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Alzheimer's disease (AD) is the most common neurodegenerative disease, with an increasing prevalence. Currently, there is no ideal diagnostic molecular imaging agent for diagnosing AD. Antibodies (Abs) have been proposed to close this gap as they can bind selectively and with high affinity to amyloid β (Aβ)--one of the molecular hallmarks of AD. Abs can even be designed to selectively bind Aβ oligomers or isoforms, which are difficult to target with small imaging agents. Conventionally, Abs must be labeled with long-lived radionuclides which typically results in in high radiation burden to healthy tissue. Pretargeted imaging could solve this challenge as it allows for the use of short-lived radionuclides. To develop pretargeted imaging tools that can enter the brain, AD mouse models are useful as they allow testing of the imaging approach in a relevant animal model that could predict its clinical applicability. Several mouse models for AD have been developed with different characteristics. Commonly used models are: 5xFAD, APP/PS1 and tg-ArcSwe transgenic mice. In this study, we aimed to identify which of these models were best suited to investigate pretargeted imaging approaches beyond the blood brain barrier. We evaluated this by pretargeted autoradiography using the Aβ-targeting antibody 3D6 and an 111In-labeled Tz. Evaluation criteria were target-to-background ratios and accessibility. APP/PS1 mice showed Aβ accumulation in high and low binding brain regions and is as such less suitable for pretargeted purposes. 5xFAD and tg-ArcSwe mice showed similar uptake in high binding regions whereas low uptake in low binding regions and are better suited to evaluate pretargeted imaging approaches. 5xFAD mice are advantaged over tg-ArcSwe mice as pathology can be traced early (6 months compared to 18 months of age) and as 5xFAD mice are commercially available. [ABSTRACT FROM AUTHOR]

Placenta previa-accreta spectrum disorders are a cause of obstetric hemorrhage that can lead to maternal fetal mortality and morbidity. We aimed to describe the use of a uterine isthmic tourniquet left in situ as a new uterus-preserving approach for patients with placenta previa-accreta. In this retrospective comparative study, the patients who underwent surgery for placenta previa between 2017 and 2024 at our tertiary hospital were reviewed. Primary outcome of the study is to evaluate feasibility of uterine isthmic tourniquet left in situ for uterine preserving by preventing postpartum hemorrhage for patients with placenta previa-accreta. As a secondary outcome, group 1 (n=28) patients who were managed with uterine isthmic tourniquet left in place were compared with patients in group 2 (n=32) who were managed with only bilateral uterine artery ligation. This new approach uterine isthmic tourniquet technique prevented postpartum hemorrhage with a rate of 100 percent in group 1 patients, while uterine artery ligation prevented postpartum hemorrhage with a rate of 75 % in group 2. Postoperative additional interventions (relaparotomy hysterectomy, balloon tamponade application, uterine or vaginal packing) were performed for eight patients in group 2 (25 %) but not in group 1 (0 %) (p=0.015). The haemoglobin levels before caesarean section were similar in both groups (p=0.235), while the postoperative haemoglobin levels were lower in group 2 (9.69 ± 1.37 vs. 8.15 ± 1.32) (p=0.004). Erythrocyte suspension was given to two patients in group 1 and 12 patients in group 2 (2/28 7 % vs. 12/32 37 %, p=0.018). The uterine isthmic tourniquet left in situ technique is a safe, simple and effective for preventing postpartum hemorrhage and preserving uterus during placenta previa accreta surgery as superior to uterine artery ligation alone. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to investigate the effects of Umbelliferone (UMB) on the inflammation underlying alveolar bone resorption in mouse periodontitis. Methods: Male Swiss mice subjected to a ligature of molars were grouped as non‐treated (NT), received UMB (15, 45, or 135 mg/kg) or saline daily for 7 days, respectively, and were compared with naïve mice as control. Gingival tissues were evaluated by myeloperoxidase (MPO) activity and interleukin‐1β level by ELISA. The bone resorption was directly assessed on the region between the cement–enamel junction and the alveolar bone crest. Microscopically, histomorphometry of the furcation region, immunofluorescence for nuclear factor‐kappa B (NF‐ĸB), and immunohistochemistry for tartrate‐resistant acid phosphatase (TRAP), and cathepsin K (CTSK) were performed. Systemically, body mass variation and leukogram were analyzed. Results: Periodontitis significantly increased MPO activity, interleukin‐1β level, and NF‐ĸB+ immunofluorescence, and induced severe alveolar bone and furcation resorptions, besides increased TRAP+ and CTSK+ cells compared with naïve. UMB significantly prevented the inflammation by reducing MPO activity, interleukin‐1β level, and NF‐ĸB+ intensity, besides reduction of resorption of alveolar bone and furcation area, and TRAP+ and CTSK+ cells compared with the NT group. Periodontitis or UMB treatment did not affect the animals systemically. Conclusion: UMB improved periodontitis by reducing inflammation and bone markers. [ABSTRACT FROM AUTHOR]

Background and Objectives Bleeding agents play a vital role in preventing complications from uncontrolled bleeding, such as death and organ damage. In addition to maximum coagulation speed and minimal blood loss, these compounds should have features such as biocompatibility, degradability, hemocompatibility, suitable mechanical properties, reasonable price, and ease of use. Recent research shows that some natural polymers such as oxidized cellulose, chitosan, starch, collagen and alginate have blood clotting properties. This study has investigated the binding performance, polymer source of these materials and products available in the market. Materials and Methods In this research, the role of bleeding coagulation by natural polymers was investigated in 55 authentic English and Farsi articles. International and Persian publications such as Elsevier, Springer, Wiley Online Library, ScienceDirect and SID were used. Keywords and functional words such as blood clots, sodium alginate, chitosan, hemostatic, oxidized cellulose, collagen and starch were used for searching. Results The first step in wound healing is ligation. Subsequent steps that contribute to tissue regeneration include inflammation, proliferation, and remodeling. These materials are divided into synthetic and natural in the world market and research works. Natural coagulant polymers include oxidized cellulose, chitosan, collagen, starch, and alginate. Next, description of natural polymers, brief introduction of synthetic polymers, physical structure of binders and commercial samples have been discussed. Conclusions The use of natural polymers as hemostatic agents shows the high potential of these substances in improving therapeutic processes and reducing the side effects caused by synthetic substances, which can lead to the development of new and effective strategies in the management of acute bleeding. [ABSTRACT FROM AUTHOR]

Objective: Peri‐implantitis is one of the most common complications of implants. However, its pathogenesis has not been clarified. In recent years, mouse models are gradually being used in the study of peri‐implantitis. This review aims to summarize the methods used to induce peri‐implantitis in mice and their current applications. Method: Articles of peri‐implantitis mouse models were collected. We analyzed the various methods of inducing peri‐implantitis and their application in different areas. Results: Most researchers have induced peri‐implantitis by silk ligatures. Some others have induced peri‐implantitis by Pg gavage and LPS injection. Current applications of peri‐implantitis mouse models are in the following areas: investigation of pathogenesis and exploration of new interventions, comparison of peri‐implantitis with periodontitis, the interaction between systemic diseases and peri‐implantitis, etc. Conclusion: Silk ligature for 2–4 weeks, Pg gavage for 6 weeks, and LPS injection for 6 weeks all successfully induced peri‐implantitis in mice. Mice have the advantages of mature gene editing technology, low cost, and short time to induce peri‐implantitis. It has applications in the study of pathogenesis, non‐surgical treatments, and interactions with other diseases. However, compared with large animals, mice also have a number of disadvantages that limit their application. [ABSTRACT FROM AUTHOR]

