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Bratu AM, Bojan M, Popa C, Petrus M. Infrared to terahertz identification of chemical substances used for the production of IEDs. Spectrochim Acta A Mol Biomol Spectrosc 2024; 312:124055. [PMID: 38422931 DOI: 10.1016/j.saa.2024.124055] [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] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 03/02/2024]
Abstract
In our modern times, improvised explosive devices (IEDs) have become more sophisticated than ever, capable of causing destruction and loss of life. The creative use of homemade substances for IEDs manufactures has led to efforts in developing sensitive detection methods that can anticipate, identify and protect against improvised attacks. Laser-based spectroscopic techniques provide rapid and accurate detection of chemicals in improvised explosives, but no single method can detect all components of all explosives. In this study, two spectroscopic methods are used for the sensitive identification of 8 explosive chemical substances in the form of powders and vapors. Absorption spectra of benzene, toluene, acetone and ethylene glycol were examined with CO2 laser photoacoustic spectroscopy. The photoacoustic signals of the samples were recorded in the CO2 laser emission range from 9.2 to 10.8 µm and a different spectral behavior was observed for each analyzed substance. Time-domain spectroscopy with THz radiation was used to analyze ammonium nitrate, potassium chlorate, dinitrobenzene, hexamethylenetetramine transmission spectra in the 0.1-3 THz range, and it was observed that they have characteristic THz fingerprint spectra. CO2 laser photoacoustic spectroscopy and THz time domain spectroscopy have met the criterion of proven effectiveness in identifying explosive components. The combination of these spectroscopic methods is innovative, giving a promising new approach for detection of a large number of IED components.
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Affiliation(s)
- A M Bratu
- National Institute for Laser, Plasma and Radiation Physics, 409 Atomistilor St., PO Box MG-36, 077125 Bucharest, Romania.
| | - M Bojan
- National Institute for Laser, Plasma and Radiation Physics, 409 Atomistilor St., PO Box MG-36, 077125 Bucharest, Romania
| | - C Popa
- National Institute for Laser, Plasma and Radiation Physics, 409 Atomistilor St., PO Box MG-36, 077125 Bucharest, Romania
| | - M Petrus
- National Institute for Laser, Plasma and Radiation Physics, 409 Atomistilor St., PO Box MG-36, 077125 Bucharest, Romania
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2
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Aiolfi A, Bona D, Bonitta G, Lombardo F, Manara M, Sozzi A, Schlanger D, Popa C, Cavalli M, Campanelli G, Biondi A, Bonavina L. Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation. Cancers (Basel) 2024; 16:424. [PMID: 38275865 PMCID: PMC10814228 DOI: 10.3390/cancers16020424] [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: 12/27/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. METHODS PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. RESULTS Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI -4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI -3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI -1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. CONCLUSIONS Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Diana Schlanger
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Calin Popa
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi-Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy; (M.C.); (G.C.)
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi-Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy; (M.C.); (G.C.)
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, 95131 Catania, Italy;
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy;
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Surcel C, Dotzauer R, Mirvald C, Popa C, Olariu C, Baston C, Harza M, Gangu C, Tsaur I, Sinescu I. Current role of intraoperative cell salvage techniques in the management of renal tumors with level III and IV inferior vena cava thrombus extension. Ther Adv Urol 2024; 16:17562872241229248. [PMID: 38333071 PMCID: PMC10851714 DOI: 10.1177/17562872241229248] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Background En bloc removal of the kidney with tumor thrombus excision in a multidisciplinary team remains the standard treatment for renal cell carcinoma (RCC) with tumor thrombus extension. In order to minimize the hemodynamic impact of the surgical blood loss, intraoperative cell salvage (IOCS) techniques can decrease the need for allogeneic blood and prevent blood transfusion related complications. Objective In this article, we evaluated the safety of IOCS during radical nephrectomy with inferior vena cava thrombectomy under cardiopulmonary bypass with or without deep hypothermic circulatory arrest. Design and method In this retrospective comparative multicenter analysis, clinical characteristics of 27 consecutive patients who underwent surgery with or without IOCS between 2012 and 2022 in three referral care units were collected into a database. The need for an allogenic blood transfusion (ABT) was also recorded, defined as any transfusion that occurred either intraoperatively or during the hospital stay. Results The need for ABT in the cell saver arm was significantly smaller due to the reinfusion of rescued blood (p < 0.015). In multivariate analysis, no cell saver usage was an independent predictor for complications ⩾3 Clavien 3a [odds ratio (OR) 18.71, 95% CI 1.056-331.703, p = 0.046]. No usage of IOCS was an independent predictor for a lower risk of death (OR 0.277, 95% CI 0.062-0.825, p = 0.024). During follow-up, patients who received salvaged blood did not experience an increased risk for developing local recurrence or distant metastases. Conclusion Transfusion of autologous blood is safe and can be using during nephrectomy and thrombectomy for advanced RCC.
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Affiliation(s)
- Cristian Surcel
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Robert Dotzauer
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Cristian Mirvald
- Department of Urology, Fundeni Clinical Institute, “Carol Davila” University of Medicine and Pharmacy, 258 Fundeni Street, 2nd District, Bucharest, Romania
| | - Calin Popa
- Cardiac Center, Monza Hospital, Bucharest, Romania
| | | | - Catalin Baston
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Mihai Harza
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Constantin Gangu
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Igor Tsaur
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ioanel Sinescu
- Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Veeken LD, Opdam M, Verhoef LM, Popa C, van Crevel R, den Broeder AA. Infection incidence, timing, and dose dependency in rheumatoid arthritis patients treated with rituximab: a retrospective cohort study. Rheumatology (Oxford) 2023:kead328. [PMID: 37410085 DOI: 10.1093/rheumatology/kead328] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/07/2023] [Accepted: 06/27/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Rituximab (RTX) is a safe and effective treatment for rheumatoid arthritis (RA). However, there are some concerns about infection risk and preliminary data suggest dose and time dependency. This study aims to determine the infection incidence in a large real-life population of RA patients using RTX, with special focus on (ultra-)low dosing and time since last infusion. METHODS RA patients treated with 1000, 500 or 200 mg RTX per cycle between 2012 and 2021 at the Sint Maartenskliniek were included in a retrospective cohort study. Patient-, disease-, treatment- and infection characteristics were retrieved from electronic health records. Infection incidence rates, dose and time relations with RTX infusion were analysed using mixed-effects Poisson regression. RESULTS Among 490 patients, we identified 819 infections in 1254 patient years. Most infections were mild and respiratory tract infections were most common. Infection incidence rates were 41, 54 and 71 per 100 patient years for doses of 200, 500 and 1000 mg. Incidence rate ratio (IRR) was significantly lower for 200 mg compared to 1000 mg (adjusted IRR 0.35, 95% CI 0.17-0.72, p = 0.004). In patients receiving 1000 or 500 mg RTX, infections seemed to occur more frequently within the first two months after infusion compared to later on in the treatment cycle, suggesting an association with peak concentration. CONCLUSION Ultra-low dosing (200 mg) of RTX is associated with a lower risk of infections in RA. Future interventions focusing on ultra-low dosing and slow release of RTX (e.g. by subcutaneous administration) may lower infection risk.
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Affiliation(s)
- Lara D Veeken
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Merel Opdam
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Lise M Verhoef
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Calin Popa
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
| | - Reinout van Crevel
- Department of Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Alfons A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboudumc, Nijmegen, The Netherlands
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Gherman A, Balacescu L, Popa C, Cainap C, Vlad C, Cainap SS, Balacescu O. Baseline Expression of Exosomal miR-92a-3p and miR-221-3p Could Predict the Response to First-Line Chemotherapy and Survival in Metastatic Colorectal Cancer. Int J Mol Sci 2023; 24:10622. [PMID: 37445798 DOI: 10.3390/ijms241310622] [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: 05/03/2023] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
The status of predictive biomarkers in metastatic colorectal cancer is currently underdeveloped. Our study aimed to investigate the predictive value of six circulating exosomal miRNAs derived from plasma (miR-92a-3p, miR-143-3p, miR-146a-5p, miR-221-3p, miR-484, and miR-486-5p) for chemosensitivity, resistance patterns, and survival. Thirty-one metastatic colorectal cancer patients were selected before receiving first-line irinotecan- or oxaliplatin-based chemotherapy. Blood samples were harvested at baseline and 4-6 months after the initiation of chemotherapy. The levels of exosomal expression for each miRNA were analyzed by qPCR. Our results for patients receiving first-line FOLFOX showed significantly higher baseline levels of miR-92a-3p (p = 0.007 **), miR-146a-5p (p = 0.036 *), miR-221-3p (p = 0.047 *), and miR-484 (p = 0.009 **) in non-responders (NR) vs. responders (R). Of these, miR-92a-3p (AUC = 0.735), miR-221-3p (AUC = 0.774), and miR-484 (AUC = 0.725) demonstrated a predictive ability to discriminate responses from non-responses, regardless of the therapy used. Moreover, Cox regression analysis indicated that higher expression levels of miR-92a-3p (p = 0.008 **), miR-143-3p (p = 0.009 **), miR-221-3p (p = 0.016 *), and miR-486-5p (p = 0.019 *) at baseline were associated with worse overall survival, while patients expressing higher baseline miR-92a-3p (p = 0.003 **) and miR-486-5p (p = 0.003 **) had lower rates of progression-free survival. No predictive values for candidate microRNAs were found for the post-chemotherapy period. In line with these findings, we conclude that the increased baseline exosomal expression of miR-92a-3p and miR-221-3p seems to predict a lack of response to chemotherapy and lower OS. However, further prospective studies on more patients are needed before drawing practice-changing conclusions.
