AMPEC4: Naja ashei Venom-Derived Peptide as a Stimulator of Fibroblast Migration with Antibacterial Activity

The treatment of proctological conditions, including hemorrhoids, anal fissures, and perianal abscesses, is often complicated by bacterial infections, particularly those involving multidrug-resistant Escherichia coli. This study presents the synthesis, characterization, and biological evaluation of the newly designed synthetic peptide AMPEC4, inspired by cytotoxin 5 from Naja ashei snake venom. AMPEC4 demonstrated potent antimicrobial properties with MIC values of 100 and 200 µg/mL, effectively inhibiting biofilm formation (up to 84%) and eradicating the pre-formed biofilm by up to 35%. The antibacterial activity of AMPEC4 was further supported by a membrane permeabilization assay, demonstrating its capacity to disrupt bacterial membrane integrity in a dose-dependent manner. Furthermore, AMPEC4 significantly promoted fibroblast migration, a critical step in tissue regeneration, while exhibiting notable biocompatibility, as evidenced by the absence of hemolytic, cytotoxic, and genotoxic effects. By addressing both infection control and tissue regeneration, AMPEC4 represents a promising therapeutic strategy for managing chronic wounds, particularly in the challenging environment of the anorectal region. Its ability to target Escherichia coli reference and clinical strains while accelerating the wound-healing process underscores its potential for future clinical applications.

[Rethinking scientific integrity in plastic surgery: Reflections on editorial and institutional responsibilities]

Plastic surgery, by nature an innovative discipline, has historically relied on clinical case reports to advance its techniques. Often unique, these cases are a valuable vehicle for disseminating breakthroughs - especially in a field marked by highly individualized practices and artisanal surgical approaches, where randomized trials are often impractical. However, this reliance on case reports raises significant ethical concerns. In multidisciplinary settings, attribution of contributions often remains ambiguous. Misconduct, such as unauthorized publications or omission of institutional recognition, threatens the integrity of scientific output. As artificial intelligence reshapes biomedical research - automating literature reviews and meta-analyses - original case reports, by their singularity, escape these predictive models. Their heuristic value fully justifies their inclusion within the spectrum of scientific evidence. For this reason, their publication must be tightly regulated. Redefining publication standards in our field is essential. This includes the systematic application of international guidelines (CARE, SCARE, STROBE, GRIPP2), mandatory institutional approval before submission, formal training in research ethics for junior staff, and full transparency regarding patient consent and authorship attribution. When rigorous, novel, and well-contextualized, the clinical case remains a cornerstone of surgical progress. By safeguarding it from opportunistic misuse, we preserve its scientific and educational value.

CT-based AI framework leveraging multi-scale features for predicting pathological grade and Ki67 index in clear cell renal cell carcinoma: a multicenter study

PURPOSE

To explore whether a CT-based AI framework, leveraging multi-scale features, can offer a non-invasive approach to accurately predict pathological grade and Ki67 index in clear cell renal cell carcinoma (ccRCC).

METHODS

In this multicenter retrospective study, a total of 1073 pathologically confirmed ccRCC patients from seven cohorts were split into internal cohorts (training and validation sets) and an external test set. The AI framework comprised an image processor, a 3D-kidney and tumor segmentation model by 3D-UNet, a multi-scale features extractor built upon unsupervised learning, and a multi-task classifier utilizing XGBoost. A quantitative model interpretation technique, known as SHapley Additive exPlanations (SHAP), was employed to explore the contribution of multi-scale features.

RESULTS

The 3D-UNet model showed excellent performance in segmenting both the kidney and tumor regions, with Dice coefficients exceeding 0.92. The proposed multi-scale features model exhibited strong predictive capability for pathological grading and Ki67 index, with AUROC values of 0.84 and 0.87, respectively, in the internal validation set, and 0.82 and 0.82, respectively, in the external test set. The SHAP results demonstrated that features from radiomics, the 3D Auto-Encoder, and dimensionality reduction all made significant contributions to both prediction tasks.

CONCLUSIONS

The proposed AI framework, leveraging multi-scale features, accurately predicts the pathological grade and Ki67 index of ccRCC.

CRITICAL RELEVANCE STATEMENT

The CT-based AI framework leveraging multi-scale features offers a promising avenue for accurately predicting the pathological grade and Ki67 index of ccRCC preoperatively, indicating a direction for non-invasive assessment.

KEY POINTS

Non-invasively determining pathological grade and Ki67 index in ccRCC could guide treatment decisions. The AI framework integrates segmentation, classification, and model interpretation, enabling fully automated analysis. The AI framework enables non-invasive preoperative detection of high-risk tumors, assisting clinical decision-making.

Global, regional, and national trends in peripheral arterial disease among older adults: findings from the global burden of disease study 2021

IMPORTANCE

Lower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life.

OBJECTIVE

To evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older.

EXPOSURE

Lower extremity PAD among older adults from January 1990 to December 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes.

RESULTS

From 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking's contribution decreased.

CONCLUSIONS AND RELEVANCE

This study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

Case Report: Based on the diamond theory, successful treatment of stubborn tibial nonunion after six surgeries using PRP-augmented therapy: a case report and literature review

Background

The treatment of stubborn tibial nonunion remains a significant challenge. This case report describes a patient who underwent six surgeries and was treated using a stepwise surgical approach based on the diamond theory. The application of platelet-rich plasma (PRP) enhanced autologous iliac bone grafting combined with locked compression plate fixation ultimately achieved successful healing. This study also reviews relevant literature to explore the treatment experiences and outcomes of similar cases.

Patient and methods

A middle-aged Asian male with severe heart disease underwent five failed surgeries, including two autologous bone graft procedures. Clinically, he presented with right calf pain, poor soft tissue condition on the anterior medial tibia, and signs of nonunion. During the sixth surgery, we applied a stepwise surgical procedure based on the diamond theory, achieving excellent clinical and bone healing, as well as satisfactory limb function at a follow-up of 11.3 months post-operation.

Conclusion

We utilized a stepwise surgical procedure based on the diamond theory: locked compression plate internal fixation, PRP-enhanced structural autologous iliac bone grafting, and bioactive center creation techniques, providing a strong and stable mechanical and superior biological environment for the nonunion site.

SEMTWIST Quantification of Biofilm Infection in Human Chronic Wound Using Scanning Electron Microscopy and Machine Learning

Objective: To develop scanning electron microscopy-based Trainable Weka (Waikato Environment for Knowledge Analysis) Intelligent Segmentation Technology (SEMTWIST), an open-source software tool, for structural detection and rigorous quantification of wound biofilm aggregates in complex human wound tissue matrix. Approach: SEMTWIST model was standardized to quantify biofilm infection (BFI) abundance in 240 distinct SEM images from 60 human chronic wound-edge biospecimens (four technical replicates of each specimen). Results from SEMTWIST were compared against human expert assessments and the gold standard for molecular BFI detection, that is, peptide nucleic acid fluorescence in situ hybridization (PNA-FISH). Results: Correlation and Bland-Altman plot demonstrated a robust correlation (r = 0.82, p < 0.01), with a mean bias of 1.25, and 95% limit of agreement ranging from -43.40 to 47.11, between SEMTWIST result and the average scores assigned by trained human experts. While interexpert variability highlighted potential bias in manual assessments, SEMTWIST provided consistent results. Bacterial culture detected infection but not biofilm aggregates. Whereas the wheat germ agglutinin staining exhibited nonspecific staining of host tissue components and failed to provide a specific identification of BFI. The molecular identification of biofilm aggregates using PNA-FISH was comparable with SEMTWIST, highlighting the robustness of the developed approach. Innovation: This study introduces a novel approach "SEMTWIST" for in-depth analysis and precise differentiation of biofilm aggregates from host tissue elements, enabling accurate quantification of BFI in chronic wound SEM images. Conclusion: Open-source SEMTWIST offers a reliable and robust framework for standardized quantification of BFI burden in human chronic wound-edge tissues, supporting clinical diagnosis and guiding treatment.

Ionic Liquid-Reinforced Multifunctional Hydrogel for the Treatment of Enterocutaneous Fistula

Enterocutaneous fistulas (ECFs) profoundly impact patients' quality of life, contributing to high morbidity rates and increased mortality due to ineffective treatment options. To address this challenge, ECFGel, a multifunctional, tissue adhesive injectable hydrogel, designed to occlude, sterilize, and promote healing of ECF tracts, is developed. ECFGel is formulated using gelatin and oxidized dextran (O-Dex) as base components, which form chemical crosslinks within the hydrogel and with surrounding biological tissues, ensuring tissue adhesiveness. A choline and geranate-based ionic liquid (IL) is incorporated to provide dual functionality, potent antimicrobial activity, and mechanical enhancement. By optimizing IL concentration, ECFGel achieves rapid gelation, enhanced mechanical strength, and improved elastic recoverability. Additionally, iohexol (IOH) is added for radiopacity, enabling real-time imaging and further strengthening the hydrogel's mechanical properties. ECFGel demonstrates antiswelling properties, biodegradability, and effective tract occlusion in porcine soft tissues. It shows strong antimicrobial activity against highly resistant, patient-derived pathogens isolated from clinical ECF cases. In a porcine perianal fistula model, ECFGel enables rapid occlusion and complete healing, promoting tissue maturation, reducing bacterial load, and increasing markers of cell proliferation and vascularization compared to untreated controls. These promising results highlight ECFGel's potential as a new therapeutic option for treating infected ECFs.

Machine learning model to predict sepsis in ICU patients with intracerebral hemorrhage

Patients with intracerebral hemorrhage (ICH) are highly susceptible to sepsis. This study evaluates the efficacy of machine learning (ML) models in predicting sepsis risk in intensive care units (ICUs) patients with ICH. We conducted a retrospective analysis on ICH patients using the MIMIC-IV database, randomly dividing them into training and validation cohorts. We identified sepsis prognostic factors using Least Absolute Shrinkage and Selection Operator (LASSO) and backward stepwise logistic regression. Several machine learning algorithms were developed and assessed for predictive accuracy, with external validation performed using the eICU Collaborative Research Database (eICU-CRD). We analyzed 2,214 patients, including 1,550 in the training set, 664 in the validation set, and 513 for external validation using the eICU-CRD. The Random Forest (RF) model outperformed others, achieving Area Under the Curves (AUCs) of 0.912 in training, 0.832 in internal validation, and 0.798 in external validation. Neural Network and Logistic Regression models recorded training AUCs of 0.840 and 0.804, respectively. ML models, especially the RF model, effectively predict sepsis in ICU patients with ICH, enabling early identification and management of high-risk cases.

