Surgery in practice and science最新文献

{"title":"Red blood cell mass as a predictor of transfusion risk of packed red blood cells in cardiac surgery patients requiring cardiopulmonary bypass","authors":"Jennette Hansen,&nbsp;Niaman Nazir,&nbsp;George Zorn III","doi":"10.1016/j.sipas.2025.100321","DOIUrl":"10.1016/j.sipas.2025.100321","url":null,"abstract":"<div><h3>Introduction</h3><div>Red blood cell (RBC) transfusion in cardiac surgery is associated with adverse outcomes and increased costs. Traditional predictors such as hemoglobin and BMI offer limited physiologic insight. This study evaluates RBC mass, a calculated measure of total red cell volume, as a preoperative predictor of transfusion in adult cardiac surgery patients undergoing cardiopulmonary bypass (CPB).</div></div><div><h3>Materials and Methods</h3><div>This retrospective observational study included 463 adult patients undergoing elective cardiac surgery with CPB at a single academic center in 2024. Exclusion criteria included procedures with inherently high transfusion risk (e.g., redo sternotomy, LVAD implantation, circulatory arrest, and “bring-backs”). RBC mass was calculated using estimated blood volume (sex-adjusted mL/kg) and hematocrit. Patients were categorized into three RBC mass groups: 1–2 L, 2–3 L, and &gt;3 L. Multivariable logistic regression was used to assess the association between RBC mass and transfusion, adjusting for sex, age, BMI, and bypass time.</div></div><div><h3>Results</h3><div>Of the 463 patients, 102 (22 %) received RBC transfusions. Transfused patients had significantly lower RBC mass (mean 1.95 L) versus non-transfused (2.58 L, <em>p</em> &lt; 0.001). Patients in the 1–2 L group accounted for 54.9 % of transfusions despite representing only 25.5 % of the cohort. These patients had 18.7 times the odds of transfusion compared to those with &gt;3 L RBC mass. Female sex, older age, lower BMI, and longer CPB time were also associated with increased transfusion risk.</div></div><div><h3>Discussion</h3><div>RBC mass proved a more physiologically integrated and predictive metric for transfusion risk than hemoglobin or BMI alone. It may be especially useful in identifying at-risk female patients and those with normal hemoglobin but limited oxygen-carrying reserve.</div></div><div><h3>Conclusions</h3><div>Preoperative RBC mass is a strong independent predictor of transfusion in cardiac surgery. Its incorporation into preoperative planning may improve patient optimization and reduce unnecessary transfusions.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100321"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tackling the disparities in surgical site infections and related antimicrobial resistance in low- and middle-income countries","authors":"Rana Farsakoury ,&nbsp;Massimo Sartelli ,&nbsp;Susu M Zughaier","doi":"10.1016/j.sipas.2025.100315","DOIUrl":"10.1016/j.sipas.2025.100315","url":null,"abstract":"<div><h3>Background and purpose</h3><div>The financial burden, morbidity, and mortality of surgical site infection (SSI) is a global issue. Incidence rates of SSI are high in low- and middle-income countries (LMICs), with evidence of surge in antimicrobial resistance (AMR) in these regions. This mini review aimed to collect and analyze existing data on SSI incidence and the associated AMR in LMICs to address some concerns about causes and control strategies.</div></div><div><h3>Methods</h3><div>MEDLINE, Embase, the Cochrane Library, Scopus, AMED, Biosis, and CINAHL were all searched for this study until June 8, 2025. We included all studies comparing disparities in surgical site infections and related antimicrobial resistance in low- and middle-income countries.</div></div><div><h3>Results</h3><div>The overall SSI incidence in LMICs is higher than in high-income countries . The intertwined relationship between SSI and the rising AMR burden further complicates the issue. The emergence of AMR is driven by inappropriate antibiotic use, poor regulatory oversight and stewardship, inadequate healthcare infrastructure, economic limitations that result in incomplete or informal treatments, weak surveillance systems, and environmental contamination from hospitals, agriculture, and wastewater. Vaccination, sanitation and hygiene, infection control, education, alternative therapies consideration of, antimicrobial stewardship, and prevention, are strategies to prevent and reduce the development of AMR.