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Background and Objectives : Although breast surgery has undergone a drastic de-escalation in recent decades, axillary dissection is still indicated in some selected cases. Unfortunately, in 3-85% of cases, complications such as seroma formation occur, highlighting the need for more accurate hemostasis systems. The aim of this study is to evaluate the effectiveness of absorbable polysaccharide hemostatic such as Haemocer TM in preventing postoperative seroma. Materials and Methods : Patients referred to two surgery centers for a diagnosed breast cancer and candidates for axillary lymph node dissection were retrospectively evaluated and included in Group A (treated with Haemocer TM ) and B (control group). The primary endpoints were the drain output after 48 h, the daily amount just before the removal, and the duration of axillary drainage placement. Secondary endpoints included the presence of seroma at the ultrasound (US) follow-up, significant blood loss, hematoma, the duration of surgery, and postsurgical complications. Results : The drain output within 48 h was 196 ± 93 vs. 286 ± 38 mL in Groups A and B, respectively ( p = 0.013). The daily output before the removal was 40 ± 7 mL in Group A and 47 ± 2 mL in Group B ( p = 0.049). The duration of axillary drainage placement was shorter in the experimental group (7 ± 3 days) compared to the control group (10 ± 1 days) with a statistically significant difference (0.037). During the US follow-up, on days 7, 15, and 30, the number of patients affected by seroma and the volumes were lower in the experimental group. Conclusions : The adsorbable hemostatic powder proved to be effective both in reducing the volume of drained fluid postoperatively and in decreasing the number and volume of reported seromas during the US follow-up.

Youth offer valuable insight on health communication needs and solutions in their communities. We propose youth participatory action communication research (YPACR) as a model for health campaign development that engages youth perspectives in applying systematic theory-informed communication research to addressing youth-identified health priorities. YPACR informed a series of paid high school internship programs in West Philadelphia, in which youth interns identified mental health help-seeking communication as a need among peers. In Phase 1, guided by the reasoned action approach and Hornik & Woolf method, youth interns conducted a survey measuring behavioral beliefs, normative beliefs, and control beliefs associated with mental health help-seeking, as well as trusted sources of mental health information, among local high school students. Survey results suggested control (self-efficacy) was an important message target and peers were trusted mental health information sources. In Phase 2, youth interns developed TikTok-style messages focused on strengthening control beliefs and promoting a youth-selected mental health support resource. Youth interns distributed an online survey experiment to test whether youth-created messages shown alongside resource information increased help-seeking self-efficacy compared to an information-only control. The YPACR framework contributed to youth-relevant campaign goals, study measurements, recruitment approaches, data interpretation, and message design. We discuss the benefits and challenges of this youth-driven health campaign development model and recommendations for future research.

Background : Leiomyosarcoma (LMS) originating from the adrenal gland is exceedingly rare, constituting a minute fraction of soft tissue sarcomas. Due to its rarity, with less than 50 documented cases in English medical literature, the diagnosis and management of adrenal LMS remain challenging. The aim of this study was to perform a review of the literature, in order to evaluate the prognosis of these rare cancers and report our specific case. Methods : A systematic review of the literature was conducted using PubMed, Web of Science, Google Scholar, and Scopus databases, up to December 2020. The search utilized MeSH terms such as "Adrenal Gland Neoplasms," "Leiomyosarcoma," "Adrenalectomy," and "Smooth Muscle Tumor." The inclusion criteria focused on studies reporting patients with a histopathological diagnosis of adrenal leiomyosarcoma. The PRISMA guidelines were followed to ensure a comprehensive analysis. Results : Out of 63 identified studies, 43 met the inclusion criteria and were reviewed. These studies highlighted the rarity and aggressive behavior of adrenal leiomyosarcoma. Surgical excision remains the cornerstone of treatment, often complemented by adjuvant therapies. The reviewed case involved a 52-year-old woman who underwent a right laparoscopic adrenalectomy for a 9 × 7 × 6 cm grade 3 leiomyosarcoma. Despite subsequent adjuvant chemotherapy, hepatic metastases were detected, illustrating the aggressive nature of the disease. The literature underscores the importance of histopathological analysis and long-term surveillance for managing disease progression. Conclusions : Optimal management of adrenal leiomyosarcoma requires a multidisciplinary approach and meticulous follow-up. The rarity of the disease poses challenges for standardizing treatment, but surgical excision and tailored adjuvant therapies show promise. Further research is essential to refine treatment strategies and improve prognosis for this rare malignancy.

Background. Obesity is a prevalent condition associated with various comorbidities, impacting mortality, fertility, and quality of life. Its relationship with type 2 diabetes mellitus (DMII) is well established, with nearly 44% prevalence. Bariatric surgery has proven crucial for treating both obesity and DMII. The comparison between surgical techniques, such as sleeve gastrectomy (SG) and one anastomosis gastric bypass (OAGB), remains controversial in terms of glycemic control efficacy. This retrospective study aimed to assess DMII remission efficacy between SG and OAGB after 36 months. Methods. From January 2016 to September 2020, 201 patients who underwent SG and OAGB for morbid obesity associated with DMII were accurately followed-up with for 36 months, focusing on %HbA1c, DMII remission, anthropometric results, and nutrient deficiency. Results. Although DMII remission did not exhibit statistical significance between the groups (82% vs. 93%, SG vs. OAGB, p = 0.051), OAGB demonstrated a more robust association with glycemic control (Odds Ratio 0.51) throughout the entire follow-up and yielded superior anthropometric outcomes. Notably, nutrient deficiencies, excluding cholecalciferol, iron, and riboflavin, did not show significant intergroup differences. Conclusions. This study contributes valuable insights into the extended-term efficacy of SG and OAGB in DMII remission. The nuanced findings underscore the multifaceted nature of metabolic outcomes, suggesting that factors beyond weight loss influence diabetes resolution. Larger comparative studies are warranted to comprehensively address this issue.

