Medicine and Pharmacology

Abstract: Bariatric surgery is often presented as cancer-preventive, but its association with colorectal cancer (CRC) is less clear than for other obesity-related cancers. This critical narrative review examined epidemiological studies, evidence syntheses, human mechanistic studies and guidance identified through targeted searches updated to 31 October 2026, separating comparisons with nonsurgical obesity care from comparisons with the general population. Most meta-analyses report inverse associations, but results depend on the estimator and study selection: two largely overlapping reviews reported a nonsignificant pooled hazard ratio (HR) of 0.88 (95% confidence interval [CI] 0.69–1.12), and HRs of 0.81 and 0.75 only after excluding one study. Persistent excess colon cancer risk relative to the general population does not by itself indicate harm from surgery. The Swedish Obese Subjects study found no significant adjusted association after a median 22.2 years, and an October 2026 Nordic cohort found none for colon or rectal cancer. Human mucosal findings diverge, and experimental data offer hypotheses rather than clinical proof. The magnitude and causality of any association remain uncertain, and no late postoperative hazard is established. Screening after surgery should follow established risk factors, prior colonoscopy findings and symptoms rather than the operation alone.

Abstract: Background: Surgery remains the cornerstone of curative treatment for most solid tumors. Yet outcomes for surgical oncology patients depend on far more than the operation itself. Diagnosis, multidisciplinary planning, perioperative optimization, adjuvant therapy, psychosocial support and survivorship care are delivered by many professionals across many settings, and gaps between them can undo technical surgical success. Objective: To propose and describe an integrated healthcare ecosystem framework for surgical oncology, and to synthesize evidence on the components that connect surgical care to the wider cancer care system. Methods: A narrative review of literature on integrated care, multidisciplinary cancer care, care coordination, perioperative pathways, digital health and patient-centered support in surgical oncology. Findings were organized using the Rainbow Model of Integrated Care and the World Health Organization framework on integrated, people-centered health services. Results: The ecosystem was described across five interacting layers: clinical integration (multidisciplinary team meetings and shared treatment planning), professional integration (interprofessional roles, including specialist oncology nurses), organizational integration (patient navigation, defined care pathways and enhanced recovery programmes), system integration (digital health, shared records and remote symptom monitoring), and patient and family integration (prehabilitation, psychosocial care and survivorship planning). Evidence supports each layer individually, but studies rarely evaluate how the layers function together around the surgical patient. Conclusion: Framing surgical oncology as an integrated healthcare ecosystem shifts attention from the operation alone to the system that surrounds it. This framing has implications for service design, quality measurement and the education of future surgeons, particularly in rapidly developing health systems such as the United Arab Emirates.

Abstract:

Background: Mesh implantation is the standard approach in inguinal hernia repair. However, the use of penetrating sutures to secure the mesh slit in male patients may cause irritation to the tissues surrounding the spermatic cord. This pilot study evaluated the feasibility of a hybrid fixation technique utilizing a biodegradable, UV-curable adhesive biomaterial. Methods: Ten male patients aged 20-40 years with unilateral inguinal hernia underwent open repair and were assigned to two non-randomized groups (n = 5 each). Eligible patients were assigned alternately according to the order of enrollment. In the hybrid group, the mesh was secured partly conventionally, and the remaining portion was stabilized with the experimental UV-curable adhesive biomaterial. VAS, CCS, and EuraHS-QoL outcomes were assessed in both groups during the 24-month follow-up, whereas SF-36 data were available only for the hybrid group. Results: Adhesive-assisted partial mesh stabilization was associated with a shorter operative time than conventional fixation (52.0 ± 3.1 vs 60.2 ± 3.7 min). Mean VAS scores decreased from 2.6 and 2.8 on day 1 in the hybrid and conventional groups, respectively, to 0.8 in both groups on day 8 and 0 by week 6. Total CCS scores decreased from day 1 to 6 weeks in both groups (hybrid: 54.1% to 30.4%, conventional: 65.3% to 36.6%). No intraoperative complications or hernia recurrences were observed during the 24-month follow-up. The overall SF-36 scores increased from 77.8 preoperatively to 92.4 at 24 months. Conclusions: In this pilot cohort, hybrid fixation was feasible and was associated with shorter operative time. No intraoperative complications or hernia recurrences were observed during follow-up. These preliminary findings support further clinical investigation in larger patient populations to evaluate safety and comparative effectiveness.

