19 research outputs found
Vitamin D and Clinical Outcomes in Head and Neck Cancer: A Systematic Review
No full textBackground/Objectives: Vitamin D is classically associated with calcium and phosphate homeostasis, but recent research has expanded its role to include several new roles such as immune regulation, inflammation, and potential anti-cancer properties. The vitamin D receptor (VDR) is expressed in over 400 tissues, including those of the head and neck, implying a potential link between vitamin D and head and neck cancers (HNCs). Given the need for newer and better therapeutic approaches, this systematic review aims to synthesize existing clinical evidence on the relationship between vitamin D status and clinical outcomes in HNC patients. Methods and Results: A comprehensive literature search, across multiple databases including PubMed, Google Scholar and Science Direct, identified 187,642 studies related to vitamin D and cancer, from which 16 studies met the inclusion criteria. The inclusion criteria were English-language, full-text original research (2015–2025) on vitamin D’s role in HNC progression and treatment, focusing on human studies. The findings indicate that vitamin D deficiency is highly prevalent among HNC patients, with rates ranging from 47% to 95%, particularly in advanced-stage cancers and those undergoing intensive treatment. Inverse association between vitamin D levels and HNC risk was reported, with higher serum 25(OH)D levels linked to a 30–32% reduction in cancer risk. Additionally, higher vitamin D levels correlated with improved survival rates and reduced recurrence, though some findings lacked statistical significance. Deficiencies were associated with higher rates of malnutrition and postoperative complications, reinforcing vitamin D’s role in nutritional stability and surgical recovery. Conclusions: This systematic review highlights how common and significant vitamin D deficiency is among head and neck cancer (HNC) patients, exploring its possible role in cancer risk, prognosis, survival, treatment-related side effects, malnutrition, and post-surgical complications. The evidence suggests that while higher vitamin D levels are linked to better survival and fewer treatment-related issues, the benefits seem to level off beyond a certain point, indicating a more complex relationship. Additionally, vitamin D supplementation appears to help reduce chemoradiation side effects like mucositis, skin toxicity, dysphagia, and pain, ultimately improving patients’ quality of life during treatment
The Value of Tumor Infiltrating Lymphocytes (TIL) for Predicting the Response to Neoadjuvant Chemotherapy (NAC) in Breast Cancer according to the Molecular Subtypes
No full textIntroduction: The antitumor host immune response is an important factor in breast cancer, but its role is not fully established. The role of tumor infiltrating lymphocytes (TIL) as an immunological biomarker in breast cancer has been significantly explored in recent years. The number of patients treated with neoadjuvant chemotherapy (NAC) has increased and the identification of a biomarker to predict the probability of pCR (pathological complete response) is a high priority. Materials and methods: We evaluated 334 cases of BC treated with NAC followed by surgical resection from 2020–2022 at the Ist Clinic of Oncological Surgery, Oncological Institute “Prof Dr I Chiricuta” Cluj Napoca. Of the above, 122 cases were available for histological evaluation both in pre-NAC biopsy and post-NAC resection tissue. Evaluation of biopsy fragments and resection parts were performed using hematoxylin eosin (H&E). The TIL evaluation took place according to the recommendations of the International TIL Working Group (ITILWG). Results: There was a strong association between elevated levels of pre-NAC TIL. At the same time, there is a statistically significant correlation between stromal TIL and tumor grade, the number of lymph node metastases, the molecular subtype and the number of mitoses (p p < 0.005). We also demonstrated that high pre-NAC STIL represents a strong predictive marker for pCR. Conclusion: This study reveals the role of TIL as a predictive biomarker in breast cancer not only for the well-established TNBC (triple negative breast cancer) and HER2+ (Her2 overexpressed) subtypes but also in Luminal A and B molecular subtypes. In this scenario, the evaluation of sTIL as a novel predictive and therapy-predicting factor should become a routinely performed analysis that could guide clinicians when choosing the most appropriate therapy
Statistical Comparison of the Mechanical Properties of 3D-Printed Resin through Triple-Jetting Technology and Conventional PMMA in Orthodontic Occlusal Splint Manufacturing
No full textDental 3D-printing technologies, including stereolithography (SLA), polyjet (triple-jetting technology), and fusion deposition modeling, have revolutionized the field of orthodontic occlusal splint manufacturing. Three-dimensional printing is now currently used in many dental fields, such as restorative dentistry, prosthodontics, implantology, and orthodontics. This study aimed to assess the mechanical properties of 3D-printed materials and compare them with the conventional polymethylmethacrylate (PMMA). Compression, flexural, and tensile properties were evaluated and compared between PMMA samples (n = 20) created using the “salt and pepper” technique and digitally designed 3D-printed samples (n = 20). The samples were subjected to scanning electron microscope analysis. Statistical analysis revealed that the control material (PMMA) exhibited a significantly higher Young’s modulus of compression and tensile strength (p < 0.05). In the flexural tests, the control samples demonstrated superior load at break results (p < 0.05). However, the 3D-printed samples exhibited significantly higher maximum bending stress at maximum load (MPa) (p < 0.05). Young’s modulus of tensile testing (MPa) was statistically significant higher for the control samples, while the 3D-printed samples demonstrated significantly higher values for elongation at break (p < 0.05). These findings indicate that 3D-printed materials are a promising alternative that can be effectively utilized in clinical practice, potentially replacing traditional heat-cured resin in various applications
