Post endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent adverse event with significant morbidity following ERCP. Several guidelines have suggested the use of rectal diclofenac as a promising option to prevent PEP. Nonetheless, the recommended optimal dose and timing of administration remain unclear. The aim of this study was to evaluate the efficacy of different doses and timing of rectal diclofenac administration in preventing PEP. Literature search was conducted on 3 databases: PubMed/MEDLINE, Cochrane Library, and ScienceDirect. The included studies were evaluated for the method and reported data quality. Data were summarized and statistical analyses were performed with RevMan 5.4.1 software. Thirteen eligible studies with a total of 8602 patients undergoing ERCP were included in this study. The result showed A significantly lower moderate-severe PEP prevalence in patients treated with rectal diclofenac compared to control (RR 0.67; 95% CI: 0.51-0.89; p=0.006) was found. High-dose rectal diclofenac significantly reduced the prevalence of moderate to severe PEP (RR 0.63; 95% CI: 0.450.89; p=0.008). Administering rectal diclofenac before procedure significantly lowered the prevalence of moderate to severe PEP (RR 0.66; 95% CI: 0.47-0.92; p=0.01). Adverse events related to ERCP procedure were comparable in both groups. No adverse event related to rectal diclofenac administration was reported across all studies. High-dose rectal diclofenac administered before ERCP procedure is effective in reducing the prevalence and severity of PEP, and is well tolerated with favourable safety profile.
To identify the donor and procedural parameters that influence the platelet yield obtained by apheresis. A retrospective observation study of 60 plateletpheresis in the Blood Transfusion Institute of Federation of Bosnia and Herzegovina in Sarajevo, was done. Plateletpheresis were performed using Amicus cell separator with platelet collection protocol, and in accordance with the work procedure of the institution. The results were compared using statistical correlation and statistical comparison between groups. The demographic and hematologic parameters of donors, as well as procedural characteristics were correlated with their platelet yield. P<0.05 was considered statistically significant. The mean pre-donation platelet count was 252x10e9/L. Mean platelet yield was 3.5x10e11/unit. In the majority of donors, 48 (80%), amount of ˃3x10e11/unit was collected. Positive correlation was observed between platelet yield and pre-donation platelet count (r=0.611, p<0.000), blood volume processed (r=0.512, p<0.000), body weight (r=0.525, p<0.000), body height (r=0.264, p=0.042), and run time (r=0.514, p<0.000). Study also observed positive correlation between actual product platelet yield and the software predicted yield (rs=0.774, p<0,000) with statistical difference between them (p<0.000). Pre-donation platelet count, body weight, body height, blood volume processed and run time affected platelet yield. Optimizing the platelet yield is a matter of identifying the factors that influence the yield and thus the selection of donors, providing better quality platelet products and clinical outcomes.
Orthopedic implants must meet specific criteria, including mechanical strength, durability, and biocompatibility. This study compares the immune response of zirconia, polyether ether ketone (PEEK), and stainless-steel implants in vivo, focusing on lymphocyte and fibroblast infiltration as indicators of immune activation. A total of 27 New Zealand white rabbits were used, with nine animals in each group. Implants of zirconia, PEEK, or stainless steel were surgically placed in the thigh and observed for 4 weeks. Histological analysis measured lymphocyte and fibroblast infiltration at the implant site using a microscope at 400x magnification. Statistical analysis included the Kruskal-Wallis test for group comparisons, followed by Mann-Whitney and Bonferroni correction for pairwise comparisons. The Kruskal-Wallis test showed significant differences in lymphocyte (p=0.002) and fibroblast (p=0.003) counts among the groups. Zirconia exhibited significantly lower lymphocyte (median=0.5) and fibroblast (median=1.0) infiltration compared to stainless steel (lymphocytes: median=3.0, fibroblasts: median=2.0), and PEEK (lymphocytes: median=2.0, fibroblasts: median=3.0). Bonferroni correction confirmed zirconia showed the least immune activation (p<0.0167). Zirconia offers superior biocompatibility with minimal immune response, making it an ideal material for orthopedic implants, particularly for patients with metal sensitivities. PEEK showed moderate immune activation but is helpful for non-load-bearing applications. Stainless Steel induced the highest immune response due to the release of metal ions and corrosion. Zirconia is the most biocompatible material tested, making it a promising choice for orthopedic implants.
