Background/Aims: The irregular Z-line, defined as a segment of columnar mucosa less than 1 cm in the distal esophagus, is often biopsied despite guidelines advising against it due to a low risk of progression to esophageal adenocarcinoma (EAC). However, the clinical significance of an irregular Z-line remains unclear. This meta-analysis examines the prevalence of Barrett’s esophagus, dysplasia, and EAC in patients with an irregular Z-line. Methods: We searched Medline, Embase, and Scopus databases up to October 2023 for studies on the prevalence of Barrett’s esophagus, dysplasia, and EAC in these patients. A random-effects model was used for meta-analysis, and heterogeneity was assessed using I2 statistics. Results: Nine studies involving 17,637 patients were analyzed. Among those with an irregular Z-line, the prevalence of intestinal metaplasia was 29.4%. In patients with intestinal metaplasia, dysplasia was found in 6.2%, low-grade dysplasia in 5.9%, high-grade dysplasia in 1.6%, and EAC in 1.5%. These rates were higher compared to those without intestinal metaplasia. Conclusions Patients with an irregular Z-line and intestinal metaplasia may be at higher risk and could benefit from endoscopic surveillance. Further studies are needed to determine the necessity of biopsying irregular Z-lines.

Clinical guidelines typically endorse conventional therapies such as 5-aminosalicylic acid (5-ASA) as the mainstay of ulcerative colitis management. However, the degree of adoption and application of guideline recommendations by physicians within Asia remains unclear. This study aims to understand the prescribing patterns of 5-ASA and implementation of current guideline recommendations across Asian clinical practice. A physician survey was conducted among inflammatory bowel disease specialists in 8 Asian territories to understand practices and preferences in ulcerative colitis management, focusing on the use of 5-ASA and concordance with guideline recommendations. Survey findings were validated by country experts in diverse healthcare settings. Subgroup analyses stratified data by income levels and treatment reimbursement status. Ninety-eight valid responses were received from inflammatory bowel disease specialists or gastroenterologists among 8 economic entities. Significant differences were found in clinical practices and treatment preferences for ulcerative colitis management among different income-level and government-subsidy groups. Survey results are summarized in 8 findings that illustrate trends in 5-ASA use and guideline implementation across Asian territories. This study emphasizes socioeconomic factors that impact the adoption of guideline recommendations in real-world practice. Our findings indicate an eclectic approach to guideline implementation across Asia, based on resource availability and feasibility of treatment goals.

Background and Objectives: This study aimed to evaluate Mal de Debarquement syndrome (MdDS) in high-risk pilots using the Istanbul MdDS Symptom Questionnaire (IMdDSSQ) and investigate the effect of flight time. Subjects and Methods: The IMdDSSQ was administered to 150 healthy pilots, ≥18 years (37.47±11.14 years), on active duty, using a Google Forms link. The responses to the questionnaire were assessed based on flight time (<4 h and >4 h) and age group, for all subfactors. Results: For the MdDS diagnosis subfactor of the questionnaire, 32.1% of males and 66.7% of females reported a suspicion of MdDS after flights <4 h. As flight time increased, the number of participants reporting suspected MdDS increased in both sexes. There was a significant difference between short and long flights for all subfactors of the questionnaire across all age groups and sex comparisons (p<0.05). Conclusions As flight time and age increased, the severity of the symptoms of MdDS increased for all subfactors. With advancing age, dizziness and the severity of intolerance to visual motion increase in long flights compared to short flights, and the quality-of-life decreases. The quality-of-life of female pilots was lower than that of male pilots.

