F-18-Fluorodeoxyglucose (FDG) Positron-Emission Tomography of Echinococcus multilocularis Liver Lesions: Prospective Evaluation of its Value for Diagnosis and Follow-up during Benzimidazole Therapy

Background:: Long-term benzimidazole therapy benefits patients with non-resectable alveolar echinococcosis (AE). Methods to assess early therapeutic efficacy are lacking. Recently, AE liver lesions were reported to exhibit increased F-18-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET). To assess the value of FDG-PET for diagnosis and follow-up of AE patients. Patients/Methods:: Twenty-six consecutive patients with newly diagnosed AE were enrolled. Baseline evaluation included CT and FDG-PET. Thirteen patients (11 women; median age 50 years, range 40-76) were resected, the remaining 13 (8 women; median age 60 years, range 39-72) had non-resectable disease, were started on benzimidazoles, and CT and FDG-PET were repeated at 6, 12 and 24 months of therapy. Twelve consecutive patients with newly diagnosed cystic echinococcosis (CE) of the liver were also subjected to baseline FDG-PET. Results:: In 21/26 AE patients, baseline PET scans showed multifocally increased FDG uptake in the hepatic lesions' periphery, while liver lesions were FDG negative in 11/12 CE patients. Thus, sensitivity and specificity of FDG-PET for AE vs. CE were 81% and 92%, respectively. In 5 of 10 non-resectable patients with increased baseline FDG uptake, the intensity of uptake decreased (or disappeared) during benzimidazole therapy, in 3 by ≥2 grades within the initial 6 months. Conclusions:: FDG-PET is a sensitive and specific adjunct in the diagnosis of suspected AE and can help in differentiating AE from CE. The rapid improvement of positive PET scans with benzimidazole therapy in some patients indicates that absent FDG uptake does not necessarily reflect parasite viabilit

Shaping black holes with free fields

Starting from a metric Ansatz permitting a weak version of Birkhoff's theorem we find static black hole solutions including matter in the form of free scalar and p-form fields, with and without a cosmological constant \Lambda. Single p-form matter fields permit multiple possibilities, including dyonic solutions, self-dual instantons and metrics with Einstein-Kaelher horizons. The inclusion of multiple p-forms on the other hand, arranged in a homogeneous fashion with respect to the horizon geometry, permits the construction of higher dimensional dyonic p-form black holes and four dimensional axionic black holes with flat horizons, when \Lambda<0. It is found that axionic fields regularize black hole solutions in the sense, for example, of permitting regular -- rather than singular -- small mass Reissner-Nordstrom type black holes. Their cosmic string and Vaidya versions are also obtained.Comment: 38 pages. v2: minor changes, published versio

New hairy black hole solutions with a dilaton potential

We consider black hole solutions with a dilaton field possessing a nontrivial potential approaching a constant negative value at infinity. The asymptotic behaviour of the dilaton field is assumed to be slower than that of a localized distribution of matter. A nonabelian SU(2) gauge field is also included in the total action. The mass of the solutions admitting a power series expansion in $1/r$ at infinity and preserving the asymptotic anti-de Sitter geometry is computed by using a counterterm subtraction method. Numerical arguments are presented for the existence of hairy black hole solutions for a dilaton potential of the form $V(\phi)=C_1 \exp(2\alpha_1 \phi)+C_2 \exp(2\alpha_2 \phi)+C_3$, special attention being paid to the case of ${\cal N}=4, D=4$ gauged supergravity model of Gates and Zwiebach.Comment: 12 pages, 4 figures; v2:references added, typos corrected, small changes in Section

Boundary stress-energy tensor and Newton-Cartan geometry in Lifshitz holography

For a specific action supporting z = 2 Lifshitz geometries we identify the Lifshitz UV completion by solving for the most general solution near the Lifshitz boundary. We identify all the sources as leading components of bulk fields which requires a vielbein formalism. This includes two linear combinations of the bulk gauge field and timelike vielbein where one asymptotes to the boundary timelike vielbein and the other to the boundary gauge field. The geometry induced from the bulk onto the boundary is a novel extension of Newton-Cartan geometry that we call torsional Newton-Cartan (TNC) geometry. There is a constraint on the sources but its pairing with a Ward identity allows one to reduce the variation of the on-shell action to unconstrained sources. We compute all the vevs along with their Ward identities and derive conditions for the boundary theory to admit conserved currents obtained by contracting the boundary stress-energy tensor with a TNC analogue of a conformal Killing vector. We also obtain the anisotropic Weyl anomaly that takes the form of a Hořava-Lifshitz action defined on a TNC geometry. The Fefferman-Graham expansion contains a free function that does not appear in the variation of the on-shell action. We show that this is related to an irrelevant deformation that selects between two different UV completions

Evaluation of critical incidents in general surgery

The analysis of adverse events is a central step in critical incident reporting, but has not been described in a surgical setting. The aim of this study was to develop an evaluation protocol and assess its feasibility