Search Results (353)

Background: Cirrhosis is a progressive liver disease often associated with sarcopenia. Vitamin D and IGF-1 alterations may contribute to muscle loss and disease progression. This study evaluated their relationship in cirrhotic patients. Methods: A total of 90 patients with liver cirrhosis were included in this retrospective observational study. Clinical and laboratory data were collected, and disease severity was assessed using Child–Pugh and MELD-Na scores. Sarcopenia was evaluated using CT-based skeletal muscle index at the L3 level with sex-specific cut-offs. Patients with malignancy, acute liver failure, recent surgery, or muscle-affecting conditions were excluded. Vitamin D and IGF-1 levels were classified using standard and age-adjusted reference ranges. Results: A total of 90 patients were included, of whom 42 were alive, and 48 died during follow-up. Gender distribution was similar between groups (p = 0.388). Skeletal muscle area was significantly lower in non-survivors (110 vs. 140 cm², p = 0.002), while body mass index did not differ (p = 0.570). Vitamin D levels were significantly lower (10.0 vs. 17.9 ng/mL, p < 0.001), and hemoglobin levels were reduced in the non-survivor group (10.76 ± 2.13 vs. 12.87 ± 2.57 g/dL, p = 0.001). In multivariate analysis, age (OR 1.046, p = 0.032), MELD-Na score (OR 1.200, p = 0.001), and vitamin D level (OR 0.920, p = 0.024) were independently associated with mortality. Conclusions: CT-based sarcopenia assessment is a useful adjunct in cirrhosis when interpreted with disease severity. Radiological muscle depletion is common and associated with worse outcomes, while vitamin D deficiency independently associated with mortality, highlighting its potential as a biomarker and therapeutic target. Full article

Background/Objectives: Obesity-related insulin resistance is accompanied by chronic low-grade inflammation, but the extent to which weight loss modifies circulating cytokines in a sex-specific manner remains insufficiently understood. The aim of this study was to assess sex-specific cytokine responses and metabolic adaptation in adults with obesity and insulin resistance following a six-month weight-reduction program (WRP). Methods: Thirty-six participants (24 women and 12 men) with a value of Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) ≥ 2 underwent an individualized low-calorie diet combined with moderate physical activity and health education. Anthropometric, body composition, biochemical, oxidative stress, and cytokine parameters were evaluated before and after the intervention. Results: Both women and men showed significant reductions in body mass, Body Mass Index (BMI), waist circumference, visceral fat area (VFA), body fat mass (BFM), fasting glucose, HOMA-IR, modified Atherogenic Index of Plasma (new-AIP), malondialdehyde (MDA), and Oxidative Stress Index (OSI). Women additionally showed significant decreases in fat-free mass (FFM), skeletal-muscle mass (SMM), total body water (TBW), glycated hemoglobin A_1c (HbA1c), and triacylglycerols, whereas cholesterol in high-density lipoproteins (HDL-C) increased significantly in men. Cytokine changes were selective rather than uniform. Interleukin-1 receptor antagonist (IL-1ra), Interleukin 6 (IL-6), and Tumor Necrosis Factor alpha (TNF-α) decreased in both women and men. In sex-stratified analyses, IL-1β decreased significantly only in women, whereas IL-7 decreased significantly only in men. ClinicalTrials.gov Registration: [NCT07645105] (retrospectively registered on [11 June 2026]). Conclusions: A 6-month lifestyle-based weight-reduction program in adults with overweight or obesity and insulin resistance was associated with metabolic improvement, reduced oxidative stress, and partial attenuation of obesity-related low-grade inflammation. The observed cytokine and metabolic changes suggest sex-related patterns of immunometabolic adaptation to weight reduction. However, these findings should be interpreted cautiously because of the relatively small sex-stratified subgroups and the number of cytokine endpoints analyzed, and they require confirmation in larger, sex-balanced studies. Full article

