Hernia rate after damage control laparotomy: a retrospective review using ten core outcomes for damage control laparotomy.

Micro-LED devices smaller than 5 µm are attracting increasing attention as next-generation display technologies for VR/AR applications due to their potential for low current density operation, high resolution, and high brightness across the primary colors. However, a major challenge remains: luminescence efficiency drops significantly at low current densities. This is primarily attributed to reduced internal quantum efficiency caused by defects introduced at the device sidewalls during fabrication. To address this issue, we investigated the application of neutral beam etching (NBE)—an ultra-low-damage etching technique—for micro-LED processing [1]. We fabricated both InGaN/GaN blue and AlGaInP red micro-LEDs, with a focus on optimizing etching conditions and elucidating the etching mechanisms specific to each material system.For blue micro-LEDs, we compared NBE processes using hydrogen iodide (HI) and chlorine (Cl₂) gases. The etching byproduct of HI and indium, InI₃, is more volatile than the corresponding chlorine-based compound, InCl₃, suggesting a potential for cleaner and less damaging surfaces. Blue micro-LEDs ranging in size from 3.5 × 3.5 µm² to 20 × 20 µm² were fabricated using commercial InGaN/GaN multiple quantum well (MQW) blue LED wafers grown on sapphire substrates. Both HI and Cl₂ were supplied at 50 sccm under a chamber pressure of 0.2 Pa and a stage temperature of 130°C. Due to the difficulty of etching the electron blocking layer (AlGaN) with HI alone, the initial 180 nm was etched using Cl₂ NBE. Subsequently, HI NBE was applied for 30 minutes at an etch rate of 14.1 nm/min, resulting in a total etching depth of 603 nm as shown in Fig. 1(a). The etched surfaces were free of residues, attributed to the high volatility of InI₃ [2]. Mesa sidewalls exhibited an angle of 103° relative to the surface, indicating favorable anisotropy. Figure 1(b) shows the external quantum efficiency (EQE) of a 3.5 × 3.5 µm² blue micro-LED as a function of current density. A peak EQE of 8.5% was achieved at a low current density of 3 A/cm², with only a 43% decrease at 0.01 A/cm². These results demonstrate that HI NBE enables the fabrication of high-efficiency sub-5-µm blue GaN micro-LEDs with performance comparable to those processed using Cl₂ NBE, while potentially reducing sidewall damage and surface roughness.In contrast, for red micro-LEDs, InGaN-based MQWs require high indium content (>35%) to achieve red emission, often resulting in severe lattice strain and reduced luminescence efficiency. Therefore, AlGaInP-based structures are more commonly employed. However, processing AlGaInP micro-LEDs is challenging—especially in structures containing both high-In-content layers and GaP layers—due to differences in etch rates that lead to excessive side etching of the GaP layer. To mitigate this, we investigated the etching behavior of GaP using Cl₂ and Cl₂/BCl₃ NBE. Test samples consisted of AlGaInP MQW structures with a 0.81 µm GaP cap layer on GaAs substrates. Etching was conducted under a chamber pressure of 0.19 Pa using gas flow rates of 50 sccm (Cl₂ NBE) and 42/8 sccm (Cl₂/BCl₃ NBE), with stage temperatures of −20°C, 40°C, and 150°C to assess temperature dependence.Figure 2 shows cross-sectional SEM analysis revealed a strong temperature dependence in side etching. Cl₂/BCl₃ NBE exhibited particularly high side etch rates at elevated temperatures, reaching 457 nm/min at 150°C. This is attributed to increased chlorine radical concentration and enhanced volatility of phosphorus chlorides at high temperatures. Conversely, side etching was significantly suppressed at temperatures below 40°C. These findings suggest that for AlGaInP red micro-LEDs, minimizing side etching of the GaP layer requires low-temperature processing, ideally below 40°C, to achieve more anisotropic profiles essential for efficient light emission and device reliability.In conclusion, our study demonstrates that neutral beam etching (NBE) is a highly promising approach for the fabrication of sub-5-µm micro-LEDs, offering low damage and precise control over etch profiles. For blue InGaN/GaN micro-LEDs, HI-based NBE provided smooth surfaces and high EQE at low current densities, attributed to the high volatility of iodine-based byproducts and reduced sidewall damage. For red AlGaInP micro-LEDs, we clarified the temperature-dependent etching behavior of GaP and demonstrated that maintaining stage temperatures below 40°C significantly reduces side etching, improving anisotropy. These insights contribute to the realization of high-performance, full-color micro-LED displays for future VR/AR applications.<Reference>[1] X. L. Wang, et al., Nat Commun 14, 7569 (2023).[2] D. Ohori et al., Nanotechnology 34 (2023) 365302. Figure 1

