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Oxygen (O2) uptake by cells and tissues is a critical indicator of metabolic demand, changes in microenvironment, and pathophysiology. O2 uptake from the atmosphere accounts for virtually all the O2 consumption in the avascular cornea; however, a detailed spatiotemporal profile of corneal O2 uptake (COU) remains undetermined. Here, we used a non-invasive self-referencing optical fiber O2 sensor-the scanning micro-optrode technique (SMOT)-to report the O2 partial pressure and flux variations at the ocular surface of rodents and non-human primates. In vivo spatial mapping in mice revealed a distinct COU, characterized by a centripetal gradient with a significantly higher O2 influx at the limbus and conjunctiva regions than at the center of the cornea. This regional COU profile was reproduced ex vivo in freshly enucleated eyes. The centripetal gradient was conserved across the following species analyzed: mice, rats, and rhesus monkeys. In vivo temporal mapping in mice showed a significant increase in the O2 flux in the limbus in the evening compared to other times. Altogether, the data unveiled a conserved centripetal COU profile, which may be associated with the limbal epithelial stem cells residing at the intersection of the limbus and conjunctiva. These physiological observations will serve as a useful baseline for comparative studies with contact lens wear, ocular disease, diabetes, etc. Moreover, the sensor may be applied to understand the responses of the cornea and other tissues to various insults, drugs, or changes in the environment.

This study investigates the application of fiber optic technology to optimize completion design in a hydraulic fracture stimulation for Marcellus Shale Reservoir. With a focus on improving cluster efficiencies and overcoming interstage communication challenges, the research utilizes real-time data from distributed acoustic (DAS), temperature (DTS), and strain (DSS) measurements. The methodology comprises a comprehensive analysis of completion and stimulation reports, fiber optics, microseismic data, and well logs. Conducted at the MSEEL well pads, MIP, and Boggess, and equipped with permanent and deployable fiber optic cables, this study emphasizes that engineered/geomechanical completion design leads to sustained cluster efficiency and stage production performance. Inefficient cluster efficiencies are primarily linked to fracture communication. Recommendations include employing a geomechanical completion design, avoiding non-uniform high natural fracture zones during hydraulic fracture stimulations, implementing short stage length, and using more 100 mesh sand. These insights, derived from correlations between fracture counts, distributed strain sensing (DSS), cluster efficiency, production logging, and production data, offer significant implications for optimizing completion design in unconventional reservoirs. The effective application of fiber optic technology, providing real-time DAS, DTS, and slow strain data, proves instrumental in addressing interstage communication challenges, contributing to improved reservoir performances and cost-effective operations in hydraulic fracture stimulations. [ABSTRACT FROM AUTHOR]

Featured Application: This research highlights the implementation of a novel sensing approach allowing for geomechanics insights in rock bolt performance and behaviour; recent advancements in the technique are also presented. An often-utilized solution in terms of providing support to underground excavation, the fully grouted rebar rock bolt system presents optimization potential due to existing technological limitations in capturing and understanding its composite system response. In order to address these limitations, the development and application of Distributed Optic Fiber Sensing (DOS) allows for continuous strain monitoring (at a spatial resolution of 0.65 mm utilizing the technique defined herein) across a full spectrum of loading. A robust laboratory investigation was conducted featuring 24 rock bolt specimens. This examined the effects of two selected independent variables: rib spacing (from 13 mm to 68 mm) and grout annulus (from 7.7 mm to 22.8 mm). This body of research provides valuable insight into the performance of grouted rebar rock bolts and the effects of the selected parameters (rib spacing and size of the grout annulus), while also highlighting an advanced monitoring technique. Results indicated that rib spacing was a negative predictor of bond performance. No definite conclusions were drawn in terms of the effect of the size of grout annulus; however, findings provide limited support for an optimal sizing in relation to rib height. The results were also compared to analytic and numerical models. These insights can aid in calibrating and validating numerical models, and improve monitoring and rock bolt design within the overall goal of improving and optimizing ground support design arrangements. [ABSTRACT FROM AUTHOR]

This study investigates the application of fiber optic technology to optimize completion design in a hydraulic fracture stimulation for Marcellus Shale Reservoir. With a focus on improving cluster efficiencies and overcoming interstage communication challenges, the research utilizes real-time data from distributed acoustic (DAS), temperature (DTS), and strain (DSS) measurements. The methodology comprises a comprehensive analysis of completion and stimulation reports, fiber optics, microseismic data, and well logs. Conducted at the MSEEL well pads, MIP, and Boggess, and equipped with permanent and deployable fiber optic cables, this study emphasizes that engineered/geomechanical completion design leads to sustained cluster efficiency and stage production performance. Inefficient cluster efficiencies are primarily linked to fracture communication. Recommendations include employing a geomechanical completion design, avoiding non-uniform high natural fracture zones during hydraulic fracture stimulations, implementing short stage length, and using more 100 mesh sand. These insights, derived from correlations between fracture counts, distributed strain sensing (DSS), cluster efficiency, production logging, and production data, offer significant implications for optimizing completion design in unconventional reservoirs. The effective application of fiber optic technology, providing real-time DAS, DTS, and slow strain data, proves instrumental in addressing interstage communication challenges, contributing to improved reservoir performances and cost-effective operations in hydraulic fracture stimulations.

The advent of fiber optic technology in geophysics exploration has grown in its use in the exploration, production, and monitoring of subsurface environments, revolutionizing the way data are gathered and interpreted critically to speed up decision-making and reduce expense and time. Distributed Acoustic Sensing (DAS) has been increasingly utilized to build relationships in complex geophysics environments by utilizing continuous measurement along fiber optic cables with high spatial resolution and a frequency response of up to 10 KHz. DAS, as fiber optic technology examining backscattered light from a laser emitted inside the fiber and measuring strain changes, enables the performance of subsurface imaging in terms of real-time monitoring for Vertical Seismic Profiling (VSP), reservoir monitoring, and microseismic event detection. This review examines the most widely used fiber optic cables employed for DAS acquisition, namely Single-Mode Fiber (SMF) and Multi-Mode Fiber (MMF), with the different deployments and scopes of data used in geophysics exploration. Over the years, SMF has emerged as a preferred type of fiber optic cable utilized for DAS acquisition and, in most applications examined in this review, outperformed MMF. On the other side, MMF has proven to be preferable when used to measure distributed temperature. Finally, the fiber optic cable deployment technique and acquisition parameters constitute a pivotal preliminary step in DAS data preprocessing, offering a pathway to improve imaging resolution based on DAS measurement as a future scope of work.

Background and objectivesRecent studies have demonstrated that near-infrared (IR) imaging can be used to acquire high-contrast images of root caries and calculus on the root surfaces of extracted teeth at wavelengths longer than 1450 nm. The purpose of this study was to determine if image-guided laser ablation can be used to selectively remove calculus from tooth surfaces with minimal damage to the underlying sound cementum and dentin.Materials and methodsIn this study, sequential near-IR images at 1500-1700 nm were used to guide a diode-pumped (DPSS) Er:YAG laser for the removal of calculus from the root surfaces of 10 extracted teeth. The selectivity of removal was assessed using digital microscopy, optical coherence tomography, and surface profilometry.ResultsCalculus was removed rapidly with minimal damage to the underlying sound cementum and dentin. Image-guided ablation achieved high-selectivity, the mean volume of calculus removal was more than 27 times higher than the mean loss of cementum.ConclusionsWe have demonstrated that near-IR image-guided laser ablation can be used for the selective removal of calculus from root surfaces ex vivo. Additionally, we have demonstrated that a diode-pumped solid-state Er:YAG laser is well suited for selective removal. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

An often-utilized solution in terms of providing support to underground excavation, the fully grouted rebar rock bolt system presents optimization potential due to existing technological limitations in capturing and understanding its composite system response. In order to address these limitations, the development and application of Distributed Optic Fiber Sensing (DOS) allows for continuous strain monitoring (at a spatial resolution of 0.65 mm utilizing the technique defined herein) across a full spectrum of loading. A robust laboratory investigation was conducted featuring 24 rock bolt specimens. This examined the effects of two selected independent variables: rib spacing (from 13 mm to 68 mm) and grout annulus (from 7.7 mm to 22.8 mm). This body of research provides valuable insight into the performance of grouted rebar rock bolts and the effects of the selected parameters (rib spacing and size of the grout annulus), while also highlighting an advanced monitoring technique. Results indicated that rib spacing was a negative predictor of bond performance. No definite conclusions were drawn in terms of the effect of the size of grout annulus; however, findings provide limited support for an optimal sizing in relation to rib height. The results were also compared to analytic and numerical models. These insights can aid in calibrating and validating numerical models, and improve monitoring and rock bolt design within the overall goal of improving and optimizing ground support design arrangements.

