Curved-Crease Origami for Morphing Metamaterials.

We find a closed-form expression for the Poisson's coefficient of curved-crease variants of the "Miura ori" origami tessellation. This is done by explicitly constructing a continuous one-parameter family of isometric piecewise-smooth surfaces that describes the action of folding out of a reference state. The response of the tessellations in bending is investigated as well: using a numerical convergence scheme, the effective normal curvatures under infinitesimal bending are found to occur in a ratio equal and opposite to the Poisson's coefficient. These results are the first of their kind and, by their simplicity, should provide a fruitful benchmark for the design and modeling of curved-crease origami and compliant shell mechanisms. The developed methods are used to design a curved-crease 3D morphing solid with a tunable self-locked state.

Kinetic and statistical perspectives on the interactive effects of recalcitrant polyaromatic and sulfur heterocyclic compounds and in-vitro nanobioremediation of oily marine sediment at microcosm level.

A halotolerant biosurfactant producer Pseudomonas aeruginosa strain NSH3 (NCBI Gene Bank Accession No. MN149622) was isolated to degrade high concentrations of recalcitrant polyaromatic hydrocarbons (PAHs) and polyaromatic heterocyclic sulfur compounds (PASHs). In biphasic batch bioreactors, the biodegradation and biosurfactant-production activities of NSH3 have been significantly enhanced (p < 0.0001) by its decoration with eco-friendly prepared magnetite nanoparticles (MNPs). On an artificially contaminated sediment microcosm level, regression modeling and statistical analysis based on a 23 full factorial design of experiments were trendily applied to provide insights into the interactive impacts of such pollutants. MNPs-coated NSH3 were also innovatively applied for nanobioremediation (NBR) of in-vitro diesel oil-polluted sediment microcosms. Gravimetric, chromatographic, and microbial respiratory analyses proved the significantly enhanced biodegradation capabilities of MNPs-coated NSH3 (p < 0.001) and the complete mineralization of various recalcitrant diesel oil components. Kinetic analyses showed that the biodegradation of iso- and n-alkanes was best fitted with a second-order kinetic model equation. Nevertheless, PAHs and PASHs in biphasic batch bioreactors and sediment microcosms followed the first-order kinetic model equation. Sustainable NBR overcome the toxicity of low molecular weight hydrocarbons, mass transfer limitation, and steric hindrance of hydrophobic recalcitrant high molecular weight hydrocarbons and alkylated polyaromatic compounds.

Physical Observation of a Robust Acoustic Pumping in Waveguides with Dynamic Boundary.

Research on breaking time-reversal symmetry to realize one-way wave propagation is a growing area in photonic and phononic crystals and metamaterials. In this Letter, we present physical realization of an acoustic waveguide with spatiotemporally modulated boundary conditions to realize nonreciprocal transport and acoustic topological pumping. The modulated waveguide inspired by a water wheel consists of a helical tube rotating around a slotted tube at a controllable speed. The rotation of the helical tube creates moving boundary conditions for the exposed waveguide sections at a constant speed. We experimentally demonstrate acoustic nonreciprocity and topologically robust bulk-edge correspondences for this system, which is in good agreement with analytical and numerical predictions. The nonreciprocal waveguide is a one-dimensional analog to the two-dimensional quantum Hall effect for acoustic circulators and is characterized by a robust integer-valued Chern number. These findings provide insight into practical implications of topological modes in acoustics and the implementation of higher-dimensional topological acoustics where time serves as a synthetic dimension.

Pancreaticoduodenectomy in the Middle East: Achieving optimal results through specialization and standardization.

