Macrophage polarization in human periapical lesions in relation to histopathological diagnosis, clinical features and lesion volume: An ex vivo study.

AIM: To evaluate M1 and M2 macrophage polarization in radicular cysts and periapical granulomas through an immunohistochemical analysis and the correlation between macrophage polarization and histopathological diagnosis, clinical characteristics and lesion volume using cone-beam computed tomography. METHODOLOGY: Periapical biopsies diagnosed as radicular cysts (n = 52) and periapical granulomas (n = 51) were analysed by immunohistochemical method. Teeth with periapical lesion with no history of root canal treatment (primary lesion) and lesions persistent to root canal treatment (persistent lesions) were included. Pathological diagnosis, patients' age, gender and clinical characteristics were obtained from treatment records. A cone-beam computed tomographic periapical volume index (CBCTPAVI) score was assigned to each periapical lesion based on the volume of the lesion. Immuno-expressions of CD68 and CD163 were quantified. The CD68/CD163 ratio was adopted to represent M1 or M2 macrophage polarization. Mann-Whitney U test was used to determine the different CD68/CD163 ratio between groups of radicular cyst and periapical granuloma. Spearman's correlation test was performed to assess the correlation between the CD68/CD163 ratio and lesion volume and CBCTPAVI score. RESULTS: Radicular cysts and periapical granulomas had CD68/CD163 median of 2.05 (IQR = 1.33) and 1.26 (IQR = 0.81), respectively. A significantly higher CD68/CD163 ratio was observed in radicular cysts (p < .001). In contrast, periapical granulomas had significantly lower median of CD68/CD163 ratio. Larger lesions had a higher median of CD68/CD163 ratio, while smaller lesions had lower median of CD68/CD163 ratio (p = .007, rs = .262). CD68/CD163 ratio was significantly correlated with the CBCTPAVI score in the overall periapical lesions (p = .002, rs = .306). The higher CD68/CD163 ratio in larger lesions indicated a higher degree of M1 polarization compared to smaller lesions. Regarding the pathological diagnosis, there was a significant positive correlation between CBCTPAVI score and CD68/CD163 ratio in periapical granulomas (p < .001, rs = .453), whereas the negative correlation was observed for radicular cysts (p < .001, rs = -.471). CONCLUSIONS: Periapical granulomas are characterized by a M2-dominant macrophage polarization, while radicular cysts have significantly higher M1 macrophages. The higher degree of M1 macrophage polarization was significantly correlated with larger volume and higher CBCTPAVI scores of overall periapical lesion and periapical granuloma.

Deficiency of geranylgeranyl biphosphate synthase in kidney tubules causes cystic kidney disease.

Polycystic kidney disease (PKD) is a common hereditary kidney disease. Although PKD occurrence is associated with certain gene mutations, its onset regulatory mechanisms are still not well understood. Here, we first report that the key enzyme geranylgeranyl diphosphate synthase (GGPPS) is specifically expressed in renal tubular epithelial cells of mouse kidneys. We aimed to explore the role of GGPPS in PKD. In this study, we established a Ggppsfl/fl:Cdh16cre mouse model and compared its phenotype with that of wild-type mice. A Ggpps-downregulation HK2 cell model was also used to further determine the role of GGPPS. We found that GGPPS was specifically expressed in renal tubular epithelial cells of mouse kidneys. Its expression also increased with age. Low GGPPS expression was observed in human ADPKD tissues. In the Ggppsfl/fl:Cdh16cre mouse model, Ggpps deletion in renal tubular epithelial cells induced the occurrence and development of renal tubule cystic dilation and caused the death of mice after birth due to abnormal renal function. Enhanced proliferation of cyst-lining epithelial cells was also observed after the knockout of Ggpps. These processes were related to the increased rate of Rheb on membrane/cytoplasm and hyperactivation of mTORC1 signaling. In conclusion, the deficiency of GGPPS in kidney tubules induced the formation of renal cysts. It may play a critical role in PKD pathophysiology. A novel therapeutic strategy could be designed according to this work.

Diagnosis and surgical treatment strategies for spinal extradural arachnoid cyst: Case report and treatment insights.