Abstract: The optimal extent of lymphadenectomy for colorectal cancer has been debated for over a century. Ultraradical operations did not improve survival, and three regional approaches later defined surgical quality in different ways: station-based D3 dissection in Japan, the number of examined nodes in the United States, and complete mesocolic excision with central vascular ligation in Europe. Recent studies suggest that any benefit of extended central dissection may be confined to a minority of patients. Yet the extent of dissection is still decided on the basis of vascular landmarks, without seeing the lymphatic drainage of the individual tumor. This narrative review places fluorescence lymph node mapping (FLNM) with indocyanine green (ICG) within this debate. Because colonic lymph drains through a web-like network with skip metastasis, the sentinel node concept of breast cancer is not directly applicable. We propose that FLNM should map the D3 territory and drainage pathway of the individual tumor, show where central dissection may be extended, and check for residual fluorescent nodes, without reducing dissection below the extent we propose for the clinical stage. ICG is a drainage map rather than a metastasis marker, and tumor-replaced nodes may not fluoresce. We also review ongoing trials and emerging technologies.

Abstract: Background/Objectives: Total cell-free DNA (cfDNA) is not tumour-specific and may be affected by peri-operative injury and inflammation. We evaluated peri-operative plasma cfDNA dynamics and explored associations with recurrence and mortality in resectable non-small cell lung cancer (NSCLC). Methods: This prospective pilot cohort included 35 patients undergoing lobectomy with systematic nodal dissection and 30 healthy controls. Samples were collected pre-operatively, from the tumour-draining pulmonary vein before major manipulation, peripherally after resection, and on postoperative day 14. Analyses included group comparisons, receiver operating characteristic analysis, logistic regression and Cox regression. Results: Pre-operative cfDNA was higher in patients than controls (mean 1.96 versus 1.08 ng/µL; p = 0.002). Discrimination was modest (AUC 0.67, 95% CI 0.54–0.80), with sensitivity 49% and specificity 93% at an internally selected cut-off. cfDNA differed across timepoints (overall p = 0.008), with higher intra-operative and post-resection values than pre-operative values. Among 34 patients with complete three-year outcomes, 12 recurred and 13 died. Pre-operative cfDNA was associated with recurrence in multivariable logistic regression (adjusted OR 2.47, 95% CI 1.07–5.67; p = 0.034). Day-14 cfDNA was higher among patients who died (5.35 versus 2.17 ng/µL; p = 0.008). Conclusions: Total cfDNA showed modest diagnostic discrimination and exploratory outcome associations. Small sample size, potential model overfitting and incomplete analytical documentation limit interpretation. These hypothesis-generating findings require independent validation with standardised methods, peri-operative covariates and tumour-informed circulating tumour DNA assays.

Abstract: Anastomotic leakage (AL) remains one of the most serious complications of colorectal cancer surgery, and inadequate perfusion is one of the few causes that surgeons can cor-rect intraoperatively. Indocyanine green fluorescence angiography (ICG-FA) shows intes-tinal perfusion in real time and is widely used. Meta-analyses of randomized trials show that ICG-FA reduces overall AL by about one-third, mainly after left-sided and rectal anastomoses, although most individual trials missed their primary endpoints, and effects after right-sided resection and on grade C AL remain unproven. We explore why the trials appeared to disagree and what this implies for perfusion assessment. We consider statis-tical precision, anatomical site, leak severity, endpoints, diversion and neoadjuvant treat-ment, imaging protocols, and interpretation, then review quantitative perfusion analysis, hyperspectral and laser speckle contrast imaging, near-infrared-II imaging, and artificial intelligence. The apparent disagreement is compatible with limited precision for a moder-ate common effect, as the trials were powered for reductions of about 40% or more; differ-ences in endpoints and technique mean that they answered somewhat different questions. Separately, imaging physics and observer variability suggest that the weak point of ICG-FA is how fluorescence is measured and read. Until objective methods are shown to improve clinical outcomes, ICG-FA should be performed with a standardized protocol.

