FGF23 and primary hyperparathyroidism: is there a link?

Introduction: Data regarding the role of fibroblast growth factor 23 (FGF23) in primary hyperparathyroidism (PHPT) are scarce and discordant. Our study aimed to evaluate the prognostic impact of FGF23 upon the clinical and biochemical evolution of PHPT. Material and methods: Forty-two patients with ages between 30 and 80 years, diagnosed with PHPT caused by a sporadic, solitary parathyroid adenoma, and referred to surgery (minimally invasive parathyroidectomy) were prospectively included in the study. Serum levels of FGF23, PTH, 25(OH)D3, calcium (Ca), phosphate (P), total procollagen type 1 N-terminal propeptide, and C-terminal telopeptide of type I collagen were determined at baseline (preoperatory), one day after surgery, and in 13 patients also prospectively at three, six, and 12 months. Bone mineral density (BMD) was also evaluated before surgery in all patients and 12 months after surgery in the 13followed up patients. Results: In the 42 PHPT patients with D hypovitaminosis (mean 25(OH)D3 levels of 16.2 ± 1.5 ng/mL), preoperatory serum FGF23 concentration was within the normal range (75.55 ± 3.39 pg/mL) and remained unchanged one day post operation (81.69 ± 4.67 pg/mL, p = non-significant). The 13 patients followed prospectively for up to 12 months after surgery also showed unmodified FGF23 levels (80.9 ± 11.03 pg/mL, p = non-significant), despite PTH and Ca normalisation and vitamin D replenishment. Preoperatory FGF23 negatively correlated with PTH (r = –0.37, p = 0.038), but not with 25(OH)D3, Ca, P, bone mass, or metabolism markers. Conclusions: In PHPT, correlations between FGF23 and PTH seem rather an epiphenomenon. Therefore, we think that FGF23 evaluation and dynamics are not informative regarding PHPT severity. (Endokrynol Pol 2020; 71 (4): 306–312

Role of nurses' electrocardiography competency in emergent situations

Electrocardiography is an essential tool in emergency care and monitoring of patients with severe cardiovascular diseases. Nurses are at the center of this evaluation and play an important role in the outcome of therapy. Data shows that nurses are limited in their ability to record and interpret electrocardiography diagrams accurately. Little is known about the role nurses play in electrocardiographic evaluation in an emergency. This narrative literature review assesses the competency of nurses in electrocardiography in an emergency, the implications for medical practice, and tries to identify possible improvement solutions

Cutaneous Adverse Reactions to TNF Alpha Blockers. Case Report and Literature Review

Biological therapy is used in a wide range of medical settings. Adverse reactions to biological therapy can limit their widespread use, so early detection and treatment can adjust attempts to stop these molecules. TNF Alpha blockers may cause the following skin reactions in alpha patients: injection site reactions, infections, immune-mediated reactions (psoriasis, psoriasis, drug-induced lupus, vasculitis, hidradenitis, alopecia), allergic or neoplastic reactions. We present the case of a patient with RA who developed skin lesions during biological therapy and was diagnosed with drug-induced lupus based on clinical elements, associated autoimmunity, and dermatological evaluation. The skin lesions were attributed to the interaction of three medications (biosimilar Etanercept, Leflunomide, and Isoniazid), all of which have been implicated in causing these side effects. The solutions that saved the patient were temporarily discontinuing the immunosuppressive medication and replacing it with a local corticoid, followed by the continuation of Etanercept in associated with Methotrexate, and the patient was able to continue the biological medication and obtain a favorable response to the treatment. In conclusion, skin changes caused by TNF Alpha inhibitors are common, but vary in severity, and do not warrant therapy interruption

Organizing urban planning doctoral education in a global context

Starting in 2005, Romanian education started its true reform in a globalizing context. Universities were assessed based on their performance; as a result, the doctoral education, meant to provide for the future trainers at Bachelor’s and Master’s levels, had to re-focus on research. The process was slower in the case of urban planning, due to the fact that publications and citations are not characteristic research outputs of the field. The paper discusses the process of creating the first Romanian doctoral school of urban planning starting from the hypothesis that its new focus required a positivist systemic understanding of urban planning research. The results show that the new approach was productive and well received by the doctoral students, and has a beneficial influence on urban planning in general, increasing its international visibility

