Background and Objectives: Ozanimod is approved for the treatment of ulcerative colitis (UC). The aim of the present study was to evaluate the clinical, biochemical, and endoscopic outcomes. Materials and Methods: This was a retrospective, multicenter, cohort study. Clinical, biochemical, endoscopic, and safety data were collected from medical records. Τhe primary outcome was clinical response at week 12. Secondary outcomes included clinical remission, endoscopic improvement and remission, biochemical outcomes, treatment persistence, and safety. Clinical outcomes were assessed at weeks 12 and 48, while treatment persistence was evaluated over the complete 48-week follow-up period, using Kaplan-Meier analysis. Clinical response was defined as a ≥30% reduction in partial Mayo score and remission as a partial Mayo score < 3, with no individual sub-score > 1 and a rectal bleeding sub-score of 0. Clinical response and remission were primarily assessed using an observed-case approach, with an additional sensitivity analysis classifying discontinuations due to lack of efficacy as treatment failures. Results: A total of 79 patients were included (62.0% male; median age 44 years, IQR 31-56). Prior biologic exposure was recorded in 29.1%, and 64.6% were previously exposed to oral corticosteroids. Among patients with available clinical assessment at week 12 (n = 62), clinical response and clinical remission were achieved in 77.4% and 71.0%, respectively. Among patients with available data at week 12 (n = 32), endoscopic improvement was observed in 65.6%, while endoscopic remission was achieved in 15.6%. At week 48, among 26 evaluable patients, clinical response and remission rates were 96.2% and 84.6%, respectively; when discontinuations due to lack of efficacy were considered treatment failures, the corresponding rates were 52.1% and 45.8%. Treatment persistence did not differ significantly according to overall prior biologic exposure, whereas previous vedolizumab exposure was associated with lower treatment persistence over the week 48 follow-up (log-rank p = 0.037). In multivariable Cox regression, previous vedolizumab exposure remained associated with an increased hazard of treatment discontinuation (adjusted HR 3.07, 95% CI 1.23-7.67; p = 0.016). Adverse events were reported in 13.9% of patients. Conclusions: Ozanimod demonstrated good efficacy and a favorable safety profile in patients with moderate UC.

Frailty is highly prevalent in older patients with atrial fibrillation (AF), complicating anticoagulation decisions due to the dual elevation of both stroke and bleeding risks. This narrative review provides a framework to guide these decisions. We propose a three-step approach: (1) systematically assess frailty using a validated tool to stratify patients into risk categories; (2) translate this stratification into therapeutic choices, generally favoring direct oral anticoagulants (DOACs) over warfarin, with data suggesting a favorable bleeding profile for apixaban in frail populations, but routine switching to a DOAC should be avoided in frail patients who are stable on warfarin with good time in therapeutic range; and (3) consider specific alternatives, such as very-low-dose edoxaban, for patients with severe frailty or a prohibitive bleeding risk, while noting that this strategy should be applied within its specific regulatory and clinical context. The net clinical benefit of anticoagulation, defined as the absolute risk reduction in ischemic stroke offset by the absolute risk increase in major bleeding, diminishes with increasing frailty severity and may vanish in the most severe stages. Clinical decisions must therefore integrate dynamic frailty reassessment, multidisciplinary collaboration, and patient preferences. This review underscores a shift from purely guideline-driven to patient-value-driven individualized anticoagulation strategies in frail older adults with AF.

Hemophilia is an X-linked hereditary bleeding disorder caused by loss-of-function mutations in the genes encoding coagulation factors, leading to excessive bleeding and potentially being life-threatening. Currently, regular treatment for hemophilia is the infusion of recombinant blood coagulation factors. This approach is not only costly but can also give rise to complications such as the development of neutralizing antibodies (Nabs), which impede the therapeutic outcome. Hemophilia is a monogenic disease, making gene therapy a promising curative measure that includes gene addition and gene editing approaches. Adeno-associated virus (AAV) vectors have gained massive attention as the premier delivery vehicle for clinical gene therapy due to their diverse tissue tropisms dictated by the natural and engineered AAV capsids, their excellent safety profile since AAVs do not cause any known human diseases, low immunogenicity, and long-lasting gene expression. Several AAV-based gene addition therapies have been approved for hemophilia B and hemophilia A, and dozens of similar AAV-based clinical trials are underway. Gene editing technologies, like Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/CRISPR-associated protein 9 (Cas9), have shown immense potential in the treatment of genetic diseases. CRISPR/Cas9-mediated transgene integration provides critical advantages over regular gene insertion therapy by enabling site-specific, targeted genomic integration rather than random integration. Clinical trials focusing on AAV-CRISPR/Cas9-mediated knock-in of human genes represent the frontier of in vivo genetic medicine, and one such prominent ongoing clinical trial for hemophilia B is designed to insert the human Factor IX gene into hepatocytes. This review outlines recent advances and feasible strategies of CRISPR/Cas9-based genome editing for hemophilia therapy, highlights the potential applications of next-generation gene editing and vector delivery technologies, and offers new insights for the advantages, limitations, and future directions for these novel treatment modalities.

