Surgical tactics in acute purulent cholangitis

Catedra de chirurgie nr. 2, USMF „Nicolae Testemiţanu”, Chișinău, Republica Moldova, Conferința stiințifică „Nicolae Anestiadi – nume etern al chirurgiei basarabene” consacrată centenarului de la nașterea profesorului Nicolae Anestiadi 26 august 2016Scopul. Elaborarea managementului chirurgical în angiocolita acută purulentă. Material și metode. Prezentăm experiența clinicii în tratamentul a 645 de cazuri de colangită acută, tratați pe parcursul ultimilor 5 ani. Am recurs la tratamentul etapizat al colangitei acute purulente folosind tehnicile mini-invazive ca un standard de aur, punând accentul pe cele endoscopice (630(95%) cazuri) și foarte rar pe cele percutan-transhepatice (15(2.33%) cazuri). În cazurile extrem de grave (67(10.34%)cazuri) am fost adepții la ERCP seriate în mai multe prize cu lavajurile locale prin stend și introducerea de antibiotic local, restabilirea un grad de decompresie adecvat. Pentru pacienții extrem de dificili (15(2,26%) cazuri), suntem părtașii drenajului nazo-biliar, ce nea permis un control permanent cu lavajuri continui cu antiseptici și introducerea de antibiotici nemijlocit în CBP. Rezultate. Metodele endoscopice au permis dezobstrucția definitivă a arborelui biliar în 470(73%) cazuri. În celelalte 150(23,26%) de cazuri au permis doar o stentare(135(21%)) sau o drenare nazo-biliară(15(2,26%)) pentru asanarea colangitei purulente și cuparea sindromului icteric. Acești pacienți au beneficiat diferite intervenții chirurgicale în etapa a doua, pentru o restabilire adecvată a fluxului biliar în intestin. Mortalitatea generală a fost de 32(5%) cazuri. Concluzii. Este importantă aprecierea la justa valoare a gradului de gravitate a colangitei acute, ce permite adoptarea a unui management corect pentru fiecare caz clinic, iar aplicarea tacticii tratamentului etapizat ne va permite obținerea unor rezultate fiabile în această patologie severă.Purpose. Acute suppurative cholangitis management in appreciation. Materials and methods: There is presented clinic’s experience in the treatment of 645 cases of acute cholangitis during the last 5 years. We used the stepwise treatment of acute suppurative cholangitis using minimally invasive techniques as a gold standard, focusing on the endoscopic (630 (95%) cases) and very rarely on the percutaneous-transhepatic ones (15 (2.33%) cases). In extremely severe cases (67 (10.34%) cases) we have been for ERCP divided in steps with local lavages by stent and the introduction of local antibiotic, restoring an adequate degree of decompression. For extremely difficult patients (15 (2.26%) cases) we are partakers of nasobiliary drainage, which allowed us to control permanently with continues lavages with antiseptic and direct introduction of antibiotic in MBD. Results. The endoscopic methods allowed definitive desobstruction of the biliary tree in 470(73%) cases. In the other 150(23,26%) cases, it allowed only a stentation or a nasobiliary drainage (15(2,26%)) for sanitation of suppurative cholangitis and cutting the icteric syndrome. These patients beneficiated from different surgical interventions in the second stage for an adequate recovery of bile flow to the intestine. The general mortality was about 32(5%) cases. Conclusion. It is important to assessing the true value of the degree of severity of acute cholangitis, which allows the adoption of a right for every clinical case management and treatment tactics phased implementation will allow us to obtain reliable results in this severe disease

FRACTAL DIMENSION OF URBAN EXPANSION BASED ON REMOTE SENSING IMAGES

Fractal Dimension of Urban Expansion Based on Remote Sensing Images: In Cluj-Napoca city the process of urbanization has been accelerated during the years and implication of local authorities reflects a relevant planning policy. A good urban planning framework should take into account the society demands and also it should satisfy the natural conditions of local environment. The expansion of antropic areas it can be approached by implication of 5D variables (time as a sequence of stages, space: with x, y, z and magnitude of phenomena) into the process, which will allow us to analyse and extract the roughness of city shape. Thus, to improve the decision factor we take a different approach in this paper, looking at geometry and scale composition. Using the remote sensing (RS) and GIS techniques we manage to extract a sequence of built-up areas (from 1980 to 2012) and used the result as an input for modelling the spatialtemporal changes of urban expansion and fractal theory to analysed the geometric features. Taking the time as a parameter we can observe behaviour and changes in urban landscape, this condition have been known as self-organized – a condition which in first stage the system was without any turbulence (before the antropic factor) and during the time tend to approach chaotic behaviour (entropy state) without causing an disequilibrium in the main system

