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Valerii Luțenco,1,* Laura Rebegea,2,3,* Adrian Beznea,1,3 George Tocu,3,* Monica Moraru,3 Oana Mariana Mihailov,3,* Bogdan Mihnea Ciuntu,4,* Verginia Luțenco,5 Floris Cristian Stanculea,6 Raul Mihailov1,3,* 1Surgery I Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania; 2Oncology and Radiotherapy Clinic, Emergency Hospital “Sf. Ap. Andrei”, Galați, Romania; 3“Dunărea de Jos” University of Galati, Faculty of Medicine and Pharmacy, Galați, Romania; 4“Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania; 5Clinical Children Emergency Hospital “Sf. Ioan”, Galați, Romania; 6“Carol Davila” University of Medicine and Pharmacy, Bucuresti, Romania*These authors contributed equally to this workCorrespondence: George Tocu; Oana Mariana Mihailov, “Dunarea de Jos” University of Galati, 47 Domneasca Street, Galați, 800008, Romania, Tel +40728249228 ; +40745250391, Email george_tocu@yahoo.com; oana.mihailov@ugal.roAbstract: Breast cancer is the most common cause of cancer death in women and the second cause in the general population. The incidence has increased over time. Women in developing countries often present at an advanced stage where initial surgery is not feasible. Short disease-free intervals, the number of metastatic organs and liver metastasis were consistently associated with poor overall survival. Surgery is an integral part of the therapeutic plan for locally advanced breast cancer. The integration of surgical care into the management of patients with advanced cancer has changed substantially with the use of neoadjuvant chemotherapy. Also, more recently, neoadjuvant endocrine therapy and targeted therapies offer new opportunities to downsize the tumor burden and transform the role of surgery for this population from palliation to largely curative intent. Innovative surgical approach to the primary tumor in metastatic disease may provide survival benefits and local control in some patients. Similar to systemic therapy, surgical therapy for secondary dissemination should be considered in certain cases for improved individual outcomes. Advances in reconstructive techniques have improved the quality of life of these patients.Keywords: breast cancer, locally advanced, metastatic, individual outcomes, surgery

A tracheoesophageal fistula (TEF) is a communication between the trachea and esophagus that is acquired or congenital. Congenital TEF, without other conditions like esophageal atresia, is usually diagnosed after birth or during infancy, as the baby will develop respiratory symptomatology, mostly severe, due to fluid/food aspiration in the trachea. In adults, TEFs can be caused by malignant conditions, blunt trauma, iatrogenic injury, prolonged mechanical ventilation and excessive inflation pressure of the endotracheal tube. We report a male patient of 86 years of age who presented at the "St. Spiridon" Emergency County Hospital in January 2022, accusing breathing difficulty, productive cough and occasional stabbing pain in the posterior thorax, within the previous week. Clinical exam was typical for pneumonia, but since the patient mentioned coughing episodes during eating/drinking since December 2021, together with a history of general anesthesia for abdominal surgery in mid-November 2021, a CT scan was performed. It confirmed a TEF of 7/16 mm (transverse/cranio-caudal) in size, located at the level of T2 vertebral body. The particularity of the case resides in the uncertain etiology of the fistula. If this patient had a clear iatrogenic injury, aspiration pneumonia should have occurred within days after the intubation event. However, after the surgery the patient was fine and discharged home without any symptomatology relevant for TEF. Only after one month, he started experiencing coughing during eating, that leads us to the assumption that he might have been born with a very small and asymptomatic tracheoesophageal defect, and the intubation for general anesthesia, even if done in a correct manner, represented a trigger event which led to development of a TEF. There are very few cases reported in literature with adult patients presenting a minor structural defect that remained unnoticed for a very long time. [ABSTRACT FROM AUTHOR]

