Background: Reliable methods for survival risk stratification in gastric cancer (GC) remain limited. We evaluated the prognostic utility of preoperative red cell distribution width (RDW) and the RDW-to-albumin ratio (RAR) in patients undergoing curative surgery for GC. Materials and Methods: Clinicopathological data from 214 consecutive patients who underwent R0 resection for GC were retrospectively analyzed. The prognostic significance of RDW and RAR was assessed using time-dependent receiver operating characteristic (ROC) curves and Cox proportional hazards regression. Optimal cutoff values were determined with X-tile software. Results: Time-dependent ROC analyses demonstrated that RAR consistently yielded higher areas under the curve than RDW for predicting relapse-free survival (RFS), indicating superior discriminatory capacity. In univariate Cox analyses, both RDW and RAR were significantly associated with overall survival (OS) and RFS. Multivariate analyses confirmed that elevated RDW independently predicted poorer OS (hazard ratio [HR] 1.85, 95% confidence interval [CI] 1.11–3.08, P = 0.019) and RFS (HR 1.67, 95% CI 1.03–2.71, P = 0.039). Similarly, elevated RAR independently predicted worse OS (HR 1.77, 95% CI 1.06–2.94, P = 0.029) and RFS (HR 1.76, 95% CI 1.07–2.89, P = 0.025). Conclusions: Preoperative RAR, together with RDW, serves as an independent prognostic marker for long-term outcomes in patients with resectable GC. These easily available markers may represent more reliable and practical tools for mortality risk stratification for GC in clinical practice.

Trigeminal schwannomas are rare benign tumors comprising about 0.36% of all intracranial neoplasms. When extending from the middle to posterior cranial fossae and extracranial spaces, such as the pterygopalatine fossa, surgical access is challenging. We report a 55-year-old female with an 8-year history of right facial tingling, numbness, and paresthesia that worsened progressively over the past year. Magnetic resonance imaging (MRI) revealed a trigeminal schwannoma involving the right middle and posterior cranial fossae, porus trigeminus, and pterygopalatine fossa. The tumor was successfully resected using an expanded endoscopic endonasal approach combining the prelacrimal and modified endoscopic Denker’s approaches. Gross total resection was achieved without neurological deficits. Preservation of the nasolacrimal duct and piriform aperture minimized postoperative complications such as epiphora, alar collapse, and retraction. The patient recovered well with significant symptomatic improvement and no recurrence at follow-up. This case illustrates the efficacy of integrating prelacrimal and modified Denker’s approaches for complex skull base tumors.

Background and Objective: Appendicitis is a well-documented medical condition, with appendectomy being the definitive treatment. However, a subset of patients experiences persistent or recurrent right iliac fossa pain postoperatively. This study aims to identify the potential causes of post-appendectomy pain and propose diagnostic and therapeutic strategies. Methods: A prospective study was conducted at a tertiary care hospital between September 2022 and August 2024. Seventy-two patients who experienced persistent right iliac fossa pain two months post-appendectomy were included. Patients underwent detailed clinical, laboratory (CBC, KFT, LFT, ESR, CRP, urine analysis), and radiological investigations (USG abdomen and pelvis, X-ray abdomen, CT abdomen and pelvis). Exclusion criteria included age <18 years, female patients, prior history of urolithiasis, and lack of consent. Data were analysed for demographic distribution, surgical history, pain characteristics, imaging findings, and further interventions. Results: The highest incidence was among young adults aged 21-30 years (32%), with a male-to-female ratio of 1:1.18. The most common type of appendectomy performed was open appendectomy (48.61%), followed by laparoscopic appendectomy (36.11%).54.16% of patients experienced continuous pain, while 22.22% had colicky pain. Ultrasonography revealed multiple aetiologies, including free fluid in the pouch of Douglas (14 patients), multiple sub-centimetric lymph nodes (12 patients), right ovarian cysts (8 patients), and ureteric calculi (11 patients).CT scans and additional laboratory testing confirmed tuberculosis (4 patients) and adhesions (3 patients).Surgical interventions included laparoscopic adhesiolysis (3 patients), mesenteric lymph node biopsy (2 patients), and laparoscopic completion appendectomy for stump appendicitis (2 patients). The majority (65 patients) were managed conservatively. Conclusion: Post-appendectomy persistent pain is a multifactorial condition requiring a systematic approach to diagnosis and management. Common aetiologies include adhesions, stump appendicitis, urinary calculi, gynaecological disorders, and infective causes such as tuberculosis. A combination of clinical evaluation, imaging modalities, and targeted interventions helps in optimizing patient outcomes. Future research should focus on refining surgical techniques and developing preventive strategies to minimize post-appendectomy complications.

