Ventricular septal rupture (VSR) after acute myocardial infarction (MI) is a rare yet fatal complication. Although surgical repair is essential, the optimal timing remains controversial. We report a case of ST-Elevation Myocardial Infarction (STEMI) complicated by VSR. Fibrinolytic therapy was initially considered successful; however, the patient developed worsening dyspnoea. Further evaluation confirmed an apical VSR by echocardiography. The patient received intensive monitoring and supported with an Intra-Aortic Balloon Pump (IABP). Surgical repair was performed on day 26. Hemodynamic initially improved postoperatively, but the condition deteriorated again on the ninth day after surgery, and the patient ultimately died. This case underscores that while surgical repair is the preferred definitive treatment for VSR, the timing of intervention is critical. Proper timing requires balancing surgical risks with tissue readiness and hemodynamic stability. The interval between VSR detection and surgical repair plays a pivotal role in determining patient survival.

Honey, a natural substance, has long been valued for its dual role in both food and medicine in diverse cultural traditions, particularly in traditional Chinese medicine (TCM). It is rich in sugars, amino acids, enzymes, polyphenols, and flavonoids that contribute to its antimicrobial, antioxidant, and immunomodulatory properties. Additionally, honey is effective in managing some conditions, such as antibiotic-resistant infections, inflammation, and oxidative stress-related diseases. This review explores the extensive health benefits of honey, emphasizing the homology between food and medicine, as proposed by TCM philosophy. Further, this review explores the traditional applications of honey in respiratory health, wound healing, and gastrointestinal support, along with modern scientific validation of these uses. Moreover, the role of honey as a dietary supplement, functional food, and preservative in culinary practices is examined. Overall, this review highlights the synergy between ancient wisdom and contemporary science, advocating for the continued exploration of the role of honey in health, nutrition, and medicine.

Purpose: To create a computer-aided prediction (CAP) system to predict Wilms tumor (WT) responsiveness to preoperative chemotherapy (PC) using pre-therapy contrast-enhanced computed tomography (CECT). Materials and Methods: A single-center database was reviewed for children <18 years diagnosed with WT and received PC between 2001 and 2021. Patients were excluded if pre- and post-PC CECT were not retrievable. According to the Response Evaluation Criteria in Solid Tumors criteria, volumetric response was considered favorable if PC resulted in ≥30% tumor volume reduction.Histological response was considered favorable if post-nephrectomy specimens had ≥66% necrosis. Four steps were used to create the prediction model: tumor delineation; extraction of shape, texture and functionality-based features; integration of the extracted features and selection of the prediction model with the highest diagnostic performance. K-fold cross-validation allowed the presentation of all data in the training and testing phases. Results: A total of 63 tumors in 54 patients were used to train and test the prediction model. Patients were treated with 4–8 weeks of vincristine/actinomycin-D combination. Favorable volumetric and histologic responses were achieved in 46 tumors (73.0%) and 38 tumors (60.3%), respectively. Among machine learning classifiers, support vector machine had the best diagnostic performance with an accuracy, sensitivity, and specificity of 95.24%, 95.65%, and 94.12% for volumetric and 84.13%, 89.47%, 88% for histologic response prediction. Conclusions Based on pre-therapy CECT, CAP systems can help identify WT that are less likely to respond to PC with excellent accuracy. These tumors can be offered upfront surgery, avoiding the cons of PC.

Purpose: To assess the prognostic value of the preoperative neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic immune-inflammation response index (SIRI) in patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and Methods: One hundred seven patients were retrospectively enrolled. Chi-square (χ 2 ) tests were adopted to assess the association of the inflammatory ratios and indexes to clinical risk factors. Overall survival (OS), metastasis-free survival (MFS), local, lymph node, and contralateral recurrence-free survival (RFS) were estimated by the Kaplan–Meier method and the corresponding curves were compared using log-rank test. Univariate and multivariate survival analysis were performed using general linear models to identify risk factors for prognosis. Results: NLR, MLR, PLR, SII, and SIRI were predictive of OS (p=0.024, p=0.025, p=0.004, p=0.006, and p=0.03, respectively). Besides, PLR was predictive of local (p<0.001) and lymph node RFS (p=0.014) and SII was associated to lymph node and contralateral RFS prediction (p=0.034 and p=0.023, respectively). All candidate markers adding high NLR+high MLR+high PLR combination were independent risk factors of OS. PLR was an independent risk factor of local and lymph node RFS whereas the above cited combination and NLR were independent prognosticators of local and contralateral RFS respectively. All markers were correlated to poor postoperative clinical characteristics mainly pathological grade (p<0.05). Conclusions Preoperative NLR, MLR, PLR, SII, and SIRI were associated with higher pathologic features and worse oncological outcomes in patients treated with RNU for UTUC.

The liver hanging maneuver (LHM), introduced by Belghiti et al. in 2001, has been widely adapted to various hepatectomy techniques to reduce blood loss and facilitate parenchymal transection. However, its primary limitation is the risk of vascular injury, particularly near the inferior vena cava (IVC). In this report, we describe a modified “Loop-Hanging” maneuver designed as an alternative to enhance exposure during parenchymal transection and improve the control of Glissonean pedicles. In this case, we employed the technique during an open right hemihepatectomy on a 47-year-old male patient with a complex bile duct injury following two unsuccessful Roux-en-Y hepaticojejunostomies (RYHJ). The patient was referred to our institution due to an RYHJ stricture. Imaging identified a right hepatic artery pseudoaneurysm and a fistula to the biliary limb. After two failed attempts at endovascular embolization, a surgical approach was determined through multidisciplinary discussions. During the surgery, the liver was looped with a nasogastric tube positioned anterior to the IVC, allowing gentle upward traction that facilitated the transection, minimized bleeding, and enhanced pedicle control. The LHM is known to reduce blood loss but carries risks for patients with anatomical variations, scarring, or cirrhosis.Our “Loop-Hanging” technique retains the core advantages of LHM, simplifies the process, and diminishes the risk of vascular injury.Further research is required to assess its safety and broader applicability.