Background: The celiac trunk represents an unpaired visceral branch of the abdominal aorta, which detaches at the level of the 12th cervical vertebra. It has a trajectory of 1-2 cm and a caliber of 5-8 mm, having relations with the parietal peritoneum, the vestibule of the omental bursa, the diaphragmatic lymph nodes and the diaphragmatic pillar muscles, the caudate lobe of the liver, the vertical portion of the small gastric curvature and the median arcuate ligament. The celiac trunk trifurcates into three terminal branches: the left gastric artery, the common hepatic artery and the splenic artery. Each of these branches has a specific trajectory and relations, vascularizing the corresponding organs. Given its importance as a source of vascularization, any anatomical variation is eloquent and necessary to be known for the diagnosis and treatment of conditions at this level. Methods: The selection of articles that were included in this paper was made using the PubMed database, where the following keywords were used: variation of celiac trunk, celiac trunk and laparoscopic surgery, clinical implications of celiac trunk, celiac trunk and oncologic extensive surgery. Entering the mentioned keywords generated an initial number of 5428 references. They were subjected to a filtering process: duplicates were removed, only free full-text articles were selected, and inclusion and exclusion criteria were applied. Subsequently, the most appropriate articles for the topic of the paper were chosen, according to the Web of Science Impact Factor and suitability criteria, resulting in a final number of 28 articles. Literature review: These 28 articles were reviewed based on the criteria: anatomical variants in the branching of the celiac trunk, implications of anatomical variations of the celiac trunk in: laparoscopic surgery - treatment of median arcuate ligament syndrome, abdominal oncological surgery, liver transplant and interventional radiology. Conclusions: The anatomical variations of the celiac trunk have a significant impact on abdominal surgery, whether oncological or not, liver transplant, as well as minimally invasive radiological procedures. A correct knowledge of the up-mentioned variations significantly decreases the rate of intra- and post-interventional complications, accompanied by a smaller recovery time in the possible event of a complication, and also the general healing time following surgery. [ABSTRACT FROM AUTHOR]

Introduction: Almost all methanol resources are made synthetically and almost all cases of acute methanol poisoning result from ingestion. Clinical manifestations: Symptoms and signs are usually limited to the Central Nervous System (CNS), optic and gastrointestinal tract, usually involving mild CNS depression. Death in methanol poisoning is due to respiratory failure. Imaging explorations: The most eloquent lesion visible radiographically is bilateral putamen necrosis. In severe methanol intoxication plus coma, CT shows hypodensity in the putamen, and less commonly, in the caudate nucleus. Electrophysiological tests: On electroretinography (ERG), a-negative waves reflect photoreceptor activity and b-waves reflect impulse conduction through the bipolar cell layer including the Muller glial cell layer. Macroscopic changes: The most common lesions are ischemic and hemorrhagic cerebral infarction, with selective localization to the putamen and subcortical white matter. Changes with other cerebral and cerebellar locations have been rarely reported; for example hemorrhagic infarcts in the bilateral parasagittal region, the parieto-occipital region. Histological aspects: More recent studies show shrinkage and degeneration of neurons belonging to the parietal cortex, putamen degeneration as well as hemorrhagic necrosis and spongiosis in the optic chiasm. Other hemorrhagic lesions were observed in the pons and basal ganglia. Most studies focus on optic nerve damage, due to the frequent presence of retrobulbar optic neuritis in these patients. Conclusions: A thorough evaluation, including macroscopic and microscopic examination, imaging investigations and toxicological analysis is of paramount importance in establishing a diagnosis of acute methanol poisoning. [ABSTRACT FROM AUTHOR]

The commissural pathways of the brain have represented a point of interest for anatomists beginning with the 19th century. However, only by mid 1950s Theodor W. Blackstad achieved the experimental analysis of their functional organisation. The canal of the anterior commissure and its lateral segment were mentioned beginning with the 18th century by Vicq D'Azyr, so that in 1983 Malcolm D. Carpenter would achieve the first anatomical description of the rostral commissure. The purpose of this study is to achieve a morphometrical analysis of the mediosagittal segment of the anterior cerebral commissure, constituting an important landmark in surgical interventions at the level of the anterior wall of the third cerebral ventricle. The anatomical material is represented by 20 adult brains in the collection of "Ion Iancu" Anatomy Institute of "Gr. T. Popa" University of Medicine and Pharmacy Iaşi. The anatomical pieces were preserved through immersion into a formaldehyde solution 10% for 6 months. The images were taken with the help of a Fujifilm FinePix S3200 camera, with a resolution of 10 megapixels and processed with the ArchiCAD software. Through the measurements taken regarding the maximum and the minimum diameter, as well as through the determination of the area of the mediosagittal section, our study represents a first basis in the carrying out of an anatomical norm regarding the anterior white commissure. [ABSTRACT FROM AUTHOR]

