Gastrointestinal cancer surgery commonly leads to postoperative complications and other adverse outcomes. While prehabilitation shows promise in reducing adverse postoperative outcomes, most hospitals have resource limitations that preclude its use as standard of care. Additionally, the need to expedite surgery from diagnosis often creates a narrow window for prehabilitation initiatives. Online, self-reported screening tools may address these challenges by facilitating early identification of high-risk patients and enabling targeted preoperative interventions, thereby allowing equitable allocation of limited resources. Therefore, the primary aim of this study is to evaluate the predictive utility of a tri-modal (physical, nutritional, psychological) screening tool for patients undergoing gastrointestinal cancer surgery. This prospective international cohort study will recruit 1214 adults undergoing elective gastrointestinal cancer surgery across 35 sites from 19 countries. Participants will complete an online screening tool developed through a comprehensive, multistep, predefined process. The screening tool comprises the Duke Activity Status Index, Patient-Generated Subjective Global Assessment Short Form and the Patient Health Questionnaire-4, in English, Spanish, French or Portuguese. These tools were selected based on a scoping review, followed by an international Delphi consensus process. The primary outcomes include rate of postoperative complications, major complications (Clavien-Dindo Classification grade III-V) and overall complication severity assessed by the Comprehensive Complications Index; all assessed 30 days postoperatively. Secondary outcomes include hospital length of stay, readmission rate within 30 days, discharge destination (home vs other), days at home and alive in 30 days postsurgery, 30-day all-cause mortality and 12-month survival. Primary analyses will establish optimal screening tool cut-points to stratify patients into clinically actionable risk categories for postoperative complications and examine the independent predictive value of these screening scores after adjusting for established clinical risk factors. This study has received ethical approval from the Sydney Local Health District Human Research and Ethics Committee (X25-0333 and 2025/ETH02465) and has been registered on the Open Science Framework (10.17605/OSF.IO/HVCGD). The results of Preoperative Risk Evaluation for Cancer Treatment will be submitted to reputable journals and presented at national and international conferences.
Cardiac surgery, particularly open-heart procedures such as coronary artery bypass grafting and valve surgery, is one of the most common curative options for ischemic heart disease, congenital heart defects, and valvular disease but is also associated with severe hemodynamic hazards. Intravenous anesthetic agents such as propofol and dexmedetomidine are employed to sedate such patients in routine clinical practice. There is, however, conflicting and sporadic evidence in the literature regarding the relative effects of these two agents on hemodynamic parameters. This review systematically analyzed and contrasted the hemodynamic effects of dexmedetomidine and propofol in patients undergoing cardiac surgery. Systematic searches in the PubMed, Scopus, Embase, Web of Science, CINAHL, Cochrane Library, and Google Scholar databases were performed for randomized controlled trials published between December 2000 and 18 January 2025. Studies in which adult patients underwent cardiac surgery (e.g., coronary artery bypass grafting or valve surgery) and received dexmedetomidine or propofol for intraoperative or immediate postoperative intensive care unit (ICU) sedation were included. This was a PRISMA-guided review, and the extracted data were meta-analyzed and descriptively analyzed. The primary outcomes were hypotension and bradycardia. Secondary outcomes included vasopressor requirements, tachycardia, heart rate, atrial fibrillation (AF), ventricular tachycardia, and bleeding. Odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs) were pooled via random-effects models. Sensitivity analysis and assessment of publication bias were performed as needed. Compared with propofol, dexmedetomidine significantly increased the risk for hypotension (OR = 1.76; 95% CI: 1.25-2.48; p < 0.001) and bradycardia (OR = 2.89; 95% CI: 1.28-6.49; p = 0.01). Alternatively, dexmedetomidine significantly reduced vasopressor requirements (OR = 0.52; 95% CI: 0.32-0.84; p = 0.007) and lowered the heart rate (MD = - 4.78 beats/min; 95% CI: - 7.47 to - 2.26; p < 0.001). No considerable differences were observed in tachycardia, ventricular tachycardia, AF, or bleeding. Sensitivity analysis was employed to check for the stability of the findings, and no publication bias was detected. This meta-analysis revealed that, compared with propofol, dexmedetomidine is associated with a greater incidence of hypotension and bradycardia but lower vasopressor requirements. No considerable differences were observed in ventricular tachycardia, AF, bleeding or any other hemodynamic parameters. Evidence for several secondary outcomes remains limited; therefore, findings for less frequently reported endpoints should be interpreted cautiously. Not applicable.
