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Deep learning (DL) has experienced an exponential development in recent years, with major impact in many medical fields, especially in the field of medical image and, respectively, as a specific task, in the segmentation of the medical image. We aim to create a computer assisted diagnostic method, optimized by the use of deep learning (DL) and validated by a randomized controlled clinical trial, is a highly automated tool for diagnosing and staging precancerous and cervical cancer and thyroid cancers. We aim to design a high-performance deep learning model, combined from convolutional neural network (U-Net)-based architectures, for segmentation of the medical image that is independent of the type of organs/tissues, dimensions or type of image (2D/3D) and to validate the DL model in a randomized, controlled clinical trial. We used as a methodology primarily the analysis of U-Net-based architectures to identify the key elements that we considered important in the design and optimization of the combined DL model, from the U-Net-based architectures, imagined by us. Secondly, we will validate the performance of the DL model through a randomized controlled clinical trial. The DL model designed by us will be a highly automated tool for diagnosing and staging precancers and cervical cancer and thyroid cancers. The combined model we designed takes into account the key features of each of the architectures Overcomplete Convolutional Network Kite-Net (Kite-Net), Attention gate mechanism is an improvement added on convolutional network architecture for fast and precise segmentation of images (Attention U-Net), Harmony Densely Connected Network-Medical image Segmentation (HarDNet-MSEG). In this regard, we will create a comprehensive computer assisted diagnostic methodology validated by a randomized controlled clinical trial. The model will be a highly automated tool for diagnosing and staging precancers and cervical cancer and thyroid cancers. This would help drastically minimize the time and effort that specialists put into analyzing medical images, help to achieve a better therapeutic plan, and can provide a “second opinion” of computer assisted diagnosis.

Rationale and Objectives: Accurate diagnosis and staging of cervical precancers is essential for practical medicine in determining the extent of the lesion extension and determines the most correct and effective therapeutic approach. For accurate diagnosis and staging of cervical precancers, we aim to create a diagnostic method optimized by artificial intelligence (AI) algorithms and validated by achieving accurate and favorable results by conducting a clinical trial, during which we will use the diagnostic method optimized by artificial intelligence (AI) algorithms, to avoid errors, to increase the understanding on interpretation of colposcopy images and improve therapeutic planning. Materials and Methods: The optimization of the method will consist in the development and formation of artificial intelligence models, using complicated convolutional neural networks (CNN) to identify precancers and cancers on colposcopic images. We will use topologies that have performed well in similar image recognition projects, such as Visual Geometry Group Network (VGG16), Inception deep neural network with an architectural design that consists of repeating components referred to as Inception modules (Inception), deeply separable convolutions that significantly reduce the number of parameters (MobileNet) that is a class of Convolutional Neural Network (CNN), Return of investment for machine Learning (ROI), Fully Convolutional Network (U-Net) and Overcomplete Convolutional Network Kite-Net (KiU-Net). Validation of the diagnostic method, optimized by algorithm of artificial intelligence will consist of achieving accurate results on diagnosis and staging of cervical precancers by conducting a randomized, controlled clinical trial, for a period of 17 months. Results: We will validate the computer assisted diagnostic (CAD) method through a clinical study and, secondly, we use various network topologies specified above, which have produced promising results in the tasks of image model recognition and by using this mixture. By using this method in medical practice, we aim to avoid errors, provide precision in diagnosing, staging and establishing the therapeutic plan in cervical precancers using AI. Conclusion: This diagnostic method, optimized by artificial intelligence algorithms and validated by the clinical trial, which we consider “second opinion”, improves the quality standard in diagnosing, staging and establishing therapeutic conduct in cervical precancer.

