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SUMMARY OBJECTIVE: The aim of this study was to evaluate the effects of age and duration of sexual abstinence on semen parameters in normozoospermic men and to explore their relative contributions within physiologically normal ranges. METHODS: This retrospective study included 412 normozoospermic men defined according to World Health Organization 2010 criteria. Semen volume, sperm concentration, and motility parameters were analyzed. Participants were stratified by age and abstinence duration. Correlation analyses and multivariate linear regression models were performed. RESULTS: Increasing age was modestly associated with lower total and progressive motility and a higher proportion of immotile sperm. Longer sexual abstinence duration was associated with higher sperm concentration. The proportion of explained variance was modest but consistent across analyses. CONCLUSION: These findings suggest that age and sexual abstinence duration are associated with selected semen parameters in normozoospermic men. The observed age-related differences in the associations with sexual abstinence and semen parameters warrant further investigation in larger, prospective studies before age-specific abstinence recommendations can be considered.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the relationship between intrapartum rectovaginal distance measured by transperineal ultrasonography and obstetric anal sphincter injury severity and second-stage labor duration in nulliparous women undergoing vaginal delivery. METHODS: This prospective cohort study was conducted at a tertiary referral center in Istanbul, between September 2021 and January 2022. Of 200 consecutive nulliparous women with singleton pregnancies at ≥37 weeks’ gestation, 148 who underwent vaginal delivery were included in the primary analysis. Intrapartum rectovaginal distance was measured in the midsagittal plane by 2D transperineal ultrasonography using a single operator during the inter-contraction rest period, at a fetal head station ranging from -1 to +1. Angle of progression and levator ani anteroposterior diameter were also recorded. Obstetric injury was graded per American College of Obstetricians and Gynecologists 2016 criteria; grade 3–4 laceration (severe obstetric anal sphincter injury) was the primary outcome. RESULTS: Severe obstetric anal sphincter injury occurred in 18 vaginal deliveries (12.2%). Rectovaginal distance was significantly shorter in women with severe obstetric anal sphincter injury (6.91±1.33 mm vs. 9.94±2.75 mm, p<0.001). Second-stage duration was longer with severe obstetric anal sphincter injury (125.8±6.5 vs. 91.3±18.0 min, p<0.001). Receiver operating characteristic analysis identified an rectovaginal distance cut-off of 8.1 mm (AUC=0.846; sensitivity 88.9%, specificity 80.8%). On multivariate logistic regression, rectovaginal distance (OR 0.516, 95%CI 0.373–0.713) and body mass index (OR 1.280, 95%CI 1.078–1.521) were independently associated with severe obstetric anal sphincter injury. CONCLUSION: Intrapartum rectovaginal distance measurement by transperineal ultrasonography is a noninvasive, readily obtainable parameter that independently predicts severe obstetric anal sphincter injury and may support individualized intrapartum risk stratification. Multicenter validation with larger samples is warranted.

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SUMMARY OBJECTIVE: Sepsis is a life-threatening condition characterized by dysregulated host responses to infection and high mortality in intensive care units. Existing prognostic models are often complex or resource-intensive. The blood urea nitrogen-to-albumin ratio, reflecting renal function, metabolic stress, and nutritional status, has emerged as a potential prognostic biomarker. The aim of this study was to evaluate the predictive value of blood urea nitrogen-to-albumin ratio for 28-day mortality in septic intensive care unit patients. METHODS: This retrospective cohort study utilized data from the Medical Information Mart for Intensive Care IV (version 2.0) database. Adult patients meeting Sepsis-3 criteria were included. Suspected infection was defined by antibiotic administration and microbiological culture within 24 h. Demographic, clinical, and laboratory data were collected, and blood urea nitrogen-to-albumin ratio was calculated using values obtained within the first 24 h of intensive care unit admission. Receiver operating characteristic curve analysis, Kaplan-Meier survival analysis, and multivariate Cox regression were performed. RESULTS: A total of 6,940 patients were included, with a 28-day mortality rate of 21.6%. Blood urea nitrogen-to-albumin ratio demonstrated superior predictive performance (area under the curve (AUC)=0.647, 95%CI 0.631–0.664) compared with serum urea (AUC=0.634) and albumin (AUC=0.428), and also outperformed the Sequential Organ Failure Assessment score (AUC=0.613). The optimal cutoff value was 7.6. Patients with blood urea nitrogen-to-albumin ratio ≥7.6 had significantly higher mortality than those with lower values (p<0.001). Elevated blood urea nitrogen-to-albumin ratio remained an independent predictor of mortality after adjustment. CONCLUSION: Blood urea nitrogen-to-albumin ratio is a simple, objective, and readily available biomarker associated with 28-day mortality in septic intensive care unit patients and may contribute to risk stratification when used alongside other clinical parameters.