Burn injuries are a global health concern with a substantial sociological burden of disease, causing physical, psychological, and socioeconomic consequences. Despite the multidisciplinary and complex nature of the field, limited comprehensive bibliometric research has been conducted. A search of the Web of Science database was conducted to identify the top 100 most-cited burn-related publications. Bibliometric and visual analyses were performed using the VOSviewer, Bibliometrix, and Biblioshiny packages in R. Citation metrics, institutional networks, collaboration clusters, thematic keyword analysis, and author demographics were compiled and analyzed. The vast majority of included studies were published after 2000. The University of Texas System and Shriners Hospitals were the leading institutions and authors, highlighting the strength of US research and fostering a sense of achievement and trust in the field's progress. Our findings reveal dominant contributors and disparities in authorship and geographic representation, encouraging the research community to foster greater inclusivity and collaboration across regions.
This focused systematic review and meta-analysis evaluated robot-assisted inguinal lymphadenectomy (RAIL) versus open inguinal lymph node dissection (OILND) in penile cancer, aiming to provide robot-specific comparative estimates rather than a broad minimally invasive synthesis. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched through December 2025 for comparative studies. All meta-analyses were conducted using STATA 18, employing random-effects modeling. Binary outcomes were summarized using odds ratios (ORs), and continuous outcomes were presented as weighted mean differences (WMDs), with all estimates accompanied by 95% confidence intervals (CIs). Risk of bias in the included non-randomized comparative studies was assessed using the ROBINS-I tool. Four retrospective comparative studies involving 276 patients were included, and no randomized controlled trials were identified. A lower odds of total postoperative complications was observed with RAIL (OR = 0.52, 95% CI: 0.27, 0.97; P = 0.047), but this borderline finding should be interpreted cautiously given the small number of retrospective studies and potential residual confounding. Across individual studies, operative time generally tended to be longer with RAIL, whereas findings for estimated blood loss and drainage-related outcomes were inconsistent. Lymph node yield, skin-related complications, minor complications, and groins with positive nodes did not differ significantly between approaches. According to the GRADE assessment, the certainty of evidence was low for most pooled outcomes and very low for skin-related complications and lower-limb edema/lymphedema. RAIL may be associated with lower overall postoperative complications than open surgery, but the evidence remains low certainty and insufficient to establish a definitive morbidity-reduction benefit. In addition, several continuous perioperative variables showed extreme between-study heterogeneity and were not clinically interpretable as reliable pooled effects.
Standardized prescribing models can reduce discharge opioid prescription and excess pill volumes, mitigating potential opioid dependence and diversion after abdominal operations. This study's objective was to determine which of 2 validated discharge prescribing models resulted in fewer opioids prescribed and consumed after major abdominal surgery. This was a pragmatic single-center, phase II randomized clinical trial comparing 2 discharge opioid prescribing models: linear 5x-multiplier algorithm (last-24hrs oral morphine equivalents [OME] times 5) versus capped 3-tier model (5/15/30 pills depending on 0/1-29/≥30 mg OME in last-24hrs). Adults undergoing open abdominal cancer resections by 25 surgeons (5 specialties) were included. A non-opioid analgesic bundle was used perioperatively and at discharge. Co-primary endpoints were discharge opioid volume and 14-day post-discharge consumption. Secondary endpoints included patient satisfaction and symptom inventory. The power (80%) calculation was performed using the two-sample t-test to detect a mean difference in OME with 0.05 significance (0.025 per co-primary outcomes). From April-December 2024, 150 patients (52% female; median age 63) were randomized: 73 to 5x-multiplier; 77 to 3-tier model. Operations included hepatectomy (32%), pancreatectomy (29%), nephrectomy (13%), thoracoabdominal sarcoma resection (15%), and ovarian cytoreduction (11%). Median discharge OME was 25 mg (5x-multiplier) versus 75mg (3-tier, P<0.001), with 44% of 5x-multiplier patients discharged opioid-free (1% in 3-tier). Median post-discharge 14-day opioid consumption was 0mg (5x-multiplier) versus 10 mg (3-tier, P=0.496). Refill rates were 24% (5x-multiplier) versus 18% (3-tier, P=0.426), consistent with historical rates, with no differences in satisfaction or symptom inventory scores. The 5x-multiplier algorithm resulted in fewer prescribed discharge opioids with similar 14-day consumption, refill rates, and satisfaction, compared to a 3-tier model after intra-abdominal cancer surgery.
