The European Research Journal (EuRJ) is an international, independent, double-blind peer-reviewed, Open Access and online publishing journal, which aims to publish papers on all the related areas of basic and clinical medicine.
Association of Placental Fetal and Maternal Vascular Malperfusion with Bronchopulmonary Dysplasia and Mortality in Preterm Infants
Objective: This study aimed to investigate the association of placental histopathological abnormalities with bronchopulmonary dysplasia and mortality in preterm infants. Methods: This prospective study included preterm infants ≤32 weeks and ≤1500 g who were followed in the NICU of a tertiary university hospital between May 2019 and May 2020. The infants were separated into 2 groups as those with and without bronchopulmonary dysplasia. Placentas were evaluated according to the Amsterdam Placenta Study Group. Results: In this study, 35 preterm infants were evaluated. Birthweight was determined to be statistically significantly lower in Group 1 (1045±160.63 g) than in Group 2 (1453.95±529.08 g) (P=0.002). According to the median (min-max) gestational week at birth, the age of Group 1 [27.5 (26-29)] was statistically significantly lower than that of Group 2 [30.5 (25-32)] (P=0.001). Nosocomial sepsis was determined at a statistically higher rate in Group 1 [58.3%, n=7) than in Group 2 (13%, n=3) (P=0.015). The median length of stay in hospital was significantly longer in Group 1 [51 days (38-92)] than in Group 2 [21 days (1-74)] (P=0.001). The number of days on non-invasive ventilation was statistically significantly greater in Group 1 [11(2-57)] than in Group 2 [2(0-43)] (P=0.001). Maternal-fetal vascular malperfusion was found to be higher in Group 2. Mortality was observed in Group 2 and not in Group 1. Conclusion: No statistically significant difference was observed in placental histopathological findings between the groups, with maternal and fetal vascular malperfusion representing the most frequent lesions. Mortality was seen exclusively in the non-BPD group. These findings suggest a potential association between placental vascular pathologies and neonatal mortality; however, larger multicenter prospective studies are required to confirm this relationship.
Placental Histopathological Abnormalities
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Association of Menopausal Status with Thyroid Nodule Prevalence and Size in Women with Hypothyroidism
Objective: To examine the association between menopausal status and thyroid nodule prevalence and size in women with hypothyroidism. Methods: In this retrospective comparative study, we reviewed 149 women with hypothyroidism seen in outpatient clinics at a tertiary care hospital. Hypothyroidism was defined as a documented clinical diagnosis supported by elevated thyroid-stimulating hormone (TSH) with low or normal thyroxine (T4). Women were classified as being in the reproductive period or postmenopausal; postmenopause was defined as amenorrhoea for at least 12 months or documented postmenopausal status in the medical record. Group comparisons used the chi-square test, independent-samples t-test, or Mann-Whitney U test, as appropriate. Crude ORs with 95% CIs were calculated for key dichotomous nodule outcomes. Results: Of the 149 women, 89 (59.7%) were of reproductive age, and 60 (40.3%) were postmenopausal. Thyroid nodules were present in 61 (40.9%) patients. Postmenopausal women had a higher prevalence of nodules than reproductive-age women (56.7% vs 30.3%; crude OR, 3.00; 95% CI, 1.52–5.94; P=0.002). Nodules >1 cm were also more frequent after menopause (25.0% vs. 9.0%; crude OR, 3.38; 95% CI, 1.33–8.57; P=0.029). TSH, T4, anti-thyroid peroxidase (anti-TPO) levels, anti-TPO positivity, and levothyroxine use did not differ significantly between the groups. Conclusion: Among women with hypothyroidism, postmenopausal status was associated with a greater thyroid nodule burden and a higher frequency of nodules >1 cm. Because age and menopausal status were closely linked, the findings should be interpreted as unadjusted associations rather than independent effects of menopause.
Repeated Fecal Occult Blood Test Positivity Is Associated with Clinically Significant Colonoscopic Findings
Objective: Guaiac-based fecal occult blood testing (gFOBT) is widely used in colorectal cancer (CRC) screening programs. To evaluate the association between repeated gFOBT positivity and clinically significant colonoscopic and histopathological findings, particularly colorectal malignancy. Methods: This retrospective, single-center study included patients with positive gFOBT results who presented to the Gastroenterology Outpatient Clinic of Gazi University Faculty of Medicine between June 2017 and October 2025. Patients were categorized into three groups based on gFOBT results: single positive (Group 1), two consecutive positive tests within one month (Group 2), and an initial positive followed by a negative test (Group 3). Colonoscopic and histopathological findings were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of clinically significant malignant pathology. Results: Among 1,442 patients with positive gFOBT results, 735 (50.9%) underwent diagnostic colonoscopy. Colorectal malignancy was detected in 55 (7.5%) patients among those who underwent colonoscopy. Malignancy rates differed significantly between groups: 5.1% in Group 1, 17.4% in Group 2, and 0% in Group 3 (P<0.001). Repeated gFOBT positivity was independently associated with malignant colonoscopic findings (OR: 3.684; 95% CI: 2.027–6.694). Normal colonoscopy findings were significantly more frequent in patients with a single positive test, whereas malignant findings were markedly higher in patients with repeated positivity. Conclusion: Repeated gFOBT positivity is strongly associated with clinically significant colonoscopic pathology, particularly colorectal malignancy. Patients with consecutive positive gFOBT results represent a high-risk subgroup and should be prioritized for prompt diagnostic colonoscopy within CRC screening programs.
Determination of Urinary Calcium and Citrate Ratios in Children with Urolithiasis
Objective: The urine calcium-creatinine ratio (UCa/Cr) varies significantly with age; therefore, age-specific reference ranges are required for accurate interpretation. Using different markers in differential diagnosis may improve diagnostic accuracy. Therefore, we compared the spot urinary calcium-citrate ratio (UCa/Cit) in children with urolithiasis and in a healthy control group. We examined the relationship between the UCa/Cit ratio with age and gender and evaluated its discriminatory performance in differentiating children with urolithiasis from healthy controls. Methods: This case-control study included 121 children aged 1-18 years with urolithiasis and 107 healthy controls. UCa/Cr and UCa/Cit ratios were calculated in the spot urine sample. Differences between groups were compared, age-related trends were evaluated, and receiver operating characteristic (ROC) analyses were performed to determine diagnostic performance. Results: The UCa/Cit ratio did not show a statistically significant association with age or gender in this cohort. However, the UCa/Cit level was higher in the patient group compared to the control group (1.28±2.87 vs. 0.63±1.51 mg/mg; P<0.0001). In the ROC analysis, a value of 0.390 mg/mg was determined as the optimal cutoff point for UCa/Cit to distinguish children with urolithiasis from healthy controls (sensitivity, 66.3%; specificity, 65.2%; AUC, 0.675). Conclusion: Although UCa/Cit was significantly elevated in children with urolithiasis and was not statistically associated with age or gender in this cohort, it had limited discriminatory performance. Therefore, UCa/Cit should be considered a supportive metabolic parameter rather than a standalone diagnostic or screening test. Additional studies with standardized sampling, dietary assessment, and multicenter validation will be required to define its clinical utility in pediatric stone disease.
