Background/Objectives: The aim of this study was to investigate the association between patient demographics and overall operating time during bilateral sagittal split osteotomy (BSSO). Methods: For this retrospective study, data were collected from patients who had undergone BSSO in our hospital between 2016 and 2023. The mandibular body and mandibular ramus were evaluated from preoperative computed tomography (CT), and CT attenuation values of cortical and cancellous bone in the mandibular ramus were obtained from standardized preoperative CT images. Patient demographics (age, sex, occlusal class, and body weight) before surgery were also collected from the medical record. Results: Forty-six patients were included in this study. Weight and CT attenuation of the mandibular ramus (both cortical and cancellous bone) correlated with operating time (weight: rs = 0.304, p = 0.04; CT attenuation of mandibular ramus: rs = 0.323, p = 0.029). In addition, the Mann–Whitney U test revealed significantly greater operating time in males (p < 0.05). Effects of each variable were estimated after adjusting for other variables, and CT attenuation of the mandibular ramus (both cortical and cancellous bone) (B = 0.088, p = 0.008) was identified as having an effect on operating time. Higher CT attenuation, reflecting greater cortical and cancellous bone density, may increase resistance during osteotomy and consequently prolong operating time. Conclusions: This pilot study observed a possible association between CT attenuation of the mandibular ramus and operating time in BSSO. However, these findings are preliminary and do not imply any causal relationships. Thus, further studies with larger cohorts are required to confirm these observations.

Background: The spleen is an important organ in the evaluation of systemic diseases due to its hematologic and immunologic functions. Changes in splenic volume and surface area have diagnostic significance in various clinical conditions. This study aimed to evaluate age- and sex-related changes in splenic volume and surface area in an adult population. Material: A total of 304 abdominal CT scans (153 females, 151 males) were retrospectively evaluated. Participants aged 19–89 years were stratified by decades. Changes in splenic surface area and volume were analyzed according to age and sex using measurements obtained from these images with the 3D Slicer software package. Results: Splenic volume showed significant differences across age groups in females, whereas no statistically significant age-related difference was observed in males. Splenic surface area differed significantly according to age groups in both sexes. The highest mean splenic volume and surface area were observed in the 19–29 age group in both sexes. The lowest mean values were detected in the 80–89 age group in females and in the 70–79 age group in males. Conclusions: Splenic volume is higher in males than in females. A statistically significant decrease in splenic volume with advancing age was observed in females, whereas only a non-significant decreasing trend was noted in males. A marked reduction in splenic volume and surface area was observed particularly after the age of 70 years. This finding is associated with age-related immune decline and functional hyposplenism and carries clinical significance in terms of increased susceptibility to infections and diminished immune response in elderly individuals. Furthermore, splenic shrinkage should be considered in the assessment of hematological reserve and in the differentiation of changes related to chronic diseases.

Background/Objectives: Oculomotor nerve palsy (OMNP) is a clinically significant condition that may represent the earliest manifestation of life-threatening intracranial pathology, particularly aneurysmal compression or neoplasia. Despite its neurosurgical relevance, comprehensive meta-analytic evidence synthesizing OMNP etiologies, clinical presentation, and contemporary diagnostic pathways remains limited. Methods: Following PRISMA 2020 guidelines, MEDLINE, Scopus, and Web of Science were systematically searched for studies reporting quantitative data on OMNP. Pooled prevalence estimates were calculated using random-effects models for causes and symptoms, while a structured narrative synthesis was performed for diagnostic modalities because outcome reporting was heterogeneous and unsuitable for meta-analysis. Risk of bias was assessed using the Joanna Briggs Institute (JBI) risk of bias tool. Results: Twenty-four studies involving 5541 patients were included. Using a multivariate multilevel model to account for within-study dependence, the most common etiological category was vascular disorders (35.62%), followed by idiopathic (16.47%) and neoplastic (12.10%). Head trauma and aneurysms accounted for 11.26% and 10.08% of cases, respectively. Diplopia (60.63%) and ptosis (54.12%) remained the predominant clinical symptoms, while pupil involvement was identified in 40.62% of the pooled population. Diagnostic paradigms have shifted decisively toward non-invasive neuroimaging, with magnetic resonance imaging reported in 66% of included studies and magnetic resonance or computed tomographic angiography increasingly employed to identify surgically relevant vascular lesions. Conclusions: Although vascular disorders represented the most common etiological category, the notable prevalence of aneurysmal and neoplastic causes underscores the importance of prompt high-resolution neuroimaging and early neurosurgical assessment. Early recognition and etiological stratification remain essential to optimize management and prevent irreversible neurological morbidity.

