Search Results (6,941)

Objective: To evaluate the extent of intraoperative bacterial and tumour cell spillage during minimally invasive colorectal surgery and to assess the protective value of systematic specimen retrieval using a tear-proof extraction bag. Methods: This multicentre, prospective observational study included patients undergoing conventional or single-port laparoscopic colorectal surgery for adenocarcinoma, premalignant polyps, or chronic diverticulitis. Three intraoperative samples were obtained for microbiological and cytological analysis: after pneumoperitoneum induction (sample 1), after vascular ligation and bowel division (sample 2), and after specimen extraction using a retrieval bag (sample 3). Results: Eighty-eight patients were included. Bacterial contamination increased significantly throughout the procedure occurring in 11.4% of sample 1, 37.5% of sample 2, and 67% of sample 3 (p < 0.001). When sample 1 was positive, sample 2 was positive in 100% of cases; when sample 2 was positive, sample 3 was positive in 79% of cases. In 33 patients (37.5%), bacterial growth was detected exclusively in sample 3. Contamination in sample 2 was significantly associated with surgical approach (p = 0.013), anastomotic technique (p = 0.022), and malignant disease (p = 0.038). A longer hospital stay was significantly associated with contamination in samples 1 and 2 (p = 0.014 and p < 0.001, respectively). No tumour cells were detected in any sample, except for one case showing atypical cells without clinical relevance in sample 3. Conclusions: Intraoperative bacterial contamination progressively increases during minimally invasive colorectal surgery, peaking after specimen extraction. Most clinical and surgical variables did not significantly influence contamination rates. The use of a specimen retrieval bag demonstrated a potential protective effect by containing bacterial spillage. However, no protective effect regarding tumour cell dissemination could be demonstrated based on cytology analysis. Full article

Background: Large language models (LLMs) are increasingly used in clinical medicine, yet their ability to interpret advanced intraoperative hemodynamic monitoring—particularly in the context of liver transplantation—remains largely unexplored. In this proof-of-concept study, we evaluated ChatGPT’s capacity to interpret multimodal hemodynamic data derived from both standard anesthesia monitoring and the PiCCO system. The study also employed a structured assessment instrument (ARQuAT), adapted through a Delphi-based process to evaluate LLM-generated clinical interpretations. Methods: Ten key surgical–hemodynamic phases of liver transplantation were identified using a modified Delphi approach to capture the major physiological transitions of the procedure. Sequential screenshots representing these phases were obtained from five liver transplant recipients, yielding a total of 50 images. Each screenshot, along with standardized clinical background information, was submitted to ChatGPT. Five expert anesthesiologists independently assessed the model’s responses using the modified ARQuAT tool, which includes six content-quality domains (Accuracy, Up-to-dateness, Contextual Consistency, Clinical Usability, Trustworthiness, Clarity) and a separate catastrophic Risk item. Descriptive statistics were calculated for domain-level performance. Inter-rater reliability (Kendall’s W) and internal consistency (Cronbach’s alpha, McDonald’s omega) were also analyzed. All statistical analyses and visualizations were performed using NumIQO. Results: ChatGPT demonstrated consistently high performance across all content-quality domains, with median scores ranging from 4.6 to 4.8 and more than 90% of all ratings classified as satisfactory. Lower scores appeared only in a small subset of frames associated with abrupt hemodynamic changes and did not indicate a recurring weakness in any specific domain. Catastrophic Risk exhibited a pronounced floor effect, with 86% of ratings scored as 0 and only three isolated high-risk assessments across the dataset. Internal consistency of the six ARQuAT content domains was excellent, while inter-rater agreement was modest, reflecting ceiling effects and tied ratings among evaluators. Conclusions: ChatGPT generated clinically acceptable, contextually aligned interpretations of complex intraoperative hemodynamic data in liver transplant recipients, with minimal evidence of unsafe recommendations. These findings suggest preliminary promise for LLM-assisted interpretation of advanced monitoring, while underscoring the need for future studies involving larger datasets, dynamic physiological inputs, and expanded evaluator groups. The reliability characteristics observed also provide initial support for further refinement and broader validation of the Delphi-derived ARQuAT framework. Full article

