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This study explores the survival rates and complications associated with zirconia restorations veneered with feldspathic ceramic in patients who had been diagnosed by an orthodontist with spacing issues. All patients had previously undergone orthodontic treatment to improve aesthetics after their teeth had been properly aligned. As a result, these cases were addressed through prosthetic solutions. The study included 18 patients, with 11 pairs of restorations for females and 7 for males, all targeting the anterior region to correct diastema. The restorations were followed over a two-year period, with check-ups scheduled every six months. Of the 18 restorations, 10 experienced chipping, primarily at the incisal edges. Additionally, two cases showed a recurrence of diastema due to non-compliance with wearing their Hawley retainers. Interestingly, the failure rate was higher in female patients, indicating a potential link between gender and the durability of the restorations. Despite these challenges, the restorations that suffered chipping could be successfully repaired, which proved to be a significant benefit. These findings highlight the importance of regular follow-up visits to ensure the longevity of the restorations and to inform future treatment planning.

Over the last two decades, the US companies have faced a series of challenges caused by the two of the most significant events, namely the global financial crisis and the Covid-19 pandemic crisis. To analyze the influence of these crises along with other factors on the firm value represented by Tobin’s Q, there were estimated unbalanced panel data multiple regression models, with cross-section fixed effects, with cross-section and period fixed effects, with cross-section random effects, and with cross-section random effects with period fixed effects, using a sample of 442 non-financial companies included in the Standard & Poor’s 500 index, over a period of 20 years, from 2004 to 2023. The independent variables are divided into three categories, namely financial indicators, corporate governance variables, and dummy variables that indicate the crisis periods. The results showed that the financial leverage, asset tangibility, liquidity, firm size, the number of meetings attended by the board members annually, the proportion of the independent members on the board and the Covid-19 pandemic crisis had a positive effect on the company value, while the firm age, CEO duality, the number of the members on the board, the proportion of the females on the board and the global financial crisis exerted a negative impact on the firm value. To better differentiate the determinants of the firm value in the context of the two major events that occurred during the analyzed period, there were estimated other empirical models using interaction variables between each dummy variable showing the crisis and the other factorial variables.

This study explores the trends and limitations of research on the Common Agricultural Policy (CAP) in relation to agriculture, economy, and the environment, using a bibliometric analysis based on Web of science data. Employing co-citation maps and collaborative networks among authors and institutions, the study highlights a fragmented literature characterized by high thematic specialization and a low level of interconnectedness among researchers, hindering the development of a coherent and integrated framework. A detailed analysis of author collaborations and co-citation networks provides a clear view of the intellectual structure of the field and the ways ideas and research have been interconnected and developed over time. Additionally, the examination of highly cited articles and works has revealed not only the current gaps in research but also opportunities for future investigations. For instance, most studies have focused on the effects of Common Agricultural Policy (CAP) funding on the environment, biodiversity, farmer behaviour, and the economic outcomes of the agricultural sector. However, they have largely overlooked a comprehensive understanding of how these interactions simultaneously influence all three dimensions: economic, environmental, and agricultural. This highlights a significant opportunity for research to explore more complex and integrated connections between CAP funding and its impact on these three pillars, considering the recent evolution and changes in the global economic landscape.

Aim of the study Eugenol, a phenolic compound commonly found in plants like clove and bay leaves, has garnered significant attention in the field of dentistry due to its diverse pharmacological properties. In dentistry, eugenol is frequently employed in various forms, such as in polymerized cement with zinc oxide for restorative purposes. Its applications extend to endodontic cements like zinc oxide-eugenol formulations, which are commonly used in dental procedures. So far, according to our knowledge, no study in the literature has approached formulations based on iron oxide nanoparticles and eugenol, this study being the first. Materials and methods In the present study, it was developed for the first time a formulation based on iron oxide nanoparticles obtained through the combustion method, embedded on its surface with eugenol. The prepared formulation was characterized through electron microscopy investigations, followed by further in vitro evaluation as concerned with their biosafety use on a healthy murine epidermal cell line. Results The results obtained showed that the naked iron oxide nanoparticles are biocompatible and safe to use on the healthy murine epidermal cell line, while the eugenol compound exhibits a dose-dependent cytotoxicity reaching until a value of ~17% at the highest tested dose (100 μg/mL). In addition, the cytotoxicity of eugenol decreased when this was embedded on the iron oxide nanoparticles surface, recording a value of 11% at the highest concentration tested. Conclusions In conclusion, the in vitro studies on such type of formulation in dentistry and dental medicine highlight their multifaceted applications of iron oxide nanoparticles as well as eugenol, emphasizing their potential for advancing dental treatments and diagnostics.