Neoadjuvant immunotherapy combined with chemotherapy (NICT) improves tumor downstaging in locally advanced hypopharyngeal squamous cell carcinoma (LA-HSCC), but the effect of response-adapted surgery on outcomes is unclear. This study evaluated the efficacy and safety of NICT and compared minimally invasive versus open surgery on the basis of treatment response. We retrospectively analyzed 79 patients with stage III-IVB HSCC who received NICT. Treatment response was assessed per RECIST 1.1, and surgery was tailored accordingly. The objective response rate was 84.81%, and the pathological complete response rate was 59.49%. Grade ≥ 3 treatment-related adverse events occurred in 11.39% of patients. Following NICT, 73.4% of patients underwent transoral minimally invasive surgery, 17.7% partial laryngectomy, and 8.8% total laryngectomy, resulting in a laryngeal preservation rate of 91.14%. With a median follow-up of 15 months, there were no significant differences in progression-free or overall survival between surgical groups. However, the minimally invasive group had significantly better 1-year respiratory (89.66% versus 35.71%, p < 0.001) and phonatory (70.69% versus 0%, p < 0.001) function preservation compared to the open surgery group. Multivariate analysis confirmed that minimally invasive surgery independently predicted improved respiratory function. NICT enables high response and organ preservation in LA-HSCC, and minimally invasive surgery achieves comparable survival with superior functional outcomes, supporting its use in a personalized treatment approach.
Open-mouth jaw locking in cats is an uncommon condition often associated with temporomandibular joint (TMJ) and mandibular symphysis laxity in which mechanical coronoid-zygomatic impingement occurs. This report describes a 5-year-old Persian cat with recurrent right-sided jaw locking. Clinical examination revealed persistent open-mouth posture with mandibular deviation and mild symphyseal laxity. Computed tomography (CT) confirmed ventrolateral displacement of the right coronoid process, bilateral condylar subluxation, condylar flattening and elongation of the right retroarticular process. Due to recurrence, unilateral partial coronoidectomy was performed. Immediate and 8-week postoperative CT demonstrated restoration of mandibular alignment, improved TMJ congruity and resolution of impingement without recurrence. This case highlights the key role of CT in diagnosis, surgical planning, and follow-up of open mouth jaw locking in cats and supports surgical management in recurrent cases.
Deep vein thrombosis (DVT) involves blood clots in deep veins, primarily in the lower limbs, with a prevalence of 0.1% annually, more common in elderly men. Open appendectomy, a low-risk procedure for acute appendicitis, typically lasts 30-60 minutes under general anesthesia. Post-surgery, DVT is rare but has been observed in a unique case following an uncomplicated appendectomy, highlighting the need for increased postoperative monitoring for thrombotic complications in low-complexity surgeries. A 26-year-old Arab Iraqi male, BMI 22 kg/m2, presented with 1-day asymmetrical bilateral lower limb swelling and pain, more severe in the right leg, following an uncomplicated appendectomy. No history of prolonged immobilization or previous thromboembolic events was noted. Physical examination revealed bilateral swelling, with right leg circumference 38 cm, and positive Homan's and Moses' signs. Laboratory tests indicated mild hyponatremia, anemia, and elevated inflammatory markers. Doppler ultrasound confirmed extensive acute deep vein thrombosis (DVT) bilaterally. Treatment included bed rest, low-molecular-weight heparin, and later, rivaroxaban for 6 months. Follow-up showed stable thrombus without extension, and thrombophilia screening confirmed no hereditary conditions. A young male developed extensive bilateral lower limb DVT post-appendectomy, highlighting thromboembolic risks in low-complexity surgeries and the need for tailored venous thromboembolism (VTE) prophylaxis and further research.
