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Cross-societal differences in cooperation and trust among strangers in the provision of public goods may be key to understanding how societies are managing the COVID-19 pandemic. We report a survey conducted across 41 societies between March and May 2020 (N = 34,526), and test pre-registered hypotheses about how cross-societal differences in cooperation and trust relate to prosocial COVID-19 responses (e.g., social distancing), stringency of policies, and support for behavioral regulations (e.g., mandatory quarantine). We further tested whether cross-societal variation in institutions and ecologies theorized to impact cooperation were associated with prosocial COVID-19 responses, including institutional quality, religiosity, and historical prevalence of pathogens. We found substantial variation across societies in prosocial COVID-19 responses, stringency of policies, and support for behavioral regulations. However, we found no consistent evidence to support the idea that cross-societal variation in cooperation and trust among strangers is associated with these outcomes related to the COVID-19 pandemic. These results were replicated with another independent cross-cultural COVID-19 dataset (N = 112,136), and in both snowball and representative samples. We discuss implications of our results, including challenging the assumption that managing the COVID-19 pandemic across societies is best modeled as a public goods dilemma.

To assess whether continental extension and seismic hazard are spatially-localized on single faults or spread over wide regions containing multiple active faults, we investigated temporal and spatial slip-rate variability over many millennia using in-situ 36Cl cosmogenic exposure dating for active normal faults near Athens, Greece. We study a ~ NNE-SSW transect, sub-parallel to the extensional strain direction, constrained by two permanent GPS stations located at each end of the transect and arranged normal to the fault strikes. We sampled 3 of the 7 seven normal faults that exist between the GPS sites for 36Cl analyses. Results from Bayesian inference of the measured 36Cl data implies that some faults slip relatively-rapidly for a few millennia accompanied by relative quiescence on faults across strike, defining out-of-phase fault activity. Assuming that the decadal strain-rate derived from GPS applies over many millennia, slip on a single fault can accommodate ~ 30–75% of the regional strain-rate for a few millennia. Our results imply that only a fraction of the total number of Holocene active faults slip over timescales of a few millennia, so continental deformation and seismic hazard are localized on specific faults and over a length-scale shorter than the spacing of the present GPS network over this time-scale. Thus, (1) the identification of clustered fault activity is vital for probabilistic seismic hazard assessments, and (2) a combination of dense geodetic observations and palaeoseismology is needed to identify the precise location and width of actively deforming zones over specific time periods.

Background Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is recommended for the diagnosis of solid pancreatic masses. We aimed to evaluate whether a high needle movement acceleration value during puncture increases diagnostic accuracy. Methods EUS-FNA needle acceleration was measured using a PocketLab accelerometer connected by Bluetooth to a smartphone. Two passes (fast and slow, with higher and lower than 1g [9.8 m/s2] needle acceleration values, respectively) were performed in a random order. The sample cellularity and quality were measured using semiquantitative scales. Results 51 patients were included (32 women; mean age 63). The mean (standard deviation [SD]) acceleration values were 1.59g (0.66g) for the fast pass and 0.32g (0.19g) for the slow pass (P Conclusions A higher than 1g EUS-FNA needle acceleration may increase the diagnostic accuracy and specimen quality from solid pancreatic lesions.

The fertility preservation (FP) field has developed in the two decades and offers women the possibility to have genetic children at some point in life. Fertility preservation is urgent by definition, performed for social reasons or medical indications, such as impending gonadotoxic therapy or radical gynaecological surgery. One year after the pandemic was declared, the COVID-19 infection imposed several restrictions and limited access to health care for the infertile couple. Ovarian stimulation is a pharmacological treatment used to induce the development of ovarian follicles;FP guidelines provide different options for ovarian stimulation. We performed a systematic search on fertility preservation (FP) procedures during the COVID-19 pandemic using the keywords: FP, ovarian stimulation, assisted reproduction techniques (ART), and COVID-19. In order to update the different treatment strategies in ovarian stimulation on fertility preservation studied in the last ten years, we searched for randomized clinical trials (RCTs) focused on therapeutic agents used in current protocols, gonadotropins, gonadotropin releasing hormone (GnRH), clomiphene citrate (CC), letrozole, androgens, metformin, tamoxifen, glucocorticoids, aspirin, coenzyme Q10, and sildenafil. Fertility may be influenced by SARS-CoV-2 infection - especially in men;until more evidence confirms the effects on fertility, patients with COVID-19 positive should delay FP procedures if possible. Access to fertility conservation services decreased during the analysed period due to the medical services restrictions and the reorientation of medical resources on patients with COVID-19, without major changes in the current therapeutic protocols. In terms of pharmacotherapy in ovarian stimulation (OS) procedures, letrozole is first line therapy, superior to CC for OS. Similar ovulation and pregnancy rate can be obtained in letrozole - induced ovulation compared to gonadotropin protocol. Adjuvant therapies may be used for OS but lack proven efficacy. Further studies on adjuvant therapies and complementary support are needed, to ensure optimal condition in assisted reproductive interventions for fertility preservation, especially in gonadotoxic therapies.

Left ventricular non-compaction (LVNC) is an increasingly recognized phenotype. The current definition of the LVNC does not mention LV dysfunction as an absolute criterion in addition to morphological criteria. LV dilatation and decreased LV ejection fraction (LVEF) are often late manifestations of the disease and correlate with the occurrence of cardiovascular complications. However, to define LVNC as a cardiomyopathy, functional criteria must be fulfilled, in addition to the morphological ones. Multimodality imaging, such as myocardial deformation and myocardial work analysis derived from speckle tracking echocardiography (STE), in combination with cardiac magnetic resonance (CMR) might improve diagnosis and characterization of non-compaction, exposing earlier signs of LV systolic dysfunction. We present two comparative cases of LVNC in order to highlight the idea of subclinical dysfunction even in apparently benign forms with preserved LVEF, and also the importance of multimodality imaging approach.

