Archive issue

1. Possible role of vitamin D3 on the adipocyte/fibroblast trans-differentiation mediated by pancreas cancer

SALVATORE CHIRUMBOLO(1)

In pancreatic tumors, white adipose tissue and metabolic disorders related to adipocytes, are recently reviewed as important co-factors in pancreas pathology. Cell differentiation in pancreatic cancer might involve therefore adipose tissue and factors released by adipocytes should play a fundamental role both in cancer onset and in its progression. Among these molecules, a great interest has been devoted quite recently to the hormonal role exerted by vitamin D3 in pancreatic cancer, particularly its active 1,25 dihydroxylated form. Despite the wide bulk of evidence reporting the chemopreventive role of vitamin D, the mechanism by which active vitamin D3 is able to counteract cancer progression and malignancy is yet far to be elucidated.

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2. Development of a new HPLC method for simultaneous determination of clopidogrel and its major metabolite using a chemometric approach

Valentina Anuta(1), I. SARBU(2), I. MIRCIOIU(3), B.S. VELESCU(4)

This paper presents the development and validation of a new HPLC-UV method for simultaneous quantitative determination of clopidogrel and its hydrolysis product clopidogrel carboxylic acid (CCA) from bulk material and dosage formulations. Development of the chromatographic method is based on a design of experiments (DOE) approach. A Box-Behnken experimental design was used to build the mathematical models and to choose the significant parameters for the optimization by simultaneously taking resolution, capacity factor and peak symmetry as responses. Derringer s desirability function was used for the selection of the optimum experimental conditions in terms of mobile phase composition, column temperature and flow rate. The developed method was validated as per ICH guidelines with respect to specificity, linearity, limit of detection, limit of quantification, accuracy, precision, robustness and system suitability. The method was further employed for the study of clopidogrel bisulfate hydrolysis kinetics under different pH conditions, with special emphasis on the acidic hydrolysis studies, since different clopidogrel salts are suffering pre-systemic metabolism trough hydrolysis under the acidic pH of the stomach. This effect is generally difficult to quantify, since CCA is also the main circulating metabolite, and no differentiation between the pre-systemic and systemic CCA can be made. In the acidic environment created by a 0.1N HCl solution CLO degradation was slow at room or body temperature (25 and 37ºC respectively), less than 5% of the initial CLO amount being hydrolyzed after 48h. Under forced conditions (85ºC) however, 17.8% of CLO was transformed into CCA within 48 hours.

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3. Final Height in Children with Idiopathic Growth Hormone Deficiency treated with Growth Hormone: Albanian experience

A. GJIKOPULLI(1), Lindita Grimci(1), L. Kollcaku(1), Sonila Tomori(1), P. CULLUFI(1), P. Hoxha(1), Zamira Ylli(2)

Objective- To evaluate the efficiency of recombinant growth hormone for increasing adult height in children treated for idiopathic growth hormone deficiency and to evaluate the prognostic factor for height at the end of treatment. Design- Observational follow up study. Setting- Population based registry. Participants- All Albanian children diagnosed with idiopathic growth hormone deficiency who had attained final height. Their treatment started between 2001 and 2011. Main outcome measures- Annual changes in height, and change in height between the start of treatment and adulthood; the importance of the factors that influence on final height. Results- Adult height was obtained for 83 (55%) patients. The mean dose of growth hormone at start of treatment was 0.21 IU/kg/week for 29 patients and 0.24 IU/week for 54 patients. Height gain was 2.41±1.19 z-scores, resulting in an adult height of -1.98±1.12 z-score (girls, -2.05±1.27 z-score; boys, -1.95±1.20 z-score). Patients who completed the treatment gained 2.40±1.13 z-score of height in 4.0±2.0 years. Most of the variation in height gain was explained by regression towards the mean, patients characteristics, and delay in starting puberty. Conclusion- Nearly all our patients with idiopathic growth hormone deficiency treated with growth hormone were able to achieve their genetic height potential. Despite starting treatment late, they managed to gain 2.40±1.13 HAZ score in height and the final height for majority of them (61.5%) was within the target height range. It was found that the final height had good correlation with the prediction height, HAZ score at beginning of treatment, change of HAZ score during the puberty, duration of treatment with GH, and pubertal stage at the start of therapy.

