Search Results (3,576)

Urban forests support everyday nature-based recreation, yet recreation planning commonly classifies spaces by function while paying less attention to local acoustic conditions. This study examined whether soundscape evaluations varied primarily among individual recreational settings or between two broad types of space within one urban forest. Fifty-six participants visited four locations in a repeated-measures field design: two walking trails and two stationary recreation areas. After 20 min of ordinary walking or seated recreation at each location, participants evaluated perceived sound level, soundscape attributes, noise annoyance, and interference with recreation. Indicative sound-level observations were also conducted to provide contextual information on the acoustic conditions at the study sites. The riverside trail was rated as the most pleasant, calm, and natural, whereas the trail near an expressway received the least favorable ratings and the highest continuous-noise annoyance. Differences between the pooled categories of walking trails and resting areas were considerably smaller, indicating that aggregating heterogeneous locations into broad spatial types averages out fine-grained, location-specific acoustic nuances. The findings indicate that broad functional classifications alone provide limited guidance for recreational planning. Site-specific acoustic context should therefore be considered when locating and managing facilities for sustainable nature-based recreation. Because several environmental attributes varied simultaneously, the results describe integrated place conditions rather than causal effects of individual acoustic parameters. Full article

This study presents a multi-methodological approach combining subsurface characterization with dynamic structural assessment to evaluate Soil–Structure Interaction (SSI) mechanisms at the Palazzo Centrale. The 3D Electrical Resistivity Tomography (ERT) and active Multichannel Analysis of Surface Waves (MASW) results were compared with a lithostratigraphic core log to outline the subsurface framework. The stratigraphic framework mapped geotechnical heterogeneities within the upper 6.0 m, where a low-resistivity anomaly (≤1 log(Ω·m)) outlines a mechanically weakened, water-saturated cover deposit overlaying the basaltic lava. This characterization provides the physical baseline useful for interpreting the site response. In this framework, the ambient vibration recordings performed at the free-field sites exhibit a flat Horizontal-to-Vertical Spectral Ratio (HVSR) response within the 1.0–10.0 Hz range, whereas a localized stratigraphic peak emerges at higher frequencies near 15.0 Hz, particularly evident in the building’s courtyard. The building resonance frequency peaks, derived from the Horizontal-to-Horizontal Spectral Ratio (HHSR) analysis at 3.74 ± 0.09 Hz (NS) and 3.58 ± 0.22 Hz (EW), do not overlap with the site resonance frequencies, demonstrating a dynamic decoupling between the soil and the building within the low-to-medium frequency domain. Conversely, the secondary stratigraphic peak near 15.0 Hz overlaps with higher-order structural frequencies tracked in the HHSR datasets. Given the localized nature of this stratigraphic peak and the involvement of higher-order structural modes, this overlap suggests a limited, localized high-frequency amplification confined to specific architectural components, rather than a global site-structure hazard. Furthermore, torsional analysis reveals significant effects within the 3.8–4.0 Hz frequency band, targeting the North-East corner (peak value of 2.85 at station A4), indicating a localized dynamic anomaly due to structural heterogeneities. Overall, this multi-method approach proves highly effective for non-invasive structural diagnostics, establishing a rigorous physical reference that could be successfully integrated into future preventive conservation frameworks and routine monitoring protocols for ancient architectural heritage. Full article

Hydrogen embrittlement (HE) behavior of 31CrMoNiNbV steel subjected to austempering below the M_s temperature was investigated. The material exhibited a martensitic/bainitic dual-phase microstructure, with uniformly dispersed V- and Nb-rich MC carbides as well as Cr-rich M₃C carbides precipitated in the matrix. It achieved an ultimate tensile strength of 1688 MPa and an elongation to fracture of 10.7%. Slow strain rate tensile tests revealed that the HE susceptibility index reached 13.5%. Thermal desorption spectroscopy and hydrogen permeation tests showed that the martensite/bainite phase boundaries and the dispersed MC/M₃C carbides acted as effective hydrogen-trapping sites, lowering the hydrogen diffusivity and alleviating local hydrogen accumulation in stress-concentrated regions. Microstructural analysis further indicated that the dual-phase structure may simultaneously mitigate the hydrogen-enhanced localized plasticity and hydrogen-enhanced decohesion mechanisms, through combined stress relaxation at martensite/bainite interfaces and hydrogen immobilization by carbide traps. Full article