Surgical management in acute purulent cholangitis

Catedra de chirurgie nr. 2, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scopul studiului a fost elaborarea managementului chirurgical în angiocolita acută purulentă. Material şi metode: Prezentăm experienţa Clinicii în tratamentul a 645 de cazuri de colangită acută, tratate pe parcursul ultimilor 5 ani. Am recurs la tratamentul etapizat al colangitei acute purulente folosind tehnicile mini-invazive ca un “standard de aur”, punând accentul pe cele endoscopice – 630 (95%) cazuri şi foarte rar pe cele percutan-transhepatice – 15 (2,33%) cazuri. În cazurile extrem de grave – 67 (10,34%), am fost adepţii la ERCP seriate în mai multe prize cu lavajurile locale prin stent şi introducerea de antibiotic local, restabilirea unui grad de decompresie adecvat. Pentru pacienţii extrem de dificili – 15 (2,26%) cazuri, suntem părtaşii drenajului nazo-biliar, ce ne-a permis un control permanent cu lavajuri continue cu antiseptice şi introducerea de antibiotice nemijlocit în calea biliară principală. Rezultate: Metodele endoscopice au permis dezobstrucţia definitivă a arborelui biliar în 470 (73%) cazuri. În celelalte 150 (23,26%) cazuri – au permis doar o stentare (n=135, ce constituie 21%) sau o drenare nazo-biliară (n=15 sau 2,26%) pentru asanarea colangitei purulente şi cuparea sindromului icteric. Aceşti pacienţi au beneficiat de diferite intervenţii chirurgicale în etapa a doua, pentru o restabilire adecvată a fluxului biliar în intestin. Mortalitatea generală a fost de 32 (5%) cazuri. Concluzii: Este importantă aprecierea la justa valoare a gradului de gravitate a colangitei acute, ce permite adoptarea unui management corect pentru fiecare pacient, iar aplicarea tacticii tratamentului etapizat ne va permite obţinerea unor rezultate fiabile în această patologie severă.Purpose: Improvement of acute suppurative cholangitis management. Material and methods: There is presented clinic’s experience in the treatment of 645 cases of acute cholangitis during the last 5 years. We used the stepwise treatment of acute suppurative cholangitis using minimally invasive techniques as a gold standard, focusing on the endoscopic – 630 (95%) cases and very rarely on the percutaneous-transhepatic ones – 15 (2.33%) cases. In extremely severe cases – 67 (10.34%) we used scheduled ERCP with local lavage through stent and the topical introduction of antibiotics, achievement of an adequate decompression. For extremely difficult patients (n=15 or 2.26% cases) we are partakers of nasobiliary drainage, which allowed us to control permanently with continues lavages with antiseptic and direct introduction of antibiotic in common biliary duct. Results: The endoscopic methods allowed definitive desobstruction of the biliary tree in 470 (73%) cases. In the other 150 (23.26%) cases, it allowed only a stentation or a nasobiliary drainage (n=15 or 2.26%) for sanation of suppurative cholangitis and elimination of jaundice. These patients beneficiated from different surgical interventions on the second stage for an adequate recovery of bile flow to the intestine. The general mortality was 32 (5%) cases. Conclusions: It is important to assessing the true value of the degree of severity of acute cholangitis, which allows the election of a correct management for every patient, whereas the scheduled treatment policy will allow us to obtain reliable results in this severe disease

2′-Iodo-2,2′′,3,3′′,4,4′′,5,5′′,6,6′′-deca­methyl-1,1′:3′,1′′-terphenyl chloro­form monosolvate

The title compound, C28H33I·CHCl3, forms dimers through C—I⋯π inter­actions. The crystal structure is consolidated by the presence of C—H⋯π inter­actions between the chloro­form solvent and the main mol­ecule

Replantation of different anatomical segments of the upper limb

CNŞPMU, Conferinţa Naţională în cadrul Asociaţiei Ortopezilor – Traumatologi din Republica Moldova ”Actualităţi în microchirurgia reconstructivă”, Chișinău, Republica MoldovaÎn lucrare sunt analizate 34 cazuri de replantare ale segmentelor amputate a membrului superior. În total au fost replantate: degete – 34 cazuri, segmentul mîinei la nivelul oaselor metacarpiene –2; la nivelul oaselor carpiene – 2, la nivelul articulaţiei pumnului – 1, segmentul treimii distale a antebraţului – 1. Replantarea au fost reuşite în 20 cazuri (64.7%).In this study 34 cases replantation of amputated segments at different levels were analyzed. In total there were replanted: fingers – 34 cases, the hand segment at the level of metacarpal bones –2 cases; at the level of carpal bones – 2 cases, at the level of the wrist joint – 1 case, at the distal one-third of the forearm – 1 case. Replantations were successful in 20 cases (64.7%)

