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Summary: Background: Transcatheter arterial embolization (TAE) is an effective alternative to nonoperative management (NOM) to improve the spleen salvage rate for patients with blunt splenic injuries (BSIs), but it is not always available at some institutions. Moreover, laparoscopy has also been used to diagnose and treat trauma, including BSIs. Methods: We present our 11-year experience in performing laparoscopic surgery for spleen salvage in patients with severe BSIs when TAE is infeasible. The outcomes of laparoscopic surgery or TAE for spleen salvage in hemodynamically stable patients with severe BSIs were compared. Results: Fifty-six patients underwent interventions for severe BSIs during this period. Twenty patients underwent laparoscopic surgery, and 36 underwent TAE. There were no significant differences in demographics, preoperative conditions, or clinical characteristics (all p > 0.05). In the laparoscopic surgery group, 15 patients (75 %) underwent laparoscopic splenorrhaphy for spleen salvage surgery, and five (25 %) required splenectomy. No complications requiring intervention were observed in the laparoscopic surgery group, whereas three patients in the TAE group required a late splenectomy for splenic abscess. No significant differences were detected in the splenic preservation rate, complication rate, or length of hospital stay between the groups (all p > 0.05). Conclusion: Laparoscopy is feasible and safe for managing hemodynamically stable patients with severe BSIs, and the outcomes are comparable to those of TAE. When TAE is infeasible, laparoscopy can be considered an alternative to increase the spleen salvage rate.

Introduction Pelvic fractures often result in life-threatening bleeding and hemodynamic instability. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a promising strategy for patients with severe pelvic fractures, facilitating subsequent hemostatic interventions. Transcatheter arterial embolization (TAE) is a well-established procedure for managing pelvic fractures accompanied by hemorrhage.Ideally, an angiographic access point distinct from the initial REBOA placement is sought to maintain REBOA deflation without complete removal, thereby preventing hemodynamic instability during the procedure. However, in cases of extreme and severe pelvic trauma, gaining access for REBOA is already challenging, not to mention the additional difficulty posed by subsequent angiographic access.This study aims to assess the challenges associated with gaining access in cases where successful TAE was ultimately performed, particularly in the context of severe pelvic trauma. We investigate the complexities surrounding access management and its implications for patient outcomes.Methods We conducted a retrospective analysis of patients who presented with pelvic fractures and underwent sequential REBOA and TAE procedures at our institution between 2017 and 2023. We excluded patients with Abbreviated Injury Scores (AIS) ≥3 in systems other than the pelvis, those who underwent TAE prior to REBOA, and cases of suboptimal REBOA insertion.We collected demographic data, injury characteristics, details of the REBOA and TAE procedures, information on complications, and data on patient survival. The primary endpoints of our analysis included overall survival and the success of TAE (defined as post TAE mean arterial pressure (MAP) ≥65 mm Hg). Secondary endpoints encompassed the duration details of two interventions.Results Between 2017 and 2023, a total of 17 patients were included in this study. Among this cohort, 12 (70.6%) were male, with a median age of 51 years. Overall survival was 23.5%. Patients were grouped into angiography after REBOA deflation (AAD) or angiography after REBOA removal (AAR). AAR group was younger (39.0 vs 63.0, p=0.030) and had higher Shock Index at triage (2.30 vs 1.10, p=0.015). More patient whose post TAE MAP >=65 mm Hg was found in the AAR group, although no significant difference on overall survival (25.0% vs 22.2%, p=1.000). Angiographic cannulation times, pre-angiographic MAP, and amount of pre-angiographic transfusion of packed red blood cell were similar across groups.Conclusion Our findings provide empirical insights into vascular access selection and suggest that AAR in the management of severe pelvic fractures can be beneficial, particularly when pre-angiographic resuscitation is sufficient. Larger studies are required to validate these observations and assess long-term outcomes.Level of evidence III.

