Outcomes after Embolization in Pediatric Abdominal Solid Organ Injury: A Trauma Center Experience.

Background Trauma is a significant cause of morbidity and mortality worldwide among children. Nonoperative management is the standard of care in hemodynamically stable children with blunt abdominal solid organ injury. Embolization is a potential pathway, which has shown increasing evidence for benefit in adult trauma patients. However, the data in children is limited. Materials and Methods A retrospective analysis of hospital data of all children (<18 years of age), presenting to a tertiary-care trauma center in India, with history of blunt trauma from January 2021 to June 2023, was performed. Preprocedural imaging, angiographic and embolization details, number of blood transfusions, and length of hospital stay were assessed. Results Two hundred and sixteen children (average age: 11.65 years) presented with a history of abdominal trauma during the study period. Eighty four children were FAST positive, out of whom, 67 patients had abdominal solid organ injury on computed tomography. Liver was the most commonly injured solid organ ( n = 45), followed by the spleen and kidney. Ten children had solid abdominal organ arterial injuries for which eight children underwent embolization. The average length of hospital stay in embolization group ( n = 8) was 4 days, as compared to 11 days in children undergoing operative management ( n = 2). At 6 months follow-up, all children were asymptomatic. Conclusion Superselective embolization is a safe and feasible procedure in appropriately selected children with abdominal injury.

Unbiasing Enhanced Sampling on a High-Dimensional Free Energy Surface with a Deep Generative Model.

Biased enhanced sampling methods that utilize collective variables (CVs) are powerful tools for sampling conformational ensembles. Due to their large intrinsic dimensions, efficiently generating conformational ensembles for complex systems requires enhanced sampling on high-dimensional free energy surfaces. While temperature-accelerated molecular dynamics (TAMD) can trivially adopt many CVs in a simulation, unbiasing the simulation to generate unbiased conformational ensembles requires accurate modeling of a high-dimensional CV probability distribution, which is challenging for traditional density estimation techniques. Here we propose an unbiasing method based on the score-based diffusion model, a deep generative learning method that excels in density estimation across complex data landscapes. We demonstrate that this unbiasing approach, tested on multiple TAMD simulations, significantly outperforms traditional unbiasing methods and can generate accurate unbiased conformational ensembles. With the proposed approach, TAMD can adopt CVs that focus on improving sampling efficiency and the proposed unbiasing method enables accurate evaluation of ensemble averages of important chemical features.

Molecular van der Waals Fluids in Cavity Quantum Electrodynamics.

Intermolecular van der Waals interactions are central to chemical and physical phenomena ranging from biomolecule binding to soft-matter phase transitions. In this work, we demonstrate that strong light-matter coupling can be used to control the thermodynamic properties of many-molecule systems. Our analyses reveal orientation dependent single molecule energies and interaction energies for van der Waals molecules. For example, we find intermolecular interactions that depend on the distance between the molecules R as R-3 and R0. Moreover, we employ ab initio cavity quantum electrodynamics calculations to develop machine-learning-based interaction potentials for molecules inside optical cavities. By simulating systems ranging from 12 H2 to 144 H2 molecules, we observe varying degrees of orientational order because of cavity-modified interactions, and we explain how quantum nuclear effects, light-matter coupling strengths, number of cavity modes, molecular anisotropies, and system size all impact the extent of orientational order.

Chyluria: clearing the 'muddiness' with lipiodol lymphangiography.

Chyluria is a rare entity characterised by the presence of chyle/lymphatic fluid within the urine. It develops following an abnormal communication between the perirenal lymphatics and pelvicalyceal lymphatics. There are multiple causes of chyluria including infective (filariasis), post-traumatic, post-surgical, pregnancy and malignancy. We present a case of a 15-year-old male who presented with a complaint of the intermittent passage of milky urine for the preceding 1 year. Conventional lipiodol lymphangiography followed by cone beam computed tomography was done to look for abnormal fistulous channels. Subsequently, the patient was successfully treated with cystoscopy-guided renal pelvic instillation sclerotherapy of povidone-iodine.

Soft Functionally Gradient Materials and Structures - Natural and Manmade: A Review.

Functionally gradient materials (FGM) have gradual variations in their properties along one or more dimensions due to local compositional or structural distinctions by design. Traditionally, hard materials (e.g., metals, ceramics) are used to design and fabricate FGMs; however, there is increasing interest in polymer-based soft and compliant FGMs mainly because of their potential application in the human environment. Soft FGMs are ideally suitable to manage interfacial problems in dissimilar materials used in many emerging devices and systems for human interaction, such as soft robotics and electronic textiles and beyond. Soft systems are ubiquitous in everyday lives; they are resilient and can easily deform, absorb energy, and adapt to changing environments. Here, the basic design and functional principles of biological FGMs and their manmade counterparts are discussed using representative examples. The remarkable multifunctional properties of natural FGMs resulting from their sophisticated hierarchical structures, built from a relatively limited choice of materials, offer a rich source of new design paradigms and manufacturing strategies for manmade materials and systems for emerging technological needs. Finally, the challenges and potential pathways are highlighted to leverage soft materials' facile processability and unique properties toward functional FGMs.

