Yeditepe University Hospital

Purpose: To describe clinical and virologic outcomes after topical 5% imiquimod for VaIN (vaginal intraepithelial neoplasia) within routine clinical practice, including the assessment of available post-treatment high-risk HPV status, and to evaluate its relationship with treatment outcomes. Methods: In this retrospective-cohort study, twenty patients with histologically confirmed VaIN (low-grade VaIN = 10, high-grade VaIN = 10) were evaluated between October 2020 and October 2022. The treatment varied based on the initial VaIN grade. The primary endpoint was complete response, defined as negative cytology and/or benign follow-up biopsy. Secondary endpoints included partial response (downgrading from high-grade to low-grade), persistence/progression, adverse events, and available post-treatment high-risk HPV status. Results: Among seventeen evaluable patients, a complete response was observed in 69.2% (9/13) imiquimod-treated patients. In high-grade VaIN imiquimod-treated patients, complete response was observed in 66.7% (6/9), while 33.3% (3/9) downgraded to low-grade VaIN on biopsy as a secondary outcome, with no persistence over a median follow-up of 24 months. Low-grade VaIN showed 75% clearance with either imiquimod or observation at a median follow-up of 24 months. In one low-grade imiquimod-treated, persistent HPV16 was observed, and the lesion progressed to high-grade VaIN; however, no invasive cancers were observed during follow-up. Adverse events related to imiquimod were mild; there were no discontinuations. Among baseline high-risk HPV positive imiquimod-treated patients, post-treatment follow-up HPV testing was available in a limited subset group, and clearance was confirmed in 44% (4/9) among those with follow-up testing and presented descriptively as exploratory. Conclusions: In this single-center retrospective cohort, outcomes after topical 5% imiquimod are reported as observed findings. Complete and partial responses were observed in high-grade VaIN with acceptable tolerability and no invasive events at available intermediate follow-up (median 24 months). Post-treatment HPV testing provided complementary virologic information alongside clinical outcomes, consistent with recommendations incorporating HPV testing into VaIN follow-up, and longer surveillance is required to assess long-term oncologic outcomes.

Oral squamous cell carcinoma (OSCC) is a prevalent malignancy with a poor prognosis due to late diagnosis, with a 5-year survival rate of 35-50%.Patients with Fanconi anemia (FA) exhibit a 500-700-fold increased risk of developing OSCC at younger ages.Non-invasive biomarkers are critical for early detection in high-risk groups.The present study investigated the salivary expression levels of miR-34a and the serum levels of survivin, both of which are associated with the PI3K signaling pathway, in patients with OSCC (n=24), patients with FA (n=24) and healthy controls (n=40).The miRNA levels were quantified using reverse transcription-quantitative PCR, and protein levels were measured using ELISA.Compared to the controls, the patients with OSCC exhibited significantly lower miR-34a levels (P=0.012), and patients with FA exhibited a reduced expression of miR-34a (P=0.014).Survivin levels were elevated in patients with OSCC (P=0.04) and FA (P=0.01)compared to the controls.A negative correlation was identified between miR-34a and surviving levels (=-0.52,P=0.005) in patients with OSCC.These findings suggest that miR-34a and survivin are promising non-invasive biomarkers for assessing the risk of developing OSCC in patients with FA and OSCC.However, multicenter studies with larger cohorts are warranted to validate these results for clinical surveillance protocols.

This response addresses the comments by Arif et al. on our article, "The Chestnut Technique: A Novel Approach to Enhancing Implant Stability in Breast Augmentation." We acknowledge the limitations raised regarding patient demographics, follow-up duration, and comorbidities and agree that larger and more diverse cohorts are needed to strengthen the evidence. We also emphasize the importance of objective assessments, noting our ongoing prospective study incorporating MRI at 12 months to evaluate inferior flap viability. Additionally, we highlight the need to assess functional outcomes such as lactation and breast sensation in future research. We appreciate these constructive remarks, which underscore the importance of extended follow-up and collaborative investigations to validate and refine the Chestnut Technique as a reliable method for enhancing implant stability.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Despite advancements in implant technology and surgical techniques, achieving long-term implant stability in breast augmentation remains challenging, particularly in cases where enhanced soft tissue support is required. The chestnut technique was developed to enhance implant stability and address soft tissue support-related complications by incorporating a structurally supportive soft tissue framework. This study aims to describe the surgical steps of the chestnut technique and evaluate patient-reported outcomes following its application. This retrospective study included 60 female patients who underwent primary breast augmentation between April 2020 and November 2024. Implants were placed in a customized subpectoral pocket, ensuring superior and inferior muscle and fascia coverage with pectoral fascia support at the midsection. Patient satisfaction was assessed using the BREAST-Q module preoperatively and at 1 year postoperatively. The mean follow-up period was 31.8 months (range: 12-56 months). No cases of implant malposition, rippling, or animation deformity were observed. Minor complications occurred in 5% of patients and were successfully managed with conservative treatment. The mean BREAST-Q satisfaction score significantly increased from 23.44 ± 10.20 preoperatively to 84.46 ± 9.90 at 1 year, with similar improvements in psychosocial and sexual well-being (p < 0.001). The chestnut technique provides a safe and effective approach to primary breast augmentation, particularly in cases where enhanced soft tissue support is desired. By optimizing implant stability and minimizing displacement-related complications, it serves as a reliable alternative to conventional methods while ensuring predictable and aesthetically favorable outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/0026 .

In the TRS-483 recommendations, output correction factors to be applied in small fields are specified as a single value for each detector and field size, regardless of the Linac model, collimation, or filtering difference. Since Scp values are used in the treatment MU value calculations, if the Correction Factors due to the detector differences are entered into the TPS incompletely, the dose calculations are incorrect in the treatment plans where small fields such as SRS, SRT, SBRT are used frequently. In our study, correction factors for 7 different detectors and 9 different field sizes (0.5, 1.0, 2.0, 2.5, 3, 3.5, 4.0, 4.5, 5.0 cm2 ) were calculated using the experimental method and their compatibility with the correction factors specific to the detectors specified in the literature was investigated. 6 WFF and 6 FFF photon output factors for IBA CC01, IBA CC04, SI Extradin A16, PTW Pinpoint 3D, PTW microDiamond, Sun Nuclear Edge and PTW SRS Diode were calculated with Daisy Chain method. It was observed that ion chambers are under-response in field sizes smaller than 3 cm2 and need a larger correction factor, whereas solid-state detectors are over-response, and needs a relatively smaller correction factor than ion chambers. The percent variation between the correction factors for the two energies 6 WFF / 6 FFF was found to be a maximum of 2% for both ion chambers and solid detectors at field sizes of 2 cm2 and larger.