BACKGROUND: Pancreaticoduodenectomy is a challenging surgical intervention that remains the cornerstone in the treatment of localized peri­ampullary pathologies. The concept of treatment standardization has been well-established in many high-volume centers in the world. Here, we present our experience in pancreaticoduodenectomy from 1994 to 2015. METHODS: We performed a retrospective review of the medical charts of patients who underwent pancreaticoduodenectomy at our institution. Data was entered to SPSS statistical software and analyzed. The Mann-Whitney U and Fisher's exact tests were used to report statistical differences between groups. RESULTS: Of the 370 patients who underwent pacreaticoduodenectomy, 300 were analyzed. The 1-, 3-, 5- and 10-year survival rates were 85%, 35%, 15%, and 7%, respectively with a 30-day mortality rate of 5.0% (15 patients). The median age of the patients was 61 (13-84) years, with 193 (64.3%) males and 107 (35.7%) females. The median operative time was 300 (130-570) min. The median postoperative length of hospital stay was 12 (5-76) days. Thirty-two patients required re-laparotomies; 10 for pancreatic leak, 7 for biliary leak and 15 for control of bleeding. Seventy-five (25.0%) patients developed pancreatic fistulae. Delayed gastric emptying was present in 31 (10.3%) patients. A significant improvement in surgical outcome was observed in cases done after 2008 which indicates the important role of specialized team in surgical management. CONCLUSIONS: The number of patients undergoing pancreaticoduodenectomy has been increasing annually over the past twenty-two years in our institution with results comparable to published series from high-volume centers. Through standardization of surgical techniques and perioperative management carried out by a specialist team, our results continue to improve despite the increasing complexity of cases referred to our unit.

Observation of Nonreciprocal Wave Propagation in a Dynamic Phononic Lattice.

Acoustic waves in a linear time-invariant medium are generally reciprocal; however, reciprocity can break down in a time-variant system. In this Letter, we report on an experimental demonstration of nonreciprocity in a dynamic one-dimensional phononic crystal, where the local elastic properties are dependent on time. The system consists of an array of repelling magnets, and the on-site elastic potentials of the constitutive elements are modulated by an array of electromagnets. The modulation in time breaks time-reversal symmetry and opens a directional band gap in the dispersion relation. As shown by experimental and numerical results, nonreciprocal mechanical systems like the one presented here offer opportunities to create phononic diodes that can serve for rectification applications.

Life Threatening Complications Post-Liposuction.

BACKGROUND: Liposuction is one of the most commonly performed aesthetic procedures. It is performed worldwide as an outpatient procedure. However, the complications are underestimated and underreported by caregivers. We present a case of delayed diagnosis of bilothorax secondary to liver and gallbladder injury after tumescent liposuction. METHODS: A 26-year-old female patient was transferred to our emergency department from an aesthetic clinic with worsening dyspnea, tachypnea and fatigue. She had undergone extensive liposuction of the thighs, buttocks, back and abdomen 5 days prior to presentation. RESULTS: A chest X-ray showed significant right-sided pleural effusion. Thoracentesis was performed and drained bilious fluid. CT scan of the abdomen revealed pleural, liver and gall bladder injury. An exploratory laparoscopy confirmed the findings, the collections were drained; cholecystectomy and intraoperative cholangiogram were performed. The patient did very well postoperatively and was discharged home in 2 days. CONCLUSION: Even though liposuction is considered a simple office-based procedure, its complications can be fatal. The lack of strict laws that exclusively place this procedure in the hands of medical professionals allow these procedures to still be done by less experienced hands and in outpatient-based settings. Our case serves to highlight yet another unique but potentially fatal complication of liposuction. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Roux-en-Y Gastric Bypass Versus One Anastomosis Gastric Bypass as Revisional Surgery After Failed Sleeve Gastrectomy: A Systematic Review and Meta-analysis.

Purpose: This study aimed to assess the outcomes of revisional procedures, namely Roux-en-Y gastric bypass (RYGB) and one anastomosis gastric bypass (OAGB) following unsuccessful laparoscopic sleeve gastrectomy. Materials and Methods: This systematic review and meta-analysis included 817 patients (404 in OAGB group, 413 in RYGB group) from seven retrospective comparative studies. Data on sample size, demographics, perioperative complications, operative time, pre- and post-revisional body mass index, total weight loss, and global weight loss over follow-up were extracted. Results: The mean operative time was 98.2-201 minutes for RYGB versus 78.7-168 minutes for OAGB. Despite classical RYGB gastric bypass taking longer, mini gastric bypass resulted in greater weight loss than RYGB, with a mean difference of -5.84 (95% confidence interval [CI], -6.74 to -4.94; P<0.00001; I2=0%), greater total weight loss, and a higher diabetes remission rate (odds ratio [OR], 0.32; 95% CI, 0.14 to 0.71). However, OAGB was associated with a significantly higher incidence of postoperative gastroesophageal reflux than RYGB (52 vs. 31: OR, 0.40; 95% CI, 0.24 to 0.67; P=0.0005; I2=0%). Conclusion: OAGB was performed more quickly and boasted greater total weight loss and higher diabetes remission rates compared to RYGB after failed sleeve gastrectomy. However, OAGB also demonstrated a higher incidence of postoperative gastroesophageal reflux disease. Thus, careful patient selection is essential when considering OAGB. Trial Registration: PROSPERO Identifier: CRD42023474966.