Rationale and Objectives: Accurately establishing the diagnosis and staging of cervical and thyroid cancers is essential in medical practice in determining tumor extension and dissemination and involves the most accurate and effective therapeutic approach. For accurate diagnosis and staging of cervical and thyroid cancers, we aim to create a diagnostic method, optimized by the algorithms of artificial intelligence and validated by achieving accurate and favorable results by conducting a clinical trial, during which we will use the diagnostic method optimized by artificial intelligence (AI) algorithms, to avoid errors, to increase the understanding on interpretation computer tomography (CT) scan, magnetic resonance imaging (MRI) of the doctor and improve therapeutic planning. Materials and Methods: The optimization of the computer assisted diagnosis (CAD) method will consist in the development and formation of artificial intelligence models, using algorithms and tools used in segmental volumetric constructions to generate 3D images from MRI/CT. We propose a comparative study of current developments in “DICOM” image processing by volume rendering technique, the use of the transfer function for opacity and color, shades of gray from “DICOM” images projected in a three-dimensional space. We also use artificial intelligence (AI), through the technique of Generative Adversarial Networks (GAN), which has proven to be effective in representing complex data distributions, as we do in this study. Validation of the diagnostic method, optimized by algorithm of artificial intelligence will consist of achieving accurate results on diagnosis and staging of cervical and thyroid cancers by conducting a randomized, controlled clinical trial, for a period of 17 months. Results: We will validate the CAD method through a clinical study and, secondly, we use various network topologies specified above, which have produced promising results in the tasks of image model recognition and by using this mixture. By using this method in medical practice, we aim to avoid errors, provide precision in diagnosing, staging and establishing the therapeutic plan in cancers of the cervix and thyroid using AI. Conclusion: The use of the CAD method can increase the quality of life by avoiding intra and postoperative complications in surgery, intraoperative orientation and the precise determination of radiation doses and irradiation zone in radiotherapy.

Deep learning (DL) has seen an exponential development in recent years, with major impact in many medical fields, especially in the field of medical image. The purpose of the work converges in determining the importance of each component, describing the specificity and correlations of these elements involved in achieving the precision of interpretation of medical images using DL. The major contribution of this work is primarily to the updated characterisation of the characteristics of the constituent elements of the deep learning process, scientific data, methods of knowledge incorporation, DL models according to the objectives for which they were designed and the presentation of medical applications in accordance with these tasks. Secondly, it describes the specific correlations between the quality, type and volume of data, the deep learning patterns used in the interpretation of diagnostic medical images and their applications in medicine. Finally presents problems and directions of future research. Data quality and volume, annotations and labels, identification and automatic extraction of specific medical terms can help deep learning models perform image analysis tasks. Moreover, the development of models capable of extracting unattended features and easily incorporated into the architecture of DL networks and the development of techniques to search for a certain network architecture according to the objectives set lead to performance in the interpretation of medical images.

Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium.

The need for time and attention, given by the doctor to the patient, due to the increased volume of medical data to be interpreted and filtered for diagnostic and therapeutic purposes has encouraged the development of the option to support, constructively and effectively, deep learning models. Deep learning (DL) has experienced an exponential development in recent years, with a major impact on interpretations of the medical image. This has influenced the development, diversification and increase of the quality of scientific data, the development of knowledge construction methods and the improvement of DL models used in medical applications. All research papers focus on description, highlighting, classification of one of the constituent elements of deep learning models (DL), used in the interpretation of medical images and do not provide a unified picture of the importance and impact of each constituent in the performance of DL models. The novelty in our paper consists primarily in the unitary approach, of the constituent elements of DL models, namely, data, tools used by DL architectures or specifically constructed DL architecture combinations and highlighting their “key” features, for completion of tasks in current applications in the interpretation of medical images. The use of “key” characteristics specific to each constituent of DL models and the correct determination of their correlations, may be the subject of future research, with the aim of increasing the performance of DL models in the interpretation of medical images.

It is extremely difficult to synthesize in a paper the extremely wide diversity of the issues related to such a vast chapter such as the tumours in the ENT area and the cervical-facial region. The review analyses the variety of benign and malignant types of tumours, presenting various types of tumours on anatomical organs or regions, insisting with more extensive data from the literature on less frequent tumours or involving more distinct therapies, perhaps leading to a lack of balance and uniformity. Tumours are defined as excessive proliferation of abnormal cells that resemble more or less the tissue in which they develop and end up by acquiring biological autonomy. The study performed presents a batch of 425 patients diagnosed with benign tumours - 306 cases (72.0%) and 119 cases with ENT and cervical-facial malignant tumours that had extensions to the surrounding organs and metastatic adenopathies, admitted and treated at the Clinical Maxillofacial Surgery Clinic of the County Clinical Hospital between 1.01.2015 - 31.12.2018. The entire cancerous lesion is surgically removed together with a small surrounding healthy tissue area to ensure that all malignant cells have been removed. The purpose of the surgery is to remove all affected tissues without compromising the integrity of the structures in the other areas of the oral cavity. Tumours develop from the oropharynx: the tonsils, the base of the tongue, the soft palate, the pharyngeal posterior wall. Most often, the tumour affects the tongue floor, the mucous of the mouth and the tonsils.

