Appropriate Delivery Timing in Fetuses with Fetal Growth Restriction to Reduce Neonatal Complications: A Case-Control Study in Romania

(1) Background: The main challenge in cases of early onset fetal growth restriction is management (i.e., timing of delivery), trying to determine the optimal balance between the opposing risks of stillbirth and prematurity. The aim of this study is to determine the likelihood of neonatal complications depending on the time of birth based on Doppler parameters in fetuses with early onset fetal growth restriction; (2) Methods: A case-control study of 205 consecutive pregnant women diagnosed with early onset FGR was conducted at the Obstetrics Clinic of the Municipal Emergency Hospital in Timisoara, Romania; The case group included newborns who were delivered at the onset of umbilical arteries absent/reversed end-diastolic flow, and the control included infants delivered at the onset of reversed/absent ductus venosus A-wave. (3) Results: The overall neonatal mortality rate was 2.0%, and there was no significant statistical difference between the two study groups. In infants delivered up to 30 gestational weeks, grades III/IV intraventricular hemorrhage and bronchopulmonary dysplasia were statistically significantly more frequent in the control group. Moreover, univariate binomial logistic regression analysis on fetuses born under 30 gestational weeks shows that those included in the control group are 30 times more likely to develop bronchopulmonary dysplasia and 14 times more likely to develop intraventricular hemorrhage grades III/IV; (4) Conclusions: Infants delivered according to the occurrence of umbilical arteries absent/reversed end-diastolic flow are less likely to develop intraventricular hemorrhage grades III/IV and bronchopulmonary dysplasia.

The Predictive Role of Maternal Biological Markers and Inflammatory Scores NLR, PLR, MLR, SII, and SIRI for the Risk of Preterm Delivery

In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation (both clinical and subclinical) plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 (p-value = 0.022). PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) (p-value = 0.015). Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.

Subclinical myocardial dysfunction in patients with persistent dyspnea one year after COVID-19

Introduction

Coronavirus disease 2019 (COVID-19) rapidly spread across the globe,evolving into a global pandemic,with a crucial impact on healthcare systems. Several short-term follow-up studies emphasized the persistence of symptoms, referred as long COVID, in a significant number of discharged patients even without history of cardiopulmonary diseases, with dyspnea being one of the most frequent complaint [1–3]. Even though those reports on recovered COVID-19 patients did not describe major left ventricle (LV) function abnormalities, subtle cardiac changes may be present.

Purpose

We aimed to investigate the presence of subclinical cardiac dysfunction, assessed by transthoracic echocardiography (TTE) in recovered COVID-19 patients, without previous cardiopulmonary disease at 1 year follow-up.

Methods

310 COVID-19 consecutive hospitalized patients were prospectively included between March and April 2020. 66 patients out of 251 recovered patients had no previous history of coronary artery disease, arrhythmia, arterial hypertension, valvular heart disease, asthma, chronic obstructive pulmonary disease and obstructive sleep apnea, respectively and were included in the final analysis (Figure 1). The follow-up consisted in 2 parts, a 6-months visit including clinical and physical examination, chest computed tomography and spirometry and a 12-months visit including clinical and physical examination, spirometry and TTE.

Results

66 patients (mean age 51.39±11.15 years, 45 (68.2%) males) were included in the final analysis. 23 (34.8%) patients reported dyspnea at 1 year. TTE parameters were in the normal range, with a mean LV ejection fraction of 56.9±4.6%, mean global longitudinal strain (GLS) of −20.9±2.3%, global constructive work (GCW) of 2381.4±463.6 mmHg% and global work index (GWI) of 2132.5±419.2 mmHg%. Type 1 diastolic dysfunction was observed in 11 (16.7%) patients. One (1.5%) patient had type 2 diastolic dysfunction. A normal respiratory pattern was reported in 31 (47%) patients at 6 months spirometry, while 19 (28.8%) patients had a restriction pattern. No significant differences regarding clinical, laboratory or imaging findings at baseline were found between groups.

The following TTE parameters were significantly different in patients with and without dyspnea at 1 year: GLS (−19.97±2.14 vs. −21.38±2.37, p=0.039), GCW (2183.72±487.93 vs. 2483.14±422.42, p=0.024) and GWI (1960.06±396.21 vs. 2221.17±407.99, p=0.030). Multivariable logistic regression showed that GCW and GWI were inversely and independently associated with persistent dyspnea, one year after COVID-19 (p=0.035, OR 0.998, 95% CI 0.997–1.000; p=0.040, OR 0.998, 95% CI 0.997–1.000) (Table 1).

Conclusions

Persistent dyspnea one year after COVID-19 was present in more than a third of patients without known cardiovascular or pulmonary diseases. GCW and GWI were the only echocardiographic parameters independently associated with symptoms, suggesting a decrease in myocardial performance in this population and subclinical cardiac dysfunction.

Funding Acknowledgement

Type of funding sources: None.

Additional value of left atrium remodeling assessed by three-dimensional echocardiography for the prediction of atrial fibrillation recurrence after cryoballoon ablation

Background

Atrial fibrillation (AF) is the most common cardiac arrhythmia and it is associated with a high risk of cardiovascular complications [1]. Cryoballoon ablation (CBA) has emerged as a safe and efficient therapeutic option for AF [2]. However, AF recurrence occurs in more than 25% of the patients, which leads to repeated ablations and increased rates of complications and hospitalizations [3]. Previous reports on the role of left atrial (LA) diameter and LA volume assessed by two-dimensional echocardiography (2DE) as predictors of AF recurrence after ablation have shown controversial results [4,5]. This might be explained by the fact that these methods imply geometrical assumptions of the LA remodeling, which is a three-dimensional process [6].

Purpose

The purpose of this study was to evaluate the additional value of LA remodeling assessed by three-dimensional echocardiography (3DE) to predict AF recurrence after CBA.

Methods

Consecutive patients with paroxysmal/persistent AF undergoing CBA were prospectively included. Echocardiography was performed before CBA, according to standard recommendations. Blanking period was defined as the first three months post-ablation. The primary endpoint was AF recurrence after the blanking period.

Results

One hundred seventy two patients (62.2±12.2 years, 61% male) were included in the analysis. During the follow-up period of 11.7±1.6 months, fifty (29%) patients had AF recurrence after the blanking period. 3DE LA maximum volume index (LAVI) had the highest incremental predictive value for AF recurrence (HR 5.50, 95% CI 1.34–22.45, p<0.001) (Figure 1). Twenty-two percent of the AF recurrences occurred in patients with non-dilated LA diameter index and LAVI by 2DE (68 (39.5% patients)). In this category of patients, LAVI by 3DE was able to discriminate AF recurrence with a sensitivity of 90% and a specificity of 66%, for an optimal cut-off value of 30.4 ml/m2.

Conclusion

This study showed that LAVI assessed using 3DE had an additional predictive value for AF recurrence after CBA. Moreover, LAVI by 3DE was able to discriminate AF recurrence even in patients with non-dilated LA by M-Mode and 2DE. These findings suggest that 3DE might reflect better and earlier the asymmetric and variable nature of LA remodeling and could be a potential tool in clinical practice for an improved risk stratification and pre-ablation selection of AF patients.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Universitair Ziekenhuis Brussel: Wetenschappelijk Fonds Willy Gepts of the UZ Brussel

Prognostic value of left ventricle global constructive work in patients with cardiac amyloidosis

Background

Left ventricle (LV) global longitudinal strain (LVGLS) has demonstrated incremental diagnostic and prognostic value in patients with cardiac amyloidosis (CA), however it is sensitive to loading conditions (1). Therefore, myocardial work (MW) analysis emerged as a novel echocardiographic method that incorporates both GLS and afterload for a better assessment of LV performance in several pathologies (2). Nevertheless, data regarding its additional value in patients with CA remains limited.

Purpose

We aimed to evaluate the additional prognostic value of global constructive work (GCW), assessed using MW analysis, in patients with CA.

Method

Seventy-one unselected CA patients were included retrospectively between 2015 and 2021. Patients underwent comprehensive clinical, biochemical and imaging evaluation including two-dimentional (2D) echocardiography with MW analysis. The primary endpoint was defined as all-cause mortality and heart failure requiring hospitalization.