Hydatid cyst: Introducing a new surgical approach towards hepato-pulmonary fistula, a case report.

INTRODUCTION AND IMPORTANCE: Hydatid disease, caused by the zoonotic parasite Echinococcus granulosus, presents as cysts most commonly in the liver and the lungs. A hepato-pleural fistula is considered one of its complications and surgery remains the mainstay of treatment. A simultaneous invasive thoracic and abdominal access is routinely needed which is accompanied by increased morbidity and mortality. CASE PRESENTATION: In this case report, we present an innovative, less invasive, non-classical approach. CLINICAL DISCUSSION: We introduce a successful transabdominal transdiaphragmatic laparoscopic technique for the management of a hepato-pulmonary fistula secondary to hydatid disease of the liver. CONCLUSION: Compared to the classical method, this new surgical approach towards hepato-pulmonary fistula paves the way for minimally invasive surgeries to manage complicated hydatid disease with a lower mortality and morbidity, faster recovery and shorter hospital stay. The work has been reported in line with the SCARE 2020 criteria.

Sustainable ecofriendly recruitment of bioethanol fermentation lignocellulosic spent waste biomass for the safe reuse and discharge of petroleum production produced water via biosorption and solid biofuel production.

Sustainable lignocellulosic spent waste rice straw (SWRS) from bioethanol production inventively applied in this study to valorize petroleum production produced water (PPPW). SWRS expressed efficient pollutant removal over a wide range of petroleum concentration, temperature, pH, salinity, and mixing rate reaching approximately 217 mg/g, within four hours contact time. Kinetic studies revealed a pseudo-second-order chemisorption process with a boundary layer control and 16.97 kJ/mol activation energy where the intra-particle diffusion was not the only rate regulatory step. Thermodynamic studies revealed spontaneous, favorable, and endothermic adsorption, with a strong affinity between the SWRS and oil molecules. Biosorption mechanism studies proved the enrollment of SWRS components' lignin, cellulose, and hemicellulose in the oil uptake with the predominance of chemisorption over physisorption onto the rough and highly porous SWRS surface. A single-stage batch biosorption process was designed based on the best fitted Langmuir adsorption isotherm and applied on a real PPPW sample. The Egyptian standard limits for safe industrial effluents discharge into marine environment with a concomitant decrease in scale formation precursors were achieved recommending its safe reuse for enhanced oil recovery. Finally, for accomplishing zero-waste, SWRS disposed of PPPW treatment substantiated valorized solid biofuel with a sufficient calorific value 38.56 MJ/kg.

Primary squamous cell carcinoma of the colon: A rare case report.

INTRODUCTION AND IMPORTANCE: Squamous cell carcinoma (SCC) of the colon is an extremely rare pathologic entity, accounting for less than 1 % of all colorectal cancer cases. They tend to be very aggressive with poor outcomes and treatment strategies are still controversial due to the paucity of data available to guide management. CASE PRESENTATION: A case of a cecal mass with metastatic liver lesions. Initially diagnosed as an adenocarcinoma, the patient underwent resection with metastasectomy. Despite achieving negative surgical margins and undergoing adjuvant chemotherapy, the patient relapsed and presented with a new mass in the descending colon. The patient underwent resection with subsequent follow-up revealing distant metastasis. The patient passed away soon after. CLINICAL DISCUSSION: Primary colorectal SCC has similar presentation to adenocarcinoma of the colon. Unfortunately, it usually presents at a late stage. Diagnosis of colorectal SCC requires histologic confirmation of SCC plus exclusion of possible causes. Management is predominantly definitive radical resection followed by adjuvant chemotherapy and radiotherapy. Surgical margins should be at least 5 cm, preferably 10 cm. Lymph node yield greater than 20 was associated with improved survival. Studies assessing the prognosis of primary colorectal SCC following chemo-radiotherapy have not been done. CONCLUSION: Surgery remains the most vital important step in the management of colonic SCC. The role of chemotherapy and/or radiation remains questionable. Depending on the aggressiveness of this disease the need for further frequent.

