Comparative evaluation of nebulized versus intravenous dexmedetomidine on intubating conditions during awake fiberoptic nasotracheal intubation

BACKGROUND

There is a search for an ideal agent to facilitate awake fiberoptic intubation (AFOI). Dexmedetomidine is a selective α2 agonist which can be administered through intravenous, intramuscular, buccal, intranasal & inhalational routes. It provides good intubation conditions without oxygen desaturation but may cause hypotension and bradycardia when administered intravenously. Hence, alternative routes of administering dexmedetomidine which may improve its safety profile are worth exploring.

METHODS

In this randomised, controlled, double-blind trial, 46 ASA I/II adult participants scheduled for elective ENT surgery were randomly allocated to Group ND (Nebulised Dexmedetomidine) (n = 23) to receive nebulisation with dexmedetomidine 1μg.kg-1 and Group ID (Intravenous Dexmedetomidine) (n = 23) to receive intravenous dexmedetomidine 1μg.kg-1 before AFOI. All the patients received injection midazolam 1 mg i.v. as premedication before anaesthesia was initiated. The primary outcome was the cough score. The secondary outcomes were the RSS, SAYGO boluses, post-intubation score, hemodynamic parameters, recall of the procedure, patient satisfaction score and any side effects.

RESULTS

The cough score was significantly lower in nebulized group (2.43 ± 0.992 vs 3.52 ± 1.082) with p = 0.001. RSS(3.30 ± 0.926 vs 4.22 ± 1.126; p = 0.004), number of SAYGO boluses required (2.74 ± 0.864 vs 3.57 ± 1.161; p = 0.009) & the post intubation score (1.48 ± 0.593 vs 2.17 ± 0.778; p = 0.001) were also significantly lower in nebulized group.

CONCLUSIONS

Nebulisation with dexmedetomidine results in desirable degree of sedation and better tolerance of the procedure with adequate attenuation of the haemodynamic responses to intubation.

In-situ and label-free measurement of cytochrome C concentration with a Ti2C-MXene sensitized fiber-optic MZI sensor

BACKGROUND

The concentration of cytochrome C is demonstrated to be an effective indicator of the microbial corrosion strength of metals. Traditional cytochrome C sensor can detect cytochrome C with a low detection limit, but their use is limited by their high cost, cumbersome operation, and susceptibility to malignant environments. In addition, studies on the monitoring of cytochrome C in the field of microbial corrosion has still not been carried out. Therefore, there is a need for a highly sensitive, selective, low-cost, anti-interference, and stable cytochrome C sensor with online monitoring and remote sensing capabilities for in-situ measurement of microbial corrosion strength.

RESULTS

This paper proposed a highly sensitive label-free fiber-optic sensor based on Mach-Zehnder interferometer (MZI) for in-situ measurement of the microbial corrosion marker cytochrome C. Two-dimensional Ti2C-MXene material is uniformly immobilized onto the surface of the sensing area to improve the sensitivity, hydrophilicity, and specific surface area of the sensing area, as well as to facilitate the immobilization of specific sensitive materials. The cytochrome C antibody is modified on the surface of Ti2C-MXene to specifically recognize cytochrome C, whose concentration variation can be measured by monitoring the spectral shift of MZI sensor. Results demonstrate a measurement sensitivity of 1.428 nm/μM for cytochrome C concentrations ranging from 0 to 7.04 μM. The detection limit of the sensor is calculated to be 0.392 μM with remarkable performance, including selectivity, stability, and reliability. Besides, the measurement result of the proposed sensor in real microbial corrosive environment is consistent with that of the ideal environment.

SIGNIFICANCE AND NOVELTY

This is the first instance of achieving in-situ and label-free measurement of cytochrome C by using a fiber-optic MZI sensor, which undoubtedly provides a feasible solution for the effective monitoring of microbial metal corrosion in the environment.

Comparison of i-gel® and LMA® Supreme™ for Facilitating Fiberoptic Endotracheal Intubation: A Prospective Randomized Trial

Supraglottic airway (SGA) is an alternative to endotracheal intubation, however endotracheal intubation is often essential. One method to convert from an SGA to an endotracheal tube (ETT) is utilizing the SGA as a conduit for fiberoptic-guided advancement of an Aintree catheter (airway exchange catheter), and exchange of the SGA for an ETT. In this prospective randomized study, we compared two SGA devices in facilitating this exchange. Subjects were randomized to receive either the i-gel® or LMA® Supreme™ SGA. The SGA was placed and an Aintree intubation catheter was inserted through the SGA over a fiberoptic bronchoscope. Next, the SGA was removed, leaving the Aintree within the trachea, and an ETT was placed over the Aintree catheter and advanced into the trachea. The i-gel group exhibited shorter time to successful intubation (median, 191 vs. 434 seconds; P = .002). The i-gel group also had fewer study subjects requiring more than one attempt for successful Aintree placement (33% vs. 75%, P = .02). The i-gel group showed superior laryngeal view score (LVS) (6 vs. 4; P = .003). The i-gel SGA achieved a faster time to successful intubation, higher rate of first attempt Aintree placement, and superior LVS.

Fiberscope-Based Measurement of Coaptation Height for Intraoperative Assessment of Mitral Valve Repair

BACKGROUND

Restoring adequate coaptation height is a key principle of mitral valve (MV) repair. This study aimed to evaluate the utility of fiberscope (FS) technology to assess MV coaptation height for intraoperative use.

METHODS

Ex-vivo testing was performed on five adult porcine hearts. The left atrium (LA) was resected, and the left ventricle (LV) was pressurized retrograde to 27 ± 1mm Hg. An endoscope was inserted into the LV apex, centered under the MV orifice. An FS system (Milliscope II camera, LED light source, and 0.7 mm diameter × 15 cm long) 90° semirigid scope with 1.2 mm focal length) was mounted above the MV annulus in a custom alignment and measuring fixture. Three blinded measurements were taken at two locations on each MV, A2 and P2 segment, from the top of coaptation to the leaflet edge identified by the FS. Accurate positioning was verified using the LV endoscope. A control (metal rod of similar thickness) was used for comparison, with coaptation height recorded when the control was seen via the endoscope.

RESULTS

Coaptation heights were similar for the control and FS methods across all hearts at A2 (11.6 ± 2.6 mm control vs 11.8 ± 2.2 mm FS) and P2 (13.3 ± 2.6 mm control vs 13.4 ± 2.9 mm FS) segments, with similar measurement variability (control SD 0.1-1.0 mm; FS SD 0.1-0.9 mm). One outlier was excluded from analysis (n = 19/20). The maximum absolute difference and percent error between measurement methods were less than 1.1 mm (median [IQR], 0.6 [0.3-0.9] mm) and less than 14% (4.1 [2.2-7.6]%).

CONCLUSIONS

Utilization of a miniaturized FS enabled precise and accurate quantification of MV coaptation. This technique is promising for evaluating post-repair valve competence and coaptation height.

