Double-territory STEMI with cardiogenic shock in immune thrombocytopenic purpura with severe thrombocytopenia-a case report.

Background: Myocardial infarction (MI) in a patient with immune thrombocytopenia is a rare scenario which is very challenging to manage. Case summary: We present a rare case of a patient with immune thrombocytopenic purpura who developed double territory segment-elevation MI with cardiogenic shock. She had an extremely rare presentation with a fresh mobile thrombus in the aortic root which was trap-dooring the right coronary artery ostium and extending into the artery with an embolism into the distal left anterior descending artery. We managed this patient conservatively with excellent recovery owing to the dangerous location of the hanging thrombus, and severe thrombocytopenia. Conclusions: Multidisciplinary approach is required for the management of MI in patients with pre-existing blood disorders, with therapy tailored to the patient's presentation and treatment requirements.

Septal Artery Strangulation Causing Brugada Phenocopy: A Rare Presentation.

Brugada phenocopies are conditions that have an electrocardiography (ECG) pattern that mimics typical patterns seen in Brugada syndrome (BS). We report a rare case of a patient who had a Brugada-like ECG pattern caused by ischemia due to strangulation of the septal artery. The patient was treated with thrombolytic therapy after a probable diagnosis of ST-elevation myocardial infarction (STEMI), which resulted in hematologic complications.

Neuroinvasive Bacillus cereus Infection in Immunocompromised Hosts: Epidemiologic Investigation of 5 Patients With Acute Myeloid Leukemia.

Background: Bacillus cereus is a ubiquitous gram-positive rod-shaped bacterium that can cause sepsis and neuroinvasive disease in patients with acute leukemia or neutropenia. Methods: A single-center retrospective review was conducted to evaluate patients with acute leukemia, positive blood or cerebrospinal fluid test results for B cereus, and abnormal neuroradiographic findings between January 2018 and October 2022. Infection control practices were observed, environmental samples obtained, a dietary case-control study completed, and whole genome sequencing performed on environmental and clinical Bacillus isolates. Results: Five patients with B cereus neuroinvasive disease were identified. All patients had acute myeloid leukemia (AML), were receiving induction chemotherapy, and were neutropenic. Neurologic involvement included subarachnoid or intraparenchymal hemorrhage or brain abscess. All patients were treated with ciprofloxacin and survived with limited or no neurologic sequelae. B cereus was identified in 7 of 61 environmental samples and 1 of 19 dietary protein samples-these were unrelated to clinical isolates via sequencing. No point source was identified. Ciprofloxacin was added to the empiric antimicrobial regimen for patients with AML and prolonged or recurrent neutropenic fevers; no new cases were identified in the ensuing year. Conclusions: B cereus is ubiquitous in the hospital environment, at times leading to clusters with unrelated isolates. Fastidious infection control practices addressing a range of possible exposures are warranted, but their efficacy is unknown and they may not be sufficient to prevent all infections. Thus, including B cereus coverage in empiric regimens for patients with AML and persistent neutropenic fever may limit the morbidity of this pathogen.

Evaluating the Diagnostic Efficacy of 99mTc-Methionine Single-Photon Emission Computed Tomography-Computed Tomography: A Head-to-Head Comparison with 11C-Methionine Positron Emission Tomography-Magnetic Resonance Imaging in Glioma Patients.

Background: Amino acid positron emission tomography (PET) imaging plays a significant role in the diagnosis of gliomas and in differentiating tumor recurrence from necrosis. In this study, the authors evaluated the diagnostic efficacy of [99mTc]Tc-methionine single-photon emission computed tomography-computed tomography (SPECT-CT) in comparison with [11C]methionine PET-magnetic resonance imaging (MRI) in delineating tumors. Methods: Thirty-one (primary: 16 and postoperative: 15) patients of confirmed (either MRI or histopathological proven) glioma underwent both [99mTc]Tc-methionine SPECT-CT and [11C]methionine PET-MRI. A comparative analysis was performed between SPECT, PET, and MR images to calculate the concordance between the modalities and to evaluate the diagnostic efficacy of the [99mTc]Tc-methionine SPECT. Results: [99mTc]Tc-methionine SPECT showed comparable uptake in the tumor lesions in comparison to [11C]methionine PET. A significant and strong positive correlation was observed between the volume of tumor (Vt) in PET and Vt MR (p < 0.004). Likewise, a significant and strong positive correlation was found between Vt SPECT and Vt MR. [99mTc]-methionine has a sensitivity and specificity of 91% and 75%, respectively, compared with 82% and 100% for [11C]methionine in postoperative cases to differentiate the tumor recurrence from necrosis. The sensitivity and specificity of [99mTc]Tc-methionine was 92% and 100%, respectively, compared with 92% and 67% for [11C]methionine in primary tumors. Conclusion: [99mTc]Tc-methionine SPECT-CT is as equally good as [11C]methionine for diagnosing and differentiating it from necrosis especially in high-grade glioma.

