Cutaneous metastasis of rectal adenocarcinoma: a case report and literature review.

According to the latest data provided by Globocan 2020, the incidence of colorectal cancer ranks third, after lung cancer and breast cancer, becoming a more and more important global health issue. Of the cases diagnosed with colorectal cancer, more than 25% are diagnosed in the metastatic stage, with the presence of secondary tumors more frequently in the liver, lung and bone. Skin metastases from colorectal cancer are still rare today (< 4%). We want to present a rare, unique case in our department of a 74-year-old patient diagnosed 9 years ago with a malignant rectal tumor who, after a disease-free period of approximately 8 years and a half, developed multiple skin metastases of rectal adenocarcinoma.

A Multidisciplinary Approach to Swallowing Rehabilitation in Patients with Forward Head Posture.

(1) Background and Objectives: The forward head posture (FHP) is characterized by increased extensions of upper cervical vertebrae and flexion of the lower cervical vertebrae and upper thoracic regions, associated with muscle shortening. The compressive loading on the tissues in the cervical spine negatively impacts suprahyoid and infrahyoid muscles and generates increased tension of the masticatory muscles. The tongue has relations with the suprahyoid and the infrahyoid muscles. The pattern of swallowing evolves gradually from birth to the age of four. If this developmental transition does not occur, the result is persistent infantile or atypical swallowing-an orofacial myofunctional disorder with the tongue in improper position during swallowing, causing strain and stress on the jaw, face, head and neck. In FHP, muscles crucial to swallowing are biomechanically misaligned. The lengthening of the suprahyoid muscles necessitates stronger contractions to achieve proper hyolaryngeal movement during swallowing. This study assesses the added benefits of physiotherapy to the traditional myofunctional swallowing rehabilitation for patients with FHP. The underlying hypothesis is that without addressing FHP, swallowing rehabilitation remains challenged and potentially incomplete. (2) Materials and Methods: A total of 61 participants (12-26 years) meeting the inclusion criteria (FHP and atypical swallowing) were divided into two similar groups. Group A attended one orofacial myofunctional therapy (OMT) and one physiotherapy session per week, group B only one OMT session per week, for 20 weeks. Exclusion criteria were as follows: ankyloglossia, neurological impairment affecting tongue and swallowing, cervical osteoarticular pathology, other previous or ongoing treatments for FHP and atypical swallowing. (3) Results: There is a significant improvement in terms of movement and use of the orofacial structures (tongue, lips, cheeks), as well as in breathing and swallowing in both groups. Group A achieved better outcomes as the CVA angle was directly addressed by manual therapy and GPR techniques. (4) Conclusions: The combined therapy proved to be more effective than single OMT therapy.

Maternal Serum Amyloid A as a Marker of Preterm Birth/PROM: A Systematic Review and Meta-Analysis.

Background and Objectives: Preterm birth, one of the leading causes of neonatal mortality, occurs in between 5 and 18% of births. Premature birth can be induced by a variety of triggers, including infection or inflammation. Serum amyloid A, a family of apolipoproteins, increases significantly and rapidly at the onset of inflammation. This study aims to systematically review the results of studies in the literature that have examined the correlation between SAA and PTB/PROM. Materials and Methods: To examine the correlation between serum amyloid A levels in women who gave birth prematurely, a systematic analysis was performed according to PRISMA guidelines. Studies were retrieved by searching the electronic databases PubMed and Google Scholar. The primary outcome measure was the standardized mean difference in serum amyloid A level comparing the preterm birth or premature rupture of membranes groups and the term birth group. Results: Based on the inclusion criteria, a total of 5 manuscripts adequately addressed the desired outcome and were thus included in the analysis. All included studies showed a statistically significant difference in serum SAA levels between the preterm birth or preterm rupture of membranes groups and the term birth group. The pooled effect, according to the random effects model, is SMD = 2.70. However, the effect is not significant (p = 0.097). In addition, the analysis reveals an increased heterogeneity with an I2 = 96%. Further, the analysis of the influence on heterogeneity found a study that has a significant influence on heterogeneity. However, even after outline exclusion, heterogeneity remained high I2 = 90.7%. Conclusions: There is an association between increased levels of SAA and preterm birth/PROM, but studies have shown great heterogeneity.