Development of a novel fibre optic beam profile and dose monitor for very high energy electron radiotherapy at ultrahigh dose rates

Objective. Very high energy electrons (VHEE) in the range of 50-250 MeV are of interest for treating deep-seated tumours with FLASH radiotherapy (RT). This approach offers favourable dose distributions and the ability to deliver ultra-high dose rates (UHDR) efficiently. To make VHEE-based FLASH treatment clinically viable, a novel beam monitoring technology is explored as an alternative to transmission ionisation monitor chambers, which have non-linear responses at UHDR. This study introduces the fibre optic flash monitor (FOFM), which consists of an array of silica optical fibre-based Cherenkov sensors with a photodetector for signal readout.Approach. Experiments were conducted at the CLEAR facility at CERN using 200 MeV and 160 MeV electrons to assess the FOFM's response linearity to UHDR (characterised with radiochromic films) required for FLASH radiotherapy. Beam profile measurements made on the FOFM were compared to those using radiochromic film and scintillating yttrium aluminium garnet (YAG) screens.Main results. A range of photodetectors were evaluated, with a complementary-metal-oxide-semiconductor (CMOS) camera being the most suitable choice for this monitor. The FOFM demonstrated excellent response linearity from 0.9 Gy/pulse to 57.4 Gy/pulse (R2= 0.999). Furthermore, it did not exhibit any significant dependence on the energy between 160 MeV and 200 MeV nor the instantaneous dose rate. Gaussian fits applied to vertical beam profile measurements indicated that the FOFM could accurately provide pulse-by-pulse beam size measurements, agreeing within the error range of radiochromic film and YAG screen measurements, respectively.Significance. The FOFM proves to be a promising solution for real-time beam profile and dose monitoring for UHDR VHEE beams, with a linear response in the UHDR regime. Additionally it can perform pulse-by-pulse beam size measurements, a feature currently lacking in transmission ionisation monitor chambers, which may become crucial for implementing FLASH radiotherapy and its associated quality assurance requirements.

Efficient Sequential Detection of Two Antibiotics Using a Fiber-Optic Surface Plasmon Resonance Sensor

Antibiotic residues have become a worldwide public safety issue. It is vital to detect multiple antibiotics simultaneously using sensors. A new and efficient method is proposed for the combined detection of two antibiotics (enrofloxacin (Enro) and ciprofloxacin (Cip)) in milk using surface plasmon resonance (SPR) sensors. Based on the principle of immunosuppression, two antibiotic antigens (for Enro and Cip) were immobilized on an optical fiber surface with conjugates of bovine serum albumin using dopamine (DA) polymerization. Each single antigen was bound to its corresponding antibody to derive standard curves for Enro and Cip. The fiber-optic sensor's sensitivity was 2900 nm/RIU. Detection limits were calculated to be 1.20 ng/mL for Enro and 0.81 ng/mL for Cip. The actual system's recovery rate was obtained by testing Enro and Cip in milk samples; enrofloxacin's and ciprofloxacin's mean recoveries from the milk samples were 96.46-120.46% and 96.74-126.9%, respectively. In addition, several different regeneration solutions were tested to analyze the two target analytes' regeneration ability; NaOH and Gly-HCl solutions were found to have the best regeneration ability.

Precise detection of trace level protein using MIP-MoS2 nanocomposite functionalized PCF based interferometer

Fiber optic interferometry combined with recognizing elements has attracted intensive attention for the development of different biosensors due to its superior characteristic features. However, the immobilization of sensing elements alone is not capable of low-concentration detection due to weak interaction with the evanescent field of the sensing transducer. The utilization of different 2D materials with high absorption potential and specific surface area can enhance the intensity of the evanescent field and hence the sensitivity of the sensor. Here, a biosensor has been fabricated using an inline hetero fiber structure of photonic crystal fiber (PCF) and single-mode fiber (SMF) functionalized with a nanocomposite of molybodenum di-sulfide (MoS2) and molecular imprinting polymer (MIP) to detect trace levels of bovine serum albumin (BSA). The sensor showed a wide dynamic detection range with a high sensitivity of 2.34 × 107 pm/µg L-1. It shows working potential over a wide pH range with a subfemtomolar detection limit. The compact size, easy fabrication, stable structure, long detection range, and high sensitivity of this sensor would open a new path for the development of different biosensors for online and remote sensing applications.

Skin microcirculatory responses: A potential marker for early diabetic neuropathy assessment using a low-cost portable diffuse optical spectrometry device

Diffuse optical measurement is an evolving optical modality providing a fast and portable solution for microcirculation assessment. Diffuse optics in static and dynamic modalities are combined here in a system to assess hemodynamics in skin tissues of control and diabetic subjects. The in-house developed system consists of a laser source, fiber optic probe, a low-cost avalanche photodiode, a finite element model (FEM) derived static optical property estimator, and a software correlator for continuous flow monitoring through microvasculature. The studies demonstrated that the system quantifies the changes in blood flow rate in the immediate skin subsurface. The system is calibrated with in vitro flow models and a proof-of-concept was demonstrated on a limited number of subjects in a clinical environment. The flow changes in response to vasoconstrictive and vasodilative stimuli were analyzed and used to classify different stages of diabetes, including diabetic neuropathy.

Application of transfer learning for rapid calibration of spatially resolved diffuse reflectance probes for extraction of tissue optical properties

Significance

Treatment planning for light-based therapies including photodynamic therapy requires tissue optical property knowledge. This is recoverable with spatially resolved diffuse reflectance spectroscopy (DRS) but requires precise source-detector separation (SDS) determination and time-consuming simulations.

Aim

An artificial neural network (ANN) to map from DRS at multiple SDS to optical properties was created. This trained ANN was adapted to fiber-optic probes with varying SDS using transfer learning (TL).

Approach

An ANN mapping from measurements to Monte Carlo simulation to optical properties was created with one fiber-optic probe. A second probe with different SDS was used for TL algorithm creation. Data from a third were used to test this algorithm.

Results

The initial ANN recovered absorber concentration with RMSE = 0.29    μ M (7.5% mean error) and μ s ' at 665 nm (μ s , 665 ' ) with RMSE = 0.77    cm - 1 (2.5% mean error). For probe 2, TL significantly improved absorber concentration (0.38 versus 1.67    μ M RMSE, p = 0.0005 ) and μ ' s , 665 (0.71 versus 1.8    cm - 1 RMSE, p = 0.0005 ) recovery. A third probe also showed improved absorber (0.7 versus 4.1    μ M RMSE, p < 0.0001 ) and μ s , 665 ' (1.68 versus 2.08    cm - 1 RMSE, p = 0.2 ) recovery.

Conclusions

TL-based probe-to-probe calibration can rapidly adapt an ANN created for one probe to similar target probes, enabling accurate optical property recovery with the target probe.

Development of local-power-free, remote α-particle detection using optical fibers

We demonstrate the application of fluorescence optical fiber coupled to a telecom grade fiber as a sensor for alpha particles using alpha-specific ZnS(Ag) scintillation materials whose wavelength is down-shifted into a low-loss region of the telecom grade fiber transmission band. Telecom-grade fiber optics offer a solution for sensing alpha radiation in deep repositories and cask storage for radioactive materials due to the stability of SiO2 under normal environmental conditions and its relative radiation hardness at low radiation doses. Long-term nuclear waste storage facilities require sensors for the detection of leakage of radioactive materials that are maintenance-free, do not require power and can survive with no 'wear out' mechanisms for decades. By accomplishing the wavelength transformation, we maximize efficiencies in the detection of α-particles and signal transport and can detect alpha scintillation at distances on the order of >1 km with a sensor that is ~3% efficient and can be easily scaled as a sensor array. This paper describes the construction and testing of the sensor including manufacture of the controlled thickness films, verification of the wavelength shift from 450 to 620 nm and optimization of the sensitivity as a function of thickness. We also model the relative sensitivity of the film as a function of film thickness, and we demonstrate a signal-to-noise ratio of 10 at a range of greater than 1 km.

