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[This corrects the article DOI: 10.1371/journal.pone.0244718.].

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09–0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.

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Breast reduction surgeries encompass a wide range of methods that are continuously evolving to discover more reliable and satisfactory techniques. This presentation aims to address the research gap by sharing outcomes and experiences using the superomedial pedicle in gigantomastia, as well as the implemented protocol for managing nipple-areola complex (NAC) ischemia. The Wise pattern and superomedial pedicle reduction mammaplasty method were utilized in treating 19 patients (38 breasts). The average age of the patients was 41.47 years, with a basal mass index (BMI) of 33.27 kg/m2. The mean sternal notch to nipple (SN-N) length for the entire population was found to be 40.97 cm. On both sides, this length was statistically similar at 41.11 cm on the right side and 40.84 cm on the left side. The average weight of resected tissue from all patients was calculated to be 1793.42 g, with slightly higher weight on the right side at 1800 g compared to the left side’s weight of 1786.84 g. Postoperative NAC ischemia occurred in three patients, one bilateral case, and two unilateral cases. The study revealed that in both the groups with and without NAC ischemia, the average values were as follows: age, which ranged from 45.33 to 40.75 years; BMI, ranging from 35.01 kg/m2 to 32.95 kg/m2; SN-N distance, which varied from 40 cm to 41.09 cm; and excision material weights, ranging from 1650 g to 1810.29 g. The p-value in the comparisons was found to be greater than 0.05. These results indicate that age, BMI, SN-N distance, and excision material weight did not have an impact on NAC vascularity issues. All NACs were successfully saved through a protocol involving hyperbaric oxygen therapy (HOT) and vacuum-assisted therapy (VAT). The study suggests that utilizing a superomedial flap is a viable option for treating gigantomastia and highlights the effectiveness of their outlined protocol in managing postoperative complications. While acknowledging the need for comparative studies, the study proposes incorporating HOT and VAT into protocols aimed at saving NACs.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

IntroductionAs long-term outcome in patients with acute myocardial infarction (MI) is predicted by final infarct size (IS), reducing IS is of paramount importance. Recent experimental studies have demonstrated a strong infarct-sparing effect of SGLT2 inhibitors – a class of drugs which have proved to be safe and beneficial in patients with heart failure. Repurposing SGLT2 inhibitors for the benefit of patients presenting with an acute MI should be preceded by investigation of the underlying mechanisms of infarct limitation. Experimental and clinical data indicate a potential role for autonomic modulation in these mechanisms, specifically sympatho-inhibition. The aim of this study was to evaluate the role of parasympathetic tone in the infarct-sparing effect of SGLT2 inhibitors.MethodsTwenty seven Sprague Dawley rats were fed with the diet containing the SGLT2 inhibitor Ertugliflozin or vehicle for 3 days. Myocardial ischaemia/reperfusion injury was caused by a 40-min left anterior descending coronary artery occlusion followed by 2 hours of reperfusion under isoflurane anaesthesia (4% for induction and 1.5-2% for maintenance). Two groups of animals, pre-treated with Ertugliflozin, were subjected to parasympathetic denervation prior to myocardial ischaemia, either with the muscarinic receptor antagonist, atropine sulfate i.v. (2 mg/kg bolus, then 1 mg/kg/h), or bilateral cervical vagotomy (figure 1).Abstract BS16 Figure 1The effect of parasympathetic denervation on acute cardioprotection by SGLT2 inhibitor Ertugliflozin (Ertu). IS – infarct size, AAR – area at risk. ** - p<0.01, *** - p<0.001.ResultsPre-treatment with Ertugliflozin reduced IS by 63% (p<0.001). Blocking muscarinic receptors with atropine abolished the infarct-limiting effect of Ertugliflozin (IS=45±2%, p>0.05 vs. vehicle, p<0.001 vs. ertugliflozin), whereas bilateral mechanical vagotomy only attenuated cardioprotection (IS=32±5%, p<0.01 vs vehicle and Ertugliflozin).ConclusionThese results suggest that the Infarct-limiting effect of SGLT2 inhibitor Ertugliflozin may be mediated via M-cholinoreceptors.Conflict of InterestNo

IntroductionTri-axial system (TAS) via trans-femoral access (TFA) is widely used for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). Quadri-axial system (QAS) via TFA has been rarely reported and not systematically described.Aim of StudyTo demonstrate safety and effectiveness of QAS compared with TAS for MT.MethodsWe retrospectively analyzed 321 consecutive patients who underwent MT for AIS at our Institution from August 2019 to December 2022. Patients were divided in two groups: TAS (using short 8F sheath) and QAS (using long 8F sheath). Puncture to recanalization time, number of passes for recanalization, mTICI score, technical failure due to aortic arch/vessel anatomy, complication rate were compared.ResultsTAS was used in 179 patients and QAS in 142 patients. Mean procedure duration was 53.2 minutes in TAS and 43.64 minutes in QAS group. In TAS group procedure was completed in 96% (n=172) and abandoned in 1.67% (n=3) for challenging vascular anatomy. In QAS group procedure was completed in 99% (n=141); none was abandoned due to vascular anatomy. Favourable recanalization was reported in 62% (n=107) in TAS and in 81% (n=115) in QAS group. First pass recanalization was achieved in 42% (n=75) in TAS and 51% (n=75) in QAS group. Complication rate (4%) was similar in both groups.ConclusionQAS via TFA for MT in AIS is a safe and effective technique, even in challenging cases, allowing faster and more successful procedures without increasing complications. QAS could redefine and widen the boundaries of TFA in AIS.Disclosure of InterestNothing to disclose.