Pub Date : 2025-08-26DOI: 10.1186/s13017-025-00644-0
Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain
Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m
{"title":"Variation and accuracy of intra-abdominal pressure measurement in different body positions: a prospective study","authors":"Salar Tayebi, Robert Wise, Prashant Nasa, Luca Malbrain, Johan Stiens, Wojciech Dabrowski, Manu L. N. G. Malbrain","doi":"10.1186/s13017-025-00644-0","DOIUrl":"https://doi.org/10.1186/s13017-025-00644-0","url":null,"abstract":"Recent studies confirm that intra-abdominal hypertension (IAH) frequently develops in critically ill patients, posing a significant risk of organ failure and increased mortality. Accurate intra-abdominal pressure (IAP) measurement is essential for effective diagnosis, prevention, and treatment. Previous studies indicate that accurate IAP measurement using traditional Foley catheters requires the bladder to be filled with a maximum of 25 mL of sterile saline solution after clamping the catheter, restricting the ability to monitor IAP continuously due to variations in the bladder fill volume. The TraumaGuard catheter enables continuous IAP measurement irrespective of bladder fill volume. The primary objective was the validation of the TraumaGuard catheter (Sentinel Medical Technologies, Jacksonville, Florida, USA), a new continuous bladder pressure monitoring device. ICU patients were studied across different body positions to assess measurement accuracy by comparing the correlation, bias, precision, and agreement between IAP readings obtained using the TraumaGuard catheter and the FoleyManometer measurement method (SecurMeter, Deltamed, Viadana, Italy), which serves as the gold standard. The secondary endpoint of this study was to investigate the impact of different body positions on IAP. Adult ICU patients (≥ 18 years) requiring bladder catheterisation were enrolled. IAP was measured using a TraumaGuard catheter (IAPTG) and FoleyManometer method (IAPFM) across multiple positions to have a broad range of IAP values and to study the impact of body position on IAP measurement. Pairwise analysis of IAPTG and IAPFM in the supine, reverse Trendelenburg (15°, 30°, and 45°), and head-of-bed (HOB) elevation positions (15°, 30°, and 45°) was performed using correlation, concordance, and Bland-Altman analyses. The error-grid analysis assessed the risk associated with inaccurate measurements at each body position. The robustness of the TraumaGuard catheter as a detection system for IAH detection system was evaluated by receiver operating characteristic (ROC) curve. The IAP variation as a function of body position was investigated and compared with the reviewed literature. Gender, age, body mass index (BMI), and sequential organ failure assessment (SOFA) score were also recorded for each participant. Twenty-five adult ICU patients with a mean age of 63.6 ± 11.6 years and BMI of 28.3 ± 3.7 kg/m2 were included. The mean IAP increased from 9.8 ± 1.7 mmHg in supine to 10.4 ± 1.5 mmHg in reverse Trendelenburg and 14.9 ± 1.6 mmHg in HOB elevation positions. The correlation coefficients were 0.9, 0.9, and 0.8 for supine, reverse Trendelenburg, and HOB elevation positions. The supine positions showed a bias and precision of 0.8 and 1.7 mmHg according to Bland-Altman analysis. Reverse Trendelenburg and HOB elevation positions showed a bias of − 0.3 and 1.5 mmHg with a precision of 1.5 and 1.6 mmHg, respectively. The lower and upper limits of agreement were − 2.5–4.2 m","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"15 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).