To demonstrate the possibilities of reconstructing a prosthetic stump in a complex defect using staged osteotomy and lengthening, since for successful prosthetic replacement of the tibial stump, its sufficient length is necessary, which is not always possible. In this article, we present a 25-year-old man diagnosed with a non-prosthetic short stump of the right tibia with extensive necrotized scars of the anterior and end surfaces, closely soldered to the bone sawdust, which underwent lengthening of the short stump of the tibia using the Ilizarov method. The uniqueness of the performed operation is the shortening of the tibia along with the removal of pathologically altered tissues, the formation of a stump, osteotomy of the tibial stump with its subsequent lengthening.Thereconstructionlasted 105 days (5 daysoffixation, 25 daysoflengthening, 75 daysoffixation), whichallowedtoobtain a functionalstump. A stump was created that provided functional prosthetics. We believe that the technique can be successfully used in young people even in the absence of soft tissue reserve of the stump.
Myocardial infarction (MI) is a cardiovascular disease that is the leading cause of death at all ages. Inflammation and oxidation processes constitute the basic pathophysiology of MI development. C-reactive protein (CRP) and transforming growth factor β (TGF-β) are markers that are often used to evaluate the level of inflammation, especially in MI. This study aimed to evaluate the anti-inflammatory potential of thymoquinone (TQ), the major bioactive compound of Nigella sativa, by assessing its binding affinity through molecular docking, in which TQ exhibited more favorable binding energies compared to the native ligand. Using the VegaZZ, PyMOL, and BIOVIA Discovery Studio tools, AutoDock Vina software was used for in silico research to test the active molecule TQ and produce visual profiles of native CRP and TGF-β ligands. Using the pkCSM method, pharmacokinetic predictions were carried out. Thymoquinone (2-methyl-5-propan-2-ylcyclohexa-2,5-diene-1,4-dione) showed favorable binding affinity to both CRP and TGF-β, with docking scores of –3.60 and –4.15 kcal/mol, respectively, which are more favorable than those of the native ligands (–2.39 and –2.73 kcal/mol) and comparable to enalapril (–4.84 and –6.13 kcal/mol). The RMSD value for CRP was 1.421 Å, while the value for TGF-β was 0.253 Å, indicating excellent structural alignment and validating the docking approach. These in silico findings suggest that TQ warrants further investigation in vitro and in vivo as a potential modulator of inflammatory pathways in MI.
Vaccine hesitancy challenges global public health, with parental attitudes significantly impacting childhood immunization. This study examined parental perceptions of vaccine safety, effectiveness, and decision-making factors in Bosnia and Herzegovina. A cross-sectional survey was conducted in March 2025 with 233 parents at a Primary Healthcare Center in Gračanica. A structured questionnaire based on the Parent Attitude about Childhood Vaccines (PACV) assessed sociodemographic data, vaccination experiences, information sources, and attitudes toward vaccines using a Likert scale. Among 233 participants, 195 (83.7%) fully vaccinated their children, 30 (12.9%) practiced selective vaccination, and eight (3.4%) refused all vaccines. Vaccine hesitancy was significantly associated with lower education, (26.3% vs. 5.1%; p<0.001), rural residence (76.3% vs. 48.2%; p=0.002), and having three or more children (34.2% vs. 12.3%; p=0.01). Trust in healthcare professionals strongly influenced behavior, with 178 (91.3%) of parents who fully trusted doctors adhering to the immunization schedule. Concerns about autism were reported by 14 (36.8%) of hesitant parents and were significantly associated with delayed or refused vaccination (p<0.001). Although overall confidence was high, vaccine hesitancy persisted due to perceived risks. Strengthening healthcare communication and addressing misinformation, particularly autism concerns, may help improve vaccine uptake.
