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The chronic complications of diabetes mellitus (DM) are accompanied by inflammatory manifestations. Our study aimed to assess the association between inflammatory status, reflected by C-reactive protein (CRP) values and the evolution of type 1 and 2 DM patients, evaluated by glycated hemoglobin (HbA1c) levels, the length of disease duration, the average time until the onset of microvascular complications and their risk of occurrence. We conducted a retrospective observational study, involving 192 patients, randomly selected from the medical records of the Centre for Diabetes Mellitus, Nutrition and Metabolic Diseases, Cluj-Napoca, Romania. We noted significant differences between the two patient groups concerning HbA1c levels in patients with stage I nephropathy and CRP values in those with retinopathy. A significant positive correlation between the levels of studied biomarkers and disease duration was noted for type 1, but not for type 2 patients. We found a higher risk of chronic complications in patients with type 2, compared to those with type 1 DM: the relative risk was higher by 1.87 (1.59–1.97) times for nephropathy, 2.57 (1.56–4.18) times for retinopathy and 3.66 (3.00–3.82) times for neuropathy. Our study indicates a direct link between systemic inflammation and the timely progression of type 1 DM. In patients with type 2 DM, no statistical significance was found between the levels of studied biomarkers and the occurrence of microvascular complications. Nephropathy appeared sooner in type 1 DM patients, while retinopathy and neuropathy had a similar pattern of occurrence in both types of patients.

Aim: In our study, we evaluated the prognostic value of four calculated inflammatory ratios in patients with colorectal cancer. Material and methods: A six-year retrospective study was conducted on subjects admitted for colorectal cancer at "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania, from January 2014 until September 2019. The medical charts of patients diagnosed with colorectal cancer were used as the source of raw data and for the calculation of four ratios (neutrophil-to-lymphocyte ratio-NLR, derived neutrophil-to-lymphocyte ratio-dNLR, platelet-to-lymphocyte ratio-PLR, and systemic immune-inflammation index-SII), considered as prognostic markers related to mortality in colorectal cancer. Results: One thousand six hundred and eighty-eight patients, with ages ranging from 17 to 98 years, were evaluated. NLR and dNLR displayed significantly higher values among patients who died (NLR: 4.2 for deceased vs. 3.4 for alive, P-value=0.0224; dNLR: 2.7 for deceased vs. 2.3 for alive, Pvalue= 0.0566). Ischemic cardiomyopathy (odds ratio (OR)=2.70), liver cirrhosis (OR=7.84), postoperative complications (OR=2.39), and neutrophil-to-lymphocyte ratio (OR=1.08) proved to be significant prognostic factors for the primary outcome, independent of age and gender. Conclusions: Patients with high NLR, postoperative complications, ischemic cardiomyopathy an d/or liver cirrhosis are the candidates to a less favorable outcome among subjects with colorectal cancer regardless the age and gender.

Aim: To evaluate if smoking, quantified by the serum cotinine levels, is related to the evolution of patients with critical limb ischemia (CLI).Method: A pilot study was conducted on CLI pa...

Translation involves ethical decision-making in challenging contexts. Codes of practice help professional translators identify ethical issues and formulate appropriate, justifiable responses. However, new and growing forms of community translation operate outside the professional realm, and substantial differences exist between the two approaches. How relevant, then, are professional codes in the new contexts? What alternative ‘codes’ (stated or implicit) have been developed by the new groups? The content of professional codes is compared here to a broad range of community approaches to identify themes common across both, and areas where the new community might be making an original contribution. This reveals different priorities in the professional and non-professional codes. Community translation initiatives have found novel solutions to some ethical problems and challenges, particularly in self-regulation and community policing, improved interpretation of code content, an emphasis on shared values rather than individual rights, and strong mentoring.

Fetal inflammatory response syndrome is associated with increased neonatal morbidity and mortality. The aim of the present study was to evaluate the dynamics of the plasmatic value of pro-inflammatory cytokines: tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and neutrophil activating peptide 78 (ENA-78) and the anti-inflammatory cytokine IL-10 in the first and third day of life and the correlation with neonatal morbidities and mortality. The current research was designed as a prospective case control study included 80 neonates hospitalized at the 3rd level Neonatal Intensive Care Unit (NICU), 1st Gynecology Clinic, County Emergency Hospital, Cluj-Napoca, Romania. For each patient, the following parameters were noted: pH at first hour of life, oxygen saturation, fraction of inspired oxygen (FiO2) and duration of premature rupture of the membranes (PROM). Measurements of cytokines were determined from venous blood in the first and third day of life. The values of all cytokines were higher in the newborns from mothers with PROM. The value of IL-6 in the study group was higher compared to the controls during the first day of life and met the highest value in necrotizing enterocolitis (NEC). ENA-78 was higher in the study group (P=0.037) and decreased during the first 3 days of life. The highest value of ENA-78 was found in the neonates with cerebral hemorrhage. IL-10 also had values with a significant difference in the first day of life between both groups (P=0.02). IL-10 had the highest value in sepsis cases. In conclusion, among the inflammatory parameters that were evaluated, the dynamics of ENA-78 and IL-10 were found to influence the neonatal prognosis of newborns with PROM. The decrease in ENA-78 and IL-10 during the third day of life could suggest the evolution towards the ending of the inflammatory process and an increase in the survival rate was noted.

A variety of Reinforcement Learning (RL) techniques blends with one or more techniques from Evolutionary Computation (EC) resulting in hybrid methods classified according to their goal, new focus, and their component methodologies. We denote this class of hybrid algorithmic techniques as the evolutionary computation versus reinforcement learning (ECRL) paradigm. This overview considers the entire spectrum of algorithmic aspects and proposes a novel methodology that analyses the technical resemblances and differences in ECRL. Our design analyses the motivation for each ECRL paradigm, the underlying natural models, the sub-component algorithmic techniques, as well as the properties of their ensemble.

This paper describes a novel reinforcement learning system for learning to play the game of Tron. The system combines Q-learning, multi-layer perceptrons, vision grids, opponent modelling, and Monte Carlo rollouts in a novel way. By learning an opponent model, Monte Carlo rollouts can be effectively applied to generate state trajectories for all possible actions from which improved action estimates can be computed. This allows to extend experience replay by making it possible to update the state-action values of all actions in a given game state simultaneously. The results show that the use of experience replay that updates the Q-values of all actions simultaneously strongly outperforms the conventional experience replay that only updates the Q-value of the performed action. The results also show that using short or long rollout horizons during training lead to similar good performances against two fixed opponents.

