Small Wall Research Articles

Direct Visualization and Quantitative Imaging of Small Airway Anatomy In Vivo Using Deep Learning Assisted Diffractive OCT.

In vivo imaging and quantification of the microstructures of small airways in three dimensions (3D) allows a better understanding and management of airway diseases, such as asthma and chronic obstructive pulmonary disease (COPD). At present, the resolution and contrast of the currently available conventional optical coherence tomography (OCT) imaging technologies operating at 1300 nm remain challenging to directly visualize the fine microstructures of small airways in vivo. We developed an ultrahigh-resolution diffractive endoscopic OCT at 800 nm to afford a resolving power of 1.7 µm (in tissue) with an improved contrast and a custom deep residual learning based image segmentation framework to perform accurate and automated 3D quantification of airway anatomy. The 800-nm diffractive OCT enabled the direct delineation of the structural components in the small airway wall in vivo. We further first demonstrated the 3D anatomic quantification of critical tissue compartments of small airways in sheep using the automated segmentation method. The deep learning assisted diffractive OCT provides a unique ability to access the small airways, directly visualize and quantify the important tissue compartments, such as airway smooth muscle, in the airway wall in vivo in 3D. These pilot results suggest a potential technology for calculating volumetric measurements of small airways in patients in vivo.

Emergency laparoscopic surgery on a patient who visited the emergency room with lower abdominal pain

Internal hernias account for fewer than 6% of all small intestinal obstructions; of these, hernias caused by defects in the sigmoid colon are particularly challenging to detect. Misdiagnosis may occur if non-surgical symptoms (such as rebound tenderness) are not observed in the emergency room. We report the case of a consent who visited the emergency room with recurrent non-specific lower abdominal pain. She exhibited an internal hernia that had triggered small intestinal ischemia between the mesosigmoid (mesentery) and ovary. A 36-year-old female patient visited the emergency room of our hospital with acute left-lower abdominal pain, nausea, and vomiting that occurred 1 h after meals. We found no palpable mass or enlarged organ. Abdominal computed tomography (CT) revealed segmental small bowel wall thickening with mesenteric congestion in the left-lower quadrant, and small bowel ischemia attributable to internal herniation or adhesion. In addition, a small amount of pelvic ascites and multiple liver cysts were observed. A surgeon was immediately consulted and emergency laparoscopic surgery was performed.

Scattering Tendency of Surface Objects during Thrusting in Vicinity of Celestial Body

When a spacecraft fires its thrusters near the surface of a celestial body, objects on the surface of the body are scattered in the vertical direction and adhere to the cameras and ranging instruments mounted on the spacecraft, degrading their performance. In order to establish a future spacecraft design theory that is less sensitive to the scattering of surface objects, we first investigate the scattering factors and scattering tendencies of surface objects. We predict that celestial surface objects are scattered according to the wall angle of the crater created by the thruster plume. The relationship between the crater shape and the object dispersal angle is not fully understood. Mechanisms of crater formation include viscous erosion, which creates craters with a small wall angle, and bearing capacity failure, which creates craters with a large wall angle. Here, we experimentally clarify the transition point between the two crater formation mechanisms when the thruster plume penetrates soil with various shear strength values. We find that the objects disperse along the crater wall for both mechanisms. Based on the results, we examine measures for preventing the spacecraft from being hit by scattered surface objects.

Tree-Ring Dated Changes in Gloucestershire’s Vernacular Timber-Frame Traditions

A main component of the Gloucestershire Dendrochronology Project was the systematic recording and accurate dating by tree-ring analysis of 50 buildings in Newent, Tewkesbury and Gloucester. Together with 128 previously published tree-ring-dated buildings, this has allowed date ranges for 42 stylistic features of vernacular timber-framing in Gloucestershire to be established. Two periods of rapid change from the 1380–1400s and the 1520–50s are shown. The first period is marked by the use of the crown-strut truss, the rise of open-hall decoration and the use of passing braces and close studding. The second period sees the increased use of first-floor flooring, smoke control, on-edge joists and small square panels, and both windbraces and wall braces change shape from curved to straight.

