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The grazing robot is a dynamic system, consisting of a platform (the body of the robot) and a number of legs with structures similar to the kinematic chains of manipulator robots. Grazing robots can have a redundant number of legs, therefore they can ensure a static stability even if one or more legs are destroyed [10]. The objective of the work is to design a mobile robot controlled with the Arduino board controlled by an ESP 32 logic processor. The robot proposed in the paper is a spider-type robot with four legs, named SPIDER4LEGS. The components used to make the robot are the following: ESP32 development board, ESP ROOM-32, WiFi and Bluetooth BLE, Dual Core; PCA9685 module, I2C interface, 16 CH, servo motor; 12 Servo motors SG90 180 degrees. A possible field of application of these robots is the internal inspection of pipelines transporting petroleum products [7],[8],[9].

The status of predictive biomarkers in metastatic colorectal cancer is currently underdeveloped. Our study aimed to investigate the predictive value of six circulating exosomal miRNAs derived from plasma (miR-92a-3p, miR-143-3p, miR-146a-5p, miR-221-3p, miR-484, and miR-486-5p) for chemosensitivity, resistance patterns, and survival. Thirty-one metastatic colorectal cancer patients were selected before receiving first-line irinotecan- or oxaliplatin-based chemotherapy. Blood samples were harvested at baseline and 4–6 months after the initiation of chemotherapy. The levels of exosomal expression for each miRNA were analyzed by qPCR. Our results for patients receiving first-line FOLFOX showed significantly higher baseline levels of miR-92a-3p (p = 0.007 **), miR-146a-5p (p = 0.036 *), miR-221-3p (p = 0.047 *), and miR-484 (p = 0.009 **) in non-responders (NR) vs. responders (R). Of these, miR-92a-3p (AUC = 0.735), miR-221-3p (AUC = 0.774), and miR-484 (AUC = 0.725) demonstrated a predictive ability to discriminate responses from non-responses, regardless of the therapy used. Moreover, Cox regression analysis indicated that higher expression levels of miR-92a-3p (p = 0.008 **), miR-143-3p (p = 0.009 **), miR-221-3p (p = 0.016 *), and miR-486-5p (p = 0.019 *) at baseline were associated with worse overall survival, while patients expressing higher baseline miR-92a-3p (p = 0.003 **) and miR-486-5p (p = 0.003 **) had lower rates of progression-free survival. No predictive values for candidate microRNAs were found for the post-chemotherapy period. In line with these findings, we conclude that the increased baseline exosomal expression of miR-92a-3p and miR-221-3p seems to predict a lack of response to chemotherapy and lower OS. However, further prospective studies on more patients are needed before drawing practice-changing conclusions. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this study was to evaluate the impact of the interval between surgery and adjuvant treatments regarding the overall survival and recurrence-free survival in patients from a developing country. For stages II and III rectal cancer, international guidelines recommend neoadjuvant chemoradiotherapy (CRT) regardless of the tumor location. In the developing countries there is a shortage of radiotherapy centers, specialists, which lead to long waiting lists for radiotherapy. These problems might lead to protocol deviations. Methods. We conducted a retrospective study on 161 patients with rectal cancer treated with surgery, postoperative CRT and with or without chemotherapy for a total of 6 months, at The Oncology Institute Cluj-Napoca between 2006-2010. All patients had 5 years of follow-up. Results. A total of 161 patients were enrolled in this study. The majority of patients were locally advanced stages (89.44%). The well known prognostic factors, such as TNM stage, performance status, CEA serum level, perineural, vascular and lymphatic invasion, and node capsular effraction had a statistically significant influence on overall survival. In 21.12% of patients the first adjuvant treatment was started in the first 4 weeks after surgery. Only 13.04% of patients started the concomitant CRT within the limit of 6 weeks after surgery. Concerning the time between surgery and CRT, we did not observe a statistically significantly difference in OS if the radiotherapy started after the first 6 weeks (p=0.701). The OS rate for locally advanced rectal cancer patients was 69.44%. Conclusions. In rectal cancer, the importance of the first therapeutic act is crucial. Following international guidelines provides a survival advantage and a better quality of life. In case of adjuvant treatment, it is recommended to start this treatment as soon as the local infrastructure allows it. [ABSTRACT FROM AUTHOR]

