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Background: As the demand for digital dentistry constantly increases, digital devices are gradually replacing conventional methods of recording occlusal contacts. The study aimed to assess the inter-rater reliability of occlusal contact point detection using 40 μm articulating paper, Medit i700, and OccluSense and to compare the distribution of occlusal contacts using the articulating paper and intraoral scanner. Material and Methods: The study included 25 participants aged 20 to 30 (13 women and 12 men). Photographs of contact points were taken and marked in maximum intercuspal position (MIP), in protrusive and laterotrusive movements, on working and non-working sides using 40 μm articulating paper and digital devices. The Cohen's Kappa coefficient assessed the inter-rater reliability. The Wilcoxon signed-rank test was used to compare dependent groups, articulating paper, and Medit i700. Results: The Cohen's Kappa index showed that almost perfect agreement was achieved with 40 μm articulating paper. Compared to Medit i700, the 40 μm articulating paper showed an increased mean number of contacts per tooth, except for the third molars. Conclusions: The 40 μm articulating paper has detected more overall contacts than the digital devices, particularly in the posterior areas. An ideal method for registering occlusal contacts has not been established yet. [ABSTRACT FROM AUTHOR]

Introduction. Heart failure (HF) is characterized by neuroendocrine activation. The cardiac natriuretic hormones, including atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), together with their related pro-peptides (proANP and proBNP) represent a group of peptide hormones produced by the heart. A normal NT-proBNP level has a high negative predictive value for heart failure. The use of NT-proBNP testing is helpful in diagnosing acute HF in the emergency care setting, allowing an early and optimal treatment. The purpose of this study is to assess the prognostic value of NT-proBNP in heart failure in children younger than 3 years old and to establish whether it correlates with the NYHA/Ross functional class and left ventricle systolic function.

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Background/Aim: The aim of the study was to assess the relationship between myocardial fibrosis characteristics (percentage, localization, heterogeneity), evaluated by a non-invasive method such as cardiac magnetic resonance (CMR), with the extrasystolic ventricular arrhythmia in patients with non-ischemic cardiomyopathy. Patients and Methods: The study prospectively included 173 consecutive patients who underwent electrocardiogram Holter monitoring, transthoracic echocardiography and CMR with late gadolinium enhancement (LGE). Results: In univariate analysis, both the presence (OR=105, 95% CI=1 .01-1.09; p=0.015), the percentage of fibrosis >15% (p=0.018), the septum size, the fibrosis in either lateral or septal walls (p=0.004), as well as fibrosis in the midwall (p=0.019) were statistically significant higher in the group with extrasystolic arrhythmia. After adjustment, the percentage of fibrosis >15%, had higher odds of extra systolic arrhythmia [OR=3.78 (95% CI=1.52-10.62, p=0.007)]. Conclusion: The presence, percentage, and localisation of left ventricle myocardial fibrosis characterized by LGE-CMR was associated with ventricular arrhythmias. [ABSTRACT FROM AUTHOR]

Background: Receiver Operator Characteristic (ROC) curve, is a graphical plot which presents the performance of a binary classifier when the discrimination cutoff is varied. The aim of this work was to create an extension for R Commander that offers a graphical user interface for Receiver Operator Characteristic tools provided by several existing command line accessible packages like pROC and ROCR. Material and Methods: The extension was built and tested with R version 3.2.0 and R Commander 2.1-7. Results: We built an extension called RcmdrPlugin.ROC that we uploaded on the CRAN servers. The extension adds a new menu called ROC, along with two submenus pROC and ROCR that broadly corresponds to commands available to access the functions of these packages. The pROC menu offers several commands: to plot a ROC curve for a dataset or for a logistic regression model, to compare paired and unpaired ROC curves, each providing the following tabs: General (to select the variables for the analysis, and options for switching cases with controls); Smoothing (allowing the user to select different types of smoothing -- binominal, density, distributions like normal, lognormal, ...); AUC (to specify the partial area under the curve (AUC) options), CI (to select the options of confidence intervals (CI) -- the level, computing method: DeLong, bootstrap, ...); Plot (for the plotting options). The ROCR dialogue window offers more options in choosing the performance measures for the plot. Conclusion: The RcmdrPlugin.ROC extension helps less advanced users of R accessing ROC tools in a friendly graphical user interface. [ABSTRACT FROM AUTHOR]

