Medicina

Background and Objectives: Brain radionecrosis is an under-recognized but potentially life-altering late complication of radiotherapy in patients with locally advanced nasopharyngeal cancer. Temporal lobe radionecrosis and high-dose exposure to the hippocampus are strongly associated with cognitive decline and radiation-induced dementia, negatively impacting patients’ long-term quality of life (QoL). This study aimed to evaluate and compare radiation dose distributions to critical brain structures across three radiotherapy techniques—3D conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT)—in order to assess potential neurocognitive risks and support hippocampal-sparing protocols. Materials and Methods: Ten patients previously treated with 3D-CRT were retrospectively replanned using IMRT and VMAT techniques on the Eclipse v13.3 (VARIAN) planning system. Bilateral hippocampi and temporal lobes were delineated as organs at risk (OARs) according to the RTOG atlas, and dosimetric parameters including D_max, D_mean, and D_min were recorded. V7.3 values were evaluated for hippocampal avoidance regions. Results: While IMRT and VMAT provided improved target volume coverage and reduced high-dose exposure to many standard OARs, both techniques were associated with increased D_mean and D_min to the hippocampus and temporal lobes compared to 3D-CRT. The highest D_max values to the temporal lobes were observed in 3D-CRT plans, indicating a potential risk of radionecrosis. VMAT plans showed hippocampal mean doses exceeding 10 Gy in some cases, with V7.3 > 40%, breaching established neurocognitive risk thresholds. Conclusions: These findings support the routine delineation of the hippocampus and temporal lobes as OARs in radiotherapy planning for nasopharyngeal cancer. The implementation of hippocampal-sparing strategies, particularly in IMRT and VMAT, is recommended to reduce the risk of radiation-induced cognitive toxicity and preserve long-term QoL in survivors. Full article

Background and Objectives: Breast cancer is a leading global health challenge, where early detection is essential for improving survival outcomes. Two-dimensional (2D) mammography is the established standard for breast cancer screening; however, its diagnostic accuracy is limited by factors such as breast density and inter-reader variability. Recent advances in artificial intelligence (AI) have shown promise in enhancing radiological interpretation. This study aimed to assess the utility of AI in improving lesion detection and classification in 2D mammography. Materials and Methods: A retrospective analysis was performed on a dataset of 578 mammographic images obtained from a single radiology center. The dataset consisted of 36% pathologic and 64% normal cases, and was partitioned into training (403 images), validation (87 images), and test (88 images) sets. Image preprocessing involved grayscale conversion, contrast-limited adaptive histogram equalization (CLAHE), noise reduction, and sharpening. A convolutional neural network (CNN) model was developed using transfer learning with ResNet50. Model performance was evaluated using sensitivity, specificity, accuracy, and area under the receiver operating characteristic (AUC-ROC) curve. Results: The AI model achieved an overall classification accuracy of 88.5% and an AUC-ROC of 0.93, demonstrating strong discriminative capability between normal and pathologic cases. Notably, the model exhibited a high specificity of 92.7%, contributing to a reduction in false positives and improved screening efficiency. Conclusions: AI-assisted 2D mammography holds potential to enhance breast cancer detection by improving lesion classification and reducing false-positive findings. Although the model achieved high specificity, further optimization is required to minimize false negatives. Future efforts should aim to improve model sensitivity, incorporate multimodal imaging techniques, and validate results across larger, multicenter prospective cohorts to ensure effective integration into clinical radiology workflows. Full article

Background and Objective: This study’s objective was to determine the impact of the percentage of lung tissue within the normal density range (PLND) on exacerbations and hospitalizations compared with the modified Bhalla and Reiff scores. We also investigated the effects of these measures on pulmonary function tests (PFTs). Materials and Methods: This retrospective analysis involved adult cystic fibrosis (CF) patients who had thoracic computed tomography (CT) while in a stable clinical condition. A dedicated radiologist analyzed CT images and conducted modified Bhalla, Reiff, and PLND assessments. We analyzed the exacerbations and hospitalizations in the year after the CT scan. We also examined PFTs at the time of the CT scan and one year later. Results: This study’s population consisted of 63 subjects (33 men), with a median age of 23.2 years. The median modified Bhalla score was 9.0 (IQR: 7.0–12.0), the median Reiff score was 11.0 (IQR: 8.0–15.0), and the median PLND was 79.4% (IQR: 74.5–82.0). The Bhalla score had the strongest relationship with both the number of exacerbations (p < 0.001, r: −0.559) and hospitalizations the following year (p < 0.001, r: −0.636), followed by the PLND score and the Reiff score. Youden’s index shows that the optimum cut-off values for hospitalization at ≤2 and >2 are 6.5 for the modified Bhalla score, 13.5 for the Reiff score, and 76.5% for the PLND. Conclusions: The measurement of PLND may serve as a predictor for exacerbation and hospitalization rates, aligning with the modified Bhalla and Reiff scores, and shows potential for application in follow-up assessments. Full article

