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Aim: Evaluate impact of lymph node ratio as prognostic factor in gastric cancer., Methods: We studied 463 patients with gastric cancer who underwent curative gastric surgery with D1 or D2 lymphadenectomy, Data were collected from May 1996 through December 2010 at Department of General Surgery of Parma University Hospital. We divided patients in two groups according to number of nodes removed Results: The results of the present nonrandomized retrospective single centre study confirm the promising role of the LNR as an independent prognostic factor. Overall survival between LNR categories are statistically significant different between LNR0 and LNR1., Conclusion: The ratio between the number of metastatic and analysed lymph nodes in patients with gastric cancer can discriminate patients better than the AJCC/UICC staging system: it seems to be related to a more sensitive in the evaluation of overall survival.

Background: Epidural dumbbell-shaped chordomas are localized slow growing, and malignant/aggressive neoplasms. Here, we present a 62-year-old male with a T3-T4 dumbbell-shaped chordoma and reviewed the appropriate literature., Case Description: A 62-year-old male presented with a three-month history of thoracic pain. When the thoracolumbar magnetic resonance (MR) showed a T3-T4 dumbbell-shaped intracanalicular/extradural tumor, he underwent tumor removal. After the histological examination proved the lesion was a spinal chordoma, he underwent a secondary radical transthoracic tumor resection. Postoperatively, the patient was able to walk without assistance, and at 6-month follow-up, was neurologically intact with only residual paresthesias., Conclusion: Malignant spinal chordomas may mimic benign neurinomas on MR scans. Here, biopsy of the lesion to confirm the diagnosis of chordoma was critical and directed subsequent definitive transthoracic tumor resection., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

Anorectal emergencies comprise a wide variety of diseases that share common symptoms, i.e., anorectal pain or bleeding and might require immediate management. While most of the underlying conditions do not need inpatient management, some of them could be life-threatening and need prompt recognition and treatment. It is well known that an incorrect diagnosis is frequent for anorectal diseases and that a delayed diagnosis is related to an impaired outcome. This paper aims to improve the knowledge and the awareness on this specific topic and to provide a useful tool for every physician dealing with anorectal emergencies.The present guidelines have been developed according to the GRADE methodology. To create these guidelines, a panel of experts was designed and charged by the boards of the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) to perform a systematic review of the available literature and to provide evidence-based statements with immediate practical application. All the statements were presented and discussed during the WSES-AAST-WJES Consensus Conference on Anorectal Emergencies, and for each statement, a consensus among the WSES-AAST panel of experts was reached. We structured our work into seven main topics to cover the entire management of patients with anorectal emergencies and to provide an up-to-date, easy-to-use tool that can help physicians and surgeons during the decision-making process., (© 2021. The Author(s).)

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy., Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift., Conclusion: According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

Background: Serum phosphorylated neurofilament-heavy chain (pNF-H) has not been longitudinally evaluated in dogs that develop progressive myelomalacia (PMM) after Type I intervertebral disc herniation (IVDH)., Objectives: To determine if serum pNF-H concentrations would predict outcome of neuroligical disease in dogs with acute, severe thoracolumbar myelopathy secondary to Type I IVDH., Animals: Thirty-nine client-owned dogs with thoracolumbar myelopathy secondary to IVDH., Methods: Prospective controlled cohort study. Serum was collected from dogs undergoing hemilaminectomy at multiple timepoints. Final neurological status was established at 12 months and groups were stratified accordingly. Comparisons between outcome and pNF-H concentration at each timepoint was examined using Kruskal-Wallis analysis of variance on ranks and receiver operator characteristics curve analysis., Results: Median serum pNF-H concentrations were not significantly different between deep pain negative dogs that did or did not recover at any timepoint (baseline: 0.37 ng/mL [0-0.9 ng/mL] vs 0 ng/mL [0-0.9 ng/mL], P > 1; 24 hours: 1.25 ng/mL [0.35-7.23 ng/mL] vs 1.53 ng/mL [0-11.94 ng/mL], P > 1; 48 hours: 1.22 ng/mL [0.63-6.62 ng/mL] vs 2.12 ng/mL [0-20.72 ng/mL], P >  1; 72 hours: 2.77 ng/mL [1.33-6.62 ng/mL] vs 16.69 ng/mL [4.02-40.12 ng/mL], P >  1). Dogs that developed PMM had significantly higher serum pNF-H concentrations after surgery compared to all other cohorts at 24 hours: 39.88 ng/mL (25.74-50.68 ng/mL); P < .05 and 72 hours: 223.9 ng/mL (155.4-263.7 ng/mL); P < .05. A serum pNF-H concentration ≥31.39 ng/mL was 83.33% sensitive and 100% specific for identifying PMM in this cohort., Conclusions and Clinical Importance: Serum pNF-H is a promising biomarker for antemortem diagnosis of PMM in dogs with acute, severe thoracolumbar myelopathy secondary to Type I IVDH., (© 2021 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.)

Background: Tethered spinal cord syndrome (TCS) can occur after the surgical repair of lipomeningoceles (LMCs). In these cases, the tethering results from postoperative adhesions between the spinal cord and the overlying repaired dura. A watertight dural closure using the residual dura and/or the surrounding tissues does not always provide enough space for the spinal cord and risks retethering. Here, we report a 16-year-old patient with secondary TCS following lipomeningocele repair who successfully underwent release of the tethered filum terminale utilizing a novel dural splitting reconstructive technique to attain a water-tight closure without the need for a duroplasty., Methods: A 16-year-old patient had a LMC repaired at birth. She now presented with progressive low back pain, and gait disturbances. The MRI documented secondary spinal cord tethering at the prior spinal dysraphism repair site., Results: A secondary release of the filum terminale utilizing a novel dural splitting technique to avoid the need for a duroplasty was performed., Conclusion: Here, in a 16-year-old patient with a recurrent tethered cord syndrome following repair of a LMC at birth, we utilized a novel dural splitting reconstruction technique and averted the need for a duroplasty., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

We describe the case of a 42-year-old man undergoing elective embolisation of an arteriovenous malformation at the level of the right posterior cerebral artery under propofol anaesthesia. We used the SedLine Brain Function Monitor (Masimo) to titrate the anaesthetic depth with propofol. At the end of the procedure, the patient aroused from anaesthesia very rapidly after the reversal of deep neuromuscular block with sugammadex, despite still significant calculated doses of propofol at the effect site. This rapid arousal was monitored using the SedLine Brain Function Monitor., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Burkitt's lymphoma is a non-Hodgkin B-cell lymphoma, occurring mostly in Equatorial Africa. According to the WHO, classification is three different variants: sporadic, endemic, and immunodeficient-associated. Here, we present a patient with "sporadic" primary epidural Burkitt's lymphoma resulting in chronic low back pain (LBP)., Case Description: A 63-year-old female presented with a 2-month history of LBP and the left lower extremity sciatica. The thoracolumbar MRI showed a L5 irregular, osteolytic epidural lesion that was hypointense on T1-weighted images, hyperintense on STIR studies, and inhomogeneously enhanced with contrast. Additional hypointense lesions were also seen at the L2, L3, and L4 levels. The patient underwent a L4-L5 laminectomy for piecemeal epidural resection of tumor, and a L4-S1 transpedicular screws/rod fusion. In addition, a L2-L3 radiofrequency ablation was performed. The histological examination documented a primary "sporadic" spinal Burkitt's lymphoma. The patient subsequently was treated with both radiotherapy/chemoradiotherapy., Conclusion: Primary "sporadic" spinal Burkitt's lymphoma is rare. Following tumor resection, adjunctive radiation and chemotherapy are typically warranted., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