Recent studies challenge the initial belief that medial unicompartmental knee arthroplasty (UKA) is contraindicated for patients with anterior cruciate ligament deficiency (ACLD) due to increased risk of periprosthetic tibial fractures, revealing promising outcomes with advancements in surgical techniques and patient selection. This study aimed to evaluate the outcomes of patients who received medial unicompartmental knee arthroplasty with anterior cruciate ligament deficiency. Five patients, aged 59-74, with knee pain, joint instability, and limited mobility, were treated for medial compartment osteoarthritis and ACLD using an Oxford design mobile-bearing unicompartmental knee prosthesis. Medial UKA offers excellent clinical outcomes in ACL-deficient patients, improving knee function and reducing pain. It challenges the traditional view of ACLD as a contraindication, preserving knee kinematics and offering enhanced postoperative recovery. Advances in surgical techniques and prosthesis design expand their suitability. Medial UKA may be a viable treatment option for Osteoarthritis patients with ACLD, potentially offering an alternative to total knee arthroplasty.
Environmental factors may influence postoperative outcomes and quality of life following total hip replacement (THR). This study investigated the impact of the geographical location of the surgical site, as well as the patient’s place of birth and residence, on treatment outcomes in individuals with artificial hips. A prospective study was conducted involving 280 patients (both genderes; mean age 62 ± 8.8 years) who underwent THR due to primary or secondary hip osteoarthritis. Patients were divided into two groups: Group A (n = 64) included individuals who were not operated on in their place of birth and residence, while Group B (n = 216) consisted of those who were born, resided, and underwent surgery in the same geographical location. Outcomes were assessed using the EQ-5D questionnaire (covering mobility, self-care, usual activities, pain/discomfort, and anxiety/depression), the Visual Analogue Scale (VAS) for pain, and a VAS-based treatment satisfaction scale, administered preoperatively and one year postoperatively. Statistical analysis was performed using Fisher’s exact test (p < 0.05). Only 22.9% of all patients underwent surgery in their place of birth and residence, mostly for primary hip osteoarthritis. Preoperatively, Group A reported significantly greater limitations in self-care (p < 0.05). One year postoperatively, Group B showed significantly higher VAS scores for treatment satisfaction (p < 0.05). Patients who underwent total hip replacement in their place of birth and residence demonstrated better postoperative outcomes compared to those who had relocated.
Many studies have demonstrated that over half of the World's population is infected with Helicobacter pylori (H. pylori). To evaluate the current H. pylori seroprevalence in Bosnia and Herzegovina (B&H), H. pylori antibodies (immunoglobulin G, IgG) from patients with suspected presence were analyzed. In total, 201/471 (42.7%) males and 270/471 (57.3%) females were enrolled between June 2024 and July 2024. They were tested using the enzyme-linked immunosorbent assay (ELISA) method. The overall seroprevalence of H. pylori infection was 214 (out of 471; 45.4%) and did not differ in relation to sex. The seroprevalence rate of H. pylori was highest in the 50–69 age group, 81 (out of 137; 59.1%; 95% CI: 2.2–5.6), followed by the ≥70 age group, 17 (out of 31; 54.8%; CI: 2.0–6.7), and the 30–49 age group, 101 (out of 219; 46.1%; 95% CI: 1.7–4.3). The lowest seroprevalence rate was in the younger age group (≤29) with 15 (out of 84; 17.8%). Older age groups were more likely to be H. pylori positive and equivocal, while younger age groups negative for H. pylori infection. This single-center study is the first study providing information on the H. pylori seroprevalence in the B&H population and investigating its association with age and sex. Further research is needed to explore other risk factors and to develop effective ways to reduce the burden of this infection.
