Objective: Lumbosacral conjoined nerve root anomalies complicate lumbar spine surgery due to difficult preoperative recognition and high iatrogenic injury risks. Traditional classification systems primarily account for classical 2-root configurations, failing to reflect the full morphological spectrum encountered intraoperatively. This study aimed to present a surgical case series of conjoined and anomalous lumbosacral nerve roots, focusing on atypical variants not fully accommodated by current anatomical classifications. Methods: This retrospective, single-center series included 9 patients with intraoperatively confirmed anomalous lumbosacral nerve roots who underwent decompression or discectomy between 2022 and 2025. Clinical data, preoperative magnetic resonance imaging findings, intraoperative microscopic observations, surgical strategies, and 6-month postoperative outcomes were reviewed. Morphological patterns were evaluated using existing systems and grouped as classical or atypical. Results: Six cases demonstrated classical variants (duplicated, adjacent, or bilateral conjoined roots). Three cases showed atypical morphologies: a high lumbar multiroot fusion (2 L4, 1 L5), a triple-root fusion variant, and a uniganglionic composite root with S1 duplication. Surgical management was individualized based on intraoperative anatomy, utilizing wide foraminotomy, extended hemilaminectomy, partial facetectomy, or axillary microdissection. The mean (SD) low back pain visual analogue scale (VAS) score decreased from 6.2 (2.4) preoperatively to 3.2 (1.9) at 6 months. Preoperative foot drop improved at 6 months (tibialis anterior strength: 2/5 to 3/5; extensor hallucis longus strength: 4/5). No permanent neural injury, new deficits, or reoperations occurred. Conclusion: Lumbosacral nerve root anomalies demonstrate complex, atypical morphologies that elude conventional classification. Recognition of these variants and anatomy-guided decompression are essential to minimize neural injury and optimize surgical safety.
Objective: The aim of this study was to investigate the association between transient tachypnea of the newborn (TTN) and ABO/Rh blood groups. Methods: This retrospective study included a total of 187 newborns followed in a fourth-level neonatal intensive care unit (NICU) from January 2023 to June 2025. The study group comprised 119 newborns diagnosed with TTN, and the control group comprised 68 healthy newborns. Demographic characteristics, birth-related information, laboratory data, and ABO/Rh blood groups were obtained from the electronic medical records system and compared between the groups. Results: There was no statistically significant difference between the TTN and control groups in ABO/Rh blood group distribution (P = .850). Male sex was more frequent in the TTN group (67.2% vs 48.5%; P = .012), and the cesarean delivery rate was significantly higher (80.7% vs 63.2%; P = .009). Leukocyte and neutrophil counts were significantly higher in the TTN group (P = .001 and P = .010, respectively); no differences were found for other laboratory parameters. The gestational age at birth, birth weight, and Apgar scores were similar in both groups. Conclusions: No significant association was found between ABO/Rh blood groups and the development of TTN. However, male sex and cesarean section delivery were associated with the condition, indicating that perinatal factors are more influential than blood groups in TTN development.
Objective: To evaluate the effect of intraoperatively detected urethral strictures requiring concomitant internal urethrotomy on postoperative stricture recurrence following transurethral resection of the prostate (TURP). Methods: This retrospective cohort study included 92 patients who underwent bipolar TURP for benign prostatic hyperplasia (BPH) between March and December 2024. Based on intraoperative findings, 56 patients received TURP alone, whereas 36 underwent TURP combined with internal urethrotomy for an intraoperatively detected urethral stricture. Clinical variables, including age, prostate-specific antigen (PSA) level, prostate volume, and maximum urinary flow rate (Qmax), were recorded preoperatively and at 1 and 6 months postoperatively. Patients who developed a reduction in Qmax) combined with obstructive symptoms were further evaluated for recurrent urethral stricture via flexible cystoscopy. Results: The 2 groups showed no significant differences in baseline demographic or clinical characteristics. Urethral stricture recurrence was not observed in any patient at the 1-month postoperative follow-up. At the 6-month follow-up, stricture recurrence was identified in 3 of 56 patients (5.4%) in the TURP-alone group and 9 of 36 patients (25.0%) in the TURP plus internal urethrotomy group (P = .015). Postoperative Qmax values did not differ significantly between the groups. Conclusion: Postoperative urethral stricture recurrence is significantly more frequent when an intraoperatively identified stricture requires concomitant internal urethrotomy during TURP. These patients require closer postprocedural surveillance and should be counseled regarding the elevated risk of recurrence.