INTRODUCTION: Spinal extradural arachnoid cyst (SEAC) is a rare condition that can cause significant neurological symptoms. Accurate diagnosis and effective surgical treatment are crucial for patient recovery. This study aims to elucidate the diagnostic process and surgical treatment strategies for SEAC through a case report. CASE PRESENTATION: A 33-year-old female patient with no significant medical history presented with intermittent lower back pain for over three months, which gradually worsened, but without accompanying limb numbness or weakness. Neurological examination revealed no abnormalities. Magnetic resonance imaging (MRI) and myelography confirmed a spinal extradural arachnoid cyst at the thoracic level. The patient underwent minimally invasive surgical resection of the cyst and dural repair, resulting in significant relief of pain postoperatively. DISCUSSION: This case highlights the importance of precise diagnostic localization and meticulous surgical technique in treating SEAC. The patient showed significant improvement in symptoms post-surgery, with no recurrence observed during follow-up. CONCLUSION: The successful treatment of SEAC in this case demonstrates the effectiveness of minimally invasive surgical resection and dural repair. This case provides valuable insights and recommendations for managing similar cases in clinical practice.

Performance of explainable artificial intelligence in guiding the management of patients with a pancreatic cyst.

BACKGROUND/OBJECTIVES: Pancreatic cyst management can be distilled into three separate pathways - discharge, monitoring or surgery- based on the risk of malignant transformation. This study compares the performance of artificial intelligence (AI) models to clinical care for this task. METHODS: Two explainable boosting machine (EBM) models were developed and evaluated using clinical features only, or clinical features and cyst fluid molecular markers (CFMM) using a publicly available dataset, consisting of 850 cases (median age 64; 65 % female) with independent training (429 cases) and holdout test cohorts (421 cases). There were 137 cysts with no malignant potential, 114 malignant cysts, and 599 IPMNs and MCNs. RESULTS: The EBM and EBM with CFMM models had higher accuracy for identifying patients requiring monitoring (0.88 and 0.82) and surgery (0.66 and 0.82) respectively compared with current clinical care (0.62 and 0.58). For discharge, the EBM with CFMM model had a higher accuracy (0.91) than either the EBM model (0.84) or current clinical care (0.86). In the cohort of patients who underwent surgical resection, use of the EBM-CFMM model would have decreased the number of unnecessary surgeries by 59 % (n = 92), increased correct surgeries by 7.5 % (n = 11), identified patients who require monitoring by 122 % (n = 76), and increased the number of patients correctly classified for discharge by 138 % (n = 18) compared to clinical care. CONCLUSIONS: EBM models had greater sensitivity and specificity for identifying the correct management compared with either clinical management or previous AI models. The model predictions are demonstrated to be interpretable by clinicians.

Diagnostic yield of endoscopic ultrasound in dilated common bile duct with non-diagnostic cross-sectional imaging.

BACKGROUND: Biliary dilatation without obvious etiology on cross sectional imaging warrants further investigation. This study aimed to assess yield of endoscopic ultrasound in providing etiologic diagnosis in such situation. METHODS: Prospective cohort of consecutive patients with biliary dilatation & non diagnostic computed tomography (CT) and /or magnetic resonance imaging (MRI) underwent endoscopic ultrasound (EUS) with/without fine needle aspiration cytology (FNAC) and were followed clinically, biochemically with/without radiology for up to six months. The findings of EUS were corroborated with histopathology of surgical specimens and endoscopic retrograde cholangiography (ERCP) findings in relevant cases. RESULTS: Median age of 121 patients completing follow up was 55 years. 98.2% patients were symptomatic and median common bile duct (CBD) diameter was 13 mm. EUS was able to identify lesions attributable for biliary dilatation in (67 out of 121) 55.4% cases with ampullary neoplasm being the commonest (29 out of 67 i.e. 43%). Multivariate logistic regression analysis identified jaundice as the predictor of positive diagnosis on EUS, of finding ampullary lesion and pancreatic lesion on EUS. EUS had sensitivity, specificity, positive predictive value and diagnostic accuracy of 95.65%, 94.23%, 95.65% and 95.04% respectively in providing etiologic diagnosis. Threshold value for baseline bilirubin of 10 mg%, for baseline CA 19.9 of 225 u/L and for largest CBD diameter of 16 mm were determined to have specificity of 98%, 95%, 92.5% respectively of finding a positive diagnosis on EUS. CONCLUSION: EUS provides considerable diagnostic yield with high accuracy in biliary dilatation when cross sectional imaging fails to provide etiologic diagnosis.

