Medicine and Pharmacology

Abstract: Background: Shift work disrupts circadian rhythm and is associated with sleep disturbances and psychological distress. These factors may contribute to both gastroesophageal reflux disease (GERD) and temporomandibular disorders (TMD). However, the interplay between reflux symptoms, TMD severity, oral parafunctional behavior, and psy-chological distress in healthcare workers remains insufficiently explored. Object: To evaluate the association between GERD symptom severity and TMD severity among healthcare professionals and to investigate the role of shift work, oral parafunctions, and psychological distress in this relationship. Methods: This prospective cross-sectional study included healthcare professionals working at a tertiary hospital. Data were collected using validated questionnaires: GERD-HRQL, Fonseca Anam-nestic Index, Oral Behavior Checklist (OBC), Depression Anxiety Stress Scale (DASS-21), and Epworth Sleepiness Scale (ESS). Participants were categorized as shift workers (≥4 night shifts/month) and non-shift workers. Correlation and multi-variable regression analyses were performed. Results: A total of 240 participants were included. GERD symptom severity was positively correlated with TMD severity (r=0.31, p< 0.001), oral parafunction scores (r=0.28, p< 0.001), and DASS-21 stress scores (r=0.35, p< 0.001). Shift workers had significantly higher GERD-HRQL and TMD scores (p< 0.05). In multivariate analysis, TMD severity, stress score, and shift work remained independent predictors of GERD symptom severity. Conclusion: GERD symptoms in healthcare workers were significantly associated with TMD se-verity, oral parafunctional behavior, and psychological distress. Shift work appears to amplify this relationship. These findings suggest a need for multidisciplinary ap-proaches targeting occupational health.

Abstract: Background/Objectives: Acute hand infections are common in emergency surgery. Amputation is the ultimate fate when antibiotics and the prior surgical repair fail. Unsurprisingly, clinician tend to exaggerate with the evidence-based indications of antibiotic treatment and flaps. Methods: We investigate 166 risk association of community-acquired (traumatic) hand infection with amputation, overall treatment failure and the necessity for a secondary flap, using a specifically-designed retrospective single-center cohort between March 2018 October 2020 in Germany. Results: Among 600 adult patients (362 males; 71 (11.8%) with diabetes mellitus), 58 (9.7%) required an amputation. Multivariate Cox regression analysis identified only inherent risks associated with "amputation": male sex (odds ratio [OR] 3.12, 95% confidence interval [CI] 1.28-7.69), advanced age (OR 1.03, 95% CI 1.01-1.04), diabetes (OR 2.40, 95% CI 1.15-5.01, whereas all interventional variables such as early flapping or antibiotic-related parameters (early empiric antibiotic use, total duration of antibiotics and of tits parenteral part, choice of agents,) could not alter outcomes. Conclusions: In severe (traumatic) hand infections among adult German patients, the outcomes are determined by the extent of trauma and underlying co-morbidities. The outcomes do not seem to be effectively reduced by exaggerations of the indication of surgical or antibiotic interventions.

Abstract: Background/Objectives: Emergency abdominal surgery is associated with substantial morbidity and mortality due to disease severity, physiological instability, and limited opportunities for preoperative optimization. Accurate risk stratification is therefore essential for guiding clinical decision-making and resource allocation. This review aims to provide a contemporary overview of predictive models and artificial intelligence (AI) applications for risk stratification in emergency abdominal surgery. Methods: A narrative review of the literature was conducted using PubMed/MEDLINE, Scopus, and Web of Science databases. Studies addressing conventional risk assessment tools, predictive modeling, machine learning, deep learning, radiomics, explainable AI, and clinical implementation in emergency abdominal surgery were evaluated. Relevant publications concerning acute appendicitis, acute cholecystitis, intestinal obstruction, emergency laparotomy, abdominal sepsis, and acute mesenteric ischemia were included. Results: Conventional risk assessment systems, including ASA, APACHE II, SOFA, POSSUM, SORT, and NELA, remain widely used but are limited by static risk calculations and restricted adaptability. Recent advances in AI have enabled the development of machine learning and deep learning models capable of integrating complex clinical, laboratory, and imaging data to improve the prediction of disease severity, postoperative complications, and mortality. Disease-specific applications have demonstrated promising results in acute appendicitis, acute cholecystitis, intestinal obstruction, abdominal sepsis, and emergency laparotomy. Emerging technologies such as radiomics, computer vision, and explainable AI further enhance predictive performance and model interpretability. However, challenges related to external validation, algorithmic bias, transparency, regulatory compliance, and clinical integration remain significant barriers to widespread implementation. Conclusions: Artificial intelligence has the potential to significantly enhance risk stratification in emergency abdominal surgery by enabling more precise and individualized prediction of adverse outcomes. Although current evidence is encouraging, robust prospective validation and responsible clinical implementation are required before AI-driven predictive models can be routinely incorporated into emergency surgical practice.