Objective: To determine and compare pregnancy outcomes after bilateral uterine artery ligation (BUAL) or bilateral hypogastric artery ligation (BHAL) for postpartum hemorrhage (PPH). Material and Methods: This retrospective cross-sectional study was conducted from January 2010 to June 2018 at a tertiary referral hospital. Patients who had undergone arterial ligation for PPH were included in the study. Patients who had undergone BUAL and BHAL were compared with a control group in terms of fertility and pregnancy outcomes. Results: A total of 156 patients were included, of whom 47 underwent BUAl, 59 underwent BHAL and 50 were in the control group. There was no significant difference between the groups in subsequent pregnancies in terms of the incidence of miscarriage, fetal growth restriction, preeclampsia, primary cesarean deliveries, and infertility (p>0.05). There was a significant difference between all groups in gestational age at birth and birthweight. Preterm birth was observed in 32.2% of patients in the BHAL group, and this rate was significantly higher than in the BUAL (12.8%) and control (6%) groups (p=0.001). Conclusion: PPH is a life-threatening obstetric problem. The effects of interventions performed to reduce pelvic blood flow in patients may lead to persistent problems, such as preterm birth and low birth weight in the next pregnancy. However, these interventions do not appear to affect the risk of miscarriage. In subsequent pregnancies of patients who received BHAL, special attention should be paid to preterm birth. [ABSTRACT FROM AUTHOR]

Case: A 22-year-old man with a type IIIA open AO/OTA 61C2.2b pelvis fracture and hypotension received exploratory laparotomy, temporary open ligation of the bilateral internal iliac arteries, and retroperitoneal packing. After prompt fracture debridement, a pelvic binder was positioned over the thighs as a reduction aid and maintained for six hours during pelvis open reduction internal fixation. Bilateral anterior thigh compartment syndrome was diagnosed three hours after packing and binder removal. Conclusion: Prolonged application of a pelvic binder to the thighs as an intraoperative reduction tool, shortly after temporary internal iliac artery ligation, may be associated with reperfusion injury and thigh compartment syndrome. [ABSTRACT FROM AUTHOR]

Background: Buyang Huanwu Decoction (BYHWD) is a traditional Chinese medicine to treat the syndrome of qi deficiency and blood stasis. Platelets play an important role in regulating thrombus and inflammation after ischemic injury, studies have shown that BYHWD regulate myocardial fibrosis and exert anti-inflammatory effects through IL-17 and TLR4 pathways, but the mechanism of platelet activation by BYHWD in stable coronary heart disease is still unknown. In the present study, model of left anterior descending coronary artery ligation was applied to investigate the mechanisms of BYHWD on modulating platelets hyperreactivity and heart function after fibrosis of ischemic myocardial infarction (MI). Methods: Myocardial infarction model was constructed by ligation of the left anterior descending coronary artery. The rats were randomly divided into five groups: sham, model, MI with aspirin (positive), MI with a low dosage of BYHWD (BYHWD-ld) and MI with a high dosage of BYHWD (BYHWD-hd) for 28 days. Results: Coronary artery ligation prominently induced left ventricle dysfunction, increased cardiomyocyte fibrosis, which was accompanied by platelets with hyperreactivity, and high levels of inflammatory factors. BYHWD obviously reversed cardiac dysfunction and fibrosis, increased the thickness of the left ventricular wall, and inhibited aggregation ratio and CD62p expression. BYHWD restored the mitochondrial respiration of platelets after MI, concomitant with an increased telomere expression and decreased inflammation. According to the result of transcriptome sequencing, we found that 106 differentially expressed genes compared model with BYHWD treatment. Enrichment analysis screened out the Ras-related protein Rap-1 (Rap1) signaling pathway and platelet activation biological function. Quantitative real-time PCR and Western blotting were applied to found that BYHWD reduced the expression of Rap1/PI3K-Akt/Src-CDC42 genes and attenuated the overactivity of PI3 kinase/Rap1/integrin α(IIb)β(3) pathway. Conclusion: BYHWD reduced inflammation and platelet activation via the PI3 kinase/Rap1/integrin α(IIb)β(3) pathway and improved heart function after MI. [ABSTRACT FROM AUTHOR]

Objective: To compare the clinical effect of Zusanli electroacupuncture with different frequency in the treatment of patients with spleen deficiency qi depression syndrome mixed hemorrhoid external stripping and internal ligation surgery, and to provide clinical guidance for the rehabilitation of patients with spleen deficiency qi depression syndrome mixed hemorrhoid external stripping and internal ligation surgery. Methods: A total of 106 cases of patients with spleen deficiency qi depression syndrome mixed hemorrhoid external stripping and internal ligation surgery were selected and divided into study group (n=53) and control group (n=53) by random number table method. Both groups were given basic treatment with hemostatic, anti-inflammatory and analgesic drugs, while the control group was given Zusanli electroacupuncture 30 min before surgery, once a day. The study group was given Zusanli electroacupuncture30min before surgery and 2 h after surgery, twice a day. The scores of anal pain score, anal edema score, symptom relief time and pain stress mediators were compared between the two groups. Results: The anal pain score of both groups decreased 24 h after operation (P＜0. 05) and the study group was lower than the control group (P＜0. 05). The anal edema score decreased 24 h after operation in both groups (P＜0. 05), and the score in the study group was lower than that in the control group (P＜0. 05). The symptom relief (edema, pain) time in the study group was shorter than that in the control group (P＜0. 05). Prostaglandin E2 (PGE²), Substance P (SP), cortisol (COR) and adrenocorticotropin (ACTH) decreased 24 h after operation in both groups (P＜0. 05), and the study group was lower than the control group (P＜0. 05). Conclusion: The effect of Zusanli electroacupuncture is better in patients with spleen deficiency qi depression syndrome mixed hemorrhoid external stripping and internal ligation surgery. Compared with Zusanli electroacupuncture once a day, Zusanli electroacupuncture twice a day is more beneficial to improve the scores of anal pain and anal edema, clinical symptoms and pain stress mediators. [ABSTRACT FROM AUTHOR]

Background: Periodontitis is a chronic inflammatory disease mediated by dysbiosis of the oral microflora, resulting in the destruction of periodontal tissue. Increasing evidence suggested that mesenchymal stem cell (MSCs) and exosomes derived from MSCs play a critical role in periodontal tissue regeneration. However, whether stem cells from exfoliated deciduous teeth (SHED)‐secreted exosomes can improve the therapeutic potential of periodontitis is largely unknown. Objective: Here, we aim to evaluate the effect of SHED‐exosomes on inflammation, apoptosis and osteogenic differentiation in periodontitis. Methods: The periodontitis cell model was constructed by stimulating periodontal ligament stem cells (PDLSCs) with lipopolysaccharide (LPS), and the periodontitis rats were established by ligation. Results: First, we isolated exosomes from the SHED, and we figured out that exosomes secreted by SHED were enriched in miR‐92a‐3p and the exosomes enhanced proliferation and osteogenic differentiation and reduced apoptosis and inflammatory responses in PDLSCs. In addition, we found that SHED‐exosomes alleviated inflammatory effect and elevated the expression of osteogenic‐related genes in periodontitis rat model. Moreover, miR‐92a‐3p targeted downstream Krüppel‐Like Transcription Factor 4 (KLF4) and regulated the PI3K/AKT pathway. Finally, our data indicated that upregulation of KLF4 or activation of PI3K/AKT by 740Y‐P counteracted the inhibitory effect of SHED‐exosomes on periodontitis progression. Conclusion: Taken together, our finding revealed that exosomal miR‐92a‐3p derived from SHED contributed to the alleviation of periodontitis development and progression through inactivating the KLF4/PI3K/AKT signaling pathway, which may provide a potential target for the treatment of periodontitis. [ABSTRACT FROM AUTHOR]

Background and Objective: The biological effects of atmospheric plasma (cold plasma) show its applicability for controlling the etiological factors that involve tissue repair. Thus, the study evaluated the effect of atmospheric plasma therapy in the control of tissue inflammation and bone remodeling in experimental periodontitis. Methods: Fifty‐six rats were subjected to ligation in the cervical region of the first maxillary molars (8 weeks). The animals were divided into two groups (n = 28): periodontitis without treatment group (P group), and periodontitis with atmospheric plasma treatment group (P + AP group). Tissue samples were collected at 2 and 4 weeks after treatment to analyze the inflammation and bone remodeling by biochemical, histomorphometric, and immunohistochemical analyses. Results: Inflammatory infiltration in the gingival and periodontal ligament was lower in the P + AP group than in the P group (p <.05). The MPO and NAG levels were higher in the P + AP group compared to P group (p <.05). At 4 weeks, the TNF‐α level was lower and the IL‐10 level was higher in the P + AP group compared to P group (p <.05). In the P + AP group, the IL‐1β level increased in the second week and decreased in the fourth week (p <.05), the number of blood vessels was high in the gingival and periodontal ligament in the second and fourth week (p <.05); and the number of fibroblasts in the gingival tissue was low in the fourth week, and higher in the periodontal tissue in both period (p <.05). Regarding bone remodeling, the RANK and RANKL levels decreased in the P + AP group (p <.05). The OPG level did not differ between the P and P + AP groups (p >.05), but decreased from the second to the fourth experimental week in P + AP group (p <.05). Conclusions: The treatment of experimental periodontitis with atmospheric plasma for 4 weeks modulated the inflammatory response to favor the repair process and decreased the bone resorption biomarkers, indicating a better control of bone remodeling in periodontal disease. [ABSTRACT FROM AUTHOR]

