In the context in which life expectancy increases and the population becomes more active, the number of people who are affected by gonarthrosis symptoms increases proportionally. By the year 2030, in the United States of America, one in three adults is expected to suffer from gonarthrosis, this prediction will be the beginning of an epidemic. Total knee arthroplasty has been shown to relieve pain and improve joint function; however, studies have shown that active young patients still have limitations in performing high-level activities such as dancing, golfing, skiing, and gardening. Currently, modern TKA implants are designed to reproduce the normal biomechanics of the knee joint, mimicking the physiological “medial pivot” pattern with greater compliance on the medial compartment between the tibial insert and femoral condyle and less congruence on the lateral side.
The squamous cell carcinoma antigen is a tumor marker that is receiving more interest due to its biological properties and importance in both pathological and normal physiological processes. Numerous clinical studies have been conducted to determine the potential function of squamous cell carcinoma antigen and its isoform complexes in clinical practice. These studies have been prompted by the fact that not only squamous cell carcinoma antigen but also circulating immune complexes of it and immunoglobulin M are involved in normal physiological and pathological processes. The therapeutic use of squamous cell carcinoma antigen as a tumor marker for either squamous carcinoma diagnosis or for monitoring the response to radiation or chemotherapy, tumor recurrence, and treatment failure are supported by prior investigations. The diagnostic or prognostic utility of squamous cell carcinoma antigen is debatable, nevertheless, as these investigations provide conflicting findings. A uniform detection method, scoring system, and cutoff level must be devised to limit clinical variability between studies and to provide a more accurate and trustworthy comparison of data. Additionally, even if the effectiveness of several approaches is equivalent, only one method should be used for the dynamic monitoring of tumor marker kinetics.
More than 75 years after its accidental discovery, methotrexate remains an important treatment option for many diseases. Whether it is various hematological and non-hematological neoplasms, rheumatological, dermatological, or other conditions, methotrexate remains in scope. For rheumatoid arthritis, current clinical guidelines (EULAR, ACR) recommend methotrexate as the first therapeutic option. This article aims to highlight important moments in the history of this remarkable drug, to review the literature on its mechanisms of action and the arguments for which after more than half a century, methotrexate remains the gold standard in the treatment of rheumatoid arthritis but also an important option for treatment of psoriasis vulgaris (PV) and psoriatic arthritis (PsA).
Collision tumors, rare neoplasms underlying two distinct histological types of carcinomas (with different origins) separated by normal tissue, are described in many organs including the thyroid gland, but to a lesser extent. We aim to overview the current published data concerning collision tumors of the thyroid (CTT). This is a narrative review considering papers published on PubMed through a search starting from the terms “collision” and “thyroid”. Inclusion criteria are full-length articles, the English language, the timeline from inception to December 2022, and original studies with different levels of statistical evidence. We followed the main types of thyroid carcinomas: differentiated thyroid carcinoma of papillary and follicular type, anaplastic/ undifferentiated/poorly differentiated carcinoma, respectively medullary thyroid carcinoma. We identified 92 papers based on the mentioned
Coronary CT angiography is a non-invasive method of analyzing the coronary lumen through which the atheromatous bur-den can be evaluated, with the analysis of the type of plaque (soft, calcified, mixed) and the impact on the arterial lumen (stenosis, occlusion). The anatomical evaluation by coronary CT is indicated in symptomatic patients with low and medium risk factors for coronary atherosclerotic disease, in those with inconclusive laboratory and EKG results, patients with un-certain stress test results, in the evaluation of coronary grafts and intrastent stenoses. Depending on the result of the angiography, the severity of the stenosis and the management of the patient are established. In the case of mild and medium stenoses, risk factors management and drug treatment are recommended. For severe stenoses, patients are referred for interventional coronary angiography or functional evaluation. Coronary CT angiography increases the certainty of coronary atherosclerotic disease diagnosis. It has a superior discriminative capacity of plaques with low attenuation, the main predictor of myocardial infarction, with almost five-fold higher risk. Coronary CT angiography increases the adaptation of medication, and the inclusion of statin therapy decreases the risk of fatal and nonfatal myocardial infarction at 5 years and increases the quality of life.
