Archive issue

1. Strength of Omics in Uncovering Sepsis Mechanisms-A Perspective

S. DOROBANTU(1,2), A. GRIGORESCU(1,3), A. FRATEA(1,3), B. MIRAUTA(1,4), A. NEGHINA(1), G. BICA(1), A. NEACSU(1), F. DUMITRESCU(5), I. STREATA(1,2), M. NETEA(1,3), A.L. RIZA (1,2,3,4)

Background: Sepsis is a significant life-threatening condition due to a dysregulated response to infection. Large datasets yield unprecedented views and transformative insights into processes through various computational frameworks. Our aim was to highlight significant contributions from genomics, transcriptomics, proteomics in the field of sepsis, as modeled from human data. We are showcasing key findings in each omics that have improved the understanding of sepsis pathophysiology, while presenting a perspective from the group’s own contribution to the field. Discussion and Conclusions: Each of the presented omics has advanced our mechanistic understanding on sepsis pathogenicity, biomarker identification for diagnosis, prognosis, and molecular stratification purposes. Multi-omics sepsis research shows strong input from genomics, transcriptomics, proteomics. These have revealed mechanistic links and produce robust endotypes but faces challenges on the path to clinical integration. Integrative sepsis studies combine large-scale omics, paired sampling, and computational multi-omics frameworks to link molecular layers to phenotype. Addressing gaps in standardization, and age/ethnicity representation could yield actionable biomarkers, stratified therapies and improved outcomes.

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2. Patient Safety in Orthopedic Surgery: A Bibliometric Study

A. COBANOGLU(1), K. AYTEKIN(2)

Background: Patient safety is a critical issue that directly affects the success of orthopedic surgeries and requires multidisciplinary collaboration. The aim of this study is to review publications on patient safety in orthopedic surgery from past to present, analyze their bibliometric characteristics, identify prevailing trends and content, and present the existing body of evidence. Methods: A descriptive and bibliometric analysis approach was employed in the study. The data were retrieved from the Web of Science Core Collection (WoSCC) on April 7, 2025, as it is considered a primary source for academic decision-making. After applying inclusion criteria, a total of 784 articles were included in the bibliometric analysis. Results: The first publication on the subject in WoSCC was published in 1983. The total number of citations for all included publications was 11,308, with an average of 13.6 citations per article. The most prolific author was “Selene G. Parekh” (2 articles), the most productive institution was the “University of Pittsburgh” (3 articles), the most productive country was the “United States” (30 articles), and the leading journal was “Orthopedics” (8 articles). Conclusion: This bibliometric analysis revealed that in recent years, there has been a significant increase in the number of publications related to patient safety in orthopedic surgery. As the topic has gained more attention, citation rates have also increased proportionally. The most frequently researched subjects in this area include blood loss and postoperative reoperation rates following orthopedic procedures.

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3. The Potential of Mindfulness in Oncology Nursing: A Systematic Review

E. PANAGOU(1), I. TSATSOU(1), S. PARISSOPOULOS(1), D.K. PAPAGEORGIOU(2), T.I. KONSTANTINIDIS(3), O. GOVINA(1)

Oncology nurses face multiple challenges that affect both themselves and their patients. Mindfulness, as a personality trait, can be cultivated through well-designed practices and may serve as an effective strategy for maintaining nurses’ well-being. This systematic review aimed to evaluate the value and usefulness of mindfulness practice for oncology nurses. A systematic search was conducted in PubMed, Scopus, and Elsevier databases in September 2024 using the keywords: oncology nurses, haematology nurses, mindfulness, professional quality of life, compassion satisfaction, compassion fatigue, burnout, stress, resilience, and wellbeing. English-language studies published between 2010 and 2024 concerning the trait of mindfulness were included. Twelve studies met the inclusion criteria; eight were interventional and implemented mindfulness-based programs. Various assessment tools were used across studies. Interventions were delivered either in person, via audio materials, or through mobile applications. Most were based on Mindfulness-Based Stress Reduction (MBSR) principles or other mindfulness approaches such as the Zentangle method. The intervention studies were generally well-accepted by oncology nurses and demonstrated positive outcomes. Most findings supported the benefits of developing and applying mindfulness in daily clinical practice. Reported improvements included professional quality of life, resilience, stress management, sleep quality, and overall physical and psychological well-being. Despite the limited number and heterogeneity of studies, the overall evidence highlights mindfulness as a promising and effective approach to enhance the well-being and professional satisfaction of oncology nurses.

