Abstract Objectives To identify a precise and convenient bedside methodology for determining neonatal bilirubin levels. In the context of shortening hospital stays, implementing high-precision point-of-care testing provides rapid results within minutes, ensuring faster and safer neonatal management and more efficient discharge planning. Methods A total of 131 term neonates were evaluated for total bilirubin concentrations using five different methods: two transcutaneous measurements (TcB test on the forehead [h] and sternum [s]), heel-stick total serum bilirubin (TSB) capillary blood testing via a bedside gas analyzer (Radiometer) and a point-of-care spectrophotometer (Bilimeter 3D POCT), and a laboratory analysis of venous blood samples using a chemistry analyzer (Beckman Coulter). The venous blood test was used as the standard against which the other four methods were compared. Results No significant statistical differences were found between the heel-stick plasma bilirubin values obtained with the Pfaff Bilimeter 3D (3D POCT) spectrophotometer and the laboratory reference method.The 3D POCT method showed a minimal mean bias of 2.36 µmol/L compared to the venous standard. In contrast, transcutaneous (TcB) measurements and the bedside gas analyzer (Radiometer) (TSB POCT) data, characterized by significantly higher mean biases, reduced correlation coefficients for TcB, and wider 95% limits of agreement. These findings indicate a higher risk of clinical misclassification when using TcB (from the forehead and sternum) or gas analysis compared to the 3D POCT spectrophotometer. Conclusions Our study suggests that total bilirubin determination from capillary blood samples (30 µl) using the Bilimeter 3D POCT method provides results with a high level of agreement compared to venous samples analyzed via a Beckman Coulter system. This bedside methodology demonstrates strong analytical consistency with standard laboratory techniques, offering a rapid and clinically relevant alternative for neonatal bilirubin monitoring. The findings highlight the significant advantages of this spectrophotometric approach, which provides a faster diagnostic turnaround while maintaining accuracy levels suitable for clinical decision-making within the studied population.

Abstract Purpose To investigate if the use of intravenous dexamethasone prior to surgery is effective in reducing hospitalisation time for patients with ankle oedema. Methods A prospective cohort study was conducted on consecutive patients with a fresh ankle dislocated fracture. Indications for starting treatment with dexamethasone 8 mg was single blinded for patients randomly selected. A total of 62 patients were included of which 39 were females and 23 males with an age range of 20–86 years (mean 53.6). Patients who were not treated with dexamethasone were designated to a control group. Treatment with dexamethasone was started soon after admission for a maximum period of three days. Subsequently, the period of hospital stay was calculated. Results 30 patients received dexamethasone intravenous every 6 h and 32 patients were placebo, included in this study. Average hospitalisation time with dislocated ankle fracture before operation with dexamethasone treatment was reduced from 6.5 to 3 days using the U Mann–Whitney test/ two –tailed test (U = 627.500, p = 0.033). Standard deviation for Hospitalisation time before operation in the DEXA group was 2.490 while, the placebo group was 5.067, which was statistically significant. None of the patients treated with dexamethasone developed wound infection. Conclusion The use of intravenous dexamethasone prior to dislocated ankle fracture surgery can significantly reduce oedema, wound infection and hospitalisation period.

Diabetic nephropathy (DN) is a severe microvascular complication of type 2 diabetes mellitus (T2DM), driven by complex interactions between metabolic, hemodynamic, and inflammatory pathways. Prolonged inflammation has been linked to tissue damage and fibrotic lesions in certain diseases. Genetic variations in inflammatory cytokines such as interleukin-6 (IL-6) and interleukin-8 (IL-8) may influence individual susceptibility to DN. This case–control study investigated the association between two functional promoter polymorphisms-IL-6 rs1800795 (-174G > C) and IL-8 rs4073 (-251 T > A)-and the risk of diabetic nephropathy in patients with type 2 diabetes mellitus. We enrolled 100 T2DM patients with DN and 100 T2DM controls without nephropathy. Genotyping was performed using ARMS-PCR, and clinical/biochemical profiles were assessed. The results demonstrated that the IL-6 C allele and IL-8 A allele were significantly more frequent in the DN group and exhibited a clear gene-dose effect on DN risk. Carriers of these risk alleles presented with a more severe clinical phenotype, including significantly worse renal function (lower eGFR, higher creatinine), a higher prevalence of hypertension, and an adverse metabolic profile marked by dyslipidemia. These findings elevate pro-inflammatory cytokines IL-6/ IL-8 from a mere inflammatory mediator to a potential genetic fulcrum in a pathogenic network that integrates inflammatory, hemodynamic, and metabolic axes in diabetic nephropathy.

