Search results for: biophysiological parameters breast surgery

Authors: S. Haque, M. Kanapathy, E. Bollen, I. Younis, A. Mosahebi

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Background: Implant loss due to infection is the most devastating complication of implant-based breast reconstruction. The use of negative pressure wound therapy with instillation (NPWTi) for salvage of infected implant-based breast reconstructions has shown promising results to allow early reinsertion of a new implant as an alternative to current management of delayed reinsertion. This study compares the cost implication of NPWTi against current management of delayed reinsertion of infected breast implants. Methods: 20 cases of an infected breast implant treated with NPWTi (V.A.C. VERAFLO™ Therapy) followed by early re-insertion of a new implant were compared with 20 cases who had delayed reinsertion (non-NPWTi). Average cost per person was calculated using total operative expenses, cost of inpatient stay, cost of investigations, cost of antibiotics, and cost of outpatient visits. Results: Treatment with NPWTi allowed for earlier re-insertion of a new implant (NPWTi: 9.04 ± 2.92 days vs. non-NPWTi: 236.25 ± 123.89 days). The average cost per patient for NPWTi and non-NPWTi was £14,343.13 ± £2,786.70 and £8,920.31 ± £3,005.73 respectively. All patients treated with NPWTi had one admission and spent 11.9 ± 4.1days as an inpatient while non-NPWTi patients had 2.1 ± 0.3 admissions with total length of inpatient stay of 7.1 ± 5.8days. Patients treated with NPWTi had more surgeries (NPWTi: 3.35 ± 0.81 vs. non-NPWTi: 2.2 ± 0.41), however 3 non-NPWTi cases required flap reconstruction. Patients treated with NPWTi had fewer total outpatient visits (NPWTi: 12 ± 6 vs. non-NPWTi: 14.2 ± 6.3). Conclusion: Patients treated with NPWTi incurred higher average cost per patient, longer inpatient stay, and more procedures; however, had early re-insertion of new implants and fewer admissions and outpatient visits. A further study on patient-reported outcome is essential to compare cost against patient benefit.

Keywords: breast reconstruction, cost evaluation, infection, negative pressure wound therapy

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Authors: A. Dashti, M. Eskandari, L. Farahmand, P. Parvin, A. Jafargholi

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Breast Cancer is one of the most considerable diseases in the United States and other countries and is the second leading cause of death in women. Common breast cancer treatments would lead to adverse side effects such as loss of hair, nausea, and weakness. These complications arise because these cancer treatments damage some healthy cells while eliminating the cancer cells. In an effort to address these complications, laser radiation was utilized and tested as a targeted cancer treatment for breast cancer. In this regard, tissue engineering approaches are being employed by using an electrospun scaffold in order to facilitate the growth of breast cancer cells. Polycaprolacton (PCL) was used as a material for scaffold fabricating because of its biocompatibility, biodegradability, and supporting cell growth. The specific breast cancer cells have the ability to create a three-dimensional cell cluster due to the spontaneous accumulation of cells in the porosity of the scaffold under some specific conditions. Therefore, we are looking for a higher density of porosity and larger pore size. Fibers showed uniform diameter distribution and final scaffold had optimum characteristics with approximately 40% porosity. The images were taken by SEM and the density and the size of the porosity were determined with the Image. After scaffold preparation, it has cross-linked by glutaraldehyde. Then, it has been washed with glycine and phosphate buffer saline (PBS), in order to neutralize the residual glutaraldehyde. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromidefor (MTT) results have represented approximately 91.13% viability of the scaffolds for cancer cells. In order to create a cluster, Michigan Cancer Foundation-7 (MCF-7, breast cancer cell line) and Michigan Cancer Foundation-10A (MCF-10A, human mammary epithelial cell line) cells were cultured on the scaffold in 24 well plate for five days. Then, we have exposed the cluster to the laser diode 808 nm radiation to investigate the effect of laser on the tumor with different power and time. Under the same conditions, cancer cells lost their viability more than the healthy ones. In conclusion, laser therapy is a viable method to destroy the target cells and has a minimum effect on the healthy tissues and cells and it can improve the other method of cancer treatments limitations.

Keywords: breast cancer, electrospun scaffold, polycaprolacton, laser diode, cancer treatment

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Authors: Gökçe Erdemir, İlhan Yaylım, Serap Erdem-Kuruca, Musa Mutlu Can

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It has been determined that the main reason for the death of cancer disease is caused by metastases rather than the primary tumor. The cells that leave the primary tumor and enter the circulation and cause metastasis in the secondary organs are called "circulating tumor cells" (CTCs). The presence and number of circulating tumor cells has been associated with poor prognosis in many major types of cancer, including breast, prostate, and colorectal cancer. It is thought that knowledge of circulating tumor cells, which are seen as the main cause of cancer-related deaths due to metastasis, plays a key role in the diagnosis and treatment of cancer. The fact that tissue biopsies used in cancer diagnosis and follow-up are an invasive method and are insufficient in understanding the risk of metastasis and the progression of the disease have led to new searches. Liquid biopsy tests performed with a small amount of blood sample taken from the patient for the detection of CTCs are easy and reliable, as well as allowing more than one sample to be taken over time to follow the prognosis. However, since these cells are found in very small amounts in the blood, it is very difficult to capture them and specially designed analytical techniques and devices are required. Methods based on the biological and physical properties of the cells are used to capture these cells in the blood. Early diagnosis is very important in following the prognosis of tumors of epithelial origin such as breast, lung, colon and prostate. Molecules such as EpCAM, vimentin, and cytokeratins are expressed on the surface of cells that pass into the circulation from very few primary tumors and reach secondary organs from the circulation, and are used in the diagnosis of cancer in the early stage. For example, increased EpCAM expression in breast and prostate cancer has been associated with prognosis. These molecules can be determined in some blood or body fluids to be taken from patients. However, more sensitive methods are required to be able to determine when they are at a low level according to the course of the disease. The aim is to detect these molecules found in very few cancer cells with the help of sensitive, fast-sensing biosensors, first in breast cancer cells reproduced in vitro and then in blood samples taken from breast cancer patients. In this way, cancer cells can be diagnosed early and easily and effectively treated.