636 LOOKING AT THE BIGGER PICTURE: FROM ACUTE MYOCARDITIS TO THE DIAGNOSIS OF A MULTISYSTEMIC DISEASE

Abstract A 49-year-old man without cardiovascular risk factors, recently diagnosed of asthma and rino-sinusal polyposis, entered the Emergency Department for chest pain, shortness of breath and non-productive cough. The patient was in stable conditions. Laboratory exams showed eosinophilic leucocytosis (WBC 33.000/sqmm, 60% eosinophils) and a mild elevation of C-reactive protein (CRP 2,2 mg/dL). ECG showed a sinus rhythm with flat T-waves in the antero-lateral leads. Troponin values were high but not suggestive of acute myocardial damage (9900 - 9700 ng/L). Echocardiography showed normal biventricular volumes with moderately depressed left ventricular ejection fraction (40%), hypokinesia of the antero-lateral wall in the mid-apical segments and mild pericardial effusion. During the hospital stay he developed progressive respiratory failure, and he was transferred to a tertiary center to perform an endomyocardial biopsy (EMB) in the suspicion of acute myocarditis. EMB showed multifocal interstitial and sub-endocardial inflammatory infiltrates (predominantly eosinophils) with foci of myocellular damage, small vessels wall inflammation with hypertrophy of the muscular tunica. The overall picture was consistent with diffuse moderate eosinophilic myocarditis with small vessels vasculitis. The right heart cath performed in the same procedure and during diuretic therapy showed a normal hemodynamic profile (RAP 5 mmHg, PCWP 13 mmHg, CI 3,7 L/min/sqm). The patient was treated with high dose steroids, first intravenously (methylprednisolone 125 mg/day for three days), then orally (prednisone 80 mg/day) in slow decalage until a maintenance dose of 12.5 mg daily. The recent-onset of asthma with hyper-eosinophilia and rhino-sinus-bronchial syndrome in the light of the present cardiac condition was consistent with eosinophilic granulomatosis with polyangiitis (EGPA). Chest CT showed two areas of ground glass at the left superior and right superior lobes. Other potential haematological and infective causes of hyper eosinophilia and viral causes of myocarditis were ruled out. After the treatment, his clinical conditions improved, ECG was completely normalized, left ventricular systolic function improved (LVEF 50%) and eosinophil count was significantly reduced (Eosinophils 830/sqmm, 8,9%), whereas CT showed resolution of the lung infiltrates. One month after discharge, the patient was still asymptomatic. Cardiac MRI showed normal biventricular ejection fraction (LVEF 55%) with circumferential subendocardial fibrosis involving only the left ventricle. EMB showed a complete resolution of the inflammatory infiltrates and of the vasculitic aspects. Eosinophil count was elevated (5660/sqmm, 36%). Therefore, steroidal dose was raised to 50 mg/day. After rheumatologic evaluation, a steroidal sparing strategy with cyclophosphamide and anti-IL5 antibody Mepolizumab was adopted, with good laboratory response. Three months later, cardiac MRI showed no signs of active disease. No further EMB was scheduled. Through the presentation of this unusual cause of acute myocarditis, we want to underscore the importance of an early referral to a tertiary level center of patients with suspected myocarditis and reduced systolic function and the usefulness of histology to guide medical therapy in specific forms of myocarditis that can lead to a potential complete recovery.

Experimental Analysis of Surface Application of Fiber-Reinforced Polymer Composite on Shear Behavior of Masonry Walls Made of Autoclaved Concrete Blocks

This paper presents the results of an experimental study of the shear behavior of masonry walls made of aero autoclaved concrete (AAC) blocks strengthened by externally bonded fiber-reinforced polymer (FRP) composites. Fifteen small wall specimens were constructed and tested in a diagonal compression scheme. Two types of composite materials—carbon- and glass-reinforced polymers—were arranged in two configurations of vertical strips, adopted to the location of the unfilled head joints. The effect of the strengthening location and strengthening materials on changes in the strength and deformability parameters are discussed and the failure process of unstrengthened walls is also presented. The placement of the composite on unfilled head joints proved to be a better solution. Carbon-fiber-reinforced polymer (CFRP) strips provided a threefold increase in stiffness, a 48% increase in load-bearing capacity and a high level of ductility in the post-cracking phase. Glass-fiber-reinforced polymer (GFRP) strips offered a 56% increase in load-bearing capacity but did not change the stiffness of the masonry and provided relatively little ductility. Placing the composite between unfilled joints was only reasonable for CFRP composites, providing a 35% increase in load-bearing capacity but with negligible ductility of the masonry.