Hierarchical cluster (HCA) and canonical correlation (CCA) analyses were employed to explore the multivariate relationships among chemical components (proximate, mineral and lipidic components) of lean beef longissimus dorsii lumborum (LDL) and selected carcass traits of cattle fattened on pasture under tropical conditions (bulls, n = 60; steers, n = 60; from 2.5 to 4.0 years of age, estimated by dentition). The variables backfat thickness (BFT), Ca, Mn, Cu, C14:0, C15:0, and C20:0 showed the highest coefficients of variation. Three clusters were defined by the HCA. Out of all carcass traits, only BFT differed significantly ( p < 0.001) among clusters. Clusters significantly ( p < 0.001) differed for total lipids (TLIPIDS), moisture, dry matter (DM), fatty acid composition, cholesterol content, and mineral composition (except for Fe). The variables that define the canonical variate "CARCASS" were BFT and degree of marbling (MARBLING). TLIPIDS was the main variable for the "PROXIMATE" canonical variate, while C16:0 and C18:1 c had the most relevant contribution to the "LIPIDS" canonical variate. BFT and MARBLING were highly cross-correlated with TLIPIDS which, in turn, was significantly affected by the IM lipid content. Carcass traits were poorly correlated with mineral content. These findings allow for the possibility to develop selection criteria based on BFT and/or marbling to sort carcasses, from grass-fed cattle fattened under tropical conditions, with differing nutritional values. Further analyses are needed to study the effects of sex condition on the associations among carcass traits and lipidic components.

Background: Exposure to metals/metalloids, including essential and nonessential elements, has been associated to male reproductive health in animals. However, findings from human studies are inconsistent., Objectives: To investigate the impact of exposure to multiple metals/metalloids at environmental levels on the conventional human semen-quality parameters., Materials and Methods: Men living in rural or industrial areas were recruited by personalized letters. No exclusion criteria were applied. Each man provided one semen sample and one blood sample. We analyzed the semen sample both to determine conventional sperm parameters (concentration, progressive motility and normal forms) and to quantify lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As), nickel (Ni), vanadium (V) and selenium (Se) levels. The levels of these metals/metalloids were also quantified in venous blood and spermatozoa samples. Associations between the blood/seminal plasma metal/metalloid levels and semen quality parameters were assessed using confounder adjusted logistic regression models. Correlation and interactions between blood/seminal plasma and semen metal/metalloid levels were investigated using the Spearman's correlation., Results: We found a positive association of seminal plasma cadmium level with lower Total count (OR = 4.48, 95%CI 0.25-80); whereas lead (OR = 4.51, 95%CI 0.86-23) and cadmium (OR = 3.45, 95%CI 0.77-16) seminal plasma levels had a positive association with progressive sperm motility. Overall, these associations remained suggestive after adjustment, though statistically unstable risks. Finally, we found weak interactions between beneficial effects of Se and detrimental ones only for Cd and Pb blood level on sperm concentration, total sperm count and progressive sperm motility., Conclusions: Our findings suggest that environmental exposure to Pb and Cd contributes to a decline in human semen quality, whereas Se can have beneficial effects. Measurements of metals/metalloids in the seminal fluid may be more predictable of semen quality than conventional blood measurements., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Navigated instrumented spine surgery is burden by a low but significant screw mispositioning risks, respectively, for the 2D imaging system from 15% to 40% and, for the 3D imaging system, ranging from 4.1% to 11.5%. The primary objective of this study was to demonstrate the efficacy of a new screw-like tool in order to further decrease pedicle screws mispositioning rate during vertebral navigated spine surgery., Methods: Between January and June 2019 an initial case series of 18 patients were enrolled. All patients underwent a pedicle screw fixation, both in thoracic (Th10-Th12) and lumbosacral (L1-S1) spine, using O-arm (Medtronic Navigation, Louisville, CO, USA) and StealthStation S7 surgical navigation system (Medtronic Navigation). Evaluation of pedicle screws placement accuracy using the new tool in adjunct to the classic reference frame, was performed following the Gertzbein and Robbins classification., Results: A total of 94 screws have been placed. Among them, 98.9% were completely inside cortical bone (grade A) and only 1.1% with a breach of less than 2 mm (grade B)., Conclusions: Our new "screw-like" tool coupled to the classic reference frame device could improve accuracy during navigated spine surgery and potentially reducing to zero the risks for screw mispositioning.

Diaphragmatic hernia (DH) can be congenital or acquired. DH is a potentially life-threatening condition and the management in emergency setting remain unclear. Nonspecific symptoms can delay the diagnosis. We report a case of a 63-year-old man admitted for abdominal pain and nausea. He was successfully treated with damage control surgery.

Cribiform-morular thyroid carcinoma is a rare variant of papillary thyroid carcinoma. It is usually related to Familial Adenomatous Polyposis (FAP) but rarely it may be sporadic. This variant of PTC occurs in young females and it is rare in the elderly. We report a case of a 20 years old female presenting thyroid carcinoma and personal history of FAP.

We report a peculiar case of jejunal diverticulitis in 54-year-old female. Since hospital admission, a colonic diverticulitis was suspected. CT scan of the abdomen showed multiple fluid collections with free intraperitoneal extraluminal air, suggesting bowel perforation. A complicated acute diverticulitis of the colon was suspected but intraoperatively, a perforated acute diverticulitis of jejunum was detected. The aim of this work is to evidence the key role of CT scan of the abdomen in differential diagnosis of unfrequently pathological entities, such as jejunal diverticulitis, to prevent diagnostic mistakes.

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection., Case Description: A 55-year-old immunocompromised female (i.e., history 17 years ago of Hodgkin's lymphoma, nodular sclerosis variant) recently developed a SARS-CoV-2 infection treated with nonsteroidal anti-inflammatory agents. She then reported the sudden onset of cervicodorsalgia after a slight cervical flexion/extension maneuver. The brain and cervicothoracic spine MRI studies documented a clival anterior spinal epidural hematoma with maximum spinal compression at the T1-T2 level; it also extended inferiorly to the T6 level. Two weeks later, the follow-up MRI showed a remarkable reduction in the anteroposterior diameter of the hematoma that correlated with significant neurological improvement and almost complete pain regression. She was discharged after a total 15-day hospital stay, with complete symptoms relief., Conclusion: We present a 55-year-old chronically immunocompromised (i.e., due to the history of Hodgkin's lymphoma) female who, following a SARS-CoV-2 infection, developed an anterior SSEH extending from the clivus to the T6 spinal level that spontaneously regressed without surgical intervention., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Surgical Neurology International.)