背景研究集成机器学习（EL）模型在急性坏死性胰腺炎（ANP）患者感染性胰腺坏死（IPN）预测中的价值。方法对2011年1月至2023年12月湘雅医院收治的1073例急性坏死性胰腺炎（ANP）患者进行综合分析。根据IPN的发生情况将患者分为IPN组和无菌胰腺坏死（SPN）组。所有ANP患者随机分为训练数据集和验证数据集，比例为7:3。结合LASSO、随机森林、SVM等多个机器学习模型构建EL模型。为了验证EL模型的稳定性，选取湘雅第三医院的78例ANP患者进行外部验证，并构建Fagan nomogram来评估后验概率。结果通过LASSO回归，确定了31个危险因素，构建了EL模型。EL模型在训练数据集中的预测准确率为92.6%。在验证数据集中，预测准确率为91.5%。与LR模型相比，EL模型的AUC值更高(训练数据集：0.916 vs. 0.744；验证数据集：0.919 vs. 0.742)和净效益率。EL模型预测7 d、7 ~ 14 d和14 d后IPN的AUC分别为0.888、0.906和0.901。此外，外部验证结果进一步验证了EL模型的准确性（AUC: 0.883）。基于EL模型的Fagan模态图可以用来估计IPN预测的准确性。结论与LR模型相比，EL模型对IPN的预测效率更高，具有更高的预测价值和潜在的临床效益。此外，EL模型在IPN发作的不同阶段表现稳定，使临床医生能够及时调整治疗策略，最终改善患者的预后。试验注册本研究注册在www.researchregistry.com（唯一识别码：researchregistry10652）。
{"title":"Prediction of infected pancreatic necrosis in patients with acute necrotizing pancreatitis based on ensemble machine learning model.","authors":"Zefang Sun,Yan Fu,Jiarong Li,Baiqi Liu,Xiaoyue Hong,Chiayen Lin,Dingcheng Shen,Caihong Ning,Lu Chen,Xiaoping Yi,Gengwen Huang","doi":"10.1186/s13017-025-00642-2","DOIUrl":"https://doi.org/10.1186/s13017-025-00642-2","url":null,"abstract":"BACKGROUNDTo study the value of ensemble machine learning (EL) model in the prediction of infected pancreatic necrosis (IPN) among patients with acute necrotizing pancreatitis (ANP).METHODSThis study comprehensively analyzed 1073 acute necrotizing pancreatitis (ANP) patients admitted to Xiangya hospital from January 2011 to December 2023. The patients were divided into IPN group and sterile pancreatic necrosis (SPN) group based on IPN occurrence. All ANP patients were randomly divided into training dataset and validation dataset with a ratio of 7:3. The EL model was built by integrating multiple machine learning models (LASSO, random forest, and SVM). To verify the stability of the EL model, 78 ANP patients from the Third Xiangya hospital were included for external validation, and a Fagan nomogram was constructed to assess the posterior probability.RESULTSThe EL model was constructed with 31 risk factors identified through LASSO regression. The prediction accuracy of the EL model in the training dataset was 92.6%. In the validation dataset, the prediction accuracy was 91.5%. Compared with the LR model, the EL model demonstrated higher AUC values (training dataset: 0.916 vs. 0.744; validation dataset: 0.919 vs. 0.742) and net benefit rate. The AUC of the EL model for predicting IPN within 7 days, 7-14 days, and after 14 days were 0.888, 0.906, and 0.901, respectively. In addition, the external validation results further indicated the accuracy of the EL model (AUC: 0.883). An EL model-based Fagan nomogram could be used to estimate the accuracy of IPN predictions.CONCLUSIONThe EL model demonstrates superior predictive efficiency for IPN compared to the LR model, offering greater predictive value and potential clinical benefits. Furthermore, the EL model shows stable performance across different stages of IPN onset, enabling clinicians to make timely adjustments to treatment strategies and ultimately improve patient outcomes.TRIAL REGISTRATIONThe study is registered at www.researchregistry.com (Unique Identifying number: researchregistry10652).","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"9 1","pages":"69"},"PeriodicalIF":8.0,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144792104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Correction: World Journal of Emergency Surgery (2025) 20:19
https://doi.org/10.1186/s13017-025-00593-8
In this article [1], Mengdi Jin was mistakenly listed as a co-first author.
The original article has been corrected.
Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.
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Liuquan Mou and Haideng Song are co-first authors.
Authors and Affiliations
Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
Liuquan Mu, Kaige Li, Yushan Guo & Nan Jiang
Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China
Liuquan Mu
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China
Haideng Song & Mengdi Jin
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Correspondence to Nan Jiang.
