Search Results (3,099)

Objectives: We developed an original protocol for standing balance and walking function training using immersive virtual reality (IVR) combined with a bodyweight-supporting (BWS) system. The purpose of this study was to evaluate the feasibility of IVR training in poststroke patients and to identify clinical characteristics associated with walking improvement. Methods: A total of 22 poststroke patients admitted to a rehabilitation ward were enrolled. All participants received conventional physical therapy daily, and IVR training was initiated when balance recovery plateaued. The original IVR training was conducted for 10 consecutive days using a BWS system, enabling safe and repetitive practice of standing weight shifting and advanced stepping tasks, with task difficulty individually adjusted. Primary outcomes were the Berg Balance Scale (BBS), Functional Reaching Test (FRT), and walking time on the 10-m walk test (10 MWT). Changes in 10 MWT (Δ10 MWT) were calculated, and participants were dichotomized into good and poor walking improvement groups based on Δ10 MWT to compare baseline clinical characteristics (e.g., BBS, FRT, and Functional Ambulation Categories [FAC]) between the groups. Receiver operating characteristic (ROC) curve analyses were conducted to identify cutoff values associated with greater improvements in walking. Results: BBS, FRT, and 10 MWT improved significantly after the 10-day IVR training (p < 0.01). ROC analyses identified FAC ≤ 3 and BBS ≤ 42 before training as cutoff values associated with greater improvement in walking performance. Conclusions: Our proposed IVR training approach using a BWS system could be safely implemented and might improve standing balance and walking function in poststroke patients with a balance disability. Full article

Cibotium barometz (L.) J.Sm., a medicinal fern, relies on three interconnected processes for in vitro propagation: spore germination, ordered gametophyte development, and successful initiation and early establishment of the sporophyte generation. However, during aseptic subculture, gametophytes frequently deviate from this developmental trajectory. The predominant abnormalities include filamentous arrest, thick fan-shaped blades, and irregular spatulate blades, all of which were associated with reduced archegonial maturation and subsequent sporophyte establishment. In this study, developmental time-course observation, paraffin-section histology, and medium-regulation experiments were integrated to establish a diagnosis–recovery–initiation framework for Cibotium barometz gametophytes. Spore germination and gametophyte development were divided into eight practical checkpoints: spore imbibition, spore-wall rupture, rhizoid emergence, rhizoid elongation, filamentous prothallus, lamellar prothallus, cordate gametophyte, and sporophyte formation. The ontogeny of archegonia was delineated into six histological stages, ranging from the initial-cell stage to the pre-fertilization stage. Based on an integrative assessment of population appearance, individual morphology, and anatomical sections, abnormal gametophytes were classified into three diagnostic categories. Filamentous arrest manifested as wool-like or thread-like growth patterns, featuring persistent chain-like cellular organization and failure to develop a two-dimensional blade. Thick fan-shaped blades showed pronounced enlargement and thickening; section images revealed narrow, densely packed cells, accumulation of storage compounds, and localized wall thickening, a pattern consistent with, but not sufficient to demonstrate, a preferential shift toward vegetative proliferation. Irregular spatulate blades were narrow and asymmetric and showed morphological and histological features suggestive of disrupted tissue polarity. Although archegonial initial cells or primordium-like structures were intermittently detected, they infrequently advanced to mature archegonia. Medium treatment significantly affected arrest rate, hypertrophy rate, sporophyte initiation, and mean young-sporophyte height (p < 0.001). Murashige and Skoog (MS) medium supplemented with IAA, 6-BA, and activated carbon was associated with the highest arrest rate, whereas full-strength MS medium was associated with the most pronounced hypertrophy. Among hormone-free subculture treatments, 1/2 MS + activated carbon gave the highest sporophyte initiation rate (71.45% ± 9.16%); the same formula also performed well in primary hormone-free cultures (70.54% ± 9.07%). Correlation analysis showed a strong positive association between sporophyte initiation rate and mean young-sporophyte height (r = 0.935, p < 0.001), while arrest and hypertrophy were negatively associated with sporophyte initiation. These results support evaluating in vitro propagation using quantified developmental outcomes—arrest rate, hypertrophy rate, sporophyte initiation rate, and mean young-sporophyte height—rather than biomass alone. Under the tested conditions, hormone-free 1/2 MS + activated carbon was associated with the most favorable recovery outcomes; the underlying mechanisms require validation by quantitative histology, gene-expression analysis, endogenous-hormone profiling, and direct measurement of compounds adsorbed by activated carbon. Full article

