Theoretical prediction of the electronic structure, optical properties and contact characteristics of a type-I MoS2/MoGe2N4 heterostructure towards optoelectronic devices.

Recently, the combination of two different two-dimensional (2D) semiconductors to generate van der Waals (vdW) heterostructures has emerged as an effective strategy to tailor their physical properties, paving the way for the development of next-generation devices with improved performance and functionality. In this work, we designed an MoS2/MoGe2N4 heterostructure and explored its electronic structures, optical properties and contact characteristics using first-principles calculations. The MoS2/MoGe2N4 heterostructure is predicted to be energetically, thermally and dynamically stable, indicating its feasibility for experimental synthesis in the future. The MoS2/MoGe2N4 heterostructure forms type-I band alignment, suggesting that it can be considered as a promising material for optoelectronic devices, such as light-emitting diodes, and in laser applications. Furthermore, the type-I MoS2/MoGe2N4 heterostructure has enhanced optical absorption in both the visible and ultraviolet regions. More interestingly, the electronic properties and contact characteristics of the MoS2/MoGe2N4 heterostructure can be tailored by applying in-plane biaxial strain. Under the application of compressive and tensile strains, transformations between type-I and type-II band alignments and between semiconductor and metal can be achieved in the MoS2/MoGe2N4 heterostructure. Our findings could provide useful guidance for experimental synthesis of materials based on the MoS2/MoGe2N4 heterostructure for electronic and optoelectronic applications.

Perfect Resonant Absorption of Guided Water Waves by Autler-Townes Splitting.

The control of guided water wave propagation based on the Autler-Townes splitting resonance concept is demonstrated experimentally, numerically, and theoretically. Complete wave absorption is achieved using an asymmetric pointlike scatterer made of two closely spaced resonant side channels connected to a guide and designed so that its energy leakage is in perfect balance with the inherent viscous losses in the system. We demonstrate that the nature of the resonators and guide junction completely controls the positions of the wave numbers at the reflection and transmission zeros on the real axis; the asymmetry of the resonators completely controls their positions on the imaginary axis. Thus, by adjusting these two independent parameters, we obtain a zero reflection and transmission.

Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults.

BACKGROUND: Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)-associated tuberculous meningitis despite limited data supporting their safety and efficacy. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization. RESULTS: A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P = 0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P = 0.52). CONCLUSIONS: Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817.).

A Multi-Disciplinary Approach for the Management of Prosthetic Joint Infections: An Australian Perspective.

Introduction: Prosthetic joint infections (PJI) are a major complication of hip and knee arthroplasty, imposing significant morbidity and mortality. Orthopaedic oncology units have utilised a multi-disciplinary team (MDT) approach for some time. PJI is not only an equally life-threatening condition, it also requires input from multiple healthcare personnel and treatment can vary significantly between individuals given the diversity in microbiological, surgical and host factors. Our arthroplasty service established an MDT meeting to manage this complex patient group. This study describes the philosophy and implementation of an MDT approach to the management of PJIs at a tertiary hospital in Australia. Materials and methods: A retrospective review of all patients that presented to the MDT PJI meeting from October 2017 to April 2020 was performed. Patient characteristics, microbiological profile and management were reviewed. Results: One hundred and one patients were reviewed over 2.5 years with a mean age of 69.2 years (SD 11.9). Patients presenting predominantly had a primary TKR (32%) or primary THR (22%). Results of Microbiology cultures varied, with 42% Gram-positive organisms, 13% Gram-negative organisms, 2% fungus and 1% yeast origin. Management mainly consisted of two-stage revision (28%), debridement-antibiotics-and-implant retention (22%) and antibiotic suppression (14%). A total of 91.5% of patients who underwent surgical management were considered cured at one year. Conclusion: PJIs are complex and require coordinated care by a number of healthcare personnel. The MDT process has allowed collaboration between Orthopaedic, Infectious Disease and Microbiology departments and aims to improve the quality of care provided to patients, potentially reducing morbidity and mortality of patients with PJI.

Edwardsiella tarda, a rare human pathogen isolated from a perihepatic abscess: Implications of transient versus long term colonization of the gastrointestinal tract.

Although gastroenteritis is the most commonly described manifestation of Edwardsiella tarda infection, the pathogenesis and transient or long-term colonization of the gastrointestinal tract of this organism in human disease is not clear. We describe a rare manifestation of E. tarda infection in a perihepatic abscess in the setting of a patient with perforated cholecystitis and its successful eradication following antibiotic treatment.