Total arterial revascularization using robot assisted minimally invasive coronary artery bypass: an Indian experience.

Objective: The aim of this study is to analyze the early outcomes of Total Arterial Revascularization using Robot Assisted Minimally Invasive Coronary Artery Bypass at our center between June 2019 and January 2023. Methods: This is a retrospective analysis of 195 patients who underwent Total Arterial Coronary Revascularization through Robot Assisted Minimally Invasive Coronary Artery Bypass procedure (RA-CABG) during the period of June 2019 and January 2023 in a quaternary care center in India. Primary outcome variables were in-hospital and 30-day mortality. Secondary outcome variables included duration of surgery, length of intensive care unit (ICU) stay, in-hospital stay and perioperative morbidity. The entire patient population was divided into two groups for a subgroup analysis based on when the surgery was conducted i.e. the years since the robotic program was begun at our institution with 81 patients in group I (2019-2021), and 114 patients in group II (2022-2023). Results: 195 patients [88.7% male, mean age of 61.34 ± 9.58 years] underwent RA-CABG during the 5-year period (2019-2023) by a single experienced surgeon and his team. Conversion to larger thoracic incisions was required in 5 cases (2.59%). In-hospital and 30-day mortality was 1.02% each. The average length of ICU stay and hospital stay were 2.82 ± 1.17 days and 5.84 ± 1.71 days respectively. The duration of ICU stay correlated with the number of internal mammary artery grafts procured (p = 0.0022). Median duration of follow-up was 11 months. Overall mortality was 3.62% and cardiac related mortality was 2.07%, and 5 patients (2.59%) underwent percutaneous coronary intervention. Results of the sub-group analysis revealed a statistically significant difference between the groups in terms of number of internal mammary artery grafts procured (p = 0.010), need for transfusions (p = 0.00031), ICU stay (p = 0.0005) and in-hospital stay (p = 0.0006). Conclusions: Total Arterial Coronary Revascularization through RA-CABG is a viable procedure in select patients. An experienced surgeon and team are required. Further studies in the form of randomized trials with long term follow-up are required to establish the overall utility, effectiveness and benefits to the patients.

A cavity loadlock apparatus for next-generation quantum optics experiments.

Cavity quantum electrodynamics (QED), the study of the interaction between quantized emitters and photons confined in an optical cavity, is an important tool for quantum science in computing, networking, and synthetic matter. In atomic cavity QED, this approach typically relies upon an ultrahigh vacuum chamber that hosts a cold trapped atomic ensemble and an optical cavity. Upgrading the cavity necessitates a months-long laborious process of removing external optics, venting, replacing the resonator, baking, and replacing optics, constituting a substantial bottleneck to innovation in resonator design. In this work, we demonstrate that the flexibility of optical cavities and the quick turnaround time in switching between them can be restored with the vacuum loadlock technique-reducing the cycle time to install a cavity, bake it, and transport it into the science chamber for days, achieving 3 × 10-10 Torr pressure in the science chamber. By reducing vacuum limitations, this approach is particularly powerful for labs interested in quickly exploring novel optic cavities or any other atomic physics relying on in-vacuum optics.

Development of an economical method to synthesize O-(2-[18 F]fluoroethyl)-L-tyrosine (18 FFET).

Positron emission tomography (PET) using O-(2-[18 F]fluoroethyl)-L-tyrosine ([18 F]FET) has shown great success in differentiating tumor recurrence from necrosis. In this study, we are reporting the experience of synthesis [18 F]FET by varying the concentration of TET precursor in different chemistry modules. TET precursor (2-10 mg) was used for the synthesis of [18 F]FET in an automated (MX Tracerlab) module (n = 6) and semiautomated (FX2N Tracerlab) module (n = 19). The quality control was performed for all the preparations. For human imaging, 220 ± 50 MBq of [18 F]FET was briefly injected into the patient to acquire PET-MR images. The radiochemical purity was greater than 95% for the final product in both modules. The decay corrected average yield was 10.7 ± 4.7% (10 mg, n = 3) and 8.2 ± 2.6% (2 mg, n = 3) with automated chemistry module and 36.7 ± 7.3% (8-10 mg, n = 12), 26.4 ± 3.1% (5-7 mg, n = 4), and 35.1 ± 3.8% (2-4 mg, n = 3) with semiautomated chemistry modules. The PET imaging showed uptake at the lesion site (SUVmax = 7.5 ± 2.6) and concordance with the MR image. The [18 F]FET was produced with a higher radiochemical yield with 2.0 mg of the precursor with substantial yield and is suitable for brain tumor imaging.