</div></div><div><h3>Conclusion</h3><div>AMR is a dire global problem that requires immediate action to combat its spread. Effective AMR surveillance from a \"One Health\" viewpoint is needed in LMICs to map and track the spread of resistance. Environmental resistome sample is required to detect the factors influencing resistance. Searching for solution to colistin resistance, a last resort antibiotic, is critical.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100315"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145325319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nationwide survey of Indian cardiac surgeons on the management of acute type A aortic dissection","authors":"Mohammed Idhrees ,&nbsp;Nimrat Grewal ,&nbsp;Mohammed Ayyub ,&nbsp;Jasima Nilofer ,&nbsp;Bashi Velayudhan","doi":"10.1016/j.sipas.2025.100316","DOIUrl":"10.1016/j.sipas.2025.100316","url":null,"abstract":"<div><h3>Objective</h3><div>Acute Type A aortic dissection (ATAAD) is associated with high morbidity and mortality, and management strategies vary widely among surgeons. This study aimes to evaluate practice patterns and decision-making among Indian cardiac surgeons regarding ATAAD, with focus on differences related to surgical experience and institutional case volume.</div></div><div><h3>Methods</h3><div>A 23-item electronic questionnaire covering preoperative, intraoperative and postoperative management of ATAAD was distributed to all members of the Indian Association of Cardiovascular-Thoracic Surgeons. Ninety-three responses were analyzed and compared according to surgeon experience (&lt;10, 10–20, &gt;20 years) and institutional aortic surgery volume (high vs low).</div></div><div><h3>Results</h3><div>Over one-quarter of surgeons (26.9 %) declined to operate on patients &gt;70 years old, a practice more frequent among surgeons with &lt;20 years of experience (32% vs 5.56 % p=0.011). Active cardiopulmonary resuscitation (56 %), and preoperative stroke (52.7%) were the most common reasons to withhold surgery, whereas senior surgeons (&gt;20 years) were more likely to operate despite malperfusion or CPR (38.8 % vs 13.3 %, p=0.005).</div><div>Dual arterial cannulation was preferred by 62.4% of surgeons, with a shift toward single site cannulation with increasing experience (p=0.008). The distal anastomosis was performed using on-clamp technique by 26.8 % of respondents, more frequently among low-volume aortic surgeons (35.1 % vs 13.8%, p=0.012).</div></div><div><h3>Conclusion</h3><div>Management of ATAAD in India shows substantial variation, strongly influenced by surgeon experience and aortic surgery volume. Differences are particularly evident in patients selection, cannulation strategy and distal repair techniques. These findings highlight the need for structured referral systems and the potential benefit of developing high-volume ‘aortic centres’ in India.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100316"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors affecting acute aortic dissection mortality: A multicentre cohort study","authors":"Joshua G. Kovoor ,&nbsp;John M. Glynatsis ,&nbsp;Nikolaos C. Glynatsis ,&nbsp;Domenico Perrotta ,&nbsp;Elyssa Chan ,&nbsp;Timothy Daniell ,&nbsp;Stephen Bacchi ,&nbsp;Brandon Stretton ,&nbsp;Daksh Tyagi ,&nbsp;Joseph N. Hewitt ,&nbsp;Angelyn L.W. Khong ,&nbsp;Diana U. Siriwardena ,&nbsp;David X.H. Ling ,&nbsp;Christopher D. Ovenden ,&nbsp;Rohan Arasu ,&nbsp;Jonathan Henry W. Jacobsen ,&nbsp;Suzanne Edwards ,&nbsp;Matthew Marshall-Webb ,&nbsp;Pramesh Kovoor ,&nbsp;Benjamin A.J. Reddi ,&nbsp;Aashray K. Gupta","doi":"10.1016/j.sipas.2025.100311","DOIUrl":"10.1016/j.sipas.2025.100311","url":null,"abstract":"<div><h3>Background</h3><div>Acute aortic dissection (AAD) is an emergency associated with high mortality. Timely diagnosis is challenging, and delays may affect patient outcomes. We aimed to identify clinical and temporal factors associated with mortality after AAD.