Since its definition in 2022, postpancreatectomy acute pancreatitis has been increasingly recognized as a critical postoperative entity, but its clinical significance has not been evaluated through systematic review and meta-analysis. The aim of current study was to evaluate the clinical implications of postoperative hyperamylasemia and postpancreatectomy acute pancreatitis according to the International Study Group for Pancreatic Surgery consensus definition. A systematic review with meta-analysis was conducted in PubMed, EMBASE, and Cochrane Library databases. Studies published between January 2022 and August 2024 that used the International Study Group for Pancreatic Surgery definitions for postoperative hyperamylasemia and postpancreatectomy acute pancreatitis were included. Risk ratios with 95% confidence intervals were calculated using a Mantel-Haenszel random-effects model. Eleven studies were included in the meta-analysis. Postoperative hyperamylasemia was associated with increased postoperative pancreatic fistula rates (risk ratio, 0.33; 95% confidence interval, 0.21-0.51; P < .001). Postpancreatectomy acute pancreatitis was associated with greater rates of postoperative pancreatic fistula (risk ratio, 0.24; 95% confidence interval, 0.17-0.35; P < .001), postoperative pancreatic hemorrhage (risk ratio, 0.39; 95% confidence interval, 0.26-0.59; P < .001), delayed gastric emptying (risk ratio, 0.57; 95% confidence interval, 0.41-0.79; P = .007), Clavien-Dindo classification IIIa or greater complications (risk ratio, 0.38; 95% confidence interval, 0.25-0.58; P < .001), mortality (risk ratio, 0.42; 95% confidence interval, 0.27-0.65; P = .001), and longer hospital stays (mean difference, -7.76 days; 95% confidence interval, -12.52 to 3.00; P = .001). This first meta-analysis exploring their clinical significance demonstrates that both postoperative hyperamylasemia and postpancreatectomy acute pancreatitis are associated with increased postoperative complications after pancreatectomy. The adoption of these definitions in clinical practice could significantly impact the postoperative course by early stratifying patients at higher risk for additional morbidity.

To evaluate the efficacy and safety of sotatercept, an activin signaling inhibitor, in pulmonary arterial hypertension (PAH). We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) comparing sotatercept versus placebo in PAH. We calculated pooled risk ratios (RR) and mean differences (MD) with their 95% confidence intervals (CI) using a random-effects model. Heterogeneity was assessed with I² statistics. The GRADE approach was used to assess the certainty of evidence. Three RCTs comprising 601 patients were included. Compared to placebo, sotatercept significantly improved 6-minute walk distance (MD 40.57 m; 95% CI 26.64 to 54.5; p < 0.01), and WHO functional class (RR 2.04; 95% CI 1.53 to 2.7; p < 0.01). Sotatercept reduced pulmonary vascular resistance (MD -233.18 dyn·sec·cm^-5; 95% CI -295.84 to -170.52; p < 0.01) and pulmonary artery pressure (MD -14.94 mmHg; 95% CI -19.62 to -10.27; p < 0.01) at study end. No significant differences were observed in all-cause mortality or NT-proBNP levels. Sotatercept was associated with epistaxis, increased hemoglobin, and telangiectasia adverse events. Sotatercept improves exercise capacity, WHO functional class and pulmonary hemodynamics in PAH, with an acceptable safety profile. Long-term studies are needed to confirm sustained benefits. www.crd.york.ac.uk/prospero identifier is CRD420251032174.

Background/Objectives: Antimicrobial resistance (AMR) is an escalating global threat driven by antibiotic misuse and bacterial adaptation. Efflux pumps are major contributors to multidrug resistance in Escherichia coli, as they expel antibiotics and reduce their intracellular activity. This study examined efflux-mediated resistance in extended-spectrum beta-lactamase (ESBL)-producing E. coli and evaluated the potential of several efflux pump inhibitors (EPIs)—promethazine (PMZ), thioridazine (TZ), carbonyl cyanide m-chlorophenyl hydrazine (CCCP), reserpine (RES), and phenyl-arginine-β-naphthylamide (PAβN)—as therapeutic adjuncts. Methods: Antibacterial and anti-biofilm activities of EPIs were tested using broth microdilution, real-time fluorimetry, and crystal violet assays, while ceftriaxone–PMZ interactions were assessed by checkerboard analysis. Results: TZ and CCCP showed strain-specific antibacterial activity, whereas PMZ, RES, and PAβN did not exert any effect. PMZ, TZ, and especially CCCP effectively inhibited efflux pump function, while RES and PAβN were less active. Biofilm inhibition varied between strains, with PMZ and TZ producing moderate reductions. We observed a quite weak synergism between ciprofloxacin, ceftriaxone, and PMZ; however, the result was not significant. Conclusions: Overall, the results highlight the central role of efflux pumps in ESBL-producing E. coli and indicate that EPIs can reverse resistance (e.g., PMZ) and exhibit potent anti-biofilm activity and show additive interactions with antibiotics. However, further studies are needed to optimize their safety, pharmacokinetics, and antibiotic pairing for potential clinical use.

Jeong HJ, et al. Ann Surg Treat Res. 2025 Apr;108(4):231-239. https://doi.org/10.4174/astr.2025.108.4.231

Background: Postoperative pancreatic fistula (POPF) is the major complication following pancreatic surgery, significantly impacting patient outcomes. Intraoperative blood loss (IBL) represents a modifiable risk factor for POPF, but its actual clinical relevance is not clearly defined. This study explores the available literature to reappraise the association of IBL and the development of POPF. Methods: A systematic review and meta-analysis of original studies published between January 2006 and August 2025, reporting IBL in patients undergoing pancreatic resections and its association with POPF were performed. Studies that used the International Study Group on Pancreatic Surgery (ISGPS) or the International Study Group on Pancreatic Fistula Definition (ISGPF) definitions for POPF were included. Qualitative synthesis included all eligible studies; quantitative meta-analysis was conducted for studies reporting IBL in both POPF and no-POPF groups. Results: A total of 26 studies were included in the qualitative review and 12 in the meta-analysis. Among 13,108 patients who underwent pancreatic resections, the overall POPF rate was 20%. IBL was identified as an independent risk-factor of POPF in 17 studies. The meta-analysis, which included 10,008 patients, showed that IBL was significantly higher in the POPF group compared to the no-POPF group [Mean difference (MD): 112.46 ml (30.39, 194.53), p = 0.01]. Conclusions: IBL is an independent predictor of POPF. Intraoperative measures to minimize its occurrence and magnitude are key to ameliorate the outcomes of pancreas surgery.