Abstract:

Intraoperative assessment of pancreatic quality, followed by sampling for the potential isolation of Langerhans islets for subsequent autotransplantation, is currently a key component of post-total pancreatectomy diabetes mellitus treatment. The aim of this study was to quantitatively evaluate pancreatic parenchymal stiffness using optical coherence elastography (OCE) imaging, and to investigate the utility of the OCE method as a potential indicator of islet yield after pancreatectomy. A total of 41 freshly excised human pancreatic specimens, containing pancreatic ductal adenocarcinoma (PDAC) and surrounding non-tumorous tissues post-pancreatectomy, were studied. In this research, the stiffness (Young’s modulus, kPa) and its color-coded 2D distribution were calculated for various pancreatic samples using compression OCE. Stiffness values were compared between intact pancreatic parenchyma (islet-poor and islet-rich) and pancreatic lesion groups (parenchymal fibrosis and/or PDAC invasion). The data were confirmed by histological analysis. In addition, the measured stiffness values for various morphological groups of the pancreatic samples were compared with the number of isolated islets obtained from pancreatic samples after collagenase treatment. The study demonstrated that OCE can effectively distinguish areas of pancreatic lesions and identify intact pancreatic parenchyma containing Langerhans islets. A highly significant increase in mean stiffness (p<0.0001) was observed in postoperative pancreatic samples exhibiting signs of parenchymal fibrosis or PDAC invasion compared to unaffected, intact pancreatic parenchyma. For the first time, a relationship between stiffness values and the number of isolated pancreatic islets was demonstrated, in particular, the number of isolated islets significantly decreased (≤110 pcs/g) in samples exhibiting stiffness values above 150 kPa and below 75 kPa. The optimal stiffness range for the efficient isolation of islets (≥120 pcs/g) from pancreatic tissue was identified as 75–150 kPa. The study introduces a novel approach for rapid and objective intraoperative assessment of pancreatic tissue quality using real-time OCE data. This technique facilitates the identification of regions affected by pancreatic lesions and supports the selection of intact pancreatic parenchyma, potentially enhancing the accuracy of Langerhans islet yield predictions during surgical resection.

Abstract: Artificial intelligence (AI) offers multiple advantages such as: improvement and accuracy of the diagnosis, decrease of the doctors’ workload, decrease of the hospitalization costs, becoming increasingly widespread, studied, and applied in medicine. The use of AI and the study of the specialty literature raise ethical and legal questions for which there is no unanimous answer yet. Medical liability (malpractice) for AI‑related errors and damages for the patient prompt legal reflections on this topic. The diagnostic algorithms of AI raise questions regarding the risks of using AI in the diagnosis and treatment of cancer (especially in rare cases), the information provided to the patient, all of these having moral and legal implications, as well as regarding the impact on the empathic doctor–patient relationship. Actually, the use of AI in the medical field has triggered a revolution in the doctor-patient relationship, but it has possible medico‑legal consequences as well. The current legal framework regulating medical liability when AI is applied is inadequate and requires urgent measures, because there is no specific and uniform legislation to regulate the liability of the various parties involved in applying AI, or that of the end-users. Consequently, greater attention should be paid to the risk of applying AI, to the necessity to regulate its safe use, and to maintain the safety standards of the patient by continuously adapting and updating the system.

Abstract: Patient satisfaction is crucial to aesthetic surgery, yet measuring how well outcomes meet patient expectations has always been challenging. Rather than relying on the surgeon’s impression, we’ve synthesized research on Patient-Reported Outcome Measures (PROMs) in facial aesthetics. Our work zeroes in on the FACE-Q instrument and explores newer technological applications. We conducted a comprehensive literature review of studies on facelifts (563 patients across 10 studies), injectable treatments (2292 patients in 23 studies), and rhinoplasty (937 patients across 10 studies). Our original data came from a Dutch cohort of Clinique Rebelle in Amsterdam—259 patients undergoing facial procedures, supplemented by Computerized Adaptive Testing (CAT) simulation research. The FACE-Q scales demonstrated strong psychometric properties—Cronbach’s alpha between 0.885 and 0.951—and successfully captured differences between patients that traditional photos miss. CAT methods reduced questionnaire length by roughly 71% without sacrificing measurement accuracy (r = 0.98 with complete surveys). Looking ahead, machine learning shows real potential for forecasting patient satisfaction outcomes. Implementing routine PROM collection in aesthetic practice makes sense on multiple fronts: better patient selection, benchmarking quality across surgeons, protecting against medicolegal concerns, and aligning with value-based healthcare models. We also discuss how AI and 3D imaging might reshape outcome assessment going forward.