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4. Interpretable Survival Modeling for Mortality Risk Stratification in Heart Failure Using Cox Proportional Hazard Regression

C.R. DANCIULESCU(1), D.S TANESCU(1), D.O. ALEXANDRU(2), M. SERBANESCU(2)

Background: Heart failure remains a major contributor to morbidity and mortality, highlighting the need for prognostic models that can accurately characterize survival risk while remaining interpretable for clinical use. Statistical survival models are well suited for this task, as they explicitly address time-to-event outcomes and censoring. Methodology: A retrospective survival analysis was conducted on a cohort of 299 patients diagnosed with heart failure. Time to all-cause mortality was analyzed using Cox proportional hazards regression, with right-censoring appropriately handled. The model incorporated routinely collected demographic, clinical, and laboratory variables. Internal validation was performed using bootstrap resampling to assess model stability and discriminative performance. Results: During the follow-up period, 96 patients (32.1%) experienced the event of interest. The Cox model showed stable, moderate discriminative ability under resampling, with a concordance index close to 0.70. Renal function, anemia, age, hypertension, ejection fraction, and serum sodium were identified as independent predictors of mortality, with serum creatinine exhibiting the strongest association with adverse outcomes. Conclusions: Cox proportional hazards regression offers a statistically robust and clinically interpretable approach for mortality risk prediction in heart failure. Using routinely available clinical variables, the model provides reproducible prognostic insights and supports practical risk stratification in cardiovascular research.

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5. Mindful Eating in Lebanon: Validating a New Approach to Combat Obesity and Cardiovascular Diseases

H.A. MOGHRABI(1,2), C.A. OMAR(1), Z. DHAINI(1)

Background: The rising prevalence of obesity and cardiovascular diseases in Lebanon underscores the urgency of effective intervention strategies. Mindful eating represents a promising approach by fostering awareness and healthier eating behaviors. Objective: This study aims to validate the Mindful Eating Questionnaire (MEQ) within the Lebanese context, assessing its factor structure, reliability, and validity. It further examines how mindful eating addresses physiological and stress-related factors prevalent in the Lebanese population. Additionally, a new instrument, the Mindful Eating Behavior Scale (MEBS), has been developed to evaluate the attention component of mindful eating and its internal structure, reliability, and convergent validity. Methods: A cross-sectional ancillary study was conducted between February 11 and 25, 2024, recruiting participants aged 13 years and above from all Lebanese governorates. Recruitment involved advertisements at the Lebanese University and Beirut Arab University, supplemented by snowball sampling to ensure population diversity. Data were collected electronically through a comprehensive questionnaire comprising demographic items and validated scales measuring psychological and behavioral domains. Participation was anonymous and voluntary, with informed consent obtained to maintain ethical standards. Importance & Recommendations: By validating mindful eating tools and exploring their relationship with dietary habits and psychological well-being, this research seeks to establish mindful eating as an effective strategy to enhance health outcomes in Lebanon. The findings will inform healthcare professionals and policymakers in designing targeted interventions addressing obesity, stress, and related mental health conditions.

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6. Ultrasound Guided Injection of Collagen for Elbow Lateral Epicondylitis - A Pilot Study