Postoperative symptoms such as pain, burning, and itching are common following open excisional hemorrhoidectomy and are often associated with several factors, including wound healing. This study evaluated the efficacy of Propionibacterium extract gel (PeG) in promoting wound healing and reducing pain, burning, and itching compared to an ointment containing hyaluronic acid and silver sulfadiazine (HA-SSD). In this multicenter, phase IV randomized controlled trial, patients undergoing open excisional hemorrhoidectomy were randomly assigned in a 1:1 ratio to receive PeG or HA-SSD. The primary outcome (wound healing) was evaluated on the basis of grade of epithelialization. Secondary outcomes (pain, burning, and itching) were assessed using a 10-point visual analogue scale at baseline and 10, 20, and 40 days postoperatively. Of the 119 screened patients, 64 (53.78%) received PeG and 55 (46.22%) received HA-SSD. The baseline characteristics were comparable. After 20 days, 46 (75.4%) of the PeG group patients had an epithelialization grade > 50% (vs n = 37, 72.6% of the HA-SSD group; p = 0.02). By day 40, complete wound healing occurred in 52 (85.3%) of the PeG group patients (vs n = 25, 52.1% of the HA-SSD group; p = 0.003). Both treatments reduced postoperative pain over time, with no significant between-group difference (p = 0.24). PeG demonstrated a superior reduction in burning (p = 0.02) and itching (p = 0.001). Patient satisfaction was higher with PeG (n = 45, 75% vs n = 9, 18.8% of the HA-SSD group, p < 0.001), with no reported adverse reactions. PeG was more efficient than HA-SSD in promoting wound healing, alleviating burning and itching, and enhancing patient satisfaction following hemorrhoidectomy. This study supports the safety and effectiveness of PeG as a therapeutic option for postoperative management. NCT06872151, retrospectively registered on 6 March 2025.
The incidence of silent brain infarction (SBI) and perioperative neurocognitive disorders (PND) is higher in cardiac surgery. However, standard preventive strategies remain unknown due to limited evidence. This multicentre, prospective, randomised controlled clinical trial with a 1-year follow-up includes patients undergoing elective cardiac surgery with cardiopulmonary bypass (CPB). 912 participants are randomly assigned 1:1 into either the intervention group with neuroprotective anaesthesia targets (mean arterial pressure 65-90 mm Hg, bispectral index 40-60, bilateral regional cerebral oxygen saturation ≥60%, arterial inflow temperature <37℃ and rewarming rate <0.5℃/min after exceeding 30℃ during CPB) or the control group maintained by anaesthetists according to routine care. The primary outcome is the 7-day incidence of new-onset SBI. The key secondary outcome is the 30-day incidence of PND. The secondary outcomes include the 5-day incidence of postoperative delirium, the 30-day incidence of new-onset overt stroke, the 1-year incidence of new-onset overt stroke, the 30-day incidence of transient ischaemic attack (TIA), the 1-year incidence of TIA, the 1-year incidence of PND, the 30-day and 1-year composite incidence of major adverse events (renal insufficiency, myocardial infarction, pulmonary embolism, seizure, all-cause mortality), length of stay (LOS) in intensive care unit, LOS in hospital and hospitalisation cost. The trial was approved by the Institutional Review Board/Independent Ethics Committee of Fuwai Hospital (Approval No. 2024-2445) and all participating centres. We will disseminate the trial findings in peer-reviewed journals and present the results at national or international conferences. NCT07048002.