Background: Evidence Based Medicine (EBM) represents the use of the best latest evidence obtained by systematic search together with personal clinical experience and patient values. Clinical evidences are quantified by a number of indicators. R is a free and powerful environment for statistical computing and graphics, used mainly in command line interface. The aim of this work was to create an extension for R Commander to offer a graphical user interface to calculate the most used EBM indicators. Materials and Methods: The extension was created in R and then tested in R 3.1.1 and R Commander 2.1-1. Results: The extension was successfully created and was named RcmdrPlugin.EBM, being available for download on Comprehensive R Archive Network servers. The extension creates a new menu called EBM, which offers an interface to calculate the following indicators with their confidence intervals: diagnosis (sensitivity, specificity, diagnostic accuracy, Youden's index, positive/negative likelihood ratio, positive/negative predictive value, number needed to diagnose), therapeutic (absolute risk reduction, relative risk reduction, odds ratio, relative risk, number needed to treat/harm), prognostic (attributable risk, relative risk, odds ratio). Conclusion: It is now easy to compute EBM indicators in R, with the graphical user interface extension of R Commander. [ABSTRACT FROM AUTHOR]

Diabetes is a serious condition that damages many systems and organs, mainly the blood vessels and the nerves. The importance of the diabetes and its complications, along with the prevalence of the disease makes it a major public health problem worldwide. The spread of diabetes and its complications can be evaluated, and action steps based on this information can be taken, by the use of national diabetes registers and databases. A register of a chronic disease (such as diabetes) is an application used to capture, manage and offer information about chronic diseases to support an organized management of patient health care. Till now in Romania there are there are only disparate initiatives at hospital level, without any systematized regional or national monitoring through registers. The aim of this paper was to identify a way to help in the developing a national register for diabetes, that makes use of current medical information sources, and to develop the structure of a diabetes register and database for diabetes in Romania. The paper presents the medical sources of information that can provide data to a diabetes register, their degree of trust, algorithms for entering new diabetes cases, or removing cases from the register. The structure of a diabetes database, and registry, and for a form to input data in them is detailed in the article. [ABSTRACT FROM AUTHOR]

Introduction: Quality research and quality evidence based medicine practice has an important pillar in a solid bibliographic documentation. Quality bibliographic documentation makes use of search strategies to retrieve articles from search engines of bibliographic databases. The AIM of this study was the identification of useful search terms to be used in search strategies that try to find meta-analyses of survival data. Materials and methods: A qualitative study based on text analysis was undertaken to identify useful terms for search strategies in abstracts of scientific papers. Survival analysis meta-analyses publication type studies, published between 1996 and 2005, were searched in Medline bibliographic database through Pubmed web interface. Each abstract was analysed and each important terms were noted down if they were considered to be useful in the creation of search strategies for analysis of survival data, or meta-analyses. Results: Pubmed search yielded 773 results. From these search results 401 (52%) fulfilled inclusion criteria. The terms that were identified as useful in search strategies for meta-analyses of survival data are presented in the paper. [ABSTRACT FROM AUTHOR]

Introduction. QUOROM represents an instrument to improve the quality of reporting of meta-analysis of randomized controlled trials. The aim of this study was the assessing of conformity to QUOROM criteria about all the chapters of a analysis of randomized controlled trials in reporting of abstracts of meta-analisis of survival data. Materials and methods. The study was an observational descriptive study. Meta-analysis papers of survival data of randomized controlled trials were searched in Pubmed, published between July 1999 and December 2005, using the search string "survival rate OR survival analysis" and the limits "Meta-Analysis, Humans". The meta-analysis of survival data were identified by assessing the title and abstracts. The quality of reporting of the abstracts of these studies was assessed. The concepts from QUOROM declaration, referring to all the chapters of a meta-analysis were assessed to see if they were reported in these abstracts. The number and percentage of the reporting of these concepts were presented for the assessed papers. Results. The search resulted in 466 results, from which 260 (56%) met the inclusion criteria, and from those 121 (47%) analysed randomized controlled trials. The QUOROM concepts that were less reported were: motivation for the review, or the biological rationale; naming of databases used; using unpublished studies; manual search; using expert informants; criteria for exclusion; assessing validity and data abstraction; methods for combining results; clinical and statistical heterogenicity; dealing with missing data; assessing publication bias; agreement on assessing selection criteria, and study validity; discussion on clinical implication of the findings; presenting possible biases in making of the meta-analysis. Conclusion. The results justify the necessity of using with much more rigour the QUOROM methodology to report abstracts of meta-analysis of survival data. [ABSTRACT FROM AUTHOR]

