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Traditional modality of using public property, the concession has played a significant role in the development of the modern state by capitalizing on those goods that by their legal nature have an inalienable character as well as by entrusting some works or public services to legal entities of private law which can execute them or make them more efficient.The economic development of the last decades of the states of the European Union, the acceleration of the commercial exchanges and the extension of the forms of circulation of the goods and services at community level have determined the reconsideration of the concession contract as a legal instrument for the capitalization of the public property goods, of the works and services that the state owns.The consolidation, at national level, of some legal norms meant to regulate concession and its forms was significantly influenced by the provisions of Directive 2014/23/EU of the European Parliament and of the Council of 26 February 2014 on the award of concession contracts. Thus, Law no. 100/2016 regarding the concession of works and services as well as the recent Government Emergency Ordinance no. 57/2019 on the Administrative Code implement the new European vision.

This article, published in the Romanian Journal of Oral Rehabilitation, discusses the principles of specific treatment and palliative care in advanced head and neck cancer. It emphasizes the challenges faced by medical teams in managing advanced cases and highlights the importance of a multidisciplinary approach and empathic connection between the medical team, patients, and their families. The article also addresses the impact of late diagnosis and the complexity of multimodal oncological treatment. It provides a case study of a patient with pharyngolaryngeal squamous cell carcinoma and reviews recent articles on chemotherapy, radiotherapy, immunotherapy, and palliative care for head and neck cancers. The text concludes by emphasizing the need for collaboration between clinicians and addressing both the scientific and emotional aspects of treatment. This comprehensive article offers valuable insights for researchers and healthcare professionals interested in head and neck cancer management. [Extracted from the article]

The field of transplantation, including the specialized area of vascularized composite allotransplantation (VCA), has been transformed since the first hand transplant in 1998. The major challenge in VCA comes from the need for life-long immunosuppressive therapy due to its non-vital nature and a high rate of systemic complications. Ongoing research is focused on immunosuppressive therapeutic strategies to avoid toxicity and promote donor-specific tolerance. This includes studying the balance between tolerance and effector mechanisms in immune modulation, particularly the role of costimulatory signals in T lymphocyte activation. Costimulatory signals during T cell activation can have either stimulatory or inhibitory effects. Interfering with T cell activation through costimulation blockade strategies shows potential in avoiding rejection and prolonging the survival of transplanted organs. This review paper aims to summarize current data on the immunologic role of costimulatory blockade in the field of transplantation. It focuses on strategies that can be applied in vascularized composite allotransplantation, offering insights into novel methods for enhancing the success and safety of these procedures. [ABSTRACT FROM AUTHOR]

Background: Rectal cancer is one of the most common malignant pathologies worldwide. Currently, the standard treatment of this pathology consists of radio‑chemotherapy followed by low anterior resection with total mesorectal excision or abdominoperineal proctectomy for medium/low rectal cancer. Objectives: In recent years, another treatment strategy has been proposed, stemming from the finding that up to 40% of patients receiving neoadjuvant treatment had a complete pathological response. This method, also referred to as the watch and wait approach, implies delaying surgery and following a rigorous protocol for patients who have developed a complete response to neoadjuvant treatment with a good oncologic outcome. The objective of this study was to highlight the merits of this approach in selected patients. Case Reports: In this study, we present two patients with low‑rectal tumors who developed complete response post neoadjuvant therapy and for whom the watch and wait protocol has been applied over the past 4 years. Conclusion: Although the watch and wait protocol appears to be a feasible option in the management of patients with a complete clinical and pathological response post neoadjuvant therapy, more prospective studies and randomized trials comparing this approach with standard surgical treatment are required before establishing it as the standard of care for distal rectal cancer. Therefore, establishing universal criteria for the selection and assessment of the patients with a complete clinical response following neoadjuvant treatment is required. [ABSTRACT FROM AUTHOR]

