Suchergebnisse

"Background: A germline mutation of the MisMatch Repairgene that causes a malfunctioning DNA system is the defining feature of the hereditary illness known as Lynch syndrome. This review will discuss the endocrine aspects of LS and highlight current advancements in the area. Methods: We searched the available literature of the last 10 years for terms such as endocrine tumors and LS. Our goal is to provide a summary of the most recent information available on the endocrine perspective in Lynch syndrome. Results: The hormonal chemoprevention methods cited are the use of combined oral contraceptives, the use of progestogen-releasing intrauterine devices, and the use of progesterone-only drugs. In addition, after surgical exclusion of the uterus and ovaries, a method frequently adopted for LS patients, it is necessary to start hormonal menopausal therapy, taking into account certain age-specific features. In addition, numerous LS-associated endocrine tumor types have been described. Conclusions: Many hormonal variants are available that are useful in the chemoprevention involved in the treatment of LS. Menopausal hormone therapy is imperative for LS patients who need it. Clinicians need to be aware of the possible association of certain types of aggressive endocrine cancers associated with LS."

"Virtual reality (VR), initially a form of entertainment has begun to find its way in healthcare practice. One of its main areas of interest is the treatment of psychiatric disorders. When using VR, the basic ethical principles underlying the physician-patient relationship should be respected, but they should be customized by the presence of an additional layer of complexity generated by the interposition of the virtual world. The physician-patient relationship is often multidirectional, often including a larger team of healthcare professionals, family members or acquaintances, working conjointly to optimize the medical care. Each time other participants are involved within this relationship, the complexity of the ethical issues tends to increase. For example, if the patient has decreased insight, it is possible that other persons must make some medical decisions – resulting a prioritization of beneficence compared to autonomy. Also, we must take into account the fact that many psychiatric symptoms can be seen as a form of "virtual reality" by the patient. The healthcare provider must take additional safety measures to minimize the harms made by VR techniques in psychiatric patients, by using methods that are individually tailored. The main aim of this paper is to debate the ethical aspects surrounding the applicability of virtual reality in treating psychiatric patients, with an emphasis on the elements that were mentioned earlier. "

Introduction: Matrix metalloproteinases (MMPs) are key enzymes involved in degradation of extracellular colagen matrix during periodontal disease progression. The aim of our work was to study the levels of MMP-1, MMP-2, MMP-7, MMP-9 and MMP-10 in saliva of patients with chronic periodontitis. Materials and methods: The study included 22 patients with chronic periodontal disease and 15 controls. We collect unstimulated whole saliva from all volunteers included in the study. Salivary levels of mentioned MMPs were analyzed using magnetic bead-based multiplex assays and Luminex technology. Results: MMP-1, MMP-7, MMP-9 and MMP-10 present statistically increased salivary levels at patients with periodontal disease versus the control group (p<0.05). Salivary level of MMP-2 at patients with chronic periodontitis was increased but statistically insignificant compared with healthy subjects (p=0.1). Conclusions. The increased level of these enzymes in patients diagnosed with periodontal disease reflects their implication in periodontal tissue degradation. Saliva is an excellent fluid useful in monitoring the severity of this oral disease that affects about half of the adult population around the world.

"A successful nose reconstruction is represented by a normal look and nasal breathing preservation. The choice of method is based on the site, size, depth of the defect, donor availability, and surgeon experience. There are multiple methods of restoring nasal cover, from primary repair to healing by secondary intention, from primary suture, skin graft to locoregional flaps, but all of them should be integrated into a personalized approach, keeping the nasal functions, a good aesthetic outcome and without any tumor infiltration. This paper consisting of a retrospective study of 9 patients diagnosticated with squamous cell carcinoma revealed the importance of skin properties and skin changes during aging. Despite all aesthetic principles, skin is the most important resource in facial reconstruction. "

The diagnosis in Carpian tunnel syndrom is based on clinical symptoms and electrodiagnostic studies. Electrodiagnostic studies help to stage both motor and sensory nerve damage.

"Background: Cardiovascular disease can be triggered and accelerated by hypertension and the underlying changes in the structure and function of arteries. The purpose of this review is to explore some vascular changes that occur in hypertension as a consequence of the imbalance between cell proliferation and cell death, processes that play an important role in stabilizing the thickness of the arterial wall during vascular remodeling. Methods: The authors conducted research through PubMed and Google Scholar databases using the following search formula: (hypertensive*) AND ((vascular modifications)) OR (vascular changes)) AND (cell death). Results: From 40 articles, only 17 publications were included in this study, taking into account four processes that can be preceded or followed by inflammation and depend on the interaction between local growth factors, vasoactive substances, and hemodynamic stimuli: Cell proliferation and growth; Cell migration; Cell death; Degradation or reorganization of extracellular matrix. Conclusions: To summarize, maladaptive vascular changes in hypertension can represent a major argument for prompt and maximal therapeutic intervention in patients with high cardiovascular risk. Moreover, they can represent an important step in discovering new markers of cardiovascular risk and in the development of new targeted therapies for different pathways of cellular signaling through which the reversibility of abnormal vascular changes could be obtained. "

The communication in the field of health can be defined as a communication strategy used to inform and influence individual and community decisions with the aim of improving and enriching personal and community behaviors and public health practices. It includes studying public health attitudes and behaviours to determine the type, frequency and format of the messages.

