Handheld Lung Ultrasound to Detect COVID-19 Pneumonia in Inpatients: A Prospective Cohort Study.

Background: Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. Purpose: To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. Results: Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. Conclusions: The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia.

Materials Innovations for Quantum Technology Acceleration: A Perspective.

A broad perspective of quantum technology state of the art is provided and critical stumbling blocks for quantum technology development are identified. Innovations in demonstrating and understanding electron entanglement phenomena using bulk and low-dimensional materials and structures are summarized. Correlated photon-pair generation via processes such as nonlinear optics is discussed. Application of qubits to current and future high-impact quantum technology development is presented. Approaches for realizing unique qubit features for large-scale encrypted communication, sensing, computing, and other technologies are still evolving; thus, materials innovation is crucially important. A perspective on materials modeling approaches for quantum technology acceleration that incorporate physics-based AI/ML, integrated with quantum metrology is discussed.

Development and validation of a novel prediction score for cardiac tamponade in emergency department patients with pericardial effusion.

AIMS: Determining which patients with pericardial effusion require urgent intervention can be challenging. We sought to develop a novel, simple risk prediction score for patients with pericardial effusion. METHODS AND RESULTS: Adult patients admitted through the emergency department (ED) with pericardial effusion were retrospectively evaluated. The overall cohort was divided into a derivation and validation cohort for the generation and validation of a novel risk score using logistic regression. The primary outcome was a pericardial drainage procedure or death attributed to cardiac tamponade within 24 h of ED arrival. Among 195 eligible patients, 102 (52%) experienced the primary outcome. Four variables were selected for the novel score: systolic blood pressure < 100 mmHg (1.5 points), effusion diameter [1-2 cm (0 points), 2-3 cm (1.5 points), >3 cm (2 points)], right ventricular diastolic collapse (2 points), and mitral inflow velocity variation > 25% (1 point). The need for pericardial drainage within 24 h was stratified as low (<2 points), intermediate (2-4 points), or high (≥4 points), which corresponded to risks of 8.1% [95% confidence interval (CI) 3.0-16.8%], 63.8% [95% CI 50.1-76.0%], and 93.7% [95% CI 84.5-98.2%]. The area under the curve of the simplified score was 0.94 for the derivation and 0.91 for the validation cohort. CONCLUSION: Among ED patients with pericardial effusion, a four-variable prediction score consisting of systolic blood pressure, effusion diameter, right ventricular collapse, and mitral inflow velocity variation can accurately predict the need for urgent pericardial drainage. Prospective validation of this novel score is warranted.

Nanoleite: a new semiconducting carbon allotrope predicted by density functional theory.

In this report, a new carbon allotrope named nanoleite is proposed. Its crystal structure is constructed by embedding carbon nanotubes into the matrix of lonsdaleite periodically, leading to a hexagonal primitive unit cell. The equilibrium structure of nanoleite is fully relaxed by density functional theory calculation, and we demonstrate that nanoleite is a semiconductor with an indirect energy bandgap of 2.06 eV. Furthermore, it has a high absorption coefficient in the visible spectrum range, which is comparable to that of the gallium arsenide and indium phosphide. X-ray diffraction patterns and phonon modes are also studied.

Carbon sp chains in diamond nanocavities.

We propose a new class of carbon allotropes obtained by combining linear sp carbon chains with sp3 bulk carbon. The structure of these crystalline carbon allotropes consists of sp chains inserted in cylindrical cavities periodically arranged in hexagonal diamond (lonsdaleite). We carry out a detailed computational analysis of the structural, electronic, and vibrational properties of a simple form in this class: a single C6 strand embedded in a nm-sized cavity. We obtain a metallic allotrope exhibiting characteristic high-frequency vibrations associated with the sp chain stretching modes, and characterized by long-time room-temperature stability. In addition, we suggest how numerous similar allotropes could be constructed within this class, that we call zayedenes, all characterized by comparable metallicity and high-frequency vibrations.

Effects of immobilization angle on tendon healing after achilles rupture in a rat model.

