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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.

Ultrasound-assisted catheter-directed thrombolysis using the EkoSonic Endovascular System (EKOS) is an established treatment for intermediate high-risk pulmonary embolism (IHR-PE). However, the optimal timing of treatment initiation remains uncertain. Early right ventricular (RV) unloading may improve outcomes by reducing RV pressure overload and preventing haemodynamic deterioration. We conducted a retrospective multicentre analysis of patients with IHR-PE treated with EKOS at three tertiary centres. Patients were stratified by time from CT-confirmed diagnosis to EKOS initiation: early (<12&#x2009;hours) versus delayed (>12&#x2009;hours). Echocardiographic parameters included RV/left ventricular (LV) ratio, tricuspid annular plane systolic excursion (TAPSE), LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes were intensive care unit (ICU) length of stay, complications, bleeding events and in-hospital mortality. 3-month follow-up was available in two centres. Overall, 152&#x2009;patients were included (early n=106; delayed n=46) in the study. Baseline characteristics were largely comparable, although dyspnoea New York Heart Association (NYHA) class II-III was more frequent in the early group (NYHA III: 73% vs 46%, p=0.001). Both groups showed significant improvements in RV/LV ratio, TAPSE, sPAP and LVEF (all p<0.001). Early treatment resulted in numerically greater RV functional improvement (Early &#x394; Discharge (D)-Admission (A) TAPSE early 4.86&#xb1;5.14&#x2009;mm vs delayed &#x394; D-A 3.5&#xb1;5&#x2009;mm), without statistically significant differences between groups. At 3-month follow-up, RV recovery measured by TAPSE was comparable. Early EKOS therapy was associated with a significantly shorter ICU stay (median 24&#x2009;hours vs 45.5&#x2009;hours, p=0.033), fewer PE-related complications (p=0.03), while procedure-related complications and in-hospital mortality did not differ. In IHR-PE, EKOS initiation within 12 hours is associated with a significantly shorter ICU stay and significantly less PE-related complications. These findings support early EKOS treatment strategies and warrant confirmation in prospective studies.

Superior orbital sulcus hollowness is a common aesthetic concern that may result from structural changes, trauma, or excessive fat removal during upper blepharoplasty, and it can be further exacerbated by age-related orbital remodeling. Traditional corrective approaches such as fat redistribution and autologous fat grafting carry limitations, including graft atrophy and the risk of embolic complications. This study evaluated the safety and outcomes of superior orbital sulcus correction using a medial-pedicled preseptal orbicularis oculi muscle flap. This retrospective study analyzed 481 patients who underwent upper blepharoplasty between January 2017 and June 2024, of whom 45 received additional correction of superior orbital sulcus hollowness with a medial-pedicled preseptal orbicularis oculi muscle flap. Exclusion criteria included male sex, previous upper eyelid surgery, levator dehiscence, less than six months of follow-up, and refusal to complete the FACE-Q Adverse Effects questionnaire. The mean follow-up duration was 8 months, and the mean patient age was 51.4 years. Postoperative complications and patient-reported outcomes were evaluated and compared with those of patients undergoing conventional upper blepharoplasty. Early postoperative complications, including transient lagophthalmos and edema, were self-limiting. In the conventional blepharoplasty group, 16 patients developed medial canthal scarring, with four requiring revision. In the flap group, transient supraorbital hypoesthesia occurred in 71% of patients and resolved within a few months, and no cases of flap necrosis were observed. Statistical analysis using the Mann-Whitney U test demonstrated no significant difference in FACE-Q scores between the two groups (U = 8828.0, p = 0.251). The medial-pedicled preseptal orbicularis oculi muscle flap appears to be a safe, reproducible, and anatomically sound technique for selected patients with superior orbital sulcus hollowness. Although the relatively uniform flap volume may not fully correct the deformity in all cases and patient numbers were limited, this method provides a promising alternative to fat grafting without adding long-term complications, with the potential to enhance aesthetic outcomes and patient satisfaction. