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Cite this article as: Chen X, Xu H, Chen S, Gu W, Wang Z, Zhang X. A straw shows which way the wind blows: A successful cannulation of abnormal duodenal papilla. Turk J Gastroenterol. 2026;37(3):406-408.
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Rotary press forging (RPF) has been introduced in the last century. Despite its advantages, it produces defects in the forgings such as mushrooming, eccentricity, and twisting. Rotary hammer forging (RHF) is a new process invented by the author to reduce such defects. RHF is considered as a multi-axes compression forging process where the material is subjected to several repeated hammering blows to be deformed incrementally and partially, while the produced deformation zone is swept over the whole area of the workpiece. Previous works showed that the specimen geometry, the inclination angle and the rotational speed affect such defects as mushrooming effect, eccentricity and twisting angle, but they are less severe in RHF than RPF. The present work has studied the effect of the forming degree (FD) on the forgings produced by both RPF and RHF to compare between the two processes. Special set-ups have been used where a die is rotating while either a pressing head or hammering head is used to deform the specimen. Independent variable parameters were chosen such that the specimen geometry H/D = 1, the inclination angle = 4[Formula: see text], the rotational speed N =260 rpm, number of blows per revolution in case of RHF = 1.2. The results showed that FD has its influence on the mushrooming effect, twisting angle, and eccentricity, although they are less in the case of RHF. RHF reduces the defects referred to RPF by 5 to 13% for the mushrooming effect, 0 to 33% for the eccentricity, and 70 to 80% for the twisting angle. Thus, RHF is advantageous than RPF.
The oceanic wet-thermal and chloride salt environment creates extremely harsh service conditions for marine infrastructures. As a green construction material, geopolymer concrete has a promising application prospect in marine engineering due to its excellent durability. The impact resistance of geopolymer concrete subjected to wet-thermal and chloride salt environment is of great significance for the durability and quality of marine engineering structures. This study uses nano-SiO2 (NS) and hybrid fibers (HF) to enhance the impact resistance of geopolymer gel concrete (GPC). Radial basis function (RBF) and back-propagation (BP) composite neural networks are used to predict the impact resistance of NS and HF-reinforced geopolymer gel concrete (NSHFGPC). The impact resistance of NSHFGPC specimens is characterized by two indicators: the cumulative number of repeated impact blows required to initiate the first visible crack (N1) and the cumulative number of impact blows corresponding to ultimate failure (N2). To evaluate the durability of NSHFGPC under oceanic conditions, specimens were exposed to a simulated marine environment within a simulation test chamber for 60 days prior to impact testing. The 60-day duration was selected to achieve a sufficient level of chloride penetration and matrix aging. Based on the resulting experimental database, an RBF-BP neural network was constructed to predict the material's impact resistance. In this study, grid search and K-fold cross-validation were employed to select the optimal hyperparameters. Compared to standalone RBF and BP models, the RBF-BP network demonstrated superior performance, achieving R2 values of 0.900 and 0.922. These results represent improvements of 20.18% and 11.18% over the standalone RBF model, respectively. Consequently, the RBF-BP algorithm serves as an experimental tool for predicting NSHFGPC impact resistance and guiding future mix design optimization.
The mandible, due to its anatomical position, mobility, and functional role, is one of the bones most frequently involved in maxillofacial trauma, with fracture patterns influenced by impact mechanisms and anatomical characteristics. This study aimed to analyse the relationship between trauma mechanisms and affected anatomical subsites in patients with isolated mandibular fractures treated at a regional public hospital in Buenos Aires Province. A retrospective cross-sectional observational study was conducted using medical records, surgical reports, and diagnostic imaging of patients treated between 2011 and 2024. Isolated mandibular fractures were included, while pathological fractures, dentoalveolar injuries, and cases with incomplete data were excluded. Trauma mechanisms were classified as interpersonal aggression, vehicular accidents, falls from height, contact sports, and blows with blunt objects. Interpersonal aggression was the most frequent trauma mechanism, followed by falls from height and vehicular accidents. The mandibular angle, parasymphysis, and condyle were the most commonly affected anatomical sites. Multivariable analysis showed a higher probability of condylar fractures in falls from height (OR = 4.75; 95% CI: 2.24-10.3; p < 0.001) and vehicular accidents (OR = 3.02; 95% CI: 1.28-7.13; p = 0.01). Falls were also associated with a lower probability of mandibular angle fractures (OR = 0.16; 95% CI: 0.06-0.36; p < 0.001), while blunt object trauma showed a positive association with mandibular body fractures (OR = 3.12; 95% CI: 1.04-8.95; p = 0.04). These findings indicate that trauma mechanisms influence the anatomical distribution of mandibular fractures, providing relevant information for diagnostic assessment and surgical planning.
