In Response to the Comment on “Stump Closure Technique for Appendectomy”

Aim: Selenium is an essential trace element for the human body, which significantly affects the growth and development of children. This study aimed to investigate the effects of selenium on child development, analyze emerging concepts, and predict future trends. Material and Methods: Using comprehensive search strategies in the Scopus and Web of Science Core Collection databases, 155 articles in English were identified. Publications, citations, prominent authors, collaboration networks, and influential journals were analyzed using the tools Biblioshiny and Bibliometrics R. Results: A steady growth trajectory was shown, with publications and research findings over the past 51 years demonstrating an increasing awareness of the positive effects of selenium on child development and growth. The United States and China were identified as the leading contributors. Peking University, Charité - Universitätsmedizin Berlin, and Humboldt University were the leading institutions, with Skalny A. and Chen J. identified as the most prolific authors. Biological Trace Element Research has emerged as the leading journal for disseminating knowledge in this field. In addition, keyword analysis revealed the importance of terms such as “selenium,” “human,” and “child.” Overall, this comprehensive study, the product of a global collaboration on selenium and its relationship to child growth, provides an in-depth study of selenium. Conclusion: The results of this analysis highlight future research priorities and the need for continued research in this area, advocating for expanded interdisciplinary studies to further explore the mechanisms and broader effects of selenium on child development and health.

Aim: This study aimed to evaluate the ability of CpG-rich subregions within the A2UCOE element, excluding the HNRPA2B1 and CBX3 promoters, to sustain long-term transgene expression in lentiviral systems. These regions are cloned upstream of the spleen focus-forming virus (SFFV) promoter and tested in P19 and F9 cells. Material and Methods: The study assessed the ubiquitous chromatin opening element (UCOE) activity of three A2UCOE subregions that lack promoters. Using P19 and F9 murine embryonal carcinoma cells, enhanced green fluorescent protein (eGFP) expression stability and durability were examined in undifferentiated and differentiated states. Lentiviral vectors (LVs) containing CpG-rich, promoterless fragments, 455UCOE (OFA1), 527UCOE (OFA2), and 945UCOE (OFA3), were transduced into the cells, and sustained transcriptional activity was analyzed via flow cytometry. Results: Some vectors sustained eGFP expression, while others exhibited a rapid decline in both undifferentiated and differentiated states. Specifically, the OFA1, OFA2, and OFA3 vectors showed trends similar to the SEW vector, with significant reductions in eGFP expression over time. None of the CBX3-derived fragments provided stable expression, suggesting no UCOE activity. The rates of expression decline were similar between the SEW vector with the SFFV promoter and the LVs containing OFA1, OFA2, and OFA3. Conclusion: CpG-rich, promoterless fragments failed to support stable transgene expression in murine embryonal carcinoma cells, indicating a lack of UCOE functionality. These findings highlight the role of promoter and regulatory elements in maintaining open chromatin for gene therapy. Future studies should investigate other CpG-rich regions or minimal promoters to improve transgene stability.

Oral focal mucinosis (OFM) is a relatively uncommon benign connective tissue lesion of unknown etiology, primarily affecting the gingiva. Clinically, OFM has no specific appearance; it resembles more specific conditions like fibroepithelial hyperplasia and other reactive lesions. Histologically, it is characterized by loose myxoid connective tissue stroma with slightly enlarged fibroblasts. This case report aimed to describe clinical, histological, and immunohistochemical features of an OFM in a 71-year-old edentulous male patient affecting the right maxillary alveolar mucosa. The lesion presented as a painless, dome-shaped, sessile nodule. Histopathological examination revealed a circumscribed area of increased mucin deposition within the lamina propria, devoid of inflammatory cells. This case highlights the importance of considering OFM in the differential diagnosis of soft tissue lesions of the oral cavity, even in edentulous patients, and underscores the diagnostic role of histopathology.

