Neutrophil­to­lymphocyte, platelet­to­lymphocyte and lymphocyte­to­monocyte ratios are associated with amputation rates in patients with peripheral arterial disease and diabetes mellitus who underwent revascularization: A Romanian regional center study.

Inflammation plays an important role in peripheral artery disease (PAD), contributing to the onset and progression of atherosclerosis, as well as to the rupture of atherosclerotic plaques. Studies have revealed that due to their inflammatory nature, leucocytes play an important role in the development of atherosclerosis. A retrospective study was conducted involving 203 patients with PAD admitted to Targu Mures Emergency County Hospital for revascularization surgery between January 2017 and June 2019 (of which 47 were treated by endovascular intervention, and 156 underwent classical surgical intervention). Among all patients included in the study, 47 patients required amputation following the revascularization intervention. The results indicated that though the mean patient age in the non-amputation group was higher than that in the amputation group, that the difference was not significant. With regard to sex distribution, 72% of the patients from the amputation group were male, while from the non-amputation group, 74% were male. The neutrophil-to-lymphocyte ratio (NLR) cut-off value for the prediction of amputation in PAD was 3.485 (sensitivity, 60.42%; specificity 72.44%), whereas the platelet-to-lymphocyte ratio (PLR) value was 152, (sensitivity, 54.17%; specificity, 71.79%), and was 2.55 for the lymphocyte-to-monocyte ration (LMR; sensitivity, 56.25%; specificity, 66.88%). The study concluded that in patients with PAD, the NLR and PLR were increased, while the LMR was decreased, which was also associated with a higher rate of amputation after revascularization, despite the lack of correlation between these factors, Fontaine classification and the number of damaged vessels. Therefore, pre-operative alterations in NLR, PLR and LMR may predict the need for amputation in patients with PAD, or those who underwent a revascularization intervention.

Morphological and morphometrical study of the auditory ossicles in chinchilla.

This study is meant to illustrate and describe the features of the auditory ossicles of the chinchilla (Chinchilla lanigera), one of the species used more and more frequently in otology and ear surgery as animal model. Cephalic extremities of 12 C. lanigera individuals obtained from a private farm, where this species was bred for fur, were used in this study. The ossicles were obtained either by direct surgical harvesting by mastoid approach or after a dermestid beetle exposure followed by anatomical dissection. The three ossicles that form the assembly are the malleus, incus and stapes. After the removal of these ossicles, a series of anatomical descriptions were made, followed by seriate sets of measurements. The malleus and incus form a joined-single unit called the maleo-incal complex, with an elongated straight appearance, also due to the development of the anterior process. The handle of the malleus and the long process of incus are almost perpendicular to the main axis of the maleo-incal complex. The presence of the muscular process on the handle of the malleus is recorded. The overall shape of the incus is given by the uneven development of the two processes and the reduced neck part. The stapes is the smallest of the components that maintains the well-known architecture in accordance with the general model. The morphology of all three ossicles is backed by a series of measurements, some standard, some adapted to the morphology of the ossicles. From the very reduced comparative metrical data at our disposal, our study presents an average of 10% lower values for the ones presented earlier by other researchers in the same species.

René leriche and the development of 20(th) century surgery.

René Leriche (1879-1955) was a 20(th) century French surgeon generally known in medicine for the syndrome that carries his name, namely the Leriche syndrome in the aorto-iliac occlusive disease. This paper is published to mark the commemoration of 60 year since Leriche's death. Although Dr. Leriche's legacy resides in the domain of vascular medicine, his research enclosed bone pathology and surgical management of pain. Having his surgical training done under professors Mathieu Jaboulay and Antonin Poncet, his friendship and association with Alexis Carrel and William Halsted have contributed to René Leriche's development as a surgeon, researcher and thinker. Following the footsteps of his mentors, he produced outstanding clinical and academic work which had earned him a good reputation among his students and colleagues. Surgeons such as Jean Kunlin, Jao Cid dos Santos, Michael DeBakey, René Fontaine and others came to study and learn from him. These future generations of surgeons would themselves bring much contribution to the understanding and treatment of vascular diseases and medicine in general. René Leriche pioneered medicine with his research and ideas. His assiduous work of teaching, research and clinical practice made his influence last to our present.