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SUMMARY OBJECTIVE: Sex estimation is a fundamental component of forensic identification when DNA analysis is not feasible. Because cranial morphology and sexual dimorphism vary among populations, population-specific standards are required. However, occipital bone morphometric data for Turkish adults remain limited. Therefore, the aim of this study was to evaluate the reliability of occipital bone measurements obtained from cranial computed tomography for sex estimation in Turkish adults. METHODS: Three-dimensional cranial computed tomography images of 384 individuals (192 females, 192 males), aged 18–65, obtained between 01/01/2010 and 31/12/2021, were retrospectively analyzed. Nine anatomical distances on the occipital bone were measured, and their discriminative roles in sex estimation were assessed using logistic regression analysis. Additionally, inter-observer agreement was evaluated by comparing measurements from two independent observers. RESULTS: The combined analysis of all measurements yielded a sex prediction accuracy of 82.8% for females and 80.2% for males. Foramen magnum width, occipital condyle length, occipital condyle width, and external occipital protuberance depth were identified as the most discriminative variables. A model combining these four variables achieved classification accuracies of 83.3% for females and 79.2% for males, with an overall accuracy of 81.3%. The full model including all nine measurements showed an overall accuracy of 81.5%. High intra- and inter-observer agreement was observed. CONCLUSION: Computed tomography-based morphometric analysis of the occipital bone is a reliable method for sex estimation in forensic medicine. These results support the development of population-specific reference data for the Turkish population.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the scientific quality, reliability, and educational value of YouTube videos on Vaginal Natural Orifice Transluminal Endoscopic Surgery using structured assessment tools. METHODS: This cross-sectional study analyzed 20 YouTube videos on Vaginal Natural Orifice Transluminal Endoscopic Surgery identified using the keywords "Vaginal Natural Orifice Transluminal Endoscopic Surgery," "Vaginal Natural Orifice Transluminal Endoscopic Surgery hysterectomy," "vaginal natural orifice endoscopic surgery," and "transvaginal NOTES." Two obstetrics and gynecology specialists independently evaluated the videos using the Global Quality Scale, modified DISCERN, and Journal of the American Medical Association benchmarks. Analyses included non-parametric group comparisons, Spearman correlation, multiple linear regression, and intraclass correlation coefficient analysis. RESULTS: The median number of views was 2,565 (interquartile range: 13,322). The mean Global Quality Scale, modified DISCERN, and Journal of the American Medical Association scores were 4.17±0.94, 3.95±0.84, and 2.65±0.93, respectively. Inter-rater agreement was moderate for Global Quality Scale and modified DISCERN and good for Journal of the American Medical Association. A statistically significant difference by channel type was observed only for modified DISCERN scores. Although Global Quality Scale scores were moderately correlated with likes (ρ=0.565, p=0.009), multiple linear regression showed no independent association between popularity or technical quality variables and quality scores (p>0.05). CONCLUSION: Vaginal Natural Orifice Transluminal Endoscopic Surgery videos on YouTube may provide valuable educational content; however, popularity metrics do not reflect scientific reliability. Video selection for surgical education should be based on structured quality assessment tools rather than view count alone.

