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Introduction: Robotic surgery (RS) is gaining prominence in colorectal procedures owing to advantages like three-dimensional vision and enhanced dexterity, particularly in rectal surgery. Although recent reviews report similar outcomes between laparoscopic surgery (LS) and RS, this study investigates the evolving trends in outcomes over time, paralleling the increasing experience in RS. Methods: A systematic review, meta-analysis and meta-regression were conducted of randomised controlled trials exploring postoperative outcomes in patients undergoing RS or LS for colorectal pathology. The primary outcome measure was postoperative complications. Risk of bias was evaluated using the Cochrane Collaboration's assessment tool. Randomised controlled trials were identified from the PubMed®, Embase® and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases via the Cochrane Central Register of Controlled Trials. Results: Of 491 articles screened, 13 fulfilled the inclusion criteria. Meta-analysis of postoperative complications revealed no significant difference between RS and LS (relative risk [RR]: 0.96, 95% confidence interval [CI]: 0.79 to 1.18, p=0.72). Meta-regression analysis of postoperative complications demonstrated a significant trend favouring RS over time (yearly change in Ln(RR): −0.0620, 95% CI: −0.1057 to −0.0183, p=0.005). Secondary outcome measures included operative time, length of stay, blood loss, conversion to open surgery, positive circumferential resection margins and lymph nodes retrieved. The only significant findings were shorter operative time favouring LS (mean difference: 41.48 minutes, 95% CI: 22.15 to 60.81 minutes, p<0.001) and fewer conversions favouring RS (RR: 0.57, 95% CI: 0.37 to 0.85, p=0.007). Conclusions: As experience in RS grows, evidence suggests an increasing safety profile for patients. Meta-regression revealed a significant temporal trend with complication rates favouring RS over LS. Heterogeneous reporting of complications hindered subgroup analysis of minor and major complications. LS remains quicker. Rising adoption of RS coupled with emerging evidence is expected to further elucidate its clinical efficacy. [ABSTRACT FROM AUTHOR]

Cerebellar ataxia has been described as being associated with hypogonadism for almost 100 years. In the majority of cases, hypogonadism is hypogonadotropic. The association of cerebellar ataxia with hypergonadotropic hypogonadism is a rare genetic disorder with a recessive mode of inheritance. Cerebellar ataxia and hypogonadism can also occur associated with a large spectrum of additional clinical manifestations, including mental retardation, sensorineural deafness, choroidal dystrophy, ectodermal dysplasia and short stature, and polyneuropathy. We report the case of a woman with early-onset spinocerebellar ataxia, primary amenorrhea due to hypergonadotropic hypogonadism, and late-onset sensorineural hearing loss. Additional family members from the father's side are affected with late-onset hearing loss, suggesting a dominant mode of inheritance. [ABSTRACT FROM AUTHOR]

Unlabelled: To investigate the toxic effect of tobacco smoke on the fetus, we measured in cord blood the concentrations of alpha-fetoprotein (AFP), the principal serum protein in early ontogenic development, and erythropoietin (EPO), as an index of chronic fetal hypoxia. A total of 103 consecutively enrolled term newborns of smoking mothers and 103 term infants of nonsmoking parents were studied. The mean +/- SD AFP concentrations in the newborns of the mothers who smoked 1-50, 5-50, and 10-50 cigarettes/day were 86.4 +/- 88.9, 96.3 +/- 91.9 and 118.7 +/- 103.7 ng/ml, respectively. The difference of all three groups from the control neonates (57.7 +/- 37.2) was significant. The EPO concentrations in the newborns of the mothers who smoked 1-50 (53.9 +/- 64.6 mU/ml) and 5-50 (56.3 +/- 68.5) cigarettes/day were significantly greater than in the control neonates (29.5 +/- 16.1). In the newborns of the smoking mothers there was a significant positive correlation between AFP concentrations and number of cigarettes smoked per day, and a negative correlation between AFP and birth weight or length. There was no correlation between AFP and EPO concentrations, as well as between EPO and birth weight, length or number of cigarettes smoked per day.Conclusion: The absence of a correlation between erythropoietin and birth weight or length and the negative correlations between alpha-fetoprotein and these anthropometric parameters suggest that the intra-uterine growth retardation caused by maternal smoking is not due to tissue hypoxia, but that both growth retardation and elevated alpha-fetoprotein result from the direct or indirect toxic effect of a factor(s) present in tobacco smoke. [ABSTRACT FROM AUTHOR]