Quantum-enabled millimetre wave to optical transduction using neutral atoms.

Early experiments with transiting circular Rydberg atoms in a superconducting resonator laid the foundations of modern cavity and circuit quantum electrodynamics1, and helped explore the defining features of quantum mechanics such as entanglement. Whereas ultracold atoms and superconducting circuits have since taken rather independent paths in the exploration of new physics, taking advantage of their complementary strengths in an integrated system enables access to fundamentally new parameter regimes and device capabilities2,3. Here we report on such a system, coupling an ensemble of cold 85Rb atoms simultaneously to an, as far as we are aware, first-of-its-kind optically accessible, three-dimensional superconducting resonator4 and a vibration-suppressed optical cavity in a cryogenic (5 K) environment. To demonstrate the capabilities of this platform, and with an eye towards quantum networking5, we leverage the strong coupling between Rydberg atoms and the superconducting resonator to implement a quantum-enabled millimetre wave (mmwave) photon to optical photon transducer6. We measured an internal conversion efficiency of 58(11)%, a conversion bandwidth of 360(20) kHz and added thermal noise of 0.6 photons, in agreement with a parameter-free theory. Extensions of this technique will allow near-unity efficiency transduction in both the mmwave and microwave regimes. More broadly, our results open a new field of hybrid mmwave/optical quantum science, with prospects for operation deep in the strong coupling regime for efficient generation of metrologically or computationally useful entangled states7 and quantum simulation/computation with strong non-local interactions8.

Use of Fluphenazine in Bipolar Disorder With a History of Substance Abuse: A Report of Two Cases.

One of the major mental health problems with an increased rate of medication failures and treatment resistance arises with the combination of substance use and mood disorders. The purpose of this report is to discuss the off-label use of fluphenazine in managing bipolar disorder in patients with a history of substance abuse, its efficacy, and the importance of having community resources such as assertive community treatment in monitoring treatment progress and improving overall health outcomes. First-generation antipsychotics, like fluphenazine, should be used cautiously with the risks and benefits weighed against possible side effects. This report shows how fluphenazine can successfully be used as an off-label maintenance option in challenging cases.

Optical mode conversion via spatiotemporally modulated atomic susceptibility.

Light is an excellent medium for both classical and quantum information transmission due to its speed, manipulability, and abundant degrees of freedom into which to encode information. Recently, space-division multiplexing has gained attention as a means to substantially increase the rate of information transfer by utilizing sets of infinite-dimensional propagation eigenmodes such as the Laguerre-Gaussian "donut" modes. Encoding in these high-dimensional spaces necessitates devices capable of manipulating photonic degrees of freedom with high efficiency. In this work, we demonstrate controlling the optical susceptibility of an atomic sample can be used as powerful tool for manipulating the degrees of freedom of light that pass through the sample. Utilizing this tool, we demonstrate photonic mode conversion between two Laguerre-Gaussian modes of a twisted optical cavity with high efficiency. We spatiotemporally modulate the optical susceptibility of an atomic sample that sits at the cavity waist using an auxiliary Stark-shifting beam, in effect creating a mode-coupling optic that converts modes of orbital angular momentum l = 3 → l = 0. The internal conversion efficiency saturates near unity as a function of the atom number and modulation beam intensity, finding application in topological few-body state preparation, quantum communication, and potential development as a flexible tabletop device.

Synthesis, characterization, and radiosynthesis of fluorine-18-AVT-011 as a Pgp chemoresistance imaging marker.

