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(1) Colorectal cancer is a major cause of cancer-related death, with colorectal adenomas (CRAs) serving as precursors. Identifying risk factors such as vitamin D deficiency and the insulin-like growth factor (IGF) axis is crucial for prevention. (2) This case–control study included 85 participants (53 CRA patients and 32 controls) who underwent colonoscopy. We measured serum vitamin D3 (cholecalciferol), calcidiol (vitamin D metabolite), calcitriol (active vitamin D metabolite), insulin-like growth factor-1 (IGF-1), and insulin-like growth factor binding protein-3 (IGFBP-3) to explore their associations with CRA risk. (3) Results: We found that lower cholecalciferol levels were a significant risk factor for CRA (OR = 4.63, p = 0.004). Although no significant differences in calcidiol and calcitriol levels were observed between CRA patients and controls, calcidiol deficiency was common in the study population. IGF-1 levels inversely correlated with age, calcitriol, and IGFBP-3 in CRA patients. (4) This study highlights the potential of lower cholecalciferol levels to detect patients at risk of CRA when calcidiol values cannot, suggesting the importance of evaluating different vitamin D metabolites in cancer prevention research. Our findings underscore the need to further investigate the interactions between calcitriol, the active form of vitamin D, and the IGF axis in colorectal cancer development. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is one of the most common neoplasms in developed countries, with increasing incidence and mortality, even in young people. A variety of serum markers have been associated with CRC (CEA, CA 19-9), but neither should be used as a screening tool for the diagnosis or evolution staging of CRC. The sensitivity and specificity of these markers are not as good as is required, so new ones need to be found. Matrix Gla protein and PIVKA II are involved in carcinogenesis, but few studies have evaluated their usefulness in predicting the presence and severity of CRC. Two hundred patients were divided into three groups: 80 patients were included in the control group; 80 with CRC and without hepatic metastasis were included in Group 1; 40 patients with CRC and hepatic metastasis were included in Group 2. Vitamin K-dependent proteins (VKDPs) levels in plasma were determined. Patients with CRC without methastasis (Group 1) and CRC patients with methastasis (Group 2) presented significantly higher values of CEA, CA 19-9, PIVKA II (310.05 ± 38.22 vs. 430.13 ± 122.13 vs. 20.23 ± 10.90), and ucMGP (14,300.00 ± 2387.02 vs. 13,410.52 ± 2243.16 vs. 1780.31 ± 864.70) compared to control group (Group 0). Interestingly, Group 1 presented the greatest PIVKA II values. Out of all the markers, significant differences between the histological subgroups were found only for ucMGP, but only in non-metastatic CRC. Studying the discrimination capacity between the patients with CRC vs. those without, no significant differences were found between the classical tumor markers and the VKDP AUROC curves (PIVKA II and ucMGP AUROCs = 1). For the metastatic stage, the sensitivity and specificity of the VKDPs were lower in comparison with those of CA 19-9 and CEA, respectively (PIVKA II AUROC = 0.789, ucMGP AUROC = 0.608). The serum levels of these VKDPs are significantly altered in patients with colorectal carcinoma; it is possible to find additional value of these in the early stages of the disease. [ABSTRACT FROM AUTHOR]

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fatal lung disease with a median survival rate of 2-4 years after diagnosis, occurring primarily in older adults. The diagnosis is suggested by histology or radiologic evidence of a usual interstitial pneumonia (UIP) pattern and exclusion of known cases of pulmonary fibrosis. There are some comorbidities associated with IPF such as pulmonary hypertension, emphysema, chronic obstructive pulmonary disease (COPD), asthma, lung cancer, cardiovascular disorders, gastroesophageal reflux disease (GERD), sleep disorders and psychiatric disturbances. The management of IPF focuses on the amelioration of symptoms, preserving lung function, improving health status, minimizing the adverse effects of therapy and improving survival. Pulmonary rehabilitation is suggested for IPF patients when adequate medical therapy controls poorly the disease progression and mental, physical or social consequences of the illness persist during daily life. Currently, there are only two approved available antifibrotic therapies, pirfenidone and nintedanib, capable to reduce disease progression and physical deterioration, but cure is elusive and improvements are hardly observed. In addition, there is a continuous need of non-drug therapy components which should be included in IPF patient management: education, psychosocial support, exercise training, nutrition, symptom management and palliative care, non-invasive ventilation and pulmonary transplant. These complementary therapies have been proven to improve dyspnea, exercise capacity, fatigue and quality of life.

