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A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Elsevier, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these chal lenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnos tic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assess ment. Core principles include the need for a high-quality liver biopsy (≥ 10 mm), mandatory exclusion of cir rhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standard-ized major and minor histologic criteria were devel oped collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorpo-rating histology, clinical features, associated conditions, and concommi tant etiologies was developed and validated using the Delphi method. This consensus provides the first inter nationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the develop ment of robust, internationally harmonized clinical and translational research cohorts.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Elsevier, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Non-cirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology, such as idiopathic portal hypertension (IPH), non-cirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia, leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy (> −10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standardized major and minor histologic criteria were developed collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorporating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(Springer Nature Link, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collabora tion. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomen clature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Ameri cas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto–sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamen tally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy (≥10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standardized major and minor histologic criteria were developed col laboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorporating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
Durable patellar stability and high patient‐reported success at minimum 5‐year follow‐up after isolated suture tape MPFL reconstruction
(Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
Purpose: To evaluate the mid‐to‐ long‐term clinical and radiological out comes of isolated medial patellofemoral ligament reconstruction (MPFL‐R) using a high‐strength suture tape (HSST) construct in patients with recur rent patellar instability and no major osseous risk factors. Methods: Patients treated with isolated MPFL‐R using HSST and a single knotless femoral anchor between 2015 and 2021 were retrospectively re viewed. Inclusion criteria were recurrent lateral patellar instability (≥2 disloca tions or symptomatic subluxations) refractory to nonoperative treatment and a minimum postoperative follow‐up of 60 months. Patients requiring concomitant bony realignment or presenting with major anatomic risk factors (e.g., high grade trochlear dysplasia, severe patella alta, tibial tubercle–trochlear groove distance >20mm) were excluded. Clinical outcomes were assessed with the International Knee Documentation Committee (IKDC) subjective score, Kujala score and visual analogue scale (VAS) for pain. Patellar tilt was mea sured on axial magnetic resonance imaging (MRI). Postoperative instability events, complications and reoperations were recorded. Clinically meaningful improvements were assessed using minimal clinically important difference (MCID) and patient‐acceptable symptomatic state (PASS) thresholds. Kaplan Meier survival analysis was performed to estimate 5‐year survivorship free from redislocation (primary endpoint) and any postoperative instability (secondary endpoint). Postoperative instability was defined as clinically docu mented redislocation or symptomatic subluxation. Results: Eighty‐one patients (mean age 20.8 years; 31.4% female) were included. At a mean follow‐up of 79.4±14.3 months, one redislocation (1.2%) and two subluxations (2.5%) occurred. Five‐year survivorship free from redislocation was 98.8% (95% confidence interval [CI], 96.4%–100%), and survivorship free from any postoperative instability was 96.3% (95% CI, 92.2%–100%). All patient‐reported outcome measures improved signifi cantly from baseline to final follow‐up (all p<0.001). Ninety‐six percent of patients achieved the PASS threshold for IKDC (95% CI, 89.7%–98.7%), whereas PASS attainment for the Kujala score ranged from 74% to 86% depending on the applied cut‐off. Radiologically, patellar tilt improved substantially on MRI (p<0.001). Postoperative complications were infrequent and manageable, including five cases of arthrofibrosis (requiring manipulation under anaesthesia), one deep infection (treated with arthro scopic debridement) and three cases of implant‐related bursitis at the femoral fixation site. Conclusion: Isolated MPFL reconstruction using an HSST construct pro vided durable patellar stability and significant functional improvement at a minimum 5‐year follow‐up. This technique represents a reliable mid‐to long‐term option for isolated MPFL‐R in appropriately selected patients, especially when graft harvest morbidity and patellar bone preservation are concerns.
