Search Results (85)

Background: Accurate reconstruction of the orbit after trauma or oncological resection requires reliable anatomical references. In unilateral cases, the contralateral orbit can guide repair, but bilateral injuries or pathologies remove this option. To address this problem, we developed a new morphological classification of orbits based on three linear dimensions. Methods: A total of 499 orbits from patients of Caucasian descent (age 8–88 years) were analyzed using three-dimensional models generated from cone-beam and fan-beam CT scans. Orbital depth (D), height (H), and width (W) were measured, and proportional indices were calculated. K-means clustering (k = 3) identified recurring morphotypes, validated by linear discriminant analysis (LDA) and supported by ANOVA, Kruskal–Wallis, and correlation tests (age and sex). Results: Three morphotypes were identified: Tall & Broad (type A, 33.5%), Deep & Broad (type B, 30.2%), and Compact (type C, 36.2%). All dimensions differed significantly between groups (ANOVA, p < 1 × 10⁻¹⁶; η² = 0.40–0.51). Male orbits were significantly deeper and wider than female ones (p < 0.001). LDA demonstrated excellent separation with 97.5% accuracy. A simplified decision algorithm achieved 82.1% classification accuracy. In situations where only orbital depth could be measured, an alternative cut-off-based method reached 61.5% accuracy, with type B and C better distinguished than type A. Conclusions: The proposed classification provides a reproducible framework for describing orbital morphology. It may serve as a reference in cases where local anatomy is disrupted or the contralateral orbit is unavailable. Even millimeter-scale differences in orbital dimensions may correspond to clinically relevant changes in orbital volume and globe position, underlining the potential usefulness of this system in surgical planning. Full article

Polyethylene terephthalate glycol-modified (PETG) is a transparent, stable copolymer commonly used in biomedical devices such as surgical guides, clear aligners, and anatomical models. Its biocompatibility must be assessed not only for cytotoxicity, but also for subtle molecular and immunological responses, especially when in contact with mucosal or hormone-sensitive tissues. This study evaluated the biological safety of PETG processed via CNC milling and CO₂ laser cutting, two methods that preserve bulk chemistry but may alter surface properties. PETG diskettes were analyzed by FT-IR, ¹H-NMR, and GC–MS to confirm chemical integrity and absence of degradation products. Biocompatibility was tested using MCF-7 epithelial cells and THP-1 monocytes. Cell viability remained above 90% over seven days. Inflammatory (COX-2, TNFα, IL-8, IL-1α, IL-4, IL-10, IFNγ) and hormone-related (ERα, ERβ) gene expression was analyzed by qRT-PCR. Gene profiling revealed only modest, non-significant changes: COX-2 was upregulated 1.8-fold after laser processing, and ERα increased 1.6-fold following milling—both below thresholds considered biologically active. These findings indicate that mechanical surface treatments induce minimal bioactivity, with no meaningful immune or hormonal stimulation. PETG remains functionally inert under the tested conditions, supporting its continued safe use in intraoral and hormone-sensitive biomedical applications. Full article

