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This review presents the pathophysiological changes underlying dyslipidemia and hyperuricemia. The way in which these health conditions influence each other is through insulin resistance, persistent inflammatory state, oxidative stress and endothelial damage. Insulin resistance influences lipid metabolism and uric acid elimination, leading to triglyceride accumulation and increased uric acid levels. Inflammatory mediators in adipose tissue and cytokine cascades maintain an inflammatory status, favor lipid peroxidation and decrease renal uric acid clearance. Reactive oxygen species amplified by oxidized lipoproteins and urate compromise nitric oxide signaling pathways and vascular homeostasis. Genetic and epigenetic alterations in genes involved in metabolic transport, cytokine regulation and microRNA expression also occur. This dual pathology favors vascular vulnerability and systemic metabolic dysregulation. Effective management requires more than simple monitoring of serum markers. This should target the molecular mechanisms that fuel cardiovascular and metabolic damage.

Background: Robotic-assisted D2 gastrectomy combines minimally invasive benefits with enhanced precision, though its technical complexity creates a significant learning curve. This study evaluates the learning process and its impact on surgical outcomes.

Methods: We conducted a PRISMA-compliant meta-analysis of studies from major databases (2010-2023) including ≥10 robotic D2 gastrectomies. Outcomes assessed operative metrics, complications and oncological results using random-effects models.

Results: Analysis of 30 studies (4,589 patients) revealed that proficiency required 25-50 cases. Significant improvements after achieving proficiency included 35% reduction in operative time (94.6 minutes), 50% less blood loss (89.2 mL), 18% increased lymph node yield (5.3 nodes) and 62% fewer major complications. High-volume centers achieved proficiency 12 cases sooner than low-volume counterparts.

Conclusion: Robotic D2 gastrectomy demands 25-50 cases for mastery, with outcomes improving substantially post-learning curve. Centralized training and standardized protocols are crucial for optimal implementation.

Objectives: Physiological gingival pigmentation is considered aesthetically unappealing, and individuals diagnosed with it often want to reduce or remove the pigmentation. There are various techniques for depigmentation, with laser treatment considered the simplest, most reliable and most cost-effective option. This study assessed two different treatments for physiological gingival pigmentation.

Materials and methods: A total of 12 patients who had gingival pigmentation were randomly divided into a control group (treated with a bur) and a test group (treated with a laser). The same experienced periodontist performed all the procedures. Patient-reported outcomes of the treatments were obtained through a quality of life questionnaire adapted from Melzack's McGill pain questionnaire, which patients completed one day, one week and four weeks after therapy. Additionally, 15 experienced dentists assessed clinical photographs using a Likert scale to compare the clinical outcomes before and one month after the intervention.

Results: Patients were similarly satisfied with both laser and bur depigmentation treatments (54.17%, mean = 2.71, SD = 0.624; 50.0%, mean = 2.50, SD = 1.034, respectively). The patients' satisfaction results were non-significant (P > 0.05), except in terms of noticing an aesthetic change, which was significant (P < 0.05) in favor of the laser approach. The satisfaction rate was higher for laser treatment (84.44%, mean = 4.21) compared to bur depigmentation (78.67%, mean = 3.93). The results were statistically non-significant (P > 0.05). One month after treatment, four patients from the control group reported that the treatment met their expectations, while one participant said it exceeded expectations.

Conclusion: Within the limitations of this study, the findings suggested that laser treatment was slightly superior to bur treatment for managing gingival pigmentation.

The use of angioembolization in trauma situations is widely reported in both the adult and pediatric populations. However, its application in pediatric oncology is limited due to insufficient data in the literature. There are documentations that arterial embolization of the tumor preoperatively can reduce blood loss, achieve resectability and favorable outcomes. We describe two cases of children with solid tumors who underwent angioembolization during the management of their disease, as well as the outcomes of our intervention.

Background: Transoral ultrasonic surgery (TOUSS) has emerged as a minimally invasive technique for the treatment of head and neck malignancies, offering oncologic outcomes comparable to robotic-assisted approaches, but with lower costs and wider accessibility.

Objective: This study aims to evaluate the clinical and functional outcomes of TOUSS in a single-institution cohort, including the first documented cases of total transoral laryngectomy performed via TOUSS in Romania.