Background: Enhanced Recovery After Surgery (ERAS) protocols aim to reduce surgical stress and optimize postoperative recovery, yet anesthesiologists’ knowledge of these protocols remains incompletely characterized. Methods: This cross-sectional survey (May–August 2025) evaluated knowledge of general and surgery-specific ERAS protocols among anesthesiology specialists, faculty, and residents in Turkey using a 37-item questionnaire based on current ERAS Society guidelines; the primary outcome was the continuous knowledge score, with Bloom’s cutoffs applied descriptively. Results: Among 380 participants (72.4% specialists/faculty, 27.6% residents), the mean standardized score was 68.5 ± 10.3; 47.6% (95% CI 42.7–52.7%) and 28.2% (95% CI 23.9–32.9%) had moderate and high knowledge, respectively. Professional title was independently associated with knowledge: scores were higher among specialists and faculty than residents (β = 5.92 and 6.79), and residents were less likely than specialists (OR 0.423) or faculty (OR 0.344) to fall in a higher knowledge category. Preoperative knowledge was lower than intraoperative/postoperative scores. Module-specific scores, interpreted descriptively because modules differ in item difficulty and subspecialty exposure, were highest in bariatric (74.6%) and lowest in colorectal surgery (49.8%). Conclusions: Anesthesiologists demonstrated predominantly moderate theoretical ERAS knowledge, with gaps in preoperative optimization and specific modules, indicating that curricula and continuing education may benefit from greater emphasis on these areas. Full article

Intensive yak fattening in cold alpine regions requires essential long-term high-concentration feeding, which disrupts rumen microbial homeostasis and causes inefficient digestion of nutrients. Lactobacillus may have probiotic potential for ruminants, yet its regulation of rumen function is poorly understood under high-energy diets. During a 120-day feeding experiment, 120 male Pamir yaks were allocated to four dietary treatments, with LEG and LLG serving as the primary comparison for evaluating 0.02% Lactobacillus supplementation to explore the regulatory effects of Lactobacillus supplementation on the rumen microbiota and host metabolism of yaks during a fattening process based on a concentrate feed diet via phenotypic data (body wight and nutrient digestibility) and multi-omics analyses (rumen microbial sequencing and rumen epithelial transcriptome) in a concentrate-based rearing yak model. The results showed that Lactobacillus intervention reduced OTU (Operational Taxonomic Unit) richness during the early fattening period and subsequently promoted microbial recovery through colonization resistance, which significantly enhanced microbial diversity (p < 0.05), and restructured the microbial community structure toward efficient energy utilization under high-concentrate feeding by reducing Prevotellaceae and Ruminococcaceae abundance, increasing the Bacillota/Bacteroidota ratio (p < 0.05). Concurrently, Lactobacillus enhanced the apparent digestibility of dry matter, crude protein, and fibrous components (p < 0.05). According to the transcriptomic analysis, there was an activation of signaling pathways related to IL-18 and TNF, and up-regulation of immune-and metabolism-related genes, in addition to strengthening the rumen mucosal barrier function. Multi-omics integration supported that dietary supplementation of Lactobacillus can optimize rumen fermentation, enhance nutrient digestion, and strengthen immune defense in Pamir yaks fed high-concentrate in cold seasons. These modifications demonstrate the positive effects of the Lactobacillus supplementation strategy on yak rumen health without interfering with the high-energy intensive rearing pattern. The present research presents a scientific basis for the use of targeted probiotic strategies to improve the rumen health and efficiency of alpine yak production systems. Full article