Keywords: electrochemical biosensors, breast cancer, circulating tumor cells, EpCAM, Vimentin, Cytokeratins

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Authors: Vishal Bhatnagar

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The objective of this study is to compare the efficacy of epidural analgesia of two amide local anesthetics, ropivacaine and levobupivacaine, with fentanyl for postoperative analgesia in major abdominal surgery CRS+HIPEC. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) are done for primary peritoneal malignancies or peritoneal spread of malignant neoplasm. CRS and HIPEC are considered one of the most painful surgery among all major abdominal surgeries. Poorly managed postoperative pain elevates stress, increases anxiety, causes prolonged Hospital stay, increases opioid requirement and side effects, increases the cost of treatment and psychological effects on patient and family. It affects the quality of life of patients. The epidural technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, higher patient satisfaction, and an improvement in life quality in the postoperative days after abdominal surgery than other analgesic techniques.

Keywords: HIPEC, postoperative analgesia, cytoreductive surgery, VAS score, rescue analgesia

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Authors: Ramin Mehdiabadi, Neda Menbari, Mohammad Nazir Menbari

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As a pressing public health concern, breast cancer stands as the predominant oncological diagnosis and principal cause of cancer-related mortality among women globally, accounting for 11.7% of new cancer incidences and 6.9% of cancer-related deaths. The annual figures indicate that approximately 230,480 women are diagnosed with breast cancer in the United States alone, with 39,520 succumbing to the disease. While developed economies have reported a deceleration in both incidence and mortality rates across various forms of cancer, including breast cancer, emerging and low-income economies manifest a contrary escalation, largely attributable to lifestyle-mediated risk factors such as tobacco usage, physical inactivity, and high caloric intake. Breast cancer is distinctly characterized by molecular heterogeneity, manifesting in specific subtypes delineated by biomarkers—Estrogen Receptors (ER), Progesterone Receptors (PR), and Human Epidermal Growth Factor Receptor 2 (HER2). These subtypes, comprising Luminal A, Luminal B, HER2-enriched, triple-negative/basal-like, and normal-like, necessitate nuanced, subtype-specific therapeutic regimens, thereby challenging the applicability of generalized treatment protocols. Within this molecular complexity, the transcription factor Forkhead Box M1 (FoxM1) has garnered attention as a significant driver of cellular proliferation, tumorigenesis, metastatic progression, and treatment resistance in a spectrum of human malignancies, including breast cancer. Concurrently, microRNAs (miRs), specifically miR-216b-5p, have been identified as post-transcriptional gene expression regulators and potential tumor suppressors. The overarching objective of this academic investigation is to explicate the multifaceted interrelationship between FoxM1 and miR-216b-5p across the disparate molecular subtypes of breast cancer. Employing a methodologically rigorous, interdisciplinary research design that incorporates cutting-edge molecular biology techniques, sophisticated bioinformatics analytics, and exhaustive meta-analyses of extant clinical data, this scholarly endeavor aims to unveil novel biomarker-specific therapeutic pathways. By doing so, this research is positioned to make a seminal contribution to the advancement of personalized, efficacious, and minimally toxic treatment paradigms, thus profoundly impacting the global efforts to ameliorate the burden of breast cancer.

Keywords: breast cancer, fox m1, microRNAs, mir-216b-5p, gene expression

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Authors: David Jurado, Carlos Ávila

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Detection of early signs of breast cancer development is crucial to quickly diagnose the disease and to define adequate treatment to increase the survival probability of the patient. Computer Aided Detection systems (CADs), along with modern data techniques such as Machine Learning (ML) and Neural Networks (NN), have shown an overall improvement in digital mammography cancer diagnosis, reducing the false positive and false negative rates becoming important tools for the diagnostic evaluations performed by specialized radiologists. However, ML and NN-based algorithms rely on datasets that might bring issues to the segmentation tasks. In the present work, an automatic segmentation and detection algorithm is described. This algorithm uses image processing techniques along with the Hough transform to automatically identify microcalcifications that are highly correlated with breast cancer development in the early stages. Along with image processing, automatic segmentation of high-contrast objects is done using edge extraction and circle Hough transform. This provides the geometrical features needed for an automatic mask design which extracts statistical features of the regions of interest. The results shown in this study prove the potential of this tool for further diagnostics and classification of mammographic images due to the low sensitivity to noisy images and low contrast mammographies.

Keywords: breast cancer, segmentation, X-ray imaging, hough transform, image analysis

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Authors: Sukhee Park, Gaab Soo Kim

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Purpose: We aimed to evaluate the adequacy of second-generation laryngeal mask airway use during prolonged abdominal surgery in respect of ventilation, oxygenation, postoperative pulmonary complications (PPC), and postoperative non-pulmonary complications on living donor kidney transplant (LDKT) surgery. Methods: In total, 257 recipients who underwent LDKT using either laryngeal mask airway-ProSeal (LMA-P) or endotracheal tube (ETT) were retrospectively analyzed. Arterial partial pressure of carbon dioxide (PaCO2 and ratio of arterial partial pressure of oxygen to fractional inspired oxygen (PFR) during surgery were compared between two groups. In addition, PPC including pulmonary aspiration and postoperative non-pulmonary complications including nausea, vomiting, hoarseness, vocal cord palsy, delirium, and atrial fibrillation were also compared. Results: PaCO2 and PFR during surgery were not significantly different between the two groups. PPC was also not significantly different between the two groups. Interestingly, the incidence of delirium was significantly lower in the LMA-P group than the ETT group (3.0% vs. 10.3%, P = 0.029). Conclusions: During prolonged abdominal surgery such as LDKT, second-generation laryngeal mask airway offers adequate ventilation and oxygenation and can be considered a suitable alternative to ETT.