This study was conducted based on hybrid damping control theory, and an equivalent damping ratio calculation method was proposed. Additionally, a response calculation method for the elastoplastic stage of the hybrid control system was developed. Furthermore, a cooperative working mechanism between viscous dampers and metal composite dampers was introduced. A time–history analysis was employed to verify the system’s effectiveness in optimizing the multi-dimensional seismic performance of frame structures. Using actual engineering as the research background, an elastoplastic analysis of the hybrid control system was conducted. The analysis results show that the first three natural periods of vibration were shortened by 6.1% (in the X direction), 5.9% (in the Y direction), and 21.0% (torsion), effectively enhancing the overall stiffness of the structure. Under seismic action, the inter-story displacement decreased by 37.1% to 0.166 m in the X direction and by 48.3% to 0.080 m in the Y direction; the base shear forces were reduced by 58.8% (in the X direction) and 41.7% (in the Y direction). Regarding damage control, the number of plastic hinges was significantly reduced, and they appeared only on the most unfavorable floors; the axial compressive stress peaks in the frame columns were strictly controlled below 0.65 fc, and the inter-story displacement angles (&lt;1/50) met the standards of GB50011-2010 for key protection structures. The hybrid system demonstrated multi-dimensional synergistic effects, whereby the viscous dampers primarily controlled the acceleration responses in the X direction, while the metal composite dampers dominated energy dissipation in Y displacement. The difference in seismic reduction efficiency between the two main axes was less than 11%, and a 21% improvement in the torsional period was achieved simultaneously.

Dried plasma offers a practical alternative for remote damage control resuscitation, providing hemostatic support and volume replacement. The Arctic presents challenges that necessitate the need for blood-based resuscitation to extend the "golden hour." To address this, we evaluated the hemostatic and thermal stability of dried plasma following exposure during military Arctic operations. OctaplasLG powder kits were deployed with Canadian Armed Forces medical providers during three Arctic operations. Dried plasma was subjected to substantial temperature fluctuations (-35.2 to 26.5°C) and multiple freeze-thaw cycles. Upon return, dried plasma was reconstituted and evaluated using hemostatic/coagulation panels and differential scanning calorimetry (DSC). Arctic-exposed dried plasma retained visual integrity and protein concentration consistent with controls. Hemostatic function, including prothrombin time, activated partial thromboplastin time, fibrinogen, D-dimer, factor V, factor VIII, plasminogen, antithrombin III, protein C, ADAMTS13, and viscoelastic profiles remained within normal ranges, with protein S activity below the lower limit. However, von Willebrand factor antigen levels were elevated in both dried plasma groups, though distribution remained normal and unlikely to be clinically significant for resuscitation. DSC thermograms revealed five characteristic thermal transitions consistent with controls, indicating preserved structural integrity. Enthalpy analysis demonstrated a strong correlation with fibrinogen concentration, suggesting its role in plasma stability. Dried plasma retains its hemostatic and thermal stability following Arctic deployment, supporting remote damage control resuscitation in the absence of whole blood. Nonetheless, field implementation is challenged by the propensity of the diluent to freeze and the logistical requirement for warmed infusion.

