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This paper investigates the determinants of environmental sustainability by analyzing the impact of various economic, fiscal, and energy-related variables on greenhouse gas (GHG) emissions and energy intensity (EI) across 27 European Union member states from 2005 to 2022. Using dynamic panel data analysis through the system Generalized Method of Moments (GMM) estimator, we explore how key factors such as GDP per capita growth, foreign direct investment (FDI), portfolio investments (PI), trade openness (TO), and stock market performance (SMP) influence environmental outcomes. Additionally, the analysis examines the role of fiscal policies, represented by government deficit/surplus (GDT), and energy-related factors, such as renewable energy consumption (REC) and research and development expenditure (ERD), in shaping sustainability. The findings reveal that while GDP growth correlates positively with increased GHG emissions, it negatively impacts energy intensity, suggesting that economic expansion may drive emissions upward while concurrently promoting greater energy efficiency. Trade openness significantly mitigates GHG emissions, indicating that enhanced international trade facilitates access to cleaner technologies. The effects of FDI and PI present a more ambivalent picture, often associated with elevated GHG emissions in the absence of stringent regulatory frameworks. Notably, renewable energy adoption emerges as a critical driver of sustainability, effectively mitigating the environmental impacts of globalization. This study provides valuable insights into the complex interplay between economic globalization and environmental sustainability, offering actionable policy recommendations to align economic growth with the EU's long-term environmental objectives.

Introducere. Conform datelor OMS, cancerul reprezintă una din principalele cauze de deces în țările dezvoltate, cedând numai maladiilor cardiovasculare. Astfel, în fiecare an, pe glob decedează de cancer circa 10 mln de oameni. Se presupune că mortalitatea prin cancer în lume va continua să crească și până în 2030 numărul de decese de cancer va depăși cifra de 11 mln. Aproximativ 19% din toare cancerele sunt cauzate de factorii mediului ambiant, inclusiv și de condițiile de muncă nesatisfăcătoare. Se etimează că 1,3 mln. decese au loc în fiecare an din cauza factorilor profesionali. Obiective. Identificarea factorilor de risc cancerigeni ocupaționali primari și evaluarea impactului acestora asupra sănătății lucrătorilor. Material și metode. Acest studiu a folosit o metodologie de revizuire sistematică a literaturii pentru a identificarea și analiza factorii de risc asociați cu cancerul profesional și pentru a evalua strategiile preventive. Articolele au fost obținute din baze de date precum PubMed și Google Scholar publicate în ultimii 14 ani, folosind cuvinte cheie predefinite și operatori booleeni. Revizuirea a inclus studii publicate în ultimele decenii care se concentrează pe diverse industrii și expuneri profesionale. Rezultate. În UE și în alte țări dezvoltate, cancerul reprezintă un procent estimat la 53% din decesele profesionale; ca urmare, date fiabile privind expunerea profesională la factorii de risc de cancer sunt esențiale atât pentru siguranța și sănătatea lucrătorilor, cât și pentru o economie productivă și durabilă. În cazul cancerului, cauza bolii este multifactorială, iar, în prezent, există un număr mare de cancerigeni umani cunoscuți. Este bine cunoscut faptul că agenții cancerigeni profesionali rămân a patra cea mai frecventă cauză de cancer în lumea occidentală dezvoltată. Determinarea riscului de cancer profesional este complicată și mai mult de o serie de factori profesionali și neprofesionali, perioada de latență lungă pentru dezvoltarea cancerului și susceptibilitatea indivizilor la agenți cancerigeni, diferențele dintre cancerele profesionale și non-profesionale, etc. Concluzii. Argumentarea măsurilor de prevenție și promovarea sănătății populației active, precum și cunoașterea caracteristicilor cantitative ale relațiilor cauzale, au o importanță deosebită și va contribui la subestimarea bolilor profesionale.

Introducere. Afecțiunile musculo-scheletice (AMS) sunt cele mai frecvent raportate cauze ale bolilor profesionale. Deși profesorii afectați continuă să fie activi, mulți își încheie cariera didactică mai devreme din cauza acestor probleme de sănătate. Scopul lucrării a fost de a descrie „poziția neergonomică” la locul de muncă, afecțiunile musculo-scheletice și problemele de sănătate apărute la cadrele didactice din Republica Moldova. Material și metode. A fost realizat un studiu transversal pe un eșantion de judecată de 750 de profesori care lucrează în școlile din Republica Moldova. Indicatorii goniometrici ai posturilor de muncă au fost evaluați prin metoda fotografică și prin sincronizarea activităților ocupaționale. Prezența disconfortului musculo-scheletic și factorii asociați au fost evaluate cu ajutorul unui chestionar. Rezultate. Din cei 620 de participanți, 97% erau femei, vârsta medie – 46.6±3.77 ani. Dintre profesori, 87,5% adoptă o poziție de lucru neergonomică, datele goniometrice au arătat abateri de la unghiurile fiziologice articulare pentru radiocarpian, cot, șold, genunchi și tibio-tarsian. Unghiul de abatere a gâtului de la verticală a fost de 24,80°, abaterea umărului – 4,60°, iar abaterea trunchiului a depășit poziția fiziologică cu o medie de 17,50°. Bolile cronice ale sistemului locomotor au avut o prevalență de 37,3%, în timp ce artrita, artroza și alte modificări articulare distructive au avut o prevalență de 28,9%. Mai mult de 21,7% dintre respondenți au raportat durere la nivelul membrelor la sfârșitul zilei de lucru. Concluzii. Prevalența durerii musculo-scheletice, în special a „durerii cronice ale bolilor sistemului locomotor” (artrita, artroza, durerea la nivelul membrelor) a afectat mai mult de 1/3 dintre profesorii implicați în studiu. Aceste rezultate evidențiază nevoia implementării unor măsuri ergonomice preventive care să reducă expunerea, apoi riscul de AMS și, astfel, să minimizeze durerea cauzată de bolile cronice ale sistemului locomotor.

Obiective. Leziunile traumatice prin cădere reprezintă o problemă semnificativă de sănătate globală, provoacă adesea dizabilități, mortalitate și morbiditate ridicată în întreaga lume. Căderile sunt a doua cauză de deces neintenționat la nivel mondial. Aproximativ o treime din persoanele vârstnice suferă o cădere cel puțin o dată pe an, iar această rată crește semnificativ pentru cei peste 80 de ani. Scopul prezentului studiu a fost de a identifica cauzelor producerii traumatismelor prin cădere și elaborarea măsurilor de prevenție a acestora la populația cu vârsta de 65 ani și peste, din Republica Moldova. Materiale și metode. În total, folosind bazele de date Google Scholar și PubMed au fost incluse în analiză 20 articole, selectate conform criteriilor de includere și de excludere. Datele din aceste articole, au fost evaluate, sintetizate și descrise narativ. Rezultate. Potrivit studiilor revizuite, printre factorii care pot duce la diverse traumatisme prin cădere la vârstnici se regăsesc: istoricul individual, slăbiciunea musculară și lipsa de echilibru, deficiențele vizuale, administrarea mai multor medicamente, precum sedativele, antidepresivele și antihipertensivele, deficiența de vitamina D, factori de mediu de interior și exterior, sau tulburările cognitive. Măsurile preventive pot reduce riscul de cădere, contribuind la un stil de viață independent și sigur pentru această comunitate. Concluzii. Studierea factorilor de risc, implicați în diverse traumatisme la vârstnici prin cădere ar putea ajuta factorii de decizie să adopte strategii și abordări eficiente pentru prevenirea și controlul acestora.

