Transoral robotic surgery (TORS) has evolved into a common surgical modality used to treat primarily oropharyngeal malignant and benign pathologies. The single port Intuitive Surgical da Vinci surgical robotics system facilitates access to the hypopharynx and cervical esophagus. We aim to describe our approach and advantages of the technique.
The current study focuses on the thermal distribution in the boundary layer of a wedge with a variable surface temperature. The governing equations of MHD flow for variable wall temperature conditions can be converted to ODE by using similarity solutions, and the Hartmann number (Ha) from 1 to 3 can be solved via the colocation method. This method’s results are compared to those of the numerical method, and it is then evaluated and validated. As the angle or Ha increases, the width of the hydrodynamic boundary layer decreases, and the slope of the boundary layer increases, increasing the coefficient of friction on the surface. The results are obtained for variable wall temperature (n), Prandtl number (Pr) and Eckert number (Ec), where they are 0.5≤n≤1.5, 0.5≤Pr≤5, and 0.001≤Ec≤0.002, and at a certain angle. It is observed that when Ha, Pr, and n increase, the thermal boundary layer grows faster than before; thus, thickness decreases and the Nusselt number (Nu) rises; however, as the Ec adds, the Nu decreases on the wall.
Traditional agrosystems, where humans, crops and microbes have coevolved over long periods, can serve as models to understand the eco-evolutionary determinants of disease dynamics and help the engineering of durably resistant agrosystems. Here, we investigated the genetic and phenotypic relationship between rice (Oryza sativa) landraces and their rice blast pathogen (Pyricularia oryzae) in the traditional Yuanyang terraces of flooded rice paddies in China, where rice landraces have been grown and bred over centuries without significant disease outbreaks. Analyses of genetic subdivision revealed that indica rice plants clustered according to landrace names. Three new diverse lineages of rice blast specific to the Yuanyang terraces coexisted with lineages previously detected at the worldwide scale. Population subdivision in the pathogen population did not mirror pattern of population subdivision in the host. Measuring the pathogenicity of rice blast isolates on landraces revealed generalist life histories. Our results suggest that the implementation of disease control strategies based on the emergence or maintenance of a generalist lifestyle in pathogens may sustainably reduce the burden of disease in crops.
Background Malignant brain tumors are among the most threatening diseases of the central nervous system, and despite increasingly updated treatments, the prognosis has not been improved. Tumor treating fields (TTFields) are an emerging approach in cancer treatment using intermediate-frequency and low-intensity electric field, and can lead to development of novel therapeutic options. Recent findings A series of biological processes induced by TTFields to exert anti-cancer effects have been identified, and applications of TTFields in oncology have been increasingly reported. This review addresses the mechanisms of TTFields and recent advances in the application of TTFields therapy in malignant brain tumors, especially in glioblastoma (GBM). Conclusions As a novel therapeutic strategies, TTFields have shown promising results in many clinical trials, especially in GBM, and continue to evolve. A growing number of patients with malignant brain tumors are being enrolled in ongoing clinical studies demonstrating that TTFields-based combination therapies can improve treatment outcomes.
Direct visualization of polymer crystalline structure remains challenging due to the lack of contrast across different microphases of polymers. Here we address this conundrum using an aggregation-induced emission luminogen (AIEgen) with confinement fluorescence effect, which could be used as a “built-in” sensor to label different crystalline phases. Computational simulations reveal that the confined space induces the AIEgens to take a more planar conformation, resulting in a red-shifted emission spectrum. With this property, the information of various polymer crystalline forms is converted into different fluorescence colors, which is attributed to the different spatial dimensions of the polymer amorphous layer between lamellar crystals where the AIEgens are located. Finally, polymer crystalline phases distinction, quantitative crystallinity determination, and stereocomplex crystals visualization are achieved, providing a relationship between crystalline microstructure and fluorescence signals. This work demonstrates the potential of AIE fluorescence technology in polymer science, providing a theoretical and experimental guideline for the materials processing and optimization of mechanical performance.