Abstract: Reduction malarplasty (RMP) is performed frequently in East Asia. Although various complications of RMP have been reported, intracranial hemorrhage has been described only rarely. Although intracranial hemorrhage is an extremely rare complication, it is a catastrophic event that should not occur in aesthetic plastic surgery. In this review, I de-scribe the occurrence and prevention of this serious complication through a detailed analysis of intracranial hemorrhage following RMP. The two major surgical approaches to RMP are the coronal and intraoral incisions. In the coronal approach, osteotomy is per-formed under direct visualization, which allows precise bone cutting. There is no risk of penetrating the intracranial cavity during RMP performed via the coronal approach. Two reported cases of intracranial hemorrhage occurred during RMP performed via the intraoral approach due to inappropriate instrument handling. There is a potential risk of injury to the middle cranial fossa by a reciprocating saw or chisel during osteotomy of the zygomatic body. When performing an osteotomy on a zygomatic body using a reciprocat-ing saw in RMP via the intraoral approach, surgeons should avoid inserting the saw too deeply to prevent injury to the middle cranial fossa.

Abstract: Abstract Objective: This study aims to report a clinical case involving posterior fixation combined with anterior transoral plate osteosynthesis in the management of chronic Gehweiler Ⅲb atlas fracture-dislocation, thereby providing a reference for similar cases. Methods: A patient with atlas fracture-dislocation secondary to fall injury underwent surgical intervention. Preoperative diagnosis confirmed Gehweiler Ⅲb fracture with right atlantoaxial lateral mass dislocation. The treatment protocol involved posterior reduction, instrumentation, and anterior transoral screw-plate fixation. Results: The postoperative recovery proceeded without complications, with significant alleviation of cervical pain. The most recent follow-up assessment revealed favorable osseous consolidation and appropriate stabilization of the internal fixation apparatus. The VAS score decreased from 4 preoperatively to 0 postoperatively, the NDI decreased from 64% to 16%, concurrent with notable enhancement in patient quality of life. Conclusions: The implementation of combined posterior fixation and anterior transoral plate osteosynthesis demonstrates significant efficacy in ameliorating clinical manifestations and facilitating osseous consolidation in cases of chronic Gehweiler Ⅲb atlas fracture-dislocation. This surgical strategy demonstrates favorable therapeutic outcomes for refractory atlas fractures and warrants clinical application in analogous scenarios, but still requires extensive clinical verification.