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Affiliation(s)
- Alexandra Gherman
- 11th Department of Medical Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Medical Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Loredana Balacescu
- 11th Department of Medical Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Genetics, Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Calin Popa
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania
- Department of Surgery, Surgery Unit No 3, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania
| | - Calin Cainap
- 11th Department of Medical Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Medical Oncology, The Oncology Institute "Prof. Dr. Ion Chiricuta", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
| | - Catalin Vlad
- Department of Surgery, The Oncology Institute "Prof. Dr. Ion Chiricuta", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 8 Victor Babes Street, 400012 Cluj-Napoca, Romania
| | - Simona S Cainap
- Department of Mother and Child, Pediatric Cardiology, University of Medicine and Pharmacy "Iuliu Hatieganu", 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania
- Department of Paediatric Cardiology, Pediatric Clinic No 2, Emergency County Hospital for Children, 68 Motilor Street, 400370 Cluj-Napoca, Romania
| | - Ovidiu Balacescu
- 11th Department of Medical Oncology, University of Medicine and Pharmacy "Iuliu Hatieganu", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
- Department of Genetics, Genomics and Experimental Pathology, The Oncology Institute "Prof. Dr. Ion Chiricuta", 34-36 Republicii Street, 400015 Cluj-Napoca, Romania
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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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Popa C, Abdul Halim N, Pestean C, Ober C, Elisei R, Al Momani T, Schlanger D, Graur F, Zaharie F, Al Hajjar N. Residents can do it! A hands-on training program in laparoscopic liver surgery for general surgery residents. Eur Surg Res 2023:000528691. [PMID: 36592620 DOI: 10.1159/000528691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Laparoscopic liver resections (LLR) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic "step-by-step" program for LLR performed by residents using the swine training model Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants' performance results in terms of operative time, blood loss, conversion, trainers' intervention and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior attending surgeons who didn't follow the protocol and had not performed LLR previously, and to another 24 residents in a third workshop, who had not taken the training program before but followed the protocol Results: All residents fully completed the surgical procedures. Trained residents achieved better operative times and less blood loss compared to senior surgeons (p<0.017), however, the remaining parameters were comparable. When compared to non-trained residents, those who underwent training achieved significantly better results only in operative times (p<0.001) Conclusion: A continuous LLR "step-by-step" training program on swine for residents is feasible and the "step-by-step" protocol is a valuable tool for a proper surgical education.
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Puia A, Schlanger D, Fetti A, Popa C, Necula A, Al Hajjar N. Do Patient Delay and Diagnostic Delay Influence Long Term Survival in Patients with Gastric Cancer? J Gastrointestin Liver Dis 2022; 31:396-402. [PMID: 36535052 DOI: 10.15403/jgld-4486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Gastric cancer is one of the most common malignancies, with an aggressive evolution and a poor long-term prognosis. No screening program is available in Europe for this pathology; therefore, the delay from the appearance of the first symptom until the initiation of treatment might influence the prognosis of gastric cancer patients. We aimed to investigate the impact on the prognosis of the delay in the presentation and diagnosis in patients with gastric adenocarcinoma. METHODS Our study is a retrospective, single-center, observational cohort study, based on patients diagnosed with gastric adenocarcinoma and operated in our institution between 2013 and 2021. We have defined patient delay as the time from the onset of symptoms to the first encounter with a health care provider and diagnosis delay as the time from the first consultation with a health care provider to the establishment of the final diagnosis. RESULTS A total of 671 patients were included in our study. The survival rate at 5 years was 55% for the patients operated with curative intent and 7.4% for the patients operated with palliative intent. Patient delay and diagnosis delay were not correlated with the overall survival. A lower survival was observed for patients admitted through transfer (p<0.001) or the emergency department (p<0.001). No statistically significant relationship was identified between patient delay or diagnosis delay and the age, gender or area of origin of patients. Patients that experienced melena or hematemesis had a shorter patient delay, with a highly significant statistical relationship (p<0.01). Patients that experienced nausea, epigastric pain, palpable epigastric tumor mass or anorexia also had a highly significant statistical relationship between the symptoms and the patient delay interval. CONCLUSIONS The overall survival is not influenced by the patient delay or diagnosis delay. An earlier presentation was correlated with some specific exhibited symptoms: upper gastro-intestinal bleeding, abdominal pain, palpable epigastric tumor, nausea.
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Affiliation(s)
- Aida Puia
- Community Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Diana Schlanger
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. .
| | - Alin Fetti
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Calin Popa
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Alexandru Necula
- Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [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] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Heijman MWJ, van den Ende C, Popa C, Vriezekolk JE. OP0210-HPR THE OCCURRENCE OF OVERWHELMING FATIGUE IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A DAILY DIARY STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.2118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundCross sectional research shows that nearly half of the individuals with osteoarthritis (OA) experience fatigue and over one third experience severe fatigue (1). However, few studies have addressed the unpredictable and fluctuating course of fatigue in OA including the occurrence of overwhelming fatigue as evidenced from qualitative research (2). In-depth understanding of the course of fatigue and its determinants may inform clinical decision making and treatment.ObjectivesTo explore 1) the occurrence of overwhelming fatigue and its determinants and 2) the variability of daily experienced fatigue in individuals with knee OA.MethodsA daily diary design. 73 participants with a self-reported diagnosis of knee OA aged >40 years and in possession of a Smartphone completed a baseline questionnaire on demographics, health status (EQ5D-VAS), and self-efficacy (Arthritis Self-Efficacy Scale (ASES)). This was followed by daily assessments with regard to overwhelming fatigue, fatigue severity, pain, sleep, and perceived exertion of physical activities (PEPA) over a 7 day period. A yes/no format was used to assess overwhelming fatigue and a numeric rating scale (NRS, 0-10) was used to assess fatigue severity, pain, sleep, and PEPA. The variability of fatigue was assessed by calculating the standard deviation (SD) per participant over this 7 day period. Comparisons between participants with and without overwhelming fatigue were conducted by unpaired t-tests and Pearson’s chi-square tests where appropriate.Results47 participants were included in the analysis. Overwhelming fatigue occurred at least once in 26 (55%) participants with mean= 2.7 (SD= 1.4) over a 7 day period. Differences of participants with and without overwhelming fatigue are displayed in Table 1.Table 1.Characteristics of participants (n=47) included in the analysis.Characteristics*All participants (n=47)Participants with overwhelming fatigue (n=26)Participants without overwhelming fatigue (n=21)Difference (95% CI)p-valueAge63.4 (8.6)61.7 (8.5)65.5 (8.5)-3.8 (-8.8; 1.2)0.13Female (n (%))39 (83%)23 (88%)16 (76%)0.47BMI27.4 (4.6)28.0 (5.1)26.5 (3.8)1.5 (-1.1; 4.1)0.25Health status67.5 (13.8)66.0 (13.5)69.5 (14.2)-3.5 (-11.7; 4.7)0.39ASES pain2.9 (1.0)3.2 (0.8)2.5 (1.1)0.7 (0.1; 1.3)0.02ASES os2.5 (0.8)2.7 (0.8)2.2 (0.7)0.5 (0.1; 1.0)0.02Fatigue severity4.9 (1.7)5.5 (1.5)4.1 (1.6)1.3 (0.4; 2.3)0.01Pain4.2 (1.9)4.8 (1.6)3.4 (2.0)1.4 (0.3; 2.5)0.01Sleep5.9 (1.6)5.5 (1.7)6.4 (1.4)-0.9 (-1.8; -0.0)0.05PEPA4.9 (1.2)5.0 (1.2)4.8 (1.3)0.2 (-0.6; 0.9)0.64ASES, Arthritis Self-Efficacy Scale; ASES os, other symptoms; PEPA, perceived exertion of physical activities. For health status, ASES pain, ASES os, and sleep, higher scores reflect better outcomes; for PEPA, higher scores reflect more PEPA; for fatigue severity and pain, higher scores reflect higher levels. *mean (SD) unless otherwise statedg.The variability of daily experienced fatigue per participant ranged from SD= 0.2 to 2.9 (Figure 1). This was not significantly different between participants with and without overwhelming fatigue.Figure 1.Standard deviations of average fatigue severity over a 7 day period per participant (n=47).ConclusionOur findings suggest that more than half of the participants experienced at least one episode of overwhelming fatigue and that this is related to self-efficacy, fatigue severity, pain, and sleep. Fatigue remained fairly stable over time by the majority of participants.References[1]Overman CL, Kool MB, da Silva JAP, Geenen R. The prevalence of severe fatigue in rheumatic diseases: an international study. Clin Rheumatol. 2016;35:409–15.[2]Power JD, Badley EM, French MR, Wall AJ, Hawker GA. Fatigue in osteoarthritis: A qualitative study. BMC Musculoskeletal Disorders. 2008;9:63.AcknowledgementsWe would like to thank Yvonne Peters for her involvement in the study design and data collection.Disclosure of InterestsNone declared
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Schlanger D, Popa C, Pașca S, Seicean A, Al Hajjar N. The role of systemic immuno-inflammatory factors in resectable pancreatic adenocarcinoma: a cohort retrospective study. World J Surg Oncol 2022; 20:144. [PMID: 35513845 PMCID: PMC9074307 DOI: 10.1186/s12957-022-02606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic cancer is an aggressive malignancy, surgery being the only potentially curative treatment. The systemic inflammatory response is an important factor in the development of cancer. There is still controversy regarding its role in pancreatic cancer. METHODS Our study is a retrospective observational cohort study. We included patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), who underwent surgical resection in our hospital, between January 2012 and December 2019. We gathered information from preoperative and postoperative blood tests. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were determined. RESULTS We included 312 patients. All the immune-inflammatory scores assessed significantly changed after the surgery. The impact on overall survival of these markers showed that only some of the postoperative scores predicted survival: high PLR had a negative prognostic impact, while high lymphocyte and PNI values had a positive effect on overall survival. DISCUSSION The circulating immune cells and their values integrated in the assessed prognostic scores suffer statistically significant changes after curative pancreatic surgery. Only the postoperative values of lymphocyte count, PLR, and PNI seem to influence the overall survival in PDAC. TRIAL REGISTRATION ClinicalTrials.gov-identifier NCT05025371 .
