Atef A. Hassan

Robotic-assisted bronchoscopy (RAB) and computed tomography–guided transthoracic biopsy (CTTB) are competing strategies for sampling peripheral pulmonary lesions (PPLs). Whether they differ in yield or safety is uncertain. To our knowledge, this is the first systematic review restricted to direct comparisons. We searched MEDLINE, Europe PMC, Scopus, Web of Science and ClinicalTrials.gov from inception to 7 July 2026 for studies directly comparing RAB with CTTB in adults with PPLs. The primary outcome was strict 2024 American Thoracic Society/American College of Chest Physicians diagnostic yield. Risk of bias was assessed with ROBINS-I and certainty with GRADE. A cohort-genealogy step identified, per outcome, the largest set of cohorts sharing no patients; only that set was pooled, with Hartung–Knapp and Mantel–Haenszel sensitivity analyses. Five retrospective studies from one US health system were eligible. Four share patients; at most three cohorts are mutually independent. Across those three, diagnostic yield was comparable (risk ratio [RR] 0.99, 95% confidence interval [CI] 0.93–1.06; I²=24%; Hartung–Knapp 0.87–1.13), with an identical relative effect under strict and intermediate definitions although absolute yields fell from 88% to 74–84% under strict criteria. Pneumothorax requiring a chest tube and/or admission was about three-quarters less frequent with RAB across all three cohorts (RR 0.25, 95% CI 0.14–0.46; I²=0%; Hartung–Knapp 0.07–0.96). Strict yield (RR 0.99) and any pneumothorax (RR 0.06) were reported by two cohorts each and neither survives the few-studies correction. RAB took about 50 min longer than CTTB where same-session staging endobronchial ultrasound was counted in the robotic time, but only about 8 min longer than CTTB where it was not. Only one cohort reported yield by lesion size category and none reported yield by bronchus sign or lung zone, so lesion-level subgroups could not be pooled. Certainty was low for pleural complications and very low elsewhere. Low-certainty evidence indicates that RAB is associated with fewer pleural complications, with no statistically detectable difference in diagnostic yield; equivalence was not formally established. Because all evidence is retrospective, confined to one health system, and almost never stratified by lesion size or accessibility, these findings are hypothesis-generating and require a multicenter randomized trial.

Objective: To evaluate the preliminary safety, feasibility, and short‐term outcomes of the autologous transobturator fascia lata sling for female SUI to our knowledge the first series using fascia lata via a transobturator route, in view of the mesh‐related complications of synthetic midurethral slings and the limitations of rectus fascia harvest in women with prior abdominal surgery, central obesity, or scarred fascia. Methods: Prospective single‐arm pilot feasibility and safety study of 40 women with SUI or stress‐predominant mixed urinary incontinence (MUI) who underwent autologous transobturator fascia lata sling at Al‐Azhar University Hospitals (June 2023 to May 2025; NCT05646745). Outcomes were assessed at 24 h, 2 weeks, and 3 months using the cough stress test, ICIQ‐FLUTS questionnaire, and VAS pain scores. Results: Mean age was 48.9 ± 7.8 years; BMI 31.4 ± 4.1 kg/m ² . At 3 months, the overall success rate (cured + improved) was 87.5%, and the objective cure rate (negative cough stress test) was 72.5%. ICIQ‐FLUTS incontinence score decreased from 12.75 ± 3.41 to 3.23 ± 2.91 ( p < 0.001, Cohen's d = 2.79); incontinence QOL from 35.88 ± 5.83 to 4.50 ± 7.22 ( p < 0.001, d = 5.38). No voiding dysfunction, sling erosion, or major complications occurred. Grade I incontinence achieved 100% success. Thigh and groin pain resolved by 3 months in 92.5% and 100%, respectively. Conclusion: This preliminary exploratory study suggests that autologous transobturator fascia lata sling is a feasible and promising mesh‐free technique for female SUI with favorable short‐term outcomes at 3 months. These results must be interpreted cautiously given the small sample size, short follow‐up, and absence of a control group. Longer follow‐up, multicenter validation, and randomized comparative studies are warranted. Trial Registration: ClinicalTrials.gov : NCT05646745

