Signal-Averaged ECG: Basics to Current Issues

Signal-averaged ECG (SAECG) is a high-resolution, noninvasive electrocardiographic method enabling detection of late ventricular potentials (LVP), which are low-amplitude and high-frequency signals, predicting reentry ventricular arrhythmias, and sudden cardiac death (SCD). Three criteria are used to detect late ventricular potentials as follows: signal-average ECG QRS duration (SAECG-QRS), the duration of the terminal part of the QRS complex with an amplitude below 40 μV (LAS40) and the root mean square (RSM) signal amplitude of the last 40 ms of the signal < 20 μV (RMS40). Late ventricular potentials can be detected not only at the end of a QRS complex but also as intra-QRS (IQRS) potentials. Signal-averaged ECG was modified to enable the analysis of the P-wave and to detect atrial late potentials (ALPs), low-amplitude potentials at the terminal part of the filtered P-wave, and predictors of atrial fibrillation (AF). Late atrial and ventricular potentials originate from areas of delayed, fragmented, and heterogenous conduction within atrial or ventricular myocardium. This chapter reviews the most important mechanisms explaining the occurrence of late ventricular, intra-QRS, and atrial potentials; their predictive value for arrhythmia, focusing on recent clinical data, long-term follow-up, and outcome; and analysis of SAECG variables in cardiac and noncardiac diseases

ROMANIA'S REAL CONVERGENCE TO THE EUROPEAN UNION Dragos Mihai Ungureanu , Permanent Representation of Romania to the European Union Ruxandra Dana Vilag, Romanian-American University Bucharest George Horia Ionescu, Romanian-American University Bucharest Florian Bogdan Stoian, “Lucian Blaga†University of Sibiu

In the process of European integration, switching in 1999 to the third stageof Economic and Monetary Union, has intensified the need to coordinate economic andsectoral policies of the Member States. The process of coordination is necessary toharmonize national economic policy objectives in order to minimize the negative impactof economic policy measures taken by some member countries to other member countriesand reduce the temptation for Member States to have behavior riders. Real Convergenceis an essential goal of Romanian integration into the European Union. Attenuation of thedevelopment gaps maintained between Romania and the EU can not be achieved solelythrough the use of market forces. Economic transformations occurring globally andincreased risk aversion contributed to a signifiant reduction of capital flows to Romania,increased pressures upon exchange rate.Real convergence, nominal convergence, integration, European Union

FINANCIAL CONTAGION AND INVESTORS BEHAVIOR

International capital markets, in general, seem to be volatile markets, influenced bymany factors, a phenomenon that affects both developed markets, as well as least developed, withemerging market economies suffering most because of this. It is clear, however, that volatility willremain for as long as it is delayed the adoption of specific measures at national and internationalfinancial architecture level, measures that may be necessary to reduce these risks, to limit theirimpact, and that the question financial market can relapse in a manner as efficiently as possible.investor behaviour, financial crisis, rational investor, irational investor, financial contagion

ASSESING THE IMPLEMENTATION OF REAL CONVERGENCE IN ROMANIA

The convergence is an essential objective of the integration process of Romania in the European Union. Minimizing gaps in the level of development that arise between Romania and the average European Union can not be achieved solely through the use of marconvergence, European Union, real convergence

Advanced Ultrasound Techniques in Preoperative Diagnostic of Thyroid Cancers

The most precise evaluation of thyroid masses is by high-sensitive ultrasound. Complementary to B-mode ultrasound, elastography can add valuable information by determining tissue stiffness—an important predictor for malignancy. All major guidelines recommend nodules with high suspicious ultrasound characteristics larger than 1 cm to be addressed to ultrasound-guided fine needle aspiration biopsy (FNAB) to rule out malignancy. The main limitation of this procedure is represented by indeterminate cytology, which accounts for up to 20–25% of biopsy results. Molecular markers imply elevated costs and their performance needs further study. Elastography may be helpful in establishing the optimal therapeutic attitude for this cytological category. Currently, there are two ultrasound elastography methods available for assessing tissue stiffness using the parallel deformation to the applied force direction (strain) or the perpendicular deformation to the force direction (shear wave). These methods will be presented and compared in this chapter, with their indications and limitations for a better understanding of their application in nodular thyroid pathology

