Search

Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD).

This paper presents the development of the hardware and software architecture of a sixdegrees of freedom (DOF) parallel robot (PARA-SILSROB) by illustrating all the stages undertaken to achieve the experimental model of the robot. Based on the experimental model, the control architecture is also presented, which is primarily based on a master–slave control system through which the surgeon controls the robot using the master console composed of commercial peripheral components (two 3D Space Mouse devices, computer, and keyboard) integrated with the solution developed in this study and presented in this paper. The robot was developed also according to the surgical protocol and surgeon's requirements, and for the functionality testing of the mechanical structure, two experimental stands were used. The first stand presented several surgical steps, such as manipulation, resection, and suture of experimental tissues (simulating real-life robot-assisted surgical maneuvers) using commercial instruments. The second stand presented a simulation of an esophagectomy for esophageal cancer and digestive reconstruction through a right intercostal approach. For this testing phase, the organs were created using 3D reconstruction, and their simplified models were 3D printed using PolyJet technology. Furthermore, the input trajectory generated using the master console was compared with the robot actuator's movements and the obtained results were used for validation of the proposed robot control system. [ABSTRACT FROM AUTHOR]

Pancreatic cancer is one of the most aggressive, heterogeneous, and fatal types of human cancer; therefore, more effective therapeutic drugs are urgently needed. Human epidermal growth factor receptor 2 (HER2) overexpression and amplification have been identified as a cornerstone in this pathology. The aim of this review is to identify HER2 membrane overexpression in relation to pancreatic cancer pathways that can be used in order to develop a targeted therapy. After searching the keywords, 174 articles were found during a time span of 10 years, between 2013 and 2023, but only twelve scientific papers were qualified for this investigation. The new era of biomolecular research found a significant relationship between HER2 overexpression and pancreatic cancer cells in 25–30% of cases. The variables are dependent on tumor-derived cells, with differences in receptor overexpression between PDAC (pancreatic ductal adenocarcinoma), BTC (biliary tract cancer), ampullary carcinoma, and PNETs (pancreatic neuroendocrine tumors). HER2 overexpression is frequently encountered in human pancreatic carcinoma cell lines, and the ERBB family is one of the targets in the near future of therapy, with good results in phase I, II, and III studies evaluating downregulation and tumor downstaging, respectively. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma (HCC) ranks as the third leading cause of cancer-related deaths worldwide, with liver resection being the most effective for curative intent. The hepatic venous pressure gradient (HVPG), transient elastography-liver stiffness measurement (TE-LSM), and TAC score are intricately connected with the postoperative evolution of cirrhosis. The primary objective of our study is to evaluate the predictive value of key parameters for surgical patients. The proposed predictors can better presume treatment outcomes in HCC and potentially allow an improvement in therapeutic strategy. Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer and the third contributor to malignancy-related deaths worldwide. The hepatic venous pressure gradient (HVPG), transient elastography-liver stiffness measurement (TE-LSM), and the association between TBS (tumor burden score), alpha-fetoprotein levels, and the Child–Pugh classification (TAC score) can serve as valuable prognostic indicators for these patients. Therefore, the main objective of our research was to analyze the prognostic value of the HVPG, TE-LSM, TBS, and TAC scores. An observational and survival study was conducted on 144 subjects. Our findings indicated that HVPG greater than 10 mmHg, AFP surpassing 400 ng/mL, an advanced C–P class, and low TAC score are independent predictors of overall survival. During the multivariate analysis, AFP serum levels and C–P class proved statistically significant. The present study revealed significant differences in overall survival between the two groups divided upon HVPG values and settled by the cutoff of 10 mmHg (p = 0.02). Moreover, by dividing the cohort into three groups based on the TAC score (very low, low, and moderate), statistically significant differences in overall survival were observed across the groups (p = 0.004). [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most aggressive, heterogenous, and fatal types of human cancer for which screening, and more effective therapeutic drugs are urgently needed. Early-stage detection and treatment greatly improve the 5-year survival rate. In the era of targeted therapies for all types of cancer, a complete metabolomic profile is mandatory before neoadjuvant therapy to assign the correct drugs and check the response to the treatment given. The aim of this study is to discover specific metabolic biomarkers or a sequence of metabolomic indicators that possess precise diagnostic capabilities in predicting the efficacy of neoadjuvant therapy. After searching the keywords, a total of 108 articles were identified during a timeframe of 10 years (2013–2023). Within this set, one article was excluded due to the use of non-English language. Six scientific papers were qualified for this investigation after eliminating all duplicates, publications not referring to the subject matter, open access restriction papers, and those not applicable to humans. Biomolecular analysis found a correlation between metabolomic analysis of colorectal cancer samples and poor progression-free survival rates. Biomarkers are instrumental in predicting a patient's response to specific treatments, guiding the selection of targeted therapies, and indicating resistance to certain drugs. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer is the fourth most frequently diagnosed form of cancer and the third leading cause of cancer-related mortality worldwide. The aim of this review is to identify individual metabolic biomarkers and their association with accurate diagnostic values, which can predict gastric cancer metastasis. Materials and Methods: After searching the keywords, 83 articles were found over a period of 13 years. One was eliminated because it was not written in English, and two were published outside the selected period. Seven scientific papers were qualified for this investigation after eliminating duplicates, non-related articles, systematic reviews, and restricted access studies. Results: New metabolic biomarkers with predictive value for gastric cancer metastasis and for elucidating metabolic pathways of the metastatic process have been found. The pathogenic processes can be outlined as follows: pro-oxidant capacity, T-cell inactivation, cell cycle arrest, energy production and mitochondrial enzyme impairment, cell viability and pro-apoptotic effect, enhanced degradation of collagen extracellular matrix, migration, invasion, structural protein synthesis, and tumoral angiogenesis. Conclusion: Metabolic biomarkers have been recognized as independent risk factors in the molecular process of gastric cancer metastasis, with good diagnostic and prognostic value. [ABSTRACT FROM AUTHOR]

