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Current Issues.
Volume 1 Issue 1
Case Report Month : 05 (2017)
Rare Neoplastic Condition: How to Treat a Thyroid Lymphoma?
Marica Grasso
Introduction: Primary Thyroid Lymphoma (PTL), although a rare malignancy, can arise in common chronic inflammatory conditions such as
Hashimoto’s thyroiditis. Early detection of malignancy can play a vital role in improved outcomes.
Case Report: We report the case of a 61-year-old man who was referred to the emergency unit due to compressive cervical symptoms.
Fine needle aspiration cytology of the thyroid gland was performed, proving the presence of a dedifferentiated neoplasm (Tyr5).
The patient was submitted to a total thyroidectomy and histological examination revealed a diagnosis of extra nodal marginal B-cell lymphoma
(MALT lymphoma) in a background of chronic lymphocytic thyroiditis.
Results: Thyroid gland does not contain lymphoid tissue. Under pathological conditions, the appearance of lymphocytes may occur promoting the
further development of the disease. This close relationship is probably due to chronic antigenic stimulation leading to malignant transformation. In
this clinical case, the previous diagnosis of Hashimoto’s thyroiditis was not known, but the thyroid histological examination proved the coexistence
of this autoimmune disease.
Conclusion: PTL is a rare disease and the pre-operative diagnosis is not easy. To achieve a permanent resolution of symptoms or a survival
improvement, active surgical intervention is mandatory.
Research Article Month : 05 (2017)
Validation of a Predictive Tool for Assessing the Risk of Non-Sentinel Node
Metastases in Breast Cancer Patients with Sentinel Lymph Node Metastasis
Marco Gipponi
Background: An original predictive tool based on the primary tumor’s and sentinel node’s features able to assess the risk and the extent of nodal
metastases into residual axillary lymph nodes after sentinel node biopsy was proposed.
Materials and Methods: A training set of 1,836 breast cancer patients was assessed to select those clinico-pathological factors to be included into a
multivariate model that was validated in 201 patients.
Results: T stage category (P = .018); histological grading (P = .048), and number of metastatic SN (P = .027) were included into the predictive model
and tested into the validation set (AUC of the ROC curve was .638; P = .001). Four categories of patients, based on the individual probability to have
one or more additional positive nodes, were identified.
Conclusion: This predictive tool may aid in the decision-making as for completion axillary dissection in breast cancer patients with sentinel node
metastasis.
Case Report Month : 05 (2017)
Neglected Congenital Bilateral Trigger Thumb: A Case Reports
Rudy
Neglected congenital bilateral trigger thumb is an uncommon anomaly in children. Its management is controversial, ranging from observation to
extensive surgical release. We report a case presentation of bilateral trigger thumb with a brief review of literature.
Case Report: A 3 years old girl presented with fixed flexion deformity of interphalangeal joints of both thumb. We diagnosed as neglected bilateral
trigger thumb and released of bilateral A1 pulleys.
Methods: The operation was performed under general anaesthesia. A transverse incision was made over the nodule in the tendon of flexor pollicis
longus. The A 1 pulley was divided longitudinally. The tendon of flexor pollicis longus was then delivered into the wound to break down any
adhesions. The thumb was assessed for full extension at the interphalangeal joint.
Results: All thumb MP (metacarpophalangeal) joints were stable with less than 200 of passive hyperextension.The range of motion of MP and IP
was symmetric for both thumb. The children were allowed to mobilise the thumb freely within the dressings. There is no complication occur with
our patient.
Research Article Month : 05 (2017)
Interaction and Correlation of Pin1 with Aurora B Expression in Human
Colorectal Carcinoma Cells
Lixin Jiang and Jian Chen
Background: The Peptidyl-prolylisomerase (PPIase) Pin1 and Aurora B kinase are two important proteins involved in cell cycle progression. They
are frequently over expressed or amplified in human tumors and are regarded as new diagnostic and therapeutic targets. However, to the best of our
knowledge, there is currently no published report about the interaction between Pin1 and Aurora B.