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Percutaneous endoscopic lumbar discectomy (PELD) is a preferred minimally invasive surgery for lumbar disc herniation (LDH); however, postoperative recurrence, nerve root damage, and hyperesthesia continue to present key clinical challenges. Chitosan represents a novel preventive approach against postoperative complications. This study aimed to assess the clinical efficacy of ultrasound-guided percutaneous endoscopic interlaminar discectomy (PEID) plus medical chitosan in treating lumbar 4-5 disc herniation (L4-5 LDH). Totally, 200 L4-5 LDH patients were prospectively recruited and randomly divided into the control group (ultrasound-guided PEID) and observation group (ultrasound-guided PEID plus medical chitosan). Low back and leg pain and lumbar dysfunction were assessed preoperatively and postoperatively using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA). Efficacy and postoperative complications were evaluated according to the modified MacNab criteria. Logistic regression analyses identified the risk factors. Mann-Whitney U test was used for inter-group comparisons, and the Kruskal-Wallis test for timepoint comparisons. The two groups showed significant differences in pre-treatment Pfirrmann classification and operation time. As time progressed, patients exhibited reduced VAS and ODI scores and increased JOA scores postoperatively. Significant differences were observed in VAS, JOA, and ODI scores in the observation group at 2&#x2009;weeks postoperatively. The observation group demonstrated superior treatment efficacy and a lower complication incidence than the control group. Age, disease course, and postoperative bleeding were independent risk factors affecting clinical efficacy of ultrasound-guided PEID plus chitosan. Ultrasound-guided PEID plus medical chitosan reduces postoperative pain and perioperative complications, demonstrating superior clinical efficacy.

Migration is one of the most feared complications following lip filler. The use of a specific filler with a high degree of elasticity and cohesiveness could be the key to solve the problem if injections are performed in the correct anatomical plane. The purpose of this study was to describe the authors' 5-year experience with a new concept of lip filling, iLips. This reproducible approach combines elasticity and cohesiveness of a 25,5 mg/ml filler injected through superficial micro-tunnels in a virtual space between orbicularis muscle and mucosa creating a tridimensional net that respects lip dynamic also leading to a low risk of filler migration. A total of 4583 consecutive patients who underwent lip filler with iLips technique were enrolled in this prospective study. An objective evaluation on the aesthetic results was obtained by a jury composed of 3 external plastic surgeons using Lip Fullness Merz scale. PROMs were investigated through FACE-Q administration to the patients ("Psychological function", "Satisfaction with outcome" and "Satisfaction with lips" scales). Statistical analysis was performed through Prism10. Complications were reported. t-test with Welch's correction showed an improvement in Lip Fullness Merz score both in upper and lower lip (p<0.05). A similar trend was shown also for "Psychological function", "Satisfaction with outcome" and "Satisfaction with lips" mean values after the procedure. Just 2 cases of major vascular complications were reported. iLips &#xae; seem to be a safe, highly reproducible, effective and satisfying approach for lip augmentation positively impacting also the patient's psychological sphere. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Parotidectomy for benign tumors requires meticulous facial nerve preservation, yet the optimal dissection technique between anterograde dissection (AD) and retrograde dissection (RD) remains uncertain, prompting this updated meta-analysis comparing their outcomes. Twenty-one studies (1632 patients) were included. Outcomes comprised operative parameters, postoperative complications, and facial nerve recovery. Pooled effects were estimated using odds ratios (ORs) and mean differences with 95% confidence intervals (CIs). RD significantly reduced transient facial nerve palsy versus AD (OR, 0.73; 95% CI, 0.54-0.98), with no difference in permanent palsy. Recovery was similar at 1, 6, and 12&#x2009;months, although AD showed faster recovery at 3&#x2009;months. Other complications were comparable. RD was associated with shorter operative time, less blood loss, and smaller resected tissue volume. Subgroup analysis indicated reduced transient palsy mainly in superficial parotidectomy. RD offers advantages over AD, particularly in superficial parotidectomy, though further randomized trials are warranted.