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Affiliation(s)
- D. Schlanger
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - C. Popa
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - S. Pașca
- Department of Haematology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400012 Cluj-Napoca, Romania
| | - A. Seicean
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162 Cluj-Napoca, Romania
| | - N. Al Hajjar
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
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Schlanger D, Graur F, Popa C, Moiș E, Al Hajjar N. The role of artificial intelligence in pancreatic surgery: a systematic review. Updates Surg 2022; 74:417-429. [PMID: 35237939 DOI: 10.1007/s13304-022-01255-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 10/25/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
Artificial intelligence (AI), including machine learning (ML), is being slowly incorporated in medical practice, to provide a more precise and personalized approach. Pancreatic surgery is an evolving field, which offers the only curative option for patients with pancreatic cancer. Increasing amounts of data are available in medicine: AI and ML can help incorporate large amounts of information in clinical practice. We conducted a systematic review, based on PRISMA criteria, of studies that explored the use of AI or ML algorithms in pancreatic surgery. To our knowledge, this is the first systematic review on this topic. Twenty-five eligible studies were included in this review; 12 studies with implications in the preoperative diagnosis, while 13 studies had implications in patient evolution. Preoperative diagnosis, such as predicting the malignancy of IPMNs, differential diagnosis between pancreatic cystic lesions, classification of different pancreatic tumours, and establishment of the correct management for each of these lesions, can be facilitated through different AI or ML algorithms. Postoperative evolution can also be predicted, and some studies reported prediction models for complications, including postoperative pancreatic fistula, while other studies have analysed the implications for prognosis evaluation (from predicting a textbook outcome, the risk of metastasis or relapse, or the mortality rate and survival). One study discussed the possibility of predicting an intraoperative complication-massive intraoperative bleeding. Artificial intelligence and machine learning models have promising applications in pancreatic surgery, in the preoperative period (high-accuracy diagnosis) and postoperative setting (prognosis evaluation and complication prediction), and the intraoperative applications have been less explored.
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Affiliation(s)
- D Schlanger
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - F Graur
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania. .,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania.
| | - C Popa
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - E Moiș
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - N Al Hajjar
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. 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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Schlanger D, Popa C, Rusu I, Hajjar NA. Pancreatic Adenocarcinoma Associated to Intraductal Papillary Mucinous Neoplasia: Histopathological Particularities and Clinical Implications. Chirurgia (Bucur) 2022; 117:454-462. [DOI: 10.21614/chirurgia.2760] [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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Mocan T, Stiufiuc R, Popa C, Nenu I, Pestean C, Nagy AL, Mocan LP, Leucuta DC, Hajjar NA, Sparchez Z. Percutaneous ultrasound guided PEG-coated gold nanoparticles enhanced radiofrequency ablation in liver. Sci Rep 2021; 11:1316. [PMID: 33446793 PMCID: PMC7809408 DOI: 10.1038/s41598-020-79917-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/23/2020] [Indexed: 01/22/2023] Open
Abstract
To investigate the effects of PEG-coated gold nanoparticles on ablation zone volumes following in vivo radiofrequency ablation of porcine liver. This prospective study was performed following institutional animal care and committee approval was used. Radiofrequency ablations were performed in the livers of ten Sus scrofa domesticus swines. During each ablation, 10 mL (mL) of Peg-coated gold nanoparticles at two different concentrations (0.5 mg/mL and 0.01 mg/mL) were injected through the electrode channel into the target zone. For the control group, 10 mL of physiological saline was used. Five to ten minutes after each ablation, contrast enhanced ultrasound (CEUS) was performed to evaluate the volume of the coagulation zone. On day five we performed another CEUS and the animals were sacrificed. Treated tissues were explanted for quantification of the ablation zones' volumes. Hematoxylin and eosin (H&E) staining was also performed for histologic analysis. A total of 30 ablations were performed in the livers. The mean coagulation zone volume as measured by CEUS on day 5 after RFA was: 21.69 ± 3.39 cm3, 19.22 ± 5.77 cm3, and 8.80 ± 3.33 cm3 for N1, N2 and PS respectively. The coagulation zone volume after N1 and N2 treatments was significantly higher compared to PS treatment (p < 0.001 and p = 0.025 respectively). There was no difference between N1 and N2 treatment (p = 0.60). In our proof-of concept, pilot study we have shown for the first time that when injected directly into the target tissue during RFA, gold nanoparticles can substantially increase the coagulation zone.
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Affiliation(s)
- Tudor Mocan
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Rares Stiufiuc
- Department of Bionanoscopy, MedFuture Research Center for Advanced Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, Pasteur 4-6, 400337, Cluj-Napoca, Romania
| | - Calin Popa
- 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Iuliana Nenu
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Cosmin Pestean
- Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Calea Manastur no. 3-5, 400372, Cluj-Napoca, Romania
| | - Andras Laszlo Nagy
- Faculty of Veterinary Medicine, University of Agricultural Sciences and Veterinary Medicine, Calea Manastur no. 3-5, 400372, Cluj-Napoca, Romania
| | - Lavinia Patricia Mocan
- Histology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Daniel Corneliu Leucuta
- Medical Informatics and Biostatistics Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania.
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Popa C, Voicescu GT, Pestean C, Graur F, Momani TA, Al-Hajjar N, Liviu I. An innovative approach for laparoscopic liver resections. Training protocol. Ann Ital Chir 2020; 91:105-111. [PMID: 32180581] [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: 06/10/2023]
Abstract
AIM To evaluate the benefits of systematical use of ex vivo liver model and CT imaging in the planning process for swine laparoscopic liver resections done by residents during a dedicated training program. MATERIAL AND METHODS Thirty general surgery residents, part of a dedicated and continuous training program, were equally divided into two groups: first one which performed laparoscopic liver resections without planning stage and the second one which systematically used an interactive tutorial for establishing the strategy for the resection followed by performing open liver dissection and the same resection on an ex vivo swine model. Afterwards, laparoscopic procedures were performed on twenty anesthetized domestic pigs. RESULTS All teams successfully completed the procedure, with no conversions to open approach and without trainers' intervention. The second group was faster than the first group on both minor and major resections (p=0.0001). The blood loss was significantly lower on the second group (p=0.005). DISCUSSION The residents surpassed our expectations regarding the operation time, blood loss and conversions, validating our training program. The step-by-step program was developed using the IDEAL paradigm, being now at the end of the 2b phase (exploration), when the residents realize the benefits of this model. The reduction in blood loss and loss of functional parenchyma demonstrates the utility of a warming-up phase. CONCLUSIONS The "warming up" by adding the imagistic and anatomical data to the core protocol offer more clarity before laparoscopic liver resections and makes an upgrade for our "step by step" protocol. KEY WORDS Experimental model, Laparoscopic liver resections, Residents.