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SUMMARY OBJECTIVE: Attention-deficit hyperactivity disorder is a neurodevelopmental disorder associated with metabolic and neuropeptidergic processes. Gastrin-releasing peptide and neuromedin B, which are bombesin-like peptides, have been studied only to a limited extent in adult attention-deficit hyperactivity disorder, despite their role in energy homeostasis and central nervous system function. The aim of this study was to evaluate gastrin-releasing peptide and neuromedin B levels in untreated adult attention-deficit hyperactivity disorder patients and to examine their relationship with clinical symptom severity. METHODS: This cross-sectional study included 55 untreated adult attention-deficit hyperactivity disorder patients and 32 healthy controls. Attention-deficit hyperactivity disorder diagnoses were confirmed using SCID-5/CV and DIVA 2.0, and symptom severity was assessed using the Adult Attention-Deficit Hyperactivity Disorder Self-Report Scale. Gastrin-releasing peptide and neuromedin B levels in fasting serum were measured using the ELISA method. Group comparisons, Pearson correlations, hierarchical regression, and receiver operating characteristic analyses were performed. RESULTS: Gastrin-releasing peptide (22.83±24.18 pg/mL) and neuromedin B (1.83±2.86 pg/mL) levels were significantly lower in the attention-deficit hyperactivity disorder group compared to the control group (p=0.004 and p=0.037, respectively). Gastrin-releasing peptide and neuromedin B levels were negatively correlated with Attention-Deficit Hyperactivity Disorder Self-Report Scale total and subscale scores (p<0.001 for all). In regression analyses, gastrin-releasing peptide was an independent predictor of Attention-Deficit Hyperactivity Disorder Self-Report Scale total score (β=-0.642, p=0.024). In receiver operating characteristic analyses, gastrin-releasing peptide (AUC=0.746) and neuromedin B (AUC=0.719) showed significant performance in distinguishing attention-deficit hyperactivity disorder. CONCLUSION: The findings suggest that gastrin-releasing peptide, in particular, may be associated with clinical symptom severity in adult attention-deficit hyperactivity disorder and is a potential biomarker candidate.

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SUMMARY OBJECTIVE: Artificial intelligence tools are increasingly used to provide individualized feedback in medical education. The aim of this study was to compare the quality of feedback generated by ChatGPT and Gemini during scenario-based clinical reasoning activities. METHODS: A convergent mixed-methods study was conducted with 32 medical interns randomly assigned to ChatGPT (n=16) or Gemini (n=16). Following a virtual patient interview on iron deficiency anemia, artificial intelligence-generated feedback was evaluated by interns and medical education specialists using an 11-item rubric assessing clarity, accuracy, structure, identification of strengths and weaknesses, contribution to clinical reasoning, and overall educational value. Quantitative data were analyzed using descriptive statistics and Mann-Whitney U tests, while qualitative data were examined through content analysis. RESULTS: Interns rated ChatGPT slightly higher than Gemini (1.80±0.20 vs. 1.75±0.26), whereas specialists reported similar scores (1.91±0.06 vs. 1.87±0.10). No statistically significant differences were identified (p>0.05). Both systems were perceived as clear, supportive, and constructive; however, insufficient patient-centeredness emerged as a common limitation of both artificial intelligence systems. Qualitative findings indicated that ChatGPT provided more structured and reflective feedback, whereas Gemini offered more concrete examples. Common limitations included insufficient patient-centeredness, lack of systematicity, and occasional unrealistic statements. CONCLUSION: ChatGPT and Gemini generated educationally useful feedback for scenario-based clinical reasoning activities. Although artificial intelligence tools cannot replace expert supervision, they may support personalized learning and reduce faculty workload when used under human oversight.

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SUMMARY OBJECTIVE: Subacute granulomatous thyroiditis is a self-limited inflammatory disorder and the most common cause of painful thyroid disease. Surgically treated cases offer a unique opportunity to explore its histopathological spectrum and co-occurring thyroid pathologies. METHODS: We retrospectively analyzed 44 thyroidectomy specimens diagnosed with subacute granulomatous thyroiditis between 2009 and 2019, evaluating clinical data and detailed histopathological features including inflammation extent and associated thyroid lesions. RESULTS: The cohort comprised 36 females and 8 males (mean age 48.1±8.9 years). Preoperative fine-needle aspiration cytology was performed in 68.2% but correctly suggested subacute granulomatous thyroiditis in only one case. Surgery was most indicated for multinodular goiter (63.6%). All cases exhibited confluent folliculocentric granulomas; additional findings included fibrosis (90.9%), neutrophilic infiltration (63.6%), follicular atrophy (63.6%), and perineural inflammation (63.6%). Coexisting follicular nodular disease was present in 88.6% and chronic lymphocytic thyroiditis in 15.9%. Concomitant malignancy was identified in 13 cases (29.5%), predominantly subcentimeter papillary thyroid carcinomas, with no significant clinicopathological associations (p>0.05). CONCLUSION: Subacute granulomatous thyroiditis demonstrates broader pathological significance than traditionally recognized. Perineural inflammation may contribute to pain generation, and the elevated malignancy rate most likely reflects incidental detection due to extensive sampling. These findings highlight diagnostic pitfalls and underscore the importance of careful pathological assessment.

