Marjolin's ulcer is a rare, aggressive cutaneous malignancy arising in chronic wounds, scars, and burns, for which prognostic and treatment data remain fragmented across small retrospective series. We conducted a systematic review and meta-analysis, registered with the International Prospective Register of Systematic Reviews (PROSPERO) and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), searching PubMed, EMBASE, Scopus, the Cochrane Library, and ScienceDirect for case series and cohort studies (≥10 patients) reporting histologically confirmed malignancy arising in scars, ulcers, or chronic wounds. Pooled proportions were estimated using random-effects models (restricted maximum likelihood (REML)) with logit transformation, treatment arms were compared using log risk ratios, and risk of bias was assessed with the Joanna Briggs Institute (JBI) checklist. Fifty-one studies comprising 2,388 patients across 18 countries were included. Squamous cell carcinoma predominated (95.7%), arising chiefly in the lower limb (58.9%) after a long latency (median 29.5 years). The pooled local recurrence rate was 20% (95% confidence interval (CI) 16%-24%; I² = 66.3%), while the pooled rate of regional nodal metastasis at diagnosis was 19% (95% CI 15%-24%; I² = 78.5%); the pooled five-year overall survival was 61% (95% CI 49%-72%). Adding adjuvant radiotherapy to surgery showed no significant effect on local recurrence (log risk ratio 0.78, 95% CI -1.56-3.12), though confounded by indication. Evidence certainty was low to very low; wide local excision with clear margins, according to the oncological principles, remains the cornerstone of management.

Abstract Cranioplasty is an essential neurosurgical procedure for the reconstruction of skull defects following trauma, tumor resection, infection, or decompressive surgery. While advances in biomaterials and manufacturing techniques have improved clinical outcomes, the economic implications of different cranioplasty strategies remain a critical factor in decision-making. The objective of this study is to evaluate the cost-effectiveness and economic outcomes of various cranioplasty materials and techniques, including autologous bone, polymethylmethacrylate (PMMA), titanium, and polyetheretherketone. A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and registered in PROSPERO (CRD420261336008). A comprehensive search of PubMed, Scopus, ScienceDirect, and Cochrane CENTRAL was performed up to March 2026. Studies reporting economic outcomes of cranioplasty procedures were included. Data were extracted independently by two reviewers, and methodological quality was assessed using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in cost reporting and study design, a narrative synthesis was performed. Nineteen studies were included, demonstrating considerable heterogeneity in study design and economic evaluation methods. Autologous bone, while initially cost-effective, was associated with high rates of resorption (22–25%) and increased revision-related costs. Synthetic implants such as titanium and PEEK showed higher upfront costs but improved long-term cost-effectiveness due to lower complication rates. PMMA, particularly with in-house 3D-printing and locally manufactured molds, emerged as a highly economical alternative, achieving cost reductions of up to 97% while maintaining acceptable clinical outcomes. Surgical strategy also influenced costs, with immediate bone flap replacement proving more cost-effective than delayed cranioplasty. Overall study quality ranged from moderate to high. The cost-effectiveness of cranioplasty depends on balancing initial material costs with long-term outcomes. Synthetic implants may offer superior long-term value, whereas PMMA with low-cost manufacturing provides an effective solution in resource-limited settings. Individualized decision-making and standardized economic evaluations are essential to optimize outcomes.

