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Parastomal hernia is one of the most common late complications after stoma formation, significantly decreasing patient's quality of life and negatively impacting body image and physical functioning. Progress has been made regarding the surgical technique of stoma creation in different categories of patients, but a better understanding of the risk factors is crucial in reducing the likeliness of parastomal hernia formation and in helping develop risk stratification strategies for pre-and post-operation management. However, currently there is limited consensus on the associated risk factors. Accordingly, for this narrative review, the authors conducted a literature review through three databases (PubMed, Web of Science, and Scopus) and categorized the identified risk factors into the following three categories: patient-, surgery-, and disease-related. Within these categories, the following 10 risk factors were identified and discussed: age, gender, waist circumference, type of ostomy, laparoscopic approach, aperture size >3 cm, stoma not passing through the middle of rectus abdominis muscle, BMI >25 kg/m2, altered collagen metabolism, and diabetes.

Background. Sepsis presents significant diagnostic and prognostic challenges, and traditional scoring systems, such as SOFA and APACHE, show limitations in predictive accuracy. Machine learning (ML)-based predictive survival models can support risk assessment and treatment decision-making in the intensive care unit (ICU) by accounting for the numerous and complex factors that influence the outcome in the septic patient. Methods. A systematic literature review of studies published from 2014 to 2024 was conducted using the PubMed database. Eligible studies investigated the development of ML models incorporating commonly available laboratory and clinical data for predicting survival outcomes in adult ICU patients with sepsis. Study selection followed the PRISMA guidelines and relied on predefined inclusion criteria. All records were independently assessed by two reviewers, with conflicts resolved by a third senior reviewer. Data related to study design, methodology, results, and interpretation of the results were extracted in a predefined grid. Results. Overall, 19 studies were identified, encompassing primarily logistic regression, random forests, and neural networks. Most used datasets were US-based (MIMIC-III, MIMIC-IV, and eICU-CRD). The most common variables used in model development were age, albumin levels, lactate levels, and ventilator. ML models demonstrated superior performance metrics compared to conventional methods and traditional scoring systems. The best-performing model was a gradient boosting decision tree, with an area under curve of 0.992, an accuracy of 0.954, and a sensitivity of 0.917. However, several critical limitations should be carefully considered when interpreting the results, such as population selection bias (i.e., single center studies), small sample sizes, limited external validation, and model interpretability. Conclusions. Through real-time integration of routine laboratory and clinical data, ML-based tools can assist clinical decision-making and enhance the consistency and quality of sepsis management across various healthcare contexts, including ICUs with limited resources. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) into healthcare, particularly in the field of gastroenterology, marks a significant advancement in the diagnosis and treatment of pancreatic disorders. This narrative review explores the application of AI in enhancing Endoscopic Ultrasound (EUS) imaging techniques for pancreatic pathologies, focusing on developments over the past decade. Through a comprehensive literature search across several scientific databases, including PubMed, Google Scholar, and Web of Science, this paper selects and analyzes 50 studies that highlight the role, benefits, precision rates, and limitations of AI in EUS. The findings suggest that AI not only improves the quality of endoscopic procedures, as acknowledged by a majority of gastroenterologists in the UK and USA, but also offers a promising future for medical diagnostics and treatment, potentially addressing the shortage of specialists and reducing morbidity and mortality rates. Despite AI's infancy in clinical applications and the ethical concerns regarding data privacy, its integration into EUS has enhanced diagnostic accuracy and provided minimally invasive therapeutic alternatives. This review underscores the necessity for further clinical data to evaluate the applicability and reliability of AI in healthcare, advocating for a collaborative approach between physicians and AI technologies to revolutionize the traditional clinical diagnosis and expand treatment possibilities in gastroenterology. [ABSTRACT FROM AUTHOR]

Traumatic abdominal wall hernias (TAWHs) are uncommon health conditions that involve a disruption of the muscular layers after a blunt abdominal injury. A consensus in the management of TAWHs has not been established, owing to the scarce number of reported cases. These hernias can occur under a broad array of clinical presentations, from stable and asymptomatic patients to emergency situations with associated intra-abdominal injuries. The aetiology of TAWHs is diverse and can occur at all ages, however it is more likely to be reported in children and elderly patients. Clinical findings must be correlated with a CT scan, which will confirm the diagnosis. Early diagnosis and treatment were found to be associated with a lower risk of complications and mesh use during the surgical repair is an efficient mean of reducing recurrences after the surgical repair. However, the timing of repair and surgical solution still depends on the patient's condition.