The development of the optic nerve and its surrounding tissues during the early fetal period is a convoluted period because it spans both the organogenesis period and the fetal period. This study details the microscopic anatomy and histoembryology of the optic nerve in embryos during the early fetal period, including the second half of the first trimester of pregnancy. Serial sections through the orbit of variously aged embryos allowed us to analyze the nerve in both longitudinal and transverse aspects. A histological assessment and description of the structures surrounding and inside the nerve were performed, highlighting the cellular subtypes involved. By employing immunohistochemical techniques, we could characterize the presence and distribution of astrocytes within the optic nerve. Our findings suggest that by the 8th gestational week (WG) the structures are homologs to all the adult ones but with an early appearance so that maturation processes take place afterward. By this age, the axons forming the nerve are definitive adult axons. The glial cells do not yet exhibit adult phenotype, but their aspect becomes adult toward the 13th week. During its development the optic nerve increases in size then, at 14 weeks, it shrinks considerably, possibly through its neural maturation process. The morphological primordium of the blood–nerve barrier can be first noted at 10 WG and at 13 WG the morphological blood–nerve barrier is definitive. The meningeal primordium can be first noted as a layer of agglomerated fibroblasts, later toward 13 WG splitting in pachymeninx and leptomeninges and leaving space for intrinsic blood vessels.

Background: Due to the rapid development of new diagnostic and therapeutic endoscopic techniques, there has been a gap between their development and implementation in daily practice, as well as in their uptake in guideline recommendations1. We investigated the effectiveness of spectral focused imaging (SFI), a new optical chromoendoscopy system (SonoScape, Shenzhen, China)2, in diagnosing subtle mucosal changes in patients with inactive ulcerative colitis. Materials and Methods: A group of 12 patients with quiescent ulcerative colitis were randomly assigned at a 1:1 ratio to undergo colonoscopy with high-definition white light (group A) or SFI (group B). The mucosal pattern, location of the mucosal changes (measured in centimeters from the anal verge), morphology, size and duration of the endoscopic procedure were recorded, while the disease activity was established following the Mayo endoscopic score for ulcerative colitis. Subsequent to the endoscopic characterization, targeted biopsies (or random biopsies in a case of normal colonic mucosa) were obtained from every segment for histopathological follow-up analysis. Results: The median endoscopic activity index, based on the Mayo ulcerative colitis endoscopic score, was 1 for both groups of patients. Taking into account the duration of the examination, the median value was 17.3 minutes in group A and 18.5 minutes in group B. Upon examining the concordance between the endoscopic prediction of disease activity and the histological findings, we obtained a 55% degree of conformity in group A, compared to 90% in group B. Conclusions: This pilot study showed that image-enhanced endoscopy using SFI might increase the rate of detection and demarcation for subtle inflammatory changes in the mucosa, correlating with potential histologic activity. Furthermore, this diagnostic tool could provide a more accurate and earlier identification of areas of minimal inflammation than conventional techniques.

Background and objective: Iliopsoas abscess (IPA) is a rare condition with varied symptomology and etiology. Less than one-third of patients with IPA present in the emergency department (ED) with the traditional triad of fever, back pain, and restricted hip motion (or limp), leading to delays in diagnosis and management. Acute liver failure is also a rare clinical presentation in the ED, being associated with high morbidity and mortality. It occurs most often in young patients without pre-existing liver disease, presenting unique challenges in clinical management. Most cases currently happen because of drug-induced liver injury (DILI), mainly from acetaminophen or idiosyncratic drug reactions. This case report aims to raise awareness among healthcare professionals regarding the two atypical presentations in ED and introduce a potential differential diagnosis when evaluating patients with fever and back pain or liver enzyme elevations with or without nonspecific symptoms associated with the development of jaundice. The intention is to provide insights into the signs and symptoms that may indicate the presence of an iliopsoas abscess and prompt additional investigations. Case report: Here, we describe a case of primary iliopsoas abscess associated with drug-induced liver injury in our ED. The patient complained of pain in the left lumbar region and fatigue that started two weeks before this presentation, claiming that, during the previous night, the pain suddenly worsened. At the first clinical examination in the ED, the patient presented pain at palpation in the right hypochondriac and left lumbar regions, accompanied by fever, vomiting, and jaundice. On abdominal ultrasonography, the diagnosis of acute cholangitis was suspected. The laboratory test shows leukocytosis with neutrophilia, thrombocytosis, elevated liver enzymes, and hyperbilirubinemia with the predominance of indirect bilirubin. After analyzing the laboratory test results, we repeated and performed a more detailed anamnesis and medical history of the patient. Because of her increasing pain and persistent fever, she recognized excessive consumption in the last five days of drug-induced hepatotoxicity. We performed abdominal and pelvic computed tomography, which confirmed the diagnosis of cholelithiasis observed with the diameter of the bile duct within normal limits but also showed an abscess collection fused to the interfibrillar level of the left iliopsoas muscle, a diagnosis we most likely would have missed. The patient was hospitalized in the General Surgery Department, and surgical abscess drainage was performed. The patient’s evolution was excellent; she was discharged after 11 days. Conclusions: The case presented here exemplifies how iliopsoas abscess, a rare cause of back pain, can quickly go unrecognized, especially in the emergency department. Our experiences will raise awareness among doctors in emergency departments about this uncommon but essential diagnosis. With advancements in diagnostic tools and techniques, we hope that more cases of iliopsoas abscess will be accurately diagnosed. Moreover, no case report from the literature has presented IPA associated with DILI. This case is unique because our patient did not exhibit classic features of either pathology. This case also emphasizes the importance of a medical history that includes thorough evaluations of potential high utilization of drug-induced hepatotoxicity.

BackgroundOsteoarthritis (OA) is a disabling condition that affects more than one-third of people older than 65 years. Currently, 80% of these patients report movement limitations, 20% are unable to perform major activities of daily living, and approximately 11% require personal care. In 2014, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended, as the first step in the pharmacological treatment of knee osteoarthritis, a background therapy with chronic symptomatic slow-acting osteoarthritic drugs such as glucosamine sulfate, chondroitin sulfate, and hyaluronic acid. The latter has been extensively evaluated in clinical trials as intra-articular and oral administration. Recent reviews have shown that studies on oral hyaluronic acid generally measure symptoms using only subjective parameters, such as visual analog scales or quality of life questionnaires. As a result, objective measures are lacking, and data validity is generally impaired. ObjectiveThe main goal of this pilot study with oral hyaluronic acid is to evaluate the feasibility of using objective tools as outcomes to evaluate improvements in knee mobility. We propose ultrasound and range of motion measurements with a goniometer that could objectively correlate changes in joint mobility with pain reduction, as assessed by the visual analog scale. The secondary objective is to collect data to estimate the time and budget for the main double-blind study randomized trial. These data may be quantitative (such as enrollment rate per month, number of screening failures, and new potential outcomes) and qualitative (such as site logistical issues, patient reluctance to enroll, and interpersonal difficulties for investigators). MethodsThis open-label pilot and feasibility study is conducted in an orthopedic clinic (Timisoara, Romania). The study includes male and female participants, aged 50-70 years, who have been diagnosed with symptomatic knee OA and have experienced mild joint discomfort for at least 6 months. Eight patients must be enrolled and treated with Syalox 300 Plus (River Pharma) for 8 weeks. It is a dietary supplement containing high-molecular-weight hyaluronic acid, which has already been marketed in several European countries. Assessments are made at the baseline and final visits. ResultsRecruitment and treatment of the 8 patients began on February 15, 2018, and was completed on May 25, 2018. Data analysis was planned to be completed by the end of 2018. The study was funded in February 2019. We expect the results to be published in a peer-reviewed clinical journal in the last quarter of 2024. ConclusionsThe data from this pilot study will be used to assess the feasibility of a future randomized clinical trial in OA. In particular, the planned outcomes (eg, ultrasound and range of motion), safety, and quantitative and qualitative data must be evaluated to estimate in advance the time and budget required for the future main study. Finally, the pilot study should provide preliminary information on the efficacy of the investigational product. Trial RegistrationClinicalTrials.gov NCT03421054; https://clinicaltrials.gov/study/NCT03421054 International Registered Report Identifier (IRRID)RR1-10.2196/13642

