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BACKGROUND: Mechanical thrombectomy (MT) has revolutionized the treatment of acute ischemic stroke (AIS) due to large vessel occlusion (LVO), but its efficacy and safety in medium vessel occlusion (MeVO) remain less explored. This multicenter, retrospective study aims to investigate the incidence and clinical outcomes of vessel perforations (confirmed by extravasation during an angiographic series) during MT for AIS caused by MeVO. METHODS: Data were collected from 37 academic centers across North America, Asia, and Europe between September 2017 and July 2021. A total of 1373 AIS patients with MeVO underwent MT. Baseline characteristics, procedural details, and clinical outcomes were analyzed. RESULTS: The incidence of vessel perforation was 4.8% (66/1373). Notably, our analysis indicates variations in perforation rates across different arterial segments: 8.9% in M3 segments, 4.3% in M2 segments, and 8.3% in A2 segments (p = 0.612). Patients with perforation had significantly worse outcomes, with lower rates of favorable angiographic outcomes (TICI 2c-3: 23% vs 58.9%, p

Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for the treatment of symptomatic gallbladder disease. Although the incidence of postoperative complications is generally lower with this approach, gallbladder perforation represents a serious risk that is among the most common complications of laparoscopic cholecystectomy. The sequalae that can follow iatrogenic perforation have not been well documented and only a few case reports exist in the current literature. In this paper we discuss two case reports of delayed perihepatic abscesses following prior laparoscopic cholecystectomy, ultimately resulting in fistulous tracts. The course of the disease is discussed along with the diagnostic workup and eventual successful management of the aforementioned complications. Treating enteric fistulae requires a systematic approach and is carried out in phases. Enteric fistula formation following laparoscopic cholecystectomy is a rare complication of retained gallstones that can present months to years following the index operation. Significant care should be taken to avoid perforation and all efforts should be made to retrieve stones if spillage occurs.

The efficiency of smooth surface solar air heaters (SAHs) is often limited by viscous boundary layer formation and aerodynamic constraints, resulting in suboptimal thermal performance. This study introduces a novel enhancement technique using centerline perforated sine wave baffles as turbulators on the SAH surface to improve heat transfer and reduce flow resistance. The current work deals with experimental analysis of solar air heater performance using centerline perforated sine wave baffles placed as turbulators over the surface of solar air heater. Experimental analyses are conducted by varying Reynolds number, relative baffle pitch, relative baffle height, angle of attack, and relative perforation diameter, ranging from 3000 to 18,000, 8 to 14, 0.4 to 0.55, 10° to 45°, and 0.1 to 0.2 respectively. Collected experimental data are utilized to develop predictive machine learning models for Nusselt number, friction factor, and thermo-hydraulic analysis. Several models including Linear Regression, Random Forest, K-Nearest Neighbors, Adaptive Boosting, and Extreme Gradient Boosting are employed, with their performance evaluated using Mean Absolute Error, Mean Squared Error, Root Mean Squared Error, and R2. Extreme Gradient Boosting emerges as the most effective predictive model with an R2 value of 98.2%, alongside Mean Absolute Error and Root Mean Squared Error values of 8.025 and 11.3 respectively. Multi-objective optimization techniques such as Particle Swarm Optimization, Simulated Annealing, Genetic Algorithm, and Hybrid Genetic Algorithm are employed for this purpose. The optimized parameters obtained from Genetic Algorithm include Reynolds number, and values of 17,447, 8.37, 0.48, 25.045, and 0.11 respectively, aiming at maximizing and while minimizing. The results of genetic algorithms are being taken as optimal parameters which resulted in Reynolds number, relative baffle pitch, relative baffle height, angle of attack, and relative perforation diameter as 17,447, 8.37, 0.48, 25.045 and 0.11. [ABSTRACT FROM AUTHOR]

The intestine, as a crucial organ of the human body, has remained enigmatic despite the remarkable advancements in modern medical technology. Over the past decades, the invention of endoscopic technology has made the noninvasive intervention of the intestine a reality, expanding diagnostic and therapeutic options for diseases. However, due to the single-treatment feature of endoscopic procedures, continuous or repeated medication administration, sampling, and decompression drainage within the intestine have yet to be fulfilled. These limitations persisted until the invention of colonic transendoscopic enteral tubing (TET) in 2014, which realized repeated fecal microbiota transplantation, medication administration, and decompression drainage for the treatment of colon perforation and intestinal obstruction, as well as in situ dynamic sampling. These breakthroughs have not gone unnoticed, gaining global attention and recommendations from guidelines and consensuses. TET has emerged as a novel microbial research tool that offers new paradigms for human microbiome research. This review aims to update the research progress based on TET. [ABSTRACT FROM AUTHOR]

Background: Gastrojejunostomy junction perforation is a rare yet critical complication associated with enteral tube placement, presenting unique challenges in patients with a history of Roux-en-Y gastric bypass surgery. Case presentation: A 63-year-old white female with a complex medical history, including heart failure, atrial fibrillation, stage 4 chronic kidney disease, and prior Roux-en-Y gastric bypass surgery in 2015, experienced a significant decline in her health. She was discharged to a skilled nursing facility after a fall but deteriorated rapidly in the 2 weeks before admission. She presented with symptoms of failure to thrive, abdominal/back pain, inability to eat or drink, constipation, and stool incontinence. Lab tests showed anemia, electrolyte imbalances, and acute kidney injury. Imaging confirmed Roux-en-Y gastric bypass anatomy and a small hiatal hernia. Despite treatment attempts, her condition worsened. Nutrition discussions led to a temporary Dobhoff tube placement, considering her Roux-en-Y gastric bypass history, with plans for a gastrostomy tube. However, Dobhoff tube placement posed challenges, and imaging later revealed perforation near the gastrojejunostomy junction. After consulting with the family, the decision was made to transition the patient to comfort care due to her overall condition. Yearly education of staff about Roux-en-Y gastric bypass anatomy and updated Dobhoff placement protocol was implemented with physician oversight. Further imaging protocol in a patient who had had a Roux-en-Y gastric bypass was updated to include fluoroscopic guidance when endoscopic placement was unavailable. Conclusions: This case highlights the intricacies of managing patients with Roux-en-Y gastric bypass history and underscores the need for meticulous planning and consideration of anatomical variations when performing procedures involving the gastrointestinal tract and the importance of involving multiple healthcare disciplines in complex decision-making and preventive measures to enhance patient safety in similar cases. [ABSTRACT FROM AUTHOR]

Root canal perforations are frequent but critical complications in endodontic treatments, which can pose a risk of irreversible damage to the affected tooth. These perforations typically occur during root canal preparation or endodontic post placement, presenting significant therapeutic challenges. The main objective in the management of such complications is to seal the perforation, thus preventing bacterial invasion and tooth loss. This report details the case of a 70‐year‐old patient with a perforation in the palatal wall of the middle root section of tooth #11. The treatment approach involved magnification techniques and the application of a bioactive material known as Biodentine. This case underscores the critical role of accurate radiographic evaluation and the use of biocompatible materials in the management of root perforations. Despite inherent challenges, proper diagnosis and planning, combined with appropriate techniques and materials, can lead to satisfactory results, effectively preserving the structure of the tooth. [ABSTRACT FROM AUTHOR]

