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Background and Objectives: Sustained virologic responses (SVRs) lead to a decrease in portal hypertension, the regression of fibrosis, and the improvement in the hepatic synthesis of procoagulant and anticoagulant factors. We aimed to assess the influence of SVR on coagulation parameters in cirrhotic patients with HCV treated with DAAs. Methods: We performed a prospective study in the Institute of Gastroenterology and Hepatology Iasi, Romania, between January 2022 and February 2024. We included patients diagnosed with compensated and decompensated HCV-related liver cirrhosis, treated with direct antivirals (PrOD ± RBV or SOF/LED ± RBV) for 12/24 weeks. Blood samples for biochemical, immunological, and coagulation tests were collected at the baseline, end of treatment (EOT), and once sustained virological response had been achieved over a period of 12/24 weeks (SVR12/24). Results: We analyzed a group of 52 patients with HCV-related liver cirrhosis, predominantly female (68.0%), and the degree of severity of cirrhosis placed the patients mainly in Child–Pugh classes B (40%) and C (36%). All patients achieved SVRs. The MELD score decreased at EOT (13.48 ± 4.273; p = 0.001) and SVR (9.88 ± 2.774; p = 0.000), compared to the baseline (14.92 ± 4.707). The FibroScan values decreased at SVR (17.596 ± 3.7276; p = 0.000) compared to the baseline (26.068 ± 7.0954). For all common coagulation parameters (platelets, INR, PT, fibrinogen, aPTT), there was a trend towards improvement during treatment, including changes which were statistically significant for the majority of patients. Factor II was low at the baseline (75.40 ± 7.506) but increased at EOT (87.40 ± 9.587) and, later, at SVR (99.12 ± 11.695; p = 0.000). The FVIII values increased at the baseline (175.52 ± 16.414) and decreased at EOT (151.48 ± 13.703) and SVR (143.40 ± 13.937). The FvW values decreased during treatment (146.84 ± 9.428, at baseline; 141.32 ± 9.690, p = 0.000, at EOT; and 126.68 ± 17.960, at SVR). In regard to the anticoagulant factors (PC, PS, ATIII), a significant improvement was brought on by SVR. Advanced stages of liver disease showed the most diminished FII activity, while at the baseline and in Child–Pugh C patients we recorded the highest values of FVIII and FvW. Conclusions: Our study proved that the “reset” of coagulopathy might be due to the improvement in liver function due to viral eradication secondary to AAD therapy.

Background/Objectives: This study investigates the biocompatibility and physiological impacts of silver nanoparticles (AgNPs) functionalized with Spirulina protein extract (SPE) on laboratory rats. The objective was to assess and compare the systemic distribution, organ accumulation, and changes in hematological and biochemical parameters between biofunctionalized and non-functionalized silver nanoparticles. Methods: AgNPs were functionalized with SPE. Adult Wistar rats were administered these nanoparticles to assess their distribution across various organs using ICP-MS analysis. Hematological and biochemical markers were measured to evaluate systemic effects. Results: Functionalized silver nanoparticles demonstrated preferential accumulation in the brain, liver, and testicles, with significant clearance observed post-administration. The persistence of AgNPs SPE in reproductive organs was established. Hematological analysis revealed moderate changes, suggesting mild immune activation. Biochemical tests indicated transient increases in liver enzymes, signaling reversible hepatic stress. Conclusions: The biofunctionalization of AgNPs with Spirulina protein extract modifies the nanoparticles’ systemic behavior and organ distribution, enhancing their biocompatibility while inducing minimal physiological stress. These findings support the potential of Spirulina-based coatings to mitigate the toxicity and enhance the therapeutic efficacy of nanomedical agents.