Endogenous circadian clocks control 24-h physiological and behavioral rhythms in mammals. Here, we report a real-time in vivo fluorescence recording system that enables long-term monitoring of circadian rhythms in the brains of freely moving mice. With a designed reporter of circadian clock gene expression, we tracked robust Cry1 transcription reporter rhythms in the suprachiasmatic nucleus (SCN) of WT, Cry1-/- , and Cry2-/- mice in LD (12 h light, 12 h dark) and DD (constant darkness) conditions and verified that signals remained stable for over 6 mo. Further, we recorded Cry1 transcriptional rhythms in the subparaventricular zone (SPZ) and hippocampal CA1/2 regions of WT mice housed under LD and DD conditions. By using a Cre-loxP system, we recorded Per2 and Cry1 transcription rhythms specifically in vasoactive intestinal peptide (VIP) neurons of the SCN. Finally, we demonstrated the dynamics of Per2 and Cry1 transcriptional rhythms in SCN VIP neurons following an 8-h phase advance in the light/dark cycle.

INTRODUCTION:Reusable ureteroscope durability and need for repair are significant sources of expense and inefficiency for patients and urologists. Utilization of LithoVue™, a disposable flexible digital ureteroscope, may address some of these concerns. To identify its economic impact on clinical care, we performed a micro-cost comparison between flexible reusable fiberoptic ureteroscopes (URF-P6™) and LithoVue. PATIENTS AND METHODS:For this prospective, single-center micro-costing study, all consecutive ureteroscopies performed during 1 week each in July and August 2016 utilized either URF-P6 or LithoVue ureteroscopes respectively. Workflow data were collected, including intraoperative events, postoperative reprocessing cycle timing, consumables usage, and ureteroscope cost data. RESULTS:Intraoperative data analysis showed mean total operating room time for URF-P6 and LithoVue cases were 93.4 ± 32.3 and 73.6 ± 17.4 minutes, respectively (p = 0.093). Mean cost of operating room usage per case was calculated at $1618.72 ± 441.39 for URF-P6 and $1348.64 ± 237.40 for LithoVue based on institutional cost rates exclusive of disposables. Postoperative data analysis revealed costs of $107.27 for labor and consumables during reprocessing for URF-P6 cases. The costs of ureteroscope repair and capital acquisition for each URF-P6 case were $957.71 and $116.02, respectively. The total ureteroscope cost per case for URF-P6 and LithoVue were $2799.72 and $2852.29, respectively. CONCLUSIONS:Micro-cost analysis revealed that the cost of LithoVue acquisition is higher per case compared to reusable fiberoptic ureteroscopes, but savings are realized in labor, consumables, and repair. When accounting for these factors, the total cost per case utilizing these two ureteroscopes were comparable.

Purpose: The purpose of this study was to describe the use of a wire and catheters embedded with optical fiber (Fiber Optic RealShape [FORS]) to catheterize tortuous target vessels avoiding radiation. Technique: A virtual biplane vies was simulated coupling traditional x-ray system, preoperative CT scan, and FORS system to treat an isolated hypogastric aneurysm. Despite the complex anatomy, catheterization of all target vessels was possible in 12 minutes with 19 seconds of fluoroscopy time (Radiation Exposure 3.8 mGy×cm2). A minimal invasive endovascular exclusion of the aneurysm was achieved through selective coil-embolization of the iliolumbar artery and implantation of balloon expandable covered stents, thus preserving the perfusion of the superior gluteal artery. Conclusion: FORS guidance allowed catheterization of a target vessel with challenging anatomy with a low radiation exposure. [ABSTRACT FROM AUTHOR]

While functional endoscopic evaluation of swallowing (FEES) is the most useful diagnostic test for the evaluation of dysphagia, it cannot evaluate the esophageal phase of swallowing. To evaluate if a modification for the FEES exam by swallowing an empty capsule and screening of the upper esophagus could be used for early detection of esophageal dysphagia. A prospective, single-center, pilot study. At the end of a standard FEES exam, the patients were asked to swallow an empty capsule. Fifteen seconds later, the endoscope was inserted into the upper esophagus. A pathological capsule test was defined when the capsule was seen in the esophagus. In such cases, the patient was advised to undergo a gastroscopy, MBS, or esophageal manometry, which were compared to the results of the capsule test. The capsule test was utilized in 109 patients. A pathological capsule test was found in 55 patients (57.8%). In 48 patients (87.3%), an isolated or combined esophageal dysphagia was seen. The accuracy value of the capsule test compared to gastroenterology tests was 83.3%, sensitivity 88.46%, specificity 75%, PPV 85%, and NPV 80%. A modification of the standard FEES exam by including an empty capsule swallow test with an upper esophagus examination may provide a useful screening tool for esophageal dysphagia., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose. Ethical Approval: The ethics committee of our medical center ‘‘Soroka university medical center’’ at Beer-sheeba Israel approved the research (Trial Number 0066-20)., (© 2024. The Author(s).)

Aspiration detected in the fiberoptic endoscopy evaluation of swallowing (FEES) has been inconsistently associated with pneumonia, with no evidence of the risk of pneumonia from other alterations in swallowing safety detected in FEES. We conducted a dynamic, ambidirectional cohort study involving 148 subjects at risk of dysphagia in a tertiary university hospital. Our aim was to determine the risk of pneumonia attributed to alterations in swallowing safety detected during FEES. We used multivariate negative binomial regression models to adjust for potential confounders. The incidence density rate (IR) of pneumonia in patients with tracheal aspiration of any consistency was 26.6/100 people-years (RR 7.25; 95% CI: 3.50-14.98; P < 0.001). The IR was 19.7/100 people-years (RR 7.85; 95% CI: 3.34-18.47; P < 0.001) in those with laryngeal penetration of any consistency and 18.1/100 people-years (RR 6.24; 95% CI: 2.58-15.09; P < 0.001) in those with pharyngeal residue of any consistency. When adjusted for aspiration, the association of residue and penetration with pneumonia disappeared, suggesting that their risk of pneumonia is dependent on the presence of aspiration and that only aspiration is independently associated with pneumonia. This increased risk of pneumonia was significant in uni- and multivariate negative binomial regression models. We found an independently increased risk of pneumonia among patients with dysphagia and aspiration detected during FEES. Alterations in the oral and pharyngeal phases of swallowing, without aspiration, did not increase the risk of pneumonia., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s).)

Background: Given the prevalence of cardiovascular disease, encountering difficult airways in this patient population is quite common. The challenge for anesthesiologists lies not only in establishing the airway but also in managing the hemodynamic instability caused by sympathetic activation during intubation. The purpose of this report is to describe the anesthetic experience of this patient with severe mitral and tricuspid regurgitation, atrial fibrillation with rapid ventricular response, and moderate pulmonary hypertension with an anticipated difficult airway., Case Presentation: This case report describes intubation with fibreoptic bronchoscopy after the induction of general anesthesia in a cardiac surgical patient diagnosed with severe mitral and tricuspid regurgitation, rapid atrial fibrillation, and moderate pulmonary hypertension who underwent mitral and tricuspid valve replacements. The patient had a history of difficult intubation. Therefore, having considered that the benefits of intubation after general anesthesia induction outweighed the risks of awake intubation, the choice of fibreoptic bronchoscopy-guided intubation was performed following general anesthesia induction. No adverse events occurred throughout the proceeding., Conclusion: This case highlights the importance of considering both airway safety and maintaining hemodynamic stability when cardiac surgery patients encounter an anticipated difficult airway. Awake intubation is not the only option, and intubation after general anesthesia may be considered when the benefits are evaluated to outweigh the risks., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Written informed consent was obtained from the patient for publication of this case report. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Putrescine is a kind of physical diamine that is closely related to food deterioration and food quality safety. This study employs a novel fiber optic biosensor based on S-tapered and waist extension techniques, as well as localized surface plasmon resonance (LSPR), to detect putrescine accurately. The gold nanoparticles (AuNPs) are fixed on the fiber to excite LSPR. Furthermore, the multi-walled carbon nanotubes (MWCNTs) and niobium carbide (Nb 2 CT x ) are used to increase the binding sites of enzymes to improve the sensing performance of probes. In this work, the fiber probe surface is functionalized by diamine oxidase (DAO) to improve selectivity. The sensitivity and limit of detection of the fiber optic biosensor are 2.04 nm/lg(µM) and 0.267 µM over a linear range of 0-100 µM, respectively. In addition, the tests of repeatability, reusability, selectivity, pH value, and real samples of the sensor probe are assessed to demonstrate the potential in measuring putrescine.