COMPLETE SACRAL SPINA BIFIDA OCCULTA fortuitously DISCOVERED IN A TRAUMA PATIENT (Abstract): Sacral spina bifida occulta (SSBO) is a defect occurring during embryonic life when the neural tube develops. It consists of o complete lack of the posterior wall of the sacral canal, which anatomically is represented by the median sacral crest. This condition belongs to a larger group of pathologies named spina bifida, the latter comprising also the meningocele and the myelomeningocele. In this paper we present a totally asymptomatic complete SSBO in a 47- year old patient with multiple traumas that arrived at "Sf Spiridon" Emergency County Hospital in Iasi, Romania. He experienced an accidental fall from approximately 1.5 - 2.0 metres and we managed to discover his sacral defect during the CT scans he underwent in the Radiology Department. We present the axial and the reconstructed CT images and discuss the anatomy of the sacrum in both complete and incomplete SSBO, pointing towards possible complications that might arise in case of injury at this level. We have reviewed the related literature on PubMed discovering the controversies amongst classification and the methodological approach of this condition. Several data is presented comparatively and an emphasis is done on the prevalence of this rare finding in several anthropological studies, based on archaeological sites from abroad and even located in our city, Iasi. [ABSTRACT FROM AUTHOR]

The educational counseling, an integral part of the pedagogical correlation between educator and student, represents an important factor in preventing difficulties that can interfere with the psycho-social development of the student. Similarly, pastoral counseling, a component of the missionary activity performed by the Church, highlights the values of Christian Morality that are shared to all growing individuals, not only, but it has the purpose to correct the behavioural deviations and lackings, both spiritual and educational. Both educational and pastoral counseling are preoccupied, in the same manner, with the valorization of human dignity and quality, of free communication of one's emotions, experiences, aspirations, both personal and professional, of the responsibility of one's decisions, of the seriousness and competence in relation to one's problems. The present study proposes a comparative analysis of the notes defining the educational counseling and pastoral counseling in axiological and praxiological terms. Also, we wanted to highlight the necessity of a real collaboration between family, school and Church, to prevent parents-children conflicts. In this regard, we want to describe a case of educational and pastoral intervention. [ABSTRACT FROM AUTHOR]

In this study in vivo models were used, two dry skulls on which simulated periapical lesions were induced, being magnified with the help of 3 spherical drills of different sizes. 13 teeth were included, thus obtaining 104 images collected through periapical radiographies and CBCT in the initial state and after each drilling process, which were analysed by 5 dentists. The sensitivity and the specificity, as well as the kappa coefficient were measured. The purpose of this study is to compare the diagnostic accuracy of endodontists in diagnosing artificially generated periapical lesions, using the digital periapical radiography (DPR) and cone-beam computed tomography (CBCT). [ABSTRACT FROM AUTHOR]

Background: Primary renal leiomyoma was confirmed as a rare benign tumor formed by smooth muscle fibers and usually asymptomatic. Purpose: to describe a subcapsular cortical renal leiomyoma with probable vascular origin. Materials and methods: case report of a patient with pain in the left flank with imaging exploration (ultrasonoangiography, abdominal CT and MRI) and microscopic and immunohistochemically postoperatively evaluation. Results: a well-defined solid nodular tumor of about 40mmx50mmx45mm was observed in the upper polar renal cortex, beneath the renal capsule. The tumor mass was poorly vascularized, non-invasive and of benign aspect, hypoechogenic and isodense with renal cortex, with hypo intense heterogeneous signal in T2-weighted image, with fibrous/muscular aspect, and central hypodense area (potential necrosis). Histopathology (fusiform bundled smooth muscle cells) and immunohistochemistry of the tumor cells (positive to actin and negative to MB45) supported the diagnosis of renal leiomyoma. Postoperative evolution was normal at 3 months with no recurrence. Conclusions: Histopathology results confirmed the vascular origin for subscapular leiomyoma. Intratumoral necrosis is associated to degenerative lesions of the muscle fibers. The present tumor mass had an absolute surgical indication. [ABSTRACT FROM AUTHOR]

