Portal Hypertension and Ascites Due to an Arterioportal Fistula: Sequela of a Remote Traumatic Liver Laceration

Arterioportal fistulas (APFs) are a group of vascular disorders, in which systemic arteries communicate with the portal circulation, presenting as a congenital syndrome or more commonly acquired from iatrogenic instrumentation or abdominal trauma. We report the case of a 58-year-old man who developed ascites without underlying risk factors for portal hypertension, which was attributed to an APF found on imaging, manifesting 43 years after sustaining a liver laceration. After angiographic embolization of the APF, the patient's ascites resolved completely. The prolonged latent period between the patient's abdominal trauma and eventual presentation with ascites highlights the need to consider vascular malformations in the differential diagnosis of unexplained noncirrhotic portal hypertension

Enhanced Depth Imaging Optical Coherence Tomography of Optic Nerve Head Drusen: A Comparison of Cases with and without Visual Field Loss

PURPOSE: Enhanced depth imaging (EDI) spectral-domain optical coherence tomography (SD OCT) has been recognized as the most sensitive tool to diagnose optic nerve head drusen (ONHD). The relationship between OCT characteristics and visual loss has not been well documented. This study compares EDI SD OCT-determined morphologic characteristics of drusen in eyes with or without visual field (VF) defects. DESIGN: Descriptive study of patients attending the neuro-ophthalmology service of Moorfields Eye Hospital between January 2013 and October 2014. SUBJECTS: Patients with diagnosed ONHD and EDI SD OCT imaging of the optic nerve head. METHODS: Eyes with and without VF defects were compared with regard to retinal nerve fiber layer (RNFL) thickness, drusen morphology, size, extent, visibility on funduscopy, ultrasound, and fundus autofluorescence. MAIN OUTCOME MEASURES: Difference in OCT characteristics of ONHD between patients with or without VF defects. RESULTS: Of 38 patients, 69 eyes with ONHD were included. Thirty-three eyes had a normal VF with average mean deviation (MD) -0.96 (±1.2) dB and pattern standard deviation (PSD) 1.6 (±0.3) dB (group I), and 36 eyes had VF defects with MD -13.7 (±10.4) dB and PSD 7.2 (±3.6) dB (group II). Mean global RNFL thickness was 62 (±20.9) μm in the latter group and 99.0 (±12.9) μm in group I. In group I, the predominant drusen type was peripapillary drusen, of variable size. In group II, most eyes had confluent (P 500 μm; P < 0.003) drusen, and drusen were more commonly visible on funduscopy (P = 0.001), ultrasound (P = 0.013), and autofluorescence (P = 0.002). Differences between the 2 groups reached statistical significance in a clustered analysis. RNFL thinning and autofluorescence showed relative sparing of the temporal sector. Sixty-four percent of patients with a VF defect in 1 eye also had a VF defect in their fellow eye. CONCLUSIONS: Drusen size and drusen type as classified by OCT morphologic characteristics are significantly different in patients with or without VF defects. Confluent, large, and autofluorescent drusen were more commonly found in patients with VF defects. These findings may assist in clarifying how drusen give rise to visual loss, which is currently not known

Examining the direct effect of the use of traffic safety technologies in Abu Dhabi highways on other traffic safety dimensions

his paper presents the findings of a study, implemented in Abu Dhabi, which aimed to examine the direct effects of the use of traffic safety technologies on the mitigation of risks associated with traffic accidents. The study adopted the use of a questionnaire-based survey with traffic safety experts in Abu Dhabi Emirate. The views of more than a hundred respondents were collected on areas such as the status of existing traffic safety technologies in Abu Dhabi’s highway network, the impact of traffic safety technologies on enforcement, existing highway design practices, effects of driver education on safety and the impact of safety technologies on the efficiency of emergency responses. Factor analysis and Freidman tests were employed for the interrogation of the data in order to extract findings from the views of different experts on the aforementioned areas. The analysis showed that the deployment of traffic safety technologies has a positive impact on the efficiency of enforcement practices and improvements on traffic safety, and on enhancing operators’ efficiency and capability in taking appropriate and prompt action in situations calling for emergency responses. Moreover, speed cameras and VMS deployment are highly favoured in addressing engineering design shortfalls. Also, training and awareness enhance the efficiency and effectiveness of traffic safety technologies

The GIP receptor displays higher basal activity than the GLP-1 receptor but does not recruit GRK2 or arrestin3 effectively.

