Endoscopic vacuum therapy (EVT) has emerged as a transformative approach for managing gastrointestinal (GI) transmural defects, offering a less invasive and more promising alternative to surgery. Initially developed to address anastomotic leaks after rectal surgery, the application of EVT has expanded to include other locations within the GI tract. This review investigated the principles, indications, procedures, outcomes, challenges, and future perspectives of EVT for the management of GI transmural defects. In conclusion, EVT has demonstrated favorable outcomes in GI defect closure, with reduced complications, shortened hospital stay, and decreased morbidity rates as compared with conventional treatments. Although EVT faces challenges in some specific anatomical locations and in managing severe complications such as major bleeding, ongoing advancements in technology and standardization efforts offer promise for broader indications and better outcomes. Future perspectives include exploring novel EVT devices, refining patient selection criteria and pre-emptive applications, and standardizing procedural protocols.

Incidental gallbladder cancer (iGBC) diagnosed post-histopathological examination of gallbladders removed assuming benign gallstone disease constitutes a significant proportion of GBC patients. Most iGBC patients present with early-stage disease. The standard care for localized (non-metastatic) iGBC includes a reoperation for complete extended (radical) cholecystectomy involving liver resection and lymphadenectomy, followed by postoperative adjuvant systemic therapy. However, a major drawback of this approach is the high recurrence rate within six months post-radical surgery, which undermines the benefits of the extensive procedure; notably, most recurrences are distant, highlighting the efficacy of systemic therapy. Similar to other gastrointestinal cancers, there appears to be a potential for neoadjuvant systemic therapy (chemotherapy) before reoperative surgery in iGBC cases. The premise that neoadjuvant systemic therapy aids in selecting diseases with more favorable biological characteristics and addresses micro-metastatic disease appears applicable to iGBC as well. This systematic review examines the current evidence supporting or refuting neoadjuvant therapy and discusses criteria for selecting patients who would derive significant benefit, along with proposing an optimal chemotherapy regimen for iGBC patients. Improved outcomes have been reported in patients undergoing reoperation after 4 to 14 weeks following the initial cholecystectomy compared to immediate reoperation. Limited, yet promising, evidence supports the use of 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy prior to reoperative surgery in select high-risk iGBC cases.

Methods: This study included 41 patients with single-level grades 1 or 2 LS from February 2023 to February 2024. Clinical outcomes were assessed using the Visual Analog Scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI). Bridwell fusion grades were evaluated via lumbar spine computed tomography performed 6 months postoperatively. Results: Over a mean follow-up period of 10.6 months (range, 7–18 months), significant improvements were observed in VAS scores for low back pain (from 7.8±0.8 to 2.1±1.4) and leg pain (from 8.1±1.3 to 1.9±1.5) as well as ODI scores (from 50.4±15.4 to 14.8±10.5). The cohort consisted of patients with grades 1 (73.2%) and 2 LS (26.8%) at L4–L5 (58.6%), L5–S1 (34.1%), and L3–L4 (7.3%) levels. The mean operation time was 182.8±36.4 minutes, with a mean intraoperative blood loss of 190.5±81.3 mL and a mean hospital stay of 7.2±3.6 days. Successful fusion (Bridwell grades I/II) was achieved in 82.9% of the cases, with a 4.9% incidence of cage subsidence. Minor complications included durotomies in two patients (4.9%), whereas no major complications, such as nerve root injury, hardware-related issues, or postoperative infections, were reported. Conclusions The described BE-LIF technique, using HA bone grafts, which are an autologous bone from the preserved IAP, and a TLIF cage, is a viable, safe, and effective option for treating low-grade LS. This approach achieves favorable clinical outcomes and high fusion rates, which provides a cost-effective alternative to advanced surgical implants.

Purpose: Corneal melanoma (CM) is a rare malignancy that develops from melanocytes within the cornea, constituting a minority of all ocular tumors. In this study, we sought to investigate the clinicopathological characteristics correlated with the prognosis of CM patients. Methods: We collected patients with CM between 1983 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards regression was used for univariate analysis to value hazard ratio of malignant CM versus spindle cell melanoma and nodular melanoma subgroups. Kaplan-Meier survival analysis and log-rank test were also performed to identify additional prognostic markers and confirm the findings of the Cox hazard ratio. Results: A total of 29 eligible patients were collected in our study. Age at diagnosis, laterality, primary site, tumor size, the extent of disease, marital status, income, residential area, and treatment showed no significant prognostic factors for CM patients (p > 0.05). However, when concerned with the primary site of malignant melanoma, spindle cell melanoma and nodular melanoma were found to show significantly poorer prognosis in CM patients (both p < 0.05). Conclusions Age at diagnosis, laterality, primary site, tumor size, the extent of disease, and treatment were not significant prognostic indicators for CM patients. Spindle cell melanoma and nodular melanoma were notable for showing worse survival outcomes than malignant melanoma. Although the sample size in the SEER database was limited, our findings may provide motivation for tailoring individualized treatments for patients with CM with different primary sites.