The research examined the effects of prolonged oral Lactobacillus rhamnosus intake on rabbit intestinal tissue morphology. The study included twelve male rabbits aged 10–12 months and weighing 1.5–2.0 kg who received random assignment to two groups of six animals each. The control group received distilled water but the experimental group received L. rhamnosus orally at 0.25 mL/kg/day for 45 days. The research team performed histological and morphometric analysis on duodenal samples to measure villus height and width and crypt depth and villus area and VH/CD ratio and muscularis thickness through ImageJ software. The extended probiotic treatment caused villus disorganization and epithelial necrosis and villus fusion and inflammatory infiltration and submucosal edema. The quantitative analysis showed that all measured parameters including villus height and VH/CD ratio and villus area and muscularis thickness demonstrated significant decreases (p<0.05) when compared to the control group. The results show that absorptive capacity was impaired. The duodenal mucosa developed structural and functional changes because of extended exposure to high L. rhamnosus concentrations which indicates that long-term probiotic use could be harmful. Research needs to determine the correct dosage amounts and duration of treatment for non-rodent species.
To determine the frequency and identify predictors of Continuous positive airway pressure (CPAP) failure in neonates of varying gestational ages in a resource-limited setting, where CPAP is often used beyond the preterm population. Prospective observational study of 119 neonates started on CPAP within 24 hours of birth for respiratory distress. We collected Demographic, clinical, and perinatal data. CPAP failure was defined by persistent hypoxia or severe respiratory distress despite maximal settings, necessitating mechanical ventilation. Univariate and multivariable binary logistic regression analyses identify predictors of CPAP failure. Results: The CPAP failure rate was 33.6%. Univariate analysis identified lower gestational age ( ≤ 30 weeks), lower birth weight (≤1200 g), female sex, vaginal delivery, and a 5-minute Apgar score < 7 as significant predictors. However, in the multivariable model, only a 5-minute Apgar score < 7 remained an independent predictor (Adjusted Odds Ratio AOR 5.315; p=0.006). Antenatal corticosteroid, age at CPAP initiation, and initial Fraction of inspired oxygen (FiO)₂ were not significant. Neonates with birth weight <1200g had shorter duration of successful CPAP use as revealed by Kaplan-Meier survival analysis (p<0.001) Conclusion: This study confirms that CPAP failure is a frequent and serious problem in our resource-limited NICU. A low 5-minute Apgar score is a significant predictor of failure. To save more newborns, we must focus on improving neonatal resuscitation and make clear guidelines for respiratory care in our specific context.
Distal radius fractures are among the most common orthopedic injuries, posing significant challenges due to their high prevalence and potential for long-term functional impairment. Volar locking plates have emerged as the gold standard for managing unstable and extra-articular fractures, offering superior outcomes compared to traditional methods. This study evaluates the clinical, radiographic, and functional outcomes of volar locking plate fixation in 34 patients with intra and extra-articular distal radius fractures. This retrospective study analyzed 34 patients treated for intra and extra-articular distal radius fractures with volar locking plates at a single orthopedic center. Patients were followed for a mean duration of 24 months (range: 12–36 months). Outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score, Visual Analog Scale (VAS) for pain, range of motion (ROM), and radiographic parameters. Complications, including hardware-related issues and soft tissue irritation, were recorded. Statistical analysis compared preoperative and postoperative outcomes, with significance set at p < 0.05. The mean DASH score at the final follow-up was 4.2 ± 1.8, reflecting excellent functional recovery. Pain relief was complete, with all patients reporting a VAS score of 0. ROM restoration was highly satisfactory, achieving 93–98% of contralateral wrist motion. Radiographic evaluations confirmed 100% fracture consolidation with no cases of malunion or nonunion. Complications were minimal, with only two patients experiencing transient soft tissue discomfort, managed conservatively. No tendon irritation or hardware-related complications were observed. Volar locking plate fixation for intra and extra-articular distal radius fractures demonstrated excellent clinical, functional, and radiographic outcomes in this cohort of 34 patients. The low-profile design and anatomical contouring of modern plates minimized complications while promoting effective pain relief and rapid functional recovery.