</div></div><div><h3>Methodology</h3><div>We performed a retrospective cohort study across four tertiary hospitals of type A and type B AADs diagnosed over a 20-year period. The outcomes of the study were in-hospital mortality, 30-day mortality, and mid-term (6-month) mortality. Univariate linear and bivariate logistic regression analyses were conducted to evaluate the relationship between mortality and demographic and clinical factors.</div></div><div><h3>Results</h3><div>The study included 149 AAD patients. Of these, 103 (69.1 %) were Stanford type A and 46 (30.9 %) Stanford type B. In-hospital mortality was 29.1 % (<em>n</em> = 30) for type A vs 10.9 % (<em>n</em> = 5) for type B. For type A patients, every one-year increase in age increased odds of in-hospital mortality by 4 % (<em>p</em> = 0.0076), and odds of in-hospital mortality were 10.9 times greater with conservative management than surgical (<em>p</em> &lt; 0.0001). Patients with type A dissection had odds of in-hospital mortality 3.0 times greater than type B (<em>p</em> = 0.0005). 30-day mortality rate was 29.1 % (<em>n</em> = 30) for type A dissection vs 10.9 % (<em>n</em> = 5) for type B. 6-month mortality rate was 30.1 % (<em>n</em> = 31) for type A dissection vs 10.9 % (<em>n</em> = 5) for type B. Predictors of 30-day and 6-month mortality were similar to those of in-hospital mortality.</div></div><div><h3>Conclusion</h3><div>Even with tertiary care AAD carries a high burden of mortality. Those with type A dissections, increased age, and non-surgical management are at an increased risk of mortality.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100311"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term outcomes and mortality in older patients with breast cancer at a single tertiary center","authors":"Nora Trabulsi ,&nbsp;Nada AbuBakr Alkhateeb ,&nbsp;Feryal Omar Attiah ,&nbsp;Rozan Altaifi ,&nbsp;Bana Fakeeh ,&nbsp;Alaa Shabkah ,&nbsp;Ali Farsi ,&nbsp;Somayah Saeed Bawazeer ,&nbsp;Salma Sait ,&nbsp;Marwan Al-Hajeili","doi":"10.1016/j.sipas.2025.100313","DOIUrl":"10.1016/j.sipas.2025.100313","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer (BC) affect women worldwide, and with a rising global incidence, it represents a burden on health systems. In Saudi Arabia, the number of cases of BC and its age distribution have notably increased. Despite this increase, data on BC characteristics, management, and outcomes in this demographic are limited.</div></div><div><h3>Methods</h3><div>We performed this retrospective descriptive study at King Abdulaziz University Hospital in Jeddah, Saudi Arabia, spanning 2008 to 2020. It included older women (60 years or older) diagnosed with primary BC. Data from hospital records included patient demographics, comorbidities, treatments, and short-term outcomes within 30 days of treatment. We aimed to determine the significant associations of patient, disease and treatment factors with length of stay, short-term outcomes, and mortality.</div></div><div><h3>Results</h3><div>The study included 115 older female patients with BC, with a mean age of 67 years. Comorbidities such as diabetes (39.1 %) and hypertension (40.9 %) were prevalent. Most patients were diagnosed with stage T2 (49 %) and N1 (42 %) nonmetastatic invasive ductal carcinoma (88.7 %). The recurrence rate was 21 %, while the crude all-cause mortality rate was 20 %. Short-term outcomes showed a 4.35 % readmission rate and a 2.6 % reoperation rate, with an average hospital stay of 3.61 days. Positive surgical margins, type of surgery, and the presence of metastasis significantly predicted extended hospital stays. Smoking was significantly linked to overall morbidities within 30 days.</div></div><div><h3>Conclusion</h3><div>This study highlights the unique characteristics and treatment outcomes of older women with BC. Comorbidities, tumor stage, and receptor status are crucial for its management and outcomes. The findings emphasize the need for tailored treatment strategies, in consideration of older patients' distinct profiles. Future research should include comparative analyses with younger cohorts to establish age-specific recommendations and optimize treatment approaches for older women.