A Comprehensive View on the Quercetin Impact on Colorectal Cancer.

Colorectal cancer (CRC) represents the third type of cancer in incidence and second in mortality worldwide, with the newly diagnosed case number on the rise. Among the diagnosed patients, approximately 70% have no hereditary germ-line mutations or family history of pathology, thus being termed sporadic CRC. Diet and environmental factors are to date considered solely responsible for the development of sporadic CRC; therefore; attention should be directed towards the discovery of preventative actions to combat the CRC initiation, promotion, and progression. Quercetin is a polyphenolic flavonoid plant secondary metabolite with a well-characterized antioxidant activity. It has been extensively reported as an anti-carcinogenic agent in the scientific literature, and the modulated targets of quercetin have been also characterized in the context of CRC, mainly in original research publications. In this fairly comprehensive review, we summarize the molecular targets of quercetin reported to date in in vivo and in vitro CRC models, while also giving background information about the signal transduction pathways that it up- and downregulates. Among the most relevant modulated pathways, the Wnt/ß-catenin, PI3K/AKT, MAPK/Erk, JNK, or p38, p53, and NF-κB have been described. With this work, we hope to encourage further quests in the elucidation of quercetin anti-carcinogenic activity as single agent, as dietary component, or as pharmaconutrient delivered in the form of plant extracts.

Systematic Review and Meta-Analysis of Laparoscopic versus Robotic-Assisted Surgery for Colon Cancer: Efficacy, Safety, and Outcomes-A Focus on Studies from 2020-2024.

BACKGROUND: Minimally invasive surgery in the treatment of colon cancer has significantly advanced over the years. This systematic review and meta-analysis aimed to compare the operative outcomes of robotic and laparoscopic surgery in the treatment of colon cancer, focusing on operative time, hospital stay, conversion rates, anastomotic leak rates, and total number lymph node harvested. METHODS: Following PRISMA guidelines, we conducted a systematic search across four databases up to January 2024, registering our protocol with PROSPERO (CRD42024513326). We included studies comparing robotic and laparoscopic surgeries for colon cancer, assessing operative time, hospital length of stay, and other perioperative outcomes. Risk of bias was evaluated using the JBI Critical Appraisal Checklist. Statistical analysis utilized a mix of fixed and random-effects models based on heterogeneity. RESULTS: A total of 21 studies met the inclusion criteria, encompassing 50,771 patients, with 21.75% undergoing robotic surgery and 78.25% laparoscopic surgery. Robotic surgery was associated with longer operative times (SMD = -1.27, p < 0.00001) but shorter hospital stays (MD = 0.42, p = 0.003) compared to laparoscopic surgery. Conversion rates were significantly higher in laparoscopic procedures (OR = 2.02, p < 0.00001). No significant differences were found in anastomotic leak rates. A higher number of lymph nodes was harvested by robotic approach (MD = -0.65, p = 0.04). Publication bias was addressed through funnel plot analysis and Egger's test, indicating the presence of asymmetry (p = 0.006). CONCLUSIONS: The choice of surgical method should be individualized, considering factors such as surgeon expertise, medical facilities, and patient-specific considerations. Future research should aim to elucidate long-term outcomes to further guide the clinical decision-making.

Genetic Profiling and Survival Outcomes in Romanian Colorectal Cancer Patients.