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Achim F, Gheorghe M, Constantin A, Hoara P, Popa C, Alkadour A, Vergu I, Birceanu A, Constantinoiu S. TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY 3D HD FOR THORACIC ESOPHAGEAL CANCER AFTER NEOADJUVANT CHEMORADIOTHERAPY. JSS 2018. [DOI: 10.33695/jss.v5i3.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Esophagectomy is a major surgical procedure with morbidity, and mortality related to the patient'scondition, stage of the disease at the moment of diagnosis, complementary treatments and surgicalexperience of the surgeon. Minimally invasive esophagectomy (MIE) may lead to a reduction inperioperative morbidity and mortality with an acceptable quality of life and similar oncologic resultsto an open approach. We present an experience of the Center of Excellence in Esophageal Surgeryregarding totally MIE through thoracolaparoscopic modified McKeown triple approach, followedby esophageal reconstruction by gastric intrathoracic pull-up and cervical esophagogastricanastomosis and feeding jejunostomy in a patient with thoracic esophageal cancer who underwentpreoperative neoadjuvant chemoradiotherapy. The short-term outcomes of the totally minimallyinvasive esophagectomy procedure were very encouraging. The overall operative times were:thoracoscopic - 120 minutes, laparoscopic - 130 minutes and cervical - 50 minutes with a total of360 minutes. The intraoperative blood loss was 200 ml. The postoperative outcome was favorablewith early feeding on the jejunostomy. The control of cervical anastomosis was performed in the 6thday postoperative and the patient was discharged in the 10th day postoperative without anysymptomatology. At the first and third-month follow-up was not reported any postoperativecomplications. The totally minimally invasive approach using advanced technology of endoscopicsurgery allowed for this patient a simple postoperative evolution, no major complications and agood recovery after extensive surgery. The solid experience in open esophageal surgery ofUpper Gastro-Intestinal surgeons provides a fast learning curve of complex minimally invasivesurgical procedures with reduced perioperative morbidity. Long-term follow-up can confirm theresults from the literature regarding the survival, which is expected to be for these patients atleast equivalent with outcomes after open esophagectomy.
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Antonescu F, Adam M, Popa C, Tuţă S. A review of cervical spine MRI in ALS patients. J Med Life 2018; 11:123-127. [PMID: 30140318 PMCID: PMC6101680] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Rationale. In recent years, significant advances have been made on the subject of MRI examination techniques, which have opened new avenues of research regarding the spinal involvement in amyotrophic lateral sclerosis (ALS). Objective. Our objective was to compile and analyze the available literature data, concerning the MRI of the cervical spine in ALS, detailing the metrics and their significance in diagnosis and follow-up. Methods and results. We have conducted an extensive search on the subject using literature data published over the last fifteen years, correlating it with our own experience. In ALS, there is a permanent interest in developing new biomarkers that might be sensitive to spatial and temporal patterns of neurodegeneration, which will permit early diagnosis and hopefully lead to new therapeutic approaches. Both diffusion tensor imaging (DTI) and spinal cord morphometry (especially spinal atrophy) reflect different aspects of the disease and correlate with clinical deterioration. Newer approaches like inhomogeneous magnetization transfer (ihMTR) and multiparametric analysis seem to have better sensitivity, are more appropriate for follow-up, and lend themselves to prognostic conclusions. Discussion. We conclude that MRI is a constantly expanding field, a unique non-invasive tool with immense potential in evaluating the in vivo evolution of the neurodegenerative ALS process, both structurally and functionally, with high hopes for the future. Abbreviations: ALS - amyotrophic lateral sclerosis, UMN - upper motor neuron, LMN - lower motor neuron, EMG - electromyography, CST - cortico-spinal tract, FLAIR - fluid-attenuated inversion recovery, MND - motor neuron disease, DTI - Diffusion tensor imaging, FA - fractional anisotropy, MD - mean diffusivity, ihMTR - inhomogeneous magnetization transfer, fMRI - functional MRI.
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Affiliation(s)
- F Antonescu
- National Institute of Neurology and Neurovascular Diseases, Bucharest,“Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - M Adam
- MEDINST Diagnostic Center, Bucharest
| | - C Popa
- National Institute of Neurology and Neurovascular Diseases, Bucharest,“Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - S Tuţă
- National Institute of Neurology and Neurovascular Diseases, Bucharest,“Carol Davila” University of Medicine and Pharmacy, Bucharest
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Nieuwenhuis L, Brown V, Popa C, Fransen J. SAT0121 The Effect of Type 2 Diabetes on Disease Activity in Male and Female Rheumatoid Arthritis Patients: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4208] [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] [Indexed: 11/04/2022]
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Căldăraru C, Popa C, Fruntelată A, Bălănescu Ş. Acute Atherothrombotic Disease and Severe Bleeding: A Difficult Clinical Presentation in Medical Practice. Rom J Intern Med 2016; 53:349-54. [PMID: 26939212 DOI: 10.1515/rjim-2015-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Management of antithrombotic therapy in elderly patients with unstable atherothrombotic disease and increased risk of bleeding is a major clinical challenge. We report the case of a 79 year- old diabetic man with rheumatoid arthritis on both oral corticosteroids and NSAID therapy with mild renal dysfunction, who presented to our hospital because of disabling claudication. Prior to admission he had several episodes of TIA. He also had recurrent small rectal bleeding and mild anemia attributed to his long-standing hemorrhoid disease. Angiography showed a sub-occlusive left internal carotid artery stenosis associated with a significant LAD stenosis and complex peripheral artery disease. Cataclysmic bleeding and hemorrhagic shock occurred in the third day post admission. Withdrawal of all antithrombotic treatment, blood transfusion and emergency sigmoidectomy were performed for bleeding colonic diverticulosis. Subsequently antiplatelet therapy was reinitiated and the patient successfully underwent left carotid artery endarterectomy and LAD stenting. He was discharged from hospital on the 21(st) day post admission and is doing well at 24 months follow-up.
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Turusbekova N, Popa C, Dragos M, van der Werf MJ, Dinca I. Strengthening TB infection control in specialized health facilities in Romania--using a participatory approach. Public Health 2016; 131:75-81. [PMID: 26782050 DOI: 10.1016/j.puhe.2015.10.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/23/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In 2012, the tuberculosis (TB) notification rate among Romanian TB facility doctors and nurses was 7.2 times higher than in the general population. This indicates that transmission is ongoing inside TB facilities and that TB infection control measures are insufficient. To help prevent nosocomial TB transmission a project was implemented that aimed at providing nationwide tailor-made technical assistance in TB infection control (TB-IC) in TB treatment facilities, including the development of TB infection control plans. The objective of the present article is to describe the implementation of the project and to discuss successes and challenges. STUDY DESIGN The project was an implementation study using two methods of evaluation: (1) a cross sectional questionnaire study; and (2) collection of information, during the training, on challenges related to infection control and to the project implementation. METHODS The project team developed a TB facility infection control (TB-IC) plan template, together with the Romanian experts. The template was discussed and agreed upon with the experts at a meeting and thereafter distributed by email to all TB facilities. Afterwards, a training of trainers (TOT) seminar was organized which included the provision of information about different training methods, as well as information about TB-IC. The TOT was followed by training for key TB-IC providers. Information about use of the TB-IC template was gathered through a self-administered questionnaire sent to all participants of the expert meeting and the training (42 people). Additionally, non-systematized discussions were held on broader challenges in TB-IC implementation during the training. RESULTS Within the project 42 key TB-IC service providers were trained in TB-IC, including 9 who were trained at a TOT seminar. The trainees were specialists working at the national level, such as country TB coordinators, or at the TB facility level: TB doctors, epidemiologists, laboratory specialists and maintenance engineers. Out of 42 key TB-IC service providers who were trained, only eighteen responded to the questionnaire (no reminders were sent). Out of these, 14 had used the TB-IC plan template after the project team disseminated it to them by email. The remaining four TB-IC service providers indicated that they were planning to use the template to develop or update their facility TB-IC plans. Related to the use of TB-IC plan template, the following broader challenges in TB-IC were identified: a lack of authority of the individuals responsible for TB-IC to implement the TB-IC measures, lack of training among facility epidemiologists on TB, underdeveloped system for reporting TB in healthcare workers, difficulties with triage of the TB suspects, and poor facility infrastructure hampering implementation of TB-IC measures. DISCUSSION Implementing TB-IC plans in Romanian health care facilities proved to be challenging, mainly due to the fact that the national infection control plan for TB was not yet adopted at the time of project implementation, and therefore there was neither a regulatory framework to support TB facility-IC planning nor any related budget allocations for the implementation of the facilities' TB-IC plans. Nonetheless, most respondents who answered the questionnaire (18 of 42 responded) indicated that they had started using the TB-IC plan template, which represents a full package of infection control measures that, when implemented effectively and in its entirety, may be expected to reduce nosocomial transmission. The study's limitations are: very low survey response rate, thus there is a likelihood of responder bias.
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Affiliation(s)
| | - C Popa
- National Institute of Pulmonology "Marius Nasta", Romania
| | - M Dragos
- Pneumophitisiology Hospital Baia Mare, Romania
| | | | - I Dinca
- European Centre for Disease Prevention and Control, Sweden.
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Cristea I, Popa C. Spontaneous vertebral artery dissection with multiple supratentorial and infratentorial acute infarcts in the posterior circulation Case report. J Med Life 2016; 9:294-296. [PMID: 27974938 PMCID: PMC5154318] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The article represents a case of a young patient with atypical clinical and paraclinical presentation of vertebral artery dissection by multiple cerebral infarcts, localized at the supratentorial and infratentorial levels in the posterior circulation. A case of a 21-year-old man, without a history of trauma in the cervical area or at the cranial level, without recent chiropractic maneuvers or practicing a sport, which required rapid, extreme, rotational movements of the neck, was examined. He presented to the emergency room with nausea, numbness of the left limbs, dysarthria, and incoordination of walking, with multiple objective signs at the neurological examination, which revealed right vertebral artery subacute dissection after the paraclinical investigations. The case was particular due to the atypical debut symptomatology, through the installation of the clinical picture in stages, during 4 hours and by multiple infarcts through the artery-to-artery embolic mechanism in the posterior cerebral territory. Abbreviations: PICA = posterior inferior cerebellar artery, CT = computed tomography, MRI = magnetic resonance imaging, angio MRI = mangnetic resonance angiography, FLAIR = fluid attenuated inversion recovery, FS = fat suppression, ADC = apparent diffusion coefficient, DWI = diffusion weighted imaging, T1/ T2 = T1/ T2 weighted image-basic pulse sequences in MRI, VA = vertebral artery, 3D-TOF = 3D Time of Flight.