Electrical Coupling Effect of Forksheet FET for Power, Performance, and Area Analysis

We analyze the electrical coupling effect of a fork-shaped field-effect transistor (FSFET) and compare FSFET and the nanosheet FET (NSFET) in terms of logic cell power, performance, and area. FSFET enables excellent scaling and is a promising candidate to replace NSFET at the sub 3-nm node. However, FSFETs are vulnerable to electrical coupling because n/p-type FETs (N/PFETs) are close to each other with the dielectric wall in the middle. This electrical coupling causes threshold voltage shift and increases in subthreshold slope, ON-current, and drain-induced barrier lowering (DIBL). Since the gate bias of the adjacent device has a greater effect than the source and drain, the coupling effect occurs more when the gates of N/PFETs are split. Our results show that small wall, small channel width, and high wall permittivity cause a significant electrical coupling in a sub 3-nm node. Coupling within the criteria can be secured for an FSFET with a 15-nm channel width by applying a 17-nm SiO2 wall. With these coupling guidelines, the FSFET logic cell shows up to 21% improvement in an area compared to NSFET at the 15-nm channel width. Compared with NSFET, the FSFET shows an almost similar performance at the same power; in this case, the area improves by 15.5%–16.4%. Overall, FSFET should be designed to improve the electrical coupling, and FSFET can achieve almost the same power and performance as NSFET in a small area.

Optic Foraminotomy versus Anterior Clinoidectomy for Small Superior-Projecting Paraclinoid Aneurysms: Visual and Angiographic Outcome Evaluation

Optic foraminotomy (OF) has been recently proposed as an alternative to anterior clinoidectomy (AC) for selected types of paraclinoid aneurysms. In this study, OF and AC were compared for small superior-projecting paraclinoid aneurysms assuming visual and angiographic results as outcome measures. Indications for OF are also discussed. Data of patients who underwent surgery for a paraclinoid aneurysm in the last 10 years were collected across 3 tertiary hospitals. Small to regular-size and superior projecting aneurysms were sorted. Multiple and complex aneurysms were excluded. Records of patients who went through OF were compared with those of patients who underwent AC. Neurologic outcome was reported as a modified Rankin Scale. Aneurysm complete occlusion rate and rate of approach-related worsened vision were selected as outcome measures of efficacy and safety, respectively, of the OF versus AC. Unpaired t test and χ2 test were used for numerical and categorical variables, respectively. A P value less than 0.05 was considered statistically significant. OF and AC groups involved 18 and 25 patients, respectively. Complication rate, overall neurologic outcome, rate of approach-related worsened vision, and complete occlusion rate did not differ between the groups. The average follow-up was 51 ± 34 and 60 ± 41 months in the OF and AC groups, respectively. Compared to AC, OF did not show either a higher rate of approach-related worsened vision or a lower aneurysm complete occlusion rate. OF can be considered a valid alternative to the AC for small superior-projecting dorsal ICA wall paraclinoid aneurysms.

Fabrication of laminated bamboo composites from small diameter bamboo (Neosinocalamus affinis) by sand blasting surface modification

Sand blasting was proposed as a surface modification approach on the small diameter and thin culm wall bamboo species of Neosinocalamus affinis for the fabrication of laminated bamboo composites. The results revealed that sand blasting modification could almost wipe off the wax and silicons deposited on the green and yellow surfaces by removing or damaging the suberized and siliceous cells, pith membrane, and compact arranged sclereid , resulting in the uncovering of the porous structure. Meanwhile, the surface roughness was also increased by the sand blasting modification, which provided appropriate surface characteristics for resin permeability. The weight loss after sand blasting modification was merely 4.3%, and the internal structure was mostly preserved. Average modulus of rupture, modulus of elasticity, and compressive strength of the laminated bamboo composites fabricated from Neosinocalamus affinis were comparable to previous reported similar products and were higher than those from Phyllostachys pubescens and Phyllostachys bissetii. The findings in this study revealed that sand blasting modification could be used as an efficient and environmentally friendly approach on the high yield production of laminated bamboo composites from small diameter and thin culm wall bamboo species. • Sand blasting was efficient in cleaning up non-lignocellulosic substances on bamboo surfaces. • Laminated bamboo composites with yield of 96% was successfully fabricated. • The composites showed comparable mechanical strength with previously reported products. • Sand blasting surface modification was suitable for small diameter bamboo utilization.

