Background
Percutaneous transhepatic biliary drainage (PTBD) is a minimally invasive procedure used in malignant biliary obstruction, including cholangiocarcinoma, pancreatic cancer, and tumors of the liver hilum, duodenum, and major papilla. In selected patients, endoluminal radiofrequency ablation (RFA) followed by stent placement may improve ductal patency. Prior reports, including our own experience, have suggested possible benefits in prolonging stent patency, and in some cases contributing to survival advantage, although evidence remains limited and heterogeneous.

Methods
A 78-year-old male presented with obstructive jaundice due to a tumor obstructing the middle third of the common bile duct. Imaging and laboratory findings confirmed elevated direct bilirubin. After ultrasound and fluoroscopy-guided right-sided PTBD, the patient underwent percutaneous recanalization of the malignant stricture two weeks later, via the mature drainage fistula under intravenous analgesia. A 0.035-inch guidewire was advanced into the duodenum, an 8 French bipolar endobiliary RFA catheter was positioned at the obstruction, and energy was applied (15 watts for 2 minutes). A 10 mm self-expanding metal stent was subsequently deployed to restore bile duct patency. The procedure was conducted as part of compassionate use without institutional review board (IRB) approval, given the palliative setting.

Results
The patient’s bilirubin levels normalized, and there were no immediate complications. He was discharged in stable condition and referred to oncology for systemic therapy and palliative care. Known potential risks of RFA and stenting include cholangitis, biliary perforation, bleeding, and stent occlusion, but none were encountered in this case.

Conclusions
This case supports the feasibility and short-term safety of combining PTBD with endoluminal RFA and stenting in inoperable cholangiocarcinoma. While prior reports have suggested potential benefits for stent patency and symptom-free survival, the present case does not provide evidence of a direct effect on tumor progression. The procedure remains primarily palliative, and further controlled studies are required to clarify its role in modifying survival or long-term outcomes.

Purpose: To retrospectively evaluate several parameters associated with the occurrence of pulmonary hemorrhage in patients undergoing CT-guided percutaneous lung biopsy (PLB), focusing on pulmonary hypertension (PH).

Methods and Materials: This study enrolled patients with pulmonary lesions, who underwent CT-guided PLB for histological diagnosis. The systolic pulmonary artery pressure (sPAP) was determined using echocardiography. PH was defined as sPAP of 35 mmHg or higher. The pulmonary hemorrhage was classified as follows: grade 0: no hemorrhage; grade 1: hemorrhage with a width of ≤ 2 cm around needle; grade 2: hemorrhage > 2 cm in width and sublobar; grade 3: lobar hemorrhage or greater; and grade 4: hemothorax). Higher-grade pulmonary hemorrhage was defined as grade 2 or higher.

Results: We included 400 patients (mean age: 69 ± 12 years; 206 women) with indeterminate lung lesions who underwent CT-guided PLB. A total of 186 patients had PH at a rate of 46.5%. The rate of patients without PH was 53.5% (214/400). The baseline characteristics of both groups were similar without significant differences except for age. The rate of overall hemorrhage was higher in patients with PH compared to patients without PH (66.7% vs 49.5%; p-value <0.001). The rate of higher-grade hemorrhage in patients with PH was also higher compared to patients without PH (46.2% vs 24.8%; p-value <0.001). No hemorrhage-related deaths were observed in either group. An sPAP threshold of 36 mmHg showed a sensitivity of 72% and specificity of 56% for predicting higher-grade hemorrhage. Size of lung lesion, sPAP, length of intrapulmonary needle path and age were, on both univariate and multivariate analyses, significant factors for higher-grade hemorrhage. Both main pulmonary artery diameter and main pulmonary artery diameter to ascending aorta diameter ratio were not significantly associated with higher-grade hemorrhage in either univariate or multivariate analyses.