Accurate protein function prediction (PFP) is essential for understanding biological systems. However, structure-based graph neural networks often rely on fixed-distance contact maps, which may inadequately capture continuous, multi-scale spatial topologies, while the long-tail distribution of Gene Ontology (GO) labels may bias prediction toward frequent functions. We propose DHST, a deep hybrid structure–topology framework that integrates sequence semantics from a pretrained protein language model with local structural information learned by a residual graph convolutional network. DHST further introduces site-specific persistent homology to encode multi-scale topological invariants and a topology-guided residue-wise gated fusion module to modulate structure–semantics representations using local topological embeddings. The fused residue features are aggregated through dual-path pooling, and a weighted binary cross-entropy loss is used to mitigate the adverse effects of label imbalance. On the PDB dataset, DHST achieved area under the precision–recall curve (AUPR) scores of 0.779, 0.481, and 0.557 for molecular function (MF), biological process (BP), and cellular component (CC), respectively; on the AF2 dataset, the corresponding scores were 0.729, 0.390, and 0.459. The model also demonstrated robust generalization to low-homology proteins and maintained strong predictive performance across GO terms with different levels of functional specificity. Ablation results supported the contributions of the main components. Full article

Periprosthetic joint infection (PJI) remains one of the most serious complications of arthroplasty, largely due to the formation of microbial biofilms on implant surfaces. Biofilm-associated infections exhibit increased tolerance to antimicrobial therapy and host immune responses, making eradication difficult and often requiring repeated surgical interventions. Consequently, there is a growing need for effective local therapeutic strategies capable of delivering high concentrations of antimicrobial agents directly to the site of infection while minimizing systemic toxicity. Hydrogels have emerged as promising drug delivery platforms for the management of biofilm-associated PJI. Their biocompatibility, injectability, high water content, and tunable physicochemical properties enable controlled and localized release of therapeutic agents within the infected peri-implant environment. This narrative review summarizes recent advances in hydrogel-based approaches, including antibiotic-loaded hydrogels, systems incorporating anti-biofilm enzymes, bacteriophage-loaded formulations, and nanoparticle-enhanced platforms. It also highlights future research directions, with particular emphasis on the need for expanded clinical studies to facilitate the translation of emerging hydrogel-based therapies into clinical practice. Further development of these systems should focus on the incorporation of novel therapeutic agents into hydrogel platforms, aiming to enhance biofilm eradication and improve treatment outcomes in patients with PJI. Particular attention is given to stimuli-responsive (“smart”) hydrogels that release therapeutic payloads in response to infection-related triggers such as pH changes, with emphasis on the need for expanded clinical studies to facilitate the translation of emerging hydrogel-based therapies into clinical practice. Further development of these systems should focus on the incorporation of novel therapeutic agents into hydrogel platforms, aiming to enhance biofilm eradication and improve treatment outcomes in patients with PJI. Full article

Accommodation establishments constitute a core component of tourism infrastructure, and their location choices directly affect water resource utilization, land pressure, and the spatial equilibrium of tourism development—issues that are particularly acute in vast arid regions. Yet the spatial organization of accommodation supply across extensive drylands characterized by fragmented oasis distribution, and the reasons why standard and non-standard accommodation follow divergent location logics, remain poorly understood. This study addresses three questions: (1) How are nine accommodation categories, differentiated by type and quality, distributed across Xinjiang? (2) Do directional spatial associations exist among categories that are consistent with hierarchical, path-dependent development? (3) Which factors drive these patterns, and do their effects exhibit the nonlinearity and threshold behavior predicted by location theory? Drawing on 12,073 accommodation establishments from the Ctrip platform, we construct a staged analytical framework in which each technique answers a specific question: the nearest-neighbor index and standard deviational ellipse characterize global patterns; kernel density estimation and OPTICS clustering identify local agglomerations; directional local co-location quotients measure asymmetric spatial associations; and XGBoost–SHAP isolates nonlinear drivers and threshold effects. Results reveal a highly concentrated “single-core, multi-center” structure anchored by Urumqi, Yining, and Kashgar, with rapid expansion toward the Ili Valley, Kashgar, and Altay since 2019. Standard accommodation tracks urban centrality and transport nodes, while non-standard accommodation tracks tourism resource endowments, consistent with location-theoretic expectations. Directional co-location analysis reveals hierarchical spatial associations among categories, and driving factors exhibit pronounced nonlinear threshold effects. From a sustainability perspective, the identified thresholds—elevation (1360 m), water-body proximity, and distance to rural tourism demonstration sites (3 km)—constitute quantifiable, spatially explicit sustainability indicators that can be incorporated into planning tools to monitor and steer accommodation development away from ecologically sensitive zones. Global Moran’s I diagnostics of model residuals (reduction of 83–99.7%) suggest that these findings are unlikely to be artifacts of spatial autocorrelation; this diagnostic, however, complements rather than replaces spatially blocked validation. The study contributes category-differentiated, spatially directed evidence for policies balancing tourism expansion against water security and ecosystem integrity, serving sustainable tourism development in arid-region destinations. Full article

