Orthorhombic HfO2 with embedded Ge nanoparticles in nonvolatile memories used for the detection of ionizing radiation.

Trilayer memory capacitors of control HfO2/floating gate of Ge nanoparticles in HfO2/tunnel HfO2/Si substrate deposited by magnetron sputtering and subsequently annealed are investigated for the first time for applications in radiation dosimetry. In the floating gate (FG), amorphous Ge nanoparticles (NPs) are arranged in two rows inside the HfO2 matrix. The HfO2 matrix is formed of orthorhombic/tetragonal nanocrystals (NCs). The adjacent thin films to the FG are also formed of orthorhombic/tetragonal HfO2 NCs. This phase is formed during annealing, in samples with thick control HfO2, in the presence of Ge, being induced by the stress. In the rest of the control oxide, HfO2 NCs are monoclinic. Orthorhombic HfO2 has ferroelectric properties and therefore enhances the memory window produced by charge storage in Ge NPs to above 6 V. The high sensitivity of 0.8 mV Gy-1 to α particle irradiation from a 241Am source was measured by monitoring the flatband potential during radiation exposure after electrical writing of the memory.

Palatal Reconstruction after Major Surgical Excision.

Oncological excision surgery in the oral and maxillofacial area amputates important structures or open cavities (sinus, nose, mouth) which are usually "closed". The disappearance of an eye, tongue, soft palate or cheek, raises serious issues regarding the resumption of partial or total functions of that region, in terms of social reintegration of the patient. In the cephalic extremity, the reconstruction material is limited, so specialists resort to resources located away from the defect to achieve closure. The temporal flap isn't used very often, although this procedure has the advantages of a shorter time for surgery and for healing.

Effects of Platelet Rich Fibrin on Full Thickness Skin Grafts in the Rat Model-Planimetry Results.

Platelets play a crucial role in wound healing as they are reservoirs of growth factors and cytokines which play a fundamental role in homeostasis and tissue remodeling. Recently, fields such as dermatology and plastic and reconstructive surgery have become interested in the tissue regenerative properties of these compounds, especially since it promotes wound healing, improves scar outcomes and has rejuvenating effects on the skin and other tissues. We evaluated the effects of Platelet Rich Fibrin (PRF) in full thickness skin graft healing. Our study included 40 male Wistar rats. Skin grafts were assessed macroscopically using planimetry. The full thickness skin grafts in the test group, displayed a lower necrosis rate compared to the control group. Our study displays the potential benefits of using Platelet Rich compounds to facilitate wound healing and integration of full thickness skin grafts.

Case Presentation of Soft Tissue Defect after Bimalleolar Fracture Osteosynthesis.

A 59-year-old patient presented in the ER with wound dehiscence and skin necrosis on the right ankle, with osteosynthesis implant visible, after open reduction and fixation with plate and screws, performed abroad, 16 days prior to the presentation, for a bimalleolar fracture. The patient was admitted to the plastic surgery department, where surgical debridement of the necrotic tissue was initially performed. Postoperatively, the patient was treated with Negative-pressure wound therapy (VAC dressing) and Platelet rich plasma (PRP) therapy. Upon obtaining granulation tissue without signs of infection, a sural fasciocutaneous flap was performed to cover the skin defect. Proper graft integration and healing was observed.

Quantification of liver fibrosis in chronic hepatitis B virus infection.

Chronic hepatitis B virus infection (HBV) is considered a global public issue with more than 78.000 people per year dying of its evolution. With liver transplantation as the only viable therapeutic option but only in end-stage disease, hepatitis B progression may generally be influenced by various factors. Assessing fibrosis stage plays an important part in future decisions on the patients' wealth with available antiviral agents capable of preventing fibrosis passing to an end-stage liver disease. Several methods have been taken into consideration as an alternative for HBV quantification status, such as imaging techniques and serum based biomarkers. Magnetic resonance imaging, ultrasound, and elastography are considered non-invasive imaging techniques frequently used to quantify disease progression as well as patients future prognostic. Consequently, both direct and indirect biomarkers have been studied for differentiating between fibrosis stages. This paper reviews the current standings in HBV non-invasive liver fibrosis quantification, presenting the prognostic factors and available assessment procedures that might eventually replace liver biopsy.

