Background

Self-Expanding Metallic Stents (SEMSs) are an effective way to relieve malignant colonic obstruction. In those with incurable disease, stents may provide palliation and avoidance of surgery and its associated complications. Emergent surgery for colonic obstruction has historically had a high mortality rate of 10% to 30%. Colonic SEMSs can also decrease hospital stay and reduce hospital costs compared to emergency surgery and improve quality of life.

Methods

We retrospectively evaluated 16 patients with incurable cancer and colonic obstruction consecutively undergoing SEMS placement over a period of 18 months. All patients were diagnosed as having colorectal obstruction due to incurable CRC or extracolonic cancer. Major complications included events leading to surgical or endoscopic reintervention or requiring admission to the intensive care unit. Perforation, stent obstruction, and migration were considered to be major complications.

Results

During the study period, a total of 16 patients were treated endoscopically by placement of a colonic SEMS. The average age of the patient was 61 years. There were 4 patients with rectal cancer , 10 patients with sigmoid and recto-sigmoid growth, and 2 patients with anastomotic recurrence at Ileo-colic anastomosis after right hemicolectomy. In two patients, a stent could be placed on the 2^nd attempt after a failed 1^st attempt. We had two complications: one patient experiencedstent migration, following which the stent was retrieved and colostomy was performed; another patient experienced perforation, which was managed conservatively. The average survival time after stenting was less than 6 months. Colonic stents were maintained until death.

Conclusions

Colonic stenting offers a low-risk, high-success-rate alternative compared to surgery. It is also associated with shorter hospital stay and less severe complications. In a cohort whose life expectancy rarely exceeds 6 months, this may translate to better quality of life, earlier palliative chemotherapy commencement, and lower medical expenses. While SEMSs may induce lower acute complications and acute mortality rates, surgery may be associated with better long-term outcomes.

Introduction

Suppurative thyroiditis comprises less than 1% of thyroid diseases. More often, this condition occurs in immunocompromised individuals or those with pre-existing thyroid disorders. In adults aged 50 years and older, thyroid cancer should also be excluded.

Methods

A 57 year-old male was urgently hospitalized with pain and tenderness of the left side of the neck. Ultrasonography revealed pronounced swelling of the neck soft tissues and a non-homogenous mass 2 cm below the skin surface 9.0 x 5.2 x 9.0 cm in size, which was spreading behind the sternum. Contrast-enhanced CT-angiography of the neck demonstrated a thyroid gland left lobe lesion 7.0 x 6.0 x 9.0 cm in size with a thin capsule, containing a fluid component with strings of calcification and accumulating contrast at the periphery, tracheal compression by 50%, and massive locoregional lymphadenopathy. An abscess of the thyroid gland left lobe cyst was suspected.

Results

Considering the patient's stable condition, ultrasound-guided drainage of the formation under local anesthesia was decided upon and performed. In the post-operative period, the patient's vital signs were within the normal ranges, and he received conservative therapy to the full extent. A pathology report of the lesion stated the presence of a chronic abscess and a thyroid gland left lobe tumor of undetermined malignancy potential. The patient underwent left hemithyroidectomy in a planned manner. The specimen histological picture met the criteria for papillary thyroid cancer of the infiltrative follicular variant, pT3aN0M0, with signs of lymphovascular invasion. The edges of the resection were without signs of tumor growth.

Conclusions

Thyroid cancer can be induced by inflammatory processes. In this case, a male patient was treated for thyroid abscess, but eventually he was diagnosed with papillary thyroid cancer. Since the risk of having cancer increases with age, older patients should be monitored more closely for the presence of malignancy.

Introduction: Pneumonia is a lung infection caused by microorganisms, transmitted through coughing and inhaling infected droplets. Symptoms include a persistent cough, shortness of breath, fever, and chest pain. Diagnosis involves medical history, chest X-rays, lab tests, and exams. Improved environmental conditions have led to a decrease in pneumonia cases.