Major depressive disorder (MDD) is a complex mental health condition with a multifaceted and incompletely elucidated pathophysiology. MicroRNAs (miRNAs) have emerged as potential biomarkers due to their role in gene regulation and the observed dysregulation in MDD. The aim of this study is to detect the presence of specific molecular diagnostic biomarkers in major depressive disorder. This cross-sectional study analyzed plasma miRNA expression in ten MDD patients and eight healthy controls using real-time PCR. Differentially expressed miRNAs were identified using independent t-tests, and their diagnostic potential was assessed with ROC curve analysis. Fifteen miRNAs exhibited significant dysregulation in MDD patients. Notably, hsa-miR-29c-3p, hsa-miR-376a-3p, hsa-miR-532-5p, and hsa-miR-339-5p showed excellent discriminatory power (AUC > 0.8). This study identifies differentially expressed plasma miRNAs in MDD, suggesting their potential for improved diagnosis and personalized treatment. However, further validation in larger cohorts and investigation into their functional roles are warranted.

This study explored the use of mandarin peels as an important source of health-promoting compounds by utilizing green methods (i.e., pulsed electric field and ultrasound-assisted extraction), along with conventional stirring. The impact of several extraction parameters, such as extraction duration, temperature, and solvent composition, on the recovery of bioactive compounds was evaluated through a response surface methodology. To identify the most effective conditions for all assays, a partial least-squares analysis was implemented. It was revealed that a combination of the above techniques was optimal at 80 °C for 30 min, with 75% v/v of ethanol in water as the extraction solvent. The concentration of bioactive compounds in the optimum extract had a total polyphenol content of 18.69 mg of gallic acid equivalents (GAE) per gram of dry weight (dw), and an ascorbic acid concentration of 18.25 mg/g dw. However, correlation analyses revealed a rather negative relationship between these bioactive compounds. The chromatographic analysis of optimum extracts supported this result by quantifying 20.53 mg/g dw of total individual polyphenols, with hesperidin being the dominant compound (13.98 mg/g dw). The antioxidant assays, including ferric-reducing antioxidant power and DPPH• inhibition activity, were measured at 123.21 and 65.12 μmol of ascorbic acid equivalents (AAE) per gram of dw, respectively. This research enhances the valorization of mandarin peels as a renewable source of bioactive compounds, providing the opportunity to generate high-added-value products from food waste in the food and pharmaceutical sectors.

The digital transformation of education aims to equip the human capital with a set of digital skills characterized by complementarity that can be applied interdisciplinary. Besides, digitalization is often linked with economic development and efficiency, which led to the adoption of the Digital Education Action Plan 2021-2027 by the European Commission. As one of the EU-27 high-income member states, Romania fails in terms of digitalization of the human capital or economy. Hence, the main purpose of this study was to investigate the impact of digital education and human capital development on sustainable economic growth in Romania. The methodological approach used both qualitative and quantitative methods, like the regression model that allowed the quantification of relationships between variables. Data collection was applied for the period between 2020 and 2024. The main findings suggest that many systemic issues prevent Romania from taking advantage of its robust digital infrastructure. Despite the important growth potential presented by Romania, the lack of a clear innovation strategy to develop digitalization for sustainable economic growth had a very negative effect on the development of digital competencies of the human capital. Further research should focus on the role of digital skills in labour market resilience, the impact of digital education on regional economic disparities, and the governance and policy interventions in digital transformation.

The evaluation of chlorhexidine-carrier nanosystems based on iron oxide magnetic nanoparticles (IOMNPs), has gained significant attention in recent years due to the unique properties of the magnetic nanoparticles (NPSs). Chlorhexidine (CHX), a well-established antimicrobial agent, has been widely used in medical applications, including oral hygiene and surgical antisepsis. This study aims to report an in vitro and in ovo toxicological screening of the synthesized CHX-NPS nanosystem, of the carrier matrix (maghemite NPSs) and of the drug to be delivered (CHX solution), by employing two types of cell lines—HaCaT immortalized human keratinocytes and JB6 Cl 41-5a murine epidermal cells. After the characterization of the CHX-NPS nanosystem through infrared spectroscopy and electronic microscopy, the in vitro results showed that the CHX antimicrobial efficacy was enhanced when delivered through a nanoscale system, with improved bioavailability and reduced toxicity when this was tested as the newly CHX-NPS nanosystem. The in ovo screening exhibited that the CHX-NPS nanosystem did not cause any sign of irritation on the chorioallantoic membrane vasculature and was classified as a non-irritant substance. Despite this, future research should focus on optimizing this type of nanosystem and conducting comprehensive in vivo studies to validate its therapeutic efficacy and safety in clinical settings.