Background: Intensive Care Unit (ICU) readmission and in-hospital mortality are critical indicators of patient outcomes following ICU discharge. Patients readmitted to the ICU often face worse prognosis, higher healthcare costs, and prolonged hospital stays. Identifying high-risk patients is essential for optimizing post-ICU care and resource allocation. Methods: This two-phase study included the following: (1) a retrospective analysis of ICU survivors in a mixed medical–surgical ICU to identify risk factors associated with ICU readmission and in-hospital mortality, and (2) a prospective validation of a newly developed predictive model: the Worse Outcome Score (WOScore). Data collected included demographics, ICU admission characteristics, severity scores (SAPS II, SAPS III, APACHE II, SOFA), interventions, complications and discharge parameters. Results: Among 1.190 ICU survivors, 126 (10.6%) were readmitted to the ICU, and 192 (16.1%) died in hospital after ICU discharge. Key risk factors for ICU readmission included Diabetes Mellitus, SAPS III on admission, and ICU-acquired infections (Ventilator-Associated Pneumonia (VAP) and Catheter-Related Bloodstream Infection, (CRBSI)). Predictors of in-hospital mortality were identified: medical admission, high SAPS III score, high lactate level on ICU admission, tracheostomy, reduced GCS at discharge, blood transfusion, CRBSI, and Acute Kidney Injury (AKI) during ICU stay. The WOScore, developed based on the results above, demonstrated strong predictive ability (AUC: 0.845 derivation, 0.886 validation). A cut-off of 20 distinguished high-risk patients (sensitivity: 88.1%, specificity: 73.0%). Conclusions: ICU readmission and in-hospital mortality are influenced by patient severity, underlying comorbidities, and ICU-related complications. The WOScore provides an effective, easy-to-use risk stratification tool that can guide clinicians in identifying high-risk patients at ICU discharge and guide post-ICU interventions, potentially improving patients’ outcomes and optimizing resource allocation. Further multi-center studies are necessary to validate the model in diverse healthcare settings. Full article

Background: Hearing loss results from diverse biological insults along the auditory pathway, including sensory hair cell death, neural degeneration, and central auditory processing deficits. Implantable auditory neuroprostheses, such as cochlear and brainstem implants, aim to restore hearing by directly stimulating neural structures. Advances in neurobiology and device technology underpin the development of more sophisticated implants tailored to the biological complexity of auditory dysfunction. Aim: This narrative review of reviews aims to map the integration of artificial intelligence (AI) in auditory neuroprosthetics, analyzing recent research trends, key thematic areas, and the opportunities and challenges of AI-enhanced devices. By synthesizing biological and computational perspectives, it seeks to guide future interdisciplinary efforts toward more adaptive and biologically informed hearing restoration solutions. Methods: This narrative review analyzed recent literature reviews from PubMed and Scopus (last 5 years), focusing on AI integration with auditory neuroprosthetics and related biological processes. Emphasis was placed on studies linking AI innovations to neural plasticity and device–nerve interactions, excluding purely computational works. The ANDJ (a standard narrative review checklist) checklist guided a transparent, rigorous narrative approach suited to this interdisciplinary, rapidly evolving field. Results and discussion: Eighteen recent review articles were analyzed, highlighting significant advancements in the integration of artificial intelligence with auditory neuroprosthetics, particularly cochlear implants. Established areas include predictive modeling, biologically inspired signal processing, and AI-assisted surgical planning, while emerging fields such as multisensory augmentation and remote care remain underexplored. Key limitations involve fragmented biological datasets, lack of standardized biomarkers, and regulatory challenges related to algorithm transparency and clinical application. This review emphasizes the urgent need for AI frameworks that deeply integrate biological and clinical insights, expanding focus beyond cochlear implants to other neuroprosthetic devices. To complement this overview, a targeted analysis of recent cutting-edge studies was also conducted, starting from the emerging gaps to capture the latest technological and biological innovations shaping the field. These findings guide future research toward more biologically meaningful, ethical, and clinically impactful solutions. Conclusions: This narrative review highlights progress in integrating AI with auditory neuroprosthetics, emphasizing the importance of biological foundations and interdisciplinary approaches. It also recognizes ongoing challenges such as data limitations and the need for clear ethical frameworks. Collaboration across fields is vital to foster innovation and improve patient care. Full article

