Pub Date : 2025-11-29DOI: 10.1016/j.sipas.2025.100322
Sina Samenezhad , Dorna Rafighi
Artificial intelligence (AI) is gradually altering urology by improving diagnostic precision, prognostic evaluation, and therapy decisions in a broad spectrum of urologic diseases. Utilizing machine learning, deep learning, and radiomics, applications of AI have exhibited promise in enhancing cancer identification, stratification, and therapy response prediction, especially in prostate, bladder, and kidney cancers. Beyond cancer therapy, AI enables individually tailored care for benign diseases like benign prostatic hyperplasia, urolithiasis, Functional Urology even in pediatrics by enhancing diagnostic ability and outcome prediction. Heterogeneity of data, model explainability, ethical issues, and lack of prospective validation constrain incorporation into everyday practice. This review summarizes current applications and discusses methodological and ethical limitation, and defines future directions toward enhancing multidisciplinary interaction, standardization across datasets, and prudent implementation. Eventually, AI provides large-scale opportunity to transform urologic care by facilitating individually tailored, expedient, and equitable patient care.
{"title":"The role of artificial intelligence in advancing urologic care: From diagnostics to therapeutics","authors":"Sina Samenezhad , Dorna Rafighi","doi":"10.1016/j.sipas.2025.100322","DOIUrl":"10.1016/j.sipas.2025.100322","url":null,"abstract":"<div><div>Artificial intelligence (AI) is gradually altering urology by improving diagnostic precision, prognostic evaluation, and therapy decisions in a broad spectrum of urologic diseases. Utilizing machine learning, deep learning, and radiomics, applications of AI have exhibited promise in enhancing cancer identification, stratification, and therapy response prediction, especially in prostate, bladder, and kidney cancers. Beyond cancer therapy, AI enables individually tailored care for benign diseases like benign prostatic hyperplasia, urolithiasis, Functional Urology even in pediatrics by enhancing diagnostic ability and outcome prediction. Heterogeneity of data, model explainability, ethical issues, and lack of prospective validation constrain incorporation into everyday practice. This review summarizes current applications and discusses methodological and ethical limitation, and defines future directions toward enhancing multidisciplinary interaction, standardization across datasets, and prudent implementation. Eventually, AI provides large-scale opportunity to transform urologic care by facilitating individually tailored, expedient, and equitable patient care.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"24 ","pages":"Article 100322"},"PeriodicalIF":0.8,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145792282","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}
Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC.
Methods
We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4.
Results
Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations.
Conclusion
Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.
{"title":"Outcomes of primary intestinal anastomosis versus stoma in necrotizing enterocolitis: A systematic review and meta-analysis","authors":"Amani N. Alansari , Salma Mani , Marwa Messaoud , Tariq Altokhais","doi":"10.1016/j.sipas.2025.100319","DOIUrl":"10.1016/j.sipas.2025.100319","url":null,"abstract":"<div><h3>Background</h3><div>Approximately one-quarter of necrotizing enterocolitis (NEC) cases require surgical resection due to bowel perforation, necrosis, or failure to respond to conservative management. In such cases, the optimal method for restoring intestinal continuity remains debatable. Stoma is traditionally favored over primary anastomosis for its perceived safety, particularly in unstable infants, but it is associated with complications such as fluid and electrolyte imbalances, impaired growth, and the need for a second surgery. This study aims to systematically review and analyze the evidence comparing stoma versus primary anastomosis in neonates undergoing surgery for NEC.</div></div><div><h3>Methods</h3><div>We searched PubMed, Web of Science (WOS), the Cochrane Library, and Scopus for studies comparing the outcomes of stoma versus primary anastomosis in neonates with NEC. The primary outcomes included overall postoperative complications, intestinal perforation, stricture, mortality, wound infection, time to full enteral nutrition, time to end parenteral nutrition, and length of hospital stay. The meta-analysis was conducted using Review Manager (RevMan) version 5.4.</div></div><div><h3>Results</h3><div>Eighteen studies were included in the meta-analysis. Primary anastomosis was associated with lower mortality risk: (risk ratios (RR) = 0.61; 95 % confidence interval (CI): 0.42:0.88). No significant differences were observed between groups in overall complications, wound infection, duration of hospital stay, duration of parenteral nutrition, the need for a second operation (excluding stoma closure), strictures, and perforations.</div></div><div><h3>Conclusion</h3><div>Primary anastomosis for neonates with NEC is associated with lower mortality and comparable complication rates compared to stoma formation in selected cases.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100319"},"PeriodicalIF":0.8,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145579187","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}
Pub Date : 2025-10-26DOI: 10.1016/j.sipas.2025.100318
Muhammad Mohsin Khan , Noman Shah , Bipin Chaurasia
Introduction
This systematic review aimed to synthesize the literature on integrating biophysical principles such as Laplace’s law with patient-specific hemodynamics to create a more precise and mechanistic framework for assessing rupture risk in unruptured intracranial aneurysms.
