Evaluarea markerilor inflamaţiei la pacienţii cu restenoză intra-stent expuşi revascularizării

Inflamația nespecifi că este un factor important în dezvoltarea afecțiunilor aterosclerotice și remodelarea vasculară. Patogeneza restenozei intrastent rămâne o problemă primordială a cardiologiei intervenționale, iar inflamația se prezintă ca un factor declanșator important. Scopul acestui studiu constă în evaluarea a 11 markeri circulanți ai inflamației la 68 de pacienți până la și după (24 ore, 1, 3, 6 și 12 luni) restenoză. Rezultatele primite indică o creștere preprocedurală veridică (cu 33,3-73,8%) a majorității citokinelor: factorului necrozei tumorale-α (TNF-alpha), interleukinelor (IL) 6 și 8, proteinei chemoatractantă a monocitelor 1 (MCP-1), proteinei inflamatoare 1-α a macrofagelor (MIP-1-alpha), creștere mai pronunțată, receptorului solubil al proteinei membranare SD40 și rezistinei. IL-2 și IL-12 au crescut nesemnificativ (8,1- 12,7%). În același timp heregulina 1β s-a micșorat cu 42,6% (

STAGE SPEECH AND AFFECTIVE HEARING

The issue of the word’s sound shell and the interdependence between emotion and word is still under discussion, especially nowadays, when the quality of communication is not a concern anymore, both on and off the stage. The ability to detect the partner’s voice tones is unusual, it allows an actor to hear sounds, modulations, unheard until then, unseen, and mysterious tones. The habit to hear and understand the “language of emotions” is valuable without which an actor cannot exist in an indirect dialog, where the text is different from the subtext, or even opposite sometimes. The intonational expressiveness of speaking depends also on the sensitivity, the person’s emotional receptiveness that directly depends on the affective hearing. This is possible only when having a developed verbal perception seen from two angles: auditory and affective

Structure and form particularities of interradicular and interdental septa

Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Interdental and interradicular septa represents anatomical structures that reference in different types of pathologies like: marginal periodontitis, paradontosis and dental migrations. In literature does not exist enough information about the structure and form varieties of interalveolar septa. We can mention next forms of septa: sharp lance form, dome form, crescent form and dissected form which is divided in: dissected properly and dissected in steps. All this types of forms have a different influence on pathological appearance on the bone structure. Another particularity is an cortical difference that may be not so pronounced at some persons, while to others it is more pronounced. Also a particularity is in the structure of cancellous bone where we can see the distance between bone trabeculae. By time in some pathological conditions we atest changes in interrdental and interradicular septa - thinning the cortical at septa's peaks, outbreaks of spongy bone tissue thinning etc. Purpose: Studying varieties of form and factors that influence their changes at interdental and interradicular septa's level in normal and pathological cases. Material and methods: Were studied 132 radiograms of patients that received medical help in USMF ,,Nicolae Testemitanu" dental clinic and in private dental clinic ,,Parodent Prim" SRL from Chisinau city. Radiographic clichés were analized at fluoroscopy. For study we used Новик И.О. classification.The method of collectioning the information was by selective method-were selected only radiograms that coresponded our classification criteria. Therewith we used the method of observation and analyze of types of interdental and interradicular septa in norm and pathological disease. Discussion results: Anatomical structures of interdental and interradicular septa are in strong relation with various factors: tooth anatomy of teeth and their position in the dental arch, type of vascularization, local physico-chemical conditions and local systemic factors. The interdental septum protrude at alveolar level and is more massive in relation with vestibular and oral alveolar wall. Interradicular septum are perfored by multiple holes, through which nervs and blood vessels pass. Cortical thickness is reduced at maxillary level than at mandibula. Normally the anatomical structure of septum is not standart, it has individual particularities (of shape, bone density). Analyzing the obtained data, we found that from 132 radiograms only 19 (14.39%) of cases was detected with normal structure interdental and interradiculare septa to young persons - 16-35 years. From this numbers, dome shaped septum -27,2 %; sharped lance- 25,3 %; halfmoon-46,72% and dissected shape-0,78%. Conclusion: 1. The analysis of data from speciality literature that confirms the four types of interdental septum: dome shaped, halfmoon, sharped lance and dissected shape. 2. The basic factors that influence the shape of septa are: the teeth anatomy and their position in arch, the functional ocluzal forces that are transmitted, type of vascularization, physico-chemical conditions of individual local and systemic factors. 3.Obtained results are in relationship with results from speciality literatury that refers to the form of septum: dome-27,2%; sharped lance- 25,3%; halfmoon-46,72% and dissected form- 0,78%. 4. Pathological condition mostly apears molars region where prevail the dome shaped septa