In 2021, the World Health Organization recommended new extensively drug-resistant (XDR) and pre-XDR tuberculosis (TB) definitions. In a recent cohort of TB patients in Eastern Europe, we show that XDR TB as currently defined is associated with exceptionally poor treatment outcomes, considerably worse than for the former definition (31% vs. 54% treatment success).

Abstract This study focuses on improving the accuracy of assessing liver damage and early detection for improved treatment strategies. In this study, we examine the human liver using a modified Atangana-Baleanu fractional derivative based on the mathematical model to understand and predict the behavior of the human liver. The iteration method and fixed-point theory are used to investigate the presence of a unique solution in the new model. Furthermore, the homotopy analysis transform method, whose convergence is also examined, implements the mathematical model. Finally, numerical testing is performed to demonstrate the findings better. According to real clinical data comparison, the new fractional model outperforms the classical integer-order model with coherent temporal derivatives.

Primary vaginal sarcoma is an extremely rare malignant condition within the field of gynecological pathologies. We present the case of a 53-year old patient with no history of gynecological issues or associated comorbidities who presented to our clinic with recurrent vaginal bleeding during menopause. We want to emphasize the importance of diagnostic management, going through all the necessary steps from local gynecological examination to vaginal biopsy, optimizing results with advanced imaging techniques. Once the histopathological diagnosis of vaginal leiomyosarcoma was established, the therapeutic approach was discussed within a multidisciplinary committee consisting of a gynecologist, surgeon, and oncologist. As a result, the patient underwent tailored surgical intervention relatively quickly after presentation, followed by referral to the oncology department, where she is currently undergoing her third course of adjuvant chemotherapy. Our current objective is the long-term follow-up of the patient and the acquisition of data regarding her survival and quality of life. These facts may contribute in the future to the implementation of standardized therapeutic guidelines for such a rare condition.

Microsurgery, a pivotal surgical field that changed medical perspectives in the 20th century, presents numerous technical challenges due to the precision it requires from the surgeon. To acquire the requisite skills, comprehensive training is imperative. Initiation into microsurgical training on experimental models is a prerequisite before translating these skills to clinical applications. The employment of non-living models in medical training offers a myriad of advantages, notably characterized by their accessibility and cost-effectiveness. Non-living models, such as latex gloves, leaves, flower petals, silicon tubes and chicken legs, provide aspiring microsurgeons an opportunity to train the essential technical skills required in microsurgical practice. Such models significantly alleviate ethical concerns associated with the use of live specimens and human cadaveric models. Furthermore, they exhibit a satisfactory emulation of human vascular properties, providing a realistic context for medical practice. Although the primary focus of this paper is on non-living models, it is important to highlight the transition to living models, specifically small animal models, as a mandatory and advanced phase in microsurgical training, before translating to clinical practice.

Abstract There are several overlapping clinical practice guidelines in acute pancreatitis (AP), however, none of them contains suggestions on patient discharge. The Hungarian Pancreatic Study Group (HPSG) has recently developed a laboratory data and symptom-based discharge protocol which needs to be validated. (1) A survey was conducted involving all members of the International Association of Pancreatology (IAP) to understand the characteristics of international discharge protocols. (2) We investigated the safety and effectiveness of the HPSG-discharge protocol. According to our international survey, 87.5% (49/56) of the centres had no discharge protocol. Patients discharged based on protocols have a significantly shorter median length of hospitalization (LOH) (7 (5;10) days vs. 8 (5;12) days) p

Background/Objectives: Ongoing challenges in epilepsy therapy warrant research on alternative treatments that offer improved efficacy and reduced side effects. Designed to enhance mitochondrial targeting and increase bioavailability, mitocurcumin (MitoCur) was evaluated for the first time as an antiepileptic agent, with curcumin (Cur) and sodium valproate (VPA), a standard antiepileptic drug, included for comparison. This study investigated the effects on seizure onset, severity, and progression in a zebrafish model of pentylenetetrazole (PTZ)-induced seizures and measured the concentrations of the compounds in brain tissue. Methods: Zebrafish were pre-treated with MitoCur and Cur (both at 0.25 and 0.5 µM doses) and VPA (0.25 and 0.5 mM) and observed for four minutes to establish baseline locomotor behavior. Subsequently, the animals were exposed to a 5 mM PTZ solution for 10 min, during which seizure progression was observed and scored as follows: 1—increased swimming; 2—burst swimming, left and right movements; 3—circular movements; 4—clonic seizure-like behavior; 5—loss of body posture. The studied compounds were quantified in brain tissue through HPLC and LC-MS. Results: Compared to the control group, all treatments reduced the distance moved and the average velocity, without significant differences between compounds or doses. During PTZ exposure, seizure latencies revealed that all treatments effectively delayed seizure onset up to score 4, demonstrating efficacy in managing moderate seizure activity. Notably, MitoCur also provided significant protection against the most severe seizure score (score 5). Brain tissue uptake analysis indicated that MitoCur achieved higher concentrations in the brain compared to Cur, at both doses. Conclusions: These results highlight the potential of MitoCur as a candidate for seizure management.

Knowing the bacterial strains in the intensive care unit (ICU) is important for reducing the rate of bacterial transmission and the risk of healthcare-associated infections (HAIs), allowing for targeted interventions to reduce the risk of death by HAIs. We performed a retrospective case-control study in a single center that included 320 bacteriologically screened patients from the ICU of the Infectious Diseases Hospital in Constanta between September 2017 and March 2020. Sixty-five secondary bacterial infections were identified as the cause of hospital admission and 60 bacterial colonizations. There were 20 cases and 300 controls for the mortality rate and risk factors for death. Multivariate analysis identified that hospitalization of patients for HIV infection (OR 11.82, 95% CI: 1.69-83.62, P ≤0.05) and Clostridioides difficile infection (OR 7.38, 95% CI: 1.39 -39.22, P ≤ 0.05) were independent risk factors associated with death. We observed that the number of colonizations or secondary infections in the ICU was similar, and the mortality rate in the ICU was influenced by HIV infection or Clostridioides difficile infection.