Hydatid Disease of the Liver in the Middle East: A Single Center Experience.

Background: Human cystic echinococcosis (CE), most commonly caused by echinococcosis granulosis, is the most common presentation of hydatid disease of the liver and is considered endemic in the Middle East region. Patients and Methods: This study is a retrospective single-center analysis of all patients with hepatic hydatid disease presenting for surgical management from 2001 to 2019. Results: From 2001 to 2019, 100 patients (54 males, 46 females) were diagnosed with hydatid disease of the liver with a mean age of 45 years (range, 19-82). The most common presenting symptom was right upper quadrant abdominal pain followed by incidental finding of cyst on imaging. Thirteen patients (13%) presented with signs and symptoms of obstructive jaundice. Of the 100 patients, 39 underwent laparoscopic surgery and 61 underwent open surgery. The most common complications were as follows: 16 bile leaks (16%), 14 intra-abdominal fluid collections (14%), 8 wound infections (8%), and 3 patients had biliary strictures (3%). Of the 100, 8 patients(8%) had recurrence of their hepatic hydatid disease. Conclusions: Hydatid disease of the liver is not a common disease, and its management can include medical, surgical, and interventional radiology. The decision depends on the size and complexity of the cyst and its location. Bile leak is a common complication and should be managed conservatively or through intervention by radiology or endoscopic retrograde cholangiopancreatography (ERCP).

The implications and management of complex biliary injuries at a tertiary hepatobiliary specialty center.

Injuries of the biliary tract and complex injuries involving vascular and parenchymal tissue can be detrimental despite the improved use of laparoscopy. Complex biliary injuries are variable depending on the type of injury as well as patient and surgeon factors. We present four cases of complex biliary injuries at our tertiary referral center with hepatobiliary expertise: biliary stenosis with obstruction, double duct system anatomy, combined right hepatic arterial transection and biliary duct injury, and a complete pedicle injury. Early identification and specialized repair of complex biliary injuries is essential to minimize patient morbidity. Notably, consulting a specialist intraoperatively in case of difficult dissection and visualization or a suspected injury and considering bail-out strategies such as a subtotal cholecystectomy or conversion are safe approaches to minimize complex biliary injuries. Earlier recognition and repair of complex biliary injuries improves outcomes when immediate intraoperative repair can be performed rather than delayed postoperatively.

Biosynthesized magnetite nanoparticles as an environmental opulence and sustainable wastewater treatment.

This review emphasizes the win-win one-pot valorization process of different waste biomass that composed of many biological macromolecules (e.g. polysaccharides, polyphenols, carbohydrates, lipids, enzymes, proteins, etc.) and other biomolecules (e.g. alkaloids, terpenoids, tannins, phenolics, carotenoids, amino acids, sugars, vitamins, etc.) into biofunctionalized magnetite (Fe3O4) nanoparticles (BMNPs). It illustrates the sustainable recruitment of microbial intra- and extra-cellular metabolites, proteins, and/or enzymes in the biosynthesis of BMNPs. It elucidates the environmental affluence of such sustainable, cost-effective, and ecofriendly BMNPs as an antimicrobial agent for water disinfection, photo-degrader, and adsorbent for different xenobiotics, organic and inorganic water pollutants. It confers the future environmental aspects of BMNPs in biofuels production from lipids and lignocellulosic wastes, biosensors manufacturing and bio-upgrading of petroleum fractions, etc. It discusses the circular economy, challenges, and opportunities for scaling up the zero-waste green synthesis of MNPs. Nevertheless, imminent investigations are still needed to elucidate the exact rule of biological macro- and micro- molecules in BMNPs synthesis and mechanisms involved in its microbicidal and photodegradation activities. Accentuated researches are more required on the toxicity and/or biosafety of the green synthesized BMNPs to humans and other non-target organisms to ensure its eco-safety upon environmental applications.