Abstract: Background: Textbook Outcome (TO) is an emerging composite indicator to assess quality of care in colorectal cancer surgery by integrating oncologic adequacy and short-term postoperative outcomes into a single measure. However, its applicability in second-level hospitals remains poorly explored. Methods: A retrospective analysis of consecutive patients undergoing curative-intent colorectal cancer resection between January 2023 and December 2024 was performed. TO was defined as: R0 resection, ≥12 lymphnodes harvested, no major complications (Clavien-Dindo ≥IIIb), no re-operations, no 30-day readmission, length of stay < 10 days, and 90-day survival. Primary analysis focused on elective resections. Emergency cases were analyzed separately. Comparisons between groups were performed using the Mann–Whitney U test for continuous variables and Fisher’s exact test with risk ratios for categorical variables. Results: Seventy-seven patients were included: 62 elective and 15 emergency resections. Overall, TO was achieved in 45 of 77 patients (58.4%); specifically, TO was achieved in 69.4% (43/62) of elective cases. Individual TO components were satisfied in >90% of elective patients except LOS (72.6%). Emergency resections showed a markedly lower TO rate (13.3% vs 69.4%; p=0.0001), driven mainly by length of stay failure, higher major morbidity and mortality. Frailty, emergency surgery, open approach, and locally advanced tumor (p< 0.05) appeared significantly associated with TO failure. Conclusions: TO represents a valuable quality measure in colorectal surgery. Even in second-level hospital settings a satisfying rate of TO achievement can be reached. Emergency resections dramatically reduced TO attainment, despite preserved oncological standards, supporting separate reporting and benchmarking for elective and emergency colorectal cancer surgery.

Abstract: Background/Objectives: When presented with chronic osteomyelitis of the diabetic foot (DFO), clinicians, patients and their families have two options: rational use of antibiotics or direct surgery. Methods: We conducted a narrative, scientific literature review and administered questionnaires to DFO experts to investigate the factors indicating conservative, antibiotic-based therapy vs. direct surgery to treat DFO. Results: If large necrotic areas and destructed bone are present, providers may opt for a direct surgical amputation or internal resection of the infected bone (conservative surgery). Alternatively, they can choose conservative (targeted) antibiotic therapy lasting several weeks, with minimal soft tissue debridement, off-loading and iterative professional wound care. Conclusions: It is difficult to decide between the two treatments. The rationale for choosing either approach is complex, involving many clinical aspects to consider, which we discuss in this article.

Abstract: Introduction: Reconstruction of maxillary defects remains challenging because of the complex functional and aesthetic roles of the midface. Although both prosthetic obturation and microvascular reconstruction are established options, selecting the optimal modality remains controversial, particularly in low- and middle-income countries where resources may influence decision-making. This study evaluated functional and aesthetic outcomes of fibula free flap reconstruction compared with obturator rehabilitation following unilateral maxillectomy. Patients and Methods: This retrospective comparative study included 30 patients who underwent unilateral maxillectomy followed by either FFF reconstruction (n = 10) or obturator rehabilitation (n = 20) between November 2023 and November 2025. Demographic, clinical, operative, functional, and aesthetic data were collected from medical records and follow-up assessments. Functional outcomes were evaluated using a simplified Speech Intelligibility Scale and the Functional Oral Intake Scale (FOIS). Aesthetic outcomes were assessed using patient-reported satisfaction scores. Statistical analysis was performed using SPSS, with p < 0.05 considered statistically significant. Results: Patients in the FFF group were significantly younger than those in the obturator group (30.70 ± 13.70 vs. 49.15 ± 12.01 years, p = 0.002). Operative time and hospital stay were significantly longer in the FFF group (14.20 ± 1.23 vs. 4.15 ± 1.42 hours and 7.40 ± 0.84 vs. 4.05 ± 1.64 days, respectively; p < 0.001 for both). Functional outcomes favored FFF reconstruction, with significantly better speech intelligibility and speech scores at 6 months (p = 0.017 and p = 0.011, respectively). Although FOIS scores and dietary performance tended to be better in the FFF group, these differences did not reach statistical significance. Aesthetic satisfaction was higher in the FFF group but without statistically significant difference. Complications were limited and predominantly minor in both groups. Conclusion: Fibula free flap reconstruction provided better functional outcomes, particularly speech, in carefully selected patients with unilateral maxillary defects. However, obturator rehabilitation remains a reliable and resource-conscious alternative. Therefore, reconstructive decisions should be individualized according to patient factors, functional demands, and institutional capability.

