The Impact of Cancer Stem Cells in Colorectal Cancer.

Despite incessant research, colorectal cancer (CRC) is still one of the most common causes of fatality in both men and women worldwide. Over time, advancements in medical treatments have notably enhanced the survival rates of patients with colorectal cancer. Managing metastatic CRC involves a complex tradeoff between the potential benefits and adverse effects of treatment, considering factors like disease progression, treatment toxicity, drug resistance, and the overall impact on the patient's quality of life. An increasing body of evidence highlights the significance of the cancer stem cell (CSC) concept, proposing that CSCs occupy a central role in triggering cancer. CSCs have been a focal point of extensive research in a variety of cancer types, including CRC. Colorectal cancer stem cells (CCSCs) play a crucial role in tumor initiation, metastasis, and therapy resistance, making them potential treatment targets. Various methods exist for isolating CCSCs, and understanding the mechanisms of drug resistance associated with them is crucial. This paper offers an overview of the current body of research pertaining to the comprehension of CSCs in colorectal cancer.

Aggressive Male Breast Cancer-Clinical and Therapeutic Aspects Correlated with the Histopathological Examination: A Case Report and Literature Review.

Breast cancer is often seen as a disease that occurs in women, but it can also appear in men in a very small percentage, below 1%. Men have a minimal amount of breast tissue compared to women, which has the potential to become malignant in a similar way to women, although much less frequently. A patient presented with advanced local invasion due to the low amount of breast tissue, with the tumor quickly invading the adjacent structures. Histopathological and immunohistochemical examinations have an extremely important role in the pathology of breast cancer. Given that male breast cancer is rare and there are not enough surgeons specializing in breast surgery in our country, there is a lack of experience in the management and early diagnosis of this type of cancer, which will be highlighted in this article.

Clinical and Morphological Characteristics of Gastrointestinal Stromal Tumor.

Introduction: Gastrointestinal stromal tumors (GIST) are a rare form of cancer located within the gastrointestinal (GI) tract, defined as tumors with spindle, epithelioid, or occasionally pleomorphic cells. They originate in the interstitial cells of Cajal, with the function of "pacemaker" of gastrointestinal motility. Their behavior is dictated by changes in the c-kit/PDGFRA gene, which is often highlighted by immunolabeling. Methods: We report the clinical, macroscopic, microscopic, and immunohistochemical characteristics of consecutive patients diagnosed with GIST who underwent surgical removal of the tumor in our department between 2008-2022. Results: We included 20 consecutive patients. The presentation was considered a surgical emergency requiring immediate surgical intervention in most subjects. The most common localization is the small intestine (n=9, 45%), followed by the stomach (n=7, 35%), colon (n=3, 15%), and peritoneum (n=1, n=5%). Histologically, the tumors were predominantly mixed (n=10, 50%) followed by spindle type (n=8, 40%) and epithelioid - 2 cases (10%). Conclusion: The clinical presentation of GISTs remains heterogeneous, and the diagnosis is predominantly postsurgical, using complex immunohistochemistry analysis. The tumor size and number of mitoses are strongly associated with the long-term prognosis.

Assessing immunological surgical stress markers in patients undergoing digestive surgery for pancreatic, hepatic and gastric tumors.

PURPOSE: Cytokines like IL-6, IL-10 and other factors like CRP are involved in the postoperative inflammatory-stress response. The association between IL-6, IL-10, CRP, albumin and early postoperative complications and deaths was analyzed on a cohort of cancer patient. METHODS: The plasma levels of IL-6, IL-10 and serum levels of c-reactive protein (CRP) and albumin were measured in 85 patients undergoing surgical resection of pancreatic, hepatic and gastric tumors. The measurement of the studied biochemical parameters was made at three time points: before the operation, and on the 1st and 3rd day after the operation. RESULTS: Of the 85 patients, 28 suffered early postoperative complications (14 gastric cancer patients; 11 pancreatic cancer patients; 3 liver cancer patients) and 9 patients died in the early postoperative period (5 gastric cancer patients; 4 pancreatic cancer patients; 0 liver cancer patients). Patients with elevated levels of serum CRP on the 3rd postoperative day had a significant increased risk of death. Also, patients with higher levels of IL-10 on the 3rd postoperative day demonstrated a significantly increased risk of early postoperative complications. CONCLUSION: This study demonstrates that plasma IL-10 concentration is positively associated with postoperative complications.