Postoperative hypoparathyroidism is most commonly caused by the extirpation, injury or devascularisation of parathyroid glands. The aim of this study is to establish correlations between the advanced thyroid cancer staging, the appropriate individual treatment, the results obtained, the frequency and intensity of transient and/or permanent post-operative hypocalcemia. The present study can be continued with further researches in order to improve and develop surgical, oncological and endocrine management protocols for patients diagnosed with advanced thyroid cancer and also to avoid these relatively frequent and important complications.

Nodular goiter is a rare condition in children and adolescents and compared with adults, thyroid nodules are more frequent malignant in pediatric population. We have investigated the prevalence of thyroid carcinoma among the thyroid disorder emphasizing on the surgical treatment in term of indication, methods and complications. Retrospective study of 35 children and adolescents with nodular goiter. Demographic data, thyroid ultrasonographic features, fine needle biopsy aspiration, hormonal profile, surgical treatment procedure as well as histological aspects were recorded. Study included 26 (74%) girls and 9 (26%) boys with a mean age of 11.66 years. Fine needle aspiration biopsy was performed in 10 cases due to the TIRADS score � 4 with Bethesda II in 3 cases, Bethesda III in 4 cases and Bethesda V in 3 cases. The surgical treatment was performed in 16 (45.7%) cases due to fine needle aspiration biopsy results or due to the relapse after medical treatment. Lobectomy was performed in 7 (43.7%) cases while total thyroidectomy was the final option for the rest of 9 (56.3%) patients. As a result of pathological examination in 8 cases the thyroid carcinoma has been found. The rest of 8 patients presented benign thyroid findings (follicular adenoma, toxic adenoma and Graves� disease with follicular adenoma). The prevalence of thyroid carcinoma among the pediatric population with thyroid nodules was 22.8% most affected being the female gender.

In the actual pandemic context, cancer patients are at additional risk, and protocols are always changing. We present the case of a 62-year-old patient who develops three types of cancer over four years and who was admitted to the hospital in the Emergency Room for hematemesis, melena, and abdominal pain. We know from the pathological antecedents that he was operated in 2017 for a left scapular tumour (basal cell carcinoma). The current clinical examination reveals another right scapular tumour (malignant melanoma), and the hematemesis comes from a gastro-esophageal junction tumour (squamous cell carcinoma). SARS CoV2 infection changes the rules of treatment in such a case. Thus, the patient is operated for the right scapular tumour, the gastrectomy being delayed due to the lung lesions given by SARS CoV2. Finally, the patient undergoes surgery for the gastric tumour, the RT-PCR retest being negative.

Hurthle cell carcinoma is a rare thyroid neoplasm which originates from the follicular epithelium of the thyroid gland and is considered a true rarity in young patients. A 30 year-old woman was admitted to our department with palpable anterior cervical mass due to enlarged thyroid. The ultrasound revealed a large thyroid nodule with central hypoechogenicity, peripheral hyperechogenicity and positive Doppler signal. The patient had no distinguishable lateral cervical lymphadenopathy. The TI-RADS calculation (thyroid image reporting data system) classified the nodule as TR4 (4 points), which indicated a fine needle aspiration biopsy (FNAB), declined by the patient. Total thyroidectomy was performed and the histological findings associated with immunohistochemical study revealed the diagnosis of Hurthle cell carcinoma with capsular and vascular invasion. Because the microscopic vascular invasion was < 4 foci the patient was classified as low-risk group. Even so, due to the young age she was referred to radioactive iodine therapy for completion of curative treatment. This case illustrates the difficulties in the management of thyroid nodules with suspicious features on ultrasound, in the absence of FNAB exploration, and the unusual presence of Hurthle cell carcinoma in a young age patient, knowing the 6th decade is the average age for this rare type of thyroid neoplasm.

The treatment of chronic pancreatitis consists of conservative and surgical treatment. The current development of interventional endoscopy techniques links the two above-mentioned treatments, offering less invasive solutions. In the treatment of chronic pancreatitis, a progressive approach is needed. Establishing any type of treatment is useless if the patient does not follow the recommendation to mainatin a proper diet. The study was conducted on a group of 61 patientshospitalized and operated for chronic forms of pancreatitis. Pancreatic insufficiency due to chronic pancreatitis is not a simple enzymatic deficiency, but an interactive complex of secretory, motor and endocrine functional disorders. Therefore, developing drug therapy will require not only the simple administration of enzymes in the intestine but also the restoration of the integrity of disruptive digestive functions.