BACKGROUND: The increasing incidence of colorectal cancer is one of the most frequently addressed medical topics worldwide. It represents the third most commonly diagnosed cancer in both men and women globally, with significant implications for public health. Mortality for this type of malignancy remains high, second only to lung cancer. Given their clinical relevance, the identification and understanding of KRAS and BRAF mutations have become crucial components of personalized medicine approaches in colorectal cancer. Hence, our desire is to carry out a research that analyzes the impact of these mutations in terms of survival and mortality on patients diagnosed with colorectal cancer. METHODS: We conducted a retrospective study spanning from 2018 to 2022, which involved 118 patients diagnosed with colorectal cancer. The patients were selected from the databases of the Oradea County Emergency Clinical Hospital and Pelican Oradea Hospital. Genetic testing was performed at the "Resident Laboratory" clinic. Subsequently, patients were divided into two groups of equal size based on the presence or absence of mutations. RESULTS: The survival rate one year after the diagnosis of colorectal cancer is 84.74% (N=50/59) for the mutant group versus 67.96% (N=40/59) for the wild-type group. The survival rate at five years from the diagnosis of colorectal cancer is 25.93% (N=15/59) for patients with wild-type tumors compared to 33.54% (N=20/59) for patients with tumors with mutant status (p=0.483, HR=1.153, CI 95% 0.7661-1.735). The five-year survival rate, depending on the mutation present, highlights the fact that the average overall survival for those with the KRAS mutation is 38.6 months (CI 95% 35.22-41.97) and for those with the BRAF mutation is 8.3 months (CI 95% 5.42-11.17) (p=0.039). The mortality rate for mutant KRAS is 44.89% (N=22/50), while for those with mutant BRAF, it is 100% (N=6/6). CONCLUSIONS: We observed no statistically significant difference in overall survival rate and disease-free interval between the two studied groups, but the overall survival was better for those with mutations present (38.64 months versus 31.07 months for wild-type tumors). The mortality rate is higher among tumors with wild-type status (p=0.005), in the first year after the diagnosis of colorectal cancer. The BRAF mutation confers a much worse prognosis than the KRAS mutation, from both the survival analysis and the mortality rate.

Exploring the Potential of Oral Microbiome Biomarkers for Colorectal Cancer Diagnosis and Prognosis: A Systematic Review.

There is growing evidence indicating that the oral microbiota, specifically certain periodontopathogens such as Fusobacterium nucleatum, may play a role in the development of colorectal cancer and that it could potentially be used as a biomarker for diagnosing colorectal cancer (CRC). The question beneath this systematic review is whether the development or progression of colorectal cancer can be attributed to the presence of certain oral bacteria, which could be used for discovering non-invasive biomarkers for CRC. This review aims to give an overview of the actual status of published studies regarding the oral pathogens related to colorectal cancer and assess the effectiveness of the oral microbiome derived biomarkers. A systematic literature search was performed using four databases, Web of Science, Scopus, PubMed, and Science Direct, on the 3rd and 4th of March 2023. The studies that did not have matching inclusion/exclusion criteria were winnowed out. A total of fourteen studies were included. The risk of bias was performed by using QUADAS-2. After assessing the studies, the general conclusion is that oral microbiota-based biomarkers can become a promising non-invasive tool for detecting CRC, but further research is needed in order to determine the mechanisms of oral dysbiosis in colorectal carcinogenesis.

Primary headache management in a multidisciplinary team - a pilot study.

Tension-type headaches and migraines are bidirectionally related to dysfunctions of the cervical and masticatory muscles and some psychosocial factors. Our pilot study aimed to investigate the connections between primary headaches, bruxism, and psychosocial issues. In addition, we aimed to assess the effectiveness of a multidisciplinary approach in decreasing the intensity and frequency of headache episodes and bruxism. Sixty-seven patients previously diagnosed with primary headache and bruxism were divided into two similar groups. One group benefited from manual therapy alone, while the other received manual therapy and counseling sessions for three months. Statistical data analysis was conducted using SPSS, Version 24, using the paired Student's t-tests and McNemar's tests. After the three-month intervention period, we observed substantial improvements across various parameters. Some demonstrated statistically significant differences, while others did not reach statistical significance. When comparing the outcomes, the combined therapy proved more effective than manual therapy alone.

