Background: Liver biopsy performed after less invasive workup, including imaging, for evaluation of abnormal liver function studies occasionally reveals large bile duct obstruction on histology without evidence of biliary obstruction on prior imaging. The utility of ERCP in this setting has not been studied in pediatrics. In the present study, we address this important clinical issue. Methods: A retrospective review of pediatric pathology and clinical records from 2010 to 2019 identified 123 pediatric patients with large duct obstruction on liver biopsy performed after imaging revealed no evidence of biliary obstruction. The absolute standardized difference (ASD) was used to compare baseline covariates between patients who underwent ERCP vs. all others. Covariates included age, gender, race, ethnicity, BMI, and labs (total bilirubin, GGT, alkaline phosphatase, AST, ALT, platelets, and INR). Results: Of 85 unique patients who met inclusion/exclusion criteria, 15 (17.6%) underwent ERCP. The majority of these patients who underwent ERCP (80%) had a therapeutic endoscopic intervention with a favorable impact on clinical trajectory. The mean age of patients with large duct obstruction was 7 years old. Most patients were white (47%), followed by Asian (17%). Only 25% of patients identified as Hispanic. The mean laboratory values were as follows: total bilirubin 4.61 mg/dL, GGT 353 U/L, alkaline phosphatase 403 U/L, AST 343 U/L, ALT 251 U/L, platelets 289 K/uL, and INR 1.19. Absolute standardized differences comparing baseline covariates between the ERCP and non-ERCP groups are included in Table 1. The largest absolute standardized difference between the two groups was for race (1.17), ethnicity (0.553), and GGT (0.463). Age, alkaline phosphatase, and INR were not significantly different between the two groups (ASD <0.2 for both). Conclusions: Only 17.6% of pediatric patients with large ducts undergo ERCP. Pediatric patients who underwent ERCP were more likely to be white, non-Hispanic, and have elevated GGT. Of interest, age did not differ significantly between the two groups, which may reflect enhanced uniformity of utilization of ERCP across age groups in pediatrics. Additional multi-center studies, including more patients and focused on understanding the utility of ERCP and the range of outcomes following the diagnosis of large duct obstruction in pediatrics, would be informative to guide pediatric hepatology and endoscopic practices.

Background/Objectives: Surgical ward rounds are central to trainee education but are often associated with stress, cognitive overload, and inconsistent learning. Advances in artificial intelligence (AI), particularly large language models (LLMs), offer new ways to support trainees by simulating ward-round questioning, enhancing preparedness, and reducing anxiety. This study explores the role of generative AI in surgical ward-round education. Methods: Hypothetical plastic and reconstructive surgery ward-round scenarios were developed, including flexor tenosynovitis, DIEP flap monitoring, acute burns, and abscess management. Using de-identified vignettes, AI platforms (ChatGPT-4.5 and Gemini 2.0) generated consultant-level questions and structured responses. Outputs were assessed qualitatively for relevance, educational value, and alignment with surgical competencies. Results: ChatGPT-4.5 showed a strong ability to anticipate consultant-style questions and deliver concise, accurate answers across multiple surgical domains. ChatGPT-4.5 consistently outperformed Gemini 2.0 across all domains, with higher expert Likert ratings for accuracy, clarity, and educational value. It was particularly effective in pre-ward round preparation, enabling simulated questioning that mirrored consultant expectations. AI also aided post-round consolidation by providing tailored summaries and revision materials. Limitations included occasional inaccuracies, risk of over-reliance, and privacy considerations. Conclusions: Generative AI, particularly ChatGPT-4.5, shows promise as a supplementary tool in surgical ward-round education. While both models demonstrated utility, ChatGPT-4.5 was superior in replicating consultant-level questioning and providing structured responses. Pilot programs with ethical oversight are needed to evaluate their impact on trainee confidence, performance, and outcomes. Although plastic surgery cases were used for proof of concept, the findings are relevant to surgical education across subspecialties.