Background/Objective: Cancer cachexia is a multifactorial syndrome that contributes to adverse surgical outcomes in gastric cancer (GC), yet weight-based criteria often fail to detect subclinical cases. This study aimed to assess the prognostic utility of the Cancer Cachexia Index (CXI) in predicting severe postoperative complications after curative gastrectomy. Methods: We retrospectively analyzed 301 patients with GC who underwent curative surgery between January 2020 and October 2023. CXI was calculated as L3 skeletal muscle index × serum albumin/neutrophil-to-lymphocyte ratio (NLR), and patients were stratified into low- and high-CXI groups based on sex-specific medians. Postoperative complications were classified using Clavien–Dindo, with grade ≥ III considered major morbidity. Group comparisons included rates of major complications and hospital stay. Results: The low-CXI group had significantly lower muscle mass and albumin levels, higher inflammatory markers, and more T4 tumors. Major complications occurred more frequently in this group (p < 0.001). In multivariate logistic regression, low CXI independently predicted severe complications (OR: 2.89; 95% CI: 1.42–5.85; p = 0.003), alongside older age and smoking. Receiver operating characteristic (ROC) analysis showed a CXI cut-off of 34.75 yielded high specificity (94.86%) for predicting major morbidity. Conclusions: Preoperative CXI is an effective predictor of severe postoperative morbidity in GC patients, outperforming traditional nutritional and inflammatory markers. Incorporation of CXI into routine preoperative assessment may enhance surgical risk stratification and guide perioperative optimization. Full article

Background and objectives: Patient-specific components (PSC) represent an innovative option for total knee arthroplasty (TKA) in advanced osteoarthritis. Their effectiveness, however, closely relies on accurate positioning. Our study investigates the accuracy achieved by means of an inertial-based extramedullary cutting guide and the postoperative clinical and radiographic outcomes. Methods and materials: This was a prospective, single-arm, pilot study involving patients undergoing primary TKA with YourKnee^TM PSC. Femoral and tibial bone resections were performed using the Perseus inertial-based extramedullary cutting guide. Postoperative mechanical alignment and component positioning were assessed by computed tomography. Clinical outcomes were evaluated preoperatively and at 1, 3, 6, and 12 months postoperatively by main knee function and clinical outcome measures. Results: The study population included a small cohort (n= 12, four females/eight males, mean age 69 ± 5.65 years, mean BMI 25.7 ± 3.8 kg/m², KL grade > 3) with no control group. The mean absolute error between the planned and obtained Hip–Knee–Ankle angle was 1.36° ± 1.06 and within ±3° of all cases. Mean coronal alignment error was 1.87° ± 0.87 and 1.67° ± 0.75 for the femoral and tibial components, respectively. The mean sagittal alignment error was 1.89° ± 1.24 and 2.45° ± 0.87 for the femoral and the tibial components, respectively. Patients showed significant improvement in clinical and functional scores within the first 6 months: OKS increased from 20.64 ± 2.77 at the preoperative screening to 42.27 ± 4.34 (p < 0.0001), total KSS rose from 90.64 ± 17.25 to 169.36 ± 23.57 (p < 0.0001), and FJS reached 85.09 ± 17.14 at 6 months (p = 0.0031), indicating excellent functional recovery and forgotten joint effect. Knee ROM improved from 90.91° ± 11.14 to 110.36° ± 8.44 (p < 0.0001). After 6 months, outcome scores plateaued, suggesting an early stabilization of clinical benefits. No signs of radiolucency were detected on X-rays at 3- and 12-month follow-ups. Conclusions: The Perseus inertial-based extramedullary cutting guide used in combination with the YourKnee^TM PSCs resulted in accurate intraoperative prosthesis positioning and significant improvements in clinical and functional outcomes at 6 months after surgery. Despite the small sample size and absence of a control group, the results suggest that such combination represents a viable option to conventional surgical instrumentation and current off-the-shelf prosthetic designs. Full article

