38 research outputs found
Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer?
No full textThe status of axillary lymph nodes is an important prognostic factor in the outcome of breast cancer tumors. New trials changed the attitude towards axillary clearance. In the era of development of new immune therapies for breast cancer, it is important to identify a biomarker that can predict lymph node status. Tumor-infiltrating lymphocytes (TILs) are a valuable indicator of the immune microenvironment that plays the central role in new anticancer drugs. Although the correlation between TILs and response to chemotherapy was established by previous studies, our retrospective study investigated the correlation between TILs and lymph node status. We analyzed data on 172 patients. According to stage, patients were divided in two groups: patients who underwent primary surgical treatment (breast-conserving or mastectomy and sentinel lymph node (SLN) biopsy +/− axillary clearance in conformity with lymph node status) and patients who received chemotherapy prior to surgical treatment (breast-conserving or mastectomy + axillary clearance). We showed a good inverse correlation between TILs and lymph nodes status for both early stage and locally advanced breast cancers. Moreover, TILs are a predictor for positive lymph nodes in the axilla in patients undergoing axillary clearance after SLN biopsy, with no statistical difference between the intrinsic or histological subtype of breast cancers. We also obtained a significant correlation between TILs and response to chemotherapy with no significative difference according to histological subtype. Although further data have still to be gathered before meeting the criteria for clinical utility, this study demonstrates that TILs are one of the most accredited forthcoming biomarkers for breast cancer (BC) patients
The Role of Tumor-Infiltrating B Lymphocytes in Colorectal Cancer Patients: A Systematic Review of Immune Landscape Evolution
No full textBackground: Previous studies have found that the presence and density of tumor-infiltrating T lymphocytes has significant prognostic value in colon and rectal cancer. However, there is a paucity of systematic reviews focusing on the role of tumor-infiltrating B lymphocytes (TIBLs) in colorectal cancer. The aim of this review was to assess the role of all known subsets of TIBLs implicated in colorectal cancer, as well as to identify the methodologies used for the identification of TIBLs and establish their prognostic value in the colorectal tumor microenvironment (TME). Methods: A systematic literature search was conducted from 2000 to 2025 using the PubMed (Medline), Embase and Cochrane Library databases. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed to identify eligible studies. Results: A total of 32 original papers involving 5766 individual patients met the inclusion criteria. Several B cell types in the immune TME of colon and rectal cancer were identified, each with specific roles and prognostic value. Several distinct methodologies were used for the identification of these cells, according to specific detection protocols used by various institutions. Certain immunological pathways through which these cells may be involved in the carcinogenesis of colorectal tumors have also been identified, which may potentially lead to the development of novel immunotherapy targets. Conclusions: We concluded that TIBLs play a significant role in the immune microenvironment of colorectal cancer, providing theoretical evidence for potential biomarkers which may constitute a valuable target for individualized treatment
Multilayered Porous Titanium-Based 3rd Generation Biomaterial Designed for Endosseous Implants
No full textThis work proposes a novel complex multi-layered material consisting of porous titanium as a substrate and a complex coating consisting of a chitosan film engulfing microsphere loaded with growth factors such as BMP2 (bone morphogenic protein 2) and IGF1 (insulin-like growth factor-1). The microspheres were obtained through deposition of dual layers of calcium cross linked pectin–chitosan/pectin polyelectrolyte onto a BSA (bovine serum albumin) gel core. The multilayer was conceived to behave like a 3rd generation biomaterial, by slow delivery of viable growth factors around implants, and to assist the healing of implantation wound and the development of new vital bone. The biologic effect of the delivery of growth factors was studied in vitro, on MSC-CD1 mesenchymal stem cells, and in vivo, on CD1 mice. Proliferation and differentiation of cells were accelerated by growth factors, especially IGF1 for proliferation and BMP2 for differentiation. In vivo tests analyzed histologically and by MicroCT show a more structured tissue around BMP2 samples. The present concept will give the best clinical results if both growth factors are delivered together by a coating film that contains a double population of microcarriers
