Merkel cell carcinoma (MCC) is primarily a disease of the elderly Caucasian, with most cases occurring in individuals over 50. Immune checkpoint inhibitors (ICI) treatment has shown promising results in MCC patients. Although ~34% of MCC patients are expected to exhibit at least one of the predictive biomarkers (PD-L1, high tumor mutational burden/TMB-H/, and microsatellite instability), their clinical significance in MCC is not fully understood. PD-L1 expression has been variably described in MCC, but its predictive value has not been established yet. Our literature survey indicates conflicting results regarding the predictive value of TMB in ICI therapy for MCC. Avelumab therapy has shown promising results in Merkel cell polyomavirus (MCPyV)-negative MCC patients with TMB-H, while pembrolizumab therapy has shown better response in patients with low TMB. A study evaluating neoadjuvant nivolumab therapy found no significant difference in treatment response between the tumor etiologies and TMB levels. In addition to ICI therapy, other treatments that induce apoptosis, such as milademetan, have demonstrated positive responses in MCPyV-positive MCC, with few somatic mutations and wild-type TP53. This review summarizes current knowledge and discusses emerging and potentially predictive biomarkers for MCC therapy with ICI.

The current study aimed to explore whether the level of decrease in platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and mean platelet volume (MPV) has prognostic value for major adverse cardiovascular events (MACEs) in acute myocardial infarction without ST-segment elevation (NSTEMI) treated with clopidogrel. In this prospective observational cohort study, PDW, P-LCR, and MPV were determined on admission at the hospital and 24 h after clopidogrel treatment in 170 non-STEMI patients. MACEs were assessed over a one-year follow-up period. Using the Cox regression test, a decrease in PDW showed a significant association with the incidence of MACEs (odds ratio [OR] 0.82, 95% confidence interval [CI] 0.66–0.99, p = 0.049) and overall survival rate (OR 0.95, 95% CI = 0.91–0.99, p = 0.016). Patients with a decrease in PDW<9.9% had a higher incidence of MACEs (OR 0.42, 95% CI = 0.24–0.72, p = 0.002) and a lower survival rate (OR 0.32, 95% CI = 0.12–0.90, p = 0.03) than patients who had a decrease in PDW < 9.9%. In the Kaplan–Meier analysis using log-rank test, patients who had a decrease in PDW < 9.9% had an increased risk for MACEs (p = 0.002) and lethal outcomes (p = 0.002). However, a decrease in MPV or P-LCR did not have prognostic value. A decrease in PDW < 9.9% measured 24 h after clopidogrel treatment in NSTEMI patients has good prognostic value for determining the short-term risks of MACEs, possibly providing a better risk stratification of those patients.

Background: The development of novel medical imaging technologies and treatment procedures hinges on the availability of accurate and versatile phantoms. This paper presents a cost-effective approach for creating anthropomorphic abdominal phantoms. Methods: This study proposes a cost-effective method using 3D printing and readily available materials (beeswax, plaster, and epoxy resin) to create high-fidelity anthropomorphic abdominal phantoms. The three-dimensionally printed phantoms exhibited X-ray attenuation properties closely matching those of human tissues, with measured Hounsfield unit (HU) values of −115.41 ± 20.29 HU for fat, 65.61 ± 18.06 HU for muscle, and 510 ± 131.2 HU for bone. These values were compared against patient images and a commercially available phantom, and no statistically significant difference was observed in fat tissue simulation (p = 0.428). Differences were observed for muscle and bone tissues, in which the 3D-printed phantom demonstrated higher HU values compared with patient images (p < 0.001). The 3D-printed phantom’s bone simulation was statistically like that of the commercially available phantom (p = 0.063). Conclusion: This method offers a cost-effective, accessible, and customizable alternative for abdominal phantoms. This innovation has the potential to accelerate advancements in abdominal imaging research, leading to improved diagnostic tools and treatment options for patients. These phantoms could be used to develop and test new imaging techniques with high accuracy.