Study On Instruments And Methodologies Used In The Analysis Of The Religious Phenomena Through Statistic Surveying Techniques

This article presents the content of a statistical research instrument(survey) which was used in a statistical survey focused on the religiousphenomena and the (inter)connections generated within social and economic processes. We considered a descriptive operational fashion for each item (item) included in the survey. Due to the limited space of this article, we haven’t presented all sections of the survey

CLINICAL-STATISTICAL CROSS-SECTIONAL STUDY ON THE PREVALENCE OF GINGIVAL RECESSION

The aim of this cross-sectional study was to determine, în a group of patients, the prevalence of gingival recession (GR) and to assess its risk factors by making correlations between GR and demographic, dental, etiological items. Material and method. The study was carried ouţ on a batch of 422 patients, aged 20-59 years, who showed up at a private practice în Bucharest during 2016-2018. Data collection was performed by questionnaire method and clinical examination with mirror and periodontal probe; the presence of GR was measured în mm, from cementum-enamel junction (CEJ) to the gingival margin on facial and oral surfaces of all teeth and was reported according to Miller's classification, into 4 classes. The Silness-Löe plaque index (PI) and the degree of evolution by determining the extension în the surface, according to Marini's criteria were calculated. The data were analyzed using SPSS software version 20, and Chi-Square test for the comparative analysis. Results and discussions. GR prevalence was 66%, with greater impairment în older patients (19% în the 20-29 age group to 30% în the 50-59 age group), în males (55%) and lower incisors. Statistical analysis showed the presence of statistical significance between GR and the analyzed etiological factors (presence of plaque, type of brushing, dental changes (position, location, shape), biotype, history of orthodontic treatments, endocrine changes and premenopause). Smoking and drinking alcohol were also considered predisposing factors. The study showed that there îs a statistically significant correlation between smoking and the presence of hygiene, brushing and dental malpositions and also an association between the degree of education and analyzed etiologic factors. Conclusions. More than half of the examined patients shows GR. Plaque, brushing type, dental changes, biotype, orthodontic treatments, endocrine and premenopausal changes, smoking and alcohol consumption are etiological factors significantly associated with GR appearance

Leptin and adiponectin dynamics at patients with rectal neoplasm - Gender differences.

BackgroundNumerous studies associate adipokines with colorectal malignancy, but few data deal with patients suffering exclusively of rectal carcinoma (RC).AimsWe evaluated leptin and adiponectin levels in RC patients compared to healthy population and their dynamics after surgery.Material and methodsSerum leptin and adiponectin were evaluated before surgery in 59 RC consecutive patients (38 males and 21 females), and in age and weight matched healthy controls. Measurements were repeated at 24, 72 hours and 7 days after surgery.ResultsAdipokine levels were higher in women. Controls had higher leptin (32.±4.34 vs 9.51±1.73 ng/ml in women and 11±2.66 vs 2.54±0.39 ng/ml in men, p = 0.00048 and 0.0032) and lower adiponectin (9±0.64 vs 11.85±1.02 μg/ml in women and 7.39±0.51 vs 8.5±0.62 μg/ml in men, p = 0.017 and 0.019) than RC patients. Surgery caused an increase of leptin from 5.11±0.8 to 18.7±2.42 ng/ml, p = 6.85 x 10¨8, and a decrease of adiponectin from 9.71±0.58 to 7.87±0.47 μg/ml, p = 1.4 x 10¨10 for all RC patients and returned thereafter to the initial range at 7 days. Adipokines were correlated with body weight (BW). The significance of correlation persisted after surgery only in males, but disappeared in females. Adipokines were not modified by tumor position, presurgical chemoradiotherapy or surgical technique. Women with RC experiencing weight loss had higher adiponectin than women without weight modifications (pConclusionsAdipokine levels of patients with RC differ from the healthy population, possibly reflecting an adaptation to disease. Adipokine modifications after surgery may be related to acute surgical stress. Whether leptin and adiponectin directly interact is not clear. Women have higher adipokine levels, more so after significant weight loss, but the strength of their correlation with BW decreases after surgery. These data suggest gender differences in the adipokine profile of RC patients which may find clinical applications