Objective: To evaluate whether early and late restenosis- and occlusion-related outcomes differ between primary closure and patch angioplasty after carotid endarterectomy (CEA). Methods: This retrospective single-center cohort study included 89 patients who underwent CEA between January 2009 and December 2011; 17 patients underwent primary closure and 72 underwent patch angioplasty. Significant restenosis (≥50%) was defined by duplex ultrasonography, and total occlusion was defined by absent detectable flow. The primary outcome was a composite of significant restenosis or complete arterial occlusion. Results: Among the 89 patients (mean [SD] age, 65.33 [9.10] years; 68 [76.4%] male), 18 (20.2%) reached the composite endpoint during a mean follow-up of approximately 30 months. Early postoperative events occurred only after patch angioplasty, whereas both events in the primary closure group occurred during late follow-up. The cumulative event rate did not differ significantly between primary closure and patch angioplasty (11.8% vs 22.2%; P = .41). Kaplan–Meier analyses showed no statistically significant between-group difference in event-free survival either before or after exclusion of early postoperative events (log-rank P = .15 and P = .29, respectively). Conclusions: Primary closure was not associated with a statistically significant difference in restenosis- or occlusion-related outcomes compared with patch angioplasty after carotid endarterectomy. The observational design, nonrandom treatment allocation, small primary closure group, and potential overestimation of restenosis by duplex ultrasonography preclude conclusions regarding superiority or equivalence.
Objective: This study aimed to comprehensively investigate whether admission nutritional–inflammatory composite indices reflect the angiographic extent of coronary artery involvement in patients with non-ST-segment elevation myocardial infarction (NSTEMI), utilizing an ordinal modeling framework that preserves the hierarchical spectrum of 1-vessel disease (1VD), 2-vessel disease (2VD), and 3-vessel disease (3VD). Methods: A retrospective, single-center analysis was performed in 430 consecutive patients with NSTEMI who underwent index coronary angiography and percutaneous coronary intervention without a prior history of coronary artery disease. Participants were categorized by the extent of obstructive disease into 1VD (n = 199), 2VD (n = 159), and 3VD (n = 72) groups. The hemoglobin-albumin-lymphocyte-platelet (HALP) score, Nutritional Risk Index (NRI), atherogenic index of plasma (AIP), and triglyceride–glucose (TyG) index were examined. Results: Both NRI and HALP score exhibited a stepwise decline from 1VD to 3VD (NRI medians: 102.30, 98.05, and 96.25, P < .001; HALP medians: 4.81, 4.08, and 3.88, P < .001). By contrast, AIP and TyG index showed no statistically significant variation across vessel groups (P = .36 and P = .19, respectively). In adjusted ordinal regression, both NRI (odds ratio [OR], 0.90; 95% CI, 0.87–0.92; P < .001) and HALP score (OR, 0.79; 95% CI, 0.72–0.86; P < .001) remained independently associated with vessel-group category. Conclusions: Lower NRI and HALP values were independently associated with a greater extent of angiographic coronary artery involvement after multivariable adjustment, although NRI demonstrated greater incremental discriminative performance. Neither AIP nor the TyG index showed a significant association with coronary involvement.