In the framework of the MICADO (Measurement and Instrumentation for Cleaning And Decommissioning Operations) European Union (EU) project, aimed at the full digitization of low- and intermediate-level radioactive waste management, a set of 32 solid state thermal neutron detectors named SiLiF has been built and characterized. MICADO encompasses a complete active and passive characterization of the radwaste drums with neutrons and gamma rays, followed by a longer-term monitoring phase. The SiLiF detectors are suitable for the monitoring of nuclear materials and can be used around radioactive waste drums possibly containing small quantities of actinides, as well as around spent fuel casks in interim storage or during transportation. Suitable polyethylene moderators can be exploited to better shape the detector response to the expected neutron spectrum, according to Monte Carlo simulations that were performed. These detectors were extensively tested with an AmBe neutron source, and the results show a quite uniform and reproducible behavior.

Despite improvements in family planning (FP) knowledge and services in West Africa, unmet need for FP continues to grow. Many programs apply a demographically and biologically driven definition of unmet need, overlooking the complex social environment in which fertility and FP decisions are made. This longitudinal, qualitative cohort study captures the changing nature of FP need, attitudes and behaviors, taking into account life context to inform understanding of the complex behavior change process. Purposively sampled, 25 women and 25 men participated in three rounds of in-depth interviews over 18 months. Analyses used a social network influence lens. Findings suggest alignment of six foundational building blocks operating at individual, couple, services, and social levels is essential to meet FP need. If one block is weak, a person may not achieve met need. Women and men commonly follow five pathways as they seek to fulfill their FP need. Some pathways achieve met need (determined users, quick converters), some do not (side effect avoiders), and some do not lead to consistent FP outcomes (male-priority decision makers, gender-egalitarian decision makers). Findings clarify the role of social determinants of FP and offer insight into program approaches informed by user typologies and return on program investments., (© 2021 The Authors. Studies in Family Planning published by Wiley Periodicals LLC on behalf of Population Council.)

Open conduit basaltic volcanoes can be potentially hazardous as the eruptive activity may turn suddenly from a steady state to highly explosive. Unexpected changes in explosion intensity are recurrent at Stromboli volcano, where major explosions and large-scale paroxysms sometimes break off the ordinary, Strombolian activity with little or no warning. Two powerful paroxysmal eruptions took place at Stromboli volcano during the summer 2019, causing widespread fires, consistent damages across the island, injuries and one fatality. Prediction of similar events is really challenging for the modern volcanology, though models propaedeutic to early-warning monitoring systems are not properly assessed yet in many volcanoes worldwide. Here, we present a multi-parametric study that combines petrological and geophysical data to investigate processes generating the two paroxysms. The time information derived by Li enrichments in plagioclase crystals correlates with tilt time series derived by seismometers installed on the island, highlighting the dominant role of shallow conduit processes in triggering the 2019 paroxysmal activity. Our dataset conceives a mechanism of gas slug formation and fast upward migration that finally triggered the eruptions in very limited times. The proposed model questions our capability to forecast such kind of paroxysms in times that are rapid enough to allow mitigation of the associated risk.

Background: COVID-19 is a terrific pandemic and a potential risk for every health care professional (HCP), especially during emergency conditions where the right timing is essential for the correct treatment. During surgery the correct setting of operative room (OR) is mandatory to reduce the risk of contamination. Personal protection equipment (PPE), specific devices, and planned OR setting are essential during surgery in pandemic COVID-19. Methods: Medline, PubMed, Scientific societies recommendations, and guidelines were consulted to identify articles reporting the setup of OR during pandemic COVID-19. Results: OR must have a high-efficiency particulate air (HEPA) filter with negative pressure and a high air exchange cycle rate. Every supply kit should be packed and placed in the OR before patient arrival. A detailed checklist of equipment and devices is necessary. Personal PPE at the highest level should be provided to every HCP (Association of the Advancement of Medical Instrumentation [AAMI]-Level-III surgical gowns; double latex-free gloves with Acceptable Quality Level <1.0; FFP3 or powered air-purifying respirator masks with face shield). Anesthesia should be performed with a rapid sequence intubation. During surgery energy devices should be settled to the lower level in combination with a smoke evacuation switch pen with disposable smoke evacuation HEPA filter to minimize surgical smoke spread. During laparoscopy low pneumoperitoneum pressures and aspiration systems must be provided. Conclusions: Emergency surgery during pandemic COVID-19 increases the risk for every HCP in the OR. A theoretical risk of transmission from the surgical field exists. It is mandatory the adoption of strong strategies to reduce the risk of contamination in the OR.

Background: Thoracic complications from retained abdominal gallstones are quite rare and the incidence rate ranges between 0.08% and 0.3%. Diagnosis and treatment of these complications are challenging due to the uncommon presentations and the debated role of the thoracic approach. This review of all cases reported in literature aims to discuss the best practice of this rare condition., Methods: A comprehensive literature search was performed for articles from January 1993 to May 2019 using PubMed, MEDLINE, Embase, ScienceDirect. The following mesh-words were used: 'cholelithopthysis', 'thoracic', 'gallstones' 'retained', and 'spilled'. All cases of thoracic complications from retained gallstones after laparoscopic cholecystectomy were extrapolated., Results: Twenty-four patients were included in this study. The most common symptoms were fever, hemoptysis and lithoptysis. Symptoms after laparoscopic cholecystectomy were presented after a mean time of 9.8±14.2 months (range from one week to 60 months). Delayed diagnosis was found in fourteen patients (58.4.%). Only four subjects were treated successfully with antibiotic therapy alone (16.7%), whereas 20 patients needed surgery or interventional radiology (83.3%). Seven patients (29.2%) were successfully managed with an abdominal approach. Three patients were managed using thoracentesis, thoracoscopic-thoracotomic drainage (12.5%). Right lung decortication and pulmonary wedge resections were necessary for ten patients (41.6%)., Conclusion: Clinicians always must inquire about the previous cholecystectomy for cholelithiasis related diseases in all patients suffering from recurrent right-sided pleural/lung affections, to improve diagnostic delay. The escalated approach must be performed: empirical antimicrobial therapy followed by targeted therapy as soon as microbiological data are available; afterwards, abdominal surgery is effective in approximately 30% of patients while the remaining patients have to be submitted to a thoracic approach.