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4. Variability of Normal Values of Electroretinogram Parameters Due to Aging in Healthy Individuals

ANDREEA C. CORICI(1), D.O. Alexandru(2), OANA M. CORICI(1), MIHAELA PUIANU(3), Maria Iancau(1), A. Stefanescu(3)

Aim- To find normal values of implicit time and amplitudes of full-field electroretinogram and to determine their changes with age in healthy Romanian subjects. Material and Methods- The prospective study included 59 healthy subjects aged between 20 and 80 years old; in the end, we had valid ERG recordings for all tests from 54 subjects. All of the participants underwent full-field ERG, recorded with Metrovision MonPack One system. The implicit times and amplitudes were analyzed for a and b waves in dark-adapted 0.01 ERG, dark-adapted 3.0 ERG, dark-adapted oscillatory potentials, light-adapted 3.0 ERG, and 30Hz flicker ERG according to International Society for Clinical Electrophysiology of Vision (ISCEV) protocols. Results- ERG latency values were bigger in subjects above 50 years old than in younger subjects for b wave in dark adapted 0.01, dark adapted 3.0, light adapted 3.0 and dark adapted 3.0 flicker and for a wave in dark adapted 0.01 and dark adapted 3.0 ERG. There was no significant difference in latency values for dark adapted 3.0 oscillatory potentials between young and old subjects. Because of increased variability, we could not prove that observed differences for amplitudes held statistical significance. Conclusions- This study proves there is a major loss in retinal activity due to aging, most of it being caused by the rod cells delayed response. Also, oscillatory potentials do not seem to be affected by age, and could prove a valuable test to investigate for changes in patients with Diabetes mellitus.

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5. Cytopathological Aspects in the Bronchoalveolar Lavage Fluid in Chronic Obstructive Pulmonary Disease

F. PETRESCU(1), OCTAVIA ILEANA PETRESCU(2), ISABELA SILOSI(3), C. TAISESCU(4), ANA-MARIA PETRESCU(5), M.C. FORTOFOIU(1), Aurelia Enescu(6), ANCA STEFANIA ENESCU(7), DANIELA CIOBANU(1), V. BICIUSCA(1)

Chronic Obstructive Pulmonary Disease (COPD) is a clinical syndrome characterised by a slow progressive decline in expiratory airflow [1], a process that has gradually developed over the years. Studies of patients with COPD show an inflammatory process in the small airways [2]. The aim of this paper is to identify the cytopathological aspects of the liquids present in the bronchoalveolar lavage in patients with COPD. We were performed a descriptive analytical case-control and prospective study on forty patients with COPD and ten asymptomatic smokers (healthy smokers or patients at risk). The percentage of marcophage, the type of the dominant inflamatory cell, in the bronchoalveolar lavage (BAL) liquid was significantly higher at patients with mild and moderate COPD as compared to patients with severe and very severe COPD. In the present work, the percentage of the neutrophil in the BAL liquid was significantly higher at patients with severe and very severe COPD, as compared to the patients with mild and moderate COPD and to aparently healthy smokers. In conclusion, we can say that COPD is characterized by an inflammatory process located in the small airways with predominant participation of macrophages, the procentage of macrophages in BAL fluid variyng inversely proportional to the severity of the disease.