This study assessed the learning perception of undergraduate medical students on three types of teaching (classical/online/hybrid), in relation to coping strategies, stress, and social support, in the context of the SARS-CoV-2 pandemic. Additionally, we explored gender differences and the perceived usefulness of teaching. 201 students (48 men, 153 women; mean age = 22.900, SD = 2.830) participated in the study. They answered a Multidimensional Scale of Perceived Social Support, a Brief Cope Scale, a Student-life Stress Inventory, a visual analog scale for usefulness, and a survey collecting their perceptions about learning across teaching types. Results point out a preference for classical teaching, followed by the hybrid and online formats. Online teaching was identified as more advantageous in terms of time management and seeking information. Denial and substance use were statistically associated with poor communication, bad time using, and impaired learning. Both stress and social support had ambivalent associations with learning perceptions. Gender differences were limited to behavioral disengagement and higher social support perceived by women. Although classical teaching was globally perceived as the most useful, online teaching was considered desirable by male urban respondents. These data may contribute to the strategic growth and refinement of web-based teaching methods in medical universities.

Stress exposure can take a toll on the adjustment of young individuals, including students. The aim of this study was to investigate the impact of burnout and impostor syndrome (IS) on self-esteem and academic performance in medical students. The participants were 331 undergraduate medical students (102 men, 229 women; 89.7% native, 12,1% international; mean age = 21.18, SD = 2.338). The study instruments included the Copenhagen Burnout Inventory for Students (CBI-S), Clance Impostor Phenomenon Scale (CIPS), and Rosenberg’s Self-Esteem Scale, while academic performance (AP) was reported as received GPA (objective AP) and expected GPA (subjective AP). The statistical analysis comprised independent t-tests, MANOVA, ANOVA, and correlational and mediational analyses. The results showed that native students had lower self-esteem and higher scores of personal burnout and IS. Irrespective of cultural differences, women scored higher than men in IS and in personal burnout, while men had higher self-esteem than women. Burnout and IS were correlated with a decrease in self-esteem (adj. R2 = 0.531) in the overall sample, whereas in native students, IS was correlated with a difference between subjective and objective self-assessments of AP (adj. R2 = 0.027). Burnout and impostor syndrome, despite not directly impacting academic performance, may significantly influence self-esteem, making them a target for preventive or interventional measures.

Anatomy education has evolved significantly with the introduction of diverse instructional techniques. This review evaluates these methods, including traditional cadaver dissection, three-dimensional (3D) model printing, virtual dissection using tools like the Anatomage table, problem-based learning (PBL), and the use of wax and plastinated models. Each approach presents unique benefits and challenges. Cadaver dissection remains invaluable for providing hands-on experience and a deep understanding of anatomical structures, although it faces ethical, logistical, and financial constraints. Wax and plastinated models offer durable, precise representations of anatomical structures without the ethical concerns associated with cadavers. Additionally, 3D printing and virtual dissection have emerged as effective supplementary tools, enhancing spatial understanding and allowing repeated practice. PBL integrates anatomical knowledge with clinical reasoning, promoting critical thinking and problem-solving skills. The main aim of this study was to gather and analyze students’ opinions on various anatomy teaching methods, while a secondary objective was to review the literature on novel and traditional approaches in anatomy education. This review emphasizes the importance of incorporating a variety of teaching methods to create a dynamic and engaging anatomy curriculum, preparing students for clinical practice.

Psychotic disorders in youth pose significant challenges for mental health services, necessitating a detailed understanding of the interplay between risk factors and resilience. This systematic review aimed to assess how resilience factors might buffer the adverse effects of risk factors on the development of psychosis among youth, thereby informing targeted interventions. Studies were selected based on criteria including a focus on individuals aged up to 25 years old at risk for psychosis, the examination of both risk factors and resilience, and the use of validated instruments for measuring outcomes. Literature searches were conducted across several databases, such as PubMed, Scopus, and Web of Science. Data extraction emphasized odds ratios (ORs) and hazard ratios (HRs) for risk factors, including familial, developmental, and socio-environmental influences. The review included and analyzed nine studies, encompassing a diverse sample of 140,972 participants. Significant findings indicate that highly supportive familial and community environments significantly reduce the risk of psychosis onset. For instance, children with strong family support and engagement in structured activities demonstrated a 40% lower incidence of developing psychotic symptoms [p < 0.05]. Furthermore, the presence of neurobehavioral deficits, such as impaired verbal memory and attention, emerged as significant predictors of psychosis, with these children exhibiting a threefold increase in risk compared to their peers [OR = 3.2, 95% CI: 2.1–4.8, p < 0.01]. Resilience factors play a critical role in mitigating the impact of psychosocial and neurobiological risks in the development of psychosis among youths. Interventions enhancing resilience could potentially alter the trajectory of psychosis development, emphasizing the need for early and targeted psychosocial interventions to support at-risk populations. This study underscores the importance of fostering resilience through both individual-focused and community-based strategies to prevent the onset of psychotic disorders in vulnerable young populations.

