We have developed a biomechanical energy harvester that generates electricity during human walking with little extra effort. Unlike conventional human-powered generators that use positive muscle ...work, our technology assists muscles in performing negative work, analogous to regenerative braking in hybrid cars, where energy normally dissipated during braking drives a generator instead. The energy harvester mounts at the knee and selectively engages power generation at the end of the swing phase, thus assisting deceleration of the joint. Test subjects walking with one device on each leg produced an average of 5 watts of electricity, which is about 10 times that of shoe-mounted devices. The cost of harvesting--the additional metabolic power required to produce 1 watt of electricity--is less than one-eighth of that for conventional human power generation. Producing substantial electricity with little extra effort makes this method well-suited for charging powered prosthetic limbs and other portable medical devices.
OBJECTIVES:Over 30% of critically ill patients on positive-pressure mechanical ventilation have difficulty weaning from the ventilator, many of whom acquire ventilator-induced diaphragm dysfunction. ...Temporary transvenous phrenic nerve pacing using a novel electrode-bearing catheter may provide a means to prevent diaphragm atrophy, to strengthen an atrophied diaphragm, and mitigate the harms of mechanical ventilation. We tested the initial safety, feasibility, and impact on ventilation of this novel approach.
DESIGN:First-in-Humans case series.
SETTING:Angiogram suite.
PATIENTS:Twenty-four sedated, mechanically ventilated patients immediately prior to an elective atrial septal defect repair procedure.
INTERVENTIONS:A 9.5-Fr central venous catheter with 19 embedded electrodes was placed via Seldinger technique into the left subclavian vein and superior vena cava and evaluated for up to 90 minutes. The electrode combinations determined to provide best transvenous stimulation of the right and left phrenic nerves were activated in synchrony with mechanically ventilated breaths.
MEASUREMENTS AND MAIN RESULTS:One patient could not be tested for reasons unrelated to the device. In the 23 patients who underwent the full protocol, transvenous stimulation activated the diaphragm in 22 of 23 (96%) left phrenic capture attempts and 20 of 23 (87%) right phrenic capture attempts. In one subject, a congenital left-sided superior vena cava precluded right-sided capture. Significant reductions in ventilator pressure-time-product were achieved during stimulation assisted breaths in all 22 paced subjects (range, 9.9–48.6%; p < 0.001). There were no adverse events either immediately or at 2-week follow-up.
CONCLUSIONS:In this First-in-Human series, diaphragm pacing with a temporary catheter was safe and effectively contributed to ventilation in conjunction with a mechanical ventilator.
Tar balls (TBs) are a specific particle type that is abundant in the global troposphere, in particular in biomass smoke plumes. These particles belong to the family of atmospheric brown carbon (BrC), ...which can absorb light in the visible range of the solar spectrum. Albeit TBs are typically present as individual particles in biomass smoke plumes, their absorption properties have been only indirectly inferred from field observations or calculations based on their electron energy-loss spectra. This is because in biomass smoke TBs coexist with various other particle types (e.g., organic particles with inorganic inclusions and soot, the latter emitted mainly during flaming conditions) from which they cannot be physically separated; thus, a direct experimental determination of their absorption properties is not feasible. Very recently we have demonstrated that TBs can be generated in the laboratory from droplets of wood tar that resemble atmospheric TBs in all of their observed properties. As a follow-up study, we have installed on-line instruments to our laboratory set-up, which generate pure TB particles to measure the absorption and scattering, as well as the size distribution of the particles. In addition, samples were collected for transmission electron microscopy (TEM) and total carbon (TC) analysis. The effects of experimental parameters were also studied. The mass absorption coefficients of the laboratory-generated TBs were found to be in the range of 0.8–3.0 m2 g−1 at 550 nm, with absorption Ångström exponents (AAE) between 2.7 and 3.4 (average 2.9) in the wavelength range 467–652 nm. The refractive index of TBs as derived from Mie calculations was about 1.84 − 0.21i at 550 nm. In the brown carbon continuum, these values fall closer to those of soot than to other light-absorbing species such as humic-like substances (HULIS). Considering the abundance of TBs in biomass smoke and the global magnitude of biomass burning emissions, these findings may have substantial influence on the understanding of global radiative energy fluxes.