Abstract: Introduction: Uterine leiomyosarcoma (uLMS) is a rare, highly aggressive malignancy arising from the smooth muscle tissue of the uterine wall. It typically presents with abnormal vaginal bleeding, pelvic pain, or a pelvic mass. In rare instances, symptoms may result from local invasion or metastasis. We report a case of uLMS initially diagnosed following colonic perforation due to direct tumor invasion, accompanied by a comprehensive narrative review of the literature on the incidental identification of uterine sarcomas during emergency general surgery to further emphasize the diagnostic challenges, treatment approaches, and need for individualized care in these complex cases. Case Presentation: A 45-year-old woman presented to the Emergency Department with acute abdominal pain of several hours' duration, in the absence of other associated symptoms. An emergency exploratory laparotomy was performed, revealing feculent peritonitis secondary to sigmoid colon rupture, resulting from local invasion by a large uterine mass. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was undertaken, followed by en bloc resection of the sigmoid colon, appendectomy and construction of a terminal colostomy. Her postoperative course was uneventful, and she was discharged on postoperative day eight. Histopathological examination of the specimen revealed a high-grade uterine leiomyosarcoma. Following evaluation by a multidisciplinary oncology board, the patient received adjuvant chemotherapy. Methods and Results: A narrative review of the literature was performed to identify cases of uterine sarcomas incidentally diagnosed during emergency surgery performed by general surgeons. Including the present case, six cases were identified. Most patients presented with acute abdomen mimicking gastrointestinal pathology, with diagnosis established intraoperatively or postoperatively. Definitive surgical management was achieved during the initial emergency procedure in all cases. Conclusion: Although exceptionally rare, uterine sarcoma should be considered in the differential diagnosis of acute abdomen in female patients undergoing emergency surgery. Awareness of this atypical presentation, the appropriate diagnostic approach, real-time intraoperative adaptability, and individualized multidisciplinary management are essential for ensuring appropriate surgical management and optimizing patient care.

Abstract: Background: Despite reducing hernia recurrence, synthetic meshes often trigger persistent foreign body responses (FBR). Mesh Enriched Therapies (MET), incorporating autologous cellular components (MSCs, PRP, SVF), can regeneratively reprogram the host-prosthetic interactome. Methods: Following PRISMA-ScR guidelines, a systematic search of PubMed, Embase, and Scopus (2000–2025) was conducted. We utilized the PCC (Population, Concept, Context) framework to map evidence across systemic inflammation, local FBR, and bio-augmentation strategies. Results: Sixty-five studies were synthesized into three pillars. Systemic Response (n=25): Established a predictable "foreign body signature" dominated by CRP and IL-6 spikes within 48h post-implantation. Local FBR (n=19): Human explant data (up to 180 months) revealed a perpetual immune-mediated state, characterized by MMP-2 driven matrix remodeling and "bridging fibrosis." MET Integration (n=21): Biological enrichment shifted the M1/M2 macrophage ratio toward a pro-regenerative (CD163+/CD206+) phenotype. While MET consistently enhanced VEGF-driven angiogenesis and improved the Collagen I/III ratio, a 22.2% discrepancy rate underscored the criticality of precise TGF-β1 dosage and release kinetics to avoid hyper-fibrosis. Conclusions: MET shifts hernia repair from passive mechanical reinforcement to active "biocamouflage" and integration. By modulating the Th1/Th2 rheostat, enriched therapies mitigate chronic inflammation and long-term complications. Standardized clinical trials are essential to optimize the therapeutic window for hybrid integration.