Block vertebrae or vertebral synostosis is the fusion of two or more vertebrae in different regions of the vertebral column. Fusion of the vertebrae can be congenital or acquired. The fusion can be asymptomatic and pass undiscovered or can cause pain and restricted mobility of the spine. We performed a complete set of imaging investigations to a 30-years old male with posttraumatic injury, addressed to Emergency Care Compartment of "Sf. Spiridon" Hospital in Iassy. On cervical radiography we identified the fusion between C3 and C4 vertebras, corresponding to a vertebral block. The second case is an anatomical specimen, from the bone collection of "Gr. T. Popa" University of Medicine and Pharmacy of Iassy Anatomical Institute, which consist of the fusion between C2 and C3 vertebras. The aim of this report is to alert the clinicians to the presence of asymptomatic block vertebrae and to report such a case fortuitously discovered on neck radiography. [ABSTRACT FROM AUTHOR]

Musculocutaneous nerve is a terminal branch of brachial plexus, originating from the anterior rami of C5-C6 spinal nerves. Usually, it arises from the lateral cord and innervates the anterior muscular compartment of the arm and the skin of the lateral surface of the forearm. During routine dissection of a 62-years-old female cadaver, we identified a particular distribution of the terminal branches of brachial plexus: musculocutaneous nerve origin from median nerve. The muscles of the anterior compartment of the arm are supplied by the median nerve, as well as the skin sensitivity of the lateral forearm. This variation is associated with an accessory communicating bundle between the lateral cord of the brachial plexus and the medial root of the median nerve. The aim of this report is to highlight an anatomical variation of the brachial plexus with surgical and neurological implications and to review the morphological types based on their frequencies. [ABSTRACT FROM AUTHOR]

This paper presents the results of a research initiated in the period 2014-2015 at a rural school in Constanta, Romania. The research pursued achievement an investigation on the correlation between learning styles and academic performance of students. The research revealed the following: the student acquires information, interacts with the colleagues and the teachers, participates actively in solving of the various learning tasks, if used two or all learning styles. The teacher, as an educational advisor, has an important role in identifying educational experiences to optimize students' learning opportunities. The small group of subjects is an evident shortcoming of this research, but we intend to extend it to a larger number of subjects, from a greater number of schools, both rural and urban areas. [ABSTRACT FROM AUTHOR]

Flow-cytometry on cellular suspensions shows the presence of lymphocytary infiltrate and a considerable concentration of helper T cells and cytotoxic T cells .The levels of T cells were increased in the tumor areas where a high grade of morphological changes has been observed.T cells infiltrate in tumors are mostly seen as evidence of a protective immune response and have been associated with better prognosis .T cells are capable of secreting a repertoire of molecules that are able to regulate intercellular signaling. The object of the present study is to analyze the composition of the lymphocytary infiltrate associated with breast cancer and its implications in further evolution of the tumor and the therapeutic possibilities. [ABSTRACT FROM AUTHOR]

The authors have analysed a number of 220 patients who underwent laparoscopic cholecystectomy between May 2008 - May 2013 at the 1st Surgical Clinic, "Sf. Spiridon" University Hospital. Peroperative iatrogenic lesions of the common bile duct occurred in 7 cases. In 3 out of the 7 cases, surgical intraoperative exploration was necessary in order to establish immediately the diagnosis. Laparotomy for corrective surgery was required in all cases. There were practiced end-to-end anastomosis with Kehr T tube in total bile duct sections (4 cases) and placement of a probe Kehr T tube in partial injuries (3 cases). In all of the 7 cases a Penrose drain was placed into the subhepatic space. The postoperatory evolution was favourable with no subsequently mortalities. [ABSTRACT FROM AUTHOR]

