Control valve stiction is a frequent nonlinear fault in process industries that causes stick-slip motion, inducing sustained oscillations in process variables. This negatively impacts plant performance, reducing product quality and lowering plant efficiency. Many existing techniques lack robustness across varying operating conditions, highlighting the need for both accurate and computationally fast solutions. In this work, we propose a model-free data-driven method for stiction detection by analyzing the dynamic interaction between the controller output (OP) and process variable (PV). The proposed method utilizes time-augmented signal representations to construct heatmaps that emphasize slow-varying and stagnation-prone regions in PV relative to OP. A physically interpretable PV/OP heat ratio is then extracted as a compact feature for threshold-based classification using ROC analysis. The classifier trained on a dataset of 58 industrial loops achieved an optimal threshold that, when evaluated on a test set of 20 loops, resulted in 95% accuracy. In addition, cross-validation results (78-81%) and sensitivity analysis confirm consistent performance, robustness, and reasonable generalization under different dataset partitions and parameter variations. Overall, the proposed framework provides a practical and interpretable solution for near real-time stiction detection in industrial control systems.
The ABC transporter Scarlet is known for its role in pigment deposition within insect eye pigment granules. However, its extraocular functions remain largely unexplored. To investigate the role of Scarlet(LOCMI17149) in olfactory modulation and its regulatory mechanisms in the brains of the migratory locusts. The expression patterns and functions of scarlet(LOCMI17149) were analyzed by quantitative PCR (qPCR), fluorescence in situ hybridization and RNAi knockdown. Enzyme linked immunosorbent assay (ELISA) was employed to measure xanthurenic acid (XA) titers. Pharmacological interventions were performed to validate the role of XA and scarlet(LOCMI17149) in multi-unit electrophysiology. DNA-RNA immunoprecipitation (DRIP), chromatin immunoprecipitation (ChIP) and qPCR were conducted to measure the levels of R-loop and histone modification. Among the four Scarlet orthologs, one scarlet(LOCMI17149) is predominantly expressed in the antennae and brain. This expression pattern implicates its roles in olfactory processing. RNAi knockdown of scarlet(LOCMI17149) impaired olfactory preference for plant volatiles and common odorants (indole and β-ionone). This behavioral deficit caused by scarlet(LOCMI17149) RNAi knockdown is linked to a metabolic shift, characterized by decreased 3-hydroxykynurenine (3-HK) and elevated levels of its metabolite XA in the brain. Intracerebral injection of XA recapitulates the olfactory impairment and implicates it as a key behavioral effector. Local field potential (LFP) and electroantennogram (EAG) analysis support that XA suppresses the neurophysiological activity in the antennae and brains of locusts. Furthermore, we discover that an R-loop structure (Scarlet-RL) forms at scarlet(LOCMI17149) locus. Knockdown of Scarlet-RL with antisense oligonucleotides (ASO) increases scarlet(LOCMI17149) mRNA expression, indicating that Scarlet-RL acts as a transcriptional repressor in scarlet(LOCMI17149) transcription. Scarlet-RL mediates the synthesis of nascent mRNAs through histone modification. This study provides the first evidence that Scarlet-RL directly controls the transcription of this chemosensory regulator, revealing a novel epigenetic mechanism that orchestrates insect olfactory preference.
