Signal-Averaged ECG: Basics to Current Issues

Signal-averaged ECG (SAECG) is a high-resolution, noninvasive electrocardiographic method enabling detection of late ventricular potentials (LVP), which are low-amplitude and high-frequency signals, predicting reentry ventricular arrhythmias, and sudden cardiac death (SCD). Three criteria are used to detect late ventricular potentials as follows: signal-average ECG QRS duration (SAECG-QRS), the duration of the terminal part of the QRS complex with an amplitude below 40 μV (LAS40) and the root mean square (RSM) signal amplitude of the last 40 ms of the signal < 20 μV (RMS40). Late ventricular potentials can be detected not only at the end of a QRS complex but also as intra-QRS (IQRS) potentials. Signal-averaged ECG was modified to enable the analysis of the P-wave and to detect atrial late potentials (ALPs), low-amplitude potentials at the terminal part of the filtered P-wave, and predictors of atrial fibrillation (AF). Late atrial and ventricular potentials originate from areas of delayed, fragmented, and heterogenous conduction within atrial or ventricular myocardium. This chapter reviews the most important mechanisms explaining the occurrence of late ventricular, intra-QRS, and atrial potentials; their predictive value for arrhythmia, focusing on recent clinical data, long-term follow-up, and outcome; and analysis of SAECG variables in cardiac and noncardiac diseases

ROMANIA'S REAL CONVERGENCE TO THE EUROPEAN UNION Dragos Mihai Ungureanu , Permanent Representation of Romania to the European Union Ruxandra Dana Vilag, Romanian-American University Bucharest George Horia Ionescu, Romanian-American University Bucharest Florian Bogdan Stoian, “Lucian Blaga†University of Sibiu

In the process of European integration, switching in 1999 to the third stageof Economic and Monetary Union, has intensified the need to coordinate economic andsectoral policies of the Member States. The process of coordination is necessary toharmonize national economic policy objectives in order to minimize the negative impactof economic policy measures taken by some member countries to other member countriesand reduce the temptation for Member States to have behavior riders. Real Convergenceis an essential goal of Romanian integration into the European Union. Attenuation of thedevelopment gaps maintained between Romania and the EU can not be achieved solelythrough the use of market forces. Economic transformations occurring globally andincreased risk aversion contributed to a signifiant reduction of capital flows to Romania,increased pressures upon exchange rate.Real convergence, nominal convergence, integration, European Union

FINANCIAL CONTAGION AND INVESTORS BEHAVIOR

International capital markets, in general, seem to be volatile markets, influenced bymany factors, a phenomenon that affects both developed markets, as well as least developed, withemerging market economies suffering most because of this. It is clear, however, that volatility willremain for as long as it is delayed the adoption of specific measures at national and internationalfinancial architecture level, measures that may be necessary to reduce these risks, to limit theirimpact, and that the question financial market can relapse in a manner as efficiently as possible.investor behaviour, financial crisis, rational investor, irational investor, financial contagion

ASSESING THE IMPLEMENTATION OF REAL CONVERGENCE IN ROMANIA

The convergence is an essential objective of the integration process of Romania in the European Union. Minimizing gaps in the level of development that arise between Romania and the average European Union can not be achieved solely through the use of marconvergence, European Union, real convergence

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

The most precise evaluation of thyroid masses is by high-sensitive ultrasound. Complementary to B-mode ultrasound, elastography can add valuable information by determining tissue stiffness—an important predictor for malignancy. All major guidelines recommend nodules with high suspicious ultrasound characteristics larger than 1 cm to be addressed to ultrasound-guided fine needle aspiration biopsy (FNAB) to rule out malignancy. The main limitation of this procedure is represented by indeterminate cytology, which accounts for up to 20–25% of biopsy results. Molecular markers imply elevated costs and their performance needs further study. Elastography may be helpful in establishing the optimal therapeutic attitude for this cytological category. Currently, there are two ultrasound elastography methods available for assessing tissue stiffness using the parallel deformation to the applied force direction (strain) or the perpendicular deformation to the force direction (shear wave). These methods will be presented and compared in this chapter, with their indications and limitations for a better understanding of their application in nodular thyroid pathology

Impact of ultrasound elastography in evaluating Bethesda category IV thyroid nodules with histopathological correlation