Sudden tailings dam breaches trigger large-scale heavy metal compound pollution in coupled surface water–groundwater systems, requiring systematic full-cycle ecological damage quantification tools applicable to diverse contamination types. This study constructs an integrated full-cycle ecological damage assessment framework for sudden water pollution accidents, integrating three core modules: multi-model pollutant migration prediction, multi-scale aquatic biological damage diagnosis, and three-dimensional ecological-economic loss accounting. The framework adopts a modular design that can potentially accommodate heavy metals (Cd, Cr, As, Pb) and organic pollutants such as polycyclic aromatic hydrocarbons (PAHs), with standardized molecular, individual, and population-level biological endpoints and corresponding pollutant dose–response templates reserved as reference calculation modules. However, applicability beyond this case has not been validated and requires case-specific calibration. To verify the operability and accuracy of the proposed integrated system, a typical tailings dam leakage incident dominated by hexavalent chromium (Cr(VI)) and arsenic (As) pollution was selected as the practical validation case; all field monitoring, pollutant simulation, and final economic loss quantification in this case exclusively rely on on-site measured Cr(VI) and As data, while Cd and PAH-related biological response curves and remediation cost formulas retained in the manuscript only serve as illustrative universal template components of the framework rather than case-measured results. For the Cr(VI)/As pollution case, the advection–diffusion model simulation revealed that the Cr(VI) contamination plume horizontally spread 250 m within 48 h and extended to 560 m after seven days, and anaerobic groundwater environments drove the transformation of toxic mobile trivalent arsenic (As(III)) from primary pentavalent arsenic. The calibrated SWAT model achieved Nash–Sutcliffe efficiency (NSE) coefficients of 0.75 for dissolved Cr(VI) and 0.68 for particulate As. The graph theory-based rapid prediction model cut computation duration down to minutes; when validated against independent field monitoring data, it yielded an average relative error of 14.2%, and its consistency with the SWAT model reached 10.5% relative deviation, satisfying the accuracy requirement for emergency early warning. Field biological monitoring demonstrated substantial ecological impairment: metallothionein (MT) expression in fish tissues was markedly elevated (the reported 6.2-fold induction value derives from standard Cd exposure template tests within the framework, with analogous MT upregulation also observed for field Cr(VI)/As co-stress), and benthic community Shannon diversity declined by over 50% in polluted river reaches. The standardized Ecological Damage Index (EDI) of the case was calculated as 480.2, indicating severe aquatic ecosystem damage, with total comprehensive ecological and economic losses reaching 17.25 million CNY. This study innovatively couples high-precision physical transport models with fast emergency prediction algorithms and establishes a complete multi-tier biological indicator chain linking molecular biomarkers to community integrity metrics; the three-dimensional loss accounting system integrating ecosystem service impairment, restoration expenditure, and post-pollution recovery loss realizes closed-loop full-cycle damage evaluation. The proposed framework, demonstrated for Cr(VI) and As pollution, has a modular design that may potentially be extended to other pollutants such as Cd and PAHs by adjusting model parameters, providing a quantitative reference for emergency disposal, pollution remediation, and ecological compensation of water contamination accidents, although further validation across different pollutants and hydrological settings is required. Full article