NOD2 Arg702Trp Polymorphism in Romanian Patients with Gastric Cancer.

PURPOSE: Our study aimed to assess a possible correlation between NOD2 Arg702Trp (rs2066844) polymorphism and gastric cancer risk in a Romanian population. MATERIAL/METHODS: A total of 322 subjects (72 patients with gastric adenocarcinoma and 250 healthy controls) were included. Genomic DNA was extracted from blood leukocytes and NOD2 Arg702Trp polymorphism was genotyped by Real-Time PCR using specific TaqMan probes. RESULTS: No statistically significant difference was observed between gastric cancer patients and controls when we compared one genotype with other genotype (the CC genotype serves as reference) (OR 0.45, 95% CI: 0.10 - 2.05) or when we compared allele frequencies (the C allele serves as reference) (OR 0.46, 95% CI: 0.11 - 2.04). We examined separately the association of this polymorphism with tumor site and histologic type and no correlation was found. CONCLUSION: NOD2 Arg702Trp polymorphism is not associated with gastric cancer risk and further investigations are needed to elucidate the contribution of NOD2 gene in gastric carcinogenesis.

The Role of Podoplanin in the Lymphangiogenesis of Oral Squamous Carcinomas.

Oral squamous cells carcinoma (OSCC) mortality rate ranges between 29-40/100,000 inhabitants. Regional lymph node metastases occur in 30-40% cases and are associated with unfavorable prognosis and decreased survival. Recentely it was suggested that the tumor-associated lymphatic vessels formation plays an active role in metastasis proces of several human malignancies, including OSCC. In the present study we investigated comparatively podoplanin immunoexpression in OSCC in both the tumor cells and lymphatic vessels reported to clinicopathological prognostic parameters. Material and methods The study included a total of 25 cases of OSCC. We investigated clinico-pathological parameters as age, gender, tumor site, and degree of differentiation, size and depth of invasion (pT), lymph node status (pN). Histologic classification was done according to the WHO criteria. For immunohistochemical (IHC) analysis we used podoplanin (Dako, clone D2-40). As visualization system it was used LSAB2 (Dako, Redox, Romania, code K0675) and chromogen DAB (Dako, Redox, Romania, code K3468). Negative controls were obtained by omitting the primary antibodies. IHC quantification was done intensity score and by lymphatic microdensity (LVD), intratumoral and on the advancing edge. For the statistical analysis we used Student's t-tests, ANOVA, chi square and Pearson, using SPSS 10 software. Results Podoplanin immunoexpression in tumor parenchyma presented with an average of 43%, varying intensity. We found a higher intensity in weak and moderately differentiated SCC then in well differentiated ones and no difference intratumoral aand advancing edge. In relation to the degree of tumor differentiation the mean LVD D2-40 was higher in the advancing edge. SCC who presented lymph node metastasis mean values for LVD D2-4 was higher then at advancing edge and higher than those of non-metastatic carcinomas. Conclusions Podoplanin immunoexpresion suggests the involvement both in tumor growth and the acquisition of an lymphangiogenic phenotype invasive by autocrine mechanisms.

Cutaneous leiomyosarcoma - Case report.

