Abstract: Background: Cervical anastomosis is widely used in esophageal cancer surgery. Although thoracic inlet size has been associated with anastomotic complications in retrosternal reconstruction, their relevance in posterior mediastinal (PM) reconstruction remains uncertain. This study evaluated whether thoracic inlet dimensions influence postoperative outcomes after cervical anastomosis performed through the PM route. Methods: A retrospective review was conducted on patients who underwent PM reconstruction between January 2021 and March 2025. Preoperative computed tomography was used to measure interclavicular distance (ICD), sterno-vertebral distance (SVD), and thoracic inlet area (TIA). Demographic, operative, and postoperative variables were analyzed. Univariable comparisons were performed according to postoperative mortality, and multivariable logistic regression was used to assess the independent association between TIA and mortality. Results: Sixty-seven patients were included. Postoperative complications occurred in 20 patients (29.9%), and anastomotic leakage was observed in 10 (15.0%). Overall mortality was 13.4% (n = 9). Among non-survivors, 6 patients (66.7%) had anastomotic leakage, compared with 4 of 58 survivors (6.9%). Thoracic inlet area was significantly lower in non-survivors than in survivors (median 513.5 vs 703.3 mm², p = 0.012). In multivariable logistic regression analysis adjusted for age, ASA classification, and sex, TIA demonstrated an inverse association with mortality (OR 0.996, 95% CI 0.992–1.000, p = 0.060), although statistical significance was not retained after adjustment. Conclusions: A smaller thoracic inlet area was associated with increased postoperative mortality after PM esophagectomy. The markedly higher rate of anastomotic leakage among non-survivors suggests that leakage may represent an important clinical pathway linking thoracic inlet geometry to adverse outcomes. Larger multicenter studies are needed to validate the prognostic relevance of thoracic inlet anatomy in PM reconstruction.

Abstract: Pregnancy-associated breast cancer (PABC) is a rare but increasingly encountered clinical entity, largely driven by delayed childbearing, and poses significant diagnostic and therapeutic challenges due to physiological breast changes and concerns regarding fetal safety. This narrative review aims to synthesize current evidence on the epidemiology, clinical presentation, diagnostic strategies, surgical management, systemic therapy, obstetrical considerations, and emerging applications of artificial intelligence in PABC. A comprehensive literature search was conducted across major databases, prioritizing recent studies, international guidelines, and large cohort analyses. Available evidence indicates that PABC is frequently diagnosed at a more advanced stage, partly due to delayed recognition. Ultrasound represents the first-line imaging modality, while mammography with shielding and selected MRI protocols may be safely used for staging. Surgical treatment is feasible during pregnancy, and anthracycline-based chemotherapy, with selected taxanes, can be administered during the second and third trimesters with acceptable maternal and fetal outcomes. In contrast, radiotherapy and most targeted therapies are deferred until postpartum. Obstetrical management should aim to avoid iatrogenic prematurity while ensuring adequate fetal monitoring. A multidisciplinary, trimester-adapted approach remains essential, although further prospective studies are required to address existing evidence gaps and optimize long-term outcomes.

Abstract: Background: Risk stratification in cardiac surgery has long depended on logistic regression models built from a fixed set of preoperative variables an approach that, while extensively validated, cannot capture the complexity of real patient physiology. Deep learning (DL) offers a fundamentally different paradigm, one capable of detecting non-linear interactions across high-dimensional datasets. We conducted this systematic review and meta-analysis to quantify whether that theoretical advantage translates into measurably better prediction of postoperative mortality after cardiac SurgeryMethods: We searched PubMed/MEDLINE, Embase, and IEEE Xplore following PRISMA 2020 and Cochrane Prognosis Methods Group guidelines. Eligible studies directly compared DL architectures against established risk scores namely EuroSCORE II or STS-PROM for short-term mortality in adult cardiac surgery populations. Methodological quality was assessed with PROBAST+AI. Because raw AUC values are bounded and violate normality assumptions required for standard pooling, all estimates were logit-transformed prior to meta-analysis using a restricted maximum likelihood random-effects model.Results: Six studies met inclusion criteria, representing 250,560 patients across markedly different clinical settings. Deep learning models shows to have achieved a pooled AUC of 0.856 (95% CI: 0.774 - 0.913). This came with a caveat: between-study heterogeneity was substantial (I² = 91.3%), reflecting the diversity of architectures, cohort sizes, and institutional contexts included. Traditional risk scores yielded a pooled AUC of 0.815 (95% CI: 0.754–0.864; I² = 77.9%).Conclusion: DL models outperform conventional risk scores on discrimination. The gap, however, sits alongside serious unresolved questions heterogeneity is high, calibration data are largely absent from the primary literature, and most evidence comes from retrospective single-centre cohorts. Standardized reporting frameworks are a prerequisite, not a recommendation, before these models enter routine clinical practice.

