Mechanical thrombectomy, an opportunity in pediatric ischemic stroke management?

Universitatea Lucian Blaga Sibiu, Facultatea de Medicină, Spitalul Clinic de Pediatrie, Sibiu, Clinica Polisano, Sibiu, RomâniaSummary. Theme topicality. The data looking at the results on mechanical thrombectomy in pediatric ischemic stroke (IS) using modern devices are limited. Material and methods consist in the inventory of recent literature medical data on mechanical thrombectomy in pediatric ischemic stroke. Results. Revision of the literature data revealed 22 cases of mechanical thrombectomy done with modern devices in pediatric ischemic stroke which shows the partial or complete vessel recanalization in all cases (100%) and a favorable clinical result in 20 cases (91%). In each of these cases were used modern devices of reperfusion (suction catheters and stent-retrievers), Solitaire ones in 11 cases (50%), Penumbra suction devices in 4 cases (18%), respectively, and thrombectomy devices, such as Capture, Phenox, Revive and Trevo, each in one single case (5%). In 3 cases (14%) were necessary more than one device. The Penumbra device (from the second line) was necessary in each case. Conclusions. The preliminary studies suggest that mechanical thrombectomy using modern devices could be a safe and efficient treatment option in children and adolescents with acute ischemic stroke.Rezumat. Actualitatea temei. Datele privind rezultatele trombectomiei mecanice în accidentul vascular cerebral (AVC) ischemic pediatric utilizând dispozitive moderne sunt limitate. Materialul şi metoda constau în inventarierea datelor din literatura medicală recentă privind trombectomia mecanică în AVC ischemic la copil. Rezultate. Revizuirea datelor din literatură a scos la iveală 22 de cazuri de trombectomie mecanică efectuată cu dispozitive moderne în AVC ischemic pediatric care arată recanalizarea parţială sau completă a vasului în toate cazurile (100%) şi rezultat clinic favorabil în 20 de cazuri (91%). Au fost utilizate în fiecare dintre aceste cazuri dispozitive moderne de reperfuzie (catetere de aspiraţie şi stent-retrievers), respectiv stent-retriever Solitaire în 11 cazuri (50%), dispozitiv de aspiraţie Penumbra în 4 cazuri (18%), iar dispozitivele de trombectomie Capture, Phenox, Revive şi Trevo au fost utilizate în numai 1 caz (5%). În 3 cazuri (14%) au fost necesare mai multe dispozitive. Dispozitivul Penumbra (de linia a doua) a fost necesar în fiecare caz. Concluzii. Studiile preliminare sugerează că trombectomia mecanică cu dispozitive moderne ar putea fi o opţiune de tratament sigură şi eficientă la copiii şi adolescenţii cu AVC ischemic acut

Intercultural Education for Creative Entrepreneurship

Intercultural education is specific to the multicultural environment in Europe. The European focus on intercultural education is reflected in the documents, reports and measures taken through various financially supported projects. This article presents a research on the characterization of entrepreneurial potential in the case of an intercultural group of Romanian and Serbian trainees who became the target of a cross-border project between Romania and Serbia. The project, of which the designed Creative Entrepreneurship Training Program is part of, is entitled ‘InclusiveArt – Access to Culture for Disadvantaged Children and Youth.’ It implies a dynamic partnership formed by two NGOs (the Intercultural Institute Timisoara and ‘Nevo Parudimos,’ from Resita), one local public authority (the city of Zrenjanin) and one public cultural institution (the Centre for Fine and Applied Arts Terra, Kikinda). The proposed Creative Entrepreneurship Training Program (created in English) plans to help young potential entrepreneurs from the Banat Area in order to develop disadvantaged communities, by establishing commercially viable (self-sustaining) projects/businesses, based on a creative idea, as well as through the provision of a six-day training course for a group of 40 people aged 18 to 35. The training is delivered by a team of academics and training professionals from the Politehnica University Timisoara and the Intercultural Institute Timisoara, both from Romania. The proposed intercultural education program associated with the project implementation aims to the development of entrepreneurship competencies of young people that will be active in creative industries. The potential entrepreneurship characterization considered entrepreneurial traits, such as concerns, motivations, aptitudes and attitudes, as a result of data processing from a self-assessment test. The research results and conclusions support the definition of the structure, content and the didactic strategy adopted for the intercultural education program implementation