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Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th
{"title":"Correction: Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries","authors":"Liuquan Mu, Haideng Song, Mengdi Jin, Kaige Li, Yushan Guo, Nan Jiang","doi":"10.1186/s13017-025-00638-y","DOIUrl":"https://doi.org/10.1186/s13017-025-00638-y","url":null,"abstract":"<p><b>Correction: World Journal of Emergency Surgery (2025) 20:19</b></p><p><b>https://doi.org/10.1186/s13017-025-00593-8</b></p><p>In this article [1], Mengdi Jin was mistakenly listed as a co-first author.</p><p>The original article has been corrected.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Mu L, Song H, Jin M, et al. Role of the admission muscle injury indicators in early coagulopathy, inflammation and acute kidney injury in patients with severe multiple injuries. World J Emerg Surg. 2025;20:19. https://doi.org/10.1186/s13017-025-00593-8.</p><p>Article PubMed PubMed Central Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><span>Author notes</span><ol><li><p>Liuquan Mou and Haideng Song are co-first authors.</p></li></ol><h3>Authors and Affiliations</h3><ol><li><p>Department of Trauma Center, China-Japan Union Hospital of Jilin University, Changchun, 130033, China</p><p>Liuquan Mu, Kaige Li, Yushan Guo & Nan Jiang</p></li><li><p>Department of Emergency, Cheeloo College of Medicine, Weihai Municipal Hospital, Shandong University, Weihai, 264200, China</p><p>Liuquan Mu</p></li><li><p>Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, 130021, China</p><p>Haideng Song & Mengdi Jin</p></li></ol><span>Authors</span><ol><li><span>Liuquan Mu</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Haideng Song</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Mengdi Jin</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Kaige Li</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Yushan Guo</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Nan Jiang</span>View author publications<p><span>Search author on:</span><span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Corresponding author</h3><p>Correspondence to Nan Jiang.</p><h3>Publisher’s note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other th","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"96 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-06DOI: 10.1186/s13017-025-00640-4
Qing Long, Chaochi Yue, Bin He, Jun Li
Multiple skip incision skin-sparing debridement (MSISSD) is a surgical procedure that excises infected tissue to achieve source control while retaining the infected but viable skin, thus overcoming some limitations of traditional surgical debridement. We aimed to introduce this skin-sparing debridement technique for the treatment of perianal necrotizing fasciitis (PNF) and retrospectively analyze its efficacy and safety. Patients with PNF who received MSISSD between January 2021 and August 2024 were included in this retrospective analysis. We investigated the patient characteristics (sex, age, disease duration, and LRINEC score) and clinical data (comorbid diseases, length of stay in the intensive care unit [ICU LOS], microbiological culture results, number of debridements, length of stay [LOS], wound healing time, treatment outcomes, and follow-up status). Twenty-two patients with PNF were enrolled, including 19 males (86%) and three females (14%). The median age, disease duration, and LRINEC score was 59.5 years (range: 26–77), 4.5 days (range: 2–10), and 4 (range: 1–10), respectively, and five cases had a LRINEC score ≥ 6 (23%). Among the 22 patients included, the most common comorbid disease was diabetes, with nine cases (41%). Nine (41%) patients were admitted to the ICU, with a median ICU LOS of 2 days. Of the patients with positive wound cultures (14, 64%), polymicrobial infections were identified in 3 (21%) and monomicrobial infections in 11 (79%). The most commonly isolated microorganisms were Escherichia coli (8, 57%) and Klebsiella pneumoniae (5, 36%). One patient underwent debridement twice, while the remaining patients underwent debridement once. The median LOS was 18 days, and the wound healing time was 61 days. No patient underwent reconstruction surgery. During the median follow-up period of 11 months, one patient developed anal fistula 6 months after surgery and recovered after undergoing anal fistula resection. No patient experienced recurrence of PNF or anal incontinence. MSISSD appears to be a promising and effective method for skin protection debridement, which can effectively protect the skin while ensuring adequate drainage, and rarely causing severe anal dysfunction.
