Objective: Endoscopic step-up strategies for necrotizing pancreatitis are poorly documented in multidisciplinary real-world clinical practice. This study evaluated the feasibility and clinical outcomes of an endoscopic management strategy within a structured multidisciplinary framework for patients with necrotizing pancreatitis. Methods: This retrospective, single-center study evaluated 13 consecutive patients with necrotizing pancreatitis who underwent endoscopic treatment between January 2022 and December 2025. Demographic characteristics, disease severity via the Modified Computed Tomography Severity Index (MCTSI), details of endoscopic interventions, microbiological findings, and clinical outcomes were analyzed. Results: The median disease severity score was 8 (range, 4–10). Patients underwent a median of 6 (range, 2–15) endoscopic interventions, with the initial intervention performed at a median of 18 days (range, 1–90) from diagnosis. The median follow-up duration was 7 months (range, 1–41). Lumen-apposing metal stents followed by coaxial plastic pigtail stents were utilized in most patients. Microbiological cultures predominantly revealed Candida spp. and Klebsiella pneumoniae, including multidrug-resistant organisms in a subset. The median hospital stay was 21 days (range, 8–97), and the median intensive care unit (ICU) stay was 0 days (range, 0–44). No in-hospital mortality was observed; long-term complications occurred in a minority of patients. Conclusions: Endoscopic management within a structured multidisciplinary framework is a feasible and safe treatment strategy for necrotizing pancreatitis. Given the limited sample size, larger prospective studies are warranted to validate these findings.
Objective: Parkinson disease (PD) involves dopaminergic neuron loss from mitochondrial dysfunction and oxidative stress. We investigated the combined, sequential effects of mesenchymal stem cell–derived mitochondrial transplantation (MitoTr) and pharmacological agmatine modulation in a PD–like undifferentiated SH-SY5Y cellular model. Methods: Undifferentiated SH-SY5Y cells were exposed to 6-hydroxydopamine (6-OHDA; 350 μM) for 24 hours and sequentially treated with mitochondria (5 or 10 μg/mL) and agmatine (100 μM; 2 hours post-MitoTr). Cell viability was assessed via MTT assays (n = 8 independent experiments). Total-lysate cytochrome c ELISA (n = 3) and Western blots for DJ-1, REDD1, and α-synuclein (n = 4) were performed across 4 core groups. Results: 6-OHDA significantly reduced viability compared with Control (mean [SEM], 0.50 [0.05] vs 1.00 [0.04]; P < .001); postinjury agmatine restored it to near-control levels (mean [SEM], 0.97 [0.20]; P < .001\) vs 6-OHDA), while agmatine alone had no effect (P > .99). Conversely, MitoTr-containing groups showed significantly lower viability than Control, Agmatine, and Agmatine + 6-OHDA groups (P < .001). Most MitoTr arms fell significantly below 6-OHDA alone (P < .05), except the 5 μg/mL triple group (P = .13). Expression of DJ-1, REDD1, and α-synuclein decreased numerically relative to Control without statistical significance (P > .05). Total-lysate cytochrome c was significantly elevated only in the triple-combination group compared with the Control group (mean [SEM], 36.01 [3.65] versus 22.63 [1.08] ng/mL; P = .03). Conclusions: Postinjury agmatine rescued 6-OHDA-induced viability loss, but sequential MitoTr followed by agmatine caused an additional marked reduction in viability rather than synergistic neuroprotection. Molecular alterations remained exploratory and nonsignificant. This MitoTr-associated loss may reflect antiproliferative effects in neuroblastoma-derived cells, underscoring the need for optimized protocols and nonmalignant models.