Low back pain (LBP) is a common medical condition with a negative impact on quality of life and work. It also leads to financial costs for the health system by increasing the costs of medical treatment. Numerous studies have focused on the effects of exercise, with some highlighting the role of protective studies in LBP while other studies have shown no beneficial. There is moderate-certainty evidence that therapeutic exercise is beneficial in the treatment of chronic low back pain compared with other treatment modalities. Muscle strengthening and the creation of spinal mobility through specific exercise is a recognized therapeutic approach to the prevention and treatment of LBP. The main objecvtive is to evaluate the effectiveness of a physi-cal therapy program utilizing the 360 Huber platform on the quality of life for individuals with chronic lumbar radiculopathy. A randomized controlled trial was conducted with 30 participants diagnosed with chronic lumbar radiculopathy. Participants were divided into an ex-perimental group (n=20) receiving the 360 Huber platform-based rehabilitation protocol, and a control group (n=10) continuing standard care. The intervention included 15 sessions of physical therapy on the 360 Huber platform, complemented by electrotherapy and therapeutic massage. The Oswestry Disability Index (ODI) was administered pre- and post-intervention to assess changes in functional outcomes and quality of life. The experimental group demonstrat-ed a significant reduction in ODI scores, with an average decrease of 1.85 points (10.11%) from 18.30 to 16.45. The paired t-test analysis revealed a statistically significant difference (p < 0.001) and a very large effect size (1.11), indicating substantial improvements in functional outcomes. The control group showed no significant changes. The rehabilitation protocol using the 360 Huber platform, combined with electrotherapy and therapeutic massage, effectively im-proves functional outcomes and quality of life for patients with chronic lumbar radiculopathy. The study highlights the potential of integrating advanced technology with traditional physical therapy methods to enhance treatment efficacy. Future research with larger sample sizes and longer follow-up periods is recommended to confirm these findings and explore additional therapeutic modalities.

The extensive development of nanotechnologies has allowed nanoparticles to impact living systems through different pathways. The effect of single exposure to high concentrations of silver and copper nanoparticles (50–200 mg/L) on Vaccinium myrtillus L. under field conditions was investigated. Nanoparticle uptake in different segments of Vaccinium myrtillus L. was assessed by applying inductively coupled plasma–atomic emission spectroscopy and a particle-induced X-ray emission technique. Copper nanoparticles mainly accumulated in the roots and leaves, while silver nanoparticles showed a higher affinity for the roots and berries. The nanoparticles’ effects on the pigments and antioxidant activity of the plant’s leaves were also evaluated. The possible human health risk associated with the consumption of nanoparticle-contaminated berries was assessed. The results indicated that the consumption of berries contaminated with nanoparticles presented a low risk for human health.

Valentina-Fineta Chiriac,1,2 Daniel-Corneliu Leucuța,3 Daniela-Viorica Moșoiu4,5 1Department of Medical Oncology, C&abreve;l&abreve;rași Emergency County Hospital, C&abreve;l&abreve;rași, Romania; 2PhD Student, Faculty of Medicine, Transilvania University, Brașov, Romania; 3Department of Medical Informatics and Biostatistics, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; 4Director for Education & National Development HOSPICE Casa Sperantei, Brașov, Romania; 5Faculty of Medicine, Transilvania University, Brașov, RomaniaCorrespondence: Valentina-Fineta Chiriac, Email valentinafchiriac@gmail.comContext: Pain management is a constant struggle. Transcranial direct current stimulation (tDCS) is a neuromodulation technique with proved efficacy in chronic pain.Objective: The aim of the study is to provide a bibliometric perspective regarding articles on pain and tDCS. Having a visualized and systematically overview of publication trends, new research ideas could arise for clinicians.Methods: Articles on pain and tDCS were retrieved from Web of Science database. Using the R software version 4.1.2 and the “biblioshiny” R package, a quantitative and statistical analysis was performed. Time trend, number of publications, journals and authors, author country and institution, as well as citations and references were visualized.Results: A total of 554 publication fulfilled the criteria and were analyzed. The scientific production has been increasing over time with an annual growth of 17.1%. Brain Stimulation Journal and Journal of Pain are the leading journals regarding articles and citations. Fregni F. (83 articles) is the most prolific researcher with important authorship in the field. USA is the country with most authors involved in the topic (558 authors), whereas the leading institution is represented by Universidade Federal Rio Grande Do Sul (84 articles). Lefaucheur JP. article from 2017 has the maximum citations, while keywords in trend in the last three years are osteoarthritis and low back pain.Conclusion: This is the first bibliometric study that reflects the trends of tDCS in the field of pain. Journals as well as authors are limited and clustered. However the number of articles as well as number of citations are constantly increasing, supporting the idea that this is an emerging topic. The information obtained could be an important practical basis for future pain management research.Keywords: chronic pain, noninvasive electric brain stimulation, neuromodulation, bibliometric analysis, Web of Science

