Search Results (116)

Bladder cancer (BC) is the most frequent cancer of the urinary system and one of the most common malignancies in the world. In the last decade, many studies have been conducted to better understand the pathophysiological mechanisms of BC to find innovative markers for disease monitoring and treatment. In this study, we aim to identify miRNAs whose expression is associated with specific tumoral characteristics and risks of disease progression. Forty-one BC patients were enrolled in this study. The expression of 84 miRNAs was evaluated by qRT-PCR analysis on tumoral and peritumoral tissues. The results highlighted the association of the miRNA-17-92 cluster with BC, with miR-17-5p, miR-18a-5p, miR-19a-3p, and miR-20a-5p (members of this cluster) being upregulated in the tumoral tissue and correlated with muscle invasion and tumor grading. Taken together, our study identified a panel of 26 dysregulated miRNAs in BC, some of which may be associated with aggressiveness and the risk of progression of this malignancy. Full article

Background: Anemia and preeclampsia are common and independently associated with adverse neonatal outcomes. Their combined effect, however, remains insufficiently explored. This study aims to evaluate the impact of second-trimester maternal anemia on neonatal outcomes in pregnancies complicated by preeclampsia, and to assess its predictive value for preterm birth and NICU admission. Methods: We conducted a retrospective cohort study including 3517 singleton births from a Romanian tertiary maternity hospital between October 2023 and December 2024. A total of 295 preeclamptic pregnancies were stratified by anemia severity (none, mild, moderate-to-severe) and compared with 428 matched non-preeclamptic anemic pregnancies matched by closest-neighbor selection. Neonatal outcomes included birthweight, gestational age, anthropometric parameters, Apgar score, preterm birth, and NICU admission. Logistic regression and ROC curve analysis were performed using anemia severity as a predictor. Results: Moderate-to-severe anemia in preeclamptic pregnancies was associated with significantly lower birthweight (2618 ± 461 g), shorter gestational age (36.6 ± 2.0 weeks), and higher preterm birth (41.1%) and NICU admission rates (40.0%) were compared to non-anemic counterparts. Each increase in anemia severity conferred 84% higher odds of preterm delivery (OR = 1.84; AUC = 0.63) and a 49% increase in NICU admission (OR = 1.49; AUC = 0.58). Youden’s indices were 0.25 and 0.14, respectively. Conclusions: Maternal anemia is associated with increased neonatal morbidity in preeclamptic pregnancies, with moderate predictive value for preterm birth. These findings support the integration of early anemia screening and risk stratification into hypertensive pregnancy protocols to improve perinatal outcomes. Full article

Background and Objectives: The accuracy of breast cancer diagnosis depends on the concordance between imaging features and pathological findings. While BI-RADS (Breast Imaging Reporting and Data System) provides standardized risk stratification, its correlation with histologic grade and immunohistochemical markers remains underexplored. This study assessed the diagnostic performance of BI-RADS 3, 4, and 5 classifications and their association with tumor grade and markers such as ER, PR, HER2, and Ki-67. Materials and Methods: In this prospective study, 67 women aged 33–82 years (mean 56.4) underwent both mammography and ultrasound. All lesions were biopsied using ultrasound-guided 14G core needles. Imaging characteristics (e.g., margins, echogenicity, calcifications), histopathological subtype, and immunohistochemical data were collected. Statistical methods included logistic regression, Chi-square tests, and Spearman’s correlation to assess associations between BI-RADS, histology, and immunohistochemical markers. Results: BI-RADS 5 lesions showed a 91% malignancy rate. Evaluated features included spiculated margins, pleomorphic microcalcifications, and hypoechoic masses with posterior shadowing, and were correlated with histological and immunohistochemical results. Invasive tumors typically appeared as irregular, hypoechoic masses with posterior shadowing, while mucinous carcinomas mimicked benign features. Higher BI-RADS scores correlated significantly with increased Ki-67 index (ρ = 0.76, p < 0.001). Logistic regression yielded an AUC of 0.877, with 93.8% sensitivity and 80.0% specificity. Conclusions: BI-RADS scoring effectively predicts malignancy and correlates with tumor proliferative markers. Integrating imaging, histopathology, and molecular profiling enhances diagnostic precision and supports risk-adapted clinical management in breast oncology. Full article

Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with over 20 million cases annually. The evolution of hernia surgery has transitioned from tension-based techniques to tension-free approaches, significantly reducing recurrence rates. This review explores the history, advancements, and current trends in minimally invasive inguinal hernia repair, focusing on laparoscopic techniques such as transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), single-incision laparoscopic surgery (SILS), and robotic-assisted repair. The importance of prosthetic meshes is emphasized, detailing their mechanical properties, pore size, weight classifications, and biocompatibility. Additionally, various mesh fixation methods—including tacks, sutures, and glues—are analyzed, with a discussion on their impact on postoperative complications such as chronic pain, adhesions, and infection risk. The debate between TAPP and TEP techniques is examined, highlighting the ongoing quest to determine the most effective approach. Emerging advancements, including drug-loaded meshes and dual-layered prosthetics, aim to improve integration and reduce complications. Despite significant progress, no universally superior technique or mesh exists, underscoring the need for individualized surgical approaches. Future research should focus on optimizing materials, refining fixation strategies, and enhancing patient outcomes in minimally invasive hernia repair. Full article

Background: The use of vasoconstrictors in dental anesthesia during pregnancy raises clinical concerns due to their potential effects on uteroplacental blood flow and fetal well-being. Despite widespread use, the safety profiles of agents such as epinephrine, levonordefrin, and felypressin remain insufficiently reviewed, particularly in isolation from local anesthetics. Methods: A systematic literature search was conducted using PubMed (MEDLINE) for studies published between January 2000 and May 2025, following PRISMA 2020 guidelines. Included studies assessed the use, pharmacokinetics, or outcomes of vasoconstrictor agents used in dental procedures during pregnancy. Articles were selected based on predefined inclusion criteria and synthesized narratively. Results: Out of 95 screened records, only six narrative reviews and three clinical guidelines met eligibility criteria. Epinephrine was the most frequently described agent, generally regarded as safe at low dental doses (1:100,000–1:200,000) when properly administered. Levonordefrin showed insufficient safety data and was associated with potential uterine vasoconstriction. Felypressin was contraindicated due to its oxytocic properties and high risk of inducing uterine contractions. Conclusions: Among vasoconstrictors, epinephrine remains the only agent with an acceptable safety profile in pregnancy when used correctly. Levonordefrin lacks adequate evidence, and felypressin poses clear risks. Until further clinical trials are available, individualized risk assessment and adherence to obstetric and dental guidelines are critical for ensuring maternal and fetal safety. Full article

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) represents a severe complication associated with bisphosphonate therapy commonly used in patients with osteoporosis and malignancies. Methods: This retrospective study evaluates the risk factors and clinical outcomes of BRONJ patients treated at the Oral and Maxillofacial Surgery Clinic in Iaşi, Romania, with the goal of optimizing preventive and therapeutic strategies. Data from 72 BRONJ patients treated between January 2013 and December 2023 were analyzed. Results: The majority (83.3%) of patients had underlying malignancies, predominantly breast and prostate cancers. The mandible was most affected, with tooth extraction identified as the primary triggering event. Systemic comorbidities, notably arterial hypertension, diabetes mellitus, and concurrent chemotherapy, were significantly associated with increased BRONJ severity. Surgical intervention was frequently required, with sequestrectomy being the predominant procedure, reflecting advanced disease at the time of diagnosis. Conclusions: The findings underline the critical importance of early identification, preventive dental management, and a collaborative multidisciplinary approach to improve patient prognosis. Full article

The work presented in this paper discusses the steps taken to design, implement, and test a mechatronic test stand that uses historical wind power data to generate thermal power that could be used by small-to-medium consumers. The work also pertains to usage in areas where large wind turbines could not be installed due to space restrictions, such as highly populated areas. A rotor flux control (RFC) speed-controlled 2.2 kW AC motor was used to simulate the action of a wind turbine on a 6 cm³ hydraulic pump. The setup allows for a small form factor and a much lighter turbine to be installed. The paper describes the schematic, installation, usage, and initial results obtained using a hydraulic test stand developed by the authors. The initial work allowed us to obtain different temperatures of the hydraulic oil, up to 60 °C, over a period of 30 min, for various pressures and flow rates, thus confirming that the system is functional overall. Further work will elaborate on the effect of different wind patterns on the setup, as well as provide an in-depth study on a use case for the system. Full article