Abstract Objective This study aimed to retrospectively evaluate triglyceride-glucose (TyG) index levels in patients with sudden sensorineural hearing loss (SSNHL) and explore its potential as a biomarker for early diagnosis or risk prediction. Methods This retrospective study included patients aged 18 years who were diagnosed with SSNHL from 2017 to 2024 following institutional ethics approval (2025-01/164). Complete fasting triglyceride (TG), fasting plasma glucose (FPG), and audiometric data (baseline and 3-month pure tone averages) were required for eligibility. Patients with a history of chronic otitis media, otosclerosis, meniere’s disease, or prior ear surgery were excluded from the study. Hearing thresholds of 500, 1000, 2000, and 4000 Hz were evaluated using the modified Siegel criteria. Statistical analyses were performed using R (version 4.4.1) and JASP (version 0.19.0), with p < 0.05 considered statistically significant. Results A total of 396 patients were included, with 50% serving as the control group. No significant differences in age, sex, glucose, or TG levels were observed between the groups. However, the SSNHL group had significantly higher TyG index values ( p <0.001). The TyG index was strongly associated with the severity and recovery of hearing loss, as determined by the modified Siegel criteria (p < 0.001), and was positively correlated with hearing thresholds across frequencies. TyG was identified as an independent risk factor for SSNHL (Odds ratio = 0.55; p <0.001). However, the ROC analysis revealed limited discriminatory capacity (AUC = 0.619), indicating that TyG may not be a sufficient standalone diagnostic marker. Conclusion This study is among the first to analyze the relationship between SSHL and the TyG index. The TyG index was identified as an independent risk factor for SSNHL and may serve as a potential predictive biomarker, particularly within multivariate models.

Abstract Background Methotrexate (MTX), a widely used antifolate agent in oncology and autoimmune disorders, has been increasingly associated with neurotoxic effects in the central nervous system. Hyperbaric oxygen (HBO) therapy has emerged as a potential neuroprotective approach through modulation of oxidative stress and cellular stress-response pathways, including autophagy and apoptosis. However, the region-specific effects of MTX and HBO on the autophagy–apoptosis axis within the hippocampus remain incompletely understood. Materials and Methods Adult male Sprague Dawley rats were randomly assigned to four groups: SALINE, HBO, MTX, and MTX + HBO. Hippocampal dentate gyrus (DG) and cornu ammonis (CA) subregions were analyzed. Immunohistochemistry was used to assess autophagy- and apoptosis-related markers, including LC3, Beclin-1, p62/SQSTM1, and cleaved Caspase-3 (Asp175). DNA fragmentation was evaluated using the TUNEL assay. Quantitative analyses were performed using animal-based mean values, and statistical comparisons were conducted using one-way ANOVA followed by Tukey post hoc testing ( p < 0.05). Results MTX administration was associated with increased LC3 and Beclin-1 immunoreactivity, indicating activation of early-phase autophagy-related signaling, accompanied by p62 accumulation and elevated Caspase-3 immunoreactivity, a pattern consistent with disrupted downstream autophagic processing and enhanced apoptotic signaling. HBO treatment alone induced a more limited increase in LC3 and Beclin-1 while reducing basal p62 and Caspase-3 levels, suggesting a modulatory and adaptive cellular response rather than overt stress activation. In the MTX + HBO group, p62 and Caspase-3 levels were reduced relative to MTX alone, indicating partial attenuation of MTX-associated cellular stress. TUNEL labeling was negative in all groups, suggesting that apoptotic processes were captured at an early or pre-fragmentation stage. Conclusions The present findings indicate that MTX exposure is associated with preserved autophagy initiation signals but impaired downstream processing and increased apoptotic signaling in the hippocampus. HBO treatment appears to modulate this imbalance by attenuating autophagy-associated stress and apoptotic signaling in a region-dependent manner, without providing definitive evidence of fully restored autophagic flux. These results support the biological plausibility of HBO as an adjunctive strategy to mitigate MTX-associated hippocampal stress while underscoring the need for future studies incorporating direct flux assessments, sex-specific analyses, and functional outcomes.