Background: We aimed to assess the ability of comprehensive complication index (CCI) and Clavien-Dindo complication (CDC) scale to predict excessive length of hospital stay (e-LOS) in patients undergoing liver resection for hepatocellular carcinoma., Methods: Patients were identified from an Italian multi-institutional database and randomly selected to be included in either a derivation or validation set. Multivariate logistic regression models and ROC curve analysis including either CCI or CDC as predictors of e-LOS were fitted to compare predictive performance. E-LOS was defined as a LOS longer than the 75th percentile among patients with at least one complication., Results: A total of 2669 patients were analyzed (1345 for derivation and 1324 for validation). The odds ratio (OR) was 5.590 (95%CI 4.201; 7.438) for CCI and 5.507 (4.152; 7.304) for CDC. The AUC was 0.964 for CCI and 0.893 for CDC in the derivation set and 0.962 vs. 0.890 in the validation set, respectively. In patients with at least two complications, the OR was 2.793 (1.896; 4.115) for CCI and 2.439 (1.666; 3.570) for CDC with an AUC of 0.850 and 0.673, respectively in the derivation cohort. The AUC was 0.806 for CCI and 0.658 for CDC in the validation set., Conclusions: When reporting postoperative morbidity in liver surgery, CCI is a preferable scale.

Introduction: Complicated diaphragmatic hernia (DH) can be congenital or acquired. Congenital diaphragmatic hernias (CDH) are rare and often can be asymptomatic until adulthood. Traumatic diaphragmatic hernia (TDH) is a complication that occurs in about 1-5% of victims of road accidents and in 10-15% of penetrating traumas of the lower chest. CDH and TDH are potentially life-threatening conditions, and the management in emergency setting still debated. This study aims to evaluate the surgical treatment options in emergency setting., Methods: A bibliographic research reporting the item "emergency surgery" linked with "traumatic diaphragmatic rupture" and "congenital diaphragmatic hernia" was performed. Several parameters were recorded including sex, age, etiology, diagnosis, treatment, site and herniated organs., Results: The research included 146 articles, and 1542 patients were analyzed. Most of the complicated diaphragmatic hernias occurred for a diaphragmatic defect due to trauma, only 7.2% occurred for a congenital diaphragmatic defect. The main diagnostic method used was chest X-ray and CT scan. Laparotomic approach still remains predominant compared to the minimally invasive approach., Conclusion: Surgery is the treatment of choice and is strongly influenced by the preoperative setting, performed mainly with X-ray and CT scan. Minimally invasive approach is safe and feasible but is highly dependent on the surgeon's expertise, especially in emergency setting.

Background: Considerable differences in terms of prognosis exist between the right-sided (RCC) and the left-sided colon cancer (LCC). Aim of the work: In this study, we evaluated prognostic implications of primary tumor location (PTL) among patients who underwent curative-intent hepatectomy for synchronous (SM) and metachronous (MM) colorectal liver metastases (CRLM)., Methods: The study population included all consecutive patients affected by CRLM scheduled for first liver resection at three Italian oncological centers., Results: A total of 204 patients who underwent CRLM resection were included, 50% with RCC. Synchronous lesions were prevalent (n=133, 65%). Median OS was respectively 40.3 months for SM-RCC, 53.5 months for SM-LCC, 64.5 months for MM-RCC and 81.6 months for MM-LCC. Patients with MM-LCC showed an OS better than patients with SM-RCC (p=0.008) and SM-LCC (p=0.002). PTL had no influence on RFS. RCC group had less recurrences (75% vs 86.5%), though further surgery with curative-intent was possible more in LCC group (29.3% vs 32.5%). Cox proportional hazards model analysis showed that age and the presence of SM vs MM was associated with a significantly higher hazard ratio (HR) for death (HR=1.024; 95%CI=1.005-1.043; p=0.011 and HR=2.010; 95%CI=1.328-3.043; p=0.001, respectively)., Conclusions: We confirmed that patients with CRLM and right-sided primary colon cancer experience worse survival after hepatic resection. The timing of metastasis has been revealed as important prognostic factor.

Aim: evaluating the impact of screening programmes on colorectal cancer (CRC) in Italy., Methods: we studied 1292 patients with colorectal cancer. Data were collected from January 2004 through December 2015 in Parma University Hospital. We compared clinophatological features to evaluate the real impact of screening programmes on detecting early stage colorectal cancers in target population., Results: screening programmes with fecal occult blood test (FOBT) and colonoscopy covered only patients from 50 to 69. In our study we reported that the 52,3% of patients with CRC were over 70 and out of screen time, while only 47,7% were under 70. Early detection seems to be related to early stage of CRC and to an improved overall survival., Conclusion: The importance of early detection in colorectal cancers represents the most important outcome for OS. The risk of colorectal cancer is increased in elderly. Actual screening programmes cover less than 50% of population with colorectal cancer. Screening should be considered for patients over 70, due to the high number of new diagnosis in symptomatic disease and worst prognosis, in accordance with advanced cancer stage and comorbidities in elderly.

Objective Evaluate the impact of Covid-19 in a critical area and analyze the changes in the daily activities in a General Surgery Unit of a tertiary Covid-Hospital.   Methods We report and compared all the surgical procedures performed between two periods (March and April 2019 and March and April 2020) at General Surgery Department of Parma University Hospital, a tertiary Covid-Hospital.   Results Between March and April 2019, a total of 232 surgical procedures were performed. Between March and April 2020 only 61 surgical procedures were performed. In 2019 84 patients underwent surgery for cancer and 171 underwent surgery for benign diseases. In 2020 only 37 patients underwent surgery for oncological reasons and 24 underwent surgery for benign diseases.   Conclusions During pandemic Covid-19 the access to health services was limited and poor. Limited access to health services and the fear of Covid-19 infection can explain the lower number of elective surgical procedures for cancer in 2020 compared to the same period in the 2019.

Background: Extraforaminal lumbar disc herniation (ELDH) amounts of 7%-12% of all lumbar disc herniations. Although they have already been widely described, an optimal treatment is still under discussion in the literature., Objective: We describe a novel application of navigation using 2D/3D imaging system to plan an adequate surgical trajectory and performing a neuronavigated microdiscectomy in ELDH that has not been previously described., Methods: This is a retrospective study in a single institution. Between February 2017 and July 2020, a total of 12 patients (7 males and 5 females), with a mean age of 56 years (range 49-71 years), have been treated because of ELDH through a far lateral microdiscectomy using 2D/3D imaging system-assisted neuronavigation (O-arm)., Results: No intraoperative and/or postoperative complications were recorded. Patients presented a mean preoperative Visual Analog Scale (VAS) score of 7.83 ± 0.83 (range 7-9). At the day of discharge, leg pain VAS score effectively improved, decreasing to a mean value of 1.83 ± 0.83 (range 1-3). Further, low back and radicular pain improvement was recorded at 1-, 6-, and 12-month follow-up, respectively., Conclusion: We described a novel use of 2D/3D imaging system navigation in the microsurgical treatment of ELDH that has not previously reported. This technique is safe and effective and provides more intraoperative details compared to fluoroscopy, which can be crucial for the success of the procedure and to reduce complications and particularly indicated in complex cases with altered anatomy., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Craniovertebral Junction and Spine.)