Hemodynamic and clinical effects of the levonorgestrel-releasing intrauterine system in symptomatic adenomyosis: A prospective doppler ultrasound study
(Elsevier, 2026) Şahin, Eda Adeviye; Şahin, Turan; Şahin, Hanifi; Küçüközkan, Tuncay
Objectifs : Évaluer les résultats cliniques, biologiques et les modifications hémodynamiques utérines après la pose d’un système intra-utérin au lévonorgestrel (SIU-LNG) chez des femmes atteintes d’adénomyose symptomatique associée à des saignements menstruels abondants. Méthodes : Cette étude prospective observationnelle a inclus des femmes préménopausées âgées de ≥30 ans présentant une adénomyose diagnostiquée par échographie transvaginale selon des critères échographiques reconnus compatibles avec les descripteurs ultérieurement formalisés dans le consensus MUSA révisé. Les pertes menstruelles évaluées par le Pictorial Blood Loss Assessment Chart (PBAC), la douleur évaluée par échelle visuelle analogique (EVA), les paramètres hématologiques, le volume utérin ainsi que les indices Doppler des artères utérines — indice de résistance (IR) et indice de pulsatilité (IP) — ont été évalués avant la pose du SIU-LNG et après 12 mois de suivi. Les comparaisons avant/après traitement ont été réalisées à l’aide de tests statistiques appariés. Résultats : Soixante-cinq patientes ont complété le suivi à 12 mois. Les scores PBAC ont significativement diminué (169,6 ± 49,6 vs 42,4 ± 20,6 ; p < 0,001), de même que les scores EVA (4,2 ± 1,8 vs 2,4 ± 0,8 ; p < 0,001). Les taux d’hémoglobine et d’hématocrite ont augmenté significativement (p < 0,001). Une réduction significative du volume utérin a été observée (161,3 ± 33,5 mL vs 123,0 ± 28,0 mL ; p < 0,001). Les valeurs d’IP des artères utérines n’ont pas été modifiées de manière significative, tandis que les valeurs d’IR ont augmenté significativement des deux côtés (p < 0,001). Aucune corrélation significative n’a été observée entre les variations de l’IR, la diminution du score PBAC et la réduction du volume utérin. Une aménorrhée a été observée chez 21,5 % des patientes à 12 mois. Aucun cas de maladie inflammatoire pelvienne ni de formation de kyste ovarien n’a été rapporté. Conclusions : Chez les femmes atteintes d’adénomyose symptomatique, le SIU-LNG est associé à une amélioration clinique et hématologique significative ainsi qu’à une réduction du volume utérin à 12 mois. L’augmentation observée de l’indice de résistance des artères utérines suggère que des modifications hémodynamiques pourraient participer à la réduction des saignements, en complément de la suppression endométriale, bien que cette relation demeure exploratoire. Le SIU-LNG apparaît ainsi comme une option thérapeutique efficace, bien tolérée et conservatrice de l’utérus dans la prise en charge de l’adénomyose symptomatique.
Therapeutic potential of alpha‑tocopherol in reducing oxidative stress and inflammatory damage after experimental traumatic brain injury and pentylenetetrazol‑induced seizures
(Springer Nature Link, 2026) Demirtaş, Cumaali; Yıldırım, Hava; Demir, Hüseyin; Kıroğlu, Sezin; Şevgin, Kübra; Beyaztaş, Hakan; Güler, Eray Metin; Hekimoğlu, Gulam; Aykın, Uğur; Coşkunpınar, Ender Mehmet; Yıldırım, Mehmet
The effects of alpha-tocopherol on seizure parameters, locomotor-cognitive functions, inflammatory response, oxidative stress response, histopathological changes, immunohistochemical parameters, and miRNA fold changes were investigated in rats with traumatic brain injury (TBI) and pentylenetetrazol (PTZ)-induced seizures. Sprague–Dawley male rats were randomly divided into three groups: Control (n = 8), TBI + PTZ (n = 10), and TBI + PTZ + tocopherol (n = 10). After inducing TBI in animals using the weight-drop method, increased post-injury seizure susceptibility was achieved by administering subconvulsive doses of PTZ. Saline was administered intraperitoneally to the control and TBI + PTZ groups for 6 days, while 500 mg/kg alpha-tocopherol was administered intraperitoneally to the TBI + PTZ + tocopherol group. Seizure intensity, sei zure frequency, and total seizure duration were significantly reduced in the TBI + PTZ + tocopherol group compared to the TBI + PTZ group (p < 0.05). No significant adverse effects related to TBI and PTZ were observed in the animals’ locomotor activity, anxiety-like behaviors, or learning and memory test outcomes. In the TBI + PTZ + tocopherol group, significant reductions were observed in inflammatory cytokine response, oxidative stress, and SUR1-TRPM4 channel activity compared to the TBI + PTZ group (p < 0.001). While degenerative and apoptotic neurons and the number of 8-OHdG-positive cells in the CA1 and dentate gyrus regions were limited in the TBI + PTZ + tocopherol group, downregulated miR-324-5p increased (p < 0.05). Alpha-tocopherol reduced the severity and duration of seizures, reduced oxidative stress and inflammation, and stabilized the thiol-disulfide balance. It also reduced degenerative cell structures and DNA damage in the cortex, hippocam pus, and dentate gyrus. In conclusion, the findings of this study suggest that alpha-tocopherol is a potential neuroprotective agent that modulates early epileptogenic network instability in TBI and seizure susceptibility through multiple pathways, including oxidative stress, inflammation, and ion channel regulation.