The concept of chronic pancreatitis has been stated in our country much later than acute pancreatitis. This manuscript proposes a synthesis of the etiopathogenic, diagnostic and therapeutic data in chronic pancreatitis based on actual information correlated with the results of our experimental study. The experiment was conducted on 18 animals, in which was performed the intraduodenal ligation of the pancreatic duct apertures and the obstruction of the pancreatic ducts with intraparenchymatous, intraoperative neoprene injections. We investigated the lesions by using intraoperative pancreatic tissue collected after injections. The results encourage us to continue the research and to choose genetically modified animals because are closer to the human one.

Primary hyperparathyroidism is a common hormonal disorder, third in the order of importance after diabetes and hyperthyroidism. The aim of this study is to quantify qualitatively and quantitatively the effects of parathyroid hormone hypersecretion in a group of patients diagnosed with primary hyperparathyroidism. The study, was conducted on 200 patients with hyperparathyroidism, admitted in St. Spiridon Emergency Clinical Hospital in Iasi. In the study, we noted that primary hyperparathyroidism is three times more common in women than in males, being twice as many cases in patients older than 55 years as among the youngest. The most common forms are based on genetic determinism or are associated with other endocrinopathies. The obtained results encourage us to continue the research and, at the same time, we must point out that there is a high percentage of undiagnosed people among the apparently healthy population.

Colorectal cancer is a malignant disease with high morbidity and mortality. Ki-67 is a marker of cell proliferation associated with a low survival in colorectal cancer patients. Its expression is increased in patients with Dukes C or D colorectal cancer versus those in stage A or B. The purpose of the study is to evaluate the immunohistochemical expression of the Ki-67 marker in colorectal adenocarcinomas. The study was performed on a group of 28 patients diagnosed with rectal cancer. We made the histopathological and immunohistochemical evaluation of patients in the study group. The evaluation was performed on the sections stained with hematoxylin-eosin, and for mucinous forms, on sections stained with alcian blue. The topography of the Ki-67 reaction is strictly nuclear, evident in areas with intense proliferative activity. In cases with a strong positive response to Ki-67, the prognosis is worse, with invasion of the perirectal tissues and metastases. The lack of Ki-67 expression in nearby neoplastic tissues suggests that cancerous tissue proliferates in a pathway that it is not correlated with adjacent tissues. The Ki-67 could be useful in the prognosis of patients with colorectal cancer.

Purpose To correlate the volume of parathyroid adenomas with the hormonal and metabolic profile at patients diagnosed with primary hyperparathyroidism (pHPTH). Patients and Methods Cross-sectional multicentric study, enrolling 52 patients with pHPTH from two medical institutions. Serum calcium and PTH were evaluated in all patients before surgery, whereas 25OHD3 was measured only in the 33 patients recruited form one medical unit. The volume of parathyroid adenoma was measured by using the formula of a rotating ellipsoid. Results We observed a significant correlation of the volume of parathyroid adenomas with PTH at patients from the two units and in the whole group (p < 0.0001), but not with serum calcium (p = 0.494). Twenty-five out of the 33 patients at whom 25OHD3 was measured had levels in the range of deficiency. 25OHD3 was not correlated with PTH or calcium levels, but was negatively correlated to the adenoma volume and positively to the PTH/volume ratio (p = 0.041 and p = 0.048, respectively). Conclusions The volume of parathyroid adenoma seems to be related to preoperative PTH and 25OHD3, but not to calcium level. Vitamin D deficiency is frequently found at patients with pHPTH and may contribute to particular disease profiles, including larger parathyroid adenomas.

Background The coexistence of hyperparathyroidism and thyroid cancer presents important diagnostic and management challenges. With minimally invasive parathyroid surgery trending, preoperative thyroid imaging becomes more important as concomitant thyroid and parathyroid lesions are reported. The aim of the study was to evaluate the rate of thyroid cancer in patients operated for either primary (PHPT) or secondary hyperparathyroidism (SHPT). Methods Our retrospective study included PHPT and SHPT patients submitted to parathyroidectomy and, when indicated, concomitant thyroid surgery between 2010 and 2017. Results Parathyroidectomy was performed in 217 patients: 140 (64.5%) for PHPT and 77 (35.5%) for SHPT. Concomitant thyroid surgery was performed in 75 patients with PHPT (53.6%), and 19 papillary thyroid carcinomas (PTC) were found, accounting for 13.6% from all cases with PHPT and 25.3% from PHPT cases with concomitant thyroid surgery. Thirty-one of operated SHPT patients (40.3%) also underwent thyroid surgery and 9 PTC cases were diagnosed (11.7% of all SHPT patients and 29% of patients with concomitant thyroid surgery). We found differences between PHPT and SHPT patients (p

