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Catalin Pestrea,1– 3 Ecaterina Cicala,1 Alexandra Gherghina,1 Florin Ortan,1 Dana Pop2,3 1Department of Interventional Cardiology, Brasov County Clinical Emergency Hospital, Brasov, 500326, Romania; 2 5th Department of Internal Medicine, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, 400012, Romania; 3Department of Cardiology, Clinical Rehabilitation Hospital, Cluj-Napoca, 400347, RomaniaCorrespondence: Catalin Pestrea, Brasov County Clinical Emergency Hospital, Brasov, 500326, Romania, Tel +40745003637, Email pestrea.catalin@gmail.comPurpose: Although feasibility studies have included older patients, specific data for His bundle pacing (HBP) in this population is scarce. The aim of this study was to evaluate the feasibility and mid-term performance of HBP in the elderly (70 to 79 years old) versus the very elderly (80 years old and above) patients with conventional indications for pacing.Patients and Methods: About 105 patients older than 70 years of age with attempted HBP from the 1st of January 2019 to the 31st of December 2021 were reviewed. Clinical and procedural characteristics were recorded at baseline, and after a mid-term follow-up period.Results: The procedural success rate was similar in both age groups (68.49% vs 65.62%). There was no significant difference in pacing or sensing thresholds, impedance, and fluoroscopy times. For both age intervals, patients with a baseline narrow QRS maintained a similar QRS duration after pacing, while in patients with a wide QRS, the paced QRS was significantly shorter. Baseline QRS duration, left bundle branch block morphology, and ejection fraction, were significantly associated with HBP procedural failure. The mean follow-up period was 830.34 days for the elderly and 722.76 days for the very elderly. After the follow-up period, both sensing and pacing thresholds were similar between the groups. Compared to the baseline values, there were no significant changes in both pacing and sensing parameters, irrespective of the age interval. During follow-up, no lead dislodgements were recorded. There were two cases of significant pacing threshold rise in the elderly (4%) and three cases in the very elderly group (14.2%) which were managed conservatively, without lead revision.Conclusion: In elderly and very elderly patients, HBP is a feasible procedure associated with constant pacing and sensing parameters and with low complication rates over mid-term follow-up.Keywords: conduction system pacing, elderly and very elderly, feasibility study, mid-term follow-up

His bundle and left bundle branch pacing are regarded as physiological options for permanent ventricular pacing because they use the fast-conducting specialized tissue for depolarization. The development, more than a decade ago, of a dedicated delivery kit using a lumenless lead, revolutionized the procedures and dramatically increased the success rate. After these consistent results, the industry is focusing now on releasing more tools for conduction system pacing.

Malignant nasopharyngeal tumors account for approximately 4% of ENT malignant tumor pathology and 1% of all cancers. The diagnosis of nasopharyngeal tumors is often late, the reason being the location in a silent anatomical region in terms of symptomatology and accessibility. Thus, approximately 70% of newly diagnosed patients with nasopharyngeal carcinoma unfortunately present with the condition in an advanced local stage. The early signs and symptoms are varied (nasal obstruction, hearing loss, otalgia, headache) and are usually ignored by the patient and even by the doctor in the initial stage of nasopharyngeal tumor evolution. Approximately 5% of patients have systemic metastases at presentation, the most common location being bone. Latent Epstein-Barr virus infection appears to be involved in the pathogenesis of nasopharyngeal carcinoma. There is no exact evidence of how often a nasopharynx tumor’s first sign is unilateral hearing loss. Thus, further work is required to determine that exactly to help patients get diagnosed faster and therefore improving their therapeutical options. This study aims to explore which symptoms are most common as the first indication of NPC, as well as how these symptoms compare to each other in terms of frequency and likelihood of occurrence.

In the current context of the global climate changes, in the Romanian Carpathians strong pressures exercises on mountain ecosystems due to the massive and uncontrolled deforestation, expansion of the urban areas and land restitution (followed mostly by the land use changing). In these circumstances, the soils mountain sensitivity increased. The paper investigates the biota functionality in providing ecosystem services in a highly sensitive soil environment (with highly acidity and hydromorphic threats) located in Padurea Craiului Mountains. The studied area is an island of acid rocks located in a massive of limestones. The absolute altitude is 600 – 800 m and the land use is secondary grassland. The analytical results of the studied soil profile showed a very low (5.14 – 5.76) pH, as a result the vegetation is acidophilic. The organic matter content is low, as well as the N, P, K values. The micromorphological investigation showed textural, depleted, and redoximorphic pedofeatures generated by the strongly influence of the coastal spring water. In such a highly sensitive mountain soil, the biota (less studied in hydromorphic soils) is adapted to the hard environmental conditions, its functionality being limited and specialized. Consequently melioration is required to improve the environment and further biota functionality to provide higher-value ecosystem services.

