Perspectives on the diagnostic, predictive and prognostic markers of neuroendocrine neoplasms (Review)

Neuroendocrine neoplasms (NENs) are a heterogeneous group of rare tumors with different types of physiology and prognosis. Therefore, prognostic information, including morphological differentiation, grade, tumor stage and primary location, are invaluable and contribute to the formulation of treatment decisions. Biomarkers that are currently used, including chromogranin A (CgA), serotonin and neuron-specific enolase, are singular parameters that cannot be used to accurately predict variables associated with tumor growth, including proliferation, metabolic rate and metastatic potential. In addition, site-specific biomarkers, such as insulin and gastrin, cannot be applied to all types of NENs. The clinical application of broad-spectrum markers, as it is the case for CgA, remains controversial despite being widely used. Due to limitations of the currently available mono-analyte biomarkers, recent studies were conducted to explore novel parameters for NEN diagnosis, prognosis, therapy stratification and evaluation of treatment response. Identification of prognostic factors for predicting NEN outcome is a critical requirement for the planning of adequate clinical management. Advances in ‘liquid’ biopsies and genomic analysis techniques, including microRNA, circulating tumor DNA or circulating tumor cells and sophisticated biomathematical analysis techniques, such as NETest or molecular image-based biomarkers, are currently under investigation as potentially novel tools for the management of NENs in the future. Despite these recent findings yielding promising observations, further research is necessary. The present review therefore summarizes the existing knowledge and recent advancements in the exploration of biochemical markers for NENs, with focus on gastroenteropancreatic-neuroendocrine tumors.

[Residual stress evaluation]

Paper presents the results of an international research project carried out by author in the laboratories of the University of Pisa, Italy and funded by NATO. Research showed the feasibility of the measurement of residual stress up to 90% of the material yields strength using a four gages rosette and analytical relations. This new method can be used with an improved accuracy in residual stress measurements in bones, prosthesis and implants.

[The use of CAD/CAM and rapid fabrication technologies in prosthesis and orthotics manufacturing]

Modern CAD/CAM and rapid fabrication technologies used in the prosthesis and orthotics manufacturing are based on 3D scanning, 3D reconstruction and computer aided fabrication.

AIM

Paper approaches a study on the manufacture of customised orthosis (foot insole) through CAD/CAM and rapid fabrication technologies, using most economical devices and software available in Romania.

MATERIAL AND METHODS

Paper describes a method used in the data acquisition, reconstruction and fabrication of a foot insole made of acrylonitrile butadiene styrene (ABS). Data acquisition is accomplished using non contact 3D scanner with structured light. Structured-light 3D scanner is a device for scanning the three dimensional shape of an anatomical surface using projected light patterns and a camera system. All working steps from 3D scanning to computer aided fabrication of the foot insole through rapid ptototyping are described. Peculiar attention has been given to the image processing steps from 3D reconstruction to the final 3D CAD modelling of the foot insole.

RESULTS

The approached method showed a good accuracy in scanning of anatomic surfaces and in speeding up fabrication of leg orthosis. The 3D printer was able to build durable ABS thermoplastic insoles without post treatment.

CONCLUSIONS

Approached fabrication method showed the advantages of manufacturing of orthosis and prosthesis components through CAD/CAM and Rapid Fabrication technologies. New prosthetic laboratories may be equipped with Rapid Fabrication technologies like 3D scanners and 3D printers.

[Clinical and therapeutical considerations regarding the diagnosis and treatment in meconial disease]

The meconium disease represents a problem of great impact over the vital prognosis of the newborn, the mortality of this disease being rated in various studies between 30 and 50%. The meconial disease that reunites the meconial ileus and the meconial peritonitis is often associated with cystic fibrosis a disease of general impact over the entire organism increasing the gravity and influencing the vital prognosis of these patients. The authors' purpose is to evaluate the results obtained after the treatment of the meconial disease in the Pediatric Surgery Clinic of the Emergency Hospital of Craiova over a period of 10 years. The study has been made on a number of 16 cases of meconial ileus, plug and peritonitis analising the difficulty of the diagnostic process, the preoperative care as well as the possibilities of surgical treatment. The surgical treatment is composed of multiple procedures including simple suture of the bowel defect and segmentary bowel resections with primary anastomosis and/or secondary anastomosis after ileostoma. The mortality on the studied cases was of 37.5% despite recent progresses achieved in postoperative care of these type of patients.