Background: Hereditary cancer syndromes such as BRCA1/2 and Lynch syndrome significantly increase the lifetime risk of ovarian, fallopian tube, and endometrial cancers. Risk-reducing salpingo-oophorectomy (RRSO) and hysterectomy are standard preventive strategies. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) has recently emerged as a minimally invasive, scarless alternative that may enhance patient acceptance while maintaining oncologic safety. Objective: This narrative review aims to synthesize the current evidence regarding the role of vNOTES in risk-reducing gynecologic surgery for women with hereditary cancer syndromes, focusing on surgical feasibility, technical considerations, oncologic safety, and patient-reported outcomes. Methods: A structured literature search was conducted in PubMed and Web of Science for studies published between January 2000 and April 2025, using terms related to vNOTES, prophylactic gynecologic surgery, BRCA mutations, and Lynch syndrome. Inclusion criteria focused on studies reporting outcomes of vNOTES in risk-reducing or oncologic contexts. A total of eight studies were included for qualitative synthesis. Results: vNOTES has demonstrated technical feasibility and favorable surgical outcomes in risk-reducing procedures such as RRSO and hysterectomy in BRCA and Lynch syndrome carriers. Comparative studies report lower postoperative pain, faster recovery, and high patient satisfaction, with oncologic standards maintained through specimen containment, peritoneal inspection, and adherence to the SEE-FIM protocol. Limitations include the learning curve and restricted access to the upper abdomen, which may necessitate hybrid approaches in selected cases. Conclusions: vNOTES offers a promising, patient-centered surgical approach for hereditary cancer prevention, combining oncologic safety with enhanced recovery and cosmetic benefits. Further research is needed to standardize protocols, evaluate long-term outcomes, and define its role within broader personalized cancer prevention strategies. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease globally, and current estimates indicate an increase in incidence and prevalence in the general population. The design of the prospective study was to evaluate the response of patients with MASLD to an original formula consisting of silymarin, vitamin E, and essential phospholipids. In total, 200 patients were initially enrolled in the study and a total of 190 who participated in all four visits were included in our analysis. During the visits, liver function tests, lipid profiles, blood glucose level, fibrosis, and steatosis values and grades were assessed. From baseline, visit 0, to month 6th, visit III, a statistically significant difference (p-value < 0.0001) was observed in the reduction in ALT, AST, GGT, ALP, TG, total cholesterol, and blood glucose levels. There was a significant decrease in the fibrosis value from the first visit to the last visit (p = 0.002). Even though administered separately, silymarin, essential phospholipids, and vitamin E have established their efficacy in MASLD, this study demonstrates that their combination produces an indubitable effect on liver steatosis, even in a short cure of 6 months, and it can be proposed due to it having no adverse effects on patients with MASLD. Full article

Background/Objective: Preeclampsia is a hypertensive disorder associated with pregnancy that has a significant impact on maternal and neonatal health and has the potential to result in significant perinatal adverse outcomes. Maternal education has been proposed as a protective factor during pregnancy; however, its role in preeclamptic pregnancies remains unclear. This study aimed to explore the relationship between maternal education level, as defined by ISCED classification, and neonatal outcomes (birth weight, gestational age, and APGAR score) in pregnancies complicated by preeclampsia. Methods: A retrospective case-control analysis was conducted on 674 deliveries at a single tertiary center in Western Romania between January 2022 and August 2024. Neonatal outcomes, specifically birth weight, gestational age, and APGAR scores were studied and stratified into three ISCED-based maternal education subgroups. Statistical analyses, including ANOVA, chi-square tests, and logistic regression, were used to analyze the effect of maternal education, with confounders such as maternal age and chronic hypertension being controlled for. Results: Preeclampsia was associated with lower birth weight (p < 0.001), gestational age at birth (p < 0.001), and APGAR scores (p < 0.001) than the control group. Maternal level of education was associated with better neonatal outcomes in the preeclamptic group, with lower odds of fetal growth restriction (OR = 0.68, p = 0.03) and preterm birth; however, the effect was less pronounced in the control group. Conclusions: Maternal education partially mitigates the adverse effects of preeclampsia on neonatal well-being, birth weight, and gestational age at birth. These findings underscore the importance of incorporating maternal education into prenatal care programs to improve perinatal outcomes, with a special focus on high-risk pregnancies. Full article