Background: Infection and sepsis represent major complications after abdominal surgery for secondary peritonitis. Finding new tools that can help identify patients at risk for developing postoperative complications is of the utmost importance for clinicians. We tried to evaluate the use of different biomarkers in evaluating the postoperative prognosis of patients with secondary peritonitis. Methods: We searched the available literature on the usefulness of serum biomarkers in evaluating prognosis in patients with secondary peritonitis. Results: Elevated postoperative lactate levels and high procalcitonin (PCT) levels were associated with negative outcomes. C-reactive protein values increase rapidly in response to the surgical insult but have no value in assessing the overall prognosis. Conclusion: Procalcitonin (PCT) is superior to other biomarkers in predicting severe septic complications and overall mortality in patients with secondary peritonitis.
Background: Cardiovascular disease can be triggered and accelerated by hypertension and the underlying changes in the structure and function of arteries. The purpose of this review is to explore some vascular changes that occur in hypertension as a consequence of the imbalance between cell proliferation and cell death, processes that play an important role in stabilizing the thickness of the arterial wall during vascular remodeling. Methods: The authors conducted research through PubMed and Google Scholar databases using the following search formula: (hypertensive*) AND ((vascular modifications)) OR (vascular changes)) AND (cell death). Results: From 40 articles, only 17 publications were included in this study, taking into account four processes that can be preceded or followed by inflammation and depend on the interaction between local growth factors, vasoactive substances, and hemodynamic stimuli: Cell proliferation and growth; Cell migration; Cell death; Degradation or reorganization of extracellular matrix. Conclusions: To summarize, maladaptive vascular changes in hypertension can represent a major argument for prompt and maximal therapeutic intervention in patients with high cardiovascular risk. Moreover, they can represent an important step in discovering new markers of cardiovascular risk and in the development of new targeted therapies for different pathways of cellular signaling through which the reversibility of abnormal vascular changes could be obtained.
Matrix metalloproteinases (MMPs) are a member of the protein family intimately associated with zinc-containing endopeptidases, which are the main proteases implicated in extracellular matrix (ECM) degradation. The high ability of MMPs in the degradation of extracellular proteins is an important event in many normal biological as well as pathologic processes, including tumor progression, tissue repair, wound healing, developmental morphogenesis, and inflammatory diseases. This review is focused on the description of the modulation mechanism of MMPs via oncoviruses. Up to now, a large number of oncogenic viruses have been detected and recognized as etiologic factors of multiple human cancers. Actually, by expression of several viral oncoproteins of tumorigenic viruses with the simple genetic system, we are able to deregulate or modulate the pathways of cell transformation procedure in malignancy. In brief, upregulated expression of MMPs genes by direct (through DNA binding) , as well as indirect interactions (by activating PI-3K/AKT, ERK/MAPK, IFN/JAK/STAT, JNK, NF-κB signaling pathways and/or immune response) with tumorigenic viruses, have a noticeable role in the proliferation of cells, as well as angiogenesis, mobility, EMT, invasiveness, and metastatic features. In fact, the growth of tumor-related researchers offers a future perspective for the efficiency of targeted, molecular-based therapies and its anticancer effects via diverse mechanisms such as the suppression of viral oncoproteins.
Total hip replacement surgery (THR) is one of the most common surgeries performed in modern orthopedics, and in most cases offers a significant improvement in the quality of the patient's life. However, after some time, wear and osteolysis do appear, which leads to the need for revision surgery. With the indication being widened to a more young and active population, the need for extending the lifespan of the prosthesis is mandatory. Although several bearing surfaces have been studied over the years, and a lot of couplings are in use, the choice of the right combination of materials is still controversial. Biotribology tries to answer some of the current questions regarding the best bearing surface to use, being the branch of science and technology that studies friction, wear, and lubrication of different materials in the human body. In the present day, a large number of materials are in use for total hip replacement, but choosing the right combination of materials is still controversial, and is being done on one hand by the surgeon’s experience and on the other hand by the age and activity of the patient. The objective of this review is to try to present the main advantages and disadvantages of different materials and try to answer the most difficult question of them all: What is the right material to use for THR-bearing surfaces?
Low levels of vitamin D in patients with osteoarthritis (ΟΑ) rather adversely affect the structure and function of articular cartilage. Low levels of vitamin D are also associated with joint pain, limited physical activity, quality of life, as well as decreased muscle strength, primarily in the lower extremities with adverse OA progression. A high percentage of low vitamin D levels was found in patients with OA and joint arthroplasty as well as a less satisfactory postoperative follow-up in patients with low vitamin D levels. The administration of vitamin D supplementation in patients with knee osteoarthritis has been associated with improved articular cartilage architecture, and reduced joint pain, combined with improved functionality and quality of life in patients with OA.