Conclusions: Pulmonary hypertension significantly increases the risk of pulmonary hemorrhage in patients undergoing CT-guided lung biopsy. Estimating sPAP using echocardiography prior to biopsy should be integrated into clinical practice to possibly predict pulmonary hemorrhage.

Introduction: Postoperative cognitive decline (POCD) is one of the most serious side effects after coronary artery bypass grafting (CABG). Significant postoperative cognitive impairment is seen in CABG patients. POCD, encompasses deterioration in social functioning, memory, orientation, attention, and judgment. Cognitive reserve (CR), a protective factor that has been considered to operate as a buffer against the impacts of neuropathology, may be able to mitigate these adverse effects.

Method: We investigated the prevalence of POCD and CR in individuals with coronary artery disease undergoing CABG. We postulated that, following heart surgery, elevated CR would guard against POCD. Participants: We evaluated 113 patients both prior to and four months following cardiopulmonary bypass surgery. Measures: The evaluation comprised measures of depression, anxiety, CR, and cognitive functioning.

Results: Based on median split, each patient was assigned to either the high (n=57) or low CR (n = 56) group. According to the result of chi-square tests, patients with low CR were significantly more likely than those with high CR to exhibit postsurgical cognitive deterioration in executive skills, attention, memory, and visuospatial perception during post-surgery neuropsychological evaluation.

Conclusions: According to our findings, CR can predict the neuropsychological results of heart surgery, identify patients with low CR, and assist them in enrolling in intervention programs that may improve their overall functional outcome following surgery or slow cognitive aging or lower the risk of dementia. Determining whether patients will need cognitive rehabilitation is essential due to the frequency and severity of post-operative cardiac dysfunction (POCD) and its impact on daily activities and functioning, which are aspects of quality of life, indicating that CR can predict the neuropsychological results after heart surgery and identifying patients with low CR and including them in intervention programs to improve the patients' overall functional outcome after surgery.

Introduction:

Oral cavity is a common site of complications in patients with head and neck cancer undergoing radiotherapy. Maintaining good oral health and educating patients plays a critical role in managing the adverse effects of treatment and preserving quality of life.

Methods:

This cross-sectional, descriptive study involved 30 patients (22 men, 8 women; mean age 69.2 ± 12.4 years) and was carried out in the Radiation Therapy Departments of the two General Hospital of Patras: P.G.N.P., the ̏ Panagia I Voithia ̋ , and G.H., ̏Agios Andreas Hospital'', from April 01 2024 to September 30, 2024. Thirteen patients were examined at the ̏ Panagia I Voithia ̋ Hospital and 17 at the ̏Agios Andreas Hospital'' in Patras. Data was collected in three phases—prior to, during, and after radiotherapy—through clinical examination, history taking, and a structured questionnaire with dental health measurements. Statistical analysis was conducted using IBM SPSS 27.0, with significance set at p < 0.05.

Results:

Participants exhibited poor oral health, with a high mean DMFT index (Decayed, Missing, Filled Teeth) of 24.3 ± 7.6 and notable periodontal issues. A significant majority (90%) reported visiting a dentist only when problems arose, and oral hygiene practices were generally inadequate. A negative correlation was found between DMFT scores and educational level (ρ = –0.531, p = 0.003). Radiotherapy led to a statistically significant increase in oral pain (Z = –4.585, p < 0.001), jaw discomfort (Z = –2.271, p = 0.023), and deterioration in quality of life, particularly regarding pain at work (Z = –4.820, p < 0.001).

Conclusion:
The findings highlight the need for systematic dental assessment and patient education before, during, and after radiotherapy to reduce complications and improve quality of life. Integrating oral health evaluations into the standard treatment protocol for head and neck cancer patients is strongly recommended.

