Overview of Some Risk Factors in Cardiovascular Disease

Much more specialists are nowadays aligning themselves on the view according to which the prevalence of cardiovascular disease will reach epidemic levels in the near future due to the increase of hypertension, diabetes and obesity. Most epidemiological studies indicate that we are confronted with a multiplication of risk factors, with an emphasis on their genetic conditioning as well as an acceleration of the effects generated by non-genetic factors. According to WHO recommendations, the appropriate methods of reducing the cardiovascular risk are those that combine health policies with efficient education measures. Long-term results of these measures aim to decrease the incidence of complications and associated costs with their treatment at the same time with increasing the quality of life. Approximately 50% of deaths from heart disease could be prevented through sustained action on the main cause—hypertension—and by treating risk factors, primarily hyperlipidemia and elevated body weight. Atherosclerotic disease requires a rigorous approach because identifying predisposing risk factors with proven implications in the initiation and progression of this disease, as well as modulation of those with protective role, can have a significant impact in finding an appropriate treatment in order to improve cardiovascular diseases and their consequences

Time to Switch to Second-line Antiretroviral Therapy in Children With Human Immunodeficiency Virus in Europe and Thailand.

Background: Data on durability of first-line antiretroviral therapy (ART) in children with human immunodeficiency virus (HIV) are limited. We assessed time to switch to second-line therapy in 16 European countries and Thailand. Methods: Children aged <18 years initiating combination ART (≥2 nucleoside reverse transcriptase inhibitors [NRTIs] plus nonnucleoside reverse transcriptase inhibitor [NNRTI] or boosted protease inhibitor [PI]) were included. Switch to second-line was defined as (i) change across drug class (PI to NNRTI or vice versa) or within PI class plus change of ≥1 NRTI; (ii) change from single to dual PI; or (iii) addition of a new drug class. Cumulative incidence of switch was calculated with death and loss to follow-up as competing risks. Results: Of 3668 children included, median age at ART initiation was 6.1 (interquartile range (IQR), 1.7-10.5) years. Initial regimens were 32% PI based, 34% nevirapine (NVP) based, and 33% efavirenz based. Median duration of follow-up was 5.4 (IQR, 2.9-8.3) years. Cumulative incidence of switch at 5 years was 21% (95% confidence interval, 20%-23%), with significant regional variations. Median time to switch was 30 (IQR, 16-58) months; two-thirds of switches were related to treatment failure. In multivariable analysis, older age, severe immunosuppression and higher viral load (VL) at ART start, and NVP-based initial regimens were associated with increased risk of switch. Conclusions: One in 5 children switched to a second-line regimen by 5 years of ART, with two-thirds failure related. Advanced HIV, older age, and NVP-based regimens were associated with increased risk of switch

Is There a Place for Elastography in the Diagnosis of Hepatocellular Carcinoma?

Background and Aims: Elastography can provide information regarding tissue stiffness (TS). This study aimed to analyze the elastographic features of hepatocellular carcinoma (HCC) and the factors that influence intratumoral elastographic variability in patients with liver cirrhosis. Methods: This prospective study included 115 patients with liver cirrhosis and hepatocellular carcinoma evaluated between June 2016–November 2019. A total of 88 HCC nodules visualized in conventional abdominal ultrasound (US) met the inclusion criteria and underwent elastographic evaluation. Elastographic measurements (EM) were performed in HCC and liver parenchyma using VTQ (Virtual Touch Quantification), a point shear wave elastography (pSWE) technique. In all patients, we performed contrast-enhanced ultrasound (CEUS), and the final diagnosis of HCC was established by contrast-enhanced-CT or contrast-enhanced-MRI. Results: The mean VTQ values in HCCs were 2.16 ± 0.75 m/s. TS was significantly lower in HCCs than in the surrounding liver parenchyma 2.16 ± 0.75 m/s vs. 2.78 ± 0.92 (p &lt; 0.001). We did not find significant differences between the first five and the last five EM, and the intra-observer reproducibility was excellent ICC: 0.902 (95% CI: 0.87–0.950). However, the tumor size, heterogeneity, and depth correlated with higher intralesional stiffness variability (p &lt; 0.001). Conclusions: VTQ brings additional information for HCC characterization. Intra-observer reproducibility for both HCC and liver parenchyma was excellent. Knowing the stiffness of HCC’s might endorse an algorithm-based approach towards focal liver lesions (FLLs) in liver cirrhosis

Numerical and Experimental Study of the Fatigue Behavior for a Medical Rehabilitation Exoskeleton Device Using the Resonance Method

In this paper, the dynamic behavior of a hip level joint device of an active exoskeleton used in the medical field is analyzed. The finite element method is used in order to determine the first frequencies and the eigenmodes, necessary for the fatigue testing in the resonance regime

Numerical and Experimental Study of the Fatigue Behavior for a Medical Rehabilitation Exoskeleton Device Using the Resonance Method

In this paper, the dynamic behavior of a hip level joint device of an active exoskeleton used in the medical field is analyzed. The finite element method is used in order to determine the first frequencies and the eigenmodes, necessary for the fatigue testing in the resonance regime