Purpose: Pathological nipple discharge (PND) is associated with malignancy. This study aimed to investigate the value of fiberoptic ductoscopy (FDS) and the feasibility of immediate injection of methylene blue after FDS to identify discharging ducts and intraductal lesions without overflow of methylene blue during surgery., Methods: From May 2019 to December 2023, 164 PND patients were enrolled. Methylene blue was injected into the discharging ducts immediately after FDS. Surgery was underwent several hours later. The dyeing effect and the operation time were assessed. The pathological results were analyzed with clinical characteristics and ductoscopic appearances., Results: The overall detection rate of malignancy was 14.0% (23/164). Both ultrasound (US) and mammography (MG) were negative in 80 (48.8%) patients, while pathology yielded 10 (12.5%) breast cancers. Statistical analysis revealed that patients exhibiting older age, menopause, positive MG, and bloody discharge had a higher propensity for malignancy (P < 0.05). Ductoscopic features such as multiple and distal lesions, irregular morphology and hemorrhage of the lesions, and roughness and stiffness of the ductal walls were associated with malignancy (P < 0.05). Conducting surgery 12-24 h after injection of methylene blue resulted in optimal dyeing without overflow of methylene blue., Conclusion: FDS is an effective and feasible examination for PND patients with negative imaging results. Immediate injection of methylene blue after FDS allows clear identification of discharging ducts and intraductal lesions without overflow of methylene blue. This approach may be useful in guiding selective ductectomy for the detection of early breast cancer., Competing Interests: Declarations. Ethics approval: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of Tengzhou Central People’s Hospital (Date: March 20, 2023/NO.2023-Ethical Review-29). Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirmed that human research participants provided informed consent for publication of the images in Figs. 1, 2 and 3. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The integration of fiber optics and plasmonic sensors is promising to improve the practical usability over conventional bulky sensors and systems. To achieve high sensitivity, it typically requires fabrication of well-defined plasmonic nanostructures on optical fibers, which greatly increases the cost and complexity of the sensors. Here, we present a fiber-optic sensor system by using chemical absorption of gold nanoparticles and a replaceable configuration. By functioning gold nanoparticles with aptamers or antibodies, we demonstrate the applications in chemical sensing using two different modes. Measuring shift in resonance wavelength enables the Pb 2+ detection with a high linearity and a limit of detection of 0.097 nM, and measuring absorption peak amplitude enables the detection of E. coli in urinary tract infection with a dynamic range between 10 3 to 10 8  CFU/mL. The high sensitivity, simple fabrication and disposability of this sensing approach could pave the way for point-of-care testing with fiber-optic plasmonic sensors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Flexible fibreoptic bronchoscopy (FFB) has the potential to enhance diagnostic capabilities and improve pulmonary function in children on extracorporeal membrane oxygenation (ECMO)., Objectives: The objective of this study was to evaluate the benefits (clinical, radiological, and microbiological) of FFB and assess associated complications in children on ECMO., Methods: We conducted a single-centre retrospective observational cohort study in a tertiary paediatric intensive care unit. All FFB episodes performed during the study period on children aged 0-18 years on ECMO were included., Results: Out of the 155 children who received ECMO, 36 (23%) underwent a total of 92 episodes of FFB. FFB provided anatomical and pathological information in 53% (19/36) of cases and proved beneficial in clearing the airways in 62% (54/87) of the episodes. Overall, patients exhibited transient increases in ECMO and mechanical ventilation support 1 h post FFB in 14% (13/92) and 9.7% (9/92) episodes, respectively. At 6 h, the mean fraction of inspired oxygen on the mechanical ventilator was lower (0.46 [±0.21] vs 0.53 [±0.21] p < 0.01), with no change in mean airway pressure. Similarly, compared to pre-FFB, the fraction of inspired oxygen on the mechanical ventilator on ECMO was lower at 6 h and 24 h (0.65 [±0.25] vs 0.71 [±0.23] p < 0.01 and 0.006, respectively), with no significant change in the sweep gas flow and ECMO flow. The radiological imaging indicated improved or stable findings in 91% (83/91) of FFB episodes. FFB contributed to the identification of new and previously unknown microbiological information in 75% (27/36) of the patients. The incidence of major complications was 7.6%. Minor self-resolving bleeding occurred in 25% (23/92) episodes, and major bleeding occurred in two episodes, with a total of 10 episodes needing blood product transfusion., Conclusions: FFB is a valuable adjunct in managing children with severe respiratory failure on ECMO, offering clinical benefits with a low rate of major complications. Further studies should aim to develop a consensus approach encompassing criteria and clinical management around FFB in patients on ECMO., (Crown Copyright © 2024. Published by Elsevier Ltd. All rights reserved.)

Background: Opioids are used to suppress cough during fiberoptic bronchoscopy (FOB). However, evidence regarding the optimal dose of remifentanil during FOB under ciprofol sedation is limited. This study aimed to investigate the effective concentration (EC) of remifentanil required to suppress bronchoscopy responses during FOB under ciprofol sedation in elderly patients., Materials and Methods: Elderly patients aged 60 to 90 years with American Society of Anesthesiologists (ASA) physical status I-III, scheduled for FOB, were enrolled. Patients were assigned to either the male or the female group. Remifentanil was administered intravenously prior to ciprofol administration. The endpoints included responses to FOB, such as vocal cords movement, coughing, and body movement. The EC 50 and EC 95 values of remifentanil required to alleviate the responses to FOB were calculated using Dixon's up-and-down method for both male and female groups. Probit analysis was used to generate a dose-response curve., Results: Thirty-nine patients (19 males and 20 females) were enrolled. The EC 50 values (plasma concentration) of remifentanil for blunting FOB responses under ciprofol sedation were 3.25 (2.75 to 3.26) ng/mL and 2.25 (1.75 to 2.25) ng/mL in males and females, respectively ( p = 0.0023). Probit analysis indicated that the EC 50 of remifentanil required to suppress responses to FOB under ciprofol sedation was 3.102 [95% confidence interval (CI):2.694 to 3.749] ng/mL and 2.052 [95% CI: 1.345 to 2.750] ng/mL in males and females, respectively. The EC 95 of remifentanil required to suppress responses to FOB under ciprofol sedation was 3.741 [95% CI: 3.366 to 7.699] ng/mL and 2.943 [95% CI: 2.456 to 9.533] ng/mL in males and females, respectively., Conclusion: The results indicate differences between males and females in the EC 50 and EC 95 of remifentanil needed to suppress responses to FOB under ciprofol sedation while preserving spontaneous breathing in elderly patients., Trial Registration: The study was registered with chictr.org.cn (ChiCTR2300077720; 17 th November 2023)., Competing Interests: The authors report no conflicts of interest in this work., (© 2024 Lan et al.)

Objective: To evaluate the ability of near-infrared light transillumination (NIR-LT) to detect interproximal enamel and dentinal caries lesions compared to clinical-visual inspection aided by fiber-optic transillumination (FOTI)., Method and Materials: From 170 Finnish adolescents aged 15 to 17 years, 5,294 interproximal surfaces of premolars and molars were examined first clinical-visually aided by FOTI (VI&#43;FOTI) using the International Caries Detection and Assessment System (ICDAS) classification. Subsequently, the surfaces were examined using NIR-LT. The extent of lesions was determined using the modified NIR-LT classification based on the Söchtig criteria. For the analyses, data on maxillary and mandibular premolars and molars were combined. Distributions of lesions were presented as frequencies. Differences between VI&#43;FOTI and NIR-LT at the tooth and tooth surface levels were analyzed by chi-square and Fisher exact tests. Sensitivity and specificity of the NIR-LT method to detect any lesion was performed using VI&#43;FOTI as the gold standard., Results: By VI&#43;FOTI, 92.4% surfaces were classified as sound and by NIR-LT, 88.2%. Enamel caries lesions were found on 7.0% of the surfaces by VI&#43;FOTI and on 11.6% by NIR-LT. Nearly double the number of enamel lesions were identified by NIR-LT for all examined teeth groups, except for mandibular molars where this was 1.3-fold. In 66% of the surfaces, the differences between NIR-LT and VI&#43;FOTI findings were statistically significant (P .001). The sensitivity for all teeth of NIR-LT was 48.4% and the specificity was 91.1%., Conclusion: Radiation-free NIR-LT method shows considerable potential as a supplementary method for early detection of caries lesions among low-caries prevalence adolescents.

