Search

Mesothelial cysts of the diaphragm are uncommon congenital lesions that can be easily misdiagnosed due to their resemblance to other cystic formations, particularly hepatic hydatid cysts. We present the case of a 19-year-old male with no significant past medical history who complained of dull, heavy pain in the right costovertebral region persisting for several weeks. Initial laboratory tests were within normal limits. A contrast-enhanced CT scan revealed a retrohepatic cystic lesion measuring 45 mm, closely associated with the right hemidiaphragm and liver, which was suggestive of a hydatid cyst. However, negative hydatid serology ruled out this diagnosis, leading to the decision for surgical intervention. During surgery via a right subcostal approach, a 4 cm cystic lesion was found tightly adherent to the diaphragm. Complete excision of the cyst along with repair of the diaphragmatic defect was performed without complications. Histopathological examination confirmed the diagnosis of a mesothelial cyst of the diaphragm, a rare benign entity. The patient had an uneventful postoperative course and was discharged on the third day. Follow-up over one year showed no recurrence of symptoms or lesions. This case highlights the diagnostic challenges associated with mesothelial cysts and emphasizes the importance of surgical excision for definitive diagnosis and symptom relief.

Meckel's diverticulum, a congenital anomaly of the omphalomesenteric duct, is a rare cause of acute abdomen and poses significant diagnostic challenges due to its variable presentation and complications such as perforation. We present the case of a 19-year-old male with a 24-hour history of right iliac fossa pain progressing to generalized abdominal tenderness. Laboratory results showed leukocytosis and elevated C-reactive protein, while CT imaging suggested pneumoperitoneum and an inflamed Meckel diverticulum. Laparoscopic exploration, followed by conversion to laparotomy, confirmed a perforated Meckel diverticulum, which was resected with an uneventful recovery. This case highlights the importance of including Meckel's diverticulum in the differential diagnosis of acute abdomen in young patients, emphasizing the utility of CT imaging and the need for prompt surgical intervention to achieve favorable outcomes.

Introduction: Sister Mary Joseph's Nodule (SMJN) is a rare clinical sign of metastatic abdominal malignancies, particularly cholangiocarcinoma, with limited reported cases in the literature. SMJN is associated with poor prognosis, often indicating advanced disease with widespread metastasis. Case presentation: we present a new case report of SMJN in a 46-year-old patient who presented with ten days of right upper quadrant pain, obstructive jaundice, and fever. Physical examination revealed obstructive jaundice with scratchy lesions in the trunk and tenderness in the right upper quadrant, along with a two-centimeter protuberant, tender ulcerated umbilical nodule. Despite previous management with antibiotics and local care, the nodule had been progressively growing over a month. Imaging studies revealed a hilar cholangiocarcinoma with extensive local invasion and multiple distant metastases, including cutaneous involvement at the umbilicus. Biopsies of the umbilical lesion confirmed metastatic adenocarcinoma of the biliary tree. Palliative measures, including biliary stent placement and chemotherapy, were initiated. Discussion: SMJN is a rare but notable cutaneous manifestation associated with advanced intra-abdominal malignancies. Although often linked to gastric, pancreatic, and ovarian cancers, it is uncommonly reported with cholangiocarcinoma. SMJN typically signifies a late-stage, metastatic progression, with prognosis largely determined by the underlying primary cancer's aggressiveness and the extent of metastasis. In this case, SMJN presented alongside other symptoms of advanced disease, such as obstructive jaundice and extensive local invasion, underscoring its prognostic significance. Recognition of SMJN is essential for prompt diagnosis and initiation of palliative interventions in patients with suspected metastatic disease. This case adds to the limited literature on cholangiocarcinoma-associated SMJN and highlights the need for awareness among clinicians regarding atypical metastatic presentations, which may facilitate earlier diagnosis and tailored care strategies. Conclusion: This case emphasizes the importance of recognizing SMJN as a rare but crucial indicator of advanced cholangiocarcinoma. It highlights the clinical challenges posed by metastatic cholangiocarcinoma and underscores the need for a comprehensive approach to palliative care in patients with SMJN.