Background and Objectives: Virtual reality (VR) applications change the perception of reality, resulting in a feeling of being in a natural environment. The occurrence of cybersickness (CS) when using VR applications is a well-documented side effect, and the Simulator Sickness Questionnaire (SSQ) has been used to assess CS. Considering the speed of VR technology development, CS will likely become a frequently researched and discussed topics in the near future. Therefore, the aim of this study was to conduct a Turkish validity and reliability study and introduce the SSQ to Turkish medical literature. Materials and Methods: A total of 160 healthy individuals (80 females and 80 males) aged >18 years (28.4±7.2 years) were included in our study. The SSQ was provided to the participants through Google Forms before and after the VR provocation experience and within the scope of the test and retest protocol. Results: The reliability and internal consistency of the questionnaire were observed at a high level (Cronbach’s alpha=0.854, Spearman-Brown coefficient r=0.871). Factor analysis was performed and the questionnaire was divided into three subfactors, consistent with the original questionnaire. In the responses obtained from the participants before and after VR provocation, statistically significant differences were observed in 13 of the 16 items in the questionnaire that are related to VR provocation (p<0.05). Statistically, the differences in fatigue, dizziness, and vertigo were greater in females than in males (p<0.05). Conclusions The Turkish version of the SSQ is an effective tool for measuring the side effects in VR environments. The inclusion of the SSQ in the Turkish literature enables the inclusion of non-English-speaking participants in research, especially for disciplines that consider peripheral and central vestibular disorders.

Objective: This study aims at spotlighting different lines of management of aggressive vertebral hemangioma (VH) through a retrospective analysis of single center experience. Methods: Patients diagnosed with aggressive VHs in a tertiary referral center were reviewed from 2014 through 2024. Data of patients who met the inclusion criteria were analyzed. Patients of all ages, both sexes, and all varieties of clinical presentation were included, only patients who underwent at least one intervention were included. Results: The study included nine patients, comprising six females and three males, with a mean age of 29.3 years (ranging from 14 to 46). Six patients underwent Trans-arterial embolization (TAE), of whom five underwent further surgical procedures, while one patient found TAE to be sufficient as a stand-alone management technique. Eight patients underwent surgical management, five of whom were pre-operatively embolized. Conclusions Aggressive VHs are rare, and their management is challenging. Most cases require a multi-modal management, especially when presented with neurological deficit. Pre-operative embolization and/or vertebroplasty are safe and useful tools to decrease intra-operative bleeding of such a vascular pathology in cases undergoing open surgical procedures.

Background: Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes—such as spherical, amorphous, or spiculated tumors—can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter-based T staging and to conduct comparative survival analyses between these methods. Methods: We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test. Results: The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage. Conclusion T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.

Microangiopathic hemolytic anemia (MAHA) is a rare subtype of hemolytic anemia characterized by elevated hemolytic markers and red blood cell destruction. Though uncommon, MAHA can occur as a complication of acute pancreatitis because of the associated inflammatory response. Patients with MAHA secondary to pancreatitis show favorable outcomes when treated with plasma exchange.This paper presents the case of a patient diagnosed with acute pancreatitis-induced hemolytic anemia and thrombocytopenia, who was managed successfully with plasma exchange, steroids, and rituximab. Clinicians should maintain a high index of suspicion in patients with acute pancreatitis who present with anemia, thrombocytopenia, and schistocytes on peripheral smears, even in the absence of end-organ injuries and with normal ADAMTS13 activity. The early initiation of plasmapheresis can be lifesaving. The timely introduction of rituximab in cases where plasma exchange and steroids are insufficient, despite the ADAMTS13 activity status, may lead to better outcomes.

Testosterone extends its impact beyond sexual function, playing a crucial role in shaping overall male health, including aspects such as muscle mass, bone density, mood regulation, and energy levels. Lipoic acid, a cofactor for specific enzymes, particularly dehydrogenases involved in cellular energy production, has been studied for its impact on testosterone. This comprehensive review systematically scoured PubMed and Scopus databases using the keywords “lipoic acid” and “testosterone.” It encompassed all relevant English papers published from November 1971 to the present, including full texts and abstracts, along with research elucidating the biochemical mechanisms linking lipoic acid to testosterone. In summary, lipoic acid consistently restores testosterone levels, offering promise as an intervention in testicular health, especially in cases of testicular toxicity caused by various harmful agents. Its mechanisms encompass nitric oxide enhancement, fortification of testicular antioxidants, elevation of luteinizing hormone, enhancement of steroidogenesis, and the maintenance of energy production. These mechanisms underscore the therapeutic potential of lipoic acid for testicular health.