George Ionuț Golea

Background/Objectives: Microfracture remains the most widely used first-line procedure for focal chondral defects of the knee, but its fibrocartilaginous repair deteriorates over time. This review asked whether adding an orthobiologic or scaffold to marrow stimulation changes clinical, structural or safety outcomes compared with isolated marrow stimulation, by augmentation type. Methods: PubMed, Scopus and the Cochrane Library (January 2016 to July 2026) and ClinicalTrials.gov were searched for randomized and non-randomized comparative studies with at least 12 months of follow-up (PROSPERO CRD420261484998, registered retrospectively). Risk of bias was assessed with RoB 2 and ROBINS-I; findings were synthesized without meta-analysis (SWiM) by effect direction, exploratory sign tests and unpooled standardized mean differences, and certainty was rated with GRADE. Results: Fifteen studies (six randomized; 630 patients; follow-up 12 months to 10 years) were included. Across augmentation types, the point estimate for function favored augmentation in eight out of nine independent evidence sources (p = 0.039) but not when the four unclassifiable studies were counted as unfavorable (8 of 13; p = 0.58), and clinically important IKDC differences occurred only in non-randomized cohorts. A structural advantage was statistically supported in two out of ten studies, in one only on a group-by-time interaction. Further surgery occurred mainly after isolated marrow stimulation, but events were few, and harms were inconsistently reported. Conclusions: Effects differ by augment and should not be generalized to augmentation as a class. Type I/III collagen membranes may improve patient-reported function, and cellular or autologous tissue products, chiefly adipose-derived, may improve pain and symptoms (low certainty); effects on structure, reoperation and safety are very uncertain. Adequately powered randomized trials of each augment are needed.

Background/Objectives: Breast cancer management relies on multidisciplinary team (MDT) decisions that integrate clinical, radiological, pathological, and patient-related factors. Large language models (LLMs) may support such decisions, but evidence based on real-world cases remains limited. Methods: We evaluated the agreement between ChatGPT-5.5 (OpenAI, San Francisco, CA, USA) and real MDT management of patients with invasive breast cancer. In this single-center, retrospective, proof-of-concept study, standardized preoperative clinical vignettes for 86 patients with invasive breast carcinoma were independently evaluated by GPT-5.5 (frozen prompt, Medium reasoning mode, Web Search enabled). AI-generated recommendations were compared with the MDT reference standard across eight therapeutic domains (four surgical, four non-surgical), yielding 688 individual decisions. Agreement was summarized descriptively and with Cohen’s κ. Results: GPT-5.5 produced complete recommendations for all vignettes. Overall concordance was 90.8% (625/688). Agreement was highest for endocrine therapy, radiotherapy, and targeted therapy (100% each) and for axillary surgery (93.0%, κ = 0.86), and lowest for breast reconstruction (80.2%), oncoplastic surgery (82.6%) and neoadjuvant chemotherapy (83.7%). Surgical concordance was 85.8% (295/344). Discordances occurred predominantly in individualized surgical decisions; none were observed for endocrine therapy, radiotherapy, or targeted therapy. Conclusions: GPT-5.5 showed high overall concordance with real MDT decisions, particularly for guideline-driven systemic therapy, but was less reliable for individualized surgical planning. These findings should be regarded as exploratory and cannot be assumed to be generalizable across institutions or clinical settings. LLMs should complement, not replace, multidisciplinary expertise; prospective multicenter validation is warranted.

