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Acute cholecystitis is typically managed with laparoscopic cholecystectomy, though inflammation and distorted anatomy can increase operative difficulty. Robotic cholecystectomy may offer technical advantages through improved visualisation and instrument dexterity, yet current evidence is limited, heterogeneous, and entirely observational, with no randomized trials comparing the two approaches in the emergency setting. This systematic review and meta-analysis synthesises existing comparative data to determine whether robotic assistance confers meaningful operative or postoperative benefits over standard laparoscopy in acute cholecystitis. A PRISMA-compliant systematic review and meta-analysis was performed. Comprehensive searches of major databases (2015–2025) identified comparative studies of robotic versus laparoscopic cholecystectomy for acute/emergency cholecystitis in adults. Eligible studies reported at least one perioperative or postoperative outcome; elective, paediatric, single-incision, and non-comparative designs were excluded. Outcomes included operative time, conversion, intra-operative complications, bile duct injury, length of stay, readmission, reoperation, and mortality. Risk of bias was assessed using ROBINS-I. Meta-analyses were conducted in RevMan using random-effects models, with heterogeneity assessed by I² and standard continuity corrections applied for zero-event studies. Seven observational studies comprising 143,717 patients met the inclusion criteria. Operative time and length of stay could not be meta-analysed due to inconsistent reporting and were therefore summarised narratively, with both outcomes appearing broadly comparable between robotic and laparoscopic groups. Meta-analysis demonstrated a significantly lower risk of conversion to open surgery with robotic cholecystectomy (RR 0.61, 95
Venous thromboembolism (VTE) is the leading cause of preventable hospital deaths. Adults hospitalised with psychiatric illness vary in their risk of VTE, and therefore in their likelihood of benefiting from thromboprophylaxis. There is a paucity of evidence-based practice guidelines addressing VTE prophylaxis for this population despite recognition of additional VTE risk factors in this population. To develop an evidence-based guideline on VTE prophylaxis for patients hospitalised with psychiatric illness using Grading of Recommendations, Assessment, Development and Evaluation (GRADE). An international, multidisciplinary, guideline panel including clinical experts, methodologists, and a patient partner was recruited by invitation. Panelists were selected based on methodological and clinical expertise on this subject. Panel members were diverse in geography (from Ireland, the United Kingdom, France, and Canada), expertise and gender. The panel was composed of four advanced specialist psychiatric pharmacists, four consultant haematologists, four consultant psychiatrists, one advanced nurse practitioner in psychiatry, one advanced nurse practitioner in anticoagulation, a methodologist with expertise using GRADE, and a patient partner with lived experience of VTE. The panel prioritised two clinical questions and related population, interventions, outcomes, and secondary analyses according to their importance for patients. GRADE was used to assess certainty of evidence and to move from evidence to risk-stratified recommendations. The panel made three recommendations: a strong recommendation against parenteral pharmacological prophylaxis for patients at low risk of VTE (moderate-certainty evidence); a conditional recommendation in favour of parenteral pharmacological prophylaxis in high-risk patients (low-certainty evidence); and a strong recommendation against graduated compression stockings in patients at high risk of VTE with a contraindication to parenteral pharmacological prophylaxis (low-certainty evidence). Clinicians should not use parenteral pharmacological prophylaxis in adults hospitalised with psychiatric illness at low risk of VTE; and should consider using parenteral pharmacological prophylaxis for high-risk adults with no contraindications. Graduated compression stockings are not recommended in high-risk patients when parenteral pharmacological prophylaxis is contraindicated. These GRADE- based recommendations offer one of the first evidence-based practice guidelines for thromboprophylaxis decisions in psychiatric in-patient settings.
