Small bowel evisceration in a perforated uterine prolapse

The evisceration of the bowel through the vaginal vault is an extremely rare condition and a surgical emergency with a high-reported mortality rate. Vaginal evisceration most commonly affects menopausal women with a hysterectomy or those with previous vaginal surgery. The most common risk factors include the triad of post-menopausal atrophy, previous vaginal surgery and enterocele. Estrogen deficiency in post-menopausal women leads to weaker pelvic support structures and a thin, atrophic vagina, making it more prone to rupture. Previous vaginal surgery leaves scar tissue with diminished vascularity in the vaginal wall and apex, predisposing it to dehiscence. Post hysterectomy, the axis of the vagina may be changed, making it more vertical or shortened and resulting in the vagina losing its valve-like mechanism. We present a 70-year-old female brought to the emergency department with a vaginal prolapse complicated by bowel evisceration, without any history of vaginal surgery, hysterectomy or trauma. The bowel was inspected and irrigated copiously, then reduced into the abdominal cavity as it was still viable. A total vaginal hysterectomy with an anterior and posterior colporrhaphy was done. The patient had a successful recovery with no complication. We present this case due to its rarity, the absence of previous vaginal surgery, trauma, or hysterectomy and the successful multidisciplinary surgical approach with total recovery

New 'Mixed-Mode' Optoelectronic Applications Possibilities using Phase-Change Materials and Devices

To date the main applications of phase-change materials and devices have been limited to the provision of non-volatile memories. Recently, however, the potential has been demonstrated for using a phase-change approach for the provision of entirely new concepts in optoelectronics, including phase-change displays, integrated phase-change photonic memories, optical modulation and optical computing [1-3]. Such novel applications are enabled by the ability of phase-change devices to operate in a 'mixed-mode' configuration, where the excitation is provided electrically and the sensing is carried out optically, or vice-versa. Exploitation of this mixed-mode is made possible in phase-change materials due to the large and simultaneous changes that occur in both refractive index and electrical resistivity on transformation between amorphous and crystalline states. In this paper, based on studies part-funded by the NSF Materials World Network, we present recent results of the use of such mixed-mode operation to provide new applications, including a demonstration of phase-change optoelectronics devices that can be used to make ultrathin all-solid-state colour displays of ultrahigh resolution [1], and hybrid integrated phase-change photonic circuits that offer both a low-power, multi-level memory capability and a computing functionality [2,3]. As so often mentioned by the late (and sadly missed) Stanford Ovhinsky at previous MRS meetings [4], phase-change materials have the potential to provide us with so much more than simple digital memory - a potential that we are now beginning to realize and exploit. [1] P Hosseini, C D Wright and H Bhaskaran, Nature 511, 206 (2014) [2] C Rios , P Hosseini , C D Wright , H Bhaskaran and W H P Pernice, Advanced Materials 26, 1372 (2014) [3] C D Wright, Y Liu, K I Kohary, M M Aziz, R J Hicken, Advanced Materials 23, 3408 (2011) [4] S R Ovshinsky and B Pashmakov, MRS Proceedings 803, 49 (2004

Thermal and phase transformations analysis in a PREMOMET® steel

Thermal analysis in a PREMOMET® steel has been performed by differential scanning calorimetry (DSC) and highresolution dilatometry. The phase transformation temperatures (Ac1, Ac3, Ms and Mf) of this steel were obtained by the two methods at different heating rates showing good agreement between both techniques. The enthalpy of α-γ transformation for this steel was measured using the thermograms acquired by DSC and microstructure was analyzed by scanning electron microscope (SEM). The results showed that this steel retained a martensitic structure for all conditions

Thermal and phase transformations analysis in a PREMOMET® steel

Thermal analysis in a PREMOMET® steel has been performed by differential scanning calorimetry (DSC) and highresolution dilatometry. The phase transformation temperatures (Ac1, Ac3, Ms and Mf) of this steel were obtained by the two methods at different heating rates showing good agreement between both techniques. The enthalpy of α-γ transformation for this steel was measured using the thermograms acquired by DSC and microstructure was analyzed by scanning electron microscope (SEM). The results showed that this steel retained a martensitic structure for all conditions

Nanomechanics of graphene oxide-bacteriophage based self-assembled porous composites.

Graphene oxide, integrated with the filamentous bacteriophage M13, forms a 3D large-scale multifunctional porous structure by self-assembly, with considerable potential for applications. We performed Raman spectroscopy under pressure on this porous composite to understand its fundamental mechanics. The results show that at low applied pressure, the [Formula: see text] bonds of graphene oxide stiffen very little with increasing pressure, suggesting a complicated behaviour of water intercalated between the graphene layers. The key message of this paper is that water in a confined space can have a significant impact on the nanostructure that hosts it. We introduced carbon nanotubes during the self-assembly of graphene oxide and M13, and a similar porous macro-structure was observed. However, in the presence of carbon nanotubes, pressure is transmitted to the [Formula: see text] bonds of graphene oxide straightforwardly as in graphite. The electrical conductivity of the composite containing carbon nanotubes is improved by about 30 times at a bias voltage of 10 V. This observation suggests that the porous structure has potential in applications where good electrical conductivity is desired, such as sensors and batteries