Background/Objectives: The soluble fms-like tyrosine kinase-1 (sFlt-1) to placental growth factor (PlGF) ratio is an established biomarker in the diagnosis of preeclampsia; however, its significance outside overt hypertensive disorders of pregnancy remains unclear. Emerging evidence suggests that angiogenic imbalance may reflect subclinical placental dysfunction even in otherwise low-risk pregnancies. To investigate associations between the sFlt-1/PlGF ratio and maternal and neonatal outcomes in a low-risk term obstetric population, beyond established diagnostic cut-offs. Methods: This prospective cohort study included 87 women with singleton term pregnancies. Serum sFlt-1 and PlGF concentrations were measured at hospital admission before delivery, and the sFlt-1/PlGF ratio was calculated. The primary outcome was estimated blood loss at delivery. Secondary maternal outcomes included postpartum hemoglobin decline, uterine atony, and fibrinogen concentration. Neonatal outcomes included birthweight, umbilical artery pH, and bilirubin concentration. Multivariable regression models were used to evaluate associations between the ln-transformed sFlt-1/PlGF ratio and outcomes after adjustment for prespecified maternal and obstetric covariates. Results: Each doubling of the sFlt-1/PlGF ratio was associated with greater estimated peripartum blood loss (+78.0 mL, 95% CI 42.1–113.9; p < 0.001), a larger postpartum hemoglobin decline (+0.078 g/dL, 95% CI 0.008–0.148; p = 0.030), lower fibrinogen concentration (−20.7 mg/dL, 95% CI −30.5 to −10.9; p < 0.001), and lower neonatal birthweight (−64.6 g, 95% CI −102.0 to −27.2; p = 0.001). No significant associations were observed for uterine atony, premature rupture of membranes, or umbilical artery pulsatility index above the 75th centile. Conclusions: In low-risk term pregnancies, higher sFlt-1/PlGF ratios were associated with greater estimated peripartum blood loss, lower fibrinogen concentrations, and lower neonatal birthweight. These findings support the hypothesis that variation in angiogenic balance may reflect subclinical placental dysfunction even in apparently uncomplicated pregnancies. Further prospective studies are needed to validate these exploratory observations and determine their clinical relevance. Full article

Background/Objective: Postpartum hemorrhage is a leading cause of maternal morbidity and mortality, particularly among high-risk women undergoing cesarean section. This systematic review and meta-analysis evaluated the efficacy and safety of prophylactic tranexamic acid in high-risk cesarean sections. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted. Risk of bias was assessed using RoB 2.0 and certainty of evidence was evaluated with GRADE. Random-effects meta-analyses, subgroup analyses and sensitivity analyses were performed. PROSPERO: CRD420251087054. Results: Nine randomized controlled trials involving 1776 participants were included. Tranexamic acid reduced total blood loss (MD −300.78; 95% CI −459.78 to −157.77), with greater efficacy when administered 15–20 min before incision (SMD −0.61; 95% CI −0.82 to −0.39). It also reduced intraoperative blood loss (MD −256.71 mL; 95% CI −375.04 to −138.39), blood loss >1000 mL (RR 0.24; 95% CI 0.14 to 0.41), additional uterotonics (RR 0.37; 95% CI 0.24 to 0.58), blood transfusions (RR 0.30; 95% CI 0.22 to 0.40), and complementary surgical interventions (RR 0.35; 95% CI 0.16 to 0.78). Conclusions: Prophylactic tranexamic acid may reduce blood loss in high-risk cesarean deliveries, particularly when administered 15–20 min before skin incision. It may decrease total and intraoperative blood loss and blood loss exceeding 1000 mL. It also likely reduces the postoperative decline in hemoglobin, the need for additional uterotonics, blood transfusions, and complementary surgical interventions; however, its effect on hematocrit remains uncertain. Full article