Pigmentation anomalies and lesions are aspects of wild bat populations that have been rarely addressed and scarcely documented. We captured a total of 4,118 bats belonging to 30 species during 2020, 2021, and 2022 in the municipalities of Santa Maria Huatulco and San Miguel Lachiguiri, Oaxaca, southeastern Mexico. Of these, 9 individuals (0.21 %) showed piebaldism (6 females and 3 males), and 11 individuals (0.26 %) had skin and hair lesions (7 females and 4 males). The highest number of piebaldism and lesions was observed in Natalus mexicanus (6 of the 20 individuals), followed by Mormoops megalophylla (n = 4), Pteronotus mesoamericanus (n = 3), Pteronotus fulvus (n = 3), Glossophaga mutica (n = 2), and Artibeus lituratus (n = 2). The months with the highest number of bats with piebaldism and lesions were October (n = 6) and July 2021. Seventeen records occurred in caves, two in the medium sub-evergreen forest, and one in a human settlement. To date, it has not been confirmed that skin depigmentation in bats affects the social life and reproductive activity of bats, but they could be more susceptible to predation events. Furthermore, lesions could negatively affect flight performance and, consequently, foraging efficiency. [ABSTRACT FROM AUTHOR]

Introduction: Peritonitis due to Hollow viscus perforation is the commonest cause for the acute abdomen next to Acute appendicitis. It is the most common emergency surgery done for a case of acute abdomen. Among the cases of hollow viscus perforation Duodenal and Gastric perforations are the commonest, followed by Ileal, Appendicular, and large bowel. The incidence of Gastric perforation is on the rise followed by the Ileal perforation accounting for about 20% of total hollow viscus perforation. Among the causes for Enteric perforation, Typhoid ileal perforation is common. Aim: To study the Enteric Perforation due to Typhoid. Objectives: 1. To study the incidence of Ileal perforation in relation to age and sex. 2. To evaluate the mode of clinical presentation in patients with ileal perforation due to typhoid. 3. To study the management and outcome of patients with ileal perforation due to typhoid. Study Design: Prospective observational study. Study Population: All patients presenting to emergency and surgical OPD with symptoms of peritonitis (hollow viscus perforation). Materials And Methods: This study was done in the Department of General Surgery, SVRRGGH, Tirupathi. The materials for the study were collected from patients presenting to the surgical outpatient department and emergency with features of hollow viscus perforation during the period of December, 2020- December 2021 were included in the study. Inclusion Criteria: 1. Patients with age above 18 years present with features of hollow viscus perforation. 2. Patients with intraoperative findings of ileal perforation. 3. Patient who gave consent for emergency exploratory laparotomy. Exclusion Criteria: 1. Patients with the intraoperative finding of hollow viscus perforation other than ileal perforation. 2. Patients with cardiovascular, pulmonary disease. Observation And Results: This study shows the common etiology of Ileal perforation was Typhoid (Enteric fever) accounting for 83% followed by Tuberculosis 8%. The average age of presentation was between 20 and 40 years. There was a male preponderance with 70%. The majority of the cases accounting for 53% were seen during the 3rd and 4th week of the typhoid fever. The predominant symptoms were abdominal pain and vomiting. The most common sign elicited was guarding and rigidity in all cases 100%. The most reliable test that identified perforation was x-ray 100%. The biopsy culture of the perforated ulcer edge had yielded positive results of 73% when compared to blood culture and serum widal tests. All the perforations in the present study were found within 50cm of the terminal ileum. None were noted beyond 50 cm from the ileocecal junction, due to the presence of more Peyer’s patches in the terminal ileum. 77% of ileal perforations were single in number. The primary closure and peritoneal lavage were the procedure done in 70% of cases. Postoperative complications were seen in 37%. The most common complication encountered was the Wound infection accounting for 30% overall. The re-exploration rate was 6% done in 2 cases. The mortality in the present study was 6.66%. [ABSTRACT FROM AUTHOR]

Background: Little is known about the physiopathological factors or mechanisms that underlie tumor invasion of the serosa and lead to perforation in the peritoneal cavity. The aim of the work was to analyze the pathological and immunohistochemical factors of tumor neoangiogenesis which could influence tumor perforation in colorectal cancer. Results and discussions: 451 cases of complicated colorectal carcinomas were statistically analyzed, of which 19 cases were perforated sigmoid tumors. The immunohistochemical detection of mutant p53 proteins was the first molecular parameter examined in the context of the search for markers predicting the natural evolution mode in colorectal carcinomas. Conclusions: Both loss of p53 and overexpression of bcl-2 proteins confer immortalization on cancer cells by inhibiting the processes leading to apoptosis. The paper proposes a review of the specialized literature, but also the presentation of a clinical case. [ABSTRACT FROM AUTHOR]

Reinforced concrete (RC) structures are mainly designed to withstand both static and dynamic loads. However, due to the highly nonlinear behavior of RC structures subjected to extreme dynamic loads, these structures have a very complex damage behavior under dynamic impact loading. In fact, current existing methods for damage‐simulation and prediction are generally based on either empirical data, simplified mechanical approaches or complex numerical simulations mainly using the finite element method. In this regard, empirical and semi‐empirical models can be considered to calculate the load‐bearing capacity in a simplified way with only a few input parameters. Hence, using current experimental test data, this paper aims to analyze and assess existing empirical and semi‐analytical approaches that are established in standards and guidelines. Accordingly, a functional relationship in terms of an impact factor is found. Based on the obtained results, different approaches are also developed to describe the resistance to projectile penetration of RC structures as well as the force interaction between projectile and RC structures. [ABSTRACT FROM AUTHOR]

The effectiveness of biocements applied in specialistic endodontic procedures can be influenced by multiple factors, including the postplacement chemical action of the irrigating solution. This in vitro study aimed to assess the impact of 2% chlorhexidine digluconate on the surface structure and chemical composition of Biodentine as a perforation repair cement. A total of 54 Biodentine specimens were prepared with strict adherence to the manufacturer's instructions and irrigated with 2% chlorhexidine with or without ultrasonic activation. The material specimens were divided into three setting-time-based groups: group A—rinsed after 12 min of setting, group B—after 45 min, and group C—after 24 h. The control group was not subjected to any irrigation protocol. The evaluation of the microappearance of biocement surface was performed with the aid of a scanning electron microscope (SEM). The chemical composition of Biodentine was analyzed with the energy dispersive spectroscopy (EDS) method. The SEM images of the specimens in group B and C revealed a heterogeneous and layered surface morphology. The EDS results are comparable between pairs of cement specimens in both groups: after 5 min and 20 min CHX irrigation as well as after 5 min and 20 min ultrasonically activated CHX irrigation. To conclude, the 12 min Biodentine setting time is not recommended when used in perforation closure. Irrigation protocol involving 2% chlorhexidine visibly affected the tested material surface. The EDS results did not confirm any significant changes in Biodentine chemical composition. Further research is required to analyze the influence of the observed changes on the outcome of the endodontic treatment. [ABSTRACT FROM AUTHOR]