AI-driven projection tomography with multicore fibre-optic cell rotation

Optical tomography has emerged as a non-invasive imaging method, providing three-dimensional insights into subcellular structures and thereby enabling a deeper understanding of cellular functions, interactions, and processes. Conventional optical tomography methods are constrained by a limited illumination scanning range, leading to anisotropic resolution and incomplete imaging of cellular structures. To overcome this problem, we employ a compact multi-core fibre-optic cell rotator system that facilitates precise optical manipulation of cells within a microfluidic chip, achieving full-angle projection tomography with isotropic resolution. Moreover, we demonstrate an AI-driven tomographic reconstruction workflow, which can be a paradigm shift from conventional computational methods, often demanding manual processing, to a fully autonomous process. The performance of the proposed cell rotation tomography approach is validated through the three-dimensional reconstruction of cell phantoms and HL60 human cancer cells. The versatility of this learning-based tomographic reconstruction workflow paves the way for its broad application across diverse tomographic imaging modalities, including but not limited to flow cytometry tomography and acoustic rotation tomography. Therefore, this AI-driven approach can propel advancements in cell biology, aiding in the inception of pioneering therapeutics, and augmenting early-stage cancer diagnostics.

Trace detection of canine distemper virus based on Michelson-interferometer sensing probe

A single-mode-fiber (SMF)-multimode-fiber (MMF)-tri-core-fiber (TCF) Michelson probe structure is proposed for trace detection of canine distemper virus (CDV). One end of the TCF is cut flat and fused with the multimode fiber, and the other end is coated with a silver film to enhance the reflection, and an optic-fiber sensing probe with SMF-MMF-TCF structure is obtained. The (PDDA/PSS)3 multilayer film is modified on the surface of the fiber by layer-by-layer self-assembly method as a polyelectrolyte binder to immobilize CDV antibodies to form a (PDDA/PSS)3 /CDV antibody composite membrane for specific detection of CDV antigens. The response-recovery test of the sensor is performed to verify its repeatability. The detection limit, the sensitivity, and the linear fitting degree for CDV antigen are 0.1236 pg/mL, 1.1776 dB/(pg/mL), and 0.9899, respectively. At the same time, the stability, selectivity, and clinical samples of the sensors were also verified.

Curious Case of Pediatric One-Lung Ventilation with Two Endotracheal Tubes: A Case Report

ABSTRACT

One-lung ventilation is indicated during thoracic surgery for visualization and exposure of surgical site. It is achieved with bronchial blockers, double-lumen endobronchial tube, single-lumen endotracheal tubes and Univent tube for infants and children. Fibreoptic bronchoscope is required for placing and confirming the correct position of these tubes. We report a perioperative management of safe conduct of one lung ventilation for a 6-year child undergoing left lower lobe lobectomy through C-MAC video laryngoscope guided two single lumen tubes in limited resource settings where paediatric-sized fibreoptic bronchoscope is unavailable.

A D-Shaped Polymer Optical Fiber Surface Plasmon Resonance Biosensor for Breast Cancer Detection Applications

Fiber-optic biosensors have garnered significant attention and witnessed rapid development in recent years owing to their remarkable attributes such as high sensitivity, immunity to electromagnetic interference, and real-time monitoring. They have emerged as a potential tool in the realm of biomarker detection for low-concentration and small molecules. In this paper, a portable and cost-effective optical fiber biosensor based on surface plasmon resonance for the early detection of breast cancer is demonstrated. By utilizing the aptamer human epidermal growth factor receptor 2 (HER2) as a specific biomarker for breast cancer, the presence of the HER2 protein can be detected through an antigen-antibody binding technique. The detection method was accomplished by modifying a layer of HER2 aptamer on the flat surface of a gold-coated D-shaped polymer optical fiber (core/cladding diameter 120/490 μm), of which the residual thickness after side-polishing was about 245 μm, the thickness of the coated gold layer was 50 nm, and the initial wavelength in pure water was around 1200 nm. For low-concentration detection of the HER2 protein, the device exhibited a wavelength shift of ~1.37 nm with a concentration of 1 μg/mL (e.g., 5.5 nM), which corresponded to a limit of detection of ~5.28 nM. Notably, the response time of the biosensor was measured to be as fast as 5 s. The proposed biosensor exhibits the potential for early detection of HER2 protein in initial cancer serum and offers a pathway to early prevention of breast cancer.

Diffuse reflectance spectroscopy for colorectal cancer surgical guidance: towards real-time tissue characterization and new biomarkers

Colorectal cancer (CRC) is the third most common and second most deadly type of cancer worldwide, representing 11.3% of the diagnosed cancer cases and resulting in 10.2% (0.88 million) of the cancer related deaths in 2020. CRCs are typically detected at the late stage, which leads to high mortality and morbidity. Mortality and poor prognosis are partially caused by cancer recurrence and postoperative complications. Patient survival could be increased by improving precision in surgical resection using accurate surgical guidance tools based on diffuse reflectance spectroscopy (DRS). DRS enables real-time tissue identification for potential cancer margin delineation through determination of the circumferential resection margin (CRM), while also supporting non-invasive and label-free approaches for laparoscopic surgery to avoid short-term complications of open surgery as suitable. In this study, we have estimated the scattering properties and chromophore concentrations based on 2949 DRS measurements of freshly excised ex vivo specimens of 47 patients, and used this estimation to classify normal colorectal wall (CW), fat and tumor tissues. DRS measurements were performed with fiber-optic probes of 630 μm source-detector distance (SDD; probe 1) and 2500 μm SDD (probe 2) to measure tissue layers ∼0.5-1 mm and ∼0.5-2 mm deep, respectively. By using the 5-fold cross-validation of machine learning models generated with the classification and regression tree (CART) algorithm, we achieved 95.9 ± 0.7% sensitivity, 98.9 ± 0.3% specificity, 90.2 ± 0.4% accuracy, and 95.5 ± 0.3% AUC for probe 1. Similarly, we achieved 96.9 ± 0.8% sensitivity, 98.9 ± 0.2% specificity, 94.0 ± 0.4% accuracy, and 96.7 ± 0.4% AUC for probe 2.

Rapid ultra-sensitive nucleic acid detection using plasmonic fiber-optic spectral combs and gold nanoparticle-tagged targets

Nucleic acid (NA) is a widely-used biomarker for viruses. Accurate quantification of NA can provide a reliable basis for point-of-care diagnosis and treatment. Here, we propose a tilted fiber Bragg grating (TFBG)-based plasmonic fiber-optic spectral comb for fast response and ultralow limit NA detection. The TFBG is coated with a gold film which enables excitation of surface plasmon resonance (SPR), and single-stranded probe NAs with known base sequences are assembled on the gold film. To enhance sensitivity of refractive index (RI) for sensing a chosen combination of probe and target NAs around the TFBG surface, gold nanoparticles (AuNPs) are bonded to the target NA molecules as "RI-labels". The NA combination-induced aggregation of AuNPs induces significant spectral responses in the TFBG that would be below the detection threshold for the NAs in the absence of the AuNPs. The proposed TFBG-SPR NA sensor shows a fast response time of 30 s and an ultra-wide NA detection range from 1 × 10-18 mol/L to 1 × 10-7 mol/L. In the NA concentration range of 1 × 10-12 mol/L (1 pM) to 105 pM, an ultra-high sensitivity of 1.534 dB/lg(pM) is obtained. The sensor achieves an ultra-low limit of detection down to 1.0 × 10-18 mol/L (1 aM), which is more than an order of magnitude lower than the previous reports. The proposed sensor not only shows potentials in practical applications of NA detection, but also provides a new way for TFBG-SPR biochemical sensors to achieve higher RI sensitivity.

