A 43-year-old woman presented with bilateral lower extremity weakness due to an intradural extramedullary spinal cord tumor. Surgery revealed Ewing sarcoma, a rare presentation known as primary intradural extramedullary Ewing sarcoma (PIEES). Despite initial treatment with radiation and chemotherapy, tumor recurrence occurred after 17 months. Further interventions included additional surgery, radiation, and chemotherapy. The disease progressed to leptomeningeal metastases along the spinal cord, prompting various treatments including targeted spinal radiation and systemic therapies. Brain metastases subsequently developed, necessitating whole-brain radiation and intrathecal chemotherapy. This case highlights the aggressive nature of PIEES, its potential for widespread leptomeningeal metastasis, and the challenges in its management, underscoring the need for multidisciplinary approaches in treating this rare and aggressive malignancy.

Purpose: The integration of video-based learning into surgical education highlights the need for high-quality instructional content, especially for complex procedures such as percutaneous nephrolithotomy (PCNL). This study aimed to systematically evaluate and compare the educational quality of YouTube videos demonstrating supine and prone PCNL techniques. Materials and Methods: A comprehensive YouTube search was conducted between January 6 and 19, 2025, using the keywords “supine PCNL,” “prone PCNL,” “supine percutaneous nephrolithotomy,” and “prone percutaneous nephrolithotomy.” Eligible videos were assessed using three validated scoring systems: Global Quality Score (GQS), the DISCERN instrument (a validated tool for assessing the quality of health information), and the JAMA (Journal of the American Medical Association) criteria, along with a novel tool, the PCNL-Edu Score (educational score). A total of 120 videos (60 supine, 60 prone) were included. Results: Supine PCNL videos demonstrated significantly higher DISCERN reliability scores (p=0.037), GQS scores (p=0.001), and PCNL-Edu Scores (p=0.018) compared to prone PCNL videos. Subgroup analyses showed no significant differences in educational quality based on video source (academic/individual) or video type (educational/surgical demonstration). In correlation analyses, video length positively correlated with PCNL-Edu Scores in both groups (prone: p=0.004, supine: p=0.001), whereas popularity metrics such as views (prone: p=0.069, supine: p=0.061) and likes (prone: p=0.183, supine: p=0.225) were not significantly associated with educational quality. Conclusions Supine PCNL videos currently offer superior instructional quality on YouTube. The PCNL-Edu Score provides a focused framework for evaluating surgical videos and underscores the need for standardized guidelines to improve video-based surgical education.

Purpose: Real-world evidence comparing surgical techniques for symptomatic hemorrhoidal disease (HD) remains limited, despite the availability of multiple approaches. This study aimed to evaluate short-term, interim outcomes from a prospective, nationwide cohort study that compared the effectiveness of different operative techniques based on patient-reported outcome measures (PROMs) in patients with symptomatic HD. Methods: A prospective, nationwide cohort study was conducted at 20 tertiary care centers across Turkiye between July 2022 and July 2024. Adult patients aged 18 years or older with symptomatic HD (grades I–IV) who underwent surgery during this period were included. The choice of procedure was determined by the operating surgeon, and patients were categorized into excisional, fixative, and ablative groups according to the surgical approach used. The primary outcomes were changes in the Hemorrhoidal Disease Symptom Score, Short Health ScaleHD, visual analog scale for pain, and patient satisfaction, assessed from the preoperative period to postoperative day 7 and postoperative week 6. Results: The study included a total of 315 patients after excluding those who did not fulfil the inclusion criteria. Among them, 239 (78.9%) were male, with a mean age of 43.7±11.7 years. The distribution of patients across surgical groups was 207 (65.7%) in the excisional group, 30 (9.5%) in the fixative group, and 78 (24.8%) in the ablative group. All groups demonstrated significant improvements in PROM scores from preoperative to postoperative assessments. However, no statistically significant differences were observed between groups at any time point for PROM scores or for changes in PROM scores across consecutive evaluations (P≥0.05 for all comparisons). Urinary retention occurred more frequently, and hospital stays were longer in the fixative group (P=0.006 and P<0.001, respectively). The excisional group had a greater need for narcotic use and longer duration of use (P=0.003 and P<0.001, respectively). Conclusion This real-world cohort study shows that all 3 surgical approaches are effective for HD, providing comparable short-term symptomatic relief and patient satisfaction. These techniques appear equally valid treatment options, and the choice of procedure may best be individualized based on patient-specific characteristics and surgeon preference.Trial registration: ClinicalTrials.gov identifier: NCT05429060

Introduction: Corona Mortis (CMOR) is a term used to describe an anatomical vascular variant of retropubic anastomosis located posterior to superior pubic ramus. We aim to provide sufficient data on the incidence, morphology and mean location of ‘crown of death’ in Asian population. Other objectives include to assess the relationship between CMOR incidence with gender, race and age. Materials and methods: This is a cross-sectional cadaveric study involving 164 randomly selected fresh multiracial Asian hemipelves (82 cadavers). Hemipelves were dissected to expose and evaluate the vascular elements posterior to superior pubic rami. Data were analysed using Chi-Square, ttest and with the help of IBM SPSS Statistics v26 software. Results: CMOR was found in 117 hemipelves (71.3%). No new morphological subtype was found. The mean distance of CMOR to symphysis pubis was 54.72mm (SD 9.35). Based on the results, it is evident that precaution needed to be taken at least within 55mm from symphysis pubis during any surgical intervention. The lack of statistically significant correlation between CMOR occurrence and gender, race and age suggest that the incidence of CMOR could be sporadic in manner. Conclusion: We conclude that CMOR is not just aberrant vessel as the incidence is high and this finding is comparable to other studies. The mean location of CMOR obtained in this study will guide surgeons from various disciplines in Asia to manage traumatic vascular injury and to perform a safe surgical procedure involving the pelvis area.