Single junction crystalline silicon (c-Si) solar cells are reaching their practical efficiency limit while perovskite/c-Si tandem solar cells have achieved efficiencies above the theoretical limit of single junction c-Si solar cells. Next to low-thermal budget silicon heterojunction architecture, high-thermal budget carrier-selective passivating contacts (CSPCs) based on polycrystalline-SiO x (poly-SiO x) also constitute a promising architecture for high efficiency perovskite/c-Si tandem solar cells. In this work, we present the development of c-Si bottom cells based on high-temperature poly-SiO x CSPCs and demonstrate novel high-efficiency four-terminal (4T) and two-terminal (2T) perovskite/c-Si tandem solar cells. First, we tuned the ultra-thin, thermally grown SiO x. Then we optimized the passivation properties of p-type and n-type doped poly-SiO x CSPCs. Here, we have optimized the p-type doped poly-SiO x CSPC on textured interfaces via a two-step annealing process. Finally, we integrated such bottom solar cells in both 4T and 2T tandems, achieving 28.1% and 23.2% conversion efficiency, respectively.
In recent years, developing dopant-free carrier-selective contacts, instead of heavily doped Si layer (either externally or internally), for crystalline silicon (c-Si) solar cells have attracted considerable interests with the aims to reduce parasitic light absorption and fabrication cost. However, the stability still remains a big challenge for dopant-free contacts, especially when thermal treatment is involved, which limits their industrial adoption. In this study, a perovskite material ZnTiO 3 combining with an ultrathin (~1 nm) SiO 2 film and Al layer is used as an electron-selective contact, forming an isotype heterojunction with n-type c-Si. The perovskite/c-Si heterojunction solar cells exhibit a performance-enhanced effect by post-metallization annealing when the annealing temperature is 200-350 °C. Thanks to the post-annealing treatment, an impressive efficiency of 22.0% has been demonstrated, which is 3.5% in absolute value higher than that of the as-fabricated solar cell. A detailed material and device characterization reveal that post annealing leads to the diffusion of Al into ZnTiO 3 film, thus doping the film and reducing its work function. Besides, the coverage of SiO 2 is also improved. Both these two factors contribute to the enhanced passivation effect and electron selectivity of the ZnTiO 3-based contact, and hence improve the cell performance.
Necrotizing pneumonia (NP) is a severe form of lung disease with a high mortality rate. Although NP generally occurs as a complication in community-acquired pneumonia, our case illustrates that NP can occur as a secondary infection even if the clinical course of COVID-19 pneumonia is favorable, particularly in intubated patients.
Room-temperature phosphorescence (RTP) of purely organic materials is easily quenched with unexpected purposes because the excited triplet state is extremely susceptible to external stimuli. How to stabilize the RTP property of purely organic luminogens is still challenging and considered as the bottleneck in the further advancement of the bottom-up approach. Here, we describe a gated strategy that can effectively harness RTP by employing complexation/dissociation with proton. Due to the order-disorder transition orientation of intermolecular packing, the RTP of triazine derivative Br-TRZ will easily vanish upon mechanical force. Impressively, by enhancing its intramolecular charge transfer effect, the protonated Br-TRZ stubbornly possesses an obvious RTP under external grinding, whatever in the ordered or disordered intermolecular arrangement state. Consequently, the “Lock” gate of RTP was achieved in the protonated Br-TRZ molecule. Combined with theoretical calculation analysis, the enhanced charge transfer effect can narrow the singlet−triplet energy gap significantly, and stabilize the RTP property of triazine derivative sequentially. Furthermore, the locked RTP can be tuned via proton and counterions repeatedly and show excellent reversibility. This gated RTP concept provide an effective strategy for stabilizing the RTP emission of purely organic systems.
