Fournier's gangrene complicated by lower limb necrotising fasciitis and pelvic bone osteomyelitis: A case report with literature review.

INTRODUCTION AND IMPORTANCE: Fournier's gangrene is a urological emergency associated with high mortality and morbidity. Severe gangrene resulting in pelvic bone and lower limb involvement are extremely rare. CASE PRESENTATION: We report a rare case of Fournier's gangrene that is complicated by necrotising fasciitis of the lower limb and osteomyelitis of the pelvic bone, in a patient with previous prostatic adenocarcinoma. The patient was promptly resuscitated, started on broad spectrum antibiotics and then underwent an emergent surgical debridement, followed by multiple relook debridement and definitive reconstruction. Throughout the patient's hospitalisation, he was managed in a multidisciplinary team involving surgeons from different specialities, physicians and allied health staff. CLINICAL DISCUSSION: Extension of Fournier's gangrene into distant structures is rare but serious complications. To date, there is only one other case reported in literature. The relationship between prior prostatic malignancy and Fournier's gangrene can be explored in subsequent studies. CONCLUSION: We present a rare case of Fournier's gangrene with pelvic and distal limb involvement. We highlight the possible yet devastating complications of this disease and discuss treatment options available for the holistic management of patients with Fournier's gangrene.

Graft retrieval incisions in minimally invasive donor nephrectomy: Systematic review and network meta-analysis.

BACKGROUND: Various incisions are employed for graft extraction during minimally invasive donor nephrectomy, but an overarching synthesis of associated short-term donor outcomes is lacking. METHODS: An electronic literature search was conducted on PubMed, EMBASE and Scopus for studies comparing ≥2 graft extraction incisions in laparoscopic or robotic donor nephrectomy with ≥10 patients per arm. Eligible study designs included randomized trials, case-control, and cohort studies. Primary outcomes were donor length of stay (LOS); in-hospital analgesic requirement; and postoperative complications. Secondary outcomes were warm ischemia time (WIT), total operation time (TOT), and estimated blood loss (EBL). Random-effects Frequentist network meta-analyses were conducted for all outcomes. RESULTS: Twenty-nine studies (4702 patients) were shortlisted. Six incisions were analyzed: iliac, Pfannenstiel, midline hand-assisted laparoscopic (HAL), midline umbilical, flank and transvaginal natural orifice transluminal endoscopic surgery (NOTES). The flank incision had significantly longer LOS than all other incisions. LOS was significantly longer in Pfannenstiel than iliac incision (mean difference [MD] = 0.29, 95%CI = 0.002-0.58 days). Midline HAL had significantly shorter TOT than most other incisions. Midline umbilical incisions had significantly higher WIT than midline HAL and Pfannenstiel incisions. Midline HAL had shorter WIT than transvaginal NOTES (MD = 0.80, 95%CI = 0.05-1.56 min). No major differences were seen in analgesia requirement, postoperative complications and EBL. CONCLUSION: Six different incisions for graft retrieval are broadly comparable across most short-term outcomes although long-term outcomes remain to be elucidated. Iliac and Pfannenstiel incisions yielded similar outcomes besides marginally lower LOS for the former. Midline incision for HAL may be associated with shorter TOT, and transvaginal NOTES is an effective technique for selected female donors. TRIAL REGISTRATION: PROSPERO CRD42023445407.

Quantum Signatures of Black Hole Mass Superpositions.

We present a new operational framework for studying "superpositions of spacetimes," which are of fundamental interest in the development of a theory of quantum gravity. Our approach capitalizes on nonlocal correlations in curved spacetime quantum field theory, allowing us to formulate a metric for spacetime superpositions as well as characterizing the coupling of particle detectors to a quantum field. We apply our approach to analyze the dynamics of a detector (using the Unruh-deWitt model) in a spacetime generated by a Banados-Teitelboim-Zanelli black hole in a superposition of masses. We find that the detector exhibits signatures of quantum-gravitational effects corroborating and extending Bekenstein's seminal conjecture concerning the quantized mass spectrum of black holes in quantum gravity. Crucially, this result follows directly from our approach, without any additional assumptions about the black hole mass properties.

Relativistic Bohmian trajectories of photons via weak measurements.

Bohmian mechanics is a nonlocal hidden-variable interpretation of quantum theory which predicts that particles follow deterministic trajectories in spacetime. Historically, the study of Bohmian trajectories has mainly been restricted to nonrelativistic regimes due to the widely held belief that the theory is incompatible with special relativity. Here, we present an approach for constructing the relativistic Bohmian-type velocity field of single particles. The advantage of our proposal is that it is operational in nature, grounded in weak measurements of the particle's momentum and energy. We apply our weak measurement formalism to obtain the relativistic spacetime trajectories of photons in a Michelson-Sagnac interferometer. The trajectories satisfy quantum-mechanical continuity and the relativistic velocity addition rule. We propose a modified Alcubierre metric which could give rise to these trajectories within the paradigm of general relativity.