Incarcerated vermiform appendix in a left-sided inguinal hernia

We report here of a patient with an incarcerated vermiform appendix occurring in a left-sided indirect inguinal hernia. Occasionally, appendices are found in a hernial sac; however, the finding of an incarcerated vermiform appendix in an inguinal hernia on the left side is very unusual and has only been previously described once. The patient suffering this rare entity underwent appendectomy and repair of the hernia and experienced an uneventful postoperative recovery. The possibility of the presence of a situs inversus, or malrotation, as an underlying cause for the observed pathology was excluded by x-ray examinatio

Numerical simulation of a turbulent wake subjected to adverse pressure gradient

Results are presented of high-fidelity scale-resolving simulations of the wake flow exposed to adverse pressure gradient (APG). Specifically, zonal RANS-IDDES computations are performed of the flow model designed and manufactured at the Technische Universität Braunschweig in the framework of a joint German-Russian project "Wake in Adverse Pressure gradient". The model includes a flat plate as the wake generator and two pairs of thin liner foils creating APG. Results of the computations of mean flow characteristics agree with currently available experimental data and differ from those of the RANS predictions. This suggests the necessity of RANS models improvement which is planned to be done with the use of the combined experimental/numerical database on the mean flow and turbulence statistics of the wake accumulated in the course of the project

Localization Recall Precision (LRP): A New Performance Metric for Object Detection

Average precision (AP), the area under the recall-precision (RP) curve, is the standard performance measure for object detection. Despite its wide acceptance, it has a number of shortcomings, the most important of which are (i) the inability to distinguish very different RP curves, and (ii) the lack of directly measuring bounding box localization accuracy. In this paper, we propose 'Localization Recall Precision (LRP) Error', a new metric which we specifically designed for object detection. LRP Error is composed of three components related to localization, false negative (FN) rate and false positive (FP) rate. Based on LRP, we introduce the 'Optimal LRP', the minimum achievable LRP error representing the best achievable configuration of the detector in terms of recall-precision and the tightness of the boxes. In contrast to AP, which considers precisions over the entire recall domain, Optimal LRP determines the 'best' confidence score threshold for a class, which balances the trade-off between localization and recall-precision. In our experiments, we show that, for state-of-the-art object (SOTA) detectors, Optimal LRP provides richer and more discriminative information than AP. We also demonstrate that the best confidence score thresholds vary significantly among classes and detectors. Moreover, we present LRP results of a simple online video object detector which uses a SOTA still image object detector and show that the class-specific optimized thresholds increase the accuracy against the common approach of using a general threshold for all classes. At https://github.com/cancam/LRP we provide the source code that can compute LRP for the PASCAL VOC and MSCOCO datasets. Our source code can easily be adapted to other datasets as well.Comment: to appear in ECCV 201

Multiscale analysis of human tissue engineered matrices for heart valve tissue engineering applications

Human tissue-engineered matrices (hTEMs) have been proposed as a promising approach for in-situ tissue engineered heart valves (TEHVs). However, there is still a limited understanding on how ECM composition in hTEMs develops over tissue culture time. Therefore, we performed a longitudinal hTEM assessment by 1) multiscale evaluation of hTEM composition during culture time (2, 4, 6-weeks), using (immuno)histology, biochemical assays, and mass spectrometry (LC-MS/MS); 2) analysis of protein pathways involved in ECM development using gene set enrichment analysis (GSEA); and 3) assessment of hTEM mechanical characterization using uniaxial tensile testing. Finally, as proof-of-concept, TEHVs manufactured using 6-weeks hTEM samples were tested in a pulse duplicator. LC-MS/MS confirmed the tissue culture time-dependent increase in ECM proteins observed in histology and biochemical assays, revealing the most abundant collagens (COL6,COL12), proteoglycans (HSPG2,VCAN), and glycoproteins (FN,TNC). GSEA identified the most represented protein pathways in the hTEM at 2-weeks (mRNA metabolic processes), 4-weeks (ECM production), and 6-weeks (ECM organization and maturation). Uniaxial mechanical testing showed increased stiffness and stress at failure, and reduction in strain over tissue culture time. hTEM-based TEHVs demonstrated promising in vitro performance at both pulmonary and aortic pressure conditions, with symmetric leaflet coaptation and no stenosis. In conclusion, ECM protein abundance and maturation increased over tissue culture time, with consequent improvement of hTEM mechanical characterics. These findings suggest that longer tissue culture impacts tissue organization, leading to an hTEM that may be suitable for high-pressure applications. STATEMENT OF SIGNIFICANCE: : It is believed that the composition of the extracellular matrix (ECM) in the human tissue engineered matrices (hTEM) may favor tissue engineered heart valve (TEHV) remodeling upon implantation. However, the exact protein composition of the hTEM, and how this impacts tissue mechanical properties, remains unclear. Hence, we developed a reproducible rotation-based tissue culture method to produce hTEM samples. We performed a longitudinal assessment using different analytical techniques and mass spectrometry. Our data provided an in-depth characterization of the hTEM proteome with focus on ECM components, their development, and how they may impact the mechanical properties. Based on these results, we manufactured functional hTEM-based TEHVs at aortic-like condition in vitro. These outcomes pose an important step in translating hTEM-based TEHVs into clinics and in predicting their remodeling potential upon implantation

Hepatic teratoma and peritoneal gliomatosis: a case report

The hepatic teratoma is a very rare entity of which only 25 cases have been published so far. In our case the hepatic teratoma is associated with peritoneal gliomatosis, which is an indicator for an ongoing peritoneal spread of a teratoma. Wall calcifications and the homogeneity as well as the well defined border misled the radiologist to the diagnosis of an echinococcal cyst, which is the most common differential diagnosis, however the hepatic teratoma has to be taking into consideration when dealing with unclear hepatic cysts, although it is very rare

Therapeutic benefits of distal ventricular pacing in mid-cavity obstructive hypertrophic cardiomyopathy.