Spinal cord stimulation (SCS) is an established therapy for chronic pain, but post-implant care depends on timely identification of evolving patient needs. Remote monitoring may help detect therapy-use changes that scheduled follow-up and patient-initiated contact can miss. We evaluated Proactive Intelligence, a workflow-integrated, human-in-the-loop AI recommender using passively collected SCS device-interaction data to support care without added patients' data-entry burden. We conducted a prospective, observational real-world pilot among research-consented patients implanted with Prospera SCS devices. Proactive Intelligence used a hybrid neural network incorporating longitudinal therapy-use patterns, operational variables, and patient history/demography to identify patient-days with therapy-adjustment-associated patterns. Model outputs were translated into a prioritized daily review list for the Embrace Care Team (ECT), which reviewed cases, performed outreach when appropriate, adjudicated behavioral-change reasons, and recorded downstream patient care actions. Outcomes included model enrichment, field adjudication yield, intervention distribution, and pain-score change after outreach when follow-up pain scores were available. Model development used data from 747 permanently implanted patients with sufficient telemetry. Confirmed reprogramming events were rare, occurring at 0.77% per patient-day. At the high-specificity threshold, the model achieved a positive predictive value of 28.8% and sensitivity of 8.6% on a held-out test set, corresponding to approximately 37-fold enrichment over baseline prevalence. During the pilot, predictions were generated across 101,042 patient-days. Across 91 operational days, the ECT reviewed 188 cases involving 175 unique patients. Among reviewed cases, 152 patients responded within three outreach attempts, yielding an 80.9% response rate. Of all reviewed cases, 66.0% were adjudicated as "therapy-related." Among reachable patients, the therapy-related yield was 81.6%, and "Address therapy" actions occurred in 67.8% of cases, including reprogramming and therapy adjustment/discussion. Among cases with follow-up pain scores, therapy-relevant cases showed significant mean NRS reduction after outreach, with improvement after both reprogramming and non-reprogramming therapy adjustment. To our knowledge, this pilot represents the first real-world evaluation of an ECT driven, human-in-the-loop care workflow supported by passively collected SCS device interaction data, without added patient data-entry burden. The findings suggest that machine learning can assist longitudinal SCS care by surfacing behaviorally meaningful changes for timely human review, contextual interpretation, and coordinated support.
Preclinical studies suggest a novel aldosterone regulation pathway: the mineralocorticoid receptor (MR) on the adrenal cortex is a part of an MR-mediated ultra-short feedback loop regulating aldosterone production. Activation of MR on the adrenal decreases aldosterone; blockade of the MR increases aldosterone. Whether this regulatory pathway exists in humans is unknown. This was a double-blinded, 3-way crossover study of 23 healthy participants on a low sodium diet (10 mEq/day). Participants received three study drugs in random order: MR antagonist (eplerenone), MR agonist (fludrocortisone), and placebo. Study drugs were administered at 6:30AM on three separate days with 48 h between each administration. After 90 min, participants received sequential infusions of angiotensin-II (ANGII) for 45 min followed 60 min later by cosyntropin for 45 min. Aldosterone was measured before and after each infusion. Multi-level mixed effects linear regression was used to analyze the data. The change in aldosterone between baseline and post-cosyntropin infusion was greater after treatment with eplerenone as compared to placebo (5.16 ± 2.01 ng/dL, p = 0.01). There were no differences with fludrocortisone as compared to placebo. With ANGII stimulation, there were no differences in the change in aldosterone with either eplerenone or fludrocortisone versus placebo. In humans, MR antagonist treatment led to a greater increase in aldosterone in response to cosyntropin stimulation as compared to placebo, but not after ANGII stimulation. Future studies are needed to investigate the presence of a MR-mediated ultra-short feedback loop at the level of the adrenal gland regulating aldosterone production in humans. NCT02871648.
Sequential nephron blockade is commonly used to augment diuresis in patients with volume overload receiving loop diuretics. While metolazone is frequently used, acetazolamide has emerged as an alternative adjunctive agent. Real-world data comparing these strategies remain limited. This study evaluated the effectiveness and safety of acetazolamide vs metolazone as adjunctive therapy. This single-center, retrospective cohort study included adult patients receiving adjunctive acetazolamide or metolazone with loop diuretics for volume overload. The primary outcome was cumulative urine output within 48 hours. Secondary outcomes included high diuretic response (urine output above the cohort median), hypotension, acute kidney injury, hypokalemia, and metabolic acidosis. Multivariable regression and propensity score-matched analyses were performed. A total of 120 patients were included (metolazone, n = 70; acetazolamide, n = 50). Patients receiving metolazone were older and had higher baseline serum creatinine levels. Mean (SD) cumulative urine output was greater with acetazolamide (10,637 [13,847] vs 5,752 [10,231] mL; P = 0.028). After adjustment, acetazolamide remained associated with greater urine output (β = 4,735 mL; 95% confidence interval [CI], 39-9,430 mL; P = 0.048). High diuretic response occurred more frequently with acetazolamide (64% vs 40%), with higher adjusted odds (odds ratio, 3.18; 95% CI, 1.40-7.47; P = 0.0065). Findings were consistent in propensity score-matched analyses. Adverse event rates were similar between the groups. Adjunctive acetazolamide was associated with greater urine output and a higher likelihood of achieving a robust diuretic response compared with metolazone. Given the retrospective study design, these findings are hypothesis generating and warrant confirmation in prospective comparative studies.