This study presents a detailed statistical optimization methodology for improving the performance of high-strength concrete through the strategic integration of weathered crystalline rock (WCR) fine aggregate. Utilizing Taguchi L5 orthogonal array design, the research assessed the impact of varying WCR replacement levels (0%, 5%, 10%, 15% and 20%) on essential concrete properties, encompassing mechanical strength, fresh properties, durability metrics and impact resistance. The experimental program included 175 specimens tested across seven response variables to find out how they worked together in detail. By using signal-to-noise ratio analysis and grey relational analysis together, the best replacement strategies were found. For example, adding 5% WCR resulted in better multi-objective performance with a grey relational grade of 0.953. Using mechanical property correlations, advanced regression modeling was able to predict compressive strength very well (R² = 0.997). ANOVA statistical validation showed that all response variables had significant factor contributions (> 94%). The optimized mix had a compressive strength of 74.5 MPa, improved workability (66.3 mm slump) and impact resistance (778 blows). The results show that using WCR strategically can help meet both structural performance goals and sustainability goals at the same time. This sets a strong foundation for developing sustainable high-strength concrete for use in infrastructure.
Perhaps the most classical diffusion model for chemotaxis is the Keller-Segel system u t = Δ u - ∇ · ( u ∇ v ) in R 2 × ( 0 , T ) , v = ( - Δ R 2 ) - 1 u : = 1 2 π ∫ R 2 log 1 | x - z | u ( z , t ) d z , u ( · , 0 ) = u 0 ⋆ ≥ 0 in R 2 . We show that there exists ε > 0 such that for any m satisfying 8 π < m ≤ 8 π + ε and any k given points q 1 , . . . , q k in R 2 there is an initial data u 0 ∗ of ( ∗ ) for which the solution u(x, t) blows up in finite time as t → T with the approximate profile u ( x , t ) = ∑ j = 1 k 1 λ j 2 ( t ) U x - ξ j ( t ) λ j ( t ) ( 1 + o ( 1 ) ) , U ( y ) = 8 ( 1 + | y | 2 ) 2 , with λ j ( t ) ≈ 2 e - γ + 2 2 T - t e - | ln ( T - t ) | 2 where γ = 0.57721 . . . is the Euler-Mascheroni constant, ξ j ( t ) → q j ∈ R 2 and such that ∫ R 2 u ( x , t ) d x = k m . This construction generalizes the existence result of the stable blow-up dynamics recently proved in [17, 18].
The American Heart Association (AHA) regularly updates its evidence-based practice recommendations for basic life support, advanced cardiovascular life support, pediatric life support, and neonatal life support. This article reviews the latest AHA guidelines, which were released in October 2025, highlights important changes, and demonstrates how nurses can incorporate these changes into their practice. Examples of new practice recommendations include back blows and abdominal thrusts in the management of severe foreign body obstruction in the conscious adult, use of the two thumbs encircling approach or heel of one hand when providing infant chest compressions, and the administration of an initial 200 Joule synchronized shock in the unstable patient with atrial fibrillation.
Pediatric cardiac arrest primarily arises from asphyxia in infants and trauma in older children, contrasting with adult etiologies dominated by cardiac events. This underscores prevention as the cornerstone of pediatric basic life support, through injury mitigation like child restraint systems and water supervision, safe sleep practices including supine positioning on firm surfaces with caregiver smoking cessation to reduce sudden infant death syndrome, plus awareness of child abuse and adolescent suicide prevention. In hospitals, pediatric early warning systems (PEWS) enable early deterioration detection via vital sign scoring for timely intervention. Major updates in the 2025 pediatric basic life support guidelines reflect evidence-driven refinements. First, hospitals should implement PEWS to prompt rapid response teams for at-risk inpatients. Second, all rescuers (lay and healthcare providers) should employ the two-thumb encircling hands technique for infant chest compressions for optimal depth (about 4 cm), rate (100-120/min), and recoil; one-hand heel compression serves as backup if infeasible. Third, lay rescuers may apply automated external defibrillators for nontraumatic out-of-hospital cardiac arrest in children aged 1 year or older, prioritizing prompt attachment after initial cardiopulmonary resuscitation (CPR) cycles to address potential shockable rhythms. Fourth, for infant foreign body airway obstruction, alternate five back blows (over the spine between scapulae) with five chest thrusts (using heel-of-hand on sternum) until cleared or unresponsive, then transition to CPR. These updates aim to enhance bystander intervention, CPR quality, and survival with favorable neurologic outcomes in pediatric cardiac arrest.