Lung cancer surgery is associated with significant postoperative morbidity (15%-40%)&#x2009;and mortality (2%-5%), with considerable interhospital variability. This study conducts the first national longitudinal analysis of performance trajectories in lung cancer surgery using advanced trajectory modelling approaches to understand temporal dynamics of quality evolution across hospitals. We included all adult patients (French national hospital database, n=56&#x2009;299; 148 hospitals) who underwent lung resection for primary lung cancer in 2020-2024. The primary outcome was severe complications including major postoperative complications and 30-day mortality. Annual logistic regression models incorporating clinical and procedural variables calculated risk-adjusted rates (RAR) for each hospital. Hospitals were classified using funnel plots corrected for overdispersion. Hidden Markov Models estimated transition probabilities between performance categories, while group-based multitrajectory models identified subgroups of hospitals sharing similar evolution profiles, stratified by activity volume (low, <43; medium, 43-100; high, >100 procedures/year). Predictive models demonstrated excellent stable discrimination (mean area under the ROC curve=0.890). Markov models revealed strong performance inertia (persistence probabilities &#x2265;78%). Trajectory analysis identified a complex non-linear relationship between volume and quality. Medium-volume hospitals showed optimal improvement trajectories (45.4-45.8%&#x2009;RAR reduction). Conversely, some low-volume centres experienced catastrophic deterioration (843% RAR increase), while paradoxically, a subgroup of high-volume hospitals also showed concerning performance degradation (151% increase). This study demonstrates heterogeneous performance trajectories in French lung cancer surgery, challenging the assumption that high-volume alone guarantees quality and suggesting organisational complexity challenges. This study shows the value of implementing systematic outcome monitoring using existing administrative data to target quality improvement interventions and reduce inter-hospital performance variations.

Adequate renal perfusion is critical for maintaining kidney function, and its impairment contributes significantly to acute kidney injury (AKI) and related cardiovascular complications. Dopamine (DA) is clinically employed to improve renal perfusion, but its efficacy remains controversial due to paradoxical vasoconstriction at higher doses. This study systematically evaluates DA-induced vasomotor responses in human intrarenal arteries and elucidates the underlying molecular mechanisms. Human intrarenal artery segments, including interlobar (IA, &#x223c;1 mm), arcuate (AA, &#x223c;500&#x202f;&#x3bc;m), and interlobular arteries (ILA, &#x223c;200&#x202f;&#x3bc;m), were analyzed using ex vivo tension assays, pharmacological interventions, RNA sequencing, and siRNA silencing to delineate segment-specific DA responses and molecular basis. DA (1&#x202f;nM-10&#x202f;&#xb5;M) consistently induces vasodilation across all human intrarenal arteries, challenging the conventional notion that "renal-dose DA" causes vasoconstriction. IA and AA segments exhibit more pronounced vasodilation than ILA, mediated by dopamine receptor D1 (DRD1)-dependent protein kinase A (PKA)-BK channel signaling. Specifically, higher expression and activity of the BK channel regulatory &#x3b2;-subunit (KCNMB1) in IA and AA accounted for their increased sensitivity to DA. Transcriptomic profiling further identified distinct molecular heterogeneity among IA, AA and ILA segments, reflecting their divergent physiological roles. In contrast, rodent intrarenal arteries respond to DA with vasoconstriction rather than dilation, due to the lack of the BK channel pore-forming &#x3b1;-subunit (KCNMA1), which shifts the balance toward &#x3b1;-adrenergic vasoconstriction. Our study overturns the traditional paradigm of "renal-dose DA"-induced vasoconstriction, supports DRD1 agonism as a promising strategy for renal hypoperfusion, and emphasizes critical species differences that necessitate human-based validation in translational vascular research.