Background/Objectives: The application of additive manufacturing in medicine, and specifically in personalised medicine, has achieved notable development. This article aims to present the results and benefits of applying a comprehensive methodology to simulate, plan, and manufacture customised three-dimensional medical prosthetic devices for use in surgery to restore bone structures with congenital and acquired malformations. Methods: To digitally reconstruct a bone structure in three dimensions from a medical image, a segmentation process is developed to correlate the anatomical model. Then, this model is filtered using a post-processing step to generate stereolithography (STL) files, which are rendered using specialised software. The segmentation of tomographic images is achieved by the specific intensity selection, facilitating the analysis of compact and soft tissues within the anatomical region of interest. With the help of a thresholding algorithm, a three-dimensional digital model of the anatomical structure is obtained, ready for printing the required structure. Results: The described cases demonstrate that the use of anatomical test models, cutting guides, and customised prostheses reduces surgical time and hospital stay, and achieves better aesthetic and functional results. Using materials such as polylactic acid (PLA) for presurgical models, appropriate resins for cutting guides, and biocompatible materials such as polyether ether ketone (PEEK) or polymethylmethacrylate (PMMA) for prostheses, the described improvements are achieved. Conclusions: The achievements attained demonstrate the feasibility of applying these techniques, their advantages and their accessibility in Ecuador. They also reinforce the ideas of personalised medicine in the search for medical treatments and procedures tailored to the needs of each patient. Full article

Retained products of conception (RPOC) represent a significant cause of morbidity in the post-abortive and postpartum periods, potentially leading to abnormal uterine bleeding, pelvic pain, infections, and intrauterine adhesions. Accurate diagnosis is crucial to avoid unnecessary surgical interventions and to preserve future fertility. Transvaginal ultrasound constitutes the primary imaging modality for identifying RPOC, but the lack of standardized diagnostic criteria complicates clinical decision-making. This narrative review explores the current literature on sonographic findings associated with RPOC, focusing on the diagnostic value of endometrial thickness (ET), the presence of intrauterine echogenic masses, and the use of Color Doppler imaging. Although an ET ≥15 mm is frequently used to suspect RPOC, the variability in cut-off thresholds and limited specificity reduce its diagnostic reliability. The detection of an echogenic intrauterine mass appears to be the most sensitive and specific sonographic feature. Color Doppler assessment, particularly the presence of enhanced myometrial vascularity (EMV) and classification systems like the Gutenberg score, offers further insight by stratifying hemorrhagic risk and guiding therapeutic choices. However, vascular parameters such as peak systolic velocity (PSV) and resistive index (RI) demonstrate a substantial overlap between benign and pathological conditions, limiting their stand-alone utility. The review also addresses the differential diagnosis of RPOC, including blood clots, arteriovenous malformations, placental polyps, gestational trophoblastic disease, and endometrial osseous metaplasia. The role of three-dimensional ultrasound remains limited in clinical practice, offering no significant advantage over two-dimensional imaging. Finally, the timing of follow-up ultrasound after medical treatment with misoprostol is critical: delayed assessment reduces overtreatment by allowing time for spontaneous resolution. In conclusion, despite advances in ultrasound technology, the diagnosis of RPOC remains challenging due to heterogeneity in imaging findings and inter-observer variability. A multimodal approach integrating grayscale and Doppler ultrasound with clinical evaluation is essential for optimal management. Full article

