Water quality of Danube Delta systems: ecological status and prediction using machine-learning algorithms.

Environmental issues have a worldwide impact on water bodies, including the Danube Delta, the largest European wetland. The Water Framework Directive (2000/60/EC) implementation operates toward solving environmental issues from European and national level. As a consequence, the water quality and the biocenosis structure was altered, especially the composition of the macro invertebrate community which is closely related to habitat and substrate heterogeneity. This study aims to assess the ecological status of Southern Branch of the Danube Delta, Saint Gheorghe, using benthic fauna and a computational method as an alternative for monitoring the water quality in real time. The analysis of spatial and temporal variability of unicriterial and multicriterial indices were used to assess the current status of aquatic systems. In addition, chemical status was characterized. Coliform bacteria and several chemical parameters were used to feed machine-learning (ML) algorithms to simulate a real-time classification method. Overall, the assessment of the water bodies indicated a moderate ecological status based on the biological quality elements or a good ecological status based on chemical and ML algorithms criteria.

Accurate Diagnosis of Sigmoid Colon Endometriosis by Immunohistochemistry and Transmission Electron Microscopy - A Case Report.

Endometriosis is described as the presence of functioning endometrial tissue at sites outside the uterus. Up to 15% ofwomen in their reproductive period are affected by this condition. Endometriosis is mostly foundon the uterosacral ligaments, inside the rectovaginalseptum or vagina, in the rectosigmoid area, ovarianfossa, pelvic peritoneum, ureters, and bladder, causinga distortion of the pelvic anatomy. Colonic involvement is rare but is usually found at the level of the rectum or the sigmoid colon. Acute presentation with intestinal obstruction or perforation is rare. While malignant transformation of endometrial lesions is rare, findings of dysplasia on pathology sections can give rise to questions of management. Immunohistochemistry and electron microscopy can help decision making. We present the case of a 38 year old woman with intestinal obstruction caused by sigmoid colon endometriosis with moderate dysplasia in which transmission electron microscopy was used for postoperative diagnosis. Detailed analysis of these cases, while logistically difficult, can prove useful in understanding the etiology and pathophysiology of the disease.

Novel method for proliferation of oral keratinocyte stem cells.

BACKGROUND AND OBJECTIVE: Stem cell-based tissue engineering offers clear advantages over conventional normal cell approaches. Owing to their specific characteristics, oral keratinocyte stem cells represent an attractive solution for therapeutic applications. However, when cultured in vitro, these cells lose their unique properties, acquiring a limited capacity for self-renewal, and differentiate rapidly into normal functional keratinocytes. The main aim of the present study was to develop an in-vitro method for the expansion of oral keratinocyte stem cells using a biomaterial approach. MATERIAL AND METHODS: Oral keratinocyte stem cells were isolated based on the identification of two surface markers - integrin α6ß4 and CD71 - using a magnetic method. The cells were cultured on specific substrates formed from blends of polymers: poly(lactide-co-glycolide) (PLGA); poly(lactide-co-glycolide) + polyurethane (PLGA + PU); and poly(lactide-co-glycolide) + extracellular matrix (PLGA + ECM). The polymers were deposited using a laser-based technique - matrix-assisted pulsed laser evaporation. The cells were analyzed for cell size, cell proliferation, colony-forming efficiency, cell adhesion markers (such as E-cadherin and beta 1 integrin), keratinocyte stem cells and differentiation markers. The methods included ELISAs, immunofluorescence and atomic force microscopy imaging. RESULTS: After 14 d in culture, cells seeded on PLGA + PU stained positive for p63, cd44H, cytokeratin 19 and integrin α6ß4 and negative for involucrin, cytokeratin 14 and cytokeratin 10. The levels of adhesion molecules were significantly increased in cells grown on PLGA + PU: at 14 d the E-cadherin levels were 5.4 ± 0.2 ng/mL (for cells grown on PLGA + PU) vs. 4.1 ± 0.4 ng/mL (for cells grown on control medium) (n = 5, p < 0.05 Bonferroni). Oral keratinocyte stem cells grown on PLGA + PU had the highest colony-forming efficiency and proliferation rate, together with the smallest cell size, compared with cells grown on control medium or other polymeric substrates. CONCLUSION: The present study demonstrates that by culturing oral keratinocyte stem cells on PLGA blended with PU it is possible to preserve their phenotype in vitro and to guide their short-term expansion and proliferation. Certain stem-cell characteristics are preserved and their short-term expansion may be enhanced.