Background: Intentional tooth replantation (ITR) is a promising treatment option for preserving teeth in cases where conventional endodontic therapy is challenging, or when previous endodontic treatment and apicoectomy have been unsuccessful. The procedure involves extracting the compromised tooth, preserving the alveolar socket and root surface, performing extraoral endodontic therapy, and replanting the tooth in the alveolar socket. Objective: An increase in evidence-based support for ITR has improved the viability of ITR as a treatment option for patients. This review aims to further establish and provide new areas of potential research for ITR with respect to root morphology, extraction, and surgical techniques, maintenance of the tooth socket, and methods for post-op stabilization. Materials and Methods: A literature review was performed across PubMed from 1 January 1980 to 1 July 2025, with a focus on oral surgery techniques, atraumatic extraction techniques, topographical discrepancies in root system anatomy, and ITR procedural outcomes. Conclusions: Although ITR is not a common procedure performed in contemporary clinical practice, gathering sufficient data on the variables influencing the procedure may help patient outcome and improve communication between the endodontist and oral surgeons. Full article

Background: Treatment of chronic painful insertional Achilles tendinopathy is known to be challenging. If non-surgical treatment does not give sufficient relief of symptoms, surgery may be indicated. Treatment with ultrasound (US)- and colour Doppler (CD)-guided wide-awake-local-anaesthetic-no-tourniquet (WALANT) surgery for insertional Achilles tendinopathy is a new approach with promising clinical results. This study aimed to evaluate clinical results of this new approach on patients suffering from insertional Achilles tendinopathy. Methods: Forty-eight consecutive patients with 53 symptomatic tendons (33 men with 34 tendons, mean age 49.3 ± 12.0 years; 14 women with 18 tendons, mean age 55.0 ± 7.4 years) and a duration of more than 12 months with painful insertional Achilles tendinopathy (including tendon, bursae, bone, and plantaris pathology) were included. US- and CD-guided WALANT surgery with removal of pathological bursae, bone, and tendons was used. Immediate weight-bearing loading was allowed, followed by a structured rehabilitation protocol for the first 12 weeks after surgery. VISA-A scores before and after surgery and a questionnaire that evaluated subjective satisfaction with the treatment and current activity level were used. Results: In total, 42/48 patients with 46/53 tendons participated in a 3-year follow-up (mean 34 ± 9 months) by an independent examiner; 39/42 patients with 43/46 tendons were satisfied (n = 37) with the treatment. The mean VISA-A score increased significantly from 41.9 ± 18.2 pre-operatively to 87.7 ± 18.2 post-operatively (p < 0.001). There were three surgical complications, two superficial wound infections, and one minor wound rupture. Conclusions: Patients who suffered from chronic painful insertional Achilles tendinopathy treated with US- and CD-guided WALANT surgery followed by immediate weight-bearing showed high patient subjective satisfaction rates and better functional scores at the 3-year follow-up with a low complication rate. This novel treatment approach warrants more study, including randomised trials comparing it against traditional surgical procedures according to Nunley and Keck and Kelly. Full article

Background/Objectives: Cleft lip and/or palate are common craniofacial anomalies whose surgical repair is classified as clean-contaminated and may be complicated by surgical site infection or palatal fistula. Despite widespread perioperative antibiotic use, there are no standardized, evidence-based recommendations, and rising antimicrobial resistance underlines the need for rational prescribing. This systematic scoping review aimed to map current evidence on prophylactic antibiotic therapy and related perioperative measures in cleft surgery. Methods: A scoping review was conducted using the Arksey and O’Malley framework and reported in line with PRISMA 2020. PubMed, Mendeley and Google Scholar were searched (January 2015–10 February 2025) for English-language retrospective studies, clinical trials, survey studies and systematic reviews concerning prophylactic antibiotics, bone grafting procedures, mouthwash use or oral microbiota in patients undergoing cleft lip and/or palate surgery. Six reviewers independently screened records; two experienced clinicians extracted data on study characteristics, antimicrobial regimens and infectious or microbiological outcomes. Given heterogeneity and the scoping aim, no formal risk-of-bias assessment or meta-analysis was performed. Results: A total of 40 studies met the inclusion criteria, including 21 original research articles. Considerable variation in antibiotic choice, timing and duration was observed, with no clear superiority of any regimen. Single-dose perioperative prophylaxis appeared non-inferior to prolonged courses in several settings. Oral microbiota studies highlighted colonization by resistant and opportunistic pathogens in cleft patients. Conclusions: Current evidence supports individualized, often short-course perioperative antibiotic strategies rather than routine prolonged therapy. High-quality randomized and microbiological studies are required to develop standardized, resistance-conscious guidelines. Full article