Keywords: laryngeal mask airway, prolonged abdominal surgery, kidney transplantation, postoperative pulmonary complication

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Authors: Naser Shagerdi Esmaeli, Mohsen Hamidpour

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Purposes: The activation of coagulation in patients with cancer contributes significantly to morbidity and mortality rates and may play a fundamental role in the host response to growing tumor’s. Patients with cancer are clearly at high risk for the development of venous thromboembolism (VTE), particularly during chemotherapy and surgery. This situation is aggravated by the use of venous access catheters and possibly growth factors. Methods: Data derived from large, randomized, controlled trials have been used to determine the true incidence of this complication of cancer and its treatment. The incidence based on the analyses of these randomized controlled trials varies from 1% for limited stage patients with breast cancer treated with tamoxifen to 60% for patients with any type of cancer who are subjected to orthopedic surgery and do not receive prophylactic therapy. Results: In view of the morbidity and mortality attributable to VTE in cancer, widespread utilization of prophylactic anticoagulation therapy, which has proven safe and effective in a variety of situations, should be considered. While migratory thrombophlebitis is a clear indicator of an underlying neoplasm, the risk of cancer in patients with the more typical form of VTE has been the subject of intense debate over recent years. Conclusion: Some investigators have suggested that the relative risk of being diagnosed with occult cancer within six months of an episode of VTE (particularly recurrent VTE) could be up to 10-fold. However, the cost-effectiveness of aggressive screening for cancer in patients with VTE has not yet been defined adequately.

Keywords: venous thromboembolism, malignancy, cancer, tumor, heparin

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Authors: Prachi Abhishek Dave, Manisha Singh

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Purpose: The purpose is to study the microbiological profile, prognostic factors, and outcomes of surgery for microbial keratitis (MK) associated endophthalmitis. Methods: It is a retrospective analysis of 39 MK associated endophthalmitis cases which underwent combined PKP with VR surgery. Results: The majority (84.6%) of patients had a history of previous ocular surgery, cataract surgery being the most common (51.2%). Six patients had a history of trauma and 8 patients had corneal graft infection. The culture positivity rate was 92.3%. Organisms isolated were Streptococcal sp (20.5%), Pseudomonas (15.3%), Staphylococcal sp (12.8%) and Fungus (35.8%). Final visual acuities ranged from NPL to 20/120. Poor anatomic success was seen in 15(38.46%) eyes (9-phthisis, 6-eviscerated). Fungal cases had a poor success rate (P-0.02). Conclusion: MK associated endophthalmitis is a sight threatening ocular condition. Fungal etiology carries a poorer prognosis. Timely surgical intervention can achieve favourable anatomical and functional results.

Keywords: endophthalmitis, microbial keratitis, penetrating keratoplasty, vitreo retinal surgery

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Authors: J. Szpor, K. Witczak, M. Storman, A. Orchel, D. Hodorowicz-Zaniewska, K. Okoń, A. Klimkowska

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Core needle biopsy (CNB) is well established as an important diagnostic tool in diagnosing breast cancer and it is now considered the initial method of choice for diagnosing breast disease. In comparison to fine needle aspiration (FNA), CNB provides more architectural information allowing for the evaluation of prognostic and predictive factors for breast cancer, including histological grade—one of three prognostic factors used to calculate the Nottingham Prognostic Index. Several studies have previously described the concordance rate between CNB and surgical excision specimen in determination of histological grade (HG). The concordance rate previously ascribed to overall grade varies widely across literature, ranging from 59-91%. The aim of this study is to see how the data looks like in material at authors’ institution and are the results as compared to those described in previous literature. The study population included 157 women with a breast tumor who underwent a core needle biopsy for breast carcinoma and a subsequent surgical excision of the tumor. Both materials were evaluated for the determination of histological grade (scale from 1 to 3). HG was assessed only in core needle biopsies containing at least 10 well preserved HPF with invasive tumor. The degree of concordance between CNB and surgical excision specimen for the determination of tumor grade was assessed by Cohen’s kappa coefficient. The level of agreement between core needle biopsy and surgical resection specimen for overall histologic grading was 73% (113 of 155 cases). CNB correctly predicted the grade of the surgical excision specimen in 21 cases for grade 1 tumors (Kappa coefficient κ = 0.525 95% CI (0.3634; 0.6818), 52 cases for grade 2 (Kappa coefficient κ = 0.5652 95% CI (0.458; 0.667) and 40 cases for stage 3 tumors (Kappa coefficient κ = 0.6154 95% CI (0.4862; 0.7309). The highest level of agreement was observed in grade 3 malignancies. In 9 of 42 (21%) discordant cases, the grade was higher in the CNB than in the surgical excision. This composed 6% of the overall discordance. These results correspond to the noted in the literature, showing that underestimation occurs more frequently than overestimation. This study shows that authors’ institution’s histologic grading of CNBs and surgical excisions shows a fairly good correlation and is consistent with findings in previous reports. Despite the inevitable limitations of CNB, CNB is an effective method for diagnosing breast cancer and managing treatment options. Assessment of tumour grade by CNB is useful for the planning of treatment, so in authors’ opinion it is worthy to implement it in daily practice.

Keywords: breast cancer, concordance, core needle biopsy, histological grade

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Authors: Jake Hindmarch, Edward Farley, Norman Eizenberg, Mark Midwinter

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There is a need to bring the anatomical knowledge of medical students up to the standards required by surgical specialties. Contention exists amongst anatomists, clinicians, and surgeons about the standard of anatomical knowledge medical students need. The aim of this study was to explore the standards which the Royal Australasian College of Surgeons are applying knowledge of anatomy. Furthermore, to align medical school teaching to what the surgical profession requires from graduates.: The 2018 volume of the ANZ Journal of Surgery was narrowed down to 254 articles by applying the search term “Anatomy”. The main topic was then extracted from each paper. The content of the paper was assessed for ‘novel description’ or ‘application’ of anatomical knowledge’ and classified accordingly. The majority of papers with an anatomical focus was from the general surgery specialty, which focused on surgical techniques, outcomes and management. Vascular surgery had the highest percentage of papers with a novel description and application of anatomy. Cardiothoracic and paediatric surgery had no papers with a novel description of anatomy. Finally, a novel application of anatomy was the main focus of each speciality. Firstly, a high proportion of novel applications and descriptions of anatomy are in general surgery. Secondly, vascular surgery had the largest proportion of novel application and description of anatomy, namely due to the rise of therapeutic imaging and endovascular techniques. Finally, all disciplines demonstrated a trend towards having a higher proportion of novel application of anatomical knowledge

Keywords: anatomical knowledge, anatomy, surgery, novel anatomy

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Authors: Debasmita Mukhopadhyay, Manika Pal Bhadra

