Double-balloon enteroscopy (DBE) is an essential diagnostic and therapeutic modality for small-bowel disorders. Most prior studies on age-related differences in DBE involved limited age groups and small cohorts. We evaluated age-specific differences in the indications, findings, therapeutic interventions, and complications of DBE in a large single-center cohort. We retrospectively analyzed 817 patients who underwent 1101 DBE procedures between January 2006 and January 2023 at a tertiary center. The patients were grouped as young (18-44 years), middle-aged (45-64 years), and elderly (≥65 years). Demographics, indications, endoscopic and pathological findings, interventions, and complications were compared among groups. Bleeding was the most frequent indication in elderly patients, whereas diarrhea, abdominal pain, inflammatory bowel disease, and polyposis syndromes were more common in younger patients. Inflammatory lesions and polyps predominated in younger patients, whereas vascular lesions and tumors were more frequent in elderly patients (P < .05). Diagnostic interventions predominated in young and middle-aged patients, whereas therapeutic interventions were more common in the elderly (P < .001). Benign and malignant neoplasms were more common in the elderly, whereas celiac disease and polyposis syndrome were more common in younger individuals (P < .05). The overall complication rate was 2.6%, with a higher but nonsignificant rate of anesthesia-related complications in the elderly (P = .11). DBE is safe and effective in all age groups. Age was significantly associated with clinical indications and endoscopic findings, and recognizing these patterns can guide more targeted use of DBE and improve diagnostic accuracy.

Upper limb lymphedema is a common complication after breast cancer surgery and may substantially impair upper limb function and quality of life. In clinical rehabilitation practice, external application of Sizi Powder combined with TDP therapy has been used as an adjunctive intervention; however, the available clinical evidence remains limited. This study aimed to evaluate the efficacy and safety of Sizi Powder external application combined with TDP therapy in patients with upper limb lymphedema after breast cancer surgery. This single-center retrospective cohort study included 86 patients with unilateral upper limb lymphedema after breast cancer surgery. According to the treatment received in routine clinical practice, patients were assigned to either a combination group treated with Sizi Powder external application plus TDP therapy (n = 44) or a control group receiving conventional rehabilitation management alone (n = 42). Outcome measures included changes in arm circumference difference, symptom scores, upper limb functional indicators, overall treatment response, and treatment-related adverse events. Multivariable logistic regression analysis was further performed to identify factors associated with clinical improvement. Both groups showed improvement after treatment, whereas the combination group demonstrated greater reductions in arm circumference difference at the wrist, 10 cm below the elbow, the elbow, and 10 cm above the elbow. Posttreatment swelling, pain, and heaviness scores were significantly lower in the combination group than in the control group. In addition, shoulder flexion, shoulder abduction, and DASH score improved more markedly in the combination group. Although the overall response rate was higher in the combination group than in the control group, the between-group difference did not reach statistical significance. Adverse events were mild and infrequent in both groups, and no serious treatment-related adverse events were observed. After adjustment for selected baseline covariates, combination treatment remained significantly associated with clinical improvement. Sizi Powder external application combined with TDP therapy may be a safe and beneficial adjunctive intervention for patients with upper limb lymphedema after breast cancer surgery, particularly in reducing swelling, alleviating symptom burden, and improving selected functional outcomes. Larger prospective studies are warranted to further confirm these findings.

Total vaginal hysterectomy (TVH) has been performed even for enlarged uterine myoma, but it is regarded as more inferior than total abdominal hysterectomy (TAH). The aim of this study was to compare the role of surgical choice in patients undergoing either TVH or TAH for uterine myoma. In this retrospective cohort study, 140 hysterectomies with bilateral adnexectomy were planned for postmenopausal women with uterine myoma between 2020 and 2024, in a tertiary center hospital. The diagnosis was established after clinical symptomatology and transvaginal ultrasound, with histopathological confirmation obtained postoperatively. The patients were divided into 2 groups: the TVH group (n = 70) and the TAH group (n = 70). Patient features such as age, uterine weight, body mass index (BMI), parity, operative time, intraoperative blood loss, hospital stay, medical history, surgical history, intra and postoperative complications, and adhesions were assessed. Mean age, uterine weight, BMI, and parity showed no significant difference between the groups. Instead, the TVH group was linked with significantly shorter operative time, lower intraoperative blood loss, and reduced hospital stay compared to the TAH group (P < .001). However, there were more medical and surgical histories in patients from the TAH group compared with the TVH group, including postoperative complications (11.44% vs 4.29%) and adhesions (32.86% vs 20%). In most cases, uterine hemisection, tactical myomectomy, or morcellation were used in order to reduce uterine size for the TVH group (78.57%). Our findings sustain that shorter operating time, lower intraoperative blood loss, and reduced hospital stay recommend TVH as a suitable choice in carefully selected postmenopausal women with enlarged uterine myoma.