Spontaneous intraperitoneal rupture of hepatic hydatid cysts is a rare but serious complication that can lead to significant morbidity and mortality due to risks such as anaphylactic shock and secondary peritoneal hydatidosis. This report presents the case of a 59-year-old male farmer from a rural area of Tunisia who presented with severe abdominal pain, nausea, and vomiting. Diagnostic imaging revealed a large hepatic cyst with free peritoneal fluid, indicating a ruptured hydatid cyst. Emergency surgery involved cyst evacuation, peritoneal lavage, and drainage. Postoperatively, the patient developed a transient biliary fistula but recovered well with albendazole therapy to prevent recurrence. Six months post-surgery, the patient remains asymptomatic. The case underscores the importance of considering hydatid disease in acute abdomen diagnoses in endemic regions and highlights the critical role of imaging and timely surgical intervention. The literature review indicates variability in the prevalence of cyst rupture and emphasizes the need for a comprehensive approach combining surgery and antiparasitic treatment for effective management and recurrence prevention.

The dynamic analysis of structures with uncertain parameters presents an attractive field of structural health monitoring in many cases of technological interest. In the dynamic analysis of hydraulic structures, such as existing dams, modeling assumptions, resulting inaccuracies, and changes in seismic loading are typically the main sources of uncertainties. Many hydraulic structures of concrete can be subjected to seismic loads. However, it is necessary to take haphazard or random phenomena as crucial considerations when assessing the security of these structures or planning new ones. This paper shows computational analysis for the characterization of the behavior of a concrete gravity dam under seismic loads, which are considered sources of uncertainties. The multi-linear regression methodology was performed and applied to evaluate the dynamic response of the considered structure. Numerous nonlinear time history analyses based on Latin Hypercube Sampling were realized to investigate the effect of uncertain parameters on the dynamic response. These analyses were applied to two types of seismic actions, the near and far earthquakes, which act on a concrete gravity dam. Then, a sensitivity analysis was used for each random variable to quantify its risk and clarify its influence on the dynamic behavior of the dam. Results divulge that for near-fault cases, major variables affecting the global sensitivity across all limit states are the Young’s modulus of soil and concrete. On the other hand, for far-fault cases, the important variables influencing the global sensitivity index include the compressive strength of concrete, Young’s modulus of soil, and cohesion.

In the context of developing modern smart energy systems, integrating Vehicle-to-Grid (V2G) technology within microgrids offers valuable prospects for advancing energy efficiency and sustainability. In this perspective, motivation for the present work mainly stems from the rising need for intelligent and innovative grid management strategies that are capable of balancing energy demand and supply, sustaining economic viability, securing system stability as well as accommodating the growing penetration of Electric Vehicles (EVs). However, strategically managing the dynamic interaction between EVs participating in V2G operations and the microgrid can become complex due to various shifting factors. These include different charging/discharging preferences, EVs flexibility constraints as well as stochastic V2G variables. Thereby, a robust and comprehensive framework is needed to optimize EV-microgrid interactions. In response to this challenge, this study investigates a non-cooperative game approach for decentralized optimization of V2G operations within a microgrid environment. A case study with 5 EVs then with a fleet of 100 EVs is developed and analyzed to showcase the suggested approach. Numerical results show that with 5 EVs, the contribution to the microgrid's daily energy demand is about 5.5%, which increases to 35.37% with 100 EVs. These results highlight the effectiveness of the proposed framework and provide valuable insights for enhancing microgrid sustainability and smart grid management.