Background: Postoperative hyperbilirubinemia is a serious complication after cardiac surgery and has been associated with increased perioperative morbidity and mortality. However, data specifically addressing patients undergoing redo valve surgery remain limited. This study aimed to determine the incidence and risk factors of postoperative hyperbilirubinemia after redo valve surgery, and evaluate its association with early postoperative outcomes. Methods: We retrospectively reviewed 259 adult patients who underwent elective redo valve surgery under cardiopulmonary bypass (CPB) between March 2018 and July 2024. Postoperative hyperbilirubinemia was defined as a serum total bilirubin level > 3 mg/dL at any time after surgery. Patients were divided into a hyperbilirubinemia group and a non-hyperbilirubinemia group. Perioperative variables were compared between groups. Univariable and multivariable logistic regression analyses were performed to identify risk factors for postoperative hyperbilirubinemia. Postoperative complications and in-hospital mortality were also compared. Results: Postoperative hyperbilirubinemia occurred in 101 of 259 patients (39.0%). Compared with patients without hyperbilirubinemia, those with hyperbilirubinemia had longer mechanical ventilation and intensive care unit stay, and higher rates of pneumonia, reintubation, tracheostomy, continuous renal replacement therapy, and in-hospital mortality. Univariable logistic regression showed that higher EuroSCORE II, higher preoperative total bilirubin and direct bilirubin levels, lower hemoglobin and platelet count, pulmonary hypertension, anemia, longer operative time, CPB duration, and aortic cross-clamp time, lower nasopharyngeal temperature, greater intraoperative blood loss, larger red blood cell and plasma transfusion volumes, and concomitant surgery on all three valves were associated with postoperative hyperbilirubinemia. Multivariable analysis identified elevated preoperative direct bilirubin, prolonged CPB duration, and more plasma transfusion as independent risk factors. Receiver operating characteristic analysis showed that peak postoperative total bilirubin had moderate prognostic discrimination for in-hospital mortality, with an optimal cut-off value of 3.95 mg/dL (AUC 0.756, sensitivity 66.7%, specificity 80.2%, p = 0.003). Conclusions: Postoperative hyperbilirubinemia is common after redo valve surgery and is associated with worse early postoperative outcomes and higher in-hospital mortality. In this setting, postoperative bilirubin elevation should be interpreted primarily as a prognostic marker of perioperative stress and hepatic vulnerability rather than a direct causal driver of adverse outcomes. Elevated preoperative direct bilirubin, prolonged CPB duration, and greater plasma transfusion were independently associated with the development of postoperative hyperbilirubinemia in this high-risk population. Full article

Background and Objectives: With contemporary blood management strategies substantially reducing transfusion rates after total knee arthroplasty (TKA), conventional endpoints such as transfusion incidence and estimated blood loss may have limited sensitivity for evaluating adjunctive hemostatic interventions. As postoperative anemia evolves dynamically over time, hemoglobin kinetics and cumulative anemia burden may offer more informative measures of treatment effect. This study evaluated whether implementation of a topical thrombin–carboxymethyl starch hemostatic agent within a standardized modern blood management protocol was associated with smaller early postoperative hemoglobin decline and lower cumulative anemia burden after TKA. Materials and Methods: In this single-center, retrospective, pre–post observational study, consecutive patients aged 50 years or older undergoing primary unilateral TKA for osteoarthritis before and after implementation of a thrombin–carboxymethyl starch topical hemostatic agent were compared. Perioperative management was otherwise standardized and unchanged. Patients were matched 1:1 using propensity scores derived from eight prespecified covariates. Co-primary endpoints were hemoglobin change from baseline to postoperative day 1 and day 2, and cumulative anemia burden quantified by the area under the hemoglobin-deficit curve from POD 0 to POD 13 was assessed as a key secondary endpoint. Results: Of 564 patients assessed for eligibility, 328 met the inclusion criteria, and 70 propensity score-matched pairs were included in the final analysis. Unless otherwise specified, the outcomes reported below were analyzed in these 70 matched pairs. In the matched cohort, the intervention group had a lesser hemoglobin decrease at postoperative day (POD) 1 than the control group (2.12 ± 0.97 vs. 2.42 ± 0.98 g/dL), corresponding to a paired mean difference of 0.30 g/dL (95% CI, 0.08–0.52; p = 0.008). The between-group difference at POD 2 was not statistically significant (paired mean difference, 0.15 g/dL; 95% CI, −0.03 to 0.33; p = 0.10). The area under the hemoglobin-deficit curve from POD 0 to POD 13 was lower in the intervention group (18.6 ± 5.2 vs. 21.3 ± 5.6 g/dL × day), with a paired mean difference of 2.7 g/dL × day (95% CI, 0.9–4.5; p = 0.004). Estimated total blood loss, formula-derived hidden blood loss, and transfusion rates did not differ significantly between groups. Conclusions: Use of a thrombin–carboxymethyl starch topical hemostatic agent was associated with modest attenuation of early postoperative hemoglobin decline and lower cumulative anemia burden after TKA, without significant differences in estimated blood loss or transfusion occurrence. Hemoglobin kinetics and cumulative anemia burden may provide complementary outcome measures in contemporary low-transfusion practice, although these findings should be interpreted cautiously given the observational design and low transfusion event rate. Full article

