Artistic Realization Technologies

Introduction:Laparotomy is the standard treatment for penetrating abdominal trauma; however, the role of laparoscopy is expanding. We report the case of a penetrating jejunal injury in a patient who initially presented with shock but was successfully managed using a laparoscopic-first approach.Case presentation:A 61-year-old male with a history of distal gastrectomy presented with a self-inflicted abdominal stab wound and had ingested antihypertensive drugs and cigarettes. He was initially diagnosed with hemorrhagic shock (systolic blood pressure, 60–70 mmHg), which stabilized after fluid resuscitation. Computed tomography revealed a hemoperitoneum, free air, and omental herniation. A laparoscopic-first approach identified 1200 mL of hemoperitoneum and a full-thickness jejunal perforation. The small bowel was inspected using the “running the bowel” technique, and the perforation was repaired with a two-layer handsewn technique. Therefore, the hybrid laparoscopic/anterior open approach was deemed useful. The patient recovered uneventfully.Discussion:This case suggests that a laparoscopic-first approach can be safely applied to select patients who initially present with transient hemodynamic instability but stabilize after resuscitation. Careful patient selection and systematic exploration are critical to avoid missed injuries. A pragmatic hybrid approach preserves the benefits of minimal invasion.Conclusion:The laparoscopic-first approach is a safe and feasible option for treating small-bowel injuries in selected patients who achieve hemodynamic stability after resuscitation. This strategy facilitates faster recovery and is particularly beneficial in selected patients requiring rapid postoperative recovery, such as those with psychiatric comorbidities.

The Smart Specialisation Strategy (S3) guides regional policies towards innovation-driven investments aligned with territorial strengths. Despite the widespread adoption of S3, empirical evidence on how the attitudes of firms influence investment choices within regional specialisation domains remains limited. This study addresses this gap by analysing non-linear relationships between firms' environmental awareness, technological modernisation, and investment behaviours. The analysis utilises data from the 2022 ISTAT Permanent Census of Enterprises, which developed a composite index to identify specialised firms by territorial and sectoral criteria. To assess the relationships between environmental sensitivity and sustainable investments, as well as technological modernisation attitudes and digitalisation investments, Spearman’s rank correlations were calculated to determine relationships at both the regional and specialisation-domain levels, as well as cluster analyses. The findings highlight the potential of differentiated environmental and digital interventions tailored to sector-specific contexts. Future studies might investigate causal dynamics via longitudinal analyses to gain deeper insights into these relationships.

