Background: While prostate-specific membrane antigen (PSMA)-targeted imaging has revolutionized metastatic detection, unspecific bone uptake (UBU)—particularly in the ribs—is a common but diagnostically challenging finding in prostate cancer (PCa) patients. This review aims to synthesize current evidence on PSMA-avid rib lesions in PCa and to propose a structured approach for differentiating true metastases from benign mimics. Methods: A comprehensive literature search across PubMed, EMBASE, Scopus, and Web of Science identified relevant studies on PSMA imaging interpretation, tracer-specific patterns, rib lesion morphology, and clinical correlates. Data on uptake intensity, CT features, lesion number, location, tracer type, patient-specific risk factors, and follow-up behavior were extracted and analyzed. Results: Most solitary rib lesions are benign, particularly in low-risk patients or when located in the anterior/lateral arcs. Metastatic lesions are more likely to present as multiple foci, show cortical destruction on CT, exhibit high uptake intensity, and occur in patients with elevated PSA, high Gleason score, or ongoing androgen deprivation. ¹⁸F-PSMA-1007 is especially prone to UBU in the ribs compared to ⁶⁸Ga-PSMA-11. Based on these variables, we propose a clinical decision tree to guide interpretation of PSMA-avid rib lesions. Conclusions: Accurate interpretation of rib lesions on PSMA PET/CT requires a multimodal, context-sensitive approach. Our diagnostic decision tree guides precise differentiation of benign versus metastatic rib lesions, enhancing staging accuracy and clinical decision-making. Biomarker-guided therapies offer potential for personalized treatment, though rib-specific validation remains a critical need.

Introduction and importance: Shoulder dystocia is a rare but serious obstetric emergency that can cause severe complications for both mother and baby. Rapid and effective intervention is crucial to avoid adverse outcomes. Case presentation: A 38-year-old woman with gestational diabetes and a history of two cesarean sections presented at 38 weeks and 6 days of gestation in labor. Despite risk factors for shoulder dystocia, vaginal delivery was attempted. After the head delivered, the fetal shoulder became impacted. Standard maneuvers, including McRoberts, suprapubic pressure, and the “All Fours” position, failed to resolve the dystocia. Ultimately, the Zavanelli maneuver was performed, returning the fetal head to the uterus, followed by an emergency cesarean section. The infant was born with a low Apgar score, requiring resuscitation and NICU admission, but was discharged in good condition after ten days, with no signs of Erb’s palsy. Clinical discussion: This case emphasizes the importance of anticipating shoulder dystocia in high-risk patients and being prepared for advanced interventions. Although the Zavanelli maneuver is rarely performed due to its technical difficulty and associated risks, it can be life-saving when executed promptly by an experienced team. Conclusion: This report demonstrates the successful use of the Zavanelli maneuver after all other methods failed. Timely and skilled application of this maneuver can prevent devastating complications and underscores the need for preparedness and training in managing severe shoulder dystocia.

Rapid and accurate identification of Leishmania species is important for the diagnosis and epidemiological surveillance of cutaneous leishmaniasis (CL). High-resolution melting (HRM) analysis has emerged as a rapid molecular approach for species discrimination. This study aimed to preliminarily evaluate a quantitative real-time PCR coupled with HRM (qPCR-HRM) assay targeting kinetoplast minicircle DNA (kDNA) for differentiation of Leishmania major and Leishmania tropica in northeastern Iran. A qPCR-HRM assay targeting the kDNA region was developed using species-specific primers. Clinical samples from 60 patients with suspected CL in North Khorasan and Razavi Khorasan provinces were examined microscopically and cultured. DNA extracted from cultured promastigotes was analyzed using qPCR-HRM, and the results were compared with conventional PCR and ITS1-rDNA sequencing. In addition, ITS1-rDNA sequence analysis was performed to evaluate the genetic diversity of L. major isolates. Among the 60 suspected CL samples, 13 were positive by molecular analysis. qPCR-HRM successfully differentiated reference strains of L. major and L. tropica based on distinct melting temperature profiles, with a mean ΔTm of approximately 0.86 °C (L. major: 84.13 °C; L. tropica: 83.27 °C). All clinical isolates were identified as L. major by qPCR-HRM and confirmed by ITS1 sequencing, showing complete agreement between the two methods. ITS1-rDNA analysis of the 13 L. major isolates identified nine sequence types and seven haplotypes. The qPCR-HRM assay demonstrated promising performance for rapid differentiation of L. major and L. tropica under the conditions evaluated in this study. However, further validation using larger numbers of direct clinical specimens representing both species is required before routine diagnostic application.

Background: Pulmonary arterial hypertension (PAH) is a critical complication in patients undergoing hemodialysis (HD) and may lead to right heart failure. Vascular endothelial growth factor (VEGF), a key mediator of angiogenesis and endo thelial function, has been implicated in PAH pathogenesis. This study aimed to investigate the relationship between serum VEGF levels and other clinical variables with PAH in HD patients. Methods: This study involved 76 patients from 3 HD centers. Pulmonary artery pressure (PAP) was assessed using Doppler echocardiography, and serum VEGF levels were measured using the enzyme-linked immunosorbent assay method. Patients were categorized into two groups: normal PAP (<30 mmHg) and PAH (≥30 mmHg). Pulmonary arterial hypertension severity was further classified as mild, moderate, or severe. Statistical analyses, including proportional tests and regression models, were used to compare variables across groups. Results: No significant correlation was observed between VEGF levels and PAH (P = .5237). However, hemoglobin (Hb levels showed a significant association with PAH (P = .045). Systolic blood pressure (BP) was identified as a potential factor influencing PAH severity (P = .009). Conclusion: While VEGF does not appear to directly influence PAH severity, other factors such as lower hemoglobin levels and higher systolic BP may contribute to the risk and progression of PAH in HD patients. These findings highlight the mul tifactorial nature of PAH in this population and underscore the need for further research to identify additional risk factors and therapeutic targets. Cite this article as: Saeed M, Saber A, Mohammadi-Jorjafki SM, Ghanean G. Association between VEGF levels and pulmonary artery pressure in hemodialysis patients: A descriptive-analytical study on related variables. Turk J Nephrol. 2026;35(1):62-66.