(2,4,6-Trimethyl­phen­yl)boronic acid–triphenyl­phosphine oxide (1/1)

In the crystal structure of the title compound, C9H13BO2·C18H15OP, there are O—H⋯O hydrogen bonds between the O atom of triphenyl­phosphine oxide and one hy­droxy group of the boronic acid. Boronic acid mol­ecules form inversion-related hydrogen-bonded dimers in an R 2 2(8) motif. The structure is consolidated by inter­molecular C—H⋯O bonds and C—H⋯π inter­actions

Вирусные гепатиты В, С и D в Республике Молдова: достижения и проблемы

Agenția Națională pentru Sănătate Publică, IP Universitatea de Stat de Medicină și Farmacie Nicolae Testemițanu, IMSP Centrul Republican de Diagnosticare MedicalăRealizarea primelor trei Programe Naționale de combatere a hepatitelor virale B, C și D în Republica Moldova, începând cu anul 1997, au condus la reducerea semnificativă a morbidității prin hepatitele virale B, C și D acute, dar pe fundalul incidenței sporite a hepatitelor virale cronice, unde indicatorii îi depășesc vădit pe cei din țările Comunității Europene. Studiile realizate demonstrează că contingentele de populație cu risc sporit de infectare continuă să prezinte un potențial înalt ca sursă reală de infectare cu virusurile hepatice nominalizate pentru alte categorii de populație. Ca urmare a utilizării tehnicilor de biologie moleculară, au fost evidențiate genotipurile și subgenotipurile virusurilor hepatitelor B, C și D în special la contingentele de populație cu risc sporit de infectare, demonstrând că unele posedă un potențial înalt de cronicizare, cu evoluție spre ciroză și cancer hepatocelular. Utilizarea produselor antivirale de ultimă generație recomandate de OMS pentru tratamentul hepatitelor virale B și C a demonstrat o eficacitate înaltă nu numai terapeutică, ci și profi lactică, manifestată prin reducerea numărului de bolnavi purtători de virusuri și a noilor focare. Este important de menționat că prejudiciul economic prevenit ca urmare a realizării Programelor Naționale de combatere a hepatitelor virale în perioada 1997-2015 a constituit 822.453 mii lei, pe când cheltuielile din bugetul de stat pentru realizarea acestor programe au alcătuit 84.618,5 mii lei. Realizarea integrală a prezentului Program de combatere a hepatitelor virale B, C și D în contextul Planului Strategic al OMS de eliminare a hepatitelor virale parenterale până în anul 2030 va avea un beneficiu socioeconomic extrem de important pentru Republica Moldova.The implementation of the first three National Programs against viral hepatitis B, C and D in the Republic of Moldova since 1997 has allowed to significantly reduce morbidity of acute viral hepatitis B, C and D, but on the increased background of incidence of chronic viral hepatitis the indicators clearly outweigh those in the European Community. Studies have shown that the contingent of population at high risk of infection continues to show a high potential as a real source of infection with viral hepatitis viruses for other population categories. As a result of the use of molecular biology techniques, the genotypes and subgenotypes of hepatitis B, C and D viruses have been highlighted, particularly in contingent of population at high risk of infection, demonstrating that some have a high potential for chronicization with progression to cirrhosis and hepatocellular cancer. Using of next-generation antiviral drugs in the treatment of viral hepatitis B and C recommended by the WHO has shown a high, not only therapeutic but also prophylactic efficacy manifested by reducing the number of virus-bearing patients, and new outbreaks. It is important to note that the economic prejudice prevented by the implementation of the National Programs against viral hepatitis during the period 1997-2015 amounted to 822.453 thousand lei, while the spending from the State Budget for the implementation of the nominated programs amounted to 84.618.5 thousand lei. The full implementation of the current Program for combating viral hepatitis B, C and D in the context of the WHO Strategic Plan for the elimination of parenteral viral hepatitis by 2030 will have a very important socio-economic benefit for the Republic of Moldova.Реализация первых трех Национальных программ по борьбе с вирусными гепатитами B, C и D в Республике Молдова с 1997 года позволила значительно снизить заболеваемость острыми вирусными гепатитами B, C и D, но на фоне высокого уровня заболеваемости хроническими вирусными гепатитами, показатели явно перевешивают показатели стран Европейского Cоюза. Исследования показали, что среди групп населения с высоким риском инфицирования все еще присутствует высокий потенциал в качестве реального источника заражения вирусами гепатитов для других категорий населения. В результате использования методов молекулярной биологии были выделены генотипы и субгенотипы вирусов гепатитов B, C и D, особенно среди групп с высоким риском инфицирования, демонстрируя, что некоторые имеют высокий потенциал к хронизации и прогрессированию к циррозу и гепатоцеллюлярного рака. Использование противовирусных препаратов последнего поколения для лечения вирусных гепатитов В, C и D, рекомендованных ВОЗ, продемонстрировало не только высокую терапевтическую, но и профилактическую эффективность за счет сокращения числа вирусоносителей и новых очагов инфекции. Важно отметить, что предотвращённый экономический ущерб в результате реализации Национальных программ по борьбе с вирусными гепатитами в период 1997–2015 годов составил 822.453 тысяч леев, а расходы государственного бюд-жета на реализацию указанных программ составили 84.618,5 тысяч леев. Полная реализация текущей Программы по борьбе с вирусными гепатитами B, C и D в контексте Стратегического плана ВОЗ по элиминации парентеральных вирусных гепатитов к 2030 году будет иметь важное социально-экономическое значение для Республики Молдова