Rapid sequence intubation (RSI) in helicopter emergency medical services (HEMS) is conventionally performed at the scene before transport, potentially delaying time to definitive care. The feasibility of performing RSI during flight in civilian HEMS operations has not been established in the United Kingdom. We evaluate the feasibility, safety, and temporal efficiency of performing simulated in-flight RSI in an AW169 helicopter under operational flight conditions. A prospective proof-of-concept study using high-fidelity simulation was conducted across 2 phases (May 2023, January 2025) at the Air Ambulance Charity Kent Surrey Sussex. Eight simulations were completed by 4 distinct clinical teams comprising operationally experienced HEMS physicians and paramedics. Scenarios replicated a standardized traumatic brain injury scenario requiring RSI during the return transit phase. The primary outcome was time from RSI checklist initiation to confirmed intubation. Secondary outcomes included overall mission times, safety events, and crew-perceived feasibility assessed via post-scenario questionnaires. All simulations (8/8, 100%) achieved successful first-pass intubation. Median time from checklist initiation to confirmed intubation was 5 minutes (interquartile range [IQR]: 5-7). Median total mission time from base departure to RSI completion was 42 minutes (IQR 40-44). No safety events, procedural complications, or communication failures occurred. Crew questionnaires (93% response rate) confirmed unanimous perceived feasibility, with participants identifying adequate workspace, effective communication, and manageable equipment accessibility. High-fidelity simulation demonstrates that in-flight RSI is technically feasible in an AW169 helicopter, with consistent procedural times and no safety events. These findings may support further evaluation of in-flight RSI as a complementary strategy for time-critical patients where scene-based airway management may delay definitive care.

To provide a comprehensive review of the biological rationale, clinical evidence, and practical perioperative management of immunotherapy for the head and neck surgeon. Standard treatment for resectable head and neck squamous cell carcinoma (HNSCC) has reached a survival plateau, with over 50% of patients experiencing recurrence. The integration of immune checkpoint inhibitors (ICIs) into the neoadjuvant window represents a paradigm shift toward biologically adapted surgical intervention. Neoadjuvant immunotherapy capitalizes on an intact immune substrate to create an in&#xa0;situ vaccine, avoiding the post-surgical immune desert that limits adjuvant efficacy. Emerging phase III data confirm that perioperative ICI significantly improves event-free survival. Successful implementation requires the surgeon to navigate unique diagnostic challenges, such as distinguishing rare but anatomically risky pseudoprogression from true progression. While combination therapies (chemoimmunotherapy or immunoradiotherapy) yield higher pathologic complete response rates, they also increase toxicity. Intraoperatively, ICI monotherapy generally preserves tissue planes without increasing surgical delays or major wound complications. Standard biomarkers like PD-L1 and TMB, alongside emerging tools such as liquid biopsy (ctDNA), are essential for patient selection and dynamic monitoring. The transition to neoadjuvant immunotherapy facilitates future surgical de-escalation and function-preserving approaches. To optimize outcomes, the modern surgeon must act as a surgical immunologist, interpreting translational data to guide real-time operative planning.