Abdominal-perineal rectal amputation retains a well-defined place in the surgical treatment of rectal cancer, despite technical advances. The authors present the case of a 67-year-old patient who developed an entero-perineal fistula involving the last ileal loop, two years after an abdominal-perineal rectal amputation for a radiotreated rectal neoplasm. For surgical treatment of the fistula, right ileo-hemicolectomy with ileo-transverse anastomosis were performed. The fistulous tract is treated by soft field typhoon meshing in the same manner of treating the perineal wound after rectal amputation. The evolution is favorable, with the closure of the perineal wound, 6 weeks after surgery. The peculiarity of the case consists in the way of surgical solution. This case presentation is important due to the rarity of the ileo-perineal fistula after amputation of the rectum, as well as due to the particular way of surgical resolution.

International audience; Background: Ofatumumab, a subcutaneous anti-CD20 monoclonal antibody, selectively depletes B cells. Teriflunomide, an oral inhibitor of pyrimidine synthesis, reduces T-cell and B-cell activation. The relative effects of these two drugs in patients with multiple sclerosis are not known.Methods: In two double-blind, double-dummy, phase 3 trials, we randomly assigned patients with relapsing multiple sclerosis to receive subcutaneous ofatumumab (20 mg every 4 weeks after 20-mg loading doses at days 1, 7, and 14) or oral teriflunomide (14 mg daily) for up to 30 months. The primary end point was the annualized relapse rate. Secondary end points included disability worsening confirmed at 3 months or 6 months, disability improvement confirmed at 6 months, the number of gadolinium-enhancing lesions per T1-weighted magnetic resonance imaging (MRI) scan, the annualized rate of new or enlarging lesions on T2-weighted MRI, serum neurofilament light chain levels at month 3, and change in brain volume.Results: Overall, 946 patients were assigned to receive ofatumumab and 936 to receive teriflunomide; the median follow-up was 1.6 years. The annualized relapse rates in the ofatumumab and teriflunomide groups were 0.11 and 0.22, respectively, in trial 1 (difference, -0.11; 95% confidence interval [CI], -0.16 to -0.06; P

Patient-reported outcome instruments provide valuable insight into disease-related morbidity known only to the patient and complement more objective outcome tools in the clinical trial setting. They are of particular importance in systemic sclerosis owing to the challenges around defining disease activity, the episodic nature of many disease-specific manifestations and the paucity of validated objective surrogate outcome measures for use in clinical trials. Early clinical trials of systemic sclerosis often incorporated legacy patient-reported outcome instruments, but the last 20 years has witnessed the emergence of several scleroderma-specific instruments that are now being routinely used alongside other outcomes in systemic sclerosis clinical trials. More recently, the value of patient-reported outcomes has been highlighted by their prominence in the American College of Rheumatology Combined Response Index for Systemic Sclerosis that has been utilized as the primary endpoint of recent clinical trials of early diffuse systemic sclerosis. This review considers the role and performance of the various patient-reported outcome instruments utilized in systemic sclerosis clinical trials, the current positioning of patient-reported outcome instruments within clinical trial endpoint models across the range of systemic sclerosis disease manifestations and, where applicable, we shall highlight areas for future research.

Gastrointestinal stromal tumors (GIST�sare the most common mesenchymal neoplasms of the alimentary tract. Angiogenesis is an essential condition in the growth and development of tumors, especially in the case of GISTs due to their particular behavior. The aggressive behavior depends on the size and site of the tumor in close relationship with the intratumoral vascular development. The purpose of this study is to investigate, using immunohistochemical stainings, the types of intratumoral vessels in GIST�s, knowing the interrelation between the tumor angiogenesis and the response to the targeted antivascular therapy, influencing directly the prognosis. In our research, in all 37 cases the most numerous vessels were the immature and intermediate ones, signaling an increased angiogenic activity. The perivascular cell free vessels are the most sensitive at antivascular therapy with tyrosine kinase receptor inhibitors, providing a good response and prognosis to the treatment. Immature vessels evaluation especially, could be a an important sign in assessment of the effectiveness of antivascular therapy in GIST.

Male infertility is a common and complex problem affecting 1 out of 20 men. Despite extensive research in this area, in many cases, the underlying causes are unknown. Epigenetic changes control a series of processes within the body, including male fertility. Classification of infertile men using a more detailed analysis of DNA methylation patterns could reveal a new level of low rates of fertilization, implantation, or pregnancy. In this context, it seemed to us to use the techniques available to evaluate the degree of global methylation of DNA in infertile patients who have modified sperm counts, but also those who apparently do not have a clear cause of infertility. For this we used the Quest 5mC-Zymoresaerch-ELISA kit that can detect within about 5 hours the global level of genome methylation. Claims on which common illnesses have an epigenetic base are still open to speculation, but if true, it can imprint a new direction in medicine. Our data, although from a pilot study, are consistent with those in the literature. A recent study has shown that DNA methylation levels were significantly higher in oligoasthenoteratozoospermia patients than in the control group and the increase in global DNA methylation and histone retention in men with oligoasthenoteratozoospermia.

Gender dysphoria is not a condition that the Romanian pediatrician commonly encounters in his/her practice. However, in light of the progress made in order to diagnose early and establish a correct treatment, as well as in the evolving context of society, including the one of our country, medical cases will not be long in coming. This paper aims to briefly review, the main characteristics of the disease and the role that the pediatrician can play in the life of the patient already diagnosed or not yet, with gender dysphoria.

