PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

BACKGROUND

Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment.

METHODS

All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals.

RESULTS

A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death.

CONCLUSION

Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions.

A scoring system for predicting malignancy in intraductal papillary mucinous neoplasms of the pancreas: a multicenter EUROPEAN validation

PURPOSE

A preoperative estimate of the risk of malignancy for intraductal papillary mucinous neoplasms (IPMN) is important. The present study carries out an external validation of the Shin score in a European multicenter cohort.

METHODS

An observational multicenter European study from 2010 to 2015. All consecutive patients undergoing surgery for IPMN at 35 hospitals with histological-confirmed IPMN were included.

RESULTS

A total of 567 patients were included. The score was significantly associated with the presence of malignancy (p < 0.001). In all, 64% of the patients with benign IPMN had a Shin score < 3 and 57% of those with a diagnosis of malignancy had a score ≥ 3. The relative risk (RR) with a Shin score of 3 was 1.37 (95% CI: 1.07-1.77), with a sensitivity of 57.1% and specificity of 64.4%.

CONCLUSION

Patients with a Shin score ≤ 1 should undergo surveillance, while patients with a score ≥ 4 should undergo surgery. Treatment of patients with Shin scores of 2 or 3 should be individualized because these scores cannot accurately predict malignancy of IPMNs. This score should not be the only criterion and should be applied in accordance with agreed clinical guidelines.

Long term outcome after ablation of persistent atrial fibrillation in patients with postprocedurally unmasked sinus node disease

Funding Acknowledgements

Type of funding sources: None.

Background

About three percent of patients with persistent atrial fibrillation [AF] additionally suffer from a concealed sinus node disease [SND]. We sought to determine the ablation success one year after ablation of persistent AF in patients with postprocedurally unmasked SND.

Methods and Results

In total 2239 patients with an ablation of persistent AF at our center were screened for a postprocedurally unmasked SND, which made cardiac pacing necessary within one week after ablation. In a propensity score matched case control study, the longterm ablation success of 51 patients (mean age 73±8years, 58% male) with postprocedurally unmasked SND after ablation of persistent AF was compared to that of 102 patients without SND after ablation of persistent AF. Controls were matched to cases based on the propensity score considering age, body mass index, left ventricular ejection fraction, gender, blood pressure, diabetes mellitus, atrial low voltage, previous number of ablations and method of ablation.

One year after ablation of persistent AF, 20 (39%) patients with postprocedurally unmasked SND and 61 (60%) patients without postprocedurally unmasked SND were in sinus rhythm (p=0.025). The number of repeat ablation procedures within the follow up year did not differ significantly between cases and controls (0.60±0.68 vs 0.53±0.80, p=0.574).

Conclusion

In patients with a postprocedurally unmasked SND after ablation of persistent AF, longterm ablation success seems to be worse compared to patients without postprocedurally unmasked SND.

Correlation of local impedance, global impedance and contact force with resulting lesion size in RF ablation

Funding Acknowledgements

Type of funding sources: None.

Background

During clinical application of RF-energy, several parameters are constantly observed, e.g. RF time, power, global impedance and temperature. The new parameter "local impedance" is gaining importance and might be a possible real-time marker for predicting long-lasting RF-lesions and increasing safety. The aim of this study was to investigate the correlation between local and global impedance as well as RF power and contact force.

Methods

RF-lesions were created using an ex vivo model with porcine cardiac preparations. These were put in a saline-filled container with a dispersive electrode. Global impedance was held at 120 Ohm by adjusting saline and water. Additionally, a heated thermostat and a circulation pump were installed to imitate blood flow. RF-lesions were produced with different settings of energy and contact force (20, 30, 40 and 50 watts; contact force of 0-5g, 10-15g and 20-25g). While creating the lesions, global and local impedance, temperature, energy and RF time were documented, as well as the current lesion width and depth. Local and global impedance drops were calculated as the difference between baseline impedance and current impedance.

Results

In total, 1223 measurements were made during application of RF-energy. 6 steam pops occurred. Contact force, local and global impedance changes showed highly significant correlations with lesion depth and diameter. Amongst analyzed values, local impedance drop showed highest correlation with lesion diameter and depth (r = 0,391 and 0,613; p&lt;0,001). Visualized in Figure 1 and 2, global and local impedance correlate with lesion diameter and depth.

Discussion

Local impedance was found to be a suitable real-time marker for lesion size, showing significantly higher correlations with RF lesion size than contact force and global impedance. Further investigation is necessary to find a cut off for a safe but long-lasting RF-lesion.

Electrode tissue coupling is a new main determinant of RF lesion creation, experience from a cardiac animal model

Funding Acknowledgements

Type of funding sources: None.

