Surgeries

Background/Objectives: Artificial intelligence (AI) holds great potential to reshape the academic paradigm. They can process large volumes of information, assist in academic literature reviews, and augment the overall quality of scientific discourse. This narrative review examines the application of various AI tools in surgical research, its present capabilities, future directions, and potential challenges. Methods: A search was performed by two independent authors for relevant studies on PubMed, Cochrane Library, Web of Science, and EMBASE databases from January 1901 until March 2025. Studies were included if they were written in English and discussed the use of AI tools in surgical research. They were excluded if they were not in English and discussed the use of AI tools in medical research. Results: Forty-two articles were included in this review. The findings underscore a range of AI tools such as writing enhancers, LLMs, search engine optimizers, image interpreters and generators, content organization and search systems, and audio analysis tools, along with their influence on medical research. Despite the multitude of benefits presented by AI tools, risks such as data security, inherent biases, accuracy, and ethical dilemmas are of concern and warrant attention. Conclusions: AI could offer significant contributions to medical research in the form of superior data analysis, predictive abilities, personalized treatment strategies, enhanced diagnostic accuracy, amplified research, educational, and publication processes. However, to unlock the full potential of AI in surgical research, we must institute robust frameworks and ethical guidelines. Full article

Introduction: The escalating scarcity of skilled healthcare professionals is particularly pronounced within surgical specialties, where the prospect of attracting prospective medical practitioners poses formidable challenges. Throughout their academic journey, students exhibit diminishing enthusiasm and motivation to pursue careers in surgery, including trauma surgery. It is postulated that the caliber of teaching plays a pivotal role in influencing students’ subsequent specialization choices. Methods: This prospective observational study was conducted among a cohort of third-year medical students at the German University Medicine Greifswald. The methodology encompassed the utilization of a self-administered questionnaire to procure data. Results: The study encompassed 177 participants, of whom 34.7% expressed an inclination toward a career in surgery (22.7% in trauma surgery). Participants who reported a favorable impact from the examination course displayed a significantly heightened interest in clinical clerkships within trauma surgery (p < 0.001), and even expressed a contemplation of specializing in orthopedics and trauma surgery (p = 0.001). Logistic regression analysis highlighted that the convergence of practical training and positive role modeling emerged as the most influential factors augmenting the allure of trauma surgery. Conclusions: Evidently, students who gleaned substantial benefits from high-quality practical instruction in trauma surgery exhibited a significantly heightened likelihood of pursuing this domain in their future endeavors. Surgical academic institutions stand to leverage this insight in their strategic planning for attracting and retaining potential residents. Cultivating a positive affinity for trauma surgery should be instilled early in the curriculum, subsequently sustained through ongoing immersive engagement that encompasses professional as well as interpersonal dimensions. Full article

Background/Objectives: The introduction of innovative technologies for the management of oral diseases has revolutionized treatment approaches, offering less invasive options and improved outcomes. Among oral cavity diseases, sialolithiasis is the most common disorder of the salivary glands. It involves the formation of calculi or stones within the salivary ducts, primarily affecting the submandibular gland due to its tortuous duct and the alkaline nature of its saliva. In particular, laser-assisted techniques have shown significant promise in enhancing the precision and safety in the management of sialolith removal. This article aims to present a case report and also explores the scientific evidence supporting these innovative methods, highlighting their benefits and limitations in clinical practice. Methods: This research was conducted using PubMed and Scopus search engines with a combination of relevant keywords, including laser, laser-assisted, laser treatment in combination with sialolith, sialolith removal, and sialoadenectomy. Selected articles were carefully reviewed to identify studies reporting data on the effectiveness of laser-assisted sialolith removal. Results: Results from the literature review indicate a growing interest in the application of diode laser and CO₂, with evidence suggesting improved clinical outcomes and reduced postoperative pain compared to traditional methods. Conclusions: Although lasers offer enhanced safety and reduced morbidity and bleeding, which ensures optimal visibility, certain limitations must be considered, including the need for an adequate training period. Further randomized clinical trials and longer follow-up studies are needed to better evaluate their use in sialolith removal. Full article