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MiRNAs contribute to oncogenesis either as tumor suppressors or oncogenes. Hence, discovery of miRNA-based therapeutics are imperative to ameliorate cancer. Modulation of miRNA maturation is accomplished via several therapeutic agents, including small molecules and oligonucleotides. Due to the attractive pharmacokinetic properties of small molecules over oligonucleotides, we set to identify small molecule inhibitors of a metastasis-inducing microRNA. Cytotoxicity profile of aza-flavanone C1 was analyzed in a panel of breast cancer cells employing the NCI-60 screen protocols. Flow cytometry, immunofluorescence and western blotting of apoptotic or EMT markers were performed to analyze the effect of C1. A dual luciferase assay unequivocally suggested that C1 repressed endogenous miR-10b in MDA-MB-231 cells. A derivative of aza-flavanone C1 is shown as a strong inhibitor miR-10b. Blockade of miR-10b by C1 resulted in decreased expression of miR-10b targets in an aggressive breast cancer cell line model, MDA-MB-231. Abrogation of TWIST1, an EMT-inducing transcription factor also contributed to C1 mediated apoptosis. Moreover C1 exhibited a specific and selective down-regulation of miR-10b and did not function as a general inhibitor of miRNA biogenesis or other oncomiRs of breast carcinoma. Aza-flavanone congener C1 functions as a potent inhibitor of the metastasis-inducing microRNA, miR-10b. Our present study provides evidence for targeting metastasis-inducing microRNA, miR-10b with a derivative of Aza-flavanone. Better pharmacokinetic properties of small molecules place them as attractive agents compared to nucleic acids based therapies to target miRNA. Further work, in generating analogues based on aza-flavanone moieties will significantly improve the affinity of the small molecules to bind miR-10b. Finally, it is imperative to develop small molecules as novel miRNA-therapeutics in the fight against cancer.

Keywords: breast cancer, microRNA, metastasis, EMT

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Authors: Martin Dupuy, Solange Grunenwald, Pierre-Louis Colombo, Laurence Mahieu, Pomone Richard, Philippe Bartoli

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Endonasal endoscopic trans-sphenoidal surgery for pituitary tumours has become a mainstay of treatment over the last two decades. Although it is generally accepted that there is no significant difference between endoscopic versus microscopic approach for surgical outcomes (endocrine and ophthalmologic status), nasal morbidity seems to the benefit of endoscopic procedures. Minimally invasive endoscopic surgery needs an operative learning curve to achieve surgeon’s efficiency. This learning curve is now well known for surgical outcomes and complications rate, however, few data are available for nasal morbidity. The aim of our series is to document operative experience and nasal quality of life after (NQOL) endoscopic trans-sphenoidal surgery. The prospective pituitary surgical cohort consisted of 525 consecutives patients referred to our Skull Base Diseases Department. Endoscopic procedures were performed by a single neurosurgeon using an uninostril approach. NQOL was evaluated using the Sino-Nasal Test (SNOT-22), the Anterior Base Nasal Inventory (ASBNI) and the Skull Base Inventory Score (SBIS). Data were collected before surgery during hospital stay and 3 months after the surgery. The seventy first patients were compared to the latest 70 patients. There was no significant difference between comparison score before versus after surgery for SNOT-22, ASBNI and SBIS during the single surgeon’s learning curve. Our series demonstrates that in our institution there is no statistically significant learning curve for NQOL after uninostril endoscopic pituitary surgery. A careful progression through sinonasal structures with very limited mucosal incision is associated with minimal morbidity and preserves nasal function. Conservative and minimal invasive approach could be achieved early during learning curve.

Keywords: pituitary surgery, quality of life, minimal invasive surgery, learning curve, pituitary tumours, skull base surgery, endoscopic surgery

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Authors: Cristina Núñez, Rufina Bastida, Elena Labisbal, Alejandro Macías, María T. Pereira, José M. Vila

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A highly selective quinoline-based fluorescent sensor L was designed in order to functionalize gold nanoparticles (GNPs@L). The cytotoxicity of compound L and GNPs@L on the MCF-7 breast cancer cells was explored and it was observed that L and GNPs@L compounds induced apoptosis in MCF-7 cancer cells. The cellular uptake of the hybrid system GNPs@L was studied using confocal laser scanning microscopy (CLSM).

Keywords: cytotoxicity, fluorescent probes, nanoparticles, quinoline

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Authors: Salma Mirza, Syeda Asma Naqvi, Khalid Mohammed Khan, M. Iqbal Choudhary

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In this study twenty-five (25) newly synthesized compounds substituted aryl thiazoles (SAT) 1-25 were synthesized, and in vitro cytotoxicity of these compounds was evaluated against four cancer cell lines namely, MCF-7 (ER+ve breast), MDA-MB-231 (ER-ve breast), HCT116 (colorectal), and, HeLa (cervical) and compared with the standard anticancer drug doxorubicin with IC50 value of 1.56 ± 0.05 μM. Among them, compounds 1, 4-8 and 19 were found to be active against all four cell lines. Compound 20 was found to be selectively active against MCF7 cells with IC50 value of 40.21 ± 4.15 µM, whereas compound 19 was active against only MCF7 and HeLa cells with IC50 values of 46.72 ± 1.8 and 19.86 ± 0.11 μM, respectively. These results suggest that aryl thiazoles 1 and 4 deserve to be investigated further in vivo as anti-cancer agents.

Keywords: anticancer agents, breast cancer cell lines (MCF7, MDA-MB-231), colorectal cancer cell line (HCT-116), cervical cancer cell line (HeLa), Thiazole derivatives

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Authors: Mukesh K., Siddiqui A. K., Abbas H., Gupta R.

