University Clinical Centre Maribor

Pediatric cholecystitis and cholelithiasis management is heterogeneous. We surveyed European centers to map current practices, training exposure, and outcomes of pediatric biliary cholecystectomy. A 24-item cross-sectional international survey was developed by the European Union of Medical Specialists (UEMS) Section of Paediatric Surgery and distributed to centers in 31 UEMS member states. Items covered institutional resources, indications and timing, surgical approach and adjuncts (ERCP, ICG), training exposure, and center-level outcomes; results are reported as n (%), median (IQR). Outcomes were reported at the center level and were self-reported by participating institutions. Thirty-two centers from 23/31 states responded (74.2%). Pediatric surgeons were primary operators in 84% (shared with adult surgeons in 16%); ERCP access was 66%. Trainee operator share was 22.5% (IQR 5-50) and simulator access 56%. ICG cholangiography was routine in 12.5% and selective in 31%. Acute calculous cholecystitis: 6% always index-admission and 59.4% interval (29-41 days) cholecystectomy; post-ERCP choledocholithiasis: 16% always index-admission cholecystectomy. In 2023, 185 cases were reported: 98.9% laparoscopic with 1.6% conversion; median age 14 years (IQR 12.25-15), operative time 90min (IQR 60-110), length of stay 2 days (IQR 1-2); 10 complications (5.4%). Substantial heterogeneity persists in both care pathways and training exposure; most centers lack formal pediatric-specific guidelines, and trainee-led operating remains limited, supporting the need for evidence-based protocols and structured training pathways.

Continuously changing environments have a paramount role in the evolution of cooperative behavior. Previous works have shown that the transitions among different games, as the feedback between behaviors and environments, can promote cooperative behavior significantly. Quantitative analysis, however, is limited to homogeneous populations, while realistic populations in nature are often more complex and highly heterogeneous. We hereby provide an analytical treatment of when the evolution of cooperation can be supported in stochastic games, applying to arbitrary spatial heterogeneity and payoff structure. We highlight that the rule and frequency of game changes can have surprisingly diverse effects on evolutionary outcomes, depending on the governing social dilemmas. While stochastic games favor the evolution of cooperation in donation games, this is not the case for public goods games and snowdrift games. Hence, our framework and model results offer a more subtle insight into the long-standing enigma. Dynamic environments influence the evolution of cooperative behavior, yet existing analyses often overlook population heterogeneity observed in realistic populations in nature. This study provides an analytical framework for stochastic games, revealing that game change dynamics can variably impact cooperation, enhancing it in donation games but not in public goods or snowdrift games, offering nuanced evolutionary insights.

Evidence from rheumatology supports a within-class treatment switch for JAK-inhibitors (JAKi), but data in ulcerative colitis (UC) remain limited. We aimed to assess the effectiveness and safety of initiating a second JAKi in patients with UC previously treated with another JAKi. We conducted a multicenter retrospective study, including patients with UC starting a second JAKi after prior JAKi exposure. The primary endpoint was Week 12 steroid-free clinical remission (SFCR-rectal bleeding subscore = 0, stool frequency subscore ≤ 1, and no steroids). We included 243 patients (median follow-up: 38 [21-57] weeks). At Weeks 12, 26, and 52, SFCR was achieved in 116/243 (48%), 120/243 (49%), and 69/243 (28%), respectively. Secondary loss of response to the first JAKi was associated with higher SFCR at Week 12 compared to primary failure (odds ratio [OR] = 1.92, 95% confidence interval [CI] = 1.11-3.30, P = 0.02). Higher baseline disease activity (OR = 0.68, 95% CI = 0.68-0.55, P < 0.01) and steroid use (OR = 0.23, 95% CI = 0.13-0.42, P < 0.01) had lower odds of Week 12 SFCR. Endoscopic remission occurred in 22/243 (9%) (<Week 26) and 27/243 (11%) (26-78 weeks), and endoscopic improvement in 53/243 (22%) and 45/243 (19%), respectively. Sixty-seven (28%) patients discontinued the second JAKi, mostly due to primary (36/67) or secondary failure (22/67). Sixty-six adverse events (mostly acne and infections) occurred in 56 (23%) patients, without major thromboembolic or cardiovascular events. Treatment with a second JAKi is effective and safe in patients with UC already exposed to JAKi. Primary failure to a first JAKi and steroid use at initiation of the second JAKi might reduce the likelihood of success with the second JAKi.

