The Riverside University Health System - Medical Center, or RUHS-MC, formerly Riverside County Regional Medical Center, or RCRMC, and also formerly Riverside General Hospital University Medical Center, or RGH UMC, is a public teaching hospital located at 26520 Cactus Avenue, Moreno Valley, California, United States, operated by the County of Riverside. It is classified as a Level II Adult & Pediatric Trauma Center. Founded in 1893, and originally located in downtown Riverside, California, the hospital has since relocated. The current facility opened on March 31, 1998, but for the greatest part of its history the hospital was located at 9851 Magnolia Avenue in Riverside. While at that location, and operating under the name Riverside General Hospital University Medical Center, two nationally followed patient stories developed. The case of the first patient, Elizabeth Bouvia, in 1983, eventually resulted in a landmark court decision that allows mentally competent adults to refuse forced feeding by patient care facilities, allowing for the possibility of starvation, if the patient cannot otherwise ingest adequate nutrition. The second patient, Gloria Ramirez, in 1994 died in unusual circumstances in which a number of her care-givers were seriously sickened and fainted by what were claimed to be fumes emanating from Ramirez's body.
To map and critically appraise the current literature on Artificial Intelligence (AI) applications in emergency general surgery, with a focus on clinical decision-support tools for preoperative risk stratification and intraoperative assistance, and to identify ethical, structural, and regulatory barriers to implementation. A scoping review was conducted within the ARIES project, following established methodological frameworks. Relevant studies evaluating AI-based tools in emergency surgical settings were systematically identified and analyzed. The literature describes AI applications mainly in two domains: preoperative decision support, including risk prediction and diagnostic or triage models for acute abdominal and traumatic conditions, and intraoperative assistance, largely focused on computer vision–based systems for anatomical recognition, safety guidance, and navigation in minimally invasive emergency procedures. Additional contributions address training and telementoring platforms, as well as cross-cutting ethical, legal, and regulatory considerations relevant to AI adoption in emergency surgical care. AI has the potential to complement emergency surgeons’ clinical judgment, but its routine adoption in emergency surgical practice remains limited. Addressing methodological, ethical, and regulatory challenges, together with the development of robust data infrastructures and targeted training pathways, is essential to support safe, effective, and equitable implementation in acute care settings. In addition, the lack of dedicated investment and sustainable funding models for large-scale clinical implementation and prospective evaluation represents a critical barrier to the translation of AI from research into routine emergency surgical practice.
BACKGROUND:Neurosurgical training is uniquely constrained by prolonged duration, limited case volumes, and high-stakes decision-making that demands simultaneous mastery of technical skills, clinical judgment, professionalism, and communication. Traditional assessment systems often detect late deficits and provide insufficiently granular feedback for early, individualized remediation. METHODS:We implemented an integrated educational performance framework in an Accreditation Council for Graduate Medical Education (ACGME) osteopathic-recognized neurosurgery residency consisting of: (1) a point-based quarterly promotion system capturing required clinical, scholarly, and professional activities; (2) a resident-generated multiple-choice question and quiz program linked to didactic content and in-service exam domains; (3) simulation-enhanced technical training using cadavers, three-dimensional (3D)-printed models, and virtual reality; and (4) a predictive analytics dashboard that synthesizes longitudinal performance signals to identify strengths and emerging risks early. RESULTS:Across trainees, quarterly point totals and quiz performance provided actionable early markers of engagement and knowledge acquisition. Residents falling ≥10% below quarterly point thresholds on two consecutive quarters were reliably identified for goal-oriented success plans, enabling targeted remediation or, when necessary, determination of inability to meet program requirements. Quiz participation and scores are tracked with bi-monthly examinations and annual in-service performance, allowing topic-specific coaching and peer-mentoring by high performers. Simulation interventions demonstrated measurable skill acquisition and procedural efficiency improvements consistent with prior published program outcomes. CONCLUSIONS:A novel combined point-quiz-simulation framework, strengthened by predictive analytics, creates a closed-loop competency system that detects deficits early, amplifies strengths, and aligns resident and faculty actions to program mission, milestones, and patient-centered outcomes. This approach is feasible, transferable, and may help address regional neurosurgical access gaps by accelerating the development of safe, independent surgeons while preserving wellness and professionalism. A core finding of this manuscript is that measurable structure improves resident function.
