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This study introduces a physics-guided self-supervised framework for few-shot ultrasonic defect detection in concrete structures, addressing the dual challenges of scarce labels and domain variability in structural health monitoring (SHM). Our method integrates physics-informed augmentations, contrastive representation learning, and adversarial domain alignment within a mutually reinforcing cycle, enabling robust defect classification with minimal supervision. A Physics-Informed Augmentation Module synthesizes realistic ultrasonic signals, training a Transformer encoder to extract invariant features while suppressing sensor noise. An Adversarial Feature Aligner further improves cross-domain generalization by mitigating distribution shifts across heterogeneous concretes. Experimental validation on three benchmark datasets demonstrates 63–66% accuracy in one-shot cross-domain tasks and up to 89% in five-shot settings. These results represent 12–15 percentage point gains over modern few-shot baselines, with improvements statistically significant at p < 0.001. Compatible with existing ultrasonic hardware, the proposed framework bridges physics-based modeling and machine learning while paving the way for scalable, field-ready SHM solutions for aging infrastructure and resilient smart cities.

This study proposes a field-calibrated, NDT-integrated BIM modeling framework to improve the reliability of post-earthquake assessment for reinforced concrete (RC) buildings. The approach combines destructive and nondestructive testing (NDT) data—including core drilling, Schmidt hammer, ultrasonic pulse velocity (UPV), and Windsor probe—through a site-specific WinSonReb regression model. The calibrated material properties (average compressive strength ≈ 18.6 MPa, CoV > 20%) were embedded into a Building Information Modeling (BIM) environment, producing an as-is, NDT-calibrated BIM model representing a Level-2 static digital twin of the structure. Nonlinear static pushover analyses performed in accordance with TBDY-2018 and ASCE 41-17 showed that the calibrated model exhibits a fundamental period of 0.85 s—approximately 18% longer than the uncalibrated BIM model. This elongation increased displacement demand and caused a shift in performance classification: while the uncalibrated model indicated Life Safety (LS), the calibrated model predicted behavior approaching Collapse Prevention (CP) in the Y direction. Furthermore, calibration reversed the predicted damage hierarchy, from ductile beam hinging to brittle column- and wall-controlled failure near elevator openings, consistent with post-event observations from the 2023 Kahramanmaraş earthquakes. These results demonstrate that integrating field-calibrated NDT data into BIM-based seismic models fundamentally alters both strength estimation and failure-mechanism prediction, reducing epistemic uncertainty and providing a more conservative basis for retrofit prioritization. Although demonstrated on a single case study, the proposed workflow offers a realistic and scalable pathway for NDT-supported seismic performance assessment of existing RC buildings.

INTRODUCTION:Older adults with inflammatory bowel disease (IBD) are at higher risk for postoperative complications as compared to their younger counterparts; however, factors contributing to this are unknown. We assessed risk factors associated with adverse IBD-related surgical outcomes, evaluated trends in emergency surgery, and explored differential risks by age.METHODS:Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified adults ≥18 years of age who underwent an IBD-related intestinal resection from 2005 to 2019. Our primary outcome included a 30-day composite of mortality, readmission, reoperation, and/or major postoperative complication.RESULTS:Overall, 49,746 intestinal resections were performed with 9,390 (18.8%) occurring among older adults with IBD. Nearly 37% of older adults experienced an adverse outcome as compared to 28.1% among younger adults with IBD (P < 0.01). Among all adults with IBD, the presence of preoperative sepsis (adjusted odds ratio [aOR], 2.08; 95% confidence interval [CI] 1.94-2.24), malnutrition (aOR, 1.22; 95% CI 1.14-1.31), dependent functional status (aOR, 6.92; 95% CI 4.36-11.57), and requiring emergency surgery (aOR, 1.50; 95% CI 1.38-1.64) increased the odds of an adverse postoperative outcome, with similar results observed when stratifying by age. Furthermore, 8.8% of surgeries among older adults were emergent, with no change observed over time (P = 0.16).DISCUSSION:Preoperative factors contributing to the risk of an adverse surgical outcome are similar between younger and older individuals with IBD, and include elements such as malnutrition and functional status. Incorporating these measures into surgical decision-making can reduce surgical delays in older individuals at low risk and help target interventions in those at high risk, transforming care for thousands of older adults with IBD.

Robotic platforms are being adopted in surgery at an increasingly rapid pace, with implications for the field of general surgery and residency training. This evolution has prompted discussion on the ideal methods used to train current surgical residents in the use of robotic platforms.The colorectal surgery department at our institution has implemented a standardized robotic surgery curriculum designed to establish clear expectations for residents’ progression, autonomy, and the skills that should be acquired by the conclusion of their training. The curriculum outlines key surgical objectives, representing essential steps that require distinct skills and anatomical knowledge, organized by postgraduate year level as a general guide to the resident’s ability.The goals of this standardized curriculum include increasing resident engagement in acquiring robotic skills, dividing complete procedures into manageable steps and objectives, and promoting faculty participation to allow residents to operate independently, within defined competency levels. Upon completion of the curriculum, residents report confidence in performing common robotic colorectal surgeries.We aim to expand the implementation of this curriculum model to other departments within our institution and encourage the adoption of similar standardized robotic training by other academic centers in this new era of robotic surgery.To underscore the benefits and importance of a standardized robotic surgery curriculum for residents with our experience in the division of colorectal surgery.