Objective: To compare the efficacy and safety of lytic-free rheolytic mechanical thrombectomy vs tissue plasminogen activator (tPA)-assisted rotational thrombectomy combined with conventional balloon angioplasty for iliofemoral deep vein thrombosis (DVT), and to analyze periprocedural hematological stress and persistent limb asymmetry. Methods: Data from 88 patients treated endovascularly for unilateral iliofemoral DVT from 2020 to 2025 were retrospectively analyzed. Patients underwent either tPA-assisted rotational thrombectomy (group A, n = 58) or lytic-free rheolytic thrombectomy (group B, n = 30). Primary endpoints were safety (bleeding rates, hematocrit [HCT] decreases) and 1-year primary patency. Secondary endpoints included 1-year Villalta scores, bailout stenting rates, and calf diameter asymmetry. Results: Bailout stenting rates following conventional balloon angioplasty were similar between group A and group B (19.0% vs 16.7%). Bleeding complications causing significant HCT decreases occurred in 15.5% (n = 9) of patients in group A, whereas no bleeding events occurred in group B (0%). Both devices induced mild, transient leukocyte increases and platelet decreases. At the 1-year follow-up, a total of 94.3% of patients with patent lumens achieved a Villalta score less than 5. However, significant calf diameter asymmetry persisted in 44.3% (n = 39) of the overall cohort. The 1-year primary patency rate was 87.9% for group A and 83.3% for group B (P = .534). Active malignancy significantly reduced 1-year primary patency to 68.4% compared with 91.3% in patients without malignancy. Conclusions: Lytic-free rheolytic thrombectomy significantly mitigates bleeding risks associated with tPA-assisted rotational thrombectomy while achieving equivalent 1-year patency outcomes. Furthermore, persistent calf asymmetry frequently remains despite symptomatic relief, indicating that limb diameter symmetry alone is an insufficient criterion for complete recovery or procedural success.
Objective: Hyperglycemia is associated with adverse outcomes in patients with COVID-19. However, the prognostic significance of chronic glycemic status, reflected by glycated hemoglobin (HbA1c), and relative hyperglycemia, assessed by the stress hyperglycemia ratio (SHR), remains unclear. This study aimed to evaluate the association of HbA1c and SHR with in-hospital mortality in critically ill patients with COVID-19. Methods: In this retrospective observational study, 324 adult patients with confirmed COVID-19 admitted to the intensive care unit were evaluated. Admission blood glucose and HbA1c levels were obtained from laboratory records. The SHR was calculated to assess relative hyperglycemia. Factors associated with in-hospital mortality were analyzed using multivariable logistic regression. Results: Of the 324 patients included in the study, 125 (38.6%) died during hospitalization. Non-survivors had a significantly higher SHR compared with survivors (median, 1.30 [IQR, 0.65] vs 1.15 [IQR, 0.43]; P = .003). Admission glucose levels were also higher in non-survivors (178 versus 147 mg/dL; P = .01), as was the glycemic gap (34.3 and 20.2 mg/dL, respectively; P = .008). In contrast, HbA1c levels were similar between non-survivors and survivors (median, 5.9% [IQR, 2.5] vs 5.8% [IQR, 2.2]; P = .589). In multivariable logistic regression analysis, SHR remained independently associated with mortality across all adjusted models. Receiver operating characteristic (ROC) analysis showed that SHR had the highest predictive performance for the outcome (area under the curve [AUC] = 0..611) compared with glycemic gap, admission glucose, and HbA1c. Conclusions: Relative hyperglycemia assessed by the SHR may be a more informative prognostic marker of mortality in critically ill patients with COVID-19 than chronic glycemic status reflected by HbA1c.
