Batuhan Ayhan

Background: Malignant Fibrous Histiocytoma (MFH), reclassified as undifferentiated pleomorphic sarcoma (UPS) in the 2013 World Health Organization (WHO) classification, is a high-grade pleomorphic sarcoma of mesenchymal origin. It is the most common soft-tissue sarcoma in late adulthood, predominantly affecting males aged 40-80. Surgical resection remains the cornerstone of treatment, while radiotherapy (RT) and chemotherapy (CT) are used selectively to improve local control and survival. This study evaluated the prognostic impact of surgical margin status and adjuvant treatments.Methods: This retrospective study evaluated 57 patients with MFH/UPS (31 males, 26 females) treated and followed between 1994 and 2022. All patients underwent surgical intervention, and those developing local recurrence were treated with second or third surgical procedures when feasible. Surgical margin status (R0, R1, R2) and its association with local recurrence and distant metastasis were analyzed.Results: Negative surgical margins (R0 resection) achieved during the initial surgery were strongly associated with improved local disease control. Positive surgical margins (R1/R2) were significantly associated with the development of lung metastases. Repeated surgeries and adjuvant therapies were insufficient to compensate for inadequate initial surgical margins.Conclusions: Achieving wide, margin-negative resection at the initial surgical intervention is the most critical determinant of oncologic outcome in MFH/UPS. While RT and CT may provide adjunctive benefits in selected cases, optimal surgical management remains the key factor for long-term disease control.

Background: This study aimed to quantify public interest in platelet-rich plasma (PRP) and stem cell injections for hip and knee osteoarthritis (OA) in Türkiye using the Google Trends (GT) tool, and to characterize temporal, seasonal, geographic, and regional trends across the country's seven geographic regions. Methods: GT parameters were configured from January 2015 through December 2025, with geographic filtering restricted to Türkiye (geo=TR). Turkish-language search terms corresponding to PRP/knee, PRP/hip, stem cell/knee, and stem cell/hip OA were queried. Relative search volume (RSV) data were retrieved and analyzed using linear regression models. Seasonal means, city-level comparisons, and regional analyses across Türkiye's seven geographic regions were performed. Results: PRP-related searches demonstrated a significant linear increase across all models (R²=0.93–0.94; p < 0.001), with the PRP·Knee model exhibiting the steepest growth slope (+6.31 RSV/year). Conversely, stem cell searches declined following a 2015–2016 peak (R²=0.87–0.89). Seasonally, October represented the peak month for search interest, while January marked the trough. Geographically, the Marmara Region recorded the highest PRP RSV (94), and Eastern Anatolia the lowest (45). Western Türkiye demonstrated a 1.7-fold higher mean PRP RSV compared to Eastern Türkiye. Conclusions: Public interest in PRP is rising steadily across Türkiye, whereas interest in stem cell therapy is declining, likely reflecting regulatory restrictions and an expectation-evidence gap. These findings provide actionable data for patient counseling, shared decision-making, and the prioritization of future clinical research.

Aims: Chondrosarcoma is the second most common primary malignant bone tumor. Despite growing research output, a comprehensive citation analysis of the most influential original research articles has not been published. This study aimed to identify and characterize the 100 most-cited original research articles on chondrosarcoma and to evaluate scientific productivity, citation impact, collaboration patterns, and emerging research trends.Methods: A bibliometric analysis was conducted using the Web of Science (WoS) Core Collection database. A topic search (TS) was applied with the term “chondrosarcoma.” Inclusion was restricted to original research articles published in English in journals indexed within the Science Citation Index expanded (SCIE). Articles were further filtered to include only those with “chondrosarcoma” in the title. The 100 most-cited articles were identified and sorted by total WoS Core citation count. Descriptive statistics were performed with Microsoft Excel (Microsoft, Redmond, WA, USA). Network visualization analyses were conducted using VOSviewer (version 1.6.20; Leiden University, Leiden, Netherlands).Results: The initial search retrieved 9,806 publications; 6,305 remained after applying Article, English, and SCIE filters. Of these, 464 articles had “chondrosarcoma” in the title, from which the 100 most-cited were selected. These articles accumulated 6,763 total citations, with a mean of 67.6 per article (range: 37-542).Conclusion: To our knowledge, this is the first top 100 citation-ranked bibliometric analysis of original research articles with “chondrosarcoma” in the title. The field has undergone a marked paradigm shift from descriptive clinicopathology toward molecular oncology and targeted therapy, particularly signaling pathway research and non-coding RNA biology. These findings provide a structured reference for researchers and clinicians navigating the chondrosarcoma literature.

Aims: Large language models (LLMs) have demonstrated promising performance in medical examinations; however, their effectiveness in orthopedics-particularly in visually demanding questions-remains unclear. This study aimed to compare the performance of ChatGPT-5.2 and Gemini 3 Pro on orthopedics and traumatology questions from the Turkish Medical Specialization Examination (TUS).Methods: A total of 7.200 TUS questions from 2006 to 2021 were screened, and 163 orthopedics-related questions with validated answer keys were included. Questions were categorized into seven subspecialties and classified as text-based (n=154) or visual (n=9). Each question was independently presented to both models in Turkish without prior prompting. Responses were recorded as correct or incorrect. Statistical analyses included the McNemar test for paired comparisons and Fisher’s exact test for within-model comparisons of visual versus text-based performance.Results: ChatGPT-5.2 achieved an accuracy of 93.3% (152/163), while Gemini 3 Pro achieved 92.0% (150/163), with no statistically significant difference between models (p=0.593). Both models showed higher error rates on visual questions than on text-based questions (ChatGPT-5.2: 44.4% vs. 4.5%, p=0.001; Gemini 3 Pro: 33.3% vs. 6.5%, p=0.025); however, these visual comparisons were based on only nine items and should be regarded as exploratory. Error distribution across subspecialties was similar between models, with orthopedic trauma showing the highest error frequency.Conclusion: Both ChatGPT-5.2 and Gemini 3 Pro demonstrated high overall accuracy in orthopedic examination questions, with no significant difference between models. However, both models exhibited a marked decline in performance on visually based questions, highlighting persistent limitations in multimodal reasoning. Future research should incorporate larger visual datasets to better evaluate AI performance in orthopedic contexts.

