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Background: Traumatic brain injuries (TBI) are common in emergency departments (ED) and may cause long-term negative outcomes but knowledge on how the first assessment of children with TBI may predict outcomes is lacking. This study aimed to expand the knowledge by describing the incidence, visits, causes, and outcomes of TBI in children in Iceland., Methods: A retrospective descriptive data analysis was conducted on electronic medical records of children aged 0-17 that visited Landspitali EDs due to a traumatic head injury in 2010-2021. Cases were based on registered ICD-10 diagnosis and data was collected on demographics, causes, triage, length of stay (LOS), admissions and mortality rates. Descriptive statistics were calculated, and associations of variables tested for significance., Results: The study sample included 30,014 emergency visits. The majority involved boys (61.21 %) and children under 6 years old (57.99 %, M = 5.98 years). Girls had a significantly lower mean age (5.75 years vs 6.13 years, p < 0.001). The highest incidence was in one-year olds (729 per 100,000) and was on average 310 per 100,000 children of all ages. Total yearly visits decreased throughout the study period (M = 2,501). Emergency Severity Index (ESI) of 4 (50.77 %) was the most common, with 59.6 % of ESI = 1 cases admitted (p < 0.001). The average LOS was 2.2 h and 1.05 % were admitted. Falls (43.62 %) and soft tissue injuries (73.68 %) were the most common, with intracranial injuries (42.57 %) being the most common in ED observations and admissions. Throughout the study period, 30 (0.10 %) died, thereof three within a week post-injury. In total, 26.64 % of children had at least one revisit to the ED with a traumatic head injury., Conclusions: Children commonly visit EDs due to TBI, mostly with mild injuries but one fourth revisited with a new head injury. There may be groups of children that require specialised follow-up care and assessment to detect and prevent further complications of TBI. Paediatric emergency nurses may be in a key position in identifying children in need of follow-up care. Further research is needed to enhance knowledge of outcomes of TBI in children and to reflect the important role of nurses in paediatric TBI care., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Background: Surgery in the Trendelenburg position (TP) with pneumoperitoneum (PP) is beneficial in several aspects but is associated with postoperative complications, such as postoperative nausea and vomiting (PONV). The mechanism behind this is unknown, but an increase in intracranial pressure (ICP) has been suggested. There are several studies of non-invasively estimated ICP during surgery in TP with PP. The association between perioperative estimated ICP and postoperative complications has not yet been reviewed. Methods: We performed a scoping review of peer-reviewed clinical studies reporting on both perioperative estimation of ICP and postoperative complications in patients undergoing surgery in TP with PP. The literature search was performed in February 2025 on PubMed, CINAHL, and Web of Science. Results and conclusions: Ten of 12 included studies suggested associations between perioperative elevation of estimated ICP and postoperative complications, most notably PONV. This may have clinical implications since elevated ICP can be treated. Future research should focus on the association between perioperative ICP estimation and postoperative complications and the effects of ICP-lowering strategies on postoperative outcomes. [ABSTRACT FROM AUTHOR]

Vanishing bile duct syndrome (VBDS) is a serious drug induced liver injury characterized by chronic cholestasis and loss of intrahepatic bile ducts. VBDS has been reported also following checkpoint inhibitor treatment. We compared CD3 + , CD4 + , CD8 + , CD20 + , CD57 + , PD-1 + and PD-L1 + lymphocyte infiltrates in liver biopsies of patients that encountered VBDS (n = 2) or hepatotoxicity (n = 3) after pembrolizumab (n = 4) or nivolumab (n = 1) treatment with samples from normal liver (n = 10), non-alcohol steatohepatitis (NASH, n = 10), primary biliary cholangitis (PBC, n = 10) or pembrolizumab-treated patients without adverse events (n = 2). Notably, none of the cancer patients had primary nor metastatic liver tumors. We also studied direct growth effects of pembrolizumab on primary human intrahepatic biliary epithelial cells (HIBEpiC) in vitro. Liver sections of all checkpoint inhibitor- treated patients exhibited significantly higher CD3 + infiltration than normal livers, and significantly higher PD-L1 + , CD4 + and CD8 + infiltration, than other groups. PD-1 + infiltration was significantly increased in livers of patients with severe hepatic adverse event. CD57 + infiltration was similar in normal livers, NASH- and PBC groups, but highly increased in the checkpoint inhibitor-treated patients. Immune cell infiltrates were similar between NASH and normal livers. PBC samples had significantly higher CD3 + , CD4 + , CD8 + and CD20 + infiltrates than normal livers. HIBEpiC express PD-L1 but pembrolizumab did not affect their viability in vitro. Our findings suggest that VBDS is not due to direct cytotoxicity of checkpoint inhibitors and that the immunological attack against livers induced by these drugs is different from other cholestatic liver conditions. Biological insight: Checkpoint inhibitors upregulate PD-1 and PD-L1, as well as cytotoxic CD57 + cells in the non-cancerous liver tissues and this may be associated with checkpoint inhibitor-induced hepatotoxicity. [ABSTRACT FROM AUTHOR]

