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Acute appendicitis is the touchstone of any surgeon. The most common surgical pathology, acute appendicitis, has known over time, depending on the level of scientific knowledge, different therapeutic approaches, from absolute surgical abstinence to absolute surgical indication. No other aspect of surgical pathology has created so many occasions of successes and undeserved failures. Technologization of surgery through the introduction of laparoscopy brought - in addition to indisputable advantages (but whose importance decreases, also indisputably, with patients' age) and additional factors of operative risk - a risk that increases with age and extent of the intervention. At the current time there are clinical studies that optionally support first-line antibiotic treatment for uncomplicated acute appendicitis, surgical treatment being reserved for complicated acute appendicitis. This differentiated therapeutic attitude is possible due to the progresses achieved in abdominal imaging exploration used in the diagnosis of acute appendicitis, including ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI), which have allowed a correct morphopathological diagnosis of acute appendicitis. The clinical examination and continuous monitoring of the evolution are essential for the diagnosis and assessment of the effectiveness of the indicated treatment. Unfortunately, Dieulafoy's assertion from the Listerian period that "one should no longer die of acute appendicitis" is still relevant today, in the era of antibiotic therapy and technologization of surgery, as well as - especially - the completion made by Lejars, "with exceptions" ("sauf exceptions").

Septal cartilage defect with intact mucosa bilaterally refers to a condition where there is a loss or absence of cartilage within the nasal septum, while the overlying mucosal lining remains intact on both sides. This is typically identified accidentally during surgical or radiological assessments. A wide range of possible causes has been documented, resulting in a diverse diagnostic approach. In this study, we present a rare case of septal cartilage defect with intact mucosa bilaterally after nasal decongestant abuse.

Objectives: To investigate the relationship between structural retinal changes and functional visual field (VF) deficits in patients with branch retinal vein occlusion (BRVO), aiming to identify potential biomarkers for predicting visual impairment.

Materials and methods: This cross-sectional study included 34 patients with unilateral BRVO who were recruited from two tertiary centers in Greece. Comprehensive ophthalmic examinations were performed, including visual acuity, intraocular pressure (IOP) and imaging studies such as optical coherence tomography (OCT), OCT angiography (OCT-A), and fundus photography. Retinal alterations, including atrophy, edema, hemorrhages and neovascularization, were assessed by two masked graders. Visual field testing was performed using Humphrey perimetry. Logistic regression analyses were employed to examine associations between imaging biomarkers and the presence of VF defects.

Results: Patients included in the present study had a mean age of 69.1 ± 10.6 years and 58.8% of them were females. Visual field defects were present in 26.5% (9/34) of patients. Structural changes such as retinal atrophy and neovascularization were more prevalent in patients with VF defects. Univariate analysis did not identify OCT-A vessel density or central retinal thickness as significant predictors. Similarly, multivariate logistic regression found no statistically significant associations at the 0.05 level, although trends suggested a relationship between structural damage and functional impairment.

Conclusions: Structural retinal changes, particularly atrophy and neovascularization, appear to be associated with VF defects in BRVO. Despite the lack of statistically significant predictors in multivariate models, these findings highlight the importance of comprehensive functional assessments beyond visual acuity. Future advancements in VF testing technologies may enhance early detection and management of functional deficits in BRVO patients.

Objective: The goal of this study was to test and compare how well three modern composite materials - Charisma Classic (Kulzer), G-ænial Anterior (GC Corporation) and Omnichroma (Tokuyama) - adhere to enamel surfaces that were prepared in the same way for all three of them.

Materials and method: Fifteen human teeth were extracted out, cleaned and kept in isotonic saline for the study. Before the adhesive system was applied, the enamel surfaces were etched with 37% phosphoric acid, cleaned and dried. Each composite was poured into standardised cylindrical moulds (3 mm diameter, 3 mm height) and light-cured for 40 seconds. The specimens were placed in epoxy resin and evaluated using an Instron 8872 universal testing equipment to determine shear bond strength. Five tests were conducted on each material and the mean results were identified by leaving out the outliers.

Results: G-ænial Anterior had the highest average SBS value (about 341 N), followed by Omnichroma (about 269 N) and Charisma Classic (about 266 N). Notably, two G-ænial samples showed cohesive fractures within the composite, which means that the bonds between the different parts are very strong. Most of the time, the Charisma and Omnichroma samples failed to adhere at the tooth-composite interface.

Conclusions: G-ænial Anterior had the best adhesion to enamel among all examined materials. This was shown by both the bond strength and the way the bond failed. The results indicate that using it in high-stress clinical situations may make it work more effectively and last longer. Even though Charisma Classic and Omnichroma demonstrated steady and moderate adherence, improved adhesive procedures might help them achieve the best possible clinical results.

Introduction: Among the signaling pathways that regulate critical cell and tissue functions, the Hippo pathway is of great significance and under continuous investigation. The Hippo is a highly conversed pathway initially observed and decoded in Drosophila melanogaster. It consists of core molecules such as mammalian STE20-like kinase 1/2 (MST1/2), protein Salvador homologue 1 (SAV1) and MOBKL1A/B (MOB1A/B), and large tumour suppressor kinase 1/2 (LATS1/2), whereas the Yes-associated protein 1 (YAP), and WW-domain-containing transcription regulator 1 (TAZ) proteins act as transcriptional coactivators that bind to the transcriptional enhanced associated domain family 1(TEAD-1).

Objective: The purpose of the current molecular review was to describe the main molecular and functional aspects of the Hippo pathway and its deregulation in specific eye lesions.