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SUMMARY BACKGROUND: The clinical course of hospitalized children with overweight has been scarcely investigated. Previous studies suggest that these children experience longer hospital stays and greater weight loss than their normal-weight peers, potentially compromising lean body mass and immune function. OBJECTIVE: The aim of this study was to investigate the association between nutritional status at hospital admission and hospital length of stay, and to compare weight loss trajectories between children with overweight and those with normal weight. METHODS: This prospective study included 125 hospitalized children and adolescents aged 2–14 years. Anthropometric measurements and sociodemographic and clinical data were collected. Associations with hospital length of stay were assessed using multiple Poisson regression, and weight loss trajectories were analyzed using analysis of covariance. RESULTS: Of the 125 participants, 56.8% were male, and 29.6% had overweight. Asthma was the most common reason for hospitalization (25.6%). Children with overweight had a 25% longer hospital stay than those with normal weight. Among children with overweight, each additional day of hospitalization was associated with a mean weight loss of 0.20 kg (95%CI 0.14–0.26) and a 0.04-unit decrease in body mass index-for-age z-score (95%CI 0.01–0.06). CONCLUSION: Overweight at hospital admission was associated with a longer hospital stay and progressive weight loss during hospitalization.

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SUMMARY OBJECTIVE: Sexual dysfunction has not been investigated in women with anti-synthetase syndrome. The aim of this study was to determine the prevalence of sexual dysfunction in women with anti-synthetase syndrome compared with healthy controls (CTR), to evaluate associated clinical factors, and to assess the effect of cognitive behavioral therapy on sexual function and related outcomes. METHODS: This single-center study included a cross-sectional evaluation conducted between March and August 2023 and a prospective interventional phase. Thirty-three women with anti-synthetase syndrome and 31 CTR were included. Sexual function, sexual distress, quality of life, fatigue, depression, body image, physical activity, and disease-related parameters were assessed using validated questionnaires. Multivariate logistic regression was used to identify factors independently associated with sexual dysfunction. Patients with anti-synthetase syndrome and sexual dysfunction were invited to participate in group-based cognitive behavioral therapy, with up to 90 days’ follow-up. RESULTS: Groups were comparable with respect to age and marital status. Sexual dysfunction prevalence was significantly higher in the anti-synthetase syndrome group than in CTR (81.8 vs. 51.6%; p=0.016). Anti-synthetase syndrome was independently associated with sexual dysfunction (OR 4.11; 95%CI 1.20–15.78). Within the anti-synthetase syndrome cohort, patients with and without sexual dysfunction were similar across most variables, except for prednisone use, which occurred only in patients with sexual dysfunction. Six patients completed cognitive behavioral therapy, showing improvements in sexual distress, sexual function—particularly arousal—and fatigue at 90 days. CONCLUSION: Sexual dysfunction is highly prevalent in women with anti-synthetase syndrome and appears intrinsically associated with the disease. Cognitive behavioral therapy represents a promising non-pharmacological strategy to improve sexual function, distress, and fatigue in this population.

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SUMMARY BACKGROUND: Moral distress is defined as a psycho-emotional experience that occurs when individuals recognize the morally appropriate course of action but are unable to carry it out due to external constraints such as institutional hierarchies, organizational norms, or authority pressures. In medical education, this phenomenon is particularly frequent, given the deeply ethical nature of clinical decisions and patient care. OBJECTIVE: The aim of this study was to translate and adapt the Moral Distress from Professionalism Dilemmas checklist into Brazilian Portuguese. METHODS: The translation and cross-cultural adaptation process followed internationally recognized guidelines. It included independent translations by two professionals (one with and one without medical training), synthesis of the versions, back-translation, expert committee review, pretesting with 200 medical interns, and final evaluation. RESULTS: Of the 200 medical students invited, 160 (80%) completed the checklist, with no significant differences by year or gender. Depending on the item, between 0 and 57.5% of participants reported exposure to the professionalism dilemmas investigated. Among exposed students, the intensity of moral distress varied considerably across situations. CONCLUSION: Moral distress is a prevalent phenomenon in medical education. The adapted checklist demonstrated semantic and conceptual equivalence to the original and may serve as a valuable tool to identify, quantify, and understand moral distress among medical students in clinical training.