Background

Radiofrequency (RF) current is a classic ablation technology used in the EP lab. By now it is assumed that RF lesion size is mainly determined by RF power, duration and contact force. This ex vivo animal model study shows that a new parameter - "electrode tissue coupling" (ETC) - plays an additional major role in RF lesion creation. The ETC level describes the amount of electric contact between the RF electrode and cardiac tissue: In minor ETC levels, only the distal electrode connects to tissue. In full ETC levels, the whole RF electrode is embedded in cardiac tissue.

Methods

RF-lesions were created using an ex vivo porcine cardiac model. The experimental setup consisted of a saline-filled container, a dispersive electrode, a heated thermostat and a circulation pump to imitate in vivo conditions. Global impedance was kept at 120 Ohm as well as the temperature at 37°C. RF-lesions were created using identic values of RF duration and contact force. A RF power of 20W, 30W, 40W, and 50W was used. The ETC levels were systematically varied between minor and full coupling. All parameters (power, temperature, global and local impedance, contact force, ETC, lesion size) were measured constantly during application of RF-current, enabling real-time correlation of RF parameters and lesion size.

Results

In total, 1923 measurements during application of RF-current were analyzed. In ETC III (full tissue coupling), lesions became significantly wider and deeper. In 20W ablations, lesion diameters were significantly (1.68 fold) larger when applying ETC III instead of ETC I. This relation was found in variations of RF parameters (Table 1).

Interestingly, baseline local impedance and local impedance drop showed a high correlation with selected ETC levels. The average baseline local impedance in ETC I was 207.2 Ohm, compared to 267.3 Ohm in ETC III (p &lt; 0.01).

Discussion

In addition to by now known parameters (power, duration, contact force), electrode tissue coupling is a main determinant of lesion size. Higher ETC levels result in higher amounts of RF current going into adjacent tissue instead of current dissipation into the blood pool. In clinical practice, the ETC level can be predicted by baseline local and global impedance. Observation of these parameters should become clinical practice during RF ablation.

THE SURGICAL TREATMENT OF CHONDROBLASTIC OSTEOSARCOMA - A CASE REPORT

Osteosarcoma is the most common primary malignant bone tumor, with a higher prevalence among children and young adults. Its most frequent localization is in the distal femur, followed by the proximal humerus and the proximal femur. In this article, we will describe the case of a 25-year-old male patient who presented to our medical facility, accusing spontaneous pain and swelling, both originating from the left knee. The X-ray of the distal femur showed a heterogeneous mass around the left femoral metaphysis with massive periosteal reaction. The computerized tomography (CT) analysis revealed cortical destruction, with extra-compartmental localization. The patient has later undergone to an incisional biopsy. The histopathology report showed the presence of a chondroblastic osteosarcoma. According to the multidisciplinary diagnosis, the tumor was finallyclassified as type IIB on the Enneking classification. In such cases, the elective surgical procedure is reconstructive surgery, consisting of wide resection of the distal femur, followed by modular reconstruction. After the surgery, the patient’s condition improved significantly and the functional outcome of the reconstructed joint was also satisfying.

Microwave-dried or air-dried? Consumers' stated preferences and attitudes for organic dried strawberries. A multi-country investigation in Europe

Non-thermal food processing technologies are becoming more important in the organic food sector because, beyond preserving the organic feature, they could offer organic products with additional benefits in terms of enhanced nutritional content and healthiness as well as better sensory properties that could satisfy the more complex demands of organic consumers. Berries have a well-known health benefits and show increasing market shares in European markets while dehydration can increase the food convenience in terms of extended shelf-life. This study investigates for the first time organic consumers' stated preferences, attitudes and individual differences for a non-thermal organic processing technology. Specifically, we investigated consumers' preferences for organic dried strawberries varying in drying technology used, such as the most conventional (i.e. thermal) air drying and the most innovative (i.e. non-thermal) microwave drying, origin, price levels, and nutrient contents in three European countries: Norway, Romania and Turkey. Data from a total of 614 consumers were collected through an online choice experiment. Results show that on average consumers prefer organic dried strawberries produced with air drying technology that have national origin, with natural nutrient content and at low price, but country and individual differences are identified. Consumers who showed least rejection for microwave dried products are young, mostly from Norway and have higher positive attitudes towards new food technologies. Consumers who showed most rejection for microwave dried products are older, mostly from Turkey and have higher positive attitudes for organic, natural and ecological products. Organic producers who adopt microwave drying might better inform consumers about the characteristics, the process and highlight the nutritional benefits of such technology. Finally, this research informs policy makers about the need to define and regulate more clearly microwave drying as an organic technology, as well as to regulate labelling to ensure that consumers are not misled and correctly informed about the new technology.

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

BACKGROUND

Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.

METHODS

This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.