Maxillofacial injuries are commonly observed among women who have experienced domestic violence. The prevalence and characteristics of these injuries in Jordan remain underexplored. This study aimed to evaluate the frequency and patterns of maxillofacial injuries among females affected by domestic violence in Jordan. A total of 2643 records of domestic violence-related maxillofacial injuries in females were retrieved from the Family Protection and Juvenile Department and the Accident and Emergency (A&E) departments of two major hospitals in Jordan. Descriptive statistics were computed, and associations were evaluated using Chi-square and Kruskal-Wallis tests. Significance was set at p ≤ 0.05. The mean age at the time of injury was 29.19 years (SD: 11.8). The spouse was responsible for violent acts in 20% of cases. In 89.9% of cases, injuries were caused by direct blows. Soft tissue injuries were observed in most cases (98.1%), followed by midfacial fractures (5.6%), dentoalveolar injuries (1.7%), upper face fractures (1.2%), and lower face fractures (0.9%). The vast majority did not require surgical intervention (98.9%). Concomitant injuries to other body regions were identified in 70.6% of cases, with the upper extremities the most frequently affected (50.4%). Trauma to the upper extremities showed a significant inverse association with midfacial fractures (p < 0.001). Recurrent trauma was documented in 7.6% of cases. Individuals with recurrent trauma were more likely to present with concomitant injuries to other body regions (84.2%) than first-time trauma victims (69.5%). Facial soft-tissue injuries were the most frequent. Midfacial fractures were the most common facial fracture type, though they were rare and less likely when an upper-limb injury occurred. Repeated trauma increases the likelihood of multiple fractures, emphasizing the need for early detection, reporting, and referral by healthcare professionals including oral & maxillofacial surgeons and dental health professionals.
Dynamic probes, such as the dynamic probe light (DPL) with a 10 kg hammer weight, are easy to use and enable rapid, in-situ compaction control of embankments. However, the use of these light tools in dense soil is limited because the number of blows can be greatly increased and may even exceed the maximum allowable value. For dense soil types, in order to be able to rely on the test results, heavier tools with hammers of 30–50 kg should be used. This will reduce the speed and ease of testing because of the heavy weight of the tool. In the current study, numerous tests were conducted on soil compacted in a physical model to develop a tool for dense soil. The priority was maintaining speed and ease of testing by modifying the specifications of the DPL tool. The results showed that the efficiency and penetration power of the newly developed tools were higher than those of the DPL tool, even though the hammer weight and energy input remained constant. Statistical analysis of the dynamic probing test results confirmed data repeatability and sufficient confidence for establishing new empirical correlations.
The blowing and drying stages in the plastic manufacturing process generate many defects due to a lack of accuracy in estimating thermal convection and its diffusion control. Therefore, dual digital poka-yoke simulator phases have been built to describe the unsteady state of convection-diffusion mathematically (i.e., parabolic behavior), and converted to ordinary type using a discrete singular convolution transformer. The numerical solution improves the mechanism of JRNS (Jidoka recruit's network system) to be easily programmed to be highly controlled. The mathematical poka-yoke simulator formulation relies on Runge-Kutta 4th order and five-stage fourth-order robust stability protective Runge-Kutta (SSP-RK54) schemes as discussed in 1st phase and called Mat-Poka-Yoke system (Mat-PYS) alternating between three stages. The accuracy of the Mat-PYS has been tested via measuring the rate of convergence, the absolute error, the L2 error, and the L∞ error, with errors up to [Formula: see text]. The obtained outcomes are described both in tabular and graphical form, which almost includes the validity of these mechanisms to hold on to the precision, efficiency, simplicity, and applicability for solving convection-diffusion equations. The applicability emphasized via parametric analysis to debate the effect of convective velocities, diffusion coefficients, and time at different locations on results to resist the defect causes generation as demonstrated in 2nd phase. The OEE for plastic injection machine process has been improved from 76.6% to 88.9% when controlled by proposed mechanism, and products quality improved to 5.2 sigma level.