Abstract: Surgical resection remains a curative-intent treatment for hepatocellular carcinoma, but procedure-specific evidence for open minor hepatectomy using Takasaki’s Glissonean pedicle control remains limited. We retrospectively reviewed 74 consecutive patients with histologically confirmed hepatocellular carcinoma who underwent elective open minor hepatectomy, defined as resection of fewer than three Couinaud segments, using Takasaki-style Glissonean pedicle control at a Vietnamese hepatopancreatobiliary center between January 2021 and March 2024. Survival was estimated using the Kaplan–Meier method, and prognostic factors were explored using Cox regression. All patients had Child–Pugh class A liver function; 81.1% were hepatitis B surface antigen-positive and 87.8% had Barcelona Clinic Liver Cancer stage A disease. Median tumor diameter, operative time, and blood loss were 42 mm, 150 min, and 200 mL, respectively. R0 resection was achieved in 94.6%. Post-hepatectomy liver failure, major complications, and 90-day mortality occurred in 1.4%, 4.1%, and 1.4%, respectively. At a median follow-up of 39.6 months, 3-year overall and disease-free survival were 74.7% and 59.9%. This approach appears feasible and safe in selected Child–Pugh class A patients, with acceptable mid-term oncological outcomes.

Abstract: Background/Objectives: Total or partial pancreatectomy is associated with significant metabolic stress and high risk of postoperative malnutrition. Accurate estimation of resting energy expenditure (REE) is essential, as predictive equations may not reflect true energy needs. Methods: A prospective study among patients undergoing total or partial pancreatectomy for pancreatic tumors was conducted. REE was measured by indirect calorimetry (mREE) and compared with the Harris–Benedict and Schofield equations and the weight-based approaches (25 and 30 kcal/kg). Agreement was assessed using linear regression and Bland–Altman analysis, accuracy indices included ±10%, ±20%, Mean Absolute Percentage Error (MAPE) and Root Mean Square Error (RMSE). Results: In 26 patients (mean age, 66.7±8.7 years; 53.8% male) undergoing pancreatic resection (17 pancreaticoduodenectomies, 8 distal pancreatectomies, 1 total pancreatectomy), 60% were at preoperative malnutrition risk. Median measured REE was 1482 kcal/day, rising to 1706 kcal/day after activity adjustment (×1.15) within 14 postoperative days. At 3-6 months postoperatively, patients demonstrated significant declines in nutritional status with a median body weight reduction of −7.3% and a decrease in BMI of −2 kg/m2. The 30 kcal/kg method showed the lowest accuracy (MAPE 23.2%, RMSE 417 kcal/day) and overestimated energy needs. Harris–Benedict underestimated mREE in 61.5% of cases, while the 25 kcal/kg approach showed more balanced performance. Conclusions: Patients undergoing pancreatic resection exhibit elevated postoperative energy demands. Predictive equations lack reliability, favoring indirect calorimetry for precision. Sustained weight loss underscores the need for prolonged nutritional surveillance.

Abstract: Background: Extraskeletal osteosarcomas are rare, malignant mesenchymal neoplasms of soft tissues. They account for less than 1% of the soft tissue sarcomas. Primary breast osteosarcomas are extremely rare. They are often aggressive with poor prognosis and often pose diagnostic dilemma for the surgeon. We present a case along with the relative review of the literature. Materials and Methods: Demographics and imaging studies of the selected patient were collected. Written consent was obtained. The literature review included only articles cited on PubMed. The keywords used were “primary breast osteosarcoma”, “breast cancer” and “soft-tissue sarcoma”. Results: A 74-year-old woman presented with a large mass with hard texture on her right breast. She noticed this mass 2 months prior admission. Mammography and breast ultrasound showed a well-circumscribed round-shaped calcified mass on the upper central portion of the right breast. No clinically enlarged lymph nodes were detected in the axilla. Initially a benign calcified fibroadenoma was considered propable. However, the mass was enlarged in less than two months. Due to the tumors’ growth a lumpectomy was performed. The pathological examination revealed breast osteosarcoma with negative margins. Given the negative staging, tumor board recommended adjuvant chemotherapy and the patient had reached 4-year survival but died due to non-disease related issues. Conclusion: Primary breast osteosarcoma is an extremely rare clinical entity. A preoperative diagnosis is challenging. Due to the rarity of the disease, its clinical features range and treatment modalities remain highly personalized. High suspicion and proper treatment ensure early diagnosis and optimal prognosis.