Introduction. The introduction of robotic-guided procedures in surgical techniques has brought an increase in the accuracy and control of resections. Surgery has evolved as a technique since the development of laparoscopy, which has added to the visualisation of the peritoneal cavity from a different perspective. Multi-armed robot associated with real-time intraoperative imaging devices brings important manoeuvrability and dexterity improvements in certain surgical fields. Materials and Methods. The present study is designed to synthesise the development of imaging techniques with a focus on ultrasonography in robotic surgery in the last ten years regarding abdominal surgical interventions. Results. All studies involved abdominal surgery. Out of the seven studies, two were performed in clinical trials. The other five studies were performed on organs or simulators and attempted to develop a hybrid surgical technique using ultrasonography and robotic surgery. Most studies aim to surgically identify both blood vessels and nerve structures through this combined technique (surgery and imaging). Conclusions. Ultrasonography is often used in minimally invasive surgical techniques. This adds to the visualisation of blood vessels, the correct identification of tumour margins, and the location of surgical instruments in the tissue. The development of ultrasound technology from 2D to 3D and 4D has brought improvements in minimally invasive and robotic surgical techniques, and it should be further studied to bring surgery to a higher level. [ABSTRACT FROM AUTHOR]

Background & Aims: In the last years increasing scientific evidence drew attention on the potential effects of anesthetic drugs on postoperative outcome in cancer patients. Local anesthetics, especially lidocaine, have been intensively studied in relation with postoperative outcome in colorectal cancer patients. Our study objectives were to investigate the effects of perioperative intravenous lidocaine infusion on neutrophil-to-lymphocyte ratio and short-term postoperative outcome. Additionally, we also looked at 1 year outcome after intended radical colorectal cancer surgery. Methods: 150 patients scheduled for colorectal cancer surgery were randomized to receive sevoflurane anaesthesia with or without 48 hours lidocaine infusion. Results: 73 patients were included in the group A (sevoflurane) and 77 in the group B (sevoflurane with lidocaine). Lidocaine infusion did not modify neutrophil-to-lymphocyte ratio at 24 hours after surgery (p=0.58). Patients receiving intravenous lidocaine had significantly lower morphine consumption (p=0.04), faster mobilization time (p=0.001) and fewer days spent in the hospital (p=0.04). Moreover, at 1 year follow-up, patients in group B had a significant decreased rate of recurrences (p=0.03). There was no significant difference in 1 year survival (p=0.22). Conclusions: In our study, intravenous lidocaine infusion hastened the postoperative recovery of patients in terms of mobilization, hospital discharge and opioid consumption and reduced 1 year recurrence rate. Further studies on larger groups of patients are needed. [ABSTRACT FROM AUTHOR]

