Search

We report the case of a 77-year-old patient admitted for worsening dyspnea, palpitations and dizziness. The electrocardiogram (ECG) showed atrial fibrillation (AF) and left bundle branch block (LBBB). Clinical examination showed hypoxemia (SaO2 87% room air), jugular venous distension, pitting edema, arrhythmic heart sounds, a splitting of the second heart sound and systolic murmur (III–IV/VI) in the tricuspid area. Transthoracic echocardiography (TTE) showed right heart dilation, moderate tricuspid regurgitation, biventricular hypertrophy, and a dilated coronary sinus (CS). Agitated saline injection in the left basilar vein raised a suspicion of persistent left superior vena cava (PLSVC) to coronary sinus fistula. Transesophgaeal ecocardiography (TOE) showed a superior sinus venosus defect, with bidirectional shunt, and persistence of LSVC. CT angiography confirmed and detalied the malformation features. A low suspicion for congenital defects in older adults presents a significant diagnostic challenge. Multimodality cardiac imaging is critical in determining the etiology of right heart dilation, and knowledge of the anatomy and physiology of various shunt lesions is essential for clinicians.

Parkinson's disease (PD) is the second most common neurodegenerative disorder among the elderly, the diagnostic and prognostic of which is based mostly on clinical signs. LevoDopa replacement is the gold standard therapy for PD, as it ameliorates the motor symptoms. However, it does not affect the progression of the disease and its long‐term use triggers severe complications. There are no bona fide biomarkers for monitoring the patients’ response to LevoDopa and predicting the efficacy of levodopa treatment. Here, we have combined qPCR microRNA array screening with analysis of validated miRs in naïve versus Levodopa‐treated PD patients. We have identified plasma miR‐19b as a possible biomarker for LevoDopa therapy and validated this result in human differentiated dopaminergic neurons exposed to LevoDopa. In silico analysis suggests that the LevoDopa‐induced miR‐19b regulates ubiquitin‐mediated proteolysis.

The aim of this paper is to explore the relationship between intelligence and economic and financial crimes. For this purpose, we use a cross-sectional sample of 182 countries for the time span of 2012–2017. Our research provides empirical evidence on the existence of a significant impact of intelligence upon economic and financial crimes. When we analyze the entire sample, we find that intelligent people are more prone to comply with the law and thus increase the efficiency of implementing government policies to reduce economic and financial crimes. However, when we conduct our analysis among the two subgroups of high- and low-income countries, different results are obtained. For high-income countries, we obtain evidence of a positive coefficient for the impact of intelligence on economic and financial crimes, meaning that increased intellectual capacities of people from these countries, including high professional knowledge and skills, are used to break the traditional technology in order to get illegal benefits. Our results conducted for the low-income countries' subsample do not support intelligence as being a determining factor for economic and financial crimes; in these countries, other determinants are more important for engaging in such activities. Our study may have important implications for the policymakers who must acknowledge that various policies in the field of economic and financial crimes need to be differentially adopted depending on the level of development of each country, which offers different ways of involvement in such crimes, related to the level of people's intelligence.

Valentin Petre Matei,1 Alexandra Ioana Mihăilescu,1,2 Iuliana Raluca Gheorghe,3 Ruxandra Grigoraş,4 Andrei Crasan,5 Alina Roșca,1,6 Ovidiu Popa-Velea2 1Clinical Hospital of Psychiatry “Alexandru Obregia”, Bucharest, Romania; 2Department of Medical Psychology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 3Department of Marketing and Medical Technology, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania; 4Voila Psychiatric Hospital, Câmpina, Romania; 5The City Hospital of Curtea De Argeş, Curtea De Argeș, Romania; 6Department of Psychiatry, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, RomaniaCorrespondence: Iuliana Raluca Gheorghe Email raluca.gheorghe@umfcd.roPurpose: This study examined the validity of subjective clinical prognosis (SCP), a commonly used clinical tool, in first episode psychosis patients included in the European First Episode Schizophrenia Trial (EUFEST) study.Patients and Methods: The study comprised 455 patients from the EUFEST trial (mean age 25.92, SD=5.45; 188 (41.31%) women, 267 (58.69%) men). SCP was classified into three mutually exclusive groups: “good prognosis” (GP) (n=265), “average prognosis” (AP) (n=131), and “poor prognosis” (PP) (n=59). The validity of the SCP was assessed by investigating the differences between the SCP groups and completer or responder status of the patients, during 1 year of the trial.Results: The proportion of completers was significantly higher in the GP group (64.4%) compared to the AP group (25.6%) (OR=1.62, 95% CI=1.062– 2.476, p< 0.031) and the PP group (10%) (OR=2.17, 95% CI=1.226– 3.853, p< 0.009) throughout the whole duration of the trial. In what concerns responsiveness, a significantly higher number of responders were registered in the GP group compared to the AP and the PP groups in the first three months of treatment, but this outcome did not persist afterwards.Conclusion: In terms of its predictive value at first episode schizophrenic patients, SCP seems to be reliable for treatment completion, but has a limited utility in what concerns responsiveness to treatment. This finding suggests the necessity of creating a prediction model potentially including, besides SCP, other measurement-based variables.Keywords: anti-psychotics, first episode psychosis, prognosis, schizophrenia