Corrugator supercilii muscle and its relationship with neurovascular structures of the frontal region: A cadaveric study
(Springer Nature Link, 2026) Yıldız, Nilay; Nteli Chatzioglou, Gkionoul; Coşkun, Osman; Kale, Ayşin; Gayretli, Özcan
Background The corrugator supercilii muscle (CSM) is a critical anatomical target for botulinum toxin injections and surgical interventions in migraine treatment and facial rejuvenation. However, complications such as sensory loss or vascular injury may arise due to its proximity to neurovascular structures. This study aims to delineate the precise anatomy of the CSM and its relationship with the supratrochlear (STN) and supraorbital nerves (SON) to enhance procedural safety. Methods A cadaveric dissection was performed on 44 hemifaces of 22 formalin-fixed cadavers (11 male and 11 female). The CSM and adjacent neurovascular structures were dissected, photographed, and measured using ImageJ software. Morphometric parameters included distances related to the CSM, as well as branching patterns of the STN and SON were evaluated. Results The CSM length was significantly longer in females (30.53 ± 2.60 mm; 28.93 ± 2.15 mm, p = 0.032). The STN exhibited complex branching (> 3 branches) in 48% of cases, with 13.6% piercing the CSM anteriorly. The SON medial branch pierced the CSM’s lateral segments (46.5% 3rd segment; 53.5% 2nd segment). The supratrochlear artery crossed the CSM 14.84 ± 2.05 mm (females) and 15.43 ± 2.04 mm (males) from the midline, while the supraorbital artery lay 25.38 ± 3.76 mm (females) and 24.49 ± 4.55 mm (males) lateral to the midline. Conclusions The CSM’s intimate relationship with the STN, SON, and associated vessels underscores the risk of iatrogenic injury during forehead procedures. Anatomical variations in nerve branching and muscle morphology highlight the need for individualized approaches to botulinum toxin injection and surgical resection. These findings may reduce complications and improve outcomes in migraine surgery and aesthetic interventions. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Clarifications and response to the letter: QIPB vs ESPB
(Springer Nature Link, 2026) Turan, Engin İhsan; Özen, Volkan; Alver, Selçuk; Umutoğlu, Tarık; Çevik, Serdar; Çiftçi, Bahadır; Şahin, Ayça Sultan
We sincerely thank Dr. Butt and colleagues for their thoughtful comments [1] regarding our study comparing quadro-iliac plane block (QIPB) and erector spinae plane block (ESPB) for postoperative analgesia in single-level lumbar discectomy [2]. We appreciate the opportunity to clarify several points.
Juvenile xanthogranuloma in a congenital melanocytic nevus
(Mattioli 1885, 2026) Duman, Nilay; Yaman, Banu; Oraloğlu, Göktürk; Kararaslan, Işıl
A 6-year-old boy was evaluated for a 6-month history of a 2x1mm yellowish papule that developed within a congenital melanocytic nevus (CMN) located on his back. Dermoscopic examination showed a homogeneous yellowish background with localized pigmented struc tures. In vivo reflectance confocal microscopy revealed an area with sharp borders, characterized by thinning of the epidermis and the absence of rete ridges. At the dermo- epidermal junction, the dermal papillae did not exhibit the typical ringed pattern.
