Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival rate of 13%. Surgical resection followed by adjuvant chemotherapy remains the only curative approach. However, complications such as postoperative pancreatic fistula (POPF) and postpancreatectomy hemorrhage (PPH) often delay or prevent further treatment. Reliable preoperative biomarkers for predicting these complications are lacking. This study investigated soluble CD40 (sCD40) as a potential predictive marker for pancreas-specific complications after pancreatoduodenectomy (PD) in patients with PDAC. Preoperative serum samples from 185 patients with PDAC undergoing pylorus-preserving pancreatoduodenectomy or a Whipple procedure were analyzed using enzyme-linked immunosorbent assay to quantify sCD40 levels. Clinical and postoperative data were systematically collected and classified. Of the 185 patients, 151 underwent pylorus-preserving PD and 34 a Whipple procedure. Clinically relevant POPF occurred in 9.7% and PPH in 7.6% of patients. Preoperative sCD40 levels were significantly lower in patients who developed POPF or PPH (P = 0.025 and P = 0.008). The association remained significant in multivariable analysis. Receiver operating characteristic analysis demonstrated an area under the curve of 0.660 for sCD40. Adding leukocytes and body mass index improved predictive performance (area under the curve 0.705 for POPF and 0.752 for PPH). Reduced preoperative sCD40 serum levels are associated with a higher risk of POPF and PPH after PD. Combining sCD40 with leukocytes and BMI may enhance preoperative risk assessment in patients with PDAC.
We aimed to explore the predictive role of radiomic features of body compositions in the occurrence of delayed awakening after flexible ureteroscopic lithotripsy, and further develop a predictive model to identify patients at higher risk. We analyzed the data from 314 admitted patients undergoing total intravenous general anesthesia at two institutions. Binary logistic regression was used to assess univariable and multivariable associations of clinical factors with delayed awakening. Radiomic features of body compositions were deeply extracted from preoperative computed tomography (CT) scans using ResNet50 model. We developed a combined model by integrating significant clinical variables with radiomic score. SHapley Additive explanation (SHAP) method was adopted for model interpretation and helping clinicians understand the predictive results. At multivariable analysis, CT-derived visceral adipose tissue area and skeletal muscle index were independent predictors of postoperative delayed awakening. The combined model had area under curves (AUCs) of 0.85(95%CI: 0.82, 0.89), 0.83(95%CI: 0.80, 0.87) and 0.80(95%CI: 0.76, 0.84) in the derivation, internal and external test datasets, respectively. 8 radiomic features were selected using Spearman rank correlation test and the least absolute shrinkage and selection operator logistic regression analysis. This combined model showed better discrimination and calibration than clinical model alone. Furthermore, SHAP plots quantified the impact of key variables on prediction at the global level. The combined model may allow estimation of the risk of postoperative delayed awakening after flexible ureteroscopic lithotripsy.
Neuropathic pain caused by spinal cord injury severely compromises patients' quality of life. The clinical application of ropivacaine is limited by its short duration of action and the significant side effects associated with repeated administration. In this study, we developed a Gelatin methacryloyl/hyaluronic acid-based hydrogel (Ropi-GelMA/HA) to enable localized and controlled delivery of ropivacaine by photo-crosslinking. In a rat model of spinal cord contusion, Ropi-GelMA/HA was associated with lower Nav1.3 and TNF-α expression and higher NGF and BDNF expression, together with improved motor recovery in rats with SCI. In vitro studies further supported the hydrogel's favorable biocompatibility and controlled release behavior during the early phase after administration. Under the tested dosing regimens, Ropi-GelMA/HA was associated with reduced hepatorenal toxicity and more durable analgesic efficacy compared with free ropivacaine, resulting in prolonged analgesic effects and improved functional outcomes under localized controlled delivery conditions. These findings highlight the potential clinical utility of Ropi-GelMA/HA in the treatment of neuropathic pain following spinal cord injury.
