Personalized nuclear imaging protocol in cases with nodular goiter and parathyroid adenoma.

A 62 years old woman was diagnosed with multinodular toxic goiter and primary hyperparathyroidism/left parathyroid adenoma by hormonal assessment, ultrasound and nuclear thyroid/parathyroid scans. Cervical ultrasound illustrated a multinodular aspect of the thyroid with solid nodules and cystic-component nodules; the larger one represented a multinodular complex with necrosis areas in the left thyroid lobe, ACR TI-RADS score 4 (moderately suspicious). Functional nuclear imaging was performed for accurate differential diagnosis between thyroid vs. parathyroid localization, between cold vs. hot nodules, and eventually, for guiding the choice of a subsequent Fine-Needle Aspiration Biopsy (FNAB). Scans described an early intense 99mTc-sestaMIBI uptake with no 99mTc-pertechnetate uptake in the left thyroid lobe larger nodule. Due to the suspicion of malignancy for this nodule, we performed an additional scan (1 hour before the classical 2 hours parathyroid delayed scan). The intense uptake persists in both delayed scans suggesting no malignant phenotype and which was confirmed after surgery by benign histology. In conclusion, using a 99mTc-sestaMIBI personalized protocol, related to the radiotracer cellular uptake mechanisms: 1 hour scan (supplementary image, corresponding to the maximum uptake pattern of 99mTc-sestaMIBI for cancer cells) and 2 hours scan (for parathyroid washout evaluation) may avoid unnecessary extensive thyroid surgery.

Screening of Congenital Hypothyroidism in North-East Romania. Benefits and Messages for Further Improvement.

BACKGROUND: If not diagnosed at birth, congenital hypothyroidism (CH) can cause deleterious, irreversible neurodevelopmental sequels. The importance of thyroid newborn screening (NBS) is therefore well established. OBJECTIVE: To evaluate the efficacy of NBS for CH in North-East Romania. METHODS: Retrospective, descriptive study involving 271662 newborns screened between 2010 and 2019 for CH and phenylketonuria in maternities from six Romanian North-Eastern counties by measuring neonatal TSH (neoTSH) in the whole blood extracted from the heel between days 3 and 5 after birth. Values found higher than a cut-off level of 10 mIU/L were followed by serum evaluation of TSH and fT4 for the confirmation of CH. Thyroid ultrasound was further performed at children found with CH. RESULTS: NeoTSH was found elevated in 417 newborns, but CH was subsequently confirmed in only 57 cases (1/4766 newborns). Mean age at the time when diagnosis was communicated was of 37.2 ± 15 days (between 9 and 157 days). Mean age when therapy was started was of 44.2 ± 17.9 days (between 13 and 160 days) with a mean delay of one week from diagnosis (between 0 and 62 days). Thyroid ultrasound revealed athyreosis in only 3 cases, atrophic thyroid gland in other 10 cases, whereas the thyroid was described as present in the remnant 44 cases. The number of first year follow-up visits greatly varied from 0 to 5, with an average of 2. CONCLUSIONS: NBS allowed rapid diagnosis of CH in North East Romania. The communication of diagnosis to families and therapy onset were however often delayed. Diagnosis and therapy onset before the age of two weeks, as well as a tighter follow-up should be assured by the healthcare system. Etiological diagnosis should be more accurate, for a better prognosis of disease severity, as well as the possibility of genetic advice in selected cases.

Body composition and circulating estradiol are the main bone density predictors in healthy young and middle-aged men.

PURPOSE: Current fracture risk assessment options in men call for improved evaluation strategies. Recent research directed towards non-classic bone mass determinants have often yielded scarce and conflicting results. We aimed at investigating the impact of novel potential bone mass regulators together with classic determinants of bone status in healthy young and middle-aged men. METHODS: Anthropometric measurements, all-site bone mineral density (BMD) and body composition parameters assessed by dual-energy X-ray absorptiometry and also serum concentrations of (1) the adipokines leptin and resistin, (2) vitamin D and parathormone (PTH), (3) sex hormone binding globulin (SHBG), total testosterone and estradiol (free testosterone was also calculated) and (4) C-terminal telopeptide of type I collagen (CTx) were obtained from 30 apparently healthy male volunteers aged 20-65 years enrolled in this cross-sectional study. RESULTS: Only lean mass (LM) and total estradiol independently predicted BMD in men in multiple regression analysis, together explaining 49% (p ≤ 0.001) of whole-body BMD variance. Hierarchical regression analysis with whole-body BMD as outcome variable demonstrated that the body mass index (BMI) beta coefficient became nonsignificant when LM was added to the model. Adipokines, fat parameters, testosterone (total and free), SHBG, PTH and vitamin D were not independently associated with BMD or CTx. CONCLUSIONS: The present study shows that LM and sex hormones-namely estradiol-are the main determinants of bone mass in young and middle-aged men. The effects of BMI upon BMD seem to be largely mediated by LM. Lifestyle interventions should focus on preserving LM in men for improved bone outcomes.