BackgroundEmerging evidence suggests that shortened, simplified treatment regimens for rifampicin-resistant tuberculosis (RR-TB) can achieve comparable end-of-treatment (EOT) outcomes to longer regimens. We compared a 6-month regimen containing bedaquiline, pretomanid, linezolid, and moxifloxacin (BPaLM) to a standard of care strategy using a 9- or 18-month regimen depending on whether fluoroquinolone resistance (FQ-R) was detected on drug susceptibility testing (DST).Methods and findingsThe primary objective was to determine whether 6 months of BPaLM is a cost-effective treatment strategy for RR-TB. We used genomic and demographic data to parameterize a mathematical model estimating long-term health outcomes measured in quality-adjusted life years (QALYs) and lifetime costs in 2022 USD ($) for each treatment strategy for patients 15 years and older diagnosed with pulmonary RR-TB in Moldova, a country with a high burden of TB drug resistance. For each individual, we simulated the natural history of TB and associated treatment outcomes, as well as the process of acquiring resistance to each of 12 anti-TB drugs. Compared to the standard of care, 6 months of BPaLM was cost-effective. This strategy was estimated to reduce lifetime costs by $3,366 (95% UI: [1,465, 5,742] p < 0.001) per individual, with a nonsignificant change in QALYs (-0.06; 95% UI: [-0.49, 0.03] p = 0.790). For those stopping moxifloxacin under the BPaLM regimen, continuing with BPaL plus clofazimine (BPaLC) provided more QALYs at lower cost than continuing with BPaL alone. Strategies based on 6 months of BPaLM had at least a 93% chance of being cost-effective, so long as BPaLC was continued in the event of stopping moxifloxacin. BPaLM for 6 months also reduced the average time spent with TB resistant to amikacin, bedaquiline, clofazimine, cycloserine, moxifloxacin, and pyrazinamide, while it increased the average time spent with TB resistant to delamanid and pretomanid. Sensitivity analyses showed 6 months of BPaLM to be cost-effective across a broad range of values for the relative effectiveness of BPaLM, and the proportion of the cohort with FQ-R. Compared to the standard of care, 6 months of BPaLM would be expected to save Moldova's national TB program budget $7.1 million (95% UI: [1.3 million, 15.4 million] p = 0.002) over the 5-year period from implementation. Our analysis did not account for all possible interactions between specific drugs with regard to treatment outcomes, resistance acquisition, or the consequences of specific types of severe adverse events, nor did we model how the intervention may affect TB transmission dynamics.ConclusionsCompared to standard of care, longer regimens, the implementation of the 6-month BPaLM regimen could improve the cost-effectiveness of care for individuals diagnosed with RR-TB, particularly in settings with a high burden of drug-resistant TB. Further research may be warranted to explore the impact and cost-effectiveness of shorter RR-TB regimens across settings with varied drug-resistant TB burdens and national income levels.

Abstract Deep learning segmentation algorithms can produce reproducible results in a matter of seconds. However, their application to more complex datasets is uncertain and may fail in the presence of severe structural abnormalities—such as those commonly seen in stroke patients. In this investigation, six recent, deep learning-based hippocampal segmentation algorithms were tested on 641 stroke patients of a multicentric, open-source dataset ATLAS 2.0. The comparisons of the volumes showed that the methods are not interchangeable with concordance correlation coefficients from 0.266 to 0.816. While the segmentation algorithms demonstrated an overall good performance (volumetric similarity [VS] 0.816 to 0.972, DICE score 0.786 to 0.921, and Hausdorff distance [HD] 2.69 to 6.34), no single out-performing algorithm was identified: FastSurfer performed best in VS, QuickNat in DICE and average HD, and Hippodeep in HD. Segmentation performance was significantly lower for ipsilesional segmentation, with a decrease in performance as a function of lesion size due to the pathology-based domain shift. Only QuickNat showed a more robust performance in volumetric similarity. Even though there are many pre-trained segmentation methods, it is important to be aware of the possible decrease in performance for the segmentation results on the lesion side due to the pathology-based domain shift. The segmentation algorithm should be selected based on the research question and the evaluation parameter needed. More research is needed to improve current hippocampal segmentation methods.

Abstract This paper presents a novel supervised convolutional neural network architecture, “DUCK-Net”, capable of effectively learning and generalizing from small amounts of medical images to perform accurate segmentation tasks. Our model utilizes an encoder-decoder structure with a residual downsampling mechanism and a custom convolutional block to capture and process image information at multiple resolutions in the encoder segment. We employ data augmentation techniques to enrich the training set, thus increasing our model's performance. While our architecture is versatile and applicable to various segmentation tasks, in this study, we demonstrate its capabilities specifically for polyp segmentation in colonoscopy images. We evaluate the performance of our method on several popular benchmark datasets for polyp segmentation, Kvasir-SEG, CVC-ClinicDB, CVC-ColonDB, and ETIS-LARIBPOLYPDB showing that it achieves state-of-the-art results in terms of mean Dice coefficient, Jaccard index, Precision, Recall, and Accuracy. Our approach demonstrates strong generalization capabilities, achieving excellent performance even with limited training data.

Endocrine damage in infectious diseases (bacterial, viral) has been proven for a long time, confirming the disruption of the functions of most endocrine glands via the hypothalamic-pituitary-glandular axis. Endocrine activity takes place in tandem with the activity of the immune system. They inter-condition and influence each other, any change in one sector influencing the other (positively or negatively). Severe (critical), bacterial or viral infections go through the stage of SEPSIS, the background of which is the disruption (disorganization) of the host’s response to the infection. The mechanisms by which the endocrine glands are affected are multiple (direct, immunologically mediated, thrombotic) leading to multiple, morphological and functional lesions. The recovery of these injuries takes place over time, and permanent sequelae are possible. The recent pandemic caused by SARS-CoV-2, through the ways of manifestation and evolution of the diseases, justifies the interest regarding the endocrine damage in the SARS-CoV-2 infection, both in the acute and post-acute phase (long COVID evolves with symptoms, some newly appeared, which are also present in non-COVID endocrinopathies). Material. The arguments regarding the endocrine damage were extracted from the publications mentioned at the end of the work as bibliographic titles. The results highlight the endocrine damage in infections, especially in severe ones - and the impact on the immediate and late evolution of the illnesses. Conclusions. In order to understand the pathogenic, physio-pathological and clinical aspects of an infection, attention must be paid to the state of the endocrine system in correlation with the immune system, especially in patients receiving shorter or longer corticosteroid therapy.

This research introduces novel concepts in sequence theory, including Bessel convergence, Bessel boundedness, Bessel statistical convergence, and Bessel statistical Cauchy sequences. These concepts establish new inclusion relations and related results within mathematical analysis. Additionally, we extend the first and second Korovkin-type approximation theorems by incorporating Bessel statistical convergence, providing a more robust and comprehensive framework than existing results. The practical implications of these theorems are demonstrated through examples involving the classical Bernstein operator and Fejér convolution operators. This work contributes to the foundational understanding of sequence behavior, with potential applications across various scientific disciplines.