Background/Objectives: Obstructive salivary gland disorders—primarily sialolithiasis and ductal stenosis—remain a significant source of morbidity, often requiring surgical intervention. Sialendoscopy has emerged as a minimally invasive, gland-preserving technique for both diagnosis and treatment. This retrospective study aimed to evaluate diagnostic and interventional sialendoscopy outcomes in a Romanian patient cohort and to identify gland-specific considerations in the management of salivary gland obstruction; Methods: A total of 89 patients with confirmed obstructive salivary gland disease (parotid or submandibular) were included. The most common indications included lithiasis, ductal stenosis, sialadenitis, and mixed pathologies; two cases of juvenile recurrent parotitis (JRP) were also managed. All patients underwent clinical evaluation, imaging (ultrasound, CBCT, CT, MR sialography), and sialendoscopic treatment between 2021 and 2025 in two centers. Data on demographics, imaging, calculus size, procedural technique, anesthesia, and complications were collected and analyzed using descriptive and inferential statistics; Results: The submandibular gland was more frequently involved (70.8%), with larger calculi compared to the parotid (mean 7.6 mm vs. 5.1 mm; p = 0.004). Minimally invasive techniques were predominantly used: sialolithotomy and intracorporeal lithotripsy were each performed in 32.6% of cases. Submandibulectomy was required in only 5.6% of patients. Most procedures (93.3%) were conducted under local anesthesia. Complication rates were low and primarily minor and self-limiting; Conclusions: Sialendoscopy is a safe and effective gland-preserving approach in managing obstructive salivary gland disorders. Gland-specific anatomy influences diagnostic pathways and therapeutic choices. These findings support broader adoption of sialendoscopy in routine practice and highlight the need for tailored management protocols based on gland involvement and stone characteristics. However, the study is limited by the absence of standardized post-intervention quality-of-life assessments and structured follow-up data on symptom recurrence. Full article

Background: Colorectal cancer (CRC) remains a major cause of cancer-related mortality worldwide, underscoring the need for more efficient and resource-conscious screening strategies. Methods: We screened 51,437 individuals (50–74 y) in South-West Oltenia, Romania, with FIT values of ≥20 µg Hb/g. Of the 2825 FIT-positive individuals, 1550 completed colonoscopy, and we recorded their age, sex, residence, education, comorbidities, medications, and FIT values. After imputing < 8% missing data via multiple imputation, we reduced dimensionality with an autoencoder (ReLU, dropout 0.5, L2, 100 epochs, batch 32) and applied K-Means clustering (k = 5). The following are examples of actionable clusters: Cluster 0 (“High-FIT malignant”): FIT > 200 µg/g, age > 65, diabetes; Cluster 2 (“Low-risk mixed”): FIT 100–199 µg/g, age < 60, no comorbidities; Cluster 3 (“Intermediate-risk older”): FIT 150–200 µg/g, ≥3 comorbidities, rural. Cluster labels were then predicted by a feed-forward neural network (64–32 neurons, dropout 0.6) and validated via 5-fold cross-validation plus a temporal hold-out. Results: Five distinct patient clusters were identified, enabling the development of a composite risk score. Notably, Cluster 0, characterized by elevated FIT levels, exhibited a malignancy rate of 50.91%, while the overall CRC diagnostic rate among colonoscoped patients was approximately 13.87%. This stratification model enhances the diagnostic yield by prioritizing high-risk patients for urgent colonoscopy and sparing low-risk individuals from unnecessary invasive procedures. Conclusions: The AI-driven composite risk score offers a refined framework for CRC risk stratification and optimized resource allocation. Its implementation can lead to earlier detection of advanced lesions, thereby improving patient outcomes. Further external validation on independent cohorts and regions is essential to confirm its broad utility, with potential future integration of additional biomarkers (e.g., genetic or omics-based indicators) to further enhance predictive accuracy. Full article

The anticipated growth of the aviation industry has driven regulators to establish stringent targets for achieving net-zero greenhouse gas emissions, which are challenging to meet with conventional aircraft configurations. The strut-braced wing configuration has emerged as a promising alternative for improving aerodynamic efficiency. This study investigates the aerodynamic performance of such a configuration using a high-fidelity computational fluid dynamics analysis, conducted in two phases. The first phase involves a parametric study examining the effects of two key parameters: the length and the tilt angle of the strut’s elbow. The reference configuration is based on the strut braced wing configuration from the Platform for Aircraft Drag Reduction Innovation workshop. Building on the insights from the parametric study, the second phase involves an optimization of the strut’s geometry, focusing on minimizing aerodynamic drag. The results demonstrate an 11.5% reduction in the drag coefficient while maintaining the same lift coefficient, primarily attributed to a decrease in shockwave interactions within the strut–wing gap. These findings, combined with the parametric study, provide valuable insights into the influence of strut geometric parameters on drag minimization, highlighting their potential role in advancing sustainable aircraft design. Full article