Background & Objectives: Targeted-release budesonide (TRB) is the first approved agent aimed at targeting the early pathogenetic cascade in IgA nephropathy (IgAN). Materials and Methods: This prospective study included Caucasian IgAN patients diagnosed within the last 5 years, who had started a 10-month TRB treatment and were followed in the outpatient clinic. All participants had been on the maximal supportive care dose for at least the previous 6 months. Kidney function and proteinuria levels were recorded at the start of TRB treatment (T0) and at 3, 6, and 10 months (T3, T6, and T10, respectively), while urinary monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-9 (MMP-9) and clusterin (CLU) levels were measured at T0 and T3. Results: In the cohort of all patients (mean age 53.24 ± 12.76 years, estimated glomerular filtration rate (eGFR 52.84 ± 25.93 mL/min/1.73 m², proteinuria 2.84 ± 1.26 g/24 h), significant correlations were observed at T0 between MMP-9 and MCP-1 (r = 0.74, p = 0.004), MMP-9 and uCLU (r = 0.77, p = 0.002), and MCP-1 and uCLU (r = 0.65, p = 0.01). At T3, a significant correlation between MMP-9 and urinary CLU (uCLU) persisted (r = 0.71, p = 0.03). Higher MCP-1 (r = −0.560, p = 0.046) and MMP-9 (r = −0.330, p = 0.012) levels at T0 were associated with reduced proteinuria. Conversely, increased clusterin at T3 (r = 0.599, p = 0.031) was associated with worsening proteinuria. Conclusions: The treatment response to TRB was heterogeneous, with recent diagnosis (RD) patients showing improved kidney function and proteinuria, while older diagnosis (OD) patients exhibited worsening biomarkers and declining kidney function. Therefore, early interventions are crucial in IgAN patients. Finally, the biomarkers studied can be used prognostically to monitor disease progression. Full article

Background and Objectives: Hepatitis A is an infectious disease caused by the hepatitis A virus (HAV), which is transmitted via the fecal–oral route, either through the consumption of contaminated food and water or through direct contact with an infected individual. The incidence of HAV is closely associated with socioeconomic factors, access to clean drinking water, sanitation safety, and hygiene. This study aimed to determine HAV seroprevalence and shifting endemicities of hepatitis A virus infection. The seroprevalence and endemicity status were assessed based on the age at the midpoint of population immunity (AMPI). Materials and Methods: A cross-sectional seroprevalence study was conducted in two contrasting areas (urban vs. rural) in Bandung, Indonesia. All participants underwent serological testing for anti-HAV IgG using a chemiluminescent microparticle immunoassay (CMIA) and participated in questionnaire interviews. Socioeconomic status was assessed using the Water/sanitation, Assets, Maternal education, and Income (WAMI) index. All statistical analyses were performed using SPSS 18, with a p-value of <0.05 considered significant. Results: A total of 1280 participants were tested (640 living in urban areas; 640 living in rural areas). The total prevalence of HAV seropositivity was 50.5% (95% confidence interval [CI]: 47.7–53.3%), with prevalences of 46.1% (95% CI: 42.5–54.4%) across urban sites and 54.7% (95% CI: 50.7–58.6%) across rural sites. The AMPI was within the 20–24-year age group, with an age point of 22 years, classified as an intermediate HAV endemicity status. Conclusions: the study found a shift in HAV endemicity status from low to intermediate, supporting the need for large-scale national hepatitis A vaccination in Indonesia. Full article