A nonenzymic microfiber optic-biosensor modified phenylboric acid for sensitively and specifically detecting low glucose concentration

A microfiber interferometer coated with sensitive films formed by amide bond between 3-Carboxy-4-fluorophenylboronic acid (FPBA) and polydopamine (PDA) for the detection of trace glucose concentration is designed and demonstrated. Due to a huge evanescent field, this microfiber interferometer has a very sensitive response to the refractive index (RI) of the surrounding environment, which has excellent sensing performance including RI sensitivity response of 1825.83 nm/RIU and low temperature response of -0.04 nm/°C. Due to the good film-forming performance of PDA, whose the amino group coupled with the carboxyl molecule on FPBA to form an amide bond, PDA/FPBA can be attached to the microfiber interferometer for detecting different concentrations of glucose. The concentration range of glucose detection is 0.1-20 mM with a sensitivity of 1.71 nm/mM and a limit of detection of 12.6 ppm. Finally, the sensor is tested in actual samples of human urine to detect different concentrations of glucose and proved to be responsive and reproducible in urine. We can estimate the concentration of glucose in urine by wavelength shift. The sensor has the advantages of simple manufacture, low cost, high sensitivity, and specific recognition glucose in urine. In addition, the success of this sensor shows that the combination of ultrafine fiber and organic chemical materials has broad prospects in the field of optical detection.

In-situ label-free temperature-compensated DNA hybridization detection with a fiber-optic interferometer and a fiber Bragg grating for microfluidic chip

We demonstrated a temperature-compensated optofluidic DNA biosensor available for microfluidic chip. The optofluidic sensor was composed of an interferometer and a fiber Bragg grating (FBG) by femtosecond laser direct writing micro/nano processing technology. The sensing arm of the interferometer was suspended on the inner wall of the microchannel and could directly interact with the microfluid. With the immobilization of the single stranded probe DNA (pDNA), this optofluidic biosensor could achieve specific detection of single stranded complementary DNA (scDNA). The experimental results indicated that a linear response within 50 nM and the detection limit of 1.87 nM were achieved. In addition, the optofluidic biosensor could simultaneously monitor temperature to avoid temperature fluctuations interfering with the DNA hybridization detection process. And, the optofluidic detection channel could achieve fast sample replacement within 10 s at a flow rate of 2 μL/min and sample consumption only required nanoliters. This optofluidic DNA biosensor had the advantages of label-free, good specificity, dual parameter detection, low sample consumption, fast response, and easy repeatable preparation, which was of great significance for the field of DNA hybridization research and solving the temperature sensitivity problem of biosensors and had good prospects in biological analysis.

Expedited awake tracheal intubation using ropivacaine topicalisation for the evacuation of a postoperative neck haematoma in the presence of lignocaine allergy

Progressive airway compromise from a neck haematoma is a feared complication of head and neck surgery that can rapidly lead to death if not urgently intervened upon. We report a case of a patient developing a progressively expanding neck haematoma on the first postoperative night after parotidectomy and neck dissection for malignancy. Although he did not have respiratory compromise or stridor, ultrasound examination of his airway revealed marked tracheal deviation, and flexible nasoendoscopy showed significant supraglottic swelling. The decision was made for an awake fibreoptic intubation; however, a complicating factor was a history of lignocaine allergy. This case report describes the unconventional use of atomised ropivacaine in a concentration of 0.5% for topicalisation of the airway. Along with conscious sedation with remifentanil, ropivacaine provided excellent conditions for awake intubation, following which a significant amount of blood was evacuated from the face and neck.

Fibreoptic intubation: a commitment to an indispensable technique

Recent evidence has shown that fibreoptic intubation is still an indispensable technique for safe management of predicted difficult airways, despite the implementation of new technologies such as videolaryngoscopy. It is therefore our obligation as anaesthesia societies and as practicing anaesthetists to offer this technique to our patients in clearly designated situations.

Flexible Bronchoscopy Combined With Videolaryngoscope For Tracheal Intubation In A Child With Hunter Syndrome: A Case Report

Hunter syndrome (mucopolysaccharidosis type II) has the highest reported prevalence of difficult tracheal intubation among the seven known types of mucopolysaccharidoses. Despite improved difficult airway guidelines and equipment, conventional approaches may fail in some cases. A 10-year-old child with Hunter syndrome, was scheduled for multiple dental extractions. On the first visit, failed intubation was declared as per Difficult Airway Society guidelines in the surgical day-care suite of our institute and the procedure was postponed. The case was then planned to be handled in the main operating room with additional preparation and input from the paediatric otolaryngologist for possible tracheostomy, paediatric intensive care for postoperative need for ventilation, and difficult airway resource faculty for an unconventional approach-videolaryngoscope combined with fibreoptic bronchoscope-which resulted in safe administration of anaesthesia. This case illustrates the importance of meticulous planning in the management of previously failed airway.

Fiber optic probe-based ATR-FTIR spectroscopy for rapid breast cancer detection: A pilot study

Breast cancer diagnosis is crucial for timely treatment and improved outcomes. This paper proposes a novel approach for rapid breast cancer diagnosis using optical fiber probe-based attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy from 750 to 4000 cm-1 . The technique enables direct analysis of tissue samples, eliminating the need for microtome sectioning and staining, thus saving time and resources. By capturing molecular fingerprint information, various machine-learning models were used to analyze the spectroscopic data to classify cancerous and non-cancerous tissues accurately. Comparing deparaffinized and paraffinized samples reveals the impact of sample preparation and experimental methods. The study demonstrates a strong correlation between the cancerous nature of a sample and its ATR-FTIR spectrum, suggesting its potential for breast cancer diagnosis (sensitivity of 74.2% and specificity of 78.3%). The proposed approach holds promise for integration into clinical operations, providing a rapid method for preliminary breast cancer diagnosis.