Incidental appendiceal mass as the only manifestation of endometriosis.

Appendiceal endometriosis is a rare condition that remains difficult to diagnose preoperatively. Herein, we present a case of appendiceal endometriosis presenting as a neuroendocrine tumor. A 34-year-old Caucasian woman was found to have an appendiceal mass with a small fluid collection on routine transvaginal ultrasound. The patient denied any symptoms. Features were consistent with those of a neuroendocrine tumour of the appendix. Laparoscopic appendectomy followed by histopathology revealed endometriosis with negative cytology for malignant cells. Preoperative characteristics of appendiceal tumours in women of childbearing age should be further investigated. Establishing clinical and surgical guidelines is the key to avoid invasive procedures and related adverse outcomes.

Photocatalytic and biocidal activities of ZnTiO2 oxynitride heterojunction with MOF-5 and g-C3N4: A case study for textile wastewater treatment under direct sunlight.

The work aimed to synthesize three heterojunction photocatalysts (Eg = 2.65-2.78 eV) via in-situ encapsulation of 5% zinc doped titanium oxynitride (Zn0.05TiOxNy) catalyst into MOF-5 and bulk (BCN)/sulfur-doped (SCN) g-C3N4 supports using a microwave method. The prepared photocatalysts were characterized and utilized to purify textile industrial wastewater from the organic dye (e.g., methylene blue, MB) and microbial (e.g., E. coli, S. aureus, and C. albicans) contaminants under dark, visible, and solar lights. The output data confirmed the higher activity of Zn0.05TiOxNy@SCN and Zn0.05TiOxNy@MOF-5 for photo-induced microbial growth inactivation (> 90%) under visible light, with photo-biocidal efficiency of 0.91-1.69 mCFU/Einstein. Such a phenomenon is ascribed to the synergism between the high antimicrobial capacity of supports and photoactivity of Zn0.05TiOxNy. Also, Zn0.05TiOxNy@SCN exhibited far superiority to mineralize MB dye (Kphoto of 2.73 × 10-2 min-1) under direct sunlight due to its high photonic (ζ% of 4.4-8.3%)/quantum (QE of 0.56-0.54%) efficiencies for the generation of hydroxyl and superoxide (-•O2/•OH) oxidative species. As a practical case study, all heterojunction photocatalysts also demonstrated high-performance stability (5 cycles) for real textile wastewater treatment under sunlight (efficiency = 76.1-84.6%).

Biodesulfurization of refractory sulfur compounds in petro-diesel by a novel hydrocarbon tolerable strain Paenibacillus glucanolyticus HN4.

One of the main precursors of air pollution and acid rains is the presence of the recalcitrant thiophenic compounds, for example dibenzothiophene (DBT) and its derivatives in transportation fuels. In an attempt to achieve the worldwide regulations of ultra-low sulfur transportation fuels without affecting its hydrocarbon skeleton, a biphasic medium containing 100 mg/L DBT dissolved in n-hexadecane (1/4 oil/water v/v) used for enrichment and isolation of selective biodesulfurizing bacterium from an oil-polluted sediment sample collected from Egyptian Red Sea shoreline. The isolated bacterium is facultative anaerobe, motile, spore-former, and mesophile. It is genetically identified as Paenibacillus glucanolyticus strain HN4 (NCBI Gene Bank Accession No. MT645230). HN4 desulfurized DBT as a model of the recalcitrant thiophenic compounds without affecting its hydrocarbon skeleton via the 4S-pathway producing 2-hydroxybiphenyl (2-HBP) as a dead end product. HN4 substantiated to be a hydrocarbon tolerant, biosurfactants(s) producer, and endorsed unique enzymatic system capable of desulfurizing broad range of thiophenic compounds and expressed an efficient desulfurization activity against the recalcitrant alkylated DBTs. As far our knowledge, it is the first reported BDS study using P. glucanolyticus. Statistical optimization based on One-Factor-At-A-Time (OFAT) technique and response surface methodology (RSM) applied for elucidation of mathematical model correlations describing and optimizing the effect of different physicochemical parameters on batch biphasic BDS process. That illustrated an approximate increase in BDS efficiency by 1.34 fold and recorded 94% sulfur removal in biphasic batch process at optimum operation conditions of 120 h, 0.14 wt% S-content model oil (DBT dissolved in n-hexadecane), 33.5 °C, pH7 and 1/1 oil/water phase ratio, and 147 rpm. Resting cells of HN4 in a biphasic reactor (1/1 v/v) decreased the sulfur content of a refractory thiophenic model oil (thiophene, benzothiophene, DBT, and alkylated DBT dissolved in n-hexadecane) from 0.14 to 0.027 wt%, and petro-diesel from 0.2 to 0.04 wt%, within 120 h, keeping the calorific value of the treated fuel intact. Consequently, that novel strain could be recommended as a promising candidate for BDS as complementary to hydrodesulfurization process in oil refinery.

