Lymphadenectomy in the surgical management of the malignant gastric tumors

Scopul lucrării. Tumorile gastrice de-a lungul anilor rămân o provocare chirurgicală nu numai în Republica Moldova, dar și la nivelul mondial. Tratamentul chirurgical pe tot parcursul evoluției rămâne o metodă principală, evoluând de la unica posibilitate de tratament la o etapă de abordare multidisciplinară. În clinica chirurgie 2 s-a schimbat și tactica chirurgicală, de la rezecție gastrică simpla la gastrectomii totale sau subtotale asociate cu limfodisectie extinse, metastazectomii sau rezecții multiviscerale. Pentru a atinge principalul scop în tratamentul CG, prelungirea supraviețuirii generale a acestor pacienți, s-a adoptat o abordare chirurgicală agresivă pentru obținerea eventualii rezecabilități oncologice. Materiale și metode. Retrospectiv s-au analizat 386 pacienți internați în clinica chirurgie 2 pe parcursul anilor 2000-2019 cu diagnosticul de CG. 316 (81,9%) au fost supuși tratamentului potențial curativ (rezecție chirurgicală), iar alții 94 (18,1%) au beneficiat doar de tratament paliativ. Rezultate. Complicațiile CG (hemoragii profuze, perforații cu peritonită) au fost motivul de intervenții chirurgicale pe indicații vitale în 29 cazuri. Spectrul de intervenții chirurgicale programate: disecție submucoasă a CG în stadiul Tis, T1, gastrectomii totale sau subtotale asociate cu limfadenectomie D1, D2, D3, gastrectomii asociate cu metastazectomii hepatice, pancreatectomie distală și/ sau splenectomie, rezecții pluriviscerale în CG cu invazie în organe vecine. Ca rezultat am obținut morbiditatea postoperatorie 16%, mortalitatea 2%. Supraviețuirea generală la 5 ani în toate stadiile 37%. Supraviețuirea generală la pacienții în stadiul II și III după limfadenectomie D1, D2 și D3 este 38%, 44% și 45% corespunzător. Pacienți operați în stadiul IV local avansat au o supraviețuire similară de 28-30% în toate modalitățile de limfadenectomie. La fel rezecția R0 oferă o supraviețuire generală la 5 ani și supraviețuire fără recidivă mai lungă în stadiul II, III (41%) vs R1(34%) și nu prezintă diferență în stadiul IV local avansat (28%). Concluzii. Paralel cu evoluția tratamentului adjuvant s-a schimbat și atitudinea chirurgicală față de cancerul gastric CG. Studiile clinice și evoluțiile tehnice moderne au facilitat puternic utilizarea unei abordări multimodale în tratamentul CG. Abordarea chirurgicală este diversă de la intervenții endoscopice minim invazive până la gastrectomii totale cu limfodisectii extinse și rezecții pluriviscerale. Gastrectomiile asociate cu limfadenectomie D2 a devenit operație standard în orice stadiu al CG.Aim of study. Gastric cancer (GC) over the years remains a surgical challenge not only in the Republic of Moldova, but also in the world. Surgical treatment throughout evolution remains a major method, evolving from the unique treatment option to a multidisciplinary approach. Over the years, Surgery Clinic 2 has also changed surgical tactics, from simple gastric resection to total gastrectomies or subtotal gastrectomies associated with extensive lymphodissection, metastasectomy, or multivisceral resections. In order to achieve the main goal in the treatment of GC, to prolong the overall survival of these patients, an aggressive surgical approach was adopted to obtain eventual oncological resection. Materials and methods. We analyzed 386 patients admitted to Surgery 2 clinic during the years 2000-2019 with the diagnosis of GC. Out of which 316 (81.9%) were subjected to the potential curative treatment (surgical resection), 94 (18.1%) benefited only from palliative treatment. Results. Complications of gastric cancer (profuse haemorrhage, perforation with peritonitis) have been the cause of vital signs surgery in 29 cases. The spectrum of surgery: submucosal dissection of GC in stage Tis, T1, total or subtotal gastrectomy associated with lymphadenectomy D1, D2, D3, gastrectomy associated with hepatic metastasectomy, distal pancreatectomy and/or splenectomy, plurivisceral resections in gastric cancer with invasion in adjacent organs. Postoperative morbidity 16%, 2% mortality. Overall survival at 5 years at all stages 37%. Overall survival in Stage II and III patients after D1, D2 and D3 lymphadenectomy is 38%, 44% and 45%. Patients operated in the locally advanced stage IV have similar survival rates of 28-30% in all lymphadenectomy modalities. Similarly, R0 resection provides overall 5-year survival and recurrence free survival in Stage II, III (41%) versus R1 (34%) and no difference in locally advanced stage IV (28%). Conclusions. With the progression of adjuvant treatment, surgical attitude for GC has also changed. Clinical studies and modern technical developments have greatly facilitated the use of a multimodal approach to the treatment of gastric cancer. The surgical approach is varied from minimally invasive endoscopic interventions to total gastrectomies with extensive lymphadenectomy and plurivisceral resections. Gastrectomy associated with D2 lymphadenectomy has become standard surgery in any stage of GC

