Background/Objectives: Atrial fibrillation (AF) and chronic kidney disease (CKD) frequently coexist and are associated with a high risk of cardiovascular complications. Previous studies have primarily focused on differences in clinical profiles by anticoagulant therapy or arrhythmia. Only a limited number of studies have evaluated the impact of CKD severity on patients' clinical characteristics. Methods: This retrospective observational study aimed to characterize the clinical profile of contemporary patients with AF and CKD with an estimated glomerular filtration rate (eGFR) of 15-49 mL/min/1.73 m². The analysis included patients with AF from the CRAFT registry (NCT02987062). Patients were divided into two groups according to eGFR: 15-49 mL/min/1.73 m² and ≥50 mL/min/1.73 m². The groups were compared with respect to demographic characteristics, comorbidities, and treatment patterns. Statistical analyses included the Mann-Whitney U test, the chi-square test and multivariable logistic regression analysis. Results: A total of 3203 patients with AF were included, of whom 1153 had eGFR < 50 mL/min/1.73 m². Compared with patients with eGFR ≥ 50 mL/min/1.73 m², those with lower eGFR were significantly older, more often female, and had a higher burden of comorbidities, including arterial hypertension, heart failure, coronary artery disease, and diabetes mellitus. Direct oral anticoagulants were the predominant anticoagulant therapy, irrespective of renal function. Conclusions: Patients with AF and moderate-to-severe CKD present a distinct clinical profile characterized by advanced age and a higher burden of comorbidities. These findings improve the understanding of the clinical profile of patients with AF and moderate-to-severe CKD and may support risk assessment and clinical decision-making.

Gestational diabetes mellitus (GDM) is a common metabolic complication of pregnancy and is associated with an increased risk of short-term adverse maternal and neonatal outcomes, as well as long-term metabolic disorders in both mothers and offspring. Exacerbated insulin resistance and inadequate compensatory pancreatic β-cell function constitute the core pathophysiological basis of GDM. Adiponectin is an insulin-sensitizing adipokine that plays important roles in glucose and lipid metabolism, inflammatory regulation, and energy homoeostasis. Changes in maternal circulating adiponectin levels during pregnancy are closely associated with reduced insulin sensitivity and increased risk of GDM. This review systematically summarizes the roles of adiponectin and its distinct isoforms, particularly high-molecular-weight adiponectin, in GDM development, metabolic regulation, and early risk assessment. We also integrate potential interactions between adiponectin and placental hormones, nutrient transport, local inflammation, oxidative stress, and exosome-related mechanisms. In addition, this review discusses the key issues related to adiponectin measurement standardization, gestational timing of blood sampling, population heterogeneity, combined prediction models, and their integration into the oral glucose tolerance test (OGTT). The current findings support adiponectin as a candidate biomarker for early GDM risk stratification and combined prediction models; however, adiponectin cannot replace OGTT as a diagnostic criterion.

Background: The onset of type 2 diabetes mellitus (T2DM) is often preceded by prediabetes, a reversible state of insulin resistance and impaired glucose regulation driven by the chronic consumption of a high-calorie diet and sedentary lifestyle. Prediabetes is characterised by impaired glucose tolerance and elevated glycated haemoglobin (HbA1c). Although metformin improves insulin sensitivity, adherence limitations to lifestyle interventions highlight the need for alternative drugs that can be effective even without dietary intervention. In our laboratory, we synthesised a novel ruthenium complex that exhibits elevated biological activity. Accordingly, this study investigated the metabolic effects of a novel ruthenium (II)-uracil Schiff base complex in HFHC diet-induced prediabetic rats, with and without dietary intervention. Methods: Forty-eight male Sprague-Dawley rats (150-180 g) were divided into two groups, the standard diet (n = 12) and HFHC diet groups (n = 36), for prediabetic induction. Prediabetic animals were randomly assigned to respective treatment groups. The ruthenium complex was administered to prediabetic rats once a day, every third day, for 12 weeks, while monitoring changes in blood glucose, caloric intake, and body weight. Results: Diet-induced prediabetes resulted in increased fasting blood glucose and elevated HbA1c. The administration of the ruthenium (II)-uracil Schiff base complex reduced fasting blood glucose, improved insulin levels and ghrelin, enhanced GLUT4 expression, and significantly increased skeletal muscle glycogen, especially when combined with dietary intervention. Conclusions: The findings showed that the ruthenium complex exerts a pronounced effect on ameliorating glucose homeostasis, enhancing skeletal muscle glucose uptake, and improving overall metabolic function.