Investigation of osteoblast cells behavior in polymeric 3D micropatterned scaffolds using digital holographic microscopy.

The effect of micropatterned polymeric scaffolds on the features of the cultured cells at different time intervals after seeding was investigated by digital holographic microscopy. Both parallel and perpendicular walls, with different heights, were fabricated using two-photon lithography on photopolymers. The walls were subsequently coated with polypyrrole-based thin films using the matrix assisted pulsed laser evaporation technique. Osteoblast-like cells, MG-63 line, were cultured on these polymeric 3D micropatterned scaffolds. To analyze these scaffolds with/without cultured cells, an inverted digital holographic microscope, which provides 3D images, was used. Information about the samples' refractive indices and heights was obtained from the phase shift introduced in the optical path. Characteristics of cell adhesion, alignment, orientation, and morphology as a function of the wall heights and time from seeding were highlighted.

Breast-conserving surgery in breast cancer.

The breast cancer treatment is based nowadays on new surgical options: breast-conserving surgery, which applies at least for the first and second stage cancer, with radical intention. We have been practicing breast-conserving surgery for the last 16 years and we have performed 303 breast conserving operations from a total of 673. We recorded 12 local recurrences (3,96%) and 2 deaths due to cancer progression. Our protocol includes removal of the primary tumor with enough surrounding tissue to ensure negative margins of the resectable specimen, associated with axillary lymph-node dissection and postoperative breast irradiation. Our oncologist indicated chemotherapy on different postoperative conditions: tumor size, axillary lymph node involvement, patient's age, etc. The purpose of this paper is to emphasize our modest experience, nevertheless to draw the attention on important results, obtained by long-term monitoring of the patients who underwent breast-conserving surgery, in a two prospective protocols, and demonstrate the importance and applicability of breast conserving therapy. The conclusion of this study is that breast-conserving surgery followed by breast irradiation is reliable, as the results are similar with radical mastectomies; the main objective is to obtain a good cosmetic result, which depends on tumor size / breast size.

[Diseases mimicking advanced-stage epithelial ovarian cancer]. / Afectiuni mimând cancerul ovarian epitelial în stadiu avansat.

This paper draws attention towards 3 cases with different pathologies all of which suggesting however both clinically and by imaging means as the most likely diagnosis advanced-stage epithelial ovarian cancer since all these three postmenopausal women had been admitted to the hospital with ascites, pelvic masses and deterioration of the physical wellbeing (fatigue, decreased appetite, weight loss, pallor). Findings during exploratory laparotomy on all these three pacients included ascites (hemorragic in one case) diffuse tumorous implants throughout the abdominal and pelvic peritoneal surfaces (in two cases) and the ovarian tumour. Postoperatively, the final histopathologic diagnoses consisted of primary peritoneal carcinoma (one pacient), peritoneal tuberculosis (TB, one pacient) and hepatic cirrosis with an incidental benign adnexial mass (one pacient). Moreover, nonmalignant ovarian tumours were certified in all three cases under current presentation. The differential diagnosis of the ovarian cancer and a tailored approach to treatment for each of these three pathologic entities will also be described in detail.

Magnetically-driven 2D cells organization on superparamagnetic micromagnets fabricated by laser direct writing.