FINDINGS

Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05-2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).

INTERPRETATION

Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.

FUNDING

DFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant, National Institute of Health Research Global Health Research Unit Grant.

Synthesis of New Methionine Derivatives for the Treatment of Paracetamol - Induced Hepatic Injury

The direct pharmacological properties of amino acids and the possibility of using them as carriers for other active pharmacological substances are well known. Methionine, being able to yield the methyl group, is very important in the treatment of hepatic diseases. Paracetamol acute poisoning causes liver injury in both humans and animals. The study is designed to synthesize some new methionine derivatives and to<br />establish a possible correlation between the new structure and the pharmacological properties. To this end, acute experimental poisoning with Panadol® (paracetamol) was performed while, for the treatment of liver injury caused by this compound, two original synthesis derivatives of methionine, namely N-(m-nitrobenzoyl)- L-methionine and N-(m-aminobenzoyl)-L-methionine, were used. Male Wistar rats were administered<br />Panadol® (paracetamol) per oral (7500 mg/kg). N-(m-nitrobenzoyl)-L-methionine (m-NBM) 50 mg/kg and<br />N-(m-aminobenzoyl)-L-methionine (m-ABM) 50 mg/kg were given intraperitoneally, 30 minutes after Panadol® administration. Biochemical parameters such as SGOT, SGPT, serum bilirubin and glycemia were estimated to assess the liver function. Panadol® (paracetamol) poisoning produced an increase in serum transaminases, bilirubin and glicemia. These effects were reduced by treatment with m-NBM and especially m-ABM. These biochemical observations were supplemented by histopathological examination of liver sections. The results obtained with m-ABM were comparable with those reported on methionine, which is a recognised antidote in paracetamol poisoning.

CEREBRAL VASOMOTOR REACTIVITY IN PATIENTS WITH ARTERIAL HYPERTENSION AND COGNITIVE IMPAIRMENT

Objectives. The aim of our study is to determine whether cerebral vasomotor reactivity is impaired in patients with arterial hypertension and cognitive impairment and how this hemodynamic parameter is associated with different functions of cognition. Materials and methods. We included 87 patients with arterial hypertension divided into two groups, one with neurocognitive impairment ranging from mild to severe aged between 47 and 90 years (70.2 ± 11.4) and the second group without cognitive impairment aged between 41 and 86 years (60.1 ± 11.4). We excluded patients with significant hemodynamic cervico-cerebral arterial stenoses, arrhythmias and other diseases that may impair cerebral vasomotor reactivity. All the patients underwent assessment of vasomotor reactivity and neurocognitive functions. Results. BHI values were significantly lower in the first group of patients compared to the second one. The percent of patients with impaired cerebral vasomotor reactivity was significantly higher in the group of patients with cognitive impairment, as compared to the other group (54.35% vs 29.27%, p=0.01). There was a significant statistical difference between the MMSE, MOCA and clock test scores among patients with and without impaired vasomotor reactivity. This difference was also maintained for visuospatial/executive, naming and language domains of the MOCA test. Conclusions. Impaired cerebral vasomotor reactivity is more frequent in patients with arterial hypertension and cognitive impairment. Patients with arterial hypertension and impaired vasomotor reactivity have poorer cognitive performance, cognitive functions most affected in patients with impaired vasomotor reactivity being language, visuospatial and executive ones.

Treatment of Cubital Tunnel Syndrome by Frontal Partial Medial Epicondylectomy. A Retrospective Series of 55 Cases

The outcomes of 55 cases of cubital tunnel syndrome treated by a partial frontal epicondylectomy are presented at a mean follow-up of 38 months follow-up. According to McGowan classification, 25 cases were grade I (45%), 12 grade II (22%) and 18 grade III (33%). The results (Wilson and Krout classification) were excellent or good in 41 patients (75%), fair in nine patients and unchanged in five, without any worsening or recurrence. Total relief was reported in 80% of grade I, 75% of grade II and 66% of grade III patients. Seven painful scars and one persistent 15° elbow extension deficit were the only complications. The satisfaction rate was 93%. This technique preserves bony protection, the blood supply and gliding tissues for the nerve and nerve recovery were comparable to other surgical procedures. Residual pain at the osteotomy site was not a serious problem.

Self - inflicted lesions in children - indicator of intra familial abuse

Self - inflicted lesions refers to a behavioural disorder with a complex ethiology. The occurrence of these cases in minors seems to be on the increase in last years, as well as minors abuse. On the assumption that there is a possible relation between minors abuse and this behavioural disorder, it has been evaluated comparatively the frequency with which it occurs among the minors examined in the forensic practice following reported abuse and the frequency with which it appears among the general population, sampled from the pupils in the final year of a high school in Bistrita.