Background: Nontuberculous mycobacteria (NTM) represents an important cause of infection, particularly in immunocompromised patients. Spondylodiscitis is unusual and may be associated with underlying causes such as drug abuse. Timely diagnosis and treatment are critical, as without this, patients will demonstrate progressive neurological deterioration. Here, we present a rare case of Mycobacterium mucogenicum spondylodiscitis in a 36-year-old male, along with a focused literature review., Case Description: A 36-year-old female with previous drug abuse presented with 3-years of progressive thoracolumbar pain. The MRI of the spine revealed paravertebral abscesses from Th10-L1 with vertebral lesions involving Th11-Th12 levels (e.g., vertebral body collapse/deformity and destruction of the posterior vertebral walls). After a needle CT-guided biopsy of the paravertebral tissues, real time-polymerase chain reaction (RT-PCR) amplification documented NTM; the final identification was M. mucogenicum . The patient then underwent a Th11-Th12 decompressive laminectomy, facetectomy, granulomatous tissue debridement, and posterior pedicle screw fusion from Th8-Th10, and L1-L3. Postoperatively, the patient's pain resolved, and she was left with residual lower extremities dysesthesias; 6-months later, she could walk without assistance., Conclusion: Spondylodiscitis caused by M. mucogenicum is rare, and the medical and surgical treatment is comparable to that for other NTM groups., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

Background: In the past decades the right colon cancer showed a higher incidence rate than left colon cancer. This trend is known as "proximal shift" or "rightwards shift." We evaluated rightward shift phenomenon in our region., Methods: We collected data from 1101 colorectal cancer patients who underwent curative surgery at Parma University Hospital from 01 January 2004 through 01 January 2018. We divided patients into seven subgroups according to the time of surgery to evaluate epidemiological changes through the years of colon cancer., Results: We found a non-linear rightward shift trend of CRC. The incidence of RCC was the 40% between 2004-2005 and 51% in the biennium 2016-2017 (60% in 2012-2013 and 57% in 2014-2015). The patients with RCC were significantly older than patients with LCC. RCCs have poor differentiated tumors. Metastatic disease showed a similar distribution both in left and right CRCs. Peritoneum was the most common metastasis location from right-sided colon cancer., Conclusions: Data suggest the existence of two different tumor entities in CRC between right-sided colon cancer and left-sided colon cancer. The proximal shift may be a reflection of improved screening programs, diagnostic accuracy and population aging. Ethnicity, gender, diet, environment, and socioeconomic status contribute to CRC incidence and prevalence in different regions.

Background: Intramedullary spinal cord metastases represent 4-8.5% of the central nervous system metastases and affect only 0.1-0.4% of all patients. Those originating from renal cell carcinoma (RCC) are extremely rare. Of the eight patients described in the literature with metastatic RCC and intramedullary cord lesion, only five were found in the cervical spine. Here, the authors add a 6 th case involving an RCC intramedullary metastasis at the C1-C2 level., Case Description: A 78-year-old male patient presented with intermittent cervicalgia of 5 months duration accompanied by few weeks of a progressive severe right hemiparesis, up to hemiplegia. The magnetic resonance imaging (MRI) examination revealed an intramedullary expansive lesion measuring 10 mm×15 mm at the C1-C2 level; it readily enhanced with contrast. A total body computed tomography (CT) scan documented an 85 mm mass involving the right kidney, extending to the ipsilateral adrenal gland, and posteriorly infiltrating the ipsilateral psoas muscle. The subsequent CT-guided fine-needle biopsy confirmed the diagnosis of an RCC (Stage IV). The patient next underwent total surgical total removal of the C1-C2 intramedullary mass, following which he exhibited a slight motor improvement, with the right hemiparesis (2/5). He died after 14 months due to global RCC tumor progression., Conclusion: The present case highlights that a patient without a prior known diagnosis of RCC may present with an intramedullary C1-C2 metastasis. In such cases, global staging is critical to determine whether primary lesion resection versus excision of metastases (e.g., in this case, the C1-C2 intramedullary tumor) are warranted., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

Background: Intradural disc herniations (IDHs) are rare occurrences (0.26-0.30%), and most frequently involve the lumbar spine at the L4-L5 level. Here, we present a patient with an L1-L2 IDH and reviewed the current literature., Case Description: A 65-year-old female presented with the acute onset of bilateral paraparesis accompanied by urinary dysfunction. The lumbar MRI showed a mass at the L1-L2 level with caudal migration, accompanied by a positive "hawk-beak" sign. At surgery, consisting of a L1-L2 laminectomy, a large IDH was encountered responsible for marked cauda equina/root compression. Postoperatively, the patient immediately fully recovered. The literature we identified cited just seven similar studies of L1-L2 IDH., Conclusion: In a 65-year-old female, an IDH was anticipated at the L1-L2 level due to the combined MR findings of a large L1-L2 mass with caudal migration and the positive "hawk-beak" sign., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Surgical Neurology International.)

Background: Histiocytic sarcoma affecting the central nervous system (CNS HS) in dogs may present as primary or disseminated disease, often characterized by inflammation. Prognosis is poor, and imaging differentiation from other CNS tumors can be problematic., Objective: To characterize the clinicopathological inflammatory features, breed predisposition, and survival in dogs with CNS HS., Animals: One hundred two dogs with HS, 62 dogs with meningioma., Methods: Retrospective case series. Records were reviewed for results of cerebrospinal fluid (CSF) analysis, CBC, treatment, and outcome data., Results: Predisposition for CNS HS was seen in Bernese Mountain Dogs, Golden Retrievers, Rottweilers, Corgis, and Shetland Sheepdogs (P ≤ .001). Corgis and Shetland Sheepdogs had predominantly primary tumors; Rottweilers had exclusively disseminated tumors. Marked CSF inflammation was characteristic of primary rather than disseminated HS, and neoplastic cells were detected in CSF of 52% of affected dogs. Increased neutrophil to lymphocyte ratios were seen in all groups relative to controls (P <.008) but not among tumor subtypes. Definitive versus palliative treatment resulted in improved survival times (P < .001), but overall prognosis was poor., Conclusions and Clinical Importance: Clinicopathological differences between primary and disseminated HS suggest that tumor biological behavior and origin may be different. Corgis and Shetland Sheepdogs are predisposed to primary CNS HS, characterized by inflammatory CSF. High total nucleated cell count and the presence of neoplastic cells support the use of CSF analysis as a valuable diagnostic test. Prognosis for CNS HS is poor, but further evaluation of inflammatory mechanisms may provide novel therapeutic opportunities., (© 2020 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.)