Reweighted Manifold Learning of Collective Variables from Enhanced Sampling Simulations.

Enhanced sampling methods are indispensable in computational chemistry and physics, where atomistic simulations cannot exhaustively sample the high-dimensional configuration space of dynamical systems due to the sampling problem. A class of such enhanced sampling methods works by identifying a few slow degrees of freedom, termed collective variables (CVs), and enhancing the sampling along these CVs. Selecting CVs to analyze and drive the sampling is not trivial and often relies on chemical intuition. Despite routinely circumventing this issue using manifold learning to estimate CVs directly from standard simulations, such methods cannot provide mappings to a low-dimensional manifold from enhanced sampling simulations, as the geometry and density of the learned manifold are biased. Here, we address this crucial issue and provide a general reweighting framework based on anisotropic diffusion maps for manifold learning that takes into account that the learning data set is sampled from a biased probability distribution. We consider manifold learning methods based on constructing a Markov chain describing transition probabilities between high-dimensional samples. We show that our framework reverts the biasing effect, yielding CVs that correctly describe the equilibrium density. This advancement enables the construction of low-dimensional CVs using manifold learning directly from the data generated by enhanced sampling simulations. We call our framework reweighted manifold learning. We show that it can be used in many manifold learning techniques on data from both standard and enhanced sampling simulations.

Venolymphatic malformation of tongue: a prompt life saving intervention.

Venolymphatic malformations (VLMs) of the head and neck can have varied clinical presentation with associated complications. Timely diagnosis and treatment is warranted to curb the morbidity and obtain satisfactory outcomes. We present the case of a male patient in his early 20s with VLM of the tongue who received precise interventions which were executed with active contributions from a team of anaesthesiologists, interventional radiologists, oral and maxillofacial surgeons and intensivists. We highlight the importance of an immediate, comprehensive and multimodal treatment approach for VLMs of the maxillofacial region.

Emergency Uterine Bleeding: A Pictorial Essay of Imaging and Endovascular Management.

Abnormal uterine bleeding is a common presentation in the emergency department. A spectrum of uterine vascular abnormalities can lead to potentially fatal hemorrhage. Radiology plays a crucial role in the early diagnosis of the cause of bleeding with the role of an interventional radiologist being pivotal in the management of these cases. This article provides a pictorial review of angiographic appearance of various uterine vascular abnormality and their management by endovascular technique.

Bioinspired Bistable Dielectric Elastomer Actuators: Programmable Shapes and Application as Binary Valves.

Nature has plenty of imitable examples of bistable thin structures that can actuate in response to mechanical and environmental stimuli, such as touch, light, and moisture. Scientists and engineers have used these as models to develop real-world systems with enhanced shape stability, energy efficiency, and power output. The bistable leaf of the Venus Flytrap (VFT) has a uniquely simple structure that enables exquisite actuation to trap the prey instantly. In this study, we present a strategy, inspired and derived from the VFT, which incorporates dielectric elastomer (DE) layers in a bistable actuator capable of reversible snapping through electrical stimulation. The trilayered laminated actuator is composed of two prestrained layers and a strain-limiting middle layer. The balance between elastic energy and bending energy of the laminates results in bistable shapes. We explore a broad design space of the bistable architecture through analysis and experiments to validate the fabrication parameters. The rapid snap-through between the two stable configurations is activated by a voltage pulse applied on the DE layers that change the laminate's strain field. Whereas a high electric field is used as the actuation trigger, the self-stabilization characteristic of the bistable structure obviates the need for continuous voltage supply. Finally, we recommended a new method of flow control by modulating porosity on curved surfaces through operating bistable dielectric elastomer actuators as binary valves.

Cascade of Complications Following Carotid Body Tumor Excision.

Carotid body tumor excision can lead to various complications including vascular injury and pseudoaneurysm formation. Here we describe a case of carotid body tumor excision followed by series of complications including pseudoaneurysm formation, failure of primary surgical repair, carotid stump syndrome following parent artery occlusion, and persistent hypotension.

Thermoelectric Materials for Textile Applications.

