Oncogenesis- kaleidoscopic and multi-level reality

Oncogenesis is an extremely complex phenomenon. The mechanisms by which cancer is induced is only partially known. Consequently, therapeutic targets may be uncertain and results are often unsatisfactory. The purpose of this paper is to develop a trans-level and multiple transdisciplinary perspective describing the kaleidoscopic reality of oncogenesis. This manner of understanding oncogenesis as a complex process characterized by a non-linear dynamic, far from equilibrium and with unpredictable evolution, transcends the classical perspective and requires a paradigm shift. This approach is also facilitated by recent studies that focus on group phenomena, with emerging behaviors in a continuous phase transition. Biological systems, and obviously the human organism, express this type of behavior with critical self-organizing valences in the context of a genome - mesotope (environment) - phenotype interaction. For example, nature has transposed in the ecosystem, among other things, the performance pattern of its mineral history represented by the dynamic energy-matter-information unit (the principle of invariance). And multi-cell biological systems in the phylogenetic tree crown have multiple directed aerobic metabolisms in accordance with specific functions. Cancers, in turn, have a hybrid (anaerobic and aerobic) and unidirectional metabolism whose only and ultimate reason is the survival of the malignant cell. Understanding the transdisciplinary reality of oncogenesis offers novel development paths for new therapeutic strategies compared to current ones which have relatively limited efficiency

Forensic and clinical diagnosis in shaken baby syndrome , between child abuse and iatrogenic abuse

“Shaken baby syndrome” in child abuse cases is a challenge for pediatrician and forensic experts, often a diagnosis of exclusion, with overwhelming moral and legal implications. Diagnosis is based on: subdural bleeding, rupture of retinal vessels, traumatic diffuse axonal injury with diffuse brain encephalopathy in the absence of external traumatic injuries and anamnesis data of an accidentally head injury. Microscopic findings in diffuse axonal injuries were initially considered as a specific traumatic effect due to unrestricted movement and accelerated rotation of the head. Immunohistochemistry of beta amyloid protein precursor is gold standard method for identifying pathological diffuse axonal lesions, which is however non-specific in brain trauma. In the diagnosis of this syndrome pediatricians and forensic examiners must take into account the particularities of each case, avoiding scientific speculation, to intuit controversies and always be familiar with the differential diagnosis

QUALITY MANAGEMENT IN THE ROMANIAN PHARMACEUTICAL FIELD DURING THE COVID-19 PANDEMIC

Health services are very important, as in any economy, because the life of all mankind depends on them. Bearing in mind that the pharmacist is the first and last filter in the medical system, we believe that they have a decisive role in the COVID-19 pandemic. Pharmacists must take extra measures to protect themselves, their families, and the community. All patients can be considered as COVID-positive, but pharmacists will offer them the same services and care as before.In the last 15 years, Romania has faced a complex socio-demographic process.The decrease in the birth rate, the general mortality rate and the emigration of the young population led both to the aging of the working age population and to the decrease of the total population of the country.All this aspect led to the reduction of the population size and required a rethinking of the health services system of social protection, in view of prolonging the active life of the population both from the point of view of the quality of the services offered and of the infrastructural facilities.The consumption of services represents an indicator of the quality of life, which we want to discuss in this article

The implementation of the internal audit in the public sector from Romania

In compliance with the European requirements, Romania started implementing internal audit in the public sector in 1999 through the reform at the level of the Public Internal Financial Control System. To set the startegic directions on a short and medium term for public internal financial control in Romania, the Strategy for Developing the Public Internal Financial Control in Romania has been developed and it was finalised in October 2001. This document set up the architecture for the new internal audit system in the public sector. Negociations for Chapter 28 – Financial Control started during the Intergovernmental Conference Romania – EU from June 28th 2002, in compliance with the Common Position of the European Union, and the implementation of the Action Plan for the new system was done in several stages: a) Setting up the legal framework for internal audit, including norms and procedures; b) Institution building, namely reengineering the old internal control structures; c) Professional training; d) Strengthening the internal audit activity by raising the awareness of the management on the internal audit role; After analising the current stage of implementation for internal audit in the public sector, we may conclude that Romania is on the right track, supporting the set-up and strengthening of the internal audit function at the level of the entities, in accordance with the good practice in the field. To conclude, the efforts made to harmonise the national legislation in this field with the acquis communautaire should proceed, focusing on even stricter requirements, so that an harmonisation between the Romanian legislative framework, the European Union directives and the International Audit Standards may be achieved.internal audit, reformof the public financial control, public sector.

