Cryostripping – 10 years of experience in chronic venous disease treatment

Scopul lucrării. Prezentarea avantajelor cryostripping-ului în tratamentul bolii venoase cronice (BVC). Materiale și metode. Studiul a inclus 1327 pacienți dispensarizați în Compartimentul de Flebologie din cadrul Clinicii I Chirurgie SCJUT, în perioada septembrie 2013 – aprilie 2023, l-a care s-a practicat cura BVC prin cryostripping. Am analizat avantajele tehnice, durata și costurile intervenției, perioada de spitalizare, rezultatele postoperatorii, fezabilitatea metodei. Datele obținute au fost comparate cu cele rezultate în urma safenectomiei clasice. Rezultate. Avantajele tehnice ale metodei constau într-o incizie proximală mai mică, comparativ cu operația clasică, și lipsa necesității contrainciziei distale. Durata medie a intervenției a fost 41 ± 12.8 minute, iar costurile consumabilelor de 52 ± 10 €/intervenție. Perioada medie de spitalizare a fost 1.05±0.41 zile. Rezultatele postoperatorii au fost favorabile, rata complicațiilor precoce fiind redusă (echimoze Ø < 2cm - 33,23%; hematom - 2,11%; tromboză venoasă profundă - 0,15%; parestezii tranzitorii 3.01%). Comparativ cu safenectomia clasică, costurile consumabilelor/intervenție sunt similare, iar durata intervenției, perioada de spitalizare și rata complicațiilor sunt statistic semnificativ mai reduse. Un avantaj al metodei este faptul că cryosondele se pot steriliza, fiind reutilizabile, din punct de vedere economic, tehnica pretându-se atât în spitalele de stat, cât și în clinicile private. Concluzii. Cryostripping-ul este o procedură chirurgicală radicală, fiind o modalitate eficientă pentru tratamentul BVC și aducând un număr mare de avantaje comparativ cu safenectomia clasică.Aim of study. Presenting cryostripping advantages in chronic venous disease (CVD) treatment. Materials and methods. The study included 1327 patients diagnosed with CVD admitted in the Phlebology Department, 1st Surgical Department, Emergency County Hospital Timișoara, between September 2013 and April 2023, which were operated using cryostripping as surgical procedure. The technical advantages of the procedure, the duration and costs of the intervention, the hospitalization period, the post-operative results, and the feasibility of the method were analyzed. The obtained data were compared with those resulting from patients operated by classic saphenectomy. Results. The technical advantages of the method consist in a smaller proximal incision, compared to the classic operation. Distal counterincision is not necessary, either. The average duration of the intervention was 41 ± 12.8 minutes, and the costs of consumables were about 52 ± 10 €/intervention. The average hospitalization period was 1.05±0.41 days. The post-operative results were favourable, early complications rate being reduced (ecchymoses Ø < 2cm - 33.23%; hematoma - 2.11%; deep vein thrombosis - 0.15%; transient paresthesias 3.01%). Compared to classic saphenectomy, the costs of consumables/intervention are similar, intervention time, hospitalization period and complication rate being statistically significantly lower. An advantage of the method is the fact that the cryo-probes can be sterilized, being reusable; from the economic point of view, the technique perfectly fits in both state hospitals and private clinics. Conclusions. Cryostripping is a radical surgical procedure which brings a significant number of advantages compared to the classic saphenectomy, being an effective alternative in CVD treatment

Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis

This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians’ chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada’s single payer system ought to be maintained and strengthened, but not through privatization

Influenţa condiţiilor de păstrare asupra unor compuşi bioactivi din fructele de pădure şi contribuţia acestora asupra sănătăţii umane