Abstract: Background/Objectives: Axillary lymph node dissection (ALND) remains an essential component of breast cancer surgery for selected patients, particularly those with clinically involved nodes or residual disease after neoadjuvant therapy. However, ALND is consistently associated with postoperative lymphatic morbidity, including seroma formation, prolonged drainage, and breast cancer–related lymphedema (BCRL), which adversely affect quality of life and increase healthcare utilization. This review aims to evaluate contemporary ALND strategies with a particular focus on the Total Sealing Technique (TST), a technique-centered approach that emphasizes comprehensive lymphatic sealing rather than device substitution. Methods: A narrative review of the literature was conducted to synthesize available experimental, histopathological, and clinical evidence related to TST. Studies evaluating biological mechanisms, perioperative outcomes, long-term lymphatic complications, and health economic implications of TST were reviewed and contextualized alongside data from conventional electrocautery-based techniques and energy-device substitution strategies. Results: Across published studies, TST is consistently associated with reductions in postoperative drainage volume, duration of drain placement, incidence of seroma formation, and length of hospital stay. Importantly, long-term follow-up data demonstrate a marked reduction in the incidence of BCRL compared with conventional ALND techniques. These benefits are achieved without increases in operative time, perioperative complications, or compromise of oncological safety. From a health economic perspective, reductions in inpatient hospitalization, outpatient seroma management, and long-term lymphedema-related care translate into meaningful per-patient cost savings. Conclusions: The available evidence supports TST as a reproducible and scalable surgical strategy that effectively reduces both short-term postoperative morbidity and long-term lymphatic complications following ALND. By addressing lymphatic injury at the time of initial surgery, TST aligns with contemporary priorities in breast cancer care, including survivorship, quality of life, and value-based healthcare delivery.

Abstract:

Background: High-voltage electrical injuries, though less common than domestic electrocution in developing countries, can be devastating, particularly when involving bilateral lower limbs. These injuries pose significant challenges due to prolonged immobilisation and complications such as deep vein thrombosis, pressure ulcers, and potential limb loss. Case Presentation: We report the case of a 60-year-old male who sustained bilateral ankle high-voltage electrical burns following accidental contact with an overhead transmission line. The injuries resulted in extensive soft-tissue loss and exposed joints. Management: The patient was managed through a multidisciplinary approach involving the burns team, orthopaedic surgeons, rehabilitation specialists, and social counsellors. The treatment strategy included serial debridements, negative pressure wound therapy (NPWT), skeletal stabilisation using hybrid Ilizarov external fixators, and staged soft-tissue reconstruction with a reverse sural artery flap and split-thickness skin grafting. Outcome: The limb salvage outcome was successful, with progressive wound healing and functional recovery. The coordinated involvement of multiple specialties played a pivotal role in managing this complex case. Conclusion: This case highlights the importance of early multidisciplinary collaboration in the successful management of high-voltage electrical injuries, particularly those involving bilateral lower extremities with joint exposure.

Abstract: Background/Objectives: Obesity is frequently associated with dyslipidemia, insulin re-sistance, and increased cardiovascular risk. Bariatric surgery, particularly Roux-en-Y gastric bypass (RYGB), has been shown to improve metabolic outcomes; however, data integrating lipid profile changes with atherogenic and insulin resistance indices over extended follow-up remain limited. This study aimed to evaluate the longitudinal impact of RYGB on lipid parameters, atherogenic indices, and insulin resistance markers up to 18 months postoperatively. Methods: A longitudinal observational study was conducted in 40 adults with obesity (mean age 46.6 years; 82.5% women) undergoing RYGB. Bio-chemical and anthropometric data were collected preoperatively (E1) and at 6 (E3), 12 (E4), and 18 (E5) months after surgery. Lipid profile parameters, atherogenic indices (TG/HDL ratio, atherogenic indices Castelli I and Castelli II), and insulin resistance–related indices (TyG-BMI, MTS-IR) were analyzed descriptively over time. Results: RYGB induced a marked and sustained reduction in triglycerides, total cholesterol, and LDL cholesterol, alongside a progressive increase in HDL cholesterol. All atherogenic indices demon-strated consistent postoperative declines, indicating reduced cardiovascular risk. Insulin resistance indices showed pronounced improvement, particularly within the first 12 months, with stabilization thereafter. These metabolic benefits occurred in parallel with significant weight loss and reductions in central adiposity. Conclusions: Roux-en-Y gastric bypass promotes sustained improvements in lipid metabolism, atherogenic risk, and insulin resistance up to 18 months after surgery. The integration of lipid-derived and insulin resistance indices provides valuable insight into postoperative cardiometabolic risk reduction, supporting the role of bariatric surgery as an effective intervention for long-term cardiovascular risk mitigation.