One of the most obvious trends in current prosthetic dentistry is the introduction of digital techniques. Of these, the techniques that offer the possibility of aesthetic prefiguration of the final prosthetic result are of particular interest to the dentist. The aim of this paper was to verify the applicability of the Digital Smile Design application, which is the most commonly, used aesthetic prefiguration application, an application designed for the dentate patient, to full edentulism. Two groups of full edentulous patients were formed: the first group, complete denture carriers, dissatisfied with the aesthetic aspects, that they wanted to improve in the new denture, and, the second group, newly bimaxillary full edentulous patients with high aesthetic expectations. Thus, on the first group, the tests were performed on the existing denture, and the second one with the maxillary occlusion template. However, the view of the final result offered the patients the chance to have a realistic picture of their desires regarding the shape, color, size of the teeth, which were inadequate in relation to age and facial typology. The use of this application also improves communication with the dental laboratory. In full edentulism, the current DSD technique can be used with some limitations and the use of it in this field needs more complex studies on larger groups of patients.

Renal disease in pregnancy is a rare pathology, but it raises several problems in terms of normal pregnancy evolution. Among pregnant women with renal injury, the rate of complications such as spontaneous abortion, preeclampsia, hypertension, intrauterine growth restriction, premature birth, fetal and neonatal mortality are much higher. For a good understanding of the pathology and a correct management of pregnant women with renal disease, it is necessary to know the normal pregnancy changes and the differentiation of chronic kidney disease from the acute injuries occurring during pregnancy. It is useful to ensure counseling prior to conception and to perform all prophylactic measures in order to prevent pregnancy complications and subsequent decline in renal function in all cases of pregnant women with chronic renal insufficiency. Treatment of acute renal failure in pregnancy involves therapy of the underlying condition that caused renal injury, prevention of irreversible kidney injury and pre-vention of maternal and fetal secondary complications. Monitoring carefully this cate-gory of pregnant women, although additional risks strike, often results in favorabl pregnancy evolution.

One of the most controversial topics in total knee arthroplasty is rotation of the femoral component. The current gold-standard in total knee arthroplasty consists in positioning the femoral component in 3 degrees of external rotation to the epicondylar axis, having as reference the tangent to the posterior condyles. Achieving the correct rotation of the femoral components is one of the main goals during total knee arthroplasty. Multiple complications can result from internal femoral rotation, such as lateral patellar tilt, patellar subluxation or dislocation, mobilization with movement on pain, and low survival rates of the femoral components. Postoperative rotational assessment of protective components can only be performed correctly using computed tomography. The known evaluation methods are related to anteversion of the femoral neck, femoral trans-epicondylar line, insertion of the posterior cruciate ligament from the tibia and tibial tuberosity. The purpose of this study was to evaluate the rotation of the prosthetic components in the group of patients with the methods validated by studies and to find alternatives to evaluate the rotation of the femoral component. Thirty-four patients diagnosted with gonarthrosis, proposed for total knee arthroplasty, were included in the study. This is a prospective cohort study in which applied statistics consisted of analyzing data using frequency and percentage for qualitative and mean variables and standard deviation for quantitative variables

Breast cancer remains a significant health concern, with predictions indicating a rise in global incidence. While the
primary focus is on oncological radicality, the aesthetic and psychological impacts of surgical interventions, such as radical
mastectomy, cannot be ignored. This study, conducted over 8 years, aimed to identify factors that can prevent unnecessary
lymphadenectomy. The research analyzed various parameters, including age, BMI, tumor size, and immunohistochemistry, to
determine their correlation with axillary lymph node invasion. The results highlighted the importance of tumor size and estrogen
receptor status in predicting axillary lymph node metastasis. The study underscores the value of sentinel lymph node biopsy in
early breast cancer treatment, emphasizing its benefits over complete axillary lymph node dissection.

Colorectal cancer is the third most common cancer worldwide and represents a significant major public health issue.
Therefore, the interest in detecting the multiple factors implied in the development of cancer has increased recently. One of the
factors could be the Helicobacter pylori infection, but a direct causal connection is missing. This gram-negative bacterium infects
approximately 4 billion individuals globally and various conditions such as gastroduodenal ulcers or gastric adenocarcinomas can
be induced by it. Some of the reported carcinogenic effects of Helicobacter pylori bacterium are hypergastrinemia, chronic
inflammation, dysbiosis, and toxin production. Each of these elements involved in the pathogenesis has various mechanisms of
action. Dysbiosis can occur due to various treatments for the eradication of the Helicobacter pylori infection. This bacterium also
has a proinflammatory effect at the gastric level which can predispose to the development of dysplasia or even neoplasia. The
toxins produced by this bacterium, such as the vacuolating cytotoxin A, promote inflammation. In this review, we discuss the
possible connections between the Helicobacter pylori infection, through its diverse pathogenic mechanisms, and colorectal
neoplasm. Prospective studies are necessary to determine whether there certainly is a direct link between the two conditions.

Background and Aim: Health technology assessment for drugs is a necessary step in developing health policies that are
focused on patients and getting the best value for scarce resources. One important feature of health technology assessment is
transparency. In many countries, health technology assessment is followed by negotiations between pharmaceutical companies
and health authorities to determine whether a drug will be publicly funded. These negotiations often result in Managed Entry
Agreements, which typically include confidentiality clauses covering the final price of the drug. Methods: We reviewed Romanian
legislation starting in 2014 to assess the level of confidentiality and transparency in drug pricing and reimbursement. Results: We
found that for drugs with Managed Entry Agreements, the level of discounts is confidential, the public does not know how much
the government is paying for each of these drugs, the volumes (units) of drugs are not transparently published by the payer, the
outcomes, in terms of patients treated by therapeutic area, therapeutic success, and resource utilization, are confidential.
Conclusions: We consider that too much confidentiality can prevent the public from knowing if the government is getting good
value for money, but too little confidentiality can lead to higher drug prices or a lack of drugs from the market.