Management of rectourinary fistula (RUF) is challenging due to limited data and variability in presentation and treatment. We conducted a systematic review of radical prostatectomy (RP)-related RUF to assess clinical features, diagnostics, treatments, and outcomes, and to propose a structured algorithm to guide management. We conducted a systematic review in accordance with PRISMA guidelines to evaluate the clinical presentation, diagnostic strategies, management approaches, and outcomes of RUF following RP. A comprehensive search of PubMed, Embase, and Web of Science was performed from database inception to January 2025. Data were extracted on patient demographics, symptoms, diagnostic modalities, management strategies, surgical repair techniques and treatment outcomes. A total of 455 cases of RUF following RP were identified across 34 studies. The reported incidence of RUF ranged from <0.01% to 1.5%. The most frequent presenting symptoms were urine leakage per rectum (60.7%), fecaluria (44.1%), and pneumaturia (50.0%). Fecal and/or urinary diversion was utilized in over 60% of cases, with a median stoma duration of 3 months and an indwelling urinary catheter duration of 1 month. Conservative management (observation, fluid replacement and antibiotic therapy) was attempted in a minority of patients and was generally associated with success rates below 50%. Surgical repair was performed in nearly all cases, with the transperineal and transsphincteric approaches being the most commonly employed techniques. The median time to fistula closure ranged from 0.5 to 30 months, with reported surgical success rates varying between 41% and 100%. We propose a management flowchart based on our clinical experience, outlining the diagnostic and therapeutic approach to rectal injury and RP-related RUF. RUF after RP remains a challenging complication, often requiring stepwise management. Conservative treatments rarely succeed, and surgery is often necessary. Our proposed algorithm aims to standardize the approach to RI and RUF, guiding treatment decisions and improving outcomes.
Ureteral stents are routinely used following endourological procedures to ensure adequate drainage and prevent obstruction. However, stent-related morbidity remains common, and optimal stent dwell time and removal methods are not well defined. This systematic review aimed to evaluate clinical and procedural factors influencing ureteral stent dwell time and the methods used for stent removal after endourological interventions. A systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO. MEDLINE and Embase were searched from inception to October 2025. Randomized controlled trials and comparative observational studies evaluating ureteral stent dwell time and/or removal methods in adults undergoing endourological procedures were included. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Thirty-two studies encompassing 4,373 patients were included. Reported stent dwell times varied widely, most commonly ranging between 10 and 14 days in uncomplicated cases, with longer durations associated with increased rates of encrustation and removal difficulty. Removal techniques included rigid cystoscopy (48.7%), flexible cystoscopy (19.9%), extraction strings (23.5%), and device-assisted methods (7.9%). Less invasive approaches, particularly flexible cystoscopy and extraction-string removal, were consistently associated with reduced pain scores and improved patient comfort, although extraction strings carried a small risk of premature dislodgement. While practice patterns vary, the evidence suggests that a 10-14 day dwell time might be the optimal window to balance healing with the prevention of encrustation. Less invasive removal approaches, particularly flexible cystoscopy and extraction-string techniques, were generally associated with lower pain scores and high procedural success rates in selected patients. While these methods are safe and better tolerated, extraction strings carried a small, reproducible risk of premature dislodgement. High-quality prospective studies are needed to define determinant-based, individualized stent management strategies.
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A simple suspension method has been widely used in Japan, however, chemical interactions among drugs in co-suspensions have not been fully clarified. Magnesium oxide (MgO), which is frequently prescribed as a laxative, can interact with various drugs. Eplerenone and spironolactone, potassium-sparing diuretics, are sometimes co-prescribed with MgO to older patients. In this study, we investigated the chemical stability of eplerenone and spironolactone in a co-suspension with MgO and characterized the structures of the degradation products that were formed under the conditions. An eplerenone or spironolactone tablet was soaked with or without an MgO tablet in warm water in a tube according to a standard simple suspension method. The contents in the tube were mixed by inversion after 10 min, 1 h or 5 h to prepare a simple suspension. In separate experiments, the suspension prepared after 10 min soaking was allowed to stand for 50 min or 4.8 h at room temperature. The suspensions were immediately analyzed by high-performance liquid chromatography. The recovery rates of the diuretics from the suspensions were calculated relative to the labeled amounts. The degradation products were isolated and the structures analyzed by high-resolution mass spectrometry. The high-performance liquid chromatographic analysis showed that the diuretics were stable in their simple suspensions without MgO under any of the conditions. When co-suspended with MgO, a slight degradation was observed for eplerenone after just 10 min soaking and the degradation was statistically significant after 5 h soaking, whereas spironolactone was stable even after 5 h soaking. On the other hand, when the co-suspensions with MgO were left alone after mixing, eplerenone significantly degraded in 50 min, and spironolactone slightly degraded in the same period. Based on the mass spectra from the degradation products, hydrolysis of the lactone ring was shown to have occurred in both diuretics co-suspended with MgO. For spironolactone, hydrolysis and elimination of the thioester were also shown to have occurred in the co-suspensions. Eplerenone is more unstable than spironolactone in the simple co-suspension with MgO. As such, the simple co-suspensions of eplerenone are preferably prepared immediately before administration.
