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Surgical patients and their families experience high rates of perioperative anxiety, which determine a negative impact on their surgery-related outcomes. Understanding what communicational aspects positively impact perioperative anxiety may help promote more efficient, patient-centered communication approaches which could address this issue. The aim of this scoping review was to synthesize published research on communication between surgical employees and adult patients and their relatives, and its role in managing perioperative anxiety.A scoping review approach was used across four international databases to search for publications detailing communicational interventions and approaches employed in surgical contexts and their impact on surgical patients' and their caregivers' perioperative anxiety levels. Results were narratively synthesized.Twenty-two studies were included in this scoping review, which were grouped according to their communication intervention into one of five categories: technology-assisted interventions, interpersonal communication, educational programs, tools for facilitating exchange of information and theory-derived communication strategies. Records reported mixed results in terms of reducing perioperative anxiety. Facilitating and hindering factors in interpersonal communication in this context were further synthesized.A multitude of communicational approaches and their effect on anxiety have been investigated within surgical settings, with varying results. Existing evidence suggests that it is vital to address surgical patients' anxiety through personalized empathetic communication, tailored to an individual's case, preferences, and needs. Key aspects of patient-healthcare professional communication which may impact perioperative anxiety were identified and may be utilized in future trainings for communication skills among surgical teams.

The present paper addresses the development of a closing and sealing system for a container which shall safely bring 100 g of regolith from the surface of Phobos, one of the moons of Mars. Based on a set of requirements defined by the ESA (European Space Agency), a design of the closing and sealing system was made and FEA (Finite Element Analysis) was employed to validate the design. The closing and sealing mechanism along with the Vault (container to be sealed) proved the capability to overcome the Robotic Arm misalignments, to ensure the Vault closing and to maintain the leak tightness (maximum admissible leak rate of 10−4 mbar*l/s Helium) during the trip back to Earth. All these features were validated following an extensive test campaign implying mechanical loads, shocks, thermal vacuum cycling, dust contamination, impact tests and several functional verifications. The mechanism demonstrated the targeted maturity level (TRL 5) and it can be further developed in order to be qualified for a specific mission/application.

The activities presented under this paper were focused on designing, manufacturing, testing and evaluation of a metallic antenna reflector for space applications. The main challenge was to obtain a low mass, while maintaining the reflector capability to withstand the mechanical loads encountered during the launching phase, as well as the harsh space environment with significant temperature variations, without any detrimental effect over the dimensional stability of the reflective surface. The chosen material was titanium alloy for the reflector and stainless steel for fasteners and mounting supports. Manufacturing parameters have been investigated aiming for low internal stresses during processing and to obtain the best results in terms of dimensional accuracy and surface roughness. One of the five analysed reflector architectures (reflector breadboards) was selected and manufactured using two different finishing operations, milling and turning, the latter being the one presenting the best results. Dimensional accuracy of the reflector breadboard, before and after vibration and environmental tests, was found to be smaller than the imposed requirements, thus validating the reflector proposed design. After the breadboarding activity, an optimized version of the antenna reflector (demonstrator), also validated by structural analysis, was developed. Unfortunately, the measured profile deviation of the demonstrator was higher than the imposed requirements (by 50%), mainly due to internal stresses during mechanical processing of the new geometry. Before the experimental evaluation of the reflector demonstrator, a surface coating was developed and applied to the reflective surface of the demonstrator. Despite the profile deviation, the demonstrator meets the imposed mechanical requirements and offers important lessons to be applied in the future development activities.

Purpose and objectives. The purpose of this paper was to compare the “outcomes” of patients with peritonitis according to the surgical method selected (laparoscopic vs. conventional/open), in the treatment of such a severe pathology, in order to obtain an efficient management of postoperative morbidities and the reduction of the mortality rate (currently estimated at 5% - 40%). Material and method. We carried out a retrospective, observational, non-randomized study on a sample of hospitalized patients, based on a descriptive and analytical epidemiological investigation, supported by the laparoscopic experience of the General Surgery Clinic in “Sf. Ioan” Emergency Clinical Hospital of Bucharest in the last decade (01.01.2009-31.12.2018). Results. We identified a sample of 378 patients with peritonitis, of which 109 were operated laparoscopically (i.e. 28.84%), and 269 patients (i.e. 71.16%) were operated traditionally. Following a rough analysis, it was observed that patients who underwent open surgery were hospitalized on an average 4.73 days longer than those operated laparoscopically (11.67 days vs. 6.94 days), the effect being statistically significant (p < 0.01). In the traditionally operated group of patients, the average duration of surgery was 46.31 minutes longer than those operated laparoscopically (113.92 vs. 67.60), the effect being also statistically significant (p < 0.01). Conclusions. The conventional surgical approach is statistically significantly associated with an increased duration of operative time and hospitalization in patients with peritonitis and can be considered a factor of severe evolutive prognosis in the therapeutic management of this pathology.

