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The best timing of cholecystectomy on patients with acute gallbladder pathology is still unclearly defined. Some studies have reported that cholecystectomy during the index acute admission presents an increased morbidity rate, extended duration of stay and increased costs. The study below is aiming at finding the most accurate moment to practice the surgery when acute cholecystitis is confirmed. Consequently, 368 patients admitted to hospital from January 2013 to December 2015 with the diagnosis of acute cholecystitis (AC) who underwent cholecystectomy in the 2nd Department of Surgery, Emergency County Hospital, Timi�oara, Romania constituted the two lots. The cases were retrospectively identified, introduced into the database and the data were subsequently analyzed according to various parameters. The study results reveal that laparoscopic cholecystectomy (LC) in the first 24 hours is safe procedure on the majority of the cases. Also, our findings sustain that emergency cholecystectomy can reduce the length of hospital stay, having similar rates of conversion to open surgery, complications and outcome compared with a delayed operation.

Colorectal cancer (CRC) is one of the leading causes of death among cancer patients in Romania. It is known as a heterogeneous disease, characterized by diversion in multiple molecular pathways during its evolutionary process. This research was focusing on the two biomarkers that are related to CRC, specifically Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 19-9 (CA 19-9). Being an integral part of a wider study, we explored the use of a novel platform to support the strictly controlled process of data collection on colorectal cancer cases. We collected data about the patients regarding baseline clinical parameters, medical history, important comorbidities, intraoperative findings and adverse events, tumor characteristics, histological findings and main laboratory data (blood cell count, serum protein electrophoresis, liver and kidney function tests, serum levels of CEA and CA19-9). The results suggest that these two biomarkers are useful preoperative indicators of local recurrences and prognosis in colorectal cancer. Increased levels of both tumor markers are correlated with an advanced stage of the disease and a poor prognosis. Finally, this study aims to provide the necessary infrastructure, geared towards efficient, safe and comprehensive clinical evaluation of CRC cases.

The aim of this study was to determine if body mass can be considered a risk factor for infertility, and if we can find any correlations between the age values and the FSH and estradiol values, and between the BMI values and the FSH and estradiol values. Our whole sample contains 100 patients splinted in two groups (pregnant patients N1=57 subjects, 57%, and not � pregnant patients N1=43 subjects,43%). In the first part we conducted our analysis on the whole group and after that we focused the analysis on the two groups and we made some comparisons between the groups. We obtained a medium, extremely significant correlation in all scenarios between the age and the FSH values. This is the best association from all the cases which we tested. In all twelve cases we have a positive correlation (r ] 0). As well, we obtained that a BMI value higher than 25can be considered a risk factor for obtaining a pregnancy (p[0.05, RR ] 1, OR]1) . Our study shows that women who have weight problems have much less chances of conceiving a baby, even if they ovulate normally. The risk of infertility increases proportionally to the extra pounds. Irregular ovulation in women is the most common fertility disorder due to obesity disease.

Urinary incontinence is one of the most common diseases, 25% of women between 18 and 80 years suffer from it. Urinary incontinence can be described as accidently loss of small amounts of urine. The solution involves a surgical procedure, such as sling procedures and bladder neck suspension procedures. The methods of surgical interventions have evolved due to a minimum period of hospitalization (sling, TVT), or performing laparoscopic surgery instead of the classical Burch surgery. Studies reviled that the most effective interventions are those which restore the urethra by retro pubic urethropexy, pubovaginal sling and synthetic mid-urethral slings. This type of surgery has currently the highest success rate (85-90% on 5 years after surgery), and the lowest relapse rate. In our study we obtained the same success rate for the TVT procedure.