Chronic inflammation is demonstrated to play a direct role in carcinogenesis. Our exploratory study aimed to assess the potential added value of two inflammation biomarkers, chitotriosidase and neopterin, in follow-up evaluation of patients with colorectal cancer (CRC). An observational exploratory study was conducted. Patients with CRC and matched controls (1:1, age, sex, and living environment) were evaluated. The patients with CRC (CRC group) and controls were assessed at baseline (before surgical intervention for patients with CRC). Patients with CRC were also evaluated at 1-year follow-up. Significantly more patients with blood group A (54.5% vs. 25.0%) and smokers (50.0% vs. 22.7%) were in the CRC group. The serum values of chitotriosidase and neopterin were higher in CRC patients than in controls, but only neopterin reached the conventional level of statistical significance (p-value = 0.015). The circulating chitotriosidase and neopterin values decreased significantly at 1-year follow-up (p-value < 0.0001). Patients with higher N- and M-stage showed statistically significant higher levels of chitotriosidase and neopterin at baseline and 1-year follow-up (p-values < 0.03). Circulating chitotriosidase levels also showed statistically significant differences regarding baseline and 1-year follow-up on patients with CRC and different differentiation grades (p-values < 0.02). The circulating levels of neopterin significantly decreased at 1-year follow-up, indicating its potential as a prognostic marker. The circulating values of chitotriosidase and neopterin exhibit significant differences in patients with than without recurrences. Our results support further evaluation of chitotriosidase and neopterin as prognostic markers in patients with CRC. [ABSTRACT FROM AUTHOR]

Background: SILS (single incision laparoscopic surgery) and NOTES (natural orifice transluminal endoscopic surgery) are considered breakthroughs in minimally invasive surgery, the first consisting in the surgeon working via a single entrance site and the second via a natural orifice (e.g., oral cavity). Methods: Since 2000 until 2022, the original articles published in the online databases were analyzed. Eligible studies included information about the current therapy of patients with liver surgical pathology and how the two new techniques improve the surgical approach. Results: A total of 798 studies were identified. By applying the exclusion criteria, nine studies remained to be included in the review. Two out of nine studies examined the NOTES approach in liver surgery, whereas the other seven focused on the SILS technique. The age of the patients ranged between 24 and 83 years. Liver resections for hepatocellular carcinoma or colorectal metastases were undertaken and biliary or hydatid cysts were removed. The mean procedure time was 95 to 205 min and the average diameter of the lesions was 5 cm. Conclusions: When practiced by multidisciplinary teams, transvaginal liver resection is feasible and safe. The goals of SILS and NOTES are to be less intrusive, more easily tolerated and aesthetic. [ABSTRACT FROM AUTHOR]

(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) directly affects the quality of life, patients experimenting limited walking ability and disability. The purpose of the current study was to investigate the walking and climbing patterns of patients with lower extremity PAD in relation with several risk factors, applied on Romanian population. A cohort non-randomized design was conducted and all eligible subjects who self-referred for medical care since March 2016 until February 2017 at the Second Surgery Department, County Clinical Emergency Hospital of Cluj-Napoca were included. The eligible patients were older than 18 years, with leg pain and Rutherford grade from I to IV. The following tests were applied to each subject included in the study to investigate the capacity to walk as far as possible in six minute (6 minute walking test), the capacity to climb stairs (climbing stairs test) and the capacity to walk on a treadmill (treadmill test) until the pain occurred. Twenty-four patients with mean age of 65.08±8.53 years were investigated. Almost 81% of patients were with chronic pain, 46% were overweight, and 79% were smokers. The results on applied walking tests were as follows: 279.17±70.58 meters to 6-minutes walking test, 77.50±21.80 stairs and 182.50±73.34 meters on treadmill test. The results of the walking tests significantly correlate with each other (ρ>0.93, p<0.0001), and all applied tests significantly correlate with toe gangrene (ρ>|0.52|, p<0.01) and toe disarticulation (ρ>0.62, p<0.002). It can be concluded that any of the applied walking test proved reliable instrument, able to identify the patients with most severe PAD. [ABSTRACT FROM AUTHOR]