The molecular mechanism and therapeutic landscape of copper and cuproptosis in cancer

Copper, an essential micronutrient, plays significant roles in numerous biological functions. Recent studies have identified imbalances in copper homeostasis across various cancers, along with the emergence of cuproptosis, a novel copper-dependent form of cell death that is crucial for tumor suppression and therapeutic resistance. As a result, manipulating copper levels has garnered increasing interest as an innovative approach to cancer therapy. In this review, we first delineate copper homeostasis at both cellular and systemic levels, clarifying copper's protumorigenic and antitumorigenic functions in cancer. We then outline the key milestones and molecular mechanisms of cuproptosis, including both mitochondria-dependent and independent pathways. Next, we explore the roles of cuproptosis in cancer biology, as well as the interactions mediated by cuproptosis between cancer cells and the immune system. We also summarize emerging therapeutic opportunities targeting copper and discuss the clinical associations of cuproptosis-related genes. Finally, we examine potential biomarkers for cuproptosis and put forward the existing challenges and future prospects for leveraging cuproptosis in cancer therapy. Overall, this review enhances our understanding of the molecular mechanisms and therapeutic landscape of copper and cuproptosis in cancer, highlighting the potential of copper- or cuproptosis-based therapies for cancer treatment.

Addressing Temporal Muscle Atrophy and Enhancing Cranioplasty Outcome: A Technical Note

BACKGROUND AND OBJECTIVES

Decompressive craniectomy (DC) is a critical surgical intervention for reducing elevated intracranial pressure. However, subsequent cranioplasty (CP) can be complicated by adhesions between anatomic layers, particularly the temporalis muscle (TM), dura mater, and brain surface. A dual-layer dural substitute during DC can help prevent these adhesions, improving CP outcomes.

METHODS

In this three-year prospective multicenter study, 59 patients underwent DC followed by CP. A dual-layer dural substitute was placed between the TM and dura mater (and sometimes the subcutaneous layer) during DC. Outcomes evaluated included adhesion formation, ease of dissection during CP, and overall functional results.

RESULTS

No infections or wound complications were reported. The dual-layer technique significantly reduced adhesions in the muscle-cutaneous flap layers, facilitating TM elevation during CP. This resulted in minimal fibrotic adhesions, no change in TM thickness postoperatively, significantly shorter operative times, negligible blood loss, and a 0% rate of postoperative CP-related epilepsy.

CONCLUSION

Using a dual-layer dural substitute during DC effectively prevents adhesion formation, reducing wound healing complications. This technique improves subsequent CP success by facilitating TM elevation, preserving its function, and protecting underlying brain structures. It also shortens surgical time, minimizes blood loss, reduces hospital stays, and lowers postoperative epilepsy rates.

CT-based quantification of intratumoral heterogeneity for predicting distant metastasis in retroperitoneal sarcoma

OBJECTIVES

Retroperitoneal sarcoma (RPS) is highly heterogeneous, leading to different risks of distant metastasis (DM) among patients with the same clinical stage. This study aims to develop a quantitative method for assessing intratumoral heterogeneity (ITH) using preoperative contrast-enhanced CT (CECT) scans and evaluate its ability to predict DM risk.

METHODS

We conducted a retrospective analysis of 274 PRS patients who underwent complete surgical resection and were monitored for ≥ 36 months at two centers. Conventional radiomics (C-radiomics), ITH radiomics, and deep-learning (DL) features were extracted from the preoperative CECT scans and developed single-modality models. Clinical indicators and high-throughput CECT features were integrated to develop a combined model for predicting DM. The performance of the models was evaluated by measuring the receiver operating characteristic curve and Harrell's concordance index (C-index). Distant metastasis-free survival (DMFS) was also predicted to further assess survival benefits.

RESULTS

The ITH model demonstrated satisfactory predictive capability for DM in internal and external validation cohorts (AUC: 0.735, 0.765; C-index: 0.691, 0.729). The combined model that combined clinicoradiological variables, ITH-score, and DL-score achieved the best predictive performance in internal and external validation cohorts (AUC: 0.864, 0.801; C-index: 0.770, 0.752), successfully stratified patients into high- and low-risk groups for DM (p < 0.05).

CONCLUSIONS

The combined model demonstrated promising potential for accurately predicting the DM risk and stratifying the DMFS risk in RPS patients undergoing complete surgical resection, providing a valuable tool for guiding treatment decisions and follow-up strategies.

CRITICAL RELEVANCE STATEMENT

The intratumoral heterogeneity analysis facilitates the identification of high-risk retroperitoneal sarcoma patients prone to distant metastasis and poor prognoses, enabling the selection of candidates for more aggressive surgical and post-surgical interventions.

KEY POINTS

Preoperative identification of retroperitoneal sarcoma (RPS) with a high potential for distant metastasis (DM) is crucial for targeted interventional strategies. Quantitative assessment of intratumoral heterogeneity achieved reasonable performance for predicting DM. The integrated model combining clinicoradiological variables, ITH radiomics, and deep-learning features effectively predicted distant metastasis-free survival.

Perioperative and long-term outcomes of surgical treatment for penetrating aortic ulcer in the aortic arch: A retrospective cohort analysis

OBJECTIVE

This study was designed to evaluate the perioperative and long-term outcomes of surgical treatment, including open and hybrid repairs, for patients with penetrating aortic ulcer (PAU) in the aortic arch.

METHODS

A single-center retrospective analysis from China was conducted on 72 patients with PAU in the aortic arch who underwent surgical treatment including open and hybrid repairs between January 2010 and December 2022. The study included 10 patients in the urgent repair group and 62 patients in the elective repair group. The primary endpoints included major adverse events and long-term survival. Major adverse events included in-hospital mortality, reoperation for bleeding, stroke, paraplegia, and acute renal failure.

RESULTS

The rate of major adverse events was 13.9 ​% (10/72), with an in-hospital mortality rate of 2.8 ​% (2/72). The mean follow-up period was 69 months. The overall survival rates at 1, 5, and 7 years after surgery were 95.8 ​%, 91.8 ​%, and 86.0 ​%, respectively. Subgroup and regression analyses showed that urgent repair was not significantly associated with the occurrence of major adverse events and long-term survival. Age (OR: 1.12, 95 ​% CI: 1.00-1.26; P ​= ​0.042) and diabetes (OR: 5.98, 95 ​% CI: 1.01-35.32; P ​= ​0.048) were found to be independent risk factors for major adverse events as well as NYHA grade ​≥ ​III (HR: 14.68, 95 ​% CI: 2.11-102.10; P ​= ​0.007) and diabetes (HR: 5.39, 95 ​% CI: 1.10-26.37; P ​= ​0.038) proved to be independent risk factors for overall survival. Compared to the elective repair group, patients who underwent urgent repair had larger PAUs (P ​= ​0.052), more frequent localization in Zone 0 or Zone 1 (P ​= ​0.038), and were more likely to undergo open surgery, particularly total arch replacement with frozen elephant trunk (P ​= ​0.001). They also experienced longer cardiopulmonary bypass time (P ​= ​0.004), lower minimum temperature (P ​= ​0.001), and lower total expenditure (P ​< ​0.001).

CONCLUSIONS

The surgical management of PAU in the aortic arch using open or hybrid repair techniques appears to be feasible, with favorable perioperative and long-term outcomes. However, heightened vigilance may be required for elderly patients, diabetic patients, and those with cardiac insufficiency.

Outcomes and safety of repeated microvascular decompression for recurrent trigeminal neuralgia

OBJECTIVE

Recurrent Trigeminal Neuralgia (TN) poses significant challenges for treatment, often necessitating repeated Microvascular Decompression (MVD). This study aims to evaluate the safety, efficacy, and prognostic factors associated with repeated MVD for recurrent TN at our institution. A retrospective review was conducted on 147 patients who underwent repeated MVD between September 2010 and September 2023. Data on surgical procedures, postoperative outcomes, and recurrence rates were collected. The primary endpoint was recurrent pain. Univariate and multivariate Cox proportional hazards analyses were used to identify predictors of pain recurrence. In this cohort, 147 patients underwent revision surgery, comprising 97 females and 50 males. The primary reason for the nonresolution in 96 patients was adhesions of Teflon pledgets to the trigeminal nerve, while in 51 patients, previously missed vascular compression was identified. After a median follow-up of 53.3 months, 14 patients were lost to follow-up. Twelve patients (9.0%) reported no pain relief after repeated MVD, while 121 patients (91.0%) achieved complete pain relief. The most common complication was facial numbness, occurring in 101 cases (68.7%), followed by blurred vision (11 patients, 7.5%), hearing impairment (8 patients, 5.4%), poor wound healing (2 patients, 1.4%), postoperative stroke confirmed by CT imaging (2 patients, 1.4%) and permanent ataxia (2 patients, 1.4%). The mortality rate for repeated MVD at our center was zero. Twenty-four patients (19.8%) experienced pain recurrence, with a median pain-free survival (PFS) of 36.0 months. The 5- and 10-year PFS rates were 80.8% and 54.5%, respectively. Patients who underwent combined partial sensory rhizotomy (PSR) and MVD (Hazard Ratio [HR] 0.203, 95% Confidence Interval [CI] 0.047-0.882, p = 0.033) or circumferential dissection and MVD (HR 0.295, 95% CI 0.099-0.882, p = 0.029) had lower recurrence rates compared to MVD alone. Long-term facial numbness was the most common complication, particularly in patients undergoing PSR. Repeated MVD is effective and safe for recurrent TN. PSR with MVD is associated with lower rate of TN recurrence but increases the risk of facial numbness. Conversely, circumferential dissection is associated with lower recurrence rates without increasing postoperative facial numbness.

CLINICAL TRIAL NUMBER

Not applicable.

Predicting treatment response to systemic therapy in advanced gallbladder cancer using multiphase enhanced CT images

BACKGROUND

Accurate estimation of treatment response can help clinicians identify patients who would potentially benefit from systemic therapy. This study aimed to develop and externally validate a model for predicting treatment response to systemic therapy in advanced gallbladder cancer (GBC).