Results

The population (mean age 76,76±11.52 years, 73.2% males) consisted of 53 (74.6%) patients with transthyretin (ATTR), 14 (19.7%) patients with light-chain (AL), and 4 (5.6%) patients with unknown phenotype of CA. The primary endpoint was reached in 37 (52.1%) patients. Patient with the primary endpoint had a significantly lower LV ejection fraction (LVEF) (40.54% vs. 49.31%, p=0.003), LVGLS (−9.26% vs. −11.32%, p=0.017) and GCW (1034.47mmHg% vs. 1424.86 mmHg%, p=0.005) than those without. No significant clinical differences were found between the two groups. Multivariable analysis (Figure 1) showed that LVEF (p=0.003; odds ratio (OR): 0.881; 95% confidence interval (CI): 0.810–0.959), LVGLS (p=0.021; OR: 0.688; 95% CI: 0.502–0.944) and GCW (p=0.016; OR: 0.995; 95% CI: 0.991–0.999) were independent predictors for the primary outcome. The model including GCW had the best discriminative ability to predict the primary endpoint (C-index = 0.900; 95% CI: 0.781–1.000, p=0.001). A GCW less than 1443mmHg% was able to predict the primary endpoint with a sensitivity of 94.1% and a specificity of 64.3% (Figure 2; area under the curve (AUC): 0.771 (95% CI: 0.581–0.961; p=0.005).

Conclusion

In patients with CA, a decrease in GCW as a reflection of an impaired systolic performance of the LV was independently associated with an increase in heart failure hospitalization and all-cause mortality. Further prospective studies are warranted in order to confirm the potential role of GCW to improve the prognosis of CA patients.

Funding Acknowledgement

Type of funding sources: None.

The impact of long COVID on myocardial work performance

Background

Long COVID emerged as a new condition, following the acute episode of coronavirus disease 2019 (COVID-19),exerting a significant impact on patients' quality of life [1]. Several studies involving COVID-19 survivors emphasized the presence of cardiac abnormalities following the acute infection. However, data on possible mechanisms associated to long COVID remain limited. Clinical applications of myocardial work (MW) analysis, assessed by transthoracic echocardiography (TTE) have expended recently, showing an additional value in detecting cardiac dysfunction compared to standard parameters such as left ventricle ejection fraction (LVEF) or global longitudinal strain (GLS) in various pathologies, including COVID-19 [2]. Nevertheless, its potential role in detecting subclinical cardiac dysfunction in long COVID remained unexplored.

Purpose

We assessed the association between subclinical cardiac dysfunction evaluated by global work index (GWI) and global constructive work (GCW) and long COVID.

Methods

We included 310 COVID-19 patients hospitalized between March and April 2020. All patients were invited to a systematic one-year follow-up, including clinical evaluation, TTE with MW assessment, chest-computed tomography and spirometry. 140 patients completed the follow-up. Normal values for GWI and GCW were defined as 1926±247 mmHg% and 2224±229 mmHg% [3]. The primary endpoint was long COVID, characterized by a cluster of symptoms such as fatigue or dyspnea more than 3 months after the acute infection, without any other explanation.

Results

140 patients (57.1±13.9 years, 90 (64.3%) males) had a mean follow-up of 337.1±34.5 days.The mean values of LVEF, GWI and GCW were 55.2±3.2%, 2105.9±403.3 mmHg% and 2377.8±446.2 mmHg%. 83 (61%) patients had long COVID. No significant differences in terms of comorbidities, clinical evaluation and COVID-19 severity were found between patients with and without long COVID. GCW (2276.7±410.3 vs 2516.5±458.6, p=0.006) and GWI (2008.5±358.9 vs 2242.2±427.0, p=0.003) were the only TTE parameters different between patients with and without long COVID. Multivariable regression analysis showed that GWI <1926 mmHg% (OR 6.095; CI: 2.024–18.355, p=0.001) and GCW <2224 mmHg% (OR 3.205; CI: 1.181–8.694, p=0.022) were the only MW parameters independently associated with long COVID, irrespective of age or the severity of the acute infection, at one year. In a subgroup analysis of 77 patients without previous cardiovascular diseases, long COVID was diagnosed in 45 (58.4%)patients. GWI <1926 mmHg% (OR 8.015; CI: 2.149–29.887, p=0.002) remained independently associated with long COVID at 1 year follow-up.

Conclusions

Long COVID, frequently observed in recovered COVID-19 patients may indicate the presence of subclinical cardiac dysfunction, reflected by a decrease of the left ventricle performance, assessed by GWI and GCW.Long-term follow-up including cardiac screening should be performed in order to identify patients at risk who would benefit from cardiac rehabilitation programs.

Funding Acknowledgement

Type of funding sources: None.

Clinical features and management of trophoblastic epithelioid tumors: A systematic review

BACKGROUND

This study aimed to systematically review the existing literature on epithelioid trophoblastic tumors (ETTs), the rarest type of gestational trophoblastic neoplasia.

METHODS

A systematic review according to PRISMA guidelines was performed, using ScienceDirect, Web of Science, and Scopus databases. The only filter used was the English language. Eligibility/inclusion criteria: retrospective observational studies (case reports, case series) including full case description of epithelioid trophoblastic tumor lesions.

RESULTS

Seventy studies were assessed for synthesis, including 147 cases. 66.7% of patients with ETT presented with irregular vaginal bleeding. Pretreatment β-hCG levels ranged up to 1000 mIU/mL in 58.5% patients. Of most patients, 42.2% had stage I disease, 10.9% stage II, 25.2% stage III, and 21.8% of patients had stage IV. The most common sites of metastatic disease were the lungs, followed by the liver and brain. After treatment, complete remission was achieved in 75.5% of patients, partial remission in 10.2% of patients, and 14.3% of patients died. On univariate and multivariate analyses, stage IV disease was an independent prognostic factor for overall and disease-free survival.

CONCLUSIONS

Hysterectomy and metastatic lesion resection are essential for controlling ETT. Investigational studies on molecules like EGFR, VEGF, PD-1, CD105, and LPCAT1 are potential therapeutic targets for metastatic ETT.

New Insights in the Diagnosis of Rare Adenocarcinoma Variants of the Cervix—Case Report and Review of Literature

We report the case of a 29-year-old patient with low-grade squamous intraepithelial lesion (L-SIL), negative human papilloma virus (HPV), positive p16/Ki-67 dual-staining and colposcopy suggestive for severe dysplastic lesion. The patient underwent a loop electrosurgical excision procedure (LEEP), the pathology report revealing mesonephric hyperplasia and adenocarcinoma. The patient also opted for non-standard fertility-sparing treatment. The trachelectomy pathology report described a zone of hyperplasia at the limit of resection towards the uterine isthmus. Two supplementary interpretations of the slides and immunohistochemistry (IHC) were performed. The results supported the diagnosis of mesonephric adenocarcinoma, although with difficulty in differentiating it from mesonephric hyperplasia. Given the discordant pathology results that were inconclusive in establishing a precise diagnosis of the lesion and the state of the limits of resection, the patient was referred to a specialist abroad. Furthermore, the additional interpretation of the slides and IHC were performed, the results suggesting a clear cell carcinoma. The positive p16/Ki-67 dual-staining prior to LEEP, the non-specific IHC and the difficulties in establishing a diagnosis made the case interesting. Given the limitations of cytology and the fact that these variants are independent of HPV infection, dual staining p16/Ki-67 could potentially become useful in the diagnosis of rare adenocarcinoma variants of the cervix, however further documentation is required.

Predictive Value of SOFA and qSOFA for In-Hospital Mortality in COVID-19 Patients: A Single-Center Study in Romania

Two years after the outbreak of the COVID-19 pandemic, the disease continues to claim victims worldwide. Assessing the disease’s severity on admission may be useful in reducing mortality among patients with COVID-19. The present study was designed to assess the prognostic value of SOFA and qSOFA scoring systems for in-hospital mortality among patients with COVID-19. The study included 133 patients with COVID-19 proven by reverse transcriptase polymerase chain reaction (RT-PCR) admitted to the Municipal Emergency Clinical Hospital of Timisoara, Romania between 1 October 2020 and 15 March 2021. Data on clinical features and laboratory findings on admission were collected from electronic medical records and used to compute SOFA and qSOFA. Mean SOFA and qSOFA values were higher in the non-survivor group compared to survivors (3.5 vs. 1 for SOFA and 2 vs. 1 for qSOFA, respectively). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were performed to determine the discrimination accuracy, both risk scores being excellent predictors of in-hospital mortality, with ROC–AUC values of 0.800 for SOFA and 0.794 for qSOFA. The regression analysis showed that for every one-point increase in SOFA score, mortality risk increased by 1.82 and for every one-point increase in qSOFA score, mortality risk increased by 5.23. In addition, patients with SOFA and qSOFA above the cut-off values have an increased risk of mortality with ORs of 7.46 and 11.3, respectively. In conclusion, SOFA and qSOFA are excellent predictors of in-hospital mortality among COVID-19 patients. These scores determined at admission could help physicians identify those patients at high risk of severe COVID-19.