Objective: Platelet indices are routinely available, but their diagnostic value in patients with stroke-suggestive symptoms remains uncertain. This study evaluated the diagnostic and prognostic performance of these indices in an emergency department population. Methods: This retrospective study included adults who underwent neurology consultation between June 1, 2023, and June 1, 2026. Eligible patients had stroke-suggestive symptoms, relevant neuroimaging, and complete blood count data. Patients were classified as having acute ischemic stroke (AIS), transient ischemic attack (TIA), or nonstroke presentation. Platelet count, mean platelet volume (MPV), plateletcrit, platelet distribution width, and their derived ratios were analyzed. Diagnostic performance was assessed using receiver operating characteristic curve analysis and logistic regression. Thirty-day mortality was evaluated among patients with ischemic cerebrovascular events. Results: Of 4218 screened patients, 1079 were included: 799 nonstroke, 256 AIS, and 24 TIA. None of the platelet parameters differed significantly between the nonstroke and combined stroke/TIA groups. Area under the curve (AUC) values ranged from 0.50 to 0.51. None of the parameters remained significantly associated with ischemic cerebrovascular events after adjustment for age, sex, hypertension, diabetes mellitus, and previous stroke. MPV was lower in 30-day nonsurvivors than in survivors (median [IQR], 10.6 [9.7-11.1] fL vs 11.1 [10.3-11.8] fL; P = .049); however, this association was based on univariable analysis only because the limited number of mortality events (n = 16) precluded reliable multivariable analysis. Conclusions: Platelet parameters did not provide clinically meaningful diagnostic discrimination between ischemic cerebrovascular events and nonstroke presentations. The isolated association between lower MPV and 30-day mortality was exploratory and should be interpreted cautiously.
Objective: To examine the association between menopausal status and thyroid nodule prevalence and size in women with hypothyroidism. Methods: In this retrospective comparative study, we reviewed 149 women with hypothyroidism seen in outpatient clinics at a tertiary care hospital. Hypothyroidism was defined as a documented clinical diagnosis supported by elevated thyroid-stimulating hormone (TSH) with low or normal thyroxine (T4). Women were classified as being in the reproductive period or postmenopausal; postmenopause was defined as amenorrhea for at least 12 months or documented postmenopausal status in the medical record. Group comparisons used the χ² test, independent-samples t test, or Mann-Whitney U test, as appropriate. Crude ORs with 95% CIs were calculated for key dichotomous nodule outcomes. Results: Of the 149 women, 89 (59.7%) were of reproductive age and 60 (40.3%) were postmenopausal. Thyroid nodules were present in 61 (40.9%) patients. Postmenopausal women had a higher prevalence of nodules than reproductive-age women (56.7% vs 30.3%; crude OR, 3.00; 95% CI, 1.52–5.94; P = .002). Nodules > 1 cm were also more frequent after menopause (25.0% vs 8.9% [reported as 9.0%]; crude OR, 3.38; 95% CI, 1.33–8.57; P = .03). TSH, T4, anti-thyroid peroxidase (anti-TPO) levels, anti-TPO positivity, and levothyroxine use did not differ significantly between the groups. Conclusions: Among women with hypothyroidism, postmenopausal status was associated with a greater thyroid nodule burden and a higher frequency of nodules larger than 1 cm. Because age and menopausal status were closely linked, the findings should be interpreted as unadjusted associations rather than independent effects of menopause.
Objective: To compare early and 1-y outcomes after anterior-to-posterior screw fixation and direct posterior fixation of the posterior malleolus in Weber type C trimalleolar ankle fractures. Methods: This retrospective cohort study included 183 patients: 78 treated with anterior-to-posterior fixation and 105 with direct posterior fixation. The visual analog scale (VAS), Olerud-Molander Ankle Score (OMAS), and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were assessed at 3 mo and 1 y. Radiological alignment, residual posterior step-off, ankle motion, and return to work were also compared. Results: At 3 mo, posterior fixation was associated with lower VAS scores (mean [SD], 0.99 [1.07] vs 2.09 [1.14]), higher OMAS (mean [SD], 82.11 [6.68] vs 72.76 [8.78]), and higher AOFAS scores (mean [SD], 85.19 [6.82] vs 76.78 [7.87]; all P < .001). These scores did not differ significantly at 1 y. Syndesmotic screw fixation was less frequent after posterior fixation (4.8% vs 94.9%; P < .001). Residual posterior step-off was slightly lower after posterior fixation (mean [SD], 0.06 [0.14] mm vs 0.09 [0.13] mm; P = .01), with all values below 2 mm. Mortise alignment, final ankle motion, and return-to-work time were comparable between groups. Conclusions: Direct posterior fixation was associated with better early pain and function and less frequent syndesmotic screw fixation. Clinical outcomes converged and were similar at 1 y. Prospective studies are needed to determine whether these associations are causal.