The vallecula is a mucosal recess of the hypopharynx situated between the base of the tongue and the lingual surface of the epiglottis and bordered laterally by the glossoepiglottic folds. Lesions in this region are uncommon and encompass a broad differential diagnosis, including vallecular cysts, lingual tonsil hypertrophy, minor salivary gland tumors, squamous cell carcinoma, and, rarely, lymphoproliferative disease. Primary extranodal non-Hodgkin lymphoma of the vallecula is exceptionally rare, and follicular large B-cell lymphoma (FLBCL) has not previously been reported at this site. We present the case of a 62-year-old man who presented with progressive dysphagia and persistent globus sensation for 2-3 months. Flexible laryngoscopy demonstrated a well-circumscribed, smooth, cystic-appearing, pedunculated vallecular mass without mucosal ulceration or airway compromise. The patient underwent direct microlaryngoscopy with transoral excisional biopsy. Histopathologic evaluation revealed a high-grade lymphoid neoplasm. Immunophenotyping demonstrated positivity for cluster of differentiation 20 (CD20), cluster of differentiation 10 (CD10), and B-cell lymphoma 6 (BCL6), with co-expression of B-cell lymphoma 2 (BCL2), an elevated Ki-67 proliferation index, and light-chain restriction. Fluorescence in situ hybridization excluded common rearrangements, supporting a diagnosis of CD10-positive LBCL of follicular germinal center origin, classified as FLBCL according to the World Health Organization 5th edition classification of tumors. The patient was treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP), followed by involved-site radiotherapy (30 Gy), and achieved a complete metabolic response on surveillance positron emission tomography at six months. The literature on lymphoma involving the vallecula and tongue base is limited to small series and isolated case reports. Diffuse LBCL (DLBCL) predominates, whereas other histologic subtypes have been reported only sporadically. Presentations are typically characterized by dysphagia and globus sensation, and definitive diagnosis requires adequate tissue sampling. To our knowledge, this case represents the first reported occurrence of FLBCL arising in the vallecula. Lymphoma should be considered in the differential diagnosis of atypical or persistent vallecular masses, and adequate submucosal tissue sampling is essential for establishing the diagnosis, particularly in lesions with benign-appearing features.

Pyoderma gangrenosum (PG) is a rare, sterile neutrophilic dermatosis characterized by rapidly progressive, painful cutaneous ulcerations and frequently associated with systemic diseases, including inflammatory bowel disease, rheumatologic disorders, and hematologic malignancies. In particular, recognition of PG as a cutaneous manifestation of an underlying hematologic neoplasm can be critical for timely diagnosis of the systemic disease. Postoperative PG after total hip arthroplasty may closely mimic early periprosthetic joint infection and can lead to unnecessary surgical revisions and prolonged antibiotic therapy.  An 83-year-old woman underwent elective right total hip arthroplasty for end-stage osteoarthritis. Her history included arterial hypertension and mild leukocytopenia; the left hip arthroplasty 10 years earlier had been uncomplicated. The index procedure and early postoperative course were initially uneventful. On postoperative day 6, erythema developed around the wound, followed by pustule formation, purulent-hemorrhagic secretion, and a secondary rise in C-reactive protein (CRP). Early periprosthetic joint infection was suspected, and the patient underwent two revision surgeries with extensive debridement, head and liner exchange, and broad-spectrum antibiotics. Intraoperatively, inflammation remained confined to skin and subcutaneous tissue without fascial or muscular involvement, and microbiological cultures were largely negative or yielded organisms interpreted as contaminants. Dermatologic consultation and histopathologic examination ultimately confirmed PG. Negative-pressure wound therapy was discontinued, topical wound management was continued, and systemic corticosteroids were initiated after early granulation tissue formation, resulting in gradual local improvement and secondary wound healing. Given the known association between PG and hematologic malignancies, a targeted hematologic work-up was performed and subsequently revealed an underlying hairy cell leukemia, providing a unifying explanation for the patient's chronic leukocytopenia. Postoperative PG after elective total hip arthroplasty is a diagnostic challenge that may be misinterpreted as early periprosthetic joint infection. Atypical wound deterioration with severe pain, superficial distribution of inflammation, negative cultures, and pathergy after surgical interventions should raise suspicion of PG and prompt dermatologic and histopathologic evaluation. In addition, clinicians should be aware of the strong association between PG and hematologic malignancies and pursue appropriate hematologic assessment when clinically indicated. Early recognition and timely immunosuppressive treatment are crucial to avoid repeated surgical trauma and to facilitate prompt identification and management of associated systemic diseases such as hairy cell leukemia.