Background: The effects of housing conditions on animal physiology, behavior or stress are still debated. The aim of this study was to investigate the effects of three different housing systems, individually ventilated cages (IVC), classical small cages with floor surface area of 500 cm2 (CC500) and classical large cages with floor surface area of 800 cm2 (CC800) on body weight, sensory-motor performances, depression-like behavior, plasma corticosterone and brain oxidative stress parameters in C57BL/6 mice. The mice housed in one of the cages from birth to 6 months of age. Hang wire and adhesive removal tests were performed to evaluate somatosensory and motor performances. The extent of depression was determined by the forced swim test. Blood corticosterone levels were measured. In addition, brain malondialdehyde (MDA), total antioxidant status (TAS) and total oxidant status (TOS) levels were analyzed. Results: The depression-like behavior of the groups was similar. Although there were no significant differences in hang wire test among groups, CC500 group required longer durations in adhesive removal test. The body weight and plasma corticosterone levels of CC800 group were significantly higher than other groups. The oxidative stress parameters were highest in CC500 cage. Conclusions Our study showed that the least stressful housing condition was IVC cage systems. Interestingly, the number of mice in the classical cages had a significant effect on stress levels and sensory-motor performance.

During the coronavirus disease 2019 (COVID-19) pandemic, the worldwide medical education system was affected tremendously due to the suspension of clinical activities and lockdown to prevent the spread of the disease. The delivery of clinical training was modified to alternative methods including online classrooms, recorded video, use of simulated patients and hybrid teaching. Several institutions worldwide chose to postpone their scheduled examination, which requires physical attendance or opted for virtual examination. Malaysian centralised postgraduate orthopaedic exit examination was postponed in 2020 and later recommenced in 2021 with three different centres across the country: north, east and central Malaysia. This article describes the preparation and challenges faced in conducting a face-to-face clinical exit examination for postgraduate orthopaedic candidates in Universiti Putra Malaysia in May 2021, during the Conditional Movement Control Order phase. The examination was a success, and no outbreak of COVID-19 was reported from the event.

MANAGEMENT OF PERIPHERAL OSSIFYING FIBROMA IN AN ADOLESCENT: A CASE REPORT Introduction: Peripheral ossifying fibroma (POF) makes up between 2-9% of all gingival lesions and a third of all localized hyperplastic gingival lesions. It is commonly seen in the anterior segment of both maxilla and mandible. Case report: This case describes the management of peripheral ossifying fibroma (POF) associated with tooth displacement affecting the anterior segment of the maxilla of a 15-year-old boy. Complete surgical removal was done followed by the placement of a BIPP dressing at the surgical site. The post-operative clinical outcome was successful whereby the pathologically displaced tooth erupted into the arch spontaneously and was well-aligned without the need for any orthodontic treatment. Conclusion: Complete removal of POF lesion followed by good oral hygiene maintenance ensures a favourable outcome and no evidence of recurrence.

THE USE OF HYPNOSIS AS AN ADJUNCT TO NITROUS OXIDE/OXYGEN SEDATION: A CASE SERIES It is known that managing patients with dental fear and anxiety is challenging for clinicians and patients. This series of case reports highlights the importance and benefits of dental management under clinical hypnosis as an adjunct to nitrous oxide inhalation sedation for ages six to fifteen. These treatments range from pulp therapy, extraction and minor oral surgery. Customised hypnosis scripts were utilised for each patient, and the metaphors used were tailored to the patient’s interest and preference. The intended treatment was successfully carried out in all the patients. Five cases discussed in this case series were initially indicated for treatment under general anaesthesia, but treatment was successfully carried out using hypnosis and nitrous oxide/oxygen sedation. In the two surgical cases, nitrous oxide was tapered off once local anaesthesia was achieved, and the state of relaxation was maintained using a hypnotic trance, reducing the anaesthetic agent’s utilisation. Hypnosis successfully reduces patients’ anxiety, allowing them to feel more relaxed and confident about accepting future dental treatment without the need for pharmacological intervention.

INTERPRETATION OF EMOJI® IN MALAY LANGUAGE AMONG CHILDREN IN MALAYSIA The existing dental anxiety scales for paediatric patients tend to categorize and label children according to their level of cooperation. However, human emotions are more complex, and each child is unique. Hence, a more dynamic and interactive method should be introduced for a better understanding of the patient’s current state of emotion. The aim of this study was to investigate the interpretation and understanding of children towards frequently used emoji® for the development of an emoji® dental emotional spectrum. Both online and physical surveys were conducted among 147 Malay language-speaking children aged between 4-to-16 years in Malaysia. The children were asked to interpret 30 pre-selected emoji® images in their own words using the Malay Language. The pre-selected emoji® represent happiness, neutral, fear, sadness, and anger. The interpretations were subsequently based on their similar meaning, a process that was validated by two experts in the field of linguistics. The study involved participants with an average age of 9.2 years, with the majority of them being female (61.2%). Of the 30 pre-selected emoji® images used in this study, 13 had respondent agreement exceeding 60% which was the threshold set for suitability for use in evaluating dental emotion. The remaining 17 emoji® images have a remarkable variability in the interpretation which indicates potential misinterpretation by the respondents. The 13 emoji® images range from happiness, neutral, fear, dislike, unhappy, sad, anxious, and angry with the emoji® images which represent “excited” (94.0%), “loudly crying” (97.3%) and “angry” (91.8%) had the highest agreement. Meanwhile, the emoji® images represented “confounded” and “downcast” had the least agreement among respondents (1.3%). Despite the universal meaning imposed by emoji®, the interpretations may vary in different populations and age groups. Emoji® images hold the potential to serve as a valuable tool for identifying and managing children’s behaviour.