Relationship between placental thickness and amniotic fluid index in single uncomplicated pregnancy 

Larsen syndrome is a rare congenital skeletal dysplasia characterized by multiple joint dislocations and distinctive craniofacial features, which can complicate neonatal airway management. We report a term female neonate born at 40 weeks of gestation, weighing 2200 grams, delivered spontaneously in a peripheral facility with thick meconium-stained amniotic fluid. The infant did not cry at birth and exhibited severe respiratory depression (Apgar scores 3–4–5). Initial resuscitation, including airway clearance and positive pressure ventilation without a self-inflating bag, was performed to achieve effective lung aeration, resulting in gradual improvement in oxygen saturation from 93% to 100%. Clinical examination revealed congenital knee dislocation and cephalhematoma, while anthropometric assessment indicated intrauterine growth restriction. Chest auscultation demonstrated no adventitious sounds despite persistent tachypnea. This case highlights the complexity of neonatal stabilization when meconium aspiration syndrome coexists with syndromic skeletal anomalies. In resource-limited settings, structured resuscitation protocols and careful handling of the airway and limbs are essential to optimize outcomes and prevent further injury.

Abstract In this research work, two natural and one synthetic wax were used for the inner surface coating of a high‐density polyethylene (HDPE) specimen to make it self‐lubricating and reduce wettability. This includes solvent etching by chromic acid and further impregnating the substrate with waxes. The chromic acid etching of the HDPE specimen results in changing the surface properties, leading to essential surface roughness. These surfaces are further functionalized with a natural wax‐like, carnauba wax, candelilla wax and synthetic wax‐like, erucamide wax that produces a durable, repellant, and fluid roll‐off surface. For impregnation, a coating on the substrate waxes used was a non‐toxic, self‐lubricating coating material and exhibited reduced wear and friction. Surface properties of HDPE surfaces, like contact angle measurement, spreading coefficient, wetting energy, and work of adhesion checked with the help of a contact angle analyzer. Surface morphology was investigated by scanning electron microscopy. Amongst these three waxes, synthetic wax (erucamide) exhibits a higher contact angle and increases hydrophobicity. Material flow test carried out with a thick fluid like ketchup. This test also suggests that erucamide wax gives better fluid repellant properties and a maximum amount of thick fluid roll‐off.

ABSTRACT This study explores the exchange flow of two miscible fluids in both straight horizontal and slanted rectangular channels, employing analytical and experimental methods. It aims to elucidate the front velocity and behavior of the fluid interface, with a keen focus on capturing high-resolution temporal variations in front velocity to identify any oscillatory patterns. The research proposes a straightforward analytical model to predict interface behavior and front velocity under stable conditions with minimal mixing. A key innovation of the study is the validation of this model in predicting interface evolution in stable scenarios. Additionally, it analyzes fluid thickness in horizontal channels, contributing to a deeper understanding of flow dynamics and trends in front velocity. The work’s novelty is highlighted in two main areas: in the inertia-dominated regime, front velocity is regarded as a time-dependent variable, and a quantitative analysis of front velocity fluctuations at higher inclinations is presented. In the viscous-dominated regime, the study affirms the applicability of the analytical model for forecasting interface behavior and front velocity variations in horizontal channels, with potential applicability to other inclinations or displacement flows, assuming minimal mixing and stability are maintained.

