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Background: Deroofing and local excision are common clinic-based surgical options for hidradenitis suppurativa (HS). Evidence suggests deroofing may have lower rates of adverse events (AEs), defined as disease recurrence or post-surgical complications., Objective: This cost-utility analysis evaluates the economic and health-related impacts of clinic-based deroofing versus excision for HS, comparing direct medical costs and quality-adjusted life-years (QALYs)., Methods: A Markov model was developed based on a literature review of clinical outcomes, EQ-5D utilities, and resource utilization. Patients began in a pre-procedural state and transitioned monthly between three health states: responders (no AEs), non-responders (≥1 AE), and death. The model assessed cost-effectiveness over a two-year horizon from the U.S. healthcare system perspective., Results: Deroofing provided an additional 0.19 QALYs at a cost of USD$311.39 per patient relative to excision, yielding a favorable incremental cost-effectiveness ratio of USD$1,677.10/QALY, below the USD$50,000/QALY threshold., Limitations: Methodological constraints from limited published data were addressed through multiple sensitivity analyses. Cost-effectiveness was sensitive to AE rates, secondary costs, and utility values., Conclusion: Deroofing is more cost-effective than excision for clinic-based procedural management of HS, offering improved QoL at a modest incremental cost., (Copyright © 2024. Published by Elsevier Inc.)

National trends show rapid increases in the use of mechanical circulatory support devices (MCSD) over the last 20 years. While current literature has not proven a mortality benefit in cardiogenic shock as a complication of acute myocardial infarction (AMI-CS) with percutaneous MCSD, these devices are vital to maximizing cardiopulmonary parameters for definitive therapy. To minimize complications, many different techniques have been described including a novel off-pump direct apical cannulation for venoarterial-extracorporeal membrane oxygenation (VA-ECMO). This technique allows early ambulation and avoids peripheral artery access complications but has only been described in small case series. Our case series represents the largest summary of patients (50) using this technique and contains the only comparison data to date. Fifty-four percentage of our patients were Society for Cardiovascular Angiography and Interventions (SCAI) stage D and 22% were arrested before cannulation. We achieved flows on average >5 L/min and most patients required biventricular drainage (86%) and an oxygenator (92%). Thirty day survival was 56% and most survivors were bridged to heart transplant (30%). Our most common complication was bleeding (16%). This technique showed significant improvement in ejection fraction (EF), cardiac output/index (CO/CI), and pulmonary artery pressures. This case series demonstrates the safety and efficacy of this novel technique for central cannulation in cardiogenic shock at large scale within a single institution., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © ASAIO 2024.)

Cancer patients, due to their immunocompromised status, are at an increased risk for severe SARS-CoV-2 infection. Since severe SARS-CoV-2 infection causes multiple organ damage through IL-6-mediated inflammation while stimulating hypoxia, and malignancy promotes hypoxia-induced cellular metabolic alterations leading to cell death, we propose a mechanistic interplay between both conditions that results in an upregulation of IL-6 secretion resulting in enhanced cytokine production and systemic injury. Hypoxia mediated by both conditions results in cell necrosis, dysregulation of oxidative phosphorylation, and mitochondrial dysfunction. This produces free radicals and cytokines that result in systemic inflammatory injury. Hypoxia also catalyzes the breakdown of COX-1 and 2 resulting in bronchoconstriction and pulmonary edema, which further exacerbates tissue hypoxia. Given this disease model, therapeutic options are currently being studied against severe SARS-COV-2. In this study, we review several promising therapies against severe disease supported by clinical trial evidence-including Allocetra, monoclonal antibodies (Tixagevimab-Cilgavimab), peginterferon lambda, Baricitinib, Remdesivir, Sarilumab, Tocilizumab, Anakinra, Bevacizumab, exosomes, and mesenchymal stem cells. Due to the virus's rapid adaptive evolution and diverse symptomatic manifestation, the use of combination therapies offers a promising approach to decrease systemic injury. By investing in such targeted interventions, cases of severe SARS-CoV-2 should decrease along with its associated long-term sequelae and thereby allow cancer patients to resume their treatments., (© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Ischemic stroke is the second leading cause of death worldwide. Following an ischemic event, neuronal death is triggered by uncontrolled glutamate release leading to overactivation of glutamate sensitive N -methyl-d-aspartate receptor (NMDAR). For gating, NMDARs require not only the binding of glutamate, but also of glycine or a glycine-like compound as a co-agonist. Low glycine doses enhance NMDAR function, whereas high doses trigger glycine-induced NMDAR internalization (GINI) in vitro . Here, we report that following an ischemic event, in vivo , GINI also occurs and provides neuroprotection in the presence of a GlyT1 antagonist (GlyT1-A). Mice pretreated with a GlyT1-A, which increases synaptic glycine levels, exhibited smaller stroke volume, reduced cell death, and minimized behavioral deficits following stroke induction by either photothrombosis or endothelin-1. Moreover, we show evidence that in ischemic conditions, GlyT1-As preserve the vasculature in the peri-infarct area. Therefore, GlyT1 could be a new target for the treatment of ischemic stroke., Competing Interests: We have no competing interest to declare., (© 2021 The Authors.)