Plaque-type morphea in children

We present the case of a girl, aged 8-year-old, with a history of acrocyanosis and repeated respiratory infections with beta-hemolytic streptococcus, which was consulted for the presence of skin lesions in the right buttock area. Clinical examination showed, in the right buttock region, an oval plaque with a diameter about 12 cm, hard, well defined, with irregular outline. The biopsy was performed and it revealed typical aspects of plaque-type morphea. The epidermis was mostly atrophic, with areas of ridge reduction; an important proliferation of collagen fibers within superficial and deep dermis and an abundant lymphocytic inflammatory infiltrate throughout the dermal thickness reaching hypodermic level and infiltrating it. General treatment consisted of antibiotics; vitamin E; local treatment with topical cortisone; analogues of vitamin D3 to which we associated topical adjuvants with repairing and healing role applied to the biopsied area. Evolution was favorable after three months of treatment, with obvious improvement of skin lesions; skin became more elastic and the purple red contour ring disappeared.

[Ergonomic technology. Design study]

The paper deals with domains and technological developments and related supports that enhance the rehabilitation process. Ergonomic Technology, Rehabilitation Engineering, Accessibility and Assistive technology are factors involved in promoting a greater independence for people with disabilities by designing and developing new devices with improved design and functionality. Results of a device design study for people with disabilities are presented.

[Evolutive particularities of appendicular plastron in children]

This paper analyses the experience of the Paediatric Surgery Department from the Emergency Hospital in Craiova regarding the clinical and therapeutical evaluation of 55 cases with appendicular plastron admitted in our department between 1997-2006. We analyse both the evolution and the complications in managing these cases, together with particular aspects of differential diagnosis related to this group of age. These 55 cases were children aged between 2 and 15 years with a 15 days average hospitalization period. Applying a standard treatment we had favorable results in 85% of cases with 15% cases underwent surgical treatment from the first admission. Comparative to a study realised in our dept. between 1975-1996, which registered 30 cases with a mortality of 6.70%, the present one revealed in the latest years an important increase of the number of appendicular plastron with a significant low mortality.

[The tension induced by orthodontic forces in the dentoperiodontal system studied by the finite element method]

The aim of this study was to quantify the stress induced in the periodontal ligaments by the orthodontic appliances. A finite element model of an orthodontic system, applied on a lower premolar, was developed in different loading conditions. The maximum stress values depend on the location, direction and the magnitude of force application.

[Graphic reconstruction of anatomic surfaces]

The paper deals with the graphic reconstruction of anatomic surfaces in a virtual 3D setting. Scanning technologies and soft provides a greater flexibility in the digitization of surfaces and a higher resolution and accuracy. An alternative cheap method for the reconstruction of 3D anatomic surfaces is presented in connection with some studies and international projects developed by Medical Design research team.

[Clinical and therapeutical considerations regarding a rare case of pre-pyloric stenosis]

The neonatal obstacle caused by a pre-pyloric diaphragm represent a rare cause of high oclusion in new-born. We present the case of a 6 days old new-born admitted in our department for nonbilious vomiting and feeding intolerance in which the clinical exam and the imagistic explorations (plain and contrast abdominal X-Rays, and ultrasound) could not reveal an evident cause for the oclusion. The surgical intervention imposed by the simptoms revealed the existece of a complete diaphragm in the prepyloric region. The initial excision of the diaphragm was not sufficient, the patient undergoing a second surgical intervention of gastrojejunal anastromosis with favorable evolution this time. The authors are presenting diagnosis and theraputical management peculiarities of this rare condition.

[Bowel intussusception on the child: clinical therapeutical study]

Intussusceptions is the most common cause of bowel obstruction in children between 5 months and 1 year of age. Intussusceptions occurs when a portion of the bowel folds like a telescope, with one segment slipping inside another segment. This study refers to a group of 72 children, with intussusceptions diagnosis between 1975-2000 in our clinic. The authors are also analyzing these cases from the point of view of frequency on years, seasons, age, sex, residence, clinical forms, time since the intussusceptions occurred until the treatment begun.

[The use of open source software in graphic anatomic reconstructions and in biomechanic simulations]

The objective of this study was to obtain three-dimensional (3D) images and to perform biomechanical simulations starting from DICOM images obtained by computed tomography (CT). Open source software were used to prepare digitized 2D images of tissue sections and to create 3D reconstruction from the segmented structures. Finally, 3D images were used in open source software in order to perform biomechanic simulations. This study demonstrates the applicability and feasibility of open source software developed in our days for the 3D reconstruction and biomechanic simulation. The use of open source software may improve the efficiency of investments in imaging technologies and in CAD/CAM technologies for implants and prosthesis fabrication which need expensive specialized software.