Loner or socializer? Ravens' adrenocortical response to individual separation depends on social integration.

Non-breeding common ravens (Corvus corax) live in complex social groups with a high degree of fission-fusion dynamics. They form valuable relationships and alliances with some conspecifics, while taking coordinated action against others. In ravens, affiliates reconcile their conflicts, console each other after conflicts with a third party, and provide each other with social support - all behaviors that presumably reduce corticosterone levels and alleviate stress. However, how well an individual is socially integrated in a (sub)group might vary substantially. This raises the question whether the social integration of a raven affects its stress responses to fission-fusion dynamics. The present study aims to investigate this effect experimentally by separating single ravens (n=16) individually from their group for four days and subsequently reintroducing them. To determine stress response patterns in the separated individuals we measured the amounts of immunoreactive corticosterone metabolites (CM) in droppings. We compared two enzyme immunoassays, which we validated by conducting an ACTH challenge, and finally decided to apply an 11-oxoetiocholanolone enzyme immunoassay. Additionally, we determined levels of social integration using focal observations. Our findings suggest that a strong social integration is related to low CM levels when the individuals are within the group and high levels during separations, implying that separation leads to stress in these birds. In contrast, poorly socially integrated ravens seem to exhibit the opposite pattern, indicating that to them group living is more stressful than being temporarily separated. We, therefore, conclude that the birds' adrenocortical activity is modulated by their social integration.

Preoperative vagal activity predicts clinical outcomes after total knee replacement.

Total knee replacement (TKR) surgery carries with it significant surgical trauma and activates complex inflammatory pathways, which initially assist healing. However, impaired regulation of inflammatory pathways can cause tissue damage and postoperative complications. The vagus nerve regulates inflammation, the activity of which is indexed by heart-rate variability (HRV), which predicts postoperative pain, longer hospitalization and improved recovery during the postoperative period. The present study examined the relationship between presurgical HRV, inflammation and complications after TKR. The present study assessed data from 41 patients undergoing TKR. A retrospective design was used, where preoperative electrocardiograms were scanned to determine HRV. Outcome measures included inflammation [C-reactive protein (CRP) levels] over four postoperative days, length of stay (LOS), and complications. Preoperative HRV predicted the trajectory of postoperative CRP levels. The low HRV group demonstrated higher overall postoperative CRP and a longer time to recover than patients with high HRV. Furthermore, the magnitude of inflammatory decline between postoperative days two and four was associated with LOS. However, HRV did not predict postoperative complications. In conclusion, patients with lower presurgical vagal activity had a worse postoperative inflammatory profile than those with high vagal tone. In the age of personalized medicine, such findings may have implications for identifying and preparing patients before surgery.

Lower Limit of Normality of Segmental Multilayer Longitudinal Strain in Healthy Adult Subjects.

Speckle tracking echocardiography is an advanced imaging technique that allows for a more detailed assessment of cardiac global and regional function. Reference values for segmental longitudinal layered strain (subendocardial, mid-myocardial, and subepicardial) are scarce, limiting the clinical use of these measurements in clinical practice. Two hundred consecutive Caucasian healthy subjects (mean age = 37 ± 11 years) were enrolled in the study. The mean values of global longitudinal strain (GLS) for endocardial (Endo), mid-myocardial (Myo) and epicardial (Epi) layers were -22.9 ± 2.7, -20.0 ± 2.4 and -17.5 ± 2.1, respectively. The GLSEndo/GLSMyo ratio was 1.1 ± 0.05, while the GLSEndo/GLSEpi ratio was 1.3 ± 0.05. The apical strain-sparing ratio was >1 in 10% of the subjects (endocardium) and 7% (mid-myocardium). The lower limits for segmental LS were as follows: for endocardial LS, -10% (basal), -12% (mid), -14% (apical); for mid-myocardial LS, -10% -10% (basal), -10% (mid), -10% (apical); and for epicardial LS, -7% (basal), -8% (mid), -8% (apical). The findings of this study provide data regarding the lower limit of normality of LS for each LV segment and suggest, for practical considerations, that an LS value below 10% should be considered abnormal in any segment. Further larger studies are warranted to confirm these findings.