Large Language Model Superiority in Guideline-Based Neurointerventional Multiple-Choice Questions: Performance Analysis of Radiologists vs. LLMs Across Experience Levels
Objective: To assess large language models’ (LLMs) mastery of contemporary consensus documents in guideline-based neurointerventional decision-making domains and to compare their performance with radiologists of different experience levels. Methods: In this cross-sectional study, 100 single-best-answer, five-option MCQs were derived from three CIRSE guideline sources. A non-participating general radiologist authored the items (33 carotid stenting, 33 thrombectomy, 34 acute stroke EVT). One neurointerventional radiologist, two general radiologists, and one resident answered independently, blinded to the key. The same set was posed in January 2026 to Claude 4.5 Opus, ChatGPT 5.2 Instant, and Gemini 3 Pro using default settings and a standardized prompt. Accuracy was compared with McNemar’s test and Bonferroni correction (P≤0.002). Results: The highest accuracy was observed with Claude 4.5 Opus (0.99±0.10); ChatGPT 5.2 Instant (0.96±0.19) and Gemini 3 Pro (0.95±0.21) showed comparable performance. Among human participants, the neurointerventional radiologist achieved the highest accuracy (0.85±0.35), while general radiologists scored 0.67–0.70 and the resident achieved 0.57. Each of the three LLMs significantly outperformed all human groups. Moreover, Claude 4.5 Opus also demonstrated significantly higher performance than the neurointerventional radiologist (P=0.001). Conclusion: LLMs have reached a competitive level with neurointerventional radiologists in recalling and interpreting neurointerventional guideline knowledge. In particular, Claude 4.5 Opus demonstrated strong performance and appears to be a promising candidate for “real-time decision support” applications. Multimodel validation and verification studies using real clinical scenario–based designs are warranted.
Determinants of Mediastinal Lymph Node Attenuation on Non-Contrast Chest Computed Tomography
Objective: To investigate clinical determinants of mediastinal lymph node attenuation (MLNA) on non-contrast chest computed tomography (CT), focusing on smoking history and cardiometabolic factors. Methods: In this retrospective single-center study, individuals undergoing non-contrast chest CT without known cardiopulmonary disease were included. MLNA was measured in Hounsfield units (HU) from the largest visible mediastinal lymph node. Smoking status (ever vs never), age, sex, hypertension, diabetes mellitus, and body mass index were recorded. Multivariable linear regression identified independent predictors of MLNA. Receiver operating characteristic (ROC) analysis evaluated attenuation for discriminating smoking history. Results: A total of 138 individuals were analyzed (82 ever smokers, 56 never smokers). MLNA was higher in ever smokers than never smokers (median 39.5 vs 35 HU, P=0.001). In multivariable analysis, smoking history remained independently associated with increased attenuation (B=5.48 HU, 95% confidence interval [CI]: 1.72–9.23, P=0.005). Age (B=0.33 HU/year, P<0.001), hypertension (B=6.55 HU, P=0.009), and diabetes mellitus (B=5.93 HU, P=0.043) were also independent predictors, whereas sex and BMI were not significant. The model explained 41% of attenuation variance (R²=0.41). ROC analysis demonstrated moderate discrimination for smoking history (area under curve [AUC] = 0.66; optimal cut-off 46 HU, specificity of 89.3%). Attenuation values were highest among current smokers in exploratory analyses. Conclusion: Smoking history, age, hypertension, and diabetes mellitus are independently associated with increased mediastinal lymph node attenuation on non-contrast CT. Elevated attenuation may reflect chronic inflammatory activation, fibrotic remodeling, and cumulative cardiometabolic tissue injury rather than overt pathology, supporting its role as a contextual imaging marker in risk-aware radiologic interpretation.
Ameliorative Effects of Geraniol on Cyclophosphamide-Induced Nephrotoxicity: Evidence from Nuclear Factor Erythroid 2-related Factor 2 (Nrf-2) Activation and Apoptosis Modulation
Objective: The cyclophosphamide (CP)-related nephrotoxicity may impede cancer treatment. This study investigated the efficacy of geraniol (Ge) at two doses against CP nephrotoxicity. Methods: Fourty-two Wistar albino rats were allocated into six groups (n=7 each group): Group I, control; Group II, CP; Group III, CP+Ge 100 mg/kg; Group IV, CP+Ge 200 mg/kg; Group V, Ge 100 mg/kg; and Group VI, Ge 200 mg/kg. At the end of study, alterations in renal tissues were evaluated using hematoxylin-eosin and histopathological scores were determined. Masson’s trichrome and Periodic acid–Schiff (PAS) staining were also performed for evaluation of fibrosis, parietal layer of Bowman capsule, and Bowman’s space. Immunofluorescence analysis assessed oxidative stress and apoptosis. Consequently, the expression levels of nuclear factor erythroid 2-related factor 2 (Nrf-2), caspase 3, and caspase 9 were evaluated. Results: CP caused the histopathological changes, including tubular damage, glomerular degeneration, interstitial inflammation. Ge restored the increased histopathological scores, parietal layer of Bowman capsule, and Bowman’s space caused by CP without dose dependence (P<0.001 for both dose). CP decreased the expression of Nrf-2, while Ge improved this disturbance with greater efficacy at a higher dose (P<0.001 for all). CP exposure increased both caspase 3 and caspase 9 (P<0.001 for both). Ge decreased the expressions of caspase 3 and caspase 9 at two doses (P<0.001 for all). In addition, Ge was more effective in repairing caspase 3 at a higher dose (P=0.006). Conclusion: Ge seems to effectively reverse CP-induced nephrotoxicity. The histopathological improvements are mediated by mechanisms involving the attenuation of oxidative stress and apoptosis. The efficacy of Ge is also dose-dependent.
Global News Exposure and Perinatal Anxiety in Pregnant Women: A Cross-Sectional Study
Objective: This study aimed to investigate the relationship between global news exposure and perinatal anxiety levels among pregnant women. Methods: This cross-sectional analytical study included 180 pregnant women. Data were collected via an online questionnaire consisting of sociodemographic characteristics, global news consumption habits, and the Perinatal Anxiety Screening Scale (PASS). Correlations were assessed using Spearman analysis, and independent predictors were evaluated with multivariate linear regression. Results: A total of 169 participants were included in the final analysis. The mean PASS score was 34.2±15.8. Significant positive correlations were found between anxiety levels and daily news checking frequency (r=0.172, P=0.025), fear of missing news (r=0.154, P=0.046), repetitive checking behavior (r=0.262, P<0.001), post-exposure tension (r=0.236, P=0.002), and perceived impact of negative news on pregnancy (r=0.343, P<0.001). In multivariate analysis, repetitive checking behavior and perceived negative impact remained independent predictors. Conclusion: Global news exposure is significantly associated with perinatal anxiety. This relationship appears to be driven more by behavioral and cognitive responses to news rather than exposure duration.