Rezumat.Scopul prezentului studiu a fost estimarea relației dintrenivelul TNF-α și gradul de microcristalizare (GMC) a fluidului oral(FO) la copiii cu tumori maligne în regiunea capului și gâtului (RCG). În studiul de tip caz-martor au fost incluși 72 de copii cu vârste cuprinse între 1 și18 ani repartizați în 2 loturi identice după structură. Lotul de cercetare (L1)a fost constituit din 36decopiicutumorimaligneînRCG. În lotul martor (L0)au fost incluși 36 de copii conventional sănătoși. S-au studiat biomarkerii combinați - morfologici (GMC al FO) și nivelul citokineiTNF-α în FO la copii cu tumori maligne în RCG și subiecții conventional sănătoși. TNF-α în FO a fost apreciat prin metoda de analiză imunoenzimatică. Analiza rezultatelor studiului a elucidat nivelul crescut al TNF-α, în FO al copiilor cu tumori maligne, comparativ cu subiecții sănătoși. Analiza corelațională a depistat relaţia inversă semnificativă (r=-0,83, р

Background and Objectives: The rate of head and neck cancer (HNC) is expected to increase by 30% by 2030. However, there are many similarities between the symptomatology of a benign and a malign diagnosis; thus, a protocol for conducting a full head and neck examination is of high importance since the absence of adenopathy does not exclude a malignant diagnosis and also a favorable prognosis. Material and methods: The current study presents a retrospective study on 515 adult patients who underwent a biopsy for possible head and neck tumor pathology. Results: The patients identified with cancer were older than the rest of the group, with a higher developing trend in men than in women. However, the top 10 symptomatology patterns were identical in the malign and benign groups, meaning that new HNC may be missed due to the common symptomatology between benign and malign outcomes. Conclusions: The importance of a full ear, nose, and throat (ENT) examination may be of significant relevance for a proper diagnosis that can improve the overall prognosis of a patient with cancer. The absence of routine screening tests and screening guidelines for oral and pharyngeal cancers represents a significant barrier to secondary HNC prevention.

Financial irregularities can occur in the management of assets and may be caused by faulty accounting procedures, erroneous estimates, inadequate depreciation or unexpected losses. Such irregularities and errors can affect both the financial statements and the overall performance of the firm. Financial errors can have similar effects. They could arise either from incorrect accounting for asset acquisition or depreciation, negligence or misinterpretation of accounting rules. Such mistakes can disrupt financial statements and the understanding of a company's financial performance and stability. Based on the indicators reported by firms in 2021, this study identifies both at the level of each county and by taxpayer category, situations where fixed assets are lower than tangible assets, and the risk of non-compliance in financial reporting appears to be significant.

The main objective of the research was to visualize and analyze complex datasets for the development of keyword maps and the identification of clusters of connected terms. In order to highlight thematic relationships between words, thus providing insight into the dynamics of the domains of interest, we used VOSviewer, a versatile digital tool. With this tool we detected subdomains connected with fraud or various specialisations within the domain. The approach adopted for this study was the bibliometric analysis of a total volume of 1377 articles, which were indexed in the Scopus database over a nine-year period from 2015 to 2023. The primary topic of these articles was tax evasion, while secondary topics were accounting, forgery and legal issues. In addition, the keywords used, relevant by their frequency and impact, gave us the opportunity to identify dominant themes and uncover less explored areas of research, thus being able to guide future directions of study.