New Perspectives in Therapy of Intoxications by Organophosphoric Compounds

Little references actually exist on neutralization therapy which could constitute the missing ring from an efficient treatment. As structural model capable to interact with organophosphoric substances, at the level of phosphor (P) atom, the common chemical element of the hole class of substances, was proposed those of benzimidazole. Different quantities of benzimidazole were put in contact with a fix quantity of trichlorphon in acid conditions and formation of a new compound was evidentiated by infrared spectrometry. Similar experiments were made utilizing benzimidazole derivatives (2 methyl or 2 benzyl benzimidazole) and different temperatures: 35°C and 40°C. By increasing massic rate: benzimidazole/triclorfon as well an increased reaction temperature, have favourably influenced trichlorphon capture. The obtained results justified an continuation of researches in the direction of new compounds with a structure similar with that of benzimidazole for funding an efficient neutralization therapy for organophosphoric substances.

Formation and deposition of stable silver nanoparticles encapsulated in solid spheres

We prepared solid spheres, with diameters between 100 and 400 nm, encapsulating silver nanocrystallites (about 20 ± 10 nm in diameter), by heating colloidal solutions of silver in methoxyethanol at 120 °C. Stable coatings were obtained using spin coating and rapid thermal processing on optical glass substrates. UV-Vis spectroscopy measurements demonstrated the remarkable stability against aggregation and particle growth, even after prolonged heating at 120 °C and exposed at direct sunlight, of the solutions, even using high concentrations of silver (1 M), and coatings of spheres encapsulating silver.

Formation mechanism and red light emission photoluminescence of single-phase crystalline Eu2O2CO3 nanoplates compared with Y2O3:Eu phosphor

The photoluminescence properties and formation mechanism of a novel stoichiometric phosphor are presented. Nanoplates of pure single-phase crystalline Eu2O2CO3 oxycarbonate (hexagonal type-II) were synthesized by dry autoclaving under autogenic pressure (under 3 MPa) using an efficient, high yield solid state green-chemistry route that can be extended to other rare-earth oxycarbonate and oxide systems, resulting in the full conversion of a simple commercial precursor in single-crystalline nanoplates with strong visible luminescence. Phosphors made of an oxide host and an active luminescent dopant ion are the commercial standard (i.e., Y2O3:Eu). It is generally considered that the activity of luminescent species, such as Eu3+, is quenched and disappears above a certain concentration of them in the lattice (concentration quenching). The truly stoichoimetric oxycarbonate phosphor without active dopant ions exhibits very strong red emission when excited by different excitations, in the UV and visible range, without any concentration quenching effect. The bright red light emission spectra of the of the photo-excited phosphor nanoplates under UV and visible light excitation is compared with that of a standard Y2O3:Eu commercial red phosphor powder, and the thermal conversion mechanism is proposed to obtain the single-phase stable stoichiometric oxycarbonate nanoplates.

Phases in the temporal multiscale evolution of the drug release mechanism in IPN-type chitosan based hydrogels

Different release mechanisms are identified in the temporal evolution of drug release from IPN-type hydrogels, conducted over longer timescales.

Evaluation of the wound-healing effect of a novel Hypericum perforatum ointment in skin injury

The present experiment aims to formulate and characterize a new phytotherapy ointment based on a total extract of Hypericum perforatum included in a novel ointment base. In order to investigate the healing properties of the ointment, in vivo experimental wound models of linear incision, circular excision and thermal burn were performed on Wistar rats. Topical treatment was achieved daily, for 21 days. Clinical and macroscopic evaluation, determination of wound contraction rate, period of re-epithelialization, and histopathological examination were achieved, along with the determination of the particle diameter and particle size distribution of the ointment. The results demonstrate that the tested novel ointment has significant wound healing effect in skin injuries and reveals to be safe for use.

Robotic surgery of locally advanced gastric cancer -- an initial experience

BACKGROUND

The treatment of gastric cancer is currently based on open gastric resection and regional lymph node dissection. Although the minimally invasive approach is currently being adopted for ever more complex procedures in order to improve post-operative outcomes, the laparoscopic radical D2 gastrectomy has not yet gained a wide acceptance, it being considered one of the most difficult operations in general surgery. Robotic surgery is better than the conventional laparoscopic approach, in that it avoids some of its limitations. Wristed instruments with seven degrees of freedom, the tremor filtering system, the ability to scale motion, and tridimensional vision improve the surgeons' dexterity when a fine manipulation of tissues in a narrow, fixed operating field or handsewn sutures are required. This study will attempt to evaluate the feasibility of robotic total and subtotal gastrectomy for locally advanced gastric cancer.

METHODS

Two patients with locally advanced gastric adenocarcinoma underwent robot-assisted gastrectomy with D2 lymph node dissection, with no open or laparoscopic conversion.