Primary colonic lymphoma is a rare neoplasm. Perforation with fecal peritonitis as the initial manifestation is an exceptional and life-threatening complication requiring emergency surgical management. We report a case of diffuse large B-cell lymphoma of the colon presenting with fecal peritonitis, highlighting the diagnostic challenges and multidisciplinary approach required. A 70-year-old female patient with a history of hypertension presented to the emergency department with an acute abdomen, septic shock, and generalized peritonitis. Abdominal computed tomography (CT) revealed fecal peritonitis secondary to perforation of a cecal tumor. Emergency right oncologic colectomy with double stoma was performed because of generalized purulent peritoneal contamination. Histopathological and immunohistochemical examination confirmed diffuse large B-cell lymphoma, germinal center type, with a high proliferation index (antigen Ki-67, 90%), cluster of differentiation 79a (CD79a)-positive, and cluster of differentiation 3 (CD3)-negative. The postoperative course was uneventful after a two-day intensive care unit (ICU) stay. The patient received four cycles of immunochemotherapy based on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). At six months, PET-CT evaluation demonstrated a partial response, and treatment is ongoing to complete six cycles. This case illustrates that colonic lymphoma should be considered in the differential diagnosis of acute abdomen with tumor perforation. Emergency colectomy serves both diagnostic and therapeutic purposes by controlling the septic source and providing tissue for definitive histological diagnosis. Multidisciplinary management combining emergency surgery and adjuvant immunochemotherapy is essential for optimizing outcomes in this rare presentation.

Low-grade appendiceal mucinous neoplasms (LAMN) are rare clinical entities. These lesions are characterized by an expansive growth pattern and a significant propensity for peritoneal dissemination, potentially leading to pseudomyxoma peritonei. Preoperative diagnosis of appendiceal mucinous neoplasm remains a formidable challenge, particularly in female patients, as clinical presentations often mimic common gynecological pathologies. This report describes the case of a 63-year-old female with a history of schizophrenia and previous pelvic surgeries who presented with generalized colicky abdominal pain, vomiting, and diarrhea. Initial diagnostic workup, including computed tomography, suggested a massive pyo/hydrometra and severe pelvic inflammatory disease, for which she received intravenous antibiotic therapy. Despite treatment, persistent pain led to a follow-up imaging study revealing a significant pelvic collection. During exploratory laparotomy, free mucin was identified in the right iliac fossa, and intraoperative biopsy reported acellular mucinous implants. A right hemicolectomy with a terminal ileostomy was performed after identifying a perforated appendix with a tumor base exceeding two centimeters. Histopathological analysis confirmed a low-grade appendiceal mucinous neoplasm, staged as pTis N0 pM1a (Stage IVA), with 16 negative lymph nodes and clear surgical margins. This case illustrates the diagnostic complexity of LAMN in elderly women, where mucinous collections can accurately simulate intrauterine or pelvic inflammatory processes such as massive pyo/hydrometra. It highlights the necessity of including appendiceal neoplasms in the differential diagnosis of complex pelvic masses to avoid iatrogenic rupture and optimize surgical outcomes. Precise surgical technique and long-term oncological surveillance remain critical, as the risk of late recurrence and progression to pseudomyxoma peritonei persists even in cases with acellular mucin and negative margins.

Twin pregnancies with a partial hydatidiform mole and a coexisting live fetus are exceptionally rare, and progression to chemoresistant gestational trophoblastic neoplasia (GTN) is even less common. We report the case of a 28-year-old nulligravid woman with prior ovulation induction who presented with a twin pregnancy consisting of a partial hydatidiform mole and a coexisting live normal fetus. Following spontaneous abortion and uterine evacuation, histopathological examination and immunohistochemistry demonstrated p57 positivity, supporting the diagnosis of partial hydatidiform mole, and a normal placental tissue with a fetus without malformations. Despite apparently favorable pathological findings, the patient developed giant theca-lutein cysts complicated by ovarian torsion, progression to GTN, resistance to methotrexate and actinomycin-D, and subsequent pulmonary metastasis. Multi-agent chemotherapy with EMA-CO (etoposide, methotrexate, actinomycin-D, cyclophosphamide, and vincristine) achieved complete clinical and biochemical remission, with no evidence of recurrence after three years of follow-up. This case highlights that partial hydatidiform mole with a coexisting live fetus may rarely exhibit aggressive clinical behavior despite reassuring histopathological and immunohistochemical features. Careful clinical and human chorionic gonadotropin surveillance remains essential in complex molar pregnancies.