Abstract: Traumatic injuries cause morbidity and mortality in Mediterranean loggerhead sea turtles (Caretta caretta). This retrospective study evaluated 157 turtles at the University of Bari Sea Turtle Clinic from 2015 to 2022; these represented 7.74% of 2028 turtles evaluated. Lesions were classified by site, severity, and chronicity. All turtles underwent radiography; multidetector computed tomography (MDCT) was performed in selected cases. Each wound was swabbed for aerobic bacterial culture and antimicrobial susceptibility testing. Lesions involved a single site in 115 turtles (73.2%) and multiple sites in 42 (26.8%); the carapace, flippers, and skull were most frequently affected. MDCT characterized cranial and skeletal injuries and residual flipper vascularization. Cultures yielded 121 bacterial isolates, of which 76 (63%) exhibited a multidrug-resistant phenotype. Overall, 137 turtles (87.3%) were released, 17 (10.8%) died, and 3 (1.9%) were euthanized. In single-site cases, lesion severity was associated with outcome (p = 0.045), whereas anatomical site was not. In multiple-site cases, neither severity nor site was associated with outcome; associations with hook and fishing-line ingestion were exploratory. These findings indicate that outcome may reflect the combined effects of lesion severity and concurrent clinical conditions and support the use of advanced imaging, microbiological investigation, and targeted therapeutic management in sea turtle rehabilitation.

Abstract: Introduction: Full-endoscopic decompression has shown favorable outcomes for lumbar spinal stenosis (LSS) with Grade I degenerative lumbar spondylolisthesis (DLS); however, concerns remain regarding postoperative segmental instability and slip progression. This study evaluated the clinical and radiographic outcomes of sequential full-endoscopic unilateral laminotomy for bilateral decompression (FE-ULBD) followed by adjunct interspinous stabilization. Material and Methods: We retrospectively evaluated 47 patients with symptomatic single-level LSS and Grade I DLS who underwent sequential FE-ULBD followed by adjunct interspinous stabilization between January 2022 and April 2025. Clinical outcomes were assessed using visual analog scale (VAS) scores for leg and back pain, the Oswestry Disability Index (ODI), and the modified MacNab criteria. Radiographic outcomes included percent slip, mean disc height, dynamic angular motion, segmental translation, and segmental instability. Radiographic progression was defined as an increase in percent slip of more than 5 percentage points at 12 months. Results: VAS scores for leg and back pain and ODI scores improved significantly (all P < 0.001), and 42 patients (89.4%) achieved favorable modified MacNab outcomes. The percent slip and segmental translation showed no significant changes after 12 months. Segmental instability decreased from 36.2% to 23.4%, although the difference was not statistically significant (P = 0.146). Radiographic progression occurred in 4 patients (8.5%) and was not associated with worse 12-month clinical outcomes. Complications occurred in 6 patients (12.8%), and 4 patients (8.5%) underwent revision surgery. Conclusions: Sequential FE-ULBD, followed by adjunct interspinous stabilization, was associated with significant clinical improvement, and radiographic parameters were generally maintained over 1 year.

Abstract: Large language models (LLMs) show varying accuracy on professional examinations, particularly for questions involving visual materials. This study compared GPT-4o, o3, GPT-5 Thinking, and Gemini 3 on 400 Japanese National Dental Technician Examination questions from 2018–2022 and investigated whether between-model differences varied by question format. The dataset comprised 252 text-only questions and 148 questions accompanied by visual materials. Accuracy was compared using Cochran’s Q test and Holm-adjusted exact McNemar tests. A question-level mixed-effects logistic regression assessed model-by-item-type interactions while accounting for examination year. Overall accuracy was 63.8% for GPT-4o, 70.8% for o3, 74.8% for GPT-5 Thinking, and 80.5% for Gemini 3 (Cochran’s Q, p < 0.001). Gemini 3 significantly outperformed the other models, whereas o3 and GPT-5 Thinking did not differ significantly after adjust-ment. All models showed lower accuracy on visual-material questions than on text-only questions. The overall model-by-item-type interaction was significant (likelihood-ratio χ² = 11.756, p = 0.008), indicating that between-model differences varied by question format. The relative advantages of GPT-5 Thinking and Gemini 3 over GPT-4o were at-tenuated for visual-material questions. These findings highlight format-dependent dif-ferences in LLM performance and the limitations of aggregate accuracy as a bench-marking metric.

