BACKGROUND This retrospective study from a single center included 105 patients with avascular necrosis of the talus in our hospital from January 2021 to January 2024 and aimed to compare outcomes from management with customized 3-dimensional (3D) printed partial talus replacement with ankle arthrodesis. MATERIAL AND METHODS The replacement group (n=49) received digital customized 3D-printed partial talus replacement surgery, and the arthrodesis group (n=53) underwent ankle arthrodesis. Efficacy of the 2 surgical methods was evaluated by comparing the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, pain visual analog scale (VAS), ankle range of motion (ROM), SF-36 quality of life scale, and complication rate before surgery and at last follow-up. RESULTS At final follow-up, the observation group showed significantly better outcomes than the conventional group in AOFAS score (85.88±3.56 vs 78.51±4.12, P<0.001), ankle ROM (48.31°±4.95° vs 0.91°±1.13°, P<0.001), and the SF-36 Physical Component Summary (74.12±4.10 vs 55.83±4.96, P<0.001) and Mental Component Summary (81.26±5.12 vs 68.15±5.93, P<0.001). VAS scores were also significantly lower in the observation group (1.71±0.71 vs 2.57±0.87, P<0.001). Overall complication rates were similar (8.1% vs 11.3%, P=0.592); however, the reoperation rate was lower in the observation group (0% vs 3.7%). CONCLUSIONS In early follow-up, 3D-printed partial talus replacement for extensive talus necrosis demonstrates superior joint function, ROM, and quality of life compared with ankle arthrodesis, without increasing complications, suggesting it is a safe and effective joint-preserving alternative.
BACKGROUND Lacosamide is an antiepileptic drug widely used to treat partial-onset seizures. During extracorporeal therapies or intravenous administration, lacosamide adsorption to filtration membranes and its stability in solutions may influence therapeutic efficacy. This in vitro study evaluated lacosamide adsorption to different dialysis filter membranes in saline and plasma solutions, as well as its stability in these solutions. MATERIAL AND METHODS Lacosamide (200 µg/mL) was prepared in 0.9% NaCl and bovine plasma, then perfused through 3 types of dialysis filters: polysulfone (PS), polyacrylonitrile (PAN), and polyacrylonitrile polyethyleneimine (PAN-PEI). Samples were collected at 0, 5, 15, 30, 45, 60, and 90 minutes. Lacosamide concentrations were measured using high-performance liquid chromatography. Repeated-measures analysis of variance and post hoc tests were used to evaluate concentration changes over time among filter types. RESULTS Lacosamide remained stable in saline and plasma solutions over 90 minutes, showing under 7% variation in concentration. In 0.9% NaCl, significant adsorption occurred across all filters, with total reductions of 14.73% for PAN-PEI, 20.71% for PAN, and 33.52% for PS filters at 90 minutes. In plasma, adsorption was lower for PS filters (17.96%) but greater for PAN-PEI (23.04%) and PAN (27.71%) filters. No significant differences in adsorption were detected among filters (P>0.05). CONCLUSIONS Lacosamide demonstrated chemical stability with measurable adsorption to dialysis membranes. Adsorption was more pronounced in plasma than in saline for PAN-PEI and PAN membranes. These findings indicate that lacosamide concentrations may decrease during extracorporeal circulation and should be considered in settings involving hemodialysis or continuous renal replacement therapy.
BACKGROUND Insulin resistance is associated with kidney stone risk, and estimated glucose disposal rate (eGDR) is a validated surrogate marker of insulin resistance. This study examined the association between eGDR and kidney stone prevalence. MATERIAL AND METHODS Data were derived from a cross-sectional dataset collected at the Health Management Center, Affiliated Hospital of Yangzhou University (HMC-AHYU). Participants were stratified into 4 groups according to eGDR quartile. Logistic regression models were used to estimate the association between eGDR and kidney stone prevalence. Nonlinear relationships were explored via restricted cubic splines and threshold-effect analyses. Subgroup analyses were conducted to examine potential effect modification, and receiver operating characteristic curves were used to compare discriminative performances among metrics. RESULTS Overall, 23 527 individuals from HMC-AHYU were included. When stratified by quartile, lower eGDR values were associated with increased odds of kidney stones. After multivariable adjustment, each 1-unit increase in eGDR was associated with a 16% reduction in the odds of kidney stones (odds ratio [OR]=0.84, 95% confidence interval [CI]: 0.81-0.87). Compared with the lowest quartile (Q1), the highest quartile (Q4) exhibited 48% lower odds (OR=0.52, 95% CI: 0.41-0.65), with a significant dose-response relationship observed across quartiles. Threshold-effect analyses identified eGDR inflection points at 9.02 and 10.87. eGDR demonstrated the strongest discriminative ability for kidney stones (area under the curve=0.692, 95% CI: 0.679-0.705). Validation using 1000 bootstrap resamples confirmed model stability. CONCLUSIONS Lower eGDR levels were associated with increased kidney stone prevalence. eGDR may serve as a biomarker for high kidney stone risk.
