Indiana University Hospital

Background: Miniaturized percutaneous nephrolithotomy techniques have been developed to reduce the morbidity associated with standard percutaneous nephrolithotomy (PCNL) while maintaining high stone clearance. Among these approaches, mini-PCNL and ultra-mini PCNL (UMP) are increasingly used; however, their optimal indications remain incompletely defined. Aims: To review and synthesize current evidence regarding the efficacy, safety, and clinical indications of mini-PCNL and UMP in the management of kidney stone disease. Methods: A narrative review of the literature was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Clinical studies, comparative analyses, meta-analyses, reviews, and international guideline documents addressing mini-PCNL and UMP were included. Evidence was synthesized descriptively with emphasis on stone- and patient-related factors influencing technique selection. Results: Both mini-PCNL and UMP demonstrated high stone-free rates when applied in appropriately selected patients. Mini-PCNL achieved superior stone clearance for larger (15–30 mm), multiple, or high-density renal stones, owing to efficient fragment extraction. UMP was associated with lower perioperative morbidity, reduced bleeding risk, and shorter hospital stay, with optimal outcomes observed in smaller stone burdens. Differences in efficacy between techniques were minimal for stones <15 mm but became more pronounced with increasing stone size and complexity. Conclusions: Mini-PCNL and UMP are complementary techniques in contemporary percutaneous stone surgery. Mini-PCNL is best suited for larger or more complex stones requiring active fragment removal, whereas UMP offers advantages in minimizing invasiveness and accelerating recovery in selected patients. Individualized treatment selection based on stone characteristics, patient factors, and surgical expertise is essential to optimize outcomes.

Background: Obesity is a global health problem due to its increasing prevalence over the past several decades. It is strongly associated with an elevated risk of cardiovascular diseases, both directly through metabolic mechanisms affecting the circulatory system and indirectly through traditional risk factors such as hypertension, dyslipidemia, and type 2 diabetes. Aim: This review discusses the pathological changes occurring in the cardiovascular system under the influence of obesity. It presents the mechanisms linking obesity with selected cardiovascular diseases and outlines the role of physical activity in obesity. Methods: The review was conducted using the PubMed, Web of Science and Google Scholar databases, limited to full-text, open-access publications from the years 2013–2025. Results: As body weight increases, the risk of cardiovascular diseases such as heart failure, hypertension, and arrhythmias also rises. Weight reduction helps lower the risk of developing these disorders. Combined aerobic and resistance training (CART), as well as High-Intensity Interval Training (HIIT), has a beneficial effect on well-being and the condition of the cardiovascular system. Conclusion: Obesity and the metabolic disturbances it causes are strongly associated with an increased risk of cardiovascular diseases. Obesity is not only a co-existing factor but also an independent risk factor for cardiovascular conditions. Effective intervention requires an individual approach.

Background: iron deficiency anemia (IDA) is a widespread, preventable condition that diminishes work capacity, cognition, and overall health. Dysregulation of iron homeostasis — principally via hepcidin‑mediated sequestration — distinguishes absolute deficiency from functional deficiency, guides diagnostic interpretation and helps to choose the type therapy. Aim: The aim of this article is to compare the available oral iron supplements with respect to efficacy, tolerability and practical use. It summarizes current evidence regarding optimal dosing and frequency of administration in individuals with iron deficiency and iron-deficiency anemia. Methods: narrative review of literature up to 2025, prioritizing recent meta‑analyses, systematic reviews, randomized controlled trials, phase III randomized studies and other high‑quality studies. Searches were conducted in PubMed/MEDLINE, Embase, Web of Science and Google Scholar. Key search terms included oral iron, ferrous sulfate, liposomal iron, sucrosomial iron, ferric maltol and ferrous bisglycinate. This review compares their efficacy and tolerability. Study selection, data extraction, and quality evaluation followed standard review procedures; findings were synthesized and summarized in tables. Results: new supplements generally achieve comparable or faster hematologic responses at lower elemental iron doses and are associated with fewer gastrointestinal side effects, which may improve adherence, particularly in patients intolerant of ferrous salts or with inflammatory conditions. Dosing approaches that account for hepcidin dynamics (alternate-day or single morning dosing) enhance absorption. Heterogeneity in study populations, dosing regimens and outcome measures limits direct comparisons. Conclusion: oral iron formulations show broadly similar efficacy; selection should prioritize tolerability, comorbidity context, and dosing strategies that optimize absorption. Individualized therapy with routine monitoring of hemoglobin and ferritin improves outcomes and adherence.