The deltoid ligament (DL) is the primary stabilizer of the medial ankle, but its injury mechanisms remain poorly understood. This study aimed to investigate the injury risk and mechanisms of individual DL bundles under both acute and chronic conditions to inform prevention and treatment strategies. A validated finite element model of the human foot was used to examine peak stresses in DL bundles under four acute loading scenarios. Chronic loading was simulated by applying gait loads after transecting the lateral ligaments, and the resulting DL stresses were compared with those of the intact model. Additionally, thirty-nine rats were assigned to three groups: a lateral ligament rupture group (LR, n = 13), a tibialis posterior tendon rupture group (TPR, n = 13), and a sham group (n = 13). After 6 weeks of treadmill running, the mechanical properties and histological characteristics of the DL, along with ankle joint morphology and articular stresses, were evaluated to further verify the hypothesized mechanisms of chronic injury. Under acute loadings, the tibiocalcaneal ligament (TCL), anterior tibiotalar ligament (ATTL), and deep posterior tibiotalar ligament (dPTTL) showed the highest stress under pronation-external rotation loading. Lateral ligament rupture increased DL stress during gait. After 6 weeks of treadmill running, the LR and TPR groups showed roughened articular surfaces with osteophyte formation, increased articular stress, decreased talar bone volume fraction, lower failure load and stiffness ratios of the DL (p < 0.01), reduced fluorescence intensity of COL1, and elevated levels of COL3, MMP-2 and IL-1β compared with the sham group (p < 0.01). The TCL, ATTL, and dPTTL bundles are particularly susceptible to acute injury, with pronation-external rotation posing the greatest risk. Chronic degeneration of the DL occurs following rupture of the lateral ligament or tibialis posterior tendon, with a more pronounced effect after lateral ligament rupture.
Dexmedetomidine (DEX) is increasingly used for neonatal sedation, but safety data remain limited. We conducted a single-center retrospective study including neonates receiving continuous DEX infusion. Cardiorespiratory events were extracted from bedside monitoring during the 8 h before and the 24 h after initiation. Hemodynamic and clinical parameters were analyzed, and autonomic activity was assessed using Newborn Infant Parasympathetic Evaluation (NIPE) monitoring in a subgroup. Thirty-seven infants (18 preterm, 19 term) were included; 86% received concomitant morphine. Bradycardia episodes increased after DEX initiation, particularly in preterm infants (p < 0.05). In contrast, hypotension, lactate levels remained unchanged, while urine output varied over time without a clinically meaningful reduction. Hypoxemic events decreased, while oxygen requirements remained stable. In the NIPE subgroup, heart rate decreased, with a trend toward increased NIPE values. DEX was associated with increased bradycardia without clear evidence of impaired hemodynamic or respiratory tolerance. These findings suggest an overall reassuring short-term safety profile and suggest a physiologically mediated sedative effect. What is Known: • Dexmedetomidine is increasingly used for sedation in preterm and term neonates, but cardiorespiratory safety data remain limited. • Bradycardia is the most frequently reported adverse effect. What is New: • Continuous monitor-derived data show increased bradycardia after dexmedetomidine initiation, without hypotension or impaired perfusion, while hypoxemic events decreased. • Autonomic monitoring (NIPE) suggests a trend toward increased parasympathetic activity, which may reflect modulation of autonomic balance under dexmedetomidine.
The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
Complications after pancreatoduodenectomy for pancreatic ductal adenocarcinoma (PDAC) are associated with delays or omission of adjuvant chemotherapy (AC). Similar data for patients who undergo distal pancreatectomy (DP) are lacking. A retrospective cohort study was conducted using the SEER-Medicare database to identify patients who underwent upfront DP for PDAC (2010-2019). Multilevel logistic regression and Cox proportional hazards models were used to evaluate the association of postoperative complications with AC omission and delay as well as survival endpoints based on receipt of AC. Of 1029 patients identified, 613 (59.6 %) received AC. Patients with complications had lower rates of AC (50.0 % vs 61.1 %; p = 0.013) and multi-agent AC (25.0 % vs 28.2 %; p = 0.039) and higher rates of delays in AC (42.9 % vs 21.4 %; p < 0.001) than those without complications. In multivariable analysis, complications were associated with a lower rate of AC (hazard ratio [HR], 0.67; 95 % confidence interval [CI], 0.54-0.84; p < 0.001) and a higher rate of delayed AC (odds ratio [OR], 3.36; 95 % CI 1.92-5.91; p < 0.001). For survival, receipt of AC overall (HR, 0.56; 95 % CI 0.47-0.67; p < 0.001), even when delayed (HR, 0.72; 95 % CI 0.57-0.90; p = 0.005), was associated with better overall survival (OS) than no AC. However, delayed AC was associated with worse OS than timely AC (HR, 1.27; 95 % CI 1.01-1.62; p = 0.04). Patients who experienced a postoperative complication after DP for left-side PDAC had lower rates of AC overall and higher rates of delayed AC, both associated with worse OS.