Abstract: Artificial intelligence (AI) is increasingly integrated into emergency general surgery (EGS), where rapid diagnosis, accurate decision-making, and timely intervention are essential for improving patient outcomes. Recent advances in machine learning, deep learning, computer vision, and predictive analytics have enabled AI-assisted systems to support clinicians throughout the perioperative workflow. Current applications include radiologic image interpretation, diagnosis of acute abdominal conditions, surgical workflow recognition, intraoperative anatomical guidance, postoperative complication prediction, and intensive care monitoring. AI technologies may improve diagnostic accuracy, optimize operative planning, enhance surgical safety, and facilitate personalized perioperative management. In minimally invasive surgery, computer vision and real-time data analysis have shown promising results for intraoperative decision support and surgical education. However, important limitations remain, including concerns regarding data quality, algorithm transparency, ethical governance, regulatory approval, and implementation disparities between healthcare systems. In addition, much of the current evidence is derived from retrospective or highly specialized datasets, limiting broad clinical applicability. This narrative review summarizes the current clinical applications of AI in emergency general surgery and discusses emerging technologies, existing challenges, and future perspectives regarding the integration of AI into acute surgical care.

Abstract: Background/Objectives: Extramammary Paget’s Disease (EMPD) of the perineal region is a rare intraepidermal adenocarcinoma requiring wide excision, resulting in extensive defects that are challenging to reconstruct while preserving contour and function. This study evaluated the safety and efficacy of pedicled superficial circumflex iliac artery perforator (SCIP) flaps and pedicled anterolateral thigh (ALT) flaps for reconstruction of perineal defects following wide excision of EMPD. Methods: This retrospective case series reviewed patients with perineal EMPD who underwent wide excision followed by reconstruction using pedicled SCIP flaps or pedicled ALT flaps. Patient demographic and lesion characteristics, operative and flap characteristics, post-reconstruction complications, oncologic outcomes, and satisfaction were analyzed. Results: 15 patients (mean age 63 years, SD 7.3) were included in this case series. 10 patients underwent reconstruction using pedicled SCIP flaps (mean 106 cm², SD 23.3) and 5 patients with pedicled ALT flaps (mean 245.2 cm², SD 41.2). All flaps survived, but one patient developed limited partial necrosis managed with secondary healing. During a mean follow-up of 17.7 months (SD 1.3), one patient (6.7%) developed recurrence and eventually distant metastasis resulting in death. Most patients (93.3%) reported overall satisfaction with cosmetic and functional outcomes. Conclusions: Pedicled SCIP and ALT flap reconstruction provides reliable, well-vascularized tissue coverage for perineal EMPD defects and achieves favorable aesthetic and functional outcomes with acceptable complication rates. The choice between flap types should be tailored to defect size, location, and patient characteristics.

Abstract: Background/Objectives: Intraoperative ultrasound (IOUS) has become an integral component of modern hepatic oncology surgery, providing real-time imaging guidance during liver resections for hepatocellular carcinoma, colorectal liver metastases, and other primary or secondary hepatic malignancies. Despite substantial improvements in preoperative imaging modalities, occult lesions, disappearing metastases after chemotherapy, and complex vascular relationships continue to represent major in-traoperative challenges. This structured narrative review aimed to evaluate the con-temporary role of IOUS in hepatic oncology surgery, with particular emphasis on con-trast-enhanced intraoperative ultrasound (CE-IOUS), minimally invasive liver sur-gery, navigation-assisted hepatectomy, and emerging artificial intelligence-based technologies. Methods: A structured literature review was conducted using PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar databases. Peer-reviewed studies, interna-tional guidelines, consensus statements, systematic reviews, and technological reports addressing IOUS applications in liver surgery were analyzed. Particular focus was placed on studies evaluating lesion detection, intraoperative strategy modification, disappearing colorectal liver metastases, parenchymal-sparing hepatectomy, laparo-scopic and robotic liver surgery, navigation systems, augmented reality integration, and AI-assisted imaging technologies. Results: Contemporary evidence demonstrates that IOUS continues to significantly influence intraoperative decision-making despite advances in magnetic resonance imaging and multidetector computed tomography. CE-IOUS improves the detection of occult hepatic lesions and residual disease after systemic chemotherapy, particularly in disappearing colorectal liver metastases. IOUS-guided anatomical and parenchy-mal-sparing resections contribute to preservation of functional liver parenchyma while maintaining oncologic radicality. In minimally invasive liver surgery, laparo-scopic ultrasound remains essential for lesion localization and vascular mapping. Re-cent developments integrating navigation systems, augmented reality platforms, and AI-assisted image recognition suggest a progressive transition toward digitally assisted precision liver surgery. Conclusions: IOUS remains a cornerstone of modern hepatic oncology surgery and continues to evolve from a localization tool into a comprehensive platform for preci-sion-guided liver resection. The integration of CE-IOUS, navigation technologies, and artificial intelligence may further enhance intraoperative accuracy, oncologic safety, and individualized surgical planning in the future.