EUS-guided gastroenterostomy with a lumen apposing self-expandable metallic stent relieves gastric outlet obstruction - a Scandinavian case series.

BACKGROUND: EUS-guided gastroenterostomy (EUS-GE) with lumen-apposing metallic stents (LAMS) in patients with gastric outlet obstruction (GOO) has proven to be an alternative to luminal stenting in the duodenum and surgical gastroenterostomy. In severely ill patients, the method can provide improved quality of life (QoL) and symptom relief by restoration of the luminal passage of fluid and nutrients to the small intestine. AIM: To assess the technical and clinical success and safety of EUS-GE. MATERIAL AND METHODS: A dual center retrospective case series of 33 consecutive patients with GOO due to malignant (n = 28) or non-malignant conditions (n = 5). The patients were treated with EUS-GE using cautery enhanced LAMS. Procedures were performed guided by EUS and fluoroscopy in general anesthesia or conscious sedation. RESULTS: Technical success was achieved in all patients. The median procedure time was 71 min and the median hospital stay was three days. Thirty (91%) patients were able to resume oral nutrition after the procedure. Ten patients (30%) experienced adverse events (AEs), including migration of the stent, bleeding, and infection. Four patients had fatal AEs (12%). All stent-related AEs were handled endoscopically. Five patients (15%) needed re-intervention. The median survival time for patients with malignant obstruction was 8.5 weeks (0.5-76), and 13 patients with obstructing malignancies lived 12 weeks or longer. CONCLUSION: EUS-GE is a minimally invasive and efficient method for restoration of the gastrointestinal passage and may improve palliative care for patients with GOO. The method has potential hazards and should only be offered in expert centers that regularly perform the procedure.

Carbon and methane cycling in arsenic-contaminated aquifers.

Geogenic arsenic (As) contamination of groundwater is a health threat to millions of people worldwide, particularly in alluvial regions of South and Southeast Asia. Mitigation measures are often hindered by high heterogeneities in As concentrations, the cause(s) of which are elusive. Here we used a comprehensive suite of stable isotope analyses and hydrogeochemical parameters to shed light on the mechanisms in a typical high-As Holocene aquifer near Hanoi where groundwater is advected to a low-As Pleistocene aquifer. Carbon isotope signatures (δ13C-CH4, δ13C-DOC, δ13C-DIC) provided evidence that fermentation, methanogenesis and methanotrophy are actively contributing to the As heterogeneity. Methanogenesis occurred concurrently where As levels are high (>200 µg/L) and DOC-enriched aquitard pore water infiltrates into the aquifer. Along the flowpath to the Holocene/Pleistocene aquifer transition, methane oxidation causes a strong shift in δ13C-CH4 from -87‰ to +47‰, indicating high reactivity. These findings demonstrate a previously overlooked role of methane cycling and DOC infiltration in high-As aquifers.

A stable, unified model for resonant Faraday cages.

We study some effective transmission conditions able to reproduce the effect of a periodic array of Dirichlet wires on wave propagation, in particular when the array delimits an acoustic Faraday cage able to resonate. In the study of Hewett & Hewitt (2016 Proc. R. Soc. A 472, 20160062 (doi:10.1098/rspa.2016.0062)) different transmission conditions emerge from the asymptotic analysis whose validity depends on the frequency, specifically the distance to a resonance frequency of the cage. In practice, dealing with such conditions is difficult, especially if the problem is set in the time domain. In the present study, we demonstrate the validity of a simpler unified model derived in Marigo & Maurel (2016 Proc. R. Soc. A 472, 20160068 (doi:10.1098/rspa.2016.0068)), where unified means valid whatever the distance to the resonance frequencies. The effectiveness of the model is discussed in the harmonic regime owing to explicit solutions. It is also exemplified in the time domain, where a formulation guaranteeing the stability of the numerical scheme has been implemented.

The role of optic nerve sheath diameter ultrasound in brain infection.