Long-term results of endovenous laser ablation of saphenous vein reflux: Up to nine years of follow-up.

INTRODUCTION: Endovenous laser ablation (EVLA) has become the gold standard for the treatment of saphenous vein reflux. We report the long-term clinical and ultrasound results of EVLA. METHODS: This study is a retrospective review of patients who underwent EVLA of saphenous vein over four years. Clinical results were assessed using venous clinical severity score (VCSS), and ultrasound results were classified according to Bush classification. RESULTS: Over a median follow-up time of 4.4 years, 168 EVLA-treated patients showed a drop in VCSS from 4.38 to 1.39. Ultrasound results of 140 treated great saphenous veins showed that 64% had one or more cause of recurrence. The presence of neovascularization correlated well with the lack of improvement of VCSS. CONCLUSION: EVLA resulted in drop in VCSS from 4.38 to 1.39. Among 140 treated great saphenous veins, reflux in the anterior accessory saphenous vein was the primary cause (23.5%) of recurrence.

Perioperative Management of Pancreaticoduodenectomy: Avoiding Admission to the Intensive Care Unit.

INTRODUCTION: With the advancement in surgical expertise at high-volume centers and advances in perioperative management, pancreaticoduodenectomy is becoming safer and remains the gold standard for treating periampullary pathologies. We describe our experience in optimizing perioperative management in order to avoid admission to the intensive care unit and improve outcomes. METHOD: Retrospective data were collected on 370 surgical patients who underwent a pancreaticoduodenectomy between the years 1994 and 2016. RESULTS: Of the 370 patients, 200 operated between 2009 and 2016 did not require intensive care admission, blood transfusion, or central line insertion. The results were compared between different time intervals: before the year 1998, between the years 1998 and 2008, and between the years 2009 and 2016. The median blood loss dropped from 800 to 400 to 300 mL, respectively. The median operative time also dropped from 360 to 335 to 215 min, respectively. In addition, the median length of hospital stay decreased from 25 to 16 to 7 days, respectively. CONCLUSION: With the centralization of pancreaticoduodenectomy in high-volume centers and with specialized surgeons performing the surgery, there is a significant decrease in the onset of postoperative complications with a lesser need for blood transfusions and, subsequently, better recovery of patients without the need for intensive care unit admission.

Erratum: Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean?

[This corrects the article DOI: 10.1093/jscr/rjy135.][This corrects the article DOI: 10.1093/jscr/rjy135.].

Triple thrombophilic simultaneous mutations in patients after bariatric surgery: is there a role for screening in the Eastern Mediterranean?

BACKGROUND AND PURPOSE: Thrombophilia is a hypercoagulable state that predisposes to thrombosis. Several genetic risk factors have been shown to predispose to thromboembolic events. Homozygosity to a thrombophilic mutation certainly predisposes the affected patient to more serious symptoms. MATERIALS AND METHODS: Here we present a case of a 56-year-old male patient who underwent sleeve gastrectomy for morbid obesity, presenting to our institution with abdominal pain. Investigations revealed thrombosis of the splenic, axillary vein as well as the right pulmonary artery. The patient was found to have triple thrombophilic mutations. RESULTS: To our knowledge, this is the first reported case of three specific simultaneous thrombophilic mutations in a patient from the Eastern Middle East. CONCLUSION: We suggest a role for screening for thrombophilic mutations in the Eastern Mediterranean patients undergoing bariatric surgeries for morbid obesity due to the increased risk of thrombosis in this group of patients.