Benign obstructive pathology of extrahepatic biliary ducts: diagnosis and treatment

Catedra Chirurgie nr.2, USMF ”Nicolae Testemiţanu”, LCŞ “Chirurgia reconstructivă a tractului digestiv”, Spitalul Clinic Republican, Secţia Endoscopie, Spitalul Internaţional “Medpark”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Tratamentul de elecţie în patologia benignă a căilor biliare extrahepatice (CBE): stenoza papilei duodenale mari (PDM), stricturi ale căii biliare principale (CBP), colangite, coledocolitiaza pe fondalul malrotaţiei duodenale (MRD) asociată cu duodenostază, este chirurgical. Metodele endoscopice: colangiopancreatografia retrogradă endoscopică (CPGRE), papilosfincterotomia endoscopică (PSTE) cu sau fără litextracţie permit stabilirea diagnosticului de patologie a CBE şi selectarea tratamentului potrivit. Scopul studiului: Optimizarea tratamentului chirurgical al pacienţilor cu patologie benignă a CBE pe fondal de MRD asociată cu duodenostază. Material şi metode: Lotul de cercetare – 140 pacienţi selectaţi în perioada 1998-2014. Toţi au fost examinaţi conform algoritmului diagnostic stabilit în Clinica Chirurgie nr.2. Apreciate clinic trei grade ale duodenostazei: compensată, subcompensată, decompensată. Rezultate: Tratamentul chirurgical a fost bazat pe principii etiopatogenetice în funcţie de gradele clinice. I – Stricturile PDM și duodenostază compensată – CPGRE+PSTE – 130 pacienţi (92,8%); II – Stricturile PDM + coledocolitiază + angiocolită şi duodenostază subcompensată – CPGRE + PSTE + litextracţie + sanarea CBE cu terapie medicamentoasă complexă – 98 pacienţi (70,0%); III – Megalocoledoc şi duodenostază decompensată – transecţie supraduodenală de CBP cu implantarea ei în ansa jejunală în ”Y a la Roux”, cu o lungime optimă a ansei de 80 cm – 12 pacienţi (8,57%). Concluzii: Metoda tratamentului chirurgical aplicat depinde de gravitatea patologiei CBE şi stadializarea duodenostazei. Eficienţa acestui tratament chirurgical este determinată de dispariţia semnelor clinice de colangită cronică, cu rezultate bune în perioada postoperatorie – 131 (93,57%) pacienţi, ce au fost reintegraţi socio-familial şi profesional.Introduction: The elective treatment in the pathology of extrahepatic biliary ducts (EBD): stenosis of large duodenal papilla (LDP), stricture of the main biliary duct (MBD), cholangitis, coledocholithiasis on the background of duodenal malrotation (DMR) associated with duodenostasis is a surgical one. Endoscopic methods: endoscopic retrograde cholecistopancreatography (ERCP), endoscopic papilosphyncterotomy (EPST) with or without stones extraction can determine the diagnosis of EBD pathology and treat it as well. The aim of the study: optimizing of surgical treatment of patients with benign EBD pathology on the background of DMR associated with duodenostasis. Material and methods: Studied group – 140 patients selected from 1998 to 2014 period. All of them were examined according to the algorithm proposed by Surgical Department Nr.2. There were three clinical stages of duodenostasis: compensated, subcompensated, decompensated. Results: Surgical treatment – based on ethiopathogenetic principles related to clinical stages. I – LDP strictures and compensated duodenostasis – ERCP+EPST – 130 patients (92.8%); II – LDP strictures + choledocolithiasis + cholangitis and subcompensated duodenostasis – ERCP + EPST + litextraction + MBD sanation and complex drug therapy – 98 patients (70.0%); III – Megalocholedoc and decompensated duodenostasis – supraduodenal transsection of MBD with its implantation in a 80 cm long “Y a la Roux” intestinal loop – 12 patients (8.57%). Conclusions: The chosen surgical method depends on the gravity of EBD pathology and duodenostasis stage. The efficiency of surgical treatment is determined by disappearance of clinical signs of chronic cholangitis with good postoperative results – 131 (93.75%) patients reintegrated in socio-familial and professional aspects