METHODS

We recruited 399 eligible GBC patients across four institutions. Multivariable logistic regression analysis was performed to identify independent clinical factors related to therapeutic efficacy. This deep learning (DL) radiomics signature was developed for predicting treatment response using multiphase enhanced CT images. Then, the DL radiomic-clinical (DLRSC) model was built by combining the DL signature and significant clinical factors, and its predictive performance was evaluated using area under the curve (AUC). Gradient-weighted class activation mapping analysis was performed to help clinicians better understand the predictive results. Furthermore, patients were stratified into low- and high-score groups by the DLRSC model. The progression-free survival (PFS) and overall survival (OS) between the two different groups were compared.

RESULTS

Multivariable analysis revealed that tumor size was a significant predictor of efficacy. The DLRSC model showed great predictive performance, with AUCs of 0.86 (95% CI, 0.82-0.89) and 0.84 (95% CI, 0.80-0.87) in the internal and external test datasets, respectively. This model showed great discrimination, calibration, and clinical utility. Moreover, Kaplan-Meier survival analysis revealed that low-score group patients who were insensitive to systemic therapy predicted by the DLRSC model had worse PFS and OS.

CONCLUSION

The DLRSC model allows for predicting treatment response in advanced GBC patients receiving systemic therapy. The survival benefit provided by the DLRSC model was also assessed.

KEY POINTS

Question No effective tools exist for identifying patients who would potentially benefit from systemic therapy in clinical practice. Findings Our combined model allows for predicting treatment response to systemic therapy in advanced gallbladder cancer. Clinical relevance With the help of this model, clinicians could inform patients of the risk of potential ineffective treatment. Such a strategy can reduce unnecessary adverse events and effectively help reallocate societal healthcare resources.

Novel classification for microspherophakia and its related surgical implications: a retrospective cohort study

BACKGROUND

A novel classification for microspherophakia (MSP) was developed using a nomogram model to stratify patients and evaluate surgical outcomes.

METHODS

The study involved 99 eyes from 64 MSP patients, divided into training (64 eyes) and validation (35 eyes) cohorts. Primary outcome included the best corrected distance visual acuity (BCVA) at the 1-year follow-up, and the secondary outcome was intraocular pressure (IOP) control. MSP patients achieving a BCVA of ≤0.2 logarithm of the minimal angle of resolution with successful IOP control were categorised into the favourable outcomes group, while those not meeting these criteria were placed in the unfavourable outcomes group. A nomogram model was constructed to predict unfavourable outcomes by identifying associated risk factors.

RESULTS

In the training cohort, 39.06% (25/64) achieved favourable outcomes, while 60.94% (39/64) had unfavourable outcomes. Decreased anterior chamber depth (ACD) and the presence of glaucoma were identified as risk factors for predicting unfavourable outcomes. The concordance index for the training and validation cohorts was 0.828 and 0.768, respectively. A nomogram-derived cut-off value of 56 points stratified patients into low-risk (≤56 points) and high-risk (>56 points) groups. Postoperative BCVA was significantly better in the low-risk group at 6-month and 1-year follow-ups.

CONCLUSION

MSP patients in the low-risk group achieved satisfactory outcomes. For high-risk patients with shallowing ACD, early surgical intervention is recommended to prevent secondary glaucoma. Close monitoring of IOP and glaucoma progression is crucial for patients with secondary glaucoma. This classification offers valuable insights for outcome stratification and guidance in clinical decision-making for MSP management. However, the limitations of this study include its small sample size, which may impact generalisability, and future studies with larger cohorts are needed to validate and refine the nomogram.

Clinical comparison of percutaneous endoscopic interlaminar vs. unilateral biportal endoscopic discectomy for lumbar disc herniation: a retrospective study

This study investigated the comparative effectiveness of unilateral biportal endoscopic discectomy (UBED) and percutaneous endoscopic lumbar discectomy (PELD) in managing lumbar disc herniation (LDH). Clinical data from 146 LDH patients treated surgically at the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine (January 2020-January 2023) were retrospectively analyzed. Patients were categorized into UBED (n = 84) and PELD (n = 62) groups. Key metrics such as surgical time, incision length, fluoroscopy frequency, blood loss, hospital stay, complications, visual analog scale (VAS) scores, and the Oswestry Disability Index (ODI) were compared. The average age of patients in the UBED group was 53.46 ± 15.60 years, whereas the average age of patients in the PELD group was 55.61 ± 15.52 years (P = 0.411). Their BMI was 24.17 ± 2.94 and 23.90 ± 2.61, respectively (P = 0.558). The duration of symptoms was 10.52 ± 5.23 months in the UBED group and 11.66 ± 6.02 months in the PELD group (P = 0.225). The surgical time was 66.67 ± 15.83 min in the UBED group and 69.11 ± 25.84 min in the PELD group (P = 0.481). Intraoperative blood loss was 76.81 ± 26.74 ml in the UBED group and 69.44 ± 25.74 ml in the PELD group (P = 0.096). The hospital stay was 5.39 ± 1.83 days in the UBED group and 5.11 ± 3.42 days in the PELD group (P = 0.525). The average follow-up time was 16.46 ± 4.52 months in the UBED group and 15.71 ± 3.83 months in the PELD group (P = 0.289). Compared with those before the operation, the VAS score, JOA score, and ODI of both groups significantly improved on the first day postoperatively, at 3 months, and at 6 months. No significant intergroup differences were noted in terms of intraoperative blood loss, hospital stay, or postoperative functional scores. Both groups showed marked postoperative improvements in functional outcomes. The postoperative satisfaction rates of patients in the UBED group and PELD group were 91.7% and 87.1%, respectively. Notably, the UBED group demonstrated a reduced fluoroscopy frequency and significantly lower rates of complications and recurrence. In terms of imaging, the disc Height of the two groups of patients showed a slight decrease after surgery, whereas the spinal canal area increased compared to before surgery, and there was no difference between the groups. UBED and PELD effectively alleviate LDH symptoms, but UBED has advantages in reducing fluoroscopy dependence, complications, and recurrence.

Global burden of colon and rectal cancer and attributable risk factors in 204 countries and territories from 1990 to 2021

OBJECTIVE

Colon and rectal cancers (CRCs) are among the most common malignancies worldwide. While previous studies have examined the disease burden and risk factors of CRC at regional levels, they lack the granularity needed for country-specific policy development. Using updated data from the Global Burden of Disease (GBD) 2021 study, this research explores the national-level spatial distribution of CRC burdens linked to key risk factors and analyzes temporal trends in their contributions. The findings aim to support the formulation of precise public health policies to effectively reduce CRC incidence.

METHODS

Based on data from the GBD study 2021, we examined CRC-related incidence, prevalence, mortality, disability-adjusted life years (DALYs), and associated risk factors. Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and DALY rate (ASDR) were obtained and analyzed from 1990 to 2021. We used regression analysis and stratification across the four World Bank regions to assess geographical variations and the effect of economic development levels. We further assessed the contribution of various risk factors to CRC-related deaths and DALYs, while analyzing the distribution and temporal trends of the top three contributing risk factors.

RESULTS

On a global scale, the ASDR for CRC declined from 357.33 per 100,000 in 1990 to 283.24 per 100,000 in 2021 (95% confidence interval [CI]: -0.82 to -0.64). In 2021, the regions classified by the World Bank as high income exhibited the highest ASDR in 2021, at 347.35 per 100,000, while the lower-middle-income regions reported the lowest ASDR, at 179.48 per 100,000. During this period, the global ASMR fell from 15.56 to 12.40 per 100,000, while the ASIR rose from 24.04 to 25.60 per 100,000. However, these trends were not consistent across different World Bank income regions. Key risk factors contributing to CRC included high red meat consumption, obesity, insufficient calcium intake, and alcohol consumption, with variations observed among the World Bank income groups.

CONCLUSION

Although the global burden of colorectal cancer (CRC) has declined from 1990 to 2021, particularly in high-income regions, the incidence rate continues to rise. The increase is more pronounced among individuals aged 50 years and older, who also bear a higher absolute incidence than younger populations. High red meat consumption, high body mass index (BMI), and low calcium intake remain the leading global risk factors for CRC. Effective weight management and the promotion of healthy lifestyles are essential strategies for reducing CRC risk across sexes, while smoking and alcohol control are particularly critical for alleviating the burden among males.

Catheter Injectable Multifunctional Biomaterial for the Treatment of Infected Enterocutaneous Fistulas

Enterocutaneous fistulas (ECF) are challenging to treat contributing to high morbidity and high mortality rates, significantly impacting the quality of life of the patients. Its susceptibility to antibiotic-resistant infections often leads to chronic inflammation, complicating treatment with conventional methods. Here, 18NC75-10P-1IL is reported, which is a multi-functional shear-thinning hydrogel comprised of gelatin and nanosilicates for injectability, an ionic liquid for bactericidal effects, and platelet rich fibrin fraction for pro-healing properties; this biomaterial is engineered for the treatment of ECFs. Through rigorous testing, the mechanical properties of 18NC75-10P-1IL were tailored for catheter injection to achieve durable occlusion of fistulous tracts under external pressures simulating clinical scenarios. 18NC75-10P-1IL demonstrated pro-healing effects and anti-microbial activity against highly resistant patient-derived bacteria known to be associated with ECF. Subcutaneous implantation and anorectal fistula models confirmed its biocompatibility, pro-healing, anti-inflammatory, and anti-microbial properties compared to control materials, suggesting promising potential for clinical translation in the treatment of human ECFs.

Factors and Experiences Associated With Unscheduled Hospital Readmission After Lateral Lumbar Interbody Fusion: A Case-Controlled Study

PURPOSE

Understanding the risk factors associated with unscheduled readmission following lateral lumbar interbody fusion (LLIF) is crucial for mitigating the occurrence of these costly events. This study aims to ascertain the incidence and factors of unscheduled hospital readmission subsequent to LLIF.

METHODS

A retrospective analysis was conducted on patients who underwent LLIF at our institution from March 2016 to February 2023. Instances of unscheduled hospital readmission after LLIF were meticulously recorded, including baseline demographics, characteristics of spine pathology, surgical interventions, duration between two hospitalizations, and hospitalization costs and duration. Reasons for readmission were categorized based on their etiology. A case-control methodology was employed to compare unscheduled hospital readmission patients against planned readmission patients due to staged surgery. Parametric data were analyzed with a two-tailed T-test, nonparametric data with the Wilcoxon rank-sum test, and categorical data with the χ 2 test.