F. PORTA(1,2), E. FILIPPUCCI(3), X. BARNI(1,2), S.C.DINESCU(4,5), F.A. VREJU(4,5)

Background: Lateral epicondylitis (LE), commonly known as tennis elbow, is an enthesopathy involving the insertion of the common extensor tendon (CET), frequently associated with overuse and degenerative changes. While several conservative therapies exist-including NSAIDs, corticosteroids, PRP, and physiotherapy-none have proven uniformly effective, and some carry undesirable side effects. Recently, collagen peptides have emerged as a promising therapeutic option due to their regenerative and anti-inflammatory properties. Objective: To evaluate the efficacy and safety of ultrasound-guided injections of low-molecular-weight peptides (LWPs) derived from hydrolyzed collagen in patients with LE and partial-thickness CET tears. Methods: This retrospective study included 13 patients with persistent epicondylar pain and ultrasonographic evidence of partial CET tears. Patients received two US-guided injections of collagen peptides, at baseline and at two weeks. Clinical outcomes were assessed using the Numeric Rating Scale (NRS) for pain, while structural changes were monitored via greyscale (GS) and Power Doppler ultrasound at predefined follow-up points. Results: Pain scores improved significantly as early as three days post-injection (mean NRS reduction from 7.5 to 4.8; p<0.05), with continued improvement to 2.5 at one month. Doppler signal decreased significantly, indicating reduced inflammation. Tendon lesions resolved in 8/13 patients and decreased in size in 3. Only two patients experienced mild, transient post-injection pain. Conclusion: Collagen peptide injections appear to be safe and effective treatment for LE, offering significant pain relief and tendon healing. These preliminary findings support further prospective, controlled trials to validate long-term efficacy and positioning in clinical practice.

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7. Prevalence of Vitamin D Deficiency and its Association with Disease Severity in Children Hospitalized with Acute Respiratory Infections

M. NICOLAE(1), C.M. MIHAI(1,2,3), T. CHISNOIU(2,3), O.C. ARGHIR(1,4)

Background: Vitamin D deficiency (VDD) is highly prevalent in pediatric patients, and it has been implicated in the pathogenesis and clinical severity of acute respiratory infections (ARI). Objectives: To evaluate the prevalence of VDD and its association with ARI disease severity and clinical outcomes in hospitalized pediatric patients. Methods: A 4-year prospective case-control study, conducted between 2021 and 2024, in two Romanian pediatric hospitals, included 400 inpatients, aged 0-18 years, admitted for ARI. Patients were stratified into cases with a low level of vitamin D (n=200) and controls with a normal vitamin D (n=200). Clinical severity of ARI, inflammatory biomarkers, presence of fever, need for supplemental oxygen, and length of hospital stay were recorded and analyzed in both cases and controls. Results: Low serum vitamin D levels were significantly associated with severe ARI (26.5% vs. 5.5%), fever at admission (61.0% vs. 32.0%), and increased requirement for oxygen therapy (69.5% vs. 21.0%). Cases also exhibited higher C-reactive protein levels (3.50 vs. 1.64mg/L), higher clinical severity scores (3.77 vs. 1.62), and longer hospital length of stay (4.68 vs. 2.89 days). Conclusions: Vitamin D deficiency was strongly associated with increased disease severity and adverse clinical outcomes in pediatric inpatients with ARI.

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8. A Pilot Study of a Cognitive-Behavioral and Meaning-Centered Intervention to Mitigate Doping-Related Distress

C. COLITA(1), L. ZAGREAN(2), D. COLITA(1), A. POPA-WAGNER(3)

Background: Doping experiences and related suspicions can produce lasting psychological distress in athletes, including anxiety, guilt, and depressive symptoms. Addressing these consequences requires interventions that combine cognitive-behavioral strategies with meaning-centered techniques to promote emotional recovery and ethical self-reflection. Methods: This pilot study evaluated a cognitive-behavioral and meaning-centered intervention designed to reduce anxiety and depression among athletes affected by doping-related distress. Thirty-nine current or former Romanian athletes participated in a six-session program integrating cognitive restructuring, behavioral activation, and exercises focused on purpose and self-transcendence. Standardized measures of anxiety, depression, and meaning in sports were administered before and after the intervention. Results: Higher baseline levels of meaning and purpose in sports were negatively correlated with both depression and anxiety. Pre-post comparisons showed a small reduction in anxiety and a moderate reduction in depression, alongside a small increase in meaning and values/spirituality in sport, as reflected by effect sizes. All psychometric measures demonstrated high internal consistency. Network analyses identified central items within each scale at pretest and posttest. Conclusions: A meaning-centered cognitive-behavioral framework may enhance resilience, promote ethical awareness, and support psychological recovery in athletes experiencing doping-related distress. These preliminary results encourage further controlled studies to confirm efficacy and refine the integration of meaning-oriented techniques in sports psychology interventions.