Background and Objectives: Osteoporosis is a common chronic condition after menopause that increases the risk of fractures. In South Korea, the prevalence of osteoporosis among adults aged 50 and older is 22.4%, with 94.4% of treated patients being women, highlighting its significant impact on postmenopausal health. In this study, we examine the sales trends of osteoporosis medications in Korea from 2018 to 2023 to understand current usage patterns and market dynamics. Materials and Methods: This study is a retrospective analysis based on pre-recorded sales data from Intercontinental Marketing Services (IMS). Data covering a five-year period (2018–2023) were analyzed to examine the sales trends of osteoporosis medications, including bisphosphonates, selective estrogen receptor modulators (SERMs), parathyroid hormone analogs, denosumab, romosozumab, and others. Romosozumab, approved in November 2019, was included in the analysis. Given the nature of this study, no direct patient data or clinical interventions were involved. Results: The total market size for osteoporosis medications in South Korea reached USD 285.42 million in 2023, reflecting a 15.3% increase from 2022. Bisphosphonates, previously the dominant therapy, experienced an 11% decline in market share over five years. Meanwhile, denosumab, a receptor activator of the nuclear factor-κB ligand inhibitor, showed a remarkable growth rate of 957.6% from 2018 to 2023, surpassing bisphosphonates in their market share. Romosozumab, a newly introduced anabolic agent, accounted for 7.4% of the market, with sales increasing by 59% in 2023. Conclusions: This analysis revealed major shifts in treatment preferences, with newer drugs like denosumab and romosozumab gaining prominence over traditional bisphosphonates. These trends highlight the increasing clinical adoption of anabolic agents for high-risk patients and the impact of expanded reimbursement policies on osteoporosis management. Given the increasing use of advanced therapies, it is essential to monitor treatment access, patient adherence, and long-term clinical outcomes. Understanding these sales trends can aid healthcare professionals and policymakers in optimizing osteoporosis treatment strategies and ensuring better patient care. Full article

Background and Objectives: This study compared the effects of blood flow restriction resistance exercise (BFR-RE) and high-load resistance exercise (HL-RE) in voluntary exhaustion on quadriceps muscle adaptations in untrained young males. Materials and Methods: This study used a randomized controlled design that included 30 untrained young males (age = 21.42 ± 2.51). The BFR-RE group performed leg extension exercises with 60% occlusion pressure and 30% of one maximum repetition in volitional exhaustion. The same exercise was conducted at 70% 1RM in the HL-RE group. Fourteen variables were used to evaluate the intervention efficacy, including muscle thickness, stiffness, strength, cross-sectional area (CSA), and subcutaneous fat thickness. Analyses were reported using frequentist and Bayesian approaches. The Bayes factor (BF10 and BFincl) was interpreted based on negative and positive values. Results: The results revealed that the main effect of time was statistically significant for muscle strength, thickness, CSA, and stiffness (p < 0.05, BFincl > 1) and, in intragroup comparisons, both groups showed improvements in these parameters (p < 0.05, BF10 > 1). A statistically significant decrease in subcutaneous fat thickness was observed in the BFR-RE group (p < 0.05, BF10 > 1), while this change was not observed in the HL-RE group (p > 0.05, BF10 < 1). Similarly, a statistically significant increase in right rectus femoris muscle stiffness was detected in the BFR-RE group (p < 0.05, BF10 > 1) but not in the HL-RE group (p > 0.05, BF10 < 1). Furthermore, time’s main effect was statistically insignificant for thigh circumference (p > 0.05, BFincl < 1). The group × time interaction was statistically significant only for peak power leg flexion left (p < 0.05, BFincl > 1), and a statistically significant difference in favor of the BFR-RE group was observed in the intergroup comparisons (p < 0.05, BF10 > 1). Conclusions: In conclusion, BF-RE exercise with voluntary exhaustion may be as effective as HL-RE for hypertrophic adaptations in untrained young males. Full article