Methods: The 88-year-old male patient exhibits symptoms including a persistent cough, fever, and breathlessness, from the aspiration of pathogens from the upper respiratory tract into the lungs. The chest X-ray revealed new opacity in the interstitial lung tissue of the left lower lobe, suggesting a lung infection.

Results: This patient's pneumonia is classified as Community-Acquired Pneumonia (CAP), as it developed within 48 hours of hospitalization. Both influenza A and B and COVID-19 rapid antigen test results were negative. According to the American Thoracic Society, patients with CAP and risk factors for MRSA (Methicillin-resistant Staphylococcus aureus) and Pseudomonas aeruginosa should be treated with extended-spectrum antibiotics. Empiric options for P. aeruginosa include piperacillin–tazobactam, cefepime, and meropenem. The doctor prescribed meropenem 1 g intravenous therapy (IV) every 8 hours. Due to the patient’s kidney problems (CrCl: 36 mL/min; estimated glomerular filtration rate (eGFR): 46 mL/min/1.73m²), the dosage should be adjusted to 1 g IV every 12 hours, resulting in a drug-related problem (DRP): overdose.

The patient's CURB-65 score (confusion, uremia, respiratory rate, blood pressure, and age of 65 or older) of 2 indicated the need for inpatient care, making hospitalization appropriate. A comparison using indication, efficacy, safety, adherence, and cost (IESAC) suggests changing to oral ciprofloxacin, which is more effective against P. aeruginosa, has fewer side effects, and is less expensive than levofloxacin.

Conclusions: The goal of therapy is to eliminate the pathogen and prevent complications or recurrence. The therapeutic plan includes completing the full course of antibiotics and monitoring for complications. Patient education emphasizes adherence to the treatment plan for optimal recovery.

Introduction:
Cartilage damage, caused by injury or degenerative diseases, presents significant challenges due to the tissue's limited self-healing capacity. Polymeric hydrogels, with their biocompatibility, tunable mechanical properties, and ability to mimic the extracellular matrix, are emerging as promising materials for cartilage regeneration. This study investigates the potential of polymeric hydrogels as cartilage substitutes, emphasizing their role in supporting tissue repair and integration.

Methods:
Biodegradable hydrogels were synthesized using alginate (2% w/v) and PVA (10% w/v), with 5% (w/v) calcium phosphate nanoparticles to enhance bioactivity. The hydrogels were characterized for mechanical strength, swelling ratio (250 ± 15%), and degradation (15% mass loss in 30 days). In vitro studies using chondrocyte cultures assessed cell viability (>90% after 7 days) and extracellular matrix production. Further, 3D-printing was employed to fabricate patient-specific hydrogel scaffolds with a porosity of 300 ± 20 μm to mimic native cartilage architecture.

Results:
The hydrogels exhibited mechanical properties similar to natural cartilage, with controlled swelling and degradation suitable for integration into damaged tissues. The 3D-printed scaffolds demonstrated consistent geometry, promoting nutrient diffusion and matrix deposition.

Conclusions:
Polymeric hydrogels represent a promising solution for cartilage regeneration, offering mechanical and biological properties that support tissue repair. Their adaptability to 3D printing enables personalized approaches, highlighting their potential for clinical applications in treating cartilage defects.

Acknowledgments:
This study was conducted within the SMART-MAT Functional Materials Scientific Club as part of the "Biocomposites for Regenerative Medicine Applications" project, funded by FutureLab at Cracow University of Technology.

Introduction:
Chronic wounds pose significant challenges in clinical practice, particularly in orthopedic surgery, where tissue repair is crucial for recovery. Biohydrogels enriched with adaptogens, natural compounds known for their stress-modulating and regenerative properties, offer a novel approach to enhancing wound healing. This study explores the development and application of biohydrogels containing adaptogens for innovative therapies targeting chronic wounds.