The paper addresses the synthesis of a nano-fibre network by coaxial electrospinning, embedding the healing agent dicyclopentadiene (DCPD) in polyacrylonitrile (PAN) fibres. Compared to other encapsulation methods, the use of nano-fibres filled with healing agent have no effect on the mechanical properties of the matrix and can address a larger healing area. Additionally, carbon nanotubes were added as nanofillers to enhance the reactivity between DCPD and the epoxydic matrix. The self-healing capability of the nano-fibre network was carried out by flexural tests, at epoxy resin level and composite level. Results obtained from Fourier transform infrared (FTIR) spectrometry, thermogravimetric analysis (TGA) and scanning electron microscopy (SEM) confirmed the successful encapsulation of DCPD healing agent in PAN fibres. Flexural tests indicate that after 48 h, the epoxy resin has recovered 84% of its flexural strength while the composite material recovered 93%.

In the space industry, the market demand for high-pressure mechanically pumped fluid loop (MPFL) systems has increased the interest for integrating advanced technologies in the manufacturing process of critical components with complex geometries. The conventional manufacturing process of a closed impeller encounters different technical challenges, but using additive manufacturing (AM) technology, the small component is printed, fulfilling the quality requirements. This paper presents the Laser Powder Bed Fusion (LPBF) process of a closed impeller designed for a centrifugal pump integrated in an MPFL system with the objective of defining a complete manufacturing process. A set of three closed impellers was manufactured, and each closed impeller was subjected to dimensional accuracy analysis, before and after applying an iterative finishing process for the internal surface area. One of the impellers was validated through non-destructive testing (NDT) activities, and finally, a preliminary balancing was performed for the G2.5 class. The process setup (building orientation and support structure) defined in the current study for a pre-existing geometry of the closed impeller takes full advantages of LPBF technology and represents an important step in the development of complex structural components, increasing the technological readiness level of the AM process for space applications.

Introduction: Acute mesenteric ischemia represents one of the most severe pathological entity that needs rapid diagnosis and initiation of treatment in order to reduce the mortality rate and the long-term morbidity. Material and method: A monocentric, retrospective study that included 68 patients with acute mesenteric ischemia with or without bowel infarction has been undertaken within the General Surgery Department of the “Sfântul Pantelimon” Clinical Emergency Hospital from Bucharest, Romania, between January 2014 and January 2019, a 2nd grade hospital, according to the provisions of the Order of the Ministry of Public Health no. 1764 of 22 December 2006 on the approval of criteria for the classifi cation of local, county and regional emergency hospitals in terms of competences, material and human resources and their capacity to provide emergency medical care and medical care for patients in critical condition, published in the Federal Law Gazette of Romania, Part I, no. 63 of 26 January 2007. Results and conclusions: Acute mesenteric ischemia is associated with poor outcomes, high morbidity and mortality rates, making the early diagnosis and treatment initiation imperative in order to prevent severe complications, such as transmural bowel infarction, and, thus, potentially decreasing the morbidity and mortality rates.

The mission objective of the Phobos Sample Return is to collect and return 100 g of Phobos’ surface material to Earth inside a tight enclosure composed of a Vault, a Sample Container and sealing elements. One important aspect of the project was the development of a closing mechanism capable of ensuring a pushing force high enough compared to the available force of the robotic arm (40 N). The need for a higher pushing force derived from the design tests which were carried out to experimentally determine the necessary force to overcome the resistance of the sealing element when the vault is closed. Two types of sealing elements, custom made for this project, along with two SC with different geometrical shapes in the sealing area were tested. For better accuracy, the tests considered the imposed operational temperature domain for the vault, ECSS standards and the test rig set-up being performed at environmental temperature (+20 °C), −20 °C, −60 °C and +70 °C. The results of the tests highlighted that the negative temperature has a significant influence over the closing force, as this force is increasing once the operational temperature is decreasing. Based on the work performed, the most suitable type of sealing element was identified, in particular the piston geometry which allows a smaller force to close the vault.

