Hemobilia due to cystic artery pseudoaneurysm: A rare late complication of laparoscopic cholecystectomy

We discuss a patient with late presentation of hemobilia following cholecystectomy, which is unusual because pseudoaneurysm caused by vascular injury during surgery typically presents soon after surgery. Endoscopic retrograde cholangiopancreatography revealed a large blood clot arising from the biliary orifice with subsequent computed tomography angiography diagnosing a large pseudoaneurysm in the region of the cystic artery adjacent to the cholecystectomy clips. Embolization was performed via direct percutaneous puncture of the pseudoaneurysm

Exploring the potential of a hybrid device combining solar water heating and molecular solar thermal energy storage

A hybrid solar energy system consisting of a molecular solar thermal energy storage system (MOST) combined with a solar water heating system (SWH) is presented. The MOST chemical energy storage system is based on norbornadiene–quadricyclane derivatives allowing for conversion of solar energy into stored chemical energy at up to 103 kJ mol1 (396 kJ kg1 ). It is demonstrated that 1.1% of incoming solar energy can be stored in the chemical system without significantly compromising the efficiency of the solar water heating system, leading to efficiencies of combined solar water heating and solar energy storage of up to 80%. Moreover, prospects for future improvement and possible applications are discussed

Mesoscopic scattering of spin s particles

Quantum effects in weakly disordered systems are governed by the properties of the elementary interaction between propagating particles and impurities. Long range mesoscopic effects due to multiple scattering are derived by iterating the single scattering vertex, which has to be appropriately diagonalized. In the present contribution, we present a systematic and detailed diagonalisation of the diffuson and cooperon vertices responsible for weak localisation effects. We obtain general expressions for eigenvalues and projectors onto eigenmodes, for any spin and arbitrary elementary interaction with impurities. This description provides a common frame for a unified theory of mesoscopic spin physics for electrons, photons, and other quantum particles. We treat in detail the case of spin-flip scattering of electrons by freely orientable magnetic impurities and briefly review the case of photon scattering from degenerate dipole transitions in cold atomic gases.Comment: published version, with a new figure and new section

Galaxy Clusters as Reservoirs of Heavy Dark Matter and High-Energy Cosmic Rays: Constraints from Neutrino Observations

Galaxy Clusters (GCs) are the largest reservoirs of both dark matter and cosmic rays (CRs). Dark matter self-annihilation can lead to a high luminosity in gamma rays and neutrinos, enhanced by a strong degree of clustering in dark matter substructures. Hadronic CR interactions can also lead to a high luminosity in gamma rays and neutrinos, enhanced by the confinement of CRs from cluster accretion/merger shocks and active galactic nuclei. We show that IceCube/KM3Net observations of high-energy neutrinos can probe the nature of GCs and the separate dark matter and CR emission processes, taking into account how the results depend on the still-substantial uncertainties. Neutrino observations are relevant at high energies, especially at >10 TeV. Our results should be useful for improving experimental searches for high-energy neutrino emission. Neutrino telescopes are sensitive to extended sources formed by dark matter substructures and CRs distributed over large scales. Recent observations by Fermi and imaging atmospheric Cherenkov telescopes have placed interesting constraints on the gamma-ray emission from GCs. We also provide calculations of the gamma-ray fluxes, taking into account electromagnetic cascades inside GCs, which can be important for injections at sufficiently high energies. This also allows us to extend previous gamma-ray constraints to very high dark matter masses and significant CR injections at very high energies. Using both neutrinos and gamma rays, which can lead to comparable constraints, will allow more complete understandings of GCs. Neutrinos are essential for some dark matter annihilation channels, and for hadronic instead of electronic CRs. Our results suggest that the multi-messenger observations of GCs will be able to give useful constraints on specific models of dark matter and CRs. [Abstract abridged.]Comment: 31 pages, 20 figures, 1 table, accepted for publication in JCAP, references and discussions adde

Propagation of ultrahigh energy nuclei in clusters of galaxies: resulting composition and secondary emissions

