A green sample preparation strategy for Cl and S determination in crude oil by ion chromatography.

To Fix or Replace? A Systematic Review and Meta-Analysis on Surgical Management of Acetabular Fractures in the Elderly.

Italian register of therapeutic apheresis: 30 years of activity.

Report of the PGDIS Task Group on the status of PGT-A.

Impact of Enhanced Recovery After Surgery on factors affecting postoperative recovery in colorectal cancer: a multicenter propensity score-matched analysis.

There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice.

To evaluate the diagnostic accuracy and feasibility of the swirl sign, a novel bedside visual adjunct, for confirmation of epidural catheter placement. Prospective, randomized, parallel-group pilot diagnostic study. Single tertiary-care teaching hospital. Adult patients (18–65 years) with American Society of Anesthesiologists physical status I–III undergoing elective lower abdominal or lower limb surgery under combined spinal–epidural anesthesia. Patients were randomized to epidural catheter confirmation using the swirl sign combined with a conventional test dose (swirl group) or test dose alone (control group). The primary outcome was successful epidural block, defined as achievement of bilateral sensory block to T10 within 20 min without catheter reinsertion. Successful clinical block served as the pragmatic reference standard for diagnostic accuracy analysis. Secondary outcomes included diagnostic accuracy of the swirl sign (sensitivity, specificity, predictive values), onset time of analgesia, need for catheter reinsertion, and interobserver agreement for swirl sign interpretation. A total of 180 patients were randomized (90 per group). Successful epidural block occurred in 94.4% of patients in the swirl group and 89.4% in the control group ( p = 0.21). Time to onset of T10 sensory block was shorter in the swirl group (11.2 ± 2.3 vs 12.1 ± 2.6 min; p = 0.03). The swirl sign demonstrated a sensitivity of 96.6%, specificity of 80.0%, positive predictive value of 98.9%, and negative predictive value of 57.1% when compared with successful clinical block as the reference standard. Interobserver agreement for swirl sign interpretation was excellent (κ = 0.84). No serious complications were observed. The swirl sign is a feasible and highly sensitive bedside adjunct for epidural catheter confirmation, with excellent interobserver reproducibility. It did not significantly alter overall block success rates and should be considered an adjunctive diagnostic indicator rather than a replacement for standard confirmation methods. As an initial evaluation, this randomized pilot study supports further validation of the swirl sign in larger and multicenter settings.

Hemorrhage in Robot-assisted Partial Nephrectomy: A Multicentric, Retrospective Analysis of Blood Transfusion and Bleeding Requiring Intervention in 3726 Cases.

There are conflicting recommendations surrounding the use of intraoperative wound irrigation (IOWI) to reduce surgical site infections (SSIs) for patients undergoing laparotomy. This study aimed to perform a systematic review and network meta-analysis of randomised clinical trials (RCTs) to elucidate the most appropriate IOWI solution to reduce SSIs following laparotomy. A systematic review and network meta-analysis (NMA) was performed as per preferred reporting items for systematic reviews and meta-analysis (PRISMA)-NMA extension. Data analytics were performed using shiny and R. 11 RCTs were included involving 2943 patients. Overall, 1292 patients were randomised to normal saline (NS) (43.9%), 771 to povidone iodine (PI) (26.2%), 519 to polyhexidine (PH) (17.6%), 180 to electrolysed strongly acidic aqueous solution (ESAAS) (6.1%), 102 to none (control) (3.5%) and 79 to olanexidine (O) (2.7%). Non-significant differences in patient age, gender, body mass indices, or American Society of Anaesthesiologist grade were observed for each IOWI group (all P > 0.050). At NMA, IOWI using PH significantly reduced all cause SSIs in patients undergoing laparotomy (odds ratio (OR): 0.54, 95% confidence interval (CI): 0.36 - 0.80). Furthermore, IOWI using PH (OR: 0.54, 95% CI: 0.36 - 0.80) and ESAAS (OR: 0.36, 95% CI: 0.13 - 0.98) significantly reduced superficial SSI (SSSI) in patients undergoing laparotomy. For patients undergoing laparotomy in the elective setting, PH significantly reduced both SSI (OR: 0.41, 95% CI: 0.25 - 0.68) and SSSI (OR: 0.42, 95% CI: 0.22 - 0.82) rates. IOWI with PH reduces SSIs in patients undergoing laparotomy and should therefore be considered in patients undergoing this procedure.