The goal of our study was the qualitative evaluation of the anterior cerebral commissure on dissected anatomical pieces. Material and methods: the anatomical material consisted of 45 adult brains, fixated in formalin solution for 10-16 weeks. The images were acquired with a Zeiss operator microscope and recorded on a Sony F717 digital camera. Results and discussions: this study of the anterior cerebral commissure allowed us to create an original regionalization of this structure in four distinct segments. Conclusions: The comparative study of the anatomical pieces provided a useful baseline for imagistic data interpretation. The qualitative analysis of the anterior cerebral commissure led us to create a practical regionalization of this structure and to recognize it as an important landmark of the third cerebral ventricle. [ABSTRACT FROM AUTHOR]

This study presents the morphological, morphopathological and immunohistochemical aspects of digestive heterotopic accessory pancreas (performed in 2nd Surgical Clinic of .Sf. Spiridon. Emergency Hospital from Iasi between jan. 1986 and dec. 2011) Results: 30 patients of this retrospective study (19 males/63,3% and 11 females/36,6%) aged between 23 and 78 years were grouped (regarding the diagnosis circumstances) in: A group, clinical symptomatic cases (5 patients/16,6%) with obstructive prepyloric polypoid tumors that required antrectomy and gastroduodenal anastomosis; group B, coincidental cases (19 patients/ 63,3%) - 14 patients of group B (73,6%) with pyloroduodenal stenosis and the remaining cases (26,3%) with severe upper-GI bleeding that required a subtotal gastric resection (3 patients) or antrectomy (2 cases) and group C, incidental cases (6 patients/20,0%) in which the histopathological diagnosis of a jejunal pancreas heterotopy occurred after an extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. On direct or endoscopic exploration of clinical manifested cases, the lesion was prepyloric nodular or polipoid tumor, sized between 2.5 - 4 × 2.0 - 3.5 × 1.0 - 2.0 cm and had a yellowish colour on the sectioned aspect. Based on the histological classification of Heinrich H. the accesory heterotypic pancreatic tissues may be classified as: type I - ducts, acini and pancreatic islets in 40,0% cases, type II - ducts and acini in 43,3% cases and type III - exclusively with ducts in 16,6% cases. In 76,6% cases which means 23 patients, the pancreatic heterotopy was localized in mucosal and submucosal layers; in 16,6% of cases /5 patients - intramucosal and in 6,3% /2 patients the location was in the subserous layer (based on immunomarkers assessment for synaptophysine, EMA, CK 7 on the epithelium of the ducts and acini of digestive heterotopic accessory pancreas). Conclusion: The most frequent location of heterotopic accessory pancreas is the digestive one. The reports showed an incidence of 70-90% of cases. [ABSTRACT FROM AUTHOR]

The surgical anatomy of the recurrent laryngeal nerve has been extensively described in the literature and consequences of injury are well known. The superior laryngeal nerve has received less attention by both anatomists and surgeons. The authors describe a variation of the external branch of the superior laryngeal nerve around the superior thyroid artery during a routine anatomical dissection. Injury to the superior laryngeal nerve significantly increases morbidity following certain procedures and may have catastrophic consequences for voice professionals, as it can often lead to voice fatigue and decreased pitch range. Identification and preservation should therefore be a priority. The superior laryngeal nerve is at risk in a variety of neck procedures and the surgeon should be familiar with its course and anatomical variations. [ABSTRACT FROM AUTHOR]