Introduction Wearing personal protective equipment that provides more protection than is necessary compromises the effectiveness of medical procedures. Using simulants, we aimed to assess the risk of secondary exposure in the operating room during surgery on patients with mustard-contaminated penetrating wounds. Methods The evaluation was performed in an operating room equipped with a laminar flow ventilation system. The damage control procedure was simulated three times using a dummy with a contaminated abdominal wound, after prehospital decontamination. First, a fluorescent marker was used to assess cross-contamination by the liquid phase. Second, methyl salicylate was used twice at increasing doses (probable and worst-case scenarios) to evaluate vapor-phase atmospheric contamination. Finally, the atmospheric concentration of methyl salicylate in the operating room was modeled. Results The transfer of the fluorescent marker to surfaces was minimal and strictly confined to the surgical area. Methyl salicylate vapor was only detected in the worst-case scenario, with the highest concentrations in the surgical area. The measured mean atmospheric concentration of methyl salicylate was close to the modeled concentration. Discussion The measured ambient and individual methyl salicylate concentrations, as well as the modeled mean atmospheric concentration, were all below the Acute Exposure Limit Level 1 for sulfur mustard over a 1 h exposure period. Therefore, the risk of secondary exposure through the vapor phase is estimated to be very low. However, the results may vary slightly in the case of poor-quality sulfur mustard, due to its slight differences in physical and chemical properties compared to pure sulfur mustard. Conclusion If a patient exposed to sulfur mustard with a contaminated penetrating wound is treated in the operating room of our facility for less than one hour, after prehospital decontamination, the personal protective equipment usually required for exposure to a chemical warfare agent could be reduced by removing the full-face air-purifying respirator.

The current research aims to study the effectiveness and quality of reinforced concrete (ECC) connections when exposed to seismic stresses using ABAQUS software. The study examined and analyzed eight different specimen models with an exact mapping modified Concrete Damaged Plasticity (CDP) model for ECC and validated their representations by comparing them with test results presented in well-established studies in the literature. In summary, there were total improvements in the performance of the ECC reinforced models. For instance, ductility improvements of 40-70%, energy dissipation capacity (up to 55-85%) which implies that the ECC reinforced joints under seismic loading can dissipate more energy upon yielding than their conventional concrete counterparts, and a maximum crack width of ≤ 0.1 mm, compared to 2.5 mm in conventional concrete. This improvement not only increases safety but provides opportunities for a new structural design philosophy in which the design criteria are based on "damage control", rather than simple "collapse prevention"; significantly reducing repair costs from post earthquake inspection and damage or extending the life of the structure. In essence the current work provides a practical-agent validated examples of modeling ECC in modern numerical software along with rational and validated suggestions on how to effectively design with it.

Role 2 (R2) U.S. military treatment facilities (MTFs) provide forward damage control resuscitation and surgery. There are many configurations of R2 surgical teams, but each service defines external fixation (EF) as a requisite skill. To inform planning of potential future conflicts, this study describes EF utilization in recent past conflicts. The Department of Defense Trauma Registry (DoDTR) was retrospectively reviewed from 2003 to 2023. All combat casualties who underwent EF at U.S. MTFs were included. The primary outcome was the MTF level at which EF was performed. Secondary outcomes included the anatomic site of EF and population receiving EFs. Trends in these outcomes were evaluated across time and military operation. Six thousand one hundred eleven patients received 9,310 EFs; 2,600 were U.S. casualties, 1,630 foreign civilian, 275 North Atlantic Treaty Organization (NATO) military, and 1,605 non-NATO military. 19.5% of EFs were placed at R2, 67.6% at Role 3 (R3), 4.9% at Role 4 (R4), and 8.0% at R4-Continental US (R4C) MTFs. 78.0% of patients undergoing their first EF at R3 bypassed the R2. 67.5% of EFs were on the lower extremity and 19.4% were on the upper extremity. At both R2 and R3, the lower extremity was the predominant EF site (69.6% and 67.3% respectively). External pelvic fixation was rarely performed (0.3% and 0.1%). These results offer valuable insight into modern logistical concerns in the delivery of forward surgical care. First and foremost, it underscores the importance of maintaining EF capability in expeditionary surgical teams, especially at lower echelons of care. Given the increasing prevalence of EF at R2s and the logistical challenges of evacuation in future conflicts, consideration should be given to both sustaining orthopedic-trained surgeons in theater and ensuring all general surgeons have robust orthopedic capabilities.