BACKGROUND:Morel-Lavallee lesions are traumatic closed degloving injuries. Operative intervention remains the primary treatment approach. However, high-quality postoperative outcomes data are limited. This study aimed to determine the rate of wound complications associated with Morel-Lavallee lesions and identify risk factors for postoperative wound complications. METHODS:A prospective, multicenter, observational study (2021-2024) was conducted across 15 trauma centers. Adult patients with a Morel-Lavallee lesion who underwent operative management were included. The primary outcome was incidence of wound complications, defined as cellulitis, deep wound infection, skin necrosis, necrotizing soft tissue infection, and organized hematoma. Multivariable logistic regression was performed to identify predictors of wound complications. RESULTS:Among 134 patients who underwent operative intervention for Morel-Lavallee lesions, 27 (20.1%) developed a postoperative wound complication. Wound complications included skin necrosis (n = 10, 7.5%), deep wound infection (n = 9, 6.7%), cellulitis (n = 7, 5.2%), organized hematoma (n = 7, 5.2%), and necrotizing soft tissue infection (n = 3, 2.2%). In patients with wound complications, more frequent mechanisms of injury were bicycle collision (14.8% vs. 1.9%, P = .004) and pedestrian struck by motor vehicle (37.0% vs. 15.0%, P = .010). On multivariable analysis, only pedestrian struck by motor vehicle mechanism of injury (odds ratio 3.44, 95% CI 1.29-9.17, P = .014) was an independent predictor of increased wound complications when also controlling for closure of dead space, current tobacco use, and diabetes. CONCLUSION:More than one fifth of patients undergoing operative management of Morel-Lavallee lesions developed a postoperative wound complication. The only independent predictor of wound complications was pedestrian struck by motor vehicle mechanism of injury. These findings may help guide patient counseling.
ABSTRACT Background Non‐alcoholic fatty liver disease (NAFLD) has emerged as a significant public health issue due to its close association with metabolic abnormalities. Concurrently, celiac disease (CD), an autoimmune disorder triggered by gluten, has been increasingly investigated in connection with various chronic conditions. Given the potential link between these two conditions, this systematic review and meta‐analysis aimed to determine the prevalence of CD in individuals diagnosed with NAFLD. Methods A comprehensive literature search was performed in multiple databases including PubMed, Scopus, Embase, and Web of Science. Studies were considered eligible if they reported clear data regarding CD prevalence among NAFLD populations. Results Pooled data analysis revealed an overall CD prevalence of 3.8% (95% CI: 0.02–0.07) among NAFLD patients, with significant heterogeneity observed (I2 = 97.36%, p < 0.01). Further subgroup analyses demonstrated variations in CD prevalence related to disease characteristics; notably, the prevalence was higher among patients specifically evaluated for CD using serological and histological methods. Exploratory stratified analyses indicated that CD was more prevalent in patients with NAFLD who had lower body mass index (BMI), higher levels of aspartate aminotransferase (AST), lower hemoglobin (HB) concentrations, and reduced platelet (PLT) counts. Conclusion The findings from this meta‐analysis suggest a higher‐than‐expected prevalence of CD among patients with NAFLD, though the substantial heterogeneity across studies limits the precision of this estimate. These findings indicate that clinicians may consider selective screening for CD, particularly in patients presenting with specific clinical features. However, given the exploratory nature of the subgroup analyses and the variability in diagnostic approaches across included studies, larger prospective studies with standardized diagnostic criteria are needed to confirm these observations and better elucidate the relationship between these two conditions.
Lumbar laminectomy is one of the most common spinal procedures, yet the extent of bone removal remains highly operator-dependent, resulting in significant variability in decompression outcomes. Insufficient decompression risks symptom persistence, while over-resection of the facet joints causes iatrogenic instability, and uncontrolled instrument passes near the inner lamina cortex carry well-documented risk of dural injury and cerebrospinal fluid (CSF) leak. A standardized, stepwise technique that reduces these risks, promotes operative efficiency, and provides a teachable framework for neurosurgical residents has not been widely described. We present a reproducible six-step lumbar laminectomy technique centered on bilateral troughing with a 3-mm matchstick burr, progressive eggshell thinning with a 5-mm diamond burr, and en bloc lamina removal, with intraoperative navigation used at defined checkpoints to confirm the medial facet border, pedicle proximity, trough depth, and final decompression extent. The technique is illustrated with a case of a 70-year-old man with multilevel lumbar stenosis (Schizas grade C-D at L3-5) and a prior L4-5 discectomy who underwent L3-L5 laminectomy using this approach; the estimated blood loss was 30 mL, the troughing and en bloc removal were completed in approximately 15 minutes, and the patient was discharged on postoperative day three without complication. The staged matchstick-to-diamond burr sequence reduces the risk of inadvertent dural injury while maintaining operative efficiency, and navigation serves as a confirmatory adjunct rather than a primary guide. The technique is designed to be learned by neurosurgical residents, with each step building anatomical understanding and safeguarding against dural injury and facet violation, and merits prospective evaluation in larger cohorts.
