The Management of Reno-Ureteral Lithiasis - from Emergency Presentation to Definitive Treatment

Introduction: The aim of our study was to retrospectively evaluate the stone-free rate after the second intervention for every performed procedure (semirigid ureteroscopy, flexible ureteroscopy, semirigid plus flexible ureteroscopy and percutaneous nephrolithotomy). Materials and methods: A total of 149 patients, who came to the emergency room of "Saint John" Emergency Clinical Hospital, Bucharest, Romania, with acute renal pathology suggesting the presence of renal and/or ureteral lithiasis confirmed by imagining (x-ray, ultrasonography or computer tomography), were included in this retrospective study, which was conducted between September 2021 and September 2022. All selected patients had an indication of emergency surgical intervention that consisted of a double-J stent mounting. We analyzed the stone-free rate after the secondary intervention, which was one of the following procedures: semirigid ureteroscopy, flexible ureteroscopy, combined semirigid and flexible ureteroscopy (F-URS), and percutaneous nephrolithotomy (PCNL). Patients came back for the secondary intervention and were reevaluated using imaging techniques. Results:Endoscopic procedures were performed by 14 surgeons over a time period of two to six weeks after the initial stenting procedure. Encrusted stents were encountered in four cases and in five cases the patients were admitted with obstruction of previously inserted stents. From the total of 149 patients, 68 (45,6%) subjects underwent semirigid ureteroscopy, with a stone-free rate of 86% (59 cases), 32 (21,4%) F-URS, with a stone-free rate of 90,6% (30 cases), 41 (27,5%) combined flexible and semirigid ureteroscopy, with a stone-free rate of 90,24% (37 cases), and eight (5,3%) patients received PCNL, with a stone-free rate of 75% (six cases). Overall stone-free rate for all procedures was 90,06%. The mean operative time was 23 minutes. No major incidents or complications occurred during the procedures. Conclusion:The emergency pre-stenting before the definitive treatment of reno-ureteral lithiasis is a safe procedure. Flexible ureteroscopy was the most successful secondary intervention, with the highest rate of achieving stone-free status.

Epidemiology and impact of frailty in patients with atrial fibrillation in Europe

BACKGROUND

Frailty is a medical syndrome characterised by reduced physiological reserve and increased vulnerability to stressors. Data regarding the relationship between frailty and atrial fibrillation (AF) are still inconsistent.

OBJECTIVES

We aim to perform a comprehensive evaluation of frailty in a large European cohort of AF patients.

METHODS

A 40-item frailty index (FI) was built according to the accumulation of deficits model in the AF patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry. Association of baseline characteristics, clinical management, quality of life, healthcare resources use and risk of outcomes with frailty was examined.

RESULTS

Among 10,177 patients [mean age (standard deviation) 69.0 (11.4) years, 4,103 (40.3%) females], 6,066 (59.6%) were pre-frail and 2,172 (21.3%) were frail, whereas only 1,939 (19.1%) were considered robust. Baseline thromboembolic and bleeding risks were independently associated with increasing FI. Frail patients with AF were less likely to be treated with oral anticoagulants (OACs) (odds ratio 0.70, 95% confidence interval 0.55-0.89), especially with non-vitamin K antagonist OACs and managed with a rhythm control strategy, compared with robust patients. Increasing frailty was associated with a higher risk for all outcomes examined, with a non-linear exponential relationship. The use of OAC was associated with a lower risk of outcomes, except in patients with very/extremely high frailty.

CONCLUSIONS

In this large cohort of AF patients, there was a high burden of frailty, influencing clinical management and risk of adverse outcomes. The clinical benefit of OAC is maintained in patients with high frailty, but not in very high/extremely frail ones.