Since prehistoric times, textiles have served an important role-providing necessary protection and comfort. Recently, the rise of electronic textiles (e-textiles) as part of the larger efforts to develop smart textiles, has paved the way for enhancing textile functionalities including sensing, energy harvesting, and active heating and cooling. Recent attention has focused on the integration of thermoelectric (TE) functionalities into textiles-making fabrics capable of either converting body heating into electricity (Seebeck effect) or conversely using electricity to provide next-to-skin heating/cooling (Peltier effect). Various TE materials have been explored, classified broadly into (i) inorganic, (ii) organic, and (iii) hybrid organic-inorganic. TE figure-of-merit (ZT) is commonly used to correlate Seebeck coefficient, electrical and thermal conductivity. For textiles, it is important to think of appropriate materials not just in terms of ZT, but also whether they are flexible, conformable, and easily processable. Commercial TEs usually compromise rigid, sometimes toxic, inorganic materials such as bismuth and lead. For textiles, organic and hybrid TE materials are more appropriate. Carbon-based TE materials have been especially attractive since graphene and carbon nanotubes have excellent transport properties with easy modifications to create TE materials with high ZT and textile compatibility. This review focuses on flexible TE materials and their integration into textiles.

Mn Dimer Can Be Described Accurately with Density Functional Calculations When Self-Interaction Correction Is Applied.

Qualitatively incorrect results are obtained for the Mn dimer in density functional theory calculations using the generalized gradient approximation (GGA), and similar results are obtained from local density and meta-GGA functionals. The coupling is predicted to be ferromagnetic rather than antiferromagnetic, and the bond between the atoms is predicted to be an order of magnitude too strong and approximately an Ångstrøm too short. Explicit, self-interaction correction (SIC) applied to a commonly used GGA energy functional, however, provides close agreement with both experimental data and high-level, multireference wave function calculations. These results show that the failure is not due to a strong correlation but rather the single electron self-interaction that is necessarily introduced in estimates of the classical Coulomb and exchange-correlation energy when only the total electron density is used as the input. The corrected functional depends explicitly on the orbital densities and can, therefore, avoid the introduction of a self-Coulomb interaction. The error arises because of an overstabilization of bonding d-states in the minority spin channel resulting from an overestimate of the d-electron self-interaction in the semilocal exchange-correlation functionals. Since the computational effort in the SIC calculations scales with the system size in the same way as for regular semilocal functional calculations, this approach provides a way to calculate properties of Mn nanoclusters as well as biomolecules and extended solids, where Mn dimers and larger cluster are present, while multireference wave function calculations can only be applied to small systems.

Textile-based Pressure Sensors for Monitoring Prosthetic-Socket Interfaces.

Amputees are prone to experiencing discomfort when wearing their prosthetic devices. As the amputee population grows this becomes a more prevalent and pressing concern. There is a need for new prosthetic technologies to construct more comfortable and well-fitted liners and sockets. One of the well-recognized impediments to the development of new prosthetic technology is the lack of practical inner socket sensors to monitor the inner socket environment (ISE), or the region between the residual limb and the socket. Here we present a capacitive pressure sensor fabricated through a simple, and scalable sewing process using commercially available conductive yarns and textile materials. This fully-textile sensor provides a soft, flexible, and comfortable sensing system for monitoring the ISE. We provide details of our low-power sensor system capable of high-speed data collection from up to four sensor arrays. Additionally, we demonstrate two custom set-ups to test and validate the textile-based sensors in a simulated prosthetic environment. Finally, we utilize the textile-based sensors to study the ISE of a bilateral transtibial amputee. Results indicate that the textile-based sensors provide a promising potential for seamlessly monitoring the ISE.

Extracranial carotid artery pseudoaneurysm due to Mycobacterium tuberculosis.

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.

CDK12 inhibition reduces abnormalities in cells from patients with myotonic dystrophy and in a mouse model.

Myotonic dystrophy type 1 (DM1) is an RNA-based disease with no current treatment. It is caused by a transcribed CTG repeat expansion within the 3' untranslated region of the dystrophia myotonica protein kinase (DMPK) gene. Mutant repeat expansion transcripts remain in the nuclei of patients' cells, forming distinct microscopically detectable foci that contribute substantially to the pathophysiology of the condition. Here, we report small-molecule inhibitors that remove nuclear foci and have beneficial effects in the HSALR mouse model, reducing transgene expression, leading to improvements in myotonia, splicing, and centralized nuclei. Using chemoproteomics in combination with cell-based assays, we identify cyclin-dependent kinase 12 (CDK12) as a druggable target for this condition. CDK12 is a protein elevated in DM1 cell lines and patient muscle biopsies, and our results showed that its inhibition led to reduced expression of repeat expansion RNA. Some of the inhibitors identified in this study are currently the subject of clinical trials for other indications and provide valuable starting points for a drug development program in DM1.

3D Printing of Textiles: Potential Roadmap to Printing with Fibers.