Objective Hydroxychloroquine (HCQ) has immunomodulatory, antithrombotic, cardiovascular, antimicrobial, and antineoplastic effects. In this study, we aimed to investigate the antiapoptotic and immunomodulator effects of intraperitoneal HCQ on hypoxic–ischemic (HI) injury in newborn rats. Study Design Wistar albino rats, 7 to 10 days old, were randomly divided into three groups: hypoxic–ischemic encephalopathy (HIE) group, HIE treated with HCQ group, and Sham group. Left common carotid artery ligation and hypoxia model were performed in HIE and HCQ groups. The HCQ group was treated with 80 mg/kg intraperitoneal HCQ every 24 hours for 3 days, while Sham and HIE groups were given physiological saline. After 72 hours, rats were decapitated and brain tissues were stained with hematoxylin and eosin, TUNEL, and IL-1β for histopathological grading and neuronal cell injury. Results Neuronal apoptosis was statistically lower in all neuroanatomical areas in the HCQ group compared with the HIE group. IL-1β-stained areas were similar in both HCQ and HIE groups but significantly higher compared with the Sham group. Histopathological grading scores were found to be lower in the HCQ group on the left parietal cortex and hippocampus region. Conclusion In this study, we have shown for the first time that HCQ treatment decreased apoptosis in HI newborn rat model in both hemispheres. HCQ may be a promising adjuvant therapy in neonatal HIE. Key Points HCQ decreased neuronal apoptosis in the ischemic penumbra of the rat brain. HCQ attenuates hypoxia–ischemia-induced brain injury in neonatal rats. HCQ has no anti-inflammatory effect on HI injury. [ABSTRACT FROM AUTHOR]

Objective: To examine the efficacy of uterine artery ligation (UAL) with or without subsequent haemostatic procedures in management of postpartum haemorrhage (PPH) during Caesarean section. Methods: Women who underwent UAL with or without subsequent haemostatic procedures were compared in terms of maternal demographics, antenatal risk factors, delivery details, causes of PPH, sequence of treatment modalities used, and short-term complications. Results: A total of 173 women underwent UAL with or without subsequent haemostatic procedures. The success rate of haemostasis was 96.5% (167/173) after UAL with or without subsequent haemostatic procedures; it was 81.5% (141/173) after UAL alone. Multivariate analysis revealed that women with prior PPH had a higher risk for haemostasis failure after UAL alone (adjusted odds ratio [aOR]=10.35, p=0.027), whereas women with placenta praevia had a lower risk for haemostasis failure after UAL alone (aOR=0.05, p=0.001). Compared with UAL alone, UAL followed by haemostatic procedures resulted in a higher risk of postoperative complications including haemorrhagic shock (p=0.012), disseminated intravascular coagulopathy (p<0.001), and intensive care unit admission (p<0.001). There were five cases of bowel injury and one case of pelvic vessel injury. Conclusion: UAL is an effective and safe first-line surgical procedure for management of PPH during Caesarean section, especially for women with placenta praevia. [ABSTRACT FROM AUTHOR]

Background: In primarily unresectable liver tumors, ALPPS (Associating Liver Partition and Portal Vein Ligation for Staged hepatectomy) may offer curative two-stage hepatectomy trough a fast and extensive hypertrophy. However, concerns have been raised about the invasiveness of the procedure. Full robotic ALPPS has the potential to reduce the postoperative morbidity trough a less invasive access. The aim of this study was to compare the perioperative outcomes of open and full robotic ALPPS. Methods: The bicentric study included open ALPPS cases from the University Hospital Zurich, Switzerland and robotic ALPPS cases from the University of Modena and Reggio Emilia, Italy from 01/2015 to 07/2022. Main outcomes were intraoperative parameters and overall complications. Results: Open and full robotic ALPPS were performed in 36 and 7 cases. Robotic ALPPS was associated with less blood loss after both stages (418 ± 237 ml vs. 319 ± 197 ml; P = 0.04 and 631 ± 354 ml vs. 258 ± 53 ml; P = 0.01) as well as a higher rate of interstage discharge (86% vs. 37%; P = 0.02). OT was longer with robotic ALPPS after both stages (371 ± 70 min vs. 449 ± 81 min; P = 0.01 and 282 ± 87 min vs. 373 ± 90 min; P = 0.02). After ALPPS stage 2, there was no difference for overall complications (86% vs. 86%; P = 1.00) and major complications (43% vs. 39%; P = 0.86). The total length of hospital stay was similar (23 ± 17 days vs. 26 ± 13; P = 0.56). Conclusion: Robotic ALPPS was safely implemented and showed potential for improved perioperative outcomes compared to open ALPPS in an experienced robotic center. The robotic approach might bring the perioperative risk profile of ALPPS closer to interventional techniques of portal vein embolization/liver venous deprivation. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Self‐harm by ligature is common within inpatient mental healthcare settings and is a dangerous method of self‐harm. Most fatal and non‐fatal suicidal behaviours in inpatient settings are a result of ligature use.There is a lack of research which has explored the experiences of staff members who work within inpatient settings where patients may self‐harm by ligature. What the paper adds to existing knowledge: Key issues related to self‐harm by ligature reported by staff included (1) understaffing increasing risk of ligature incidents, (2) spreading of self‐harm by ligature within inpatient settings and (3) negative attitudes of staff related to patients who self‐harm by ligature.Working with self‐harm by ligature can have negative impacts on staff's personal (e.g. fear of blame) and professional lives (e.g. increased cautiousness). Many staff members currently feel underprepared by training related to working with self‐harm by ligature, and unsupported after responding to a ligature incident. What are the implications for practice: Training about self‐harm by ligature needs to be improved and be accessible for all inpatient mental healthcare staff. Training should be coproduced, and could include practical components, education on potential reasons for self‐harm, and acknowledgement of the emotional impact on staff.Support for staff members who respond to ligature incidents should be available for all staff members who respond to self‐harm by ligature incidents. Stigma associated with accessing support should be challenged, alongside blame cultures within the workplace. Introduction: Self‐harm by ligature is a common form of self‐harm within inpatient mental health services in England, where most suicides within inpatient settings involve hanging or suffocation. However, little research has examined the experiences of staff members working with this method of self‐harm. Aim: We explored the experiences of clinical staff who work with patients who self‐harm by ligature. Method: A staff survey was developed and disseminated to clinical staff working in inpatient settings in England. Quantitative data were analysed using descriptive statistics, and qualitative data using the framework approach. The study was STROBE checklist compliant. Results: 275 staff members participated. Challenges most frequently reported about working with self‐harm by ligature included understaffing (210, 76.6%), spreading of ligature incidents (198, 72.8%) and negative attitudes held by clinical staff towards such patients (185, 68.5%). Participants' responses indicated that this work could have significant impacts on their professional and personal lives. Staff often reported inadequate training and lack of preparedness, alongside insufficient support opportunities following ligature incidents. Discussion: Staff had a diverse range of professional and personal experiences and identified multiple challenges associated with working with patients who have self‐harmed by ligature. Implications for Practice: There is a need to improve accessibility, format and content of training and support for staff working within inpatient settings where patients may self‐harm by ligature. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate the efficacy and safety of the combination of minimally invasive methods for the treatment of incompetent great saphenous vein and perforating veins. Methods: Between December 2019 and October 2020, F-care radiofrequency ablation combined with ultrasound-guided foam sclerotherapy and residual perforator ligation and concomitant microphlebectomy were adopted for all eligible patients. The clinical symptoms scores, complications, and quality of life were recorded. Results: 49 patients (64 limbs) with a mean age of 63.29 ± 10.14 years, and 60.9% 4 were male. The 1-year truncal closure rate was 63/64 (98.4%). 1 A significant improvement in the Venous Disability Score, the Venous Segmental Disease Score, the Venous Clinical Severity Score and Chronic Venous Disease Quality of Life Questionnaire Score, at 12 months after the combination of minimally invasive treatment, were observed in the study. One patient developed intermuscular vein thrombosis that was successfully managed with rivaroxaban. Conclusions: The combination of minimally invasive methods is a safe and effective method for the treatment of lower extremity varicose veins. Further large-scale, prospective, multi-center studies are needed to further verify the findings of this study. [ABSTRACT FROM AUTHOR]

