Frailty is common among patients undergoing vascular surgery and is associated with poorer postoperative outcomes. However, the use of frailty assessment tools in vascular services varies considerably. This study explored how vascular healthcare professionals (HCPs) understand frailty and perceive the role of frailty assessment to inform future service development. A national mixed-methods study was conducted. A questionnaire captured clinicians' knowledge, attitudes, and current frailty assessment practices. Semi-structured interviews with consultant and trainee vascular surgeons and other allied healthcare professionals explored experiences in depth. Quantitative data were analysed descriptively; qualitative data were examined using reflexive thematic analysis. Findings were integrated during interpretation. Survey responses (n = 60) showed that frailty is widely recognised as clinically important, yet its assessment is inconsistent, with most respondents (73%) relying on subjective judgement rather than formal tools. Interviews (n = 20) identified four overarching themes: (i) conceptualising frailty through a vascular lens; identifying (ii) drivers for change in approach to frailty; the (iii) assessment of frailty by the vascular team was varied but important; and HCPs identified potential risks and benefits to (iv) operationalising frailty for vascular services. Clinicians perceived value in standardising frailty assessment to support early identification, guide optimisation, enhance shared decision-making, and create a common language across specialties. Participants described benefits of collaborative models involving geriatricians, including improved medical management, streamlined discharge planning, and better continuity across hospital-community interfaces. However, barriers included limited time, staffing constraints, uncertainty about tool selection, concerns about service ownership and potential deskilling. Most clinicians felt a multidisciplinary frailty-informed model would ultimately improve outcomes and patient experience if adequately resourced. Vascular HCPs consider frailty assessment clinically meaningful and potentially transformative, but current practice is inconsistent. Participants perceived strong value in standardising frailty assessment to improve education, awareness and a shared understanding which would promote cross-disciplinary working. Improved health outcomes, patient counselling/education and job role satisfaction were implicated in this movement. However, optimal tool selection and its impact on clinical outcomes remain uncertain and require prospective evaluation before widespread adoption.

To evaluate the early outcomes of total laparoscopic Kasai portoenterostomy (TL-KPE) for Type III biliary atresia (BA). A retrospective analysis included 45 pediatric patients with Type III BA who underwent Kasai portoenterostomy between January 2018 and December 2024. Patients were divided into three groups (n = 15 each): open KPE (O-KPE), conventional laparoscopic KPE (L-KPE, with extracorporeal intestinal anastomosis), and TL-KPE (with fully intracorporeal anastomosis). Comparative parameters included operative time, intraoperative blood loss, postoperative recovery metrics, incidence of cholangitis within 6 months, jaundice clearance, and native liver survival rates. Compared with the O-KPE group, the TL-KPE group showed significantly less intraoperative blood loss (P = 0.016). Compared with both the O-KPE and L-KPE groups, the TL-KPE group had markedly shorter time to bowel recovery and postoperative fasting time (all P < 0.001). Postoperative hospital stay was also significantly shorter in the TL-KPE group compared to the O-KPE (P = 0.016) and L-KPE (P = 0.034) groups. There were no significant differences among the three groups in operative time (P = 0.052), incidence of postoperative complications (P = 0.132), jaundice clearance cases (P = 0.278), early cholangitis (P = 0.932), or recurrent cholangitis (P = 1.000). No perioperative deaths occurred in any group. TL-KPE is a safe and technically feasible approach for Type III BA that enhances short-term postoperative recovery. These early results warrant further multicenter prospective studies with longer follow-up to evaluate potential long-term benefits on native liver survival.

Readmission after carotid revascularization is an important quality indicator; however, comparative evidence for carotid endarterectomy (CEA) versus carotid artery stenting (CAS) remains focused mainly on 30-day outcomes. We compared unplanned 30-day and 90-day readmissions after nonelective CEA versus CAS and identified predictors, principal readmission diagnoses, and readmission-related resource utilization. We conducted a retrospective cohort study using the 2016-2017 Nationwide Readmission Database. Adults aged ≥ 18 years who underwent nonelective carotid revascularization were included. The 30-day cohort comprised 56,207 index admissions (CEA, 39,912; CAS, 16,295), and the 90-day cohort comprised 46,481 index admissions (CEA, 33,064; CAS, 13,418). Survey-weighted multivariable logistic regression was used to estimate the readmission risk, and generalized linear models were used to assess the index admission length of stay and total hospital charges. After adjustment, CAS and CEA had similar odds of 30-day readmission (OR 1.11, 95% CI 0.99-1.24; p = 0.065), whereas CAS was associated with higher odds of 90-day readmission (OR 1.12, 95% CI 1.03-1.22; p = 0.010). Index admissions for CAS involved longer hospital stays than CEA (11 vs. 9 days; p = 0.006 and p = 0.004) and higher total charges (USD 207,627 vs. 139,063 at 30 days; USD 204,055 vs. 138,216 at 90 days; both p < 0.001; difference ~ USD 66,000-69,000 per episode). Independent predictors of readmission included congestive heart failure, diabetes mellitus, chronic kidney disease, coronary artery disease, atrial fibrillation, and metastatic cancer; depression independently predicted 90-day readmission only (OR 1.19; p = 0.005). Cerebrovascular diagnoses accounted for most of the readmissions. CEA and CAS had similar adjusted 30-day readmission risks; however, CAS was associated with a higher 90-day readmission risk and higher index admission resource use. Specific comorbidities, particularly CHF, diabetes, CKD, atrial fibrillation, metastatic cancer, and depression (at 90 days), identify patients who may benefit most from targeted peri-discharge optimization. These findings support extended post-discharge surveillance after CAS, comorbidity-focused transition planning, and SNF-to-home pathway reviews.