Chronic threatening limb ischemia of the inferior limbs (CLTI) is the final stage of peripheral arterial disease (PAD) and is one of the most feared atherosclerotic manifestations because if left untreated, in time, it can lead to amputation. Although there are currently numerous treatment techniques, both open and endovascular, it is a pathology that has no underlying treatment. Therefore, current studies are very much focused on new therapeutic possibilities that can be applied in the early stages of the atherosclerotic process. In numerous studies in the literature, miRNAs have been identified as important markers of atherosclerosis. The present study aims to identify the expression of three miRNAs—miR-199a, miR-20a, and miR-30c—in patients with chronic limb-threatening ischemia in the pre- and post-revascularization periods. The aim of the study is to identify whether these three markers play a role in critical ischemia and whether they have the potential for future use in new treatments of this pathology.

Background and Objectives: This study investigates the relationship between thyroid eye disease (TED) and open-angle glaucoma (OAG), focusing on disease severity and clinical features. Materials and Methods: Conducted at the Timis County Emergency Clinical Hospital, the research included 106 patients, with 53 having both conditions and 53 having only OAG. Key metrics analyzed included intraocular pressure (IOP) using a Goldmann applanation tonometer, the retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) characteristics evaluated using optical coherence tomography (OCT). Results: Results indicated that patients with both TED and OAG experienced a 6.09% reduction in RNFL thickness and showed more rapid disease progression, with 48.35% having active TED. The mean IOP in TED patients was 27.5 ± 4.9 mmHg, which was similar to those with only OAG. Demographic factors, including age and gender, influenced the clinical course and disease severity. Conclusions: These findings underscore the importance of specialized monitoring and treatment strategies for patients with coexisting TED and OAG to prevent vision loss.

Backround: Depression is a significant concern in clinical and preclinical psychoneurobiological sciences due to its high prevalence and its individual and collective consequences. Identifying efficient biomarkers for accurate diagnosis is crucial, with ideal biomarkers having detectable serum levels and conformational and thermal stability. This study aims to identify stable plasma biomarkers for the diagnosis and prognosis of major depressive disorder, as the pathogenesis of the disorder remains incompletely understood, affecting diagnosis accuracy. Methods: Thus, this study included ten MDD patients and eight healthy controls. The present work analyzed miRNAs in patients with major depressive disorder compared to healthy controls. Results: Eleven specific miRNAs, particularly hsa-miR-874-3p; hsa-let-7d-5p; and hsa-miR-93-3p showed upregulation-type plasma variations in the group of patients with major depressive disorder. miRNA functionality is linked to depressive pathophysiology. Conclusions: This study identifies a “bouquet” of miRNAs with significant upregulation variations in patients with major depressive disorder, suggesting further research to determine their suitability for personalization and evaluation, ultimately becoming integral components of major depression serological evaluations.

This groundbreaking study leverages Google Trends to probe into consumer awareness of Romanian food products certified under European quality schemes, Protected Designation of Origin (PDO), Protected Geographical Indication (PGI), and Traditional Specialty Guaranteed (TSG), delivering prompt insights and addressing an existing research void. By adopting an innovative methodology through big data analytics - Google Trends and analyzing 12 sets of search terms, this study brings fresh insights to academic discourse and provides valuable information for marketers and policymakers. Prominent search interest was detected for 'Salam de Sibiu', ‘Plăcintă dobrogeană', and 'Magiun de prune Topoloveni', pointing to significant consumer familiarity. The study also unveiled regional search patterns, signifying location-based preferences, and potential marketing prospects. However, a marked contrast was found between the high interest in the products and the relatively low awareness of their European quality labels, highlighting a need for enhanced communication initiatives around these certifications. The study could be limited by its focus on Romanian certified food products, which may not be applicable to other geographical contexts. Future research endeavours may also seek to integrate data from Google Trends data with additional indicators of consumer behaviour.

The article delves into the multifaceted aspects of financing Romania's education system amidst the imperative of sustainable development. It navigates through the challenges and opportunities inherent in funding education, emphasizing its profound influence on economic, social, and environmental progress. It underscores the pivotal role of investment in education for fostering holistic development, stressing the necessity for adopting sustainable financial approaches to bolster the education sector. By examining the interplay between financial strategies and educational outcomes, the article advocates for a concerted effort in formulating policies that not only address immediate funding needs but also align with long-term sustainability goals. Ultimately, it posits that sustainable financing mechanisms are indispensable for nurturing a robust education system capable of driving enduring progress and prosperity in Romania.

Abstract Background Acrometastasis is an uncommon finding in non-small cell lung cancer and is usually a sign of multimetastatic disease. Few case reports have suggested solitary digital metastasis as the single secondary lesion of oligometastatic non-small cell lung cancer. Case presentation This case report describes an unusual presentation of a Kirsten rat sarcoma viral oncogene homolog-mutated lung adenocarcinoma with a solitary bone metastasis in the fourth finger medial phalanx, which was also the first sign of the disease, in a 63-year-old Caucasian female patient. Digital surgical amputation was performed. After histopathological confirmation and radiological exclusion of other secondary lesions, chemoimmunotherapy in a first-line setting was initiated. A partial metabolic response in the primary lung lesion was observed after four cycles. Maintenance therapy is currently being continued. Conclusion Solitary digital metastasis is a rare finding in non-small cell lung cancer. Further studies are needed to investigate the mechanisms behind this particular dissemination process.