Abstract:

Background: In non-obese patients with type 2 diabetes mellitus (T2DM), metabolic surgery is often limited by the unexpected inconsistent outcomes. Although pylorus-preserving gastric bypass procedures have been widely adopted, incomplete foregut exclusion frequently results in unsatisfactory glycemic control or relapse. To address this limitation, we propose Single Anastomosis Pyloro-Enterostomy (SAPE), designed to achieve complete duodenal exclusion while maintaining pyloric sphincter function. Methods: Based on long-term clinical observation and analysis of incretin dynamics, SAPE was developed as a loop-type single-anastomosis configuration incorporating a sufficiently long biliopancreatic (BP) limb. The duodenal tissue attached to the pyloric ring is completely removed, and the small intestine is anastomosed directly to the pylorus using interrupted sutures to preserve sphincteric motility. Anatomical design was guided by evidence from enteroendocrine physiology, epithelial-mesenchymal crosstalk, and reprogramming of regional intestinal identity after anastomosis. Results: Compared with pylorus-preserving duodenal-jejunal bypass (DJB) and other incomplete foregut-excluding procedures, SAPE theoretically enables more profound and durable suppression of a key diabetogenic signal originating from the proximal small intestine. The combination of complete duodenal exclusion and an adequately long BP limb minimizes the re-expansion of proximal epithelial identity and maintains long-term glycemic improvement without compromising digestive continuity or nutritional status. Conclusion: SAPE may provide a physiologically optimized surgical framework for the treatment of non-obese T2DM by integrating anatomical precision with metabolic efficacy. This technique ensures complete foregut exclusion, preserves pyloric function, and potentially prevents enteroendocrine reprogramming associated with late glycemic relapse. Further clinical evaluation is warranted to confirm its metabolic and functional outcomes.

Abstract: Nipple-sparing mastectomy (NSM) with immediate implant-based breast reconstruction (IBBR) optimizes aesthetic outcomes, yet transection of intercostal sensory nerves commonly results in persistent nipple-areolar complex (NAC) anesthesia and, in some patients, denervation-related symptoms. NAC neurotization has emerged as an intraoperative strategy intended to improve protective sensation and potentially erogenous sensation by reconnecting donor intercostal nerves to the retroareolar plexus or to targets within the nipple. Here, we provide an anatomy-first narrative synthesis of the medial and lateral sensory corridors, with emphasis on the lateral cutaneous branches of T3–T5 and the reported anatomical landmarks that facilitate donor identification during NSM. We then review the biological constraints governing regeneration across the long trajectories typical of IBBR, including evidence suggesting reduced performance of acellular nerve allografts with increasing gap length and the rationale for autologous nerve transfers. Technical approaches are organized by (i) donor selection and harvest depth, (ii) graft choice, and (iii) distal coaptation strategies ranging from subareolar stump coaptation to targeted NAC reinnervation and direct nipple neurotization techniques. We also summarize the current clinical evidence regarding sensory recovery kinetics, safety and complications, operative time and cost, and propose practical checkpoints for intraoperative decision-making and standardized postoperative assessment. Collectively, available data support NAC neurotization as a feasible adjunct to NSM-IBBR, while highlighting the need for harmonized outcome reporting and longer follow-up to define comparative effectiveness among techniques.