Background: Structured titanium (ST) cages are designed to enhance osseointegration and fusion in lumbar interbody procedures. However, clinical and radiological outcomes following TLIF using ST cages—particularly with or without adjacent-level dynamic stabilization (DSS)—have not been widely reported. Objective: To evaluate 12-month fusion outcomes and patient-reported outcomes (PROMs) after TLIF with structured titanium cages, comparing cases with and without adjacent-level DSS. Methods: In this retrospective cohort study, 82 patients undergoing TLIF with ST cages were analyzed—41 with hybrid instrumentation (TLIF + DSS) and 41 with TLIF alone. PROMs (ODI, VAS for back and leg pain, EQ-5D-5L) were assessed preoperatively and at 12 months. Fusion was assessed via CT scans at 12 months. Results: PROMs significantly improved over time in both groups (p < 0.001 for ODI, VAS back, VAS leg), but there were no significant differences between the hybrid and non-hybrid groups. Overall, the interbody fusion rate was 84%. Complete fusion was observed in 84% of the hybrid group and 80% of the TLIF-only group (p = 0.716), with very low rates of non-union. Conclusions: Structured titanium cages demonstrated excellent 1-year fusion rates and supported significant clinical improvement after TLIF. The addition of dynamic stabilization had no measurable effect on patient-reported or radiological outcomes at 12 months. Long-term studies are needed to assess any potential effect of DSS on adjacent segment disease. Full article

Preoperative facial markings are critical to surgical precision and aesthetic outcomes in plastic surgery, yet remain operator-dependent and variably documented. Generative artificial intelligence (AI), particularly large multimodal models, offers potential for the automated illustration of surgical plans. This study compares the performances of ChatGPT-4o and Gemini Advanced in generating standardised preoperative markings for aesthetic facial procedures. Methods: Six text prompts describing common facial aesthetic surgeries were developed using established marking protocols. Each prompt was submitted once to ChatGPT-4o and Gemini Advanced, yielding twelve illustrations. Three board-certified plastic surgeons independently evaluated the images using a five-domain Likert scale assessing incision clarity, anatomical accuracy, template conformity, clinical usefulness, and overall graphic quality. A composite score out of 25 was calculated. Data were analysed using paired t-tests, and interrater reliability was assessed with intraclass correlation coefficients. Results: ChatGPT-4o significantly outperformed Gemini Advanced in composite scores (mean 18.0 ± 1.4 vs. 13.9 ± 1.6, p = 0.001, Cohen’s d = 1.69). Superior performance was noted across all domains, particularly in clarity (mean difference 0.83, p = 0.002) and graphic quality (mean difference 0.90, p = 0.001). Interrater reliability was good (ICC = 0.82). Discussion: ChatGPT-4o demonstrated higher fidelity in translating surgical prompts into anatomically appropriate, clinically useful illustrations. However, neither system achieved the precision required for clinical implementation without revision. These models may serve as adjuncts in education and preliminary planning. Future work should explore model fine-tuning, surgeon-guided generation, and performance in reconstructive procedures. Full article

Background: BCI and AI-driven image segmentation are revolutionizing precision neurosurgery by enhancing surgical accuracy, reducing human error, and improving patient outcomes. Methods: This systematic review explores the integration of AI techniques—particularly DL and CNNs—with neuroimaging modalities such as MRI, CT, EEG, and ECoG for automated brain mapping and tissue classification. Eligible clinical and computational studies, primarily published between 2015 and 2025, were identified via PubMed, Scopus, and IEEE Xplore. The review follows PRISMA guidelines and is registered with the OSF (registration number: J59CY). Results: AI-based segmentation methods have demonstrated Dice similarity coefficients exceeding 0.91 in glioma boundary delineation and tumor segmentation tasks. Concurrently, BCI systems leveraging EEG and SSVEP paradigms have achieved information transfer rates surpassing 22.5 bits/min, enabling high-speed neural decoding with sub-second latency. We critically evaluate real-time neural signal processing pipelines and AI-guided surgical robotics, emphasizing clinical performance and architectural constraints. Integrated systems improve targeting precision and postoperative recovery across select neurosurgical applications. Conclusions: This review consolidates recent advancements in BCI and AI-driven medical imaging, identifies barriers to clinical adoption—including signal reliability, latency bottlenecks, and ethical uncertainties—and outlines research pathways essential for realizing closed-loop, intelligent neurosurgical platforms. Full article