RESULTS

The post-operative evolution was uneventful and they were both discharged without complications. The number of lymph nodes retrieved was comparable to open surgery. Currently, after a follow-up period of 23 and 26 months respectively, both patients are disease-free.

CONCLUSIONS

Robotic surgery can be a simpler way of expanding the indications of minimally invasive surgery so as to include the advanced gastric cancer. However, controlled prospective studies are needed in order to evaluate the role of robotics in the management of gastric cancer.

Microparticles based on natural and synthetic polymers for ophthalmic applications

Sodium salt of carboxymethylcellulose/poly(vinyl alcohol) particles suitable for application in ocular drug administration were prepared by crosslinking with epichlorohydrin in an alkaline medium, in reverse emulsion. The influence of parameters related with the particles elaboration process (ratio between polymer mixture and crosslinking agent, concentration of polymer solution, duration of crosslinking reaction, stirring intensity, etc.) based on their composition, size, and swelling ability was studied. Obtained microparticles fulfill the requirements for biomaterials-they are formed from biocompatible polymers; the acute toxicity value (LD(50)) is high enough to consider these materials as weakly toxic (hence able to introduce within the organism); they are able to include and release drugs in a controlled way. The in vivo adrenalin ocular delivery from the microparticles was tested on voluntary human patient. The particles showed good adhesion properties without irritation to the patient and proved the capability to treat the ocular congestion.

Nanoparticles biodistribution in the eye

Nowadays the management of ocular diseases is limited by the inability for controlled drug delivery. In the present study micro and nanoparticles based on Chitosan labeled with fluorescein, prepared by double crosslinking method in water/oil emulsion, were investigated as a new vehicle for intraocular drug delivery. The main objective was to study the biodistribution of the prepared particles after beind administered into the anterior chamber of pig eyes. Nanoparticles were characterized by Scanning Electron Microscopy Laser Difractometry and analysis was performed by Confocal Laser Microscopy. The designed micro and nanoparticles have average size from 500 nm to 2 microm and present round shape, smooth surface, relative high dimensional poly-dispersity and relative high porosity. The particles also present good biodistribution at corneal, scleral, retinal and optic nerve level after being administered. After this eliminary phase we intend to use Chitosan based nanoparticles as a controlled drug delivery system for therapies concerning endophthalmitis, age related macular degeneration etc.

In vitro antimicrobial activity of Romanian medicinal plants hydroalcoholic extracts on planktonic and adhered cells

The aim of this study was to assess the antibacterial and antifungal potential of some Romanian medicinal plants, arnica--Arnica montana, wormwood--Artemisia absinthium and nettle--Urtica dioica. In order to perform this antimicrobial screening, we obtained the vegetal extracts and we tested them on a series of Gram-positive and Gram-negative bacteria, and also against two fungal strains. The vegetal extracts showed antimicrobial activity preferentially directed against the planktonic fungal and bacterial growth, while the effect against biofilm formation and development was demonstrated only against S. aureus and C. albicans. Our in vitro assays indicate that the studied plant extracts are a significant source of natural alternatives to antimicrobial therapy, thus avoiding antibiotic therapy, the use of which has become excessive in recent years.

Enzyme-assisted purification of denatured atelocollagen, using pronase as scavenging agent

Collagen liquid-crystal characteristics can be exploited in advanced applications, like microelectromechanical systems (MEMS), collagen-silica biohybrids or intelligent substrates for tissue engineering. Such applications necessarily require high purity of the collagen colloidal solutions, in terms of macromolecular unitary composition, which is equivalent to almost zero poydispersity. In this work a protocol for the enzyme-assisted removal of non-triple helical polypeptide entities in atelocollagen solutions was conceived, using pronase as scavenger, in the presence of poly(ethyleneglycol) (PEG 10000) as a crowding agent, trimethylamine-N-oxide dihydrate, (TMAO) as kosmotropic agent and anhydrous sodium sulfate as anti-chaotrope salt. Unusually high enzyme concentration (3 : 100 w/w 5 U/mg Pronase : total dry protein) imposes the triple-helix integrity protection, which was achieved by means of protective adjuvants. The adjuvant agents mixture comprising the crowder, the kosmotrope and the anti-chaotropic salt, was formulated according to the Design of Experiments (DOE) principles. The crowding agent represents the key factor in modulating pronase hydrolytic action upon atelocollagen substrate. The optimal adjuvant mixture tested in order to confirm the model validity had the composition: 0.675 PEG, 0.200 TMAO, 0.125 Na2SO4 (mass fractions). The proposed protocol is suitable for purifying medium and large quantities of atelocollagen previously solubilized through an alkali-enzyme technique.