The nature and origin of the cold interstellar medium (ISM) in early-type galaxies are still a matter of debate, and understanding the role of this component in galaxy evolution and in fuelling the ...central supermassive black holes requires more observational constraints. Here, we present a multiwavelength study of the ISM in eight nearby, X-ray and optically bright, giant elliptical galaxies, all central dominant members of relatively low-mass groups. Using far-infrared spectral imaging with the Herschel Photodetector Array Camera & Spectrometer, we map the emission of cold gas in the cooling lines of C iiλ157 μm, O i λ63 μm and O ib λ145 μm. Additionally, we present Hα+N ii imaging of warm ionized gas with the Southern Astrophysical Research (SOAR) telescope, and a study of the thermodynamic structure of the hot X-ray emitting plasma with Chandra. All systems with extended Hα emission in our sample (6/8 galaxies) display significant C ii line emission indicating the presence of reservoirs of cold gas. This emission is cospatial with the optical Hα+N ii emitting nebulae and the lowest entropy soft X-ray emitting plasma. The entropy profiles of the hot galactic atmospheres show a clear dichotomy, with the systems displaying extended emission-line nebulae having lower entropies beyond r 1 kpc than the cold-gas-poor systems. We show that while the hot atmospheres of the cold-gas-poor galaxies are thermally stable outside of their innermost cores, the atmospheres of the cold-gas-rich systems are prone to cooling instabilities. This provides considerable weight to the argument that cold gas in giant ellipticals is produced chiefly by cooling from the hot phase. We show that cooling instabilities may develop more easily in rotating systems and discuss an alternative condition for thermal instability for this case. The hot atmospheres of cold-gas-rich galaxies display disturbed morphologies indicating that the accretion of clumpy multiphase gas in these systems may result in variable power output of the AGN jets, potentially triggering sporadic, larger outbursts. In the two cold-gas-poor, X-ray morphologically relaxed galaxies of our sample, NGC 1399 and NGC 4472, powerful AGN outbursts may have destroyed or removed most of the cold gas from the cores, allowing the jets to propagate and deposit most of their energy further out, increasing the entropy of the hot galactic atmospheres and leaving their cores relatively undisturbed.
Background and Objectives
Fluorescence‐guided surgery using epidermal growth factor receptor (EGFR) targeting has been performed successfully in clinical trials using a variety of fluorescent agents. ...We investigate ABY‐029 (anti‐EGFR Affibody® molecule labeled with IRDye 800CW) compared with a small‐molecule perfusion agent, IRDye 700DX carboxylate, in a panel of soft‐tissue sarcomas with varying levels of EGFR expression and vascularization.
Methods
Five xenograft soft‐tissue sarcoma cell lines were implanted into immunosuppressed mice. ABY‐029 and IRDye 700DX were each administered at 4.98 μM. Fluorescence from in vivo and ex vivo (fresh and formalin‐fixed) fixed tissues were compared. The performance of three fluorescence imaging systems was assessed for ex vivo tissues.
Results
ABY‐029 is retained longer within tumor tissue and achieves higher tumor‐to‐background ratios both in vivo and ex vivo than IRDye 700DX. ABY‐029 fluorescence is less susceptible to formalin fixation than IRDye 700DX, but both agents have disproportional signal loss in a variety of tissues. The Pearl Impulse provides the highest contrast‐to‐noise ratio, but all systems have individual advantages.
Conclusions
ABY‐029 demonstrates promise to assist in wide local excision of soft‐tissue sarcomas. Further clinical evaluation of in situ or freshly excised ex vivo tissues using fluorescence imaging systems is warranted.
Background The National Wilms Tumor Study (NWTS) approach to treating stage III favorable-histology Wilms tumor (FHWT) is Regimen DD4A (vincristine, dactinomycin, and doxorubicin) and radiation ...therapy. Further risk stratification is required to improve outcomes and reduce late effects. We evaluated clinical and biologic variables for patients with stage III FHWT without combined loss of heterozygosity (LOH) at chromosomes 1p and 16q treated in the Children's Oncology Group protocol AREN0532. Methods From October 2006 to August 2013, 588 prospectively treated, centrally reviewed patients with stage III FHWT were treated with Regimen DD4A and radiation therapy. Tumor LOH at 1p and 16q was determined by microsatellite analysis. Ineligible patients (n = 5) and those with combined LOH 1p/16q (n = 40) were excluded. Results A total of 535 patients with stage III disease were studied. Median follow-up was 5.2 years (range, 0.2 to 9.5). Four-year event-free survival (EFS) and overall survival estimates were 88% (95% CI, 85% to 91%) and 97% (95% CI, 95% to 99%), respectively. A total of 58 of 66 relapses occurred in the first 2 years, predominantly pulmonary (n = 36). Eighteen patients died, 14 secondary to disease. A better EFS was associated with negative lymph node status ( P < .01) and absence of LOH 1p or 16q ( P < .01), but not with gross residual disease or peritoneal implants. In contrast, the 4-year EFS was only 74% in patients with combined positive lymph node status and LOH 1p or 16q. A total of 123 patients (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed anaplasia (n = 8; excluded from survival analysis); low risk/completely necrotic (n = 7; zero relapses), intermediate risk (n = 63; six relapses), and high-risk/blastemal type (n=7; five relapses). Conclusion Most patients with stage III FHWT had good EFS/overall survival with DD4A and radiation therapy. Combined lymph node and LOH status was highly predictive of EFS and should be considered as a potential prognostic marker for future trials.
