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Ursu CP, Ciocan A, Ursu Ș, Ciocan RA, Gherman CD, Cordoș AA, Vălean D, Pop RS, Furcea LE, Procopeț B, Ștefănescu H, Moiș EI, Al Hajjar N, Graur F. Prognostic Indicators of Overall Survival in Hepatocellular Carcinoma Patients Undergoing Liver Resection. Cancers (Basel) 2024; 16:1427. [PMID: 38611104 PMCID: PMC11010842 DOI: 10.3390/cancers16071427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 03/27/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Hepatocellular carcinoma (HCC) is the predominant form of primary liver cancer and the third contributor to malignancy-related deaths worldwide. The hepatic venous pressure gradient (HVPG), transient elastography-liver stiffness measurement (TE-LSM), and the association between TBS (tumor burden score), alpha-fetoprotein levels, and the Child-Pugh classification (TAC score) can serve as valuable prognostic indicators for these patients. Therefore, the main objective of our research was to analyze the prognostic value of the HVPG, TE-LSM, TBS, and TAC scores. An observational and survival study was conducted on 144 subjects. Our findings indicated that HVPG greater than 10 mmHg, AFP surpassing 400 ng/mL, an advanced C-P class, and low TAC score are independent predictors of overall survival. During the multivariate analysis, AFP serum levels and C-P class proved statistically significant. The present study revealed significant differences in overall survival between the two groups divided upon HVPG values and settled by the cutoff of 10 mmHg (p = 0.02). Moreover, by dividing the cohort into three groups based on the TAC score (very low, low, and moderate), statistically significant differences in overall survival were observed across the groups (p = 0.004).
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Affiliation(s)
- Cristina-Paula Ursu
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Ștefan Ursu
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
| | - Ariana-Anamaria Cordoș
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
- Romanian Society of Medical Informatics, 300041 Timișoara, Romania
| | - Dan Vălean
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Rodica Sorina Pop
- Department of Community Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Avram Iancu Street, No. 31, 400347 Cluj-Napoca, Romania
| | - Luminița Elena Furcea
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Bogdan Procopeț
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- Department of Internal Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Horia Ștefănescu
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Emil Ioan Moiș
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Florin Graur
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
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Ciocan RA, Ciocan A, Mihăileanu FV, Ursu CP, Ursu Ș, Bodea C, Cordoș AA, Chiș BA, Al Hajjar N, Dîrzu N, Dîrzu DS. Metabolic Signatures: Pioneering the Frontier of Rectal Cancer Diagnosis and Response to Neoadjuvant Treatment with Biomarkers-A Systematic Review. Int J Mol Sci 2024; 25:2381. [PMID: 38397058 PMCID: PMC10889270 DOI: 10.3390/ijms25042381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 02/25/2024] Open
Abstract
Colorectal cancer (CRC) is one of the most aggressive, heterogenous, and fatal types of human cancer for which screening, and more effective therapeutic drugs are urgently needed. Early-stage detection and treatment greatly improve the 5-year survival rate. In the era of targeted therapies for all types of cancer, a complete metabolomic profile is mandatory before neoadjuvant therapy to assign the correct drugs and check the response to the treatment given. The aim of this study is to discover specific metabolic biomarkers or a sequence of metabolomic indicators that possess precise diagnostic capabilities in predicting the efficacy of neoadjuvant therapy. After searching the keywords, a total of 108 articles were identified during a timeframe of 10 years (2013-2023). Within this set, one article was excluded due to the use of non-English language. Six scientific papers were qualified for this investigation after eliminating all duplicates, publications not referring to the subject matter, open access restriction papers, and those not applicable to humans. Biomolecular analysis found a correlation between metabolomic analysis of colorectal cancer samples and poor progression-free survival rates. Biomarkers are instrumental in predicting a patient's response to specific treatments, guiding the selection of targeted therapies, and indicating resistance to certain drugs.