Background: Right-sided metastatic colon cancer represents a clinically distinct subgroup with inferior outcomes and uncertain optimal biologic treatment selection, even among patients with RAS wild-type disease. Real-world data focusing specifically on right-sided RAS wild-type metastatic colon cancer remain limited. This study aimed to describe clinicopathologic characteristics, metastatic patterns, treatment approaches, and survival outcomes in this population using a national multicenter registry. Methods: This retrospective multicenter cohort study was conducted using data from the ONKO-KOLON Türkiye registry. Patients with pathologically confirmed KRAS/NRAS wild-type metastatic colorectal cancer and available primary tumor localization were evaluated. The main analytic cohort included patients with right-sided metastatic colon cancer, defined as right colon or transverse colon tumors. Left-sided colon cancer patients were used as a contextual comparator, while rectal cancer patients were excluded from sidedness-based colon comparisons. Survival outcomes were estimated using the Kaplan–Meier method, and prognostic factors were evaluated using Cox regression analyses. Results: Among 1079 patients in the source cohort, primary tumor localization was available in 1065 patients. Of these, 213 had right-sided colon cancer, 464 had left-sided colon cancer, and 388 had rectal cancer. In the right-sided cohort, median age was 61.5 years, 64.3% were male, and 66.7% had synchronous/de novo metastatic disease. Liver metastasis was the most common metastatic site (63.4%), followed by lymph node (31.0%), lung (21.1%), and peritoneal metastases (15.5%). First-line anti-VEGF-based treatment was used in 46.0% of patients, while anti-EGFR-based treatment was used in 40.8%. Among evaluable patients, the objective response rate was 46.8% and the disease control rate was 79.2%. Median progression-free survival was 10.0 months, and median overall survival was 24.0 months. In unadjusted exploratory analysis, median OS was 27.0 months with anti-EGFR-based treatment and 17.0 months with anti-VEGF-based treatment (log-rank p = 0.022), whereas median PFS was 10.0 months in both groups. In an extended covariate-adjusted multiple-imputation sensitivity model, the anti-EGFR OS estimate did not meet statistical significance (adjusted HR 0.66, 95% CI 0.43–1.00; p = 0.051). In a secondary contextual comparison, median overall survival was shorter in the right-sided than in the left-sided colon cancer group (24.0 vs. 28.0 months; HR 1.47, 95% CI 1.19–1.82; p < 0.001), whereas progression-free survival did not differ significantly. Conclusions: This study provides a descriptive account of metastatic patterns, treatment approaches, and outcomes in a dedicated right-sided RAS wild-type metastatic colon cancer cohort. The unadjusted OS difference between biological treatment groups was not confirmed after measured covariate adjustment and should not be interpreted as evidence of comparative treatment effectiveness. Because molecular profiling was incomplete, this study cannot identify biomarker-defined treatment subgroups. Prospective studies with complete, predefined molecular characterization are needed before molecularly informed treatment selection hypotheses can be evaluated in this population. Full article