Introduction. Pulmonary rehabilitation is recognized as a complementary, non-pharmacological therapy for patients with COPD and pulmonary fibrosis. For pleural effusion, however there are not current recommendations in the existing literature. The aim of this study was to evaluate the beneficial role of respiratory rehabilitation (RR) in patients with pleural effusion and to review the main physiotherapy (kinetic therapeutic) techniques, as part of RR programs. Material and method. The article exemplifies three cases of acute pleural effusion or pachypleuritis, describing the diagnostic and treatment procedures as well as the pulmonary rehabilitation technique used. Results and discussions. Treatment goals, intervention, types of exercises were explained for each type of pleural disease. The diaphragmatic breathing, relaxation and/or antalgic postures, early mobilization, and a daily walking are recommended. Conclusions. Pulmonary rehabilitation should be applied in every patient with acute pleural effusion or pachypleuritis considering the potential benefits of physical therapy in the management of the patient`s illness.

Asthma is defined by The Initiative for Asthma (GINA 2018) as a heterogeneous disease, which include chronic airway inflammation and a history of respiratory symptoms. In the last decades asthma had a rise in prevalence, becoming one of the most frequent diagnosed diseases in the world. The main goals of asthma management are to achieve good symptom control, minimize the risks of exacerbations, decrease rescue medication intake, improve the quality of life by decreasing respiratory system inflammation and ameliorating the patient’s lung function. Beside effective medications, asthma continues to impair quality of life for most patients. Due to the difficulty of controlling symptoms and exacerbations, the need of developing complementary options of treatment is increasing in order to achieve an optimum control and a lower risk of acute episodes or fatal events. Pulmonary rehabilitation is suggested for asthma patients when adequate medical therapy poorly control the symptoms and mental, physical or social consequences of illness persist during the daily life. The following non-drug therapy components are included in the rehabilitation program: physical training, comprehensive smoking cessation program, comprehensive patient education, respiratory physiotherapy, psychosocial support and comprehensive nutritional counseling. These complementary therapies have been proven to improve muscle strength, exercise capacity and symptomatology. Also, it has been associated to fewer exacerbations and a lower use of rescue medication, leading to a better quality of life.

Background. Obesity and overweight are two pathologies that are more and more frequent in the XXIst century diagnosis and are causing high morbidity and mortality rates in the general population, especially through cardiovascular complications.

Introduction: Asthma, a chronic lung disease, is a major health challenge worldwide with increased addressability to health services. There are different asthma phenotypes, which have different evolution and can be specifically tracked. The measurement of fractional expired nitric oxide (FeNo) with different devices reflects the eosinophilic inflammation of the airways, and can be used to evaluate the allergic phenotype and predict the treatment responses. The new GINA (Global Initiative for Asthma) guideline recommends FeNO monitoring to assess adherence to cortisone treatment in high doses before prescribing biological treatment, and as a means of monitoring the decrease in oral corticosteroid treatment. Objective: The aim of the study is to analyze the applicability of FeNO in monitoring response to therapy. Material and methods: An observational study was carried out on 129 subjects with a previously established diagnosis of asthma. The research was based on the determination of FeNO with NObreath. Those with intermediate FeNO received a low dose of inhaled corticosteroids in mono/dual therapy, those with increased FeNO received medium ICS mono/dual therapy. FeNO testing, its values and doses of ICS were below the the ATS / ERS guidelines. Results: FeNO reduction is strictly dependent on the cortisone dose. Applying the dual therapy from the beginning does not bring additional benefits in comparison with cortisone in monotherapy, in terms of FeNO value. Conclusions: Recommendations that include FeNO testing can help monitor response to treatment. [ABSTRACT FROM AUTHOR]