This article reports the efficiency of the Damon® self-ligating brackets, for the treatment of a Class II, hypodivergent adult patient. We present a case report of a non-extraction treatment for an adult male patient, and we evaluate the effiency of the treatment by recording the effects obtained over time and comparing them with data from the literature regarding this aspect.

The motivation for creating of an interactive map for school is the desire to collect all the necessary information from different sources into one web map to facilitate and standardize the process of teaching geography of the Republic of Moldova, and due to the interactivity of the map to increase student academic achievement and motivation. In the article the methodology of the research, which is carried out within scientific project, the creation of Land Use Web school map of Moldova is considered. The content of the Land Use Web Map and interface screenshots showing functions of interactive map are presented in the article. In the main part of the article, the technology of the creation of Land Use map is described developed by means of work with spatial data of Laboratory of Geomorphology and Ecopedology of Institute of Ecology and Geography and using tools of Web-based mapping software ArcGIS Online. The first result of the study is the description of the technology by which any other thematic web map can be created. The second result is the Land Use web map of Moldova, which through the Internet can be used in any country of the world by students and school teachers.

The aim of the study was to develop a new method for mercury determination from plants grown on mercury-polluted soils as well as to evaluate the mobility and bioavailability of mercury in the soil and its transfer to different plant organs (root, stem, leaves) from three different plants, such as mustard (Sinapis alba), thyme (Thymus serpyllum) and wild thyme. A cold vapor atomic absorption spectrometry (CV-AAS) method for the detection of mercury in plants was developed. The developed method was validated in the laboratory and was verified using two different certified reference materials (CRMs) type matrices, namely: NIST 1515 Apple Leaves and BCR-482 Lichen.

This study investigated whether an intervention, in the form of short educational sessions, influenced pupils' experiences of group work or cooperative learning (CL). The hypothesis tested was that an intervention for teachers and pupils would lead to pupils' increased (a) collective efficacy, (b) self-efficacy and, (c) positive interdependence, as well as (d) less negative interdependence. The participants were pupils from years 5 and 8 in three compulsory schools in Sweden, working in 22 groups divided into one intervention group and one control group (11 work groups in each condition). Data were collected through a questionnaire before and after participation in the study and analysed using a repeated measure ANOVA and 2×2 ANOVA. The results showed an increased collective efficacy, self-efficacy and positive interdependence and a reduction of negative interdependence. The conclusion is that the intervention provided for teachers and pupils did have an effect, thus promoting successful working as a group.

In the context of waters polluted with different high-risk contaminants, the development of efficient materials able to efficiently clean them is necessary. In the first part, the present review focuses on the ability of various types of magnetic layered double hydroxide materials to act as adsorbents for water contaminated mainly with heavy metals and dyes. Also, this paper reviews the ability of different magnetic layered double hydroxide materials to act as potential adsorbents for the treatment of wastewater contaminated with other types of pollutants, such as pharmaceutical products, phenolic compounds, phytohormones, and fungicides. In the second part, the applicability of the catalytic method for water depollution is explored. Thus, the use of simple or composite materials based on Fe3O4 is reviewed for the purpose of the catalytic degradation of organic compounds (dyes/phenols/pharmaceuticals). At the end, a review of multifunctional materials able to simultaneously neutralize different types of pollutants from wastewater is provided.