Bacground/Objectives: There is limited evidence on the role of glucagon-like peptide-1 receptor agonists in heart failure. We aimed to analyze the clinical efficacy of oral semaglutide in terms of health status and change in body weight in patients with heart failure with reduced ejection fraction, type 2 diabetes, and obesity. Methods: This observational, retrospective, real-world study included patients treated with oral semaglutide (Oral-Sema Group) and without glucagon-like peptide-1 receptor agonists (Control Group). The primary outcome was heart failure status, defined as a ≥5 point difference in the Kansas City Cardiomyopathy Questionnaire total symptom score, and change in body weight at 24 months. Results: After 1:1 propensity score matching, 162 patients were included in each group (mean age 71.0 years, mean body mass index 32.1, 52.9% females). Patients in the Oral-Sema Group were more likely to have improvement in heart failure health status from baseline to 24 months (OR: 2.45; 95%CI: 1.25–3.65; p = 0.012). The mean change in body weight was −8.0 ± 2.1 kg in patients with oral semaglutide and −1.9 ± 1.0 kg in control patients (p < 0.01). After treatment, there were negative correlations between the Kansas City Cardiomyopathy Questionnaire total symptom score and body weight (r = −0.558, p < 0.01) and glycated hemoglobin (r = −0.491, p = 0.017). It had good tolerability and safety. Conclusions: Oral semaglutide was associated with an improvement in heart failure health status and weight loss in patients with heart failure with reduced ejection fraction, type 2 diabetes, and obesity. Further research on glucagon-like peptide-1 receptor agonists in heart failure with reduced ejection fraction is needed. Full article

Background/Objectives: Iron deficiency (ID) can occur before anemia and may impair performance, recovery, and hematological function, particularly in athletes. Female basketball players may be especially vulnerable due to high training demands and sex-specific iron losses. Therefore, this study aimed to compare nutrient intake and hematological and iron status biomarkers between ID and non-ID female basketball players, and to examine diet–biomarker correlations. Methods: Twenty-four female basketball players completed the study. Athletes were stratified by ferritin, with ID defined as <30 μg/L, resulting in 12 athletes per group. Dietary intake was assessed using a 48 h food record. Energy, macronutrients, fiber, iron, calcium, folate, vitamin B₁₂, and vitamin C intakes were analyzed. Blood biomarkers included red blood cells (RBCs), hemoglobin (HGB), hematocrit (HTC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), ferritin, serum iron, transferrin, total iron-binding capacity (TIBC), and unsaturated iron-binding capacity (UIBC). Results: ID athletes had significantly lower fiber, iron, folate, and vitamin C intakes than non-ID. They also showed significantly lower HGB, HTC, MCV, MCH, and ferritin, and higher transferrin, UIBC and TIBC. Iron intake correlated positively with HGB, HTC, MCV, MCH, serum iron, and ferritin, and negatively with UIBC. Conclusions: Iron deficient female basketball players may present less favorable dietary profiles and altered hematological and iron status biomarkers. In this context, quarterly assessment of iron status biomarkers should be supported by nutrition education aimed at improving iron intake, alongside monitoring of energy and macronutrient intake in relation to training load. These approaches may help identify athletes requiring nutrition-focused support, although larger studies with longer-term dietary assessment are warranted. Full article

