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Background: Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war for better understanding and future considerations by war surgeons of the vascular trauma management. The aim of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior vena cava. Case presentation: A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the abdomen from a mortars' explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and received primary surgical treatment within one hour after the injury according to the "golden hour" principle. Then, evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads (packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall defect as well as defects of the inferior vena cava. Conclusions: Application of Damage Control Surgery is a useful approach in the management of severe vascular injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic tool for the searching and removal of ferromagnetic foreign bodies reduces operative trauma and reduces the time for identification of foreign bodies. [ABSTRACT FROM AUTHOR]

Polymeric elastomers are extensively employed to fabricate implantable medical devices. However, implantation of the elastomers can induce a strong immune rejection known as the foreign body response (FBR), diminishing their efficacy. Herein, we present a group of immunocompatible elastomers, termed easy-to-synthesize vinyl-based anti-FBR dense elastomers (EVADE). EVADE materials effectively suppress the inflammation and capsule formation in subcutaneous models of rodents and non-human primates for at least one year and two months, respectively. Implantation of EVADE materials significantly reduces the expression of inflammation-related proteins S100A8/A9 in adjacent tissues compared to polydimethylsiloxane. We also show that inhibition or knockout of S100A8/A9 leads to substantial attenuation of fibrosis in mice, suggesting a target for fibrosis inhibition. Continuous subcutaneous insulin infusion (CSII) catheters constructed from EVADE elastomers demonstrate significantly improved longevity and performance compared to commercial catheters. The EVADE materials reported here may enhance and extend function in various medical devices by resisting the local immune responses. Fibrous capsule formation limits the lifetime of implanted devices. Here, the authors report on an elastomer designed to reduce the immune response which shows enhanced device utility in both mice and non-human primate models, including in an insulin infusion catheter model. [ABSTRACT FROM AUTHOR]

Purpose: Fibroblast activation protein (FAP)-inhibitor (FAPI)-PET tracers allow imaging of the FAP-expressing cancer associated fibroblasts (CAF) and also the normal activated fibroblasts (NAF) involved in inflammation/fibrosis that may be present after invasive medical interventions. We evaluated [68Ga]Ga-FAPI-46 uptake patterns post-medical/invasive non-systemic interventions. Methods: This single-center retrospective analysis was conducted in 79 consecutive patients who underwent [68Ga]Ga-FAPI-46 PET/CT. Investigators reviewed prior patient medical/invasive interventions (surgery, endoscopy, biopsy, radiotherapy, foreign body placement (FBP) defined as implanted medical/surgical material present at time of scan) and characterized the anatomically corresponding FAPI uptake intensity both visually (positive if above surrounding background) and quantitatively (SUVmax). Interventions with missing data/images or confounders of [68Ga]Ga-FAPI-46 uptake (partial volume effect, other cause of increased uptake) were excluded. Available correlative FDG, DOTATATE and PSMA PET/CTs were analyzed when available. Results: 163 medical/invasive interventions (mostly surgeries (49%), endoscopies (18%) and non-surgical biopsies (10%)) in 60 subjects were included for analysis. 43/163 (26%) involved FBP. FAPI uptake occurred in 24/163 (15%) of interventions (average SUVmax 3.2 (mild), range 1.5–5.1). The median time-interval post-intervention to FAPI-PET was 47.5 months and was shorter when FAPI uptake was present (median 9.5 months) than when absent (median 60.1 months; p = 0.001). Cut-off time beyond which no FAPI uptake would be present post-intervention without FBP was 8.2 months, with a sensitivity, specificity, positive predictive value and negative predictive value of 82, 90, 99 and 31% respectively. No optimal cutoff point could be determined when considering interventions with FBP. No significant difference was detected between frequency of [68Ga]Ga-FAPI-46 and [18F]FDG uptake in intervention sites. Compared to [68Ga]Ga-PSMA-11, [68Ga]Ga-FAPI-46 revealed more frequent and intense post-interventional tracer uptake. Conclusion: [68Ga]Ga-FAPI-46 uptake from medical/invasive interventions without FBP appears to be time dependent, nearly always absent beyond 8 months post-intervention, but frequently present for years with FBP. [ABSTRACT FROM AUTHOR]

Although paediatric patients with gastrointestinal (GI) foreign bodies require multiple resources, they often present with few or no discernible symptoms and are typically assigned a low acuity level during triage. We compared the predictive accuracy of the revised Korean Triage and Acuity Scale (rKTAS), which elevates acuity by one step in relation to anticipated resource utilization, with that of the conventional KTAS for clinical outcomes. This was a retrospective study of National Emergency Department Information System data. Data on patient and ED characteristics, resources used, and clinical outcomes were collected from January 2018 to December 2021 for patients with GI foreign bodies aged under 19. The primary outcome was rKTAS accuracy in predicting hospitalization, ICU admission, operating room (OR) use, and ED length of stay (EDLOS). The AUROC was used to evaluate the performance via of the KTAS and rKTAS. In total, 25,324 paediatric patients visited the ED for GI tract foreign bodies. The mean age was 3.8 years, and 51% (12,923) were between 1 and 4 year old. Although most (23,658; 93.4%) were discharged, 4.9% required hospitalization. Two or more resources were utilized in 2514 (9.9%) cases, and 3,514 individuals had their triage levels increased by one step. Compared with those of the KTAS, the AUROCs of the rKTAS for predicting overall hospitalization (p < 0.05), admission to general wards (p < 0.05), ICU admission (p = 0.01), and admission via the OR (p < 0.05)were higher than KTAS. Compared with that with the KTAS, the EDLOS with the rKTAS was longer at levels 1, 2, and 3. The adjusted rKTAS is a better predictor of clinical outcomes for paediatric patients with GI tract foreign bodies than the KTAS. [ABSTRACT FROM AUTHOR]

Subcutaneous nodular lesions in a patient with significantly elevated inflammatory markers always raise the possibility of infectious diagnoses such as atypical infection, pyogenic abscess, mycobacterial infection, and malignancy. Definitive diagnosis requires tissue biopsy and histopathologic examination. The atypical presentation of a foreign body granuloma with concurrent intraoperative findings supports the diagnosis of gouty arthritis. We report a case of a 67-year-old man who presented with an inflammatory nodular lesion on the left elbow that was initially suspected to have an infectious cause. Histopathologic examination of the nodular tissue later revealed that the patient had a foreign body granuloma due to urate crystal deposition. The atypical appearance of the gouty arthritis, the low serum urate level, the negative crystal identification in the synovial fluid, and the markedly elevated inflammatory markers, which did not respond to the previous antibiotic and steroid therapy, raised the suspicion of atypical infection in this case. [ABSTRACT FROM AUTHOR]