Research on laser preparation and grinding performance of hydrophilic structured grinding wheels

In order to solve the problems of workpiece damage and grinding wheel clogging when grinding difficult-to-cut materials such as alumina ceramics, organisms with regular hexagonal structures distributed on the body surface and with strong hydrophilicity and high anti-wear functions were used as biomimetic objects for the first time, and the preparation process optimization, structure size design and grinding performance evaluation of hydrophilic structured bronze-bonded diamond grinding wheels were explored in this paper. The influence of the preparation process parameters on the micro-topography and the dimensional accuracy of the structure on the surface of the grinding wheel was revealed, and a new laser structuring process based on the coordinated control of focus position and scanning times was proposed, which could efficiently prepare regular hexagonal structures with a small wall inclination angle and a depth of several millimeters on the surface of the grinding wheel. It was the first to clarify the influence of sub-millimeter-scale structure size on the contact angle of grinding fluid droplet on the surface of the grinding wheel and the surface hydrophilicity of the grinding wheel. Compared with that of the non-structured grinding wheel, the hydrophilicity of the structured grinding wheel was significantly improved, and its surface hydrophilicity increased with the increase of the structure spacing and depth, but had little correlation with the structure side length. The grinding performance of hydrophilic structured grinding wheels and non-structured grinding wheels was evaluated under extreme working conditions. Under the condition of grinding depth of 50 μm, 100 μm and 200 μm, compared with that of the non-structured grinding wheel, the peak grinding temperature of the structured grinding wheel was reduced by 18.0%, 30.4% and 15.2%, respectively, and the surface damage depth of the alumina ceramic after grinding by the structured grinding wheel was reduced by 53.7%, 46.8% and 24.3%, respectively. The hydrophilic structured grinding wheel can enhance the storage and transportation capacity of grinding fluid/chips, effectively relieve the clogging and dullness of the grinding wheel, and significantly reduce the high temperature and damage of grinding. In the next step, we will try to apply this type of grinding wheel to form grinding, in order to provide a reliable solution for suppressing form grinding damage of difficult-to-cut materials.

Experimental and Numerical Study on LCF Crack Propagation of Coiled Tubing Steel

Coiled tubing (CT) is a joint-less long oil pipe that is wound around a reel and can be run and pulled continuously. Due to the particularity of the operating process, low-cycle fatigue (LCF) failure of the CT constitutes the main production cost. Aiming at the characteristics of small diameter and thin wall of CT, a single-edge-notched (SEN) arc specimen was designed and machined. LCF tests were conducted with force-controlled mode. Cyclic softening of the CT steel was presented and crack growing rates were measured. Meanwhile, finite element simulation was carried out to obtain the relationships among J-integral, crack size and load. Based on the experimental and numerical results, the speed of the LCF crack growth of the CT steel is expressed as an explicit function of the J-integral. It provides a basis for predicting the LCF life of the CT under working conditions from the perspective of crack propagation.

High Throughput Omnidirectional Printing of Tubular Microstructures from Elastomeric Polymers.

Bioelastomers are extensively used in biomedical applications due to their desirable mechanical strength, tunable properties, and chemical versatility; however, three-dimensional (3D) printing bioelastomers into microscale structures has proven elusive. Herein, a high throughput omnidirectional printing approach via coaxial extrusion is described that fabricates perfusable elastomeric microtubes of unprecedently small inner diameter (350-550µm) and wall thickness (40-60µm). The versatility of this approach is shown through the printing of two different polymeric elastomers, followed by photocrosslinking and removal of the fugitive inner phase. Designed experiments are used to tune the microtube dimensions and stiffness to match that of native ex vivo rat vasculature. This approach affords the fabrication of multiple biomimetic shapes resembling cochlea and kidney glomerulus and affords facile, high-throughput generation of perfusable structures that can be seeded with endothelial cells for biomedical applications. Post-printing laser micromachining is performed to generate micro-sized holes (520µm) in the tube wall to tune microstructure permeability. Importantly, for organ-on-a-chip applications, the described approach takes only 3.6min to print microtubes (without microholes) over an entire 96-well plate device, in contrast to comparable hole-free structures that take between 1.5 and 6.5days to fabricate using a manual 3D stamping approach.