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Affiliation(s)
- I Cristea
- Neurologic Clinic, National Institute of Neurology and Cerebrovascular Diseases, Bucharest, Romania;
“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Popa
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Romanian Society of Stroke; Neurology Department, National Institute of Neurology and Cerebrovascular Diseases, Bucharest, Romania
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Cristea I, Popa C. Correlations between the semiologic changes and the imaging aspects in the lateral bulbar infarction. J Med Life 2016; 9:270-274. [PMID: 27974932 PMCID: PMC5154312] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The study aimed to evaluate the correlations between the clinical and paraclinical data in the lateral bulbar infarction, benefiting from the access to the semiologic characteristics of a group studied and the MRI angiography, without a contrast agent, through the 3D TOF technique combined with MIP, as an imaging technique for the evaluation of the arterial lesion. The study group included 20 patients with lateral bulbar infarction, 14 men, and 6 women aged between 21 and 80 years, the mean age being 56, 9 years, who were enrolled in the study in the period 2012 and 2014, following the admission in the National Institute of Neurology and Neurovascular Diseases. All the patients enrolled in this stage study, performed brain MRI - in the Medinst laboratory, which included the following sequences T1, T2, Flair, DWI, MRI angiography without contrast agent (3D TOF combined with MIP). The study was retrospective. Following the analysis of the 3D TOF sequences combined with MIP, it was found that in the group studied, 8 patients had damage at the level of the vertebral artery, 2 at the level of the posterior inferior cerebellar artery and 10 patients presented mixed lesions of both the vertebral artery and of the PICA artery. In terms of the mechanism involved, most of the lateral bulbar infarctions were generated by arterial dissection (9 cases) and 6 cases had atheroma as etiology. Regarding the risk factors, dyslipidemia and smoking predominated in the studied group and the most common signs and symptoms were gait abnormalities, the ataxia of the limbs, dysphonia, and Horner syndrome. Abbreviations: 3D TOF = 3D time of flight angiography, MIP = maximum intensity projection, MRI = magnetic resonance imaging, CT = computed tomography, FLAIR = fluid attenuated inversion recovery, DWI = diffusion weighted imaging, HTA = hypertension, DZ II = diabetes mellitus, VA = vertebral artery, PICA = posterior inferior cerebellar artery, VG = vertigo, NT = nystagmus, N/ E = nausea/ emesis, DP = dysphagia, PVP = pharyngeal/ vocal cord paresis, HS = Horner syndrome, PTH = pain/ temperature hypesthesia, LA = ipsilateral limb ataxia, GA = Gait ataxia, C-R-F = Cardiovascular risk factors, L = left, R = right.
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Affiliation(s)
- I Cristea
- Neurologic Clinic, National Institute of Neurology and Cerebrovascular Diseases, Bucharest, Romania;
“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Popa
- ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; Romanian Society of Stroke; Neurology Department, National Institute of Neurology and Cerebrovascular Diseases, Bucharest, Romania
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Paşcalău V, Soritau O, Popa F, Pavel C, Coman V, Perhaita I, Borodi G, Dirzu N, Tabaran F, Popa C. Curcumin delivered through bovine serum albumin/polysaccharides multilayered microcapsules. J Biomater Appl 2015; 30:857-72. [DOI: 10.1177/0885328215603797] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the paper is to obtain and characterize k-carrageenan–chitosan dual hydrogel multilayers shell BSA gel microcapsules, as a carrier for curcumin, and as a possible antitumoral agent in biological studies. We used the CaCO3 template to synthesize non-toxic CaCO3/BSA particles as microtemplates by coprecipitating a CaCl2 solution that contains dissolved BSA, with an equimolar Na2CO3 solution. The microcapsules shell is assembled through a layer-by-layer deposition technique of calcium cross-linked k-carrageenan hydrogel alternating with polyelectrolite complex hydrogel formed via electrostatic interactions between k-carrageenan and chitosan. After the removal of CaCO3 through Ca2+ complexation with EDTA, and by a slightly treatment with HCl diluted solution, the BSA core is turned into a BSA gel through a thermal treatment. The BSA gel microcapsules were then loaded with curcumin, through a diffusion process from curcumin ethanolic solution. All the synthesized particles and microcapsules were stucturally characterized by: Fourier Transform Infrared Spectroscopy, UV–Vis Spectrometry, X-ray diffraction, thermal analysis, fluorescence spectroscopy, fluorescence optical microscopy, confocal laser scanning microscopy and scanning electron microscopy. The behavior of curcumin loaded microcapsules in media of different pH (SGF, SIF and PBS) was studied in order to reveal the kinetics and the release profile of curcumin. The in vitro evaluation of the antitumoral activity of encapsulated curcumin microcapsules on HeLa cell line and the primary culture of mesenchymal stem cells is the main reason of the microcapsules synthesis as BSA-based vehicle meant to enhance the biodisponibility of curcumin, whose anti-tumor, anti-oxidant and anti-inflammatory properties are well known.
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Affiliation(s)
- V Paşcalău
- Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - O Soritau
- The Oncology Institute Prof. Dr. I. Chiricuta, Cluj-Napoca, Romania
| | - F Popa
- Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - C Pavel
- Technical University of Cluj-Napoca, Cluj-Napoca, Romania
| | - V Coman
- “Raluca Ripan” Institute for Research in Chemistry, Cluj-Napoca, Romania
| | - I Perhaita
- “Raluca Ripan” Institute for Research in Chemistry, Cluj-Napoca, Romania
| | - G Borodi
- National Institute for Research and Development of Isotopic and Molecular Technologies, Cluj-Napoca, Romania
| | - N Dirzu
- The Oncology Institute Prof. Dr. I. Chiricuta, Cluj-Napoca, Romania
| | - F Tabaran
- University of Agricultural Science and Veterinary Medicine, Cluj-Napoca, Romania
| | - C Popa
- Technical University of Cluj-Napoca, Cluj-Napoca, Romania
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Padulo J, Tabben M, Ardigò LP, Ionel M, Popa C, Gevat C, Zagatto AM, Dello Iacono A. Repeated sprint ability related to recovery time in young soccer players. Res Sports Med 2015; 23:412-23. [PMID: 26274891 DOI: 10.1080/15438627.2015.1076419] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [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: 10/23/2022]
Abstract
This study aimed to describe the influence of recovery duration during a repeated sprint ability (RSA) test (6 × 40 m) by investigating a number of variables, such as general performance, metabolic demand, and muscular stretch-shortening performance. Seventeen male soccer outfield players (16 ± 0 years, 66 ± 10 kg) performed three field shuttle-running tests with 15, 20, and 25-sec recoveries. In addition to specific shuttle test's variables, blood lactate concentration and vertical jump height were assessed. Resulting measures were highly reliable (intra-class correlation coefficient up to 0.86). 25-sec recovery improved test performance (-3% total time from 15-sec to 25-sec recovery), vertical jump height (+7% post-test height from 15-sec to 25-sec recovery), and decreased blood lactate accumulation (-33% post-test from 15-sec to 25-sec recovery). Study findings suggest that metabolic acidosis plays a role in worsening performance and fatigue development during the shuttle test. A 25-sec recovery duration maximized performance, containing metabolic-anaerobic power involvement and muscular stretch-shortening performance deterioration during a RSA test.