Attitudes towards free-roaming dogs and dog ownership practices in Bulgaria, Italy, and Ukraine.

Free-roaming dog population management is conducted to mitigate risks to public health, livestock losses, wildlife conservation, and dog health and welfare. This study aimed to determine attitudes towards free-roaming dogs and their management and describe dog ownership practices in three European countries. We distributed an online questionnaire comprising questions relating to dog ownership practices and attitudes towards free-roaming dogs using social media. We used logistic regression and ordinal probit models to determine associations between demographic and other factors with ownership practices and attitudes towards free-roaming dogs. This study found that most surveyed respondents wanted to see a reduction in free-roaming dog numbers, and felt that this should be achieved through sheltering, catch-neuter-release, and by controlling owned dog breeding. We identified significant associations between both attitudes and ownership practices with gender, religious beliefs, age, education level, reason for dog ownership, previous experience with free-roaming dogs, and country of residence. Respondents who identified as: (i) male, (ii) holding religious beliefs, (iii) owning dogs for practical reasons, (iv) being young, or (v) having no schooling or primary education had a lower probability of neutering and a higher probability of allowing dogs to roam. Respondents who identified as: (i) female, (ii) feeling threatened by free-roaming dogs, (iii) older, or (iv) having more education had a higher probability of answering that increases in free-roaming dog numbers should be prevented. These findings can help to inform future dog population management interventions in these countries. We emphasise the importance of considering local attitudes and dog ownership practices in the development of effective dog population management approaches.

Assessing the impact of free-roaming dog population management through systems modelling.

Free-roaming dogs can present significant challenges to public health, wildlife conservation, and livestock production. Free-roaming dogs may also experience poor health and welfare. Dog population management is widely conducted to mitigate these issues. To ensure efficient use of resources, it is critical that effective, cost-efficient, and high-welfare strategies are identified. The dog population comprises distinct subpopulations characterised by their restriction status and level of ownership, but the assessment of dog population management often fails to consider the impact of the interaction between subpopulations on management success. We present a system dynamics model that incorporates an interactive and dynamic system of dog subpopulations. Methods incorporating both fertility control and responsible ownership interventions (leading to a reduction in abandonment and roaming of owned dogs, and an increase in shelter adoptions) have the greatest potential to reduce free-roaming dog population sizes over longer periods of time, whilst being cost-effective and improving overall welfare. We suggest that future management should be applied at high levels of coverage and should target all sources of population increase, such as abandonment, births, and owners of free-roaming dogs, to ensure effective and cost-efficient reduction in free-roaming dog numbers.

Population dynamics of free-roaming dogs in two European regions and implications for population control.