The efficiency of local search is proportional to the number and the distribution of basins of attraction. Often combinatorial optimisation problems have a large number of local optima, uncountable with available computational resources. Approximating the number of basins of attraction and the minimal number of samples for visiting all basins at least once are complex problems for which we assume specific distributions of basins of attraction. We define two types of basins of attraction of multi-objective combinatorial optimisation problems with complementary properties. Acknowledging that each local search run generates a Pareto front of solutions, either each Pareto local solution corresponds to a basin of attraction, or a Pareto basin matches an entire Pareto local front. Simulations compare parametric and non-parametric estimators on bi-objective quadratic assignment problem instances.

The aim of the present study was to assess the influence of localization, age or sex and histopathological characteristics upon the chance of developing lymphatic or hematogenous metastatic spread over time, or a positive sentinel lymph node in cutaneous melanoma patients. Patients from the Department of Dermatology, County Emergency Hospital Cluj-Napoca (Cluj-Napoca, Romania), presenting with cutaneous melanoma confirmed histopathologically and a SPECT/CT or lymphoscintigraphic examination to detect the sentinel lymph node, were included in the present study. Our results revealed that Breslow index >2 mm [odds ratio (OR)=4.22, 95% confidence interval (CI) (1.12; 15.93)], presence of ulceration [OR=6.01, 95% CI (1.87; 19.35)], and positive sentinel lymph node [for at least one sentinel lymph node OR=3.58, 95% CI (1.06; 12.04)] were risk factors for hematogenous metastases. All these, except for the Breslow index >2 mm, were demonstrated to be a risk factor for lymphatic spread metastases over time. Ulceration and male sex also represented risk factors for a positive sentinel lymph node, men having a higher risk of developing sentinel lymph nodes than women [adjusted OR=2.27, 95% CI (1.00; 5.13)]. In conclusion, the predictors that influence the occurrence of lymphatic or hematogenous metastases may differ, ulceration and positive sentinel lymph node being common for both types of metastatic spread, while Breslow index being a significant predictor only for hematogenous metastases. Male sex and the presence of ulceration were demonstrated to be significant risk factors for positive sentinel lymph nodes.

Background: Gaucher disease (GD) is caused by a recessively inherited deficiency of glucocerebrosidase which is encoded by the GBA gene in which nearly 450 mutations have been described. However, only a few genotype- phenotype correlations have been clearly established. The aim of this study was to investigate molecular features of GD in Romanian patients and to evaluate their impact on treatment response. Material and methods: 69 patients, diagnosed between 1997 and 2014 at our national referral laboratory, were included in this study. Frequent point mutations (N370S, L444P, 84GG, R463C) were detected by amplification and restriction enzyme digestion. Recombinant alleles (recTL, recNciI, recA456P) were screened by DNA sequencing. Plasma chitotriosidase served as a biomarker of disease severity throughout the follow-up period. Results: 66 patients had the non-neuronopathic (type 1) form of GD and 3 had the chronic neuronopathic (type 3) phenotype. We identified 79% of the mutant alleles, among which the most frequent mutations were N370S (54%) and L444P (18%). We found a statistically significant (p

The chronic complications of diabetes mellitus (DM) are accompanied by inflammatory manifestations. Our study aimed to evaluate a possible association between the inflammatory status (reflected by serum chitotriosidase and neopterin) and the timely evolution and occurrence of chronic microvascular complications in patients with type 1 DM. This observational, cross-sectional study included 82 type 1 DM patients from the Centre for Diabetes, Nutrition and Metabolic Diseases, Cluj-Napoca, Romania. Our results demonstrated a link between the extent of inflammation, evaluated by the enzymatic activity of circulating chitotriosidase, and the onset of microvascular complications, especially diabetic neuropathy and retinopathy. Chitotriosidase enzymatic activity showed an ascending evolution over time. In non-smoking patients, the increase in chitotriosidase activity was correlated with the extent of microalbuminuria and the decline of glomerular filtration rate, while in smokers, only the presence of a positive correlation between chitotriosidase activity and disease progression was noticed. According to our results, the time span between the moment of diagnosis and the onset of microvascular complications was longer in non-smokers than in smokers. These results also imply that increased chitotriosidase activity may be a predictor of endothelial dysfunction in type 1 DM.

Objective Optical coherence tomography (OCT) is a noninvasive, high-resolution imaging technique that was suggested to be a powerful biomarker of neurodegeneration. The objective of our study is to assess the pattern of retinal OCT changes in patients with visual pathway tumors. Methods A prospective clinical study was conducted and patients with single cerebral tumors with potential of compression on the visual pathway were included. Patients with multiple and/or metastatic tumors were excluded. Each patient underwent a neurosurgical and ophthalmologic evaluation, cranial-cerebral magnetic resonance imaging, and ocular OCT in both eyes. The OCT parameters included circumpapillary retinal nerve fiber layer thickness (average and sector thickness) and retinal thickness in the macular area (average and sector thickness). Results Fifty patients were investigated clinically and by magnetic resonance imaging, and 18 patients were excluded. Thirty-two patients were eligible for the study and completed the retinal OCT. Eighteen patients had tumors with compressive potential on the optic chiasm, 11 patients had tumors close to the optic radiations, and 3 patients had tumors in the occipital lobe. A specific pattern of OCT changes was found for each site. Regional parameters of both optic nerve and macula were altered. Conclusions Retinal OCT is a promising tool for the in vivo assessment of the neurodegeneration pattern in patients with intracranial tumors. The evaluation of single intracranial tumors with compressive potential on the visual pathway is a good candidate for the study of neurodegeneration.

Our study aimed to evaluate if within the Romanian physician community differences on how different generations use social media exist.The perceptions toward social media of Romanian physicians were investigated using a 17-items questionnaire. Data available in 2017 on the Romanian College of Physicians’ website as mailing address represented the available population. The invitation to the study was randomly sent to 2,000 doctors in November 2017. 271 (13.6%) questionnaires were returned properly filled. Majority of the respondents (65.7%) used Facebook. Doctors search for medical information (79.3%) on social media daily (27.6%). 28% of the respondents never offer medical advice via social media to colleagues nor patients (23.0%). 22.3% of the responders acknowledge a healthcare professionals’ community on social media, but it is not seen as helping accomplish daily tasks, treating the patients, improving work performance or the services provided. Most of the doctors do not discuss social media utilization for searching health information (66%) nor interact with their patients via social media (68.3%), still the ones that do it, prefer Facebook (16.2%). Our study suggests that the usability of social media among Romanian physicians is low. Most of the Romanian doctors do not use these platforms in their medical practice.

