Controlled chemical transformation of nanostructures is a promising technique to obtain precisely designed novel materials, which are difficult to synthesize otherwise. We report high-temperature ...vapor-phase anion-exchange reactions to chemically transform II–VI semiconductor nanostructures (100–300 nm length scale) while retaining the single crystallinity, crystal structure, morphology, and even defect distribution of the parent material via atomic templating. The concept of atomic templating is employed to obtain kinetically controlled, thermodynamically metastable structural phases such as zincblende CdSe and CdS from zincblende CdTe upon complete chemical replacement of Te with Se or S. The underlying transformation mechanisms are explained through first-principles density functional theory calculations. Atomic templating is a unique path to independently tune materials’ phase and composition at the nanoscale, allowing the synthesis of novel materials.
Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) can be performed under either conscious sedation or general anesthesia. Herein, we describe the diagnostic yield and ...complications of EBUS-TBNA performed under bronchoscopist-directed conscious sedation.
This is a retrospective analysis of data collected in the bronchoscopy suite of this center on EBUS-TBNA or endoscopic ultrasound with a bronchoscope-guided fine needle aspiration (EUS-B-FNA) procedures performed between July 2011 and January 2016. All procedures were performed under bronchoscopist-directed conscious sedation with midazolam and pentazocine. The diagnostic yield, sample adequacy rate, complications, and doses of sedative agents are presented.
Of the total 1005 EBUS-TBNA/EUS-B-FNA procedures performed during the study period, 1004 were performed under conscious sedation in spontaneously breathing subjects mean (SD) age, 45.9 (15.8) years; 378 (37.6%) women. The mean (SD) doses of midazolam and pentazocine used were 2.53 (1.8) mg and 30.9 (6.9) mg, respectively. The diagnostic yield of the procedure (972 subjects) was 61.2%. Complications related to EBUS were observed in 60 (5.9%) subjects. Majority of them were minor and self-limiting; major complications occurred in 11 (1.1%) subjects and included respiratory failure requiring assisted ventilation (n=6), arrhythmia (n=3), and hypotension (n=2). Escalation of the level of care was needed in only 8 (0.8%) subjects.
EBUS-TBNA/EUS-B-FNA performed under bronchoscopist-guided conscious sedation was found to be safe and is associated with a reasonable diagnostic yield.
Advancements in the intensive care unit (ICU) have improved critically ill subjects' short-term outcomes. However, there is a need to understand the long-term outcomes of these subjects. Herein, we ...study the long-term outcomes and factors associated with poor outcomes in critically ill subjects with medical illnesses.
All subjects (≥12 years) discharged after an ICU stay of at least 48 hours were included. We evaluated the subjects at 3 and 6 months after ICU discharge. At each visit, subjects were administered the World Health Organization Quality of Life Instrument (WHO-QOL-BREF) questionnaire. The primary outcome was mortality at 6 months after ICU discharge. The key secondary outcome was quality of life (QOL) at 6 months.
In total, 265 subjects were admitted to the ICU, of whom 53 subjects (20%) died in the ICU, and 54 were excluded. Finally, 158 subjects were included: 10 (6.3%) subjects were lost to follow-up. The mortality at 6 months was 17.7% (28/158). Most subjects 16.5% (26/158) died within the initial 3 months after ICU discharge. Quality of life scores were low in all the domains of WHO-QOL-BREF. About 12% (
= 14) of subjects could not perform the activity of daily living at 6 months. After adjusting for covariates, ICU-acquired weakness at the time of discharge (OR 15.12; 95% CI, 2.08-109.81,
<0.01) and requirement for home ventilation (OR 22; 95% CI, 3.1-155,
<0.01) were associated with mortality at 6 months.
Intensive care unit survivors have a high risk of death and a poor QOL during the initial 6 months following discharge.
Kodati R, Muthu V, Agarwal R, Dhooria S, Aggarwal AN, Prasad KT,
. Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study. Indian J Crit Care Med 2022;26(10):1078-1085.
No study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in subjects with acute exacerbation of chronic ...obstructive pulmonary disease (AECOPD).
In this randomized controlled trial, we compared NAVA-NIV with ASV-NIV for delivering NIV in consecutive subjects with AECOPD. The primary outcome was NIV failure rate (invasive mechanical ventilation). The key secondary outcomes were number of NIV manipulations, asynchrony index, and 90-day mortality.
We enrolled 76 subjects (NAVA-NIV, n = 36, ASV-NIV, n = 40; 74% males) with a mean ± SD age of 61.4 ± 8.2 years. We found no difference in NIV failure rates between the two arms (NAVA-NIV vs. ASV-NIV; 8/36 22.2% vs. 8/40 20%; p = 0.83). The median physician manipulations for NIV were significantly less in the ASV-NIV arm than in the NAVA-NIV arm (2 0.8–4 vs. 3 2–5; p= 0.014) during the initial 24-h. We found no difference in median asynchrony index (NAVA-NIV vs. ASV-NIV, 16.6% vs. 16.4%, p = 0.5) and 90-day mortality (22.2% vs. 17.5%, p = 0.67).
The use of NAVA-NIV was not superior to ASV-NIV in reducing NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV had similar asynchrony index and 90-day mortality.
www.clinicaltrials.gov (NCT04414891).
Study question: Is NAVA-NIV associated with fewer NIV failure (need for airway intubation) than ASV-NIV in AECOPD due to superior patient-ventilator interactions?
Results: We found no difference in NIV failure rates between the two arms. The asynchrony index and 90-day mortality was similar in both the study arm. ASV-NIV however, required fewer physician manipulations.