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100313"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of tumor-infiltrating lymphocytes, tumor associated neutrophils and metabolic checkpoint molecules on survival of patients with metastatic pancreatic ductal adenocarcinoma","authors":"Tao Zhang ,&nbsp;Rainer C. Miksch ,&nbsp;Ughur Aghamaliyev ,&nbsp;Maximilian Weniger ,&nbsp;Michael Günther ,&nbsp;Steffen Ormanns ,&nbsp;Fatma Parsa ,&nbsp;Jan G. D’Haese ,&nbsp;Alexandr V. Bazhin ,&nbsp;Matthias Ilmer ,&nbsp;Bernhard W. Renz ,&nbsp;Jens Werner","doi":"10.1016/j.sipas.2025.100320","DOIUrl":"10.1016/j.sipas.2025.100320","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to investigate the tumor microenvironment (TME) of metastatic PDAC, focusing on tumor-infiltrating leukocytes (TILs) and metabolic checkpoint molecules (MCMs).</div></div><div><h3>Background</h3><div>The role of TME in primary and metastatic PDAC is not well understood. Furthermore, the role of energy metabolism in metastatic PDAC is unclear. Therefore, this study aimed to explore the TME in primary tumors and metastases of PDAC, and its prognostic role.</div></div><div><h3>Materials and Methods</h3><div>We included 26 cases of metastatic PDAC in this study. We performed immunohistochemistry for TILs and MCMs (HIF-1α, GLUT1, and PDHK1) in primary and corresponding metastatic tumor tissues. We quantified stromal TILs and MCMs using a tumor immune stroma (QTiS) algorithm and correlated the data with clinical outcome.</div></div><div><h3>Results</h3><div>We found that CD3⁺, CD8⁺, and CD20⁺ TILs were increased in primary tumors compared to metastatic ones. Kaplan-Meier plots revealed that high infiltration of CD20⁺ and its combinations in primary tumors correlated with better OS in metastatic PDAC patients. We also found that high infiltration of CD8⁺ TILs in metastatic tumors correlated with better OS, as did the low density of GLUT1 in both PDAC primary and metastatic tumors. A multivariate Cox regression analysis revealed that CD8⁺ TILs in metastatic tumors and GLUT1 in PDAC primary and metastatic tumors were independent predictors of survival.</div></div><div><h3>Conclusion</h3><div>Distribution of TILs in the TMEs of primary and metastases of metastatic PDAC is different. Our results suggest that TILs (CD8⁺) and MCMs (GLUT1) in tumor stromal areas can predict OS of patients with metastatic PDAC.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100320"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing outcomes of one-way Heimlich valve with conventional chest tube drainage for primary spontaneous pneumothorax: a randomized clinical trial","authors":"Mohammad Hadi Bahri ,&nbsp;Seyed Mohammad Naghibalghora ,&nbsp;Mojtaba Ahmadinejad ,&nbsp;Kourosh Kabir ,&nbsp;Nazanin Khezri","doi":"10.1016/j.sipas.2025.100314","DOIUrl":"10.1016/j.sipas.2025.100314","url":null,"abstract":"<div><h3>Background</h3><div>Primary spontaneous pneumothorax (PSP) is the accumulation of air in the pleural space without underlying lung disease. Standard management often involves chest tube insertion connected to an underwater seal drainage system (bottle), but alternatives like the Heimlich one-way valve exist. This study aimed to compare the clinical outcomes of using a Heimlich valve versus standard chest tube drainage for PSP.</div></div><div><h3>Methods</h3><div>This was a single-center, open-label, parallel-group randomized controlled trial conducted at Shahid Madani Hospital, Karaj, Iran, from March 2023 to March 2024. Forty patients aged 18–40 years with symptomatic PSP (&gt;15% collapse) were randomized (1:1 ratio) using block randomization. The intervention group received a 28 Fr chest tube connected to a Heimlich valve. The control group received a 28 Fr chest tube attached to an underwater sealed bottle. Primary outcomes included length of hospital stay, time to return to normal activities other outcomes included pain scores (Visual Analog Scale - VAS), dyspnea score (0–10), ease of getting out of bed (0–10), need for ketorolac analgesia, treatment failure (requiring VATS within 7 days), 30-day rehospitalization, and complications.