Material and method: A systematic review of the literature was carried out based on the international medical database PubMed. The year 2005 was set as a prominent time limit for the publication date of the majority of articles, whereas specific references of great importance and historical value in the field of the Hippo discovery and analysis were also included. The following keywords were used: Hippo, TAZ, LATS, YAP1, eye, signaling pathway. A pool of 70 important articles was selected for the present review describing the connections between the implicated in HIPPO pathway molecules, the corresponding normal biochemical and functional features of them, and the deregulation mechanisms that are involved in the pathogenesis of eye lesions.

Results: According to the selected publications, Hippo deregulation is observed in a broad spectrum of benign and neoplastic eye diseases. TAZ, LATS, and YAP1 proteins are negatively influenced by the deregulation of the core molecules in them.

Conclusions: Hippo deregulation is critically involved in retina- and lens-related benign lesions as well as in conjunctival fibrosis and ocular surface squamous neoplasia. YAP/TEAD point mutations and abnormal expression of other molecules are the main genetic mechanisms in these lesions.

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant cardiovascular benefits beyond glycemic control, with emerging evidence suggesting antiarrhythmic effects. This prospective study aimed to establish a study protocol for a future trial assessing the impact of SGLT2i on arrhythmia burden in patients with implantable cardiac devices without heart failure with reduced ejection fraction (HFrEF) and to provide preliminary data on clinical trends.

Methods: Patients with cardiac implantable electrical devices (CIEDs) who underwent routine device interrogation were allocated to either SGLT2i treatment or standard care without SGLT2i based on clinical judgment and patient preference, grounded by existing evidence of potential anti-arrhythmic benefits. Arrhythmic events, including atrial high-rate episodes (AHRE), atrial fibrillation (AF) and non-sustained ventricular tachycardia (NSVT), were assessed at baseline and after a one-year follow-up. Levels of N-terminal pro b-type natriuretic peptide (NT-proBNP) or brain natriuretic peptide (BNP) were also evaluated.

Results: Seventeen patients completed follow-up (eight in the SGLT2i group, nine in the control group). The proportion of patients with arrhythmic events remained unchanged in the control group, whereas a trend toward reduced arrhythmic burden was observed in the SGLT2i group, albeit without achieving statistical significance. Additionally, three patients in the control group progressed to permanent AF, whereas no such progression was observed in the SGLT2i-treated group. BNP values showed a significant reduction in the SGLT2i group after treatment.

Conclusions: This study outlines a feasible protocol for CIED-based arrhythmia monitoring and provides preliminary evidence suggesting a potential antiarrhythmic effect of SGLT2i. Larger randomized controlled trials are needed to confirm these findings.

Background: Myofascial pain syndrome (MPS) of the trapezius is a common cause of chronic neck and shoulder pain. Among various treatments, trigger point injections (TPIs) using local anesthetics like bupivacaine are frequently administered, though clinical evidence supporting their use remains limited.

Objective: To evaluate the efficacy of bupivacaine trigger-point injections in patients with trapezius myofascial pain syndrome.

Methods: A retrospective record review of 69 patients diagnosed with trapezius MPS and treated with (0.25%) bupivacaine TPIs in a tertiary care center was conducted. Pain was assessed using the visual analog scale (VAS) and functionality using the neck pain and disability index (NPD) at four time points: pre-injection, immediately after injection, two weeks and one month post-injection. Repeated measures ANOVA and post-hoc analysis were used to evaluate statistical significance.

Results: Significant reductions in VAS and NPD scores were observed over time (p < 0.001). The mean VAS decreased from (6.10) to (2.64) and mean NPD from (31.7) to (12.8) over one month. Most patients (n = 65, 94.2%) experienced no adverse effects. Overall, 48 (70.6%) of patients were satisfied with the treatment.

Conclusion: Bupivacaine trigger point injections are effective and safe for pain relief and functional improvement in trapezius MPS.

The management of segmental bone defects of the tibial shaft remains a challenging endeavor for orthopedic surgeons. These defects are usually the result of high energy fractures and are frequently associated with high nonunion and infection rates. Achieving appropriate alignment during intramedullary nailing is crucial and often presents technical hurdles. The scope of this paper is to describe and discuss the intraoperative use of a provisional locking plate in achieving satisfactory reduction in the setting of a large tibial shaft bone defect. This technique presents distinct advantages for these challenging cases, including ease of application, satisfactory reduction, intraoperative stability and cost-effectiveness.

Introduction: Palmaris longus (PL) is the most superficial flexor muscle of the anterior compartment of the forearm in humans, which exhibits frequent anatomical variance. It has been observed that the complete absence of PL is the most commonly reported variance, followed by reversed, duplicated and hypertrophied muscle variants. The incidence of the complete agenesis of PL varies from 0.6% to 26.6%. So, it may be considered as an inconstant muscle. It is known to be more commonly absent unilaterally than bilaterally. The prevalence of unilateral absence of the PL is more commonly found on the left side. Unilateral agenesis of the PL is relatively more widely encountered in males compared to females.

Material and methods: During the routine cadaveric dissections at the Department of Anatomy, AIIMS, Jodhpur, we observed palmaris longus muscle variations in 64 upper limbs of 32 cadavers (22 males and 10 females).

Results: We observed agenesis of the palmaris longus muscle in six (9.4%) upper limbs out of 64 cadaveric upper limbs. The bilateral absence of palmaris longus was observed in two cadavers (6.25%), while unilateral absence was also observed in two cadavers (6.25%). We also observed agenesis of the PL was more prevalent in males (11.33%) in comparison to females (5%).

Conclusion: Palmaris longus is significant surgically as it is employed for various tendon graft procedures, lip augmentation, ptosis correction and management of facial palsy.