Tarsal tunnel syndrome (TTS), or tibial nerve compression at the internal malleolus level, is a frequently missed disease among clinicians, although it can be found in diabetic patients (almost half of them will develop peripheral neuropathy and related complications) and in non-diabetic patients due to the existence of tumors and anatomical accessory elments. The aim of this paper is to increase the level of awareness regarding the TTS diagnostic tools and treatments among doctors. The main source of literature review was PubMed database and the author’s personal experience. Although it is considered a rare disease, for sure underdiagnosed, left without treatment, TTS will lead to foot sensitive and motor deficits with dramatic effects on patients quality of life and survival. Patient’s history, clinical examination (positive Tinel sign, objective testing of increased sensibility threshold) and paraclinical examination (soft tissue ultrasonography and nervous conduction studies) highlight the diagnostic. The conservative and minimally invasive therapeutic methods are efficient, but limited in time, the surgical solution – tarsal tunnel decompresion – being still the elective procedure, even in critical peripheral neuropathy [ABSTRACT FROM AUTHOR]

Copyright of Gândirea Militară Românească is the property of Romanian Armed Forces Defence Staff and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Injuries to the upper limb may determine unexpected simple or complex soft tissue defects, due to different types of underlying injury mechanism, clean cut/stabs, crushing, torsion, avulsion or mixed types, which pose a challenge for the reconstructive surgeon. Ideally, all arterial, venous and nervous lesions, in the distal upper limb should be repaired in an end-to-end technique, outside of injury zones, with healthy ends, in a tension free manner. However, situations arise where, either a tension-free repair is not possible, or a considerable defect is met, often representing a challenge to the surgeon. Therefore, a timely decision is imposed in order to find the most favorable approach to restore limb or segment perfusion, ensuring efficient venous return, as well as providing a sensate repair. Usage of vein grafts represents an essential tool comprised in the reconstructive surgeon’s armamentarium, with high versatility in nerve, arterial and venous reconstruction. Not only does it provide an ideal solution, with high adaptability to each case, but it also may enhance short- and long-term outcome, offering an optimal reconstructive option in any upper limb trauma situation, regardless of etiology. We aim to describe our therapeutic strategies in a series of challenging trauma cases involving digital structures from the upper limb. Interposed vein grafts were used to re-stablish sensate function in a patient with a collateral digital nerve defect, but also to bridge vital digit arterial defect in a torsion-avulsion thumb amputation, as well as re-establishing venous flow in patients with Urbaniak II finger degloving injury. [ABSTRACT FROM AUTHOR]

Copyright of Romanian Journal of Family Medicine / Revista Română de Medicina Familiei is the property of Media DOM Express and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Paliatia: Journal of Palliative Care is the property of HOSPICE Casa Sperantei Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Paliatia: Journal of Palliative Care is the property of HOSPICE Casa Sperantei Foundation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The application of the measures and the carrying out of activities specific to defence are ensured by the public authorities of the Romanian state, of which the authorities of the public administration play a vital role. In addition to the Parliament and to the President of Romania, the representative authorities in which the will of the people is expressed directly, the authorities of the local and central public administration, through their exercised powers, enforce the Constitution and the laws and guarantee the existence of an effective national defence system. [ABSTRACT FROM AUTHOR]

With a distinguished role in the construction of the European identity, the principle of subsidiarity represents one of the most important principles specific to the European Union. Next to the principle of proportionality, the subsidiarity was included among the principles, which govern and control the delimitation and the execution of the competences, so that in the areas that are not of their exclusive competence, the Union intervenes only if the objectives of the proposed action cannot be satisfactory realized by the Member States not only on a central level but also on a local or regional level but can better realized on the level of the Union. Transferred in the area of the public administration as a veritable premise for an efficient administration, the principle of subsidiarity assures the execution of the compet ences by the authority of the local public administration on the administrative level closest to the citizen. [ABSTRACT FROM AUTHOR]