Cutaneous leiomyosarcoma (CLM) is a very rare smooth muscle tumor arising from the dermis or subcutaneous tissue in the skin. Superficial leiomyosarcoma originates in the superficial dermis or subcutaneous tissue and represents about 3% of the soft tissue sarcomas. CLM presents in persons of all ages but with a peak between 60-70 years old. It may also occur anywhere on the body; the existing cases reported it on the face and trunk. The clinic of leiomyosarcoma consists in a firm dermal nodule, which can be painful, pruritic or paresthestic. The tumor is of 1-3 cm in diameter and can often be seen as a solitary formation. We report one case of a cutaneous leiomyosarcoma arising in the chest region of a 79- year-old male. Leiomyosarcoma is a rare entity whose clinical presentation may appear nonspecific, making diagnosis difficult. Primary tumor excision with wide oncological safety margins is considered, when suitable case, the most appropriate method. Other therapeutic methods, such as radio- or chemotherapy are described as without significant benefits. Despite the claims of radical surgical treatment, due to recurrence rates, the prognosis remains poor. We recommend long-term follow-up of patients to capture a subsequent malignant disease progression.

Bullous pemphigoid associated with psoriasis, breast cancer and Parkinson's disease.

Bullous pemphigoid (BP) and psoriasis vulgaris represent two clinically well characterized, inflammatory, chronic skin diseases. A 62 years old female patient, from rural areas, was admitted for the presence of erythematous plaques covered by large tense blisters with clear fluid, located symmetrically on the anterior part of the upper limbs, the trunk, the neck and the lower limbs. Also the lesions were intense itching. Lesions occurred three days before presentation at the clinic. Medical history revealed psoriasis diagnosed 28 years ago, breast cancer treated with surgery, radio and chemotherapy three years ago and Parkinson's disease diagnosed 3 weeks prior to presentation to the dermatology clinic. Histopathology examination revealed: atrophic epidermis with subepidermal presence of a blister containing numerous eosinophils and neutrophils. In the papillary dermis neutrophils and eosinophils predominantly vascular. Bullous pemphigoid has multiple etiology. Bullous pemphigoid is an autoimmune subepidermal bullous dermatosis which may be associated with psoriasis. Medical literature and cases reported in dermatology journals claim that bullous pemphigoid is often associated with psoriasis, though the immunogenetical and immunopathologycal mecanismes are still not known. Our patient has three different diseases but their etiology and pathogenesis can interfere.

Role of MRI in the diagnosis and evaluation of cavernous hemangioma of the arm.

Sinusoidal hemangioma is a rare type of cavernous hemangioma with different clinico-pathological aspects. They are usually localized in the extremities with interest in the subcutaneous layer. The new imaging techniques play an important role in diagnosis, evaluation and follow-up of these types of tumors. We describe the case of a 21-year-old patient, four times operated for a recurrent soft tissue tumor, located intramuscularly in the distal third of the upper limb. Plain X-ray and computer tomography (CT) showed a nonspecific mass with calcification. The MRI (magnetic resonance imaging) exam demonstrated a lobulated heterogeneous signal tumor mass in the biceps brachial muscles, with high signal intensity on T2 weighted images and intermediate signal on T1 weighted images. MRI accurately assessed the extent of the tumor and evaluated the recurrence. MRI imagings combined with contrast-enhanced sequences were used to classify the lesions in low flow vascular disorders. CT angiography with multiplanar reconstructions (MPR), maximum intensity projections (MIP) and volume-rendered reconstructions (VR) was useful in confirming the venous origin of the tumor.

The economic analysis of two treatment procedures for incisional hernias - alloplastic versus tissular.

Incisional hernias are a common complication of abdominal surgery. Research shows that their incidence reaches 10%-11% of the total number of patients subject to laparotomy. Recurrent hernias are the main complication of eventrations and its rate ranges from 5 to 54%, depending on both the surgical procedure used and the follow-up methods. The goal of this study is the comparative cost analysis of two procedures used in the treatment of event rations, tissular versus alloplastic, the former, leading very often to recurrence requiring a new surgical intervention. The analysis comprised 156 cases of surgeries performed for incisional hernia in 2007 in the clinic of Surgery III, SUUB (Bucharest University Emergency Hospital). Tissular procedures were used in 42 cases and prosthetic procedures in 114 cases. The medium-term postoperative follow-up has revealed 17 relapses (40.4%) in the tissular batch and no relapse in the batch where parietal prosthesis was used. If the short-term costs of the tissular procedures are low as compared with the prosthetic procedures, on the medium-term the costs increase by 24.35% due to the high rate of relapses of tissular procedures. Therefore, the tissular procedure must be abandoned due to the high rate of relapse, as this drives additional costs required for the alloplastic repair of the abdominal parietal defects in a subsequent surgical intervention.

