Idiopathic intracranial hypertension without papilledema (IIHWOP) remains poorly understood. This review summarizes the diagnostic challenges and potential management of adults with IIHWOP. A detailed search of the scientific literature, combining MeSH and free-text terms, included all English-language papers on PubMed, from inception to June 8, 2025. In this review, we used the term IIHWOP to describe patients without evidence of active or previous papilledema. The diagnosis of IIHWOP is based on elevated lumbar puncture opening pressure accompanied by either sixth cranial nerve palsy or neuroimaging features of intracranial hypertension, which may lack specificity. Clinical presentation frequently mimics primary headache disorders, and lumbar puncture remains an invasive procedure without clear management implications in IIHWOP, as there are no high-quality studies evaluating medical or surgical therapies. Recommendations for investigation and clinical care remain largely inferred from idiopathic intracranial hypertension. Given the absence of evidence for risk of vision loss, invasive procedures should be avoided, and management should focus on weight loss and optimized headache management.

Real-world evidence of the impact of guideline concordance on survival in non-small cell lung cancer.

First- and second-line medical and surgical therapies for trigeminal neuralgia (TN) may have limited efficacy or tolerability in some individuals. In addition, even when these therapies are initially successful, efficacy frequently wanes over time. This narrative review presents medication options for intractable trigeminal neuralgia with a focus on new and upcoming therapies. Lacosamide, eslicarbazepine, and botulinum toxin are increasingly used for intractable TN, with recent studies demonstrating efficacy. Basimglurant and vixotrigine (BIIB074) are investigational agents currently or recently studied for treatment of TN. Intravenous (i.v.) sodium channel blockers, i.v. magnesium, multiple formulations of lidocaine, and sumatriptan can be used for acute treatment of intractable TN. Multiple medical therapies exist for treatment of intractable TN, with newer options demonstrating efficacy in recent studies. Investigational agents are currently being studied as potential future options for management of intractable TN.

Peri-implantitis management is clinically demanding and may be accompanied by professional anxiety; however, the extent to experience level and practice setting shape treatment decisions and anxiety has not been fully clarified. Previous surveys have described clinicians' knowledge and attitudes toward peri-implantitis, yet evidence integrating therapeutic preferences with clinician anxiety remains scarce. This study assessed Turkish periodontists' awareness and treatment priorities for peri-implant diseases and examined the influence of professional experience, postgraduate exposure, and workplace setting on treatment selection and anxiety during severe peri-implantitis management. A cross-sectional, web-based survey was conducted between April and December 2025 among periodontology specialists in Turkey. The questionnaire collected demographic and professional characteristics, education and awareness regarding peri-implant diseases, clinical approaches to peri-implantitis, and anxiety using the Beck Anxiety Inventory (BAI). BAI scores were categorized as minimal (0-7), mild (8-15), moderate (16-25), and severe (26-63). Group comparisons were performed with chi-square tests. Multivariable binary logistic regression evaluated predictors of choosing surgical (vs. non-surgical) peri-implantitis therapy and predictors of the presence of anxiety (BAI ≥ 8). Statistical analyses were performed with IBM SPSS Statistics for Windows, Version 25.0. Data from 184 periodontists were analyzed (79.3% female; mean professional experience 14.50 ± 9.16 years). Most participants reported minimal anxiety during severe peri-implantitis management (78.3%), with mild (12.0%), moderate (6.5%), and severe anxiety (3.3%) less frequent. In regression analysis for treatment selection, private (vs. public) practice independently predicted a higher likelihood of choosing surgical modalities (OR = 2.212, 95% CI 1.171-4.177; p = 0.014). In regression analysis for anxiety, greater specialist experience was associated with lower odds of anxiety (OR = 0.839, 95% CI 0.760-0.925; p < 0.001), while gender and practice setting were not significant. Among Turkish periodontists, anxiety related to severe peri-implantitis management was generally low and decreased with increasing specialty experience. Practice setting, rather than experience or anxiety, was the key independent predictor of choosing surgical treatment, with private-sector clinicians more likely to select surgical approaches. These findings support the value of structured postgraduate exposure, continued professional development, and early-career support to strengthen confident, evidence-based peri-implantitis care across diverse practice environments.

