bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical Investigation of Effects of Ripple Type Needle Erosion on Pressure Inside a Pelton Nozzle
Authors: Satyal Sajan , Abregu Jim , Bhattarai Bikram Singh , Nascimben Francesco , Chitrakar Sailesh , Neopane Hari Prasad , Gunnar Dahlhaug Ole
Published: August 2024

Pelton turbines, a commonly used impulse turbine for hydroelectric generation which converts the potential energy of the water into kinetic energy through a needle structure within the nozzle system. However, the exposure of the Pelton turbine components such as needle, seat ring, buckets to the sediment laden water can erode these components. The erosion on the needle can also lead to the efficiency degradation. This study aims to investigate the effect of needle erosion on the pressure dynamics within the Pelton nozzle system. For the study purpose, the nozzle system from Pelton rig at the Waterpower Laboratory, NTNU is used and a general erosion pattern is developed through literature and field information. The research focuses on analysing the difference in pressure distribution between the normal and eroded needles under different opening conditions, with the objective of understanding how erosion affects the nozzle performance. Single-phase 3-D simulations are performed with an unstructured ANSYS mesh and the CFX solver. This study examines the static pressure at the inner surface of the nozzle casing wall. The results show that for a constant head at the inlet boundary condition, the static pressure with eroded needles was significantly lower than that with normal needles. The pressure difference was around 1.88 kPa for a 60% nozzle opening and around 3.57 kPa for a 40% nozzle opening. The reduction in pressure is due to the increased area in the needle orifice and nozzle outlet caused by erosion, which is more pronounced at lower openings.

The findings reveal a direct correlation between needle erosion and alterations in pressure distribution, highlighting the necessity for vigilant monitoring and timely maintenance. The study provides valuable insights into optimizing turbine performance in sediment-laden water conditions and underscores the importance of addressing needle erosion to maintain efficiency.
Evaluation of the jet distortion by sediment erosion in the needle in the Pelton turbines
Authors: Abregu Jim , Scheuer Jonas , Satyal Sajan , Solemslie Bjørn W. , Dahlhaug Ole G.
Published: August 2024

In order to succeed in the transition to a more renewable energy sector, the hydropower industry must overcome multiple challenges in the coming decades, including the need for faster and reversible turbines to support emerging renewable energy sources. In addition, the location of new projects in tropical and semi-tropical areas poses unique considerations, as does the increase in sediment.

Evaluating sediment erosion in turbines is a critical challenge, which may partly be addressed by analyzing the behavior of water jets from eroded nozzles in Pelton turbines. This paper presents an evaluation of the quality of the jet under various hydraulic conditions, focusing on needle erosion. The study is part of a research project conducted in the Waterpower Laboratory at NTNU, focusing on Pelton turbines.

Furthermore, this paper investigates erosion patterns caused by sediments on the needle and explores the impact on jet performance. Through high-speed visualization and image processing, the behavior of a jet from the needle tip to a representative distance downstream has been investigated. The investigation revealed discernible differences between jets with eroded and uneroded needles in size and edge variation.
Numerical Investigation on Hydraulic Performance of Reversible Pump Turbines with Various Wrap Angles in Turbine Mode of Operation
Authors: Bhurtel Mausam , Bijukchhe Pawan Lal , Pokharel Nischal , Thapa Biraj Singh
Published: August 2024

Reversible Pump Turbines (RPTs) are radial turbines, used in Pumped Storage Hydropower (PHS) plants. They have two modes of operation: generating and pumping. Despite of their uniqueness and importance, RPTs have typical range of operation at both modes and are prone to undesirable instabilities. The shape of the geometry plays a crucial role on reducing these characteristics and even the minor changes to the geometry can have a significant impact on its performance. In this paper, the effect of blade wrap angles on the hydraulic performance of runner was studied in an attempt to mitigate instabilities at turbine mode of operation. For that, two dimensionally similar RPT runners were designed using CFTurbo software by only varying wrap angle. The wrap angle considered for the runners are 150° and 180°. Steady state simulation was done in ANSYS-CFX for both the designs under same boundary conditions. It was found that the hydrodynamic performance of the runner gradually decreases in both cases when the operating condition deviates from normal operating range, causing flow instabilities within the runner. The study also found that varying blade wrap angles had no significant impact on the reduction of instabilities on RPTs, however it is an important parameter that comes into play while designing turbines at different head and flow conditions.
A numerical study on the effect of spanwise installation of vortex generators on Francis runner blades
Authors: Kayastha Atmaram , Neopane Hari Prasad , Dahlhaug Ole Gunnar
Published: August 2024