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Affiliation(s)
- J Padulo
- a University eCampus , Novedrate , Italy.,b Tunisian Research Laboratory 'Sports Performance Optimization' , National Center of Medicine and Science in Sports , Tunis , Tunisia
| | - M Tabben
- c Faculté des Sports, Centre d'Etudes des Transformations des Activités Physiques et Sportives , Université de Rouen , Rouen , France
| | - L P Ardigò
- d School of Exercise and Sport Science, Department of Neurological and Movement Sciences , University of Verona , Verona , Italy
| | - M Ionel
- e Faculty of Physical Education and Sport , Universitatea Ovidius Constanţa , Constanţa , Romania
| | - C Popa
- e Faculty of Physical Education and Sport , Universitatea Ovidius Constanţa , Constanţa , Romania
| | - C Gevat
- e Faculty of Physical Education and Sport , Universitatea Ovidius Constanţa , Constanţa , Romania
| | - A M Zagatto
- f Department of Physical Education, Faculty of Sciences , Univ Estadual Paulista - UNESP , Bauru , Brazil
| | - A Dello Iacono
- g Science Life , Orde Wingate Institute for Physical Education and Sports , Netanya , Israel
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Damen M, Heinhuis B, Tweehuysen L, den Broeder A, Netea M, Popa C, Joosten L. SAT0025 Shift in Genetic Composition of an IL-32 Promoter Polymorphism Resuls in a Higher Cytokine Production in RA Patients. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Heinhuis B, Damen M, Holewijn S, de Graaf J, Fransen J, Popa C, Joosten L. SAT0011 An IL-32 Promoter SNP Associated with Lower HDL and Anti-CCP Promoting Atherosclerosis in RA. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5183] [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] [Indexed: 11/03/2022]
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Martu A, Popa C, Luchian I, Martu I, Oanta C, Martu S. Evaluation of the efficiency of 2 types of periodontal probing. Balkan J Dent Med 2015. [DOI: 10.1515/bjdm-2015-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The periodontal probing has an important role in clinical examination of the periodontal status; different types of periodontal probes have been described. The aim of this investigation was to evaluate comparatively the efficiency of periodontal probing with conventional periodontal probe and electronic periodontal probe. Material and Methods: We examined 57 patients, each patient being subjected to conventional and electronic probing. We assessed the tolerance degree for each probing type and also the time consumed by probing and periodontal charting. Results: The periodontal probing with the electronic probe revealed superior results regarding the accuracy of the measurements, the tolerance level and the time consumed. Conclusions: The electronic periodontal probing is an exceptionally accurate method in establishing diagnosis and assessing treatment results. The electronic periodontal probe represents an efficient and useful tool for measurements of the gingival sulcus and periodontal pockets, and also for determination of the periodontal risk.
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Coll NS, Smidler A, Puigvert M, Popa C, Valls M, Dangl JL. The plant metacaspase AtMC1 in pathogen-triggered programmed cell death and aging: functional linkage with autophagy. Cell Death Differ 2014; 21:1399-408. [PMID: 24786830 DOI: 10.1038/cdd.2014.50] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/11/2014] [Accepted: 03/13/2014] [Indexed: 01/01/2023] Open
Abstract
Autophagy is a major nutrient recycling mechanism in plants. However, its functional connection with programmed cell death (PCD) is a topic of active debate and remains not well understood. Our previous studies established the plant metacaspase AtMC1 as a positive regulator of pathogen-triggered PCD. Here, we explored the linkage between plant autophagy and AtMC1 function in the context of pathogen-triggered PCD and aging. We observed that autophagy acts as a positive regulator of pathogen-triggered PCD in a parallel pathway to AtMC1. In addition, we unveiled an additional, pro-survival homeostatic function of AtMC1 in aging plants that acts in parallel to a similar pro-survival function of autophagy. This novel pro-survival role of AtMC1 may be functionally related to its prodomain-mediated aggregate localization and potential clearance, in agreement with recent findings using the single budding yeast metacaspase YCA1. We propose a unifying model whereby autophagy and AtMC1 are part of parallel pathways, both positively regulating HR cell death in young plants, when these functions are not masked by the cumulative stresses of aging, and negatively regulating senescence in older plants.
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Affiliation(s)
- N S Coll
- 1] Department of Biology, University of North Carolina, Chapel Hill, NC 27599, USA [2] Centre for Research in Agricultural Genomics, Barcelona, Spain
| | - A Smidler
- Department of Biology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - M Puigvert
- Centre for Research in Agricultural Genomics, Barcelona, Spain
| | - C Popa
- Centre for Research in Agricultural Genomics, Barcelona, Spain
| | - M Valls
- 1] Centre for Research in Agricultural Genomics, Barcelona, Spain [2] Department of Genetics, Universitat de Barcelona, Barcelona, Spain
| | - J L Dangl
- 1] Department of Biology, University of North Carolina, Chapel Hill, NC 27599, USA [2] Howard Hughes Medical Institute, University of North Carolina, Chapel Hill, NC 27599, USA [3] Curriculum in Genetics and Molecular Biology, University of North Carolina, Chapel Hill, NC 27599, USA [4] Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC 27599, USA [5] Carolina Center for Genome Sciences University of North Carolina, Chapel Hill, NC, USA
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Arts EEA, Popa C, Den Broeder AA, Semb AG, Toms T, Kitas GD, van Riel PL, Fransen J. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 2014; 74:668-74. [PMID: 24389293 DOI: 10.1136/annrheumdis-2013-204024] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was undertaken to assess the predictive ability of 4 established cardiovascular (CV) risk models for the 10-year risk of fatal and non-fatal CV diseases in European patients with rheumatoid arthritis. METHODS Prospectively collected data from the Nijmegen early rheumatoid arthritis (RA) inception cohort was used. Discriminatory ability for CV risk prediction was estimated by the area under the receiver operating characteristic curve. Calibration was assessed by comparing the observed versus expected number of events using Hosmer-Lemeshov tests and calibration plots. Sensitivity and specificity were calculated for the cut-off values of 10% and 20% predicted risk. RESULTS Areas under the receiver operating characteristic curve were 0.78-0.80, indicating moderate to good discrimination between patients with and without a CV event. The CV risk models Systematic Coronary Risk Evaluation (SCORE), Framingham risk score (FRS) and Reynolds risk score (RRS) primarily underestimated CV risk at low and middle observed risk levels, and mostly overestimated CV risk at higher observed risk levels. The QRisk II primarily overestimated observed CV risk. For the 10% and 20% cut-off values used as indicators for CV preventive treatment, sensitivity ranged from 68-87% and 40-65%, respectively and specificity ranged from 55-76% and 77-88%, respectively. Depending on the model, up to 32% of observed CV events occurred in patients with RA who were classified as low risk (<10%) for CV disease. CONCLUSIONS Established risk models generally underestimate (Systematic Coronary Risk Evaluation score, Framingham Risk Score, Reynolds risk score) or overestimate (QRisk II) CV risk in patients with RA.
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Affiliation(s)
- E E A Arts
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Popa
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A A Den Broeder
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A G Semb
- Department of Rheumatology, Maartenskliniek, Nijmegen, The Netherlands
| | - T Toms
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - G D Kitas
- Department of Rheumatology, Dudley NHS Hospital Group, Dudley, UK
| | - P L van Riel
- Department of Rheumatology, Dudley NHS Hospital Group, Dudley, UK
| | - J Fransen
- Department of Rheumatology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Ghelmez D, Sorin Tuţă S, Popa C. Cerebral microbleeds (CMBs) - relevance for mechanisms of cerebral hemorrhage--analysis of 24 MRI evaluated patients. J Med Life 2013; 6:437-9. [PMID: 24868257 PMCID: PMC4034296] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/19/2013] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The new MRI techniques introduced in the last decade allowed the detection of cerebral microbleeds (CMBs) in different groups of diseases: stroke, Alzheimer disease, vascular dementia or healthy people of advanced age. CMBs are radiologically defined as small, rounded, homogeneous, hypointense lesions on T2*-weighed gradient-recalled echo (T2*-GRE) sequences. OBJECTIVE AND METHOD We evaluated the prevalence, number and location of CBMs in a cohort of 26 consecutive cerebral hemorrhage patients admitted in the National Institute of Neurology and Neurovascular Diseases. We also assessed the association between CMB, classical vascular risk factors and small vessel disease. RESULTS AND CONCLUSIONS From the 26 patients, 2 patients had secondary intracerebral hemorrhage (ICH) (hemorrhage in metastasis, respectively a cavernoma). From the 24 ICH patients 12 have had at least 1 CMB lesion. The average volume of the cerebral hemorrhage was larger in patients with CMBs, with a relative increase of 42%. Small vessel disease was associated with a significant increase in the presence of CMBs (relative increase of 86%). In both cases, however, since the number of patients enrolled was small, the correlations did not reach statistical significance.
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Affiliation(s)
- D Ghelmez
- National Institute of Neurology and Neurovascular Diseases, Bucharest,”Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - S Sorin Tuţă
- National Institute of Neurology and Neurovascular Diseases, Bucharest,”Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - C Popa
- National Institute of Neurology and Neurovascular Diseases, Bucharest,”Carol Davila” University of Medicine and Pharmacy, Bucharest
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Mendes V, Ducos C, d’Aragon C, Popa C, Montessuy R, Cochet E, Gay E. À propos d’un cas de cruralgie déficitaire révélant un anévrysme rompu de l’aorte abdominale. Neurochirurgie 2013. [DOI: 10.1016/j.neuchi.2013.10.104] [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] [Indexed: 10/25/2022]
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Belengeanu V, Misceo D, Popescu C, Stoian M, Belengeanu A, Popa C, Pilat L, Leordean V, Frunza I, Chirila D. Modern technology contribution to elucidation of cytogenetic abnormalities—case of study. Curr Opin Biotechnol 2013. [DOI: 10.1016/j.copbio.2013.05.293] [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] [Indexed: 10/26/2022]
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Arts E, Smith J, Arntz O, Popa C, Semb A, van de Loo F, van Riel P, Kitas G, Fransen J. FRI0109 Predicting cardiovascular disease in rheumatoid arthritis: The effect of long-term storage on measured cholesterol levels in frozen serum samples. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2566] [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] [Indexed: 11/03/2022]
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Popa C, Ionescu S, Cretu CM, Popa L, Mihãilã D, Potecã T, Simion I, Simion S. A primary hydatid cyst in the abdominal wall -- case report. Chirurgia (Bucur) 2012; 107:655-658. [PMID: 23116842] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION A solitary primary hydatid cyst in the abdominal wall is an exceptional entity, even in countries where the Echinococcus infection has a high rate, being considered an endemic disease. CASE PRESENTATION We report a case of a 70-year-old Caucasian man who presented to our clinic with a slow-growing painless parietal mass in the abdominal wall, right flank area. The diagnosis of cystic mass was established at the ultrasound exam. There were no findings that could describe a hydatic cyst. The punction at the surgical intervention revealed a "clear, stone liquid like"; due to the high risk of major injury of the abdominal wall, we performed partial resection of the outer cystic wall, proligerous membrane removal and drainage. The patient had an uneventful post-operative recovery. The histopathology confirmed the suspected diagnosis. CONCLUSION Hydatid cyst should be considered in the differential diagnosis of every abdominal intraparietal cystic mass, especially in regions where the disease is endemic. The best treatment is the total excision of the cyst preserving an intact wall (complete cystectomy). Otherwise, removing the proligerous membrane with partial pericyst's resection (partial pericystectomy) and drainage should be considered.