Background and Objectives: Self-medication includes the use of drugs or herbal preparations based on one’s own discretion or the recommendation of another person, often a family member, friend, neighbor, or even a pharmacist, without prior examination and consultation with a doctor. The goal of this study was to determine respondents’ reasons for using self-medication, determine the frequency of self-medication, and analyze differences in respondents’ attitudes about self-medication in relation to several factors. Materials and Methods: The study was conducted as a cross-sectional observational study. The respondents were patients seeking medical examination at the Health Center in Jagodina who had used over-the-counter medications during the COVID-19 pandemic. A total of 175 respondents participated in the study. The study design provided answers to questions about the respondents’ self-medication habits during the COVID-19 pandemic. Results: More than half of the respondents (53.71%) bought medicines without a prescription, with most cases involving analgesics (52.83%). Almost three-quarters of the respondents were completely vaccinated (74.29%) against COVID-19. Additionally, 39.62% of participants used vitamins as part of their self-medication during the COVID-19 pandemic. Among the vitamins, respondents most commonly used a combination of vitamins C and D (20.75%), vitamin D (5.66%), vitamin C (5.66%), and vitamin A (1.89%). Conclusions: Self-medication for the treatment of coronavirus is more often used by younger respondents, who are not yet married, do not have their own income, and rarely visit a doctor. As for supplements, respondents used zinc, and as for vitamins, respondents mostly used a combination of vitamins C and D. Full article

Background and Objectives: Percutaneous endoscopic gastrostomy (PEG) is a safe, minimally invasive method preferred for long-term enteral nutrition. While most procedural complications are minor and occur in the early period, there are also major complications that can lead to death. This study aims to investigate the minor and major complications, the timing of minor complications in patients with PEG tube placement, and the relevant literature. Materials and Methods: We conducted a retrospective review of 652 patients who underwent PEG tube placement between 1 January 2010 and 31 October 2024. This study investigated the age, gender, primary disease, minor and major complications, early and late complications, and the time to the emergence of minor complications in patients who underwent PEG tube placement. Results: The majority of patients underwent PEG insertion due to neurological diseases, with stroke being the most common cause. The minor complication rate was 17.1%, while the major complication rate was 9.5%. The most common minor complication was peristomal infection (5.2%), and the most common major complication was buried bumper syndrome. Thirty-nine patients (12.7%) experienced complications in the early period, while 17 patients (5.5%) experienced them in the late period. The transverse colon, which was injured, was the most commonly affected internal organ. Conclusion: PEG is widely used for neurological diseases, such as cerebrovascular disease and dementia, with minor complications being more common than major ones. There is no significant difference between early and late minor complications. Full article

Background and Objectives: Extracorporeal membrane oxygenation (ECMO) can support patients with severe cardiopulmonary failure, but it poses risks such as hemolysis, leading to complications. Plasma-free hemoglobin (PFH) is a hemolysis biomarker, with elevated levels linked to mortality. This study evaluates PFH and ECMO survival in COVID-19, non-COVID-19 pulmonary, and cardiac patients, focusing on late PFH spikes. Materials and Methods: We retrospectively analyzed 122 ECMO patients treated at our tertiary hospital (January 2020–December 2021). Patients were categorized by indication: post-COVID-19, non-COVID-19 pulmonary, or cardiac. We classified patients as Expired (died during ECMO or ≤30 days post-ECMO) or Survived (>30 days post-ECMO). Data included demographics, ECMO duration, and PFH values at 24 h and during the last 3 and 5 ECMO days. Groups were compared using two-tailed t-tests, with p < 0.05 indicating significance. Results: COVID-19 patients survived after significantly longer ECMO duration than non-COVID-19 pulmonary and cardiac patients. Expired COVID-19 patients had higher PFH values during the last 3 and 5 days of ECMO compared to survivors. Cardiac patients had the highest overall PFH levels regardless of mortality. No significant differences in PFH trends were observed between non-COVID-19 pulmonary and cardiac patients. Conclusions: Late PFH spikes correlated with mortality in COVID-19 patients, suggesting the utility of measuring late PFH spikes in ECMO management. Additionally, COVID-19 pulmonary patients survived when undergoing ECMO significantly longer than both groups, while VA ECMO was more prone to hemolysis. However, technical cannulation differences and frequent use of an Impella pump in cardiac patients may increase blood stress and PFH values. Full article

