Prognostic assessment plays a crucial role in guiding therapeutic decision-making for patients with sepsis, particularly in intensive care settings. This study aimed to develop a multivariable model to predict 28-day mortality among intensive care unit (ICU) patients with sepsis by integrating serum lactate levels, the National Early Warning Score (NEWS), and the Predisposition, Infection, Response, and Organ Dysfunction (PIRO) score. Demographic information, clinical characteristics, and laboratory findings routinely collected at ICU admission were used to calculate the NEWS and PIRO scores for each patient. Patients were categorized as survivors or non-survivors based on their outcome. Both logistic regression and Cox proportional hazards models were applied for mortality prediction analysis. The final analysis included 205 patients diagnosed with sepsis (mean age: 73.6 ± 13.2 years; 53.2% male), of whom 109 died during hospitalization. Logistic regression analysis revealed that lactate, NEWS, and PIRO scores were independently associated with 28-day mortality. Combining lactate levels with NEWS and PIRO significantly enhanced mortality prediction, with the greatest accuracy observed when all three parameters were integrated. Pairwise analyses demonstrated that adding lactate to the base model significantly improved predictive accuracy (DBA: −0.103, p = 0.003), and incorporating lactate into a model already including NEWS further enhanced its predictive value (DBA: −0.042, p = 0.037). In conclusion, serum lactate measured at initial ICU admission provides valuable prognostic information for predicting 28-day mortality in sepsis patients. Furthermore, combining lactate levels with NEWS and PIRO scores substantially enhances the accuracy of mortality prediction in these patients.

Internal hernias are a rare but significant cause of acute small bowel obstruction, often presenting diagnostic challenges due to their non-specific clinical manifestations. This case report describes a 74-year-old female with acute small bowel obstruction caused by a transverse mesocolic internal hernia, an uncommon subtype. The patient presented with abdominal pain, bloating, and vomiting, with a history of hypertension, asthma, and diabetes mellitus, but no previous abdominal surgeries. Abdominal tomography revealed signs consistent with small bowel obstruction, and emergency surgery was performed. Intraoperatively, a distal jejunal loop was found trapped in an abnormal mesenteric opening near the splenic flexure and descending colon. The hernia was reduced, and a small perforation in the bowel was repaired. The patient had an uneventful recovery and was discharged on the 10th postoperative day. This case highlights the importance of early diagnosis and surgical intervention in managing internal hernias to prevent complications. Laparotomy remains a viable option in elderly patients with significant comorbidities, although laparoscopic surgery may be considered in selected cases.

Aim: To investigate the antitumor effects of tarantula cubensis alcoholic extract (TCE) on the human hepatocellular cell line (HepG2). Methods: Various concentrations (1, 5, 10, 20, 50, 100, 250, and 500 µg/ml) of TCE were applied to HepG2 cells, which were then incubated for 24, 48, and 72 hours. Analysis was performed using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assays. Immunohistochemistry and apoptosis (Ki-67) analysis were conducted on cells treated with 1 and 5 µg/ml TCE for 24, 48, and 72 hours. Results: The most appropriate doses of TCE for the HepG2 cell line were found to be 5 µg/ml at 24 hours and 1 µg/ml at 48 and 72 hours. Ki-67 H-SCOR in HepG2 cells treated with TCE significantly decreased compared to the control group (p<0.001). Conclusion Our study suggests that TCE may alter normal cancer physiology by stimulating apoptosis in HepG2 cells via the Ki-67 pathway, leading to cell death. Therefore, TCE has the potential to provide a new perspective in the treatment of HCC.

Purpose This study evaluated whether the systemic immune-inflammation index (SII), calculated from admission blood counts, predicts complicated acute diverticulitis, intensive care unit (ICU) admission, and 30-day mortality. Methods In this single-center retrospective observational study, 182 adults with computed tomography-confirmed acute diverticulitis and 182 age-matched controls were analyzed. Admission neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and SII were calculated. Associations with clinical severity, complications, ICU admission, readmission, and mortality were assessed using non-parametric tests, Spearman correlation, and receiver operating characteristic analysis. Results White blood cell count, neutrophil count, C-reactive protein (CRP), NLR, PLR, and SII were higher in patients than in controls, whereas lymphocyte count was lower (all p < 0.001). SII correlated strongly with NLR (rho = 0.942), PLR (rho = 0.875), and CRP (rho = 0.673; all p < 0.001), and was also associated with abscess size, length of stay, and Clavien-Dindo grade. For 30-day mortality, SII yielded the highest discrimination (area under the curve [AUC] = 0.890, 95% confidence interval [CI]: 0.812–0.968). At a cut-off of 1917.74, sensitivity was 88.9% and specificity was 77.4%. Its performance was more limited for complicated disease (AUC = 0.635) and ICU admission (AUC = 0.678). Conclusion Admission SII reflects inflammatory burden and adverse clinical course in acute diverticulitis. It appears most useful for short-term mortality risk stratification, but should complement rather than replace clinical assessment and imaging.

Undescended testis (cryptorchidism) is a common congenital anomaly in childhood but rarely seen in adults. Inguinal hernia can occasionally coexist with undescended testes, although such a presentation is uncommon in adult patients. We report a rare case of a 28-year-old male with a right inguinal hernia who was found to have an atrophic testis within the hernia sac during lapa-roscopic transabdominal preperitoneal (TAPP) repair. The patient had a history of bilateral orchi-opexy in infancy. Preoperative ultrasonography did not detect the undescended testis. Intraopera-tively, orchiectomy was performed following urology consultation, and the TAPP procedure was completed successfully. The postoperative course was uneventful, and pathology revealed an atrophic testis without malignancy. This case highlights the importance of preoperative suspicion and the benefits of the laparoscopic approach in managing such coexisting pathologies in adults.

Gastrointestinal stromal tumors (GISTs) represent the most prevalent mesenchymal neoplasms of the gastrointestinal (GI) tract, typically originating in the stomach (60%) and small intestine (30%). Among the segments of the small intestine, the jejunum is a relatively uncommon site for GIST occurrence. The coexistence of GISTs in patients with a prior history of breast cancer is exceedingly rare, and poses a unique diagnostic and therapeutic challenge due to the possibility of metastatic disease versus a second primary tumor. We present the case of a 55-year-old female with a prior diagnosis of breast carcinoma, who was incidentally found to have a jejunal mass during routine oncologic surveillance. Radiological and endoscopic evaluations raised suspicion for a submucosal tumor, which was subsequently confirmed as a jejunal GIST via histopathological and immunohistochemical analysis following surgical resection. The patient underwent curative segmental jejunal resection with negative margins and had an uneventful postoperative recovery. Risk assessment based on size and mitotic index placed the tumor in a low-risk category, and no adjuvant therapy was deemed necessary. This case highlights the importance of considering GISTs in the differential diagnosis of incidental small bowel masses, especially in patients with a history of malignancy, and underscores the role of complete surgical excision in achieving curative outcomes.