The coronavirus disease 2019 (COVID-19) pandemic has necessitated the identification of biomarkers that can predict disease severity, particularly in vulnerable populations such as individuals with diabetes. This study aims to evaluate the predictive value of inflammatory and liver function markers, specifically derived Neutrophil to Lymphocyte Ratio (dNLR), aspartate aminotransferase (AST)-to-lymphocyte ratio (ALRI), AST to Platelet Ratio Index (APRI), and Systemic Inflammation Index (SII), in COVID-19 patients with and without diabetes. This cross-sectional study included 336 participants, comprising 168 patients with diabetes matched with 168 without, based on gender, body mass index (BMI), and COVID-19 severity at hospitalization. The study was conducted at Victor Babes Hospital for Infectious Diseases and Pulmonology from January 2021 to December 2023. All participants had a confirmed SARS-CoV-2 infection and met the inclusion criteria of being 18 years or older with type 1 or type 2 diabetes as per American Diabetes Association guidelines. At 3 days post symptom onset, significant differences in inflammatory and liver function markers were observed between the two groups. The dNLR, ALRI, APRI, and SII were notably higher in diabetic patients. At a dNLR cutoff of 2.685, the sensitivity and specificity were 70.312% and 65.978%, respectively, with an AUC of 0.624 (p < 0.001). The ALRI showed a cutoff of 0.812, with a sensitivity of 76.429% and specificity of 69.541% (AUC 0.752, p < 0.001). These markers demonstrated statistically significant hazard ratios at both 3 and 7 days, indicating their predictive relevance for severe COVID-19 outcomes. For instance, at 7 days, SII demonstrated a hazard ratio of 2.62 (CI: 1.29–5.04, p < 0.001), highlighting its strong prognostic capability. The study successfully identified significant differences in inflammatory and liver function markers between COVID-19 patients with and without diabetes, with these markers showing good predictive value for disease severity. The results underscore the potential of these biomarkers, particularly ALRI and SII, as valuable tools in managing COVID-19, aiding in the timely identification of patients at increased risk of severe outcomes.

The anatomical variations in the lower limb veins play a critical role in venous reflux surgeries. This study presents an analysis of the great saphenous vein (GSV) proximal part’s anatomical peculiarities, with 257 patients included, who were operated for venous reflux. This study highlighted a progressive increase in the GSV diameter in conjunction with the complexity of the anatomical variations, ranging from no tributaries to more than five tributaries, an anterior accessory GSV, or venous aneurysms. Statistical analysis evidenced this expansion to be significantly correlated with the variations. Additionally, the progression of the chronic venous disease (CVD) stages was notably more prevalent in the complex anatomical variations, suggesting a nuanced interplay between the GSV anatomy and CVD severity. Conclusively, our research articulates the paramount importance of recognizing GSV anatomical variations in optimizing surgical outcomes for CVD patients. These insights not only pave the way for enhanced diagnostic accuracy but also support the strategic framework within which surgical and interventional treatments are devised, advocating for personalized approaches to venous reflux surgery.

Non-functioning adrenal incidentalomas (NFAIs) have been placed in relationship with a higher risk of glucose profile anomalies, while the full-blown typical picture of Cushing’s syndrome (CS) and associated secondary (glucocorticoid-induced) diabetes mellitus is not explicitly confirmed in this instance. Our objective was to highlight the most recent data concerning the glucose profile, particularly, type 2 diabetes mellitus (T2DM) in NFAIs with/without mild autonomous cortisol secretion (MACS). This was a comprehensive review of the literature; the search was conducted according to various combinations of key terms. We included English-published, original studies across a 5-year window of publication time (from January 2020 until 1 April 2024) on PubMed. We excluded case reports, reviews, studies on T1DM or secondary diabetes, and experimental data. We identified 37 studies of various designs (14 retrospective studies as well 13 cross-sectional, 4 cohorts, 3 prospective, and 2 case–control studies) that analysed 17,391 individuals, with a female-to-male ratio of 1.47 (aged between 14 and 96 years). T2DM prevalence in MACS (affecting 10 to 30% of NFAIs) ranged from 12% to 44%. The highest T2DM prevalence in NFAI was 45.2% in one study. MACS versus (non-MACS) NFAIs (n = 16) showed an increased risk of T2DM and even of prediabetes or higher fasting plasma glucose or HbA1c (no unanimous results). T2DM prevalence was analysed in NFAI (N = 1243, female-to-male ratio of 1.11, mean age of 60.42) versus (non-tumour) controls (N = 1548, female-to-male ratio of 0.91, average age of 60.22) amid four studies, and two of them were confirmatory with respect to a higher rate in NFAIs. Four studies included a sub-group of CS compared to NFAI/MACS, and two of them did not confirm an increased rate of glucose profile anomalies in CS versus NFAIs/ACS. The longest period of follow-up with concern to the glycaemic profile was 10.5 years, and one cohort showed a significant increase in the T2DM rate at 17.9% compared to the baseline value of 0.03%. Additionally, inconsistent data from six studies enrolling 1039 individuals that underwent adrenalectomy (N = 674) and conservative management (N = 365) pinpointed the impact of the surgery in NFAIs. The regulation of the glucose metabolism after adrenalectomy versus baseline versus conservative management (n = 3) was improved. To our knowledge, this comprehensive review included one of the largest recent analyses in the field of glucose profile amid the confirmation of MACS/NFAI. In light of the rising incidence of NFAI/AIs due to easier access to imagery scans and endocrine evaluation across the spectrum of modern medicine, it is critical to assess if these patients have an increased frequency of cardio-metabolic disorders that worsen their overall comorbidity and mortality profile, including via the confirmation of T2DM.

