Oxidative stress, inflammation and endothelial dysfunction: implications in atherosclerosis. Note II.

NADPH oxidase (nicotinamide adenine dinucleotide phosphate-oxidase), with its generically termed NOX isoforms, is the major source of ROS (reactive oxigen species) in biological systems. The oxidant/ antioxidant imbalance in favor of oxidants in the vascular system generates ROS via activation of NADPH oxidase. ROS are small oxygen-derived molecules with an important role in various biological processes (physiological or pathological). Some processes are beneficial and necessary for life under physiological conditions, but they are noxious, harmful under pathophysiological conditions. NADPH oxidases are present in phagocytes and in a wide variety of nonphagocytic cells. The enzyme generates superoxide by transferring electrons from NADPH inside the cell across the membrane and coupling them to molecular oxygen to produce superoxide anion, a reactive free-radical. Structurally, NADPH oxidase is a multicomponent enzyme which includes two integral membrane proteins, glycoprotein gp91phox and adaptor protein p22phox, which together form the heterodimeric flavocytochrome b558 that constitutes the core of the enzyme. During the resting state, the multidomain regulatory subunits p40phox, p47phox, p67phox are located in the cytosol organized as a complex. The activation of phagocytic NADPH oxidase occurs through a complex series of protein interactions. The increased production of free radicals under pathophysiological conditions is an integral part of the production of cardiovascular diseases and in particular of atherosclerosis. At the onset and progression of atherosclerosis, various non-traditional intercorrelated risk factors contribute such as oxidative stress, inflammation and endothelial dysfunction. Oxidative stress plays a crucial role not only in the formation but also in the evolution and destabilization of lesions. Oxidative stress is closely linked to endothelial damage. Endothelium modulates vascular tone by releasing specific vasoactive substances. At the onset and progression of atherosclerosis contributes to decreasing the bioavailability of NO (nitric oxide) or EDRF (endothelium-derived relaxing factor) with an important role in conserving vasodilation and inhibiting vasoconstriction. Clinical and paraclinical investigations show that inflammatory reactions operate at all stages of atherosclerotic events. According to the theory of oxidative stress, atherosclerosis is also the result of the particularly oxidative changes of LDL (low density lipoproteins) in the arterial wall. Excess ROS can produce peroxinitrite with NO, the cytotoxic oxidant important mediator of LDL oxidation with proaterogenic action

The use of spectral techniques to monitor the vegetation status in a protected area in the Iasi county

Remote sensing technology offers the possibility to monitor biophysical attributes and changes in plant biomass and productivity during the growing season, which can enable sustainable management. Recent advances in satellite remote sensing technology have produced innovative sensors for monitoring the Earth's surface, with increasing spatial and temporal resolution of available satellite images, such as those provided by the Sentinel-2, creating new opportunities for environmental monitoring and the generation of accurate datasets. This study aimed to assess vegetation condition during the spring, summer and autumn seasons in a protected area near Iasi, ROSCI0058, using biophysical indices derived from Sentinel-2 satellite imagery. The study area was chosen due to the existence of signals indicating the possibility of changes in the type and health status of vegetation within the site of Community importance. The analysis was based on a series of vegetation-specific spectral indices such as: normalized differential vegetation index (NDVI), leaf area index (LAI), canopy chlorophyll content (CCC), canopy water content (CWC), fraction of photosynthetically active absorbed radiation (FAPAR) and fraction of canopy cover (FCOVER), derived from Sentinel-2 high-resolution images. The time series of satellite images used covers the phenophase periods specific to the spontaneous flora in the period 2020-2022. With SNAP software the Sentinel-2 images were pre-processed to convert the reflectance of the ToA images to BoA, vegetation indices were calculated, after which final distribution maps were created with ArcGIS. The results indicate that the highest values for NDVI, LAI, FAPAR, FCOVER, CAB and CW did not follow a pattern, they occurred at different times of the year, as follows: in the spring season, the highest value was on April 10, 2020; in the summer season, highlighting the values of July 9, 2021 while for the fall, the year 2022 recorded the highest values on September 7, the results being directly proportional to the variation of climatic parameters. The analysis also considered the type of land use, with non-irrigated arable land having the highest values for various indices. The results highlight the potential of Sentinel-2 images for these types of studies, as they can be used to observe and assess the health of the vegetation cover