Développement d'un capteur colorimétrique innovant pour la détection directe du phénol dans l'air et dans l'eau

International audienc

Gray matter networks and clinical progression in subjects with predementia Alzheimer's disease

We studied whether gray matter network parameters are associated with rate of clinical progression in nondemented subjects who have abnormal amyloid markers in the cerebrospinal fluid (CSF), that is, predementia Alzheimer's disease. Nondemented subjects (62 with subjective cognitive decline; 160 with mild cognitive impairment (MCI); age = 68 ± 8 years; Mini-Mental State Examination (MMSE) = 28 ± 2.4) were selected from the Amsterdam Dementia Cohort when they had abnormal amyloid in CSF (<640 pg/mL). Networks were extracted from gray matter structural magnetic resonance imaging (MRI), and 9 parameters were calculated. Cox proportional hazards models were used to test associations between each connectivity predictor and rate of progression to MCI or dementia. After a median time of 2.2 years, 122 (55%) subjects showed clinical progression. Lower network parameter values were associated with increased risk for progression, with the strongest hazard ratio of 0.29 for clustering (95% confidence interval = 0.12-0.70; p < 0.01). Results remained after correcting for tau, hippocampal volume, and MMSE scores. Our results suggest that at predementia stages, gray matter network parameters may have use to identify subjects who will show fast clinical progression

Reliability investigation of a carbon nanotube array thermal interface material

As feature density increases within microelectronics, so does the dissipated power density, which puts an increased demand on thermal management. Thermal interface materials (TIMs) are used at the interface between contacting surfaces to reduce the thermal resistance, and is a critical component within many electronics systems. Arrays of carbon nanotubes (CNTs) have gained significant interest for application as TIMs, due to the high thermal conductivity, no internal thermal contact resistances and an excellent conformability. While studies show excellent thermal performance, there has to date been no investigation into the reliability of CNT array TIMs. In this study, CNT array TIMs bonded with polymer to close a Si-Cu interface were subjected to thermal cycling. Thermal interface resistance measurements showed a large degradation of the thermal performance of the interface within the first 100 cycles. More detailed thermal investigation of the interface components showed that the connection between CNTs and catalyst substrate degrades during thermal cycling even in the absence of thermal expansion mismatch, and the nature of this degradation was further analyzed using X-ray photoelectron spectroscopy. This study indicates that the reliability will be an important consideration for further development and commercialization of CNT array TIMs

Особенности развития и клинического течения пневмоторакса у больных новой коронавирусной инфекцией