In this observational pilot study, we investigated the impact of Dolutegravir, Raltegravir, Elvitegravir (Integrase Strand Transfer Inhibitors, INSTIs), or boosted Darunavir (a Protease Inhibitor, PI) in combination with two nucleoside reverstranscriptase inhibitors (Emtricitabine/Tenofovir disoproxil or Lamivudine/Tenofovir disoproxil, NRTI) on four interleukins (IL-4, IL-10, IL-13, and IL-21) as immune activation markers in naïve HIV(Human Immunodeficiency Virus)-infected patients during the first six months of combined standard-of-care antiretroviral therapy (cART). Newly diagnosed with HIV-infected subjects and without any disease that could affect the immune activation markers were evaluated. The patients’ physicians recommended the cART as standard-of-care and the ILs were measured before cART and six months of cART. The levels of CD4+ T-cells count and CD4+/CD8+ ratio significantly increased at six months (P-value+/CD8+ >1 was observed in 25% of patients treated with Raltegravir and half of those treated with Dolutegravir. At six months of cART, viral load was detectable in only 6/31 individuals. IL-21 had an undetectable level in 30/31 patients after six months of cART. Our results suggest the potency in restoring immune markers in HIV-infected patients with all investigated drugs. Dolutegravir showed a tendency to statistically significant changes in IL-4 and IL-10. A clinical trial with random allocation of medication and an extensive follow-up is needed to replicate this research and validate the usefulness of evaluated ILs as markers of cART effectiveness.

The trade-off between the exploration of large size neighborhoods and the exploitation of Pareto fronts with high cardinality is a challenging task for the metaheuristics for many-objective combinatorial optimization problems. Cartesian products of scalarization functions, or simpler, Cartesian scalarization, is a novel technique that simplifies the search by reducing the number of objectives using sets of scalarization functions. Cartesian scalarization is an alternative to scalarization functions that scales up the local search for many-objective spaces. We introduce a method that automatically generates Cartesian scalarization functions; we use combinatorics to analyze the properties of Cartesian scalarization functions. Cartesian scalarization local search (CsLs) uses a set of Cartesian scalarization functions to generate a quality Pareto local front. We show that CsLs is a well-defined local search algorithm that converges to a Pareto local solution set in finite time. Cartesian scalarization outperforms other Pareto and scalarization local search methods on many-objective combinatorial optimization instances.

Biomarker research is an important area of investigation in Gaucher disease, caused by an inherited deficiency of a lysosomal enzyme, glucocerebrosidase. We evaluated the usefulness of neopterin, as a novel biomarker reflecting chronic inflammation and immune system activation in Gaucher disease and analysed its evolution in response to enzyme replacement therapy (ERT).Circulating plasma neopterin levels in 31 patients with non-neuronopathic Gaucher disease were measured before and after the onset of ERT and were compared with those of 18 healthy controls. Plasma chitotriosidase activity was also monitored, as a reference biomarker, against which we evaluated the evolution of neopterin.Neopterin levels were significantly increased in treatment-naïve patients (mean 11.90 ± 5.82 nM) compared with controls (6.63 ± 5.59 nM, Mann-Whitney U test P = 0.001), but returned to normal levels (6.92 ± 4.66 nM) following ERT. Investigating the diagnostic value of neopterin by receiver operating characteristic analysis, we found a cut-off value of 7.613 nM that corresponds to an area under the curve of 0.780 and indicates a good discrimination capacity, with a sensitivity of 0.774 and a specificity of 0.778.Our results suggest that measurement of circulating neopterin may be considered as a novel test for the confirmation of diagnosis and monitoring of the efficacy of therapeutic intervention in Gaucher disease. Plasma neopterin levels reflect the global accumulation and activation of Gaucher cells and the extent of chronic immune activation in this disorder.Neopterin may be an alternative storage cell biomarker in Gaucher disease, especially in chitotriosidase-deficient patients.

Effects on wave propagation achievable by introduction of a negative-stiffness component are investigated via perhaps the simplest discrete repeating element that can remain stable in the component’s presence. When the system is elastic, appropriate tuning of the stabilized component’s negative stiffness introduces a no-pass zone theoretically extending from zero to an arbitrarily high frequency, tunable by a mass ratio adjustment. When the negative-stiffness component is tuned to the system’s stability limit and a mass ratio is sufficiently small, the system restricts propagation to waves of approximately a single arbitrary frequency, adjustable by tuning the stiffness ratio of the positive-stiffness components. The elastic system’s general solutions are closed-form and transparent. When damping is added, the general solutions are still closed-form, but so complex that they do not clearly display how the negative stiffness component affects the system’s response and how it should best be tuned to achieve desired effects. Approximate solutions having these features are obtained via four perturbation analyses: one for long wavelengths; one for small damping; and two for small mass ratios. The long-wavelengths solution shows that appropriate tuning of the negative-stiffness component can prevent propagation of long-wavelength waves. The small damping solution shows that the zero-damping low-frequency no-pass zone remains, while waves that do propagate are highly damped when a mass ratio is made small. Finally, very interesting effects are achievable at the full system’s stability limit. For small mass ratios, the wavelength range of waves prohibited from propagation can be adjusted, from all to none, by tuning the system’s damping: When one mass ratio is small, all waves with wavelengths larger than an arbitrary damping-adjusted value can be prohibited from propagation, while when the inverse of this mass ratio is small, all waves with wavelengths outside an arbitrary single adjustable value or range of values can be prohibited from propagation. All of the approximate solutions’ analytically-transparent predictions are confirmed by the exact solution. The conclusions are that a stabilized tuned negative-stiffness component greatly enhances control of wave propagation in a purely elastic system, and when adjustable damping is added, even further control is facilitated.

