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Abstract We notice that the important early decreasing part of the main phase (MP) from the positive main phase onset (MPO) to 0-level of Dst and SymH indices is missed in the treatment of the main phase (MP) of geomagnetic storms. We correct this inconsistency in 848 storms having positive MPO (out of 1164 storms) in SymH during 1981–2019 by raising the 0-level of SymH to the MPO-level. The correction considers the full range of the main phase, increases the corrected (revised) storm intensity (SymHMin*) and impulsive strength (IpsSymH*) by up to − 149 nT and − 134 nT, respectively, and seems important for all aspects of global space weather. For example, the corrected SymHMin* changes the conventional storm identification and classification and corrected IpsSymH* clearly identifies all 3 severe space weather (SvSW) events from over 1100 normal space weather (NSW) events with a separation of 52 nT; it also identifies all 8 minor-system-damage space weather (MSW) events from the NSW events.

As a result of the research, 109 individuals of two amphibian species: the common frog (Rana temporaria) and the common toad (Bufo bufo) were selected. These two species are the most numerous among other species of amphibians within the studied territory, therefore, they can be considered typical species in the anthropogenically transformed habitats of the Ukrainian Roztochchia. During the analysis of the collected material, Ivlev’s selectivity index was used to determine the selective attitude of the studied amphibian species to the number of consumed objects. Comparing data obtained from Barber’s traps and material extracted from the stomachs of amphibians, it was concluded that depending on the habitat type, both the common frog (Rana temporaria) and the common toad (Bufo bufo) show a certain feeding selectivity. The common toad consumes mostly the representatives of Annelida (15%), Arachnida (15%) and Coleoptera (18%), what makes up 48% of all consumed objects in total. The common frog, under the conditions of anthropogenically transformed environment, prefers Mollusca (15%), Myriapoda (20%) and Hemiptera (20%) mostly, what is 55% in total. In half of the stomachs we examined for, both amphibian species, plant residues were found, specifically parts of leaves and branches. Additionally, in individuals of the Bufo bufo species, stones were discovered in the stomach. Most likely, these items ended up there accidentally during the capture of primary food objects. Species of tailless amphibians are highly vulnerable to the negative impact of various anthropogenic factors. Deforestation, water bodies drainage, and global or local environmental pollution can significantly affect diverse ecosystems. This, in turn, may lead to the disappearance of segments of the dietary spectrum for amphibians. Monitoring the trophic interactions of this animal class is crucial, given the importance of amphibians as vital links in food chains. This factor underscores the need for periodic trophic monitoring, as amphibians play a pivotal role in sustaining ecological balance within their vulnerable populations.

