Natural Compounds for Wound Healing

Many plants or plant-derived compounds with high levels of antioxidants and anti-inflammatory, immunomodulatory, and antimicrobial properties could be of great benefit for wound healing. Several studies have documented the use of plant extracts for the development of bioactive wound dressings. The purpose of this chapter is to give an update about the vegetal and bee products, which can be used as bioactive substances in wound dressings or in other formulations for wound healing. The adverse effects of plant and bee extracts, such as contact allergies, are also presented. In order to better exploit the huge reservoir of pharmacologically active plant-derived compounds and extracts, standardized methodology and clinical trials are necessary to give more concrete evidence supporting the use of traditional medicine in wound management

Left atrial geometric and functional remodeling parameters by cardiac magnetic resonance imaging and outcome prediction in patients with severe aortic stenosis

BACKGROUND: Emerging studies are beginning to shape the role of afflicted left atrium’s (LA) function and strain in cardiovascular diseases including aortic stenosis (AS), especially for risk stratification and outcome prediction. Cardiac magnetic resonance imaging (CMR) is becoming increasingly useful in determining parameters of LA, however, in patients with AS, this has not been yet approached. AIMS: The study sought to evaluate the role of CMR in characterizing LA geometry and function in patients with severe AS. METHODS: We prospectively evaluated 70 patients with symptomatic severe AS and 70 controls. LA volumes, function and strain were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, and heart failure hospitalization) was evaluated over a median of 13 months. Time-to-event outcomes were analyzed accordingly. RESULTS: Besides increased LA volumes (LAVs) and LA sphericity index (LASI) (P <0.001), LA phasic functions and strain were considerably defective in patients with AS (all P <0.001). LV mass (LVM), end-diastolic and end-systolic volumes were also significantly associated withal LA strain parameters (P <0.001). Regarding outcome prediction, decreased total (LA-et), active (LA-ea) and passive strain (LA-ep), along with enhanced LASI were independently associated with outcome (P <0.001). Time-to-event analysis showed significantly higher risk to reach the composite outcome for LA-et <31.1% [HR=6.981; 95%CI (2.74–17.77),  P <0.001)], LA-ep <14.5% [HR = 2.68; 95% CI (1.00–7.18), P<0.01)], and LA-ea <21.2% [HR = 2.02; 95% CI (1.07–3.83), P <0.03]. CONCLUSION: Patients with severe AS have significantly remodelled LA, with impaired phasic function and strain. Amongst all CMR parameters, LAVmin, LASI, LAPF and LA-ep appear to be independent predictors for outcome

OP0319 DIAGNOSTIC ACCURACY OF ULTRASOUND IN CALCIUM PYROPHOSPHATE DEPOSITION DISEASE: PRELIMINARY RESULTS OF THE OMERACT US IN CPPD SUB-GROUP

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An Integrative Approach to Assess Subjective Well-Being. A Case Study on Romanian University Students

Subjective well-being (SWB) has presented long-lasting interest for researchers and the recent focus on the economic approach to SWB led to increased awareness of the topic. Despite the significant number of studies, conceptualizing and assessing SWB, along with finding predictors of SWB, need further empirical exploration. Following this rationale, using statistical and econometric methods (correlation analysis, Principal Component Analysis (PCA), Multinomial Logistic Regression (MLR)) applied on data collected via a survey on students from Bucharest University of Economic Studies (363 respondents), this study explores and provides insights that support a better understanding of defining and measuring SWB. Additionally, the study offers valuable information on the main determinants of SWB for a particular group, in this case, Romanian business students. According to findings, we argue that: (1) when assessing perception of life satisfaction and happiness, Romanian students tend to make slight distinctions between these two concepts; (2) question order effect is not significant, whereas negative sentiments (such as pessimism) impact self-assessment of happiness, but not of life satisfaction; (3) the main predictors for SWB are satisfaction with current activities, level of optimism/pessimism, health, and safety of the neighborhood. This paper proposes a new approach to modeling SWB by MLR, which features expressing the dependent variable with respect to the principal factors obtained by PCA

Ultrasound Methods in the Evaluation of Atherosclerosis: From Pathophysiology to Clinic

Atherosclerosis is a key pathological process that causes a plethora of pathologies, including coronary artery disease, peripheral artery disease, and ischemic stroke. The silent progression of the atherosclerotic disease prompts for new surveillance tools that can visualize, characterize, and provide a risk evaluation of the atherosclerotic plaque. Conventional ultrasound methods—bright (B)-mode US plus Doppler mode—provide a rapid, cost-efficient way to visualize an established plaque and give a rapid risk stratification of the patient through the Gray–Weale standardization—echolucent plaques with ≥50% stenosis have a significantly greater risk of ipsilateral stroke. Although rather disputed, the measurement of carotid intima-media thickness (C-IMT) may prove useful in identifying subclinical atherosclerosis. In addition, contrast-enhanced ultrasonography (CEUS) allows for a better image resolution and the visualization and quantification of plaque neovascularization, which has been correlated with future cardiovascular events. Newly emerging elastography techniques such as strain elastography and shear-wave elastography add a new dimension to this evaluation—the biomechanics of the arterial wall, which is altered in atherosclerosis. The invasive counterpart, intravascular ultrasound (IVUS), enables an individualized assessment of the anti-atherosclerotic therapies, as well as a direct risk assessment of these lesions through virtual histology IVUS

