Comparison of Transesophageal Echocardiography Probe as Surface Probe with Vascular Probe During Right Internal Jugular Vein Catheterization in Cardiac Surgeries.

CONTEXT: USG vascular probe and TEE probe can help during central venous catheterization (CVC) and can confirm the location of guide wire in the neck vessels. We proposed this study, as there are only few studies comparing between TEE probe as surface probe and USG vascular probe for right IJV cannulation. AIMS: To compare the TEE probe as a surface probe and USG vascular probe during right IJV catheterization in cardiac surgeries. SETTINGS AND DESIGN: Prospective, comparative study. METHODS AND MATERIAL: One twenty-four patients of either sex posted for major elective cardiac surgery were included in this study. Patients were divided into two groups (TEE group and USG group) of 62 by assigning the study participants alternatively to each group. The goal of this study was to compare the puncture time, visualization of IJV to first successful puncture, quality of the imaging with needle tip positioning, and catheter positioning using both TEE probe and vascular probe. The primary outcome was comparison of time from visualization of the IJV to successful puncture using both TEE probe as a surface probe and vascular probe. Secondary outcome was to compare the quality of image with respect to needle tip positioning and compare quality of image with respect to catheter position using both probes. STATISTICAL ANALYSIS USED: Statistical analyses were performed by using a statistical software package SPSS, version 20.0. RESULTS: The observation and results of our study clearly show the feasibility of TEE as surface probe for guiding central venous catheter in right IJV just like the vascular linear probe. There was no significant difference between the two groups (P > 0.05). No statistical differences were found in the puncture time, image quality, needle tip positioning, wire positioning, and catheter positioning between the two groups. All the P values were greater than 0.05. CONCLUSIONS: The TEE probe can be used as an alternative method to guide IJV puncturing and catheterization when the vascular probe is not available. It is feasible especially in cardiac surgeries where the TEE monitoring machine is a must in modern anesthesia and readily available than an ultrasound machine.

Neuronal diversity can improve machine learning for physics and beyond.

Diversity conveys advantages in nature, yet homogeneous neurons typically comprise the layers of artificial neural networks. Here we construct neural networks from neurons that learn their own activation functions, quickly diversify, and subsequently outperform their homogeneous counterparts on image classification and nonlinear regression tasks. Sub-networks instantiate the neurons, which meta-learn especially efficient sets of nonlinear responses. Examples include conventional neural networks classifying digits and forecasting a van der Pol oscillator and physics-informed Hamiltonian neural networks learning Hénon-Heiles stellar orbits and the swing of a video recorded pendulum clock. Such learned diversity provides examples of dynamical systems selecting diversity over uniformity and elucidates the role of diversity in natural and artificial systems.

Bilateral Microvascular Submandibular Gland Transfer with Implantation of Wharton's Duct in Superior Conjunctival Fornix: A Vision-Saving Procedure for Severe Dry Eye Disease.

Dry eye can initially cause mild symptoms of irritation and may rapidly progress to corneal scarring and blindness. Tear substitutes can only help for mild cases. With the advancement in microsurgical techniques, an option of transferring vascularized salivary glands has shown positive results. We present a case of a 5-year-old boy with congenital alacrimia with ocular surface damage. Vascularized autologous submandibular gland transfer was considered as a viable option for this patient. We performed the gland transfer in two separate stages for the two eyes (1 year 5 months apart). The patient was evaluated for up to 2 years for the right eye and for 7 months for the left eye. Dry eye workup showed drastic improvement (right > left). Biochemical analysis showed gradual transition to resemble that of natural tears. This procedure can result in significant symptomatic improvement and can be a promising treatment option for cases of severe dry eye.

More than meets the eye: Expanding and reviewing the clinical and mutational spectrum of brittle cornea syndrome.

Brittle cornea syndrome (BCS) is a rare autosomal recessive disorder characterized by corneal thinning and fragility, leading to corneal rupture, the main hallmark of this disorder. Non-ocular symptoms include not only hearing loss but also signs of connective tissue fragility, placing it in the Ehlers-Danlos syndrome (EDS) spectrum. It is caused by biallelic pathogenic variants in ZNF469 or PRDM5, which presumably encode transcription factors for extracellular matrix components. We report the clinical and molecular features of nine novel BCS families, four of which harbor variants in ZNF469 and five in PRDM5. We also performed a genotype- and phenotype-oriented literature overview of all (n = 85) reported patients with ZNF469 (n = 53) and PRDM5 (n = 32) variants. Musculoskeletal findings may be the main reason for referral and often raise suspicion of another heritable connective tissue disorder, such as kyphoscoliotic EDS, osteogenesis imperfecta, or Marfan syndrome, especially when a corneal rupture has not yet occurred. Our findings highlight the multisystemic nature of BCS and validate its inclusion in the EDS classification. Importantly, gene panels for heritable connective tissue disorders should include ZNF469 and PRDM5 to allow for timely diagnosis and appropriate preventive measures for this rare condition.

Anomalous spin-orbit torques in magnetic single-layer films.

The spin Hall effect couples charge and spin transport1-3, enabling electrical control of magnetization4,5. A quintessential example of spin-Hall-related transport is the anomalous Hall effect (AHE)6, first observed in 1880, in which an electric current perpendicular to the magnetization in a magnetic film generates charge accumulation on the surfaces. Here, we report the observation of a counterpart of the AHE that we term the anomalous spin-orbit torque (ASOT), wherein an electric current parallel to the magnetization generates opposite spin-orbit torques on the surfaces of the magnetic film. We interpret the ASOT as being due to a spin-Hall-like current generated with an efficiency of 0.053 ± 0.003 in Ni80Fe20, comparable to the spin Hall angle of Pt7. Similar effects are also observed in other common ferromagnetic metals, including Co, Ni and Fe. First-principles calculations corroborate the order of magnitude of the measured values. This work suggests that a strong spin current with spin polarization transverse to the magnetization can be generated within a ferromagnet, despite spin dephasing8. The large magnitude of the ASOT should be taken into consideration when investigating spin-orbit torques in ferromagnetic/non-magnetic bilayers.