THE NECESITY FOR AUDITING THE FINANCIAL-ACCOUNTING ACTIVITY

Many financial-accounting information users mistake internal audit and accounting. These confusion has, at is basis, the fact that most internal audit activities regard financial-accounting information and the fact that most internal auditors have a significant background in fields regarding accounting. Although the origins of accounting and audit are not clearly defined they have different application domains. The practice has imposed the abandonment of the entity’s internal audit correlated with the financial-accounting function significance and the growth of its importance by including the internal audit function in the direct subordination of the general managementaudit, system, value for money, performance, financial-accounting information

Creación y puesta en marcha de una empresa para la venta online de bolsos de piel

El objetivo de este proyecto es el de crear una tienda online real donde los posibles clientes puedan explorar los productos de piel natural que ofrece la tienda y puedan realizar sus pedidos a través de los mecanismos que ofrece la web. Para ello utilizaremos la plataforma gratuita PrestaShop para implementar la web de la tienda, registraremos nuestro dominio y contrataremos hospedaje web, cumpliendo con todos los tramites legales ante Hacienda y la Seguridad Social.Calota, OC. (2015). Creación y puesta en marcha de una empresa para la venta online de bolsos de piel. http://hdl.handle.net/10251/56499.Archivo delegad

The role of reactive astrocitose in the chronological evolution of traumatic brain injury

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions. Materials and methods. The present study consists of a series of 23 medico-legal cases that underwent autopsy inTeleormanCounty(Romania) Department of Forensic Medicine during 2007–2016, with full immune-histochemical microscopic examination using GFAP staining. The study consists of two groups, a series of 13 cases with cranio-cerebral trauma with different posttraumatic survival periods and 9 cases as a control group. Results and discussions. We discovered GFAP+ reactive astrocytes even when death occurred immediately after the trauma event and up to 4 months after the traumatic incident. We also discovered an intense positive correlation between the density of the GFAP+ cell from the perilesional area and the posttraumatic survival period. The highest cerebral density of the GFAP+ astrocytes occurred with acute death prior (1 to 24 hours) and the lowest in the chronic period (over 2 weeks). Conclusions. The gradual and differentiated appearance of the reactive astrocytes in close relation with the cerebral posttraumatic interval, with specific lesional and perilesional distribution as well as in surrounding area, clearly demonstrates that the state of the reactive astrocitose may constitute an objective index for evaluation of the elapsed time after the posttraumatic event

The role of reactive astrocitose in the chronological evolution of traumatic brain injury

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions. Materials and methods. The present study consists of a series of 23 medico-legal cases that underwent autopsy inTeleormanCounty(Romania) Department of Forensic Medicine during 2007–2016, with full immune-histochemical microscopic examination using GFAP staining. The study consists of two groups, a series of 13 cases with cranio-cerebral trauma with different posttraumatic survival periods and 9 cases as a control group. Results and discussions. We discovered GFAP+ reactive astrocytes even when death occurred immediately after the trauma event and up to 4 months after the traumatic incident. We also discovered an intense positive correlation between the density of the GFAP+ cell from the perilesional area and the posttraumatic survival period. The highest cerebral density of the GFAP+ astrocytes occurred with acute death prior (1 to 24 hours) and the lowest in the chronic period (over 2 weeks). Conclusions. The gradual and differentiated appearance of the reactive astrocytes in close relation with the cerebral posttraumatic interval, with specific lesional and perilesional distribution as well as in surrounding area, clearly demonstrates that the state of the reactive astrocitose may constitute an objective index for evaluation of the elapsed time after the posttraumatic event

Does acute passive stretching increase muscle length in children with cerebral palsy?