A Comparative Analysis of the Anatomy, Phenolic Profile, and Antioxidant Capacity of Tussilago farfara L. Vegetative Organs.

Tussilago farfara L., a perennial species, is a medicinal herb used in traditional medicine, mainly for the treatment of respiratory tract-related pathology. In traditional Chinese medicine, flower buds are preferred; in Europe, the leaves are used; and in some parts of India, the whole plant is utilized. This preferential usage of the plant organs might be based on differences in the chemical composition due to environmental conditions, along with preferred traditional and cultural approaches. In this article, the impact of pedoclimatic growth conditions on the morpho-anatomical development and phytochemical profile of the plant were studied on T. farfara in the vegetative state, collected from two different locations in the Romanian spontaneous flora, revealing significant variations. Furthermore, the antioxidant profile of the specific extracts from the aerial and subterranean plant parts is also in accordance with these discrepancies. The plant anatomy was assessed histologically by optical microscopy, while the analytical chemistry evaluation was based on LC/MS and spectral methods for the evaluation of the antioxidant and enzyme inhibitory activity. To our knowledge, this is the first comparative analysis contextually reporting on the histology, phenolic profile, antioxidant capacity, and geographical location of the vegetative form of T. farfara.

Combining the HSP90 inhibitor TAS-116 with metformin effectively degrades the NLRP3 and attenuates inflammasome activation in rats: A new management paradigm for ulcerative colitis.

Ulcerative colitis (UC) is a prevalent type of inflammatory bowel diseases that may predispose patients to acquire colitis-related cancer if treatment was not effective. Despite the presence of an array of established treatment options, current modalities are not successful for a substanial number of patients. The activation of the NLRP3 inflammasome is critical in the development of inflammatory processes in the colon. Additionally, the regulation of NLRP3 via HSP90 inhibition is a potential target to treat UC. Moreover, during inflammation, autophagy allows the turnover of malfunctioning proteins and therefore stands as a viable strategy for inactivating NLRP3 inflammasomes and halting hyperinflammation. Herein, we evaluated the effect of autophagy induction using metformin in the context of HSP90 inhibition by TAS-116 in the dextran sodium sulfate (DSS)-induced UC in rats. We revealed that TAS-116-induced interruption of the protein complex containing HSP90 and NLRP3 might hamper and delay the start of the inflammatory cascade ensued by the NLRP3 inflammasome oligomerization. In such circumstances, the unprotected NLRP3 is subjected to autophagic degradation in an environment of metformin-promoted autophagic signaling. As a result, such dynamic synergy was efficient in combating colon damage and immune-cell infiltration. This was confirmed by the macroscopic and microscopic investigations. Further, biochemical analysis revealed subdued inflammation cascade and oxidative injury. Therefore, simultaneous administration of TAS-116 and metformin is a new management paradigm aimed at inducing malfunction in the NLRP3 followed by augmenting its autophagic degradation, respectively. However, further studies should be conducted to assess the reliability and consistency of this novel approach.

Diagnosis and Therapeutic Management in Postcholecistectomy Alithiasic Cholangitis.

Introduction:The objective of the current retrospective study is to present the results of a personal research on the prevalence and treatment of alithiasic cholangitis in hospitalized patients. Material and methods:The research was based on the following criteria: case selection according to gender, age and diagnosis, anamnesis information, clinical, paraclinical, imagery and laboratory investigation methods, therapeutic approach. Results:Between 2016-2018, 109 cases had a discharge diagnosis of postcholecystectomy cholangitis following clinical and paraclinical examinations. In a large percentage, cholangitis was alithiasic, imagery assessments showing only a dilation of the intra- and/or extra-hepatic biliary ducts (81 cases, 91.01%). Conclusions:Alithiasic cholangitis has been the main biliary cause in the postcholecystectomy pathology in this reference study (91.01%). In hospitalized people with alithiasic cholangitis as main diagnosis, highlighted endoscopic retrograde cholangiopancreatography (ERCP) represented a modern therapeutic approach; this allows the improvement of sphincter Oddi functional disorders through sphincterotomy/sphincteroplasty (6.75%).