Elastography: A New Ultrasound Technique in Nodular Thyroid Pathology

Elastography is a new technique for evaluating the stiffness of nodules. It is generally recognised that malignant thyroid lesions are harder than benign lesions. Different elastographic techniques are presented, with characteristics, advantages and limitations. Qualitative and semiquantitative methods are described. Comparison of the main existing techniques, static and dynamic elastographies, is presented in this chapter. Strain elastography seems to have a better diagnostic quality than shear wave elastography in the diagnosis of thyroid cancer disease. A positive elastogram, suggestive for malignancy is more useful in diagnosis than a positive grey-scale ultrasound evaluation. Elastography increases the specificity of grey scale ultrasound (US), it should be always integrated with its information and should be considered as a complement of conventional US

Importanța estetică a mâinii operate

Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Background. Traumatic hand injury represents one of the greatest distressing injuries. Severe hand injuries are related to high efforts for surgical and functional reconstructions to accomplish a satisfactory functional and aesthetic result. Objective of the study. The study was designed to mark the aesthetic importance in the practice of reconstructive surgery on the operated hand, in terms of the correlation between the severity of injuries and the postoperative aesthetic result. Material and Methods. In this retrospective study, we evaluated 175 patients with severe hand injuries in the Clinic of Plastic Surgery at IMU Hospital. The sample included 107 men, 68 women, aged between 15-60 years. Hand injuries were on the phalanges in 115 cases, in the metacarpal region 32, at the level of the carpus 23 and in 5 cases was extended on entire surface of the hand. Results. In the current study we examined the correlation between the hand injury severity scoring system and the quality of life of the pacient in terms of aesthetics associated with functional outcome and psychological impact. The study showed that psychological impact of the event, satisfaction of apperance and hand function were found to be correlated to low indicator of injury. Conclusion. The attempt to preserve both the function and the aesthetic aspect in each group of injuries with a high HISS score requires a lot of effort, time, major costs and technique. The increase of the quality of life, the integration in the society, as well as the desire for recovery rise gradually. Introducere. Traumatismele mâinii reprezintă una dintre cele mai mari suferințe. Reconstrucțiile chirurgicale sunt critice și necesită iscusința chirurgului pentru păstrarea structurii anatomice, funcției și importanța esteticului. Scopul lucrării. Studiul a fost conceput pentru a marca importanța estetică în practica chirurgiei reconstructive asupra mâinii operate din prisma corelației dintre gravitatea leziunilor și rezultatului estetic postoperator. Material și Metode. Studiu de tip observațional s-a desfășurat în Clinica de Chirurgie Plastică în Institutul de Medicină Urgentă. Eșantionul a cuprins 175 pacienți cu tramatisme mutilante. Bărbați 107, femei 68, cu vârsta de la 15-60 ani. Leziunile au fost pe falange în 115 cazuri, în regiunea metacarpiană 32, la nivelul carpului 23 și în 5 cazuri pe întreaga suprafață a mâinii. Rezultate. Studiul s-a exat pe examinarea relației dintre severitatea traumei la mâina operată și modificarea calității vieții pacientului prin prisma esteticului corelat cu impactul funcțional și psihologic. Studiul a demonstrat legătura atât dintre satisfacția imaginii, cât și a funcției mâinii operate, corelate cu indicatorul mic al injuriei. Concluzii. Încercarea de a păstra atât funcția, cât și aspectul estetic în fiecare grup de patologii necesită mult efort. Valoarea înaltă a scorului HISS solicită timp, costuri majore și tehnică de performanță. Sporirea calității vieții, integrării în societate și dorința de recuperare cresc gradual