RESULTS

A total of 1521 patients who received LLIF at our institution were included in the study. A total of 59 patients (3.88%) were unscheduled readmitted due to adjacent segment disease (ASD), cage subsidence, the original surgical segments remaining narrow, spondylodiscitis, and pain. 51 patients (3.35%) experienced reoperation, predominantly attributable to ASD. Compared to planned readmission patients, unscheduled readmission patients tended to be younger, had a lower likelihood of having scoliosis, and were more likely to have short-segment surgery and higher initial hospitalization costs. Among unscheduled readmission patients, patients receiving short-segment surgery, as well as those who paid less during the initial hospitalization, demonstrated a higher likelihood of a 90-day readmission rate.

CONCLUSION

Our findings indicated the heightened risks of unscheduled hospital readmission after LLIF. Taking targeted measures against these risk factors is expected to reduce the healthcare burden caused by unplanned readmissions in the future.

Application of sodium alginate and polyethylene glycol bilayer multifunctional hydrogel microneedles in infectious and diabetic wounds

Chronic wounds are challenging to heal due to persistent infection, prolonged inflammation, and impaired angiogenesis, which can ultimately lead to severe disabilities. Current treatment strategies are unable to provide the comprehensive conditions needed for effective chronic wound healing. Herein, we proposed a multifunctional microneedle patch for chronic wound healing, consisting of a needle-like drug-loading gel (DG) constructed with polyethylene glycol (PEG) and a backing hydrogel (BHG) layer constructed with sodium alginate. This design combines the therapeutic effects of drug delivery with the protective benefits of a hydrogel. The needle-like DG layer effectively penetrates the bacterial biofilm, releasing Erythromycin, Vaccarin, Demethylsuberosin, and Cyanidin, agents with synergistic antibacterial, anti-inflammatory, pro-angiogenic, and antioxidant effects in a temperature response-dependent manner. Together, these components address multiple barriers to chronic wound healing. The DG layer also maintains a moist wound environment for the wound. The pH-responsive properties of Cyanidin visually indicate the wound healing status. The multifunctional microneedle patch (DG@BHG) significant enhances healing in both infected and diabetic wounds, leveraging the combined effects of drug action and hydrogel support. This approach presents a novel therapeutic strategy for chronic wound healing by addressing infection, inflammation, and angiogenesis simultaneously.

Secular trends in periprosthetic joint infections following primary hip and knee arthroplasties: A 15-year cohort study from the VINCat Program (2008-2022)

BACKGROUND

The VINCat program, established in Catalonia, Spain, in 2006, is a comprehensive infection prevention program for healthcare-associated infections. This study aims to analyze long-term trends in periprosthetic joint infections (PJI) following primary hip and knee arthroplasties over 15-year period (2008-2022).

METHODS

PJI was defined according to CDC-NHSN criteria and updated in 2016 to incorporate the Musculoskeletal Infection Society classification. Data on PJI following total hip arthroplasty (THA), total knee arthroplasty (TKA), and hip hemiarthroplasty (HHA) were prospectively collected and analyzed across three periods: 2008-2012, 2013-2017, and 2018-2022.

RESULTS

Sixty-seven hospitals participated in the surveillance, reporting 189,063 procedures, including 61,267 THA (median age: 69 years, 47% female), 115,940 TKA (median age: 73 years, 68% female), and 11,856 HHA (median age: 86 years, 73% females). PJI incidence rates for THA were 0.9%, 1.1%, and 1.2% across the three periods (odds ratio (OR):1.14, 95% CI: 0.96-1.35). For TKA, rates were 0.9%, 1.0%, and 0.9% (OR:0.95, 95% CI: 0.83-1.09). The incidence of HHA-PJI declined from 3.4% to 2.3% and 1.8% (OR:0.77, 95% CI:0.58-1.03). Overall, the most common etiology was coagulase negative staphylococci followed by Staphylococcus aureus. PJIs were diagnosed after hospital discharge in 87.1% of THA, 89.6% of TKA, and 73.9% of HHA.

CONCLUSIONS

The incidence of PJI remains low despite an aging population undergoing orthopedic surgery, highlighting the effectiveness of current infection prevention strategies. A robust, long-term surveillance system is crucial for monitoring epidemiological trends and guiding the implementation of evidence-based preventive measures.

Risk factors of mortality among heart failure patients in Jordan: the Jordanian Heart Failure Registry (JoHFR)

Background

Heart failure is one of the most common medical burdens facing the healthcare system worldwide. Based on our knowledge, only two heart failure registries have been conducted in the Middle East. Therefore, we decided to conduct this heart failure registry to investigate the follow-up results of patients with both acute and chronic heart failure in Jordan.

Methods

This study is a prospective observational multicenter national registry encompassing 21 health institutes in Jordan, comprising university hospitals, private hospitals, and private clinics. The criteria of inclusion were patients visiting the cardiology clinic or inpatients who were admitted due to acute decompensated HF. The primary outcome was 30-day mortality.

Results

The total number of enrolled patients in the study was 2128, with a total number of deaths during the follow-up of 204. Multivariate analysis demonstrated that smoking (odds ratio [OR] = 3.214; 1.005-5139), positive family history of premature coronary artery disease (OR = 2.686; 1.504-4.798), insulin (OR = 2.300; 1.356-3.899), hyponatremia at presentation (OR = 7.058; 1.698-29.342) and increased left ventricular diameter (OR = 1.009; 1.002-1.016) were significantly associated with higher odds of mortality.

Conclusion

Smoking, positive family history of premature coronary artery disease, insulin use, hyponatremia on presentation, and increased left ventricular diameter were associated with patients' mortality. Physicians should monitor these factors among patients to identify patients who are at higher risk of detrimental outcomes.

Understanding and practices of over-the-counter drugs for self-care among students of different medical faculties in a low-and middle-income country

Introduction

Over-the-counter (OTC) drugs play a critical role in self-care, markedly in low- and middle-income countries (LMICs) like Nepal. Understanding and practices related to OTC drug use among health science students are crucial, given their role in the future of healthcare. This study was conducted with the objective to compare and assess the understanding and practices of OTC drugs for self-care among medical, pharmacy, and nursing students and evaluate the impact of their education on these practices.

Methods

A multicenter comparative cross-sectional study was conducted across three health science colleges affiliated with different universities in Nepal. A total of 129 health science students from medicine (77), pharmacy (23), and nursing (29) faculties were selected. Understanding and practice scores were analyzed, and socio-demographic variables were examined for associations with OTC drug use.

Results

Most students exhibited moderate to poor understanding and practices regarding OTC drug use. Understanding scores were comparable across faculties, with medical students showing the highest proportion of good understanding (7.8%). Practice scores were highest among pharmacy students (4.34%). A significant number of students self-medicated without consulting healthcare professionals and often used OTC drugs due to convenience. There were no statistically significant differences in understanding and practice of OTC based on socio-demographic factors, including faculties.

Conclusion

The study highlighted a general lack of understanding and inadequate practices related to OTC drugs among health science students. These findings underscore the need for improved education and regulation to promote responsible self-medication practices.

Structural modeling of IBS severity: the mediating role of negative meta-emotions in stress, hostile attribution, and cognitive bias - a cross-sectional study

Background

Irritable bowel syndrome (IBS) is one of the most prevalent gastrointestinal disorders, significantly affecting the quality of life of patients. Recent research indicates that psychological factors, such as stress and hostile attribution, can exacerbate the severity of IBS symptoms. This study aims to explore the structural relationships among IBS symptom severity, hostile attribution, perceived stress, and cognitive bias, with a mediating role of negative meta-emotions.

Methods

This descriptive-correlational, cross-sectional study was conducted on 300 adults diagnosed with IBS in Tabriz. Data were collected using validated questionnaires, including the Hostile Attribution Scale, the Perceived Stress Scale, the Negative Meta-Emotion Questionnaire, and the Cognitive Bias Scale. Data was analyzed using SPSS software and Structural Equation Modeling (SEM) in AMOS software.

Results

The findings revealed that perceived stress and hostile attribution significantly influenced cognitive biases (P < 0.01). Furthermore, negative meta-emotions acted as a mediating variable in these relationships and had a positive and significant impact on IBS symptom severity. SEM analysis indicated that the overall effect of perceived stress on cognitive bias was 0.55, while the impact of hostile attribution was 0.49. These results underscore the crucial role of negative meta-emotions in enhancing the relationships among the studied variables.

Conclusion

This study highlights the importance of negative meta-emotions as key mediators in explaining IBS symptoms. The obtained results can assist in designing effective psychological interventions for managing IBS symptoms. Addressing psychological factors and negative meta-emotions in the treatment of this disorder may lead to improvements in patient's quality of life and reductions in the severity of their symptoms. Future research should focus on investigating targeted interventions in this area and conducting longitudinal analyses.

Cemental tear - a series of 14 cases of surgical periodontal treatments with a follow-up of up to ten years

Cemental tear is a relatively uncommon condition with low awareness among dentists. It can mimic other periodontal diseases as well as endodontic disease, and it should be part of the differential diagnosis. The total number of cases reported worldwide is still low and knowledge on conservative treatment prognosis is poor. This case series aims to report retrospectively the long-term results of teeth with cemental tear treated consecutively with periodontal surgery. Patients were managed between the years 2012-2023 in a specialist clinic in the north of Sweden. The treatment consisted of periodontal surgery with or without regenerative techniques, and when necessary, orthograde or retrograde endodontics. Fourteen patients (14 teeth), ranging from 36-85 years old, of which ten were male, were observed up to 131 months. Four teeth were extracted, all within the first 12 months, with clear signs of remaining infection. Three patients showed uncertain healing. One tooth was rescheduled for operation but in another location of the same tooth. The other six patients successfully healed, one after a re-operation. Conservative treatment of cemental tears has an acceptable prognosis, even in severely damaged teeth.