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Affiliation(s)
- Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania;
| | - Andra Ciocan
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Florin Vasile Mihăileanu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
| | - Cristina-Paula Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
| | - Ștefan Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
| | - Cătălin Bodea
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
| | | | - Bogdan Augustin Chiș
- Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania;
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400162 Cluj-Napoca, Romania; (F.V.M.); (C.-P.U.); (Ș.U.); (C.B.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, 400162 Cluj-Napoca, Romania
| | - Noemi Dîrzu
- Clinical Laboratory Department, Transilvania Hospital, 400486 Cluj-Napoca, Romania
| | - Dan-Sebastian Dîrzu
- Emergency County Hospital Cluj, 400006 Cluj-Napoca, Romania;
- STAR—UBB Institute, Babeș Bolyai University, 400084 Cluj-Napoca, Romania
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Ursu Ș, Ciocan A, Ursu CP, Gherman CD, Ciocan RA, Pop RS, Spârchez Z, Zaharie F, Al Hajjar N. Role of Metabolomics in Pathogenesis and Prompt Diagnosis of Gastric Cancer Metastasis-A Systematic Review. Diagnostics (Basel) 2023; 13:3401. [PMID: 37998537 PMCID: PMC10670422 DOI: 10.3390/diagnostics13223401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Gastric cancer is the fourth most frequently diagnosed form of cancer and the third leading cause of cancer-related mortality worldwide. The aim of this review is to identify individual metabolic biomarkers and their association with accurate diagnostic values, which can predict gastric cancer metastasis. MATERIALS AND METHODS After searching the keywords, 83 articles were found over a period of 13 years. One was eliminated because it was not written in English, and two were published outside the selected period. Seven scientific papers were qualified for this investigation after eliminating duplicates, non-related articles, systematic reviews, and restricted access studies. RESULTS New metabolic biomarkers with predictive value for gastric cancer metastasis and for elucidating metabolic pathways of the metastatic process have been found. The pathogenic processes can be outlined as follows: pro-oxidant capacity, T-cell inactivation, cell cycle arrest, energy production and mitochondrial enzyme impairment, cell viability and pro-apoptotic effect, enhanced degradation of collagen extracellular matrix, migration, invasion, structural protein synthesis, and tumoral angiogenesis. CONCLUSION Metabolic biomarkers have been recognized as independent risk factors in the molecular process of gastric cancer metastasis, with good diagnostic and prognostic value.
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Affiliation(s)
- Ștefan Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Cristina-Paula Ursu
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (C.D.G.); (R.A.C.)
| | - Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania; (C.D.G.); (R.A.C.)
| | - Rodica Sorina Pop
- Department of Community Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Avram Iancu Street, No. 31, 400347 Cluj-Napoca, Romania;
| | - Zeno Spârchez
- Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania;
| | - Florin Zaharie
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania; (Ș.U.); (C.-P.U.); (F.Z.); (N.A.H.)
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Croitorilor Street, No. 19–21, 400162 Cluj-Napoca, Romania
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Ciocan RA, Graur F, Ciocan A, Cismaru CA, Pintilie SR, Berindan-Neagoe I, Hajjar NA, Gherman CD. Robot-Guided Ultrasonography in Surgical Interventions. Diagnostics (Basel) 2023; 13:2456. [PMID: 37510199 PMCID: PMC10378616 DOI: 10.3390/diagnostics13142456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION The introduction of robotic-guided procedures in surgical techniques has brought an increase in the accuracy and control of resections. Surgery has evolved as a technique since the development of laparoscopy, which has added to the visualisation of the peritoneal cavity from a different perspective. Multi-armed robot associated with real-time intraoperative imaging devices brings important manoeuvrability and dexterity improvements in certain surgical fields. MATERIALS AND METHODS The present study is designed to synthesise the development of imaging techniques with a focus on ultrasonography in robotic surgery in the last ten years regarding abdominal surgical interventions. RESULTS All studies involved abdominal surgery. Out of the seven studies, two were performed in clinical trials. The other five studies were performed on organs or simulators and attempted to develop a hybrid surgical technique using ultrasonography and robotic surgery. Most studies aim to surgically identify both blood vessels and nerve structures through this combined technique (surgery and imaging). CONCLUSIONS Ultrasonography is often used in minimally invasive surgical techniques. This adds to the visualisation of blood vessels, the correct identification of tumour margins, and the location of surgical instruments in the tissue. The development of ultrasound technology from 2D to 3D and 4D has brought improvements in minimally invasive and robotic surgical techniques, and it should be further studied to bring surgery to a higher level.