Abstract: Background/Objectives: We examined whether lower linear endovenous energy density (LEED) in the anterior saphenous vein (ASV) was proportional to its smaller diameter during simultaneous great saphenous vein (GSV) and ASV ablation. Methods: This exploratory retrospective study used 136 procedural records from a 433-patient source cohort. The primary comparison included 56 ipsilateral GSV–ASV pairs from 46 procedures. Nominal endovenous fluence equivalent (EFE) was calculated from LEED and pre-tumescence diameter measured with patients recumbent. Bilateral log ratios were averaged within procedures. Patient-linked clinical outcomes were not analyzed. Results: Procedure-weighted ASV/GSV ratios were 0.58 for diameter (95% confidence interval [CI], 0.55–0.62), 0.75 for LEED (95% CI, 0.70–0.80), and 1.29 for nominal EFE (95% CI, 1.19–1.40). Lower ASV LEED with higher nominal EFE occurred in 39 of 56 limbs. The between-wavelength EFE-ratio contrast was 0.97 (95% CI, 0.82–1.15). Excluding ambiguous records yielded an EFE ratio of 1.27 (95% CI, 1.17–1.39). Conclusions: The reduction in ASV LEED was smaller than the reduction in recorded diameter. Reporting measurement conditions alongside diameter and LEED improves dosimetric interpretation. These findings do not establish optimal dosing or clinical benefit.

Abstract: Unresectable multifocal hepatocellular carcinoma (HCC) is generally managed with systemic therapy, including immune checkpoint inhibitors and molecular targeted agents. When adequate tumor control is achieved, conversion to surgical resection may become feasible. A 59-year-old man with untreated chronic hepatitis C was found to have seven HCC lesions during magnetic resonance imaging surveillance. Systemic therapy with atezolizumab (1200 mg/body) plus bevacizumab (15 mg/kg) was initiated for unresectable multifocal HCC. After three cycles, contrast-enhanced computed tomography showed tumor shrinkage, with a 28% reduction in the sum of target lesion diameters, corresponding to stable disease according to Response Evaluation Criteria in Solid Tumors v1.1. The future liver remnant volume was 39.2%. After two additional cycles of atezolizumab monotherapy as bridging therapy, the patient underwent extended right hepatectomy, including resection of segment 4 and partial resection of segment 2. Pathological examination confirmed R0 resection, with viable tumor cells and focal necrosis. The postoperative course was uneventful, and antiviral therapy for hepatitis C resulted in a sustained virological response. The patient remains recurrence-free. Systemic therapy with atezolizumab plus bevacizumab enabled successful conversion surgery for seven HCC lesions. This multimodal approach may represent a viable treatment option for carefully selected patients with initially unresectable multifocal HCC.

Abstract: Background/Objectives. To compare clinical and angiographic outcomes after staged bilateral ovarian and parauterine vein embolization using coils or vascular plugs in women with pelvic congestion syndrome. Methods. We retrospectively compared 97 coil-treated and 103 plug-treated premenopausal women with complete six-month follow-up after staged bilateral ovarian and parauterine embolization at two centres from February 2025 to March 2026. Device selection reflected anatomy, availability, and operator preference. Left-sided treatment preceded right-sided treatment by approximately one month. Before right-sided embolization, venography assessed filling of previously treated left parauterine veins. Pain was assessed with a continuous-line visual analogue scale (VAS), scored 0–10, at baseline and six months after bilateral completion. Comparisons were unadjusted. Results. Six-month VAS was 1.4 ± 0.7 with coils and 4.2 ± 1.1 with plugs (mean difference, −2.80 points; 95% confidence interval, −3.06 to −2.54; P < .001). Parauterine opacification occurred in 15/97 (15.5%) versus 77/103 (74.8%; risk difference, −59.3 percentage points; 95% confidence interval, −68.7 to −46.8; P < .001). Immediate technical success was reported in all patients. Combined angiographic intervals were 18.0 ± 2.5 versus 22.0 ± 3.7 minutes. Transient increased pelvic pain occurred in 33.0% versus 37.9%. No migration, ovarian vein rupture, or unplanned repeat embolization was reported through six months. Conclusions. Coil treatment was associated with lower six-month pain scores and less parauterine opacification during contralateral venography. Nonrandom device selection and unadjusted comparisons prevent conclusions about causal device superiority.

