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Abstract Sepia melanin, a biopigment extracted from the ink sac of cuttlefish, is relevant to sustainable organic electronics. In this work, we flexographically print films from an ink of Sepia melanin including shellac as a bio-sourced binder on silver electrode-patterned paper. We examine the electrical response in high humidity and ambient conditions (here the electronic conductivity is as high as 10−4 S/cm). Additionally, we study the biodegradation of the printed films and their individual constituents based on their mineralization into CO2 under composting conditions. The printed films exhibit biodegradation levels of about 97 ± 25% in 85 d. We observe microorganism colonization on the printed film’s surface. The analysis of the microbial community on the compost reveals that bacterial species within the Acidimicrobiia class, specifically Actinomarinales order, are potentially responsible for the biodegradation of the printed film. Meanwhile, ecotoxicity tests conducted by germinating Lolium multiflorum and Tagetes erecta suggest that printed films have negligible phytotoxicity.

Chronic threatening limb ischemia of the inferior limbs (CLTI) is the final stage of peripheral arterial disease (PAD) and is one of the most feared atherosclerotic manifestations because if left untreated, in time, it can lead to amputation. Although there are currently numerous treatment techniques, both open and endovascular, it is a pathology that has no underlying treatment. Therefore, current studies are very much focused on new therapeutic possibilities that can be applied in the early stages of the atherosclerotic process. In numerous studies in the literature, miRNAs have been identified as important markers of atherosclerosis. The present study aims to identify the expression of three miRNAs—miR-199a, miR-20a, and miR-30c—in patients with chronic limb-threatening ischemia in the pre- and post-revascularization periods. The aim of the study is to identify whether these three markers play a role in critical ischemia and whether they have the potential for future use in new treatments of this pathology.

This research explores the historical emergence, expansion and evolution of entrepreneurial networks in Niigata Prefecture in Japan, indicating the existence of prominent “local milieu”, which led to the creation and activation of regional clusters and centers for industrial growth and collaboration. The emergence and expansion of such clusters was directly and indirectly impacted by the local geography, physical distance and “perceived distance”. This paper illustrates how “perceived distance” influenced the evolution of industrial clusters, as well as the roles played by key local influencers during this time of growth.

Background: Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI. Methods: A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched—Web of Science, Medline, and EMBASE—for the studies assessing CLTI and the biological markers related to it. Results: We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients. Conclusions: All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.

Abstract Four pinaceae pine resins analyzed in this study: black pine, shore pine, Baltic amber, and rosin demonstrate excellent dielectric properties, outstanding film forming, and ease of processability from ethyl alcohol solutions. Their trap‐free nature allows fabrication of virtually hysteresis‐free organic field effect transistors operating in a low voltage window with excellent stability under bias stress. Such green constituents represent an excellent choice of materials for applications targeting biocompatibility and biodegradability of electronics and sensors, within the overall effort of sustainable electronics development and environmental friendliness.

In an effort to transform business operations and to integrate the property into the Sheraton chain of the hotel after a recent acquisition of the Okinawa Sunmarina Resort, the Starwood group was exploring opportunities for revamping talent operations, organizational architecture and internal communications. Shifting from pure intuition and just “doing one’s best” to a data-driven business operation was one of the first initiatives the management implemented. Along with this, the Starwood Group introduced a series of new talent operations, geared at hiring and successfully on-boarding international talent needed to provide multilingual service to a rapidly diversifying clientele. These initiatives were complemented by a combination of carefully devised data utilization and cognitive architecture techniques, which were meant to induce awe and to create agile employee and customer engagement. The main purpose of this article is to analyze the effectiveness of the techniques utilized by the Starwood Group to revamp organizational architecture and to modernize communications and talent operations in order to illustrate the effectiveness of digitalization, built architecture and user engagement initiatives in creating modern organizations, integrated communications, and agile talent operations.

This paper illustrates how Toyota Motor Corporation (TMC), focuses on culture and talent engineering to nurture business sustainability, innovation and growth. The authors of this paper worked directly with TMC directors, business leaders, executives, organizational architects and talent operators to determine the main components and characteristics of their talent strategy. The authors have also explored how key elements of traditional Japanese business practices were considered when developing the corporate strategy.