Does laser treatment affect outcome in pilonidal sinus disease? Long-term multicenter retrospective analysis of pit-picking alone vs. pit-picking with laser
(Springer Nature Link, 2026) Arslan, Naciye Çiğdem; Bilgin, İsmail Ahmet; Gülcü, Barış; Bayraktar, Barış; Eray, İsmail Cem; Bisgin, Tayfun; Yıldırım, Yasemin; Aghayeva, Afaq; Aydın, İshak; Bilgiç, Çağrı; Bölük, Salih; Kurtul, Cahide İnci; Ramoğlu, Nur; Yıldırım, Ali; Erenler Bayraktar, İlknur; Bayraktar, Onur
Objectives: The optimal management of pilonidal sinus disease (PSD) remains controversial, with multiple treatment approaches available. Pit-picking is a minimally invasive technique, often enhanced with laser treatment (LT), but the long-term benefits of LT remain uncertain. The objective of this study is to compare pit-picking alone versus pit-picking combined with LT. Methods: This is a multicenter retrospective cohort study including seven centers across Turkey. Patients who underwent pit-picking surgery for PSD between June 2017 and March 2025 were included. Patients receiving adjunctive treatments beyond LT, undergoing excisional procedures, or with incomplete follow-up data were excluded. Pit-picking surgeries performed with or without LT were compared. The primary measure was the recurrence rate at 5 years. Secondary outcomes were postoperative pain, time to complete healing, complications, return to work, and costs. Results: Of 306 patients, 109 (35.6%) underwent pit-picking alone, and 197 (64.4%) received pit-picking with LT. The complication rate was lower in the LT group (6.1% vs. 14.7%, p = 0.012). Patients treated with LT had shorter times to pain-free sitting (median 5 vs. 7 days, p < 0.001) and return to work (3 vs. 6 days, p < 0.001). Complete healing was achieved in 97.4% of patients, with a median time of 14 days. Recurrence rates at 5 years were similar (pit-picking: 13.8%, pit-picking + LT: 12.7%, p = 0.460). Costs were higher for the LT group ($1212 ± 146 vs. $888 ± 148), although complicated pit-picking cases had comparable costs to the LT group ($1198 ± 370, p = 0.004). Risk factors for recurrence included high BMI, family history, advanced Tezel stage, and postoperative complications. Conclusions: While LT improves early postoperative outcomes, it does not impact long-term recurrence rates. The increased cost of LT should be weighed against its benefits in reducing complications, pain, and recovery time. Further randomized trials are needed to refine patient selection criteria and assess cost-effectiveness.
Increased residual anterior knee laxity at one year is associated with a dose‐dependent increase in graft re‐rupture risk following hamstring autograft ACL reconstruction in athletes
(Wiley, 2026) Erden, Tunay; Ağır, Muzaffer; Kayaalp, Mahmut Enes; Toker, Berkin; Taşer, Ömer
Purpose: Residual anterior knee laxity following anterior cruciate ligament reconstruction (ACLR) has been associated with inferior subjective out comes and an increased risk of revision surgery; however, its prognostic value for predicting subsequent graft re‐rupture remains unclear. This study aimed to assess the association between KT‐1000–measured 1‐year post operative anterior knee laxity and graft re‐rupture after ACLR. We hy pothesised that increased residual anterior knee laxity at 1 year post operatively would be associated with a higher risk of graft re‐rupture in a dose‐dependent manner. Methods: This retrospective cohort study included 1011 amateur and pro fessional athletes who underwent primary ACLR with hamstring tendon autograft (HTA) between 2005 and 2024 by a single surgeon using a standardised surgical technique. Patients undergoing revision ACLR, mul tiligament reconstruction, or any lateral extra‐articular augmentation pro cedure were excluded. Anterior knee laxity was quantified using the KT 1000 arthrometer at a mean of 12.1±1.3 months post‐operatively. A landmark time‐to‐event design was applied, with follow‐up starting from the KT‐1000 assessment to minimise immortal time bias and to focus on anterior knee laxity after biological graft maturation. The primary exposure was KT‐1000 side‐to‐side difference (SSD), analysed as both a continuous variable and using clinically relevant thresholds (<3mm, 3–5mm, and >5mm). Associations between post‐operative laxity and graft re‐rupture, adjusting for demographic, surgical, and activity‐related factors were assessed using a multivariable Cox proportional hazards model. Secondary analyses evaluated the relationship between KT‐1000 laxity, return‐to‐play status, and post‐operative activity level. Results: Patients who experienced graft re‐rupture had significantly greater post‐operative KT‐1000 SSD compared with those without re‐rupture (3.5 ± 1.3mm vs. 2.1±0.9mm; p<0.001). Increased KT‐1000 SSD was independently associated with higher graft re‐rupture risk (adjusted hazard ratio, 2.97 per 1‐mm increase; 95% confidence interval [CI], 2.5–3.5). Higher laxity categories were associated with progressively increased re‐rupture risk with adjusted hazard ratios of 1.76 (95% CI, 1.3–2.3; p<0.001) for 3–5mm and 8.85 (95% CI, 4.7–16.4; p<0.001) for >5mm compared with <3mm. Post‐operative 1‐year KT‐1000 anterior knee laxity was not significantly associated with return‐to‐play status (odds ratio, 0.84 per 1‐mm increase; 95% CI, 0.6–1.1; p=0.28), but was modestly associ ated with lower post‐operative Tegner activity level (p<0.001). Conclusion: KT‐1000–measured post‐operative anterior knee laxity at 1 year post‐operatively was independently associated with the risk of sub sequent graft re‐rupture after HTA ACLR in athletic patients. These findings suggest that residual laxity may serve as a useful risk stratification tool, rather than a deterministic predictor of failure, and should be interpreted in the context of overall clinical and biomechanical assessment. Level of Evidence: Level III.