To analyze the effect of vitamin D administration on serum 25(OH)D levels and biomarkers of metabolic syndrome and atherosclerosis (homeostatic model assessment of insulin resistance [HOMA-IR], adiponectin, homocysteine, and high sensitivity C-reactive protein [hs-CRP]) in epilepsy patients receiving enzymatic antiseizure medications (ASMs). This double-blind, randomized, placebo-controlled trial randomized 40 adult epilepsy patients treated with enzymatic ASMs to receive vitamin D3 (2,000 IU/day) or placebo for 12 weeks. The primary outcome was the change in serum 25-hydroxyvitamin D (25[OH]D) levels. Secondary outcomes included changes in HOMA-IR, adiponectin, homocysteine, and hs-CRP. Data were analyzed using a per-protocol approach. Thirty-four patients completed the study. Vitamin D supplementation yielded a significantly greater increase in serum 25(OH)D (10.67 ± 8.16 vs. –1.29 ± 3.96 ng/mL; p < 0.001) and adiponectin (1.38 ± 3.05 vs. 0.34 ± 1.89 µg/mL; p = 0.045), as well as a significantly greater reduction in hs-CRP (–6.74 ± 14.65 vs. 1.81 ± 7.75 mg/L; p = 0.041) compared with placebo. Conversely, no significant differences were observed between groups regarding the changes in HOMA-IR (–0.24 ± 3.71 vs. –0.14 ± 3.38; p = 0.940) or homocysteine (7.90 ± 1.79 vs. 8.15 ± 2.70 µmol/L; p = 0.290). Vitamin D supplementation (2,000 IU/day) effectively restores 25(OH)D levels and improves adiponectin and hs-CRP in epilepsy patients on enzymatic ASMs, suggesting a potential benefit for cardiovascular risk reduction. However, vitamin D alone did not prevent the rise in homocysteine, likely due to the concurrent cessation of B-vitamin supplementation.
Infectious spondylodiscitis is a rare but serious spinal infection that often presents with nonspecific symptoms like fever and back pain, causing delayed diagnosis. This study aimed to describe clinical features, identify etiological agents, and outline treatment approache in patients treated at the Department of Infectious Diseases, Cantonal Hospital Zenica, Bosnia and Herzegovina, from January 2022 to December 2023. This retrospective descriptive study included 60 patients diagnosed with infectious spondylodiscitis based on clinical symptoms (fever and/or spinal pain) and confirmed by magnetic resonance imaging (MRI) or scintigraphy. Data were collected from medical records and included demographic information, clinical presentation, laboratory results: hemoglobin, leukocytes, C-reactive protein (CRP), liver enzymes), microbiological findings (blood cultures and serology), imaging, and treatment details. Median time from symptom onset to hospital admission was 30 days. Blood culture was positive in 31 (51.6%) patients, while etiology was identified in 57 (95%) cases. Brucella species was the most common pathogen, confirmed serologically in 46 (90.2%) of brucella cases. Most patients had a history of unpasteurized dairy consumption or animal contact. The MRI was performed in 58 (96.7%) of patients, confirming vertebral inflammation. Complications such as abscesses, epidural collections, or empyema occurred in 35 (58.3%) patients. Due to its nonspecific presentation, infectious spondylodiscitis is often diagnosed late. In endemic regions, brucellosis should be considered as a potential cause. Blood cultures and serology are key for etiological confirmation, while MRI remains the diagnostic gold standard. Targeted antimicrobial therapy is the mainstay of treatment, with surgery indicated in complicated cases.
