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Beauvericin (BEA), Enniatin B (ENN B), and Ochratoxin A (OTA) are mycotoxins produced by fungi species. Their main effect on several organs and systems is associated with chronic exposure going from immunotoxicity, estrogenic disorders, and renal failure to cancer (in animals and humans). OTA belongs to Group 1 according to the International Agency for Research in Cancer (IARC) and it has legislated limited values; not happening for BEA nor ENN B. Exposure to mixtures of mycotoxins occurs through food intake in daily consumption. The aim of this study was to evaluate the implication of BEA, ENN B, and OTA individually and combined in producing cytotoxicity in cells for immunological studies and cancer cell lines (human leukemia cells (HL-60), fresh human peripheral blood mononuclear cells (PBMCs), and human breast cancer (MDA-MB-231) cells). Cells were treated for 4 h and 24 h at different concentrations of BEA, ENN B, and OTA, respectively. Viability assays were carried out by flow cytometry using DAPI (4',6-diamindino-2-phenylindole, dihydrochloride) as a viability dye and the potential effects of synergism, addition, and antagonism were assessed through the Chou and Talalay method. Individual OTA treatment exerted the greatest cytotoxicity for PBMC cells (IC 50 0.5 μM) while ENN B for HL-60 (IC 50 0.25 μM) and MDA-MB-231 (IC 50 0.15 μM). In binary combination [ENN B + OTA] resulted in exerting the greatest cytotoxicity for HL-60 and MDA-MB-231 cells; while [BEA + OTA] in PBMC cells. The triple combination resulted in being highly cytotoxic for PBMC cells compared to HL-60 and MDA-MB-231 cells. In summary, PBMC cells were the most sensible cells for all three mycotoxins and the presence of OTA in any of the combinations had the greatest toxicity causing synergism as the most common cytotoxic effect., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Endometrial stromal sarcoma (ESS) is a rare tumor, predominantly occurring as a primary tumor of the uterus. Rare cases of primary extrauterine ESS (EESS) have been reported. Low-grade ESS (LG-ESS) is more common than high-grade ESS (HG-ESS). We present five cases of ESS and one case of EESS. All cases received external radiotherapy (EBRT) at the Radiotherapy Department of the Emergency Clinical Hospital 'Sfantul Apostol Andrei' Galati, during 2004-2020. Five cases underwent EBRT in two-dimensional (2D) technique and only one patient received EBRT with three-dimensinal conformational radiotherapy (3DCRT) technique with a linear accelerator, Elekta Synergy. Five patients were referred to postoperative radiotherapy after hysterectomy. The median age of the patients was 57.4 years. One patient was referred to radiotherapy with palliative intent. EESS localized in the retroperitoneum, in the para-aortic region, was identified in one 64-year-old patient with a personal history of hysterectomy and bilateral salpingo-oophorectomy in 1997; EESS was complicated with vertebral extension at the L1-L2 level and spinal cord compression syndrome. ESS represents a rare diagnosis and a high- or low-grade tumor profile is distinguished by immunohistochemistry (IHC) tests. Up to 30% of patients have EESS at presentation. The treatment of ESS is multimodal, its management requiring a multidisciplinary team, and it is different according to the primary tumor location and tumor staging. The role of adjuvant radiotherapy remains controversial in high-grade EESS and due to the rarity of these cases there are limited data concerning the efficacy of adjuvant EBRT available from prospective randomized control clinical trials., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Rebegea et al.)

Background: Cardiac metastasis may be encountered more frequently than primary cardiac tumors. They are discovered at autopsies with an incidence between 1.5 - 20%. The primary tumors that generate cardiac metastasis are malignant melanomas, lymphoma, the lungs, the breast, the esophagus. The organ most affected is the pericardium (62-81%). In 90% of cases from a clinical point of view, they are generally silent. In the case of patients diagnosed with breast cancer and who have undergone radiotherapy, differential diagnosis with fibrosis post radiotherapy interferes. The treatment is palliative and should be administered according to the primary location of the tumor and the patient's performance status. Case presentation: We are presenting the case of a 73-year-old diagnosed and treated for a breast neoplasm in the left breast in 2006. After a period of time of 9 years, the patient presents secondary sternal bone determination, radio-treated and for which she once again goes under hormonal therapy. In 2018, patient performed an imaging evaluation that revealed lung metastases. At the moment of stage review, performed in 2020, secondary epicardial determinations are noted. We present the case, the therapeutic management, diagnostic procedures and treatment and also, we discuss the data from literature. Conclusion: Cardiac metastases are rare and and in most cases are silent. The incidence has changed due to treatment options and imaging investigations. Stereotactic body radiation therapy can be considereda a therapeutic option in the cases with good performance status and with oligometastatic disease., (Celsius.)