Septic obstructing ureteral stones are a time-critical urological emergency. Although urgent drainage is recommended, uncertainty persists regarding the comparative effectiveness of decompression strategies and the influence of timing in real-world practice. We analyzed adults with sepsis or septic shock and obstructing ureteral stones (n = 9,172) from the U.S. HCUP National Inpatient Sample (2016-2022). Exposures included any decompression (ureteral stent or percutaneous nephrostomy [PCN]) versus conservative care, and decompression timing (same-day [day 0] vs. ≥ day 1; ≤ 24 h vs. > 24 h). The primary outcome was in-hospital mortality; secondary outcomes were acute kidney injury (AKI), mechanical ventilation, dialysis, and length of stay. Adjusted associations were estimated using propensity score matching, overlap weighting, instrumental variable (IV) analysis, and landmark/time-dependent survival models with a prespecified 12-variable adjustment set. Overall mortality was 2.5%. Decompression was associated with lower mortality than conservative care (1.6% vs. 4.0%; risk difference - 2.4% [95% CI - 3.2 to - 1.7]; number needed to treat ≈ 41). Late decompression (> 24 h) versus early (≤ 24 h) was associated with higher odds of mortality (OR 2.17 [1.38-3.41]), AKI, ventilation, and dialysis. In exploratory analyses among decompressed patients, PCN showed higher adjusted mortality than stenting (5.5% vs. 2.8%; OR 2.05 [1.31-3.09]); IV results were directionally consistent but likely reflect residual confounding by indication and feasibility. Urgent decompression, particularly within 24 h, was associated with lower in-hospital mortality and fewer organ-failure outcomes. Modality differences should be interpreted as hypothesis-generating; PCN remains essential when retrograde stenting is not feasible.

Distal tibial fractures are challenging to manage owing to limited soft-tissue coverage and compromised blood supply. Minimally invasive plate osteosynthes

Background: Deep learning (DL) is increasingly applied to arthroscopic video for instrument recognition, anatomical segmentation, and intraoperative event detection. The performance, architectures, and real-time feasibility of these systems remain incompletely characterized. This systematic review aimed to evaluate the performance, architectures, and real-time feasibility of DL for classification, segmentation, and detection in arthroscopic video interpretation. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020, PubMed/ MEDLINE, Ovid, and the Cochrane Library were searched (February 2025), supplemented by artificial intelligence-assisted queries (Elicit, Undermind). Eligible studies applied DL to arthroscopy for classification, segmentation, or detection with quantitative performance and/or inference speed. Two reviewers independently screened, extracted, and assessed quality using Quality Assessment of Diagnostic Accuracy Studies-2; the protocol was registered in International Prospective Register of Systematic Reviews. Results: Six studies met inclusion criteria (knee = 2, shoulder = 2, wrist = 1, non-site-specific bleeding = 1). Classification achieved high accuracy for instrument recognition (up to 99.1%, sensitivity = 0.988) and bleeding- frame detection (95.8%, sensitivity = 97.3%). Segmentation was strongest for large bony structures (Dice 0.79-0.89) and weakest for deformable tissues (meniscus Dice = 0.48). U-Net variants (U-Net++, DeepLab v3+) predominated with frequent transfer learning. Two studies achieved real-time inference (15-60 frames per second). Risk of bias was high across all studies. Conclusion: Based on 6 heterogeneous studies, DL appears technically feasible for arthroscopic image interpretation, particularly instrument classification and osseous segmentation, though findings should be interpreted as preliminary. No study evaluated impact on surgical decision-making or patient outcomes, and none was deployed prospectively in live surgery. Translation will require multicentre datasets, standardized reporting, and prospective evaluation against clinically meaningful endpoints. Cite this article as: Lasslett C, Reddy R, Giritharan G, et al. Deep learning for real-time image interpretation in arthroscopy: a systematic review of classification, segmentation, and detection tasks. Eurasian J Med. 2026, 58(4), 1415, doi: 10.5152/ eurasianjmed.2026.261415.