Type 2 diabetes mellitus is a complex condition with high prevalence in the global population, implying multiple complications for the entire organism. It is essential to understand its implications in the development and evolution of other pathologies in order to manage efficiently their complications thus decreasing overall mortality. A surgical pathology potentially associated with type 2 diabetes is acute mesenteric ischemia. Although it has a decreased prevalence in the global population, mesenteric infarction is related to an extremely high mortality rate due to its elusive clinical presentation and rapid progression. The difficult diagnosis emphasizes the need to make associations between acute mesenteric ischemia and other pathologies involved in its evolution, such as type 2 diabetes mellitus. This metabolic disease raises the risk of macro and microvascular complications, therefore disturbing the vascularization of the bowel. The purpose of this review is to describe how diabetes is particularly involved in all four types of mesenteric infarction by modulating different physiopathological mechanisms based on the process of atherosclerosis and other endothelial molecular processes. [ABSTRACT FROM AUTHOR]

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specific mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fistula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime.

To modulate the bioactivity and boost the therapeutic outcome of implantable metallic devices, biodegradable coatings based on polylactide (PLA) and graphene oxide nanosheets (nGOs) loaded with Zinforo™ (Zin) have been proposed in this study as innovative alternatives for the local management of biofilm-associated periprosthetic infections. Using a modified Hummers protocol, high-purity and ultra-thin nGOs have been obtained, as evidenced by X-ray diffraction (XRD) and transmission electron microscopy (TEM) investigations. The matrix-assisted pulsed laser evaporation (MAPLE) technique has been successfully employed to obtain the PLA-nGO-Zin coatings. The stoichiometric and uniform transfer was revealed by infrared microscopy (IRM) and scanning electron microscopy (SEM) studies. In vitro evaluation, performed on fresh blood samples, has shown the excellent hemocompatibility of PLA-nGO-Zin-coated samples (with a hemolytic index of 1.15%), together with their anti-inflammatory ability. Moreover, the PLA-nGO-Zin coatings significantly inhibited the development of mature bacterial biofilms, inducing important anti-biofilm efficiency in the as-coated samples. The herein-reported results evidence the promising potential of PLA-nGO-Zin coatings to be used for the biocompatible and antimicrobial surface modification of metallic implants. [ABSTRACT FROM AUTHOR]

Gastrointestinal cancers are characterized by a frequent incidence, a high number of associated deaths, and a tremendous burden on the medical system and patients worldwide. As conventional chemotherapeutic drugs face numerous limitations, researchers started to investigate better alternatives for extending drug efficacy and limiting adverse effects. A remarkably increasing interest has been addressed to chitosan and cyclodextrins, two highly versatile natural carbohydrate materials endowed with unique physicochemical properties. In this respect, numerous studies reported on fabricating various chitosan and cyclodextrin-based formulations that enabled prolonged circulation times, improved cellular internalization of carried drugs, preferential uptake by the targeted cells, reduced side effects, enhanced apoptosis rates, and increased tumor suppression rates. Therefore, this paper aims to briefly present the advantageous properties of these oligo- and polysaccharides for designing drug delivery systems, further focusing the discussion on nanocarrier systems based on chitosan/cyclodextrins for treating different gastrointestinal cancers. Specifically, there are reviewed studies describing promising solutions for colorectal, liver, gastric, pancreatic, and other types of cancers of the digestive system towards creating an updated framework of what concerns anticancer chitosan/cyclodextrin-based drug delivery systems. [ABSTRACT FROM AUTHOR]