[Rectal lesions in children. Clinico-therapeutic considerations of 12 cases]

The lesions of the anus and the rectum are not very really found in children, representing even a appreciable percentage; in the Pediatric Surgery Clinic of the University Hospital no. 1 of Craiova were admitted and operated 12 patients with lesions of the rectum between 1986 and 1998. The causes of these lesions were: polytraumatism--3, falls in different sharp things--7, rectal perforations on the septic base from the peritoneal cavity--1, iatrogenic cause--1. The surgical treatment were consisted in: the suture of wounds on the perineal way, lavage, drainage, antibiotherapy--6 cases, the iliac left anus with the re-establishing of the continuity--3 cases, the suture of wounds on the perineal and abdominal ways--2 cases. The conditions were good in 9 cases--cured, and 3 deceases (2 polytraumatism, 1 case malformed new-born with perforation produced by using haegar).

[Descriptive motor sciences]

The paper presents a new approach to human movements and positions using Descriptive Geometry, a discipline used in 2D and 3D description of object positions in space. Some particular positions of the human body are depicted using a reference system formed by three orthogonal planes: horizontal, vertical and lateral. Positions of arms are described using precise terms used in Descriptive Geometry. The use of precise terms in human positions description can improve communication and understanding of more complex positions in space.

[Update in diagnosis and treatment of esophageal atresia]

The paper present a number of 17 cases of esophageal atresia, hospitalised and operated in a period of 4 years (2001-2004). The authors are underlining the importance of the prenatal diagnosis, preoperative and postoperative care, the chance for primary anastomosis for type III A of the disease, complications and prognosis related to the type of atresia. Esophageal atresia is a success of a complex team where the role of the neonatologist and anesthesiologist, next to the surgeon, is very important.

[The gastroschisis: clinical and therapeutic considerations]

Gastroschisis is a severe congenital malformation of the abdominal wall, with relative low incidence. The authors are analysing different therapeutic methods, in a group of 17 cases, hospitalised and operated in Department of Pediatric Surgery, Emergency Hospital of Craiova. They are underlining the importance of the ultrasound prenatal diagnosis of the malformation, close related to different therapeutic methods applied in this period of time and also are advising secondary closure of the abdominal wall, using a synthetic material (Silo-bag) for temporary coverage of the intestine developed outside the peritoneal cavity. This method helped with the decreasing of mortality in gastroschisis but with high costs of treatment.

[Distance learning using internet in the field of bioengineering]

The Leonardo da Vinci training programme supports innovative transnational initiatives for promoting the knowledge, aptitudes and skills necessary for successful integration into working life. Biomedical engineering is an emerging interdisciplinary field that contributes to understand, define and solve problems in biomedical technology within industrial and health service contexts. Paper presents a Leonardo da Vinci pilot-project called Web-based learning and training in the field of biomedical and design engineering (WEBD). This project has started on 2001. The WEBD project proposes to use advanced learning technologies to provide education in the www. Project uses interactive 3D graphics and virtual reality tools. The WEBD distance training permits users to experience and interact with a life-like model or environment, in safety and at convenient times, while providing a degree of control over the simulation that is usually not possible in the real-life situation.

[Errors and difficulties in the diagnosis and management of acute and chronic abdomen in children]

The authors are reviewing on a lot of 2844 cases between 1996 and 2000 the difficult problems of differential diagnosis between acute surgical abdomen in children and intestinal tuberculosis, abdominal tumors and inflammatory diseases such as acute osteomielitis. They are presenting 13 particular cases in which the acute abdomen diagnosis was difficult or even omitted.

Zeolitical materials for microbiological filtrations

The paper presents some aspects about synthesis of new materials called zeolites which can be utilised as filters with wide application in clinical practice in microbiology and in pharmaceutical industry. The SAPO-5, SAPO-11 and SAPO-34 zeolites were synthesised by hydrothermal crystallisation and using different mixtures. The crystallisation was carried out in teflon-lined stainless steel autoclaves at 180-195 degrees C for 1-2 days, under autogenous pressure. Filtering properties of these materials are different because their pore diameters are different.

[Advances and limits in biomedical stress quantification in dento-periodontal structures]

The stress quantification in dento-periodontal structures is an important concept, as stress in the tissue and in surrounding structures. A number of clinical studies have suggested figures for such an optimal stress strange. The clinical experiments can be completed with mathematical analysing methods as finite element method. Once the basics of biomechanics understood laws the treatment goes clearly defined, the computer aided design improve the optimal restorative prosthetic or orthodontic appliance. The finite element method (FEM) makes possible the numerical simulation of different clinical situations. Based upon mathematical modelling and extrapolation from experimental studies, practical conclusions can be drawn concerning the different types of forces and their subsequent induced relationship to the stresses. Clinical and histological experiments confirm the mathematical prediction offered by the FEM.