Abstract There is a lack of studies that concurrently differentiate the effect of the holiday season from the weekend effect on mortality risk in patients with acute myocardial infarction (AMI). We evaluated the mortality risk among patients admitted with AMI who underwent percutaneous coronary intervention, using data from the Taiwan National Health Insurance Research Database. Adult AMI patients admitted during January and February between 2013 and 2020 were enrolled and classified into the holiday season (using the Chinese New Year holiday seasons as an indicator) (n = 1729), weekend (n = 4725), and weekday (n = 14,583) groups according to the first day of admission. A multivariable logistic regression model was used to assess the risk. With the weekday group or the weekend group as the reference, the holiday season group did not have increased risks of in-hospital mortality (adjusted odds ratio [aOR] 1.15; 95% confidence intervals [CI] 0.93–1.42 or aOR 1.23; 95% CI 0.96–1.56) and 7-day mortality (aOR 1.20; 95% CI 0.90–1.58 or aOR 1.24; 95% CI 0.90–1.70). Stratified and subgroup analyses showed similar trends. We conclude that holiday season-initiated admissions were not associated with higher mortality risks in AMI admission cases than weekday or weekend admissions.

Abstract Background Amyand’s hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand’s hernia. Case presentation A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand’s hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months. Conclusions Unlike the traditional definition of Amyand’s hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand’s hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.

In this work, we quantitatively compare computer simulations and existing cell tracking data of P. aeruginosa surface motility in order to analyse the underlying motility mechanism. We present a three dimensional twitching motility model, that simulates the extension, retraction and surface association of individual Type IV Pili (TFP), and is informed by recent experimental observations of TFP. Sensitivity analysis is implemented to minimise the number of model parameters, and quantitative estimates for the remaining parameters are inferred from tracking data by approximate Bayesian computation. We argue that the motility mechanism is highly sensitive to experimental conditions. We predict a TFP retraction speed for the tracking data we study that is in a good agreement with experimental results obtained under very similar conditions. Furthermore, we examine whether estimates for biologically important parameters, whose direct experimental determination is challenging, can be inferred directly from tracking data. One example is the width of the distribution of TFP on the bacteria body. We predict that the TFP are broadly distributed over the bacteria pole in both walking and crawling motility types. Moreover, we identified specific configurations of TFP that lead to transitions between walking and crawling states.

Cooling water towers are commonly used in industrial and commercial applications. Industrial sites frequently have harsh environments, with certain characteristics such as poor air quality, close proximity to the ocean, large quantities of dust, or water supplies with a high mineral content. In such environments, the quality of electrical conductivity in the cooling water towers can be significantly negatively affected. Once minerals (e.g., calcium and magnesium) form in the water, conductivity becomes too high, and cooling water towers can become easily clogged in a short time; this leads to a situation in which the cooling water host cannot be cooled, causing it to crash. This is a serious situation because manufacturing processes are then completely shut down, and production yield is thus severely reduced. To solve these problems, in this study, we develop a practical designation for a photovoltaic industry company called Company-L. Three control methods are proposed: the motor control method, the PID control method, and the fuzzy PID control method. These approaches are proposed as solutions for successfully controlling the forced replenishment and drainage of cooling water towers and controlling the opening of proportional control valves for water release; this will further dilute the electrical conductivity and control it, bringing it to 300 µS/cm. In the experimental processes, we first used practical data from Company-L for our case study. Second, from the experimental results of the proposed model for the motor control method, we can see that if electrical conductivity is out of control and the conductivity value exceeds 1000 µS/cm, the communication software LINE v8.5.0 (accessible via smartphone) displays a notification that the water quality of the cooling water towers requires attention. Third, although the PID control method is shown to have errors within an acceptable range, the proportional (P) controller must be precisely controlled; this control method has not yet reached this precise control in the present study. Finally, the fuzzy PID control method was found to have the greatest effect, with the lowest level of errors and the most accurate control. In conclusion, the present study proposes solutions to reduce the risk of ice-water host machines crashing; the solutions use fuzzy logic and can be used to ensure the smooth operation of manufacturing processes in industries. Practically, this study contributes an applicable technical innovation: the use of the fuzzy PID control model to control cooling water towers in industrial applications. Concurrently, we present a three-tier monitoring checkpoint that contributes to the PID control method.