Impact of Structured Massage Therapy on Physiological Stability, Comfort, Sleep, and Stress in Late Preterm Infants: A Randomized Controlled Trial
Objective: This randomized controlled trial aimed to evaluate the effects of structured massage therapy on sleep quality, stress, comfort, and physiological parameters in late preterm infants. Methods: Forty late preterm infants (35–37 gestational weeks) were randomly allocated to a massage group (n=20) or a control group (n=20). The intervention group received a standardized 15-minute massage three times daily for three consecutive days. Data were collected using physiological monitoring, the Premature Infant Comfort Scale (PICS), the Neonatal Stress Scale (NSS), and actigraphy (SOMNOwatch™). This study was conducted in the neonatal intensive care units of Van Training and Research Hospital, University of Health Sciences, between September 2024 and September 2025, and was approved by the relevant institutional ethics committee in accordance with the Declaration of Helsinki. Results: Massage therapy significantly improved physiological stability, demonstrated by lower heart rate and respiratory rate and higher oxygen saturation compared to controls (P<0.05). Post-intervention comfort scores were significantly higher in the massage group (P=0.002). Significant within-group improvements were observed in sleep and stress parameters (P<0.001); however, no statistically significant between-group differences were identified (P>0.05). Conclusion: Massage therapy is an effective and clinically relevant non-pharmacological intervention for enhancing physiological stability and comfort in late preterm infants. Although improvements in sleep and stress were comparable to routine care, the significant improvement in comfort supports its integration into neonatal nursing protocols to optimize immediate clinical outcomes and neurobehavioral organization. Clinical Trials Number: NCT07322731
Impact of Visual Awareness of Postoperative Appearance on Functional Recovery After High Tibial Osteotomy: A Retrospective Case-Control Study
Objective: This study aimed to evaluate the impact of visual awareness of preoperative and postoperative leg appearance on patient satisfaction and functional recovery after medial open-wedge high tibial osteotomy (MOWHTO) in patients with varus malalignment. We hypothesized that providing patients with visual feedback of their cosmetic improvement may enhance perceived functional outcomes and overall satisfaction. Methods: A retrospective case-control study was conducted including 57 patients who underwent MOWHTO for varus malalignment between 2019 and 2023. Patients were divided into two groups: Group 1 (n=24), who were shown preoperative and postoperative leg photographs, and Group 2 (n=33), who were not. Functional outcomes were assessed using the Short Form-36 (SF-36) physical and mental scores and Lysholm score. Radiological parameters and joint range of motion were also evaluated preoperatively and at final follow-up. Results: Both groups showed significant postoperative improvements in SF-36 and Lysholm scores (P<0.05). However, Group 1 demonstrated significantly higher postoperative SF-36 physical (P=0.001), SF-36 mental (P=0.001), and Lysholm scores (P=0.002) compared to Group 2. Although radiological parameters and joint range of motion improved significantly in both groups, there were no significant differences between groups. Conclusion: Visual presentation of preoperative and postoperative leg photographs may increase patient awareness of surgical changes and be associated with improved patient-reported outcomes and satisfaction following MOWHTO. Incorporating visual methods into patient education may present a simple approach to influencing postoperative perception.
Association of Type 2 Diabetes Mellitus with Dyslipidemia in Hypertensive Patients: A Retrospective Cross-Sectional Study
Objective: This study aimed to examine the association between type 2 diabetes mellitus (T2DM) and metabolic profile alterations—particularly dyslipidemia—in patients with hypertension, and to determine whether T2DM is independently associated with dyslipidemia in this population. Methods: This retrospective cross-sectional study included 191 patients with a documented diagnosis of hypertension followed between September 1, 2024, and September 1, 2025. Participants were categorized according to T2DM status. Demographic, clinical, and laboratory data were retrieved from electronic medical records. Continuous variables are expressed as median (interquartile range) and categorical variables as counts and percentages. Group comparisons were performed using the Mann–Whitney U and chi-square tests. Associations between variables were evaluated using Spearman's rank correlation analysis, and factors independently associated with dyslipidemia were identified using binary logistic regression analysis. Results: Participants had a median age of 50.0 (42.0–58.0) years; 66.0% were female and 24.1% had T2DM. Triglyceride levels were significantly higher in the T2DM group (P=0.039), as were C-reactive protein concentrations (P=0.025). Dyslipidemia was present in 56.5% of patients with T2DM compared with 13.8% of those without (P<0.001). In multivariable analysis, T2DM remained independently associated with dyslipidemia (odds ratio=4.47, 95% confidence interval: 1.58–12.67; P=0.005), as did age (odds ratio=1.038; P=0.049). Conclusion: T2DM in hypertensive individuals was significantly and independently associated with dyslipidemia, most prominently reflected by elevated triglyceride levels. Lipid screening and cardiometabolic risk management should be approached more comprehensively in hypertensive patients with T2DM.
The Relationship Between Temporomandibular Disorder Risk, Temporal Muscle Thickness, Headache Severity, and Jaw Movements in Individuals with Tooth Loss
Objective: This study was conducted to evaluate the relationship between the risk of temporomandibular joint disorder (TMD), headache severity, ultrasonographic temporal muscle thickness, and functional jaw movements in individuals presenting with tooth loss. Methods: Thirty-eight individuals aged 21-55 years (mean 32.23±9.6) with one or more missing teeth were included in the study. TMD risk and headache intensity were documented using the Turkish-validated Fonseca Anamnestic Index (FAI) and the Visual Analog Scale (VAS), respectively. Temporal muscle thickness was assessed using a B-mode ultrasonographic device equipped with a high-frequency linear transducer in the relaxed jaw position while the participant was seated. Jaw movements were measured using a mouth goniometer. Results: A strong positive association was identified between the risk of TMD and headache severity (r=0.96, P<0.001). In contrast, TMD risk showed strong negative associations with temporal muscle thickness (r=-0.73 (left) and r=-0.82 (right), P<0.001) and maximum mouth opening (r=-0.87, P<0.001). TMD risk exhibited moderate inverse associations with both jaw protrusion (r=-0.52) and retrusion (r=-0.61), with significance levels at P<0.05). Conclusion: This cross-sectional correlational study suggests that early identification and management of biomechanical alterations associated with tooth loss may be important for reducing long-term functional complications through preventive dental care, timely prosthetic rehabilitation, and targeted physiotherapy.