The growing prevalence of micro- and nanoplastics (MNPs) in the environment elicits concerns about their possible impact on human neurological health. Although studies on animals have suggested neurotoxic effects, evidence from humans is still scarce. This systematic review gathers existing human data to assess the presence, types, detection techniques, and neurological consequences of MNPs in different biological matrices. A comprehensive review was performed on peer-reviewed research concentrating on human studies that report the detection of MNPs in biological tissues and fluids. Four qualifying studies were identified: one clinical observational study, two cadaveric analyses, and one quasi-experimental trial. The data collected encompassed demographics, detection methods, types and concentrations of polymers, biological matrices examined, and neurological biomarkers. MNPs were observed in cerebrospinal fluid (CSF), faeces, urine, olfactory bulbs (OBs), and in brain, liver, and kidney tissues from postmortem cases. The polymers that were reported most frequently were polyethylene (PE) and polypropylene (PP). The detection methods included micro-Fourier transform infrared spectroscopy (µFTIR), pyrolysis-gas chromatography/mass spectrometry (Py-GC/MS), laser direct infrared imaging (LDIR), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Although the available evidence is limited, emerging findings indicate the possible accumulation of MNPs in the human central nervous system (CNS), particularly in individuals with dementia or compromised blood-brain barrier (BBB) integrity. Relationships were noted between MNP exposure and disruptions in the BBB, inflammatory markers, and alterations in the gut-brain axis. This review consolidates the findings and emphasizes the need for further exploration of human exposure to MNPs and their possible accumulation in neural tissues. Although there is variability in methodologies used in the reviewed articles, PE and PP stand out as the primary polymers of concern. While a direct causal relationship cannot yet be confirmed, the results highlight the necessity for improved detection methods, larger sample sizes, and long-term studies to better understand the impact of MNPs on neuroinflammation and neurodegeneration.

Abstract Primary central nervous system lymphoma (PCNSL) is a rare, aggressive extranodal non-Hodgkin lymphoma confined to the central nervous system (CNS). Despite advances in imaging, definitive diagnosis requires tissue confirmation, most often via stereotactic or open biopsy. However, diagnostic yield is frequently compromised by preoperative corticosteroid use, and the role of surgical resection remains debated. This umbrella review synthesizes systematic reviews and meta-analyses to clarify the diagnostic utility, safety, and clinical impact of biopsy procedures in PCNSL. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a protocol was registered in PROSPERO (CRD420251103759). Electronic databases (PubMed, EMBASE, Cochrane, SCOPUS, ScienceDirect) were searched for systematic reviews and meta-analyses addressing biopsy in PCNSL. Eligible studies reported outcomes including diagnostic accuracy, safety, treatment impact, or survival. Methodological quality was assessed using AMSTAR 2, and findings were narratively synthesized due to heterogeneity. Six systematic reviews/meta-analyses comprising 91 unique primary studies were included. Brain biopsy demonstrated markedly superior diagnostic yield compared to cerebrospinal fluid (CSF) analysis (92.3 vs. 7.4%). Stereotactic biopsy was safe, with low morbidity (5.1%) and mortality (0.7%). Preoperative corticosteroid use significantly increased nondiagnostic biopsy risk (RR 2.1 overall; RR 3.0 for stereotactic procedures). Evidence for the survival benefit of surgical resection was inconsistent: one meta-analysis reported improved overall and progression-free survival (HR ∼0.63–0.64), while another found no significant differences. Clinical impact data showed biopsy altered management in ∼60% of cases and improved outcomes in ∼34%. Evidence quality ranged from critically low to high, with common methodological limitations. Brain biopsy should be prioritized over CSF analysis for suspected PCNSL, given its superior diagnostic yield and acceptable safety profile. Corticosteroids should be avoided pre-biopsy when clinically feasible, with open biopsy considered if steroids are unavoidable. Surgical resection may benefit selected patients with superficial, solitary lesions, though evidence remains of low certainty. Prospective randomized trials and standardized outcome definitions are urgently needed to refine diagnostic and therapeutic strategies in this rare disease.