Hydro turbine operation far off from its best efficiency point introduces vortices and swirl that detaches flow from the blade surface. This break-off of flow accounts to loss in hydrodynamic lift accompanied by pressure fluctuations and vibration that leads to poor performance and mechanical failure of the turbine blades. Vortex generators (VGs) are efficient passive devices deployed to enhance aerodynamic lift of wind turbine blades and aircraft wings and can improve hydrodynamic lift on turbine runner blades as well. This study aims to investigate on the possibility of installation of VGs on the runner blade at leading edge, midspan and trailing edge of the runner blade. The study is carried out on a model Francis turbine developed at Waterpower Laboratory, NTNU. The numerical study is mainly focused on improving performance of the turbine at low speed as well as at the best efficiency speed. The operating head selected for the study is 11.94 m and the speed of the turbine is varied from 233 rpm to 433 rpm at an increment of 25 rpm. The turbine is simulated at different positions of guide vanes and hydraulic performance is calculated and the results of the analysis are compared with reference case without VGs. The results at deep-part load show major improvement in runner efficiency with increment in values up to 4%. The core purpose of the research is to develop effective techniques to operate traditional turbine runner at variable speed with cost-efficient minimal modifications in the geometry of the runner blades.
Site-Specific Seismic Hazard Analysis for Shallow Tunnel in Nepal
Authors: Thapa Umesh Jung , Thapa Pradip , Paudel Satish , Timalsina Shiva Prasad , Khadka Shyam Sundar
Published: August 2024

Several seismic codes are implemented for the design and construction of superstructures in Nepal but there is no seismic guideline for shallow tunnels which are often constructed using conventional engineering approaches. The uniform hazard spectrum was obtained after performing a Probabilistic Seismic Hazard Analysis at Dhulikhel and the target spectrum was estimated by comparing it with the spectrum recommended by the seismic code of Nepal Building Code NBC 105:2020 and Indian standard IS 1893:2016. The average response spectrum from ten recorded earthquake ground motions was selected from a peer ground motion database with the known shear wave velocity obtained from geophysical survey. The comparative analysis revealed that the design spectra for identical soil classes, as determined by this study are slightly higher than those prescribed by the present seismic code provisions. This finding emphasizes the necessity for developing more specific guidelines tailored to the design of shallow tunnels in Nepal to ensure their structural resilience in the event of an earthquake.
Introduction
Authors: Ungemah Joe
Published: August 2024

This chapter introduces the concept of being a fanatic and the historical connotations that the term elicits. Whereas common definitions of fanaticism emphasize strangeness or extreme behavior, the book is positioned to embrace fanaticism for all the benefits it provides while acknowledging that passion can sometimes go too deep and interfere with healthy living. The introduction outlines the structure and content of the chapters with an overview of how personality and context come together to influence whether an individual will find a passion area and stick with it. Positive and problematic versions of fanaticism are introduced, in addition to the social, physical, emotive, and cognitive psychological domains that provide the backbone to the book’s primary model. A set of motivations are proposed, which are said to combine in unique patterns to drive and maintain fanatic behavior. If harnessed, these motivations provide opportunities for human connection and the potential to heighten fanatic experiences.
Galactic Connections
Authors: Ungemah Joe
Published: August 2024

This chapter enters the world of science fiction fanatics and the conventions they attend. Drawn together by a common interests in the genre, they make connections that go beyond art and movies, sometimes finding hope in humankind and more often joy in sharing fantastic worlds with like-minded people. Science fiction is shown to build bridges to existing and new relationships alike, with the benefits extending to psychological well-being, helping fanatics deal with loss or reinvent healthier ways of living. This is put in contrast to other types of fandom, notably football hooliganism, where identification with a team can spill into physical confrontation. Science fiction and fantasy can also be part of therapy itself, providing a mechanism for therapists to relate better to their clients, a metaphor for life’s troubles, or ways for clients to try out new behaviors in a safe environment.
Lemons to Lemonade
Authors: Ungemah Joe
Published: August 2024

This chapter considers how individuals cope with hardship and tragedy through activism and joining groups that drive social change. Using a negative life event as the motivation to do something meaningful produces a different type of fanaticism, one that extends beyond the individual to make other lives better. Individuals who once relied on the support of others transform into the providers of support, often to people outside their immediate social universe. They show a level of empathy that is difficult to replicate without the lived experience of trauma and loss. This journey is difficult and not guaranteed, but those who successfully navigate grief rediscover life’s purpose and redefine their personal identities. The stories captured here demonstrate that trauma or tragedy may never be forgotten, but peace and balance can be restored through a deep connection with others.
Virtual Escapism
Authors: Ungemah Joe
Published: August 2024

This chapter dives into the pursuit of escapism, where gamers leave the physical world to reinvent their personal identity and make fresh social connections. The virtual world provides a blank canvas for gamers to question who they are and to behave in ways that people in the real world might consider out of character. Yet if taken too far, gamers have the potential to prioritize the virtual world and lose their anchor to real life, a symptom of addiction similar to other forms of fanaticism. A set of entrepreneurs, who are also early adopters of augmented and virtual reality, provide an alternative perspective by advocating for the benefits of the technology and offer everything from therapies for Alzheimer’s patients and pain reduction to commercial applications in architecture. Fanatics of virtual reality look to break the boundaries of the physical world, reinventing themselves and their environments along the way, but sometimes place real-world relationships at risk.
Compulsive Perfection
Authors: Ungemah Joe
Published: August 2024