This study aimed to examine 8th-grade students' views on the concepts of nanotechnology and nanoscience through the use of the Metaverse in science courses. The study group sample consists of five students from both the before- and after-experience groups, all of whom are in 8th grade. This study employed a qualitative research method with a case study design. Observation, interview, and document analysis were used as data collection tools. Necessary measures have been taken to ensure the validity and reliability of the research within its scope. The data were analyzed using a content analysis approach. As a result of the interviews, data were collected and analyzed. As a result of the textual examinations, code, category, and theme were determined. The findings were presented in categories through tables, and the participants' answers were included in direct quotations. Upon reviewing the literature, it becomes apparent that most studies in nanotechnology and nanoscience are conducted for informational purposes, typically presented as presentations or reports. Given the limited availability of nanotechnology and metaverse education, the study was divided into two groups: a before-experience group and an after-experience group. As a result of the survey, 8th-grade students experience the metaverse and have future expectations for nanotechnology and nanoscience. Their cognitive and affective interests have increased, as evidenced by their questioning why these applications cannot be applied to all courses and by their correct expression of the concepts. At the same time, it has been concluded that using rich materials to concretize abstract concepts, such as nanotechnology, facilitates their teaching. The study provides qualitative evidence that Metaverse-based instruction can enhance both cognitive and affective dimensions of science learning, offering design implications for integrating immersive technologies into middle school curricula to teach abstract concepts.
Oral lichen planus is a chronic disease of the oral mucosa, with pain as one of its main symptoms. This study aimed to assess the correlation between the results of four pain intensity measures-including the Visual Analog Scale (VAS), Numeric Rating Scale (NRS), Short Form McGill Pain Questionnaire (SF-MPQ), and Verbal Rating Scale (VRS)- in a population of patients diagnosed with oral lichen planus. In this prospective observational study, 66 patients with oral lichen planus participated. Four pain assessment scales were used, including VAS, NRS, VRS, and SF-MPQ. Participants completed these assessments at baseline and again after two weeks of treatment. A paired t-test, Spearman correlation, linear regression analysis, and adjusted multiple regression analysis (regarding age and level of education) were used to analyze the data. All four scales were sensitive to changes in pain after treatment and a significant reduction in pain scores was observed (p < 0.001). There was a strong positive correlation between all scales (p < 0.001). Regression analysis showed that scores on each scale could significantly predict scores on the other scales (p < 0.001). Multiple regression analysis adjusted for age and level of education, showed the correlations between the pain scales remained strong and significant (p < 0.001). These commonly used pain assessment scales showed strong correlation with each other, and it seems that the results obtained from each might be comparable with the others. However, further researches in larger studies and different populations are needed.
In this study, we have optimized a stabilizer formulation using native corn starch (A: 0-2%), acetylated distarch phosphate (B: 0-2%), and gelatin (C: 0.1-0.4%) via a D-optimal mixture design approach. The study aimed to quantify main and interaction effects and identify an optimum formulation under predefined quality targets. Physicochemical, textural, and sensory characteristics were monitored during storage at 4 °C. Syneresis after 28 days was predominantly influenced by ingredient type and concentration; gelatin significantly reduced syneresis, whereas native and modified starches contributed to increased syneresis. Gelatin showed a softening effect on texture immediately post-production but induced hardness during storage. Both starch types increased hardness throughout storage. Gelatin improved overall acceptability and a significant positive interaction was observed among all three ingredients (ABC). Conversely, binary interactions (AB and AC) negatively impacted sensory scores. Two optimized formulations with highest desirability were optimum 1 (0.998% A, 0.872% B, and 0.129% C) and optimum 2 (1.116% A, 0.526% B, and 0.358% C). After the experiments, observed values for optimum 1 closely matched the predicted values, confirming model accuracy and it was recommended for stirred yogurt formulation.