Background: Pleural mesothelioma (PM) is a type of cancer that is difficult to diagnose and treat. Patients may have vastly varying prognoses, and prognostic factors may help guide the clinical approach. As a recently identified biomarker, the pan-Immune-Inflammation-Value (PIV) is a simple, comprehensive, and peripheral blood cell-based biomarker. Methods: The present study represents a retrospective observational analysis carried out within a single-center setting. Ninety-five patients with PM stages I–IV were enrolled in the study. We analyzed the correlation between patients’ demographic characteristics, clinicopathological factors such as histological subtypes, surgery status, tumor thickness, blood-based parameters, and treatment options with their prognoses. PIV was calculated by the following formula: (neutrophil count × monocyte count × platelet count)/lymphocyte count. Additionally, blood-based parameters were used to calculate the platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune inflammation index (SII). Results: We categorized the patients into two groups, low PIV group (PIV ≤ 732.3) and high PIV group (PIV > 732.3) according to the determined cut-off value, which was defined as the median. It was revealed that high PIV was associated with poor survival outcomes. The median follow-up period was 15.8 months (interquartile range, IQR, 7.1 to 29.8 months). The median overall survival (OS) was significantly longer in patients in the low PIV group (median 29.8 months, 95% confidence interval (CI), 15.6 to 44) than the high PIV group (median 14.7 months, 95% CI, 10.8 to 18.6 p < 0.001). Furthermore, the study revealed that patients with low PIV, NLR, and SII values were more likely to be eligible for surgery and were diagnosed at earlier stages. Additionally, these markers were identified as potential predictors of disease-free survival (DFS) in the surgical cohort and of treatment response across the entire patient population. Conclusions: In addition to well-established clinical factors such as stage, histologic subtype, resectability, and Eastern Cooperative Oncology Group (ECOG) performance status (PS), PIV emerged as an independent and significant prognostic factor of overall survival (OS) in patients with PM. Moreover, PIV also demonstrated a remarkable independent prognostic value for disease-free survival (DFS) in this patient population. Additionally, some clues are provided for conditions such as treatment responses, staging, and suitability for surgery. As such, in this cohort, it has outperformed the other blood-based markers based on our findings. Given its ease of calculation and cost-effectiveness, PIV represents a promising and practical prognostic tool in the clinical management of pleural mesothelioma. It can be easily calculated using routinely available laboratory parameters for every cancer patient, requiring no additional cost or complex procedures, thus facilitating its integration into everyday clinical practice. Full article

Background/Objectives: Upper tract urothelial carcinoma (UTUC) is often complicated by intravesical recurrence and cancer progression following radical nephroureterectomy (RNU). Identifying reliable prognostic biomarkers remains crucial for optimizing postoperative surveillance. The goal of this study was to assess the prognostic value of the De Ritis ratio (AST/ALT) in predicting bladder recurrence and oncologic outcomes in patients with clinically localized UTUC undergoing RNU. Methods: This retrospective study analyzed 87 patients treated with RNU between 2018 and 2025. Preoperative De Ritis ratios were calculated, and an optimal cut-off value of 1.682 was determined using ROC analysis. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed using the Kaplan–Meier and Cox regression methods. Logistic regression was used to identify independent predictors of bladder recurrence. Results: A high De Ritis ratio was significantly associated with increased bladder recurrence and worse RFS and CSS, but not OS. Multivariate analysis confirmed that an elevated De Ritis ratio, current smoking, positive surgical margins, and synchronous bladder cancer were the independent predictors of bladder recurrence. The De Ritis ratio demonstrated strong discriminatory performance (AUC: 0.807), with good sensitivity and specificity for predicting recurrence. Conclusions: The De Ritis ratio is a simple, cost-effective preoperative biomarker that may aid in identifying UTUC patients at higher risk for intravesical recurrence and cancer-specific mortality. Incorporating this ratio into clinical decision-making could enhance risk stratification and guide tailored follow-up strategies. Full article