Introduction. Asthma, a chronic lung disease, is a major health challenge worldwide with increased addressability to health services. There are different asthma phenotypes, which have different evolution and can be specifically tracked. The measurement of fractional expired nitric oxide (FeNo) with different devices reflects the eosinophilic inflammation of the airways, and can be used to evaluate the allergic phenotype and predict the treatment responses. The new GINA (Global Initiative for Asthma) guideline recommends FeNO monitoring to assess adherence to cortisone treatment in high doses before prescribing biological treatment, and as a means of monitoring the decrease in oral corticosteroid treatment. Objective. The aim of the study is to analyze the applicability of FeNO in monitoring response to therapy. Materials and method. An observational study was carried out on 129 subjects with a previously established diagnosis of asthma. The research was based on the determination of FeNO with NO breath. Those with intermediate FeNO received a low dose of inhaled corticosteroids in mono/dual therapy, those with increased FeNO received medium ICS mono/dual therapy. FeNO testing, its values and doses of ICS were below the the ATS / ERS guidelines. Results. FeNO reduction is strictly dependent on the cortisone dose. Applying the dual therapy from the beginning does not bring additional benefits in comparison with cortisone in monotherapy, in terms of FeNO value. Conclusion. Recommendations that include FeNO testing can help monitor response to treatment. [ABSTRACT FROM AUTHOR]

Lungs have long been considered sterile, but recent research has shown that a large number of microbiological organisms exist in the lungs of healthy subjects (including bacteria, fungi, and viruses), collectively known as the microbiome. It undergoes changes in patients with respiratory pathology. Studies in idiopathic pulmonary fibrosis show that a large number of bacteria or the abundant presence of potentially pathogenic bacteria can cause disease progression and exacerbation, and can implicitly increase mortality. There seems to be a quantitative balance, a well-established proportion between the components of this microbiome, which is disturbed during a disease and can reach a "state of pulmonary dysbiosis". Evidence suggests that the microbiome may be used as a prognostic biomarker and may also explain the pathogenesis of interstitial fibrosis. [ABSTRACT FROM AUTHOR]

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Introduction. Pesticides are widely employed in agriculture, and the food industry is forced to combat the pests and diseases they cause. Respiratory pathology is related to occupational exposure to pesticides. Impairment of pulmonary function was observed among people professionally exposed to pesticides. Because of the marked use of pesticides in agriculture during the last 20 years, there has been a significant increase in respiratory problems within the population, not only among people who come in direct contact with them, but even in the case of manipulators. Objective. The aim is a review of the literature of the past 10 years on the correlation between occupational exposure to pesticides and respiratory pathology. Materials and method. Electronic search in ‘Pub Med’ and ‘Web of Science’ was performed in September 2019 to find papers regarding the above-investigated aspects. Abstracts and full-text articles containing the targeted subject were included. Reviews and studies about the influence of pesticides on other pathologies than respiratory were excluded. After applying the inclusion and exclusion criteria, eligible full-text articles were identified. Conclusions. Exposure to pesticides is highly correlated with respiratory pathologies (asthma, COPD, lung cancer). Contact with these substances can occur at any time in the production, transport, preparation or application of the treatments. Numerous studies documented the association between exposure to pesticides, and therefore the increased incidence of respiratory, cardiovascular and renal diseases, as well as the aging phenomeno [ABSTRACT FROM AUTHOR]

Duodenal carcinoids are rare tumours of the small intestine with heterogenous clinical and pathological characteristics. The long-term prognosis is very good if discovered in the early stages. We present the case of a patient with a non-functional duodenal carcinoid tumour discovered incidentally during an upper gastrointestinal endoscopy. The diagnosis was confirmed through immunohistochemistry. Treatment consisted of the endoscopic resection of the tumour and the surveillance of the patient for the following 2 years, with no signs of recurrence. We have conducted a literature review regarding the clinical manifestations, diagnosis, treatment, and follow-up of patients with this type of tumours. [ABSTRACT FROM AUTHOR]