Cardiac interventions in the setting of a ST-elevation myocardial infarction (STEMI) often require complex decision-making, especially when confronted with coronary bifurcation lesions. Although provisional stenting is the first choice regarding revascularization, bailout or upfront two stents may be required.

Both citizens and political parties refer to novel participatory practices in the contemporary crisis of representative democracy. Survey data indicate a growing demand for such practices within the electorate, while political parties have also begun discussing them more frequently. However, previous studies on citizens’ attitudes and parties’ discourse on democratic innovations rarely speak to each other. It remains unclear whether citizens’ attitudes and parties’ discourse are congruent. This article seeks to address this gap in the literature and analyses the extent to which political parties reflect citizens’ attitudes towards referendums and citizens’ deliberation in their manifestos. We cover 15 political parties in Germany and the UK. Our analysis uses party manifesto data between 2010 and 2024, and data from surveys conducted on national representative samples. Our findings reveal that political parties and citizens rarely have congruent approaches towards referendums and deliberative practices. People’s enthusiasm about referendums is hardly reflected in parties’ rhetoric, but the latter reacts gradually to the public appetite for deliberation. There are visible differences between opposition parties and those in government.

This study evaluates the synergy of coalition for hybrid renewable energy (RWB) system alternatives. In this context, the alternative sources of hybrid RWB system are examined to illustrate the impact-relation directions among them with multi SWARA based on q-ROFs and golden cut. Next, the performances of renewable alternatives are measured in terms of the synergy of coalition with game theory and Shapley value. It is concluded that solar energy is the most suitable RWB alternative for synergy to increase efficiency in investments. However, biomass does not have a significant influence on providing synergy in energy investments. Therefore, solar energy should be prioritized for hybrid energy investments. Especially with the effect of technological developments, the efficiency of solar energy investments increases significantly. Thus, solar energy investments have become quite suitable for increasing the synergy in hybrid energy projects. Furthermore, necessary research should be conducted to make biomass energy more efficient.

Nasopharyngeal hemorrhage is one of the most common ear, nose, and throat (ENT) emergencies that present in a hospital or primary care clinic. While many cases of hemorrhage are self-limiting, in more severe cases medical intervention is necessary, either to cauterize the bleeding vessel or to pack the nose with various materials (thus involving specialized medical care and time, which implicitly lead to additional costs). In the case of the packaging, the medical treatment can in some cases be extremely painful and unpleasant. Tranexamic acid is an affordable, inexpensive, easy-to-use antifibrinolytic agent and with no notable side effects, as demonstrated by numerous studies related to most surgical fields. The aim of this paper is to provide an evidence-based approach to the use of tranexamic acid (TXA) in nasopharyngeal hemorrhages in our research center, comparing with the available literature on the subject, but presented in an updated form. As a conclusion, the combined use (intravenous and topical) of TXA may be a reasonable, safe and non-invasive option for hemodynamic stabilization of rhino-pharyngeal bleeding.

Despite continuous investigations in the diagnosis and treatment of severe acute pancreatitis (SAP), this disease still remains a critical condition with a mortality rate of up to 35%. The pathophysiology of SAP involves an important inflammatory reaction of the pancreas (mediated by inflammatory cytokines and immune system activation), causing severe local tissue damage as well as important systemic imbalances. IL-17 is an inflammatory mediator that have a pivotal role in SAP evolution, generating multiple interactions between inflammatory cytokines and significantly influencing the immune system response. Consequently, continuous renal replacement therapy/CRRT was added to the conventional therapy, leading to improved treatment results. This review aims to evaluate the involvement of Interleukin 17 in the diagnosis, pathogenesis and evolution of SAP, as well as the role of CRRT in reducing elevated serum levels of IL-17. As a conclusion, CRRT is a promising method to eliminate cytokine mediators from the blood, thus leading to a reduction of both pancreatic/peripancreatic tissue damage and systemic imbalances in severe acute pancreatitis, being strongly correlated with better therapeutic outcomes.

The aim of the research is to illustrate how the degree of effectiveness of fiscal policy measures varies depending on the level of public debt within a group of Central and Eastern European (CEE) states. To this end, a T-SVAR (Threshold Structural Vector Autoregressive) model was implemented, based on two regimes, calibrated as a function of the evolution of public debt. The results illustrate that, in most of the countries analysed, increasing government expenditure generates a stronger increase in economic growth under the low public debt regime in comparison with the situation at the level of the high public debt regime. Thus, the effectiveness of fiscal policy measures declines as the level of government debt rises. Another result obtained within the analysis highlights that the positive effect of public debt reduction on economic growth is more strongly felt in the higher public debt regime than under a low public debt regime. On the basis of these results, it is recommended that the CEE countries continue their efforts to reduce public debt in order to increase the effectiveness of fiscal policy measures.