Exploring silver-based and carbon-based nanomaterials' excellent intrinsic antipathogenic effects represents an attractive alternative for fabricating anti-infective formulations. Using chemical synthesis protocols, stearate-conjugated silver (Ag@C18) nanoparticles and graphene oxide nanosheets (nGOs) were herein obtained and investigated in terms of composition and microstructure. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) characterizations revealed the formation of nanomaterials with desirable physical properties, while X-ray diffraction (XRD) analyses confirmed the high purity of synthesized nanomaterials. Further, laser-processed Ag@C18-nGO coatings were developed, optimized, and evaluated in terms of biological and microbiological outcomes. The highly biocompatible Ag@C18-nGO nanostructured coatings proved suitable candidates for the local modulation of biofilm-associated periprosthetic infections. [ABSTRACT FROM AUTHOR]

Simple Summary: An analysis of the presence of mutations of 105 genes in appendiceal cancers through the lens of the reviewed literature supports the view that in most of them, the inactivation of tumor suppressor genes, such as TP53 and SMAD4, is required in parallel with the reactivation of genes with oncogenic potentials, such as KRAS, GNAS, and BRAF, which support the main tumor processes, cell proliferation, angiogenesis, and evasion of apoptosis. Of all appendiceal cancers, the most mutated genes are reported in mucinous neoplasms of the appendix, not including those in the RAS–RAF–MEK–ERK signaling pathway, followed by low-grade appendiceal mucinous neoplasms, appendiceal goblet cell adenocarcinomas, and mucinous adenocarcinomas of the appendix, in which this signaling pathway is most frequently affected, showing its importance in their tumorigenesis. Microsatellite instability rarely occurs in appendix cancers, being reported only in adenocarcinomas. In appendiceal cancers, the most frequently mutated genes are (i) KRAS, which, when reactivated, restores signal transduction via the RAS–RAF–MEK–ERK signaling pathway and stimulates cell proliferation in the early stages of tumor transformation, and then angiogenesis; (ii) TP53, whose inactivation leads to the inhibition of programmed cell death; (iii) GNAS, which, when reactivated, links the cAMP pathway to the RAS–RAF–MEK–ERK signaling pathway, stimulating cell proliferation and angiogenesis; (iv) SMAD4, exhibiting typical tumor-suppressive activity, blocking the transmission of oncogenic TGFB signals via the SMAD2/SMAD3 heterodimer; and (v) BRAF, which is part of the RAS–RAF–MEK–ERK signaling pathway. Diverse mutations are reported in other genes, which are part of secondary or less critical signaling pathways for tumor progression, but which amplify the phenotypic diversity of appendiceal cancers. In this review, we will present the main genetic mutations involved in appendix tumors and their roles in cell proliferation and survival, and in tumor invasiveness, angiogenesis, and acquired resistance to anti-growth signals. [ABSTRACT FROM AUTHOR]

Background: Incisional hernias represent a common complication following a midline incision, generating impairment, lower quality of life, and social costs. The aim of this narrative review is to determine in which manner risk factors - such as age, gender, postoperative complications, and even the overall health system - impact the satisfaction and expectations of the patients. Methods: A literature search was performed through PubMed, Web of Science, and SpringerLink, addressing both international and national articles. Only full-text articles published in the last 12 years were chosen. Each individual positive or negative factor was then targeted. Results: Statistically, the majority of patients were satisfied with the outcomes of the reparative surgery. Even so, complications can still occur, which are more likely to appear in the early postoperative stages. In most of these cases, the patients complained of strenuous movement, chronic pain, or recurrence, leaving the option of another surgical repair up to the patient's wishes. On the one hand it seems that robotic-assisted surgery (RAS), absorbable sutures, suture fixation without tacks, and the male gender were associated with a better quality of life and less recurrence or other complications. On the other hand, lack of communication between patients and health personnel, chronic health diseases, and the female gender were linked to a tendency of developing more complications and therefore, a lower quality of life. Conclusion: Statistically, in most of the cases, the patients were satisfied with the results. While it is safe to say that an incisional hernia repair increases the quality of life, there is still a small, but significant percentage of people that do not benefit from it as much as they expected. More awareness should be raised and the communication between patients and health personnel improved. [ABSTRACT FROM AUTHOR]