Minimally invasive approach to colorectal tumors - 3 years of experience in a private hospital

Spitalul Privat ”Sanador”, București, România, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Abordul minim invaziv al tumorilor colo-rectale reprezintă o preocupare a colectivului Spitalului privat Sanador, în pofida adresabilității crescute a cancerelor în stadii avansate, procentul acestora din totalul intervențiilor chirurgicale pentru această patologie rămânând constant, printr-o atentă selecție a pacienților, care sa beneficieze de avantajele laparoscopiei. Material și metode: Studiul prezent analizează intervențiile chirurgicale pentru tumori colo-rectale efectuate între anii 2016-2018 în Spitalul Sanador București. Din totalul de 214 intervenții chirurgicale pentru patologia colo-rectală, 41 au fost prin abord minim invaziv, reprezentând procentual 20% din totalul intervențiilor pentru această patologie, procentul fiind constant în fiecare din acești ani: 2016 – 13 intervenții prin abord minim invaziv din totalul de 68 (19.11%); 2017 – 17 intervenții prin abord minim invaziv din totalul de 79 (21.5%); 2018 – 11 intervenții chirurgicale prin abord minim invaziv dintr-un total de 57 (19.3%). Rezultate: Cele mai frecvente localizări ale tumorilor pentru care indicația a fost de abord minim invaziv, au fost cele recto-sigmoidiene (28). Selecția pacienților s-a facut după stadializarea preoperatorie, admitându-se ca și abord laparoscopic tumori T1, T2, T3, în rare cazuri T4. În cazul tumorilor avansate, substadializate preoperator, s-a tentat efectuarea a cât mai multor timpi din cadrul rezecției, prin abord minim invaziv, iar cazurile in care anastomozele au fost efectuate extracorporeal nu au fost interpretate ca și conversie. Concluzii: Rezultatele bune se înscriu în rândul celor ale centrelor cu volum și experiența mari în abordarea minim invazivă a tumorilor colo-rectale și constituie premize pentru creșterea procentului de astfel de intervenții în clinica noastră.Introduction: The minimally invasive approach of colorectal tumors is a concern of the Sanador private hospital team, despite the increased addressability of cancers in advanced stages, their percentage of total surgical interventions for this pathology remaining constantly through a careful selection of patients who benefit from the advantages of laparoscopy. Material and methods: The present study examines surgical interventions for colorectal tumors performed between 2016-2018 at Sanador Hospital Bucharest. Of the total of 214 surgical procedures for rectal pathology, 41 were by minimally invasive approach, accounting for 20% of all interventions for this pathology, the percentage being constant in each of these years: 2016-13 interventions through the minimally invasive approach of the total of 68 (19.11%); 2017 - 17 interventions through minimally invasive approach from the total of 79 (21.5%); 2018 - 11 minimally invasive surgical interventions from a total of 57 (19.3%). Results: The most common tumor localizations for which the indication was minimally invasive were the recto-sigmoid (28). Selection of patients was made after preoperative staging, admitting as a laparoscopic approach T1, T2, T3 tumors, in rare cases T4. In the case of advanced tumors, pre-operative substations, it was tempting to perform as many times as possible in the resection through a minimally invasive approach, and the cases in which the anastomoses were performed extracorporeally were not interpreted as conversion. Conclusions: Good results are among those with large volume centers and great experience in the minimally invasive approach of colorectal tumors and are prerequisites for increasing the percentage of such interventions in our clinic

The crosstalk between insulin resistance, systemic inflammation, redox imbalance and the thyroid in subjects with obesity

We aimed at assessing the interaction between visceral adipose tissue (VAT), insulin resistance (IR), circulating levels of monocyte chemoattractant protein-1 (MCP-1) and malondialdehyde (MDA) and the thyroid parameters in obese subjects. Methods. Obese subjects without thyroid pathologies or diseases associated with systemic inflammation and OS were recruited. Insulinemia, visceral fat thickness, metabolic and thyroid parameters were assayed. Circulating levels of MCP-1 and MDA were used to quantify inflammation and OS. Results. A number of 160 obese subjects were included. The MCP-1 level increased with the degree of obesity and HOMA-IR. MCP 1 was positively associated with antithyroperoxidase antibody (TPOab) levels and the frequency of Hashimoto’s thyroiditis (HT). The MDA level was positively correlated with the degree of obesity, aspartate aminotransferase and MCP-1. MDA was an independent predictor for the occurrence of hypothyroidism. IR patients showed higher fT3 levels and a positive association between insulin and TPOab levels. Conclusions. Systemic inflammation increased with VAT, IR and OS and was correlated with the frequency and the severity of HT, suggesting that, in obesity, MCP-1 could be part of the etiopathogenesis of autoimmune thyroiditis. MDA was an independent risk factor for hypothyroidism; therefore, redox imbalance associated with obesity can produce cell damage and thyroid dysfunction. FT3 is increased in IR patients, thus being a marker for the severity of metabolic impairment