Methods: The interaction between Pin1 and Aurora B in human colorectal cancer cells HCT116 was investigated by Glutathione S-Transferase (GST)
pull-down and immunoprecipitation assays. Their colocalization during mitosis was confirmed by immunofluorescence staining.
Results: We showed binding betweenPin1 and Aurora B in vitro. Over expression of Pin1 resulted in decreased levels of the Aurora B protein,
whereas over expression of Aurora B led to increased expression of Pin1. During mitosis, from the Gap phase to cytokinesis, Aurora B and Pin1
colocalized in the cytoplasm or on the chromosome.
Conclusion: Aurora B could be a substrate for Pin1through the recognition of the pT35 and pT64 sites of Aurora B. Prolyl isomerization by Pin1
may accelerate Aurora B turnover.
Research Article Month : 05 (2017)
Identical Geometrical Profile for Both Craters and Arbitrary Long Incisions
Produced by CO2 Laser Beams onto Irradiated Biological and Non-biological
Samples: The Importance of the Crater’s Horizon Acceleration
Franco Canestri
Background status: In order to forecast with sufficient precision the geometrical profile of a cut
obtained via a moving surgical CO2 laser beam emitting in Continuous Wave (CW), it is recommendable
to produce a single crater with the same desired safety depth and acceptable superficial damage first.
This precaution allows to reduce the risks of starting an uncontrolled cutting process with unfavorable
consequences: a single crater allows to test the selected laser set-up (output power, focal length and beam
profile) under minimal damaging conditions in a volume with the same structural and thermodynamic
characteristics of the cut and where no significant irreversible and permanent large damages can occur.
Goals and objectives: the next logical step is then to select a proper scanning speed of the same laser
focal head and modified set-up over the surgical area to treat, which then would allow to produce a cut
with the identical safe profile obtained with the single accepted test crater.
In more mathematical terms, the incognita to determine is the correct power density distributed over
the complete desired cut length which produces the identical geometrical profile of the original test crater.
As consequence, the correct “cut – speed” equation must guarantee the production of the original test
crater profile all the way from the start to the end of the desired arbitrary incision.
Materials and methods: this Paper presents two separate analytical models and proposes some
preliminary experimental results to be considered for both crater pre-testing and cut generation phases
obtained via CW - CO2 laser beams during forecasting and pre-simulations of challenging interventions
in Operating Room.
Conclusion: the experimental evidence of the presence of an acceleration phase during the early
crater production process in both biological and non-biological is presented and discussed as well.
Volume 2 Issue 1
Review Article Month : 07 (2018)
Robot-assisted Toupet fundoplication and associated cholecystectomy in
symptomatic giant hiatal hernia with situs viscerumin versus—A case report
and literature review
Angela Romano
Introduction: Giant Hiatus Hernia (GHH) is defined as migration of >30% of the stomach with or without other intra-abdominal organs into
the chest. Situs Viscerum Inversusis a rare congenital condition in which the major visceral organs are reversed from their normal arrangement;
they are translated (completely or partially) on the opposite side of the body. Diagnosis is often incidental. We report a Robot-assisted Toupet
fundoplication for a giant hiatal hernia with gastro oesophageal reflux disease and cholelithiasis, in a 63-years-old woman with Situs Viscerum
Inversus (SVI).
Case Presentation: A 63-year-old woman with Situs Viscerum Inversus was diagnosed with giant sliding hiatus hernia. We performed a Robotassisted
procedure of reduction of hiatal hernia in abdomenand Toupet fundoplication with Bio A mesh placement and gastropexy procedure
associated to cholecystectomy. The operation time was of 190 minutes. The patient was discharged on third postoperative day after X-ray check and
he tolerated a solid food.
Conclusion: Minimally invasive surgery represents, nowadays, the standard approach for hiatal hernia and cholelithiasis. In challenging cases as
the giant hernias ad rare anomaly as situs viscerum inversus, the surgical treatment can be facilitated by the use of robotic technology
Review Article Month : 07 (2018)
Surgery 4.0 vs. 4th Generation Robots: Clash of the Titans in the Near Future
of Robotic Surgery
Savvas Hirides
Because title of this article contains many terms that most people -
including most surgeons - are not familiar with, we will try to describe
each one of the protagonists of the predicted “clash of titans” in robotic
surgery, beginning around the year 2020.