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9. Comparative Histological Quantification of Prostate Cancer on Surgical Specimens

A.M. STOICULESCU(1), A.E. STEPAN(2), B.C.A NDREIANA(2), O. CRETU(2)

Prostatic acinar adenocarcinomas (PAA) are frequently diagnosed by biopsy, but sometimes they can be identified incidentally on transurethral resection (TURP) tumor fragments. The classical histological information provided by resection and prostate biopsy specimens is the basis for the therapeutic approach and the establishment of the prognosis of the tumors. In this study, we analyzed 135 PAA that were diagnosed incidentally or for which curative therapy was practiced, for which we established the diagnostic differences for tumor type, tumor grade, presence of perineural (IPN) and lymphovascular invasion (LVI) on radical prostatectomy (RP) and TURP specimens. The tumor type, especially foamy PAA (FPAA) and colloid PAA (CoPAA) were identified mainly on PR, while atrophic PAA (APAA), and pseudohyperplastic PAA (PPAA) mainly on TURP. High ISUP 3-5 grading groups were associated mainly with RP, while ISUP 1-2 were more frequently present on TURP. IPN was present in both types of specimens, while the presence of LVI was more frequent on RP. For the most accurate evaluation of the histological parameters associated with PAA, the information provided by TURP seems insufficient and can be complemented by targeted biopsies for the accuracy of the therapeutic decision and prognosis.

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10. Comparison between Pulmonary Rehabilitation and Dance in Patients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Clinical Trial

T. FERREIRA DE ANDRADE LIMA(1,2,3), L.F. DA FONSECA REIS(1), H. OLIMPIO JUNIOR(4,5), S. SANTOS PEREIRA(2,3), G.P.M. DE SOUZA DINIZ(2,3), J.I. SOARES(2,3,6), C. HENRIQUE DA COSTA(7), Y.R. DE SOUZA(2,3,8,9), A.J. LOPES(1,7,10)

Although dance is understudied in the context of chronic obstructive pulmonary disease (COPD), it is a physical activity that can improve individuals' psychological state and physical function. The aim of this research was to compare the impact of physical training using dance versus pulmonary rehabilitation (PR) on functional capacity, lung and muscle function, and quality of life (QoL) in COPD patients. This randomized controlled clinical trial involved 11 patients who underwent dance (DG) and 11 patients who underwent PR (PRG). The patients were evaluated using the following assessments: the mMRC scale, the COPD Assessment Test (CAT), the Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), spirometry, handgrip strength (HGS), the 1-repetition maximum (1-RM) test, and the 6-minute walk test (6MWT). In the intra-group comparison, the DG showed an increase in 6-minute walking distance (6MWD) (p=0.003), a reduction in the mMRC scale, and an improvement in the SF-36 physical functioning and vitality domains. In the intra-group comparison, the PRG showed an increase in 6MWD (p=0.007), a reduction in the mMRC scale, an increase in HGS, an increase in the 1-RM test, and an improvement in all SF-36 domains. In the comparison between groups, the PRG showed an improvement in QoL in the following domains: general perceptions of health and limitations of physical and emotional roles. In conclusion, for patients with COPD, a dance program has the potential to improve functional capacity, the degree of dyspnea, and QoL. However, when compared to a PR, dance is less effective in addressing muscle dysfunction.

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11. Comparative Analysis of Adolescent and Adult Drug Use Profiles: Sociopsychological and Behavioral Insights from a DUDIT-Based Evaluation

R.DANOIU(1), A.M.BIZDOACA(2), M.DAVIOIU(3), I.R.TUDORASCU(4), C.E. NEGROIU(4)

Drug use harms physical and mental health and disrupts family, social, and work life. We compared substance-use patterns in adolescents versus adults across sociopsychological and behavioral domains. Sixty participants who acknowledged psychoactive-substance use were enrolled: 30 adolescents (16-17 years) and 30 adults (18-47 years). The Drug Use Disorders Identification Test (DUDIT) and a brief sociological questionnaire were administered. Adolescents reported more polydrug use (p<0.001) and were more likely to take drugs the morning after a heavy session (p=0.029). Adults showed higher craving (p=0.041), greater guilt (p=0.033), more confrontations about use (p=0.044), and felt more heavily influenced by drugs (p=0.003). Adults also reported more health problems attributable to use (p=0.005) and a higher rate of specialist treatment (p<0.001). Total DUDIT scores were higher in adults, although the difference was not significant (p=0.127). Cannabis was the most commonly used substance in both cohorts, consistent with European trends; highly harmful drugs (e.g., cocaine, amphetamines, heroin) were rarely reported. Most adults lacked a stable romantic relationship, and all participants came from non-traditional family structures, suggesting early relational instability may shape later substance-use trajectories. These findings delineate distinct age-related profiles: adolescent use is characterized by experimentation and binge-linked patterns, whereas adult use is marked by dependence-related features and greater clinical consequences.