Inflammatory bowel disease, comprised of Crohn's disease (CD) and ulcerative colitis (UC), is a chronic, immune-mediated disorder of the gastrointestinal tract. The therapeutic landscape for IBD has expanded significantly in the last 2 decades with the introduction of biological agents and small-molecule therapies that target specific inflammatory pathways. This review provides an overview of current medical and surgical treatment options for IBD, emphasizing mechanisms of action, clinical efficacy, and safety profiles. Biological therapies, including TNF-α inhibitors, integrin blockers, and interleukin inhibitors, have improved rates of clinical remission and mucosal healing in patients with moderate-to-severe disease. Small-molecule agents, such as Janus kinase (JAK) inhibitors and sphingosine-1-phosphate (S1P) receptor modulators, offer effective oral alternatives for patients who are refractory to or intolerant of biologics. Comparative studies among these therapies continue to guide individualized treatment approaches. This review discusses the emerging role of head-to-head trials, safety considerations, and evolving treatment algorithms that integrate new agents into clinical practice. While IBD remains incurable, current therapies offer promising long-term disease control, relief of symptoms, and improved quality of life.

Rotator cuff disease (RCD) constitutes the most common cause of shoulder pain, with partial-thickness rotator cuff tears (PT-RCTs) representing a substantial subset that may progress over time. Although both surgical and non-surgical interventions are employed in clinical practice, a consensus regarding the optimal management of symptomatic PT-RCTs is lacking, and a comprehensive synthesis of available evidence has not yet been conducted. A systematic review was conducted according to PRISMA guidelines using MEDLINE, EMBASE, CENTRAL, ClinicalTrials.gov, and WHO ICTRP. Studies on arthroscopic surgical and/or non-surgical treatments for PT-RCTs in patients ≥ 18 years were included. Clinical outcomes (Constant Score (CS), ASES Score, VAS for pain) were extracted. Random-effects meta-analysis and descriptive statistics were used to analyze outcomes and study characteristics. Of the 9,894 trials screened, 33 trials with a total of 1,818 patients met the inclusion criteria. Comparing pooled weighted mean outcomes across studies, surgical cohorts demonstrated higher scores than non-surgical cohorts in both the CS (p = 0.0095) and the ASES (p = 0.0060). However, no specific surgical technique proved superior, with neither Reconstruction versus Debridement (CS, p = 0.19; ASES, p = 0.06) nor Tear Completion versus Transtendon Repair (CS, p = 0.13; ASES, p = 0.65) reaching statistical significance. Although surgical treatment was statistically superior to non-surgical approaches, the observed differences remained below the minimal clinically important differences (MCID), indicating limited clinical relevance. Pooled analyses showed higher Constant and ASES scores in surgical cohorts. However, the magnitude of this difference does not exceed MCID, indicating limited clinical relevance. No surgical technique demonstrated significant superiority. These findings highlight the need for individualized treatment decisions, considering the limited clinical benefit of surgery over non-surgical approaches. The protocol was registered in PROSPERO with ID: CRD42023487714.

Predictors of Medication Cessation After Benign Prostatic Hyperplasia Procedures.