This study aimed to deepen the understanding of Osgood-Schlatter Disease (OSD) by characterizing MRI findings and comparing differences based on gender and laterality to enhance diagnostic precision and guide treatment. We retrospectively analyzed MRI scans of 81 OSD patients acquired using a Siemens 3.0T scanner. Two experienced radiologists independently evaluated patellar ligament morphology, tibial tuberosity characteristics (including staging), and adjacent tissue alterations. Statistical analyses compared findings based on gender and affected side. Significant differences were observed between male and female patients regarding age at presentation, severity of patellar tendon distortion, and tibial tuberosity staging. Specifically, males presented at a later age with more severe manifestations. In contrast, no significant differences were detected based on the affected side (left vs. right) for any evaluated parameters, including associated findings. Comprehensive MRI analysis reveals distinct gender-related differences in OSD presentation, particularly concerning age, patellar tendon distortion, and tibial tuberosity involvement, with males exhibiting more severe and later-onset disease. These findings contribute valuable insights for the diagnosis and clinical understanding of OSD. No significant laterality differences were identified.

This study aimed to compare the clinical outcomes of three surgical methods (wedge resection, segmentectomy and lobectomy) in non-small cell lung cancer (NSCLC). We retrospectively analyzed 130 NSCLC patients who underwent thoracoscopic surgery. Patients were categorized into wedge resection (n = 50), segmentectomy (n = 40) and lobectomy (n = 40) groups. Baseline characteristics, perioperative parameters (operative time, drainage time, length of hospital stay, intraoperative blood loss), postoperative adverse events (reoperation, atrial arrhythmia, pulmonary embolism, prolonged air leak, pulmonary infection, pneumothorax, pleural effusion, atelectasis), and survival rates stratified by tumor diameter (< 1.0cm, 1.1-2.0cm) were recorded and compared. Baseline characteristics were comparable among the three groups (P > 0.05). For tumors < 1.0cm, the overall survival (OS) rates were similar among wedge resection, segmentectomy, and lobectomy groups (88% vs. 90.48% vs. 91.30%) (P > 0.05). In tumors measuring 1.1-2.0cm, the observed OS rates were 92.00% for wedge resection, 63.16% for segmentectomy, and 64.71% for lobectomy (P < 0.05). The three surgical approaches showed significant differences in the number of lymph nodes sampled, the detection rate of positive lymph nodes, and the resection method (P < 0.05), while no statistically significant difference was observed in the margin status (P > 0.05). Wedge resection was associated with the shortest operative time and drainage time (P < 0.05), while length of hospital stay and intraoperative blood loss did not differ significantly across the three approaches (P > 0.05). The incidence of postoperative adverse events presented no discernible difference in the three surgical approaches (P > 0.05). For tumors smaller than 1cm, wedge resection was associated with OS similar to that of segmentectomy and lobectomy. For selected tumors measuring 1.1-2.0cm, wedge resection was associated with higher observed OS in this cohort and with shorter operative and drainage times; prospective validation is needed.