An NLP-driven framework for automated radiology–pathology concordance assessment in breast biopsy
(MDPI Publishing, 2026) Esmerer, Emel; Nazlı, Mehmet Ali; Uzun-Per, Meryem; Gümüş Değidiben, Melike; Söyleyici, Merve; Tahir, Eren; Bal, Mert
Background/Objectives: To develop and assess the feasibility of a natural language processing (NLP) framework for automated assessment of radiology-pathology concordance in breast biopsy using machine learning-based analysis of unstructured reports. Methods: This retrospective study included 766 paired radiology and pathology reports from ultrasound- or mammography-guided breast biopsies (August 2020-May 2024). Reports underwent translation, normalization, tokenization, lemmatization, and synonym expansion, followed by structured encoding of BI-RADS and pathology categories. Three models were trained: a Decision Tree, a LightGBM classifier, and a fine-tuned BioBERT model. Concordance labels were defined by multidisciplinary consensus. Performance metrics included accuracy, sensitivity, specificity, F1-score, area under the curve (AUC), and Cohen's kappa. SHapley Additive exPlanations (SHAP) analysis was used to identify influential features. Results: Among 766 cases, 707 (92.3%) were concordant and 59 (7.7%) were initially discordant. After excluding B3 lesions (n = 46), 13 true discordant cases remained (1.7%). Including B3 lesions increased clinically non-concordant or indeterminate cases from 1.7% to 7.7%, indicating that the apparent performance of the models is likely sensitive to case definition and dataset composition. BI-RADS 4a was the most common category (31.3%), and benign pathology (B2) accounted for 64.4% of biopsies. Within this dataset, LightGBM yielded the highest apparent AUC (0.999) (however, given the extremely small number of true discordant cases, this estimate is likely unstable and should be interpreted with caution), while BioBERT showed the strongest agreement with expert consensus (κ = 0.89). SHAP analysis identified clinically meaningful terms such as calcification, hypoechoic, ductal, and carcinoma as key contributors to model predictions. Given the very limited number of true discordant cases, these performance estimates are likely unstable and should be regarded as preliminary, requiring validation in larger, multi-center cohorts. Conclusions: This study presents a proof-of-concept NLP-based framework for radiology-pathology concordance assessment. The models showed promising performance in identifying potentially discordant cases; however, given the limited number of true discordant samples, these findings should be considered preliminary and require further validation in larger, multi-center datasets before clinical implementation.
Trace determination of heptachlor in soil samples by Toner@CuFe2O4 nanocomposites based microextraction-gas chromatography-mass spectrometry
(Nature Research, 2026) Doru, Esra Sultan; Ali, Büşra; Serbest, Hakan; Bakırdere, Sezgin
In this paper, a green, sensitive, and accurate analytical method was described for the determination of heptachlor at low levels in the GC-MS system. In this context, the preconcentration of heptachlor was achieved by applying the dispersive solid-phase microextraction (DSPME) method prior to the separation and quantification in the GC-MS system. Toner@CuFe₂O₄ nanocomposites were synthesized by the hydrothermal synthesis method and used as the sorbent for the first time in literature. Under the optimal conditions determined by the univariate optimization approach, the limit of detection (LOD) and limit of quantification (LOQ) were found to be 0.61 µg kg⁻¹ and 2,0 µg kg⁻¹, respectively, and the sensitivity of the GC-MS system was enhanced by 68.5-fold. The applicability of the Toner@CuFe₂O₄-DSPME-GC-MS system was assessed by spiking tests applied to soil samples. The recovery results in the range of 93.2% and 105.7% obtained by applying the matrix matching calibration strategy proved the feasibility of the method. The Eco-scale and BAGI tools developed for green and analytical applicability assessment gave scores of 85 and 65, respectively, confirming that the method is environmentally friendly and analytically applicable.