Robot-assisted hepatectomy for hepatocellular carcinoma has attracted increasing attention in minimally invasive hepatobiliary surgery, yet its global research landscape has not been systematically characterized. This study aimed to investigate the overall publication profile, collaborative relationships, citation architecture, and thematic changes in the literature on robotic liver resection for hepatocellular carcinoma by using bibliometric and visualization methods. Publications indexed in the Web of Science Core Collection (Science Citation Index Expanded) between January 1, 2008, and December 31, 2025, were retrieved on April 16, 2026. After stepwise screening at the database level, 373 English-language articles and reviews were included. Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica were used to evaluate annual publication and citation trends, the contributions of countries and institutions, collaboration networks, influential references, and keyword-based research focuses. Publication output and citation activity generally increased across the study interval, with more evident growth in recent years. China showed the strongest cumulative growth in publication output and ranked first in citation counts, while Japan and the USA also demonstrated substantial citation influence. Berlin-affiliated entities, including Free University of Berlin, Humboldt University of Berlin, and Charité Universitätsmedizin Berlin, appeared among the leading institutional affiliations, although this pattern may partly reflect WoSCC affiliation parsing. The literature was concentrated mainly in journals related to minimally invasive surgery, robotic surgery, and hepatobiliary or gastrointestinal surgery. Keyword co-occurrence, clustering, burst, and timeline analyses suggested that research attention has gradually evolved beyond early feasibility and technical exploration, with growing emphasis on anatomy-based resection strategies, perioperative functional assessment, and oncologic outcome-related issues, particularly in relation to anatomical liver resection, glissonian approach, caudate lobe, liver function, recurrence, and open liver resection. Overall, this study maps the global knowledge structure and thematic development of research on robot-assisted hepatectomy for hepatocellular carcinoma and suggests that research attention has gradually shifted toward more specialized and outcome-oriented investigation over time.
We aimed to (1) quantify changes in discrimination when adding intraoperative data to preoperative data and (2) compare tabular machine learning with feature engineering against a time-aware LSTM-based model. Retrospective cohort of 46 204 adults undergoing 57 055 eligible noncardiac surgery in the INSPIRE database. We extracted 38 preoperative and 49 intraoperative variables; acute kidney injury (AKI) was defined by KDIGO serum creatinine criteria and modeled as stage 2/3 postoperative AKI. Models were trained on preoperative-only and combined pre- and intraoperative data. Intraoperative series were summarized using eight statistical features for tabular models or integrated directly using an MLP+LSTM architecture. GBT with combined features achieved the highest AUROC (0.896, 95% CI, 0.878-0.914), followed by combined AutoGluon (0.893, 95% CI, 0.877-0.909) and preoperative-only GBT (0.891, 95% CI, 0.871-0.910). ASA-PS ≥3 (AUROC 0.723, 95% CI, 0.700-0.746) and adapted GS-AKI (AUROC 0.719, 95% CI, 0.700-0.739) underperformed machine-learning models. The hybrid MLP+LSTM model did not outperform simpler tabular models (AUROC 0.870, 95% CI, 0.848-0.892). The small gain from adding low-frequency intraoperative summaries suggests that most discriminative information for stage 2/3 postoperative AKI was available before surgery. Preoperative tabular ML models provided excellent prediction of postoperative AKI, and added limited incremental discrimination at the available sampling frequency. Future work should evaluate whether higher-frequency intraoperative signals better leverage time-aware architectures.