Moyamoya arteriopathy is a leading cause of cerebral ischemia in children. In pediatric patients with symptomatic or progressive moyamoya disease, surgical revascularization is the mainstay of treatment; however, there is limited comparative evidence demonstrating an advantage of surgical revascularization over nonsurgical management in North American cohorts. The authors aimed to determine whether surgery reduces the risk of subsequent ischemic events in North American children with symptomatic ischemic moyamoya arteriopathy compared to nonsurgical management alone. Patients treated conservatively at the Sainte-Justine University Hospital Center in Montréal, Canada, were compared to patients treated surgically through indirect revascularization, predominantly performed at the Seattle Children's Hospital. Data were acquired via retrospective review of patients treated at both institutions. Time to event analysis via multivariable Cox regression for postoperative ipsilateral ischemic stroke or transient ischemic attack (TIA) recurrence was performed. Forty-nine patients with a median (IQR) age of 6.0 (3.0-9.0) years were included. Twenty-four patients (49.0%) were treated nonsurgically, while 25 patients (51.0%) were treated surgically. Among the 42 patients with subtype data available, 15 (35.7%) had moyamoya disease and 27 (64.3%) had moyamoya syndrome. On Kaplan-Meier analysis, patients who underwent nonsurgical management had 12-, 24-, and 60-month recurrence-free rates from an ipsilateral ischemic event of 52.8%, 52.8%, and 31.7%, respectively. In contrast, patients who underwent surgical management had 12-, 24-, and 60-month recurrence-free rates from an ipsilateral ischemic event of 87.7%, 83.0%, and 83.0%, respectively. In the entire cohort, surgical intervention (HR 0.15, 95% CI 0.04-0.51) and White race (HR 0.18, 95% CI 0.06-0.56) were both independently associated with longer time to ipsilateral ischemic event recurrence. Pediatric patients with symptomatic ischemic moyamoya arteriopathy treated nonsurgically had worse outcomes compared with those managed surgically. These findings support pursuing surgical revascularization therapy in North American children and youth with symptomatic ischemic moyamoya arteriopathy.

Α-Ketoglutarate ameliorates appendicitis by modulating Gln metabolism and inhibiting NF - κB signaling pathway.

ABSTRACTIntroductionVariations in craniofacial anatomy have been associated with the development of obstructive sleep apnea (OSA) and may impact the response to medical and surgical therapies. This study aims to evaluate the effect of malocclusion on the clinical response to hypoglossal nerve stimulator (HNS) therapy.MethodsThis is a retrospective cohort study evaluating patients with OSA who underwent HNS placement between May 2017 and December 2022. Occlusion was determined using Angle's Classification Criteria, and outcome measures including preoperative and postoperative Apnea‐Hypopnea Index (AHI), lowest O2 saturation (SpO2), and Epworth Sleepiness Scale (ESS) scores were analyzed. Two cohorts were created by grouping patients with normal occlusion and those with class II or class III malocclusion.ResultsOf the 64 patients included in the study, 49 had normal occlusion and 15 had malocclusion. There was no significant difference in age, BMI, or pre‐operative AHI between groups. The median AHI in those with normal occlusion was significantly reduced with HNS therapy, going from 35.9 to 8.2 (p < 0.0001), while the reduction in those with malocclusion was not significant (32.8 vs. 24.0, p = 0.1258). 75.5% of those with normal occlusion met criteria for surgical success as defined by Sher et al. while success was only achieved in 33.3% of those with malocclusion (p < 0.01).ConclusionThis study suggests patients with malocclusion may experience diminished efficacy to HNS therapy. This information may help identify individuals who are less likely to benefit from HNS therapy or who may require alternative (maxillomandibular advancement) or combination therapy (HNS with oral appliance).Level of Evidence3.

Trigeminal neuralgia associated with multiple sclerosis (MS-TN) is frequently refractory to medical and procedural therapy, particularly in the absence of neurovascular compression. Surgical options are limited when microvascular decompression is not appropriate. We report a salvage surgical approach combining internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory MS-related trigeminal neuralgia. A 50-year-old woman with relapsing-remitting multiple sclerosis presented with medically refractory right-sided trigeminal neuralgia predominantly involving the V2/V3 distributions. She had previously failed optimisation of pharmacotherapy, two percutaneous retrogasserian glycerol rhizotomies, and Gamma Knife radiosurgery performed within the preceding year. Posterior fossa exploration via a retrosigmoid approach demonstrated no neurovascular conflict. Internal neurolysis (nerve combing) was therefore performed and supplemented with targeted glycerol delivery to the proximal cisternal segment of the trigeminal root adjacent to the radiologically relevant demyelinating lesion. Postoperatively, the patient experienced immediate improvement in facial pain with preservation of trigeminal sensation and no new neurological deficits. Her early postoperative course was complicated by a wound infection requiring surgical washout and antibiotic therapy. At 43-month follow-up, she remained free of ipsilateral trigeminal neuralgia with substantially reduced medication requirements. She later developed contralateral facial pain controlled with low-dose carbamazepine without recurrence on the operated side. This report describes, to our knowledge, the first published case of combined internal neurolysis and targeted proximal trigeminal root glycerol injection for refractory multiple sclerosis-related trigeminal neuralgia. In this highly selected case, durable ipsilateral pain control was observed. However, causal interpretation is limited by the single-case design, the combined nature of the intervention, and the potential delayed effects of prior radiosurgery. This approach should therefore be regarded as hypothesis-generating rather than practice-defining, but may merit further study as a salvage strategy in selected patients without neurovascular compression after failure of medical, percutaneous, and radiosurgical treatments.