Introduction: Fishbone (FB) ingestion is a rare cause of gastrointestinal perforation. Herein, we report a case of FB-induced colonic perforation, in which the presence of a penile colonic carcinoma may have contributed to the development of the perforation. Case Presentation: An 83-year-old man was admitted to our hospital with severe abdominal pain during bowel movement. Computed tomography (CT) yielded a diagnosis of sigmoid colonic perforation due to FB and secondary peritonitis. Preoperative endoscopic examination suggested that the perforation was associated with a stalked colon tumor in the vicinity. After undergoing low anterior resection and sigmoid colostomy, the patient is currently doing well. Conclusion: The incidence of FB-induced colorectal-cancer-related perforation is expected to increase in the future owing to an aging society, the increase in the rates of colorectal cancer, and increase in fish consumption. This rare case suggests that preoperative examinations are important and that even relatively small polyps can contribute to gastrointestinal perforation caused by FBs. Older individuals should exercise caution during fish ingestion. [ABSTRACT FROM AUTHOR]

Regarding the safety of casing during the production of hydrogen gas during the perforation operation in the curve section of ultra deep horizontal wells, the theoretical stress calculation formula near the perforation hole and the tensile strength, external extrusion strength, and internal pressure strength that three different sizes of casing can withstand were derived based on the plate hole theory and casing performance calculation formula; It also analyzed the stress distribution of the casing in the curve section before perforation operations, and found that under the worst working conditions, the stress on the casing body is less than the yield strength, and the high stress area of the casing is mainly concentrated in the axial direction. Increasing the wall thickness of the casing does not have a significant effect on reducing the high stress area, but reducing the diameter, density, curvature of the curve section, and using a single spiral distribution will effectively improve the stress distribution on the casing, which is more conducive to the safety of perforation operations in the curve section; Finally, physical and chemical properties and stress corrosion experiments were conducted on the casing used on site, and it was found that there will be a large number of pitting pits for the initiation of cracks in the casing underground. Therefore, an analysis was conducted on the crack propagation caused by the initial cracks generated by perforation operations. It was found that changing the initial crack length, angle, and casing wall thickness has little significance in reducing crack propagation, while reducing the curvature of the curve section has a significant impact on casing crack propagation. The research methods and achievements in the article provide theoretical guidance for the safety evaluation of casing during perforation operations in the curve section of ultra deep horizontal wells. • Analyzed the stress of casing in curved wells, it can guide construction operations. • Evaluated the casing after perforation, which can prevent downhole casing failure. • Corrosion experiments were conducted on casings with different chromium contents. • Explored the propagation of casing cracks after curved perforation operations. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Meckel's diverticulitis (MD) mimics acute appendicitis with right lower abdominal pain. Clinicians must consider MD in acute abdomen cases to avoid diagnostic delays. Perforated MD can lead to serious complications. Timely use of advanced imaging and surgical assessment is essential for accurate diagnosis and management. Meckel's diverticulum (MD) is a gastrointestinal congenital anomaly that signifies a persistent remnant of the omphalomesenteric duct. While frequently asymptomatic, its complications vary widely, ranging from mild and painless to potentially life‐threatening conditions. This is a case of a 4‐year‐old female patient with sudden abdominal pain and tenderness, with an elusive cause before surgery. The definitive diagnosis of a perforated MD was established during diagnostic laparoscopy due to worsening symptoms. Detecting MD and its potential complications requires a high degree of suspicion. Once recognized, prompt management is essential to prevent further complications. Although perforation is uncommon in MD, its symptoms can mimic acute appendicitis, confusing emergency settings. This article underscores the significance of diagnosing MD, despite its rarity, and emphasizes the necessity for swift treatment upon identification. [ABSTRACT FROM AUTHOR]

Background: Transesophageal echocardiography (TEE) is mandatory before transvenous lead extraction (TLE), but its usefulness remains underestimated. This study aims to describe the broad range of TEE findings in TLE candidates, as well as their influence on procedure complexity, major complications (MCs) and long-term survival. Methods: Preoperative TEE was performed in 1191 patients undergoing TLE. Results: Lead thickening (OR = 1.536; p = 0.007), lead adhesion to heart structures (OR = 2.531; p < 0.001) and abnormally long lead loops (OR = 1.632; p = 0.006) increased the complexity of TLE. Vegetation-like masses on the lead (OR = 4.080; p = 0.44), lead thickening (OR = 2.389; p = 0.049) and lead adhesion to heart structures (OR = 6.341; p < 0.001) increased the rate of MCs. The presence of vegetations (HR = 7.254; p < 0.001) was the strongest predictor of death during a 1-year follow-up period. Conclusions: TEE before TLE provides a lot of important information for the operator. Apart from the visualization of possible vegetations, it can also detect various forms of lead-related scar tissue. Build-up of scar tissue and the presence of long lead loops are associated with increased complexity of the procedure and risk of MCs. Preoperative TEE performed outside the operating room may have an impact on the clinical decision-making process, such as transferring potentially more difficult patients to a more experienced center or having the procedure performed by the most experienced operator. Moreover, the presence of masses or vegetations on the leads significantly increases 1-year and all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: There is a discrepancy in the surgical and endoscopic literature for managing duodenal perforations. Although often managed conservatively, surgical repair is the standard treatment for duodenal perforations. This contrasts with the gastroenterology literature, which now recommends endoscopic repair of duodenal perforations, which are more frequently iatrogenic from the growing field of advanced endoscopic procedures. This study aims to provide a scoping review to summarize the current literature content and quality on endoscopic repair of duodenal perforations. Methods: The protocol for performing this scoping review was outlined by the Joanna Briggs Institute. All studies that reported primary outcomes of patients who had undergone endoscopic repair of duodenal perforations before February 2022, regardless of perforation etiology or repair type were reviewed, with studies after 1999 meeting inclusion criteria. The study excluded articles that did not report clinical outcomes of endoscopic repair, articles that did not describe where in the gastrointestinal tract the endoscopic repair occurred, pediatric patients, and animal studies. Results: 7606 abstracts were screened, with 474 full articles reviewed and 152 studies met inclusion criteria. 560 patients had duodenal perforations repaired endoscopically, with a technical success rate of 90.4% and a survival rate of 86.7%. Most of these perforations (74.5%) were iatrogenic from endoscopic procedures or surgery. Only one randomized control trial (RCT) was found, and 53% of studies were case reports. Conclusion: These results suggest that endoscopic repair could emerge as a viable first-line treatment for duodenal perforation and highlight the need for more high-quality research in this topic. [ABSTRACT FROM AUTHOR]

Trauma to the cervical region may result in critical injury to the airway, the neck vasculature, and the pharynx or oesophagus. These three systems should be systematically assessed, alongside ATLS protocols, in all patients presenting with blunt or penetrating trauma to the head and neck region. The majority of trauma centres now have a policy of selective neck exploration based on clinical and radiological findings. It is therefore essential to be aware of the symptoms and clinical signs of injury of key neck structures, so that neck exploration can be performed promptly in patients who require it. [ABSTRACT FROM AUTHOR]

Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure in which endoscopy and fluoroscopy are used together to diagnose and treat problems in the pancreatic and biliary ductal systems. According to published studies, the frequency of perforation associated with ERCP is reported to be less than 1%. In our study, we aimed to retrospectively analyze the data of patients we followed after ERCP perforation to examine treatment approaches. In this study, data from 33 patients who underwent ERCP at a tertiary stage education and research hospital between November 2016 and April 2021 and were identified to have developed perforation during or after the procedure were retrospectively evaluated. The indications and outcomes of ERCP for patients, as well as laboratory and imaging findings, were analyzed in detail. The age distribution of the 33 patients included in the study ranged from 20 to 83 years, with a mean age of 57.1±17.6 years. Perforation developed during the initial ERCP procedure in 66.7% of the patients, and on seven of the ten patients in whom perforation was detected during the procedure, interventions were performed during the procedure. Although the mortality rate in patients with Stapfer type 1 or type 2 perforations (33.3%) was higher compared to the patients with type 3 or type 4 perforations (11.1%), the observed difference was not found to be statistically significant. In conclusion, the management of patients with ERCP perforation should be approached in a multidisciplinary manner, and non-operative approaches should always be considered in the appropriate patient population. Closely and dynamically monitoring of patients and algorithmic approaches should standardized. [ABSTRACT FROM AUTHOR]