Cannabis use has increased substantially in the United States, driven by broader legalization, decriminalization, and expanding medical and recreational availability. For facial plastic surgeons, the clinical implications remain difficult to define because “cannabis use” encompasses heterogeneous products and routes, including smoked flower, vaping, concentrates, edibles, pharmaceutical cannabinoids, topical cannabidiol (CBD), and frequent co-use with tobacco or nicotine. Current evidence suggests that systemic cannabis use, particularly inhaled or heavy perioperative use, may be associated with increased surgical complications in selected populations; however, existing studies are limited by retrospective design, inconsistent exposure definitions, inadequate dose and route characterization, and confounding by tobacco use and comorbidities. Cannabinoids exert biologic effects through the endocannabinoid system, particularly CB1 and CB2 receptors, which are expressed in the central nervous system, immune cells, vasculature, and skin. These pathways influence inflammation, keratinocyte proliferation, fibroblast activity, angiogenesis, immune surveillance, pain signaling, and tissue remodeling. The net effect of cannabinoid exposure on wound healing is likely context dependent, varying based on receptor expression, wound-healing phase, route of administration, cannabinoid composition, local tissue environment, and patient-specific risk factors. Preclinical and early dermatologic literature suggests potential therapeutic roles for topical cannabinoids, especially CBD, in modulating inflammation and epithelial repair. In contrast, systemic perioperative cannabis use has been associated in several surgical cohorts with infection, delayed healing, hematoma, nonunion, and reoperation. Evidence specific to facial plastic surgery remains sparse. The most directly relevant study evaluated cannabis and tobacco use in patients undergoing operative mandibular fracture repair. Cannabis-only use was not associated with increased complications, although the cohort was small; concurrent cannabis and tobacco use was associated with higher rates of surgical site infection, facial nonunion, abscess, debridement, and malocclusion. To date, no published studies address cannabis-associated outcomes in rhinoplasty, rhytidectomy, blepharoplasty, browlift, or facial rejuvenation. This review summarizes the biologic rationale, available surgical evidence, and clinical considerations for incorporating cannabis use into individualized perioperative risk assessment in facial plastic surgery. Full article

This study presents the first evaluation of the degree of nonlinearity in site response at strong-motion stations in Türkiye during the 6 February 2023 Kahramanmaraş earthquake sequence (Mw 7.8 and Mw 7.5) using earthquake horizontal-to-vertical spectral ratios (eHVSRs). The analysis uses 2050 weak-motion and 175 strong-motion records from 24 AFAD stations in the Kahramanmaraş and Hatay regions, where some of the strongest ground motions and most severe damage were observed. The selected stations cover a broad range of site conditions, from soft alluvial deposits to relatively stiff sites, as characterized by Vs30. Conventional assessments of nonlinear site response generally rely on peak ground-motion measures and one-dimensional site proxies, particularly Vs30. In contrast, this study evaluates nonlinear behavior within a record-based framework that accounts for the combined influence of source characteristics, propagation path, local site conditions, and basin-related wave effects. Nonlinear site response is quantified by comparing strong-motion and weak-motion eHVSR spectra, where the weak-motion reference is derived from records with peak ground velocity (PGV) lower than 1 cm/s. A principal methodological contribution is the use of record-specific S-wave windows selected according to the event-dependent energy content of each record, rather than a uniform fixed-duration window. This energy-based procedure focuses on the dominant S-wave energy while reducing pre-event noise and late-arriving coda effects. Incorporating record-specific S-wave duration improves degree of nonlinearity (DNL) estimates, proving that nonlinear response is driven not just by peak amplitude and near-surface stiffness but also by duration-dependent cyclic deformation demand. The proposed framework provides record-based constraints for empirical ground-motion models and regional three-dimensional physics-based earthquake simulations. Full article

Conventional needle-based vaccination may cause tissue injury and increase the risk of cross-contamination between animals. This study evaluated the immunological effects of delivering an inactivated porcine circovirus type 2 (PCV2) vaccine using a needle-free jet injection system compared with needle injection in pigs. Immune responses were assessed using enzyme-linked immunosorbent assay (ELISA) for PCV2-specific antibody levels on days 7, 14, and 28 post-vaccination. Cellular architecture at injection sites and differential gene expression were analyzed using immunohistochemistry and transcriptome sequencing. Results showed that pigs receiving needle-free vaccination at 0.50 mL and 0.75 mL injection volumes exhibited higher PCV2-specific antibody responses than pigs receiving 1.0 mL needle injection. Needle-free vaccination also preserved dermal collagen fiber architecture, altered antigen-presenting cell distribution, and was associated with distinct activation of immune-related pathways, particularly those involved in leukocyte migration and cytokine-cytokine receptor interactions. These findings indicate that needle-free vaccination was associated with distinct PCV2-specific antibody responses and local immune microenvironment changes, supporting its potential as an alternative vaccine delivery strategy for swine PCV2 vaccination. Full article