Background and Objectives: This study aimed to assess the frequency and distribution of facial bone injuries in terms of age, sex, residence, location, and etiology in the north-eastern region of Romania. Materials and Methods: This retrospective study was conducted within the Oral and Maxillofacial Clinics of “Sf. Spiridon” Hospital, Iași. The study group included 701 subjects (mean age 41.02 ± 18.45; sex: 603 males and 98 females) who were diagnosed with an orbital wall disorder. The epidemiological data on orbital wall fractures—including sociodemographic features, etiology, and location—were statistically analyzed. Results: The prevalence of orbital pathology was 1.47% congenital cases, 1.75% tumors, and 96.7% orbital fractures. The distribution of sex, age group, residence, and orbital localization varied significantly among the three diagnostic categories: tumors, congenital conditions, and fractures. Regarding sex, fractures were significantly more frequent in males (87.0%) compared to congenital cases (70.0%) and tumors (41.7%), while tumors showed a female predominance (58.3%) (p < 0.001). Congenital conditions predominantly affected patients under 20 years old (90.0%), whereas fractures were more evenly distributed across age groups, with higher frequencies between 31 and 50 years. In contrast, tumors involving the orbital walls were more frequent in older patients, with 33.3% in the 61–70 age group and 25.0% over 70 years. Regarding orbital localization, fractures were more likely to be bilateral (37.3%) or on the right side (44.3%), whereas congenital orbital defects and orbital tumors were predominantly unilateral and left-sided (70.0% and 66.7%, respectively). Bilateral involvement was rare in congenital cases (10.0%) and absent in tumors. Conclusions: The data support the finding that men are significantly more prone to trauma and orbital fractures, especially as a result of interpersonal violence and accidents, highlighting the need for preventive measures tailored to sex and socio-professional context. Full article

Background: Pre-eclampsia is a significant hypertensive disorder affecting 2–8% of pregnancies globally, significantly contributing to maternal/perinatal deaths. Early identification of at-risk patients is crucial for reducing these mortalities, yet first-trimester screening remains inaccessible in many low-resource settings. This study aims to develop a second-trimester risk stratification model based on clinical parameters to assist in managing pre-eclampsia in diverse healthcare contexts. Methods: This retrospective cohort study analyzed medical records from 700 pregnancies (350 with preeclampsia, 350 controls) between January 2021 and August 2024 at a tertiary medical center in western Romania. Sample size was calculated to achieve 90% power with α = 0.05 for detecting clinically significant differences between groups. Data analysis focused on clinical variables such as maternal age, hypertension, diabetes, and socioeconomic factors. A scoring model was developed using logistic regression and validated for predictive accuracy using ROC curve analysis, with AUC as the primary metric. Calibration was assessed using the Hosmer–Lemeshow test. Results: The risk stratification model demonstrated an AUC of 0.91 (95% CI: 0.88–0.94), indicating high discriminative capability. The model showed good calibration (p = 0.78). Sensitivity was 74.4%, and specificity reached 97.8%. Patients were categorized into low (0–4 points), moderate (5–7 points), and high-risk (≥8 points) groups based on optimized cut-off values. High-risk patients showed significantly higher rates of adverse outcomes, including eclampsia (12.3% vs. 0% in low-risk, p < 0.001) and HELLP syndrome (8.7% vs. 0.5% in low-risk, p < 0.001). Neonates born to high-risk mothers had lower birth weight (mean difference: 486 g, p < 0.001), smaller head circumference (mean difference: 2.3 cm, p < 0.001), and lower APGAR scores (median difference: 2 points, p < 0.001). Conclusions: This novel model offers a practical second-trimester risk assessment tool that leverages routine clinical data available after 20 weeks of gestation. It facilitates targeted care and resource allocation, particularly benefiting settings lacking early screening access. Implementation of risk-stratified management protocols could significantly improve maternal and neonatal outcomes in diverse healthcare environments. Full article