The main criteria underlying this research consist in assessing the influence of the principal storage technologies on the content of some bioactive compounds contained by berry fruits. To balance fluctuations in product supply and market demand, fresh berry fruits often require short-or long-term storage in order to extend the supply of the berry fruits beyond the end ofthe harvest season. Understanding the interaction between the fruits and the environment is crucial for obtaining the most suitable conditions for extending shelf life. Portions of 250 g of strawberries, cranberries, gooseberries, blackberries or raspberries contain considerably more than the minimum daily requirement of vitamin C, while most of the other fruit can provide more than half the daily requirement. In order to freeze the berries fruits, generally no pretreatments are applied and therefore no changes in nutritive values occur during storage if proper packaging is used. During thawing, however, losses may occur. The fruits were monitorized in three fixed time points of refrigerated storage conditions at 20C, and also after different freezing condition (-180C in laboratory freezing condition and from supermarket freezing condition). The biological material studied was represented by 4 types of berries, as follows: Vaccinum myrtillius, Ribes rubrum, Rubus fructicocus and Rubus idaeus which were asseassed in terms of quality in fresh condition (T0 –moment), and after 3, respectively 7 days of refrigerate storage condition as well as after 6 month of freezing (in bulk and packaged in polyethylene bags). The soluble dry matter substances content was noticed to decrease in refrigerated storage condition between T1 and T2 time points (p<0.001). As concerning the differences in vitamin C content between fruits storage in bulk and packaged with polyethylene film were highlight significantly higher values (p<0.001) for all analyzed species that were packaged also in freezing storage conditions. When compared to the other fruits tested, the red gooseberries (43.5 mg/ 100 g), followed by raspberries (35.6 mg/ 100 g) were evidenced by their high vitamin C content. By keeping the fruits refrigerated for 7 days, although the sensory characteristics have undergone major changes, a significant decrease in vitamin C content is noted, however its final values at Tf moment are still remarkable: 27.8 mg/ 100 g for currants and 24.3 mg/ 100 g for raspberries

Care of acute conditions and chronic diseases in Canada and the United States: Rapid systematic review and meta-analysis

This study tested the hypothesis that socioeconomically vulnerable Canadians with diverse acute conditions or chronic diseases have health care access and survival advantages over their counterparts in the USA. A rapid systematic review retrieved 25 studies (34 independent cohorts) published between 2003 and 2018. They were synthesized with a streamlined meta-analysis. Very low-income Canadian patients were consistently and highly advantaged in terms of health care access and survival compared with their counterparts in the USA who lived in poverty and/or were uninsured or underinsured. In aggregate and controlling for specific conditions or diseases and typically 4 to 9 comorbid factors or biomarkers, Canadians’ chances of receiving better health care were estimated to be 36% greater than their American counterparts (RR=1.36, 95% CI 1.35-1.37). This estimate was significantly larger than that based on general patient or non-vulnerable population comparisons (RR=1.09, 95% CI 1.08-1.10). Contrary to prevalent political rhetoric, three studies observed that Americans experience more than twice the risk of long waits for breast or colon cancer care or of dying while they wait for an organ transplant (RR=2.36, 95% CI 2.09-2.66). These findings were replicated across externally valid national studies and more internally valid, metropolitan or provincial/state comparisons. Socioeconomically vulnerable Canadians are consistently and highly advantaged on health care access and outcomes compared to their American counterparts. Less vulnerable comparisons found more modest Canadian advantages. The Affordable Care Act ought to be fully supported including the expansion of Medicaid across all states. Canada’s single payer system ought to be maintained and strengthened, but not through privatization