Background/Objectives: We aim to identify the postoperative acute kidney injury (AKI) risk factors and the predictors of severe AKI derived from routine perioperative elements in patients with aortoiliac occlusive disease who underwent aorto-bifemoral bypass as arterial revascularization. This involves a dynamic assessment throughout the perioperative period. Methods: Preoperative, intraoperative, early postoperative and day-one-after-surgery data were retrospectively reviewed in consecutive patients who underwent elective aorto-bifemoral bypass for aortoiliac occlusive disease classified as TASC II D at the “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases in Bucharest, Romania, between 2017 and 2023. Results: Preoperative clearance of creatinine (OR 1.037, CI95%: 1.009–1.066), the duration of the surgery (OR 1.435, CI 95%: 1.100–1.873), and the change between the day-one-after-surgery and preoperative systemic inflammatory response index (DeltaSIRI_1_preop) (OR 1.080, CI 95%: 1.012–1.152) were identified as independent risk factors for postoperative AKI in patients undergoing aorto-bifemoral revascularization for aortoiliac occlusive disease. The most severe form of AKI was strongly predicted by the number of packed red blood cells transfused (AUC 0.924, p = 0.001), the patient’s age (AUC 0.895, p = 0.001), and the duration of the surgery (AUC 0.895, p = 0.001). Furthermore, various routine and cost-effective variables related to the preoperative period, the early postoperative period, and the first day after surgery also demonstrated significant predictive value. Conclusions: We conducted a dynamic perioperative assessment of AKI associated with major vascular surgery. This aims to equip clinicians with a practical and cost-effective tool for evaluating AKI, thereby facilitating a more individualized approach to the diagnosis of this complication.

Purpose: This study aims to evaluate the ability of radiomic features obtained from technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) planar images to distinguish renal cortical uptake patterns among patients with chronic kidney disease (CKD). We also assessed the association between selected radiomic features and progressive renal function loss during follow-up. Methods: The study included a total of 185 patients: patients with Diabetes mellitus (DM) + hypertension (HTN) diagnosis (Group 1, n = 30), patients with HTN diagnosis alone (Group 2, n = 86), and patients with no history of DM or HTN who were followed for CKD (Group 3, n = 69). Intergroup comparisons were performed using the Kruskal–Wallis test with Bonferroni-corrected post hoc pairwise testing; the proportion of significantly different features was assessed using FDR correction. As a secondary exploratory analysis, the relationship between selected radiomic features and time to first observed ≥20% eGFR decline at follow-up was evaluated using univariate L2-penalised Cox proportional hazards regression with feature selection guided by the events-per-variable principle and model discrimination quantified using Harrell’s C-index. Results: Intensity Kurtosis values showed a statistically significant difference among the groups: −0.11 (−0.31 to 0.12) for Group 1, −0.24 (−0.41 to −0.04) for Group 2, and −0.33 (−0.45 to −0.16) for Group 3 (p = 0.001). Mean Intensity values were found to be 60.66 (31.01–89.39) in Group 1 and 90.46 (72.87–106.34) in Group 3 (p < 0.001). Age, gender, and baseline eGFR did not differ between groups. Radiomic analysis revealed significant intergroup differences predominantly in intensity- and texture-based features, while morphological features showed more limited differentiation. In the secondary exploratory longitudinal analysis, Centre of Mass Shift was the only morphological feature significantly associated with time to first observed ≥20% eGFR decline at follow-up (HR per SD: 0.74; 95% CI: 0.58–0.94; p = 0.015; C-index: 0.57). Conclusions: Radiomic features from Tc-99m DMSA planar images reveal quantitative differences between clinically defined CKD subgroups even when cortical uptake appears visually indistinguishable. The threshold-specific association of Centre of Mass Shift with subsequent eGFR decline, beyond baseline renal function, suggests that DMSA radiomics may provide exploratory prognostic information that warrants prospective validation.