Introduction: Intestinal tuberculosis (ITB), a rare yet severe manifestation of Mycobacterium tuberculosis infection, poses significant diagnostic and therapeutic challenges due to its nonspecific clinical presentation. Perforation, a life-threatening complication, necessitates prompt surgical intervention and effective antituberculous therapy. Case presentation: This case study highlights a 41-year-old immunocompetent male who presented with fever, abdominal pain, vomiting, and significant weight loss. A computed tomography scan revealed minimal pneumoperitoneum, intestinal wall thickening, mesenteric fat stranding, lymphadenopathy, and an intra-abdominal abscess. Exploratory laparotomy identified a perforation at the terminal ileum, leading to ileocaecal resection and stoma formation. Histopathological examination confirmed ITB, and a nine-month regimen of antituberculous medication was initiated. Discussion: ITB, more common in immunocompromised individuals, can also affect immunocompetent patients, often mimicking other gastrointestinal conditions and delaying diagnosis. This case underscores the importance of considering ITB in differential diagnoses for patients with vague gastrointestinal symptoms. Diagnostic confirmation typically requires a combination of clinical, radiological, and microbiological assessments, with histopathology playing a crucial role. Factors such as age and comorbidities can increase the risk of severe complications like perforation. Surgical resection with anastomosis tends to yield better outcomes than direct closure, and comprehensive antituberculous therapy is essential for successful treatment. Conclusion: The complexity of diagnosing and managing ITB, compounded by its severe complications, necessitates heightened awareness among healthcare providers. Accurate diagnosis, timely surgical intervention, and rigorous antituberculous therapy are vital for improving patient outcomes, especially in high-risk populations or regions with prevalent TB.

In the context of growing focus over climate changes and promoting sustainability across a various range of fields, microgrids can play a significant role in global decarbonization endeavors, contributing to carbon neutrality and ultimately attaining net-zero emissions in the energy sector. The objective of this paper is to address the integration of voluntary carbon trading within microgrid communities, in the perspective to mitigate greenhouse gas (GHG) emissions and boost the integration of renewable energy sources (RES). Introducing five modular algorithms managing key aspects of carbon trading, the study engineers a comprehensive framework aiming to optimally orchestrate the Voluntary Carbon Market (VCM) within microgrids. Particularly, the developed algorithms address aspects such as market enrollment decision, optimal energy dispatch, managing the market transactions, sellers-buyers matching as well as the dynamic adjustment of carbon credit prices and emission taxes. The framework has been rigorously tested across three distinct scenarios. Results show that the developed VCM, with adequate configurations, has the potential to incentivize microgrids to curtail their GHG emissions, encourage the integration of more RES into their generation mix, and rewards the more proactive microgrids with substantial financial incentives.

This study confronts the new concept of ‘surface storage’ with the old concept of ‘sponge effect’ to explain the spatio-temporal variability of the annual daily maximum flows measured in 17 watersheds of southern Quebec during the period 1930–2019. The new concept takes into account the hydrological impacts of wetlands and other topographic components of the landscape (lakes, depressions, ditches, etc.) while that of the sponge effect only takes into account the hydrological impacts of wetlands. With regard to spatial variability, the area of wetlands and other water bodies is the variable best correlated negatively with the magnitude but positively with the duration of flows. As for the temporal variability, the application of the long-term trend tests revealed a significant increase in the magnitude and, to a lesser extent, the duration of the flows occurring in the watersheds of the north shore characterized by a greater area of wetlands and other water bodies (>5%). This increase is explained by the fact that the storage capacity of these land types, which remains unchanged over time, does not make it possible to store the surplus runoff water brought by the increase in rainfall during the snowmelt season. HIGHLIGHTS Wetlands are negatively correlated with the magnitude of flood flows.; Wetlands are positively correlated with their duration.; Wetlands are not correlated to their frequency and variability.; Wetlands can promote significant increases in flood magnitude and duration over time.; This spatio-temporal variability in the magnitude and duration of flood flows is due to the storage of surface water by wetlands.;