Background. In this article, we present a study that tries to characterize the patient with rectal cancer who addresses the Brașov County Emergency Clinical Hospital (SCJUBv). Aim. The aim of the study is to characterize from an epidemiological and clinical point of view the population group with rectal cancer that addresses the Brașov County Emergency Clinical Hospital, most of them being from Brașov County. We created a profile of the patient with rectal cancer in this area, outlining some risk factors. Material and methods. We conducted a prospective study of patients with rectal cancer hospitalized and operated in SCJUBv between 01.01.2013 and 31.12.2018. They were analyzed according to: age, sex, presence of associated diseases, symptoms at admission, presence of distant metastases, type of surgical treatment applied, local extension and histological type of the tumor. Results. The studied group includes 79 patients hospitalized and operated at the Brașov County Emergency Clinical Hospital. Of these, 49 were men and 30 were women. The average age of the group is 67.76 years. Patients in the study group had multiple associated conditions. The first five places are occupied by the following diseases: hypertensive disorder, ischemic heart disease, anemia, dyslipidemia, type II diabetes. At hospital admission, the patients showed the following symptoms: rectorrhagia, intestinal transit disorders, weight loss, pain in the lower abdomen, perineal pain, loss of appetite, nausea and vomiting. Preoperative imaging examinations (ultrasound, CT) revealed secondary determinations located in the intra-abdominal lymph nodes, hepatic and pulmonary. Rectal amputation was performed in 67 cases and anterior rectal resection with anastomosis in 12 of the cases. The analysis of the histopathological examination bulletins allowed the quantification of the local extension of the tumor. Conclusions. Based on this epidemiological and clinical study, we can draw the "robot portrait" of the patient with rectal cancer hospitalized in SCJU Brașov: is a 67-68 year old male, also presenting cardiovascular diseases with doctor appointment for rectal bleeding and intestinal transit disorders. Surgery will be performed with an amputation of the rectum. The histopathological diagnosis will be G2 adenocarcinoma in most cases

This paper examines women's movement between sex work and intimate economies, with a specific focus on how non-Chinese women in Hong Kong leverage intimacy as a means of managing legal and socio-economic precarity within various institutional and individual constraints. To capture the diversity of women's experiences, we use the term 'intimate-material exchanges' to broadly refer to compensation or material support provided in exchange for sexually intimate relations. We ground our analysis of the interactional processes involved in intimate-material exchanges in 39 interviews with ethnically non-Chinese women and men in Hong Kong. For the women in this study, intimate-material exchanges were shaped by migration and distinguished by pragmatism, strategy and intentionality that involved adapting, improvising and experimenting with sexual scripts in an ambiguous legal space in order to derive maximum material benefit. We conclude with a discussion of the implications of migration and intimate-material exchanges for sex worker rights.

Background Contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can visualize necrotic areas and vessels inside lesions. CH-EUS findings combined with EUS-guided fine-needle aspiration (EUS-FNA) improves diagnosis in pancreatic solid masses. CH-EUS can also guide EUS-FNA (CH-EUS-FNA), potentially improving the diagnostic rate of EUS-FNA, but such superiority has not been proved in prospective studies. We aimed to assess whether CH-EUS-FNA is superior to standard EUS-FNA for specific diagnosis of solid pancreatic masses and what factors affect the diagnostic rate. Methods This randomized controlled study in one tertiary medical academic center included patients with suspected pancreatic solid masses on transabdominal ultrasound or computed tomography (CT) scan. Two passes with a 22-G standard FNA needle were done using EUS-FNA and CH-EUS-FNA in random order, and the visible core obtained was sent for histological analysis. Final diagnosis was based on EUS-FNA or surgical specimen results and on 12-month follow-up by imaging. Results 148 patients were evaluated. EUS-FNA and CH-EUS-FNA showed diagnostic sensitivities of 85.5 % and 87.6 %, respectively (not significantly different) and the combined sensitivity of the two passes was 93.8 %. The false-negative rate was not significantly different when hypoenhanced or hyperenhanced lesions were compared with the EUS-FNA results. No differences were seen for the results related to location, size, tumor stage, chronic pancreatitis features, or presence of biliary plastic stent. Conclusions The diagnostic rates for samples obtained using 22-G needles with standard EUS-FNA and CH-EUS-FNA were not statistically significantly different.

We present an unusual case of an intra-abdominal collection which evidenced a rare etiology and raises diagnostic particularities. Background. Fish bones ingestion is frequent, but seldom followed by complications. Those are often reported at specific sites. Objectives. This case report emphasizes the unusual presentation and site localization of a colonic perforation by a small fish bone, in the context of limited radiological accuracy at the diagnostic phase. Case presentation. A 37 year old male was admitted to the gastroenterology ward with upper and left sided abdominal pain associated with fever and marked fatigue. His medical history was marked by a sleeve gastrectomy in 2010 for obesity. Abdominal signs and elevated acute inflammatory syndrome on blood tests were followed by computer tomography which revealed a pericolic mass near the left splenic flexure. The pain and fever increased in intensity, so a laparotomy was proposed. Intraoperatively, a tumor-like lesion was found and a resection with oncologic limits was performed. Microscopic examination of the specimen revealed a fish bone, but only after surgery did the patient confirm that he had eaten fish meal the week before. The post-operative period was uneventful. Conclusion. Fish bones remain some of the most frequently ingested alimentary foreign bodies; they may cause atypical clinical presentations, frequently omitted by the patients themselves if symptoms appear delayed. They could also lead to possible high-risk complications which need to be addressed by surgeons.

Recognition of simple shapes and numerosity estimation for small quantities are often studied independently of each other, but we know that these processes are both rapid and accurate, suggesting that they may be mediated by common neural mechanisms. Here we address this issue by examining how spatial configuration, shape complexity, and luminance polarity of elements affect numerosity estimation. We directly compared the Event Related Potential (ERP) time-course for numerosity estimation under shape and random configurations and found a larger N2 component for shape over lateral-occipital electrodes (250–400 ms), which also increased with higher numbers. We identified a Left Mid Frontal (LMF; 400–650 ms) component over left-lateralised medial frontal sites that specifically separated low and high numbers of elements, irrespective of their spatial configuration. Different luminance-polarities increased N2 amplitude only, suggesting that shape but not numerosity is selective to polarity. Functional microstates confined numerosity to a strict topographic distribution occurring within the LMF time-window, while a microstate responding only to shape-configuration was evidenced earlier, in the N2 time-window. We conclude that shape-coding precedes numerosity estimation, which can be improved when the number of elements and shape vertices are matched. Thus, numerosity estimation around the subitizing range is facilitated by a shape-template matching process.