Dorsal seroma is a common complication of autologous latissimus dorsi flap (ALDF) in breast reconstruction, and has limited the use of this technique, despite its aesthetic success. It is important to find a right technique to limit the incidence of seroma formation after ALDF. The aim of this study was to evaluate the effectiveness and tolerance of a dorsal quilting technique called "running quilting" using barbed resorbable suture in seroma prevention. Three hundred patients who underwent ALDF breast reconstruction in the period between 2004 and 2014 were included in this study. The population was divided in 3 groups; without quilting, with simple quilting suture, and with running quilting using barbed suture. The incidence of small seromas (requiring 1 or 2 aspirations during routine postoperative visits without adding additional appointments to the follow-up routine) was not significantly decreased: it was 54% in the non-quilted group, 47% in group 2 Quilting, and 34% in group 3 running quilting. However, quilting reduced the duration of drainage, and the rate of late seromas (from 8% to 0%), and chronic sero-hematomas completely disappeared in our experience. Running quilting using barbed suture is highly effective in preventing late and refractory donor-site seromas. Its effectiveness is expected to increase the use of ALDF in breast reconstruction, which we consider currently as one of the best autologous reconstruction techniques. [ABSTRACT FROM AUTHOR]

Background: A venous aneurysm (VA) is a focal dilatation of a nonvariceal vein (diameter increased by at least 1.5 times compared to the adjacent upstream or downstream venous segment), which carries a risk of venous thromboembolism (VTE) when located in the deep veins of the lower limbs but also when it affects the veins above the muscle fascia. Case: We report the case of a 40-year-old woman who presented with a painful and disabling mass-like lesion of the upper third of the right calf. A Doppler ultrasound (DUS) examination revealed a small saphenous vein (SSV) dilated at the saphenopopliteal junction (SPJ) and thrombosed along its entire length. Anticoagulant treatment was initiated but although the thrombosis regressed on DUS, the functional impotence and the persistence of pain prompted a stripping of the SSV. Histology allowed the diagnosis of SSV's primary aneurysm. Discussion: Dilated segments of the saphenous vein are not always varicose veins (VVs). True VAs can develop on veins located above the muscular fascia and, like deep VAs, may trigger VTE. Small saphenous vein aneurysms have seldom been reported, and only a few clinical observations have described the thrombosis of a SSV aneurysm. Any mass in the popliteal fossa or upper part of the calf should be examined by DUS to look for an SSV aneurysm. Excision of the saphenous vein with junctional ligation is advised if thrombosis is present at the time of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Aneurysms of the middle colic artery (MCAA) and its branches are exceedingly rare accounting for <3% of total visceral aneurysms. Very few MCAA cases have been reported in the literature with only three cases accounting for a diameter >4 cm. Method: We describe the successful open repair with ligation of a 4.2 cm asymptomatic MCAA in a female patient through the gastrohepatic ligament taking meticulous caution to avoid injury of the pancreas. The postoperative period was uneventful and the patient was discharged from the hospital on the fifth postoperative day. At 1 month follow-up the postoperative computed tomographic angiography documented complete exclusion of the MCAA and absence of contrast agent in the sac both in the arterial and the venous phase. Conclusion: While the endovascular treatment is the first-line option for visceral aneurysms, the open approach is still reserved for certain cases of hostile anatomy, challenging location and large size. Our case highlights the irreplaceable role of open surgery and underlines the collaboration between surgical specialties. [ABSTRACT FROM AUTHOR]

Objective: Juvenile Nasopharyngeal Angiofbroma (JNA) is a benign, yet locally aggressive tumor with a rich blood supply. Surgical management is the mainstay treatment for JNA, however, blood loss is a big concern during surgery. This retrospective study aims to evaluate the efcacy of ligating the feeding vessels of JNA based on preoperative imaging, potentially eliminating the need for preoperative embolization. Methods: We retrospectively analyzed the medical records of 380 patients who underwent surgery for JNA at our tertiary care, high volume center, without prior embolization. Preoperative scans were reviewed to identify the location of feeding vessels. Surgical techniques were adapted to ligate the major feeding vessel(s) identifed preoperatively. Intraoperative blood loss was meticulously recorded. Results: In the 380 patients, the mean blood loss increased with advancing disease stage. The average blood loss across all stages was 635.54 mL. This observed blood loss was signifcantly lower compared to data published by other studies that employed preoperative embolization for blood loss reduction. Conclusion: Preoperative evaluation of imaging for feeding vessel localization accurately correlated with intraoperative fndings. Ligation of identifed feeding vessels might eliminate the need for preoperative embolization in JNA surgery. [ABSTRACT FROM AUTHOR]

Background: Although the laparoscopic approach become standard for the treatment of many surgical conditions many studies still debating whether laparoscopic surgery has significant advantages over open surgery in regards to hernia or hydrocele treatment. This study aimed to evaluate the outcomes of treatment of treatment of communicating hydrocele in pediatric patients between laparoscopic percutaneous internal ring suturing (PIRS) and open ligation of the patent processus vaginalis (PPV). Methods: The medical records of pediatric patients who underwent surgery for communicating hydrocele between 1 January 2019 and 1 January 2024 were retrospectively reviewed. The primary objective of the study is to investigate the outcomes of treatment (complications and recurrence rates) of communicating hydrocele in children between laparoscopic and open surgical approaches. Secondary outcomes of the study are the duration of surgery and anesthesia, length of hospital stay (LOS), frequency of hospital readmissions (ReAd) and unplanned return to the operating room (uROR). Results: A total of 198 children underwent surgery for a communicating hydrocele (205 repairs, as 7 cases were bilateral) and were included in the study. Of these, 87 children underwent a PIRS, while the remaining 111 cases underwent open ligation of the PPV. No recurrence of the hydrocele was observed in any of the study groups. Intraoperative complication (epigastric vein injury) was noted in two cases in both groups (2.3% vs. 1.8%, p > 0.999). A slightly higher number of postoperative complications was observed in the open group (n = 7, 6.3%) compared to the PIRS group (n = 2, 2.3%) (p = 0.190). The median duration of surgery (15 min (IQR 10, 17) vs. 21 min (IQR 15, 25); p < 0.001) and anesthesia (30 min (IQR 25, 40) vs. 40 min (IQR 35, 40); p < 0.001) were significantly lower in the PIRS group compared to open ligation of the PPV. In addition, a significantly shorter median of LOS was observed in the PIRS group compared to the open PPV group (9 h (IQR 8, 12) vs. 24 h (IQR 12, 24; p < 0.001). No cases of ReAd and uROR were observed in any of the study groups. Conclusions: PIRS is a safe and effective laparoscopic technique that can be used in the treatment of communicating hydrocele in children. PIRS showed excellent outcomes and a low incidence of complications and recurrences, comparable to traditional open surgery. [ABSTRACT FROM AUTHOR]