{"title":"Multiple skip incision skin-sparing debridement for perianal necrotizing fasciitis: a retrospective study","authors":"Qing Long, Chaochi Yue, Bin He, Jun Li","doi":"10.1186/s13017-025-00640-4","DOIUrl":"https://doi.org/10.1186/s13017-025-00640-4","url":null,"abstract":"Multiple skip incision skin-sparing debridement (MSISSD) is a surgical procedure that excises infected tissue to achieve source control while retaining the infected but viable skin, thus overcoming some limitations of traditional surgical debridement. We aimed to introduce this skin-sparing debridement technique for the treatment of perianal necrotizing fasciitis (PNF) and retrospectively analyze its efficacy and safety. Patients with PNF who received MSISSD between January 2021 and August 2024 were included in this retrospective analysis. We investigated the patient characteristics (sex, age, disease duration, and LRINEC score) and clinical data (comorbid diseases, length of stay in the intensive care unit [ICU LOS], microbiological culture results, number of debridements, length of stay [LOS], wound healing time, treatment outcomes, and follow-up status). Twenty-two patients with PNF were enrolled, including 19 males (86%) and three females (14%). The median age, disease duration, and LRINEC score was 59.5 years (range: 26–77), 4.5 days (range: 2–10), and 4 (range: 1–10), respectively, and five cases had a LRINEC score ≥ 6 (23%). Among the 22 patients included, the most common comorbid disease was diabetes, with nine cases (41%). Nine (41%) patients were admitted to the ICU, with a median ICU LOS of 2 days. Of the patients with positive wound cultures (14, 64%), polymicrobial infections were identified in 3 (21%) and monomicrobial infections in 11 (79%). The most commonly isolated microorganisms were Escherichia coli (8, 57%) and Klebsiella pneumoniae (5, 36%). One patient underwent debridement twice, while the remaining patients underwent debridement once. The median LOS was 18 days, and the wound healing time was 61 days. No patient underwent reconstruction surgery. During the median follow-up period of 11 months, one patient developed anal fistula 6 months after surgery and recovered after undergoing anal fistula resection. No patient experienced recurrence of PNF or anal incontinence. MSISSD appears to be a promising and effective method for skin protection debridement, which can effectively protect the skin while ensuring adequate drainage, and rarely causing severe anal dysfunction.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"11 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wound healing is challenging in cases of impaired microcirculation, leading to wound chronicity, decreased quality of life, and increased morbidity. Surgical site infections (SSIs) pose a significant challenge in diabetic, hypertensive, and obese patients due to impaired microcirculation. Negative pressure wound therapy (NPWT) is a widely used adjunct in wound management, but its optimal parameters in this subgroup remain uncertain. Tailored management is essential, taking into consideration tissue perfusion status and the potential benefit of novel strategies for tissue healing. We report a case seires of three obese patients with diabetes mellitus type 2 and arterial hypertension who developed severe SSIs after abdominal surgery, with extended flap mobilization and were managed with tailored NPWT strategies, including lower negative pressures, NPWT with instillation and dwell time (NPWTi-d), reticulated open cell foam dressings with through holes (ROCF-CC), and ultrasonic-assisted wound debridement (UAW). Based on these cases, we propose the ANSWER score (tAilored Negative presSure Wound thErapy in micRoangiopathy) to optimize NPWT pressure settings. In Patient 1, NPWT using silver dressings was initiated at a continuous pressure of -125 mmHg, but after extended necrosis developed, the negative pressure was reduced to -50 mmHg. In Patients 2 and 3, a continuous NPWT was set at -50 mmHg, which is the lower value of the available negative pressure range for the system used, resulting in significantly fewer necrotic areas. Dressings were changed every 48–72 h and culture-directed antibiotics were administered to all patients. Our findings suggest that the use of NPWT remains a basic element in promoting acute and chronic wound healing. Innovative techniques such as NPWTi-d, ROCF-CC, and UAW debridement, combined with low negative pressure levels, may achieve optimal results in patients with microangiopathy. Microcirculation plays a crucial role in wound healing, since impaired healing and a low rate of tissue regeneration have been observed in patients with compromised tissue perfusion, such as patients with diabetes, obesity, or arterial hypertension. However, the use of NPWT in patients with microangiopathy and extensive tissue dissection at the default operating pressure of -125 mmHg may lead to further ischemic necrosis. Based on our case series, a clinical score (ANSWER score- tAilored Negative presSure Wound thErapy in micRoangiopathy) is proposed as a useful tool that reflects the ideal level of negative pressure for patients with impaired microcirculation. The ANSWER score assigns risk factors (obesity, arterial hypertension, diabetes) a point each, reducing NPWT pressure accordingly (-25 mmHg per point from − 125 mmHg). Tailored NPWT settings, based on the ANSWER score, may enhance wound healing outcomes in patients with microangiopathy. Further clinical studies are warranted to validate this approach.