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Background: General Anesthesia is a standard for breast onco-surgery. The issue of postoperative pain and the occurrence of nausea and vomiting has prompted the quest for a superior methodology with fewer complications. Over the recent couple of years, paravertebral block (PVB) has acquired huge fame either in combination with GA or alone for anesthetic management. In this study, we aim to evaluate the efficacy of morphine and clonidine as an adjunct to ropivacaine in a paravertebral block in breast cancer patients undergoing modified radical mastectomy. Methods: In this study, total 90 patients were divided into three groups (30 each) on the basis of computer-generated randomization. Group C (Control): Paravertebral block with 0.25% ropivacaine (19ml) and 1 ml saline; Group M- Paravertebral block with 0.25% ropivacaine(19ml) + 20 microgram/kg body weight morphine; Group N: Paravertebral block with 0.25% ropivacaine(19ml) +1.0 microgram/kg body weight clonidine. The postoperative pain intensity was recorded using the visual analog scale (VAS) and Sedation was observed by the Ramsay Sedation score (RSS). Results: The VAS was similar at 0hr, 2hr and 4 hr in the postoperative period among all the groups. There was a significant (p=0.003) difference in VAS from 6 hr to 20 hr in the postoperative period among the groups. A significant (p<0.05) difference was observed among the groups at 8 hr to 20 hr). The first requirement of analgesia was significantly (p=0.001) higher in Group N (7.70±1.74) than in Group C (4.43±1.43) and Group M (7.33±2.21). Conclusion: The morphine in the paravertebral block provides better postoperative analgesia. The consumption of rescue analgesia was significantly reduced in the morphine group as compared to the clonidine group. The procedure also proved to be safe as no complication was encountered in the paravertebral block in our study.

Keywords: ropivacaine, morphine, clonidine, paravertebral block

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Authors: Abhishek Dave, Manisha Singh

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Purpose: The study aims to evaluate the outcomes of combined Penetrating keratoplasty (PKP) and Vitreo-Retinal (VR) surgery in patients having endophthalmitis with poor corneal clarity. Methods: PKP with VR Surgery was performed in 43 eyes. This is a retrospective analysis of their preoperative, intraoperative and microbiological characteristics and anatomical and functional outcomes. Results: Corneal opacification was due to corneal ulcer in 30 (69.7%), graft infection in 8 (18.6%), bullous keratopathy in 4 and corneal scar in 1 eye. Postoperative visual acuity improved in 20 (46.5%), not changed in 14 (32.5%) and deteriorated in 9 eyes (20.9%). Poor anatomic success was seen in 15 (34.88%) eyes (9-phthisis bulbi, 6-eviscerated). Graft remained clear in 24 eyes (1 year). Microbiology revealed bacteria in 26, fungus in 14 and no growth in 3 eyes. Six out of 11 patients having poor vision in the fellow eye, too, achieved functional success. Conclusion: PKP with VR surgery is a complex but globe-salvaging procedure for poor prognosis eyes, which otherwise would need evisceration.

Keywords: penetrating keratoplasty, VR surgery, endophthalmitis, corneal ulcer

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Authors: Ramon Sancibrian, Carlos Redondo-Figuero, Maria C. Gutierrez-Diez, Esther G. Sarabia, Maria A. Benito-Gonzalez, Jose C. Manuel-Palazuelos

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In this paper, the design and evaluation of a handle for laparoscopic surgery is presented. The design of the handle is based on ergonomic principles and tries to avoid awkward postures for surgeons. The handle combines the so-called power-grip and accurate-grip in order to provide strength and accuracy in the performance of surgery. The handle is tested using both objective and subjective approaches. The objective approach uses motion capture techniques to obtain the angles of forearm, arm, wrist and hand. The muscular effort is obtained with electromyography electrodes. On the other hand, a subjective survey has been carried out using questionnaires. Results confirm that the handle is preferred by the majority of the surgeons.

Keywords: laparoscopic surgery, ergonomics, mechanical design, biomechanics

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Authors: Yasmine Aridi, Lara Nasreddine, Maya Khalil, Arafat Tfayli, Anas Mugharbel, Farah Naja

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Breast cancer is the most commonly diagnosed cancer site among women worldwide and the second most common cause of cancer mortality. Breast cancer rates differ vastly between geographical areas, countries, and within the same country. In Lebanon, the proportion of breast cancer to all other sites of tumor is 38.2%; these rates are still lower than those observed worldwide, but remain the highest among Arab countries. Studies and evidence based reviews show a strong association between breast cancer development and prognosis and dietary habits, specifically the Mediterranean diet (MD). As such, the aim of this study is to examine dietary patterns and adherence to the MD among a sample of 182 breast cancer female patients in Beirut, Lebanon. Subjects were recruited from two major hospitals; a private medical center and a public hospital. All subjects were administered two questionnaires: socio- demographics and Mediterranean diet adherence. Five Mediterranean scores were calculated: MS, MSDPS, PMDI, PREDIMED and DDS. The mean age of the participants was 53.78 years. The overall adherence to the Mediterranean diet (MD) was low since the sample means of 3 out of the 5 calculated scores were less than the scores’ medians. Given that 4 out of the 5 Mediterranean scores significantly varied between the recruitment sites, women in the private medical center were found to adhere more to the MD. Our results also show that the majority of the sample population’s intakes are exceeding the recommendations for total and saturated fat, while meeting the requirements for fiber, EPA, DHA and Linolenic Acid. Participants in the private medical center were consuming significantly more calories, carbohydrates, fiber, sugar, Lycopene, Calcium, Iron and Folate and less fat. After conducting multivariate linear regression analyses, the following significant results were observed: positive associations between MD (CPMDI, PREDIMED) and monthly income & current state of health, while negative associations between MD (MSDPS, PREDIMED) and age & employment status. Our findings indicated a low overall adherence to the MD and identified factors associated with it; which suggests a need to address dietary habits among BC patients in Lebanon, specifically encouraging them to adhere to their traditional Mediterranean diet.

Keywords: Adherence, Breast cancer, Dietary patterns, Mediterranean diet, Nutrition

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Authors: Javier Enciso-Benavides, Fredy Fabian, Carlos Castaneda, Luis Alfaro, Alex Choque, Aparicio Aguilar, Javier Enciso

