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Funding Acknowledgements This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF Ventriculo-arterial coupling (VAC) reflects the interaction between the ventricle and the arterial system and its prognostic role was studied in different clinical settings. VAC can be assessed with echocardiography as the ratio between the arterial elastance (Ea) and the end-systolic left ventricular elastance (EES). Data concerning the role of VAC in severe aortic stenosis (AS) are scarce. We aimed to determine VAC in patients (pts) with severe AS and assess its relationship with symptoms. We included 61 consecutive pts with severe AS (vave area There were no significant differences in age (p = 0.08) and aortic valve area (p = 0.18) between groups. Variations of Ea and EES between groups were not significant (p = 0.08 and p = 0.94, respectively). However, VAC differed significantly between the 3 groups, being most impaired in group A (1.11 ± 0.69), followed by 0.77 ± 0.23 in group B and 0.73 ± 0.16 in group C (p = 0.03). The left ventricular ejection fraction (EF) also differed significantly between groups: 41 ± 13% in group A, 51 ± 11% in group B and 57 ± 3% in group C (p VAC is impaired in patients with severe AS and acute heart failure and it differs significantly from VAC in severe AS with chronic, stable symptoms and from VAC in asymptomatic severe AS. This suggests that the progression of symptoms in severe AS might be related to the interactions between the left ventricle and the vascular load, making thus VAC a potential therapeutic target and a parameter to be considered in the thorough evaluation of patients with severe AS. Group A Group B Group C Ea 2.69 ± 1.31 2.09 ± 0.94 1.95 ± 0.60 p = 0.08 EES 2.93 ± 1.90 2.87 ± 1.33 2.71 ± 0.73 p = 0.94 VAC 1.11 ± 0.69 0.77 ± 0.23* 0.73 ± 0.16* p = 0.03 EF 41 ± 13% 51 ± 11%* 57 ± 3%* p

Ventriculo-arterial coupling (VAC) represents a comprehensive expression of the mechanical efficiency and performance of the ventriculo-vascular system. It is defined as the ratio between the arterial elastance (Ea) and the end-systolic ventricular elastance (EES) and it has potential clinical applicability in different settings. The interaction between the ventricle and the aorta in the setting of acute heart failure has been insufficiently investigated. We sought to assess the VAC in patients with acute pulmonary edema (PE) and to establish its relationship with the ejection fraction (EF) and clinical outcome. We included 120 consecutive patients (mean age 74±12 years, 61 men) admitted for acute PE, with either preserved or reduced EF. The control group consisted of 50 subjects (mean age 40±13 years, 35 men) with no previous cardiac history. All patients underwent standard echocardiography on admission and we assessed the VAC non-invasively. We followed the patients for a composite endpoint of death, recurrent PE and acute coronary syndrome (ACS) for a month after hospitalisation. The VAC was significantly impaired in the acute PE group: 1.05±0.49 vs. 0.84±0.16 (p 14 patients (12%) in the study group had at least one in-hospital major cardiovascular event (MACE): in the low EF subgroup, there were 7 recurrent PE (11.5%) and 1 death (1.6%), while in the preserved EF subgroup, there were 5 recurrent PE (8.5%) and 1 ACS (1.7%). There was no significant difference in VAC between patients with in-hospital MACE and MACE-free patients (p=0.55 for low EF subgroup, p=0.59 for preserved EF subgroup). 10 patients (8.3%) in the study group had at least one MACE in the first month after discharge: in the low EF subgroup, there were 4 recurrent PE (6.6%) and 1 death (1.6%), while in the preserved EF subgroup, there were 2 deaths (3.4%) and 3 recurrent PE (5.1%). VAC was more impaired in low EF patients with MACE at 1 month (2.27±0.85) vs. low EF patients MACE-free at 1 month (1.21±0.44, p=0.04). No differences in VAC were noticed for the preserved EF subgroup (p=0.97). Ventriculo-vascular interaction is decoupled in acute PE, with VAC being more impaired when the EF is reduced. Furthermore, for patients with acute PE and low EF, VAC was worse in those who suffered a MACE at 30 days. This suggests the prognostic value of VAC in acute PE and it highlights the importance of integrating this easy-to-obtain parameter in the echocardiographic evaluation of acute heart failure patients. Acknowledgement/Funding This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF

Background The left atrium (LA) is a highly dynamic chamber that has 3 mechanical functions (reservoir, conduit, booster pump), as well as additional endocrine and regulatory properties. It is a marker of both the severity and chronicity of diastolic dysfunction and its remodelling has been shown to be a reliable predictor of clinical outcome in patients with heart disease. While LA function has been extensively studied in chronic heart failure, information about LA mechanics in patients with acute heart failure and preserved left ventricular ejection fraction (EF) are scarce. Purpose We sought to assess LA mechanics in a cohort of patients with acute pulmonary edema and preserved EF and compare it with a normal reference group. Methods We included 50 consecutive patients (22 men) with acute pulmonary edema, preserved EF and sinus rhythm in our study. Patients with significant mitral or aortic valve disease were not considered eligible. The control group consisted of 30 subjects (18 men) with no previous cardiovascular disease. We performed conventional transthoracic echocardiography for all patients and we assessed various parameters of LA mechanics. To evaluate the reservoir function, we determined the total ejection volume (EV), the total EF, the LA expansion index (LAEI) and the LA function index (LAFI). To evaluate the conduit function, we determined the passive EV and passive EF. For the booster pump function, we determined the active EV, active EF, the atrial filling fraction, the ejection force and the LA kinetic energy (LAKE). We used T-test to compare the parameters between the two groups. Results The mean age in the study group was 72±14 years, while in the control group the mean age was 56±16 years (p=0.06). The total EV did not differ significantly between groups (p=0.44). The total LA ejection fraction was lower in the study group: 29±10% vs. 51±9% (p Conclusion All three integrated phases of left atrial mechanics (reservoir, conduit, booster pump) are impaired in patients with acute pulmonary edema and preserved left ventricular EF. These findings highlight the importance of diastolic dysfunction in the pathogenesis of acute heart failure for these patients and they suggest that LA dysfunction might be a potential therapeutic target in this clinical setting. Acknowledgement/Funding This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF

Objective: The persistence of high prevalence of thyroid pathology (goiter, nodules) in Romanian population, despite the correction of iodine defi ciency, determined us to evaluate the impact of factors different than iodine intake on the thyroid gland as environmental endocrine disruptors. We studied the potential correlation between pesticide exposure and parameters of the function, autoimmunity and morphology of the thyroid in a group of greenhouse workers (GHWs) exposed to multiple uncontrolled pesticides across agricultural seasons. Materials and methods: A group of 108 GHWs, 18‐78 year olds, with normal iodine intake, from a plain village, exposed to multiple pesticides was enrolled voluntary in this study. Thyroid echography, thyroid parameters [thyroid stimulating hormone (TSH), free T4 (FT4), and antibody to thyroid peroxidase (ATPO)], some of the used pesticides (chlorpyrifos, trichloropyridinol (TCP), carbofurane, cypermethrin, dimethoate) and cholinesterase activity were determined in biological samples (urine, blood) collected across two agricultural seasons. Results: The median urinary iodine concentration in children from this village was 135.20 µg/L, while median TSH and median FT4 was 1.72 μUI/mL and 16.68 pmol/L, respectively. Hypothyroidism (TSH > 4.2 μUI/mL) was present in 12.4% of patients, median TSH value was 7.26 μUI/mL. In four of them post-thyroidectomy hypothyroidism was present. Elevated titres of anti-TPO antibodies were found in 22 (20.37%). Echographic pattern of thyroiditis was present in 16.49% of the patients, and thyroid nodules were detected by ultrasonography in 38.13%. There were two subjects with Graves’ disease. The detectable level of TCP was bigger in the fi rst season (range 120‐190 μg/L) than in the second (range 0.7‐1.7 μg/L). The range of seasonal concentration of urinary carbofurane was 0.004‐0.25 μg/mL. Cypermethrin was detected in a small number of subjects (range: 12.5‐13.3 μg/g creatinine). Dimethoate was undetectable. Conclusions: The distribution of thyroid disorders in study group living in an area with normal iodine intake did not differ from known epidemiological studies. The most frequently encountered pesticide was chlorpyrifos. Some samples presented several pesticides simultaneously.

The progressive behavior of human papillomavirus (HPV) associated neoplasia in immunossuppressed patients has been clearly demonstrated. Hodgkin’s disease and its treatment render a patient highly susceptible to persistent HPV and its consequences, thus requiring a more aggressive treatment and a closer follow-up protocol. We present the case of a 41-years old patient diagnosed with nodular sclerosing Hodgkin lymphoma receiving radiochemotherapy regimen. After having completed the oncologic therapy the patient was addressed to our clinic presenting abnormal uterine bleeding; a HPV 16-positive high-grade cervical intraepithelial neoplasia diagnosis was established. We obtained persistent disease after conservative treatment which finally leads us to performing a total hysterectomy. We observed a rapidly progressive course of high-grade HPV-induced neoplasia in a case of Hodgkin’s disease patient which may represent an accelerated version of untreated neoplasia in the immunocompetent. Screening and prompt treatment are of utmost importance in this group at risk.

The Semantic Web has opened new horizons for internet applications in general and for e-Learning in particular. The e-Learning community is aiming at having much more effective services than what is currently provided by any of the available computer aided tutoring, or learning management systems. The e-Learning process is no more restricted to providing courses online. Nowadays, knowledge is distributed throughout the Web on millions of pages, PDF files, multimedia and other resources. The learner is not necessarily someone who is registered in a course or needs e-Learning to support a particular course. Students and researchers need vast amount of material and spend considerable amount of time trying to learn about a particular subject or find relevant information. This research reports on the work in progress to develop a framework for Semantic Web mining and exploration, a practical method towards Semantic Web application to e-Learning along with its design framework is suggested.

This study describes 8 years of experience (1990-97) in the first Romanian center for family planning and contraception, which started in Bucharest at the Clinic Hospital of Obstetrics and Gynecology 'Prof. Dr. P. Sirbu' on 27 February 1990. A total of 14,258 women had attended the clinic by 1 January 1998. Trends in the use of contraceptives and the number of births and abortions at the center are described. During the 8 years, the induced abortions decreased by 65% and the uncompleted abortions (illegal abortions) by 45%. Hormonal contraception was the most commonly used contraceptive method (61.5%), followed by intrauterine devices (28.8%) and local contraception (barrier methods: condoms, diaphragms, spermicides) (9%).