Background: Pulmonary lobectomy remains the gold standard for early-stage non-small cell lung cancer, with the primary goal of complete tumor removal. Postoperative imaging is critical for evaluating recovery and identifying complications, yet systematic descriptions of radiologic patterns after lobectomy are limited. Methods: We conducted a retrospective analysis of 125 patients who underwent pulmonary lobectomy between 2019 and 2024 at a tertiary thoracic surgery center. Preoperative and postoperative imaging findings were coded and compared using a standardized classification system. Modalities included chest radiography, thoracic CT, ultrasound, PET-CT and MRI. Results: Postoperative imaging demonstrated a clear reduction in pathological findings. Emphysema decreased from 29.6% to 21.6%, pleural effusion from 12.8% to 3.2%, atelectasis/pleural thickening from 15.2% to 8.8%, and ground-glass infiltrates from 12.0% to 8.0%. The proportion of patients without abnormalities increased from 18.5% to 24.8%. Chest radiography (92%) and CT (89.6%) were the most frequently employed modalities. Patients treated with VATS lobectomy showed slightly fewer postoperative abnormalities compared with those undergoing open surgery. Conclusions: Pulmonary lobectomy is associated with measurable radiologic improvement, reflecting favorable structural recovery. Routine imaging follow-up, particularly chest radiography, remains essential for early detection of complications and guiding postoperative care. However, the retrospective single-center design and limited generalizability represent important limitations that should be considered when interpreting these findings.

Background/Objectives: The global incidence of thyroid cancer has been increasing, necessitating improved diagnostic strategies for detecting lymph node metastases. Fine-Needle Aspiration Biopsy (FNA) is a widely used diagnostic tool; however, its accuracy is sometimes limited, particularly in cases with non-diagnostic results. Washout Thyroglobulin (Washout Tg) measurement has emerged as an important adjunctive tool in refining thyroid cancer diagnosis. Methods: This retrospective study analyzed 723 patients who underwent thyroid cancer surgery at Samsung Medical Center from 2013 to 2023. The patients were categorized based on their thyroid status into three groups: 1. total thyroidectomy with modified radical neck dissection (mRND); 2. completion thyroidectomy with mRND; and 3. mRND or selective neck dissection (SND) without thyroidectomy. The Washout Tg levels and their diagnostic performance were evaluated using Receiver Operating Characteristic (ROC) analysis, determining the optimal cutoff values for predicting lymph node metastasis. Results: Washout Tg demonstrated high sensitivity for detecting metastases, with the optimal cutoff values varying based on thyroid status. For the patients who had total thyroidectomy, the cutoff was 23.3 ng/mL (AUC = 0.85, sensitivity = 82.6%, and specificity = 75.0%). In completion thyroidectomy cases, a threshold of 7.2 ng/mL (AUC = 0.879) achieved 98.4% sensitivity and 80.0% specificity. For patients without thyroidectomy (mRND/SND group), a cutoff of 0.1 ng/mL (AUC = 0.766) yielded 98.9% sensitivity but lower specificity (60.0%). Additionally, the Washout Tg/serum Tg ratio demonstrated high diagnostic accuracy with a cutoff of >1 (sensitivity = 97.09% and specificity = 63.64%). Conclusions: The Washout Tg measurement and the Washout Tg/serum Tg ratio play a crucial role in detecting lymph node metastases, particularly in patients post-thyroidectomy. The findings emphasize the necessity of adjusting the Washout Tg cutoff values based on thyroid status to enhance diagnostic accuracy. Further prospective studies are required to validate these thresholds and optimize their clinical application.

Background: Primary cicatricial alopecias (PCA) are inflammatory disorders that cause permanent hair loss through follicular destruction and fibrosis. Hair transplantation (HT) may restore coverage in stable or end-stage PCA cases. This review assesses the efficacy of HT in PCA including optimal timing, graft survival rates, and the risk of disease reactivation. Material & Methods: A PubMed literature search identified 33 studies of HT in lichen planopilaris (LPP), frontal fibrosing alopecia (FFA), discoid lupus erythematosus, central centrifugal cicatricial alopecia, pseudopelade of Brocq, morphea en coup de sabre, and folliculitis decalvans from the 1960s to present. Reviews were excluded. Results: Among 147 PCA patients, 87.8% had positive HT outcomes. LPP showed high graft survival (70–90%). In contrast, eyebrow FFA (75%), folliculitis decalvans (25%), and scalp FFA (8.6%) had the highest failure rates. Follicular unit extraction was used slightly more than follicular unit transplantation. Notably, 46 patients developed PCA post-HT for presumed androgenetic alopecia. Discussion: HT in PCA can succeed with careful patient selection and stable disease (ideally ≥12–24 months). Graft survival varies by subtype. LPP has consistently reported successful outcomes post-transplantation, whereas folliculitis decalvans and FFA had the poorest outcomes. Adjuncts like immunosuppressants, PRP, and minoxidil may enhance results. Conclusions: Hair transplantation is viable in quiescent PCA, but outcomes are subtype-dependent. Many surgeons already perform these surgeries, but the published literature is lacking, and more research is needed to establish standardized timing, improve long-term graft survival, and clarify the risk of post-HT PCA onset.