This chapter dives into the world of innovation and entrepreneurialism, to uncover the motivation behind creating something new and sharing it with the world. Faced with financial obstacles, public embarrassment, and potential failure, fanatics of innovation and creativity are resilient in their pursuit to create something amazing. Their internal need for achievement drives their behavior towards a positive version of perfection, while their low fear of failure keeps their self-confidence running high. Like other forms of fanaticism, much of the innovator’s activity is solarity, achieving a state of flow when the creativity is running strong. This is very different for individuals demonstrating negative forms of perfectionism, which is rooted in perceived high social expectations, or those suffering from obsessive-compulsive disorder, where driving toward perfection acts as a bully and sucks enjoyment away. Through exposure therapy, the bully is contained and balance restored to allow individuals to pursue their passions.
Happiness on Sale
Authors: Ungemah Joe
Published: August 2024

This chapter investigates how indulgent treats can either maintain or repair a positive mood. Self gifts, like chocolate or soda, work to balance out negativity and restore individuals to homeostasis, whether bought deliberately or as a form of impulse buying. These effects work best if the consumer is fully in the present moment and mindful of the enjoyment that they receiving. If used in excess, a dependency on treats can lead to both physical and mental health issues, as consumers forget how to regulate themselves in the absence of a mechanism to boost mood. Longer-term happiness is best addressed through psychological techniques that focus on awareness of root causes and behavior change, such as visioning or acceptance and commitment therapy. Fanaticism of indulgent treats is not localized to the consumption of the treat, but rather extends to those who have devoted their professional lives to creating or selling treats for the happiness it brings to others. These individuals are fanatics of happiness and the experience of watching others indulge to forget life’s worries.
Subordinate–Superior Interactions and the Economy of the Passions
Authors: Taylor Hillary
Published: August 2024

This chapter examines contemporary theorizations of the passions in conjunction with other sources. Interactions between socially unequal parties were framed as exchanges in pleasure or enjoyment. The pleasure allegedly experienced by each party varied in relation to their position. This way of conceptualizing social relations served multiple functions. It collectively provided authorities with comforting narratives that they could tell themselves about how their authority operated. It enabled the ‘better’ sort to articulate a positive sense of identity vis-à-vis the gentry—the social group that had traditionally been regarded as playing the most important role in the maintenance of the social order. It euphemized and concealed the unease that labouring and poor people could feel when they encountered their ‘betters’, as well as the role that such encounters might play in the naturalization of their subordination.
The Costs of Inarticulacy
Authors: Taylor Hillary
Published: August 2024

This chapter examines ‘inarticulacy’ as a social and an ideological phenomenon in early modern England. It considers contemporary attitudes towards stammering, disfluent, and ‘incoherent’ speech, how these attitudes were shaped by speakers’ social position, and the experiences of ‘inarticulate’ individuals who occupied different places in the hierarchy. The costs of inarticulacy varied in relation to a given speaker’s social position. For members of the gentry and ‘better’ sort, disfluent speech could not only compromise their ability to project their authority in the expected manner but also enable their inferiors to resist demands that were made of them. The costs of inarticulacy were different for poor and labouring people. When they spoke disfluently in power-laden situations, they unwittingly justified their subordination by confirming commonplace assumptions about the relationship between social inferiority, language, and cognitive ability.
Conclusion
Authors: Taylor Hillary
Published: August 2024

The conclusion reprises the book’s main arguments about the ways in which language reflected, reproduced, and naturalized inequality in early modern England. It extends the discussion by demonstrating that these points were not altogether lost on contemporaries through an examination of some mid-seventeenth century radicals’ commentaries on the relationship between language, socio-economic inequality, and existing structures of authority. In their estimation, the creation of a more just social order would require—among other things—a restructuring of existing modes of social interaction; in practice, their efforts met with limited success. It concludes by considering the implications that the analyses advanced over the course of the book might have for our understanding of the social history of politics in early modern England.
Electrical Properties of Materials, 11th Edition
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

A classic text in the field, providing a readable and accessible guide for students of electrical and electronic engineering.

The 11th edition includes many new diagrams and photographs illustrating fundamental material properties, measurement systems, and new applications.

