To compare the longitudinal clinical efficacy of intra-articular polynucleotide (PN) injection combined with prescribed rehabilitation therapy in patients with knee osteoarthritis (KOA) with and without type 2 diabetes mellitus (T2DM), to investigate the influence of glycemic control on treatment outcomes, and to construct a predictive model.

A total of 458 patients with KOA who received PN combined with rehabilitation therapy were retrospectively enrolled. After 1:2 propensity score matching (PSM), 270 patients were included (90 in the diabetes mellitus [DM] group and 180 in the non-DM group). Generalized estimating equations (GEE) were used to compare the longitudinal trajectories of Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between the two groups. Stratified analyses were further performed within the DM subgroup according to baseline glycated hemoglobin (HbA1c) levels. Least absolute shrinkage and selection operator (LASSO) regression combined with multivariable Logistic regression was used to construct a nomogram predicting the probability of achieving Patient Acceptable Symptom State (PASS) at 6 months.

After matching, no significant differences were observed between the two groups in the improvement trajectories of VAS and WOMAC scores (group effect, P > 0.05). Within the DM subgroup, the PASS achievement rate was significantly higher in patients with HbA1c < 7.0% than in those with HbA1c ≥ 7.0% (75.00% vs. 52.38%, P = 0.0248). The nomogram identified rehabilitation adherence (odds ratio [OR] = 2.95, 95% CI: 1.62-5.40), whereas uncontrolled DM (HbA1c ≥ 7.0%; OR = 0.40, 95% CI: 0.22-0.78), KL grade IV (OR = 0.35, 95% CI: 0.18-0.70), and BMI ≥ 28 kg/m² (OR = 0.58, 95% CI: 0.35-0.96) were inversely associated with PASS achievement. The nomogram yielded a C-index of 0.82.

Among patients with KOA receiving intra-articular PN injection together with a prescribed rehabilitation program, those with T2DM showed 6-month clinical outcome trajectories comparable to those without DM. Good glycemic control and favorable rehabilitation adherence are key factors for optimizing therapeutic outcomes.

Metabolic dysfunction-associated steatotic liver disease (MASLD), previously termed non-alcoholic fatty liver disease (NAFLD), is the hepatic presentation of metabolic syndrome. It shares the common pathophysiology of insulin resistance with type 2 diabetic mellitus (T2DM). The aim of this study was to establish the predictive ability of non-invasive liver fat indices-Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), Visceral Adiposity Index (VAI), Triglyceride and Glucose Index (TyG), and NAFLD-Liver Fat Score (NAFLD-LFS)-to determine fatty liver among patients with T2DM.

A cross-sectional analytical study was conducted on 260 newly diagnosed patients with type 2 diabetes. Anthropometric measurements were taken, while ultrasound scan was performed to determine fatty liver; its grade and blood samples were used to determine biochemical parameters. Liver fat index scores were calculated using standardized equations and analyzed using the statistical software SPSS version 23.0.

The incidence of MASLD among patients with T2DM was 69.2%. Three of the liver fat indices-FLI, HSI, and NAFLD-LFS-showed strong statistically significant correlations (p < 0.001) with liver ultrasonographic findings while the remaining indices-VAI and TyG-showed moderately significant correlations (p < 0.01). The cutoff values, sensitivities, and specificities of each index were determined by receiver operating characteristic (ROC) curve analysis. FLI showed the highest diagnostic performance [area under the curve (AUC) = 0.947; 95% confidence interval (CI): 0.923-0.971] with 75% sensitivity and 100% specificity with a cutoff value of 46.12. Both HSI (AUC = 0.847; 95% CI: 0.812-0.902) and NAFLD-LFS (AUC = 0.847; 95% CI: 0.800-0.894) showed good diagnostic performance with sensitivities of 68.3% and 76.1%, specificities of 95.5% and 85%, and cutoff values of 37.02 and 0.906, respectively. A moderate diagnostic performance was observed in the remaining indices: TyG (AUC = 0.707; 95% CI: 0.642-0.772) and VAI (AUC = 0.670; 95% CI: 0.602-0.739). Based on the multivariable logistic regression analysis, both FLI [adjusted odds ratio (aOR) = 1.144, 95% CI: 1.090-1.201, p ≤ 0.001] and HSI (aOR = 1.366, 95% CI: 1.157-1.614, p ≤ 0.001) were able to independently predict the presence or absence of fatty liver.