Robotic Surgery: Actual Achievements
Robotic surgery was first introduced in surgical theaters after the
year 2000, bringing a two-sided revolution, one real and one dealing
with the “wishful thinking” of innovator surgeons who grew up with
Sci-Fi films. These innovators have finally landed to the cruel reality of
2018, without any particular transformation of the health systems due
to the presence of robots alone. Instead, their hopes were swept away by
the black hole of global financial crisis. Therefore they are still struggling
against great opposition by surgeons, patients, hospital managers and
insurance companies when it comes down to paying for the increased
costs of using the available systems.
Research Article Month : 07 (2018)
Potential Clinical Significance of Cytotoxicity Evaluation of Biodegradable
Mg-6Zn Alloy on IEC-6, CT26 and A7r5 Cell Lines
Leiming Zhu
The recent using of Mg-based Mg-6Zn alloys for biodegradable implants was not supported with sufficient toxicity evaluation data. This work
presented a thorough cytotoxicity evaluation of Mg-6Zn alloy for biodegradable implants. Three cell lines (IEC-6, CT26 and A7r5 cells) were used
to evaluate the cytotoxicity of Mg-6Zn alloy on intestinal wall cells in vitro. Cell viability and proliferation capability were assessed by MTT assay.
Cell proliferation was investigated by flow cytometric analysis. Three types of cell lines were exposed to Mg-6Zn alloy extracts for 24h, 48h and
72 hours for subsequent research assay, the cytotoxicity assay of Mg-6Zn alloy extracts at different concentrations and the effect on cells factors
expression levels were studied, and the biodegradation capability of Mg-6Zn alloy was also studied. The results indicated that, with the increasing of
the concentrations of Mg-6Zn alloy extract, the impact of Mg-6Zn alloy on the viability and proliferation capability of three types of cell lines was not
obvious, but when the culture time was prolonged, the Mg alloy extract as an obvious inhibitory effect on colon cancer cell CT26 growth (P<0.05).
Although Mg-6Zn alloy extracts could have slight effect on the cell cycle of CT26 cell, there was no significant difference when compared with IEC-6.
Mg alloys was subjected to slight corrosion after 3 weeks of immersion in the intestinal juice, and severe dramatic corrosion was observed at fourth
weeks. In conclusion, Mg-6Zn alloy can be suggested as a suitable candidate of biodegradable implants to be used in biomedical applications
Volume 2 Issue 2
Research Article Month : 06 (2018)
Effect of Coupled Plasma Filtration Adsorption on Inflammatory Mediators
and Liver Function of Patients with Severe Acute Pancreatitis
Qing-Hua W
Background: To study the effect of coupled plasma filtration adsorption (CPFA) on the inflammatory mediators and liver function of patients with
severe acute pancreatitis (SAP). Nowadays, CPFA is widely used in the therapy for patients with septicopyemia and septic shock and the outcome
is better. However, its role in inflammatory mediators and the liver function of SAP patients are poorly understood.
Method: 46 patients with severe acute pancreatitis (SAP) were randomly divided into the CPFA group and the control group .The control group
received conventional treatment in ICU, while the CPFA group received CPFA therapy besides conventional treatment for 3-10days. The changes of
inflammatory mediators and liver function index before treatment and after treatment for 4 days and 8 days was determined.
Results: Compared with the control group, the serum level of TNF-?, IL-1, IL-6 and liver function index (AST, ALT, R-GT and total bilirubin) were
decreased and the serum level of
IL-10 was increased in the CPFA group patients in 4th days and in 8th days. and the difference between the two groups was statistically significant
(p< 0.05).
Conclusions: CPFA therapy can effectively reduce serum levels of TNF-?, IL-1, IL-6, and increase serum level of IL-10 and protect the liver
function in SAP patients, and also improve overall body conditions. The study indicated that CPFA could be improving the clinical manifestations
and eliminating inflammatory mediators and protection of liver function. It could be proved safe and feasible and an adjunctive therapy for SAP
patients.