COVID-19 in a child with multiple comorbidities

A female child, 1 year-old and 2 months, diagnosed with multiple neurological conditions, including myelomeningocele and operated hydrocephalus, was diagnosed with SARS-CoV-2 in October 2020 and hospitalized in our clinic. At the time of the onset of the disease, the patient had a febrile episode, laboratory blood tests showed a slightly increased biological inflammatory syndrome, and mixed pneumonia was described radiologically. Thus, antibiotic treatment was initiated, with laboratory tests and control imaging within normal limits after several days of admission. Being an institutionalized child, according to the epidemiological recommendations of that time, she was hospitalized in our clinic during the 14 days of the illness. Thus, on the 15th day of the disease she was discharged, with negative SARS-CoV-2 control RT-PCR, with good general condition, afebrile over 10 days.

SARS-CoV-2 infection in a child with Fanconi anemia and determined immunosuppressed status

Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Paraclinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administered. The evolution is favorable, and the SARS-CoV-2 RT-PCR control test is negative on the eighth day of hospitalization. Conclusions. Immunocompromised status is not a major risk factor for severe COVID-19 in children.

Current Challenges in Deciphering Sutton Nevi-Literature Review and Personal Experience

Halo nevi, known as leukoderma acquisitum centrifugum, Sutton nevus, leukopigmentary nevus, perinevoid vitiligo, or perinevoid leukoderma, together with vitiligo and melanoma-associated hypopigmentation, belong to the group of dermatoses designated as immunological leukodermas. The etiology and pathogenesis of halo nevi has not been fully elucidated. There are several mechanisms through which a lymphocytic infiltrate can induce tumoral regression. In this review, we aimed to update the knowledge about Sutton nevi starting with the clinical appearance and dermoscopic features, continuing with information regarding conventional microscopy, immunohistochemistry, and the immunological mechanisms responsible for the occurrence of halo nevi. We also included in the article original unpublished results when discussing dermoscopic, pathologic and immunohistochemical results in halo nevi. Sutton nevi are valuable models for studying antitumor reactions that the human body can generate. The slow and effective mechanism against a melanocytic skin tumor can teach us important lessons about both autoimmune diseases and anticancer defenses.

A PARTICULAR CASE OF SARS-COV-2 INFECTION IN TWINS

Introduction. Although SARS-CoV-2 infection is more common in adults, many cases have been reported in the pediatric population. Case presentation. An 8-month-old infant from twin pregnancy, confirmed with COVID-19, is hospitalized with nasal obstruction, serous rhinorrhea, rare cough and watery stools. The epidemiological link is known, both the parents and the maternal grandparents of the infant being confirmed with COVID-19. Biologically, he presented with thrombocytosis and discrete inflammatory syndrome, and the lung radiograph did not show any lesions. At the same time, the twin sister was hospitalized, who presented a similar symptomatology, with a negative SARS-CoV-2 PCR test, but the lung radiograph showed specific lesions of COVID-19. During hospitalization, 2 more SARS-CoV-2 PCR tests were performed, but with negative results. The evolution of the twins was favorable under symptomatic treatment, respectively antibiotic and symptomatic treatment. Conclusion. SARS-CoV-2 infection may be asymptomatic, especially in infants and newborns, and has a lower prevalence.

Refractive Lens Exchange in Hyperopic Presbyopes with the Acrysof IQ Panoptix Intraocular Lens: One-Year Results and Analysis of the Literature

Purpose

To assess the functional and refractive outcomes in hyperopia and presbyopia correction by clear lens exchange with the intraocular trifocal artificial lens (IOL) Acrysof IQ Panoptix implant at 1 year.

Materials and Methods

A number of 128 eyes (64 patients) underwent clear lens exchange with placement of the trifocal IOL Acrysof IQ Panoptix implant for hyperopia and presbyopia. Prior to the surgery the patients had a complete ocular examination. In all cases the artificial lens was implanted in the bag without any intraoperative complications. Visual acuity (VA) at distance, intermediate and near and ocular refraction were evaluated at 4 weeks, 6 and 12 months postoperatively.