Introduction. Scalp tumours raise multiple problems regarding the radical excision of the neoplasm followed by reconstructive surgery. Prolonged sun exposure and administration of immunosuppressive medication are the main risk factors for the onset of this neoplasm. The paper presents the advantages and disadvantages of scalp reconstruction using rhomboid flaps, after surgical excision of the skin cancer. Case presentation. The paper presents the case of a 83-year-old patient admitted for the treatment of squamous cell carcinoma located on the scalp. The pathological history of the patient showed that there were multiple hospitalizations for the treatment of chronic heart failure and hypertension. The therapeutic protocol included excision of a squamous cell carcinoma located in the scalp, followed by immediate reconstruction with three rhomboid flaps advanced towards the midline. The local evolution of the patient was favorable, the flaps integrating without complications, obtaining in this context a very good result from an aesthetic point of view. Conclusions. The use of the reconstructive technique involving the transposition of three rhomboid flaps to cover the soft tissue defects located in the scalp region is a feasible solution that offers very good aesthetic results.

Introduction. Breast cancer continues to be a major challenge, both in terms of risk factors and how they influence its evolution, as well as in terms of its treatment. Objectives. This study will show how age and oral contraceptives, used at different stages of patients' lives, influence or not, the evolution of breast cancer. Materials and method. The study was performed on a group of 90 breast cancer patients, hospitalized and operated in the Surgery Clinic 2 of the Braşov County Emergency Clinical Hospital. Results and discussions. The results of this study show how age and oral contraceptives influence the various variables of breast cancer, thus contributing to the understanding of the development of different forms of breast cancer and the application of therapeutic methods as effective as possible. Conclusions. Age and oral contraceptives significantly influence the development of breast cancer, depending on their use, at different stages of patients' lives.

Margaret Atwood’s The Handmaid’s Tale (1985) has recently returned to the spotlight with the success of its TV adaptation and with her decision to deliver a sequel. Speculative fiction invites speculative criticism; in this spirit, this paper investigates The Testaments (2019), tracing the rewriting of politics embedded in the narrative. Whilst the inspiration for The Handmaid’s Tale came from the rise of Christian fundamentalism, it is obvious from Atwood’s more recent statements that she considers the Trump era “a rollback of women’s rights” (2018). The slogan of second-wave feminists, ‘the personal is political,’ is now as topical as it was in the 1960s, and The Testaments may well become a literary manifesto of a new (fourth) wave as part of the storm surge of feminism. Therefore, before turning to Atwood, an outline of the chronological clashes of feminism(s) and a discussion on women and language is presented. This is followed by an examination of the three main characters and representatives of ideas.

The calcaneal spurs are a specific condition of middle and old age. It manifests through plantar osteophytosis on plantar fascia insertion, and is largely associated with plantar fasciitis. Calcaneal spurs are asymptomatic until they are mechanically irritated and inflamed, they respond through a local intense pain. The proposed treatment is conservative, and uses physiotherapy applied locally such as TENS current, ultrasound and passiv/active stretches. The study was performed on a group of 10 patients, treated daily with the physiotherapy complex program. Patients are evaluated according to the VAS pain assessment scale at the beginning of the treatment and at the end. The evaluated parameters were: pain at rest, pain in standing position, and pain in walking. The results showed a favorable evolution in pain reduction, in all patients treated within 10 days. All the data obtained from the evaluations were processed statistically based on specialized software.

ObjectivesPatient-reported outcome measures (PROMs) are important for clinical practice and research. Given the high unmet need, our aim was to develop a comprehensive PROM for systemic sclerosis (SSc), jointly with patient experts.MethodsThis European Alliance of Associations for Rheumatology (EULAR)-endorsed project involved 11 European SSc centres. Relevant health dimensions were chosen and prioritised by patients. The resulting Systemic Sclerosis Impact of Disease (ScleroID) questionnaire was subsequently weighted and validated by Outcome Measures in Rheumatology criteria in an observational cohort study, cross-sectionally and longitudinally. As comparators, SSc-Health Assessment Questionnaire (HAQ), EuroQol Five Dimensional (EQ-5D), Short Form-36 (SF-36) were included.ResultsInitially, 17 health dimensions were selected and prioritised. The top 10 health dimensions were selected for the ScleroID questionnaire. Importantly, Raynaud’s phenomenon, impaired hand function, pain and fatigue had the highest patient-reported disease impact. The validation cohort study included 472 patients with a baseline visit, from which 109 had a test–retest reliability visit and 113 had a follow-up visit (85% female, 38% diffuse SSc, mean age 58 years, mean disease duration 9 years). The total ScleroID score showed strong Pearson correlation coefficients with comparators (SSc-HAQ, 0.73; Patient’s global assessment, Visual Analogue Scale 0.77; HAQ-Disability Index, 0.62; SF-36 physical score, −0.62; each pConclusionsWe have developed and validated the EULAR ScleroID, which is a novel, brief, disease-specific, patient-derived, disease impact PROM, suitable for research and clinical use in SSc.

As the European Union adopted the Green Deal [1] and proposed the framework for achieving climate neutrality by the end of 2050 [2], industrial end-users are more focused than ever on achieving the highest possible environmental impact reduction. The main focus of future investment in the industrial sector will now be on diminishing the $\mathrm{C}\mathrm{O}_{2, eq}$ emissions, in order to maintain financial stability, especially in the context of the fourth phase of the EU-ETS mechanism [3], which implies a constant reduction in the number of CO 2 certificates allocation until 2030. This will lead to a potential decrease of investment in the electricity end-use efficiency of various industrial sectors. In this paper, the economic impact generated by the power transformers in various industrial end-users boundaries, relative to actual operating scenarios was analysed in order to determine the best course of action for the sector to minimize the operating costs with the internal power distribution grids.

