CD34-Structure, Functions and Relationship with Cancer Stem Cells.

The CD34 protein was identified almost four decades ago as a biomarker for hematopoietic stem cell progenitors. CD34 expression of these stem cells has been exploited for therapeutic purposes in various hematological disorders. In the last few decades, studies have revealed the presence of CD34 expression on other types of cells with non-hematopoietic origins, such as interstitial cells, endothelial cells, fibrocytes, and muscle satellite cells. Furthermore, CD34 expression may also be found on a variety of cancer stem cells. Nowadays, the molecular functions of this protein have been involved in a variety of cellular functions, such as enhancing proliferation and blocking cell differentiation, enhanced lymphocyte adhesion, and cell morphogenesis. Although a complete understanding of this transmembrane protein, including its developmental origins, its stem cell connections, and other functions, is yet to be achieved. In this paper, we aimed to carry out a systematic analysis of the structure, functions, and relationship with cancer stem cells of CD34 based on the literature overview.

Open and Laparoscopic Surgical Approache in Incisional Hernias: A Descriptive Analysis.

Background: Incisional hernias, occurring in 10-20% of patients post-abdominal surgery, significantly affect patient quality of life and healthcare systems. This study analyses two hernia repair methods: laparoscopic intraperitoneal onlay mesh (IPOM) and open on-lay hernioplasty. Key analysis factors include operative time, postoperative pain, complications, length of hospital stay, recovery speed, and recurrence rates, with the goal of identifying the most effective and beneficial approach for patients. Methods: We conducted a retrospective study on 70 patients with postoperative parietal defects at the Dr Carol Davila Clinical Nephrology Hospital, Bucharest, from January 2018 to December 2021. Patients underwent either laparoscopic IPOM (42 patients) or open hernioplasty (28 patients) for uncomplicated incisional hernia repair. We analyzed demographic data, comorbidities, defect size and location, previous surgeries, and surgical outcomes. Results: The laparoscopic group had a slightly shorter operative time and significantly lower postoperative pain levels, as assessed by the Visual Analog Scale. The laparoscopic approach also resulted in shorter hospital stays and quicker return to routine activities. Complications, such as seroma and hematoma, were more common in the open surgery group, but no wound infections or prosthesis rejections were observed in either group. Notably, the open surgery group showed a higher recurrence rate (11 %) compared to none in the laparoscopic group within a one-year follow-up. Conclusion: Laparoscopic IPOM for incisional hernia repair shows benefits over open hernioplasty, with less pain, shorter hospitalization, faster recovery, and lower recurrence. Its growing preference and potential for further research are highlighted.

Parameters for Predicting Tumour Response Following Neoadjuvant Chemoradiotherapy for Patients with Rectal Cancer.

Introduction: Pathologic response following neoadjuvant chemoradiotherapy (nCRT) can vary from pathologic complete response (pCR), to tumour downstaging or minimum to no response. Our goal was to evaluate the parameters that could predict response to neoadjuvant therapy for patients with rectal cancer. Method: We performed a retrospective study and reviewed the medical documentation for patients that received treatment for rectal cancer in our surgical department between 2014-2018 and received nCRT. Results: A total of 98 patients were included in the study. 66 patients were males (67,3%) and 32 were females (32,7%). The mean age was 64,6 (39-87). The 48 months overall survival rate was 81,63% and the 48 months disease-free survival rate was 69,38%. Tumour grading was considered as a statisti cally significant parameter for evaluating the pathologic response. The tumours most likely to respond to radio-chemotherapy were G1 or G2 grade. T4 tumours compared with lesser T stages were less likely to achieve pathologic complete response. Elevated CEA levels predicted a poor pathologic response to nCRT. Conclusion: Our study concluded that tumour related factors, biologic and imagistic findings such as tumour stage, lymph node, tumour differentiation grade and CEA levels can be used as parameters for predicting the tumour response following neoadjuvant therapy.

The Value of Endoscopy as a Predictive Factor when Evaluating the Clinical Response to Neoadjuvant Chemoradiotherapy for Patients with Rectal Cancer.