Conservative (non-operative) treatment of Achilles tendon ruptures is a common alternative to operative treatment. Following rupture, ankle immobilization in plantarflexion is thought to aid healing by restoring tendon end-to-end apposition. However, early activity may improve limb function, challenging the role of immobilization position on tendon healing, as it may affect loading across the injury site. This study investigated the effects of ankle immobilization angle in a rat model of Achilles tendon rupture. We hypothesized that manipulating the ankle from full plantarflexion into a more dorsiflexed position during the immobilization period would result in superior hindlimb function and tendon properties, but that prolonged casting in dorsiflexion would result in inferior outcomes. After Achilles tendon transection, animals were randomized into eight immobilization groups ranging from full plantarflexion (160°) to mid-point (90°) to full dorsiflexion (20°), with or without angle manipulation. Tendon properties and ankle function were influenced by ankle immobilization position and time. Tendon lengthening occurred after 1 week at 20° compared to more plantarflexed angles, and was associated with loss of propulsion force. Dorsiflexing the ankle during immobilization from 160° to 90° produced a stiffer, more aligned tendon, but did not lead to functional changes compared to immobilization at 160°. Although more dorsiflexed immobilization can enhance tissue properties and function of healing Achilles tendon following rupture, full dorsiflexion creates significant tendon elongation regardless of application time. This study suggests that the use of moderate plantarflexion and earlier return to activity can provide improved clinical outcomes. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Effects of pulsed electromagnetic field therapy at different frequencies and durations on rotator cuff tendon-to-bone healing in a rat model.

BACKGROUND: Rotator cuff tears affect millions of individuals each year, often requiring surgical intervention. However, repair failure remains common. We have previously shown that pulsed electromagnetic field (PEMF) therapy improved tendon-to-bone healing in a rat rotator cuff model. The purpose of this study was to determine the influence of both PEMF frequency and exposure time on rotator cuff healing. METHODS: Two hundred ten Sprague-Dawley rats underwent acute bilateral supraspinatus injury and repair followed by either Physio-Stim PEMF or high-frequency PEMF therapy for 1, 3, or 6 hours daily. Control animals did not receive PEMF therapy. Mechanical and histologic properties were assessed at 4, 8, and 16 weeks. RESULTS: Improvements in different mechanical properties at various endpoints were identified for all treatment modalities when compared with untreated animals, regardless of PEMF frequency or duration. Of note, 1 hour of Physio-Stim treatment showed significant improvements in tendon mechanical properties across all time points, including increases in both modulus and stiffness as early as 4 weeks. Collagen organization improved for several of the treatment groups compared with controls. In addition, improvements in type I collagen and fibronectin expression were identified with PEMF treatment. An important finding was that no adverse effects were identified in any mechanical or histologic property. CONCLUSIONS: Overall, our results suggest that PEMF therapy has a positive effect on rat rotator cuff healing for each electromagnetic fundamental pulse frequency and treatment duration tested in this study.

Complications of cosmetic eye whitening.

Introduced in 2008 and subsequently popularized in South Korea, cosmetic eye whitening has been offered as a treatment of chronic conjunctival hyperemia. Patients undergo conjunctivectomy with topical mitomycin C (MMC) 0.02% application to achieve a whitened appearance from bleaching of avascular sclera. Much speculation has arisen from this procedure given the limited available evidence on its efficacy and safety. A literature search was performed to review common complications of cosmetic eye whitening, including chronic conjunctival epithelial defects, scleral thinning, avascular zones in the sclera, dry eye syndrome, and diplopia requiring strabismus surgery. Informing the general public of the risks of this procedure is of great importance for dermatologists and other cosmetic surgeons.

Version Correction via Eccentric Reaming Compromises Remaining Bone Quality in B2 Glenoids: A Computational Study.