In vitro biocompatibility and corrosion resistance of a new implant titanium base alloy

One objective of this work was to study the corrosion resistance of the new implant Ti-10Zr-5Ta-5Nb alloy in physiological fluids of different pH values, simulating the extreme functional conditions. Another objective was in vitro biocompatibility evaluation of the new alloy using human fetal osteoblast cell line hFOB 1.19. Cytocompatibility was assessed by determination of possible material cytotoxic effects, cell morphology and cell adhesion. The thermo-mechanical processing of the new implant alloy consisted in plastic deformation (almost 90%) performed by hot rolling accompanied by an initial and final heat treatment. The new Ti-10Zr-5Ta-5Nb alloy presented self-passivation, with a large passive potential range and low passive current densities, namely, a very good anticorrosive resistance in Ringer solution of acid, neutral and alkaline pH values. Cell viability was not affected by the alloy substrate presence and a very good compatibility was noticed.

[Minimally invasive splenectomy for thrombocytopenia associated with liver cirrhosis]

Thrombocytopenia is a common complication in patients with chronic liver disease and corelates with the severity of cirrhosis. Severe trombocytopenia can sinificantly increase the risk of spontaneous bleeding, but even if it is not symptomatic it can complicate the medical management of the cirrhotic patient by postponing diagnistic or therapeutic procedures (liver biopsy, interferon therapy, hepatocellular carcinoma resection). In consequence, numerous procedures were imagined to reverse thrombocytopenia associated with liver cirrhosis, among wich splenectomy. Due to the extreme invasiveness of the clasic approach in patients with hipersplenism (risk of bleeding, postoperative pain) especially in those with advanced cirrhosis, minimally invasive splenectomy appears to offer a safe and effective method for reversing thrombocytopenia in a highly selected group of patients with liver cirrhosis (Child A cirrhosis without other significant medical comorbid conditions). In these cases the surgical procedure is associated with low morbidity, blood loss and short hospital stay.

Micro- and nanoparticles--medical applications

It is a long-standing need of the pharmaceutical industry, physicians, and patients to improve pharmaceutical formulations by establishing simpler, less expensive preparations and treatments, while reducing toxicity. This need can be met with the know-how of drug delivery science that has already made advance developments in improved delivery of injectibles, oral formulations, drug device implants, as well as topical and transdermal delivery formulations, especially in the case of drug delivery to the brain, an untouchable region by traditional drug delivery systems. The reason behind the failure of conventional delivery systems in reaching the brain is the blood brain barrier (BBB) composed of tight tissues making it impervious to outside agents. Nanotechnology has the potential to address and resolve this challenge and make brain a reachable target for drug delivery systems, by combining unique elements of size, surface activity and charge of nanostructures. Micro and nanoparticles have opened up unexpected ways in diagnostics and therapeutics in medicine. The previous treatment strategies in the fields of autoimmune diseases and cancer involved non-targeted treatment options with extensive "collateral damage." Nanodelivery of drugs is predicted to reduce this collateral damage, extend the drug's availability and effectiveness at the site, and reduce toxicity and cost with a high pay-off load. In this review we present the role of micro and nanoparticles in drug delivery and some applications in the health care fields.

Robotic radical hysterectomy with pelvic lymphadenectomy: our early experience

INTRODUCTION

Robotic surgery overcomes some limitations of laparoscopic surgery for prostate, rectal and uterine cancer. In this study we analyze the feasibility of robotic radical hysterectomy with pelvic lymphadenectomy in gynecological cancers in a developping program of robotic surgery.

MATERIAL AND METHODS

This prospective study started the 1st of March 2008. Since then, 250 cases of robotic surgery were performed out of which 29 cases addressed gynecological conditions. We selected all radical interventions summing up to 19 cases.

RESULTS

Our final group consisted of 19 patients, a gedbetween 30 and 78 years old, with an average age of 53.22 years (+/- 10.03). Twelve patients were diagnosed with cervical cancer, the rest of them with endometrial cancer. Mean operative time was 180 +/- 23.45 min. Oral intake were started the next day after the operation and the patients were discharged 3.5 (+/- 1.2) days postoperatively. There were 3 urinary complications in patients with tumors adherent to the urinary bladder.

CONCLUSIONS

We believe that robotic radical hysterectomy with pelvic lymphadenectomy in gynecological cancers is a rapid, feasible, and secure method that should be used whenever available. However further prospective studies and late follow-up results are needed in order to fully assess the value of this new technology.