Influence of layer thickness on formation quality, microstructure, mechanical properties, and corrosion resistance of WE43 magnesium alloy fabricated by laser powder bed fusion

Laser powder bed fusion (L-PBF) of Mg alloys has provided tremendous opportunities for customized production of aeronautical and medical parts. Layer thickness (LT) is of great significance to the L-PBF process but has not been studied for Mg alloys. In this study, WE43 Mg alloy bulk cubes, porous scaffolds, and thin walls with layer thicknesses of 10, 20, 30, and 40 μm were fabricated. The required laser energy input increased with increasing layer thickness and was different for the bulk cubes and porous scaffolds. Porosity tended to occur at the connection joints in porous scaffolds for LT40 and could be eliminated by reducing the laser energy input. For thin wall parts, a large overhang angle or a small wall thickness resulted in porosity when a large layer thicknesses was used, and the porosity disappeared by reducing the layer thickness or laser energy input. A deeper keyhole penetration was found in all occasions with porosity, explaining the influence of layer thickness, geometrical structure, and laser energy input on the porosity. All the samples achieved a high fusion quality with a relative density of over 99.5% using the optimized laser energy input. The increased layer thickness resulted to more precipitation phases, finer grain sizes and decreased grain texture. With the similar high fusion quality, the tensile strength and elongation of bulk samples were significantly improved from 257 MPa and 1.41% with the 10 μm layer to 287 MPa and 15.12 % with the 40 μm layer, in accordance with the microstructural change. The effect of layer thickness on the compressive properties of porous scaffolds was limited, however. The corrosion rate of bulk samples accelerated with increasing the layer thickness, mainly attributed to the increased number of precipitation phases.

S3393 Diffuse Large B Cell Lymphoma Presenting as Bleeding and Hypoalbuminemia: A Case Report

Introduction: Diffuse large B cell lymphoma (DLBCL) accounts for 38-57% of primary gastrointestinal (GI) lymphomas. Initial presentation can include nonspecific symptoms, such as weight loss, fatigue, and nausea. Imaging studies are typically nonspecific as well. Therefore, patients are commonly misdiagnosed or diagnosis is delayed. 20-30% of GI lymphomas are in the small intestine but are rarely in the jejunum. We present a rare case of jejunal DLBCL and illustrate the diagnostic difficulties. Case Description/Methods: A 49-year-old male presented with weeks of dizziness, dyspnea, hematochezia, and 30-pound unintentional weight loss over 4 months. Labs were notable for anemia and severe hypoalbuminemia (1.9 g/dL). Esophagogastroduodenoscopy and colonoscopy revealed diverticulosis and hemorrhoids, which were the presumed etiology of his symptoms. One month later, the patient presented similarly. Imaging demonstrated bilateral pulmonary emboli and intramural thickening of the jejunum. For worsening hypoalbuminemia (1.3 g/dL), the patient was scheduled for outpatient work-up. However, he presented again for acute GI bleed and severe anemia. Push enteroscopy revealed patchy mucosal changes in the jejunum and biopsies were consistent with DLBCL. The patient was started on chemotherapy and reported improvement in symptoms and resolution of his GI bleed. Discussion: Primary GI DLBCL is rarely found in the jejunum due to the lack of lymphoid tissue, making this case noteworthy. GI DLBCL is difficult to diagnose, since patients may be asymptomatic or present with nonspecific symptoms. Small intestinal DLBCL can present with GI bleeding, which can easily lead to a misdiagnosis of a diverticular or hemorrhoidal bleed. Imaging studies can be nonspecific and obtaining confirmation through biopsy can prove difficult due to its location, further complicating the diagnosis. One unique aspect of this case that led to the diagnosis was the severity of hypoalbuminemia. The patient was not malnourished, had no clinically apparent protein-losing enteropathy, and no proteinuria or liver failure, making underlying malignancy likely. Differential diagnoses of small bowel wall thickening on imaging is wide and includes infections, primary inflammatory processes such as IBD, and neoplastic lesions. DLBCL may have unusual clinical presentations, subtle laboratory findings and may not be easily diagnosed with initial imaging; thus, clinicians should remain vigilant of this possible diagnosis.