Abstract: Soft tissue reconstruction often requires biomaterials that provide temporary mechanical support while allowing vascular integration and tissue remodeling. In reconstructive breast surgery, these demands converge within a uniquely challenging environment characterized by large surface areas, variable perfusion, frequent exposure to radiation, and reliance on prosthetic implants. As a result, breast reconstruction has emerged as a clinically relevant model for evaluating the performance and limitations of soft tissue scaffolds. Acellular dermal matrices (ADM) were initially adopted to provide biologically derived reinforcement based on the premise of host integration and neovascularization. While ADM reshaped implant-based reconstruction, accumulating clinical experience has revealed important constraints, including variability in mechanical properties, inconsistent vascularization, susceptibility to fibrosis, and limited performance in compromised tissue beds. These limitations have driven increasing interest in synthetic polymer scaffolds engineered for predictable mechanics, controlled degradation, and scalable manufacturing. This narrative review examines the evolution from ADM to synthetic and hybrid scaffold systems in breast reconstruction. We discuss how scaffold architecture, thickness, porosity, and degradation kinetics influence angiogenesis, immune response, and mechanical load transfer during healing. Hybrid strategies that integrate selective bioactivity within synthetic frameworks are also considered, highlighting both their translational promise and practical challenges. These concepts are particularly relevant for implant-based breast reconstruction, where scaffold performance directly influences complication rates, implant stability, and long-term reconstructive outcomes.

Abstract: Background/Objectives: Proximal phalangeal fractures account for 38% of all phalangeal fractures, with unstable patterns requiring surgical intervention. Various modalities have been explored, including open reduction and internal fixation, percutaneous K-wire fixation, and intramedullary techniques. This study explores the technical nuances, indication, and outcomes of antegrade cannulated compressive screw (CCS) fixation of proximal phalangeal fractures. Methods: This retrospective case series involved 18 closed proximal phalanx fractures in 16 patients who underwent intramedullary headless screw fixation between January 2018 and December 2023. Records were reviewed for demographics, fracture characteristics, and screw type. With the metacarpophalangeal joint flexed at 60°–75°, a 1 cm longitudinal incision was made, the extensor tendon split, and a 0.9 mm guidewire advanced anterogradely along the phalangeal axis under fluoroscopy. A 2.2 mm or 3.0 mm SpeedTip CCS (Medartis, Basel, Switzerland) was selected based on phalanx size and advanced until fully buried below the cartilage line. Postoperatively, patients were immobilized in a volar intrinsic-plus splint, transitioned to a gutter splint within five to seven days, and commenced on range of motion exercises within one week. Primary outcomes included radiographic union, TAM, QuickDASH scores, and postoperative complications. Results: All fractures were healed within acceptable radiological parameters and with no postoperative complications. Mean TAM was measured to be 216° ± 7.7° (range 200°-230°) and mean QuickDASH was 10.1 ± 3.8 (range 5-16). Conclusions: Antegrade intramedullary headless screw fixation is a safe and effective technique for unstable proximal phalanx fractures yielding excellent functional outcomes with early mobilization and minimal complications.

Abstract: Objective: Intraoperative biopsy in perforated gastric ulcers has traditionally been widely used to exclude the risk of malignancy. However, despite accumulating evidence in recent years indicating a low incidence of malignancy, it remains unclear to what extent this approach has been adopted by surgeons. This study aimed to evaluate the attitudes of general surgeons in Türkiye toward intraoperative biopsy in perforated gastric ulcers and to identify the factors influencing this decision. Materials and Methods: This descriptive, cross-sectional survey study was conducted among actively practicing general surgeons across Türkiye. A total of 361 surgeons were included. The survey included demographic data, biopsy practices in perforated gastric ulcers, preferred surgical approaches, and postoperative endoscopy planning. Multivariable logistic regression analysis was performed to determine factors associated with routine intraoperative biopsy. Results: The mean age of participants was 41.4±10.3 years, and the mean duration of surgical experience was 12.8±9.7 years. Only 24.2% of surgeons correctly estimated the current malignancy risk (<5%) in perforated gastric ulcers; 102 participants did not provide a quantitative estimate. Among respondents, 52.9% reported performing routine biopsy, 42.9% selective biopsy, and 4.2% no biopsy. In multivariable analysis, age, surgical experience, and perceived malignancy risk were associated with routine biopsy; however, these relationships did not reach independent statistical significance. The vast majority of participants (87.0%) recommended postoperative endoscopy. Conclusion: In Türkiye, intraoperative biopsy in perforated gastric ulcers continues to be widely practiced despite the low malignancy rates reported in contemporary literature. Surgeons’ biopsy decisions are largely influenced by perceived malignancy risk, experience, and traditional clinical approaches. These findings suggest that an evidence-based strategy relying on selective biopsy and planned postoperative endoscopy, rather than routine intraoperative biopsy, should be more effectively integrated into clinical practice.