BackgroundDepersonalisation-Derealisation Disorder (DDD) is a distressing mental health condition which causes individuals to have a sense of 'unreality' or detachment about themselves and/or the world around them. DDD is chronically under-researched, and as a result, under-diagnosed, with a population prevalence of about 1%. In systematic reviews, Cognitive Behavioural Therapy (CBT) has been found to be the only intervention with significant clinical impact on alleviating the symptoms of DDD. However, previous studies have suffered from small sample sizes, reliance on expert clinicians to provide therapy and narrow population demographics. This feasibility randomised controlled trial aims to provide more robust evidence for the treatment efficacy of CBT in DDD.MethodsThe study aims to recruit 40 participants from two NHS trusts, 20 per arm from two community Mental Health NHS services in London. The intervention group will receive 12-24 individual CBT sessions over a 6-month period from CBT therapists following specialist training for DDD. The control group will receive Treatment as Usual. We will assess the feasibility of a future RCT through measuring the acceptability of the intervention, and assessing our ability to recruit, retain and randomise participants. We will calculate the correlation of scores on the Cambridge Depersonalisation Scale, its baseline standard deviation, assess the magnitude/direction of change and characterise the uncertainty in the outcome scores and the probability that the results have been obtained by chance.DiscussionThe outputs of this trial will guide whether a definite RCT is feasible and acceptable, for both the clinician and participant.Trial registrationThe ISRCTN registration number is ISRCTN97686121(https://doi.org/10.1186/ISRCTN97686121).

Applying whole-genome-sequencing, we aimed to detect transmission events of multidrug-resistant/rifampin-resistant strains of Mycobacterium tuberculosis complex at a tuberculosis hospital in Chisinau, Moldova. We recorded ward, room, and bed information for each patient and monitored in-hospital transfers over 1 year. Detailed molecular and patient surveillance revealed only 2 nosocomial transmission events.

Abstract Reference methods for microbiological safety assessments of cosmetics rely on culture methods that reveal colonies of live microorganisms on growth media. Rapid molecular technologies, such as qPCR, detects the presence of target DNA in samples from dead and viable cells. DNA intercalating dyes, such as propidium monoazide (PMAxx), are capable of restricting PCR amplification to viable microbial cells. Here we developed singleplex and multiplex real time (qPCR) assays for the detection of Bacillus cereus (B. cereus) using 16S rRNA and phosphatidylcholine-specific phospholipase C (PLC) gene specific sequences coupled with PMAxx. The limit of detection was determined to be ~ 1 log CFU/ml for 16S rRNA and 3 log CFU/ml for PLC detection in pure culture using an eye shadow isolate, B. cereus 3A. We assessed the inclusivity and exclusivity of our qPCR assays using 212 strains, including 143 members of B. cereus, 38 non- B. cereus. and 31 non-Bacillus species; inclusivity was 100% for the 16S rRNA and 97.9% for the PLC targets; the exclusivity was 100% for 16S rRNA and 98.6% for PLC targets. These qPCR assays were then used to assess samples of commercial cosmetics: one set of liquid face toners (N = 3), artificially contaminated with B. cereus 3A, and one set of powdered cosmetics (N = 8), previously determined to be contaminated with B. cereus. For some samples, test portions were analyzed by qPCR in parallel, with and without PMAxx treatment. All test portions were simultaneously streaked on BACARA plates to confirm viable cells of B. cereus, according to the culture method. We found no difference in sensitivity between the singleplex and the multiplex qPCR assays (P > 0.05). Inoculated samples that did not recover B. cereus on plates still showed amplification of the DNA targets. However, that amplification was significantly delayed in PMAxx –treated samples (P

Biological therapy is used in a wide range of medical settings. Adverse reactions to biological therapy can limit their widespread use, so early detection and treatment can adjust attempts to stop these molecules. TNF Alpha blockers may cause the following skin reactions in alpha patients: injection site reactions, infections, immune-mediated reactions (psoriasis, psoriasis, drug-induced lupus, vasculitis, hidradenitis, alopecia), allergic or neoplastic reactions. We present the case of a patient with RA who developed skin lesions during biological therapy and was diagnosed with drug-induced lupus based on clinical elements, associated autoimmunity, and dermatological evaluation. The skin lesions were attributed to the interaction of three medications (biosimilar Etanercept, Leflunomide, and Isoniazid), all of which have been implicated in causing these side effects. The solutions that saved the patient were temporarily discontinuing the immunosuppressive medication and replacing it with a local corticoid, followed by the continuation of Etanercept in associated with Methotrexate, and the patient was able to continue the biological medication and obtain a favorable response to the treatment. In conclusion, skin changes caused by TNF Alpha inhibitors are common, but vary in severity, and do not warrant therapy interruption.

In dental practice, the fidelity of a model is given by the quality and type of material used, the technique by which it is made, and last but not least by the experience and skill of the dental technician. But, the emergence of CAD-CAM technology has led to a major change in the stages of making the working model, through the development of the virtual model. Thus, the purpose of this material is to perform a comparative study between several techniques for obtaining sectional working models, with or without pins, compared to the virtual model obtained by CAD-CAM technique.

Dental veneers made of ceramic masses are considered on conservative solution for patients that require an enhancement of shape, shade, dimension and/or position of anterior teeth. Ceramic veneers are successfully used on large scale to hide tooth discoloration, to correct the position and minor defects of teeth, without removing significant quantities of hard tissues.

Ventricular arrhythmias may occur in patients without anatomical heart abnormalities, a condition that is known as idiopathic ventricular arrhythmias. The most common form originates at the level of the outflow tracts. It can manifest as PVCs, non-sustained ventricular tachycardia (VT), and sustained VT. A 52-year-old female patient was admitted for 2 episodes of syncope related to a high burden of premature ventricular contractions (PVCs) and several episodes of VT with the same QRS morphology as the PVCs. A diagnosis of sustained monomorphic VT was formulated in a patient with no structural heart disease and a normal ejection fraction. Antiarrhythmic drugs such as metoprolol, propafenone, and amiodarone failed to reduce the number of PVCs, hence catheter ablation was suggested to the patient. The patient consented to the treatment, and following catheter ablation, the patient no longer experienced syncope. The 24-hour Holter ECG monitoring revealed no PVCs or VTs. PVCs and VTs from the RVOT are typically benign with a good prognosis. Catheter ablation should be employed as the definitive treatment for RVOT-VT, as our case demonstrates only partial response to antiarrhythmic drugs.

Gout is a chronic metabolic disease, characterized by joint inflammation caused by monosodium urate monohydrate crystals. The main objective of this study was to identify the prevalence of gout in a rheumatology department in Romania and secondary to describe the characteristics of patients diagnosed with this condition, with emphasis on the comorbidities. This is a longitudinal, retrospective study on 280 patients from the Department of Internal Medicine and Rheumatology, „Dr. I. Cantacuzino” Hospital, from January 2017 to May 2019, diagnosed with chronic or acute gout. The prevalence of gout in our hospital in 2 years period was 0.97%. Gouty attack was diagnosed in 38.2% of cases, while 61.8% were evaluated for chronic gout. Male frequency was 69.6%, alcohol consummation was observed in more than half of the cohort (53.2%) and 72.1% were retired persons. The most frequent comorbidity was hypertension (HBP) (82.1%) followed by dyslipidemia (65.3%), atherosclerotic disease(ATS) (55.0%) and chronic kidney disease (53.9%). There was a significant association between HBP, ATS and dyslipidemia with chronic gout (p=0.038, p=0.022 and p=0.009, respectively). The rate of gouty attack significantly increased with the serum level of uric acid(p

For developing novel photosensitizers with therapeutic potential in non-malignant and malignant cutaneous disorders, the unsymmetrical porphyrin, 5-(2-hydroxy-3-methoxyphenyl)-10, 15, 20-tris-(4-carboxymethylphenyl) porphyrin, was evaluated in silico and in vitro. The cellular uptake of the investigated porphyrin and its ability to perform photodynamic therapy were investigated in terms of the viability, proliferation, and necrosis of human HaCaT keratinocytes and human Hs27 skin fibroblasts, in correlation with the predictions regarding diffusion through cell membranes, ADMET profile (absorption, distribution, metabolism, elimination, toxicity), and potential pharmacological mechanism. Molecular docking and 250 ns molecular dynamics simulations revealed that P5.2 has the potential to form a relatively stable complex with the carbonic anhydrase IX catalytic site, the lowest predicted free energy of binding (MM/PBSA) being −39.097 kcal/mol. The results of the in vitro study showed that P5.2 is incorporated within 24 h in the investigated cells, especially in HaCaT keratinocytes, indicating its photosensitizing ability. Nevertheless, P5.2 does not exert significant cytotoxicity in “dark” conditions. In turn, PDT induced a decrease in the number of metabolically active HaCaT keratinocytes within 24 h, accompanied by a 4-fold increase in lactate dehydrogenase release, indicating its ability to perform PDT in human skin cells. The experimental results suggest that the asymmetrical porphyrin is a promising candidate theranostics agent for skin disorders.