Absolute and Functional Iron Deficiency in Colon Cancer: A Cohort Study
No full textBackground and Objectives: Iron is an essential micronutrient for many biological functions and has been found to be intimately linked to cancer biology. Although the effects of increased dietary iron consumption in the development of CRC have been previously investigated in several cohort studies, the available evidence on the involvement of iron deficiency in this process is relatively scarce. Previously published papers did not analyze specific outcomes, such as the presence of biologically aggressive histopathological characteristics, that are associated with the subtypes of iron deficiency. The purpose of this study was to investigate the connection between the development of colorectal cancer and the presence of functional iron deficiency (FID), which is defined as insufficient biological availability of iron in the presence of adequate storage reserves, or absolute iron deficiency (AID), which is defined as severely depleted iron storage levels. Materials and Methods: Our paper represents a single center registry-based cohort study. Iron levels were routinely evaluated upon diagnosis of CRC and the collected data were coupled with patient- and tumor-specific data (2018–2022). Spearman’s correlation coefficient and the chi-squared test were used to analyze the association. Results: Out of 129 patients, 75 (58.13%) were anemic. AID was identified in 26.35% of cases and FID was encountered in 51.16% of cases. A statistically significant association between FID and lymphatic invasion was encountered. An analysis of the correlation demonstrated a significant association between anemia and right-sided tumor location. Conclusions: Functional iron deficiency seems to be independently associated with lymphatic invasion. Although a statistically significant correlation with the T or N stage was not demonstrated, the analysis suggested a potential positive relationship between the presence of FID and more aggressive tumor characteristics
Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique
No full textIntroduction. Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. Material and methods. In total, 30 breast cancer patients scheduled for axillary lymph node dissection were enrolled in our study. The lymphatic nodes that drain the arm were identified by injecting 1 mL of blue dye in the ipsilateral upper arm; then, the ARM nodes were resected along with the other lymph nodes and sent for histological evaluation. Results. Identification of ARM node was successful in 18 patients (60%) and 22.22% of the identified ARM lymph nodes had metastatic involvement. Patients with identified ARM nodes had a significant lower BMI and a statistically significant relationship between axillary lymph node status and ARM node metastases was proven. Most of ARM lymph nodes (96.3%) were found above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle. Conclusions. The ARM procedure is easy to reproduce but might not be appropriate for patients with a high BMI. The rate of metastatic involvement of ARM nodes is significant and no factor can predict it, showing that the preservation of these nodes cannot be considered
Artificial Intelligence as a Potential Tool for Predicting Surgical Margin Status in Early Breast Cancer Using Mammographic Specimen Images
No full textBackground/Objectives: Breast cancer is the most common malignancy among women globally, with an increasing incidence, particularly in younger populations. Achieving complete surgical excision is essential to reduce recurrence. Artificial intelligence (AI), including large language models like ChatGPT, has potential for supporting diagnostic tasks, though its role in surgical oncology remains limited. Methods: This retrospective study evaluated ChatGPT’s performance (ChatGPT-4, OpenAI, March 2025) in predicting surgical margin status (R0 or R1) based on intraoperative mammograms of lumpectomy specimens. AI-generated responses were compared with histopathological findings. Performance was evaluated using sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), F1 score, and Cohen’s kappa coefficient. Results: Out of a total of 100 patients, ChatGPT achieved an accuracy of 84.0% in predicting surgical margin status. Sensitivity for identifying R1 cases (incomplete excision) was 60.0%, while specificity for R0 (complete excision) was 86.7%. The positive predictive value (PPV) was 33.3%, and the negative predictive value (NPV) was 95.1%. The F1 score for R1 classification was 0.43, and Cohen’s kappa coefficient was 0.34, indicating moderate agreement with histopathological findings. Conclusions: ChatGPT demonstrated moderate accuracy in confirming complete excision but showed limited reliability in identifying incomplete margins. While promising, these findings emphasize the need for domain-specific training and further validation before such models can be implemented in clinical breast cancer workflows