Laparoscopic treatment for perforated duodenal ulcer

Clinica de Chirurgie 2, UMF “Victor Babeș” Timișoara, Clinica de Chirurgie, UMF ”Carol Davila”, București, Clinica de Chirurgie 2, UMF ”Grigore T Popa”, Iași, Clinica de Chirurgie 2, Facultatea de Medicină, Universitatea ”Ovidius”, Constanța, Clinica de Chirurgie 2, Facultatea de Medicina, Sibiu, Clinica de Chirurgie 1, UMF ”Iuliu Hațieganu”, Cluj- Napoca, Departamentul de Chirurgie I, Facultatea de Medicină, UMF Craiova, România, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Acest studiu retrospectiv evaluează rezultatele tratamentului laparoscopic în ulcerul duodenal perforat și este realizat în 7 spitale cu experiență în chirurgia laparoscopica din România. Material și metode: Între anii 2006 și 2013, 297 pacienți (48 femei, 249 bărbați) cu vârste cuprinse între 18 și 77 ani au fost supuși intervenției chirurgicale laparoscopice pentru ulcer duodenal perforat, cu utilizarea a 3 (61%), 4 (29%) sau 5 (10%) trocare. Șaizeci și doi (21%) dintre pacienți au prezentat o formă ușoară, 190 (64,1%) au prezentat o formă moderată și 45 (14,9%) o formă severă de peritonită. Procedurile utilizate au fost: sutura simplă – 118 (39,8%) pacienți, sutura cu epiplonoplastie – 176 (59,5%), doar epiplonoplastie – 1 (0,3%) pacient, excizie și sutură – 1 (0,3%) pacient. Rezultate: Durata intervențiilor a fost între 30 și 120 minute, cu o medie de 65 minute. Mortalitatea a fost nulă. Complicații: infecții parietale – 3 (1%), fistule duodenale – 3 (1%), abcese abdominale – 2 (0,6%), hemoragii digestive – 1 (0,3%) și stenoza duodenală – 1 (0,3%). Durata medie de spitalizare – 5,5 zile. În comparație cu tehnica clasica, pacienții au necesitat mai puține analgetice și antibiotice, cu 80% mai puține pansamente și au avut cu 70% mai puține infecții parietale în evoluția postoperatorie. Concluzii: Tratamentul laparoscopic pentru ulcerul duodenal perforat, este recomandat chiar și în cazurile cu peritonită severă, evoluția postoperatorie fiind cu mai puține complicații și cu o recuperare mai rapidă fața de procedura clasică. Aceast abord poate fi considerat “standard de aur” în tratamentul ulcerului duodenal perforat.Introduction: This retrospective study evaluates results of the laparoscopic treatment of perforated duodenal ulcer obtained in 7 centers with experience in laparoscopic surgery from Romania. Material and methods: A total of 297 (48 women and 249 men) patients with perforated duodenal ulcer underwent laparoscopic intervention between 2006 and 2013, with ages 18 to 77 years. Three (61%), 4 (29%) or 5 (10%) trocars were used. In 62 patients (21%) was diagnosed mild form of peritonitis, in 190 (64.1%) – moderate and in 45 (14.9%) – severe peritonitis. Types of repair used in this study: simple suture – 118 (39.8%) patients, suture with omental patch – 176 (59.5%), only sutured omental patch – 1 (0.3%), excision and suture – 1 (0.3%) patient. Results: Operation time was between 30 and 120 min, with average of 65 min. Mortality rate was zero. Complications: parietal infections – 3 (1%), duodenal fistula – 3 (1%), intraabdominal abscesses – 2 (0.6%), digestive bleeding – 1 (0.3%) and duodenal stenosis – 1 (0.3%). Average length of hospital stay – 5.5 days. Patients treated using laparoscopic technique needed less analgesics, antibiotics, 80% less dressing procedures and had 70% less surgical site infections in comparison to traditional operation. Conclusions: Laparoscopic treatment of perforated duodenal ulcer can be recommended even for patients with severe peritonitis. This treatment is associated with fewer complications and more rapid recovery than traditional intervention. Laparoscopic repair can be considered “gold standard” in the treatment of perforated duodenal ulcer

Academic student satisfaction and perceived performance in the e-learning environment during the COVID-19 pandemic: Evidence across ten countries