Retrieving electrical impedance maps at the nanoscale rapidly via nondestructive inspection with a high signal-to-noise ratio is an unmet need, likely to impact various applications from biomedicine to energy conversion. In this study, we develop a multimodal functional imaging instrument that is characterized by the dual capability of impedance mapping and phase quantitation, high spatial resolution, and low temporal noise. To achieve this, we advance a quantitative phase imaging system, referred to as epi-magnified image spatial spectrum microscopy combined with electrical actuation, to provide complementary maps of the optical path and electrical impedance. We demonstrate our system with high-resolution maps of optical path differences and electrical impedance variations that can distinguish nanosized, semi-transparent, structured coatings involving two materials with relatively similar electrical properties. We map heterogeneous interfaces corresponding to an indium tin oxide layer exposed by holes with diameters as small as ~550 nm in a titanium (dioxide) over-layer deposited on a glass support. We show that electrical modulation during the phase imaging of a macro-electrode is decisive for retrieving electrical impedance distributions with submicron spatial resolution and beyond the limitations of electrode-based technologies (surface or scanning technologies). The findings, which are substantiated by a theoretical model that fits the experimental data very well enable achieving electro-optical maps with high spatial and temporal resolutions. The virtues and limitations of the novel optoelectrochemical method that provides grounds for a wider range of electrically modulated optical methods for measuring the electric field locally are critically discussed., Microscopy: phased-in approach puts nanoscale electrical impedance on the map A microscope capable of real-time, label-free analysis of nanoscale structures and their associated electrical properties could find applications in both biology and materials science. High-resolution microscopy methods that detect variations in the phase of a laser as it passes through samples are helping researchers overcome the limits of traditional optical imaging. In a joint effort, the groups led by Eugen Gheorghiu from the International Centre of Biodynamics in Bucharest, Romania, and by Gabriel Popescu from the University of Illinois at Urbana Champaign have now developed an instrument that combines phase imaging with alternating voltage perturbations to measure a target’s refractive index and electrical impedance maps that can reveal properties including tumors in human tissue, or defects on coating surfaces. The team’s microscope proved capable of distinguishing the impedance contrasts and geometry of different nanostructures on a macroelectrode with submicron resolution.

In this paper an overview of the construction materials industry, from an embedded energy point of view will be presented. A case study for four brick factories in Romania will also analyzed. The Energy Performance Indicators (EnPI) of each factory will be evaluated and compared with the global reference values and the most technically and economically feasible Energy Performance Improvement Actions (EPIAs) will be presented. The replicability of these EPIA’s in different materials manufacturing industries will be also analyzed.

Waste Heat Recovery (WHR) Systems are spreading more and more in cement factories and are essential in achieving the energy performance required by the European Directives, legislation, and standards. Using WHR Systems may assure an important percentage of the energy required by the manufacturing process, with no additional fuel and no additional greenhouse gas emissions. Using the waste heat as a power generation source, increases the energy efficiency of the process and decreases the thermal energy losses. As long as the kiln is functional, so is the WHR powerplant, generating the energy in an efficient manufacturing process with low operational costs and increased reliability. This paper aims at evaluating the actual technic and economic performance of a WHR System compared to the estimated performance determined in the feasibility study which was done prior to the investment in order to prove the viability of the technology in the cement manufacturing industrial sector. The paper proves that the WHR proved to be financially inefficient if the feasibility study input data was considered and correlated with the actual technical performance but lead to extremely attractive financial indicators when considering actual, updated capital expenditures and operational expenditures and technical performance.

As Cryptocurrency becomes more and more popular so does its demand for mining rigs. At the end of 2020 there were approximately 5,392 different cryptocurrencies available with a total market capitalization of more than $201bn [1]. Cryptocurrencies are using decentralized, distributed systems in order to operate. The mining process involves solving cryptographic equations, which are ultimately used for ensuring encryption of the blockchain transactions, through the use of IT equipment - the most efficient way of doing it being by building mining farms which use Graphics Processing Units (GPUs). The Crypto farmers are rewarded with a share of the transaction they facilitate. As the Cryptocurrency market grows exponentially every year, so does its hunger for energy. For example, the Bitcoin Energy Consumption Index is evaluated to reach 77.782 TWh/year in 2021 [2], which, for comparison, is approximately 1.5 times larger than the entire electricity consumption of Romania in 2020 [3]. In this paper, the transition of Cryptocurrency mining processes towards environmental sustainability will be analysed. A Crypto-farm’s Energy Performance Indicators (EPI) and Power Quality Indices (PQI) will be evaluated and, with the use of dedicated software solutions, the authors will propose an action plan to minimize the environmental impact of the energy boundary and to maximize the EPI, thus maximizing the profitability of this new type of business.

Iodoform (triiodomethane), a yellow crystalline solid, belonging to the family of organic halogen compounds, is used as an antiseptic. Its antiseptic action is due to the slow release of iodine under the action of catalase from wounds. Currently, it is widely used only in dentistry and in veterinary medicine. We have extended, with good results, the use of iodoform as an antiseptic for other types of surgical or traumatic wounds that have been infected with piogens. Between 2009 and 2018, on 242 cases of different wounds, we obtained good results, with no severe adverse effects.