We present a case of an infant patient with Robin sequence (Pierre Robin sequence; PRS) who underwent general anesthesia for a glossopexy procedure. Pediatric patients with PRS are prone to upper airway obstruction during general anesthesia induction and intubation difficulties due to micrognathia and glossoptosis. In this case, we facilitated mask ventilation by inserting a nasopharyngeal airway before induction and successfully intubated the patient using a 2-person technique that combined the use of a video laryngoscope and a flexible fiber-optic scope. This experience suggests that the use of appropriate devices can help ensure airway patency and enhance visualization and maneuverability during intubation.

Introduction: Fibre-optic intubation is a crucial technique for the management of difficult airways in clinical practice, and its success rate is positively associated with the operator's experience. However, because of its low utilisation rate in clinical practice, mastery of this technique by novices often relies heavily on simulation teaching. In recent years, virtual reality (VR) technology has been introduced to simulation training of fibre-optic intubation. However, because of limited sample sizes and conflicting findings, there remains an ongoing debate regarding the widespread adoption of VR technology. The objective of this study is to evaluate the impact of VR technology on the effectiveness of fibre-optic intubation training and to provide evidence-based insights to advance VR simulation methods in this field., Methods and Analysis: We will search the MEDLINE/OVID, Embase/OVID, Cochrane Central Register of Controlled Trials/OVID, CNKI and Wanfang databases from inception to March 2024. We will only include randomised controlled trials, with no restrictions on language of publication. The primary outcome will be the global rating scale score for flexible bronchoscope manipulation. The secondary outcomes will be the fibre-optic skills checklist, intubation time and proportion of successful intubations. We will assess the quality of all included trials according to the Cochrane risk-of-bias V.2 (Risk of Bias 2) tool for randomised trials. We will use the Review Manager software to perform a meta-analysis using a random-effects model and the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence., Ethics and Dissemination: Ethical approval is not required for this review because we will be using only published data. We plan to submit our review to peer-reviewed academic journals., Prospero Registration Number: CRD42024525158., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Study Objective: Reports are limited regarding supraglottic airway (SGA) usage in children in the prone position. This study aimed to compare the clinical performance of the Ambu®AuraGain™, a 2nd generation SGA, in children undergoing surgery in the prone and supine positions. We hypothesized that oropharyngeal leak pressure (OLP) in the prone position would not be inferior to that in the supine position., Design: Single-center, prospective, non-randomized controlled study., Setting: Operating room., Patients: One hundred and twenty-six children, American Society of Anesthesiologists (ASA) physical status I-III, aged 2-12 years, undergoing elective surgery for 2 h or less in the supine or prone position., Interventions: After induction of general anesthesia and insertion of the AuraGain, patients were positioned either supine or prone, according to type of surgery., Measurements: OLP immediately after surgical positioning was measured as the primary outcome. The anatomical position of the AuraGain was evaluated using a flexible fiberoptic bronchoscope (Olympus LF-DP Tracheal Intubation Fiberscope, Melville, New York, USA). Airway maneuvers performed during placement and maintenance of the AuraGain and airway-related adverse events were recorded., Main Findings: The mean difference in OLP immediately after positioning was 0.048 cmH 2 O (95 % confidence interval: -1.521 to 1.616), and the non-inferiority hypothesis was accepted (P < 0.001 for non-inferiority). There was no significant difference in the anatomical position of the SGA and adverse events. Airway maneuvers were significantly more commonly performed during placement in the Prone group compared to the Supine group (51 (81.0 %) vs. 3 (4.8 %), respectively; P < 0.001)., Conclusion: OLP when using AuraGain in the prone position in children was not inferior to that in the supine position. This suggests that the AuraGain may be an effective option for children undergoing short surgical procedures in the prone position., Competing Interests: Declaration of competing interest All authors have participated in (a) conception and design, or analysis and interpretation of the data; (b) drafting the article or revising it critically for important intellectual content; and (c) approval of the final version. This manuscript has not been submitted to, nor is under review at, another journal or other publishing venue. The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Obstetric difficult airway management has emerged as a critical safety issue, and unsuccessful intubation can lead to morbidity and mortality. A literature review of difficult and failed obstetric intubations from the 1970s to 2015 shows that the incidence of failed intubation is unchanged, remaining at one per 390 anesthetics. Our obstetric case report highlights an obstetric difficult airway secondary to limited mouth opening; rescue of the airway with an i-gel®; and establishment of a definitive airway with the aid of an Aintree intubation catheter and flexible fiberoptic scope-guided intubation through the i-gel®, a second-generation supraglottic airway., Competing Interests: Name: Amy I Lee, MD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author; she is the corresponding author for this article. Disclosures: None. Name: Jaime Ortiz, MD, MBA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Maya S. Suresh, MD Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None., (Copyright © 2024 by the American Association of Nurse Anesthesiology.)

The urgent need for efficient and accurate automated screening tools for COVID-19 detection has led to research efforts exploring various approaches. In this study, we present pioneering research on COVID-19 detection using a hybrid model that combines convolutional neural networks (CNN) with a bi-directional long short-term memory (Bi-LSTM) network, in conjunction with fiber optic data for SARS-CoV-2 Immunoglobulin G (IgG) antibodies. Our research introduces a comprehensive data preprocessing pipeline and evaluates the performance of four different deep learning (DL) algorithms: CNN, CNN-RNN, BiLSTM, and CNN-BiLSTM, in classifying samples as positive or negative for the COVID-19 virus. Among these, the CNN-BiLSTM classifier demonstrated superior performance on the training datasets, achieving an accuracy of 89 %, a recall of 88 %, a precision of 90 %, an F1-score of 89 %, a specificity of 90 %, a geometric mean (G-mean) of 89 %, and a receiver operating characteristic (ROC) of 96 %. In addition, the achieved classification results were compared with those reported in the literature. The findings indicate that the proposed model has promising potential for classifying COVID-19 and could serve as a valuable tool for healthcare professionals. The use of IgG antibodies to detect the virus enhances the specificity and accuracy of the diagnostic tool., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Study Objective: Remimazolam's benefits for patients undergoing painless flexible fiberoptic bronchoscopy remain uncertain. We aimed to compare the efficacy and safety of remimazolam and dexmedetomidine in flexible fiberoptic bronchoscopy (FFB)., Design: Randomized controlled trial., Setting: University hospital., Patients: Between April 2021 and September 2022, patients undergoing painless flexible fiberoptic bronchoscopy were recruited., Interventions: The patients were randomly assigned with a 1:1 ratio to remimazolam-remifentanil group (RR group) or dexmedetomidine-remifentanil group (DR group)., Measurements: The primary outcome was the procedure interruption rate during bronchoscopy. Secondary outcomes were hemodynamic changes, resuscitation time, rescue medication usage rate and dose, satisfaction scores of patients and bronchoscopists, operation-related complications, and adverse events., Main Results: A total of 363 patients were included for final analysis. The interruption rates of bronchoscopy were 8.2 % in the RR group and 39.2 % in the DR group (P < 0.05). The rescue medication usage rate (4.4 % vs. 38.7 %, P < 0.05) and dose (1.51 ± 8.15 mg vs. 13.17 ± 18.86 mg, P < 0.05) were lower in the RR group compared with the DR group. The incidence of oxygen desaturation was significantly lower in the RR group than in the DR group (14.3 % vs. 44.2 %, P < 0.05). Hemodynamic changes in patients in the DR group were significant, with longer recovery time and lower satisfaction scores for both inpatients and bronchoscopists (P < 0.05), compared with the RR group. However, there were no significant differences between groups in terms of operation-related complications (P > 0.05) except for postoperative dizziness, which was more common in the DR group (P < 0.05)., Conclusions: Remimazolam is effective and safe in painless flexible fiberoptic bronchoscopy. It allows a lower procedure interruption rate and incidence of oxygen desaturation, providing better hemodynamic stability compared to dexmedetomidine., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: Although dysphagia is a common symptom among patients with Spinal Muscular Atrophy Type 1 (SMA1), scant data exist on the application of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in this population. The aim was to analyze FEES feasibility, swallow safety and efficacy, dysphagia phenotype, and agreement with VideoFluoroscopic Swallow Study (VFSS) in children with symptomatic, medication-treated SMA1 and oral feeding., Methods: 10 children with SMA1 underwent FEES. Six patients had also a VFSS. Two clinicians independently rated FEES and VFSS videos. Swallowing safety was assessed using the Penetration-Aspiration scale (PAS). Dysphagia phenotypes were defined according to the classification defined by Warnecke et al. Swallowing efficacy was evaluated with the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) in FEES, whereas pharyngeal residue was rated as present or absent in VFSS., Results: FEES was performed in all children without complications. Four children tolerated bolus trials during FEES, in 4 children swallowing characteristics were inferred based on post-swallow residues, while 2 children refused to eat and only saliva management was assessed. The dysphagia phenotype of predominance of residue in the piriform sinuses was documented in 7/8 children. The PAS score was < 3 in 3 children and > 5 in one child. Swallowing efficacy was impaired in 8/8 children. VFSS showed complete agreement with FEES., Conclusions: FEES is a feasible examination in children with SMA1. Swallowing safety and efficacy are impaired in nearly all patients with strong agreement between FEES and VFSS. Dysphagia is characterized by the predominance of residue in the piriform sinus., Competing Interests: Declarations Ethical approval This study is a retrospective case-series. The study was conducted following the Declaration of Helsinki. Ethical approval was not sought for the present study because of the retrospective design. Informed consent Written informed consent was collected for each patient or caregiver. Competing interests The authors have no relevant financial or non-financial interests to disclose., (© 2024. The Author(s).)