Thrombolysis in pediatric stroke

Universitatea Lucian Blaga Sibiu, Facultatea de Medicină, Spitalul Clinic de Pediatrie Sibiu, Clinica Polisano Sibiu, RomâniaSummary. Theme topicality. The acute stroke incidence is known as 2.3-13 in 100,000 children. Patients with acute pediatric stroke may suffer recurrent accidents and a decrease in life quality for long periods of time. The delay in pediatric stroke diagnostic and the lack of pediatric treatment protocols lead to not knowing of efficacy and safety of a treatment strategy. The objective of the paper is the study of treatment potential concerning diminishing morbidity in pediatric stroke using intravascular therapy, thrombolytic agent intervention, respectively, such as tissue plasminogen activator (tPA). The material and methods. Have been searched in medical database and recent guides the recommendation, current treatment practices and representative studies in endovascular treatment in pediatric stroke, in the last years. The selected studies have evaluated the clinical features (age, gender, risk factors), imaging features (occlusive vessels), and treatment (endovascular treatment type, drug type, dosing, time of administration). Results. The most recent study (the retrospective one) shows 68 pediatric stroke cases treated with IA fibrinolysis (n = 24; 35.3%) and IA mechanical thrombectomy (with/without IA or IV fibrinolysis). The mean age was 10.3 years, with 1.8 and 18 years limits, the meantime of treatment was 13.7 hours. All 68 endovascular treatment cases analysis in children with stroke shows good clinical (65.7%) and radiological (67.2%, with complete recanalization) results, in an average tracking time of 5.3 months. The IA mechanical thrombectomy group presented significantly best clinical results than the IA thrombolysis group (79.1% against 20.5%, p0.001) and radiological results (complete recanalization, 79.1% against 38.9%, p0.002), with fewer complications (13.6% against 37.5%, p0.006). Conclusions. Yet, paradoxically, pediatric stroke therapy does not benefit from a prospective study looking at the pediatric regulation of everything that means intravascular therapy by thrombolytic agent intervention, such as tPA. The clinical management is relatively different between specialized centers, reflecting, in particular, the lack of concern in treatment protocols.Rezumat. Actualitatea temei. Incidenţa accidentului ischemic acut (AIS) este de 2,3-13 la 100.000 de copii. Pacienţii cu AIS pediatric pot suferi accidente recurente şi scăderea calităţii vieţii pentru lungi perioade de timp. Întârzierea diagnosticului de accident vascular cerebral (AVC) pediatric şi lipsa protocoalelor de tratament pentru populaţia de vârstă pediatrică duc la necunoaşterea eficacităţii şi siguranţei unor strategii de tratament. Obiectivele lucrării constau în studiul potenţialului de reducere a morbidităţii la copiii cu AIS acut prin terapii intravasculare, respectiv prin intervenţia unui agent trombolitic, cum ar fi activatorul de plasminogen tisular (tPA). Material şi metode. Au fost căutate în bazele de date medicale şi ghidurile recente recomandările, practicile curente de tratament şi studiile reprezentative pentru tratamentul endovascular în AIS pediatric, din ultimii ani. Studiile selectate au evaluat caracteristicile clinice (vârsta, sexul şi factorii de risc), imagistice (vasele ocluzate) şi tratamentul (tipul de tratament endovascular, medicaţia, posologia, timpul de administrare a tratamentului). Rezultate. Studiul cel mai recent (retrospectiv) prezintă 68 cazuri de AIS pediatric tratate cu fi brinoliză IA (n = 24; 35,3%) şi trombectomie mecanică IA (cu sau fără fi brinoliză IV sau IA). Vârsta medie a fost de 10,3 ani, cu limite între 1,8 şi 18 ani, timpul mediu de tratament de a fost de 13,7 ore. Analiza celor 68 cazuri de terapii endovasculare la copiii cu accident AIS a furnizat rezultate clinice (65,7%) şi rezultate radiologice (67,2%, recanalizare completă) bune, întrun timp de urmărire mediu de 5,3 luni. Grupul de trombectomie mecanică IA a prezentat rezultate clinice semnificativ mai bune decât grupul de tromboliză IA (79,5%, faţă de 20,5%, p0,001) şi rezultate radiologice (recanalizare completă, 79,1%, faţă de 38,9%, p0,002) cu mai puţine complicaţii (13,6%, faţă de 37,5%, p0,006). Concluzii. Totuşi, paradoxal, terapia AIS acut la copii nu beneficiază încă de un studiu prospectiv privind reglementarea la copil a tot ceea ce înseamnă terapie intravasculară prin intervenţia unui agent trombolitic, cum ar fi tPA. Managementul clinic este relativ diferit între centre specializate, refl ectând îndeosebi o lipsă de preocupare pentru protocoalele de tratament