Background/Objectives: Sodium butyrate, a short-chain fatty acid produced by gut microbial fermentation of dietary fiber, has attracted increasing interest as a potential adjunctive therapy for ulcerative colitis (UC) because of its anti-inflammatory, barrier-protective, and immunomodulatory properties. This systematic review aimed to evaluate the current clinical and preclinical evidence regarding the efficacy and mechanisms of sodium butyrate in UC. Methods: A systematic review was conducted in accordance with the PRISMA 2020 guidelines and registered in PROSPERO (CRD420261437741). PubMed/MEDLINE, Scopus, Web of Science, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched from February through April 2026. Eligible clinical and experimental studies investigating oral or rectal administration of sodium butyrate in UC or experimental colitis were included. Risk of bias was assessed using RoB 2, ROBINS-I, or the SYRCLE tool according to study design. Results: Twenty-two studies were included, comprising ten clinical trials, one prospective observational study and eleven preclinical animal studies. In adults diagnosed with UC, oral sodium butyrate, particularly microencapsulated formulations, demonstrated encouraging effects as an adjunct to standard therapy by improving clinical remission rates, quality of life and reducing disease activity and inflammatory biomarkers. Evidence in pediatric inflammatory bowel disease remained inconsistent. Studies evaluating rectal sodium butyrate enemas reported variable clinical efficacy despite evidence of local biological activity. Preclinical studies consistently demonstrated reduced intestinal inflammation, improved epithelial barrier integrity, modulation of oxidative stress, favorable alterations of the gut microbiota, and regulation of several mechanistic pathways identified across individual preclinical studies, including PI3K/AKT/mTOR, WNT/ERK, ERK/STAT3, autophagy and ferroptosis. Conclusions: Current evidence suggests that sodium butyrate represents a promising adjunctive therapeutic strategy for UC, supported by consistent mechanistic findings and encouraging clinical results, particularly with oral formulations. However, the available clinical evidence remains heterogeneous, and larger, well-designed randomized controlled trials with standardized formulations and treatment protocols are required before its routine clinical implementation can be considered.

Background and Clinical Significance: Malignant melanoma with primary or metastatic intestinal involvement is a rare entity, often diagnosed late and associated with severe complications such as bowel obstruction and perforation. Differential diagnosis of primary intestinal lymphoma may be challenging in the absence of an identifiable primary lesion. Case Presentation: We report the case of a 35-year-old male with no significant medical history who was admitted for persistent abdominal symptoms. Contrast-enhanced abdominal CT revealed a giant circumferential jejunal mass (109/147/156 mm) causing marked luminal stenosis and mesenteric lymphadenopathy, initially raising suspicion of primary intestinal lymphoma. The patient subsequently developed upper intestinal obstruction and severe anemia (Hb 5.5 g/dL), requiring an emergency exploratory laparotomy. Intraoperatively, a voluminous unresectable tumor extending to the mesenteric root was identified, and a feeding jejunostomy was performed. The postoperative course was complicated by tumor perforation and generalized peritonitis, necessitating reoperation. Histopathological examination established the diagnosis of malignant melanoma, with no identifiable primary site, which is most consistent with metastatic melanoma (MUP). PET-CT staging demonstrated metastatic disease (mesenteric, retroperitoneal and supraclavicular lymph nodes, as well as subcutaneous nodules), consistent with a stage IV disease. Molecular analysis revealed a BRAF V600E mutation. Combined immunotherapy (Nivolumab + Ipilimumab) was initiated, resulting in a partial radiological response after three cycles. Conclusions: Intestinal involvement by malignant melanoma might mimic other gastrointestinal malignancies and be the cause of a delayed diagnosis and severe surgical complications. Multidisciplinary management is essential, and modern immunotherapy offers promising outcomes even in advanced-stage disease.