Predictive Value of Blood Coagulation Parameters in Poor Outcomes in COVID-19 Patients: A Retrospective Observational Study in Romania

SARS-CoV-2 infection produces alterations in blood clotting, especially in severe cases of COVID-19. Abnormal coagulation parameters in patients with COVID-19 are important prognostic factors of disease severity. The objective of this study was to evaluate the predictive value of aPTT, D-dimer, INR and PT in the mortality of patients with COVID-19. A retrospective, single-center, observational study was conducted on COVID-19 patients admitted to the Municipal Emergency Clinical Hospital in Timisoara, Romania, between August and October 2021. Patients were confirmed as COVID-19 positive by reverse transcription-polymerase chain reaction (RT-PCR) assay. After applying the inclusion/exclusion criteria, a total of 82 patients were included in the analysis. Receiver operating characteristic (ROC) curves of D-Dimer, INR, PT and aPTT were generated to assess whether the baseline of each of these biomarkers was accurately predictive for mortality in patients with COVID-19. Mortality among patients enrolled in this study was 20.7%, associated with older age and presence of heart disease. The areas under the ROC curve (AUC-ROC) of D-Dimer, INR, PT, and aPTT were 0.751, 0.724, 0.706 and 0.753. Differences in survival for patients with coagulation biomarker levels above cut-off values compared to patients below these values were statistically significant. All evaluated parameters had significant differences and good performance in predicting mortality of COVID-19 patients, except fibrinogen, which had no significant difference. Moreover, aPTT and D-dimer were the best performing parameters in predicting mortality in patients with SARS-CoV-2 infection.

Calcium, Magnesium, and Zinc Supplementation during Pregnancy: The Additive Value of Micronutrients on Maternal Immune Response after SARS-CoV-2 Infection

Magnesium may contribute to the immune response during and after SARS-CoV-2 infection by acting as a cofactor for immunoglobulin production and other processes required for T and B cell activity. Considering magnesium as a recommended dietary supplement during pregnancy and the possible role of magnesium deficiency in COVID-19 and its complications, the current study sought to determine the effect of magnesium and magnesium-containing nutritional supplements on the immune response following SARS-CoV-2 infection in pregnant women, as well as to observe differences in pregnancy outcomes based on the supplements taken during pregnancy. The study followed a cross-sectional design, where patients with a history of SARS-CoV-2 infection during their pregnancy were surveyed for their preferences in nutritional supplementation and their profile compared with existing records from the institutional database. A cohort of 448 pregnant women with COVID-19 during 22 months of the pandemic was assembled, out of which 13.6% took a magnesium-only supplement, and 16.5% supplemented their diet with a combination of calcium, magnesium, and zinc. Around 60% of patients in the no-supplementation group had the SARS-CoV-2 anti-RBD lower than 500 U/mL, compared with 50% in those who took magnesium-based supplements. A quantity of magnesium >450 mg in the taken supplements determined higher levels of antibody titers after COVID-19. Low magnesium dosage (<450 mg) was an independent risk factor for a weak immune response (OR-1.25, p-value = 0.003). The observed findings suggest supplementing the nutritional intake of pregnant women with magnesium-based supplements to determine higher levels of SARS-CoV-2 anti-RBD antibodies, although causality remains unclear.

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

During the COVID-19 pandemic, it was observed that patients with heart disease are more likely to be hospitalized and develop severe COVID-19. Cardiac disease takes the top position among patient comorbidities, heart failure (HF) prevalence reaching almost 5% in the general population older than 35 years in Romania. This retrospective study aimed to determine the potential use of the NYHA classification for HF in hospitalized patients with COVID-19 as prognostic tool for in-hospital mortality, length of hospitalization, and probability of rehospitalization for HF decompensation. We observed that patients with advanced HF had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as NYHA I and II. However, regardless of existing diseases, NYHA III, and, especially, NYHA IV, patients were at greatest risk for mortality following SARS-CoV-2 infection. They required significantly longer durations of hospitalization, ICU admission for mechanical ventilation, and developed multiple severe complications. NYHA IV patients required a median duration of 20 days of hospitalization, and their in-hospital mortality was as high as 47.8%. Cardiac biomarkers were significantly altered in patients with SARS-CoV-2 and advanced HF. Although the study sample was small, all patients with NYHA IV who recovered from COVID-19 required a rehospitalization in the following month, and 65.2% of the patients at initial presentation died during the next six months. The most significant risk factor for mortality was the development of severe in-hospital complications (OR = 4.38), while ICU admission was the strongest predictor for rehospitalization (OR = 5.19). Our result highlights that HF patients continue to be vulnerable post SARS-CoV-2 infection. Physicians and policymakers should consider this population’s high likelihood of hospital readmissions when making discharge, hospital capacity planning, and post-discharge patient monitoring choices.

Determinants of COVID-19 Vaccination Hesitancy among Romanian Pregnant Women

Universal COVID-19 immunization is seen as a critical approach for limiting the spread of SARS-CoV-2 and reducing the danger of new variations emerging in the general population, especially in pregnant women. The literature and accessible research data indicate that vaccination intentions vary greatly by country, with Romania ranking among the European nations with the lowest vaccination rates. Thus, we aimed to investigate the prevalence and extent of COVID-19 vaccine hesitancy among pregnant women in Romania and the factors influencing their decision. A cross-sectional study was conducted on pregnant women referred to the Obstetrics and Gynecology Clinic of the Timisoara Municipal Emergency Hospital in Romania. Participants were asked to complete the validated VAX scale about vaccine hesitancy and to report their willingness to receive a COVID-19 vaccine and their reasons for hesitancy. The group of 184 pregnant women who completed the survey recorded significantly more hesitant respondents than the non-pregnant group with 161 respondents (52.2% vs. 40.3%). They had significantly higher average scores in all VAX scale subsections, while 78.1% of them gave credits to social media for their COVID-19 vaccination decision, compared with 63.0% of non-pregnant women. The independent risk factors for hesitancy were determined as not being afraid of COVID-19 OR = 1.89, below-average income OR = 2.06, trusting social media rumors OR = 2.38, not believing in SARS-CoV-2 existence OR = 2.67, and being a vaccination non-believer OR = 3.15. We advocate for pregnant women to get vaccinated against COVID-19 and for the development of targeted campaigns to address the factors of hesitation. This research emphasizes the critical need for delivering the COVID-19 immunization to the whole community, including pregnant women who may have vaccine-related concerns.

Role of Dual-Staining p16/Ki-67 in the Management of Patients under 30 Years with ASC-US/L-SIL

Patients diagnosed with low-grade squamous intraepithelial lesion ((L-SIL) or atypical squamous cells of undetermined significance (ASC-US) are subjected to additional investigations, such as colposcopy and biopsy, to rule out cervical intraepithelial neoplasia 2+ (CIN 2+). Especially in young patients, lesions tend to regress spontaneously, and many human papilloma virus (HPV) infections are transient. Dual-staining p16/Ki-67 has been proposed for the triage of patients with ASC-US or L-SIL, but no prospective study addressing only this subgroup of patients has been conducted so far. We performed a prospective study including all eligible patients referred for a loop electrosurgical excision procedure (LEEP) in the Department of Obstetrics and Gynecology of Timișoara University City Hospital. HPV genotyping and dual-staining for p16/Ki-67 were performed prior to LEEP, at 6 and 12 months after LEEP. A total of 60 patients were included in the study and completed the follow-up evaluation. We analyzed the sensitivity and specificity for biopsy-confirmed CIN2+ using the 95% confidence interval (CI) of high-risk human papilloma virus (HR-HPV), dual-staining p16/Ki-67, colposcopy, and combinations of the tests on all patients and separately for the ASC-US and L-SIL groups. Dual-staining p16/Ki-67 alone or in combination with HR-HPV and/or colposcopy showed a higher specificity that HR-HPV and/or colposcopy for the diagnosis of biopsy confirmed CIN2+ in patients under 30 years. Colposcopy + p16/Ki-67 and HR-HPV + colposcopy + p16/Ki-67 showed the highest specificity in our study.

Prognostic value of coronary artery calcium score in hospitalized COVID - 19 patients

Funding Acknowledgements

Type of funding sources: None.

Background

The association of known cardiovascular risk factors with poor prognosis of coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2). 

Purpose

We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients.

Methods

We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded. Low dose non - contrast chest computed tomography (CT) was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1-3 (mild), 4-5 (moderate) and ≥ 6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in-hospital treatment, and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all - cause mortality, heart failure, acute coronary syndrome, atrial fibrillation and stroke.