Results

The mean age was 53.49 ±7.377 years old (range 40–73 years). As high as 51.57% of the patients were males and 48.43% were females. The mean achieved refraction was 0.26 ± 0.73D. Almost 60.93% of patients were within ±0.25D of the target refraction, with 82.03% eyes within ±0.50D of the planned correction. At 1 year after surgery, 96.45% of eyes had a stable refraction (p >0.05). At 1 year, a total of 92.25%, 89.92% and 91.47% achieved a monocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. At the same time point, a total of 95.35%, 91.47% and 93.80% achieved a binocular uncorrected distance, intermediate and near visual acuity of 0.2 logarithm of the minimum angle of resolution or better, respectively. There was no statistically significant difference (p>0.05) between the postoperative uncorrected and best corrected VA (distance, intermediate, near) at 6 months and postoperative uncorrected and best corrected VA (distance, intermediate, near) at 12 months. None of our patients had any intraoperative complications. Two cases (1.56%) developed posterior capsule opacification. Twelve patients (18.75%) complained about photic phenomena such as glare and haloes, but this symptom disappeared after 6 months postoperatively. As high as93.56% of patients had a high satisfaction with the outcomes of the surgery. Spectacle independence was obtained in 97.65% eyes.

Conclusion

The Acrysof Panoptix trifocal artificial lens offers a good vision at distance, intermediate and near, with a good quality of vision and refraction.

FSH RECEPTOR AND FSH BETA CHAIN POLYMORPHISM INVOLVEMENT IN INFERTILITY AND ENDOMETRIOSIS DISEASE

OBJECTIVES

The purpose of this study was to evaluate the association between the follicle-stimulating hormone (FSH) receptor (c.-29G>A) and FSH beta chain (c.-280G>T) polymorphisms and endometriosis in Romanian women.

MATERIAL AND METHODS

We performed the polymorphic analysis of the FSH receptor gene and FSH beta chain in 44 patients with endometriosis and 34 controls. Genomic DNA was obtained from peripheral blood and polymorphisms were investigated using restriction fragment length polymorphism analysis (RFLP).

RESULTS

There were no significant differences in genotype frequencies of FSH receptor gene between endometriosis patients and controls. For the heterozygous type of the FSH receptor polymorphism (c.-29G>A) we did not find a significant difference in its frequency between patients with minimal/mild and moderate/severe endometriosis (p = 0.136). Also, the FSH beta chain (c.-280G> T) polymorphism frequency was not significantly associated with the severity of endometriosis (p = 0.966).

CONCLUSIONS

FSH receptor and FSH beta chain polymorphisms do not seem to influence the severity of endometriosis, but they could be correlated with female infertility (primary or secondary), therefore further studies are required to debate this topic.

Stroke prevention in elderly patients with non-valvular atrial fibrillation in the BALKAN-AF survey

BACKGROUND

Atrial fibrillation (AF) is common amongst the elderly, but this group tends to be suboptimally treated. Limited data are available on the stroke prevention strategies in the elderly, especially in the Balkan region.

AIM

We investigated the use of oral anticoagulant therapy (OAC) amongst elderly AF patients in clinical practice in the Balkan region.

METHOD

A 12-week prospective snapshot survey (2014-2015) of consecutive non-valvular AF patients was conducted in Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Montenegro, Romania and Serbia. Data were collected via an electronic case report form.

RESULTS

Of 2671 patients, 418 (15.6%) were ≥80 years old. Overall, OAC was used in 1965 patients (73.6%). Compared with younger patients, the elderly (age ≥ 80) had a higher mean CHA₂ DS₂ -VASc score (3.22 ± 1.71 vs 4.89 ± 1.35, P < .001) and more often a HAS-BLED score of ≥3 (n = 198 [47.0%] vs n = 625 [27.3%], P < .001), but were less likely to receive OAC (n = 269 [64.4%] vs n = 1696 [75.3%], odds ratio [OR] 0.91; 95%CI 0.86-0.97, P = .003). There was no significant association between OAC use and mean CHA₂ DS₂ -VASc (OR 0.86; 95%CI 0.75-1.00, P = .053) or HAS-BLED score (OR 1.21; 95%CI 0.81-1.81, P = .349) in the elderly.