Children are frequently reported as cases of foreign body ingestion, with fishbone ingestion being particularly prevalent in communities where fish consumption is common. Although many instances of foreign body ingestion resolve spontaneously, the ingestion of sharp objects like fishbones poses a greater risk of morbidity and mortality due to their propensity for causing complications. Furthermore, incidents of foreign body ingestion often present with nonspecific symptoms or may go unnoticed, potentially leading to misdiagnosis and complicating the clinical course. We present a case of a 2-year-old boy initially misdiagnosed with constipation and treated with laxatives due to intermittent progressive abdominal pain. Subsequently, he presented to the emergency department where radiological and laboratory investigations revealed signs of inflammation and localized abdominal fluid collection containing a linear hyperdense object, indicating complicated foreign body ingestion with perforation. Urgent laparotomy revealed an omental abscess, which was excised, and the perforation site was repaired with sutures. This case underscores the risk of misdiagnosis and the importance of timely recognition and management. It also emphasizes the critical role of imaging, particularly computed tomography, in accurate diagnosis and differentiation from other common conditions.

Abstract Background Gastrojejunostomy junction perforation is a rare yet critical complication associated with enteral tube placement, presenting unique challenges in patients with a history of Roux-en-Y gastric bypass surgery. Case presentation A 63-year-old white female with a complex medical history, including heart failure, atrial fibrillation, stage 4 chronic kidney disease, and prior Roux-en-Y gastric bypass surgery in 2015, experienced a significant decline in her health. She was discharged to a skilled nursing facility after a fall but deteriorated rapidly in the 2 weeks before admission. She presented with symptoms of failure to thrive, abdominal/back pain, inability to eat or drink, constipation, and stool incontinence. Lab tests showed anemia, electrolyte imbalances, and acute kidney injury. Imaging confirmed Roux-en-Y gastric bypass anatomy and a small hiatal hernia. Despite treatment attempts, her condition worsened. Nutrition discussions led to a temporary Dobhoff tube placement, considering her Roux-en-Y gastric bypass history, with plans for a gastrostomy tube. However, Dobhoff tube placement posed challenges, and imaging later revealed perforation near the gastrojejunostomy junction. After consulting with the family, the decision was made to transition the patient to comfort care due to her overall condition. Yearly education of staff about Roux-en-Y gastric bypass anatomy and updated Dobhoff placement protocol was implemented with physician oversight. Further imaging protocol in a patient who had had a Roux-en-Y gastric bypass was updated to include fluoroscopic guidance when endoscopic placement was unavailable. Conclusions This case highlights the intricacies of managing patients with Roux-en-Y gastric bypass history and underscores the need for meticulous planning and consideration of anatomical variations when performing procedures involving the gastrointestinal tract and the importance of involving multiple healthcare disciplines in complex decision-making and preventive measures to enhance patient safety in similar cases.

Introduction: Fishbone (FB) ingestion is a rare cause of gastrointestinal perforation. Herein, we report a case of FB-induced colonic perforation, in which the presence of a penile colonic carcinoma may have contributed to the development of the perforation. Case Presentation: An 83-year-old man was admitted to our hospital with severe abdominal pain during bowel movement. Computed tomography (CT) yielded a diagnosis of sigmoid colonic perforation due to FB and secondary peritonitis. Preoperative endoscopic examination suggested that the perforation was associated with a stalked colon tumor in the vicinity. After undergoing low anterior resection and sigmoid colostomy, the patient is currently doing well. Conclusion: The incidence of FB-induced colorectal-cancer-related perforation is expected to increase in the future owing to an aging society, the increase in the rates of colorectal cancer, and increase in fish consumption. This rare case suggests that preoperative examinations are important and that even relatively small polyps can contribute to gastrointestinal perforation caused by FBs. Older individuals should exercise caution during fish ingestion.

Extraluminal foreign bodies are rare. Fish bone is the most common foreign body ingested by adults, while coin is the most common foreign body ingested among children. Sharp pricking pain is a sign of sharp foreign body (FB) ingestion. If the symptom persists, one should keep in mind the possibility of a migratory foreign body, even if the esophagoscopy results are negative. In order to ensure that foreign bodies are not missed radiologically, there is the role of consultation from a second radiologist to correlate with the patient's symptoms. Here we present an atypical case of recurrent neck abscess due to a migrating fishbone that penetrated the left thyroid lobe and settled in the left lower third neck subcutaneous tissue within two months. [ABSTRACT FROM AUTHOR]

Background: High perforation risk hinders the widespread adoption of ESD for colorectal neoplasms. This study was performed to determine the risk factors of colorectal endoscopic submucosal dissection (ESD)-induced perforation and develop a predictive model. Methods: A total of 1046 colorectal neoplasms in 1011 patients were retrospectively enrolled from January 2011 to December 2021, in a single tertiary center as the derivation cohort. We identified independent risk factors for perforation using univariate analysis and multi-variate logistic regression. A nomogram was developed based on the logistic regression model and prospectively applied to 266 colorectal neoplasms as the validation cohort. The performance of the predictive model was evaluated with the receiver operating characteristic curve, calibration plot, and decision curve analysis. Results: Independent pre-operative factors for colorectal ESD-induced perforation were tumor located in the left colon [odds ratio (OR) 2.39, P = 0.040], size ≥ 40 mm (OR 3.36, P < 0.001), ≥2/3 circumference (OR 7.55, P = 0.004), located across folds (OR 6.26, P < 0.001), and laterally spreading tumor (non-granular type, OR 2.34, P = 0.029; granular type, OR 2.46, P = 0.021). The nomogram model incorporating the pre-operative factors performed well in both the derivation and validation cohorts (areas under the curve of 0.750 and 0.806, respectively). Decision curve analysis demonstrated that the clinical benefit of the nomogram was favorable. Conclusions: The novel nomogram, developed and prospectively validated, incorporating tumor size, location, and morphology can successfully predict perforation during ESD for colorectal neoplasms.

Abstract Background The management of type II endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is still controversial. This study aimed to compare the effects of covered self-expandable metallic stent (SEMS), surgery, and conservative treatment for type II perforation. Methods From January 2010 to December 2021, this study collected relevant data from five large hospitals in China. The data of ERCP difficulty grading and ERCP-related perforation in 26,673 cases that underwent ERCP during 11 years were retrospectively analyzed. Of 55 patients with type II perforation, 41 patients were implanted with a biliary covered SEMS (stent group), 10 underwent surgery (surgery group), and 4 received conservative treatment (conservative group). Results Among the 55 patients with type II perforation, ERCP and computed tomography diagnostic rates of type II perforation were 10.91% (6/55) and 89.09% (49/55), respectively. The incidence of type II perforation in grade 5 ERCP (0.43%, 11/2,537) was significantly higher than that in grade 1–3 ERCP (0.16%, 32/19,471). (P = 0.004) and grade 1–4 ERCP (0.26%,12/4,665) (P = 0.008), respectively. Among the 10 patients in the surgical group, primary repair was performed in only 7 patients in whom location of the perforation could be identified. The incidence of retroperitoneal abscess was significantly lower in the stent group than in the surgery group (P = 0.018) and the conservative group (P = 0.001), respectively. The average hospital stay in the stent group was shorter than that in the surgery group (P = 0.000) and conservative group (P = 0.001), respectively. Conclusions The incidence of type II perforation was dependent on the degree of difficulty of ERCP. The treatment of type II perforation with a covered SEMS can significantly reduce the incidence of retroperitoneal abscess and shorten the hospital stay, with better results than surgical and conservative treatments.