Abstract Balanced detection based on double beams is widely used to reduce common-mode noises, such as laser intensity fluctuation and irregular wavelength scanning, in absorption spectroscopy. However, employing an additional detector can increase the total system noise due to added non-negligible thermal noise of the detector, particularly with mid-infrared (IR) detectors. Herein, we demonstrate a new optical method based on double-beam modulation (DBM) that uses a single-element detector but keeps the advantage of double-beam balanced detection. The sample and reference path beams were modulated out-of-phase with each other at a high frequency, and their average and difference signals were measured by two lock-in amplifiers and converted into absorbance. DBM was coupled with our previously reported solvent absorption compensation (SAC) method to eliminate the IR absorption contribution of water in aqueous solutions. The DBM-SAC method enabled us to acquire IR absorption spectra of bovine serum albumin solutions down to 0.02 mg/mL. We investigated the noise characteristics of DBM measurements when the wavelength was either fixed or scanned. The results demonstrate that DBM can lower the limit of detection by ten times compared to the non-modulation method.

The technical skills of using geographical information systems (GIS) are often taught in different higher education disciplines apart from geocapabilities or geographic disciplinary expertise. Theorised to include capabilities such as spatial thinking, geographical imagination and structured ways to explore places, the concept of geocapabilities has been developed from educator perspectives but student perspectives have yet to be empirically examined. Drawing upon recommendations that students can better acquire geocapabilities through research and authentic problem-solving, this study examines how 27 higher education students' perceptions of geocapabilities evolved as they learnt technical skills of web mapping through investigating real-world issues with ArcGIS StoryMaps. Content analyses of students' pre- and post-class reflections suggest that students' perceptions aligned with existing theorisations of geocapabilties in areas such as spatial thinking and geographical imagination. However, students also perceived that geographers need curiosity, interest, enthusiasm, and love for geography, and generic skills for working and living in the world that are not geography-related. Through making story maps with GIS, students' perceptions of geocapabilities shifted significantly in the areas of geographical practice and application, geographical imagination and interdisciplinarity. The implications of these findings for higher education teaching of GIS and how it informs the theorisation of geocapabilities are discussed.

Background: Noninvasive caries treatments work topically, which may limit efficacy. The authors hypothesized that an alternative approach using mineral-loaded particles designed to target the subsurface of noncavitated caries lesions could be advantageous. This study shows in vitro proof-of-concept. Methods: Mineral-loaded cationic starch (MLCS) particles were prepared, containing calcium, phosphate, and fluoride to provide fluoride-plus (FP) and fluoride-free (FF) alternatives. Particles were characterized for mineral loading and release. MLCS-FP and -FF treatments vs 1,000 ppm fluoride and deionized water controls were evaluated on natural smooth-surface caries lesions (n = 15 per group) after a 20-day protocol with immersion in artificial saliva with amylase and acid challenge. Treatment efficacy was assessed by microcomputed tomography, labeled fluorescence imaging, and blinded qualitative visual assessment. Results: In aqueous suspension and absent amylase, particles showed sustained mineral ion release. The tomographic evaluation found significant (multivariable regression analysis, P < .05) restoration of lesion mineral density by MLCS-FP and MLCS-FF (42.9% and 38.6%, respectively) vs fluoride and negative controls (7.4% and −18%, respectively), particularly for the lesion subsurface (13.8% [13.0%], 15.9% [9.4%], −2.2% [7.3%], and −1.8% [4.0%] relative hydroxyapatite density for 0.25 through 0.45 μm lesion depth for FP, FF, fluoride, and deionized water, respectively). Visually reduced white opacity (Fisher exact test, P = .038, MLCS-FF vs fluoride) and labeled fluorescence (analysis of variance, P < .05 for MLCS-FF [75.4%], MLCS-FP [75.7%], fluoride [64.1%] vs negative control [−0.2%]) were observed. Conclusions: These foundational studies show the potential of mineral-loaded starch particles to remineralize enamel as a new approach to treating early caries by subsurface targeted mineral delivery. The in vitro study results indicated that targeted particles improved treatment efficacy, with the data supporting the superiority of MLCS-FP and FF formulations over control conditions for subsurface remineralization and visual esthetic.

Undergraduate research experience is the process where undergraduates contribute to the development of a subject field through their inquiry-based learning (IBL). IBL is a student-centered learning strategy. Students work as professional scientists do, through inquiry. This article presents approaches to IBL and practices of an instructor from China for strengthening and facilitating IBL in geographical information science (GIS). Two paths were proposed for the development of the students on the basis of four modes of IBL. The practical experience was introduced in two parts: course design and IBL tool development for classroom teaching, and undergraduate mentoring outside of the classroom.