Non-motor symptoms (NMS) are increasingly recognized as significant contributors to the overall burden of craniocervical dystonia (CCD), yet they remain underdiagnosed. This international, multi-centre observational study aimed to evaluate the prevalence and burden of NMS in 167 patients with adult-onset idiopathic CCD across Poland, the UK, and Germany, using the validated Dystonia Non-Motor Symptoms Questionnaire (DNMSQUEST). Participants were assessed at the end of their botulinum neurotoxin treatment cycle. The majority of patients (94.6%) reported at least one NMS, and over half experienced five or more, with pain (62.3%) and sleep dysfunction (68.8%) being the most common. Emotional disturbances, including anxiety (34.7%) and depression (35.9%), were also prevalent. The total DNMSQUEST score averaged 5.9 ± 3.8. NMS burden was categorized as low in 42.5%, medium in 35.3%, and high in 22.2% of patients. Combined cervical and cranial dystonia was associated with the highest NMS burden (mean DNMSQUEST score 9.28 ± 3.09). NMS were significantly more prevalent in CCD compared to a small healthy control group. Sleep dysfunction and pain were strongly correlated with higher total NMS scores. Impairments in activities of daily living (69.5%) and a substantial proportion of patients (49.7%) reported balance and gait difficulties. Comparisons with prior DNMSQUESTQ validation cohorts revealed similar symptom patterns, supporting the cross-cultural applicability of the questionnaire. This study highlights the significant and multifaceted burden of NMS in CCD and underscores the importance of incorporating structured NMS assessment into routine clinical care. Particular attention should be paid to sleep dysfunction and pain, which appear to be central to the NMS burden in CCD.

The European Society of Gynaecological Oncology (ESGO) recognizes that poorly designed instruments and operating room environments contribute to musculoskeletal injuries, fatigue, and burnout, disproportionately affecting female and smaller-stature surgeons. Ergonomic equity is central to ensuring surgical precision, team well-being, and optimal patient outcomes. ESGO calls for close collaboration between surgeons, industry partners, and hospital systems to re-design surgical instruments and equipment. Adaptable grip sizes, adjustable weight distribution, and inclusive workstation designs must be prioritized to accommodate diverse anthropometric needs and improve comfort, dexterity, and performance. INCLUSIVE OPERATING ROOM DESIGN AND STANDARDIZED SUPPORT MEASURES: Operating rooms should be designed to support diverse surgical teams, including surgeons of different statures, hand sizes, and physical capacities. ESGO recommends adjustable tables, consoles, lighting, and pedals, alongside consistent policies for accommodating pregnant and postpartum surgeons through measures such as flexible seating and scheduled breaks. ESGO advocates for the integration of ergonomic training into surgical education and continuing professional development. Standardized guidelines, intraoperative microbreaks, and mentorship initiatives are key strategies to reduce injury risks, enhance surgical longevity, and foster equality, diversity, and inclusion within gynecological oncology.

BackgroundOut-of-hospital cardiac arrest (OHCA) is a major contributor to overall morbidity and mortality. Survival depends on several factors, including rhythm shockability and timely defibrillation; for the latter, the availability of Public Access Defibrillators (PADs) is crucial. Across countries, PADs can be a limited resource, necessitating strategic placement to ensure optimal accessibility and effective utilization. The objective of this scoping review was to analyse existing experience with PAD positioning and to identify potential for the geospatial optimisation of PAD positioning.MethodsAn electronic search of PubMed and Scopus databases was performed to identify studies on PAD positioning. We included peer-reviewed articles as well as graduate and undergraduate theses, and excluded conference abstracts, books, and book chapters. Only English-language publications were considered. A Risk of Bias analysis was conducted and reported using Mixed Method Appraisal Tool. We adhered to PRISMA-ScR guidelines. Using the PCC framework, the Population was the general public, the Concept was PAD optimization, and the Context ranged from buildings to nations. Data charting was done manually. We quantitatively synthesized findings from included studies based on extracted data and Synthesis Without Meta-Analysis guidelines.ResultsWe included 43 works, mostly from North America. We found substantial diversity in study methodologies, outcome measures and results reporting. Within buildings, PADs are recommended to be positioned centrally or in elevators. Outside, places with high-footfall were preferred. Optimisation models most often employed the Maximal Covering Location Problem. Most studies based their models on the locations of existing and candidate PADs, alongside historical or simulated OHCA occurrences, and tried to minimise that distance.ConclusionsIn this scoping review of studies optimising PAD network deployment, we found that PAD network optimisation is feasible and improves coverage of historical OHCA locations. Data-driven positioning strategies should incorporate historical OHCA locations, population health indicators, and socioeconomic variables to identify high-risk zones effectively and inform appropriate PAD density. Future studies should adopt prospective and real-world design, while adhering to guidelines for reporting results.Graphical Supplementary InformationThe online version contains supplementary material available at 10.1186/s13049-025-01527-8.