Objectives: Frailty is increasingly recognized as a key determinant of surgical risk in elderly patients undergoing aortic valve replacement (AVR). This study aimed to evaluate the prognostic value of the modified Frailty Index (mFI) in a homogeneous cohort of octogenarians undergoing minimally invasive surgical AVR, to enhance risk stratification and guide surgical decision-making. Methods: We retrospectively analyzed 67 patients aged ≥ 80 years (mean 84.1 ± 3.2) who underwent isolated minimally invasive AVR. The mFI was calculated preoperatively using standardized clinical variables. Primary outcomes included 30-day mortality and perioperative complications; long-term survival was also assessed. Receiver operating characteristic (ROC) curves identified optimal mFI cut-offs. Kaplan-Meier and Cox regression analyses were used to evaluate survival and predictors of mortality. Results: The mFI demonstrated a strong prognostic accuracy. An mFI > 0.455 predicted 30-day mortality with 81.8% sensitivity and 88.4% specificity (AUC = 0.888, p < 0.001), while an mFI > 0.273 predicted perioperative complications (AUC = 0.818, p < 0.001). During a median follow-up of 51.8 ± 36.4 months, 24 patients (45.3%) died. One-year survival was 83.7%. The mFI > 0.455 was the strongest independent predictor of early mortality (HR 6.34, p = 0.001); mFI > 0.273, HFpEF with NT-proBNP > 1000 pg/mL, and chronic kidney disease were predictors of long-term mortality. Conclusions: The mFI is a simple, reproducible tool that reliably predicts early and late outcomes in very elderly patients undergoing minimally invasive AVR. Integrating frailty into preoperative evaluation may improve patient selection by prioritizing physiological over chronological age. Full article

Objectives: This pre-clinical feasibility study evaluates the accuracy of a novel augmented reality-based (AR-based) guidance technology using head-mounted displays (HMDs) for the placement of patient-specific instruments (PSIs)—also referred to as surgical guides—and osteotomy performance in pelvic tumour resections. The goal is to improve PSI placement accuracy and osteotomy execution while assessing user perception and workflow efficiency. Methods: The study was conducted on ten 3D-printed pelvic phantoms derived from CT scans of cadaveric specimens. Custom PSIs were designed and printed to guide osteotomies at the supraacetabular, symphysial, and ischial regions. An AR application was developed for the HoloLens 2 HMD to display PSI location and cutting planes. The workflow included manual supraacetabular PSI placement, AR-guided placement of the other PSIs and osteotomy execution. Postoperative CT scans were analysed to measure angular and distance errors in PSI placement and osteotomies. Task times and user feedback were also recorded. Results: The mean angular deviation for PSI placement was 2.20°, with a mean distance error of 1.19 mm (95% CI: 0.86 to 1.52 mm). Osteotomies showed an overall mean angular deviation of 3.73° compared to planned cuts, all within the predefined threshold of less than 5°. AR-assisted guidance added less than two minutes per procedure. User feedback highlighted the intuitive interface and high usability, especially for visualising cutting planes. Conclusions: Integrating AR through HMDs is a feasible and accurate method for enhancing PSI placement and osteotomy performance in pelvic tumour resections. The system provides reliable guidance even in cases of PSI failure and adds minimal time to the surgical workflow while significantly improving accuracy. Further validation in cadaveric models is needed to ensure its clinical applicability. Full article

Background/Objectives: Limb malalignment disrupts physiological joint forces and predisposes individuals to the development of osteoarthritis. Surgical interventions such as distal femur or high tibial osteotomy aim to restore mechanical balance on weight-bearing joints, thereby reducing long-term morbidity. Accurate alignment is crucial since it cannot be adjusted after stabilization with plates and screws. Recent advances in personalized medicine offer the opportunity to tailor surgical corrections to each patient’s unique anatomy and biomechanical profile. This study evaluates the benefits of 3D planning and patient-specific cutting guides over traditional 2D planning with standard implants for alignment correction procedures. Methods: We assessed limb alignment parameters pre- and postoperatively in patients with varus and valgus lower limb malalignment undergoing acute realignment surgery. The cohort included 23 opening-wedge high tibial osteotomies and 28 opening-wedge distal femur osteotomies. We compared the accuracy of postoperative alignment parameters between patients undergoing traditional 2D preoperative X-ray planning and those using 3D reconstructions of CT data. Outcome measures included mechanical axis deviation and tibiofemoral angles. Results: 3D reconstructions of computerized tomography data and patient-specific cutting guides significantly reduced the variation in postoperative limb alignment parameters relative to preoperative goals. In contrast, traditional 2D planning with standard non-custom implants resulted in higher deviations from the targeted alignment. Conclusions: Utilizing 3D CT reconstructions and patient-specific cutting guides enhances the accuracy of postoperative limb realignment compared to traditional 2D X-ray planning with standard non-custom implants. Patient-specific instrumentation and personalized approaches represent a key step toward precision orthopedic surgery, tailoring correction strategies to individual patient anatomy and potentially improving long-term joint health. This improvement may reduce the morbidity associated with lower limb malalignment and delay the onset of osteoarthritis. Level of Evidence: Therapeutic Level III. Full article