P-glycoprotein (Pgp) is the most studied ATP-binding cassette (ABC) efflux transporter and contributes to chemoresistance. A few tracers have been developed to detect the in-vivo status of chemoresistance using positron emission tomography (PET) imaging. In our study, we have synthesized labeled AVT-011 with fluorine-18 (18F) followed by in-vitro and in-vivo analysis. Tosylate AVT-011 precursor was synthesized and characterized by 1H-NMR and 13C-NMR. AVT-011 was labeled with 18F using the nucleophilic substitution method, and a standard set of quality control was performed. The specificity for Pgp was tested in U87MG cells with and without an inhibitor (tariquidar). The biodistribution and in-vivo stability were tested in the small animals (mice). The biodistribution data of [18F]-AVT-011 was extracted from the PET-CT imaging of breast cancer patients (n = 6). The precursor was synthesized with 36 ± 4% yield and 97 ± 2% purity. The labeling was more than 95% with a 42 ± 2% yield, as evaluated by Radio-HPLC. The cell-binding assay showed a specificity of the tracer for Pgp as the uptake increased by twice after blocking the Pgp receptors. The radiotracer showed a hepatorenal excretion pathway for clearance in an animal study. The uptake was higher in the liver, lungs, spleen, and heart at 15 min and decreased at 60 min. The patients' distribution showed similar uptake patterns as observed in the small animals. [18F]AVT-011 was characterized successfully with high radiochemical purity and yield. The in-vitro and in-vivo studies proved its specificity for Pgp and safe for patient use.

Observations of Atmospheric Tides in the Middle and Upper Atmosphere of Mars From MAVEN and MRO.

Variability in the Martian upper atmosphere is strongly linked to the lower atmosphere and much of it can be attributed to vertical wave propagation. Atmospheric tides in particular are a well-known phenomenon in the Martian atmosphere that play a key role in the transport of energy as they propagate to higher altitudes. Previous theoretical predictions and observations suggest that tides producing wavenumber-2 and wavenumber-3 patterns are strongest in a fixed local time at high altitudes, however, the energy they carry and the region of deposition are not well characterized. Given the availability of atmospheric observations from several spacecraft at the same time, in this paper, the nature and behavior of tides are studied concurrently at several altitudes. Here, six intervals are identified focused at fixed low latitudes utilizing simultaneous observations of the middle and upper atmosphere from in situ and remote sensing instruments on different spacecraft. In the middle atmosphere, strong wavenumber-2 signatures are identified in the intervals north of the equator whereas, in the south, wavenumber-3 signatures are strongest. Wave signatures observed in the upper atmosphere seem to be dominated by a mix of wavenumbers-2 and -3. Seasonal variation is observed in the northern intervals, with very little interannual variability in all intervals considered. Estimates of energy based on dominant wavenumber amplitude suggest that most of the energy dissipates below ∼90 km. Furthermore, model sampled output captures the dominant wavenumbers observed in the middle atmosphere as well as the energy dissipation characteristics.

Cyclophilin A Impairs Efferocytosis and Accelerates Atherosclerosis by Overexpressing CD 47 and Down-Regulating Calreticulin.

Impairment of efferocytosis in apoptotic macrophages is a known determinant of the severity of atherosclerosis and the vulnerability of plaques to rupture. The precise mechanisms involved in impaired efferocytosis are unclear. Given the well-recognized role of the inflammatory cytokine cyclophilin A (Cyp A) in modulating several atherogenic mechanisms in high-glucose primed monocytes, we investigated the role of Cyp A in macrophage efferocytosis. The efficiency of efferocytosis in RAW 264.7 macrophages grown in vitro and primed with cyclophilin A was assessed using flow cytometry and confocal assays. Cholesterol content in cells was measured using cell-based cholesterol efflux assay. Proteomic analysis and bioinformatics tools were employed to decipher the link between cyclophilin A and the known ligand receptors involved in efferocytosis. Cyclophilin A was found to impair efferocytosis in apoptotic macrophages by reducing ABCA1-mediated cholesterol efflux in foam cells derived from macrophages. Cyclophilin A-primed macrophages showed an increase in expression of the don't-eat-me signal CD 47 and a decrease in the expression of the eat-me signal, calreticulin. Phagocytosis was restored upon silencing of cyclophilin A. New Zealand white rabbits were fed a high-fat diet, and lesions in their aortae were analyzed histologically for evidence of atherosclerosis and the expression of Cyp A, CD 47 and calreticulin, the ligand receptor involved in efferocytosis. Gene and protein expressions in aortae and macrophages were analyzed by real-time PCR and Western blotting. Cyclophilin A, via its effects on the expression of CD 47 and calreticulin, impairs efferocytosis in apoptotic macrophages. Together with its impact on cholesterol efflux from macrophages, these effects can amplify other mechanisms of Cyp A in accelerating the progression of atherosclerosis.

A review of modern technologies for tackling COVID-19 pandemic.