Results

Two hundred eighty patients (63.2 ± 16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of 0. MACE rate was 21.8% (61 patients). Multivariable logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.209, 95% CI 0.052–0.833, p = 0.027), with a negative predictive value of 84.5% (sensitivity 72%, specificity 55%), independent of age, risk factors or disease severity (Figure 2).

Conclusion

The absence of CAC had a high negative predictive value for MACE in patients hospitalized with COVID-19, independent of the presence of cardiac risk factors or disease severity. These findings reinforce the idea that the assessment of CAC could be a useful marker for risk stratification and management of COVID - 19 patients. Future directions should focus on the implementation of CAC score into mid - term and long - term follow - up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk. Abstract Figure.  Abstract Figure.

Heavy metal ion concentration in the amniotic fluid of preterm and term pregnancies from two cities with different industrial output

The growth and development of the fetus is a complex phenomenon that can be influenced by several variables. High quantities of heavy metal ions in the amniotic fluid have been linked to poor health, especially in industrial, polluted and poor areas. The aim of the present study was to assess the differences in the concentration of these ions between preterm (weeks 15-37) and term pregnancies (starting at week 37). Another objective was to compare pregnancies from two cities with different industry levels. Two sample lots from two Romanian cities were analyzed. A total of 100 patients from Timisoara were compared with 60 from Petrosani, a heavy industry city in Romania. Demographic data were collected, and amniocentesis was performed on all women. Lead (Pb), copper (Cu), nickel (Ni), cadmium (Cd), arsenic (As), iron (Fe) and zinc (Zn) concentrations were assessed. Descriptive and analytical statistics were performed using the Mann-Whitney U test for non-parametric data and the Fisher's exact test for categorical data. In addition, categorical data was represented graphically. In the Timisoara cohort, the differences in heavy metal concentrations between preterm and term pregnancies were not statistically significant. In the Petrosani cohort, however, the concentrations of Zn (P=0.02606) and Cd (P=0.01512) were higher in preterm than in term pregnancies. When comparing the two cohorts as a whole, the concentration of Pb (P=0.04513), Cd (P=0.00002), As (P=0.03027) and Zn (P<0.00001) were higher in the patients from Petrosani than in those from Timisoara. Only Cu concentrations were higher in the Timisoara cohort (P<0.00001). The concentrations of Ni (P=0.78150) and Fe (P=0.44540) did not differ statistically. Thus, amniocentesis is an important diagnostic and exploratory tool in determining differences in the concentrations of elements such as heavy metal ions. Research over a longer period of time should be carried out to examine the relation between heavy metal ions concentration and possible postnatal health outcomes.

Prognostic value of coronary artery calcium score in hospitalized COVID-19 patients

Background

The association between known cardiovascular risk factors and poor prognosis of patients diagnosed with coronavirus disease 2019 (COVID-19) has been recently emphasized (1). Coronary artery calcium (CAC) score assessed by computed tomography (CT) is considered a risk modifier in primary prevention of cardiovascular disease and has shown to improve cardiovascular risk prediction in addition to classical risk factors (2).

Purpose

We hypothesized that the absence of CAC might have an additional predictive value for an improved cardiovascular outcome of hospitalized COVID-19 patients.

Methods

We prospectively included 310 consecutive hospitalized patients with COVID-19. Thirty patients with a history of coronary artery disease were excluded.Low dose non-contrast chest CT was performed in all patients at admission. Visual assessment of CAC in every coronary artery was obtained by using an ordinal scoring of 0, 1, 2 or 3 corresponding to absent, mild, moderate or severe CAC score. A total score was calculated by summing the score of each vessel, which was further categorized as 0 (undetectable), 1–3 (mild), 4–5 (moderate) and ≥6 (severe). (Figure 1). Demographics, medical history, clinical characteristics, laboratory findings, imaging data, in–hospital treatment and outcomes were retrospectively analyzed. A composite endpoint of major adverse cardiovascular events (MACE) was defined as all-cause mortality and cardiovascular events (heart failure, myocarditis, arrhythmia, acute coronary syndrome, stroke, pulmonary embolism).

Results

Two-hundred eighty patients (63.2±16.7 years old, 57.5% male) were included in the analysis. One hundred thirty one (46.7%) patients had a CAC score of zero. MACE-rate was 24.2% (68 patients). Multivariate logistic regression showed that the absence of CAC was inversely associated with MACE (OR 0.264, 95% 0.071–0.981, p=0.047), with a negative predictive value (NPV) of 81.4%, sensitivity 70%, specificity 55%, independent of age, risk factors or disease severity (Table 1).

Conclusion

The absence of CAC translated into a low risk for MACE in COVID-19 patients, even in the presence of cardiac risk factors, which reinforces the idea that the assessment of CAC score in COVID-19 patients could be a useful marker for patients risk stratification and management. Future directions should focus on the implementation of CAC score into mid-term and long-term follow-up of this particular population, to provide a more precise and earlier estimation of cardiovascular risk

Funding Acknowledgement

Type of funding sources: None. Figure 1Table 1

Elastofibroma Dorsi, a Rare Condition, with Challenging Diagnosis. Case Report and Literature Review

Elastofibroma dorsi (ED) is known as a particular clinical and biological entity. We report a case of a bilateral elastofibroma dorsi (ED) in a 65-year-old female who presented to the Department of General and Oncologic Surgery of Emergency Clinical Municipal Hospital Timisoara, Romania. The patient was symptomatic on the right side, presenting pain in the interscapulothoracic region associated with a variable tumoral mass, dependent on the position of the right arm. Imaging studies revealed a well-defined, bilateral tumoral mass with alternation of the muscular and fatty tissue. The initial diagnosis of lipoma was taken into consideration based on the CT scan and clinical findings. Surgical excision of the right subscapular tumor was performed without any postoperative complications. Microscopic examination of hematoxylin and eosin, Masson’s trichrome, and orcein stained slides revealed the diagnosis of ED. Considering the high rate of reported postoperative complications and the asymptomatic presentation of the contralateral subscapular mass, the patient underwent clinical and imagistic monitoring for the contralateral tumor. Due to its rare nature, ED is a difficult preoperative diagnosis that can, however, be suggested by its specific location and may require an accurate histopathological examination for a final diagnosis.

Long noncoding RNAs may impact podocytes and proximal tubule function through modulating miRNAs expression in Early Diabetic Kidney Disease of Type 2 Diabetes Mellitus patients

Aims: Long noncoding RNAs (lncRNAs) play key roles in the pathophysiology of DKD involving actions of microRNAs (miRNAs). The aims of the study were to establish the involvement of selected lncRNAs in the epigenetic mechanisms of podocyte damage and tubular injury in DKD of type 2 diabetes mellitus (DM) patients in relation to a particular miRNAs profile. Methods: A total of 136 patients with type 2 DM and 25 healthy subjects were assessed in a cross-sectional study concerning urinary albumin: creatinine ratio (UACR), eGFR, biomarkers of podocyte damage (synaptopodin, podocalyxin) and of proximal tubule (PT) dysfunction (Kidney injury molecule-1-KIM-1, N-acetyl-D-glucosaminidase-NAG), urinary lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1), nuclear-enriched abundant transcript 1 (NEAT1), myocardial infarction-associated transcript (MIAT), taurine-upregulated gene 1 (TUG1), urinary miRNA21, 124, 93, 29a. Results: Multivariable regression analysis showed that urinary lncMALAT1 correlated directly with urinary synaptopodin, podocalyxin, KIM-1, NAG, miRNA21, 124, UACR, and negatively with eGFR, miRNA93, 29a (p<0.0001; R2=0.727); urinary lncNEAT1 correlated directly with synaptopodin, KIM-1, NAG, miRNA21, 124, and negatively with eGFR, miRNA93, 29a (p<0.0001; R2=0.702); urinary lncMIAT correlated directly with miRNA93 and 29a, eGFR (p<0.0001; R2=0.671) and negatively with synaptopodin, KIM-1, NAG, UACR, miRNA21, 124 (p<0.0001; R2=0.654); urinary lncTUG1 correlated directly with eGFR, miRNA93, 29a, and negatively with synaptopodin, podocalyxin, NAG, miRNA21, 124 (p<0.0001; R2=0.748). Conclusions: In patients with type 2 DM lncRNAs exert either deleterious or protective functions within glomeruli and PT. LncRNAs may contribute to DKD through modulating miRNAs expression and activities. This observation holds true independently of albuminuria and DKD stage.

Long-term evolution of echocardiography parameters in Brugada syndrome patients

Funding Acknowledgements

Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ESC Research Grant

Background

Brugada syndrome is a heritable disorder with a high risk of sudden death. Although being a primary electrical disorder, subtle structural changes have repeatedly been described. Little is known about the long-term structural evolution in Brugada syndrome.