Breast cylindroma: A rare and unexpected diagnosis.

Cylindroma is a benign adnexal tumor histologically characterized by clusters of small basaloid cells arranged in a pattern resembling a jigsaw puzzle. Breast cylindromas are extremely rare with approximately 20 reported cases throughout literature. We present a case of a 71-year-old female with a slow growing cystic breast mass, originally identified 8 years prior to biopsy. Mammography and ultrasound demonstrated features of a simple cyst with circumscribed margins and anechoic internal echogenicity, respectively. Biopsy was performed due to increase in size, revealing the pathologic entity of cylindroma. The patient ultimately underwent surgical excision, which confirmed the diagnosis. We discuss the radiology, pathology and clinical course of breast cylindroma.

Nontraumatic intra-diploic arachnoid cyst communicating with sphenoid bone and in close proximity to cavernous sinus in a known case of Wilson disease: A rare entity.

Arachnoid cysts can be intra-cranial or along the spinal cord. Intracranial arachnoid cyst is a very rare finding, trauma being the leading case of it. It is extremely rare for the development of intra-diploic arachnoid cyst without a traumatic history. We present a case of an intra-diploic arachnoid cyst communicating with the greater wing of the sphenoid and in close proximity to the cavernous sinus in a known case of Wilson disease for 22 years. Due to its low incidence, there is a gap in the knowledge and discussion of this cystic lesion, its pathophysiology and management, which are discussed in this case report.

Adnexal Torsion During Pregnancy in a Surrogate Patient Post-tubal Ligation: A Case Report.

Adnexal torsion during pregnancy is rare and is complicated by ambiguous symptoms and often nonspecific imaging findings. Differential diagnoses of torsion include a ruptured ovarian cyst, tubo-ovarian abscess, and appendicitis. A low threshold for the recommended surgical laparoscopy is necessary to avoid delayed diagnosis and fetal or maternal complications. We present a case of a 30-year-old woman at 10 weeks gestation as a surrogate carrier, admitted for progressive, sharp lower right quadrant abdominal pain. On presentation, she was afebrile and vitally stable, with moderate leukocytosis and elevated inflammatory markers. Transvaginal ultrasound showed a 6 x 6 cm adnexal mass/cyst, without ovarian vascular compromise, in addition to a tubular structure indicating possible hydrosalpinx. Initially, her presenting symptoms partially resolved following antibiotics and analgesics, which led us to consider a tubo-ovarian abscess as the culprit. However, upon a recurrence of pain, we proceeded with a diagnostic laparoscopy, with a high suspicion of ovarian torsion. A right adnexal torsion and paratubal cyst were identified; detorsion with preservation of adnexa and cystectomy was performed, with resolution of the pain in the postoperative period. This case underscores the importance of identifying multiple risk factors and complex clinical scenarios for ovarian torsion in premenopausal patients in the context of surrogate pregnancies following tubal ligation. Our findings contribute to the existing literature by emphasizing the need for a high index of suspicion for adnexal torsion, as it is imperative to prevent complications and ensure prompt surgical intervention.

A rare presentation of hematosalpinx with torsion in a thirteen year-old virgin: a case report.

A medical condition called hematosalpinx causes an accumulation of blood within the fallopian tube. It is usually seen in patients with ectopic pregnancy. Inflammatory disease of the pelvis, tubal cancer, pelvic trauma, and endometriosis are further causes. Here, we report a unique case of hematosalpinx with associated tubal torsion in a 13-year-old female lacking any previously reported contributing causes. She is celibate and presented with abdominal pain and fever. Beta-hcg was not present, and her menstrual cycle was regular. Pelvic ultrasound sonography revealed a large cyst and was suggestive of a right paraovarian cyst. An exploratory laparotomy was performed and a giant hematosalpinx was observed in an otherwise normal ovary. In conclusion, although very rare in adolescence, hematosalpinx must be considered in the differential diagnosis. This unusual instance highlights new concerns regarding the pathogenesis of hematosalpinx.

Isolated Muscular Echinococcosis of the Hand and Forearm: A Case Report.