Abstract: Background: Haematological derangements, including thrombocytopenia are common in burn patients and are usually attributed to SIRS or sepsis. However, rare haematological malignancies may present with similar laboratory findings, posing a diagnostic challenge. We report a case of a patient with a minor burn injury managed at home who presented six days post-injury with bicytopenia, leucocytosis and active bleeding. Initial differentials included sepsis, DIC, NSAID-induced gastrointestinal bleed, and toxic shock syndrome, with malignancy not initially suspected due to low incidence. Methods: This case is a retrospective view on the patients clinical notes, blood investigations , surgical investigation and documentation of their management. Results: Subsequent evaluation revealed Acute Promyelocytic Leukaemia (APL), a rare but potentially curable subtype of Acute Myeloid Leukaemia and this was the cause of the patient’s bleeding tendency. This poses the question of whether a blood smear should be done routinely for haematological abnormalities in burns patients too. Conclusion: Muganza et al [1] demonstrated that platelet decline predicts poor outcomes in severe burns, while prior malignancy increases sepsis risk [3]. This case highlights the importance of considering haematologic malignancy in atypical presentations and the potential value of routine peripheral blood smear screening in patients with persistent cytopenias. Derangements in blood counts should be investigated broadly, without the assumption of infection as the sole cause, as prompt diagnosis and treatment of conditions like APL can substantially improve clinical outcomes, even in critically ill patients.

Abstract: Background: Short bowel syndrome (SBS) is a severe form of intestinal failure often associated with high output jejunostomy, fluid and electrolyte imbalance, and long-term dependence on parenteral nutrition (PN). In patients with type I SBS, restorative surgery may reduce PN dependence and enable conversion to type II or III SBS through restoration of intestinal continuity. Methods: We report our single-center experience. Between 2018 and 2025, nine adult patients with chronic type I SBS and high output jejunostomy underwent restorative surgery within a multidisciplinary intestinal rehabilitation program. All patients were PN-dependent preoperatively, and two had intestinal failure-associated liver disease (IFALD). Surgical strategies were individualized according to residual anatomy and focused on restoration of intestinal continuity, without bowel lengthening procedures. Clinical outcomes were descriptively analyzed. Results: Intestinal continuity was successfully restored in all patients, resulting in conversion from type I to type II or III SBS. A clinically relevant improvement in intestinal function was observed in all cases. Complete enteral autonomy was achieved in three patients, while the remaining patients experienced a meaningful reduction in PN requirements, including partial or nocturnal supplementation. Five of nine patients developed postoperative complications: one required reoperation and one endoscopic treatment for anastomotic bleeding. No perioperative mortality was recorded. Conclusions: In adult patients with type I SBS, restorative surgery enables anatomical and functional conversion to type II or III SBS. When performed within specialized multidisciplinary programs and guided by careful management of hostile abdomen, this approach may result in significant functional improvement and reduced PN dependence.

Abstract: Background: Robot-assisted surgery has become increasingly used across multiple specialties; however, its integration into aesthetic plastic surgery remains limited. Individualized patient requirements, such as concealed scar placement, superficial soft tissue dissection, and patient-specific docking angles, are major challenges to their adoption, unlike in other specialties. This review aimed to evaluate the current use of robotic systems in plastic surgery, with a particular focus on aesthetic procedures, operative outcomes, and existing technological limitations. Methods: Multiple databases, including PubMed, Scopus, and Google Scholar, were systematically searched to identify studies published between 2011 and 2026. Data on robotic platforms, operative duration, rehabilitation outcomes, and aesthetic indications were extracted and analyzed. Robotic systems such as da Vinci, Symani, MUSA, and ARTAS demonstrated feasibility across reconstructive subspecialties. However, their clinical application remains limited, as purely aesthetic procedures are rare, highlighting a significant lack of standardized docking methods and dedicated instruments. Results: The data showed that robotic platforms offer great advantages, such as precision and minimally invasive access; however, their high costs, bulky instrumentation, and limited docking methods are hurdles for their adoption in aesthetic surgery. Conclusions: Robot-assisted aesthetic plastic surgery remains in an early developmental stage. Further research is required to establish reproducible docking standards and expand its clinical indications. Advancements in single-port systems, artificial intelligence integration, and surgeon training will facilitate broader clinical implementation.