Background: The radial forearm free flap (RFFF) remains one of the most reliable and widely adopted reconstructive options for head and neck defects because of its consistent vascular anatomy, long pedicle, and excellent tissue pliability. Nevertheless, donor-site morbidity continues to represent its principal drawback and may negatively affect postoperative recovery, upper-limb function, and patient satisfaction. Although numerous surgical modifications and donor-site reconstruction techniques have been proposed to reduce morbidity, the available evidence remains fragmented and heterogeneous. This systematic review and meta-analysis aimed to quantify the incidence of the principal donor-site complications following RFFF harvest and critically evaluate the current evidence regarding strategies to minimize donor-site morbidity. Methods: This systematic review and meta-analysis was conducted according to the PRISMA 2020 statement and prospectively registered in PROSPERO (CRD420261423543). PubMed/MEDLINE, Embase, and Scopus were systematically searched from inception to June 2026. Clinical studies reporting donor-site outcomes after RFFF harvest for head and neck reconstruction were eligible. Primary outcomes were tendon exposure and skin graft loss/failure. Random-effects meta-analyses were performed to estimate pooled incidence rates. Secondary complications, functional outcomes, and patient-reported outcome measures were synthesized qualitatively. Methodological quality and certainty of evidence were assessed using the Joanna Briggs Institute critical appraisal tools and the GRADE framework. Results: Twenty-two studies met the inclusion criteria for qualitative synthesis. Fourteen studies were included in the meta-analysis of tendon exposure and twelve in the meta-analysis of graft loss/failure. The pooled incidence of tendon exposure was 8% (95% CI, 7–11%; I² = 0%), whereas the pooled incidence of graft loss/failure was 11% (95% CI, 7–16%; I² = 67.1%). Delayed wound healing, infection, sensory disturbances, scar-related morbidity, and functional impairment were reported inconsistently across studies, precluding quantitative synthesis. Available studies generally reported limited long-term functional impairment, although substantial heterogeneity in assessment methods and follow-up precluded quantitative synthesis. Overall certainty of evidence was rated as low. Conclusions: Donor-site morbidity following RFFF harvest remains clinically relevant despite the excellent reconstructive reliability of the flap. Approximately one in twelve patients experiences tendon exposure and one in ten experiences graft loss or failure. Current evidence does not support the superiority of any specific donor-site reconstruction technique. Future high-quality prospective comparative studies adopting standardized outcome definitions and validated patient-reported measures are required to optimize donor-site management and improve reconstructive decision-making. Full article

Heavy and extra-heavy oils represent a large and growing share of recoverable hydrocarbon resources, yet their extreme viscosity, high heteroatom content, and non-Newtonian behavior routinely defeat empirical correlations developed for conventional crude. Machine learning has emerged as a candidate response to this modeling gap, but existing reviews largely catalog applications without asking whether the technology is actually ready for industrial deployment. This critical review synthesizes machine learning applications across five thematic domains of the heavy-oil value chain: physicochemical property prediction, enhanced oil recovery, flow assurance, reactive recovery, and downstream upgrading. Studies are read through a three-phase historical lens, tracing the field’s progression from empirical-correlation replacement to methodological diversification to physics-informed and closed-loop integration, and evaluated against a Technology Readiness Level (TRL) scale adapted specifically for heavy-oil machine learning. The multilayer perceptron anchors more of the primary corpus than any other architecture, a pattern that, in our interpretation, reflects small-sample, low-dimensional regression needs rather than any demonstrated advantage over other architectures. Enhanced oil recovery is the only cluster to reach organizational-scale deployment, anchored by a single multi-decade operator program, Chevron’s San Joaquin Valley i-field; the remaining clusters are constrained less by modeling sophistication than by single-basin datasets and undisclosed uncertainty. Measured against three falsifiable deployability criteria, fidelity preservation below 10° API, operator-grade interpretability, and demonstrated laboratory-to-field transferability, no study in the reviewed corpus is documented to satisfy all three simultaneously; because industrial implementations are frequently proprietary, this is a statement about the published record identified by this search, not a claim that the capability does not exist. Federated learning, physics-informed architectures, and sequence-aware models emerge as the directions most likely to close this gap. Full article

There are limited data on the optimal time of renal replacement therapy (RRT) after cardiac surgery, and published results are controversial. In our study, an answer was sought to the question of the correct timing of RRT in diabetic patients with post-cardiac surgery acute kidney injury (AKI). Forty-four adult patients with DM who required postoperative RRT were included in our single-center prospective study. According to the time of onset of RRT, the patients were divided into two groups: those whose RRT was initiated with the early protocol (RRT started before conventional urgent indications developed) or the standard protocol (RRT started after at least one conventional urgent indication developed). The primary endpoint was in-hospital mortality; secondary endpoints were RRT duration, renal recovery, and ICU and hospital length of stay. A total of 54.5% of the 44 participants were female, while the mean age was 65 ± 9. Early RRT protocol was performed on 21(47.7%) and the standard protocol was performed on 23 (52.3%) patients. Twenty-three patients (52.3%) died during follow-up. Patient survival was found to be significantly higher in the group of patients who received the early RRT protocol, based on univariate analysis, binary regression analysis, Cox regression analysis, and log-rank analysis, compared to the standard protocol group (respectively, p < 0.001, p < 0.03, p < 0.01, and p < 0.001). It was found that RRT initiation with an early protocol was advantageous in terms of survival in the post-cardiac surgery AKI group of diabetic patients. We believe that the study results provide guidance on the follow-up of this group of patients. Full article