Introduction: Hydatid diseases are a parasitic infestation of human and herbivorous animals caused by a cestode, Echinococcus granulosus. The liver and lung are commonly involved organs and the involvement of muscles and bones is very unusual, even in the countries where echinococcal infestation is endemic. Case Report: We report a case of muscular hydatidosis of the hand and forearm in a 71-year-old male without particular histories, who consulted for tumefaction of the right hand and forearm evolving for 2 years. Biology and the standard radiographs were without anomalies. The diagnosis was evoked on magnetic resonance imaging (MRI) and confirmed by surgical biopsy and excision. The operative follow-up was simple with no recurrence after 3 years. Conclusion: Muscular echinococcosis is an extremely rare disease. An MRI evaluation should be taken into account as the gold standard in the diagnosis. Surgical cystectomy is often indicated, and an excision with wide margins is mandatory to avoid the rupture of the cyst and anaphylaxis. Adjuvant pharmacological therapy is recommended to minimize the risk of recurrence.

Magnetic resonance imaging features of bilateral multiloculated extraneural ganglion cysts of the occipito-atlanto-axial joint causing hypoglossal nerve paralysis in a dog.

A 14-year-old spayed female Miniature Pinscher presented with tongue curling, dysphagia, hypersalivation, and sublingual gland swelling. Comprehensive evaluation, including neurologic and musculoskeletal examinations, blood work, and urinalysis, revealed no abnormalities other than tongue-related signs. Magnetic resonance imaging (MRI) revealed a multilobed cystic structure in the occipito-atlanto-axial joint, compressing the right hypoglossal canal. The lesion appeared cerebrospinal fluid (CSF)-like on T1-weighted and T2-weighted images, and hyperintense compared with CSF on fluid-attenuated inversion recovery T2-weighted images. The scans suggested mucinous content with enhanced peripheral areas on contrast-enhanced images. Surgical removal and drainage of this cyst were performed, and clinical signs improved markedly. The dorsal cyst was tentatively diagnosed as a ganglion cyst based on histopathologic and imaging findings. Ganglion cysts should be considered in the differential diagnosis for dogs with similar MRI findings and neurologic signs.

Spleen salvation: A successful case of spleen-preserving surgery for hydatid cyst.

INTRODUCTION AND SIGNIFICANCE: Hydatid disease is a parasitic infection caused by tapeworm larvae that can affect different organs, including the spleen. While isolated hydatid cysts in the spleen are rare, they are usually asymptomatic and are frequently discovered incidentally. Treatment options depend on several factors, such as cyst location, size, and number. CASE PRESENTATION: We present the case of a 9-year-old child who lives in rural areas. He was suffering from pain in the left flank for 3 months. An ultrasound and CT scan of the abdomen were performed. It was found that there was a solitary hydatid cyst in the spleen, about half the size of the spleen. Surgical intervention was performed and the cyst was completely removed without opening the cyst and with preservation of normal splenic tissue. CLINICAL DISCUSSION: In cases of splenic cysts, the spleen must be preserved and the cyst must be removed with caution so as not to rupture it. Therefore, protecting the child from the possibility of hydatid cyst spread and anaphylactic shock. CONCLUSION: In conclusion, this article underscores the importance of differential diagnosis of a hydatid cyst in the spleen and taking the necessary preventive measures before and during surgery to avoid the rupture of the cyst.

Characteristics and outcomes of minimally invasive surgery for congenital biliary dilatation in children aged <6 years: Comparison between children and adults.

BACKGROUND/PURPOSE: We evaluated the minimally invasive surgery for congenital biliary dilatation (CBD) in adults and children and analyzed the surgical outcomes, especially in children aged <6 years. METHODS: Characteristics and surgical outcomes of patients with CBD who underwent minimally invasive surgery at our hospital between 2013 and 2023 were retrospectively reviewed. RESULTS: Overall, 129 patients (89 children aged <6 years, 9 children aged between 6 and 18 years, and 21 adults) were included in this study. Children exhibited more protein plug presence and abnormal biochemical data than adults. Incidence of postoperative pancreatic fistulas was highest in the adult group (3.4%, 11%, and 33%, respectively, p < .01). In children aged <6 years, postoperative bile leakage and pancreatic fistulas occurred in 9.0% and 3.4% of patients, respectively. Multivariate logistic regression analysis revealed that the Todani IVA was associated with a decrease in postoperative bile leakage (odds ratio: -1.7; 95% confidence interval: (-3.3)-(-0.22), p = .03). CONCLUSION: Adults with CBD required prolonged operative times and had more short-term complications than children with CBD. In children aged <6 years, minimally invasive surgery for CBD can be safely performed; however, a small diameter of the bile duct may be associated with bile leakage.