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12. Baseline Low-Dose CT Findings in a High-Risk Romanian Population: First Experience with Lung Cancer Screening

C.M. CIOFIAC(1,2), M.A. ENE(2,3), L.M. FLORESCU(1,3), R.V.T. OLARU(3), I.A. GHEONEA(1,3)

Background: Low-dose computed tomography (LDCT) screening has demonstrated significant reductions in lung cancer mortality among high-risk individuals. However, data from Eastern European populations remain scarce, and no national screening program currently exists in Romania. Objective: To describe the baseline demographic characteristics, LDCT findings, and incidental pulmonary abnormalities in a high-risk Romanian cohort undergoing the first round of lung cancer screening. Methods: This single-center, observational study included 42 participants aged 43-76 years (mean 56.4), all of whom underwent baseline LDCT between during one month in 2025. Participants were categorized according to the Lung-RADS system, and incidental findings were recorded. Descriptive statistical analysis was performed for demographic and imaging variables. Results: The cohort included 27 smokers (63%), 11 former smokers (26%), and 4 never-smokers (9%), with a mean BMI of 28.3. Most participants (81%) were classified as Lung-RADS 1-2, while 4 participants (9%) had Lung-RADS 3-4 findings requiring closer follow-up. The most frequent incidental pulmonary abnormalities were fibrosis (63%), followed by emphysema (5%), pulmonary infection (5%), and others (2%). Conclusion: Baseline LDCT screening in this Romanian high-risk cohort revealed a predominance of low-risk nodules and smoking-related lung changes. These findings highlight both clinical feasibility and the need for structured lung cancer screening implementation at the national level.

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13. AQP4 drives gliotic changes in an APPPS1 mouse model of Alzheimer’s Disease

M.D. MANESCU(1), B. CATALIN(2), V.O. MATEESCU(1), G.C. ROSU(1), I.K.S. BOBOC(2), A. ISTRATE-OFITERU(1), I.M. LILIAC(1), C.J. BUSUIOC(1), D. PIRICI(1)

Alzheimer’s disease (AD) is the most common form of dementia, accounting for most of the cases, especially in individuals aged 65 and older. While the existence of genetic factors has helped us create animal models of AD that mimic APP and Ab overproduction, sporadic cases represent the bulk casuistry, and most probably their pathology is related to a loss of function towards the clearance of Ab rather than consecutive the overproduction of Ab alone. It is known that aquaporin 4 (AQP4) facilitation amplifies the perivascular Ab clearance route and decreases Ab deposits in animal models of AD, however it is now known how the glial component of the CNS responds to this treatment. We have aimed here to assess the glial response in a APPPS1 transgenic mouse model of AD, after one month of pharmacological facilitation or inhibition of AQP4. To this extent, we have utilized APPPS1 mice of 2 months of age, treated daily for 28 days with either TGN-020 AQP4 inhibitor or the TGN-073 AQP4 facilitator, and compared their GFAP expression in the brain with that of untreated APPPS1 and wild-type animals. Our image analysis of the GFAP immunohistochemical pattern, showed that AQP4 facilitation increases GFAP expression in the brains of APPPS1 animals, compared to untreated APPPS1 animals, but complexity-lacunarity morphological patterns resemble in fact those of wild-type animals, rather than that of the APPPS1 untreated animals, suggesting that this GFAP reactivity might represent a benefic amyloid-clearance astrocytic profile.