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Affiliation(s)
- Răzvan Alexandru Ciocan
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
| | - Florin Graur
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Cosmin Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Sebastian Romeo Pintilie
- "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Victor Babeș Street, No. 8, 400347 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Claudia Diana Gherman
- Department of Surgery-Practical Abilities, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania
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Alexa AL, Ciocan A, Zaharie F, Valean D, Sargarovschi S, Breazu C, Al Hajjar N, Ionescu D. The Influence of Intravenous Lidocaine Infusion on Postoperative Outcome and Neutrophil-to-Lymphocyte Ratio in Colorectal Cancer Patients. A Pilot Study. J Gastrointestin Liver Dis 2023; 32:156-161. [PMID: 37345602 DOI: 10.15403/jgld-4962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND AIMS In the last years increasing scientific evidence drew attention on the potential effects of anesthetic drugs on postoperative outcome in cancer patients. Local anesthetics, especially lidocaine, have been intensively studied in relation with postoperative outcome in colorectal cancer patients. Our study objectives were to investigate the effects of perioperative intravenous lidocaine infusion on neutrophil-to-lymphocyte ratio and short-term postoperative outcome. Additionally, we also looked at 1 year outcome after intended radical colorectal cancer surgery. METHODS 150 patients scheduled for colorectal cancer surgery were randomized to receive sevoflurane anaesthesia with or without 48 hours lidocaine infusion. RESULTS 73 patients were included in the group A (sevoflurane) and 77 in the group B (sevoflurane with lidocaine). Lidocaine infusion did not modify neutrophil-to-lymphocyte ratio at 24 hours after surgery (p=0.58). Patients receiving intravenous lidocaine had significantly lower morphine consumption (p=0.04), faster mobilization time (p=0.001) and fewer days spent in the hospital (p=0.04). Moreover, at 1 year follow- up, patients in group B had a significant decreased rate of recurrences (p=0.03). There was no significant difference in 1 year survival (p=0.22). CONCLUSIONS In our study, intravenous lidocaine infusion hastened the postoperative recovery of patients in terms of mobilization, hospital discharge and opioid consumption and reduced 1 year recurrence rate. Further studies on larger groups of patients are needed.
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Affiliation(s)
- Alexandru Leonard Alexa
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania.
| | - Andra Ciocan
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Florin Zaharie
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Dan Valean
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Sergiu Sargarovschi
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania.
| | - Caius Breazu
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca; Romania.
| | - Nadim Al Hajjar
- Department of Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj- Napoca, Romania.
| | - Daniela Ionescu
- 1 st Department of Anesthesia and Intensive Care, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj- Napoca, Romania; Research Association in Anesthesia and Intensive Care (ACATI), Cluj-Napoca, Romania; Department of Anesthesia and Intensive Care, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Cluj-Napoca, Romania; Outcome Research Consortium, Cleveland, USA.
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Zaharie F, Valean D, Zaharie R, Popa C, Mois E, Schlanger D, Fetti A, Zdrehus C, Ciocan A, Al-Hajjar N. Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience? World J Gastrointest Surg 2023; 15:847-858. [PMID: 37342852 PMCID: PMC10277938 DOI: 10.4240/wjgs.v15.i5.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.
AIM To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.
METHODS Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).
RESULTS There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).
CONCLUSION Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Dan Valean
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Roxana Zaharie
- Department of Gastroenterology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
| | - Calin Popa
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Emil Mois
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Diana Schlanger
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Alin Fetti
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Claudiu Zdrehus
- Department of Anaesthesiology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Andra Ciocan
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Nadim Al-Hajjar
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
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Ciocan A, Ciocan RA, Al Hajjar N, Benea AM, Pandrea SL, Cătană CS, Drugan C, Oprea VC, Dîrzu DS, Bolboacă SD. Exploratory Evaluation of Neopterin and Chitotriosidase as Potential Circulating Biomarkers for Colorectal Cancer. Biomedicines 2023; 11:biomedicines11030894. [PMID: 36979873 PMCID: PMC10046191 DOI: 10.3390/biomedicines11030894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/15/2023] Open
Abstract
Chronic inflammation is demonstrated to play a direct role in carcinogenesis. Our exploratory study aimed to assess the potential added value of two inflammation biomarkers, chitotriosidase and neopterin, in follow-up evaluation of patients with colorectal cancer (CRC). An observational exploratory study was conducted. Patients with CRC and matched controls (1:1, age, sex, and living environment) were evaluated. The patients with CRC (CRC group) and controls were assessed at baseline (before surgical intervention for patients with CRC). Patients with CRC were also evaluated at 1-year follow-up. Significantly more patients with blood group A (54.5% vs. 25.0%) and smokers (50.0% vs. 22.7%) were in the CRC group. The serum values of chitotriosidase and neopterin were higher in CRC patients than in controls, but only neopterin reached the conventional level of statistical significance (p-value = 0.015). The circulating chitotriosidase and neopterin values decreased significantly at 1-year follow-up (p-value < 0.0001). Patients with higher N- and M-stage showed statistically significant higher levels of chitotriosidase and neopterin at baseline and 1-year follow-up (p-values < 0.03). Circulating chitotriosidase levels also showed statistically significant differences regarding baseline and 1-year follow-up on patients with CRC and different differentiation grades (p-values < 0.02). The circulating levels of neopterin significantly decreased at 1-year follow-up, indicating its potential as a prognostic marker. The circulating values of chitotriosidase and neopterin exhibit significant differences in patients with than without recurrences. Our results support further evaluation of chitotriosidase and neopterin as prognostic markers in patients with CRC.