Abstract: The compelling study by Liu et al delivers a critical verdict: The primary tumor site is not merely an anatomical detail, but a fundamental prognostic imperative in the surgical management of colorectal liver metastases. Their analysis of 178 patients definitively establishes right-sided colonic origin as an independent harbinger of aggressive disease, characterized by significantly higher recurrence rates and inferior survival outcomes compared to left-sided and rectal cancers. This biological dichotomy is further elucidated by the strong association of right-sided tumors with an adverse prognostic profile, including rampant lymph node metastasis, elevated D-dimer (reflecting a pro-thrombotic, pro-metastatic state), hypoalbuminemia, and resistance to neoadjuvant therapy. These findings necessitate an immediate paradigm shift in clinical practice. We can no longer treat colorectal cancer as a monolith. Preoperative risk stratification, surgical decision-making, and adjuvant therapy plans must be tailored according to the primary tumor location. For patients with right-sided primaries, these data suggest a more aggressive multimodal approach and vigilant, personalized surveillance to improve upon the discouraging outcomes this study clearly exposes.

Abstract: Background: Digital pulp reconstruction with toe based flaps reliably restores sensibility, durability, and contour, one aspect that has received little attention is the healing be-havior of viable digital fat. This study evaluates outcomes from a large series of free toe flaps with specific attention to the healing behavior of preserved subcutaneous fat and its contribution to contour refinements. Methods: We retrospectively reviewed consecutive digital reconstructions performed with free toe flaps and several variations (pulp toe flap, chimeric pulp toe flap, trimmed great toe flap and chimeric pulp+ trimmed great toe). Particular attention was given to healthy subcutaneous fat deliberately maintained or exposed to help shape the final contour. All patients were followed clinically and pho-tographically until complete healing occurred. Results: A total of 133 patients underwent a finger reconstruction with a with free toe flaps and several variations. The preserved fat layer was intentionally left exposed to promote healthy granulation and spontaneous epithelialization, contributing favorably to the final contour of the distal pulp as the nail advanced. All wounds healed within three to four weeks without the need for skin grafts. All patients achieved good to excellent functional and aesthetic outcomes with minimal donor-site morbidity .Conclusion: This large retrospective series confirms the reliability of healthy flap to help in the shape of the digital reconstruction, highlighting the re-generative potential of viable digital fat. Incorporating this concept into flap design may reduce the need for grafting, minimize donor-site morbidity, and enhance reconstructive outcomes in hand surgery.

Abstract: Background: Ductoscopic resolution is insufficient to distinguish the flat lesions and microcalcifications that indicate malignancy in patients with pathologic nipple discharge (PND). This study evaluated the feasibility of imaging intraductal epithelial layers, premalignant, or malignant lesions using catheter-integrated optical coherence tomography (OCT) through the nipple orifices. Methods: Mastectomy specimens were prospectively obtained from patients who had undergone simple or skin-sparing mastectomies for either malignancy (n = 14) or prophylaxis (n = 4). Ductoscopy was used to ensure that the OCT catheter was safely inserted through the nipple orifice of the ex vivo specimens. Cross-sectional OCT scanning of the ductal epithelial layers was performed to acquire high-resolution images of approximately one million pixels. The abnormal lesions identified on the OCT images were evaluated using correlating histopathologic analyses. Results: Fourteen out of 18 mastectomy specimens could be cannulated and distended using ductoscopic instruments and saline. Only 4 out of 18 specimens had presented with clinical PND. To confirm that the ductoscopic trocars were located inside the ducts, 14 specimens were randomly selected and explored with ductoscopy. The OCT catheter was able to insert through the ductoscopic trocars in 10 specimens and revealed one in situ ductal cancer (DCIS) in a cancer-involved specimen and one florid ductal hyperplasia in a prophylactic specimen. Both lesions were confirmed by histopathological correlations. The OCT scanning did not detect malignant lesions in 80% of the specimens without PND; however, the OCT scanning did detect microcalcifications and undefined lesions. Conclusion: This is the first published study to confirm the feasibility of intraductal breast OCT to show millimetric Florid Ductal Hyperplasia and a DCIS in a prophylactic and cancer involved specimen, respectively.