3D printing (3DP) has transformed engineering, manufacturing, and the use of advanced materials due to its ability to produce objects from a variety of materials, ranging from soft polymers to rigid ceramics. 3DP offers the advantage of being able to print at a variety of lengths scales; from a few micrometers to many meters. 3DP has the unique ability to produce customized small lots, efficiently. Yet, one crucial industry that has not been able to adequately explore its potential is textile manufacturing. The research in 3DP of textiles has lagged behind other areas primarily due to the difficulty in obtaining some of the unique characteristics of strength, flexibility, etc., of textiles, utilizing a fundamentally different manufacturing technology. Textiles are their own class of materials due to the specific structural developments that occur during the various stages of textile manufacturing: from fiber extrusion to assembly of the fibers to fabrics. Here, the current 3DP technologies are reviewed with emphasis on soft and anisotropic structures, as well as the efforts toward 3DP of textiles. Finally, a potential pathway to 3DP of textiles, dubbed as printing with fibers to create textile structures is proposed for further exploration.

HDAC4 and 5 repression of TBX5 is relieved by protein kinase D1.

TBX5 is a T-box family transcription factor that regulates heart and forelimb development in vertebrates and functional deficiencies in this protein result in Holt-Oram syndrome. Recently, we have shown that acetylation of TBX5 potentiates its activity and is important for heart and limb development. Here we report that class II histone deacetylases HDAC4 and HDAC5 associate with TBX5 and repress its role in cardiac gene transcription. Both HDAC4 and HDAC5 deacetylate TBX5, which promotes its relocation to the cytoplasm and HDAC4 antagonizes the physical association and functional cooperation between TBX5 and MEF2C. We also show that protein kinase D1 (PRKD1) relieves the HDAC4/5-mediated repression of TBX5. Thus, this study reveals a novel interaction of HDAC4/5 and PRKD1 in the regulation of TBX5 transcriptional activity.

Characterization and Adsorption Behavior of Strontium from Aqueous Solutions onto Chitosan-Fuller's Earth Beads.

Fuller's earth spherical beads using chitosan as a binder were prepared for the removal of strontium ions from aqueous solution. The adsorbents were characterized by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), which revealed the porous nature of the beads. The Brunauer⁻Emmett⁻Teller (BET) surface area of the beads was found to be 48.5 m²/g. The adsorption capacities of the beads were evaluated under both batch and dynamic conditions. The adsorption capacity was found to be ~29 mg/g of adsorbent at 298 K when the equilibrium concentration of strontium in the solution was 925 mg/L at pH 6.5. The X-ray photoelectron spectroscopy (XPS) data suggest that strontium uptake by the beads occurs mainly through an ion-exchange process. Kinetic data indicate that the sorption of strontium onto the beads follows anomalous diffusion. Thermodynamic data suggest that the ion-exchange of Sr2+ on the bead surface was feasible, spontaneous and endothermic in nature.

Adsorption of Zn(II) ions by chitosan coated diatomaceous earth.

In this work, chitosan coated diatomaceous earth (CCDE) beads were synthesized by a drop-wise method and characterized by FTIR, BET, SEM, EDS, and zeta potential for Zn(II) ion removal from aqueous solution in batch and continuous processes. Several parameters have been studied such as solution-pH, initial Zn(II) ion concentration, temperature, flow rate, and contact time to investigate the Zn(II) ion uptake. The maximum adsorption capacity of Zn(II) ion onto CCDE beads was 127.4mg/g in batch studies. The adsorption followed Pseudo second order and was well fitted to Langmuir model, indicating monolayer adsorption behavior. The continuous adsorption studies showed decreasing breakthrough and exhausted time with increasing flow rate of solution. The breakthrough points were 220 and 115min at flow rate 3 and 6mL/min, respectively. Loaded CCDE beads with Zn(II) ions were successfully regenerated by 0.2M NaOH without damaging the adsorbents and up to 87% recovery in the fourth cycle. Anions in the solution had an insignificant effect on Zn(II) ion uptake by CCDE beads. Overall results suggested that the prepared adsorbents could be employed as a low-cost, sustainable, and excellent alternative material for Zn(II) ion removal from wastewater.

Acetylation of TBX5 by KAT2B and KAT2A regulates heart and limb development.

TBX5 plays a critical role in heart and forelimb development. Mutations in TBX5 cause Holt-Oram syndrome, an autosomal dominant condition that affects the formation of the heart and upper-limb. Several studies have provided significant insight into the role of TBX5 in cardiogenesis; however, how TBX5 activity is regulated by other factors is still unknown. Here we report that histone acetyltransferases KAT2A and KAT2B associate with TBX5 and acetylate it at Lys339. Acetylation potentiates its transcriptional activity and is required for nuclear retention. Morpholino-mediated knockdown of kat2a and kat2b transcripts in zebrafish severely perturb heart and limb development, mirroring the tbx5a knockdown phenotype. The phenotypes found in MO-injected embryos were also observed when we introduced mutations in the kat2a or kat2b genes using the CRISPR-Cas system. These studies highlight the importance of KAT2A and KAT2B modulation of TBX5 and their impact on heart and limb development.