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Affiliation(s)
- Andra Ciocan
- Department of Surgery—Surgery Clinic III, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Răzvan A. Ciocan
- Department of Surgery—Practical Abilities, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania
- County Emergency Clinical Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
- Correspondence: (R.A.C.); (S.D.B.)
| | - Nadim Al Hajjar
- Department of Surgery—Surgery Clinic III, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Andreea M. Benea
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Stanca L. Pandrea
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 400006 Cluj-Napoca, Romania
- Department of Microbiology, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
| | - Cristina S. Cătană
- Department of Medical Biochemistry, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
| | - Cristina Drugan
- Department of Medical Biochemistry, “Iuliu Haţieganu” University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
| | - Valentin C. Oprea
- Department of Surgery—Surgery Clinic II, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400006 Cluj-Napoca, Romania
- “Dr. Constantin Papilian” Military Emergency Hospital Cluj-Napoca, 400132 Cluj-Napoca, Romania
| | - Dan S. Dîrzu
- County Emergency Clinical Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400349 Cluj-Napoca, Romania
- Correspondence: (R.A.C.); (S.D.B.)
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Ciocan A, Margarit S, Bartos A, Ciobanu L, Iancu I, A Ciocan R, Al Hajjar N. Emergency liver resection for non-traumatic lesions. A systematic review. Ann Ital Chir 2023; 94:580-586. [PMID: 38131361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
AIM Primary liver tumors have an incidence of 20% regarding benign tumors respectively 5.7% of the overall incident cases of cancer. In any major hepatic injury, the surgical treatment has two main goals: hemostasis and excision of the affected liver segments. We aimed to systematic review the non-traumatic emergency liver resections, in order to raise concern about a rather rare, but difficult to treat hepatic pathology, which implies divergent therapeutical approach, and emergency liver surgery remains the first or backup option. METHODS A literature survey was performed guided by the words "liver resections", "major liver resections", "emergency liver resection". "hepatocellular carcinoma" using four databases: Pubmed, Scopus, Web of Science and Embase. All titles referred in English, published from 2000 until 2021, were checked for eligibility. RESULTS Six publications were considered relevant for major liver resections in emergency, from a total of 331 articles that were reviewed. Large hepatocellular carcinomas and adenomas were the most common types of tumors found at risk for spontaneous rupture. The patients with hemodynamic instability, reduced liver function and large tumors had lower long-term survival and disease-free survival. Major hepatectomy was indicated as a viable solution for prolonging survival rate, whenever the patient's general status permits it per primam. CONCLUSIONS Emergency major liver resection for tumoral causes prolongs survival even if the cause is usually malignant. The tumor can be resected with negative resection margins, respecting the correct oncological requirements, both per primam or staged approach according to each case specifically. KEY WORDS Adenoma, Emergency, Hemorrhage, Hepatocellular Carcinoma, Liver Resection, Liver Tumors.
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Schlanger D, Popa C, Ciocan A, Șofron C, Al Hajjar N. Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series. J Clin Med 2022; 11:jcm11102891. [PMID: 35629017 PMCID: PMC9143146 DOI: 10.3390/jcm11102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival.
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Affiliation(s)
- Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-074-357-8432
| | - Andra Ciocan
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Cornelia Șofron
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
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Zaharie F, Valean D, Popa C, Mois E, Graur F, Munteanu D, Schlanger D, Ciocan A, Puia C, Al Hajjar N. Surgical technique in the laparoscopic repair of Morgagni hernia in adults. How do we do it? Hernia 2022; 26:1389-1394. [PMID: 35013791 DOI: 10.1007/s10029-021-02559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adult Morgagni hernias are rare congenital diaphragmatic hernias, which can present with an array of symptoms based on the size and the contents of it. This article focuses primarily on the laparoscopic repair with transfascial suturing. METHODS A number of five patients over the course of 10 years were admitted in our clinic, one of them being admitted with emergency symptoms. Four of the patients were treated laparoscopically, one of them requiring conversion to open approach. RESULTS The median age was 53 (range 44-71), 80% of the patients being females. Four of the patients received laparoscopic treatment with transfascial suturing, the fifth being converted, but respecting the same technique. The median surgery duration was 110 min, with a median blood loss of 30 ml. Removal of the sac was attempted in two cases. Median hospitalization stay was 3 days, with a median follow-up of 21 months, with no postoperative complications reported. CONCLUSIONS Laparoscopic repair with transfascial suturing provides an feasible and efficient repair, compared to the other laparoscopic techniques. Although no postoperative complications were reported, the removal of the sac still remains an controversial issue.