This study compares the impacts of climate, agriculture and wetlands on the spatio-temporal variability of seasonal daily minimum flows during the period 1930–2019 in 17 watersheds of southern Quebec (Canada). In terms of spatial variability, correlation analysis revealed that seasonal daily minimum flows were mainly negatively correlated with the agricultural surface area in watersheds in spring, summer and fall. In winter, these flows were positively correlated with the wetland surface area and March temperatures but negatively correlated with snowfall. During all four seasons, spatial variability was characterized by higher daily minimum flow values on the north shore (smaller agricultural surface area and larger wetland surface area) than those on the south shore. As for temporal variability, the application of six tests of the long-term trend analysis showed that most agricultural watersheds are characterized by a significant increase in flows during the four seasons due to the reduction in agricultural area, thus favoring water infiltration, and increased rainfall in summer and fall. On the other hand, the reduction in the snowfall resulted in a reduction in summer daily minimum flows observed in several less agricultural watersheds. HIGHLIGHTS Daily minimum flows were primarily correlated with the agricultural area in spring, summer and fall.; Daily minimum flows were primarily correlated with wetlands in winter.; Daily minimum flows increased significantly over time in winter and fall.; Daily minimum flows decreased overall over time in spring and summer.; Flow increases were widespread across all four seasons in the most agricultural watersheds.;

Abstract Flexible hybrid electronics (FHE) offers potential for fast computation and communication needed in applications such as human–machine interfaces, electronic skin, etc. FHE typically comprises devices that can vary from nano‐ to chip scale, and their integration using a common process is often challenging. Herein, a printed electronics route is presented to integrate the ultrathin chips (chip‐scale) and nanowires (NWs)‐based electronic layers (nanoscale) on the same substrate. The fabrication process is categorized into three stages: i) direct transfer printing of ultrathin chips (UTCs), ii) contact printing of nanoscale structures, and iii) metal printing using the direct ink write (DIW) method to define electrodes/interconnects. The UTC printing process is carefully optimized by studying the performance of transistors present on them. Electrical data collected from 14 transistors located on 3 different chips show negligible variation in performance after they are transfer printed—thus confirming the efficacy of the printing technique. The superior grade quality of ZnO‐NWs‐based electronic layers printed on the same substrate is also demonstrated by constructing UV photodetectors using DIW printing. The photodetectors show high responsivity (≈2 × 107 A W−1) and specific detectivity (≈5 × 1015 Jones) at a low UV intensity of 0.5 µW cm−2.

Abstract Ewing's sarcoma tumors (ES) are a rare entity exceptionally localized on the liver. We report a case of an ES of the liver in a 26‐year‐old man who presented with abdominal pain. The diagnosis was confirmed with a histopathological examination of the left hepatectomy specimen and adjuvant chemotherapy was received.

Abstract Transfer printing of high mobility inorganic nanostructures, using an elastomeric transfer stamp, is a potential route for high-performance printed electronics. Using this method to transfer nanostructures with high yield, uniformity and excellent registration over large area remain a challenge. Herein, we present the ‘direct roll transfer’ as a single-step process, i.e., without using any elastomeric stamp, to print nanoribbons (NRs) on different substrates with excellent registration (retaining spacing, orientation, etc.) and transfer yield (∼95%). The silicon NR based field-effect transistors printed using direct roll transfer consistently show high performance i.e., high on-state current (Ion) >1 mA, high mobility (μ eff) >600 cm2/Vs, high on/off ratio (I on/off) of around 106, and low hysteresis (