Combination of bilateral rectus sheath and modified BRILMA blocks for postoperative analgesia in pediatric liver transplantation: A tailored approach
(Edizioni Minerva Medica, 2026) Alver, Selçuk; Çiftçi, Bahadır; Büget, Mehmet İlke; Emek, Ertan; Erbiş, Halil; Öztürk, Nadi Nazım; Umutoğlu, Tarık
Combination of bilateral rectus sheath and modified BRILMA blocks for postoperative analgesia in pediatric liver transplantation: A tailored approach
Suboptimal LDL-cholesterol control under the 2019 ESC/EAS dyslipidemia guidelines: Results from the nationwide TEMD-2 study in type 2 diabetes
(Wiley, 2026) Telci Çaklılı, Özge; Haymana, Cem; Demirci, İbrahim; Kebapçı, Medine Nur; Sarıakçalı, Barış; Evren, Bahri; Dizdar, Oğuzhan Sıtkı; Salman, Serpil; Ersoy, Canan; Satman, İlhan; Bayram, Fahri; Sönmez, Alper
Background: Lowering LDL cholesterol (LDL-C) decreases cardiovascular risk substantially in type 2 diabetes. Despite stricter LDL-cholesterol targets in the 2019 ESC/EAS dyslipidemia guidelines, target achievement in clinical practice remains insuffi cient. TEMD-2 is designed to evaluate LDL-cholesterol target attainment in Turkish patients with type 2 diabetes in the context of the updated 2019 ESC/EAS guidelines. Methods: This multicenter cross-sectional study included adults with type 2 diabetes followed in 70 tertiary endocrine clinics across 36 cities between October 2022 and January 2023. Sociodemographic characteristics, comorbidities, lifestyle factors, com plications, laboratory measurements, and lipid-lowering therapies were assessed using standardized questionnaires and clinical evaluations. LDL-C target was assigned according to cardiovascular risk categories. Independent predictors of goal attainment were identified using multivariable logistic regression. Results: Among 4956 adults with type 2 diabetes, 99.5% required statin therapy, whereas 37.1% were on treatment. Overall, 8.3% of the cohort achieved LDL-cholesterol targets, with attainment lowest in those at very high risk (5.8%). Target achievement among statin users was 57.7% in moderate-risk, 18.1% in high-risk, and 9.4% in very-high-risk patients. Individuals on target had lower body mass index, haemoglobin A1c (HbA1c), triglycerides, and a lower prevalence of microvascular complications. Statin therapy was the strongest positive predictor of success (odds ratio 2.39), while smoking, presence of neuropathy, nephropathy, female sex, older age, and higher HbA1c were associated with lower likelihood of achieving LDL-cholesterol goals. Therapeutic inertia was present in 87.2% of patients, defined as no intensification of lipid-lowering therapy despite LDL-cholesterol levels above target.
LuminaConsent: AI-driven standardization and quality enhancement of urological informed consent documentation
(Kare Publishing, 2026) Topçu, İbrahim; Soylu, Tuncay; Şimşekoğlu, Muhammed Fatih; Tuzcu, Esra Melis; Salman, Zeynep; Demir, Perihan; Kaç, Beyzanur; Kartal, Muhammed Yusuf; Suzan, Serhat; Karaman, Muhammet İhsan
Objective: Informed consent is the cornerstone of modern medical ethics, but current documentation systems negatively impact patient autonomy and clinical quality due to deficiencies in readability, comprehensibility, and standardization. These is sues hinder patient participation and require innovative solutions. This study introduces the AI-powered LuminaConsent system to address standard deficiencies, comprehensibility issues, and efficiency constraints in urological informed consent documents. Methods: In a three-armed comparative study, LuminaConsent (artificial intelligence), Turkish Urological Surgery Asso ciation standard forms, and expert-developed documents were evaluated in 10 urological procedures. The system is based on the RAG architecture, which uses OpenAI’s GPT-4o-mini model and a special knowledge base consisting of 12 clinical publications. Three independent urology specialists conducted a blind evaluation using a 100-point scale across five areas: scientific content accuracy, patient communication effectiveness, quality of risk-benefit information, perioperative guidance, and legal-ethical compliance. RESULTS: LuminaConsent achieved higher performance with mean scores of 82.33 points (SD±4.2) versus 78.77 points (SD±6.1) for professional society standards and 57.43 points (SD±3.8) for specialist documentation, representing statisti cally significant improvements of 43.3% over specialist practices (p<0.001) and 4.5% over professional society standards (p<0.05). The system demonstrated consistent high-quality output across all procedures while generating comprehensive documentation within 96-180 seconds compared to traditional processes requiring multiple days. Conclusion: LuminaConsent offers a pioneering model for systematic AI integration in clinical practice with its evidence based content generation and bilingual processing capabilities. The findings support the potential to empower patient auton omy, reduce application variations, and improve ethical standards.