308 Background: Risk stratification in localised prostate cancer (PCa) based on clinicopathological parameters is inadequate, leading to under- and over-treatment. We used CHHiP trial data to externally validate a previously-developed MMAI prognostic model with potential for cost-effective improved treatment personalisation. Methods: H&E slides from CHHiP translational substudy patients were centrally reviewed by a uro-pathologist between 2013 and 2015, with Gleason grade group (GGG) rescored using contemporary guidelines. GGG was reassigned in 52% of cases. We evaluated the locked ArteraAI prostate MMAI algorithm v1.2 which combines age, T-stage, and PSA with digital prostate biopsy H&E images. Multivariable cox regression analysis of biochemical/clinical recurrence (BCR; trial primary endpoint) and development of distant metastases (DM) were performed with models including age and MMAI as continuous (per 0.1 increase) and categorical (ArteraAI pre-validated 3-tier risk groups) variables. The additional prognostic value of MMAI beyond UK-recommended Cambridge Prognostic Group (CPG) and NCCN risk group models was assessed by change in Concordance Index and Likelihood Ratio Test (LRT). Results: Of 1854 patients with centrally-reviewed pathology, 1797 (97%) had clinical data and H&E with sufficient tumour for MMAI analysis. Median follow up was 14.3 years. Patients were classified as MMAI High (129, 7.2%), Intermediate (885, 49.2%) or Low (783, 43.6%). In univariable analysis, high MMAI score was significantly associated with increased BCR risk, as both a categorical variable (MMAI High risk hazard ratio (HR) = 5.07, 95%CI = 3.77-6.81, p=<0.001, MMAI Intermediate-risk HR = 1.90, 1.52-2.36, p=<0.001), and continuous variable (MMAI raw score HR = 1.55, 1.44-1.67, p=<0.001). MMAI was also significantly associated with DM. Addition of MMAI to CPG and NCCN multivariable models significantly improves discrimination (C-index) and overall fit (change in LRT) for BCR and DM (Table 1). Conclusions: ArteraAI MMAI improves prediction of BCR and DM in CHHiP over standard criteria. This first large-scale external validation in a contemporary UK cohort of localised PCa with rigorously standardized care will inform future prospective trials of MMAI biomarker-guided PCa treatment selection. Endpoint Model C index (MMAI risk group) ΔLRT χ² (p) C index (MMAI raw score) ΔLRT χ² (p) BCR CPG + ageCPG + age + MMAI 0.620.65+0.03 p=<0.001 55.6 p=<0.001 0.620.67+0.05 p=<0.001 67.5 p=<0.001 BCR NCCN + ageNCCN + age + MMAI 0.590.64+0.05 p=<0.001 67.2 p=<0.001 0.590.66+0.07 p=<0.001 80.9 p=<0.001 DM CPG + ageCPG + age + MMAI 0.650.71+0.06 p=0.001 35.3 p=<0.001 0.650.73+0.08p=<0.001 47.0 p=<0.001 DM NCCN + ageNCCN + age + MMAI 0.610.70+0.09 p=<0.001 43.4 p=<0.001 0.610.72+0.11 p=<0.001 55.8 p=<0.001 Total, n=1794. Events BCR, n = 426 (23.7%), DM, n = 121 (6.7%).

Pseudomyogenic hemangioendothelioma (PMH) is an extremely rare intermediate-grade vascular neoplasm. It often arises in the distal extremities and characteristically involves multiple tissue planes. It has a male predominance, and usually affects individuals in the second to fourth decades of life. Here we report a 54-year-old man who presented with an occipital mass lasting for three months. On imaging studies, the occipital bone tumors were expansile, well circumscribed and lytic, accompanied by adjacent scalp and subcutaneous nodules, with marked enhancement of the lesion upon contrast administration. FDG PET/CT demonstrated high FDG affinity in the lesion. Surgical pathology diagnosed as PMH.

Posttraumatic stress disorder (PTSD) is a severe psychiatric condition associated with significant impairments in daily functioning. Although psychotherapy is the recommended first-line treatment, off-label psychotropic medications are frequently used. This study examined national treatment patterns and disparities in pediatric PTSD care using a large, diverse data set. We conducted a retrospective analysis of pediatric patients (ages: 6 to 18) diagnosed with PTSD (ICD-10: F43.1; N = 61,516) from the TriNetX Research Network. Treatment patterns were analyzed across demographic and clinical variables. Odds ratios (ORs), hazard ratios (HRs), and 95% CIs were calculated. The average age at diagnosis was 11.2 years (SD = 3.67), with females comprising 58.3% of the cohort. Mood disorders (59.2%), ADHD, and anxiety disorders were common comorbidities. Antidepressants were prescribed to 51.4% of patients, most commonly sertraline and fluoxetine. Antipsychotics were used in 30.5% of cases, but only 19.2% had prior psychotherapy. Overall, psychotherapy utilization was 35.5%. Black and Hispanic youth were less likely to receive most psychotropics, and Black youth had lower odds of receiving psychotherapy (OR: 0.85, 95% CI: 0.81-0.89), though antipsychotic use did not differ significantly. After controlling for confounders, greater clinical severity was associated with increased antipsychotic use (aHR: 2.79, 95% CI: 2.68-2.90). This study highlights substantial variability in pediatric PTSD care, including frequent psychotropic use, often preceding psychotherapy, and significant racial and ethnic disparities. These findings emphasize the need for standardized protocols, better access to evidence-based care, and targeted strategies to reduce inequities.