Purpose

We aimed to assess the evolution of echocardiographic parameters in Brugada syndrome and the presence of markers of structural evolution.

Methods

Brugada syndrome patients with minimum two complete transthoracic echocardiographic examinations were included. Clinical data were collected retrospectively. We analyzed all available echocardiographic examinations and assessed the evolution of cardiac parameters over time and its association with patient characteristics. 

Results

The study included 113 Brugada syndrome patients [47 (33-55) years, 59 (52%) female, spontaneous type 1 ECG in 26 (23%)], with a total of 258 echocardiographies, collected over a period of 6.8 (6.6-7.1) years. Proximal and distal right ventricular outflow tract and basal right ventricular diameter dilated at a rate of 0.2 (0.1-0.3) mm/year (p = 0.004), 0.4 (0.3-0.5) mm/year (p &lt; 0.001) and 0.6 (0.4-0.8) mm/year (p &lt; 0.001) respectively (Figure). Left ventricular mechanical dispersion increased from 38 (±11) ms to 42 (±12) ms (p = 0.001). Neither male sex, nor presenting a spontaneous type 1 ECG pattern were associated with worse structural evolution.

Conclusion

We observed progressive right ventricular outflow tract and basal right ventricle dilation and an increasing contractile dyssynchrony in Brugada syndrome, potentially indicating a progressive structural affection. Further research is warranted to unravel underlying mechanisms and possible clinical implications of progressive structural changes in Brugada syndrome.

Abstract Figure.

The sagittal grooves of the middle nasal turbinate determine paradoxical curvatures and bifidities

Background

Paradoxical curvature of the middle nasal turbinate (MT) is a common anatomic variant, usually found and reported on coronal CT slices. However, less attention has been paid to the sagittal groove (SG) which is determining it.

Aim

The study aimed to determine paradoxical curvatures and bifidities in the sagittal groves of middle nasal turbinate.

Material and Method

A retrospective CBCT study on the archived files of 52 adult patients was performed.

Results

Different patterns of MT bifidity were found: (1) unilateral bifid MTs; (2) bifid and trifid MTs and "wandering" single SGs; (3) bilateral bifid middle turbinates and double SGs, (4) bilateral false bifid appearance due to middle and superior turbinates fusion and (5) bifid concha bullosa media. Digital "dissections" of patients' files allowed us to conclude that paradoxical curvature as well as bifidity of MTs relate to the placement and number of the SGs on the MTs. Such SGs were previously documented in prenatal MTs since the 14th week, as well as in pædiatric patients.

Conclusions

It seems reasonable to speculate that paradoxical curvature, as well as bifidity of MT, this later being previously undocumented, are just adult vestiges of the primitive MT morphology. Nevertheless, documentation of the MT morphology should not rely exclusively on coronal CTs, as combined morphologies of that turbinate could occur.

Green and Synthetic Metallic Nanoparticles - Obtaining, Characterization and Biological Evaluation in Association with Lupeol

The field of metal nanotechnology continues to draw the attention of researchers from different areas due to the outstanding properties of nanoparticles. The main aims of this research were to obtain and to study two types of gold nanoparticles; different obtaining pathways (the chemical synthesis and the biosynthesis based on an aqueous extract of lemon balm) were involved in this research. The chemically synthesized nanoparticles were loaded with lupeol. After a preliminary physico-chemical characterization, the compounds obtained were tested in order to evaluate the effects on the viability of colon cancer cells. The formulation of these new gold nanoparticles with average size between 38 and 82 nm, with a good stability against the tendency to form agglomerations according to the Zeta potential values, was confirmed by UV-Vis spectra; the particles containing lupeol have show the best activity against the colon cancer cells.

P1275 In-hospital outcome of patients with infective endocarditis: is echocardiography enough?

Background

Despite improvements in medical and surgical therapy, infective endocarditis (IE) remains a deadly disease. Echocardiography is the first-line diagnostic tool. However, data regarding its role in the prognostic assessment of in-hospital clinical outcome of IE are scarce.

Purpose

We sought to assess the role of echocardiography to predict the in-hospital outcome in a large cohort of patients diagnosed with definite IE and its association with clinical presentation and microorganisms.

Methods

We retrospectively included patients from two centers between 2006 and 2018. Transthoracic and transesophageal echocardiography were performed in all patients. The clinical endpoints were in-hospital death, embolic events (cerebrovascular and non-cerebrovascular), shock (septic shock and cardiogenic shock) and cardiac surgery.

Results

183 patients with definite IE (age 68.9 ± 14.2 years old, 68.9% male) were evaluated. Ninety three (50.8%) patients had aortic valve IE and 81 (44.3%) patients presented with mitral valve IE. Twenty three patients had multivalvular IE. The in-hospital mortality rate was 22.4%. Sixty patients (32.8%) had embolic events and 42 (23%) patients developed shock during hospitalization. Surgery was performed in 103 (56.3%) patients. Mitral valve IE on echocardiography was an independent predictor of in-hospital mortality (p = 0.038, OR 0.38, 95% CI 0.15 – 0.94) and aortic valve IE on echocardiography was an independent predictor of embolic events (p = 0.018, OR 0.36, 95% 0.16-0.84). The presence of a new cardiac murmur upon admission was predictive for the need of cardiac surgery (p = 0.042, OR 0.51, 95% CI 0.22- 1.09) and correlated with the severity of valvular regurgitation identified by echocardiography (p = 0.024). Methicillin resistant Staphylococcus aureus (MRSA) as the causative microorganism was an independent predictor for in - hospital mortality and for the development of shock during hospitalization (p = 0.010, OR 0.13 95% CI 0.30 - 0.62 and p = 0.027, OR 6.11, 95% CI 1.22 – 30.37, respectively). No correlation was found between MRSA and echocardiographic parameters.

Conclusion

Mitral valve IE was an independent predictor of in - hospital mortality. Furthermore, aortic valve IE was an independent predictor of embolic events. The presence of a new cardiac murmur was predictive for the need of cardiac surgery and correlated with the severity of valvular regurgitation by echocardiography. Our findings suggest that a thorough physical examination upon admission is required in combination with a comprehensive echocardiographic exam for early identification of patients with IE at high - risk for in-hospital death and complications.

P4661Increased levels of sST2 in patients with mitral annulus disjunction and ventricular arrhythmias

Background

Mitral annulus disjunction (MAD), a basal displacement of the mitral valve annulus, is described as a possible aetiology of sudden cardiac death. Stretch-induced fibrosis in the sub-valvular apparatus has been suggested as the substrate of arrhythmias.

Purpose

We hypothesized that the stretch related biomarker soluble Suppression of Tumorigenicity-2 (sST2) is a marker of ventricular arrhythmias in patients with MAD.

Methods

We included patients with ≥1 mm MAD on cardiac magnetic resonance imaging, and recorded left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE) suggesting papillary muscle fibrosis. Circulating levels of sST2 were assessed by blood sampling. The occurrence of ventricular arrhythmias, defined as aborted cardiac arrest, sustained or non-sustained ventricular tachycardia, was assessed retrospectively.

Results

We included 72 patients with MAD [55 (35–62) years old, 48 (67%) female], of which 22 (31%) had ventricular arrhythmias. Patients with ventricular arrhythmias had lower LVEF (60±6% vs. 63±6%, p=0.04), more prevalent papillary muscle fibrosis [14 (64%) vs. 10 (20%), p<0.001] and higher sST2 levels [31.6±10.1 ng/mL vs. 25.3±9.2 ng/mL, p=0.01] compared to those without. Combining sST2-level, LVEF and papillary muscle fibrosis optimally detected individuals with arrhythmias (area under the curve 0.82, 95% CI 0.73–0.92) and improved the risk model (p<0.05) compared to individual parameters (Figure right panel).

Conclusion

Circulating sST2 levels were higher in patients with MAD and ventricular arrhythmias compared to patients without arrhythmias. Combining sST2, LVEF and LGE may improve risk stratification in patients with MAD.

Acknowledgement/Funding

This work was supported by public grant [203489/030] from the Norwegian Research Council, Oslo, Norway. E. Scheirlynck received an ESC research grant

Evaluation of a Skin Carcinoma Xenograft Mice Model Supplemented by Chemical Immunosuppression

As we know today, cancer is a disease caused by the uncontrolled growth of a single cell. This development is triggered by mutations, changes in DNA that affect genes in such a way that they increase cancer cells. In the present study, an experimental model based on skin carcinoma xenograft mice was developed and tested. There were studied: the mice weight, the tumor volume, and the evolution of different skin parameters such as transepidermal water loss (TWL), erythema and the hydration level of stratum corneum; mice were divided in four groups: a control group, a group of mice injected with physiological saline solution, another one with immunosuppression, and a group of mice with immunosuppression and xenograft of A375 cells. The results indicate that administration of cyclophosphamide significantly reduced the number of neutrophils and lymphocytes and last two mice groups revealed more pronounced modifications of skin parameters compared to first two groups.

