Coronary artery calcium (CAC) scoring is an increasingly adopted, non-invasive modality for assessing coronary artery disease (CAD). However, its diagnostic reliability in comparison to invasive coronary angiography (ICA) remains controversial. This study evaluated the diagnostic performance of CAC scoring in predicting CAD using ICA as the reference. Adults who underwent both coronary computed tomography angiography (CCTA) with CAC scoring and ICA within a three-month interval were retrospectively analyzed between 2018 and 2024. Obstructive CAD was defined as ≥ 50% stenosis on ICA. Patients were stratified by CAC scores: 0 (group 1), 1–399 (group 2), and ≥400 (group 3). Chi-square analysis was utilized to assess the differences in CAC scores compared to ICA. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CAC against ICA were all calculated using R version 4.4.0. Among 110 patients (mean age 53 ± 10; 86.4% males), obstructive CAD was found in 25% of patients in group 1, 56% of patients in group 2, and 79% of patients in group 3 (χ² = 14.21, p < 0.001). CAC demonstrated a sensitivity of 91.2%, specificity of 63.2%, a PPV of 92.2%, and an NPV of 60%. While a CAC score of 400 or higher strongly predicts significant CAD, scores of zero or intermediate values fail to exclude obstructive disease reliably. These findings reaffirm that CAC scoring is a useful stratification tool but should be interpreted with caution, particularly in high-risk patients, and confirmed with ICA when appropriate.

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is increasingly used in severe acute respiratory distress syndrome (ARDS) when conventional mechanical ventilation (CMV) fails. While large trials such as Conventional ventilatory Support vs Extracorporeal membrane oxygenation for Severe Adult Respiratory failure and Extracorporeal membrane Oxygenation for Severe Acute Respiratory Distress Syndrome have demonstrated ECMO's benefit in general ARDS, trauma-induced ARDS remains underrepresented. This systematic review and meta-analysis aimed to assess ECMO's efficacy and safety compared with CMV in adult trauma patients with ARDS. METHODS: We systematically searched PubMed, Embase, and Cochrane Central from inception to March 2025 following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eligible studies included adult trauma patients with ARDS treated with ECMO (venovenous or venoarterial) versus CMV. The primary outcome was mortality; secondary outcomes included complications, ventilator-associated pneumonia, duration of mechanical ventilation, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Risk of bias was assessed using the Risk of Bias in Nonrandomized Studies of Interventions tool. RESULTS: Four observational cohort studies involving 1,526 patients (ECMO, 179; CMV, 1,347) were included. Extracorporeal membrane oxygenation was associated with significantly lower mortality (odds ratio, 0.29; 95% confidence interval [CI], 0.14–0.62; p = 0.001), with an even greater benefit in the venovenous ECMO subgroup (odds ratio, 0.19; 95% CI, 0.07–0.53; p = 0.002). Extracorporeal membrane oxygenation recipients had significantly longer ICU stays (standardized mean difference, 1.54; 95% CI, 0.97–2.12; p < 0.01), but no significant differences were found in total complications, ventilator-associated pneumonia, or hospital LOS. CONCLUSION: Extracorporeal membrane oxygenation appears to reduce mortality in adult trauma-induced ARDS but is associated with prolonged ICU stay and substantial resource demands. Given the limitations of observational data, variable selection criteria, and heterogeneity across studies, these findings remain hypothesis generating. Prospective trauma-specific studies are needed to confirm the benefit and guide optimal use. LEVEL OF EVIDENCE: Systematic Review and Meta-analysis; Level IV.