The opioid epidemic has created challenges in treating patients who inject drugs or those who are at risk of overdose due to psychiatric illnesses. Patients who self-inject into their vascular access devices (SIVADs) are at risk of infection, prolonged hospitalization, suboptimal care, overdose, or death. In response to incidents where patients have overdosed by SIVAD, the intravenous (IV) CareLock™ device was developed to prevent patients from accessing their IVs while still allowing providers to administer medications. We engaged a multidisciplinary team to analyze mitigation methods and perform a gap analysis to create a comprehensive protocol to reduce SIVAD. A multidisciplinary protocol identified patients at risk of SIVAD to guide the use of our IV CareLock™ device. This protocol prevented SIVAD while allowing providers to continue using the IV. Our novel device and protocol allowed providers to safely care for at-risk patients, reducing the potential for adverse outcomes.

This paper examines Pune’s evolving municipal wastewater management framework as a model for sustainable urban development policy in rapidly urbanising Indian cities. Through a comprehensive analysis of infrastructure expansion, technological innovation, and regulatory frameworks, we assess the effectiveness of decentralised treatment strategies in addressing urban environmental challenges. Our study reveals that despite significant infrastructure investments totalling ₹1,173 crore under the JICA-funded Project for Pollution Abatement of River Mula-Mutha (PARMM), Pune continues to face a 503 MLD daily treatment gap, with only 49% of generated sewage receiving treatment. Using a multi-parametric policy assessment, integrating performance data from 11 sewage treatment plants, policy documents, and environmental monitoring reports, the research finds that while technological diversification demonstrates promise, persistent funding delays, land acquisition disputes, and the "subsidy barrier" in water pricing threaten environmental sustainability outcomes. The research contributes to sustainable urban development literature by demonstrating how policy integration, technology choice, institutional coordination, and financial sustainability mechanisms determine wastewater management effectiveness.

To investigate the prevalence, risk factors, and protective measures of occupational contact dermatitis (OCD) among nurses in Hefei, China; create a predictive model for nurses' experiencing contact dermatitis; and assess the model's effectiveness. A cross-sectional survey using the Nordic Occupational Skin Questionnaire 2002 was conducted among 273 nurses at a hospital in Hefei, China, from December 2022 to February 2023. Predictive factors for nurses' contact dermatitis were identified through regression analyses. A predictive model, represented by a nomogram, was established based on these factors, and its predictive performance was evaluated by calibration curve and the decision curve analysis plot. Contact dermatitis was found among 20.51% of nurses. Those with allergies were 4.34 times more likely to develop OCD (95% CI = 2.29-8.24), whereas individuals with dry skin had a 2.82 times higher risk (95% CI = 1.07-7.47). Using protective gloves and uniforms reduced the risk by 50% to 60%. The established nomogram model exhibited an area under the receiver operating characteristic curve of 0.734 (95% CI = 0.661-0.807), demonstrated satisfactory calibration, and showed a favorable net benefit. Nurses with allergies or dry skin are more likely to develop OCD, but wearing gloves is a helpful preventive measure. The created model predicts nurses' OCD risk, which can identify high-risk individuals for early intervention.

This paper examines how chaos and order interact across evolutionary and cellular biology and the visual arts, proposing that creativity in both natural and artistic systems emerges from their dynamic tension. It presents a collaborative project in which a robotic drawing machine and a human painter co-created artworks, representing structured and unpredictable processes respectively. By comparing biological mechanisms such as mutation and repair with compositional strategies in visual art, the study positions chaos and order as universal design principles. The paper further demonstrates how these principles can be materially expressed in contemporary artistic practice, particularly through emerging AI-based and robotic technologies, and discusses their implications for future human�AI creative partnerships.