Copyright of Revista Romana de Bioetica is the property of College of Physicians in Iasi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. The number of patients developing multiple primary cancers, synchronous or metachronous, has been increasing during the last couple of years. Literature considers that this increase is due to the development of the medical diagnosis techniques, the treatment and monitoring of neoplastic patients, known as having a higher risk of developing a second neoplasia compared to the risk of the general population; the increase in the average life expectancy of modern population is also added to such. Description. We present the case of a 73-yearold Caucasian patient, former smoker for 15 years, diagnosed in January 2016 with a routine CT scan, with two lung lesions in the upper right lobe. The pathological history of the patient shows two synchronous neoplasias of cecum and descending colon treated radically: sequential resection and adjuvant chemotherapy. After a disease-free period of 8 years, in January 2016, two spiculiform lung lesions are discovered in the upper right lobe, suspected of being tuberculosis lesions. The patient had undergone tuberculostatic treatment for 5 months, under which it was discovered that the lung lesions grew. After a PET-CT reassessment, which notices the increased metabolic activity of the lung lesions, a surgical treatment is decided - LASER assisted non-anatomic resection. The extemporaneous histopathological examination shows a carcinomatous infiltration for both lesions, but the parafin histopathological examination shows two different results: lung squamous carcinoma and lung metastasis of malignant melanoma - results confirmed by the immunohistochemical analysis. The dermatologic examination uncovered a melanomatous lesion in the nail bed in the second toe of the left foot, for which the resection of the intermediate and distal phalanges was performed. The histopathological examination confirms a Clark stage III malignant melanoma. Conclusions. We consider that the association of two synchronous cancers of colon with a metachronous lung cancer and an oligometastatic melanoma is rare, and has not been reported in literature according to our knowledge. Due to the increased risk of developing a second malignancy, patients with neoplasias require long-term follow-up, and the cases with multiple malignancies are subject to a customised multimodal treatment plan. [ABSTRACT FROM AUTHOR]

Nerve entrapment syndromes in the upper extremity represent a common occurrence, but in many cases these are not correctly diagnosed, leading to severe complications. Carpal tunnel syndrome is the most frequent compressive syndrome. The promptitude in establishing a correct diagnosis and initiating an adequate treatment is essential in reducing the morbidity associated with nerve compression in upper limb, improving the quality of life of the patient and also ensuring a faster socio-professional reinsertion. Nerve lesions demonstrate a variable evolution, with different recovery and prognosis. We developed a prospective clinical study with the aim to evaluate a series of patient characteristics that influence the disease evolution and may serve as predictive factors for treatment outcome in compressive neuropathies. Further manipulation of those parameters may direct our therapeutic strategies for obtain a maximal functional recovery, the supreme desiderate in peripheral nerves pathology. [ABSTRACT FROM AUTHOR]

Nerve entrapment syndromes in the upper extremity represent a common occurrence, but in many cases these are not correctly diagnosed, leading to severe complications. Carpal tunnel syndrome is the most frequent compressive syndrome. The promptitude in establishing a correct diagnosis and initiating an adequate treatment is essential in reducing the morbidity associated with nerve compression in upper limb, improving the quality of life of the patient and also ensuring a faster socio-professional reinsertion. Nerve lesions demonstrate a variable evolution, with different recovery and prognosis. We developed a prospective clinical study with the aim to evaluate a series of patient characteristics that influence the disease evolution and may serve as predictive factors for treatment outcome in compressive neuropathies. Further manipulation of those parameters may direct our therapeutic strategies for obtain a maximal functional recovery, the supreme desiderate in peripheral nerves pathology. [ABSTRACT FROM AUTHOR]

Tumor nerve compressions in the upper limb are relatively rare, usually involving ganglion cysts and benign tumors. We present a case series of five patients with peripheral nerve compression in the upper limb due to tumor or cystic masses- ulnar nerve compression in the Guyon’s tunnel due to a ganglion cyst, large median nerve schwannoma compressing anterior interosseous nerve and median nerve, voluminous lipoma compressing median nerve in the proximal forearm, superficial branch of radial nerve compression by a synovial cyst and elbow region lipoma compressing radial nerve. In the beginning, those benign lesions are asymptomatic but, as they continue to grow adjacent to a peripheral nerve clinical manifestations appear progressively as compressive neuropathies. After a preoperative imagistic analysis, tumor resection with careful dissection, in order to preserve the neurovascular structures, is the elective surgical procedure in order to obtain an optimal functional recovery. [ABSTRACT FROM AUTHOR]

