Imaging and Biomarkers: The Assesment of Pulmonary Embolism Risk and Early Mortality.

Background and Objectives: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. Materials and Methods: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. Results: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, p < 0.001, and for AF, p = 0.0036; COVID-19, p = 0.003; and cancer patients, p = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, p = 0.045, and cancer patients, p = 0.038. The relationship PAOI-D-dimer and PAOI-c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815-0.982). Conclusions: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.

Predictive Value of HPV, p53, and p16 in the Post-Treatment Evolution of Malignant Tumors of the Oropharynx and Retromolar Trigone-Oropharynx Junction.

Background and objectives: Knowledge of the interactions and influences of infectious, genetic, and environmental factors on the evolution and treatment response of malignant tumors is essential for improving the management of the disease and increasing patient survival. The objective of this study was to establish the contribution of human papillomavirus (HPV), as well as p53 and p16 tumor markers, alongside associated factors (smoking and alcohol consumption), in the progression of malignancies located in the oropharynx and at the retromolar trigone-oropharyngeal junction. Materials and Methods: We performed a prospective study including 50 patients with malignant tumors of the oropharynx and retromolar trigone-oropharyngeal junction. In all patients, the presence and type of HPV were determined, as well as the status of the tumor markers p53 and p16. The associated risk factors, biopsy results, treatment method, and post-treatment evolution were all documented. Statistical analyses were performed to evaluate the correlations between the determining factors and their influence on the post-treatment evolution. An overall increased survival rate was found in HPV(+) patients. Results: Our study outlined the prevalence of different high-risk subtypes of HPV from the ones presented by other studies, suggesting a possible geographic variation. Correlations between the p53 and p16 statuses and patient survival could be established. The association of smoking and alcohol consumption strongly correlated with an unfavorable evolution. Conclusions: Awareness of the differences in the post-treatment evolution of the patients in relation to the presence of the factors determined in our study could change the future management of such cases for ensuring improved treatment outcomes.

Improving the Treatment Outcome of Naso-Orbito-Ethmoido-Maxillary Fractures Using Virtual Three-Dimensional Anthropometric Data.

BACKGROUND: Naso-orbito-ethmoido-maxillary (NOEM) fractures are usually the result of a high or moderate intensity impact to the upper midface. These types of fractures are difficult to treat and are frequently misdiagnosed. Craniometric analysis can be of real aid in the treatment of NOEM complex fractures by establishing midfacial proportions. AIM: This study aims to establish the distances between selected anthropometric points and midfacial proportions found in the adult Caucasian population and to determine if any differences exist between genders. METHODOLOGY: Measurements between anthropometric points, nasion (N), dacryon (D), infraorbital foramen (IOF), frontomalare orbitale (FMO), rhinion (Rhi) and porion (Po), were made on 3D models obtained using patients' CT exams. RESULTS: Significant differences were found between genders for the orbital dimensions represented by N-FMO (p = 0.000), N-IOF (p = 0.000), Rhi-FMO (p = 0.000), Rhi-IOF (p = 0.000), nose bridge width N-D (p = 0.001), Rhi-D (p = 0.016), D-D (p = 0.038) and the projection of the nose evaluated by Rhi-Po (p = 0.000), N-Po (p = 0.000), while a t-test showed that there are no significant differences between males and females for the N-Rhi (p = 0.254). CONCLUSIONS: The values of these measurements can be utilized during skeletal reconstruction after NOEM fractures, especially for bilateral comminuted fractures where no points of comparison are available.

The Landscape of Nanovectors for Modulation in Cancer Immunotherapy.

Immunotherapy represents a promising strategy for the treatment of cancer, which functions via the reprogramming and activation of antitumor immunity. However, adverse events resulting from immunotherapy that are related to the low specificity of tumor cell-targeting represent a limitation of immunotherapy's efficacy. The potential of nanotechnologies is represented by the possibilities of immunotherapeutical agents being carried by nanoparticles with various material types, shapes, sizes, coated ligands, associated loading methods, hydrophilicities, elasticities, and biocompatibilities. In this review, the principal types of nanovectors (nanopharmaceutics and bioinspired nanoparticles) are summarized along with the shortcomings in nanoparticle delivery and the main factors that modulate efficacy (the EPR effect, protein coronas, and microbiota). The mechanisms by which nanovectors can target cancer cells, the tumor immune microenvironment (TIME), and the peripheral immune system are also presented. A possible mathematical model for the cellular communication mechanisms related to exosomes as nanocarriers is proposed.

Correlations between HPV, p53 and p16 in malignancies involving the retromolar trigone-oropharynx junction.

The aim of this study is to enhance knowledge regarding the behavior of human papilloma virus (HPV)-associated malignancies between two territories - maxillofacial and otorhinolaryngology. The HPV status and genotype, p16 and p53 expression were performed in 50 patients with malignancies located at the junction between the oropharynx and retromolar trigone alone or oropharynx spread to the junction. These were correlated with the treatment response, prognosis and survival of this kind of tumor located in oral posterior region, marking the transition between two territories (maxillofacial and otorhinolaryngology) of the selected cases. Results showed better treatment outcome and improved prognosis in HPV-positive compared to HPV-negative patients, and a strong link between HPV presence and p16 expression. Multimodal treatment including surgery, radiotherapy and chemotherapy provided the best results, although surgery was only an option in a limited number of cases, due to the advanced stage at presentation and extension in the surrounding tissues, considering the complex anatomy of the area. In the context of the increasing incidence of HPV-positive head and neck cancer, HPV testing together with molecular profiling for p16 and p53 tumor markers could help diagnose malignancies in the initial stages, and also provide important clues towards a targeted, more efficient treatment.