Ideal for undergraduates, the book is also an invaluable reference for graduate students and others wishing to explore this rapidly expanding field
The Electron as a Particle
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Describes a number of electrical aspects of material behaviour best understood using a particle rather than a wave model of an electron, including electrical conductivity, the Hall effect, electromagnetic waves in solids, transmission and reflection at boundaries between media with different properties, electromagnetic waves in the presence of a magnetic field, plasma waves, surface plasmons at boundaries between metals and dielectrics, thermal noise (otherwise known as Johnson noise) and heat flow.
The hydrogen atom and the periodic table
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Considers solutions of the Schrödinger wave equation for a single electron confined in the potential distribution associated with the hydrogen atom. Finds spherically-symmetric solutions, together with their associated energy levels and probability distributions. Introduces the idea of quantum numbers to describe more general non-symmetric states. Considers the additional effect of electron spin, and introduces Pauli’s exclusion principle as the limit to the number of electrons in any given state. Discusses how the periodic table of the elements can follow from solutions of the Schrödinger equation for atoms with larger numbers of electrons.
The free electron theory of metals
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Introduces the idea of free electrons in a metal as solutions of the Schrödinger equation for the potential distribution defining a large, three-dimensional volume, finds the associated density of states, shows that the probability of occupation of those states is given by the Fermi-Dirac distribution function, and uses these ideas to define the specific heat of electrons. Introduces the work function as the energy needed for an electron to escape from a metal, and shows how a supply of thermal energy can increase emission in the heated tungsten filament. Shows further how strong electric fields can reshape the confining potential barrier (the Schottky effect), allowing escape by tunneling and enabling the field emission microscope. Shows how the energy may alternatively be provided by photons in the photoelectric effect. Finally, considers a related application for tungsten filament, the tungsten-halogen lamp, and electron behaviour at a junction between two metals.
Semiconductors
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Summarises basic semiconductor material properties needed before any device fabrication can begin, starting with pure (or intrinsic) group V material such as silicon, and then moving to doped (or extrinsic) material that uses impurities to control the carrier type. Discusses the behaviour of carriers, including the scattering of carriers from the lattice and impurities, and the relation between electron and hole densities that follows from generation and recombination processes. Considers alternative III-V and II-VI materials, non-equilibrium processes such as photoconduction, the effect of the detailed band structure in real semiconductors, and the possibilities offered by lower-cost materials with a less than perfect crystal lattice (amorphous semiconductors). Concludes by discussing how properties such as carrier mobility, the Hall coefficient, the effective mass and the energy gap are measured, and how pure material may be grown and controllably doped with impurity atoms.
Magnetic materials
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Uses the classical Curie-Weiss model to explain the mechanisms underpinning the phenomenon of permanent magnetism. Discusses the Curie temperature at which magnetization is lost, the formation and subsequent change in shape of magnetic domains, the nature of domain walls, the hysteresis curve for magnetization and demagnetization, magnetic anisotropy, soft and hard magnetic materials, and the perfomance of the best modern materials. Uses detailed quantum mechanical theory and the periodic table to compare the different forms of magnetism, including paramagnetism, antiferromagnetism, ferromagnetism and ferrimagnetism. Considers additional magnetic phenomena including electron spin resonance, nuclear magnetic resonance, cyclotron resonance, the quantum Hall effect, the magneto-electric effect, magnetoresistance and spin waves. Presents applications for magnetic materials including spintronic devices, Faraday effect isolators, sensors, read heads for magnetic data storage and permanent magnet electric motors.
Artificial materials or metamaterials
Authors: Solymar Laszlo , Walsh Donald , Syms Richard
Published: August 2024

Describes new artificial materials generally operating in the electromagnetic domain and based either on structured dielectrics (photonic bandgap materials), or combinations of structured dielectrics and metals (metamaterials). Discusses the dielectric properties of arrays of wires and the magnetic properties of arrays of resonant loops such as split ring resonators. Introduces the idea of an effective permittivity and permeability at RF or optical frequency resulting from these ararngements and discusses the new effects that can arise when both are negative (and the refractive index is also negative). Considers applications in the form of photonic bandgap fibres (which can confine light inside a hollow core), the perfect lens (whose resolution can exceed the diffraction limit) and detectors for magnetic resonance imaging (whose periodic construction can provide patient safety in internal imaging).
Politics and Society in Mid Thirteenth-Century England
Authors: Coss Peter
Published: August 2024

This book is a reinterpretation of what it prefers to call the ‘crisis’ rather than the ‘revolution’ of mid-thirteenth-century England. Paradoxically, given the multidirectional nature of modern research, the interpretation of the political history of this period has remained locked into a traditional framework bequeathed by the mid-twentieth-century historian R. F. Treharne, and embellished by the emphases and accentuations of his present-day successors. With its high-flown interpretation of concepts like community, its constitutionalism, its ready identification of a national enterprise, and its predilection for idealism and progressive thinking, this interpretation remains uncomfortably close to the Whig interpretation of English history. It is reinforced by a continuation of a rather ahistorical reverence for the baronial leader Simon de Montfort. The book offers an alternative, less idealistic, and more down-to-earth approach which is anchored in the social mores and cultural values of thirteenth-century England. More emphasis is placed upon the interests, ambitions, and needs of contemporaries, upon social networks of various kinds, and upon how interests both clashed and cohered as people strove to improve or preserve their situations. It was a crisis born of political instability, but in the context of institutional, administrative, and legal growth, that is to say at a particular point in the evolution of the state. It deals with the generation of the crisis, the factors which influenced its course, and its (partial) resolution. In short, it explores the anatomy and physiology of a troubled realm.
Spontaneous Renal Artery Dissection in Active Duty Male
Authors: Kennedy John , Rouse Jake , Roth Michael
Published: August 2024