Skin Specific Cells and UVB Damage An experimental assessment

The alarming increased incidence of skin cancers is closely related to ultraviolet radiation exposure, known to induce cellular transformation in epidermal and dermal layers. The current study describes the behavior of normal (human keratinocytes � HaCat and fibroblasts -1BR3) and tumor cells (human � A375 and murine � B164A5 and B16-F0 - melanoma) after UVB irradiation. A dose of 40 mJ/cm2 (312 nm) led to a decrease of both normal and tumor cells viability in a post-exposure time dependent manner, the most statistically significant reduction being recorded at 24h post-exposure. Moreover, some changes in the shape of cells exposed to UVB were detected. Our results confirm the cytotoxic effects associated with UVB exposure and could be further employed to evaluate the photo-protective effects of different agents.

Total Polyphenol Content and Antiproliferative Activity of Green Tea Extracts Collected from Romanian Pharmaceuticals Market

Total polyphenol content and anti proliferative activity of five green tea extracts available on the Romanian pharmaceuticals market was analyzed. Results show dose-dependent anti proliferative activity of the selected samples against B164A5 mouse melanoma and A375 human melanoma cell lines. Sample 3, the richest sample in polyphenols showed the highest anti proliferative potential against the screened melanoma cell lines.

TREATMENTS OF HEPATITIS C VIRUS LIVER CIRRHOSIS WITH PEGYLAT INTERFERON-RIBAVIRIN AND INTERFERON FREE – COMPARATIVE STUDY

The article describes the adverse effects and efficiency of hepatitis C virus liver cirrhosis treatments available through the National Health Insurance Services, on a population of patients hospitalized at Victor Babes Infectious and Tropical Diseases Hospital, from 2012 to 2016. The population of patients was split into two distinct groups, for which we’ve recorded and comparatively analyzed demographic, clinical and paraclinical characteristics in a database. An evident success was recorded, from the point of view of hitting a clinical SVR index, in the DAA therapy group A, 87% percent compared to 2% in group B for the traditional standard therapy of PegInterferon + Ribavirin. Likewise, the number of adverse effects was lower in Group B versus Group A. Some side effects remained specific to the current cirrhosis treatment, which should be closely monitored.

Immunohistochemical profile of the estrogen and progesterone receptors in mammary benign lesions

The immunohistochemical diagnosis for estrogen and progesterone receptors must be carried out in the tracking of every primary tumor, benign or malign, especially in the case of in situ carcinoma.

MATERIAL AND METHOD

We have studied the expression of estrogen and progesterone receptors in benign lesions, identifying phenotypes depending on the presence of estrogen and progesterone receptors.

RESULTS

The result "positive" or "negative" in the report sent to the doctor is not sufficient, the inclusion of the total score in the case of a positive result, the clone used, the usage / non-usage of antigenic exposure and also the quality control being necessary. The benign mammary lesions occur in the context of a hormonal imbalance, which, in the long run runs the risk of developing a mammary carcinoma.

CONCLUSION

The further study of the hormonal spectrum of those lesions, considered as pre-malignant, may lead to the identification of some groups of hyperplastic lesions, presenting a high risk for developing a mammary cancer.

Morphological variability of the renal artery branching pattern: a brief review and an anatomical study

The segmental branches of the renal artery vary in number and origin. The 1998, Terminologia Anatomica homologates two branches of the renal artery (anterior, posterior) and five segmental arteries: four from the anterior branch and one from the posterior one. The purpose of this study is to evaluate the renal artery branching pattern, the number and origin of the segmental arteries, as well as to review data from similar studies. The study material consisted of 60 formalin-fixed adult kidneys. Dissections and microdissections were performed on the renal arteries and their branches. The branching of the renal artery was prehilar in 81.67% of cases, hilar in 10% and intra-sinusal in 8.33%. The number branches varied as follows: two branches in 42 cases (70%), three branches in 14 cases (23.33%) and four branches in four cases (6.67%). We subsequently analyzed the origin of the segmental arteries and found that in 53% of the cases the segmental arteries arose independently from the renal artery's branches, while in 47% of the cases they derived from common trunks of type I (85%) or II (15%). Type I trunks are those that originate directly from the main renal artery. They divide either into 2-3 segmental branches, or into just 1-2 branches and a smaller trunk (type II). The type II trunks further divide into 2-3 other segmental branches. These common trunks must be taken into account to avoid confusion with the segmental arteries. Knowledge of these variations is useful not only morphologically, but also clinically.

The heterogeneity of craniofacial morphology in Prader-Willi patients

Prader-Willi syndrome is a complex genetic disorder with narrow spectrum of facial phenotypic signs, which make the clinical diagnosis difficult in some cases. There are several reports describing the craniofacial appearance of Prader-Willi patients, but there are only a few cephalometric studies for these patients. In this study were included 18 patients with Prader-Willi syndrome and a control group of 18 subjects of both sexes selected based on specific criteria. The cephalometric radiographs of the patients were taken using the standardized technique with centric teeth in occlusion and lips in relaxed position. Angular, horizontal and linear measurements were analyzed for the study group and for the control group. We established that in Prader-Willi patients, there is a decrease of the majority of parameters but the degree of this reduction varies widely between patients and clinically typical facies not always have smaller measurements which can be found in an unusual facies. Facial dysmorphism in Prader-Willi patients varies a group ranging from miss proportions that do not alter the facial architecture as regard of facial typology, skeletal class and pattern of development to a severe disturbance of those. There is a degree of clinical heterogeneity between subjects with Prader-Willi syndrome on clinical evaluation and cephalometric study confirms the heterogeneity for this patients. Because the identification of smaller dimensions for majority of parameters in children and adults, the possibility of developmental delay or growth retardation delay can be excluded. These findings are important for the orthodontist for optimum timing of orthodontic management of patients with Prader-Willi syndrome.

Macroscopic, mesoscopic and microscopic morphology of the gastric plexus--ontogeny of the celiac ganglion

The vagus trunks, anterior and posterior, and their respective branches control the parasympathetic innervation of the stomach. After giving off a few thin branches, at the lower part of the esophagus and the cardiac region of the stomach, the anterior vagal trunk divides into its main branches: four or five consecutive direct branches which supply the upper part of the lesser curvature; these nerves do not form plexuses and thus, they may be individually dissected. One of the branches is stronger than the others and is called the principal anterior nerve of the lesser curvature (anterior nerve of Latarjet). The present study was conducted on eight fetuses of different gestational age (resulting from spontaneous abortions, without malformations), observing the Romanian laws of professional ethics, and 15 adult cadavers (male and female) whose celiac region was dissected macro- and mesoscopically to reveal both the celiac ganglia and their afferent and efferent vessels. For the microscopic study, we used the Bielschowsky silver staining method. The meso- and macroscopic dissections revealed the anterior and posterior vagal trunks in all the specimens (100%), as well as a rich gastric periarterial plexus. The microscopic samples focused on the ontogeny of the celiac ganglion in various gestational stages.

Cephalometric investigation of Class III dentoalveolar malocclusion

The aim of our study was to identify the most important anatomical landmarks in the cephalometric evaluation of Class III patients and to clarify the morphological characteristics of these cases. A group of 10 Class III orthodontic patients was evaluated in this study. The control group consisted of 10 patients with average occlusion and skeletal characteristics. Digital lateral cephalometric X-rays were performed and different measurements were analyzed. Cephalometric data were evaluated with the CephX specialized software for orthodontic diagnosis and the results were statistically analyzed. The Class III group presented specific characteristics such as prognathic mandible, large gonial angle, short maxillary length, higher lower facial height. These findings can be useful for the diagnosis and treatment planning of orthodontic cases with dental÷keletal anomalies, especially in cases when surgical approach is considered. The surgical decision must be taken after an accurate investigation of the lateral cephalometric parameters.

Chondrosarcoma of the upper end of the femur

Chondrosarcoma is a malignant tumor that produces cartilage matrix. Occurs in the fourth to sixth decades and has a male to female ratio of 2/1. It is most common in the long bones and on the surface of the pelvis. The authors present a case of chondrosarcoma of the upper end of the femur of a 50-year-old female patient who has come in our Department of Orthopedics and Traumatology two month ago, complaining of severe and persistent pain in the left hip joint and presenting limitation of adduction movement, limitation of internal-external rotation movements, and also could not be able to do thigh flexion on the abdomen. The woman presented a four-month history of persistent and severe pain, not assigned at anti-inflammatory drugs. Laboratory tests not had shown any significance. On radiographies and magnetic nuclear resonance the lesion was shown very clear, deciding for biopsy. The tumor had been large surgical excised with safe limits. Histopathology indicated the histological feature as a differentiated chondrosarcoma, grade III. Our patient has started the chemotherapy and radiation.