Brain infections cause significant morbidity and mortality worldwide, especially in resource-limited settings with high HIV co-infection rates. Raised intracranial pressure [ICP] may complicate brain infection and worsen neurological injury, yet invasive ICP monitoring is often unavailable. Optic nerve sheath diameter [ONSD] ultrasound may allow detection of raised ICP at the bedside; however, pathology in brain infection is different to traumatic brain injury, in which most studies have been performed. The use of ONSD ultrasound has been described in tuberculous meningitis, cryptococcal meningitis and cerebral malaria; however correlation with invasive ICP measurement has not been performed. Normal optic nerve sheath values are not yet established for most populations, and thresholds for clinical intervention cannot be assumed to match those used in non-infective brain pathology. ONSD ultrasound may be suitable for use in resource-limited settings by clinicians with limited ultrasound training. Standardisation of scanning technique, consensus on normal ONSD values, and action on abnormal results, are areas for future research. This scoping review examines the role of ONSD ultrasound in brain infection. We discuss pathophysiology, and describe the rationale, practicalities, and challenges of utilising ONSD ultrasound for brain infection monitoring and management. We discuss the existing evidence base for this technique, and identify knowledge gaps and future research priorities.

Description and phylogenetic analyses of ribosomal transcription units from species of Fasciolidae (Platyhelminthes: Digenea).

Many members of Fasciolidae are common trematodes in cattle, buffaloes, sheep, elephants, pigs, with some capable of infecting humans also. In this study, the complete or near-complete sequences of ribosomal transcription unit (rTU or rDNA), each of Fasciola hepatica (Australia), Fascioloides jacksoni (Sri Lanka), Fasciolopsis buski (Vietnam) and three isolates of F. gigantica (Vietnam), were obtained and characterized. The full length of rDNA for each F. hepatica, 'hybrid' Fasciola sp., Fas. jacksoni and Fa. Buski, was 7657 bp, 7966 bp, 7781 bp and 8361 bp, with the complete intergenic spacer region (IGS) (862 bp, 1170 bp, 987 bp and 561 bp), respectively. The rDNA of two 'pure' F. gigantica isolates from Vietnam was 6794 bp with unsequenced IGS. For 28S rRNA genes the Fasciola spp. are equal, 1958 bp for 18S, 160 bp for 5.8S, 3863 bp and 454 bp for ITS1 but ITS2 differ by one nucleotide (Thymine) (359 or 360 bp). The ITS1 of the sensu lato Fa. buski has some distinguishable features, 286 bp for ITS2, 3862 bp for 28S and four repeat units of 356-361 bp each found in ITS1. The 28S rDNA analysis showed the lowest level of divergence (0-0.57%) between F. hepatica and F. gigantica and higher (2.23-2.62%) and highest (6-6.42%) for Fas. jacksoni and Fasciolopsis, respectively. The tree of 43 strains/species clearly produced a well-supported phylogeny, where 18 fasciolids consistently grouped, forming a discrete Fasciolidae clade, distinct from Philophthalmidae, Echinostomatidae and Echinochasmidae in Echinostomatoidea. Fascioloides jacksoni is outside Fasciola spp.: basal with Fas. magna, as previously demonstrated.

Enhanced resonance of sparse arrays of Helmholtz resonators-Application to perfect absorption.

The influence of the spacing on the resonance of a periodic arrangement of Helmholtz resonators is inspected. An effective problem is used which accurately captures the properties of the resonant array within a large range of frequencies, and whose simplified version leaves an impedance condition. It is shown that the strength of the resonance is enhanced when the array becomes sparser. This degree of freedom on the radiative damping is of particular interest since it does not affect the resonance frequency nor the damping due to losses within each resonator; in addition, it does not affect the total thickness of the array. It is shown that it can be used for the design of a perfect absorbing wall.

Axially perpendicular offset scheme for obtaining Raman spectra of housed samples in glass bottles with minimized glass-peak background.

An axially perpendicular offset (APO) scheme based on an axially perpendicular geometrical arrangement of laser illumination and photon detection, enabling spatially offset Raman spectroscopy (SORS), is proposed as a versatile tool for the minimization of the glass background in direct measurements of Raman spectra of samples housed in glass bottles. This strategy is based on the possibility of isolating glass photons from sample photons by properly locating a detector beneath the sample-housing bottle, because glass photons are much more localized near the glass wall while sample photons are widely distributed throughout the bottle. In addition, the curved bottom of the glass vial enabling forming the conical photon-detection volume would be further effective in exclusion of the glass photons in the acquisition of sample spectra. The APO scheme was validated by measuring the Raman spectra of 66% ethanol housed in four glass bottles of different sizes and colors; the measurements were performed by varying the offset distance from 2 mm to 20 mm. The intensity of the glass background decreased rapidly with increasing the offset distance; on the other hand, the variation in the ethanol intensity was relatively insignificant. In all cases, the offset distance of 16 mm minimized the presence of glass background in the spectra, thereby helping to highlight the pure ethanol bands and producing nearly similar sample spectral features regardless of contained bottles. The results of the Monte Carlo simulation were in accordance with the experimental observations, and the suppression of glass photons in the APO scheme was clearly explained and visualized by the simulation.