Our article presents some of the challenges of the surgical treatment of T4 (>15 cm) retroperitoneal liposarcomas (up to 65∕56∕30 cm, 25.5 kg) series of cases treated by the Department of Surgical Oncology, Prof. Dr. Ion Chiricuţa Oncology Institute, Cluj-Napoca (IOCN), Romania, with illustrations, insisting on important blood vessels and nerves dissection and preservation and discussions of strategies with references to important articles from the last 10 years specialty literature. Challenges do not come only from intraoperative difficulties but also from establishing the right attitude from the extent of resection and oncological safety point of view, the role of the pathologist being very important because histological subtype and completeness of the resections are the most important prognostic factors for such tumors. Despite all today available aids in decision making, like nomograms or high-resolution imagery, sometimes this decision is to be taken intraoperative based on surgeon's expertise and skills. That is why is strongly advised that such cases to be treated in high-volume specialized tertiary centers of surgical oncology.

An observational study on 22 patients presenting with acute limb ischemia and SARS-CoV-2 infection, and without any other embolic risk factors, was performed. All patients were classified according to Rutherford classification for acute limb ischemia. The primary goal of this study was to assess the risk of amputation in these patients after revascularization procedures. The secondary goal was to find the correlation between acute limb ischemia (ALI) severity, patient comorbidities, risk of death, and the association of SARS-CoV-2 infection. The patients were treated by open surgery (18 patients—81.81%) or by the means of endovascular techniques (four patients—18.18%). The amputation-free survival rate was 81.81% in hospital and 86.36% at 1-month follow-up. In this study, the presence of SARS-CoV-2 infection did not influence the amputation-free survival rate: it was only the risk factor for the arterial thrombosis and the trigger for the acute ischemic event. The application of the standard treatment—open surgery or endovascular revascularization—in patients with acute limb ischemia and SARS-CoV-2 infection represents the key to success for lower limb salvage.

Objective: Ureteral metastasis of prostate cancer is a very rare pathology, that can be confused with an upper urinary tract urothelial carcinoma, with great implications in the surgical management and therapy of the disease. Case: A 56-years old male patient admitted to the emergency room with 2 weeks history of left flank pain without low urinary tract symptoms or hematuria. PSA level was 43,4 ng/ml. The patient underwent prostate needle biopsy and ureteral biopsy using flexible ureteroscopy, after the Lich-Gregoire ureterovesical reimplantation. In this case, renal colic as the first symptom of a ureteral metastasis secondary to prostate cancer is extremely rare which diagnosed in the patient. Conclusion: Neoureterocystostomy is a safe and effective treatment for ureteral obstruction due to prostate cancer metastasis, with low morbidity and significant benefits in terms of quality of life for patients with life expectancy more than 10 years.

Poor oral hygiene, in terms of gingival bleeding and increasing accumulation of plaque and calculus with increasing age, have been reported among school-aged children, in both developed- and developing countries, causing unsatisfactory oral health among children. The aim of this study was to determine oral hygiene status by calculating Oral Hygiene Index -Simplified (OHI-S), using disclosing agents, and to examine whether socio-economic and behavioral correlates of oral hygiene status, in school children from rural areas, N-W Romania. For the highlighting of the bacterial plaque were used two tone dental plaque disclosing agent, which contains Erythrosine and Brilliant Blue FCF. The OHI-S index is divided according to its values in several categories as follows: very good hygiene = OHI-S Index between 0 and 1; good hygiene = OHI-S Index between 1.1 and 2; unsatisfactory hygiene = OHI-S Index between 2.1 and 3; poor hygiene = Index OHI-S between 3.1 and 6. The average value of the OHI-S index in children in rural areas of N-W Romania was 1.78, a higher value than most of the values identified in the bibliographical references. Using disclosing agents may improve oral health status in schoolchildren, by increasing the awareness of their personal oral hygiene condition.

The aim of this paper consists in providing a general overview of the notion of intellectual capital as a key to maximizing the corporate performance. Following the researches carried out, we present the delimitations of the intellectual capital in relation with human capital, relational capital and structural capital. In terms of its measurement, we focus on a question which could be a solid base for the next studies: “Can intellectual capital be evaluated?” In this regard, a number of methods (direct and methods based on assets returns), generic model and individual company models were presented, concluding in this way with a hierarchy in terms of utility and their importance.

