Background: Although it has been suggested that papillary morphology and periampullary diverticulum (PAD) may affect the outcomes of endoscopic retrograde cholangiopancreatography (ERCP), the independent effects of these factors have not been clearly established. In this study, we aimed to evaluate the association of papillary morphology and PAD with ERCP success, procedural difficulty, and post-ERCP complications. Methods: Records of 1046 ERCP procedures performed at a single center were retrospectively reviewed. The primary analysis included 693 patients with native papillae and no prior sphincterotomy. Papilla morphology was available for 381 patients and periampullary diverticulum (PAD) status for 633. Outcomes included cannulation success, difficult cannulation, cannulation time, number of cannulation attempts, post-ERCP complications, and length of hospital stay. Multivariable Firth penalized logistic regression was used to evaluate independent associations with difficult cannulation, overall complications, cannulation failure, and post-ERCP pancreatitis (PEP), adjusting for papilla morphology, PAD status, age, sex, American Society of Anesthesiologists (ASA) physical status class, and Charlson Comorbidity Index (CCI). Results: Regular papilla morphology, compared with the pooled group of atypical papilla morphologies (Small, Bulging, Ridged), was associated with significantly higher cannulation success (97.4% vs. 91.2%; p = 0.012), shorter cannulation time (median 3.0 vs. 4.0 min; p = 0.009), fewer cannulation attempts (p = 0.007), and shorter hospital stay (median 5.0 vs. 6.0 days; p = 0.013). The presence of a PAD was not significantly associated with any procedural outcome or complication (all p > 0.05). CCI was independently associated with cannulation failure (adjusted OR 1.40 per one-point increase; 95% CI 1.03–1.91; p = 0.031) and was the only factor reaching statistical significance across the four multivariable models. The multivariable model showed modest discrimination for difficult cannulation (area under the receiver operating characteristic curve [AUC] = 0.596; 95% CI 0.515–0.675). Conclusions: Atypical papillary morphology was associated with lower cannulation success, longer cannulation time, and more cannulation attempts in univariable analyses; however, neither papillary morphology nor periampullary diverticulum was independently associated with ERCP outcomes. Among the variables evaluated, higher CCI was the only factor independently associated with cannulation failure; however, this finding should be interpreted cautiously given the small number of failure events.
Background: Triple-negative breast carcinoma (TNBC) comprises several histological entities with different molecular alterations and clinical behaviour. Recognising these entities is important for accurate classification and for choosing appropriate immunohistochemical and molecular tests. Methods: We conducted a narrative review of English-language literature identified through PubMed/MEDLINE, Scopus, Web of Science Core Collection, citation searching and a Scopus publication list. Journal publications available through 24 August 2026 were eligible. Current reporting and regulatory guidance was obtained from official websites. Findings were synthesised qualitatively, without statistical pooling. Results: The review included 93 journal publications and two official documents. Secretory carcinoma, adenoid cystic carcinoma, tall cell carcinoma with reversed polarity and metaplastic carcinoma require a different diagnostic approach from conventional high-grade invasive breast carcinoma of no special type. Architectural, cytological and stromal findings guide the differential diagnosis and the selection of immunohistochemical stains and molecular assays. Limited sampling, tumour heterogeneity and treatment-related changes can affect tissue selection and interpretation. Conclusions: Pathology reports should specify the histological type and clearly state any remaining diagnostic uncertainty. Morphology should guide diagnostic testing, while validated predictive biomarkers and clinical criteria determine treatment eligibility.
Background/Objectives: The number of hip fractures among centenarians is rising, yet their outcomes and the factors influencing mortality remain inadequately characterized. This study compared postoperative outcomes between centenarians and non-centenarians and examined perioperative factors associated with mortality. Methods: This retrospective cohort study included 31 centenarians (≥100 years) who underwent hip fracture surgery between October 2022 and March 2024 and 176 consecutive non-centenarians (65–99 years) admitted between October 2022 and April 2023. Associations between centenarian status, American Society of Anesthesiologists (ASA) score, comorbidity-only Charlson Comorbidity Index (CCI), surgical procedure, and time to surgery with 30-day and 12-month mortality were analyzed using logistic regression with clinically pre-selected covariates (Firth’s method for 30-day mortality). Results: Centenarians exhibited higher ASA scores, while CCI values did not differ between groups. Centenarians experienced longer intensive care unit and hospital stays. The complication rate was numerically higher among centenarians (35.5% vs. 30.1%), although this difference was not statistically significant (p = 0.55). Thirty-day mortality was 29.0% for centenarians compared to 6.2% for non-centenarians, and 12-month mortality was 80.6% versus 30.1% (both p < 0.001). Centenarian status (30-day odds ratio [OR] 4.87, 95% confidence interval [CI] 1.73–13.60; 12-month OR 8.19, 95% CI 3.16–24.22) and higher ASA scores were associated with increased mortality, whereas CCI was not. Longer time to surgery was associated with higher 12-month mortality (OR 1.23 per 24 h, 95% CI 1.01–1.51). Conclusions: Centenarians demonstrated substantially higher short- and long-term mortality following hip fracture surgery compared to younger older adults. Extreme age and elevated ASA scores were associated with increased mortality, although unmeasured factors such as frailty may contribute to these associations. Hip fracture in centenarians should be considered a major life-limiting event that necessitates early goals-of-care discussions.