{"title":"Tailored Negative Pressure Wound Therapy with instillation in diabetic, hypertensive, and obese patients-when guideline treatment is not enough: a case series and a proposal for the ANSWER score","authors":"Orestis Ioannidis, Elissavet Anestiadou, Konstantinos Zapsalis, Konstantinos Siozos, Ourania Kerasidou, Savvas Symeonidis, Stefanos Bitsianis, Manousos-Georgios Pramateftakis, Efstathios Kotidis, Ioannis Mantzoros, Konstantinos Angelopoulos, Barbara Driagka, Angeliki Cheva, Stamatios Angelopoulos","doi":"10.1186/s13017-025-00605-7","DOIUrl":"https://doi.org/10.1186/s13017-025-00605-7","url":null,"abstract":"Wound healing is challenging in cases of impaired microcirculation, leading to wound chronicity, decreased quality of life, and increased morbidity. Surgical site infections (SSIs) pose a significant challenge in diabetic, hypertensive, and obese patients due to impaired microcirculation. Negative pressure wound therapy (NPWT) is a widely used adjunct in wound management, but its optimal parameters in this subgroup remain uncertain. Tailored management is essential, taking into consideration tissue perfusion status and the potential benefit of novel strategies for tissue healing. We report a case seires of three obese patients with diabetes mellitus type 2 and arterial hypertension who developed severe SSIs after abdominal surgery, with extended flap mobilization and were managed with tailored NPWT strategies, including lower negative pressures, NPWT with instillation and dwell time (NPWTi-d), reticulated open cell foam dressings with through holes (ROCF-CC), and ultrasonic-assisted wound debridement (UAW). Based on these cases, we propose the ANSWER score (tAilored Negative presSure Wound thErapy in micRoangiopathy) to optimize NPWT pressure settings. In Patient 1, NPWT using silver dressings was initiated at a continuous pressure of -125 mmHg, but after extended necrosis developed, the negative pressure was reduced to -50 mmHg. In Patients 2 and 3, a continuous NPWT was set at -50 mmHg, which is the lower value of the available negative pressure range for the system used, resulting in significantly fewer necrotic areas. Dressings were changed every 48–72 h and culture-directed antibiotics were administered to all patients. Our findings suggest that the use of NPWT remains a basic element in promoting acute and chronic wound healing. Innovative techniques such as NPWTi-d, ROCF-CC, and UAW debridement, combined with low negative pressure levels, may achieve optimal results in patients with microangiopathy. Microcirculation plays a crucial role in wound healing, since impaired healing and a low rate of tissue regeneration have been observed in patients with compromised tissue perfusion, such as patients with diabetes, obesity, or arterial hypertension. However, the use of NPWT in patients with microangiopathy and extensive tissue dissection at the default operating pressure of -125 mmHg may lead to further ischemic necrosis. Based on our case series, a clinical score (ANSWER score- tAilored Negative presSure Wound thErapy in micRoangiopathy) is proposed as a useful tool that reflects the ideal level of negative pressure for patients with impaired microcirculation. The ANSWER score assigns risk factors (obesity, arterial hypertension, diabetes) a point each, reducing NPWT pressure accordingly (-25 mmHg per point from − 125 mmHg). Tailored NPWT settings, based on the ANSWER score, may enhance wound healing outcomes in patients with microangiopathy. Further clinical studies are warranted to validate this approach.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"7 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144747577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-28DOI: 10.1186/s13017-025-00610-w
Yasir Musa Kesgin, Ahmet Zahit Kaan, Metehan Arslan, Yusuf Bilgin, Erkan Somuncu, Serhan Yılmaz, Ali Kocataş
