Metabolic syndrome: From molecular mechanisms to novel therapies

The metabolic syndrome (MetS) consists of a cluster of metabolic abnormalities including central obesity, insulin resistance, glucose intolerance, hypertension, and atherogenic dyslipidemia [...]

Lipoproteins and cardiovascular disease: An update on the clinical significance of atherogenic small, dense LDL and new therapeutical options

Dyslipidemia is a potent risk factor for the genesis and progression of cardiovascular disease (CVD), and both the concentration and type of low-density lipoproteins (LDL) augment this association. The small, dense LDL (sdLDL) subfraction is the subtype which is most strongly predictive of atherosclerosis and cardiovascular events. In addition to the traditionally available lipid-lowering treatment options, certain novel therapies have been shown to favorably impact sdLDL, among them the antidiabetic class of agents known as glucagon-like peptide 1 receptor agonists (GLP1-RAs). These drugs seem to alter the pathophysiologic mechanisms responsible for the formation and accumulation of atherogenic lipoprotein particles, thus potentially reducing cardiovascular outcomes. They represent a uniquely targeted therapeutic approach to reduce cardiometabolic risk and warrant further study for their beneficial nonglycemic actions

Endocrinology in the time of covid-19: A rapid evolution of knowledge and care

American singer-writer and visual artist Bob Dylan produced the song "The Times They Are a-Changin" in the 1960s, which became a rallying cry for the civil rights and anti-war movements in that decade [...]

Incretin-Based Therapies Role in COVID-19 Era: Evolving Insights

The current coronavirus disease 2019 (COVID-19) pandemic has led the scientific community to breach new frontiers in the understanding of human physiology and disease pathogenesis. It has been hypothesized that the human dipeptidyl peptidase 4 (DPP4) enzyme receptor may be a functional target for the spike proteins of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Since DPP4-inhibitors are currently used for the treatment of patients with type-2 diabetes (T2DM), there is currently high interest in the possibility that these agents, or incretin-based therapies (IBTs) in general, may be of benefit against the new coronavirus infection. Diabetes is associated with increased COVID-19 severity and mortality, and accumulating evidence suggests that IBTs may favorably alter the clinical course of SARS-CoV-2 infection due to their inherent mechanisms of action. Further research into prognostic variables associated with various antidiabetic treatment regimens, and in particular the IBT, in patients with T2DM affected by the COVID-19 pandemic is therefore warranted

Pheochromocytoma – clinical manifestations, diagnosis and current perioperative management

Pheochromocytoma is a neuroendocrine tumor characterized by the excessive production of catecholamines (epinephrine, norepinephrine, and dopamine). The diagnosis is suspected due to hypertensive paroxysms, associated with vegetative phenomena, due to the catecholaminergic hypersecretion. Diagnosis involves biochemical tests that reveal elevated levels of catecholamine metabolites (metanephrine and normetanephrine). Functional imaging, such as 123I-metaiodobenzylguanidine scintigraphy (123I-MIBG), has increased specificity in identifying the catecholamine-producing tumor and its metastases. The gold-standard treatment for patients with pheochromocytoma is represented by the surgical removal of the tumor. Before surgical resection, it is important to optimize blood pressure and intravascular volume in order to avoid negative hemodynamic events

RESEARCH ON THE IMPLEMENTATION OF INDUSTRY 4.0 IN INTEGRATED MANUFACTURING SYSTEMS

In the context of Industry 4.0, manufacturing systems are being upgraded to a smart level. Intelligent manufacturing takes advantage of advanced technologies, information and manufacturing to achieve flexible, intelligent and reconfigurable manufacturing processes in order to address a dynamic and global market. It allows all physical processes and information flows to be available, when and where they are needed across supply chains, multiple industries, small and medium enterprises (SMEs) and large companies. Smart manufacturing requires certain core technologies to activate devices or machines in order to vary their behaviors in response to different situations and requirements based on past experiences and learning abilities. The technologies allow direct communication with the production, thus allowing the solution and adaptation of problems and decisions that must be taken in a timely manner

Use of Novel Antidiabetic Agents in Patients with Type\ua02 Diabetes and COVID-19: A Critical Review

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19). The latter is a pandemic that has the potential of developing into a severe illness manifesting as systemic inflammatory response syndrome, acute respiratory distress syndrome, multi-organ involvement and shock. In addition, advanced age and male sex and certain underlying health conditions, like type 2 diabetes mellitus (T2DM), predispose to a higher risk of greater COVID-19 severity and mortality. This calls for an urgent identification of antidiabetic agents associated with more favourable COVID-19 outcomes among patients with T2DM, as well as recognition of their potential underlying mechanisms. It is crucial that individuals with T2DM be kept under very stringent glycaemic control in order to avoid developing various cardiovascular, renal and metabolic complications associated with more severe forms of COVID-19 that lead to increased mortality. The use of novel antidiabetic agents dipeptidyl peptidase 4 inhibitors (DPP4i), sodium-glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1 receptor agonists (GLP-1RAs) in subjects with T2DM may have beneficial effects on COVID-19 outcomes. However, relevant studies either show inconsistent results (DPP4i) or are still too few (SGLT2i and GLP-1RAs). Further research is therefore needed to assess the impact of these agents on COVID-19 outcomes

Atherosclerosis development and progression: the role of atherogenic small, dense LDL.