We demonstrate a proof of concept for magnetically-driven 2D cells organization on superparamagnetic micromagnets fabricated by laser direct writing via two photon polymerization (LDW via TPP) of a photopolymerizable superparamagnetic composite. The composite consisted of a commercially available, biocompatible photopolymer (Ormocore) mixed with 4 mg/mL superparamagnetic nanoparticles (MNPs). The micromagnets were designed in the shape of squares with 70 µm lateral dimension. To minimize the role of topographical cues on the cellular attachment, we fabricated 2D microarrays similar with a chessboard: the superparamagnetic micromagnets alternated with non-magnetic areas of identical shape and lateral size as the micromagnets, made from Ormocore by LDW via TPP. The height difference between the superparamagnetic and non-magnetic areas was of ~ 6 µm. In the absence of a static magnetic field, MNPs-free fibroblasts attached uniformly on the entire 2D microarray, with no preference for the superparamagnetic or non-magnetic areas. Under a static magnetic field of 1.3 T, the fibroblasts attached exclusively on the superparamagnetic micromagnets, resulting a precise 2D cell organization on the chessboard-like microarray. The described method has significant potential for fabricating biocompatible micromagnets with well-defined geometries for building skin grafts adapted for optimum tissue integration, starting from single cell manipulation up to the engineering of whole tissues.

Impact of Hysterectomy on Urethral Suspension with Transobturator Sling for Treatment of Stress Urinary Incontinence in Women.

Urinary stress incontinence is a condition that increases with age, influenced by many factors, mainly anatomical pathological ones, determined by changes of muscular pelvic floor, but also by hormonal and local neurological modifications. The aim of the study was an overview of the efficacy of stress urinary incontinencetherapy with transobturatorurethralsling suspension in patients with or without prior hysterectomy. Additionally, we evaluated the effectiveness and the rate of side effects of this method. The study group consisted of 100 patients and, within it, 32 patients (group A)underwent a hysterectomy.We noticed an improvement of symptoms, a reduced discomfort and an increase of quality of life, more prominent in group B (patients without previous hysterectomy) (p=0,0012, p=0,17 respectively, p=0,03). We consider that transobturator approach in treating stress urinary incontinence is a simple, rapid and effective procedure and, not lastly, modern technique that assures a significant improvement of symptomsand quality of life for the patients; positioning the sling along to the insufficient pubourethral ligaments reinforces the structures supporting the urethra; this approach is minimally-invasive with rapid recovery, reduced hospitalization, is cost effective and involves minimal risks of infection, bleeding, etc. moreover, the transobturator tension free sling has some advantages (no pain or tension). The rate of success of the treatment is significantly lower in patients with prior hysterectomy.

Cell imaging by coherent backscattering microscopy using frequency-shifted optical feedback in a microchip laser.

In this work, we present a new development of the laser optical feedback imaging technique for imaging biological structures with a high resolution. The first results obtained on human red blood cells and mice cerebral and muscular tissues slices are shown. The performances of the system and its future developments are also discussed.

[Stress urinary incontinence. Diagnostic and therapeutic aspects]. / Incontinenta urinara de efort. Aspecte diagnostice si terapeutice.

OBJECTIVE: The paper analyses the incidence, diagnosis and treatment options available for stress urinary incontinence (SUI) in women with pelvic floor dysfunction admitted to Craiova's Surgery Clinic IV. METHODS: This is a retrospective 10-year study comprising a surgical cohort of 420 patients with significant enough to alter quality of life SUI associated to ureterocele and cystocele and in 353 cases with rectocele too. The highest incidence of SUI was encountered between 50 and 59 years of age (range 39 - 81 years). In 21 of this case series the diagnosis of SUI was established soon after the surgical repair of the urethro-cystocele. The diagnosis of SUI was based on careful history and physical examination with emphasis on the gynecologic survey of the abdomen and pelvis but in the absence (for objective reasons) of urodynamic testing which is especially useful for SUI pathophysiological evaluation and thus surgery success rate prediction. All our 420 severe SUI associated with vaginal wall hernias underwent surgical treatment by either open Burch retropubic urethropexy or anterior colporraphy. RESULTS: Among anterior colporraphy treated patients SUI persisted in 19.3% of the cases (33 patients). Complications of Burch urethropexy procedure (despite its high ability for cure) in our case series include: urinary retention, hemorrhage into the space of Retzius, intraoperative injury to the bladder and long-term postoperative incisional hernia. Moreover, 5 patients (2%) of the group who underwent Burch operation were readmitted with recurrent urinary incontinence between 2 and 6 months after the aforementioned surgical intervention despite its good anatomical results in all of these cases. CONCLUSIONS: SUI is a prevalent disorder of women that can be diagnosed easily with history and physical exam. If symptoms persist and severely affect quality of life, despite modern noninvasive treatments, several surgical procedures are now available.