Spontaneous renal artery dissection is a rare condition with nonspecific symptoms that can be challenging to diagnose. We present the case of a 25-year-old male presenting with left flank pain, mild leukocytosis, and a benign urinalysis found to have renal artery dissection on computed tomography angiogram. The patient’s condition improved following conservative management with anticoagulants. This case demonstrates that Spontaneous renal artery dissection may be a potential cause of renal artery infarction in young, previously healthy patients.
Radiology Nursing
Authors: Arslan Ellen F.
Published: August 2024

These nurses provide care throughout various imaging exams.
Prolonged Antibiotic Infusions Reduce Mortality in Adults with Sepsis and Septic Shock
Authors: Rosenberg Karen
Published: August 2024

According to this study:
Thank You Is Never Enough
Authors: Gallion Anna H.
Published: August 2024

An appreciation of all that nurses give
A review of vaping's health effects, treatment, and policy implications
Authors: Buettner-Schmidt Kelly , Fraase Kolby Schaeffer , Barnacle Mykell , Peltier Allison , Saarinen Heidi , Maack Brody , Turrubiates Nancy
Published: August 2024

The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.
Proportion and clinical characteristics of metabolic-associated fatty liver disease and associated liver fibrosis in an urban Chinese population
Authors: Hou Mengmeng , Gu Qi , Cui Jiawei , Dou Yao , Huang Xiuhong , Li Jie , Qiao Liang , Nan Yuemin
Published: August 2024

Background:

Metabolic-associated fatty liver disease (MAFLD) is the predominant form of chronic liver disease worldwide. This study was designed to investigate the proportion and characteristics of MAFLD within the general Chinese population and to identify the contributory risk factors for liver fibrosis among MAFLD individuals.

Methods:

The participants were recruited from a cohort undergoing routine health evaluations at the Third Hospital of Hebei Medical University between May 2019 and March 2023. The diagnosis of MAFLD was based on the established clinical practice guidelines. The fibrosis-4 index score (FIB-4) was employed to evaluate hepatic fibrosis, with a FIB-4 score of ≥1.3 indicating significant fibrosis. Binary logistic regression analyses were used to determine risk factors associated with significant hepatic fibrosis in MAFLD.

Results:

A total of 22,970 participants who underwent comprehensive medical examinations were included in the analysis. The overall proportion of MAFLD was 28.77% (6608/22,970), with 16.87% (1115/6608) of these patients showing significant fibrosis as assessed using FIB-4. Independent risk factors for significant liver fibrosis in MAFLD patients were male (odds ratio [OR] = 0.676, 95% confidence interval [CI]: 0.558–0.821), hepatitis B surface antigen (HBsAg) positivity (OR = 2.611, 95% CI: 1.557–4.379), body mass index ≥23.00 kg/m2 (OR = 0.632, 95% CI: 0.470–0.851), blood pressure ≥130/85 mmHg (OR = 1.885, 95% CI: 1.564–2.272), and plasma glucose ≥5.6 mmol/L (OR = 1.815, 95% CI: 1.507–2.186) (all P <0.001).

Conclusions:

The proportion of MAFLD in an urban Chinese population is 28.77%. About 16.87% of MAFLD patients presented with significant liver fibrosis.
POU2F1 inhibits miR-29b1/a cluster-mediated suppression of PIK3R1 and PIK3R3 expression to regulate gastric cancer cell invasion and migration
Authors: Xiao Yizhi , Yang Ping , Xiao Wushuang , Yu Zhen , Li Jiaying , Li Xiaofeng , Lin Jianjiao , Zhang Jieming , Pei Miaomiao , Hong Linjie , Yang Juanying , Lin Zhizhao , Jiang Ping , Xiang Li , Li Guoxin , Ai Xinbo , Dai Weiyu , Tang Weimei , Wang Jide
Published: August 2024

Background:

The transcription factor POU2F1 regulates the expression levels of microRNAs in neoplasia. However, the miR-29b1/a cluster modulated by POU2F1 in gastric cancer (GC) remains unknown.

Methods:

Gene expression in GC cells was evaluated using reverse-transcription polymerase chain reaction (PCR), western blotting, immunohistochemistry, and RNA in situ hybridization. Co-immunoprecipitation was performed to evaluate protein interactions. Transwell migration and invasion assays were performed to investigate the biological behavior of GC cells. MiR-29b1/a cluster promoter analysis and luciferase activity assay for the 3′-UTR study were performed in GC cells. In vivo tumor metastasis was evaluated in nude mice.