Background/Objectives: Meniscectomy is commonly performed to treat meniscal injury. Recovery of patients and restoration of functional capacity may be influenced by several factors, among which postoperative rehabilitation could play a significant role. The objective was to compare clinical and functional status in patients undergoing meniscectomy according to receipt of postoperative rehabilitation. Methods: An ambispective cohort study was conducted in 89 patients who underwent meniscectomy. The primary outcome was functional capacity, assessed using the Timed Up and Go (TUG) test. The primary exposure was receipt of postoperative rehabilitation. Secondary outcomes included knee range of motion (goniometry), pain intensity (visual analogue scale, VAS), and kinesiophobia (Tampa Scale of Kinesiophobia). Results: Functional capacity differed significantly between patients who received postoperative rehabilitation and those who did not (U = 490; p = 0.03), with lower (better) TUG times in the rehabilitation group. A significant difference was also observed between patients who did and did not engage in preoperative regular physical exercise (U = 680.0; p = 0.01), with better postoperative functional performance in those who had not exercised preoperatively. A sex difference was identified, with females demonstrating superior functional performances compared with males (U = 1187.0; p = 0.01). Older age was positively associated with functional impairment (β = 0.02; p = 0.02). Conclusions: Postoperative rehabilitation was associated with superior objective functional performance after meniscectomy, alongside improvements in pain, range of motion, and kinesiophobia. Female sex and younger age predicted better function; preoperative inactivity was associated with superior postoperative performance, while postoperative exercise showed no clear association. Findings should be interpreted cautiously in view of potential residual confounding and the small non-rehabilitation subgroup, and warrant validation in larger, preferably randomised, cohorts.

Purpose: This review examines the recent literature on total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA) published in the Knee Surgery Sports Traumatology and Arthroscopy (KSSTA) journal in 2023. The aim was to identify key research themes, advancements, and global contributions to knee surgery research. Methods: Articles published in KSSTA in 2023 were identified through a structured database search using the term “knee OR TKA OR UKA”. Inclusion criteria focused on primary studies, reviews, and case reports in English related to TKA or UKA. Data were extracted and synthesized thematically to analyze research trends and gaps. Results: The search yielded to 75 articles, 63 focused on TKA and 12 on UKA. Most contributions originated from Europe, followed by Asia and North America. Robotic-assisted TKA emerged as a significant advancement, enhancing surgical precision but requiring further validation through extended follow-up studies. Personalized implants showed potential for improved outcomes, though cost-effectiveness remains a concern. In UKA, slight overcorrection during alignment was associated with better functional results. Conclusions: The literature in the 2023 KSSTA highlights journal-specific trends and innovations in knee surgery. While techniques like robotic TKA and personalized implants are promising, further research is essential to standardize protocols and evaluate long-term impacts, emphasizing the need for sustained research efforts in knee orthopedics.