Methods:
Biohydrogels were synthesized using natural and synthetic polymers, including alginate (3% w/v) and polyvinyl alcohol (10% w/v), enriched with adaptogens such as ginseng extract (from 1% to 5% w/v) and ashwagandha (from 1% to 5% w/v). We characterized properties including mechanical strength , swelling ratio (from 180% to 380%) and biodegradation. In vitro studies evaluated biocompatibility and the effect of adaptogens on fibroblast proliferation (viability >92% after 7 days (p < 0.05))and collagen synthesis. The hydrogels were further tested for their antimicrobial properties and ability to support tissue regeneration in chronic wound models.

Results:
The biohydrogels demonstrated excellent water retention and mechanical stability, suitable for prolonged wound coverage. Adaptogen-enriched hydrogels significantly enhanced fibroblast proliferation and collagen deposition compared to control hydrogels. Antimicrobial tests confirmed reduced bacterial growth, creating a favorable environment for healing. The preliminary in vivo models indicated accelerated wound closure and reduced inflammation in chronic wound conditions.

Conclusions:
Biohydrogels containing adaptogens represent an innovative therapeutic option for chronic wound management in orthopedic surgery and beyond. Their unique properties, combining enhanced regenerative capacity with antimicrobial effects, make them a promising solution for improving patient outcomes.

Acknowledgments: This project was financed with funds from the state budget granted by the Minister of Science within the framework of the "Student Scientific Clubs Create Innovations" (SKN/SP/601893/2024) "Application of Biohydrogels Containing Adaptogens in Innovative Chronic Wound Therapy" . This research was carried out within the SMART-MAT Functional Materials Science Club (section Smart-Mat) at the Faculty of Materials Engineering and Physics of the Cracow University of Technology.

Introduction:
Regenerative medicine in orthopedic surgery demands advanced materials capable of mimicking the dynamic properties of native tissues. Hydrogels based on collagen, a natural extracellular matrix component, and polyvinylpyrrolidone (PVP), a versatile synthetic polymer, provide a unique combination of biocompatibility and mechanical stability. This project focuses on developing functional hydrogels using 4D printing technology to address the challenges of tissue repair in orthopedic applications.

Methods:
Collagen–PVP hydrogels were synthesized using collagen (5% w/v) and PVP (10% w/v) to form a hybrid polymer network with tunable mechanical and biological properties. Scaffolds were fabricated using 4D printing, enabling stimuli-responsive behaviors such as shape-memory and swelling. Mechanical testing revealed a compression modulus, and the swelling capacity reached from 150 ± 25% to 375 ± 25% in physiological conditions. Biodegradation analysis indicated a 15% mass loss over 30 days. Cellular studies using osteoblasts and chondrocytes assessed biocompatibility (>90% cell viability after 7 days) and differentiation.

Results:
The collagen–PVP hydrogels demonstrated excellent mechanical strength and elasticity, suitable for load-bearing orthopedic applications. The 4D-printed scaffolds exhibited dynamic shape adaptation in response to temperature and hydration changes. Cellular studies confirmed high biocompatibility, with a significant proliferation and differentiation of osteoblasts and chondrocytes. The hybrid hydrogels also showed controlled degradation profiles, aligning with tissue healing timelines.

Conclusions:
Collagen–PVP hydrogels fabricated using 4D printing represent a promising solution for orthopedic regenerative applications. Their combination of adaptability, biocompatibility, and mechanical performance positions them as advanced materials for cartilage and bone repair. Further studies will focus on in vivo evaluations and the integration of bioactive agents to enhance therapeutic outcomes.

Acknowledgments: This research was carried out within the SMART-MAT Functional Materials Scientific Club of the Faculty of Materials Engineering and Physics at Cracow University of Technology and as part of the project entitled "Functional Hydrogels Fabricated Using 4D Printing" financed by the FutureLab organization operating at Cracow University of Technology.