Abies pinsapo Boiss., is an endemic tree species to southern Spain whose pollination has not been studied in detail since its pollen grains have historically been included together with the rest of the Pinaceae species in the same type. However, it is possible to distinguish the pollen of A. pinsapo from the rest based on its size, but no clear references are currently available for fresh pollen. The aim of this study is to establish the size range of fresh pollen of A. pinsapo to characterize the atmospheric seasonality and intensity of this pollen type, as well as the pollination trends of this species in the Sierra de las Nieves National Park during the period 2018-2025 using aerobiological registers. In addition, we have analysed the relationship between meteorological variables and the pollen dispersal of this species. After establishing the size ranges for distinguishing A. pinsapo pollen, we observed that its pollination occurs between March and June. Temperatures and wind speed positively correlated with the airborne pollen concentrations of A. pinsapo, while for the relative humidity negative coefficients were obtained. Besides this, high frequencies of winds blowing from the nearest A. pinsapo forests generally increase the pollen detection. Despite using several trend analysis techniques and considering several main pollen season (MPS) definitions, no significant trends have been detected in the parameters of the MPS studied, except for a single method and MPS combination.
Air-induced separation of flexible rod-like particle mixtures in a specific separator is numerically investigated using a coupled Discrete Element Method (DEM) and Computational Fluid Dynamics (CFD) approach. In the separator, the mixture of flexible rod-like particles of different lengths and material densities deposits under the effect of gravity, and a horizontal airflow stream intersects the particle flow, blowing lighter particles in the mixture to translate horizontally and allowing the heavier ones to fall downwards. The model particles represent flexible biomass materials, specifically tobacco and stem particles. The initial packing density of the particle mixture is 8% by volume. The physical mechanism that causes particle segregation is analyzed. Subsequently, parametric studies are performed to examine the effects of some critical parameters on the extent of segregation, including inflow air velocities, initial particle packing density, volume fraction of heavier particles, particle size distribution, and flow field geometry. Finally, a suggestion is proposed to promote particle segregation in such a type of separator.
A patient with a maxillectomy and persistent hypernasality despite wearing a digitally fabricated obturator and receiving speech therapy was treated with a nasal speaking valve (NSV) adjunct. Using speech intelligibility tests, the Kumakura Speech Handicap Index-7, nasalance scores, and the blowing test, speech outcomes were assessed under 3 conditions: without a prosthesis, with digitally fabricated obturator alone, and with the combined use of an obturator and NSV. The combined use of the obturator and NSV improved speech intelligibility and reduced hypernasality, suggesting clinical benefit for this adjunct in rehabilitation.
Biodegradable polymer blends are promising materials for flexible packaging films with tunable properties. In this work, poly(butylene succinate)/poly(vinyl alcohol) (PBS/PVOH) blown films were produced by twin-screw melt compounding followed by film blowing, and the effect of PVOH content on phase organization, processability, morphology, and functional performance was investigated. The blends showed phase-separated morphologies and composition-dependent structural evolution. DSC indicated that both polymers largely retained their crystallization ability, although the crystallinity decrease was more evident for PVOH. Rheological analysis revealed limited compatibility and increasing elastic response at higher PVOH contents, consistent with the formation of structured PVOH insoluble gel-like domains. SEM confirmed droplet-matrix morphologies, becoming coarser and more heterogeneous at high PVOH content, with film-blowing instability for PBS/PVOH 20/80. PVOH incorporation improved oxygen and water-vapor barrier properties and increased stiffness, but progressively reduced ductility. Model fitting supported the structure-property correlations, relating film performance to blend composition, morphology, and PVOH phase organization. Among the processable formulations, PBS/PVOH 80/20 showed the best balance between improved barrier properties and acceptable extensibility for food packaging application. Overall, PBS/PVOH blown films are promising biodegradable systems for flexible food packaging, provided that PVOH phase structuring is properly controlled.