A comparison regarding antiproliferative action between soy total extract and genistein

The aim of this study is to make a comparison between the action of genistein and total soy extract regarding anticancer action on two different in vivo models: phytobiological test and animal model, and to see which of the two tested samples present a greater antiproliferative effect. Soybean seeds were grounded and a solvent formed of DMSO-ethanol-water in rapport 5-70-25 v/v/v was prepared. The extraction was made using an ultrasonic bath (Falc LCD Series) for 30 minutes, 59 kHz. The solvent was evaporated with a rotary evaporator at 50°C. Genistein was acquired from Extrasynthèse (France), hydroxypropyl-γ-cyclodextrin (HPGCD) from Cyclolab Hungary, 7,12-dimethylbenz[a]anthracene (DMBA), dimethylsulfoxide (DMSO), and 12-O-tetradecanoylphorbol-13-acetate (TPA) from Sigma Aldrich, Germany. Because of the poor water solubility, genistein was prepared in a complex with hydroxypropyl-γ-cyclodextrin in a molar ratio 1:2 by kneading method and total soy extract in a mass ratio 1:4 also by kneading method. Phytobiological test indicated an inhibition index over 50% in case of solutions of concentration between 8-33% in both samples, suggesting a possible antiproliferative action at a superior level. Study on C57BL/6J mice was made on which it was induced cancer with physical agents like DMBA, and it was promoted with TPA. Mice where divided in four groups: Group A - blank group, Group B - mice who received total soy extract, Group C - mice who received genistein, Group D - untreated mice. Results on animal model show that both soy total extract and genistein inhibited the initiation and promotion of chemically-induced skin tumorigenesis, but genistein had a greater success in recovering skin lesions type experimental malignant melanoma.

Human epidermal growth factor receptor 2 (HER2/neu) supraexpression in the mammary tumors

A series of morphological and molecular factors can be used in order to appreciate the prognostic of mammary cancer. A multitude of molecular factors has been investigated in order to identify a prognostic factor, one of the most studied factors being HER2 (human epidermal receptor growth factor). For this purpose, we have carried out an immunohistochemical research, in order to determine the correlation between the presence of morphological factors in tumor formation, different stages of evolution, and the response to therapy. We have correlated HER2 expression with the histological type of carcinomas, the histological differential degree, ER, PR immunohistochemical expression, as well as the available clinical data. Within the studied carcinomas, we have identified a number of 98/156 (62.8%) carcinomas HER2/neu negative, out of which 74/156 (47.4%) did not reveal the presence of HER2/neu and 24/156 (15.4%) have been quantified as being 1+. The HER2/neu supraexpression was encountered in 58/156 (37.17%) cases: in 34/156 (21.8%) cases the immunostaining was interpreted as being 2+ and in 24/156 (15.4%) cases it was interpreted as being 3+. HER2/neu supraexpression should be routinely determined through immunohistochemical methods in all primary mammary tumors, especially in those poorly differentiated.

Anatomical variations of the hepatic portal vein associated with incomplete celiac trunk

An association of two anatomical variations was revealed in a 65-year-old male cadaver: the first variation concerns the forming of the trunk of the hepatic portal vein, while the second concerns the branches of the celiac trunk. In this case, the inferior and superior mesenteric veins form a common trunk that is further united with the splenic vein and gives rise to the hepatic portal vein. At the same time, the existence of an incomplete (branched) celiac trunk was revealed, the hepatosplenic trunk from which the common hepatic artery and the splenic artery arise; the left gastric artery arises separately at 0.5 cm superolaterally from the origin of the celiac trunk. Familiarity with this anatomical variation provides useful information for abdominal surgery procedures.

Diagnostic value of a negative single color duplex ultrasound in deep vein thrombosis suspicion during pregnancy

OBJECTIVE

to determine whether a negative single complete ultrasound (US) of the lower limbs veins is a safe and accurate diagnostic method to rule out deep venous thrombosis (DVT) in pregnancy.

MATERIAL AND METHODS

We performed a prospective study on 87 consecutive pregnant women with clinical suspicion of DVT in "Dr. D. Popescu" Maternity, Timişoara, between January 2007 and December 2009. All cases were investigated by color duplex ultrasound. Those who were negative but with high clinical probability of DVT underwent MR venography, the rest with negative US findings did not received anticoagulant therapy and US was repeated after seven days. All were instructed about the signs and symptoms of DVT and asked to return at six weeks postpartum when they were questioned if presented any.

RESULTS

from the 87 women 30 (34.48%) were found positive and two (2.29%) had a high clinical suspicion of DVT. 55 (63.21%) with negative findings repeated the US exam after 7 days which remained negative. Only 43 (78.18%) returned for the 6 weeks postpartum visit and none of them experienced any thromboembolic event during follow-up.

CONCLUSIONS

A single complete color duplex ultrasonography of lower limbs veins appears to be a safe method to rule out the diagnosis of deep venous thrombosis in pregnant women and if negative is safe to withhold heparin therapy.

Altered anatomy in a case with a buccally impacted maxillary canine tooth

Bilateral dissections of maxilla were performed in a human adult cadaver head, male, aged 53 years. After the en block removal of the soft tissues in the oral and infraorbital regions, the antero-lateral surface of maxilla was exposed and also the vestibular aspect of the upper alveolar process. An oblique labially impacted right upper canine was evidenced, completely submucosal: its apex was tangent to the maxillary sinus floor, while the superior side of the apical part of the root was in close relation with the floor of the laterally expanded inferior nasal meatus. Superior and adjacent to the neck of that impacted canine a follicular cyst was evidenced and the antral wall presented distally to the apex of the impacted canine a dehiscent area, where the antral mucosa was only covered by an incomplete thin bony lamella. The incisors on that side were present but no resorption was identified at their level. Within the anterior border of the wall separating the maxillary sinus, small, and the inferior nasal meatus, the nerve for that impacted canine was coursing; the nerves for the upper incisors were initially located within the antero-lateral wall of the inferior nasal meatus. Although small, the maxillary sinus presented a supero-medial recess above the enlarged inferior nasal meatus and lateral to the normally-sized middle nasal meatus.

The spermatic ganglion in humans: an anatomical update

The male gonad receives nerve fibers from the autonomic ganglionic system. By the present study, we aimed to bring detailed evidences, topographic and structural, on the spermatic ganglia (SG) in humans, as suppliers of autonomic fibers for the testis. We performed retroperitoneal dissections in 25 formalin-fixed human male adult cadavers. Histology used the Hematoxylin-Eosin and we also used Bielschowsky silver stains. Immunohistochemistry used antibodies for tyrosine hydroxylase. In 20÷10 specimens, we identified left spermatic ganglia (LSG) at the aortic origin of the left testicular artery (LTA); in five specimens the LTA left the renal artery but LSG were juxtaposed on the aorta at about the level of origin of a normal LTA. In 15÷25 cadavers, there were right spermatic ganglia (RSG) related to the right testicular artery (RTA) that in 12 cadavers had a precaval disposition. A specimen with retrocaval RTA presented an inferior renal ganglion, supplying both the renal and the RTA. The SG presented renal, lumbar and intermesenteric roots. The inferior branch of the SG connected it to the inferior mesenteric plexus while its infero-lateral branch adjoined the testicular artery. Microscopy confirmed the SG as nervous ganglia and the respective neuronal populations were tyrosine hydroxylase positive, allowing us to consider these ganglia as sympathetic. We bring here the first-time evidence of the SG topography and cathecolaminergic nature in humans; this ganglion may influence the male gonad via the inferior mesenteric plexus and via the vascular path of the testicular artery.

Preoperative ultrasonography as a mean of predicting the conversion of mini cholecystectomy into classic cholecystectomy

Cholecystectomy is considered to be the treatment of choice in symptomatic biliary lithiasis. Lately, due to medical progress, classic cholecystectomy has been gradually replaced by laparoscopic cholecystectomy and by mini cholecystectomy. Therefore, it is very important to determine certain preoperative factors which might predict the conversion of mini cholecystectomy (MC) into classic cholecystectomy (CC).