Opioid use is a widespread epidemic, and traumatic stress exposure is a critical risk factor in opioid use and relapse. There is a significant gap in our understanding of how stress contributes to heroin use, and there are limited studies investigating individual differences underlying stress reactivity and subsequent stress-induced heroin self-administration. We hypothesized that greater individual vulnerability to stress would predict higher demand for heroin self-administration in a within-subjects rodent model of stress and heroin use comorbidity. Male rats were exposed to inescapable intermittent swim stress and individual biological (corticosterone) or behavioral (open field, social exploration, and forced swim tests) measures were assessed before and after the stress episode. Individual demand for self-administered heroin (0.05 mg/kg/infusion; 12-hour sessions) was assessed using a behavioral economics approach followed by extinction and reinstatement tests triggered by stress re-exposure, non-contingent cue presentations, and yohimbine (0, 1.0, or 2.5 mg/kg). We found that behavioral, biological, and a combination of behavioral and biological markers sampled prior and after the stress episode that occurred weeks before the access to heroin selfadministration predicted the magnitude of individual demand for heroin. Non-contingent presentation of cues, that were previously associated with heroin, reinstated heroin seeking in extinction. For the first time, we show that individual biological response to an ecologically relevant stressor in combination with associated behavioral markers can be used to predict subsequent economic demand for heroin.

Pac-Xon is an arcade video game in which the player tries to fill a level space by conquering blocks while being threatened by enemies. In this paper it is investigatedwhether a reinforcement learning (RL) agent can successfully learn to play this game. The RL agent consists of a multilayer perceptron (MLP) that uses a feature representation of the game state through input variables and gives Q-values foreach possible action as output. For training the agent, the use of Q-learning is compared to two double Q-learning variants, the original algorithm and a novel variant. Furthermore, we have set up an alternative reward function which presents higher rewards towards the end of a level to try to increase the performance ofthe algorithms. The results show that all algorithms can be used to successfully learn to play Pac-Xon. Furthermore both double Q-learning variants obtain significantly higher performances than Q-learning and the progressive reward function does not yield better results than the regular reward function.

Background: Data regarding the effects of multifetal pregnancy on the incidence of gestational diabetes mellitus (GDM) are inconsistent and even conflicting. Twin pregnancies have been associated with no increase, a marginal increase or a higher incidence of gestational diabetes. In triplet pregnancies, these effects have not been investigated yet. Objectives: To analyze the results of the glucose challenge and tolerance tests in singleton, twin and triplet pregnancies. Study design: A retrospective database analysis of pregnant women with singletons, twins or triplets who had complete results of the 50 g glucose challenge test (GCT) and the 100 g oral glucose tolerance test (OGTT). The cohort included 12,382 singletons, 515 twins and 39 triplets. Results: There were significantly higher rates of abnormal GCTs in twins and triplets compared to singletons (45.4% and 33.3%, respectively vs. 13.7%, P Conclusions: Glucose intolerance is aggravated in multifetal pregnancies. The likelihood of an abnormal GCT and gestational diabetes is higher in twins and triplets compared to singletons.

Objective: To evaluate autonomic modulation of heart rate in pregnant women treated with oxytocin to induce labor and with atosiban (an oxytocin antagonist) to arrest preterm labor.Methods: A prospective study with two cohorts: 14 pregnant women treated with atosiban for premature uterine contractions, and 28 women undergoing induction of labor with oxytocin. Computerized analyses of the electrocardiogram were performed with spectral and nonlinear dynamic analyses.Results: Atosiban did not alter any of the variables associated with heart rate variability, whereas oxytocin showed a dose-dependent decrease in heart rate (p

CONTEXT: Endometriosis is a common gynecological disease, characterized by ectopic deposits of endometrial tissue outside of the uterine cavity, and it is associated with pelvic pain and infertility, with an important impact on the quality of life. At this point there is a controversy regarding the etiology and pathophysiology of endometriosis and it seems that pro-angiogenic growth factors might be involved, but their role is not completely understood. OBJECTIVE: To evaluate the serum concentration of the main growth factors in patients with diagnosed endometriosis compared to healthy controls. SUBJECTS AND METHODS: A total of 157 women were divided into two study groups (Group I – endometriosis; Group 2 – healthy women). Serum levels of VEGF, G-CSF, GM-CSF, b-FGF, EGF, and HGF were measured with Human Multiplex Cytokine Panels. RESULTS: VEGF serum levels were significantly lower in women with endometriosis compared to controls (1.924±0.145 compared to 1.806±0.078 pg/mL, p

Even though vitamin D is widely acknowledged as having a potential immunomodulatory role in asthma, its exact beneficial mechanisms are yet to be clarified. An optimal serum 25-hydroxy-vitamin D (25-OH-VitD) level in pediatric asthma patients might not rely solely on the effect of dose-dependent vitamin D3 intake, but might also be influenced by factors related to insufficient asthma control. We aimed to survey the prevalence of serum 25-OH-VitD deficiency and analyze whether suboptimal levels were associated with asthma severity factors. The current cross-sectional study enrolled 131 pediatric asthma or asthma-suggestive recurrent wheezing patients, for whom serum 25-OH-VitD, IgE, and eosinophil count were assessed. The prevalence of suboptimal serum 25-OH-VitD was 58.8%. A suboptimal vitamin D status was associated with asthma exacerbation in the previous month (p = 0.02). Even under seasonal oral vitamin D3 supplementation, patients with a positive history of asthma attack in the previous four weeks presented significantly lower serum 25-OH-VitD concentrations, compared to their peers with no disease exacerbation. In conclusion, sequential measurements of serum 25-OH-VitD might prove useful for future studies evaluating the dynamic changes in vitamin D3 status in regard to asthma, especially in symptomatic patients.