Primary hyperparathyroidism (PHPT), an endocrine condition caused by a parathyroid adenoma (PTA) in 80-85% of the cases, has shifted in the modern era to a mildly symptomatic phenotype due to the prompt recognition of hypercalcemia and to a minimally invasive surgical approach which has a curative potential. Clinical complications of PHTH are either related to high calcium or parathyroid hormone [also parathormone (PTH)] or both, while the originating tumor typically is small, without local mass effects. A distinct entity is represented by giant PTA (GPTA) which is considered at a weight of more than 3 (3.5) grams. The present article is a review of the literature involving practical points of non-syndromic PHPT-related GPTA. Most authors agree that pre-operatory calcium and PTH are higher in GPTA vs. non-GPTA. However, the clinical presentation of PHPT may be less severe, probably due to local mass effects that bring the patient to an early medical evaluation. Age distribution, sex ratio, rate of successful pre-operatory location do not differ from non-giant PTA. Hypovitaminosis D is more frequent in PTA of higher dimensions. Post-operative hypocalcemia, but not recurrent/persistent PHPT, is expected, even hungry bone disease. A higher rate of atypia is described although the tumor is mostly benign. Unusual presentations such as cystic transformation, initial diagnosis during pregnancy or auto-infarction have been reported. The ectopic localization of PTA presented in almost 15% of all cases may also be found in GPTA. What are the exact cutoffs for defining GPTA is still an open issue.

This study aimed to investigate the relationship between somatic symptom disorder (SSD) and sleep disorders, following three research questions: (1) How are these disorders correlated? (2) What are the comorbidities reported in these patients? and (3) What are the most effective pharmacological and non-pharmacological treatments for both conditions? PubMed, Scopus, OVID, Medline, and ProQuest databases were searched for relevant articles published between 1957–2020. Search terms included “somatic symptoms disorder”, “sleep disorders”, “insomnia”, “somatoform”, “somatization”, “therapeutic”, “psychotherapy”, and alternative, formerly used terms for SSD. Forty papers were finally included in the study. Prevalence of insomnia in SSD patients ranged between 20.4–48%, with this being strongly correlated to somatic symptoms and psychosocial disability. The most relevant comorbidities were generalized anxiety disorder, depression, fatigue, negative mood, substance use, orthorexia, alexithymia, anorexia, weight loss, poor eating habits, and acute stress disorder. Patients receiving antidepressant therapy reported significant improvements in insomnia and somatic symptoms. In terms of non-pharmacological interventions, cognitive-behavioral therapy (CBT) showed improvements in sleep outcomes, while the Specialized Treatment for Severe Bodily Distress Syndromes (STreSS) may represent an additional promising option. Future research could include other medical and psychosocial variables to complete the picture of the relationship between sleep disorders and somatic symptoms.

Incomplete right bundle branch block (IRBBB), an entity undefined by a general consensus, can express a large pallet of both benign and pathological patterns. IRBBB is a common electrocardiogram (ECG) finding at all ages, more frequent in men and athletes. Usually, IRBBB does not need further evaluation; however, if abnormalities are found on the clinical exam, heart disease should be excluded. The RSR’ pattern and a QRS width below 100 ms define the crista supraventricularis (CSV) pattern. CSV is a right ventricular crest, one of the last structures to be depolarized by the Purkinje network. CSV pattern might result from posterior apex deviation, subpulmonic area delay, or late CSV activation. IRBBB can appear because of higher placement of electrodes V1 and V2 and pectus excavatum, in which P wave is negative, or in athletes, considered a benign pattern unless family history, symptoms, or left ventricular hypertrophy. It is necessary to differentiate IRBBB from pathological patterns such as type-2 Brugada ECG pattern, right ventricular enlargement, arrhythmogenic right ventricular cardiomyopathy, ventricular preexcitation—Wolf-Parkinson-White syndrome, and hyperkalemia. Examiners should be particularly alert to the splitting of the second heart sound because RBBB is a common finding in ostium secundum atrial septal defect. Therefore, clinicians need to be familiar with this ECG finding, which is not always a benign condition.

The aim of this paper is to present the analysis of the international reinsurance market. After we have made a literature review, we highlighted a brief history of it and then a brief analysis of the main actors operating in the international reinsurance market. Following this analysis, a top of reinsurance companies was made, then a classification and also the current challenges faced by the global reinsurance market, the Covid-19 crisis, were presented. We have studied the impact of the coronavirus pandemic on the companies mentioned before as being part of the top ranking. The results of the study showed that the crisis had a major impact, destabilizing the reinsurance market. Keywords: reinsurance, international market, pandemic

Despite the extensive recent development of different techniques for endoscopic evaluation for both diagnostic and therapeutic reasons, the small bowel remains quite difficult to visualize. Capsule endoscopy and device assisted enteroscopy are presently considered the best diagnostic tools for examination of small bowel disorders, assessing diverse pathologies such as obscure gastrointestinal bleeding, iron deficiency anemia, Crohn disease, small bowel tumors and polyposis syndromes. Like any other imagistic method, it has specific indications, and contraindications, and possibly it is more important to consider limitations. In order to obtain a better result, it is necessary to respect the procedural quality indicators. Among them the use of prokinetics - diverse pharmacological substances increasing the success rate of capsule endoscopy have raised debates. Capsule endoscopy small bowel evaluation is a reliable, non-invasive and safe with many advantages and minimum risks, with a proper selection of patients, and can be used as first line investigation.