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Background: The use of biomarkers in breast cancer diagnosis, therapy, and prognosis has gained increasing interest. Cancer stem cells (CSCs) are a subpopulation of tumor cells that can drive tumor initiation and may cause relapse. Therefore, due to the importance of diagnosis, therapy, and prognosis, several biomarkers that characterize CSCs have been identified; however, in treatment-naïve triple-negative breast tumors, there is an urgent need to identify new biomarkers and therapeutic targets. According to this, the aim of this study was to identify serum proteins associated with cancer stem cells and pluripotency in women with triple-negative breast tumors in order to subsequently identify a biomarker for this type of breast tumor. Material and Methods: Whole blood samples from 12 women with histopathologically diagnosed triple-negative breast tumors were used after obtaining informed consent from the patient. Blood serum was obtained by conventional procedure and frozen at -80ºC. Identification of cancer stem cell-associated proteins was performed by matrix-assisted laser desorption/ionisation-assisted laser desorption/ionisation mass spectrometry (MALDI-TOF MS), protein analysis was obtained using the AB Sciex TOF/TOF™ 5800 system (AB Sciex, USA). Sequences not aligned by ProteinPilot™ software were analyzed by Protein BLAST. Results: The following proteins related to pluripotency and cancer stem cells were identified by MALDI TOF/TOF mass spectrometry: A-chain, Serpin A12 [Homo sapiens], AIEBP [Homo sapiens], Alpha-one antitrypsin, AT {internal fragment} [human, partial peptide, 20 aa] [Homo sapiens], collagen alpha 1 chain precursor variant [Homo sapiens], retinoblastoma-associated protein variant [Homo sapiens], insulin receptor, CRA_c isoform [Homo sapiens], Hydroxyisourate hydrolase [Streptomyces scopuliridis], MUCIN-6 [Macaca mulatta], Alpha-actinin-3 [Chrysochloris asiatica], Polyprotein M, CRA_d isoform, partial [Homo sapiens], Transcription factor SOX-12 [Homo sapiens]. Recommendations: The serum proteins identified in this study should be investigated in the exosome of triple-negative breast cancer stem cells and in the blood serum of women without breast cancer. Subsequently, proteins found only in the blood serum of women with triple-negative breast cancer should be identified in situ in triple-negative breast cancer tissue in order to identify a biomarker to study the evolution of this type of cancer, or that could be a therapeutic target. Conclusions: Eleven cancer stem cell-related serum proteins were identified in 12 women with triple-negative breast cancer, of which MUCIN-6, retinoblastoma-associated protein variant, transcription factor SOX-12, and collagen alpha 1 chain are the most representative and have not been studied so far in this type of breast tumor. Acknowledgement: This work was supported by Proyecto CONCYTEC–Banco Mundial “Mejoramiento y Ampliacion de los Servicios del Sistema Nacional de Ciencia Tecnología e Innovacion Tecnologica” 8682-PE (104-2018-FONDECYT-BM-IADT-AV).

Keywords: triple-negative breast cancer, MALDI TOF/TOF MS, serum proteins, cancer stem cells

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Authors: Ashraf Mohammadzadeh, Ahmad Shah Farhat, Azin Vaezi, Aradokht Vaezi

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Background & Aim: Preterm infants born at less than 34 weeks postconceptional age are not as neurologically mature as their term counterparts and thus have difficulty coordinating sucking, swallowing and breathing. As a result, they are traditionally gavage fed until they are able to oral feed successfully. The aim of study was to evaluate comparative effect of orogastric and breast feeding on oxygen saturation in very low birth weight infant (<1500gm). Patients and Methods: In this clinical trial all babies admitted in the Neonatal Research Center of Imamreza Hospital, Mashhad during a 4 months period were elected. Criteria for entrance to study included birth weight ≤ 1500 grams, exclusive breastfeeding, having no special problem after 48 hours, receivinge only routine care and intake of milk was 100cc/kg/day. Each neonate received two rounds of orogastric and breast feeding in the morning and in the afternoon, during which mean oxygen saturation was measured by pulse-oxymetry. During the study the heart rate and temperature of the neonates were monitored, and in case of hypothermia, bradycardia(less than 100 per minute) or apnea the feeding was discontinued and the study was repeated the following day. Data analysis was carried out using SPSS. Results: Fifty neonates were studied. The average birth weight was 1267.20±165.42 grams and average gestational age was 31.81±1.92 and female/male ratio was 1.2. There was no significant statistical difference in arterial oxygen saturation in orogastric and breast feeding in the morning and in the afternoon. (p=0.16 in the morning and p=0.6 in the afternoon). There was no complication of apnea, hypothermia or bradycardia. Conclusion: There was no significant statistical difference between the two methods in arterial oxygen saturation. It seems that oral feeding (which is a natural route) and skin contact between the mother and neonate causes a strong emotional bonding between the two and brings about better social adaptation for the neonate. Also shorter period of stay in hospital is more preferred, and breast feeding should be started at the earliest possible time after birth.

Keywords: Very low birth weight (V.L.B.W), O2 Saturation, Breast Feeding, Tube Feeding

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Authors: Angel Champion, Sadia Kanwal, Rafat Siddiqui

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Harnessing phytochemicals from plant sources presents a novel opportunity to prevent or treat malignant diseases, including breast cancer. Chemotherapy lacks precision in targeting cancerous cells while sparing normal cells, but a phytopharmaceutical approach may offer a solution. Dandelion, a common weed plant, is rich in phytochemicals and provides a safer, more cost-effective alternative with lower toxicity than traditional pharmaceuticals for conditions such as breast cancer. In this study, an in-vitro experiment will be conducted using the ethanol extract of Dandelion on triple-negative MDA-231 breast cancer cell lines. The polyphenolic analysis revealed that the Dandelion extract, particularly from the root and leaf (both cut and sifted), had the most potent antioxidant properties and exhibited the most potent antioxidation activity from the powdered leaf extract. The extract exhibits prospective promising effects for inducing cell proliferation and apoptosis in breast cancer cells, highlighting its potential for targeted therapeutic interventions. Standardizing methods for Dandelion use is crucial for future clinical applications in cancer treatment. Combining plant-derived compounds with cancer nanotechnology holds the potential for effective strategies in battling malignant diseases. Utilizing liposomes as carriers for phytoconstituent anti-cancer agents offers improved solubility, bioavailability, immunoregulatory effects, advancing anticancer immune function, and reducing toxicity. This integrated approach of natural products and nanotechnology has significant potential to revolutionize healthcare globally, especially in underserved communities where herbal medicine is prevalent.