The aging process of the face is characterized by dermal thinning, loss of elasticity, and wrinkle formation. Injection of autologous micrografts containing fibroblasts (Am-FBs) has emerged as a promising regenerative technique. This trial aims to assess the efficacy and safety of Am-FBs for facial rejuvenation. A randomized, open-label, controlled study was conducted. Forty patients presenting with mild to moderate dermal thinning, reduced elasticity, and wrinkles were divided into two groups: a study group (SG; n = 20) that received Am-FBs treatment and a control group (CG; n = 20) treated with a hyaluronic acid (HA)-based skin booster. Both groups received treatment at baseline (T0), at one month (T1), and at three months (T2). Clinical outcomes were evaluated at T1, T2, T3 (6 months), and T4 (12 months) through patient and physician evaluations, the Wrinkle Severity Rating Scale (WSRS), and objective skin elasticity metrics. In vitro evaluation of the Am-FBs and immunophenotypic characterization of the nucleated cell population contained in the Am-FBs suspension was performed. At T4, the SG showed significantly greater improvements in wrinkle depth, skin elasticity, and WSRS score than the CG (p < 0.01). The physician's evaluation showed scores ranging from 9 to 4 (p = 0.049), whereas patient self-assessments ranged from 9 to 5 (p = 0.039). Patient satisfaction was higher in the SG. The in vitro analysis documented 2.780.750 nucleated cells/ml in Am-FBs with a viability of 89.61% and immunophenotype: CD34%0.2, CD45%0.2, CD44%98.7, CD200%80.0, Cytokeratin 15%99.4. Am-FBs significantly improve signs of facial aging and present a safe option for skin rejuvenation.
Minimally invasive surgery (MIS) has reshaped modern operative care by reducing tissue trauma and accelerating recovery compared with open procedures. Despite extensive research, inconsistencies remain across specialties regarding recovery outcomes and comparative effectiveness, and open surgery remains necessary in selected complex cases where minimally invasive access may be unsuitable or unsafe. This systematic review aimed to evaluate and compare patient recovery following minimally invasive and open surgical approaches. A structured search was conducted across major databases for studies published between 2015 and May 2026, including randomized and observational comparative designs. Data were extracted using a standardized approach and synthesized narratively due to heterogeneity in study designs, surgical procedures, and outcome reporting. Key outcomes included length of hospital stay, postoperative pain, complication rates, operative time, and functional recovery. Findings indicated shorter hospital stay, reduced postoperative pain, and faster recovery in minimally invasive groups, while operative time and cost varied across procedures. Complication profiles favored minimally invasive approaches in many procedures, although differences were procedure-specific. Robotic-assisted approaches did not demonstrate uniform recovery superiority over conventional laparoscopic techniques. MIS enhances short-term recovery and supports improved patient outcomes and healthcare efficiency when applied to appropriate patients and procedures. Conventional open surgery continues to have an important role in technically demanding, advanced, or anatomically complex procedures. Further research should address long-term outcomes, cost-effectiveness, complication-specific endpoints, and technological integration to strengthen evidence-based clinical decision-making across diverse surgical populations and settings.
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Scoping reviews are widely used across the health sciences to map evidence, clarify concepts, and identify knowledge gaps. Although protocol development and registration are increasingly encouraged, empirical evidence describing contemporary registration practices remains limited. This study aimed to evaluate current practices in scoping review protocol registration and reporting in high-impact health sciences journals published between 2024 and 2025. We conducted an empirical meta-research study of scoping reviews published in first-quartile journals according to the Journal Citation Reports and indexed in PubMed. Data were extracted independently using a standardized form and included protocol registration status, registry platform, public accessibility, peer-reviewed protocol publication, reported protocol components, and methodological guidance cited. Descriptive analyses were used to assess registration patterns and methodological consistency. Multivariable logistic regression models were fitted to explore factors associated with protocol registration reporting and the presence of a peer-reviewed protocol. Among 2,546 screened records, 1,267 scoping reviews underwent full data extraction. Overall, 549 reviews reported a registered protocol, of which 483 were publicly accessible and included in the analysis. Protocol registration was identified in 43.3% of scoping reviews, while peer-reviewed protocol publication was rare (5.1%). Most protocols were registered on the Open Science Framework (OSF) (n = 478). Protocol content frequently included core methodological elements but also reported additional items beyond those addressed in the JBI Manual for Evidence Synthesis. Although many methodological documents were cited, only two provided explicit guidance for scoping review protocol development. Post hoc analyses identified substantial heterogeneity in protocol registration practices across journals, publishers, and corresponding author countries, suggesting that registration practices are influenced by a combination of editorial policies, local research cultures, and differing methodological perspectives. Protocol registration practices in scoping reviews remain heterogeneous across high-impact health sciences journals. The findings demonstrate substantial variability in protocol content, registration approaches, and use of methodological guidance, while reinforcing ongoing methodological discussions regarding protocol registration and standardization in scoping reviews.