The research has as objective to analyse the evolution of the employed population and the gross domestic product in services, in the Western Region of Romania, from 2016-2020, respectively to highlight the importance of the employed population’s contribution to the creation of the gross domestic product. Based on the statistical data series, the absolute, relative and average indicators were calculated, with the aim of identifying for each type of service the increase, the dynamics index and the rate of growth of the employed population and the gross domestic product, both in absolute values and in values mediums. The employed population and the gross domestic product registered positive values for most services, and negative values only for the population employed in Financial Intermediation and Insurance services, Other service activities, Education, Public Administration and Defence; social insurance from the public system, as well as to the gross domestic product for Real Estate Transaction services and Financial Intermediation and Insurance services.

The purpose of the research is to identify the preference, motivation, attitude and satisfaction of consumers towards the resorts found in the Semenic Tourist Area. The paper presents the results obtained through direct research, respectively an occasional survey using the questionnaire, through used to identify if there is tourist demand, what is the frequency of consumption and what budget is reserved for a minimum stay, respectively the attitude of consumers regarding the main sources of information when choosing a tourist accommodation structure, depending on unit type, classification, rates and payment methods. At the same time, the preference for purchasing tourist services, the motivation, the selection criteria used when choosing a tourist accommodation structure, the degree of satisfaction with the basic and additional services offered, the degree of satisfaction with the natural environment, road transport and cable installations, tourist routes, ski slopes, facilities for entertainment and relaxation were also identified.

Background and Objectives: Familial hypercholesterolemia (FH) is a genetic disease that is massively underdiagnosed worldwide. Affected patients are at high risk of cardiovascular events at young ages. Early intervention in childhood could help prevent heart attacks and cerebral strokes in these patients. Materials and Methods: We conducted an interventional study including 10 patients that previously underwent genetic testing for familial hypercholesterolemia. These patients received lifestyle and diet recommendations that they followed for a year before being reevaluated. Results: Patients with negative genetic testing were able to achieve lower levels in their lipid panel values compared to the patients with positive genetic testing, with lifestyle changes alone. LDL-cholesterol levels decreased by 18.5% in patients without FH while patients genetically confirmed with FH failed to achieve lower LDL-cholesterol levels without medication. Conclusions: Genetic testing for FH is not always part of screening algorithms for FH. Some studies even advise against it. Our study proved the importance of genetic testing for FH when suspecting this disorder and choosing the treatment course for patients.

The transnational political participation of migrants has been extensively analyzed in the literature. Previous explanations focus on individual determinants ranging from political interest or efficacy to social ties or socio-demographic characteristics. So far, little attention has been paid to the contrast between factors related to their lives in two different countries. The present article adds to this burgeoning literature by identifying and comparing the effects of several attitudes and behaviors of migrants in the host and home country on their voter turnout in home country elections. We use individual-level data from a survey conducted in 2022 on 1,058 Romanian migrants living around the world. The results indicate that migrants who remain anchored in the politics of their home country—without necessarily striving to return—and those who are engaged in their host communities are more likely to vote. Migrant voter turnout is not determined by poor integration in the host society.

This thematic issue covers the participation and representation of migrants in contemporary politics. It focuses on two interconnected analytical dimensions: countries of residence and countries of origin, as arenas of political engagement and the supply and demand sides of political representation. The articles in the thematic issue advance the existing knowledge in migration studies and party politics both theoretically and empirically. They do so by proposing innovative analytical frameworks to assess the extent of participation and representation and by bringing evidence that fosters a better understanding of the intricate relationship between migration and politics.

Artificial Intelligence and Deepfake Technologies have brought a new dimension to the generation of fake data, making it easier and faster than ever before—this fake data could include text, images, sounds, videos, etc. This has brought new challenges that require the faster development of tools and techniques to avoid fraudulent activities at pace and scale. Our focus in this research study is to empirically evaluate the use and effectiveness of deep learning models such as Convolutional Neural Networks (CNNs) and Patch-based Neural Networks in the context of successful identification of real and fake images. We chose the healthcare domain as a potential case study where the fake medical data generation approach could be used to make false insurance claims. For this purpose, we obtained publicly available skin cancer data and used recently introduced stable diffusion approaches—a more effective technique than prior approaches such as Generative Adversarial Network (GAN)—to generate fake skin cancer images. To the best of our knowledge, and based on the literature review, this is one of the few research studies that uses images generated using stable diffusion along with real image data. As part of the exploratory analysis, we analyzed histograms of fake and real images using individual color channels and averaged across training and testing datasets. The histogram analysis demonstrated a clear change by shifting the mean and overall distribution of both real and fake images (more prominent in blue and green) in the training data whereas, in the test data, both means were different from the training data, so it appears to be non-trivial to set a threshold which could give better predictive capability. We also conducted a user study to observe where the naked eye could identify any patterns for classifying real and fake images, and the accuracy of the test data was observed to be 68%. The adoption of deep learning predictive approaches (i.e., patch-based and CNN-based) has demonstrated similar accuracy (~100%) in training and validation subsets of the data, and the same was observed for the test subset with and without StratifiedKFold (k = 3). Our analysis has demonstrated that state-of-the-art exploratory and deep-learning approaches are effective enough to detect images generated from stable diffusion vs. real images.