Objectives: Laparotomy for lower intestinal perforation is associated with a high incidence of surgical site infections. This study aimed to assess whether incisional negative pressure wound therapy (iNPWT) could reduce the incidence of these infections and wound dehiscence in patients with lower intestinal perforation. Methods: This single-center prospective study was conducted between September 2019 and July 2022. In the therapy group, wounds were closed with subcuticular sutures, and iNPWT was applied at -120 mmHg for 5 days. A total of 10 days of iNPWT was employed. These patients were compared with a historical control group. The iNPWT group (Group A) comprised 22 patients.The historical control group (Group B) had 65 patients. outlines patient characteristics and compares the two study groups. Results: Patient characteristics were demographically similar. The incidence of surgical site infections was lower in the therapy group than in the control group (9.1% vs. 52.3%, p < 0.001). Wound dehiscence was not observed in the therapy group but was noted in three patients (4.6%) in the control group. In univariate and multivariate analysis, an application of the therapy device was associated with reduced incidence of surgical site infections (p < 0.001 and p = 0.002, respectively). Conclusions: The application of iNPWT in patients with lower intestinal perforation was associated with reduced surgical site infections.

Abstract Objectives Esophageal perforations are a complex clinical scenario that have been poorly studied. To date, there is no grading of esophageal perforations, the reason being that the outcome is very heterogeneous, because the perforation is very heterogeneous. A grading of the severity of the perforation may guide treatment, and could ultimately affect morbidity and mortality. Methods The observation period of the study was four years. All patients with a perforation of the esophagus aged 18 to 90 years were included. All anastomotic insufficiencies or fistulas after surgery of the esophagus were excluded. The cause of the injury and the time interval between the event and the start of therapy were analyzed. The severity of each perforation was classified based on the results of a diagnostic CT scan, gastroscopy as well as clinical and laboratory findings. Therapy and signs of infection were evaluated. Endpoints of the study were patient recovery or death. The study was conducted as a retrospective single-center study at a university hospital of Düsseldorf. The study has been approved by the review board. Patients gave their informed consent before data collection. All data were analyzed using SPSS 29 (IBM SPSS Statistics software). Results Age, gender and cause of the esophageal perforation did not impact significantly on overall survival. The duration of injury > 24 h (p = 0.01), presence of mediastinitis (p = 0.01) and necrosis of the esophagus (p = 0.02) were associated with an unfavorable outcome. The correlation of the clinical grading of the severity of the perforation based on the endoscopic, radiological and clinical findings with the overall survival of patients was significant. Patients categorized into the four grades of severity (I–IV) had an overall survival of 100%, 100%, 70% and 50%, respectively. Conclusion The severity of esophageal perforations can be systematically rated grades I to IV based on the radiological, endoscopic and clinical findings at diagnosis. Due to the grading and its correlation to the overall survival, a comparison of patients, their treatment and outcome becomes possible. In future, the grade of a perforation may guide treatment, and therefore affect morbidity and mortality.

Among the foreign bodies (FB) of the digestive tract, magnets account for approximately 1.97%. The presence of magnetic FB in the gastrointestinal tract is characterized by nonspecific symptoms, difficulties in collecting anamnesis due to the age of patients and low alertness of parents and medical professionals. Currently, multiple magnets are the most dangerous FB of the gastrointestinal tract. Being in different parts of the digestive tract, they are attracted to each other and cause a number of complications: ischemia and bedsores of the wall of the hollow organ, volvulus, intestinal obstruction, perforation of the wall and surrounding anatomical structures, intestinal fistulas, bleeding, intussusception. 2 clinical examples of the presence, developed complications and surgical removal of multiple magnetic FB and postoperative management of patients are described. The peculiarities of the cases are the formation of an interintestinal fistula passing through the mesentery of the small intestine, as a result of the attraction of magnets located in different parts of the small intestine, and the formation of 4 perforations located in different parts of the intestine, as a result of the attraction of 3 magnets. Magnetic FB themselves in the gastrointestinal tract, as a rule, do not have clinical manifestations; symptoms correspond to developed complications. Not all children report ingesting magnetic FB. To exclude magnetic FB left during surgery in the gastrointestinal tract, intraoperative radiography is necessary.

Abstract Background Matrix metalloproteinase-7 (MMP-7) is associated with biliary injury. This study aimed to evaluate the relationships of serum MMP-7 with clinical characteristics in choledochal cysts (CDC) children. Methods Between June 2020 and July 2022, we conducted a prospective study of CDCs who underwent one-stage definitive operation at our center. Serum MMP-7 was measured using an enzyme-linked immunosorbent assay. We evaluated the relationships between serum MMP-7 and age, laboratory tests, imaging examinations, liver fibrosis, MMP-7 expression, and perforation. Results A total of 328 CDCs were enrolled in the study, with a median serum MMP-7 of 7.67 ng/mL. Higher serum MMP-7 was correlated with younger age at diagnosis (p

Root perforations represent artificial communication between the endodontic system and the periodontal space or the oral cavity. While it is true that they can reduce the success rates of endodontic treatment in the long term, nevertheless, with the new bioceramic materials, the evolution is promising. The aim of this retrospective study was to assess the prevalence of perforations in root canal-treated maxillary and mandibular posterior teeth based on findings from images taken using cone-beam computed tomography (CBCT) and to review the most predictable, appropriate non-surgical treatment procedures for the clinical management of these conditions, highlighting some relevant clinical cases of complex oral rehabilitation.

Highlights Composite structures in the aerospace and railway industries frequently experience single or multiple low‐ or high‐velocity impacts. The dynamic behavior of composite structures under single impacts cannot be extrapolated to multiple impacts. This study investigates the influence of the distance between projectiles in simultaneous multiple impact scenarios using a finite element model for multiple impacts on carbon fiber‐reinforced polymer (CFRP) laminate plates. The critical distance between projectiles, where stress wave interaction becomes significant, was identified. Results indicate that a distance between the centres of the projectiles of approximately two to three times the projectile diameter is the most damaging for simultaneous multiple impacts. A finite element model for multiple impacts on CFRP laminate plates was developed. Four different distances between projectiles were evaluated. The ballistic limit, out‐of‐plane displacements, energy absorption, and related parameters were studied. A distance of twice the projectile diameter was identified as the most critical. The distance between projectiles significantly affects the synergistic effects. [ABSTRACT FROM AUTHOR]

