Background and aimsColorectal cancer is one of the most frequent digestive malignancies, being the third cause of death by cancer, despite early diagnosis and therapeutic progress made over the past years. Standard treatment in these patients is to preserve the anal sphincter with restoration of intestinal function by mechanical colorectal anastomosis or coloanal anastomosis, and to maintain genitourinary function by preservation of hypogastric nerves.MethodsIn order to emphasize the importance of this surgical technique in the Fourth Surgical Clinic of the CF Clinical Hospital Cluj-Napoca, we conducted a prospective observational interventional study over a 3-year period (2013–2016) in 165 patients hospitalized for rectal and rectosigmoid adenocarcinoma in various disease stages, who underwent Dixon surgery using the two techniques of manual and mechanical end-to-end anastomosis. For mechanical anastomosis, we used Covidien and Panther circular staplers. The patients were assigned to two groups, group A in which Dixon surgery with manual end-to-end anastomosis was performed (116 patients), and group B in which Dixon surgery with mechanical end-to-end anastomosis was carried out (49 patients).ResultsMechanical anastomosis allowed to restore intestinal continuity following low anterior resection in 21 patients with lower rectal adenocarcinoma compared to 2 patients in whom intestinal continuity was restored by manual anastomosis, with a statistically significant difference (p<0.000001). The double-row mechanical suture technique is associated with a reduced duration of surgery (121.67 minutes for Dixon surgery with mechanical anastomosis, compared to 165.931 minutes for Dixon surgery with manual anastomosis, p<0.0001).ConclusionThe use of circular transanal staplers facilitates end-to-end anastomosis by double-row mechanical suture, allowing to perform low anterior resection in situations when the restoration of intestinal continuity by manual anastomosis is technically not possible, with the aim to preserve the anal sphincter, to restore intestinal function and maintain genitourinary function through preservation of hypogastric nerves.

Background/Aim: Post-stroke spasticity is a significant debilitating condition with negative consequences on individual functional independence and quality of life. This study aimed to identify the differences between transcutaneous electrical stimulation (TENS), ultrasound therapy and paraffin procedures on post-stroke upper extremity spasticity and dexterity. Patients and Methods: Twenty-six patients were enrolled in the study, divided into three therapy groups: TENS (n=9), paraffin (n=10) and ultrasound therapy (n=7). For 10 days, the patients received specific group therapy and conventional physical therapy exercises for upper extremities. Modified Ashworth Scale, Functional Independence Measure, Functional Coefficient, Stroke Specific Quality of Life Scale, Activities of Daily Living score and ABILHAND questionnaire were used to assess the participants before and after therapy. Results: The results of the group comparisons by analysis of variance showed no significant difference between outcomes by the applied treatments. In contrast, one-way analysis of variance suggested significant improvements in patients in all three groups after therapy. Step-wise regression results on functional independence measure and quality-of-life scales suggested that functional range of motion values for elbow and wrist influence individual independence and quality of life. Conclusion: TENS, ultrasound, and paraffin therapy bring equal benefits in the management of post-stroke spasticity.

Background: Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person’s physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. Methods: A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. Results: We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. Conclusions: The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.

No abstract

Spinal cord injury (SCI) can markedly alter the autonomic nervous system’s functions. It immediately causes autonomic and somatic hypo- or arreflexia, a state known as spinal shock. SCI determines the enhancement of two gastric reflexes that appear in normal conditions: the receptive and adaptative reflexes. Furthermore, this study also tried to evaluate the causes that led to such modifications: either vagal control, nitric oxide (NO)-pathways or intestine-intestinal reflexes. Male Wistar rats (N=25) were subjected to laminectomy (Sham group) or laminectomy + complete Spinal Cord Transection (SCT), between C7 and T1 vertebrae under anesthesia (SCT group). Before the surgery, the rats had water and food ad libitum; after the surgery, rats were fasted for 24 hours, still having access to water. The next day, all animals were subjected to a catheterism of their right carotid artery, a tracheostomy and a flexible balloon introduction down to the stomach’s fundix region, also under anesthesia. Rats were connected to a Power-Lab® system, via a pressure transducer (in order to measure the arterial pressure – MAP - and the heart rate - HR), and to a modified Plethysmometer (in order to measure the fundical gastric volume - GV variation). Vagal control was studied via cervical vagotomy; NO-mediation - via NO synthesis inhibitors (L-NAME); intestinointestinal reflexes - by using laxatives (Lactulone). Statistical analysis revealed, in some cases, that GV is significantly (p<0.05) augmented in SCT rats (2,4±0,09; 3,1±0,05; 3,7±0,06 ml) than in Sham (2,2±0,12; 2,9±0,12; 3,3±0,15 ml). Nevertheless, MAP and HR, were subsequently lower (p<0.05) in SCT (63,5±21,1mm Hg; 227,1±25,2 BPM) than in the control group (88,2±14,4mm Hg; 427,0±19,2 BPM). In summary, the increase of GV in SCT, seems to involve vagal pathways and/or NO-mediation, but still not neglecting the colic-gastric reflexes.

Introduction: Squamous cell carcinoma (SCC) is the most common skin cancer with a high rate of death. Different lymphocyte populations play an important role in modulating the immune response in the tumor microenvironment. The increase in the proportion of cluster of differentiation (CD)4+ CD25+ regulatory T-cell (Treg) lymphocytes is associated, in different studies, with the increase of the cell multiplication rate. Aim: To analyze the Treg lymphocyte subpopulations and to correlate the results with the presence of the CD8+ cytotoxic T-cell (Tc) lymphocyte population. Materials and Methods: Sixty primary skin SCC specimens were incubated with anti-CD8 (clone SP57) rabbit monoclonal antibody and anti-CD25 (clone 4C9) mouse monoclonal antibody. Results: The ratio of the intratumoral/peritumoral CD4+ CD25+ forkhead box protein p3 (Foxp3) lymphocytes was 0.46, emphasizing that at tumor margins, where tumor aggressiveness is higher, these lymphocytes subpopulations facilitate tumor progression. The comparative analysis of the tumor microenvironment profile revealed that in the case of intratumoral immune response, the number of Tc-type lymphocytes (CD8+) was 3.34 times higher compared to Treg lymphocytes (p<0001). In the peritumoral area, the number of Tc lymphocytes was 5.05 times higher compared to Treg lymphocytes (p<0001). Conclusions: Treg lymphocytes inhibition may cause the suppression of the antitumoral cell immune response in the tumor environment. We believe that Treg lymphocytes should represent a focus of interest for a new personalized therapy. New studies are needed to better understand the immune response in the tumor microenvironment.

No abstract

Collagen membranes have been widely investigated in animal studies and human clinical studies, and have demonstrated excellent biocompatibility, biodegradability and cell affinity. Membrane porosity and 3D architecture are considered to be crucial for cellular infiltration and proliferation, in the process of wound heling. In this context, the aim of our study was the prepare and to investigate comparatively the structural and morphological properties of collagenic membranes modified with a natural bio-compound (respectively azelaic acid) and to evaluate their bio-integration and immune response in the framework of an animal model. Our results shown a porous structure with a honeycomb-style architecture achieved as a result of azelaic acid incorporation in collagenic membrane, with a beneficial effect on tissue remodelling and rapid healing. The bio-integration of azelaic acid-collagenic membrane was faster compared to pure collagenic one, with only minor inflammatory events.