EXPLORING SURGICAL OPTIONS AND THEIR IMPACT ON DUPUYTREN’S DISEASE: OUTCOMES AND CONSIDERATIONS

Universitatea de Stat de Medicină şi Farmacie „Nicolae Testemiţanu”, Chişinău, Republica MoldovaIntroducere. Maladia Dupuytren este o afecțiune caracterizată prin contractura progresivă a fasciei palmare, conducând la afectarea funcționalității mâinii. Diversele tehnici chirurgicale utilizate și eficacitatea lor rămân a fi subiect de cercetare. Scopul lucrării. Acest studiu a avut ca scop analiza diferitor tehnici chirurgicale utilizate în maladia Dupuytren, evaluând ratele de recurență, îmbunătățirea funcțională și satisfacția pacientului. Material și metode. A fost realizat un reviu sistematic prin căutarea în bazele de date electronice: PubMed, Scopus, Elsevier și Embase, pentru studii publicate între 2010 și 2023, care au inclus tehnici chirurgicale și rezultatele acestora, rata de recurență, îmbunătățirea funcțională a mâinii, rezultate raportate de pacienți și rata de complicații. Rezultate. Reviul a inclus 25 de studii, cuprinzând diverse tehnici chirurgicale: fasciectomie deschisă, fasciectomie limitată, aponeurotomie percutană cu ac și injectare de colagenază. Rata de recurență a variat în funcție de tehnicile utilizate, fasciectomia deschisă fiind asociată cu rate mai scăzute de recurență. Ratele de satisfacție ale pacienților au fost, în general, crescute, majoritatea persoanelor experimentând ameliorarea simptomelor și îmbunătățirea funcției mâinii. Ratele de complicații au fost relativ scăzute, cel mai frecvent întâlnindu-se probleme legate de vindecarea plăgilor. Concluzii. Tehnicile chirurgicale utilizate în maladia Dupuytren oferă rezultate variate. Fasciectomia deschisă rămâne o opțiune de încredere pentru obținerea rezultatelor favorabile, cu rate reduse de recurență. Studii comparative suplimentare și urmărirea pe termen lung sunt necesare pentru a optimiza ghidurile de tratament și a optimiza abordările chirurgicale.Background. Dupuytren’s disease is a common hand condition characterized by progressive contracture of the palmar fascia, leading to impaired hand function. Various surgical techniques are employed to treat Dupuytren’s disease, but their comparative outcomes and effectiveness remain a subject of investigation. Objective of the study. This study aimed to comprehensively analyze different surgical techniques for Dupuytren’s disease, evaluating recurrence rates, functional improvement, and patient satisfaction. Material and methods. A systematic review was conducted by searching electronic databases including PubMed, Scopus, Elsevier and Embase for studies published between 2010 and 2023, including studies reporting on surgical techniques and their outcomes, recurrence rates, hand function improvement, patient-reported outcomes, and complication rates. Results. The review encompassed 25 studies involving various surgical techniques: open fasciectomy, limited fasciectomy, needle aponeurotomy, and collagenase injection. The recurrence rates varied across the techniques, with open fasciectomy generally associated with lower rates compared to other approaches. Functional improvement was observed across all techniques, although the extent varied. Patient satisfaction rates were generally high, with most individuals experiencing relief from symptoms and improved hand function. Complication rates were relatively low, with the most common being wound healing issues. Conclusion. Surgical techniques in Dupuytren’s disease offer varying outcomes. Open fasciectomy remains a reliable option for achieving favorable outcomes with lower recurrence rates. Further comparative studies and longterm follow-up are necessary to refine treatment guidelines and optimize surgical approaches

Unmodifiable variables related to thyroid cancer incidence

The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it helps select an optimal personalized therapy. The present analysis is an observational, prospective study that enrolled all patients with thyroid disease who were operated upon at a single center. The study aimed to determine the most frequent age at presentation, the predominance of one sex over the other, the incidence of malignant thyroid disease, and the relative risk for each sex to develop thyroid carcinoma. The incidence of thyroid carcinoma was higher for women than for men, with a higher relative risk in the female subgroup. Incidence was also highest in the 50-60-year-old group. Given that studies show better survival for women and for younger patients, even when presenting with advanced disease, compared with older, male patients, such prognostic indicators should be a factor in the treatment decision