Atherosclerosis is responsible for large cardiovascular mortality in many countries globally. It has been shown over the last decades that the reduction of atherosclerotic progression is a critical factor for preventing future cardiovascular events. Low-density lipoproteins (LDL) have been successfully targeted, and their reduction is one of the key preventing measures in patients with atherosclerotic disease. LDL particles are pivotal for the formation and progression of atherosclerotic plaques; yet, they are quite heterogeneous, and smaller, denser LDL species are the most atherogenic. These particles have greater arterial entry and retention, higher susceptibility to oxidation, as well as reduced affinity for the LDL receptor. Increased proportion of small, dense LDL particles is an integral part of the atherogenic lipoprotein phenotype, the most common form of dyslipidemia associated with insulin resistance. Recent data suggest that both genetic and epigenetic factors might induce expression of this specific lipid pattern. In addition, a typical finding of increased small, dense LDL particles was confirmed in different categories of patients with elevated cardiovascular risk. Small, dense LDL is an independent risk factor for cardiovascular diseases, which emphasizes the clinical importance of both the quality and the quantity of LDL. An effective management of atherosclerotic disease should take into account the presence of small, dense LDL in order to prevent cardiovascular complications

Breast reconstruction on actinic affected territory by using of the latissimus dorsi flap plasty and dermotension (Case report)

Clinica de Chirurgie Plastică și Microchirurgie Reconstructivă, USMF “Nicolae Testemițanu”, Chișinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Caz clinic: Lucrarea reflectă cazul clinic al unei femei de 33 ani supusă amputației totale de sîn pe motiv oncologic. Postoperator a urmat 3 cure de radioterapie. La 6 luni de la intervenția chirurgicală primară a susținut un examen complex după care a primit acordul medical la refacerea plastică a sânului. La momentul examinării în Clinica de chirurgie plastică prezenta dureri în regiunea cicatricei rămase după amputația sânului. La prima etapă de tratament s-a decis înlăturarea cicatricelor aderate agresiv de hemitorace și plastia defectului rămas cu un lambou insular din latissimus dorsi. Etapa a doua a urmat după obținerea regenerării primei etape – implantarea unui expander tisular cu un volum maximal de 500 ml. Etapa a treia a avut loc după umplerea balonului expandat. Sub surplusul tegumentar în schimbul expanderului am plasat o proteză mamară. Cunoscând că un component al tratamentului a fost iradierea actinică, temerea pentru înlaturarea cicatricei și plastia defectului cu țesuturi locale era argumentată. Astfel motivați am decis să folosim lamboul insular latissimus dorsi din regiunea sănătoasă. Dimensiunile lui maxime au permis expandarea, care a rezultat cu refacerea sânului prin punerea unui implant mamar. Concluzii: Utilizarea metodelor de chirurgie plastică-reconstructivă și estetică într-o consecutivitate corectă permit refacerea sânului după amputații oncologice, chiar dacă regiunea marcată este tratată actinic.Clinical case: We present a clinical case of 33 years old female, which was subjected to total breast amputation. After surgery she followed 3 cycles of radiation therapy. At 6 months after primary surgery she underwent a comprehensive examination after which has received medical agreement for plastic restoring of the breast. At the moment of the examination she has been complaining on pain in the region of the scar. In the first stage of the treatment it was decided to remove the aggressive adhered on hemithorax scars and to do the plasty of the defect with a free latissimus dorsi flap. The second stage was constituted of implanting a tissue expander. The third stage: under the tissue’s excess instead of expander we have placed a mammary prosthesis. Knowing that one of the treatment factors was actinic radiation, the fear for the removal of the scar and the plasty of the defect with local tissues was substantiated. Thus, we decided to use latissimus dorsi flap from the healthy region. Its maximal dimensions have allowed expanding resulting with restoration of the breast by placing a mammary implant. Conclusion: Using the methods of plastic-reconstructive and aesthetic surgery in a correct order allows the rebuilding of the breast after oncological amputations, even if the region was exposed to actinic treatment