Introduction: The aim of this study was to investigate the spatial relationship between the incisive canal (IC) and apical region of the maxillary central incisors in the Korean population, using cone-beam computed tomography (CBCT) imaging. The findings are intended to inform and improve the planning and execution of immediate implant placement in the maxillary esthetic zone. Materials and methods: CBCT data were collected from 94 patients (48 men, 46 women) aged 20–79 years at Gangnam Dental Clinic, Seoul, South Korea. The sample was divided according to age into three groups: 20–39 years, 40–59 years, and 60–79 years. Exclusion criteria included missing maxillary anterior teeth, severe crowding, periodontitis, pathology, and image artifacts. Measurements of the distance from the root apex to the incisive canal (RIC-11-P, RIC-21-P) and from the root apex to the buccal bone (RBB-11-B, RBB-21-B) were taken from CBCT images. Statistical analyses were conducted using Welch’s t-test, ANOVA, and Pearson correlation, with significance set at p < 0.05. Results: The mean distances from the root apex to the incisive canal were 3.77 mm (RIC-11-P) and 3.62 mm (RIC-21-P), while the mean distances to the buccal bone were 0.86 mm and 0.94 mm, respectively. Males exhibited significantly greater distances compared to females, both in the NPC-to-root apex and buccal bone measurements. Age-related variations were observed, with younger individuals showing shorter distances from the IC to the root apex. However, ANOVA tests and Pearson correlation analysis indicated no statistically significant correlation in these distances across different age groups. The study highlights significant gender differences in maxillary central incisor anatomy, with males having larger distances from the root apex to both the IC and buccal bone, which has implications for implant placement. While age-related changes were observed, they did not significantly affect the mean distances in a statistically meaningful way. Conclusions: These findings underscore the need for personalized treatment planning in immediate implant placement, particularly in relation to gender and age. Comparisons with other population studies suggest that these anatomical differences may be consistent across various ethnic groups, though individual variance factors should still be considered.

Orthognathic surgery, particularly maxillomandibular advancement (MMA), has emerged as an effective therapeutic option for patients with moderate to severe OSA who are refractory to conventional treatments. The wedge osteotomy of the maxilla, often performed in combination with mandibular surgery, can be a surgical treatment for obstructive sleep apnea (OSA). This case series report describes 6 OSA patients without anteroposterior maxillary deficiency who were treated with wedge osteotomy of the maxilla. Material and Methods: We conducted a retrospective analysis of 6 patients who underwent maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA), all operated on consecutively by the same surgeon between 2018 and 2024 at the Maxillofacial Surgery of San Camillo-Forlanini Hospital, in Rome, Italy. Patients were evaluated using a CAD/CAM-assisted approach. A pre- and postoperative comparative analysis was conducted to assess the effectiveness of the surgical treatment in improving OSA-related parameters. Maxillary wedge osteotomy and bilateral sagittal split osteotomies (BSSO) of the mandibular ramus were digitally planned. Results: The comparison between preoperative and postoperative CT scans, along with 3D reconstructions generated using dedicated software, revealed a counterclockwise rotation of the occlusal plane, resulting in a mandibular advancement of approximately 13 mm. The CT shows a significant increase in airway volume following the skeletal repositioning. The airway volume increased from 20.665 ± 546 mm3 to 27.177 ± 446 mm3. Conclusions: Counterclockwise rotational orthognathic surgery without maxillary advancement has been shown to effectively enlarge the posterior pharyngeal space while also delivering excellent esthetic outcomes.

Background: With the advancement of AI-powered online tools, patients are increasingly turning to AI for guidance on healthcare-related issues. Methods: Acting as patients, we posed eight direct questions concerning a common clinical condition—liver cysts—to four AI chatbots: ChatGPT, Perplexity, Copilot, and Gemini. The responses were collected and compared both among the chatbots and with the current literature, including the most recent guidelines. Results: Overall, the responses from the four chatbots were generally consistent with the literature, with only a few inaccuracies noted. For questions addressing “grey areas” in clinical research, all chatbots provided generalized answers. ChatGPT, Copilot, and Gemini highlighted the lack of conclusive evidence in the literature, while Perplexity offered speculative correlations not supported by data. Importantly, all chatbots recommended consulting a healthcare professional. While Perplexity, Copilot, and Gemini included references in their responses, not all cited sources were academic or of medium/high evidence quality. An analysis of Flesch Readability Ease Scores and Estimated Reading Grade Levels indicated that ChatGPT and Gemini provided the most readable and comprehensible responses. Conclusions: The integration of chatbots into real-world healthcare scenarios requires thorough testing to prevent potentially serious consequences from misuse. While undeniably innovative, this technology presents significant risks if implemented improperly.