Abstract: Background: Laparoscopic surgery requires technical, perceptual and psychomotor skills that differ from those used in open surgery. Simulation, box trainers, virtual reality and augmented reality have therefore been incorporated into surgical education to support safe, repeated practice before exposure to real clinical scenarios. However, evidence on students’ perceptions of these technologies remains dispersed, and direct evidence for Surgical Instrumentation students is particularly limited. Objective: To map the available evidence on health sciences students’ perceptions of emerging technologies in laparoscopic training and to identify implications for Surgical Instrumentation education. Methods: A scoping review was conducted following PRISMA-ScR and JBI guidance. The review question was structured using the PCC framework: population, health sciences and surgical training students; concept, perceptions of emerging technologies; and context, laparoscopic surgery education. PubMed/MEDLINE, Scopus, Web of Science, Redalyc and Google Scholar were searched for publications in English or Spanish from January 2020 to March 2025. Two reviewers independently screened records and resolved disagreements by consensus. Findings were synthesized narratively. Results: A total of 1,800 records were identified. Fifty-seven full-text reports were assessed, and 11 studies met the eligibility criteria. Ten of the 11 studies reported favorable perceptions of emerging technologies, mainly related to confidence, satisfaction, perceived safety, self-efficacy and opportunities for repeated practice. Most studies involved medical students, surgical residents, nursing students or mixed surgical trainees; only one study directly addressed Surgical Instrumentation students. Conclusions: Emerging technologies are generally perceived favorably in laparoscopic training, but their educational value depends on structured pedagogy, feedback, faculty development, access to equipment, and objective assessment. The limited direct evidence in Surgical Instrumentation supports the need for multicenter studies, validated perception instruments and competency-based evaluations adapted to this professional field.

Abstract: Background: Intestinal stomas affect an estimated 1.5 million people worldwide. The comparative psychosocial burden of colostomy versus ileostomy remains poorly synthesised, leaving clinicians without quantitative guidance for shared decision-making. Methods: PRISMA-2020-compliant systematic review and random-effects meta-analysis (DerSimonian–Laird) of studies published January 2000–March 2026 (PubMed/MEDLINE, Embase, Cochrane Library, PsycINFO). Of 47 studies in the systematic review (n = 38,612), 22 contributed extractable means ± SD to the quantitative meta-analysis. The SMD was coded as colostomy minus ileostomy on the respective scale: a positive SMD on symptom/burden scales (depression, body image disturbance) indicates greater burden in colostomy; a positive SMD on HRQoL scales (higher = better) indicates better HRQoL in colostomy. Subgroup analyses were prespecified for stoma duration (temporary vs. permanent) and indication (oncological, IBD, other). Publication bias was assessed with Egger’s test and trim-and-fill. Results: Colostomy patients had slightly better global HRQoL on disease-specific instruments than ileostomy patients (SMD = +0.12, 95% CI +0.03 to +0.21; I² = 46%), driven by output-related morbidity in ileostomy. However, colostomy patients experienced greater depressive symptoms (SMD = +0.42, 95% CI +0.10 to +0.74; I² = 8%), worse body image (SMD = +0.36, 95% CI +0.14 to +0.58; I² = 61%), and poorer sexual function, particularly after abdominoperineal resection (SMD = −0.48, 95% CI −0.71 to −0.25 on higher = better scales). Permanent stomas were associated with greater body image disturbance and poorer physical functioning than temporary stomas Conclusions: Colostomy and ileostomy produce comparable global HRQoL but distinct psychosocial signatures. Stoma type alone is a weaker determinant of HRQoL than duration, complications, sex, age, and indication. These findings should inform individualised counselling, stoma siting, and structured psychosocial follow-up programmes.