A case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst.

Introduction: This report describes a case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst. Case presentation: The patient was identified when no left kidney was detected in the fetal period. Abdominal ultrasonography and pelvic plain MRI at 6 months old revealed a 10-mm cystic lesion on the dorsal aspect of the bladder. Cysto-urethroscopy at 1 year old revealed a rather short posterior urethra and right and left inferior crests extending from the posterior urethra beyond the bladder neck. The ejaculatory duct opening was identified on the bladder trigone. Conclusion: Anatomical abnormality of the ejaculatory duct may represent a cause of infertility and ejaculatory dysfunction in Zinner syndrome. Endoscopic evaluation should be performed for this rare anomaly, even in children.

Orbital hydatid cyst and its successful treatment: A case report from Afghanistan.

Purpose: This study aims to underscore the rarity of intraorbital hydatid disease caused by Echinococcus granulosus, emphasizing the importance of comprehensive exploration and documentation for effective management. Observations: Clinical presentations include proptosis, visual deterioration, ocular motility disruptions, and chemosis. A case study of an 8-year-old boy with a retroorbital hydatid cyst successfully resected through a right transcaruncular orbitotomy approach is presented, highlighting surgical complexities and the efficacy of pre and post-operative albendazole therapy. Conclusion and Importance: The successful excision and management of the intraorbital hydatid cyst underscore the significance of accurate diagnosis and precise surgical intervention. This case emphasizes the importance of expanding knowledge about this rare manifestation, contributing to enhanced diagnostic and treatment strategies for optimal outcomes in managing global health concerns.

Efficacy of KTP Laser-Assisted Marsupialization in the Treatment of Vocal Cysts.

OBJECTIVES: Vocal cysts, common benign laryngeal lesions, often lead to voice disturbances. Total surgical enucleation presents challenges due to the delicate nature of vocal tissues. Conventional surgery carries risks of recurrence and decreased voice quality due to incomplete removal and potential vocal fold damage. This study investigates the efficacy of Potassium-Titanyl-Phosphate (KTP) laser-assisted marsupialization for the treatment of vocal cysts. SUBJECTS AND METHODS: We retrospectively analyzed 78 patients who underwent either conventional surgery or KTP laser-assisted marsupialization to compare the voice outcomes and recurrence rates of the two groups. RESULTS: KTP laser-assisted group (B) demonstrated significantly higher recurrence rates (18.4%) compared to conventional surgery group (5%). The mean time to cyst recurrence were 12.4months in group A and 10.9months in group B. The degree of postoperative improvement in all voice parameters was not significantly different between the two groups. CONCLUSIONS: While KTP laser-assisted marsupialization may offer some advantages such as reduced vocal fold damage and ease technique, the higher recurrence rates observed in this study suggest that this technique may not achieve cure rates comparable to conventional surgery. Therefore, careful consideration is necessary when selecting patients for this procedure, and further research is needed to refine the technique and evaluate its long-term efficacy. LEVEL OF EVIDENCE: Level III.

Pediatric spinal arachnoid cysts with compressive myelopathy: single-center experience and update on surgical management.

PURPOSE: This study describes the surgical outcome of pediatric primary spinal arachnoid cysts (SACs) presenting with compressive myelopathy and gives an update on the classification and management of these rare lesions. METHODS: We performed a single-center retrospective analysis of pediatric patients operated for primary spinal arachnoid cysts. The clinical and radiologic profiles and surgical outcomes of these children were analyzed. Subgroup analysis was done in the laminoplasty vs laminectomy groups to see for the development of spinal deformity. RESULTS: There were 10 males and seven females with a mean age of 10.4 years (range:6-14 years). The cysts extended to an average of 5.2 levels (range:2-8). They were extradural in seven (41%) and intradural in 10 (59%). Six intradural and four extradural cysts underwent laminectomy (n = 10) while four intradural and three extradural cysts underwent laminoplasty (n = 7). Although three out of 10 cases in the laminectomy group and none in the laminoplasty group had post-operative spinal deformity, this result was not statistically significant (p = 0.110). There was a moderate negative correlation between post-operative cord occupancy ratio (COR) and post-operative McCormick grade (Pearson correlation coefficient = -0.453, p = 0.068), suggesting that higher CORs are associated with lower McCormick grades. CONCLUSION: Symptomatic pediatric primary spinal arachnoid cysts are safely and effectively managed by marsupialization or microsurgical excision. Considering the growing age group, laminoplasty rather than laminectomy should be the standard surgical procedure to prevent late postoperative spinal deformity. Clinically significant recurrences are rare in the setting of adequate cord expansion and restored subarachnoid CSF flow following surgery.