Purpose: There is currently no ideal radiotracer for imaging bacterial infections. Radiolabelled d-amino acids are promising candidates because they are actively incorporated into the peptidoglycan of the bacterial cell wall, a structural feature which is absent in human cells. This work describes fluorine-18 labelled analogues of d-tyrosine and d-methionine, O-(2-[18F]fluoroethyl)-d-tyrosine (d-[18F]FET) and S-(3-[18F]fluoropropyl)-d-homocysteine (d-[18F]FPHCys), and their pilot evaluation studies as potential radiotracers for imaging bacterial infection. Procedures: d-[18F]FET and d-[18F]FPHCys were prepared in classical fluorination-deprotection reactions, and their uptake in Staphylococcus aureus and Pseudomonas aeruginosa was evaluated over 2 h. Heat killed bacteria were used as controls. A clinically-relevant foreign body model of S. aureus infection was established in Balb/c mice, as well as a sterile foreign body to mimic inflammation. The ex vivo biodistribution of d-[18F]FPHCys in the infected and inflamed mice was evaluated after 1 h, by dissection and gamma counting. The uptake was compared to that of [18F]FDG. Results: In vitro uptake of both d-[18F]FET and d-[18F]FPHCys was specific to live bacteria. Uptake was higher in S. aureus than in P. aeruginosa for both radiotracers, and of the two, higher for d-[18F]FPHCys than d-[18F]FET. Blocking experiments with non-radioactive d-[19F]FPHCys confirmed specificity of uptake. In vivo, d-[18F]FPHCys had greater accumulation in S. aureus infection compared with sterile inflammation, which was statistically significant. As anticipated, [18F]FDG showed no significant difference in uptake between infection and inflammation. Conclusions: d-[18F]FPHCys uptake was higher in infected tissues than inflammation, and represents a fluorine-18 labelled d-AA with potential to detect a S. aureus reference strain (Xen29) in vivo. Additional studies are needed to evaluate uptake of this radiotracer in clinical isolates. [ABSTRACT FROM AUTHOR]

Retrograde movement of gastric contents into the pharynx is termed Laryngopharyngeal Reflux (LPR). It represents an extraesophageal manifestation associated with gastroesophageal reflux disease (GERD). The objective of the study is to investigate the clinical profile of LPR and its response to treatment. Three hundred consecutive patients who presented to the ENT outpatient department with a clinical profile of LPR were selected. The patients' symptoms were assessed using the Reflux Symptom Index (RSI), followed by an endoscopic examination of the larynx and scoring using the Reflux Finding Score (RFS). Patients were started on LPR treatment if they had an RSI score of 13 and an RFS of more than 7. The patients were then started on medication and monitored for three months. The most common symptom in our research sample (52%) was a foreign body sensation in the throat. On endoscopic examination of the larynx, the most common sign was hyperemia/erythema of laryngeal tissue, especially bilateral arytenoids. Most of our patients responded favorably to a combination of pantoprazole (40 mg) and domperidone (30 mg) for 4 weeks. This was measured by the reduction in RSI and RFS scores. LPR is a frequently encountered clinical entity, and otorhinolaryngologists should consider it when treating patients with chronic symptoms such as throat pain and voice changes. Appropriate LPR diagnosis and care can help prevent unnecessary prescriptions for antibiotics and surgical interventions in these patients. [ABSTRACT FROM AUTHOR]

Ingested fish bone is a common otorhinolaryngology emergency in Malaysia. Fish bone is commonly impacted in the oropharynx for young patients and oesophagus for elderly patients. Rarely, a fish bone migrated extraluminal and require surgical exploration. We report a five cases of fish bone which involved extraluminal migration, and needed repeat CT scans and various types of surgical exploration. [ABSTRACT FROM AUTHOR]

Devices for the gastrointestinal tract are widely available and constantly advancing with less invasive techniques. They play a crucial role in diagnostic and therapeutic interventions and are commonly placed by interventional radiologists, gastroenterologists, and surgeons. These devices frequently appear in imaging studies, which verify their proper placement, identify any complications, or may be incidentally detected. Radiologists must be able to identify these devices at imaging and understand their intended purpose to assess their efficacy, detect complications such as incorrect positioning, and avoid misinterpreting them as abnormalities. Furthermore, many patients with these devices may require MRI, making assessing compatibility essential for safe patient care. This review seeks to provide a succinct and practical handbook for radiologists regarding both common and uncommon gastrointestinal devices. In addition to textual descriptions of clinical indications, imaging findings, complications, and MRI compatibility, the review incorporates a summary table as a quick reference point for key information and illustrative images for each device. [ABSTRACT FROM AUTHOR]

The early diagnosis and treatment of foreign body aspiration (FBA) can significantly improve the overall prognosis of children. There are significant differences in the epidemiology and clinical characteristics of FBA in different regions. Therefore, we conducted a real-world study in the western region of China with over 4000 patients. The aim of this study was to improve the understanding of FBA in terms of its types, the specific months of its occurrence, and the distribution of primary caregiver characteristics in western China. We collected the clinical and epidemiological data of children who were diagnosed with FBA in our hospital over the past 20 years through a big data centre. We matched the data of healthy children who underwent routine physical examinations at the paediatric health clinic during the same period to analyse the differences in the data of actual guardians. A total of 4227 patients from five provinces were included in this study. Foreign bodies were removed by rigid bronchoscopy in 99.4% (4202/4227) of patients, with a median age of 19 months and a median surgical duration 16 min. January was the most common month of onset for 1725 patients, followed by February, with 1027 patients. The most common types of foreign objects were melon peanuts, seeds and walnuts, accounting for 47.2%, 15.3%, and 10.2%, respectively. In the FBA group, the proportion of grandparents who were primary caregivers was 70.33% (2973/4227), which was significantly greater than the 63.05% in the healthy group (2665/4227) (P < 0.01). FBA most commonly occurs in January and February. More than 60% of FBAs occur between the ages of 1 and 2 years, and the incidence of FBA may be greater in children who are cared for by grandparents. A rigid bronchoscope can be used to remove most aspirated foreign bodies in a median of 16 min. [ABSTRACT FROM AUTHOR]

Background: Upper gastrointestinal foreign body ingestion is a common digestive tract emergency, of which completely embedded ones were challenging for most endoscopists. We aim to evaluate the efficacy and safety of endoscopic submucosal fenestration in the treatment of completely embedded upper gastrointestinal foreign bodies. Methods: From December 2018 to December 2021, 19 patients with completely embedded upper gastrointestinal foreign bodies who underwent endoscopic submucosal fenestration in Zhongshan Hospital, Fudan University were included. The safety, efficacy, and outcome were retrospectively reviewed. Results: Among the 19 patients, 15 foreign bodies were embedded in the esophagus, 3 located in the gastric wall, and 1 located in the duodenal bulb. The foreign bodies were successfully managed in 12 cases, and 7 failed after attempts of repeated exploration. Two cases confirmed completely traversing into the mediastinum were successfully removed after transfer to surgery. One case had retrieval of a foreign body in a half-year examination. Till now, 3 failed patients had great relief of symptoms and only one patient claimed occasional thoracodynia. Of note, there were neither serious adverse events, nor long-term complications during the follow-up. Conclusion: In disposing of foreign bodies completely embedded in the upper gastrointestinal tract, ESF is a safe and effective alternative to surgery. [ABSTRACT FROM AUTHOR]