Electric aviation and unmanned aerial vehicles (UAVs) depend on lightweight composites to preserve payload and range, yet mass reduction, recycled content, or bio-based content alone does not establish component suitability. Candidate systems must also satisfy coupled structural, thermal, fire, electrical, manufacturing, durability, repair, and circularity requirements. This structured critical narrative review evaluates thermoplastic carbon-fibre-reinforced polymer (CFRP) systems, recycled-carbon-fibre composites, natural-fibre systems, bio-based and recyclable matrices, hybrid architectures, and multifunctional composites using a component-specific framework based on source role, evidence maturity, test comparability, and failure consequence. The framework links processing and chemistry to defects, retained performance, repair and recovery, and the evidence required for defined aircraft and UAV components. Thermoplastic CFRP provides the strongest near-term pathway for secondary and semi-structural components, although weld durability, impact tolerance, fire response, and process conformity remain system specific. Recycled-carbon-fibre and natural-fibre systems are most defensible for lower-consequence covers, fairings, housings, interiors, and UAV parts when feedstock variability, moisture, porosity, and fire performance are controlled. Battery enclosures, primary structures, rotor-support members, and structural-battery systems require representative coupled-hazard and component-scale evidence. The resulting adoption pathways are bounded by component and operating conditions, with manufacturing, durability, repair, recovery, and qualification evidence specified for each application. Full article

Complex narrow-channel reservoirs are strongly constrained by depositional architecture, resulting in highly nonuniform areal waterflood sweep, and pronounced water-cut variations among different channel types. These characteristics pose substantial challenges to stabilizing oil production and controlling water cut at high water-cut stages. To elucidate how narrow-channel planform architecture controls waterflood sweep, gel-assisted flow-field regulation by heterogeneous-phase composite flooding (HPCF), and remaining-oil mobilization, three representative configurations were reproduced in two-dimensional visual physical models. Sequential waterflood–HPCF–post-waterflood experiments were conducted, and time-lapse images and dynamic production data were integrated to characterize sweep evolution and remaining-oil mobilization across displacement stages. The results demonstrate that narrow-channel architecture exerts primary control on preferential flow-path development, gel migration and retention, spatial fluid redistribution, and displacement performance. During waterflooding, injected water preferentially migrated through high-permeability zones along channel centerlines, leaving channel margins, branch termini, and poorly connected regions insufficiently swept. After HPCF injection, the gel-containing composite system preferentially entered the established dominant flow paths. Gel retention and accumulation selectively increased flow resistance in these pathways, while mobility control induced subsequent fluids to divert toward bypassed regions, thereby enlarging the macroscopic swept volume and improving local displacement efficiency. A low injection rate promoted sustained gel-assisted flow diversion within bifurcated channels, whereas a high injection rate facilitated gel-slug propagation against the geometric constraints of highly sinuous channels and expanded its spatial coverage. Compared with waterflooding alone, HPCF increased the ultimate oil recovery of the three channel models by 19.23–26.47 percentage points. These findings clarify the coupled effects of narrow-channel architecture, gel transport and injection parameters on the profile-control and oil-recovery performance of HPCF, providing a mechanistic basis for water control and development optimization in high-water-cut narrow-channel reservoirs. Full article