Medical websites, as well as patient data, and user data on medical websites, have to be secured, and effort should be put to increase the privacy of the users. PHP is one of the most used scripting languages for website development. But it is highly criticized from the security point of view. Developers should build medical PHP websites with security in mind, beside their efforts to fulfill the website purpose. The most common attacks, and security issues on PHP websites are: SQL injection attack (where an attacker tries to insert malicious code in the SQL queries); cross-site scripting (where external code is injected in the output of the website); crosssite request forgery (where unwanted commands are injected from a user that the website trusts); session hijacking (where the session ID of the user is stolen); broken authentication and access control; sensitive data exposure; error logging; using components with known vulnerabilities. Their description and ways to mitigate are presented. [ABSTRACT FROM AUTHOR]

Our paper presents the state of art of our research project, code PN-II-RUTE- 2011-3-0170, supported by the Romanian National Authority for Scientific Research, CNCS-UEFISCDI, whose aim is to recover an ancient lexicographical work, and to put it to circulation by means of computerization. It's about the Lexicon of Buda (1825), a masterwork of the Enlightenment age movement of Transylvanian School, which fully aligns the Romanian lexicography, by means of the tools it puts to use, to the dictionary tradition of Europe. Putting the content of lexicon in digital form aims to multiple goals, such as: (a) to promote the cultural and linguistic inherited background, (b) to be an available platform to a large public, (c) to offer a search-available corpus to the public. [ABSTRACT FROM AUTHOR]

Objectives: The need to monitor, track, evaluate and proper manage adverse drug reactions (ADRs) in the hospital setting has become a fundamental component of the routine clinical practice and of the healthcare system. Computerized systems are used for such data entry, storage and further analysis with the final goal of avoiding ADRs. This paper describes a database designed for this purpose as part of a pharmacovigilance program in Romania. Methods and Setting: Stimulated spontaneous reporting is the method used for the detection of ADRs in two internal medicine departments. The ADRs collection is paper based. The information is further evaluated for various parameters and then the data is entered into the database. In the design of the database we took into consideration some basic requirements for such a database: comfortable user interface with easy access and handling, high level of security, data protection and desired statistics. Results: The database was designed in order to include a complete description of ADRs (e.g. causality, preventability, severity, outcome, type of ADR, risk factors, drug interactions). Auxiliary databases such as ICD-10, ATC codes and the MedDRA terminology are being used. The database has been in operation for a year, during which approximately 250 ADR case reports have been evaluated and entered. Conclusions: To improve and strengthen the ADRs reporting at a hospital level we developed and populated a computer-based system for standardized collection, evaluation and storage of ADRs that could be further adopted by other academic hospitals that want to keep track of preventable ADRs. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome is associated with an increase in cardiovascular morbidity and mortality. Since the first description of MS, several definitions have been elaborated (IDF, AHA, Who, NCEP). Arterial stiffness is a strong independent predictor of cardiovascular events and cardiovascular mortality in various groups of patients. Aim: The purpose of present study was to investigate the impact of the different definitions of MS on arterial stiffness. Material and Methods: we investigated 214 patients, mean age 60.04±9.98 years. Arterial stiffness was evaluated using TensioMed TM Arteriograph. Results: Using the three definitions of the metabolic syndrome - IDF 2005, AHA, NCEP -, a proportion of 71.5% (153 patients), 72.9% (156 patients) and 62.1% (133 patients), respectively, had metabolic syndrome. Pulse wave velocity in the group of patients with metabolic syndrome was increased compared to those without metabolic syndrome, but the difference was not statistically significant (IDF - 10.37±2.13m/sec vs 10.04±2.21m/sec, AHA 10.40±2.14m/sec vs 9.93±2.19m/sec, NCEP 10.47±1.86m/sec vs 9.95±2.55m/sec). A statistically significant difference between pulse wave velocity in men with metabolic syndrome compared to those without metabolic syndrome was found, the relationship being not true in women. Conclusion: Patients with MS (especially men) have increased arterial stiffness parameters than those without metabolic syndrome. All the three definitions used have the same ability to identify patients with arterial stiffness. Arterial stiffness parameters are more altered as the number of criteria for the definition of metabolic syndrome increases, regardless of the definition used. [ABSTRACT FROM AUTHOR]