Bioassay-guided fractionation of the methanolic extract of Artemisia iwayomogi Kitamura led to the isolation of 12 known compounds (1‒12). Notably, this study marks the first report of 3-epimeridinol (1) being isolated and structurally characterized from a natural source. Additionally, compounds 3, 4, and 7 were isolated from the Asteraceae family for the first time. The structural elucidation of the isolated compound was achieved through analysis of 1D, 2D NMR, and MS data. Upon evaluation of their inhibitory effects against lipopolysaccharideinduced nitric oxide production, compound 12 demonstrated significant inhibitory activity with greater potency than the reference compound quercetin. These results established A. iwayomogi as a promising source of antiinflammatory agents.

We describe the treatment of a 54-year-old man with a history of methicillin-resistant Staphylococcus aureus pericarditis who presented with left ventricular pseudoaneurysm following prior left anterior thoracotomy pericardial window. Surgical intervention included pseudoaneurysm repair using a wide patch. Additionally, an attempted mitral valve repair was converted to replacement due to intraoperative findings of significant calcification of the mitral anterior leaflet and annulus, along with suspected rheumatic changes.Our report highlights the management of concurrent cardiac pseudoaneurysm and mitral annular calcification, emphasizing the role of comprehensive imaging both perioperatively and intraoperatively in achieving durable outcomes.

Purpose: Corneal melanoma (CM) is a rare malignancy that develops from melanocytes within the cornea, constituting a minority of all ocular tumors. In this study, we sought to investigate the clinicopathological characteristics correlated with the prognosis of CM patients. Methods: We collected patients with CM between 1983 and 2018 from the Surveillance, Epidemiology, and End Results (SEER) database. Cox proportional hazards regression was used for univariate analysis to value hazard ratio of malignant CM versus spindle cell melanoma and nodular melanoma subgroups. Kaplan-Meier survival analysis and log-rank test were also performed to identify additional prognostic markers and confirm the findings of the Cox hazard ratio. Results: A total of 29 eligible patients were collected in our study. Age at diagnosis, laterality, primary site, tumor size, the extent of disease, marital status, income, residential area, and treatment showed no significant prognostic factors for CM patients (p > 0.05). However, when concerned with the primary site of malignant melanoma, spindle cell melanoma and nodular melanoma were found to show significantly poorer prognosis in CM patients (both p < 0.05). Conclusions Age at diagnosis, laterality, primary site, tumor size, the extent of disease, and treatment were not significant prognostic indicators for CM patients. Spindle cell melanoma and nodular melanoma were notable for showing worse survival outcomes than malignant melanoma. Although the sample size in the SEER database was limited, our findings may provide motivation for tailoring individualized treatments for patients with CM with different primary sites.

Bioassay-guided fractionation of the methanolic extract of Artemisia iwayomogi Kitamura led to the isolation of 12 known compounds (1‒12). Notably, this study marks the first report of 3-epimeridinol (1) being isolated and structurally characterized from a natural source. Additionally, compounds 3, 4, and 7 were isolated from the Asteraceae family for the first time. The structural elucidation of the isolated compound was achieved through analysis of 1D, 2D NMR, and MS data. Upon evaluation of their inhibitory effects against lipopolysaccharideinduced nitric oxide production, compound 12 demonstrated significant inhibitory activity with greater potency than the reference compound quercetin. These results established A. iwayomogi as a promising source of antiinflammatory agents.

Objective: There is increased use of 3-dimensional (3D)-printing for manufacturing of interbody cages to create microscale surface features that promote bone formation. Those features may be vulnerable to abrasion and/or delamination during cage impaction. Our objective was to quantify loss of mass and changes in surface topography of 3D-printed titanium interbody cages due to surgical impaction. Methods: Eight surfaces of four 3D-printed titanium modular interbody fusion cages were tested. The cages were impacted into the Sawbones model with compression preload of either 200N or 400N using a guided 1-lb (0.45 kg) drop weight. Mass and surface roughness parameters of each endplate were recorded and compared for differences. Results: Significant weight loss was observed for the superior endplate group and for both 200N and 400N preloads. For pooled data comparison, significant postimpaction decreases were observed for mean roughness, root-mean-squared roughness, mean roughness depth, and total height of roughness profile. No significant differences were observed for profile skewness and kurtosis. There were significant changes in almost all roughness parameters in the anterior region of the cage postimpaction with significant changes in 2 out of 6 parameters in the middle, posterior, and central regions postimpaction. Conclusion Three-dimensional-printed titanium interbody fusion cages underwent loss of mass and alteration in surface topography during benchtop testing replicating physiologic conditions. There was an endplate- and region-specific postimpaction change in roughness parameters. The anterior surface experienced the largest change in surface parameters postimpaction. Our results have implications for future cage design and pre-approval testing of 3D-printed implants.