Background and Objectives: Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are important regulators of insulin secretion, and their functional loss is an early characteristic of type 2 diabetes mellitus (T2DM). Pharmacological levels of GLP-1, but not GIP, can overcome this loss. GLP-1 and GIP exert their insulinotropic effects through their respective receptors expressed on pancreatic β-cells. Both the GLP-1 receptor (GLP-1R) and the GIP receptor (GIPR) are members of the secretin family of G protein-coupled receptors (GPCRs) and couple positively to adenylate cyclase. We compared the signalling properties of these two receptors to gain further insight into why GLP-1, but not GIP, remains insulinotropic in T2DM patients. Methods: GLP-1R and GIPR were transiently expressed in HEK-293 cells, and basal and ligand-induced cAMP production were investigated using a cAMP-responsive luciferase reporter gene assay. Arrestin3 (Arr3) recruitment to the two receptors was investigated using enzyme fragment complementation, confocal microscopy and fluorescence resonance energy transfer (FRET). Results: GIPR displayed significantly higher (P<0.05) ligand-independent activity than GLP-1R. Arr3 displayed a robust translocation to agonist-stimulated GLP-1R but not to GIPR. These observations were confirmed in FRET experiments, in which GLP-1 stimulated the recruitment of both GPCR kinase 2 (GRK2) and Arr3 to GLP-1R. These interactions were not reversed upon agonist washout. In contrast, GIP did not stimulate recruitment of either GRK2 or Arr3 to its receptor. Interestingly, arrestin remained at the plasma membrane even after prolonged (30 min) stimulation with GLP-1. Although the GLP-1R/arrestin interaction could not be reversed by agonist washout, GLP-1R and arrestin did not co-internalise, suggesting that GLP-1R is a class A receptor with regard to arrestin binding. Conclusions:: GIPR displays higher basal activity than GLP-1R but does not effectively recruit GRK2 or Arr3

High temperature thermoelectric properties of Zn-doped Eu_5In_2Sb_6

The complex bonding environment of many ternary Zintl phases, which often results in low thermal conductivity, makes them strong contenders as thermoelectric materials. Here, we extend the investigation of A_5In_2Sb_6 Zintl compounds with the Ca_5Ga_2As_6 crystal structure to the only known rare-earth analogue: Eu_5In_2Sb_6. Zn-doped samples with compositions of Eu_5In_(2−x)ZnxSb_6 (x = 0, 0.025, 0.05, 0.1, 0.2) were synthesized via ball milling followed by hot pressing. Eu_5In_2Sb_6 showed significant improvements in air stability relative to its alkaline earth metal analogues. Eu5In2Sb6 exhibits semiconducting behavior with possible two band behavior suggested by increasing band mass as a function of Zn content, and two distinct transitions observed in optical absorption measurements (at 0.15 and 0.27 eV). The p-type Hall mobility of Eu_5In_2Sb_6 was found to be much larger than that of the alkaline earth containing A_5In_2Sb_6 phases (A = Sr, Ca) consistent with the reduced hole effective mass (1.1 me). Zn doping was successful in optimizing the carrier concentration, leading to a zT of up to 0.4 at ∼660 K, which is comparable to that of Zn-doped Sr_5In_2Sb_6