The ability to understand and model proteins’ dynamics is of great relevance in biology and medicine. A good comprehension of the way the proteins change their structure is important as these transitions give the function of the protein within the organism. In this paper we are introducing an unsupervised learning based approach using variational autoencoders, for uncovering protein motions and conformational transitions. The main goal of the research is to offer an interpretable method for proteins’ trajectories visualisation by learning a low dimensional space that accurately represents the input data, as empirically confirmed through the performed experiments. An additional aim is to comparatively evaluate the impact of two protein representations on the learning process.

This paper aims to explore the entrepreneurship perception among diverse populations in Romania typically seen as vulnerable. It also aims to provide support regarding how the concept might be useful in considering and designing alternative policy interventions. The vulnerable population groups studied in the paper differ by age (seniors), gender (females), income (low income population) and residence (rural community). The paper attempts to answer three research questions: (1) how attitudes towards entrepreneurship differ among vulnerable population groups; (2) how intention of starting a business varies among studied population; and (3) what is the likelihood and desirability of studied population to consider entrepreneurship as a career choice. The data analysed in the paper are extracted from the Amway Global Entrepreneurship Report (AGER) developed for Romania, for the period 2014-2016. Analysis is conducted by taken into consideration the following dimensions of the “entrepreneurship perception”: attitude towards entrepreneurship, intention of starting a business, entrepreneurship as a career choice, and likelihood of self-employment. The paper aims to contribute to advancing research on the less addressed and less understood entrepreneurship perception among vulnerable populations. In the paper we make recommendations for governmental institutions that are meant to contribute to designing policy interventions that will nurture entrepreneurship spirit in Romania.

Stress investigation especially in young healthy adults is a main mental health issue due to its individual and social consequences on long term. In order to characterize physiological, pathological and biochemical mechanisms of stress response, several biomarkers were proposed. Among these, the evaluation of the salivary biomarkers represents a fast and simple procedure, both in healthy subjects and patients. Saliva contains a wide range of parameters reflecting physiologic endocrine and immune responses, such as biologically active form of certain hormones (e.g. cortisol), growth factors, immune molecules. The present article is focused on cortisol evaluation as possible biomarker of stress and its analyze in the context of literature data.

Diabetic retinopathy is a well-known complication of diabetes, a major cause of vision loss worldwide. Purpose. The present study investigates the correlation between hypertension and evolution of diabetic retinopathy in patients with type II diabetes. Materials and methods. We conducted a prospective study between June and December 2016, on 24 patients hospitalized in Ophthalmology Clinic, Emergency University Hospital Bucharest, with AO: diabetic retinopathy and arterial hypertension under medical treatment. Patients were evaluated at baseline, 2 months, 4 months and 6 months through comprehensive eye examination and measuring the value of blood pressure (BP). Comparative data were analyzed in patients with compensated hypertension (BP = 150 mmHg). Results. Of the 24 patients, 15 had values offset BP (group A) and 9 associated hypertension subcompensated (group B). In group A proportion of patients (at baseline) with diabetic retinopathy absent or nonproliferative was higher than patients in group B (47% vs. 22%, p = 0.052995019518117). Patients in group B had a higher tendency to record an evolution of diabetic retinopathy (in group B, 55.55% of patients had a progression, and in group A, only 26.66%). Conclusions. Incomplete therapeutic control of hypertension may affect the retinal microvasculature impacting the progression of diabetic retinopathy. Maintaining a strict control of systolic BP of permanent value bellow 140 mmHg should be part of the patient management guide of the diabetic patient in order to prevent ophthalmic complications with major risk of vision loss.

While technology and business patterns are evolving at a very high pace, new markets are developing, and so are consumer preferences and expectations. Over the past 30 years, entertainment industries have become sectors with immense profits and sustainable growth, the children segment being the greatest contender. However, the multitude of options in terms of attractions to choose from is not always accompanied by strict knowledge of operational standards, thus creating an increase in the risk of injury that children are subjected to during their play-time. Despite the fact that most playground equipment’s are not properly certified or do not comply with the specific provisions, most cases remain inconclusive, due to lack of evidence arising from a knowledge gap that the authorities must cover. In case of playground accidents, the investigators need to be well aware and up to date with the regulations, not only to determine who to hold accountable, but also to be able to take the necessary control measures in order to reduce children play-related injuries.

Managing natural or human-made crisis events involves making decisions based on information gathered directly by first responders in the field using information and communication technologies (ICT), in combination with remote sensing (satellite, Earth Observation - EO) technologies delivering images and sensor data. For efficient crisis and disaster management, this information needs to be timely available and as accurate as possible, meaning that the available technologies need to be intelligently selected and combined to meet such requirements. In this short paper, we present such an approach in which semi-automatized analytics using combination of very high-resolution EO imagery and crowdsourcing technologies is demonstrated to improve and optimize the efficiency of crisis management before, during and after disaster events.

This review discusses the current research data on using microRNAs as biomarkers for the diagnostics and screening of Parkinson’s Disease (PD). We provide a comprehensive, critical analysis of the overwhelmingly diverse data on circulant microRNAs associated with PD. We also highlight the possible underlying molecular pathogenesis-related circulant microRNAs in the context of the natural history of PD.