Introduction: Peri-implantitis is a pathological condition that occurs in the tissues surrounding dental implants, characterized by inflammation and progressive resorption of the supporting bone. The diagnosis of peri-implantitis is established through clinical evaluation, characterized by periodontal probing of >3 mm, bleeding on probing, and suppuration, combined with radiological evidence. The current literature outlines two main therapeutic approaches—non-surgical techniques and surgical techniques—which can be further divided into regenerative and resective treatments. The aim of this report is to present a clinical case regarding the surgical management of peri-implantitis, focusing on the correction of the hard and soft tissue.

Methods: The patient came to our attention referring to painful symptoms, with edema and gingival hypertrophy. Following a clinical evaluation, an 8 mm probing depth corresponding to the implant in the #2.5 area was found, leading to a diagnosis of peri-implantitis. After local anesthesia, the opening of a full-thickness flap was performed, followed by the removal of the inflammatory tissue. Deproteinized bovine bone and collagen membrane were used for the graft to achieve regeneration of the hard tissues. A connective tissue graft was harvested from the palate in order to regenerate the soft tissue as well. A 5/0 Vicryl suture was performed in the region of interest, ensuring flap repositioning with graft stabilization.

Results: The patient underwent clinical and radiographical follow-up at 60 and 120 days after surgery, which highlighted their complete healing with correction of the hard and soft tissues in the treated area.

Conclusions: The current literature describes different therapy strategies for peri-implantitis. Recent research emphasizes the value of a regenerative technique that restores both the hard and soft tissue's integrity. A surgical approach with a regenerative technique, due to the improvement of the peri-implant tissue conditions, ensures an enhancement in long-term stability and functional outcomes.

BACKGROUND INFORMATION:

Esophageal carcinoma is one of the most aggressive malignant diseases. At present, neoadjuvant chemotherapy and chemoradiotherapy are regarded as the standard modalities for the treatment of locally advanced esophageal cancer. Patients receiving neoadjuvant therapy and reaching a pathological complete response have better survival outcomes and a lower recurrence risk. In those not achieving pathological CR, nivolumab is recommended as per NCCN, ESMO, and ASCO guidelines. The advantages of adjuvant Nivolumab were shown in the CheckMate 577 trial. At a median follow-up of 24.4 months, the median disease-free survival was twice as long with nivolumab (22.4 versus 11 months; HR for disease progression or death was 0.69). The overall survival data were not sufficient. While it was well tolerated, it is unclear whether the use of this treatment is feasible in our developing country, as most patients are not able to afford this expensive medication.

METHODS AND RESULTS:

At our institution, we conducted a retrospective study of esophageal squamous cell carcinoma patients who underwent the neoadjuvant CROSS protocol followed by surgery for a period of 2 years. Of the total forty-three (43) esophageal squamous cell carcinoma patients, seventeen (17) had a complete pathologic response. Out of the twenty-six (26) patients with residual disease, only one (1) received adjuvant nivolumab. Nivolumab was well tolerated. Three patients underwent chemotherapy, and the rest entered the follow-up period. The patient who received nivolumab is now in the follow-up period and has had disease-free survival for 40 months so far. Overall survival has not been reached yet.

CONCLUSIONS:

Among patients treated with neoadjuvant chemoradiotherapy, the majority of recurrences occur within one year. The pattern of recurrence was distant, locoregional, or both in 60, 30, and 10% of patients, respectively. Although guidelines recommend nivolumab for patients with residual disease, cost constraints prevent most of them from benefitting from this treatment in developing countries like India. To ascertain what can be done to further delay recurrence and gain better disease-free survival rates, many more studies are required.

Introduction:

Stroke, or cerebrovascular disease, occurs when the brain is deprived of blood due to blocked or ruptured blood vessels, leading to brain tissue damage. Ischemic stroke, which accounts for about 80% of all strokes, is primarily caused by blood clots, often due to atherosclerosis. Other causes include blood vessel inflammation or embolism, where foreign material blocks blood flow to the brain.