Abstract The Printed Electronics (PE) is expected to revolutionise the way electronics will be manufactured in the future. Building on the achievements of the traditional printing industry, and the recent advances in flexible electronics and digital technologies, PE may even substitute the conventional silicon-based electronics if the performance of printed devices and circuits can be at par with silicon-based devices. In this regard, the inorganic semiconducting materials-based approaches have opened new avenues as printed nano (e.g. nanowires (NWs), nanoribbons (NRs) etc.), micro (e.g. microwires (MWs)) and chip (e.g. ultra-thin chips (UTCs)) scale structures from these materials have been shown to have performances at par with silicon-based electronics. This paper reviews the developments related to inorganic semiconducting materials based high-performance large area PE, particularly using the two routes i.e. Contact Printing (CP) and Transfer Printing (TP). The detailed survey of these technologies for large area PE onto various unconventional substrates (e.g. plastic, paper etc.) is presented along with some examples of electronic devices and circuit developed with printed NWs, NRs and UTCs. Finally, we discuss the opportunities offered by PE, and the technical challenges and viable solutions for the integration of inorganic functional materials into large areas, 3D layouts for high throughput, and industrial-scale manufacturing using printing technologies.

Abstract We described two cases of acute pancreatitis secondary to ansa pancreatica. The first patient was diagnosed on MRCP and improved after standard treatment of AP. In the second case, ansa pancreatica was diagnosed on IOP. At the second episode of AP, sphincterotomy of the minor papilla was performed.

Abstract Chilaiditi sign is a rare condition typically mistaken for pneumoperitoneum. CT scan can confirm the diagnosis. Its management is conservative that is why it should be well known by surgeons to avoid unnecessary exploratory laparotomies.

Fifty-five patients who suffered from COVID-19, who were still very ill after several months, with extreme fatigue, effort exhaustion, brain fog, anomia, memory disorder, anosmia, dysgeusia, and other multi-systemic health problems have been followed in a family practice setting between May 2021 and July 2022. Data extracted from the medical records of the 55 patients (40 women), mean age 42.4 (12 to 79 years), and a qualitative study of 6 of them using a semi-open-ended questionnaire allowed to highlight the clinical picture described by WHO as post-acute COVID-19 syndrome (PACS) also known as long COVID. We used brain single-photon emission computed tomography (SPECT-CT) in thirty-two patients with a high severity index and a highly impaired functional status, demonstrating vascular encephalopathy in twenty nine patients and supporting the hypothesis of a persistent cerebral vascular flow disorder in post COVID-19 condition. The patients will benefit from the consortium COVID Human Genetic Effort (covidhge.com) to explore the genetic and immunological basis of their problem, as 23/55 cases don’t have immunological certainty of a COVID-19 infection. There is no known verified treatment. Analyzing the data from the first 52 patients, three categories of patients emerged over time: 16 patients made a full recovery after 6–8 months, 15 patients were able to return to life and work after 12–18 months with some sequelae, both groups being considered cured. In the third group, 21 patients are still very ill and unable to resume their work and life after 18 months. The biopsychosocial consequences on patients’ lives are severe and family doctors are left out in the cold. It is necessary to test the reproducibility of this description, conducted on a small number of patients. Nevertheless, identifying, monitoring and supporting these patients is a necessity in family medicine.

Abstract It is imperative for surgeons to have a heightened awareness of complications of jejunal diverticular disease so that they can act quickly and contribute to a successful clinical outcome for their patients.

Abstract Focal nodular hyperplasia (FNH) is a common asymptomatic benign hepatic tumor encountered in middle‐aged women. However, pedunculated FNH is exceedingly rare and more frequently associated with complications. That is why surgical management is mandatory in this form.

Abstract We wish to highlight that on encountering a suspicious hepatic and a colonic lesion, the possibility of TB should also be kept in mind apart from the obvious possibility of metastasis of a colonic cancer especially in an endemic country like Tunisia.

Gallbladder agenesis is a rare congenital malformation characterized by the absence of the gallbladder and cystic duct due to an anomaly in the embryonic development. It is commonly associated with other congenital abnormalities, and the isolated form is extremely rare. Its clinical presentation is variable. Actually, GA is more often incidentally diagnosed. MRCP is considered to be the diagnosis method of choice since it avoids unnecessary and risky surgery in symptomatic patients. Here we report the case of a radiologically incidentally discovered gallbladder agenesis in a 68-year-old patient.