Introduction: Standard treatment rectal cancer according to numerous international guidelines recommends neoadjuvant chemoradiotherapy (nCRT). Literature data suggests that a better response to nCRT (greater tumour regression) leads to improved overall survival rates (OS) and disease-free survival rates (DFS). Tumour response to nCRT can be assessed either through clinical or pathological examination. The clinical tumour response is evaluated via a digital rectal examination, endoscopy (with or without ultrasound) and DWI-MRI. Our goal was to see if, when evaluating the clinical response to neoadjuvant chemoradiotherapy we can rely on the endoscopic findings and if it could have a predictive value for the overall outcomes. Method: A retrospective study was performed on 43 patients that were treated for rectal cancer in our clinic following neoadjuvant chemoradiotherapy. We divided the patients into two groups regarding the endoscopy grading. Results: Patients with a better response (endoscopy good grade) had a better disease free survival rate and lower recurrence rate compared to patients with a endoscopy low grade (86,5% vs 56,6%) and (10.34% vs 42,85%). Conclusion: Endoscopy could be a useful tool in appreciating the tumour response to nCRT, and further research is needed in determining the best method for evaluating clinical response to neo adjuvant therapy in patients with rectal cancer.

Intraoperative monitoring of parathyroid hormone can confirm the complete excision of hyperfunctional parathyroid tissue, as the plasma half-life of PTH is approximately 5 minutes. The purpose of this study was to analyse the values of parathormon (PTH) and the intraoperative impact in patients with secondary hyperparathyroidism of renal cause (sHPT). A series of 86 patients who were hospitalised in our clinic between February 2015 to December 2018, were included in the study rom. All patients underwent surgery with PTH monitoring. PTH was determined preoperatively, intraoperatively 15 minutes after parathyroidectomy and postoperatively. Out of a total of 86 patients, 6 patients had non-functional renal transplant. 81 patients were operated on per primam and 5 patients were operated for disease recurrence. There were 77 total parathyroidectomies and 4 subtotal parathyroidectomies. One patient had 5 parathyroid glands. There were 4 patients with recurrent hyper-plastic tissue excision. Blood samples were collected intraoperatively through the puncture of the jugular vein. The PTH value was determined by the Elecsys PTH STATAÂA® test. The mean value of preoperative PTH was 1658 pg / mL and decreased to 46.5 pg / mL at the end of the operation. Subsequently, the level of PTH harvested at 3-6 months increased slightly to 59.8 pg / mL. 80 (93%) of patients had elevated preoperative calcium values. Recurrent hyperparathyroidism was found in 1 of the 4 patients who underwent subtotal parathyroidectomy. IPTH value is influenced by the intraoperative manipulation of the parathyroid glands, the individual variability of PTH half-life and the physiological state of the patient. The decrease of PTH measured intraoperatively at 15 minutes after harvest with at least 90% of the preoperative value indicates the success of a total parathyroidectomy, with normalisation of calcium and PTH.

Introduction: The present study aims to determine the mean duration of the conservative management that can be tolerated by the patients with intestinal obstruction secondary to the postoperative peritoneal adhesions, in order to postpone the surgical intervention. Material and method: The data of the patients with intestinal obstruction secondary to postoperative peritoneal adhesions were retrospectively collected and analysed. The number of readmissions, the type of the therapeutic management, the duration of the conservative treatment, the number of surgical reinterventions and the intraoperative aspect represented the studied variables. Results: 543 patients with intestinal obstruction secondary to postoperative peritoneal adhesions, admitted in the Surgical Department of “Sfântul Pantelimon” Emergency Hospital from Bucharest, Romania, between January 2014 and July 2018, were enrolled in the study. 233 patients underwent conservative treatment, 310 patients being surgically treated. The mean interval necessary for the monitoring of the patients non- operatively treated was 7 days, within a range of 2 to 14 days. For the surgically treated cases, the mean monitoring interval was 5 days, within a range of 1 to 14 days. Among the patients that underwent surgical treatment, there were 276 cases of adhesiolysis, 31 cases of intestinal resection with anastomosis and 3 cases of intestinal resection with terminal ileo- or colostomy. Conclusion: Under strict monitoring, a signifi cant number of cases of intestinal obstruction secondary to postoperative peritoneal adhesions can, successfully, be treated using conservative management, within 7-10 days.