Green MIP-based electrochemical sensing platform for environmental ivermectin analysis
(American Chemical Society, 2026) Aydemir, Zeynep; Kaya, Beril Sena; Dorreh, Setareh; Al Faysal, Abdullah; Erdoğan, Taner; Gölcü, Ayşegül
Ivermectin (IVM), a macrocyclic lactone derived from Streptomyces avermitilis, is widely recognized as a “wonder drug” for its broad-spectrum efficacy against internal and external parasites in human and veterinary medicine. Owing to its potent pharmacological activity, precise quantification of IVM is essential for therapeutic monitoring and dose optimization. In this study, we report the design of a novel electrochemical sensor based on molecularly imprinted polymer (MIP) technology, specifically tailored for the selective detection of IVM. The sensor was fabricated via an electropolymerization strategy employing methacrylic acid (MAA) as the functional monomer and aniline as the comonomer in phosphate-buffered saline (PBS, pH 7.0). To the best of our knowledge, this represents the first electropolymerization-based MIP sensor developed for IVM determination. The resulting MAA-IVM@MIP/GCE sensor was thoroughly characterized using cyclic voltammetry (CV), electrochemical impedance spectroscopy (EIS), Fourier-transform infrared spectroscopy (FTIR), and scanning electron microscopy (SEM). Electrochemical detection was achieved through an indirect redox probe approach with 5.0 mM [Fe(CN)6] 3−/4−, providing a wide linear range (1 × 10−12 −1 × 10−11 M) and remarkably low limits of detection (LOD: 2.91 × 10−13 M) and quantification (LOQ: 9.71 × 10−13 M). The sensor demonstrated high sensitivity, reproducibility, and selectivity, clearly distinguishing IVM from structurally related compounds. It maintained strong analytical performance in pharmaceutical formulations, biological matrices, and environmental samples such as tap water and soil, showing minimal matrix interference. These results confirm the platform’s robustness and applicability. Density functional theory (DFT) calculations were performed to evaluate template−monomer interactions and determine the optimal template:monomer ratio for the MIP-based sensor. The results revealed that the 1:1 complex exhibited the most favorable binding characteristics, consistent with the experimental findings. In addition, the sensor fabrication strategy was designed in accordance with green analytical chemistry principles. The electropolymerization process was performed in aqueous phosphate-buffered saline under mild conditions without the use of excessive cross-linkers or hazardous reagents. The approach minimizes organic solvent consumption, reduces energy requirements, and enables sensor reusability, thereby contributing to a sustainable and environmentally responsible analytical platform. Overall, this cost-effective, scalable, and environmentally conscious electrochemical sensor provides a practical tool for reliable IVM monitoring and has strong potential for clinical diagnostics, pharmacokinetics, and pharmaceutical quality control.
A multisociety consensus statement on a new common definition and diagnostic criteria for PSVD or NCPF
(AASLD, 2026) Hernandez Gea, Virginia; Paradis, Valerie; Guindi, Maha; Alves, Venancio A.F.; Aqul, Amal; Cerda, Eira; Darwish Murad, Sarwa; Das, Prasenjit; Örmeci, Necati; Rautou, Pierre Emmanuel
Noncirrhotic portal hypertension has historically been described using heterogeneous and region-specific terminology—such as idiopathic portal hypertension (IPH), noncirrhotic portal fibrosis (NCPF), obliterative portal venopathy, and nodular regenerative hyperplasia—leading to substantial variability in diagnosis, reporting, and international research collaboration. Differences in guideline definitions from major societies (AASLD, EASL, and APASL), together with the presence of characteristic histologic lesions in patients without clinically overt portal hypertension, have further complicated disease classification. To address these challenges, a large, multisociety, international initiative was convened to harmonize nomenclature and diagnostic criteria. Representatives from liver, pathology, and pediatric hepatology societies across the Americas, Europe, and Asia participated in a structured consensus process that included specialized working groups and external Delphi validation. The initiative produced a globally harmonized and implementable diagnostic framework. Consensus was reached that the terms porto-sinusoidal vascular disorder (PSVD) and NCPF may be used interchangeably when identical diagnostic criteria are applied, and that they should be written as PSVD or NCPF. The diagnosis was defined as fundamentally clinicopathological, requiring integrated assessment. Core principles include the need for a high-quality liver biopsy ( ≥ 10 mm), mandatory exclusion of cirrhosis, and systematic exclusion of specific alternative conditions. Importantly, the consensus recognizes that PSVD or NCPF may be diagnosed even without clinical portal hypertension and may coexist with other liver diseases, provided cirrhosis is excluded. Standard ized major and minor histologic criteria were developed collaboratively by expert pathologists and externally validated. Features of portal hypertension were harmonized into specific and nonspecific categories applicable to routine clinical practice. An integrated diagnostic scoring system incorpo rating histology, clinical features, associated conditions, and concommitant etiologies was developed and validated using the Delphi method. This consensus provides the first internationally endorsed, unified framework for the diagnosis of PSVD or NCPF. Its global implementation is expected to reduce diagnostic variability, improve comparability across regions, and facilitate the development of robust, internationally harmonized clinical and translational research cohorts.