Several types of soft tissue masses occur in the lower extremities. A mass associated with blood vessels is often difficult to diagnose. A 15-year-old male patient visited the author's hospital with discomfort and edema in his right calf that had persisted for six months. A physical examination showed no palpable mass other than mild edema. Three masses were found during the ultrasound scan along the small saphenous vein. The masses had a cyst-like appearance and were filled with thrombus. In duplex ultrasound, vascular reflux was represented inside the masses. During surgery, it was suspected that vascular deformation occurred in the small saphenous vein, and simple ligation and resection treatments were performed. The patient was finally diagnosed with venous aneurysms accompanied by thrombosis based on the histology tests. The symptoms disappeared after surgery, and there were no recurrences or unusual findings at the follow-up one year later. Venous aneurysms occurring in the superficial veins of the lower extremities are rarely reported, but treatment and diagnosis are important. This paper reports a case of an aneurysm on the small saphenous vein. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study is to evaluate and compare the effectiveness of endovenous microwave ablation (EMA) and high ligation and strippingn (HLS) of the great saphenous vein (GSV) in the treatment of varicose veins. Methods: We included 182 patients in each EMA and HLS groups. Follow-up outcomes included AVVQ, VCSS, chronic venous insufficiency questionnaire-14 (CIVIQ14) score, clinical recurrence rate of varicose vein treatment, and patient satisfaction during the 1-year follow-up period. Results: At the 1-year follow-up, no significant difference was found in the clinical recurrence rate of varicose veins between the EMA and HLS groups (p =.75). The duration of the operation and the length of hospital stay for patients in the EMA group was shorter than that for the HLS group (p <.01). The Aberdeen Varicose Vein Questionnaire (AVVQ), Venous Clinical Severity Score (VCSS) score, and ecchymosis were lower for patients who underwent EMA surgery (p <.01). Conclusion: Our research results confirm that EMA improves patients' quality of life with lower limb varicose veins, with EMA showing higher patient satisfaction. [ABSTRACT FROM AUTHOR]

Statement of the Problem: Periodontitis is an inflammatory disease that causes bone loss. Some patients do not respond well to the classic treatment and need therapies that minimize bone loss, the main sequel of the disease. Chenopodium ambrosioides L. has stood out due to its anti-inflammatory and anti-oxidative activities. However, no study has yet investigated its effect on periodontitis. Purpose: This study aimed to evaluate the bone protective effect of Chenopodium ambrosioides L. (CAL) extract on ligature-induced periodontitis model in rats. Materials and Method: For this, a pre-clinical assay was performed, using male Wistar rats divided into 3 groups: Naive (N) (n=6), not submitted to any procedure; Saline (SAL) (n=6), submitted to ligature-induced periodontitis and receiving 2 ml/kg of 0.9% saline solution; and CAL extract, which was subdivided into 3 subgroups (n=6/subgroup) receiving the CAL at 3 (CAL3), 10 (CAL10) or 30 mg/kg (CAL30). All agents were given, by oral gavage, 30 min before periodontitis induction and daily until euthanasia (11th day). By then, maxillae were removed for macroscopic, histological, and histometric analyses. Kidneys, liver, and stomach were collected to evaluate the safety of CAL extract. Highperformance liquid chromatography (HPLC) assay was used to investigate the flavonoid content in the extract. Results: Chenopodium ambrosioides L. extract at 30mg/kg showed a reduction by 58% in bone loss marked by an increase (+35%) in the number of osteoblasts and a reduction (- 51%) on the number of osteoclasts (p< 0.05). No significant alteration in the liver, kidney, or stomach was seen. Rutin was the main flavonoid found. Conclusion: In summary, it was observed that Chenopodium ambrosioides L. extract has shown important anti-inflammatory and bone anabolic and anti-resorptive properties without causing toxicity in the main organs. Rutin, as the main flavonoid of the extract, seems to be responsible for the beneficial effect of this agent. [ABSTRACT FROM AUTHOR]

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Congenital extrahepatic portosystemic shunts (CEPS) are rare anomalies connecting the portal system to the inferior vena cava. This report discusses a 10-year-old boy with Type II c CEPS, presenting cyanosis and dyspnea. Surgical ligation resulted in significant improvement in symptoms. Early identification and intervention are crucial, necessitating a protocolized approach. [ABSTRACT FROM AUTHOR]

The article discusses a study on revivification in extracorporeal cardiopulmonary resuscitation (ECPR) and thoraco-abdominal normothermic regional perfusion (TA-NRP) conducted by Rachel G. Clarke and Christian J. Vercler, published in the journal. It also discusses the procedural similarities between ECPR and TA-NRP, challenges in determining death by circulatory criteria, and the ethical implications of differentiating between the intentions and actions of physicians in both procedures.

The article discusses the complexities surrounding the implementation of the thoracoabdominal normothermic regional perfusion in organ donation after circulatory determination of death (TANRP-DCDD) protocol. It also discusses the challenges faced by the medical and ethics community in understanding and framing the discourse around TANRP-DCDD, including the interpretation of circulatory criteria of death, the preservation of death through ligating vessels.

Simple Summary: The increasing popularity of ALPPS (Associating Liver Partition and Portal vein Ligation for Staged hepatectomy) in treating unresectable liver tumors has extended to perihilar cholangiocarcinoma (phCC), despite some reservations about its use in these cases. This systematic review and pooled data analysis, which included 112 phCC patients from 18 studies, was based on the literature from MEDLINE and Web of Science up to December 2023. The findings showed significant rates of major morbidity (43%) and mortality (22%), with a post-hepatectomy liver failure (PHLF) rate of 23%. However, promising one-year disease-free and overall survival rates were observed at 65% and 69%, respectively. This study concludes that ALPPS offers a viable treatment option for phCC, potentially superior to alternatives, although it is associated with considerable risks. Improvements in surgical techniques and perioperative management could further enhance its efficacy and safety. Background: ALPPS popularity is increasing among surgeons worldwide and its indications are expanding to cure patients with primarily unresectable liver tumors. Few reports recommended limitations or even contraindications of ALPPS in perihilar cholangiocarcinoma (phCC). Here, we discuss the results of ALPPS in patients with phCC in a systematic review as well as a pooled data analysis. Methods: MEDLINE and Web of Science databases were systematically searched for relevant literature up to December 2023. All studies reporting ALPPS in the management of phCC were included. A single-arm meta-analysis of proportions was carried out to estimate the overall rate of outcomes. Results: After obtaining 207 articles from the primary search, data of 18 studies containing 112 phCC patients were included in our systematic review. Rates of major morbidity and mortality were calculated to be 43% and 22%, respectively. The meta-analysis revealed a PHLF rate of 23%. One-year disease-free survival was 65% and one-year overall survival was 69%. Conclusions: ALPPS provides a good chance of cure for patients with phCC in comparison to alternative treatment options, but at the expense of debatable morbidity and mortality. With refinement of the surgical technique and better perioperative patient management, the results of ALPPS in patients with phCC were improved. [ABSTRACT FROM AUTHOR]

Simple Summary: Routine blood parameters (e.g., the neutrophil-to-lymphocyte ratio, NLR) are valuable tools for diagnosing inflammatory, infectious, and metabolic conditions. Dogs with congenital liver shunts show evidence of generalized inflammation and clinical signs that may overlap with those of other diseases. Therefore, the potential diagnostic and prognostic value of blood cell ratios, including the NLR, was investigated in 106 dogs with congenital liver shunts and compared to two other disease groups. An association was detected between the blood NLR and systemic inflammation but not with any characteristics of the liver shunt or clinical correlates. The NLR could not distinguish the three disease groups, dogs with liver shunts that were either medically or surgically treated, or dogs either with successful shunt surgery or those with surgical complications. However, lower NLRs (<2.53) were predictive of dogs with liver shunt surgery requiring only one PSS closure session rather than two consecutive surgeries. Thus, evaluating the blood NLR might be clinically useful in dogs with liver shunts. Although this parameter may have little value in distinguishing dogs with a liver shunt from dogs with other diseases, it appears to be predictive for the number of surgical sessions required for shunt closure via ligation. The neutrophil-to-lymphocyte ratio (NLR) can help in assessing inflammatory diseases, sepsis, and chronic hepatic conditions in humans. Dogs with congenital portosystemic shunts (PSSs) have signs of generalized inflammation, and the clinical signs can overlap with other conditions, including hypoadrenocorticism (HOC). Thus, the potential diagnostic and prognostic value of leukocyte ratios as surrogate markers was assessed in a retrospective case–control study including 106 dogs diagnosed with PSSs. The disease control groups were dogs with parenchymal hepatopathy (PH; n = 22) or HOC (n = 31). In the PSS dogs, the blood NLRs were associated with the severity of systemic inflammation but not with the shunt type, hepatoencephalopathy, systemic infection, or hypoglycemia. The baseline NLRs did not differ between the three disease groups, between medically and surgically treated PSS dogs, or between those with successful PSS ligation and dogs experiencing peri-/post-surgical complications. However, dogs requiring two consecutive surgical interventions had significantly higher NLRs, and an NLR of <2.53 distinguished dogs with successful shunt ligation in one surgery from those requiring two consecutive surgeries for PSS closure. The blood NLR might be a useful clinicopathologic variable in PSS, but its value in helping differentiate PSS from HOC cases appears low. Integrating the NLR into a diagnostic algorithm may allow for a prediction of the number of surgical interventions required. [ABSTRACT FROM AUTHOR]