The current study showed that all five liver fat indices have the ability to predict the presence or absence of fatty liver among patients with T2DM. FLI and HSI showed the highest performance among the five indices, which can be used as screening tools for fatty liver more efficiently. The findings provide reliable alternative methods for detecting fatty liver in a resource-limited clinical setting simplifying patient management.

Type 2 diabetes mellitus (T2DM) is rapidly increasing in India, with rural communities facing greater challenges due to limited nutrition literacy and micronutrient deficiencies. Dietary vitamin B12 inadequacy and poor vitamin B12 status have been implicated in neuropathy, yet evidence linking nutrition knowledge, B12 intake and neuropathy risk in rural Indian populations in patients with diabetes is limited. This study assessed nutrition knowledge, vitamin B12 intake, glycemic control and neuropathy prevalence among adults with T2DM in rural Telangana.

A cross-sectional study was conducted among 150 adults aged above 20 years with established T2DM. Data collected included demographics, anthropometry, fasting and postprandial glucose and glycated hemoglobin (HbA1c). Neuropathy was assessed using the Michigan Neuropathy Screening Instrument (MNSI) and Vibration Perception Threshold (VPT). Nutrition knowledge was evaluated using a validated modified Dietary Knowledge Questionnaire (DKQ), while vitamin B12 intake was estimated using the Cobalamin Intake in North Indians by Food Frequency Questionnaire (COIN-FFQ).

Participants (mean age 52.8 ± 11.26 years) showed poor glycemic control (fasting glucose 169.88 mg/dL, postprandial glucose 242.33 mg/dL, HbA1c 7.95%). Nutrition knowledge was inadequate in 44% of participants. Estimated dietary vitamin B12 intake was 4.28 ± 2.36 µg/day, and neuropathy was present in 44.66%. Weak but significant correlations were observed between body mass index (BMI) and B12 (negative), B12 and HbA1c (positive), and nutrition knowledge and HbA1c (negative). No association was found between B12 intake and neuropathy.

The findings highlight poor glycemic control, low nutrition literacy and high prevalence of neuropathy, emphasizing the need for targeted nutrition education and routine screening for vitamin B12 status in rural T2DM populations.

Myositis ossificans (MO) is a benign, self-limiting lesion characterized by heterotopic ossification that can mimic malignancy both radiographically and histologically. Non-traumatic MO is particularly challenging to diagnose, especially when arising adjacent to major neurovascular structures. Recent studies have identified ubiquitin-specific peptidase 6 (USP6) gene rearrangements in a subset of MO, linking it to a family of transient fibroblastic/myofibroblastic neoplasms. We present a 21-year-old female who presented with progressive right lower extremity pain and weakness without a history of trauma. Imaging revealed an intramuscular thigh mass adjacent to the femoral nerve, raising concern for a peripheral nerve sheath tumor or malignancy. Due to worsening symptoms and diagnostic uncertainty, the patient underwent surgical resection with femoral nerve neuroplasty. Histopathological analysis demonstrated a spindle cell lesion with zonal ossification, and fluorescence in situ hybridization confirmed a USP6 gene rearrangement, establishing the diagnosis of non-traumatic MO. Postoperatively, the patient experienced improvement in strength and partial sensory recovery. Non-traumatic MO can closely mimic peripheral nerve sheath tumors when arising adjacent to major nerves, creating significant diagnostic uncertainty. This case highlights the importance of integrating imaging features, histology, and molecular confirmation of USP6 rearrangement to accurately distinguish benign pseudosarcomatous lesions from malignancy and guide appropriate management.