I-gel Plus acts as a superior conduit for fiberoptic intubation than standard i-gel

The supraglottic airway (SGA) is widely used. I-gel Plus is a next-generation i-gel with some improvements, including facilitation of fiberoptic tracheal intubation (FOI). To compare the performance of i-gel Plus and standard i-gel as conduits for FOI, a Thiel-embalmed cadaveric study was conducted. Twenty-two anesthesiologists were enrolled as operators in Experiment 1. The i-gel Plus and standard i-gel were inserted into one cadaver, and the FOI was performed through each SGA. The primary outcome was time required for FOI. The secondary outcomes were the number of attempts and visual analog scale (VAS) score for difficulty in FOI. Moreover, fiberoptic views of the vocal cords in each SGA were assessed by an attending anesthesiologist using nine cadavers in Experiment 2. The percentage of glottic opening (POGO) score without fiberscope tip upward flexion and upward angle of the fiberscope tip to obtain a 100% POGO score were evaluated as secondary outcomes. The time for FOI through i-gel Plus was significantly shorter than that through standard i-gel (median (IQR), i-gel Plus: 30.3 (25.4-39.0) s, vs standard i-gel: 54.7 (29.6-135.0) s; median of differences, 24.4 s; adjusted 95% confidence interval, 3.0-105.7; adjusted P = 0.040). Although the number of attempts for successful FOI was not significantly different, the VAS score for difficulty in the i-gel Plus group was significantly lower (easier) than that in the standard i-gel group. Moreover, i-gel Plus required a significantly smaller upward angle of the fiberscope tip to obtain a 100% POGO score. FOI can be performed more easily using i-gel Plus than using standard i-gel because of the improved fiberoptic visibility of vocal cords.

Study on the Design and Performance of a Glove Based on the FBG Array for Hand Posture Sensing

This study introduces a new wearable fiber-optic sensor glove. The glove utilizes a flexible material, polydimethylsiloxane (PDMS), and a silicone tube to encapsulate fiber Bragg gratings (FBGs). It is employed to enable the self-perception of hand posture, gesture recognition, and the prediction of grasping objects. The investigation employs the Support Vector Machine (SVM) approach for predicting grasping objects. The proposed fiber-optic sensor glove can concurrently monitor the motion of 14 hand joints comprising 5 metacarpophalangeal joints (MCP), 5 proximal interphalangeal joints (PIP), and 4 distal interphalangeal joints (DIP). To expand the measurement range of the sensors, a sinusoidal layout incorporates the FBG array into the glove. The experimental results indicate that the wearable sensing glove can track finger flexion within a range of 0° to 100°, with a modest minimum measurement error (Error) of 0.176° and a minimum standard deviation (SD) of 0.685°. Notably, the glove accurately detects hand gestures in real-time and even forecasts grasping actions. The fiber-optic smart glove technology proposed herein holds promising potential for industrial applications, including object grasping, 3D displays via virtual reality, and human-computer interaction.

Rapid detection of vaccinia virus using biofunctionalized fiber-optic ball-tip biosensors

In this work, we present the development and biofunctionalization of a fiber-optic ball-resonator biosensor for the real-time detection of vaccinia poxvirus. We fabricated several ball-tip resonators, functionalized through a silanization process to immobilize two bioreceptors: the monoclonal anti-L1R antibody targeting the L1R protein, and the polyclonal rabbit serum antibodies targeting the whole vaccinia virus (VV) pathogen. Experimental measurements were carried out to detect VV in concentrations from 103 to 108 plaque-forming units (PFU), with a limit of detection of around 1.7-4.3 × 103 PFU and a log-quadratic pattern, with a response up to 5 × 10-4 RIU (refractive index units). The specificity was assessed against herpes simplex virus, used as a non-specific control, with the best results obtained with anti-L1R monoclonal antibodies, and through the detection of vaccinia virus/herpes simplex-1 combination. The obtained results provide a real-time viral recognition with a label-free sensing platform, having rapid response and ease of manufacturing, and paving the road to the seamless detection of poxviruses affecting different human and animal species using optical fibers.

A L-glutamine binding protein modified MNM structured optical fiber biosensor based on surface plasmon resonance sensing for detection of L-glutamine metabolism in vitro embryo culture

A surface plasmon resonance (SPR) optical fiber sensor with multimode-coreless-multimode (MNM) structure was developed, which modified by L-glutamine-binding protein (QBP) for detection of L-glutamine (Gln). The QBP was immobilized on the surface of gold films by chemical cross-linking and exhibited a binding affinity for L-glutamine. The conformation of QBP can be changed from the "open" to the "closed", which led to a red-shift of the SPR peak when QBP bounded to L-glutamine. There was a good linear correlation between is a dependence of the SPR peak on and the concentration of L-glutamine concentration in the range 10-100 μM, with a sensitivity of 10.797nm/log10[Gln] for L-glutamine in the in vitro embryo culture (IVC) medium environment, and the limit of detection (LOD) is 1.187 μM. This QBP-modified MNM structure optical fiber SPR sensor provides a new idea for the developmental potential assessment of embryos in the process of in vitro embryo culture.

Sensitivity of the amide I band to matrix manipulation in bone: a Raman micro-spectroscopy and spatially offset Raman spectroscopy study

The fracture resistance of bone arises from the hierarchical arrangement of minerals, collagen fibrils (i.e., cross-linked triple helices of α1 and α2 collagen I chains), non-collagenous proteins, and water. Raman spectroscopy (RS) is not only sensitive to the relative fractions of these constituents, but also to the secondary structure of bone proteins. To assess the ability of RS to detect differences in the protein structure, we quantified the effect of sequentially autoclaving (AC) human cortical bone at 100 °C (∼34.47 kPa) and then at 120 °C (∼117.21 kPa) on the amide I band using a commercial Raman micro-spectroscopy (μRS) instrument and custom spatially offset RS (SORS) instrument in which rings of collection fiber optics are offset from the central excitation fiber optics within a hand-held, cylindrical probe. Being clinically viable, measurements by SORS involved collecting Raman spectra of cadaveric femur mid-shafts (5 male & 5 female donors) through layers of a tissue mimic. Otherwise, μRS and SORS measurements were acquired directly from each bone. AC-related changes in the helical status of collagen I were assessed using amide I sub-peak ratios (intensity, I, at ∼1670 cm-1 relative to intensities at ∼1610 cm-1 and ∼1640 cm-1). The autoclaving manipulation significantly decreased the selected amide I sub-peak ratios as well as shifted peaks at ∼1605 cm-1 (μRS), ∼1636 cm-1 (SORS) and ∼1667 cm-1 in both μRS and SORS. Compared to μRS, SORS detected more significant differences in the amide I sub-peak ratios when the fiber optic probe was directly applied to bone. SORS also detected AC-related decreases in I1670/I1610 and I1670/I1640 when spectra were acquired through layers of the tissue mimic with a thickness ≤2 mm by the 7 mm offset ring, but not with the 5 mm or 6 mm offset ring. Overall, the SORS instrument was more sensitive than the conventional μRS instrument to pressure- and temperature-related changes in the organic matrix that affect the fracture resistance of bone, but SORS analysis of the amide I band is limited to an overlying thickness layer of 2 mm.

Fiber-Optic-Based System for High-Resolution Monitoring of Stretch in Excised Tissues

Cardiovascular diseases cause a high number of deaths nowadays. To improve these statistics, new strategies to better understand the electrical and mechanical abnormalities underlying them are urgently required. This study focuses on the development of a sensor to measure tissue stretch in excised tissues, enabling improved knowledge of biomechanical properties and allowing greater control in real time. A system made of biocompatible materials is described, which is based on two cantilevered platforms that integrate an optical fiber inside them to quantify the amount of stretch the tissues are exposed to with a precision of μm. The operating principle of the sensor is based on the variation of the optical path with the movement of the platforms onto which the samples are fixed. The conducted tests highlight that this system, based on a simple topology and technology, is capable of achieving the desired purpose (a resolution of ∼1 μm), enabling the tissue to be bathed in any medium within the system.