Diabetes mellitus, chronic complication in patients with acromegaly: case report and review of the literature.

UNLABELLED: Disturbances of glucose metabolism are frequently observed in patients with acromegaly. Excess amounts of GH and IGF1 interacts with metabolic regulation, and indeed, GH hypersecretion is associated with hepatic and peripheral insulin resistance; this and also other mechanisms are involved in the development of diabetes mellitus. It can quickly improve if the levels of GH decline after the therapy. CASE REPORT: We present a patientof 54 years old, admitted in the clinic in 2009, with diagnosis of acromegaly. MRI scan reveals an expansive pituitary tumor 15/16/17 mm. Values of GH, IGF1 and blood glucose were much above normal. Body mass index 27, 5 kg/m2. After 12 months of a medical treatment with somatostatin analogues, the evolution of blood parameters was favorable, but the patient has discontinued his treatment. At the hospitalization in 2012 there is a precarious control of the diabetes under oral antidiabetic agents. A new treatment has been applied: it was practiced surgical transsphenoidal ablation. At last admit, May 2014, the value IGF1 has been normal, GH has been below 1 ng/mL, and HbAlc was 5.27%. Dyslipidemic syndrome has been constantly present; the values of triglycerides and cholesterol should be a little more upper limit. CONCLUSIONS: Following successful treatment of acromegaly with surgery, glucose tolerance improves. Balancing type 2 diabetes, with return to normal HbA1c and the decrease in cholesterol and triglycerides values, represents the result of favorable normalization GH in our patients with acromegaly.

Biliary Hamartoma.

Biliary hamartoma or von Mayenburg complex (VMCs) is a rare benign congenital malformation of the biliary duct. Patients are usually asymptomatic. Hepatic lesions are incidentally discovered on ultrasonography (US) and subsequent radiological methods are necessary for confirmation. A correct diagnosis is established when typical imaging findings are present, otherwise histological confirmation might be needed.

[Unique monoblock lung right-left, unique pleural cavity]. / Plamân monobloc dreapta-stânga. Cavitate pleurala unica. Plamîn hipoplazic stâng. Caz clinic.

A 34-year-old female with WPW syndrome has been under surgical treatment in our clinic with left basal chronic pleural empyema. During the surgical intervention multiple anatomical anomalies were detected, like unique pleural cavity, monoblock lung left-right, hypoplasic left lung, no scissures on the left side, no left pulmonary arteria with an aberrant arteria for the left lung derived from the right pulmonary arteria, the same for the bronchis. The pleural-pulmonary shelling proceeded without incidents and it has been finalized with the drainage of the whole pleural cavity.

[Brown tumors of upper and lower jaws in Recklinghausen neurofibromatosis. A case report]. / Tumori brune ale maxilarului si mandibulei in neurofibromatoza Recklinghausen. Observatii pe marginea unui caz.

We report the case of a 41-year-old patient who presented multiple cafe au lait spots and exophytic tumors of the upper jaw, causing facial asymmetry and masticatory impairment. Physical examination and paraclinical investigations established the diagnosis of NF1 (type 1 neurofibromatosis) associated with brown tumors in jaws and left nasal bone, caused by a primary hyperparathyroidism (Oxyphilic adenoma). The parathyroidectomy determines brown tumors regression and sclerosis with no dependence on their localization.

[MRI in the differential diagnosis of liver focal lesions]. / Irm în diagnosticul leziunilor focale hepatice.

51 patients with focal liver abnormalities at ultrasound were examined by MRI. The cases with liver metastasis of known origin submitted for staging and cholangiocarcinomas of the external bile ducts or gall bladder with liver invasion were not included in the study. Most of the examinations were performed for suspected hepatocarcinoma. MRI studies, using 2D T1 and T2 weighted FSE sequences and T1 weighted 3D SPGRE contrast enhanced sequences were able to differentiate between different kinds of benign lesions e.g. large hemangiomas or FNH or even complicated hydatic cysts from hepatocarcinoma.

[MRI in acute pancreatitis]. / IRM in pancreatita acuta.

26 patients with clinical and biological suspicion of acute pancreatitis were examined by MRI. The general indications for pancreatic MRI were: suboptimal or equivocal CT or ultrasonography findings (e.g. focal pancreatic enlargement with no mass discernable on CT or US), contraindications to iodinated contrast administration (e.g. contrast allergy history and renal failure). Using fast scanning techniques most of them with breath holding and fat saturation MRI was able to depict the lesions involved (e.g. the presence and distribution of necrotic areas and fluid collections, the existence of subsequent chronic pancreatic changes) which are consistent with CT findings. MRCP demonstrated etiology, like cholelithiasis.

[Normal bone mineral content levels determined by quantitative computer tomography (QCT) in the population of Moldavia]. / Valorile normale ale continutului mineral osos determinate prin computertomografie cantitativa (QCT) la populatia din Moldova.

UNLABELLED: To determine by QCT-BMD the normal osteodensitometric levels in the population of both sexes (18-80 years) from Moldavia districts. MATERIAL AND METHOD: The study used the BMD (bone mineral density) option of CT PACE GE-CGR (QCT) device which compares the CT levels in the area of interest restricted to the trabecular area of L1-L4 vertebrae with the values of a phantom with different hydroxyapatite concentrations. In order to develop a regional standard, an average of 10 both sexes subjects free of osteoporosis-generating diseases were investigated per each 5-year age group, age range 18 to 80 years, selected at random from the 8 districts of Moldavia. In both genders, data were plotted against age and were analysed with linear regression tests and the evolution curve (age-related) for each gender was drawn. RESULTS: The levels of score Z in both sexes were obtained. The obtained standard may be used as a reference database for the QCT investigation of the spine both in the male and female Romanian population.