Abstract: Background The structural integrity of the abdominal wall is critically dependent on the organization of aponeurotic tissue, a dense collagen-rich connective structure responsible for directional force transmission. While the clinical relevance of the aponeurosis is well recognized in abdominal wall reconstruction, its nano-scale structural organization remains insufficiently characterized. Atomic force microscopy (AFM) provides a suitable approach for investigating surface morphology and nano-architectural features of biological tissues. Methods Human aponeurotic tissue samples were analyzed using atomic force microscopy operated in contact-mode deflection and topography imaging. Two-dimensional and three-dimensional surface topographies were acquired at the micrometer scale to assess nano-architectural organization. Areal surface roughness parameters (Sa, Sq, Sp, Sv, Sy) were calculated to quantify morphological heterogeneity. AFM deflection imaging was used to evaluate relative spatial variations in the tip–sample interaction signal (deflection contrast) across collagen-dense and interfibrillar regions. Results AFM analysis revealed a well-organized fibrillar architecture with preferential orientation, consistent with the anisotropic organization of aponeurotic connective tissue. Deflection images demonstrated spatial variations in the tip–sample interaction signal across collagen-dense and interfibrillar regions, indicating heterogeneity at the scanned scale. Surface topography showed a continuous morphology with moderate height variations and smooth transitions between structural elements. Roughness parameters reflected a compact extracellular matrix organization within the scanned areas, without features suggestive of surface disruption. Conclusions Atomic force microscopy enables detailed nano-scale structural characterization of human aponeurotic tissue and reveals spatial heterogeneity in deflection/interaction contrast at the scanned scale. These findings provide a nano-scale reference framework for future comparative investigations involving synthetic meshes and may contribute to a more refined understanding of tissue–implant interactions in abdominal wall reconstruction.

Abstract: Background: Auricular carcinomas often require extensive surgical resection, resulting in complex three-dimensional defects,in some cases involving mastoid process exposure. Reconstruction aims to restore contour, protect underlying structures, and maintain patency of the external auditory canal (EAC). Case presentation and methods: We present a 45-year-old male patient, without comorbidities, who underwent subtotal auricular resection and wide retroauricular excision for basal cell carcinoma, resulting in mastoid bone exposure. Reconstruction was achieved using a temporal muscle flap covered by a skin graft, combined with a Z-plasty of the external auditory meatus to prevent postoperative stenosis. Recovery was uneventful, and 4 year follow-up demonstrated stable structural outcomes, preserved diameter of the meatus, without recurrence of the disease.The patient is prepared for autologous or prosthetic auricular reconstruction. Conclusion: A temporalis muscle flap with skin graft coverage offers a reliable, vascularized solution for large post-oncologic auricular defects while preserving the external auditory canal. Z-plasty remains a critical technique for preventing meatal stenosis.

Abstract: Facial gender-affirming surgery (FGAS) is a transformative step for transgender individuals in their gender care journey. Even so, the way outcomes are measured and reported is highly inconsistent and unstudied. This limits the ability to compare studies or develop clear, patient-centered benchmarks for success. We systematically assess how current research defines FGAS outcomes and lay the groundwork for a unified core outcome set (COS). A systematic review was conducted following PRISMA 2020 guidelines. PubMed was searched through March 15, 2025, we identified 334 studies, and four reviewers independently screened studies. After screening, 232 studies met inclusion criteria, encompassing 30,937 patients. Data were extracted on study characteristics, surgical procedures, outcome domains, measurement tools, and follow-up duration. Descriptive statistics and chi-square analyses were used to evaluate reporting trends. Most studies emphasized aesthetic outcomes (61.6%) and complications (60.0%), fewer addressed psychosocial well-being (45.7%), quality of life (21.6%), or reoperation rates (20.7%). Only 26 of the 232 studies used validated outcome instruments, such as FACE-Q or PROMIS (p < 0.001). Among studies that reported satisfaction, only 41.2% provided numerical or stratified scores. Outcome reporting in FGAS research is fragmented and dominated by subjective or unvalidated assessments. A standardized COS is needed to unify research practices, facilitate meaningful comparisons, and ensure that outcomes align with patient-defined measures of surgical success.