IntroductionFine needle aspiration (FNA) is the gold standard method recommended in the diagnosis of thyroid nodules. Bethesda IV cytology results are identified in 7-9% of nodules investigated through FNA, with reported malignancy rate in a wide range of 10-40%. The recommended treatment is either surgical or risk additional molecular testing before surgery. However, a large number of nodules belonging to this category (60-80%) are observed to be benign after surgical excision, which can put the patient at risk of unnecessary surgical morbidity. This study aimed to assess the diagnostic performance of conventional ultrasound, the ACR TI-RADS score and elastography in cases of Bethesda IV cytology on FNA.MethodsWe evaluated ninety-seven consecutive cases with Bethesda category IV results on FNA by using conventional B-mode ultrasound, qualitative strain or shear-wave elastography (Hitachi Preirus Machine, Hitachi Inc., Japan and Aixplorer Mach 30 Supersonic Imagine, Aix-en-Provence, France) and all nodules were classified according to the ACR TI-RADS system. Conventional ultrasound was used to categorize the nodules as potentially malignant based on the following features: hypoechogenicity, inhomogeneity, a taller than wide shape, irregular margins, presence of microcalcifications, an interrupted thyroid capsule and suspicious cervical lymph nodes. Elastography classified nodules with increased stiffness as suspicious for malignancy.ResultsWe considered pathology results as the gold standard diagnosis, finding that 32 out of 97 nodules were carcinomas (33%) and 65 out of 97 were benign nodules (67%). The benign group included twenty cases of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). Finally, we compared ultrasound data with pathology results, which showed that nineteen out of the 32 malignant nodules presented with increased stiffness on elastography (p=0.0002). On conventional ultrasound, we found that microcalcifications (p=0.007), hypoechogenicity and irregular margins (p=0.006) are features which can distinguish between benign and malignant nodules with statistical significance.DiscussionIntegrating elastography as a parameter of the ACR TI-RADS score in the evaluation of Bethesda category IV nodules showed a sensitivity of 90.62% in detecting thyroid cancer cases (p=0.006). We can conclude that elastographic stiffness as an addition to high risk features observed on conventional ultrasound improves the detection of malignant nodules in cases with Bethesda IV cytology

Exploring the air pollution with particulate matter - PM10, COVID-19 cases evolution in Romania and exposure to aeroallergens

Constant exposure to the atmospheric air polluted with particulate matter is considered to have a negative influence on human health, even if it is found at values that may not exceed the maximum allowable concentration. Starting from the correlation between atmospheric air polluted with PM and COVID-19 incidence/mortality, this research had as first objective to assess the exposure to an average concentration of PM10 in Romania and, in particular, in Bucharest for a period of six years and the cumulative incidence of COVID-19 cases per 1000 inhabitants (continuing previous research, from 2020). Subsequently, we studied the cumulative incidence of COVID-19 cases per 1000 inhabitants until January 2022. Another research objective was to identify a possible association between the atmospheric air polluted with particulate matter, viruses (SARS-CoV-2) and aeroallergens (common ragweed). To achieve the first two proposed objectives, the research method used was a univariate statistical analysis, correlation and regression analysis, subsequently analyzing the data and comparing with the results obtained in the research conducted previously (2020). In the selection of data, which formed the basis of the last part of the research, we used the recommendations of the PRISMA-ScR Guidelines, which were useful and guided us in the proper conduct of the research and in obtaining results in line with the proposed purpose. The applied regression model showed that in Bucharest, 86.34% of the variation in the cases incidence is explained by the variation in the PM10 concentration. In the second part of the research, we observed an exponential increase in the number of cases, without demonstrating a direct causal relationship with exposure to particulate matter air polluted. Otherwise, we additionally studied the data on the existence of a causal relationship between the increase of pollen in the atmospheric air over time and the incidence of SARS-CoV-2 infection, as well as the data that considered that there would be no causal relationship between these parameters

Elastography: A New Ultrasound Technique in Nodular Thyroid Pathology

Elastography is a new technique for evaluating the stiffness of nodules. It is generally recognised that malignant thyroid lesions are harder than benign lesions. Different elastographic techniques are presented, with characteristics, advantages and limitations. Qualitative and semiquantitative methods are described. Comparison of the main existing techniques, static and dynamic elastographies, is presented in this chapter. Strain elastography seems to have a better diagnostic quality than shear wave elastography in the diagnosis of thyroid cancer disease. A positive elastogram, suggestive for malignancy is more useful in diagnosis than a positive grey-scale ultrasound evaluation. Elastography increases the specificity of grey scale ultrasound (US), it should be always integrated with its information and should be considered as a complement of conventional US

Importanța estetică a mâinii operate

Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Introducere. Traumatismele mâinii reprezintă una dintre cele mai mari suferințe. Reconstrucțiile chirurgicale sunt critice și necesită iscusința chirurgului pentru păstrarea structurii anatomice, funcției și importanța esteticului. Scopul lucrării. Studiul a fost conceput pentru a marca importanța estetică în practica chirurgiei reconstructive asupra mâinii operate din prisma corelației dintre gravitatea leziunilor și rezultatului estetic postoperator. Material și Metode. Studiu de tip observațional s-a desfășurat în Clinica de Chirurgie Plastică în Institutul de Medicină Urgentă. Eșantionul a cuprins 175 pacienți cu tramatisme mutilante. Bărbați 107, femei 68, cu vârsta de la 15-60 ani. Leziunile au fost pe falange în 115 cazuri, în regiunea metacarpiană 32, la nivelul carpului 23 și în 5 cazuri pe întreaga suprafață a mâinii. Rezultate. Studiul s-a exat pe examinarea relației dintre severitatea traumei la mâina operată și modificarea calității vieții pacientului prin prisma esteticului corelat cu impactul funcțional și psihologic. Studiul a demonstrat legătura atât dintre satisfacția imaginii, cât și a funcției mâinii operate, corelate cu indicatorul mic al injuriei. Concluzii. Încercarea de a păstra atât funcția, cât și aspectul estetic în fiecare grup de patologii necesită mult efort. Valoarea înaltă a scorului HISS solicită timp, costuri majore și tehnică de performanță. Sporirea calității vieții, integrării în societate și dorința de recuperare cresc gradual