Background: Conventional palatoplasty involves operating in a narrow oral cavity space with surgical loupe visualization. Today, some surgeons resort to surgical microscopes to improve visualization and obtain more precise muscle dissection. The RoboticScope is a head movement–controlled system that moves the robotic arm loaded with 3-dimensional visualization technology, allowing surgeons complete freedom to use their hands during surgery. Methods: This was a retrospective pilot analysis of 8 pediatric patients, split into 2 cohorts of 4, comparing conventional palatoplasty to RoboticScope-assisted palatoplasty performed in 2023. Patient demographics collected included age, sex, and cleft palate classification (Veau I–IV). Variables measured included operative time, postoperative analgesia, oral intake, hospital stay, and complication rates. Ergonomic evaluations were performed through surgeons documenting their feedback on comfort and surgical efficiency, including dissection and repair. Results: RoboticScope-assisted palatoplasty averaged 28 minutes longer than the conventional method. Postoperative analgesic needs also differed: 100% of the patients who underwent conventional palatoplasty required morphine, whereas only 50% of the RoboticScope patients required morphine. Seventy-five percent of the RoboticScope patients demonstrated good oral intake on day 1, and 50% of the patients were discharged 1 day earlier than the conventional group. Conclusions: This study concludes that RoboticScope-assisted palatoplasty is safe and feasible, and is associated with fewer analgesic needs, better oral intake, and ergonomic benefits for surgeons than conventional palatoplasty. However, due to the limited nature of the study sample, future multicenter studies with a larger cohort group would be essential to validate these outcomes.

Systemic tranexamic acid (TXA) reduces bleeding in nasal surgery but carries theoretical systemic risks. Topical TXA is an alternative, yet its efficacy in rhinoplasty and septoplasty is controversial because of inconsistent findings in individual trials. The aim of the authors of this systematic review and meta-analysis is to synthesize the evidence on the effectiveness of topical TXA in this setting. A systematic literature search was conducted from inception to July 2025 for randomized controlled trials (RCTs) comparing topical TXA to control in adults undergoing rhinoplasty, septoplasty, or septorhinoplasty. Primary outcomes included intraoperative blood loss, postoperative edema, and ecchymosis. Data were pooled using a random-effects model. Seven RCTs comprising 514 patients were included. The use of topical TXA was associated with a significant reduction in intraoperative blood loss (standardized mean difference [SMD] −1.20, 95% CI, −2.34 to −0.07; P = .04), overall postoperative edema (SMD −0.87, 95% CI, −1.35 to −0.39; P < .001), and ecchymosis (SMD −1.16, 95% CI, −1.63 to −0.69; P < .001). Secondary outcomes, such as surgeon satisfaction (SMD 0.74, 95% CI, −0.24 to 1.73, P = .14) and operative time (SMD −1.03, 95% CI, −2.69 to 0.62, P = .22), showed no statistically significant differences between the groups. In patients undergoing rhinoplasty or septoplasty, topical TXA significantly reduces intraoperative blood loss and postoperative edema and ecchymosis. These findings suggest it may serve as an effective adjunct for improving hemostasis and postoperative recovery. Level of Evidence: 3 (Therapeutic)

Donor-site pain after abdominal-based autologous breast reconstruction affects opioid use and recovery. Liposomal bupivacaine (LB) delivered via the transversus abdominis plane (TAP) block may enhance analgesia compared with standard bupivacaine (SB), yet its added clinical benefit remains unclear. A systematic review and meta-analysis was conducted according to PRISMA 2020 and Cochrane guidelines. Databases searched included PubMed, Embase, and Cochrane Library. Studies comparing LB with SB for the TAP block were included. Outcomes included postoperative opioid consumption, pain scores, hospital length of stay (LOS), time to ambulation, and complications. Both pairwise and single-arm meta-analyses were performed using a random-effects model. A total of twelve studies were included in the analysis, comprising 1,690 participants. Pairwise meta-analyses indicated a trend favoring the use of LB in relation to total opioid use (SMD, –0.17; 95% CI [–1.20, 0.86]; p = 0.75) and LOS (SMD, –0.83 days; 95% CI [–1.76, 0.09]; p = 0.08). However, neither finding was statistically significant. In single-arm analyses, the pooled inpatient opioid use with LB was 132.61 oral morphine equivalents (OME), with post-anesthesia care unit (PACU) use at 17.56 OME and an average LOS of 3.39 days. The pooled rates of seroma and flap loss were 8% and 1.08%, respectively. Additionally, cost and ambulation outcomes varied across the studies. Liposomal bupivacaine appears safe and may offer modest recovery benefits in abdominal-based breast reconstruction. However, its incremental advantage over standard bupivacaine remains uncertain in ERAS-optimized settings. Selective use is recommended pending further high-quality trials.