Physical performance impairments are common in cancer survivors and can limit daily activities, quality of life, and long-term health. Although structured exercise programs have proven beneficial for improving physical performance, maintenance of these benefits is unclear. This study aimed to systematically evaluate whether improvements in physical performance are maintained following structured exercise oncology interventions. A systematic search was conducted for randomized controlled trials (RCTs) published between January 1990 and March 2025. Eligible trials engaged adult cancer survivors in structured exercise interventions and reported objective measures of cardiorespiratory fitness, muscular strength, and/or walking capacity at the end of the intervention and ≥ 3 months after program completion. Data were pooled using random-effects meta-analyses with weighted mean differences (WMD) used to summarize effects. Twenty-four RCTs (2289 participants; mean follow-up post-intervention = 8 months) were included. Exercise significantly improved cardiorespiratory fitness at post-intervention (WMD =  + 1.76 ml/kg/min; p = 0.008); however, improvements were attenuated at follow-up (WMD =  + 1.24 ml/kg/min; p = 0.130). Similarly, upper and lower body strength improved post-intervention (WMD = + 3.35 kg; p = 0.001; WMD =  + 12.7 kg; p = 0.045), but effects diminished at follow-up (WMD =  + 1.80 kg; p = 0.081; WMD =  + 10.0 kg; p = 0.093). In contrast, walking capacity increased post-intervention (WMD = + 40.3 m; p = 0.002) and remained elevated at follow-up (WMD =  + 49.4 m; p = 0.006). Certainty of evidence ranged from very low to low across outcomes, primarily due to risk of bias, inconsistency, and imprecision in effect estimates. Structured exercise interventions were found to produce short-term improvements in physical performance among cancer survivors. Although gains in cardiorespiratory fitness and muscular strength appeared to persist at follow-up, they were attenuated compared with post-intervention and supported by very low certainty evidence. In contrast, walking capacity demonstrated sustained improvements at follow-up, though the certainty of evidence remained low. Future work is needed to identify longer-term effects (> 12 months) and develop strategies to better maintain improved physical performance. While exercise programs can improve physical performance, these benefits may not persist without ongoing support. Cancer survivors should be encouraged to continue self-directed exercise after program completion, and exercise programs should incorporate strategies to maintain longer-term improvements in physical performance.
Postoperative gastrointestinal (GI) bleeding is a serious complication after hip fracture surgery in older adults, yet perioperative risk stratification remains limited because commonly used GI-bleeding scores are not tailored to orthopedic settings. This study aimed to develop and internally validate an interpretable model to predict postoperative GI bleeding risk in elderly hip fracture patients, using data routinely available during the perioperative period. We retrospectively included 342 elderly patients who underwent hip fracture surgery at the Third Hospital of Hebei Medical University from January to December 2023. The outcome was GI bleeding within 1 month after surgery, confirmed by medical records and/or telephone follow-up. Patients were randomly split into a training set (n = 242) and a validation set (n = 100). Predictors were screened using LASSO with 10-fold cross-validation, followed by multivariable logistic regression to identify independent risk factors. Ten prediction algorithms were trained and compared. Model performance was assessed by AUC, calibration, and decision curve analysis, and interpretability was evaluated using SHAP. GI bleeding occurred in 38 patients (11.1%). Multivariable analysis identified four independent predictors: alcohol consumption history (OR 8.109, 95% CI 2.463-26.69), glucocorticoid use (OR 4.922, 95% CI 1.055-22.97), NSAID use (OR 6.851, 95% CI 1.811-25.915), and higher systemic immune-inflammation index (SII) (OR 1.001, 95% CI 1.000-1.002). Among the tested models, LightGBM showed the best overall performance, with AUCs of 0.843 (training) and 0.817 (validation), good calibration, and the highest net benefit on decision curve analysis. SHAP results ranked feature importance as SII, NSAID use, alcohol consumption history, and glucocorticoid use, consistent with regression findings. We developed and validated an interpretable LightGBM model that predicts postoperative GI bleeding risk in elderly hip fracture patients using routinely available clinical data. The final model incorporates only preoperative variables, systemic inflammation, NSAID use, alcohol history, and glucocorticoid use, supporting its application for early risk stratification prior to surgery.
