Encapsulating Peritoneal Sclerosis: A study on pathophysiology, clinical aspects and management

__Abstract__ This thesis describes the results of studies focusing on the pathophysiology, clinical aspects, and management of encapsulating peritoneal sclerosis (EPS). We have reported on the presence of inflammation in EPS, described several clinical aspects, and focused on the entity of posttransplantation EPS. Furthermore, recommendations for both diagnosis and management of patients with EPS have been provided

Post-transplantation encapsulating peritoneal sclerosis without inflammation or radiological abnormalities

Background: Post-transplantation encapsulating peritoneal sclerosis (EPS) causing bowel obstruction has been identified as a serious complication after kidney transplantation in patients previously treated with peritoneal dialysis. Systemic inflammation and abnormalities on an abdominal computed tomography (CT) scan are important hallmarks of EPS. To our knowledge, this is the first report of a case being diagnosed with late-onset post-transplantation EPS without systemic inflammation or abnormalities on a CT scan which could only be diagnosed by laparotomy. Case presentation. A 59-year old female presented because of symptoms of bowel obstruction 33 months after kidney transplantation. The patient had a 26-month history of peritoneal dialysis before her first kidney transplantation and was treated with peritoneal dialysis for 4 years before undergoing a second kidney transplantation. Physical examination was unremarkable and laboratory tests showed no signs of systemic inflammation (C-reactive protein <1 mg/L). An abdominal CT scan did not reveal any abnormalities fitting the diagnosis of EPS, except a "feces sign". Given the severity of the progressive symptoms, a diagnostic laparotomy was performed, visualizing a classical EPS. Total peritonectomy and enterolysis were performed, leading to restoration of peristalsis. Conclusion: EPS may occur several years after kidney transplantation in the absence of inflammation and typical radiological abnormalities. Obtaining a diagnosis of post-transplantation EPS is challenging, however, a low threshold for surgical exploration in case of high clinical suspicion and negative findings on the CT scan is mandatory

Evaluating different scenarios for optimizing energy consumption to achieve sustainable green building in Malaysia

One of the most users of energy in the construction industry is residential buildings that use the high value of energy. Because of the high effect of construction activities on environment, serious attention should be given to sustainability concept in construction activities. There are climate factors such as temperature, humidity and pressure that have a considerable effect on the sustainability of green buildings based on energy consumption. The main goal of this paper is to achieve a sustainable green building by optimizing the energy consumption based on two significant factors which are temperature and humidity. To achieve this goal, the design of experiments (DOE) and building simulation are applied. A two-storey house in Malaysia was selected as the case study. The final result shows that to achieve the optimum value of cooling load to have a sustained design of green residential buildings all the significant factors should be placed on a low level which it means that temperature and humidity should be equal to 20 degrees Celsius and 60% respectively

Factors Affecting the Consumer Purchasing Decisions of Perishable Foods: Exploring the Attitudes and the Preferences

The present study is designed to make a comprehensive understanding of the attitude of the urban consumers and explore the factors involved in dealing with the perishable food of certain kinds. The rise of the middle class stipulates the enhancement of the shopping environment; hence witnessing a substantial increase of the number of the supermarkets in developing countries like Bangladesh will not be surprising. A number of urban supermarkets in recent times start selling perishable foods that were once available in Bangladesh only in flea markets (Kaccha Bazaar). However, due to the lack of proper infrastructure, agro-based perishable food reaches the urban market via a long process of chain mediations and raises concerns about quality and price for both retailers and consumers. Very often the attitudes of consumers regarding perishable foods are unknown and their preferences remain unidentified. This high level of uncertainty regarding the attitude of consumers and the unpopularity regarding overall food quality need to be resolved to ensure the continuity of the business and guarantee the quality of the products. This has made the study of the consumers’ attitude towards perishable food, especially relevant for emerging economies like Bangladesh. The data is collected from one hundred (100) consumers, who buy food regularly from both super-shops and flea markets in Dhaka city. The collected data are analyzed in terms of factors like importance, expectation and perceived actual level of value to show the gap in terms of perishable foods involved

BESARAN PENYESUAIAN (ADJUSTMENT) DOKUMEN KEPEMILIKAN TANAH PADA PENILAIAN TANAH PERTANIAN DENGAN LUAS SAMPAI DENGAN 10 HA DI KOTA BIMA TAHUN 2020

Abstract One of the factors that influences the value in land appraisal using market data approach is ownership document. Therefore, the existence and type of ownership document are two of the factors that must be considered by the appraiser, both for the appraisal object and comparison object. This study discusses how to measure the adjustment of ownership documents in the form of land title certificate when compared to tax payable statement on land and building tax and/or statement letter form Head of Urban Village. The research was conducted in 2020 using a case study method and agricultural land in the city of Bima with an area of up to 10 hectares as the research object. The sampling method used was purposive sampling with a span of data collection time from June to September 2020 and obtained 8 data which were the population of agricultural land buying and selling transactions and agricultural land selling deals during that period. The researchers found that ownership document affected land transactions price by 0.4% s.d. 0.5% and could be calculated using the cost to land price ratio formula which will be explained further in this paper. The results of this study are expected to provide convenience for the appraiser to appraise agricultural land and can be used as a preliminary study for further research development. Keywords: land valuation, market data approach, asset managemen