Background and Objectives: Despite the growing amount of new research, the pathophysiology of glaucoma remains unclear. The aim of this study was to determine the relationship between intracranial pressure (ICP), ocular blood flow and structural optic nerve parameters. Materials and Methods: A prospective clinical study was conducted involving 24 patients with open-angle glaucoma and 25 healthy controls. Routine clinical examination was performed. Swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA) images were taken (DRI-OCT Triton, Topcon). The vessel density (VD) values of the ONH were calculated around the optic nerve head (ONH). An orbital Doppler device (Vittamed 205, Kaunas, Lithuania) was used for non-invasive ICP measurements. Color Doppler imaging (CDI) (Mindray M7, Shenzhen, China) was used for retrobulbar blood flow measurements in the ophthalmic artery (OA), central retinal artery (CRA) and short posterior ciliary arteries (SPCAs). Results: ICP was 8.35 ± 2.8 mmHg in the glaucoma group and 8.45 ± 3.19 mmHg in the control group (p = 0.907). In the glaucoma group, the VD of the superficial vascular plexus in the inferior-nasal (NI) sector of the ONH showed a correlation with ICP (r = 0.451, p = 0.05). In contrast, the control group exhibited weaker correlations. CRA peak systolic velocity (PSV) demonstrated significant moderate correlations with VD in multiple retinal layers, including the avascular retina layer in the temporal (T) sector (r = 0.637, p = 0.001). Conclusions: Lower ICP was significantly associated with the lower VD of the superficial plexus layer in the inferior-nasal sector in the glaucoma group, with the control group exhibiting weaker correlations in all sectors. Further longitudinal studies with larger sample sizes are needed to establish associations between intracranial pressure, ocular blood flow and ONH parameters. Full article

Background and Objectives: The aim of this study was to compare the short- and long-term effectiveness of ultrasound-guided percutaneous release (CTR-US) and mini-open surgery in the treatment of carpal tunnel syndrome (CTS). Materials and Methods: A retrospective analysis was conducted on 172 patients who underwent surgical treatment for CTS between 2015 and 2020. The patients were divided into two groups: those who underwent CTR-US (Group A, n = 66) and those treated with mini-open surgery (Group B, n = 106). All patients were evaluated using the Boston Carpal Tunnel Questionnaire (BCTQ) and the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) scores before surgery and at 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Electrophysiological and ultrasound findings were also compared. Statistical analyses were performed using t-tests, Mann–Whitney U tests, and Chi-square tests, with significance set at p < 0.05. Results: A total of 172 patients who met the study criteria were included. Among the participants, 112 were women and 60 were men. The mean age was calculated as 61 years for female patients and 54 years for male patients. No significant differences were found between the groups in terms of age, gender, laterality, and disease duration. Both groups demonstrated significant improvements in BCTQ and QDASH scores at all postoperative time points compared to preoperative scores (p < 0.001). The CTR-US group showed advantages in shorter treatment duration (p < 0.001), lower cost (p < 0.05), and faster recovery time. Electrophysiological evaluations revealed faster improvements in distal motor latency (DML) and sensory conduction velocity (SCV) in the CTR-US group (p < 0.05). Ultrasound assessments indicated that both methods achieved effective release of the transverse carpal ligament. No significant differences were observed between the groups in long-term questionnaire scores. Conclusion: CTR-US offers advantages such as shorter treatment duration, lower cost, and faster recovery due to its minimally invasive nature. Consistent with the literature, CTR-US provided faster recovery and improved patient comfort. However, mini-open surgery remains a reliable alternative with long-term symptom control and low complication rates. Our study found that both methods are effective, but CTR-US stands out for its esthetic and functional advantages. Full article