Ventral hernia mesh repair is considered a standard procedure in most countries and widely accepted as superior to primary suture repair. We conducted a 5 years retrospective observational study on large and giant incizional hernia repair in our Clinics. 176 consecutive patients who had a ventral hernia repair with mesh implant in 2012-2016 were evaluated in terms of demographic characteristics, comorbidities, surgical conditions (defect size, mesh type, positioning of the mesh, length of hospital) and surgical outcomes by means of EuraHS-QoL score pre- and 30 days postoperative to assess quality of life (Qol). Alloplastic substitution with polypropylene, polyester and Dacron mesh has been used in all cases. Polypropylene mesh has been used in most of cases (91%). Most preferred mesh position was intraperitoneal (78%), then retromuscular (15%) and preperitoneal (7%). Immediate postoperative complications appeared in 41 cases (23.3%). Mean hospital length was 14,3 days. We could notice a double pre- and postoperative difference for the pain, with statistical significance (2.71�1.70; p=0.23) and the same pattern of distribution for restriction of activities and for cosmetic discomfort.

In this study, we evaluated the diagnostic utility of pulls wave velocity (PWV) alone or in combination with other diagnostic markers in predicting pre-eclampsia (PE) on high-risk women. Pregnant women at high risk for PE were recruited between 32 and 36 weeks of gestation period. This study is the first in Romanian and shows that PWV may be a potentially promising predictor of early-onset PE in women at high risk for PE. All these patients were treated and were instructed according to the ESC/ESH guidelines regarding hypertensive patients. Statistical analysis was performed using the Chi-square, a Mann-Whitney test, Pearson correlation, and linear regression tests.After we ran several test the main conclusions are that there is a positive correlation between the para-clinics data (creatinine, Esbach proteinuria) and the pulls wave velocity for aorta (PWVao). The risk for preeclampsia is increasing if the body mass index (BMI) of the patients is higher than the average value (BMI]26) or if the patient is a smoker.

Sleeve gastrectomy (SG) and gastric plication (GP) are surgical procedures providing weight loss through several mechanisms incompletely understood. Rat models allow the possibility of tight regulation of experimental conditions, making them the ideal candidates for animal models in bariatric surgery. The aim of this study was to compare the weight and metabolic changes between sleeve gastrectomy and gastric plication in a rat model with type 2 induced diabetes mellitus and obesity. Fifteen male Wistar rats were fed with DIO food (Bio Serv �F3282 - Mouse Diet, High Fat, Fat Calories -60%), after 36 weeks were allocated to the study three arms-SG, GP and sham operation (SO). Four weeks after the surgery the rats were weighted again. Blood tests were performed before surgery and four weeks after surgery searching for blood glucose, total cholesterol, HDL, triglycerides, and LDL. At the onset of the study, the rats were 9 weeks old and had an average body mass of 231.6g � 31.58. After 36 weeks of DIO, one day preoperatively body weight was 774.93g � 95.02. The preoperatively average of body weight in the SG group was 777.4g �104.66, 775.4 g �104.6 in the GP group, respectively 772g �79 in the SO group. 4 weeks after surgery the mean body weight in the SG group was 648.8g �99.09, in the GP group was 695.6g �99.09, respectively 825.4g �79.87 in the SO fed ad libitum group. There was a significant decrease of mean fasting glucose levels at 4 weeks postoperative in the SG group compared to the SO group (87.4mg/dL�8.73 versus 103.6 mg/dlL�4.66, p= 0.01). The same trend of mean fasting glucose was registered in the GP group versus the SO group (92.8 � 5.67 mg/dl vs 103.6 mg/dl � 4.66, p=0.01). Our study provides evidence of the positive effects of bariatric surgery for treating patients with morbid obesity associated with diabetes mellitus and dyslipidemia and the use of rats to study the mechanisms of weight reduction and metabolic changes in bariatric surgery.