Improved Estimates of Cosmological Perturbations

We recently derived exact solutions for the scalar, vector and tensor mode functions of a single, minimally coupled scalar plus gravity in an arbitrary homogeneous and isotropic background. These solutions are applied to obtain improved estimates for the primordial scalar and tensor power spectra of anisotropies in the cosmic microwave background.Comment: 31 pages, 4 figures, LaTeX 2epsilon, this version corrects an embarrasing mistake (in the published version) for the parameter q_C. Affected eqns are 105, 109-110, 124, 148-153 and 155-15

Energy-Momentum Tensor of Particles Created in an Expanding Universe

We present a general formulation of the time-dependent initial value problem for a quantum scalar field of arbitrary mass and curvature coupling in a FRW cosmological model. We introduce an adiabatic number basis which has the virtue that the divergent parts of the quantum expectation value of the energy-momentum tensor are isolated in the vacuum piece of , and may be removed using adiabatic subtraction. The resulting renormalized is conserved, independent of the cutoff, and has a physically transparent, quasiclassical form in terms of the average number of created adiabatic `particles'. By analyzing the evolution of the adiabatic particle number in de Sitter spacetime we exhibit the time structure of the particle creation process, which can be understood in terms of the time at which different momentum scales enter the horizon. A numerical scheme to compute as a function of time with arbitrary adiabatic initial states (not necessarily de Sitter invariant) is described. For minimally coupled, massless fields, at late times the renormalized goes asymptotically to the de Sitter invariant state previously found by Allen and Folacci, and not to the zero mass limit of the Bunch-Davies vacuum. If the mass m and the curvature coupling xi differ from zero, but satisfy m^2+xi R=0, the energy density and pressure of the scalar field grow linearly in cosmic time demonstrating that, at least in this case, backreaction effects become significant and cannot be neglected in de Sitter spacetime.Comment: 28 pages, Revtex, 11 embedded .ps figure

CD4-positive T cells and M2 macrophages dominate the peritoneal infiltrate of patients with encapsulating peritoneal sclerosis

Background: Encapsulating peritoneal sclerosis (EPS) is a severe complication of peritoneal dialysis (PD). Previously, it has been shown that infiltrating CD4-positive T cells and M2 macrophages are associated with several fibrotic conditions. Therefore, the characteristics of the peritoneal cell infiltrate in EPS may be of interest to understand EPS pathogenesis. In this study, we aim to elucidate the composition of the peritoneal cell infiltrate in EPS patients and relate the findings to clinical outcome. Study Design, Setting, and Participants: We studied peritoneal membrane biopsies of 23 EPS patients and compared them to biopsies of 15 PD patients without EPS. The cellular infiltrate was characterized by immunohistochemistry to detect T cells(CD3-positive), CD4-positive (CD4+) and CD8-positive T cell subsets, B cells(CD20-positive), granulocytes(CD15-positive), macrophages(CD68-positive), M1(CD80-positive), and M2(CD163-positive) macrophages. Tissues were analysed using digital image analysis. Kaplan-Meier survival analysis was performed to investigate the survival in the different staining groups. Results: The cellular infiltrate in EPS biopsies was dominated by mononuclear cells. For both CD3 and CD68, the median percentage of area stained was higher in biopsies of EPS as opposed to non-EPS patients (p<0.001). EPS biopsies showed a higher percentage of area stained for CD4 (1.29%(0.61-3.20)) compared to CD8 (0.71%(0.46-1.01), p = 0.04), while in the non-EPS group these cells were almost equally represented (respectively 0.28%(0.05-0.83) versus 0.22%(0.17-0.43), p = 0.97). The percentage of area stained for both CD80 and CD163 was higher in EPS than in non-EPS biopsies (p<0.001), with CD163+cells being the most abundant phenotype. Virtually no CD20-positive and CD15-positive cells were present in biopsies of a subgroup of EPS patients. No relation was found between the composition of the mononuclear cell infiltrate and clinical outcome. Conclusions: A characteristic mononuclear cell infiltrate consisting of CD4+ and CD163+ cells dominates the peritoneum of EPS patients. These findings suggest a role for both CD4+ T cells and M2 macrophages in the pathogenesis of EPS

Long-term alterations in brain and behavior after postnatal Zika virus infection in infant macaques

Zika virus (ZIKV) infection has a profound impact on the fetal nervous system. The postnatal period is also a time of rapid brain growth, and it is important to understand the potential neurobehavioral consequences of ZIKV infection during infancy. Here we show that postnatal ZIKV infection in a rhesus macaque model resulted in long-term behavioral, motor, and cognitive changes, including increased emotional reactivity, decreased social contact, loss of balance, and deficits in visual recognition memory at one year of age. Structural and functional MRI showed that ZIKV-infected infant rhesus macaques had persistent enlargement of lateral ventricles, smaller volumes and altered functional connectivity between brain areas important for socioemotional behavior, cognitive, and motor function (e.g. amygdala, hippocampus, cerebellum). Neuropathological changes corresponded with neuroimaging results and were consistent with the behavioral and memory deficits. Overall, this study demonstrates that postnatal ZIKV infection in this model may have long-lasting neurodevelopmental consequences