Cutaneous metastases from endometrial cancer are rare and unusual. This is the case of a 72 years old female patient, diagnosed in 2018 with G3 endometrial serous carcinoma (ESC). At 18 months from the surgical intervention, the patient developed bilateral inguinal lymph nodes metastases and skin secondary lesions; histological and immunohistochemical tests were performed. Computed tomography scan did not indicate visceral secondary lesions, local or regional relapses. We present the treatment practiced, the case's evolution and we discuss about epidemiology, molecular biology, treatment options and management of advanced and local lesions. The appearance of skin metastases in theses cases is associated with poor prognosis and treatment options are limited to palliative chemotherapy and radiotherapy., (Celsius.)

Background: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe., Methods: Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined., Results: Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046)., Conclusion: This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied.

Unlabelled: Authors present some results of clinical epidemiological research carried out on a sample of 277 patients with viral hepatitis A (VHA), hospitalized in Suceava County, during 8 years., Material and Method: An annual evolution of VHA incidence correlated with the epidemiological territorial situation was highlighted., Results: Incidence of VHA in 20-40 age group represented 70.8%, and 33.5% in 20-25 age group. Diagnosis index was unfavourable with influence for interval of hospitalization over 21 days in 9.7% of cases. The VHA characteristic medium clinical form was kept in 80.1% of total patients. ASAT and ALAT levels were correlated with the clinical forms, age structure and early diagnosis difficulties.

Unlabelled: Nowadays, researchers from various fields of study and geographical regions continue to pay attention to viral hepatitis A. Due to a resistant virus, with predominant enteral transmission, with endemic epidemic manifestations and a remarkable clinical polymorphism, affecting children especially, hepatitis A does not chronicize, but, in adults, it is responsible for forms with prolonged evolution and severe, sometimes., Material and Methods: Results of clinical epidemiological and laboratory studies carried on a sample of 10321 patients suffering from hepatitis A, from two lots: 5530, Suceava; 4791, Botosani; 5400, males; 4921 females; age from < 1 to = 55., Results: In Suceava County, the hepatitis A incidence had epidemic values in 1996 (229%000) and 1997 (224%000). The most affected age groups, with hospitalized clinical forms, were 5-14 (42.3%) and 15-24 (24.9%). In Botosani County, epidemic peaks registered in 1999 (213%000), and inter-epidemic in the other years. The most affected age group was of 5-14, with 48.9% from all the admitted cases, but 52% from all cases belonged to age groups over 25.

Unlabelled: Viral hepatitis A (VHA) maintains the first place among hepatitis with various etiologies, by high levels of morbidity, affecting mainly children and teenagers age groups and, sometimes, with major risks in adults and when over- and co-infected with other hepatitis viruses. It also is involved in travellers' and nosocomial diseases., Material and Method: The assessment of VHA morbidity data highlighted that VHA registered yearly values between 106.8 and 307.1% hundred thousand inhabitants, both at the national and Suceava County levels, during the period 1970-1995., Results: An important decline (24.8-47.8% hundred thousand) was registered, between 1996 and 2006. In the Suceava County, after the epidemic peaks from '80-'90 decade, with morbidity of 379.1% hundred thousand in 1989 and 331.8% hundred thousand in 1990, inter-epidemic and epidemic periods with reduced amplitude were registered. In 2006, morbidity reached a low value of 15.0% hundred thousand., Conclusion: Our study of "comparative epidemiology", on reported cases and those confirmed by hospitalisation, in the Suceava County, highlighted that the later proportion was under 50%, with an increase during 2005 (> 90%). A significant decrease in multi-annual trend of VHA morbidity registered for reported cases but not for those hospitalised.