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii (T. gondii), presents a significant global health concern, particularly for immunocompromised individuals and congenitally infected newborns. Despite its widespread prevalence, there are limited data on T. gondii seroprevalence and ocular toxoplasmosis in Romania. This review aims to summarize the research accomplished on the prevalence and epidemiology of human ocular toxoplasmosis in Romania. Ocular toxoplasmosis, a leading cause of infectious posterior uveitis worldwide, involves complex interactions between host immune responses and parasite factors. Clinically, it presents as focal necrotizing retinitis, characterized by active focal retinal lesions with adjacent chorioretinal scarring, often accompanied by vitreous inflammation and anterior chamber reactions. Diagnosis relies on clinical examination supported by fundus photography, optical coherence tomography (OCT), and serological assays. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, conducting a literature review on PubMed, Google Scholar, and Scopus. Our focus was on ocular toxoplasmosis in Romania, and we used keywords and specific MeSH terms. Finally, 17 articles met all the criteria, as summarized in the PRISMA diagram. This study underscores the need for improved diagnostic methods, increased research efforts, and comprehensive public health education to mitigate the burden of toxoplasmosis and ocular toxoplasmosis in Romania.

Diabetes mellitus (DM) is a chronic metabolic disorder marked by hyperglycemia due to defects in insulin secretion, action, or both, with a global prevalence that has tripled in recent decades. This condition poses significant public health challenges, affecting individuals, healthcare systems, and economies worldwide. Among its numerous complications, ocular surface disease (OSD) is a significant concern, yet understanding its pathophysiology, diagnosis, and management remains challenging. This review aims to explore the epidemiology, pathophysiology, clinical manifestations, diagnostic approaches, and management strategies of diabetes-related OSD. The ocular surface, including the cornea, conjunctiva, and associated structures, is vital for maintaining eye health, with the lacrimal functional unit (LFU) playing a crucial role in tear film regulation. In DM, changes in glycosaminoglycan metabolism, collagen synthesis, oxygen consumption, and LFU dysfunction contribute to ocular complications. Persistent hyperglycemia leads to the expression of cytokines, chemokines, and cell adhesion molecules, resulting in neuropathy, tear film abnormalities, and epithelial lesions. Recent advances in molecular research and therapeutic modalities, such as gene and stem cell therapies, show promise for managing diabetic ocular complications. Future research should focus on pathogenetically oriented therapies for diabetic neuropathy and keratopathy, transitioning from animal models to clinical trials to improve patient outcomes.

CT angiography might be a suitable procedure to avoid arterial puncture in combined intracavitary and interstitial brachytherapy for cervical cancer curatively treated with combined chemoradiation and brachytherapy boost. Data in the literature about this technique are scarce. We introduced this method and collected brachytherapy data from patients treated in our department between May 2021 and April 2024. We analyzed the applicator subtype, needle insertion (planned versus implanted), implanted depth and the role of CT angiography in selecting needle trajectories and insertion depths. None of the patients managed through this protocol experienced atrial puncture and consequent hemorrhage. Needle positions were accurately selected with the aid of CT angiography with proper coverage of brachytherapy targets and avoidance of organs at risk. CT angiography is a promising method for guiding needle insertion during interstitial brachytherapy.

