Posttraumatic Injury Polymorphism - The Experience of an Emergency Surgical Department During 5 Years.

Introduction: Traumatic injuries are a major public health problem, being one of the main causes of death, the subsequent decline in the quality of life of the patients involved, as well as the costs of hospitalization in the health system. Material and Method: We conducted a 5-year retrospective study on 798 hospitalized patients with traumatic injuries, by collecting a series of general, clinical, imaging and biological parameters. Results: The results showed a higher proportion of male patients, the main lesion mechanism being represented by road accidents, followed by falls from another level. The most common traumatic intraabdominal parenchymal lesions were splenic, followed by hepatic and renal lesions. In addition to intraabdominal trauma, the lesion balance also included thoracic, spinal cord, head and limb injuries. A total of 288 patients underwent emergency surgery, but there were also cases of delayed surgical procedures or reoperations. We had 67 deceased patients. Conclusions: Trauma is a major public health problem, both socially and economically, being responsible for a significant number of deaths, but also in terms of the significant number of hospitalizations and the subsequent impact on the quality of life of those involved.

The Impact on the Long-term Outcomes of Hormonal Status After Hepatic Resection for Breast Cancer Liver Metastases.

BACKGROUND/AIM: Breast cancer remains one of the most frequently encountered malignancies worldwide, which is in most cases diagnosed in early stages of disease. However, although surgery and adjuvant oncological treatment are performed with curative intent, a certain number of cases will develop distant metastases. In cases presenting oligometastatic disease, surgery might be tempted in order to maximize the benefit in terms of survival. The aim of this paper was to identify which cases could benefit most after liver resection for breast cancer liver metastases. MATERIALS AND METHODS: The study included 67 patients submitted to surgery for breast cancer liver metastases between 2003 and 2017 in the "Dan Setlacec" Center of Gastrointestinal Diseases and Liver Transplantation, Fundeni Clinical Institute. RESULTS: Patients diagnosed with hormone-positive breast tumors reported a significantly higher disease-free and overall survival after resection of the primary tumor. After resection for breast cancer liver metastases, patients presenting hormone receptors at the level of the metastatic sites also experienced a better outcome when compared to those in which hormonal receptors were absent. However, the difference was not statistically significant. CONCLUSION: Liver resection for breast cancer liver metastases seems to be associated with the best outcomes in terms of survival in patients presenting positive hormonal receptors status.

Gene-expression Profiling in Non-small Cell Lung Cancer with Invasion of Mediastinal Lymph Nodes for Prognosis Evaluation.

BACKGROUND/AIM: The aim of the study was to determine the pathways and expression profile of the genes that might predict response to neoadjuvant chemotherapy in patients with stage IIIA non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: We evaluated, by microarray, the gene-expression profile of tumoral mediastinal lymph node samples surgically removed from 27 patients with stage IIIA NSCLC before neoadjuvant chemotherapy treatment. Depending on the response to the induction treatment, the patients were divided in two groups: group A: patients whose disease evolved, stabilized or who had minor response to chemotherapy, and group B: patients whose disease stabilized or had major response to chemotherapy. RESULTS: The microarray experiments identified 1,127 genes with a modified expression in the tumoral tissue compared to normal tissue with p≤0.05 and 44 genes with p≤0.01. The identified up-regulated genes between tumoral versus normal tissue included collagen, type I, alpha 1 (COL1A1), inhibin beta A (INHBA) and thioredoxin interacting protein (TXNIP). Pathways identified with a false-discovery rate of <0.005 included: cytokine pathways, focal adhesion or extracellular matrix receptor interaction. CONCLUSION: Our approach identified important characteristics of NSCLC and pointed-out molecular differences between sub-groups of patients based on their response to therapy.

Utilizing nanobody technology to target non-immunodominant domains of VAR2CSA.

Placental malaria is a major health problem for both pregnant women and their fetuses in malaria endemic regions. It is triggered by the accumulation of Plasmodium falciparum-infected erythrocytes (IE) in the intervillous spaces of the placenta and is associated with foetal growth restriction and maternal anemia. IE accumulation is supported by the binding of the parasite-expressed protein VAR2CSA to placental chondroitin sulfate A (CSA). Defining specific CSA-binding epitopes of VAR2CSA, against which to target the immune response, is essential for the development of a vaccine aimed at blocking IE adhesion. However, the development of a VAR2CSA adhesion-blocking vaccine remains challenging due to (i) the large size of VAR2CSA and (ii) the extensive immune selection for polymorphisms and thereby non-neutralizing B-cell epitopes. Camelid heavy-chain-only antibodies (HcAbs) are known to target epitopes that are less immunogenic to classical IgG and, due to their small size and protruding antigen-binding loop, able to reach and recognize cryptic, conformational epitopes which are inaccessible to conventional antibodies. The variable heavy chain (VHH) domain is the antigen-binding site of camelid HcAbs, the so called Nanobody, which represents the smallest known (15 kDa) intact, native antigen-binding fragment. In this study, we have used the Nanobody technology, an approach new to malaria research, to generate small and functional antibody fragments recognizing unique epitopes broadly distributed on VAR2CSA.

Rehabilitation in a patient with replantation of amputated distal leg.

BACKGROUND: Many studies have been reported on replantation of an upper extremity after traumatic amputation, but there are only a few case reports on replantation of the lower extremities rather than amputation surgery. This is due to preoperative factors, complications and the possibility of good prosthetic substitution.We describe here the dynamic evaluation necessary for a continuous rehabilitation treatment in a subject with replanted left foot after traumatic amputation. CASE REPORT: A 58-year-old male person with amputation of the left leg at the level of the left talocrural joint, with talar dome and bimalleolar fractures and complete section of the blood vessels, nerves and tendons was considered for replantation surgery 7 hours after a traumatic injury.For an accurate evaluation of the postoperative conditions over time, clinical functional assessment combined with imaging and neurophysiological examination were conducted.Rehabilitation program is aimed to train the motor and sensory function of the replanted foot and to prevent undesired biomechanical changes that limit person's ability to perform everyday tasks. During the rehabilitation program there were a progressive recovery of the patient's protective sensation, active motion angles of the left ankle joint and muscle power of the replanted leg. Those are sufficient for walking activity and help the patient considerably in performing his everyday minimal housework. CONCLUSIONS: A well designed postoperative dynamic rehabilitation program is necessary in order to regain functionality after successful distal leg replantation surgery. The clinical and imaging evaluation support a dynamic rehabilitation program adapted to different stages of functional recovery.