MATERIAL AND METHOD

The possibility of selecting high-risk conversion patients has important clinical implications, both for the surgeon and for the patient. Differentiating preoperative risk allows the surgeon to inform the patient about a high conversion risk to CC, and about the ensuing consequences: longer hospitalization period, longer postoperative recovery, greater costs. All the patients were examined by ultrasonography. The tests recorded six parameters: the diameter of the biliary duct (mm), the number of calculi, the diameter of the largest calculus (mm), the contracted aspect of the gallbladder, the distance between the tegument and the gallbladder fundus (cm), the distance between the tegument and the cystic duct (cm). All the variables were introduced into an initial model, which was checked using the colinearity method and significant observations, and subsequently reduced by eliminating insignificant predictive factors, revealed by Wald tests.

RESULTS

The significant predictive conversion factors to CC, quantified on the basis of regression analysis, are: age > 70, calculus with a diameter > 20 mm, biliary duct with a diameter > 6 mm, contracted gallbladder, distance between the tegument and gallbladder fundus > 7.2 cm, distance between the tegument and cystic duct > 17.1 cm.

CONCLUSION

Being a procedure that can be carried out on an outpatient basis and with rather low costs, ultrasonography plays a very important role in the preoperative prediction of converting MC to CC.

Compression and walking compared with bed rest in the treatment of proximal deep venous thrombosis during pregnancy

The purpose was to evaluate the benefits of compression and early mobilization in comparison with compression and bed rest in the acute stage of proximal deep venous thrombosis (DVT) in pregnant women.

METHOD

Thirty-two consecutive pregnant women with proximal DVT diagnosed by color duplex ultrasound were divided into two groups. Group A consisted of 15 patients who received elastic compression bandages and early mobilization, and group B including 17 patients with compression bandages and bed rest. All patients received heparin therapy. The clinical characteristics of the two groups were comparable. We assessed the reduction of subjective pain daily with a Visual Analogue Scale (VAS) and the objective pain using Lowenberg test, the reduction of edema was recorded initially and on day 2, 4 and 7. Ultrasound was repeated after seven days.

RESULTS

Resolution of subjective pain was faster during the first three days and near absent at the end of the study period in group A (p < 0.001). Objective pain seriously reduced in group A during the observation period while in group B decreased during the first three days almost by half but remained constantly present over the remaining days (p < 0.001). The same was true for the measurement of leg circumference (p < 0.05). There was no pulmonary embolism and progression of thrombus diameter.

CONCLUSION

Pregnant women with proximal deep vein thrombosis may benefit from leg compression and early mobilization for a faster resolution of the signs and symptoms and this method does not seem to be an additional risk factor for pulmonary embolism.

An anatomical study of the thyroid arteries anastomoses

Collateral circles in neck own a particular importance in compensating the symptoms due to the unilateral occlusion of the common carotid artery. In addition, surgical procedures at the level of the thyroid gland and larynx raise the problem of a good knowledge of the arterial morphology at those levels. The present study was designed to investigate the possible morphologies of the thyroid arteries anastomoses. For the present study, 20 human adult specimens were dissected, 15 in cadavers and other five on laryngeal specimens drawn at autopsies. Dissections evidenced bilateral and unilateral anastomoses of the thyroid arteries classified as extra laryngeal and intra laryngeal, the former constantly being represented by the supra isthmic arcade made by the superior thyroid arteries and the retrolobar anastomoses of the superior and inferior thyroid arteries. Constant intra laryngeal anastomoses were those of the superior laryngeal artery with the inferior laryngeal artery and, respectively, with the cricothyroid artery. The analogy with the cardiac collateral circulation, the thyroid arteries anastomoses may be classified as intrathyroid and interthyroid arterial anastomoses. We also present in this paper a rare variant that we did not find described in the references we investigated, represented by the paramedian perilaryngeal anastomose of the suprahyoid branch emerged from the lingual artery and the cricothyroid artery sent by the superior thyroid artery. The thyroid arteries supply the collateral circles in neck; the clinicians must be aware of their possible functional value and the surgeons must take into account these arterial morphologies while acting on the neck viscera.

The maxillary recess of the sphenoid sinus

The most studied recess of the sphenoid sinus seems to be the lateral one, which is highly variable. Less attention seems to be paid to the maxillary recess, extending anterior, inferior and lateral towards the maxillary sinus. Twenty patients were referred for CT of the paranasal sinuses (axial CT), during a 3-month period. After examining the morphology of the sphenoid sinuses, the authors found bilateral maxillary recesses in one patient. On either side, the maxillary recess of the sphenoid sinus was directed anterior and lateral, being separated from the maxillary sinus by a distinctive bony wall; the longitudinal size of these recesses was 1.36 cm, on the left, and 1.22 cm, on the right. As it becomes part of the antero-medial wall of the pterygopalatine fossa, the maxillary recess of the sphenoid sinus should be evaluated prior to the endoscopic endonasal approach of the fossa; the detail becomes more relevant when one takes into account the fact that in our case, on the right side, the CT-scan suggested that the sphenopalatine artery could traverse directly through the maxillary recess. Therefore, such a maxillary recess of the sphenoid sinus seems to be anatomically located in the situs of the orbital process of the palatine bone and thus, it assumes the respective topography. The differential diagnosis with a Haller cell is relevant--the surgical procedures that approach a Haller cell could lead to a misdiagnosed maxillary recess of the sphenoid sinus into the middle nasal meatus. This aspect determined us to consider the maxillary recess of the sphenoid sinus as a false Haller cell and to claim the imperative of a CT-evaluation performed prior to interventions.

Utero-adnexal damage in septic abortion. Histopathological study on 91 cases

Septic abortion represents the main causes of abortion-induced maternal death. Hysterectomy may represent a beneficial therapeutic solution for septic abortion, nevertheless with irreversible effects on a woman's reproductive condition. The study analyzes the anatomopathological damage found in ninety-one patients hospitalized for septic abortion. The patients were admitted to the "Dr. D. Popescu" Clinical Hospital, Timisoara, between 1980-1989 and 1999-2008; hysterectomy was performed in all the cases to eliminate uterine sepsis responsible for the emerging complications.

Helicobacter pylori infection and gastric MALTomas: an up-to-date and therapy highlight

During the last 20 years Helicobacter pylori (Hp) has been, undoubtly, the star of gastroenterology and microbiology, so much to deserve the "Nobel prize 2005" for biology and medicine to its discoverers. More recently, an increased interest arised on Hp and its linkages with other medical fi elds such as immunology, surgery and dentistry. The outcome of the pathologies due to such bacterium is dependent on many factors, including bacterial genotype, host physiology and genetics, and environmental factors such as diet. In spite of its clear involvement in some pathologies like acute and chronic gastritis, peptic ulcer and gastric cancer, very little is known about another pathology recently proved to be closely associated to the infection by Hp: the gastric MALToma, which account for 7% of all newly diagnosed non-Hodgkin's lymphoma. The chronic infection of the gastric mucosa from Helicobacter pylori primes a complex pathogenic process which could determine the onset of the gastric cancer through some intermediary steps. On these bases, in 1994, the International Agency for Cancer Research (IARC) defined this bacterium a "class I carcinogenic agent" for gastric cancer. The MALT lymphomas are the most frequent lymphoid neoplasms of the digestive tract; we can also observe other and more rare lymphomatous tumours with specific clinical patterns, like the T-lymphoma associated with lymphomatous polyposis and enteropathy. The development of gastric lymphomas is usually preceded by the acquisition of lymphatic tissue, after inflammatory stimuli and particularly after the infection from Hp, which organizes itself with the characteristics of the MALT. Recently, a number of papers have highlighted the remarkable efficacy of Hp eradicating therapy in patients with low-grade MALT lymphoma of the stomach without other modalities, e.g. surgery and systemic chemotherapy. The aim of this study is to be helpful for a comprehensive understanding the possible connections between Hp and gastric MALT lymphoma, evaluating the best therapy strategies, surgical and non surgical, actually available for its treatment.

The Microbial Oxidation of Iron and Sulphur in an Acid Solution from an Auriferous Sulphides Mine from the South-West of Romania

The rock layers from above the cavity are slowly crossed, through micro cracks, by the rain water. The rain water arrives on the cavity wall as a concentrated solution with a high acidity level (pH 1-1.5). The percolating acid solution is crowded by acidophilic microorganisms with a dominating population of chemo-autotrophic bacteria Acidithiobacillus ferrooxidans provides the primary organic substance by oxidation of pyrite from the cavity walls and with six strains of Penicillium representing the heterotrophic organisms that use the organic substance from the primary producer. Between the A. ferrooxidans population and the Penicillium strain populations a close trophic relationship is established and the microorganisms number depends on the acid solution concentration. The ferric hydroxide formed through the oxidation of pyrite by A. ferrooxidans is deposed at the Penicillium hyphae exterior and forms minerals structures.