Intraoperative cholangiography (IOC) is widely used to delineate biliary anatomy and confirm ductal integrity during liver resection. However, conventional radiographic IOC requires a C-arm set-up, may interrupt the operative workflow, and exposes patients and operating-room personnel to ionizing radiation. Contrast-enhanced intraoperative ultrasonic cholangiography (CE-IOUSC) combines intrabiliary injection of highly diluted perfluorobutane microbubbles (Sonazoid®) with contrast harmonic ultrasonography, enabling real-time visualization that can be repeated on demand without radiation. We hypothesize that CE-IOUSC provides superior procedural convenience while maintaining biliary visualization and safety. This is a single-center, open-label, randomized, parallel-group, phase III comparative trial. Adults (≥ 20 years) scheduled for liver resection, including living donors, are eligible when cholecystectomy and transcystic catheterization via the cystic duct are feasible. After informed consent, participants are randomized 1:1 (stratified by liver condition: normal vs. impaired) to CE-IOUSC or conventional radiographic IOC using a computer-generated sequence. In both arms, cholangiography is performed twice-before and after bile duct division-with additional imaging permitted as clinically required. Conventional IOC uses diluted iothalamate contrast (Urografin®) under C-arm fluoroscopy. CE-IOUSC uses 1,000-fold diluted Sonazoid® administered through the cystic duct and evaluated using intraoperative ultrasonography in contrast mode. Cross-over "rescue" cholangiography with the alternative modality is allowed when the assigned method is unsuccessful or inadequate. The primary endpoint is the cumulative time required to complete intraoperative cholangiography, including any additional imaging and repeated attempts. Secondary endpoints include surgeon-rated usability (5-point Likert questionnaire completed by the primary operator immediately after surgery), detectability of biliary structures (segmental visualization rates assessed by predefined criteria), postoperative biliary complications (bile leak or stricture graded by Clavien-Dindo), cross-over rescue efficacy, and safety outcomes (procedure-related adverse events and perioperative laboratory changes). Outcomes will be analyzed primarily on an intention-to-treat basis. This trial will quantify whether CE-IOUSC improves the efficiency and usability of intraoperative biliary imaging without compromising visualization or patient safety. The results will inform evidence-based adoption of ultrasound-based cholangiography as a practical alternative to conventional radiographic IOC in liver resection. Japan Registry of Clinical Trials (jRCT), jRCTs051230202.

Acute appendicitis (AA) is a common cause of acute abdomen. Appendiceal base gangrene or perforation represents a severe form of complicated appendicitis, in which secure closure of the appendiceal stump is crucial for surgical management, and no standardized optimal strategy has yet been established. This study aimed to evaluate the safety and feasibility of laparoscopic endostapler partial cecal resection in patients with complicated appendicitis involving appendiceal base gangrene or perforation. A retrospective study was conducted on consecutive patients who underwent surgical treatment for appendicitis at our center between January 2021 and January 2025. Patients classified as Gomes grade 3B (appendiceal base gangrene or perforation) were identified based on intraoperative findings. Baseline characteristics and perioperative outcomes were collected. Exploratory analyses across appendicitis subtypes were performed to provide contextual information. A single-arm descriptive analysis was conducted in the Gomes grade 3B cohort. The primary outcomes were postoperative complications and readmission assessed over a 3-month follow-up period. A total of 785 patients were included in the analysis, including 484 with uncomplicated appendicitis and 301 with complicated appendicitis, of whom 277 did not involve the appendiceal base and 24 were classified as Gomes grade 3B. In the Gomes grade 3B cohort, all patients successfully underwent laparoscopic surgery without conversion to open surgery or intraoperative complications. The mean operative time was 123.33 ± 16.59min. The median time to oral intake was 3.0 days (2.5-3.0), and the median length of hospital stay was 5.0 days (5.0-5.0). Postoperative complications occurred in three patients (12.50%), all classified as Clavien-Dindo grade I-II. No severe complications (Clavien-Dindo grade III-V) or readmissions were observed during the 3-month follow-up period. Laparoscopic endostapler partial cecal resection showed technical feasibility and acceptable short-term safety in patients with complicated appendicitis with appendiceal base involvement. This technique may represent a potential surgical option for this specific patient population, although further studies are required.

Postoperative complications, including severe pain, perianal edema, and prolonged wound healing, significantly impact patient recovery following mixed hemorrhoid surgery. This study aimed to evaluate the clinical efficacy of a topical wound care ointment (Suile) in promoting postoperative recovery and tissue remodeling. In this randomized controlled trial, 78 patients with stage III-IV mixed hemorrhoids were enrolled and allocated to either a treatment group (topical Suile ointment containing bismuth subgallate and borneol) or a control group (standard povidone-iodine care). Primary and secondary outcomes included pain intensity (Visual Analog Scale, VAS), wound edema scores, scar formation (Vancouver Scar Scale, VSS), and clinical cure rate. Data were analyzed using repeated-measures ANOVA with Bonferroni post-hoc corrections to assess longitudinal recovery patterns. By day 28, the treatment group demonstrated a significantly higher clinical cure rate compared to the control group (69.23% vs. 35.90%, P < 0.01). Repeated-measures ANOVA revealed highly significant improvements in the treatment group for both pain and scar formation. Specifically, VAS scores were significantly lower in the Suile group from days 3 to 14 (P < 0.001), with a large effect size at the primary endpoint (day 7, Cohen's d = 0.88). Furthermore, Suile application led to significantly superior scar outcomes (VSS scores) by the end of the follow-up period (Group effect P < 0.001; day 28 P < 0.001). While wound edema scores were lower in the treatment group at several time points, the overall group effect for edema did not reach statistical significance (P = 0.146). No serious adverse events were reported. Topical application of Suile ointment significantly alleviates postoperative pain, enhances the quality of scar formation, and accelerates overall wound healing after mixed hemorrhoid surgery. These findings suggest that Suile is a safe and effective therapeutic option for optimizing postoperative recovery in proctological practice. Chinese Clinical Trial Registry (ChiCTR), ChiCTR2600123181. Registered on 22 April 2026. Retrospectively registered.The trial was registered retrospectively due to administrative delays; however, the study protocol and outcomes were defined prior to patient enrollment."