Objectives: This study aimed to differentiate patients with placenta accreta spectrum (PAS) from those with placenta previa (PP) and to assess the association between preoperative inflammatory and coagulation parameters and intraoperative blood loss. Methods: In this retrospective case-control study, 545 pregnant women were enrolled and divided into five groups: control (n = 251), PP (n = 246), PP with accreta (PPA, n = 18), PP with increta (PPI, n = 27), and PP with percreta (PPP, n = 33). Preoperative serum levels of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), delta neutrophil index (DNI), prothrombin time, fibrin degradation products (FDPs), D-dimer, and activated partial thromboplastin time (APTT) were analyzed. Results: The PPP group demonstrated significantly higher values of FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI, and lower APTT values compared to the other groups (p < 0.001). For predicting PAS, SIRI and DNI showed the highest diagnostic performance, each achieving 100% sensitivity and specificity, with optimal cut-off values of 2.01 and 2.45, respectively. For predicting intraoperative blood loss ≥1000 mL, PLR and SIRI exhibited the highest diagnostic accuracy, with optimal cut-off values of 122.5 (sensitivity 76.6%; specificity 72.6%) and 2.25 (sensitivity 73.4%; specificity 74.1%), respectively. Conclusions: FDP, D-dimer, NLR, PLR, SII, SIRI, and DNI may serve as valuable biomarkers for differentiating PP from PAS, thereby enhancing preoperative risk assessment and guiding surgical planning to improve maternal outcomes. Additionally, PT, D-dimer, FDP, NLR, and DNI were identified as significant independent predictors of intraoperative blood loss. Full article

Pancreatic cystic lesions (PCLs) are increasingly identified via computerized tomography (CT) and magnetic resonance (MR), with a prevalence of 2–45%. Distinguishing mucinous PCLs (M-PCLs), which include intraductal papillary mucinous neoplasms (IPMNs) and mucinous cystic neoplasms (MCNs) that can progress to pancreatic ductal adenocarcinoma, from non-mucinous PCLs (NM-PCLs) is essential. Carcinoembryonic antigen (CEA) remains widely used but often demonstrates limited sensitivity and specificity. In contrast, endoscopic ultrasound-guided measurement of intracystic glucose more accurately differentiates PCL subtypes, as tumor-related metabolic changes lower cyst fluid glucose in mucinous lesions. Numerous prospective and retrospective studies suggest a glucose cut-off between 30 and 50 mg/dL, yielding a sensitivity of 88–95% and specificity of 76–91%, frequently outperforming CEA. Additional benefits include immediate point-of-care assessment via standard glucometers and minimal interference from blood contamination. DNA-based biomarkers, including KRAS and GNAS mutations, enhance specificity (up to 99%) but exhibit moderate sensitivity (61–71%) and necessitate specialized, expensive platforms. Molecular analyses can be crucial in high-risk lesions, yet their uptake is constrained by technical challenges. In practice, combining glucose assessment with targeted molecular assays refines risk stratification and informs the choice between surgical resection or active surveillance. Future investigations should establish standardized glucose thresholds, improve the cost-effectiveness of genetic testing, and integrate advanced biomarkers into routine protocols. Ultimately, these strategies aim to optimize patient management, limit unnecessary interventions for benign lesions, and ensure timely therapy for lesions at risk of malignant transformation. Full article