Purpose: We evaluated the effectiveness of early start of long-acting insulin during management of diabetic ketoacidosis (DKA) in pediatric patients. Methods: Patients with DKA were randomly assigned to receive either a traditional DKA management protocol or concurrent administration of subcutaneous (SC) long-acting insulin alongside intravenous insulin during DKA treatment. The primary outcomes were duration of insulin infusion and adverse effects of the intervention, mainly hypoglycemia and hypokalemia. Results: For this study, 100 pediatric patients with DKA were enrolled, 50 in each group (group I received the conventional DKA management and group II received conventional DKA management plus SC long-acting insulin once daily). Patients in group II showed a significant reduction in both duration and dose of insulin infusion compared to group I, with a median (interquartile range) of 68.5 hours (45.00–88.25 hours) versus 72 hours (70.25–95.5 hours) (P=0.0001) and an insulin dose of 3.48±1.00 units/kg versus 4.04±1.17 units/kg (P=0.016), respectively. Concurrent administration of SC long-acting insulin with intravenous insulin during DKA treatment was associated with a decreased risk of hypoglycemia (number of hypoglycemia events: group I, 22 events; group II, 12 events, P=0.029), with no increased risk of hypokalemia compared to the control group (number of hypokalemia events: group I, 12 events; group II, 19 events, P=0.147). Conclusion The current study showed that coadministration of SC long-acting insulin in addition to the usual insulin infusion during DKA management in the pediatric population can lead to a shorter duration of insulin infusion. In addition, this approach is not associated with increased risk of hypoglycemia or hypokalemia. Moreover, coadministration of long-acting insulin may be associated with a decreased incidence of hypoglycemia.

Background/Aims: Biliary obstruction drainage in patients with hepatocellular carcinoma (HCC) is associated with symptom palliation, improved access to chemotherapy, and improved survival. Stent placement and exchange via endoscopic retrograde cholangiopancreatography biliary drainage risk traversing the HCC, a hypervascular tumor and causing bleeding. Endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) potentially prevents procedure-related bleeding. Therefore, we evaluated the efficacy and safety of EUS-HGS as an alternative treatment for biliary obstruction in patients with HCC. Methods: This was a retrospective study of all EUS-HGS procedures performed in patients with HCC at the Aichi Cancer Center Hospital, Japan, from February 2017 to August 2023. Results: A total of 14 EUS-HGS procedures (42.9% primary) were attempted in 10 HCC patients (mean age 71.5 years, 80.0% male). Clinical and technical success rates were 92.9% and 90.9%, respectively. The observed procedure details in the 13 successful procedures included B3 puncture (53.8%), 22-G needle (53.8%), fully covered self-expandable metal stent (100%), and mean procedure time (32.7 minutes). There was no bleeding. Mild complications occurred in 27.3%. All patients resumed oral intake within 24 hours. Conclusions EUS-HGS is a technically feasible and clinically effective initial or salvage drainage option for the treatment of biliary obstruction in patients with HCC.

Purpose: For end stage arthritis of the hip joint, total hip arthroplasty (THA) is the treatment of choice. Dual mobility (DM) liner is an implant designed to provide enhanced stability. Long-term effects and implant survivability remain areas of active research despite modern advancements in increased jump distance and dislocation reductions. The aim of this study is to understand the current research landscape and emerging trends through a bibliometric analysis of DM THA. Materials and Methods: An analysis of THA DM publications from between 1982-2022 was conducted through an extensive review of Web of Science Core Collection literature. To identify key trends, contributions, and thematic areas of focus, data on publications, authors, institutions, and countries were extracted and analyzed. Results: The bibliographic search identified 314 articles, with a notable increase in publications over the period of study. Globally, the leading contributors were France and the USA. The analysis highlighted the Journal of Arthroplasty as the most relevant journal. Research themes included mechanical complications, comparative outcomes, metallosis, and corrosion concerns. Conclusion This study provides a comprehensive DM THA research landscape overview highlighting postoperative outcome value. In an effort to guide future research, contributors, sources, and thematic trends were analyzed.

Purpose: Total hip arthroplasty (THA), a commonly performed surgical procedure for management of end-stage osteoarthritis, is considered minimally invasive and the popularity of the direct anterior approach (DAA) is increasing. The objective of this study is to analyze the current literature on DAA THA through conduct of a comprehensive bibliometric analysis. Materials and Methods: A comprehensive search of the Web of Science Core Collection was conducted for identification of articles published between 1993 and 2022. Specific keywords associated with hip replacement and the anterior approach were used as an attempt to identify articles published in scientific journals. Results: As a result of the analysis, 743 articles were linked to DAA THA. The highest number of annual publications was reported for 2021, with 120 articles, followed by 2022 with 113 articles, 2020 with 104 articles, and 2018 with 69 articles. The United States led in contributions with 34.1% in production. The Medical University of Innsbruck contributed the highest number of studies with 263 articles, followed by the University of Ottawa with 229. The Journal of Arthroplasty emerged as the most influential journal with 903 articles and 4,571 citations. Keywords including “dislocation,” “posterior approach,” and “revision” were used frequently in 2015-2020, along with the increasing emphasis on perioperative complications and comparing different approaches. Conclusion The findings of this analysis provide helpful insights into the current attitude regarding DAA THA research, highlighting emerging trends and guiding the direction of future research. The increasing scientific production reflects growing interest in DAA THA.