Lymphedema represents a chronic condition with impaired lymphatic transport, having primary and secondary etiologies. The most common type of secondary lymphedema in western countries is represented by breast cancer related upper limb lymphedema. This condition, once installed, determines limb structure changes, progressive functional impairment, specific complications, consequently impacting the quality of patient’s life. An accurate diagnosis is mandatory, using both clinical and imagistic methods with clear definition disease extent as per standardized staging systems, in order to further provide an adequate therapeutic strategy. The main therapeutic goal in patients with lymphedema is represented by limb volume reduction with subsequent symptoms relief, improving quality of life and avoiding complications such as recurrent infections. Through this paper, we aim to present a comprehensive overview of current therapeutic options of breast cancer upper limb related lymphedema. Therapeutic approach comprises of non-surgical (conservative) therapy, which is mandatory as initial therapy and surgical procedures for selected cases. Most patients with lymphedema benefit from conservative treatment alone. In non-responsive cases, in patients with progressive disease, in late stage complicated lymphedema, and also recently added as prophylactic strategy, surgical treatment, trough recent developed techniques, offer very good results in long-term control of disease. Surgical options are classified firstly in physiologic procedures that aim to create new lymphatic channels, promote physiologic drainage of the lymph and should be considered early in the course of the disease, and secondly ablative procedures that reduce through liposuction or various excision techniques the volume of the affected limb. Both types of techniques can be combined to ensure the best functional outcome of the patient. [ABSTRACT FROM AUTHOR]

Upper limb trauma cases vary from simple to high energy impactful injuries, with different etiologies; situations which frequently require unique, demanding and challenging endeavors in order to obtain the most favorable outcome. Experience, good decision-making and knowledge of functional goals are mandatory in order to elaborate a therapeutic plan and execute it accordingly. Although cases differ in nature and prognosis, respecting a set of therapeutic principles whilst dealing with either simple or complex cases, will enhance patient outcome and give the surgeon the confidence to tackle any kind of upper limb trauma. After clearing out vital threat, the emergency surgery represents the first threshold in achieving and restoring normal function and biomechanics, mostly in young and labor active patients, with the mindset to salvage as much tissue as possible, with a thorough debridement and step-by-step approach to different types of tissues. Secondary surgery and reconstructive surgery can be planned timely, with prior discussion with both the therapist and the patient in order to enhance patient’s upper limb function and aesthetic and ensure social reintegration. [ABSTRACT FROM AUTHOR]

Burn injuries are unique in comparison to other types of trauma because of their severity and major systemic impact produced by extensive lesions with disfunctions that can persist even several years after the injury. Multiple complications can occur during burn injury evolution, from which infections are the most severe and the most frequently encountered, requiring adequate diagnosis and treatment. In most burn centers, increased mortality rates associate with severe burn injuries aggravated by the development of sepsis. There are multiple sources of infections in burned patients: lungs, wounds, catheters, gastrointestinal and urinary tract. Pathogens are often multi-resistant bacteria but also fungi and viruses appear as opportunistic infections. The main goal is represented by prevention of organ dysfunction development through specific supportive measures that avoid its onset. Early excision of the burn eschar and wound grafting is essential for patient outcome, decreasing duration of hospitalization, infectious risk and mortality. As a principle, antibiotic treatment in burn infectious complications is started empirically, with broad spectrum agents if the results of microbiological cultures are not available and immediately after the antibiogram is available, targeted antibiotic is introduced. De-escalation strategy is promoted in order to prevent antimicrobial resistance: narrow spectrum drugs with proven efficacy on determined germs are administered, avoiding if possible, reserve antibiotics. [ABSTRACT FROM AUTHOR]