Objective: Ozone is an inorganic gas utilized for medical purposes. Ozone therapy has gained increasing popularity in recent years and is employed in the treatment of chronic diseases associated with inflammation. The red cell distribution width/albumin ratio (RAR) has recently emerged as an inflammatory marker. The aim of this study was to evaluate the efficacy of ozone therapy in patients with spinal pain and to investigate the effect of ozone therapy on inflammation through changes in the RAR value. Methods: This prospective pilot study was conducted in a pre- and post-treatment design on patients with spinal pain. In addition to demographic data, visual analog scale (VAS) scores and RAR values were recorded before and after ozone therapy. All patients underwent major ozone autohemotherapy. Data were analyzed using the SPSS software. Results: During the study period, 93 patients presented to the ozone therapy unit. After applying the exclusion criteria, 66 patients were included in the analysis. The mean (SD) pretreatment VAS score was 6.74 (1.53), while the mean (SD) posttreatment VAS score was 4.08 (1.54) (P < .05). The mean (SD) pretreatment RAR value was 3.37 (0.64), which decreased to 3.14 (0.50) following ozone therapy (P < .05). Conclusion: Our findings demonstrate that major ozone autohemotherapy is effective in alleviating spinal pain. Furthermore, the reduction in RAR values before and after treatment indicates that major ozone autohemotherapy exerts an anti-inflammatory effect.
Objective: To evaluate the inflammatory profiles in individuals with methamphetamine use disorder (MUD), methamphetamine-associated psychosis (MAP), schizophrenia, and healthy controls by comparing C-reactive protein (CRP) and hemogram-derived inflammatory markers. Methods: This retrospective study included 280 male participants divided into four age-, body mass index -, and smoking status-matched groups (n = 70 each): MUD, MAP, schizophrenia, and healthy controls. All patients had been free from psychotropic treatment for at least 2 months prior to blood sampling. CRP, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-CRP ratio (LCR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV) were analyzed. Multinomial logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: Compared with healthy controls, all patient groups showed significantly higher CRP, NLR, MLR, SII, SIRI, and PIV levels alongside lower LCR values. Patients with MAP exhibited significantly higher SIRI and PIV levels than those with schizophrenia. Multinomial logistic regression identified NLR, PIV, and SIRI as the biomarkers most strongly associated with MAP. ROC analyses demonstrated that PIV, SIRI, and CRP provided the highest discriminatory performance, particularly in distinguishing MAP and MUD from healthy controls. Conclusions: MUD, MAP, and schizophrenia share common inflammatory alterations; however, MAP is characterized by a greater inflammatory burden, as specifically reflected by elevated SIRI and PIV. These inexpensive and readily accessible hematological indices may serve as adjunctive biomarkers for investigating the biological mechanisms underlying psychosis and methamphetamine-related disorders.
Objective: To compare the accuracy of 2 artificial intelligence models, ChatGPT and NotebookLM, in answering clinical questions regarding narcolepsy management. Methods: A set of 30 clinical questions was developed based on 2 reference documents: the 2021 European guideline on the management of narcolepsy in adults and children, and the American Academy of Sleep Medicine clinical practice guideline for the treatment of central disorders of hypersomnolence. Both models were queried with the question set. Three independent scorers evaluated the responses across 4 categories (Accuracy, Evidence Reasoning, Additional Information, and Information Integration) using a binary scale (1 = criterion met, 0 = criterion not met). Interrater reliability was assessed using Cohen kappa and Fleiss kappa. Performance comparisons between the models were analyzed using the McNemar test, Wilcoxon signed-rank test, and Mann-Whitney U test, while scorer consistency was checked via the Friedman test. Results: ChatGPT achieved 261 of 360 positive ratings (72.5%), whereas NotebookLM achieved 179 of 360 (49.7%). ChatGPT scored significantly higher than NotebookLM in Accuracy (P < .001) and Evidence Reasoning (P < .001). No statistically significant differences were observed between the 2 models in Additional Information or Information Integration. Conclusion: ChatGPT demonstrated superior accuracy and internal consistency in answering narcolepsy-related clinical questions compared with NotebookLM. However, neither model showed high proficiency in providing necessary additional clinical information.