IntroductionSpinal cord stimulation (SCS) is a widely accepted therapy in patients with chronic intractable neuropathic pain in the trunk and limbs. However, open-loop (OL) SCS systems, which rely on fixed stimulation parameters and subjective feedback, face limitations in delivering consistent neural activation and durable pain relief. Anatomical and physiological characteristics of the cervical spinal cord, such as decreased cerebrospinal fluid thickness and increased mobility, exacerbate these challenges. Limited evidence exists on differences in cervical and thoracic neurophysiology, and the corresponding impact on neural activation in SCS. This post hoc analysis characterizes neurophysiological differences between the cervical and thoracic regions using evoked compound action potential (ECAP)-controlled closed-loop (CL) technology to assess implications for SCS dosing and therapy optimization.MethodsGlobal study and real-world chronic pain patients implanted with ECAP-controlled CL-SCS systems were included. To identify differences between cervical (n = 187) and thoracic (n = 1899) neurophysiology, the relationship between stimulation current and neural activation was analyzed. Additionally, neural activation stability was evaluated in both in-clinic and out-of-clinic settings.ResultsThe cervical spinal cord demonstrated significantly lower ECAP thresholds (p < 0.001) and > 100% higher spinal cord sensitivity compared to the thoracic region (p < 0.001). Cervical therapeutic dosing range was ≥ 48% narrower (p < 0.001), increasing the risk of overstimulation with OL-SCS. CL-SCS significantly improved dose accuracy in both regions (p < 0.001) during postural changes simulating activities of daily living. These findings highlight the superior precision and consistency in neural dosing with ECAP-controlled CL systems.ConclusionsThis is the first study to objectively characterize differences in cervical and thoracic spinal neurophysiology using SCS. ECAP-controlled CL-SCS maintains consistent neural activation in both cervical and thoracic regions. Given the heightened sensitivity and narrow dosing range in the cervical region, ECAP-controlled CL-SCS may enhance therapeutic outcomes through more precise and consistent neural dosing compared to OL systems.

To evaluate the association between localized features of diabetic macular edema (DME) and point-wise retinal sensitivity (RS) assessed with microperimetry (MP) using deep learning (DL)-based automated quantification on optical coherence tomography (OCT) scans. Cross-sectional study. Twenty eyes of 20 subjects with clinically significant DME were included in this study. Patients with DME visible on OCT scans (Spectralis Heidelberg Retina Angiograph [HRA]+OCT) completed 2 MP examinations using a custom 45 stimuli grid on MAIA (CenterVue). MP stimuli were coregistered with the corresponding OCT location using image registration algorithms. DL-based algorithms were used to quantify intraretinal fluid (IRF) and ellipsoid zone (EZ) thickness. Hard exudates (HEs) were quantified semiautomatically. Multivariable mixed-effect models were calculated to investigate the association between DME-specific OCT features and point-wise RS. As EZ thickness values below HEs were excluded, the models included either EZ thickness or HEs. A total of 1800 MP stimuli from 20 eyes of 20 patients were analyzed. Stimuli with IRF (n = 568) showed significantly decreased RS compared to areas without (estimate [95% CI]: -1.11 dB [-1.69, -0.52]; p = 0.0002). IRF volume was significantly negatively (-0.45 dB/nL [-0.71; -0.18]; p = 0.001) and EZ thickness positively (0.14 dB/µm [0.1; 0.19]; p < 0.0001) associated with localized point-wise RS. In the multivariable mixed model, including HE volume instead of EZ thickness, a negative impact on RS was observed (-0.43/0.1 nL [-0.81; -0.05]; p = 0.027). DME-specific features, as analyzed on OCT, have a significant impact on point-wise RS. IRF and HE volume showed a negative and EZ thickness, a positive association with localized RS.

IntroductionAnti-vascular endothelial growth factor therapy has revolutionised the treatment of neovascular age-related macular degeneration (nAMD). However, some patients face recurrent and persistent disease activity despite ongoing treatment. Faricimab (trade name: Vabysmo) is a recently approved therapy which targets two pathways involved in nAMD. This study aims to assess changes in best-corrected visual acuity (BCVA) and treatment frequency among patients currently treated for nAMD who switch to intravitreal faricimab therapy under a treat-and-extend regimen.Methods and analysisThe FURGGHORN Study is a prospective, open-label, single-arm, multicentre investigator-initiated clinical trial. 102 patients with nAMD meeting inclusion criteria were recruited from 12 clinical sites across Australia and Singapore. Following 4 monthly loading doses of faricimab, treatment intervals were adjusted according to a regimen developed based on real-world practice patterns and consensus guidelines. The primary endpoint is the change from BCVA at week 52. Secondary endpoints include the proportions of patients at different treatment intervals, changes in central macular thickness and retinal fluid dimensions.Ethics and disseminationThis study was designed, implemented and reported in accordance with the International Conference on Harmonisation Harmonised Tripartite Guidelines for Good Clinical Practice, with applicable local regulations and with the ethical principles laid down in the Declaration of Helsinki. Ethics approval was obtained from Bellberry Limited (2022-12-1388), St Vincent’s Hospital Human Research Ethics Committee (2023/STE01568) and Singhealth Centralized Institutional Review Board (2023-2190). Results will be disseminated at scientific meetings and through peer-reviewed publications.Trial registration numberACTRN12623000215628.