Pure pectus carinatum (not associated with pectus excavatum) solved by MIRPC (minimally invasive repair of pectus carinatum) associated with bilateral mamarian hypoplasia solved by bilateral breast implants.

We present the case of a young 24-year-old woman with an important but symmetrical pectus carinatum, not associated with pectus excavatum, without cardiorespiratory symptoms but with significant psychosocial implications for the patient, solved by the minimally invasive technique described by Abramson(reversed Nuss procedure) - MIRPC (Minimally invasive Repair of Pectus carinatum). The sternal malformation was associated with bilateral mammary hypoplasia, solved by bilateral breast implants 10 months later. The evolution was favorable and the aesthetic result was satisfactory for the patient.

Face Basosquamous Carcinoma, a Case Report.

Face basosquamous or metatypical carcinoma is a rare and controversial form of skin cancer. It is characterized by increased incidence of recurrence and distant metastases. We present the case of a patient of 71 years with an ulcerative lesion of 3/4 cm in the nasal pyramid. The injury occurred due to trauma to the nasal pyramid, produced 13 years ago. After investigation, which included ORL examination, imaging and oncology exam, surgery was decided to completely ablate tumor formation. The resulted defect of 4/5 cm was covered by mobilizing a forehead flap based on right supratrohleare artery pedicle. Histopathological examination revealed the diagnosis of basosquamous or metatypical carcinoma. The patient was referred to the oncology service for treatment.

Expression of CXCR4, MMP-13 and ß-catenin in different histological subtypes of facial basal cell carcinoma.

Basal cell carcinoma (BCC) is one of the most common skin neoplasms in humans, accounting for almost 80% of all non-melanoma skin cancers worldwide. The nodular and infiltrative-morpheaform are the most common BCC types in the head and neck region and together with the micronodular subtypes are the most aggressive tumors, because of their tendency to infiltrate the deep subcutis, muscles and even bones. To explain the local aggressive behavior and their metastatic potential, many studies have been performed to identify the molecular determinants implicated in BCC tumor progression. For this reason, we investigated the immunohistochemical expression of CXCR4, MMP-13 and ß-catenin expression in six metatypical, eight infiltrative-morpheaform, six micronodular and five superficial facial BCCs. For all three markers, the tumor reactivity varied with the histological type. The highest reactivity was observed in metatypical subtype, especially at the level of areas with squamous cells differentiation. The lowest reactivity was recorded in micronodular and superficial BCC subtypes. Regardless histological subtype, the tumor reactivity was higher at the advancing edge and additional a strong stromal reaction was noticed for all investigated markers peculiar in fibroblasts, inflammatory cells and endothelial cells. All these data proved the utility of CXCR4, MMP-13 and ß-catenin immunohistochemical investigation in BCCs both for identification of high-aggressive tumors and to develop novel more efficient therapeutic strategy for these patients by targeting these biomarkers.

Locally recurrent colorectal cancer: results of surgical therapy.