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6. Somatosensory Evoked Potentials in Predicting Motor Deficit after Ischemic or Hemorrhagic Stroke

LIDIA CALUGARU(1), G.T. CALUGARU(2), O.M. CALUGARU(2)

25 patients with stroke and hemiparesis in antecedents were recruited for the study. Objective: Recording Short Latency Somato-Sensory Evoked Potentials (SSEP) in dynamics and clinical assessment of th motor impairments. Results: The latency of the N20 wave from SSEP calculated from the dynamic recordings is increased at the level of the injured hemisphere. Medium latency of the recorded N20 wave at the level of the injured hemisphere and the recording at the level of the uninjured hemisphere have a statistically significant difference (p<0.05). Conclusion: The absence or minimal modification of the SSEP post-stroke is correlated with an improved motor performance, while increased latencies of the N 20 wave are associated with a low rate of motor rehabilitation after the stroke(in this case, SSEP modifications can appear for long periods).

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7. The Influence of Personality Factors and Stress on Academic Performance

FLORINA NECHITA(1), D.O. ALEXANDRU(1), R. TURCU-STIOLICA(2), D. NECHITA(2)

The personality factors exert a proved influence on the way the students learn and evolve throughout their academic period. This study was performed on a representative group of 259 students from the University of Medicine and aimed at analyzing the influence of three personality factors, Neuroticism, Extraversion, Conscientiousness, and of stress on the academic performance. The results revealed that only two of the personality factors have a significant influence and that stress has more of a motivational role.

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8. Role of gadoxetic acid-enhanced 3T MRI combined with diffusion in small HCC diagnosis - case presentation

IOANA ANDREEA GHEONEA(1), C. CRISTEA(2), LARISA SANDULESCU(2), A. BONDARI(1), SIMONA BONDARI(1)

We present the case of a patient with chronic viral hepatitis B and cirrhosis referred to the Gastroenterology Department for evaluation. The contrast-enhanced ultrasound and elastography revealed a nodule in the right liver lobe suggesting the diagnosis of dysplastic nodule. The patient performed contrast enhanced multi-detector computer-tomography, showing a subcapsular nodule with enhanced centre and lack of enhancement in the perifery, highly suspicious for HCC. The HCC final diagnosis was assessed by using 3T magnetic resonance imaging system along with hepatocyt specific contrast agents and diffusion sequences, pointing to the importance of state-of-the-art imaging techniques in the liver nodules assessment.

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9. Plurietiologyc Possibilities and Difficulties of Seizures Management in Pregnancy

LUCIANA TEODORA ROTARU(1), RENATA MARIA POPESCU(2), C. BOERIU(3)

Background - Pre-existing pathology, the development of acute new one strictly dependent of the pregnancy or an independent acute or chronic medical problems generate a highly complex disease that requires a nuanced interpretation of the pregnant women in an attempt to identify the most favorable solutions for evaluation and treatment. Case report - 26-28 weeks pregnant women, 23 years old, known epilepsy, HIV encephalitis and pulmonary TB in inconsistent treatment with prolonged seizure status. Emergency air evacuation from a third degree medical center to regional center ( first level) under general anesthesia. After 24 hours, conscious, without focal signs. Favorable ongoing pregnancy. Conclusions - Considering the medical history, we analyzed several possibly triggering and maintenance of the crisis elements so that clarification of them constituted the main challenges. Finding an imaging examination solution with minimal harming effect on the fetus was a key decision points. Tocography and excluding eclampsia as the etiology were the main reasons to refrain from practicing cesarean section and magnesium sulphate administration. Paralytic agents use, in particular succinylcholine was a decisional key point, considering the variation in serum cholynesterase activity in peripartum period. The phenytoin administration was also a difficult choice because of the risk of bradycardia to the fetus. No any adverse event as effects of the crisis and medical intervention on the mother reported to the newborn during the first 8 months of life, but cerebral palsy continues to concern before 24 months.

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10. What kind of a gastric tumor is this?

M. RIMBAS(1), GIANINA MICU(2)

This case report describes a gastric small submucosal tumor endosonographically resembling a gastrointestinal stromal tumor (GIST). The presence of calcifications inside prompted for the surgical excision, and the pathologic examination revealed in fact the presence of a glomangioma (glomus tumor). The presented case is an illustration of the fact that not all masses arising from the muscularis propria layer are GISTs, and the endosonographer must always think of alternative diagnoses.

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