Expression Profile of IL-17 in lung tissues of patients with lung cancer and COPD and clinical significance

The purpose of this experiment to analyze the expression and clinical significance of interleukin-17 (IL-17) in lung tissue of lung cancer patients with chronic obstructive pulmonary disease (COPD). For this aim, 68 patients with lung cancer and chronic obstructive pulmonary disease who were admitted to our hospital from February 2020 to February 2022 were selected as the research objects of the study group. The specimens were fresh lung tissue obtained after lobectomy; In addition, 54 healthy subjects were selected as the control group during the same period, and fresh lung tissue obtained by minimally invasive lung volume reduction was selected as the sample. The clinical baseline data of the two groups were observed and compared. The mean alveolar area, small airway inflammation score and Ma tube wall thickness were measured. The expression of IL-17 was detected by immunohistochemistry. Results showed that gender, average age and average body mass index of the two groups (P > 0.05); At present, the proportion of smokers, pulmonary artery systolic pressure, PaCO2 level and CRP level in the study group are high, PaO2 level, FEV1% predicted value, FEV1 / FVC and FIB level are low, and the number of acute exacerbations in the past year is high (P > 0.05). In the study group, the average alveolar area, the thickness of the Ma tube wall, the lymphocyte infiltration score of the tracheal wall and the total pathological score of the small airway were higher (P > 0.05). The expression of IL-17 in the airway wall and lung parenchyma was higher in the study group (P > 0.05). IL-17 expression in lung tissue of lung cancer patients with COPD was positively correlated with body mass index, and negatively correlated with CRP, FIB, FEV1% predicted value and the number of acute exacerbations in the past year; CRP and the number of acute exacerbations in the past year were independent variables and independent influencing factors of IL-17 expression (P < 0.05). In conclusion, IL-17 is highly expressed in the lung tissues of patients with lung cancer and COPD, which may play an important role in the occurrence and development of the disease.

Thanatophoric dysplasia: a case report at Federal Medical Centre Yenagoa, Bayelsa state Nigeria

Thanatophoric dysplasia is a rare congenital severe skeletal disorder previously considered lethal but some survivals beyond the neonatal period have been reported due to extensive medical interventions. There have been a few studies on thanatophoric dysplasia in Africa and specifically in Nigeria hence this case report of an 8-day old female who was born with clinical features that were consistent with thanatophoric dysplasia creating awareness in this region. An eight-day old female term neonate who was seen in the special care baby unit with respiratory distress and limb abnormalities from birth. Two obstetric ultrasound scans had revealed a fetus with severe limb deformity. At presentation, she was in respiratory distress, with dysmorphic features, small chest wall with chest hypertelorism. The limbs were short having marks of amniotic bands with lymphoedema affecting both lower limbs. There were no palmar creases. Skeletal survey done revealed marked hypoplasia of the chest cavity, and widening of both proximal and distal epiphyses of all long bones showing telephone receiving appearance. Echocardiography and abdominal ultrasound scans were normal. It was documented that thanatophoric dysplasia was inherited in an autosomal dominant fashion however sporadic mutations do occur as seen in this patient who had no family history. Facility for genetic testing to analyse the fibroblast growth factor receptor (FGFR3) for typing and determining possible mutations was not available to confirm the diagnosis however, her clinical features and radiological findings were suggestive of thanotophoric dysplasia type 1.