Background: Implant-related infection following femoral fracture surgery is a severe complication in elderly patients and is associated with high morbidity and mortality. Most available evidence on periprosthetic joint infection (PJI) derives from elective arthroplasty populations, which differ substantially from patients undergoing surgery for femoral fractures. This study aimed to investigate the microbiological profile and clinical characteristics of implant-related infections after proximal femoral fracture surgery. Materials and Methods: A retrospective observational study was conducted on 20 patients aged ≥70 years who developed implant-related infection after surgical treatment of proximal femoral fractures between 2020 and 2025 at a referral trauma center. Surgical procedures included intramedullary nailing, hemiarthroplasty, and total hip arthroplasty. Only patients with Charlson Comorbidity Index ≥ 4 and infection occurring within one year of the index surgery were included. Clinical, surgical, microbiological, and antibiotic therapy data were retrospectively reviewed. Results: The cohort had a mean age of 82.4 years and a high comorbidity burden (mean Charlson index 4.8). The most frequently isolated pathogen was Staphylococcus aureus (25.9%), with 85% methicillin-resistant strains. Other pathogens included Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli. Polymicrobial infections were observed in 25% of patients. One-year mortality was 25%. Conclusions: Implant-related infections after femoral fracture surgery represent a distinct clinical entity compared with elective PJI, characterized by frail patients and a higher prevalence of multidrug-resistant organisms. These findings highlight the need for tailored preventive and therapeutic strategies in this high-risk population.

Recurrent Laryngeal Nerve Reinnervation.

Class III skeletal malocclusion can be managed with surgical or nonsurgical orthodontic therapy. In selected cases, camouflage treatment may be planned after an accurate evaluation, also including Wits appraisal and Holdaway angle. Several studies have already analyzed the achieved outcomes between orthodontic camouflage and surgical therapy using multibracket appliances. However, recent advances in three-dimensional (3D) digital planning with clear aligners (CA) have opened new opportunities for managing Class III discrepancies. This research aims to evaluate, retrospectively, the dentoskeletal and aesthetic outcomes obtained using three-dimensional (3D) digital planning with clear aligners with 2 different protocols (surgical approach versus camouflage). Lateral x-rays of 23 Class III patients treated successfully (8 patients with a camouflage protocol and 15 with bimaxillary surgery) were collected and analyzed using Dolphin (Dolphin Imaging & Management Solutions, Chatsworth, CA) before (T0) and after (T1) treatment. Statistical comparisons between the 2 groups were performed using the t test and ANCOVA test ( P < 0.05). Independent t tests revealed statistically significant improvements in the surgical group for SNB (-2.7 degrees), Wits (+6.8mm), Overjet (+5.7mm), and IMPA (+3.3 degrees). However, ANCOVA revealed significant group effects only for SNB and ANB, favoring the surgical approach, and for upper-incisor inclination, favoring the camouflage approach, indicating that baseline severity accounted for most of the differences observed in unadjusted analyses. Both camouflage and surgical protocols with clear aligners achieved clinically meaningful outcomes; however, statistically significant dentoskeletal improvements were observed only in the surgical group, while the camouflage approach showed satisfactory root torque control.