Objective: Feeding difficulties are common in neonates with cleft palate with or without cleft lip (CP/L) and may delay breastfeeding initiation. This study aimed to evaluate feeding outcomes and practical bedside feeding strategies in neonates with CP/L managed in a tertiary hospital. Methods: This retrospective case series included neonates with CP/L hospitalized in a tertiary neonatal intensive care unit (NICU) between January 2020 and April 2026. Demographic characteristics, cleft type, associated anomalies, respiratory support requirements, feeding methods, time to first breastfeeding, time to full enteral feeding, hospitalization duration, discharge weight, and feeding outcomes at discharge were reviewed. Results: Twelve neonates with CP/L were included. Complete cleft palate was the most common anomaly (n = 7, 58%). One infant with trisomy 18 died before enteral feeding was established and was excluded from discharge feeding analyses. Among the remaining 11 infants, the median time to first breastfeeding was 2 days (range, 2–25 days), the median time to full enteral feeding was 6 days (range, 2–39 days), and the median length of hospitalization was 10 days (range, 7–65 days). Feeding tolerance was satisfactory in 10 of 11 surviving infants. At discharge, 9 infants were receiving breastfeeding either exclusively or with bottle feeding. Delayed transition to oral feeding was mainly observed in syndromic infants and those requiring respiratory support. Conclusion: In this cohort, many nonsyndromic neonates with CP/L achieved successful oral feeding with simple bedside feeding strategies and breastfeeding support. Within the limitations of this case series, routine reliance on specialized feeding devices was not necessary to achieve oral feeding in most nonsyndromic infants.
Objective: Human epidermal growth factor receptor 2 (HER2) is a key molecular driver involved in tumor proliferation and survival and a well-established therapeutic target in breast cancer, while its role in gastrointestinal adenocarcinomas remains heterogeneous and continues to evolve. This study aimed to evaluate HER2 expression patterns and positivity rates in gastric and colorectal adenocarcinomas encountered in routine pathology practice. Methods: Pathology records of gastric and colorectal adenocarcinomas diagnosed between January 2015 and January 2025 were reviewed retrospectively. A total of 124 gastric and 122 colorectal adenocarcinoma cases were included. HER2 immunohistochemical staining results were reassessed and categorized as 0, 1+, 2+, or 3+. Equivocal (2+) cases were further evaluated using available in situ hybridization (ISH) data. Results: HER2 positivity was identified in 4.8% of gastric adenocarcinomas and 3.3% of colorectal adenocarcinomas. This difference was not statistically significant (P = .75). In gastric cancers, HER2 positivity was more frequently observed in intestinal-type tumors (7.1%) compared with diffuse-type tumors (1.9%), although this difference did not reach statistical significance (P = .22). No HER2 amplification was identified in equivocal gastric cases. In colorectal carcinomas, HER2 positivity was limited to the conventional adenocarcinoma subtype. Conclusion: HER2 expression is present in a small subset of gastric and colorectal adenocarcinomas and was more frequently observed in intestinal-type gastric adenocarcinomas than in diffuse-type tumors. These findings provide descriptive data regarding HER2 expression patterns in gastrointestinal adenocarcinomas encountered in routine pathology practice and contribute to the existing literature on HER2 expression in these malignancies.
Objectives: Spondyloarthritis (SpA) is associated with increased cardiovascular morbidity driven by endothelial dysfunction, yet the role of the Endothelial Activation and Stress Index (EASIX) in this context is unclear. This study evaluated the association of EASIX with disease duration, activity, physical function, spinal mobility, and health-related quality of life in patients with SpA. Methods: Medical records of 69 patients with axial or peripheral SpA classified according to Assessment of SpondyloArthritis international Society criteria were reviewed. Clinical assessment included measures of disease activity (Bath Ankylosing Spondylitis Disease Activity Index [BASDAI] and Ankylosing Spondylitis Disease Activity Score based on C-reactive protein [ASDAS-CRP]), physical function (Bath Ankylosing Spondylitis Functional Index [BASFI]), spinal mobility (Bath Ankylosing Spondylitis Metrology Index [BASMI]), and health-related quality of life (12-Item Short Form Health Survey [SF-12]). EASIX was evaluated using correlation, subgroup, regression, ROC, and sensitivity analyses. Results: Disease duration was the only variable consistently associated with EASIX (r = 0.408, P < .001). Patients with disease duration >5 years had higher EASIX values (P = .001), and the association remained significant in multivariable analyses. Conversely, EASIX showed no relevant association with established indicators of disease activity, physical function, spinal mobility, or health-related quality of life. Conclusions: EASIX appeared to be associated with disease duration rather than current disease activity. These findings suggest that EASIX may reflect cumulative endothelial stress rather than contemporaneous inflammatory activity. Future prospective longitudinal studies are needed to examine this hypothesis.