Mucous membrane pemphigoid (MMP) is a rare autoimmune subepidermal blistering disorder predominantly affecting mucosal surfaces, including the oral cavity, ocular, nasal, tracheal, and esophageal epithelia. This disease frequently induces irreversible scarring, with severe manifestations potentially causing blindness, airway stenosis, and life-threatening complications. Consequently, early detection, accurate diagnosis, and prompt therapeutic intervention are critical for patients' outcomes. Diagnostic and therapeutic challenges arise from atypical initial presentations, limited sensitivity of immunological assays, and adverse effects associated with conventional therapies such as glucocorticoids and immunosuppressive agents. These limitations necessitate enhanced clinical recognition and proactive management to mitigate complications and reduce mortality. &#x9ecf;&#x819c;&#x7c7b;&#x5929;&#x75b1;&#x75ae;&#xff08;mucous membrane pemphigoid&#xff0c;MMP&#xff09;&#x662f;&#x4e00;&#x79cd;&#x4e3b;&#x8981;&#x7d2f;&#x53ca;&#x53e3;&#x8154;&#x3001;&#x773c;&#x3001;&#x9f3b;&#x3001;&#x6c14;&#x7ba1;&#x3001;&#x98df;&#x7ba1;&#x7b49;&#x9ecf;&#x819c;&#x90e8;&#x4f4d;&#x7684;&#x7f55;&#x89c1;&#x81ea;&#x8eab;&#x514d;&#x75ab;&#x6027;&#x8868;&#x76ae;&#x4e0b;&#x75b1;&#x75c5;&#x3002;&#x672c;&#x75c5;&#x5e38;&#x5bfc;&#x81f4;&#x4e0d;&#x53ef;&#x9006;&#x7684;&#x7622;&#x75d5;&#x5f62;&#x6210;&#xff0c;&#x4e25;&#x91cd;&#x8005;&#x53ef;&#x81f4;&#x5931;&#x660e;&#x3001;&#x6c14;&#x9053;&#x72ed;&#x7a84;&#x7b49;&#x5e76;&#x53d1;&#x75c7;&#x53d1;&#x751f;&#xff0c;&#x8fdb;&#x800c;&#x5371;&#x53ca;&#x751f;&#x547d;&#x3002;&#x56e0;&#x6b64;&#xff0c;&#x672c;&#x75c5;&#x7684;&#x65e9;&#x671f;&#x53d1;&#x73b0;&#x3001;&#x8bca;&#x65ad;&#x548c;&#x53ca;&#x65f6;&#x6cbb;&#x7597;&#x5bf9;&#x60a3;&#x8005;&#x81f3;&#x5173;&#x91cd;&#x8981;&#x3002;&#x7531;&#x4e8e;&#x60a3;&#x8005;&#x75be;&#x75c5;&#x521d;&#x671f;&#x4e0d;&#x5178;&#x578b;&#x7684;&#x4e34;&#x5e8a;&#x8868;&#x73b0;&#xff0c;&#x514d;&#x75ab;&#x5b66;&#x68c0;&#x67e5;&#x7075;&#x654f;&#x5ea6;&#x6709;&#x9650;&#xff0c;&#x4f20;&#x7edf;&#x6cbb;&#x7597;&#x5982;&#x7cd6;&#x76ae;&#x8d28;&#x6fc0;&#x7d20;&#x3001;&#x514d;&#x75ab;&#x6291;&#x5236;&#x5242;&#x7684;&#x526f;&#x4f5c;&#x7528;&#xff0c;&#x589e;&#x52a0;&#x4e86;&#x672c;&#x75c5;&#x7684;&#x8bca;&#x6cbb;&#x96be;&#x5ea6;&#x3002;&#x56e0;&#x6b64;&#xff0c;&#x9700;&#x8981;&#x4e34;&#x5e8a;&#x533b;&#x751f;&#x63d0;&#x9ad8;&#x5bf9;&#x672c;&#x75c5;&#x7684;&#x8ba4;&#x8bc6;&#x3001;&#x65e9;&#x671f;&#x5e72;&#x9884;&#x672c;&#x75c5;&#xff0c;&#x8fdb;&#x800c;&#x964d;&#x4f4e;&#x5e76;&#x53d1;&#x75c7;&#x548c;&#x75c5;&#x6b7b;&#x7387;&#x3002;&#x672c;&#x6587;&#x68b3;&#x7406;&#x4e86;&#x4e0e;MMP&#x4e25;&#x91cd;&#x7a0b;&#x5ea6;&#x76f8;&#x5173;&#x7684;&#x6f5c;&#x5728;&#x56e0;&#x7d20;&#xff0c;&#x5e76;&#x5bf9;MMP&#x7684;&#x6cbb;&#x7597;&#x8fdb;&#x5c55;&#x8fdb;&#x884c;&#x9610;&#x8ff0;&#xff0c;&#x8fdb;&#x800c;&#x63d0;&#x9ad8;&#x4e34;&#x5e8a;&#x533b;&#x751f;&#x5bf9;&#x672c;&#x75c5;&#x7684;&#x5173;&#x6ce8;&#xff0c;&#x5e76;&#x53ca;&#x65f6;&#x91c7;&#x53d6;&#x6709;&#x6548;&#x7684;&#x6cbb;&#x7597;&#x63aa;&#x65bd;&#x9884;&#x9632;&#x5e76;&#x53d1;&#x75c7;&#x7684;&#x53d1;&#x751f;&#xff0c;&#x6539;&#x5584;&#x60a3;&#x8005;&#x9884;&#x540e;&#x3002;.