MIDDLE TERM IMPACT OF SLEEVE GASTRECTOMY ON MAJOR CARDIOVASCULAR RISK FACTORS IN A GROUP OF ROMANIAN OBESE PATIENTS.

BACKGROUND AND AIM: The goals of bariatric surgery are to improve the quality of life by lowering body mass index (BMI) but also to treat obesity comorbidities. The aim of our study was to evaluate the impact of laparoscopic sleeve gastrectomy (LSG) on metabolic parameters. METHODS: 85 obese patients treated by bariatric surgery LSG procedure were included in the study. Basal, 6 and 12 months after surgery serum glucose levels and lipid fractions were measured. Metabolic syndrome criteria according to IDF 2006 were evaluated at baseline and after bariatric surgery. RESULTS: Our group included 61.2 % female patients, the mean age was 40.2 ±10.2 years and the metabolic syndrome criteria at baseline were confirmed in 69.4% of the study group. At twelve months after the intervention, the mean excess weight loss (%EWL) was 72%, with age and BMI subgroups variations. We found significant improvements of serum concentrations for triglycerides (P-value = 0.001, decreased by 30%), HDL-cholesterol (P-value = 0.017, increased by 26%), total cholesterol (P-value = 0.043, decreased by 12%) and glucose (P-value = 0.007, decreased by 12%). CONCLUSIONS: The positive effect of bariatric surgery was confirmed for lipid fractions and fasting glucose levels, also the metabolic syndrome prevalence was significantly reduced, all these changes contribute to lower cardiovascular risk together with significant weight loss.

Concepts in local treatment of extensive paediatric burns.

There is a wide variety of local therapeutical methods for extensive burns. This article aims to be a general overview of the most common methods used in the local treatment for extensive burns, both in our clinic and globally. Clinical examples are shown from our clinic; cases of the last 8 years. None of the less there is no such thing as the "perfect method of treatment" but a thin balance between the clinical experience of plastic surgeons, every case particularities and specified characteristics, meaning advantages, disadvantages and limited indications of local topics or methods of skin covering.

Electrocutions--treatment strategy (case presentation).

Electrical injuries are a form of trauma with extreme gravity and a unique pathophysiology: they affect the entire organism. A wide range of voltages may cause electrical accidents. Complications should be anticipated and prevented in order to minimize the complication risk and assure a vital, functional and esthetic prognosis as good as possible. The article presents a case treated in our clinic together with the unique particular clinical situation and algorithm that led to a favorable result.

A rare case of metastatic squamous urachal carcinoma.

Squamous cell carcinoma is a very rare type of urachal malignancy, only a few cases being reported in the medical literature. We present the case of a 49-year-old male patient diagnosed with infected squamous cell urachal carcinoma with multiple pulmonary metastases, after complaints of lower abdominal pain, abdominal mass and fever, without respiratory symptoms. The abdominal ultrasonography and the CT scan revealed a tumoral mass in the lower abdomen in contact with the abdominal wall and the urinary bladder dome, displacing the small bowel. Pulmonary nodular lesions were described in the left lobe pyramid. The intraoperative diagnosis was necrotic urachal tumor with urinary bladder dome invasion and suspected pulmonary metastases, and tumor ablation with bladder dome resection and suture of the bladder were performed. The histopathological result was poorly differentiated squamous cell carcinoma (G3), with negative resection margins. The patient recovered well after surgery, but the prognosis is very poor due to the metastatic stage in which the tumor was diagnosed, no standard chemotherapy regimen for the treatment of metastatic urachal carcinoma being known as effective until now.

Epidemiology and histology of malignant thyroid nodules in North East Region of Romania (Moldavia) before and after alimentary salt universal iodination.