After 4,000 damage-control surgeries: Are we doing more damage?

Finite element and simplified analytical models for self-centering piers with damage control design concept

Snow manipulation regulates soil temperature, reducing overwintering diseases and supporting pasture growth, though it has a limited effect on supporting grass growth. This study assessed the snow manipulation effects on overwintering damage and disease control in timothy (TY), orchardgrass (OG), and perennial ryegrass (PR). Snow manipulation decreased Mild-T days (soil temperatures near 0 °C), which correlated with reduces disease severity, particularly in TY. In plots with < 20 consecutive Mild-T days, maximum disease severity was lowest in TY (0.13) compared with that in OG (1.78) and PR (1.63). However, total overwintering damage also depended on disease and frost resistance. Although snow mold reduction did not consistently decrease damage, PR exhibited severe frost damage, making it highly vulnerable to snow manipulation. Contrastingly, OG compensated for overwintering losses with strong regrowth, maintaining similar dry matter yield. Snow manipulation effectively controls overwintering diseases but may raise frost damage in less cold-resistant species. TY showed the greatest adaptability, PR was highly frost-susceptible, and OG maintained productivity despite overwinter losses. These findings highlight the need to consider disease and frost resistance when using snow manipulation for disease control.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-21885-8.

Damage control surgery (DCS) is the standard approach for managing severely injured patients with trauma who present with extreme physiological derangements. The optimal timing for planned reoperation after the initial DCS remains contentious. Although traditional guidelines recommend reoperation within 24-48h, emerging evidence suggests this interval may not be appropriate for all patients. This systematic review and meta-analysis evaluated the impact of early versus delayed planned reoperations on the clinical outcomes in patients with trauma following DCS. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251049990). PubMed, Embase, and the Cochrane Library were searched from inception to 28 July 2025. Eligible studies compared early (≤ 48h) with delayed (> 48h) planned reoperation after DCS in adult patients with trauma. The primary outcome was re-bleeding; secondary outcomes were in-hospital mortality and infection rates. Study quality was assessed using the Newcastle-Ottawa Scale, and the certainty of evidence was graded using the GRADE approach. Meta-analysis was conducted using random-effects models. Seven retrospective cohort studies involving 965 patients met the inclusion criteria. No prospective or randomised controlled trials were identified. Early planned reoperation was associated with significantly higher re-bleeding rates (OR 3.01; 95% CI 1.21-7.51; P = 0.02), indicating three-fold higher odds of re-bleeding with early intervention compared to delayed reoperation. No significant differences were observed in mortality (OR 0.79; 95% CI 0.51-1.23; P = 0.29; I2 = 0%) or infection rates (OR 1.05; 95% CI 0.54-2.05; P = 0.89; I2 = 65%). Delayed planned reoperation beyond 48h after DCS significantly reduces the risk of re-bleeding, without increasing mortality or infection rates. These findings support an individualised approach to reoperation timing guided by patient physiology, rather than rigid adherence to conventional 24- to 48-h protocols.

Jakarta, which is close to the earthquake path, has a high potential for seismic hazards, so building structures must be designed to withstand earthquakes. The X Building, located in West Jakarta, is expected to have an earthquake-resistant structure, evaluated using pushover analysis. This study aims to assess the performance of the X Building structure against earthquake loads using pushover analysis with ETAS software. X Building underwent translation in patterns 1 and 2, followed by rotation in pattern 3. The value of the structure period in the X direction is 2.578 seconds, and in the Y direction is 2.252 seconds. The mass participation requirement has been met, with a participation rate of 90% or higher in all three directions. There is torsional irregularity in the Y direction. The dynamic shear force after scaling is 10,503.93 kN (X) and 10,503.94 kN (Y). When the performance point is reached, the roof displacement is 623.182 mm (X) and 513.267 mm (Y). The total number of plastic hinges is 2774 in the X direction and 2330 in the Y direction. The structural performance level obtained is Damage Control (DC). The ductility value in the X direction is 1.31, and in the Y direction is 1.12.