Background: Although controversial, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to manage liver injuries. This matched cohort study evaluated outcomes in severe liver injuries treated with REBOA or without REBOA., Methods: Trauma Quality Improvement Program database study. Patients with high-grade liver injuries (IV and V) treated with REBOA were propensity score matched (1:2) with similar patients managed without REBOA. Outcomes included mortality and complications., Results: 252 patients treated with REBOA were matched with 503 patients managed without REBOA. Overall mortality was significantly higher in the REBOA group [57.9 ​% vs. 35.2 ​% (p ​< ​0.001)]. The REBOA group patients had higher blood product transfusion requirements., Conclusion: REBOA use in patients with high-grade liver injuries may be associated with poorer outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Introduction: The optimal management of major stump complications (operative infection or dehiscence) following below-knee-amputation (BKA) is unknown. We evaluated a novel operative strategy to aggressively treat major stump complications hypothesizing it would improve our rate of BKA salvage., Methods: Retrospective review of patients requiring operative intervention for BKA stump complications between 2015 and 2021. A novel strategy employing staged operative debridement for source control, negative pressure wound therapy, and reformalization was compared to standard care (less structured operative source control or above knee amputation)., Results: 32 patients were studied, 29 of which were male (90.6%) with an average age of 56.1 ± 9.6 y. 30 (93.8%) had diabetes and 11 (34.4%) peripheral arterial disease (PAD). The novel strategy was used in 13 patients and 19 had standard care. Novel strategy patients had higher BKA salvage rates, 100% vs 73.7% ( P = .064), and postoperative ambulatory status, 84.6% vs 57.9% ( P = .141). Importantly, none of the patients undergoing the novel therapy had PAD, while all progressing to above-knee amputation (AKA) did. To better assess the efficacy of the novel technique, patients progressing to AKA were excluded. Patients undergoing novel therapy who had their BKA level salvaged (n = 13) were compared to usual care (n = 14). The novel therapy's time to prosthetic referral was 72.8 ± 53.7 days vs 247 ± 121.6 days ( P < .001), but they did undergo more operations (4.3 ± 2.0 vs 1.9 ± 1.1, P < .001)., Conclusion: Utilization of a novel operative strategy for BKA stump complications is effective in salvaging BKAs, particularly for patients without PAD., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Patients with hematologic malignancies undergo splenectomy for both diagnostic and therapeutic purposes. Although minimally invasive surgery continues to be increasingly utilized for a variety of abdominal operations, no large-scale data has compared the postoperative outcomes for laparoscopic vs open splenectomy in patients with hematologic malignancy., Methods: Patients with a diagnosis of hematologic malignancy who underwent laparoscopic and open splenectomy between 2015 and 2020 were queried using the ACS-NSQIP database. 30-day outcomes of laparoscopic vs open splenectomy were compared., Results: Out of 430 patients included in the study, 52.6% were male, with a mean age of 63.4 ± 13.1 years. 233 patients (54.2%) underwent laparoscopic splenectomy. On bivariate analysis, laparoscopic surgery was associated with lower rates of 30-day mortality [2.1% vs 11.7% ( P < .001)] and morbidity [9.0% vs 24.4% ( P < .001)]. On multivariate regression, elective operations (OR .255, 95%CI: 0.084-.778, P = .016) and laparoscopic surgery (OR .239, 95%CI: 0.075-.760, P = .015) were independently associated with lower mortality, while history of metastatic cancer (OR 3.331, 95%CI: 1.144-9.699, P = .027) was associated with higher mortality. Laparoscopic surgery (OR .401, 95%CI: 0.209-.770, P = .006) and steroid use (OR 2.714, 95%CI: 1.279-5.757, P = .009) were the only two factors independently associated with 30-day morbidity. Laparoscopic surgery was also associated with shorter hospital length of stay (median 3 [IQR:3] vs 6 [IQR:7] days)., Conclusion: Laparoscopic splenectomy was associated with lower 30-day mortality and morbidity, and shorter length of stay in patients with hematologic malignancies. These data suggest that laparoscopic approach, when feasible, may be preferred for splenectomy in this patient population., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Racial disparities in colorectal cancer for Black patients have led to a significant mortality difference when compared to White patients, a gap which has remained to this day. These differences have been linked to poorer quality insurance and socioeconomic status in addition to lower access to high-quality health care resources, which are emblematic of systemic racial inequities. Disparities impact nearly every point along the colorectal cancer care continuum and include barriers to screening, surgical care, oncologic care, and surveillance. These critical faults are the driving forces behind the mortality difference Black patients face. Health care systems should strive to correct these disparities through both cultural competency at the provider level and public policy change at the national level.

Background: Multiple socioeconomic and clinical factors have been implicated in the health disparities that exist amongst vulnerable populations with colorectal cancer. Efforts have been directed toward addressing these factors to improve outcomes. We evaluate the impact of primary care physicians (PCP) on the surgical presentation and outcomes of colorectal cancer at a safety-net hospital., Methods: A retrospective chart review of 331 patients diagnosed with colorectal adenocarcinoma between 2014 and 2020 at a single-institution urban county medical center., Results: The cohort was predominantly male (59%) and Hispanic (52.1%). Thirty-two percent of patients had a PCP at time of diagnosis. Patients with PCPs compared to those without PCPs had significantly lower rates of acute presentation (perforation or obstruction) (17.0 vs 38.1%, P < .001), higher rates of surgical resection (83.0 vs 70.7%, P = .016), and were less likely to have metastatic disease at presentation (20.4 vs 33.5%, P = .02). Overall, having a PCP also improved probability of survival (HR 1.36, P < .04)., Conclusion: Having a PCP at the time of colorectal cancer diagnosis is associated with improved outcomes in a safety-net population, with significant differences in surgical presentation and resection.

Background: High-grade hepatic trauma can be devastating, with complications being common if patients survive. Studies comparing outcome differences between blunt and penetrating mechanism are lacking. This study aimed to describe and evaluate the association of traumatic mechanism with complications in patients sustaining grades IV and V liver injuries., Methods: A retrospective review of all adults who suffered grades IV and V liver injury from 2015-2020 was performed at a level I trauma center in an urban area. Outcomes in patients with blunt and penetrating mechanisms were compared., Results: A total of 103 patients were included, of which 44 (43%) were penetrating and the remainder blunt. Patients with penetrating injuries were younger, more often male, and more likely to undergo initial operative management (82% vs 40%, P < .001). Regardless of mechanism, high grade liver injuries had similar rates of complications, including bile leak (17% vs 23%, P = . 559) and intrabdominal abscess (7% vs 16%, P = . 239), and similar need for endoscopic retrograde cholangiopancreatography (12% vs 19%, P = . 379). Penetrating injuries required more re-interventions (42% vs 19%, P = . 033), specifically more percutaneous drainage procedures (36% vs 12%, P = . 016). Overall mortality was 29% and did not differ by mechanism., Discussion: Morbidity and mortality are high for grades IV and V liver injuries. Penetrating high-grade hepatic injuries are more likely to be managed operatively, but mortality and overall complications are similar to blunt mechanisms. This may allow for uniform algorithms to define management strategies regardless of mechanism.