UNLABELLED: Research on the relationship between iodine exposure and thyroid cancer risk is limited and the findings are inconclusive. OBJECTIVES: Given this molecular data on iodine we decided to evaluate the changes of incidence and histology of thyroid cancer in the North-Eastern region of Romania (Moldavia) after the government decision from 2004 that introduced the universal iodination of alimentary salt. After this decision values of urinary iodine increased from 50 microg/L (2001-2002) to 117 microg/L (2006 -2008). MATERIAL AND METHODS: We compared the incidence and the histology of thyroid cancer in residents living in an area known as a mild endemic goiter region (Moldavia-Romania) between 2001-2004 with the incidence and the histology of thyroid cancer between 2005-2008 in the same region after the introduction of universal iodization of alimentary salt. RESULTS: The number of papillary cancers increased from 125 cases (2001-2004) to 276 cases (2005-2008). The number of follicular cancer decreased from 52 cases (2001-2004) to 27 cases (2005-2008). The ratio between papillary and follicular cancers increased from 4.80 / 1 (2001-2004) at 10.61 / 1 (2005-2008). The number of medullar thyroid carcinoma increased from six cases (2001-2004) to 24 cases (2005-2008). Thyroid anaplastic carcinomas number increased from 7 cases (2001-2004) to 12 cases (2005-2008). The total number of thyroid cancer has increased dramatically after the introduction of universal iodination of alimentary salt with 178% compared to 2001-2004 (from 190 cases in 2001-2004 to 339 cases in 2005-2008), despite the fact that the number thyroidectomies decreased from 1734 (2001-2004) to 1449 (2005-2008). CONCLUSION: After the introduction the universal iodination of alimentary salt starting from 2004 the total number of thyroid cancers increased comparative with the period before universal iodination of alimentary salt.

[Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases]. / Transplantul hepatic--indicati, tehnica, rezultate-analiza unei serii clinice de 200 de cazuri.

INTRODUCTION: Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. MATERIAL AND METHODS: Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). CONCLUSIONS: The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

Understanding the time variant connectivity of the language network in developmental dyslexia: new insights using Granger causality.

The reading process takes place in a neuronal network comprising the inferior frontal, posterior dorsal and posterior ventral brain areas. It is suggested that developmental dyslexia is caused by a disruption of the two posterior network areas. What remains debatable is whether these areas are affected in their functionality or whether the neuronal networking (connectivity) of these areas suffer from a disturbed information transfer. Thus, it is of major interest to investigate the time flow of the directed information transfer (time variant connectivity) within the neuronal reading network of dyslexic subjects. We investigated adolescents with dyslexia and normal-reading controls with functional magnetic resonance imaging and electroencephalography (EEG) with a paradigm addressing basic visual, orthographic and phonological processing. EEG data were analyzed with the time variant Granger causality index (tvGCI) to investigate the temporal order of the directed information transfer (time variant causal connectivity: which network node passes when information to which network node) during reading in dyslexic readers. Results show that the reading network of dyslexic readers comprises the same brain areas as identified in normal-reading subjects. The tvGCI analysis of the network profiles of dyslexic readers indicates that dyslexics show a difference in timing and localization of connectivity within this reading network compared to normal readers. Dyslexic readers use right hemisphere language areas to counterbalance posterior left hemisphere processing deficits. The compensatory involvement of homologue right hemisphere brain areas for the reading process may be the neurobiological background for the significantly longer reading times by dyslexics.

Modelling and analysis of time-variant directed interrelations between brain regions based on BOLD-signals.

Time-variant Granger Causality Index (tvGCI) was applied to simulated and measured BOLD signals to investigate the reliability of time-variant analysis approaches for the identification of directed interrelations between brain areas on the basis of fMRI data. Single-shot fMRI data of a single image slice with short repetition times (200 ms, 16000 frames/subject, 64x64 voxels) were acquired from 5 healthy subjects during an externally-driven, self-paced finger-tapping paradigm (57-59 single taps for each subject). BOLD signals were derived from the pre-supplementary motor area (preSMA), the supplementary motor area (SMA), and the primary motor cortex (M1). The simulations were carried out by means of a Dynamic Causal Modelling (DCM) approach. The tvGCI as well as time-variant Partial Directed Coherence (tvPDC) were used to identify the modelled connectivity network (connectivity structure - CS - of the DCM). Different CSs were applied by using dynamic systems (Generalized Dynamic Neural Network - GDNN) and trivariate autoregressive (AR) processes. The influence of the low-pass characteristics of the simulated hemodynamic response (Balloon model) and of the measuring noise was tested. Additionally, our modelling strategy considered "spontaneous" BOLD fluctuations before, during, and after the appearance of the event-related BOLD component. Couplings which were extracted from the simulated signals were statistically evaluated (tvGCI for shuffled data, confidence tubes for tvGCI courses). We demonstrate that connections of our CS models can be correctly identified during the event-related BOLD component and with signal-to-noise-ratios corresponding to those of the measured data. The results based on simulations can be used to examine the reliability of connectivity identification based on BOLD signals by means of time-variant as well as time-invariant connectivity measures and enable a better interpretation of the analysis results using fMRI data. A readiness-BOLD response was only detected in one subject. However, in two subjects a strong time-variant connection (tvGCI) from preSMA to SMA was observed 3 s before the tapping was executed. This connection was accompanied by a weaker rise of the tvGCI from preSMA to M1. These preceding interrelations were confirmed in the other subjects by the dynamics of tvGCI courses. Based on the results of tvGCI analysis, the time-evolution of an individual connectivity network is shown for each subject.