Background/Objectives: Immediate implant placement into fresh extraction sockets is often assumed to provide lower primary stability than placement into healed ridges, but comparative data for subcrestal Morse-taper (conical-connection) implants are lacking. This study compared insertion torque value (ITV) and implant stability quotient (ISQ) between two management protocols: immediate placement and delayed placement. Methods: This retrospective single-surgeon cohort included consecutive Argon K3 Pro implants placed in 2019–2022, grouped as immediate (IM), delayed into sites grafted within the preceding 12 months (DG) or delayed into healed ridges (HR). The protocols differed in more than timing (placement depth, grafting, flap design and healing management). ITV, ISQ at placement and ISQ at 3 months were compared with mixed-effects models accounting for multiple implants per patient. ISQ differences were tested against a post hoc ±5-unit equivalence margin; no equivalence test was applied to ITV. Results: Of 178 implants screened, 130 implants in 85 patients (52 women, 33 men) were analyzed: 56 IM, 30 DG and 44 HR. No difference was detected in ITV (delayed minus IM −1.4 Ncm, 95% CI −5.0 to 2.1), placement ISQ (IM 72.3 ± 7.8 vs. delayed 72.5 ± 9.0) or 3-month ISQ (78.8 ± 4.8 vs. 79.4 ± 5.6); in the primary analysis, the 90% confidence intervals of both ISQ differences lay within ±5 units, but the placement ISQ interval did not lie within ±3 units, and equivalence at placement was borderline in a size-adjusted sensitivity analysis. ISQ change was strongly related to starting ISQ (Spearman’s ρ = −0.77), largely through arithmetic coupling and regression to the mean, and baseline-adjusted 3-month ISQ did not differ between protocols (p = 0.46). All 19 immediate implants starting below ISQ 70 reached ISQ ≥ 70 by 3 months under the protocol used. In an exploratory analysis, ITV correlated with placement ISQ in healed ridges (ρ = 0.55) and more weakly in extraction sockets (ρ = 0.25); the difference between these correlations was inconsistent across methods. Conclusions: In this cohort, immediate and delayed protocols showed no detectable difference in insertion torque or ISQ, and ISQ differences were statistically within a post hoc ±5-unit margin. Whether torque is a weaker indicator of stability in extraction sockets is a hypothesis for prospective study.
Background/Objectives: The Hemoglobin–Albumin–Lymphocyte–Platelet (HALP) score integrates hematologic, nutritional, immune, and platelet parameters, but its prognostic value in acute upper gastrointestinal bleeding (UGIB) remains uncertain. We compared the performance of HALP with AIMS65, Glasgow–Blatchford Score (GBS), and Rockall scores. Methods: We retrospectively studied consecutive adults with endoscopy-confirmed UGIB presenting to the emergency department from January 2021 through December 2024. Outcomes were in-hospital mortality, packed red blood cell (PRBC) transfusion within 24 h, and composite severe UGIB, defined as ≥2 PRBC units transfused within 24 h or UGIB-related intensive care unit admission. Discrimination was assessed using receiver operating characteristic curves and areas under the curve (AUCs); pairwise comparisons used the correlated-sample DeLong test. Firth-penalized logistic regression assessed the adjusted association between HALP and in-hospital mortality. Results: Of 209 patients, 24 (11.5%) died and 36 (17.2%) had variceal bleeding. For mortality, AUCs were 0.580 for inverse HALP, 0.802 for AIMS65, 0.733 for GBS, and 0.731 for Rockall. For 24-h PRBC transfusion, AUCs were 0.629, 0.642, 0.814, and 0.511, respectively; for severe UGIB, they were 0.622, 0.594, 0.781, and 0.501. No statistically significant adjusted association between HALP and mortality was observed (aOR, 0.91 per 10-point increase; p = 0.571). Conclusions: HALP showed limited discrimination across the evaluated UGIB outcomes, and no statistically significant adjusted association with mortality was observed. AIMS65 had the highest observed AUC point estimate for mortality, although its AUC did not differ significantly from those of GBS or Rockall. GBS had the highest AUCs for PRBC transfusion and severe UGIB. These findings support outcome-specific selection of UGIB risk scores and do not support the use of HALP as a stand-alone risk-stratification tool without external validation.
