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Pulmonary complications following urological, gastrointestinal and gynaecological abdominal Surgery––A post-hoc analysis of an observational study in 29 countries
(2026-01-01) Vermeulen T.D.; Hemmes S.N.T.; Blok S.; Schultz M.J.; Hiesmayr M.; Mills G.H.; Putensen C.; Schmid W.; Serpa Neto A.; Severgnini P.; Vidal Melo M.F.; Wrigge H.; Hollmann M.W.; Gama de Abreu M.; van Meenen D.M.P.; Hemmes S.N.T.; Neto A.S.; Binnekade J.M.; Canet J.; Hedenstierna G.; Jaber S.; Hiesmayr M.; Hollmann M.W.; Mills G.H.; Vidal Melo M.F.; Pearse R.; Putensen C.; Schmid W.; Severgnini P.; Wrigge H.; de Abreu M.G.; Pelosi P.; Schultz M.J.; Kroell W.; Metzler H.; Struber G.; Wegscheider T.; Gombotz H.; Hiesmayr M.; Schmid W.; Urbanek B.; Kahn D.; Momeni M.; Pospiech A.; Lois F.; Forget P.; Grosu I.; Poelaert J.; van Mossevelde V.; van Malderen M.C.; Dylst D.; van Melkebeek J.; Beran M.; de Hert S.; De Baerdemaeker L.; Heyse B.; Van Limmen J.; Wyffels P.; Jacobs T.; Roels N.; De Bruyne A.; van de Velde S.; Juros-Zovko M.; Djonoviċ- Omanoviċ D.; Pernar S.; Zunic J.; Miskovic P.; Zilic A.; Kvolik S.; Ivic D.; Azenic-Venzera D.; Skiljic S.; Vinkovic H.; Oputric I.; Juricic K.; Frkovic V.; Kopic J.; Mirkovic I.; Karanovic N.; Carev M.; Dropulic N.; Pavicic Saric J.; Erceg G.; Bogdanovic Dvorscak M.; Mazul-Sunko B.; Marija Pavicic A.; Goranovic T.; Maldini B.; Radocaj T.; Gavranovic Z.; Mladic-Batinica I.; Sehovic M.; Stourac P.; Harazim H.; Smekalova O.; Kosinova M.; Kolacek T.; Hudacek K.; Drab M.; Brujevic J.; Vermeulen T.D.; Mahidol University
BackgroundThe incidence of postoperative pulmonary complications (PPCs33Postoperative Pulmonary Complications.) following abdominal surgery varies across surgical specialties. It remains unclear to what extent the incidence of PPCs is attributable to known patient–related factors and anaesthesia duration, rather than to differences inherent to the surgical specialty itself.MethodsPost-hoc analysis of an observational study describing postoperative outcomes in patients undergoing urological, gastrointestinal, and gynaecological abdominal surgery. The primary endpoint was a composite measure of PPCs. Secondary endpoints included the individual incidence of each PPC. Propensity score weighting was used to create a cohort with similar patient characteristics and anaesthesia duration.ResultsThe cohort consisted of 3306 patients across 146 centres in 29 countries–367 underwent urological surgery, 2100 underwent gastrointestinal surgery, and 839 underwent gynaecological surgery. Risk scores for PPCs were highest in urological surgical patients, followed by gastrointestinal and gynaecological surgical patients. PPCs also occurred most often after urological surgery (17.7%), followed by gastrointestinal (14.9%) and gynaecological surgery (9.8%) (p < 0.001). After weighting, these differences in incidence disappeared, with comparable rates across the three groups (urological surgery 15.7%, gastrointestinal 14.5%, gynaecological 12.2%; p = 0.340). Apart from unplanned supplementary oxygen, all PPCs were most frequent after gastrointestinal surgery and least common following gynaecological surgery.ConclusionsIn this worldwide cohort of patients undergoing abdominal surgery, the incidence of PPCs varied across urological, gastrointestinal, and gynaecological surgery; the differences in incidence may be more strongly influenced by patient–related factors and anaesthesia duration than by the characteristics of the surgical specialty itself. Gastrointestinal surgeries showed the highest rates of severe PPCs.