We study the survival of ultrahigh energy nuclei injected in clusters of galaxies, as well as their secondary neutrino and photon emissions, using a complete numerical propagation method and a realistic modeling of the magnetic, baryonic and photonic backgrounds. It is found that the survival of heavy nuclei highly depends on the injection position and on the profile of the magnetic field. Taking into account the limited lifetime of the central source could also lead in some cases to the detection of a cosmic ray afterglow, temporally decorrelated from neutrino and gamma ray emissions. We calculate that the diffusive neutrino flux around 1 PeV coming from clusters of galaxies may have a chance to be detected by current instruments. The observation of single sources in neutrinos and in gamma rays produced by ultrahigh energy cosmic rays will be more difficult. Signals coming from lower energy cosmic rays (E < 1 PeV), if they exist, might however be detected by Fermi, for reasonable sets of parameters.Comment: 19 pages, 15 figures, version to appear in ApJ (minor changes

Intercomparison of the northern hemisphere winter mid-latitude atmospheric variability of the IPCC models

We compare, for the overlapping time frame 1962-2000, the estimate of the northern hemisphere (NH) mid-latitude winter atmospheric variability within the XX century simulations of 17 global climate models (GCMs) included in the IPCC-4AR with the NCEP and ECMWF reanalyses. We compute the Hayashi spectra of the 500hPa geopotential height fields and introduce an integral measure of the variability observed in the NH on different spectral sub-domains. Only two high-resolution GCMs have a good agreement with reanalyses. Large biases, in most cases larger than 20%, are found between the wave climatologies of most GCMs and the reanalyses, with a relative span of around 50%. The travelling baroclinic waves are usually overestimated, while the planetary waves are usually underestimated, in agreement with previous studies performed on global weather forecasting models. When comparing the results of various versions of similar GCMs, it is clear that in some cases the vertical resolution of the atmosphere and, somewhat unexpectedly, of the adopted ocean model seem to be critical in determining the agreement with the reanalyses. The GCMs ensemble is biased with respect to the reanalyses but is comparable to the best 5 GCMs. This study suggests serious caveats with respect to the ability of most of the presently available GCMs in representing the statistics of the global scale atmospheric dynamics of the present climate and, a fortiori, in the perspective of modelling climate change.Comment: 39 pages, 8 figures, 2 table

Aspiration therapy for the treatment of obesity: 4-year results of a multicenter randomized controlled trial.

BackgroundThe AspireAssist is the first Food and Drug Administration-approved endoluminal device indicated for treatment of class II and III obesity.ObjectivesWe earlier reported 1-year results of the PATHWAY study. Here, we report 4-year outcomes.SettingUnited States-based, 10-center, randomized controlled trial involving 171 participants with the treatment arm receiving Aspiration Therapy (AT) plus Lifestyle Therapy and the control arm receiving Lifestyle Therapy (2:1 randomization).MethodsAT participants were permitted to continue in the study for an additional year up to a maximum of 5 years providing they maintained at least 10% total weight loss (TWL) from baseline at each year end. For AT participants who continued the study, 5 medical monitoring visits were provided at weeks 60, 68, 76, 90, and 104 and thereafter once every 13 weeks up to week 260. Exclusion criteria were a history of eating disorder or evidence of eating disorder on a validated questionnaire. Follow-up weight, quality of life, and co-morbidities were compared with the baseline levels. In addition, rates of serious adverse event, persistent fistula, withdrawal, and A-tube replacement were reported. All analyses were performed using a per-protocol analysis.ResultsOf the 82 AT participants who completed 1 year, 58 continued to this phase of the trial. Mean baseline body mass index of these 58 patients was 41.6 ± 4.5 kg/m2. At the end of first year (at the beginning of the follow-up study), these 58 patients had a body mass index of 34.1 ± 5.4 kg/m2 and had achieved an 18.3 ± 8.0% TWL. On a per protocol basis, patients experienced 14.2%, 15.3%, 16.6%, and 18.7% TWL at 1, 2, 3, and 4 years, respectively (P &lt; .01 for all). Forty of 58 patients (69%) achieved at least 10% TWL at 4 years or at time of study withdrawal. Improvements in quality of life scores and select cardiometabolic parameters were also maintained through 4 years. There were 2 serious adverse events reported in the second through fourth years, both of which resolved with removal or replacement of the A tube. Two persistent fistulas required surgical repair, representing approximately 2% of all tube removals. There were no clinically significant metabolic or electrolytes disorders observed, nor any evidence for development of any eating disorders.ConclusionsThe results of this midterm study have shown that AT is a safe, effective, and durable weight loss alternative for people with class II and III obesity and who are willing to commit to using the therapy and adhere to adjustments in eating behavior