Methods
This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2010 and December 2024 were identified from databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The Joanna Briggs Institute checklist and Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool were used to assess study quality and bias.
Results
These studies showed increasing integration of Laplace's law with patient-specific flow simulations and vessel wall modeling. Hemodynamic models frequently revealed that areas with low wall shear stress or high oscillatory shear index overlapped with regions of high mechanical stress. Thin walled blebs small outpouchings on aneurysms were particularly prone to rupture and were often associated with abnormal flow patterns and higher wall tension. The synthesized evidence supports the conceptual validity of an integrative model that spatially correlates high wall tension with adverse hemodynamic patterns.
Conclusion
This review demonstrates that the proposed integration of Laplace’s law with advanced hemodynamic modeling, as evidenced by the literature, holds promise for improving rupture risk prediction. Future research should focus on implementing this combined approach in a clinical cohort to compare its predictive ability against existing models like the PHASES score.
本系统综述旨在综合有关将拉普拉斯定律等生物物理原理与患者特异性血流动力学相结合的文献，以创建一个更精确和更机械的框架来评估未破裂颅内动脉瘤的破裂风险。方法本系统评价遵循系统评价和荟萃分析首选报告项目（PRISMA）指南。2010年1月至2024年12月期间发表的研究从PubMed、Scopus、Web of Science、IEEE explore和b谷歌Scholar等数据库中确定。采用乔安娜布里格斯研究所检查表和非随机干预研究的偏倚风险（ROBINS-I）工具评估研究质量和偏倚。结果这些研究表明拉普拉斯定律与患者特定流动模拟和血管壁建模的结合越来越多。血流动力学模型经常显示低壁剪切应力或高振荡剪切指数区域与高机械应力区域重叠。动脉瘤上的薄壁小泡特别容易破裂，常伴有异常的血流模式和较高的壁张力。综合证据支持高壁张力与不利血流动力学模式在空间上相关的综合模型的概念有效性。结论本综述表明，将拉普拉斯定律与先进的血流动力学建模相结合，如文献所示，有望改善破裂风险预测。未来的研究应侧重于在临床队列中实施这种联合方法，以比较其与现有模型（如分期评分）的预测能力。
{"title":"Integrating Laplace's law with patient-specific hemodynamics to predict rupture risk in unruptured intracranial aneurysms: A systematic review of a biophysical and computational framework","authors":"Muhammad Mohsin Khan , Noman Shah , Bipin Chaurasia","doi":"10.1016/j.sipas.2025.100318","DOIUrl":"10.1016/j.sipas.2025.100318","url":null,"abstract":"<div><h3>Introduction</h3><div>This systematic review aimed to synthesize the literature on integrating biophysical principles such as Laplace’s law with patient-specific hemodynamics to create a more precise and mechanistic framework for assessing rupture risk in unruptured intracranial aneurysms.</div></div><div><h3>Methods</h3><div>This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2010 and December 2024 were identified from databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The Joanna Briggs Institute checklist and Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool were used to assess study quality and bias.</div></div><div><h3>Results</h3><div>These studies showed increasing integration of Laplace's law with patient-specific flow simulations and vessel wall modeling. Hemodynamic models frequently revealed that areas with low wall shear stress or high oscillatory shear index overlapped with regions of high mechanical stress. Thin walled blebs small outpouchings on aneurysms were particularly prone to rupture and were often associated with abnormal flow patterns and higher wall tension. The synthesized evidence supports the conceptual validity of an integrative model that spatially correlates high wall tension with adverse hemodynamic patterns.</div></div><div><h3>Conclusion</h3><div>This review demonstrates that the proposed integration of Laplace’s law with advanced hemodynamic modeling, as evidenced by the literature, holds promise for improving rupture risk prediction. Future research should focus on implementing this combined approach in a clinical cohort to compare its predictive ability against existing models like the PHASES score.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100318"},"PeriodicalIF":0.8,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466405","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}
Pub Date : 2025-10-24DOI: 10.1016/j.sipas.2025.100317
Wenwei Liao , Bin Peng , Guanggui Ding , Zhikai Li , Guangsuo Wang
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.
