Laparoscopic low anterior resection with total mesorectal excision for rectal cancer

Rectal resections are the only treatment with curative intent currently accepted world wide. When performed in elective circumstances, laparoscopic rectal excision is technically feasible in surgical approach of mid-rectal cancer in a considerable number of patients. There are many benefits of the laparoscopic approach to rectal resection such as short hospitalization, less pain, less postoperative complications and improved quality of life. However, one mandatory condition in laparoscopic resection of rectum includes complete excision of the rectum and mesorectum, generally ensuring a minimal distal margin of 2cm and circumferential radial clearance before performing a coloanal anastomosis. Here, we present a laparoscopic approach for rectal cancer treatment consisting in a wide resection of the rectum, including the entire fascia with the enclosed mesentery of the rectum.     

Chronic Cerebrospinal Venous Insufficiency as a Cause of Multiple Sclerosis: Controversy and Reality

Multiple sclerosis (MS) is a relapsing and progressive disorder of the central nervous system. It is characterized most commonly by episodes of clinical worsening, followed by clinical improvement. Pathologically, MS is associated with focal areas of myelin destruction, inflammation, and axonal transection (“demyelinating plaques”) in the brain and spinal cord. Traditionally, MS has been considered an autoimmune disorder, with the primary pathophysiology arising from an errant immune system. Recent work has raised the possibility that MS is not caused primarily by an immune abnormality but may instead arise from venous anomalies affecting the jugular and/or azygos venous systems. This condition has been called chronic cerebrospinal venous insufficiency (CCSVI). It has been proposed that CCSVI may be pathogenic in MS, causing venous back pressure and iron deposition, with a secondary immune response. Some investigators have proceeded to unblinded nonrandomized angioplasty and stenting procedures in patients with CCSVI, with anecdotal reports of symptom improvement. Because of conflicting data on the presence of CCSVI and the absence of controlled trials of CCSVI intervention, the current standard of clinical care is neither to evaluate multiple sclerosis (MS) patients for CCSVI anomalies, nor to intervene with procedures to alter such anomalies. There is intense interest and ongoing work to evaluate the presence of venous anomalies in MS patients as well as in normal controls and patients with other neurologic conditions; to characterize such anomalies, if present; and to further understand whether the concept of a “backpressure” pathology is borne out by the evidence. If CCSVI is indeed a pathogenic mechanism for some subset of the MS population, this would dramatically change the focus of attention for therapeutic endeavors and monitoring for this population and would bring MS therapeutics firmly into the area of vascular intervention. On the other hand, the history of MS research contains many novel and potentially paradigm-shifting ideas that were later disproved by other investigators.     

Biomedical applications of prokaryotic carbonic anhydrases

Introduction: The hydration/dehydration of CO₂ catalyzed by carbonic anhydrases (CAs, EC 4.2.1.1) is a crucial physiological reaction for the survival of all living organisms because it is connected with numerous biosynthetic and biochemical pathways requiring CO₂ or HCO₃^?, such as respiration, photosynthesis, carboxylation reactions, pH homeostasis, secretion of electrolytes, transport of CO₂, bicarbonate, etc.

Areas covered: The bacterial genome encodes CAs belonging to the α-, β-, and γ-CA classes able to ensure the survival and/or satisfying the metabolic needs of the bacteria, as demonstrated by in vivo and in vitro experiments. The discovery of new anti-infectives that target new bacterial pathways, such as those involving CAs, may lead to effective therapies against diseases subject to the antibiotic resistance. This aspect is important in pharmaceutical and biomedical research but received little attention till recently.

Expert opinion: An overview of the potential use of CAs in biomedical applications, as drug targets, bioindicators, and within artificial organs is presented. The discovery of thermostable bacterial CAs allowed the use of CAs in biotechnological applications, but patents related to the use of bacterial CAs in the development of pharmacological agents are scarce.     

Prevalence and Assessment of Malnutrition Risk among Hospitalized Children in Romania

Malnutrition is a prevalent condition in hospitalized children. Our aims were to evaluate the nutritional state and to validate the STRONGkids risk assessment tool in a hospitalized paediatric population in Romania. This is a prospective single-centre study in a tertiary teaching hospital in Romania (May 2011-January 2012). We calculated the STRONGkids score and measured the children''s height and weight. Standard deviation <-2 for weight-for-height and height-for-age was considered to indicate acute or chronic malnutrition respectively. Two hundred seventy-one children were included, with median age of 5.2 years and median hospital stay of 2.01 days. Prevalence of malnutrition and severe malnutrition was 37% and 15% respectively. Using the STRONGkids screening tool, 58% of the children were found at risk of malnutrition (24% were at high risk). The kappa coefficient of agreement between STRONGkids and WHO malnutrition classification was 0.61. When a low serum protein level was used in upgrading STRONGkids risk category, kappa increased significantly to 0.71 (p=0.001). A modified STRONGkids score, incorporating total serum protein levels, performs well in predicting malnutrition in hospitalized paediatric population in Romania.Key words: Child, Malnutrition, Serum proteins, Romania     