Root canal irrigation during endodontic treatment

Department of odontology, periodontology and pathology Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of MoldovaIntroduction. Root canal irrigation aims to clean and disinfect root canal system by removing organic tissue, smear layer and microorganisms. The most commonly used irrigants are: NaOCl 0,5-5,25%, EDTA 17%, MTAD, CHX (0.2%, 1%, and 2%), citric acid (10%). Aim of the study. To monitor over the time the effectiveness of endodontic treatment using different irrigants in combination with sonic and ultrasonic activation systems. Materials and methods. The study was based on the treatment of 15 patients with pulpitis and periapical processes who were subjected to endodontic treatment of 9 single rooted teeth and 10 multiple rooted teeth. The irrigation protocol of pulpitis treatment entailed: 2,5%NaOCl; 17%EDTA;5,25%NaOCl; final irrigation: 5,25%NaOCl+ultrasonic activation;17%EDTA+sonic activation; distilled water; drying and filling. In the treatment of patients with periapical processes, the root canals were irrigated as follows: 5,25%NaOCl ;17% EDTA ;2%CHX, temporary filling with calcium hydroxide for 10 days. The second visit entailed removal of the temporary filling, irrigation with 17%EDTA; distilled water; 2%CHX drying and filling, X-ray. Results. The patients were examined at 3, 6 and 12 moths. The study showed that treatment by using different irrigants in combination with sonic and ultrasonic activation had a high rate of success (95-97%). This protocol of irrigation was selected in treatment of pulpitis and periapical lesions due to the properties of each irrigant: NaOCl has bactericidal cytotoxicity, dissolves organic material, it has no effect on the smear layer. EDTA effectively removes the smear layer by chelating the inorganic components of the dentine. It does not have any antibacterial activity and does not dissolve the organic tissues. CHX has a wide antimicrobial spectrum and is effective against Gram-positive and Gram- negative bacteria, especially against E.faecalis. Conclusions. Successful endodontic treatment depends on the correct use of the irrigants, respecting the consecutivity, concentration and application time of each irrigant and also a tridimensional filling of root canal

Эволюция эхокардиографических параметров у пациентов с острым инфарктом миокарда без подъема сегмента ST перенесших чрезкожную реваскуляризацию миокарда.

Ecocardiographic evolution in patients with acute miocardial infarction without ST-segment elevation after percutaneus myocardial revascularizationScopul studiului a fost evaluarea evoluției ecocardiografice a pacienților cu infarct miocardic acut fără elevarea segmentului ST (NSTEMI) la 6 luni după revascularizarea miocardică percutană în funcție de timpul de reperfuzie. Au fost examinate ecocardiografic două loturi a câte 126 de pacienți cu NSTEMI. Pacienții din primul lot au fost supuși revascularizării în primele 72 de ore de la debutul simptomelor, din lotul doi – de la 72 de ore până la 30 de zile. Ecocardiografia (ECOCG) a fost efectuată a doua zi după intervenție și la 6 luni. A fost depistată evoluția ecocardiografică mai favorabilă la pacienți care au fost supuși revascularizării amânate.Эволюция эхокардиографических параметров у пациентов с острым инфарктом миокарда без подъема сегмента ST перенесших чрезкожную реваскуляризацию миокарда

Особенности гемостаза у больных с инфарктом миокарда без подъема сегмента ST при некоторых сопутствующих заболеваниях