Spinal cord injury (SCI) is a devastating condition characterized by complex primary and secondary pathophysiological mechanisms that result in motor, sensory, and autonomic dysfunctions. Despite advances in surgical, pharmacological, and biological therapies, effective treatments remain limited due to the multifactorial nature of SCI and the hostile post-injury microenvironment. In this context, biomaterial-based approaches have emerged as promising platforms, as they can provide both structural support and localized therapeutic delivery. Hydrogel-based systems, in particular, have attracted increasing attention due to their ability to mimic the extracellular matrix, modulate the injury microenvironment, and deliver bioactive molecules or cells in a controlled manner. In particular, combinatorial approaches integrating drugs, growth factors, or cellular components often show enhanced efficacy compared to single-component systems. However, direct comparison across studies is limited by substantial heterogeneity in injury models, outcome measures, and experimental design, as well as by reproducibility challenges associated with complex multi-component constructs. Furthermore, translational progress remains constrained by regulatory classification, manufacturing scalability, and standardization issues. Overall, while hydrogel-based strategies represent a promising platform for SCI repair, future research must prioritize reproducibility, simplification of design, and alignment with regulatory and clinical requirements to enable successful translation.

Gastric emptying, which exhibits a substantial inter-, but much lesser intraindividual, variation in health and is frequently disordered (particularly delayed) in diabetes, is now appreciated to be a major determinant of postprandial glycemia. The incretin hormones glucose dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1), are secreted in the proximal and distal small intestine respectively in response to nutrients. GLP-1, together with peptide tyrosine-tyrosine (PYY), stimulates potent negative feedback on gastric emptying. Modulation of gastric emptying, through dietary, pharmacologic and surgical therapies has been utilized in current clinical practice for the treatment of hyperglycemia, particularly relating to type 2 diabetes. We review the complex, interdependent, relationships between gastric emptying, small intestinal transit, glucose absorption, neurohormonal regulatory responses and postprandial glycemia. We discuss how this has informed fundamental advances in the understanding and rational management of obesity, stress hyperglycemia, type 1, 2 and gestational diabetes and provide recommendations for research priorities that have the potential to impact on practice. We also discuss the frequent complication of abnormally delayed gastric emptying (gastroparesis) in both type 1 and type 2 diabetes, the implications for management of diabetes and the impact of treatment on gastric emptying. With the increasing recognition of the importance of gastric emptying in the management of conditions associated with disordered glucose metabolism, and the advent and increasing use of GLP-1 receptor agonists, an improved definition of the interactions between gastrointestinal motility (gastric emptying and small intestinal transit) and enteropancreatic hormonal responses is essential.

Alpha-blockers and 5-α- reductase inhibitors are a mainstay of lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia treatment; however, there can be associated sexual function deterioration with these agents. We compared sexual function over 5years after continuous daily treatment with pharmaceutical agents in the NIH-Medical Therapy of Prostatic Symptoms (MTOPS) study versus a single water vapor thermal therapy (WVTT) procedure (Rezum RCT) in subjects with matched criteria for LUTS severity and prostate size. We used baseline sexual function data from cohorts of the MTOPS study (n= 1157) randomized to doxazosin, finasteride, combination therapy, and placebo, and sexually active men at baseline (n= 86) who received WVTT. MTOPS participants completed the Brief Male Sexual Function Inventory, while Rezum RCT participants completed the International Index of Erectile Function-15 and Male Sexual Health Questionnaire. Average percentage changes from baseline were developed using a linear mixed repeated measures model with fixed effects for treatment and follow-up visits. Men experienced significant worsening of sexual desire, erectile and ejaculatory function, and overall sexual satisfaction with finasteride and combination drug therapy. Men on doxazosin similarly had a significant decline in sexual desire, erectile, and ejaculatory function, but overall sexual satisfaction was preserved. WVTT patients experienced a significant increase in sexual desire and erectile function at 1-year follow-up and a significant increase in overall sexual satisfaction over 5years. There was a significant decrease in ejaculatory function of approximately -10% (vs. -20% combination therapy) from baseline levels from 3 to 5years of follow-up with WVTT. WVTT is an established office-based minimally invasive surgical therapy that offers sustained improvements in LUTS with minimal to no sexual side effects when compared to pharmacologic therapies, which all demonstrated significant negative impacts on sexual function. This study represents a novel comparison of data between two large landmark randomized controlled trials with robust clinical follow-up and little attrition. A limitation of the study is the utilization of two differing validated sexual function inventories that were utilized within each trial. WVTT may offer more favorable outcomes for sexual function compared to pharmacologic treatments, which are consistently associated with declines across multiple domains.