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Affiliation(s)
- C Popa
- General Surgery Department, Colentina Clinical Hospital, Bucharest, Romania.
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Mihaila D, Poteca T, Ionescu S, Bratucu E, Straja, Popa C, Grigore C, Ionescu S, Bratucu E, Poteca T, Popa C, Grigore C, Anghel R. 412. The Use of Prostheses Techniques in Bilio- and Pancreatico-jejunal Anastomoses After Cephalic Duodenopancreatectomy. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.376] [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] [Indexed: 10/27/2022] Open
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Ionescu S, Popa C, Mihaila D, Bratucu E, Straja D, Poteca T, Grigore C. 364. Rectal Cancer: Measurement of the Tissue Response to Preoperative Radiotherapy. Eur J Surg Oncol 2012. [DOI: 10.1016/j.ejso.2012.06.341] [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] [Indexed: 10/27/2022] Open
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Popa C, Ionescu S, Mihăilă D, Gal I, Potecă T, Simion S. Evaluating the treatment of metastatic colorectal cancer with monoclonal antibodies. J Med Life 2012; 5:168-72. [PMID: 22802884 PMCID: PMC3391878] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 05/04/2012] [Indexed: 11/22/2022] Open
Abstract
The ability to tailor biologic therapy based on the status of tumor biomarkers and monoclonal antibodies has become very important in the last years. The role of tumor biomarkers in treating colorectal cancer, specifically the K-RAS gene, was identified. K-RAS had a higher interest after Lievre and colleagues reported at the 2008 American Society of Clinical Oncology (ASCO) meeting, their analysis of K-RAS mutations in tumors from patients who did not appear to benefit from cetuximab therapy, providing additional data involving K-RAS mutant tumors and their lack of response to cetuximab, as part of first-line therapy for metastatic colorectal cancer. Furthermore, other trials evaluated the K-RAS status and the first-line treatment of metastatic colorectal cancer, the treatment of refractory metastatic cancer and dual-antibody therapy in the first-line treatment of colorectal cancer. Patients with mutant K-RAS colorectal tumors have no benefit from cetuximab, no matter the type of chemotherapy regimen.
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Affiliation(s)
- C Popa
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - S Ionescu
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - D Mihăilă
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - I Gal
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - T Potecă
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - S Simion
- General Surgery Clinic, “Colentina” Clinic Hospital, Bucharest, Romania, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Liberti D, Di Maria C, De Luca P, Alberico M, Popa C, Sagliocco O, Scalzulli MR, De Blasio E. In-hospital rapid response system: effects on outcome and workload. Crit Care 2012. [PMCID: PMC3363924 DOI: 10.1186/cc11113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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van den Hoogen MWF, Popa C, Elving LD, van der Meer JWM. [Reimbursement for alternative medical treatment in the Netherlands, incomprehensible]. Ned Tijdschr Geneeskd 2012; 156:A4227. [PMID: 22316681] [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: 05/31/2023]
Abstract
It is remarkable that, at a time when not only doctors but also the Health Care Inspectorate (IGZ) and the health insurance companies are paying increasing attention to the quality of conventional medicine, many alternative methods of treatments without a scientific basis are accepted in the Netherlands. Even though it has been conclusively demonstrated that most alternative therapies do not work and despite the absence of scientific proof of the safety and efficacy of alternative treatments, health insurance companies do often reimburse the incurred costs. Because the safety of alternative therapies is not guaranteed, these are neither in the interest of the patient nor of society. Moreover, they are associated with considerable costs for the individual patient. By reimbursing the costs of insufficiently proven treatments, the health insurance companies are applying double standards. Reimbursement for these therapies is made at the expense of other effective and proven treatments. This can be changed through the concerted efforts of policy-makers, doctors, the IGZ, and health insurance companies.
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Popa C, Dekker HM, van Deuren M. Feverless red neck: why worry? Retropharyngeal abscess (RPA) with GABHS. Neth J Med 2011; 69:451-474. [PMID: 22058264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- C Popa
- Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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Popa C, Wever PC, Moviat M. H1N1 vaccination: expect the unexpected. Neth J Med 2011; 69:223-246. [PMID: 21646670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- C Popa
- Department of Internal Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
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Arsene D, Vasilescu F, Toader C, Bălan A, Popa C, Ardeleanu C. Clinico-pathological correlations in fatal ischemic stroke. An immunohistochemical study of human brain penumbra. Rom J Morphol Embryol 2011; 52:29-38. [PMID: 21424029] [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: 05/30/2023]
Abstract
Ischemic stroke is one of the most frequent pathologies with high invalidating potential and a leading cause of death. The brain tissue adjacent to the central necrotic core, defined as penumbra, was extensively characterized mostly by imaging techniques and in animal models. Our goal was to identify a large panel of molecules in this particular area on human brains harvested at autopsy. Twenty-one patients with ischemic stroke and seven control cases were taken into study. We used immunohistochemistry to characterize necrotic lesions. Metalloproteinases, mostly MMP-9, seem to be involved in brain ischemia, but as a protective and not as a deleterious factor. Apoptotic molecules are not increasingly expressed in stroke compared to control cases. Mast cell enzymes chymase and tryptase are described for the first time in neurons and glia, even with unclear significance. Microglia appears active in stroke and stimulating methods directed to it could be useful. Nitric oxide synthases and cyclooxygenase-2 were also involved in stroke cases but not in control ones. Other factors as VEGF and its receptors, PDGF, b-FGF or TNF-alpha showed no significant expression related to ischemic brain injury. Animal study of penumbra and human tissue findings are distinct and research should be focused on the latter approach in order to find valuable and safe therapeutic methods.
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Affiliation(s)
- D Arsene
- Department of Histopathology and Immunohistochemistry, "Victor Babes" National Institute of Pathology, Bucharest, Romania.
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Sinescu C, Popa F, Grigorean VT, Onose G, Sandu A, Popescu M, Burnei G, Strambu V, Popa C. Molecular basis of vascular events following spinal cord injury. J Med Life 2010; 3:254-61. [PMID: 20945816 PMCID: PMC3018992] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The aim of this article is to analyze the effects of the molecular basis of vascular events following spinal cord injury and their contribution in pathogenesis. First of all, we reviewed the anatomy of spinal cord vessels. The pathophysiology of spinal cord injuries revealed two types of pathogenic mechanisms. The primary event, the mechanic trauma, results in a disruption of neural and vascular structures into the spinal cord. It is followed by secondary pathogenesis that leads to the progression of the initial lesion. We reviewed vascular responses following spinal cord injury, focusing on both primary and secondary events. The intraparenchymal hemorrhage is a direct consequence of trauma; it has a typical pattem of distribution into the contused spinal cord, inside the gray matter and, it is radially extended into the white matter. The intraparenchymal hemorrhage is restricted to the dorsal columns, into adjacent rostral and caudal spinal segments. Distribution of chronic lesions overlaps the pattern of the early intraparenchymal hemorrhage. We described the mechanisms of action, role, induction and distribution of the heme oxygenase isoenzymes 1 and 2. Posttraumatic inflammatory response contributes to secondary pathogenesis. We analyzed the types of cells participating in the inflammatory response, the moment of appearance after the injury, the decrease in number, and the nature of their actions. The disruption of the blood-spinal cord barrier is biphasic. It exposes the spinal cord to inflammatory cells and to toxic effects of other molecules. Endothelin 1 mediates oxidative stress into the spinal cord through the modulation of spinal cord blood flow. The role of matrix metalloproteinases in blood-spinal cord barrier disruption, inflammation, and angiogenesis are reviewed.