A mechanical obstruction is not a physiological entity, and when it occurs within the 30-day postoperative period, it is called an early postoperative small bowel obstruction. Kinking of small bowel segments at the ileostomy outlet secondary to a distended bladder is an unusual source of early postoperative small bowel obstruction. A 36-year-old female underwent a redo J-Pouch surgery and creation of loop ileostomy after pouch failure related to recurrent small bowel obstruction and perianal fistulae. Her foley catheter was removed on postoperative day 3 and she passed a trial of void test. On postoperative day 6, the abdomen became progressively more distended. Computerized tomography (CT) imaging with IV contrast showed small bowel distension extending to the midline anterior to the urinary bladder where it demonstrated a narrowed lumen. These findings were thought to be the cause of small bowel obstruction at this level before the ileostomy. Immediately after CT, a foley catheter was applied with which 2 L of urine was removed, and consequently, gas and stool were observed in the ostomy soon thereafter. Although rare, urinary retention may cause intestinal obstruction, especially in the presence of a loop ileostomy in close proximity.

Background Carbon-monoxide (CO) poisoning is a substantial cause of preventable mortality. In Turkey, no nationwide data are being collected nowadays. In our study, we aimed to assess the trend in deaths related to CO exposure in all provinces of Turkey in a 10-year period by using the records of a news agency which collects the news from the majority of the national newspapers, local newspapers and television channels. Methods In this study, 27,881 news items that were released between January 2008 to December 2017 which included keywords of “poisoning” and “death” or “carbon monoxide” and “death” were evaluated. 2667 non-fire related deaths were used in the final analyses. Results In a 10-year period, the risk of CO-related death in Turkey was 0.35/100000. 1371 (51.4%) of the victims were male and the median age of the patients was 45 years (range, 15 days-108 years). Most of the deaths occurred ≥50 years of age. Stoves were the predominant source [ n  = 2096 (78.6%)]. There was a stagnating trend of CO-related deaths. Most of the incidents occurred in winter. The Middle Anatolian region was of the highest risk in CO-related mortality. Conclusions In conclusion, CO poisoning is still a considerable public health concern in Turkey. Results of our study showed that stoves are still frequently being used and are the cause of death especially in rural areas with lower socioeconomic status. A better organized, nationwide surveillance and management approaches are needed to demonstrate the true burden CO related morbidity and mortality as well as its prevention in Turkey.

In patients with failing ileo-anal pouches there is often diagnostic uncertainty. In this setting, we may offer revisional pouch surgery with biologic \"coverage\" for presumed Crohn's disease (CD) which enables an alternative to pouch excision and end ileostomy to highly motivated patients. The aim of this study is to assess postoperative outcomes in patients who underwent revisional/redo ileal pouch anal anastomosis (IPAA) for failing pouches with biologic coverage for possible CD. This is a retrospective cross-sectional study based on data from a tertiary inflammatory bowel disease center. Patients who underwent revisional/redo IPAA surgery between September 2016 and December 2022 were included. The primary outcome measure was the rate of functioning pouch. Of the 213 patients who underwent revisional/redo IPAA surgery, 17 underwent redo IPAA surgery with biologic coverage due to concern for CD. An additional seven patients were started on biologics between the two operative stages of redo IPAA surgery. At a median follow-up of 17 months, the functioning pouch rate was 75%. Revisional IPAA surgery for suspected CD-related complications leading to pouch failure, in conjunction with concurrent medical therapy, provides a stoma-free alternative to patients otherwise facing pouch excision and end ileostomy. Despite the limited number of patients and varying follow-up times, this approach shows promise for maintaining pouch function in a challenging patient population.

Abstract Background Many patients with Crohn’s disease (CD) require fecal diversion. To understand the long-term outcomes, we performed a multicenter review of the experience with retained excluded rectums. Methods We reviewed the medical records of all CD patients between 1990 and 2014 who had undergone diversionary surgery with retention of the excluded rectum for at least 6 months and who had at least 2 years of postoperative follow-up. Results From all the CD patients in the institutions’ databases, there were 197 who met all our inclusion criteria. A total of 92 (46.7%) of 197 patients ultimately underwent subsequent proctectomy, while 105 (53.3%) still had retained rectums at time of last follow-up. Among these 105 patients with retained rectums, 50 (47.6%) underwent reanastomosis, while the other 55 (52.4%) retained excluded rectums. Of these 55 patients whose rectums remained excluded, 20 (36.4%) were symptom-free, but the other 35 (63.6%) were symptomatic. Among the 50 patients who had been reconnected, 28 (56%) were symptom-free, while 22(44%) were symptomatic. From our entire cohort of 197 cases, 149 (75.6%) either ultimately lost their rectums or remained symptomatic with retained rectums, while only 28 (14.2%) of 197, and only 4 (5.9%) of 66 with initial perianal disease, were able to achieve reanastomosis without further problems. Four patients developed anorectal dysplasia or cancer. Conclusions In this multicenter cohort of patients with CD who had fecal diversion, fewer than 15%, and only 6% with perianal disease, achieved reanastomosis without experiencing disease persistence. Lay Summary Patients with distal Crohn’s disease often undergo colon resection with a stoma to divert the intestinal stream from the rectum in hopes of achieving sufficient healing to allow ultimate re-establishment of intestinal continuity. Patients and practitioners alike should be aware of the long-term success rates of this procedure. Our retrospective study of 197 patients found that half required later proctectomy and an additional one-quarter remained symptomatic with excluded rectums. Only 14% remained symptom-free after reanastomosis, and only 6% if perianal disease was the initial surgical indication. These data provide estimation of long-term surgical outcomes.