Background/Objectives: To develop and preliminarily evaluate a practical Python-based program for dynamic intracardiac blood flow visualization and the extraction of new quantitative parameters, serving as an initial step toward future flow-based cardiac evaluation. Methods: The method was technically explored across five imaging modalities (angiography, MRI, ICE, TEE, TTE) using standard diagnostic hardware. Preliminary testing used ECG-gated ICE DICOM images from sixteen patients undergoing first-time AF ablation. Results: The program produced dynamic full-chamber flow visualizations and automatically computed two image-derived surrogate markers of flow-pattern behavior, the *turbulence index (TI)* and *blood mobility fraction (BMF)*, across cardiac cycles. Distinct preliminary flow patterns were observed between sinus rhythm and atrial fibrillation. Outputs are exportable for AI analysis. Conclusions: This proof-of-concept approach demonstrates feasibility for routine intracardiac flow assessments, and introduces TI and BMF as potential flow-based biomarkers for future prognostic use after additional validation.

Background and Clinical Significance: Dyskeratosis congenita (DC) is a rare inherited disorder classified as a telomere biology disorder and characterized by multisystem involvement, including bone marrow failure and mucocutaneous abnormalities. Oral manifestations such as leukoplakia, increased susceptibility to infection, and abnormal dental development have been reported; however, detailed descriptions of long-term oral functional management in pediatric patients remain limited. This report aims to describe the longitudinal oral management and imaging-based assessment of dental development in a child with DC and to discuss the clinical implications in the context of existing literature. Case Presentation: A female patient diagnosed with dyskeratosis congenita due to a heterozygous TINF2 mutation was followed from early childhood. She underwent hematopoietic stem-cell transplantation at five years of age and later required lung and liver transplantation. Long-term oral management included regular professional oral care, preventive strategies, and periodic imaging evaluation. Panoramic radiographs obtained over several years demonstrated generalized delayed eruption and incomplete root formation relative to chronological age, with apparent early arrest of root elongation. Discussion: This case highlights the potential association between telomere dysfunction, intensive systemic therapy in early childhood, and arrested odontogenesis. These findings suggest a possible association between telomere dysfunction, early intensive systemic therapy, and impaired root formation. Despite severe systemic disease, continuous preventive oral care and imaging-based monitoring were effective in maintaining oral health and detecting mucosal changes. Conclusions: Long-term preventive oral management combined with noninvasive imaging assessment may play an important role in preserving oral function and monitoring dental development in pediatric patients with dyskeratosis congenita. This case adds to the limited literature on longitudinal oral outcomes in this rare disorder.

Background: Liver cirrhosis, particularly in its decompensated stages, is associated with high short-term mortality among hospitalized patients. Although the prognostic value of the Child–Pugh classification is well established, its independent impact on survival in real-world tertiary emergency settings requires further evaluation. This study aimed to assess the prognostic role of Child–Pugh stage and other clinical factors on short- and mid-term survival in hospitalized cirrhotic patients over a 10-year period. Methods: We conducted a retrospective cohort study including 2831 patients hospitalized for liver cirrhosis between 2015 and 2025. Among them, 631 patients with complete Child–Pugh staging were included in the survival analysis. Survival time was defined as the interval between the first hospitalization and the last recorded discharge or in-hospital death. Survival differences were assessed using Kaplan–Meier curves and log-rank tests, while independent predictors of mortality were identified using multivariate Cox proportional hazards regression. A complementary logistic regression model was used to evaluate predictors of mortality as a binary outcome. Results: Among the 631 staged patients, 13.5% were classified as Child–Pugh A, 31.9% as Child–Pugh B and 54.7% as Child–Pugh C. In-hospital mortality increased significantly across stages (1.2%, 9.0% and 46.7%, respectively; p < 0.001). One-year survival was 98.7% for Child–Pugh A, 83.6% for Child–Pugh B and 40.7% for Child–Pugh C (log-rank p < 0.001). In multivariate Coxregression analysis, the strongest predictor of mortality was mixed cirrhosis type (HR = 8.58, 95% CI: 4.81–15.32, p < 0.001). Child–Pugh C was also independently associated with a markedly increased mortality risk compared with Child–Pugh A (HR = 25.11, 95% CI: 3.44–183.29, p = 0.002). Alcohol-related etiology (HR = 1.81, 95% CI: 1.09–3.01, p = 0.023) and age (HR = 1.18 per SD increase, 95% CI: 1.00–1.39, p = 0.050) were additionalindependent predictors. The Cox model demonstrated good discrimination (C-statistic ≈ 0.80). In the logistic regression model, mixed cirrhosis type (OR = 13.28, p < 0.001) and Child–Pugh stage (OR = 8.66, p < 0.001) were the strongest predictors of mortality, while ascites showed an inverse association after adjustment (OR = 0.62, p = 0.036). The logistic model showed excellent discrimination (AUC = 0.865). Conclusions: Child–Pugh stage remains a strong and independent predictor of survival in hospitalized patients with decompensated cirrhosis. The marked survival gradient across stages, particularly the substantially reduced survival observed in Child–Pugh C patients, highlights thecontinued clinical utility of this simple classification for early risk stratification intertiary emergency hospital settings.