Textbook outcome (TO) is a concept that describes achieving an uneventful course for a patient undergoing surgery. It was first described for colorectal surgery and is now increasingly linked to various topics of surgical literature. After the S.P.Ri.M.A.C.C. Study, the authors applied the concept to emergency cholecystectomies. In this study, we aimed to question whether being an older patient commands a difference in textbook outcome rates. All patients undergoing emergency cholecystectomy in a single tertiary hospital between 2020 and 2024 were included in this study. The TO criteria included no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, a hospital stay of ≤ 7 days and complete laparoscopic surgery. Group A included patients younger than 65 years and the others comprised group B. The study was conducted with 212 patients, of whom 123 (58%) were female. Conversion to open and subtotal cholecystectomy were similar between groups. The textbook outcome rate was 88% in the younger group and 72% in the elderly patients (p = 0.040). However, multivariate logistic regression analyses did not support age as a significant factor in textbook outcome. Length of hospital stay (> 7 days) and postoperative complications were determined to be reasons for not achieving the textbook outcome. The textbook outcome rate in older patients was not similar to that in younger patients. Surgical and non-surgical causes should be highlighted. Risk stratification remains important in the management of acute cholecystitis. Larger studies with patient-centred data are needed to improve the concept.
{"title":"Is there a difference in textbook outcomes of emergency cholecystectomy in older patients compared with younger patients?","authors":"Yasir Musa Kesgin, Ahmet Zahit Kaan, Metehan Arslan, Yusuf Bilgin, Erkan Somuncu, Serhan Yılmaz, Ali Kocataş","doi":"10.1186/s13017-025-00610-w","DOIUrl":"https://doi.org/10.1186/s13017-025-00610-w","url":null,"abstract":"Textbook outcome (TO) is a concept that describes achieving an uneventful course for a patient undergoing surgery. It was first described for colorectal surgery and is now increasingly linked to various topics of surgical literature. After the S.P.Ri.M.A.C.C. Study, the authors applied the concept to emergency cholecystectomies. In this study, we aimed to question whether being an older patient commands a difference in textbook outcome rates. All patients undergoing emergency cholecystectomy in a single tertiary hospital between 2020 and 2024 were included in this study. The TO criteria included no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, a hospital stay of ≤ 7 days and complete laparoscopic surgery. Group A included patients younger than 65 years and the others comprised group B. The study was conducted with 212 patients, of whom 123 (58%) were female. Conversion to open and subtotal cholecystectomy were similar between groups. The textbook outcome rate was 88% in the younger group and 72% in the elderly patients (p = 0.040). However, multivariate logistic regression analyses did not support age as a significant factor in textbook outcome. Length of hospital stay (> 7 days) and postoperative complications were determined to be reasons for not achieving the textbook outcome. The textbook outcome rate in older patients was not similar to that in younger patients. Surgical and non-surgical causes should be highlighted. Risk stratification remains important in the management of acute cholecystitis. Larger studies with patient-centred data are needed to improve the concept.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"708 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-25DOI: 10.1186/s13017-025-00637-z
Fikri M. Abu-Zidan, Yousef F. Abu-Zidan, Arif Alper Cevik
To develop and evaluate a practical, low-cost ultrasound training simulator for teaching basic ultrasound physics and knobology, including probe orientation, tissue impedance, essential hand movements, and recognizing image artifacts while observing scanned objects. The simulator consists of (1) one complete lemon, (2) half a lemon, (3) half a kiwi fruit, and (4) an avocado pit. These objects were secured inside a plastic box using screws, nails and double-sided foam tape, after which the box was filled with water. The estimated total cost was less than 15 US dollars. The simulator was prospectively tested to teach basic ultrasound physics during the period of 4th January 2021 till 14th October 2021 on 59 undergraduate junior surgical clerkship students, who had no prior exposure to ultrasound. Quantitative feedback was collected through a Likert-scale questionnaire evaluating educational value, skill acquisition, and user satisfaction. Qualitative data were obtained from open-ended questions. Descriptive statistics were used for quantitative responses, while inductive thematic analysis was applied to qualitative comments. 