Two FGF4 retrogenes on chromosomes 12 (12- FGF4 RG) and 18 (18- FGF4 RG) contribute to short-limbed phenotypes in dogs. 12- FGF4 RG has also been associated with intervertebral disc disease (IVDD). Both of these retrogenes were found to be widespread among dog breeds with allele frequencies ranging from 0.02 to 1; however, their additive contribution to disease is unknown. Surgical cases of IVDD ( n = 569) were evaluated for age of onset, disc calcification, and genotypes for the FGF4 retrogenes. Multivariable linear regression analysis identified the presence of one or two copies of 12- FGF4 RG associated with significantly younger age at first surgery in a dominant manner. 18- FGF4 RG had only a minor effect in dogs with one copy. Multivariable logistic regression showed that 12- FGF4 RG had an additive effect on radiographic disc calcification, while 18- FGF4 RG had no effect. Multivariable logistic regression using mixed breed cases and controls identified only 12- FGF4 RG as highly associated with disc herniation in a dominant manner (Odds Ratio, OR, 18.42, 95% Confidence Interval (CI) 7.44 to 50.26; P < 0.001). The relative risk for disc surgery associated with 12- FGF4 RG varied from 5.5 to 15.1 within segregating breeds and mixed breeds. The FGF4 retrogene on CFA12 acts in a dominant manner to decrease the age of onset and increase the overall risk of disc disease in dogs. Other modifiers of risk may be present within certain breeds, including the FGF4 retrogene on CFA18., Competing Interests: The University of California at Davis has a patent pending for genetic testing for the chromosome 12 FGF4 retrogene.

A new sequence of eruptions occurred at Mt. Etna volcano during the first half of 2017, after almost 8 months of quiescence. These episodes had low-to-mild intensity and markedly differ from the violent paroxysms occurred at the Voragine Crater (VOR) during December 2015 and May 2016. Despite the general weak explosive nature of the eruptions, the activity during 2017 revealed unusually complex dynamics of magma ascent and interaction. Detection and investigation of such dynamics required a multidisciplinary approach in which bulk rock compositions, crystal chemical zoning, diffusion chronometry and ground deformation data have been combined. Bulk rock major and trace elements suggest that the 2017 magmas followed a differentiation path similar to that experienced by magmas erupted at Mt. Etna during the 2015-16 eruptions at VOR. Olivine core compositions and zoning patterns indicate the presence of multiple magmatic environments at depth that strictly interacted each other through some episodes of intrusion and mixing before and during the 2017 eruptive events. Timescales retrieved from diffusion chronometry on olivine normal and reverse zoning correlate well with the ground deformation stages detected through geodetic data and associated models, thus allowing to track the evolution through time of the 2017 volcanic activity. Combination of all petrological and geodetic observations supports the idea that dynamics of magma transfer driving the eruptive episodes of 2017 have been a direct consequence of the violent eruptions occurred at VOR on May 2016, which boosted the ascent of new magma from depth and improved the efficiency of the plumbing system to transfer it upward to the surface. We propose a mechanism of self-feeding replenishment of the volcano plumbing system during 2017, where magma recharge from depth is triggered by sudden unloading of the magma column consequential to the violent paroxysmal activity occurred on May 2016 at VOR.

Objective: To describe pet owner preferences within the veterinary community when choosing operative techniques for canine spay., Study Design: Prospective survey., Sample Population: 1234 respondents from 5 veterinary university teaching hospitals in North America., Methods: An electronic survey was distributed to faculty, students, and staff that currently are or previously were dog owners. Responses were analyzed to determine what spay technique respondents would choose for their own dogs. Surgical options offered included open celiotomy, 2-port (TP) laparoscopy, single-port (SP) laparoscopy, and natural orifice transluminal endoscopic surgery (NOTES)., Results: TP laparoscopic ovariectomy (OVE) was the most popular choice, followed by SP laparoscopic OVE; NOTES was the least popular technique when all surgical options were available. If only minimally invasive surgeries were offered, 0.3% of respondents would refuse surgery. Nearly half (48%) of respondents were willing to spend between $100 and $200 more for a minimally invasive OVE than for an open celiotomy., Conclusion: Minimally invasive OVE is an acceptable operative approach to those in the veterinary community. Additional study is required to correlate these findings with the general veterinary client population., (© 2018 The American College of Veterinary Surgeons.)

Lithium gradients in plagioclase are capable of recording extremely short-lived processes associated with gas loss from magmas prior to extrusion at the surface. We present SIMS profiles of the 7 Li/ 30 Si ion ratio in plagioclase crystals from products of the paroxysmal sequence that occurred in the period 2011-2013 at Mt. Etna (Italy) in an attempt to constrain the final ascent and degassing processes leading to these powerful eruptions involving basic magma. The observed Li concentrations reflect cycles of Li addition to the melt through gas flushing, and a syn-eruptive stage of magma degassing driven by decompression that finally produce significant Li depletion from the melt. Modeling the decreases in Li concentration in plagioclase by diffusion allowed determination of magma ascent timescales that are on the order of minutes or less. Knowledge of the storage depth beneath the volcano has led to the quantification of a mean magma ascent velocity of ~43 m/s for paroxysmal eruptions at Etna. The importance of these results relies on the application of methods, recently used exclusively for closed-system volcanoes producing violent eruptions, to open-conduit systems that have generally quiet eruptive periods of activity sometimes interrupted by sudden re-awakening and the production of anomalously energetic eruptions.

Given widespread misunderstanding of pregnancy risk, awareness of one's fertility has the potential to influence sexual and reproductive health behaviors. This mixed-methods study examined the impact of a serial radio drama in Rwanda, Impano n'Impamba, on fertility awareness and other factors related to family planning uptake by comparing listeners and non-listeners in a nationally representative household survey (n = 1477) and analyzing in-depth interviews with 32 listeners. Listeners had higher fertility awareness than non-listeners for key concepts, including the menstrual cycle, onset of fertility, and postpartum pregnancy risk. Qualitative interviews suggest discussion groups provided an invaluable opportunity to ask questions to a knowledgeable facilitator and clarify the fertility awareness information. No significant differences in modern family planning use or intention to use were found between listeners and non-listeners, but listeners reported greater supportive norms, self-efficacy, and discussion of family planning. Qualitative interviews suggest that increased discussion about family planning occurred because the drama emboldened people to talk about uncomfortable and taboo topics. Post-broadcast, listeners of Impano n'Impamba had greater fertility awareness then non-listeners and were more likely to experience intermediate outcomes related to family planning such as perception of positive family planning norms, a feeling of self-efficacy, and increased communication with others related to family planning. The study provides lessons for future interventions with the aim of increasing fertility awareness to improve sexual and reproductive health.

Objective: To describe the surgical technique and evaluate short-term outcome after minimally invasive small intestinal exploration and targeted organ biopsy with a wound retractor device (WRD) in cats., Study Design: Multi-institutional retrospective study., Animals: Forty-two cats., Methods: A wound retractor was inserted into the abdomen on the ventral midline through a 2-4 cm incision at the level of the umbilicus. Short segments (6-10 cm long) of intestinal tract were sequentially exteriorized and explored through the WRD. Full thickness, small intestinal biopsies were obtained extracorporeally via the WRD. A commercially available single-port device was inserted through the WRD for laparoscopic exploration of the abdomen., Results: The majority of the small intestine could be exteriorized and explored through the WRD. In all cases, full thickness biopsies of the small intestine of diagnostic quality were obtained. The most common histological findings were inflammatory bowel disease (n = 16), intestinal lymphoma (n = 14), and eosinophilic enteritis (n = 7). Two cases required conversion to a traditional open laparotomy due to abdominal pathology diagnosed after placement of the WRD (abdominal adhesions and need for a splenectomy). Postoperative complications occurred in 4 of 39 cats (10.3%), leading to 2 deaths after discharge from the hospital., Conclusions and Clinical Relevance: MISIETB with a WRD alone or combined with laparoscopy is a safe technique for small intestinal exploration and targeted abdominal organ biopsy in cats. Single-port laparoscopy can effectively be performed through the WRD for complete abdominal exploration and biopsy of abdominal organs., (© 2017 The American College of Veterinary Surgeons.)