Under select indications, extracranial-intracranial (EC-IC) bypass surgery is performed for intracranial revascularization. This study aimed to identify risk factors for 30-day readmission after EC-IC bypass surgery using data from the American College of Surgeons National Surgical Quality Improvement Program database. We conducted a longitudinal analysis of the American College of Surgeons National Surgical Quality Improvement Program database from 2011 to 2020. Patients who underwent EC-IC bypass, identified by current procedural terminology code 61711, were included. The primary outcome was a 30-day readmission. Variables such as age, body mass index (BMI), operation time, total length of stay, preoperative duration, sex, race, home discharge status, elective surgery status, diabetes, smoking status, dyspnea, independent status, chronic obstructive pulmonary disease, congestive heart failure, hypertension, dialysis, cancer, chronic steroid use, sepsis, septic shock, emergency surgery status, wound classification, and American Society of Anesthesiologists classification were analyzed. Statistical analysis included univariate and multivariate logistic regression to identify independent predictors of readmission. Among 350 patients who underwent EC-IC bypass, 32 (9.1%) were readmitted within 30 days. Univariate analysis revealed that readmitted patients had a significantly higher BMI (35.0 vs 30.0, P < .001) and a higher prevalence of diabetes (53.1% vs 28.6%, P = .008), dialysis (6.3% vs 0.3%, P = .02), and Black race patients (28.1% vs 14.8%, P = .02). Multivariate analysis identified BMI as an independent predictor of readmission (OR 1.07, 95% CI 1.01-1.13, P = .015). This study highlights BMI as a significant predictor of 30-day readmission after EC-IC bypass surgery. These findings underscore the importance of preoperative optimization and targeted postoperative care for high-risk patient populations. Future research should focus on prospective studies to validate these findings and explore additional factors contributing to readmission, aiming to improve patient outcomes and reduce health care costs associated with readmissions.

Identifying Factors Associated With Postdischarge Mortality After Readmission Following Pancreaticoduodenectomy.

Implementation of Colectomy Guidelines: Increasing Rate of Safe Anastomosis in Emergency General Surgery Patients.

Left-sided pancreatectomies are increasingly done by minimally invasive surgery (MIS), but variation persists in clinical practice. The implementation of MIS at a population level may identify areas for improvement. The aim of this study was to investigate the implementation of minimally invasive left-sided pancreatic resections at a national level, using population-adjusted resection rates and impact on a composite ideal outcome. All open and laparoscopic left-sided pancreatectomies as recorded in a national quality register, as a nationwide IDEAL stage IV cohort study from 2016 to 2023. Population-adjusted resection rates over time were calculated. Rates of ideal outcome were calculated and risk was expressed as odds ratio with 95% CI. The study period included 817 left-sided pancreatectomies, of which 519 (63.5%) were by minimally invasive access. The temporal age- and sex-adjusted resection rates for open and laparoscopic procedures were stable, but with regional variation in MIS. MIS was associated with shorter hospital stays and increased discharge-to-home rates. Patients selected for laparoscopy were younger, had better performance status and American Society for Anesthesiology risk score, and achieved higher ideal outcomes. In multivariable analysis, achieving an ideal outcome was associated with MIS in nonobese patients with good performance status in the recent time period and with health region. A temporal stability in resection rates and access type within regions demonstrated significant differences in the use of MIS. Although MIS was associated with the selection of younger, nonobese patients and lower rates of malignant lesions, it was also associated with 2-fold higher rates of ideal outcomes.

Seminars in pediatric sugery pediatric metabolic and bariatric surgery.

To retrospectively review the indications, timing, outcomes, and complications of membrane-based therapeutic plasma exchange (mTPE) in critically ill children at a single-center pediatric intensive care unit (PICU). Retrospective observational study. A tertiary-care PICU at All-India Institute of Medical Sciences (AIIMS), Raipur. A total of 106 patients aged 1 month to 18 years who underwent mTPE between January 2022 and December 2024. Patients had a median age of 144 months (IQR: 13-216). Renal and hepatic diseases were the most common indications. Overall, 61.3% of patients recovered and were discharged. Complications (inclusive of minor and line-related events) were observed in 35.8% of patients. Logistic regression analysis identified fluid-refractory shock at admission (p < 0.001), elevated Pediatric Risk of Mortality (PRISM-3) scores (p = 0.007), and concurrent continuous renal replacement therapy (CRRT) (p = 0.016) as statistically significant predictors of mortality. In the subgroup of patients with liver disease, time to mTPE initiation was an independent, significant predictor of mortality (p = 0.013). Membrane-based therapeutic plasma exchange is a safe and feasible adjunct therapy in critically ill children. While mTPE is most effective for conditions classified as American Society for Apheresis (ASFA) category I, its outcomes are highly variable and are significantly influenced by the underlying condition and the timing of the intervention, particularly for acute liver failure.