AREN0321 evaluated the activity of vincristine and irinotecan (VI) in patients with newly diagnosed diffuse anaplastic Wilms tumor (DAWT) and whether a regimen containing carboplatin (regimen UH1) in ...addition to regimen I agents used in the National Wilms Tumor Study 5 (NWTS-5; vincristine, doxorubicin, cyclophosphamide, and etoposide plus radiotherapy) would improve patient outcomes.
Patients with stage II to IV DAWT without measurable disease received regimen UH1. Patients with stage IV measurable disease were eligible to receive VI (vincristine, 1.5 mg/m
per day intravenously on days 1 and 8; irinotecan, 20 mg/m
per day intravenously on days 1-5 and 8-12 of a 21-day cycle) in an upfront window; those with complete (CR) or partial response (PR) had VI incorporated into regimen UH1 (regimen UH2). The study was designed to detect improvement in outcomes of patients with stage II to IV DAWT compared with historical controls treated with regimen I.
Sixty-six eligible patients were enrolled. Of 14 patients with stage IV measurable disease who received VI, 11 (79%) achieved CR (n = 1) or PR (n = 10) after 2 cycles. Doses of doxorubicin, cyclophosphamide, and etoposide were reduced midstudy because of nonhematologic toxicity. Four patients (6%) died as a result of toxicity. Four-year event-free survival, relapse-free survival, and overall survival rates were 67.7% (95% CI, 55.9% to 79.4%), 72.9% (95% CI, 61.5% to 84.4%), and 73.7% (95% CI, 62.7% to 84.8%), respectively, compared with 57.5% (95% CI, 47.6% to 67.4%;
= .26), 57.5% (95% CI, 47.6% to 67.4%;
= .048), and 59.2% (95% CI, 49.4% to 69.0%;
= .08), respectively, in NWTS-5.
VI produced a high response rate in patients with metastatic DAWT. AREN0321 treatment seemed to improve outcomes for patients with stage II to IV DAWT compared with NWTS-5, but with increased toxicity. The UH2 regimen warrants further investigation with modifications to reduce toxicity.
Atmospheric tar balls are particles of special morphology and composition that are fairly abundant in the plumes of biomass smoke. These particles form a specific subset of brown carbon (BrC) which ...has been shown to play a significant role in atmospheric shortwave absorption and, by extension, climate forcing. Here we suggest that tar balls are produced by the direct emission of liquid tar droplets followed by heat transformation upon biomass burning. For the first time in atmospheric chemistry we generated tar-ball particles from liquid tar obtained previously by dry distillation of wood in an all-glass apparatus in the laboratory with the total exclusion of flame processes. The particles were perfectly spherical with a mean optical diameter of 300 nm, refractory, externally mixed, and homogeneous in the contrast of the transmission electron microscopy (TEM) images. They lacked any graphene-like microstructure and exhibited a mean carbon-to-oxygen ratio of 10. All of the observed characteristics of laboratory-generated particles were very similar to those reported for atmospheric tar-ball particles in the literature, strongly supporting our hypothesis regarding the formation mechanism of atmospheric tar-ball particles.
Summarize current knowledge of lymphatic malformation medical, sclerotherapy, and surgical treatment; and highlight areas of treatment controversy and treatment difficulty that need improvement.
...Panel presentation of various aspects of lymphatic malformation treatment.
The mainstay of lymphatic malformation treatment has been surgical resection, which has been refined through lesion staging and radiographic characterization. Intralesional sclerotherapy in macrocystic lymphatic malformations is effective. Suprahyoid microcystic lymphatic malformations are more difficult to treat than macrocystic lymphatic malformations in the infrahyoid and posterior cervical regions. Bilateral suprahyoid lymphatic malformations require staged treatment to prevent complications. Lymphatic malformation treatment planning is primarily determined by the presence or possibility of functional compromise. Problematic areas include chronic lymphatic malformation inflammation, dental health maintenance, macroglossia, airway obstruction, and dental malocclusion.
Lymphatic malformation treatment improvements have been made through radiographic characterization and staging of lymphatic malformations. Direct malformation involvement of the upper aerodigestive tract can cause significant functional compromise that is difficult to treat.
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