Primary-directed local therapy (PDLT) in de novo metastatic prostate cancer remains controversial. Evidence from randomized trials supports benefit in low-volume disease, but the influence of metastatic phenotype and treatment timing is unclear. We conducted a population-based target trial emulation to evaluate the effect of PDLT timing on overall survival and identify factors associated with early therapy. Using SEER 18 registries (2010-2022), we identified 16,740 men with de novo metastatic prostate adenocarcinoma and complete metastatic site data. Patients were classified by metastatic phenotype (bone-only, lung-only, liver ± others, brain ± others, polymetastatic). We emulated a target trial comparing early PDLT (≤ 6 months), deferred PDLT (6-12 months), and no PDLT, using a clone-censor-weight approach with stabilized inverse probability of censoring weights. Weighted Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall survival. Subgroup analyses evaluated effect modification by metastatic phenotype and by treatment modality, with additional sensitivity analyses stratified by diagnosis era. Logistic regression identified predictors of early PDLT receipt. Overall, 31.0% received PDLT within 12 months (early: 29.3%, deferred: 0.3%). Early and deferred PDLT were associated with statistically significant but very small relative survival differences (HR 0.96, 95% CI 0.93-1.00; HR 0.97, 95% CI 0.94-0.99); the absolute difference at 36 months was 0.16 months (≈ 5 days) for early PDLT. Benefits were confined to bone-only disease (early HR 0.93, 95% CI 0.90-0.97), whereas early PDLT was associated with worse outcomes in lung-only (HR 1.45, 95% CI 1.10-1.91) and liver ± others (HR 1.14, 95% CI 1.02-1.28). The 36-month RMST gain attributed to deferred PDLT (1.72 months) is statistically significant but should be considered exploratory given the very small subgroup size (n = 52). Younger age, lower PSA, brain involvement, and more recent diagnosis predicted early PDLT. PDLT in bone-only metastatic prostate cancer was associated with a small relative survival difference of uncertain clinical relevance. Associations with worse outcomes in visceral metastatic phenotypes likely reflect residual confounding by indication and should not be interpreted as causal harm. Metastatic phenotype may add to existing volume-based stratification rather than replace it. Findings concerning the deferred-PDLT subgroup are exploratory and require prospective validation.

Children with congenital and acquired heart disease (CAHD) are at high risk for venous thromboembolism (VTE). Traditional anticoagulants such as vitamin K antagonists (VKAs) and low-molecular-weight heparin (LMWH) present challenges in pediatrics due to burdensome administration, frequent monitoring, and adherence issues. Direct oral anticoagulants (DOACs) have transformed adult anticoagulation, but their role in pediatric CAHD remains uncertain. To evaluate the efficacy and safety of DOACs compared with standard-of-care (SOC) anticoagulation in pediatric patients with CAHD. We systematically searched PubMed, Scopus, Web of Science, and Embase through July 1, 2025. Eligible studies included RCTs comparing DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) with VKAs, LMWH, or aspirin in patients < 18 years with CAHD. Relative risks (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Prespecified subgroup analyses were performed for children with congenital heart disease (CHD). Four RCTs, including 732 patients, were analyzed. In the overall population (patients with congenital and acquired heart disease), DOACs significantly reduced thromboembolic events compared to standard-of-care anticoagulation (RR = 0.42, 95% CI: 0.18–0.97; p = 0.04). In the prespecified congenital heart disease (CHD) subgroup, a trend toward reduced events was observed but did not reach statistical significance (RR = 0.29, 95% CI: 0.06–1.29). Individual thromboembolic outcomes (stroke, pulmonary embolism, deep vein thrombosis, and intracardiac thrombus) were rare, with no significant differences between DOAC and control groups in either the overall population or the CHD subgroup (all p > 0.05). Regarding safety, major bleeding rates were similar between DOAC and control groups in the overall population (RR = 0.91, 95% CI: 0.25–3.35) and the CHD subgroup (RR = 1.36, 95% CI: 0.06–32.65). Clinically relevant non-major bleeding was also comparable between DOAC and control groups overall (RR = 0.62, 95% CI: 0.23–1.68) and in the CHD subgroup (RR = 0.75, 95% CI: 0.19–2.49). DOACs seem to be effective and safe for thromboprophylaxis in pediatric patients with CAHD. They reduce the risk of thromboembolism without increasing bleeding complications. The online version contains supplementary material available at 10.1186/s12959-026-00850-z.