 nm range. The dye laser was pumped by SHG (532 nm) radiation from an electro-optically Q-switched Nd:YAG laser having a pulse repetition rate of 10 Hz and a pulse width of 10 ns. A conversion efficiency of 4.01% was obtained for generation of UV at 343.5 nm. Finally, we have measured the transmission, refractive index, absorbance, and conductivity properties of BIBO crystal in the THz domain. We also ascertained the coherence length, relative permittivity and reflectivity of the crystal.

Tilted-potential photonic crystal cavities for integrated quantum photonics.

We propose and investigate a new type of photonic crystal (PhC) cavity for integrated quantum photonics, which provides tailored optical modes with both confined and extended spatial components. The structures consist of elongated PhC cavities in which the effective index of refraction is varied quasi-linearly along their axis, implemented by systematic lateral shifts of the PhC holes. The confined modes have approximately Airy-function envelopes, exhibiting single peaks and extended tails, which is useful for optimizing single photon extraction and transmission in integrated quantum photonic devices. The measured spectrally resolved near-field patterns of such devices show the expected spatial and resonance wavelength behavior, in agreement with numerical simulations of the Airy-Bloch modes. The effects of fabrication-induced disorder on the mode features are also analyzed and discussed. Selective excitation of specific Airy-Bloch modes using integrated, site-controlled quantum dots as localized light sources is demonstrated. Based on the tilted-potential cavity, multiple-QD single photon emitters exploiting wavelength division multiplexing are proposed.

Limiting the Spectral Diffusion of Nano-Scale Light Emitters using the Purcell effect in a Photonic-Confined Environment.

Partial suppression of the spectral diffusion of quantum dot (QD) excitons tuned to resonance of a nano-photonic cavity is reported. The suppression is caused by the Purcell enhancement of the QD-exciton recombination rate, which alters the rate of charging of the solid-state environment by the QD itself. The effect can be used to spectrally-stabilize solid-state emitters of single photons and other non-classical states of light.

Deterministic radiative coupling of two semiconductor quantum dots to the optical mode of a photonic crystal nanocavity.

A system of two site-controlled semiconductor quantum dots (QDs) is deterministically integrated with a photonic crystal membrane nano-cavity. The two QDs are identified via their reproducible emission spectral features, and their coupling to the fundamental cavity mode is established by emission co-polarization and cavity feeding features. A theoretical model accounting for phonon interaction and pure dephasing reproduces the observed results and permits extraction of the light-matter coupling constant for this system. The demonstrated approach offers a platform for scaling up the integration of QD systems and nano-photonic elements for integrated quantum photonics applications.

Effect of Pure Dephasing and Phonon Scattering on the Coupling of Semiconductor Quantum Dots to Optical Cavities.

Using site-controlled semiconductor quantum dots (QDs) free of multiexcitonic continuum states, integrated with photonic crystal membrane cavities, we clarify the effects of pure dephasing and phonon scattering on exciton-cavity coupling in the weak-coupling regime. In particular, the observed QD-cavity copolarization and cavity mode feeding versus QD-cavity detuning are explained quantitatively by a model of a two-level system embedded in a solid-state environment.

End of life issues in the intensive care units.

A structured discussion of End-of-Life (EOL) issues is a relatively new phenomenon in India. Personal beliefs, cultural and religious influences, peer, family and societal pressures affect EOL decisions. Indian law does not provide sanction to contentious issues such as do-not-resuscitate (DNR) orders, living wills, and euthanasia. Finally, published data on EOL decisions in Indian ICUs is lacking. What is needed is a prospective determination of which patients will benefit from aggressive management and life-support. A consensus regarding the concept of Medical Futility is necessary to give impetus to further discussion on more advanced policies including ideas such as Managed Care to restrict unnecessary health care costs, euthanasia, the principle of withhold and/or withdraw, ethical and moral guidelines that would govern decisions regarding futile treatment, informed consent to EOL decisions and do-not-resuscitate orders. This review examines the above concepts as practiced worldwide and looks at some landmark judgments that have shaped current Indian policy, as well as raising talking points for possible legislative intervention in the field.

1D and 2D arrays of coupled photonic crystal cavities with a site-controlled quantum wire light source.

We investigated experimentally 1D and 2D arrays of coupled L3 photonic crystal cavities. The optical modes of the coupled cavity arrays are fed by a site-controlled quantum wire light source. By performing photoluminescence measurements and relying on near-field calculation of the cavitiy modes, we evidence optical coupling between the cavities as well as supermode delocalization. In particular, for small cavity separations, fabrication induced disorder effects are shown to be negligible compared to optical coupling between cavities.

Comparison of transcriptional response to phorbol ester, bryostatin 1, and bryostatin analogs in LNCaP and U937 cancer cell lines provides insight into their differential mechanism of action.