Foreign body ingestion in children is a frequent cause for medical consultation. Although most foreign bodies are spontaneously eliminated from the gastrointestinal tract, life-threatening complications such as gastrointestinal obstruction or perforation can occur. We report the case of a 6-year-old boy who died 2 days after the onset of nausea and abdominal pain, with no foreign body ingestion witnessed or reported in the previous days. Autopsy showed a diffuse peritonitis and a perforation of the transverse colon caused by three high-powered magnets stacked together, and attached to the outer stomach wall via a fourth magnet located in the stomach. The cause of death was peritonitis due to bowel perforation by ingested magnets, which were shown to have come from a toy belonging to the child. Ingestion of multiple high-powered magnets carries a high risk of gastrointestinal complications and can exceptionally have a fatal outcome, especially as it often goes unreported and causes non-specific gastrointestinal symptoms that can delay diagnosis and management. This case highlights the need to raise public awareness of the potential risks of ingesting such magnets and to strengthen safety standards to protect children from this serious health hazard. [ABSTRACT FROM AUTHOR]

Purpose: To determine and report the underlying cause of local inflammation causing recurrent neuropathy and multiple operations in a patient with a Barricaid® device. Methods: After removal of this patient's Barricaid® device, we sent local inflammatory tissue to pathology for histochemical analysis. Upon discovery of giant cells formation with polarizable foreign bodies, we performed a literature review regarding the Barricaid® device and its elements. Results: After two previous operations and three trials of conservative management, the presented patient underwent an L5/S1 TLIF with removal of her previously installed Barricaid® device. There were no signs of device instability/failure nor were there obvious signs of infection. Inflamed tissue proximal to the Barricaid® device was discovered, debrided, and sample sent to pathology. Removal of the Barricaid® device led to subsequent and durable relief of her symptoms. During review of this case, we discovered the polyethylene terephthalate (PET) weave used in the Barricaid® device is known to induce foreign body reactions, and this precise finding was seen in the majority of animal data submitted to the FDA for the device's acceptance. Conclusion: Given the constellation of this patient's symptoms, imaging, intraoperative, and pathology findings, previously published reports, and pre-approval data submitted to the FDA, we conclude that the inflammatory response to the PET weave in this patient's Barricaid® device was the ultimate cause of her continued neuropathy despite multiple prior surgical interventions. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this retrospective study was to explore the clinical characteristics of and diagnostic and therapeutic strategies for the removal of fish bones that migrate to the neck. Methods: We reviewed the clinical data of 30 patients over the past 12 years who underwent neck surgery in our otorhinolaryngology department for the migration of fish bones from the throat. The location of fish bones and the positivity rate of different examination methods (neck CT and B-ultrasound) were evaluated statistically. The diagnosis and treatment strategy for fish bone migration to the neck was also summarized. Results: A total of 24 patients had a history of foreign body ingestion. The duration from foreign body ingestion to the appearance of symptoms in the neck ranged from 26 to 151 days, with a median of 50 days (interquartile range, 32–86 days). Among the 24 patients with fish bones located in the front or side of the neck, 50% (12/24) and 100% (24/24) of whom had positive neck CT and B-ultrasound results, respectively. Additionally, for 6 patients with fish bones in the retropharyngeal space, the positive rate for neck CT was 100%, whereas neck B-ultrasound showed negative results due to the air and depth in the trachea and esophagus. A strong correlation was observed between the length of fish bones detected by B-ultrasound and CT and the actual length. Indeed, no significant difference was observed between the length of fish bone determined by B-ultrasound and the actual length. In patients with fish bones located in the anterior and lateral neck regions, the foreign bodies were successfully removed by a lateral cervical approach operation (23/24). For the 6 cases with fish bones located in the retropharyngeal space, all (6/6) were removed by incising the posterior pharyngeal wall with assistance from transoral endoscopy. Conclusions: The techniques of B-ultrasound and CT have advantages for the diagnosis of migratory foreign bodies in the neck. Although B-ultrasound is more accurate for estimating the length of migratory fish bones in the neck, a combination of both methods can improve the preoperative positive rate of diagnosis. Therefore, a variety of surgical approaches should be employed to manage the different locations of cervical foreign bodies. [ABSTRACT FROM AUTHOR]

Musculoskeletal infections consist of different clinical conditions that are commonly encountered in daily clinical settings. As clinical findings and even laboratory tests cannot always be specific, imaging plays a crucial role in the diagnosis and treatment of these cases. Musculoskeletal infections most commonly occur secondary to direct inoculation into the skin involuntarily affected by trauma, microorganism, foreign bodies, or in diabetic ulcers; direct infections can also occur from voluntary causes due to surgery, vaccinations, or other iatrogenic procedures. Hematogenous spread of infection from a remote focus can also be a cause for musculoskeletal infections. Risk factors for soft tissue and bone infections include immunosuppression, old age, corticosteroid use, systemic illnesses, malnutrition, obesity, and burns. Most literature discusses musculoskeletal infections according to the diagnostic tools or forms of infection seen in different soft tissue anatomical planes or bones. This review article aims to evaluate musculoskeletal infections that occur due to direct inoculation to the musculoskeletal tissues, by focusing on the traumatic mechanism with emphasis on the radiological findings. [ABSTRACT FROM AUTHOR]

Clinical manifestations of dermatological and musculoskeletal conditions can sometimes overlap, leading to confusion in diagnosis. Patients with nail and skin infections may undergo imaging examinations with suspicions of muscle, tendon, or joint injuries. Dermatological infections often involve soft tissues and musculoskeletal structures, and their etiology can range from fungi, bacteria, viruses, to protozoa. Relying solely on physical examination may not be sufficient for accurate diagnosis and treatment planning, necessitating the use of complementary imaging exams. The objective of this paper is to present and discuss imaging findings of the main infectious conditions affecting the nail apparatus and skin. The paper also highlights the importance of imaging in clarifying diagnostic uncertainties and guiding appropriate treatment for dermatological conditions. [ABSTRACT FROM AUTHOR]

Microglia are important players in surveillance and repair of the brain. Implanting an electrode into the cortex activates microglia, produces an inflammatory cascade, triggers the foreign body response, and opens the blood-brain barrier. These changes can impede intracortical brain-computer interfaces performance. Using two-photon imaging of implanted microelectrodes, we test the hypothesis that low-intensity pulsed ultrasound stimulation can reduce microglia-mediated neuroinflammation following the implantation of microelectrodes. In the first week of treatment, we found that low-intensity pulsed ultrasound stimulation increased microglia migration speed by 128%, enhanced microglia expansion area by 109%, and a reduction in microglial activation by 17%, indicating improved tissue healing and surveillance. Microglial coverage of the microelectrode was reduced by 50% and astrocytic scarring by 36% resulting in an increase in recording performance at chronic time. The data indicate that low-intensity pulsed ultrasound stimulation helps reduce the foreign body response around chronic intracortical microelectrodes. Implanting an electrode into the cortex activates microglia, triggers the foreign body response, and impedes intracortical brain-computer interface. Here, the authors apply low-intensity pulsed ultrasound stimulation (LIPUS) after probe insertion to reduce microglia-mediated neuroinflammation. [ABSTRACT FROM AUTHOR]