Methodology:

Assessment of Current Drugs and Therapy:

The patient presented with symptoms of ischemic stroke, such as left-sided facial droop and a stiff tongue, and was stabilized during the acute phase. To prevent recurrence, secondary prevention was necessary. Diagnosed with cardioembolic stroke and a CHA2DS2-VAS score of 6, indicating a high risk of recurrent stroke, the patient requires an anticoagulant. Options include Warfarin, Dabigatran, Rivaroxaban, Apixaban, and Edoxaban.

Results and Conclusion:

The IESAC table shows that Non-Vitamin K Antagonist Oral Anticoagulants (NOACs) generally present a lower risk of ischemic stroke than Warfarin, though they are more expensive. Rivaroxaban is not recommended for those with a creatinine clearance of <30 mL/min.

Given the patient’s participation in the 30-baht (THB) healthcare program and stable INR levels on Warfarin (3 mg) for a year, it was decided that Warfarin be continued. To address other stroke risk factors, Atorvastatin (40 mg), Nebivolol (5 mg), and Enalapril (5 mg) were prescribed to control cholesterol and blood pressure.

The CHA2DS2-VAS should be reassessed at each visit to evaluate stroke risk. INR levels must be monitored if the patient is on Warfarin. Bleeding, chest tightness, difficulty breathing, and severe headaches need to be monitored. If INR is not within the target range, switching to an NOAC, like Apixaban 5 mg, twice daily is recommended. The patient should consistently manage atrial fibrillation, dyslipidemia, and hypertension, monitor symptoms using BEFAST (Balance, Eyes, Face, Arms, Speech, and Time), and seek immediate medical help if any signs appear.

Hormone receptor-positive (HR+) breast cancer represents a therapeutic challenge, particularly with endocrine resistance and progression despite multiple lines of therapy. A 64-year-old woman with no significant comorbidities was diagnosed with carcinoma of the left breast (ER/PR positive, HER2/neu negative). She underwent modified radical mastectomy and axillary dissection with histopathological staging of pT2N2aM0. The patient received adjuvant chemotherapy (4 cycles of Adriamycin and cyclophosphamide followed by 4 cycles of docetaxel) and conventional radiotherapy (40 Gy/15 fractions). Hormonal therapy with Anastrozole was initiated post-treatment. After 18 months, a local recurrence was noted on the anterior chest wall. PET-CT revealed a metabolically active nodule (SUV 6.2), confirmed by FNAC and excisional biopsy (ER-8, PR-8, HER2/neu negative on FISH, Ki-67 12%). The patient was switched from Anastrozole to Exemestane, but disease progression occurred within a year, suggesting endocrine resistance. Fifteen months later, PET-CT showed metabolically active cervical, axillary, and mediastinal lymph nodes, and a supraclavicular lymph node biopsy confirmed metastatic carcinoma (ER-0, PR-2%, HER2/neu negative on FISH, Ki-67 20%). Next, the patient received chemotherapy with Gemcitabine plus Carboplatin; however, clinical progression with increasing lymph node size was observed after 2 cycles. Eribulin is an antimicrotubule agent that destroys rapidly dividing cells. Therefore, we decided to switch the patient to treatment with eribulin (day 1, day 8 regimen). After completing 6 cycles, PET-CT showed complete metabolic response (CMR) with a resolution of previous lesions. The patient tolerated Eribulin well, with minimal side effects, and continues maintenance therapy. This case highlights the complexity of treating endocrine-refractory HR+ metastatic breast cancer, particularly in the context of progression with prior chemotherapy. The success of Eribulin in achieving CMR highlights its effectiveness as a treatment option in heavily pretreated patients. Implementing tailored therapeutic strategies in this type of cases remains essential for the treatment of advanced HR+ breast cancer.