European Society of Anaesthesiology

Dear Editor, We read with interest Pilia et al.’s[1] meta-analysis on the sacral erector spinae plane block. The terminology used is imprecise, as the local anaesthetic (LA) injection targets the osseomuscular plane between the multifidus muscle and sacrum, via median or paramedian approaches. The anatomically accurate term is sacral multifidus plane block (SMPB).[2] Since 2019, multiple RCTs have explored SMPB across diverse surgical contexts.[3-5] Restricting inclusion to only three trials (n = 180) narrows the evidence base and limits external validity. Although the LA volume was uniform (20 mL), the composition varied (with or without 4 mg dexamethasone), introducing a potential confounding factor.. Pain was assessed using the visual analogue scale in one study and the numeric rating scale in two others, limiting direct comparability. The 24-h mean difference (−0.87/10) was below the minimal clinically important difference in acute postoperative pain, cited in literature as 1 point on a 10-point scale,[6] thereby questioning the clinical significance of the finding. High heterogeneity in secondary outcomes (12-h pain scores, opioid consumption, and time to first rescue analgesia) further limits applicability, particularly without sensitivity or subgroup analyses. Only 24-h pain was consistently analysed, overlooking the early nociception period (0–6 h). Although trial sequential analysis suggested significance for the primary outcome, the required information size was unmet for key secondary endpoints, cautioning against overinterpretation. The trials involved only American Society of Anesthesiologists (ASA) I–II adults undergoing low-complexity elective surgeries under spinal anaesthesia, thus limiting extrapolation to high-risk patients (ASA III–IV), complex procedures, or general anaesthesia settings, where analgesic performance may vary. Future systematic reviews must address the concerns mentioned above and ensure methodological transparency through prospective registration and adherence to reporting standards. Presentation at conferences/CMEs and abstract publication None. Study data availability Not applicable. Disclosure of use of artificial intelligence (AI)-assistive or generative tools The AI tools or language models (LLM) have not been utilised in the manuscript, except that software has been used for grammar corrections. Declaration of use of permitted tools Not applicable. Authors contributions TM: Concepts, Design, Definition of intellectual content, literature search, data analyses, manuscript preparation, editing. ASN: Manuscript editing, review and approval. Supplementary material None. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

To clarify the impact of systematic nursing on preventing lower limb deep venous thrombosis after obstetrics and gynaecology surgery. The study was conducted at the Nanjing Women and Children's Healthcare Hospital, Nanjing, China, from November 2020 to November 2022, and comprised women inpatients who had undergone caesarean section. The subjects were randomised into control group CG and observation group OG. CG subjects underwent conventional nursing, while OG subjects received systematic nursing intervention, including preoperative, intraoperative and postoperative nursing. Negative emotions, nursing satisfaction, complication incidence and lower limb status were compared between the groups. Data was analysed using SPSS 27. Of the 100 subjects, 50(50%) women were in CG group with mean age 29.41±1.34 years, while 50(50%) were in OG group with mean age 29.55±1.35 years. Post-intervention, negative emotion scores were lower, nursing satisfaction scores were higher, the incidences of lower limb deep venous thrombosis and pulmonary embolism were fewer, and the scores of lower limb status were lower in OG group compared to CG (p<0.05). The application of systematic nursing intervention in obstetrics and gynaecology patients undergoing surgery could effectively prevent lower limb deep venous thrombosis, reduce the incidence of pulmonary embolism, improve patients' lower limb status and negative emotions, and increase satisfaction level with nursing.