Background
Congenital heart disease (CHD) is the most prevalent congenital anomaly, with outcomes strongly influenced by disease complexity. Beyond genetic and environmental determinants, maternal-fetal immuno-haematological interactions may contribute to CHD risk and severity. ABO and Rh incompatibilities can trigger immune responses in utero, yet their role in CHD severity remains unclear. This study assessed associations between maternal-child blood groups, compatibility patterns, and CHD severity using the Risk Adjustment for Congenital Heart Surgery (RACHS) scoring system and cyanosis status.

Methods
A retrospective cohort of 900 non-syndromic singleton children with CHD (0-12 years) undergoing surgical correction and their mothers was analysed at a tertiary referral center. Maternal and child ABO/Rh blood groups and compatibility status were documented. CHD was categorised as simple (RACHS 1), moderate (RACHS 2), or complex (RACHS ≥3), and as cyanotic vs. acyanotic. Associations were tested using comparative statistics and ordinal regression with subgroup validation by age.

Results
Of 900 cases, 562 (62.4%) were acyanotic; RACHS distribution was 64 simple, 432 moderate, and 404 complex. Blood group B predominated in mothers (n=319, 35.4%) and children (n=316, 35.1%). ABO and Rh incompatibilities occurred in 257 (28.6%) and n=44 (4.9%) dyads, respectively. Maternal-child ABO discordance was significantly associated with moderate CHD (OR=3.31, 95% CI: 1.19-9.18; p=0.022), while Rh incompatibility showed a notable trend with cyanotic CHD (p=0.076) in children aged 1-5 years. Maternal blood groups B and AB were protective against CHD severity compared to O (OR=0.26-0.41, p <0.05). Child blood groups A, B, and AB also conferred protection against moderate and complex CHDs (OR=0.29-0.39, p <0.05). No significant association was observed for combined ABOxRh discordance.

Conclusion
This study provides the first evidence that maternal–child blood group relationships, particularly ABO incompatibility, may influence CHD severity. These findings warrant multicentric validation and exploration of underlying immunogenetic mechanisms.

Background
Maternal nutrition during the periconceptional period plays a crucial role in fetal cardiogenesis. Infants with congenital heart disease (CHD) face a dual burden of structural disease and malnutrition, which exacerbates morbidity, surgical risk, and survival. The influence of maternal dietary patterns and micronutrient supplementation on postnatal nutritional outcomes in CHD-affected infants remains underexplored.

Objective
To evaluate the association between maternal periconceptional nutrition—specifically dietary patterns, meal frequency, and micronutrient intake—and the prevalence of malnutrition in infants with CHD.

Methods
This cross-sectional study analyzed outpatient data of Indian-origin patients who underwent echocardiographic screening at a tertiary cardiac hospital (2022-2025). Maternal periconceptional dietary intake was retrospectively assessed via a validated in-house questionnaire and restricted to non-syndromic infants from singleton primigravida pregnancies to minimize recall bias. Infant’s postnatal malnutrition was classified using WHO z-scores, and associations were evaluated using SPSS.

Results
Of 17,093 screened patients, 13,972 (81.7%) were diagnosed with CHD, including 6,980 infants. After applying the inclusion criteria, 2,243 mother–infant dyads were analyzed. Malnutrition prevalence was high: 75.2% underweight, 49.6% stunted, and 73.1% wasted. Among mothers, 15.8% reported no micronutrient supplementation. Dietary patterns were 50.9% vegetarian, 44.8% non-vegetarian, 3.9% eggetarian, and 0.2% vegan. Additionally, 8% consumed ≤1 meal/day during pregnancy. The type of food showed no significant association with malnutrition. However, consuming ≥2 meals/day was protective, reducing odds of stunting by 30% (p = 0.024) and wasting by 31% (p = 0.024). Micronutrient supplementation reduced underweight by 29% (p = 0.020) and stunting by 41% (p = 0.020) among CHD infants.

Conclusion
This large cohort study underscores the impact of maternal nutrition—particularly adequate meal frequency and micronutrient supplementation—in reducing postnatal malnutrition among CHD infants, emphasizing the need for targeted nutritional interventions during early pregnancy.