Suicide is a leading cause of maternal mortality, yet there are currently no evidence-based perinatal suicide prevention programs. Given the risk of serious outcomes if undetected or inadequately treated, the goal of this study was to further understand the screening and treatment experiences of individuals with perinatal suicidal thoughts and behaviors (STBs). Qualitative data were generated from in-depth interviews with 13 individuals primarily from the United States who experienced perinatal suicidality at least 6 months prior to participation. Thematic analysis was used to examine the experiences of participants with respect to screening and treatment of perinatal STBs. Regarding screening, three major themes were identified: (1) gaps in comprehensive/routine screening for STBs (e.g., infrequent screenings or non-specific to suicide), (2) attitudes toward disclosure of STBs (resulting in omission of symptoms or downplaying of severity), and (3) importance of follow-up after screening. Three themes influenced participants' treatment experiences: (1) providers' engagement in care, (2) shared decision-making between provider and patient, and (3) impact of perinatal-specific treatment programs. Findings from this study highlight critical gaps in screening for and treatment of perinatal STBs. Implementing routine screening and comprehensive follow-up and improving treatment experiences are essential for improving the care of individuals with perinatal STBs and reducing maternal mortality.
To compare perioperative outcomes between the 48-h short-stay pathway and traditional inpatient management for patients undergoing robot-assisted partial nephrectomy (RAPN), and to evaluate the feasibility, safety, recovery efficiency, and economic benefits of the 48-h short-stay pathway. This retrospective study included 175 patients who underwent RAPN between February 2022 and June 2024. Patients were assigned to a 48-h short-stay group (n = 60) or a traditional inpatient group (n = 115). A 1:1 propensity score matching (PSM) was conducted to balance baseline characteristics, including age, sex, BMI, comorbidities, tumor features, surgeon identity, and surgical year. Perioperative outcomes, recovery indicators, complications, and medical costs were compared. After PSM, 53 matched pairs were analyzed. The short-stay group showed significantly shorter operative time, less intraoperative blood loss, shorter warm ischemia time, earlier mobilization, earlier oral intake, faster bowel function recovery, and shorter bed rest (all P < 0.05). The short-stay group had 71.7% of patients discharged on postoperative day (POD) 1 and 100% within 48 h, while the traditional group had 22.6% on POD1, 33.96% on POD2, and 43.4% on POD ≥ 3 (P < 0.001). Both total and postoperative hospital stays were significantly shorter in the short-stay group (2.00 vs. 6.00 days, P < 0.001), with lower hospitalization costs (P < 0.001). Postoperative creatinine was lower in the short-stay group (P = 0.023), while creatinine change was comparable (P = 0.063). Complication rates, emergency department visits, and 30-day readmission rates were similar between groups (all P > 0.05). The short-stay group had a significantly lower drain placement rate (P = 0.002) without increased adverse events. The 48-h short-stay pathway for selected patients undergoing RAPN is feasible and safe. It accelerates postoperative recovery, shortens hospital stay, reduces medical costs, and optimizes healthcare resource utilization, without compromising safety or oncological early outcomes.
With waning vaccine-induced immunity and the continued emergence of immune-evasive SARS-CoV-2 variants, booster vaccination has become essential for sustaining population-level protection. However, scalable and reliable serological tools for monitoring post-booster humoral immunity across different vaccine platforms remain insufficiently evaluated. We conducted a cross-sectional study and a booster cohort study to systematically compare the performance and concordance of surrogate virus neutralization test (sVNT), pseudovirus neutralization test (pVNT), and binding IgG antibody assays. In the cross-sectional analysis, serum samples from 259 individuals collected 1-2 months after a third dose of inactivated vaccine were used to compare sVNT and pVNT. In the booster cohort, paired sera from 288 participants receiving a fourth dose with different vaccine platforms were analyzed to evaluate the relationship between sVNT and IgG responses. Correlation and agreement were assessed using Spearman correlation and Bland-Altman analyses. In the cross-sectional study, sVNT showed strong concordance with pVNT, demonstrated by a very high correlation (r = 0.97) and good agreement in Bland-Altman analysis. In the booster cohort study, IgG antibody levels correlated strongly with sVNT overall (r = 0.91). The correlation strength remained highly consistent across different vaccine platforms, with no statistically significant differences observed. Collectively, these findings demonstrate that sVNT closely reflects functional neutralizing activity, supporting its utility for large-scale immune monitoring. sVNT offers an optimal balance of analytical performance and scalability for high-throughput monitoring without requiring cell-based assays. Consequently, we propose a tiered immune monitoring strategy: utilizing sVNT for broad population-level surveillance and reserving pVNT for targeted, precise functional assessment.