Histopathological Study on Conservatively Operated Breast Carcinomas.

In this histopathological study we looked at 303 cases of breast carcinomas, managed though conservative breast surgery and later analysed with the help of a classical histopathological technique, paraffin embedding. The carcinomas were assessed in terms of tumor size, lymph node status, histological type, correlation between invasive tumors and an situ carcinoma component, resection margins, grading and patients age. Following assessment, we looked at associations between above morphological and clinical parameters and ipsilateral local recurrences. We concluded that more than half of our cases were carcinomas, measuring between 2 cm and 5 cm, with no associated lymph node involvement, in keeping with pTNM criteria for stage II. By far, in our study, the most frequent histopathological type was type NOS (63.37%) followed by invasive lobular carcinoma (10.56%) and mixed ducto-lobular invasive carcinoma (6.27%). Other types of invasive carcinoma were rarer, each representing less than 4% of cases. In regards to in situ carcinomas we noted the most common histological types to be both cribriform intraductal carcinoma and comedocarcinoma, each identified in 1.65% of cases. Amongst invasive breast carcinomas, infiltrating ductal carcinoma not otherwise specified (NOS) was found to be most commonly associated with in situ ductal carcinoma lesions. This was seen in 34.9% of cases, and was the only type associated with an extensive in situ component. Analysing the grading of mammary carcinomas in our study showed that the vast majority of cases (63.04%) were grade 3 tumors. In regards to surgical resection margins, ¾ of cases were noted to have negative margins. Tumor recurrences were noted in 12 cases. These cases were most commonly noted to reoccur following initial poorly differentiated, infiltrating ductal carcinomas, not otherwise specified (NOS), with positive resection margins, measuring less than 2 cm. Patiens tended to be under the age of 40 and had positive lymph nodes. The emergence of local recurrences after conservative surgery for early breast cancer is singnificantly linked to poorly differentiated primary tumors (p <0.05) but not correlated with histological type, presence of extensive intraductal carcinoma component, size of primary breast tumor or lymph node status ( p> 0.05). In terms of increasing the risk of ipsilateral recurrence the most important aspect highlighted in our sudy was the status of the resection margins. Patients with positive resection margins had a significantly high risk to develop recurrences after the conservative surgery, compared to those with negative margins (p <0.001).

[The experience at the 4th Surgery Department of the University Hospital C.F. Craiova in the surgical treatment of inguinal hernia]. / Experienta Clinicii Chirurgicale IV a Spitalului Universitar C. F. Craiova în folosirea plaselor sintetice în tratamentul chirurgical al herniilor inghinale.

This paper aim is to present the experience of Surgery Department IV of University Hospital C. R. Craiova in groin hernias treatment using prosthetic meshes, also describing an original technical procedure of mesh-plasty that we have been practicing successfully in our clinic. The study is based on a number of 1757 groin hernias operated in Surgery Department IV of University Hospital C. F. Craiova during a period of 11 years (1993-2003). There have been used prosthetic meshes in a number of 230 hernias operated for the most part in the last years since mesh repair has become habitually. We have been using so far only prosthetic mesh made in Romania (polyester mesh). We had a single recurrent hernia and the immediate complications were minimal. The study refers us to practice prosthetic mesh repair in an extensive way and offers a technical alternative in using of prosthetic meshes by a simple and efficient procedure with good postoperative results.