The aim of the study was to determine long-term outcome in Crohn's disease patients hospitalised for acute abdominal pain. Retrospective chart review was made of consecutive Crohn's disease patients hospitalised for acute abdominal pain at the tertiary referral centre in Eastern Europe. Between 2015 and 2020, 65 patients with Crohn's disease were admitted at least once to the emergency room because of acute abdominal pain. Thirteen were admitted twice, eight — three times, three — four times, and three — five times. Most patients had ileal involvement. There were two intra-abdominal abscesses. Fifty-three of 65 underwent abdominal imaging. Forty-five were treated with antibiotics (65%), 17 with steroids (26%), eight received a nasogastric tube and three — parenteral nutrition. Six underwent an intestinal resection during the initial hospitalisation (9%). The hospitalisation length median was eight days and significantly longer in those who underwent surgery (28 vs. 9, p = 0.003). The median follow-up time was 42.8 months. During the follow-up period, 26 (40%) readmitted for abdominal emergencies, 14 underwent surgery — either at the initial or later hospitalisation (21%). Thirteen of 14 surgeries were emergencies, and three were concluded by ostomy formation (21%). One developed postoperative intra-abdominal complication, and two died postoperatively (14%). Complicated disease was associated with hospital readmission (HR, 5.8, 95% CI:1.4–23.3; p = 0.013) and enhanced probability to undergo intestinal surgery (HR, 10.3, 95% CI: 2.4–44.1; p = 0.002). An elevated CRP was associated with decreased risk of hospital readmission (HR, 0.08, 95% CI: 0.01–0.55; p = 0.010). Ileocolic disease was the main cause of hospitalisation for acute abdominal pain. Complicated (stricturing or penetrating) disease should be diagnosed early and surveilled closely. [ABSTRACT FROM AUTHOR]

Purpose: To formulate and evaluate the diagnostic performance and utility of a new CT difficulty score in predicting difficult laparoscopic surgery in cases of gallbladder (GB) perforation. Methods: This prospective single centre study included a total of 48 diagnosed cases of GB perforation on CT between December 2021 and June 2023, out of which 24 patients were operated. A new 6-point CT difficulty scoring system was devised to predict difficult laparoscopic approach, based on patterns of inflammation around the perforated GB that were found to be surgically relevant. The pre-operative imaging findings on CT were studied in detail and correlation coefficients of various imaging findings were calculated to predict difficult surgery. Results: On CECT, the type of perforation, according to the revised Niemeier's classification could be exactly delineated in all 48 patients. A CT difficulty score of ≥ 3 was found to a good predictor difficult laparoscopic approach, with statistical significance (p = 0.001), sensitivity of 94.44%, specificity of 83.33%, PPV of 94.44% and NPV of 83.33%. Inflammatory changes around duodenum showed maximum correlation coefficient of 0.744 (p = 0.0001), around colon showed a correlation coefficient of 0.657 (p = 0.0005), and in the omentum had a correlation coefficient of 0.5 (p = 0.013)). Inter-observer agreement was also calculated for various findings and it was found to have moderate to strong agreement (κ value 0.5–1.0). Conclusion: The CT difficulty scoring system can be an effective tool in predicting difficult laparoscopic surgery in cases of GB perforation in an emergency setting which can help in decision making and improved patient outcome. [ABSTRACT FROM AUTHOR]

Background: To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure. Methods: Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis. Results: Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4–23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00–30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00–12.25] days) and non-surgical group (9.00[7.00–13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00–16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00–10.00]) than in the non-surgical group (9.00[7.00–11.00]) and surgical group (11.00[9.00–13.00]) (p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00–5.25]) than in the non-surgical group (7.00[6.13–9.00]) and surgical group (8.00[6.53–10.00]), respectively (p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687–0.993), 1.077 (1.005–1.154), and 1.025 (1.006–1.043), respectively (all p < 0.05). Conclusion: OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction. [ABSTRACT FROM AUTHOR]

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Perforation of Meckel's diverticulum (MD) is rare, particularly by foreign body. High index of suspicion and thorough intraoperative assessment is needed in patients undergoing surgery for acute appendicitis, specifically when appendix appears normal. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. While often asymptomatic, it can present with several complications. Perforation due to foreign body ingestion is rare but can have severe consequences if late diagnosis occurs. A 13‐year‐old male, initially suspected of acute appendicitis, was eventually diagnosed with perforation of MD by a wood splinter‐like foreign body after intraoperative assessment. Histological analysis revealed ectopic colonic tissue within the MD, a finding whose implications are not well understood, in contrast with the well‐established complications associated with ectopic gastric and pancreatic tissues. This case highlights the diagnostic challenges of MD, which can mimic acute appendicitis, emphasizing the need for high suspicion when faced with atypical clinical presentation such as foreign body‐induced perforation. Although surgical resection of asymptomatic MD remains controversial, we recommend a case‐specific approach based on risk factors to guide decision‐making on surgical resection for asymptomatic MD. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the treatment quality factors associated with the risk of radiographic detection of apical periodontitis (AP) in root-filled teeth (RFT) on CBCT images. Methods: Two hundred eighty-five CBCT scans of patients (range 18-60, mean 35.1) years old were selected from a pool of CBCT scans which were taken from 2016-2022. Gender and age were recorded. The presence/absence of AP, unfilled canal, perforation, zipping and ledge and homogenous/nonhomogeneous root canal filling (RCF), adequate/inadequate coronal restoration and under/over filled RCF and those within 0-2 mm from the radiographic apex were recorded for RFTs. Kappa was used to assess intra-consensus reliability. Chisquare and Binary logistic regression were used to assess and predict risk factors related to the detection of AP. A significant difference was set at p<0.05. Results: AP was present in 81.5% of RFTs. No significant difference was present in the AP prevalence in RFT between males and females, maxilla and mandible, right and left sides, RFT with adequate and inadequate coronal restoration and RFT with/without zipping and ledge and between RFT with overfilled and those with RCF end within 0-2 mm from the radiographic apex (p>0.05), respectively. Significantly higher AP prevalence was present in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF (p<0.05), respectively. The odds of AP detection were 2.02, 5.5, 2 and 1.98 times higher in RFT with unfilled canal, perforations, non-homogenous and underfilled RCF, respectively. Intra-consensus reliability was (0.98, 0.95, 0.85, 0.81, 0.88, 0.85 and 0.92) for AP, unfilled canal, perforation, zipping and ledge, homogeneity of RCF, coronal restoration and length of RCF, respectively. Conclusion: The vast majority of teeth with previous root fillings presented with AP. AP detection risk was significantly higher in root-filled teeth with perforation, non-homogeneous, and underfilled root canal filling. Other factors do not influence the radiographic detection of AP in CBCT images. [ABSTRACT FROM AUTHOR]

Background: The management of type II endoscopic retrograde cholangiopancreatography (ERCP)-related perforation is still controversial. This study aimed to compare the effects of covered self-expandable metallic stent (SEMS), surgery, and conservative treatment for type II perforation. Methods: From January 2010 to December 2021, this study collected relevant data from five large hospitals in China. The data of ERCP difficulty grading and ERCP-related perforation in 26,673 cases that underwent ERCP during 11 years were retrospectively analyzed. Of 55 patients with type II perforation, 41 patients were implanted with a biliary covered SEMS (stent group), 10 underwent surgery (surgery group), and 4 received conservative treatment (conservative group). Results: Among the 55 patients with type II perforation, ERCP and computed tomography diagnostic rates of type II perforation were 10.91% (6/55) and 89.09% (49/55), respectively. The incidence of type II perforation in grade 5 ERCP (0.43%, 11/2,537) was significantly higher than that in grade 1–3 ERCP (0.16%, 32/19,471). (P = 0.004) and grade 1–4 ERCP (0.26%,12/4,665) (P = 0.008), respectively. Among the 10 patients in the surgical group, primary repair was performed in only 7 patients in whom location of the perforation could be identified. The incidence of retroperitoneal abscess was significantly lower in the stent group than in the surgery group (P = 0.018) and the conservative group (P = 0.001), respectively. The average hospital stay in the stent group was shorter than that in the surgery group (P = 0.000) and conservative group (P = 0.001), respectively. Conclusions: The incidence of type II perforation was dependent on the degree of difficulty of ERCP. The treatment of type II perforation with a covered SEMS can significantly reduce the incidence of retroperitoneal abscess and shorten the hospital stay, with better results than surgical and conservative treatments. [ABSTRACT FROM AUTHOR]