(1) Background: Oxidative stress plays a pivotal role in the pathogenesis of various diseases, including neurodegenerative disorders, cardiovascular diseases, cancer, and diabetes, highlighting the pressing need for effective antioxidant interventions. (2) Methods: In this study, we aimed to develop and characterise two novel antioxidant formulations, F3 and F4, as therapeutic interventions for oxidative stress-related conditions. (3) Results: The physicochemical characterisation, preformulation analysis, formulation, preparation of filling powders for capsules, capsule content evaluation, and antioxidant activity assessment of the two novel antioxidant formulations were assessed. These formulations comprise a combination of well-established antioxidants like quercetin, biotin, coenzyme Q10, and resveratrol. Through comprehensive testing, the formulations’ antioxidant efficacy, stability, and potential synergistic interactions were evaluated. (4) Conclusions: The findings underscore the promising potential of these formulations as therapeutic interventions for oxidative stress-related disorders and highlight the significance of antioxidant interventions in mitigating their progression.

Advanced and metastatic cervical cancer remains a formidable challenge in oncology, with immune checkpoint inhibitors such as the PD-1 inhibitor nivolumab emerging as a potential therapeutic option. This systematic review rigorously assesses the effectiveness and outcomes of various nivolumab treatment regimens within this patient cohort, drawing from clinical trials and real-world evidence up to December 2023. Following a comprehensive search across PubMed, Scopus, and Embase, four studies were deemed eligible, involving a collective total of 80 patients. One preliminary trial data were excluded from the final analysis, as well as four other proceedings and abstracts on the efficacy and safety of nivolumab on advanced cervical cancer. The patients’ average age across these studies was 48 years, with an average of 38% having an Eastern Cooperative Oncology Group (ECOG) performance status of 1. Notably, 64% of all patients were positive for high-risk HPV, and 71% exhibited PD-L1 positivity, indicating a substantial target population for nivolumab. The analysis revealed a pooled objective response rate (ORR) of 48%, with a disease control rate (DCR) averaging 71%. Moreover, progression-free survival (PFS) at 6 months was observed at an average rate of 50%, reflecting the significant potential of nivolumab in managing advanced stages of the disease. The review highlights the influence of PD-L1 status on response rates and underscores the enhanced outcomes associated with combination therapy approaches. By delineating the variability in treatment efficacy and pinpointing key factors affecting therapeutic response and survival, this systematic review calls for further investigations to refine nivolumab’s clinical application, aiming to improve patient outcomes in advanced and metastatic cervical cancer.

Abstract Magnetic nanomaterials are increasingly impacting the field of biology and medicine. Their versatility in terms of shape, structure, composition, coating, and magnetic responsivity make them attractive for drug delivery, cell targeting and imaging. Adipose derived-mesenchymal cells (ASCs) are intensely scrutinized for tissue engineering and regenerative medicine. However, differentiation into musculoskeletal lineages can be challenging. In this paper, we show that uncoated nickel nanowires (Ni NW) partially released from their alumina membrane offer a mechanically-responsive substrate with regular topography that can be used for the delivery of magneto-mechanical stimulation. We have used a tailored protocol for improving ASCs adherence to the substrate, and showed that cells retain their characteristic fibroblastic appearance, cytoskeletal fiber distribution and good viability. We report here for the first time significant increase in osteogenic but not adipogenic differentiation of ASCs on Ni NW exposed to 4 mT magnetic field compared to non-exposed. Moreover, magnetic actuation is shown to induce ASCs osteogenesis but not adipogenesis in the absence of external biochemical cues. While these findings need to be verified in vivo, the use of Ni NW substrate for inducing osteogenesis in the absence of specific differentiation factors is attractive for bone engineering. Implant coating with similar surfaces for orthopedic and dentistry could be as well envisaged as a modality to improve osteointegration.

Introduction: Hypertension and diabetes mellitus affect a large number of patients and can significantly influence their life expectancy. Changes in metabolic and oxidative stress parameters are common in these pathologies, contributing to associated complications. The aim of the study was assessment of relationship between laboratory parameters and their role in evaluation of cardiovascular risk, and possible gender-related differences in the protective factors.

Metaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer first described by pathologists in 2000. It is usually discovered in advanced stages and has a low survival rate. It is divided into various subtypes: low- grade adenosquamous, fibromatosis-like metaplastic, squamous cell, spindle cell, metaplastic with mesenchymal differentiation (including chondroid, osseous, or other types), mixed metaplastic, and myoepithelial carcinomas. Surgery is the treatment of choice, followed by adjuvant chemotherapy and/or radiotherapy. We present the case of a 44-year-old woman with metaplastic breast cancer, reviewing the characteristics of this condition, the particularities of the case, and the treatment chosen in this particular situation.

Introduction. The risk factors for multiple sclerosis (MS) and cancer overlap to a large extent. The objective of our study was to estimate the prevalence and risk ratios (RR) of cancers in patients with MS and to identify which types of cancer have the lowest frequency. Materials and methods. We carried out research of the literature in the PubMed, Medline, and Google Academic databases, with the aim of identifying large-scale studies addressing the link between different cancers and MS. From 411 relevant articles, we selected 13 scientific papers for further analysis, comprising 109,276 patients diagnosed with MS from different countries. Results. Of all MS patients, 5.1% were diagnosed with a certain type of cancer compared to 5.5% in the general population; the cancers with the lowest incidence were respiratory, digestive, and blood cancers. Conclusions. The results of our analysis suggested that MS patients are less exposed to respiratory, digestive, and blood cancers, but more research is needed to understand if some disease-modifying therapies play a role in this regard.

One of the most frequent benign tumor pathology in children is represented by infantile hemangiomas (IHs). Although they are mostly cutaneous, sometimes they can develop at visceral level, the liver being the most common localization. Objectives. Estimating visceral hemangiomas (VHs) prevalence, and identification of risk factors for VHs in patients with infantile cutaneous hemangiomas (ICHs). Materials and methods. 6 years cross-sectional study (2012-2017) including children diagnosed with ICHs, admitted in I.N.S.M.C “Alfred-Rusescu“. All patients underwent an ultrasound screening for the detection of VHs. In order to identify possible risk factors, we collected demographic and perinatal data. Outcomes. 138 patients diagnosed with infantile cutaneous hemangiomas (ICHs) were included, with a slight predominance of girls (58%). The prevalence of the VHs in our study was 7,24% (10 patients). The liver was the most common visceral localization (7 patients). Conclusions. Female gender, preterm birth, low birth weight, and multiple gestations were described as potential risk factors for IHs. In our study, only multiple gestations tend to be associated with visceral hemangiomas, but without a significant statistical correlation.