Aim: This study aimed to compare neurological and functional outcomes, including cervical range of motion (ROM), in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) who underwent either open-door laminoplasty (LP) or posterior cervical fusion (PCF) surgery. Material and Methods: This retrospective, single-center study included 38 patients, 11 female and 27 male, diagnosed with CSM and OPLL who underwent LP (n=20) or PCF (n=18) between 2014 and 2016. Clinical outcomes were assessed using the Japanese Orthopedic Association (JOA), visual analog scale (VAS), and Nurick scores. Cervical ROM values, including flexion, extension, lateral flexion, and rotation, were measured preoperatively and six months postoperatively in collaboration with physical therapy specialists. Results: Both LP and PCF groups showed significant postoperative improvement in JOA, VAS, and Nurick scores (all p<0.001), with no significant differences between groups (p=0.405, p=0.708, and p=0.963, respectively). Cervical ROM values significantly decreased in all directions postoperatively in both groups. Flexion (p<0.001), left lateral flexion (p=0.007), and left rotation (p=0.003) declined more severely in the PCF group, whereas the difference between groups did not reach statistical significance level in extension (p=0.105), right lateral flexion (p=0.065), and right rotation (p=0.067). Conclusion: LP and PCF offer similar neurological recovery in patients with CSM. However, LP better preserves postoperative cervical ROM. Despite the observed ROM reduction, daily functional activities remained largely unaffected. Long-term, larger studies are recommended for further validate these findings.

Aim: This study aimed to evaluate the impact of atrioventricular (AV) optimization of biventricular pacemakers on cardiac hemodynamic parameters, particularly mitral inflow and aortic valve velocity-time integral (VTI), using impedance cardiography (ICG) and echocardiography in patients with symptomatic systolic heart failure and left bundle branch block unresponsive to cardiac resynchronization therapy. Material and Methods: The study included 20 patients, 10 (50%) males and 10 (50%) females, aged between 18 and 80 years, who had undergone biventricular pacemaker implantation and did not have aortic stenosis, decompensated heart failure, or echocardiographically optimized AV interval measurements. Hemodynamic values were calculated following ICG measurements. Results: The mean AV delay time did not change after AV optimization (p=0.685). However, optimization led to a statistically significant increase in mitral inflow VTI and aortic valve VTI (both p<0.001). No significant post-optimization variations were observed in hemodynamic parameters obtained by ICG compared to baseline measurements. There was a statistically significant decrease in heart rate when compared to the pre-optimization values (p=0.003). Conclusion: This study identified a significant enhancement in echocardiographic parameters attributable to AV optimization. The results obtained with AV optimization were consistent with those of large-scale randomized studies. However, further comprehensive studies are needed to assess the individual patient responses and long-term outcomes.

Aim: This study aimed to evaluate the short-term clinical and functional outcomes of reverse shoulder arthroplasty (RSA) in patients with cuff tear arthropathy and complex proximal humeral fractures. Material and Methods: A retrospective review was conducted on 15 patients who underwent RSA between January 2019 and July 2024 at a single tertiary center. Clinical evaluations were performed preoperatively and at 3 and 6 months postoperatively. Pain was assessed using the visual analog scale (VAS), and functional status was measured using the quick disabilities of the arm, shoulder and hand (Quick DASH) questionnaire. Shoulder range of motion (ROM) was recorded in abduction, flexion, and external rotation. Internal rotation was assessed by the vertebral level reached. Results: The mean age was 74.3±6.8 years, and 80% (n=12) of the patients were female. Cuff tear arthropathy was the most common indication (86.7%, n=13). At 6 months postoperatively, the mean VAS score improved significantly from 7.9±1.2 to 2.3±1.1 (p<0.001), while the Quick DASH score decreased from 78.2±6.5 to 27.6±9.3 (p<0.001). Abduction and flexion increased from 68.4±17.3° and 71.2±16.1° to 115.6±21.2° and 105.7±18.5° postoperatively, respectively (p<0.001). No major complications were observed during follow-up. Conclusion: RSA provides substantial short-term improvements in pain reduction, functional capacity, and ROM in a rare and complex patient group. These findings support its use as a reliable surgical option in carefully selected cases with irreparable rotator cuff pathology and complex fractures.