Objective: Collateral coronary vessels may provide an alternative route of blood flow to ischemic myocardial tissue, particularly in the presence of chronic total occlusion (CTO). The influence of nutritional status on the formation of coronary collateral vessels remains incompletely understood, and evidence concerning the role of the Geriatric Nutritional Risk Index (GNRI) in collateral vessel development among elderly individuals with CTO is scarce. Hence, we sought to assess the predictive value of GNRI for collateral vessel development in elderly patients with CTO. Methods: The study cohort consisted of 93 consecutive patients aged 65 years or older who were diagnosed with CTO at a single institution. Collateral filling was graded angiographically according to the Rentrop score and categorized as poor (grades 0–1) or well-developed (grades 2–3). Nutritional risk was quantified using the GNRI formula, which incorporates serum albumin concentration and body weight adjusted for ideal body weight. Factors associated with insufficient collateral formation were evaluated using logistic regression analyses. The diagnostic performance of the GNRI was further examined by receiver operating characteristic (ROC) curve analysis. Results: Poor collateral circulation was identified in 52 patients (55.9%), whereas 41 patients (44.1%) exhibited well-developed collateral vessels. Individuals with well-developed collateralization had significantly higher GNRI values than those with poor collateralization (mean [SD], 105.61 [5.60] vs 102.21 [6.12]; P = .006). Multivariable analysis demonstrated that the GNRI was independently associated with inadequate collateral formation. ROC analysis showed a modest discriminatory ability for the GNRI, with an area under the curve (AUC) of 0.696. Conclusions: Lower GNRI values are independently associated with less extensive collateral vessel formation among older individuals with CTO. GNRI may represent a practical and readily available tool for identifying patients who are more likely to exhibit insufficient collateral growth.
Objective: This study aimed to evaluate the predictive value of clinical and electroencephalographic (EEG) findings for identifying epileptogenic structural lesions on cranial magnetic resonance imaging (MRI) in pediatric epilepsy, and to assess the contribution of MRI to diagnostic reclassification. Methods: A total of 207 pediatric patients with a confirmed diagnosis of epilepsy were retrospectively analyzed. The diagnostic workflow was evaluated through a stepwise model integrating clinical assessment, EEG, and MRI. The primary endpoints comprised the MRI positivity rate, defined by the detection of epileptogenic structural lesions, and the diagnostic reclassification rate, defined as any modification in epilepsy type classification or etiological category following the incorporation of EEG and/or MRI findings. Independent predictors of MRI positivity were identified using multivariable logistic regression analysis. Results: Epileptogenic structural lesions were identified in 9.7% of patients. Despite a relatively modest MRI positivity rate, imaging significantly contributed to diagnostic refinement. Among cases with normal EEG findings, MRI revealed structural pathology in 12%. The overall diagnostic reclassification rate following the addition of MRI was 9.7%. In multivariable analysis, focal-onset seizures (OR=2.63), developmental delay (OR=2.91), abnormal neurological examination (OR=3.08), and focal epileptiform EEG activity (OR=2.47) emerged as independent predictors of MRI positivity (all P<0.05). Agreement between EEG and MRI lateralization was moderate (κ=0.60). Conclusion: In pediatric epilepsy, MRI may substantially contribute to etiological classification, particularly in the presence of high-risk clinical and electrophysiological features. These findings support the implementation of a risk-stratified, stepwise diagnostic approach to optimize clinical management.