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Affiliation(s)
- F Zaharie
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Valean
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.
| | - C Popa
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - E Mois
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - F Graur
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Munteanu
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Schlanger
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania
| | - A Ciocan
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - C Puia
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - N Al Hajjar
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
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Ciocan RA, Ciocan A, Zaharie FV, Popa C, Schlanger D, Alexa A, Ionescu D, Hajjar NA. Perioperative Management of Patients with Pancreatic Cancer - the ERAS Protocols. Chirurgia (Bucur) 2022; 117:415-422. [DOI: 10.21614/chirurgia.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
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Ciocan A, Bolboacă SD, Drugan C, Ciocan RA, Graur F, Al Hajjar N. The Pattern of Calculated Inflammation Ratios as Prognostic Values in Patients with Colorectal Cancer. Comb Chem High Throughput Screen 2021; 24:1428-1435. [PMID: 33081678 DOI: 10.2174/1386207323666201020111946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 11/22/2022]
Abstract
AIM In this study, we evaluated the prognostic value of four calculated inflammatory ratios in patients with colorectal cancer. MATERIALS AND METHODS A six-year retrospective study was conducted on subjects admitted for colorectal cancer at "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania, from January 2014 until September 2019. The medical charts of patients diagnosed with colorectal cancer were used as the source of raw data and for the calculation of four ratios (neutrophil-to-lymphocyte ratio-NLR, derived neutrophil-to-lymphocyte ratio-dNLR, platelet-to-lymphocyte ratio-PLR, and systemic immune-inflammation index-SII), considered as prognostic markers related to mortality in colorectal cancer. RESULTS One thousand six hundred and eighty-eight patients, with ages ranging from 17 to 98 years, were evaluated. NLR and dNLR displayed significantly higher values among patients who died (NLR: 4.2 for deceased vs. 3.4 for alive, P-value=0.0224; dNLR: 2.7 for deceased vs. 2.3 for alive, P-value=0.0566). Ischemic cardiomyopathy (odds ratio (OR)=2.70), liver cirrhosis (OR=7.84), post-operative complications (OR=2.39), and neutrophil-to-lymphocyte ratio (OR=1.08) proved to be significant prognostic factors for the primary outcome, independent of age and gender. CONCLUSION Patients with high NLR, post-operative complications, ischemic cardiomyopathy, and/or liver cirrhosis are the candidates to a less favorable outcome among subjects with colorectal cancer regardless the age and gender.
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Affiliation(s)
- Andra Ciocan
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj- Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj- Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania
| | | | - Răzvan A Ciocan
- Department of Practical Skills - Humanities Sciences, "Iuliu Ha, Romania
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Ciocan A, Ciocan RA, Al Hajjar N, Gherman CD, Bolboacă SD. Abilities of Pre-Treatment Inflammation Ratios as Classification or Prediction Models for Patients with Colorectal Cancer. Diagnostics (Basel) 2021; 11:diagnostics11030566. [PMID: 33801031 PMCID: PMC8003848 DOI: 10.3390/diagnostics11030566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Systemic inflammatory status is known as an important factor of colorectal cancer prognosis. Our study aimed to evaluate the performances of inflammation biomarker ratios as classification models of seven outcomes in patients with colorectal cancer. Methods: A retrospective cohort study was conducted on subjects with colorectal cancer over five years at a single center in Transylvania, Romania. Seven derived ratios were calculated based on laboratory data: neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR), platelet-to-lymphocyte (PLR), lymphocyte-to-monocyte (LMR) and albumin-to-globulin (AGR) ratios, Systemic Immune Inflammation Index (SII) and Prognostic Nutritional Index (PNI). The utility of these ratios as predictors for seven outcomes was further evaluated in multivariable regression models. Results: Our study shows that the evaluated ratios exhibit specific performances for individual outcomes, proving a fair ability as screening tools (NLR and dNLR for survival, T stage and M stage; NLR and SII for T stage; and PLR for M stage). A dNLR over 3.1 (OR = 2.48, 95% CI (1.421 to 4.331)) shows predictive value for survival. A value of NLR over 3.10 (OR = 1.389, 95% CI (1.061 to 1.817)) is positively associated with an advanced T stage, while LMR is negatively related to the T stage (OR = 0.919, 95% CI (0.867 to 0.975)). NLR over 4.25 (OR = 2.647, 95% CI (2.128 to 3.360)) is positively associated with, while PNI is negatively related (OR = 0.970, 95% CI (0.947 to 0.993)) to, the M stage. Conclusion: Each of the evaluated ratios possesses prognostic value for certain outcomes considered, but the reported models need external validation to recommend their clinical practice utilization.