New coronavirus infection (COVID-19) is a modern global problem that requires the rapid development of diagnostic and treatment methods, as well as the study of pathological effects on body tissues. Due to severe damage to the respiratory organs, special attention is paid to the study of pneumothorax as a manifestation of gas syndrome, one of the complications of COVID-19.The purpose of the study was to assess the incidence of pneumothorax as a complication of COVID-19, the features of the development of the pathological process, and to determine the criteria for treatment tactics.Materials and methods. In total, for the period from April 2020 to May 2022 at the Clinical Infectious Diseases Hospital named after. S.P. Botkin treated 31532 patients with a confirmed diagnosis of COVID-19. As part of this study, the case histories of 316 patients with clinical manifestations of gas syndrome were retrospectively analyzed. All patients were diagnosed with COVID-19, the diagnostic criterion of which was a positive result of the PCR test – the detection of RNA in a swab taken from the nasopharynx and oropharynx.Results. Analysis of case histories showed that severe COVID-19 occurs in all age groups. Collapse of half of the lung was observed in most cases (59 patients). The main treatment method for pneumothorax was Bulau drainage. At the same time, in 47 patients (32%) this method required active aspiration. In 37 patients (26%), drainage was corrected and the pleural cavity was re-drained. In 37 patients, the result of hospitalization was a fatal outcome, the main causes of which were severe pneumonia and/or severe immunodeficiency, 75 patients (52%) were discharged from the hospital in a stable condition.Conclusions. The occurrence of pneumothorax in patients with COVID-19 is characterized by late onset, protracted course, the formation of purulent complications and a high incidence of fatal outcomes, which do not always correlate with the severity of pneumonia.Новая коронавирусная инфекция – это современная глобальная проблема, требующая быстрой разработки методов диагностики и лечения, а также изучения патологического влияния на ткани организма. Вследствие выраженного повреждения органов дыхания особо важным представляется изучение пневмоторакса как проявления газового синдрома, одного из осложнений новой коронавирусной инфекции.Цель: оценить частоту встречаемости пневмоторакса как осложнения новой коронавирусной инфекции, особенности развития патологического процесса, а также определить критерии в лечебной тактике.Материалы и методы. Всего за период с апреля 2020 г. по май 2022 г. в Клинической инфекционной больнице им. С.П. Боткина пролечено 31 532 пациента с подтвержденным диагнозом новой коронавирусной инфекции. В рамках данного исследования ретроспективно проанализированы истории болезни 316 пациентов с клиническими проявлениями газового синдрома. У всех больных был выявлен COVID-19, диагностическим критерием которого являлся положительный результат ПЦР-теста – обнаружение РНК в мазке, взятом из носоглотки и ротоглотки.Результаты. Анализ историй болезни показал, что тяжелое течение новой коронавирусной инфекции встречается во всех возрастных группах. Коллабирование легкого на 1/2 наблюдалось в большей части случаев (59 пациентов). Основным методом лечения пневмоторакса является дренирование по Бюлау. При этом у 47 пациентов (32%) данный метод потребовал проведения активной аспирации. У 37 пациентов (26%) проведена коррекция дренажа и редренирование плевральной полости. У 37 пациентов итогом госпитализации стал летальных исход, основными причинами которого являлись тяжелое течение пневмонии и/или выраженный иммунодефицит, 75 пациентов (52%) были выписаны из стационара.Выводы. Возникновение пневмоторакса у больных с новой коронавирусной инфекции характеризуется поздним появлением, затяжным течением, формированием гнойных осложнений и высокой частотой летальных исходов, которые не всегда коррелируют с тяжестью течения пневмонии

Destruction of Dopaminergic Neurons in the Midbrain by 6-Hydroxydopamine Decreases Hippocampal Cell Proliferation in Rats: Reversal by Fluoxetine

Background Non-motor symptoms (e.g., depression, anxiety, and cognitive deficits) in patients with Parkinson disease (PD) precede the onset of the motor symptoms. Although these symptoms do not respond to pharmacological dopamine replacement therapy, their precise pathological mechanisms are currently unclear. The present study was undertaken to examine whether the unilateral 6-hydroxydopamine (6-OHDA) lesion to the substantia nigra pars compacta (SNc), which represents a model of long-term dopaminergic neurotoxicity, could affect cell proliferation in the adult rat brain. Furthermore, we examined the effects of the selective serotonin reuptake inhibitor (SSRI) fluoxetine and the selective noradrenaline reuptake inhibitor maprotiline on the reduction in cell proliferation in the subgranular zone (SGZ) by the unilateral 6-OHDA lesion. Methodology/Principal Findings A single unilateral injection of 6-OHDA into the rat SNc resulted in an almost complete loss of tyrosine hydroxylase (TH) immunoreactivity in the striatum and SNc, as well as in reductions of TH-positive cells and fibers in the ventral tegmental area (VTA). On the other hand, an injection of vehicle alone showed no overt change in TH immunoreactivity. A unilateral 6-OHDA lesion to SNc significantly decreased cell proliferation in the SGZ ipsilateral to the 6-OHDA lesion, but not in the contralateral SGZ or the subventricular zone (SVZ), of rats. Furthermore, subchronic (14 days) administration of fluoxetine (5 mg/kg/day), but not maprotiline significantly attenuated the reduction in cell proliferation in the SGZ by unilateral 6-OHDA lesion. Conclusions/Significance The present study suggests that cell proliferation in the SGZ of the dentate gyrus might be, in part, under dopaminergic control by SNc and VTA, and that subchronic administration of fluoxetine reversed the reduction in cell proliferation in the SGZ by 6-OHDA. Therefore, SSRIs such as fluoxetine might be potential therapeutic drugs for non-motor symptoms as well as motor symptoms in patients with PD, which might be associated with the reduction in cell proliferation in the SGZ