Observational studies have suggested an increased risk of extraesophageal cancers in patients with gastroesophageal reflux disease (GERD), but whether these associations are causal remains uncertain. This study systematically evaluated the potential associations between genetically predicted GERD and 22 extraesophageal cancers. Genetic instruments for GERD were obtained from a large genome-wide association study including 129,080 cases and 473,524 controls. Outcome data for 22 site-specific extraesophageal cancers were obtained from multiple genome-wide association study datasets, including the UK Biobank, FinnGen, and international cancer consortia. Two-sample Mendelian randomization (MR) analyses were performed, and dataset-specific MR estimates were subsequently combined using meta-analysis. For positive findings, reverse MR and Multivariable Mendelian randomization analyses were further conducted to assess causal direction and independence from body mass index, smoking intensity, and alcohol consumption. Meta-analysis of two-sample MR showed Bonferroni-significant positive associations of genetically predicted GERD with lung cancer (odds ratio [OR] = 1.220; 95% confidence interval [CI]: 1.100-1.354; P = .0002) and pancreatic cancer (OR = 1.517; 95% CI: 1.214-1.895; P = .0002). Suggestive positive associations were also observed for laryngeal cancer (OR = 1.774; 95% CI: 1.091-2.884; P = .021) and bladder cancer (OR = 1.254; 95% CI: 1.047-1.501; P = .014), although neither survived Bonferroni correction. In Multivariable Mendelian randomization analyses accounting for body mass index, smoking intensity, and alcohol consumption, the association with lung cancer remained statistically significant (OR = 1.190; 95% CI: 1.040-1.362; P = .012), whereas the associations with pancreatic, laryngeal, and bladder cancers were no longer statistically significant. These findings provide genetic evidence supporting an association between genetically predicted GERD and lung cancer. The evidence for pancreatic, laryngeal, and bladder cancers was less robust and requires further validation in larger independent datasets. These findings may help prioritize future research on cancer risk among individuals with GERD, with further studies warranted to validate the observed associations and clarify their underlying mechanisms.

Pulmonary hypertension (PH) may occur in diverse clinical contexts. Group 5 PH includes conditions with unclear or multifactorial mechanisms, including tumor-associated PH. Evidence regarding the frequency and clinical significance of elevated right ventricular systolic pressure (RVSP) in patients with mediastinal tumors (MT) is limited. This study aimed to identify clinical and echocardiographic factors associated with elevated RVSP suggestive of PH in patients with MT. This retrospective observational study included patients with MT who underwent transthoracic echocardiography (TTE) at a single tertiary center from January 2010 to December 2019. Clinical variables and echocardiographic parameters were compared between patients with and without elevated RVSP. Echocardiographic signs suggestive of PH were defined as an estimated RVSP ≥ 35 mm Hg; PH was not confirmed by right-heart catheterization. Fifty-five patients (mean age, 62 ± 13 years; 31 women [56%]) were analyzed. Echocardiographic signs suggestive of PH were observed in 21 patients (38%). Twenty-two patients were asymptomatic, and no symptoms were clearly attributable to elevated RVSP. Forty-seven patients (86%) underwent surgery, and 24 (44%) had malignant tumors; elevated RVSP was not associated with malignancy. Patients with elevated RVSP were older than those without elevated RVSP (67 ± 10 vs 59 ± 14 years, P = .017). Smaller left ventricular (LV) end-systolic (29.4 ± 3.6 vs 31.6 ± 3.6 mm, P = .040) and end-diastolic dimensions (4.2 ± 0.3 vs 4.5 ± 0.3 cm, P = .004), and higher LV ejection fraction (LVEF; 69 ± 6% vs 65 ± 5%, P = .019), were associated with elevated RVSP. In exploratory multivariable analysis, older age, smaller LV dimensions, and higher LVEF remained independently associated with elevated RVSP. Elevated RVSP was not significantly associated with clinical symptoms or malignancy. Echocardiographic signs suggestive of PH were relatively common in patients with MT and were associated with older age, smaller LV dimensions, and relatively hyperdynamic LV function. These findings represent echocardiographic associations rather than invasively confirmed PH and require validation in larger prospective studies.