Background: Meckel's diverticulum (MD) is the most common congenital abnormality of the gastrointestinal tract. However, MD is rare in clinical practice, and perforation of a MD by a foreign body is even rarer. Preoperative diagnosis is difficult because there is often insufficient information; therefore it is usually diagnosed intraoperatively. Although rare, it should be considered as a differential diagnosis in patients who have ingested foreign bodies. Case presentation: The following is the case of a 52-year-old female patient who was admitted because of generalized abdominal pain for 5 days, related to nausea and vomiting. She also stopped passing gas. Inflammatory indicators were elevated, and computed tomography (CT) revealed gas–liquid levels in the small intestine and high-density objects in the ileum. Based on the patient's condition, laparotomy was performed instead because the laparoscopic procedure was difficult to perform. Intraoperatively, a foreign body perforated the diverticulum of the terminal ileum, resulting in the development of an abdominal abscess. Finally, we performed resection of the ileal diverticula and partial resection of the ileum. After the surgery, it was confirmed that the foreign bodies were two dentures accidentally eaten by the patient. Conclusion: A thorough understanding of the clinical presentation, imaging features, and treatment of MD and its complications will assist clinicians in making prompt and accurate diagnoses and providing symptomatic treatment. [ABSTRACT FROM AUTHOR]

Automated Foreign Object Debris (FOD) detection offers significant benefit to the aviation industry by reducing human error and enabling continuous surveillance. This paper focuses on addressing the intricacies of FOD detection, with a specific emphasis on treating FODs as "small" objects, a facet which has received limited attention in prior research. This study provides a pioneering evaluation of state-of-the-art object detectors, including both anchor-based models including SSD, YOLOv5m, Scaled YOLOv4 and anchorless models CenterNet and YOLOv8m, applied to a multiclass FOD dataset, "FOD in Airports (FOD-A)", as well as meticulously curated subset of FOD-A featuring small FODs. The findings reveal that the anchorless object detector YOLOv8m gives the best time accuracy trade off outperforming all compared anchor-based and anchorless approaches. To address the challenge of detecting small FODs, this study optimizes YOLOv8m model by making architectural modifications and incorporating a dedicated, shallow detection head that is purpose-built for the precise identification of small objects. The proposed model, termed as "Improved YOLOv8", outperforms YOLOv8m by a margin of 1.02 in Average Precision for small objects (APs), achieving a mean average precision (mAP) of 93.8%. Notably, Improved YOLOv8 also has better mAP than all the considered anchor-based and anchorless object detectors examined, as well as those featured in prior FOD-A dataset research. [ABSTRACT FROM AUTHOR]

Implantable neural probes, essential for brain electrophysiological research, have advanced with ultra-flexible designs to mitigate immune responses and postoperative complications. Strategies of shuttle-assisted implantation and temporary stiffening address issues in penetrating these probes into the target region, avoiding undesired bending. However, the risk of intraoperative bleeding remains due to these implants' necessary rigidity during insertion. Here, we describe a neural probe with mechanical compliance accompanying self-implantation along the principal axis in the absence of bleeding. Crucial to the behavior is its anisotropic relaxation, which is dominated by the cross-sectional in-plane deformation inhibition due to interchain interactions between the parallel backbones in the globally aligned polymer system. We observed the ensured upright insertion of the probe into the brain while avoiding angiorrhexis with a two-photon microscope and a high-speed camera. The probes permit electrophysiological studies with minimal foreign body responses and imageological compatibility, underscoring their clinical potential. [ABSTRACT FROM AUTHOR]

Background: The incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor. Case presentation: A 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated. Conclusions: This was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor. [ABSTRACT FROM AUTHOR]

Most artificial intelligence (AI) studies have attempted to identify dental implant systems (DISs) while excluding low-quality and distorted dental radiographs, limiting their actual clinical use. This study aimed to evaluate the effectiveness of an AI model, trained on a large and multi-center dataset, in identifying different types of DIS in low-quality and distorted dental radiographs. Based on the fine-tuned pre-trained ResNet-50 algorithm, 156,965 panoramic and periapical radiological images were used as training and validation datasets, and 530 low-quality and distorted images of four types (including those not perpendicular to the axis of the fixture, radiation overexposure, cut off the apex of the fixture, and containing foreign bodies) were used as test datasets. Moreover, the accuracy performance of low-quality and distorted DIS classification was compared using AI and five periodontists. Based on a test dataset, the performance evaluation of the AI model achieved accuracy, precision, recall, and F1 score metrics of 95.05%, 95.91%, 92.49%, and 94.17%, respectively. However, five periodontists performed the classification of nine types of DISs based on four different types of low-quality and distorted radiographs, achieving a mean overall accuracy of 37.2 ± 29.0%. Within the limitations of this study, AI demonstrated superior accuracy in identifying DIS from low-quality or distorted radiographs, outperforming dental professionals in classification tasks. However, for actual clinical application of AI, extensive standardization research on low-quality and distorted radiographic images is essential. [ABSTRACT FROM AUTHOR]

Artificial Intelligence (AI) has emerged as a transformative force within medical imaging, making significant strides within emergency radiology. Presently, there is a strong reliance on radiologists to accurately diagnose and characterize foreign bodies in a timely fashion, a task that can be readily augmented with AI tools. This article will first explore the most common clinical scenarios involving foreign bodies, such as retained surgical instruments, open and penetrating injuries, catheter and tube malposition, and foreign body ingestion and aspiration. By initially exploring the existing imaging techniques employed for diagnosing these conditions, the potential role of AI in detecting non-biological materials can be better elucidated. Yet, the heterogeneous nature of foreign bodies and limited data availability complicates the development of computer-aided detection models. Despite these challenges, integrating AI can potentially decrease radiologist workload, enhance diagnostic accuracy, and improve patient outcomes. [ABSTRACT FROM AUTHOR]

Rubber band constriction syndrome has been described in the literature, although there are very few case reports. Non-healing recurrent tenosynovitis and synovitis of the wrist joint demonstrating a circular rubber band on imaging has not been described before. Imaging studies showed retained circular band deep to the extensor tendons, embedded within the joint capsule. Surgical removal of the band by open incision led to a dramatic improvement in the outcome of the patient. Level of evidence V. [ABSTRACT FROM AUTHOR]