Background and Objectives: Cutaneous melanoma (CM) poses a continuous challenge in oncology due to the developing resistance to available treatments. Doxorubicin (DOX) is noted as one of the most effective chemotherapeutics, although associated toxicity and resistance limit its use in CM treatment. Consequently, DOX has become a promising candidate for combination therapies targeting this neoplasm. Genistein (GEN) gathered significant attention due to its anti-neoplastic properties and ability to enhance the effects of DOX against several cancers, yet this association remains underexplored in CM. Therefore, this study investigated the combination therapy regimen comprising GEN and DOX in terms of anti-melanoma activity and safety profile. Materials and Methods: The in vitro experiments were performed on SK-MEL-28 and HaCaT cells. Cell viability was determined using MTT assay. Cell morphology and confluence were inspected microscopically. Nuclear and cytoskeletal aspects were assessed via immunofluorescence. Apoptosis and oxidative stress were quantified through caspase activity and intracellular reactive oxygen species (ROS) production, respectively. The irritant effect was evaluated on the chorioallantoic membrane. Results: The results revealed that the combination of GEN 10 µM with DOX (0.5 and 1 µM) provided augmented cytotoxic events (e.g., reduced cell viability, altered cell morphology and confluence, apoptotic-like impairments in nuclear shape and cytoskeletal network, increased caspases-3/7 and -9 activity, and elevated ROS) in SK-MEL-28 cells, compared to individual treatments, and exerted a strong synergistic interaction. Simultaneously, GEN 10 µM efficiently surpassed the toxic effects (e.g., viability and confluence loss, hypertrophy, and cytoskeletal condensation) of DOX (0.5 and 1 µM) in HaCaT cells. In ovo, GEN 10 µM + DOX 1 µM treatment was classified as non-irritant. Conclusions: These findings stand as one of the first contributions revealing the beneficial therapeutic interplay between GEN and DOX at physiologically achievable concentrations that resulted in elevated anti-tumor properties in CM cells and alleviated toxicity in keratinocytes. Full article

Background and Objectives: Forward head posture (FHP) is associated with reduced stability limits, impaired balance performance, and compromised cervical proprioception. This study investigated the effects of capital flexion exercise (CFE) on the craniovertebral angle (CVA), trunk control, balance, and gait in chronic stroke patients with forward head posture. Materials and Methods: Twenty-six subjects were randomly assigned to the CFE group or the control group (n = 13 each). The CFE group underwent a familiarization process and performed CFE for 9 min per session, 3 times a week for 6 weeks, as well as the existing neurodevelopmental treatment (NDT). The control group received only the existing NDT. Results: The CVA, the Korean version of the Postural Assessment Scale for Stroke (K-PASS), the Berg Balance Scale (BBS), and the Timed Up and Go test (TUG) improved after the intervention in the CFE group (p < 0.05). In the control group, CVA and TUG improved after the intervention (p < 0.05). The CVA (d = 1.34, p = 0.002), K-PASS (d = 1.36, p = 0.000), and BBS (d = 1.68, p = 0.000) values of the CFE group showed statistically significant improvement compared to the control group. Although TUG improved in the CFE group, the between-group difference was not statistically significant (d = −0.28, p = 0.467). Conclusions: This study suggests that capital flexion exercises effectively improve craniovertebral angle, trunk control, and balance in chronic stroke patients with forward head posture. Full article

Background and Objectives: Distal radius fractures (DRFs) are among the most common fractures globally, with a lifetime incidence of around 9%. They typically present in two age peaks: high-impact trauma in patients under 40 and low-energy trauma in those over 40. Intra-articular DRFs are classified according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, influencing the treatment approach. Surgical management, particularly open reduction and internal fixation (ORIF) using volar plate osteosynthesis, is considered the gold standard. This study aims to compare the treatment costs of fluoroscopy-assisted ORIF and arthroscopy-assisted ORIF for intra-articular DRF. The analysis includes surgical procedure costs, material expenses, and operating time to evaluate the cost-effectiveness of both methods, considering reimbursement within the German healthcare system. Materials and Methods: A retrospective, monocentric study was conducted at Ludwig-Maximilians-University (LMU) Hospital, a supraregional hand trauma center in southern Germany. Patients with DRFs requiring ORIF were treated either with fluoroscopy or arthroscopic assistance. Group 1 included patients treated by the Department of Hand Surgery (Plastic Surgery), subdivided into Group 1a (arthroscopy-assisted) and Group 1b (fluoroscopy-only). Group 2 comprised patients treated by Orthopaedics and Trauma Surgery (fluoroscopy-only). Costs associated with surgical procedures, including materials, operating time, and postoperative care, were analyzed. Results: A total of 43 DRFs were treated. Group 1 consisted of 17 cases, with an average age of 49.6 years (SD = 19.4) and a 64% majority of female patients. Of these, 10 cases were treated with arthroscopy-assisted ORIF (Group 1a) and 7 with fluoroscopy-only ORIF (Group 1b). In Group 1a, the average age was 53.9 years (SD = 16.3) with 60% female and 40% male patients, while in Group 1b, the average age was 43.6 years (SD = 23.1) with 71.4% female patients. Group 2 included 25 cases, with an average age of 54.2 years (SD = 21.0) and a distribution of 64% female and 36% male patients. There was no significant difference in age and gender distribution within the groups and subgroups (p > 0.05). The mean procedure time was longer for arthroscopically assisted ORIF (111.5 min) compared to fluoroscopy-only ORIF (80.1 min), and even longer compared to Group 2 (65.0 min). Material costs were slightly higher in Group 1. Total costs for Group 1 averaged EUR 4906.58, with subgroup costs of EUR 5448.24 for arthroscopy-assisted and EUR 4132.80 for fluoroscopy-only. In comparison, Group 2 costs averaged EUR 3344.08. Conclusions: Intra-articular DRFs with severely displaced fragments or concomitant injuries benefit from arthroscopically assisted fracture treatment. While material costs do not significantly differ between arthroscopically assisted and fluoroscopy-only treatments, the significantly longer procedure time for arthroscopy-assisted ORIF results in the largest cost component. Despite this, reimbursement through the DRG system remains fixed and does not account for the increased operative duration or complexity of arthroscopic procedures. Our findings demonstrate that DRF treatment, regardless of the method used, is either not or only marginally cost-covering under the current German reimbursement structure. In the context of the ongoing shift towards outpatient hand surgery, including the management of DRF, adequate reimbursement rates are necessary to ensure the economic viability of DRF management, particularly for complex intra-articular fractures requiring arthroscopic assistance. Full article