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SUMMARY OBJECTIVE: Accurate identification of the anatomical femoral head center is critical in total hip arthroplasty for optimal implant positioning and long-term survival. The Ranawat triangle method is widely used for this purpose, but its applicability may vary across populations. The aim of this study was to evaluate the accuracy and suitability of the Ranawat triangle method in estimating the anatomical femoral head center in a Turkish population. METHODS: Standardized anteroposterior pelvic radiographs of 260 non-fractured hips from 312 patients aged 60–90 were retrospectively analyzed. Pelvic height, pelvic width, and femoral head diameter were measured. The coordinates of the anatomical femoral head center were calculated anatomically and using the Ranawat triangle method. Deviations between the two were assessed in both axes, with <5 mm considered acceptable error. RESULTS: Anatomical femoral head center estimated by the Ranawat triangle method was positioned an average of 4.7±1.5 mm medially and 1.0±0.8 mm cranially in men, and 4.8±1.1 mm medially and 1.1±0.7 mm cranially in women, relative to the anatomical center. While 100% of Y-axis errors and 58.1% of X-axis errors were within 5 mm. Strong positive correlations were found between pelvic height and Cy (r=0.59), and pelvic width and Cx (r=0.82). CONCLUSION: The Ranawat triangle method method demonstrated excellent accuracy in predicting the vertical (Y-axis) position of the anatomical femoral head center but showed moderate lateral (X-axis) deviations in over 40% of cases. Despite its limitations in lateral offset prediction, it may serve as a practical reference method for preoperative planning, particularly for estimating the vertical position of the hip rotation center in Turkish total hip arthroplasty patients.

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SUMMARY OBJECTIVE: The aim of this study was to determine the effectiveness of micronutrient supplementation on female sexual desire levels. METHODS: For this systematic review and meta-analysis, studies were identified by searching the PubMed, Web of Science, ScienceDirect, Google Scholar, and Higher Education Council (YÖK) Thesis Center databases without any year restrictions. After screening, eight studies were included in the analysis. Data were synthesized using meta-analysis and narrative methods. RESULTS: In this systematic review and meta-analysis, micronutrient supplementation was associated with a statistically significant effect on women’s sexual desire (standardized mean difference: -0.597, 95%CI -1.126 to -0.068, Z=-2.211, p=0.027); however, substantial heterogeneity was observed (I2 =87.2%) indicating considerable variability across studies. CONCLUSION: This systematic review suggests a potential role for micronutrients, but the evidence is weak and highly inconsistent. High-quality, low-heterogeneity research is urgently needed.

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SUMMARY OBJECTIVE: The aim of this study was to investigate the association between partner hygiene behaviors, quantified using an exploratory partner hygiene score, and vaginitis subtypes, and to evaluate the relationship between baseline partner hygiene and short-term recurrence. METHODS: This prospective observational study included women aged 18–45 years presenting with vaginitis symptoms to a gynecology outpatient clinic. Vaginitis subtypes were diagnosed using standardized clinical and laboratory criteria. Partner hygiene behaviors were assessed using a seven-item partner hygiene score (range: 0–14). Participants were followed for 3 months to assess clinically confirmed symptomatic recurrence. Associations between partner hygiene score and vaginitis subtypes were analyzed cross-sectionally, while recurrence analyses were performed prospectively. RESULTS: A total of 108 women were included. Diagnoses included bacterial vaginosis (45.4%), vulvovaginal candidiasis (29.6%), Trichomonas vaginalis infection (10.2%), mixed vaginitis (11.1%), and non-specific vaginitis (3.7%). Median partner hygiene score scores were significantly lower in women with bacterial vaginosis and trichomoniasis compared with vulvovaginal candidiasis (p<0.001). Each one-point decrease in partner hygiene score was associated with higher odds of bacterial vaginosis. During follow-up, recurrence occurred in 33% of cases, but baseline partner hygiene score was not associated with recurrence. CONCLUSION: Lower partner hygiene scores were associated with dysbiosis-predominant vaginitis phenotypes, particularly bacterial vaginosis and trichomoniasis. Although no association was observed with short-term recurrence, these findings are hypothesis-generating and require confirmation in larger prospective studies.