Proteins are essential molecules, that must correctly perform their roles for the good health of living organisms. The majority of proteins operate in complexes and the way they interact has pivotal influence on the proper functioning of such organisms. In this study we address the problem of protein–protein interaction and we propose and investigate a method based on the use of an ensemble of autoencoders. Our approach, entitled AutoPPI, adopts a strategy based on two autoencoders, one for each type of interactions (positive and negative) and we advance three types of neural network architectures for the autoencoders. Experiments were performed on several data sets comprising proteins from four different species. The results indicate good performances of our proposed model, with accuracy and AUC values of over 0.97 in all cases. The best performing model relies on a Siamese architecture in both the encoder and the decoder, which advantageously captures common features in protein pairs. Comparisons with other machine learning techniques applied for the same problem prove that AutoPPI outperforms most of its contenders, for the considered data sets.

The aim of this study was to evaluate the protective effects of resveratrol and curcumin in an experimental rat model of intestinal ischemia–reperfusion (I/R). Forty-eight adult Wistar rats were used: 12 animals undergoing the sham surgery and 36 animals undergoing laparotomy, with 15 min of mesentric artery clamping. The animals from the latter group (n = 12) were pretreated, for 1 week, with vehicle (CTR), resveratrol (RES), and curcumin (CUR). After 1 h and 6 h of reperfusion, respectively, cyclooxigenase (COX)-2, mucin-1, E-cadherin, nuclear factor (NK)-κB expressions, and tumor necrosis factor related apoptosis-inducing ligand (TRAIL) were assessed in the small intestine. Oxidative stress markers were determined in tissue homogenate and serum, and histopathological analysis was performed. Pretreatment with RES decreased the expression of COX-2 and NF-κB at both intervals and increased E-cadherin (p < 0.05) and mucin-1 production after 1 h. CUR had a beneficial effect on COX-2, NF-κB, and E-cadherin expressions, both after 1 h and after 6 h (p < 0.0001). The two compounds increased TRAIL levels and had a protective effect on oxidative stress and histopathological lesions, both after 1 h and after 6 h. Our results suggested that RES and CUR had beneficial effects in intestinal I/R and may represent a promising option for complementary treatment of this pathological condition.

The objective of our study was to investigate glycemic, oxidative/antioxidative and inflammatory status in letrozole and estradiol valerate induced polycystic ovarian syndrome (PCOS) models. Sixty adult female Wistar rats were divided into four groups: L (0.2 mg letrozole/0.5 ml carboxymethyl cellulose (CMC), daily for 30 days), the control group CL, EV (one i.m. injection of 5 mg EV/0.5 ml sesame oil) and its corresponding control group CEV. After 30 days, ovarian morphology was assessed through ultrasound, serum free testosterone was determined, and an oral glucose tolerance test was performed. Blood, muscle, liver and periovarian adipose tissue (POAT) were collected for oxidative/antioxidative and inflammatory status evaluation. Free testosterone was increased only in the L group, while fasting glycemia was higher in the EV group. Both L and EV led to a significantly decreased level of muscle malondialehyde (MDA) and liver glutathione peroxidase (GPx) activity, while in POAT, MDA level diminished and GPx activity increased. The only difference between the two protocols was in muscle, where after L administration, GPx activity was significantly lower. Implementation of both protocols resulted in an increased expression of pNFKB in muscle, liver and POAT. The expression of monocyte chemoattractant protein 1 (MCP1) increased in liver and POAT after L administration, while in the EV group, MCP1 and STAT3 decreased in POAT. Our study shows that both protocols are characterized by an inflammatory environment in the usually insulin resistant tissues of human PCOS, without generating oxidative stress. In addition, EV has mild metabolic effects and unexpected interference with MCP1 expression in POAT, which require further investigation.

Aim: Our study aimed to assess the usefulness of contrast-enhanced ultrasound (CEUS) in the initial evaluation of the graft function.Materials and method: A cross-sectional study was conducted in the early postoperative period on patients with kidney transplantation, between September 2017 to November 2018. Two groups of patients were investigated; delayed graft function (DGF) and early graft function (EGF). All patients were examined by grey scale, Doppler ultrasound and CEUS.Results: Nineteen patients, aged from 23 to 64 years (mean age 50 years), 7 in the DGF group and 12 in the EGF group were evaluated. The resistive index (RI) show significantly higher values in the DGF group at the level of upper interlobar artery (p=0.025) and medium interlobar artery (p=0.02). The CEUS investigation shows a greater region of interest (ROI) area (p=0.02) and lower values for wash-out area under the curve (WoAUC) (p=0.047) and respectively wash-in and wash-out area under the curve (WiWoAUC) (p=0.031) for the DGF group. The quality of fit (QoF) proved lower in the DGF group either for evaluation of global graft (p=0.012), cortex (p=0.025), or medulla (p=0.009).A significant relationship among all patients was found between the glomerular filtration rate (GFR) [ml/min] and the renal artery fall time (FT) [s] (p=0.012), WoAUC [a.u.] (p=0.03), and WiWoAUC [a.u.] (p=0.024). The arterial QoF [%] was associated with the arterial ROI area (p=0.048).Conclusions: Intensity CEUS parameters WoAUC and WiWoAUC may be useful to diagnose and follow-up grafts with delayed function. Additional studies on larger cohorts are required for the recommendation of CEUS as a routine evaluation of the transplanted kidney.