Burdens of Breast Cancer and Projections for 2030 Among Women in Asia: Findings from the 2021 Global Burden of Disease Study

Background: Employing the most recent dataset from the Global Burden of Disease (GBD) Study 2021, this report sought to delineate the current epidemiologic landscape of breast cancer in Asian women. Methods: We examined the evolving trends in disease prevalence and explored the correlations between breast cancer and factors such as age, temporal periods, and generational cohorts. We utilized an autoregressive integrated moving average (ARIMA) model to predict the incidence and deaths of breast cancer in Asia. Results: From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized DALYs rate (ASDR), and age-standardized mortality rate showed an overall upward trend for Asian women with breast cancer. In 2021, the high-income Asia Pacific region had the highest ASIR value, while South Asia had the lowest ASIR value. The highest age-standardized mortality rate and ASDR values in 2021 occurred in Southeast Asia, while the lowest values for these metrics were in East Asia. In 2021, breast cancer incidence and DALYs were highest in the 50-54 age group, with deaths peaking in the 55-59 age group. The leading risk factor attributed to breast cancer deaths in Asia in 1990 and 2021 was a "diet high in red meat". Breast cancer incidence and mortality rates are expected to continue to rise in Asia over the next 10 years. Conclusions: The burden of breast cancer in Asian women is increasing, especially in low SDI countries. This study highlighted the differences between populations and regions and predicted the incidence and mortality rates of breast cancer in Asia over the next decade using an ARIMA model. An increased awareness of breast cancer risk factors and prevention strategies is necessary to reduce breast cancer burden in the future.

Superior mesenteric artery syndrome following colorectal surgery: a systematic review

Background

Superior mesenteric artery syndrome (SMAS) is a rare characterized by obstruction of the third portion of the duodenum due to compression of this region between the superior mesenteric artery (SMA) and aorta. Diagnosis of SMAS post-surgical procedures is challenging due to nonspecific symptoms.

Methods

In accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, five electronic databases were systematically searched of all case reports published on SMAS diagnosed after colorectal procedures up to October 2023. The primary search of the databases revealed a total of 70 published articles. Thirty-eight studies were included.

Aim

to discuss the prevalence of SMAS post-colorectal surgery, possible causes, preventive measures and best management options.

Results

Total proctocolectomy with ileal J-pouch anal anastomosis was the most commonly reported surgical procedure (41.6%) preceding the diagnosis. Onset of symptoms since the primary operation had a wide range 1 day to >10 years. With a significant relation (P = 0.017) between duration of conservative treatment (>2 weeks) and its success.

Limitations

Our study was limited by a small sample size, the retrospective nature of data collection, variability in patient populations, surgical techniques, and postoperative care protocols across the included studies, and short follow-up periods.

Discussion

Majority of patient with SMAS following a colorectal surgery had successful conservative management (62.9%) within the time frame of 2-4 weeks (78.5%), while most reported patients with more extended conservative period eventually resorted to surgical management.

Conclusion

While conservative management is usually effective, surgical intervention should always be considered if there is no improvement within 4 weeks. Future research should focus on larger prospective studies to validate these findings and explore additional predictors of treatment success.

Reconstructive strategies using abdominal flaps for cutaneous malignancies: A case series

INTRODUCTION AND IMPORTANCE

Cutaneous lesions such as Marjolin's ulcer-a malignant transformation of chronic ulcerative wounds or scars into squamous cell carcinoma-and fungating soft tissue sarcomas, which are rapidly progressing tumours originating from mesenchymal tissues, exhibit a diverse range of clinical and pathological characteristics. These aggressive malignancies are characterized by high recurrence rates and poor prognoses. Traditionally, amputation was the primary treatment; however, limb salvage has become the preferred approach, necessitating extensive reconstruction with flap reconstruction.

CASE PRESENTATION

In this report, we present two cases of Marjolin's ulcer and one case of a fungating soft tissue sarcoma, detailing their clinical presentations, diagnostic workups, and management. Each patient underwent wide tumour excision followed by abdominal flap reconstruction.

CLINICAL DISCUSSION

The shift from amputation to limb-sparing surgery highlights the advancements in oncologic and reconstructive techniques, allowing for better functional and aesthetic outcomes.

CONCLUSION

This report underscores the critical role of early detection and a multidisciplinary approach in optimizing limb preservation and functional outcomes.

Owner-inflicted ocular injuries: A novel study of dog bite trauma caused by familiar pets: A case series

INTRODUCTION AND IMPORTANCE

This novel study aims to investigate ocular injuries caused by dog bites inflicted by the victims' own pets. The study examines the types of injuries, the breeds of dogs involved, the demographics of the victims, and the clinical management strategies used. It also seeks to highlight the need for preventive measures and the importance of responsible dog ownership in minimizing these injuries.

CASE PRESENTATION

A retrospective review of medical records from Shiraz Eye Center, Khalili Hospital, between 2022 and 2024 was conducted for patients who suffered ocular trauma from bites by their domestic dogs. Only patients with identifiable dog breeds were included. Data collected included patient age, gender, injury type, surgical intervention, medical management, outcomes, and complications. All patients underwent surgery within 2 days of injury and were followed up for at least 3 months. The majority of patients (71 %) were between 12 and 28 years old. Rottweilers and German Shepherds were the most commonly involved breeds. The most frequent injury was lower canaliculi lacerations (57 %), with some cases presenting both lower and upper lid margin lacerations. Surgical interventions primarily involved canalicular repair with Crawford stents and lateral tarsal strip procedures. Complications included ectropion and telecanthus in two cases, but no visual impairments were noted.

DISCUSSION

This study underscores the significant risk of ocular injuries inflicted by owners' own dogs, with young individuals being the most affected group. Rottweilers and German Shepherds were the most frequently involved breeds, but smaller breeds like Pomeranians also caused serious injuries. Lower canalicular lacerations were the most common injury, reflecting the anatomical vulnerability of the central facial region. Timely surgical intervention, primarily canalicular repair with Crawford stents and lid margin repairs, yielded positive outcomes with minimal complications. These findings emphasize the importance of responsible pet ownership, public education, and preventive strategies to reduce such injuries. Additionally, the psychological impact of these injuries, particularly in children, remains an area requiring further research.

CONCLUSION

This study highlights the risks of ocular injuries from dog bites inflicted by familiar pets. It emphasizes the importance of responsible dog ownership, public education, and preventive measures, particularly for vulnerable groups. Further research into the psychological impact of these injuries and larger studies are needed to develop effective prevention strategies.

Utilizing explainable machine learning for progression-free survival prediction in high-grade serous ovarian cancer: insights from a prospective cohort study

BACKGROUND

High-grade serous ovarian cancer (HGSOC) remains one of the most challenging gynecological malignancies, with over 70% of ovarian cancer patients ultimately experiencing disease progression. The current prognostic tools for progression-free survival (PFS) in HGSOC patients have limitations. This study aims to develop an explainable machine learning (ML) model for predicting PFS in HGSOC patients.

METHODS

Nine ML algorithms for PFS prediction were developed using a prospective cohort of 310 HGSOC patients consecutively enrolled from a large Chinese tertiary hospital between January 2017 and December 2020. The optimal model was internally validated using the 1000 bootstrap method. The SHapley Additive exPlanations (SHAP) method was employed to interpret the model in terms of feature importance and feature effects. The final model, constructed with the optimal feature subset, was deployed as an interactive web-based Shiny app.

RESULTS

The random survival forest (RSF) model demonstrated superior predictive performance compared to other ML models, the RFS model constructed with an optimal feature subset in the optimal imputed dataset achieved a superior 1000 bootstrap C-index of 0.755 (95% CI: 0.750-0.780) and a Brier score of 0.183 (95% CI: 0.175-0.190). SHAP analysis identified tumor residual, HE4, FIGO stage, T stage, CA125, age, ascites volume, platelet counts, and BMI as the top nine contributing factors. It also revealed potential nonlinear relationships and important thresholds between HE4, CA125, age, ascites volume, platelet counts, the body mass index, and PFS risk. Additionally, interaction effects were found between tumor residual and age, HE4, and CA125. Finally, an interactive web-based Shiny app for the model was developed and accessible at https://rsfmodels.shinyapps.io/ocRSF/ .

CONCLUSION

An explainable ML model for PFS prediction in HGSOC patients was developed with superior results. The publicly accessible web tool based on the optimized model facilitates its utility in clinical settings, potentially improving individualized patient management and treatment decision-making in HGSOC.

Intrauterine infusion of autologous endometrial stem cells for the treatment of moderate and severe intrauterine adhesions: a before-and-after study

BACKGROUND

Intrauterine adhesions (IUAs) can easily cause female infertility or recurrent abortion, but there is still no effective treatment to improve the pregnancy and live birth rates in patients with IUAs. In recent years, great advances have been made in stem cell therapy; however, additional clarity is needed on the clinical efficacy of endometrial stem cells in the treatment of IUAs.

MATERIALS AND METHODS

Fifteen patients with moderate-to-severe IUAs were included in the study at Xiangtan Central Hospital from 2018 to 2020. Patients were treated with endometrial stem cells and sodium hyaluronate gel by intrauterine perfusion in combination with estrogen and acetylsalicylic acid support therapy. Then, data on the pregnancy and live birth status was collected within two years after treatment. To explore the underlying mechanism, primary endometrial stem cells from healthy individuals and IUA patients, as well as fifth-generation endometrial stem cells from IUA patients, were further conducted with RNA sequencing to screen for differentially expressed genes, which were subsequently used for functional enrichment analysis.

RESULTS

After endometrial stem cell transplantation into the uterine cavity, the American Fertility Society scores of all patients decreased, and hysteroscopy revealed an improvement in the uterine condition and a reduction in adhesion symptoms. The total pregnancy rate of the 15 patients was 60.0% and the live birth rate was 53.3%. In addition, RNA sequencing analysis revealed that the cytokine - cytokine receptor interaction was associated with endometrial repair by endometrial stem cells.

CONCLUSIONS

Intrauterine infusion of autologous endometrial stem cells is highly effective for patients with moderate-to-severe IUA, and is a promising treatment strategy.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, CHICTR1800016769, Registered 22 June 2018- Retrospectively registered, https://www.chictr.org.cn/showproj.html?proj=27042 .

The yield of axillary clearance in breast cancer in Khartoum locality -Sudan: a cross-sectional study

Objectives

Axillary clearance is an established part of the management of breast cancer. The aim of this study was to determine the number of retrieved lymph nodes (LNs) after axillary clearance surgery.