Postoperative delirium (POD) represents a frequent complication among patients undergoing joint replacement surgery. While sleep disturbance is prevalent during the perioperative period, its relationship with POD has not been fully clarified. To this end, the present study was conducted to investigate the association between preoperative sleep disturbance and POD in elderly patients undergoing joint replacement. This prospective cohort study recruited 200 patients undergoing elective knee or total hip replacement surgery between April 10th and July 15th, 2025, retrospectively registered with the Chinese Clinical Trial Registry (ChiCTR2500113120) on November 25, 2025. Specifically, preoperative subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) on the day of admission. POD was assessed twice daily using the Chinese version of the 3-Minute diagnostic assessment for delirium based on the Confusion Assessment Method (3D-CAM) within the first postoperative week. Multivariable logistic regression was performed to examine the association between preoperative sleep disturbance and POD, adjusting for age, sex, American Society of Anesthesiologists (ASA) classification, alcohol consumption, smoking,comorbidity, education level, type of anesthesia and PCIA. Preoperative sleep disturbance was observed in 69 of 200 patients (35%), with POD present in28 patients (14%). Followingmultivariable adjustment, preoperative sleep disturbance was independently associated with the occurrence of POD (OR: 2.84, 95% CI: 1.24-6.50, P = 0.013). The RCS curve revealed a significant positive linear association: as the PSQI score increased, POD risk increased gradually (P for overall = 0.036, P for nonlinear = 0.190). Exploratory subgroup analyses indicated a significant association between preoperative sleep disturbance and POD among patients under 80 years of age, females, patients with a normal BMI, and those with an ASA Ⅱ. In elderly patients undergoing elective knee or total hip replacement surgery, preoperative sleep disturbance is independently associated with an increased risk of POD.

This study examined whether preoperative prognostic nutritional index (PNI) was related to long-term major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG). This single-center retrospective cohort study analyzed 550 patients with CHD who underwent CABG at the First Affiliated Hospital of Nanchang University between January 2014 and August 2025. PNI was treated as both a continuous variable and tertiles. Multivariable Cox models were used to evaluate its associations with study outcomes, and Kaplan-Meier as well as receiver operating characteristic (ROC) analyses were additionally performed. Subgroup analyses, a sensitivity analysis excluding patients with chronic kidney disease (CKD), and supplementary comparisons with the Geriatric Nutritional Risk Index (GNRI) and EuroSCORE II were also undertaken. Over a median follow-up of 46.1 months, 113 patients developed MACE, 94 died from any cause, and 61 died from cardiovascular causes. After multivariable adjustment, higher PNI remained independently related to lower risks of MACE (HR per 1-unit increase: 0.948, 95% CI 0.917-0.979; P = 0.001), all-cause mortality (HR 0.938, 95% CI 0.904-0.973; P < 0.001), and cardiovascular mortality (HR 0.939, 95% CI 0.900-0.980; P = 0.004). Patients in the highest tertile had lower risks of MACE and cardiovascular mortality than those in the lowest tertile. Similar overall patterns were observed in subgroup, quartile, and sensitivity analyses. Although PNI was significantly correlated with all three outcomes, its discriminatory performance was modest (AUCs: 0.596 for MACE, 0.616 for all-cause mortality, and 0.608 for cardiovascular mortality). GNRI and EuroSCORE II yielded numerically higher AUC values, and the combination of PNI with EuroSCORE II also showed a numerical improvement, but none of these differences reached statistical significance. Lower preoperative PNI corresponded to higher long-term risks of MACE, all-cause mortality, and cardiovascular mortality after CABG. However, these findings should be interpreted cautiously due to the single-center retrospective design and the limited discriminatory performance of PNI.