The Phobos Sample Return Mission (PhSR) is a phase of the Mars Robotic Exploration Preparation program, with the main objective to acquire and return 100 grams of Phobos soil (regolith) on Earth. First, a complete surface map with topographic and mineralogical information will be obtained by the spacecraft. After a successful sampling, an ERV containing the ERC with the regolith sample will head back to the Earth. Following touch-down, the ERC will be retrieved and opened in a dedicated environment. Given the importance and value of such return sample, it must be well protected between the moments when the ERC is closed on Phobos after the sampling operation until landing on Earth surface. Thus, a special containment system is necessary, capable of withstanding the harsh space environment and the mechanical stress occurred during the mission, while preserving the integrity of the regolith sample. Following previous sampling missions (Hayabusa, Stardust) and the problems raised by the contamination, one can say that the sealing system is probably the most important part of a sample containment system, as it shall protect the sample from Earth contaminants, but also to protect the Earth against possible micro-organisms or other hazardous substances found in space. This paper aims to analyse a variety of sealing technologies with importance in space applications like a sample return mission, measuring qualitatively and quantitatively the performance of a sealing technology when it comes to fulfilling a series of requirements imposed by the sample return mission profile. Using these requirements and mission data as inputs, a trade-off analysis was made, to identify the most suitable sealing technology for a PhSR Mission. It was concluded that sealing technologies such as O-rings and Gaskets can be successfully used in these kind of missions, paying also attention to a proper design of the containment system.

Subdivision is an indispensable technique in mass metrology because it allows the determination of the mass of weights of various nominal values and the realisation of the mass scale.After the redefinition of the kilogram, this technique is becoming more important since the realisation of the kilogram now contributes a greater uncertainty than before. This means that the reference mass standard used to calibrate a set of weights has higher uncertainty (the previous definition of the kilogram had zero uncertainty), which increases the uncertainty of all the weights. A rigorous analysis is set about investigating whether this seriously affects the measurement capabilities, and if it does, how it can be compensated.Project 19RPT02, “Improvement of the realisation of the mass scale” (EMPIR [1] Call 2019 –Research Potential), has been, among others, dedicated to this problem, and some of the findings are presented here.

Liver cirrhosis is a major health problem worldwide with a prevalence that varies greatly from one geographical area to another. Besides the risk factors common to the general population to develop gallstone disease such as advanced age, female sex or positive family history of gallstones, in patients with liver cirrhosis there are additional risk factors that contribute to the occurrence of gallstones. They are more frequent in patients with a longer duration of the disease and in Child B and C stages. Gallstones disease occurs three times more frequently in patients with liver cirrhosis than in non-cirrhotic patients. Surgery is required if symptoms or complications related to the presence of gallstones occur and a thorough preoperative evaluation and optimization of patient’s condition is necessary prior to surgery. The procedure of choice in these situations is laparoscopic cholecystectomy. The technique has some particularities resulting from local anatomical changes and conversion to open technique remains low and morbidity and mortality rates are within acceptable limits.

Tuberculosis is in the top 10 causes of death worldwide, being one of the most deadly infectious diseases. It is estimated that one of three people from the entire earth population has a latent infection with M tuberculosis. This aerobic bacterium possesses the ability to persist in host tissues for years and to begin replication once immunity declines. The lungs are most frequent site of infection as the Mycobacterium tuberculosis is carried by aerosol droplets and is commonly transmitted by respiratory route. The second way of transmission is by contaminated food. Intestinal contamination coexists with pulmonary tuberculosis and only 10% represent primitive enteric diseases. The ileocecal region is involved most frequently. Even in this context isolated appendicular involvement remains rare. We report the case of appendicular tuberculosis in a 17-year-old woman with no evidence of other location of disease elsewhere in the body.