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14. Histological Profile of Chronic Inflammation in Gastric Adenocarcinomas

R. PISICA-ILINCA(1), A.M. BADIU(2), M.M. FLORESCU(2), A.E. STEPAN(2)

Gastric adenocarcinomas (GAC) constitute a major problem in clinical practice, for which late diagnosis and heterogeneity contribute greatly to maintaining epidemiological mortality rates. One of the recent approaches related to the prognosis and therapy of GAC refers to the activation of an effective antitumor immune response, which is not fully known in terms of cellular substrate or interaction with the tumor parenchyma. In this study, we analyzed the chronic mononuclear inflammatory infiltrate in 125 primitive GAC, in relation to the classic histological parameters of tumor aggressiveness, based on a composite histological score (CHS) that took into account the distribution and density of the elements tracked. The results indicated significant differences, most GAC having a predominantly peritumoral infiltrate except for poorly cohesive signet ring cell carcinomas (PC-SRC) in which intratumoral elements predominated. Density and CHS were higher in PC-SRC GAC and MX-GAC (mixed), in high-grade, stage III tumors with vascular invasion. Although the pattern or density of inflammation in GAC does not necessarily reflect the orientation or antitumor efficacy of immune elements, the data obtained may be useful for the development of histological criteria to assist in stratifying patients for therapy.

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15. Hydroxychloroquine-Induced Hypoglycemia in a Non-Diabetic Patient with Chronic Kidney Disease and Rheumatoid Arthritis

K. ENGLISH(1)

Hydroxychloroquine (HCQ) is an immunomodulatory medication commonly used to treat several autoimmune diseases. Due to its tendency to change insulin metabolism by increasing production and reducing clearance, HCQ can cause hypoglycemia in patients with or without diabetes, albeit this is rare. There is documented evidence of HCQ-induced hypoglycemia in the literature. However, none to our knowledge has reported this adverse effect in a patient with chronic kidney disease not undergoing dialysis. We describe the case of an 81-year-old woman who went to the emergency room for care after experiencing abrupt dizziness and unconsciousness. Pertinent history includes four prior episodes of hypoglycemia after the recent initiation of HCQ for rheumatoid arthritis. Fasting glucose was <40 mg/dL on presentation. Given the appearance of symptoms after the initiation of the medication and the absence of symptoms with normal glucose upon discontinuation, it was concluded that HCQ was the likely culprit for the recurrent episodes of hypoglycemia. Physicians should be aware of this rare but possible adverse effect of HCQ, especially in older patients and patients with chronic kidney disease. Prompt elimination of the medication can reduce the risk of some of the devastating consequences of hypoglycemia.

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16. The Brain-Face Connection in Holoprosencephaly: Case Report and Literature Review

A.F. STANCIOI-CISMARU(1,2,3), F.G. DITA(3,4), R.C. PANA(2,5), M. DINU(1,2), M.A. CIOPONEA(2,3), R.M. ROBU(2,3), R.G. CAPITANESCU(1,2), O.C. SIRBU(1,2), B.C. ANDREIANA(6,7), S. TUDORACHE(1,2)

Background and Objectives: Holoprosencephaly (HPE) is a congenital brain malformation caused by the incomplete division of the forebrain during early embryogenesis. It results in a spectrum of structural abnormalities, ranging from alobar to lobar forms, and milder, more difficult to diagnose variants. Alobar HPE is often associated with midline craniofacial defects due to shared developmental origins. Both malformations are amenable at the first trimester anomaly scan. Case report and systematic review: We present a late diagnosed and complex case, subject of major obstetric complications. The late booking prenatal ultrasound examination revealed alobar HPE associating facial and great vessels anomalies. Subsequently, severe sudden hemorrhage due to central placenta praevia required emergency cesarean section. Neonatal death occurred shortly after birth. We performed a literature review on HPE cases associated with facial defects, aiming to highlight the broad spectrum of cerebral malformations, their associated outcomes, and to analyze maternal and fetal features. Results: We identified and analyzed 26 studies, including 34 fetuses/neonates. The most severe and common form-the alobar type, was diagnosed prenatally in 22 cases (64.71%). There were 16 reported births and 16 terminations of pregnancy. The neonatal outcome was unfavorable in all alobar HPE cases. In non-alobar forms, neonatal survival beyond several months postpartum was reported in two cases. Conclusions: HPE is a severe congenital brain malformation, most often lethal. Alobar form can be diagnosed in early pregnancy. Survival beyond the neonatal period is rare and associated with significant neurological impairment.

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