Middle meningeal artery embolization (MMAE) is a relatively new option for treating chronic subdural hematoma (CSDH). First used in the year 2000 in patients with CSDH and pronounced coagulopathy, today there are several large randomized controlled trials available that report on the efficacy of MMAE. Based on a complex pathophysiological model of CSDH with a focus on inflammation, fibrinolysis, and neoangiogenesis, the MMAE procedure works by blocking the pathological vessels of the CSDH membranes, whose activity prevents resorption of a CSDH. Embolization of the middle meningeal artery requires precise knowledge of the individual anatomy, as severe adverse effects can result from misembolization in critical collaterals. In principle, particles, liquid embolic agents, and coils are available as embolic agents, although particles and liquid embolic agents have been used in the randomized controlled trials published so far. Based on the latest large trials, MMAE is currently recommended by interdisciplinary consensus for patients with de novo CSDH and contraindications to surgical therapy, as well as for patients with recurrence as an adjunct to conventional therapy. Numerous other trials on MMAE have already been registered, so additional data regarding previously unanswered questions are expected in the near future. · MMAE is an increasingly important treatment option for CSDH.. · MMAE devascularises pathological haematoma membranes.. · Recent studies show a significant reduction in CSDH recurrences and reoperations following MMAE.. · A thorough understanding of anatomy and careful patient selection are crucial.. · Michael AE, Behme D, Nikoubashman O etal. Embolization of the Middle Meningeal Artery in Chronic Subdural Hematomas. Rofo 2026; DOI 10.1055/a-2851-9748.

Diverticular per oral endoscopic septotomy with selective crurotomy as salvage therapy for severe esophagogastric junction outflow obstruction after endoscopic and surgical therapy.

After neoadjuvant chemotherapy (NACT) of breast cancer, an accurate response assessment is essential for the de-escalation of surgical therapy. This study evaluated whether breast imaging procedures can reliably predict a pathologic complete response (pCR). This retrospective, monocenter study included 388 cases of invasive breast cancer treated by NACT. Most of the patients received mammography (MG) and ultrasound (US). In some cases, magnetic resonance imaging (MRI) was performed for special indications. The absence of residual tumor on imaging was defined as clinical complete response (cCR). Minimal signs of residual tumor were categorized as near-cCR. The primary endpoints were negative predictive values (NPVs) and false-negative rates (FNRs) of all imaging methods, combined and separately, for the whole cohort and subgroups of triple-negative (TN), human epidermal growth factor 2-positive (HER2+), and hormone receptor-positive (HR+)/HER2- breast cancer. The overall pCR rate was 40.7 %, with most pCR cases having triple-negative breast cancer (TNBC) (n = 85, 57.8 %). The highest NPV (71.6 %) and the lowest FNR (11.0 %) in the overall cohort were achieved by the combination of ultrasound and mammography. In the TNBC subgroup, NPVs ranged from 78.1 % to 83.7 %, compared with lower NPVs in the HR+ subgroup (34.2-50.0 %). If near-cCR cases were defined together with cCR as a "negative" test result, the predictive accuracy of imaging decreased in the whole cohort (FNR, 34.8 %; NPV, 56.1 %). Standard imaging is insufficient to predict pCR reliably in an unselected cohort. Strict patient selection and additional diagnostics are necessary for safe confirmation of pCR.