Keywords: apoptosis, antioxidant activity, cancer nanotechnology, phytopharmaceutical

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Authors: Iveta Bryjova

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Recording of viscoelastic strain-vs-time curves with the aid of the suction method and a follow-up analysis, resulting into evaluation of standard viscoelastic parameters, is a significant technique for non-invasive contact diagnostics of mechanical properties of skin and assessment of its conditions, particularly in acute burns, hypertrophic scarring (the most common complication of burn trauma) and reconstructive surgery. For elimination of the skin thickness contribution, usable viscoelastic parameters deduced from the strain-vs-time curves are restricted to the relative ones (i.e. those expressed as a ratio of two dimensional parameters), like grosselasticity, net-elasticity, biological elasticity or Qu’s area parameters, in literature and practice conventionally referred to as R2, R5, R6, R7, Q1, Q2, and Q3. With the exception of parameters R2 and Q1, the remaining ones substantially depend on the position of inflection point separating the elastic linear and viscoelastic segments of the strain-vs-time curve. The standard algorithm implemented in commercially available devices relies heavily on the experimental fact that the inflection time comes about 0.1 sec after the suction switch-on/off, which depreciates credibility of parameters thus obtained. Although the Qu’s US 7,556,605 patent suggests a method of improving the precision of the inflection determination, there is still room for nonnegligible improving. In this contribution, a novel method of inflection point determination utilizing the advantageous properties of the Savitzky–Golay filtering is presented. The method allows computation of derivatives of smoothed strain-vs-time curve, more exact location of inflection and consequently more reliable values of aforementioned viscoelastic parameters. An improved applicability of the five inflection-dependent relative viscoelastic parameters is demonstrated by recasting a former study under the new method, and by comparing its results with those provided by the methods that have been used so far.

Keywords: Savitzky–Golay filter, scarring, skin, viscoelasticity

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Authors: Amichai Ben ari, Daniella Margalit

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Medical procedures, such as surgery, may have traumatic significance for some children. This study examines the relationship between maltreatment in children and the development Pediatric Medical Traumatic Stress (PMTS). To this end, differences in the level of distress of children after surgery were examined between two groups: children who were maltreated ("children at risk") and children from the control group ("children who are not at risk"). The study involved 230 parents of children who came to the hospital to undergo surgery. Parents filled out demographic questionnaires to measure socioeconomic variables and psychological questionnaires to measure the distress of the child and parent before surgery. After 6 months from the time of surgery, the parents again filled in the questionnaire measuring the child's distress. The results of the study showed that the level of distress experienced by children at risk after surgery was significantly higher relative to children who are not at risk. It was also found that the level of distress experienced by parents of children at risk in relation to their child’s surgery is significantly higher compared to parents of children who are not at risk. Finally, it was found that the variables: (1) pre-morbid psychological functioning of the child. (2) Parental and family functioning in daily life. (3) Exposure of the child to traumatic events. (4) Support factors for the family. Are variables that predict the development of PMTS in children after surgery, but only for children at risk and not for children who are not at risk. The significance of the findings in relation to the need to identify at-risk populations in the hospitals and the policies derived from them were discussed, and several directions were raised for further research.

Keywords: children at risk, pediatric medical traumatic stress (PMTS), PTSD, medical procedures

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Authors: Fiona Lourenco, William Allen

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Dentofacial deformities are primarily surgically treated via orthognathic surgery. Health-related quality of life is concerned with aspects of quality of life that relate specifically to an individual’s health. Design and Setting: Retrospective analysis of patients who had orthognathic surgery from January 2018 - December 2022 at the trust using the previously validated Orthognathic Quality of Life questionnaire (OQoL). Materials and Methods: 32 Patient questionnaires (which included pre-operative and post-operative separate sections) were obtained via telephone survey. The data was analysed using the two-tailed paired t-test and Wilcoxon signed-rank test. Results: The change in perception post-surgery was highly significant (both tests resulted in p<0.001 for overall analysis as well as for each domain). Overall, a 74% improvement in QoL was seen following orthognathic surgery. Reports of improvement in each domain were as follows: 71% in the social aspect of the deformity domain, 76% in facial aesthetics, 60% in function, and 57% improvement in awareness of facial deformity. Conclusion: The assessment of QoL is becoming progressively imperative in clinical research. The above data shows that orthognathic surgery has a significant improvement in the QoL of patients post-operatively. The results demonstrate improvement in all domains, with perceptions in facial aesthetics seeing the highest change post-operatively.

Keywords: dentofacial, oral, facial asymmetry, orthognathic surgery, quality of life

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Authors: Khalid Iqbal

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This work presents a comparison of an anthropomorphic PRESAGE® dosimeter and radiochromic film measurements with a commercial treatment planning system to determine the feasibility of PRESAGE® for 3D dosimetry in breast IMRT. An anthropomorphic PRESAGE® phantom was created in the shape of a breast phantom. A five-field IMRT plan was generated with a commercially available treatment planning system and delivered to the PRESAGE® phantom. The anthropomorphic PRESAGE® was scanned with the Duke midsized optical CT scanner (DMOS-RPC) and the OD distribution was converted to dose. Comparisons were performed between the dose distribution calculated with the Pinnacle3 treatment planning system, PRESAGE®, and EBT2 film measurements. DVHs, gamma maps, and line profiles were used to evaluate the agreement. Gamma map comparisons showed that Pinnacle3 agreed with PRESAGE® as greater than 95% of comparison points for the PTV passed a ± 3%/± 3 mm criterion when the outer 8 mm of phantom data were discluded. Edge artifacts were observed in the optical CT reconstruction, from the surface to approximately 8 mm depth. These artifacts resulted in dose differences between Pinnacle3 and PRESAGE® of up to 5% between the surface and a depth of 8 mm and decreased with increasing depth in the phantom. Line profile comparisons between all three independent measurements yielded a maximum difference of 2% within the central 80% of the field width. For the breast IMRT plan studied, the Pinnacle3 calculations agreed with PRESAGE® measurements to within the ±3%/± 3 mm gamma criterion. This work demonstrates the feasibility of the PRESAGE® to be fashioned into anthropomorphic shape, and establishes the accuracy of Pinnacle3 for breast IMRT. Furthermore, these data have established the groundwork for future investigations into 3D dosimetry with more complex anthropomorphic phantoms.