It is of utmost importance to comprehend the impact that psychological factors have on physical rehabilitation, specifically in regards to wound healing following ligation of oesophageal varices in patients with liver cirrhosis. The present study investigated the correlation between wound recovery rates and psychological well‐being, stress and mental health. From January 2022 to September 2023, 148 patients from were evaluated as part of this cross‐sectional observational study. The psychological well‐being of participants was evaluated utilizing the Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS) and Psychological General Well‐Being Index (PGWBI). The rates of wound recovery were assessed following ligation. The mean duration for wound recovery was 28.37 ± 9.65 days. The mean wounds healing time of patients who obtained higher PSS scores (18.55) was marginally longer. On the contrary, there was a moderate reduction in healing time associated with higher HADS scores (mean 14.10). On average (68.88), PGWBI scores indicated a negligible effect on wound healing. The variance in healing durations between Child‐Pugh classifications A, B and C (mean values of 28.65, 26.90 and 29.57 days respectively) suggested that the severity of liver disease has an impact. As a result of ligation of oesophageal varices, the study demonstrated that psychological factors and wound recovery in patients with liver cirrhosis are intricately intertwined. There seems to be the substantial and intricate relationship between stress, mental health and wound recovery. The results of this study supported the notion that psychological evaluation and support should be incorporated into the management of patients with liver cirrhosis. [ABSTRACT FROM AUTHOR]

Aim. The present study evaluated the therapeutic effects of luteolin in alleviating pulpitis of dental pulp- (DP-) derived microvesicles (MVs) via the inhibition of protein kinase R- (PKR-) mediated inflammation. Methodology. Proteomic analysis of immortalized human dental pulp (DP-1) cell-derived MVs was performed to identify PKR-associated molecules. The effect of luteolin on PKR phosphorylation in DP-1 cells and the expression of tumor necrosis factor-α (TNF-α) in THP-1 macrophage-like cells were validated. The effect of luteolin on cell proliferation was compared with that of chemical PKR inhibitors (C16 and 2-AP) and the unique commercially available sedative guaiacol-parachlorophenol. In the dog experimental pulpitis model, the pulps were treated with (1) saline, (2) guaiacol-parachlorophenol, and (3) luteolin. Sixteen teeth from four dogs were extracted, and the pulp tissues were analyzed using hematoxylin and eosin staining. Immunohistochemical staining was performed to analyze the expression of phosphorylated PKR (pPKR), myeloperoxidase (MPO), and CD68. Experimental endodontic-periodontal complex lesions were established in mouse molar through a silk ligature and simultaneous MV injection. MVs were prepared from DP-1 cells with or without pretreatment with 2-AP or luteolin. A three-dimensional microcomputed tomography analysis was performed on day 7 (n = 6). Periodontal bone resorption volumes were calculated for each group (nonligated–ligated), and the ratio of bone volume to tissue volume was measured. Results. Proteomic analysis identified an endogenous PKR activator, and a protein activator of interferon-induced PKR, also known as PACT, was included in MVs. Luteolin inhibited the expressions of pPKR in DP-1 cells and TNF-α in THP-1 cells with the lowest suppression of cell proliferation. In the dog model of experimental pulpitis, luteolin treatment suppressed the expression of pPKR-, MPO-, and CD68-positive cells in pulp tissues, whereas guaiacol-parachlorophenol treatment caused coagulative necrosis and disruption. In a mouse model of endodontic-periodontal complex lesions, luteolin treatment significantly decreased MV-induced alveolar bone resorption. Conclusion. Luteolin is an effective and safe compound that inhibits PKR activation in DP-derived MVs, enabling pulp preservation. [ABSTRACT FROM AUTHOR]

Introduction: Ligation of the intersphincteric fistula tract (LIFT) is a sphincter-preserving procedure for treating anal fistula of cryptoglandular origin. Our prospective study aimed to determine the postoperative outcomes of patients undergoing LIFT in emergency and elective settings. Methods: This was a single-centre prospective observational study of the LIFT procedure for the treatment of anal fistulas. The differences in the 6-month postoperative outcomes between the emergency and elective procedures were analysed, including the healing rate, healing time, recurrence rate, recurrence time, postoperative complications and length of hospital stay. Results: Twenty-two patients were recruited for this study: 11 patients underwent LIFT as an emergency procedure (EM-LIFT), while the others underwent LIFT as an elective procedure (EL-LIFT). The healing rate for the EM-LIFT group was 90.9% (n = 10), with a median healing time of 2 months (range 0.5-4). For the EL-LIFT group, the healing rate was 100% (n = 11), with the same median healing time of 2 months (range 0.5-4). Two of the patients in the EM-LIFT group developed recurrence, with a median recurrence time of 5 months (range 4-6) and three developed recurrence in the EL-LIFT group, with the same median recurrence time of 5 months (range 4-6). There were minor postoperative complications of pain and subcutaneous infection, with no faecal incontinence. There was no statistically significant difference in postoperative outcomes between the groups. Conclusion: EM-LIFT is a feasible and safe primary procedure for active cryptoglandular-type anal fistulas. [ABSTRACT FROM AUTHOR]

Simple Summary: This research is dedicated to exploring the enduring discussion about the optimal level of ligation of the inferior mesenteric artery (IMA) during rectal cancer surgery, with an emphasis on historical, technical, and patient-centered dimensions. The study seeks to elucidate the unresolved issues by critically evaluating factors, such as the anastomotic leakage risk, genitourinary function implications, and oncological outcomes. The aim is to offer a nuanced perspective that transcends conventional paradigms, guiding surgeons and researchers toward a more individualized approach, mainly based on patient anatomy and surgeon preference. Efforts made by this research can lead to the refinement of surgical techniques and a better understanding of the intricate considerations involved in rectal cancer surgery, which can contribute to the ongoing evolution of medical practices in this area. Within the intricate field of rectal cancer surgery, the contentious debate over the optimal level of ligation of the inferior mesenteric artery (IMA) persists as an ongoing discussion, influencing surgical approaches and patient outcomes. This narrative review incorporates historical perspectives, technical considerations, and functional as well as oncological outcomes, addressing key questions related to anastomotic leakage risks, genitourinary function, and oncological concerns, providing a more critical understanding of the well-known inconclusive evidence. Beyond the dichotomy of high versus low tie, it navigates the complexities of colorectal cancer surgery with a fresh perspective, posing a transformative question: "Is low tie ligation truly reproducible?" Considering a multidimensional approach that enhances patient outcomes by integrating the surgeon, patient, technique, and technology, instead of a rigid and categorical statement, we argued that a balanced response to this challenging question may require compromise. [ABSTRACT FROM AUTHOR]

Background: Superficial thrombophlebitis (ST) has traditionally been considered a benign thrombotic condition in most patients. Patients with localization along the large veins and near their junctions with the deep veins are at a particularly high risk of developing DVT and PTE. The initial approach of ligation of the great saphenous vein for the purpose of prophylaxis has been replaced in the guidelines by the increasingly widespread use of anticoagulants in the last 30 years. The surgical approach seems to be neglected for no good reasons during that time. The aim of our study is to investigate early and late complications in our large series of patients with ST and surgical treatment and to reveal, in particular, long-term survival rate. Material and methods: Presented are the results of simple surgical treatment of 190 consecutive patients with ST localized in upper half on femoral area by clinical signs or less then 5 cm by ultrasound is presented. Saphenous vein ligation was performed mainly under local anesthesia with additional therapy. Results: Early local standard surgical complications were found in 4.2% of the patients with 0% mortality. In a 6-year period, 14 patients or 7.4% died, and there was no significant difference for the period with the general population, the group of deceased was 12 years older. Conclusion: These data show that saphenous vein ligation in the subgroup of patients with ST in the upper part of the thigh by clinical or ultrasound evidence is still a reliable and safe method for significantly reducing the risk of DVT and PE with excellent long term survival rate at acceptable price. [ABSTRACT FROM AUTHOR]