The outbreak of the COVID-19 pandemic has dramatically shaped higher education and seen the distinct rise of e-learning as a compulsory element of the modern educational landscape. Accordingly, this study highlights the factors which have influenced how students perceive their academic performance during this emergency changeover to e-learning. The empirical analysis is performed on a sample of 10,092 higher education students from 10 countries across 4 continents during the pandemic’s first wave through an online survey. A structural equation model revealed the quality of e-learning was mainly derived from service quality, the teacher’s active role in the process of online education, and the overall system quality, while the students’ digital competencies and online interactions with their colleagues and teachers were considered to be slightly less important factors. The impact of e-learning quality on the students’ performance was strongly mediated by their satisfaction with e-learning. In general, the model gave quite consistent results across countries, gender, study fields, and levels of study. The findings provide a basis for policy recommendations to support decision-makers incorporate e-learning issues in the current and any new similar circumstances.info:eu-repo/semantics/publishedVersio

Higher education students’ achievement emotions and their antecedents in e-learning amid COVID-19 pandemic: A multi-country survey

The outbreak of the COVID-19 pandemic has had a wide range of negative consequences for higher education students. We explored the generalizability of the control-value theory of achievement emotions for e-learning, focusing on their antecedents. We involved 17019 higher education students from 13 countries, who completed an online survey during the first wave of the pandemic. A structural equation model revealed that proximal antecedents (e-learning self-efficacy, computer self-efficacy) mediated the relation between environmental antecedents (cognitive and motivational quality of the task) and positive and negative achievement emotions, with some exceptions. The model was invariant across country, area of study, and gender. The rates of achievement emotions varied according to these same factors. Beyond their theoretical relevance, these findings could be the basis for policy recommendations to support stakeholders in coping with the challenges of e-learning and the current and future sequelae of the pandemic.info:eu-repo/semantics/publishedVersio

Oral microbe-host interactions: influence of β-glucans on gene expression of inflammatory cytokines and metabolome profile

Background: The aim of this study was to evaluate the effects of β-glucan on the expression of inflammatory mediators and metabolomic profile of oral cells [keratinocytes (OBA-9) and fibroblasts (HGF-1) in a dual-chamber model] infected by Aggregatibacter actinomycetemcomitans. The periodontopathogen was applied and allowed to cross the top layer of cells (OBA-9) to reach the bottom layer of cells (HGF-1) and induce the synthesis of immune factors and cytokines in the host cells. β-glucan (10 μg/mL or 20 μg/mL) were added, and the transcriptional factors and metabolites produced were quantified in the remaining cell layers and supernatant. Results: The relative expression of interleukin (IL)-1-α and IL-18 genes in HGF-1 decreased with 10 μg/mL or 20 μg/mL of β-glucan, where as the expression of PTGS-2 decreased only with 10 μg/mL. The expression of IL-1-α increased with 20 μg/mL and that of IL-18 increased with 10 μg/mL in OBA-9; the expression of BCL 2, EP 300, and PTGS-2 decreased with the higher dose of β-glucan. The production of the metabolite 4-aminobutyric acid presented lower concentrations under 20 μg/mL, whereas the concentrations of 2-deoxytetronic acid NIST and oxalic acid decreased at both concentrations used. Acetophenone, benzoic acid, and pinitol presented reduced concentrations only when treated with 10 μg/mL of β-glucan. Conclusions: Treatment with β-glucans positively modulated the immune response and production of metabolites

Unravelling the complexity of domestication:A case study using morphometrics and ancient DNA analyses of archaeological pigs from Romania

Funding statement. This work was supported by the Natural Environment Research Council (NE/F003382/1) and the Leverhulme Trust (F/00 128/AX) Acknowledgements. Archaeozoological analyses conducted by A. Ba˘la˘s¸escu were supported by three grants from the Romanian National Authority for Scientific Research, CNCS UEFISCDI (PN-II-RU-TE-20113-0146, PN-II-ID-PCE-2011-3-0982 and PN-IIID-PCE-2011-3-1015). We thank the archeologists Ca˘ta˘lin Bem, Alexandru Dragoman, Valentin Dumitras¸cu, Laura Dietrich, Raluca Koga˘lniceanu, Cristian Micu, Sta˘nica Pandrea, Valentin Parnic, George Trohani, Valentina Voinea for the material they generously provided. We thank the many institutions and individuals that provided sample material and access to collections, especially the curators of the Museum fu¨r Naturkunde, Berlin; Muse´um National d’Histoire Naturelle, Paris; Muse´um d’Histoire Naturelle, Gene`ve; Museum fu¨r Haustierkunde, Halle; National Museum of Natural History, Washington; The Field Museum, Chicago and The American Museum of Natural History, New York; The Naturhistorisches Museum, BernPeer reviewedPublisher PD