Biatrial macro-reentrant tachycardias are rare in patients without prior atrial intervention and often pose diagnostic and therapeutic challenges. We present a case of de novo single-loop biatrial flutter in a structurally normal heart, in which high-density mapping was critical to understanding the reentrant circuit. Initial attempts at ablation in the left atrium were unsuccessful. Successful entrainment could be demonstrated from both the lateral mitral annulus and cavotricuspid isthmus. Ablation at the cavotricuspid isthmus resulted in termination with durable success. This case highlights the importance of reassessing the mechanism when attempts at ablation fail to modify tachycardia and reinforce CTI as a critical substrate even in complex biatrial activation patterns.
Laboratory single-species ecotoxicity tests provide early-warning indicators of hazards from shipping open-loop scrubber effluent. However, such tests, conducted under highly controlled, microbiota-free conditions, neglect contaminant interactions with diverse microbial communities (billions of cells L⁻¹) prior to encountering larger marine organisms. Extrapolating results of single-species experiments and their modeling outcomes to marine ecosystems can overestimate ecological risk and can result in policies such as banning open-loop scrubbers. In fact, scrubbers may not only result in reduced SOx emissions but may also lower atmospheric Polycyclic Aromatic Hydrocarbons (PAHs) emissions, especially in port areas, thus contributing to improved air quality. Obviously, such trade-offs between cleaner air and cleaner seas present challenges to policymakers. Mesocosm ecotoxicity experiments show bacterioplankton, phytoplankton, and metazoan plankton communities' resilience to diluted effluent in seawater and the increase of bacterial xenobiotic biodegradation gene machinery. These experiments indicate a fast bacterial biodegradation of abundant PAHs affecting the exposure levels to the rest of marine organisms. Another key factor mitigating PAH impacts in mesocosms is diatom-dominated phytoplankton as their enlarged phycosphere is a microhabitat for PAH-degrading bacteria. Marine microbes can quickly break down pollutants and sustainable environmental risk assessment policies must weigh this natural resilience alongside the air-quality gains from scrubbers.
Sustainable battery waste management requires moving beyond element recovery toward full-component reutilization. Here, we report a redox-ligand-coupled chemical reprogramming strategy that transforms chemically distinct components of battery waste into functional energy storage materials. Using LiCoO2 and polyethylene terephthalate (PET) as a model system, terephthalate and ethylene glycol generated from PET depolymerization act synergistically as coordinating ligands, proton sources, and reductants, enabling the dissolution of cathode materials and their in situ reconstruction into a redox-active metal-organic framework (cobalt terephthalate, CoTPA) under hydrothermal conditions without external leaching agents or reductants. This self-reinforcing reaction network couples polymer depolymerization with cathode deconstruction, eliminating external reagents and complex separation processes. The resulting CoTPA anode delivers a reversible capacity of ≈1170 mAh g-1 at 0.1 A g-1, and retains 92.1% of its initial capacity after 500 cycles at 1 A g-1. When integrated with regenerated graphite (RG), CoTPA enables a battery-level closed-loop dual-ion battery (DIB) with an energy density of 304 Wh kg-1 (based on total active material mass). The strategy is extended to layered oxide cathodes and diverse PET sources. Beyond conventional recycling, this work establishes a chemistry-driven paradigm that reprograms waste components into value-added functional materials, offering a scalable pathway toward circular energy storage.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Developing microrobotic systems for accurate and fast manipulation of microobjects or living cells has the potential to significantly advance biomedical and microfabrication applications. Despite recent progress in this field, comprehensive multistimuli responsive, fast, and precisely controllable microrobots remain limited. In this study, automated position and speed control of acoustically powered, bubble-based, magnetically steerable microrobots is demonstrated, along with micromanipulation of mammalian cells using these microswimmers. Enhanced control of the microswimmers is achieved by designing and implementing a closed-loop control system that guides the microrobots along a predetermined path while modulating their speed by adjusting the acoustic frequency near the resonant value. The microrobots are guided to cells, enabling cell manipulation by pulling them with the microrobots. Overall, the results highlight the capability and controllability of these magnetically and acoustically responsive microrobots for future cell-based applications, including manipulation, delivery, and microsurgery.