Chimeric antigen receptor (CAR)-T cell therapy has emerged as a revolutionary treatment for hematologic malignancies and solid tumors. Multiple approved products and ongoing clinical trials have demonstrated its remarkable antitumor efficacy. However, its clinical application is severely limited by prominent cardiotoxicity, which is closely associated with high morbidity and mortality, posing an urgent clinical challenge. This review systematically elucidates the pathophysiological mechanisms underlying CAR-T cell therapy-induced cardiotoxicity, which can be primarily categorized into acute and long-term adverse effects. Acute cardiotoxicity is driven by cytokine release syndrome (CRS) through macrophage and monocyte activation, endothelial dysfunction, and subsequent myocardial injury, leading to hypotension, reduced left ventricular ejection fraction, and cardiac arrhythmias. Long-term cardiotoxicity is mainly caused by B-cell aplasia-induced immune deficiency and secondary hemophagocytic lymphohistiocytosis, which trigger infectious complications, myocardial ischemia, and apoptosis. We have further summarized clinical pharmacological interventions for such cardiotoxicity, including interleukin (IL)-6 receptor antagonists (tocilizumab), interferon-&#x3b3; inhibitors (emapalumab), and Janus kinase inhibitors (ruxolitinib). However, none of these drugs can completely alleviate CRS or CAR-T cell therapy-induced cardiotoxicity in all patients. Preclinical agents targeting inflammatory cytokines (IL-1&#x3b2;, tumor necrosis factor-&#x3b1;) and signaling pathways have shown efficacy in ameliorating cardiotoxicity in various animal models. These findings provide novel directions and drug candidates for the treatment of CAR-T cell therapy-induced myocardial toxicity. This review provides a comprehensive theoretical basis for optimizing cardiovascular safety management and developing novel targeted interventions for CAR-T cell therapy.

Prophylactic pancreatic duct stent (PDS) placement is used during endoscopic retrograde cholangiopancreatography (ERCP) to prevent post-ERCP pancreatitis (PEP) and facilitate difficult biliary cannulation; however, the optimal retention duration of prophylactic PDS remains uncertain. This trial compared 2-week versus 4-week PDS retention to determine the strategy that minimizes the need for endoscopic stent removal without compromising safety. In this prospective multicenter trial, adults undergoing ERCP with placement of a 5-Fr single-pigtail unflanged PDS were randomized in a 1:1 ratio to undergo scheduled assessment at 2 or 4 weeks post-ERCP to evaluate PDS retention via abdominal radiography. The primary outcome was the proportion of patients requiring endoscopic stent removal due to confirmed PDS retention. Secondary outcomes included spontaneous stent dislodgment, incidence and severity of PEP and PDS-associated pancreatitis, and length of hospital stay. Among 182 screened patients, 160 were randomized, and 156 were analyzed (80 in the 2-week group; 76 in the 4-week group). The primary outcome, requirement for endoscopic PDS removal, was significantly lower in the 4-week group than in the 2-week group (6.6% [5/76] vs. 18.8% [15/80]; OR, 0.305; 95% CI, 0.105-0.887; P=0.030). This was driven by a higher spontaneous dislodgment rate in the 4-week group (92.1% [70/76] vs. 81.3% [65/80]; OR, 0.371; 95% CI, 0.136-1.015; P=0.061). PEP developed in 10.5% (8/76) of the 4-week group and 15.0% (12/80) of the 2-week group (P=0.403), with a median onset of 1-day post-ERCP. PEP was predominantly mild, with only two moderate cases in each group. No cases of PDS-associated pancreatitis were observed during the study period. A 4-week retention strategy reduced the need for endoscopic stent removal without increasing the incidence of PEP or other clinically relevant complications. (ClinicalTrials.gov Identifier: NCT04691674).