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Comportarea planşeelor cu grinzi şi corpuri de umplutură la solicitări în planul lor

The article details several aspects related to the behaviour of floors designed to be made of reinforced or pre-stressed concrete beams (pre-beams), and super-concrete filled frames. The design of such floors shall meet the strength and stability requirements for gravity loadings and the requirements related to their behaviour as horizontal diaphragms (horizontal stiff plate). The load applied to the floors was the gravity load corresponding to the current useful loading, after which the load was applied horizontally up to the maximum bending imposed in the horizontal plane. Instruments were used to steadily check the deformations and rotations induced by the moving side. The maximum response of the floor to horizontal seismic loads was tested and the possibility to consider such elements as significantly rigid elements in the horizontal plane and their computer design were analyzed

The Impact of FDI on Entrepreneurship in the European Countries

AbstractThis paper considers the impact of foreign direct investments (FDI) on the entrepreneurial activity in 16 European countries. Data for the early-stage entrepreneurial activity are provided by the Global Entrepreneurship Monitor (GEM), which made also a distinction between necessity- and opportunity-driven entrepreneurs. We assess the role of both inwards and outwards FDI for the period 2005-2011. Our results show that the inwards FDI positively influence the opportunity-driven entrepreneurs while the outwards FDI have a positive influence on the necessity-driven entrepreneurs and a negative impact on the other category of entrepreneurs. The results regarding the FDI impact on the opportunity-driven entrepreneurs are strongly robust in terms of panel data expansion and control variables. Our findings show also that the opportunity entrepreneurship is associated with more developed, innovation-driven economies, while the necessity entrepreneurship characterizes the European efficiency-driven economies

The Innovative Use of Intelligent Chatbot for Sustainable Health Education Admission Process: Learnt Lessons and Good Practices

This article presents the methodology of creation of an innovative used by intelligent chatbots which support the admission process in universities. The lifecycle of the ontology, unlike the classical lifecycles, has six stages: conceptualization, formalization, development, testing, production and maintenance. This leads to sustainability of the chatbot, called Ana, which has been implemented at the “Iuliu Hatieganu” University of Medicine and Pharmacy from Cluj-Napoca during the admission session throughout July–September 2022, for international candidates. The sustainability of the chatbot comes from the continuous maintenance and updates of the ontology, based on candidates’ interraction with the system and updates of the admission procedures. Over time, the chatbot is able to answer the questions according to the present situation of the admission and the real needs of the candidates. Ana had a huge impact, succeeding to resolve a number of 5173 applicants requests, and only 809 messages was transferred to the human operators, statistics which show a high cost-benefit improvement in terms of reducing the travel expenses for the candidates and also for the university. The article also summarizes the good practices in developing and use of such an intelligent chatbot