Abstract: Background: Youngswick osteotomy is an Austin-derived distal first-metatarsal decompression osteotomy intended to preserve first metatarsophalangeal joint motion in hallux limitus and hallux rigidus. An additional dorsal parallel cut permits shortening; plantar translation depends on cut geometry. Objective: To examine how operative geometry, procedural variation and concomitant surgery affect interpretation of the clinical evidence for Youngswick osteotomy. Methods: This critical narrative review drew on structured searches of PubMed, Ovid MEDLINE and Embase, and the Knowledge Network, supplemented by reference checking. Reports of Youngswick osteotomy were assessed separately from studies of other decompression procedures. Differences between studies prevented quantitative synthesis.Results: Clinical cohorts report improvement in pain, function and dorsiflexion, but evidence is predominantly observational and procedures and outcome measures vary. Frequent concomitant cheilectomy limits isolation of the osteotomy’s independent effect. Plantar-pressure findings suggest possible transfer loading, and symptom improvement can coexist with radiographic progression. Available direct comparisons do not establish superiority. Conclusion: Youngswick osteotomy remains an option for patients who wish to retain motion and have sufficient joint function to benefit from decompression. Selection is guided by clinical assessment rather than validated criteria. The best cut geometry, its comparative benefit and its ability to delay arthrodesis remain uncertain.

Abstract: Postoperative pneumonia synthesis requires compatible outcomes, adjustment sets, and independent populations. This study examines how eligibility and modelling decisions affect the interpretation of perioperative vulnerability. A targeted, non-exhaustive review used 159 references and an inventory of 58 candidate reports. Four hip-fracture cohorts contributed to exploratory meta-analyses using restricted maximum likelihood and modified Hartung–Knapp inference. Nine analyses were checked using two Python implementations; eight leave-one-out analyses and twelve crude-to-adjusted comparisons were examined. Eighteen AI-assisted QUIPS domain judgments covered three cohorts; independent human reconciliation was not completed. The quantitative dataset comprised 6223 patients and 461 pneumonia events. Under permissive eligibility, the adjusted odds ratio for age was 1.47 per decade (95% confidence interval 1.06–2.02). Strict eligibility retained two cohorts, below the protocol-specific pooling threshold. Removing Tian from the unadjusted male-sex analysis changed the pooled odds ratio from 1.33 to 1.02 (0.50–2.07). The implementations agreed within 0.000001. The audit identified discordant matched-sample denominators in Shin. Other complications remained separate outcomes. Numerical reproducibility does not establish absence of bias. The inventory does not establish 57 independent eligible cohorts, and these findings cannot be reported as a completed systematic review.

Abstract: Background: Robotic-assisted spine surgery has evolved from mechanically guided pedicle screw placement into increasingly integrated platforms combining preoperative planning, intraoperative three-dimensional imaging, navigation, and robotic trajectory guidance. Although pedicle screw insertion remains the most extensively studied application, robotic technology is progressively being incorporated into minimally invasive fusion procedures, deformity surgery, trauma, revision surgery, and oncological reconstruction. The principal proposed benefits include improved instrumentation accuracy, reduced dependence on intraoperative fluoroscopy, reproducible execution of preplanned trajectories, and facilitation of minimally invasive workflows. However, uncertainty remains regarding its effect on patient-centered clinical outcomes, cost-effectiveness, radiation exposure, and superiority over contemporary navigation systems. Methods: A structured literature review was conducted to evaluate contemporary evidence concerning robotic-assisted thoracic and lumbar spinal instrumentation, as well as to assess potential future developments in this field. Comparative studies and systematic reviews/meta-analysis evaluating robotic-assisted techniques against free hand, fluoroscopy-guided, or comput-er-assisted navigation techniques were considered. Outcomes of interest included pedicle screw accuracy, intraoperative and postoperative screw revision, radiation exposure, operative time, blood loss, hospital length of stay, complications, patient-reported outcomes, learning curve, and economic considerations. Robotic platforms were additionally considered separately because differences between imaging, registration, mechanical guidance, and workflow may limit generalization of pulled results across systems. Results: The most consistent advantage of robotic-assisted spinal instrumentation concerns pedicle screw accuracy. Contemporary systematic reviews and meta-analysis generally demonstrate higher rates of optimal od clinically acceptable screw placement compared with conventional freehand or fluoroscopy-guided techniques, although the magnitude of benefit varies among robotic platforms, indications, and comparator techniques. Recent evidence also suggests that robotic assistance may provide an accuracy advantage over image-based navigation, however, differences in revision rates, operative time, blood loss, and complications are substantially less consistent. Radiation outcomes depend strongly on how exposure is defined. Robotic workflows can reduce occupational exposure to the surgical team by shifting imaging toward preoperative or intraoperative three-dimensional acquisition, but total patient radiation dose vary according to imaging modality, registration strategy, and institutional protocol. Evidence regarding operative duration is similarly heterogeneous and influenced by the learning curve and workflow maturity. Some studies report reductions in blood loss and length of stay, particularly when robotic assistance facilitates minimally invasive surgery, although these advantages cannot always be attributed to robotics independently of the operative approach. Evidence demonstrating superior long-term patient-reported outcomes, lower neurological complication rates, or reduced reoperation remains limited. High acquisition and maintenance cost, platform-specific workflows, registration errors, technical failure, and the need for dedicated team training remain important barriers to widespread implementation. Conclusions: Robotic assistance has become an established precision technology for spinal instrumentation, with the strongest evidence supporting improved pedicle screw placement accuracy. Its clinical value extends beyond accuracy through integration with navigation, advanced imaging, and minimally invasive surgical workflows, however, improved technical precision should not be equated automatically with superior patient outcomes. Future research should increasingly compare robotic systems with contemporary three-dimensional navigation rather than fluoroscopy alone and should prioritize standardized patient-centered outcomes, radiation dosimetry, workflow efficiency, long-term revision rates, and cost-effectiveness. Advances in artificial intelligence, automated surgical planning, augmented reality, and increasingly autonomous robotic functions my further expand the role of robotics from trajectory guidance toward comprehensive digital surgical platforms.