Introduction: Spasmodic dysphonia (SD) and muscle tension dysphonia (MTD ) are two different disorders with different etiology that influence the quality of voice, characterized by similar perceptual and acoustic features. It is known that the emergence of compensatory mechanisms can lead to problems in the differential diagnosis of adductor spasmodic dysphonia (ADSD) and primary hyperkinetic dysphonia (MTD) by fiberoptic video laryngoscopy (FLS). So, the goal of this paper is to determine acoustic objective differential diagnostic criteria for distinguishing between SD and MTD and confirm clinical laryngeal findings by FLS and diagnosis. Patients and methods: Eight women with MTD and eight women with SD diagnosed at the Department of Audiology and Phoniatrics of the Clinical Hospital Center Rijeka participated in this study. A phoniatrician and a speech language pathologist (SLP) participated in the diagnostic procedure. FLS and SLP assessment were performed. Samples of extended phonation of the vowel /a/ and reading were collected. The samples were analyzed in the computer program Praat, which was used to measure the duration of words and sentences, the percentage of brakes in phonation and words, and cepstral peak prominence (CPPS). Results: This study found that four acoustic parameters (word duration, sentence duration, percentage of brakes /a/, percentage of brakes (word)) separate SD and MTD well. CPPS does not separate these two groups of patients. Furthermore, it was confirmed that by analyzing the phonation pattern of the vowel /a/ in the computer program Praat it is possible to classify these two disorders with a cut-off value of 5%. If the percentage of delay in the phonation pattern of the vowel /a/ is greater than or equal to 5%, it is very likely that it is a voice sample of a person with SD. Conclusion: Acoustic measures applicable in clinical conditions were determined. It has been shown that acoustic analysis of voice samples can provide valuable differential diagnostic data. This suggests that acoustic analysis of voice samples should be an integral part of the standard diagnostic protocol for voice disorders besides FLS.

ObjectiveLithoVue™ is a novel, single-use, digital flexible ureteroscope that was released to the US market in January 2016. There are scant data regarding its performance in humans. Procedural outcomes comparing LithoVue with reusable ureteroscopes are presented in patients undergoing ureteroscopy for upper urinary tract pathology.Patients and methodsClinical outcomes between two groups of patients undergoing flexible ureteroscopy for upper urinary tract pathology were analyzed. The first group underwent surgery utilizing LithoVue, and the second group used reusable fiber-optic flexible ureteroscopes. Differences in procedural outcomes, operative times, and time spent in hospital were analyzed using two-tailed t-tests and chi-squared and Fisher's exact tests.ResultsOne hundred fifteen cases utilizing LithoVue and 65 cases utilizing reusable ureteroscopes were included in this study. Demographics, surgical indications, stone size, location, total stone burden, composition, procedural outcomes, and complications were comparable between groups. For all cases, LithoVue procedures lasted 54.1 ± 25.7 minutes compared with 64.5 ± 37.0 minutes for reusable scope procedures (p

Awake fiberoptic intubation (AFOI) in pediatric patients remains a continuous challenge for the anesthetists, and is considered more cumbersome a procedure as compared to the adult population. The coexistence of unstable cervical spine injuries, although rare, but complicates the procedure even more. Proper pre-planning, adequate sedation and analgesia and the patient’s conscious cooperation are needed to ensure success. We describe a stepby- step approach to a successful AFOI in a 12-year-old child who had atlantooccipital instability and had a halo-vest on. Titrated dose of sedation and analgesia, obtunding airway reflex and patient’s cooperation is a key to successful AFOI in this patient. Abbreviations: AFIO: Awake fiberoptic intubation; OMF: Oromaxillofacial; BMI: body mass index; TCI: Targetcontrolled infusion. [ABSTRACT FROM AUTHOR]

Purpose: Report of a successful case of endovascular recanalization of an occluded superficial femoral artery (SFA) using Fiber Optic RealShape (FORS) technology. Case Report: A 79-year-old male was referred for evaluation of multiple ischemic pretibial ulcers of the right lower extremity. Computed tomography–angiography (CTA) imaging confirmed significant stenosis of the right common femoral artery (CFA) and an occlusion of the SFA from its origin to the Hunter's canal. The patient was treated with a hybrid surgical procedure: an endarterectomy of the CFA and SFA origin was performed combined with an endovascular recanalization of the occluded SFA using FORS technology. During recanalization, the FORS guidewire slowly twisted subintimally around the occluded lumen of the SFA, maintaining the created corkscrew shape after pre-dilation with the percutaneous transluminal angioplasty (PTA) balloon and subsequent stenting. Conclusions: FORS technology can be successfully used during recanalization of an occluded SFA without the use of fluoroscopy. The corkscrew shape formed during recanalization in this case was retained during PTA balloon pre-dilation and stenting; this potentially improves hemodynamics and thereby reduces the risk of in-stent restenosis. However, expanding patient series and longer follow-up data are needed to increase the understanding of the feasibility and effectiveness of using FORS in the treatment of peripheral arterial occlusive disease. [ABSTRACT FROM AUTHOR]

