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Archaeological research conducted at St. Michael’s Roman-Catholic Cathedral from Alba Iulia in the spring of 2011 revealed vestiges belonging to the Roman period, Middle Ages and Modern period. The research has been conducted within the project of restoration of the St. Michael’s Cathedral and of the Vauban Fortress of Alba Iulia. This study presents three stone pieces from the Roman times, re-used in constructions dating to the Medieval period and the beginning of the modern period. The first analyzed piece represents a funerary Roman inscription discovered in the ruins of a building dated to the 14th century. The text of the inscription refers to Marcus Granius Stabilianus, buried with two of his children (Marcus Granius Stabilianus and Grania Sabina). Based on the funerary inscription, the monument can be date between the first half of the 2nd century and the beginning of the 3rd century AD. The second piece represents the medallion of a funerary stele preserved in fragmentary state. The stele was discovered at the base of a lime kiln, generally dated in fifteenth and sixteenth centuries. The medallion represents the deceased (male character) and his family. The last analyzed piece is a fragment of a Roman sarcophagus cover found in the foundation of the eastern pillar of the entrance into the Episcopal Palace’s courtyard. Every piece discussed in the present article was made of whiteyellow limestone.

Endometrial adenocarcinoma (ADK) is one of the most common uterine cancer and the fourth neoplasia mortality cause in women according to the literature data. ADK is encountered in the sixth decade of life, the mean age being 63 years. Only 2-5% of cases are found in women less than 40 years old. We present the case of a 63-year-old woman admitted in our Clinic for hypogastric pain and reduced vaginal sanguinolent discharge. The genital examination and transvaginal ultrasound (US) scan were strongly suggestive for a type 0 myoma tending to be expelled through the cervical canal. Laparotomy and total hysterectomy with bilateral adnexectomy were performed. Histological examination identified a grade G1 well-differentiated endometrioid ADK without uterine wall invasion. The immunohistochemistry study for estrogen receptors expression revealed moderate and strong nuclear immunostaining in more than 70% of the tumoral cells, as well as a mosaic p16 immunoexpression, a cytokeratin 7 (CK7) immunophenotype, no p53 overexpression and low Ki67 index (estimated at 10-15%). Considering the incidental finding, the early stage and limited localization of the ADK at the myoma surface level surgery was considered sufficient as treatment but follow-up was conducted by magnetic resonance imaging (MRI) and general examination every six months. The most interesting aspect of the case was the atypical presence of an active myoma in menopause and the totally unsuspicious US appearance of the endometrium. The endometrial ADK was accidentally discovered in an unusual specimen without any other symptom.

Platelets play an essential role in atherothrombosis and for this reason they are the primary target of antithrombotic therapy in ischemic stroke. We discussed here the evidence for efficacy and safety of current knowledge in antiplatelet therapy for stroke prevention after an acute ischemic stroke or transient ischemic attack. After an acute episode, long-term antithrombotic therapy is essential for the secondary prevention of stroke recurrence and complications. Antiplatelet therapy for acute ischemic stroke (non-cardioembolic) or ischemic stroke consists of three antiplatelet drugs, in accordance with Food and Drug Administration (FDA) from the USA and also with the Guidelines published by the American Heart Association (AHA) and nevertheless with the Guidelines of the American Stroke Association (ASA), in 2014, for preventing vascular events, such as stroke. These are aspirin, clopidogrel and dipyridamole. Moreover, recent randomized clinical trials and the last Guidelines for stroke of AHA∕ASA, in 2018, also mention ticagrelor. All of these antiplatelet therapies, besides inhibiting acute arterial thrombosis, also interfere with physiological hemostasis. In conclusion, we can say that current recommendations focused primarily on the therapy with aspirin for the secondary prevention of stroke in patients that presented vascular events, such as ischemic stroke of non-cardioembolic cause or transient ischemic attack and, as appropriate, aspirin plus dipyridamol or clopidogrel. The new therapy with ticagrelor in secondary stroke prevention seems to be promising, but more randomized clinical trials are needed to accurately assess the safety and efficacy of this new antiplatelet drug.