Phosphaturic mesenchymal tumors (PMTs) are uncommon, predominantly benign neoplasms frequently associated with dysregulated phosphate metabolism through the overproduction of fibroblast growth factor 23 (FGF23). Elevated levels of FGF23 lead to phosphate depletion, which may impair tissue oxygen delivery, central respiratory drive, and respiratory muscle function. Systemic manifestations may include osteomalacia and neuromuscular dysfunction, with an increased risk of respiratory and cardiovascular complications. PMTs often present with nonspecific clinical findings and may remain unrecognized during the perioperative period, presenting significant challenges for anesthetic planning and management. We report the case of a 72-year-old male with tumor-induced osteomalacia (TIO), a right temporal mass, and multiple comorbidities, including hypertension and obstructive sleep apnea. The patient reported progressive headaches and general weakness. After neurosurgical evaluation, he underwent elective surgical excision under general anesthesia. Intraoperatively, he developed hypotension following induction of anesthesia, requiring vasopressor support with ephedrine boluses and a continuous phenylephrine infusion. The remainder of the procedure was uneventful, and the patient was extubated and transferred to the intensive care unit in stable condition. This case highlights the importance of recognizing potential complications in patients with metabolic abnormalities presenting with PMTs, particularly disturbances in phosphate homeostasis that may have significant anesthetic implications. The use of video laryngoscopy, judicious administration of neuromuscular blocking agents, and an individualized anesthetic strategy facilitated secure airway management, minimized cervical manipulation, and supported an uneventful recovery. Moreover, integrating anesthetic selection with comprehensive perioperative planning is essential to address the metabolic, musculoskeletal, respiratory, and hemodynamic challenges associated with TIO, particularly in patients with significant comorbidities.

In recent years, pulmonary segmentectomy has become a preferred treatment option for early-stage lung cancer. The primary factor encouraging clinicians to choose segmentectomy is the assumption of greater parenchymal preservation. In this study, we investigated the parenchyma-sparing effect of robotic pulmonary segmentectomy compared with robotic lobectomy using artificial intelligence (AI)-assisted 3-dimensional (3D) volumetric analysis.

Preoperative and postoperative thoracic computed tomography scans of patients diagnosed with lung cancer between January 2022 and December 2025 who underwent robotic lobectomy or segmentectomy were analyzed using Synapse 3D software. Resected, remaining, expected, and measured lung volumes were calculated. Differences between predicted and measured values were analyzed using the independent-samples t test or the Mann-Whitney U test, depending on the data distribution.

A total of 39 patients were included in the study. Lobectomy was performed in 21 patients, and segmentectomy in 18. The median resected lung volume was 360.5 mL (interquartile range [IQR]: 198-550) in the segmentectomy group and 896 mL (IQR: 599-1194) in the lobectomy group (P < .001). The difference in expected remaining lung volume percentages between the lobectomy and segmentectomy groups was statistically significant (P < .001), whereas the difference in measured postoperative remaining lung volumes was not statistically significant (P = .1).

This pilot study demonstrated that robotic segmentectomy may not provide the expected parenchymal preservation advantage compared with lobectomy. Further prospective multicenter studies with larger cohorts are required.

Advanced rectal and anal malignancies often require dissections beyond total mesorectal planes for improved oncological outcomes. While minimally invasive techniques facilitate this approach, they result in larger perineal defects, creating reconstructive challenges. Robotic-assisted surgery enhances precision, visualisation, and ergonomics, potentially optimising outcomes. However, data on robotics beyond total mesorectal excision (bTME) remain limited. This study evaluated robotic bTME and synchronous gracilis or PAP (profunda artery perforator) flap reconstruction.

This retrospective case series reviewed 10 patients with locally advanced or recurrent anorectal cancer who underwent elective robotic bTME with synchronous perineal gracilis or PAP flap reconstruction.

Median operative time was 465 minutes. Gracilis flap harvest was concurrent. No major flap-related complications or reoperations. R0 resection was achieved in 80%. At 1-year, local recurrence was 0%, distant metastases 30%, and disease-free survival 70%.

Robotics bTME with synchronous gracilis or PAP flap reconstruction is feasible, efficient, and oncologically safe.