Methods for evaluation of immobilized-small molecule-binding aptamers are rare. In this study, taking the evaluation of 17β-Estradiol (E2) aptamers as an example, we first summarized the reported affinity and specificity results of 16 E2 aptamers, highlighting the issues of insufficient and inconsistent results and the lacking of evaluation of immobilized aptamers. We further exemplified the limited application scope of current affinity techniques by testing the two most widely-applied E2 aptamers, Kim76 and Alsa35, using the three label-free fluorescence assays and two nuclease protection assays. Subsequently, we evaluated the affinity of immobilized-E2 aptamers, Alsa35 and E09, using fiber optic evanescent wave aptasensor (FOEW) based on the competitive binding of target and fluorophore-labeled complementary strand with the fiber surface immobilized-aptamer. The results revealed that Alsa35 had the better affinity and specificity than E09. Using Alsa35-based FOEW, the enzyme-free detection of E2 spiked in river water and human serum was respectively realized with the unprecedented limits of detection (LOD, S/N = 3) of 4.75 (undiluted river water) and 206 pM (undiluted serum). FOEW is a valuable addition to analytical approaches for evaluation of immobilized-aptamers and a general platform for ultrasensitive target detection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Many animals convergently evolved photosynthetic symbioses. In bivalves, giant clams (Cardiidae: Tridacninae) gape open to irradiate their symbionts, but heart cockles (Cardiidae: Fraginae) stay closed because sunlight passes through transparent windows in their shells. Here, we show that heart cockles (Corculum cardissa and spp.) use biophotonic adaptations to transmit sunlight for photosynthesis. Heart cockles transmit 11-62% of photosynthetically active radiation (mean = 31%) but only 5-28% of potentially harmful UV radiation (mean = 14%) to their symbionts. Beneath each window, microlenses condense light to penetrate more deeply into the symbiont-rich tissue. Within each window, aragonite forms narrow fibrous prisms perpendicular to the surface. These bundled "fiber optic cables" project images through the shell with a resolution of >100 lines/mm. Parameter sweeps show that the aragonite fibers' size (~1 µm diameter), morphology (long fibers rather than plates), and orientation (along the optical c-axis) transmit more light than many other possible designs. Heart cockle shell windows are thus: (i) the first instance of fiber optic cable bundles in an organism to our knowledge; (ii) a second evolution, with epidermal cells in angiosperm plants, of condensing lenses for photosynthesis; and (iii) a photonic system that efficiently transmits useful light while protecting photosymbionts from UV radiation., Competing Interests: Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: In oral maxillofacial surgery, the nasal tracheal tube is mostly used to provide a better surgical field for oral, head and neck operations. Postoperative sore throat and hoarseness are common following tracheal intubation, with an incidence of 11-55%. Then, we previously reported advantage technique of fiberoptic scope to decrease the risk which the tip of the tube is visualized as the tube is advanced which helps avoid impingement of the tube. However, the extent to which this technique causes postoperative complications is unknown compared to traditional technique. The aim of this study was retrospectively to determine the effect of postoperative sore throat following nasotracheal intubation by tip of the tube is visualized by fiberoptic scope., Method: Anesthesia records of the adult patients with nasotracheal intubation were checked. Patients underwent oral maxillofacial surgery from January 2021 until March 2023. Facilitated with rocuronium, nasotracheal intubation was performed using the traditional or observative method by fiberoptic scope with a 4.8 mm outer diameter. Intubation was performed with a cuffed 6.5-8.0 mm ID nasotracheal tube. The following variables were recorded: gender, age, height, weight, ASA classification, anesthesia time, duration of intubation, tube size, intubation attempts, fentanyl and remifentanil. The postoperative sore throat and the incidence of hoarseness were recorded at operative day and at the day after operative day, and the time to recovery., Result: A total of 104 cases (traditional fiberoptic intubation n = 51, observative fiberoptic intubation n = 53) were enrolled in this retrospective study. There were no significant differences in clinical characteristics and anesthetic data. There was not significant difference in incidence of postoperative sore throat, hoarseness and recovery between the two groups (P = 0.61, 0.44, 0.90). For subjects reporting postoperative sore throat (n = 30), there was not a significant difference in VAS means at operative day and at the day after operative day between the two groups (P = 0.81, 0.91)., Conclusion: We found that postoperative sore throat and recovery were not influenced by observative fiberoptic scope for nasotracheal intubation., Competing Interests: Declarations Ethics approval and consent to participate The need for informed consent was waived by Kyushu University Institutional Review Board for Clinical Research. Consent for publication Not Applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To study the clinical effectiveness of visual laryngoscopy combined with fiberoptic bronchoscopy-guided double-lumen endotracheal tube intubation in thoracic surgery patients with predicted difficult airways in thoracic surgery airways., Methods: We randomly divided 162 patients with predicted difficult airways who required double-lumen tracheal intubation for thoracic surgery and randomly divided them into the video laryngoscopy group (Group VL, n = 54),fiberoptic bronchoscopy group (Group F, n = 54), and video laryngoscopy combined with fiberoptic bronchoscopy group (Group FVL, n = 54) according to the randomized number table method. Then, the success rate of the first intubation, the duration of intubation, the duration of positioning, the degree of exposure of the vocal cords (Cormack-Lehane grade), and the adverse reactions during intubation were recorded and analyzed., Results: The success rate of first-time intubation was significantly higher in the FVL group than in the F and VL groups (92.6% vs. 87.0% vs. 53.7%, P < 0.001), and the time of intubation in the FVL group was significantly shorter than that in the VL and F groups [(26.22 ± 9.34) s vs. (42.35 ± 11.21) s vs. (46.78 ± 21.96) s, P < 0.001)]. The positioning time in the FVL group was significantly shorter than that in the F and VL groups [(83.76 ± 15.18) s vs. (102.72 ± 21.89) s vs. (145.41 ± 20.12) s, F = 144.896, P < 0.001)].The number of patients with Cormack-Lehane grades I-II was significantly lower in the FVL group and the VL group than in the F group (88.9% vs. 77.8% vs. 59.3%, P < 0.05).The incidence of postoperative sore throat was significantly lower in the FVL group and the F group than in the VL group (22.4% vs. 27.6% vs. 50%, P < 0.001)., Conclusion: In difficult airway patients with high airway risk indices who require double-lumen endotracheal intubation, visual laryngoscopy combined with fiberoptic bronchoscopy improved the success rate of first-time intubation and shortened the intubation and positioning time., Trial Registration: Chinese Clinical Trial Register (identifier: ChiCTR2300076304; Date of registration: September 29, 2023)., (© 2024. The Author(s).)

Background: The video laryngoscope (VLS) has been proven to be an effective insertion device for airway management. However, no laryngoscope has been specifically designed for the placement of the laryngeal mask airway (LMA). We improved the current VLS and developed a novel VLS method. This study aimed to evaluate the clinical efficacy of an improved VLS for inserting a flexible laryngeal mask airway (F-LMA) compared with the standard blind method., Methods: One hundred and fifty-seven patients who underwent F-LMA insertion under general anesthesia were randomly assigned to either the standard blind insertion technique (group B) or VLS -assisted insertion (group VL). First attempt success rates were recorded. Secondary outcomes included oropharyngeal leakage pressure (OLP), fiberoptic view, insertion time, position adjustment, reinsertion rate, and postoperative airway morbidity., Results: The first-attempt success rate was higher in group VL than that in group B (99% vs. 86%; p = 0.002). The OLP was significantly higher in the VLS-guided technique (26.4 ± 5.1 vs 23.8 ± 4.4 cmH 2 O, p = 0.002). The fiberoptic view was significantly better in the group VL (p < 0.001) and required less readjustment and reinsertion to establish an effective airway (p < 0.001). The insertion time was shorter in the group B than that in group VL (33.9 vs 41.3 s, p < 0.001). Hemodynamic stress responses and postoperative airway complications did not differ between the two groups., Conclusions: The new VLS-guided insertion technology has a high success rate, achieves greater OLP, and provides an ideal anatomical position with minimal adjustment, without increasing the risk of hemodynamic stress or adverse events., Trial Registration: Chinese Clinical Trial Registry (registration number: ChiCTR2300075866; https://www.chictr.org.cn)., Competing Interests: Declaration of competing interest All authors have no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Cervical cancer can be detected at an early stage through the changes occurring in biochemical and morphological properties of epithelium layer. Fluorescence spectroscopy has the ability to identify these subtle changes non-invasively and in real time with good accuracy in comparison with conventional techniques. In this paper, we report the usage of a custom designed spatially resolved fibre-optic probe (SRFOP), which consists of 77 fibres in two concentric rings, for the detection of cervical cancer using fluorescence spectroscopy technique. The aim of this study is to classify different grades of cervical precancer on the basis of their fluorescence spectra followed by a robust classification algorithm. Fluorescence spectra of 28 cervical tissue samples of different categories have been recorded using six detector fibres of FOP at different spatial locations with the source fibre (SF). A 405 nm laser diode source has been utilised to excite the samples and a USB 4000 Ocean Optics spectrometer to collect the output spectra in the wavelength range 400-700 nm. Principal component analysis (PCA) was applied to the collected spectra to reduce the dimensionality of the data while preserving the most significant features for classification. The first 10 principal components, which captured the majority of the variance in the spectra, were selected as input features for the classification model. Classification was then performed using an artificial neural network (ANN) with a specific architecture, including an input layer, hidden layers, and a softmax activation function in the output layer. Experimental and classification results both demonstrate that proximal fibres (PFs) perform better than distal fibres (DFs) in capturing the discriminatory features present in the epithelium layer of cervical tissue samples as PF collect most of the signal from the epithelium layer. The combined approach of spatially resolved fluorescence spectroscopy and PCA-ANN classification techniques is able to discriminate different grades of cervical precancer and normal with an average sensitivity, specificity and accuracy of 93.33%, 96.67% and 95.57%, respectively., (© 2024 Wiley‐VCH GmbH.)

Glioblastoma (GBM) is one of the most lethal human malignancies. The current standard-of-care is highly invasive with strong toxic side effects, leading to poor prognosis and high mortality. As a safe and effective clinical approach, photodynamic therapy (PDT) has emerged as a suitable option for GBM. Nevertheless, its implementation is significantly impeded by the limits of light penetration depth and the firm reliance on oxygen. To overcome these challenges, herein, a promising strategy that harnesses a modified optical fiber and less oxygen-dependent Type I aggregation-induced emission (AIE) photosensitizer (PS) is developed for the first time to realize in vivo GBM treatments. The proposed AIE PS, namely TTTMN, characterized by a highly twisted molecular architecture and a bulky spacer, exhibits enhanced near-infrared emission and strong production of hydroxyl and superoxide radicals at the aggregated state, thus affording efficient fluorescence imaging-guided PDT once formulated into nanoparticles. The inhibition of orthotopic and subcutaneous GBM xenografts provides compelling evidence of the treatment efficacy of Type I PDT irradiated through a tumor-inserted optical fiber. These findings highlight the substantially improved therapeutic outcomes achieved through fiber optic-mediated Type I PDT, positioning it as a promising therapeutic modality for GBM., (© 2024 Wiley‐VCH GmbH.)