CONCLUSION

In the BALKAN-AF Survey, elderly AF patients were less likely to receive the guideline-adherent treatment despite their less favourable risk profile. Since OAC nonuse among the elderly was not associated with increased HAS-BLED score, factors other than patients' risk profile could influence the implementation of guideline-adherent treatment for thromboprophylaxis in the elderly AF patients.

P832 ESCAPE Stroke: first results

Objective

"ESCAPE Stroke" (Enhancement, Segmentation and Characterization of Atheroma PlaquE for Stroke Prevention) is a multidisciplinary project that aims to develop a new software tool to obtain maximum information about carotid atherosclerosis, through the (semi)automatic analysis of the morphological characteristics of the carotid plaque. We present the first results for evaluating this software.

Methods

For the morphological analysis of the characteristics of the atheroma plaques, a database of 117 carotid ultrasound images was used. The extracted morphological features refer to the degree of echogenicity, texture and the surface of the atheroma plaque.

Regarding to echogenicity of the atheroma plaques, the implemented software algorithm divides the plaques into four classes as follows:

• Anechogenic A type, the echogenic areas representing less than 25% of the plaque. The 117 plaques subjected to computerized analysis were classified as: 54 Type E plaques, 57 Type E / 2 plaques, 6 Type A / 2 plaques and no Type A plaques

• A / 2 type: predominantly anechogenic, anechogenic areas accounting for more than 50% of the plaque but less than 75%;

• Type E / 2: predominantly echogenic, echogenic areas accounting for more than 50% of the plaque but less than 75%;

• Type E: echogenic, an-echogenic areas representing less than 25% of the plaque; (Figure 1)

On the subject of texture of atheroma plaques, the implemented software algorithm studies the homogeneity. In order to quantify the degree of homogeneity of the atheroma plaques, from the Spatial Gray Level Dependency Matrix, a number of functions have been calculated that have become the homogeneity-classification parameters. The 117 plaques were divided into three different classes (Figure 1) as follows:

• 28 plaques type 1, with uniform consistency regardless of their echogenicity;

• 51 plaques type 2, with an average non-uniform consistency, the distribution of gray levels in the atheroma plaque varies but does not go through the entire interval from hypo-echogenic zones to hyper-echogenic zones;

• 38 plaques type 3, with high non-uniform consistency, with hypo-echogenic and hyper-echogenic zones.

With regard to the surface of the atheroma plaques, it is defined as smooth and regular, slightly irregular or ulcerated (Figure 1). Using different contour parameters, the 117 atheroma plaques subjected to computerized analysis were classified as follows:

• 48 plaques with smooth and regular surface;

• 55 plaques with slightly irregular surface;

• 14 plaques with ulcerative surface; The overall agreement between software analysis and "eyeball" assessment made by 2 independent physicians was 69% for echogenicity, 58% for homogeneity and 74% for plaque surface evaluation.

Conclusion

Our automatic/semiautomatic method for plaque characterization could add important information in atheroma plaque assessment and further research is needed in order to confirm its value.

Abstract P832 Figure1

Epigenetics, Assisted Reproduction, and Intracytoplasmic Sperm Injection: A Review of the Current Data

Since the birth of the first in vitro fertilisation baby in 1978, >5 million babies have been born worldwide using assisted reproductive technologies (ART). ART were initially considered safe, but, in recent years, concerns regarding the association between these procedures and the increasing incidence of imprinting diseases have developed. There are numerous steps involved in ART and there are many variables that must be considered; even parental infertility may play an important role in offspring epigenetic modifications. This review presents available data from the literature regarding the incidence of these epigenetic modifications after ART, with a primary focus on oocyte insemination methodology. The authors conclude that ART, especially intracytoplasmic sperm injection, may induce epigenetic changes that can be transmitted to the offspring, but additional data are necessary to evaluate the factors involved and to determine the safety of each ART step.