In recent years, there has been rapid growth in aesthetic medicine and an increase in the number of minimally invasive procedures aimed at improving appearance. With the increasing number of procedures performed, the incidence of post-operative complications is also rising, and high-frequency ultrasound (HFUS) is increasingly being used to assess these complications. The article presents the case of a 52-year-old woman who reported for an HFUS examination several months after non-surgical nose correction with hyaluronic acid (HA) and implantation of polydioxanone (PDO) lifting threads. The patient experienced post-treatment complications in the form of erythema, oedema and pain, followed by blanching and bruising of the skin. Hyaluronidase and prednisone were used for treatment. Four months after the procedure, the patient returned for another HFUS examination because, despite the disappearance of most symptoms, uneven purple-blue discoloration of the skin on the nose and a subjective feeling of cold persisted. At the time of the HFUS examination, the discoloration was barely visible. The grey-scale HFUS examination revealed foci corresponding to HA deposits and PDO threads located in close proximity to the dorsal artery of the nose. A Doppler examination revealed blood flow disturbances in this artery, which may indicate compression by the threads and be the likely cause of the patient’s complaints. High-frequency ultrasound has proven to be a useful diagnostic method for assessing such complications. Due to its safety, non-invasiveness and high reliability, HFUS has the potential to become a common diagnostic tool in aesthetic medicine practice. Full article

Objectives: To compare the therapeutic efficacy and safety of balloon-assisted transarterial chemoembolization (B-TACE) versus conventional TACE (C-TACE) in hepatocellular carcinoma (HCC) and to evaluate the potential predictive value of intraoperative balloon-occluded arterial stump pressure (Boasp). Methods: In this prospective, single-centre, randomized controlled study, 60 patients with hepatocellular carcinoma were allocated to either the B-TACE group (n = 30) or the C-TACE group (n = 30). One patient in the B-TACE group was lost to follow-up after allocation. The primary analyses were conducted according to the intention-to-treat (ITT) principle, including all randomized patients, with conservative handling of missing data. Sensitivity analyses were performed to assess the robustness of the results. Tumor response and survival outcomes were evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) and Cox proportional hazards regression models. Intraoperative balloon-occluded arterial stump pressure (BOASP) was measured as an exploratory parameter to quantify embolization adequacy. Adverse events (AEs) were systematically assessed and graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. Results: TACE achieved a higher 3-month ORR (63.3% vs. 10.0%, p < 0.001) and 6-month disease control rates (80.0% vs. 36.7%, p < 0.001), with PFS (HR = 0.30, 95% CI 0.148–0.608) and procedures within 6 months (1 vs. 3, p < 0.001). The 6-month surgical conversion rate was higher (34.5% vs. 6.7%, p = 0.009). Changes in Boasp correlated with efficacy (AUC = 0.825, p = 0.0398). Severe infections were lower in B-TACE (17.2% vs. 76.7%, p < 0.001). Conclusions: B-TACE offers superior efficacy, survival, and surgical conversion versus C-TACE with favorable safety. Boasp provides a quantitative biomarker for predicting treatment response. Full article

Background: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72–0.92) and 1-year mortality (OR 0.76, 95% CI 0.61–0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes. Full article

Objectives: This study aimed to evaluate the diagnostic value of presepsin in differentiating benign and malignant causes of cervical lymphadenopathy and to compare its performance with conventional inflammatory markers, including C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil-to-lymphocyte ratio (NLR). Methods: A total of 76 individuals were enrolled, including 52 patients who underwent excisional biopsy for cervical lymphadenopathy and 24 healthy controls. Serum presepsin, CRP, ESR, and complete blood count parameters were measured preoperatively. Patients were classified according to histopathological diagnosis as reactive, granulomatous, or malignant lymphadenopathy. Correlation and receiver operating characteristic (ROC) analyses were performed to assess the diagnostic performance of biomarkers. Results: Median presepsin, CRP, ESR, NLR, and monocyte-to-lymphocyte ratio (MLR) levels were significantly higher in the patient group compared with controls (all p < 0.001). Presepsin levels correlated positively with CRP (r = 0.42), ESR (r = 0.38), and NLR (r = 0.36). Although subgroup analysis revealed no statistically significant differences in presepsin levels among reactive, granulomatous, and malignant cases (p = 0.50), ROC analysis demonstrated the highest diagnostic accuracy for presepsin (AUC = 0.85), followed by CRP (AUC = 0.78), ESR (AUC = 0.74), and NLR (AUC = 0.72). A presepsin threshold of >210 pg/mL predicted malignancy with 82.4% sensitivity and 78.6% specificity. Conclusions: Presepsin provides an objective and noninvasive tool that complements traditional inflammatory markers in the diagnostic evaluation of cervical lymphadenopathy. Its superior diagnostic performance for malignancy prediction suggests potential utility in guiding biopsy decisions and avoiding unnecessary surgical procedures in benign cases. Full article