Keywords: 3D dosimetry, PRESAGE®, IMRT, QA, EBT2 GAFCHROMIC film

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Authors: Marwa M. Abu-Serie, Marwa M. Eltarahony

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The search for reliable, effective, and safe nanoparticles (NPs) as a treatment for cancer is a pressing priority. In this study, Cu-NPs were fabricated by Streptomyces cyaneofuscatus through simultaneous bioreduction strategy of copper nitrate salt. The as-prepared Cu-NPs subjected to structural analysis; energy-dispersive X-ray spectroscopy, elemental mapping, X-ray diffraction, transmission electron microscopy, and ζ-potential. These biological synthesized Cu-NPs were mixed with disulfiram (DS), forming a nanocomplex of Cu-DS with a size of ~135 nm. The prepared nanocomplex (nanoCu-DS) exhibited higher anticancer activity than that of free complex of DS-Cu, Cu-NPs, and DS alone. This was illustrated by the lowest IC50 of nanoCu-DS (< 4 µM) against human breast and liver cancer cell lines comparing with DS-Cu, Cu-NPs, and DS (~8, 22.98-33.51 and 11.95-14.86, respectively). Moreover, flow cytometric analysis confirmed that higher apoptosis percentage range of nanoCu-DS-treated in MDA-MB 231, MCF-7, Huh-7, and HepG-2 cells (51.24-65.28%) than free complex of Cu-DS ( < 4.5%). Regarding inhibition potency of liver and breast cancer cell migration, no significant difference was recorded between free and nanocomplex. Furthermore, nanoCu-DS suppressed gene expression of β-catenine, Akt, and NF-κB and upregulated p53 expression (> 3, >15, > 5 and ≥ 3 folds, respectively) more efficiently than free complex (all ~ 1 fold) in MDA-MB 231 and Huh-7 cells. Our finding proved this prepared nano complex has a powerful anticancer activity relative to free complex, thereby offering a promising cancer treatment.

Keywords: biologically prepared Cu-NPs, breast cancer cell lines, liver cancer cell lines, nanoCu- disulfiram

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Authors: Reetika Sharma, Lalit Tejwani, Himanshu Shekhar, Arun Singhvi

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Purpose: Advanced Glaucoma with Failed trab is not an uncommon sight in glaucoma clinic, and such cases usually tend to present with high intraocular pressure (IOP) and advanced cupping, or even glaucomatous atrophy stage. Re-surgery is needed for such cases, and wound modulation poses a major challenge in these cases. We share our experience in this case series with the use of Ologen (collagen matrix implant) along with MMC 0.04% used in surgery. The purpose of the study was to evaluate the efficacy and outcome of collagen matrix implant in re-trabeculectomy in advanced glaucoma cases. Methodology: Eleven eyes of 11 patients (one eye of one patient) underwent re-trabeculectomy surgery with MMC and Ologen. Ologen implant was used in sub scleral and subconjunctival space, as a spacer and wound modulator. In five cases, triple modulation with implant soaked in anti-VEGF was used. Results: All patients had cupping more than 0.9, and one case was GOA. All cases were on maximal medication at presentation and majority were on systemic anti-glaucoma therapy also. Post-surgery, follow-up ranged from 13 – 34 months, and all cases had a follow longer than the gap between previous surgery (which was failed) and re-trab. One case needed AC reformation and one needling was done. Phaco was done at same sitting in four cases. All cases had their IOP lowered post surgery, and vision was maintained in all, however one case was considered as failed re-surgery case. Topical medication was needed in seven cases post-surgery also. Conclusion: Ologen as adjuvant should be considered in all re-trab cases and all high risk and advanced cases, and triple modulation can be next step in these cases. Aggressive IOP control and non- reluctance to continue topical medications post second surgery should be considered in such cases, to give them best possible vision.

Keywords: failed trabeculectomy, ologen, trabeculectomy, advanced glaucoma

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Authors: K. Bensafia, A. Mansour, G. Le Maillot, B. Clement, O. Reynet, P. Ariès, S. Haddab

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This paper presents a system designed for wireless acquisition, the recording of electrocardiogram (ECG) signals and the monitoring of the heart’s health during surgery. This wireless recording system allows us to visualize and monitor the state of the heart’s health during a surgery, even if the patient is moved from the operating theater to post anesthesia care unit. The acquired signal is transmitted via a Bluetooth unit to a PC where the data are displayed, stored and processed. To test the reliability of our system, a comparison between ECG signals processed by a conventional ECG monitoring system (Datex-Ohmeda) and by our wireless system is made. The comparison is based on the shape of the ECG signal, the duration of the QRS complex, the P and T waves, as well as the position of the ST segments with respect to the isoelectric line. The proposed system is presented and discussed. The results have confirmed that the use of Bluetooth during surgery does not affect the devices used and vice versa. Pre- and post-processing steps are briefly discussed. Experimental results are also provided.

Keywords: electrocardiography, monitoring, surgery, wireless system

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Authors: Maryam Zahedifard, Fadhil Lafta Faraj, Maryam Hajrezaie, Nazia Abdul Majid, Mahmood Ameen Abdulla, Hapipah Mohd Ali

Abstract:

In the current study, we prepared two new quinazoline schiff bases through condensation reaction of 2-aminobenzhydrazide with 5-bromosalicylaldehyde and 3-methoxy-5-bromosalicylaldehyde. The chemical structures of both newly synthesized compounds (1 and 2) were confirmed by FT-IR and X-ray crystallography studies. The cytotoxic effect of compounds was investigated against MCF-7 human breast cancer cells. MTT results showed that (1) and (2) decreased the viability of MCF-7 cells in a time-dependent manner, exhibiting an IC50 value of 3.23 ± 0.28 µg/mL and 3.41 ± 0.34 µg/mL, respectively, after a 72-hours treatment period. In contrast, they did not show significant anti-proliferative effect towards MCF-10A normal breast cells and WRL-68 normal liver cells. We found a perturbation in mitochondrial membrane potential and increased cytochrome c release from the mitochondria to the cytosol, suggesting an activation of apoptosis by compounds, which was confirmed by activation of the initiator caspase-9 and the executioner caspases-3/7. (1) was also able to trigger extrinsic pathway via activation of caspase-8 and inhibition of NF-κB translocation. The acute toxicity test showed no toxicity effect of the compounds in rats. Our results showed that the selected synthesized compounds are highly potent to induce apoptosis in MCF-7 cells via either intrinsic or extrinsic mitochondrial pathway.

Keywords: Quinazoline Schiff base, apoptosis, MCF-7 human breast cancer cell line, caspase, NF-κB translocation

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