Context: Given the proportion of Kenyan women not using hormonal contraceptives, the country appears to have a substantial need for a modern, natural family planning option. The CycleBeads® mobile phone application (app), a digital platform for the Standard Days Method® of family planning, could help address this issue., Methods: After the CycleBeads app was promoted in Kenya in May-June 2015, a three-month pilot study was conducted to collect quantitative and qualitative data from 185 female app users. Chi-square testing, binary logistic regression and thematic content analysis were used to assess whether the app brought new users to family planning, to understand users' experiences and to assess how user experiences vary by distribution channel., Results: Participants learned about the app through nongovernmental organizations (17%), via digital media (33%) or from family or friends (50%). Most used the app to track their periods (54%) or prevent pregnancy (37%); a few used it to plan a pregnancy (7%) or for other reasons (2%). The main reason for choosing the Standard Days Method was fear of side effects from hormonal methods (64%). The majority of women found the app and method easy to use (53%). Among those preventing pregnancy, 42% had never before used a method. By midline, all participants knew when fertile days occurred, and most (97%) knew the method's cycle-length requirements. Women reported high rates of condom use (88%), abstinence (68%) and withdrawal (46%) on fertile days., Conclusion: Offering the CycleBeads app to support women in use of the Standard Days Method may expand family planning options, reduce unmet need and make family planning more widely available.

Medical records of 22 dogs treated with carboplatin (n = 8) or carboplatin and cytarabine (n = 14) chemotherapy for relapsed or refractory lymphoma between 2000 and 2013 were retrospectively reviewed. The clinical response rate was 18.2% (4/22). Median time to progression was 18 days (56 for responders; 12 for non-responders, P = 0.0006). Median overall survival time was 28 days (109 for responders; 21 for non-responders, P = 0.0007). Thrombocytopenia and neutropenia occurred in 84.2% (16/19) and 52.6% (10/19), respectively. Grade IV thrombocytopenia and neutropenia occurred in 56.3% (9/16) and 60.0% (6/10), respectively. Dogs that received both drugs were more likely to become neutropenic (P = 0.022) or thrombocytopenic (P = 0.001) than dogs receiving carboplatin alone. All responders received both drugs giving a 28.6% (4/14) response rate for the combination. Although some dogs responded to the combination, toxicity was high and the responses were not durable. With adequate supportive care, this protocol may be an acceptable rescue option for some dogs., (© 2015 John Wiley & Sons Ltd.)

Male (n=66) water buffalo (Buffalo) and Brahman-influenced cattle (Brahman) were born, raised, weaned, fattened on grazing savannah and harvested at two different ages (19 and 24months) to compare lipid composition of the longissimus thoracis muscle. Half of the animals were castrated at seven months of age (MOA) to examine the castration effects. At 24 MOA Brahman steers showed the highest content of total lipids (P<0.05). No significant variation was detected in cholesterol content for either the main or interaction effects in the age groups. Some individual fatty acids varied with the species (P<0.05), however, interspecific similarities were found in fatty acid ratios. For health-related indices, only atherogenic index (AI) showed lower values in favor of Buffalo meat (P<0.05) at both harvesting ages. Although, meat derived from both bovid groups was leaner and showed lower cholesterol level, AI indicates that Buffalo meat might be beneficial from a human health standpoint., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objective: To evaluate the effects of the co-administration of midazolam on the dose requirement for propofol anesthesia induction, heart rate (HR), systolic arterial pressure (SAP) and the incidence of excitement., Study Design: Prospective, randomized, controlled and blinded clinical study, with owner consent., Animals: Seventeen healthy, client owned dogs weighing 28 ± 18 kg and aged 4.9 ± 3.9 years old., Methods: Dogs were sedated with acepromazine 0.025 mg kg(-1) and morphine 0.25 mg kg(-1) intramuscularly (IM), 30 minutes prior to induction of anesthesia. Patients were randomly allocated to receive midazolam (MP; 0.2 mg kg(-1) ) or sterile normal saline (CP; 0.04 mL kg(-1) ) intravenously (IV) over 15 seconds. Propofol was administered IV immediately following test drug and delivered at 3 mg kg(-1)  minute(-1) until intubation was possible. Scoring of pre-induction sedation, ease of intubation, quality of induction, and presence or absence of excitement following co-induction agent, was recorded. HR, SAP and respiratory rate (fR ) were obtained immediately prior to, immediately following, and 5 minutes following induction of anesthesia., Results: There were no significant differences between groups with regard to weight, age, gender, or sedation. Excitement occurred in 5/9 dogs following midazolam administration, with none noted in the control group. The dose of propofol administered to the midazolam group was significantly less than in the control group. Differences in HR were not significant between groups. SAP was significantly lower in the midazolam group compared with baseline values 5 minutes after its administration. However, values remained clinically acceptable., Conclusions and Clinical Relevance: The co-administration of midazolam with propofol decreased the total dose of propofol needed for induction of anesthesia in sedated healthy dogs, caused some excitement and a clinically unimportant decrease in SAP., (© 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.)

A 75.9-kg, 3.5-year-old male Irish Wolfhound dog with a 2-3-week history of gagging and eating difficulties was referred to the University of Florida Veterinary Medical Hospital (Gainesville, Florida) for evaluation of a large cranial mediastinal mass suspected to be a thymoma or lymphosarcoma. The patient had 4 months of nearly 10 kg progressive weight loss with severe flank sensitivity and radiographically apparent lumbar vertebral changes interpreted as discospondylitis. Lab work revealed hyperglobulinemia, mild proteinuria, normal T4, negative Brucella canis titer, and negative blood and urine bacterial cultures. A thoracotomy revealed a nonresectable, destructive, space-occupying mediastinal mass resulting in euthanasia without surgical recovery. Biopsies from the mass were collected during surgery for histology. Microscopic examination revealed extensive granulomatous cellulitis and lymphadenitis characterized by central cavitated necrotic areas containing debris and degenerate neutrophils, intermediate zones of fibrovascular proliferation with marked mixed inflammation, peripheral fibrosis, frequent multinucleated macrophages, and scattered mineralization. The necrotic material contained dense mats of 2 µm wide by 8-15 µm long fungal hyphae with parallel walls, acute angle branching, frequent septae, and occasional bulb-like dilations. DNA sequencing and phylogenetic analysis of the internal transcribed spacer region confirmed the presence of a fungus in the Inonotus tropicalis group. Inonotus tropicalis is primarily a wood decay fungus that is found on dead wood from angiosperms in tropical and subtropical habitats. Isolates of the I. tropicalis group have been detected a few times from immunosuppressed human beings with X-linked granulomatous disease.