Results:

POU2F1 is overexpressed in GC cell lines and binds to the miR-29b1/a cluster promoter. POU2F1 is upregulated, whereas mature miR-29b-3p and miR-29a-3p are downregulated in GC tissues. POU2F1 promotes GC metastasis by inhibiting miR-29b-3p or miR-29a-3p expression in vitro and in vivo. Furthermore, PIK3R1 and/or PIK3R3 are direct targets of miR-29b-3p and/or miR-29a-3p, and the ectopic expression of PIK3R1 or PIK3R3 reverses the suppressive effect of mature miR-29b-3p and/or miR-29a-3p on GC cell metastasis and invasion. Additionally, the interaction of PIK3R1 with PIK3R3 promotes migration and invasion, and miR-29b-3p, miR-29a-3p, PIK3R1, and PIK3R3 regulate migration and invasion via the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/Akt/mTOR) pathway in GC cells. In addition, POU2F1, PIK3R1, and PIK3R3 expression levels negatively correlated with miR-29b-3p and miR-29a-3p expression levels in GC tissue samples.

Conclusions:

The POU2F1-miR-29b-3p/miR-29a-3p-PIK3R1/PIK3R1 signaling axis regulates tumor progression and may be a promising therapeutic target for GC.
Kirenol Alleviates Inflammation and Oxidative Stress to Improve Myocardial Ischemia/Reperfusion Injury in Rats
Authors: Shi Jinlong , Guan Bingfeng , Gong Minghui , He Xinyi
Published: August 2024

Ischemic heart disease gravely threatens human health and even results in death. Kirenol is predominantly derived from the Herba Siegesbeckiae plant species and possesses a wide range of biological effects (such as antibacterial, anti-inflammatory, anticancer, and cardioprotective). However, the regulatory effects and associated mechanisms of kirenol in myocardial ischemia/reperfusion injury (MI/RI) remain unclear. In this study, first, the MI/RI rat model was established. It was demonstrated that kirenol protected against the aggravation of cardiac function in MI/RI rats. In addition, the inflammation was induced by ischemia reperfusion (IR), which was likewise affected by kirenol (5 or 10 mg/kg). Moreover, IR enhanced oxidative stress, a process that was counteracted by kirenol. Next, cell apoptosis was discovered to be heightened after IR, but this effect was neutralized by kirenol. Finally, it was revealed that kirenol has the ability to block the activation of the NF-κB pathway. In conclusion, it was disclosed that kirenol alleviated inflammation and oxidative stress through modulating the NF-κB pathway to improve MI/RI in rats. This work may offer novel insights for searching useful drugs for treating MI/RI.
Comparison of Oncological and Aesthetic Outcomes between Tissue Rearrangement Technique and Pedicled Latissimus Dorsi Flap Reconstruction in Cases of Upper Outer Quadrant Breast Cancer
Authors: Ahmed Ahmed S. , Mohamed Mohamed A.K. , Mostafa Hesham S. , El Naggar Abdel Naser M.E. , Ali Abdel Halim M.A. , Ahmed Ahmed Safaa , Ibrahim Mostafa F.
Published: August 2024

Background:

Emerging as an adjunct to breast-conserving surgery, oncoplastic breast surgery seeks to improve the cosmetic and functional outcomes for breast cancer surgery. The objective was to assess the potential advantages of using the latissimus dorsi (LD) flap, in comparison with local tissue rearrangement, in terms of aesthetic results and postoperative problems.

Methods:

This study compared the outcomes of patients with a malignant tumor removed from the upper outer quadrant of the breast using a comparative nonrandomized control approach. Participants were split into two groups: reconstruction using local tissue rearrangement was performed on 20 patients (group A), and a pedicled LD flap was used to treat the same number of patients (group B). All patients were examined in the clinics’ outpatient setting. Every 3 months, the medical oncology team would do a thorough clinical assessment.

Results:

Better aesthetic outcomes were significantly higher among patients with an LD flap. The LD flap was able to maintain breast shape in 90%, breast volume in 85%, and the nipple-areola complex direction in 90% of patients. Surgeons’ evaluation of both techniques reported significantly higher satisfaction for LD flap than local tissue replacement. Patient satisfaction was significantly higher among patients with an LD flap. With regard to the postoperative complications, there were no significant differences between either group.

Conclusions:

Oncoplastic breast surgery with reconstruction using the pedicled LD flap provides maintenance of the shape of female breasts with better aesthetic outcomes and patient and surgeon satisfaction than reconstruction using local tissue rearrangement, with a comparable complication rate.
Geospatial Demand for Approved Cleft Care in the United States
Authors: Parham Matthew J. , Williams Austin D. , Layon Sarah A. , Burns Heather R. , Abu-Ghname Amjed , Hollier Larry H.
Published: August 2024

Background:

Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association–approved cleft teams.