Sepsis is a major health problem that causes millions of deaths worldwide every year. Due to the complexity of its pathophysiology, there is no clear treatment method for it. Existing treatments impose an additional financial burden on the health systems of countries every year. Clinical and preclinical studies are continuously being conducted in order to prevent the development of sepsis, treat patients with sepsis, reduce mortality, and solve the socioeconomic problems that arise from it. However, it is not possible to directly test every study and potential new treatment in humans. Preclinical studies enable an understanding of pathophysiological events and the development of targeted therapies. For this purpose, many experimental sepsis models have been and continue to be applied. The extent to which these models can reflect the human sepsis condition is an important issue that needs to be emphasized. Each method has different strengths and weaknesses. Researchers should choose the most appropriate experimental model according to the characteristics of the experiments they plan and, if possible, conduct their studies on different models. [ABSTRACT FROM AUTHOR]

Background: Cholestasis is described as a disease in which bile flow from the liver is reduced or stopped, and due to its oxidative effects, irreversible consequences may occur. Objectives: Due to the remarkable antioxidant properties of Oliveria decumbens (OD) and the contribution of oxidants to the progression of bile duct ligation (BDL)-induced cholestasis, this research aimed to examine how the OD ethanolic extract affected liver damage and oxidant-antioxidant balance markers in BDL-induced cholestasis. Methods: Forty male Wistar rats weighing 200 - 250 g were used. Cholestasis was induced using the BDL approach. The rats were categorized into four groups: Group l, sham-control (SC); group 2, cholestatic; group 3, SC + OD; and group 4, cholestatic + OD. A dose of OD ethanolic extract was administered orally (500 mg/kg/day) to rats for seven days. Seven days following surgery, the rats' blood samples were collected; after sacrifice, a part of the liver tissue was isolated. A histopathological examination was performed, while the rest was stored at -70°C in liquid nitrogen. Heparin-containing tubes were used to gather blood samples. In plasma and hepatic tissue, biochemical tests, histopathological evaluations, and oxidative stress markers staining levels were performed. Results: Our findings showed that OD could effectively reduce liver injury by reducing the activity of liver function enzymes (AST and ALP). At the same time, it did not affect total bilirubin and protein. Bile duct ligation-induced hepatic markers of protein oxidation (PCO) and reactive nitrogen species (NO) were significantly decreased by OD, and it also promoted liver antioxidant capacity by enhancing superoxide dismutase (SOD) activities. Moreover, OD treatment prevented liver bile duct proliferative changes in histopathologic analysis. Conclusions: Our study confirmed that OD exerts substantial hepatoprotective activities against BDL-induced cholestasis by improving liver damage markers and regulating oxidative stress. It may be a beneficial therapeutic agent for managing cholestasis. Bioassay-guided isolation and identification of bioactive OD secondary metabolites can further direct the discovery of potential natural-based drug candidates. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to develop and evaluate a low-cost orbital prosthesis for simulation of endoscopically assisted intra-orbital anterior ethmoidal artery ligation. Methods: A low-cost orbital prosthesis was built and evaluated by ENT surgical trainees. Feedback was given following the assessment in the form of a face validity questionnaire. Results: Results were scored on a Likert scale of 1–7 (low to high). Trainees had limited exposure to the procedure (40 per cent) and predominantly low levels of confidence (mean, 3.67) that correlated with a lack of first-hand experience. The anatomy and likeness to human tissue of the prosthesis were both ranked highly, with mean scores of 5.0 and 4.93, respectively. Conclusion: The results of this study support the idea that a simple anatomical prosthesis for the simulation of endoscopic anterior ethmoidal artery ligation can be created with potential value to otolaryngology surgical training. To the authors' knowledge, this is the first documentation of simulated surgical epistaxis management using an artificial anatomical model. [ABSTRACT FROM AUTHOR]

Objective: The aim of the investigation is to analyze the results of endoscopic varicose vein ligation (EVL) in patients with portal hypertension; to estimate the character and frequency of early and late postoperative complications after EVL; to evaluate the possibility of endoscopic ligation at the moment of active bleeding. Methods: This work includes an analysis of 138 procedures for endoscopic ligation of the esophageal varices in 111 patients from 2016 to 2020. Intrahepatic form of portal hypertension was in 90 patients, extrahepatic form - in 21 patients. The total number of interventions performed was divided into 2 groups. In the first group of patients with EVL was performed urgently, and the second group includes patients, if necessary, with targeted prescription and secondary prevention of portal esophageal bleeding. Results: In 74 (53.6%) cases out of 138, different types of complications were detected. There were 2 lethal cases (1.4%). It should be noted that there were no lethal outcomes in second group after EVL, and after urgent operations, the mortality rate was 33.3%. The most critical complication of ligation was the resumption of hemorrhage due to the site of ligation in the early (1-3 days) and late periods after surgery (5-10 days). Conclusion: In this analysis of the studied cases of complications after EVL, the most common complication was pain syndrome and early and late bleeding were also identified. We showed that control esophagogastroscopies helped to identify bleeding recurrences; examination algorithms in case of detection of bleeding complication after EVL, and measures to prevent the development of recurrent hemorrhage were also necessary. [ABSTRACT FROM AUTHOR]

We present here-in the technical details of harvesting the left radial artery in a 50-year-old man undergoing coronary artery bypass grafting. The radial artery has been harvested atraumatically using a Harmonic scalpel (Ethicon Endosurgery LLC, Johnson & Johnson Company, Guaynaba, Puerto Rico, USA) and two vessel loops by "No touch" technique, thereby preventing perioperative spasm. The postoperative recovery was uneventful. [ABSTRACT FROM AUTHOR]

Aims: Children evaluated for abdominal pain are increasingly recognized to have pancreatic lesions by imaging modalities. Malignant lesions of the pancreas have also been diagnosed at regular intervals, the most common being solid cystic pseudopapillary neoplasm (SPT) -- Borderline (uncertain malignant potential). Surgical resection of this tumor should provide adequate tumor free margins and also should preserve pancreatic tissue. Radical resection of the pancreas will lead to pancreatic insufficiency. Herein, we describe the technique of central pancreatectomy wherein tumor excision gives adequate clearance but preserves the pancreatic tissue, thereby reducing significant morbidity. Materials and Methods: Three children ages ranging between 11 to 12 years diagnosed to have SPT were included in the study. Results: All children underwent successful central pancreatectomy and had an uneventful post operative recovery. Conclusion: Central pancreatectomy offers a good volume of remanant pancreas preserving near normal pancreatic function making it an ideal procedure for select cases. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) is one of the main cancer-related mortality worldwide. Thus, there is a constant search for improvement in treatment strategies to enhance the prognosis of this malignancy. The study aims to investigate the combined antitumor activity of ammonium tetrathiomolybdate (TM, copper chelator) combined with hepatic artery ligation (HAL) for liver cancer. Methods: A total of 40 Sprague-Dawley (SD) rats bearing hepatic tumors were randomly divided into four groups: the control group without any treatment (control), HAL only (HAL), given TM by gavage (TM), and given TM combined with HAL (HAL + TM). The concentrations of serum copper were measured at the predetermined time points. Tumor growth rate, overall survival (OS), expression of hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and microvessel density (MVD), as determined by immunohistochemical examination, were compared. Results: HAL treatment transiently could elevate alanine transaminase (ALT) and aspartate transaminase (AST) but resumed to baseline within 1 week. Serum copper was significantly increased in tumor-bearing animals over time. The values of serum copper in the three treatment groups were significantly lower than those in the control group at different time points, with the lowest values observed in the TM group (P <.05). The average tumor size was 30.33 ± 2.58, 20.83 ± 2.93, 16.80 ± 3.84, and 10.88 ± 1.08 mm in the control, HAL, TM, and HAL + TM groups, respectively (HAL + TM vs other groups, all P <.05). In addition, the expression levels of HIF-1α, VEGF, and MVD were significantly lower in the HAL + TM group than those in the other groups (P <.05). The OS of rats in the combined groups was significantly prolonged combined to the other groups (P <.05), with survival time of 19.1 ± 0.64, 25.4 ± 1.24, 25.3 ± 1.78, and 29.9 ± 2.22 days in the control, HAL, TM, and HAL + TM groups, respectively. Conclusion: These findings suggest that combined treatment with TM and HAL holds great potential for liver cancer treatment by reducing tumor hypoxia and angiogenesis. The observed results indicate that these combinations may offer a novel target and strategy for interventional therapy of liver cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: Pancreatic tumours usually require surgical removal. With advancing technology, these operations can be performed using laparoscopic and robotic techniques, which reduce surgical trauma to patients compared to conventional open surgery. In theory, robotic surgery should yield better outcomes due to its superior precision and control. Our study provided more evidence in support of this theory after comparing 62 patients who had laparoscopic surgery with 61 patients who had robotic surgery for the removal of their pancreatic tumours. We found that robotic surgeries resulted in fewer cases of conversion to open operations and fewer complications. Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed and compared with regard to short-term outcomes. A total of 62 consecutive LDP cases and 61 RDP cases were performed. There was more conversion to open surgeries in the laparoscopic group compared with the robotic group (21.0% vs. 1.6%, p = 0.001). The LDP group also had a higher rate of postoperative complications (43.5% vs. 23.0%, p = 0.005). However, there was no significant difference between the two groups in terms of major complication or pancreatic fistular after operations (p = 0.20 and p = 0.71, respectively). For planned spleen-preserving operations, the RDP group had a shorter mean operative time (147 min vs. 194 min, p = 0.015) and a reduced total length of hospital stay compared with the LDP group (4 days vs. 7 days, p = 0.0002). The failure rate for spleen preservation was 0% in RDP and 20% (n = 5/25) in the LDP group (p = 0.009). RDP offered a better method for splenic preservation with Kimura's technique compared with LDP to avoid the risk of splenic infarction and gastric varices related to ligation and division of splenic pedicles. RDP should be the standard operation for the resection of pancreatic tumours at the body and tail of the pancreas without involving the celiac axis or common hepatic artery. [ABSTRACT FROM AUTHOR]