Background and Aim: Colorectal cancer is the third most common cancer worldwide both in men and women. The scope of this systematic review was to investigate if mobile applications exists and what are the benefits in the screening, diagnostic, pre-operative preparation, or post-operative follow-ups on the patients with colorectal cancer. Materials and Methods: We used the frame of PRISMA guideline. On September 1th, 2023, we systematically searched PubMed using the MeSH terms "Colorectal Neoplasms" and "Mobile Applications". No restrictions on the types of articles or publication date were imposed. Results: A total of 24 items were retained. The article's titles and abstracts were screened and 7 articles were removed due to the absence of the abstracts (n=2), the article described a prognostic scoring model (n=2), one was a systematic review, one was reviewing the use of SMS and one was a letter to the editor. Out of the 17 remaining articles, only 7 were available in full text and all were testing mobile applications. The scope of using the applications was to facilitate screening (n=3), recovery (n = 3) and monitor chemotoxicity (n=1). Conclusions: Mobile tools appear as an opportunity for rapid access and increased adherence to colorectal cancer screening guidelines. Mobile applications focused on patient recovery post colorectal cancer surgery need a more patient-centric approach. The mobile application built for monitoring chemotoxicity was deemed to address many of the limitations of identifying and quantifying chemotherapy toxicities. All in all, mobile applications may enhance existing clinical care and provide cost-effective real-time patient support, which may reduce the likelihood of hospital admission. [ABSTRACT FROM AUTHOR]

Transcutaneous electrical nerve stimulation (TENS) is a technique in which pulsed low-voltage electrical currents are delivered through electrodes applied on the intact skin surface of the painful area of the body, by using a special device in order to stimulate peripheral nerves including those for pain relief. This method is used to manage acute and chronic pain, conditions of nociceptive or neuropathic origin. All clinical trials with TENS for postoperative acute pain were included. Case reports, reviews, protocols, letters to the editor, animal experimental research, guidelines, and ongoing or uncompleted trials were excluded. Two hundred fifty-two articles involving postoperative pain and transcutaneous electric nerve stimulation were identified by applying the aforementioned search strategy which resulted in including 18 articles in the analysis. The number of patients assessed for eligibility in each article varies from a maximum of 800 to a minimum of 3. In 88.89% of the articles the frequency of the TENS applied in the patients was mentioned. In half of the research performed in the selected articles pain was evaluated with the visual analogue scale. Immediate postoperative active mobilization of the patient is a key point of shortening the convalescence period and hospitalisation, the one individual in cause being able to attend work and social activities as soon as possible therefore being able to discover non-invasive, simple to use methods that reduce pain overall and the consumption of pharmaceutical analgesics is mandatory. The TENS technique is a non-invasive, safe, complementary technique used in order to reduce acute postoperative pain and improve pulmonary function, especially deep breathing, facilitating active movement and recovery of the patient and significant morbidity reduction. [ABSTRACT FROM AUTHOR]

Background: Systemic inflammatory status is known as an important factor of colorectal cancer prognosis. Our study aimed to evaluate the performances of inflammation biomarker ratios as classification models of seven outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on subjects with colorectal cancer over five years at a single center in Transylvania, Romania. Seven derived ratios were calculated based on laboratory data: neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) and albumin-to-globulin (AGR) ratios, Systemic Immune Inflammation Index (SII) and Prognostic Nutritional Index (PNI). The utility of these ratios as predictors for seven outcomes was further evaluated in multivariable regression models. Results: Our study shows that the evaluated ratios exhibit specific performances for individual outcomes, proving a fair ability as screening tools (NLR and dNLR for survival, T stage and M stage; NLR and SII for T stage; and PLR for M stage). A dNLR over 3.1 (OR = 2.48, 95% CI (1.421 to 4.331)) shows predictive value for survival. A value of NLR over 3.10 (OR = 1.389, 95% CI (1.061 to 1.817)) is positively associated with an advanced T stage, while LMR is negatively related to the T stage (OR = 0.919, 95% CI (0.867 to 0.975)). NLR over 4.25 (OR = 2.647, 95% CI (2.128 to 3.360)) is positively associated with, while PNI is negatively related (OR = 0.970, 95% CI (0.947 to 0.993)) to, the M stage. Conclusion: Each of the evaluated ratios possesses prognostic value for certain outcomes considered, but the reported models need external validation to recommend their clinical practice utilization. [ABSTRACT FROM AUTHOR]