OPTICAL MICROSCOPY STUDY ON THE MARGINAL ADAPTATION OF TUNNEL RESTAURATIONS WITH RESINS COMPOSITE

Minimally invasive restoration is the modern way of treatment in dental therapy. Tunneling / tunnel preparation is a viable option for minimally invasive restoration of proximal caries located on the posterior teeth, with approach from the occlusal aspect of the tooth. The aim of this study is to check by means of optical microscopy the ability of marginal adaptation to dental structures of the tunnel type restorations. Material and method. For this study, 36 extracted teeth were used, on which tunnel preparations were performed both on the mesial and the distal aspects of the teeth. The preparations took into account the protocol and principles of minimally invasive therapy. For all restorations, a combination of composite resins was used. The tunnel preparation was restored using flow composites and a normal consistency composite was used to restore occlusal morphology. Depending on the restoration materials and the adhesive system used, the teeth were divided into 3 groups with 12 teeth each. Group 1: Fine Etch 37%, Adper Single Bond 2, 3M Espe, Beautifil Flow Plus, Shofu, Beautifil II, Shofu. Group 2: Fine Etch 37%,Zmack Bond, Zhermack, Es Flow,Zmack Comp, Zhermack. Group 3: Opti Bond XTR, Kerr, SDR, Dentsply, Premise, Kerr. To highlight marginal microleakage, the teeth were isolated using a nail polish applied across the entire dental surface except for the 2 mm area surrounding the proximal restorations.They were then immersed for 24 hours in 2% methylene blue. Finally, the teeth were washed and cut in mesio-distal direction at low speed by means of a diamond disk, under cooling with water. Results and discussions. The optical microscope examination revealed marginal microleakage in all three restored groups. The results of the study showed that the lowest microleakage was revealed in restorations that used giomers and single-step adhesive system. Conclusions. The combination of flow and high-consistency composite resins seems to be a viable solution for tunneling restorations

STUDY ON THE DEGREE OF ENAMEL DAMAGE ACCORDING TO DIFFERENT ETCHING PROTOCOLS USED FOR FIXED ORTHODONTIC APPLIANCES

Along with whitening techniques, fixed orthodontic appliances (FOA) is currently one of the patients' favorite maneuvers looking for aesthetic appearance. Most of the time, FOA results are spectacular, but the appearance of demineralization and white spot lesions (WSL) around brackets is one of the great challenges for both the clinician and the patient. So it is important not to act to ease their appearance, by applying inappropriate enamel demin-eralization techniques to the FOA adhesion process. Material and method. For this study, 20 lower incisors were used and braces were bonded in the middle third of the vestibular aspect. For the application of the brackets, the bonding protocol and the manufacturers' indications have been respected. Only the enamel etching time was modified to allow the teeth to be divided into 3 groups: the first group, the etching time was 30 seconds, for the second 45 seconds and 60 seconds respectively for the third group. The teeth were kept in distilled water for one month and then the brackets were removed. The remaining composite areas on the teeth were kept. For SEM evaluation of the enamel / hybrid layer, the teeth were longitudinally sectioned using a diamond disk under water cooling and at low speed. Results. Increasing the etching time with phosphoric acid of the enamel over 30 sec, value that gives a favorable etching pattern for adhesion, has the consequence of forming a thicker hybrid layer after application of the primer. Conclusions. Etching of the enamel for 60 seconds with phosphoric acid is followed by the formation of a thick hybrid layer and the settlement of an unfavorable etching pattern. After brackets removing, the etched enamel surfaces can be remineralized with saliva ions, but the more aggressive the etching, the more incomplete the remineralization, favoring the installation of white spot lesions