[The mirage of the first lesion (gallstones) and laparoscopic cholecystectomy are able to defer the diagnosis of colon cancer]. / Mirajul primei leziuni (litiaza veziculara) si colecistectomia laparoscopica pot întârzia diagnosticul de cancer colic.

The study's aim was to analyze a series of colon cancer cases in which the mirage of the first (clinically most obvious) lesion (gallstones) along with its minimally invasive approach - that explored only the biliary disease - had contributed to the delay of large bowel malignancy' diagnosis and treatment. 1327 patients aged between 17 and 83 years and diagnosed with cholecystolithiasis were operated upon laparoscopically in the Department of General Surgery of Craiova CFR University Hospital from 2000 through 2004. Four out of these 1327 patients (0,3%) were readmitted with the diagnosis of colon carcinoma between 1 and 16 months after the laparoscopic cholecystectomy. Our retrospective study gives a full report on these 4 cases insisting upon the links between their clinical - laboratory evaluations and final diagnosis. Despite the low laparoscopic cholecystectomy overlooked colon cancer' incidence it seems reasonable to both improve the technique of peritoneal cavity exploration during this type of surgery and extend the preoperative evaluation whenever the slightest suspicion of associated pathology is raised especially in patients over 50 years of age.

[Tuberculous perforation of the small bowel]. / Perforatii intestinale de cauza tuberculoasa.

The authors present their experience with two cases of acute peritonitis scattered characteristic lesions were secondary to the tuberculous of the bowel. It is noteworthy, as far as these two cases are concerned, the rarity of intestinal tuberculous fistulation occurrence in addition to the peculiarity of both their preoperative course with its related diagnostic and operative timing difficulties and their postsurgical recurrent perforation complicated evolution. This article also pin-points the special management problems due to the gravity of these cases.

[Acute necrotizing enterocolitis in an adult--a clinical study]. / Enterocolita acuta necrozanta la adult--studiu clinic.

The authors retrospectively reviewed 24 cases of necrotizing enterocolitis, in which the diagnosis was made or confirmed intraoperatively. This article points to the complex pathophysiology and preoperative diagnostic difficulties of necrotizing enterocolitis due to its clinical heterogeneity and lack of specificity of the laboratory findings. Given all these preoperative problems quite too often the best operatory moment is los and despite the somehow simple intraoperative diagnosis and the modern, well established surgical principles: resection of the necrotic segment with secondary reanastomosis (whenever possible), the post-therapeutic mortality rate remains disappointingly high (70.8%).

[Plastic repair with Plastex-type synthetic mesh in abdominal wall defects]. / Plastia cu plasa sintetica tip "Plastex" în defectele parietale abdominale.

This paper analyses a statistical series of 53 patients suffering from single or multiple abdominal wall defects and who were managed by plastic surgery with Plastex type synthetic mesh. Our results are pleading for the extension of the indications of Plastex mesh buttressing surgery beyond the usual recurrent "hernia" cases to the patients admitted with nonrecurrent either large abdominal wall defects or, and poor-quality musculoaponevrotic parietes of the abdominal wall. Our study recorded recurrence and postoperative morbidity rates have been minimal due to both a correct selection of cases for this type of surgical repair and an adequate patient preoperative management in which antibiotic and thromboembolic prophylaxis have been applied on a regular basis.

[A plea for the conservative treatment of breast cancer]. / Pledoarie pentru tratamentul conservator al cancerului de sân.

This article is a plea for the implementation of early-stage breast cancer conservative therapy into as many surgical clinics as possible. The aforementioned statement relies mainly on published papers and data (the protocol included) provided to us by Instituti Clinici di Perfezionamento di Milano experts in breast cancer conservative therapy and to a lesser extent on our not too numerous results (30 cases) obtained over the past 2 years since we applied the Milano protocol on a regular basis. Thus we support the view that the breast-conserving treatment is suitable for clinical stage I or II carcinoma whose tumors are 3 cm or less in greatest diameter, provided axillary lymphadenectomy is associated for prognostic and future management guidance reasons, but not for cure. Breast-limited postoperative radiation treatment is foremost aimed at local recurrences rate reduction without significantly influencing survival rate. Postoperative chemotherapy, indicated for node-positive patients and/or primary tumors over 1 cm in greatest, diameter, has been proved to contribute to long-term survival rate. However, both the small sample size and the short period of observation of our study prevented us from drawing firm conclusions directly.