Efficacy of methotrexate as anti-inflammatory and anti-proliferative drug in dermatology: Three case reports

Methotrexate (MTX) is a folic acid analog with anti-proliferative (anti-neoplastic, cytotoxic), immunosuppressive and anti-inflammatory properties, which has been used in the treatment of various cutaneous disorders, such as psoriasis, keratoacanthoma, pityriasis rubra pilaris, atopic dermatitis, mycosis fungoides, bullous skin diseases, systemic sclerosis, morphea, lupus erythematosus, dermatomyositis and crusted scabies. Inhibition of cell proliferation is explained through its role in blocking DNA/RNA synthesis, by inhibiting dihydrofolate reductase, necessary for the production of pyrimidine and purine nucleotides. An anticancer effect can be related to α-oxoaldehyde metabolism (MTX increases methylglyoxal levels). Its anti-inflammatory property is based on the inhibition of 5-aminoimidazole-4-carboxamide ribonucleotide transformylase, thus increasing intracellular and extracellular adenosine, a purine nucleoside with anti-inflammatory effect. This drug can limit inflammation by scavenging free radicals and decreasing malondialdehyde-acetaldehyde protein-adduct production. Moreover, the anti-proliferative and anti-inflammatory effects can also be related to inhibition of the DNA methylation pathway, thus inhibiting methionine formation. The aim of the present study was to report various dermatological cases from our daily practice that demonstrate the efficacy of MTX in the treatment of cutaneous diseases, highlighting different mechanisms of action: its anti-inflammatory effect in psoriasis and its anti-proliferative, and anti-neoplastic effect in well-differentiated squamous cell carcinoma or in keratoacanthoma. Moreover, different administration pathways and doses are addressed. Assessment of the treatment plan, clinical improvement of cutaneous lesions, biologic evaluation, final aesthetic result, quality of life, as well as potential adverse effects and drug tolerance related to each case mentioned.

Matrix metalloproteinases expression in lentigo maligna∕lentigo maligna melanoma - a review of the literature and personal experience

Cutaneous melanoma is the most aggressive type of skin cancer, with high invasive potential. Lentigo maligna melanoma (LMM) is a relatively rare type, accounting for about 10% of all melanomas, while the most common subtype of melanoma on the face, typically on chronically sun-exposed skin of elderly people. Its in situ stage is lentigo maligna (LM). During the process of transformation from LM to LMM, tumor cells secrete or induce the release from neighboring cells of large amounts of matrix metalloproteinases (MMPs) that degrade the extracellular matrix. Some MMPs, as MMP3 and MMP9 expressed melanoma cells is associated with statistical significance in both in vitro and in vivo studies, with an invasive phenotype. Unfortunately, there is scarce data published about MMPs expression in LM∕LMM, as majority of research on melanoma refer to superficial spreading and nodular melanoma. Our personal, unpublished yet fully data is an attempt to complete a specific panel of immunohistochemical markers that could explain the slow growing rate of LMM.

Microemulsion-made gadolinium carbonate hollow nanospheres showing magnetothermal heating and drug release

Gadolinium carbonate (Gd₂(CO₃)₃) hollow nanospheres and their suitability for drug transport and magnetothermally-induced drug release are presented. The hollow nanospheres are prepared via a microemulsion-based synthesis using tris(tetramethylcyclopentadienyl)gadolinium(iii) and CO₂ as the starting materials. Size, structure and composition of the as-prepared Gd₂(CO₃)₃ hollow nanospheres are comprehensively validated by several independent analytical methods (HRTEM, HAADF-STEM, DLS, EDXS, XRD, FT-IR, DTA-TG). Accordingly, they exhibit an outer diameter of 26 ± 4 nm, an inner cavity of 7 ± 2 nm, and a wall thickness of 9 ± 3 nm. As a conceptual study, the nanocontainer-functionality of the Gd₂(CO₃)₃ hollow nanospheres is validated upon filling with the anti-cancerogenic agent doxorubicin (DOX), which is straightforward via the microemulsion (ME) strategy. The resulting DOX@Gd₂(CO₃)₃ nanocontainers provide the option of multimodal imaging including optical and magnetic resonance imaging (OI, MRI) as well as magnetothermal heating and drug release. As a proof-of-concept, we could already prove the intrinsic DOX-based fluorescence, a low systemic toxicity according to in vitro studies as well as the magnetothermal effect and a magnetothermally-induced DOX release. In particular, the latter is new for Gd-containing nanoparticles and highly promising in view of theranostic nanocontainers and synergistic physical and chemical tumor treatment.