To describe the real-world efficacy and safety outcome measurements of faricimab use in treatment-resistant neovascular age-related macular degeneration (nAMD) in a cohort of Asian patients. A tertiary hospital in central Singapore serving a resident population of approximately 1.5million. Retrospective chart review of patients with nAMD previously treated using intravitreal bevacizumab, ranibizumab or aflibercept and were switched to faricimab between August 2022 to August 2023. Patients were switched to faricimab due to either the ineffectiveness of prior anti-VEGF agents to achieve retinal dryness or inadequate treatment intervals. Only patients who had at least one follow-up visit after switching to faricimab were included in the analysis. Primary outcome measures included best-corrected visual acuity (BCVA) in ETDRS letter score and Optical Coherence Tomography (OCT) measurements including central subfield thickness (CST), presence or absence of intraretinal fluid (IRF), subretinal fluid (SRF), intraretinal cysts and subretinal hyperreflective material (SRHM). Secondary outcome measures included adverse events and treatment history such as the mean number of injections and treatment intervals. One hundred and nineteen eyes (117 patients) with a mean age of 75.6 (58-93 years) were switched to faricimab and included in the analysis. Of these, 55 (47.0%) were males. The mean number of intravitreal anti-VEGF injections received was 28.2 ± 19.5 prior to switching to faricimab. The majority of these were switched from ranibizumab (26.1%) and aflibercept (73.1%). At baseline, BCVA was 62.7 ± 19.9 letter and mean CST on OCT was 352.5μm ± 128.5μm. Only 11 (9.2%) eyes were dry on OCT at baseline: 39.5% had presence of IRF, 72.3% had presence of SRF, 41.2% had presence of intraretinal cysts, and 50.4% had presence of SRHM. After switching to faricimab, the eyes received a mean of 4.8 ± 2.7 faricimab injections up to the time of data cut-off. At last visit, the mean BCVA maintained at 60.3 ± 20.7 letter and mean CST reduction was - 41.6μm (p < 0.001). Compared to baseline, 49 (41.2%) were dry on OCT: 24.4% had presence of IRF, 41.2% had presence of SRF, 29.4% had presence of intraretinal cysts, and 48.7% had presence of SRHM (all p < 0.001). No serious ocular adverse events were reported. Switching patients with nAMD to faricimab in real-world scenarios has demonstrated the ability to maintain vision while adding anatomical gains in those previously resistant to alternative anti-VEGF therapy. Faricimab is well-tolerated with no serious ocular adverse events reported.

INTRODUCTION:Neuroimaging genetics have advanced Alzheimer’s disease (AD) research, yet frameworks mechanistically connecting genes to neurological outcomes via functional genomics are needed to elucidate genetic associations. To address this challenge, we assessed relationships between AD-associated variants and disease via their impact on gene expression and neuroimaging phenotypes.METHODS:We mapped established AD genes to neuroimaging traits using NeuroimaGene atlas and predicted transcript-driven AD neurological features by comparing gene-derived neuroimaging features to clinical neuroimaging data. Genetic correlation and covariance analyses characterized shared genetic architecture between AD endophenotypes and neuroimaging features and identified neuroimaging features associated with dementia family history.RESULTS:Our analyses implicate PSMC3 expression as a strong contributor to AD pathophysiology and indicate AD endophenotypes, including dementia family history, linked to frontal cortex thickness, volume, and cerebrospinal fluid volume changes.DISCUSSION:Our findings prioritize AD genes whose regulation is associated with vulnerable brain regions, offering a potential mechanistic framework for downstream functional validation.

Chitosan membrane tailored for topical acne treatment by incorporating Pickering encapsulated tea tree oil based on organosilane-modified palygorskite.