Research Article Month : 06 (2018)
Controlled Release Needles versus Swaged Needles on Subdermal Wound
Closures: A Pilot Study
Bradley Saunders
Purpose: to compare suture time and closure quality of a swaged-on needle versus a Controlled Release needle (CR) for a better wound closure
to achieve efficient and cosmetically pleasing outcomes.
Methods: Eight midlevel and senior orthopaedic residents performed a seven-centimeter wound closure onporcine skin with both suture types.
Closures were timed, and an image was captured on each specimen. Evaluations of images were conducted by threeboard certified orthopaedic
surgery faculty on aspects of closure quality and overall pass/fail measures.
Results: Mean time to closure differed significantly by needle type: CR time was 225.7 seconds, 95% CI (205.1, 246.3), whereasswaged was 265.8
seconds, 95% CI (242.3, 289.2); p = 0.011. Interrater agreement showed no statistical difference for closure quality, except forknot visibility where
the swaged-ontype had more reports of no knot visualization. Evaluations for pass/fail ratesdid not find statistical difference between needle types.
Conclusions: This study demonstrates that wound closure procedures utilizing controlled release needlesare significantly faster and provides
similar outcomes. Future studies should evaluate potential cost savings using this method
Research Article Month : 06 (2018)
Electroacupuncture or Transcutaneous Electroacupuncture for the
Treatment of Postoperative Ileus after Abdominal Surgery:
A Systematic Review and Meta-Analysis
Jian Chen
Background & Aim: Postoperative ileus (POI) is a common status
after abdominal surgery. At present, there is no ideal effective treatment
for these patients. Electroacupuncture (EA) and transcutaneous
electroacupuncture (TEA) are chosen as novel alternative treatments.
The aim of this study is to evaluate the efficacy of EA or TEA to improve
POI status of postoperative patients.
Methods: We systematically screened all randomized controlled
trials (RCTs) on databases including PubMed, Web of Science, China
National Knowledge Infrastructure (CNKI), Wanfang, EBSCO,
Scopus and Ovid. We finally included fifteen-five high quality RCTs.
Two reviewers independently conducted risk of bias assessment using
Cochrane risk of bias tool, data extraction and statistical analysis.
The primary outcomes included time to first flatus and time to first
defecation, and the secondary outcomes included time to bowel
sound recovery, time to first oral feeding, length of hospital stay and
postoperative analgesic consumption. And subgroup analysis was
conducted for laparoscopic surgery patients. All meta-analysis was
performed by a random or fixed effect model with RevMan 5.3.
Results: A total of 15 trials involving 965 participates were
included. Meta-analysis favored EA or TEA treatment for POI status
including time to first flatus (MD -11.60h, 95%CI -16.19h to -7.02h,
I2=94%, REM), time to first defecation (MD -12.94h, 95%CI -18.82h
to -7.06h, I2=90%, REM), time to bowel sound recovery (MD -7.25h,
95%CI -10.27h to -4.24h, I2=85%, REM), time to first oral feeding (MD
-15.76h, 95%CI -23.91h to -7.61h, I2=47%, REM) and length of hospital
stay (MD -1.19d, 95%CI -1.78d to -0.6d, I2=44%, REM). There was no
significant difference of postoperative analgesic consumption between
EA and control group (P=0.39). Subgroup analysis also favoured EA or
TEA including time to first flatus (MD -2.46h, 95%CI -3.96h to -0.96h,
I2=0%, FIXED), time to first oral feeding (MD -10.73h, 95%CI -16.91h
to -4.55h, I2=0%, FIXED) and length of hospital stay (MD -1.30d, 95%CI
-2.10d to -0.51d, I2=32%, REM).
Conclusion: This meta-analysis suggests that EA or TEA is
an effective and safe treatment for POI after abdominal surgery.
Considering the methodology of included trials is not satisfactory due to
the high risk of bias and the trials were basically performed in mainland
China, more high-quality clinical trials should be conducted worldwide
to confirm this conclusion. The mechanism of EA or TEA needs further
investigation in the future.