The objective of this study was to analyze the epidemiological links of the human immunodeficiency virus (HIV), hepatitis C virus (HCV) and HIV-HCV coinfections to less studied types of transmission in certain populations. We performed an observational, prospective study on 903 patients aged between 15–87 years who took part in the Open Test Project. They were divided in two subgroups: general population vs. individuals from prisons who were questioned about multiple risk factors. A chi-square independence test was used to establish correlations between risk factors and results of screening tests. Logistic regression was used to calculate the probability of a reactive screening test based on each independent risk factor and age. HIV was very strongly associated with unprotected sexual intercourse with HIV-positive partners (the strongest association), unprotected sexual intercourse with sex workers, newly diagnosed sexually transmitted diseases (STDs), intravenous drug users (IDUs) and sharing injecting materials. In the case of HCV reactive tests, very strong associations have been established with IDUs (the strongest association), unprotected sex with IDUs and sharing injecting materials. Our study indicates the need for implementing targeted public health programs, tailored to the local epidemiology that can ultimately lead to micro-elimination of hepatitis and HIV infections in this area.

A paramagnetic A3B-type Mn(III)-porphyrin was synthesized and characterized by physical–chemical methods (UV-Vis, FT-IR, 1H-NMR spectroscopy). The obtained compound was tested as a sensitive material for the spectrophotometric and potentiometric detection of iodine species. Using UV-Vis spectroscopy, the triiodide anions could be detected with high precision in the concentration interval of 1.02 × 10−5 to 2.3 × 10−5 M, with an LOD of 9.44 × 10−6 M. The PVC-based electrode using DOP as a plasticizer showed a sensitivity toward iodide in a wide concentration range of 1.0 × 10−5 to 1.0 × 10−1 M, with an LOD of 8.0 × 10−6 M. Both methods are simple, low-cost, and efficient for the detection of iodine species in synthetic samples and pharmaceuticals.

We face significant environmental pollution problems due to various industries, such as the aluminum industry, which generates large amounts of red mud (RM) waste, or agriculture, in which case the use of pesticides creates huge water pollution problems. In this context, the present study offers a better perspective to originally solve both environmental issues. Thus, the main target of the study referred to using RM waste as a filler for preparing composite copolymer beads. Thereafter, this can achieve significant removal of water pollutants due to their adsorption/oxidation characteristics. As evidenced by the changes in chemical structure and composition, thermal stability, morphology, and porosity, RM was homogenously incorporated in poly(acrylonitrile-co-acrylic acid) beads prepared by wet phase inversion. The final assessment for the removal of pesticides by adsorption and oxidation processes was proven successful. In this regard, 2,4-dichlorophenoxyacetic acid was chosen as a model pollutant, for which an adsorption capacity of 16.08 mg/g composite beads was achieved.

Background and aims: Increases in both the prevalence and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) and obesity are closely related. Type 2 diabetes (T2DM) has been associated with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis and hepatocellular carcinoma. Semaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist approved for the treatment of T2DM and has an important role in weight loss. Also, it may represent a new therapeutic option for the treatment of MASH in obese diabetic patients. The main outcomes were changes from baseline in liver steatosis and fibrosis at week 24. Material and methods: A total of one hundred eighty-seven patients with T2DM were eligible for this prospective study; ninety-five subjects were treated with oral semaglutide, and ninety-two patients were treated with dapagliflozin as an add-on to metformin. All the subjects were evaluated using Vibration Controlled Transient Elastography (VCTE) from June to December 2022. Results: From our cohort, 54% of the patients were females, with a mean age of 59.92 ± 11.89 years and a mean body mass index (BMI) of 29.53 ± 5.33 kg/m2. Following a six-month medication period, we observed a substantial reduction in anthropometric measurements, including the BMI, waist circumference (WC), and waist-to-hip ratio (WtHr), in both groups. Regarding HbA1c, a notable decrease was observed in the semaglutide group (p < 0.001) when compared to the dapagliflozin group (p = 0.011). In addition, the liver stiffness measurement (LSM) according to VCTE improved significantly in the semaglutide group participants from 8.07 ± 2.90 kPa at baseline to 6.51 ± 3.09 kPa after medication (p < 0.001). Conclusion: The superior metabolic effects of semaglutide, correlated to dapagliflozin, may contribute to a more efficient decrease in hepatic stress and injury, leading to a substantial enhancement of liver function in T2DM patients. Further investigations conducted over an ideal timeframe are necessary to confirm the evidence presented in this study.