58 students filled the questionnaire (response rate of 98.3%), 57 of them (98.3%) recommended the simulator to peers, and all assessed items received the highest median rating (5 out of 5), including items assessing conceptual understanding, procedural skills, and enjoyment. Thematic analysis provided three major themes: Learning Enhancement, Engagement and Motivation, and Training Limitations. Students reported improved understanding of ultrasound physics, artifact recognition, and probe handling. The simulator was described as engaging and enjoyable, promoting self-directed learning. However, students noted limitations related to session duration, realism, and the need for additional practice opportunities. The proposed low-cost ultrasound simulator was highly rated for its educational value and engagement potential. Qualitative insights complemented these findings by revealing strong learner enthusiasm. Expanding session duration and increasing clinical fidelity may further enhance its utility.
{"title":"Lunch box and fruits as a simulator for teaching basic physics of ultrasound: A mixed research methods study","authors":"Fikri M. Abu-Zidan, Yousef F. Abu-Zidan, Arif Alper Cevik","doi":"10.1186/s13017-025-00637-z","DOIUrl":"https://doi.org/10.1186/s13017-025-00637-z","url":null,"abstract":"To develop and evaluate a practical, low-cost ultrasound training simulator for teaching basic ultrasound physics and knobology, including probe orientation, tissue impedance, essential hand movements, and recognizing image artifacts while observing scanned objects. The simulator consists of (1) one complete lemon, (2) half a lemon, (3) half a kiwi fruit, and (4) an avocado pit. These objects were secured inside a plastic box using screws, nails and double-sided foam tape, after which the box was filled with water. The estimated total cost was less than 15 US dollars. The simulator was prospectively tested to teach basic ultrasound physics during the period of 4th January 2021 till 14th October 2021 on 59 undergraduate junior surgical clerkship students, who had no prior exposure to ultrasound. Quantitative feedback was collected through a Likert-scale questionnaire evaluating educational value, skill acquisition, and user satisfaction. Qualitative data were obtained from open-ended questions. Descriptive statistics were used for quantitative responses, while inductive thematic analysis was applied to qualitative comments. 58 students filled the questionnaire (response rate of 98.3%), 57 of them (98.3%) recommended the simulator to peers, and all assessed items received the highest median rating (5 out of 5), including items assessing conceptual understanding, procedural skills, and enjoyment. Thematic analysis provided three major themes: Learning Enhancement, Engagement and Motivation, and Training Limitations. Students reported improved understanding of ultrasound physics, artifact recognition, and probe handling. The simulator was described as engaging and enjoyable, promoting self-directed learning. However, students noted limitations related to session duration, realism, and the need for additional practice opportunities. The proposed low-cost ultrasound simulator was highly rated for its educational value and engagement potential. Qualitative insights complemented these findings by revealing strong learner enthusiasm. Expanding session duration and increasing clinical fidelity may further enhance its utility.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"712 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144701538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-14DOI: 10.1186/s13017-025-00635-1
Rui-Tao Sun, Chang-Lei Li, Yu-Min Jiang, Ao-Yun Hao, Kui Liu, Kun Li, Bin Tan, Xiao-Nan Yang, Jiu-Fa Cui, Wen-Ye Bai, Wei-Yu Hu, Jing-Yu Cao, Chao Qu