Development of a two-beveled-fiber polarized fiber-optic Raman probe coupled with a ball lens for in vivo superficial epithelial Raman measurements in endoscopy

We report on the development of a two-beveled-fiber polarized (TBFP) fiber-optic Raman probe coupled with a ball lens for in vivo superficial epithelial Raman measurements in endoscopy. The two-beveled fibers positioned symmetrically along a ball lens, in synergy with paired parallel-polarized polarizers integrated between the fibers and the ball lens, maximize the Raman signal excitation and collection from the superficial epithelium where gastrointestinal (GI) precancer arises. Monte Carlo (MC) simulations and two-layer tissue phantom experiments show that the probe developed detects ∼90% of the Raman signal from the superficial epithelium. The suitability of the probe developed for rapid (<3 s) superficial epithelial Raman measurements is demonstrated on fresh swine esophagus, stomach, and colon tissues, followed by their differentiation with high accuracies (92.1% for esophagus [sensitivity: 89.3%, specificity: 93.2%], 94.1% for stomach [sensitivity: 86.2%, specificity: 97.2%], and 94.1% for colon [sensitivity: 93.2%, specificity: 94.7%]). The presented results suggest the great potential of the developed probe for enhancing in vivo superficial epithelial Raman measurements in endoscopy.

Development and in-vivo validation of a portable phosphorescence lifetime-based fiber-optic oxygen sensor

Oxygenation is a crucial indicator of tissue viability and function. Oxygen tension ([Formula: see text]), i.e. the amount of molecular oxygen present in the tissue is a direct result of supply (perfusion) and consumption. Thus, measurement of [Formula: see text] is an effective method to monitor tissue viability. However, tissue oximetry sensors commonly used in clinical practice instead rely on measuring oxygen saturation ([Formula: see text]), largely due to the lack of reliable, affordable [Formula: see text] sensing solutions. To address this issue we present a proof-of-concept design and validation of a low-cost, lifetime-based oxygen sensing fiber. The sensor consists of readily-available off-the shelf components such as a microcontroller, a light-emitting diode (LED), an avalanche photodiode (APD), a temperature sensor, as well as a bright in-house developed porphyrin molecule. The device was calibrated using a benchtop setup and evaluated in three in vivo animal models. Our findings show that the new device design in combination with the bright porphyrin has the potential to be a useful and accurate tool for measuring [Formula: see text] in tissue, while also highlighting some of the limitations and challenges of oxygen measurements in this context.

Real-time in vivo dose measurement using ruby-based fibre optic dosimetry during internal radiation therapy

In vivo dosimetry (IVD) in a commonly used liver cancer treatment of selective internal radiation therapy (SIRT) has been done based on the post-treatment image-based dosimetry approach. Real-time IVD is necessary to verify the dose delivery and detect errors during the treatment for better patient outcomes. This study aims to develop a fibre optic dosimeter (FOD) for in vivo real-time dose rate measurement during internal beta radiation therapy, e.g., SIRT. A ruby fibre optic probe was prepared and studied the radioluminescence (RL) characteristics, including its major challenge of stem effect arising from Cherenkov radiation and luminescence from the irradiated fibre. The stem signal was suppressed adequately using the stem removal technique of optical filtering, and only 2.3 ± 1.1% stem signal was contributed to the measured RL signal. A linear dose rate response was observed during the exposure of the ruby probe to varying dose rates using a 6 MeV electron beam and a positron-emitting radionuclide fluorine-18. The ruby exhibited a temporally non-constant RL signal, which increased the RL signal by 0.84 ± 0.29 counts/sec2 during the irradiation of the maximum dose rate used in this study of 9 Gy/min for 2 min. The ability of ruby FOD to measure the absolute dose rate with sufficient stem effect suppression and the linear RL dose rate response indicates its suitability for real-time IVD during internal beta radiation therapy. Future work will investigate the time-dependent RL characteristic of ruby and validate post-treatment image-based dosimetry using ruby-based FOD.

Fabry-Perot Interferometric Fiber-Optic Sensor for Rapid and Accurate Thrombus Detection

We present a fiber-optic sensor based on the principles of a Fabry-Perot interferometer (FPI), which promptly, sensitively, and precisely detects blood clot formation. This sensor has two types of sensor tips; the first was crafted by splicing a tapered fiber into a single-mode fiber (SMF), where fine-tuning was achieved by adjusting the tapered diameter and length. The second type is an ultra-compact blood FPI situated on the core of a single-mode fiber. The sensor performance was evaluated via clot-formation-indicating spectrum shifts induced by the varied quantities of a thrombin reagent introduced into the blood. The most remarkable spectral sensitivity of the micro-tip fiber type was approximately 7 nm/μL, with a power sensitivity of 4.1 dB/μL, obtained with a taper fiber diameter and length of 55 and 300 μm, respectively. For the SMF type, spectral sensitivity was observed to be 8.7 nm/μL, with an optical power sensitivity of 0.4 dB/μL. This pioneering fiber-optic thrombosis sensor has the potential for in situ applications, healthcare, medical monitoring, harsh environments, and chemical and biological sensing. The study underscores the scope of optical technology in thrombus detection, establishing a platform for future medical research and application.

Monitoring the Opening of Rapid Palatal Expansion (RPE) in a 3D-Printed Skull Model Using Fiber Optic F-P Sensors

We present a novel method for the online measurement of multi-point opening distances of midpalatal sutures during a rapid palatal expansion (RPE) using fiber optic Fabry-Perot (F-P) sensors. The sensor consists of an optical fiber with a cut flat end face and an optical reflector, which are implanted into the palatal base structure of an expander and is capable of measuring the precise distance between two optical reflective surfaces. As a demonstration, a 3D-printed skull model containing the maxilla and zygomaticomaxillary complex (ZMC) was produced and a miniscrew-assisted rapid palatal expander (MARPE) with two guide rods was used to generate the midpalatal suture expansion. The reflected spectrums of the sensors were used to dynamically extract cavity length information for full process monitoring of expansion. The dynamic opening of the midpalatal suture during the gradual activation of the expander was measured, and a displacement resolution of 2.5 μm was demonstrated. The angle of expansion was derived and the results suggested that the midpalatal suture was opened with a slight V-type expansion of 0.03 rad at the first loading and subsequently expanded in parallel. This finding might be useful for understanding the mechanical mechanisms that lead to different types of expansion. The use of a fiber optic sensor for mounting the rapid palatal expander facilitates biomechanical studies and experimental and clinical evaluation of the effects of RPE.

Label-Free DNA Detection Using Etched Tilted Bragg Fiber Grating-Based Biosensor

A label-free-based fiber optic biosensor based on etched tilted Bragg fiber grating (TFBG) is proposed and practically demonstrated. Conventional phase mask technic has been utilized to inscribe tilted fiber Bragg grating with a tilt angle of 10°, while the etching has been accomplished with hydrofluoric acid. A composite of polyethylenimine (PEI)/poly(acrylic acid) (PAA) has been thermally deposited on the etched TFBG, followed by immobilization of probe DNA (pDNA) on this deposited layer. The hybridization of pDNA with the complementary DNA (cDNA) has been monitored using wavelength-dependent interrogation. The reproducibility of the probes has been demonstrated by fabricating three identical probes and their response has been investigated for cDNA concentration ranging from 0 μM to 3 μM. The maximum sensitivity has been found to be 320 pm/μM, with the detection limit being 0.65 μM. Furthermore, the response of the probes towards non-cDNA has also been investigated in order to establish its specificity.