Background: Cubital tunnel syndrome is the second most common compressive neuropathy of the upper limb, and it is characterized by ulnar nerve compression at the elbow. Traditional surgical options, including simple decompression and anterior transposition, have limitations in addressing ulnar nerve instability. This study introduces and evaluates the short-term outcomes of a novel surgical technique, the fascio-aponeurotic epicondylar flap (FAEF), for stabilizing the ulnar nerve and managing its instability. Materials and methods: A retrospective study was conducted on ten patients with longstanding cubital tunnel syndrome and confirmed ulnar nerve dislocation or instability. All patients underwent surgical intervention using the FAEF technique, which involves creating a quadrangular fascial flap from the epicondylar fascia to stabilize the ulnar nerve within the retrocondylar groove. Outcomes were assessed using clinical follow-ups, the Michigan Hand Outcomes Questionnaire (MHQ), VAS, and qDASH scores over a 90-day postoperative period. Results: All ten patients experienced complete resolution of neurological symptoms, including paresthesia, pain, and nerve clicking, by the final follow-up. Postoperative recovery was uneventful, with no complications such as infections or hematomas. Grip strength and hand functionality were fully restored, with significant improvements in MHQ scores (mean: 94). Dynamic elbow mobilization initiated on the first postoperative day resulted in full recovery of elbow range of motion. No recurrence of ulnar nerve dislocation was observed. Discussion: The FAEF technique effectively stabilizes the ulnar nerve, alleviates symptoms, and restores function while minimizing risks associated with traditional procedures, such as nerve trauma and elbow instability. By preserving the anatomical integrity of the medial epicondyle and enhancing nerve mobility, this approach represents a less invasive alternative to anterior transposition and medial epicondylectomy. Conclusions: The FAEF technique is a viable and effective surgical option for managing ulnar nerve instability in cubital tunnel syndrome. It offers a less invasive solution with excellent short-term outcomes, making it a promising addition to the surgical armamentarium for this condition. Further studies are warranted to evaluate long-term efficacy and broader applicability. Full article

Background/Objectives: Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition of the nasal cavity and paranasal sinuses that significantly impact patients’ quality of life and imposes a substantial burden on healthcare systems and society, including considerable costs associated with surgical management when required. This review aimed to provide a comprehensive overview of the burden of CRS, encompassing its impact on patients, society, and the economy, while also highlighting the latest advancements in diagnosis and treatment. Methods: A systematic review using PubMed, Embase and Google Scholar databases identified recent literature published in English, adhering to PRISMA guidelines. Search terms included “chronic rhinosinusitis”, “burden”, “quality of life”, “economic impact”, “diagnosis”, “treatment”, and “endotypes”. Original research, reviews, and meta-analyses were included, while case reports, surgical-only studies, and non-English articles were excluded. Results: Characterized by persistent symptoms such as nasal congestion, facial pressure, and discharge, CRS often leads to decreased productivity, missed workdays, and impaired sleep. Recent advances in understanding the pathophysiology of CRS have led to the identification of distinct endotypes, including type 2 inflammation characterized by eosinophilic infiltration, and type 1 inflammation with a neutrophilic predominance. Conclusions: This understanding has paved the way for targeted therapies, including biologic agents that have shown promising results in managing CRS, particularly in patients with type 2 inflammation. Full article

Background: Hallux rigidus (HR) is a common forefoot disorder, and surgical treatment is typically guided by the severity of the condition, as defined by the Coughlin and Shurnas four-grade classification. This study aimed to compare clinical and functional outcomes in patients undergoing first metatarsophalangeal joint arthrodesis (FMTPJA) with or without the use of an interfragmentary (IF) screw in addition to a dorsal plate. Methods: We retrospectively evaluated a cohort of patients who underwent surgery with a FMTPJA, dividing patients in two groups: patients who underwent FMTPJA through dorsal plate associated with an interfragmentary screw (WIS group) and patients who underwent FMTPJA through dorsal plate without an interfragmentary screw (WOIS group). The primary outcomes were analyzed using the FAAM score and FAAM sport score. Secondary outcomes included VAS, patient satisfaction, recovery time to return to sports, and the level of postoperative sports activity compared to preoperative levels. Results: In paired analyses, the WOIS group showed statistically significant improvements in both the FAAM and FAAM sport scores (p = 0.01). In contrast, the WIS group showed significant improvement only in the FAAM sport score (p = 0.01), while the FAAM score did not reach statistical significance (p = 0.42). Multivariate analysis revealed that a higher preoperative FAAM score predicted a higher postoperative FAAM score (p = 0.75), while the use of an IF screw was associated with a lower expected postoperative FAAM score (p = 0.25). Increased BMI and older age were significantly associated with lower postoperative FAAM scores. Conclusions: Both surgical techniques led to significant clinical improvements. However, patients in the WOIS group showed a trend toward faster recovery and higher postoperative sports activity levels, particularly in the athletic population. Although no statistically significant differences were found between groups overall, these findings suggest potential benefits of avoiding an IF screw in selected patients. Further prospective studies are warranted to better delineate the clinical impact of screw usage in FMTPJA. Full article