BACKGROUND: Version correction via eccentric reaming reduces clinically important retroversion in Walch type B2 glenoids (those with substantial glenoid retroversion and a second, sclerotic neoglenoid cavity) before total shoulder arthroplasty (TSA). Clinically, an increased risk of glenoid component loosening in B2 glenoids was hypothesized to be the result of compromised glenoid bone quality attributable to eccentric reaming. However, no established guidelines exist regarding how much version correction can be applied without compromising the quality of glenoid bone. QUESTIONS/PURPOSES: (1) How does version correction correlate to the reaming depth and the volume of resected bone during eccentric reaming of B2 glenoids? (2) How does version correction affect the density of the remaining glenoid bone? (3) How does version correction affect the spatial distribution of high-quality bone in the remaining glenoid? METHODS: CT scans of 25 patients identified with Walch type B2 glenoids (age, 68 ± 9 years; 14 males, 11 females) were selected from a cohort of 111 patients (age, 69 ± 10 years; 50 males, 61 females) with primary shoulder osteoarthritis who underwent TSA. Virtual TSA with version corrections of 0°, 5°, 10°, and 15° was performed on 25 CT-reconstructed three-dimensional models of B2 scapulae. After simulated eccentric reaming at each version correction angle, bone density (Hounsfield units [HUs]) was analyzed in five adjacent 1-mm layers under the reamed glenoid surface. Remaining high-quality bone (> 650 HUs) distribution in each 1-mm layer at different version corrections was observed on spatial distribution maps. RESULTS: Larger version corrections required more bone resection, especially from the anterior glenoid. Mean bone densities in the first 1-mm bone bed under the reamed surface were lower with 10° (523.3 ± 79.9 HUs) and 15° (479.5 ± 81.0 HUs) version corrections relative to 0° (0°, 609.0 ± 103.9 HUs; mean difference between 0° and 15°, 129.5 HUs [95% CI, 46.3-212.8 HUs], p < 0.001; mean difference between 0° and 10°, 85.7 HUs [95% CI, 8.6-162.9 HUs], p = 0.021) version correction. Similar results were observed for the second 1-mm bone bed. Spatial distribution maps qualitatively showed a decreased frequency of high-quality bone in the anterior glenoid as version correction increased. CONCLUSIONS: A version correction as low as 10° was shown to reduce the density of the glenoid bone bed for TSA glenoid fixation in our computational study that simulated reaming on CT-reconstructed B2 glenoid models. Increased version correction resulted in gradual depletion of high-quality bone from the anterior region of B2 glenoids. CLINICAL RELEVANCE: This computational study of eccentric reaming of the glenoid before TSA quantitatively showed glenoid bone quality is sensitive to version correction via simulated eccentric reaming. The bone density results of our study may benefit surgeons to better plan TSA on B2 glenoids needing durable bone support, and help to clarify goals for development of precision surgical tools.

A Double-Blind Randomized Comparison of Continuous Interscalene, Supraclavicular, and Suprascapular Blocks for Total Shoulder Arthroplasty.

BACKGROUND AND OBJECTIVES: Continuous brachial plexus blocks at the interscalene level are associated with known diaphragm dysfunction from phrenic nerve paresis. More distal blocks along the brachial plexus may provide postsurgical analgesia while potentially having less effect on diaphragm function. Continuous interscalene, continuous supraclavicular, and continuous suprascapular nerve blocks were evaluated for respiratory function and analgesia after total shoulder arthroplasty. METHODS: After ethics board approval, subjects presenting for total shoulder arthroplasty were planned for randomization in a 1:1:1 ratio of a continuous interscalene, supraclavicular, or suprascapular block. The primary outcome was the assessment of vital capacity after 24 hours of continuous nerve block infusion (6 mL/h; 0.2% ropivacaine), without an initial bolus of local anesthetic during catheter placement. Additional outcomes included diaphragm excursion, pain scores, opioid consumption, and adverse effects. RESULTS: Seventy-five subjects, 25 per group, completed the study. At 24 hours of continuous infusion only (no initial block bolus), the mean vital capacity reduction in the continuous interscalene control group was 991 mL (95% confidence interval [CI], 820-1162). Compared to the interscalene group, the continuous supraclavicular group had a mean vital capacity reduction of 803 mL (95% CI, 616-991; P = 0.322). The continuous suprascapular group had a significantly improved mean vital capacity reduction of 464 mL (95% CI, 289-639; P < 0.001) when similarly compared against the interscalene group. A relative compromise in ultrasound-measured diaphragm excursion was identified in the interscalene group compared to both the supraclavicular group (P = 0.012) and the suprascapular group (P < 0.001). Mean pain scores on an 11-point scale (2.2, 1.6, and 2.6) and 24-hour opioid consumption (13.8 mg, 9.9 mg, and 21.8 mg) for groups interscalene, supraclavicular, and suprascapular, respectively, did not show statistically significant differences. Less adverse effects (Horner syndrome, dyspnea, and hoarseness) were noted in the suprascapular group when compared with the interscalene group (P = 0.002). CONCLUSIONS: A continuous suprascapular block may be a useful analgesic alternative to the interscalene or supraclavicular approaches when the preservation of lung function is a priority after shoulder replacement surgery.