Introduction. Tuberculosis, a major cause of morbidity and mortality, is the second cause of death from an infectious disease, after HIV/AIDS. Each second, a new infection occurs around the globe. Pulmonary tuberculosis can equally affect a performance athlete as well as an aspiring athlete. Physical exercise must be individualized and customized. Pulmonary rehabilitation guides 3 recommend types of exercises for patients with obstructive pathology: stretching, cardiovascular exercise or aerobics. Exercises must be started under medical supervision and must be interrupted if: the ventricular altitude increases above the maximum estimated level for the age, oxygen saturation (SaO2). Aim. The current review aims at raising awareness on post-tuberculosis disabilities and on the fact that such a frequent pathology with major sequelae is currently being ignored, since there are very few studies on this subject. Material and Method. The purpose of this research was to summarize the current literature regarding the influence of physical activity on patients with pulmonary tuberculosis. An electronic search of Pub Med database and Web of Science was conducted until September 2018. Results and discussions: Only the studies that were published in English were included in this research. The search in the databases was performed using the following keywords: "pulmonary tuberculosis" or "physical activity in respiratory diseases". The studies from the reference list of the databases were then searched manually. Conclusions. Current pulmonary rehabilitation programs with clear evidence of clinical improvement of the chronic pulmonary pathology are being studied excessively without placing too much emphasis on tuberculosis. It is necessary to develop guidelines for these patients, with a precise onset of the rehabilitation programs, adapted and individualized exercise types, as well as other measures for assessing the outcomes. [ABSTRACT FROM AUTHOR]

Microleakage is the most common cause of bracket debonding. Moreover, different thermal expansion coefficients between the enamel, the adhesive, and the bracket bases will cause repeated expansion and contraction, adding more stress to the bonding strength. Debonding represents the failure of the adhesion between the brackets and the tooth enamel. The debonding of brackets from the enamel surface is the result of several factors, such as acid-etching and drying, adhesive application, and the time and type of photo activation. The under polymerization process of composite photo activation may lead to early bracket debonding. Objective. The aim of this research is to review the available studies assessing bracket debonding due to microleakage. Material and Methods. An electronic search in Pub Med database and Web of Science was conducted between September-October 2018. The inclusion criteria were articles written in English, full-text articles, studies published in the last 5 years, studies in vivo, ex vivo, and in vitro. The outcome measures in this research were the conditions that determine orthodontic bracket debonding due to microleakage. Results. The MEDLINE search resulted in 510 titles and abstracts that were relevant to the present topic; after selecting the articles published in the last five years, 74 were available for further selection. After the exclusion of all the studies irrelevant for the aim of the paper, 13 articles were finally included in this research. In vitro studies showed that microleakage score was higher in the gingival margin at the enamel-adhesive interfaces and in the occlusal margin at the adhesive-metal bracket interfaces. Conclusion. Bracket debonding remains the main concern during the orthodontic treatment, despite the new techniques. [ABSTRACT FROM AUTHOR]

HIIT training (high intensity interval training) is one of the most effective means of improving both cardio-respiratory and metabolic functions as well as physical performance of athletes. It includes a series of intensive physical exercises (e.g. running until reaching 90% of the maximum possible pulse), with intermittent rest periods. Active intervals can range between 45 and 240 seconds and alternate with easy exercise periods or even rest periods. This type of training is based on a different principle than regular exercises, where the effort is constantly dosed with an average intensity over a longer period of time. Initially, these exercised were used for practicing performance athletics, but they were also adopted by the fitness world for their efficacy in burning fat, which has been demonstrated in multiple studies. It has been observed that the attainment of the maximum cardiovascular performance and peripheral adaptation by athletes is determined by reaching 90% of the maximum aerobic capacity [VO2max]. Thus, new trends in sports medicine structure specific training protocols that allow 90% of VO2 max to be maintained for long periods of time. Moreover, there is evidence that HIIT influences cardiovascular response, anaerobic glycogenesis, blood glucose levels, neuromuscular yield, and musculoskeletal tension, parameters that can be improved not only in athletes but also in individuals with metabolic syndrome. The HIIT recommendation is made after considering a number of factors such as the intensity and duration of the exercise as well as the recovery period, the exercise mode, and the number of repetitions and series. [ABSTRACT FROM AUTHOR]