Background: Transcervical radiofrequency ablation (TRFA), particularly using the SONATA^® System, is a minimally invasive and uterus-preserving treatment for uterine fibroids. While effective, its reliance on intrauterine ultrasound (IUS) with limited 2D visualization can present challenges, especially for trainees who must mentally reconstruct 3D anatomy in real-time from traditional radiology reports. Objective: This study explores the benefits of using 3D Smart MRI technology in improving procedural accuracy and user experience during simulated TRFA procedures performed by OB/GYN residents. Methods: In a randomized human subject study, 14 OB/GYN residents performed mock TRFA procedures on silicone uterine phantom models embedded with fibroids. The control group received standard written MRI reports, while the intervention group used the Smart MRI 3D visualization tool. We assessed quantitative outcomes including procedure time and fibroid miss rate. Additionally, participants completed post-procedure user experience questionnaires to assess the perceived utility and ease of use of the 3D tool. Results: While procedure time did not differ significantly between groups, there was a notable reduction in the miss rate for one of the fibroids (17% vs. 75%). Residents using Smart MRI reported higher confidence in identifying and treating all fibroids (83% vs. 43%) and rated their spatial understanding significantly higher on Likert-scale assessments (4.6 vs. 3.25). The technology also received high scores for its impact on clinical decision-making (4.8) and intraoperative efficiency (4.5). Conclusions: Overall, this study indicated that the use of 3D Smart MRI was well-received by residents, who reported enhanced intraoperative performance, including greater confidence, more informed decision-making, and improved procedural efficiency. Moreover, the notably lower miss rate observed in the Smart MRI group points to the tool’s potential in improving the detection and treatment of fibroids that may be missed otherwise. Full article

Objective: Neurogenic thoracic outlet syndrome (nTOS) is a rare compression neuropathy, and establishing a firm diagnosis can be challenging. Interscalene nerve blocks with Ropivacaine and Dexamethasone have been proposed in cases with typical symptoms and without evident pathology of the thoracic outlet (i.e., disputed nTOS) to establish the diagnosis. The aim of this study was to evaluate the effectiveness of interscalene nerve block for long-term pain relief in patients with true and disputed nTOS. Methods: Patients between 18 and 90 years of age with either true or disputed nTOS were prospectively included in the study. All patients received an interscalene nerve block with Ropivacaine and Dexamethasone. At baseline, 2, 6, 12, and 24 weeks after infiltration, minimum and maximum pain levels were assessed using the numeric rating scale (NRS 0–10). Furthermore, arm function was assessed using the Quick-DASH, and health-related quality of life was assessed by means of the SF-12 questionnaire. Statistical analysis was performed with SPSS version 29.0 using the Wilcoxon signed rank test and t-test for paired samples. A p-value below 0.05 was considered statistically significant. Results: A total of 21 patients were included in the study. There was a significant decrease in the minimum (Pmin) and maximum (Pmax) mean pain levels at 2 and 6 weeks after the baseline. Thereafter, 12 patients dropped out of the study due to surgery. In the remaining nine patients, pain levels remained significantly lower than baseline at 12 and 24 weeks after infiltration. Quick-DASH scores as well as the physical domain of the SF-12 showed significant improvement compared to baseline. Conclusions: In patients with true and disputed nTOS, long-term pain relief can be achieved with the interscalene nerve block with Ropivacaine and Dexamethasone. Additionally, the study indicated an improvement in arm function and health-related quality of life. In patients with disputed nTOS, the interscalene nerve block may be a useful tool to establish the diagnosis of clinically relevant true nTOS. Key points: Question: Does a scalene nerve block with Ropivacaine and Dexamethasone lead to long-term pain relief in patients with a neurogenic thoracic outlet syndrome (nTOS)? Findings: A scalene nerve block with Ropivacaine and Dexamethasone leads to significant pain relief, as well as an improvement in arm function and health-related quality of life for patients with a neurogenic TOS. Meaning: This study provides new insights into the diagnostic of neurogenic TOS and may be used as a short- and long-term pain therapy. Full article