Bryostatin 1, like the phorbol esters, binds to and activates protein kinase C (PKC) but paradoxically antagonizes many but not all phorbol ester responses. Previously, we have compared patterns of biological response to bryostatin 1, phorbol ester, and the bryostatin 1 derivative Merle 23 in two human cancer cell lines, LNCaP and U937. Bryostatin 1 fails to induce a typical phorbol ester biological response in either cell line, whereas Merle 23 resembles phorbol ester in the U937 cells and bryostatin 1 in the LNCaP cells. Here, we have compared the pattern of their transcriptional response in both cell lines. We examined by qPCR the transcriptional response as a function of dose and time for a series of genes regulated by PKCs. In both cell lines bryostatin 1 differed primarily from phorbol ester in having a shorter duration of transcriptional modulation. This was not due to bryostatin 1 instability, since bryostatin 1 suppressed the phorbol ester response. In both cell lines Merle 23 induced a pattern of transcription largely like that of phorbol ester although with a modest reduction at later times in the LNCaP cells, suggesting that the difference in biological response of the two cell lines to Merle 23 lies downstream of this transcriptional regulation. For a series of bryostatins and analogs which ranged from bryostatin 1-like to phorbol ester-like in activity on the U937 cells, the duration of transcriptional response correlated with the pattern of biological activity, suggesting that this may provide a robust platform for structure activity analysis.

Current concepts in the management of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) are still common following surgery. This is not only distressing to the patient, but increases costs. The thorough understanding of the mechanism of nausea and vomiting and a careful assessment of risk factors provide a rationale for appropriate management of PONV. Strategy to reduce baseline risk and the adoption of a multimodal approach will most likely ensure success in the management of PONV.

Symmetries and the polarized optical spectra of exciton complexes in quantum dots.

A systematic and simple theoretical approach is proposed to analyze true degeneracies and polarized decay patterns of exciton complexes in semiconductor quantum dots. The results provide reliable spectral signatures for efficient symmetry characterization, and predict original features for low C(2v) and high C(3v) symmetries. Excellent agreement with single quantum dot spectroscopy of real pyramidal InGaAs/AlGaAs quantum dots grown along [111] is demonstrated. The high sensitivity of biexciton quantum states to exact high symmetry can be turned into an efficient uninvasive postgrowth selection procedure for quantum entanglement applications.

Ordered systems of site-controlled pyramidal quantum dots incorporated in photonic crystal cavities.

The coupling of a prescribed number of site-controlled pyramidal quantum dots (QDs) with photonic crystal (PhC) cavities was studied by polarization and power-dependent photoluminescence measurements. The energy of the cavity mode could be readily tuned, making use of the high spectral uniformity of the QDs and designing PhC cavities with different hole radii. Efficient coupling of the PhC cavity modes both to the ground state and to the excited state transitions of the QDs was observed, whereas no evidence for far off-resonant coupling was found.

Phonon-mediated coupling of InGaAs/GaAs quantum-dot excitons to photonic crystal cavities.

We demonstrate that the emission characteristics of site-controlled InGaAs/GaAs single quantum dots embedded in photonic crystal slab cavities correspond to single confined excitons coupled to cavity modes, unlike previous reports of similar systems based on self-assembled quantum dots. By using polarization-resolved photoluminescence spectroscopy at different temperatures and a theoretical model, we show that the exciton-cavity interaction range is limited to the phonon sidebands. Photon-correlation and pump-power dependence experiments under nonresonant excitation conditions further establish that the cavity is fed only by a single exciton.

Obstructive sleep apnoea syndrome in children and anaesthesia.

Obstructive sleep apnoea syndrome (OSAS) is a common medical disorder among adults, which is increasingly being recognized in children too. It is a breathing disorder characterized by upper airway obstruction with or without intermittent complete obstruction that disrupts normal breathing during sleep. Anatomical and neuromuscular disorders are mainly responsible for this disorder. This disorder leads to a state of chronic hypoxemia, which has significant cardiac, pulmonary and central nervous system implications. Diagnosis of OSAS is based on thorough history and clinical examination along with appropriate sleep studies including polysomnography. The mainstay of treatment of paediatric OSAS is adenotonsillectomy. Good anaesthetic practice in Paediatric patients with OSAS revolves around good and ideal airway management. Early detection of airway obstruction, intense monitoring to warn of impending airway problems and appropriate and early intervention of airway compromise are good anaesthetic practices. Coexisting medical problems should be adequately addressed and safe analgesic techniques in the perioperative period go towards improving outcomes in patients with paediatric OSAS.

Amniotic fluid embolism.

The disastrous entry of amniotic fluid into the maternal circulation leads to dramatic sequelae of clinical events, characteristically referred to as Amniotic fluid embolism (AFE). The underlying mechanism for AFE is still poorly understood. Unfortunately, this situation has very grave maternal and fetal consequences. AFE can occur during labor, caesarean section, dilatation and evacuation or in the immediate postpartum period. The pathophysiology is believed to be immune mediated which affects the respiratory, cardiovascular, neurological and hematological systems. Undetected and untreated it culminates into fulminant pulmonary edema, intractable convulsions, disseminated intravascular coagulation (DIC), malignant arrhythmias and cardiac arrest. Definite diagnosis can be confirmed by identification of lanugo, fetal hair and fetal squamous cells (squames) in blood aspirated from the right ventricle. Usually the diagnosis is made clinically and by exclusion of other causes. The cornerstone of management is a multidisciplinary approach with supportive treatment of failing organs systems. Despite improved modalities for diagnosing AFE, and better intensive care support facilities, the mortality is still high.