The Use of Wound Infiltration for Postoperative Pain Management after Breast Cancer Surgery: A Randomized Clinical Study
No full text(1) Background: The present study aims to evaluate the reduction of postoperative pain in breast surgery using a series of local analgesics, which were infiltrated into the wound; (2) Methods: Envelopes containing allocation were prepared prior to the study. The patients involved were randomly assigned to the groups of local anesthesia infiltration (Group A) or normal pain management with intravenous analgesics (Group B). The random allocation sequence was generated using computer-generated random numbers. The normally distributed continuous data were expressed as the means (SD) and were assessed using the analysis of variance (ANOVA), independent-sample t-test, or paired t-test; (3) Results: The development of the postoperative pain stages was recorded using the VAS score. Therefore, for Group A, the following results were obtained: the VAS at 6 h postoperatively showed an average value of 0.63 and a maximum value of 3. The results for Group B were the following: the VAS score at 6 h postoperatively showed an average value of 4.92, a maximum of 8, and a minimum of 2; (4) Conclusions: We can confirm that there are favorable statistical indicators regarding the postoperative pain management process during the first 24–38 h after a surgical intervention for breast cancer using local infiltration of anesthetics
VRAM Flap for Pelvic Floor Reconstruction after Pelvic Exenteration and Abdominoperineal Excision
No full textDue to the still large number of patients diagnosed with pelvic neoplasms (colorectal, gynecological, and urological) in advanced stages right from the initial diagnosis, surgery represents the mainstay of treatment, often implying wide, eventually multi-organ resections in order to achieve negative surgical margins. Perineal wound morbidity, particularly in extralevator abominoperineal excision, leads to complications and local infection rates of up to 40%. Strategies to reduce postoperative wound complications are being pursued to address this issue. The VRAM flap remains the gold standard for autologous reconstruction after pelvic oncological resection; it was initially designed for abdominal wall defects and later expanded for large pelvic tissue defects. The flap’s application is based on its physical characteristics, including abundant tissue and a generous skin paddle, which effectively obliterates dead space after exenterations. The generous skin paddle offers good cosmetic and functional outcomes at the recipient site. This article describes the case of a patient histopathologically diagnosed with stage IIIA squamous cell carcinoma of the uterine cervix who received multimodal onco-surgical treatment. The surgical mainstay of this treatment is pelvic exenteration. Pelvic reconstruction after this major surgery was performed using a vertical flap with the rectus abdominis
Sentinel Lymph Node Biopsy in Breast Cancer Using Different Types of Tracers According to Molecular Subtypes and Breast Density—A Randomized Clinical Study
No full textBackground: Sentinel lymph node biopsy (SLNB) has become a method more and more frequently used in loco-regional breast cancer in the initial stages. Starting from the first report on the technical feasibility of the sentinel node method in breast cancer, published by Krag (1993) and Giuliano (1994), the method underwent numerous improvements and was also largely used worldwide. Methods: This article is a prospective study that took place at the “SJUPBT Surgery Clinic Timisoara” over a period of 1 year between July 2023 and July 2024, during which 137 underwent sentinel lymph node biopsy (SLNB) based on the current guidelines. For the identification of sentinel lymph nodes, we used various methods, including single traces and also a dual tracer and triple tracer. Results: Breast density represents a predictive biomarker for the identification rate of a sentinel node, being directly correlated with BMI (above 30 kg/m2) and with an age of above 50 years. The classification of the patients according to breast density represents an important criterion given that an adipose breast density (Tabar-Gram I-II) represents a lower IR of SLN compared with a density of the fibro-nodular type (Tabar-Gram III-V). We did not obtain any statistically significant data for the linear correlations between IR and the molecular profile, whether referring to the luminal subtypes (Luminal A and Luminal B) or to the non-luminal ones (HER2+ and TNBC), with p > 0.05, 0.201 [0.88, 0.167]; z = 1.82
Ground-based Characterization of (98943) Torifune 2001 CC21, the Target of the Hayabusa2# Space Mission