The early 2000s brought over an intrinsic change in the way businesses operate. Many organizations experienced a fundamental transformation in the way people connect, work and co-create value for the business and the wider scope of stakeholders. This transformation was supported by the rapid development and implementation of collaborative technology, as well as by a major metamorphosis of working styles: remote work (tele-work), alternative employment, dual carriers (double employment) and many others. Corporate Japan has also experienced a major shift from the traditional physical office-based, life-time employment to a wide variety of working agreements and collaboration styles. This paper analyzes how digital technology has eased cross-divisional collaboration and value co-creation at NTT Communications, a subsidiary of Nippon Telegraph and Telephone (NTT) Corporation, the largest telecommunications company in Japan.

This research illustrates how a traditional Japanese company, Ina Food Industry, focuses on talent operations, engagement, their well being and social innovation. The authors worked with key executives and talent operators from Ina Food Industry to underpin the main characteristics of their talent operations strategy and to determine how the organization draws from its corporate philosophy and core elements of traditional Japanese culture to create sustainable user engagement and to develop a unique employee value proposition. JEL Classification: M10, L66

Following a recent acquisition and integration of Alico, one of the strongest non-Japanese insurers operating in the Japanese market, MetLife announced in 2014 that it would change its corporate name from MetLife Alico to MetLife Japan. The rebranding exercise would mean much more than a simple change of names – it led to infer an implicit change of culture, work style and user interactions. While this change did not seem to mean much to policy holders in Japan, whose premiums were well secured by legal bindings, it meant a lot to employees – especially ex-Alico employees, who were starting to feel somewhat left out by the rebranding initiative. This paper monitors the cultural transformation process which occurred at MetLife Japan between 2014 and 2015 and focuses on the internal communications process, in order to illustrate the various phases of change and the impact of corporate actions on employee engagement. Furthermore, the authors observed and monitored the various stages of the “MetLife Way” development in Japan and have collected insights on corporate transformation phenomena at the time of business rebranding. JEL Classification: M39; M14; O17.

We demonstrate in this work the practical use of uniform mixtures of a bioresin shellac and four natural clays, i.e. montmorillonite, sepiolite, halloysite and vermiculate as dielectrics in organic field effect transistors (OFETs). We present a thorough characterization of their processability and film forming characteristic, surface characterization, elaborate dielectric investigation and the fabrication of field effect transistors with two classic organic semiconductors, i.e. pentacene and fullerene C60. We show that low operating voltage of approximately 4 V is possible for all the OFETs using several combinations of clays and shellac. The capacitance measurements show an improvement of the dielectric constant of shellac by a factor of 2, to values in excess of 7 in the uniform mixtures of sepiolite and montmorillonite with this bioresin. [ABSTRACT FROM AUTHOR]

Central and Eastern European (CEE) countries have recently implemented reforms to health care provider payment systems, which include changing payment methods and related systems such as contracting, management information systems, and accountability mechanisms. This study examines factors influencing provider payment reforms implemented since 2010 in Bulgaria, Croatia, Czechia, Estonia, Latvia, Lithuania, Hungary, Poland, and Romania. A four-stage mixed methods approach was used: developing a theoretical framework and data collection form using existing literature, mapping payment reforms, consulting with national health policy experts, and conducting a comparative analysis. Qualitative analysis included inductive thematic analysis and deductive approaches based on an existing health policy model, distinguishing context, content, process, and actors. We analyzed 27 payment reforms that focus mainly on hospitals and primary health care. We identified 14 major factor themes influencing those reforms. These factors primarily related to the policy process (pilot study, coordination of implementation systems, availability of funds, IT systems, training for providers, reform management) and content (availability of performance indicators, use of clinical guidelines, favorability of the payment system for providers, tariff valuation). Two factors concerned the reform context (political willingness or support, regulatory framework, and bureaucracy) and two were in the actors’ dimension (engagement of stakeholders, capacity of stakeholders). This study highlights that the content and manner of implementation (process) of a reform are crucial. Stakeholder involvement and their capacities could influence every dimension of the reform cycle. The nine countries analyzed share similarities in barriers and facilitators, suggesting the potential for cross-country learning.

Abstract Background Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. Methods Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). Results Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. Conclusions Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.

In this paper we investigate nonlinear systems of second order ODEs describing the dynamics of two coupled nonlinear oscillators of a mechanical system. We obtain, under certain assumptions, some stability results for the null solution. Also, we show that in the presence of a time-dependent external force, every solution starting from sufficiently small initial data and its derivative are bounded or go to zero as the time tends to $+\infty$, provided that suitable conditions are satisfied. Our theoretical results are illustrated with numerical simulations.