The European roe deer (Capreolus capreolus) is one of the most abundant ungulate species in Europe. Many studies have investigated its distribution, behavior, and ecology, but few have focused on its role as bioindicators for pollutants, particularly regarding antlers, which has been shown to indicate also deer physiology. The presence of geothermal power plants can induce accumulation of potentially polluting elements (such as Tl, S, and Pb). Thus, we collected roe deer samples from areas of Tuscany (Italy) where power plants are present. They were divided according to whether their home range included areas close or far from geothermal power plants. We analyzed the body measurements and the profile of the minerals in the liver and antlers tissues using the ICP-OES technique. Results showed that livers from roe deer close to power plant accumulated higher quantity of Bi, Co, Ni, Tl, and S compared to controls. Males culled close to geothermal power plants had significantly lower values for weight and chest circumference, and also, the antlers showed higher values for Li and Sr in the first sampling position. Thus, despite the small sample size in this preliminary study, antlers and livers of roe deer seem to be a bioindicator of industrial impact on the environment.

: This study describes the effects that Cu supplementation of late-gestating and lactating females (hinds) of Iberian red deer fed a balanced diet have on milk production, composition, and somatic cell count (SCC). Experimental hinds ( n = 9) were subcutaneously injected every 42 days with Cu (0.83 mg Cu/kg body weight) from day 202 of gestation until the end of lactation (week 18). Control hinds ( n = 8) were injected with a physiological saline solution with the same volume and at the same frequency as the experimental group. Copper supplementation decreased the SCC from 1.64 to 1.36 log 10/mL ( p = 0.003) and modified the milk mineral profile. In particular, milk from hinds supplemented with Cu had more Ca ( p = 0.02), Mg ( p = 0.06), and K ( p = 0.03) than milk from control hinds. However, Cu supplementation did not influence the Cu content of milk. Therefore, it can be concluded that Cu supplementation of hinds fed a balanced diet from late-gestation to the end of lactation could be a good strategy to reduce SCC and modify the mineral profile of milk increasing its Ca content., Competing Interests: The authors declare no conflicts of interest.

Traditional brain retraction has been associated with significant damage to the healthy brain tissue particularly when attempting to expose a deep-seated lesion of the brain. Tubular retractors tend to provide a surgical corridor to treat these lesions while minimizing the extent of retraction on the brain. Intraoperative ultrasound can be used as a handy adjunct in maximizing the safe resection primarily by identifying the entry point, visualizing the lesion, and providing real-time feedback on the extent of resection. The authors provide a technical note with case illustrations on the use of tubular retractors augmented with intraoperative ultrasound to ensure a maximal safe resection of deep-seated brain lesions., Competing Interests: The authors have declared financial relationships, which are detailed in the next section.