A physical model for sound production in the harmonica is proposed that is capable of pitch bending, and tested against experimental measurements on a real instrument. The model couples reed vibrations, airflow through the reed openings, and the acoustic resonance on the mouth side of a harmonica hole. By using one of three cylindrical tubes with different diameters as a resonator, time-domain simulations are conducted while the tube length is varied. The simulations successfully reproduce blow bending at hole 7 of a 10-hole diatonic harmonica, draw bending at hole 4, and overblowing at hole 6. The blow-bending simulation closely matches the experimental results obtained under the same conditions. Using a small-amplitude approximation, the conditions for self-excitation are derived, and the frequencies satisfying these conditions are calculated. The frequencies obtained experimentally, those from simulation, and those predicted by the theoretical analysis-each depending on tube diameter and length-show good agreement. A detailed examination of the sounding conditions further explains that, in the bending simulation, the sound frequency changes continuously with tube length, whereas in the overblow simulation, normal blowing is suddenly transformed into overblowing after a brief silent interval.
This case report presented a unique, integrated nursing management strategy for a 47-year-old male with extreme complexity arising from radiation-induced enterovesical fistula and severe malnutrition-sarcopenia syndrome following irradiated rectal cancer surgery, addressing a critical literature gap in systematic protocols for high-mortality cases. It demonstrated the practical application and sequencing of advanced, refined interventions within a Damage Control Surgery (DCS) framework, offering a replicable model. Key admission findings included severe metabolic derangement (BMI 13.2 kg/m2, serum albumin 20 g/L, handgrip strength 12 kg), uncontrolled intra-abdominal and gluteal abscesses with multidrug-resistant organisms, complex skin integrity issues (chronic sacrococcygeal pressure injury, incontinence-associated dermatitis), and anatomical complications (presacral abscess, small bowel dilation of 9.87 × 9.86 cm, right ureteric obstruction). Primary diagnoses were radiation-induced multivisceral fistula, severe malnutrition-sarcopenia, and intra-abdominal infection. A phased, MDT-driven approach included: infection control via dual-catheter negative pressure irrigation; nutritional rehabilitation using a stepwise protocol from parenteral to enteral nutrition (short-peptide formula) guided by precise energy calculation and managed with a "ten-aspect" strategy; advanced wound care combining recombinant human epidermal growth factor (rh-EGF) gel with silver ion dressings; and comprehensive functional rehabilitation through a personalized graded exercise prescription, including respiratory training via balloon blowing exercises enhanced by motivational tools (e.g., hanging inflated balloons bedside for engagement). Outcomes after 118 days showed substantial improvement: nutritional and metabolic recovery (weight increased from 38 kg to 41 kg, albumin rose to 35 g/L, electrolyte imbalances corrected); infection resolution (drainage cultures negative, abscesses resolved, bowel dilation reduced to 3.4 × 3.5 cm); physical function restoration (handgrip strength improved from 12 kg to 25 kg, patient progressed from bedbound to ambulating 2 h daily); and complete wound healing. The paramount lesson was that successful management required a systematic, phased, MDT-based nursing model integrating advanced technical interventions with meticulous, protocol-driven supportive care (e.g., structured nutrition and rehabilitation), proving critical for transforming prognosis in similar complex scenarios.
The plastic pollution crisis demands sustainable alternatives to petroleum-based foams. Cellulose-based foams, renewable and biodegradable, are a good candidate. In this study, fully degradable cellulose foams are fabricated from methyl cellulose (MC) alone via a simple, additive-free method. The method combines mechanical foaming and oven drying without blowing, stabilizing, or cross-linking agents. First, stable wet foam is obtained by mechanically agitating an aqueous MC solution. Amphiphilic MC molecules stabilize the foam at the air-water interface. During oven-drying, the thermal gelation of MC solidifies the structure into solid foam. The resulting MC foam has a very low density (10.02 mg·cm-3), high porosity (99.28%), and excellent thermal insulation (thermal conductivity as low as 37.35 mW·m-1 K-1). It also has moisture-induced form interlocking capability, retaining 89.5% of its original tensile strength when form-interlocked and adhering well to common packaging materials. Additionally, the MC foam can be chemically modified for extra functionalities like flame retardancy and hydrophobicity. This research presents a new way to fabricate lightweight, moisture-induced form interlocking, and eco-friendly cellulose foams as a sustainable and versatile alternative to conventional plastic foams.