In 2025, the European Nuclear Society Young Generation Network (ENS YGN) celebrates three decades of empowering students and young professionals in the nuclear field across Europe. Since its foundation in 1995, ENS YGN has grown into a vibrant and influential network, representing approximately 4000 members in 21 European countries. It has played a pivotal role in fostering cross-border collaboration, promoting knowledge exchange, and inspiring the next generation of nuclear professionals.The visions of ENS YGN are diverse: to facilitate professional development, encourage innovation, promote leadership, and build a strong sense of community among young people in nuclear science and technology. The network achieves these goals through a variety of initiatives, including the triannual Core Committee Meetings (CCMs), where representatives from national YGNs gather to share best practices, coordinate activities, and shape the network’s strategic direction.One of the flagship events of ENS YGN is the European Nuclear Young Generation Forum (ENYGF), held biennially. This forum brings together hundreds of young professionals and students for a week of technical sessions, workshops, cultural exchange, and networking. It serves as a platform for showcasing innovation, discussing policy, and strengthening international ties. In collaboration with the International Atomic Energy Agency (IAEA), ENS YGN collaborates in hosting the NEM School (Nuclear Energy Management School) in parallel to ENYGF, which has been running since 2021. This programme equips future leaders of national YGNs with essential skills in nuclear governance, communication, and strategic planning, reinforcing the network’s commitment to leadership development and capacity building. Also since 2021, ENS YGN facilitates the European edition of Innovation for Nuclear (I4N). The annual competition encourages creative thinking and foster innovation in nuclear technologies, applications, or systems among young professionals and students throughout all disciplines.At the national level, individual YGNs organise a wide range of activities tailored to their local contexts. These include technical visits to nuclear facilities, national conferences, public outreach campaigns, and community-building events. Many national networks also engage in digital outreach, such as podcasts and webinars, to broaden their impact and reach new audiences. ENS YGN also collaborates with international organisations and stakeholders to amplify the voice of young professionals in global nuclear discourse. Through these partnerships, the network contributes to shaping the future of the industry while ensuring that the perspectives of younger generations are heard and valued.As the nuclear sector faces challenges related to sustainability, innovation, and public perception, the role of ENS YGN remains more relevant than ever. By connecting and inspiring young professionals, the network not only supports individual career development but also contributes to the long-term resilience and vitality of the European nuclear industry.

Tumor-infiltrating lymphocytes (TILs) are a provocative biomarker in melanoma, influencing diagnosis, prognosis, and immunotherapy outcomes; however, traditional pathologist-read TIL assessment on hematoxylin and eosin-stained slides is prone to interobserver variability, leading to inconsistent clinical decisions. Therefore, development of newer TIL scoring approaches that produce more reliable and consistent readouts is important. To evaluate the analytical and clinical validity of a machine learning algorithm for TIL quantification in melanoma compared with traditional pathologist-read methods. This multioperator, global, multi-institutional prognostic study compared TIL scoring reproducibility between traditional pathologist-read methods and an artificial intelligence (AI)-driven approach. The study was conducted using retrospective cohorts of patients with melanoma between January 2022 and June 2023 across 45 institutions, with tissue evaluated by participants from academic, clinical, and research institutions. Participants were selected to ensure diverse expertise and professional backgrounds. Intraclass correlation coefficient (ICC) values were calculated for the manual and AI-assisted arms using log-transformed data. Kendall W values were calculated for Clark scores (brisk = 3, nonbrisk = 2, and sparse = 1). Reliabilities of ICC and W values were classified as moderate (0.40-0.60), good (0.61-0.80), or excellent (>0.80). AI TIL measurements were dichotomized using the 16.6 and median cutoffs. Univariable and multivariable Cox regression analyses assessed the prognostic value of TIL scores adjusted for clinicopathologic variables. There were 111 patients with melanoma in the independent testing cohort (median [range] age at diagnosis, 61.0 [25.0-87.0] years; 56 [50.5%] male) who contributed melanoma whole tissue sections. A total of 98 participants evaluated TILs on 60 hematoxylin and eosin-stained melanoma tissue sections. All 40 participants in the manual arm were pathologists, while the AI-assisted arm included 11 pathologists and 47 nonpathologists (scientists). The AI algorithm demonstrated superior reproducibility, with ICCs higher than 0.90 for all machine learning TIL variables, significantly outperforming manual assessments (ICC, 0.61 for AI-derived stromal TILs vs Kendall W, 0.44 for manual Clark TIL scoring). AI-based TIL scores showed prognostic associations with patient outcomes (n = 111) using the median cutoff approach with a hazard ratio (HR) of 0.45 (95% CI, 0.26-0.80; P = .005), and using the cutoff of 16.6, with an HR of 0.56 (95% CI, 0.32-0.98; P = .04). In this prognostic study of TIL quantification in melanoma, the AI algorithm demonstrated superior reproducibility and prognostic associations compared with traditional methods. Although the retrospective nature of the cohorts limits demonstration of clinical utility, the publicly available dataset and open-source AI tool offer a foundation for future validation and integration into melanoma management.