Splenic cyst deroofing complicated with B lymphoma.

BACKGROUND: Splenic cysts are uncommon and very rarely malignant therefore their treatment isn't standardized. In case of symptomatic cysts different surgical approaches have been suggested. Primary malignant lymphoma of the spleen comprises less than 1% of non-Hodgkin's lymphomas. To our knowledge, only 203 cases of splenic large B-cell lymphoma (LBCL) have been reported to date and only 2 of them were fibrin-associated splenic cysts. CASE PRESENTATION: 27-year-old model with a 19 × 13 cm splenic cyst without data of malignancy in the preliminary study and therefore treated with laparoscopic deroofing. After histological diagnosis of LBCL with a fibrin/EBV-associated splenic pseudocyst, the patient received 4 cycles of Rituximab and a laparoscopic splenectomy was performed due to resurgence of the pseudocyst. No evidence of malignancy has been found during follow up (EBV viral load every 3 months during the first year, PET-CT every 6 months during the first year and annual afterwards) performed after the splenectomy. DISCUSSION AND CONCLUSIONS: The value of tumor markers and radiology for diagnosis of splenic cysts is put into question. Only 60 cases of Fibrin-associated LBCL (FA-LBCL) have been described in the literature therefore there are no treatment guidelines for them even though surgery together with systemic treatment has been the prevalent route with good results in most cases.

Quercetin ameliorates oxidative stress-induced apoptosis of granulosa cells in dairy cow follicular cysts by activating autophagy via the SIRT1/ROS/AMPK signaling pathway.

BACKGROUND: Follicular cysts contribute significantly to reproductive loss in high-yield dairy cows. This results from the death of follicular granulosa cells (GCs) caused by oxidative stress. Quercetin is known to have significant antioxidant and anti-apoptotic effects. However, the effect of quercetin on follicular cysts has yet been elucidated. Therefore, this study aimed to explore the anti-oxidant and anti-apoptosis effects and potential molecular mechanisms of quercetin in H2O2-induced primary cow GCs and 3-nitropropionic acid (3-NPA)-induced mouse model of oxidative stress and thus treat ovarian cysts in dairy cows. RESULTS: In this study, compared with estrus cows, cows with follicular cysts showed heightened levels of oxidative stress and increased follicular cell apoptosis, while autophagy levels were reduced. A model of oxidative stress was induced in vitro by H2O2 and showed significant increases in apoptosis together with reduced autophagy. These effects were significantly ameliorated by quercetin. Effects similar to those of quercetin were observed after treatment of cells with the reactive oxygen species (ROS) inhibitor N-acetylcysteine (NAC). Further investigations using chloroquine (autophagy inhibitor), rapamycin (autophagy activator), selisistat (SIRT1 inhibitor), and compound C (AMPK inhibitor) showed that chloroquine counteracted the effects of quercetin on oxidative stress-induced apoptosis, while rapamycin had the same effect as quercetin. In addition, the SIRT1/AMPK pathway inhibitors antagonized quercetin-mediated mitigation of the effects of oxidative stress on increased apoptosis and reduced autophagy. Consistent with the results in vitro, in mouse ovarian oxidative stress model induced by 3-NPA, quercetin activated autophagy through the SIRT1/AMPK signaling pathway, while alleviating oxidative stress damage and inhibiting apoptosis in mouse ovaries. CONCLUSIONS: These findings indicate that quercetin can inhibit apoptosis in GCs and restore ovarian function by activating autophagy through the SIRT1/ROS/AMPK signaling pathway, suggesting a new direction for the treatment of ovarian follicular cysts in high-yield dairy cows.