Introduction: Selective progesterone receptor modulators (SPRMs), such as Mifepristone, Asoprisnil, Ulipristal acetate (UPA) and Vilaprisan, were tested for their antiproliferative effects on uterine fibroids. In Romania, despite the UPA availability, physicians remained reserved on the lack of experience and concerns about the safety of the drug on endometrium., Patients, Materials and Methods: We performed an observational study on premenopausal women with symptomatic uterine fibroids. The patients received UPA in doses of 5 mg for 12-13 weeks. The fibroids dimensions and endometrium thickness were recorded at before and after the treatment. The pathological samples were assessed by two pathologists, and they recorded progesterone receptor modulator associated endometrial changes (PAEC) as extensive PAEC (EPAEC), minimally PAEC (MPAEC), absent PAEC (APAEC) and Ki67 immunoexpression in endometrium., Results: A number of 57 women were introduced in our study and we had a dropout of one patient. The fibroid dimensions and endometrial thickness decreased after UPA. The pathological exam of the endometrium revealed: APAEC in 26.8% of cases, MPAEC in 60.7% of cases and EPAEC in 12.5% of cases. EPAEC were more frequent in patients with larger fibroids. PAEC had a strong correlation with Ki67 index (p≤0.01). PAEC were more frequent in older women (p≤0.01). Ki67 had a higher expression in EPAEC - mean: 69% (range: 63-75%), standard deviation (SD): 3.95., Conclusions: UPA treatment decreased fibroids dimension and improved patients' symptoms in our study. EPAEC was associated with abundant Ki67 antigen. UPA administration for three months is a safe method without endometrial atypia but longer protocols require extended studies about the proliferative potential of the endometrium.

Podocytopathies represent a well-studied subgroup of glomerulopathies, being characterized by proteinuria due to damage or dysfunction of podocytes. Glomerular size in podocytopathies has been studied in different population, but only a few studies take in consideration the pediatric population. There are different methods to assess the glomerular size, but most of the studies report the maximal profile area as being the most accurate one. The aim of this study is to determine the range values of glomeruli in pediatric population with glomerulopathies and to establish a correlation between the measured size and several laboratory features. The patients that undergo renal biopsy in the Department of Nephrology, "Maria Skłodowska Curie" Clinical Emergency Hospital for Children, Bucharest, Romania, were divided into two groups: control vs. affected∕patient group. The control group included children that require renal biopsy for renal impairments other than high-range proteinuria (most of them recurrent microscopic asymptomatic hematuria), while the affected group had nephrotic-range proteinuria. Thirty patients were selected to be part of the control group and 30 patients in the affected group. In control group, the mean value diameter was 166.23±13.04 μm, and the area of the glomerulus had a mean value of 19 126.86±3070.83 μm². In the affected group, we obtained the following results: the mean value diameter was 192.42±28.15 μm, while the glomerular cross-sectional area had a mean value of 23 535.55±6456.57 μm². Using the linear regression, we concluded that all the cases with increased-size glomeruli had more urinary protein loss compared with the ones that had small-size glomeruli and low-range proteinuria.

Aim: The aim of our study was to assess glial fibrillary acidic protein (GFAP) glial cell phenotype in the enteric nervous system (ENS) in colorectal adenocarcinoma of different tumor grading and, also, to establish correlations between these changes and the tumor proliferative activity and the tumor-infiltrating leukocytes., Patients, Materials and Methods: We ran an observational, prospective study on a group of 52 patients diagnosed with colorectal adenocarcinoma. They were surgically treated in the 1st Surgery Clinic of the Emergency County Hospital of Craiova, Romania. From the surgically resected pieces, after pathological confirmation and tumor grading, 3-μm thick seriate sections were cut and processed for immunohistochemistry for detecting GFAP, S100, CD45 and Ki-67., Results: Evaluation of GFAP glial cell type in the ENS of colorectal cancer with different stages of differentiation showed that the density of these nervous elements is higher in well-differentiated (G1) colorectal tumors compared to moderately differentiated (G2) and poorly differentiated (G3) colorectal tumors. For well-differentiated colorectal adenocarcinoma, we did not find any correlations between GFAP glial cell type in the ENS and the tumor proliferative activity or with tumor-infiltrating leukocytes. In what the moderately and poorly differentiated adenocarcinoma are concerned, we found a high inverse variation between GFAP glial cell type in the ENS and the proliferative activity, on one hand, and, between GFAP glial cell type in the ENS and the tumor-infiltrating leukocytes, on the other hand., Conclusions: The decrease in the density of GFAP glial cell type in the ENS with tumor grading of colorectal cancer and the inverse variation with the tumor proliferative activity and with the tumor-infiltrating leukocytes might serve as putative prognostic factors in colorectal cancer.