OA19 A case of severe refractory lupus enteritis and nephritis that remitted with Obinutuzumab

Introduction/BackgroundSystemic lupus erythematosus (SLE) is an autoimmune disease that can affect almost any organ system but gastrointestinal (GI) involvement is very rare. Obinutuzumab is a humanised type II anti-CD20 monoclonal antibody that is licensed to treat haematological malignancies. It has been used in a small number of SLE patients with secondary non-depletion non-response (2NDNR) to Rituximab and appears to be effective in lupus nephritis (LN) as outlined in the NOBILITY trial. We present a case of refractory lupus enteritis (LEn) and LN in a patient with 2NDNR to repeated Rituximab cycles that achieved remission with Obinutuzumab.Description/MethodA 19-year-old African woman was diagnosed with SLE in 2018 after presenting with polyarthritis without systemic involvement. Blood tests showed leucopenia, positive antinuclear antibody, anti-double-stranded DNA >200 IU/ml and hypocomplementaemia. Prednisolone and Methotrexate were commenced. However, one month later she presented to hospital with generalised abdominal pain, vomiting and diarrhoea. CT abdomen demonstrated significant small bowel wall thickening with mucosal hyperenhancement. Multidisciplinary team (MDT) input confirmed likely LEn. She was treated successfully with intravenous Methylprednisolone and Rituximab. Total parenteral nutrition was required for two weeks.Unfortunately, four further hospital admissions followed over the next six months due to GI symptoms, transient acute kidney injury and moderate proteinuria. Small bowel oedema persisted on MRI, three months after the CT. Renal biopsy demonstrated class 2 LN. Intravenous methylprednisolone helped and further Rituximab was given but she had infusion reactions. Six months later she re-presented with abdominal pain, synovitis and had nephrotic range proteinuria. She was treated again for LEn after gastroenterology input. Further Rituximab was given (MabThera instead of Truxima) but reactions still occurred and her B cells were non-deplete. Repeat renal biopsy confirmed class 4 LN and intravenous Cyclophosphamide (Euro-Lupus regimen) was commenced. This was repeated seven months later due to persisting high disease activity and proteinuria despite a short trial of intravenous Belimumab. However, she was admitted to hospital with colitis on CT after completing the second course of Cyclophosphamide. MDT decision was to treat with Obinutuzumab. Since commencing treatment eighteen months ago, her SLE has dramatically improved and she feels well for the first time. SLEDAI-2K score is 2 (16 pre-treatment), renal function has recovered with mild proteinuria. Anti-double-stranded DNA has reduced from >200 to 52.9 IU/ml and complements normalised. She remains on Prednisolone 5mg daily and Tacrolimus and a third maintenance dose of Obinutuzumab is planned.Discussion/ResultsLEn has been reported in only 0.2-5.8% of SLE cases. It is defined by the British Isles Lupus Assessment Group (BILAG 2004) by either vasculitis or inflammation of the small bowel supported by imaging or histology. Its pathogenesis is poorly understood but thought to be related to immune complex deposition and complement activation resulting in intestinal capillary leak and submucosal oedema. Symptoms are non-specific and a review by Janssens et al. (2013) suggested abdominal pain (97%), ascites (78%), nausea (49%), vomiting (42%) and diarrhoea (32%) were the most common symptoms in patients with LEn. They reported the ileum and jejunum were most commonly affected in LE (84% and 83% respectively), followed by colon (19%), duodenum (17%) and rectum (4%).Abdominal CT is considered to be the first line investigation and ‘classic’ radiological findings are bowel wall oedema (“target sign”), engorgement/increased number of mesenteric vessels (“comb sign”) and increased attenuation of the mesenteric fat (Ha et al. 2000, and Kim et al. 2006). These were all demonstrated on our patient’s initial CT abdomen which showed engorgement of the mesenteric vessels from the proximal jejunum to the proximal ileum.LEn seldom occurs in isolation and usually presents in the context of high disease activity and other systemic involvement. It is often responsive to glucocorticoids and bowel rest but further immunosuppression with Cyclophosphamide or Rituximab might be warranted in refractory cases as in our patient’s case.Obinutuzumab has been shown to be safe, effective and steroid-sparing in renal and non-renal SLE patients with 2NDNR to Rituximab from a case series of 9 patients by Arnold et al. (2022). This applied to LN in our patient and we believe this to be the first case where refractory LEn was treated successfully with Obinutuzumab.Key learning points/ConclusionAlthough very rare, have a high index of suspicion of LEn in SLE patients who present with GI symptoms and typical radiological findings.LEn often occurs with other systemic manifestations including LN and it is important to assess for these at the time of diagnosis of LEn.Obinutuzumab is an emerging treatment for severe SLE particularly 2NDNR to Rituximab and can improve both LN and LEn. We eagerly await results from the current REGENCY and ALLEGORY clinical trials which are assessing Obinutuzumab in renal and non-renal SLE patients respectively.