Background and Aims: The non-dipper status represented by blood pressure reduction by less than 10 percent during sleep is present in about 50 percent of patients with type 2 diabetes (T2D) and hypertension, a pattern associated with more frequent cardiovascular complications and reserved prognosis. This study analyzed the predictive risk factors associated with the different dipper profiles, especially with the nocturnal pattern, following the mean arterial pressure (MAP), the mean heart rate (MHR), and the mean pulse pressure (MPP) in patients with T2D and hypertension, established by ambulatory blood pressure monitoring (ABPM)., Method: 166 consecutive patients with type 2 diabetes mellitus and hypertension were included in a cross-sectional study, and they underwent 24-hour ABPM. We excluded patients with secondary hypertension, acute coronary disease and heart failure, with oncologic or endocrine disease. The simple and multiple linear regression models were performed predicting 24-hour, day and night MAP, MHR, and MPP according to various predictors, using software R version 4.3.1., Results: There were 80 non-dippers (48.20%), 57 dippers (34.34%), 22 reverse-dippers (13.25%) and seven extreme-dippers (4.21%). A statistically significant association was observed between MAP 24-hour and total cholesterol (TC) (higher TC values were associated with higher MAP /24 h values): adjusted coefficient B of the regression slope: 0.09, 95% confidence interval CI (0.04-0.15), p=0.003. In the multivariate analysis: adjusted B: 8.64, 95% CI (-14.67-2.61), p=0.006, beta-blockers reached the threshold of statistical significance in relation to MHR/24 h, their presence decreasing the heart rate. PP/24 hours was associated in the multivariate analysis with age: adjusted B: 0.45, 95% CI (0.05-0.85), p=0.28; abdominal circumference: 0.26, 95% CI (0.03-0.49), p=0.028, and total cholesterol: 0.1, 95% CI (0.02-0.17), p=0.013. Diabetic nephropathy was statistically significantly associated with PP/24 h: adjusted B: 10.19, 95% CI (1.24-19.14), p=0.027., Conclusions: High cholesterol was associated with higher values of MAP and PP. Beta-blocker treatment lowered non-dipper MHR. Age and AC were correlated with increased PP values. These are predictive risk factors associated with the status of non-dippers established by ABPM, and they represent a veritable link to the non-dipper pattern in patients with T2D and hypertension.

Introduction: Hematologic biomarkers of inflammation may serve as valuable adjuncts in clinical practice, aiding in several aspects such as differential diagnosis, prognostic assessment for patient stratification and monitoring the efficacy of antimicrobial therapy. The aim of this study was to evaluate the efficacy of Neutrophil to Lymphocyte Ratio (NLR), Platelet to Lymphocyte Ratio (PLR), Lymphocyte to Monocyte Ratio (LMR), and Systemic Inflammatory Index (SII) in predicting bacterial sexually transmitted infections (STI)., Methods: This prospective study was conducted in the north-west region of Romania and included patients from several medical special units such as dermatology, obstetrics-gynecology, urology, and general practice. The study group comprised patients with a high suspicion of STI, while the control group consisted of healthy subjects. Quantitative data are presented as medians (interquartile ranges)., Results: The median values of SII, NLR, and SIRI were higher in the group of subjects with sexually transmitted diseases compared to the control group [604.06 (432.36 - 880.02) vs. 556.89 (388.63 - 874.19); 2.61 (1.57 - 3.3) vs. 2.29 (1.66 - 3.26); and 0.95 (0.53 - 1.52) vs. 0.89 (0.67 - 1.34)]. Regarding PLR, the median values were lower in the group of subjects with sexually transmitted diseases compared to the control group [138.1 (99.19 - 169.6) vs. 140.65 (117 - 190.32)]. As for LMR, the median values were equal between the two groups [4.64 (3.74 - 6.11) vs. 4.64 (3.75 - 5.45)]. Nevertheless, the differences did not reach the significance level., Conclusion: Our study suggests that inflammatory biomarkers might aid in detecting bacterial STIs, but their significance was not statistically confirmed. Further research on alternative laboratory tests is needed for improved STI diagnosis and management.