Real-world data regarding diuretic strategies and associated outcomes in patients hospitalized for heart failure (HF) in community health systems are limited. Evaluate associations between initial diuretic therapy, markers of decongestion, and clinical outcomes in patients hospitalized for HF. Patients hospitalized for HF from 2015-2022 across 30 health systems in the U.S. were identified in the Truveta national database. High dose loop diuretics were defined as >2.5X home dose or >160 mg IV furosemide equivalent over 24 hours. Four study groups were defined based on most intensive diuretic strategy used within 48 hours of admission: 1) high dose loop diuretics with adjuvant therapy (thiazide or acetazolamide), 2) high dose loop diuretics alone, 3) low dose loop diuretics with adjuvant therapy, and 4) low-dose loop diuretics alone. Multivariable logistic and linear regression models adjusted for clinical and demographic covariates were developed to evaluate associations between initial diuretic strategies and both in-hospital outcomes (acute kidney injury [AKI]), hemoconcentration, and weight change) and the composite of readmission or death. Patients were treated with low dose loop diuretics (N=81,734; 74.9%), high dose loop diuretics (N=17,187; 15.7%), low dose loop diuretics plus adjuvant therapy (N=7,027; 6.4%), and high dose loop diuretics plus adjuvant therapy (N=3,210; 2.9%). Patients treated with more intensive strategies had greater illness severity, including more frequent prior HF hospitalizations and worse kidney function. Adjusted weight loss during hospitalization was greater for patients treated with more intensive strategies (high dose loop with adjuvant: 4.6 lbs [4.0-5.2]; high dose loop alone: 2.1 lbs [1.9-2.4]; low dose loop with adjuvant: 1.4 lbs [1.0-1.8]), as were adjusted odds of AKI. The adjusted odds of 90-day readmission/death were not lower with more intensive initial diuretic strategies. However, odds of 90-day readmission/death were lower for every 5 lbs of achieved weight loss (adjusted odds ratio: 0.97, 95% confidence interval 0.96-0.97). More intensive diuretic strategies were used in sicker patients, improved in-hospital decongestion, but were not associated with improved 90-day outcomes. However, greater weight loss was associated with modestly lower risk of death or readmission. These data highlight the need for prospective studies to evaluate if enhancing decongestion can improve outcomes in patients hospitalized for HF.
Building complex RNA nanostructures requires precise molecular connectors for controlled self-assembly. Existing connectors, such as kissing loops, are restricted to coaxial joining, limiting accessible geometries. Here, we introduce the alpha kissing loop (alphaKL), a compact, sequence-programmable RNA connector enabling edge-to-edge helix association. The alphaKL combines a four-nucleotide kissing loop with minor- and major-groove triplex interactions, preorganizing an α-shaped conformation for cotranscriptional folding. Incorporated into RNA origami tiles, alphaKLs drive multivalent assembly into filaments and lattices, characterized by atomic force microscopy. Molecular dynamics simulations reveal that triplex occupancy at each sequence position controls the preferred interhelical angle. Cooperative backbone contacts progressively rigidify multi-alphaKL interfaces beyond individual motifs. By linking helices edge-to-edge rather than end-to-end, the alphaKL expands the RNA nanostructure design space, enabling previously inaccessible architectures.