Background/Objectives: Intestinal malignant melanoma is a rare entity, most commonly presenting as metastatic disease from a cutaneous primary source. The distinction between primary and secondary intestinal melanoma remains challenging, yet it has important diagnostic, therapeutic, and prognostic implications. This study aims to highlight the diagnostic difficulties and therapeutic considerations associated with intestinal melanoma. Methods: A narrative literature review was conducted using the PubMed database, only including articles published between January 2015 and December 2025. Case reports, case series, and reviews that described primary-like (i.e., presumed primary) or metastatic small bowel melanoma were considered eligible. Extracted data consisted of clinical presentation, diagnostic workup, histopathological and immunohistochemical features, treatment strategies, and outcomes. Results: Twenty articles met the inclusion criteria, comprising ten reporting primary intestinal melanoma and ten reporting metastatic intestinal melanoma. Primary-like intestinal melanoma was frequently solitary, amelanotic, and occurred in patients without a prior history of melanoma, whereas metastatic disease was usually multifocal and associated with a known cutaneous primary source. Clinical manifestations were nonspecific, most frequently including anemia, gastrointestinal bleeding, abdominal pain, or intestinal obstruction. Immunohistochemistry confirmed melanocytic origin in each case, but could not reliably differentiate primary from metastatic disease. Surgical resection remained the cornerstone of treatment, with systemic therapy reserved primarily for metastatic cases. Conclusions: Diagnosis of primary intestinal melanoma relies on excluding other primary sites through comprehensive clinical and imaging evaluations. Early detection using advanced endoscopic techniques and multidisciplinary management are vital for optimizing outcomes. While metastatic intestinal melanoma carries a poor prognosis, complete surgical resection of primary lesions has been associated with improved outcomes in selected patients.

Background/Objectives: Mesenchymal tumors of the gastrointestinal tract are rare and can pose significant diagnostic challenges, particularly when located in atypical sites such as the sigmoid colon. Gastrointestinal stromal tumors (GISTs) are often the primary consideration based on imaging findings; however, other spindle cell neoplasms, such as schwannomas, must also be considered. We present a case of a sigmoid colon schwannoma initially suspected to be a GIST and provide a literature review on the diagnostic and therapeutic challenges associated with these tumors. Methods: A literature review based on articles from 2015 to 2024 was conducted to identify cases of mesenchymal tumors of the colon misdiagnosed as GISTs. The review focused on the role of imaging, endoscopic biopsy, and immunohistochemistry in differentiating these neoplasms. Additionally, treatment approaches, including surgical resection versus targeted therapy, were assessed. Results: The literature review revealed that GISTs and schwannomas share overlapping imaging characteristics, including submucosal location, hyperintensity on T2-weighted MRI, and contrast enhancement. However, immunohistochemical markers remain the gold standard for differentiation. Studies also highlighted the increasing role of minimally invasive diagnostic techniques, such as fine-needle aspiration and molecular profiling, in achieving a definitive preoperative diagnosis. Unlike GISTs, which often require adjuvant therapy with tyrosine kinase inhibitors, schwannomas are typically treated with surgical excision alone, with a low risk of recurrence. Conclusions: Current evidence supports a multimodal diagnostic approach combining imaging, biopsy, and immunohistochemistry to accurately classify mesenchymal tumors of the colon. While imaging can suggest a probable diagnosis, histopathological confirmation is essential before initiating targeted therapy.

Background: Emesis is an essential survival response, because consumption of food is a key element in the survival behavior and the act of feeding can expose the majority of internal organs to toxins, altered food, viruses, bacteria or fungi. The relationship between visceral or vestibular stimuli and the anatomical structures of the brain-gut axis explain the modulation of the gastrointestinal response. We aimed to review comprehensively the current knowledge on emesis occurring in the disorders of brain-gut interaction (DBGI), i.e. functional conditions presenting with emesis. Methods: PubMed, Cochrane Library, EMBASE and WILEY databases were screened for relevant publications from the last 20 years regarding brain-gut disorders manifesting emesis. We included in the search also idiopathic gastroparesis, as a condition paralleling the postprandial distress syndrome. Results: We critically analyzed 2 articles about chronic nausea and vomiting syndrome, 9 articles about cyclic vomiting syndrome, 9 articles about cannabinoid hyperemesis, 10 articles about idiopathic gastroparesis and 6 articles about gastroparesis like-syndrome. Contradictory results regarding the implication of environmental factors in the development of emesis in DBGI demonstrate that the underlying pathogenesis is still not completely understood.