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Understanding recovery times and mechanisms of ecosystem dynamics towards the old-growth stage is crucial for forest restoration, but still poorly delineated in Mediterranean. Through tree-ring methods, we reconstructed the return of a tall canopy after severe human disturbance in a mixed beech (Fagus sylvatica) and silver fir (Abies alba) forest, located at a mountain site in the southern edge of both species' range (Gariglione, south Italy). The primary forest was extensively harvested between 1930 and 1950, removing up to 91 % of the biomass. Growth histories, climate-growth relationships and time-series of growth dominance in Gariglione were compared with a network of protected mature and old-growth beech forests distributed along a wide elevational gradient in the same region. We found that the renewed tall canopy of Gariglione is mainly composed of remnant trees, which include uncut trees and saplings, and the post-harvesting regeneration mostly represented by fir. Canopy beech trees reached maximum basal area increment (BAI) in the 1970s, 40-50 years after cutting. Then, beech BAI shifted towards negative trends in phase with drying climate (PDSI), while fir maintained a sustained growth until 2000. This growth asynchrony between the two species conferred community stability over the last decades. The network comparison highlighted the common negative impact of summer drought on high-frequency growth signals of beech in south Italy. However, analysis of long-term mean growth trends indicates decreasing BAI limited to Gariglione beech, revealing relevant differences due to site ecology and its interactions with legacy effects of past management in driving growth responses to climate change. Indeed, lowland mature beech forests showed increasing BAI in the last decades, while primary high-mountain forests displayed a remarkably stable low oscillating growth. In all the Mediterranean forests we studied, large and old trees showed a marked growth acclimation despite ongoing climate warming, demonstrating the effectiveness of landscape rewilding., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: All authors reports financial support was provided by Sila National Park Agency. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background and Objectives: Axillary lymph node (ALN) staging is crucial for the management of invasive breast cancer (BC). Although various radiological investigations are available, ultrasound (US) is the preferred tool for evaluating ALNs. Despite its immediacy, widespread use, and good predictive value, US is limited by intra- and inter-operator variability. This study aims to evaluate US and Elastosonography Shear Wave (SW-ES) parameters for ALN staging to develop a predictive model, named the Cassandra score (CS), to improve the interpretation of findings and standardize staging. Materials and Methods: Sixty-three women diagnosed with BC and treated at two Italian hospitals were enrolled in the study. A total of 529 lymph nodes were surgically removed, underwent intraoperative US examination, and were individually sent for a final histological analysis. The study aimed to establish a direct correlation between eight US-SWES features (margins, vascularity, roundness index (RI), loss of hilum fat, cortical thickness, shear-wave elastography hardness (SWEH), peripheral infiltration (PI), and hypoechoic appearance) and the histological outcome (benign vs. malignant). Results: Several statistical models were compared. PI was strongly correlated with malignant ALNs. An ROC analysis for Model A revealed an impressive AUC of 0.978 (S.E. = 0.007, p < 0.001), while in Model B, the cut-offs of SWEH and RI were modified to minimize the risk of false negatives (AUC of 0.973, S.E. = 0.009, p < 0.001). Model C used the same cut-offs as Model B, but excluded SWEH from the formula, to make the Cassandra model usable even if the US machine does not have SW-ES capability (AUC of 0.940, S.E. = 0.015, p < 0.001). A two-tiered model was finally set up, leveraging the strong predictive capabilities of SWEH and RI. In the first tier, only SWES and RI were evaluated: a positive result was predicted if both hardness and roundness were present (SWES > 137 kPa and RI < 1.55), and conversely, a negative result was predicted if both were absent (SWES < 137 kPa and RI > 1.55). In the second tier, if there was a mix of the results (SWES > 137 kPa and RI > 1.55 or SWES < 137 kPa and RI < 1.55), the algorithm in Model B was applied. The model demonstrated an overall prediction accuracy of 90.2% in the training set, 87.5% in the validation set, and 88.9% across the entire dataset. The NPV was notably high at 99.2% in the validation set. This model was named the Cassandra score (CS) and is proposed for the clinical management of BC patients. Conclusion: CS is a simple, non-invasive, fast, and reliable method that showed a PPV of 99.1% in the malignancy prediction of ALNs, potentially being also well suited for young sonographers.

Background: Axillary lymphadenectomy remains an integral part of breast cancer treatment, yet seroma formation occurs in 15% to 85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies, with controversial results., Methods: Fifty patients underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray and a collagen patch were applied to the axillary fossa in 25 patients; the other 25 patients were treated conventionally., Results: Suction drainage was removed between postoperative days 3 and 4. Seroma magnitude and duration were significantly reduced (P = .004 and .02, respectively) and there were fewer evacuative punctures in patients receiving fibrin glue and collagen patches compared with the conventional treatment group., Conclusions: Use of fibrin glue with collagen patches does not always prevent seroma formation, but it does reduce seroma magnitude and duration, as well as necessary evacuative punctures.