Maternal Serum Netrin-1 Levels in Pregnancies Complicated by Gestational Diabetes Mellitus
Objective: Gestational diabetes mellitus (GDM) is associated with metabolic and vascular disturbances, yet its underlying biological mechanisms remain incompletely understood. Netrin-1, a multifunctional protein involved in angiogenesis, inflammation, and endothelial homeostasis, has been implicated in metabolic disorders; however, clinical data in GDM are limited. This study aimed to evaluate maternal netrin-1 levels in pregnancies complicated by GDM and to assess their associations with clinical parameters. Methods: This prospective case–control study included 45 pregnant women with GDM and 80 healthy pregnant controls between 24 and 28 weeks of gestation. Serum netrin-1 concentrations were measured using enzyme-linked immunosorbent assay. Clinical characteristics, glycemic parameters, and pregnancy outcomes were recorded. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of netrin-1 for GDM, and correlation and multivariable regression analyses identified associations after adjustment for selected covariates. Results: Serum netrin-1 levels were significantly lower in GDM group compared with controls (P<0.001). Netrin-1 concentrations showed significant inverse correlations with fasting plasma glucose (r=−0.446, P=0.002) and HbA1c (r=−0.623, P<0.001). ROC analysis identified an optimal cut-off value of 0.09 ng/mL for discriminating GDM, yielding a sensitivity of 68.9% and a high specificity of 98.8% (AUC=0.861), indicating good discriminative performance. In multivariable analysis adjusted for age, body mass index, and parity, log-transformed netrin-1 levels were associated with GDM (P<0.001). Conclusion: Maternal netrin-1 levels are significantly reduced in pregnancies complicated by GDM and are closely associated with glycemic dysregulation. Netrin-1 may reflect underlying metabolic and vascular alterations and could be considered as a complementary biomarker rather than a standalone diagnostic tool in GDM.
Beyond the Node Count: Metastatic Lymph Node Ratio as a Prognostic Marker in Locally Advanced Colorectal Cancer
Objective: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality, and staging based on the number of metastatic nodes may not fully reflect nodal tumor burden. The metastatic lymph node ratio (mLNR) has been proposed as a more informative prognostic marker, but its role in locally advanced CRC is unclear. This study aimed to evaluate the prognostic value of mLNR in patients with locally advanced (T3–T4), non-metastatic CRC and to identify an optimal cut-off for recurrence prediction. Methods: We retrospectively analysed 225 patients with T3–T4, non-metastatic CRC who underwent curative resection between 2015 and 2019. Disease-free survival (DFS) and overall survival (OS) were estimated using Kaplan–Meier analysis. Associations between mLNR, recurrence, stage and survival were examined with standard statistical tests. An optimal mLNR cut-off for recurrence was derived by receiver operating characteristic (ROC) analysis. Results: Patients with recurrence had significantly higher mLNR than recurrence-free patients. mLNR correlated inversely with DFS but not with OS. Higher mLNR was associated with T4 tumors and with higher AJCC stage. ROC analysis identified an mLNR cut-off of 0.1846 (area under the curve 0.643). Patients with mLNR ≥ 0.1846 had significantly shorter DFS and OS. A lymph node yield ≥12 was associated with longer DFS but not OS. Conclusion: mLNR is associated with recurrence, tumor stage and survival in locally advanced CRC, and a threshold around 0.18 may improve risk stratification beyond conventional node counts.
Investigation of the Relationship Between Frailty and Sleep Quality in Postoperative Elderly Patients: A Descriptive Cross-Sectional Study
Objective: With the aging population, the number of elderly patients undergoing surgical procedures is increasing. Frailty and sleep disturbances are two critical phenomena that directly affect postoperative recovery outcomes. This study aimed to investigate the relationship between frailty levels and sleep quality in elderly patients hospitalized after surgery. Methods: This descriptive study was conducted between January and May 2023 with 94 elderly postoperative patients in orthopedics and abdominal surgery awards of a Training and Research Hospital. Data were collected using a sociodemographic information form, the Edmonton Frailty Scale, and the Richards–Campbell Sleep Questionnaire. Descriptive statistics and Pearson correlation analysis were used for data analysis. Results: The mean age of participants was 71.98±5.38 years, and 52.1% were female. The majority of patients (89.4%) experienced sleep disturbances during hospitalization. Participants were classified as severely frail (26.6%), mildly frail (22.3%), and moderately frail (20.2%). The mean frailty score was 8.22 and the mean sleep quality score was 245.38. A negative, very weak, and statistically non-significant correlation was found between frailty level and sleep quality (r = -0.084; P=0.336). Conclusion: Both frailty and sleep disturbances were found to be common among surgical elderly patients. The high proportion of participants in the moderate-to-severe frailty categories, combined with widespread sleep impairment during hospitalization, underscores the necessity of geriatric-sensitive approaches in surgical care. Although no statistically significant association was identified between frailty and sleep quality, factors such as pain and psychological stress were determined to negatively affect sleep quality in this population.
Early-Onset Rupture and Cardiac Embolization of an Implantable Venous Port Catheter: A Case Report of Pinch-Off Syndrome
Implantable venous access devices are indispensable for long-term treatment management in oncology patients; however they may lead to rare but serious mechanical complications. While ''Pinch-off syndrome'' is typically associated with chronic catheter wear occurring over several months, we present the case of a 46-year-old female patient who developed complete rupture and cardiac embolization only 12 days after implantation. The catheter ruptured during the first chemotherapy session, 7 days after placement, and became lodged between the right ventricle and the subclavian vein. The embolized distal fragment was successfully retrieved via the right brachial vein using a snare catheter.
Effect of Active Aspiration Drainage System Use on Postoperative Outcomes After Cardiac Surgery
Objective: Postoperative drainage systems are essential for maintaining hemodynamic stability and enabling early detection of complications after cardiac surgery. This study aimed to evaluate the impact of an active suction drainage system applying negative pressure on postoperative morbidity and mortality. Methods: This single-center retrospective study included 153 patients who underwent open-heart surgery between August 2023 and August 2024. Patients were divided into two groups based on the drainage method: active suction drainage (n=69) and conventional drainage (n=84). Postoperative drainage volume, cardiac tamponade, re-exploration for bleeding, mortality, and postoperative complications such as acute kidney injury and wound infection were evaluated. Univariate logistic regression analyses were performed to assess potential confounding factors. Results: Cardiopulmonary bypass time, aortic cross-clamp time, and total operative duration were significantly longer in the active suction group (P=0.007, P=0.009 and P=0.010, respectively), while local hemostatic agent use was higher in the conventional group (P<0.001). Despite these differences, postoperative drainage volume, re-exploration rates, incidence of cardiac tamponade, acute kidney injury, wound infection, and mortality were comparable between groups (all P>0.05). Length of hospital stay was significantly longer in the active suction group. Univariate regression analyses did not identify any independent predictors of re-exploration or cardiac tamponade (P>0.05 for all variables). Conclusion: Active suction drainage was not associated with significant differences in major postoperative outcomes compared with conventional drainage methods. Although operative variables differed between groups, these factors did not demonstrate an independent effect on clinical outcomes. A numerically higher incidence of cardiac tamponade in the active suction group did not reach statistical significance and should be interpreted cautiously. Further large-scale prospective studies are warranted.
