Michał Kusiński

Background: Blunt liver traumatic injuries are associated with high mortality and remain a significant challenge for modern healthcare systems. The aim of this study was to identify early clinical predictors of mortality in patients undergoing surgery for blunt liver injury. Material and Methods: A single-centre, retrospective observational study was conducted involving 27 adult patients who underwent surgery between 2013 and 2025 due to blunt liver injury (traffic accidents, falls from height). Clinical parameters such as GCS and shock index (SI) were correlated with the degree of injury according to the AAST OIS and WSES classifications and with the length of hospitalisation (LOS) using Spearman’s rank correlation coefficient. The study was approved by the Bioethics Committee (resolution number: RNN/86/25/KE). Results: Traffic accident victims predominated in the analysed group (81.5%). Deep consciousness disorders (GCS; ρ = −0.65) were shown to be the strongest negative predictor of survival—all deaths occurred in patients with a baseline GCS = 3. A strong positive correlation was also observed between the risk of death and the anatomical level of injury according to the AAST OIS (ρ = 0.70) and shock assessed using the SI (ρ = 0.50). Half of the patients who underwent surgery received packing (tamponade), while 51.8% underwent splenectomy. Conclusions: The GCS is the strongest independent clinical predictor of death in this group. Simple neurological and haemodynamic assessment is more useful in practice for quickly identifying critically ill patients than complex anatomical classifications such as AAST or WSES.

Adrenal tumors with unenhanced attenuation of 11–20 Hounsfield units (HU) are indeterminate on noncontrast computed tomography (CT). This interval is clinically relevant because it usually triggers additional biochemical, radiological, and multidisciplinary assessment rather than an immediate decision to operate or observe. We evaluated the pathology-confirmed histological spectrum of resected adrenal lesions across guideline-consistent attenuation categories, with particular focus on the 11–20 HU grey zone. We retrospectively reviewed 383 adults who underwent minimally invasive adrenalectomy between 2022 and 2025. Unenhanced CT attenuation values were recorded in 202 cases; two necrotised-tissue cases were excluded from the HU-based histology analysis. The final analytic cohort comprised 200 tumors classified as ≤ 10 HU, 11–20 HU, or > 20 HU. The primary outcome was final histopathology grouped as benign lesion, pheochromocytoma/paraganglioma (PPGL), metastasis, or primary malignant lesion. Clinical background was reviewed for the five non-benign 11–20 HU lesions. Exploratory multivariable logistic regression evaluated non-benign versus benign histology. The final cohort included 82 tumors with ≤ 10 HU, 44 with 11–20 HU, and 74 with > 20 HU. In the 11–20 HU group, histology was benign in 39/44 lesions (88.6%), PPGL in 3/44 (6.8%), metastasis in 1/44 (2.3%), and adrenocortical carcinoma in 1/44 (2.3%). Non-benign pathology increased from 4.9% at ≤ 10 HU to 11.4% at 11–20 HU and 33.8% at > 20 HU. In multivariable analysis, > 20 HU was associated with non-benign histology compared with ≤ 10 HU (odds ratio [OR] 10.0, 95% confidence interval [CI] 3.18–31.30), whereas 11–20 HU was not independently associated with a statistically significant increase (OR 2.81, 95% CI 0.69–11.50). Larger tumor size was also associated with non-benign histology (OR 1.30 per cm, 95% CI 1.09–1.56). Most resected adrenal tumors in the 11–20 HU grey zone were benign, but this interval still contained clinically important non-benign pathology. These findings should be interpreted as surgical-cohort data, not as prevalence estimates for true adrenal incidentalomas. Intermediate attenuation should be used as a prompt for integrated biochemical, imaging, oncological, and multidisciplinary assessment rather than as an isolated indication for adrenalectomy.

Introduction: The analysis of exercise tolerance and physical capacity plays a crucial role in the assessment of recovery and rehabilitation after surgery.Aim: The aim of the study was to assess physical capacity, exercise tolerance prior to and on day 2 after adrenalectomy on the basis of the six-minute walk test (6MWT) and Borg scale.Material and methods: The cohort study included 100 patients with adrenal tumors divided into the study group (SG,n = 50) and control group (CG, n = 50) who underwent adrenalectomy. SG patients met the criterion of inclusion: coexistingcardiovascular, respiratory, or other chronic diseases. The inclusion criteria for CG were the absence of other chronic systemiccomorbidities, age < 65 years. The 6MWT distance and Borg scale ratings (performed the day prior to and on the secondday after surgery) were analyzed according to the age, sex, comorbidities, adrenal and tumor size, hormonal type of adrenaldisease, type of surgery, and occurrence of postoperative complications.Results: Patients from SG covered significantly shorter distances (487.76 46.72 m in SG and 539.82 17.59 m in CG; p<0.001) anddemonstrated a higher level of exertion (p<0.001) before adrenalectomy and more often discontinued 6MWT after surgeries(p = 0.001) compared to CG. The authors confirmed a significant negative correlation between the age of the patients and sixminute walk distance (6MWD) before the operation in the study (rs = –0.40, p = 0.004) and control (rs = –0.74, p<0.001) groups.A significant decrease in the postoperative 6MWT distance (SG: to 231.35 4192 m, CG: to 236.82 54.10 m) and increasedintensity of dyspnea and fatigue according to the Borg scale were confirmed. SG patients were significantly more likely todevelop postoperative complications (p = 0.002).Conclusions: 6MWT is a useful tool to demonstrate physical capacity in patients before and after adrenalectomy. Patients with comorbidities more frequently discontinued 6MWT after surgery and had lower tolerance of physical effort compared to CG patients before and after surgery.