Tracheobronchial foreign body aspiration is a rare yet potentially life-threatening occurrence in adults, presenting with symptoms ranging from acute asphyxiation to coughing, breathlessness, or choking. These symptoms can be inconsistent and mimic chronic lung conditions like asthma or chronic obstructive pulmonary disease. Chest X-rays and computed tomography scans are valuable for diagnosing and locating the foreign body. However, bronchoscopy is the primary method for diagnosis and management. This case study describes a unique incident involving a fish bone lodged in the mid-trachea, emphasizing the critical importance of timely recognition and intervention. [ABSTRACT FROM AUTHOR]

In the present study, based on kinetic energy theorem and Newton's second law, the velocity equation of the hard foreign object was derived by taking the engine inlet as reference frame. Taking a certain type of aircraft as an example, the factors that influence the impact velocity of foreign objects were discussed at 100% design rotating speed of the engine. It is observed that the velocity of the foreign object is not only related to the dimension, shape, material, and impact location of the foreign object, but also related to the length of the engine inlet as well as the working state of the engine. The proposed method can be used for estimating the impact velocity in FOD tests by taking into account working state of the engine. [ABSTRACT FROM AUTHOR]

Foreign body ingestion is a common clinical occurrence worldwide, with high morbidity in the pediatric population and in adult patients with intentional attempts. Coins and button battery ingestions are more common among children. Bone impaction and swallowed dentures are usually seen in older adults. While most ingested foreign bodies pass through the gastrointestinal tract spontaneously with no complications, some require endoscopic and/or surgical intervention. Complications such as pharyngoesophageal ulceration, perforation, stricture, and deep neck infection can develop without timely diagnosis and management. The purpose of this article is to familiarize radiologists with the imaging approach to assess for characteristics and impacted locations of ingested foreign bodies in the neck. [ABSTRACT FROM AUTHOR]

Ocular trauma often involves intraocular foreign bodies (IOFBs) that pose challenges in accurate diagnosis due to their size, shape, and material composition. In this study, we proposed a novel whole-eye 3D ophthalmic ultrasound B-scan (3D-UBS) system for automating image acquisition and improved 3D visualization, thereby improving sensitivity for detecting IOFBs. 3D-UBS utilizes 14 MHz Clarius L20 probe, a motorized translation stage, and a surgical microscope for precise placement and movement. The system's 3D point spread function (PSF) is 0.377 × 0.550 × 0.894 mm3 characterized by the full-width at half-maximum intensity values in the axial, lateral and elevation directions. Digital phantom and ex vivo ocular models were prepared using four types of IOFBs (i.e., plastic, wood, metal, and glass). Ex vivo models were imaged with both 3D-UBS and clinical computed tomography (CT). Image preprocessing was performed on 3D-UBS images to remove uneven illumination and speckle noise. Multiplanar reformatting in 3D-UBS provides optimal plane selection after acquisition, reducing the need for a trained ultrasonographer. 3D-UBS outperforms CT in contrast for wood and plastic, with mean contrast improvement of 2.43 and 1.84 times, respectively. 3D-UBS was able to identify wood and plastic IOFBs larger than 250 µm and 300 in diameter, respectively. CT, with its wider PSF, was only able to detect wood and plastic IOFBs larger than 600 and 550 µm, respectively. Although contrast was higher in CT for metal and glass IOFBs, 3D-UBS provided sufficient contrast to identify those. 3D-UBS provides an easy-to-use, non-expert imaging approach for identifying small IOFBs of different materials and related ocular injuries at the point of care. [ABSTRACT FROM AUTHOR]

Suspended foreign objects on transmission lines will shorten the discharge distance, easily leading to phase-to-ground or phase-to-phase short circuits, which induces outage accidents. Foreign objects are small and difficult to identify, resulting in low detection accuracy. An improved foreign object detection method based on Swin Transformer V2 and YOLOX (ST2Rep–YOLOX) is proposed. First, the feature extraction layer ST2CSP constructed by Swin Transformer V2 is used in the original backbone network to extract global and local features. Secondly, hybrid spatial pyramid pooling (HSPP) is designed to enlarge the receptive field and retain more feature information. Then, Re-param VGG block (RepVGGBlock) is introduced to replace all 3 × 3 convolutions in the network to deepen the network and improve feature extraction capabilities. Finally, experiments are carried out on the transmission lines foreign object image dataset, which was obtained using unmanned aerial vehicles (UAVs). The experimental results show that the average accuracy of the ST2Rep–YOLOX method can reach 96.7%, which is 4.4% higher than that of YOLOX. The accuracy of the nest, kite, and balloon increased by 9.3%, 15.4%, and 9.6%, and the recall increased by 6.5%, 9.4%, and 2.5%, respectively. This method has high detection accuracy, which provides an important reference for foreign object detection in transmission lines. [ABSTRACT FROM AUTHOR]

Purpose: Rapunzel syndrome is an uncommon condition in children, and its clinical features remain unclear. This study presents the largest single-center series of pediatric cases to date, with the objective of documenting the clinical characteristics and treatment approaches for children with Rapunzel syndrome. Methods: A retrospective study was conducted in children with Rapunzel syndrome from 2019 to 2023. We recorded age, gender, symptoms, locations of bezoar, complications, and treatment options. Results: Ten patients with Rapunzel syndrome were included. The median age was 9.1 years, with all of whom were female. The most common clinical symptoms were upper abdominal mass (90%), abdominal pain (80%), and nausea and vomiting (50%). Complications occurred in six cases (60%), including small bowel obstruction (20%), severe gastric dilatation (10%), intestinal perforation (10%), choledochodilation (10%), acute pancreatitis with cholecystitis (10%). Preoperative ultrasonography suggested low-echoic foreign bodies continuing to the jejunum or ileocecal region in five cases (50%). Preoperative gastroscopy attempted in four cases (40%) to remove the foreign bodies, all of which failed. All patients underwent surgical treatment, with nine cases undergoing gastric incision foreign body removal, and one case undergoing gastric incision foreign body removal combined with intestinal perforation repair. All patients recovered well. No recurrence was observed during follow-up. Conclusion: The accuracy of ultrasound diagnosis in identifying Rapunzel syndrome is high; however, it may lead to misdiagnosis if not complemented with the patient's medical history. Endoscopic presents a heightened treatment risk and a reduced success rate. The condition commonly presents with severe complications, thus making laparotomy a safe and effective option for intervention. [ABSTRACT FROM AUTHOR]