Abstract: Objective To biomechanically and clinically compare a novel locking screw–intramedullary pin system with dynamic cross pinning for stabilization of supracondylar femur fractures in dogs. Materials and Methods Thirty-six canine cadaveric femora were randomly allocated into two groups (n = 18 each). Group I was stabilized using dynamic cross pinning, and Group II using the novel locking screw–intramedullary pin system. A standardized transverse supracondylar osteotomy was created. Constructs were subjected to axial compression and three-point bending until failure. Ultimate load to failure and displacement at failure were recorded. Torsional testing was attempted; however, rotational slippage prevented meaningful torque analysis. Clinically, twelve client-owned dogs (< 20 kg) with supracondylar femoral fractures were randomly assigned (n = 6/group). Primary clinical outcome was weight-bearing score at 60 days. Secondary outcomes included pain score, inflammation score, joint range of motion, implant stability, and radiographic callus formation. Results Group II constructs demonstrated significantly higher ultimate load to failure under axial compression and three-point bending compared with Group I (p < 0.05). In the clinical cohort, dogs treated with the locking screw–intramedullary pin system showed significantly improved weight-bearing, earlier restoration of joint motion, fewer implant-related complications, and more consistent radiographic healing at 60 days (p < 0.05). Conclusion The locking screw–intramedullary pin system demonstrated greater resistance to axial and bending loads in vitro and was associated with improved short-term functional outcomes compared with dynamic cross pinning in growing dogs. Further studies with larger sample sizes and validated torsional testing are warranted.

Abstract: Background: Cervical radiculopathy from vertebral artery loop formation (VALF) is rare; this case highlights endoscopic management after conservative failure. Methods: Clinical case about VALF treated by posterior decompression was reported. And literature review was conducted to identify studies investigating surgical treatments for a VALF. Case description: A 69-year-old woman had 4-month right C5 radiculopathy (neck pain, arm radiation, Spurling-positive) due to VALF at C4-5 confirmed by MRI and CT angiography. After failed conservative treatment, full-endoscopic posterior foraminotomy was done; symptoms resolved at 3 months. Conclusions: Clinicians should be aware that vertebral artery loop formation, although rare, is an important potential cause of cervical radiculopathy. In suspected cases, the vertebral artery should be carefully evaluated with MR or CT angiography to confirm the presence of a loop formation. Full-endoscopic posterior foraminotomy safely resolves VALF-induced radiculopathy, avoiding vascular risks of open approaches.

Abstract: Zone 2 thoracic endovascular aortic repair (TEVAR) frequently requires left subclavian artery (LSA) preservation to maintain vertebrobasilar and upper-extremity perfusion while obtaining a durable proximal seal. Dedicated single-branch endografts were de-veloped to standardize this step and to convert a traditionally hybrid scenario into a reproducible fully endovascular strategy. Two different concepts currently dominate this field: integrated unibody branch platforms, represented by Castor and the sec-ond-generation Cratos, and modular retrograde-branch systems, represented by the Gore TAG Thoracic Branch Endoprosthesis (TBE). The Castor/Cratos evidence base is broader, older, and much more heavily weighted toward type B aortic dissection, including long-term prospective multicenter data and several large real-world cohorts with fa-vorable branch patency and aortic remodeling. By contrast, TBE evidence is expanding rapidly and is supported by prospective midterm data in arch aneurysms as well as by increasingly large post-commercial series and comparative analyses across zones 0–2. Beyond outcomes, the two platforms differ substantially in branch directionality, con-tribution to proximal fixation, modularity, branch diameter range, proximal landing requirements, access profile, and regulatory/off-the-shelf availability, all of which have direct consequences for anatomical suitability in dissection, aneurysm disease, and trauma. This narrative review synthesizes current evidence and proposes an anato-my-first, pathology-aware framework for selecting between Castor/Cratos and TBE in totally endovascular zone 2 TEVAR with LSA revascularization.

Abstract: Reconstruction in head and neck surgery requires restoration of complex functions, including speech, swallowing, and breathing, while preserving as much facial form and patient identity as possible. Over the past decade, advances in preoperative digital planning, intraoperative technologies, and robotic platforms have reshaped reconstructive strategies, giving rise to the concept of hybrid reconstruction. Hybrid approaches integrate free tissue transfer with computer-aided design and manufacturing, virtual surgical planning, intraoperative navigation, and robot-assisted microsurgery to enhance precision, reproducibility, and functional outcomes. This narrative review examines the principles and applications of hybrid reconstruction in head and neck surgery with particular emphasis on osseous reconstruction of the mandible, maxilla, and midface. The roles of intraoperative navigation and robotic assistance as enabling tools are discussed, along with their potential benefits and current limitations. Functional and morphologic outcomes, patient-reported quality of life, and challenges related to cost, access, training, and evidence heterogeneity are critically reviewed. Hybrid reconstruction represents an advancement toward outcomes-driven, patient-centered care; however, thoughtful integration of emerging technologies and continued emphasis on rigorous outcome assessment are essential to guide responsible adoption in contemporary head and neck reconstructive surgery.