Title : Comment on: [Lost at Sea in Search of a Diagnosis: A Case of Unexplained Bleeding]Subtitle : Scurvy from chemotherapy-induced adverse effects in an adolescent oncology patientAuthors : Michelle Toker, BS and Benedict Wu, DO, PhDAffiliation : Division of Dermatology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USACorresponding author :Michelle TokerAlbert Einstein College of Medicine, Montefiore Medical CenterEmail: firstname.lastname@example.orgTelephone: 516-946-4726Funding and support : NoneConflicts of Interest : NoneManuscript word count : 452Reference count : 6Figure count : 1Table count : 0Key words : chemotherapy, oncology, pediatrics, nutritional deficiency, vitamin C deficiency, scurvyDear Editor,The brief report published by Amos et al in 2016 shed light on the occurrence of scurvy in pediatric and adolescent patients with dietary restrictions.1 Indeed, patients with neurodevelopmental conditions are most commonly associated with the risk of developing scurvy; other at-risk patients include those with gastrointestinal disorders, alcoholism, and psychiatric conditions.2, 3 We aim to expand upon the situations when scurvy should be considered by presenting a case of an adolescent male diagnosed with scurvy secondary to the adverse effects of his chemotherapy.A 19-year-old male with a 10-month history of high-risk pre-B-cell acute lymphoblastic leukemia was consulted by the dermatology service for a new diffuse rash present for four days. He was recently enrolled in a phase 3 randomized trial of inotuzumab ozogamicin and was receiving methotrexate and vincristine. The chemotherapy regimen induced severe dizziness, nausea, and vomiting refractory to anti-emetic medications. His aversion to chemotherapy was so strong that it caused him to feel nauseated between treatment sessions. He also endorsed painful oral and pharyngeal sores that made it difficult to tolerate a regular diet. In addition to oropharyngeal pain, he experienced marked arthralgia and fatigue, which he also attributed to the chemotherapy. Additionally, the patient reported that vincristine reduced his taste sensation, which led to a poor appetite. These adverse symptoms culminated in a loss of 6.7 kg (9.1%) in less than one month.Physical examination revealed peri-follicular purpura on the back (Fig 1A), face, and bilateral upper and lower extremities. Upon closer inspection, we noted prominent corkscrew (spiral and curly appearance) hairs (Fig 1B). The lower mucosal lip had superficial erosions with scalloped-borders and fine petechiae (Fig 1C). Laboratory evaluation revealed pancytopenia with a platelet count of 42 k/UL and low serum levels of vitamin C (<0.1 mg/dL), potassium (3.4 mEq/L), magnesium (1.1 mg/dL), and albumin (2.8 g/dL). Serum vitamin A (35 mcg/dL) levels were within normal limits. The patient was diagnosed with scurvy due to poor food intake from his chemotherapy-induced nausea, emesis, and mucositis. It was thought that acidic foods, such as citrus, exacerbated the mucosal erosions, which caused him to avoid vitamin C-rich foods.Scurvy, caused by a prolonged L-ascorbic acid (vitamin C) deficiency, may manifest as pathognomonic corkscrew hairs with petechiae, gingival pain and bleeding, vascular fragility, arthralgias, fatigue, and numerous gastrointestinal symptoms.4,5, 6 Although vitamin C deficiency was an indirect result of his chemotherapy, scurvy, by itself, may have aggravated his symptoms, thereby creating a vicious cycle of poor oral intake. Our case highlights the complex relationship between chemotherapy-induced mucocutaneous adverse effects, a limited diet, and vitamin C deficiency. We recommend clinicians to consider scurvy in oncology patients, with or without thrombocytopenia, presenting with peri-follicular purpura and corkscrew hairs.Ethics Statement: Informed patient consent was obtained for publication of the case details and photographs.
Deprescribing is an essential component of safe prescribing, especially for people with higher levels of polypharmacy. Identifying individuals prepared to consider medicine changes may facilitate deprescribing-orientated reviews. We aimed to explore the relationship between revised patient attitudes towards deprescribing (rPATD) scores and medication changes in older people prescribed ≥15 medicines. A secondary analysis of rPATD scores and prescription data from a cluster randomised controlled trial of a GP-delivered, deprescribing-orientated medication review was conducted. The association between number of medicines stopped, started and changed and baseline rPATD scores was assessed using Poisson regression adjusting for patient age, gender, study group allocation, baseline number of medicines and effects of clustering. Participants (n=404) had a mean age of 76.4 years and were prescribed a mean of 17.1 medicines at baseline. Willingness to stop a medicine was associated with higher rates of both deprescribing (IRR: 1.40; 95%CI: 1.06-1.84) and initiating medicines (IRR: 1.43; 95%CI: 1.09-1.88). Satisfaction with current medicines was associated with a lower rate of deprescribing (IRR: 0.69; 95%CI: 0.57-0.85). The rPATD questionnaire could be used as part of a deprescribing intervention to identify participants who may be prepared to engage in deprescribing, enabling more efficient use of clinician time during complex consultations.