Converse Smith-Martin cell cycle kinetics by transformed B lymphocytes.

Recent studies using direct live cell imaging have reported that individual B lymphocytes have correlated transit times between their G1 and S/G2/M phases. This finding is in contradiction with the influential model of Smith and Martin that assumed the bulk of the total cell cycle time variation arises in the G1 phase of the cell cycle with little contributed by the S/G2/M phase. Here we extend these studies to examine the relation between cell cycle phase lengths in two B lymphoma cell lines. We report that transformed B lymphoma cells undergo a short G1 period that displays little correlation with the time taken for the subsequent S/G2/M phase. Consequently, the bulk of the variation noted for total division times within a population is found in the S/G2/M phases and not the G1 phase. Models that reverse the expected source of variation and assume a single deterministic time in G1 followed by a lag + exponential distribution for S/G2/M fit the data well. These models can be improved further by adopting two sequential distributions or by using the stretched lognormal model developed for primary lymphocytes. We propose that shortening of G1 transit times and uncoupling from other cell cycle phases may be a hallmark of lymphocyte transformation that could serve as an observable phenotypic marker of cancer evolution.

Investigation of the particle size-dependent near-infrared spectral features of binary mixture samples in conjunction with Monte Carlo simulation and the influence of particle size on the accuracy of quantitative analysis.

Near-infrared (NIR) spectral features of a target component can be influenced by its particle size as well as the particle sizes of the surrounding components in multi-component samples; therefore, understanding the essence of particle size-induced spectral variation is fundamental for robust quantitative analysis. For systematic investigation, two different types of binary-component samples were prepared. First, in ambroxol/lactose powders, only the particle size of lactose (surrounding filler) was varied, while the particle size of ambroxol (a target component) remained unchanged. Second, in lactose/PE pellets, the particle size of lactose (a target component) was only varied. When measuring ambroxol/lactose powders, the absorbances of both ambroxol and lactose peaks were elevated as the particle size of lactose increased. The larger lactose particle made the photon propagation broader in the sample, so a greater amount of ambroxol was able to interact with NIR photons; this led to an increase in absorbance. In the case of lactose (10 wt%)/PE pellets, the absorbance of lactose oppositely decreased as the lactose particle size increased. Since PE was the dominant component (85-95%) and had a small particle size (7 µm), the depth of photon propagation was substantially shallow. In this situation, the larger lactose particles would sometimes not be located within the small sampling volume and/or the photons would only partially interact with the particles; this led to a decrease in the absorbance. For both binary samples, the accuracies for the determination of target concentrations deteriorated as the particle size increased. This was due to the degradation of the measurement reproducibility caused by the increased uncertainty in the photon propagation. Monte Carlo simulation was effective for probing the photon propagation inside samples and supportive to explain the experimental observations.

Navigated retrograde endoscopic myotomy (REM) for the treatment of therapy-resistant achalasia.

BACKGROUND: In achalasia, muscle spasm may involve the proximal esophagus. When the muscle spasm is located in the proximal esophagus, conventional per oral endoscopic myotomy (POEM) may not be sufficient to relieve symptoms. In this paper, we describe retrograde endoscopic myotomy (REM) as a novel approach to perform myotomy of the proximal esophagus, with the application of a navigation tool for anatomical guidance during REM. We aim to evaluate the feasibility and safety of REM and usefulness of the navigation during REM. METHOD: A 42-year-old male with type III achalasia who was treated with laparoscopic myotomy with fundoplication, multiple pneumatic balloon dilations, Botox injections and anterior POEM of the middle and distal esophagus without symptomatic effect. Repeated high-resolution- manometry (HRM) revealed occluding contractions of high amplitude around and above the aortic arch. A probe-based real-time electromagnetic navigation platform was used to facilitate real-time anatomical orientation and to evaluate myotomy position and length during REM. RESULTS: The navigation system aided in identifying the major structures of the mediastinum, and position and length of the myotomy. Twelve weeks after REM, the Eckardt score fell from seven at baseline seven to two. We also observed improvement with reduction of the pressure at the level of previous spasms in the proximal esophagus from 124 mmHg to 8 mmHg on HRM. CONCLUSION: REM makes the proximal esophagus accessible for endoscopic myotomy. Potential indication for REM is motility disorders in the proximal esophagus and therapy failure after POEM.