Changes in free-roaming dog population size are important indicators of the effectiveness of dog population management. Assessing the effectiveness of different management methods also requires estimating the processes that change population size, such as the rates of recruitment into and removal from a population. This is one of the first studies to quantify the size, rates of recruitment and removal, and health and welfare status of free-roaming dog populations in Europe. We determined the size, dynamics, and health status of free-roaming dog populations in Pescara, Italy, and Lviv, Ukraine, over a 15-month study period. Both study populations had ongoing dog population management through catch-neuter-release and sheltering programmes. Average monthly apparent survival probability was 0.93 (95% CI 0.81-1.00) in Pescara and 0.93 (95% CI 0.84-0.99) in Lviv. An average of 7 dogs km-2 were observed in Pescara and 40 dogs km-2 in Lviv. Per capita entry probabilities varied between 0.09 and 0.20 in Pescara, and 0.12 and 0.42 in Lviv. In Lviv, detection probability was lower on weekdays (odds ratio: 0.74, 95% CI 0.53-0.96) and higher on market days (odds ratio: 2.58, 95% CI 1.28-4.14), and apparent survival probability was lower in males (odds ratio: 0.25, 95% CI 0.03-0.59). Few juveniles were observed in the study populations, indicating that recruitment may be occurring by movement between dog subpopulations (e.g. from local owned or neighbouring free-roaming dog populations), with important consequences for population control. This study provides important data for planning effective dog population management and for informing population and infectious disease modelling.

Understanding orthopedic infections through a different perspective: Microcalorimetry growth curves.

Infectious disease is a serious healthcare problem in orthopedics, as well as other surgical specialties. Accurate and prompt diagnosis, as well as proper care, is critical, as infection of a surgical wound, particularly in the case of arthroplasties or the use of orthopedic implants, can have a catastrophic effect in most cases, necessitating the removal of foreign material. Lyophilized bacteria samples were obtained from Cantacuzino National Institute of Research and Development for Microbiology and Immunology and investigated microcalorimetrically. Isothermal microcalorimetry measures the temperature generated by the multiplication of microorganisms; using an adapted program, it describes the growth curve in real-time according to the received electrical signal. The thermograms of Escherichia coli and Klebsiella pneumonie were analyzed, and similarities were observed for both the time required for the bacteria to grow and the heat flow generated by their growth. Bacterial microcalorimetry has a variety of benefits, and should be regarded as a means of rapid and accurate diagnosis. Sensitivity is a valuable attribute for a diagnostic technique; when only a few microorganisms are present, microcalorimetric signs of bacterial multiplication can be observed. Microcalorimetry has potential as a simple diagnostic tool in a variety of infections, but further research is needed to ensure that it is used correctly. A thorough investigation (including kinetic analysis) of a reproducible thermal signal of bacterial growth could lead to the creation of new methods for quickly identifying bacteria.

Impact of lockdown during the COVID-19 pandemic on number of patients and patterns of injuries at a level I trauma center.

OBJECTIVE: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and its associated illness, coronavirus disease 2019 (COVID-19), has led to a global health crisis burdening frontline emergency departments, including orthopedic and trauma units. The aim of this study was to provide an overview of the impact of the lockdown secondary to the pandemic on patient numbers and pattern of injuries at the department of traumatology of the Medical University of Vienna. METHODS: This retrospective, descriptive study identified all patients admitted and enrolled onto the trauma registry at a level I trauma center, between 15 March 2020 and 30 April 2020 (lockdown) and compared them to those between 15 March 2019 and 30 April 2019 (baseline). Variables collected included patient age, sex, reason for hospital admission, place of injury, death, injury severity score (ISS), as well as American Society of Anaesthesiologists (ASA) score. RESULTS: A total of 10,938 patient visits to the trauma emergency department were analyzed, 8353 presentations during the baseline period and 2585 during lockdown. Only 1869 acutely injured and 716 follow-up patients presented during lockdown, compared to 6178 and 2175, respectively, during baseline. Throughout the COVID-19 lockdown there were significant reductions in both workplace and traffic accidents, sports injuries, number of hospitalized patients, and overall visits to the trauma emergency department; however, the number of major traumas and hip fractures remained similar. Furthermore, there was a significant increase in the frequency of injuries at home as well as hospital admissions due to attempted suicide. CONCLUSION: Despite the reduction in total number of patients, trauma departments should continue to provide adequate service during lockdown considering that severe injuries showed no change. Conditions such as breakdown of social networks and limited access to mental health care and support might account for the significant rise in hospital admissions due to suicides. We recommend that more attention and effort should be made to prevent this excess of suicide deaths.