Optic pathway gliomas (OPGs), including optic nerve gliomas, are uncommon tumors of the anterior visual pathway that arise mainly in young children, often with neurofibromatosis type 1 (NF1). The literature is now substantial, but its structure is undescribed. We mapped the most-cited OPG publications to characterize citation patterns, contributors, collaboration, and thematic development.

Scopus was searched on April 30, 2025 using a title-abstract-keyword strategy combining 4 OPG-specific phrases, with no year or document-type restriction. Records were ranked by total citations, and the 100 most-cited were retained. Two reviewers screened independently with a 3rd adjudicating; each was then classified by how directly it addressed OPG. Metadata were analyzed in Bibliometrix and VOSviewer. Distributions were assessed with the Shapiro-Wilk test and summarized as medians with interquartile ranges (IQRs); associations used Spearman correlation. Reporting follows the preliminary guideline for reporting bibliometric reviews of the biomedical literature.

The 100 records, published between 2000 and 2021, were cited 9305 times, with a median of 75 citations per article (IQR 59-108; range 41-289) and a median annual rate of 5.7 (IQR 4.2-7.8). Output peaked in 2010 (n = 9) and again in 2012, 2015, and 2016 (n = 8 each). First authors spanned 17 countries, 53 from the United States. Washington University School of Medicine appeared most often, and David H. Gutmann and Robert A. Avery were the most central authors. Neuro-Oncology (n = 9), Cancer Research (n = 5), and the International Journal of Radiation Oncology Biology Physics (n = 5) led; about four-fifths appeared in 1st-quartile journals. Keyword co-occurrence formed 3 clusters: clinical/chemotherapy, NF1 molecular biology, and imaging/diagnostics. Recent articles were cited faster than older ones (rho = 0.475, publication year vs. annual rate; P < .001). Excluding the 9 peripherally related records left every statistic essentially unchanged (median 76; IQR 59-109).

Among the most-cited OPG publications, emphasis has shifted over 2 decades from descriptive clinical series toward NF1 tumor biology, mitogen-activated protein kinase kinase-directed therapy, and quantitative imaging, with output concentrated in a few North American centers. These findings describe how attention has been distributed, not clinical importance or study quality, and are subject to the known limits of citation analysis.

The utility of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for T1 esophageal cancer is unclear. This study analyzed the usefulness of FDG-PET for T1 esophageal squamous cell carcinoma (ESCC). Medical records of patients with T1 ESCC between December 2008 and July 2024 at Pusan National University Yangsan Hospital were retrospectively reviewed. The preoperative FDG-PET/CT findings and final pathological results of patients with T1 ESCC confirmed by surgery or endoscopic resection were compared. Among the 133 patients with T1 ESCC, 84 (63.2%) had mucosal cancer, 49 (36.8%) had submucosal cancer, and 9 (6.8%) had lymph node metastasis. The maximal standardized uptake value (SUVmax) of the PET/CT images was positively correlated with the invasion depth (r = 0.670; P < .001) and tumor length (r = 0.518; P < .001). PET confirmed FDG uptake in 8 cases of mucosal cancer and 35 cases of submucosal cancer (9.5% vs 71.4%; P < .001). The negative predictive value and positive predictive value of FDG-PET/CT for identifying mucosal cancer were 84% and 81%, respectively. Of the 8 mucosal cancers in which FDG uptake was observed during PET, 5 (62.5%) were whole or near-circumferential lesions. FDG uptake observed using PET/CT was positively correlated with the invasion depth and tumor length of T1 ESCC. FDG-PET/CT may provide complementary information for risk stratification in patients with T1 ESCC.