Abstract Waning of the immune response upon vaccination in SARS-CoV-2 infection is an important subject of evaluation in this pandemic, mostly in healthcare workers (HCW) that are constantly in contact with infected samples and patients. Therefore, our study aimed to establish the specific humoral response of specific IgG and IgA antibodies upon vaccination, during the second year of pandemic and evaluating the booster shot with the same vaccine type. A group of 103 HCW with documented exposure to the virus were monitored for specific IgG and IgA levels prior to vaccination, after the first vaccination round, during the following 8 months and after the booster shot with the same vaccine type. After 8 months post-vaccination the humoral response in both IgG and IgA decreased, 2.4 times for IgG, and 2.7 times for IgA. Although the antibodies levels significantly decreased, no documented infection was registered in the group. After the booster shot, the entire group, displayed IgG increased levels, immediately after booster followed by the increase in specific IgA. IgG levels post-second round of vaccination are statistically higher compared to the first round, while IgA is restored at the same levels. Within the vaccination or booster routine for a multiple waves’ pandemic that is generating new virus variants, populational immunity remains an important issue for future implementation of prevention/control measures.

Starting with Artificial Intelligence (AI) and continuing with Machine Learning, Blockchain, IoT, Intelligent Learning Platforms, Quantum Computing, Deep Learning, Cognitive Solutions, Learning Management Systems (LMS), Intelligent Global Talent Databases, Prediction Machines and Robotic Process Automation (RPA), talent operators in the whole world are in search of implementing modern technology solutions for enhancing operational efficiency and for developing more engaged, collaborative and better connected organizations. Corporate Japan has seen an unprecedented need for revamping talent operations and organizational structures in order to incorporate modern technology and to enhance global competitiveness. Along with modern technology comes modern talent - a rapidly emerging generation of digitally native business practitioners who redefine the business landscape with their new skills, vision for the future of doing business, desires to connect and aspirations for growth. In an effort to determine how modern technological solutions have changed the dynamics of traditional Japanese organizations and reshaped the architecture of their business, this paper reveals some of the most popular technologies and talent operation practices embraced by Japanese organizations ready to compete on the global market, as illustrated in the case of NTT Communications. [ABSTRACT FROM AUTHOR]

Aim of the study The use of nitrous oxide/oxygen conscious sedation in American Society of Anesthesiologists (ASA) II dental patients has been regarded as controversial. The aim of this study was to investigate cardiovascular effects of nitrous oxide-oxygen mixture conscious sedation in ASA II patients undergoing tooth extraction. Material and methods The purpose of this study was to determine differences in heart rate (HR) and blood pressure (BP), comparing nitrous oxide/oxygen with no sedation in a sample of ASA II patients. Physiologic parameters measured were heart and respiratory rate, systolic and diastolic blood pressure and oxygen saturation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results Results did not indicated differences for any physiologic parameters, including heart rate and diastolic blood pressure. Significant differences across procedures were found for systolic blood pressure. Conclusions Although the effects of nitrous oxide/oxygen may not be statistically significant, generally it produces an attenuation in physiological responses as measured under the conditions of this study in ASA II patients.

Aim of the study Patients with comorbidities have often difficulties tolerating in-office dental treatment; therefore, they often require sedation to facilitate dental treatment. When deciding on dental treatment under sedation, the plan should be carefully determined because compared to general patients, ASA Class II patients are more likely to experience complications because of their underlying medical conditions and potential drug interactions. The purpose of this study was to evaluate the Ramsay Sedation Score on nitrous oxide-oxygen mixture conscious sedation in a sample of ASA II patient’s. Material and methods 114 ASA II patients scheduled for elective tooth extraction under local anesthesia were enrolled in this randomized controlled trial. The patients were divided into two groups: the Study group – patients that agreed to receive nitrous oxide/oxygen inhalation sedation (n = 54) and the Control group (n = 60) that included patients unwilling to be sedated. Ramsay sedation scale was used to assess adequacy of sedation. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results There was significant difference after surgery between patients exposed to nitrous oxide/oxygen inhalation sedation and the control group. Conclusions The results of this study show that nitrous oxide/oxygen sedation is a useful method for ASA Class II dental patients, who needs lower doses of sedative to obtain an adequate level of sedation.