2% Lidocaine Spray vs. 2% Lidocaine Viscous for Head and Neck Cancer with Chemoradiation Mucositis
(2026-01-01) Upalananda K.; Prasartseree T.; Promsen R.; Sukamol W.; Sakpunpanom P.; Setakornnukul J.; Suiwongsa B.; Thephamongkhol K.; Rongthong W.; Chantharasamee J.; Upalananda K.; Mahidol University
AbstractObjectivesThe use of 2% lidocaine oral viscous is constrained by its inconvenience of portability, coupled with difficulty swallowing in some cases, and its unpleasant taste. This study aimed to compare the effects of 2% peppermint lidocaine spray with conventional 2% lidocaine oral viscous on the immediate pain reduction score at baseline and 5 minutes, feasibility, and quality of life in head and neck cancer patients with chemoradiation-induced mucositis.MethodsThis study was an open-label randomized controlled trial. The patients were randomized using a block of four and divided into two groups. A research nurse collected data on pain scores and quality of life using the modified Oral Mucositis Weekly Questionnaires-Head and Neck Cancer (OMWQ-HN) (Supplement 1)In addition, the nurse monitored the use of the product by approaching patients every Friday of each week until the end of the radiation course. Randomization was performed using computer-generated blocks of four prepared by an independent statistician. Allocation concealment was maintained using sealed opaque envelopes.ResultsA total of 60 patients, patients in the 2% peppermint lidocaine spray group had significantly better scores on the OMWQ-HN-12 items and found it more practical to use and with a better flavor compared to the 2% lidocaine viscous group. The immediate reduction in pain did not differ between the groups. Therefore, we conclude that 2% peppermint lidocaine spray promotes better satisfaction and quality of life without compromising pain control in patients with head and neck cancer with chemoradiation induced mucositis.ConclusionsThe 2% peppermint lidocaine spray did not demonstrate significantly better immediate pain reduction compared to 2% viscous lidocaine, but did improve the global quality of life in patients with head and neck cancer with chemoradiation-induced mucositis.
Deep learning-based head and neck deformable image registration using spatio-temporal analysis and self attention
(2026-01-01) Lee D.; Hu Y.C.; TreeChairusame T.; Oh J.H.; Lee N.; Aristophanous M.; Cerviño L.; Zhang P.; Lee D.; Mahidol University
Background and purposeSignificant anatomical changes during head and neck cancer (HNC) radiotherapy challenge accurate dose delivery. Deformable image registration (DIR) is essential for adaptive radiotherapy (ART), yet conventional methods are too slow for online clinical use. This study proposed a novel deep learning-based DIR algorithm for longitudinal HNC imaging.Materials & methodsWe used sixty HNC patient datasets, each containing a planning CT (pCT) and six weekly cone-beam CTs (CBCTs). Fifty datasets were used for training with cross-validation, and the remaining ten were reserved for testing. The proposed DIR algorithm is a patch-based model that integrates 3D convolutional neural networks, self-attention, and a convolutional Long Short Term Memory to model temporal deformations. The model predicted bidirectional deformation vector fields and was trained with a composite loss function combining image similarity, DVF smoothness, and inverse consistency. Performance was benchmarked against the large deformation diffeomorphic metric mapping (LDDMM) algorithm using Dice similarity coefficient (DSC), Hausdorff distance, and Jacobian analysis.ResultsThe proposed method achieved significantly faster inference, performing bidirectional DIR between the pCT and all six weekly CBCTs in under 3 min and averaging about 30 s per patient, while matching or exceeding LDDMM’s accuracy. DSC remained above 0.8 for all key structures, and the method demonstrated improved DVF consistency with lower mean and 95th percentile Hausdorff distances. Unlike LDDMM, it required no manual parameter tuning, providing consistent results.ConclusionThe proposed DIR algorithm enabled rapid, accurate, and consistent image registration, supporting real-time ART workflows and retrospective dose accumulation in personalized radiotherapy.