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Affiliation(s)
- Andra Ciocan
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania;
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania;
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Răzvan A. Ciocan
- Department of Medical Skills—Human Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania;
- Correspondence: (R.A.C.); (S.D.B.)
| | - Nadim Al Hajjar
- Department of Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania;
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania
| | - Claudia D. Gherman
- Department of Medical Skills—Human Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Marinescu Street, No. 23, 400337 Cluj-Napoca, Romania;
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Street, No. 6, 400349 Cluj-Napoca, Romania;
- Correspondence: (R.A.C.); (S.D.B.)
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Ciocan A, Hajjar NA, Graur F, Oprea VC, Ciocan RA, Bolboacă SD. Receiver Operating Characteristic Prediction for Classification: Performances in Cross-Validation by Example. Mathematics 2020; 8:1741. [DOI: 10.3390/math8101741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The stability of receiver operating characteristic in context of random split used in development and validation sets, as compared to the full models for three inflammatory ratios (neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) and platelet-to-lymphocyte (PLR) ratio) evaluated as predictors for metastasis in patients with colorectal cancer, was investigated. Data belonging to patients admitted with the diagnosis of colorectal cancer from January 2014 until September 2019 in a single hospital were used. There were 1688 patients eligible for the study, 418 in the metastatic stage. All investigated inflammatory ratios proved to be significant classification models on both the full models and on cross-validations (AUCs > 0.05). High variability of the cut-off values was observed in the unrestricted and restricted split (full models: 4.255 for NLR, 2.745 for dNLR and 255.56 for PLR; random splits: cut-off from 3.215 to 5.905 for NLR, from 2.625 to 3.575 for dNLR and from 134.67 to 335.9 for PLR), but with no effect on the models characteristics or performances. The investigated biomarkes proved limited value as predictors for metastasis (AUCs < 0.8), with largely sensitivity and specificity (from 33.3% to 79.2% for the full model and 29.1% to 82.7% in the restricted splits). Our results showed that a simple random split of observations, weighting or not the patients with and whithout metastasis, in a ROC analysis assures the performances similar to the full model, if at least 70% of the available population is included in the study.
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Ciocan RA, Cătană CS, Drugan C, Gherman CD, Ciocan A, Drugan TC, Bolboacă SD. Relation between serum cotinine levels and trophic lesions in patients with critical limb ischemia: a pilot study. Acta Clin Belg 2020; 75:149-154. [PMID: 30741123 DOI: 10.1080/17843286.2019.1577530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Aim: To evaluate if smoking, quantified by the serum cotinine levels, is related to the evolution of patients with critical limb ischemia (CLI).Method: A pilot study was conducted on CLI patients who addressed at the Second Surgery Clinic of the Emergency County Hospital, Cluj-Napoca, Romania between November 2015 and December 2016. The sample of patients was split into two groups using the threshold of 15 ng/mL for the serum level of cotinine (low cotinine level - LCL vs. high cotinine level - HCL). Furthermore, the ROC analysis was conducted to identify the threshold of cotinine level able to discriminate between CLI patients with and without trophic lesions.Results: The mean age of patients was 60.7 ± 10.5 years with a significantly higher percentage of male patients (84%). A significant association was identified between urban origin and serum cotinine level, which is related to the increased number of cigarettes smoked per day among urban participants. Excepting necrectomy and toe disarticulation, no differences were found between LCL and HCL group regarding symptoms, signs or comorbidities. In smokers with CLI (38/43), a serum cotinine cut-off of 9.765 ng/mL was observed on eight out of 10 CLI patients with necrectomy and five out of 28 patients without necrectomy.Conclusion: Our study showed higher serum cotinine levels associated with a higher number of smoked cigarettes and necrectomy in patients with CLI. The serum cotinine could be a fair screening test for necrectomy in smokers CLI patients.