Alloimmunization depends on the type of the erythrocyte antigen, as well as the number of transfused doses of blood and recipient factors reflected in genetic and immunological status, comorbidities and therapy. The aim was to determine the frequency and type of antierythrocyte antibodies, to examine the correlation between the number of transfused doses and the frequency of antibodies, as well as the influence of recipient factors on the prevalence of antierythrocyte antibodies in polytransfused patients. A retrospective study was conducted in the Department of Pretransfusion Testing and Blood Product Therapy at the Polyclinic for Transfusion Medicine of the University Clinical Center Tuzla. The data of patients who received two or more doses of red blood cell concentrate, the frequency of antierythrocyte antibodies, as well as dose and patient factors including age, sex, comorbidity and therapy that influenced alloimmunization were analyzed. The highest percentage of patients developed the anti-E (23%), anti-C (11%) and anti-K (17%) antibodies. The recipient factors that have shown to be positive predictors for the development of antierythrocyte antibodies were: surgical bleeding (OR=3.74) and autoimmune diseases (OR=2.3). The probability that patients will not develop antierythrocyte antibodies was more pronounced in oncological patients (1/OR=7.14), as well as in patients with iron supplementation (1/OR=2.22) and antihypertensive therapy (1/OR=2.32). The results emphasize the importance of pretransfusion testing, illuminate the positive and negative effects of frequent transfusions, and propose strategies for improving transfusion therapy with a focus on the benefits of phenotyping erythrocytes for Rh and Kell antigens.
Optimal myocardial protection remains challenging in emergency coronary revascularization, especially in patients with severely reduced left ventricular function. Contemporary cardioplegia strategies aim to limit ischemia–reperfusion injury and enhance postoperative ventricular recovery. The aim of this study was to compare operative parameters, early postoperative outcomes, and myocardial functional recovery between single-dose Del Nido cardioplegia and conventional blood cardioplegia in adults with left ventricular ejection fraction (LVEF) ≤40% undergoing emergency isolated coronary artery bypass grafting (CABG). This retrospective study included 150 consecutive patients with left ventricular ejection fraction (LVEF) ≤40% who underwent emergency isolated CABG between 2022 and 2024. Patients were assigned to either the Del Nido group (n=80) or the conventional blood cardioplegia group (n=70). Demographics, operative variables, postoperative complications, ventricular function changes, and short-term mortality were analyzed. Myocardial recovery was assessed using ΔEF (postoperative minus preoperative LVEF). . The Del Nido group demonstrated significantly shorter aortic cross-clamp and cardiopulmonary bypass times and required less intraoperative defibrillation. The incidence of postoperative atrial fibrillation was lower in the Del Nido group (18%) compared with conventional blood cardioplegia (29%). Improvement in ventricular function was greater with Del Nido (ΔEF +5.8±2.1%) than with blood cardioplegia (+3.2±2.4%). Rates of stroke, perioperative myocardial infarction, and early mortality were comparable between groups. Single-dose Del Nido cardioplegia provides effective and safe myocardial protection in emergency low-EF CABG, offering improved operative efficiency and superior early ventricular recovery without increasing perioperative complications.
Tendon healing involves a crucial proliferative phase, during which fibroblasts and fibrocytes orchestrate collagen deposition. The use of liquid nitrogen (LN) in orthopedic oncology may inadvertently affect adjacent tendon tissues. This study aimed to evaluate the impact of LN exposure on the histological features of tendon healing. This experimental study employed a randomized post-test-only control group design involving 24 males Rattus norvegicus, randomly divided into four groups: control (no LN exposure) and three treatment groups exposed to LN for 1, 5, and 10 minutes, respectively, following Achilles tendon transection and repair. After a 21-day healing period, histological analysis was performed to assess the counts of fibroblasts, fibrocytes, and collagen content. Statistical analyses included one-way ANOVA, Post-hoc Tukey, and Pearson correlation (p<0.05 was considered significant). LN exposure significantly reduced fibroblast, fibrocyte, and collagen levels compared to controls (p<0.05). The 10-minute group showed the lowest counts. A significant negative correlation was found between LN immersion duration and the number of fibroblasts (r= -0.87), fibrocytes (r= -0.829), and collagen content (r= -0.83) (p<0.05). Liquid nitrogen (LN) impairs tendon healing in a dose-dependent manner, likely due to cryo-induced cell death and disruption of blood flow. This results in an acellular and avascular tendon matrix, hindering the repair process. LN exposure negatively impacts the proliferative phase of tendon healing in rats, suggesting the need for caution in clinical use to prevent damage to surrounding tendinous tissues.