Dense arrays of ordered pyramidal quantum dots with narrow linewidth photoluminescence spectra.

Arrays of site-controlled, pyramidal InGaAs/GaAs quantum dots (QDs) grown by organo-metallic chemical vapour deposition with densities comparable to those of self-assembled QDs (5 x 10(9) cm(-2)) are demonstrated. The QDs exhibit high quality photoluminescence spectra with inhomogeneous broadening of only 6.5 meV. The QD dipole moment was estimated through the analysis of time-resolved photoluminescence measurements. Such ordered QD arrays should be useful for applications in active nanophotonic systems such as QD lasers, modulators and switches requiring high overlap of the optical modes with the QD active region.

Gargling with ketamine attenuates the postoperative sore throat.

SUMMARY: Postoperative sore throat (POST) is a common complication of anaesthesia with endotracheal tube that affects patient satisfaction after surgery. Therefore, this complication remains to be resolved in patients undergoing endotracheal intubation. The aim of the study was to compare the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anaesthesia were randomized into: Group C, water 30 ml; Group K, ketamine 50 mg in water 29 ml. Patients were asked to gargle this mixture for 40 seconds, 5 minutes before induction of anaesthesia. POST was graded at 4, 8 and 24 hours after operation on a four-point scale (0-3). In the Control group POST occurred more frequently, when compared with patients belonging to Ketamine group, at 4, 8, and 24 hours and significantly more patients suffered severe POST in Control group at 8 and 24 hours compared with Ketamine group (P<0.05). We demonstrated that gargling with ketamine significantly attenuated POST, with no drug-related side effects were observed.

Prophylactic granisetron vs pethidine for the prevention of postoperative shivering: a randomized control trial.

SUMMARY: Shivering-the "Big Little Problem" has an incidence of 60% in early recovery phase following general anaesthesia. A number of techniques have been tried to prevent postoperative shivering. Previous study showed that, ondansetron in higher doses reduces postoperative shivering. Therefore, this study was done to compare the efficacy of prophylactic granisetron, pethidine and placebo in preventing postoperative shivering. Ninety patients aged 20-60yrs, ASA physical status I and II, scheduled for laparoscopic surgery under general anaesthesia were randomly allocated to receive either normal saline (Group S, n=30) as negative control, pethidine 25mg (Group P, n=30) as positive control or granisetron 40mcg.kg(-1) (Group G, n=30) intravenously before induction. The anaesthesia was induced with fentanyl 2mcg.kg(-1), propofol 2mg.kg(-1) and atracurium 0.5mg.kg(-1) and maintained with sevoflurane 1 - 1.5%. Nasopharyngeal temperature was measured throughout the procedure. An investigator, blinded to the treatment group, graded postoperative shivering in a scale of 0 to 4. (0= no shivering, 1= piloerection or peripheral vasoconstriction but no visible shivering, 2= muscle activity in only one muscle group 3= muscle activity in more than one muscle group, 4= shivering involving the whole body). Prophylaxis was regarded as ineffective if shivering was greater than grade 3 and intravenous pethidine 25 mg was administered as rescue medication. The three groups did not differ significantly regarding patient characteristics. The numbers of patients shivering on arrival in the recovery room at 15 minutes after operation were significantly less in Group P (7%) and Group G (17%) than in Group S (60%). Groups P and G differ significantly than in Group S (p<0.05). However, the difference between Groups P and G was not statistically significant (p>0.05). The prophylactic use of granisetron (40mcg.kg(-1)) and pethidine(25mg) intravenous were found to be effective in preventing postoperative shivering.

Obstructive sleep apnoea and anaesthesia.

Obstructive sleep apnoea (OSA) correlates positively with obesity and age, both of which are becoming increasingly prevalent. Obstructive sleep apnoea occurs much more frequently in clinical practice than formerly diagnosed, and that this condition represents complex challenges for difficulty in mask ventilation, laryngoscopic intubation, accelerated arterial desaturation, postoperative monitoring and discharge status. In this review article pathophysiology, diagnosis, and perioperative management of this group of patients have been discussed in detail.

Luttinger-liquid behavior in weakly disordered quantum wires.

We have measured the temperature dependence of the conductance in long V-groove quantum wires fabricated in GaAs/AlGaAs heterostructures. Our data are consistent with recent theories developed within the framework of the Luttinger-liquid model, in the limit of weakly disordered wires. We show that, for the relatively low level of disorder in our quantum wires, the value of the interaction parameter g congruent with 0.66, which is the expected value for GaAs. However, samples with a higher level of disorder show conductance with stronger temperature dependence, which does not allow their treatment in the framework of perturbation theory. Fitting such data with perturbation-theory models leads inevitably to wrong (lower) values of g.