Methods: A retrospective observational analysis was conducted on 39 patients treated at Colțea Clinical Hospital between 2018 and 2024. Eligible patients had T1-T3 squamous cell carcinomas of the oropharynx, oral cavity, supraglottis, or larynx, with appropriate transoral exposure. Data on demographics, tumor characteristics, perioperative outcomes and three-year follow-up were collected.

Results: The majority of tumors involved the oropharynx (n=21), followed by the lateral or base of the tongue (n=14), with two cases requiring total laryngectomy. Tracheostomy was avoided in all patients. Nasogastric tube removal occurred by day 10, and the average hospital stay was seven days. At three years, 79.5% of patients remained disease-free, with 10.3% recurrence and 10.3% lost to follow-up. Postoperative complications were minimal and surgically controlled.

Conclusion: Transoral ultrasonic surgery is a safe and effective alternative to robotic surgery, achieving favorable oncologic and functional outcomes. Its feasibility for total laryngectomy and cost-effectiveness makes it a promising option for wider adoption, particularly in low-resource settings.

Background: Insertion of a nasogastric tube (NGT) in anaesthetised and intubated patients remains technically challenging, with conventional methods reporting more than 50% first-attempt failures. Factors such as anatomical barriers, kinking and trauma contribute to difficulties. Since laparoscopic procedures require gastric decompression, alternative methods have been introduced to improve success and safety. This study compared four insertion techniques: conventional, guidewire-assisted, slit endotracheal tube-guided and neck flexion with lateral pressure.

Materials and methods: This prospective randomized controlled trial included 240 adults (ASA I-II) undergoing laparoscopic surgery under general anaesthesia between November 2018 and July 2020. Patients were randomly allocated into four groups (n=60 each): Group C (conventional), Group G (guidewire-assisted), Group E (slit endotracheal tube-guided) and Group N (neck flexion with lateral pressure). The primary outcome was first-attempt success. Secondary outcomes included insertion time and complications (kinking, coiling, trauma). Chi-square and ANOVA tests were applied (SPSS v22, p<0.05 significant).

Results: Group E achieved the highest first-attempt success rate (90%), followed by G (71.7%), N (70%) and C (53.3%) (p<0.001). Mean insertion times were shortest with Group C (19.5 ± 2.1 s) and longest with Group E (34.0 ± 3.5 s). Kinking was most frequent in Group C (25%), but absent in Groups G and E. Coiling was highest in Group C (21.7%). Trauma incidence was the greatest in Group E (31.7%) and the lowest in Group C (11.7%).

Conclusion: Modified techniques improve first-attempt success compared to the conventional method. Although the slit endotracheal tube achieved the highest success, it was associated with greater trauma and longer insertion time. Guidewire-assisted insertion offered the most balanced profile of success, efficiency and minimal complications, thus making it a reliable alternative.

Objective: Polypharmacy, defined as the use of five or more medications, is increasingly prevalent among geriatric patients due to the complexity of managing multiple chronic conditions. This study aimed to evaluate physicians' knowledge of deprescribing, their familiarity with deprescribing tools and the factors influencing the deprescribing process.

Materials and methods: This cross-sectional survey was conducted among 290 physicians from four prominent tertiary care centers in South India between October 2023 and March 2024. A self-administered semi-structured questionnaire was employed to evaluate physicians' knowledge of polypharmacy, attitudes toward fall-risk-increasing drugs (FRIDs) and practices related to deprescribing interventions. Data collection was managed using Microsoft Excel, while descriptive and bivariate analyses were performed using SPSS to analyze the findings.

Results: The study revealed that a majority of physicians (148; 51.0%) were unfamiliar with the term "deprescribing" and reported no formal training in the practice. Analysis based on physicians' knowledge scores showed that participants with higher scores (≥28) demonstrated significantly greater awareness of the Tool to Improve Medications in the Elderly via Review (TIMER) and Fit fOR The Aged (FORTA) list compared to those with lower scores. Among these more knowledgeable physicians, 48.1% (n=13; p=0.054) were aware of TIMER but had not utilized it in practice, while 33.3% (n=9; p=0.016) reported familiarity with the FORTA list without its practical application.

Conclusion: Deprescribing plays a vital role in managing polypharmacy and minimizing its associated risks in the aging population. However, its adoption is constrained by significant barriers, including a lack of awareness, insufficient formal training and limited integration of evidence-based deprescribing tools into clinical practice.

