Background: Acute malignant colorectal obstruction requires urgent management, traditionally by emergency resection or stoma formation. Colonic stenting as a bridge to surgery (BTS) has emerged as an alternative, but concerns persist regarding oncologic safety. This systematic review evaluates short-term and long-term outcomes of BTS with self-expanding metal stents (BTS-stent) compared with acute resection (AR). Methods: A systematic review was conducted on multiple databases. PubMed, Cochrane Library, and Google Scholar were searched for studies published between 2015 and 2025 reporting surgical management of obstructive colon cancer. Outcomes included perioperative morbidity and mortality, laparoscopic conversion, stoma formation, stent-related complications, and long-term overall survival (OS) and disease-free survival (DFS). Data were synthesized descriptively with reference to reported comparative effects and prior meta-analyses. Results: Fifteen studies published between 2015 and 2025 were included, encompassing 6999 patients (AR: 4944; BTS-stent: 1739; other BTS: 311). BTS was associated with higher rates of laparoscopic surgery (57% vs. 14%) and primary anastomosis, and significantly reduced stoma formation (27% vs. 60%). Postoperative morbidity and 30-day mortality were lower or comparable in BTS cohorts (4.9% vs. 7.8%). SEMS technical success ranged from 78 to 97%, with perforation rates of 0–15%, representing the main adverse event. Long-term outcomes were comparable between groups. Five-year OS ranged from 46 to 75% (BTS) and 46 to 74% (AR), with similar DFS. Subgroup data suggested possible worse outcomes in T4 tumors and improved results in selected stage III patients. Delayed surgery (>4 weeks) may improve survival, but increases complication risk. Conclusions: BTS with SEMS improves short-term outcomes without compromising long-term survival. Careful selection and avoidance of perforation are essential.

Hexavalent chromium, a widespread heavy metal, induces apoptosis via the mitochondrial pathway through Bax (pro-apoptotic) and Bcl2 (anti-apoptotic) proteins. Hypericum perforatum, rich in antioxidants, can neutralise free radicals. This study investigated the effects of CrVI on the pancreas and the protective role of Hypericum perforatum. Five groups of animals were used: control, Cr (CrVI for 3 months), CrH (CrVI + 2.5% Hypericum perforatum extract made from flowers, for 3 months), Cr2 (CrVI for 3 months + distilled water for 1 month), and CrH2 (CrVI for 3 months + Hypericum perforatum extract for 1 month). Samples were collected for histological analysis, gene expression (qRT-PCR), and blood glucose level analysis. CrVI exposure (Cr, Cr2) caused pancreatic damage: oedema, reduced islet size, endocrine cell vacuolisation, and endothelial swelling. Lesions were milder in CrH, while CrH2 resembled the control group. The Bax/Bcl2 ratio increased under CrVI (highest in Cr2), indicating apoptosis, but decreased toward control values in CrH and CrH2. Blood glucose levels confirmed these findings. CrVI proved toxic to the endocrine pancreas, inducing structural and molecular alterations that impaired carbohydrate metabolism. Administration of Hypericum perforatum extract reduced these effects, confirming its antioxidant action and potential as a protective agent against CrVI-induced oxidative stress.

Background/Objectives: Diabetic macular edema (DME) are major causes of visual impairment worldwide, with vascular endothelial growth factor (VEGF) playing a central role in disease pathogenesis. Intravitreal anti-VEGF therapy is the current standard of care for center-involving DME. Methods: This narrative review summarizes and compares the pharmacological properties, clinical efficacy, safety, and real-world performance of aflibercept and brolucizumab in the treatment of DME, based on randomized controlled trials and observational studies published between 2014 and 2025. Results: Both agents demonstrate significant improvements in visual acuity and retinal anatomy. Brolucizumab has shown non-inferior visual outcomes and, in several studies, greater reductions in central retinal thickness with the potential for extended dosing intervals, suggesting reduced treatment burden. However, post-marketing data have identified an increased risk of intraocular inflammation, including retinal vasculitis and retinal vascular occlusion, associated with brolucizumab, which has influenced its clinical use. Conclusions: Both aflibercept and brolucizumab are effective anti-VEGF therapies for diabetic macular edema, but they differ in durability and safety considerations. Aflibercept remains a reliable first-line option for many patients, while brolucizumab may be considered in carefully selected cases where treatment burden is a priority. Individualized treatment selection based on clinical characteristics, patient preferences, and safety considerations is essential for optimizing long-term outcomes.

Background: Gastric cancer (GC) remains a global health challenge, with high mortality rates often linked to late-stage diagnosis. Novel, non-invasive biomarkers are urgently needed to improve the detection and prognosis of this malignant pathology. This study aimed to evaluate the diagnostic and prognostic utility of serum Cluster of Differentiation 276 (CD276) and Dickkopf Related Protein 3 (DKK3) in patients with GC. Methods: In this case–control study, serum levels of CD276 and DKK3 were quantified in 40 GC patients and 40 age-matched healthy controls. The diagnostic performance of each marker and their combination was assessed using Receiver Operating Characteristic (ROC) curve analysis. Correlations between biomarker levels and clinicopathological features were evaluated using Spearman’s correlation. The Kaplan–Meier method and the Cox Proportional Hazards Regression Model were used to assess survival. Results: Serum CD276 levels were found to be significantly elevated in GC patients compared to healthy controls (median 60.06 vs. 18.71 units, p < 0.001). Conversely, serum DKK3 levels were significantly suppressed in the GC group (median 92.47 vs. 121.02 units, p < 0.001). In ROC analysis, CD276 demonstrated excellent diagnostic accuracy as a standalone biomarker (AUC: 0.836). DKK3 showed independent diagnostic value (AUC: 0.792), but adding DKK3 to CD276 did not provide statistically significant incremental benefit (DeLong’s p = 0.443). Survival analysis was underpowered due to limited events and short follow-up duration. Conclusions: In patients with predominantly locally advanced gastric cancer, CD276 can be a primary diagnostic marker, and the addition of DKK3 does not demonstrate a statistically significant improvement but may provide complementary information. Performance in early-stage disease requires validation in future studies. The opposing dysregulation of these markers, reflecting immune checkpoint activation (CD276) and tumor suppressor loss (DKK3), provides a robust and synergistic noninvasive signature. To assess the prognostic value of these two markers, studies involving a larger number of patients and a longer follow-up period are needed.

Clinical decision-making constitutes the core of medical practice, representing a synthesis of objective biomedical data and subjective human judgment). This article explores this process through the dual lenses of diagnostic test sensitivity and specificity, and concepts that guide the physician in balancing the imperative not to miss a serious condition against the duty to avoid undue harm or labeling of the healthy. Beyond this technical-statistical framework, the paper provides a profound analysis of the psychological dimensions—including decision-making pressure and uncertainty management—and the bioethical foundations—autonomy, beneficence, non-maleficence, and justice—that underpin every significant medical choice. Through an explicit examination of four major bioethical approaches (principist-integrative, narrative and person-centered, distributed responsibility, and the ethics of uncertainty and proportionality) and supported by detailed clinical case studies, we argue that optimal clinical decision-making is a holistic enterprise. It requires the seamless integration of scientific rigor, empathetic communication, psychological resilience, and conscious ethical practice. The article also engages with contemporary challenges such as artificial intelligence, resource allocation, and time pressure, concluding that the soul of the profession lies in this ceaseless integration, transforming protocol into compassion, data into wisdom, and technique into true human care.