Diagnostic and classification pitfalls in systemic scleroderma

Generalităţi. Sclerodermia este o boală cronică, multisistemică, de etiologie incertă, caracterizată prin alterarea, indurarea și îngroșarea tegumentului, și prin modificări de tip fibrotic, inflamator și vascular ale unor organe interne (tub digestiv, pulmon, cord, rinichi), însoţită de anomalii imune, celulare și umorale. Prezentare de caz. Prezentăm cazul unei paciente în vârstă de 62 de ani, cunoscută din 2015 cu o importantă patologie cardio-respiratorie (fibroză pulmonară difuză, bronșiectazii bilateral, bronhopneumopatie obstructivă cronică, stadiul III, cord pulmonar cronic compensat, ateroscleroză aortică și mitrală, insuficienţă mitrală forma ușoară), gastroenterologică (reflux gastro-esofagian, steatohepatită cronică, colecistopatie cronică alitiazică), endocrinologică (gușă polimicronodulară, lob tiroidian stâng). Pacienta relatează debutul insidios în urmă cu 1 an a unor fenomene respiratorii – dispnee, tuse iritativă, asociate cu fatigabilitate, astenie fizică, scădere ponderală 17 kg în 6 luni (ianuarie-iunie 2015), pirozis, epigastralgii, disfonie. Se adresează iniţial medicului pneumolog, ulterior fiind direcţionată către diverși specialiști datorită simptomatologiei persistente și rebele la tratament. În ianuarie 2016, ajunge în departamentul de dermatologie, la indicaţia medicului alergolog, acesta găsindu-se în imposibiliatatea realizării testelor cutanate din cauza modificărilor tegumentare. Clinic: se obiectivează tegumente infiltrate și indurate la nivelul mâinilor și feţei, modificări instalate progresiv, însoţite de prurit generalizat. Din anamneza activă reiese că leziunile au fost precedate cu aproximativ 20 de ani de un fenomen Raynaud repetitiv. Pacienta prezintă, de asemenea, macule acromice suborbitar bilateral. Aspectul clinic și patologiile asociate orientează diagnosticul spre sclerodermie sistemică forma acrosclerotică și vitiligo, iar prin corelaţie cu modificările bioumorale se ridică suspiciunea de tiroidită autoimună. S-a instituit corticoterapia sistemică cu Methilprednisolon 16mg/zi, medicaţie vasoactivă, antifibrozantă, bronhodilatator, iar topic se asociază dermatocorticoid și pomadă cu heparină. Evoluţia a fost lent favorabilă, cu diminuarea induraţiei la nivelul membrelor superioare după o lună de tratament. Menţionăm faptul că pacienta s-a adresat serviciului de reumatologie pentru explorări suplimentare în vederea instituirii terapiei cu antagoniști ai receptorilor endotelinei. Astfel, medicul reumatolog decide suprimarea în doze descrescânde a corticoterapiei sistemice, pacienta acuzând, după administrarea ultimei doze, alterarea bruscă a stării generale, cu exacerbarea simptomatologiei pulmonare. S-a indicat reiniţierea corticoterapiei, dar, prin suprapunerea unei viroze respiratorii, evoluţia a fost nefastă, conducând la exitus. Rezultate și concluzii. Particularitatea cazului constă în asocierea, rar raportată în literatura de specialitate, a acestor patologii autoimune, în tipologia/ atipia atingerii pulmonare precoce și amplă, caracteristică pentru sclerodermia sistemica difuză și în nerecunoașterea sclerodermiei sistemice de către serviciile clinice în evidenţa cărora se afl a pacienta. Un alt aspect important ar fi rolul corticoterapiei sistemice în controlul atingerii viscerale și cutanate. Având în vedere heterogenitatea sclerodermiei sistemice, este importantă colaborarea interdisciplinară în vederea diagnosticării corecte și