A normal evolution of the cell-cycle phases consists of multiple consecutive events, which makes it a highly complex process. Its preservation is regulated by Cyclin-Cdks (cyclin-dependent kinases) interactions and protein degradation, which is often controlled by the ubiquitin-mediated proteolysis. The goal of this review is to emphasize the most important features of the regulation of the cell-cycle involved in cancerogenesis, by presenting the involvement of E3 ubiquitin ligases SCF (Skp1-Cul1-F-box protein) and APC/C (Anaphase-promoting complex/cyclosome) in human malignancies. Also, we discuss the importance of the ubiquitin proteasome pathway blockade in cancer treatment. We know that a better understanding of the regulatory biology of the cell cycle can lead to the development of new target therapies for cancer. [ABSTRACT FROM AUTHOR]

The objective of this pilot study was to test the efficiency of a cognitivebehavioral psychological intervention, aimed at reducing emotional distress and improving quality of life in breast cancer patients undergoing radiotherapy. This was a quasi-experimental pretest/posttest study design, with a similar/equivalent control group (N=16, experimental group = 8, control group = 8). The statistical mixed design ANOVA method was used for univariate analysis of inter- and intra-group variability. Significant differences between the two groups with similar onset scores, were obtained at the end of the intervention at DT [F (1,14) = 13.63; η2 = 0.493 p = 0.002], FACT-B [t (14) = 4.55, p <0.001), CI = [13,542; 37708] ET: distress [t (14) = 5.50, p <0.001), CI = [- 819; 2069], anxiety [t (14) = - 0.15, p <0.001), CI = [- 6.81; -2.69], depression [t (14) = - 3.08, p = 0.008), CI = [- 5.73; -1.02], need help [t (14) = - 3.50, p =0.004), CI = [- 5.45; 1.30]. The interaction between time and intervention was significant for the level of emotional distress, depression, anxiety, event impact and quality of life. In conclusion, psychological group intervention can be a useful approach to increase the quality of life of breast cancer patients undergoing radiotherapy. The limitations of the study are related to the size of the sample, the compressed therapy sessions, and the absence of follow-up. [ABSTRACT FROM AUTHOR]

Background and aim. Ketamine is a drug used for the induction and maintenance of general anesthesia, for the treatment of postoperative and posttraumatic acute pain, and more recently, for the reduction of postoperative opioid requirements. The main mechanism of action of ketamine is the antagonization of N-methyl-D-aspartate (NMDA) receptors that are associated with central sensitization. In the pathogenesis of chronic pain and particularly in neuropathic pain, an important role is played by the activation of NMDA receptors. Although ketamine is indicated and used for the treatment of chronic cancer pain as an adjuvant to opioids, there are few clinical studies that clearly demonstrate the effectiveness of ketamine in this type of pain. The aim of this study is to analyze evidence-based clinical data on the effectiveness and safety of ketamine administration in the treatment of chronic neoplastic pain, and to summarize the evidence-based recommendations for the use of ketamine in the treatment of chronic cancer pain. Method. We reviewed the literature from the electronic databases ofMEDLINE, COCHRANE, PUBMED, MEDSCAPE (1998-2014), as well as chapters of specialized books (palliative care, pain management, anesthesia). Results. A number of studies support the effectiveness of ketamine in the treatment of chronic cancer pain, one study does not evidence clear clinical benefits for the use of ketamine, and some studies included too few patients to be conclusive. Conclusions. Ketamine represents an option for neoplasic pain that no longer responds to conventional opioid treatment, but this drug should be used with caution, and the development of potential side effects should be carefully monitored. [ABSTRACT FROM AUTHOR]