Background: Reconstructive surgery with free flaps is a fundamental component in head and neck surgery, but flap failure remains a significant concern. The hemoglobin, albumin, lymphocyte, and platelet (HALP) score is a prognostic factor commonly applied in the evaluation of patients suffering from malignant tumours. This score has emerged as a potential preoperative risk assessment tool; however, its predictive accuracy for free flap failure has not been fully evaluated. The potential of this formula, in the cervical–facial reconstructive area, has not yet been well studied in the international literature. Methods: This retrospective study included patients who had undergone free flap reconstruction in the maxillofacial surgery departments of Perugia and Ancona over the past ten years. To optimize the HALP formula, advanced machine learning technologies, mainly the Julius AI platform, were applied. The HALP formula was refined through three phases: the original formula, a weighted version, and the final “Modified HALP.” Predictive performance was assessed using ROC curve analysis, multivariate logistic regression, and internal validation. Results: The final version of the HALP score, created in the present study, achieved an AUC-ROC of 0.95 (95% CI: 0.91–0.99), outperforming the original and weighted versions. At the optimal cut-off, the final “Modified” HALP score demonstrated 90.91% sensitivity and 92.36% specificity, remaining an independent predictor of flap failure after adjusting for confounders. Conclusions: The aim of the study was to optimize the HALP score by integrating clinical information with the aim of making significant progress in the prediction of failure in reconstructive flaps. The Modified HALP score emerges as a powerful tool for preoperative risk stratification in free flap surgery, potentially improving patient outcomes through targeted interventions. Future research should focus on external validation and exploring the underlying biological mechanisms. Full article

Background: Robotic-assisted technology has become an increasingly utilized adjunct within the realm of primary total knee arthroplasty (TKA). Previous studies have shown that robotic-assisted total knee arthroplasty (raTKA) offers potential advantages of enhanced bony preparation and optimal implant alignment with equivalent long-term patient outcomes and component longevity in comparison to conventional TKA (cTKA). Furthermore, recent studies have identified the additional benefit of decreased surgeon physiologic stress with the use of raTKA. The purpose of this study was to compare differences in surgeon posture between primary raTKA and cTKA. Materials and Methods: We prospectively evaluated 103 consecutive primary TKA cases (48 raTKAs, 55 cTKAs) performed by three high-volume, fellowship-trained arthroplasty surgeons. Throughout each case, surgeons wore a posture-tracking device to evaluate time spent slouching. The threshold for slouching was set to 30 degrees of flexion from a neutral spinal axis. Demographic and operative factors were collected. Two-tailed tests and multivariate analysis were used to assess for differences between groups. Results: After controlling for individual surgeon differences in posture, we found a decrease in the percentage and duration of time spent slouching in raTKA cases compared to cTKA cases (42.4 vs. 72.5%, p < 0.001, 35.4 vs. 54.7 min, p = 0.037). On average, the use of the robot decreased surgeon slouching time by 19.3 min (26.6%, p < 0.001). Patient factors such as increased age and ASA 2 were also associated with favorable effects on posture (p < 0.001). Conclusions: Surgeons performing primary raTKA cases spend significantly less case time and case percentage in a slouched posture compared to conventional primary TKA cases. This suggests the potential for ergonomic benefit of robotic-assisted technology in primary TKA. Further research is needed to determine the long-term effects of posture on surgeon pain and career longevity. Full article