Numerical investigation of Richtmyer–Meshkov instability in shock accelerated finite thickness fluid layer with particles

A spinal cord stimulation (SCS) approach has been developed that uses inactive electrode contacts to record epidural spinal recordings (ESRs) generated during SCS. ESRs contain evoked compound action potentials (ECAPs) which represent a quantitative measure of synchronous neural recruitment in the spinal cord. ECAPs may be utilized as a control signal for closed-loop stimulation and aid in optimal electrode placement and parameter selection. However, the various physiological and technical factors underlying the composition of these signals are difficult to obtain experimentally due to subject variability and sources of noise, which may limit the use of ECAPs in elucidating mechanisms of SCS-induced analgesia. Therefore, the goal of this study was to use computational modeling based on detailed anatomical imaging paired with preclinical physiological data to investigate the neuromodulatory effects of SCS. We developed a computational model from an experimental data set containing imaging and ESRs from six swine. We coupled our finite element method model with multicompartment cable models to simulate the neural response to SCS. We then used a reciprocity-based approach to calculate model ECAP recordings. Model ECAPs were dependent on stimulation parameters (ie, tonic stimulation waveform and configuration) and anatomical variations (ie, dorsal cerebrospinal fluid thickness and mediolateral lead location). Our modeling results indicate that the combined choice of stimulation waveform and stimulation configuration may result in action potential initiation at different locations, which, when recorded, gives rise to ECAPs with different morphologies and amplitudes, even for approximately the same level of underlying neural activation. Our findings suggest that ECAP characteristics may not directly represent the level of neural recruitment to a stimulus and are highly dependent on stimulation parameters. Overall, the results of this study provide a mechanistic understanding of how various factors affect the composition of ECAP recordings and will help optimize the utility of ESRs in SCS.

In this paper, the effects of thickness variations on the natural and resonant frequencies of polyurethane foams have been studied. The governing Biot’s equations are solved using an analytical method, and the natural and resonant frequencies are presented alongside the variations in solid, fluid displacement, and pressure. By selecting the characteristics of three different foam samples from various references, the variations in the frequency characteristics of the foam with changes in thickness are investigated over a broad range, and specific results are provided. Based on the presented results, it is observed that as thickness increases, the solid and fluid natural frequencies, along with the resonant frequencies, shift to lower frequencies. Interestingly, the values of the natural frequencies at lower thicknesses are repeated at higher thicknesses, maintaining their values and nature while following a specific repetition rule.

Background: Secondary epiretinal membrane (ERM) is a common complication of diabetic retinopathy, but data on surgical outcome is limited. The aim of this study was to evaluate anatomical and functional outcomes after pars plana vitrectomy with ERM peeling in eyes with diabetic retinopathy. Methods: A retrospective analysis was conducted on 87 eyes of 87 consecutive patients with diabetic retinopathy who underwent ERM peeling over a ten-year period (04/2013-11/2022). Collected data included demographics, best-corrected visual acuity (BCVA), stage of diabetic retinopathy, and optical coherence tomography parameters such as central subfield retinal thickness (CSRT), macular volume (MV), and presence of hyperreflective foci, subretinal fluid, and intraretinal fluid. Statistical analyses were performed using a paired t-test and the Wilcoxon test. Results: The majority of patients had type 2 diabetes (96.6%), and 69.0% presented with diabetic macular edema (DME). The mean follow-up was 2.2 ± 2.0 years. Significant postoperative reductions were observed in CSRT (from 377.20 ± 99.28 µm to 337.99 ± 113.834 µm; p = 0.008) and MV (from 10.11 ± 1.46 mm3 to 99.28 ± 1.07 mm3; p < 0.001). No significant changes in BCVA were observed across the entire study cohort. ERM recurrence was rare (2.3%), and no major complications occurred. Conclusions: ERM peeling in diabetic eyes leads to significant anatomical improvement, especially in advanced diabetic retinopathy and DME, but with limited functional gains. The surgical indication should be carefully considered.