Context. Atrial fibrillation (AF) is the most common sustained arrhythmia in clinical practice. The increasing evidence supports links between inflammation and AF. There is evidence showing that obesity is a major cause of adipose tissue (AT) inflammation. Ghrelin (GHRL), through its growth hormone secretagogue receptor (GHS-R) present on adipose tissue macrophages (ATMs), could modulate AT inflammation. Objective. Our study aimed to evaluate the role of adipose tissue macrophages (ATMs) and their GHS-R in adipose tissue samples of right atrial appendages (RAA) biopsies. Subjects and Method. We obtained RAA biopsies from 10 obese patients, undergoing cardiac surgery for coronary artery bypass graft (CABG) and developing postoperative atrial fibrillation (POAF). The epicardial tissue samples were examined using immunohistochemistry to visualize and quantify CD68 and GSH-R expression of the ATMs. Results. Histologically, the mean adipocyte diameter (MAD) of epicardial adipose tissue (EAT) was larger in EAT samples with inflammation as compared to EAT without inflammation (84.2 µm vs. 79.6 µm). The expression of CD68 was lower in EAT without inflammation as compared to EAT with inflammation in adipose tissue samples. Similarly, the expression of GSH-R was lower in EAT samples without inflammation as compared to EAT samples with inflammation in adipose tissue. Conclusions. Increased epicardial fat area, macrophage infiltration, and GHS-R expression in epicardial ATMs appeared to be associated with postoperative atrial fibrillation in obese patients. [ABSTRACT FROM AUTHOR]

Background: Ideas about Artificial intelligence appeared about half a century ago, but only now is it becoming an essential element of everyday life. The data provided are becoming a bigger pool and we need artificial intelligence that will help us with its superhuman powers. Its interaction with medicine is improving more and more, with medicine being a domain that continues to be perfected. Materials and Methods: The most important databases were used to perform this detailed search that addresses artificial intelligence in the medical and surgical fields. Discussion: Machine learning, deep learning, neural networks and computer vision are some of the mechanisms that are becoming a trend in healthcare worldwide. Developed countries such as Japan, France and Germany have already implemented artificial intelligence in their medical systems. The help it gives is in medical diagnosis, patient monitoring, personalized therapy and workflow optimization. Artificial intelligence will help surgeons to perfect their skills, to standardize techniques and to choose the best surgical techniques. Conclusions: The goal is to predict complications, reduce diagnostic times, diagnose complex pathologies, guide surgeons intraoperatively and reduce medical errors. We are at the beginning of this, and the potential is enormous, but we must not forget the impediments that may appear and slow down its implementation.

NK cells monitor altered molecular patterns in tumors and infected cells through an ample array of receptors. Two families of evolutionarily distant receptors have converged to enable human NK cells to sense levels of HLA class I ligands, frequently abnormal in altered cells. Whilst different forms of polymorphism are a hallmark of killer-cell immunoglobulin-like receptors and their classic HLA-A, B, and C ligands, genetic diversity of killer-cell lectin-like receptors for the non-classical HLA-E (CD94/NKG2 heterodimers) is less conspicuous and has attracted less attention. A common pattern of diversification in both receptor families is evolution of pairs of inhibitory and activating homologs for a common ligand, the genes encoding activating receptors being more frequently affected by copy number variation (CNV). This is exemplified by the gene encoding the activating NKG2C subunit (KLRC2 or NKG2C), which marks an NK-cell subpopulation that differentiates or expands in response to cytomegalovirus. We have studied NKG2C diversity in 240 South European individuals, using polymerase chain reaction and sequencing methods to assess both gene CNV and single-nucleotide polymorphisms (SNPs) affecting its promoter, coding and 3'-untranslated (3'UT) regions. Sequence analysis revealed eight common SNPs-one in the promoter, two in the coding sequence, and five in the 3'UT region. These SNPs associate strongly with each other, forming three conserved extended haplotypes (frequencies: 0.456, 0.221, and 0.117). Homo- and heterozygous combination of these, together with complete gene deletion (0.175) and additional haplotypes with frequencies lower than 0.015, generate a diversity of NKG2C genotypes of potential immunological importance., (© 2022 The Authors. HLA: Immune Response Genetics published by John Wiley & Sons Ltd.)

The novel NKG2C*03 allele encodes a hybrid of the NKG2C*01 and NKG2C*02 primary structures., (© 2021 The Authors. HLA: Immune Response Genetics published by John Wiley & Sons Ltd.)