Background and Objectives: In contrast to the standardization of laparoscopic gastrectomy techniques, the complexity of intracorporeal anastomosis techniques in totally laparoscopic total gastrectomy, the lack of standardization, the positional challenges posed by working in a confined space, and varying complication rates have prevented a consensus on the optimal intracorporeal digestive tract reconstruction method. Selecting an appropriate reconstruction method for esophagojejunostomy is crucial for a successful surgical outcome. This study aims to define a modified anastomotic technique for TLTG and share our experience with this technique. Materials and Methods: A total of 21 patients who underwent TLTG with D2 LND between July 2024 and December 2024 using the sutureless L-shape esophagojejunostomy (SLEJ) technique at the Surgical Oncology Clinic of Gulhane Training and Research Hospital due to gastric cancer were included in the study. In our technique, gastrectomy, lymph node dissection, anastomosis preparation, esophagojejunostomy anastomosis, and enteroenterostomy anastomosis were all performed laparoscopically and intracorporeally. Results: The mean operative time was 180.48 min, with a mean EJ anastomosis duration of 40.24 min. In the standard technique, two Endo GIA™ staplers were used for pyloric and small bowel transection, two for EJ anastomosis, and one for intracorporeal jejunojejunostomy. In only one patient, three staplers were used for anastomosis. Therefore, the average number of staplers was 5.05, with a mean of 2.05 staplers used for anastomosis. The mean hospital stay was 8.19 days, and there were no mortalities. The number of patients with an anastomotic leakage was 1. Since the patient’s general condition remained stable, percutaneous drainage or laparotomy was not planned. The patients’ esophagojejunostomy anastomotic leak was classified as Class 1 and Grade 3a according to the Clavien–Dindo classification. The average size of our widest incision was 3.28 cm, and surgical site infections were developed in two patients. Conclusions: Sutureless L-Shape With Endoscopic Assistance (SLEJ) is an easily applicable, technically simpler, shorter-in-duration, easier-to-learn, and safer intracorporeal EJ anastomosis technique with a low rate of postoperative complications. Full article