Wilson’s disease (WD) is an autosomal recessive disorder of copper metabolism caused by ATP7B mutations, characterized by hepatic copper accumulation and multisystem involvement. Several rare inherited and acquired conditions can closely mimic WD, posing diagnostic challenges and the risk of inappropriate therapy. By examining neuroimaging patterns and distinguishing between diagnostic criteria, this narrative review provides a comprehensive synthesis of WD-mimicking disorders, emphasizing their molecular mechanisms, clinical phenotypes, and biochemical features. WD-mimicking disorders encompass ATP7A-related neurodegenerations (Menkes disease, occipital horn syndrome, X-linked distal hereditary motor neuropathy), MEDNIK syndrome, Huppke–Brendel syndrome, aceruloplasminemia, congenital disorders of glycosylation, primary familial intrahepatic cholestasis type 3, and acquired copper deficiency syndromes. Mechanisms include systemic copper deficiency, impaired intracellular trafficking, defective ceruloplasmin biosynthesis, secondary hepatic copper accumulation, and abnormal glycosylation. Clinical features range from neurodevelopmental delay, movement disorders, and hepatic dysfunction to dermatologic, hematologic, and connective-tissue abnormalities. Biochemical profiles may overlap with WD, particularly low serum ceruloplasmin and total copper, altered urinary copper excretion, and elevated hepatic copper in some disorders. Neuroimaging and genetic testing provide critical discriminative value. Management is largely supportive, with disease-specific therapies available in selected conditions, such as subcutaneous copper in Menkes disease or monosaccharide supplementation in certain congenital disorders of glycosylation subtypes. Accurate differentiation between WD and WD-mimicking disorders requires careful integration of clinical, biochemical, imaging, and molecular data. Recognition of distinctive features and understanding underlying pathophysiology are essential to avoid misdiagnosis and inappropriate anti-copper therapy, optimize management, and improve patient outcomes.

Background: Pediatric liver disease is frequently associated with abnormal conventional coagulation tests; however, prothrombin time expressed as international normalized ratio (PT-INR) incompletely reflect global hemostatic balance. Thrombin generation assay (TGA) provide an integrated assessment of coagulation and may offer complementary information in children with acute liver failure (ALF) and chronic liver disease (CLD). Methods: We enrolled 61 pediatric patients with liver disease (50 CLD, 8 ALF, 3 extrahepatic portal vein obstruction EHPVO) and 51 healthy controls. Platelet-poor plasma was prepared according to international recommendations. Thrombin generation was measured using ST Genesia (STG) with normalization to reference plasma. Group comparisons were performed using non-parametric tests; correlations between PT-INR and thrombin generation parameters were assessed, and principal component analysis (PCA) was used to explore the variance structure of thrombin generation indices and conventional coagulation variables. Results: PT-INR was significantly higher in patients than controls, particularly in ALF. Bleeding events were uncommon. Compared with controls, patients showed reduced levels of fibrinogen and multiple procoagulant/anticoagulant factors (including antithrombin and protein C), with increased factor VIII. Among thrombin generation parameters, the endogenous thrombin potential (ETP) ratio differed significantly across groups (p = 0.001), while correlations between PT-INR and thrombin generation parameters were weak or absent, no significant associations were observed even at higher Pediatric/Model for End-Stage Liver Disease scores. PCA separated thrombin generation indices from PT-INR and conventional coagulation factors, suggesting complementary information. Conclusions: In pediatric liver disease, PT-INR does not reliably reflect global coagulation capacity. Thrombin generation testing provides additional, integrative information on hemostasis and may improve laboratory assessment beyond conventional tests.