Venous leg ulcer – prevalence, clinical and economic considerations, treatment

Scopul lucrării. Evaluarea prevalenței ulcerului venos activ la pacienții din Compartimentul de Flebologie (CF), precum și a implicațiilor clinice, terapeutice și economice asociat tratamentului acestei afecțiuni. Materiale și metode. Studiul a urmărit retrospectiv toți pacienții internați în CF, Clinica I Chirurgicală SCUJT cu diagnosticul de insuficiență venoasă cronică în perioada ianuarie 2017 - decembrie 2022. Am analizat procentul pacienților aflați în stadiul clinic C6 al bolii, măsurile terapeutice, perioada de spitalizare. Rezultate. Din cele 618 internări realizate pentru diagnosticul menționat, 67 de pacienți (10.84%) prezentau ulcer venos activ. Conform antibiogramei, cele mai multe suprainfecții ale leziunilor au fost prin colonizare cu Pseudomonas spp.. Unele leziuni au fost deosebit de grave, fiind extinse circumferențial. Referitor la treatment, în 20 de cazuri s-a practicat debridarea leziunii, întreruperea refluxului venos fiind realizată în timpul doi; în 15 cazuri s-a realizat întreruperea refluxului venos per primam, ulcerația vindecându-se ulterior sub tratament conservator; în 27 cazuri s-a practicat grefarea leziunii prin plastie cu piele liberă despicată, cu întreruperea refluxului venos; în 5 cazuri s-a aplicat doar tratamentul conservator cu bandaj elasto-compresiv, ablația refluxului venos practicându-se ulterior, după închiderea ulcerației. Perioada medie de spitalizare a fost 21.3 zile (cu un maxim de 89 zile), fiind de aproximativ cinci ori mai mare comparativ cu cea a cazurilor aflate în stadiile C2-C4 (4.38 zile), implicit costurile tratamentului per pacient fiind semnificativ mai mari. Concluzii. Insuficiența venoasă cronică neglijată este încă frecvent întâlnită. Tratamentul în stadiile incipiente ale bolii este de preferat, prevenindu-se astfel complicațiile și scăzând considerabil costurile de spitalizare.Aim of study. Evaluation of the prevalence of active venous leg ulcers in patients admitted in the Phlebology Department (PD), as well as the clinical, therapeutic and economic implications associated in its treatment. Materials and methods. This retrospective study analyzed all the patients diagnosed with chronic venous insufficiency which were admitted in the PD of the 1st Surgical Clinic, Emergency County Hospital Timișoara, between January 2017 and December 2022. The percentage of patients which presented active venous leg ulcers, the therapeutic measures and the hospitalization period were analyzed. Results. From the total number of admissions (618 cases) made in the established time period, 67 patients (10.84%) presented active venous ulcers. According to the antibiogram, Pseudomonas spp. was the most frequent germ involved in lesions infection. Some lesions were particularly serious, being circumferentially extended. Regarding treatment, in 20 cases debridement of the lesion was performed, venous reflux ablation being subsequently carried out; in 15 cases, venous reflux ablation was performed as first intention, the ulceration being subsequently healed under conservative treatment; in 27 cases, skin grafts were applied, with venous reflux ablation; in 5 cases, conservative treatment with elasto-compressive bandages was applied,venous reflux ablation being performed after ulceration closure. The average hospitalization period was 21.3 days (with a maximum of 89 days), being approximately five times longer compared to that of cases in C2-C4 stages (4.38 days), implicitly treatment costs per patient being significantly higher. Conclusions. Neglected chronic venous insufficiency is still common. Treatment in the early stages of the disease is preferable, thus preventing complications and considerably reducing hospitalization costs

Effect of mineral-enriched diet and medicinal herbs on Fe, Mn, Zn, and Cu uptake in chicken

<p>Abstract</p> <p>Background</p> <p>The goal of our study was to evaluate the effects of different medicinal herbs rich in polyphenol (Lemon balm, Sage, St. John's wort and Small-flowered Willowherb) used as dietary supplements on bioaccumulation of some essential metals (Fe, Mn, Zn and Cu) in different chicken meats (liver, legs and breast).</p> <p>Results</p> <p>In different type of chicken meats (liver, legs and breast) from chickens fed with diets enriched in minerals and medicinal herbs, beneficial metals (Fe, Mn, Zn and Cu) were analysed by flame atomic absorption spectrometry. Fe is the predominant metal in liver and Zn is the predominant metal in legs and breast chicken meats. The addition of metal salts in the feed influences the accumulations of all metals in the liver, legs and breast chicken meat with specific difference to the type of metal and meat. The greatest influences were observed in legs meat for Fe and Mn. Under the influence of polyphenol-rich medicinal herbs, accumulation of metals in the liver, legs and breast chicken meat presents specific differences for each medicinal herb, to the control group that received a diet supplemented with metal salts only. Great influence on all metal accumulation factors was observed in diet enriched with sage, which had significantly positive effect for all type of chicken meats.</p> <p>Conclusions</p> <p>Under the influence of medicinal herbs rich in different type of polyphenol, accumulation of metals in the liver, legs and breast chicken meat presents significant differences from the group that received a diet supplemented only with metal salts. Each medicinal herb from diet had a specific influence on the accumulation of metals and generally moderate or poor correlations were observed between total phenols and accumulation of metals. This may be due to antagonism between metal ions and presence of other chelating agents (amino acids and protein) from feeding diets which can act as competitor for complexation of metals and influence accumulation of metals in chicken meat.</p> <p><b>Graphical abstract</b></p