ABSTRACT This work examines the fluid-structure interaction effects on the wave dispersion in smart sandwich doubly-curved shallow shells coupled with fluid, based on a novel quasi-3D shell theory. The doubly-curved shells consist of three composite layers. Graphene platelets are used to strengthen the piezoelectric polymer in the upper and bottom layers. The graphene platelets (GPLs) are graded or uniformly dispersed throughout the thickness. Five types of functionally graded (FG) graphene/piezoelectric doubly-curved shells are examined. While, the core layer is made of a negative Poisson's ratio structure. The fluid is assumed to act as a pressure on the shell. Based on the Bernoulli equation and velocity potential, the mathematical model of the fluid is yielded. Using a micromechanical model, the material parameters of the face layers are determined. Six equations of motion are derived using Hamilton's principle and a quasi-3D sinusoidal shell theory. These equations are then transformed into an eigenvalue problem using an analytical technique. A few comparative cases are presented in order to verify the results that were achieved. The effects of the graphene distribution type, shell curvatures, core thickness ratio, shallowness ratio, and fluid depth on the wave dispersion of a smart graphene/piezoelectric sandwich doubly-curved shallow shells with negative Poisson's ratio core coupled with fluid are demonstrated through a parametric investigation.

The mutual effect of projectile length and fluid core thickness in fluid-filled sandwich structures in terms of kinetic energy absorption has not been studied extensively in the literature. This research investigates the energy absorption of three-layered targets in which a water layer is confined between two steel plates and subjected to high-velocity impacts using experimental and numerical methods. In the primary experimental part of the study, three sets of specimens were fabricated with different core thicknesses (20, 30 and 40[Formula: see text]mm) to examine the influence of fluid-core thickness. The front and back skins were fabricated from DIN 1623 steel plates with one mm of thickness. Blunt-headed cylindrical steel projectiles weighing 5.5[Formula: see text]grams were fired using a gas gun, with an average input velocity of 220[Formula: see text]m/s. The entering and residual velocities of the projectile were measured using light sensors. The experimental results revealed that there is no monotonic relation between core thickness and residual velocity, and the maximum decrease in projectile velocity occurred at a fluid core thickness of 30[Formula: see text]mm. The extended experiments and numerical simulations with longer projectiles demonstrated that the projectile length could play a considerable role in the migration of the magnitude of fluid thickness corresponding to maximum energy absorption. In the extended studies within the studied parameter range, it was found that the optimum fluid thickness falls in the range of approximately twice as long as the projectile length.

ObjectiveThis study aimed to investigate the surgical outcomes and complications of completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) in patients with rib fractures in the posterior chest wall area.MethodA retrospective analysis was conducted on 30 patients who underwent completely thoracoscopic surgical stabilization of rib fractures (cTSSRF) between September 2019 and October 2023. Clinical data were gathered to compare and analyze the clinical outcomes of complications of cTSSRF and open surgical stabilization of rib fractures (oSSRF).ResultsA total of 201 rib fractures were repaired in 30 patients, including 79 rib fractures in the posterior chest wall (an average of 2.63 rib fractures/person) that were fixed by cTSSRF, and 122 rib fractures (an average of 4.06 rib fractures/person) fixed by oSSRF. No obvious thoracic collapse deformity was observed postoperatively in any patient. The median duration of chest tube removal after surgery was 3 (3–4) days, and the chest drainage volume was 586.33 ± 232.4 ml. The numeric rating scale score (NRS) was 3 (2–3.25), which was significantly lower than the preoperative score of 7 (6–8), z = -4.826, P < 0.001). The rate of implant displacement of the cTSSRF was 6.33% (5/79), which was significantly higher than that in the oSSRF of 0(0/122), χ2 = 5.53, P = 0.019. The rates of fracture malalignment were high in the cTSSRF (21.52% [20/79] vs2.46% [3/122], P < 0.001). The incidence of postoperative encapsulated pleural effusion—defined as a maximum anteroposterior fluid thickness > 20 mm surrounding the internal fixation device on axial CT scans—was 46.7% (14/30 cases) during the 7–14 day postoperative period. All patients were followed-up in outpatient clinics or by telephone for 6–24 months, and all resumed their work capacity without obvious symptoms of chest discomfort.ConclusionThe application of cTSSRF is a safe, feasible and minimally invasive surgical option, particularly in cases of rib fractures in the posterior chest wall, which are challenging to address using conventional open surgery. However, the postoperative implant displacement and fracture malalignment rates are higher than those observed in conventional surgery, which still needs to require careful evaluation of the risks and benefits of routinely performing cTSSRF.