Season of birth, a surrogate of seasonal variation of environmental exposures, has been associated with increased risk of several cancers. In the context of a Southern-Eastern Europe (SEE) consortium, we explored the potential association of birth seasonality with childhood (0-14 years) central nervous system (CNS) tumors. Primary CNS tumor cases (n = 6,014) were retrieved from 16 population-based SEE registries (1983-2015). Poisson regression and meta-analyses on birth season were performed in nine countries with available live birth data (n = 4,987). Subanalyses by birth month, age, gender and principal histology were also conducted. Children born during winter were at a slightly increased risk of developing a CNS tumor overall [incidence rate ratio (IRR): 1.06, 95% confidence intervals (CI): 0.99-1.14], and of embryonal histology specifically (IRR: 1.13, 95% CI: 1.01-1.27). The winter peak of embryonal tumors was higher among boys (IRR: 1.24, 95% CI: 1.05-1.46), especially during the first 4 years of life (IRR: 1.33, 95% CI: 1.03-1.71). In contrast, boys

Optimal wound care is an essential component in the management of systemic sclerosis (SSc) digital ulcers (DUs). DU debridement has been suggested to reduce ulcer-related pain and improve tissue healing. However, only a minority of rheumatologists perform DU debridement, and there is no standard of care/protocol. Our objectives were to (i) evaluate the current evidence for the use of debridement in DU management and (ii) assess whether there are any specific protocols. A systematic literature review was performed searching the PubMed database (between 01/01/1950-01/03/2019) in accordance with PRISMA guidelines. Two independent reviewers screened and extracted the abstracts/full manuscripts. Articles in English, which focussed on SSc-DU debridement/curettage, were included. Exclusion criteria included studies of juvenile/paediatric patients and basic/non-clinical research. Our search identified 1497 studies of which 4 studies were included in our final analysis. Three studies used scalpel debridement, and one study used this in combination with autolytic debridement. No studies specifically reported the effect on DU healing from debridement. Autolytic debridement with hyaluronate-based products was associated with significant ulcer pain and inflammation. Local anaesthetic significantly reduces pain both during and after debridement. Combined local and oral analgesia is often required for more severe or infected DUs. DU (scalpel and autolytic) debridement is being used by some clinicians in rheumatology; however, there are no standardised protocols. To improve wound care for SSc-DUs, future research should focus on developing a standardised protocol for SSc-DU debridement, with a view to facilitate randomised controlled trials to demonstrate safety and treatment efficacy.Key Points• Optimal wound care is an essential component in the management of systemic sclerosis-digital ulcers.• 'Sharp' debridement uses a scalpel, whereas 'autolytic' debridement uses dressings to optimize endogenous tissue lysis.• There is significant variation in the use of digital ulcer debridement in systemic sclerosis.• A standardized protocol and randomized controlled trials are needed to demonstrate debridement the safety and efficacy of digital ulcer debridement in systemic sclerosis.

Autonomous vehicles represent the future of transports, with many benefits, especially regarding safety. Communication is part of this concept, and the possibility to communicate with other vehicles and/or infrastructure equipment to obtain safety-related information is essential. Also, knowledge about traffic, estimation of arrival and departure times in certain points of the road network is really helpful to all the participants. In this paper is analyzed a method to predict times for public transport system. The implemented application can provide essential information for any of the above systems, since the input data are more accurate and entered as quickly as possible, the lower the default Kalman filter error of the application.

The aim of this study is to identify the restoration methods used by dentists in Romania and to relate them to the development of coronal or mixed fractures. Matherials and methods. 400 panoramic radiographies made between 2012 and 2017 were analized by an endodontics specialist. Teeth with endodontic treatment were identified and analized, their restoration method was noted and the fractures were detected. Results and discussions. The restoration methods prefered by the dentist in Romania are: dental bridges (35.72%), individual crowns (33.25%), fillings (28.64%) and a low percentage of onlays and other types of restorations. Fractures occur in less than 20% of the teeth, most of them from the lateral region. The main reasons for the appearance of fractures are: massive coronal direct restorations, bulky direct metallic posts that reduced the resistance of the roots, abutments and loosening of crowns. Conclusions. Endodontic treatments are more necessary in lateral teeth, direct fillings being the restoration method that led to the development of most of the fractures. Individual crowns have the lowest failure rates, while teeth without posts fractured twice as much as teeth that have them.

Pituitary adenomas represent approximately 15% of brain tumors; incidence is significantly on the increase due to widespread use of magnetic resonance imaging. Surgery remains the first-line treatment for most tumors overall. The role of dopaminergic agonists (DAs) and somatostatin receptor ligands (SRLs) in the treatment of pituitary adenomas is quite well established for prolactinomas and growth hormone (GH) excess. However, over the last decade new multi-receptor binding SRLs are increasingly used for treatment of acromegaly and Cushing’s disease. SRLs/DA chimeric compounds seem to have enhanced potency and efficacy when compared to that of individual SRLs or DA receptor agonists according to preclinical data. However, following negative results, more research is needed to determine if this interesting mechanism will translate into positive clinical effects for acromegaly patients. Furthermore, new agents that block adrenal steroidogenesis have been developed in phase III clinical trials for Cushing’s disease and several new compounds working at the pituitary level and/or blocking the glucocorticoid receptor are also in development. Combination therapy of drugs with similar or different mechanisms (possibly synergistic) are also on the increase. A growing awareness regarding all mechanisms involved in both control of pituitary secretion and cellular proliferation might allow for sole medical treatment of pituitary adenomas, especially macroadenomas, rather than surgery and/or radiation therapy, in the future. Moreover, the underlying decision on how to treat patients with pituitary adenomas should be individualized on a case-by-case basis with not only a goal of tumor shrinkage and biochemical control, but also of improving patients’ quality of life.