Phosphorylation reactions performed by protein kinases are one of the most studied post-translational modifications within cells. Much is understood about conserved residues within protein kinase domains that perform catalysis of the phosphotransfer reaction, yet the identity of the target substrates and downstream biological effects vary widely among cells, tissues, and organisms. Here, we characterize key residues essential for NUAK kinase activity in Drosophila melanogaster myogenesis and homeostasis. Creation of a NUAK kinase-dead mutation using Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR)/Cas9 results in lethality at the embryo to larval transition, while loss of NUAK catalytic function later in development produces aggregation of the chaperone protein αB-crystallin/CryAB in muscle tissue. Yeast 2-hybrid assays demonstrate a physical interaction between NUAK and CryAB. We further show that a phosphomimetic version of NUAK promotes the phosphorylation of CryAB and this post-translational modification occurs at 2 previously unidentified phosphosites that are conserved in the primary sequence of human CryAB. Mutation of these serine residues in D. melanogaster NUAK abolishes CryAB phosphorylation, thus, proving their necessity at the biochemical level. These studies together highlight the importance of kinase activity regulation and provide a platform to further explore muscle tissue proteostasis. [ABSTRACT FROM AUTHOR]

Background: Acute lung injury (ALI) is a severe disease that can lead to acute respiratory distress syndrome (ARDS), characterized by intractable hypoxemia, poor lung compliance, and respiratory failure, severely affecting patients' quality of life. The pathogenesis of ALI has not been fully elucidated yet, and sepsis is an important cause of ALI. Among the organ injuries caused by sepsis, the lungs are the earliest damaged ones. Radix cyathulae is reported to have analgesic, anti-inflammatory, and anti-aging effects. Cyasterone is extracted from Radix cyathulae. However, it is not known whether cyasterone has protective effects for ALI. This study aims to investigate the effect of cyasterone on sepsis-related ALI and its mechanism. Methods: We used the cecal ligation peferation (CLP) method to establish a mouse sepsis model, and cyasterone was given intraperitoneally on days 1–3 to observe its preventive effect on sepsis-related acute lung injury. Primary murine peritoneal macrophages were used to investigate the molecular mechanism of cyasterone in vitro. Results: Cyasterone pretreatment inhibits pro-inflammatory cytokine production, NLRP3 inflammasome activation, and oxidative stress in vivo and in vitro. In addition, cyasterone attenuates sepsis-induced ALI by activating nuclear factor erythroid2-related factor (Nrf2), which may be associated with AKT(Ser473)/GSK3β(Ser9) pathway activation. Conclusions: Cyasterone defends against sepsis-induced ALI by inhibiting inflammatory responses and oxidative stress, which depends heavily on the upregulation of the Nrf2 pathway through phosphorylation of AKT(Ser473)/GSK3β(Ser9). These results suggest cyasterone may be a valuable drug candidate for preventing sepsis-related ALI. [ABSTRACT FROM AUTHOR]

The article focuses on the physiology and clinical implications of a patent ductus arteriosus (PDA), emphasizing its role in fetal and neonatal circulation, potential complications, and management strategies. Topics include the hemodynamic impact of a PDA in extremely premature infants, diagnostic methods such as echocardiography and perfusion indexes.

Objective: The timing of surgical patent ductus arteriosus ligation in preterm infants remains controversial. Early ligation (<2 or 3 weeks of life) benefits preterm infants with a lower incidence of bronchopulmonary dysplasia and necrotizing enterocolitis. We present patent ductus arteriosus ligation experience in premature infants who had been transported for closure to an outside centre other than the hospital they were hospitalized. Materials and Methods: We retrospectively evaluated 17 consecutive patients who had undergone surgery of premature infant patent ductus arteriosus closure during the period of March 2009-December 2020. Patent ductus arteriosus had been clipped in 17 patients. Results: The median birth weight and age were 930 g and 28 gestation weeks, respectively. The birth age of the sub-groups were A: ≤28 weeks and B: >28 weeks and birthweight were group I: ≤800 g and group II: >800 g. The median day of PDA ligation wasa 20 days, and patients with birthweight ≤800 g were ligated later than patients weighing >800 g. Two patients had intracranial hemorrhage, 6 had bronchopulmonary dysplasia, and 2 were dead. We found that exposure to large patent ductus arteriosus and low birth age in preterm babies was associated with longer hospitalization duration, preoperative mechanical ventilation time, and sepsis. Conclusion: Infants exposed to moderate-to-large patent ductus arteriosus requiring intubation and resistant to medical therapy for more than 2 weeks should have surgical ligation as soon as possible. [ABSTRACT FROM AUTHOR]

Background: An increasing embracement of safer regional techniques as pivotal components of multimodal analgesia regimen has made fast-tracking possible following pediatric cardiac surgery. Speaking of fasttracking in pediatrics, the feasibility of on-table extubation (OTE), and its' potential benefits are also being ardently researched with simultaneous emphasis on appropriate patient selection and adequate perioperative safety. Case Series: We report eight consecutive pediatric cases featuring a combination of serratus anterior plane block (SAPB) or erector spinae plane block (ESPB) to general anesthesia (GA) for patent ductus arteriosus (PDA) ligation through a left thoracotomy incision. Following induction of GA, the left-sided SAPB was performed in five patients and the other three patients received left-sided ESPB, each with 0.5 mL/kg of 0.2% ropivacaine. Demonstrating a mean intraoperative fentanyl requirement of 3.25 ± 0.71 μg/kg, OTE could be successfully contemplated in all the 8 patients. Subsequently, the post-operative face, leg, activity, cry, and consolability (FLACC) score was recorded at 1, 2, 4, 6, 8, and 12 h. Meanwhile, all the patients depicted acceptable pain scores till 4 h, administration of 0.5 μg/Kg rescue fentanyl was necessitated in three patients each at 6-h and 8-h postoperatively (given FLACC scores ≥4), amounting to a mean 0.375 ± 0.23 μg/kg post-operative fentanyl requirement. All patients received intravenous paracetamol at 8-h postoperatively. No block-related complication or need for reintubation was discovered. Conclusion: Incorporation of fascial plane blocks (SAPB or ESPB) to the conduct of GA for PDA ligation, allowed for safe OTE in our experience, due to an opioid-sparing potential. [ABSTRACT FROM AUTHOR]