Central chondrosarcoma is the second most common primary malignant bone tumour, and grade progression markedly worsens prognosis. The contributions of lipid metabolic reprogramming and epigenetic co-dysregulation to grade progression remain poorly characterised. We integrated a bulk RNA-seq discovery cohort of 53 graded central chondrosarcomas (GSE299759) with a single-cell analysis of eight chondrosarcomas (GSE184118). Because the atypical cartilaginous tumour (ACT) and dedifferentiated groups each comprised only three samples, the Grade 3 versus Grade 2 contrast was pre-specified as the primary comparison. Curated panels of 44 lipid metabolism genes and 50 epigenetic regulators were assessed by differential expression and a correlation-based connectivity ranking, evaluated by permutation testing. In the primary Grade 3 versus Grade 2 comparison, SQLE, ACACA, and FASN were upregulated (FDR < 0.05), indicating a grade-associated increase in de novo lipogenesis. In the exploratory Grade 3 versus ACT comparison, additional lipid genes (HMGCR, LDLRAP1) and the epigenetic regulators EHMT2 and SIRT2 showed altered expression, although the small ACT group limits these estimates. A connectivity ranking highlighted FASN, KMT2C, TET2, SETD5, and KDM5B; permutation testing confirmed this co-expression structure was non-random (p < 0.0001). Single-cell analysis showed FASN, SETD5, and KDM5B are expressed predominantly in malignant cells, whereas KMT2C and TET2 are not, indicating cell-type heterogeneity. De novo lipogenesis upregulation is the most consistent lipid alteration in high-grade central chondrosarcoma, nominating SQLE, ACACA, and FASN as candidates for experimental investigation.

Background: Megaprosthetic reconstruction is the standard of care for limb salvage after tumor resection around the knee, but the full burden of unplanned revision surgery is rarely reported as a structured composite outcome. We evaluated 241 consecutive patients over 21 years at a tertiary orthopedic oncology center. Methods: This retrospective cohort included 241 patients (160 distal femur, 78 proximal tibia, three combined) treated between 2003 and 2024. Revision-free survival (RFS, composite of any unplanned revision or amputation) and amputation-free survival were estimated by Kaplan–Meier analysis; independent predictors were identified by Cox regression. A pre-specified major-event composite (amputation, implant removal, or recurrence resection) was used for sensitivity analysis. Results: Mean age was 34.9 ± 19.5 years; mean follow-up was 120.2 months. Negative resection margin (R0) was achieved in 85.5% (206/241). Unplanned revision was required in 25 patients (10.4%); overall limb salvage was 92.9%. Five-year RFS was 73.8% (distal femur) vs. 65.0% (proximal tibia; p = 0.084), and 5-year limb salvage was 88.9% vs. 84.3% (p = 0.081). Surgical margin was strongly associated with outcome: 5-year RFS 75.4% (R0) vs. 48.7% (R1/R2; p < 0.001); 5-year limb salvage 90.6% vs. 71.5% (p = 0.003). On exploratory multivariate Cox analysis, proximal tibia site and positive margin were associated with worse revision-free survival; within the proximal tibia subgroup, absence of gastrocnemius flap coverage was also associated with worse outcome (interpreted with caution given the small flap subgroup, n = 11, and limited event count). Conclusions: In this single-center series, megaprosthetic reconstruction around the knee achieved acceptable revision-free survival and limb salvage. Surgical margin status was the strongest independent predictor of both endpoints, reinforcing the well-established importance of oncologic margin quality and site-specific soft tissue strategies.

Objective: Patients increasingly seek health-related information through artificial intelligence (AI)-based chatbots. However, the reliability and clinical quality of chatbot-generated patient information remain uncertain. This study aimed to evaluate the quality and reliability of chatbot-generated responses to frequently asked patient questions regarding benign bone tumors using a structured assessment model. Methods: This descriptive and methodological study comprised twenty patient-centered commonly asked questions formulated by three fellowship-trained orthopedic oncology specialists. The inquiries encompassed diagnosis, treatment, complications, follow-up, and lifestyle-related issues pertaining to prevalent benign bone tumors. The responses produced by ChatGPT-5.2 were assessed separately by three independent orthopedic oncology specialists who had no role in formulating the questions. The quality of the response was evaluated using the Quality Analysis of Medical Artificial Intelligence (QAMAI) methodology, encompassing accuracy, clarity, relevance, completeness, citation of sources and references, and utility. Each parameter was evaluated using a five-point Likert scale. The intraclass correlation coefficient (ICC) was employed to assess interobserver reliability. Results: The greatest scores were observed in accuracy (mean score 4.27), but completeness (3.19) and the provision of sources and references (3.03) displayed somewhat lower values. The overall QAMAI score was 21.39 out of 30, reflecting good response quality consistent with the validated scoring range of 18–23 points. Interobserver agreement demonstrated good reliability for total QAMAI scores (ICC = 0.84; 95% CI: 0.74–0.91). The subdomain ICC values ranged from moderate to good agreement. Conclusion: Chatbot-generated responses provide accurate and useful preliminary information on benign bone tumors. However, shortcomings in completeness and reliance on evidence-based citations indicate that chatbot outputs should be employed under the oversight of a physician. AI chatbots can aid in patient education but cannot replace clinical decision-making processes.