Objective. To investigate the prevalence of posterolateral tubercle variants and characterize the simulated safe zones and screw insertion angles for posterior-to-anterior talar screw fixation using individual 3D models from a Northeastern Thai skeletal collection. Materials and Methods. A total of 1,106 dry tali from 553 skeletons (301 males and 252 females), aged 22–106 years, were classified according to posterolateral tubercle type. Safe zones for posterior-to-anterior (PA) screw fixation were determined for the left and right tali in both sexes using 3D simulation models, and the widest possible screw insertion angles were simulated. Results. The posterolateral tubercle was classified into three types: Type 1 (almost absent, 1.36%), Type 2 (normal, 45.48%), and Type 3 (enlarged, 53.16%). In selected individual male talus models, the illustrated safe-zone configurations ranged from 20% to 50% on the left and from 30% to 60% on the right. In selected individual female talus models, the illustrated safe-zone configurations ranged from 20% to 70% on the left and from 20% to 50% on the right. Conclusion. The enlarged posterolateral tubercle was the most prevalent variant in the Northeastern Thai skeletal sample. The selected individual models illustrated differences in simulated safe-zone configurations and insertion angles according to side and sex. These findings may provide anatomical reference information for preoperative planning of screw fixation involving the posterolateral region of the talus.
This review summarizes the current World Health Organization (WHO) classification of lung tumors, emphasizing key morphological, immunohistochemical, and molecular features relevant to diagnosis and management. Review. Primary pulmonary tumors comprise a heterogeneous spectrum of neoplasms with distinct morphological, immunophenotypic, molecular, and clinical characteristics. The current WHO classification integrates traditional histopathological assessment with immunohis- tochemical and molecular findings, reflecting advances in our understanding of tumor biology and the growing importance of precision medicine. This review summarizes the major categories of primary pulmonary tumors, including adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, large cell carcinoma, sarcomatoid carcinomas, neuroendocrine neoplasms, salivary gland-type tumors, and mesenchymal tumors specific to the lung, as well as selected rare pulmonary neoplasms. Particular attention is given to the defining morphological characteristics and diagnostic criteria of individual tumor entities, relevant immunohistochemical profiles, and recurrent molecular alterations with diagnostic, prognostic, and therapeutic implications. The challenges of diagnosing pulmonary tumors in small biopsies and cytological specimens are also addressed, with an emphasis on the judicious use of immunohistochemistry and preservation of tissues for molecular testing. Conclusion. Accurate classification of primary pulmonary tumors requires the integration of morphological, immunohistochemical, and molecular findings within the framework of the current WHO Classification of Thoracic Tumors. Recognition of the characteristic morphological and immunophenotypic features, together with appropriate molecular characterization, is essential for precise diagnosis and optimal patient management. Continued advances in molecular pathology are expected to further refine pulmonary tumor classification and contribute to increasingly personalized therapeutic strategies.
Objective. To synthesize the current knowledge regarding the embryological basis, anatomical classification, imaging characterization, and clinical implications of accessory renal arteries. Background. Anatomical variations in the renal arteries are common, affecting approximately 20-35% of the population, and have significant implications for clinical outcomes and surgical planning. Accessory renal arteries are usually terminal vessels that serve discrete renal islands with minimal collateral circulation in the body; therefore, their preoperative identification is important. However, there has been no modern synthesis of embryology, imaging, and multidisciplinary clinical treatment for these variations. Methods. A narrative review of the literature was conducted by searching PubMed and Google Scholar for publications from December 2015 to December 2025. MeSH terms and free-text keywords related to “accessory renal artery,” “multiple renal arteries,” “renal artery variations,” “renal vascular anatomy,” “kidney transplantation,” “renovascular hypertension,” “computed tomography angiography,” “magnetic resonance angiography,” and “endovascular aortic repair” were used in Boolean combinations. Peer-reviewed original studies, systematic reviews, meta-analyses, and case series were included. Conference abstracts, unpublished data, and non-English publications were excluded. Discussion. This review addresses the embryological basis and anatomical classification of accessory renal arteries; the diagnostic roles of Doppler ultrasound, computed tomography angiography, and magnetic resonance angiography; and their clinical implications in kidney transplantation, partial nephrectomy, and endovascular aortic repair, including the contested association with renovascular hypertension. Available data suggest that most accessory vessels do not independently cause hypertension, whereas stenosis of larger vessels may be a correctable etiology in selected cases. Conclusion. Accessory renal arteries have a significant clinical impact, primarily determined by the size of the vessels and the area of the kidney they supply. Preoperative characterization based on modern imaging can be reliable and can help plan and manage surgery for each patient. More prospective research is required to establish evidence-based principles for vessel maintenance and evaluate new technologies in this context.
This systematic review aims to evaluate the prevalence of burnout, its associated determinants, and the coping strategies employed by palliative care professionals. Burnout, characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment, poses a significant threat to clinician well-being and the quality of care delivered to patients with life-limiting illnesses. A comprehensive search of PubMed and Embase identified eleven eligible studies published between 2021 and 2025. Following thematic synthesis, four overarching themes were identified: (1) work-related stress: heavy workloads, emotional demands and lack of support, (2) burden of burnout: the unique stressors facing palliative care professionals, (3) impact of the COVID-19 pandemic: increased workloads and exposure to high-risk environments, and (4) coping strategies: symptom recognition and etiological factors, organizational support and resilience factors. Conclusion: Burnout remains a pervasive challenge in palliative care, and sustained, evidence-based organizational strategies are essential to protect clinician well-being and ensure high-quality patient care. Future research should determine the long-term effectiveness of these interven- tions and assess whether tailored approaches are required for specific professional groups and care settings.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the leading cause of chronic liver disease in Bosnia and Herzegovina and a major contributor to liver- and cardiovascular-related morbidity and mortality. These national guidelines provide the first country-specific, evidence-based recommendations for the diagnosis, risk stratification, and management of MASLD, covering the full disease spectrum from steatosis to cirrhosis and its complications. MASLD management is based on a coordinated, stepwise model across primary, secondary, and tertiary healthcare levels, with primary healthcare serving as the central gatekeeper and coordinator of care. Active case-finding of clinically significant fibrosis is emphasized, particularly in high-risk populations, such as individuals with type 2 diabetes mellitus or obesity. Primary healthcare plays a key role in early risk assessment through systematic evaluation of metabolic risk factors and first-line use of simple non-invasive tools, notably the FIB-4 index. A stepwise non-invasive diagnostic algorithm is recommended, with elastography (preferably vibration-controlled transient elastography or 2D shear wave elastography where available) used for further assessment in patients with indeterminate or high-risk results. Lifestyle modification and optimal management of cardiometabolic comorbidities remain the foundations of MASLD treatment. In eligible patients with type 2 diabetes mellitus and/or overweight or obesity, glucagon-like peptide-1 receptor agonists may be considered, while bariatric surgery represents an option for selected individuals with persistent obesity. Advanced MASLD, including cirrhosis, requires multidisciplinary management, surveillance for hepatocellular carcinoma, and evaluation for liver transplantation in cases of decompensation. These guidelines aim to standardize MASLD care in Bosnia and Herzegovina and strengthen the pivotal role of primary healthcare within the national MASLD care pathway.