No full textThe near-Earth asteroid (98943) Torifune, previously designated 2001 CC _21 , is the flyby target of the Hayabusa2 extended mission, nicknamed Hayabusa2 # (Small Hazardous Asteroid Reconnaissance Probe (SHARP)). The ground-based telescope observations offer a key science input for the mission's scientific investigation. During 2022–2024, this asteroid was at visible apparent magnitudes brighter than 18.5, allowing for a detailed characterization using ground-based telescope observations. We determined its rotation period P = 5.021516 ± 0.000106 hr and its absolute magnitude H = 18.78 ± 0.14. The large number of light curves allows us to estimate its axis ratio, its convex shape, and its pole orientation, λ = 301 ^∘ ± 35 ^∘ , , and ϵ = 5 ^∘ ± 3 ^∘ , respectively, which indicate a prograde rotation. We report the semiaxis of the equivalent ellipsoid, a = 0.42 km, b = 0.16 km, and c = 0.17 ± 0.03 km. Consequently, the volume-equivalent diameter is D _eq = 0.44 ± 0.06 km. Using observations conducted simultaneously with four broadband filters, we determined ( g − r ) = 0.663 ± 0.022 mag, ( r − i ) = 0.177 ± 0.012 mag, and ( i − z _s ) = −0.061 ± 0.032 mag. Additionally, we found that Torifune exhibits no detectable large-scale heterogeneity. We classified the object using a high signal-to-noise ratio spectrum (over the visible and near-infrared region) as Sq-type in the Bus–DeMeo taxonomy. We estimate a mineralogy similar to LL/L ordinary chondrites, with an ol/(ol+px) = 0.60, a Fa content of 28.5 mol%, and a Fs content of 23.4 mol%. The spectral data indicate a surface affected by moderate space weathering effects
Intraoperative transfusion practices in Europe
No full text© 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold
Intraoperative transfusion practices in Europe
No full text\ua9 2016 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. Background: Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. Methods: We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. Results: The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl-1 and increased to 9.8 (1.8) g dl-1 after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Conclusions: Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl-1), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold
Postoperative Pulmonary Complications in Conventional Laparoscopic vs Robot-Assisted Abdominal Surgery
No full textImportance: Robot-assisted surgery (RAS) is increasingly used for abdominal procedures; however, postoperative pulmonary complications (PPCs) are more frequent in patients undergoing RAS compared with patients undergoing conventional laparoscopic surgery (CLS). Objective: To compare the incidence of PPCs after CLS and RAS and to determine which patient-, surgery-, and anesthesia-related factors are associated with PPCs. Design, Setting, and Participants: This cohort study used the Laparoscopic and Robot-Assisted Surgery (LapRAS) database, a pooled dataset containing individual patient data of 2 worldwide prospective cohort studies: the Local Assessment of Ventilatory Management During General Anaesthesia for Surgery (LAS VEGAS) study and the Assessment of Ventilatory Management During General Anesthesia for Robotic Surgery and Its Effects on Postoperative Pulmonary Complications (AVATaR) study. Data were collected from adult patients requiring intraoperative ventilation during general anesthesia for CLS or RAS surgical procedures from 163 centers and 31 countries in the Americas, Europe, the Middle East, and North Africa from January 2013 to March 2019. Data were analyzed from December 2023 to October 2024. Exposures: Type of surgical approach (CLS vs RAS), duration of intraoperative ventilation, and intensity of mechanical ventilation, assessed using the 4 times the driving pressure (DP) plus respiratory rate (RR) estimator (4DP + RR). Main Outcome and Measures: The primary outcome was occurrence of 1 or more PPCs in the first 5 postoperative days. Mixed-effects logistic regression assessed associations with PPCs; mediation and matched cohort analyses served as sensitivity analyses. Results: A total of 2738 patients (median [IQR] age, 56 [41-66] years; 1456 female [53.1%]) were included. PPCs occurred in 172 of 903 patients (19.0%) in the RAS group and 174 of 1835 patients (9.5%) in the CLS group (P <.001). Duration of intraoperative ventilation was longer in RAS compared with CLS (median [IQR] duration, 219 [180-270] vs 95 [68-145] minutes; P <.001) and the intensity of mechanical ventilation was higher (median [IQR] intensity, 84 [69-100] vs 72 [60-87] 4DP + RR; P <.001). PPCs were independently associated only with duration of ventilation (adjusted odds ratio [aOR], 1.49; 95% CI, 1.33-1.66; P <.001), not with the surgical approach (ie, RAS vs CLS; aOR, 1.35; 95% CI, 0.72-2.54; P =.35) nor the intensity of ventilation as measured by 4DP + RR (aOR, 1.01; 95% CI, 1.01-1.01; P =.21). A post hoc analysis showed a more pronounced association of intensity of ventilation in surgical procedures of shorter duration. Conclusions and Relevance: In this cohort study, patients who received RAS vs CLS had a higher incidence of PPCs and received longer and more intense mechanical ventilation; however, only the duration of ventilation rather than intensity of ventilation or type of surgical approach (ie, RAS vs CLS) was independently associated with the occurrence of PPCs, indicating that the longer duration of ventilation in RAS underlies the higher incidence of PPCs observed in those who undergo this type of surgery