Antifibrotic Effect of Topical 2-Mercaptoethanesulfonate (Mesna) in a Rat Craniectomy Model
Objective: Epidural adhesions that develop after decompressive craniectomy may complicate subsequent procedures by increasing operative difficulty and the risk of tissue injury. Mechanical barrier materials are commonly used, yet they do not directly modulate the inflammatory and fibrotic processes responsible for scar formation. This study investigated whether topical 2-Mercaptoethanesulfonate (Mesna) could reduce postoperative epidural fibrosis and adhesion formation in a rat craniectomy model. Methods: Twenty-one adult male Wistar rats were randomly assigned to three groups (n=7 each): Sham, Vehicle (saline-soaked gelatin sponge), and Mesna (Mesna-soaked gelatin sponge). In the survival groups, re-exploration was performed after 4 weeks. Macroscopic adhesions were graded intraoperatively using the Rydell classification. Histopathological fibrosis and chronic inflammation were evaluated using Hematoxylin–Eosin and Masson’s Trichrome staining. Nonparametric statistical tests were applied. Results: The Mesna group showed significantly lower adhesion scores compared with the Vehicle group (median 1.0 vs 3.0, P=0.019). Fibrosis and chronic inflammation scores were also significantly reduced in the Mesna group across both staining methods (all P<0.05). Adhesion severity correlated positively with fibrosis and inflammatory scores. Conclusion: Topical Mesna application was associated with significantly lower macroscopic adhesion severity, histopathological fibrosis, and chronic inflammation in this experimental craniectomy model. These findings suggest a potential antifibrotic effect supported by macroscopic and histopathological parameters; however, the underlying molecular mechanisms remain to be clarified. Further dose-response, safety, mechanistic, and translational studies are required before clinical application.
Etiology-Based Differences in Clinical Presentation and Management of Pneumothorax: A Retrospective Study
Objective: Pneumothorax is a common thoracic emergency that may present as primary spontaneous, secondary spontaneous, or traumatic pneumothorax. This study aimed to compare the clinical characteristics, treatment approaches, and outcomes of different pneumothorax subtypes. Methods: This retrospective single-center study included adult patients diagnosed with pneumothorax between March 2024 and March 2025. Patients with incomplete records, repeated admissions, or pregnancy were excluded. Demographic characteristics, clinical presentation, treatment modalities, comorbidities, complications, and laboratory findings were analyzed. Patients were classified as primary spontaneous pneumothorax (PSP), secondary spontaneous pneumothorax (SSP), or traumatic pneumothorax. Statistical significance was defined as P<0.05. Results: A total of 154 patients were included: 44 (28.6%) with PSP, 35 (22.7%) with SSP, and 75 (48.7%) with traumatic pneumothorax. Patients with SSP were significantly older than those with PSP (66.5 vs. 41.2 years, P<0.001). Male predominance was observed in all groups (81.8%, 91.4%, and 82.7%, respectively). Dyspnea was more frequent in SSP (88.6%, P=0.029), whereas chest pain was most common in traumatic pneumothorax (94.7%, P=0.023). COPD was strongly associated with SSP (88.6%, P<0.001). Chest tube insertion was the most common treatment modality (72.7%, 80.0%, and 70.7% in PSP, SSP, and traumatic pneumothorax, respectively). Rib fractures (53.3%, P<0.001) and hemothorax (18.7%, P=0.001) were more frequent in traumatic pneumothorax. Conclusion: PSP predominantly affected younger patients, whereas SSP was strongly associated with advanced age and COPD. Traumatic pneumothorax was frequently accompanied by rib fractures and hemothorax. These findings support an etiology-based approach to pneumothorax management and may contribute to more individualized treatment strategies.
Evaluation of Ozone Therapy Effectiveness by the Red Cell Distribution Width/Albumin Ratio
Objective: Ozone is an inorganic gas utilized for medical purposes. Ozone therapy has gained increasing popularity in recent years and is employed in the treatment of chronic diseases associated with inflammation. The red cell distribution width/albumin ratio (RAR) has recently emerged as an inflammatory marker. The aim of this study was to evaluate the efficacy of ozone therapy in patients with spinal pain and to investigate the effect of ozone therapy on inflammation through changes in the RAR value. Methods: This prospective pilot study was conducted in a pre- and post-treatment design on patients with spinal pain. In addition to demographic data, visual analog scale (VAS) scores and RAR values were recorded before and after ozone therapy. All patients underwent major ozone autohemotherapy. Data were analyzed using the SPSS software. Results: During the study period, 93 patients presented to the ozone therapy unit. After applying the exclusion criteria, 66 patients were included in the analysis. The mean pre-treatment VAS score was 6.74±1.53, while the mean post-treatment VAS score was 4.08±1.54 (P<0.05). The mean pre-treatment RAR value was 3.37±0.64, which decreased to 3.14±0.50 following ozone therapy (P<0.05). Conclusion: Our findings demonstrate that major ozone autohemotherapy is effective in alleviating spinal pain. Furthermore, the reduction in RAR values before and after treatment indicates that major ozone autohemotherapy exerts an anti-inflammatory effect.
The Contribution of Yâdigâr-i Ibn-i Sharif to Orthopedics Through Fifteenth-Century Medical Knowledge: Modern Interpretations of Traditional Therapeutic Practices and an Ethnopharmacological–Orthopedic Analysis
This study examines the fifth chapter of Yâdigâr, written by the 15th-century Ottoman physician Tabîb Ibn-i Sharif, within the context of contemporary orthopedics and traumatology. The chapter addresses therapeutic approaches for musculoskeletal conditions, including fractures, dislocations, and contusions. The historical practices described in the text were interpreted in light of current biomedical and ethnopharmacological knowledge, with particular emphasis on herbal formulations and nutritional recommendations. Several of these traditional approaches suggest conceptual parallels with modern scientific understanding, especially regarding anti-inflammatory, antimicrobial, and nutritional effects that may support tissue healing. However, certain practices, such as bloodletting, are inconsistent with current orthopedic principles. Overall, this analysis indicates that historical medical texts such as Yâdigâr may provide conceptual rather than directly clinical relevance, offering valuable insights for ethnopharmacological research and contributing to a broader understanding of the historical development of orthopedic knowledge.
Endometrioid Carcinoma Metastasis and Minute Pulmonary Meningothelial-Like Nodules in the Lung: A Case Report
Minute pulmonary meningothelial-like nodules (MPMN) are rare pulmonary lesions characterized by the proliferation of cells showing meningothelial differentiation and are most commonly detected incidentally. Their coexistence with pulmonary metastases is uncommon. We report a case of metastatic endometrioid carcinoma of the lung associated with incidentally identified MPMN. A 60-year-old woman with a history of endometrioid carcinoma presented with a soft tissue density lesion measuring 38×42 mm with ill-defined margins, causing mild narrowing of the right upper lobe bronchus on computed tomography. Surgical resection of the lung mass was performed. Intraoperative frozen section examination revealed a malignant epithelial neoplasm consistent with adenocarcinoma. On permanent sections, histopathological evaluation demonstrated an epithelial tumor composed of complex and cribriform glandular structures within a desmoplastic stroma, accompanied by loss of polarity and nuclear enlargement, consistent with metastatic endometrioid carcinoma. In the wedge resection specimen obtained after frozen section examination, multiple microscopic lesions were identified in the non-neoplastic lung parenchyma. These lesions consisted of bland cells with round to ovoid nuclei arranged in whorled patterns along the alveolar septa. Immunohistochemical analysis supported the diagnoses of metastatic endometrioid carcinoma and MPMN, respectively. Based on the histopathological, immunohistochemical, and clinical findings, the mass lesion was diagnosed as metastatic endometrioid carcinoma, while the incidental parenchymal lesions were diagnosed as MPMN. To our knowledge, coexistence of MPMN with metastatic endometrioid carcinoma is exceedingly rare and not well documented in the indexed English-language literature.