Hepatitis delta virus (HDV) increases morbidity in Hepatitis B virus (HBV)-infected patients. In the mid-eighties, an outbreak of HDV fulminant hepatitis (FH) in the Central African Republic (CAR) killed 88% of patients hospitalized in Bangui. We evaluated infections with HBV and HDV among students and pregnant women, 25 years after the fulminant hepatitis (FH) outbreak to determine (i) the prevalence of HBV and HDV infection in this population, (ii) the clinical risk factors for HBV and/or HDV infections, and (iii) to characterize and compare the strains from the FH outbreak in the 1980s to the 2010 HBV–HDV strains. We performed a cross sectional study with historical comparison on FH-stored samples (n = 179) from 159 patients and dried blood-spots from volunteer students and pregnant women groups (n = 2172). We analyzed risk factors potentially associated with HBV and HDV. Previous HBV infection (presence of anti-HBc) occurred in 345/1290 students (26.7%) and 186/870 pregnant women (21.4%)(p = 0.005), including 110 students (8.8%) and 71 pregnant women (8.2%), who were also HBsAg-positive (p = 0.824). HDV infection occurred more frequently in pregnant women (n = 13; 18.8%) than students (n = 6; 5.4%) (p = 0.010). Infection in childhood was probably the main HBV risk factor. The risk factors for HDV infection were age (p = 0.040), transfusion (p = 0.039), and a tendency for tattooing (p = 0.055) and absence of condom use (p = 0.049). HBV-E and HDV-1 were highly prevalent during both the FH outbreak and the 2010 screening project. For historical samples, due to storage conditions and despite several attempts, we could only obtain partial HDV amplification representing 25% of the full-length genome. The HDV-1 mid-eighties FH-strains did not form a specific clade and were affiliated to two different HDV-1 African subgenotypes, one of which also includes the 2010 HDV-1 strains. In the Central African Republic, these findings indicate a high prevalence of previous and current HBV-E and HDV-1 infections both in the mid-eighties fulminant hepatitis outbreak and among asymptomatic young adults in 2010, and reinforce the need for universal HBV vaccination and the prevention of HDV transmission among HBsAg-positive patients through blood or sexual routes., Author summary In the Central African Republic (CAR), due to 20 years of conflict, the health system has been disorganized. This could contribute to maintenance of high transmission levels of Hepatitis B Virus (HBV) and its satellite Hepatitis Delta Virus (HDV). This work studies the evolution of both infections 25 years after a fulminant hepatitis (FH) outbreak occurring in the mid-1980s associated with HDV superinfection. In young asymptomatic adults, the results show that both HBV and HDV were still actively circulating in CAR in 2010. Indeed, more than one third of HBV-infected individuals were chronic HBV carriers. Furthermore, HDV infection could be spreading among 10% of them through blood and sexual transmission. The past FH outbreak and contemporary infections were both associated with heterogeneous HDV-1 strains, combined with HBV-E. Vaccination against HBV was uncommon among pregnant women and students, even among medical students. The study constitutes warning signals to help CAR health-care reconstruction and underlines the importance of HBV vaccination. The high level of HBV infection creates a background for HDV superinfection. Neonatal HBV vaccination is needed, together with vaccination of unprotected populations. Awareness of health authorities as well as the general public would help reduce HBV and HDV infections.

What does superdiversity mean for communication, especially in complex settings such as the legal system? Translation and interpreting play critical roles in legal contexts, notably in ensuring equality of access to justice and transparency, but superdiversity brings substantial new challenges for established working practices, and potentially for justice itself. This chapter looks critically at the impact of superdiversity on translation in legal contexts, with a particular focus on the UK. We argue that superdiversity affects significant aspects of provision, including translation quality, ethics and policy. In the Introduction, we explain why translation matters in legal contexts, provide definitions of key terms and ideas, and summarise important developments which are impacting on translation in UK legal contexts at the same time as superdiversity. In Part 2, Historical Perspectives, we present a critical account of existing research on translation in legal contexts, and of training for translators and interpreters who will work in these contexts. We argue that both research and training have been slow to consider superdiversity and its effects. In Part 3, Core Issues and Topics, we focus on the effects of superdiversity for four important areas: the logistics of translation in legal contexts, translation quality, translation ethics, and policy issues. We draw on research and direct experience of translation and interpreting practice (our own and others’), to consider how superdiversity affects the conduct and impact of transla-tion and interpreting. In Part 4, New Debates, we explain some challenges for those researching translation in superdiverse legal contexts, summarise recent and emerging work, and consider the implications of superdiversity for translation studies and translator training. In the Conclusion, we link superdiversity and translation in legal contexts to broad principles of justice and fairness, point to some new research directions, and suggest further reading.

Real-Time Strategy (RTS) games can be abstracted to resource allocation applicable in many fields and industries. We consider a simplified custom RTS game focused on mid-level combat using reinforcement learning (RL) algorithms. There are a number of contributions to game playing with RL in this paper. First, we combine hierarchical RL with a multi-layer perceptron (MLP) that receives higher-order inputs for increased learning speed and performance. Second, we compare Q-learning against Monte Carlo learning as reinforcement learning algorithms. Third, because the teams in the RTS game are multi-agent systems, we examine two different methods for assigning rewards to agents. Experiments are performed against two different fixed opponents. The results show that the combination of Q-learning and individual rewards yields the highest win-rate against the different opponents, and is able to defeat the opponent within 26 training games.

In this paper, we investigate which exploration method yields the best performance in the game Bomberman. In Bomberman the controlled agent has to kill opponents by placing bombs. The agent is represented by a multi-layer perceptron that learns to play the game with the use of Q-learning. We introduce two novel exploration strategies: Error-Driven-ε and Interval-Q, which base their explorative behavior on the temporal-difference error of Q-learning. The learning capabilities of these exploration strategies are compared to five existing methods: Random-Walk, Greedy, ε-Greedy, Diminishing ε-Greedy, and Max-Boltzmann. The results show that the methods that combine exploration with exploitation perform much better than the Random-Walk and Greedy strategies, which only select exploration or exploitation actions. Furthermore, the results show that Max-Boltzmann exploration performs the best in overall from the different techniques. The Error-Driven-ε exploration strategy also performs very well, but suffers from an unstable learning behavior.

In this paper we propose the use of vision grids as state representation to learn to play the game Tron using neural networks and reinforcement learning. This approach speeds up learning by significantly reducing the number of unique states. Furthermore, we introduce a novel opponent modelling technique, which is used to predict the opponent’s next move. The learned model of the opponent is subsequently used in Monte-Carlo roll-outs, in which the game is simulated n-steps ahead in order to determine the expected value of conducting a certain action. Finally, we compare the performance using two different activation functions in the multi-layer perceptron, namely the sigmoid and exponential linear unit (Elu). The results show that the Elu activation function outperforms the sigmoid activation function in most cases. Furthermore, vision grids significantly increase learning speed and in most cases this also increases the agent’s performance compared to when the full grid is used as state representation. Finally, the opponent modelling technique allows the agent to learn a predictive model of the opponent’s actions, which in combination with Monte-Carlo roll-outs significantly increases the agent’s performance.