Adrenal incidentalomas (AIs) are clinically silent adrenal masses that are unintentionally found during various abdominal imaging procedures. Our objective was to evaluate the bone profile in menopausal females diagnosed with AI versus a non-AI control group. This was an observational, retrospective, multi-centric, case-control study, a sub-analysis of PRECES study (“Parameters of Romanian Patients with Endocrine Conditions with or without Endocrine Surgery: real-world-evidence and retrospective study”), a multi-centric, Romanian collaborative in the field of endocrinology and connected specialities (real-world community setting). Inclusion criteria: women in menopause between 40 and 85 years. Ex-clusion criteria: active endocrine tumours or cancers, prior or current medication against osteoporosis. Assessments included bone turnover markers, central DXA, FRAX-based os-teoporotic fracture risk evaluation. AIs were defined as having a value of second day plas-ma morning cortisol after 1-mg dexamethasone suppression test of < 1.8 µg/dL [without mild autonomous cortisol secretion (MACS free), as seen in control group that did not dis-play the imaging evidence of an adrenal tumour] or between 1.8 and 5 µg/dL (MACS sub-group). Results: Demographic features of both groups (N=39 versus 95 patients) were simi-lar in terms of age (60.95±10.46 versus 61.55±7.2 years), years since menopause (14.92±10.32 versus 14.52±8.85 years), body mass index (28.03 versus 27 kg/sqcm); (p>0.1 for each). Osteopenia was the most prevalent DXA category in each group (43.6% versus 53.7%), followed by osteoporosis (20.5% versus 22.1%), while lumbar, total hip, femoral neck BMD were similar between AIs and controls. A statistically significant lower osteocal-cin in subjects with AIs, with a median (Q1, Q3) of 16.5 (11.96-20.09) ng/mL compared with the value in control groups of 23.17 (15.9-31.46) ng/mL (p=0.003) was found. In AIs group, serum baseline morning cortisol positively correlated with lumbar Z-score, and correlation coefficient reached a statistical significance (p = 0.035). Of note, a tendency for correlation with total hip BMD was found, too. To conclude, decreased osteocalcin might be the signa-ture of mild cortisol anomalies in AIs, but DXA-BMD and FRAX algorithm revealed similar parameters in AI group versus controls, as found between MACS and MACS free sub-groups.

Background: Chronic limb-threatening ischemia (CLTI), the advanced stage of peripheral arterial disease, is diagnosed in the presence of ischemic rest pain, non-healing ulcers, or gangrene. Several studies have demonstrated that inflammation and endothelial dysfunction are some of the main substrates of CLTI. Methods: A narrative review was conducted and reported according to PRISMA guidelines. Three databases were searched—Web of Science, Medline, and EMBASE—for the studies assessing CLTI and the biological markers related to it. Results: We included 22 studies, and all the markers identified (C-reactive protein, D-dimers, fibrinogen, cytokines, IL-6, TNF-α, ICAM-1 (Intracellular Adhesion Molecule-1), VCAM-1 (Vascular Cell Adhesion Molecule-1), neutrophile-to-lymphocytes ratio (NLR), IL-8, Pentraxin-3, neutrophil gelatinase-associated lipocalin (NGAL), calprotectin, E-selectin, P-selectin, neopterin, High-Mobility Group Box-1 protein (HGMB-1), Osteoprotegerin (OPG) and Sortilin) were positively associated with advanced CLTI, with major limb or major cardiovascular events in these patients. Conclusions: All the studied markers had increased values in patients with CLTI, especially when associated with diabetes mellitus, proving a very important association between diabetes and major limb or cardiovascular events in these patients. There is a need for more studies to validate these markers in terms of diagnosis or prognosis in CLTI patients and in trying to find new medical strategies that target inflammation or endothelial dysfunction in these patients.

This systematic review critically evaluates the impact of systemic treatments on outcomes and quality of life (QoL) in patients with RAS-positive stage IV colorectal cancer, with studies published up to December 2023 across PubMed, Scopus, and Web of Science. From an initial pool of 1345 articles, 11 relevant studies were selected for inclusion, encompassing a diverse range of systemic treatments, including panitumumab combined with FOLFOX4 and FOLFIRI, irinotecan paired with panitumumab, regorafenib followed by cetuximab ± irinotecan and vice versa, and panitumumab as a maintenance therapy post-induction. Patient demographics predominantly included middle-aged to elderly individuals, with a slight male predominance. Racial composition, where reported, showed a majority of Caucasian participants, highlighting the need for broader demographic inclusivity in future research. Key findings revealed that the addition of panitumumab to chemotherapy (FOLFOX4 or FOLFIRI) did not significantly compromise QoL while notably improving disease-free survival, with baseline EQ-5D HSI mean scores ranging from 0.76 to 0.78 and VAS mean scores from 70.1 to 74.1. Improvements in FACT-C scores and EQ-5D Index scores particularly favored panitumumab plus best supportive care in KRAS wild-type mCRC, with early dropout rates of 38–42% for panitumumab + BSC. Notably, cetuximab + FOLFIRI was associated with a median survival of 25.7 months versus 16.4 months for FOLFIRI alone, emphasizing the potential benefits of integrating targeted therapies with chemotherapy. In conclusion, the review underscores the significant impact of systemic treatments, particularly targeted therapies and their combinations with chemotherapy, on survival outcomes and QoL in patients with RAS-positive stage IV colorectal cancer, and the need for personalized treatment.