Introduction: Standard treatment rectal cancer according to numerous international guidelines recommends neoadjuvant chemoradiotherapy (nCRT). Literature data suggests that a better response to nCRT (greater tumour regression) leads to improved overall survival rates (OS) and disease-free survival rates (DFS). Tumour response to nCRT can be assessed either through clinical or pathological examination. The clinical tumour response is evaluated via a digital rectal examination, endoscopy (with or without ultrasound) and DWI-MRI. Our goal was to see if, when evaluating the clinical response to neoadjuvant chemoradiotherapy we can rely on the endoscopic findings and if it could have a predictive value for the overall outcomes. Method: A retrospective study was performed on 43 patients that were treated for rectal cancer in our clinic following neoadjuvant chemoradiotherapy. We divided the patients into two groups regarding the endoscopy grading. Results: Patients with a better response (endoscopy good grade) had a better disease free survival rate and lower recurrence rate compared to patients with a endoscopy low grade (86,5% vs 56,6%) and (10.34% vs 42,85%). Conclusion: Endoscopy could be a useful tool in appreciating the tumour response to nCRT, and further research is needed in determining the best method for evaluating clinical response to neo adjuvant therapy in patients with rectal cancer.

Intraoperative Monitoring of Parathormone in the Surgical Treatment of Renal Hyperparathyroidism.

Intraoperative monitoring of parathyroid hormone can confirm the complete excision of hyperfunctional parathyroid tissue, as the plasma half-life of PTH is approximately 5 minutes. The purpose of this study was to analyse the values of parathormon (PTH) and the intraoperative impact in patients with secondary hyperparathyroidism of renal cause (sHPT). A series of 86 patients who were hospitalised in our clinic between February 2015 to December 2018, were included in the study rom. All patients underwent surgery with PTH monitoring. PTH was determined preoperatively, intraoperatively 15 minutes after parathyroidectomy and postoperatively. Out of a total of 86 patients, 6 patients had non-functional renal transplant. 81 patients were operated on per primam and 5 patients were operated for disease recurrence. There were 77 total parathyroidectomies and 4 subtotal parathyroidectomies. One patient had 5 parathyroid glands. There were 4 patients with recurrent hyper-plastic tissue excision. Blood samples were collected intraoperatively through the puncture of the jugular vein. The PTH value was determined by the Elecsys PTH STATÃÂî test. The mean value of preoperative PTH was 1658 pg / mL and decreased to 46.5 pg / mL at the end of the operation. Subsequently, the level of PTH harvested at 3-6 months increased slightly to 59.8 pg / mL. 80 (93%) of patients had elevated preoperative calcium values. Recurrent hyperparathyroidism was found in 1 of the 4 patients who underwent subtotal parathyroidectomy. IPTH value is influenced by the intraoperative manipulation of the parathyroid glands, the individual variability of PTH half-life and the physiological state of the patient. The decrease of PTH measured intraoperatively at 15 minutes after harvest with at least 90% of the preoperative value indicates the success of a total parathyroidectomy, with normalisation of calcium and PTH.

Clinical Aspects of Parathyroid Hyperplasia in Secondary Renal Hyperparathyroidism.

The secondary hyperparathyroidism (sHPT) affects all patients with chronic renal failure in different degrees. The chronic kidney disease is often associated with multiple severe comorbidities, therefore the figures for mortality are higher than in the general population. The failure of medical treatment is an indication for surgical treatment. The recurrence of the disease in secondary hyperpara-thyroidism after surgical treatment using total parathyroid with autotransplantation or subtotal parathyroidectomy may be a challenge due to hyperplasia of the remaining tissue. The purpose of this retrospective study was to highlight the risk factors for the occurrence of glandular hyperplasia in patients with secondary hyperparathyroidism and to determine optimal surgery approach for secondary hyperparathyroidism in order to minimize relapse rates. Parathyroid size evaluation may suggest the presence of nodular hyperplasia contributing to an early parathyroidectomy and at the same time selecting the best surgical treatment for sHPT patients. As resistance to medical therapy is due to the presence of nodular hyperplasia, some authors recomends subtotal parathyroidectomy with the excision of these glands, with the remaining parathyroids tissue and function controlled by medical therapy (20).