It is estimated that up to 90% of patients with chronic kidney disease develop secondary hyperparathyroidism (sHPT). Although the disease has multiple manifestations, the most important pathological feature, from the point of view of increased mortality, is represented by the ectopic arterial, myocardial and cardiac valvular calcifications. The calcifications are progressive and lead to high blood pressure, left ventricular hypertrophy, atrio-ventricular blocks, angina and myocardial infarction. Therefore the risk of cardio-vascular events is increased. Failure of drug therapy to control disease progression is an indication for parathyroidectomy. In sHPT all parathyroid glands are affected, hence the need to detect 4 glands intraoperatively, by bilateral cervical exploration. However, considering the possibility of ectopic localization of these glands as well as the possibility of some supernumerary glands, it is desirable to have an imagistic map as accurate as possible, thus avoiding the risk of postoperative recurrence. The available imaging investigations are represented by the ultrasound of the cervical region, the parathyroid scintigraphy and those of the second line - CT or MRI examination. If in primary hyperparathyroidism, where there is only one parathyroid adenoma (or two), the preoperative imaging results are satisfactory, in sHPT there are many cases in which the imaging does not reveal all four parathyroid glands.

As a 5-α reductase inhibitor, Finasteride has proven effective in ameliorating two conditions documented to be androgen dependent, namely male androgenic alopecia and benign prostatic hyperplasia. Therapeutic results are maintained as long as the drug is administered, with treatment cessation generally leading to the return of symptomatology for each condition. In addition, during the therapeutic phase, several adverse effects have been reported, some of which persist long or indefinitely after treatment cessation, known as “post-finasteride syndrome.” Herein we present and discuss the most common finasteride side effects, along with a psycho-neuroendocrine rationale that could explain the persistence of many adverse effects after treatment cessation. Moreover, we argue that finasteride adverse effects occurring during finasteride administration should be delineated from postfinasteride side effects (encountered after treatment cessation), suggesting the need to be addressed separately within a therapeutic perspective. Until a tailored therapeutic approach of postfinasteride syndrome becomes available, we have noted that hand preference and sexual orientation seem to be useful as possible predicting factors for finasteride side effects and postfinasteride syndrome. Finally, even though finasteride administration is considered relatively safe, literature data urges prudence. Specifically, recent studies report that some subjects receiving finasteride develop severe depressive episodes including suicidal thoughts, in part due to persistent sexual side effects.

Gallstone ileus is a rare condition which occurs as an evolutive complication of biliary lithiasis. It occurs after stone migration from extrahepatic biliary tree to the digestive lumen, mostly through a biliary-enteric fistula. This condition involves repeated inflammatory relapses with the formation of local adhesions and generally requires a long evolution. The vast majority of patients with biliary ileus are third aged women who often have concomitant medical illnesses. Gallstone ileus surgery deals with the two components: bowel obstruction and biliary pole. Obstruction solving is approached as a surgical emergency and it requires an attitude adapted to the local situation. The attitude towards biliary surgery for gallstone ileus is a matter in debate. It could be one-stage surgery, elective surgery or expectancy and its choice is imposed by both local and general condition of the patient. We report the case of a middle-age woman whose first symptom of cholelithiasis was the gallstone ileus. Plain upright abdominal radiography revealed air-fluid levels with distended loops of the small bowel and pneumobilia. Laparotomy was decided and exploration revealed an impacted gallstone into the ileum and dense adhesions were found under the liver region. Enterolithotomy for gallstone removal was made. Postoperative evolution was uneventful with discharge on 7th day.

Main text In order to demonstrate the equivalence in calibration of 500 kg mass standard, a supplementary comparison has been carried out by 20 members of EURAMET. The overall result shows a good consistency among the participants. To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database https://www.bipm.org/kcdb/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

The project 19RPT02 “Improvement of the realisation of the mass scale” (EMPIR Call 2019 – Energy, Environment, Normative and Research Potential) has just started.Its aim is to improve the quality of one of the most important tasks in mass metrology, the realisation of the mass scale. After the new definition of the kilogram this technique is getting more important.