Aim of the study Oral anticoagulants are effective therapies for reduction of stroke risk in patients with atrial fibrillation. However, blocking elements of the clotting cascade carries an inherent risk of bleeding. Also, anticoagulated patients sometimes require tooth extractions and other invasive procedures. The purpose of the present study was to compare the relationship between the risk factors and postoperative hemorrhage among dental patients with atrial fibrillation receiving acenocumarolum versus new oral anticoagulants users. Material and methods A sample of consecutive patients exposed to oral anticoagulants who required tooth extraction at our institution were retrospectively reviewed. Categorical data are summarized as percentages, and differences between groups were tested using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results The overall bleeding rate was higher in new anticoagulant users than in acenocumarolum users (26.72% vs 12%, p = 0.03) and similar (17.8% vs 14.1%, p = 0.129) between the two groups. There were no significant differences between atrial fibrillation patients and non-atrial fibrillation patients regarding bleeding rate. The highest rates were observed in patients with congestive cardiac failure exposed to new oral anticoagulants. Conclusions According to the results of our study, patients exposed to new oral anticoagulants had higher rates of overall bleeding events than chronic acenocumarolul users.

Aim of the study Oral anticoagulants have been used to prevent first or recurrent stroke, especially among patients with arterial fibrillation and y atherosclerotic disease. Despite the widespread use in dental patients, safety of anticoagulants are controversial. The uncertainty is due to the lack of definitive clinical data. In the present review, we have attempted to compare the relationship between the risk factors and postoperative hemorrhage after tooth extraction among patients with recent stroke receiving acenocumarolum versus new oral anticoagulants users. Material and methods This is a retrospective study of all patients exposed to oral anticoagulants who required tooth extraction treated in Clinic of Oral and Maxillofacial Surgery, Carol Davila University Bucharest – Hospital of Oral and Maxillofacial Surgery from 2019 to 2020. Clinical and operative records of all patients were retrieved and reviewed from the hospital’s medical records. All data were analyzed using Stata/IC 16 software (StataCorp). Ethical approval from the local institutional ethics comitee was obtained for this study. Results In our study, there were no significant differences between continuous oral anticoagulation use prescribd for antecedents of stroke and bleeding rate (32.14% vs. 20.92%, p > 0,05). Additionally, post-extraction bleeding was statistically significant associated with the type of anticoagulant used among concomitant diabetes patients. Conclusions In patients with prior cerebrovascular accident, concomitant use of new oral anticoagulants was associated with increased risk of postoperative bleeding. Concomitant diabetes contribute to the risk of bleeding.

The aim of this study is to evaluate the long-term changes of sinus lift material. Materials and methods: We included a total number of 35 patients (20 men and 15 women), between 32 and 80 years old, evaluated on a timeframe of up to 11.6 years. Diverse biomaterials were used (allograft, xenograft, alloplastic, combinations of them), with autologous bone in some cases. Results: The appearance of the top plane of the bone over time took a large dome shape (36% of cases), a linear shape (32% of cases), an irregular shape (23% of cases), or had micro domes above the implants (7%). No significant differences were found between the groups regarding age. The radiological density of the biomaterial tended to equalize that of the native bone. The final vertical dimensions seemed to be independent of the initial native bone height but seemed to be correlated with the amount of applied biomaterial. For the study group, the biomaterial contracted on average by 10% for the maximum height (H max) and 20% for the minimum height (H min), which can explain the tendency of the upper border of the biomaterial to curve. The annual H max contraction ranged from −0.09 to +0.18 with a mean value of 2.67% (SD = 0.04, CI: [0.011, 0.041]). The median value was 1.8%. The annual H min contraction ranged from −0.24 to +0.24, with a mean value of 4.33% (SD = 0.07, CI: [0.021, 0.065]). The median value was 3.59%. There were no statistically significant gender differences (Mann–Whitney U, p = 0.483, p = 0.642). The additional application of biomaterial together with the implants seemed to have a beneficial effect on the final vertical dimension of the bio-transformed material.