Background: A barrier to same-day discharge (SDD) in bariatric and metabolic surgery (BMS) is concern over missing the early signs of complication, often detected by measurement of physiological observations. Remote patient monitoring has gained popularity in other surgeries; however, its effectiveness in BMS remains uncertain. This systematic review aims to examine the impact of remote monitoring (RM) on postoperative readmissions and complications in patients undergoing SDD after BMS., Methods: A literature search of Embase, Ovid MEDLINE, and Cochrane Central databases was conducted to identify all studies on RM used in SDD in bariatric surgery. Data were collected on patient demographics and postoperative outcomes including readmission and morbidity rates., Results: Seventeen studies including 20,380 patients were analysed. The mean age and preoperative body mass index (BMI) of patients were 41.3 ± 2.7 years and 43.3 ± 1.6 kg/m 2 respectively. The incidence of readmission for patients with and without RM was 6% (95% CI 0.03-0.13) and 2% (95% CI 0.01-0.04) respectively (p = 0.01). The overall complication rates for patients with and without RM were found to be 7% (95% CI 0.04-0.13) and 3% (95% CI 0.02-0.09) (p = 0.08). Most of the patients who were readmitted had a Clavien-Dindo score of 1 or 2 (68%). There was no mortality described in studies with the use of RM., Conclusions: SDD with RM enables a shorter hospital stay while providing a safety net for patients and clinicians; the readmission rate is expected marginally higher given the early discharge date. Future studies reporting on healthcare economics are encouraged., Competing Interests: Declarations. Ethical Approval: For this type of study, formal consent is not required. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: Use of mobile devices with high-quality cameras has expanded medical photography. We investigate the impact of different devices and conditions on photograph quality in a surgical setting., Methods: Fourteen surgeons across six centres scored photograph quality of kidneys donated for transplantation. Images were captured using an iPhone, iPad, or DSLR camera on automatic modes under varying lighting conditions. In blinded A/B testing, surgeons selected the image perceived more clinically useful for remote organ quality assessment and rated each on a 5-point Likert scale. Quality was objectively analysed using two computer vision referenceless quality assessment tools (BRISQUE & NIMA)., Results: Of 369 photographs, mobile device images were rated higher quality by surgeons (78.4%) compared to DSLR (9.4%, p < 0.001). Multilevel regression using BRISQUE showed higher quality for iPhones (β = -5.86, p < 0.001) and iPads (β = -3.90, p < 0.001) versus DSLR. Room lighting improved quality over direct overhead illumination with theatre lights (β = 17.87, p < 0.001). Inter-rater (Gwet AC = 0.78) and intra-rater (Cohen's κ = 0.86) agreements were high., Discussion: Smartphones can produce high quality photographs. These findings should reassure clinicians that smartphone devices do not compromise photograph quality and support their use in clinical practice and image analysis research.

Background: The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, due to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate the impact of visually assessed liver steatosis in grafts donated following brainstem (DBD) versus circulatory death (DCD)., Methods: NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data and adjusted regression models with interaction terms to compare the impact of visually assessed donor graft steatosis on transplant outcome., Results: 9217 recipients of deceased donor grafts were included (DBD = 7349; DCD = 1868). Multivariable cox regression revealed that the negative impact on graft survival was significantly different in DCD and DBD livers (interaction P = 0.011 and P = 0.043). The largest impact was in DCD livers (moderate steatosis: aHR = 1.851, 1.296-2.645, P = 0.001 and aHR = 5.426; severe steatosis: 1.723-17.090, P = 0.004). Visually assessed steatosis did not predict longer-term graft survival in the DBD cohort., Conclusion: The impact of visually assessed steatosis on post-transplant outcome is far greater in DCD grafts, despite an identical method of steatosis assessment. This highlights novel therapeutics should be considered for steatotic DCD grafts to allow this growing sector of the donor pool to be safely utilised., Competing Interests: Conflicts of interest None declared., (Crown Copyright © 2025. Published by Elsevier Ltd. All rights reserved.)