a stabilirii conduitei terapeutice adecvate, pentru îmbunătăţirea calităţii vieţii pacientului.Overview. Scleroderma is a chronic disease, affecting multisystem, of uncertain etiology. It is characterized by alteration, increased hardness and thickness of the skin and by fibrotic, inflammatory and vascular type changes of internal organs (gastrointestinal tract, lungs, heart, kidneys), accompanied by immunological, cellular and humoral abnormalities. Case report. We present a patient aged 62 years, known from 2015 with grave cardio-respiratory (diffuse lung fibrosis, bilateral bronchiectasis, chronic obstructive lung disease stage III, compensated chronic pulmonary heart disease, atherosclerosis, aortic and mitral stenosis, mild form of mitral regurgitation), gastroenterological (gastro-esophageal reflux, chronic steatohepatitis, chronic alithiasic gallbladder), endocrine (multimicronodular left lobe thyroidian goiter) problems. Th e patient relates insidious onset 1 year ago to respiratory phenomenon – dyspnea, irritant cough, associated with fatigue, asthenia, 17 kg weight loss within six months (January-June 2015), gastro-esophageal reflux, epigastric pain, dysphonia. The patient had initially been seen by a pulmonologist doctor, then directed to various medical specialists due to persistent rebelious symptoms refractory to treatment. In January 2016 the patient arrived in the dermatology department, sent by an allergist (allergy skin testing could not be performed because of the hardness of the skin). Clinic: infiltration and induration of the skin of the hands and face, changes progressively installed, accompanied by generalized pruritus. Repetitive Raynaud’s phenomenon has preceded skin lesions for about 20 years. The patient also presents achromic patches suborbital bilaterally. Clinical and biohumoral changes oriented the diagnosis to systemic acrosclerotic form of scleroderma associated with vitiligo and autoimmune thyroiditis. Systemic corticosteroid therapy was instituted (methylprednisolone 16 mg/day), vasoactive, antifibrotic, bronchodilator medication associated with topic dermatocorticoid and heparin ointment was applied as well. Favorable evolution has been slow, with the decrease of upper limb skin induration after one month of treatment. We note that the patient was addressed to the rheumatology service for additional examination and to switch to endothelin receptor antagonist therapy. The rheumatologist decides suppression of systemic corticosteroid therapy, decreasing doses. The patient complained of sudden alteration of general condition, with exacerbation of pulmonary symptoms aft er the last corticosteroid dose. Initiation of corticosteroid therapy was indicated, but by superimposing respiratory viruses, evolution was unfortunate, leading to exitus. Results and conlcusions. The particularity of the case lies: in the rarely reported in the literature combination of these autoimmune diseases, in typology/ atipia of early and wide lung achieving (diffuse systemic scleroderma feature) and in the inability of recognizing this disease (systemic scleroderma) by the other clinical services. Another important aspect is the role of systemic corticosteroid therapy to achieve the control of visceral and cutaneous changes. Considering the heterogeneity of systemic scleroderma, interdisciplinary collaboration is important in establishing the correct diagnosis and appropriate therapeutic management, to improve patient’s quality of life