Abstract: Acute appendicitis is the most common surgical emergency. Due to its variable clinical presentation, diagnosis can be challenging, often leading to unnecessary imaging or surgery. The François score, a simple clinico-biological tool, aims to stratify patients by diagnostic probability. Objective: To evaluate the diagnostic accuracy of the François score in patients presenting with suspected acute appendicitis at the General Surgery Department of Habib Bougatfa Hospital, Bizerte, Tunisia. Methods: A prospective co-hort study evaluating diagnostic performance was conducted from October 2021 to April 2022. Patients aged over 15 years admitted for suspected acute appendicitis were included. The François score was calculated using predefined clinical and laboratory variables. Final diagnoses were based on histopathology or imaging. Diagnostic per-formance (sensitivity, specificity, predictive values, ROC curves) was analyzed. Re-sults: A total of 139 patients were included. The mean François score was 0.58±4.31. Appendicitis was confirmed in 128 patients (92.1%). A score ≥2 was significantly asso-ciated with acute appendicitis (OR = 8.29; p = 0.024). A score ≤ -6 was inversely corre-lated with appendicitis (OR = 0.004; p < 0.001). The score demonstrated an Area Under the Curve (AUC) of 0.90. At a cut-off of -6, the score yielded a sensitivity of 99.2% and a negative predictive value of 87.5%. The score stratified patients effectively, reducing unnecessary imaging and surgery. Conclusion: The François score is a reliable, low-cost diagnostic tool for evaluating suspected acute appendicitis. It can aid clini-cians in triaging patients and optimizing the use of imaging or surgical exploration.

Abstract:

Background and Objectives: Postoperative pain and intra-abdominal adhesions are common complications following surgery. Pain delays early mobilization, whereas adhesions can lead to bowel obstruction, chronic pain, or infertility. Current treatments, including systemic analgesics and physical barrier methods, are only partially effective. We hypothesized that combining these modalities would yield superior outcomes. Accordingly, we investigated whether a lidocaine-loaded alginate–carboxymethyl cellulose–polyethylene oxide (ACPE) electrospun film could more effectively reduce both postoperative pain and adhesion formation than either component alone. Materials and Methods: An electrospun nanofiber film composed of ACPE containing lidocaine was prepared. Its effects were evaluated in rats using an incisional pain and a peritoneal adhesion model. Four groups were compared: saline control, free lidocaine, drug-free ACPE film, and lidocaine-loaded ACPE film. Fifteen rats were allocated to each group. The primary outcome was the mechanical withdrawal threshold (MWT) after plantar incision, while secondary outcomes included histological changes and adhesion scores assessed by the Moreno system. Results: The lidocaine–ACPE film significantly increased MWT compared with all other groups, demonstrating a stronger and longer-lasting analgesic effect than free lidocaine. Adhesion scores were also lowest in the film group. Histological analysis confirmed a reduction in inflammatory cell infiltration and collagen deposition. Conclusion: A lidocaine-loaded ACPE nanofiber film effectively reduced both postoperative pain and adhesion formation in a rodent model. The combination of sustained local drug release and physical barrier function provides a promising strategy to address two major postoperative complications. Further preclinical studies are warranted before clinical application.