Pancreatic cancer is a severe disease, challenging to diagnose and treat, and thereby characterized by a poor prognosis and a high mortality rate. Pancreatic ductal adenocarcinoma (PDAC) represents approximately 90% of pancreatic cancer cases, while other cases include neuroendocrine carcinoma. Despite the growing knowledge of the pathophysiology of this cancer, the mortality rate caused by it has not been effectively reduced. Recently, microRNAs have aroused great interest among scientists and clinicians, as they are negative regulators of gene expression, which participate in many processes, including those related to the development of pancreatic cancer. The aim of this review is to show how microRNAs (miRNAs) affect key signaling pathways and related cellular processes in pancreatic cancer development, progression, diagnosis and treatment. We included the results of in vitro studies, animal model of pancreatic cancer and those performed on blood, saliva and tumor tissue isolated from patients suffering from PDAC. Our investigation identified numerous dysregulated miRNAs involved in KRAS, JAK/STAT, PI3/AKT, Wnt/β-catenin and TGF-β signaling pathways participating in cell cycle control, proliferation, differentiation, apoptosis and metastasis. Moreover, some miRNAs (miRNA-23a, miRNA-24, miRNA-29c, miRNA-216a) seem to be engaged in a crosstalk between signaling pathways. Evidence concerning the utility of microRNAs in the diagnosis and therapy of this cancer is poor. Therefore, despite growing knowledge of the involvement of miRNAs in several processes associated with pancreatic cancer, we are beginning to recognize and understand their role and usefulness in clinical practice.

Background: Amiodarone-induced thyrotoxicosis (AIT) may pose treatment challenges. We present a series of patients in which we achieved the normalisation of free T3 (FT3) using intravenous methylprednisolone (ivMP) in AIT refractory to thiamazole and oral prednisone. Namely, in three males (aged 56, 50 and 64, all with a history of AF and/or a low ejection fraction), an addition of ivMP resulted in the normalisation of FT3, which allowed successful thyroidectomy. In another case of a 65-year-old man, we initially succeeded in the normalisation of FT3 using ivMP from FT4 > 7.77 ng/dL (0.93–1.7) to 2.41 ng/dL and in that of FT3 from 14.95 pg/mL (2–4.4) to 2.05 pg/mL), but four weeks after stopping ivMP, despite the continuation of thiamazole and prednisone, there was rebound thyrotoxicosis: FT4 > 7.77 ng/dL and FT3—5.46 pg/mL. Intravenous MP was restated leading to a decline in FT4 to 2.51 ng/dL and in FT3 to 1.92 pg/mL, thus allowing a successful thyroidectomy. Finally, in a 78-year-old man with AF, goitre, and AIT resistant to thiamazole, prednisone and lithium carbonate, we obtained a reduction in FT4 to 1.51 ng/dL and in FT3 to 3.17 pg/mL after seven pulses of ivMP. Oral prednisone was gradually reduced and successfully stopped about six months later. He remained on low-dose thiamazole (5 mg od). Conclusions: Pulse ivMP in addition to oral steroids may be a useful adjunct therapy either for the preparation of a thyroidectomy or as a treatment modality in drug-resistant AIT. Though a total cure is possible, there is a danger of a rebound worsening of thyrotoxicosis after premature discontinuation of ivMP.

Thyroid carcinoma is the primary endocrine malignancy worldwide. The preoperative examination of thyroid tissue lesion is often unclear. Approximately 25% of thyroid cancers cannot be diagnosed definitively without post-surgery histopathological examination. The assessment of diagnostic and differential markers of thyroid cancers is needed to improve preoperative diagnosis and reduce unnecessary treatments. Here, we assessed the expression of RASSF1A, DIRAS3, and AKAP9 genes, and the presence of BRAF V600E point mutation in benign and malignant thyroid lesions in a Polish cohort (120 patients). We have also performed a comparative analysis of gene expression using data obtained from the Gene Expression Omnibus (GEO) database (307 samples). The expression of RASSF1A and DIRAS3 was decreased, whereas AKAP9’s was increased in pathologically changed thyroid compared with normal thyroid tissue, and significantly correlated with e.g., histopathological type of lesion papillary thyroid cancer (PTC) vs follicular thyroid cancer (FTC), patient’s age, tumour stage, or its encapsulation. The receiver operating characteristic (ROC) analysis for the more aggressive FTC subtype differential marker suggests value in estimating RASSF1A and AKAP9 expression, with their area under curve (AUC), specificity, and sensitivity at 0.743 (95% CI: 0.548–0.938), 82.2%, and 66.7%; for RASSF1A, and 0.848 (95% CI: 0.698–0.998), 54.8%, and 100%, for AKAP9. Our research gives new insight into the basis of the aggressiveness and progression of thyroid cancers, and provides information on potential differential markers that may improve preoperative diagnosis.