Facial regeneration: current status and perspectives

Skin aging is a complex biological processes influenced by endogenous and exogenous factors. The primary aim of all skin anti-aging strategies is to reverse the dermal and epidermal signs of photoaging and chronological aging. Healthy and normal functioning skin barrier is an important protector against dehydration, penetration of various microorganisms, allergens, irritants, reactive oxygen species and radiation. The skin barrier may be specifically adjusted to allow penetration of desired substances.Regenerative medicine is the science of replacing, engineering or regenerating human cells, tissues or organs to restore or establish normal form and function. It uses cells, tissues, drugs, synthetic biomaterials and devices to help patients heal or regeneration. The reason of different methods of skin regeneration is to increase skin regeneration, elasticity, smoothness, density, macroscopic and microscopic aspect, changing the skin condition. It is necessary to slow down ageing processes on a cellular level concomitantly. We can provide to the skin primary structural constituents, such as collagen, elastin, to prevent the formation of wrinkles, but some products and techniques do promote the natural synthesis of these substances except elastin enhancing. Simultaneously it is necessary to prevent wrinkle formation by reduction of inflammation (topical or systemic antioxidants) in combination with sunscreens and retinoids to enhance their protective effects. An important attention must be accorded to Transforming Growth Factor- β family, other TGF-β-based approaches (Decorin and Mannose 6 Phosphate), modulation of Smad3/Smad7 Signaling, Epidermal Growth Factor family, Fibroblast Growth Factor family, Platelet-Derived Growth Factor family, Granulocyte Macrophage-Colony Stimulating Factor, Connective Tissue Growth Factor, Interleukin 10, Connexins, other approaches under investigation for scar reduction, collagen, fibronectin, laminin, elastin, glycosaminoglycans and other natural biomaterials. Regenerative Aesthetic Dermatology is focused on innovative treatments to support the skin in restoring and regenerating old and/or damaged tissue and thus improving overall skin quality, promoting faster healing while minimizing downtime and side effects for patients. The onset of effects could be instantly after procedure or can be observed gradually increasing over the time (weeks or monthes), as we are determining the skin to help itself. The regenerative treatments are encouraging the skin to build more collagen and elastin itself by bio-stimulation: resurfacing the epidermis (topical drug application, ablative LASERs, Laser radiofrequency resurfacing, ablative radiofrequency, microneedling, plasma skin resurfacing, crystal-free microdermabrasion), the formation of new collagen (IPL, Lasers, radiofrequency, infrared, Jett Plasma Medical, medical needling, mesotherapy, platelet-rich plasma, fillers as hyaluronic acid, HydraFacial MD, Oxygen facial, chemical peels, hormone replacement therapy, autologous and allogeneic stem cells, gene therapy), slow down the visible aging process by helping in the management of certain dynamic facial lines and wrinkles (Botulinum toxin). 518 Resurfacing the skin could be considered as a cancer prophylaxis and aesthetic dermatology is contributing to slowly, healthy, gracefully aging

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

DENTAL ANXIETY AMONG ADOLESCENTS-AN OVERVIEW

Dental anxiety is a phrase used to describe the fear or stress determined by dental treatments. This narrative review aims to highlight some epidemiologic aspects of the phenomenon while searching medical databases for researches relating to the topic of dental anxiety in adolescents. Adolescence represents a period of transition illustrated by changes both at physical level and behavior and personality levels. Anxiety disorders are frequent at this age and they may affect school performance, the relationships with one’s family and friends. Dental anxiety is associated with certain trigger factors such as needles or sometimes the simple sight of the dental instruments. Although most patients have a low level of dental anxiety, literature mentions the percentage of 11% for the prevalence of severe dental anxiety and 90% for low anxiety. Most studies show that the female patients are more anxious than the male patients. Among the dental procedures, the ones involving oral surgery, including tooth extraction and local anesthesia, remain the most incriminated trigger factors. This paper also presents the most known questionnaires used in current practice that help the dentist identify anxious patients as well as the etiology of this phenomenon