Correlation of Glycemic Control Parameters in Non-Diabetic Persons with Cardiovascular Risk Scores - Results from a Cross- Sectional Study

To assess the correlation between main parameters of glycemic control and cardiovascular risk scores in non-diabetic persons. Risk scores were calculated by using the University of Edinburgh Risk Calculator. Risk scores are used to estimate the probability of cardiovascular disease in individuals who have not already developed major atherosclerotic disease. We correlated the results of these scores with the parameters that describes the glycaemic profile: preprandial glicaemia, HbA1c and 1 hour and 2 h post-prandial glycaemia, determined during Oral Glucose Tolerance Test (OGTT).Both fasting glycaemia and HbA1c significantly correlated with cardiovascular risk scores calculated for a period of 10 years. The recorded post-prandial glycaemic values at 1h and 2h after glucose loading didn�t significantly correlate with calculated scores, in the study group. The observed correlations underline the importance of glycaemia in the pathogenesis of cardiovascular diseases.

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

BACKGROUND

We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific.

METHODS

During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days.

RESULTS

Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs.

CONCLUSIONS

Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically.

NEUROMONITORING THE BRANCHES OF THE RECURRENT NERVE DURING THYROIDECTOMY

The lesions of the laryngeal nerves are the most severe long term complications after thyroidectomy. Visual identification of the recurrent laryngeal nerve during thyroid surgery has been recommended in many studies as the golden standard of RLN treatment. The non recurrent laryngeal nerve should always be taken into consideration in order to avoid accidental injury during thyroid surgery. Laryngeal recurrent nerve can be difficult to identify because of rare anatomical variants, extra laryngeal branches, or in complicated thyroid operations, such as voluminous goiter or thyroid cancer. Intraoperative nerve monitoring is secure for the patient, easy to use and useful in showing the integrity of laryngeal recurrent nerve, both during and after surgery. The Departament of Surgery, Valcea Country Hospital, from January 2014 to April 2015, developed a prospective study which enrolled 123 patients who underwent thyroid interventions with neuromonitoring and all had been treated by the same surgeon. The signal obtained from RLN localization, 215 nerves (96%), from a total of 222 , show a clear and reliable EMG response. 7 nerves (3%) were not received through EMG signal. In 3 cases involving 5 RLN there was a false negative result caused by electrode malposition and in 2 cases the RLN was injured during surgery.Clinical evolution of the procedure and more extended studies are needed to show if intraoperative monitoring decreases the rate of recurrent laryngeal nerves iatrogenic injury.

Using stable isotopes in tracing contaminant sources in an industrial area: A case study on the hydrological basin of the Olt River, Romania

Tracing pollution sources and transformation of nitrogen compounds in surface- and groundwater is an issue of great significance worldwide due to the increased human activity, translated in high demand of water resources and pollution. In this work, the hydrological basin of an important chemical industrial platform in Romania (Ramnicu Valcea industrial area) was characterized in terms of the physico-chemical and isotope composition of δ(18)O and δ(2)H in water samples and δ(15)N of the inorganic nitrogen species. Throughout a period of one year, water samples from the Olt River and its more important tributaries were collected monthly in the industrial area, when the seasonal and spatial isotope patterns of the surface waters and the main sources of pollution were determined. Higher inorganic nitrogen concentrations (up to 10.2 mg N L(-1)) were measured between November 2012 and April 2013, which were designated as anthropogenic additions using the mixing calculations. The main sources of pollution with inorganic nitrogen were agriculture and residential release. The inorganic nitrogen from the industrial waste water duct had a distinct δ(15)N fingerprint (mean of -8.6‰). Also, one industrial release into the environment was identified for Olt River, at Ionesti site, in November 2012. The mean precipitation samples had the lowest inorganic nitrogen concentrations (less than 5.5 mg N L(-1)) with a distinct δ(15)N fingerprint compared to the surface and industrial waters.