Methods:

Natality data were queried from the National Vital Statistics System. Population and geographic data were obtained from the US Census Bureau. The Social Vulnerability Index (SVI) was utilized to account for social inequality. Total births with CL/P, population estimates, SVI, distance to the nearest center, and total centers within 50 km were used to generate the cleft care demand index (CCDI).

Results:

Ninety-two counties had CCDIs between 66.7 and 100. The highest scoring county, Hidalgo County, Texas, had 62 births with CL/P, population estimate of 888,367 persons, distance to the nearest cleft center of 368.4 km, and SVI of 0.99.

Conclusions:

This study demonstrates the power of geographic information systems for identifying areas with limited access to approved cleft teams. The CCDI measures cleft burden, socioeconomic disadvantage, and geographic barriers to quantify the demand for approved cleft care in each county. Utilizing these scores can help direct future interventions, outreach efforts, and cleft care center planning.
Limb Preservation and Functional Reconstruction after Complete Amputation and Replantation of the Upper Arm and Thigh
Authors: Zhou Zhegang , Yu Longbiao , Meng Fanbin , Wen Jingjing , Xiao Yingfeng , Wan Shengxiang , Zeng Hui , Yu Fei
Published: August 2024

A 26-year-old man was admitted to our hospital due to the replantation of the severed right upper arm and right thigh injury 6 days before. The patient received emergency treatment at a local hospital. He underwent amputation and replantation for the right upper arm and right thigh. After surgery, he experienced fever, limb swelling, and wound pain. At the time of admission to our hospital, the patient exhibited stable vital signs. An infection was found at the replanted wound, and the culture results showed Pseudomonas aeruginosa. After admission, the patient underwent symptomatic antiinflammatory treatment. In addition, he received fracture reduction and external fixation with a bracket, radial nerve exploration and release of the upper and lower limb external fixation with a bracket, upper femur osteotomy, and external fixation with a bracket. He also received reconstruction of elbow flexion functions with biceps femoris tendon transplantation; reconstruction of wrist joint fusion, finger extension function, and palm function; removal of the femoral external fixation with a bracket; and tibiofibular osteotomy and leg lengthening surgery. Moreover, the anterior tibial tendon was fixed to correct foot drop deformity, and the external fixation bracket was removed. Owing to these efforts, the patient achieved limb preservation with well-reconstructed functions.
Prospective Randomized Study on the Use of Sentinel Node Biopsy for High-risk Cutaneous Squamous Cell Carcinomas of the Head and Neck
Authors: Spyropoulou Georgia-Alexandra , Mpalaris Vassilis , Pervana Stavroula , Trakatelli Myrto , Foroglou Periklis , Milothridis Panagiotis , Garoufalias Theodoros , Drougou Avra , Demiri Efterpi
Published: August 2024

Background:

The use of sentinel lymph node biopsy (SLNB) for high-risk cutaneous squamous cell carcinoma (CSCC) is not yet clearly documented, especially for the head and neck area, due to its rich and cross-branching lymphatic system. We present the first prospective randomized study on the use of SLNB in high-risk CSCCs of the head and neck.

Methods:

Seventy-six patients with high-risk CSCCs of the head and neck were randomly divided into two groups: A (n = 38) and B (n = 38). In group A, SLNB was performed additionally to the excision of squamous cell carcinoma, whereas in group B, only excision of the lesion was performed. The patients were followed up for 5 years postoperatively, and local recurrences, regional metastases (regional lymph nodes), and mortality were documented.

Results:

One patient of group A, who never attended any follow-up, was excluded. Both groups had similar characteristics regarding Breslow thickness, perineurial invasion, peripheral limits, differentiation, size, previous incomplete excision, age, sex, education, sun exposure, Fitzpatrick score, previous incomplete excision, previous skin cancer, and smoking. Two patients had a positive sentinel lymph node and were submitted to regional lymphadenectomy. We documented deaths (three in group A and two in group B; P = 0.674), local recurrence (seven in group A and six in group B; P = 0.768), and regional metastasis (zero in group A and two in group B; P = 0.159).

Conclusion:

There is no clear benefit on the use of SLNB in high-risk CSCCs of the head and neck regarding metastasis, mortality, or local recurrence control.
NIRO200NX: Reliable Monitoring System for Buried Deep Inferior Epigastric Perforator Flap
Authors: Tanaka Mami , Umemoto Yasutaka , Ohashi Wataru , Watanabe Hideto , Nagata Ayako , Furukawa Hiroshi
Published: August 2024

Background:

The deep inferior epigastric perforator (DIEP) flap is a useful tool for breast reconstruction and tends to be transferred into the breast envelope as the buried flap from an aesthetic point of view. However, it is difficult to monitor the blood flow in the buried DIEP flap after reconstructive microsurgery. Near-infrared spectroscopy devices have recently been used for monitoring the blood flow of various organs. NIRO200NX (Hamamatsu Photonics) continuously measures the tissue oxygen index (TOI) and quickly reflects changes in flap blood flow. In this study, we investigated whether and how much the NIRO200NX applies to monitoring the blood flow of the buried flap.