Healthcare faces significant challenges, including workforce shortages and increasing demands. Socially assistive robots (SARs) have emerged as potential solutions to augment care, but their implementation in hospital wards remains largely unexplored. We conducted a randomized external pilot study (ISRCTN Registry, ISRCTN96689284, registered 24/02/2022) evaluating SAR intervention feasibility and effects on patient engagement and perceived quality of care (co-primary outcomes) and health-related quality of life (secondary outcome) in surgical wards. Patients (N = 229) at University Medical Center Maribor were allocated to SAR intervention (standard care + SAR) or control groups (standard care only). The SAR utilized validated, story-driven conversational capabilities providing standardized patient education, support, and basic triage through predefined dialog flows. While overall effects on patient engagement and perceived care quality were limited, the intervention showed positive impact on pain management. Contextual factors moderated intervention effects, highlighting SAR potential in specific domains. No substantial negative effects were detected. High retention rates demonstrated practical feasibility of SAR implementation in surgical settings.

Out of hospital cardiac arrest (OHCA) is a significant public health problem associated with high mortality and high healthcare costs. The Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) randomised clinical trial showed that targeted mild hypercapnia did not lead to better neurologic outcomes at 6months compared to normocapnia after OHCA. We aimed to estimate the cost-effectiveness of mild hypercapnia compared to targeted normocapnia using data from the TAME trial. Pre-specified, prospective cost-effectiveness analysis alongside the TAME RCT from a healthcare perspective using a 6-month time horizon. The analysis included 1586 patients across 63 intensive care units (ICUs), in 17 countries. The primary measure of cost-effectiveness was the cost per quality-adjusted life year (QALY). Costs were estimated for each patient by multiplying resource use data by the relevant country-specific resource unit cost. QALYs were calculated using utility scores derived from the EQ-5D-5L administered at 6-month follow-up. There were no significant differences in costs or QALYs at 6months between groups. The incremental net monetary benefit was also not significant at a willingness-to-pay threshold of $50,000 per QALY, with the 95% CI including both negative and positive values. This analysis found that the cost-effectiveness of mild hypercapnia is highly uncertain when compared with normocapnia in adult patients following OHCA, with no significant differences in either costs or outcomes. Further research is required to determine the specific circumstances under which mild hypercapnia may provide value for money.

BackgroundThe preferred timing of treatment of nonculprit lesions in patients with ST-segment elevation myocardial infarction (STEMI) remains uncertain. A comparison of immediate percutaneous coronary intervention (PCI) guided by instantaneous wave-free ratio (iFR) and deferred PCI guided by cardiac stress magnetic resonance imaging (MRI) in patients with STEMI and multivessel disease is warranted.MethodsIn this international, investigator-initiated, open-label, randomized, controlled trial, patients with STEMI and at least one nonculprit lesion who had undergone successful primary PCI were randomly assigned in a 1:1 ratio to immediate iFR-guided PCI (in lesions with >50% stenosis and an iFR of ≤0.89 [normal value, >0.89]) or deferred cardiac stress MRI–guided PCI within 6 weeks after randomization. The primary end point was a composite of death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3-year follow-up.ResultsThe trial included 1146 patients (558 in the iFR group and 588 in the MRI group) with a mean (±SD) age of 63±11 years; 78% were men. A total of 237 of 556 patients (42.6%) in the iFR group and 110 of 587 patients (18.7%) in the MRI group underwent nonculprit-lesion coronary-artery PCI. A primary-end-point event occurred in 50 patients (9.3%) in the iFR group and in 55 patients (9.8%) in the MRI group (hazard ratio, 0.95; 95% confidence interval, 0.65 to 1.40; P=0.81). Serious adverse events occurred in 145 patients in the iFR group and in 181 in the MRI group.ConclusionsAmong patients with STEMI who have undergone successful primary PCI, immediate iFR-guided PCI was not superior to deferred cardiac stress MRI–guided PCI of nonculprit coronary-artery lesions with respect to death from any cause, recurrent myocardial infarction, or hospitalization for heart failure at 3 years. (Funded by Philips Volcano and others; iMODERN ClinicalTrials.gov number, NCT03298659.)