Amyand’s hernia is a rare disorder characterized by the presence of the vermiform appendix within an inguinal hernia. It is predominantly found in the pediatric age group, and its occurrence in adulthood is rare. Hence, a systematic analysis of twenty-six case reports of Amyand’s hernia published in the peer-reviewed literature in the year 2023 is presented with emphasis on variables including age of the patient, gender, clinical presentation, side of the inguinal hernia, imaging modalities used for evaluation, achievement of preoperative diagnosis or otherwise, classification, appendix management, hernia management, surgical approach, and outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Perforation is a pathological connection between the root canal system and the external surface of the tooth that can occur unintentionally during pulp chamber preparation. The consequence of this complication is inflammation and destruction of the periodontal tissues. Therefore, it is essential to seal the perforation to avoid tooth loss. Among different bioactive materials, mineral trioxide aggregate (MTA) and Biodentine (BD) ensure a favorable prognosis in therapeutic dental procedures due to their healing properties. Materials and methods: The present case series report describes successful treatments of different sizes, locations, and immediate and mediated perforations. Results: Clinical and radiographic follow-up showed asymptomatic teeth without discomfort, swelling, fistula, or radiolucency in the furcal area. Conclusion: Mineral trioxide aggregate and BD can be successfully used as a biocompatible material for the repair of furcal and root canal perforations. [ABSTRACT FROM AUTHOR]

In this study, experimental and computational studies of the impact of forced convective flow on the heat transfer characteristics of staggered pin fins with perforations are investigated in a rectangular channel at constant heat flux with Reynolds numbers (Re) of 2 × 103–12 × 103. In particular, cylindrical pin fins with circular longitudinal (L) perforation, longitudinal/transverse (LT) perforation, and longitudinal/transverse/vertical (LTV) perforation perforations are compared to solid pin fins to find out how adding different perforation arrays affects overall heat transfer performance and also to find the best perforation configuration for maximum performance. ANSYS‐FLUENT is employed for numerical simulation, validated by experimental data. Experimental validation is conducted by attaching the heat sink to a Peltier module, inducing heat generation through current on one face in the Armfield Free and Forced Convection Heat Transfer Service Units HT 19 and HT10XC. Results highlight significant increases in Nusselt number (Nu) for perforated pins compared to solid pins, with L perforations at 8%, LT perforations at 33%, and 67% for LTV perforated pins due to transverse perforations that act as slots, which stir up the primary flow and induce secondary flow generated by vertical perforations. Regarding pressure drops, L perforations reduce by 9%, LT by 19%, and LTV by 27% compared to solid pins. The overall enhancement ratio peaks at the minimum Reynold number, notably achieving a 38% increase in the LTV perforation pin fin array. This innovative study holds promise for diverse electronic applications, offering enhanced heat transfer performance in electronic cooling systems. [ABSTRACT FROM AUTHOR]

In this study, a simulation has been performed to investigate the effect of circular perforated pinfins on the performance of microchannel heat sink by varying the number of holes and their locations on the pinfins. A total of ten configurations are considered in this work including a plain microchannel (without pinfin) and a solid pinfin case. The study was conducted on a single-phase flow using deionized water as coolant and the Reynolds numbers range from 150 to 350 when a constant heat flux of 100W/cm2 has been applied at the heated base wall of a heat sink. The results obtained indicate that the location, as well as the number of perforations, affects the heat transfer capacity and pressure drop that occurs in the microchannel. However, the outcomes of the present analysis contradict the findings for thermal airflows when identical cases have been applied to the micro heatsink. According to the present analysis case 1 (perforation at the underside of the pinfin) has the maximum Nusselt number followed by case 2 (perforation at the mid of the pinfin) and case 3 (perforation at the topside of the pinfin) whereas the minimum pressure drop is achieved by case 8 (four equidistant perforations) among pinfin configurations. The highest performance factor is achieved by case 1 at a low Reynolds number while case 6 (perforation at the underside and topside) performs best at a higher Reynolds number. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical data of patients undergoing emergency operation for small intestinal perforation secondary to small intestinal metastasis of lung cancer and explore the clinical characteristics, treatment strategies, and preventive measures. Methods The clinical data of 11 patients who underwent emergency operation for small intestinal perforation secondary to small intestinal metastasis of lung cancer at the Department of Emergency Surgery, Zhongshan Hospital, Fudan University from Jan 2018 to Jun 2023 were selected for retrospective analysis. Analysis factors included age, gender, clinical manifestations, comorbidities, past history, preoperative imaging results, preoperative blood test results, treatment, surgical methods, metastasis sites, perforation sites, pathological types, hospitalization time, and prognostic outcomes. Results All of the 11 patients went to the emergency room with abdominal pain, and their duration of abdominal pain ranged from 8 to 96 hours. There were white blood cells≥9.5× 109/L in 10 patients, neutrophil percentages≥90% in 8 patients, procalcitonin (PCT) ≥0.05 ng/mL in 10 patients, and C-reactive protein (CRP) ≥5 mg/L in 11 patients. Among the 11 patients, 7 cases had jejunal perforation and 4 cases had ileal perforation; 10 patients underwent partial small bowel resection and enterenterostomy, and 1 patient underwent small bowel perforation repairment and jejunostomy; 10 patients were receiving anti-tumor drug treatment before operation, of which 7 patients received targeted therapy alone, 2 patients received chemotherapy alone, and 1 patient received both targeted therapy and chemotherapy. Postoperative hospitalization time ranged from 4 to 71 days, of which 3 patients died and 8 patients were discharged successfully. Conclusion Jejunum is the main perforation site of small intestinal perforation secondary to small intestinal metastasis of lung cancer. Patients with advanced lung cancer should have regular comprehensive examinations to detect distant metastases early. Early detection enables timely intervention, which can help prevent serious complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the influence of various nickel-titanium (Ni-Ti) files on debris extrusion during the retreatment of teeth with simulated lateral root perforation, focusing on root resorption. Methods: Sixty human mandibular premolar teeth were divided into groups with and without perforation and further subdivided based on the retreatment technique. Lateral root perforations were created in one group (Group 1), while the other group had no perforations (Group 2). Two retreatment techniques were compared: Remover (RE)+One RECI (OR) and ProTaper Universal Retreatment (PTUR)+WaveOne Gold (WOG). The weight of the extruded debris was determined. The time of both retreatment procedures was measured. Statistical analyses were performed using a two-way analysis of variance (ANOVA) test (P < 0.05). Results: Teeth with simulated lateral root perforation exhibited higher extrusion of debris during retreatment. In both groups, RE+OR files led to more extruded debris than PTUR+WOG files. However, this difference was statistically significant in Group 2 (P < 0.001). Compared to PTUR+WOG files, RE+OR files showed a statistically significant longer time to remove obturation material (P < 0.001). Conclusion: Perforated teeth exhibited significantly higher debris extrusion. While both file systems demonstrated similar debris extrusion in perforated teeth, the RE+OR files significantly increased debris extrusion in non-perforated teeth compared to the PTUR+WOG files. [ABSTRACT FROM AUTHOR]