Classification of red wines using suitable markers coupled with multivariate statistic analysis

Methodologies for chemometric classification of five authentic red wine varieties from Murfatlar wine center, Romania, young and aged are reported. The discriminant analysis based on several anthocyanins, organic acids, (13)C/(12)C, (18)O/(16)O and D/H isotopic ratios, (1)H and (13)C NMR fingerprints revealed a very satisfactory categorization of the wines, both in terms of variety and vintage, thus illustrating the validity of selected variables for wine authentication purposes. LDA applied to the combined data shows 85.7% classification of wines according to grape variety and 71.1% classification of wines according to vintage year, including a control wine set for each categorization, thus allowing an accurate interpretation of the data. Thereby, anthocyanins, certain anthocyanin ratios, oxalic, shikimic, lactic, citric and succinic acids, sugars like glucose, amino acids like histidine, leucine, isoleucine and alanine, and also 2,3-butanediol, methanol, glycerol and isotopic variables were significant for classification of wines.

Monitoring the Laryngeal Nerves During Thyroidectomy. Initial 115 Cases Experience

The lesions of the laryngeal nerves, despite low incidence, are the most severe long term complications after thyroidectomy. Visualization after careful dissection of the recurrent laryngeal nerve (RLN) is now the golden standard among thyroid surgeons. We assessed traditional landmarks for the identification of RLN and anatomic high risk situation. The study also presented our initial experience using neuro monitoring of RLN (IONM) during surgery. The results show a recognizable Zuckerkandl tubercle in 162 of the 222 cases (72,97%). After dissection RLN was found posterior from TZ in 154 cases (95,06%) and lateral from TZ in 8 cases (4,93%). The identification of the Zuckerkandl tubercle is a useful landmark for RLN localization. As concerning high risk situations we found 2 non recurrent laryngeal nerves (both on the right side). Extra laryngeal ramification of RLN is an anatomical reality with significant incidence (23,8% in our study) and major surgical involvement. Extra laryngeal ramification of RLN occurs more often between the cross point with inferior thyroid artery and larynx entry point. Monitoring the branches of RLN we obtain major EMG signal on the anterior one. The surgical meaning is that the anterior branch carries the most important motor fibers and we have to pay extra care in the correct identification and preservation of it. From a total of 222 visually identified RLN we have 215 nerves (96,84%) with positive EMG signal on monitoring. For 7 nerves (3,15%) we had no EMG signal. In 3 cases (2 total thyroidectomies and 1 lobectomy) involving 5 RLN there was a false negative result caused by electrode malposition or desoldering from endotracheal tube. Our initial experience shows that IONM is harmless, easy to handle and a useful tool for identifying the nerve and confirm its integrity. More extended studies are needed to show if intraoperative monitoring decreases the rate of RLN iatrogenic injury.

Morphological features of melanocytic tumors with depigmented halo: review of the literature and personal results

Halo (Sutton's) phenomenon has been described as a depigmented halo that is associated most commonly with acquired melanocytic nevi; but it may be associated with various types of melanocytic skin tumors, melanoma being the most concerning. Different authors have been preoccupied with elucidating morphological features of melanocytic tumors associated with a depigmented halo. We reviewed the literature and discussed the main features of melanocytic halo tumors regarding histopathological, immune microenvironment profile and dermatoscopic appearance. We highlighted similarities and differences between Sutton's nevus and halo melanoma, also presenting relevant aspects of our results. Depigmented halo must be regarded as a phenomenon that may be associated with different types of melanocytic tumors and with a broad spectrum of histopathological atypia degree. Certain correlations between the shape, diameter, symmetry observed in clinical examination, histopathological appearance, dermatoscopic aspect of peritumoral halo and central tumor type could not be established due to insufficient data and contrasting results. Further studies are expected to add valuable information regarding the depigmented halo tumors features.