Abstract: Background/Objectives: Nonfunctioning pituitary neuroendocrine tumors (NF-PitNETs) frequently present with mass effect and may recur despite successful surgical treatment. Long-term outcomes from homogeneous surgical cohorts remain limited. Methods: We retrospectively reviewed consecutive patients who underwent microscopic transsphenoidal surgery (mTSS) of NF-PitNETs by a single surgeon at a tertiary center between 2003 and 2025. Demographic, radiographic, pathological, surgical, and follow-up data were analyzed. The primary outcome was recurrence, defined as loss of tumor control requiring additional treatment. Recurrence-free survival (RFS) was evaluated using Kaplan-Meier and Cox regression analyses. Results: A total of 381 patients were included with a median follow-up of 57 months. Median tumor size was 27 mm, and 98.5% were macroadenomas. Visual outcomes were available for 228 patients; 65.8% demonstrated postoperative improvement, while 4.8% worsened. Among 359 patients with available EOR data, GTR was achieved in 195 (54.3%), NTR in 89 (24.8%), and STR in 75 (20.9%). On multivariable logistic regression, Knosp grade >2 (OR 2.89, 95% CI 1.50-5.63; p=0.002) and subtotal resection (STR) (OR 7.62, 95% CI 3.25-17.83; p<0.001) were independently associated with recurrence. Cox regression demonstrated STR as the sole independent predictor of reduced RFS (HR 2.82, 95% CI 1.64-4.90; p<0.001). Conditioned RFS improved with longer recurrence-free intervals after GTR; however, late recurrences continued to occur, indicating persistent long-term risk. Conclusions: mTSS provides favorable visual outcomes and durable tumor control for most patients with NF-PitNETs. Knosp grade >2 and, particularly, STR are the strongest predictors of recurrence. Persistent late recurrence risk supports prolonged postoperative MRI surveillance.

Abstract: Timely recognition of intraoperative bleeding can support visualization and hemostatic response. This narrative review organizes representative systems by temporal purpose - anticipation, detection, and post-hoc assessment - while treating input sources separately. Video classifiers, object detectors, segmentation-assisted models, and synchronized device - video pipelines demonstrate distinct capabilities, but their reported metrics are not interchangeable. One device-associated detector achieved 81.0% sensitivity with 4.6% precision, corresponding to roughly eight false alerts per operation, whereas other studies evaluated event counts, duration, or warning lead time. We distinguish offline testing, streaming feasibility, and prospective intraoperative evaluation, and relate these evidence levels to event-level accuracy, alert burden, and response time. Current evidence remains limited by small datasets, uncertain transfer across procedures and institutions, workflow integration, and surgeon interaction. Future studies should test transferable contextual cues and determine prospectively whether alerts improve recognition or hemostatic response without excessive interruption.