Dental extraction is followed by decreases in alveolar volume, vertically and horizontally. This retrospective study measured vertical alveolar resorption after insertion of immediate implants, using OPG, without CBCT or additional radiographs. Patients were randomly split in two groups A (57 implants) and B (47 implants). Measurements were made by two independent observers. The types of implants were: Exacta (Biaggini Medical Devices), Nova, Dentix Millenium and Surcam. The method was based on the size of the implant and another common element of the two radiographs. It used an optimal radiologic exposure. It can be generalized to other studies. Similar results measured in the two groups showed that alveolar remodeling does not depend on the type of the implant. Half of the alveoli did not have any resorption. Another quarter showed barely perceptible clinical resorption (1-2 mm). In the last quarter were registered all the notable resorptions that were associated with various factors (temporary mobile prosthesis, surgical flap, medication and some health problems, smoking, etc.) showing real situations, not ideal conditions. Maximum resorption was unique (7.63 mm).

The cost-effectiveness of Cerebrolysin as an add-on therapy for moderate–severe acute ischemic stroke is a topic that remains understudied. This study aims to address this gap by performing a comprehensive cost-utility analysis using both deterministic and probabilistic methods from a payer perspective and within the Romanian inpatient care setting. Quality-adjusted life years (QALYs) were calculated using partial individual patient data from the 2016 Cerebrolysin and Recovery After Stroke (CARS) trial, utilizing three different health state valuation models. Cost data was extracted from actual acute care costs reported by Romanian public hospitals for reimbursement purposes for patients included in the CARS study. Incremental cost-effectiveness ratios were calculated for each treatment arm for the duration of the clinical trial. Deterministic analysis based on sample mean values indicates Cerebrolysin would be cost-effective at a threshold between roughly 18.8 and 29.9 thousand EUR, depending on valuation techniques. Probabilistic sensitivity analysis results indicate an 80% chance probability of cost-effectiveness of Cerebrolysin as an add-on therapy for acute ischemic stroke, considering a willingness-to-pay threshold of 50,000 EUR in a 90-day timeframe after stroke. Further economic evaluations of Cerebrolysin are needed to strengthen these findings, covering a timeframe of at least 12 months after the acute incident, which would account for treatment effects spanning beyond the first 90 days after ischemic stroke. These should be conducted to determine its cost-effectiveness under various care settings and patient pathways. Most importantly, modelling techniques are needed to answer important questions such as the estimates of population gain in QALYs after acute administration of Cerebrolysin and the potential offsetting of direct medical costs as a result of administering the intervention.

Background and Objectives: Groin hernia repair surgery (GHRS) is among the most common elective interventions. The aim of this three-year nationwide study on GHRS is to provide a thorough analysis of the impact that the COVID-19 pandemic had on the Romanian Health System in regard to elective procedures. Materials and Methods: 46,795 groin hernia cases obtained between 2019 and 2021 from the DRG database using ICD-10 diagnostic codes. The data were collected from all 261 GHRS performing hospitals nationwide, including 227 public hospitals (PbH) and 34 private hospitals (PvH). The 42 variables taken into account were processed using Microsoft Excel 2021, applying Chi square, F-Test Two-Sample for variances, and Two Sample t-Test. The significance threshold considered was p < 0.001. Results: Of the grand total of cases, 96.2% were inguinal hernias, 86.8% were performed on men, 15.2% were laparoscopic procedures, and 6.88% were in PvH. Overall, due to the pandemic, the total number of GHRS decreased with 44.45% in 2020 and with 29.72% in 2021 compared to pre-pandemic year 2019. April 2020 shows the steepest decrease in GHRS (91 procedures nationwide). In the private sector, there was an opposite trend with increases in the number of cases by 12.21% and a 70.22% in both pandemic years. The mean admission period (MAP) for all procedures was 5.5 days. There was a significant difference between PbH and PvH (5.75 vs. 2.8 days, p < 0.0001). During the pandemic, the MAP in PbH decreased (6.02 in 2019, 5.82 in 2020 and 5.3 in 2021), remaining stable for PvH (2.9 days in 2019, 2.85 days in 2020 and 2.74 days in 2021). Conclusions: The COVID-19 pandemic significantly reduced the overall number of GHRS performed in Romania in 2020 and 2021, compared to 2019. However, the private sector thrived with an actual increase in the number of cases. There was a significant lower MAP in the PvH compared to PbH throughout the three-year period.