{"title":"Artificial intelligence in thoracic surgery: Perspectives and challenges","authors":"Wenwei Liao , Bin Peng , Guanggui Ding , Zhikai Li , 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":"2025-10-24","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}
Pub Date : 2025-10-17DOI: 10.1016/j.sipas.2025.100316
Mohammed Idhrees , Nimrat Grewal , Mohammed Ayyub , Jasima Nilofer , Bashi Velayudhan
Objective
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.
Methods
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 (<10, 10–20, >20 years) and institutional aortic surgery volume (high vs low).
Results
Over one-quarter of surgeons (26.9 %) declined to operate on patients >70 years old, a practice more frequent among surgeons with <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 (>20 years) were more likely to operate despite malperfusion or CPR (38.8 % vs 13.3 %, p=0.005).
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).
Conclusion
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.
急性A型主动脉夹层（ATAAD）具有高发病率和死亡率，不同外科医生的治疗策略差异很大。本研究旨在评估印度心脏外科医生对ATAAD的实践模式和决策，重点关注与手术经验和机构病例量相关的差异。方法向印度心胸外科医师协会所有会员单位发放涵盖ATAAD术前、术中及术后管理的23项电子问卷。根据外科医生经验（10年、10 - 20年、20年）和机构主动脉手术量（高与低）对93例应答进行分析和比较。结果超过四分之一（26.9%）的外科医生拒绝为70岁的患者做手术，其中20年经验的外科医生拒绝为70岁患者做手术的比例更高（32% vs 5.56% p=0.011）。主动心肺复苏（56%）和术前卒中（52.7%）是最常见的不进行手术的原因，而资深外科医生（>20）更有可能在灌注不良或心肺复苏的情况下进行手术（38.8% vs 13.3%, p=0.005）。62.4%的外科医生倾向于双动脉插管，随着经验的增加，倾向于单动脉插管（p=0.008）。26.8%的应答者使用钳上技术进行远端吻合，在小容量主动脉外科医生中更为常见（35.1%对13.8%,p=0.012）。结论在印度，ATAAD的处理存在很大差异，主要受外科医生经验和主动脉手术量的影响。在患者选择、插管策略和远端修复技术方面的差异尤为明显。这些发现强调了结构化转诊系统的必要性，以及在印度发展大容量“主动脉中心”的潜在好处。
{"title":"Nationwide survey of Indian cardiac surgeons on the management of acute type A aortic dissection","authors":"Mohammed Idhrees , Nimrat Grewal , Mohammed Ayyub , Jasima Nilofer , 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 (<10, 10–20, >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 >70 years old, a practice more frequent among surgeons with <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 (>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":"2025-10-17","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}
Pub Date : 2025-10-13DOI: 10.1016/j.sipas.2025.100315
Rana Farsakoury , Massimo Sartelli , Susu M Zughaier
Background and purpose
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.
Methods
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.
Results
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.
Conclusion
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.
{"title":"Tackling the disparities in surgical site infections and related antimicrobial resistance in low- and middle-income countries","authors":"Rana Farsakoury , Massimo Sartelli , 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":"2025-10-13","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}
Pub Date : 2025-10-13DOI: 10.1016/j.sipas.2025.100314
Mohammad Hadi Bahri , Seyed Mohammad Naghibalghora , Mojtaba Ahmadinejad , Kourosh Kabir , Nazanin Khezri
Background
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.
Methods
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 (>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.
Results
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<0.01). Ketorolac use (frequency and total dose) was significantly lower in the Heimlich group (P<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).
Conclusion
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.
Trial registration
Iranian Registry of Clinical Trials (IRCT): IRCT20230208057359N1.
{"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 , Seyed Mohammad Naghibalghora , Mojtaba Ahmadinejad , Kourosh Kabir , 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 (>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<0.01). Ketorolac use (frequency and total dose) was significantly lower in the Heimlich group (P<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":"2025-10-13","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}
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.
Methods
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.
Results
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.
Conclusion
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.