Small arms ammunition like the 5.56x45 mm NATO Ball and 7.62x51 mm NATO Ball projectiles constitute a significant threat to light armoured vehicles. These vehicles are mostly comprised of single-layered metallic high-hardness steel armour, but as an essential vehicle design feature, mild steel bodywork is externally mounted in certain areas for fenders, toolkit boxes, storage boxes, etc. over the main armour, i.e., high-hardness steel armour. These are necessary design features of vehicles, so they can't be neglected regarding ballistic protection against threats. Also, to provide better ballistic protection in up-armoured vehicles, armour consisting of high-hardness steel armour is integrated or mounted just behind the existing bodywork of the car. Thus, this paper experimentally and numerically investigated the "bodywork effect," which is also called the "K-effect," and found that the configuration where the bodywork of mild steel is placed in front of high-hardness steel armour plate failed to provide better ballistic protection against the 7.62x51 NATO Ball M80 projectile fired at 0° angle of impact with a velocity of 833±20m/s from 10 m distance. However, the single high-hardness armour steel plate provided better ballistic protection than the configuration consisting of bodywork. For the validation of the experimental investigations, the arrangements were numerically simulated. The main aim of this work was to check the bodywork effect against this particular projectile and investigate factors contributing to the phenomenon. [ABSTRACT FROM AUTHOR]

Velocity fields measured in the vicinity of the perforated leading edge of a turbine nozzle vane using the particle image visualization technique are presented. Noncontact measurements were performed in a plane segment consisting of three nozzle vanes and having an optically transparent inlet section offering visual access to the region of the leading edge of the central vane for a high-speed camera and to the laser sheet. The experimental investigations were performed at a fixed incoming flow velocity of 33 m/s, and the relative air flowrate through the cooling holes varied from 1.6 to 6.4%. The cooling film flow near the leading edge was visualized for three models of vanes differing in the air supply method to the holes, hole diameter, and number. Supply of the coolant to the cooling holes from one cavity resulted in a high degree of nonuniformity in the distribution of the film over the leading edge, which was caused by a high blowing ratio for the jets injected through holes located closer to the suction side. The experimental results have revealed that separate supply of cooling air to the holes on the pressure side, leading edge, and suction size minimizes sensitivity of the formed film thickness to the relative flow rate of the coolant and provides a more uniform distribution of the coolant over the vane surface in a wide range of the blowing ratio for the jets that varies from 0.5 to 2.5. Visualization has demonstrated extensive unsteadiness of the film flow along the vane airfoil. In this case, the cooling jet fed through the central hole oscillates, thereby leading to periodic formation of a film on either the pressure side or the suction side. [ABSTRACT FROM AUTHOR]

Objectives: Esophageal perforations are a complex clinical scenario that have been poorly studied. To date, there is no grading of esophageal perforations, the reason being that the outcome is very heterogeneous, because the perforation is very heterogeneous. A grading of the severity of the perforation may guide treatment, and could ultimately affect morbidity and mortality. Methods: The observation period of the study was four years. All patients with a perforation of the esophagus aged 18 to 90 years were included. All anastomotic insufficiencies or fistulas after surgery of the esophagus were excluded. The cause of the injury and the time interval between the event and the start of therapy were analyzed. The severity of each perforation was classified based on the results of a diagnostic CT scan, gastroscopy as well as clinical and laboratory findings. Therapy and signs of infection were evaluated. Endpoints of the study were patient recovery or death. The study was conducted as a retrospective single-center study at a university hospital of Düsseldorf. The study has been approved by the review board. Patients gave their informed consent before data collection. All data were analyzed using SPSS 29 (IBM SPSS Statistics software). Results: Age, gender and cause of the esophageal perforation did not impact significantly on overall survival. The duration of injury > 24 h (p = 0.01), presence of mediastinitis (p = 0.01) and necrosis of the esophagus (p = 0.02) were associated with an unfavorable outcome. The correlation of the clinical grading of the severity of the perforation based on the endoscopic, radiological and clinical findings with the overall survival of patients was significant. Patients categorized into the four grades of severity (I–IV) had an overall survival of 100%, 100%, 70% and 50%, respectively. Conclusion: The severity of esophageal perforations can be systematically rated grades I to IV based on the radiological, endoscopic and clinical findings at diagnosis. Due to the grading and its correlation to the overall survival, a comparison of patients, their treatment and outcome becomes possible. In future, the grade of a perforation may guide treatment, and therefore affect morbidity and mortality. [ABSTRACT FROM AUTHOR]

Shaped charge perforation is an important technology for sandstone gas reservoirs. In the process of shaped charge perforating, the initial permeability and porosity of the formation are greatly reduced, directly affecting oil and gas production. This paper uses smooth particle hydrodynamics (SPH) and finite element methods (FEMs) to study the formation damage caused by the shaped charge perforation. In this perforation simulation, the impact characteristics of the metal jet formed by the liner are coupled with the damage characteristics of the sandstone. A new mathematical model is proposed to describe the damage of permeability and porosity based on the Morris and Xue models. The simulated results show that a large-scale abdominal section appears at the perforation site, and the axis of the hole tilts with the increase in the perforation depth. The porosity damage at the perforation site is the greatest, up to 60%, while the permeability recovers to 90% of its initial state after pressure relief. The degree of porosity damage decreases with the increase in negative pressure, and when the negative pressure is 30 MPa, it may cause a large amount of sand production. [ABSTRACT FROM AUTHOR]

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Copyright of FME Transactions is the property of University of Belgrade, Faculty of Mechanical Engineering and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Matrix metalloproteinase-7 (MMP-7) is associated with biliary injury. This study aimed to evaluate the relationships of serum MMP-7 with clinical characteristics in choledochal cysts (CDC) children. Methods: Between June 2020 and July 2022, we conducted a prospective study of CDCs who underwent one-stage definitive operation at our center. Serum MMP-7 was measured using an enzyme-linked immunosorbent assay. We evaluated the relationships between serum MMP-7 and age, laboratory tests, imaging examinations, liver fibrosis, MMP-7 expression, and perforation. Results: A total of 328 CDCs were enrolled in the study, with a median serum MMP-7 of 7.67 ng/mL. Higher serum MMP-7 was correlated with younger age at diagnosis (p < 0.001), larger cyst sizes (p < 0.001), higher liver fibrosis stages (p < 0.001), and higher incidence of perforation (p < 0.01). Liver MMP-7 was mainly expressed in intrahepatic and extrahepatic biliary epithelial cells. The area under the receiver operating characteristic curve (AUROC) was 0.630 (p < 0.001) for serum MMP-7 in predicting perforation. When serum MMP-7 was combined with γ-glutamyl transferase (GGT), the AUROC increased to 0.706 (p < 0.001). Conclusions: Serum MMP-7 was associated with biliary obstruction in CDCs. Patients with high serum MMP-7 were more likely to have severe liver damage and biliary injury, with higher incidences of liver fibrosis and perforation. [ABSTRACT FROM AUTHOR]