</div></div><div><h3>Results</h3><div>Forty patients (mean age 31.1±7.0 years; 80% male) were randomized to separate groups (20 per group). Baseline characteristics were similar between groups. The mean time to return to normal activities was significantly shorter in the Heimlich group (7.1±5.4 days vs. 10.2±8.0 days, P=0.014). Mean length of hospital stay was 5.6±3.0 days (Heimlich) vs. 7.3±4.6 days (Bottle), (P=0.081). Pain scores were significantly lower in the Heimlich group on days 1–4 (P&lt;0.01). Ketorolac use (frequency and total dose) was significantly lower in the Heimlich group (P&lt;0.001). Ease of getting out of bed was significantly greater in the Heimlich group throughout the assessment period. Pneumothorax resolution trended faster in the Heimlich group (P=0.077 on day 4). Dyspnea trended lower in the Heimlich group on day 4 (P=0.078). Treatment failure (requiring VATS) occurred in 1 (5%) of the Heimlich patients versus 3 (15%) of the Bottle patients (P = 0.29). Rehospitalization occurred in one patient per group (5%, P = 1.00).</div></div><div><h3>Conclusion</h3><div>In patients with PSP, management with a Heimlich valve resulted in a significantly faster return to normal activities, lower pain scores, reduced analgesic requirements, and greater ease of mobilization than standard chest tube drainage. While not statistically significant, trends suggested faster pneumothorax resolution and potentially shorter hospital stays. The Heimlich valve appears to be a safe and effective alternative, offering potential patient comfort and recovery benefits.</div></div><div><h3>Trial registration</h3><div>Iranian Registry of Clinical Trials (IRCT): IRCT20230208057359N1.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100314"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving consenting practice in trauma and orthopaedics: A single centre original mixed methods study","authors":"Kevin Joseph Jacob,&nbsp;Mohammad Naeem Mangal,&nbsp;Jack W M Lamb,&nbsp;Ahmad Abdallatif,&nbsp;Keshav Mathur,&nbsp;Mohammed Elmajee","doi":"10.1016/j.sipas.2025.100310","DOIUrl":"10.1016/j.sipas.2025.100310","url":null,"abstract":"<div><h3>Introduction</h3><div>Informed consent represents a cornerstone of ethical and legal surgical practice across numerous healthcare systems, including that of the United Kingdom. Despite its recognised importance, achieving consistency and comprehensiveness in the consent process remains a persistent challenge, particularly within busy and time-constrained clinical environments. This study critically evaluates existing consenting practices in the Department of Trauma and Orthopaedics at Worcestershire Acute Hospitals. It also presents the department’s experience with implementing electronic consent (e-consent) forms as a replacement for traditional handwritten documentation.</div></div><div><h3>Methodology</h3><div>A two-phase study was conducted at a single National Health Service (NHS) trust. In the first phase, 102 handwritten surgical consent forms were retrospectively audited against national guidelines to assess compliance in areas such as timing of consent, legibility, provision of information, and documentation of risks and alternatives. The second phase involved a structured survey of clinicians within the orthopaedic department to explore their experiences with the current process and their perceptions of electronic alternatives.</div></div><div><h3>Results</h3><div>The audit revealed major shortcomings in the handwritten consent process: only 21 % of forms were completed well in advance of surgery, fewer than half provided adequate procedural information, and just 17 % documented all available treatment options. Over 60 % were poorly legible, and most lacked complete documentation of risks and benefits. Survey results indicated widespread clinician dissatisfaction and a strong preference for e-consent systems to improve legibility, clarity, and patient engagement.</div></div><div><h3>Conclusion</h3><div>The study highlights significant deficiencies in handwritten consent practices and supports adopting standardised e-consent systems to enhance communication, patient comprehension, and medico-legal protection.