Background: Malignant melanoma is the leading cause of death in skin cancers in view of its incidence mortality in the world (1.6% cases and 0.7% deaths). In Romania, the incidence and cancer mortality are in a continuous rise. Most patients are diagnosed in the advanced stages. Objective: The purpose of this paper is to present the treatment of a complicated case of malignant melanoma. Material and methods: We present the case of a 58 year-old woman with no oncological family history; she was diagnosed with malignant melanoma of the left subscapular region (Clark level II/III) in 1999. Primary treatment was the excision with left axillary lymphadenectomy. In February 2006, she revealed a metastasis of a right ovary treated with total hysterectomy and bilateral salpingo oophorectomy. In May there was a suspicion of brain-metastatic melanoma, which was surgically treated (IHC-HMB45 positive, CK negative). In June 2008, the suspicion of a left suprarenal and common iliac metastatic melanoma was raised and then removed surgically (IHC-HMB45 and S100 positive, CK7 and CK20 negative). In December 2011, she underwent surgery of the right lumbar and humeral metastatic melanoma (IHC-HMB45 positive, CK negative). During this process the patient went through some chemotherapy cycles with Dacarbazine. Results: The patient went to physical and skin examinations performed every 3 to 6 months for the first 2 to 3 years and then once a year after that (CT scan, MRI, and/or PET-CT scan) that showed up no signs of recurrence. Conclusions: The multimodal treatment: excision with lymphadenectomy, Alpha Interferon 2B High Dose and systemic therapy in the metastatic forms leads to a good prognostic and to an extended life-span. Therapy is important, but surgery still remains the cornerstone for the treatment of malignant melanoma. [ABSTRACT FROM AUTHOR]

Purpose: The outbreak of COVID-19 pandemic has changed the provision of medical services worldwide. We assessed the impact of the pandemic on the oncological patients' visits to a tertiary cancer centre., Methods: We analysed registrations from the administrative data system of in- and outpatients in all of the departments of the Cluj-Napoca Oncology Institute, during March-October 2020, and compared to the same 7-month period of the previous year., Results: The decrease during March-October 2020 was 40.2% for new referrals overall (with the most significant drop in April, of 80%), 52.5% for medical oncology inpatients, 39% for paediatric oncology department inpatients, 69% for radiotherapy inpatients, 34.9% for surgical interventions and 31% decrease of issued pathology reports. The decrease was less important for outpatients: only 10% for medical oncology outpatient department, 33% for radiotherapy and 27% for breast cancer unit outpatients. Imaging investigations were only slightly influenced by the pandemic (reduction of 5% for MRI scans, 19% for mammograms,whereas performed CT scans were even more after the outbreak of COVID-19)., Conclusion: Our results show a decrease in the number of patients during the period after the outbreak of the COVID-19 pandemic, more for inpatients and less significant for outpatient departments, probably because of the internal circuits reorganization but also because of health care measures taken nationally and locally to limit the spread of the pandemic.

Purpose: Indocyanine green (ICG) is being used more and more in Urology along with advances in minimal invasive surgery, guiding excision and reconstruction, highlighting anatomic structures and functional features with oncologic guidance still being debatable. The purpose of this paper was to explore ICG use in urologic procedures., Methods: We present our experience (37 cases) of using ICG fluorescence guidance in urologic operations performed using 3D laparoscopy and FireFly® fluorescence imaging mode of Da Vinci X robot. The operations were the following: pelvic lymphadenectomy in radical prostatectomy, totally intracorporeal orthotopic ileal neobladder reconstruction, vesicovaginal fistula repair, partial nephrectomy and pyeloplasty. Barnard's test was used to compare postoperative complications (digestive fistula, ureteral stricture) for totally intracorporeal ileal neobladders performed with (group e, 27 cases) vs. without (group 2, 28 cases) ICG guidance., Results: ICG under near-infrared fluorescence offered a precise identification of ischemic structures- vaginal wall, distal ureteral end, ileal loop, along with vascularized tissues allowing an optimal pyeloplasty and nephron sparing surgery with partial unclamping. It also allowed the identification of a lymph node during radical prostatectomy that otherwise would not have been excised during the routinely performed pelvic lymphadenectomy. There were no complications of ICG usage and the complication rate (digestive fistula, ureteral strictures) was significantly lower (p=0.002716) for group 1 compared with group 2., Conclusions: ICG facilitates the identification of key elements (anatomy and pathological structures) in the laparoscopic and robotic treatment of both malignant and benign urologic diseases, with possible impact on perioperative complications, along with oncologic and functional postoperative outcomes.