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Affiliation(s)
- C Sinescu
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Cardiology, BucharestRomania
| | - F Popa
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘St. Pantelimon’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - VT Grigorean
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - G Onose
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Physical and Rehabilitation Medicine, BucharestRomania
| | - A Sandu
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Neurosurgery, BucharestRomania
| | - M Popescu
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,District Hospital Pitesti, Department of Neurosurgery, PitestiRomania
| | - G Burnei
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘Marie Sklodowska Curie’ Children' Clinical Emergency Hospital, Department of Pediatric Orthopedic Surgery, BucharestRomania
| | - V Strambu
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,‘St. Pantelimon’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - C Popa
- Carol Davila University of Medicine and Pharmacy, BucharestRomania
,National Institute of Neurology and Neurovascular Disorders, Department of Neurology, BucharestRomania
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Popa C, Popa F, Grigorean VT, Onose G, Sandu AM, Popescu M, Burnei G, Strambu V, Sinescu C. Vascular dysfunctions following spinal cord injury. J Med Life 2010; 3:275-85. [PMID: 20945818 PMCID: PMC3019008] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this article is to analyze the vascular dysfunctions occurring after spinal cord injury (SCI). Vascular dysfunctions are common complications of SCI. Cardiovascular disturbances are the leading causes of morbidity and mortality in both acute and chronic stages of SCI. Neuroanatomy and physiology of autonomic nervous system, sympathetic and parasympathetic, is reviewed. SCI implies disruption of descendent pathways from central centers to spinal sympathetic neurons, originating in intermediolateral nuclei of T1-L2 cord segments. Loss of supraspinal control over sympathetic nervous system results in reduced overall sympathetic activity below the level of injury and unopposed parasympathetic outflow through intact vagal nerve. SCI associates significant vascular dysfunction. Spinal shock occurs during the acute phase following SCI and it is a transitory suspension of function and reflexes below the level of the injury. Neurogenic shock, part of spinal shock, consists of severe arterial hypotension and bradycardia. Autonomic dysreflexia appears during the chronic phase, after spinal shock resolution, and it is a life-threatening syndrome of massive imbalanced reflex sympathetic discharge occurring in patients with SCI above the splanchnic sympathetic outflow (T5-T6). Arterial hypotension with orthostatic hypotension occurs in both acute and chronic phases. The etiology is multifactorial. We described a few factors influencing the orthostatic hypotension occurrence in SCI: sympathetic nervous system dysfunction, low plasma catecholamine levels, rennin-angiotensin-aldosterone activity, peripheral alpha-adrenoceptor hyperresponsiveness, impaired function of baroreceptors, hyponatremia and low plasmatic volume, cardiovascular deconditioning, morphologic changes in sympathetic neurons, plasticity within spinal circuits, and motor deficit leading to loss of skeletal muscle pumping activity. Additional associated cardiovascular concerns in SCI, such as deep vein thrombosis and long-term risk for coronary heart disease and systemic atherosclerosis are also described. Proper prophylaxis, including non-pharmacologic and pharmacological strategies, diminishes the occurrence of the vascular dysfunction following SCI. Each vascular disturbance requires a specific treatment.
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Affiliation(s)
- C Popa
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,National Institute of Neurology and Neurovascular Disorders, BucharestRomania
| | - F Popa
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘St. Pantelimon’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - VT Grigorean
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - G Onose
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Physical and Rehabilitation Medicine, BucharestRomania
| | - AM Sandu
- ‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Neurosurgery, BucharestRomania
| | - M Popescu
- District Hospital Pitesti, Department of Neurosurgery, PitestiRomania
| | - G Burnei
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘Marie Sklodowska Curie’ Children' Clinical Emergency Hospital,
Department of Pediatric Orthopedic Surgery, Bucharest
Romania
| | - V Strambu
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘St. Pantelimon’ Clinical Emergency Hospital, Department of General Surgery, BucharestRomania
| | - C Sinescu
- >‘Carol Davila’ University of Medicine and Pharmacy, Bucharest
Romania
,‘Bagdasar–Arseni’ Clinical Emergency Hospital, Department of Cardiology, UMF ‘Carol Davila’, Bucharest
Romania
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Gonganau-Nitu D, Scurtu RR, Precup CG, Dindelegan G, Biro A, Crisan C, Cocu S, Popa C, Ciuce C. Effects of the radiofrequency interference with modified titanium surgical clips on liver parenchyma--an in vivo experiment. Chirurgia (Bucur) 2010; 105:501-508. [PMID: 20941972] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM This study sets out to test the biocompatibility of titanium clips in liver, in the presence of radiofrequency. Biocompatibility is assessed at various distances from the RF electrode and different points in time. METHOD It is an experimental study conducted on pigs and makes use of histological changes that occur at the liver-titanium interface in presence of RF to test hypotheses. The titanium clips were modified in high vacuum (10 -5 atm) by heating them at 1000 degrees C and 1150 degrees C. Titanium clips were placed in liver at 0.5, 1.5 and 2.5 cm from RF probe. At 7, 14 and 28 days the inflammation, necrosis and fibrosis were assessed. RESULTS The histological alterations decrease with the distance of implantation of titanium clips. The inflammation and necrosis nearby the titanium clips decrease in time, but the fibrosis does not increased, as expected. The modified titanium at 1000 degrees C clips cause less necrosis than commercial titanium clips. The moderator role of clip type between distance and cell alteration is empirically supported only for fibrosis and necrosis. The moderator role between time and cell alteration is supported only for inflammation. CONCLUSIONS Experimental data suggests there are no preferred surgical clips in all situations. The biocompatibility of the titanium clips depends on the distance from the RF probe. The commercial ones prove less damaging if they are placed close to the RF probe (less than 1 cm) and those that were treated at 1150 C have a better bio-compatibility if placed more than 1 cm from RF probe.
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Affiliation(s)
- D Gonganau-Nitu
- Department of Surgery No 1, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca, Romania Technical University, Cluj-Napoca, Romania
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van Bon L, Popa C, Huijbens R, Vonk M, York M, Simms R, Hesselstrand R, Wuttge DM, Lafyatis R, Radstake TRDJ. Distinct evolution of TLR-mediated dendritic cell cytokine secretion in patients with limited and diffuse cutaneous systemic sclerosis. Ann Rheum Dis 2010; 69:1539-47. [DOI: 10.1136/ard.2009.128207] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Calomfirescu N, Popa C, Jurcut R, Serban M, Ginghina C. Circulating Adiponectin: Associations with Risk Factors and the Reynolds Risk Score in Women without Prior Major Cardiovascular Events. Cardiology 2010; 115:64-70. [DOI: 10.1159/000252810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Accepted: 08/07/2009] [Indexed: 11/19/2022]
Abstract
<i>Objective:</i> Adiponectin may play an important role in the interplay between metabolic changes and cardiovascular risks. Our aim was to establish if plasma adiponectin can be used to detect the metabolic syndrome (MetS) in women without a history of major cardiovascular events and to evaluate its correlation with the global cardiovascular risk expressed by the Reynolds risk score (RRS). <i>Methods:</i> 148 consecutive women without a history of cardiovascular events with or without MetS have been investigated. Clinical risks factors as well as plasma levels of lipids, fasting glucose and adiponectin were determined. <i>Results:</i> As expected, circulating adiponectin was lower in women with MetS: 26.8 ± 20.4 versus 44.3 ± 26.7 μg/ml (p < 0.001) and inversely related to the number of MetS features (r = –0.33, p < 0.001). The latter was further associated with the total cardiovascular risk calculated using RRS (r = 0.49, p < 0.001). However, there was no relationship between circulating adiponectin and this score (r = –0.14, p = NS). <i>Conclusions:</i> Plasma adiponectin levels are significantly lower in women with MetS, but as a stand-alone tool plasma adiponectin may be of little value in the diagnosis MetS. Circulating adiponectin levels are not associated with the global cardiovascular risk calculated using RRS.
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Wenink MH, Santegoets KCM, Broen JCA, van Bon L, Abdollahi-Roodsaz S, Popa C, Huijbens R, Remijn T, Lubberts E, van Riel PLCM, van den Berg WB, Radstake TRDJ. TLR2 promotes Th2/Th17 responses via TLR4 and TLR7/8 by abrogating the type I IFN amplification loop. J Immunol 2009; 183:6960-70. [PMID: 19915052 DOI: 10.4049/jimmunol.0900713] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
TLR2 plays an important role in the removal of Gram-positive bacteria; contrastingly, it also appears to have important protective effects against unrestrained inflammation and subsequent organ injury during infection and autoimmunity. We hypothesized that TLR2 tunes the phenotype of dendritic cells (DCs) activated through other TLRs, thereby fulfilling a crucial role in the modulation of the immune response. TLR2 potently inhibited TLR4- and TLR7/8-induced cytokine production by human DCs. The inhibitory effect of TLR2 on the release of TNF-alpha but not of IL-12p70 was mediated by PI3K. TLR2 inhibits the production of IL-12p70 by dampening the type 1 IFN amplification loop. When DCs were triggered with the potent synergistic combination of LPS (TLR4) and R848 (TLR7/8) in conjunction with a TLR2 ligand, a clear shift to more Th2- and Th17-prone responses in the naive and memory T cell subpopulations was observed. This shift in T cell responses was inherent to the inability of TLR2-stimulated DCs to produce IL-12p70 and was dependent on the production of IL-1 and IL-6.
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Affiliation(s)
- Mark H Wenink
- Department of Rheumatology, Radboud University Nijmegen Medical Center, Geert Grooteplein 8, 6500 HB Nijmegen, The Netherlands.
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