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SUMMARY OBJECTIVE: The aim of this study was to determine the frequency of computed tomography performed despite a positive ultrasonography in histopathologically confirmed appendicitis (potentially avoidable computed tomography), and to assess its effects on radiation exposure, cost, and emergency department length of stay. METHODS: This single-center retrospective cohort study included 887 consecutive patients who underwent appendectomy for suspected appendicitis (January 2023–December 2025). Potentially avoidable computed tomography was defined as computed tomography following a positive ultrasonography result. As length of stay was non-normal, imaging strategies were compared using the Kruskal-Wallis test, and length of stay predictors were modeled using median (quantile) regression, with a log-link gamma generalized linear model as a sensitivity analysis. Imaging cost used national tariffs; radiation was estimated as ~8 mSv per abdominal computed tomography with age-specific BEIR VII multipliers. RESULTS: Computed tomography was used in 87.6% (777/887) of cases. Of the 521 patients who underwent ultrasonography, the results were positive in 35.5%, inconclusive in 30.7%, and negative in 33.8% of cases. Potentially avoidable computed tomography was performed in 81/777 computed tomography examinations (10.4%). Notably, 43.8% (81/185) of patients with positive ultrasonography results subsequently underwent computed tomography scan, corresponding to ~648 mSv of avoidable radiation exposure and an associated cost of 26,667 TL (~US$811), with 49.4% of the affected patients being children. Length of stay did not differ across strategies (p=0.748), and computed tomography was not an independent length of stay predictor (+7.2 min; p=0.23), whereas business-hour arrival was (+15.3 min; p<0.001). CONCLUSION: Computed tomography remained frequent even after ultrasonography established the diagnosis, with no effect on emergency department length of stay, generating avoidable radiation and costs concentrated in children. Reducing computed tomography after a positive ultrasonography is a feasible opportunity to improve resource utilization while preserving patient safety.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate the prognostic performance of the Rapid Emergency Medicine Score incorporating C-reactive protein for predicting 30-day mortality in patients with septic shock and to compare its performance with the Rapid Emergency Medicine Score, National Early Warning Score, Modified Early Warning Score, quick Sequential Organ Failure Assessment, and Sequential Organ Failure Assessment. METHODS: This retrospective observational study included 124 adult patients diagnosed with septic shock in a tertiary emergency department. Rapid Emergency Medicine Score incorporating C-reactive protein was calculated as Rapid Emergency Medicine Score +(C-reactive protein /50), using an a priori clinically determined C-reactive protein scaling factor. RESULTS: The median age was 63 years, 52.4% of patients were female, and 76 patients (61.3%) died within 30 days. Rapid Emergency Medicine Score incorporating C-reactive protein had the highest numerical AUC (0.770), corresponding to moderate discrimination, followed by National Early Warning Score (0.755), Modified Early Warning Score (0.746), quick Sequential Organ Failure Assessment (0.688), Rapid Emergency Medicine Score (0.638), and Sequential Organ Failure Assessment (0.593). Rapid Emergency Medicine Score incorporating C-reactive protein had significantly higher AUCs than Rapid Emergency Medicine Score (ΔAUC=0.132, p<0.001) and Sequential Organ Failure Assessment (ΔAUC=0.177, p=0.049), whereas differences compared with National Early Warning Score, Modified Early Warning Score, and quick Sequential Organ Failure Assessment were not statistically significant. In the Firth-penalized logistic regression model, Rapid Emergency Medicine Score incorporating C-reactive protein remained associated with 30-day mortality (OR per 1-point increase, 1.22; 95%CI 1.11–1.36; p<0.001). CONCLUSION: Rapid Emergency Medicine Score incorporating C-reactive protein showed moderate discrimination for 30-day mortality in this exploratory development cohort but did not demonstrate superior discrimination compared with National Early Warning Score, Modified Early Warning Score, or quick Sequential Organ Failure Assessment. Because Rapid Emergency Medicine Score incorporating C-reactive protein was developed and evaluated in the same cohort, these findings should be considered hypothesis-generating. Independent external validation is required before its clinical utility can be established.

