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Background/aim: To evaluate the difficulty of laparoscopic adrenalectomy by investigating the usefulness of the Mayo Adhesive Probability (MAP) score for assessing adherent perinephric fat and its correlation with histological reality.

Patients and methods: We retrospectively evaluated 103 patients who underwent laparoscopic adrenalectomies. Based on preoperative computed tomography images, the patients were categorized into two groups: high (3-5 points) and low MAP (0-2 points). Clinical characteristics and perioperative data were compared between the two groups. Additionally, we analyzed the pathological tissue of the tumor and surrounding fat using hematoxylin-eosin-saffron staining.

Results: Compared with the low MAP group, the high MAP group had younger patients (59 vs. 62 years, p=0.097), more male patients (93.3% vs. 44.3%, p<0.001), and higher body mass indices (26.4 vs. 23.8, kg/m², p=0.029). The MAP group experienced a significantly higher estimated blood loss compared to the low MAP group (10 vs. 52.3, ml, p=0.047). Tumor and adhering perirenal fat tissues of pheochromocytoma, adrenal carcinoma, and metastatic adrenal tumors exhibited significantly higher expression of vascular endothelial growth factor and cluster of differentiation 204 compared to the low MAP group (p<0.001). Additionally, both proteins were highly expressed in the adhering perirenal fat in the high MAP group (p=0.020, p=0.015).

Conclusion: Patients with a preoperative MAP score ≥3, pheochromocytoma, or malignant tumor had a high risk of increased intraoperative blood loss. Strict perioperative management should be performed in such cases.

Background/aim: Atherosclerosis is a vascular inflammatory disease characterized by the activation and stress of various inflammatory cells, leading to the development of coronary artery disease and subsequently acute myocardial infarction (AMI). Among AMI cases, ST-segment elevation myocardial infarction (STEMI) is typically more severe than non-STEMI (NSTEMI). UL16-binding proteins (ULBPs), which are NKG2D ligands, can be expressed on the surface of stressed and activated cells, prompting these cells to generate microparticles (MPs). Consequently, MPs carrying ULBPs, particularly ULBP1 (ULBP1⁺ MPs), may be released into the bloodstream. This study aimed to investigate the association between ULBP1⁺ MPs and the presence of AMI and its severity.

Materials and methods: We recruited 58 AMI patients and 45 age-matched control subjects. Levels of ULBP1⁺ MPs and ULBP1⁺ MPs originating from T lymphocytes (ULBP1⁺ TMPs) were measured using flow cytometry.

Results: Both ULBP1⁺ MP and ULBP1⁺ TMP levels were significantly elevated in AMI patients compared to controls. Elevated levels of these MPs were independent risk factors for AMI with odds ratios (OR) of 4.3 (95%CI=1.5-12.3) for ULBP1⁺ MPs and 5.8 (95%CI=2.0-17.0) for ULBP1⁺ TMPs. Additionally, ULBP1⁺ TMP levels were significantly higher in STEMI patients compared to NSTEMI patients, with an independent association observed between ULBP1⁺ TMPs and STEMI (OR=3.9; 95%CI=1.2-12.8).

Conclusion: Elevated levels of ULBP1⁺ MPs and ULBP1⁺ TMPs are associated with AMI and its severity. These biomarkers could serve as indicators of vulnerable plaques that lead to AMI.

Background/aim: In rectal cancer surgery, anastomotic leakage (AL) is the most important complication and has a reported frequency of 11-15%. The causes of AL leakage are complex, and AL prevention should be performed in multiple directions. Thus, this study examined the usefulness of the comprehensive and multifaceted AL preventive measures.

Patients and methods: In total, 164 rectal surgery patients who had low rectal staple anastomosis below the peritoneal reflection were enrolled. The patients were divided into two groups: (i) the multifaceted AL prevention group (MP group, n=34) and (ii) the insufficient AL prevention group (IP group, n=130). Multifaceted AL prevention was defined as intestinal blood flow evaluated via indocyanine green (ICG)-fluorescence imaging (FI), the use of a single-staple technique (SST) without intersecting stapling lines or "dog ears", the use of transanal suture reinforcement according to the air leakage test, and the use of a transanal tube for anatomical decompression and a diverting stoma for diverting the fecal stream. The AL rates were retrospectively compared between the two groups. The data are expressed as the median and interquartile range.

Results: The rate of AL was significantly lower in the MP group (0%) than in the IP group (11.54%) (p=0.0423).

Conclusion: Multifaceted AL prevention, including ICG-FI and SST, achieved a zero incidence of AL. Multifaceted prevention significantly lessened AL more than inadequate prevention did. Therefore, if the weight of each preventive measure cannot be clearly identified, to avoid AL, it is important to take all preventive measures from multiple aspects.