BACKGROUND The clinical profile of patients hospitalized with hepatitis B virus (HBV) is increasingly influenced by coexisting conditions and death patterns. This study aimed to assess comorbidities and fatality rates among patients hospitalized for the first time with HBV between 2012 and 2023. MATERIAL AND METHODS A 12-year retrospective nationwide analysis of first-time HBV hospitalizations in Poland was conducted using data from the Nationwide General Hospital Morbidity Study. RESULTS Digestive diseases (15.6%), cardiovascular diseases (10.5%), and endocrine and metabolic disorders (9.6%) were the most prevalent comorbidities. Between 2012 and 2023, marked increases were observed in digestive (12.3%-27.4%) and metabolic (8.5%-18.5%) disorders, while circulatory diseases rose from 7.4% to 18.6% with post-2019 stabilization. Immune-related and genitourinary disorders demonstrated sustained post-2019 growth, whereas several categories, including neoplasms and respiratory diseases, showed growth-decline patterns. Hypertension and liver fibrosis were the most frequent individual diagnoses, with sustained or stepwise increases over time. Age-stratified analyses revealed a shift from infection-related conditions in younger patients toward cardiometabolic and advanced hepatic diseases in older groups. Fatality rates increased from 6.8-15.9 per 1000 hospitalizations (2012-2019) to 23.1-30.7 per 1000 (2020-2023), peaking during 2020-2021, with higher mortality in men. CONCLUSIONS First-time HBV hospitalizations are increasingly characterized by multimorbidity and rising fatality rates, particularly in older patients. These findings highlight a growing clinical and public health burden, underscoring the need for integrated, age-tailored management and improved surveillance to reduce mortality and optimize HBV care.
BACKGROUND Foreign body aspiration (FBA) is a leading cause of preventable injury and death in young children, yet diagnosis can be challenging because the choking event is not always witnessed or recognized and routine investigations have limited sensitivity. Long-duration data from Central-Eastern Europe are scarce. We characterized bronchoscopically confirmed pediatric FBA in a Polish tertiary center and factors associated with complications. MATERIAL AND METHODS In a single-center retrospective cohort, we studied children (<18 years) with a bronchoscopically confirmed foreign body admitted over 20.5 years (2001-2021). Categorical associations were tested with the chi-square, Fisher, or Fisher-Freeman-Halton exact test, and correlations with the Spearman coefficient. A multivariable logistic regression model examined factors associated with complications, with false-discovery-rate control. A 2-sided P<0.05 indicated significance. RESULTS We analyzed data from 254 children (median age 21 months; 60.6% boys). Feeding was the commonest circumstance (57.1%), and organic objects (predominantly nuts) accounted for 73.6%. The chest radiograph was normal in 16.1% and showed the classical triad in 7.5%. Rigid bronchoscopy was definitive in 90.6%, and complications occurred in 13.0%. In multivariable analysis, older age (OR 1.88, 1.18-2.98) and a prolonged or unknown interval to bronchoscopy (OR 2.75, 1.27-5.95) were independently associated with complications, whereas foreign body type was not (OR 1.02, 0.42-2.50). Bronchiectasis and fibrotic changes occurred almost exclusively with intervals exceeding 30 days or unknown. CONCLUSIONS Normal initial clinical and radiographic findings did not exclude FBA in this confirmed-case cohort. Complications were independently associated with older age and a longer or unknown interval to bronchoscopy rather than with foreign body type, although causality cannot be inferred.