Comment on “A modified ‘interrupted’ method with resting of the suture needle on the vessel wall for microvascular anastomosis”
No full textReduction of the Number of Live Animals Used for Microsurgical Skill Acquisition: An Experimental Randomized Noninferiority Trial
No full textBackground Live animals have been used for decades as one of the many training models for developing surgical skills. Microsurgery in particular relies on training for skill acquisition and maintenance, using live animal models, especially rats (murine models). Efforts are underway to reduce the number of rats sacrificed to achieve this objective. Methods A group of students with minimal microsurgical experience, after having gone through a basic microsurgical course, were randomly split into three equal groups, all three groups following a 24-week standard training program based on low- and medium-fidelity training models with standardized murine training days. In addition to the standard training regimen, each participant performed supplementary training on live rats every 4, 6, or 8 weeks. According to the training program, the procedures have been performed on chicken legs, flower petals, and rats, each procedure being blindly assessed and evaluated using validated models and scales. The primary evaluated outcome was the Stanford Microsurgery and Resident Training (SMaRT) scale result of the final rat anastomosis performed by each group, for which the tested hypothesis was one of noninferiority. The secondary outcomes were represented by the final rat anastomosis time, final chicken leg anastomosis result and time, and the final petal score. Results After the 24th week, no differences were observed between the three groups regarding their microsurgical skills, as measured by the aforementioned surgical outcomes. All participants improved significantly during the study (mean [standard deviation] 19 ± 4 points on the SMaRT scale), with no significant differences between the groups, p < 0.001 for noninferiority. Conclusion A training regimen based on low- and moderate-fidelity models, with the addition of training on a live rat every 8 weeks was noninferior to a training regimen that used a live rat every 6 weeks and also noninferior to a training regimen that used a live rat every 4 weeks
The Double Stitch Everting Technique in the End-to-Side Microvascular Anastomosis:Validation of the Technique Using a Randomized N-of-1 Trial
No full textBackground The double stitch everting (DSE) technique, in which time is won by leaving the needle inside the vessel wall in-between stitching, is a modification of the end-to-side (ETS) anastomosis in the interest of reducing anastomosis time. This ensures proper wall eversion, intima-to-intima contact, and improved suture symmetry. Methods We designed an N-of-1 randomized trial with each microsurgeon as their own control. We included 10 microsurgeons of different levels of experience who were then asked to perform classic and DSE ETS anastomoses on the chicken leg and rat femoral models. Every anastomosis was cut and evaluated using blinded assessment. Two-way analysis of variance (ANOVA) and multivariable logistic regression were used to analyze the results and for confounder adjustment. Results A total of 210 anastomoses were performed, of which 177 on the chicken leg and 43 on the rat femoral artery and vein. From the 210 anastomoses, 111 were performed using the classic technique and 99 using the DSE technique. The mean anastomosis time was 28.8 ± 11.3 minutes in the classic group and 24.6 ± 12 minutes in the DSE group (p < 0.001, t -test). There was a significant reduction (p < 0.001, two-way ANOVA) in the number of mistakes when using the DSE technique (mean 5.5 ± 2.6) compared with those using the classic technique (mean 7.7 ± 3.4). Conclusion The DSE technique for ETS anastomoses improves anastomoses times in experienced and moderately experienced microsurgeons while also improving or maintaining suture symmetry and lowering the number of mistakes.</p
Milling Effects on Hybrid Collagen / Inorganic Phase Composites
No full textPhospho-silicate glass powder consisting of particles sized up to 60 micrometers was incorporated into insoluble collagen by mechanical milling. After 8 hours milling at 180 rpm, the two phases are still separated. Increasing of mill frequency at 1800 rpm led to glass particles encapsulation in the collagen matrix after 90 minutes. The collagen structural properties after mechanical bonding to glass powder particles are investigated by vibrational spectroscopy in order to emphasize the milling effects upon the protein secondary structure.</jats:p