Spinal cord infarction caused by extensive aortic intramural hematoma.

We report the case of a 62-year-old Caucasian man, an ex-smoker, who presented to the emergency room complaining of intense lower back pain followed by immediate bilateral loss of inferior limbs motor function. Clinical examination showed complete paralysis and paranesthesia in both legs, while pain and temperature sensory examination revealed a sensory level at dermatome T6, with normal touch, vibration, and position senses. His blood pressure was 190∕100 mmHg. Computed tomography demonstrated dilated thoracic aorta (maximum diameter 44 mm) and abdominal aorta (maximum 58 mm), with extended intramural hematoma (IMH), thus establishing the diagnosis of type A aortic IMH complicated with paraplegia through spinal perfusion deficit. Due to the extension of the lesions, surgical intervention for aortic repair was considered at high risk while cerebrospinal fluid drainage was not recommended by the neurologist. The patient remained stable while hospitalized and was released from the hospital with mild improvement of neurological deficiencies.

Laparoscopic resection of giant adrenal malignant tumors, a case series and review of the literature.

Laparoscopic approach for suspected adrenal malignancies remains a controversial issue and it gets more controversial, when managing giant adrenal malignant tumors. The aim of this paper is to present five cases of patients with giant adrenal malignant tumors that underwent laparoscopic transabdominal lateral adrenalectomy in our department between 2010 and 2017. Literature is also reviewed in order to investigate the feasibility of laparoscopic resection in these cases.

A Comparison of Dynamic Hip Screw and Two Cannulated Screws in the Treatment of Undisplaced Intracapsular Neck Fractures-Two-Year Follow-Up of 453 Patients.

One of the most common fractures is that of the intracapsular femoral neck; however, the optimal implant for head-preserving treatment remains controversial. The aim of the study was to compare the outcomes of treating undisplaced intracapsular femoral neck fractures with either the dynamic hip screw (DHS) or the double cannulated screw fixation (CSFN). This retrospective cohort study analysed the data of 453 patients, with a mean age of 76.9 years, whose intracapsular fractures were treated with the DHS or CSFN between 2005 and 2013. The analysis focused on the rates of revision surgeries and complications; however, the impact of confounding exogenous factors, such as smoking and alcohol, were also considered. No significant difference was observed between the revision rates of DHS and CSFN (15.0% vs. 13.1%; p = 0.565). According to the complication rate, the advantage in favour of the CSFN was not significant (20.5% vs. 13.1%, p = 0.038). The use of the DHS was associated with a 13 min longer surgery (p < 0.0001) and a one day longer hospitalization (p = 0.242). Excessive consumption of alcohol was associated with an increased incidence of avascular necrosis (18.6% vs. 8.7%, p = 0.035). The choice of implant showed no significant impact on rates of revision surgery and complications. In terms of socioeconomic factors, the fixation with two cannulated screws was more favourable, making it the more cost-effective and less stressful method.

Migration of the Lag Screw after Intramedullary Treatment of AO/OTA 31.A2.1-3 Pertrochanteric Fractures Does Not Result in Higher Incidence of Cut-Outs, Regardless of Which Implant Was Used: A Comparison of Gamma Nail with and without U-Blade (RC) Lag Screw and Proximal Femur Nail Antirotation (PFNA).