Abstract: Background/Objectives: Intraoperative neuromonitoring (IONM) has improved safety in thyroid and parathyroid surgery, yet intermittent IONM (I-IONM) may miss traction injuries developing between stimulations. We evaluated the feasibility and clinical utility of a trend-based intermittent monitoring mode (NIM Vital NerveTrend®) that records closely spaced stimulations and plots amplitude and latency over time. Methods: We conducted a prospective observational study at a high-volume endocrine surgery unit (January–September 2025). Forty-four consecutive patients undergoing thyroidectomy and/or parathyroidectomy with NerveTrend® were enrolled. EMG responses were categorized as Green (amplitude >50% of baseline and latency < 110%), Yellow (amplitude < 50% or latency >110%), Red (amplitude < 50% and latency >110%), and Loss of Signal (LOS: amplitude < 100 µV). Primary outcomes included LOS prevalence and the association between stimulation frequency and the appearance of Yellow trends. Ethical approval: AVEN protocol 486/2024/OSS/AOUPR; informed consent obtained. Results: Of 71 nerves at risk (NAR), 55 had a valid baseline and were analyzed; LOS occurred in 3/55 NAR (5.5%). The mean number of stimulations per NAR was 4.5 (range 1–9). Cases with both Green and Yellow points had a significantly higher mean number of stimulations than cases with only Green points (5.1 vs. 3.8; Student's t-test p = 0.0059). One Red measurement occurred in a case that progressed to LOS. Conclusions: NerveTrend® provided near real-time functional feedback while maintaining the simplicity of I-IONM. Increased stimulation frequency was associated with early Yellow trend alerts, potentially signaling traction stress and enabling timely surgical adjustments. Larger multicenter studies and protocol standardization are warranted.

Abstract:

Background and Clinical Significance: Typically, late complications of temporary or left-in-situ cholecystostomy in patients with acute calculous cholecystitis are related to retained calculi, which are ultimately resolved by cholecystectomy. Neoformation of gallstones secondary to temporary cholecystostomy in an acalculous (disease-free) gallbladder may be neglected because of a low index of suspicion, until the occurrence of late complications. Case presentation: A 54-year-old female underwent surgery (open procedure, May 2003) for a complicated postbulbar ulcer (stenosis with gastric outlet obstruction; penetration into the common bile duct): troncular vagotomy, distal hemigastrectomy, Roux-en-Y gastrojejunostomy. Temporary cholecystostomy (in an acalculous gallbladder) was added as a supplementary precaution to prevent duodenal stump leakage. Despite medical advice, she never presented for control and was lost for follow-up. The patient (now aged 75) was urgently admitted 21 years later (September 2024) with acute pain in the right upper abdominal quadrant and fever. She was unable to provide medical documentation and had a poor recall of surgical history; we were able to retrieve the operative report because the patient had been operated in our clinic. Physical examination was suggestive of an abscess, overlying cellulitis centered on spontaneous purulent discharge (presumed through the pre-existing drainage tract of the previous cholecystostomy). Abdominal CT demonstrated: emphysematous calculous cholecystitis, an abdominal abscess, and cholecystocutaneous fistula. A transverse incision, centered on the cutaneous fistulous orifice, was followed by discharge of pus and calculi, parietal debridement, and extraction of a fragment of gangrenous gallbladder tissue. Magnetic resonance cholangiopancreatography (MRCP) on day 17 demonstrated a remnant gallbladder containing multiple calculi; the patient was advised to undergo complete cholecystectomy, but once again, neglected medical advice and was lost for follow-up. Conclusions and Further Directions: Temporary cholecystostomy in a disease-free (acalculous) gallbladder, associated with gastric surgery, leads to gallbladder dysmotility and neoformation of gallstones. The first clinical manifestation of silent, undetected neo-formatted calculi may consist of late, potentially lethal, biliary complications. Patients must be subjected to follow-up because the incidence of neo-formed calculi is higher than expected, compared with common gallstones. Prophylactic cholecystectomy for asymptomatic neo-formatted gallstones is a reasonable choice.