To explore the relationship between subfoveal choroidal thickness (SFCT) and persistent subretinal fluid (pSRF) at the macula after successful rhegmatogenous retinal detachment (RRD) surgery. This is a retrospective multicenter comparative study of Caucasian subjects with successful RRD repair. SFCT was measured in 2 groups: Group 1 with persistent subretinal fluid (pSRF) 1 month after repair, and Group 2 with absence of pSRF. SFCT was measured by a masked observer based on ImageJ. Multiple regression analyses were implemented to control for age, refraction, and gender. Surgery type was as follows: Group 1 (24 scleral buckle SB, 23 pars plana vitrectomy PPV, 9 SB+PPV, and 5 pneumoretinopexy), and Group 2 (68 PPV). Adjusted mean 1-month SFCT was thicker in Group 1 than in Group 2 by 41.0µm (p = 0.049). Within Group 1, PPV subgroup tended to have thinner SFCT than the other subgroups by: SB (117.4µm), SB-PPV (9.3) and pneumoretinopexy (1.2µm) (all p>0.05). SFCT at 1-month was not different between pSRF (237.5±77.2µm) and no pSRF (213.7±72.1µm) in PPV groups (p=0.2). SFCT post PPV appeared similar in eyes with or without pSRF. In eyes with pSRF, SFCT tended to be thicker following SB compared to PPV.

Faricimab was approved in the European Union in 9/2022 as the first bispecific antibody for the treatment of neovascular age-related macular degeneration (nAMD), visual impairment due to diabetic macular oedema (DME) or retinal vein occlusion. To date, the efficacy profile of faricimab has been investigated under pivotal clinical phase3study conditions in treatment-naïve nAMD patients. The prospective noninterventional study (NIS) PASSENGER is amulticentre study that aims at contributing to abetter understanding of the effectiveness, safety and impact of faricimab on quality of life in previously treated patients with nAMD under real-world conditions in Germany. The planned observation period per patient is 24months. Patients (n = 620) aged ≥ 50years with nAMD who switched to faricimab no longer than 12weeks prior to enrolment in the study, were previously treated with avascular endothelial growth factor (VEGF) inhibitor for amaximum of 36months, and had abest corrected visual acuity (BCVA) of 30-80 letters on the Early Treatment Diabetic Retinopathy Study (ETDRS) scale at the start of therapy with faricimab are eligible to participate. The primary outcome measure is the change in BCVA from baseline after 52weeks. In addition, central subfield thickness, intraretinal, subretinal and subpigment epithelial fluid over time as well as patient-reported outcomes, adherence and adverse events are recorded. The first patient was enrolled in June 2023. According to the current schedule, recruitment (24months) will be completed by June 2025 and the last patient visit is anticipated in Q2/2027. Data from the PASSENGER study are intended to contribute to abetter understanding of therapy management in daily practice in Germany.

Cholesterol granuloma is a rare, benign lesion of the mastoid air cells, often associated with glue ear and typically presenting unilaterally. Histopathologically, it comprises of granulation tissue with cholesterol crystals, multinucleated giant cells, and hemosiderin deposits from erythrocyte breakdown. While commonly found in the petrous apex, tympanomastoid cholesterol granulomas are rare, with very few cases reported in literature. It can mimic other otological conditions, leading to diagnostic challenges. We report a rare case of cholesterol granuloma presenting as acute mastoiditis in a 24-year-old female with type 1 diabetes. She presented with postauricular swelling, pain, fever, and hearing loss. Imaging revealed a cystic lesion with bony erosion in the mastoid antrum. Surgical exploration uncovered a lobulated cyst containing thick fluid, which was managed via marsupialization and reconstruction. Histopathology confirmed the diagnosis of cholesterol granuloma. This case underscores the need for clinical suspicion of rare pathologies in chronic otitis media cases and highlights the importance of timely intervention to prevent complications.