Aim of the study Glycemic control is vital in the care of diabetes mellitus and is significantly associated with the incidence of clinical complications. This study was conducted to evaluate the glycemic response to local anesthesia with various local anesthetics in patients undergoing tooth extractions. Material and methods A total of 60 patients with diabetes mellitus undergoing tooth extractions were included in this prospective, randomized clinical study. First 30 patients were given 4% articaine HCl with 1:200,000 epinephrine and other 30 patients were given 3% mepivacaine HCl, to carry out tooth extractions. Blood glucose estimations were done at definite intervals (before and after the administration of local anesthetic). Results There were no statistically significant differences in the parameters evaluated in this study. Both groups demonstrated a decrease in blood glucose levels over time. Conclusions According to the results of our study, plexal anesthesia with articaine 4% with epinephrine 1:200,000 was comparably as safe as local anesthetic with standard concentrations of plain 3% mepivacaine in diabetes melitus patients.

Aim of the study The aim of this study is to compare glycemic variability of 2% plain lidocaine to 4% articaine with epinephrine 1:200,000 during tooth extraction. Material and methods This prospective study was carried out in 60 diabetes melitus patients who presented at the Clinic of Oral and Maxillofacial Surgery, Carol Davila University, OMFS Hospital, Bucharest, from 2019 to 2020 for tooth extraction. Patients were randomly allocated to two groups (30 patients in each group) according to the type of anaesthetic solution employed. Group 1 had tooth extraction done under 4% articaine with 1:200,000 epinephrine while group 2 had tooth extraction done under plain 2% lidocaine. One tooth was extracted from each patient. Blood glucose level was recorded before surgery, after local anaesthetic injection and one hour after the administration of anesthetic agent. Results There was no statistically significant difference between the glycemic response in the two groups after administration of regional block anaesthesia. However the highest alteration in parameters was observed one hour after procedure in the two groups. Conclusions The glycemic changes induced by injecting 4% articaine with epinephrine in patients with controlled diabetes melitus during tooth extraction is within normal range and is not different from that induced by plain 2% lidocaine. The general preference given to local anesthetics without vasoconstrictor in diabetics is not supported by the present study

The epidemiology of neglected tropical diseases (NTD) is persistently underprioritized, despite NTD being widespread among the poorest populations and in the least developed countries on earth. This situation necessitates thorough and efficient public health intervention. Romania is at the brink of becoming a developed country. However, this South-Eastern European country appears to be a region that is susceptible to an underestimated burden of parasitic diseases despite recent public health reforms. Moreover, there is an evident lack of new epidemiologic data on NTD after Romania’s accession to the European Union (EU) in 2007. Using the national ICD-10 dataset for hospitalized patients in Romania, we generated time series datasets for 2008–2018. The objective was to gain deep understanding of the epidemiological distribution of three selected and highly endemic parasitic diseases, namely, ascariasis, enterobiasis and cystic echinococcosis (CE), during this period and forecast their courses for the ensuing two years. Through descriptive and inferential analysis, we observed a decline in case numbers for all three NTD. Several distributional particularities at regional level emerged. Furthermore, we performed predictions using a novel automated time series (AutoTS) machine learning tool and could interestingly show a stable course for these parasitic NTD. Such predictions can help public health officials and medical organizations to implement targeted disease prevention and control. To our knowledge, this is the first study involving a retrospective analysis of ascariasis, enterobiasis and CE on a nationwide scale in Romania. It is also the first to use AutoTS technology for parasitic NTD. Author summary Eastern and South-Eastern Europe is known to be severely affected by parasitic neglected tropical diseases (NTD) due to its tumultuous historical events of the past decades and to its uncontrolled socio-economic fluctuations. Romania is an example of such a South-Eastern European country that was known to have a high parasitic NTD burden after the fall of Communism in 1989 but has since made significant developmental improvements. However, there is scarce data regarding the incidences of parasitic NTD in Romania after its accession to the European Union in 2007. By using the ICD-10 dataset of Romania over the period 2008–2018, we performed a retrospective epidemiologic analysis of three of its most relevant parasitic diseases, ascariasis, enterobiasis and cystic echinococcosis (CE) and confirmed a downward trend strongly correlating with the country’s decreasing poverty rate. By employing a novel technology called automated time series machine learning we predicted the progress of these diseases for the ensuing two years of 2019 and 2020. Forecasted rates were observed to be constant. Such machine learning tools can help public health officials in adapting and improving targeted measures to combat parasitic NTD.