Osteosarcoma is the most common primary malignant bone tumor, typically affecting adolescents and young adults. While its development is often associated with rapid bone growth and genetic factors, the potential link between metal implants and osteosarcoma remains unclear and rarely reported. This case highlights the unusual occurrence of high-grade osteosarcoma arising at the site of a long-standing metal implant, emphasizing the importance of long-term vigilance in patients with orthopedic hardware. Because implant-associated sarcomas are exceptionally uncommon and causality cannot be inferred from individual cases, detailed clinicopathologic documentation and careful exclusion of alternative etiologies are essential. A 49-year-old White middle eastern male presented with progressive pain and swelling in the right thigh. He had sustained an open right femoral shaft fracture in 1990, treated with open intramedullary nailing using a stainless-steel nail with interlocking screws and cerclage wiring. Intermittent symptoms began in 2013, and he was admitted in 2016 with worsening pain and a presumptive diagnosis of chronic osteomyelitis; empiric antibiotics (vancomycin and meropenem) were initiated. Imaging demonstrated an aggressive osteolytic lesion in the distal femoral diaphysis/metadiaphysis adjacent to the prior fixation site, with cortical destruction and an associated soft-tissue component on magnetic resonance imaging (MRI). Core needle biopsy showed chronic inflammation with atypical stromal proliferation, and subsequent open biopsy confirmed high-grade osteogenic osteosarcoma with fibroblastic and chondroblastic differentiation. Microbiological investigations, including blood cultures and multiple intraoperative tissue cultures, were negative, and histopathology did not support osteomyelitis. The patient received perioperative multi-agent chemotherapy with methotrexate, doxorubicin, and cisplatin (MAP) and underwent hip disarticulation with negative margins. No metastatic disease was detected during 9 years of follow-up, and the patient remains disease-free (Table 1). This case adds to the limited literature describing implant-associated osteosarcoma and supports ongoing clinical vigilance for late-onset symptoms around orthopedic hardware. This case illustrates the diagnostic challenge of distinguishing infection from malignancy in patients with late-onset symptoms around orthopedic hardware. While biologically plausible mechanisms such as chronic local inflammation and metal ion exposure have been proposed, this report should be interpreted as an implant-associated presentation rather than proof of implant-induced carcinogenesis. Persistent or progressive pain or swelling near long-standing implants warrants timely imaging and biopsy.
Laparoscopy is increasingly recognized as a valuable tool in pediatric trauma management, offering the benefits of reduced morbidity compared to traditional open laparotomy. However, its precise role in blunt abdominal trauma in children remains controversial due to concerns about diagnostic accuracy, technical complexity, and patient safety. This systematic review aimed to synthesize current evidence regarding the indications, clinical outcomes, and safety profile of laparoscopic management in pediatric blunt abdominal trauma. A systematic literature search was conducted in PubMed, Web of Science, Lilacs, Scielo, and Scopus databases for studies published between January 2010 and December 2025. Eligible studies included pediatric patients (≤ 18 years old) with blunt abdominal trauma who underwent diagnostic or therapeutic laparoscopy. Screening and data extraction were performed independently by two reviewers using the Rayyan web application, following PRISMA guidelines. A descriptive analysis summarized patient characteristics, injury patterns, operative details, conversions, complications, and mortality. Twenty studies comprising 255 pediatric patients were included, with a median age of 9 years. The available evidence was predominantly derived from case reports and small case series. Conversion from laparoscopy to open surgery occurred in 39.2% of cases, reflecting both the diagnostic role of laparoscopy and intraoperative findings requiring definitive management. The most commonly reported injuries involved the bowel, pancreas, spleen, and liver. Laparoscopy was frequently used as a diagnostic tool and, in selected cases, enabled therapeutic intervention, with generally low reported complication rates and no mortality in the included studies. Median length of hospital stay was 5 days. Laparoscopy appears to be a feasible and potentially valuable adjunct in the management of pediatric blunt abdominal trauma in carefully selected, hemodynamically stable patients. It may contribute to reducing non-therapeutic laparotomies and provide both diagnostic and therapeutic benefits. However, given that current evidence is largely limited to low-level studies, these findings should be interpreted with caution and considered hypothesis-generating. Further prospective and comparative studies are required to better define its role and optimize patient selection.