Ice damage is receiving increasing attention in engineering. In practice, the occurrence time of ice damage to small-diameter pile structures in cold regions is different from traditional knowledge. Given the crucial impact of temperature on ice thermal expansion, simulating the temperature field of ice cover is of great significance. Based on actual engineering simulations of ice cover temperature, the propagation and amplitude attenuation characteristics of temperature waves are analysed. The one-dimensional heat conduction equation is discretized using the Crank-Nicolson method (time step Δt = 60 s, spatial step Δz = 0.01 m) and implemented in MATLAB R2023a. According to the temperatures in Daqing, three typical warming pro-cesses are selected for fitting, and two ice cover thicknesses are combined to simulate six working conditions. The results show that the temperature field inside the ice cover changes under different working conditions, and the thickness of the ice cover and the temperature rise time have a significant impact. During cooling, the temperature inside the ice cover still rises, affecting thermal expansion stress. The results can provide an important basis for the prevention and control of ice damage to small diameter piles.

Clinical case of comprehensive surgical treatment of a gunshot thoracoabdominal wound with liver damage, complicated by abdominal bleeding, with the use of X-ray endovascular catheter technologies in the damage control surgery tactic

In patients with perforated diverticulitis and/or intraabdominal sepsis (IAS), the best surgical strategy remains controversial. While open, non-restorative Hartmann's procedure represents the procedure of choice in many centers, ostomy-sparing and minimally invasive techniques have been increasingly utilized due to short- and long-term benefits, including a reduced stoma rate. This dynamic manuscript illustrates strategic and technical considerations of the standardized institutional staged or damage control approach to IAS. The institutional strategy to IAS is demonstrated through an emergency procedure for perforated Hinchey IV diverticulitis in a 70-year-old woman developing an acute abdomen. After a diagnostic laparoscopy, stercoral peritonitis was confirmed and the patient underwent laparotomy. A two-stage approach (stage 1: damage control with resection of the perforated sigmoid, abdominal lavage, vacuum-assisted closure (VAC) - stage 2 (36-48h later and during daytime): primary colorectal anastomosis and abdominal closure) was performed. While laparoscopic exploration represents the standard approach in hemodynamically stable patients, the staged procedure (resection and sepsis control) helped refine the definite strategy (goal of reconstruction and no ostomy) in a clinically improved patient during the second step. The patient recovered well during the critical therapeutic window, allowing to perform primary anastomosis and a stoma-free discharge. Clinical condition during surgery, surgeon expertise, and comorbidities are key determinants to decide whether to proceed to primary anastomosis in the case of IAS. An institutional series of our group revealed feasibility and safety of the staged approach, with 65% stoma-free patients at discharge. A standardized algorithm based on intraoperative hemodynamic parameters intends to guide surgical decision-making during staged procedures to seek optimized conditions allowing to proceed to primary anastomosis. A staged approach according to a predefined decisional framework may help decrease the need for ostomy creation in patients with IAS.