Advances in systemic cancer therapies such as immune checkpoint inhibitors (ICIs), tyrosine kinase inhibitors (TKIs), and anti-angiogenic agents have markedly improved survival in patients with solid and hematologic malignancies. As survivorship increases, oral rehabilitation with dental implants is increasingly sought to restore quality of life. However, these therapies may adversely affect bone healing, angiogenesis, and immune regulation, raising concerns regarding implant-related complications. This systematic review aimed to evaluate reported dental implant outcomes and complications in patients receiving novel systemic cancer therapies, emphasizing the implications for supportive oncology. This review was conducted according to PRISMA 2020 guidelines and registered in PROSPERO (CRD420251142681). PubMed/MEDLINE, Scopus, ScienceDirect, and the Cochrane Library were searched for English-language clinical reports describing dental implant outcomes in patients treated with ICIs, TKIs, or anti-angiogenic agents. Study selection, data extraction, and quality appraisal using the Joanna Briggs Institute checklist for case reports were performed independently by two reviewers. Seven case reports (2017–2024) were included, representing Level IV evidence. Two cases involving TKIs reported successful osseointegration and long-term survival. In contrast, five cases described adverse outcomes including early failure and MRONJ predominantly associated with anti-angiogenic agents, either alone or in combination with ICIs and antiresorptive agents. These complications often resulted in significant functional morbidity and the need for invasive surgical intervention. Based on limited case report evidence, anti-angiogenic therapies were more frequently observed in cases with adverse outcomes, including implant-related MRONJ and failure, while TKIs were associated with favorable outcomes in limited cases. The role of ICIs remains unclear due to sparse data, particularly regarding monotherapy effects. Given the preliminary nature of current evidence derived from case reports, prospective studies with appropriate control groups are urgently needed to establish evidence-based guidelines. CRD420251142681; 08/09/2025 • Immune checkpoint inhibitors (ICIs) may potentiate inflammatory bone loss, especially in combination with anti-VEGF or antiresorptive agents. • Limited case reports suggest anti-angiogenic agents may increase risk of implant complications. • Tyrosine Kinase Inhibitors (TKIs) appear relatively compatible with successful osseointegration in stable patients. • Proactive risk stratification and multidisciplinary coordination are essential to preserve oral function in cancer survivors. • Elective implant placement may need to be approached with caution during active anti-VEGF therapy.

BACKGROUND:Propofol is widely used for induction in glioma surgery for its neuroprotective effects and favorable recovery profile. However, its dose-dependent hypotension is a major limitation in procedures requiring stable cerebral perfusion. AIM:To compare the efficacy of propofol vs propofol-phenylephrine (PPE) combination in maintaining hemodynamic stability in patients undergoing glioma surgery. METHODS:Ninety American Society of Anesthesiologists I-II patients scheduled for elective glioma surgery were randomized to receive either propofol (group P) or a PPE admixture (group PPE). Induction was performed with slow titration of the study drug until loss of verbal response and Bispectral index < 60, followed by a continuous infusion (50 μg/kg/minute) until skin closure. Hemodynamic parameters [mean arterial pressure (MAP), systolic blood pressure, diastolic blood pressure, and heart rate] were recorded at baseline, during induction, immediately after intubation, and at predefined intraoperative time points. The incidence of hypotension, vasopressor and esmolol use, and brain relaxation scores were compared. RESULTS:Group PPE demonstrated significantly better preservation of MAP, systolic blood pressure, diastolic blood pressure, and heart rate throughout the peri-induction and intraoperative periods (P < 0.05). The mean maximum MAP reduction during induction was greater in group P compared with group PPE (19.7 mmHg vs 12.5 mmHg; P < 0.01). Hypotensive episodes were significantly more frequent in group P than in group PPE (84.4% vs 6.7%; P < 0.001). Rescue phenylephrine requirements were markedly lower in group PPE (P < 0.001). Esmolol use and brain relaxation scores were comparable between groups. CONCLUSION:Adding phenylephrine to propofol for induction and maintenance provides superior hemodynamic stability without compromising brain relaxation in glioma surgery.

ABSTRACT Objective This systematic review aimed to assess the cost‐effectiveness of decompressive craniectomy (DC) in severe traumatic brain injury (TBI) patients by analyzing relevant economic studies. Methods The authors conducted a comprehensive search across multiple databases and included economic evaluation studies, clinical trials, observational studies, or modeling studies that focused on patients who underwent DC for severe TBI. The quality of included studies was assessed using the Drummond checklist, and potential publication bias was examined. Data on total hospital costs, quality‐adjusted life years (QALY), cost per QALY, and patient demographics were extracted and analyzed. Results The included studies were of moderate to high quality. Total hospital costs increased with a higher likelihood of unfavorable outcomes. A cost–utility analysis demonstrated that DC led to a higher expected QALY gain compared to medical management. At 12 months, though, DC was the costlier option. In the Finnish cohort, the estimated cost of continued care ran to several times that of the initial admission, which raised the all‐in cost per QALY well above the figure for neurosurgical treatment alone. Cost‐effectiveness varied with the severity of TBI. Conclusions DC may be cost‐effective in the management of severe TBI in selected patients, particularly those at lower risk of an unfavorable outcome, although the available evidence is limited and heterogeneous. That value falls as injury severity rises, and at the extreme end of severity the procedure is no longer cost‐effective. Decisions about DC in severe TBI therefore turn on both the expected clinical benefit and the cost, not on either alone. Longer follow‐up would help, since much of both the cost and the recovery in these patients accrues years after surgery.