With the advancement of the ERAS (Enhanced Recovery After Surgery) concept, minimally invasive heart valve replacement surgery has become widely performed due to its advantages of smaller trauma and fewer adverse reactions. However, postoperative pain management remains complex and traditional opioid analgesia is often associated with adverse side effects. Oxycodone, an opioid agonist, has strong analgesic effects with relatively few side effects. This study aims to explore the efficacy and safety of oxycodone hydrochloride injection in multimodal pain management following minimally invasive heart valve replacement surgery. This is a prospective, double-blind, randomised controlled clinical trial designed as a non-inferiority study. The schedule of enrolment, interventions and outcome assessments is summarised in figure 2. The study period is from October 2024 to September 2027, and between 30 April 2026 and 31 October 2026, a total of 130 patients undergoing minimally invasive heart valve replacement surgery will be planned to recruit and randomly assign in a 1:1 ratio to receive either oxycodone hydrochloride injection or sufentanil for postoperative patient-controlled analgesia. The primary outcome is the Numerical Rating Scale pain score during coughing at 24 hours postoperatively. Secondary outcomes include measures of postoperative pain control, analgesic consumption, adverse events and recovery-related indicators. To address the risk of type I error due to multiple secondary outcomes, secondary endpoints are prespecified and categorised into key secondary outcomes and exploratory outcomes with corresponding statistical analysis strategies planned. This protocol is V.2.0, dated 29 December 2025. Ethical approval has been obtained from the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (XJTU1AF2024LSYY-389-04). The study will be conducted in accordance with the Declaration of Helsinki, and informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals, scientific conferences and appropriate public channels. ChiCTR2400094930.
Monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) is a rare primary intestinal T-cell lymphoma newly defined in the 2016 WHO classification, characterized by rapid progression and a poor prognosis. Fistula formation caused by intestinal lymphoma is extremely uncommon, and no previous reports have described MEITL presenting with a jejunocolic fistula. An 83-year-old woman presented with a 20-kg weight loss and generalized fatigue over the preceding year. Laboratory tests revealed hypoalbuminemia and elevated inflammatory markers. Computed tomography demonstrated wall thickening of the jejunum and descending colon, suggesting possible continuity between the two segments. Colonoscopy revealed a circumferential ulcerative lesion at the splenic flexure, and proximal to this lesion, another lumen extending in a direction different from the colonic lumen was observed. Biopsy confirmed a diagnosis of MEITL. Positron emission tomography-computed tomography (PET-CT) showed abnormal FDG uptake from the jejunum to the transverse colon, and the disease was classified as Lugano Stage II. Due to tumor location and the patient's poor general condition, both surgery and chemotherapy were considered infeasible, and best supportive care was chosen. The patient died on hospital Day 33. Jejunocolic fistula caused by MEITL is exceptionally rare. To our knowledge, this is the first reported case in which the fistulous opening was directly visualized endoscopically and a histopathological diagnosis was established by biopsy during life. This case highlights that, in patients with marked weight loss and hypoalbuminemia, gastrointestinal fistula formation should raise suspicion for malignant lymphoma, including MEITL, and that careful endoscopic examination and biopsy may contribute to early diagnosis.