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100310"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145121160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does calibration technique for distal locking screw insertion reduce radiation exposure and operative time during intramedullary nailing of humeral shaft fractures in comparison with freehand technique?","authors":"Mirza Sivro,&nbsp;Tarik Branković","doi":"10.1016/j.sipas.2025.100307","DOIUrl":"10.1016/j.sipas.2025.100307","url":null,"abstract":"<div><h3>Purpose</h3><div>The aim of this study was to compare the influence of two different methods of distal screw insertion during intramedullary nailing of humeral shaft fractures on radiation exposure and operative time.</div></div><div><h3>Methods</h3><div>A single-center retrospective study, which included 44 patients, was conducted. Patients were divided into the Freehand and Calibration groups according to the technique used for distal screw insertion. Medical records were used to collect baseline characteristics of patients and complications, and operative reports were used to collect data for outcomes which included number of expositions, dose area product (DAP), fluoroscopy time and operation time. Operation time was defined as time from skin incision to final suture.</div></div><div><h3>Results</h3><div>There were no significant differences noted between the groups in gender, age, fracture side and fracture type distribution. The mean DAP in the Calibration group measured 232.8 ± 130.1 μGy·m2, and was lower than in the Freehand group where measured value was 305.4 ± 141.6 μGy·m2, without significant difference between the groups (<em>p</em> = 0.084). Mean fluoroscopy time was also lower in the Calibration group of patients (32.3 ± 12.7 s) than in the Freehand group (39.4 ± 14.6 s), with <em>p</em> = 0.094. Mean operative time was shorter in the Calibration group (68.8 ± 27.1 min) in comparison with the Freehand group (76.5 ± 17.7 min), but without statistically significant difference (<em>p</em> = 0.272).</div></div><div><h3>Conclusion</h3><div>The usage of calibration technique for distal locking screw insertion has similar operative time and intraoperative radiation exposure during intramedullary nailing of humeral shaft fractures compared with the freehand technique.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100307"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence in thoracic surgery: Perspectives and challenges","authors":"Wenwei Liao ,&nbsp;Bin Peng ,&nbsp;Guanggui Ding ,&nbsp;Zhikai Li ,&nbsp;Guangsuo Wang","doi":"10.1016/j.sipas.2025.100317","DOIUrl":"10.1016/j.sipas.2025.100317","url":null,"abstract":"<div><div>With the advances of artificial intelligence (AI) in the medical field, particularly the widespread utilization of large language models (LLMs) such as ChatGPT, Claude, Gemini, Llama, and Deepseek, clinical practice is undergoing an unprecedented technological revolution. These cutting-edge technologies facilitate efficient processing and analysis of vast datasets, providing medical professionals with auxiliary diagnoses and treatment suggestions, while markedly enhancing the quality and efficiency of medical services. Over the past decade, the field of thoracic surgery has achieved transformative progress, primarily driven by AI innovations. Consequently, thoracic surgeons must possess a foundational understanding of AI in order to grasp its implications on their daily practice and explore potential ways of integrating this technology into their work. This article reviews the fundamental elements of AI and the relationships between AI-based techniques. It further summarizes the application of AI in thoracic surgery, aiming to enhance thoracic surgeons' comprehensive understanding of the latest developments in this area. Additionally, this article explores the challenges and limitations faced by AI, including data security and privacy concerns, issues of bias and discrimination, challenges in verification and interpretability, ethical and legal considerations, technical obstacles, as well as training and educational requirements. Finally, it explores emerging AI architectures and their paradigm-shifting impacts on medical ecosystems.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100317"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}