Enrichment and Selection of Particles through Parallel Induced-Charge Electro-osmotic Streaming for Detection of Low-Abundance Nanoparticles and Targeted Microalgae

Manipulation of micro- and nanoscale objects is an essential procedure in many detection and sensing applications, including disease diagnosis and environmental monitoring. Induced-charge electro-osmotic (ICEO) vortices present excellent advantages in the enrichment and selection of micro/nanoscale particles for downstream detection due to gentle conditions and contactless operation, but the application of this method is currently constrained by the throughput. Double-layer charging at the ends of bipolar electrodes can maintain a continuous flow of electric current in the fluidically isolated channels, which provides a feasible method to manipulate particles using parallel ICEO vortices, promoting throughput of particle manipulation without compromising efficiency and overcoming the complicated ohmic contact of electrodes. Encouraged by these, we put forward a novel method with parallel ICEO vortices to manipulate micro/nanoscale samples for downstream detection. First, we study the extension regulation of the low-frequency electric field and mediating effect of the open BPEs on the extended electric field and characterize electric equilibrium states of microparticles and their voltage dependence. Afterward, we leverage this method to enrich nanoparticles for detection of low-abundance nanoparticles with about 20- and 40-fold fluorescence intensities by integrating with a simple fiber-optic sensor. Furthermore, this technique is engineered for the selection of targeted microalgae to continuously detect their proliferation behaviors by combining with a homemade electrical impedance spectroscopy device. This method can reinforce the throughput of ICEO vortices and enables it to integrate with simple and economical sensors to accomplish disease diagnosis and environmental monitoring.

Four-wave mixing seeded by a rapid wavelength-sweeping FDML laser for nonlinear imaging at 900 nm and 1300 nm

Four-wave mixing (FWM) enables the generation and amplification of light in spectral regions where suitable fiber gain media are unavailable. The 1300 nm and 900 nm regions are of especially high interest for time-encoded (TICO) stimulated Raman scattering microscopy and spectro-temporal laser imaging by diffracted excitation (SLIDE) two-photon microscopy. We present a new, to the best of our knowledge, FWM setup where we shift the power of a home-built fully fiber-based master oscillator power amplifier (MOPA) at 1064 nm to the 1300-nm region of a rapidly wavelength-sweeping Fourier domain mode-locked (FDML) laser in a photonic crystal fiber (PCF) creating pulses in the 900-nm region. The resulting 900-nm light can be wavelength swept over 54 nm and has up to 2.5 kW (0.2 µJ) peak power and a narrow instantaneous spectral linewidth of 70 pm. The arbitrary pulse patterns of the MOPA and the fast wavelength tuning of the FDML laser (419 kHz) allow it to rapidly tune the FWM light enabling new and faster TICO-Raman microscopy, SLIDE imaging, and other applications.

Robust femtosecond-written chirped and tilted fiber Bragg gratings for Raman filtering in multi-kW fiber lasers

We present a robust chirped and tilted fiber Bragg grating (CTFBG) in a large-mode-area double-cladding fiber (LMA-DCF) written by a femtosecond (fs) laser. By implementing the fs-CTFBG into the output end of a high-power fiber laser for Raman filtering, a power handling capability of 4 kW is achieved with a Raman filtering ratio of ∼13 dB. To the best of our knowledge, this is the maximum handling power of a CTFBG for Raman filtering. The signal loss of the fs-CTFBG is 0.03 dB, which has little effect on the output laser beam quality. The air-cooled fs-CTFBG has a minimum temperature slope of 7.8°C/kW due to a self-annealing effect. This work proves the excellent performance of the fs-CTFBG, promoting the development of high-power CTFBGs.

Plug-and-play fiber-optic sensors based on engineered cells for neurochemical monitoring at high specificity in freely moving animals

In vivo detection of neurochemicals, including neurotransmitters and neuromodulators, is critical for both understanding brain mechanisms and diagnosing brain diseases. However, few sensors are competent in monitoring neurochemical dynamics in vivo at high specificity. Here, we propose the fiber-optic probes based on engineered cells (FOPECs) for plug-and-play, real-time detection of neurochemicals in freely moving animals. Taking advantages of life-evolved neurochemical receptors as key components, the chemical specificity of FOPECs is unprecedented. We demonstrate the applications of FOPECs in real-time monitoring of neurochemical dynamics under various physiology and pathology conditions. With no requirement of viral infection in advance and no dependence on animal species, FOPECs can be widely adopted in vertebrates, such as mice, rats, rabbits, and chickens. Moreover, FOPECs can be used to monitor drug metabolisms in vivo. We demonstrated the neurochemical monitoring in blood circulation systems in vivo. We expect that FOPECs will benefit not only neuroscience study but also drug discovery.

Bend-insensitive fiber optic ultrasonic tracking probe for cardiovascular interventions

BACKGROUND

Transesophageal echocardiography (TEE) is widely used to guide medical device placement in minimally invasive cardiovascular procedures. However, visualization of the device tip with TEE can be challenging. Ultrasonic tracking, enabled by an integrated fiber optic ultrasound sensor (FOUS) that receives transmissions from the TEE probe, is very well suited to improving device localization in this context. The problem addressed in this study is that tight deflections of devices such as a steerable guide catheter can result in bending of the FOUS beyond its specifications and a corresponding loss of ultrasound sensitivity.

PURPOSE

A bend-insensitive FOUS was developed, and its utility with ultrasonic tracking of a steerable tip during TEE-based image guidance was demonstrated.

METHODS

Fiberoptic ultrasound sensors were fabricated using both standard and bend insensitive single mode fibers and subjected to static bending at the distal end. The interference transfer function and ultrasound sensitivities were compared for both types of FOUS. The bend-insensitive FOUS was integrated within a steerable guide catheter, which served as an exemplar device; the signal-to-noise ratio (SNR) of tracking signals from the catheter tip with a straight and a fully deflected distal end were measured in a cardiac ultrasound phantom for over 100 frames.

RESULTS

With tight bending at the distal end (bend radius < 10 mm), the standard FOUS experienced a complete loss of US sensitivity due to high attenuation in the fiber, whereas the bend-insensitive FOUS had largely unchanged performance, with a SNR of 47.7 for straight fiber and a SNR of 36.8 at a bend radius of 3.0 mm. When integrated into the steerable guide catheter, the mean SNRs of the ultrasonic tracking signals recorded with the catheter in a cardiac phantom were similar for straight and fully deflected distal ends: 195 and 163.

CONCLUSION

The FOUS fabricated from bend-insensitive fiber overcomes the bend restrictions associated with the FOUS fabricated from standard single mode fiber, thereby enabling its use in ultrasonic tracking in a wide range of cardiovascular devices.

Sufentanil, dexmedetomidine combined with surface anesthesia for awake fiberoptic nasotracheal intubation in the patient with severe mouth opening difficulty undergoing wedge resection of the right upper lung: A case report and literature review

BACKGROUND

Severe mouth opening difficulty may increase the risk of airway management during anesthesia induction, and awake fiberoptic nasotracheal intubation (AFNI) is the first option for patients with orofacial anatomical changes.