Calcium hydroxide is the most used intracanalar medicament between apointments. It shoud be properly removed before root canal filling because its remnants could compromise the sealing of root obturation. The aim of this study was to compare the effectiveness of two type of irrigation solutions, EDTA and SmearClear in the removal of calcium hydroxide from root canals. Materials and method: twenty human single rooted teeth were prepared using ProTaper Universal instrumentation till F2, .06 taper. The canals were filled with Ca(OH)2 and after 7 days the Ca(OH)2 was removed using 3 rinses of 5 ml 15% EDTA and 5 ml 5.25% NaOCl alternately (group 1; n=10) or 3 rinses of 5 ml Smear Clear (SybronEndo) and 5 ml 5.25% NaOCl alternately (group 2; n=10). Results: On the final radiographs the best result was found in group 2 where the cleanliness of the total surface of the root canal wall when SmearClear was used obtained better results comparative to NaOCl – 15% EDTA (91.34% to 71.69%). Conclusions: under the limitation of this study, SmearClear was superior in removing Ca(OH)2 material compared to NaOCl and 15% EDTA irrigation solution.

The article is based on the GoScience project funded by the Erasmus+ programme. The project relies on the European context, where in spite of the development of science and technology fewer and fewer students follow a science career let alone one in agricultural sciences. As a result professors of science and their students from seven European countries have joined their efforts to identify innovative practices to motivate students to study and pursue a career in science. The aim of the project is to develop innovative tools for science teaching and learning which will make science education more appealing and empower students to take ownership of their learning. The article studies the main findings of the project’s research on methods and techniques used in teaching science and reading comprehension skills applied to scientific texts in foreign languages in Romania. The project’s research has identified a common conclusion: an effective reading comprehension instruction would bring about significant changes in students’ motivation to study science.

This article presents specific aspects regarding the role of endodontic medication in the conservative treatment in chronic apical periodontitis. Starting from the bacterial microflora, the etiological factor of the periapical lesions, we discuss about the modalities of identification by the means of in vivo and in vitro tests of the microorganisms present inside the root canal. The characteristics of these methods of microbiological evaluations, as well as their clinical relevance, are reviewed. The general characteristics of endodontic antimicrobial medication are presented, as well as the causes of endodontic failures in treatment in chronic apical periodontitis. It is underlined the essential importance of the rigorous biomechanical treatment, in association with endodontic lavage, which makes the antibacterial medication only have a subordinate role in the treatment of chronic apical lesions.

Purpose The paper aims to develop a microcredit evaluation model (MEM) which could serve as a useful tool for banks and NBFIs when SMEs’ economic and financial risks are evaluated. Design/methodology/approach Based on the literature review, a set of 17 qualitative and quantitative prudential indicators is selected. Further, a calculation system is developed which relies on the multiple criteria analysis model elaborated by Altman (1968); starting from this, a matrix is developed and a rating system is built. The model is tested among six NBFIs which operate on the Romanian market; three of them are labeled by the Romanian Central Bank as the worst performers, while the other ones are qualified as the best performers. Data are collected from companies’ annual reports and also from the Ministry of Finance. Findings It proves that the MEM can serve as a useful tool for the national and international NBFIs’ risk assessment. It can anticipate NBFIs’ success or fall. Furthermore, its results can be guaranteed with a probability of 95 per cent, calculated through the VaR method. Last but not least, it can also be used by the international NBFIs which intend to enter in the Romanian market. Originality/value The present paper proposes an original model based on both quantitative and qualitative indicators organized in an integrative equation. The MEM helps both parties involved in the financial grant awarding process – NBFIs are able to better assess requests from SMEs, enabling them to increase the volume of granting, whereas SMEs are able to access money for development projects more easily.

Introduction. Schools are favorable environment for information dissemination on disease prevention and supporting the health-related behaviors in oral education and promotion programs. Material and methods. The study comprised 240 middle school students aged between 10 and 15 years, 57.5% of whom were female. Pupils received an anonymous questionnaire on the level of knowledge about risk factors for tooth decay and caries prevention methods and then an oral health experiential education lesson. Results. The knowledge level is relatively high in terms of sugar consumption's and tooth brushing role on dental caries. Subjects are less informed about the involvement of the dental plaque and other risk factors. Family is the main source of oral health information, and many students rarely visit the dentist. Conclusion. There is a need for preventive programs in schools, involving teachers and parents to develop a favorable environment to health education.

Introduction. Struma ovarii represents a rare tumor, only 1% of the ovarian tumors, with an incidence of 0.3-0.7%. The positive diagnosis is obtained by microscopic examination; sometimes elevated serum levels of thyroid hormone, CA 125 and ultrasound aspects can suggest the preoperative diagnosis. Case presentation. We report the case of a 56-year-old woman with unilateral struma ovarii and no clinical or paraclinical evidence of the diagnosis to come. Transvaginal ultrasound revealed polyfibromatous uterus and apparently normal adnexa. Partial hysterectomy with bilateral salpingo-oophorectomy (considering the patients’ age) through laparotomy was performed under spinal anaesthesia. The histopathological result showed an endometrial polyp, multiple intrauterine leiomyomas, left ovary with thyroid follicles, which looked like normal thyroid tissue. The evolution of the patient was favorable, with no complications at the 6 months’ follow-up. Conclusions. In the literature, there are only a few cases of benign struma ovarium, and even less cases of malignant struma ovarium or bilateral presentation of the tumor. The particularity of the case consists in the diagnosis of struma ovarii only after surgery, in a patient without clinical or paraclinical evidence of this diagnosis.