Accurately identifying difficult laparoscopic cholecystectomy (DLC) preoperatively remains a clinical challenge. Previous studies utilizing clinical variables or morphological imaging markers have demonstrated suboptimal predictive performance. This study aims to develop an optimal radiomics-clinical model by integrating preoperative CT-based radiomics features with clinical characteristics. A retrospective analysis was conducted on 2,055 patients who underwent laparoscopic cholecystectomy (LC) for cholecystitis at our center. Preoperative CT images were processed with super-resolution reconstruction to improve consistency, and high-throughput radiomic features were extracted from the gallbladder wall region. A combination of radiomic and clinical features was selected using the Boruta-LASSO algorithm. Predictive models were constructed using six machine learning algorithms and validated, with model performance evaluated based on the AUC, accuracy, Brier score, and DCA to identify the optimal model. Model interpretability was further enhanced using the SHAP method. The Boruta-LASSO algorithm identified 10 key radiomic and clinical features for model construction, including the Rad-Score, gallbladder wall thickness, fibrinogen, C-reactive protein, and low-density lipoprotein cholesterol. Among the six machine learning models developed, the radiomics-clinical model based on the random forest algorithm demonstrated the best predictive performance, with an AUC of 0.938 in the training cohort and 0.874 in the validation cohort. The Brier score, calibration curve, and DCA confirmed the superior predictive capability of this model, significantly outperforming previously published models. The SHAP analysis further visualized the importance of features, enhancing model interpretability. This study developed the first radiomics-clinical random forest model for the preoperative prediction of DLC by machine learning algorithms. This predictive model supports safer and individualized surgical planning and treatment strategies.
{"title":"A radiomics-clinical predictive model for difficult laparoscopic cholecystectomy based on preoperative CT imaging: a retrospective single center study","authors":"Rui-Tao Sun, Chang-Lei Li, Yu-Min Jiang, Ao-Yun Hao, Kui Liu, Kun Li, Bin Tan, Xiao-Nan Yang, Jiu-Fa Cui, Wen-Ye Bai, Wei-Yu Hu, Jing-Yu Cao, Chao Qu","doi":"10.1186/s13017-025-00635-1","DOIUrl":"https://doi.org/10.1186/s13017-025-00635-1","url":null,"abstract":"Accurately identifying difficult laparoscopic cholecystectomy (DLC) preoperatively remains a clinical challenge. Previous studies utilizing clinical variables or morphological imaging markers have demonstrated suboptimal predictive performance. This study aims to develop an optimal radiomics-clinical model by integrating preoperative CT-based radiomics features with clinical characteristics. A retrospective analysis was conducted on 2,055 patients who underwent laparoscopic cholecystectomy (LC) for cholecystitis at our center. Preoperative CT images were processed with super-resolution reconstruction to improve consistency, and high-throughput radiomic features were extracted from the gallbladder wall region. A combination of radiomic and clinical features was selected using the Boruta-LASSO algorithm. Predictive models were constructed using six machine learning algorithms and validated, with model performance evaluated based on the AUC, accuracy, Brier score, and DCA to identify the optimal model. Model interpretability was further enhanced using the SHAP method. The Boruta-LASSO algorithm identified 10 key radiomic and clinical features for model construction, including the Rad-Score, gallbladder wall thickness, fibrinogen, C-reactive protein, and low-density lipoprotein cholesterol. Among the six machine learning models developed, the radiomics-clinical model based on the random forest algorithm demonstrated the best predictive performance, with an AUC of 0.938 in the training cohort and 0.874 in the validation cohort. The Brier score, calibration curve, and DCA confirmed the superior predictive capability of this model, significantly outperforming previously published models. The SHAP analysis further visualized the importance of features, enhancing model interpretability. This study developed the first radiomics-clinical random forest model for the preoperative prediction of DLC by machine learning algorithms. This predictive model supports safer and individualized surgical planning and treatment strategies.","PeriodicalId":48867,"journal":{"name":"World Journal of Emergency Surgery","volume":"14 1","pages":""},"PeriodicalIF":8.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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