Introduction:
Coronary bifurcation lesions, encountered in roughly one-fifth of PCI cases, remain among the most technically demanding scenarios in interventional cardiology. While provisional stenting has become the global default, complex anatomy or large diseased side branches often demand a planned two-stent approach. Most evidence guiding these decisions comes from Western populations, with limited data available on Indian cohorts reflecting our unique patient profiles and disease patterns. This study evaluates the clinical profile, angiographic patterns, and mid-term outcomes of bifurcation PCI using second-generation drug-eluting stents (DESs) in an Indian tertiary care setting, and to compare provisional and two-stent strategies in real-world practice.

Methods:
In this prospective observational study (April 2022–April 2023), 100 consecutive patients with major epicardial bifurcation lesions (main vessel >2.5 mm, side branch >2.3 mm) underwent PCI at a high-volume centre in Western India. Procedural details, risk factors, and lesion morphology (Medina classification) were documented. Follow-up at 8–12 months included clinical review and quantitative coronary angiography (QCA). The primary endpoint was major adverse cardiac events (MACE: death, MI, TVR, TLR, stent thrombosis); the secondary endpoint was binary in-stent restenosis (ISR).

Results:
The mean age was 60.5 ± 12.1 years; 76% were male. True bifurcation lesions (Medina 1,1,1) dominated (58%), followed by 0,1,1 (21%). Hypertension (66%) and family history (57%) were common, with significant clustering in complex patterns (1,1,1 and 1,0,1; p<0.02). Provisional stenting was used in 73%, two-stent techniques in 27% (T-stenting most frequent). ISR occurred in 16.9% overall, with no difference between strategies. The MACE rate was 16%, again comparable across groups.

Conclusion:
In this detailed Indian dataset, provisional and two-stent bifurcation PCI with second-generation DESs achieved similar mid-term safety and efficacy. Our findings reinforce an anatomy-driven approach—provisional for simpler lesions, dedicated two-stent techniques for complex bifurcations—while underscoring the need for larger multicentre Indian registries.

Surgical treatment for female stress urinary incontinence across various anatomical regions

Adam Ostrzenski, M.D., Ph.D., Dr. Habil.
Professor of Gynecology
Florida International University, Miami, Florida, USA

Abstract

Introduction: In October 2008, the FDA issued a Public Health Notification about severe complications and insufficient information suggesting that mesh-sling surgery improves clinical outcomes compared to traditional non-mesh treatments. Additionally, medical societies have raised concerns that surgical meshes and slings are linked to low but serious complications, including death, when treating stress urinary incontinence in women, and their long-term effectiveness remains uncertain. However, no recommendations were made to replace the currently used slings and meshes for treating female stress incontinence. Numerous clinical-scientific studies have shown that the native tissue of the female pelvis has considerable strength and durability. Therefore, using native tissue is suitable for surgical treatment; however, transitioning from slings and meshes to reconstruction with native tissue requires a comprehensive understanding of anatomy in various regions. With significant advancements in dynamic magnetic resonance imaging and ultrasonography, accurate identification of site-specific defects across multiple anatomical regions is now possible, allowing for targeted reconstruction.

Methods: A systematic review addressed the question, “Which anatomical regions contain the structures that support female urinary continence?" A PowerPoint presentation will summarize the findings.

Results: This systematic review documents the anatomy of female urinary continence across various anatomical regions for the first time. It also updates evidence-based medical data and emphasizes the importance of a thorough anatomical understanding when transitioning from meshes and slings to native tissue for treating urinary incontinence in women.
Furthermore, the pelvic floor muscles, endopelvic fascia, perineal membrane, and anterior-distal vaginal wall help maintain the urethra's natural position.

Conclusions: Identifying site-specific defects in various anatomical regions and repairing them with native tissue may help prevent surgical treatment failures in female stress incontinence.