Background: The invasive nature of extended pelvic lymph node dissection (ePLND) prompts the need for alternative lymphatic mapping technologies. To change the focus to "sparing nodes that are not involved," the first step is to research the feasibility of intraoperatively distinguishing the lymph drainage patterns of the prostate from healthy organs., Methods: We performed a prospective study (NCT05120973) that included 16 patients who underwent a robot-assisted radical prostatectomy + ePLND + sentinel node (using indocyanine green- 99m Tc-nanocolloid). After general anesthesia, a second fluorescent dye (fluorescein) was injected unilaterally in two deposits into the intradermis of the upper leg (n = 8) or abdominal wall (n = 8), because these are the most common locations of lymphedema in prostate cancer surgery. To distinguish between the drainage patterns, in vivo and ex vivo multispectral fluorescence imaging was performed by using a fluorescence endoscope., Results: Indocyanine green and fluorescein were visible in the same regions within the ePLND-template and co-accumulated in lymph vessels in vivo. At histopathology, fluorescein was seen in only 10 of 370 lymph nodes (possibly owing to tracer properties), none of which overlapped with indocyanine green and none were tumor-positive. Administration of fluorescein did not result in discomfort or abnormal postoperative recovery., Conclusions: Multispectral imaging can be used to distinguish lymphatic drainage patterns. Our in vivo findings indicate that within the ePLND-template, lymphatic drainage patterns of the prostate at least partly overlap with those of upper leg and abdominal wall. The properties of fluorescein render it unsuitable for confirmation of fluorescence at histopathology., Competing Interests: Disclosure: This study was partly supported by an NWO-TTW-VICI grant (TTW 16141). The sponsor played no direct role in the study., (© 2024. The Author(s).)

Background: Studies comparing oncological outcomes between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) are often limited by bias because of their multi-institutional and multiple surgeon design. Studies from a single institution and single surgeon are uncommon., Objective: To compare oncological outcomes between RARP and ORP at a single institution by a single surgeon., Design, Setting and Participants: A retrospective cohort study of 2376 men with localized prostate cancer who underwent either RARP or ORP, from 1995 to 2020 at single institution, by one surgeon was done. The first 100 cases were discounted in both cohorts to account for the learning curve., Measurements: Positive surgical margin (PSM) and biochemical recurrence (BCR) rates were measured for each cohort., Results: A total of 1566 men underwent ORP and 810 underwent RARP. BCR rates of 29.2% were found in the ORP group versus 19.5% in the RARP group (p < 0.001). PSM rates of 15.4% were found in the ORP group versus 9.0% in the RARP group (p < 0.001). A multivariate analysis of preoperative prostate specific antigen (PSA) and tumor stage (T) shows no statistically significant association with recurrence when controlled for surgical technique., Conclusions: RARP produces better oncological outcomes when compared to ORP when performed by one experienced surgeon at a single institution., Patient Summary: In this large study of men with prostate cancer still localized to the prostate. We found that better cancer removal and chances of cancer recurrence are reduced by a robot-assisted prostate removal technique, compared to the traditional open technique., (© 2025 The Author(s). International Journal of Urology published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Urological Association.)