COVID-19 and PIMS&mdash;Two Different Entities, but the Same Trigger

COVID-19 and PIMS represent two novel pathologies that have challenged the medical world during the last two years on account of their being very similar, but yet very different. Our aim was to comparatively assess children with SARS-CoV-2 infection and PIMS in terms of symptoms, clinical findings, laboratory parameters, echocardiography, and evolution. Our retrospective study included 46 children with COVID-19 (group 1), and 20 children with confirmed PIMS (group 2). We found no significant differences in terms of age, gender, and originating area between the two groups. We noticed that fever was significantly more common in the PIMS group as compared to COVID-19 group (p = 0.0217). In terms of laboratory parameters, increased bilirubin and creatinine were significantly more frequent in children with COVID-19 (p = 0.0064/p = 0.0064), while hypoalbuminemia and elevated ESR were significantly more common in those with PIMS (p &lt; 0.0001/p = 0.0127). Moreover, prognosis parameters such as D-dimers, NT-proBNP, and CK-MB were also found to be significantly higher in the PIMS group as compared to COVID-19 group (p = 0.0003/p = 0.0182/p = 0.0007). In terms of complications, most were identified in PIMS group, among which cardiac and liver impairment along with dehydration were significantly more common in children diagnosed with PIMS as compared to those detected with COVID-19. Similarly, children with PIMS had a significantly higher chance to have pathological echocardiography changes. Although difficult, the distinction between COVID-19 and PIMS is crucial for the patient&rsquo;s long-term outcome

Clinicopathological Characteristics of Incidental Papillary Thyroid Microcarcinoma in an Endemic Goiter Area

Papillary thyroid microcarcinoma (PTMC) is a common malignant disease of the endocrine system, which has rapidly increased in incidence and prevalence in recent decades. The aim of our paper was to identify correlations between pathological and clinical features of cases of PTMC. A total of 612 patients of both genders, who were operated on for benign thyroid diseases in the 3rd Surgical Unit of St. Spiridon University Hospital of Iasi, were monitored for a period of 2 years. According to pathological reports, PTMC was diagnosed in 144 cases. Of those cases, 81.2% were female and 18.8% were male, with an overall mean age of 54.77 &plusmn; 11.9 years. The mean diameter of tumors was 3.04 &plusmn; 2.2 mm (75.7% were under 5 mm), and 35.4% were multifocal tumors. Of all tumors studied, 76.4% were the follicular variant, 13.2% were conventional, and 10.4% of cases included tall cell, hobnail, or columnar variants. The underlying diseases were multinodular goiters (73.6%), adenomas (25%), Hashimoto thyroiditis (17.4%), Basedow&rsquo;s disease, and other types of hyperthyroidism (4.9%), primarily hyperparathyroidism (7.6%), with a small percentage presenting a combination thereof. Extracapsular invasion was present in 14.6% while 5.6% presented perineural invasion and 0.7% of cases had vascular invasion. Lymphatic emboli were found in 9% of cases and lymph node metastasis in 5.6% of cases. PTMC is not as innocent as believed, and further studies, performed on larger batches, would be necessary in order to identify high oncological risk cases and to determine when a more aggressive surgical approach is indicated

A Novel Symbiotic Beverage Based on Sea Buckthorn, Soy Milk and Inulin: Production, Characterization, Probiotic Viability, and Sensory Acceptance

Nowadays, vegan consumers demand that food products have more and more properties that contribute to the prevention of some diseases, such as lower fat content, increased mineral content (calcium, iron, magnesium, and phosphorus), pleasant flavor, and low calorie values. Therefore, the beverage industry has tried to offer consumers products that include probiotics, prebiotics, or symbiotics with improved flavor and appearance and beneficial effects on health. The possibility of producing beverages based on soy milk with sea buckthorn syrup or sea buckthorn powder supplemented with inulin and fermented with the Lactobacillus casei ssp. paracasei strain was examined. The aim of this study was to obtain a novel symbiotic product that exploits the bioactive potential of sea buckthorn fruits. Tests were carried out in the laboratory phase by fermenting soy milk, to which was added sea buckthorn syrup (20%) or sea buckthorn powder (3%) and inulin in proportions of 1% and 3%, with temperature variation of fermentation (30 and 37 °C). During the fermentation period, the survivability of prebiotic bacteria, pH, and titratable acidity were measured. The storage time of beverages at 4 °C ± 1 °C was 14 days, and the probiotic viability, pH, titratable acidity, and water holding capacity were determined. Novel symbiotic beverages based on sea buckthorn syrup or powder, inulin, and soy milk were successfully obtained using the Lactobacillus casei ssp. paracasei strain as a starter culture. Moreover, the inulin added to the novel symbiotic beverage offered microbiological safety and excellent sensory attributes as well

Ragweed Major Allergen Amb a 11 Recombinant Production and Clinical Implications

Ragweed pollen is highly allergenic and elicits type I hypersensitivity reactions in the exposed populations. Amb a 11 is a recently discovered component of this pollen, and its biological role in allergy is still being researched. In our study, ragweed allergy patients were recruited prospectively over a three-year period; a comprehensive questionnaire was administered, and sera were collected and stored. The production of recombinant Amb a 11 was achieved in parallel with patients’ recruitment. The gene coding for mature protein was inserted in E. coli and in Sf9 Spodoptera frugiperda cells. The recombinant allergens (designated eAmb a 11 and iAmb a 11) were tested for His-tag presence in Western blot. IgE reactivity was evaluated in 150 patients’ sera for both recombinant allergen forms in ELISA, with 5 positive sera being tested further by hRBL (humanized rat basophilic leukemia) hexosaminidase release assay. Both allergen forms were proven to be IgE-reactive His-tagged proteins, with an extensive overlap of positive sera (92 toward the former recombinant allergen, 100 toward the latter) and an overall Amb a 11 sensitization prevalence estimated at 68.67%. The hRBL mediator release assay revealed a significant, slightly weaker effect of recombinant allergens when compared with nAmb a 1. Sensitization to this major allergen appears to be associated with more severe asthma symptoms (OR = 4.71, 95% CI = 1.81–12.21). In conclusion, recombinant Amb a 11 is a bona fide allergen, which is IgE-reactive and an inducer of hRBL degranulation. It is an important IgE-reactive component from ragweed pollen, with high IgE sensitization prevalence in the sample population and allergenicity of the recombinant allergen comparable to Amb a 1