The mental health of the elderly is a matter of increased concern in the context of an aging population since currently only a small fraction of this population is receiving adequate care. The provision of treatment in primary care by the General Practitioners (GPs) has been proposed for over a decade as a potential solution, as services offered by GPs are more accessible, less susceptible to stigma, and have a more comprehensive view of the other health care problems that the elderly might suffer from. In this study, we explored the perception of Romanian GPs regarding their practice and roles in caring for the mental health of the elderly as well as the willingness to increase their future involvement in the management of dementia and other mental health problems. Data was collected via an online questionnaire structured on four dimensions: (1) GPs' sociodemographic profile and practice characteristics, (2) GPs assessment of the services available for elderly with mental health problems, (3) GPs current involvement in mental health care for different categories of problems, and (4) factors that might influence the future involvement of GPs in providing care for elderly with mental health problems. The survey was sent via the member mailing lists of the National Society for Family Medicine. Results show that GPs are currently limited by prescribing possibilities, available resources and knowledge in the area, but they are willing to expand their role in the areas of early recognition and prevention of mental health problems as well as providing disease management and collaborative care. An improved communication with mental health care professionals, a better access to resources and having more financial incentives are the three most important categories for GPs to increase their involvement. In conclusion, increasing the access to personal and professional resources and setting up functional communication channels with specialized mental health care could motivate GPs to provide timely mental health support to elderly patients.

Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.

Background and Objectives: The aim of this study was to evaluate and compare the effects of two different anti-inflammatory drugs (ketoprofen and prednisone) combined with an antibiotic (amoxicillin + clavulanic acid) and periodontal surgery on dental and periodontal parameters in patients with severe chronic periodontitis. In addition, salivary stress expressed by cortisol levels was assessed. Materials and Methods: An interventional study was performed on 22 periodontal subjects and 19 clinical healthy controls. The patients were divided in four groups, depending on treatment planning, as follows: eight patients received prednisone and antibiotherapy, associated with surgical periodontal therapy; seven patients received ketoprofen and antibiotherapy, associated with surgical periodontal therapy (group II); seven patients received only prednisone. Periodontal healthy patients underwent routine scaling and polishing. Bleeding on probing (BOP), dental mobility and salivary cortisol (ng/mL) were assessed before and after treatment. The means and standard deviations for the salivary cortisol levels (SCLs), dental and periodontal parameters were calculated for all groups using each patient as a unit of analysis. Results: Data analyses showed that the two different anti-inflammatory drugs associated with or without surgical therapy were efficient on inflammation periodontal parameters (BOP, dental mobility). Prednisone treatment alone was associated with a significant decrease of SCLs between pretreatment and post-treatment. Conclusions: In the present study, the effects of either of the anti-inflammatory drugs on inflammation evolution and salivary stress were comparable in patients undergoing antibiotherapy and surgical periodontal therapy.

Introduction. The clinical use of bioactive materials for bone augmentation has remained a challenge because of predictability and effectiveness concerns, as well as increased costs. The purpose of this study was to analyse the ability to integrate bone substitutes by evaluating the immunohistochemical expression of the platelet endothelial cell adhesion molecules, vascular endothelial growth factor, collagen IV, laminin, and osteonectin, in the vicinity of bone grafts, enabling tissue revascularization and appearance of bone lamellae. There is a lack of in vivo studies of inflammatory-driven angiogenesis in bone engineering using various grafts. Methods. The study was performed in animal experimental model on the standardized monocortical defects in the tibia of 20 New Zealand rabbits. The defects were augmented with three types of bone substituents. The used bone substituents were beta-tricalcium phosphate, bovine hydroxyapatite, and bioactive glasses. After a period of 6 months, bone fragments were harvested for histopathologic examination. Endothelial cell analysis was done by analysing vascularization with PECAM/CD31 and VEGF and fibrosis with collagen IV, laminin, and osteonectin stains. Statistical analysis was realized by descriptive analysis which was completed with the kurtosis and skewness as well as the Kruskal-Wallis and Mann-Whitney statistical tests. Results. The discoveries show that the amount of bone that is formed around beta-tricalcium phosphate and bovine hydroxyapatite is clearly superior to the bioactive glasses. Both the lumen diameter and the number of vessels were slightly increased in favor of beta-tricalcium phosphate. Conclusion. We can conclude that bone substitutes as bovine bone and beta-tricalcium phosphate have significant increased angiogenesis (and subsequent improved osteogenesis) compared to the bioactive glass. In our study, significant angiogenesis is linked with a greater tissue formation, indicating that in bone engineering with the allografts we used, inflammation has more benefic effects, the catabolic action being exceeded by the tissue formation.