Background: During metabolic associated fatty liver disease (MAFLD), lipotoxicity induces toll-like receptor 9 (TLR9) upregulation and mitochondrial DNA-induced TLR9 activation in the liver, driving metabolic hepatic inflammation. We wondered whether there is augmented erythrocyte TLR9 in MAFLD and we explored the effect of erythrocyte TLR9 activation on cholesterol and sphingomyelin content, glutaminase activity and TLR9, ferroportin and monocyte chemoattractant protein 1 (MCP-1) levels.

Methods: Twenty-four patients (15 men and nine women) with MAFLD and nine healthy controls (four men and five women) were enrolled. Erythrocytes were isolated from EDTA-containing blood. Protein levels were measured in erythrocyte lysates (Triton X-100 0.1% v/v), erythrocyte membranes (isolated by hypotonic lysis) with enzyme-linked immunosorbent assays, whereas lipids and enzyme activities were measured in erythrocyte hemoglobin-free membranes by a semi-quantitative thin layer chromatography and assay kits, respectively.

Results: The total but not surface levels of TLR9 were increased (p=0.002) in erythrocytes of MAFLD patients. Erythrocyte TLR9 activation drove cholesterol and ferroportin-1 accumulation, but not glutaminase-1 upregulation. Toll-like receptor 9 activation did not induce a significant change on the levels of TLR9 and MCP-1.

Conclusions: Erythrocyte TLR9 is upregulated in MAFLD patients and drives cholesterol and ferroportin-1 accumulation in a glutaminase-independent manner. Augmented erythrocyte TLR9 could participate in metabolic inflammation during MAFLD.

Minimally invasive surgery offers significant benefits for partial nephrectomy. Intraoperative incidents and postoperative complications lead to conversion to open surgery and increase perioperative morbidity and mortality. Understanding the factors that contribute to the occurrence of complications is important for reducing the perioperative risk. Between 2022 and 2024, we prospectively observed intraoperative complications in cases of partial nephrectomy performed laparoscopically in the Urology Department of 'Professor Dr. Theodor Burghele' Clinical Hospital, Bucharest, Romania. We report seven cases in which laparoscopic partial nephrectomy was converted to an open approach, requiring prompt management. The most common complication leading to conversion was the presence of adhesions, which made dissection of the planes difficult, followed by intraoperative bleeding, which hindered optimal visualization. Laparoscopic partial nephrectomy is challenging and its management must be individualized. Conversion during laparoscopic renal procedures is usually rare; however, a significant event is influenced by the complexity of the procedure and patient characteristics.

Background: Robotic pancreatic surgery has emerged as a minimally invasive alternative to open procedures, offering potential benefits in precision and recovery. This study evaluates the feasibility, safety and learning curve of robotic duodenopancreatectomy (RDP) and robotic distal splenopancreatectomy (RDSP) during the initial phase of implementation at a single institution.

Methods: A retrospective analysis of 20 consecutive patients, who underwent RDP (n=12) or RDSP (n=8) between January 2020 and December 2022, was performed. Data on operative time, intraoperative blood loss, conversion rates, postoperative complications (classified by Clavien-Dindo and ISGPS criteria) and length of hospital stay (LOS) were collected. Early (first six RDPs and four RDSPs) and late cases were compared to assess progression along the learning curve. Statistical analysis included Mann-Whitney U and Fisher's exact tests.

Results: The median operative time for RDP decreased from 480 minutes [interquartile range (IQR) 420-540] in early cases to 390 minutes (IQR 360-420) in later cases (p=0.03). The operative time for RDSP remained stable at 300 minutes (IQR 240-360; p=0.12). Intraoperative blood loss was 200 mL (IQR 100-400) for RDP and 150 mL (IQR 50-300) for RDSP. Two RDP cases (16.7%) required conversion to open surgery due to vascular adhesions. Postoperative complications included pancreatic fistula in 20% of cases, delayed gastric emptying in 15% of cases and major complications (Clavien-Dindo ≥III) in 25% of cases. The median LOS was 10 days (IQR 8-18) for RDP and seven days (IQR 5-10) for RDSP. No 90-day mortality was observed.

Conclusions: Robotic pancreatic resections are feasible and safe during the early learning curve, with morbidity comparable to open surgery. Operative efficiency improved significantly for RDP, highlighting the importance of structured training and case volume. These findings support the adoption of robotic techniques in pancreatic surgery, though further studies are needed to validate long-term outcomes.