Background: Optical fiber sensors have been used to detect glucose owing to advantages such as low cost, small size, and ease of operation etc. phenylboronic acid is one of the commonly used receptors for glucose detection, however phenylboronic acid based regenerative optical fiber sensors are commonly cumulative regeneration, renewable regeneration sensor has been missing from the literature., Results: In this work, instead of using phenylboronic acid, we synthesized succinylaminobenzenoboronic acid molecule (BPOA) by introducing a short chain containing carboxyl group at the other end of phenylboronic acid then covalently bonded BPOA on the surface of excessively tilted fiber grating (Ex-TFG). This provides a very stable platform for renewable regeneration and the regenerative buffer was also optimized. The proposed renewable regeneration method exhibited higher linearity and sensitivity (R 2  = 0.9992, 8 pm/mM) in relative to the conventional cumulative regeneration method (R 2  = 0.9718, 4.9 pm/mM). The binding affinity between BPOA and glucose was found to be almost constant over 140 bind/release cycles with a variation of less than 0.3 % relative standard deviation., Significance: The regenerative and label-free sensing capacity of the proposed device provides a theoretical foundation for label-free saccharide detection and the development of wearable glucose monitoring devices based on fiber optic sensors., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Oceanic facilities and equipment corrosion present considerable economic and safety concerns, predominantly due to microbial corrosion. Early detection of corrosive microbes is pivotal for effective monitoring and prevention. Yet, traditional detection methods often lack specificity, require extensive processing time, and yield inaccurate results. Hence, the need for an efficient real-time corrosive microbe monitoring technology is evident. Pseudomonas aeruginosa, a widely distributed microorganism in aquatic environments, utilizes its production of quinone-like compounds, specifically pyocyanin (PYO), to corrode metals. Here, we report a novel fiber optic surface plasmon resonance (SPR) sensor modified by the C-terminal of BrlR protein (BrlR-C), which is a specific receptor of PYO molecule, to detect P. aeruginosa in aquatic environments. The results showed that the sensor had a good ability to recognize PYO in the concentration range of 0-1 μg/mL, and showed excellent sensing performance in real-time monitoring the growth status of P. aeruginosa. With a strong selectivity of PYO, the sensor could clearly detect P. aeruginosa against other bacteria in seawater environment, and exhibited excellent anti-interference ability against variations in pH, temperature and pressure and other interfering substances. This study provides a useful tool for monitoring corrosive P. aeruginosa biofilm in aquatic environments, which is a first of its kind example that serves as a laboratory model for the application of fiber optic technology in real-world scenarios to monitoring biofilms in microbial corrosion and biofouling., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

To explore the Advantages of Indocyanine Green (ICG) Fluorescence Imaging over Conventional Fiber-Optic Imaging in Laparoscopic Cholangiography and Immediate Suture for Stone Removal. The study is a randomized controlled descriptive research. Consecutive patient data were collected from October 2022 to January 2024 at the Second People's Hospital of Chengdu for those who underwent laparoscopic bile duct exploration and stone removal, totaling 72 cases. According to the order of admission, they were randomly assigned to either the study group or the control group, with 36 cases in each group. Ten minutes preoperatively, indocyanine green (ICG) was administered intravenously through a peripheral vein to the subjects in the study group, to enable real-time fluorescent tracing of the extrahepatic bile ducts during surgery. This study compares the efficiency of bile duct structure and boundary recognition, the timeliness of bile duct incision positioning, operative time, blood loss, and the incidence of bile duct injury between patients who were injected with ICG and those who were not. In addition, it assesses liver function and white blood-cell counts rechecked 24 h postoperatively, the duration of postoperative hospital stay, and the occurrence of bile leakage. The study included 72 patients, with 36 in the indocyanine green (ICG) fluorescence group and 36 in the conventional fiber-optic group, comprising 26 males and 46 females. There were 18 patients with a history of previous biliary exploration surgery and 23 who had undergone previous cholecystectomy. During surgery, ICG fluorescence was successfully visualized in all 36 cases of the ICG group, allowing for a clear view of the anatomical structure and boundaries of the extrahepatic bile ducts. Compared to the control group, the ICG fluorescence group demonstrated a reduction in the time required for identification of the biliary system and positioning of the bile duct incision, as well as a decrease in operative time and postoperative hospital stay; intraoperative blood loss and the incidence of bile leakage were also relatively reduced, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in postoperative serum alanine aminotransferase levels, white blood-cell counts, direct bilirubin, and indirect bilirubin between the two groups (P > 0.05). One case of bile duct injury occurred in the control group. The application of ICG fluorescence navigation in laparoscopic cholecystectomy can effectively enhance the visibility of the bile ducts, rapidly identify the location for bile duct incision, and is conducive to reducing both the duration of surgery and postoperative hospital stay. It also minimizes intraoperative blood loss, prevents bile leakage and bile duct injuries. This program has demonstrating significant clinical value., (© 2024. Italian Society of Surgery (SIC).)

Several scales to assess pharyngeal residue in Fiberoptic Endoscopic Evaluation of Swallowing (FEES) are currently available. The study aimed to compare the reliability and the applicability in real clinical practice among four rating scales: the Pooling Score (P-SCORE), the Boston Residue and Clearance Scale (BRACS), the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS), and the Residue Ordinal Rating Scale (RORS). Twenty-five FEES videos were evaluated four times, once for each scale, by four speech and language pathologists. To test intra-rater reliability, the same raters re-assessed the videos two weeks apart. To test the applicability, raters recorded the time required to complete each assessment and the perceived difficulty/ease on a visual-analog scale (VAS). The intra-rater and the inter-rater reliability were calculated with Cohen's weighted Kappa and the Fleiss weighted Kappa, respectively. Time and perceived difficulty/ease scores were compared. The intra-rater reliability analysis showed almost perfect agreement for YPRSRS (k = 0.91) and RORS (k = 0.83) and substantial agreement for P-SCORE (k = 0.76) and BRACS (k = 0.74). Pairwise comparison showed no significant differences among the scales. The inter-rater reliability for the YPRSRS (k = 0.78) was significantly higher than P-SCORE (k = 0.52, p < 0.001), BRACS (k = 0.56, p < 0.001), and RORS (k = 0.65, p = 0.005). The BRACS required the longest time (p < 0.001) and was perceived as the most difficult scale (p < 0.001). The RORS was perceived as the easiest scale (p < 0.05). In conclusion, the YPRSRS showed the highest reliability, while raters perceived the RORS as the easiest to score. These results will allow clinicians to consciously choose which scale to use in clinical practice., (© 2024. The Author(s).)

Circulating tumor cell (CTC) in the blood is the main cause of cancer metastasis for death in cancer patients. It is extremely important for cancer diagnosis at an early stage and treatment to simultaneously detect and kill the CTCs. In this work, a new hybridized nanolayer, namely gold nanoparticle/gold nanorods@ Polydopamine (AuNPs/AuNRs@PDA), was coated on the Ω-shaped fiber optics (Ω-FO) for localized surface plasmonic resonance (LSPR) to perform tumor cell sensing and photothermal treatment (PTT). The PDA nanolayer was formed on a bare fiber optic through the self-polymerization of dopamine under mild conditions. The AuNRs and AuNPs were absorbed on the surface of the PDA nanolayer to form a hybridized nanolayer. The hybridized nanolayer-modified Ω-FO LSPR exhibited a high refractive index sensitivity (RIS) of 37.59 (a.u/RIU) and photothermal conversion efficiency. After being modified with the recognition element of aptamer, the Ω-FO LSPR was used to develop a sensitive and specifical tumor cell sensing. Under the irradiation of near-infrared light (NIR) laser, the Ω-FO LSPR can kill the captured tumor cells with the apoptotic/necrotic rate of 62.6 % and low side-effect for the nontarget cells. The FO LSPR sensor realized the dual functions of CTC sensing and PTT, which provided a new idea for the early diagnosis and treatment of cancer., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Abstract: Bronchoscopy is a widely used technique for diagnostic and therapeutic purposes. Though it requires anesthesia, many options are available, depending on the patient's health status, the purpose of the procedure, and the type of bronchoscope used. One such health status is heart failure, a leading cause of death, and a common challenge of anesthesiology. We report a 60-year-old male patient who is a known case of heart failure with an ejection fraction of 15%, and an implanted cardioverter defibrillator, along with concurrent ischemic heart disease, diabetes mellitus, and hypertension, who presented complaining of dysphagia. This highly morbid patient was able to successfully undergo a bronchoscopic biopsy with nerve block anesthesia considering his inadequacy for conventional methods. This report aims to shed light on these challenging cases and alert anesthesiologists on how to manage such situations in patients with cardiac morbidities., (Copyright © 2024 Copyright: © 2024 Annals of Cardiac Anaesthesia.)