S. Cantara, S. Donnini, L. Morbidelli, A. Giachetti, R. Schulz, M. Memo and M. Ziche, "Physiological Levels of Amyloid Peptides Stimulate the Angiogenic Response Through FGF-2," The FASEB Journal 18, no. 15 (2004): 1943-1945, https://doi.org/10.1096/fj.04-2114fje. The above article, published online on 24 September 2004 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the journal Editor-in-Chief, Dr. Loren E. Wold; the Federation of American Societies for Experimental Biology; and Wiley Periodicals, LLC. The journal received allegations by a third party of image manipulation present in Figure4E. Further investigation of the article confirmed the third-party concerns and also detected evidence of additional reuse and relabeling in Figures2A, 3C, and 4D and undisclosed splicing in Figure4D. The retraction has been agreed to because of the evidence of image manipulation and duplication in multiple figures, which fundamentally compromises the editors' confidence in the conclusions presented. The authors disagree with the retraction.

Surgical resection is the cornerstone of curative treatment for colorectal cancer but can be associated with postoperative morbidity. Multimodal prehabilitation may improve preoperative fitness; its effect remains unclear because small sample sizes, heterogeneity, and selective populations have limited prior studies, highlighting the need for real-world evidence. To evaluate the effectiveness of a multimodal prehabilitation program in unselected patients undergoing colorectal cancer resection. In this multicenter cohort study, patients undergoing colorectal cancer surgery who participated in a multimodal prehabilitation program were compared with historical controls from the same centers using propensity score matching accounting for age, sex, body mass index, American Society of Anesthesiologists (ASA) classification, surgical procedure, and operative approach. A total of 18 hospitals in the Netherlands participated in a nationwide implementation between 2020 and 2023. All adults who underwent elective colorectal cancer resection were eligible. Study data were analyzed from June 2014 to June 2023 for the control group and from April 2020 to June 2023 for the prehabilitation group. The program included high-intensity exercise 3 times per week, nutritional support, psychological counseling, and optimization of comorbidities including anemia, frailty management, and smoking cessation when indicated. Outcome parameters were overall, medical, and surgical complications, length of hospital stay, and rates of readmission and intensive care admissions. In total, 2384 patients were included (mean [SD] age, 70 [11] years; 1254 male [53%]; 1192 patients per group). Overall complication rates were lower in the prehabilitation group (356 of 1181 [30.1%] vs 446 of 1181 [37.8%]; odds ratio [OR], 0.71; 95% CI, 0.60-0.84) as were medical complications (182 of 1181 [15.4%] vs 290 of 1181 [24.6%]; OR, 0.56; 95% CI, 0.46-0.69) and surgical complications (253 of 1181 [21.4%] vs 294 of 1181 [24.9%]; OR, 0.82; 95% CI, 0.68-1.00). Median (IQR) length of hospital stay was 1 day shorter (4 [3-6] days vs 5 [4-8] days; P < .001), whereas rates of readmission and intensive care admission were reduced. Reduction in complication rates in the prehabilitation cohort occurred irrespective of age and ASA score. Results of this cohort study show that implementation of a uniform multimodal prehabilitation program for unselected patients undergoing colorectal cancer surgery was associated with reduced complication rates and length of hospital stay across all age and ASA score subgroups.

Immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome (IEC-HS) is a life-threatening complication of chimeric antigen receptor T cell (CAR-T) therapy. Despite its high mortality rate, IEC-HS remains underrecognized due to overlapping clinical and laboratory features with severe cytokine release syndrome (CRS), leading to delayed diagnosis and suboptimal management. This review systematically analyzes key strategies to distinguish IEC-HS from severe CRS in the literature. The analysis focuses on temporal patterns, such as the delayed onset of IEC-HS after CAR-T infusion. It also examines dynamic laboratory trends, including persistently elevated ferritin and lactate dehydrogenase levels and a slower decline in C-reactive protein (CRP). In addition, distinct cytokine profiles are discussed, such as prolonged interferon-gamma (IFN-γ) elevation and surges in chemokines and growth factors. We further identify high-risk factors for IEC-HS, including patient-specific factors (baseline inflammation, low natural killer [NK] cell counts), disease-related factors (high B-cell acute lymphoblastic leukemia [B-ALL] burden and prior high-grade CRS), and CAR-T-related factors (CD22 target, CD28 costimulation, T-cell selection, high CAR-T cell dose, excessive CAR-T cell expansion, and TET2 gene mutation). For management, we evaluate conventional therapies (corticosteroids, etoposide) and emerging immunomodulatory agents (anakinra, ruxolitinib, emapalumab), emphasizing the 2023 treatment regimen by the American Society of Transplantation and Cellular Therapy (ASTCT). By integrating risk stratification, early diagnostic criteria, and tailored therapeutic approaches, this review aims to improve clinical outcomes for IEC-HS patients.

Background/objectives Large Language Models (LLMs) are increasingly used in medicine for tasks ranging from patient communication to exam preparation. This study aimed to evaluate the feasibility of using a domain-specific, out-of-training-data radiation and cancer biology examination as a benchmarking framework for large language models, and to compare the accuracy and consistency of commonly used LLMs available at the time of data collection. Methods GPT-3.5, GPT-4, and Llama-2 were queried with 335 multiple-choice questions (MCQs) from the 2023 American Society for Radiation Oncology (ASTRO) Radiation and Cancer Biology Exam Study Guide, excluding image-based items. Each model answered all questions five times over three months to evaluate consistency. Model responses were scored against the official answer key and analyzed using one-way ANOVA with Bonferroni correction to determine statistical differences in accuracy. Results GPT-4 achieved the highest accuracy, correctly answering 81% of questions, significantly outperforming GPT-3.5 (62%) and Llama-2 (51%) (p &amp;lt; 0.001). All models performed worse on questions requiring calculations, though differences were not statistically significant. In terms of reliability, GPT-4 and Llama-2 provided consistent responses more frequently than GPT-3.5. Despite stable overall scores, all models exhibited variability in individual responses across repeated trials. GPT-4 produced the longest explanations, averaging 183 words per answer. Conclusions This study demonstrates the feasibility of using a domain-specific, out-of-training-data examination to benchmark large language model knowledge in radiation and cancer biology. While performance differences were observed among models, variability and limitations, particularly in calculation-based questions, highlight the importance of methodological benchmarking and cautious interpretation when considering medical educational applications.

This study investigated the relationship between preoperative serum vitamin D levels and acute postoperative pain scores in patients undergoing unilateral breast cancer surgery. The study was conducted at Fayoum University Hospital between September 2024 and April 2025. 184 American Society of Anesthesiologists (ASA) II-III female patients scheduled to undergo elective unilateral modified radical mastectomy were classified into two groups: 92 vitamin D-deficient (<30 nmol/L) and 92 vitamin D-sufficient (≥30 nmol/L). The primary outcome was the occurrence of moderate to severe postoperative pain (Numerical Rating Scale (NRS) >3) at 12 hours. A secondary 24-hour composite outcome (NRS >3 at any time within the first 24 hours) was used for the multivariable logistic regression. Other secondary outcomes included: preoperative serum 25(OH)D level, postoperative NRS, intraoperative fentanyl consumption, postoperative tramadol consumption, sedation scores, intraoperative and postoperative hemodynamics, patient satisfaction, and hospital stay. The baseline characteristics were well balanced between the groups, with small standardized mean differences for all variables. Patients with vitamin D deficiency had a higher occurrence of moderate to severe pain at 12 hours. In multivariable analysis, vitamin D deficiency was independently associated with moderate to severe postoperative pain at any time point during the first 24 hours (adjusted OR 3.12, 95% CI 1.58 to 6.13). Vitamin D-deficient patients had higher intraoperative fentanyl consumption (mean difference 8.04 µg, 95% CI 3.21 to 12.88) and postoperative tramadol consumption (mean difference 112.17 mg, 95% CI 101.44 to 122.91). Vitamin D deficiency is associated with a higher occurrence of moderate to severe postoperative pain and increased opioid consumption in patients undergoing unilateral modified radical mastectomy.