Abstract Objective There are many studies in the literature about the physiological and incontinence mechanisms of the anal region. However, there is a lack of information about the detailed anatomy and function of the longitudinal fibromuscular band. We have therefore studied the longitudinal fibromuscular band and its effect on the anal canal and the continence mechanism. Materials and methods The anal canals of 12 pelves of fixed cadavers abdominoperineal excision specimens were studied using a surgical microscope. Results The longitudinal fibromuscular band terminates in three fibers extending downward. Medial fibers of the band reach the most inferior part of the circular fibers of the internal anal sphincter and end at the anocutaneous line. Lateral fibers run below the superficial parts of the external anal sphincter and terminate at the ischioanal fossa. Inferior fibers spread radially in and below the subcutaneous part of the external anal sphincter and terminate in the subcutaneous. Conclusion The longitudinal fibromuscular band may play a role in incontinence because it supports the sphincter muscles in the anal canal from below. When the internal anal sphincter muscles relax, the longitudinal fibromuscular band located lateral to these muscles can assist with defecation. This will facilitate a better understanding of the mechanisms of incontinence. The anatomy of the anal canal is important in reducing the risk of recurrence in the surgical treatment of lower rectal tumors.

This randomised controlled trial (RCT) evaluated whether preoperative supplementation with 300,000 IU of cholecalciferol could reduce the risk of acute respiratory distress syndrome (ARDS) in patients undergoing oesophagectomy for carcinoma. Oesophagectomy carries substantial postoperative morbidity, particularly respiratory complications, with ARDS as the most severe form. Vitamin D has anti-inflammatory and endothelial-protective effects that may mitigate such injury. From January 2019 to June 2022, we conducted a single-centre RCT including 80 patients scheduled for oesophagectomy. Participants were randomly assigned to receive 300,000 IU of oral cholecalciferol or placebo before surgery. The primary outcome was whether supplementation reduced ARDS, assessed using the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI) at three time points: preoperatively after catheter insertion, within 1 h postoperatively, and on postoperative day one. Mean EVLWI differences between the cholecalciferol and placebo groups after catheterisation, within one hour postoperatively, and on postoperative day one were 0.3 (95% CI − 0.3 to 0.9, P = 0.384), 0.3 (95% CI − 0.5 to 0.9, P = 0.442), and 0.2 (95% CI − 1.1 to 0.7, P = 0.739). Corresponding PVPI differences were 0.1 (95% CI − 0.1 to 0.2, P = 0.240), 0 (95% CI − 0.2 to 0.2, P = 0.757), and − 0.1 (95% CI − 0.3 to 0.1, P = 0.438). A single high dose of cholecalciferol safely improved preoperative vitamin D status but did not reduce ARDS incidence. Nonetheless, potential immunological benefits associated with improved 25(OH)D levels remain plausible and warrant further investigation.

Abstract Purpose Carbonic anhydrase IX (CA-IX) is a hypoxia-regulated enzyme involved in pH homeostasis and tumor progression. This study aimed to investigate the effects of acetazolamide (AAZ), a CA-IX inhibitor, on mTOR signaling components in CAKI-2 renal carcinoma cells. Methods CAKI-2 cells were treated with AAZ and rapamycin (RAPA). Cell viability was assessed using the WST-1 assay. The expression levels of CA-IX, mTOR, phosphorylated mTOR (p-mTOR), 4E-BP1, and phosphorylated 4E-BP1 (p-4E-BP1) were evaluated using ELISA, Western blot, and immunofluorescence staining. Results AAZ treatment significantly reduced CA-IX levels ( p < 0.0001), while no significant changes were observed in mTOR, p-mTOR, 4E-BP1, or p-4E-BP1 protein levels. In contrast, RAPA treatment significantly decreased the levels of p-mTOR and p-4E-BP1 ( p < 0.05). Immunofluorescence analysis confirmed the downregulation of CA-IX following AAZ exposure, with no notable changes in the localization or intensity of mTOR and 4E-BP1 signals. Conclusion Although AAZ effectively inhibits CA-IX expression, it does not significantly impact mTOR pathway activation in CAKI-2 cells under normoxic conditions. Further studies are warranted to evaluate the role of CA-IX inhibition under hypoxic or combinatorial treatment settings.

This study is to examine the initial pass rates of the time interval between birth and the first hearing screening test on screening results, to determine the most appropriate screening time between birth and discharge, and to reduce parental anxiety and costs. Our study included all newborns screened with the ABR device between October 20, 2023, and March 31, 2024, as part of the newborn hearing screening program at the audiology clinic. Only those who passed bilaterally were given a “Pass” result. Those who remained unilateral or bilateral were given a “Fail” result and were referred. The study included 1,838 participants, 50.1% of whom were female and 49.9% male. It was determined that 1,131 participants passed bilaterally, 707 remained bilateral, 1,268 passed on the right, and 1,222 passed on the left. When the groups were compared within themselves and in pairs, the success rate of the screening test performed on the 5th day and thereafter was higher, and there was a statistically significant difference. According to our study, the likelihood of bilateral passing increases as the day of the test increases, especially after the third day.