Background: Osteoradionecrosis (ORN) of the skull base is a rare complication after head and neck radiation with a broad variety of subsequent complications. Methods: A 68-year-old woman with a complex oncological history (right-sided sphenoid meningioma; left-sided neck metastasis of a Cancer of Unknown Primary—CUP) was admitted with a right-sided epi—/ oropharyngeal mass and severe pain exacerbations for further evaluation. CT scan revealed an advanced ORN of the skull base with subsequent abruption of the ventral part of the clivus. This dislocated part of the clivus wedged in the oropharynx for 48 h and then moved towards the larynx, resulting in dyspnea and almost complete airway obstruction. Results: Due to the dangerous airway situation, an urgent exploration and removal of the dislocated clivus was necessary. After a potential cervical spine instability was ruled out, the patient's airway was initially secured with an awake tracheotomy and the clivus was removed transorally. The tracheostomy tube was removed during the ongoing inpatient stay, and the patient was discharged with significant pain relief. Conclusions: The present case illustrates an orphan complication of skull base ORN resulting in a major airway emergency situation. [ABSTRACT FROM AUTHOR]

Objectives: To compare the social, emotional, and behavioral status between the patients aged 1 to 4 years with foreign body ingestion and healthy individuals. Methods: A case control study was conducted in a tertiary level hospital over 32 months. Children, aged 1–4 years, admitted to the pediatric emergency department with foreign body ingestion were included as cases. Patients with known autism spectrum disorders, cerebral palsy and incomplete evaluation were excluded. A matched control group constituted healthy individuals. Both groups were evaluated with Aberrant Behavior Checklist (ABC) and Brief Infant-Toddler Social Emotional Assessment (BITSEA) scales. Logistic regression was performed to determine the predictors of foreign body ingestion. Results: Cases and controls included 150 children each. All ABC subscale scores (mean irritability, hyperactivity/dissonance, lethargy/social withdrawal, stereotypical behavior, and inappropriate speech) and problem area scores of BITSEA were significantly higher in the cases (P < 0.001). Hyperactivity was significantly predictive of foreign body ingestion [OR (95% CI) 1.37 (1.21, 1.55), P < 0.001] Conclusion: Younger children with foreign body ingestion screened significantly higher for behavioral and emotional problems compared to controls. Hyperactivity was an important predictor factor for foreign body aspiration. [ABSTRACT FROM AUTHOR]

The symptoms of tracheobronchial foreign body in the elderly are not typical, so they are often missed or misdiagnosed. This study aims to depict the clinical characteristics of tracheobronchial foreign body inhalation in the elderly. We retrospectively analysed the clinical data of elder patients (age ≥ 65 years) diagnosed with tracheal and bronchial foreign bodies. The data included age, sex, clinical symptoms, type and location of foreign bodies, prehospital duration, Chest CT, bronchoscopic findings, and frequencies and tools for removing these elderly patients' tracheal and bronchial foreign bodies. All patients were followed up for a half year. Fifty-nine cases were included, of which only 32.2% had a definite aspiration history. Disease duration > 30 days accounted for 27.1% of the patients. 27.1% of the patients had a history of stroke, and 23.8% had Alzheimer's Disease. Regarding clinical symptoms, patients mainly experience cough and expectoration. The most common CT findings were abnormal density shadow (37.3%) and pulmonary infiltration (22.0%). Under bronchoscopy, purulent secretions were observed in 52.5% of patients, and granulation tissue hyperplasia was observed in 45.8%. Food (55.9%) was the most common foreign object, including seafood shells (5.1%), bones (20.3%), dentures (18.6%), and tablets (20.3%). The success rate of foreign body removal under a bronchoscope was 96.7%, 28.8% of the foreign bodies were on the left and 69.5% on the right. 5.1% of the elderly patients required rigid bronchoscopy, and 6.8% required two bronchoscopies. In elderly cohorts, tracheal foreign bodies are obscured by nonspecific clinical presentations and a paucity of aspiration history, challenging timely diagnosis. Predominantly constituted by food particles, with a notable predilection for the left bronchial tree, these cases demand skilled bronchoscopic management, occasionally requiring sophisticated approaches for successful extraction. [ABSTRACT FROM AUTHOR]

Background: Ingested foreign bodies may become impacted in the upper gastrointestinal tract, requiring endoscopic removal. Aims: To establish and validate a nomogram to determine the risk of complications following endoscopic foreign body removal. Methods: We retrospectively analyzed the data of 1510 adult patients who underwent endoscopic removal of ingested foreign bodies between January 2019 and December 2022. All participants were randomly allocated in a 7:3 ratio to the training (n = 1057) and validation (n = 453) cohorts. A nomogram for the development of major complications associated with endoscopic foreign body removal was established based on risk factors identified by logistic regression analysis. Results: Four independent risk factors for the development of major complications were identified by multivariate regression analysis: older age, impaction time > 24 h, type of foreign body (animal bones and jujube pits), and number of pressure points exerted on the digestive tract wall (one and ≥ two). The nomogram constructed using these factors showed favorable discriminatory values, with an area under the curve of 0.76 (95% confidence interval, 0.73–0.78) in the training cohort and 0.74 (95% confidence interval, 0.72–0.76) in the validation cohort. Conclusions: Older patients who ingested bones or jujube pits with more pressure points exerted on the digestive tract wall more than 24 h earlier should be considered most at risk of major complications after endoscopic removal of foreign bodies. The nomogram established in this study can be conveniently used to assess patients and develop treatment plans for the management of foreign body ingestion. [ABSTRACT FROM AUTHOR]

Introduction: Chest x-rays are widely used for diagnosing chest pathology worldwide. Pediatricians frequently interpret chest radiographs in the emergency department, guiding patient management. This study aims to assess the competency of non-radiologists in interpreting emergency chest x-rays and compare it with trainees of different levels to determine the necessity of radiologist input. Methodology: A cross-sectional online survey was conducted in Saudi Arabia from September to October 2023, involving 385 participants, including pediatricians and medical interns from various regions. Carefully selected questions addressed a range of x-ray abnormalities in pediatric emergencies, assessing fundamental understanding of x-ray interpretation, such as inspiratory vs. expiratory and AP or PA films. Results: The study included 385 participants, primarily Saudi nationals in the eastern region, with an equal gender distribution and ages ranging from 20 to 29 years. Approximately 29.09% demonstrated fair knowledge, with 28% being Junior Pediatrics Residents, 18% Pediatric Consultants, and 15% Senior Pediatrics Residents. Fair knowledge was significantly associated with individuals aged 20–29 years, residents of the western region, and Junior Pediatrics Residents. Clinical knowledge varied among different groups, with 59% correctly identifying atypical pneumonia and 65% recognizing asymmetrical hyperinflation. However, rates for other conditions differed, with low identification of potential foreign body aspiration and film type. Accuracy in identifying tension pneumothorax and hyperlucency varied among clinicians. Pleural effusion films had a 65% identification rate for the diagnosis, but only 28% accurately described the X-ray and selected the correct answer for lung opacity. Conclusion: The study concluded that 29.9% of the participating physicians exhibited fair knowledge of common pediatric emergency radiological films. Junior pediatric residents showed the best knowledge, and Tetralogy of Fallot, asymmetrical hyperinflation, and pleural effusion had the highest recognition rates. In conclusion, there is still a need for radiologists in the pediatric emergency department to ensure optimal functioning. [ABSTRACT FROM AUTHOR]