{"title":"Short-term outcomes and mortality in older patients with breast cancer at a single tertiary center","authors":"Nora Trabulsi , Nada AbuBakr Alkhateeb , Feryal Omar Attiah , Rozan Altaifi , Bana Fakeeh , Alaa Shabkah , Ali Farsi , Somayah Saeed Bawazeer , Salma Sait , 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":"2025-10-10","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}
Pub Date : 2025-10-09DOI: 10.1016/j.sipas.2025.100312
Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi
Background
The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.
Methods
This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.
Results
The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; P < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; P = 0.015).
Conclusions
A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.
{"title":"Relationship between minimum heart rate and mortality in ICU patients with traumatic brain injury (TBI): a retrospective analysis based on the MIMIC-IV database","authors":"Xin Li, Meng Han, Xiaoliang Wang, Wenjuan Lang, Kai Shi","doi":"10.1016/j.sipas.2025.100312","DOIUrl":"10.1016/j.sipas.2025.100312","url":null,"abstract":"<div><h3>Background</h3><div>The association between minimum heart rate (MinHR) within 24 h of ICU admission and 1-month mortality in traumatic brain injury (TBI) patients remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed 2267 TBI patients from the MIMIC-IV v3.1 database. Multivariable Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses evaluated relationships between 24-hour MinHR and mortality.</div></div><div><h3>Results</h3><div>The cohort (median age 67 [IQR 51–80] years; 62.6% female) had a median MinHR of 59 [52–68] bpm, with 248 deaths (10.94%). RCS analysis revealed a U-shaped association (P for nonlinear =0.001) with 59 bpm as the inflection point. MinHR ≥59 bpm independently predicted higher mortality after full adjustment (HR=1.84, 95%CI:1.31–2.60; <em>P</em> < 0.001). This association was pronounced in non-hypertensive patients (HR=1.50, 95%CI:1.08–2.08; <em>P</em> = 0.015).</div></div><div><h3>Conclusions</h3><div>A U-shaped association exists between 24-hour MinHR and 1-month mortality in TBI patients, with 59 bpm as the critical threshold. MinHR ≥59 bpm independently predicts increased mortality. These findings support using 59 bpm as an alert threshold for early intervention.</div></div>","PeriodicalId":74890,"journal":{"name":"Surgery in practice and science","volume":"23 ","pages":"Article 100312"},"PeriodicalIF":0.8,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145363483","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}
Pub Date : 2025-09-21DOI: 10.1016/j.sipas.2025.100311
Joshua G. Kovoor , John M. Glynatsis , Nikolaos C. Glynatsis , Domenico Perrotta , Elyssa Chan , Timothy Daniell , Stephen Bacchi , Brandon Stretton , Daksh Tyagi , Joseph N. Hewitt , Angelyn L.W. Khong , Diana U. Siriwardena , David X.H. Ling , Christopher D. Ovenden , Rohan Arasu , Jonathan Henry W. Jacobsen , Suzanne Edwards , Matthew Marshall-Webb , Pramesh Kovoor , Benjamin A.J. Reddi , Aashray K. Gupta
Background
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.
Methodology
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.
Results
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 % (n = 30) for type A vs 10.9 % (n = 5) for type B. For type A patients, every one-year increase in age increased odds of in-hospital mortality by 4 % (p = 0.0076), and odds of in-hospital mortality were 10.9 times greater with conservative management than surgical (p < 0.0001). Patients with type A dissection had odds of in-hospital mortality 3.0 times greater than type B (p = 0.0005). 30-day mortality rate was 29.1 % (n = 30) for type A dissection vs 10.9 % (n = 5) for type B. 6-month mortality rate was 30.1 % (n = 31) for type A dissection vs 10.9 % (n = 5) for type B. Predictors of 30-day and 6-month mortality were similar to those of in-hospital mortality.
Conclusion
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.
{"title":"Factors affecting acute aortic dissection mortality: A multicentre cohort study","authors":"Joshua G. Kovoor , John M. Glynatsis , Nikolaos C. Glynatsis , Domenico Perrotta , Elyssa Chan , Timothy Daniell , Stephen Bacchi , Brandon Stretton , Daksh Tyagi , Joseph N. Hewitt , Angelyn L.W. Khong , Diana U. Siriwardena , David X.H. Ling , Christopher D. Ovenden , Rohan Arasu , Jonathan Henry W. Jacobsen , Suzanne Edwards , Matthew Marshall-Webb , Pramesh Kovoor , Benjamin A.J. Reddi , 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> < 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":"2025-09-21","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}
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