The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. [1] Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis.Along these lines, thrombosis is the result of several changes in local homeostasis: endothelial dysfunction, changes in the fibrinolytic system, increased content of some coagulation factors, decreased natural inhibitors, platelet hyperactivity [2] [3].In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired coagulation, anticoagulation, and fibrinolysis in acute vascular conditions, including coronary artery disease.We also discuss the prognostic implications of coagulation biomarkers regarding arterial thrombotic events, addressing, in particular, people who are exposed to metabolic risks (hyperlipidemia, hypertension, and diabetes).We conclude that affecting coagulation appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic and coagulant system represents a viable strategy to improve outcomes in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic and anticoagulant system and tailoring the therapy according to the need of each individual.Formarea unui tromb obstructiv în cadrul unei artere rămâne o cauză majoră a mortalității și morbidității la nivel mondial. [1] În ciuda inhibiției eficiente a funcției plachetare de către terapii antiplachetare moderne, acești agenți nu reușesc să elimine pe deplin riscul aterotrombotic. Acest lucru poate fi legat de boli vasculare extinse, dincolo de abilitățile de protecție ale agenților de tratament utilizați. Cu toate acestea, dovezi recente sugerează că riscul vascular rezidual la cei tratați cu terapii antiplachetare moderne este legat, cel puțin parțial, de liza de cheag de fibrină afectată în condiţiile unei stări procoagulante. Pe linia acestor constatări, tromboza este rezultatul apariţiei mai multor modifcări în homeostazia locală: disfuncţia endotelială, modificări ale sistemului fibrinolitic, creşterea conţinutului unor factori ai coagulării, scăderea inhibitorilor naturali, hiperactivitatea trombocitară [2] [3].În această revizuire, încercăm să aruncăm mai multă lumină asupra rolului dishomeostaziei în predispoziția la evenimente vasculare arteriale. Oferim o scurtă privire de ansamblu asupra sistemului de coagulare, urmată de abordarea rolului coagulării, anticoagulării și fibrinolizei afectate în afecțiuni vasculare acute, inclusiv in boala arteriala coronariană. De asemenea, discutăm despre implicațiile prognostice ale biomarkerilor coagulării, privind evenimentele trombotice arteriale, abordând, in special, persoanele care sunt expuse la riscuri metabolice (hiperlipidemie, hipertensiune arterială și diabet zaharat).Concluzionăm că afectarea coagularii pare să contribuie la riscul de tromboză reziduală la persoanele cu boală arterială, iar vizarea proteinelor din sistemul fibrinolitic si coagulant reprezintă o strategie viabilă pentru îmbunătățirea rezultatului în această populație.Muncă viitoare este necesară in perfecționarea abordării antitrombotice prin modularea anomaliilor patologice în sistemul fibrinolitic, coagulant și anticoagulant și extinderea strategiilor individualizate de îngrijire a pacienților, pentru a asigura cel mai bun rezultat clinic în populația cu risc vascular ridicat.Обструктивное образование тромба в артерии остается основной причиной заболеваемости и смертности во всем мире. [1] Несмотря на эффективное ингибирование функции тромбоцитов современными антитромбоцитарными препаратами, эти препараты не могут полностью устранить риск атеротромботизма. Это может быть связано с обширным сосудистым заболеванием, выходящим за рамки защитных свойств используемых лечебных средств. Однако последние данные свидетельствуют о том, что остаточный сосудистый риск у пациентов, получающих современные антитромбоцитарные препараты, связан, по крайней мере частично, с нарушением лизиса фибринового сгустка в условиях прокоагулянтного состояния. Таким образом, тромбоз является результатом нескольких изменений местного гомеостаза: эндотелиальной дисфункции, изменений в фибринолитической системе, повышенного содержания некоторых факторов свертывания крови, снижения естественных ингибиторов, гиперактивности тромбоцитов [2] [3].В этом обзоре мы пытаемся пролить больше света на роль дисгомеостаза в предрасположенности к артериально-сосудистым событиям. Мы предоставляем краткий обзор системы свертывания крови, а затем обращаемся к роли нарушений свертывания крови, антикоагуляции и фибринолиза при острых сосудистых заболеваниях, включая ишемическую болезнь сердца. Мы также обсуждаем прогностическое значение биомаркеров коагуляции в отношении артериальных тромботических событий, особенно у людей, подверженных метаболическим рискам (гиперлипидемия, гипертония и диабет).Мы пришли к выводу, что нарушение коагуляции, повидимому, способствует риску остаточного тромбоза у людей с заболеванием артерий, и нацеливание на белки из фибринолитической системы и системы свертывания представляет собой жизнеспособную стратегию для улучшения результатов в этой популяции.Необходима дальнейшая работа по совершенствованию антитромботического подхода путем модулирования патологических нарушений в фибринолитической и антикоагулянтной системе и расширения индивидуальных стратегий ухода за пациентами для обеспечения наилучшего клинического результата в популяции с высоким сосудистым риском

