Ascites as an initial presentation of spontaneously ruptured hydatid cyst

We describe the diagnosis of a 77-year-old woman admitted toour outpatient department with a 3-month history of abdominalbloating and distension. Abdominal computed tomographyrevealed a large cystic lesion in the posterior segment of the righthepatic lobe, with a separated germinal layer and widespreadascites with dense internal echoes and septal appearance. Theresult of a serum Echinococcus indirect haemagglutination testwas positive and findings were indicative of the spontaneousrupture of a hydatid cyst into the peritoneal cavity withouttrauma. Ascites is rarely seen in the course of hydatid disease,but can result from cyst rupture into the peritoneal cavity. Thisshould be considered in the differential diagnosis of ascites,especially in areas such as Turkey, where hydatid disease inendemic

Overfeeding, Autonomic Regulation and Metabolic Consequences

The autonomic nervous system plays an important role in the regulation of body processes in health and disease. Overfeeding and obesity (a disproportional increase of the fat mass of the body) are often accompanied by alterations in both sympathetic and parasympathetic autonomic functions. The overfeeding-induced changes in autonomic outflow occur with typical symptoms such as adiposity and hyperinsulinemia. There might be a causal relationship between autonomic disturbances and the consequences of overfeeding and obesity. Therefore studies were designed to investigate autonomic functioning in experimentally and genetically hyperphagic rats. Special emphasis was given to the processes that are involved in the regulation of peripheral energy substrate homeostasis. The data revealed that overfeeding is accompanied by increased parasympathetic outflow. Typical indices of vagal activity (such as the cephalic insulin release during food ingestion) were increased in all our rat models for hyperphagia. Overfeeding was also accompanied by increased sympathetic tone, reflected by enhanced baseline plasma norepinephrine (NE) levels in both VMH-lesioned animals and rats rendered obese by hyperalimentation. Plasma levels of NE during exercise were, however, reduced in these two groups of animals. This diminished increase in the exercise-induced NE outflow could be normalized by prior food deprivation. It was concluded from these experiments that overfeeding is associated with increased parasympathetic and sympathetic tone. In models for hyperphagia that display a continuously elevated nutrient intake such as the VMH-lesioned and the overfed rat, this increased sympathetic tone was accompanied by a diminished NE response to exercise. This attenuated outflow of NE was directly related to the size of the fat reserves, indicating that the feedback mechanism from the periphery to the central nervous system is altered in the overfed state.

A model for the current instabilities in GaAs‐AlGaAs heterojunction

A model is proposed for the description of the current instabilities in GaAs-AlGaAs heterojunctions. It consists of three parts: the injection of electrons via the contact into the AlGaAs layer, the partial capture of these electrons in deep centers, and the change with time of the band structure. This last ingredient is crucial, since due to the increase of the total number of electrons in the AlGaAs layer the band bending decreases making real-space transfer from the AlGaAs layer to the two-dimensional electron gas possible. We have performed quasistationary simulations of the time dependence of the current. The velocities, average energies, capture rates, etc. were taken from Monte Carlo simulations. It turned out, that the parameters for the modeling of the contact, which are to a high degree unknown, play an essential role

Is rejection a diffuse or localized process in small-bowel transplantation?

Utilization of endoscopy to both visualize and selectively biopsy an intestinal allograft has become the standard for early recognition and treatment of intestinal allograft rejection. Despite the widespread acceptance of the need for selective mucosal biopsies, it has not been shown that the histological features of intestinal allograft rejection are either localized or occur as part of a more diffuse phenomenon within a tubular allograft. To resolve these issues, 88 ileoscopies were performed in 12 small-bowel allograft recipients and mucosal biopsy samples were obtained at 5, 10, and 15 cm, respectively, from the ileal stoma. Each mucosal biopsy was labeled, processed, and evaluated individually for the presence and severity of any evidence for allograft rejection. The data obtained suggest that intestinal allograft rejection is a diffuse process, and biopsies obtained randomly from an ileal graft are likely to demonstrate evidence of allograft rejection when such is present. © 1994 Springer-Verlag New York Inc

Repurpose 2D Character Animations for a VR Environment Using BDH Shape Interpolation.