Highly photoresponsive, ZnO nanorod-based photodetector for operation in the visible spectral range.

While significant advances have been made for gold nanoparticle (AuNP)-coupled zinc oxide (ZnO) as visibly blind, ultraviolet photodetection devices, very few ZnO nanomaterial systems have been developed specifically for use in the visible wavelength regime. Further efforts to develop ZnO-based visible photodetectors (PDs) are still highly warranted in order to better understand the precise effect of AuNP load, operation wavelength, and beam position on the device output. In this study, we demonstrate significantly enhanced, photoresponse behaviors of AuNP-coupled ZnO nanorod (NR) network devices in the visible wavelength range with their photoresponse capacity comparable to, if not far exceeding, most commercial PDs as well as recently reported, visible, AuNP-coupled ZnO detectors. In addition, the nature and degree of the photoresponsivity enhancement are systematically elucidated by investigating their light-triggered electrical signals under varying incident wavelengths, AuNP amounts, and illumination positions. We discuss a possible photoconduction mechanism of our AuNP-coupled ZnO NR PDs and the origins of the high photoresponsivity. Specifically related to the AuNP amount-dependent photoresponse behaviors, the nanoparticle density yielding photoresponse maxima is explained as the interplay between localized surface plasmon resonance, plasmonic heating, and scattering in our photothermoelectric effect-driven device. We show that the AuNP-coupled ZnO NR PDs can be constructed via a straightforward method without the need for ultrahigh vacuum, sputtering procedures, or photo/electron-beam lithographic tools. Hence, the approach demonstrated in this study may serve as a convenient and viable means to advance the current state of ZnO-based PDs for operation in the visible spectral range with greatly increased photoresponsivity.

Radio frequency-mediated local thermotherapy for destruction of pancreatic tumors using Ni-Au core-shell nanowires.

We present a novel method of radio frequency (RF)-mediated thermotherapy in tumors by remotely heating nickel (Ni)-gold (Au) core-shell nanowires (CSNWs). Ectopic pancreatic tumors were developed in nude mice to evaluate the thermotherapeutic effects on tumor progression. Tumor ablation was produced by RF-mediated thermotherapy via activation of the paramagnetic properties of the Ni-Au CSNWs. Histopathology demonstrated that heat generated by RF irradiation caused significant cellular death with pyknotic nuclei and nuclear fragmentation dispersed throughout the tumors. These preliminary results suggest that thermotherapy ablation induced via RF activation of nanowires provides a potential alternative therapy for cancer treatment.

Continuous ambulatory adductor canal catheters for patients undergoing knee arthroplasty surgery.

STUDY OBJECTIVE: To determine after knee arthroplasty surgery the feasibility of discharging patients home on postoperative day 1 with continuous adductor canal blocks. DESIGN: Retrospective case series. SETTING: Outpatient setting after hospital discharge. PATIENTS: Patients undergoing knee arthroplasty surgery from October 2013 to August 2014. INTERVENTIONS: All patients received continuous adductor canal catheters for postoperative analgesia and were discharged to home on postoperative day 1. Continuous catheters were intended to remain intact in the ambulatory setting through postoperative day 3. MEASUREMENTS: Data obtained included demographic information, duration of hospital stay, resting and active pain scores, opioid utilization, opioid-induced adverse effects, complications relating to the perineural catheter, and hospital readmissions. MAIN RESULTS: Sixty-nine of 582 patients (11.9%) were discharged to home on postoperative day 1. The median numerical pain score after discharge with a continuous adductor canal block was ≤2 at rest and ≤4 with activity. After block discontinuation on postoperative day 4, median pain scores were the same. No patients reported any unintentional catheter dislodgements, falls, or dysesthesias. There were no readmissions of any patient in this cohort within 90 days of surgery. CONCLUSIONS: Ambulatory adductor canal catheters are a feasible analgesic modality after knee arthroplasty surgery as pain scores remained low and adverse events were minimal.