Aortic manipulation and prolonged ischemia during cardiopulmonary bypass remain major drivers of perioperative complications. Optimizing clamping strategies is crucial to minimize iatrogenic blood loss and improve recovery profiles within a Patient Blood Management (PBM) framework. Objectives: This study aimed to evaluate the impact of two different aortic clamping strategies—single cross-clamping versus side-clamping—on early hematologic outcomes within a Patient Blood Management (PBM) framework in patients undergoing on-pump coronary artery bypass grafting (CABG). Methods: In this retrospective cohort study, 265 patients who underwent elective isolated 3-vessel on-pump CABG between January 2019 and April 2025 were analyzed. Patients were divided into two groups: the Side-Clamp group (n = 132), where proximal anastomoses were performed under partial occlusion after releasing the main cross-clamp, and the Single Cross-Clamp group (n = 133), where all anastomoses were completed during a single arrest period. The primary outcomes were postoperative hemoglobin (Hb) drop and 24-h chest tube drainage. Results: The side-clamp technique was associated with significantly shorter cardioplegic arrest times (34.5 ± 3.7 vs. 52.0 ± 3.9 min; p < 0.001). Key findings revealed that the postoperative hemoglobin drop was significantly lower in the side-clamp group (1.9 ± 0.4 g/dL vs. 2.1 ± 0.4 g/dL; p = 0.005). Notably, the side-clamp group also exhibited significantly lower 24-h chest tube drainage (123.4 ± 28.3 mL vs. 131.0 ± 27.4 mL; p = 0.027). Multivariate linear regression analysis, adjusting for age, sex, and CPB time, confirmed the side-clamp technique as an independent predictor of superior hemoglobin preservation (β = −0.115, p = 0.009). No significant differences were observed regarding the incidence of postoperative AF (13.6% vs. 15.8%; p = 0.748) or 30-day mortality. Conclusions: The side-clamp strategy is associated with modest but statistically significant reductions in postoperative hemoglobin decline and 24-h chest tube drainage. While these differences did not translate into a significant reduction in RBC transfusion or early mortality, the side-clamp technique represents a useful technical component within a broader Patient Blood Management strategy in routine on-pump CABG practice. Full article

Background: Robot-assisted partial nephrectomy (RAPN) is an established nephron-sparing technique for localized renal tumors. It is performed using on-clamp (temporary renal artery clamping) or off-clamp (without hilar clamping) strategies. Comparative real-world evidence remains limited and is often confounded by non-randomized treatment allocation. Methods: This retrospective single-center study included 146 consecutive patients undergoing RAPN between 2020 and 2025. Patients were allocated to on-clamp (n = 108) or off-clamp (n = 38) groups based on tumor characteristics and intraoperative surgeon judgment. Perioperative, functional, and early oncological outcomes were analyzed. Tumor complexity was assessed using the RENAL nephrometry score. Surgical quality was evaluated using the Trifecta outcome (negative margins, warm ischemia time ≤25 min, and absence of Clavien–Dindo ≥III complications). Results: Off-clamp RAPN was more frequently applied in smaller tumors (p = 0.008), while RENAL scores were comparable between groups. Estimated blood loss was higher in the off-clamp group (260 ± 62 vs. 110 ± 35 mL; p < 0.0001), whereas transfusion rates and overall complication rates did not differ significantly. Trifecta achievement was similar between on-clamp and off-clamp RAPN (91.0% vs. 96.8%; p = 0.45). No significant differences were observed in early postoperative renal function (creatinine, hemoglobin, eGFR) or positive surgical margin rates. Conclusions: In this retrospective cohort, both on-clamp and off-clamp RAPN demonstrated comparable perioperative safety, functional outcomes, and early oncological efficacy. Differences in baseline tumor characteristics reflect selection bias rather than treatment effect. These findings support the feasibility of both techniques in appropriately selected patients, while highlighting the need for prospective comparative studies with adjustment for confounding factors. Full article

Tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) receptor agonist, demonstrates robust efficacy in glycemic control and weight reduction. However, substantial interindividual variability in treatment response is observed in clinical practice. In this narrative review, we summarize current evidence on clinical, genetic, and molecular predictors of tirzepatide response and discuss their implications for a precision medicine framework. Data from pivotal clinical trials, post hoc analyses, and relevant preclinical and clinical studies were evaluated to identify determinants of glycemic and weight loss responses, as well as hepatic and renal protective effects. Key clinical predictors include tirzepatide dose, duration of diabetes, β-cell function, baseline glycated hemoglobin, sex, age, race, concomitant therapies, and early treatment response. Genetic factors implicated in treatment variability include variants in GLP-1 receptor, GIP receptor, β-arrestin 1, transcription factor 7-like 2, fat mass and obesity-associated protein, and melanocortin 4 receptor, although tirzepatide-specific validation remains limited. Molecular biomarkers such as branched-chain amino acids, insulin-like growth factor–binding protein-1 and -2, the adiponectin-to-leptin ratio, high-sensitivity C-reactive protein, and interleukin-6 show potential as pharmacodynamic indicators of metabolic response. For organ-specific outcomes, procollagen type III N-terminal peptide and magnetic resonance imaging–proton density fat fraction are supported for assessing hepatoprotective effects, while cystatin C–based estimated glomerular filtration rate and urine albumin-to-creatinine ratio are validated markers of renoprotection. Additional candidates—including tumor necrosis factor receptor 1/2, kidney injury molecule-1, and neutrophil gelatinase-associated lipocalin—are promising but require prospective validation. Overall, predicting response to tirzepatide’s multifaceted therapeutic effects necessitates an integrated, multidimensional approach that incorporates clinical characteristics, genetic variation, and molecular profiling. Ongoing validation and harmonization of these predictors may help establish a precision medicine framework for optimizing tirzepatide therapy. Full article

Background: The very-low-calorie ketogenic diet (VLCKD) is increasingly used before bariatric surgery (BS), but its effects on surgical and long-term outcomes remain unclear. Objective: The aim of this study was to compare the impact of a 4-week VLCKD with a 4-week low-calorie diet (LCD) on preoperative, perioperative and postoperative outcomes for up 12 months in patients undergoing BS. Methods: In this prospective study, 72 (n = 36: VLCKD; n = 36: LCD) patients (mean age 43.2 ± 10.6 years; BMI 45.6 ± 6.4 kg/m²; 87.5% female) submitted to sleeve gastrectomy were enrolled at a tertiary care center from 2022 to 2024. Results: No adverse events were detected with both diets. The VLCKD was associated with a greater preoperative median weight loss percentage (−5.5 vs. −2.6 kg, p < 0.001), BMI reduction (−2.6 vs. −1.2 kg/m², p < 0.001), shorter hospital stay (3.0 ± 0.2 vs. 3.4 ± 0.9 days, p = 0.017), higher day-1 postoperative hemoglobin (12.7 ± 1.3 vs. 12.0 ± 1.2 g/dL, p = 0.024), and lower day-1 postoperative median C-reactive protein levels (9.7 vs. 13.4 mg/L, p = 0.042). These associations were confirmed in a multiple regression model, after adjustments for BMI at enrolment, age and sex. After 6 months, the VLCKD was associated with greater reductions in mean weight loss percentage (−24.9 ± 7.8 vs. −19.6 ± 9.4 kg, p = 0.012), BMI reduction (−11.7 ± 4.4 vs. −8.7 ± 3.9 kg/m², p = 0.003), neck circumference (−4.9 vs. −3.6 cm, p = 0.027) and lower aminotransferase levels. At 12 months, VLCKD patients maintained significant advantages over the same variables, except for neck circumference. Conclusions: A short preoperative VLCKD was safe and was associated with greater short-term weight reduction compared with the LCD, with potential benefits extending to early postoperative recovery and 1-year outcomes. Full article