Background Angiogenesis is responsible for the growth, progression, and metastasis of adult diffuse gliomas and other solid tumors. Vascular endothelial growth factor (VEGF) acts as both a pro-angiogenic and a potent angiogenic cytokine, playing a significant role in cell proliferation and endothelial cell permeability. Gliomas are characterized by vascular proliferation, which is responsible for tumor growth and biological behavior and disease outcome. CD34 is a transmembrane phosphoglycoprotein and a pan-endothelial marker that can help examine microvessel density (MVD), a measure used to assess the vascular response to VEGF. Materials and methods The present cross-sectional study, conducted on 50 histopathologically proven cases of adult diffuse glioma, was carried out to understand the angiogenic phenomenon by measuring VEGF activity and MVD. These were morphologically graded based on the Central Nervous System (CNS) World Health Organization (WHO) grading system. Immunohistochemical staining for the anti-VEGF antibody was performed to examine the expression of VEGF and scored from 0 to 3. MVD was evaluated through CD34 immunohistochemical staining. Both angiogenic factors were subsequently correlated with the tumor's histological grade. Results VEGF expression was observed in 44 of the total 50 cases of adult diffuse glioma. Overexpression was seen to be strongly correlated with higher tumor grade. Most cases revealed higher MVD that ranged from 15 to 105 microvessels/10 high-power fields (hpf). MVD was also compared with tumor grades, exhibiting a higher MVD value with increasing tumor grade in cases of adult diffuse glioma.  Conclusion Angiogenic response factors such as VEGF expression and MVD played a significant role in adult diffuse glioma progression. Its understanding, therefore, is of vital importance so that the option of personalized therapeutic strategies can be explored and the patient can benefit from the targeted treatment options against VEGF. It is expected to potentially decrease tumor growth and progression and disease burden, thereby improving overall survival outcomes in high-grade glioma and bringing a ray of hope to these patients.

Glioblastoma has been described as the most common and aggressive primary brain neoplasm in adults, with limited survival despite multimodal therapy. The prognostic impact of epidermal growth factor receptor (EGFR) amplification and its interaction with isocitrate dehydrogenase (IDH) mutation and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation remains unclear. This systematic review and meta-analysis examined how EGFR amplification level and molecular profile affect overall survival (OS) in glioblastoma. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a systematic review was performed for studies reporting OS stratified by EGFR amplification, MGMT methylation, or IDH mutation. Using a random-effects model, pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated, and I² statistics were employed to assess heterogeneity. Nine studies including 1,766 subjects were analyzed. Low or moderate EGFR amplification showed no OS impact (HR=0.98 (95% CI: 0.88-1.09); HR=0.94 (95% CI: 0.81-1.10)), whereas high amplification predicted worse survival (HR=1.19; 95% CI: 1.14-1.24; p<0.00001). EGFR amplification with MGMT methylation correlated with poorer outcomes (HR=1.38; 95% CI: 1.33-1.44), while EGFR amplification with unmethylated MGMT showed improved survival (HR=0.68; 95% CI: 0.61-0.76). Stratification by IDH status identified EGFR-negative/IDH-mutant tumors as the most favorable group (HR=0.44; 95% CI: 0.29-0.67) and EGFR-positive/IDH-wildtype as the least favorable (HR=1.33; 95% CI: 0.89-2.00). High EGFR amplification independently predicts worse survival in glioblastoma, particularly with MGMT promoter methylation and IDH-wildtype status. Integrating EGFR, MGMT, and IDH profiles refines prognostic assessment and supports personalized therapeutic strategies.