Rapid detection of A. pleuropneumoniae from clinical samples using recombinase polymerase amplification

Actinobacillus pleuropneumoniae (APP) is the causative agent of porcine pleuropneumonia, resulting in high economic impact worldwide. There are currently 19 known serovars of APP, with different ones being predominant in specific geographic regions. Outbreaks of pleuropneumonia, characterized by sudden respiratory difficulties and high mortality, can occur when infected pigs are brought into naïve herds, or by those carrying different serovars. Good biosecurity measures include regular diagnostic testing for surveillance purposes. Current gold standard diagnostic techniques lack sensitivity (bacterial culture), require expensive thermocycling machinery (PCR) and are time consuming (culture and PCR). Here we describe the development of an isothermal point-of-care diagnostic test - utilizing recombinase polymerase amplification (RPA) for the detection of APP, targeting the species-specific apxIVA gene. Our APP-RPA diagnostic test achieved a sensitivity of 10 copies/µL using a strain of APP serovar 8, which is the most prevalent serovar in the UK. Additionally, our APP-RPA assay achieved a clinical sensitivity and specificity of 84.3% and 100%, respectively, across 61 extracted clinical samples obtained from farms located in England and Portugal. Using a small subset (n = 14) of the lung tissue samples, we achieved a clinical sensitivity and specificity of 76.9% and 100%, respectively) using lung imprints made on FTA cards tested directly in the APP- RPA reaction. Our results demonstrate that our APP-RPA assay enables a suitable rapid and sensitive screening tool for this important veterinary pathogen

Theoretical Study on Superconductivity in Boron-Doped Diamond

We consider superconductivity in boron (B) doped diamond using a simplified model for the valence band of diamond. We treat the effects of substitutional disorder of B ions by the coherent potential approximation (CPA) and those of the attractive force between holes by the ladder approximation under the assumption of instantaneous interaction with the Debye cutoff. We thereby calculate the quasiparticle life time, the evolution of the single-particle spectra due to doping, and the effect of disorder on the superconducting critical temperature $T_c$. We in particular compare our results with those for supercell calculations to see the role of disorder, which turns out to be of crucial importance to $T_c$.Comment: 9 pages, 13 figures, submitted to J. Phys. Soc. Jpn., Errors in embedded eps figure files have been correcte

Granulocytes-Rich Thrombi in Cerebral Large Vessel Occlusion Are Associated with Increased Stiffness and Poorer Revascularization Outcomes

Acute stroke; Flow cytometry; Mechanical thrombectomyIctus agut; Citometria de flux; Trombectomia mecànicaIctus agudo; Citometría de flujo; Trombectomía mecánicaWe aim to identify a profile of intracranial thrombus resistant to recanalization by mechanical thrombectomy (MT) in acute stroke treatment. The first extracted clot of each MT was analyzed by flow cytometry obtaining the composition of the main leukocyte populations: granulocytes, monocytes, and lymphocytes. Demographics, reperfusion treatment, and grade of recanalization were registered. MT failure (MTF) was defined as final thrombolysis in cerebral infarction score IIa or lower and/or need of permanent intracranial stenting as a rescue therapy. To explore the relationship between stiffness of intracranial clots and cellular composition, unconfined compression tests were performed in other cohorts of cases. Thrombi obtained in 225 patients were analyzed. MTF were observed in 30 cases (13%). MTF was associated with atherosclerosis etiology (33.3% vs. 15.9%; p = 0.021) and higher number of passes (3 vs. 2; p < 0.001). Clot analysis of MTF showed higher percentage of granulocytes [82.46 vs. 68.90% p < 0.001] and lower percentage of monocytes [9.18% vs.17.34%, p < 0.001] in comparison to successful MT cases. The proportion of clot granulocytes (aOR 1.07; 95% CI 1.01–1.14) remained an independent marker of MTF. Among thirty-eight clots mechanically tested, there was a positive correlation between granulocyte proportion and thrombi stiffness (Pearson’s r = 0.35, p = 0.032), with a median clot stiffness of 30.2 (IQR, 18.9–42.7) kPa. Granulocytes-rich thrombi are harder to capture by mechanical thrombectomy due to increased stiffness, so a proportion of intracranial granulocytes might be useful to guide personalized endovascular procedures in acute stroke treatment.Open Access Funding provided by Universitat Autonoma de Barcelona. This work was supported by “Project 355/C/2017, Fundació La Marató de TV3 in Strokes and Traumatic Spinal Cord and Brain Injury, 2017 Call of Projects.

The short term debt vs. long term debt puzzle: a model for the optimal mix

This paper argues that the existing finance literature is inadequate with respect to its coverage of capital structure of small and medium sized enterprises (SMEs). In particular it is argued that the cost of equity (being both conceptually ill defined and empirically non quantifiable) is not applicable to the capital structure decisions for a large proportion of SMEs and the optimal capital structure depends only on the mix of short and long term debt. The paper then presents a model, developed by practitioners for optimising the debt mix and demonstrates its practical application using an Italian firm's debt structure as a case study