Background: Reduced mobility in patients who are critically ill is still a reality in many ICUs. This study aimed to investigate if the mobility level is associated with an extubation outcome in adult subjects. Methods: This was a prospective cohort study composed of adults who had undergone initial invasive mechanical ventilation for > 24 h and who were independently mobile before hospitalization. Subject progress was monitored from ICU admission to discharge. Data were collected daily from medical records and multidisciplinary teams by considering variables such as age, sex, body mass index, Simplified Acute Physiology Score III, type of ICU admission, comorbidities, sedation, use of vasoactive drugs, neuromuscular blockers, duration of mechanical ventilation, and ICU Mobility Scale. The primary outcome was the success of extubation. Results: ICU Mobility Scale values was not directly associated with extubation outcome. Older subjects demonstrated a reduced tendency for high ICU Mobility Scale values, as did those on prolonged usage of vasoactive drugs or mechanical ventilation. Subjects with higher ICU Mobility Scale values achieved successful extubation earlier, which suggests a link between mobility and faster extubation success. Conclusions: The level of mobility assessed 24 h after extubation was not associated with extubation success. The following characteristics were associated with a lower propensity to present a high ICU Mobility Scale value: older age, greater number of days of use of vasoactive drugs and mechanical ventilation. Subjects with higher levels of mobility had a successful extubation event earlier in the ICU course. Studies that assess mobility on a continuous basis would be more precise in identifying this association.

We are writing in response to the recently published article by Labandeyra et al ,[1][1] ‘Obturator canal block: an anatomical study’, which is a dissection study exploring the distribution of injectate following an ultrasound-guided nerve block to the exit of the obturator canal. As our

Validation of biomarker assays is mandatory not only for their applications in clinical trials but also for their subsequent transfer to clinical laboratories in routine clinical care. There are two critical components relevant to their transfer to clinical practice: regulatory oversight and methodology transfer. Both aspects are simplified where companion diagnostic (CDx) assays relevant to a given indication are being implemented in clinical laboratories. However, when laboratory developed tests (LDTs) are being used either because CDx is not available or because LDT is preferred, both aspects need special consideration from regulatory agencies as well as clinical laboratories. The key component that links these two aspects is evidence of validation of the new LDTs. For predictive and prognostic biomarkers in oncology, clinical validation is feasible only in clinical trials. This approach is not available or feasible to clinical laboratories that develop LDTs. While clinical laboratories routinely perform technical/analytical validation, depending on the type of biomarker, this may not be sufficient to provide evidence of the LDT’s clinical relevance. Laboratories must perform and document their assessment for the need for indirect clinical validation. When indirect clinical validation is required, it must be performed according to existing guidelines for this purpose. This paper provides expert consensus guidance and recommendations on how to assess for the need for indirect clinical validation and how to perform indirect clinical validation where required. This paper also provides a conceptual framework to regulatory agencies for determining requirements for validation of predictive and prognostic biomarkers in oncology.

Pulsed shortwave (radiofrequency) therapy (PSWT) is a non-invasive, non-pharmacologic analgesic used for over 7 decades.[1 2][1] The mechanism of action involves multiple factors and is only partially understood.[3][2] Over-the-counter, lightweight, battery-operated, single-use, wearable devices

This journal’s editor-in-chief, Sites, deserves praise for his balanced editorial[1][1] on reporting clinical findings, positive or negative. Academic trust and patient care require bias-free publishing. No matter how disappointing, a responsible clinician scientist must report accurate clinical