Biocompatibility of poly(lactic acid) with incorporated graphene-based materials

The incorporation of graphene-based materials has been shown to improve mechanical properties of poly(lactic acid) (PLA). In this work, PLA films and composite PLA films incorporating two graphene-based materials – graphene oxide (GO) and graphene nanoplatelets (GNP) – were prepared and characterized regarding not only biocompatibility, but also surface topography, chemistry and wettability. The presence of both fillers changed the films surface topography, increasing the roughness, and modified the wettability – the polar component of surface free energy increased 59% with GO and decreased 56% with GNP. Mouse embryo fibroblasts incubated with both fillers exceeded the IC50 in both cases with a concentration of 10 μg mL−1. No variations in cell proliferation at the surface of the composite films were observed, except for those containing GO after 24 h incubation, which presented higher cell proliferation than pristine PLA films. Platelet adhesion to PLA and PLA/GNP films was lower in the presence of plasma proteins than when no proteins were present. Furthermore, incorporation of GNP into PLA reduced platelet activation in the presence of plasma proteins. The results indicated that low concentrations of GO and GNP may be incorporated safely in PLA to improve aspects relevant for biomedical applications, such as mechanical properties.Funding for this work was partially provided by FEDER, through Programa Operacional Factores de Competitividade - COMPETE, and by National Funding through FCT - Fundacao para a Ciencia e a Tecnologia, in the framework of project PTDC/EME-PME/114808/2009 and of grant SFRH/BPD/63722/2009

Dynamical Boson Stars

The idea of stable, localized bundles of energy has strong appeal as a model for particles. In the 1950s John Wheeler envisioned such bundles as smooth configurations of electromagnetic energy that he called {\em geons}, but none were found. Instead, particle-like solutions were found in the late 1960s with the addition of a scalar field, and these were given the name {\em boson stars}. Since then, boson stars find use in a wide variety of models as sources of dark matter, as black hole mimickers, in simple models of binary systems, and as a tool in finding black holes in higher dimensions with only a single killing vector. We discuss important varieties of boson stars, their dynamic properties, and some of their uses, concentrating on recent efforts.Comment: 79 pages, 25 figures, invited review for Living Reviews in Relativity; major revision in 201

Multi-response analysis in the material characterisation of electrospun poly (lactic acid)/halloysite nanotube composite fibres based on Taguchi design of experiments: fibre diameter, non-intercalation and nucleation effects

Poly (lactic acid) (PLA)/halloysite nanotube (HNT) composite fibres were prepared by using a simple and versatile electrospinning technique. The systematic approach via Taguchi design of experiments (DoE) was implemented to investigate factorial effects of applied voltage, feed rate of solution, collector distance and HNT concentration on the fibre diameter, HNT non-intercalation and nucleation effects. The HNT intercalation level, composite fibre morphology, their associated fibre diameter and thermal properties were evaluated by means of X-ray diffraction (XRD) analysis, scanning electron microscopy (SEM), imaging analysis and differential scanning calorimetry (DSC), respectively. HNT non-intercalation phenomenon appears to be manifested as reflected by the minimal shift of XRD peaks for all electrospun PLA/HNT composite fibres. The smaller-fibre-diameter characteristic was found to be sequentially associated with the feed rate of solution, collector distance and applied voltage. The glass transition temperature (T g) and melting temperature (T m) are not highly affected by varying the material and electrospinning parameters. However, as the indicator of the nucleation effect, the crystallisation temperature (T c) of PLA/HNT composite fibres is predominantly impacted by HNT concentration and applied voltage. It is evident that HNT’s nucleating agent role is confirmed when embedded with HNTs to accelerate the cold crystallisation of composite fibres. Taguchi DoE method has been found to be an effective approach to statistically optimise critical parameters used in electrospinning in order to effectively tailor the resulting physical features and thermal properties of PLA/HNT composite fibres

Complex Risks from Old Urban Waste Landfills: Sustainability Perspective from Iasi, Romania

Landfills continue to represent the most frequent managerial practice for municipal solid wastes and an increasing and complex problem globally. In certain countries, a transition to an open society and free market is superimposed on the transition to sustainability, resulting in even higher complexity of management. This paper proposes an approach for problem-structuring of landfills in complex transitions: sustainability or unsustainability of a management approach is determined by a set of sustainability filters that are defined by sets of indicators and prioritized according the systemic concept of sustainability, which says that economy is embedded in society, which is embedded in nature. The writers exercise this approach with an old landfill in Iasi, Romania, and conclude for unsustainability, because the ecological sustainability filter is not successfully passed. Social and economic sustainability filters are also discussed in relation with the ecological sustainability indicators. The described approach allows a coherent, transdisciplinary synthesis of knowledge scattered across various disciplines, a pervasive problem in landfill management. The case study helps distinguish between generally true and context-dependent aspects.Peer reviewe