Indeterminate follicular thyroid lesions (Thyr 3A and 3B) account for 10% to 30% of all cytopathologic diagnoses, and their unpredictable behavior represents a hard clinical challenge. The possibility to preoperatively predict malignancy is largely advocated to establish a tailored surgery, preventing diagnostic thyroidectomy. We analyzed the role of the neutrophil-to-lymphocyte ratio (NLR), the platelet-to-lymphocyte ratio (PLR) and the lymphocyte-to-monocyte ratio (LMR) as prognostic factors of malignancy for indeterminate thyroid nodules. In patients affected by cytological Thyr 3A/3B nodules, NLR, PLR and LMR were retrospectively compared and correlated with definitive pathology malignancy, utilizing student's t -test, ROC analysis and logistic regression. One-hundred and thirty-eight patients presented a Thyr 3A and 215 patients presented a Thyr 3B. After the logistic regression, in Thyr 3A, none of the variables were able to predict malignancy. In Thyr 3B, NLR prognosticated thyroid cancer with an AUC value of 0.685 ( p < 0.0001) and a cut-off of 2.202. The NLR results were also similar when considering the overall cohort. The use of cytological risk stratification in addressing the management of indeterminate thyroid nodules in patients is not always reliable. NLR is an easy and reproducible inflammatory biomarker capable of improving the accuracy of preoperative prognostication of malignancy.

Study Design: Technical note, retrospective case series., Objective: Lumbar stenosis can be effectively treated using tubular unilateral laminotomy for bilateral decompression (ULBD). For multilevel stenosis, a multilevel ULBD through separate, alternating crossover approaches has been described as the "slalom technique." To increase efficacy, we introduced this approach with 2 microscopes simultaneously., Methods: We collected data on 13 patients, with multilevel lumbar stenosis, operated at our institution between 2015 and 2016 by the aforementioned technique. We assessed surgical time (ST), estimated blood loss (EBL), complications, and revision surgeries. Furthermore, we provide a stepwise instruction for performing the tandem microscopic slalom technique in a safe and efficient manner., Results: The mean age of the patients was 68 ± 8 years. The ST per level was 68 ± 19 minutes with an EBL per level of 39 ± 30 mL. We had no intraoperative complications and none of our patients required a revision surgery during a mean follow-up of 12 months., Conclusions: We have shown that this technique is feasible and can be performed safely for multisegmental lumbar spinal stenosis with minimal tissue trauma and low EBL. Furthermore, randomized controlled studies with a larger sample size may be necessary to drive any final conclusions., Competing Interests: Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Roger Härtl receives consultant fees from DePuy Synthes, Brainlab, and Ulrich and royalties from Zimmer Biomet., (© The Author(s) 2019.)

The efficacy and safety of pentoxifylline (400 mg tid orally) and acenocoumarol, administered singly or in combination, in the treatment of intermittent claudication associated with chronic occlusive arterial disease were evaluated in a multi-center, randomized, factorial, blind clinical trial involving 146 patients. The response to treatment was assessed by measuring pain-free walking time on the treadmill and by Doppler ankle/arm systolic pressure ratio at rest and after treadmill. Both pentoxifylline and acenocoumarol were significantly more effective than placebo in increasing the proportion of patients who improved their performance on the treadmill after one year of treatment. Benefit from active treatment was also apparent from the results of Doppler examinations performed after physical exercise. No significant differences were observed in comparing the effect of one active drug versus the other or versus the combined treatment. Five major hemorrhagic complications were registered in anticoagulated patients, two fatal cerebral hemorrhages and one gastrointestinal bleeding occurring in the group treated with both active drugs. The investigators conclude that (1) pentoxifylline is effective and safe in the treatment of patients with intermittent claudication (2) the benefits of oral anticoagulant therapy are outweighed by the risk of serious bleeding, and (3) the risk of bleeding is probably increased by the combined treatment with pentoxifylline.

A case of congenital factor V deficiency is reported. Despite this defect in blood coagulation, the patient had experienced recurrent thrombophlebitis and was referred to us because of deep venous thrombosis of the lower limbs associated with pulmonary embolism. Both functional and immunological assays documented a deficiency of factor V (12 and less than 10%, respectively). The available family members were investigated and the same defect was found in 2 brothers of the propositus, who also suffered from thrombotic diseases (recurrent thrombophlebitis and myocardial infarction). The propositus has been treated with long-term oral anticoagulant therapy, no hemorrhagic complications or thrombotic recurrences being recorded in 2 years' time.

Hemorheological measurements were made in 8 stable chronic haemodialysis patients observed in conventional acetate dialysis (AD) with Cuprophan membrane and then in biofiltration (BF) with PAN AN69S membrane. Blood viscosity diminished at the beginning, both during BF and AD, reaching pre-dialytic values again at the end of treatment. Blood and erythrocyte filtration increased after 20 min in AD and throughout the session in BF. Preliminary results suggest an improvement of hemorheological parameters during dialytic treatment, more notable in BF than in AD.