Methods:

We included 156 patients who underwent breast reconstruction using a DIEP flap from October 2013 to May 2022, comprising 57 exposed and 99 buried-type DIEP flap cases. We measured TOI using NIRO200NX, in combination with conventional evaluation methods, including color check, pinprick test, and Doppler sound.

Results:

A criterion of TOI 50 gave the best evaluations. All the 57 exposed-type flap cases showed no false evaluations, and NIRO200NX performed precise judgment. In 99 buried-type flap cases, NIRO200NX correctly evaluated 96 cases. For those buried-type cases, we found only two false-positive and one false-negative case. The misjudgments by NIRO200NX were likely caused by hematoma.

Conclusion:

We propose NIRO200NX as a reliable device for monitoring the blood flow of the DIEP flap and predicting the outcomes of breast reconstruction by the DIEP flap transfer.
Retrorectus Ventral Hernia Repair Utilizing T-line Hernia Mesh: Technical Descriptions
Authors: Naga Hani I. , Oyola Anna Malysz , Kim Joshua K. , Hope William W. , Farber Lee , Yoo Jin S.
Published: August 2024

The T-line hernia mesh is a synthetic, polypropylene mesh with mesh suture extensions designed to prevent anchor point failure by evenly distributing tension across the soft tissue. Previous studies have demonstrated the success of onlay ventral hernia repair with T-line hernia mesh, but retrorectus applications of the mesh have not yet been characterized. This technique article illustrates technical descriptions and clinical applications of the T-line hernia mesh in the retrorectus plane.
Fatty acid synthesis is indispensable for Kupffer cells to eliminate bacteria in ALD progression
Authors: Xie Liuyu , Wu Beng , Fan Yuanyuan , Tao Ye , Jiang Xiaoyong , Li Qing , Zhu Huaiping , Wang Hua , Hu Chaojie
Published: August 2024

Background:

Dysregulated fatty acid metabolism is closely linked to the development of alcohol-associated liver disease (ALD). KCs, which are resident macrophages in the liver, play a critical role in ALD pathogenesis. However, the effect of alcohol on fatty acid metabolism in KCs remains poorly understood. The current study aims to investigate fatty acid metabolism in KCs and its potential effect on ALD development.

Methods:

Wild-type C57BL/6 mice were fed a Lieber-DeCarli ethanol liquid diet for 3 days. Then, the liver injury and levels of intrahepatic bacteria were assessed. Next, we investigated the effects and underlying mechanisms of ethanol exposure on fatty acid metabolism and the phagocytosis of KCs, both in vivo and in vitro. Finally, we generated KCs-specific Fasn knockout and overexpression mice to evaluate the impact of FASN on the phagocytosis of KCs and ethanol-induced liver injury.

Results:

Using Bodipy493/503 to stain intracellular neutral lipids, we found significantly reduced lipid levels in KCs from mice fed an alcohol-containing diet for 3 days and in RAW264.7 macrophages exposed to ethanol. Mechanistically, alcohol exposure suppressed sterol regulatory element-binding protein 1 transcriptional activity, thereby inhibiting fatty acid synthase (FASN)-mediated de novo lipogenesis in macrophages both in vitro and in vivo. We show that genetic ablation and pharmacologic inhibition of FASN significantly impaired KC’s ability to take up and eliminate bacteria. Conversely, KCs-specific Fasn overexpression reverses the impairment of macrophage phagocytosis caused by alcohol exposure. We also revealed that KCs-specific Fasn knockout augmented KCs apoptosis and exacerbated liver injury in mice fed an alcohol-containing diet for 3 days.

Conclusions:

Our findings indicate the crucial role of de novo lipogenesis in maintaining effective KCs phagocytosis and suggest a therapeutic target for ALD based on fatty acid synthesis in KCs.
Multivisceral combined robot-assisted surgery: Single docking partial nephrectomy and cholecystectomy
Authors: Miranda Giuseppe , Scarcella Simone , Franzese Carmine , Cimadamore Alessia , Fontana Giulia , Dell’Atti Lucio , Galosi Andrea , Guerrieri Mario
Published: August 2024

We present a case of robot-assisted combined partial nephrectomy and robot-assisted cholecystectomy in a 71-year-old male patient diagnosed with a lower solid renal mass, identified during a regular oncological follow-up for non-Hodgkin’s lymphoma, and suffering of chronic cholecystitis due to a concomitant gall bladder stone. We performed both procedures during a single operative session, using a modified trocar configuration with Da Vinci-Xi Robotic Surgical System (Intuitive Surgical, Sunnyvale, California) Platform that allowed the performance of both surgeries with a total blood loss of 100 ml and 187 min of surgical time. A single docking approach of the Xi Da Vinci System resulted in feasible and allowed a reduction of hospitalization costs improving intraoperative surgical timing with all the benefits of the robotic approach for both surgeries.