Background: Isolated sphenoid sinus disease (ISSD) in children is an uncommon but clinically significant condition that may present primarily with neurological or neuro-ophthalmological symptoms rather than typical sinonasal complaints. Owing to the anatomical proximity of the sphenoid sinus to the optic nerves, cavernous sinus, and multiple cranial nerves, even localized sphenoid pathology may produce symptoms that mimic primary neurological, neuro-ophthalmological, or headache disorders, contributing to diagnostic delay. Objective: To characterize the spectrum and frequency of neurological and neuro-ophthalmological manifestations, diagnostic pathways, treatment strategies, and reported clinical outcomes in pediatric ISSD, with particular emphasis on diagnostic delay and persistent neurological sequelae. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines. PubMed and Web of Science were searched from database inception to 3 January 2026. Observational studies reporting pediatric patients aged ≤18 years with radiologically confirmed ISSD were included. Single-patient case reports, reviews, and studies without extractable pediatric data were excluded. Owing to substantial clinical and methodological heterogeneity, findings were synthesized descriptively. Risk of bias was assessed using Joanna Briggs Institute (JBI) critical appraisal tools. Results: Eleven studies comprising 136 pediatric patients were included. Most cases were inflammatory lesions (n = 121, 89%), followed by mucoceles (n = 10, 7.3%) and tumors (n = 5, 3.7%). Headache was the most frequent neurological manifestation reported in 129 patients (94.9%). Ocular manifestations were present in 33/136 patients (24.2%), whereas otolaryngological symptoms were reported in 25/134 patients (18.7%). Cranial nerve involvement was documented in 10 out of 54 patients with available data (19%), most commonly affecting cranial nerves III, V, VI, and VII. Among 79 reported initial diagnoses, primary headache disorders were the most common (49.4%), whereas sphenoid sinusitis was correctly identified in only 20.3%. Diagnosis was established using CT and/or MRI in all included cases. Antibiotic therapy was the most common treatment for inflammatory lesions, while all patients with mucoceles and tumors underwent surgical management. Full recovery was reported in 81% of inflammatory cases and in all patients with mucoceles, although follow-up reporting was heterogeneous. Conclusions: Pediatric ISSD frequently presents with neurological and neuro-ophthalmological manifestations, whereas sinonasal symptoms may be absent or subtle. Persistent or atypical neurological symptoms, particularly headache accompanied by ocular symptoms or cranial nerve deficits, should prompt consideration of sphenoid sinus pathology and early cross-sectional imaging. Full article

Background: This study aims to assess the effectiveness and safety of modified parasternal nerve block (MPSB) in providing perioperative analgesia and improving postoperative recovery in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods: Sixty-five patients scheduled for OPCABG were randomly assigned to either the intervention group (MPSB group), which received a preoperative modified parasternal block, or the control group. The primary outcome measured was intraoperative opioid consumption. Secondary outcomes included levels of inflammatory markers, postoperative pain scores (assessed using the Visual Analog Scale, VAS), incidence of postoperative nausea and vomiting (PONV), total plasma ropivacaine concentration, gastrointestinal recovery parameters, mobilization metrics, intensive care unit (ICU) parameters (mechanical ventilation duration, ICU length of stay, requirement for rescue analgesics), length of hospital stay, incidence of postoperative pulmonary complications (PPCs), and chronic pain. Results: Intraoperative sufentanil consumption was significantly reduced in the MPSB group (130.0 [IQR, 110.0–167.5] μg vs. 280.0 [IQR, 192.5–327.5] μg; p < 0.01). Inflammatory markers were consistently lower in the MPSB group. Pharmacokinetic analysis revealed a mean peak plasma ropivacaine concentration of 0.88 μg/mL, with the maximum individual concentration reaching 1.76 μg/mL at 5 min post-administration. The MPSB group demonstrated superior postoperative outcomes, including lower VAS pain scores, earlier return of gastrointestinal function, reduced duration of mechanical ventilation, decreased rescue analgesic requirements in the ICU, shorter hospital stays, and lower incidence of PPCs. Conclusions: Preoperative modified parasternal block significantly reduced perioperative opioid consumption in cardiac surgery patients. This intervention demonstrated benefits in facilitating rapid postoperative recovery. The conventional ropivacaine dosing regimen was a safe and effective analgesic approach, associated with a low risk of local anesthetic systemic toxicity. Full article