OBJECTIVE:To critically evaluate the existing evidence base surrounding the efficacy of preoperative 5-alpha reductase inhibitor (5ARI) administration in the reduction of perioperative complication rates in transurethral resection of prostate (TURP). METHODS:In April 2025, a systematic search of on-line databases was conducted to identify randomised controlled trials (RCTs) that compared surgical outcomes and complication rates in patients undergoing TURP for benign prostatic hyperplasia (BPH) who were treated preoperatively with 5ARI (finasteride or dutasteride) as compared to placebo/none. The efficacy of preoperative finasteride was evaluated through outcomes related to blood loss, rate of blood transfusion, and operative time. The physiological mechanism of 5ARI treatment was evaluated through microvessel density (MVD) and vascular endothelial growth factor (VEGF) expression of the resected specimen. RESULTS:A total of 30 RCTs met the inclusion criteria for this meta-analysis in which a total of 2974 patients underwent TURP for BPH (1464 5ARI: 1410 Control). Intraoperative blood loss was significantly lower among 5ARI-treated patients (Z = 6.37, mean difference [MD] = -82.58 mL, 95% confidence interval [CI] -107.98 to -57.18; P < 0.001), which was reflected in a significantly lesser haemoglobin drop on the first postoperative day (Z = 6.84, MD = -0.90 g/dL, 95% CI-1.16 to -0.64; P < 0.001). The MVD was significantly lower in resected specimens from 5ARI-treated patients (MD = -6.18 vessels/mm3, P < 0.001), whilst expressing significantly less VEGF (MD = -3.25, P < 0.001). Patients treated with 5ARI required blood transfusion less frequently than controls (odds ratio 0.31, P < 0.001). The use of 5ARI was associated with shorter operative time (MD = -3.47 min, P = 0.02) and lower volume of irrigation agents (MD = -2.07 L, P < 0.001). CONCLUSION:Preoperative administration of 5ARIs significantly reduces intraoperative blood loss and risk of requiring blood transfusion in patients undergoing TURP for BPH. Even short durations (2 weeks) of 5ARI therapy can significantly reduce prostate vascularity.
BACKGROUND:Checkpoint inhibitor pneumonitis (CIP) is a highly morbid complication of immune checkpoint immunotherapy, characterized by acute lung injury leading, in severe cases, to hypoxic respiratory failure and death. CIP incidence in lung cancer is high (10%-15%). Yet, the pathophysiology of CIP is poorly understood. OBJECTIVE/METHODS:To investigate the mechanisms underlying alveolar inflammation in patients with CIP, human bronchoalveolar lavage fluid (BALF) samples from control patients and patients with CIP were analyzed using flow cytometry, single-cell RNA sequencing (scRNA-seq), and ELISA. Findings were validated using multiple external cohorts. In vitro experiments and in vivo rodent models were employed to investigate the mechanisms driving alveolar inflammation in CIP. RESULTS:Analysis of scRNA-seq and flow cytometry data demonstrated increased macrophages in patients with CIP compared to controls. Several distinct proinflammatory alveolar macrophage subsets were increased in CIP. CIP macrophages expressed increased CCL18 at the transcript (scRNA-seq), cellular (flow cytometry) and secreted protein (BALF ELISA) levels. BALF CCL18 levels were associated with clinical CIP severity. CCL18 overexpression in mice promoted lung inflammation that phenocopied human CIP, including upregulation of proinflammatory macrophage subsets. CONCLUSION:These findings suggest that BALF macrophages and CCL18 protein levels are increased in patients with CIP and associate with greater CIP severity. Additionally, CCL18 promotes lung inflammation in mice that mimics human CIP, suggesting a causal role for CCL18 in CIP.
OBJECTIVES:Special AT-rich sequence binding protein 2 (SATB2) is a sensitive immunohistochemical marker of colorectal origin. Loss of SATB2 staining in colorectal cancer (CRC) has been associated with adverse outcomes, poor response to chemotherapy, and clinicopathologic features. This study summarizes the survival outcomes and clinicopathologic associations of SATB2 expression and CRC. METHODS:A literature search for studies of survival outcomes and clinicopathologic associations of SATB2 in CRC was undertaken. Meta-analysis with random-effects models was used to combine data. RESULTS:We analyzed 17 published studies comprising 7733 patients. SATB2 loss was seen in 19% of cases (risk ratio [RR], 0.19 [95% CI, 0.14-0.27]). SATB2 loss was associated with worse overall survival (RR, 0.76 [95% CI, 0.70-0.84]; P < .001) and worse disease-free survival (RR, 0.78 (95% CI, 0.72-0.86]; P < .001). SATB2 loss was associated with more advanced overall stage, nodal involvement, distant metastases, and right-sided tumor location. Loss was also associated with high-risk histologic features, including poor differentiation; lymphatic, venous, and perineural invasion; mucinous and signet ring histology; and tumor budding. SATB2 loss was also seen more commonly in microsatellite unstable and BRAF-mutated cases but was not associated with KRAS mutation. CONCLUSIONS:Loss of SATB2 staining in CRC is associated with inferior survival outcomes and adverse clinicopathologic features.