Gastroesophageal reflux disease (GERD) is a widespread gastrointestinal disorder with a significant global burden. Its multifactorial etiology is influenced by unmodifiable risk factors such as sex-based differences; men, for instance, show a higher predisposition for more severe complications like esophageal adenocarcinoma. GERDs pathophysiology is heavily connected with mechanical failure of the anti-reflux barrier, a two-component system that consists of the intrinsic lower esophageal sphincter (LES) and the extrinsic crural diaphragm. Interference in the form of hiatal hernia, hypotensive LES pressure or transient LES relaxations leads to reflux. Modern approach highlights the critical role of microscopic mucosal damage, which causes visceral hypersensitivity and allows the distinction of various phenotypes like non-erosive reflux disease and reflux hipersensitivity. Diagnosis is guided by the Lyon Consensus 2.0 using endoscopy, manometry, and impedance-pH monitoring. Treatment is a multi-step process – it includes lifestyle modification, numerous pharmacological agents such as proton pump inhibitors or newer potassium-competitive acid blockers, and, for refractory cases, interventional treatment via laparoscopic Nissen fundoplication, transoral incisionless fundoplication or magnetic sphincter augmentation.

To evaluate the rate of discrepancies between community radiologists’ interpretations of trauma studies and those of the emergency radiologists at an academic level 1 trauma center and to assess the impact on patient management provided by emergency radiologist overreads. A search of our institutional Radiology Information System (RIS) was performed to find outside overread interpretations that were performed by emergency radiologists at our institution in a 1-year period (January 1, 2023-December 31, 2023). For these patients, the outside report was obtained and compared to the emergency radiologist overread report. Discrepancies between reports were divided into major and minor discrepancies. A major discrepancy was defined as a change in interpretation that resulted in altered patient management (including interventional radiology procedure or surgery). A minor discrepancy was defined as a change in interpretation that did not alter patient management. The study cohort consisted of 301 imaging exams performed on 135 patients. The mean age was 52.3 years (range 19–97 years), included 68 males (63.7%), and a mean Injury Severity Score (ISS) of 13 (range 1–51). Patients were transferred from 29 different facilities from around our state. The most common mechanism of injury was fall (n = 128, 42.5%) followed by motor vehicle collisions (MVC, n = 103, 34.2%) and assaults (n = 25, 8.3%). Major discrepancies were found in 26 exams (8.6%) affecting 25 patients (18.5%), of which 7 required surgery or an interventional radiology procedure. Minor discrepancies were found in 49 exams (16.3%) affecting 42 patients (31.1%). In total, some discrepancy was found in 75 (24.9%) of exams affecting 62 patients (49.6%). There is a statistically significant association with a discrepancy following MVC compared to the other mechanisms of injury (p = 0.0228). We found that nearly a quarter (24.9%) of overread imaging exams affecting nearly half (49.6%) of transferred trauma patients had a discrepancy in the original report, resulting in a change in management in 18.5% of patients, with over a quarter (26.9%) of major discrepancies requiring surgery or interventional radiology procedures. Motor vehicle collisions were associated with an increased likelihood of a discrepancy. Our findings continue to support the value of reinterpretation of outside imaging exams by dedicated emergency radiologists in the setting of trauma.