Abstract: Background: Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition in neurologically impaired children. Although generally safe, inadvertent visceral organ damage during placement may result in rare, catastrophic events like gastrocolic perforation. Subsequent laparoscopic repair introduces further subtle risks, including the retention of broken surgical sharps due to the physical limitations of minimally invasive environments. Finding and extracting these small ferromagnetic components poses a severe technical dilemma, often prolonging anesthesia or forcing conversion to open laparotomy. Magnet-assisted techniques offer a rapid, low-impact rescue alternative. Case Presentation: A 14-year-old boy with severe neurodevelopmental deficits (Dandy–Walker malformation, cerebral palsy, refractory generalized epilepsy) presented with severe peritonitis two weeks following a PEG tube placement. Urgent diagnostic laparoscopy identified multi-site visceral injuries: a through-and-through perforation involving both the anterior and posterior walls of the transverse colon alongside an anterior gastric perforation, secondary to severe colon interposition. While laparoscopically repairing these visceral defects, a 26-mm curved suturing needle fractured inside a 10-mm working trocar, and the sharp tip disappeared into the peritoneal environment. Initial thorough inspection failed to localize the sharp. Postoperative abdominal radiography verified the fragment’s location within the left upper quadrant. During a secondary re-exploration, an improvised magnetic delivery system (comprising small sterile neodymium spheres sealed within a surgical glove finger) was passed through a trocar to rapidly target, capture, and extract the fragment. The subsequent course was complicated by standard adhesive mechanical ileus, requiring further laparoscopic adhesiolysis before successful stabilization. Conclusion: Concurrent gastrocolic organ perforation and intra-operative instrument fracturing represent a compounding crisis in fragile pediatric cohorts. This case highlights the biomechanical vulnerabilities of minimal-access closures and confirms that an improvised, glove-contained magnetic capture array provides a safe, highly reproducible means to locate and remove retained sharps without open surgery.

Abstract: Background/Objectives: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by dysregulated immune responses. This study aimed to assess the expression of IL-1β, IL-8, IL-10, and TNF-α in HS lesioned and non-lesioned skin and to examine their associations with selected clinical characteristics. Methods: Skin samples from HS lesions and non-lesioned skin were obtained from 52 patients. Histopathological changes were assessed using hematoxylin and eosin staining, and cytokine expression was evaluated by immunohistochemistry and quantified using ImageJ. Cytokine expression was analyzed according to Hurley stage and selected demographic and clinical characteristics. Results: Of 52 patients, 24 (46%) were female. Patient’s median age was 35.5 (IQR 26-44) years; 28 (54%) patients were categorized as Hurley stage 2 and 24 (46%) as stage 3. IL-1β, IL-8, IL-10, and TNF-α expression was significantly higher in lesioned than in non-lesioned skin (all p<0.05). IL-1β expression was higher in Hurley stage 2 than stage 3 (p=0.042), whereas IL-8 expression was higher in Hurley stage 3 (p=0.039). No significant differences were found according to sex, BMI, smoking, or biological therapy. TNF-α expression was significantly higher in patients with a positive family history of HS (p=0.049). Conclusions: HS lesions demonstrate increased expression of both pro-inflammatory and regulatory cytokines. Differences in IL-1β and IL-8 expression across Hurley stages suggest that inflammatory pathways may vary with disease stage. The association between TNF-α expression and positive family history may indicate a potential genetic influence on the inflammatory phenotype of HS.

Abstract: Complete (R0) resection remains the primary surgical objective for colorectal liver metastases (CRLM), but margin width cannot be interpreted independently of tumor anatomy, biology, and the amount of functional liver sacrificed to obtain it. This focused narrative review re-examines surgical margins from the perspective of parenchymal preservation and longitudinal multimodal treatment. We distinguish parenchymal R1 exposure (R1par), an undesirable transection-surface event associated with local recurrence, from planned vascular R1 detachment (R1vasc), which has shown more favorable outcomes than R1par in selected retrospective series but remains dependent on careful anatomical selection. Vessel-skeletonized parenchymal-sparing hepatectomy (VESPAH) is presented as one operative model for achieving complete macroscopic clearance while preserving intrahepatic vascular architecture. We further propose “treatment continuity”—preservation of the physiological and anatomical capacity to receive indicated systemic therapy and repeat local treatment—as a reportable surgical outcome. A four-axis framework integrating technical resectability, functional reserve, tumor biology, and future treatment options is outlined. R0 resection should remain the goal, but the quality of hepatectomy for CRLM may be more comprehensively assessed by considering both the margin achieved at the index operation and the treatments that remain feasible thereafter.