CASE SUMMARY

A 54-year-old man was scheduled to undergo wedge resection of the right upper lung in August 2021. The patient had a history of enlarged right maxillary lesion resection and partial right maxillary resection surgery in April 2020, which led to orofacial anatomical changes and severe mouth opening difficulty. To avoid difficult airway-related emergency scenarios, the AFNI was successfully performed through intravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia under a conscious state without any uncomfortable feeling or complications.

CONCLUSIONS

Intravenous injection of sufentanil and dexmedetomidine combined with lidocaine topical anesthesia can be used as an alternative medication scheme to relieve uncomfortable suffering for AFNI in patients with severe mouth opening difficulty.

Position Statement of the Union of European Phoniatricians (UEP): Fees and Phoniatricians' Role in Multidisciplinary and Multiprofessional Dysphagia Management Team

The need for multidisciplinary and multiprofessional management of dysphagia is constantly increasing and creating a major challenge for healthcare professionals and society, especially in terms of professional expertise and human resources. The distribution of tasks among the dysphagia team members, which includes phoniatricians, otolaryngologists, and speech-language therapists, is flexible and overlapping. For assessing dysphagia, the (fibreoptic) flexible endoscopic evaluation of swallowing (FEES), with or without videofluoroscopy, is a pivotal diagnostic tool. This position paper aims to illustrate the phoniatrician's role in performing a FEES, which is an indispensable component of the diagnostic workup of patients suffering from oropharyngeal dysphagia. It is based on the current collaborative expert view of the Swallowing Committee of the Union of European Phoniatricians and a literature review. A FEES is one of the core competences of phoniatricians due to their endoscopic expertise and experience in the field of dysphagia and diseases of the upper aerodigestive tract. Therefore, the phoniatrician is an important member of the dysphagia team, for the medical diagnostics of the aerodigestive tract and dysphagia as well as for FEES. Phoniatric competence is especially important for head and neck cancer patients, infants, and complex cases.

Multiplexed optical fiber cell temperature sensing system with high sensitivity and accuracy

Significance

A multiplexed fiber laser sensing system for cell temperature is proposed. To the best of the authors' knowledge, this is the first multilongitudinal mode (MLM) optical fiber laser sensor array designed for cell temperature sensing.

Aim

A two-channel cell temperature sensing system with high sensitivity and real-time sensing capability is achieved. The temperature change of human hepatoellular carcinomas (HepG2) cells under the influence of exogenous chemical aflatoxin B1 (AFB1) can be monitored in real time.

Approach

A fiber laser cavity consists of a pair of fiber Bragg gratings (FBGs) with matched central wavelengths and a piece of erbium-doped fiber (EDF). The static FBG is utilized for design of fiber laser cavity and laser modes selection. In comparison, the sensing FBG is used for cell temperature sensing. The sensing FBG has a length of 10 mm and a diameter of 200    μ m . Beat frequency signals (BFS) are generated by MLM lasers after optical-to-electrical conversion at a photodetector. Frequency change of a BFS is closely related to the reflected wavelength change of the sensing FBG. Through frequency division multiplexing, two fiber laser cavities are designed in the sensing system for two-channel temperature sensing. Frequency shift of a BFS that represents temperature change of cells can be automatically recorded in seconds.

Results

A two-channel cell temperature sensing system is designed with high sensitivities of 101.62 and 119.82    kHz / ° C , respectively. The temperature change of HepG2 cells under the influence of exogenous chemical AFB1 is monitored in real time.

Conclusions

The proposed system has the advantages of simple structure, high sensitivity, and two-channel sensing capability. Our study provides a simple and effective method to design a fiber laser sensor system without complex demodulation techniques and expensive optical components.

Accuracy of Intracranial Pressure Monitoring-Single Centre Observational Study and Literature Review

Intracranial hypertension and adequacy of brain blood flow are primary concerns following traumatic brain injury. Intracranial pressure (ICP) monitoring is a critical diagnostic tool in neurocritical care. However, all ICP sensors, irrespective of design, are subject to systematic and random measurement inaccuracies that can affect patient care if overlooked or disregarded. The wide choice of sensors available to surgeons raises questions about performance and suitability for treatment. This observational study offers a critical review of the clinical and experimental assessment of ICP sensor accuracy and comments on the relationship between actual clinical performance, bench testing, and manufacturer specifications. Critically, on this basis, the study offers guidelines for the selection of ICP monitoring technologies, an important clinical decision. To complement this, a literature review on important ICP monitoring considerations was included. This study utilises illustrative clinical and laboratory material from 1200 TBI patients (collected from 1992 to 2019) to present several important points regarding the accuracy of in vivo implementation of contemporary ICP transducers. In addition, a thorough literature search was performed, with sources dating from 1960 to 2021. Sources considered to be relevant matched the keywords: "intraparenchymal ICP sensors", "fiberoptic ICP sensors", "piezoelectric strain gauge sensors", "external ventricular drains", "CSF reference pressure", "ICP zero drift", and "ICP measurement accuracy". Based on single centre observations and the 76 sources reviewed in this paper, this material reports an overall anticipated measurement accuracy for intraparenchymal transducers of around ± 6.0 mm Hg with an average zero drift of <2.0 mm Hg. Precise ICP monitoring is a key tenet of neurocritical care, and accounting for zero drift is vital. Intraparenchymal piezoelectric strain gauge sensors are commonly implanted to monitor ICP. Laboratory bench testing results can differ from in vivo observations, revealing the shortcomings of current ICP sensors.

Recent Advancements of LSPR Fiber-Optic Biosensing: Combination Methods, Structure, and Prospects

Fiber-optic biosensors based on localized surface plasmon resonance (LSPR) have the advantages of great biocompatibility, label-free, strong stability, and real-time monitoring of various analytes. LSPR fiber-optic biosensors have attracted extensive research attention in the fields of environmental science, clinical medicine, disease diagnosis, and food safety. The latest development of LSPR fiber-optic biosensors in recent years has focused on the detection of clinical disease markers and the detection of various toxic substances in the environment and the progress of new sensitization mechanisms in LSPR fiber-optic sensors. Therefore, this paper reviews the LSPR fiber-optic sensors from the aspects of working principle, structure, and application fields in biosensors. According to the structure, the sensor can be divided into three categories: traditional ordinary optical fiber, special shape optical fiber, and specialty optical fiber. The advantages and disadvantages of existing and future LSPR fiber-optic biosensors are discussed in detail. Additionally, the prospect of future development of fiber-optic biosensors based on LSPR is addressed.

Development of a core-offset-based SMS fiber structure for detection of various biomolecules

This paper discusses the details about the fabrication of single-mode fiber (SMF)- and multi-mode fiber (MMF)-based core-offset sensor structures for biomolecules detection. SMF-MMF-SMF (SMS) and SMF-core-offset MMF-SMF (SMS structure with core-offset) are proposed in this paper. In the conventional SMS structure the incident light is introduced from the SMF to the MMF and then passes through the MMF to the SMF. However, in the SMS-based core offset structure (COS) the incident light is introduced from the SMF to the core offset MMF and then passes through the MMF to the SMF, and more incident light leaks at the fusion point between the SMF and the MMF. This structure causes more incident light to leak out from the sensor probe, forming evanescent waves. By analyzing the transmitted intensity, the performance of COS can be improved. The results show that the structure of the core offset has great potential for the development of fiber-optic sensors.