Background and Objectives: Non-dipping blood pressure (BP) patterns are associated with increased cardiovascular risk, but their role in periprocedural myocardial infarction (PMI) during elective percutaneous coronary intervention (PCI) remains insufficiently clarified. The objective was to investigate whether a non-dipping BP profile independently predicts PMI in hypertensive patients undergoing elective PCI. Materials and Methods: This prospective observational study enrolled 462 hypertensive patients undergoing elective PCI, categorized as dipping or non-dipping based on 24 h ambulatory BP monitoring (ABPM). Clinical, laboratory, and angiographic data were compared. PMI was defined according to the Fourth Universal Definition of Myocardial Infarction. Independent predictors of PMI were identified using multivariate logistic regression. Results: Of the 462 patients, 243 (52.6%) exhibited a non-dipping BP pattern. Non-dipping status was significantly associated with higher incidence of PMI (32.5% vs. 13.7%, p < 0.001) and a worse metabolic profile, including elevated blood glucose (p = 0.001), Hemoglobin A1c (p = 0.002), and white blood cell count (p = 0.001), and lower high-density lipoprotein cholesterol (p = 0.047). These patients more frequently underwent complex PCI (25.1% vs. 5.0%, p < 0.001). In multivariate analysis, the non-dipping BP pattern emerged as the strongest independent predictor of PMI (odds ratio 25.99, 95% confidence interval 3.16–213.92, p = 0.002), followed by complex PCI, number of stents, stent length, and diabetes mellitus. Conclusions: Non-dipping BP pattern is a powerful and independent predictor of PMI in hypertensive patients undergoing PCI. Incorporating ABPM into routine cardiovascular risk assessment may improve the identification of high-risk patients and allow for tailored preventive strategies. Full article

Background and Objectives: Spondylarthritis is a complex group of inflammatory diseases closely associated with the HLA-B27 antigen. However, the role of non-HLA-B27 alleles in the disease’s pathogenesis has gained significant scholarly attention in recent years. Case presentation: This case study presents a 49-year-old male with a history of progressive inflammatory back pain, characterized by morning stiffness and restricted spinal mobility developed over several years. Initially presenting with non-specific symptoms, the patient eventually experienced persistent axial pain and deteriorating functional limitations, which required further evaluation. Radiographic imaging supported the diagnosis of ankylosing spondylitis (AS) by identifying bilateral sacroiliitis. HLA genotyping revealed a negative result for HLA-B27 but positive results for HLA-B13 and HLA-B37. This finding serves as a foundation for exploring alternative genetic factors contributing to spondylarthritis (SpA). HLA-B13 and HLA-B37 exhibit structural and functional similarities to HLA-B27, particularly in their peptide-binding grooves. This resemblance may lead to overlapping peptide repertoires and increased T cell cross-reactivity. Moreover, these alleles belong to overlapping cross-reactive groups (CREGs) and share the Bw4 epitope. This suggests that they may contribute to disease pathogenesis via similar mechanisms, such as molecular mimicry and the dysregulation of natural killer (NK) cell interactions, as observed in HLA-B27. Conclusions: This case emphasizes the necessity of expanding diagnostic criteria to incorporate non-HLA-B27 markers, particularly for patients who are HLA-B27-negative. Enhancing our understanding of the roles of alternative genetic markers can improve diagnostic accuracy, enable personalized treatment approaches, and enhance outcomes for the diverse SpA patient population. Full article

Familial Mediterranean Fever (FMF) is characterized by recurrent febrile attacks and serositis. While colchicine is the primary treatment for FMF, some patients present resistance or intolerance with respect to this drug. Anakinra—an IL-1 receptor antagonist—has demonstrated efficacy in colchicine-resistant or -intolerant FMF patients. Background and Objectives: This study aimed to evaluate the clinical characteristics, treatment duration, response to therapy, dose interval modifications, and long-term outcomes in FMF patients treated with anakinra. Materials and Methods: We retrospectively analyzed data from 68 FMF patients who were colchicine-resistant or -intolerant and received anakinra treatment. Results: The median patient age was 40.2 years, with a predominance of female patients (57.3%). The median follow-up duration for patients treated with anakinra was 34.2 months. Anakinra dosing was successfully extended in 30.8% of patients. Eight patients discontinued anakinra due to remission, with a median remission duration of 18.4 months. In a subgroup analysis of 57 patients treated with anakinra for at least 12 months, a significant decrease was observed in Pras scores at 0 months, 3 months, and 12 months, as well as in Erythrocyte Sedimentation Rate, C-reactive protein, and Serum Amyloid A values (all p < 0.001). Statistically significant decreases in 24 h proteinuria values were found between 0 and 3 months, 3 and 12 months, and 0 and 12 months (p = 0.011, p = 0.006, and p = 0.007, respectively). Anakinra use in pregnancy and kidney transplant recipients was well tolerated. Dose extension and treatment discontinuation in remission are feasible strategies. Conclusions: These findings support the use of anakinra as a good treatment option in selected patients. Full article