This article has been made available through the Brunel Open Access Publishing Fund. Copyright @ The Authors. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and the source are credited.Background: Children with spastic cerebral palsy experience increased muscle stiffness and reduced muscle length, which may prevent elongation of the muscle during stretch. Stretching performed either by the clinician, or children themselves is used as a treatment modality to increase/maintain joint range of motion. It is not clear whether the associated increases in muscle–tendon unit length are due to increases in muscle or tendon length. The purpose was to determine whether alterations in ankle range of motion in response to acute stretching were accompanied by increases in muscle length, and whether any effects would be dependent upon stretch technique. Methods: Eight children (6–14 y) with cerebral palsy received a passive dorsiflexion stretch for 5 × 20 s to each leg, which was applied by a physiotherapist or the children themselves. Maximum dorsiflexion angle, medial gastrocnemius muscle and fascicle lengths, and Achilles tendon length were calculated at a reference angle of 10° plantarflexion, and at maximum dorsiflexion in the pre- and post-stretch trials. Findings: All variables were significantly greater during pre- and post-stretch trials compared to the resting angle, and were independent of stretch technique. There was an approximate 10° increase in maximum dorsiflexion post-stretch, and this was accounted for by elongation of both muscle (0.8 cm) and tendon (1.0 cm). Muscle fascicle length increased significantly (0.6 cm) from pre- to post-stretch. Interpretation: The results provide evidence that commonly used stretching techniques can increase overall muscle, and fascicle lengths immediately post-stretch in children with cerebral palsy

Incidence and Determinants of Symptomatic and Asymptomatic SARS-CoV-2 Breakthrough Infections After Booster Dose in a Large European Multicentric Cohort of Health Workers-ORCHESTRA Project

Background: SARS-CoV-2 breakthrough infections (BI) after vaccine booster dose are a relevant public health issue. Methods: Multicentric longitudinal cohort study within the ORCHESTRA project, involving 63,516 health workers (HW) from 14 European settings. The study investigated the cumulative incidence of SARS-CoV-2 BI after booster dose and its correlation with age, sex, job title, previous infection, and time since third dose. Results: 13,093 (20.6%) BI were observed. The cumulative incidence of BI was higher in women and in HW aged < 50 years, but nearly halved after 60 years. Nurses experienced the highest BI incidence, and administrative staff experienced the lowest. The BI incidence was higher in immunosuppressed HW (28.6%) vs others (24.9%). When controlling for gender, age, job title and infection before booster, heterologous vaccination reduced BI incidence with respect to the BNT162b2 mRNA vaccine [Odds Ratio (OR) 0.69, 95% CI 0.63-0.76]. Previous infection protected against asymptomatic infection [Relative Risk Ratio (RRR) of recent infection vs no infection 0.53, 95% CI 0.23-1.20] and even more against symptomatic infections [RRR 0.11, 95% CI 0.05-0.25]. Symptomatic infections increased from 70.5% in HW receiving the booster dose since < 64 days to 86.2% when time elapsed was > 130 days. Conclusions: The risk of BI after booster is significantly reduced by previous infection, heterologous vaccination, and older ages. Immunosuppression is relevant for increased BI incidence. Time elapsed from booster affects BI severity, confirming the public health usefulness of booster. Further research should focus on BI trend after 4th dose and its relationship with time variables across the epidemics.BackgroundSARS-CoV-2 breakthrough infections (BI) after vaccine booster dose are a relevant public health issue.MethodsMulticentric longitudinal cohort study within the ORCHESTRA project, involving 63,516 health workers (HW) from 14 European settings. The study investigated the cumulative incidence of SARS-CoV-2 BI after booster dose and its correlation with age, sex, job title, previous infection, and time since third dose.Results13,093 (20.6%) BI were observed. The cumulative incidence of BI was higher in women and in HW aged < 50 years, but nearly halved after 60 years. Nurses experienced the highest BI incidence, and administrative staff experienced the lowest. The BI incidence was higher in immunosuppressed HW (28.6%) vs others (24.9%). When controlling for gender, age, job title and infection before booster, heterologous vaccination reduced BI incidence with respect to the BNT162b2 mRNA vaccine [Odds Ratio (OR) 0.69, 95% CI 0.63-0.76]. Previous infection protected against asymptomatic infection [Relative Risk Ratio (RRR) of recent infection vs no infection 0.53, 95% CI 0.23-1.20] and even more against symptomatic infections [RRR 0.11, 95% CI 0.05-0.25]. Symptomatic infections increased from 70.5% in HW receiving the booster dose since < 64 days to 86.2% when time elapsed was > 130 days.ConclusionsThe risk of BI after booster is significantly reduced by previous infection, heterologous vaccination, and older ages. Immunosuppression is relevant for increased BI incidence. Time elapsed from booster affects BI severity, confirming the public health usefulness of booster. Further research should focus on BI trend after 4th dose and its relationship with time variables across the epidemics