Virtual Reality technology has spread rapidly in recent years. However, its growth risks ending soon due to the absence of quality content, except for few exceptions. We present an original framework that allows artists to use 2D characters and animations in a 3D Virtual Reality environment, in order to give an easier access to the production of content for the platform. In traditional platforms, 2D animation represents a more economic and immediate alternative to 3D. The challenge in adapting 2D characters to a 3D environment is to interpret the missing depth information. A 2D character is actually flat, so there is not any depth information, and every body part is at the same level of the others. We exploit mesh interpolation, billboarding and parallax scrolling to simulate the depth between each body segment of the character. We have developed a prototype of the system, and extensive tests with a 2D animation production show the effectiveness of our framework

Cost and cost‐effectiveness of a simplified treatment model with direct‐acting antivirals for chronic hepatitis C in Cambodia

Background & Aims In 2016, Médecins Sans Frontières established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct‐acting antiviral (DAA) treatment. This study analysed the cost‐effectiveness of this intervention. Methods Costs, quality adjusted life years (QALYs) and cost‐effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%/year. Patient‐level resource‐use and outcome data, treatment costs, costs of HCV‐related healthcare and EQ‐5D‐5L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost‐effectiveness ratios (cost/QALY gained) were compared to an opportunity cost‐based willingness‐to‐pay threshold for Cambodia ($248/QALY). Results The total cost of testing and treatment per patient for the full model of care was$925(IQR $668‐1631), reducing to$376(IQR $344‐422) for the simplified model of care. EQ‐5D‐5L values varied by fibrosis stage: decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost‐effective compared to no treatment ($187/QALY), cost an additional $14 485/QALY compared to the simplified model, above the willingness‐to‐pay threshold for Cambodia. This result is robust to variation in parameters. Conclusions The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low‐resource settings

International multicentre study of candida auris infections

Background: Candida auris has emerged globally as a multi-drug resistant yeast and is commonly associated with nosocomial outbreaks in ICUs. Methods: We conducted a retrospective observational multicentre study to determine the epidemiology of C. auris infections, its management strategies, patient outcomes, and infection prevention and control practices across 10 centres from five countries. Results: Significant risk factors for C. auris infection include the age group of 61–70 years (39%), recent history of ICU admission (63%), diabetes (63%), renal failure (52%), presence of CVC (91%) and previous history of antibiotic treatment (96%). C. auris was commonly isolated from blood (76%). Echinocandins were the most sensitive drugs. Most common antifungals used for treatment were caspofungin (40%), anidulafungin (28%) and micafungin (15%). The median duration of treatment was 20 days. Source removal was conductedin 74% patients. All-cause crude mortality rate after 30 days was 37%. Antifungal therapy was associated with a reduction in mortality (OR:0.27) and so was source removal (OR:0.74). Contact isolation precautions were followed in 87% patients. Conclusions: C. auris infection carries a high risk for associated mortality. The organism is mainly resistant to most azoles and even amphotericin-B. Targeted antifungal therapy, mainly an echinocandin, and source control are the prominent therapeutic approaches

The Role of Nonequilibrium Dynamical Screening in Carrier Thermalization

We investigate the role played by nonequilibrium dynamical screening in the thermalization of carriers in a simplified two-component two-band model of a semiconductor. The main feature of our approach is the theoretically sound treatment of collisions. We abandon Fermi's Golden rule in favor of a nonequilibrium field theoretic formalism as the former is applicable only in the long-time regime. We also introduce the concept of nonequilibrium dynamical screening. The dephasing of excitonic quantum beats as a result of carrier-carrier scattering is brought out. At low densities it is found that the dephasing times due to carrier-carrier scattering is in picoseconds and not femtoseconds, in agreement with experiments. The polarization dephasing rates are computed as a function of the excited carrier density and it is found that the dephasing rate for carrier-carrier scattering is proportional to the carrier density at ultralow densities. The scaling relation is sublinear at higher densities, which enables a comparison with experiment.Comment: Revised version with additional refs. 12 pages, figs. available upon request; Submitted to Phys. Rev.

Optical gain in 1.3-μm electrically driven dilute nitride VCSOAs

We report the observation of room-temperature optical gain at 1.3 μm in electrically driven dilute nitride vertical cavity semiconductor optical amplifiers. The gain is calculated with respect to injected power for samples with and without a confinement aperture. At lower injected powers, a gain of almost 10 dB is observed in both samples. At injection powers over 5 nW, the gain is observed to decrease. For nearly all investigated power levels, the sample with confinement aperture gives slightly higher gain