Characterization of Raman Scattering in Solid Samples with Different Particle Sizes and Elucidation on the Trends of Particle Size-Dependent Intensity Variations in Relation to Changes in the Sizes of Laser Illumination and Detection Area.

We have systematically characterized Raman scatterings in solid samples with different particle sizes and investigated subsequent trends of particle size-induced intensity variations. For this purpose, both lactose powders and pellets composed of five different particle sizes were prepared. Uniquely in this study, three spectral acquisition schemes with different sizes of laser illuminations and detection windows were employed for the evaluation, since it was expected that the experimental configuration would be another factor potentially influencing the intensity of the lactose peak, along with the particle size itself. In both samples, the distribution of Raman photons became broader with the increase in particle size, as the mean free path of laser photons, the average photon travel distance between consecutive scattering locations, became longer under this situation. When the particle size was the same, the Raman photon distribution was narrower in the pellets since the individual particles were more densely packed in a given volume (the shorter mean free path). When the size of the detection window was small, the number of photons reaching the detector decreased as the photon distribution was larger. Meanwhile, a large-window detector was able to collect the widely distributed Raman photons more effectively; therefore, the trends of intensity change with the variation in particle size were dissimilar depending on the employed spectral acquisition schemes. Overall, the Monte Carlo simulation was effective at probing the photon distribution inside the samples and helped to support the experimental observations.

Protection of Penaeus monodon against white spot syndrome by continuous oral administration of a low concentration of Bacillus subtilis spores expressing the VP28 antigen.

In this study, Bacillus subtilis spores expressing a chimeric protein, CotB-VP28, were used as a probiotic vaccine to protect black tiger shrimps (Penaeus monodon) against white spot syndrome virus (WSSV) infection. Oral administration of pellets coated with CotB-VP28 spores (at ≥1 × 109  CFU per g pellet) to shrimps induced immune-relating phenoloxydase activity (PO) in shrimps after 14 days of feeding (prior challenge) and at day 3 post challenge (1·26 and 1·70 fold increase respectively). A 75% protection rate was obtained by continuous feeding of the spore-coated pellets at ≥1 × 109  CFU per g for 14 days prior to WSSV challenge and during all the postchallenge period. Even when the amount of CotB-VP28 spores in feed pellets was reduced down to ≥5 × 107  CFU per g and ≥1 × 106  CFU per g, relatively high protection rates of 70 and 67·5%, respectively, were still obtained. By contrast, feeding pellets without spores (untreated group) and with naked spores (PY79 group) at ≥1 × 109  CFU per g could not protect shrimps against WSSV. These data suggest that supplementation of CotB-VP28 spores at low dose of ≥1 × 106  CFU per g could be effective as a prophylactic treatment of WSS for black tiger shrimps. SIGNIFICANCE AND IMPACT OF THE STUDY: This study reports the protective efficacy of Bacillus subtilis CotB-VP28 spores on black tiger shrimps (Penaeus monodon) against white spot syndrome virus infection. Oral administration of pellets coated with CotB-VP28 spores (≥1 × 109  CFU per g) conferred 75% protection after white spot syndrome virus challenge. Even after reducing CotB-VP28 spores in feed pellets to ≥1 × 106  CFU per g, 67·5% protections was still obtained. These data indicate that supplementation of CotB-VP28 spores at a low dose of ≥1 × 106  CFU per g could be effective in prophylaxis against white spot syndrome in black tiger shrimps.

Comprehensive development and testing of the ASIST-GBV, a screening tool for responding to gender-based violence among women in humanitarian settings.