Background. Migraine is a frequent neurological disorder affecting mostly women in the childbearing age. It is influenced by fluctuation of female hormones, especially estrogen levels. Objectives. This review aims to describe the expression of migraine during the reproductive ages summarizing the diagnosis and effective, available treatment options. Materials and methods. We performed a systematic literature review searching information on the subject in PubMed and Medscape databases between 2000-2022. Outcomes. It reveals that during the first trimester due to symptoms of hyperemesis gravidarum, migraine attacks can exacerbate, while, through second and third trimester when estrogen levels rise, women report relief of symptoms. Therapy includes firstly behavioural approach and secondly pharmacological drugs along with non-invasive procedures, some still under investigation for pregnant state. For mild cases the first line is acetaminophen alone or together with antiemetics and in more severe cases or in women with past history of migraine triptans can used as the mainstay therapy. Conclusions. Despite recent discoveries on therapy and drugs, our understanding of the way medications may affect the fetus or new-born is incomplete and further evidence is needed, bringing potential for improved management of migraine during pregnancy.

Objective. Breast cancer is the leading cause of cancer mortality in women. Most deaths from breast cancer are due to recurrences or metastatic disease. The purpose of this study is to determine the impact of age in treatment strategy correlated with clinicopathological features. Methodology: In this retrospective study, 60 female patients with histologically-confirmed primary breast cancer were included. The women were treated in the Oncofort Hospital Bucharest, Romania between 2018 and 2020. The estrogen receptor (ER), progesterone receptor (PR) and HER2 status were determined using immunohistochemistry. Results. The mean age was 34.14 years (range = 24 – 40 years). Invasive ductal carcinoma of no specific type was seen in 84.1% of patients. The rates of grade I, II and III carcinomas were 6.7%, 28,3% and 65%, respectively. Among all patients, 33.3% had estrogen receptor, progesterone receptor positive tumors and 66.66% had estrogen receptor, progesterone receptor negative tumors. The proportion of patients overexpressing oncoprotein HER2 was 13.3%. Conclusion. Prognostic value of proliferation index (Ki-67) and hormonal receptors, may vary depending on age.

The global pandemic period from 2020 to 2022 caused important alterations in oncology care. This study aimed to describe the trends and variations in patient characteristics, comorbidities, and treatment approaches during this time in Romania. We conducted a retrospective database search to identify patients with rectal cancer who underwent surgical intervention between 2020 and 2022 and the year 2019, which served as a pre-pandemic period control. This study included 164 patients, with a yearly increase of approximately 10% in surgical interventions noted from 2020 (1709 interventions) to 2022 (2118 interventions), but an overall 34.4% decrease compared with the pre-pandemic period. Notable shifts were observed in the type of surgeries performed, with laparoscopic procedures doubling from 2020 (25%) to 2022 (47.5%), confirming the decrease in emergency presentations during the last year of the COVID-19 pandemic and a recovery to normality with planned, elective interventions. Elective interventions increased significantly in 2022 (79.7%) compared with the previous years (p = 0.043), with a concurrent rise in neoadjuvant therapy uptake in 2022 (35.6%). However, significant alterations in the TNM staging, from 12.5% stage IV cases in 2020 to 25.4% in 2022 (p = 0.039), indicated an increased diagnosis of advanced stages of rectal cancer as the years progressed. There was a significant difference in albumin levels over the years (p = 0.019) and in the American Society of Anesthesiology (ASA) scores (from 6.2% ASA stage IV in 2020 to 16.9% in 2022), denoting an increase in case complexity (p = 0.043). This study reveals a trend of increasing surgical interventions and the prevalence of more advanced stages of rectal cancer during the pandemic years. Despite the subtle fluctuations in various patient characteristics and treatment approaches, notable shifts were documented in the severity at diagnosis and surgery types, pointing toward more advanced disease presentations and changes in surgical strategies over the period studied. Nevertheless, the trends in ICU admission rates and mortality did not alter significantly during the pandemic period.

Background: The cardiac biomarker NT-proBNP is released by the ventricles in response to increased cardiac wall tension, showing cardiac activity in heart failure. The primary objective of this comparative study was to analyze the variations of NT-proBNP levels among pregnant patients and to determine the potential influence of SARS-CoV-2 infection on these values. Secondly, the study focused on NT-proBNP levels and their influence on the type of birth. Methods: Blood samples were taken from 160 pregnant mothers in order to determine, through the solid-phase enzyme-linked immunosorbent assay (ELISA) method, the NT-proBNP concentrations from the plasma. The cohort was separated into two distinct groups based on SARS-CoV-2 diagnostic results: negative to the infection, and positive to the infection. Results: The SARS-CoV-2-positive group of patients presented with higher levels of NT-proBNP and had higher rates of cesarean sections. (4) Conclusions: Our research highlights the crucial relationship between elevated NT-proBNP values and the mode of giving birth, natural delivery or cesarean section, and also the influence of SARS-CoV-2 viral infection and this biomarker.

In order to select for further development novel photosensitizers for photodynamic therapy in cutaneous disorders, three unsymmetrical porphyrins, namely 5-(4-hydroxy-3-methoxyphenyl)-10,15,20-tris-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.2), 5-(2-hydroxy-5-methoxyphenyl)-10,15,20-tris-(4-carboxymethylphenyl) porphyrin (P3.2), and 5-(2,4-dihydroxyphenyl)-10,15,20-tris-(4-acetoxy-3-methoxyphenyl) porphyrin (P4.2), along with their fully symmetrical counterparts 5,10,15,20-tetrakis-(4-acetoxy-3-methoxyphenyl) porphyrin (P2.1) and 5,10,15,20-tetrakis-(4-carboxymethylphenyl) porphyrin (P3.1) were comparatively evaluated. The absorption and fluorescence properties, as well as atomic force microscopy measurements were performed to evaluate the photophysical characteristics as well as morphological and textural properties of the mentioned porphyrins. The cellular uptake of compounds and the effect of photodynamic therapy on the viability, proliferation, and necrosis of human HaCaT keratinocytes, human Hs27 skin fibroblasts, human skin SCL II squamous cell carcinoma, and B16F10 melanoma cells were assessed in vitro, in correlation with the structural and photophysical properties of the investigated porphyrins, and with the predictions regarding diffusion through cell membranes and ADMET properties. All samples were found to be isotropic and self-similar, with slightly different degrees of aggregability, had a relatively low predicted toxicity (class V), and a predicted long half-life after systemic administration. The in vitro study performed on non-malignant and malignant skin-relevant cells highlighted that the asymmetric P2.2 porphyrin qualified among the five investigated porphyrins to be a promising photosensitizer candidate for PDT in skin disorders. P2.2 was shown to accumulate well within cells, and induced by PDT a massive decrease in the number of metabolically active skin cells, partly due to cell death by necrosis. P2.2 had in this respect a better behavior than the symmetric P.2.1 compound and the related asymmetric compound P4.2. The strong action of P2.2-mediated PDT on normal skin cells might be an important drawback for further development of this compound. Meanwhile, the P3.1 and P3.2 compounds were not able to accumulate well in skin cells, and did not elicit significant PDT in vitro. Taken together, our experiments suggest that P2.2 can be a promising candidate for the development of novel photosensitizers for PDT in skin disorders.

