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Diabetic retinopathy (DR) is a microvascular disorder caused by the long-term effects of diabetes mellitus and among the primary causes of blindness worldwide. Early detection of DR is the key to its effective treatment and subsequent reduction of associated economic burden, but manual screening is time-consuming and of limited availability. A highly sensitive and specific automatic diagnostic tool would significantly improve screening programs and allow referring for further evaluation and treatment in an ophthalmology clinic only patients with significant lesions or with changes between two successive evaluations. Several deep learning-based automated diagnosis tools have been proposed to aid screening but their implementation with minimal costs is not accessible to physicians with no coding knowledge. We aimed to develop a fundus images classification model with no coding knowledge by using generative artificial intelligence (AI) implemented in Windows 11 operating system under subscription (Copilot Pro), a free image analysis tool (Fiji ImageJ2), and Vertex AI, a machine learning (ML) platform launched by Google in 2021. For this purpose, we selected a total of 2961 labelled cases from the APTOS 2019 database of DR fundus images. Images were batch segmented using a Java ImageJ script generated by Copilot Pro and based on the Contrast Limited Adaptive Histogram Equalization (CLAHE) algorithm. Segmented images were used to train an automated ML classification model to detect DR severity (5 classes - no DR, mild non-proliferative DR, moderate DR, severe DR, proliferative DR). The model achieved an area under the precision-recall curve of 0.889, with a precision rate of 83.8% and a recall rate of 77%. In conclusion, generative AI implemented into Windows operating system together with a free imaging processing tool and Vertex AI allow ophthalmologists with no coding knowledge to benefit from publicly available image databases (thousands of cases) to develop accurate automated diagnostic tools. Such tools have the potential to facilitate screening especially in areas with few specialists. [ABSTRACT FROM AUTHOR]

Fatal hemoptysis secondary to severe pulmonary veins stenosis and fibrosing mediastinitis is an exceptional late complication of radiofrequency ablation for atrial fibrillation. We report the case of a 53-year-old male with a history of atrial fibrillation treated by radiofrequency ablation and admitted in our center 6 months after the procedure because of aggravating dyspnea and fatigability. Transthoracic echocardiography showed moderate dilation of right heart cavities, severe pulmonary hypertension and a turbulent flow in superior pulmonary veins. The cardiologist suspected pulmonary vein(s) stenosis and so cardiac computed tomography (CT) angiography was performed, with findings of severe stenosis of the right superior, right inferior and left inferior pulmonary veins, near-occlusion of the left superior pulmonary vein and the vein draining the apical segment of the right lower lobe. The CT scan also revealed soft tissue attenuation of the mediastinum posterior to the left atrium suggesting fibrosing mediastinitis together with parenchymal findings consistent with pulmonary veno-oclusive disease and an area of hemorrhagic infarction. Fatal hemoptysis occurred 3 days later, before treatment was attempted. In conclusion, severe pulmonary vein stenosis and fibrosing mediastinitis are rare but devastating complications of radiofrequency ablation. Prevention and early diagnosis are the key elements as these entities are potentially life-threatening. [ABSTRACT FROM AUTHOR]