Abstract: Background: When burn patients develop cytopaenias, particularly thrombocytopaenia and anaemia, it is commonly attributed to either a systemic inflammatory response syndrome or wound sepsis. However, disproportionate haematological derangements relative to the burn severity should raise a suspicion for an alternative pathology, including underlying malignancies. Methods: We report a retrospective case review of a patient with a minor 4% total body surface area scald burn who presented with a severe thrombocytopaenia, anaemia, leucocytosis, and gastrointestinal bleeding not responsive to conventional medical therapy. Results: The severity of the cytopaenia and lack of response to blood transfusions were inconsistent with the extent of the burn injury, prompting further investigations. Subsequent evaluation of a peripheral blood smear revealed findings in keeping with acute promyelocytic leukaemia, a rare but potentially curable subtype of acute myeloid leukaemia. Conclusion: This case highlights disproportionate cytopaenias in minor burns as a critical red flag for further evaluation and a broader differential. Focusing only on sepsis as a cause may potentially delay a definitive diagnosis. We advocate for early escalation of investigations such as a peripheral blood smear assessment when refractory cytopaenias cannot sufficiently be explained by the expected progression for the burn size to potentially improve patient outcomes.

Abstract: 15% of all soft tissue tumors are located on the hand and wrist. Only 2% of lesions are malignant. Considering that most masses are benign, if clinical evaluation and ul-trasound show frankly benign features for lesions smaller than 3 cm, a primary exci-sional biopsy is justified. If the history and clinical evaluation or imaging show fea-tures suggestive of malignancy, a second-level imaging method is indicated. Treatment in a non-oncology center including unplanned excision does not influence the progno-sis. The primary objective of the study is to evaluate the effectiveness of our treatment method for wrist and hand tumors smaller than 3 cm in size, with primary excisional biopsy performed as an outpatient surgery procedure, following a clinical and anam-nestic assessment and ultrasound imaging, in terms of functional and aesthetic benefit and reduction of any painful symptoms. The secondary objectives are to demonstrate the advantages of treating these tu-mors with our procedure in limiting the overload of specialist oncology centers and to evaluate the outcomes of the excisional biopsy in terms of prognosis in patients who tested positive for malignant disease at histological examination. In the present study, we retrospectively analyzed 209 specimens from surgical ex-cision of masses with a diameter of less than 3 cm involving the wrist and hand from 01/01/2015 to 01/06/2024, from a patient aged over 18 years. In our clinic, during the first outpatient visit, the patient's medical history is collected, a clinical evaluation is performed, first-level tests such as X-rays are performed, and any ultrasound exami-nations are acquired. If no risk factors or red flags for malignant pathologies emerge, the patient is offered excision under outpatient surgery. On the day of surgery, ultrasound examinations are acquired, local anesthesia is performed with the WALANT technique, and the mass is excised. At the end of the procedure, the specimen is sent to pathology for histological examination. The most frequent histological diagnosis was ganglion cyst (44,98%) the second diagnosis in frequence was giant-cell tumor of the synovial sheath (15,32%). Only one case (0,48%) had a diagnosis of malignant disease. According to our method, in accordance with the literature, tumors < 3 cm in size can be treated with excisional biopsy, without necessarily overloading specialized on-cology centers for such tumors.