PIF1 family helicases promote genome stability during DNA replication and repair, yet the biochemical activity of human PIF1 (hPIF1) remains poorly understood. Here, we directly compare full-length hPIF1 and budding yeast Pif1 (yPif1) and show that the two enzymes operate differently. In bulk assays, hPIF1 displays weak net DNA unwinding because its robust intrinsic single-stranded DNA (ssDNA) annealing activity rapidly reforms duplex DNA behind the helicase motor. Single-molecule magnetic tweezers experiments reveal that hPIF1 is only modestly slower than yPif1 and similarly processive, indicating that poor apparent unwinding primarily reflects rapid reannealing rather than impaired motor activity. Mutagenesis and structural modeling indicate that this functional divergence depends on a yeast-specific insertion within the catalytic domain. Unlike yPif1, hPIF1 fails to stimulate Polδ-dependent displacement-loop (D-loop) extension, arguing that it does not promote DNA unwinding ahead of the migrating bubble. However, similarly to yPif1, hPIF1 likely unwinds newly synthesized DNA coupled with DNA reannealing behind the migrating D-loop. hPIF1 efficiently remodels intramolecular G-quadruplex DNA into fully base-paired dsDNA, whereas yPif1 generates ssDNA products. Together, our data support a model in which hPIF1 acts primarily as a DNA translocase that couples local unwinding with rapid rewinding to clear secondary DNA structures without generating extensive ssDNA.
The formylglycine-generating enzyme (FGE) post-translationally modifies the active site of all human sulfatases. Mutations in the SUMF1 gene encoding FGE may lead to catalytically inactive FGE or destabilize the protein. The resulting lack of sulfatase modification causes the rare disease multiple sulfatase deficiency (MSD). Previously, FGE required elastase treatment for crystallization and the structures lacked copper, although FGE is a copper-dependent enzyme. Here, we show that highly active human FGE purified from insect cells natively contains one copper ion and we report six new crystal structures revealing previously unobserved features. Several structures contain the catalytic copper ion coordinated almost linearly by the two catalytic cysteines. A structure of the MSD-causing E130D variant shows distortions in coordination of a structural Ca2+ explaining its lower stability. As part of exploratory ligand-soaking experiments, a structure of FGE soaked with N-acetyl cysteine methyl ester shows the binding of a small molecule to a site other than the active site highlighting a potential binding site to be explored in the development of pharmacological chaperones for FGE. Crystallization of FGE without elastase treatment resulted in a structure in which the previously missing loop is well defined in the electron density and partly covers the active site, indicating that it needs to adopt a different conformation for substrate binding. This assumption is supported by a second structure in which the loop faces away from the active site and leaves the substrate binding groove open and by the occasional occurrence of crystals in which the loop becomes disordered.
Counterfactual explanations offer an intuitive way to understand the prediction behavior of machine learning models. However, they still face major challenges in practice. Explanation quality is often unclear due to feature redundancy and the lack of systematic evaluation. The resulting information is fragmented and hard to integrate into a coherent decision logic. To address these issues, this paper proposes a new analysis paradigm. It reframes counterfactual explanation as an auditable and iterative investigative reasoning workflow. The paradigm consists of three tightly coupled steps. First, it focuses on causal features to reduce the initial complexity of the explanation space. This is achieved through the Minimal Feature Boundary (MFB) and interactive constraint modeling. Second, it introduces multi-dimensional quality audit views. These views incorporate metrics such as the Counterfactual Equilibrated Quality Score (CEQS). They support evidence-based filtering and comparison of counterfactual candidates. Third, it establishes a visualization-driven hypothesis testing loop. This loop links coordinated views to distribution comparison and causal exploration. It allows users to dynamically validate and iteratively refine their understanding of model's behavior. The paradigm is instantiated in the visual analytics system PeCE. Its effectiveness is demonstrated through case studies and expert interviews. The results show that the proposed paradigm improves transparency and traceability in the counterfactual explanation process. As a result, counterfactual explanations become more credible and practical as diagnostic tools.
Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a complex chronic inflammatory disease involving mucosal barrier defects, neurogenic inflammation, mast cell activation, and tissue remodeling. Current diagnosis lacks objective biomarkers, relying instead on symptom assessment and exclusion of confusable diseases. Cystoscopy is recommended for identifying Hunner lesions per ESSIC/AUA guidelines, and first-line intravesical GAG replacement therapies only achieve sustained response rates of 20-38% at 12 months. Medical-engineering integration and materials innovations propel IC management toward multi-scale regulation and intelligent repair. This article proposes intelligent materials and systems to advance IC from stepwise diagnosis to an integrated "sensing-feedback-execution" closed loop. At the diagnostic level, it integrates medical phenotyping with engineering multidimensional detection to construct a synergistic system of subjective symptoms, objective molecules, and physical function: attomolar long non-coding RNA(lncRNA) detection via CRISPR-graphene transistors, glycosaminoglycans (GAGs) quantification with 13C-FNDs, and real-time bladder monitoring with flexible electrodes and wireless sensing. At the therapeutic level, centering on targeted delivery, dynamic repair, functional remodeling, it integrates four pathways: inflammation-responsive engineered bacteria; DNA nanocages and dual-responsive hydrogels for precise release; bioprinted patches and digital twin scaffolds for personalized repair; and trimodal combination therapy for mucosa, inflammation, and fibrosis. It further envisions Material Intelligence Agent systems medicine integrating nanosensors, quantum computing, and micro-nanorobots to construct a cross-scale diagnostic and therapeutic closed loop, with dynamic individualized intervention via digital twins. This paper provides a systematic technological pathway for precision IC management and a transferable medical-engineering integration paradigm for chronic inflammatory diseases.
To evaluate whether adjuvant 9-valent human papillomavirus vaccination improves viral clearance and reduces recurrence after excisional treatment for high-grade cervical intraepithelial neoplasia (CIN2+). This retrospective cohort study included women aged 18 years and older who underwent loop electrosurgical excision procedure for histologically confirmed CIN2+ between December 2023 and January 2026. Women with pre-treatment human papillomavirus positivity, negative surgical margins, and available post-treatment follow-up data were included. Patients were stratified according to post-treatment vaccination status. The primary outcome was human papillomavirus clearance at 24 months. Secondary outcomes included clearance at 6 and 12 months, persistent infection, time to viral clearance, and CIN2+ recurrence. Multivariable logistic and Cox regression analyses were performed. A total of 666 women were included, of whom 212 (31.8%) received adjuvant vaccination and 454 (68.2%) did not. Clearance of human papillomavirus was higher in vaccinated than in unvaccinated women at 6 months (60.8% vs. 46.3%), 12 months (78.3% vs. 58.8%), and 24 months (87.7% vs. 77.8%). Persistent infection at 24 months was lower in the vaccinated group (12.3% vs. 22.2%). CIN2+ recurrence occurred in 3.8% of vaccinated women and 11.9% of unvaccinated women. Adjuvant vaccination was independently associated with faster viral clearance (adjusted hazard ratio: 2.0, 95% confidence interval: 1.5-2.7, p<0.001). Adjuvant 9-valent human papillomavirus vaccination after excisional treatment was associated with higher viral clearance and lower CIN2+ recurrence. Yüksek dereceli servikal intraepitelyal neoplazi (CIN2+) nedeniyle eksizyonel tedavi uygulanan kadınlarda adjuvan 9-valan insan papillomavirüs aşısının viral klirens ve nüks üzerine etkisini değerlendirmek. Bu retrospektif kohort çalışmasına Aralık 2023-Ocak 2026 tarihleri arasında histolojik olarak doğrulanmış CIN2+ nedeniyle loop elektrokoter eksizyon prosedürü uygulanan 18 yaş ve üzeri kadınlar dahil edildi. Tedavi öncesi insan papillomavirüs pozitifliği, negatif cerrahi sınır ve tedavi sonrası takip verisi bulunan hastalar çalışmaya alındı. Hastalar tedavi sonrası aşılama durumuna göre gruplandırıldı. Birincil sonlanım ölçütü 24. ayda insan papillomavirüs klirensiydi. İkincil sonlanım ölçütleri 6. ve 12. ay klirensi, persistan enfeksiyon, viral klirense kadar geçen süre ve CIN2+ nüksü idi. Çok değişkenli lojistik regresyon ve Cox regresyon analizleri yapıldı. Toplam 666 kadın değerlendirildi; bunların 212’si (%31,8) adjuvan aşı aldı, 454’ü (%68,2) almadı. İnsan papillomavirüs klirensi aşılanan grupta 6. ayda %60,8’e karşı %46,3, 12. ayda %78,3’e karşı %58,8 ve 24. ayda %87,7’ye karşı %77,8 olarak daha yüksekti. Yirmi dördüncü ayda persistan enfeksiyon aşılanan grupta daha düşüktü (%12,3’e karşı %22,2).CIN2+ nüksü aşılanan kadınların %3,8’inde, aşılanmayanların ise %11,9’unda görüldü. Adjuvan aşılama daha hızlı viral klirens ile bağımsız olarak ilişkiliydi (düzeltilmiş tehlike oranı: 2,0; %95 güven aralığı: 1,5-2,7; p<0,001). Eksizyonel tedavi sonrası uygulanan adjuvan 9-valan insan papillomavirüs aşısı, daha yüksek viral klirens ve daha düşük CIN2+ nüksü ile ilişkili bulundu.