Hurdles and delays in access to anti-cancer drugs in Europe

Demographic changes in the world population will cause a significant increase in the number of new cases of cancer. To handle this challenge, societies will need to adapt how they approach cancer prevention and treatment, with changes to the development and uptake of innovative anticancer drugs playing an important role. However, there are obstacles to implementing innovative drugs in clinical practice. Prior to being incorporated into daily practice, the drug must obtain regulatory and reimbursement approval, succeed in changing the prescription habits of physicians, and ultimately gain the compliance of individual patients. Developing an anticancer drug and bringing it into clinical practice is, therefore, a lengthy and complex process involving multiple partners in several areas. To optimize patient treatment and increase the likelihood of implementing health innovation, it is essential to have an overview of the full process. This review aims to describe the process and discuss the hurdles arising at each step.

Isotopic fingerprint of the middle Olt River basin, Romania

One of the most important tributaries of the Danube River in Romania, the Olt River, was characterized in its middle catchment in terms of the isotopic composition using continuous flow-isotope ratio mass spectrometry (CF-IRMS). Throughout a period of 10 months, from November 2010 to August 2011, water samples from the Olt River and its more important tributaries were collected in order to investigate the seasonal and spatial isotope patterns of the basin waters. The results revealed a significant difference between the Olt River and its tributaries, by the fact that the Olt River waters show smaller seasonal variations in the stable isotopic composition and are more depleted in (18)O and (2)H. The waters present an overall enrichment in heavy isotopes during the warm seasons.

Surgical treatment for pulmonary metastases in urogenital cancers

INTRODUCTION

The malignant disease's ability to metastasize remains one of the major obstacles when treating patients with cancer. The indication of metastasectomy is currently limited to patients undergoing treatment of the primary tumor. Resections for lung metastases of high selected patients with urogenital cancer present minimal risks and can prolong survival. Prognostic factors that determine which patients will benefit from surgery are still unclear.

MATERIAL AND RESULTS

This article presents a retrospective analysis of patients who underwent lung metastases resection between 2008 and 2013 in our clinic. Among 148 patients, 8 (5.41%) had lung metastases after urologic cancers (UC), 18 (12.16%) after genital cancers (GC), 13 (8.78%) after breast tumors and 109 (73.65%) had lung metastases from other type of tumors. The overall 6 months survival was 100% for UC, 94.44 for GC, 84.62% for BC and 87.16% for others.

DISCUSSION AND CONCLUSION

The criteria for surgery proved to have a positive predictive value and what should be considered are the following: prolonged disease-free interval (DFI), unilateral disease, the absence of systemic pathologies, oncological margins resecability and less than 3 radioimagistic detectable metastases. A negative prognosis was observed in those with primary tumor in the cervix, at least 3 metastases and a tumor larger than 3 cm. To determine how to select surgical candidates for pulmonary metastasectomy more precisely, further analysis of prognostic factors is evident and the need for a prospective, randomized, multicenter study is clear.

Lesions of the laryngeal nerves during thyroidectomy - what's new?

Lesions to the laryngeal nerves, despite their low incidence, are the most severe long term complications after thyroidectomy.Visualization after careful dissection of the recurrent laryngeal nerve (RLN) is now the gold standard among thyroid surgeons. The Zuckerkandl tubercle (TZ) is a constant landmark for the identification of the RLN. Recent studies show the occurrence of two or more branches of RLN before entering the larynx. Knowledge about their existence could prevent lesions. Some high risk surgical situations are evidenced, such as: non recurrent laryngeal nerve emerging high from the vagus and the superior laryngeal nerve type Cernea 2. Several examination procedures are mandatory for a complete postoperative evaluation: video laryngoscopy and laryngeal electromyography (LEMG) bring valuable objective and prognostic data. However, due to the unpredictability of the synkynesis process, the prognosis of recovery in RLN injuries remains difficult.