BACKGROUND: Conflict affected refugees and internally displaced persons (IDPs) are at increased vulnerability to gender-based violence (GBV). Health, psychosocial, and protection services have been implemented in humanitarian settings, but GBV remains under-reported and available services under-utilized. To improve access to existing GBV services and facilitate reporting, the ASIST-GBV screening tool was developed and tested for use in humanitarian settings. This process was completed in four phases: 1) systematic literature review, 2) qualitative research that included individual interviews and focus groups with GBV survivors and service providers, respectively, 3) pilot testing of the developed screening tool, and 4) 3-month implementation testing of the screening tool. Research was conducted among female refugees, aged ≥15 years in Ethiopia, and female IDPs, aged ≥18 years in Colombia. RESULTS: The systematic review and meta-analysis identified a range of GBV experiences and estimated a 21.4 % prevalence of sexual violence (95 % CI:14.9-28.7) among conflict-affected populations. No existing screening tools for GBV in humanitarian settings were identified. Qualitative research with GBV survivors in Ethiopia and Colombia found multiple forms of GBV experienced by refugees and IDPs that occurred during conflict, in transit, and in displaced settings. Identified forms of violence were combined into seven key items on the screening tool: threats of violence, physical violence, forced sex, sexual exploitation, forced pregnancy, forced abortion, and early or forced marriage. Cognitive testing further refined the tool. Pilot testing in both sites demonstrated preliminary feasibility where 64.8 % of participants in Ethiopia and 44.9 % of participants in Colombia were identified with recent (last 12 months) cases of GBV. Implementation testing of the screening tool, conducted as a routine service in camp/district hospitals, allowed for identification of GBV cases and referrals to services. In this phase, 50.6 % of participants in Ethiopia and 63.4 % in Colombia screened positive for recent experiences of GBV. Psychometric testing demonstrated appropriate internal consistency of the tool (Cronbach's α = 0.77) and item response theory demonstrated appropriate discrimination and difficulty of the tool. CONCLUSION: The ASIST-GBV screening tool has demonstrated utility and validity for use in confidential identification and referral of refugees and IDPs who experience GBV.

Axially perpendicular offset Raman scheme for reproducible measurement of housed samples in a noncircular container under variation of container orientation.

An axially perpendicular offset (APO) scheme that is able to directly acquire reproducible Raman spectra of samples contained in an oval container under variation of container orientation has been demonstrated. This scheme utilized an axially perpendicular geometry between the laser illumination and the Raman photon detection, namely, irradiation through a sidewall of the container and gathering of the Raman photon just beneath the container. In the case of either backscattering or transmission measurements, Raman sampling volumes for an internal sample vary when the orientation of an oval container changes; therefore, the Raman intensities of acquired spectra are inconsistent. The generated Raman photons traverse the same bottom of the container in the APO scheme; the Raman sampling volumes can be relatively more consistent under the same situation. For evaluation, the backscattering, transmission, and APO schemes were simultaneously employed to measure alcohol gel samples contained in an oval polypropylene container at five different orientations and then the accuracies of the determination of the alcohol concentrations were compared. The APO scheme provided the most reproducible spectra, yielding the best accuracy when the axial offset distance was 10 mm. Monte Carlo simulations were performed to study the characteristics of photon propagation in the APO scheme and to explain the origin of the optimal offset distance that was observed. In addition, the utility of the APO scheme was further demonstrated by analyzing samples in a circular glass container.

A rare cause of hemosuccus pancreaticus diagnosed with endoscopic ultrasound.

INTRODUCTION: Hemosuccus pancreaticus (HP), hemorrhage from the papilla of Vater through the pancreatic duct (PD), is a rare cause of upper gastrointestinal bleeding. It may be caused by chronic pancreatitis, pseudoaneurism and pancreatic tumors. Only 2% of HP involves the hepatic arteries. Endoscopic ultrasound (EUS) may not only visualize the presence of HP, previously seen on computed tomography/magnetic resonance imaging (CT/MRI), but also reveal additional pathology. CASE REPORT: A 62-year-old man was admitted with severe intermittent gastrointestinal bleeding. He underwent gastroscopy, colonoscopy and capsule endoscopy without sign of bleeding. The patient had no previous history of pancreatitis or infection. On CT and MRI scan with angiography, an aneurism of the common hepatic artery (CHA) was found, with a dilatation of the main PD toward the tail of the pancreas, but no apparent source of bleeding. EUS was then performed, and could show a partial thrombosed aneurysm of a hepatica with a diameter of 5 cm. In addition, a narrow fistula between the hepatic artery and PD could be identified using power Doppler. The patient was subsequently operated, which revealed a thrombosed arteriosclerotic aneurysm in the CHA with fistula to the PD. CONCLUSION: To the best of our knowledge, this is the second reported case of a severe gastrointestinal bleeding due to a fistula between the CHA and PD. The use of EUS in diagnosing this rare condition has not been reported before, but seems feasible.