Iron oxide nanoparticles (IONPs) represent an important advance in the field of medicine with application in both diagnostic and drug delivery domains, offering a therapeutic approach that effectively overcomes physical and biological barriers. The current study aimed to assess whether oral administration of salicylic acid-functionalized iron oxide nanoparticles (SaIONPs) may exhibit beneficial effects in alleviating histological lesions in a murine monoiodoacetate (MIA) induced knee osteoarthritis model. In order to conduct our study, 15 Wistar male rats were randomly distributed into 3 work groups: Sham (S), MIA, and NP. At the end of the experiments, all animals were sacrificed for blood, knee, and liver sampling. Our results have shown that SaIONPs reached the targeted sites and also had a chondroprotective effect represented by less severe histological lesions regarding cellularity, altered structure morphology, and proteoglycan depletion across different layers of the knee joint cartilage tissue. Moreover, SaIONPs induced a decrease in malondialdehyde (MDA) and circulating Tumor Necrosis Factor-α (TNF-α) levels. The findings of this study suggest the therapeutic potential of SaIONPs knee osteoarthritis treatment; further studies are needed to establish a correlation between the administrated dose of SaIONPs and the improvement of the morphological and biochemical parameters.

This study is an in-depth exploration of the nascent field of Natural Language Processing (NLP) and generative Artificial Intelligence (AI), and it concentrates on the vital task of distinguishing between human-generated text and content that has been produced by AI models. Particularly, this research pioneers the identification of financial text derived from AI models such as ChatGPT and paraphrasing tools like QuillBot. While our primary focus is on financial content, we have also pinpointed texts generated by paragraph rewriting tools and utilized ChatGPT for various contexts this multiclass identification was missing in previous studies. In this paper, we use a comprehensive feature extraction methodology that combines TF–IDF with Word2Vec, along with individual feature extraction methods. Importantly, combining a Random Forest model with Word2Vec results in impressive outcomes. Moreover, this study investigates the significance of the window size parameters in the Word2Vec approach, revealing that a window size of one produces outstanding scores across various metrics, including accuracy, precision, recall and the F1 measure, all reaching a notable value of 0.74. In addition to this, our developed model performs well in classification, attaining AUC values of 0.94 for the ‘GPT’ class; 0.77 for the ‘Quil’ class; and 0.89 for the ‘Real’ class. We also achieved an accuracy of 0.72, precision of 0.71, recall of 0.72, and F1 of 0.71 for our extended prepared dataset. This study contributes significantly to the evolving landscape of AI text identification, providing valuable insights and promising directions for future research.

Introduction This study evaluated the feasibility of His bundle pacing (HBP) in consecutive, unselected patients with advanced atrioventricular block (AVB) over a medium-term follow-up period, comparing procedural characteristics between nodal and infranodal sites of the conduction block.Materials and methods Seventy-five consecutive patients with second-degree or third-degree AVB in which HBP was attempted were prospectively included in this study. The clinical and procedural-related characteristics of the patients were recorded at baseline and over a mid-term follow-up.Results 72% of the patients had normal QRS duration at baseline. Intracardiac electrograms revealed nodal AVB in 46 patients (61.3%). The permanent HBP procedural success was significantly higher in nodal AVB (84.8%) vs infranodal AVB (31%). There was no statistical difference between paced QRS duration, impedance, pacing and sensing thresholds and fluoroscopy time in the two groups. Infranodal block, baseline QRS duration, left bundle branch block morphology and ejection fraction were significantly associated with HBP procedural failure. The patients were followed for a period of 627.71±160.93 days. There were no significant differences in parameters at follow-up. An increase of >1 V in the His bundle (HB) capture threshold was encountered in one patient with infranodal AVB (11.1 %) and in four patients with nodal AVB (10.25%).Conclusion Permanent HBP is a feasible pacing technique in nodal AVB with a high success rate and stable thresholds in the medium term. Most infranodal blocks are located within the HB, so there is still the possibility to capture the conduction system, although with lower success rates.