High-velocity baseball pitches place demands on the shoulder, requiring precise sensorimotor control to maintain joint stability and consistent throwing mechanics. Immersive virtual reality (IVR) has emerged as a platform for sensorimotor training, offering controlled, interactive environments, although its immediate effects on shoulder joint position sense remain unknown in overhead athletes. This preliminary within-subject pilot study evaluated whether a brief IVR-based closed kinetic chain (CKC) task using the ICAROS Lightning device could acutely improve active joint position sense (AJPS) in the dominant arm of collegiate baseball players. Nine male collegiate baseball athletes completed baseline AJPS testing during shoulder internal and external rotation before a 2-min immersive flight simulation task, then repeated AJPS assessment. Absolute angular error was the primary outcome. Following the intervention, AJPS error was significantly reduced in both rotational directions. Mean internal rotation error decreased by 4.22° (95% CI: 3.02° to 5.42°; p < 0.001; Cohen’s dz = 2.70), while mean external rotation error decreased by 4.73° (95% CI: 3.10° to 6.37°; p < 0.001; Cohen’s dz = 2.23). These preliminary findings suggest IVR-based CKC exercise acutely improves shoulder joint position sense, which may have implications for restoring proprioception following throwing-induced fatigue. Further validation is warranted in randomized controlled studies with larger, heterogeneous samples in order to determine whether these findings have meaningful effects on throwing performance or recovery. Full article

Background: Postoperative admission to critical care facilities is frequently employed following complex abdominal and gynecologic oncology surgery; however, the clinical value of routine short-stay (≤24 h) high-acuity care remains uncertain as the existing evidence is limited, heterogeneous and derived primarily from non-randomized studies. Consequently, the present critical narrative review aims to discuss the rationale for planned short-duration postoperative high-acuity care, summarize the contemporary evidence, and identify priorities for future research. Methods: Relevant studies evaluating planned postoperative admission to critical care facilities for ≤24 h following major abdominal surgery were identified through a targeted review of contemporary literature using a structured search of MEDLINE, Scopus, Google Scholar, the Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov. Evidence from observational studies investigating intensive care units, high-dependency units, post-anesthesia care units, and advanced recovery pathways was critically synthesized, with particular attention to clinical outcomes, healthcare utilization, and current knowledge gaps. Results: Nine primary studies were included, predominantly observational in design, with the majority lacking a comparative study design, thereby limiting direct evaluation of the clinical effectiveness of planned short-stay postoperative high-acuity care. None of the studies were designed to evaluate a gynecologic oncology population, limiting the direct applicability of the available evidence to this setting. As such, the current evidence is better suited to critical clinical interpretation of the rationale, patient selection, and potential role of postoperative high-acuity care than to drawing definitive conclusions regarding intervention effectiveness. Overall, the available data suggest that planned short-stay high-acuity postoperative care is not consistently associated with reductions in postoperative mortality or overall morbidity but may decrease unplanned intensive care unit admissions in selected patient populations. Most studies reported little or no effect on overall hospital length of stay, whereas increased healthcare costs were primarily observed in capacity-driven or unplanned postoperative critical care pathways. Interpretation of the available literature remains limited by the predominance of observational studies, heterogeneous patient populations, variability in critical care models, and inconsistent outcome reporting. Conclusions: Current evidence does not support routine postoperative admission to critical care facilities following major abdominal surgery, while evidence specifically addressing gynecologic oncology remains insufficient to establish specialty-specific effectiveness. However, planned, time-limited high-acuity postoperative care was not associated with an observed increase in adverse clinical outcomes in the available observational studies and may offer clinical and system-level benefits in selected high-risk patients; these findings should be interpreted cautiously given the limitations of the available evidence. Prospective studies with standardized outcome reporting and clearly defined populations are needed to inform evidence-based perioperative care strategies. Full article