Data-driven optimization of proton exchange membrane water electrolyzers using an integrated artificial neural network–genetic algorithm framework
(2026-03-24) Boekfah A.; Seanglumlert C.; Rumnum S.; Rattanaphan S.; Punurai W.; Suvanjumrat C.; Boekfah A.; Mahidol University
Proton exchange membrane water electrolyzers (PEMWEs) represent a pivotal technology for clean hydrogen generation, directly converting electrical energy into chemical energy through water splitting. Despite their intrinsic advantages—such as low specific energy demand, high-purity hydrogen output, and seamless integration with renewable power sources—their commercialization remains constrained by performance–cost trade-offs. Addressing this limitation requires predictive and optimization tools capable of capturing nonlinear electrochemical behavior under diverse operating conditions. This study presents a hybrid artificial neural network–genetic algorithm (ANN–GA) framework for the concurrent prediction and optimization of key PEMWE performance indicators: cell voltage (V), hydrogen generation rate ((Formula presented) ), and specific electrical energy consumption (E). The ANN were trained using four key inputs—water temperature ((Formula presented) ), flow rate ((Formula presented) ), current density (J), and active area (A)—based on a dataset comprising 598 experimental operating points, divided into training (70%), validation (15%), and testing (15%) subsets. The optimized network architecture, comprising two hidden layers with fifteen and ten neurons, demonstrated excellent predictive accuracy, achieving R2 = 0.99844, MAE = 4.5781, RMSE = 39.799, MAPE = 5.9704 × 1011%, and MARE = 5.9704 × 109. Validation against independent experimental data confirmed the robustness of the model, with all error metrics remaining within acceptable limits and a mean prediction deviation 2.27%. Coupled with the GA, the model successfully identified operating and design parameters that maximize efficiency while minimizing energy demand. The proposed ANN–GA framework establishes a computationally efficient and experimentally validated methodology for PEMWE optimization, advancing the development of economically viable and high-performance hydrogen production systems.
Resensitization of β-Lactams After Negative Initial Standard Evaluation: A Systematic Review and Meta-Analysis
(2026-01-01) Srisuwatchari W.; Kulalert P.; Krikeerati T.; Kanchanapoomi K.; Phinyo P.; Sompornrattanaphan M.; Srisuwatchari W.; Mahidol University
Background: β-Lactam (BL) allergy workup varies across studies because of methodological heterogeneity, which affects the estimated risk of BL resensitization after a negative allergy test. Consequently, controversy remains regarding recommendations for retesting. Objective: This systematic review and meta-analysis aimed to quantify the prevalence, severity, and determinants of BL resensitization to support safe and individualized retesting strategies. Methods: PubMed, Embase, Scopus, and CINAHL were searched from inception to August 4, 2024, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eligible studies enrolled patients with documented BL allergy who achieved a negative initial standard evaluation confirming tolerance and subsequently underwent retesting. Random-effects models generated pooled prevalence with 95% confidence intervals (CIs); subgroup analyses examined retest modality, reaction chronology, geography, and age. The strength of evidence was graded with Grading of Recommended Assessment, Development, and Evaluation (GRADE). Results: Thirty-two studies comprising 5766 retests met eligibility criteria. The overall pooled resensitization rate was 3.80% (95% CI, 2.35-5.50; I2 = 82.96%). Limiting to studies using the sequential or direct drug provocation test (DPT) across 3414 retesting evaluations, the resensitization rate was 2.44% (95% CI, 0.99-4.43; I2 = 86.08%), equivalent to 1 case detected per 41 retests. Severe reactions during retesting with these methods occurred at a rate of 0.32% (95% CI, 0.18-0.58; I2 = 0.0%). The overall strength of evidence for resensitization prevalence was graded as low. Conclusions: In DPT-based studies, the pooled resensitization risk was low (approximately 1%-4%) with substantial heterogeneity. Serious reactions during retesting were very rare. These findings do not support routine retesting after a negative evaluation, as the observed risk is in the range of de novo BL reactions in the general population.