The aim of this study is to assess the status of synapses in normal colorectal tissue compared to neoplastic colorectal tissue, and to correlate this status with survival in patients with colorectal neoplasia. Our study included 61 patients diagnosed with colorectal adenocarcinoma, representing the study group, and 53 patients diagnosed with benign conditions, that required a resection of a colorectal segment, representing the control group. We performed the immunohistochemical staining by using anti-synaptophysin antibody, which identifies synaptic vesicles and, so, we managed to analyze the expression of synapses in colorectal adenocarcinoma. Regarding both the signal area and integrated optical density (IOD) of the synaptophysin, the univariate analysis with a log-rank (Mantel-Cox) test indicated that patients with a low level of synaptophysin had a better overall survival rate than those with a high-level synaptophysin. Also, we noticed that tumor size, tumor invasion and lymph node metastasis were significantly associated with the overall survival rate, whereas the other clinicopathological features were not. In conclusion, the status of synaptic vesicles evaluated via synaptophysin expression in patients with colorectal cancer positively correlates with the survival rate and it can play a role in the neoplastic therapy process.

Constrictive pericarditis is a rare and severe disease. A 37-year-old patient was admitted in the hospital for dyspnea, precordial pain, right-sided cardiac failure. Chest X-ray showed cardiac enlargement and an opacity suggestive for pleural effusion. Echocardiography revealed an adhesive-effusive-constrictive pericarditis, a very thickened pericardium and bilateral pleural effusion. After a pericardiectomy done to restore cardiac compensation and to identify etiological factors, a tuberculous pericarditis (TBP) was diagnosed. After surgery and starting anti-TB treatment, the patient presented altered clinical status, dyspnea, dry cough, fever and delayed callus formation at sternum level. Thoracic scan revealed mediastinal air collections, pericarditis and pleurisy. Thus, the TBP diagnosis was extended to mediastinal TB and anti-TB therapy was continued. After four months of treatment, another thoracic scan showed disappearance of the mediastinal air-leakage bubbles, multiple new micronodules in both lungs and lymph nodes of up to 15 mm; also increasing pericardial and pleural effusions. This case was interpreted as a TB treatment failure situation. A retreatment regimen was started, resulting in a slow favorable outcome. Pericardial TB is a rare condition, usually with delayed diagnosis and poor treatment benefits. Whenever possible, earlier diagnostic can contribute to better management of these cases.

The aim of this study is to make a foray in the world of constitutive elements of the architectural and functional organizing of the cardiomyocytes involved in cardiomyopathies and of the genetic molecules that they express. Primary cardiomyopathies represent a group of diseases characterized by primary structural and functional changes of the myocardium, without myocardial ischemic disease, hypertension, valvulopathies or congenital cardiac diseases being involved. In the pathogenesis of the cardiomyopathies proteins, especially from the sarcomere, Z-disc, cellular cytoskeleton, sarcolemma, intercalated discs, nuclear envelope and other constitutive proteins of the cardiomyocytes are involved. Deciphering of these pathophysiological mechanisms is part of the new model of personalized medicine, and it is useful in developing and in the optimization of new strategies for the management of the patients diagnosed with this type of disease.

Colorectal cancer represents a severe public health issue. Recent studies have shown the essential role played by nerves and their neurotransmitters in tumor initiation and progression. The aim of this study is to asses the expression of beta 2-adrenergic receptors (β2A) for adrenaline and noradrenaline, and the expression of M3 muscarinic receptors (M3R) for acetylcholine (neurotransmitters produced and released by sympathetic and parasympathetic afferents of the digestive tract and also by the enteric nervous system) in different tumor gradings of colorectal adenocarcinoma, and also the tropomyosin receptor kinase A (TrkA) for the nerve growth factor produced by the cells of colorectal adenocarcinoma. Beta 2-adrenergic receptors were expressed both in normal colic tissue and in the tumor tissues, from the three patients included in the study. It was observed that both area and integrated optical density (IOD) are more elevated for this type of receptor in tumor tissues than in normal colic tissue. For the M3 muscarinic receptors, similarly to beta 2-adrenergic receptors, it was observed a growth both of the area and of the IOD with the tumor grading. The presence of TrkA receptors was also observed both in the normal colic mucosa and in the tumor tissues examined, but with a significant reduction of the signal in the poorly differentiated tumor tissue. Understanding the neurobiology of cancer in this context becomes necessary for establishing much more complex and targeted molecular targeted therapies.

