Victoria General Hospital

This review explores how the timing of surgery affects outcomes in adults with multisystem trauma requiring general surgical or orthopedic procedures. A targeted search of PubMed and other major databases up to July 2025 identified six relevant studies, including four observational cohorts, one meta-analysis, and one narrative review, collectively covering 273,683 patients. Early definitive surgery, performed within 24-48 hours of admission, was associated with lower mortality rates, fewer respiratory complications, and shorter ICU and hospital stays compared to delayed interventions. One large study reported no significant mortality difference, highlighting the importance of preoperative stabilization and individualized care. Despite variability in study design and the definition of “early” surgery, current evidence suggests that early operative management in stable trauma patients, including abdominal trauma, offers meaningful benefits in reducing complications and improving recovery.

Isotopes in the region of the nuclear chart below ⁶⁸Ni have been the subject of intense experimental and theoretical effort due to the potential onset of a new "island of inversion" when crossing the harmonic oscillator subshell closure at <em>N</em> = 40. We have measured the masses of ⁶⁴⁻⁶⁸Mn using TITAN's multiple-reflection time-of-flight mass spectrometer, resulting in the first precision mass measurements of ⁶⁷Mn and ⁶⁸Mn. These results are compared to <em>ab initio</em> calculations and modern shell model calculations and show an increase in collectivity approaching <em>N</em> = 40.

Chronic Venous Insufficiency (CVI) is a disease that can significantly affect patients' quality of life. Although modern surgical therapies such as endovenous thermal ablation (ETA), iliac vein stenting, and others have been introduced, the effectiveness and safety of each procedure needs to be further evaluated. This study aims to evaluate the effectiveness and safety of modern surgical interventions in the management of CVI, focusing on clinical outcomes such as ulcer healing, pain reduction, and improvement in patient quality of life. This systematic review was conducted following PRISMA guidelines by screening literature from PubMed, ScienceDirect, Google Scholar, and Cochrane Library between 2014 and 2024. Of the 17,500 articles identified, 10 studies were included through a rigorous selection process. Analysis was performed based on study design, population, intervention type, clinical outcomes, and safety profile. Endovenous thermal ablation showed an anatomical success rate of more than 96% with long-term clinical benefits. Iliac vein stenting significantly improved symptoms of deep vein obstruction (VAS: 9 to 2.5) with a primary patency rate of 92%. Methods such as mechanochemical ablation (MOCA) and cyanoacrylate embolization (CAE) offer minimally invasive approaches with low complication rates and fast recovery times. The combination of early ablation and compression therapy accelerates healing of chronic venous ulcers (median healing time: 56 vs. 82 days). Modern surgical interventions are proven effective and safe in the management of CVI, with thermal ablation as the gold standard and iliac vein stenting as the superior option for deep vein obstruction. This evidence-based approach provides important guidance for personalizing CVI therapy in the future. Further research is needed to evaluate long-term sustainability and to optimize evidence-based clinical guidelines.

To report summative data from the American College of Veterinary Emergency and Critical Care (ACVECC)-Veterinary Committee on Trauma (VetCOT) registry, with further individual evaluation of university and private practices and level I and II Veterinary Trauma Centers (VTCs). Multi-institutional registry data report, January 1, 2020, to December 31, 2021. VTCs identified and verified by ACVECC-VetCOT. Dogs and cats with evidence of trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in registry software use and operational definitions of data variables. Patient data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Score and Animal Trauma Triage score), key laboratory parameters, interventions, and outcome were collected. Summary descriptive data for each species are reported. Twenty-two VTCs contributed data to the VetCOT registry during a 24-month period, culminating in a total of 9758 complete trauma case records for dogs and 11734 for cats. Head trauma in dogs and cats was seen at a higher percentage in both university-only VTCs (encompassing both level I and II) (20.1% and 24.1%, respectively) and level I-only VTCs (24.3% and 24.1%, respectively), in comparison to private-only VTCs (encompassing both level I and II) (13.5% and 16.2%, respectively) and individual level II VTCs (14.1% and 18.9%, respectively). Canine and feline surgical procedures were performed at a higher percentage at university VTCs (50% and 40.5%, respectively) compared to private VTCs (39.2% and 28.6%, respectively). Overall survival to discharge for dogs and cats remains high at 93.1% and 83.6%, respectively. The VetCOT registry has continued to show powerful potential in collating a large, multifaceted, international dataset in trauma for both dogs and cats. As published in previous VetCOT registry reports, survival to discharge has remained static across both university and private practice veterinary hospitals; however, further breakdown has identified university and level I VTCs admitting and managing a higher number of head traumas, as well as university VTCs performing a higher proportion of surgical procedures. Data from this registry will continue to aid in the design of clinical trials, prospective observational studies, and translational research, which will improve the understanding and outcome of trauma patients.

BackgroundDue to the progressive decline in β-cell function, it is often necessary to utilize multiple agents with complementary mechanisms of action to address various facets and achieve glycemic control. Thus, this study aimed to evaluate the efficacy and safety of a fixed-dose combination (FDC) of metformin/sitagliptin/pioglitazone (MSP) therapy vs. metformin/sitagliptin (MS) in type 2 diabetes mellitus (T2DM).MethodsIn this phase 3, multicenter, double-blind study, patients with T2DM who exhibited inadequate glycemic control with HbA1c of 8.0–11.0% while taking ≥1500 mg/day metformin for at least 6 weeks were randomized to receive either FDC of MSP (1000/100/15 mg) or MS (1000/100 mg) per day for 24 weeks. The primary outcome measure was the change in HbA1c, and secondary outcomes included changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body weight from baseline to 24 weeks along with safety and tolerability.ResultsAmong the 236 patients randomized, 207 (87.71%) successfully completed the study. All baseline characteristics were comparable between the FDC of MSP and MS groups. There was a subsequent significant reduction of HbA1c in FDC of MSP (− 1.64) vs. MS (− 1.32); between groups was [− 0.32% (95% CI, − 0.59, − 0.05)], P = 0.0208. Similar reductions were found in FPG [− 13.2 mg/dL (95% CI, − 22.86, − 3.71)], P = 0.0068, and PPG [− 20.83 mg/dL (95% CI, − 34.11, − 7.55)], P = 0.0023. There were no significant changes in body weight. A total of 27 adverse effects (AEs) and one severe AE were reported, none of which were related to the study drug.ConclusionThe FDC of MSP demonstrated significant efficacy in managing glycemic indices and could serve as a valuable tool for physicians in the management of Indian patients with T2DM.Trial registrationClinical Trials Registry of India, CTRI/2021/10/037461.

A recent CMAJ news article discussed hospital-at-home programs as an approach to expand acute care capacity in Canada.[1][1] Despite its numerous advantages and benefits, developing and executing a hospital-at-home service that offers a true alternative to a standard hospital admission remains