Postoperative pain management in pediatric patients remains a significant challenge despite improvements in perioperative care. Regional anesthesia techniques applied as part of multimodal analgesia strategies offer the potential to reduce opioid use, accelerate recovery, and minimize side effects such as respiratory depression, nausea, and delayed mobilization. This review examines the clinical applications, advantages, and limitations of regional anesthesia blocks in the context of common pediatric surgical procedures—appendectomy, inguinal hernia repair, circumcision, cholecystectomy, and pyloromyotomy. We provide procedural comparisons in terms of analgesic efficacy, opioid-sparing effects and suitability for ambulatory surgery. In conclusion, regional anesthesia techniques have significant potential to improve postoperative outcomes in pediatric patients. However, block selection should be individualized, considering the type of surgical procedure, patient characteristics, and operator experience. Increasing applicability and routinely implementing ultrasound-guided procedures will encourage the safer and more effective use of these techniques in pediatric anesthesia. Full article

Background: The optimal timing of cytoreductive surgery for advanced high-grade serous carcinoma (HGSC) remains a critical unmet question in the modern era of platinum-based chemotherapy and PARP inhibitor (PARPi) maintenance. To address this gap, we compared outcomes following primary debulking surgery (PDS) versus interval debulking surgery (IDS) in a uniformly treated, contemporary cohort. Methods: Patients with FIGO stage IIIB–IVB HGSC treated between 2019 and 2023 were retrospectively analyzed. Baseline tumor burden was assessed using detailed radiologic and laparoscopic evaluations, including both presurgical and intraoperative assessments. Progression-free survival (PFS) and overall survival (OS) were examined using multivariable Cox proportional hazards models and reported as adjusted hazard ratios (aHRs). Subgroup analyses were rigorously conducted according to residual disease status and BRCA mutation status. Results: Among 221 patients (PDS, n = 60; IDS, n = 151), the median follow-up was 40 months. In the overall cohort, adjusted PFS and OS did not differ significantly between the PDS and IDS groups (PFS: aHR, 1.15; 95%CI, 0.67–1.98; OS: aHR, 1.24; 95%CI, 0.54–2.83). Outcomes were comparable among patients achieving R0 resection. Notably, BRCA-mutated patients demonstrated a substantial survival advantage with PDS (BRCA-mutated PFS: aHR, 3.34; 95%CI, 1.06–16.67; OS: aHR, 6.07; 95%CI, 2.13–∞), whereas BRCA wild-type patients showed no significant difference between surgical strategies. Conclusions: The findings suggest that BRCA-mutated patients may derive a survival benefit from PDS, whereas surgical timing had a limited impact on BRCA wild-type disease. This result underscores the importance of integrating molecular profiling, particularly BRCA mutation status, with surgical assessment to guide optimal and personalized treatment strategies in the PARPi era. Full article

Atlantoaxial instability (AAI) in toy- and small-breed dogs remains a significant clinical challenge, as the restricted anatomical space and risk of complications complicate the selection of implants. This study aimed to compare three patient-specific Ti-6Al-4V stabilizers for the C1–C2 region: a clinically used ventral C1–C3 plate, a shortened ventral C1–C2 plate, and a dorsal C1–C2 implant. Computed tomography, segmentation, virtual reduction, CAD/CAM design, and finite element analysis were employed to evaluate the linear-static mechanical behavior of each construct under loading ranging from 5 to 25 N, with a focus on displacements, von Mises stresses, and peri-screw bone strains. Additionally, cadaver procedures were performed in nine small-breed dogs using custom drill guides and additively manufactured implants to evaluate procedural feasibility and implantation time. Finite element models demonstrated that all stabilizers operated within material and biological safety limits. The C1–C3 plate exhibited the highest implant stresses, while the C1–C2 plate demonstrated an intermediate response, and the dorsal implant minimized implant stresses, albeit by increasing bone stresses. Cadaver experiments revealed that dorsal fixation required less implantation time than ventral fixation. Collectively, the findings indicate that all evaluated constructs represent safe stabilization options, and the choice of implant should reflect the preferred load-transfer pathway as well as anatomical or surgical constraints that may limit ventral access. Full article