Noninvasive Assessment of HCV Patients Using Ultrasound Elastography

Among patients with chronic hepatitis C (CHC) infection, extensive research showed that fibrosis progression is a proper surrogate marker for advanced liver disease, eventually leading to dramatic endpoints such as cirrhosis and hepatocellular carcinoma. Therefore, there is growing interest in the use of noninvasive methods for fibrosis assessment in order to replace liver biopsy (LB) in clinical practice and provide optimal risk stratification. Elastographic techniques, such as Vibration Controlled Transient Elastography (VCTE), point-shear wave elastography (p-SWE), and 2D-SWE have shown promising results in this regard, with excellent performance in diagnosing hepatic cirrhosis, and great accuracy for steatosis detection through the Controlled Attenuation Parameter embedded on the VCTE device. In addition, the recent introduction of highly efficient direct-acting antivirals (DAAs) led to viral eradication and a significant decrease in liver damage, lowering the risk of hepatic decompensation, and HCC. Therefore, CHC patients need proper noninvasive and repeatable methods for adequate surveillance, even after treatment, as there still remains a risk of portal hypertension and HCC. However, the usefulness for monitoring fibrosis after the sustained virological response (SVR) needs further research

Noninvasive Assessment of Hepatitis C Virus Infected Patients Using Vibration-Controlled Transient Elastography

Chronic infection with hepatitis C virus (HCV) is one of the leading causes of cirrhosis and hepatocellular carcinoma (HCC). Surveillance of these patients is an essential strategy in the prevention chain, including in the pre/post-antiviral treatment states. Ultrasound elastography techniques are emerging as key methods in the assessment of liver diseases, with a number of advantages such as their rapid, noninvasive, and cost-effective characters. The present paper critically reviews the performance of vibration-controlled transient elastography (VCTE) in the assessment of HCV patients. VCTE measures liver stiffness (LS) and the ultrasonic attenuation through the embedded controlled attenuation parameter (CAP), providing the clinician with a tool for assessing fibrosis, cirrhosis, and steatosis in a noninvasive manner. Moreover, standardized LS values enable proper staging of the underlying fibrosis, leading to an accurate identification of a subset of HCV patients that present a high risk for complications. In addition, VCTE is a valuable technique in evaluating liver fibrosis prior to HCV therapy. However, its applicability in monitoring fibrosis regression after HCV eradication is currently limited and further studies should focus on extending the boundaries of VCTE in this context. From a different perspective, VCTE may be effective in identifying clinically significant portal hypertension (CSPH). An emerging prospect of clinical significance that warrants further study is the identification of esophageal varices. Our opinion is that the advantages of VCTE currently outweigh those of other surveillance methods

Performance of Ultrasound Techniques and the Potential of Artificial Intelligence in the Evaluation of Hepatocellular Carcinoma and Non-Alcoholic Fatty Liver Disease

Global statistics show an increasing percentage of patients that develop non-alcoholic fatty liver disease (NAFLD) and NAFLD-related hepatocellular carcinoma (HCC), even in the absence of cirrhosis. In the present review, we analyzed the diagnostic performance of ultrasonography (US) in the non-invasive evaluation of NAFLD and NAFLD-related HCC, as well as possibilities of optimizing US diagnosis with the help of artificial intelligence (AI) assistance. To date, US is the first-line examination recommended in the screening of patients with clinical suspicion of NAFLD, as it is readily available and leads to a better disease-specific surveillance. However, the conventional US presents limitations that significantly hamper its applicability in quantifying NAFLD and accurately characterizing a given focal liver lesion (FLL). Ultrasound contrast agents (UCAs) are an essential add-on to the conventional B-mode US and to the Doppler US that further empower this method, allowing the evaluation of the enhancement properties and the vascular architecture of FLLs, in comparison to the background parenchyma. The current paper also explores the new universe of AI and the various implications of deep learning algorithms in the evaluation of NAFLD and NAFLD-related HCC through US methods, concluding that it could potentially be a game changer for patient care

Pharmacoeconomic Analysis of Hemophilia Care in Romania

Hemophilia, a congenital X linked disease, has the serious burden of bleeding, requiring life-long replacement with coagulation factors (CF). In the present day, there is a continuously improving treatment for this condition. Objective: Our observational, cross-sectional study aims at finding out whether a prophylactic replacement with CF is affordable from the point of view of its cost-effectiveness in our country. Material and methods: A cohort of 122 persons with hemophilia were included in this patient-reported outcome survey, and they answered a questionnaire consisting of 56 items, focused on 4 domains—socio-demographic, medical, quality of health/life and cost/cost-effectiveness. Results and discussion: The markers for quality of health/life were correlated with the direct and indirect costs of care, comparing subgroup 1 of patients with prophylactic vs. subgroup 2 with on-demand replacement. Based on the incremental quality adjusted life years and the incremental costs, we calculated the incremental cost-effectiveness ratio (ICER) proving that prophylaxis is more cost-effective than on-demand replacement on a long time basis. Conclusions: The ICER is a threshold recommending the reimbursement of costs for a life-long prophylactic replacement in our country