Methods

Over a 2-year period (January 2020-December 2022), data from 96 patients, who underwent axillary clearance surgery in Khartoum locality, were collected. Multivariate analysis was used to assess the yield of axillary clearance.

Results

The mean of total number of retrieved LNs was 12.8, the mean of positive LNs was 2.6. There was statistical correlation between the total number of retrieved LNs and total number of positive LNs (P = 0.000). 53.1% of patients had stage II breast cancer, with 91% of them having invasive ductal carcinoma. Neoadjuvant chemotherapy decreased the total number of retrieved LNs (P = 0.001). No statistically significant correlation was found between previous axillary surgery and the number of the retrieved LNs (P > 0.05).

Conclusions

There were enough axillary LNs for histological studies; the total number of positive LNs increased with the increase in total number of retrieved LNs. Neoadjuvant chemotherapy reduced the yield of axillary clearance.

Laparoscopic versus open secondary hepatectomy treating postoperative regional recurrent hepatolithiasis: a multicenter real-world study

BACKGROUND

Hepatectomy is the primary treatment for regional hepatolithiasis, but recurrence rates range from 10 to 20%, often necessitating repeat surgery. Although laparoscopic hepatectomy has been widely adopted for recurrent hepatocellular carcinoma, its use in recurrent hepatolithiasis remains limited due to technical challenges, including severe adhesions, anatomical distortions, and increased risks of complications. No large-scale study has compared laparoscopic and open repeat hepatectomy for recurrent regional hepatolithiasis.

METHODS

This multicenter retrospective study included 913 patients from nine high-volume centers in southeastern China between May 2014 and 2023. Patients were divided into laparoscopic (n = 338) and open surgery (n = 575) groups. Propensity score matching was used to balance baseline characteristics. Primary outcomes included stone clearance rates and textbook outcomes (TO), a composite measure assessing final stone clearance, hospital stay, bile leakage, major complications, and 30-day readmissions. Secondary outcomes included perioperative metrics, complication rates, and recurrence-free survival.

RESULTS

After PSM, laparoscopic surgery demonstrated comparable immediate stone clearance rates (81.07% vs. 78.40%, p = 0.386) but significantly better TO rates (61.54% vs. 46.09%, p < 0.001) to the open surgery group. The laparoscopic group had reduced blood loss (p = 0.016), shorter hospital stays (p < 0.001), faster recovery of bowel function (p < 0.001), and fewer major complications (13.91% vs. 23.08%, p = 0.003). Recurrence rates were similar between groups during a median follow-up of 36 months. Hepatic lobe atrophy and biliary strictures were identified as independent risk factors for reduced stone clearance.

CONCLUSION

Laparoscopic repeat hepatectomy offers comparable stone clearance rates to open surgery while providing significant advantages in perioperative outcomes, including reduced complications and faster recovery. These findings suggest laparoscopic surgery is a feasible and effective option for recurrent regional hepatolithiasis.

Peripheral sentinel lymphadenectomy in 163 dogs: Postoperative surgical complications and comparison between intraoperative dissection techniques

OBJECTIVE

The first aim was to describe the incidence and severity of surgical complications following peripheral lymphadenectomy in dogs. The second was to compare three surgical techniques: unassisted lymphadenectomy, intraoperative guidance by methylene blue dye alone (MB) or by a combination of γ-probe and MB (γ-MB). The third was to assess whether the number, palpability, and site of lymph nodes (LNs) influenced the incidence of complications.

STUDY DESIGN

Retrospective multicenter study.

SAMPLE POPULATION

Lymphadenectomies (n = 201) from 163 client-owned tumor-bearing dogs.

METHODS

Medical records of dogs undergoing both preoperative sentinel LN (SLN) mapping and excision of peripheral SLNs between December 2020 and April 2023 were reviewed. Signalment, intraoperative assistance technique, number of LNs, surgical time, postoperative treatments, site, and timing of complications observed were collected.

RESULTS

Seventy-two (36%) lymphadenectomies were performed without assistance, 24% with MB and 40% with γ-MB. The overall incidence of surgical complications was 7.5%, of which 80% were mild. The most frequent complication was seroma (2.5%). None of the variables considered in the logistic regression model, including intraoperative guidance, influenced the complication rate (p = .255). Using the decision tree statistical model, mandibular and retropharyngeal lymphadenectomy affected the complication rate when surgery lasted more than 21.5 min.

CONCLUSION

Lymphadenectomy of peripheral LNs was associated with a low rate of mild complications, regardless of intraoperative assistance. Mandibular and retropharyngeal lymphadenectomies lasting more than 21.5 min may result in more complications.

CLINICAL SIGNIFICANCE

Lymphadenectomy of superficial LNs is a safe procedure that is easy to perform in most cases, even without intraoperative assistance.

Diagnostic value of lymphocyte-to-monocyte ratio in Crohn's disease: a cross-sectional study

Background

Investigating non-invasive laboratory biomarkers for detecting and classifying Crohn's disease (CD) activity remains challenging. Here, we aimed to evaluate the diagnostic efficacy of immunological biomarkers in identifying disease activity in newly diagnosed CD patients.

Methods

This cross-sectional study was performed from October 2022 to July 2023 and included 20 healthy participants and 46 confirmed newly diagnosed CD patients in a Teaching Hospital for Gastroenterology and Hepatology, Sulaimani, Iraq. The patients were categorized according to the disease activity assessed according to the Harvey-Bradshaw Index and divided into remission and active CD.

Results

A statistically higher serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were found among the remission CD group (P = 0.005 and P = 0.0002, respectively) and active CD group (P < 0.0001 and P < 0.0001, respectively) compared to the healthy controls. Moreover, the mean CRP and ESR levels among active CD were also considerably higher than those of remission CD (P = 0.018 and P = 0.005, respectively). The lymphocyte-to-monocyte ratio (LMR) was significantly lower in patients with active disease (3.01 ± 1.36) than in remission patients (6.77 ± 2.17) (cutoff < 4.42, area under receiver-operating characteristic curve (ROC) = 0.807, 95% CI, 77.35-98.73%, 93% sensitivity, and 78% specificity). Although the neutrophil-to-lymphocyte ratio (NLR) was significantly elevated in active patients (3.64 ± 2.004) compared to healthy controls (1.91 ± 0.48; P = 0.0001), it is not usable for disease activity or severity as the area under the ROC curve was 0.68 (95% CI, 52.22-85.08%, sensitivity = 79%, specificity = 62%).

Conclusion

The LMR can be an affordable, easily accessible test that shows promise for determining disease activity in newly diagnosed CD patients.

Comprehensive assessment of 1-year postoperative venous thromboembolism and associated mortality risks in hepatopancreatobiliary cancer surgeries: A national survey

BACKGROUND

Venous thromboembolism is a well-recognized complication after hepatopancreatobiliary surgery. However, there is a paucity of nationwide data on risk factors and incidence within 1 year of surgery in patients undergoing hepatopancreatobiliary surgery.

METHODS

This nationwide observational population-based cohort study used data extracted from all patients undergoing surgery for cancer surgery of the liver and the pancreas in France between 1 January 2015 and 31 December 2017. Estimation of 1 postoperative year cumulative incidence of venous thromboembolism and Cox proportional hazards model on 1-year global mortality were performed.

RESULTS

During the study period, 16,960 patients underwent cancer surgery of the liver (n = 9,381) or pancreas (n = 7,579). The 90-day postoperative rate of venous thromboembolism was 6.1% (cancer surgery of the liver) and 6.7% (cancer surgery of the pancreas). Main risk factors of 90-day postoperative rate of venous thromboembolism were major hepatectomy (1.85; 1.55-2.21), left pancreatectomy (1.45; 1.18-1.79), presence of obesity (1.41; 1.16-1.71), history of venous thromboembolism (4.58; 3.41-6.14), open approach (1.31; 1.06-1.62), and the occurrence of serious surgical complication (1.55; 1.35-1.79). At 1 year, patients undergoing cancer surgery of the liver were at a lower risk of cumulative incidence (%) of venous thromboembolism compared with the cancer surgery of the pancreas group (P < .001) (7.0; 6.5-7.6 vs 9.8; 9.1-10.4). Patients with venous thromboembolism within 1 year had greater risks of 1-year global mortality for each hepatopancreatobiliary surgery group: 3.58 (95% confidence interval, 3.02-4.23) and 3.97 (95% confidence interval, 3.40-4.63), respectively.

CONCLUSION

Postoperative venous thromboembolism is a significant issue after hepatopancreatobiliary surgery, within 90 days postoperatively and up to 1 year, with the cancer surgery of the pancreas group being particularly at risk. A greater risk of global mortality within 1 year for patients experiencing early or late venous thromboembolism was found.

Surgical outcomes of isolated coronary artery bypass grafting for acute and chronic coronary artery syndromes: based on Sulaimani cardiac registry

Background

The leading cause of death worldwide is coronary artery disease. Globally, coronary artery bypass grafting is among the most frequently carried out procedures. A number of factors, including but not limited to gender, age, comorbidities, duration of cardiopulmonary bypass time, and surgical urgency, influence the short-term mortality following Coronary Artery Bypass Grafting (CABG).

Patients and methods

220 consecutive CABG patients who underwent surgery between January 2022 and December 2022 were included in a prospective comparative analysis carried out at a single location. Convenience sampling was the approach used to obtain the data.

Results

60.4 ± 9.4 CI (95% 36-81) years was the average age of all patients. Just 32.3% of participants were smokers. In 15.5% of cases, patients had emergent surgery. There was no discernible correlation between the pre-operative and intraoperative composite score and early morbidities. However, emergency surgery had a significant value of (P = 0.018) in relation to hospital mortality. Additionally, there was a strong correlation between in-hospital mortality and the cross-clamp time and CPB (P = 0.000 and 0.05). Our subjects underwent survival analysis using Kaplan-Meier, with a mean follow-up duration of 50.43 ± 12.36 weeks. Eleven deaths were reported in the first year's results.

Conclusion

Survival is significantly impacted by CABG. If at all possible, it is preferable to improve a patient's condition before surgery in order to reduce mortality. The patient's chance of survival is impacted by complications including stroke and extended intubation. In some patients, re-examination should be allowed with a low barrier because the alternative might be fatal.