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Affiliation(s)
- Răzvan A. Ciocan
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
- Department of Vascular Surgery, Second Surgical Clinic, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
| | - Cristina-Sorina Cătană
- Department of Medical Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Cristina Drugan
- Department of Medical Biochemistry, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Claudia D. Gherman
- Department of Vascular Surgery, Second Surgical Clinic, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania
- Department of Practical Skills, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andra Ciocan
- Faculty of Medicine, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Tudor C. Drugan
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Sorana D. Bolboacă
- Department of Medical Informatics and Biostatistics, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
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Gherman D, Dumitrescu CI, Ciocan A, Melincovici CS. Histopathological changes in major amputations due to diabetic foot - a review. Rom J Morphol Embryol 2018; 59:699-702. [PMID: 30534807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetes mellitus is the leading cause of non-traumatic amputations worldwide. Ulcer of the diabetic foot is one of the most prevalent lesions of diabetic patients and it occurs in the natural evolution of the disease as a tardive complication. Neuropathy is the main determinant of foot ulcer. A key role is played by the loss of sensitive nerves, which prove to be a protective barrier against high pressure applied otherwise on the foot. The morphopathological characteristics of neuropathic lesions in patients with diabetes show important improvement associated with the pressure relieving treatment strategies. Therefore, pressure seems to impose a continuous mechanical stress on the wounded foot and it also sustains a chronic inflammatory condition, which slows down the healing process. Atherosclerosis is an imminent process to every person, nonetheless patients with diabetes mellitus have this process highly accelerated and more diffuse. One of the main characteristics of macrovascular lesions in diabetes is Mönckeberg's medial calcific sclerosis, calcification of the muscular layer, which clinically translates into an ankle-brachial index of 1 or above. Diabetes affects not only the large vessels, but it also produces microvascular lesions, which in time leads to diseases like retinopathy or nephropathy. Osteomyelitis is very common in the diabetic foot infections and the medical treatments are not satisfying. It is also believed to be a consequence of peripheral neuropathy that diabetes comes with. Osteomyelitis plays an important role in the prevalence of amputations in patients with diabetes. Obtaining clean, infection free margins is the most important goal, because residual osteomyelitis is a strong predictor of clinical failure and comes with many postoperative complications, even the necessity to operate again or have a major amputation later in evolution.
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Affiliation(s)
- Diana Gherman
- Discipline of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, Romania;
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Ciocan RA, Drugan C, Gherman CD, Cătană CS, Ciocan A, Drugan TC, Bolboacă SD. Evaluation of Chitotriosidase as a Marker of Inflammatory Status in Critical Limb Ischemia. Ann Clin Lab Sci 2017; 47:713-719. [PMID: 29263045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Chitotriosidase is an enzyme secreted by activated macrophages. This study aims to investigate the usefulness of circulating chitotriosidase activity as a marker of inflammatory status in patients with critical limb ischemia (CLI). MATERIALS AND METHODS An observational gender-matched case-control study was conducted on patients hospitalized with the primary diagnosis of CLI, as well as a control group. The control group consisted of healthy volunteers. RESULTS Forty-three patients were included in each group. Similar demographic characteristics (median age of 60-62 years and overweight) were observed in both groups. Chitotriosidase activity ranged from 110 nmol/ml/hr to 1530 nmol/ml/hr in the CLI group and from 30 nmol/ml/hr to 440 nmol/ml/hr in the control group; demonstrating significantly elevated values in the CLI group (p<0.001). Median plasma chitotriosidase activity was significantly elevated in smokers compared with non-smokers in both groups (p<0.05). However, this activity had higher values in CLI than in control subjects. Receiver operating characteristic (ROC) analysis was then performed in order to verify the diagnostic accuracy of chitotriosidase as an inflammatory biomarker in CLI. CONCLUSION Circulating chitotriosidase is a test which can potentially be used for the monitoring of CLI patients without other inflammatory conditions. However, the interpretation of elevated values must take into account the inflammatory response induced by tobacco exposure.
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Affiliation(s)
- Răzvan A Ciocan
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Department of Vascular Surgery, Second Surgical Clinic, Emergency County Hospital "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina Drugan
- Department of Medical Biochemistry, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Claudia D Gherman
- Department of Vascular Surgery, Second Surgical Clinic, Emergency County Hospital "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristina-Sorina Cătană
- Department of Medical Biochemistry, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Andra Ciocan
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Tudor C Drugan
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Ciocan RA, Bolboacă SD, Rădulescu Ş, Stancu B, Ciocan A, Gherman CD. Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia. Folia Med (Plovdiv) 2017; 59:14-22. [DOI: 10.1515/folmed-2017-0014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/06/2016] [Indexed: 11/15/2022] Open
Abstract
Abstract
Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD).
Materials and methods: A four-year retrospective study was conducted with patients hospitalized in the Second Surgical Clinic at the Emergency County Hospital Cluj-Napoca. The medical charts of patients with PAOD (n=466) and CLI (n=223) were reviewed and data were collected.