The aim of the current study was to identify surgical factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). The present study analyzed data from 127 patients who underwent CABG at our institute between 2000 and 2006 and presented for ambulatory examination and coronary computed tomography angiography evaluation of graft patency in 2016 (139.78±36.64 months post-CABG). The 127 patients received 340 grafts (2.68 grafts/patient) and 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) with arterial grafts and 179 (44.86%) with saphenous vein grafts. Graft patency varied according to coronary territory, proximal anastomosis type (in situ graft, composite graft, graft anastomosed to the ascending aorta), Y anastomosis angle (47.21° for patent arterial grafts vs. 56° for occluded), and distal anastomosis angle (in sequential anastomoses irrespective to graft type, 48.60° for patent side-to-side anastomosis vs. 53.97° for occluded, 65.12° for patent end-to-side anastomosis vs. 90.80° for occluded; in single end-to-side anastomosis of arterial grafts, 39.46° for patent and 44.94° for occluded). A single end-to-side anastomosis angle 60° or greater was associated with a 5.149 occlusion odds ratio (OR) (P<0.001) for arterial grafts. Venous grafts were not sensitive to single end-to-side anastomosis angle. In conclusion, a small anastomosis angle for proximal Y and distal anastomoses is associated with a higher long-term patency of the free graft. Radial artery grafts registered higher patency rates when anastomosed to the ascending aorta compared with composite grafting with the left internal thoracic artery, whereas in situ right internal thoracic artery (RITA) anastomosed to the right coronary territory is associated with a lower patency rate compared with free RITA used to revascularise the anterolateral or circumflex territory in composite grafting. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to identify morphological and pathophysiological factors associated with long-term patency of grafts used in coronary artery bypass grafting (CABG). Methods: A total of 127 patients who underwent CABG between 2000 and 2006 and presented for computed tomography evaluation of graft patency at 139.78±36.64 months post-CABG were analyzed. Patients received 340 grafts (2.68 grafts/patient), 399 distal anastomoses (3.14 anastomoses/patient), 220 (55.14%) performed using arterial grafts, and 179 (44.86%) using saphenous vein grafts (SVGs). Results: Graft patency varied according to vessel type and coronary territory. Overall graft patency was 90.16% for the left internal thoracic artery (LITA), 75.55% for the right internal thoracic artery (RITA), 79.25% for the radial artery (RA), and 74.3% for the SVG. The maximum patency rate was obtained with the RA (80.65%) for the right coronary territory, RITA (92.86%) for the anterolateral territory, and SVG (82.54%) for the circumflex territory. The LITA-left anterior descending artery graft occluded in 13 (7.93%) cases, 7 due to competitive flow. The influence of graft length on patency rates after indexing to height was not significant. The target vessel degree of stenosis influenced arterial graft patency rates with an occlusion odds ratio (OR) of 3.02 when anastomosed to target vessels with <90% stenosis. Target vessel caliber also influenced patency rates with occlusion ORs of 2.63 for SVGs and 2.31 for arterial grafts when anastomosed to <1.5 mm target vessels. Conclusion: Morphological parameters, such as graft type, target territory, target vessel caliber, and degree of stenosis, are important factors conditioning long-term graft patency [ABSTRACT FROM AUTHOR]

The mitral valve is a complex three-dimensional structure and mitral valve repair is the therapeutic intervention of choice in patients with significant mitral regurgitation due to lower rates of mortality and reoperation, lower incidence of heart failure, infective endocarditis and atrial fibrillation compared to valve replacement. The aim of the present study is to review the classical concepts regarding the anatomy of mitral valve leaflets and to analyze their morphology related to current clinical and surgical practices. The authors analyzed intraoperatively the mitral valves of 45 patients that benefited from mitral valve repair between 2002-2014 at the Cardiovascular Diseases Institute from Iasi, Romania. The mean age was 60.09±13.68 years and the indication for surgery was established for mitral regurgitation in all cases. From a morphological point of view, two commissures separating anterior and posterior leaflets were observed in all cases. Standard clefts described by Carpentier as separating P1 from P2 scallops and P2 from P3 scallops were inconstant and noted in 30 cases (P1-P2 cleft) and 34 cases respectively (P2-P3 cleft).. In 40 cases, additional clefts were noted inside conventional Carpentier scallops. Morphometrically, the A2 scallop measured 25.31±2.54 mm, the anterior leaflet height was of 36.12±4.73 mm and the intercommissural length 35.63 ± 5.18 mm. An accurate in vivo evaluation of the mitral valve and a common nomenclature are mandatory to mitral valve surgery as confusions, anatomical variants and incomplete knowledge of the morphology and structure of mitral apparatus could interfere the result of surgical intervention. [ABSTRACT FROM AUTHOR]