Objective This prospective clinical study comparatively investigated the effects of tobacco smoking on global methylation and hydroxymethylation in oral epithelial cells. Methods Buccal cells from the inside of the cheeks were collected from 47 individuals, including smokers, former smokers, and never smokers. DNA was extracted using dedicated kits. Methylated and hydroxymethylated DNA fractions were measured using assays similar to enzyme-linked immunosorbent assays. The levels of methylation and hydroxymethylation were compared among groups using unpaired two-tailed t-tests or the Mann–Whitney U test; P Results There was no statistically significant difference in the average number of cigarettes between smoker and former smoker groups. Although methylation levels were lower for smokers (3.1%) and former smokers (2.16%), compared with never smokers (4.16%), these differences were not statistically significant. There was a two-fold increase in hydroxymethylation level in never smokers, compared with smokers. Conclusions Our findings suggest that smoking leads to global reductions in both methylation and hydroxymethylation levels in oral epithelial cells in a manner influenced by the intensity and length of exposure to tobacco smoke.

There are complex interconnections between the nervous system and the skin highlighted by the impact of stress and neuroendocrine factors on various dermatological conditions. We investigated the influence of stress on skin neurogenic inflammation induced by capsaicin. A total of 31 healthy subjects were randomized into two groups: subjects in the stress group underwent a stress-inducing protocol and those in the control group were exposed to indifferent conditions. Subsequently, topical capsaicin cream was administered on the non-dominant anterior forearm of each subject from the two groups. The assessment of the local inflammatory reaction induced by capsaicin was performed by thermography at 25 and 40 min post-application. In both groups the inflammatory reaction induced by capsaicin was evidenced at 25 min and was maintained at 40 min post-application. However, at 40 min post-application the hyperthermal area was larger in subjects from the stress group, suggesting that stress exposure is associated with an amplification of the mechanisms involved in capsaicin-induced skin neurogenic inflammation.

The aim of this pilot study was to measure force-related tooth mobility. Vertical and horizontal anterior tooth mobility in 31 healthy periodontal subjects was measured by a noncontact optical measurement technique. The subjects continuously increased the force on each tooth by biting on a load cell. An automated software program recorded tooth displacement at 9-N intervals. Vertical and horizontal displacements were subsequently measured. The vector of tooth mobility in the buccal direction was calculated using the Pythagorean theorem. The average displacements over all subjects for each tooth were determined. Global differences were assessed with the Wilcoxon test. There were no significant differences between contralateral teeth overall load stages. There were no significant differences in tooth mobility between the central and lateral incisors except for in the horizontal direction. However, there were significant differences between central incisor and canine and lateral incisor and canine teeth.

Statement of problem The osseointegration or fibrous encapsulation of immediately loaded dental implants depends largely on the extent of implant micromovement. The impact of acrylic resin or metal-reinforced acrylic resin provisional restorations on this movement is currently unknown. Purpose The purpose of this study was to isolate and measure the effect of provisional restoration type on the vertical displacement of adjacent implants under load at 2 locations. Material and methods Vertical loads ranging from 10-200 N were applied to polymethyl methacrylate resin (n=56) or metal-reinforced acrylic resin provisional restorations (n=56) supported by 4 implants inserted into homogenous artificial bone in a "u-shaped" alignment. Provisional restorations were first loaded in the anterior segment where the provisional restoration was supported by a mesial and distal implant, followed by loading on an extension 8 mm distal to the last implant. Vertical displacement of the 2 implants nearest the load application was measured and recorded using an optical image correlation technique based on photogrammetric principles. Data were subjected to a nonparametric multivariate analysis (generalized Wilcoxon test) and a Mann-Whitney test with a 2-tailed P value (α=.05). Results There was no significant difference in the vertical implant displacement of the 2 provisional restoration groups when they were loaded in the anterior segment. However, when loads were applied to the distal cantilever, metal reinforcement resulted in less vertical displacement of the next-to-last implant. The mean vertical displacement of the next-to-last implant when supporting an acrylic resin provisional restoration increased from 20 μm ±3 μm (pooled loads of 10-50 N) to 130 μm ±21 μm (pooled loads of 160-200 N), while the vertical displacement of the implant when retaining a metal-reinforced acrylic resin provisional restoration increased from 10 μm ±2 μm to 69 μm ±13 μm under the same loads ( P ≤.001). A significant difference over load stages (z=-3.22, P Conclusions The choice of material used for a provisional restoration significantly influences the vertical displacement of implants placed in artificial bone. When loads are applied to distal cantilevers, load distribution with metal reinforcement seems more favorable than with unreinforced acrylic resin. (J Prosthet Dent 2008;100:173-182)