Abstract: Research on gut-microbiota (GM) changes in infants and children with intestinal surgical conditions, and how these changes might leverage to improve outcomes, is progressing rapidly. Nonetheless, there is a lack of information regarding the role of GM following surgery for the most prevalent intestinal pediatric disorders that necessitate surgical intervention, despite it receiving considerable interest. Pre-surgical dysbiosis and post-surgical GM assessment of these disorders are still poorly understood. This detailed review has gathered insights into the current understanding of unique alterations in GM colonization following surgery for significant childhood conditions, such as necrotizing enterocolitis (NEC), Hirschsprung’s disease (HD), inflammatory bowel disease (IBD), and short bowel syndrome (SBS).In particular, surgery for NEC may result in a reduction in GM diversity. Surgical procedures for HD can alter the GM, potentially causing shifts in GM compositions and increasing the likelihood of complications such as Hirschsprung’s associated enterocolitis (HAEC). For children diagnosed with IBD, surgical interventions can bring about changes in the diversity and structure of GM, which may lead to disease recurrence or affect the success of treatment. Children with SBS, following extensive bowel resections, display abnormal GM profiles when compared to healthy children. These GM patterns may include diminished. GM diversity, an increase in inflammation-related bacteria, and a decrease in beneficial bacteria. Moreover, the most common complications that occur after surgical procedures for the above-mentioned intestinal disorders are greatly affected by the GM. Current research provides an initial understanding of the possible post-surgical implications for outcomes of these intestinal disorders. Future studies could clarify GM alterations associated with various intestinal paediatric surgical procedures and their complications, which may influence the evaluation of GM-targeted treatments.

Abstract:

Background: Anastomotic leakage remains a serious complication following colorectal surgery, often associated with significant morbidity and mortality. Impaired blood supply at the incision site has been suggested as a key contributing factor. Objective: To develop and validate a reproducible rat model of colonic anastomotic leakage induced by graded mesocolon ischemia at the incision margins. Methods: 144 rats underwent end-to-end colonic anastomosis with five different levels of mesocolon ligation, ranging from no ligation (control) to 2 cm ischemia on each side. Postoperative outcomes, including anastomotic integrity, abscess formation, and mortality, were assessed 10 days postoperatively. Results: Anastomotic leak rates increased proportionally with the extent of mesocolic ischemia: 0% in controls, 19.04% with 0.2 cm ligation, 44.23% with 0.4 cm, and 100% with 1 and 2 cm. The model was consistent and reproducible. Conclusions: This model reliably induces graded anastomotic leaks in rats and may serve as a platform for future studies evaluating interventions to reduce leak risk in high-risk colorectal surgery patients.

Abstract: Implant-based breast reconstruction (IBBR) remains the most common form of post-mastectomy reconstruction worldwide, offering patients a reliable and accessible option to restore breast contour. Advances in surgical technique, biomaterials, and implant technology have driven rapid evolution in the field, with the dual goals of improving aesthetic outcomes and minimizing patient morbidity. The prepectoral plane has been popularized due to the eliminated risk of animation deformity and reduced postoperative pain. Some concerns remain regarding mastectomy flap thickness and long-term oncologic and aesthetic outcomes. Concurrently, nipple-sparing mastectomy has improved aesthetic results and enabled surgeons to move beyond just restoring breast form and improve functional recovery as well, as demonstrated by surgical efforts aimed at restoring nipple–areolar complex (NAC) sensation. Adjunctive use of biologic matrices and synthetic meshes has broadened reconstructive options while next-generation implants seek to further enhance outcomes. Balanced against these innovations are important oncologic and systemic safety concerns, including breast implant-related cancers and the ongoing debate over breast implant illness (BII). This review highlights eight current “hot topics” in implant-based breast reconstruction: (1) prepectoral reconstruction, (2) nipple-sparing mastectomy, (3) oncoplastic techniques (4) nipple areolar complex (NAC) neurotization, (5) biologic matrices and synthetic meshes, (6) next-generation implants, (7) optimizing aesthetic outcomes, and (8) implant-associated cancer and systemic concerns. Together, these areas define the current landscape of innovation, controversy, and future directions in implant-based reconstruction.