Possible structural variation of a bio-based dimethacrylate derived from oleic acid and ethylene glycol is discussed as well as sources to obtain the starting material for manufacturing of this monomer. Furthermore, aspects influencing the transfer of a newly developed product or further scientific result to application are included into the discussion as well focusing to manufacturing processes and development of a new product for the market.
Biosafe wearable healthcare monitor has attracted significant attention owing to their applicability to wearable electronics. However, the narrow sensing range and poor response limit the application of flexible devices for comprehensive monitoring of human health-related physiological signals (i.e. pulse diagnosis). Critical challenges remain in the development of biocompatible materials and the design of flexible bio-integrated platforms for these purposes, targeting performance approaching those of conventional wafer-based technologies and long-term operational stability. In this context, this work presents a robust and flexible MXene/polydopamine (PDA)-composite-film-based pressure sensor in a portable/wearable fashion, which establishes a unique intercalated spherical-like PDA molecules structure, thereby resulting in excellent sensing performance. The MXene/PDA-based pressure sensor has sensitivity of up to 138.8 kPa-1 in the pressure range of 0.18-6.20 kPa with fast response and recovery speed (t1<100 ms; t2<50 ms). Associated embodiment involves real-time precise measurements of a variety of health-related physiological signals, ranging from wrist pulse, to finger motions, to vocalization and to facial expressions, with high sensitivity and accuracy. Studies on human subjects establish the clinical significance of these devices for future opportunities of health monitoring and intelligent control to predict and diagnose diseases.
Recent declines in eastern wild turkeys (Meleagris gallopavo silvestris) has prompted increased interest in management and research of this important game species. However, the mechanisms underlying these declines are unclear, leaving uncertainty in how best to manage this species. Foundational to effective management of wildlife species is understanding the biotic and abiotic factors that influence demographic parameters and the contribution of vital rates to population growth. Our objectives for this study were to: 1) conduct a literature review to collect all published vital rates for eastern wild turkey over the last 50 years, 2) perform a scoping review of the biotic and abiotic factors that have been studied relative to wild turkey vital rates and highlight areas that require additional research, and 3) use the published vital rates to populate a life-stage simulation analysis (LSA) and identify the vital rates that make the greatest contribution to population growth. Based on published vital rates for eastern wild turkey, we estimated a mean asymptotic population growth rate (λ) of 0.91 (95% CI = 0.71, 1.12). Vital rates associated with after second year (ASY) females were most influential in determining population growth. Survival of ASY females had the greatest elasticity (0.53), while reproduction of ASY females had lower elasticity (0.21), but high process variance, causing it to explain a greater proportion of variance in λ. Our scoping review found that most research has focused on the effects of habitat characteristics at nest sites and the direct effects of harvest on adult survival, while research on topics such as disease, weather, predators, or anthropogenic activity on vital rates have received less attention. We recommend that future research take a more mechanistic approach to understanding variation in wild turkey vital rates as this will assist managers in determining the most appropriate management approach.
The future of deprescribing research: seizing opportunities and learning from the past Michael A. Steinman, MDUniversity of California, San Francisco and the San Francisco VA Medical CenterWord count: 1549References: 10Funding: This work was supported by the National Institute on Aging (grants R24AG064025 and K24AG049057)Disclosures: Dr. Steinman receives royalties from UpToDate and honoraria from the American Geriatrics Society. This manuscript is based on a lecture given at the First International Conference on Deprescribing (ICOD), Kolding, Denmark, September 2022.