Signal informatics as an advanced integrative concept in the framework of medical informatics. New trends demonstrated by examples derived from neuroscience.

OBJECTIVES: The main objective is to show current topics and future trends in the field of medical signal processing which are derived from current research concepts. Signal processing as an integrative concept within the scope of medical informatics is demonstrated. METHODS: For all examples time-variant multivariate autoregressive models were used. Based on this modeling, the concept of Granger causality in terms of the time-variant Granger causality index and the time-variant partial directed coherence was realized to investigate directed information transfer between different brain regions. RESULTS: Signal informatics encompasses several diverse domains including: processing steps, methodologies, levels and subject fields, and applications. Five trends can be recognized and in order to illustrate these trends, three analysis strategies derived from current neuroscientific studies are presented. These examples comprise high-dimensional fMRI and EEG data. In the first example, the quantification of time-variant-directed information transfer between activated brain regions on the basis of fast-fMRI data is introduced and discussed. The second example deals with the investigation of differences in word processing between dyslexic and normal reading children. Different dynamic neural networks of the directed information transfer are identified on the basis of event-related potentials. The third example shows time-variant cortical connectivity networks derived from a source model. CONCLUSIONS: These examples strongly emphasize the integrative nature of signal informatics, encompassing processing steps, methodologies, levels and subject fields, and applications.

pi-electron ferromagnetism in metal-free carbon probed by soft x-ray dichroism.

Elemental carbon represents a fundamental building block of matter and the possibility of ferromagnetic order in carbon has attracted widespread attention. However, the origin of magnetic order in such a light element is only poorly understood and has puzzled researchers. We present a spectromicroscopy study at room temperature of proton irradiated metal-free carbon using the elemental and chemical specificity of x-ray magnetic circular dichroism. We demonstrate that the magnetic order in the investigated system originates only from the carbon pi-electron system.

[Antimicrobial activity of new 4,4'-bipyridine derivatives: and in vitro study]. / Activité antimicrobienne in vitro de nouveaux sels diquaternaires dérivés de la 4,4'-bipyridine.

The antimicrobial and antifungal activity of some 4,4'-bipyridine derivatives were studied. The diffusimetric gelose surface diffusion method with stainless steel cylinders was used to study bacteria and Sabouraud fields for Candida albicans. Comparative analysis of the results led to the following conclusions. Diquaternary salts of 4,4'-bipyridinium possess a remarkable antimicrobial and antifungal activity. The influence of R1 and R2 substitutes in the para or meta position of the benzoylic radical affects selectivity but does not greatly influence activity.

[In vitro antimicrobial activity of new 1,10-phenantroline derivatives]. / Activité antimicrobienne in vitro de nouveaux dérivés de la 1,10-phénantroline.

The antimicrobial and antifungical activities of some 1,10-phenanthroline derivatives are described. The test was performed using the diffusimetric method with stainless steel cylinders based on diffusion of the substances on the gelose surface for bacteria and Sabouraud field for Candida Albicans yeast. The comparative analysis of the obtained data leads to the following conclusions concerning the relation between structure and activity

[Fertility in prolactinomas--considerations concerning some clinical cases]. / Fertilitatea în prolactinom--consideratii asupra unor cazuri clinice.

Prolactinoma is a frequent endocrine cause of infertility in both man and women. The aim of this study was to evaluate female fertility in association with hyperprolactinemia. The study is a retrospective one, based on the cases monitored in the Endocrinology Department of Iasi. From the 113 cases of prolactinoma in women we have selected 83 women aged between 18-45 years (fertile age). The diagnosis was suspected on clinical bases: endocrine (amenorrhea-galactorrhea, associated or isolated, spaniomenorrhea, infertility), and tumoral (headache, visual disturbances) syndromes and confirmed by biological (PRL dosage) and morphological (pituitary CT) tests. We classified the found associations between prolactinoma and fertility in: no correlation (previous pregnancies with no desire for another child--76 patients = 75.2%); prolactinoma diagnosed immediately after a pregnancy by persistency of galactorrhea, lack of menses reapparition, headache (16 cases = 15.8%); prolactinoma diagnosed before pregnancy, which was obtained thanks to the hyperprolactinemia treatment (9 patients = 8.9%). All 9 patients of the last group were in remission at the moment of pregnancy apparition and had a normal pregnancy, giving birth to normal children. Infertility associated with prolactinoma is reversible with treatment. Lowering of prolactin levels to normal is often necessary to permit ovulation. Bromocriptine used by pregnant women appears to be safe for the developing fetus, at least in our study where the treatment was interrupted in most cases in the first trimester of pregnancy.