Background/Objectives: Significant weight loss, whether through bariatric surgery or medication-assisted approaches, presents unique challenges for body contouring procedures. A thorough preoperative evaluation is essential to optimize outcomes and minimize risks. Methods: A comprehensive literature search was conducted across various databases to identify studies on assessment, nutritional optimization, thromboembolic risk, and surgical planning for post-weight-loss patients, with a particular focus on those undergoing medication-assisted weight loss using Glucagon-like peptide-1 (GLP-1) agonists. Results: A detailed review of medical history, comorbidities, weight loss trajectory, and nutritional status is essential. Common conditions such as diabetes, hypertension, and sleep apnea often improve after weight loss but require ongoing management. Nutritional deficiencies, particularly in vitamins and minerals, necessitate dietary counseling and supplementation. Patients who have undergone significant weight loss are at increased risk of thromboembolic events, particularly after body contouring procedures. Surgical planning should be patient-centered, setting realistic expectations and employing a strategic, staged approach when necessary to optimize outcomes. GLP-1 agonists users require special consideration due to their distinct metabolic and physiological profiles. Conclusions: Optimizing preoperative assessment, nutrition, and thromboprophylaxis is critical for safe and effective body contouring in post-weight-loss patients. With the increasing prevalence of medication-assisted weight loss, surgical strategies must adapt to address the distinct anatomical and physiological features of these patients. Full article

Background: Pharyngeal stenosis (PS) is a common sequela of a total laryngectomy (TL), and the most common cause of postoperative dysphagia. Its exact incidence is not known. A greater understanding of this clinical complication could serve to better inform patients considering a laryngectomy. Objective: Pharyngeal stenosis (PS) is a common sequela of a total laryngectomy (TL) and causes dysphagia. This systematic review aims to characterize PS as a sequela of a TL, specifically the incidence of dysphagia requiring dilation, and the frequency/timing of dilation interventions. Data Sources: We used PubMed. Review Methods: A search of all studies from PubMed published from conception to January 2024 was conducted. Cohort studies reporting PS requiring dilation following a TL were included. Data were collected on the incidence, recurrence, median time from TL to dilation, TL indication, and reconstructive approach. Two evaluators independently performed the study screening and data collection; all the differences were resolved by a third evaluator. Results: Eleven studies met the inclusion criteria. A total of 1421 patients underwent a TL, of which 659 (46.4%) were salvage, 286 (20.1%) were the primary treatment, and 153 (10.8%) were the primary with an adjuvant treatment. A total of 255 patients underwent reconstruction, among whom 86 (33.7%) had regional and 169 (66.3%) had free flaps. The mean age at the time of the TL was 64.1 (range 20–87) years, with a male-to-female ratio of 3.4:1. The overall incidence of dysphagia after a TL requiring dilation was 26%. Of the 370 patients who required dilation, 69.4% required multiple procedures. The median time to the first dilation post-TL ranged from 9 to 24 months. The overall complication rate was 4.3%, including perforation, infection, and diminished tracheoesophageal voice quality. Conclusions: Approximately one in four patients developed stenosis requiring dilation after a TL, of which two out of three required repeat dilations. Major complications, though rare, were predominantly observed during the first few dilation procedures. Full article

Sexual dysfunction following abdominal or pelvic surgery is a significant concern that impacts the quality of life (QoL) for both men and women. This paper explores the multifaceted challenges and re-educational strategies associated with post-surgical sexual dysfunction. It highlights the physical and psychological repercussions of surgeries such as hysterectomies, pelvic organ prolapse repairs, radical prostatectomies, and rectal cancer resections. These procedures often lead to complications like dyspareunia, erectile dysfunction, and altered body image, necessitating comprehensive re-educational approaches. The review emphasizes the importance of tailored interventions, including pelvic floor muscle training (PFMT), biofeedback, manual therapy, and advanced techniques like botulinum toxin injections and sacral neuromodulation. For men, strategies such as phosphodiesterase type 5 inhibitors (PDE5i), vacuum erection devices (VEDs), intracavernosal injections, and penile prostheses are explored for their efficacy in restoring erectile function. Psychological support, including cognitive–behavioral therapy and couples counseling, is underscored as essential to addressing emotional and relational aspects of recovery. A multidisciplinary approach involving physiatrists, urologists, gynecologists, physiotherapists, psychologists, and sexual health counselors is advocated for to optimize outcomes. Integrating physical therapy modalities, as well as psychological and relational therapies, into individual rehabilitation projects is crucial for improving sexual function and overall QoL post-surgery. Future research should focus on refining these established strategies and investigating the potential of innovative therapeutic modalities. Full article