Minute Pulmonary Meningothelial-Like Nodules
Predictive Value of First Trimester APRI Score and FIB-4 Index for Gestational Diabetes Mellitus
Objective: Inflammation, liver injury, and subclinical fibrotic processes secondary to insulin resistance are thought to play an important role in gestational diabetes mellitus (GDM). This study aimed to evaluate the predictive value of the aspartate aminotransferase–platelet ratio index (APRI) and fibrosis-4 (FIB-4) index, which reflect inflammatory status and hepatic involvement, for the prediction of GDM. Methods: This retrospective study included 3,305 pregnant women who delivered at Department of Obstetrics and Gynecology, Bursa Yüksek İhtisas Training and Research Hospital between January 2020 and December 2024. Of these, 371 women were diagnosed with GDM, while 2,934 women with normal glucose tolerance constituted the control group. Oral glucose tolerance test results, APRI scores, and FIB-4 indices were compared between the groups. Results: The median APRI score and FIB-4 index were significantly higher in the GDM group than in the control group (P<0.001 and P=0.027, respectively). An APRI score >0.22 predicted GDM with a sensitivity of 61.46% and a specificity of 66.02% (AUC=0.667, P<0.001), whereas a first-trimester FIB-4 index >0.53 showed a sensitivity of 66.31% and a specificity of 41.0% (AUC=0.535, P=0.027). ROC analysis demonstrated that first-trimester APRI had significantly greater predictive ability for GDM than FIB-4 (P<0.001). Correlation analysis revealed no significant associations between APRI and clinical parameters, while the FIB-4 score showed weak positive correlations with age and parity. Conclusion: The present study suggests that both APRI score and FIB-4 index may serve as noninvasive biomarkers for the early prediction of GDM. Notably, the APRI score demonstrated superior predictive performance compared with FIB-4 index. Keywords: Gestational Diabetes Mellitus, APRI Score, FIB-4 Index, Inflammation, Oral Glucose Tolerance Test
Meeting Abstracts of the 6th Uludag Cardiology Summit, March 26-29, 2026, Bursa, Türkiye
OP-1. Prognostic Value of the HALP Score for Predicting Left Ventricular Remodeling in STEMI Patients Undergoing Primary PCI OP-2. Short Term Clinical Outcomes and Predictors of Selective Left Bundle Branch Pacing OP-3. Association Between Delayed QRS Transition Zone and Diabetes Mellitus OP-4. Vasospastic Angina: A Case of Coronary Spasm Confirmed by Ergonovine OP-5. Cardiac Effects of Chronic Pyrethroid Exposure OP-6. Effect of SGLT-2 Inhibitors on MPV in Heart Failure Patients OP-7. Evaluation of Subclinical Myocardial Dysfunction in Cirrhosis Using 4D Strain Analysis OP-8. The Role of the Intermountain Risk Score in Predicting Coronary Artery EctasiaOP-9. Association Between Uric Acid to Albumin Ratio and No-Reflow Phenomenon in Patients with NSTEMI OP-9. Association Between Uric Acid to Albumin Ratio and No-Reflow Phenomenon in Patients with NSTEMI OP-10. Coronary Vasospasm Presenting as ST-Elevation Myocardial Infarction: A Case Report OP-11. Management of a Stripped Stent within a Dissected Coronary Lesion OP-12. Prognostic Utility of the Pan-Immune-Inflammation Value (PIV) in Predicting No-Reflow Among Patients Undergoing Primary PCI for STEMI OP-13. VARC-3 Outcomes of Myval, Portico, and Evolut-R in TAVI OP-14. Colchicine Aiding Recurrent Pacemaker Pocket Inflammation Management: A Case Report OP-15. Colchicine Use After Coronary Artery Stenting: One-Year Follow-Up Results OP-16. Drug-Coated Balloon-Only Strategy for Chronic Total Occlusion: A Prospective, Two-Center Study of 48 Patients OP-17. The Role of Pharmacological Cocktails in Preventing Radial Spasm and Complications During Percutaneous Coronary Intervention (PCI): A Clinical Study OP-18. Drug-Coated Balloon-Only Strategy in a True LCx–OM Bifurcation Lesion (Medina 1.1.1): Case Report with 12-Month Follow-Up OP-19. The Utility of Atherogenic Index of Plasma in Predicting in-Hospital Ischemic Stroke in Patients Undergoing Carotid Artery Stenting OP-20. A Case of Long QT Syndrome Presenting with Ventricular Arrhythmia OP-21. Can We Predict Reperfusion in ST-Elevated Myocard Infaction? OP-22. The Effect of Volume Overload on Ventriculo-Arterial Coupling in Hemodialysis Patients OP-23. Minimal Symptoms, Maximum Risk: Hidden Type A Dissection Accompanying an 81 mm Ascending Aortic Aneurysm OP-24. Comparative Efficacy of Single- and Dual-Defibrillator Orthogonal Electrical Cardioversion in Persistent Atrial Fibrillation OP-25. Complete Atrioventricular Block and Postpartum Cardiomyopathy in a Patient With c-TGA: A Case of Right-Sided Cardiac Resynchronization Therapy OP-26. Predictive Value of Systemic Immune-Inflammation Index for INOCA OP-27. Transcatheter Closure of Mitral Paravalvular Leak Developing After Mechanical Mitral Valve Replacement: A Case Report OP-28. Acute Coronary Syndrome After Anaphylaxis: Kounis Syndrome Case OP-29. Cardiac Lymphoma: A Rare Case Report OP-30. The Clinical Significance of the Plasma Atherogenic Index in Predicting Total Occlusion in Patients with Non-ST Elevation Myocardial Infarction OP-31. Prognostic Nutritional Index and Frailty After Ischemic Stroke: Mid-Term Follow-Up Results OP-32. Diagnostic Challenge in Cardiac AL Amyloidosis: When Imaging Speaks Louder Than Serum Biomarkers OP-33. Nightmare in the Cath Lab: LMCA Dissection OP-34. Association of Preoperative Serum Magnesium Levels and Acute Kidney Injury Following Thromboembolectomy in Acute Limb Ischemia OP-35. Could the Systemic Coagulation Inflammation Index Be a Predictor of Worse Outcomes After Carotid Endarterectomy? OP-36. The Role of Exocrine Pancreatic Insufficiency in Predicting Concomitant Carotid Artery Disease in Diabetic Patients Scheduled to Undergo Coronary Artery Bypass Grafting OP-37. Relationship Between TASC II Lesion Severity and Carotid Artery Stenosis: A Cross-Sectional Analysis OP-38. Hyponatremic Seizure in a Middle-Aged Woman on Spironolactone–Hydrochlorothiazide OP-39. An Unexpected Cause of Angina: Successful Percutaneous Closure of an Internal Mammary Artery–Left Atrium Fistula OP-40. Predictors of Isolated Nocturnal Hypertension in Non-obese Non-diabetic Individuals OP-41. The Impact of Guideline-based Treatment on In-hospital