Road networks providing access to forest stands, including integral parts such as timber yards, are subjected to significant loads from timber-transporting vehicles. These loads act on the road surfaces, causing them to deform. This study measured and compared the extent of deformation at two timber yards in the mountain forests of southern Poland in the Western Carpathians. These surfaces were constructed as: crushed stone (timber yard in the Ustroń Forest District) and earth (Forest Experimental Station of the University of Agriculture in Kraków). The measurements were carried out using photogrammetric techniques based on aerial surveys by an unmanned aerial vehicle. The measurements were based on networks of reference points with coordinates in local coordinate systems. During the period between the flights, timber was being stored, handled and transported at both sites. The forest administration provided data on the volume of timber delivered to and removed from the storage yard, as well as basic information on the transport vehicles. Soil samples were taken from the surface of both storage yards for laboratory analysis to illustrate working conditions—the soil type, current moisture content, organic matter content and filtration coefficient (from the soil particle size distribution curve) were determined. Digital terrestrial model (DTM) rasters obtained from both aerial surveys at each storage yard were used to calculate differential rasters, which were analysed by plotting cross-sections at selected locations and directions and by calculating the volume of changes in surface geometry between the survey dates. The observed depths of ruts reach 0.4 m at the Ustroń storage yard and 0.5 m at the LZD storage yard, whilst changes involving the displacement of soil from the ruts above the previous surface level are 0.3 m at the Ustroń storage yard and 0.4 m at the LZD storage yard. Greater deformation was observed on the earth surface (with a high organic content and poorer drainage) than on the crushed stone surface, even though the latter was covered by an uncleared layer of mud and waste left over from timber handling. Given the two-site, single-cycle design of this study, this pattern is consistent with—but cannot on its own confirm—a stabilising effect of surface reinforcement; differences in soil moisture, organic content and observation period between the two sites may also have contributed and could not be separated from the effect of surface type alone. Full article

Surface ozone (O₃) pollution has become an increasingly important constraint on further improvements in urban air quality, particularly in industrial cities where complex terrain, local emissions, and meteorological conditions interact. In this study, hourly air pollutants, meteorological parameters, and high-time-resolution volatile organic compound (VOC) observations collected at a single urban-core site during September from 2021 to 2024 were used to investigate O₃ pollution characteristics, VOC reactivity, source contributions, and driving mechanisms in a resource-based heavy-industrial city in northwestern Henan Province, China. Ozone formation potential (OFP), diagnostic ratios, positive matrix factorization (PMF), meteorological normalization, and extreme gradient boosting combined with Shapley additive explanations (XGBoost-SHAP) were integrated to identify key reactive species, major sources, and meteorological–precursor interactions. The mean maximum daily 8 h average O₃ concentrations were 113.44, 150.32, 123.59, and 154.18 μg·m⁻³ from 2021 to 2024, respectively, with the highest level observed in 2024 despite the lowest nitrogen dioxide (NO₂) and carbon monoxide (CO) concentrations. O₃ was positively correlated with temperature and negatively correlated with relative humidity, indicating the importance of hot and relatively dry conditions. Total VOC OFP first increased and then declined, with alkenes dominating in 2021 and aromatics exceeding alkenes after 2022. Ethene, m/p-xylene, toluene, and vinyl chloride were identified as priority reactive species. PMF results showed that mixed industrial processes and vehicle exhaust were the dominant VOC sources, contributing 32.3% and 23.8%, respectively. Under the original meteorological-normalization specification, represented meteorological features accounted for 64.7% of the modeled O₃ increase during the study period. Sensitivity specifications retained meteorological dominance but showed that the exact share was model dependent. SHAP analysis further identified temperature, short-term temperature variation, relative humidity, alkenes, and NO₂ as key drivers. These results suggest that O₃ pollution in this heavy-industrial city is jointly shaped by favorable meteorological conditions, reactive VOCs, nitrogen oxides (NOx) chemistry, and combined industrial and traffic emissions. Accordingly, industrial processes, vehicle exhaust, and highly reactive VOC species are likely priority targets for mitigation, while the effectiveness of coordinated VOC–NOx control still warrants further regime-specific evaluation. Full article