Purpose: Retained foreign objects (RFOs) can place patients undergoing cataract surgery at risk for significant vision-threatening complications. In this systematic review, we examine the characteristics, clinical outcomes, and management of RFOs originating from surgical instruments or the surgical field after routine cataract surgery. Methods: Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, we searched five databases in June 2023. The inclusion criteria were peer-reviewed, full-text, English-language articles describing RFOs after routine cataract surgery. Studies that described non-routine cataract surgeries, patients with a history of ocular trauma, or organic RFOs were excluded. Two investigators independently extracted data and appraised the methodological quality of each study using Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: Twenty-eight studies were included in our qualitative synthesis describing metal, fiber, and plastic RFOs. Typically, the RFOs were detected during surgery or slit-lamp examination. Presentations of patients with metal or fiber RFOs varied, with some being asymptomatic. Patients with plastic RFOs were usually symptomatic, often with decreased visual acuity and/or anterior chamber inflammation. Metal RFOs may have originated from metal fatigue from prolonged instrument usage and contact between surgical instruments, fiber RFOs from surgical wipes and gauzes, and plastic RFOs from instrument wrapping and intraocular lens defects. Factors such as location, biocompatibility, and secondary intraocular inflammation influenced the decision to surgically remove RFOs. Following surgical removal, the signs and symptoms resolved in most patients with RFOs. The studies' GRADE ratings indicated limitations in risk of bias and imprecision. Conclusion: The presentation and management of RFOs varied depending on the type of material. To prevent RFOs, clinicians should carefully inspect surgical instruments and packs and use fiber-free wipes, towels, and gauzes. Future studies should investigate the efficacy and cost-effectiveness of different RFO prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Foreign body granulomas are postoperative inflammatory reactions to surgical materials within the body. Traditionally, sutures have been the leading cause of foreign body granulomas in the abdomen, commonly referred to as "suture granuloma". However, the use of polymer clips in modern surgeries has introduced new challenges, and reports of intra-abdominal foreign body granulomas caused by surgical clips are limited. Herein, we present a case of an intra-abdominal foreign body granuloma formed due to polymer clips. Case presentation: A 45-year-old woman who underwent laparoscopic resection for sigmoid colon adenocarcinoma subsequently developed a suspected lymph node recurrence during follow-up. Imaging showed an enlarging mass adjacent to the inferior mesenteric artery with increased fluorodeoxyglucose uptake. Laparoscopic surgical resection revealed the formation of a foreign body granuloma in response to the polymer clips. Conclusions: This case suggests that nonabsorbable polymer clips can induce granulomatous reactions postoperatively, and the appearance of lymph node recurrence may be foreign body granulomas. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the imaging characteristics of cosmetic surgery-derived foreign bodies in the maxillofacial region through a retrospective review of cosmetic material foreign bodies incidentally detected on computed tomography (CT) images in routine clinical practice. Methods: We retrospectively investigated cases of cosmetic surgery-derived foreign bodies other than dental materials in the maxillofacial region, using 5 years of CT image data stored on an imaging server. The imaging findings of these foreign bodies were investigated, along with patient age, patient sex, whether the foreign bodies were associated with the disease targeted by the CT scan, and the availability of cosmetic surgery information prior to examination. Results: Foreign bodies were more common in women (19/21 cases), and affected patients displayed a wide age range (20–84 years). Four types of cosmetic surgery-derived foreign bodies in the maxillofacial region were detected by CT examination: nasal prostheses (nasal region), lifting sutures and injectable facial fillers (both in the buccal region), and silicone chin implants (chin region). Conclusions: A cosmetic surgery-derived foreign body should be suspected when a foreign body is identified without a dental source of infection. In addition, cosmetic surgery-derived foreign bodies may be present in numerous patients, regardless of age or sex. [ABSTRACT FROM AUTHOR]

Purpose: Inhalation of a foreign body is a real emergency in pediatric age and requires prompt diagnosis and treatment to reduce mortality. The objective of this study is to analyze clinical and radiological details, types, and localization of foreign bodies in patients conducted or to our hospital with suspected inhalation. Methods: We conducted a retrospective analysis of all cases of foreign body inhalation admitted to our Pediatric Emergency Room between January 2009 and June 2022. Results: 171 patients were included in the study. In 83 patients, the FB was detected. The mean age of presentation was 2.3 years (SD: ± 2). Cough (73%) and unilateral reduced breath sound (51%) were the most common clinical symptom and clinical sign. The most frequent localization was the right main bronchus (43%). The foreign bodies retrieved were vegetable (83%), of which peanut was the most common. Chest radiographs were normal in 25%. The mean duration of hospitalization was 5 days (± 2.9). Complications such as pneumothorax were seen in two cases. Conclusions: Foreign body inhalation represents a true pediatric emergency and still a challenge in clinical practice. The best way to manage it is an early diagnosis and removal by fully trained staff. [ABSTRACT FROM AUTHOR]

Purpose: The number of seven required throws per knot was previously reported as providing sufficient security against slippage. A novel high-strength suture featuring dynamic tightening may allow for throw number reduction without compromising stability. The aims of this study were to (1) investigate the influence of the throw number and the effect of different ambient conditions on the knot security of two different high-strength sutures, and (2) compare their biomechanical competence. Methods: Two sutures (FiberWire (FW) and DynaCord (DC)) were considered for preparing alternating surgical knots. The specimens were stratified for exposure to different media during biomechanical testing—namely air (dry), saline solution (wet), and fat (fatty-wet). A monotonic tensile ramp loading to failure was applied in each test run. For each suture and ambient condition, seven specimens with three to seven throws each were tested (n = 7), evaluating their slippage and ultimate force to failure. The minimum number of throws preventing suture unraveling was determined for each suture type and condition. Results: For each suture type and condition, failure occurred via rupture in all specimens for the following minimum number of throws: FW—dry–7, wet–7, fatty-wet–7; DC—dry–6, wet–4, fatty-wet–5. When applying seven throws, FW demonstrated significantly larger slippage (6.5 ± 2.2 mm) versus DC (3.5 ± 0.4 mm) in wet (p = 0.004) but not in dry and fatty-wet conditions (p ≥ 0.313). Conclusions: The lower number of throws providing knot security of DC versus FW in the more realistic wet and fatty-wet conditions indicates that the novel DC suture may allow to decrease the foreign body volume and save surgical time without compromising the biomechanical competence. [ABSTRACT FROM AUTHOR]