The results are presented of the key comparison EURAMET 1031 (EURAMET.M.D-K1.1) that covered the measurements of density and volume of silicon spheres of three different masses at 20 °C and 101325 Pa. The volume and density determinations of 15 national metrology institutes (NMIs) were checked and linked to the CCM.D-K1 key comparison. The measurements were carried out near 20 °C and at atmospheric pressure by the hydrostatic method in the time interval from 16 May 2008 to 18 Jan 2011. The comparison was performed in two petals with three spheres in each petal. The travelling standards of petal 1 have a mass of 1001 g, 200 g and 35 g (Petal 2: 984 g, 239 g, 35 g). Whereas the reference values of the 1 kg travelling standards could be determined by the link to the CCM.D-K1 comparison, the density reference values for the smaller spheres were determined by density comparison to the 1 kg spheres using the pressure-of-flotation method. One result was wrong due to a mistake in the mass determination. Additionally, four of the 57 volume (or density) values were discrepant with En values larger than 1.1, 1.2, 1.3 and 1.6. Five NMIs achieved density uncertainties of about 1 ppm (1 × 10−6 in relative terms) or less for the 1 kg spheres. This satisfies the needs of all customers who wish to calibrate solid density standards for other laboratories. Volume determinations of mass standards, air density artefacts or sorption artefacts should reach an uncertainty of about 1 mm3 in order to reduce the effect on the mass uncertainty to about 1 μg. At least for silicon spheres this is reached by eight NMIs. Due to the higher density of stainless steel this may be different for weights and will be checked within the CCM.D-K3 comparison. The results of the comparison can be used to submit new or improved entries in the calibration measurement capabilities table in the BIPM key comparison database. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

In order to demonstrate the equivalence in calibration of mass standards among National Metrology Institutes (NMIs) of EURAMET this key comparison (KC) on 1 kg stainless steel mass standards has been carried out under the auspices of EURAMET. The comparison was undertaken with reference to the International Prototype Kilogram (IPK) as the definition of the unit of mass. The overall result shows good consistency among the participants. Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).

Introduction: Pathologic response following neoadjuvant chemoradiotherapy (nCRT) can vary from pathologic complete response (pCR), to tumour downstaging or minimum to no response. Our goal was to evaluate the parameters that could predict response to neoadjuvant therapy for patients with rectal cancer. Method: We performed a retrospective study and reviewed the medical documentation for patients that received treatment for rectal cancer in our surgical department between 2014-2018 and received nCRT. Results: A total of 98 patients were included in the study. 66 patients were males (67,3%) and 32 were females (32,7%). The mean age was 64,6 (39-87). The 48 months overall survival rate was 81,63% and the 48 months disease-free survival rate was 69,38%. Tumour grading was considered as a statisti cally significant parameter for evaluating the pathologic response. The tumours most likely to respond to radio-chemotherapy were G1 or G2 grade. T4 tumours compared with lesser T stages were less likely to achieve pathologic complete response. Elevated CEA levels predicted a poor pathologic response to nCRT. Conclusion: Our study concluded that tumour related factors, biologic and imagistic findings such as tumour stage, lymph node, tumour differentiation grade and CEA levels can be used as parameters for predicting the tumour response following neoadjuvant therapy.

Introduction. Adenomyosis is a widespread disease usually affecting the late reproductive years of the women's life, which has a great impact on their fertility. The most common form is diffuse adenomyosis, while focal adenomyosis, a cystic variant, is very rare, particularly in patients younger than 30 years old. Materials and methods. We reported a rare case of a 20-year-old Caucasian woman with cystic adenomyosis who was admitted in our service with severe chronic pelvic pain, dysmenorrhea, and menorrhagia, who had received conservative surgical treatment to preserve fertility and improve her obstetrical prognosis. Results and Discussions. Although the necrobiosis of a uterine fibroid was suspected preoperatively, the extemporaneous histopathological exam revealed adenomyosis associated with fibroleiomyoma with hyaline dystrophy and multiple foci of endometriosis of cystic formation in the wall of a young woman without any risk factors. Conclusion. Although a rare lesion in young patients, cystic adenomyosis should be considered when chronic pelvic pain is exacerbated during menstruation and is associated with a uterine tumor. In young patients, the differential diagnosis should be made with uterine malformations (hematometra), necrobiosis of uterine fibroids, pelvic endometriosis. The surgical treatment should be conservative with the excision of the lesion, always taking into account fertility preservation in young patients.