Drug information (DI) provided by hospital pharmacies aims to promote rational and safe drug therapy. While quality assessment for this task is recommended, more knowledge on the factors determining the quality is needed. We aimed to evaluate the impacts of different factors on the quality of DI provided by hospital pharmacies to healthcare professionals. Retrospectively, answers on fictitious enquiries about annual DI tests for German hospital pharmacies over five years were evaluated for content-related and structural requirements. Multivariate analysis was performed for the impact of the enquiry complexity, DI organization (specialized DI center; pharmacist responsible per day; DI on top of other routine tasks), and quality measures (second look; experience of answering pharmacist in DI/on ward; use of documentation database). In 2017–2021, 45, 71, 79, 118, and 122 hospital pharmacies participated. The enquiry complexity had a statistically significant impact on the content-related quality, with poor results for a higher complexity (years 2018/2021, OR 0.25/0.04, p < 0.01). The DI centers achieved better results regarding content-related quality than for a pharmacist responsible per day (OR 0.76/p = 0.65) or DI on top of routine tasks (OR 0.35/p = 0.02). The DI centers scored better in structural quality. The second look showed an overall trend of a better content-related and structural quality. In conclusion, specialized DI centers and second looks are recommended as quality-improving measures. Training for answering complex enquiries should be intensified.

The impact of fossil fuel utilisation in different combustion systems on climate change due to greenhouse gas accumulation in the atmosphere is rather evident. A part of these gases comes from the large engines used for propulsion in marine applications. In the continuous global effort made by engine manufacturers to mitigate this negative impact, one way is represented by the utilisation of alternative fuels such as biodiesel and methanol, based on dedicated research to fulfil the more stringent regulations concerning pollutant emissions issued by piston heat engines. In this study, a numerical investigation was conducted on a four-stroke large marine diesel engine (ALCO 16V 251C) at several engine speeds and full load conditions. Different blends of diesel–methanol and biodiesel B20–methanol with methanol mass fractions of 10% and 20% were considered for theoretical analysis in two techniques of methanol supply: direct injection mode of a blend of base fuel diesel/biodiesel B20 with methanol and injection of methanol after the intercooler, and direct injection of the base fuel. The results show that, if 10% in power loss can be acceptable, then for diesel–methanol 10%, in the direct injection technology, the NOx emission can be reduced up to 19%, but with a compromise of an 8% increase in SOOT emission, while for biodiesel B20–methanol 10%, with the same direct injection method, the NOx emissions increase by up to 58% with the benefit of reducing SOOT by up to 23% relative to the original diesel fuel operation. For a 20% methanol fraction in blend fuel, the drop in power is more than 10% regardless of the method of methanol supply and the base fuel, diesel, or B20 used.

Portal hypertension from chronic liver disease leads to the formation of collateral blood vessels called spontaneous portosystemic shunts (SPSS). These shunts may form from existing vessels or through neo-angiogenesis. Their location affects clinical outcomes due to varying risks and complications. This review summarizes current knowledge on SPSS, covering their clinical impact and management strategies. Recent data suggest that SPSS increases the risk of variceal bleeding, regardless of shunt size. The size of the shunt is crucial in the rising incidence of hepatic encephalopathy (HE) linked to SPSS. It also increases the risk of portopulmonary hypertension and portal vein thrombosis. Detecting and assessing SPSS rely on computed tomography (CT) and magnetic resonance imaging. CT enables precise measurements and the prediction of cirrhosis progression. Management focuses on liver disease progression and SPSS-related complications, like HE, variceal bleeding, and portopulmonary hypertension. Interventional radiology techniques such as balloon-occluded, plug-assisted, and coil-assisted retrograde transvenous obliteration play a pivotal role. Surgical options are rare but are considered when other methods fail. Liver transplantation (LT) often resolves SPSS. Intraoperative SPSS ligation is still recommended in patients at high risk for developing HE or graft hypoperfusion.