Presentation of a new technique to determine the plane of symmetry of a face, and to assess the degree of facial symmetry in patients with unilateral cleft lip and palate based on three-dimensional (3D) optical surface data. After having determined a plane of symmetry according to optical 3D facial surface data, we identified differences in landmarks, the surface areas of the upper lip vermilion and nostrils and virtual volumes of the midface, nose and upper lip for cleft and unaffected sides in forty 10-year-old patients suffering from complete unilateral cleft lip, alveolus and palate. The children had undergone lip repair via the Tennison-Randall technique and had received subsequent orthodontic treatment (but not secondary osteoplasty). Statistically significant differences were apparent between cleft and non-cleft sides in terms of the nasal landmarks, nostril angle and virtual volume of the nose. The upper lip was symmetrical when cleft and non-cleft sides were compared. This new technique of symmetry analysis reveals that the noses of 10-year-old patients with complete unilateral cleft lip and palate who had not undergone revisional surgery present a measurable and significant degree of asymmetry, while the upper lip is symmetrical as a consequence of interdisciplinary treatment by orthodontists and oral and maxillofacial surgeons. Further 3D analyses on larger numbers of patients will allow more comprehensive and consistent analysis of the potential and limitations of various surgical and conservative methods so as to identify those techniques with the best outcome in terms of facial symmetry.

The long-term clinical and esthetic success of an implant-supported restoration is determined by stable periimplant soft-tissue morphology that is in harmony with the surrounding tissue architecture of the natural dentition. An interdisciplinary approach can significantly improve predictability when restoring missing teeth in the anterior maxilla. This clinical report describes the application of forced orthodontic eruption prior to initiation of surgical and restorative implant treatment to achieve a coronal shift of bone and gingiva and enhance the 3-dimensional topography of the recipient implant site.

In 2003 Wal-Mart, the world’s largest retailer announced that it would require from its top 100 suppliers to tag pallets and cases of goods with radio-frequency identification (RFID) tags. Radio-frequency identification (RFID) is the wireless non-contact use of radio-frequency electromagnetic fields to transfer data, for the purposes of automatically identifying and tracking tags attached to objects. This system was born in 1999 at MIT (Massachusetts Institute of Technology) when a consortium formed of professors, researchers and supply chain professionals created a global standard system for RFID. This paper explores the benefits and drawbacks of using this technology in supply chain management. Its ten year old history shows that, even at the beginning a lot of professionals were carried away by its implementation in supply chain, many companies found it difficult to measure the return on investment of this system as the cost of deployment is rather high. As a market survey executed by IDTechEx Research shows that the turnover of the RFID market was $7.88 billion in 2013 and no less than 5.9 billion tags were sold the same year, the RFID technology plays an important role as it is deployed in many different application areas, especially in supply chain management. This paper argues that this technology can be very successfully implemented in order to improve the supply chain system and improve the value added offered to the clients, as long as the professionals make an accurate assessment of the investment needed for the implementation.

Because polycystic ovarian syndrome (PCOS) is a risk factor for type 2 diabetes, the affected women can present frequently prediabetic states such as impaired fasting glycaemia and/or impaired glucose tolerance. The purpose of our study is to explore the effect of antiandrogenic spironolactone on glucose metabolism and oxidative stress (OS) parameters in oestradiol valerate (OV) induced PCOS rat model.72 female Wistar rats were distributed either to PCOS group (n=65, OV dissolved in sesame oil, 5 mg/0.4 ml), or to non-PCOS control group (n=7, sesame oil, 0.4 ml). After a month, ultrasound was performed to assess the ovarian morphology, and the results of an initial oral glucose tolerance test (OGTT) were used to identify the animals with altered glucose metabolism (AGM). Glucose transporter 4 (GLUT4) was evaluated from muscle biopsies, OS parameters were assessed from blood and muscle samples, and ovaries of 3 rats were removed for histopathological examination. Afterwards, the AGM group was divided in a treated PCOS group denoted as Sp+D (per os spironolactone dissolved in DMSO, 2 mg/0.2 ml), and a PCOS control treated with DMSO (0.2 ml). After one month of daily treatment, a final OGTT was performed. GLUT4 and OS parameters were again evaluated and ovaries were removed for histopathological examination.As compared to the values prior to the treatment, Sp+D reversed fasting hyperglycaemia (p

Maria Schuster *, Andreas Maier , Tobias Bocklet , Emeka Nkenke , Alexandra Holst , Ulrich Eysholdt , Florian Stelzle d Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Ludwig-Maximilians-University Munich, Marchioninstrasse 15, D-81377, Munich, Germany b Pattern Recognition Lab, Technical Faculty, Friedrich-Alexander-University Erlangen-Nuremberg, Martensstrasse 3, D-91058 Erlangen, Germany Department of Phoniatrics and Pediatric Audiology, University Hospital Erlangen, Bohlenplatz 21, D-91054 Erlangen, Germany Department of Oral and Maxillofacial Surgery, University Hospital Erlangen, Glucksstrasse 11, D-91054 Erlangen, Germany e Clinic for Orthodontics, University Hospital Erlangen, Gluckstrasse 11, D-91054 Erlangen, Germany