Thyroid nodules are a common pathology found in 50 to 60% of otherwise healthy people. Diagnostic imaging techniques are help discriminating between benign and malignant nodules, while fine needle aspiration is still a gold standard. Shear wave elastography, a recent imaging technique, holds the promise to become reliable diagnostic tools and is currently used in combination with ultrasound. We here report data obtained in a series of 52 thyroid nodules analysed by means of elastography, as well as conventional and Doppler ultrasound. We found no differences in age, nodule and thyroid volume, length, width, thickness and maximum diameter between benign and malignant lesions. Several sonographic patterns are considered to be predictive of malignancy, out of which we only found the intranodular blood flow to be statistically significant. By the means of shear wave elastography we have first assessed tissue elasticities, which are shown in a range of colours, depending on tissue elasticity/stiffness. Then, we have measured and recorded four parameters automatically displayed by the system, namely SWE-mean, SWE-max, SWE-SD and SWE-ratio. Data analysis showed all these quantitative parameters had good sensitivity, specificity, positive predictive value, negative predictive value and area under the curve, as calculated by the ROC curve. As with these parameters, the cut-off points were lower than in literature, still able to indicate reliable diagnoses, which were confirmed by histopathological exam. Our conclusion is that shear wave elastography has great potential for reliably and accurately diagnosing thyroid malignancies.

The aim of our study was to assess mRNA levels in visceral fat tissue and to correlate them with clinical-biological parameters in morbidly obese patients. 38 morbidly obese patients were selected and 8 cases of non obese subjects. The expression levels of adiponectin mRNA were determined through RT-PCR. Also we assessed biochemical parameters like seric glucose level, total cholesterol and triglicerides. The expression levels of adiponectin mRNA were correlated with demographic parameters (age, sex, BMI) and with clinical parameters (HTA, hypothyroidism and type 2 diabetes). This study showed significant correlations between adiponectin mRNA levels with obesity, age, triglicerids, total cholesterol and hypothyroidism. In conclusion, the expression level of adiponectin could be used as a molecular marker in the management of obesity.

Background A high percentage of the critically ill polytrauma patients develop acute kidney injury (AKI) secondary to trauma and are therefore prone to high morbidity and mortality rates. One of the main objectives in these cases is the fast detection of the condition and continuous rigorous monitoring of the patients. Currently the panel of biomarkers available for monitoring and for the prognosis of AKI is limited. Numerous studies have proven the importance of microRNAs in this field. In this actualization paper we wish to summarize the most relevant microRNAs that can be used as biomarkers for patients with AKI. Methods For this paper, we looked into the studies available in scientific databases such as PubMed and Scopus. For the analysis we used the following key words: "miRNAs biomarker", "acute kidney injury AKI", "genetic expression in AKI", and "epigenetic microRNAs biomarkers in AKI". Results Numerous studies have shown high specificity for certain microRNA species in the case of patients with AKI. Moreover, they have reported a series of microRNAs that present high specificity and that have a strong expression in fluids that can be sampled through non-invasive methods, such as urine and saliva. Conclusions The expression of microRNAs can be successfully used in the future as a non-invasive method for the evaluation and monitoring of AKI patients.

Since a robotic surgical system was developed in the early 1990s and the first robotic-assisted radical prostatectomy was reported in 2001, robotic surgery has spread in many surgical specialties, changing surgical management. Currently, compared to other colorectal procedures, robotic surgery appears to offer great benefits for total mesorectal excision for rectal cancer. Abdominal cavity other procedures such as right hemicolectomy and high anterior resection are relatively uncomplicated and can be performed easily by laparoscopic surgery. First reports have focused on the clinical benefits of robotic rectal cancer surgery compared with laparoscopic surgery. The indications for robotic and laparoscopic rectal cancer surgery are not different. The recently published results of the ROLARR trial, comparing robot-assisted TME to laparoscopic TME, show no advantages of robot assistance in terms of intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction. A drawback of the study is the variability in experience of the participating surgeons in robotic surgery. After correction of this confounder, an advantage for robotic assistance was suggested in terms of risk of conversion to open surgery. For robotic rectal cancer surgery to become the preferred minimally invasive option, it must demonstrate that it does not have the technical difficulties and steep learning curve of laparoscopic surgery. Robotic surgery has several technical advantages over open and laparoscopic surgery. The system provides a stable operating platform, three-dimensional imaging, articulating instruments and a stable surgeon controlled camera which is mainly beneficial in areas where space and maneuverability is limited such as the pelvis.