Interventional radiology (IR) has reshaped contemporary management strategies for selected gynecological and obstetric disorders by introducing minimally invasive, organ-sparing therapeutic alternatives to conventional surgical approaches. This review examines the current applications of IR in the treatment of symptomatic uterine fibroids, pelvic congestion syndrome, placenta accreta spectrum, cesarean scar pregnancy, and selected gynecological malignancies requiring palliative or preoperative embolization. In addition, selected vascular conditions in pregnancy, including visceral and cerebral aneurysms, are discussed due to their high-risk clinical profile and growing relevance for endovascular management. These entities were chosen because of their substantial clinical relevance, risk of severe complications, and the expanding body of evidence supporting endovascular management. Techniques such as uterine artery embolization and ovarian vein embolization are associated with high technical success and meaningful symptom reduction, while simultaneously decreasing hospitalization time, perioperative morbidity, and convalescence compared with traditional surgery. In complex obstetric scenarios-including placenta accreta spectrum and splenic artery aneurysm-prophylactic balloon occlusion and endovascular embolization may significantly limit life-threatening hemorrhage and improve maternal prognosis in appropriately selected patients when implemented within a multidisciplinary setting; for splenic artery aneurysm in particular, this evidence currently derives from case reports and small case series rather than comparative trials. Imaging modalities, including ultrasonography, computed tomography, magnetic resonance imaging, and angiography, are integral to diagnosis, patient qualification, procedural planning, and post-intervention monitoring. Although existing data generally confirm the safety and efficacy of interventional techniques, important limitations persist, including heterogeneous study populations, relatively small cohorts, and insufficient long-term reproductive follow-up. Greater standardization of clinical indications and procedural protocols, ongoing technological advancement, and well-designed multicenter trials are required to consolidate the evidence base. In gynecologic oncology, embolization techniques may provide effective hemorrhage control and facilitate surgical treatment in selected patients. In addition, uterine artery embolization has emerged as an important uterus-preserving adjunct in the management of cesarean scar pregnancy, although long-term reproductive (fertility) outcome data remain limited. IR is becoming an increasingly important component of modern gynecological care, supporting individualized, uterus-preserving, and less invasive therapeutic strategies; fertility preservation specifically is an important goal that, for several of the indications discussed, remains incompletely proven by long-term reproductive-outcome data.

Despite major technological advances, contemporary drug-eluting stents (DES) remain intrinsically limited by the permanent implantation of a metallic prosthesis, exposing patients to chronic vessel caging, impaired vasomotion, neoatherosclerosis, and persistent risks of restenosis and late thrombotic events. These limitations have renewed interest in implant-sparing coronary revascularization based on the "leave-nothing-behind" concept. Drug-coated balloons (DCB) have emerged as the most mature implant-free technology, with robust evidence supporting their use beyond in-stent restenosis and small-vessel disease to increasingly complex clinical scenarios, including chronic total occlusions, diffuse coronary artery disease, bifurcation lesions, diabetes mellitus, and patients at high bleeding risk. Successful DCB angioplasty, however, depends on meticulous lesion preparation, tailored plaque modification, and selective intracoronary imaging to optimize procedural outcomes. In parallel, new-generation bioresorbable scaffolds (BRS) and bioadaptors are revitalizing the concept of temporary vessel scaffolding. By incorporating thinner struts, improved mechanical properties, enhanced biocompatibility, and restoration of vascular physiology following resorption or uncaging, these technologies aim to overcome the thrombotic limitations that hindered first-generation devices. This review provides a comprehensive overview of the biological rationale, current clinical evidence, procedural optimization, and future perspectives of implant-sparing PCI, highlighting the ongoing transition from a device-centered strategy to a personalized, morphology-guided approach in which lesion characteristics, vascular biology, and patient-specific risk drive revascularization decision-making.