This article examines genetic algorithms that are built on the "survival of the fittest" principle enunciated by Charles Darwin. By applying genetic algorithms to solving optimization problems, it is not always possible to guarantee the determination of the global optimum in polynomial time. This fact does not occur because only brute force search methods allow us to find the global optimum. Instead the genetic algorithm allows selecting good decisions, in a reasonable time, compared to other well-known deterministic or heuristic search engine optimization algorithms. The authors of this article develop an algorithm of solving the optimization problem of locations graph vertices in the line.

This case report presents an 82-year-old male initially diagnosed with classical mantle cell lymphoma (MCL) that progressed to the aggressive blastoid variant. The patient was initially treated with oral chemotherapy (PEP-C), followed by ibrutinib, but experienced disease progression with central nervous system (CNS) involvement and blastoid morphology. Despite subsequent intensive treatment, including high-dose cytarabine (Cytarabine), rituximab, and intrathecal methotrexate (Methotrexate), the patient's disease continued to advance, resulting in death. This case underscores the aggressive nature of blastoid MCL, its poor prognosis despite current therapeutic strategies, and highlights the need for individualized treatment approaches and CNS prophylaxis.

During the Cold War, the Soviet Union invested heavily in its air defense systems, so its rightful successor, Russia, has now some of the most advanced air and missile defense systems in the world. Among them, the S-400 “Triumf” surface-to-air missile system is perhaps the most criticized, shrouded in mystery, and feared system in Russia’s arsenal. Developed and then presented as capable of engaging a variety of aerial threats, the system gained a reputation, at least declaratively, of being able to counter US and NATO ambitions to win a conflict through airspace dominance.

Introducere. În ocluziile axului arterial subclavio-axilar cu ischemie severă a membrului superior s-ar impune folosirea metodelor endovasculare sau aplicarea unui bypass ortotop. În cazul imposibilității, din motive tehnice sau a stării pacientului, drept alternativă servește bypass-ul carotido-brahial. Scopul lucrării. Aprecierea posibilității utilizării bypass-ului extraanatomic carotido-brahial în revascularizarea membrului superior în ischemia severă. Material și metode. Raportul de cazuri cuprinde 5 pacienți cu ocluzia axului subclavio-axilar cu ischemie severă a membrului superior, dintre care 3 cu ocluzie acută pe fundal de stenoze aterosclerotice, la care intervenția inițială de trombectomie (embolectomie) a eșuat, un pacient cu tromboza anevrismului a. subclaviculare și un pacient cu ocluzie aterosclerotică de gradul IV cu gangrena degetului II, la care intervenția endovasculară a eșuat. La toți pacienții s-a aplicat un bypass carotido-brahial cu grefon safen intern inversat. Grefele au fost amplasate suprafascial supraclavicular. Rezultate. La toți 5 pacienți ischemia a cedat complet. La 4 din ei s-a restabilit pulsul distal. La pacientul cu ateroscleroză cronică de gradul IV, cu afectarea concomitentă a arterelor antebrațului, pulsul s-a restabilit la bifurcația arterei brahiale. La acest pacient s-a efectuat amputația degetului. Complicații nu s-au înregistrat. Incomodități subiective din cauza amplasării suprafasciale și supraclaviculare a bypass-urilor, de asemenea, n-au fost înregistrate. Concluzii. Bypass-urile carotido-brahiale localizate suprafascial și supraclavicular serversc o alternativă a bypass-urilor ortotope, inclusiv în cazurile eșecurilor sau contraindicațiilor metodelor endovasculare.