Cognitive alignment and assessment validity in a high-stakes dental specialty examination: A Bloom’s taxonomy-based analysis
(BioMed Central, 2026) Çerçi Akçay, Hülya; Üstün, Nilüfer
Background: In high-stakes postgraduate examinations, the cognitive complexity of assessment items is central to evaluating advanced clinical reasoning and decision-making competencies. Alignment between examination content, cognitive demand, and competency based educational frameworks is essential for assessment validity. This study evaluated the cognitive structure of pediatric dentistry questions in the Turkish Dental Specialty Examination (DUS) using Bloom’s revised taxonomy and examined their alignment with curricular expectations. Methods: A retrospective cross-sectional analysis was conducted on 127 officially released pediatric dentistry questions administered between 2012 and 2021. Each item was independently classified according to Bloom’s revised cognitive levels. Curriculum relevance and scientific accuracy were rated using a 5-point Likert scale. Inter rater reliability was assessed using weighted Cohen’s kappa. Associations between cognitive level and curriculum relevance were analyzed, and temporal trends across examination years were explored. Results: Questions were predominantly concentrated at the Understand and Apply levels, with fewer items categorized at the Analyze level. No questions were classified at the Evaluate or Create levels. Although lower- and higher-order cognitive skills appeared proportionally balanced when dichotomized, higher-order items largely reflected procedural application rather than advanced analytical or evaluative reasoning. No significant temporal progression toward greater cognitive complexity was observed. Curriculum relevance ratings were high overall but showed no significant association with cognitive level. Conclusions: This high-stakes specialty examination predominantly assesses lower- and intermediate-level cognitive processes, with limited representation of advanced higher-order thinking. The findings indicate potential blueprint misalignment with postgraduate competency expectations and underscore the need for deliberate integration of higher cognitive-level items to strengthen assessment validity.
Artificial intelligence applications across the spectrum of malnutrition: From undernutrition to obesity
(Elsevier, 2026) Günalan, Elif; Tartıcı, Gülser; Aladağ, Esra; Çonak, Özge
Background: Malnutrition is a significant global public health challenge, with rising prevalence and vital consequences. Recent advances in artificial intelligence (AI) have transformed approaches to understanding, monitoring, and managing these conditions. In this context, a multidimensional approach, integrating digital anthropometry and precision nutrition with image processing and AI-based mobile applications, has progressed in the field. Objectives: This study provides a comprehensive bibliometric and critical analysis of AI applications in malnutrition, including undernutrition and obesity. Methods: Using RStudio software (version 4.1.3) and the bibliometrix R package, 716 publications were identified in the Scopus database, of which 191 original research articles were analyzed. This context focuses on subfields such as digital anthropometry, precision nutrition, image processing technologies, and AI-supported mobile applications. Results: The findings highlight AI as a rapidly growing and interdisciplinary field of research. Engineering journals frequently publish cutting-edge studies, with the United States, China, Spain, and Korea leading in productivity and citations. Although diet, nutrition, and diabetes themes dominate the literature, undernutrition and obesity remain underrepresented. Conclusions: This study emphasizes the importance of transitioning the current fragmented research landscape into a standardized and ethically governed framework for the sustainable development of AI in nutrition. By bridging identified thematic imbalances and prioritizing scalable digital tools, AI can be repositioned as a strategic pillar of public health, rather than just a clinical instrument. Such a shift is essential for effectively addressing the global double burden of malnutrition and ensuring long-term, sustainable progress in the field.

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