There are many studies about the correlation between Bataknese and schizophrenia patients, one of the most common ethnic in Indonesia. Cytokine and its’ receptor disorder is one of the scope of immunology research in schizophrenia. Interleukin 3 (IL-3) is an important cytokine with various biologic roles in immune response. We would like to determine the association between the polymorphism of IL3RA gene with negative symptoms in Bataknese schizophrenia patients. This study used comparative case control approach. The negative symptoms were assessed using Positive and Negative Syndrome Scale (PANSS). Blood sampling and deoxyribonucleic acid (DNA) isolation used salting out method followed by IL3RA RS6603272 G/T genotype identification using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The data were analysed using χ2 and Kruskal Wallis test. A p<0.05 was considered statistically significant. Two hundred participants were divided into schizophrenia and healthy control groups evenly. G alleles (49.5% and 50.5%) and GT genotypes (49% and 53%) were the most common alleles and phenotypes in both groups with no significant difference in both groups (p>0.05). The analysis also did not reveal significant correlation between the polymorphism of IL3RA RS6603272 G/T with the negative symptoms of schizophrenia (p > 0.05). There was neither significant difference of the presence of G and T alleles, also GG, GT, and TT genotypes between two groups nor the correlation between polymorphism of IL3RA RS6603272 G/T with schizophrenia negative symptoms.
To investigate the impact of three-dimensional (3D) printing technology on vascular surgery, focusing on its role in preoperative planning and surgical training. A systematic review was conducted of studies published between 2017 and 2024 that evaluated 3D printing in vascular surgery. Databases searched included MEDLINE and CENTRAL. Eligible studies reported applications of 3D printing in preoperative planning, simulation, or surgical education. Analysis of relevant studies revealed that 3D-printed vascular models improved surgical precision, reduced fluoroscopy time, enhanced technical skill acquisition, and increased trainees’ confidence. Models based on computed-tomography angiography data provided accurate, patient-specific anatomy for classic or endovascular aortic aneurysm repair and other vascular procedures. 3D printing significantly enhances vascular-surgery training and preoperative preparation by providing realistic, patient-specific simulations that improve both technical competence and surgical outcomes.
To identify predictors of all-cause mortality and 6-month rehospitalisation in patients with hypertensive crisis, focusing on inflammatory indices, metabolic markers measured at admission, and antihypertensive treatment profiles. This prospective observational study included 210 adult patients with hypertensive crisis. Demographic, clinical, and therapeutic data were collected, including data on comorbidities, antihypertensive drug use, and treatment adherence. Laboratory parameters obtained at admission included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), homocysteine, and uric acid. Patients were followed for 12 months. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were conducted to identify independent predictors. Mortality occurred in 10.9% of patients, and 27.1% were rehospitalised within 6 months. Deceased patients exhibited significantly higher levels of PLR (p=0.0329), SII (p=0.0355), homocysteine (p=0.0488), and uric acid (p=0.021). In multivariate analysis, homocysteine (OR=3.55; p<0.001), uric acid (OR=1.03; p=0.007), PLR (OR=1.04; p=0.047), and SII (OR=1.01; p=0.030) remained independently associated with mortality. Chronic kidney disease (OR=2.15, p=0.012) and poor treatment adherence (OR=1.92; p=0.017) were also significant predictors. ROC analysis demonstrated moderate discriminative power, with AUC values of 0.68 for PLR, 0.66 for SII, 0.65 for homocysteine, and 0.63 for uric acid. Elevated inflammatory indices and metabolic markers, particularly homocysteine and uric acid, were independently associated with increased mortality risk. Additionally, chronic kidney disease and suboptimal adherence to antihypertensive therapy significantly contributed to adverse outcomes. These findings underscore the importance of comprehensive risk assessment and personalised management in this high-risk population.