Introduction. Inflammatory rheumatic diseases are sometimes the first manifestation of neoplasia. Case presentation. A 57 year old female patient, heavy smoker, is admitted to our clinic for 2 days old pulp necrosis of the third finger, right hand, with onset of ischemia 1 week before admission. Other manifestations were Raynaud’s phenomenon, dry mouth, dysphagia and shortness of breath after moderate physical activity with a duration of about 6 months. She was repeatedly followed-up by a pulmonologist with chest computer tomography, which detected a dimensional evolutionary mediastinal lymph node, but not investigated further. The patient had skin thickening of the hands and face, microstomia and an area of dry necrosis of 1.5/1cm in the pulp of the third finger, right hand. Laboratory tests show the presence of antinuclear antibodies with positive anti SS-A antibodies and elevated levels of serum inflammatory markers. Vascular surgery examination excludes thromboangiitis obliterans or other large vessel diseases. The presumptive diagnosis is undifferentiated connective tissue disease with systemic sclerosis and Sjögren syndrome elements, most likely secondary to the mediastinal tumor. Mediastinal biopsy shows a heterogeneous metastasis of unknown origin, and further investigations: immunohistochemistry, multiple gene mutations tests, computed tomography scan of the chest, abdomen, and pelvis, mammography, Papanicolaou test and positron emission tomography scan did not identify the primary tumor, thus delaying oncologic treatment. Conclusion. Case of undifferentiated connective tissue disease with elements of systemic sclerosis and Sjögren syndrome, most probably paraneoplastic, with chest metastasis of unknown origin, in which diagnosis and treatment were delayed due to lack of primary tumor identification.

Deep caries progress is associated with tertiary dentin formation and additional reversible or irreversible dental pulp inflammation. It seems that some particular signs of pain in irreversible pulpitis are associated to a particular caries microflora. Streptococcus species, Parvimonas micra and Dialister invisus are prevailing in cases of throbbing pain while Streptococcus mutans is incriminated in sensitivity to vertical percussion of tooth. Continuous pain is thought to be the clinical outcome of Lactobacillus implication. A better understanding of molecular signals and mechanisms induced by microbiome of deep caries that orchestrate the modulation of dental pulp complex response toward tertiary dentinogenesis or pulp inflammation it is supposed to improve diagnosis and conservative therapies of vital pulp.

Regular medical attendance proved to have a positive impact on health, therefore the aim of the study is to detect the reasons and frequency for health care use among a group of 110 urban dental patients aged between 33 and 75 years, 50% males. The subjects completed an anonymous questionnaire with items related to their medical visits patterns: reason (treatment/control and emergency) and frequency of healthcare services use; self-assessed oral and general health and socio-demographic data. Most of the patients were adults (81.8%) and with more than 12 years of study (50%). In terms of reason for attending the dental office, 72% visited the dentist for emergency reasons, mainly men, elderly, patients with low level of education, and those who self-rated their oral health as satisfying or poor. Regarding medical visits, 54% from all patients attended healthcare for emergency reasons, regardless age, gender, education level and self-perceived general health. The results showed that worse healthcare services use is associated with low education level and gender, especially men visited the dentist when there is pain only. There is need to increase the number of individuals who use regular health care, for prevention and early detection of diseases.

Overt hyperthyroidism (HT) during pregnancy is associated with a risk of maternal–fetal complications. Antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal–neonatal hypothyroidism. This study evaluated ATD treatment and thyroid function control during pregnancy, and pregnancy outcome in women with HT. Patients and methods: A retrospective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 ± 4.7 years) with HT diagnosed before or during pregnancy, a control group of 39 healthy euthyroid pregnant women was used. Results: Twenty-six women had Graves’ disease (GD, 33 pregnancies), 1 had a hyperfunctioning autonomous nodule, and 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical HT, 5 euthyroid with previous GD remission before conception). In the 8 pregnancies of GD patients diagnosed during gestation or shortly before (&lt, 6 weeks), i.e., with fetal exposure to uncontrolled HT, there was 1 spontaneous abortion at 5 weeks (3.4% of all ATD-treated pregnancies), and 1 premature delivery at 32 weeks with neonatal death in 24 h (3.4%), 1 child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). In women treated more than 6 months until conception (20 pregnancies): (a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy, (b) ATD was withdrawn in 40% of pregnancies in trimester (T)1, all on MMI &lt, 10 mg/day (relapse in 14.2%), and in up to 55% in T3, (c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T1, T2 and T3 respectively, FT4 was increased in 5.8% (T1) and subnormal in 11.75% in T2 and T3, (d) no fetal birth defects were recorded, one fetal death due to a true umbilical cord knot was registered. Mean birth weight was similar in both ATD-treated and control groups. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 ± 2.6 months). Conclusion: In hyperthyroid women with long-term ATD treatment before conception, drugs could be withdrawn in T1 in 40% of them, the thyroid function control was better, and pregnancy and fetal complications were rarer, compared to women diagnosed during pregnancy. Frequent serum TSH and FT4 monitoring is needed to maintain optimal thyroid function during pregnancy.

Background and Objectives: Myelomeningocele is the most severe form of spina bifida, a congenital neural tube defect arising from an incomplete neural tube closure during early development with damage worsening with advancing gestational age. The Management of Myelomeningocele Study (MOMS) Trial proved that surgery performed before 26 weeks of gestation significantly improved the prognosis, significantly changing treatment paradigms. This article aims to provide a review of the changes and updates in spina bifida repair over the 10-year period following the MOMS Trial. Material and methods: We performed a systematic review in the PubMed and Cochrane databases as well as a hand-search of high-impact journals using the reference list of all identified articles, searching for randomized controlled trials and observational studies. Results: We identified 27 articles published between 2011 and 2021 that fulfilled the inclusion criteria and review them in the present study. Conclusions: With growing experience and with the improvement of prenatal open and fetoscopic techniques, the outcome of SB-associated conditions could be improved and the risks to both the mother and the fetus reduced. A continuous follow-up of the treated infants and further randomized trials are essential to study the complications and advantages or disadvantages of any given treatment strategy.

Computer vision has advanced greatly in the last years, providing a useful tool to extract information from images and video streams, enhancing the capabilities of classical video detection algorithms. In the transport field, it may be used in many applications, like information systems (for people and vehicle count, identification of lost objects, etc.), but is mature enough to be trusted also safety systems (monitoring rails for foreign objects, illegal crossings, and many more). In this article, the authors present a solution to detect crowdedness in public transport stations, that can be helpful for local authorities/public transport operators to make proper decisions regarding anti-Covid measures, but also enhance the response of the public transport system.