The aims of this study were to evaluate the health-related quality of life (HRQL) according to: type of surgery, adjuvant oncological treatment and postoperative complications. We performed a retrospective case-control study between October 2013 and November 2014 at the Ear Nose and Throat Clinic of Cluj-Napoca. We included patients diagnosed with laryngeal or hypopharyngeal cancer treated with total or partial laryngectomy, and a sample of healthy volunteers recruited from the hospital stuff. We used the European Organisation for Research and Treatment of Cancer (EOTRC) core questionnaires (the QLQ-C30 version 3) and the head and neck cancer module (the QLQ-H&N35). We included in the study 80 patients diagnosed and surgically treated for laryngeal/hypopharyngeal squamous cell carcinoma and 20 healthy volunteers. Median age of the patients was 59.90 years. The most common location was the larynx, in 72 (90 %) of cases and the hypopharynx in 8 (10 %) cases. Sixty-six (82, 50 %) underwent total laryngectomy and 14 (17, 50 %) a partial laryngectomy. Forty-eight patients had received external radiation therapy, with adjuvant chemotherapy in 25 patients. Postoperative complication rates were 14 (17, 50 %) cases. We found a low score in total laryngectomy group regarding functional scales: role (28.03), emotional (37.75) and social (37.88) and a high score on insomnia (35.86) and financial difficulties (45.45). Partial laryngectomy group had a high score on functional scales: role (47.62), emotional (51.19) and social (52.38). These two QOL instruments were effective for Romanian patients. The QLQ-H&N35 questionnaire discriminating better the problems between groups compared with QLQ-C30.

Background and aim. Medical research needs statistical analyses to understand the reality of variable phenomena. There are numerous studies showing poor statistical reporting in many journals with different rankings, in different countries. Our aim was to assess the reporting of statistical analyses in original papers published in Clujul Medical journal in the year 2014. Methods. All original articles published in Clujul Medical in the year 2014 were assessed using mainly Statistical Analyses and Methods in the Published Literature guidelines. Results. The most important issues found in reporting statistical analyses were reduced reporting of: assumptions checking, difference between groups or measures of associations, confidence intervals for the primary outcomes, and errors in the statistical test choice or the descriptive statistic choice for several analyses. These results are similar with other studies assessing different journals worldwide. Conclusion. Statistical reporting in Clujul Medical, like in other journals, have to be improved.

Objectives: To assess the neonatal outcomes in newborns with intrauterine growth restriction (IUGR) in a Romanian population in a 3 level maternity unit. Methods: A matched case-control design, with one control for each patient was used. The case group comprised neonates with birth weight and birth length below the 10th percentile for the gestational age. Individual matching by gender and age of gestation was used to identify the control group. Both cases and controls were selected from the infants admitted to and discharged from the Neonatal Ward, at the First Gynecology Clinic, of the County Emergency Hospital Cluj-Napoca, Cluj-Napoca, Romania, between January 2012 and June 2014. Results: One hundred and forty-two subjects were included in each group. The cesarean delivery was significantly more frequent in the IUGR group (66.9%) compared with controls (46.5%; p =0.0006). The Apgar score at one minute was greater than or equal to 7 for most infants in both groups (77.9% IUGR group versus 77.5% control group), with no significant differences between the groups. A significantly higher percentage of infants in the IUGR group had hypoglycemia or intraventricular hemorrhage compared with the controls ( p less than 0.05). Hypoglycemia proved a significant factor for IUGR (odds ratio = 4.763, 95% confidence interval: 1.711-13.255). Conclusion: Hypoglycemia and intraventricular hemorrhage characterized the IUGR newborns. Saudi Med J 2015; Vol. 36 (8): 947-953 doi: 10.15537/smj.2015.8.11533

Background: Endometriosis is a frequent gynecologic disease with a severe impact on the quality of life in the affected women; its pathogenesis is yet to be fully understood, with an altered immunity as a possible key factor. The present study aimed to investigate the serum anti-inflammatory cytokine profile in the patients with endometriosis compared with the healthy controls. Materials and Methods: One hundred and sixty women were included, divided into two study groups (Group I - endometriosis; Group 2 - healthy women). We evaluated the serum levels of interleukin-1 receptor antagonist (IL-1Ra), IL-2, IL-2R, IL-4, IL-10, IL-13, and IL-15 with the use of Human multiplex cytokine panels. Statistical analyses (normality distribution analysis, independent t-test, Mann-Whitney U-test) were performed using IBM SPSS software (version 22.0) and GraphPad Prism (version 5.00); receiver operating characteristic curve were used to demonstrate the diagnostic performance of the studied markers. Results: The mean serum level of IL-1Ra, IL-4, and IL-10 were significantly higher in women with endometriosis compared to women free of disease from the control group (30.155, 138.459, and 1.489, respectively, compared to 14.109, 84.710, and 0.688, respectively; P < 0.001, P < 0.001, and P = 0.002, respectively.). No significant differences in the mean serum levels of IL-2, IL-13, and IL-15 were observed between the studied groups and IL-2R had a very low detection rate. Conclusion: Endometriosis is associated with elevated levels of anti-inflammatory cytokines, IL-1Ra, IL-4, and IL-10, markers that have a potential role as a prognostic factor for endometriosis.

Purpose. This study aims to evaluate the regression of retinopathy of prematurity (ROP) after one intravitreal injection of bevacizumab and the factors that influenced it.Methods. This retrospective case series was carried out at the “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. It includes all the consecutive infants treated for ROP with one intravitreal bevacizumab injection, from January 1, 2009, throughout July 31, 2013. The follow-up continued for 60 weeks after injection. We recorded ROP classification, regression, gender, gestational age, birth weight, postnatal age and postmenstrual age at treatment, and pregnancy type. Regression was analyzed according to each of the abovementioned factors, with the program IBM SPSS 20 (Chicago, Illinois, USA).Results. This study includes 74 eyes of 37 infants of which 52 had aggressive posterior ROP (70.27%) and 22 had zone I stage 3+ ROP (29.72%). One week after the bevacizumab injection, ROP regressed in 63 eyes (85.13%), with a statistically significant higher rate in zone I stage 3+ ROP (100%), as compared with aggressive posterior ROP (78.84%) (P=0.03). We recorded no complications subsequent to the intravitreal injections of bevacizumab. We identified no late retinal detachment.Conclusion. ROP regression rate after one intravitreal bevacizumab injection was 85.13%. This trial is registered with trial registration numberIRCT2014101618966N2.

The aim of the study was to investigate the serum pro-inflammatory cytokine profile in patients with diagnosed endometriosis. Material and methods: The study included 160 women, who were divided in two study groups (Group I – endometriosis; Group 2 – healthy). We evaluated the serum levels of interleukin (IL)-1β, IL-5, IL-6, IL-7, and IL-12, and of tumour necrosis factor α (TNF-α) with the use of Human Multiplex Cytokine Panels. Results: The serum level of IL-1β, IL-6, and TNF-α is significantly higher in women with endometriosis compared to women free of disease, from the control group (mean 10.777, 183.027, and 131.326, respectively, compared to 3.039, 70.043, and 75.285, respectively; p = 0.002, p < 0.001, and p = 0.015, respectively). No significant differences in the serum levels of IL-5 and IL-12 were observed between the studied groups, and IL-7 had a very low detection rate. Conclusions: Women with endometriosis have elevated levels of key pro-inflammatory cytokines, i.e. IL-1β, IL-6, and TNF-α. At the same time, IL-1β and IL-6 could be used as predictors for endometriosis.