Human papilloma virus (HPV) is one of the most frequent sexually transmitted viruses globally, with serious clinical consequences, such as cervical cancer. This study aims to evaluate knowledge and awareness of, and attitudes and beliefs towards, HPV and vaccines for it among women from several Saudi Arabian regions. A cross-sectional descriptive study was carried out among Saudi Arabian women. Data were collected from December 9, 2024, to May 9, 2025, via an online survey including women's demographics, knowledge, awareness, attitudes, and beliefs regarding HPV and vaccination against it. An overall of 627 women took part in the study. The majority of the population (32.1%) is aged from 36 to 45 years. In total, 47.4% of the participants have an adequate level of knowledge of HPV, 51.5% know that it is sexually transmitted, and 41.3% know that it can cause cervical cancer. The main information sources were the Ministry of Health and social media. Around 66.7% of the participants believed that the HPV vaccine is not safe. Marital status, religion, and educational status were demonstrably associated with overall knowledge and awareness of HPV and a vaccine for it. Age, marital status, children, region, education level, and occupation were significantly associated with beliefs concerning HPV. This study reported a gap in awareness and knowledge of cervical cancer and HPV; risk and HPV vaccination complications were found to be barriers to vaccine acceptance.

Melanoma is a dynamic health problem caused by deteriorating melanocytes that generate aberrant melanin that gives color to the skin. It remains the leading cause of death from skin cancer. The incidence and mortality rates of melanoma emphasize the need for a suitable diagnostic biopsy, which is important for the optimal treatment of newly observed melanoma patients.

This study aims to evaluate the presence of melanoma metastases, mitotic rate, ulceration, and Breslow thickness, which are the most significant predictors of mortality from melanoma and are important for the diagnosis and optimal treatment of newly diagnosed melanoma patients.

A cohort of 56 patients diagnosed with melanoma in the upper or lower limbs between 2020 and 2024 was analyzed to investigate whether partial biopsies influence melanoma metastasis. All patients underwent biopsy followed by complete resection and were followed for 3 years. We evaluated clinical characteristics, including Breslow thickness, surgical excision width, CLARK grade, ulcer presence, vascular invasion, and biopsy-excision interval, for their influence on recurrence time. The relationships between these factors and recurrence were assessed using the rank sum test and Spearman correlation analysis.

The results revealed that all patients had metastasis at varying intervals post-surgery, with different patterns observed between upper and lower limb melanomas. However, the correlation between recurrence duration and the analyzed characteristics was not statistically significant.

Thus, our current revelations conclude that complete resection of the tumor lesions is sufficient for patients diagnosed with melanoma after biopsy, and extended resection is unnecessary. &nbsp.

Chronic radiation dermatitis (CRD) is a long-term complication of radiation therapy, typically manifesting as scarred atrophic plaques with telangiectasias. In some cases, patients report persistent sensory dysesthesias such as burning, stinging, and pruritus. These symptoms are underrecognized and likely underreported but can significantly impair quality of life and are often refractory to conventional therapies. Pulsed dye laser (PDL) has demonstrated efficacy in treating CRD-associated telangiectasias, but its role in alleviating sensory symptoms has not been reported. We report 2 breast cancer patients with treatment-resistant CRD and debilitating dysesthesias who experienced substantial symptom improvement following PDL therapy. The first patient presented with a decade-long nonhealing chest wall wound and refractory pruritus. She underwent ten sessions of subpurpuric PDL at 6-week intervals, in combination with advanced wound care, and achieved complete wound healing and sustained relief of pruritus and skin fragility. The second patient presented with a burning erythematous axillary plaque present for three years. She underwent four PDL sessions at five-week intervals and reported her first meaningful reduction in burning immediately after the initial treatment, with nearly complete resolution of dysesthesia by her final session despite persistent telangiectasias. These cases suggest that PDL may offer a novel therapeutic option for CRD-associated dysesthesias, particularly when integrated with multidisciplinary care involving medical dermatology, laser specialists, and wound care. Larger, prospective studies are warranted to clarify PDL efficacy for CRD-related dysesthesias. &nbsp.