Adult Male Mice Emit Context-Specific Ultrasonic Vocalizations That Are Modulated by Prior Isolation or Group Rearing Environment

Social interactions in mice are frequently analysed in genetically modified strains in order to get insight of disorders affecting social interactions such as autism spectrum disorders. Different types of social interactions have been described, mostly between females and pups, and between adult males and females. However, we recently showed that social interactions between adult males could also encompass cognitive and motivational features. During social interactions, rodents emit ultrasonic vocalizations (USVs), but it remains unknown if call types are differently used depending of the context and if they are correlated with motivational state. Here, we recorded the calls of adult C57BL/6J male mice in various behavioral conditions, such as social interaction, novelty exploration and restraint stress. We introduced a modulator for the motivational state by comparing males maintained in isolation and males maintained in groups before the experiments. Male mice uttered USVs in all social and non-social situations, and even in a stressful restraint context. They nevertheless emitted the most important number of calls with the largest diversity of call types in social interactions, particularly when showing a high motivation for social contact. For mice maintained in social isolation, the number of calls recorded was positively correlated with the duration of social contacts, and most calls were uttered during contacts between the two mice. This correlation was not observed in mice maintained in groups. These results open the way for a deeper understanding and characterization of acoustic signals associated with social interactions. They can also help evaluating the role of motivational states in the emission of acoustic signals

Enhanced Fear Expression in a Psychopathological Mouse Model of Trait Anxiety: Pharmacological Interventions

The propensity to develop an anxiety disorder is thought to be determined by genetic and environmental factors. Here we investigated the relationship between a genetic predisposition to trait anxiety and experience-based learned fear in a psychopathological mouse model. Male CD-1 mice selectively bred for either high (HAB), or normal (NAB) anxiety-related behaviour on the elevated plus maze were subjected to classical fear conditioning. During conditioning both mouse lines showed increased fear responses as assessed by freezing behaviour. However, 24 h later, HAB mice displayed more pronounced conditioned responses to both a contextual or cued stimulus when compared with NAB mice. Interestingly, 6 h and already 1 h after fear conditioning, freezing levels were high in HAB mice but not in NAB mice. These results suggest that trait anxiety determines stronger fear memory and/or a weaker ability to inhibit fear responses in the HAB line. The enhanced fear response of HAB mice was attenuated by treatment with either the α2,3,5-subunit selective benzodiazepine partial agonist L-838,417, corticosterone or the selective neurokinin-1 receptor antagonist L-822,429. Overall, the HAB mouse line may represent an interesting model (i) for identifying biological factors underlying misguided conditioned fear responses and (ii) for studying novel anxiolytic pharmacotherapies for patients with fear-associated disorders, including post-traumatic stress disorder and phobias

Neuroregeneration in neurodegenerative disorders

<p>Abstract</p> <p>Background</p> <p>Neuroregeneration is a relatively recent concept that includes neurogenesis, neuroplasticity, and neurorestoration - implantation of viable cells as a therapeutical approach.</p> <p>Discussion</p> <p>Neurogenesis and neuroplasticity are impaired in brains of patients suffering from Alzheimer's Disease or Parkinson's Disease and correlate with low endogenous protection, as a result of a diminished growth factors expression. However, we hypothesize that the brain possesses, at least in early and medium stages of disease, a "neuroregenerative reserve", that could be exploited by growth factors or stem cells-neurorestoration therapies.</p> <p>Summary</p> <p>In this paper we review the current data regarding all three aspects of neuroregeneration in Alzheimer's Disease and Parkinson's Disease.</p