[Nonparasitic splenic cysts--therapeutic solutions]

Between 2002-2009, 25 cases of non-parasytic splenic cysts were treated in the Center of General Surgery and Liver Transplantation of Fundeni Clinical Institute. Among these cases, 11 patients were approached classically (8 total splenectomie and 3 partial cystectomies) and 14 patients were operated in a minimally invasive fashion (there were 3 total splenectomies, 2 subtotal splenectomies and 7 partial cystectomies, all accomplished laparoscopically, and one robotic total splenectomy and one robotic subtotal splenectomy). Recurrence rates vary according to the procedure. Laparoscopic partial cystectomy is a safe and feasible method, with minimal morbidity but with higher recurrence rates. The treatment of choice is the minimally invasive ideal cystectomy, achieved by laparoscopic partial splenectomy, that has the benefits of preserving the immune function of the spleen.

[New tendencies in controlled drug release--liposomes entrapped in polymer matrices]

Liposomes entrapment in different forms of polymers represents in the last few years a method to modify the drug release kinetics in order to attend the specificity of this phenomenon. This will result generally in complex systems in which liposomes are dispersed in polymer matrices like gels, hydrogels and microparticles. As a consequence the drug release will be influenced by both polymer matrix and small carrier entrapped in. The researchers are trying to control the release of drug from such solid complex system by modulating not only the vesicle properties but also those of polymer support. This kind of system is necessary also for the cases when time stable liposomes are desired, being already well known that the major drawback of this type of carrier is the stability in time and in different physiologic conditions.

Collagen-hydroxyapatite composites with applications as bone substitutes: synthesis and characterisation

The paper presents synthesis, swelling properties and in vitro degradation tests of collagen-hydroxyapatite composites, in the order to obtain new bone substitutes. Also, by using a 3D analysis with finite element the tension distribution at bone--synthesised substitute interface and in bone by comparing to bone substitute was determined.

MATERIALS AND METHOD

Collagen type I from tendon bovine source, provided from Sigma-Aldrich, has been used for materials synthesis. Composite materials have been obtained by hydroxyapatite (HA) precipitation from its precursors (aqueous solutions of CaCl2 and NaH2PO4), in the presence of NH4OH and process finalising at 37 degrees C. Three types of materials have been prepared: 75% collagen--25% HA(w/w)--Coll75-HA; 50% collagen--50% HA(w/w)--Coll50-HA; 25% collagen--75% HA(w/ w)--Coll25-HA. Swelling properties of the composite materials were evaluated gravimetrically and in vitro degradation in buffered collagenase was studied. The elasticity modulus was calculated from the dependence force versus material's strain. The 3D analysis with finite element at bone--synthesised substitute interface was performed for a right osteosynthesised fracture from femur.

RESULTS AND DISCUSSION

Materials swelling in simulated body fluids revealed higher equilibrium swelling degree for HA-collagen composites with increased content of collagen. Materials are degraded by collagenase, the degradation rate being strongly dependent by composition; a higher content of collagen makes the composites more sensitive to the specific enzyme. SEM data have shown the forming of hydroxyapatite crystals onto collagen fibers. The mechanical characterisation has shown a limited elasticity at an increased value of the applied force for Coll25-HA. Over these forces the plasticity was observed. By using the 3D analysis with finite element at bone--synthesised substitute interface a higher strength was determined in the bone by comparison to bone substitute.

CONCLUSIONS

The superior elasticity properties of the synthesised collagen-HA by comparison to physiological biomechanical limits indicate a good behaviour as resistance bone substitute with applications in the extensive bones reconstruction (endoprosthesis revision, bone infections etc.).

The occurrence and antimicrobial susceptibility of salmonellae isolated from commercially available canine raw food diets in three Canadian cities

The purpose of the present study was to evaluate the prevalence and antimicrobial resistance patterns of Salmonella isolated from commercially available canine raw food diets in Canada. A total of 166 commercial frozen raw food diet samples were purchased from randomly selected local pet stores in three Canadian cities for a period of 8 months. All samples were evaluated for the presence of Salmonella, serotyped and tested for antimicrobial susceptibility. There was an overall Salmonella prevalence of 21%; chicken was an ingredient for 67% of the Salmonella-positive diets. Eighteen different Salmonella serotypes were recovered, and resistance was observed to 12 of the 16 antimicrobials tested, with the majority of Ontario isolates exhibiting resistance to ampicillin and Calgary isolates to tetracycline. This study demonstrates the potential risk of raw food diets, especially for immunocompromised individuals, and stresses the need for implementing regulatory guidelines for the production of these diets in order to help control and ideally eliminate the bacterial risks associated with their use and consumption.