A Panorama on Multiscale Geometric Representations, Intertwining Spatial, Directional and Frequency Selectivity

The richness of natural images makes the quest for optimal representations in image processing and computer vision challenging. The latter observation has not prevented the design of image representations, which trade off between efficiency and complexity, while achieving accurate rendering of smooth regions as well as reproducing faithful contours and textures. The most recent ones, proposed in the past decade, share an hybrid heritage highlighting the multiscale and oriented nature of edges and patterns in images. This paper presents a panorama of the aforementioned literature on decompositions in multiscale, multi-orientation bases or dictionaries. They typically exhibit redundancy to improve sparsity in the transformed domain and sometimes its invariance with respect to simple geometric deformations (translation, rotation). Oriented multiscale dictionaries extend traditional wavelet processing and may offer rotation invariance. Highly redundant dictionaries require specific algorithms to simplify the search for an efficient (sparse) representation. We also discuss the extension of multiscale geometric decompositions to non-Euclidean domains such as the sphere or arbitrary meshed surfaces. The etymology of panorama suggests an overview, based on a choice of partially overlapping "pictures". We hope that this paper will contribute to the appreciation and apprehension of a stream of current research directions in image understanding.Comment: 65 pages, 33 figures, 303 reference

Costs a pretty penny: how household income impacts upon motorization in Europe and raises manufacturer branding challenges

This research starts from the findings of a previous study (Roșca, 2018) and intends to develop the preceding statistical model through testing new and more elaborated hypotheses based on the recommendations for future research made in the aforementioned work. The current paper tests demographic and transportation related variables for a multiple regression carried out at a confidence level of 95%. Regression results show a valid relationship between motorization and the selected regressors. Findings further reveal that motorization rates are most strongly influenced by the gross disposable income of households per capita (H4, β = 0.010, p = 0.000). Given that three of the demographic and transportation related research hypotheses have not been supported (age, overcrowding, fatalities), it might be argued that motorization should be looked upon more as a market(ing) feat rather than as a social or psychological fact. Car manufacturers should invest more in branding and in market segmentation in order to address the right target groups and properly position themselves with the customers. Branding, hence, becomes important as it creates an emotional connection between the corporate identity of the producers and the image that customers share about it. The closer the brand identity is to the brand image, the more of an impact the brand will have upon customers to spend part of their gross disposable income for car purchases. Starting from the main finding, this article also claims that future research needs to insist more upon the economic determinants of motorization (e.g. inflation, poverty rate, available resources, unemployment rate, interest rate etc.) and to determine their influence on brand preference and car ownership. At the same time, some other demographic variables such as age or generation could be double-checked, as researches provide shattered views upon their role: while some hold them as influential, others subjugate them to the economic determinants

Implications of Lewin’s Field Theory on Social Change

During the Second World War, Kurt Lewin was part of a wider research team commissioned by the U.S. Department of Defense to study how dietary habits of American citizens could be changed so as to avoid protein starvation due to the lengthy war efforts. Lewin’s research on food habits can be linked to his earlier studies on social fields. This paper aims to interpret Lewin’s findings on changing dietary habits by using his very own field theory approach, in order to hypothesize how the such findings can be drivers of social change, with the findings being applicable for business management settings as well. Concepts of time and space, as well as ‘simultaneity’ and ‘psychological ecology’ are brought up to discussion in order to back up the purpose of research