Acute inflammation, when unresolved, can lead to complications that impair tissue repair and therapeutic outcomes. In this study, we employed a model of lipopolysaccharide (LPS)-induced acute subcutaneous abdominal inflammation in mice to investigate the modulatory effects of elastic compression. LPS administration elicited a robust inflammatory response, characterized by increased leukocyte infiltration, edema, and upregulation of pro-inflammatory mediators. Elastic compression significantly attenuated this response, reducing leukocyte counts in subcutaneous lavage, histological inflammatory infiltrates, and the expression of key pro-inflammatory genes and proteins, including NF-&#x3ba;B, IL-1&#x3b2;, and TNF-&#x3b1;, at both 24 and 72 hours post-induction. Mechanistically, these effects may result from the compressive force altering microvascular dynamics and modulating macrophage polarization and mechanotransduction pathways, including TLR4 and integrin signaling. Additionally, compression preserved redox homeostasis, as indicated by stable oxidative stress markers and antioxidant responses. To our knowledge, this is the first study to demonstrate that elastic compression modulates inflammation at molecular, cellular, and tissue levels in an acute inflammation model. These findings support the therapeutic potential of elastic compression as a non-pharmacological strategy for managing acute inflammation, with possible applications in postoperative care, traumatic edema, and other soft tissue inflammatory conditions. Further translational and clinical studies are warranted to validate these outcomes and guide evidence-based application protocols. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Same-day discharge (SDD) after robot-assisted radical prostatectomy (RARP) is increasingly adopted as a standard of care. This systematic review and meta-analysis assess the safety and effectiveness of SDD compared with conventional inpatient (IP) management. A literature search was conducted in accordance with PRISMA guidelines using PubMed/MEDLINE, Embase, Web of Science, and Scopus databases up to February 2025, including only comparative studies reporting on SDD versus IP RARP. The primary endpoint was postoperative complication rates. Secondary endpoints included 30-day readmission rates, unplanned postoperative visits, and patient-reported satisfaction. Subgroup analysis focused on studies involving single-port (SP) robotic platforms. Nineteen studies were included, encompassing 11 211 SDD and 114 999 IP cases. Overall complication rates were lower in the SDD group (odds ratio [OR]: 0.65, 95% confidence intervals [CI]: 0.50-0.84, p <&#xa0;0.001). The pooled OR favored the outpatient group for both minor and major complications (OR: 0.52, 95% CI: 0.28-0.98, p&#xa0;=&#xa0;0.042). No significant differences were found in 30-d readmissions (OR: 0.89, 95% CI: 0.77-1.02, p&#xa0;=&#xa0;0.082), unplanned visits (odds OR: 0.61, 95% CI: 0.35-1.07, p&#xa0;=&#xa0;0.081), or continence recovery. In the SP subgroup, no differences were observed in major complications (OR: 0.71, 95% CI: 0.39-1.29; p&#xa0;=&#xa0;0.7) or readmission rates (OR: 1.88, 95% CI: 0.56-6.39, p&#xa0;=&#xa0;0.3). The main limitation was the retrospective design of most studies. The available evidence does not allow reliable causal comparisons between SDD and inpatient care after RARP; however, perioperative outcomes within SDD cohorts appear acceptable, supporting the feasibility of SDD in carefully selected patients.