Objective: To investigate whether the craniofacial vertical and sagittal jaw relationship in patients with cleft lip and palate (CLP) differed from that of age-matched noncleft controls, before and after the pubertal growth spurt. Design: Retrospective observational study. Patients: The study group comprised 126 patients with CLP, subdivided according to gender and cleft type, and the control group comprised 53 age-matched skeletal class I patients. Methods: Angular and linear measurements were taken from prepubertal and postpubertal lateral cephalograms of all patients. Results: In patients with cleft lip and palate, the maxillary retrognathism became more remarkable with increasing age; whereas, the retrognathic position of the mandible became less pronounced as compared with controls. Reduced posterior midfacial height, a common prepubertal finding in patients with cleft lip and palate, was significant in postpubertal girls and young women with unilateral cleft lip and palate (p = .002). The total anterior facial height in male patients with bilateral cleft lip and palate was larger than in control patients (p = .002) after the pubertal growth spurt due to an increased anterior midfacial height. In male patients with unilateral cleft lip and palate, this finding was due to an increased anterior lower facial height (p < .001). Conclusions: Patients with cleft lip and palate treated according to a standardized treatment concept had adequate craniofacial jaw relationships after puberty. Despite a measured skeletal class I in both male and female patients with cleft lip and palate regardless of cleft type, there was a slight tendency toward a skeletal class III. Findings were similar for all groups of cleft lip and palate patients irrespective of the type of orthodontic treatment performed.

Proper site development is a key factor for long-term clinical success of dental implants. Whereas surgical and restorative techniques have been refined to ensure predictable functional and esthetic outcome, individual clinical prerequisites do not always allow proper placement of implants when prosthetic and material properties are considered. Orthodontic tooth movement may be a viable and nonsurgical site development treatment option. With the introduction and advancements of minimal invasive and less visible orthodontic appliances, a growing number of adult patients are willing to obtain orthodontic treatment. The spectrum of modern appliances is broad and ranges from clear aligners to lingual brackets. Skeletal anchorage devices such as orthodontic mini-implants often eliminate unpopular external anchorage devices (ie, headgear) in adult patients, This article discusses the selection of an appropriate pretreatment approach by taking patient-specific criteria into account.

We prospectively evaluated the incidence of blood transfusion in 105 consecutively treated patients (45 men and 60 women) having bimaxillary orthognathic operations, to find out whether type and screen testing are adequate in clinical practice. All patients had Le Fort I osteotomy combined with bilateral sagittal split osteotomy of the ramus. The preoperative routine was restricted to type and screen testing and verification of ABO/Rhesus (Rh) status. Autologous blood donation or routine cross-matching of allogeneic units of blood was not done. Intraoperative haemoglobin concentrations and the need for blood transfusion in patients having bimaxillary osteotomies were recorded in a prospective database. The mean duration of operation was 196 min (range 115-325). The median length of hospital stay was 8 days (range 4-16). The mean (SD) reduction in haemoglobin during operation was 34 (16)g/L in men and 32 (10)g/L in women (p=0.32). No patients had an allogeneic blood transfusion. We found that type and screen testing and verification of ABO/Rh status seems to be an adequate precaution to manage blood loss. As reflected by the low rate of transfusion in the present study, severe haemorrhage that requires transfusion of allogeneic blood has become the exception rather than the rule in bimaxillary orthognathic operations.

It has been the objective of the present prospective study to assess visible volume changes of the facial soft tissue after LeFort I osteotomy with advancement and to determine the soft-tissue-to-hard-tissue ratios of advancement.Twenty adult patients (ten female, ten male, mean age 33.9 +/- 14.9 years) received a LeFort I osteotomy with advancement because of a maxillary protrusion. Lateral skull radiographs and optical three-dimensional (3D) scans of the facial surface were assessed preoperatively and 12 months after surgery. The lateral skull radiographs were used to carry out standard linear and angular cephalometric measurements. The pre- and postoperative optical 3D surface scans were registered. A well-defined area in the malar region was used to determine the visible volume changes for each side separately. The mean accommodation vector that transforms the preoperative into the postoperative surface was assessed for each facial half separately. The soft-tissue-to-hard-tissue ratios between the incision superius and the labrale superius, the maximal parasagittal advancement of soft tissue, and the accommodation vectors were calculated.A mean advancement of the incision superius of 5.3 +/- 2.1 mm was accompanied by a volume increase of 5.2 +/- 4.1 cm(3) in the right malar-midfacial region and 4.6 +/- 4.7 cm(3) on the left side, respectively, revealing a symmetrical volume change (p = 0.370). The soft-tissue-to-hard-tissue ratios were 80 +/- 94% for labrale superius and incision superius, 56 +/- 79% (right) and 51 +/- 56% (left) for accommodation vector and incision superius and 97 +/- 79% (right) and 98 +/- 89% (left) for maximal parasagittal advancement of soft tissue and incision superius.The determination of volume changes and accompanying accommodation vectors complete the cephalometric analysis during the follow-up of patients undergoing LeFort I osteotomy. The data show that maxillary advancement leads to a more pronounced shifting of the soft tissues in the malar-midfacial area than of the upper lip. The new parameters will help to assess normative soft tissue data based on 3D imaging with a view to an improved three-dimensional prediction of the operative outcome of orthognathic surgery away from the midline.