Aim: This study aimed to investigate the predictive value of prenatal ultrasonography (USG) findings in detecting chromosomal abnormalities identified through chromosomal microarray analysis (CMA) in high-risk pregnancies. Material and Methods: A retrospective analysis was conducted on 122 singleton high-risk pregnancies undergoing CMA between 2021 and 2022. High-risk status was based on advanced maternal age, abnormal screening results, USG anomalies, or relevant family history. A scoring system was applied to USG findings, assigning one point for each fetal system with an anomaly. CMA was performed as a first-tier test via amniocentesis. Maternal demographics, USG scores, CMA results, and pregnancy outcomes were recorded and analyzed. Results: Abnormal CMA results were detected in 34 (27.9%) cases. Maternal age was significantly higher in the abnormal CMA group (median 32 years vs. 29 years, p=0.030). Among pregnancies with abnormal CMA results, the rates of continuation and termination were equal at 44.1% (n=15). USG anomalies were significantly more prevalent in patients with abnormal CMA results, particularly in the abdominal (OR=2.84, 95% CI=1.01-7.96, p=0.041) and skin (OR=5.85, 95% CI=1.63-21.03, p=0.006) systems. Higher USG scores were significantly associated with abnormal CMA results (p<0.001). The most common chromosomal abnormalities were deletions (n=20, 58.8%) and duplications (n=10, 29.4%). Conclusion: USG findings, especially system-specific anomalies and elevated USG scores, are significantly associated with abnormal CMA results. Advanced maternal age is also a predictive factor. Integrating USG scoring with CMA may enhance the diagnostic value in prenatal genetic assessment. Multicenter prospective studies are needed to validate these findings and improve clinical application.

Denys-Drash syndrome (DDS) is a rare autosomal dominant disorder characterized by genital abnormalities, nephropathy, and Wilms’ tumor (WT), typically caused by heterozygous mutations in the Wilms’ tumor suppressor 1 (WT1) gene. Here, a 2-year-old male admitted with fever and abdominal pain was presented. Physical examination revealed ambiguous genitalia and a palpable abdominal mass. Imaging identified a heterogeneous mass in the left kidney, consistent with WT. Genetic analysis detected a novel heterozygous frameshift mutation in exon 8 of the WT1 gene [p.H245Tfs*2 (c.1393delC)]. WT is the most common renal tumor in children and is frequently associated with WT1 gene mutations in DDS. Given the early onset and severity of symptoms, early genetic screening for WT1 gene mutations should be considered in patients admitted with ambiguous genitalia and nephrotic syndrome. This case contributes to the understanding of WT1 gene mutations and highlights the importance of molecular analysis in children with genitourinary anomalies.

Aim: Locally advanced rectal cancer (LARC) is associated with high mortality. Although neoadjuvant chemoradiotherapy (nCRT) is the mainstay of treatment, the expected pathological response is inadequate. Research on total neoadjuvant treatment (TNT) is ongoing. This study aimed to investigate the significance of certain inflammatory and metabolic parameters in predicting treatment response and survival. Material and Methods: Data from 57 patients with LARC who underwent nCRT or TNT between 2010 and 2023 were retrospectively analyzed. The systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) were calculated from the results of the blood samples collected before the initiation of treatment, along with the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and erythrocyte distribution width (RDW)-to-lymphocyte ratio (RLR). Results: Of the patients, 52 (91.2%) had adenocarcinoma, while 5 (8.8%) had mucinous or signet-ring histology. Among 55 patients with available data, 42 (76.4%) were clinically N+. Seven (12.3%) received TNT. According to the Dworak regression score, 48 (84.2%) had a poor, and 9 (15.8%) had a good response. Six (10.5%) patients had a pathological complete response. An increase in SII per 100 units (HR=1.081, 95% CI: 1.005-1.162, p=0.036) and in RLR (HR=1.197, 95% CI: 1.025-1.398, p=0.023) was significantly associated with disease-free survival (DFS) in univariate analysis, but not in the multiple model. Conclusion: There was no significant association between the Dworak regression score and the inflammatory and metabolic parameters in response to nCRT in LARC. Further studies are needed to determine the relationship between the RLR, a novel parameter, and DFS.