Background: Respiratory syncytial virus (RSV) infection is associated to episodic exacerbations of asthma involving alveolar macrophages and chemokine production., Objective: The aim of this study was to determine the circulating levels of monocyte chemotactic protein 1 (MCP-1), regulated on activation normal T cell expressed and secreted (RANTES), and substance P (SP) in patients with and without asthma with acute respiratory RSV infection and the chemokine profile in RSV- infected monocyte cultures from normal individuals and individuals with asthma., Methods: In this regard, 31 adult patients with acute respiratory infection (15 patients with asthma) were studied. MCP-1, RANTES and SP were measured in serum and in supernatants from monocyte cultures by enzyme-linked immunosorbent assay (ELISA)., Results: Increased levels of MCP-1 and RANTES were observed in serum from patients with asthma related to RSV infection. RSV-infected monocyte cultures from healthy individuals showed increased content of those chemokines, and monocyte cultures from patients with asthma showed increased expression of MCP-1., Conclusion: These data show that RSV infection induces increased circulating level of chemokines in patients with asthma, and this finding could be mediated in part by the interaction virus-monocyte., (Copyright © 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Morbidity and mortality rates are higher in rheumatoid arthritis (RA) patients than in the general population. Many studies have shown that coronary artery disease is one of the most common causes of death in RA and seems to occur at a younger age than in the general population. RA per se is as much a cardiovascular (CV) risk factor as diabetes, arterial hypertension and dyslipidemia etc., and so it is necessary to plan a follow-up using the same diagnostic and therapeutic approaches as those commonly used for primary and secondary prevention in non-RA patients at high CV risk. All of the cardiac structures can be affected during the course of RA (valves, the conduction system, the myocardium, endocardium and pericardium, and the coronary arteries), and cardiac complications include a variety of clinical manifestations. As these are all associated with an unfavourable prognosis, it is essential to detect subclinical cardiac involvement in still asymptomatic RA patients in order to assure adequate long-term treatment., (Copyright 2009 Elsevier B.V. All rights reserved.)

Decreased expression and/or activity of antioxidant proteins leads to oxidative stress, accelerated aging, and neurodegeneration. While overwhelming levels and uncontrolled/dysregulated actions of reactive oxygen species (ROS) lead to deleterious effects, tighter regulation of those plays an important role in cell signaling. Mutations causing protein misfolding and the overload of toxic products derived from the free radical oxidation of polyunsaturated fatty acids, cholesterol, and glucose contribute to the disruption of the cellular redox homeostasis. Collectively or individually, these effects create pro-oxidant conditions in cells. Oxidative stress can induce neuronal damage, modulate intracellular signaling, and can ultimately lead to neuronal death by apoptosis or necrosis. Emerging evidence indicates that homocysteine (Hcy), a non-protein amino acid naturally present in the plasma, is implicated as a risk factor for numerous diseases. In particular, increased levels of circulating Hcy have been recognized as an independent risk factor for the development of vascular disease(s). Recent findings emphasize a relationship between elevated Hcy levels and neurodegeneration, which can be observed in Alzheimer's and Parkinson's diseases. An integrated response exists in the brain to detect and control diverse forms of stress. This is accomplished by a complex network of the so-called longevity assurance processes, which are controlled by several genes termed "vitagenes." Among these, the heat-shock proteins (HSPs) form a highly conserved system that is responsible for the preservation and repair of the correct protein conformation. Recent studies have shown that the heat-shock response (HSR) contributes to cytoprotection in a number of human diseases including inflammation, cancer, aging, and neurodegenerative disorders. Given the broad cytoprotective properties of the HSR, interest mounts currently among investigators toward discovering and developing pharmacological agents capable of inducing HSR. L: -Acetylcarnitine (LAC) is proposed as a therapeutic agent for several neurodegenerative disorders and also current evidence suggests that the compound may play a critical role in the modulation of cellular stress response in health and disease conditions. Here, we review the emerging salient concepts highlighting the pathways of neurodegeneration and the role of LAC in modulating the redox-dependent mechanisms responsible for the upregulation of vitagenes in brain that leads to the enhancement of stress tolerance in brain.

Background: Intestinal transport exhibits distinct diurnal rhythmicity. Understanding the mechanisms behind this may reveal new therapeutic strategies to modulate intestinal function in disease states such as diabetes and obesity, as well as short bowel syndrome. Although diurnal rhythms have been amply documented for several intestinal transporters, the complexity of transepithelial transport has precluded definitive attribution of rhythmicity in glucose uptake to a single transporter. To address this gap, we assessed temporal changes in glucose transport mediated by the Na(+)/glucose cotransporter SGLT1., Methods: SGLT1 expression was assessed at 4 times during the day: ZT3, ZT9, ZT15, and ZT21 (ZT, Zeitgeber time; lights on at ZT0; n = 8/ time). SGLT1 activity, which is defined as glucose uptake sensitive to the specific SGLT1 inhibitor phloridzin, was measured in everted intestinal sleeves. Changes in Sglt1 expression were assessed by real-time polymerase chain reaction (PCR) and immunoblotting., Results: Glucose uptake was significantly higher at ZT15 in jejunum (P < 0.05 vs ZT3). Phloridzin significantly reduced glucose uptake and completely abolished its rhythmicity. Sglt1 mRNA levels were significantly greater at ZT9 and ZT15 in jejunum and ileum, respectively (P < 0.05 vs ZT3), whereas SGLT1 protein levels were significantly greater at ZT15 in jejunum (P < 0.05 vs ZT3)., Conclusions: Our results definitively link diurnal changes in intestinal glucose uptake capacity to changes in both SGLT1 mRNA and protein. These findings suggest that modulation of transporter expression would enhance intestinal function and provide an impetus to elucidate the mechanisms that underlie diurnal rhythmicity in transcription. Modulation of intestinal function would benefit the management of malnutrition as well as diabetes and obesity.

The longissimus dorsi thoracis (LDT) of 64 water buffalo and 68 Zebu-influenced cattle was used to determine the mineral content variation (mg/100g of fresh tissue) according to species, age (7, 17, 19 and 24 months-of-age, MOA) and gender (steers and bulls). Buffalo LDT had higher concentrations of K, Mn, Fe, Zn and Cu at weaning (P<0.05). Phosphorous content was higher (P<0.05) at post-weaning ages. Mineral profile was affected by age without clear trends; the Na and K contents increased at 24 MOA. The age×species, age×gender and species×gender interactions affected (P<0.05) Fe content that ranged from 1.74 to 2.56mg/100g fresh tissue. Meat from both species contributes with more of 25% of K, P, Fe and Zn of the daily requirement for an adult.