INTRODUCTION: Hypertrophic cardiomyopathy (HCM) patients with left ventricular (LV) mid-cavity obstruction (LVMCO) often experience severe drug-refractory symptoms thought to be related to intraventricular obstruction. We tested whether ventricular pacing, guided by invasive haemodynamic assessment, reduced LVMCO and improved refractory symptoms. METHODS: Between December 2008 and December 2017, 16 HCM patients with severe refractory symptoms and LVMCO underwent device implantation with haemodynamic pacing study to assess the effect on invasively defined LVMCO gradients. The effect on the gradient of atrioventricular (AV) synchronous pacing from sites including right ventricular (RV) apex and middle cardiac vein (MCV) was retrospectively assessed. RESULTS: Invasive haemodynamic data were available in 14 of 16 patients. Mean pre-treatment intracavitary gradient was 77 ± 22 mmHg (in sinus rhythm) versus 21 ± 21 mmHg during pacing from optimal ventricular site (95% CI: -70.86 to -40.57, p < 0.0001). Optimal pacing site was distal MCV in 12/16 (86%), RV apex in 1/16 and via epicardial LV lead in 1/16. Pre-pacing Doppler-derived gradients were significantly higher than at follow-up (47 ± 15 versus 24 ± 16 mmHg, 95% CI: -37.19 to -13.73, p < 0.001). Median baseline NYHA class was 3, which had improved by ⩾1 NYHA class in 13 of 16 patients at 1-year post-procedure (p < 0.001). The mean follow-up duration was 4.6 ± 2.7 years with the following outcomes: 8/16 (50%) had continued symptomatic improvement, 4/16 had symptomatic decline and 4/16 died. Contributors to symptomatic decline included chronic atrial fibrillation (AF) (n = 5), phrenic nerve stimulation (n = 3) and ventricular ectopy (n = 1). CONCLUSION: In drug-refractory symptomatic LVMCO, distal ventricular pacing can reduce intracavitary obstruction and may provide long-term symptomatic relief in patients with limited treatment options. A haemodynamic pacing study is an effective strategy for identifying optimal pacing site and configuration

Epicardial catheter ablation for ventricular tachycardia on uninterrupted warfarin: A safe approach for those with a strong indication for peri-procedural anticoagulation?

BACKGROUND: Current guidelines for epicardial catheter ablation for ventricular tachycardia (VT) advocate that epicardial access is avoided in anticoagulated patients and should be performed prior to heparinisation. Recent studies have shown that epicardial access may be safe in heparinised patients. However, no data exist for patients on oral anticoagulants. We investigated the safety of obtaining epicardial access on uninterrupted warfarin. METHODS: A prospective registry of patients undergoing epicardial VT ablation over two years was analysed. Consecutive patients in whom epicardial access was attempted were included. All patients were heparinised prior to epicardial access with a target activated clotting time (ACT) of 300-350s. Patients who had procedures performed on uninterrupted warfarin (in addition to heparin) were compared to those not taking an oral anticoagulant. RESULTS: 46 patients were included of which 13 were taking warfarin. There was no significant difference in clinical and procedural characteristics (except INR and AF) between the two groups. Epicardial access was achieved in all patients. There were no deaths and no patients required surgery. A higher proportion of patients in the warfarin group had a drop in haemoglobin of >2g/dL compared to the no-warfarin group (38.5% versus 27.3%, p=0.74) and delayed pericardial drain removal (7.8% versus 3.03%, p=0.47). There was no difference in overall procedural complication rate. No patients required warfarin reversal or blood transfusion. CONCLUSION: Epicardial access can be achieved safely and effectively in patients' anticoagulated with warfarin and heparinised with therapeutic ACT. This may be an attractive option for patients with a high stroke risk

Yield and leakage currents of large area lattice matched InP/InGaAs heterostructures

Demonstrating and harnessing electroluminescent cooling at technologically viable cooling powers requires the ability to routinely fabricate large area high quality light-emitting diodes (LEDs). Detailed information on the performance and yield of relevant large area devices is not available, however. Here, we report extensive information on the yield and related large area scaling of InP/InGaAs LEDs and discuss the origin of the failure mechanisms based on lock-in thermographic imaging. The studied LEDs were fabricated as mesa structures of various sizes on epistructures grown at five different facilities specialized in the growth of III-V compound semiconductors. While the smaller mesas generally showed relatively good electrical characteristics and low leakage current densities, some of them also exhibited unusually large leakage current densities. The provided information is critical for the development and design of the optical cooling technologies relying on large area devices.Peer reviewe

Luminescence emission from forward- and reverse-biased multicrystalline silicon solar cells

We study the emission of light from industrial multicrystalline silicon solar cells under forward and reverse biases. Camera-based luminescence imaging techniques and dark lock-in thermography are used to gain information about the spatial distribution and the energy dissipation at pre-breakdown sites frequently found in multicrystalline silicon solar cells. The pre-breakdown occurs at specific sites and is associated with an increase in temperature and the emission of visible light under reverse bias. Moreover, additional light emission is found in some regions in the subband-gap range between 1400 and 1700 nm under forward bias. Investigations of multicrystalline silicon solar cells with different interstitial oxygen concentrations and with an electron microscopic analysis suggest that the local light emission in these areas is directly related to clusters of oxygen. © 2009 American Institute of Physics