Minute pulmonary meningothelial-like nodules (MPMN) are rare pulmonary lesions characterized by the proliferation of cells showing meningothelial differentiation and are most commonly detected incidentally. Their coexistence with pulmonary metastases is uncommon. We report a case of metastatic endometrioid carcinoma of the lung associated with incidentally identified MPMN. A 60-year-old woman with a history of endometrioid carcinoma presented with a soft tissue density lesion measuring 38×42 mm with ill-defined margins, causing mild narrowing of the right upper lobe bronchus on computed tomography. Surgical resection of the lung mass was performed. Intraoperative frozen section examination revealed a malignant epithelial neoplasm consistent with adenocarcinoma. On permanent sections, histopathological evaluation demonstrated an epithelial tumor composed of complex and cribriform glandular structures within a desmoplastic stroma, accompanied by loss of polarity and nuclear enlargement, consistent with metastatic endometrioid carcinoma. In the wedge resection specimen obtained after frozen section examination, multiple microscopic lesions were identified in the non-neoplastic lung parenchyma. These lesions consisted of bland cells with round to ovoid nuclei arranged in whorled patterns along the alveolar septa. Immunohistochemical analysis supported the diagnoses of metastatic endometrioid carcinoma and MPMN, respectively. Based on the histopathological, immunohistochemical, and clinical findings, the mass lesion was diagnosed as metastatic endometrioid carcinoma, while the incidental parenchymal lesions were diagnosed as MPMN. To our knowledge, coexistence of MPMN with metastatic endometrioid carcinoma is exceedingly rare and not well documented in the indexed English-language literature.
Objective: Guaiac-based fecal occult blood testing (gFOBT) is widely used in colorectal cancer (CRC) screening programs. To evaluate the association between repeated gFOBT positivity and clinically significant colonoscopic and histopathological findings, particularly colorectal malignancy. Methods: This retrospective, single-center study included patients with positive gFOBT results who presented to the Gastroenterology Outpatient Clinic of Gazi University Faculty of Medicine between June 2017 and October 2025. Patients were categorized into three groups based on gFOBT results: single positive (Group 1), two consecutive positive tests within one month (Group 2), and an initial positive followed by a negative test (Group 3). Colonoscopic and histopathological findings were compared between groups. Multivariable logistic regression analysis was performed to identify independent predictors of clinically significant malignant pathology. Results: Among 1,442 patients with positive gFOBT results, 735 (50.9%) underwent diagnostic colonoscopy. Colorectal malignancy was detected in 55 (7.5%) patients among those who underwent colonoscopy. Malignancy rates differed significantly between groups: 5.1% in Group 1, 17.4% in Group 2, and 0% in Group 3 (P<0.001). Repeated gFOBT positivity was independently associated with malignant colonoscopic findings (OR: 3.684; 95% CI: 2.027–6.694). Normal colonoscopy findings were significantly more frequent in patients with a single positive test, whereas malignant findings were markedly higher in patients with repeated positivity. Conclusion: Repeated gFOBT positivity is strongly associated with clinically significant colonoscopic pathology, particularly colorectal malignancy. Patients with consecutive positive gFOBT results represent a high-risk subgroup and should be prioritized for prompt diagnostic colonoscopy within CRC screening programs.