Objective: Acute colonic pseudo-obstruction (ACPO), also known as Ogilvie syndrome, is a rare but serious complication following cesarean section (CS). Identifying factors associated with its occurrence is critical for early recognition and prevention. This systematic review and meta-analysis aimed to synthesize available evidence on factors associated with ACPO following CS. Methods: We performed a systematic literature search across five databases (PubMed, Embase, CNKI, Wanfang, and CBM) from inception to December 2025. Studies investigating factors associated with ACPO after CS were eligible. Quality of included studies was assessed using the Newcastle–Ottawa Scale. For factors reported in at least two studies, pooled odds ratios (ORs) or weighted mean differences (WMDs) with 95% confidence intervals (CIs) were calculated. Results: Five case-control studies comprising 484 patients (103 ACPO cases and 381 controls) were included, of which four were rated as good quality. Twenty-five potential associated factors were analyzed. Several pre-/intraoperative factors demonstrated statistically significant associations with ACPO risk, including concomitant anemia (OR = 8.94, 95% CI: 2.59–30.88), previous abdominal surgery (OR = 2.39, 95% CI: 1.28–4.47), surgery duration > 1 h (OR = 4.11, 95% CI: 2.20–7.67), and blood loss > 1000 mL (OR = 5.72, 95% CI: 2.10–15.58). Intraoperative blood loss as a continuous variable (WMD = 1.30, 95% CI: 0.14–2.46) was also significantly associated with ACPO. In contrast, emergency cesarean section, opioid use, and type of anesthesia were not significantly associated. Regarding postoperative features, bed rest > 12 h (OR = 2.66, 95% CI: 1.29–5.49), postoperative fever ≥ 38 °C (OR = 3.82, 95% CI: 1.94–7.54), elevated postoperative white blood cell count (WMD = 1.22, 95% CI: 0.30–2.14), and lower postoperative hemoglobin level (WMD = −0.50, 95% CI: −0.83 to −0.18) were significantly associated with ACPO. However, these factors may represent consequences of perioperative complications or components of the early clinical presentation of ACPO. Conclusions: This systematic review and meta-analysis identified multiple perioperative factors associated with ACPO following CS. However, the use of univariate data from a limited number of studies limits interpretability. Prospective cohort studies are needed to clarify whether these factors play a causal role in the development of ACPO. Full article

Objective: To compare perioperative outcomes between robotic and conventional total laparoscopic hysterectomy in terms of operative time, intraoperative blood loss, and postoperative recovery in surgically complex cases. Methods: This retrospective cohort study included patients that underwent total laparoscopic hysterectomy between 2020 and 2022. As robotic surgery was preferentially applied to more complex cases in an effort to minimize the risk of open conversion, propensity score matching based on uterine weight and history of abdominal surgery was performed. The normality of continuous variables was assessed using the Shapiro–Wilk test; non-normally distributed variables are reported as median [interquartile range] and compared using the Mann–Whitney U test. Multivariate linear regression with log-transformed estimated blood loss was conducted to evaluate the independent association of surgical approach with hemostatic outcomes. Results: After 1:1 matching, 93 patients were analyzed per group. Robotic surgery was associated with longer operative time but lower estimated blood loss when compared with conventional laparoscopy. Postoperative hemoglobin decline, length of hospital stay, and complication rates were comparable between groups. In multivariate analysis, uterine weight and operative time were the primary determinants of estimated blood loss; surgical approach showed a modest, independent association with lower log-transformed estimated blood loss after adjustment for these factors. Conclusions: Robotic and conventional total laparoscopic hysterectomy demonstrated comparable perioperative safety profiles with different operative trade-offs. Observed differences in estimated blood loss reflect complex interactions between surgical difficulty, operative time, and instrumentation rather than inherent platform superiority. These findings support an individualized approach to surgical modality selection based on case complexity, to minimize risk of intraoperative complication leading to open conversion. Full article

Background and Objectives: This study investigated the correlation of the liver-to-spleen (L/S) Hounsfield unit ratio on abdominal CT with liver function and diabetic indicators before and after laparoscopic sleeve gastrectomy (LSG), comparing patients with and without diabetes mellitus (DM and non-DM groups). Methods: Patients undergoing LSG were categorized into DM and non-DM groups. Metabolic parameters and abdominal CT scans were assessed preoperatively and one year postoperatively. Correlations among these variables were analyzed, and intergroup comparisons were performed. Results: Preoperative body weight and postoperative weight loss were comparable between the DM and non-DM groups. Before surgery, the DM group showed significantly higher levels of fasting plasma glucose (FPG), hemoglobin A1c (HbA1c), aspartate transaminase (AST), alanine transaminase (ALT), and γ-glutamyl transpeptidase (γ-GTP). After LSG, both groups exhibited significant reductions in FPG, HbA1c, AST, ALT, and γ-GTP, along with a significant increase in the L/S ratio. The reduction in γ-GTP was more pronounced in the DM group. In the DM group, changes in glycemic markers (FPG and HbA1c) were significantly correlated with changes in liver enzymes and with the change in L/S ratio. Conclusions: LSG reduced body weight and fat mass and improved glucose metabolism and liver function in patients with obesity, regardless of their diabetes status. Improvements in liver enzymes and/or the L/S ratio were more marked in diabetic patients and might be closely linked to better glycemic control following surgery. Full article