Profiling the pathological findings of diagnostic curettage for abnormal uterine bleeding a retrospective cross-sectional study among reproductive-aged women

Background

Abnormal uterine bleeding (AUB) is a common condition among women of reproductive age. This symptom is characterized by irregularities in menstrual frequency, duration, and volume. Early detection and management of AUB are crucial for improving women's health outcomes. This study aimed to assess the pathological findings of diagnostic curettage (D&C) in women of childbearing age with AUB at Afzalipour Hospital, Kerman, Iran.

Methods

This cross-sectional study included 1053 women aged 15-49 who underwent D&C for AUB between 2020 and 2021. Patient demographics and histopathological findings were gathered retrospectively from the pathology reports. Statistical analysis was conducted using the Kruskal-Wallis test to evaluate the relationship between pathological findings and patient age.

Results

Among the participants, 99.3% of the findings were benign, with pregnancy-related issues, normal-phase lesions, and hormone imbalances being the most common diagnoses, respectively. The average ages for the normal phase and pregnancy-related issues were significantly lower than those for malignancies, which were predominantly found in older women (average age of 45 years). Statistical analysis revealed significant age-related differences in the types of pathologies (P-value <0.001).

Conclusion

This study suggests that benign conditions are the primary cause of AUB in younger women, whereas the risk of malignancy increases with age. These findings underscore the importance of targeted diagnostic approaches, timely interventions, and appropriate management, particularly in resource-limited countries, such as Iran.

Nomogram for predicting difficult transoral and submental thyroidectomy: a retrospective model development and validation study with large-scale population

OBJECTIVE

No prior studies have described or stratified the difficulty of transoral and submental thyroidectomy (TOaST). We aimed to investigate preoperative factors as indicators of difficult TOaSTs and to develop a predictive model accordingly.

METHODS

This retrospective study included 255 eligible DTC patients who underwent total thyroidectomy and central neck dissection (CND) via transoral and submental endoscopic approach between February 2021 and April 2024. These patients were randomized into training and validation groups in a 7:3 ratio. Procedures were categorized into difficult and normal TOaST based on operation time, conversion to open and intraoperative injury. Univariate and multivariate logistic regression analyses were used to assess the association between surgical difficulty and factors regarding demographics, laboratory tests and ultrasound information. A nomogram was then developed and validated internally. Surgical and oncological profiles and follow-up data were also analyzed.

RESULTS

Five independent risk factors for difficult TOaST were identified in multivariate analysis: age (OR 0.84, p < 0.001), male sex (OR 4.75, p = 0.016), thyromental distance (TMD) < 7 cm (OR 7.59, p < 0.001), presence of diffuse changes on ultrasound (OR 14.5, p < 0.001), and elevated anti-thyroid peroxidase antibody (TPO-Ab) level (OR 5.22, p = 0.005). The nomogram performed well on both the training and the validation datasets, achieving an area under curve (AUC) of 0.908 and 0.888, respectively. Calibration curves for both datasets also fit well. There was no significant difference in complication rates between the difficult and normal TOaST groups.

CONCLUSION

The developed nomogram provides a reliable, straightforward prediction of difficult TOaST, thus supporting preoperative preparation and consultation, as well as optimizing training and promotion.

The Relationship Between Jugular Foramen Schwannoma and Surrounding Membrane Structures and Its Surgical Application

BACKGROUND AND OBJECTIVES

Surgical resection of jugular foramen (JF) schwannomas with minimal neurological complications is challenging because of their difficult-to-access location and complex relationships with surrounding neurovascular structures, even for experienced neurosurgeons. In this article, we elucidate the membranous anatomy of JF schwannomas, with the aim of reducing iatrogenic injury to the lower cranial nerves (LCNs) during surgery.

METHODS

The clinical data of 31 consecutive patients with JF schwannomas were reviewed. The relationship between the tumor and the surrounding membranous structures was observed during dissection. Samples were analyzed using Masson's trichrome and immunofluorescence staining to study the membranous characteristics. Histological-radiographic correlations were also summarized.

RESULTS

In this series, we found that all 3 type B, 2 type C, and 8 type D tumors (according to the Kaye-Pellet grading system) were entirely extradural in location, whereas the 18 type A tumors could be subdural (9 cases) or extradural (9 cases), which frequently could not be predicted preoperatively based on whether the tumor had intraforaminal extension. The dural capsule, when present, could be used as an insulating layer to protect LCNs. With this subcapsular dissection technique, postoperative LCN dysfunction occurred in 10 patients (32.3%), which was usually temporary and mild.

CONCLUSION

The different relationships between the tumor and membranous structures of the JF is related to the distinct point of tumor origin and the complex anatomy of the meningeal dura within the JF. Subcapsular dissection technique is recommended for better preservation of LCNs when the dural capsule is identified.

Unleashing the potency of multi-segmental DCIA flap in mandibular reconstruction with the aid of virtual surgery- A retrospective cohort study

Although the deep circumflex iliac artery (DCIA) flap is a mainstay in mandibular reconstruction, its multi-segmental utilization is infrequently reported, primarily due to concerns regarding the variable cutaneous component and potentially inadequate vascular supply to multi-block segments. This retrospective study analyzed the outcomes of 86 patients undergoing mandibular reconstruction with multi-segmental DCIA flaps, compared to 167 patients who received conventional single-segmental flaps. The survival rate for multi-segmental flaps was comparable to that of single-segmental flaps (100% vs. 98.2%, p = 0.553). Multi-segmental flaps were used to reconstruct longer bony defects (median: 9 cm vs. 6.5 cm, p < 0.001). Despite the longer operation times in the multi-segmental group (368.8 vs. 326.8 min, p < 0.001), there was no significant increase in the incidence of surgical complications. Furthermore, postoperative QoL and Harris Hip scores did not show significant differences, despite the increased graft lengths and segmentation in the multi-segmental group. The study underscores the underrecognized efficacy of multi-segmental DCIA flaps in complex mandibular reconstructions, particularly for specific types of defects such as Brown III, Brown I (Ic), and Brown II (IIc), which can be effectively and reliably reconstructed with the aid of virtual surgical techniques. This research also confirms that concerns regarding soft tissue management with multi-segmental DCIA flaps can be effectively addressed.

Quadruple bilateral fracture-dislocation of the elbow and the wrist: A rare and complex case report

We report an exceptionally rare and complex case of quadruple bilateral fracture dislocation of the elbow and the wrist in a 39-year-old construction worker, who sustained the injury after falling from a scaffold of 9 m secondary to a 6.9 magnitude earthquake. The patient was treated with a combination of closed and open reduction, internal fixation, and radial head arthroplasty, and had a good functional outcome at 12 months follow-up, with no complications or instability. This case illustrates the challenges and the possibilities of managing such complex injuries, and adds to the scarce literature on this topic.

Assessing the feasibility of near infrared autofluorescence imaging in minimally-invasive video assisted parathyroidectomy and the autofluorescence signature of parathyroid adenomas. A single center surgical case series

BACKGROUND

The role of near-infrared autofluorescence (NIRAF)-imaging in thyroid surgery is well-established. However, its role in hyperparathyroidism surgery is yet to be defined due to the lack of consensus regarding the autofluorescence (AF) pattern of parathyroid adenomas (PAs). Furthermore, its utility in minimally invasive video-assisted parathyroidectomy (MIVAP) has yet to be assessed.

OBJECTIVE

To assess the feasibility of utilizing NIRAF-imaging via the limited-access of MIVAP and whether PAs demonstrate a unique AF signature allowing NIRAF-imaging to serve as an intraoperative diagnostic tool.

METHODS

The clinical records of patients who underwent MIVAP for hyperparathyroidism between February and October 2024 were retrospectively reviewed. The primary endpoint was to assess the feasibility of NIRAF-imaging in MIVAP and whether PAs demonstrate a defining AF pattern. Secondary endpoints included whether certain AF patterns of PAs correlated with specific PA features including cell type, size, and/or location. Furthermore, operative-time and cost implications were assessed.

RESULTS

24 consecutive patients underwent MIVAP for hyperparathyroidism. NIRAF-imaging was feasible via the limited-access with no technical difficulties reported. AF patterns included high-intensity AF in 10 (38.5%), low-intensity AF in 10 (38.5%), and cap AF in 6 (23%). A new AF pattern was also described and referred to as "double cap AF". No significant differences in the patterns of AF were observed (p = 0.2). The pattern of AF did not considerably correlate with the predominant cell type, size or location of the PA. However, mediastinal PAs demonstrated a significantly higher tendency for cap AF. The additional time added to the procedure applying the technology was only a few minutes. However, it conferred a considerable additional cost.

CONCLUSION

In experienced hands, a direct minimal-access did not preclude utilizing NIRAF-imaging. PAs seem to lack a uniform characteristic AF signature implying a limited diagnostic role of NIRAF-imaging in parathyroid surgery apart from confirming normal parathyroid tissue. The study has been registered in ClinicalTrials.gov; registration number: NCT06779760.

The role of surgical navigation in the endoscopic resection of a rare skull base tumor, case report

INTRODUCTION AND IMPORTANCE

Chondrosarcoma is a primary malignancy affecting mainly long bones. The location in the sinonasal tract and in a young female patient is exceptional. We aim through this case report to relate our own experience with a combined endoscopy-navigation approach in the resection of an ethmoidal chondrosarcoma.

CASE PRESENTATION

We report the case of an 18-year-old girl, who was presenting hyposmia, headache and unilateral retroorbital pain with a normal physical exam. Imageries were performed showing an invasive tissular and calcified ethmoidal tumor recalling a chondrosarcoma. She underwent a macroscopic complete resection of the tumor via a binostril endoscopic endonasal approach using navigation. Postoperative head CT and MRI showed a complete resection of the tumor.

CLINICAL DISCUSSION

The gold standard treatment is a complete surgical excision with tumor-free margins which is challenging in the ethmoidal location. In literature, the role of navigation in endoscopic surgeries is debated. In our case, the navigation-guided binostril endoscopic approach enabled a precise tumor localization, with a wide field of vision of vital structures nearby and of tumor limits, ensuring an excellent result with an optimal resection.

CONCLUSION

Chondrosarcomas of the sinonasal tract are rare and represent a compelling diagnostic and treatment challenge. Surgery is the mainstay treatment of sinonasal chondrosarcomas. Endoscopic endonasal surgery associated with surgical navigation offers a great control of the lesion and its margins with good results motivating its adoption as a therapeutic strategy in selected cases.