Background: Effective preoperative patient counseling is essential to shared decision-making. In thyroid surgery, patient communication can be complicated by the complex anatomy and variable surgical approaches, which may not be fully conveyed through conventional verbal explanations or schematic drawings. Virtual three-dimensional (3D) thyroid models may provide an intuitive tool to enhance patient comprehension. Methods: We conducted a randomized controlled trial at Peking Union Medical College Hospital with 94 newly-diagnosed thyroid cancer patients scheduled for thyroidectomy. Participants were assigned to either the control group (n = 47), which received preoperative drawing-based counseling, or the intervention group (n = 47), which utilized a virtual 3D model for communication. The Thyroid Navigator app, developed by Kuma Hospital, was used to provide dynamic 3D representation of the thyroid gland, surrounding structures, and potential surgical procedures. After standardized preoperative consultations, patients were surveyed to assess their understanding in pertinent anatomy and postoperative complications. Results: Patients in the 3D model group demonstrated similar correct response rates in lesion localization (p = 0.536) or parathyroid gland recognition (p = 0.071), but significantly higher accuracy in identifying the recurrent laryngeal nerve and the extent of lymph node dissection compared with the control group (p < 0.05). Moreover, comprehension of the causes of major postoperative complications—including hoarseness (recurrent laryngeal nerve injury, p = 0.004), hypocalcemia (parathyroid gland impairment, p = 0.015), and bleeding (inadequate hemostasis, p = 0.008)—was significantly improved in the 3D model group. Conclusions: Use of a virtual 3D thyroid model significantly improves patient comprehension of thyroid anatomy, surgical procedures, and potential complications, thereby enhancing clinician–patient communication. Virtual 3D models represent a practical and cost-effective supplement to conventional counseling in thyroid surgery, offering clear benefits in patient education and shared decision-making. Full article

Background/Objectives: Fluoroscopy-guided procedures are widely used across surgical and interventional specialties but expose operators to ionizing radiation with associated stochastic and deterministic effects. The aim is to characterize occupational radiation exposure, evaluate the effectiveness of shielding strategies, assess long-term cancer risks, and identify compliance patterns. Methods: This structured narrative review summarizes evidence on operator dose, shielding effectiveness, compliance with protective practices, and long-term cancer risk. A search of PubMed, Scopus, Embase, and Web of Science (limited to January 2000–March 2024) identified 62 records; 27 full texts were reviewed, and 16 studies met the inclusion criteria. Results: Across studies, unshielded chest exposure averaged 0.08–0.11 mSv per procedure, and eye exposure averaged 0.04–0.05 mSv. Lead aprons reduced exposure by about 90% at 0.25 mm and 99% at 0.5 mm, thyroid collars reduced neck dose by 60–70%, and lead glasses reduced ocular dose 2.5–4.5-fold. Compliance with aprons and thyroid collars was high, whereas lead glasses and lower-body shielding were inconsistently used. Limited epidemiologic data suggested a higher cancer burden in exposed surgeons, and Biologic Effects of Ionizing Radiation (BEIR) VII–based modeling projected increased lifetime risks of solid cancers in chronically exposed operators. Conclusions: Protective equipment substantially reduces operator dose, but exposure variability and inconsistent shielding practices persist and justify standardized monitoring, stronger enforcement of radiation safety protocols, and longitudinal studies. Full article

Background/Objectives: Preterm birth remains a major cause of neonatal morbidity and mortality, particularly in multiple pregnancies and in cases of cervical shortening. While cervical cerclage is established in singleton pregnancies, its efficacy in multiple gestations remains uncertain. This study compares pregnancy and neonatal outcomes following second-trimester cerclage in singleton and multiple pregnancies with a short cervix. Methods: In this retrospective cohort study, 96 women underwent second-trimester cerclage at a tertiary perinatal center between 2020 and 2024. All had a cervical length ≤ 25 mm or prolapsed membranes without infection or premature rupture. Primary outcomes included term delivery rate, gestational age, mode of delivery, and neonatal outcomes; secondary outcomes comprised surgical complications and rehospitalization, defined as the need for renewed inpatient care due to threatened preterm labor or procedure-related complications. Results: In total, 79 singleton and 17 multiple pregnancies were analyzed. Term delivery occurred more often in singletons (54%) than multiples (18%, p = 0.006). Mean gestational age at birth was 258 ± 25 days in singletons versus 228 ± 28 days in multiples (p < 0.001). Birth weight was significantly lower in multiples (1985 g vs. 2943 g; p < 0.001), and neonatal infections were more frequent (53% vs. 26%; p = 0.008). Caesarean delivery was more common in multiples (82% vs. 33%; p < 0.001). Apart from increased postoperative contractions in multiples (24% vs. 5%; p = 0.031), complication rates and rehospitalization (27% vs. 29%; p = 0.8) were similar. Conclusions: Second-trimester cerclage is less effective in preventing preterm birth in multiple pregnancies compared to singleton pregnancies; however, it appears to be associated with a stabilizing clinical course and may facilitate outpatient management in selected high-risk cases. These findings support individualized counseling and shared decision-making, particularly in multifetal gestations. Full article