Biophilia and &amp;#x22;Body-Philia&amp;#x22;: Does positive body image change due to short visits in outdoor green environments?

Background: Mounting evidence suggests that exposure to natural environments has beneficial effects on positive emotion, but less is known about the effects on positive body image and on the beneficial effects of green walls. Aim: The aim of the study is to examine the effects of short visits to different outdoor environments on positive body image. Methods: We recruited 200 healthy adult participants (139 women) and conducted a quasi-experimental study using within-subjects design. We examined the effect of short visits to randomly assigned ordered outdoor environments (green wall, small green garden and gray wall), as compared to baseline indoor environment on: mean positive body image, evaluated by SBAS-2 (State Body Appreciation Scale) and changes in sum of positive and negative emotions evaluated by PNAS (Positive and Negative Affect Schedule). The differences were examined using a repeated nonparametric Friedman test and any significant difference between environments was further explored using post hoc analysis with Wilcoxon signed-rank test, with Bonferroni correction. Results: The median of positive body image in the small garden environment [4.0, Inter Quartile Range (IQR):3.1- 4.74] and the green wall [3.9, IQR:3.08- 4.63] were higher compared to the gray wall [3.7, IQR:3.0 - 4.23] and to the indoor environment [3.7, IQR:2.8 - 4.53], [X2(3) = 44.27, p &amp;#x3c; 0.00]. For positive emotions, a higher but not significantly different sum was observed for small garden and green wall ([29, IQR: 23 to 35] and [28, IQR:21 to 34], respectively), and significantly higher compared to gray wall [25, IQR:20 to 31], [X2(3) = 70.453, p &amp;#x3c; 0.00]. For negative emotion, there was no significant differences between the environments. Conclusions: Short visits to outdoor green environments compared to non-green, or indoor environments, raises participants’ body appreciation and positive emotions. Keywords: Positive body image, Positive and negative emotions, Green environment, Green vertical wall

High Quality and Maximizing the Production of CNTs from the Pyrolysis of Waste Polypropylene

Thermal decomposition of plastics by pyrolysis into oil is a successful way of treating wastes. Nevertheless, the production of carbon nanotubes (CNTs) from wastes improves the feasibility of the waste management process. An experimental setup was developed to study the influence of different heating rates on the produced oil by pyrolysis of waste polypropylene (WPP), and the influence of using foamed nickel on the produced CNTs as a function of operating temperature and heating rate. Different heating rates of 5, 10, and 20 °C/min were examined, as well as the different carbon vapor deposition (CVD) temperatures of 600, 700, and 800 °C were studied. It has been found that increasing the heating rate from 5 to 20 °C/min increases the oil yield from 59.3 to 71%, but on the other hand it decreases the quality of the oil. It has been also found that increasing the heating rate decreases the quality of CNTs, i.e., uniform CNTs with small diameter and small wall thickness, and as well as the quantity. The physical properties of the produced CNTs have been improved by increasing the CVD temperature; however, the quantity of CNTs decreased. The highest yield of CNTs produced was 43.12% at the lowest CVD temperature and heating rate examined, i.e., 600 and 5 °C/min, respectively. The optimum heating rate and CVD temperature for the pyrolysis of waste polypropylene to achieve the highest quality of CNTs with moderate production of 39.34%, is the lowest heating rate examined, i.e., 5 °C/min, with a moderate CVD temperature of 700 °C.

Implementation of Business Model Canvas in Micro, Small, and Medium Eenterprises (MSME) Wall Panel Furniture as an Effort to Increase Production to Expand Market Share

Abstract. The panel furniture business is one of Indonesia's quite widely practiced industries. This makes panel furniture business activists have to innovate to create good business models and create panel furniture with high aesthetic value and good business processes in business continuity that can compete with MSMEs throughout Indonesia. This study aims to support the sustainability of business processes by implementing the Business Model Canvas. Data collection methods used in this study were interviews and observation. From the research that has been done, it is found that the implementation of the Business Model Canvas makes business processes run better than before. This is because the business processes that occur run more regularly.&#x0D;