The stability of receiver operating characteristic in context of random split used in development and validation sets, as compared to the full models for three inflammatory ratios (neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) and platelet-to-lymphocyte (PLR) ratio) evaluated as predictors for metastasis in patients with colorectal cancer, was investigated. Data belonging to patients admitted with the diagnosis of colorectal cancer from January 2014 until September 2019 in a single hospital were used. There were 1688 patients eligible for the study, 418 in the metastatic stage. All investigated inflammatory ratios proved to be significant classification models on both the full models and on cross-validations (AUCs > 0.05). High variability of the cut-off values was observed in the unrestricted and restricted split (full models: 4.255 for NLR, 2.745 for dNLR and 255.56 for PLR; random splits: cut-off from 3.215 to 5.905 for NLR, from 2.625 to 3.575 for dNLR and from 134.67 to 335.9 for PLR), but with no effect on the models characteristics or performances. The investigated biomarkes proved limited value as predictors for metastasis (AUCs < 0.8), with largely sensitivity and specificity (from 33.3% to 79.2% for the full model and 29.1% to 82.7% in the restricted splits). Our results showed that a simple random split of observations, weighting or not the patients with and whithout metastasis, in a ROC analysis assures the performances similar to the full model, if at least 70% of the available population is included in the study. [ABSTRACT FROM AUTHOR]

Background and Aim: The incidence of thyroid cancer has increased worldwide during the last decade, being one of the most common endocrine malignancies. Surgical resection, namely conventional thyroidectomy, remains at the frontline of therapy, Minimally invasive techniques gained popularity through the years. The purpose of this systematic review was to understand the most common techniques and to evaluate the outcomes of minimally invasive techniques. Materials and Methods: A literature search was conducted on 20 August 2023 using two MeSH terms: "Robotic Surgical Procedure" and "Thyroid Neoplasms" using PICOTS and PRISMA Statements. The results were narrowed to the articles available in full text. Results: A total of 31 items were retained. The article's titles and abstracts were screened and nine articles were removed as five articles were reviews, two articles were case repots, one was a letter to the editor and one was describing the impact of augmented reality. Remaining 22 articles to analyze the content. Conclusion: This study found that the most used minimally invasive thyroid surgical techniques are robotic transaxillary thyroidectomy and robotic thyroidectomy by bilateral axillo-breast approach. From the systematic review, it can be concluded that for selected patients (well-differentiated thyroid carcinoma), these modern techniques are not inferior to standard of care and are a safe alternative, with the advantage of avoiding a potentially disfiguring scar in the neck, when performed by surgeons who are familiar with and experienced in endoscopic and robotic techniques. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is one of the most common malignant tumours and the second most frequent cause of cancer-related death worldwide. The aim of this review is to identify whether phytotherapy has an effect over the treatment of HCC or if it is suitable as a combination with chemotherapy. A systematic review was performed in order to offer current information over the use of phytotherapy in HCC. We conducted an electronic search of articles published in English in peer reviewed journals between 2012-2022. After keywords were associated, 302 articles were found. After the exclusion of articles which did not meet the inclusion criteria, there were 77 articles eligible for abstract evaluation. The following were discarded: two case report, one systematic review, 36 in vitro studies and nine studies which discussed other pathologies or with no regard to phytotherapy. The remaining articles encompassed 27 in vivo studies of phytotherapy in hepatocellular carcinoma and two randomized control trials. This selection process is illustrated in the Prisma Flow Diagram. Amongst the evaluated articles, two of them researched the effect of phytotherapy over human subjects in two randomized control trials, while the others illustrated the outcomes of phytotherapy over hepatocellular carcinoma cells and murine specimens. To sum up, phytotherapy has proven its usefulness in hepatocellular carcinoma, especially throughout the following mechanisms: anti-inflammatory effect, suppressing malignant cell proliferation, inhibiting angiogenesis, stimulating apoptosis, and even sensitizing cells to chemotherapy. [ABSTRACT FROM AUTHOR]