Lipomas are among the most common benign soft-tissue tumors; however, their occurrence in the hand is uncommon, and giant lipomas in this location are particularly rare. Due to the limited anatomical space in the hand, these lesions can cause functional impairment and compression symptoms. We present the case of a 73-year-old woman who presented for evaluation with a six-year history of a mass in the right thenar region that had been progressively increasing in size, accompanied by pain during active thumb movements (flexion, adduction, and opposition), paresis, and decreased pinch strength. Physical examination revealed a soft, mobile mass with mild tenderness on palpation and reduced range of motion in the thumb. Imaging studies revealed a well-defined lipomatous lesion measuring 5 × 3 cm, with no findings suggestive of malignancy. The lipoma was excised via a thenar approach, revealing a well-encapsulated mass located beneath the flexor pollicis brevis muscle, with no involvement of adjacent neurovascular or tendinous structures. A complete resection was performed, and histopathological evaluation confirmed the diagnosis of lipoma. The patient had an uneventful postoperative course, and no complications were observed during follow-up. Although lipomas are common, their occurrence in the hand is less frequent and can complicate surgical access and hand function. Giant lipomas can cause compression symptoms due to the limited space in the hand, which may lead to sequelae. Imaging studies assist us in preoperative planning and in ruling out malignant neoplasms. Complete surgical excision remains the treatment of choice, yielding good results when adjacent structures are preserved. Giant lipomas of the hand, especially in the thenar region, are rare conditions that can significantly impair hand function. Early detection and appropriate surgical treatment are essential to prevent disease progression and restore hand function.

Nontuberculous mycobacteria (NTM) can disseminate and infect various organs throughout the body. However, whether NTM can infect tracheobronchial tissue is rarely reported. This study aimed to address the knowledge gap regarding the epidemiological, demographic, and clinical characteristics of patients with tracheobronchial NTM infection.

In this multicenter retrospective cohort study, clinical, demographic, microbiological, and radiological data from hospitalized patients with tracheobronchial NTM infections from January 2015 to May 2025 were collected and analyzed descriptively.

Twenty-nine patients (2.3%) were included, and all the patients presented with disseminated NTM infection. Seventeen patients had comorbidities, including 5 with acquired immunodeficiency syndrome and 1 with anti-interferon-γ autoantibody syndrome. Median diagnostic delay was 130 days, and 89.7% of the patients were initially misdiagnosed with tuberculosis or malignancy. The most common symptoms were cough, expectoration, anemia, fever, weight loss, skin lesions, and bone pain. Chest CT revealed nodules, patchy opacities, mass-like shadows, and bronchial stenosis, with or without hilar/mediastinal lymphadenopathy, whereas osteolytic bone destruction was evident in 11 patients. The most common features of bronchoscopy were intraluminal masses/neoplasms/nodules. Metagenomic next-generation sequencing (mNGS) of BALF (n=12) demonstrated 100% positivity, outperforming BALF culture (46.2%, 12/26) and sputum culture (39.3%, 11/28). Mycobacterium colombiense accounted for 24.1% of cases. With respect to therapeutic management, 27 patients received systemic antimicrobial therapy, while 2 did not receive specific anti-N™ treatment. One patient underwent combined endoscopic resection. Overall, 23 patients (79.3%) achieved improvement or cure, 5 showed disease progression, 1 experienced relapse, and 1 died.

Tracheobronchial NTM infection is rare but clinically significant, often occurring in the context of disseminated disease with pulmonary involvement. Immunocompromised hosts, particularly those with AIDS or anti-IFN-γ autoantibody syndrome, are highly susceptible. Bronchoscopy typically reveals mass lesions causing luminal stenosis or occlusion. In this cohort, M. colombiense was the most frequently isolated NTM species. Early bronchoscopy, mNGS-based pathogen detection, and timely systemic or endoscopic intervention should be considered to prevent irreversible airway stenosis. Further studies are needed to validate optimal treatment strategies.

https://www.ClinicalTrials.gov, identifier NCT07377864.