Interpretation: The use of NAVA-NIV compared to ASV-NIV did not reduce NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV were comparable in patient-ventilator interactions. Display omitted
•No previous study has compared neurally adjusted ventilator assist (NAVA) with adaptive support ventilation (ASV) during non-invasive ventilation (NIV) in managing subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).•This paper contributes to our knowledge?•The use of NAVA-NIV compared to ASV-NIV did not reduce NIV failure rates in AECOPD. Both NAVA-NIV and ASV-NIV were comparable in patient-ventilator interactions.•However, ASV-NIV required lesser physician NIV adjustments during the initial 24 h of NIV use. Importantly, both NAVA and ASV were safe even when used as NIV for a prolonged duration.
The International Society for Human and Animal Mycology (ISHAM) working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) a decade ago. There is a need to ...update these recommendations due to advances in diagnostics and therapeutics.
An international expert group was convened to develop guidelines for managing ABPA (caused by
spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than
spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms "recommend" and "suggest" are used when the consensus was ≥70% and <70%, respectively.
We recommend screening for
sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitisation and serum total IgE ≥500 IU·mL
and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal
-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum. We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response.
We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.
Introduction
Most data on transbronchial lung cryobiopsy (TBLC) are from single centers, with little evidence on the outcome of different methods for performing TBLC.
Objective
To report the ...diagnostic yield and safety of TBLC with different procedural techniques.
Materials and Methods
Retrospective multicenter study of subjects who underwent TBLC for the diagnosis of diffuse parenchymal lung diseases (DPLDs). The procedure was performed using various methods: flexible or rigid bronchoscopy, with or without the use of fluoroscopy or occlusion balloon.
Results
In total, 128 subjects (59% women) with a mean age of 48.9 years were included. The overall diagnostic yield of TBLC was 78.1%, with a definite diagnosis on multidisciplinary discussion made in 57 (44.5%) subjects. On a multivariate analysis, the diagnostic yield was associated with the number of biopsies taken {ajdusted odds ratio AOR 95% confidence interval (CI), 2.17 1.29‐3.67}. The incidence of pneumothorax was lower in subjects who underwent TBLC with fluoroscopic guidance (5.9% vs 20.9%), AOR (95% CI), 0.26 (0.07‐0.94). Moderate‐to‐severe bleeding occurred less frequently when an occlusion balloon was used 1.8% vs 35.7%; AOR (95% CI), 0.02 (0.001‐0.18), after adjusting for age, use of fluoroscopy, number of biopsies obtained and number of lobes sampled. Four deaths occurred; 2 because of acute exacerbation of idiopathic pulmonary fibrosis.
Conclusions
Transbronchial lung cryobiopsy was found to offer a reasonable yield in the diagnosis of DPLDs. The incidence of pneumothorax and moderate‐to‐severe bleeding was lower with the use of fluoroscopy and an occlusion balloon, respectively.
Interfaces play an important role in bulk heterojunction organic/inorganic hybrid photovoltaic devices, but directly probing the interface in order to improve device characteristics is exceedingly ...difficult. We report on a method to form core–shell inorganic nanowire–polymer hybrids of a conducting polymer, poly(3-hexlthiophene-2,5-diyl) (P3HT), and a semiconducting nanowire, cadmium sulfide (CdS), using solution processing to create the polymer shell around the nanowire in order to study the polymer–nanowire interface directly without interference from bulk effects. We have used the rod–coil transition (chromism) in P3HT to seed and enhance the crystallinity at the polymer–nanowire interface. We have shown that creating more order within the P3HT main chain, by controlling the temperature and the solvent quality, can increase the extent of polymer crystallinity present at the polymer–nanowire interface. We believe using the rod–coil transition to create more order in P3HT and the resulting polymer–nanowire interface will provide a facile pathway for designing future organic–inorganic photovoltaic devices.
Chest radiography is generally the first imaging modality used for the evaluation of pneumonia. It can establish the presence of pneumonia, determine its extent and location, and assess the response ...to treatment. Computed tomography is not used for the initial evaluation of pneumonia, but it may be used when the response to treatment is unusually slow. It helps to identify complications, detect any underlying chronic pulmonary disease, and characterise complex pneumonias. Although not diagnostic, certain imaging findings may suggest a particular microbial cause over others. Knowledge of whether pneumonia is community-acquired or nosocomial, as well as the age and immune status of the patient, can help to narrow the differential diagnoses. The purpose of this article is to briefly review the various pulmonary imaging manifestations of pathogenic organisms. This knowledge, along with the clinical history and laboratory investigations of the patient, may help to guide the treatment of pneumonia.
Oxygen vacancy formation, migration, and subsequent agglomeration into conductive filaments in transition metal oxides under applied electric field is widely believed to be responsible for ...electroforming in resistive memory devices, although direct evidence of such a pathway is lacking. Here, by utilizing strong metal-support interaction (SMSI) between Pt and TiO sub(2), we observe via transmission electron microscopy the electroforming event in lateral Pt/TiO sub(2)/Pt devices where the atomic Pt from the electrode itself acts as a tracer for the propagating oxygen vacancy front. SMSI, which originates from the d-orbital overlap between Pt atom and the reduced cation of the insulating oxide in the vicinity of oxygen vacancies, was optimized by fabricating nanoscale devices causing Pt atom migration tracking the moving oxygen vacancy front from the anode to cathode during electroforming. Experiments performed in different oxidizing and reducing conditions, which tune SMSI in the Pt-TiO sub(2) system, further confirmed the role of oxygen vacancies during electroforming. These observations also demonstrate that the noble metal electrode may not be as inert as previously assumed. Keywords: Resistive memory; strong metal-support interaction; electroforming; in situ TEM; oxygen vacancy; filament; TiO sub(2)
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