Impaired body temperature regulation can lead to severe medical consequences, including hypothermia and heatstroke. Despite its clinical significance and occurrence in individuals with cognitive impairment, this issue remains underexplored. This study investigates the underlying factors and neural basis of thermoregulatory dysfunction in individuals in the chronic phase of stroke. We recruited 112 individuals with chronic cerebrovascular disease (Mage = 61.4 years, SD = 13.1; 75.9% male). Thermoregulatory dysfunction was assessed using rating scores provided by caregivers based on observed behaviors, while neuropsychological functioning was evaluated primarily through standardized objective measures. The relationship between thermoregulatory dysfunction and neuropsychological indices was assessed using simple linear regression, followed by multiple linear regression to adjust for potential confounders. To further examine the neuroanatomical basis, voxel-based lesion-behavior mapping was performed using MRIcron. Multiple linear regression showed that thermoregulatory dysfunction was strongly associated with a hypothalamic lesion (effect size = 0.34), as well as deficits in behavioral control (0.50) and attention (0.22). Among subitems assessing behavioral control, lack of insight exhibited the strongest correlation with thermoregulatory dysfunction severity. Voxel-based lesion-behavior mapping suggested that the right dorsomedial hypothalamic lesion had the greatest impact, followed by lesions in the ventromedial and dorsomedial prefrontal areas; however, these findings did not reach statistical significance. This study demonstrates that thermoregulatory dysfunction in the chronic phase of cerebrovascular disease is associated with both hypothalamic damage and deficits in behavioral control and attention. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Pelvic fractures associated with hemodynamic instability present a major challenge in trauma care, carrying mortality rates up to 30%. Successful management requires a multidisciplinary approach focused on resuscitation, mechanical stabilization, and hemorrhage control. Based on the 2024 International Orthopaedic Trauma Association (IOTA) Annual Meeting Pelvic Symposium, this review summarizes current recommendations for the management of hemodynamically unstable patients with pelvic fractures. Initial skeletal stabilization typically involves noninvasive pelvic binding devices, such as sheets or commercially available binders, employed in both pre-hospital and hospital settings. Subsequent resuscitation strategies include hypotensive resuscitation—restricting fluid administration to maintain lower blood pressure until bleeding is controlled—and damage control resuscitation—consisting of rapid surgical interventions aimed at achieving hemostasis. Current best practice also includes early empirical administration of balanced transfusion products guided by massive transfusion protocols, with targeted adjustments based on point-of-care testing results. Hemorrhage control methods vary depending on available resources: angioembolization effectively manages arterial bleeding in well-resourced facilities, whereas preperitoneal pelvic packing offers a quick, accessible solution for venous and bone-related hemorrhage, particularly in low-resource environments. Although the timing of pelvic binder removal and definitive invasive skeletal stabilization remains controversial, recent evidence supports early definitive internal fixation within 24 hours post-injury.

Titanium alloy tubing is an ideal material for extreme oil and gas environments—characterized by high temperature, high pressure, and H 2 S/CO 2 /chloride-rich conditions—due to its low density, high strength, excellent corrosion resistance, and fatigue performance. Internationally, Grade 28/29 titanium alloys developed by RMI have been successfully applied in sour gas wells, while Weatherford’s Ti-6Al-4V drill pipes exhibit fatigue resistance ten times higher than steel counterparts. Domestic research started later, yet Chinamade titanium alloy casings achieved their first successful application in natural gas hydrate trial production in 2020, with collapse resistance exceeding 42 MPa. Key failure modes include pitting, crevice, and galvanic corrosion, especially when passive films are damaged under high-temperature (&gt;70 °C) or reducing acidic conditions. While corrosion inhibitors (e.g., Na 2 MoO 4 ) reduce corrosion rates, novel inhibitors for temperatures above 160 °C are still needed. For wear resistance, surface modifications such as TiN or DLC coatings and multilayer coating technologies significantly improve performance. Non-marking running and pulling techniques with optimized jaw designs can limit tooth marks to &lt;0.08 mm, demonstrating effectiveness in high-sulfur environments. Future developments should focus on high-temperature acid-resistant inhibitors, hard-soft alternate coatings, and damage-free running technologies to enable large-scale applications in deep-well and offshore oil and gas operations.

Narciclasine mitigates sepsis-induced cardiac dysfunction by enhancing BNIP3-mediated mitophagy and suppressing ferroptosis.

This article systematically elaborates on the application background and technical advantages of SEW (Hot stress reducing electric) casing in shale gas well casing damage control, analyzes its manufacturing process and performance requirements, and summarizes the latest progress in SEW casing material development, process research, and performance evaluation in China. Research has shown that the combination process of “high-frequency resistance welding+thermal tension reduction+full tube quenching and tempering heat treatment” can produce high-grade casing with excellent comprehensive performance, high anti extrusion strength, and good dimensional accuracy, meeting the demanding working conditions of shale gas. At present, the development of SEW casing materials is still in the trial production stage, and there are problems such as unclear material toughening mechanisms and insufficient optimization of alloy design. On this basis, this article further explores the feasibility and challenges of two material design paths based on residual austenite TRIP effect and molybdenum element microalloying. It points out that in the future, efforts should be made to deepen the research on strengthening and toughening mechanisms, optimize alloy composition and heat treatment processes, in order to develop SEW casing materials with better performance and lower cost, and promote their large-scale engineering applications.