BACKGROUND The mental foramen (MF) is a key anatomical landmark in oral and maxillofacial surgery; its accurate localization is critical for preventing neurovascular complications. This study aimed to radiologically evaluate MF position, morphology, symmetry, and interforaminal distance using panoramic radiographs, with particular emphasis on clinical relevance in surgical planning. MATERIAL AND METHODS This retrospective study included panoramic radiographs of 500 patients from the Department of Oral and Maxillofacial Surgery, Eskişehir Osmangazi University. MF position was classified into 6 categories based on relationship to adjacent teeth. Shape, symmetry, and interforaminal distance were also assessed. Statistical analyses were performed using SPSS software. RESULTS The most common MF position was at the level of the second premolar (position 4, 50.9%), followed by the area between the first and second premolars (position 3, 38.9%). A round shape was the most frequently observed morphology (40%), followed by irregular (34%) and oval (26%) forms. The MF was asymmetrically located in most cases (80.2%). The mean interforaminal distance was 51.95±7.08 mm. No statistically significant differences were observed among age groups (P=0.308); men exhibited significantly greater interforaminal distances than women (P<0.001). CONCLUSIONS Panoramic radiography is susceptible to positioning errors, magnification, and superposition artifacts; careful image acquisition and interpretation are thus essential for accurate evaluation of the MF. Although panoramic radiography can provide useful preliminary information, advanced imaging modalities may be required in complex cases. These findings may assist clinicians in improving surgical safety and reducing mental nerve injury risk during dental procedures.
BACKGROUND Spinal pedicle screw-rod fixation is widely used, but manual rod bending is time-consuming and prone to contour inconsistencies. Although computer-assisted technologies have been explored, existing systems remain limited by cost, complexity, and insufficient precision. This study evaluated a novel computer-assisted rod design and bending system, with the goal of testing whether computer-assisted rod bending reduces bending plus installation time vs manual bending in unilateral paired cases and to evaluate safety, feasibility, and rod-screw fitting accuracy. MATERIAL AND METHODS A prospective trial enrolled 26 patients (18-75 years) undergoing spinal pedicle screw-rod fixation (≥4 segments) for fractures or degenerative diseases. Twenty patients received unilateral computer-assisted bending (contralateral manual for comparison) and 6 received bilateral assisted bending. The primary outcome was bending plus installation time; secondary outcomes included complications and fitting accuracy. Wilcoxon signed-rank test was used (P<0.05). RESULTS No instrument-related complications were observed (n=26; median age 60.5 years). For 20 unilateral cases, computer-assisted bending (183.3±70.8 seconds) was significantly shorter than manual bending (236.1±119.1 s; mean reduction 52.75 seconds, P=0.017). Subgroup analyses indicated signals of greater time savings in more than 4 segments (93.9 seconds, P=0.039) and BMI of 25 kg/m2 or higher (95.3 seconds, P=0.005), although these were exploratory and not adjusted for multiplicity. CONCLUSIONS The computer-assisted system reduced bending plus installation time vs manual bending, with no instrument-related complications. Subgroup findings were exploratory and require further validation.
BACKGROUND Excisional treatment is widely used for preinvasive cervical lesions, but its effect on postoperative sexual quality of life remains uncertain. This study aimed to compare postoperative Sexual Quality of Life-Female (SQoL-F) scores and examine associated factors in women treated with cold knife conization or loop electrosurgical excision procedure (LEEP). MATERIAL AND METHODS This study included 185 sexually active women treated with cold knife conization (n=99) or LEEP (n=86) for histologically confirmed preinvasive cervical lesions during 2022-2024 and assessed at least 6 months postoperatively. The primary outcome was the total score on the validated 18-item SQoL-F questionnaire, transformed to a 0-100 scale. Between-group comparisons and multivariable linear regression with heteroskedasticity-consistent type 3 robust standard errors were performed. RESULTS Mean SQoL-F scores were similar after conization and LEEP (48.74±14.76 vs 49.70±12.76; P=0.640; Hedges' g=-0.07). In multivariable analysis, surgical technique was not associated with SQoL-F scores (ß=4.03; 95% confidence interval, -1.13 to 9.20; P=0.125). Age, marital status, weekly sexual frequency, family structure, preoperative sexual life perception, postoperative expectation, and body perception were associated with SQoL-F scores. The model explained 23.7% of the variance (R²=0.237), and internal consistency was high (Cronbach's alpha=0.886). CONCLUSIONS SQoL-F scores did not differ significantly between women who underwent cold knife conization and those who underwent LEEP. Several demographic, psychosocial, and interpersonal factors, rather than surgical technique, were associated with SQoL-F scores, although the cross-sectional design precludes causal inference.