Objective: Postoperative drainage systems are essential for maintaining hemodynamic stability and enabling early detection of complications after cardiac surgery. This study aimed to evaluate the impact of an active suction drainage system applying negative pressure on postoperative morbidity and mortality. Methods: This single-center retrospective study included 153 patients who underwent open-heart surgery between August 2023 and August 2024. Patients were divided into two groups based on the drainage method: active suction drainage (n=69) and conventional drainage (n=84). Postoperative drainage volume, cardiac tamponade, re-exploration for bleeding, mortality, and postoperative complications such as acute kidney injury and wound infection were evaluated. Univariate logistic regression analyses were performed to assess potential confounding factors. Results: Cardiopulmonary bypass time, aortic cross-clamp time, and total operative duration were significantly longer in the active suction group (P=0.007, P=0.009 and P=0.010, respectively), while local hemostatic agent use was higher in the conventional group (P<0.001). Despite these differences, postoperative drainage volume, re-exploration rates, incidence of cardiac tamponade, acute kidney injury, wound infection, and mortality were comparable between groups (all P>0.05). Length of hospital stay was significantly longer in the active suction group. Univariate regression analyses did not identify any independent predictors of re-exploration or cardiac tamponade (P>0.05 for all variables). Conclusion: Active suction drainage was not associated with significant differences in major postoperative outcomes compared with conventional drainage methods. Although operative variables differed between groups, these factors did not demonstrate an independent effect on clinical outcomes. A numerically higher incidence of cardiac tamponade in the active suction group did not reach statistical significance and should be interpreted cautiously. Further large-scale prospective studies are warranted.
Objective: To assess large language models’ (LLMs) mastery of contemporary consensus documents in guideline-based neurointerventional decision-making domains and to compare their performance with radiologists of different experience levels. Methods: In this cross-sectional study, 100 single-best-answer, five-option MCQs were derived from three CIRSE guideline sources. A non-participating general radiologist authored the items (33 carotid stenting, 33 thrombectomy, 34 acute stroke EVT). One neurointerventional radiologist, two general radiologists, and one resident answered independently, blinded to the key. The same set was posed in January 2026 to Claude 4.5 Opus, ChatGPT 5.2 Instant, and Gemini 3 Pro using default settings and a standardized prompt. Accuracy was compared with McNemar’s test and Bonferroni correction (P≤0.002). Results: The highest accuracy was observed with Claude 4.5 Opus (0.99±0.10); ChatGPT 5.2 Instant (0.96±0.19) and Gemini 3 Pro (0.95±0.21) showed comparable performance. Among human participants, the neurointerventional radiologist achieved the highest accuracy (0.85±0.35), while general radiologists scored 0.67–0.70 and the resident achieved 0.57. Each of the three LLMs significantly outperformed all human groups. Moreover, Claude 4.5 Opus also demonstrated significantly higher performance than the neurointerventional radiologist (P=0.001). Conclusion: LLMs have reached a competitive level with neurointerventional radiologists in recalling and interpreting neurointerventional guideline knowledge. In particular, Claude 4.5 Opus demonstrated strong performance and appears to be a promising candidate for “real-time decision support” applications. Multimodel validation and verification studies using real clinical scenario–based designs are warranted.
Objective: This study aimed to investigate the relationship between global news exposure and perinatal anxiety levels among pregnant women. Methods: This cross-sectional analytical study included 180 pregnant women. Data were collected via an online questionnaire consisting of sociodemographic characteristics, global news consumption habits, and the Perinatal Anxiety Screening Scale (PASS). Correlations were assessed using Spearman analysis, and independent predictors were evaluated with multivariate linear regression. Results: A total of 169 participants were included in the final analysis. The mean PASS score was 34.2±15.8. Significant positive correlations were found between anxiety levels and daily news checking frequency (r=0.172, P=0.025), fear of missing news (r=0.154, P=0.046), repetitive checking behavior (r=0.262, P<0.001), post-exposure tension (r=0.236, P=0.002), and perceived impact of negative news on pregnancy (r=0.343, P<0.001). In multivariate analysis, repetitive checking behavior and perceived negative impact remained independent predictors. Conclusion: Global news exposure is significantly associated with perinatal anxiety. This relationship appears to be driven more by behavioral and cognitive responses to news rather than exposure duration.