Background: Foreign body ingestion in adults is commonly encountered in clinical practice. The therapeutic approach of whether to follow-up or extract is often controversial. Aim: We aimed to explore predictors for spontaneous passage of ingested foreign bodies by focusing on foreign body type, length, and location of impaction. Methods: We performed a 12-year retrospective single-center study. Logistic regression analysis was done to identify predictors of spontaneous passage. Results: Overall, 365 patients with foreign body ingestion were included. The rate of spontaneous passage was 53.7% in general, while the spontaneous passage rate was 47.9% in food impaction, 44.3% in sharp objects, 88.7% in blunt objects and only 22.2% in long blunt objects (> 6 cm). On regression analysis, esophageal location was associated with a higher impaction rate and lower spontaneous passage vs. stomach and small and large intestine (OR 0.15, 95% CI 0.07–0.31, OR 0.18, 95% CI 0.09–0.37 and OR 0.02, 95% CI 0.003–0.14), respectively. Performing Receiver operating characteristics (ROC) analysis found that the maximal length above which the foreign body will fail to pass spontaneously was 3.5 cm in the stomach and 3 cm in the small intestine, with area under the curve (AUC) of 0.8509 in stomach and 0.8073 in small intestine. Conclusion: Endoscopic removal was needed for all esophageal foreign bodies, and all foreign bodies more than 3.5 cm above the duodenum. Spontaneous passage of ingested foreign body in a selected cohort of patients depends on foreign body type, location, and length. [ABSTRACT FROM AUTHOR]

Purpose: Several clinical practice guidelines (CPGs) have been produced to optimize the diagnosis and management of pediatric foreign body aspiration and ingestion. However, to date there have been no critical evaluations of their methodological rigor or quality. Herein, we address this need via the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Methods: A literature search of Embase, MEDLINE via PubMed, and Scopus was performed up until February 25, 2021. Identified CPGs were then assessed by four independent reviewers trained in AGREE II. A scaled domain score of >60% was indicated as satisfactory quality. Intraclass correlation coefficients (ICC) were calculated to assess inter-reviewer agreement. Results: 11 guidelines were assessed with only one being classified as high quality and others being either average (two) or low quality (eight). Domain 4 (clarity of presentation) achieved the highest mean score (66.41 ± 13.33%), while domain 5 (applicability) achieved the lowest score (10.80 ± 10.37%). ICC analysis revealed generally strong agreement between reviewers with a range of 0.60–0.98. Conclusion: Quality appraisal using the AGREE II instrument suggests that the methodologic rigor and quality of current guidelines for the diagnosis and management of pediatric foreign body aspiration and ingestion need significant improvement. [ABSTRACT FROM AUTHOR]

Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2–7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required. [ABSTRACT FROM AUTHOR]

Fishbones are frequently swallowed by foreign objects that can penetrate the gastrointestinal tract. Nonetheless, it is quite uncommon for these fishbones to become lodged within the tract, resulting in the formation of foreign body granulomas that resemble submucosal tumors. When encountering this situation, it's important to consider differential diagnoses such as gastric intestinal stromal tumor, gastric leiomyoma, and gastric neurofibroma. We present a case of gastric foreign body granuloma that presents with dull aching epigastric pain. The patient gave a vague history of displaced intrauterine contraceptive devices (IUCD). Contrast CT and PET scan showed a gastric antral mass possibly a gastric cancer or a migrating IUCD. Endoscopic ultrasound (EUS) suggested a perigastric foreign body reaction due to the presence of a linear echogenic structure in between the markedly thickened gastric antral wall and the right lobe of the liver. EUS-guided fine needle biopsy (EUS-FNB) revealed non-specific inflammatory reaction. Afterward, surgical exploration unveiled the cause of the mass as a foreign body granuloma caused by a perforating fishbone. [ABSTRACT FROM AUTHOR]

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal. [ABSTRACT FROM AUTHOR]

Background: Foreign Body Aspiration (FBA) is one of the paediatric emergencies which require timely diagnosis and management. The inherent tendency of children to explore small objects with their mouths often prove to be fatal as they are difficult to remove once aspirated. Case Report: We present the case of a 5-year-old boy who presented with dyspnea and vomiting following the aspiration of a pen cap. Chest radiograph and Rigid Bronchoscopy helped to identify the foreign body but it couldn't be removed by Rigid Bronchoscopy alone due it's wedge-shaped nature. Hence, an unconventional method of foreign body removal was performed by making a tracheostoma, pushing the foreign body to the level of tracheostoma and thereby taking it out from the tracheostoma under strict monitoring of anesthesia team. Conclusion: Alternative approaches like this are required for prompt intervention in a difficult case as it helps to reduce complications produced by repeated failed attempts. [ABSTRACT FROM AUTHOR]

Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0–18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1–3; moderate, 4–6; high, 7–10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11–39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P <.001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78–4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016–2019 to 50% in 2020 (P =.042). Conclusion: FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. What is Known: • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. What is New: • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Penetrating spinal injuries are generally extremely rare and are seldom encountered in pediatric patients. The non-compliance of pediatric patients with physical examination can sometimes delay diagnosis and treatment. Here, we present a case of a child who had a fall and suffered penetrating spinal trauma due to a small glass fragment. Case report: A penetrating foreign body was detected in the lumbar spinal region of a 2-year-old patient with complaints of increased restlessness on physical activity followed by difficulty in walking. The patient was operated on and followed up without any complications in the perioperative and late postoperative periods. Conclusion: A detailed physical examination is necessitated in the pediatric age group because of insufficient anamnesis. The high number of patients per physician, especially in societies having a low socioeconomic standard, prevents detailed examinations, and unnecessary examinations may cause delays in diagnosis. However, one must note that the skin findings of pediatric patients can be very helpful, especially in pediatric neurosurgery, and examination should not be neglected. [ABSTRACT FROM AUTHOR]

Foreign object encroachment is the presence of persons or items in the contact network and railroad track area, which can result in accidents, electrical failures, and train damage on the railroad. By keeping an eye on the lookout, seeing the intrusion of a foreign object, and braking quickly, train drivers can lessen the risks brought on by foreign object invasion. The question of how to maintain and monitor the continuous attention level of train drivers has been a hot issue, because of the monotonous environment of railroad operating makes the alertness decline during threat perception. Based on the theory of situational awareness, this study posits that training drivers in foreign object encroachment experience schemas can enhance their sustained attention levels, leading to improved hazard perception sensitivity. The hypothesis is subsequently verified in different route types and road types. We utilized a set of 24 videos depicting railroad traffic scenarios, generated by a driving simulator, to examine the sustained attention levels and hazard perception capabilities of train drivers. The participants in our study were divided into two groups: one group consisted of train drivers with recent experience of foreign object intrusion (n = 37), and the other group comprised train drivers without such recent experience (n = 35). The study's findings suggest that schemas have an impact on hazard sensitivity by influencing the extent of sustained attention. This effect is further moderated by the pseudoneglect effect and prioritization of task goals. The results provide confirmation that the situational awareness theory holds valuable insights for enhancing the training of train drivers in hazard perception and sustaining attention. And it also addresses a previously existing gap in the literature regarding the factors affecting train drivers' hazard perception. These findings can be instrumental in shaping training programs aimed at safety awareness, as well as the design and implementation of alertness monitoring systems for train drivers. [ABSTRACT FROM AUTHOR]