Background and Aim: The process of myocardial fibrosis is based on the remodeling of the extracellular matrix (ECM), which leads to increased myocardium stiffness and, in turn, severe alterations of the cardiac function. This phenomenon is consecutive to various types of cardiac disease, primarily infarction, due to inflammatory reactions involving various types of cellular mechanisms. We aimed in this paper to assess both microscopically and immunohistochemically the main aspects of ischemic myocardium found in areas of fibrosis and compare the findings with normal images from unaffected cardiac tissue of the same type., Materials and Methods: Our study included infarction fragments of 2/2/2 cm harvested after autopsy from 26 patients who died during 2014 at the Emergency County Hospital of Craiova, Romania, following the diagnostic of ischemic cardiomyopathy. After usual histological preparations, we performed both classical staining with Hematoxylin-Eosin and trichromic Goldner-Szekely, as well as immunohistochemical assessment using anti-alpha-SMA, anti-desmin, anti-CD34 and anti-CD68 antibodies., Results: We have evaluated myocardial fibrosis in all areas of the myocardium and noted that it primarily develops around the arterioles and metarterioles. The area of myocardial fibrosis was more extensive, myocardiocytes being surrounded by collagen fibers. Collagen interstitial fibrosis, gave a "brindle" look to the myocardium. Myocardial fibrosis areas did not reveal myofibroblasts. We found lower numbers of blood vessels with an uneven distribution in areas of myocardial fibrosis. In the areas of normal myocardium, the macrophage numbers were two to three times lower than in areas of fibrosis, also displaying larger volume, with intense reaction to CD68., Conclusions: Myocardial interstitial fibrosis occurs in outbreaks, mainly perivascular, but it affects larger areas of the myocardium interstitial space. We believe that interstitial fibrosis is a progressive process that can become permanent, thus constituting a promising therapeutic target for a large variety of cardiac conditions.

The kidney may be affected in the processes of microbial, viral, parasitic infections. Knowledge of renal disease during chronic infection, with a different location than the throat, is of particular importance for the practicing physician for the detection and prevention of impaired renal function. Chronic kidney disease recovered in the early stages can prevent the progression of renal function decline. We studied a total of 85 patients with varicose ulcers with a mean age of 66.78 +/- 12.09 years, hospitalized in the Clinic of Dermatology and a control group consisting of 110 apparently healthy individuals. Urinary abnormalities have been detected in 26 (30%) of patients studied. GFR < 60 ml/min have been detected in 14 (17%) of patients studied. CRF stage II have been detected in 36 (42%) of patients studied. We detected recurrent varicose ulcer in 2 (2%) of patients studied. In two (2%) of patients during hospitalization we found a decrease in GFR by 15 and 12 ml/min, accompanied by an increase in serum creatinine from 0.7 mg % to 1 mg % in one patient and in another patient from 1.5 mg % to 2 mg %. Urinary abnormalities detected in patients with both acute and recurrent erysipelas warn about renal impairment and the need for monitoring of the renal patients with varicose ulcers.

Erysipelas is an infectious disease caused by group A beta hemolytical streptococci which may produce renal lesions, most frequently glomerular disease. Renal injury although known is less studied in practice. Rarely bioptical exams have been performed, thus the problem of the relationship erysipelas glomerular disease is practically not solved. The aim of this study was a cross-sectional analysis of renal involvement produced by erysipelas in two departments where patients with erysipelas are diagnosed and treated: Dermatology and Infectious Diseases. We investigated 166 patients (86M, 80F; mean age 61.66 +/- 18.42) with erysipelas hospitalized in the Departments of Dermatology (55 patients-33%) and Infectious Diseases (111 patients-66%) during 2005-2009. The diagnosis was established on clinical and biological data. In these patients clinical and biological exam has been performed. We assessed GFR and urinalysis (hematuria and proteinuria). The control group consisted of 110 apparently healthy persons. Of the 166 patients with erysipelas we found asymptomatic urinary abnormalities in 82 (47%), isolated proteinuria in 19 (11%) patients and proteinuria associated with hematuria in 21 (13%) patients, and isolated hematuria in 38 (23%) patients. We did not find patients with nephrotic or nephritic syndrome. In the control group we found asymptomatic urinary abnormalities in 25 (23%) of the patients. A statistically significant difference was between the two groups (p < 0.01). Asymptomatic urinary abnormalities have been more frequent in patients with erysipelas from the Infectious Diseases Department compared to those from the Dermatology Department. A statistically significant difference has been found (p < 0.03). In patients with recurrent erysipelas (43 patients-26%) we found asymptomatic urinary abnormalities in 26 (54%) of the patients compared to the presence of asymptomatic urinary abnormalities in patients with acute erysipelas in 56 out of 123 (46%). Mean GFR in patients with erysipelas was of 73.94 +/- 27.79 ml/min. It was lower in patients with recurrent erysipelas, 72.13 +/- 24.74 mL/min respectively. Association of proteinuria with hematuria was more frequent in patients with recurrent erysipelas. Patients with asymptomatic urinary abnormalities during the course of erysipelas need to be closely monitored during antibiotic treatment.