Outcomes in Infective Endocarditis OP-42. The Effect of Unfractionated Heparin Administration Timing on Radial Artery Spasm and Occlusion in Radial Coronary Angiography OP-43. The Mediating Role of Heart Rate in the Relationship Between Smoking and Myocardial Performance Op-44. Avoiding Emergency Surgery with Imaging-Guided Thrombolysis in Mechanical Valve Thrombosis OP-45. Predictive Value of the Frontal QRS-T Angle for Coronary Thrombus Burden in Patients Presenting with Acute Myocardial Infarction OP-46. STEMI Caused by Thrombotic Subclavian Occlusion in LIMA Grafted Patient OP-47. Hemoptysis During Cardioverter-Defibrillator Implantation: A Rare Complication OP-48. Intra-Arterial Lidocaine for Resistant Radial Artery Spasm OP-49. Routine Clinical and Lipid Parameters Predict High-Grade Atrioventricular Block After Transcatheter Aortic Valve Implantation: A Pragmatic Single-Center Study OP-50. CONUT Score and Length of Hospital Stay in Acute Decompensated Heart Failure OP-51. Distinction Between Type 2 Myocardial Infarction and Myocardial Injury in Troponin Positivity: Retrospective Clinical Classification and 30-Day Prognosis OP-52. Myocardial Contraction Fraction as an Independent Predictor of Cardiovascular Mortality in Patients with Chronic Renal Failure OP-53. Surgical Stentectomy and Bypass in Coronary Full Metal Jacket OP-54. AF-Ablation Performed via Transeptal Passage Through Septal Occuder Device: A Case Report. OP-55. Acute Axillary Artery Occlusion Following Transradial Intervention: A Case Report OP-56. A Multidomain Risk Cluster for Predicting Contrast-Induced Nephropathy After Carotid Artery Stenting OP-57. An Overlooked Phenotype: Widespread Non-calcified Atherosclerosis Presenting with Vision Loss OP-58. Safety and Efficacy of Carotid Artery Stenting Without Routine Anticholinergic Pretreatment OP-59. The Dark Path of Infective Endocarditis: Prosthetic Valve Endocarditis Unveiled by Multimodality Imaging OP-60. The Cost of Pregnancy? Peripartum Cardiomyopathy Following IVF OP-61. Malignant RCA in the Shadow of Perimyocarditis Op-62. One Implantation, Two Challenges: Anatomical Difficulty and Post-Cardiac Injury Syndrome OP-63. Ozaki Procedure OP-64. Diagnostic Performance of Coronary CT Angiography Compared with Invasive Coronary Angiography and the Impact of Coronary Calcium Score: A Single-Center Real-World Study
Mutation-Associated P53 Immunohistochemical Patterns in Invasive Breast Carcinoma: Clinicopathological Correlations
Objective: TP53 mutations are the most common genetic changes in human malignancies. Recent studies suggest that specific p53 immunohistochemical staining patterns may reflect underlying TP53 mutations and have prognostic significance. This study aimed to evaluate the predictive and prognostic importance of p53 immunohistochemical staining patterns in invasive breast carcinoma. Methods: A total of 345 patients with invasive breast carcinoma were included in the present study. p53 immunohistochemistry was evaluated and categorized as wild-type, overexpression, null, cytoplasmic or equivocal. Clinicopathological variables were compared statistically. Results: Wild-type p53 staining was observed in 243 (70.4%) cases, whereas abnormal p53 staining were detected in 90 (26.1%) cases. Abnormal p53 expression were associated with a younger patient age (median 48 vs. 52 years, P=0.041), larger tumor size (29 vs. 22 mm, P<0.001), higher histological grade (P<0.001) and higher Ki-67 levels (P<0.001). Hormone receptor negativity was significantly more frequent in tumor with abnormal p53 staining (ER negativity: 63.3% vs. 9.1%; PR negativity: 65.6% vs. 21.0%; both P<0.001). HER2 positivity was also more prevalent in the abnormal p53 group (P<0.001). Triple-negative breast cancer was significantly more prevalent in tumor with abnormal p53 expression 43.3% vs. 6.6%, P<0.001. Additionally, lymph node metastasis was significantly more prevalent in the abnormal p53 group (75.6% vs. 56.8%, P=0.003). Conclusion: Abnormal p53 staining patterns are strongly associated with adverse clinicopathological features and aggressive molecular subtypes in invasive breast carcinoma. These results suggest that p53 staining patterns could be used as a practical surrogate marker to reflect tumor aggressiveness and provide prognostic information in routine pathological evaluations.
Obesity Class and Clinical Response to Multidisciplinary Weight Management in Patients with Knee Pain: A Retrospective Study
Objective: To determine the impact of reducing body mass index (BMI) and differences between obesity classes in obese patients with knee pain. Methods: This retrospective research examined ninety-three obesity center patients with complete 9-month data, including monthly weight, BMI, Visual Analog Scale (VAS), and functional status assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) assessments, who were included in the analysis. Participants were classified as obesity class I (30.0-34.9 kg/m²), class II (35.0-39.9 kg/m²), or class III (≥40.0 kg/m²). We studied pain and function changes associated with percentage BMI decrease. Results: Mean age was 50.3±11.0 years. Median BMI was 36.74 kg/m² (IQR: 33.94–40.75). All obesity groups had significant reductions in BMI, VAS and WOMAC scores, at month 9 compared to baseline (P<0.001). The magnitude of BMI reduction did not differ between groups (P=0.155). VAS and WOMAC improvements differed by category (VAS; P=0.009; WOMAC; P=0.004), with the smallest improvement in class III. Holm-corrected comparisons showed differences between class I and class III for VAS (P=0.007) and WOMAC (P=0.004), and between class II and class III for WOMAC (P=0.042). A weak association was observed between percentage BMI reduction and WOMAC improvement (rho=0.262; P=0.011), but not VAS improvement (rho=0.008; P=0.941). Conclusion: BMI reduction was associated with improvements in pain and functional status over 9 months in patients with obesity and knee pain. However, symptomatic improvement was less pronounced in class III obesity despite a similar magnitude of BMI reduction. These findings suggest that obesity severity may influence clinical response and that patients with advanced obesity may require more individualized and comprehensive management strategies.