Background/aim: Pelvic floor dysfunctions (PFDs), which encompass pelvic organ prolapse (POP), stress urinary incontinence (SUI), and anal incontinence (AI), are common degenerative diseases in women. Bone marrow mesenchymal stem cells (BMSCs) hold promise for the treatment of PFDs. Extracellular vesicles (EVs) derived from BMSCs, have displayed an extensive role in intercellular communication and tissue repair. However, efficacy of the treatment using EVs originated from BMSCs on mouse models of PFD remains unknown. This study investigated the therapeutic potential of BMSC-derived EVs in a female PFD mouse model induced by vaginal distension (VD).

Materials and methods/results: Flow cytometry analysis confirmed the positive expression of BMSC-related markers, and successful induction of multilineage differentiation further validated their characteristics. As expected, the EVs extracted from BMSCs exhibited typical cup-shaped and circular-shaped structures. In the PFD model, BMSC-derived EVs significantly reduced the levels of inflammatory cytokines (p<0.05), improved tissue repair, and mitigated neutrophil infiltration. Furthermore, EVs promoted cell proliferation, decreased expression of relaxin receptors, increased expression of elastin, and elevated collagen content in the anterior vaginal wall tissue (p<0.05), suggesting beneficial effects on tissue regeneration and connective tissue restoration in PFD.

Conclusion: BMSC-derived EVs effectively reduce tissue inflammation, promote tissue regeneration and connective tissue reconstruction, and improve pelvic support deficiency, thereby alleviating PFD induced by vaginal distension (VD) in vivo.

Background/aim: This report aimed to present identified variants with pathogenic potential in three genes - TP53, PTEN, and RB1 - in a selected sample of patients with metastatic castration-resistant prostate cancer (mCRPC) with or without the presence of circulating tumor cells (CTCs) and splice variant AR-V7.

Materials and methods: Next generation sequencing was performed on an Illumina platform to analyse the genetic profiles of 50 patients with mCRPC. Identified variants were validated using the Integrative Genomic Viewer, and the correlation between these variants and the presence of CTC/AR-V7 was subjected to statistical analysis.

Results: The study revealed a total of 15 genetic alterations in the three examined genes. The presence of rs1042522 (TP53) in mCRPC patients was associated with a significantly reduced likelihood of AR-V7 occurrence (p<0.001), indicating a protective effect. Additionally, patients with AR-V7 showed a marked increase in prostate-specific antigen (PSA) levels. Higher PSA levels were correlated with an increased risk of AR-V7 presence.

Conclusion: The identified genetic mutations and PSA levels have a moderate predictive ability for determining AR-V7 status.

Background/aim: Subdural hematoma (SDH), a critical brain condition, significantly affects the elderly, making traditional surgeries risky due to their length and potential for blood loss. Endoscope-assisted evacuation offers a safer, less invasive alternative by reducing operation time and minimizing damage, providing an effective solution for older patients. This study evaluated six patients treated with endoscopic evacuation for different stages of SDH from August 2019 to July 2023.

Patients and methods: Selection criteria were based on altered consciousness, lack of severe brain contusion, SDH thickness over 1 cm, or midline shift over 0.5 cm. The technique used a burr hole and rigid lens endoscope for hematoma removal, focusing on shorter surgery times and better outcomes.

Results: Patients aged between 63 to 84 years showed no surgical fatalities, with all recovering well by discharge. Hematoma clearance rates were 76.9% at three days, improving to 96.8% after one month.

Conclusion: Endoscope-assisted evacuation is a safe, efficient treatment for elderly patients with various stages of SDH, offering a less invasive option with potential for better outcomes. It supports the trend towards minimally invasive neurosurgery, with further research needed to optimize patient selection and understand long-term benefits.

Background/aim: This study aimed to compare the use of a rotating gantry in liver tumor carbon-ion radiotherapy using of a fixed-port for treatment planning.

Materials and methods: Thirty patients with liver tumors were analyzed. Three treatment plans were developed for each case: one with a rotating gantry with a 360° angle, one with fixed ports of 0° and 90° with a ±20° couch rolling setting, and one with fixed ports of 45° and 90° with a ±20° couch rolling setting. The dose-volume histogram parameters of the clinical target volume (CTV) and organs at risk (OARs) for each treatment plan were compared.

Results: Significant differences in the volume of the liver-gross tumor volume (GTV) of normal liver irradiated with 5 Gy to 15 Gy were found between the gantry treatment plans and fixed-port treatment plans. There were no significant differences in the OARs, except for the CTV and liver GTV, between the gantry and fixed-port treatment plans.