Global trends and insights of telesurgery research: a bibliometric analysis of publications since the 21st century

BACKGROUND

In recent years, telesurgery has shown a rapid development trend as an innovative surgical technique, and been applied to the clinical treatment of various tumor diseases. However, the current research on telesurgery is still relatively fragmented, lacking a systematic summary of its development and future directions. Addressing these limitations is crucial for advancing the application of this novel surgical technology.

METHODS

This bibliometric study of publications related to telesurgery that were indexed in the Web of Science Core Collection from 2000 to 2024. VOSviewer, CiteSpace, and Bibliometrix were used to analyze and visually represent the gathered data, and the relevant content was presented according to the BIBLIO guidelines.

RESULTS

We researched 565 publications across 269 journals authored by 2422 individuals affiliated with 917 institutions spanning 62 countries. Notably, the United States leads in the number of publications, with China also making noteworthy contributions. Kyushu University and the University of Washington emerge as prominent institutions in terms of research output within this domain. Analysis of document co-occurrence and co-citation reveals that Jacques Marescaux from France holds the top position globally among authors and wields significant influence in this field. Keyword analysis indicates that key future research directions in this area include mitigating latency issues in telesurgery, integrating advanced network communication technologies, and enhancing the performance of telesurgical robots. Furthermore, ethical and legal issues associated with telesurgery may emerge as critical challenges to be addressed for its further expansion and application.

CONCLUSION

This research provides an overview of telesurgery research findings, encompassing the evolution of research priorities in telesurgery. The study anticipates that the secure implementation and broader adoption of telesurgery will bring more benefits to patients on a global scale.

Analgesic Effectiveness of Ultrasound-Guided Unilateral Erector Spine Block Versus Paravertebral Block for Postoperative Management Among Adult Patients Undergoing Upper Abdominal Surgery: A Prospective Cohort Study

Background

The use of regional nerve blocks for postoperative analgesia in upper abdominal procedures is becoming more common. However, the postoperative analgesic effectiveness of each type of block remains controversial. This study aimed to compare the postoperative analgesic effect of ultrasound-guided erector spinae block versus paravertebral block (PVB) in upper abdominal surgery.

Methods

A hospital-based prospective cohort study was conducted on 78 adult patients undergoing upper abdominal surgery, including 39 in the erector spinae plane block (ESPB) and 39 in the PVB. The pain severity, time to first rescue analgesic administration, and total analgesic consumption were assessed 24 hour after surgery. The data were entered into Epi-Data version 4.6.02 and exported to SPSS version 26 for analysis.

Result

In total, 78 patients were analyzed with no dropouts. Postoperative visual analog scores were lower in the ESPB group at 3rd, 6th, 12th, and 24th hours (P < 0.05). The ESPB group also had a significantly longer time to the first rescue analgesic requirement (mean time in hours, 16.8 [95% CI, 14.9-18.5]; P 0.03) than the PVB group (mean time in hours, 13.1 [95% CI, 11.9-14.3]; P 0.03). Furthermore, the ESPB group exhibited significantly lower opioid consumption at 24 hours postoperation than the PVB group in cases of upper abdominal surgery.

Conclusions

An ultrasound-guided unilateral ESPB for postoperative analgesia was more effective than a PVB for adult patients undergoing upper abdominal surgery. As a result, we recommend an ESPB over a PVB. The ESPB can serve as a valuable and safe alternative to either epidural or paravertebral nerve block for postoperative pain management.

Dissecting the role of metformin in urogenital malignancies

Metformin has shown great potential for anti-tumor therapy according to laboratory results, but there is currently no consensus on the role it playing in the pathogenesis of urogenital malignancies. Initially, a systematic review was conducted on clinical research examining the association between the use of metformin and the incidence and prognosis of prevalent urogenital malignancies. Then, a retrospective analysis of the participants in NHANES was performed to strengthen the study. Given the distinct methodological advantages of Mendelian randomization (MR) in research design, whereby genetic variations influencing the exposure of interest are independent of potential confounders, available GWAS data were thoroughly collected and utilized in a two-sample MR analysis to assess the causal relationships between metformin use and various urogenital malignancies. The review of literature demonstrated inconsistencies and ambiguities in clinical findings. The retrospective analysis of 20,527 participants in the NHANES did not reveal strong evidence in the four urogenital malignancies. The current MR study indicates that metformin use is unlikely to be a causal factor in the development of five urogenital malignancies (P > 0.05), either does the reverse MR analysis (P > 0.05). Nevertheless, the results were reliable to some extent since neither heterogeneity nor pleiotropy was detected in most cases. This study suggests that metformin use does not demonstrate a protective effect on the studied urogenital malignancies, contradicting the positive results observed in laboratory settings. Additional evidence from clinical studies is required to validate this conclusion.

Long-Term Oncologic Outcome of Breast-Conserving Treatment in Patients With Breast Cancer With BRCA Variants

Importance

Patients with sporadic breast cancer have comparable prognoses after undergoing either breast-conserving treatment (BCT) or mastectomy. However, there are limited and inconsistent data on the assessment of oncologic outcomes between BCT and mastectomy in patients with pathogenic variants in BRCA1 or BRCA2.

Objective

To investigate the outcomes of BCT on recurrence and survival in patients with breast cancer with BRCA1 or BRCA2 pathogenic variants.

Design, Setting, and Participants

This retrospective multicenter cohort study analyzed patients from 13 institutions in South Korea with primary breast cancer with BRCA1 or BRCA2 pathogenic variants who underwent either BCT or mastectomy from January 2008 through December 2015. The median (IQR) follow-up period was 8.3 (6.4-9.6) years. Data were analyzed from September 2023 to August 2024.

Exposure

BRCA1 or BRCA2 pathogenic variant and BCT.

Main Outcomes and Measures

Primary outcomes were logoregional recurrence-free survival, distant recurrence-free survival, and overall survival. Propensity score matching (PSM) using the greedy nearest neighbor method was performed to match covariates to minimize potential selection bias.

Results

A total of 575 female patients with BRCA1 or BRCA2 pathogenic variants were identified, all of whom were South Korean with a mean (SD) age of 42.0 (9.7) years. Among them, 367 patients (66.2%) received BCT and 186 (33.8%) were treated with mastectomy. BCT was not a factor associated with oncologic outcomes, including locoregional recurrence, compared with mastectomy. After adjusting for clinicopathologic characteristics through 1:1 PSM, there were still no statistically significant differences in oncologic outcomes between the BCT group and the mastectomy group. Multivariate analysis showed that the type of breast surgery was not significantly associated with oncologic outcomes. In subgroup analysis among matched patients based on BRCA1 or BRCA2 status, tumor size, lymph node metastasis, histologic grade, and subtype, BCT was also not a factor associated with risk for recurrence.

Conclusions and Relevance

The findings from this cohort study of patients with BRCA1 or BRCA2 pathogenic variants suggested that there were no significant differences in oncologic outcomes between patients who underwent BCT and those who underwent mastectomy. Therefore, breast conservation with close surveillance can be considered a viable treatment option for BRCA1 or BRCA2 pathogenic variant carriers. Further studies incorporating prospectively collected data are warranted to validate our findings.

Prediction of MRI in intra-operative findings for spinal meningeal diseases

BACKGROUND

A large variety of spinal meningeal diseases have been described in the literature, and differential diagnosis is often complex, requiring a good knowledge of the different entities and accurate neuroimaging. The purpose of this article was to depict the most relevant diagnostic features on the commonly utilized MRI sequences for the main and most frequent pathologies of the spinal arachnoid and to correlate them with intraoperative findings.

MATERIAL AND METHODS

Five cases harboring each different spinal meningeal diseases were analyzed, illustrated, extensively described, and discussed: arachnoid web, arachnoiditis, idiopathic spinal cord herniation, intradural arachnoid cyst, extradural arachnoid cyst. All the cases were surgically treated in the same institution (Neurological Hospital, Lyon, France). We underlined imaging clues for differential diagnosis to help physicians to elaborate the right diagnosis and guide the surgical management.

RESULTS

MRI was efficient to determine the nature of the arachnoid or/and dural disease as well as to predict precisely the intra-operative findings. Six key-radiological features were selected, helping differential diagnosis: localization (intra/extradural/both), aspect of the spinal cord (compressive effect/displacement/scalpel sign), arachnoid bride, CSF turbulent flow, vertebral scalloping, absence of gadolinium-enhancement.

CONCLUSION

MRI demonstrated excellent correlation with intra-operative findings for all the five spinal meningeal diseases analyzed. Although rare, these pathologies must be recognized by clinicians considering that appropriate treatment most often permit to relieve the symptoms.

Paraquat poisoning: a case series of 15 survivors and narrative review

Background

Paraquat (PQ) poisoning is a grave concern in developing countries due to its wide availability. Acute paraquat poisoning can have both systemic and local manifestations, with mortality rates that can reach as high as 90%; pulmonary complications and multiple organ dysfunction syndromes being major causes. This case series is a unique retrospective observational study of 15 survivors from South India.

Case presentation

The case series consists of 15 cases, with a mean age of 24.6 years (excluding outliers), that were alleged to have taken varying amounts of paraquat dichloride. Patients exhibited a diverse range of symptoms affecting multiple organ systems, with particular emphasis on kidney, liver, and lung function. Treatments included a combination of hemodialysis, targeted drug therapy in the form of N-acetyl cysteine, anti-inflammatory therapy with corticosteriods and symptomatic therapy. The case descriptions also include the details of the amount of paraquat allegedly ingested, the ingestion to hospitalization time, demographics, etc, that further help in determination of prognosis.

Overview

PQ can cause a variety of clinical signs and symptoms, including gastrointestinal, renal, hepatic, and pulmonary problems. Less commonly, it can also affect the neurological and cardiac systems. Treatment is mainly focused on reducing the effective PQ concentration in blood, as no antidote has been named till date. The paper also discusses the various treatments available, drugs and procedures, and their mechanisms. Also prognostic factors like age, amount, ingestion to hospitalization time, etc.

Conclusion

The study underlines the need for defined treatment protocols, prognostic factors, and enforcing restrictions on availability of this deadly poison.