PURPOSE: Up to 20 % of colorectal cancer patients develop recurrent disease despite standardized surgical techniques and multimodal treatment strategies. Radical resection is the central component of curative therapy in these cases. The aim of this study was to evaluate treatment results in patients with locoregionally recurrent colorectal cancer. METHODS: From January 1995 to December 2007, surgery was performed for recurrent colorectal cancer in 82 patients who had undergone curative (R0) resection of their primary tumor. Assessment included patient, tumor and treatment characteristics, postoperative complications, and time without re-recurrence; recurrence-free and overall survival rates were calculated according to the Kaplan-Meier method. RESULTS: Resection was performed in 60 of the 82 patients (73 %), repeat R0 resection in 52 % (31/60). Patients had a postoperative morbidity of 39 % (31/82), a relaparotomy rate of 13 % (11/82), and a lethality of 7 % (6/82). Forty-eight percent of all surgically-treated patients received a permanent stoma. Re-recurrence was seen in 52 % (16/31). R0 resection was associated with a 5-year survival rate of 35 % (11/31). CONCLUSIONS: Extensive reinterventions often enable repeat R0 resection. Despite relevant morbidity, the lethality appears to be acceptable. Decisive for the prognosis is re-recurrence.

The treatment of giant rhinophyma - Case Report.

The aim of the article is to present an update on the pathophysiology, clinical features and treatment of rhinophyma. A 56 years old patient, living in urban area, presented with a giant rhinophyma which caused him not only upper airways obstruction and difficulty in eating, but also aesthetic and psycho-social disadvantages.The treatment of the patient was a surgical intervention consisting in removal of the nasal tumor and split-thickness skin grafting of the defect. The aesthetic result after surgical intervention was very good, there were no postoperative complications or recurrences.Rhinophyma represents the most advanced form of acne rosacea. The diagnosis is easy to establish based on the clinical features of the disease. In advanced forms of rhinophyma, when the tumor is giant, the main method of treatment is surgery.

VEGF and his R1 and R2 receptors expression in mast cells of oral squamous cells carcinomas and their involvement in tumoral angiogenesis.

More than 90% of malignant neoplasms of the oral cavity are squamous carcinomas of oral mucosa and most are conventional type. This study included 60 cases of oral squamous carcinoma processed by usual histological technique and stained with Hematoxylin-Eosin and Alcian Blue-Safranin (Alcian Blue powder from Sigma Aldrich, code A5268-25G) and diagnosed in the Department of Pathology, University of Medicine and Pharmacy of Craiova. Double immunohistochemical (CD105-tryptase, VEGF-, VEGFR1-, VEGFR2-tryptase) or combined histochemical and immunohistochemical reactions (VEGF÷ VEGFR1÷ VEGFR2÷Alcian Blue-Safranin) followed the particular morphological aspects of the mast cells, their relation with the blood vessels and the overlap signal of tryptase and Alcian Blue-Safranin÷VEGF and its R1 and R2 receptors in mast cells. Immunostaining for VEGF and its R1 and R2 receptors was present both in tumor cells and mast cells. Double immunohistochemical-histochemical reactions allowed us angiogenic profiling the mast cells. The signal overlap was present for VEGF-, VEGFR1-, VEGFR2-tryptase intratumoral and tumor invasion front mast cells. Student's t-test for comparison of intratumoral and the invasion front MDM showed highly significant value (p=3.23 E-08). VEGF÷ VEGFR1÷ VEGFR2÷Alcian Blue-Safranin revealed particular morphological aspects of mast cells, in with different morphology, shapes, sizes and degrees of degranulation. Statistical analysis showed a linear correlation between MDM and MVD inside the tumor (Pearson coefficient =0.47) and a weak linear correlation at the front of invasion (Pearson coefficient =0.19). This study has highlighted the importance of mast cells in the tumor growth of the oral squamous carcinomas, especially in terms of their proangiogenic profile (expression of VEGF and its R1 and R2 receptors). In addition, their quantification as MDM makes this parameter a useful prognostic marker.

Sinusoidal hemangioma of the arm: case report and review of literature.