The best intramedullary nail for the treatment of unstable AO/OTA 31.A2.1-3 fractures remains uncertain. A total of 237 patients (45 male, 192 female) were eligible for the assessment with an average age of 81.9 ± 10.5 years and a minimum follow-up of six months. We assessed the cut-out rate, the TAD and calTAD (Tip Apex distance) of three different implants. An overall cut-out rate of 2.5% (n = 6) was observed. The cut-out rate was 1.2% (n = 1) in the Proximal Femur Nail Antirotation (PFNA) group, 3.7% (n = 3) in the Gamma Nail group and 2.9% (n = 2) in the Gamma3® with a U-Blade (RC) lag-screw group. The TAD and calTAD differed between the cut-out and non-cut group-20.0 mm vs. 18.5 mm and 13.1 mm vs. 15.3 mm, respectively. A significantly higher TAD of 32.5 mm could be seen in the cut-out after PFNA (p < 0.0001). The only significant change in follow-up using Parker's ratio was observed in the PFNA group (p < 0.0001). The rate of patients requiring surgery after complications was 8.4% (n = 20) without any significant difference between the three groups. The PFNA blade showed significant migration within the femoral head, however the cut-out rate remained the smallest compared to Gamma3 with or without additional U-Blade (RC) lag screw.

The Effectiveness of Dog Population Management: A Systematic Review.

The worldwide population of domestic dogs is estimated at approximately 700 million, with around 75% classified as "free-roaming". Where free-roaming dogs exist in high densities, there are significant implications for public health, animal welfare, and wildlife. Approaches to manage dog populations include culling, fertility control, and sheltering. Understanding the effectiveness of each of these interventions is important in guiding future dog population management. We present the results of a systematic review of published studies investigating dog population management, to assess: (1) where and when studies were carried out; (2) what population management methods were used; and (3) what was the effect of the method. We evaluated the reporting quality of the published studies for strength of evidence assessment. The systematic review resulted in a corpus of 39 papers from 15 countries, reporting a wide disparity of approaches and measures of effect. We synthesised the management methods and reported effects. Fertility control was most investigated and had the greatest reported effect on dog population size. Reporting quality was low for power calculations (11%), sample size calculations (11%), and the use of control populations (17%). We provide recommendations for future studies to use common metrics and improve reporting quality, study design, and modelling approaches in order to allow better assessment of the true impact of dog population management.

Spermatic vein aneurysm: a report of a unique case and review of the literature.

A spermatic vessel aneurysm is a rare entity, described only a few times in the literature. In most cases, it is caused by trauma or inflammation and appears as a painful mass in the scrotum or the inguinal area. We present a case of a 22-year-old man who came to our Surgical Department with a painful, palpable mass in the right inguinal area. A spermatic vein aneurysm was diagnosed with the use of ultrasonography and it was surgically excised. The findings were confirmed by pathological examination. The patient is well, four months after surgery. A spermatic vessel aneurysm, though rare, should always be included in the differential diagnosis of a scrotal or inguinal mass. The lesion can be cured by surgical resection.

Mini-laparoscopic cholecystectomy with the MiniLap® percutaneous surgical system: a series of 32 patients.

BACKGROUND: In recent years, mini-laparoscopic procedures are gaining the preference of most surgeons due to their potentially better surgical outcomes. The Mini Lap Percutaneous Surgical System with MiniGrip® Handle is currently the less invasive instrument and can be applied to a wide range of operations. The current paper presents its application on percutaneous laparoscopic cholecystectomy. MATERIALS AND METHODS: From January 2017 to June 2017, 32 patients underwent percutaneous laparoscopic cholecystectomy with the MiniLap® system. All operations were performed by the same surgical team. RESULTS: No conversions and no overall complications were reported. Drainage were not necessary. Mean surgical time was 35 minutes, while patients were released in <24 hours after the operation. CONCLUSION: The MiniLap system with the use of the mini grip handle seems to sustain the benefits of performing laparoscopically. However, further trials should be conducted so as to establish its safety on cholecystectomies.

Psoriatic arthritis due to nivolumab administration a case report and review of the literature.

Nowadays we have novel equipment for lung cancer diagnosis, however; due to lack of symptoms, lung cancer is still diagnosed at a late stage. Currently we have the following therapies for non-small cell lung cancer: a) non-specific cytotoxic agents, b) targeted therapies and c) immunotherapy. Each therapy has its own advantages and adverse effects. In the current case we will present a rare case of psoriacic arthritis that was presented after two cycles of nivolumab administration and we will also present a review of the literature.