Spinal angiolipomas are rare benign tumors composed of mature adipose tissue and vascular elements, most commonly located in the thoracic epidural space. Lumbar involvement is considerably less frequent, and variable proportions of adipose and vascular tissue may result in atypical magnetic resonance imaging (MRI) characteristics and diagnostic uncertainty. We report the case of a 36-year-old woman with an approximately one-year history of persistent low back pain associated with subjective bilateral lower-extremity weakness despite a preserved neurological examination. An initial non-contrast lumbar MRI was interpreted as showing no significant abnormality other than minimal degenerative changes; however, retrospective review revealed a subtle posterior epidural lesion. Because of persistent symptoms, further investigation with contrast-enhanced MRI was performed, demonstrating an elongated epidural lesion extending from L1 to L3, predominantly involving the posterior and right posterolateral epidural space with associated foraminal extension. The lesion demonstrated areas of low T1 signal intensity and intense homogeneous contrast enhancement. The patient underwent L1-L3 laminoplasty and gross-total resection. Intraoperatively, the lesion had a macroscopically adipose appearance and was moderately vascular. Histopathological examination demonstrated mature adipose tissue admixed with numerous vascular channels, confirming the diagnosis of spinal angiolipoma. Postoperatively, pain and subjective lower-extremity weakness improved without new neurological deficits, and early postoperative MRI showed no evidence of residual or recurrent tumor. This case highlights the variable imaging appearance of lumbar spinal angiolipomas and the value of correlating MRI characteristics with intraoperative and histopathological findings, particularly in enhancing epidural lesions without a predominantly fatty appearance.

In recent years, minimal residual disease (MRD) testing has emerged as a powerful prognostic tool in multiple myeloma. Multiple meta-analyses have demonstrated that achieving MRD negativity is associated with significantly improved progression-free survival (PFS), leading to its acceptance as a surrogate endpoint in clinical trials to support accelerated drug approval. Looking forward, MRD status is poised to be incorporated into treatment decision-making; to guide escalation and de-escalation of therapy with the aims of improved progression free survival with limited treatment toxicity. In this review article, we provide an overview of the current modalities available for MRD testing, including bone marrow, peripheral blood, and imaging-based techniques. We examine the prognostic significance of MRD status, with a focus on the impact of sustained MRD negativity, outcomes with MRD resurgence, and the depth of MRD negativity on progression free survival. Finally, we discuss the rapidly evolving landscape of MRD-adapted clinical trials and how these studies are informing the development of response-adapted treatment strategies.

Although specialist palliative care has traditionally focused on patients with advanced cancer, the growing burden of chronic non-oncological diseases has highlighted the need for equitable access to palliative care services. Nevertheless, non-oncological patients continue to experience delayed referral and underutilization of specialist palliative care. This study aimed to compare the characteristics, referral patterns, and clinical outcomes of oncological and non-oncological patients referred to an in-hospital palliative care support team (PCST).

We conducted a retrospective observational study including all adult patients referred to an in-hospital PCST during 2024. Patients were classified as oncological or non-oncological according to their primary diagnosis. Oncological patients were defined as those with active malignant neoplasm or advanced cancer-related disease documented as the underlying condition prompting referral to the palliative care team. Demographic characteristics, referral timing, time from referral to specialist assessment, in-hospital mortality, and transfer to a specialized palliative care unit were compared between groups. Continuous variables were analyzed using the Mann-Whitney U test, while categorical variables were compared using the chi-square or Fisher's exact test.

A total of 204 patients were referred to the PCST during the study period. After excluding 8 patients (3.9%) with missing information regarding the underlying diagnosis, 196 patients were included in the comparative analysis, comprising 106 oncological patients (54.1%) and 90 non-oncological patients (45.9%). Non-oncological patients were significantly older than oncological patients (mean age 84.1 vs. 76.1 years, p < 0.001). In-hospital mortality was significantly higher among non-oncological patients (44/90 (48.9%) vs. 21/106 (19.8%), p < 0.001), whereas transfer to a specialized palliative care unit was more frequent among oncological patients (45/106 (42.5%) vs. 15/90 (16.7%), p < 0.001).

Non-oncological patients referred to the in-hospital PCST were older, experienced worse hospital outcomes, and had lower access to specialized palliative care units than oncological patients. The comparable response time following referral suggests that disparities arise primarily in patient identification and referral rather than in the delivery of specialist palliative care. Although non-oncological patients had a longer median interval between hospital admission and referral, this difference did not reach statistical significance, and therefore delayed referral cannot be considered a definitive explanation for the observed disparities. These findings suggest that differences between the two groups may reflect differences in disease trajectory, clinical complexity, and patterns of recognition of palliative care needs.