Развитие кардиологии в следующем десятилетии.

Cardiology development in the next decade.Bolile cardiovasculare reprezintă cauza principală responsabilă de morbiditatea și mortalitatea în lume. Direcțiile de dezvoltare, preconizate în medicina cardiovasculară pentru următorii ani, vor servi imperativului de a le reduce. În articol sunt elucidate câteva din domeniile de perspectivă. Progresele notorii în imagistica medicală, medicina de precizie, genomică și epigenetică, în tehnologiile de elaborare de medicamente noi, în medicina regenerativă, medicina de prevenție etc., au fost atinse într-o strânsă colaborare interdisciplinară și vor permite o dezvoltare oportună în domeniul cardiologiei. Va fi necesară acumularea în continuare de dovezi verosimile pentru a atinge niveluri noi, exacte și personalizate în stratificarea riscului, în diagnosticarea precoce, în optimizarea tratamentului, profilaxia bolilor CV și menținerea stării de sănătate CV.Развитие кардиологии в следующем десятилетии

Phage therapy in the era of multidrug resistance in bacteria

Introduction. Antimicrobial resistance (AMR) is an escalating global public health threat. According to statistics from the World Health Organization, approximately 700,000 people succumb to AMR annually, and this number is expected to surge in the coming years. This statistic underscores the pressing challenges posed by AMR and the urgency to develop new, effective antimicrobial therapies. Regrettably, over the past two decades, both the U.S. Food and Drug Administration and the European Medicines Agency have only sanctioned two new antibiotic classes effective against Gram-positive pathogens but with limited impact on Gram-negative bacteria. Given that many pharmaceutical companies have ceased developing new antibiotics, meeting the pressing need for novel therapeutic agents against AMR has become increasingly difficult. With the emergence of extensively drug-resistant bacterial infections and the recognition of other limitations associated with traditional antibiotics over recent decades, bacteriophage therapy has reemerged as a strategy for treating bacterial infections. Although pharmacological antibacterial therapies overshadowed this century-old therapy in decades past, the use of lytic phages to combat infections is once again on the rise. The aimof this study is to conduct a systematic review assessing the effectiveness and safety of phage therapy against multidrug-resistant bacteria by evaluating studies published over the past decade. Material and methods. This systematic review evaluates the effectiveness and safety of phage therapy against multidrug-resistant bacteria by examining studies published over the past decade. To achieve this, we conducted a bibliographic search in the PubMed and Google Scholar databases. Out of the 1450 studies identified, 25 met the inclusion criteria, encompassing a total of 145 treated patients. Results. Out of the total of 145 patients who underwent phage therapy, 128 (88.3%) experienced a reduction in or complete elimination of the bacterial load, along with an improvement in their signs and symptoms. In contrast, phage therapy was ineffective in the remaining 17 patients (11.7%). Among the patients, only 31 (21.4%) received a combination of phage therapy and antibiotics, which achieved a 100% success rate. The remaining 114 patients (78.6%) were exclusively treated with phage therapy, resulting in an 82.1% success rate. Bacterial resistance to phages was reported in 5 out of the 25 articles reviewed. In 19 clinical cases (76.0%), phage cocktails were administered, involving a combination of 2 to 12 bacteriophages, while in six cases (24.0%), a single phage was administered. The 25 cases in which phage cocktails were administered used various routes: 4 were topical (16.0%), 6 intravenous (24.0%), 5 were administered in organs or cavities (20.0%), 4 through inhalation (16.0%), and 6 cases involved more than one route of administration (24.0%). Conclusions. This analysis demonstrates that phage therapy could serve as an alternative treatment for patients with infections linked to multidrug-resistant bacteria. Nevertheless, due to the specificity of phages required for treating various bacterial strains, this therapy necessitates personalization in terms of selecting the appropriate bacteriophage type, route of administration, and dosage

