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Hanging is a common method of suicide/homicide in India. We report a series of three cases of suicidal hangings and one accidental strangulation case seen over 4 months in the Department of Trauma and Emergency Medicine. All our patients presented in very critical condition and were treated with early aggressive management resulting in excellent outcomes.

In titanium matrix composites, the size and distribution of the reinforcing particles significantly impact their mechanical properties. Accordingly, in this work, TiC-reinforced Ti-alloy matrix composites were fabricated using the directed energy deposition (DED) technology. The influence of the varying process parameters on the microstructure and properties of the TiC-reinforcing particles and the α phase in the matrix was elucidated. The results revealed that process parameters had a notable influence on the morphology and distribution of the TiC reinforcing particles as well as the morphology of the α phase. A reduction in the pulse current and increasing scanning speed led to a significant decrease in the size of TiC reinforcing particles but offered uniform distribution. Concurrently, the morphology of the α phase changes from coarse lath-like to slender lath-like to irregular block-like. The combination of the TiC particles and the α phase with distinct characteristics resulted in significant variations in the room-temperature tensile properties of the TiC/Ti-alloy composites. The tensile strength of the TiC/Ti-alloy composites exhibiting optimal performance in this work reached 1412 MPa, which is ∼28% higher than that of the forged Ti-alloy matrix (1100 MPa). This research offers the groundwork for a substantial enhancement in the overall properties of titanium matrix composites.

High-entropy alloys (HEAs) are known for their distinctive microstructural features, outstanding performance, and potential applications, establishing them as novel metallic materials. Studies indicate that face-centered cubic HEAs generally offer increased strength and toughness at lower temperatures, suitable for cryogenic applications. This work on (FeCoNi)86Al7Ti7 HEA fabricated using powder bed fusion (PBF) studies the phase composition, microstructure, and mechanical properties at both room and cryogenic temperatures (298 K and 77 K). The PBF HEA exhibits a hierarchical microstructure with columnar grains, Ti-enriched cellular substructures entangled with high-density dislocations, and L21 nanoprecipitates, contributing to an excellent strength-ductility combination at room temperature. Notably, as the temperature decreases from 298 K to 77 K, both strength and ductility increase, with a higher yield strength of ∼1.0 GPa, ultimate tensile strength of ∼1.55 GPa, and ductility of ∼42%. Dislocation strengthening is dominant at both room and cryogenic temperatures, with dislocation slip as the primary deformation mechanism at 298 K and a combination of dislocation slips and stacking faults at 77 K.

Hyperbaric oxygen therapy (HBOT), has gained attention in recent years as a potential adjunct to conventional cancer treatments, particularly in addressing tumor hypoxia which is extensively employed as a post-injury treatment, is the administration of >92% oxygen at 1.5- 3.0 ATA for 60-120 minutes. HBOT is attributed to at least five mechanisms including epigenetic regulation of gene expression, mechanical effects, bacteriostatic effects, hyperoxygenation for carbon monoxide and cyanide poisoning treatment, and restoration from hypoxia. HBOT is emerging as a promising adjunct to conventional cancer treatments, particularly in overcoming tumor hypoxia—a key feature of the tumor microenvironment (TME) that drives tumor growth, therapy resistance, and metastasis. By delivering high concentrations of oxygen under pressure, HBOT improves tissue oxygenation, potentially suppressing tumor growth, reducing hypoxia-induced resistance, and enhancing the efficacy of chemotherapy and radiotherapy. Studies have shown its anti-angiogenic effects in some tumor models and its ability to alkalize the TME. In prostate cancer, HBOT has demonstrated potential in slowing tumor growth and increasing treatment sensitivity in cell lines like DU-145 and LNCaP. Additionally, it may enhance the effectiveness of radical prostatectomy and chemotherapy by synchronizing cell cycles. Therefore, the current review highlights the key aspects of HBOT in prostate cancer therapy particularly their role addressing late radiation tissue injury (LRTI) and tumor hypoxia. We have succinctly captured the multifaceted role of HBOT in modifying the TME and comprehensive overview focuses on the advanced approaches to eliminate prostate cancer stem cells (PCSCs) and exploration of their role in anti-androgen resistance, as well as stemness-related signaling pathways and growing body of evidence supporting the potential benefits of HBOT in prostate cancer treatment. Further clinical research on HBOT could lead to significant advancements in prostate cancer treatment.

Background: While several clinical tests for diagnosing subscapularis (SSC) tears have been reported, no quantitative method reflecting tear size has been established. This study investigated muscle strength measurements that best reflect the extent of SSC tears and clarified their reliability. Methods: We analyzed 107 patients (111 shoulders) who underwent arthroscopic surgery for rotator cuff tears, assessing preoperative and postoperative muscle strength. Isometric internal rotation strength was measured by using a handheld dynamometer using three techniques: the belly-press, Napoleon, and bear-hug techniques. The correlation between the extent of complete SSC tears and preoperative strength for each technique was assessed using Spearman’s rank correlation coefficient. Intrarater reliability was assessed using the intraclass correlation coefficient (ICC) (1, 3), minimal detectable change (MDC), and MDC% based on three preoperative measurements on the operated side. Test-retest reliability was evaluated using these parameters from measurements on the nonoperated side preoperatively and at 6- and 12-month postoperative intervals. Results: The correlation coefficient between the extent of SSC tears and the strength of each muscle was approximately −0.45 for all techniques, indicating a weak negative correlation. The intrarater reliability for all techniques showed ICC (1, 3) >0.95, MDC