OBJECTIVE: Science and technology sector constituting of data science, machine learning and artificial intelligence are contributing towards COVID-19. The aim of the present study is to discuss the various aspects of modern technology used to fight against COVID-19 crisis at different scales, including medical image processing, disease tracking, prediction outcomes, computational biology and medicines. METHODS: A progressive search of the database related to modern technology towards COVID-19 is made. Further, a brief review is done on the extracted information by assessing the various aspects of modern technologies for tackling COVID-19 pandemic. RESULTS: We provide a window of thoughts on review of the technology advances used to decrease and smother the substantial impact of the outburst. Though different studies relating to modern technology towards COVID-19 have come up, yet there are still constrained applications and contributions of technology in this fight. CONCLUSIONS: On-going progress in the modern technology has contributed in improving people's lives and hence there is a solid conviction that validated research plans including artificial intelligence will be of significant advantage in helping people to fight this infection.

Sorting ultracold atoms in a three-dimensional optical lattice in a realization of Maxwell's demon.

In 1872, Maxwell proposed his famous 'demon' thought experiment1. By discerning which particles in a gas are hot and which are cold, and then performing a series of reversible actions, Maxwell's demon could rearrange the particles into a manifestly lower-entropy state. This apparent violation of the second law of thermodynamics was resolved by twentieth-century theoretical work2: the entropy of the Universe is often increased while gathering information3, and there is an unavoidable entropy increase associated with the demon's memory4. The appeal of the thought experiment has led many real experiments to be framed as demon-like. However, past experiments had no intermediate information storage5, yielded only a small change in the system entropy6,7 or involved systems of four or fewer particles8-10. Here we present an experiment that captures the full essence of Maxwell's thought experiment. We start with a randomly half-filled three-dimensional optical lattice with about 60 atoms. We make the atoms sufficiently vibrationally cold so that the initial disorder is the dominant entropy. After determining where the atoms are, we execute a series of reversible operations to create a fully filled sublattice, which is a manifestly low-entropy state. Our sorting process lowers the total entropy of the system by a factor of 2.44. This highly filled ultracold array could be used as the starting point for a neutral-atom quantum computer.

Effects of temperature and solvent on hydrothermal liquefaction of Sargassum tenerrimum algae.

The influence of various solvents (H2O, CH3OH, and C2H5OH) on product distribution and nature of products during hydrothermal liquefaction of sargassum tenerrimum algae has been examined. Hydrothermal liquefaction was performed using H2O (260, 280 and 300°C) and organic solvents CH3OH and C2H5OH (280°C) for 15min. The use of organic solvents significantly increased the yield of bio-oil. In the case of liquefaction with CH3OH and C2H5OH, the bio-oil yield was 22.8 and 23.8wt.% respectively whereas the bio-oil yield was 16.33wt.% with H2O. GC-MS analysis of the liquid products indicated the presence of various organic compounds including aromatics, nitrogenated and oxygenated compounds and higher selectivity amount of ester compounds were observed in the presence of alcoholic solvents. NMR and FT-IR showed that present of solvents have an effect on the decomposition of sargassum tenerrimum algae.

Effects of Tongue Force Training on Bulbar Motor Function in the Female SOD1-G93A Rat Model of Amyotrophic Lateral Sclerosis.

BACKGROUND: The use of exercise in amyotrophic lateral sclerosis (ALS) is controversial. Although moderate exercise appears to be beneficial for limb muscles in ALS, the effects of exercise on bulbar muscles such as the tongue have not been studied. OBJECTIVE: To determine the effects of tongue force training on bulbar motor function in the SOD1-G93A rat model of ALS. METHODS: We compared the effects of tongue force training on bulbar motor function and neuromuscular junction innervation in female SOD1-G93A rats and age-matched female wild-type controls. Half of each group underwent afternoon tongue force training sessions, and all rats were tested under minimal force conditions in the mornings. RESULTS: Tongue force did not differ between the SOD1-G93A rats and healthy controls during the morning testing sessions, nor was it affected by training. Surprisingly, decreases in tongue motility, the number of licks per session, and body weight were greater in the tongue force-trained SOD1-G93A rats. Forelimb grip force, survival, and denervation of the genioglossus (GG) muscle did not differ between the trained and untrained SOD1-G93A rats. GG innervation was correlated with changes in tongue force but not tongue motility in SOD1-G93A rats at end stage. CONCLUSIONS: The results indicate a potential deleterious effect of tongue force training on tongue motility in female SOD1-G93A rats. The lack of a relationship between GG innervation and tongue motility suggests that factors other than lower-motor neuron integrity likely accounted for this effect.