Colo-rectal intussusception is rare in adults and is often secondary to malignant lesions, rarely benign lesions such as colonic lipomas can also be the cause. We present the case a 60-year-old man who presented to the emergency department with acute abdominal pain. On physical examination, the abdomen was distended with diffuse tenderness. CT scan of the abdomen revealed a colo-rectal intussusception secondary to a rectal lipoma with parietal pneumatosis of the invaginated loop. An emergency laparotomy was performed. Intraoperatively the radiological findings were confirmed. A rectosigmoid resection (Hartmann´s procedure) taking off the lipoma and the invaginated segment of the colon was performed and the patient had an unevent full recovery. Histopathology confirmed a 6cm sub-mucosal lipoma without evidence of malignancy. As the diagnosis of a benign disease in patients presenting with colonic intussusception can only be made on pathological examination, this entity should be managed as a malignant lesion due to the high incidence of malignancy.

Groove pancreatitis (GP) is a rare form of chronic pancreatitis involving the groove area bound by the pancreatic head, the duodenum, and the common bile duct. The diagnosis of this entity is challenging since it can mimic pancreatic carcinoma. We herein report the case of groove pancreatitis diagnosed in a 37 year old men, with a past history of chronic alcohol consumption. The patient was admitted for several times over the past three years because of recurrent alcohol-induced pancreatitis. The diagnosis of groove pancreatitis was made on the basis of CT, MRI and EUS findings. A medical treatement was initially attempted. In the absence of improvement in clinical symptoms, a pancreatico-duodenectomy was performed with satisfying results at 24 months follow up. Pancreatico-duodenectomy is the treatement of choice in groove pancreatitis since it leads to total resolution of clinical symptoms.

Abstract Si‐nanoribbon‐based high‐performance field‐effect transistors (FETs) with room temperature (RT)‐deposited dielectric are presented. The distinct feature of these devices is that the high‐quality SiNx dielectric deposition at RT, directly on the transfer‐printed nanoribbons, is compatible with most flexible substrates. The performance of these FETs (mobility ≈656 cm2 V−1 s−1 and on/off ratio >106) is on par with the highest performance of similar devices reported with high‐temperature processes, and significantly higher than devices reported with low‐temperature processes. The transfer and output characteristics of nanoribbon‐based field‐effect transistors under planar, tensile, and compressive bending and multiple bending cycles (100) show excellent mechanical stability of the devices as they retain performance. The device characteristics are also compared with the equivalent simulation data. The excellent response of nanoribbon‐based FETs and the fabrication compatibility with diverse flexible substrates makes the presented approach attractive for flexible electronics applications such as conformal tactile active matrix sensors for e‐skin, where high performance is needed.

Hydatid disease is endemic in Tunisia. The involvement of the female genital tract is uncommon, and the occurrence in the fallopian tube is exceptional. We present a case of a 42-year-old woman who had complained of a 4-month history of lower abdominal pain. The abdominal ultrasonography and CT scan showed a multiloculated cystic lesion in the left adnexa. The exploratory laparotomy found a cystic mass developing in the left fallopian tube. Left salpingectomy was performed. The pathological examination confirmed the diagnosis of hydatid cyst disease. No recurrence was detected at the 2-year follow-up. Tubal hydatid cyst is an extremely rare condition that should be considered in the differential diagnosis of any cystic lesion in patients from endemic areas.

This paper aims to measure the effect of tax contributions in promoting innovation while highlighting the role of corporate taxes in governance quality in nations within and outside the Organization for Economic Co-operation and Development (OECD). The study applied the generalized method of moments (GMM) framework and found that good governance invariably increases the Innovation Index. Moreover, research and development expenditures revealed a positive association with the Innovation Index. However, corporate taxes and taxes paid by the business sector harm the Innovation Index. Following the investigation, we recommended that policymakers should plan well to balance the costs of innovation and tax incentives, to avoid stimulating unproductive innovations or affecting operating budgets.