Marius Septimiu Petrutescu

Pregnancy-associated breast cancer (PABC) is a rare but increasingly encountered clinical entity, largely driven by delayed childbearing, and poses significant diagnostic and therapeutic challenges due to physiological breast changes and concerns regarding fetal safety. This narrative review aims to synthesize current evidence on the epidemiology, clinical presentation, diagnostic strategies, surgical management, systemic therapy, obstetrical considerations, and emerging applications of artificial intelligence in PABC. A comprehensive literature search was conducted across major databases, prioritizing recent studies, international guidelines, and large cohort analyses. Available evidence indicates that PABC is frequently diagnosed at a more advanced stage, partly due to delayed recognition. Ultrasound represents the first-line imaging modality, while mammography with shielding and selected MRI protocols may be safely used for staging. Surgical treatment is feasible during pregnancy, and anthracycline-based chemotherapy, with selected taxanes, can be administered during the second and third trimesters with acceptable maternal and fetal outcomes. In contrast, radiotherapy and most targeted therapies are deferred until postpartum. Obstetrical management should aim to avoid iatrogenic prematurity while ensuring adequate fetal monitoring. A multidisciplinary, trimester-adapted approach remains essential, although further prospective studies are required to address existing evidence gaps and optimize long-term outcomes.

Despite the substantial decrease in mortality rates following a pancreaticoduodenectomy to less than 5%, morbidity rates remain significant, reaching even 73%. Postoperative pancreatic fistula is one of the most frequent major complications and is significantly associated with other complications, including patient death. Currently, there is no consensus regarding the ideal type of pancreatic anastomosis, as the question of the choice between a pancreaticogastrostomy and pancreaticojejunostomy is still open. Furthermore, worldwide implementation of an ideal pancreatic fistula risk prediction score is missing. Our study found several significant predictive factors for the postoperative occurrence of fistulas, such as the soft consistency of the pancreas, non-dilated Wirsung duct, important intraoperative blood loss, other perioperative complications, preoperative patient hypoalbuminemia, and patient weight loss. Our study also revealed that for patients who exhibit fistula risk factors, pancreaticogastrostomy demonstrates a significantly lower pancreatic fistula rate than pancreaticojejunostomy. The occurrence of pancreatic fistulas has been significantly associated with the development of other postoperative major complications, and patient death. As the current pancreatic fistula risk scores proposed by various authors have not been consensually validated, we propose a simple, easy-to-use, and sensitive score for the risk prediction of postoperative pancreatic fistula occurrence based on important predictors from statistical analyses that have also been found to be significant by most of the reported studies. The new pancreatic fistula risk score proposed by us could be extremely useful for improved therapeutic management of cephalic pancreaticoduodenectomy patients.

Background: Chronic wounds are a significant health problem with devastating consequences for patients’ physical, social, and mental health, increasing healthcare systems’ costs. Their prolonged healing times, economic burden, diminished quality of life, increased infection risk, and impact on patients’ mobility and functionality make them a major concern for healthcare professionals. Purpose: This review offers a multi-perspective analysis of the medical literature focusing on chronic wound management. Methods used: We evaluated 48 articles from the last 21 years registered in the MEDLINE and Global Health databases. The articles included in our study had a minimum of 20 citations, patients > 18 years old, and focused on chronic, complex, and hard-to-heal wounds. Extracted data were summarized into a narrative synthesis using the same health-related quality of life instrument. Results: We evaluated the efficacy of existing wound care therapies from classical methods to modern concepts, and wound care products to regenerative medicine that uses a patient’s pluripotent stem cells and growth factors. Regenerative medicine and stem cell therapies, biologic dressings and scaffolds, negative pressure wound therapy (NPWT), electrical stimulation, topical growth factors and cytokines, hyperbaric oxygen therapy (HBOT), advanced wound dressings, artificial intelligence (AI), and digital wound management are all part of the new arsenal of wound healing. Conclusion: Periodic medical evaluation and proper use of modern wound care therapies, including the use of plasma-derived products [such as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF)] combined with proper systemic support (adequate protein levels, blood sugar, vitamins involved in tissue regeneration, etc.) are the key to a faster wound healing, and, with the help of AI, can reach the fastest healing rate possible.