A popular research area in electroencephalography (EEG) is a brain-computer interface (BCI), which involves the classification of MI tasks. In this work, we proposed a novel convolutional neural network (CNN)-based method to recognize the motor imagery (MI) activities of left and right hand movements in the EEG-based BCI system. The proposed work focused on improving performance using a common average reference (CAR) filter and a novel CNN model. CAR is used to increase the signal to noise ratio of the EEG signal. We utilize a novel CNN model for EEG-based MI classification, incorporating both local and global features. Initially, we applied the CAR filter on collected EEG data. In the subsequent phase, we utilize the sliding window technique to generate a number of time segments and address the issue of overfitting. Next, we applied short-time Fourier transform (STFT) on the time segments and it provides spectrogram images. Additionally, we extracted the mu and beta bands from spectrogram images and concatenated these bands. Furthermore, the proposed model receives the concatenated images as input. The novel CNN model comprises convolution, a pooling layer, skip connection, concatenation, dropout, and a fully connected layer. The proposed methodology was evaluated on EEG data from the BCI competition IV dataset-2b, with 80% used for training and 20% for testing. Compared to the state-of-the-art models, our novel methodology achieved much better performance with an accuracy of 91.75% and also provided insightful visualizations through gradient weight class activation maps (Grad-CAM) analysis.

Abstract Minimally invasive procedures for endovascular interventions involve manual navigation of a guidewire. Endovascular interventions encompassing highly tortuous vessels would benefit from guidewires which exhibit higher dexterity. This paper introduces a version of the COAST (COaxially Aligned STeerable) guidewire system capable of exhibiting higher dexterity. The system presented in this paper consists of three coaxially aligned tubes with a tendon to actuate the middle tube. Furthermore, it is possible to independently rotate the middle tube with respect to the outer tube. This variation enables the guidewire to achieve curvature in different planes while avoiding rotation of the entire structure. We also present the simulated stability of the guidewire with different outer tube geometries and experimentally validate the model. Experimental analysis and modeling of the kinematic behavior of the system is presented. A model to calculate the curvature vs. tendon stroke relationship for the optimal notch geometry is presented with an average RMSE of 0.16 mm. A control strategy addressing the snapping instabilities to ensure reliable operation is discussed. A custom phantom vessel and an aortic arch phantom model were used to demonstrate the ability of the system to safely navigate through tortuous pathways without exhibiting these elastic instabilities.

Multi-component alloys have been confirmed to be excellent reinforcing phases in high-entropy alloy-based composite. However, achieving a balance between strength and ductility by controlling the reinforcement content remains a major challenge in the design of high-entropy alloy-based composites. In this study, CoCrFeMnNi HEA/NiCoFeAlTi HER high-entropy alloy composites were prepared using SLM technology. Interestingly, gas-atomized NiCoFeAlTi high-entropy intermetallic (HER) powder was selected as the reinforcing phase, and the CoCrFeMnNi HEA matrix was used for comparison. The influence of the reinforcement content on the composite was investigated, and high-performance HEA/HER composites were obtained, with the strengthening mechanism elucidated. The results showed that the composite with 1 wt% HER reinforcement exhibited the optimal performance, with hardness, yield strength, ultimate tensile strength, and ductility at room temperature being approximately 226.9 HV, 562 MPa, 683 MPa, and 16%, respectively. The excellent mechanical properties at both room and elevated temperatures are attributed to the synergistic effects of heterogeneous microstructure strengthening, grain refinement, and precipitation strengthening. This work provides a foundation for the development of high-entropy alloy composites reinforced by high-entropy intermetallics.

Social determinants of health (SDoH) are nonmedical factors impacting health outcomes. We evaluated the relationship between the county-level measure of SDoH and county-level fatal crash counts among geriatric and non-geriatric road users. We pooled data from the Fatality Analysis Reporting System and limited our analyses to the 3108 contiguous US counties. The outcome measures were county-level fatal crash counts involving (1) geriatric (65 years and older), (2) non-geriatric, and (3) all road users. The predictor variable was the multidimensional deprivation index (MDI), a composite measure of SDoH, measured as a three-level categorical variable defined as very highly deprived, highly deprived, and average-to-low deprived. We performed a Bayesian spatial Poisson regression analysis using integrated nested Laplace approximations and reported the adjusted crash fatality rate ratios (plus 95% credible intervals (CrI)). The median (Q1, Q3) standardized mortality rate ratios among geriatric and non-geriatric road users were 1.3 (0.6, 2.5) and 1.6 (0.9, 2.7), respectively. Counties classified as very highly deprived had 23% (95% CrI: 1.10–1.38) and 20% (95% CI: 1.08–1.32) increased geriatric and non-geriatric fatality crash rate ratios. In conclusion, improving county-level SDoH may reduce the county-level fatal rate ratios equally among geriatric and non-geriatric road users.

Abstract Introduction The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities. Methods This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron. Results Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol. Conclusion The PCFR protocol’s effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients’ pre-hospital care.