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic’s overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania.

This study delves into the effectiveness of digital marketing strategies in promoting local agricultural and food products in Romania, certified with European Union quality schemes. By examining consumer profiles, preferences, and their awareness of EU quality labels, the research uncovers the motivations driving purchasing decisions and the influence of digital marketing on these choices. Utilizing quantitative methods, including a comprehensive survey across 903 respondents, the study identifies four distinct consumer segments: Eco−Advocates, Les Connaisseurs, Price−Sensitives, and Traditionalists. These segments exhibit unique behaviors and attitudes toward certified products. The research highlights the potential of digital marketing to significantly alter consumer behavior toward EU-certified products, underscoring the importance of tailored communication strategies. It contributes to the understanding of consumer segmentation in the context of European Union quality schemes, providing valuable insights for policymakers, marketers, and producers. The findings advocate for enhanced digital marketing efforts to increase awareness and appreciation of these certified products, thereby supporting the broader objectives of quality and certification in the European agricultural and food product sector.

The escalating global prevalence of diabetes mellitus (DM) over the past two decades has led to a persistent high incidence of diabetic retinopathy (DR), necessitating screening for early symptoms and proper treatment. Effective management of DR aims to decrease vision impairment by controlling modifiable risk factors including hypertension, obesity, and dyslipidemia. Moreover, systemic medications and plant-based therapy show promise in advancing DR treatment. One of the key mechanisms related to DR pathogenesis is the polyol pathway, through which aldose reductase (AR) catalyzes the conversion of glucose to sorbitol within various tissues, including the retina, lens, ciliary body and iris. Elevated glucose levels activate AR, leading to osmotic stress, advanced glycation end-product formation, and oxidative damage. This further implies chronic inflammation, vascular permeability, and angiogenesis. Our comprehensive narrative review describes the therapeutic potential of aldose reductase inhibitors in treating DR, where both synthetic and natural inhibitors have been studied in recent decades. Our synthesis aims to guide future research and clinical interventions in DR management.

This systematic review evaluates the effectiveness of the Kansas City Cardiomyopathy Questionnaire (KCCQ) in assessing quality of life improvements among patients with heart failure (HF) undergoing various forms of exercise training rehabilitation, including telemedicine and in-person modalities, across all stages of HF, irrespective of ejection fraction (EF) and clinical status. The aim was to collate evidence from studies employing the KCCQ as a measure of quality of life (QoL). A comprehensive search strategy was implemented across PubMed, Scopus, and Embase databases, adhering to the PRISMA guidelines, including literature up until October 2023. Inclusion criteria encompassed studies on patients diagnosed with HF undergoing exercise training rehabilitation assessed by KCCQ. Nine articles met the inclusion criteria, involving a total of 3905 patients from various global locations and conducted between 2012 and 2022. Results indicated significant heterogeneity in exercise interventions and patient characteristics. Notably, high-intensity interval training (HIIT) showed a marked improvement in KCCQ scores (from 68.0 to 80.0) compared to moderate continuous training (MCT) and control groups, underscoring its potential for enhancing QoL. Additionally, a significant improvement in the 6-min walking test (6MWT) outcomes was observed, with an average increase of 106 m (95% CI: 60, 152) in one study, reflecting physical capacity enhancements. However, the difference in KCCQ scores between intervention and control groups was not statistically significant in several studies. In conclusion, the KCCQ’s effectiveness is highlighted by its ability to detect clinically meaningful improvements in QoL across diverse exercise modalities, including HIIT and MCT, tailored to the specific needs of HF populations. The consistent correlation between KCCQ score improvements and enhanced physical outcomes, such as the 6MWT, supports its reliability in capturing the nuanced benefits of exercise interventions on patient well-being.

Nowadays, technology evolves very fast and we are witnesses of major changes in dentistry. Nanotechnology improved many fields of dentistry, including endodontics. In this paper, we compared different irrigants and sealers which are currently used in endodontic treatments, their advantages and disadvantages and their limitations. In the context of emerging trends of nanotechnology in all fields of dentistry, we aimed to highlight the importance of developing new irrigants and sealers improved with nanoparticles, with superior properties compared to traditional ones. As resulted from our research, the most used irrigants in endodontics (NaOCl, EDTA, CHX) possess different kinds of advantages, but none is flawless, also having some limitations. Also, every current sealer available on the market has one or more disadvantages. For this reason, nanotechnology is very welcomed in this field and different kinds of nanoparticles were proposed for their particularities in order to improve the performances of endodontic materials. We present in this work a review of the literature regarding different types of nanoparticles, their effects on endodontic microbiota and also, their particularities.