Wound healing is a complex biologic process evolving in three phases: inflammation, proliferation, and tissue remodeling controlled by numerous growth factors and cytokines. Oral mucosa wounds heal with significantly less important scars with less numerous macrophages and mast cells and more numerous myofibroblasts than cutaneous counterparts. We analyzed 32 cutaneous and 32 oral mucosa scars for TGFbeta1, TGFbeta2, TGFbeta3, TNFalpha, PDGF BB and FGF1 expression in mesenchymal cells, endothelial cells, macrophages, and multinucleated giant cells. We identified differences in the expression of profibrotic and antifibrotic factors in oral mucosa and skin scars; TGFbeta2 was positive in cutaneous multinucleated giant cells, TNFalpha was positive in cutaneous macrophages, and both were negative in oral mucosa while TGFbeta3 was positive in oral macrophages and mostly negative in cutaneous ones. PDGF BB and FGF1 were positive in oral endothelial cells and oral macrophages and negative in macrophages with opposite positivity pattern in cutaneous scars. Based on these findings, macrophage seems to be the key player in modulating pro- and antifibrotic processes in wound regeneration.

In the present Note an existence result of asymptotically stable solutions for the integral equation $$x\left( t\right) =q\left( t\right) +\int_{0}^{t}K\left( t,s,x\left( s\right) \right) ds +\int_{0}^{\infty }G\left( t,s,x\left( s\right) \right) ds$$ is presented.

This paper shows the existence of asymptotically stable solutions to an integral equation. This is done by using a fixed point theorem, and without requiring that the solutions be bounded.

Let $X$ be an arbitrary (real or complex) Banach space, endowed with the norm $\left| \cdot \right| .$ Consider the space of the continuous functions $C\left( \left[ 0,T\right] ,X\right) $ $\left( T>0\right) $, endowed with the usual topology, and let $M$ be a closed subset of it. One proves that each operator $A:M\rightarrow M$ fulfilling for all $x,y\in M$ and for all $t\in \left[ 0,T\right] $ the condition \begin{eqnarray*} \left| \left( Ax\right) \left( t\right) -\left( Ay\right) \left( t\right) \right| &\leq &\beta \left| x\left( \nu \left( t\right) \right) -y\left( \nu \left( t\right) \right) \right| + \\ &&+\frac{k}{t^{\alpha }}\int_{0}^{t}\left| x\left( \sigma \left( s\right) \right) -y\left( \sigma \left( s\right) \right) \right| ds, \end{eqnarray*} (where $\alpha ,$ $\beta \in \lbrack 0,1)$, $k\geq 0$, and $\nu ,$ $\sigma :\left[ 0,T\right] \rightarrow \left[ 0,T\right] $ are continuous functions such that $\nu \left( t\right) \leq t,$ $\sigma \left( t\right)\leq t,$ $\forall t\in \left[ 0,T\right] $) has exactly one fixed point in $M $. Then the result is extended in $C\left( \mathbb{R}_{+},X\right) ,$ where $\mathbb{R}_{+}:=[0,\infty ).$

In this article, we study the boundary-value problem $$ ddot{x}=f(t,x,dot{x}), quad x(-infty )=x(+infty), quad dot{x}(-infty) = dot{x}(+infty ),. $$ Under adequate hypotheses and using the Bohnenblust-Karlin fixed point theorem for multivalued mappings, we establish the existence of solutions.

We discuss various properties of the nonlinear A-proper operators as well as a generalized Leray-Schauder principle. Also, a method of approximating arbitrary continuous operators by A-proper mappings is described. We construct, via appropriate Browder-Petryshyn approximation schemes, approximative solutions for linear evolution equations in Banach spaces.

Using interesting techniques, an existence result for the problem $\ddot{x}+2f\left( t\right) \dot{x}+x+g\left( t,x\right) =0,$ $\lim\limits_{t\rightarrow +\infty }x\left( t\right) =\lim\limits_{t\rightarrow +\infty }\dot{x}\left( t\right) =0,$ is given in [2]. This note treates the same problem via Schauder-Tychonoff and Banach theorems.