Compatibility of Drotaverine Hydrochloride with Ibuprofen and Ketoprofen Nonsteroidal Anti-Inflammatory Drugs Mixtures

Formulations with two or more active pharmaceutical ingredients (APIs) are a researched trend due to their convenient use compared with multiple medications. Moreover, drug-drug combinations may have a synergistic effect. Drotaverine hydrochloride (D-HCl) is commonly used for its antispasmodic action. The combination of a spasmolytic and an analgesic drug such as ibuprofen (Ibu) or ketoprofen (Ket) could become the answer for the treatment of localized pain. D-HCl:Ibu and D-HCl:Ket drug-drug interactions leading to the formation of eutectic compositions with increased bioavailability, obtained by mechanosynthesis, a green, solvent-free method was explored for the first time. The compatibility of Ibuprofen, Ketoprofen, and Drotaverine Hydrochloride was investigated using differential scanning calorimetry (DSC), X-ray diffraction (XRD), and Fourier-Transform Infrared spectroscopy (FTIR). Solid-liquid equilibrium (SLE) phase diagrams for the binary systems of active pharmaceutical ingredients were developed and the Tammann diagrams were designed to determine the eutectic compositions. The excess thermodynamic functions G^E for the pre-, post-, and eutectic compositions were obtained using the computed activity coefficients data. Results show that drotaverine-based pharmaceutical forms for pain treatment may be obtained at 0.9 respectively 0.8 molar fractions of ibuprofen and ketoprofen which is advantageous because the maximum allowed daily dose of Ibu is about 6 times higher than those of D-HCl and Ket. The obtained eutectics may be a viable option for the treatment of pain associated with cancer therapy.     

Wettability and Surface Roughness Analysis of Laser Surface Texturing of AISI 430 Stainless Steel

Due to its wide applicability in industry, devising microstructures on the surface of materials can be easily implemented and automated in technological processes. Laser Surface Texturing (LST) is applied to modify the chemical composition, morphology, and roughness of surfaces (wettability), cleaning (remove contaminants), reducing internal stresses of metals (hardening, tempering), surface energy (polymers, metals), increasing the adhesion (hybrid joining, bioengineering) and decreasing the growth of pathogenic bacteria (bioengineering). This paper is a continuation and extension of our previous studies in laser-assisted texturing of surfaces. Three different patterns (crater array-type C, two ellipses at 90° overlapping with its mirror-type B and 3 concentric octagons-type A) were applied with a nanosecond pulsed laser (active medium Nd: Fiber Diode-pumped) on the surface of a ferritic stainless steel (AISI 430). Micro texturing the surface of a material can modify its wettability behavior. A hydrophobic surface (contact angle greater than 90°) was obtained with different variations depending on the parameters. The analysis performed in this research (surface roughness, wettability) is critical for assessing the surface functionality, characteristics and properties of the stainless steel surface after the LST process. The values of the surface roughness and the contact angle are directly proportional to the number of repetitions and inversely proportional to the speed. Recommendations for the use of different texturing pattern designs are also made.     

The Emotion Word Fluency Test (EWFT): Initial psychometric,validation, and physiological evidence in young adults

Introduction: The clinical assessment of affective functioning has been slow to incorporate findings from affective neuroscience. Of particular interest in the current study is the assessment of affective word production. Method: In a series of four studies, we examined test–retest and interrater reliability for the Emotion Word Fluency Test (EWFT), basic construct validity with existing verbal fluency measures, physiological responses across verbal fluency tasks, and a novel scoring method to examine qualitative aspects of participant response sets. Results: Results demonstrated interrater and test–retest reliability values that were comparable to those of other commonly used verbal fluency tests. Construct validity was demonstrated by relations between the EWFT and other verbal fluency tests as well as through physiological evidence that performance on the EWFT is related to greater sympathetic activity than traditional verbal fluency tasks. Lastly, some of the novel scoring metrics related to two self-report measures of emotional functioning. Conclusions: Taken together, our findings provide initial support for the use of the EWFT as a measure of emotion word generation ability in young adults. This measure may prove to be useful in the assessment of affective language production in patient populations.     

Indisulam. Eisai

Eisai and the EORTC are developing indisulam, a sulfonamide which inhibits progression from the G(1) phase of the cell cycle, for the potential treatment of cancer [338089]. As of January 2001, indisulam was in phase II trials in Europe for the treatment of solid tumors, and phase II US studies have been ongoing since March 2001 [400862]. In 2001, clinical development of the drug in Japan was scheduled to begin in fiscal year 2002 [396633].