Horns are permanent structures projecting from the head of bovids, consisting of a bony horncore covered with a layer of skin and then a sheath of keratinous material showing variability of growth intensity based on nutrition. From the point of view of the horn's mechanical properties, the keratin sheath has been widely studied, but only a few studies have considered the complete structure of the horn and fewer studies have focused on the bony horncore and its characteristics. The latter showed the important role of the bony core, when cranial appendages are subject to mechanical stress (as happens during fighting). The mechanical properties of bone material, along with its mineral profile, are also important, because they can show effects of different factors, such as nutrition and mineral deficiencies in diet. For this reason, eight horncores of captive common eland male were sampled at four positions along the vertical axis of the horn. The main aim was to study variation in mechanical properties and the mineral content along the vertical axis of the horncores. We further analysed whether the spiral bony ridge present on eland horncores differs in any of the studied properties from adjacent parts of the horncore. In other antelopes, spiral ridges on the horns have been proposed to increase grip during wrestling between males. Cross-sections of the horncores were performed at four positions along the longitudinal axis and, for each position, two bone bars were extracted to be tested in impact and bending. Moreover, in the first sampling position (the closest position to the base) two bars were extracted from the spiralled bony area. The resulting fragments were used to measure ash content, bone density and mineral content. Results showed that horn bone decreased along the vertical axis, in ash (-36%), density (-32%), and in impact work 'U' (marginally significant but large effect: -48%). The concentration of several minerals decreased significantly (Mg, Cr, Mn and Tl by -33%, -25%, -31%, -43%, respectively) between the basal and the uppermost sampling site. The bone tissue of the horncore spiral compared with non-spiral bone of the same position showed a lower ash content (53% vs. 57%), Mg and Mn; in addition to showing approximately half values in work to peak force 'W', bending strength 'BS' and 'U', but not in Young's modulus of elasticity 'E'. In conclusion, similarly to the results in a totally different fighting bony structure, the antlers, the horncore of eland shows advantageous parameters in bone tissue of the base in respect to the tip, with higher values for mechanical properties, density and mineral profile. Moreover, the spiral bone tissue showed lower material mechanical properties. Probably the spiral tissue of the horn may have a role in deflecting potential cross-sectional fractures during wrestling. In addition, it may serve to improve the grip during wrestling, and we propose that it may also prevent risk of rotation of sheath with respect to internal bone not only in this, but also in other straight bovid horns., (© 2017 Anatomical Society.)

Bone ash, collagen, Ca and P composition, are considered the main factors affecting mechanical properties in bones. However, a series of studies in bone and antler have shown that some trace minerals, such as manganese, may play a role whose importance exceeds what may be expected considering their low content. A previous study showed that a reduction in manganese in antlers during a year of late winter frosts led to generalized antler breakage in Spain, which included a reduction of 30% of cortical thickness, 27% reduction in impact energy, and 10% reduction in work to peak force. Starting for this observation, we experimentally studied the effects of manganese supplementation in adults and yearling (yearlings) red deer under a balanced diet. Subjects were 29 deer of different age classes (adult n = 19, yearlings n = 10) that were divided in a manganese injected group (n = 14) and a control group (n = 15). Antler content in ashes and minerals, intrinsic mechanical properties and cross section structure were examined at 4 points along the antler beam. A one way ANOVA (mean per antler) showed that in yearlings, manganese supplementation only increased its content and that of Fe. However, in adults, Mn supplementation increased the mean content per antler of Ca, Na, P, B, Co, Cu, K, Mn, Ni, Se (while Si content was reduced), and impact work but not Young's modulus of elasticity, bending strength or work to peak force. A GLM series on characteristics in the uppermost part examined in the antler, often showing physiological exhaustion and depletion of body stores, showed also a 16% increase in work to peak force in the antlers of the treated group. Thus, manganese supplementation altered mineral composition of antler and improved structure and some mechanical properties despite animals having a balanced diet.

A 66-year-old woman presented with abdominal pain and weight loss. Ultrasonography and computed tomography demonstrated a cystic lesion of the pancreas. After surgical resection, the patient's symptoms disappeared. Microscopic examination of the cyst lining showed mature, keratinizing squamous epithelium, surrounded by lymphoid tissue. Only three cases of this type of lesion, called "lymphoepithelial cyst", have been described previously. Histogenesis of this particular type of cyst is not well know, but can be histologically differentiated from other pancreatic cysts.

With reference to a new case of pancreatic cystadenoma, the authors review the literature on the subject. These tumors are a relatively uncommon form of cystic lesion of the pancreas. They find the origin from pancreatic acinar cells or from ductal epithelium. Histologically, there are two different forms: benign, serous, microcystic adenoma and potentially malignant, mucinous, macrocystic adenoma. The type of the tumor is demonstrated by ultrasonography and computed tomography. but these examinations could not make a difference between benign and malignant form. Treatment of choice is complete tumor resection. Internal or external drainage of these cysts should not be done.

The object of this study was to value the efficacy of reflux oesophagitis treatment by H2-blockers. Fifty-one patients were treated by Cimetidine or Ranitidine. After three months, we note a clinical improvement in 84% of cases and a regression of the endoscopic lesions in 61% of cases. A long term overlooking shows a high number of recurrences when the treatment is stopped, whereas the chronic treatment has essentially a stabilizing effect on the lesions.