Introduction: Heart disease is the leading cause of death globally, with increasing cases of Atherosclerotic Cardiovascular Disease (ASVD) and coronary artery disease (CAD). Coronary CT angiography (CTA) is an advanced, non-invasive tool with high sensitivity for diagnosing CAD, offering advantages over traditional angiography, including 3D imaging and the ability to assess related structures. However, CTA involves ionizing radiation and contrast material. Several attempts have been made to record and assess the radiation doses in CTCA. Despite the implementation of various initiatives to reduce radiation exposure, there is a need for assessing the radiation exposure levels with CT examination. This study’s aim was to evaluate the radiation doses received by the adult patients during cardiac CT examination.

Methods: The retrospective study at a tertiary care hospital from May to August 2024 included adults over 15 undergoing CT angio on GE Healthcare Revolution EVO CT following standard protocol. The software on the unit generates Dose Length Product (DLP) for each patient scan, and the Effective Dose (E) was computed for each patient. Linear regression analyzed the relationship between effective dose, BMI, and injected contrast volume.

Results: The mean value of effective dose was observed to be 13. 55 mSv with a minimum of value of 0.175 mSv and maximum of 27.23mSv. The median DLP was found to be 943.26 mGy.cm, with minimum value of 12.47 mGy.cm. The linear regression analysis shows that there exists no dependence of effective dose on BMI and volume of the contrast injected.

Conclusion: Our audit shows values exceeding UK NDRLs for coronary CT angiography and coronary angiography, 4.3 mSv and 170 mGy.cm, respectively. The study suggests tailoring CTCA protocols for each patient to reduce radiation dose, optimize dosage based on patient size, improve patient selection, conduct regular audits, and raise public awareness about radiation risks.

Background and Aim: Ovarian cancer (OC) is frequently diagnosed at an advanced stage, limiting treatment options. Luteinizing hormone-releasing hormone (LHRH) receptors are overexpressed on ovarian tumour cells, enabling receptor-mediated targeting. Nano-particles (NPs) offer precise drug delivery. In nuclear medicine, theranostic NPs are promising tools for delivering both therapeutic and diagnostic agents. In our previous study, we synthesised and radiolabelled Poly-lactic-co-glycolic acid (PLGA) NPs in a single step by using an innovative microfluidic technique. This study focuses on the functionalization of PLGA NPs with LHRH for targeted ovarian cancer therapy.
Methods: PLGANPs were synthesized using a microfluidic technique, providing precise control over particle size and reproducibility. Technetium-99m (99mTc) was used to radio-label PLGA NPs. Non-radioactive formulations were synthesized under similar conditions and functionalized with LHRH. Particle size and surface charge were assessed via dynamic light scattering (DLS), and LHRH conjugation efficiency was quantified using high-performance liquid chromatography (HPLC). Cellular uptake and cytotoxicity were evaluated in LHRH receptor-positive ES-2 ovarian cancer cells.
Results: PLGA NPs synthesized at a total flow rate of 15 mL/min and a 5:1 flow rate ratio showed optimal size and radiolabelling efficiency. LHRH conjugation achieved ~70% efficiency. Zeta potential measurements confirmed successful surface modification during activation and peptide attachment. Cellular uptake and viability studies were conducted to evaluate the targeting efficiency and biocompatibility of LHRH-conjugated PLGA nanoparticles. Fluorescence intensity showed significantly higher uptake of LHRH-PLGANPs in LHRH receptor-positive ES-2 ovarian cancer cells compared to native NPs, confirming receptor-mediated internalization. In contrast, uptake in control cells remained low, indicating non-specific binding. Cell viability revealed no toxicity of PLGA NPs.
Conclusion: The microfluidic technique facilitated rapid and efficient NPs formulation, minimizing batch variability. LHRH-functionalized PLGA NPs demonstrated selective uptake in OC cells, supporting their potential as an effective targeted delivery system and future nuclear theranostic tool for OC management.