Conclusion: The study results support the potential of using a rotating gantry to reduce liver doses, especially in the low-to-medium dose range, while maintaining target and OAR doses except for the liver. A rotating gantry could be especially useful in cases in which the relationship between the tumor and OAR is complicated by location.

Background/aim: Chronic low back pain (CLBP) significantly reduces quality of life and increases reliance on healthcare resources. Despite many individuals opting for vitamin D supplementation to alleviate CLBP, its efficacy remains debatable. This meta-analysis aimed to evaluate the potential benefits of vitamin D supplementation in treating this condition.

Patients and methods: Adhering to PRISMA guidelines, we systematically reviewed the effectiveness of vitamin D supplementation in adults with CLBP, focusing exclusively on randomized controlled trials (RCTs). A comprehensive literature search was conducted up to May 2024 across multiple databases, including PubMed, Scopus, Cochrane Library, and Web of Science.

Results: Ten RCTs meeting our inclusion criteria were analyzed. The results indicated that vitamin D supplementation did not significantly reduce pain scores compared to control groups (SMD: -0.130, 95%CI=-0.260 to 0.000; I²=0%), regardless of participants' baseline vitamin D levels. Moreover, long-term supplementation showed no notable improvement in CLBP outcomes (SMD: -0.097, 95%CI=-0.290 to -0.097; I²=19.878%). Additionally, supplementation with active forms of vitamin D (SMD: -0.321, 95%CI=-0.670 to 0.028; I²=0.000%) did not result in significant pain relief for chronic lower back pain.

Conclusion: Vitamin D supplementation does not substantially alleviate CLBP. Nevertheless, it may still be considered as part of a comprehensive treatment plan. Further research is necessary to explore its long-term effects and the underlying mechanisms that may explain the observed lack of benefit.

Background/aim: The COVID-19 pandemic has intensified inquiries into the interplay between diabetes and disease severity, and the long-term impact of long-COVID. This study specifically explored the implications of different antithrombotic treatments on COVID-19 patients. It aimed to assess the long-term efficacy and safety of Vitamin K antagonists (VKA) and direct oral anticoagulants (DOACs) in mitigating thromboembolic complications in COVID-19 patients.

Patients and methods: We conducted a study on 157 patients diagnosed with COVID-19 from August 2021 to August 2023. The study evaluated shifts in anticoagulant therapy recommendations, tracking the transition from VKA to DOACs, and analyzed associated health outcomes.

Results: A significant shift from VKA to DOACs prescriptions was observed, especially in high-risk patients. Despite the change in antithrombotic treatments, incidences of varices and varices with hemorrhoids increased by 2.6% and 3.2%, respectively. Long-COVID was also linked to higher occurrences of diabetes and gastrointestinal diseases. Joint diseases rose by 14%, indicating persistent inflammation. Cardiomyopathies increased by 3.9%, predominantly in high-risk groups, and psychoanxiety disorders surged by 39.5%, highlighting the need for further research. DOAC usage was more common in older age groups, with a 10.2% increase in recommendations among high-risk patients (p<0.05).

Conclusion: The study underscores the evolving landscape of antithrombotic therapy in managing COVID-19 complications. Despite the increased use of DOACs, the rise in various health conditions suggests the necessity for personalized treatment strategies tailored to patient risk profiles.

Background/aim: Breast-conserving surgery is the preferred treatment for early-stage breast cancer but can often result in unsatisfactory cosmetic outcomes. Oncoplastic surgery aims to improve both oncologic and aesthetic outcomes by combining local excision with plastic surgery techniques. Using breast reduction techniques in breast cancer treatment has been shown to allow for wider margins of excision, leading to enhanced oncological safety and reduced recurrence rates without causing significant asymmetry. This study aimed to analyze the surgical and oncological outcomes of a large cohort of patients undergoing oncoplastic reduction mammoplasty (ORM).

Patients and methods: A retrospective analysis of postoperative surgical and oncological outcomes of all patients who underwent ORM at a single center between January 2018 and December 2023 was performed. Preoperative patient characteristics, operative and post-operative outcomes were recorded and analyzed.

Results: A total of 67 patients that underwent oncologic breast reduction were included in the final analysis - representing a total of 71 ORM, with a mean (SD) age of 53.1 (10.5) years and a mean (SD) BMI of 28.8 (5.9) kg/m² A superomedial pedicle-based technique was the most frequently used (36.6%), followed by inferior pedicle-based technique (28.1%). A complication rate of 18.3% on the ipsilateral side was observed. Salvage surgery was necessary in five cases (7.0%) due to positive margins - with one patient (1.4%) requiring margin expansion surgery and four (5.6%) a completion mastectomy.

Conclusion: This monocentric retrospective study shows that ORM is safe, with a complication rate on par with conventional breast reduction and offers satisfactory oncological outcomes.