Primary aldosteronism is one of the most common causes of secondary hypertension. This condition is characterized by autonomous hypersecretion of aldosterone which produces sodium retention and potassium excretion, resulting in high blood pressure and potential hypokalemia. Transient postoperative hyporeninemic hypoaldosteronism with an increased risk of hyperkalemia may occur in some patients. We report the case of a 63-year-old patient with persistent hypokalemia, periodic paralysis, and refractory hypertension who was diagnosed with primary hyperaldosteronism due to elevated aldosterone, undetectable plasmatic renin concentration, and the presence of a left adrenal mass. One month after the surgery, the patient was admitted with signs of severe hyperkalemia (8 mmol/L) and worsened renal function, thus requiring hemodialysis. Fluid resuscitation, loop diuretic, and sodium bicarbonate treatment decreased his potassium. Zona glomerulosa insufficiency was confirmed by hormonal tests which exposed low aldosterone–renin axis. The fludrocortisone treatment was initiated and maintained, with consequent potassium and creatinine stabilization. Old age, long duration of hypertension, impaired renal function, severe hypokalemia before surgery, and large size of the aldosterone-producing adenoma are important risk factors for serious potassium imbalance after removal of the adenoma. We have to consider monitoring the patients after surgery for primary hyperaldosteronism in order to prevent severe hyperkalemia; therefore, postoperative immediate follow-up (arterial pressure, potassium, and renal function) is mandatory.

In classical concepts, theoretical models are built assuming that the dynamics of the complex system’s stuctural units occur on continuous and differentiable motion variables. In reality, the dynamics of the natural complex systems are much more complicated. These difficulties can be overcome in a complementary approach, using the fractal concept and the corresponding non-differentiable theoretical model, such as the scale relativity theory or the extended scale relativity theory. Thus, using the last theory, fractal entropy through non-differentiable Lie groups was established and, moreover, the pairs generating mechanisms through fractal entanglement states were explained. Our model has implications in the dynamics of biological structures, in the form of the “chameleon-like” behavior of cholesterol.

Our research has focused on in vitro and in vivo evaluations of a new Carmustine (BCNU)-loaded clinoptilolite-based delivery system. Two clinoptilolite ionic forms—hydrogen form (HCLI) and sodium form (NaCLI)—were prepared, allowing a loading degree of about 5–6 mg BCNU/g of zeolite matrix due to the dual porous feature of clinoptilolite. Clinoptilolite-based delivery systems released 35.23% of the load in 12 h for the BCNU@HCLI system and only 10.82% for the BCNU@NaCLI system. The BCNU@HCLI system was chosen to develop gel and cream semisolid dosage forms. The cream (C_BCNU@HCLI) released 29.6% of the loaded BCNU after 12 h in the Nylon synthetic membrane test and 31.6% in the collagen membrane test, higher by comparison to the gel. The new cream was evaluated in vivo in a chemically induced model of skin cancer in mice. Quantitative immunohistochemistry analysis showed stronger inhibition of B-cell lymphoma-2 (bcl-2) and cyclooxygenase 2 (cox-2) protein expression, known markers for cancer survival and aggressiveness, after the treatment with C_BCNU@HCLI by comparison to all the control treatment types, including an off-label magistral formula commercially available Carmustine cream as reference, bringing evidence that a clinoptilolite-based delivery systems could be used as a cancer drug carriers and controlled release systems (skin-targeted topical delivery systems).

In this paper, we propose an analyzis method for the dynamics of polymer chains, based on a Ricatti procedure induced by possible correlations through the compatibility of the thermal radiation-classical damped oscillator dynamics. Then, the quantification (radiation frecquency is directly proportional to the color temperature) and the erasure of one bit of information becomes a natural processes induced by the system structure itself. The theory has implications in the dynamics of biological structures (arhitecture of tumors, information on tumor growth and angiogenesis, etc.) in the form of Resonant Recognition Model.