Nutrition has been identified as playing a significant role in inflammatory rheumatic conditions. Available recommendations for managing these diseases have recently included lifestyle changes as well as dietary advice as complementary to pharmacological treatments. This is a summary of the first dietary recommendations for patients suffering from rheumatic diseases, postulated by the French Society for Rheumatology. The work was performed by a group of multidisciplinary experts and it was based on a systematic literature review of available published data, also considering the quality of studies. The eight principles and nine recommendations issued target both joint and extra-articular effects of nutritional intervention. The recommendations state following a Mediterranean diet, supplementation of omega-3 polyunsaturated fatty acids. Restrictive-type diets like gluten-free, dairy-free, fasting or vitamins and trace elements supplementation are not recommended because of lack of scientifically proven benefit. The use of probiotics or spices have insufficient rationale to be recommended.

Introduction. The coronavirus disease 2019 (COVID-19) pandemic has constrained healthcare units to reorganize hospital departments, substantially reducing their capacity to perform oncology-related surgeries. Despite the efforts to reduce the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during hospitalization, COVID-19 has complicated the recovery of many surgical patients. Our objective was to assess the impact of SARS-CoV-2 infection on the postoperative evolution of patients with pancreatic surgery. Cases presentation. We present four patients with pancreaticoduodenectomy for malignant disease, operated in our hepato-biliary-pancreatic surgery department, who presented COVID-19 in the postoperative period, despite initial negative screening. 10% of patients who had pancreaticoduodenectomies were subsequently detected with minimal, moderate to severe forms of COVID-19 in the postoperative period, which led to an extension of the hospitalization period, in some cases, by up to five weeks. Conclusions. The side effects of COVID-19 pandemic are yet to have reached their limits. Pancreaticoduodenectomy is a complex surgery with high morbidity rates, but during the COVID-19 pandemics it has become more challenging.

Objectives Our study described how the WHO intra-action review (IAR) methodology was operationalised and customised in three Western Balkan countries and territories and the Republic of Moldova and analysed the common key findings to inform analyses of the lessons learnt from the pandemic response.Design We extracted data from the respective IAR reports and performed a qualitative thematic content analysis to identify common (between countries and territories) and cross-cutting (across the response pillars) themes on best practices, challenges and priority actions. The analysis involved three stages, namely: extraction of data, initial identification of emerging themes and review and definition of the themes.Setting IARs were conducted in the Republic of Moldova, Montenegro, Kosovo and the Republic of North Macedonia between December 2020 and November 2021. The IARs were conducted at different time points relative to the respective pandemic trajectories (14-day incidence rate ranging from 23 to 495 per 100 000).Results Case management was reviewed in all the IARs, while the infection prevention and control, surveillance and country-level coordination pillars were reviewed in three countries. The thematic content analysis identified four common and cross-cutting best practices, seven challenges and six priority recommendations. Recommendations included investing in sustainable human resources and technical capacities developed during the pandemic, providing continuous capacity-building and training (with regular simulation exercises), updating legislation, improving communication between healthcare providers at all levels of healthcare and enhancing digitalisation of health information systems.Conclusions The IARs provided an opportunity for continuous collective reflection and learning with multisectoral engagement. They also offered an opportunity to review public health emergency preparedness and response functions in general, thereby contributing to generic health systems strengthening and resilience beyond COVID-19. However, success in strengthening the response and preparedness requires leadership and resource allocation, prioritisation and commitment by the countries and territories themselves.

Abstract Control theory has seen recently impactful applications in network science, especially in connections with applications in network medicine. A key topic of research is that of finding minimal external interventions that offer control over the dynamics of a given network, a problem known as network controllability. We propose in this article a new solution for this problem based on genetic algorithms. We tailor our solution for applications in computational drug repurposing, seeking to maximize its use of FDA-approved drug targets in a given disease-specific protein-protein interaction network. We demonstrate our algorithm on several cancer networks and on several random networks with their edges distributed according to the Erdős–Rényi, the Scale-Free, and the Small World properties. Overall, we show that our new algorithm is more efficient in identifying relevant drug targets in a disease network, advancing the computational solutions needed for new therapeutic and drug repurposing approaches.

Abstract The unsteady, magneto-hydrodynamic generalized Couette flows of two immiscible fluids in a rectangular channel with isothermal walls under the influence of an inclined magnetic field and an axial electric field have been investigated. Both fluids are considered electrically conducting and the solid boundaries are electrically insulated. Approximate analytical solutions for the velocity, induced magnetic, and temperature fields have been determined using the Laplace transform method along with the numerical Stehfest's algorithm for the inversion of the Laplace transforms. Also, for the nonlinear differential equation of energy, a numerical scheme based on the finite differences has been developed. A particular case has been numerically and graphically studied to show the evolution of the fluid velocity, induced magnetic field, and viscous dissipation in both flow regions.

Abstract This study briefings the roles of Coriolis, and Lorentz forces on the dynamics of rotating nanofluids flow toward a continuously stretching sheet. The nanoparticles are incorporated because of their unusual qualities like upgrade the thermal transportation, which are very important in heat exchangers, modern nanotechnology, electronics, and material sciences. The primary goal of this study is to improve heat transportation. Appropriate similarity transformations are applied for the principal PDEs to transform into nonlinear dimensionless PDEs. A widely recognized Numerical scheme known as the Finite Element Method is employed to solve the resultant convective boundary layer balances. Higher input in the solvent fraction parameter has a rising effect on the primary velocity and secondary velocity magnitude, and decreasing impact on the distributions of temperature. It is seen that growing contributions of the Coriolis, and Lorentz forces cause to moderate the primary and secondary velocities, but the temperature and concentration functions show opposite trend. The concentration, temperature, and velocities distributions for suction case is prominently than that of injection case, but inverse trend is observed for local Nusselt and Sherwood numbers. These examinations are relevant to the field of plastic films, crystal growing, paper production, heat exchanger, and bio-medicine.

Abstract Prandtl–Eyring hybrid nanofluid (P-EHNF) heat transfer and entropy generation were studied in this article. A slippery heated surface is used to test the flow and thermal transport properties of P-EHNF nanofluid. This investigation will also examine the effects of nano solid tubes morphologies, porosity materials, Cattaneo–Christov heat flow, and radiative flux. Predominant flow equations are written as partial differential equations (PDE). To find the solution, the PDEs were transformed into ordinary differential equations (ODEs), then the Keller box numerical approach was used to solve the ODEs. Single-walled carbon nanotubes (SWCNT) and multi-walled carbon nanotubes (MWCNT) using Engine Oil (EO) as a base fluid are studied in this work. The flow, temperature, drag force, Nusselt amount, and entropy measurement visually show significant findings for various variables. Notably, the comparison of P-EHNF's (MWCNT-SWCNT/EO) heat transfer rate with conventional nanofluid (SWCNT-EO) results in ever more significant upsurges. Spherical-shaped nano solid particles have the highest heat transport, whereas lamina-shaped nano solid particles exhibit the lowest heat transport. The model's entropy increases as the size of the nanoparticles get larger. A similar effect is seen when the radiative flow and the Prandtl–Eyring variable-II are improved.