Background: Fever is associated with adverse outcomes in patients with subarachnoid hemorrhage. Nevertheless, the efficacy of targeted temperature management (TTM) in maintaining normothermia requires empirical validation. The objective of this study was to investigate the differences using distinct temperature control strategies. Materials and Methods: This was a single-center, retrospective study. Patients (n=136) diagnosed with aneurysmal subarachnoid hemorrhage were included. Participants were categorized into two groups: those receiving TTM for normothermia (maintaining a temperature range of 36.5 °C to 37.5 °C; n=72) during the period from 2018 to 2020, and those subjected to conventional fever control (CFC, maintaining temperatures below 38.3 °C; n=64) during the period from 2013 to 2014. The fever burden was quantified as the product of the duration of fever and the temperature deviation exceeding 38 °C (expressed in hours x °C), calculated from the first to the fourteenth day. The Modified Rankin Scale scores were evaluated at one and six months. Results: The fever burden of the TTM-N group was lower than that of the CFC group. The change in the mRS scores was higher in the TTM-N group than in the CFC group (p=0.039), particularly among participants classified with a modified Fisher grade of 4. The TTM-N group was associated with a lower rate of early infarction (10% vs. 23%, p=0.003) compared to the CFC group. Conclusion: TTM-N is likely associated with improved functional outcomes and a lower rate of early infarction. Aggressive fever control should be considered in patients with subarachnoid hemorrhage.

Since its first report in 2003, interest in robotic pancreaticoduodenectomy (RPD) has grown by pancreatic surgeons because of three-dimensional (3D) vision, wristed instruments, and improved ergonomics. In the video, we show vascular control techniques to facilitate dissection of the uncinate process, especially useful when venous vascular infiltration is suspected. This maneuver provides crucial exposure, enabling safe, high-quality oncologic dissection. A 72-year-old man presented with obstructive jaundice of one month´s evolution. Imaging and histological studies demonstrated it to be likely a neoplastic process in the head of the pancreas. RPD was performed with intraoperative vascular control. The final histopathology report showed a moderately differentiated adenocarcinoma (pT2, pN1), with all resection margins free. The external retraction and vascular control techniques described in this video are helpful to mitigate limitations of the current robotic surgery platform and can improve the safety and quality of RPD.

Double-J ureteral stents are widely used to maintain urinary drainage from the kidney to the bladder, but stent migration remains a significant complication. This review examines all aspects of double-J stent migration—from causes and incidence to clinical presentation, management, and prevention—based on clinical studies from the past five years. Overall incidence is low, but certain scenarios (orthotopic neobladders, transplant ureters, and metallic stents) carry substantially higher risk. Key risk factors include improper stent length, severe hydronephrosis, and suboptimal placement. Migration can be asymptomatic or cause a range of symptoms depending on its direction and extent. Imaging is the primary diagnostic tool, and management options range from observation to endoscopic retrieval. Preventive measures center on appropriate stent selection, correct placement technique, and timely removal. Emerging innovations such as biodegradable and sensor-equipped “smart” stents aim to further reduce migration. Although uncommon, double-J stent migration can lead to serious complications; therefore, clinicians should remain vigilant in high-risk cases and prioritize prevention to improve patient outcomes.

Background: Pancreatic adenocarcinoma (PAAD) has a low incidence but high mortality due to its late-stage diagnosis. Early-stage surgical resection is effective but limited. Semaphorin 4B ( SEMA4B ), a member of the semaphorin family, has an unclear role in PAAD pathogenesis. This study investigated SEMA4B 's expression, methylation, and its relationship to prognosis and therapy. Methods: We analyzed SEMA4B using bioinformatics tools including DriverDB v4, UALCAN, Kaplan-Meier Plotter, GSCA, TISIDB, GENI, and DepMap. We examined correlations with copy number variation (CNV), promoter methylation, survival, immune cell infiltration, gene pathways, and drug sensitivity. Results: The results show that SEMA4B overexpression positively correlates with CNV and is caused by promoter hypomethylation, particularly in early-stage PAAD. Elevated SEMA4B is associated with higher histological grades and poor overall survival. It promotes an immunosuppressive microenvironment by correlating positively with pro-tumor immune cells and negatively with anti-tumor immune cells. SEMA4B is also associated with abnormal cell cycle pathways and shows sensitivity to several FDA-approved drugs, including Lapatinib and Trametinib. It correlates positively with oncogenes ( KRAS , ERBB2 ) and negatively with tumor suppressors ( SMAD4 ). Conclusion: SEMA4B promoter hypomethylation contributes to its overexpression, with significant diagnostic and prognostic implications. Its role in immunosuppression and as a potential therapeutic target warrants further investigation in preclinical and clinical studies.