The aim of the current research was to investigate the association between plasma endocan levels and metabolic control parameters, as well as to evaluate its predictive value for clinical complications in patients with type 2 diabetes mellitus (DMT2). A total of 100 DMT2 patients participated in this prospective observational study. Plasma endocan levels were significantly elevated in DMT2 patients with HbA1c > 7% (1.38 ± 0.33 vs 0.68 ± 0.23 ng/mL; P < 0.0001), compared to patients with HbA1c ≤ 7%. Patients with plasma endocan concentrations >1.10 ng/mL (median value of 1.10 ng/mL) demonstrated significantly higher levels of metabolic parameters: body mass index (BMI), HbA1c (%), fasting glucose level, LDL cholesterol, total cholesterol, triglycerides, along with significantly lower HDL cholesterol levels. Furthermore, patients with plasma endocan levels >1.10 ng/mL were found to have an increased risk for the following complications: retinopathy (relative risk [RR]: 2.7500; 95% confidence interval [CI]: 1.2150–6.2244; P = 0.0152, nephropathy (RR: 2.0952; 95% CI: 1.2294–3.5710; P = 0.0065), neuropathy (RR: 1.9945; 95% CI: 1.2025–3.3081; P = 0.0075), angina pectoris (RR: 2.4881; 95% CI: 1.0865–5.6979; P = 0.0311, hypertension (RR: 1.1372; 95% CI: 1.0060–1.2856; P = 0.0398), cardiomyopathy (RR: 2.6190; 95% CI: 1.1507–5.9612; P = 0.0218), myocardial infarction (RR: 9.4286; 95% CI: 1.2742–69.7697; P = 0.0280) and stroke (RR: 4.4638; 95% CI: 1.3765–14.4758; P = 0.0127). Correlation analysis revealed that plasma endocan levels were positively correlated with HbA1c (%) (r = 0.856, P < 0.0001), fasting glucose level (r = 0.631, P < 0.0001), LDL (r = 0.347, P = 0.0004), cholesterol (r = 0.282, P = 0.0045), and triglycerides (r = 0.366, P = 0.0002). Conversely, plasma endocan levels were negatively correlated with HDL cholesterol (r = −0.429, P < 0.0001). In conclusion, higher plasma endocan levels were strongly associated with poor metabolic control in DMT2 patients and exhibited significant predictive value for both microvascular and macrovascular complications.

Aim 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. Methods 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. Results 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. Conclusion 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.

Aim: To compare outcomes of elective open inguinal hernia repair under local anaesthesia (LA) and general anaesthesia (GA). Methods: This retrospective cohort included 833 adults treated in Tuzla during 2017–2025. The primary outcome was any early adverse outcome within 30 days. Secondary outcomes included analgesic requirement, chronic groin pain, discomfort, dissatisfaction, and recurrence. Logistic regression adjusted for age, American Society of Anesthesiologists physical status, hernia characteristics, and technique. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported; Benjamini-Hochberg correction was applied to secondary outcomes. Results: The LA group included 425 patients and the GA group 408. Postoperative analgesia was required in 338 (79.5%) and 110 (27.0%) patients, respectively (p<0.001). An early adverse outcome occurred in 79 (18.6%) and 35 (8.6%) patients (aOR 2.08, 95% CI 1.31–3.30; p = 0.002), mainly because of more haematomas with LA, 54 (12.7%) versus 20 (4.9%) (p < 0.001). Chronic groin pain did not differ after adjustment (aOR 1.26, 95% CI 0.81–1.96; p = 0.310). Dissatisfaction was higher with LA, 85 (20.8%) versus 40 (10.1%) (aOR 1.95, 95% CI 1.27–2.99; p = 0.002). Eight recurrences were recorded. Median follow-up was 14 months (interquartile range 12–18 months). Conclusion: LA was associated with more early adverse outcomes and dissatisfaction than GA. Chronic pain did not differ after adjustment, and recurrence was similar. Selection bias and residual confounding should be considered.