Patients with multiple myeloma undergoing dorsal spinal instrumentation for malignant spinal lesions remain at high risk for postoperative complications and limited survival. Acute kidney injury (AKI) is common in myeloma and after major surgery, but its prognostic relevance in surgically treated myeloma patients and its association with subsequent CT-based body composition and bone density trajectories, remains insufficiently defined. We performed a retrospective cohort study of consecutive multiple myeloma patients undergoing dorsal spinal instrumentation between 2011 and 2024 at a tertiary referral center. Postoperative AKI was defined and staged according to KDIGO criteria based on serum creatinine changes within 7 postoperative days. Clinical outcomes included overall survival (OS), surgical site infection (SSI), and length of hospital stay (LOHS). CT-based morphometry was assessed on non-contrast whole-body CT at L3 level on a preoperative baseline scan (tCT1) and a postoperative follow-up scan. The follow-up CT scan (tCT2) was obtained approximately 9 months postoperatively as part of routine oncologic follow-up or clinical indication rather than a fixed imaging schedule, reflecting real-world clinical practice. The mean interval between tCT1 and tCT2 was 9.1&#x2009;&#xb1;&#x2009;1.2 months. Analysis included skeletal muscle index (SMI), skeletal muscle density (SMD), visceral adipose tissue (VAT), and vertebral trabecular bone status assessed by Hounsfield Units (HU). Multivariable Cox regression, logistic regression, and log-linear regression were used to evaluate the independent association of AKI with OS, SSI, and LOHS, adjusting for clinically relevant covariates. 59 patients were included (median age 69.0 years; 40.7% female); postoperative AKI occurred in 16 patients (27.1%). AKI was associated with significantly worse OS (median 224 vs. 396 days without AKI; log-rank p&#x2009;=&#x2009;0.01), with progressively shorter OS across KDIGO stages. In multivariable Cox regression, AKI remained independently associated with worse OS (adjusted hazard ratio 2.35, 95% CI 1.22-4.54; p&#x2009;=&#x2009;0.011). AKI was also associated with higher SSI rates (63% vs. 12%; p&#x2009;<&#x2009;0.01) and longer LOHS (median 29 (IQR 8) vs. 19 (IQR 9) days; p&#x2009;<&#x2009;0.001). After adjustment for age, sex, preoperative ECOG, and Charlson Comorbidity Index, AKI remained independently associated with higher SSI rates (adjusted odds ratio 3.20, 95% CI 1.11-9.26; p&#x2009;=&#x2009;0.031) and prolonged hospitalization (LOS ratio 1.34, 95% CI 1.06-1.69; p&#x2009;=&#x2009;0.014). Longitudinal CT analyses demonstrated significantly greater postoperative declines in the AKI group versus no AKI for SMI (median&#x2009;-&#x2009;44.6% vs. -18.5%; p&#x2009;<&#x2009;0.001), SMD (-&#x2009;20.5% vs. -9.2%; p&#x2009;=&#x2009;0.02), VAT (-&#x2009;29.1% vs. -24.1%; p&#x2009;<&#x2009;0.001), and HU (-&#x2009;46.2% vs. -37.7%; p&#x2009;<&#x2009;0.001). In multiple myeloma patients undergoing dorsal spinal instrumentation, postoperative AKI is independently associated with reduced survival, increased postoperative morbidity, and accelerated loss of muscle quantity, muscle quality, visceral fat, and vertebral bone density. These findings highlight AKI as a clinically meaningful systemic event with downstream catabolic consequences and support intensified perioperative nephroprotective and multidisciplinary supportive strategies in this high-risk population.