Results: The study included 689 patients; mean age 67 years for PAOD patients and 65 years for CLI patients. A significantly higher percentage of patients were male in both groups (79.25%, P < 0.0001). Most of the patients in both groups had received at least a secondary education (P < 0.0001). Most of the subjects in both groups were smokers (>71.30%) with no difference between groups (P = 0.566). No significant differences were found between the groups in comorbidities (diabetes, arterial blood hypertension, cardiac ischemia, rhythm disorders, P > 0.05). There were more CLI patients that were overweight than overweight patients with PAOD (P = 0.0004). High serum cholesterol (>200 mg/dL) and triglycerides (>150 mg/dL) levels were found in the CLI group (P < 0.05). Age was identified as a risk factors for amputation (OR = 1.03, 95%Cl [1.01−1.05], P = 0.0012).
Conclusions: The profile of a patient with critical limb ischemia and peripheral arterial occlusive disease is a 65-67-year-old male smoker with at least a secondary education. The CLI patient is overweight with pathological serum levels of cholesterol and triglycerides.
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Hiddemann L, Uebbing J, Ciocan A, Dessenne O, Niemax K. Simultaneous multi-element analysis of solid samples by laser ablation—microwave-induced plasma optical emission spectrometry. Anal Chim Acta 1993. [DOI: 10.1016/0003-2670(93)85217-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Uebbing J, Ciocan A, Hiddemann L, Niemax K. Element analysis of solid samples by laser ablation and optical spectroscopy. ACTA ACUST UNITED AC 1993. [DOI: 10.1063/1.44903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Ciocan A, Moangă M, Alexandru G, Bulandra M. [Painful manifestations in nephropathies]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1983; 35:459-70. [PMID: 6143367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Ticău S, Ciocan A, Bungeţianu G. [Experiment on the partial integration of bacteriological tests for tuberculosis at several laboratories in a circumscribed area]. Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Pneumoftiziol 1981; 30:93-8. [PMID: 6264582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Ciocan A. [Current status of chronic pyelonephritis]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1980; 32:289-300. [PMID: 6113642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Suţeanu S, Ciocan A, Rîndaşu G, Moangă M. [Clinical considerations on a group of patients with urinary infections studied in the out-patient clinic]. Rev Med Interna Neurol Psihiatr Neurochir Dermatovenerol Med Interna 1976; 28:379-87. [PMID: 14373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ciocan A. [Proceedings: The rate of recurrence in patients reported for pulmonary tuberculosis in the past 10 years]. Ftiziologia 1974; 23:39-44. [PMID: 4822459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Bungeţianu G, Ciocan A, Focşan C. [Proceedings: Value of an epidemiometric indicator of the annual rate of relapses and the incidence of relapses]. Ftiziologia 1974; 23:31-8. [PMID: 4822458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Suteanu S, Dănilă E, Ionescu-Pirvu V, Rindaşu G, Ciocan A, Steflea M, Alexandru G, Ciobanu V. [Our experience in the treatment of rheumatoid polyarthritis with Imuran and Proresid in outpatient units]. Med Interna (Bucur) 1973; 25:1491-7. [PMID: 4792568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Suţeanu S, Ciocan A, Alexandru G. [On toxic interstitial nephritis caused by consumption of phenacetin]. Med Interna (Bucur) 1973; 25:1411-34. [PMID: 4792564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Suţeanu S, Ciocan A, Dănilă E. [Current trends in the study of urinary infections]. Med Interna (Bucur) 1973; 25:1295-312. [PMID: 4602840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Suţeanu S, Ciocan A. [Current data on the diganosis and treatment of chronic pyelonephritis]. Med Interna (Bucur) 1972; 24:871-89. [PMID: 5075988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Suţeanu S, Ciocan A. [Current aspects of the pathogenesis of acute glomerulonephritis]. Med Interna (Bucur) 1971; 23:969-84. [PMID: 5093855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Ciocan A, Constantin N, Sumalevra G. [Effectiveness of hospitalization of patients with pulmonary tuberculosis]. Ftiziologia 1971; 20:55-60. [PMID: 5162264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ciobanu V, Ciocan A, Moangă M, Buzi T, Pârvu-Ionescu V, Dănilă E, Vasilescu C. [The carpal tunnel syndrome]. Med Interna (Bucur) 1970; 22:1387-92. [PMID: 5533265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Oancea R, Suman S, Filip V, Macarie O, Ciocan A. [Clinical value of the fractional clearance of BSP in hepatic functional exploration and in diagnosis of chronic liver diseases]. Med Interna (Bucur) 1966; 18:1233-40. [PMID: 5978450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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