Fenomenul coronarian Gregg în disfuncţia endotelială diabetogenă: mecanisme compensatorii de reglare

Fenomenul coronarian Gregg însumă paternul fi ziologic de reglare a perfuziei cordului prin acţiuni vasodilatatorii. Impactul diabetogen asupra endoteliului vascular s-a manifestat prin micşorarea semnifi cativă a rezervei funcţionale coronariene la acţiunea acetilcolinei şi bradikinei, factorii cheie de control al perfuziei coronariene în repaus şi efort. Totodată, sunt evidenţiate mecanisme care pot atenua insufi cienţa coronariană, acestea fi ind: creşterea expresiei receptorilor B1 ai bradikinei, augmentarea coronarodilatării mediate prin hiperpolarizarea miocitului neted coronarian şi controlul perfuziei coronariene prin axa Ang (1-7)-receptorii mas

Phage therapy in the era of multidrug resistance in bacteria

Introduction. Antimicrobial resistance (AMR) is an escalating global public health threat. According to statistics from the World Health Organization, approx-imately 700,000 people succumb to AMR annually, and this number is expected to surge in the coming years. This statistic underscores the pressing challenges posed by AMR and the urgency to develop new, effective antimicrobial therapies. Regrettably, over the past two decades, both the U.S. Food and Drug Administration and the European Medicines Agency have only sanctioned two new antibiotic classes effective against Gram-positive pathogens but with limited impact on Gram-negative bacteria. Given that many pharmaceutical companies have ceased developing new antibiotics, meeting the pressing need for novel therapeutic agents against AMR has become increasingly difficult. With the emergence of extensively drug-resistant bacterial infections and the recognition of other limitations associated with traditional antibiotics over recent decades, bacteriophage therapy has reemerged as a strategy for treating bacterial infections. Although pharmacological antibacterial therapies overshadowed this century-old therapy in decades past, the use of lytic phages to combat infections is once again on the rise. The aimof this study is to conduct a systematic review assessing the effectiveness and safety of phage therapy against multidrug-resistant bacteria by evaluat-ing studies published over the past decade. Material and methods. This systematic review evaluates the effectiveness and safety of phage therapy against multidrug-resistant bacteria by examining studies published over the past decade. To achieve this, we conducted a bibliographic search in the PubMed and Google Scholar databases. Out of the 1450 studies identified, 25 met the inclusion criteria, encompassing a total of 145 treated patients. Results. Out of the total of 145 patients who underwent phage therapy, 128 (88.3%) experienced a reduction in or complete elimination of the bacterial load, along with an improvement in their signs and symptoms. In contrast, phage therapy was ineffective in the remaining 17 patients (11.7%). Among the patients, only 31 (21.4%) received a combination of phage therapy and antibiotics, which achieved a 100% success rate. The remaining 114 patients (78.6%) were exclusively treated with phage therapy, resulting in an 82.1% success rate. Bacterial resistance to phages was reported in 5 out of the 25 articles reviewed. In 19 clinical cases (76.0%), phage cocktails were administered, involving a combination of 2 to 12 bacteriophages, while in six cases (24.0%), a single phage was administered. The 25 cases in which phage cocktails were administered used various routes: 4 were topical (16.0%), 6 intravenous (24.0%), 5 were administered in organs or cavities (20.0%), 4 through inhalation (16.0%), and 6 cases involved more than one route of administration (24.0%). Conclusions. This analysis demonstrates that phage therapy could serve as an alternative treatment for patients with infections linked to multidrug-resistant bacteria. Nevertheless, due to the specificity of phages required for treating various bacterial strains, this therapy necessitates personalization in terms of selecting the appropriate bacteriophage type, route of administration, and dosage