Aims: Sonographic estimation of fetal weight is a fundamental part of the routine obstetrical practice and may affect management decisions particularly in multiple gestations. The data available on the accuracy of sonographic estimation of fetal weight in triplets are very limited. In the present study we investigated the accuracy of sonographic fetal weight estimation and discordancy in triplet gestations. Methods: We analyzed the sonographic data of 33 sets of triplets born at one medical center between January 2001 and March 2013. Estimated fetal weight was calculated from biometric measurements and compared with actual neonatal weights following delivery. The Pearson correlation coefficient, linear regression analyses, and Bland-Altman method were used for statistical comparisons. Results: The differences between predicted and actual birth weights (ABW) were r 2=0.86, P Conclusions: Weight assessment in triplets does not fall behind that of singletons or twins, and decisions based upon these examinations are reliable in the majority of cases.

Endometriosis has an incidence reaching up to 50% in infertile women. Cytokine-mediated immune responses seem to play an important role in endometriosis pathogenesis, but still the etiology and pathophysiology remain unclear. In the current study we tried to investigate whether there is a relationship between IL-10 genetic polymorphism, serum levels of IL-10 and the presence of advanced endometriosis. The presence of IL-10 592C/A, 819T/C, 1082G/A promoter polymorphisms and IL-10 serum levels were investigated in advanced endometriosis patients compared to healthy controls. Genomic DNA was extracted from peripheral blood leukocytes and further analyzed by PCR. IL-10 serum levels were higher in endometriosis group compared to controls (1.48, 0.68, p

As the web has evolved from Web 1.0 model to 2.0, 3.0 models different services occur. Healthcare 2.0 is defined as the use of social networks to promote collaboration between patients, health professionals, medical professionals and others in health care. In Romania, the social network users have on average 3 active accounts on different websites where they spend between 30 and 120 minutes daily. There is few data about their online behavior. The study investigates through a questionnaire the habits of subjects as consumers of health services in the online environment. The study showed that the most important sources for medical information are the doctor and the Internet. The information searched online is related to a specific disease, a drug or patient information leaflet, a treatment or procedure in a hospital or a private practice. The information is sought on medical websites, collaborative projects websites or forums.

Introduction: The purpose of this study was to develop and validate a self-reported questionnaire adapted for Romanian physicians. The questionnaire will be used to assess the knowledge, attitudes and clinical practice of physicians in the Romania regarding evidence-based clinical practice (EBP). Methods: The items of the questionnaire were generated after the review of scientific literature using a focus group of experts. Between 1st and 15th of December 2016, the developed EBP-questionnaire was administered to a cohort of resident/specialist physicians (n=32) to assess the face, content and construct validity as well as its applicability. Results: The final instrument contained 23 multiple choice questions (the responder can chose one or more than one answer), one question with dichotomial answer (yes/no) and 15 open questions. An average of the Likert scores equal with 4.5 (out of 5) and a Cronbach's score of 0.993 were obtained for the whole questionnaire. 62.5% (n=20) of the participants considered this questionnaire being useful and necessary to be expand through Romanian physicians. Conclusions: The results support the face, content and construct of our 38-items questionnaire that will be further apply to evaluate the knowledge, attitudes and clinical practice of physicians in the Romania regarding evidence-based knowledge and application of its principles in clinical practice.

Background and aim High risk newborns are often much smaller than healthy infants when are discharged from hospital. Different types of feeding: breastmilk, formula or mixed can influence growth rates and improve development. The aims of the study were to evaluate the growth rates; catch–up rate and some biological parameters of the nutritional status such as: hemoglobine, iron, calcium, phosphor, magnesium, the level of plasmatic protein, nitrogen balance at differents ages : 1-2-4-6 months in three different types of nutrition – breastmilk, special formula for premature, breastmilk with premature formula or started formula. Material and methods A retrospective study was performed in a tertiary neonatal care unit between 2011–2013 in the County Hospital of Cluj, Romania on 383 infants presented to periodical examination in the follow-up program: 465 records. We divided into 3 categories : group I-VG≤32 weeks, group II-VG between 32–36 weeks and group III-VG≥36 weeks of gestation. The evaluation consultations were performed at 1-2-3-4-5-6 months. Each evaluation consisted of determining: weight, CBC, calcium, iron, magnesium, protein, Blood Urea Nitrogen (BUN) levels. Informed consent was obtained Statistical analysis was made with Microsoft Excel 2016 and IBM SPSS v.23. Results Growth rate up to 6 months wasn ‘t significantly influenced by the type of feeding (p=0.319). Hemoglobine at 2 months highlighted statistically higher values in formula fed group: 11.77±2.07g compare with premature formula fed group:10.848±1,7556g(p=0.008). The values of iron at 2 months hasn’t presented any significant differences according to the types of feeding (p=0.475). There is a significant decrease of iron levels that occurs gradually with age in the breastfed ones, r=−0.89. Different calcium levels were registered according to types of feeding (p=0.003) until 6 months. Magnesemia were not influenced by feeding type at any groups. BUN in group I was significantly smaller in breastfed compared with premature formula fed infants(p=0.000) at 2 months. Up to 6 months the value is significantly lowered in cases of breastfed, p=0.001. The values of the protein in≤32 weeks is directly influenced by the type of feeding p=0.024. Protein levels is significantly influenced in group II(p=0.026). Phosphatemia is significantly influenced by the type of feeding in group II(p=0.043). ConclutionS Increase in bodyweight of newborns under 32 SS isn’t influenced significantly by the type of feeding up to 6 months. Calcium registered significantly different values under the different types of feeding in the prematures≤32 weeks of gestation in the first 6 months of life. Phosphoremia is significantly influenced by the type of feeding in the second group. Iron drops significantly with age in breastfedgroup. The level of protein in group I is directly influenced by the type of feeding. At 2 months of age BUN is significantly influenced by the type of feeding in the first group.