[Urinary infections with hospital germs in general surgery]. / Infectii urinare cu germeni de spital în chirurgia generala.

Nosocomial urinary tract infection is the most common type of sepsis in the post-surgical patient. This paper presents our experience with 218 nosocomial urinary infections (34.93% of our postoperative infections) which complicated the postoperative course of 1002 (21.75%) urethral catheterized patients out of a total of 5950 (3.6%) operated on and under study individuals. Thus we found that urethral catheterization is the most important risk factor for post-surgery urinary infections. Moreover, in our series the postoperative urinary tract sepsis bacteriology is dominated (> 95% of cases) by aerobic gram-negative bacilli that mainly reside in the bowel and also commonly colonize the perineum. Furthermore, we demonstrated that post-surgical urinary infections did not influence directly death rate but they had a significant bearing on care costs. Finally we consider the prevention of postoperative nosocomial urinary tract sepsis as an essential principle of this condition management.

[The primitive gastric non- Hodgkin lymphoma]. / Limfomul gastric primitiv non-hodgkinian.

THE PURPOSE: Of this work is to point out diagnostic problems together with the surgical indications in primitive gastric non-Hodgkin Lymphoma (LGNH). THE MATERIAL AND METHODS: Consist of 11 cases of LGNH (3.09% of 350 gastric cancers that underwent surgery between 1991-2000) of which 4 were women and 5 men, of an average 53 years of age. Three of the cases underwent surgery for various complications (HDS, perforation and pyloric stenosis) or for other clinical forms such as the pseudo-ulcerative one (4 cases) and the gastric carcinoma mimicking form (4 cases). Preoperative diagnosis was established by means of endobiopsy in 5 cases. SURGICAL TREATMENT: total gastrectomy (4 cases), inferior polar subtotal gastrectomy (5 cases) and 2/3 gastric resection (2 cases). RESULTS: Complications involving sub-phrenic abscess that triggered re-intervention in 2 cases; no immediately postoperative mortality. THE DISCUSSIONS AND CONCLUSIONS: Are enumerating the difficulties we encountered in diagnosing the cases and especially in the preoperative histologic diagnosis, the staging of the disease and setting the treatment with an emphasis on the surgical treatment. THE COMPLICATIONS: Induced by the disease, the diagnosis uncertainty and the early stages of the disease are as many eligible indications for the first linje surgical treatment in LGNH.

[Causes of failure in the treatment of postoperative peritonitis]. / Cauze de esec în tratamentul peritonitelor postoperatorii.

The authors analyze a group of 49 postoperative peritonitis, which represent 0.57% of a total of 8550 surgical interventions performed over the last 7 years and 1.19% of 4100 laparotomies carried out in an elective operation orientated general surgery department. The mortality rate was 28.57% (14 patients) among the 49 studied cases, which represents 25% of all deaths recorded in our department over the same time interval. A full account on postoperative peritonitis vital prognostic factors is given, insisting on: specific bacteriology (nosocomial infections), peculiar etiologies (10 out of 14 fatalities were originally operated on for digestive cancers), different associations of postoperative peritonitis with other infectious and noninfectious postsurgical complications (as encountered in all 14 deaths), type of postoperative peritonitis (13 death out of 14 were due to generalized peritonitis), postoperative peritonitis secondary to ignored lesions at the original operation (3 cases--3 deaths), surgical treatment limitation (late operative timing which was responsible of 9 deaths); treatment inadequacies of peritonitis and its cause--5 fatalities.