Mesoporous silica nanoparticles (MSNs) have emerged as versatile nanocarriers for biomedical applications because of their unique physicochemical properties, including high surface area, large pore volume, excellent drug-loading capacity, controllable biodegradation, and facile surface functionalization. These characteristics have enabled the development of advanced drug delivery systems with enhanced therapeutic efficacy, targeted delivery, improved bioavailability, and reduced systemic toxicity. Recent advances in MSN synthesis, physicochemical properties, surface engineering, and functionalization strategies have significantly improved their biological performance and therapeutic potential. In particular, integrating polymers, lipids, and liposomes with MSN platforms has enhanced colloidal stability, circulation time, cellular uptake, and target specificity, thereby facilitating efficient, stimuli-responsive drug delivery. This review highlights MSN-based drug delivery systems in cancer therapy, where multifunctional nanocarriers enable site-specific delivery, controlled drug release, enhanced tumor accumulation, and reduced off-target effects. The review discusses the expanding roles of MSNs in antimicrobial therapy, wound healing, tissue engineering, and regenerative medicine, emphasizing their ability to promote localized therapeutic delivery, immunomodulation, angiogenesis, and tissue regeneration. The review discusses the diagnostic and theragnostic capabilities of MSNs for disease imaging and monitoring. It also critically evaluates current challenges related to biocompatibility, biodegradation, toxicity, biological barriers, large-scale manufacturing, clinical translation, and regulatory considerations. This review provides a comprehensive overview of recent progress, current limitations, and future opportunities for MSN-based platforms in targeted drug delivery and advanced biomedical applications, supporting their continued advancement toward clinical translation and precision medicine. Full article

Mechanical force offers a distinctive nonequilibrium mode of energy input for lignocellulosic biomass valorization through localized, transient action. This review systematically examines the multiscale physicochemical effects of mechanical force, its synergistic coupling with chemical pretreatments, and its role in enhancing enzymatic hydrolysis. The principal contribution of mechanical force is not merely particle-size reduction, but the exposure of active sites and improvement in substrate accessibility at the molecular level. Coupling mechanical force with chemical pretreatment enables the efficient component fractionation under mild conditions while mitigating irreversible lignin condensation. In high-solids enzymatic hydrolysis, a periodic mechanical energy input can tear fiber bundles, release constrained water, and renew reaction interfaces, thereby allowing enzymes to sustain a high catalytic efficiency at extremely low liquid-to-solid ratios and reducing the dependence on large amounts of free water. An economic analysis indicates that feedstock and enzyme costs dominate the overall process economics. Accordingly, mechanical-force strategies should prioritize the maximized sugar yield and reduced enzyme loading under a controlled energy input. Future research should focus on continuous operation, the balance between mechanical deconstruction and lignin structural integrity, and multidimensional evaluation frameworks that integrate the energy consumption, sugar yield, enzyme dosage, and full-process energy balance. Full article

Background and Objectives: Anastomotic leak after left-sided colectomy has not declined despite refinements in technique and patient selection, prompting interest in whether local reinforcement might influence the clinical course of leaks that occur rather than their occurrence. We describe the feasibility and safety of Hemopatch serosal reinforcement of stapled colocolic anastomoses in elective left colectomy, and the distribution of leak grades observed under two reinforcement practices in routine use. Materials and Methods: A retrospective single-centre cohort of consecutive elective left colectomies was observed (January 2013–December 2024). Reinforcement technique followed the operating surgeon’s routine practice and was therefore completely confounded with surgeon and department; the study was not designed to isolate a device effect, and no causal or comparative-effectiveness inference is drawn. Leaks were graded by the ISREC classification. Balance was quantified with standardised mean differences (SMD) and proportions with exact 95% confidence intervals; a penalised (Firth) logistic model is reported as exploratory. Results: Ninety-four patients were analysed (28 Hemopatch, 66 s-line suture). Reinforcement was applied as intended in all 28 Hemopatch cases (100%, 95% CI 87.7–100). The Hemopatch group was older (median 76.5 vs. 68 years; SMD 0.89), with further imbalance in both directions. Anastomotic leak occurred in 14.3% (95% CI 4.0–32.7) versus 13.6% (6.4–24.3); the exploratory model was uninformative (OR 1.20, 95% CI 0.32–4.48). Leak grades were distributed differently, with no Hemopatch leak requiring reoperation (0%, 95% CI 0–12.3) versus four (6.1%, 1.7–14.8) and radiologically detected leaks more frequent with Hemopatch; all intervals overlapped substantially. Length of stay (median 9 vs. 6.5 days), readmission (35.7% vs. 11.3%) and two reoperative small-bowel obstructions occurred in the Hemopatch group. Conclusions: Hemopatch serosal reinforcement was technically feasible. Leak occurrence was similar between practices; leak grades differed in distribution, with reoperation for leak absent in the Hemopatch group. As reinforcement was confounded with surgeon and department, these differences describe two practices rather than a device effect. Longer stay and higher readmission require prospective safety capture; two adhesive obstructions occurred in the Hemopatch group, with operative findings in both remote from the reinforcement site. Prospective cluster-adjusted evaluation is required before any efficacy claim. Full article