Coronary arteries disease is a major health problem with high morbidity and mortality. Coronary artery bypass grafting (CABG), a surgical revascularisation technique, is dedicated to patients with multiple, severe and complex coronary stenosis. Several conduits (systemic arteries and the great saphenous vein) are currently used to bypass diseased coronary segments. Coronary computed tomography angiography (CCTA) can evaluate CABG patency with minimum discomfort to the patient compared to conventional angiography. The current study aims to analyse the strengths and pitfalls of CCTA in CABG follow-up and to realise a pictorial review of normal aspects and potential complications. The authors retrospectively reviewed a group of 120 patients that benefited from CABG at the Cardiovascular Diseases Institute from Iasi, Romania between 2000-2010 and underwent CCTA evaluation of graft patency between 2012-2015. Patency rates were evaluated according to graft type, grafted coronary artery and target vessel degree of stenosis together with performing a pictorial review of CCTA normal and pathological aspects in CABG. Arterial grafts offered superior long-term (8.52 years) patency rates compared to veins, up to 95.56% for the left internal mammary artery anastomosed to the left descending coronary artery, 94.64% for the radial artery graft anastomosed to one obtuse marginal branch (OM), and 87.10% for the right internal mammary artery anastomosed to an OM. Lowest patency rates were obtained for the saphenous vein graft anastomosed to the right coronary artery (68.85%). In conclusion, total arterial revascularisation offers better long-tem patency rates compared to CABG using venous grafts and CCTA is a reliable method to assess graft disposition, patency, and complications. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHD) are a congruent group of complex pathologies associated with heteromorphic deviations of cardiac development; such maladies are present at birth and constitute the most commonly encountered type of human birth defect. The aim of the current study is to investigate abnormal aspects of cardiac development and the segmental approach in describing CHD based on the medical records of 68 patients aged 1 week - 44 years, diagnosed (all cases) and surgically treated (51 cases) for CHD at the Cardiovascular Diseases Institute (Iasi, Romania) between January 1rst - December 31rst 2015. Pediatric patients were treated as part of the project „100 hearts for 100 children". Out of the 51 patients surgically treated, 4 cases (7.84%) had undergone prior palliative or interventional procedures, 4 cases (7.84%) benefited from palliative interventions (shunts, pulmonary artery banding, atrial septectomy) and the rest of 43 cases (84.31%) were corrected per primam. Unoperated cases consisted in complex CHD with irreversible pulmonary arterial hypertension and neonates with critical CHD. In 14 cases (20.59%) CHD were part of syndromes like Down, di George, Noonan, heterotaxy or Williams. The type of embryological defect and the segmental classification were further correlated with the presence of associated malformations and the result of the surgical treatment in terms of palliative versus corrective surgery, single step correction, number of surgical procedures. Close cooperation between cardiac surgeons, anatomists, embryologists, and pathologists is crucial for further increase of knowledge in the field of cardiac morphogenesis explaining cardiac defects. Detailed knowledge of cardiac embryology and anatomy allows accurate diagnosis and successful management of CHD. [ABSTRACT FROM AUTHOR]

Giant cell aortitis is a relatively common condition, but its differentiation from the rarer Takayasu aortitis still poses challenges for most specialists. In this study we attempted to draw a comparison between the distinct characteristics of giant cell aortitis and Takayasu aortitis. The clinical, paraclinical and pathological data of the two diagnoses was obtained through the clinical assessment and histological study of surgically excised ascending aortas. The concerned patients, both of them females, (the Takayasu aortitis case at 36 years of age and Giant cell aortitis at 59 years, respectively) presented the same clinical picture of aortic aneurysm formation, with a singular difference: in the Takayasu aortitis, the subclavian artery was also affected. After a first closer examination the two disorders present a greater number of similarities: imaging studies have revealed aortic dilation in both patients and histopathological study of arterial lesions, represented by aortic granulomatous inflammation, was in both cases was indistinguishable. The rupture of the inflammatory aortic aneurysm, also revealed on both Takayasu and giant cell aortitis, is aknownledged in literature as a common feature for both these 2 life-treating aortitis. In conclusion, an early diagosis, proper medical treatment, and periodical life-long controls of patients with diagnosed Giant cell aortitis and Takayasu aortitis can prevent severe complications such as aortal aneurysm rupture. [ABSTRACT FROM AUTHOR]