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SUMMARY OBJECTIVE: Propofol and remifentanil are widely used for elective gastroscopy sedation. The aim of this randomized controlled trial was to compare their safety profiles, patient-reported recovery quality, and endoscopist satisfaction. METHODS: This single-center randomized controlled trial enrolled 88 adults (American Society of Anesthesiologists I–III) undergoing elective gastroscopy, allocated 1:1 to propofol (Group P, n=44) or remifentanil (Group R, n=44). Sedation depth was standardized using the Bispectral Index (target 60–80) and Ramsay Sedation Scale (target 2–3). The primary outcome was the Quality of Recovery-15 score at 30 min post-procedure; secondary outcomes included complication incidence, awakening time, and endoscopist satisfaction. RESULTS: Quality of Recovery-15 scores were comparable (median 140 vs. 140; median difference 0, 95%CI -1.0 to 1.0; p=0.95). Total complication incidence was 0% in Group P versus 61.4% in Group R (p<0.001), comprising bradycardia (27.3%), postoperative nausea and vomiting (20.5%), and desaturation (13.6%). Awakening time was shorter in Group R (3 vs. 60 s; p<0.001). Endoscopist satisfaction was significantly higher in Group P (90.9 vs. 56.8% excellent scores; p=0.003). CONCLUSION: Despite comparable patient-reported recovery quality, propofol was associated with substantially fewer perioperative adverse events (0 vs. 61.4%) and higher endoscopist satisfaction, supporting its preferential use in routine elective gastroscopy sedation. Clinical Trial Registration Number: ClinicalTrials.gov, NCT07336628. Registered January 2, 2026.

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SUMMARY OBJECTIVE: The aim of this study was to evaluate opportunistic vertebral trabecular attenuation on routine unenhanced abdominal computed tomography for predicting osteoporosis and its relationship with dual-energy X-ray absorptiometry parameters. METHODS: This retrospective study inc luded 350 patients (mean age 68.5 years) who underwent both dual-energy X-ray absorptiometry and routine unenhanced abdominal computed tomography for non-oncologic clinical indications within a 3-month interval between 2022 and 2025. Patients were grouped into normal (n=119), osteopenia (n=117), and osteoporosis (n=114) based on L1–L4 T-scores. Two blinded radiologists measured Hounsfield Unit values using regions of interest on high-resolution 0.625-mm sagittal-reconstructed computed tomography images of the L1–L4 vertebral bodies. Interobserver agreement was assessed using intraclass correlation coefficients. Diagnostic performance was evaluated using receiver operating characteristic curve analysis. RESULTS: Lumbar Hounsfield Unit values decreased progressively from normal to osteoporosis groups (p<0.001). Mean L1–L4 attenuation values for normal, osteopenia, and osteoporosis groups were 148.99±5.54, 120.39±3.84, and 78.53±3.36 Hounsfield Unit, respectively (p<0.001). Interobserver reliability was excellent (intraclass correlation coefficient: 0.90–0.94). L1 Hounsfield Unit measurements showed the highest diagnostic performance for predicting osteoporosis (area under the curve: 0.913; 95%CI 0.870–0.955). An L1 cutoff of ≤95.50 Hounsfield Unit yielded 84.60% sensitivity and 86.40% specificity. Mean L1–L4 Hounsfield Unit also showed high accuracy (area under the curve: 0.881) at a ≤95.00 Hounsfield Unit cutoff (sensitivity: 80.80%, specificity: 77.30%). CONCLUSION: Opportunistic sagittal lumbar Hounsfield Unit measurements, particularly at L1, provide high diagnostic accuracy and reproducibility for identifying osteoporosis on routine abdominal computed tomography without requiring additional imaging or radiation exposure. This protocol may facilitate early opportunistic screening for osteoporosis and support timely referral for dual-energy X-ray absorptiometry assessment.