Introduction. Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease. The pulmonary rehabilitation (PR) is a mutidisciplinary and comprehensive intervention in symptomatic patients with COPD. Objective. This review aims to synthesize evidence from available studies on the relative efficacies of different methods of rehabilitation therapies in patients with stable COPD. Material and Methods. A search was performed on the databases Pubmed, Embase, ResearchGate. Of the 410 articles retrieved from databases, only 20 met the inclusion criteria. Two reviewers independently reviewed selected eligible studies. Results. Rehabilitation is a multidisciplinary intervention in symptomatic patients with COPD, including speleotherapy, halotherapy, muscular training, soft tissue manual therapy and neuromuscular electrostimulation. All of the case-control studies using speleotherapy reported improved respiratory function to varying degrees and there were improvements in lung functional tests including forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1), oxygen saturation, partial pressure of oxygen in arterial blood, and partial pressure of carbon dioxide in arterial blood. In addition, halotherapy has been associated with relief of respiratory conditions such as COPD, asthma and cystic fibrosis by its bactericidal effect, improvement of immunity and rheological properties of secretions. Respiratory muscle training is a part of rehabilitation for COPD subjects. In patients who can not perform physical activity, neuromuscular electrostimulation (NMES) increased 6 minute walking distance and time to symptom limitation exercising at a submaximal intensity and reduced the severity of leg fatigue on completion of exercise testing. Conclusion. The management of COPD should include a multidisciplinary therapy, including rehabilitation therapies as an adjuvant to the medical treatment, especially because due to the high prevalence, mortality, and morbidity, COPD will be one of the biggest public health challenges in the next century. [ABSTRACT FROM AUTHOR]

Ethical aspects related to the approach of persons addicted to tobacco use are a particular concern of pneumologists. Considered for a long time ”an expression of the modern way of life”, smoking is viewed today as a pandemic disease, being at the same time an epidemic that can be completely prevented. We present the ethical aspects of the approach of persons addicted to tobacco use, the peculiarities of the medical approach in smoking cessation and implicitly, of the doctor-patient relationship and how to make patients responsible for their own health within this relationship. The final aim of the medical intervention was to restore patient’s autonomy in making decisions regarding smoking cessation, along with a change in lifestyle. In changing the patients’ attitude, the principles of autonomy and non-maleficence represented a strong motivation, the patients benefiting from the presence and implementation of a National Smoking Cessation Program. [ABSTRACT FROM AUTHOR]

Introduction: Asthma, a chronic lung disease, is a major health challenge worldwide with increased addressability to health services. There are different asthma phenotypes, which have different evolution and can be specifically tracked. The measurement of fractional expired nitric oxide (FeNo) with different devices reflects the eosinophilic inflammation of the airways, and can be used to evaluate the allergic phenotype and predict the treatment responses. The new GINA (Global Initiative for Asthma) guideline recommends FeNO monitoring to assess adherence to cortisone treatment in high doses before prescribing biological treatment, and as a means of monitoring the decrease in oral corticosteroid treatment., Objective: The aim of the study is to analyze the applicability of FeNO in monitoring response to therapy., Material and Methods: An observational study was carried out on 129 subjects with a previously established diagnosis of asthma. The research was based on the determination of FeNO with NObreath. Those with intermediate FeNO received a low dose of inhaled corticosteroids in mono/dual therapy, those with increased FeNO received medium ICS mono/dual therapy. FeNO testing, its values and doses of ICS were below the the ATS / ERS guidelines., Results: FeNO reduction is strictly dependent on the cortisone dose. Applying the dual therapy from the beginning does not bring additional benefits in comparison with cortisone in monotherapy, in terms of FeNO value., Conclusions: Recommendations that include FeNO testing can help monitor response to treatment.