Psychosomatic manifestations in syphilis

Disciplina Dermatologie, Universitatea de Medicină şi Farmacie “Grigore T. Popa”, Iaşi, România, Disciplina Psihiatrie, Universitatea de Medicină şi Farmacie “Grigore T. Popa”, Iaşi, România, Disciplina Oftalmologie, Universitatea de Medicină şi Farmacie “Grigore T. Popa”, Iaşi, România, Disciplina Medicină de familie Adulţi, Universitatea de Medicină şi Farmacie “Grigore T. Popa”, Iaşi, România, Disciplina Dermatologie, Universitatea de Medicină şi Farmacie “Transilvania”, Braşov, România, Congresul V Naţional de Dermatologie cu participare internaţională Chişinău, 9-11 iunie 2016, Chişinău, Republica MoldovaIntroducere şi obiective. Sifilisul este o boală contagioasă de etiologie bacteriană (Treponema pallidum), transmisă preponderent pe cale sexuală, cu interesare sistemică, cu evoluţie complexă, cronică, cu manifestări clinice proteiforme, imitând multe afecţiuni dermatologice, care afectează doar oamenii şi unele primate. În ultimii 30 de ani, aspectele clinice şi evolutive ale bolii s-au schimbat considerabil. Manifestările viscerale şi cutanate ale sifilisului terţiar sunt rareori întâlnite în prezent. În studiul de faţă, am investigat corelaţia dintre intensitatea stresului pacientului şi localizarea leziunilor cutanate ale sifilisului, mediul de provenienţă al pacientului etc. Material si metode. Lotul de studiu a fost constituit din 214 pacienţi diagnosticaţi cu sifilis, urmăriţi între anii 2011-2015, în regiunile centrală şi de nord-est ale României, cu vârste cuprinse între 2 săptămâni şi 72 de ani, de diferite religii. Rezultate. Se observă că, în pofida faptului că incidenţa sifilisului este în scădere, în general, noile cazuri sunt mai ales din mediul rural, cu un nivel de instruire scăzut, cu situaţie materială precară, fără ocupaţie, şomeri. Afecţiune cu tablou clinic polimorf, sifilisul a avut o evoluţie imprevizibilă şi un prognostic sumbru în cazurile nediagnosticate şi netratate la timp. A avut o frecvenţă considerabilă, de 0,7% din pacienţii care s-au adresat serviciilor de dermatologie între anii 2011-2015. Pacienţii cu sifilis au provenit mai frecvent din zonele rurale, probabil prin agregarea efectelor factorilor epidemiologici. Incidenţa infecţiei cu Treponema pallidum este influenţată de mai mulţi factori, printre care cei mai importanţi sunt: gradul de cultură, igienă, schimbarea comportamentului sexual al indivizilor în urma modificărilor economice, statusul imun al receptorului, cantitatea microbiană inoculată, extinderea manifestărilor comportamentale ale patologiei sociale. Atitudinea femeilor gravide a fost influenţată semnificativ de diagnostic, manifestând simptome de stres, tensiune, preocupare pentru sănătatea copilului, preocupare pentru ascunderea diagnosticului faţă de familie, faţă de anturaj. Concluzii. Atitudinea pacientului cu sifilis s-a schimbat din momentul comunicării diagnosticului de certitudine. Principalele sentimente cu care pacienţii s-au confruntat au fost cele de: ruşine, vinovăţie şi scăderea stimei de sine. Anxietatea creşte ca urmare a instalării stării tensionale. Profilul matern cu cel mai mare risc este reprezentat de o femeie tânără, care nu a primit o monitorizare prenatală adecvată, fără o minimă educaţie sexuală, care nu are cunoştinţe cu privire la standardele de sănătate şi de igienă personală. Mai mulţi părinţi au înţeles greşit să-şi exercite atribuţiile de părinte, prin refuzul tratamentului corespunzător simultan cu partenerul/partenerii sexuali, în detrimentul interesului copilului. Introduction & objectives. Syphilis is a contagious systemic disease, with complex and chronic course, with clinical proteinform manifestations, imitating many dermatological diseases, caused by Treponema pallidum, which affects only humans and some primates. In the last 30 years, clinical aspects of the disease have changed considerably. Cutaneous and visceral manifestations of late syphilis are rarely met today. We investigated the correlation between stress intensity and localization of cutaneous lesions of syphilis, the patient in the environment of origin etc. Material & methods. The total study group consisted of 214 patients diagnosed with syphilis, followed between 2011-2015, in the central and north-eastern Romania, aged between 2 weeks-72 years, of different religions. Results. We notice that despite the fact that the incidence of syphilis is generally declining, new cases tend to be more rural, in patients with poor training level, unemployed. Syphilis, disease with polymorphic clinical picture, with unpredictable evolution and grim prognosis in cases undiagnosed and untreated in time, had a considerable frequency of 0.7% among patients followed up in dermatology office between the years 2011-2015. Patients with syphilis came more frequently in rural areas, probably by aggregating effects of epidemiological factors, the incidence is influenced by many factors, among which the most important are: degree of culture, hygiene, the economic basis of individual sexual behavior change, immune status of the contacts, the amount of inoculum, expanding of behavioral manifestations of social pathology. Attitude of pregnant women was significantly influenced by the diagnosis, manifesting symptoms of stress, tension, concern for the child, concern for concealment of diagnosis. Conclusions. Attitude of patient with syphilis altered, since the diagnosis was set out. The main feelings are: facing shame, guilt and the decrease of self-esteem. Anxiety grows as a result of tensional state. Maternal profile with the highest risk is represented by a young woman who did not receive adequate prenatal monitoring, without basic sex education, who has no knowledge about health and personal hygiene standards. Some parents misunderstand to exercise parenthood, refusing fair treatment simultaneously with sexual partners to the detriment of child's interest