Laparoscopic cholecystectomy is the standard treatment for patients requiring gallbladder removal. Although the advantages of the laparoscopic technique are widely accepted, the introduction of this technique has doubled the rate of iatrogenic lesions of extrahepatic bile ducts. Research methods for biliary tree also evolved, but intraoperative cholangiography, the traditional exploring method used for the biliary tree in classic cholecystectomy remains a valuable investigation in the laparoscopic technique. We performed a retrospective study on a group of patients who underwent cholecystectomy (laparoscopic or classic). Of these, intraoperative cholangiography was performed on a total of 108 patients. Patients who underwent cholangiography motivated by preoperative investigations were excluded from the group and the study operates on patients in whom the decision to perform cholangiography was taken during surgery (45 cases). We have analyzed the criteria that led to the motivation investigation (dilated cystic duct, suspected biliary duct stones, suspicion of iatrogenic biliary injury) results and subsequent therapeutic conduct. The results showed that in 90% of the patients, the suspected diagnosis was confirmed by cholangiography (10 cases with normal cholangiography aspect, oddita 9 cases, 11 cases with bile duct stones, 2 cases with biliary tumor and 13 cases of iatrogenic biliary injury). In conclusion, the decision to perform intraoperative cholangiography proved salutary, the suspected diagnosis was confirmed and the course of treatment was adjusted accordingly.

The secondary hyperparathyroidism (sHPT) affects all patients with chronic renal failure in different degrees. The chronic kidney disease is often associated with multiple severe comorbidities, therefore the figures for mortality are higher than in the general population. The failure of medical treatment is an indication for surgical treatment. The recurrence of the disease in secondary hyperpara-thyroidism after surgical treatment using total parathyroid with autotransplantation or subtotal parathyroidectomy may be a challenge due to hyperplasia of the remaining tissue. The purpose of this retrospective study was to highlight the risk factors for the occurrence of glandular hyperplasia in patients with secondary hyperparathyroidism and to determine optimal surgery approach for secondary hyperparathyroidism in order to minimize relapse rates. Parathyroid size evaluation may suggest the presence of nodular hyperplasia contributing to an early parathyroidectomy and at the same time selecting the best surgical treatment for sHPT patients. As resistance to medical therapy is due to the presence of nodular hyperplasia, some authors recomends subtotal parathyroidectomy with the excision of these glands, with the remaining parathyroids tissue and function controlled by medical therapy (20).

The Journal of Surgical Sciences is dedicated to students at medical universities and to young doctors; it has reached its third issue, proving that early enthusiasm and the founders’ ambition are equally strong, ensuring a development well worth to dwell our attention upon. Due to the constant efforts of teachers and students involved in this project we have managed to build a communication platform through which information on medical research can be widely spread, while also maintaining the rigor of medical research and academia. It is worth recalling the permanent support provided throughout this project by "Carol Davila" University of Medicine and Pharmacy, by the Romanian Student Society for Surgery, by the Circle of Surgical Sciences, as well as by the IASS Association. Starting with the first issue of the journal, whose release took place in the National Congress of Surgery - Sinaia 2014 we focused on topics of great scientific interest, resulting from thorough investigation of the authors. The first issue of the journal brought together representative works developed within the scientific students’ circles, works that have been endorsed during the student sessions of the National Surgery Congress, the National Surgery Conferences and the Congress of Students. The second issue of the Journal of Surgical Sciences expanded the coverage of topics, authors, students, resident physicians and teachers of medical schools in the country who addressed many topics of great interest from a surgical point of view. With each new page you read in this issue, by means of in-depth studies of the authors coordinated by first hand specialists you will discover new connections that lead towards knowledge. The accuracy of the information presented, the variety of the topics addressed and the competence of the coordinating authors ensure quality content, which may be included in the scientific reference list of those concerned with broadening their knowledge horizon. With each issue we will strengthen the record of the publication and bring more numerous authors and topics which will whet your interest by means of the peculiarities addressed. What we want is that this publication should continue to stand for an actual tribune from where both enthusiastic students of the Universities of Medicine and Pharmacy in the country and abroad as well as young doctors interested in surgical sciences can spread valuable information and studies developed with utmost competence. We also intend to put the medical community events in the spotlight and we want to encourage probable initiatives of professionals who believe that they have a say in the field. Authors who wish to make their work known by means of the pages of this journal will be able to see their results printed after meeting the selection criteria established by the editorial staff.