Isolated tricuspid regurgitation (TR) represents a significant yet understudied cardiac condition, primarily arising from structural valve anomalies or secondary to right ventricular (RV) dysfunction. This thesis reviews the pathophysiology, clinical picture, and evolving management strategies for isolated TR, focusing on medical and surgical interventions and emerging transcatheter therapies. Employing a comprehensive literature review and retrospective analyses, we delve into the etiological factors, diagnostic challenges, and treatment outcomes associated with this condition. Notably, we explore the prognostic implications of isolated TR following mitral valve surgery and the efficacy of various treatment modalities in improving patient survival and quality of life. Full article

Introduction: Traumatic brain injury (TBI) involves a diverse group of head blunt and/or penetrating injuries and is a leading cause of death in the U.S., accounting for one-third of all injury-related deaths. A post-injury hyperglycemic state may commonly impact TBI prognosis and strongly correlate with injury severity. Diabetes mellitus (DM) may also be a source of concomitant hyperglycemia that can worsen prognosis, with previous literature suggesting that DM could be an independent predictor of poor outcome and mortality after TBI. Methods: Using the multi-center, national TriNetX database, we performed a propensity score-matched analysis of severe TBI patients with (DM) and without DM (NDM) from 2014 to 2024. We examined the risk of mortality and complications, including sepsis, cerebral infarction, and pulmonary embolism. We also performed a sub-group analysis comparing the risk of mortality and complications between patients with either insulin-dependent or insulin-independent forms of DM. Results: A total of 26,019 patients were included (4604 DM vs. 21,415 NDM). After propensity score matching, patients with DM had a significantly lower risk of mortality (RR: 0.815; 95% CI: 0.771–0.861; p < 0.05) and ventilator dependency (RR: 0.902; 95% CI: 0.844–0.963; p < 0.05) compared to NDM patients. However, patients with DM had a significantly higher risk of cerebral infarctions, seizures, pneumonia, and sepsis (p < 0.05). Sub-group analysis found no significant difference in mortality or complications between insulin-dependent and insulin-independent forms of DM. Conclusion: Our results suggest that hyperglycemia secondary to DM plays a complicated role in the outcomes after severe TBI. Unexpectedly, we identified both increased and decreased complications in patients with DM. These results reflect the current challenges in the literature surrounding pre-existing DM in patients’ outcomes, the impact of diabetic medications on patient outcomes, and the changing role of aggressive glucose management in critical care patients. Full article

Background: Third molar (M3) removal is considered one of the most frequent oral surgical procedures worldwide. Indications for extraction include both prophylactic and therapeutic reasons. However, this does not come without complications, and despite the widespread practice, there is no consensus on whether prophylactic M3 extraction is more beneficial than conservative management. Aims: The aim of this systematic review is to highlight and compare the main differences and outcomes between prophylactic and therapeutic removal of third molars with conservative treatment and observation. Several factors have been considered such as post-surgical infection risks and complications, hospitalization indications, economic factors and periodontal health of adjacent teeth. Methods: A literature review and meta-analysis were conducted, which comprises studies describing the incidence of postoperative complications, the periodontal status of the second molar (M2), the prevalence of caries, and the economic aspects of the M3 removal. Periodontal parameters of the adjacent teeth such as periodontal pocket depth (PPD) and clinical attachment level (CAL), as well as inferior alveolar nerve (IAN) damage and post-operative inflammatory complications such as bacteremia, were considered. Finally, hospitalization and the economic burden of this procedure were also stated. Results: Third molar retention is associated with increased periodontal disease such as PPD and accumulation of plaque to the adjacent teeth, as well as risk of caries. Contrarily, prophylactic M3 extraction is often linked to unnecessary morbidity and costs, such as risk of bacteremia, trismus, postoperative pain, IAN damage, and sometimes the need for hospitalization. From an economic aspect, this frequent procedure is mostly associated with higher direct and indirect costs, which can exceed the amount of EUR 1000 per patient without hospitalization. Conclusions: This review tried to determine whether the M3 observation and retention can be more beneficial than M3 extraction, after examining certain parameters. Findings indicate that unnecessary morbidity and costs can be attributed to third molar extraction, with postoperative complications such as pain and trismus and sometimes the need for hospitalization. Transient bacteremia also accompanies third molar removal. Full article