Nanocomposite Hydrogels Based on Poly(<i>N</i>-vinyl pyrrolidone)

Poly(N-vinyl pyrrolidone) (PNVP) is one of the most studied and recognized polymer for use in the pharmaceutical industry and medicine purposes due to its unique combination of highly essential properties such as nontoxicity, biocompatibility with human tissue, chemical stability, and good solubility in water and other solvents. Most of the PNVP-based hydrogels are characterized by low mechanical properties when handled in a swollen state. For this purpose, several methods have been reported to increase the mechanical properties of these gels by introducing an inorganic clay as a reinforcing agent. The present work deals with the preparation and detailed structural characterization of nanocomposite hydrogels based on amidic N-vinyl pyrrolidone (NVP) monomers with or without N,N-methylenbis(acrylamide) (MBA) as chemical crosslinker and different concentrations of Laponite XLG as reinforcing agent. The hydrogels were synthesized by the radical polymerization of the monomers using 2,2-azobisisobutyronitrile (AIBN) as the initiator. In this study, we evaluated the structure of PNVP-based nanocomposites by using FT-IR, their morphology through SEM–EDX, and the influence of different amounts of Laponite XLG on the final properties, by performing rheological measurements and swelling studies. The Laponite XLG, used as reinforcing agent, significantly contributed to the improvement in the mechanical properties of the nanocomposite hydrogels

ORAL HEALTH-RELATED QUALITY OF LIFE AND CARIES EXPERIENCE AMONG YOUNG ADULTS

Young adults represent the age group with the highest ability to understand the need of maintaining good oral health and the highest chance to adopt correct oral hygiene behaviors. Great attention should also be paid to risk factors for oral conditions, especially sugary aliments intake, which creates a suitable environment for developing dental caries. Young adults should be aware about the importance of reducing the frequency of consumption of these aliments. Smoking has negative effects on both general and oral health. It creates and maintains conditions favorable for developing oral diseases. Quitting smoking should be seen as an important recommendation, to ensure good oral health and quality of life. The impairment of oral health is strongly connected with quality of life. To quantify the impact of oral health on quality of life, the OHIP-14 questionnaire is widely used. Regarding the severity of the impact oral conditions have on quality of life, the most accused domains by subjects are physical pain, psychological discomfort and psychological disability. Oral health is directly influenced by caries experience, OHRQoL being lower as the caries prevalence is higher. To quantify the prevalence of dental caries, the DMFT index is one of the most used indicators. It evaluates, on one hand, the caries experience, and on the other hand, the exact number of decayed, missing and filled teeth. OHRQoL is a mandatory toll that helps understand the impact of oral conditions on general health. Both the OHIP-14 questionnaire and the DMFT index, are a real help to quantify the connection between oral conditions, most common of them being dental caries, and their negative effects on general health and on quality of life