Abstract: Objective: Impairment of the Fas/FasL apoptotic pathway is a mechanism contributing to the malignant transformation of multiple cell types The aim of this study was to evaluate the clinical usefulness of soluble forms of both Fas receptor (sFas) and its ligand (sFasL) in the serum of patients with pancreatic and papilla of Vater adenocarcinomas. Methods: Soluble levels of Fas and FasL were measured by an ELISA in the serum of 53 healthy controls and in 82 pancreatic and in 14 Vater carcinoma patients both before surgery and 30 days after surgery. The association between preoperative levels, clinicopathological features and patient survival, and their changes following surgery were evaluated. Results: Cancer patients had significantly higher sFas and lower sFasL levels compared to healthy controls and correlated significantly with both lymph node and distant metastases and advance disease stage. Elevated sFas and decreased sFasL levels correlated significantly with poor overall survival with sFas being an independent prognostic factor. Following radical tumor resection preoperative sFas levels decreased whereas sFasL levels increased. These levels remained unchanged in cases of unresectable disease. Conclusions: Increased sFas secretion by pancreatic or Vater adenocarcinomas could contribute to the escape of cancer cells from apoptosis induction. Serum levels of sFas and sFasL could be useful tumor markers with prognostic value for pancreatic or Vater adenocarcinomas.

Abstract: Background: Nutritional status is a key determinant of surgical outcomes, but its assessment in emergency settings remains challenging. The prognostic nutritional index (PNI), which is derived from the serum ALB concentration and lymphocyte count, is a rapid, objective measure of nutritional and immune status. This study evaluated the associations between the PNI and postoperative outcomes in patients undergoing emergency laparotomy. Methods: A retrospective observational study was conducted at a single district general hospital in England, including adult patients who underwent emergency laparotomy between January 2019 and December 2023. The PNI was calculated as PNI = serum albumin (g/L) + 0.005 × total lymphocyte count (cells/μL). Patients were classified as malnourished (PNI < 50) or not malnourished (PNI ≥ 50). The outcomes assessed included postoperative complications, length of hospital stay (LOS), 30-day readmission, and three-year all-cause mortality. Statistical analyses included chi-square, Mann–Whitney U, logistic regression, and Kaplan–Meier survival analyses. Results: Among 482 patients (median age 68 years; 57% male), 66% were malnourished. Malnutrition was significantly associated with higher ASA grade (p < 0.001), frailty (p = 0.028), and comorbidity burden (p < 0.001). Malnourished patients had longer LOSs (≥12 days, p < 0.001) and higher 30-day readmissions (p = 0.026). Multivariate analysis revealed that comorbidities, stoma formation, and prolonged LOS were independent predictors of a low PNI. Kaplan–Meier analysis revealed reduced three-year survival in malnourished patients (log-rank p < 0.01). Conclusion: Malnutrition, as defined by a low PNI, is highly prevalent and associated with adverse postoperative outcomes in emergency laparotomy. PNI is a simple, objective, and clinically useful tool that should be incorporated into preoperative assessments to guide early nutritional optimization.

Abstract: Background/Objectives: Type II endoleak (T2EL) remains the most frequent complication after endovascular aortic aneurysm repair (EVAR), with uncertain clinical relevance and management. While most resolve spontaneously, persistent T2ELs can lead to sac enlargement and rupture risk. This study proposes a deep learning framework for preoperative prediction of T2EL occurrence and severity using volumetric computed tomography angiography (CTA) data.Methods: A retrospective analysis of 287 patients undergoing standard EVAR (2010–2024) was performed. Preoperative CTA scans were processed for volumetric normalization and fed into a 3D convolutional neural network (CNN) trained to classify patients into three categories: no T2EL, benign T2EL, or malignant T2EL. The model was trained on 224 cases, validated on 33, and tested on an independent cohort of 30 patients. Performance metrics included accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC).Results: The CNN achieved an overall accuracy of 76.7% (95% CI: 0.63–0.90), macro-averaged F1-score of 0.77, and AUC of 0.93. Class-specific AUCs were 0.93 for no T2EL, 0.91 for benign, and 0.96 for malignant cases, confirming high discriminative capacity across outcomes. Most misclassifications occurred between adjacent categories.Conclusion: This study introduces the first end-to-end 3D CNN capable of predicting both presence and severity of T2EL directly from preoperative CTA, without manual segmentation or handcrafted features. These findings suggest that preoperative imaging encodes latent structural information predictive of endoleak-driven sac reperfusion, potentially enabling personalized pre-emptive embolization strategies and tailored surveillance after EVAR.