Background: The flow reaching the vocal folds may be lower than that at the output of high-flow nasal cannula (HFNC) system. This could be due to upper-respiratory obstruction, oxygen leakage, or other factors. The objective of this study was to observe the effect of flow through a nasopharyngeal airway on intrapharyngeal pressure (IPP) in subjects undergoing fiberoptic bronchoscopy (FOB)., Methods: Patients scheduled for FOB were invited to participate. Measurements were performed at flows of 0-60 L/min; the subjects wore WN-N95 folding medical protective masks (N95) and either underwent FOB or not. IPP at each flow was recorded following 15 s of ventilation, and the cross-sectional area (CSA) of the gastric sinus was measured before and after FOB. Hypoxemia, reflux aspiration, and other pertinent events were recorded., Results: Sixty subjects undergoing FOB at the Affiliated Hospital of Jiaxing University participated in this trial from October 2022-September 2023. IPP increased significantly with an increase in flow and also increased after placing the N95 mask with the same flow ( P < .001). When results from before to after FOB were compared, the difference in CSA was statistically significant 263.6 (220.7-300.5) mm 2 vs 305.5 (275.4-329.5) mm 2 , P < .001, but the difference in the risk of reflux aspiration was not statistically significant (0% vs 6.7%, P = .13). Complication rates during treatment were 8.3% for hypoxemia, 0% for reflux aspiration, 1.7% for hypertension, 1.7% for hypotension, 6.7% for tachycardia, 5% for bradycardia, and 10% for postoperative nausea and vomiting., Conclusions: HFNC can provide effective oxygen therapy for people undergoing FOB, and increases in IPP with flow in the range of 0-60 L/min may not increase the risk of reflux aspiration., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2024 by Daedalus Enterprises.)

Background: Respiratory disease is a predominantly observed problem in neonates. Moreover, the application of flexible bronchoscopy in newborns is gradually increasing. This study aimed to investigate the value of bronchoscopy in neonates respiratory abnormalities and evaluate the safety of bronchoscopy application., Methods: Clinical data and outcomes of 56 neonates who underwent flexible bronchoscopy were retrospectively analyzed. Correlations among indications for bronchoscopy, findings, and clinical diseases were assessed., Results: A total of 56 neonates had a minimum weight of 1200 g at the time of bronchoscopy, while the minimum gestational age at birth was 26 + 1 weeks. A total of 22 cases (39.3%) had two or more clinical indications; the five most common indications were respiratory distress in 24 (42.9%), stridor in 22 (39.3%), pulmonary atelectasis in 10 (17.6%), feeding difficulty in 10 (17.6%), and difficult weaning from mechanical ventilation in 6 (10.7%) cases. A total of 13 types of abnormalities were detected in the respiratory tract. The most common abnormalities were laryngomalacia in 29 (59.2%), tracheobroncomalacia in 8 (16.3%), and vocal cord paralysis in 6 (12.2%) cases. Bronchoalveolar lavage was performed in 39 cases. Eight cases were diagnosed by bronchoscopy and then treated with surgery in the Thoracic Surgery/Otolaryngology Department; all of them were cured and discharged from the hospital after surgery. No serious complications, such as pneumothorax or shock, occurred in any of the children, of whom none died., Conclusions: Flexible bronchoscopy could play an important role in diagnosing and identifying respiratory disorders in neonates and be safely used with few serious complications., (© 2024. The Author(s).)

Pfeiffer syndrome (PS) is a rare inherited disorder that affects the craniofacial and extremity bones but can also include anomalies of the upper and lower airways. Among the 3 subtypes, PS types 2 and 3 are the most severe. We describe the anesthetic management of a 10-year-old boy with PS type 2 scheduled for dental treatment under general anesthesia. Because of his history of Chiari malformation, avoiding neck hyperextension was recommended to prevent worsening of his neurologic function. Preoperative computed tomography revealed significant nasal stenosis but no tracheal anomalies. Considering the difficulty of nasotracheal intubation, we planned for an oral intubation. General anesthesia was induced using sevoflurane, nitrous oxide, and oxygen along with an oropharyngeal airway. After lidocaine was topically applied to the oropharynx, fiber-optic orotracheal intubation was performed under spontaneous ventilation to minimize head and neck movement. Anesthesia was maintained using desflurane and remifentanil, and no postoperative complications were observed. General anesthesia for patients with PS requires careful planning, which should include preoperative assessment of the airway to determine the feasibility of nasotracheal intubation and identify airway irregularities.

Objective: To assess whether the different fiberoptic bronchoscopy (FOB) grades of laryngeal mask airway (LMA) Supreme™ affects pharyngolaryngeal morbidity (PLM, including sore throat, dysphonia, pharyngoxerosis, and dysphagia) after general anesthesia., Methods: A total of 235 adult patients scheduled for elective laser lithotripsy undergoing general anesthesia with the placement of LMA Supreme™ were enrolled. The position of LMA Supreme™ was assessed by FOB and categorized into five grades. Meanwhile, patients were divided into four groups (grades A-D); none was assessed as grade E. We collected blinded data on PLM at 2 (H+2), 6 (H+6), and 24 hours (H+24) postoperatively. The incidence and severity of PLM as the primary outcome and incidence of PLM at three time points as a secondary outcome were compared., Results: The incidence of PLM was higher at 2 and 6 hours than at 24 hours; however, no significant difference was found between the incidence of PLM in the FOB groups. Furthermore, the severity of sore throat and dysphonia between groups were obviously differed at H+6 and H+24, but similar at H+2. The severity of postoperative pharyngoxerosis and dysphagia were similar between groups at three time points., Conclusions: A positive association was found between the severity of postoperative sore throat and dysphonia and FOB grade after LMA Supreme™ placement. PLM secondary to placement of the LMA Supreme™ was short lasting., (Copyright © 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objective: To assess FEES findings in defining oral feeding safety in children with suspected dysphagia, comparing them with clinical feeding evaluation results., Methods: This study comprised a case series involving children with suspected dysphagia, referred for evaluation by otolaryngologists and speech-language pathologists (SLPs) at a Brazilian quaternary public university hospital. These children underwent both clinical evaluations and fiberoptic endoscopic evaluation of swallowing (FEES), with a comprehensive collection of demographic and clinical data. Subsequently, the authors performed a comparative analysis of findings from both assessments., Results: Most patients successfully completed the FEES procedure (93.7%), resulting in a final number of 60 cases included in the study. The prevalence of dysphagia was confirmed in a significant 88% of these cases. Suspected aspiration on clinical SLP evaluation was present in 34 patients. Of these, FEES confirmed aspiration or penetration in 28 patients. Among the 35 patients with aspiration or penetration on FEES, 7 (20%) had no suspicion on SLP clinical assessment. All seven patients in whom clinical SLP evaluation failed to predict penetration/aspiration had neurological disorders. The median age of the children was 2.8 years, and 49 (81.6%) had neurological disorders, while 35 (58.3%) had chronic pulmonary disease. The most prevalent complaints were choking (41.6%) and sialorrhea (23.3%)., Conclusion: FEES can diagnose structural anomalies of the upper aerodigestive tract and significantly contribute to the detection of aspiration and penetration in this group of patients with suspected dysphagia, identifying moderate and severe dysphagia even in cases where clinical assessment had no suspicion., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2024 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: The use of flexible fiber-optic scopes is increasing across critical care specialities, but there is limited literature on their use in retrieval medicine. This study aims to describe a case series in which flexible fiber-optic scopes were used by New South Wales Ambulance Aeromedical Operations critical care teams., Methods: A retrospective case series was performed in our service from January 1, 2019, to December 31, 2021. We searched our electronic medical retrieval database for the terms "aScope," "Awake Fibreoptic Intubation (AFOI)," "Fibreoptic Intubation (FOI)," and "Nasal Endotracheal Tube (ETT)" to identify when a flexible fiber-optic scope was used., Results: There were 16 uses of flexible fiber-optic scopes during the study period. The most common procedure was awake nasal fiber-optic intubation, which was performed during 9 cases, 7 of which were successful. Other procedures performed included 4 cases of intubation through a supraglottic airway, 1 case of an asleep fiber-optic intubation, 1 case of flexible nasoendoscopy for upper airway assessment, and 1 case of fiber-optic bronchoscopy via tracheostomy. These procedures were performed by anesthetic, emergency and intensive care doctors. This case series describes 4 of these cases in more detail., Conclusion: This case series demonstrates a variety of procedural and diagnostic uses for flexible fiber-optic scopes in retrieval medicine. These procedures can have an important bearing on decision making and patient management. The training and clinical governance provided by our service in this skill appears to be safe and robust with high success rates of awake fiber-optic intubations., Competing Interests: Declaration of competing interest The author(s) have no relevant disclosures. There was no grant funding or financial support for this manuscript., (Crown Copyright © 2024. Published by Elsevier Inc. All rights reserved.)