OBJECTIVE • Not only has a precise characterization of libido and sexual arousal in men as a central neural process been lacking, but the interactive role of gonadal hormones and sexual orientation in such processes has never been investigated. We investigate the relationships among sexual hormones, sexual arousal, and sexual orientation in men by comparing the self-reported sexual response of heterosexual and homosexual men with locally advanced prostate neoplasm, receiving the non-steroidal anti-androgen bicalutamide as monotherapy. PATIENTS AND METHODS • 29 Romanian men participated in this study: 17 heterosexual and 12 homosexual. Patients were undergoing treatment for prostate cancer consisting of a standard daily dose of 50 mg bicalutamide, a fast acting non-steroidal anti-androgen with action comparable to other anti-androgen drugs but with reportedly fewer sexual side effects. • Patients retrospectively provided information regarding their sexual functioning measured by the IIEF prior to commencing bicalutamide treatment. • Then, about five weeks later, patients were asked to prospectively provide information regarding their current sexual functioning while undergoing bicalutamide treatment. RESULTS • Overall IIEF scores as well as the Erectile Function, Orgasmic Function, Sexual Desire, and Overall Satisfaction subscales showed group, treatment, and group by treatment effects. • The Intercourse Satisfaction subscale showed group and group by treatment effects. • On most subscales, homosexual men showed lower functioning than heterosexual men, primarily in response to treatment with bicalutamide. CONCLUSIONS • Treatment with an anti-androgen in a clinical population of men undergoing therapy for prostate cancer affected homosexual men more than heterosexual men, although not all heterosexual men were unaffected. • These results are discussed in the context of dual sexual natures, a concept recently developed in the sexual literature. • Furthermore, these findings reiterate the importance of incorporating such variables as sexual orientation into studies investigating medical treatments on sexual response.

We aimed to investigate the frequency of ectopic and supernumerary parathyroid glands in our series of renal hyperparathyroidism. From October 2011 to November 2014, 202 patients with chronic renal failure and advanced SHPT nonresponsive to medical therapy were hospitalized in the General Surgery Department of the Carol Davila Nephrology Hospital. These patients underwent a number of 188 (93%) total parathyroidectomies and a number of 14 patients (7%) subtotal parathyroidectomies. Of these 202 patients, reoperation was carried out for 14 patients (7%) in which we identified ectopic and supernumerary parathyroid glands. Operative details and pathology results were prospectively collected and reviewed after we obtained informed consent for data and pictures use. In 188 patients (93% cases), four or more parathyroid glands were removed at the first operation. In 14 cases (7%) high PTH level persisted after the initial operation. In 22 of them (11%), supernumerary glands were found at the first operation and in 6 of them (3%) at the second operation. We conclude that extensive cervical exploration in addition with preoperative imaging tests, parathyroid ultrasound; scintigraphy with Tc will reduce secondary hyperparathyroidism surgery.

Despite the continuous development of synthetic prosthetic meshes and their wide use, recurrent incisional hernias still appear in 5 to 20% of cases, with a linear incidence curve over the years, suggesting a multifactorial process rather than a simple failing technical repair as the underlying cause. Recent molecular biological research provide increasing evidence of connective tissue alterations such as a defective wound healing with impaired scarring process in patients with incisional hernia. Although there are some promising results, at present, in-depth understanding of the pathophysiological mechanisms and of the role that collagens play in the development and recurrence of incisional hernia is rather scarce. The aim of this systematic review is to summarize and evaluate the biochemical mechanisms involved in incisional hernia formation and recurrence, with a primary focus on collagen I to III ratio. Also, the consequences for surgical practice are discussed.

A comparison of volume standards was undertaken between CEM (ES), NPL (UK), PTB (DE), and INM (RO). For the comparison three silicon spheres are used as transfer standards with masses 1 kg (provided by PTB), 30 g (provided by PTB) and 125 g (provided by NPL). The aim of the EURAMET.M.D-S3 solid density comparison is to compare the results of the density (and volume and mass) determinations of solid samples of the participating laboratories and to evaluate the degrees of equivalence according to the Mutual Recognition Arrangement. The reference conditions for density and volume determination were 20 °C and 101 325 Pa. KEY WORDS FOR SEARCH Density, silicon sphere, Monte Carlo, comparison Main text To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/. The final report has been peer-reviewed and approved for publication by the CCM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).