Splenectomy is a well-established surgical option for selected patients with immune thrombocytopenic purpura and persistent thrombocytopenia despite medical therapy. Although laparoscopic splenectomy remains the standard minimally invasive approach, robotic platforms may offer advantages in technically challenging cases. We present a 40-year-old woman with a 4-year history of immune thrombocytopenic purpura, obesity, Hashimoto thyroiditis, and prior sleeve gastrectomy presented with severe thrombocytopenia and abnormal uterine bleeding. After failure of medical therapy, she underwent robotic splenectomy with the da Vinci Xi robotic platform using an anterior approach. Operative time was 240 minutes, and estimated blood loss was 200 mL. The postoperative course was uneventful, and the patient was discharged on postoperative day 3. Pathologic examination findings were compatible with immune thrombocytopenic purpura. Robotic splenectomy is safe and feasible in this selected challenging case and may be considered an alternative minimally invasive approach when enhanced visualization and precise hilar dissection are desirable.

The expanding use of antiplatelet agents, anticoagulants, and fibrinolytics has made bleeding emergencies more frequent and more complex. A structured, evidence-based approach enables emergency clinicians to identify life-threatening and critical-site bleeding, initiate resuscitation, establish which antithrombotic agent the patient received and when, and weigh the benefit of restoring hemostasis against the risk for thrombosis. This review synthesizes current guidelines and evidence on the evaluation and management of bleeding in patients receiving antithrombotic therapy, identifying areas of consensus and ongoing uncertainty. Coagulation assays, agent-specific reversal and hemostatic strategies, periprocedural management, and bleeding in pregnancy are addressed.

This case report describes a unique presentation of central neuropathic pain (CNP) in a Chinese male in his 40s, following a large right basal ganglia hemorrhage with extension into the right middle cerebral artery (MCA) territory, characterized by left shoulder pain reproducibly triggered by passive wrist and finger extension. The report outlines the sequential treatment approach implemented for pain management. Although spasticity and shoulder pain are common sequelae of stroke, this case highlights the importance of considering central neuropathic mechanisms in patients with atypical or refractory symptoms. It also underscores the heterogeneity of CNP following stroke and the need for heightened clinical awareness of this condition.

Radiation therapy is a cornerstone in the management of pelvic and thoracic malignancies, but injury to surrounding normal tissue remains a clinically significant source of late morbidity despite advances in treatment delivery. Radiation-induced proctitis and hemorrhagic cystitis are consequential pelvic toxicities, typically presenting months to years after treatment with rectal bleeding, diarrhea, urgency, tenesmus, hematuria, and irritative lower urinary tract symptoms. Beyond the pelvis, radiation enteritis and pneumonitis represent important gastrointestinal and pulmonary complications that may similarly impair quality of life. Although severe toxicity has become less common with contemporary treatment planning, management remains challenging because of the chronic, multifactorial nature of radiation injury and limited high-quality randomized evidence. Treatment is generally individualized according to symptom severity, affected organ, and chronicity. Medical therapies include anti-inflammatory agents, antioxidants, and topical or intravesical treatments aimed at reducing inflammation and promoting mucosal healing. For chronic hemorrhagic disease, endoscopic interventions such as argon plasma coagulation, radiofrequency ablation, laser therapy, and cryotherapy target friable or telangiectatic lesions. In refractory cases, hyperbaric oxygen therapy (HBOT) has emerged as an important salvage modality by promoting angiogenesis, neovascularization, and tissue repair in irradiated tissue. Surgery is reserved for severe, refractory disease or complications, including fistula, obstruction, or life-threatening hemorrhage. This review examines contemporary management of radiation-induced proctitis and hemorrhagic cystitis, with comparative discussion of radiation enteritis and pneumonitis. We highlight organ-specific differences in pathophysiology, presentation, medical and endoscopic therapies, HBOT, and surgical intervention, emphasizing a stepwise approach to management.

A 33-year-old woman presented with abnormal bleeding and vaginal discomfort. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a multilocular cystic lesion on the anterior surface of the sacrum and coccyx. The cyst was generally homogeneous, and no obvious bone infiltration was observed. Tailgut cyst was suspected preoperatively. Surgery was performed using only a retroperitoneal approach, and the mass was excised with the right obturator cavity and prevesical space open. No postoperative complications occurred. In treating tailgut cysts, retroperitoneal resection alone can be viewed as a procedure that should be actively adopted owing to its ease of procedure.