Purpose: The purpose of this study was to evaluate the predictive performance of OncoOVARIAN Dx algorithm, which takes into account tumor markers (beta HCG, CA 19.9, CEA, AFP, CA 125, HE4), general biochemistry and clinical data (age, menopause, comorbidities) in patients scheduled for surgical removal of a suspicious adnexal tumor in comparison with the Risk of Malignancy Algorithm (ROMA) model., Methods: Consecutive women diagnosed with an adnexal tumor mass and scheduled for surgical intervention at a single tertiary cancer between October 2018 - June 2019 were enrolled. Preoperative values of tumor markers and general biochemistry (ASAT, ALAT, GGT, total bilirubin, creatinine) were determined. Following surgery with adequate surgical staging, a definite pathological diagnosis was made and used as reference., Results: A total of 50 patients were selected, including 20 benign, 5 borderline and 25 malignant epithelial ovarian cancer (EOC) cases on final pathology. Borderline tumors comprised 3 serous and 2 mucinous FIGO stage I cases. Malignant tumors included 17 high grade serous, 4 endometrioid and 4 mucinous types, FIGO stage IA-IIIC. The two models demonstrated very good correlation (Phi 0.78, p<0.001). The sensibility (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) of OncoOVARIAN Dx versus ROMA model were 76.66% vs. 60%, 95% vs. 100%, 95.83% vs. 100%, 73.07% vs. 62.5%, respectively. In postmenopausal patients higher Se (85.71%), Sp (100%) and PPV (100%) were observed for OncoOVARIAN Dx., Conclusions: OncoOVARIAN Dx model demonstrated higher Se and NPV compared to ROMA and could be a useful marker in the preoperative management of adnexal masses; however larger studies are warranted to validate and further refine this algorithm.

Purpose: With the improvement of techniques and the update of diagnostic protocols in breast cancer, modern imaging proves to be effective in the diagnosis of this pathology, as well as in its prognosis. This study aimed to evaluate the effectiveness of these modern imaging techniques through a systematic assessment of the most recent studies., Methods: A PUBMED search, using certain key combinations ("breast cancer", "F18 FDG PET-CT", "MRI", "staging", "diagnosis") and some inclusion and exclusion criteria, yielded 24 articles published during 2014-2018., Results: Using these 24 articles, the various statistical tests showed a significant difference between modern imaging techniques, with respect to prognosis (p<0.05), in close correlation with the immunohistochemical profile of the tumor., Conclusions: Modern imaging techniques (F18-FDG/PET-CT, F18-FDG/PET-MRI) were validated to formulate a better prognostic value than conventional imaging, presenting a sustainable higher sensitivity and specificity in evidencing the locoregional invasion and the recurrence of this pathology.

Purpose: We report our experience with 23 cases in utilizing ileum to perform totally intracorporeal 3D laparoscopic neobladder reconstruction using two different surgical techniques., Methods: Patients candidates for reconstructive surgery were in a good biological status with a body mass index (BMI) in the range of 18.5-25 and presented a muscle-infiltrative bladder tumor with negative nodal frozen sections performed during the operation. Twenty-one modified Studer neobladder and 2 modified Y-shaped neobladder techniques for totally intracorporeal 3D laparoscopic ileal neobladder cases were performed using drawings and intra-operative images. An emphasis was made on different tips and tricks that can be applied when using ileum for the neobladder reconstruction, to avoid surgical complications and obtain optimal functional results., Results: The operations were performed in a mean time of 5 h, with a mean blood loss of 350 ml and grade II postoperative Clavien Dindo complications. The 23 patients were discharged after a mean hospital stay of 21 days and had a functional ileal neobladder after a mean of 30 days. The results were monitored also on the long-term, taking into account functional results and possible complications from utilizing ileum as a urinary reservoir., Conclusion: Resecting a digestive segment and using it as a urinary reservoir may lead to multiple complications. Therefore, laparoscopic technical adaptations and highly skilled surgical teams are required for performing a totally intracorporeal 3D laparoscopic orthotopic ileal neobladder reconstruction.