Sinusoidal hemangioma is a rare variant of cavernous hemangioma that develops more frequently subcutaneous, often in the extremities. We report the case of a 19-year-old patient three times operated for a recurrent soft tissue tumor, located in the distal third of the antero-medial face of the right arm. Treatment was surgical and consisted of microsurgical excision of a tumor with dermal and intramuscular location. Histopathological analysis showed a nodular proliferation of interconnected thin-walled blood vessels, sinusoidal growth pattern and the presence of pseudopapillary structures. Immunohistochemical investigations were positive for CD31, CD34 and Ki67 index decreased, confirming the benign nature of vascular proliferation.

Power Doppler sonography, a non-invasive method of assessment of the synovial inflammation in patients with early rheumatoid arthritis.

OBJECTIVE: To detect synovitis is important in both the diagnosis and outcome assessment of early rheumatoid arthritis. This study was meant to assess the validity and reproducibility of ultrasonography (US) as a mean of detection for the knee synovitis, by comparing US findings with clinical examination and histopathological findings in synovial membrane. METHODS: The study group included 65 patients with early rheumatoid arthritis - below 12 months from the debut, naive for DMARDs, in whom demographic data - gender, age, disease duration, the number of tender and swollen joints, HAQ score (Health Assessment Questionnaire) and serum samples for CRP, RF, anti-CCP2 antibodies (ELISA, QUANTA LiteTM, CCP IgG, INOVA Diagnostics Inc, USA), VEGF (ELISA, VEGF2, DRG International, IRC, USA) determination were recorded. Disease Activity Score for 28 joints (DAS28) was calculated. PDS signal was scored from 0 to 3 according to the overall expression of PDS findings at the knees. A sample of synovial tissue was obtained in 35 patients during the arthroscopy, and the vascularisation of the synovial tissue was evaluated by immunohistochemistry and was analyzed qualitatively by a pathologist who was unaware of the PDS findings. Written, informed consent was obtained from each patient before entering the study. They all had active synovitis of the knee, ultrasonographically confirmed, with the identification of the target biopsy sites. The study was approved by the Ethics Committee of the University of Medicine and Pharmacy of Craiova. RESULTS: Angiogenesis was evaluated and quantified by immunohistochemical evaluation of synovial VEGF, one of the most specific endothelial growing factors, that proved to correlate significantly with the serum levels of VEGF, DAS28 as well as with the power Doppler sonography (PDS) score. CONCLUSIONS: The statistical analysis of the data showed that PDS could be used as non-invasive marker with predictive value regarding synovial inflammation and disease progression in early forms of the disease as well as a useful method in the assessment of the therapeutic response.

[Surgical management of Meckel's diverticulum in adults--retrospective analyses of 62 cases]. / Atitudinea chirurgicala fata de diverticulul Meckel la adult--analiza retrospectiva a unui lot de 62 de cazuri.

Meckel's diverticulum (MD) is the most common congenital anomaly of the small intestine. We searched and analyzed the records of 62 cases with MD admitted in University Emergency Hospital Bucharest between 2001-2009. Sex ratio was M:F 3:1, with 74% male and 26% female. 51.6% (n = 32) of this where symptomatic and 48.4% (n = 30) asymptomatic, discovered during laparotomy for other reasons. The analysis highlights an increased frequency of symptomatic diverticulum at early ages, with a medium age of about 39.2 years comparing to asymptomatic group with a medium age of about 54.2 years. The diverticulum complication generated: occlusion--43.7% (n = 15), inflammation--37.5% (n = 12), bleeding, two cases of diverticulum tumor, an intussusception case and a perforation case with unknown object. 25% of the diverticulectomies were followed by postsurgery complications, the parietal suppuration being the most frequent (50%). Three patients died independent of the diverticulum or its resection, all three having an asymptomatic diverticulum. The difficult diagnosis and the seriousness of diverticulum complications force us to take into consideration DM in all cases of severe or chronic abdominal pain. The diverticulum has to be surgically removed to all patients under 50 years, especially men.