The importance of the histopathological examination in establishing the diagnosis of delayed splenic rupture. Report of a case and literature review.

In forensic activity, splenic ruptures occur frequently in cases involving abdominal trauma due to road traffic collision, strokes, falls and work accidents. Splenic lesions can occur either immediately after the trauma or within variable timeframes after it, the last scenario being the case of a delayed splenic rupture. Delayed splenic rupture is ranked third in abdominal traumatology frequency, after liver and intestine rupture. Delayed splenic rupture is more frequently the result of abdominal contusions or compressions, rather than the result of direct wounds located in the left flank. In the first stage, an intraparenchymatous hematoma is formed. The second stage occurs within a variable timeframe (between two days and one month), either spontaneously or following a second trauma, when the capsule ruptures leading to secondary peritoneal hemorrhage. In order to correctly determine the chronology of splenic lesions, histopathological (HP) investigations have an important role to play. The presence of hemosiderin highlighted by Hematoxylin-Eosin (HE) staining or special stainings, confirms the diagnosis of delayed splenic rupture. This study will present the case of a 55-year-old male from the countryside, a chronic alcohol consumer, animal care provider, who suffered multiple traumatic injuries four days prior to his death. He was found lying on the ground, presenting an open craniocerebral trauma (CCT) with a bleeding wound on the scalp. The autopsy showed CCT with meningeal hemorrhage and subdural hematoma, along with a splenic rupture presumably produced in two stages. The HP investigations did not reveal the presence of hemosiderin in the tested specimen samples. Using this scientific diagnostic criterion, it was thus confirmed that the splenic rupture occurred after the aggression, in another traumatic stage, the same one where the other thanatogenerator lesions occurred, as a result of the victim's collapse from the same level and hitting the planes with irregular surfaces.

Mechanical suture in rectal cancer.

BACKGROUND AND AIMS: Colorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves. METHODS: In order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013-2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients). RESULTS: Mechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001). CONCLUSION: The use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis is technically not possible, with the aim to preserve the anal sphincter, to restore intestinal function and maintain genitourinary function through preservation of hypogastric nerves.

New Evidences of Key Factors Involved in "Silent Stones" Etiopathogenesis and Trace Elements: Microscopic, Spectroscopic, and Biochemical Approach.

The knowledge of the key factors involved in etiopathogenesis of the gallstone disease requires chemical, structural, and elemental composition analysis. The application of different complementary analytical techniques, both microscopic and spectroscopic, are aimed to provide a more comprehensive determination of the gallbladder calculi ultrastructure and trace element identification. High sensitivity techniques such as electron microscopy (SEM), Fourier transform infrared (FTIR), electron paramagnetic resonance (EPR) spectroscopy, and X-ray diffraction (XRD) along with biochemical analysis are used in a new attempt to investigate various factors which play a regulatory role in the pathogenesis of gallstones. The microstructure of different types of gallbladder stones has specific characteristics which are related to the elemental composition. The binding of metal ions with bile salts and bilirubin plays important roles in gallstone formation as revealed by FTIR spectrum of calcium bilirubinate complex in pigment gallstones. The EPR results demonstrated the generation of bilirubin free radicals and variation of its electronic structure and conjugation system in the skeleton of bilirubin molecule during complex formation. EPR spectra of pigment gallstones demonstrate the coexistence of four paramagnetic centers including stable bilirubin free radical, Mn2+, Cu2+, and Fe3+ with distinct magnetic parameters and well-resolved hyperfine structure in the case of Mn2+ ions. The result confirms a macromolecular network structure with proteins and the formation of bilirubin-coordinated polymer. Bilirubin and bilirubinate free radical complexes may play an important role in pigment gallstone formation.