Evaluation of Anesthetic Management and Clinical Outcomes in Minimally Invasive Cardiac Surgery: A Retrospective Single-Center Study
Objective: Minimally invasive cardiac surgery (MICS) has gained increasing popularity due to reduced surgical trauma and enhanced recovery protocols. However, data focusing on anesthetic management and postoperative clinical outcomes, particularly from Turkiye, are limited. This study aimed to retrospectively evaluate anesthetic approaches and postoperative outcomes in patients undergoing minimally invasive cardiac surgery at a single tertiary center. Methods: This retrospective, exploratory observational study included adult patients who underwent minimally invasive cardiac surgery between January 1, 2020, and September 30, 2025 at our hospital. Demographic characteristics, perioperative anesthetic management, intraoperative variables, postoperative outcomes and complications were analyzed. Fascial plane block–based analgesia was compared with intravenous analgesia regarding extubation time, analgesic requirements, and length of hospital stay. Risk factors for postoperative complications were evaluated using univariate and multivariate logistic regression analyses. Results: A total of 33 patients were included in the analysis, with a mean age of 56.2±11.9 years; 75.8% were male. The most common procedures were minimally invasive coronary artery bypass grafting (42.4%) and aortic valve replacement (27.3%). Fascial plane blocks were applied in 66.7% of patients and were associated with reduced need for rescue analgesia (36.4% vs. 100%, P<0.001), earlier extubation (P=0.014), and shorter hospital stay (P=0.038), although considerable inter-patient variability was observed. Postoperative complications occurred in 42.4% of patients, with delirium (18.2%) and pneumonia (12.1%) being the most frequent. Diabetes mellitus, smoking, and prolonged cardiopulmonary bypass duration were associated with increased postoperative complication risk. In multivariate analysis, smoking remained an independent predictor of postoperative complications. Conclusion: In this exploratory single-center study, minimally invasive cardiac surgery was performed safely in appropriately selected patients. Fascial plane block–based analgesia was associated with improved postoperative recovery. These preliminary findings warrant validation in larger, prospective studies. Preoperative optimization may further enhance outcomes.
Long-Term Outcomes of Pediatric Intracardiac Masses: Clinical Course and Tumor Behavior in a Single-Center Experience
Objective: We aimed to evaluate the clinical characteristics, diagnostic pathways, echocardiographic and Holter findings, treatment strategies, and long-term outcomes of children with intracardiac masses, and to explore factors associated with tumor regression. Methods: This retrospective observational study included children with echocardiographically confirmed intracardiac masses followed at a tertiary pediatric cardiology center between January 2010 and January 2022. Demographic and clinical characteristics, tumor features, serial echocardiographic measurements, 24-hour Holter recordings, treatment strategies, and follow-up outcomes were analyzed. Results: A total of 20 patients were included. Rhabdomyoma was the most common tumor type (60%, n=12), followed by fibroma (30%, n=6). Most patients were asymptomatic or mildly symptomatic at presentation (90%, n=18). Clinically significant arrhythmias were observed in 15% (n=3), predominantly in patients with fibromas. Tumor size reduction was observed in 40% (n=8) of patients. All patients diagnosed during the fetal period (15%, n=3) exhibited tumor size reduction; all had rhabdomyomas. Everolimus was administered in 25% (n=5) of patients, with tumor size reduction observed in 80% (n=4) of treated cases; however, this was not statistically significant (P=0.253). Left ventricular systolic function remained preserved in all patients during follow-up. Conclusion: Pediatric intracardiac masses are predominantly benign but show heterogeneous clinical behavior. Tumor regression was more frequent in rhabdomyomas; however, this may reflect tumor type distribution. Arrhythmias were more frequent in fibromas, supporting rhythm surveillance. Everolimus may be considered in selected patients; however, findings should be interpreted with caution due to limited sample size and potential selection bias, and require confirmation in larger studies.
Stepwise Diagnostic Evaluation in Pediatric Epilepsy: Clinical and EEG Predictors of MRI Positivity and Diagnostic Reclassification
Objective: This study aimed to evaluate the predictive value of clinical and electroencephalographic (EEG) findings for identifying epileptogenic structural lesions on cranial magnetic resonance imaging (MRI) in pediatric epilepsy, and to assess the contribution of MRI to diagnostic reclassification. Methods: A total of 207 pediatric patients with a confirmed diagnosis of epilepsy were retrospectively analyzed. The diagnostic workflow was evaluated through a stepwise model integrating clinical assessment, EEG, and MRI. The primary endpoints comprised the MRI positivity rate, defined by the detection of epileptogenic structural lesions, and the diagnostic reclassification rate, defined as any modification in epilepsy type classification or etiological category following the incorporation of EEG and/or MRI findings. Independent predictors of MRI positivity were identified using multivariable logistic regression analysis. Results: Epileptogenic structural lesions were identified in 9.7% of patients. Despite a relatively modest MRI positivity rate, imaging significantly contributed to diagnostic refinement. Among cases with normal EEG findings, MRI revealed structural pathology in 12%. The overall diagnostic reclassification rate following the addition of MRI was 9.7%. In multivariable analysis, focal-onset seizures (OR=2.63), developmental delay (OR=2.91), abnormal neurological examination (OR=3.08), and focal epileptiform EEG activity (OR=2.47) emerged as independent predictors of MRI positivity (all P<0.05). Agreement between EEG and MRI lateralization was moderate (κ=0.60). Conclusion: In pediatric epilepsy, MRI may substantially contribute to etiological classification, particularly in the presence of high-risk clinical and electrophysiological features. These findings support the implementation of a risk-stratified, stepwise diagnostic approach to optimize clinical management.
Pediatric epilepsy; Magnetic resonance imaging; Electroencephalography
Outcomes of Single-Level and Multi-Level Thoracoscopic Sympathectomy in Primary Axillary Hyperhidrosis: A Multicenter Retrospective Analysis
Objective: Primary axillary hyperhidrosis is associated with substantial impairment in quality of life, and endoscopic thoracic sympathectomy (ETS) provides definitive treatment in refractory cases. However, the optimal level of sympathetic interruption remains controversial, and evidence directly comparing different surgical levels in axillary disease is limited. This study aimed to compare surgical outcomes among three sympathectomy levels in patients with primary axillary hyperhidrosis. Methods: This retrospective multicenter study included 83 patients who underwent bilateral clip-based thoracoscopic sympathectomy for primary axillary hyperhidrosis between 2009 and 2023. Patients were stratified into three groups: single-level R3 (n=24), single-level R4 (n=35), and multi-level R2–R4 (n=24). The primary outcome was compensatory hyperhidrosis. Secondary outcomes included complete remission, recurrence, postoperative complications, and patient satisfaction. Factors associated with outcomes were evaluated using univariate and multivariate logistic regression analyses. Results: Compensatory hyperhidrosis occurred in 83.3% of patients in the R2–R4 group, compared with 75.0% in the R3 group and 54.3% in the R4 group (P=0.045). Complete remission rates were comparable among groups (54.2%, 41.7%, and 34.3%, respectively; P=0.452). In multivariate analysis, R4 sympathectomy was associated with significantly lower odds ratio (OR) of compensatory hyperhidrosis compared with R2–R4 (OR: 0.25, 95% CI: 0.06–0.97; P=0.044). Recurrence rates did not differ significantly among groups (20.8%, 25.7%, and 12.5%, respectively; P=0.466). Recurrence was the only independent predictor of patient dissatisfaction (OR: 0.12, 95% CI: 0.03–0.44; P=0.001). Conclusion: Single-level R4 sympathectomy appears to provide a favorable balance between treatment efficacy and side-effect profile in primary axillary hyperhidrosis. Multi-level approaches were not associated with improved clinical outcomes but were linked to higher rates of compensatory hyperhidrosis. These findings should be interpreted with caution.