Introduction: Analyzing social media, insights about how products or services are perceived and used by customers can bring useful information. The aim of this study was to develop and validate 4 self-administered questionnaires to be used in the assessment of how consumers, healthcare professionals, medical students and healthcare providers use social media to retrieve health-related information. Methods: A 6 steps process was defined and applied: literature review, construct definition, survey writing, testing, reconciliation, and revision. The questionnaires had 3 focus areas: general usage, medical information retrieval, and demographics. Results: The student's questionnaires was not validated due to a low response rate (2.76% – 95%CI [1.38–4.83]). The questionnaire for healthcare providers went ahead without any changes. The validation of healthcare consumer's and healthcare practitioner's questionnaires led to changes. Conclusions: Three out of four questionnaires were successfully validated and proved reliable instruments to measure the use of social media in retrieving medical information.

The evolution of Internet from static Web “publishing” to the highly participative, and data-driven, innovations of Web 2.0 has been influencing how people search for health-related information. This review included studies indexed in the PubMed electronic database that focused on social media analysis, examining relationships between participants (patients and healthcare consumers) through social media usage. The obtained results showed that previous research regarding social media’s impact on patients and healthcare consumers aimed at a combination of platforms, but there is a penury of information about niche topics or its usage for retrieving medical information. Nevertheless, social media proved to be to be a promising tool in research mainly for recruitment purposes. The review has outlined that eHealth literacy is an attribute for populations that are female and relatively young and educated. Blogs share personal experiences, YouTube contains unregulated, high- and low-quality information that can mislead individuals, Facebook contains more marketing than health-related information, while Wikipedia is recommended for providing high-quality information. Despite healthcare practitioners’ and healthcare public institutions’ reluctance about the use of social media, this review demonstrates the usefulness of social media for patients and healthcare consumers in retrieving health-related information based on content availability and usage implications, and highlights gaps in knowledge that further research needs to fill.

Balancing the ratio between exploration and exploitation is an important problem in reinforcement learning. This paper evaluates four different exploration strategies combined with Q-learning using random stochastic mazes to investigate their performances. We will compare: UCB-1, softmax, epsilon-greedy, and pursuit. For this purpose we adapted the UCB-1 and pursuit strategies to be used in the Q-learning algorithm. The mazes consist of a single optimal goal state and two suboptimal goal states that lie closer to the starting position of the agent, which makes efficient exploration an important part of the learning agent. Furthermore, we evaluate two different kinds of reward functions, a normalized one with rewards between 0 and 1, and an unnormalized reward function that penalizes the agent for each step with a negative reward. We have performed an extensive grid-search to find the best parameters for each method and used the best parameters on novel randomly generated maze problems of different sizes.The results show that softmax exploration outperforms the other strategies, although it is harder to tune its temperature parameter. The worst performing exploration strategy is epsilon-greedy.

Background/aim: The aim of the study was to evaluate the serum concentration of main chemokines and interferons in patients with diagnosed endometriosis. Materials and methods: A total of 160 women were divided in two study groups (group 1 - endometriosis; group 2 - healthy women). Serum levels of IFN-α, IFN-γ, MCP-1, MIP-1α, MIP-1β, RANTES, eotaxin, IL-8, MIG, IP-10, and IL-17A were measured with Human Multiplex Cytokine Panels. Results. Serum levels of IFN-γ, MCP-1, and IL-8 were significantly higher (mean 14.03, 57.24, and 534.24, respectively, compared to 0.58, 20.51, and 259.82, respectively), and serum levels of IP-10 and eotaxin were significantly lower in women with endometriosis compared to the controls (mean 1.15 and 1.01, respectively, compared to 3.90 and 3.22, respectively). Conclusions. According to our results women with endometriosis have elevated levels IFN-γ, MCP-1, and IL-8, and lower serum levels of IP-10 and eotaxin, indicating unbalanced immune activity in endometriosis.

This paper focuses on cyber-security simulations in networks modeled as a Markov game with incomplete information and stochastic elements. The resulting game is an adversarial sequential decision making problem played with two agents, the attacker and defender. The two agents pit one reinforcement learning technique, like neural networks, Monte Carlo learning and Q-learning, against each other and examine their effectiveness against learning opponents. The results showed that Monte Carlo learning with the Softmax exploration strategy is most effective in performing the defender role and also for learning attacking strategies.

Multi-fetal pregnancy reduction (MFPR) is an ethically acceptable procedure aimed to increase survival and well-being of the remaining fetuses from high-order multiple gestations. In most cases we offer the procedure to triplets or quadruplets and opt to preserve twins; lately, the option to maintain a single fetus was suggested. We examined the outcomes of 140 pregnancies that underwent MFPR in our center and were followed to delivery – 105 were reduced to twins and 35 to singletons. The rate of procedure-related pregnancy loss was identical (2.9%). Leaving only one fetus was associated with a higher gestational age at delivery (35.4±2.4 weeks vs. 37.7±2.1 weeks, P

Introduction Hypercoagulation was suggested to be involved in preterm birth etiology; however, the coagulation state of preterm parturients remains unelucidated. The study aim was to evaluate the haemostatic system of pregnant women with premature uterine contractions (PUC). Materials and Methods The cohort study population consisted of 76 healthy pregnant women admitted with regular PUC. The study group included 38 women who experienced preterm birth; 14 of them had preterm premature rupture of membranes (PPROM). The control group included 38 women who eventually had term delivery. Groups were matched for maternal age, number of births and gestational age at admission. Blood samples were tested for haemostatic parameters and coagulation activation markers. Results Significantly shorter PT and aPTT were documented in the study compared to control group (25.7 ± 2 vs. 27.4 ± 2.7 seconds, P = 0.003, and 9.96 ± 0.5 vs. 10.1 ± 0.4 seconds, P = 0.05, respectively), although differences in absolute values were small. There was no significant difference between the two groups in levels of: fibrinogen, D-dimer, protein C-global, free protein S antigen, factor VIII activity, Von Willebrand factor, plasminogen activator inhibitor-1, prothrombin fragments F1 + 2 (PT F1 + 2), tissue factor and tissue factor pathway inhibitor. Women with PPROM had significantly lower PT F1 + 2 levels compared to those who had preterm delivery with intact membranes (351 ± 99 vs. 561 ± 242 pmol/L, P = 0.003). Conclusions Shortened PT and aPTT, reflecting increased thrombotic activity in maternal plasma, could serve as a marker of real preterm labor in women with premature uterine contractions. Further prospective studies in a larger cohort are warranted to validate these findings.