The aim of the study is to evaluate by multidetector computed tomography (MDCT) the prevalence, location and size of LA (left atrial) diverticula and accessory appendages, the prevalence of PVs anatomical variants and LAA (left atrial appendage) shapes in patients with atrial fibrillation (AF) compared to patients in sinus rhythm (SR). Images obtained by MDCT in a group of 100 patients with <1 year paroxysmal or persistent AF prior to radiofrequency catheter ablation and in a group of 100 patients in SR with unconfirmed or insignificant (<50%) coronary arteries stenoses were compared. The prevalence of LA diverticula (22% in AF group, 19% in SR group) and accessory appendages (6% in AF group, 5% in SR group) was not significantly different between the two groups. Similar sizes of LA diverticula and accessory appendages were registered in patients with AF and in SR. The prevalence of a common left venous trunk was significantly higher in patients with AF (30%) compared to patients in SR (18%) (p=0.047) and proved to be an independent predictor for AF (odds ratio (OR) 1.32; 95% confidence interval (CI) 0.93-1.51; p=0.002) at multivariate logistic regression. LAA had a complex shape but no significant differences concerning the prevalence of the 4 major types were registered between the groups. In conclusion, the only parameter associated with AF was the presence of a left common trunk suggesting that it is either a consequence or a predisposing factor for the development of AF.

Unlabelled: Revolutionary progresses in computer technology are of great use during forensic investigations in terms of facial identification based on reconstructions., Aim: The purpose of the current study is to evaluate the use and limits of facial reconstruction by considering soft tissues' thickness determination., Material and Method: The authors investigated the limits of three methods used for soft tissues' thickness determination on a sample group consisting of 9 cadavers, 30 ultrasound investigations and 27 cranial X-rays. The measurements were performed at standard anthropological landmarks following methods previously described in literature., Results: Measurement values for each soft tissue landmark overlapped between sexes, females having greater soft tissue thickness at two sites: infraorbital and supraorbital notches. US measurements demonstrate a much larger dependence of the soft tissue thickness according to different body posture and imply compressing soft tissues with the transducer. X-rays determinations revealed more accurate values than US, but are nocive to the subjects and can only be performed in standard radiographic positions. For cadavers, different postmortem stages and supine position generated inadequate results., Conclusion: In order to increase the degree of accuracy of craniofacial approximation it is necessary to obtain a validated data set specific for the Romanian population. This will allow a better determination of facial measurements opening new perspectives in understanding the relation between physical properties and facial soft tissue.

Unlabelled: The authors present a case where the main variants of the humerus were associated on the same specimen: the supracondylar process and the supratrochlear foramen. The supracondylar process, a bony prominence situated on the anteromedial surface of the humerus in the vicinity of the medial epicondyle, could be at the origin of ulnar or median nerve and brachial artery compression syndromes, especially when associated with Struthers' ligament., Material and Method: The anatomic specimen was discovered accidentally during a larger study aimed at establishing a current norma anatomica and morphometry of the humerus. The supracondylar process and the supratrochlear foramen were morphologically and morphometrically analyzed., Results and Discussion: The supracondylar process was situated on the anteromedial surface of a left humerus, roughly 5 cm above the medial epicondyle. It was 12.4 mm in length, mediodistally directed. The supratrochlear foramen was situated above the lateral part of the humeral trochlea, just adjacent to the middle branch of trifurcation of the anterior border of the humerus. It was ovoid in shape with the long axis transversally (6.3/3.7 mm)., Conclusions: Presentation of such variants contributes to increasing the anatomical data capital and might be important for diagnosis of peripheral neurovascular compression syndromes.