Thermoelectric Enhancement in BaGa_2Sb_2 by Zn Doping

The Zintl phase BaGa_2Sb_2 has a unique crystal structure in which large tunnels formed by ethane-like dimeric [Sb_3Ga−GaSb_3] units are filled with Ba atoms. BaGa_2Sb_2 was obtained in high purity from ball-milling followed by hot pressing. It shows semiconducting behavior, in agreement with the valence precise Zintl counting and band structure calculations, with a band gap ∼0.4 eV. The thermal conductivity of BaGa_2Sb_2 is found to be relatively low (0.95 W/K m at 550 K), which is an inherent property of compounds with complex crystal structures. As BaGa_2Sb_2 has a low carrier concentration (∼2 × 10^18 h^+/cm^3) at room temperature, the charge carrier tuning was performed by substituting trivalent Ga with divalent Zn. Zn-doped samples display heavily doped p-type semiconducting behavior with carrier concentrations in the range (5−8) × 10^19 h^+/cm^3. Correspondingly, the zT values were increased by a factor of 6 by doping compared to the undoped sample, reaching a value of ∼0.6 at 800 K. Zn-doped BaGa_2Sb_2 can thus be considered as a promising new thermoelectric material for intermediate-temperature applications

Mechanochemical synthesis and high temperature thermoelectric properties of calcium-doped lanthanum telluride La_(3−x)Ca_xTe_4

The thermoelectric properties from 300–1275 K of calcium-doped La_(3−x)Te_4 are reported. La_(3−x)Te_4 is a high temperature n-type thermoelectric material with a previously reported zT_(max) 1.1 at 1273 K and x = 0.23. Computational modeling suggests the La atoms define the density of states of the conduction band for La_(3−x)Te_4. Doping with Ca^(2+) on the La^(3+) site is explored as a means of modifying the density of states to improve the power factor and to achieve a finer control over the carrier concentration. High purity, oxide-free samples are produced by ball milling of the elements and consolidation by spark plasma sintering. Calcium substitution upon the lanthanum site was confirmed by a combination of Rietveld refinements of powder X-ray diffraction data and wave dispersive spectroscopy. A zT_(max) 1.2 is reached at 1273 K for the composition La_(2.2)Ca_(0.78)Te_4 and the relative increase compared to La_(3−x)Te_4 is attributed to the finer carrier concentration

Metamaterial Polarization Converter Analysis: Limits of Performance

In this paper we analyze the theoretical limits of a metamaterial converter that allows for linear-to- elliptical polarization transformation with any desired ellipticity and ellipse orientation. We employ the transmission line approach providing a needed level of the design generalization. Our analysis reveals that the maximal conversion efficiency for transmission through a single metamaterial layer is 50%, while the realistic re ection configuration can give the conversion efficiency up to 90%. We show that a double layer transmission converter and a single layer with a ground plane can have 100% polarization conversion efficiency. We tested our conclusions numerically reaching the designated limits of efficiency using a simple metamaterial design. Our general analysis provides useful guidelines for the metamaterial polarization converter design for virtually any frequency range of the electromagnetic waves.Comment: 10 pages, 11 figures, 2 table

The risk of cardiac failure following metal-on-metal hip arthroplasty

Aims The aim of this study was to determine whether patients with metal-on-metal (MoM) arthroplasties of the hip have an increased risk of cardiac failure compared with those with alternative types of arthroplasties (non-MoM). Patients and Methods A linkage study between the National Joint Registry, Hospital Episodes Statistics and records of the Office for National Statistics on deaths was undertaken. Patients who underwent elective total hip arthroplasty between January 2003 and December 2014 with no past history of cardiac failure were included and stratified as having either a MoM (n = 53 529) or a nonMoM (n = 482 247) arthroplasty. The primary outcome measure was the time to an admission to hospital for cardiac failure or death. Analysis was carried out using data from all patients and from those matched by propensity score. Results The risk of cardiac failure was lower in the MoM cohort compared with the non-MoM cohort (adjusted hazard ratio (aHR) 0.901; 95% confidence interval (CI) 0.853 to 0.953). The risk of cardiac failure was similar following matching (aHR 0.909; 95% CI 0.838 to 0.987) and the findings were consistent in subgroup analysis. Conclusion The risk of cardiac failure following total hip arthroplasty was not increased in those in whom MoM implants were used, compared with those in whom other types of prostheses were used, in the first seven years after surgery. Cite this article: Bone Joint J 2018;100-B:20–