Small bowel volvulus (SBV) is a rare but potentially life-threatening surgical emergency if not detected and treated on time. Primary or idiopathic SBV, occurring in the absence of any predisposing anatomical lesion, remains an uncommon clinical entity, especially in adults, accounting for a very small percentage of small bowel obstructions (SBOs) in non-volvulus-endemic regions and presenting a diagnostic challenge due to its nonspecific symptoms, lack of prior surgical history, or obvious risk factors. We report a case of a 30-year-old African man with 3 days of bowel obstruction symptoms, no prior surgical history, and clinical findings of agitation, fever, tachycardia, mild tachypnea, neutrophilia, leukocytosis, and severe hemoconcentration. Imaging revealed multiple air-fluid levels and a "sigma sign" without free air. Emergency laparotomy identified an ischemic small bowel forming a 40-cm closed loop, twisted clockwise by 360° along the mesentery, 92 cm from the ileo-cecal junction. Although idiopathic, primary SBV has been linked to dietary and cultural habits, such as the sudden consumption of large meals after fasting, and lifestyle factors, including heavy alcohol consumption and smoking, which may alter visceral motility. Given the limited literature on SBV in a virgin abdomen, adherence to available guidelines remains crucial. Idiopathic SBV in adults without prior surgery is rare and diagnostically challenging, often presenting with nonspecific symptoms. Clinical vigilance and prompt surgical intervention remain essential, as imaging should not delay treatment in critically ill patients. Systematic documentation of such cases is needed to better define risk factors and strategies for recurrence prevention. In the present case, timely surgery led to a favorable postoperative recovery.
Traumatic injuries to the fourth portion of the duodenum (D4) are exceptionally rare owing to its retroperitoneal location and protection by the ligament of Treitz. Their subtle clinical presentation and limited visibility on imaging frequently result in delayed diagnosis and increased morbidity. Complete transection of D4, associated with proximal jejunal injury after blunt abdominal trauma, is particularly uncommon and represents a diagnostic and therapeutic challenge. We report the case of a 40-year-old woman who sustained blunt abdominal trauma following a road traffic accident. She was hemodynamically stable, with mild epigastric tenderness and no external injury marks. A contrast-enhanced CT scan revealed moderate hemoperitoneum, a liver contusion, subtle supramesocolic pneumoperitoneum, mesenteric root infiltration, and an associated left renal artery dissection with renal devascularization. However, duodenal discontinuity was not clearly identified. Given the presence of indirect signs suggestive of hollow viscus injury, including mesenteric root infiltration and supramesocolic pneumoperitoneum, early surgical exploration was considered mandatory. Given the presence of indirect radiologic signs suggestive of intestinal injury, including mesenteric root infiltration and pneumoperitoneum, exploratory laparotomy was undertaken. Surgical exploration revealed a complete circumferential transection of the fourth portion of the duodenum, extending to the first jejunal loop. After debridement of devitalized tissue margins, a manual latero-terminal duodenojejunal anastomosis was performed with wide drainage. The postoperative course was favorable. D4 injuries account for less than 1% of duodenal trauma. Their retroperitoneal location often masks clinical signs, and CT sensitivity remains limited. According to the American Association for the Surgery of Trauma (AAST) classification, this lesion corresponds to a Grade III duodenal injury characterized by complete transection without pancreatic involvement. When pancreatic and ampullary structures are intact, primary duodenojejunal anastomosis represents a safe and effective reconstructive option. High clinical suspicion is required when imaging demonstrates mesenteric root infiltration or subtle pneumoperitoneum following blunt abdominal trauma. Early surgical exploration and prompt reconstruction are essential to achieve favorable outcomes.