The occurrence and anti-microbial susceptibility of Salmonellae isolated from commercially available pig ear pet treats

In Canada, there have been reported outbreaks of human salmonellosis related to exposure to animal-derived pet treats, involving pig ear treats, beef steak patty dog treats and pet treats of seafood origin. As a follow-up to recommendations made to the pig ear treat industry in 1999, a total of 245 pig ear treats were purchased in two Canadian cities to provide evidence of adoption of the recommendations and to determine the current levels of Salmonella contamination of pig ear treats available at pet stores. An overall prevalence of 4% was observed, with isolates exhibiting resistance to up to seven anti-microbials. Serotypes recovered included S. Bovismorbificans, S. Give, S. Derby and S. Typhimurium var. Copenhagen. Although the prevalence observed during this study is lower than the prevalence observed in 1999, pig ear treats should still be considered as a possible source of Salmonella and anti-microbial resistant bacteria to humans and dogs in Canada.

Prevention perspective in orthodontics and dento-facial orthopedics

In the present context of the public health directions, considering WHO main objective, that "all people of the world could reach the highest possible health level", in medicine, the accent is put on prevention. In spite of the important progresses achieved in orthodontics field, the treatment still remains a symptomatic one. In this context, we must ask ourselves what are the prevention theoretical and practical coordinates in orthodontics, which measures are available or could be elaborated for preventing the malocclusions development. From the clinical point of view, the most important element of the new perspective is that most of the cases of anomalies which in the present are cured by orthodontics are induced by functional and environmental factors and they can theoretically be prevented. Thus, the identification, control and guidance of the environmental factors which adjust the growing of the maxillaries and of the other cranio-facial structures would be the main target of a prevention program in orthodontics.

New radiopaque acrylic bone cement. II. Acrylic bone cement with bromine-containing monomer

Bromine-containing methacrylate, 2-(2-bromopropionyloxy) ethyl methacrylate (BPEM), had been used in the formulation of acrylic radiopaque cements. The effect of this monomer incorporated into the liquid phase of acrylic bone cement, on the curing parameters, thermal properties, water absorption, density, compression tests and radiopacity was studied. A decrease of maximum temperature and an increase of the setting time were observed with the addition of the bromine-containing monomer in the radiolucent cement composition. Adding BPEM in radiolucent acrylic bone cements composition results in the decrease of glass transition temperature and increase of its thermal stability. Acrylic bone cements modified with bromine-containing comonomer are characterized by polymerization shrinkage lower than the radiolucent cement. Addition of bromine-containing comonomer in radiolucent acrylic bone cement composition determines the increase of compressive strength. Acrylic bone cements modified with bromine-containing comonomer proved to be radiopaque.

Multisystemic Therapy for social, emotional, and behavioral problems in youth aged 10-17

BACKGROUND

Multisystemic Therapy (MST) is an intensive, home-based intervention for families of youth with social, emotional, and behavioral problems. Masters-level therapists engage family members in identifying and changing individual, family, and environmental factors thought to contribute to problem behavior. Intervention may include efforts to improve communication, parenting skills, peer relations, school performance, and social networks. Most MST trials were conducted by program developers in the USA; results of one independent trial are available and others are in progress.

OBJECTIVES

To provide unbiased estimates of the impacts of MST on restrictive out-of-home living arrangements, crime and delinquency, and other behavioral and psychosocial outcomes for youth and families.

SEARCH STRATEGY

Electronic searches were made of bibliographic databases (including the Cochrane Library, C2-SPECTR, PsycINFO, Science Direct and Sociological Abstracts) as well as government and professional websites, from 1985 to January 2003. Reference lists of articles were examined, and experts were contacted.

SELECTION CRITERIA

Studies where youth (age 10-17) with social, emotional, and/or behavioral problems were randomised to licensed MST programs or other conditions (usual services or alternative treatments).

DATA COLLECTION AND ANALYSIS

Two reviewers independently reviewed 266 titles and abstracts; 95 full-text reports were retrieved, and 35 unique studies were identified. Two reviewers independently read all study reports for inclusion. Eight studies were eligible for inclusion. Two reviewers independently assessed study quality and extracted data from these studies. Significant heterogeneity among studies was identified (assessed using Chi-square and I(2)), hence random effects models were used to pool data across studies. Odds ratios were used in analyses of dichotomous outcomes; standardised mean differences were used with continuous outcomes. Adjustments were made for small sample sizes (using Hedges g). Pooled estimates were weighted with inverse variance methods, and 95% confidence intervals were used.

MAIN RESULTS

The most rigorous (intent-to-treat) analysis found no significant differences between MST and usual services in restrictive out-of-home placements and arrests or convictions. Pooled results that include studies with data of varying quality tend to favor MST, but these relative effects are not significantly different from zero. The study sample size is small and effects are not consistent across studies; hence, it is not clear whether MST has clinically significant advantages over other services.

AUTHORS' CONCLUSIONS

There is inconclusive evidence of the effectiveness of MST compared with other interventions with youth. There is no evidence that MST has harmful effects.