Background and Aim: Identifying the predictive factors of tumoral and hormonal answer of somatotropinomas to the medical treatment with somatostatin analogs represent an important element for treatment management. The aim of this study was to assess the therapeutic answer of the somatotropinomas according to the T2-weighted signal intensity on the MRI., Methods: We included 31 acromegalic patients, mean age 51.35 ± 10.37 years, who underwent surgery. The patients were divided according to the T2-weighted MRI signal intensity - hypointense, hyperintense and isointense - of the GH-secreting pituitary adenoma and were evaluated after surgery, 3, 6 and 12 months with somatostatin analogs therapy., Results: 16 (51.61%) somatropinomas were hypointense, 9 (29.03%) were hyperintense and 6 (19.35%) were isointense. The median IGF-1 and GH level decreased significantly in macroadenomas (p<0.001, p<0.001, respectively), whereas GH decreased significantly only in microadenomas (p=0.010). A significant statistical correlation was found between IGF-1 or GH levels and tumor volume before surgery (Spearman=0.38, p<0.001; Spearman=0.64, p<0.001, respectively) and after surgery (Spearman=0.61, p=0.001; Spearman=0.74, p<0.001). The percentage of optimally controlled patients increased from 12.9% after surgery, to 28.57% after 12 months with somatostatin analogs. The highest percentage of optimally controlled patients with somatostatin analogs treatment was in hypointense somatotropinomas (50%)., Conclusion: The T2-weighted MRI signal intensity classifies the somatotropinomas into groups with certain evolutive and medical treatment response particularities, of which we found that the hypointense somatotropinomas have a better therapeutic response after surgery and after long-term treatment with somatostatin analogs.

Introduction: Chronic suppurative otitis media (CSOM) with and without cholesteatoma is regarded as chronic inflammation of the middle ear and mastoid mucosa that can be associated with the presence of granulation tissue and infection, which can lead to ossicular damage and hearing loss, but it is commonly known that cholesteatoma behaves aggressively. Both lesions appear to contain a predominant population of inflammatory cells, among which proinflammatory cytokines secreting keratinocyte growth factor (KGF) and its receptor (KGFR). No clear difference was demonstrated between these entities. The purpose of this study was to investigate the potential influence of KGF and KGFR in increased epithelial-cell proliferation of chronic otitis media (COM) with cholesteatoma in contrast to COM without cholesteatoma (CSOM), particularly in the granulative form, and to compare the rate of proliferation activity of epithelial cells using the Ki-67 epithelial proliferation marker expression., Patients, Materials and Methods: We analyzed 105 ears with cholesteatoma vs. 53 ears with CSOM without cholesteatoma using our KGF and KGFR variables, and the ratio of proliferating epithelial cells using Ki-67. The percentage of the specimens expressing KGF and KGFR was compared between the two groups for statistical significance using the Pearson's chi-square test. Immunohistochemical staining was conducted and the proportion of the cells staining positive for the nuclear antigen Ki-67 was evaluated in a quantitative and visual way, using light microscopes., Results: KGF was positive in 88.57% of cholesteatoma and was positive in 41.51% CSOM without cholesteatoma specimens (cholesteatoma vs. CSOM, p=0.001). The positive rate of KGFR in the CSOM group was 33.96% compared to those in cholesteatoma, which was 60.95%. Compared to the cholesteatoma specimens, a significantly smaller number of Ki-67 labeling index was detected in CSOM specimens., Conclusions: Our results indicated that the abnormal behavior of the cholesteatoma epithelium seems to be induced by the paracrine interaction between KGF and KGFR. Furthermore, we found that cholesteatoma expressing both KGF and KGFR had high Ki-67 index, which correlated with its aggressiveness. These findings suggest that excessive KGF and KGFR synthesis may contribute to the hyperproliferative state in cholesteatoma and could explain the pathological difference between cholesteatoma and CSOM.

Pituitary adenomas are benign tumors of the brain, with a relatively high prevalence in the general population, being responsible for 14.4-16.7% from all brain tumors. These tumors, although benign, have a local invasive behavior in approximately 35% of the cases. The aim of this study was to identify the differences in expression of molecular markers between primary and relapsed pituitary adenomas (as an aggressiveness indicator), as well between secreting and non-secreting pituitary adenomas. Tumor fragments were collected from 51 patients with invasive pituitary adenomas. Of these, 10 cases were operated a second time due to tumor recurrence. The tumor fragments were retrieved from the archives of the Department of Pathology, Emergency County Hospital, Cluj-Napoca, Romania. Immunohistochemical staining was performed for nine markers on 51 invasive pituitary adenomas: Ki-67, β-catenin, E-cadherin, Bcl-2, galectin-3, p53, p27, CD117, and CD44. We compared the expression differences between two groups: the first one including primary and relapsed invasive pituitary adenomas, and another one including prolactin (PRL)-secreting and non-secreting invasive pituitary adenomas. Ki-67, p53 and Bcl-2 expressions were found significant in the PRL-secreting group. CD44 immunostaining was significant only in relapsed invasive pituitary adenomas. For the β-catenin, E-cadherin, galectin-3, p27 and CD117 expression levels were not registered statistically significant differences between our groups. Our study is the first one to report a statistically significant difference between the expression of CD44 in primary and relapsed invasive pituitary adenomas and it could be used as a negative impact prognostic marker.