Abstract: Abstract Background: Acute appendicitis in girls presenting with lower abdominal pain repre-sents a frequent diagnostic dilemma, given the overlap in clinical presentation with gynecological and non-surgical causes. This study aimed to evaluate the diagnostic performance of IL-6 and CD64 and to compare them with classical inflammatory markers and the Alvarado score. Methods: We conducted an observational case–control study over a three-year period (December 2022–December 2025) at the First University Paediatric Surgery Clinic (General Hospital of Thessaloniki “Georgios Gen-nimatas”). Consecutive girls aged ≤16 years presenting with lower abdominal pain were included. The primary outcome was the presence of appendicitis (yes/no), defined by the final clinical diagnosis and, where applicable, intraoperative and/or histo-pathological confirmation. Diagnostic performance was assessed using ROC curves/AUC with 95% confidence intervals estimated by the DeLong method. The prespecified primary model was a logistic regression including the Alvarado score and log1p(IL-6). Results: Of 74 initially assessed cases, one was excluded (appendiceal neuroendocrine tumour, NET G1), yielding a final sample of 73 girls: 37 with appendi-citis and 36 without appendicitis. IL-6 was higher in the appendicitis group (median 19.41 vs 4.10 pg/mL) and showed moderate discrimination (AUC 0.696). CRP showed lower/borderline performance (AUC 0.595), whereas CD64 did not demonstrate useful discrimination (AUC 0.521). The Alvarado score had the highest discriminatory ability (AUC 0.885). Adding IL-6 to the Alvarado score did not materially improve the AUC in the common subset. Conclusions: IL-6 demonstrates moderate diagnostic perfor-mance as a standalone biomarker and may be useful as an adjunct, particularly when a clinical score is unavailable or unreliable. CD64 did not add diagnostic information in this setting. Larger, prespecified studies are required to identify clinically useful cut-offs.

Abstract: Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of IONM, hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Retrospective analysis of prospectively documented data from a clinical quality assurance registry from June 2015 to May 2016 with a 12-month follow-up of all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ENT specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruiting from June 2015 to May 2016) and structured telephone interviews every 4-6weeks to assess the exact time course of PT-VCD recovery and VC status for periods of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6/2015 - 5/2016 there were 1097 consecutive thyroid procedures. During this period, there were 78 PT-VCD (1591 nerves at risk (NAR); 4,9 %) entered into the detailed follow-up-program. Of these, 3 PT-VCD persisted at 12 months (PT-VCD 0,18 % NAR), with 6 LOF (maximum rate of potentially persisting PT-VCD of 0,54% NAR). 15% of PT-VCD recovered within 4 weeks, mean recovery time was 4.4 months and 6 months after thyroidectomy 18 % still had impaired VC laryngoscopy tests. Individual cases were followed > 12 months showing late full recovery of PT-VCD, challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks 0.39 (95%CI 0.15-0.98), p= 0.046) and more specific, secondary ntLOS to be a significant independent predictor of PT-VCP recovery > 12 weeks (OR for recovery within 12 weeks 0.303 (95%CI 0.115-0.797), p= 0.016). Conclusion: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort and a correlation with operative data and IONM. We found that recovery takes a long time and non-transitory loss of signal – especially secondary ntLOS - during IONM was associated with prolonged PT-VCD recovery. Therefore, IONM provides an additional benefit and early initiation of speech therapy may be advisable for these patients.

Abstract:

Background: Mesh implantation is the standard of care in hernia repair. However, penetrating suture fixation may contribute to chronic pain and tissue irritation. This pilot study evaluates the feasibility of a hybrid fixation technique using a biodegradable UV-curable adhesive biomaterial in inguinal hernia repair.Methods: Ten male patients (20-40 years) with unilateral inguinal hernia underwent open repair and were allocated into two groups (n = 5 each): hybrid fixation approach (part of the mesh was secured conventionally and the remaining portion was stabilized with an experimental adhesive UV-curable biomaterial within 3 minutes) and conventional mesh fixation. Pain (VAS) and patient-reported outcomes (CCS, EuraHS QoL, SF-36) were assessed at day 1, day 8, 6 weeks, 12 months, and 24 months. Ultrasonography and thermography were analysed when available as exploratory assessments.Results: The adhesive-assisted partial self-stabilization reduced operative time compared with conventional fixation (52.0 ± 3.1 vs 60.2 ± 3.7 min). Postoperative pain (VAS) in the hybrid group decreased from 2.6 ± 0.55 on day 1 to 0.8 ± 0.84 on day 8, with complete resolution by 6 weeks. Foreign-body sensation (CCS) decreased from day 1 to 6 weeks in both groups (hybrid: 54.08% to 30.38%, control: 65.32% to 36.57%). No intraoperative complications and no hernia recurrences were observed during the 24-month follow-up. Overall SF-36 scores increased from 77.8 preoperatively to 92.4 at 24 months. Conclusions: In this pilot cohort, hybrid fixation using the UV-curable adhesive was feasible and was associated with shorter operative time, with no intraoperative complications and no recurrences observed during follow-up. Further studies of hybrid mesh fixation on larger cohorts are warranted.