Assessment of the correlation between the nutrient load from migratory bird excrement and water quality by principal component analysis in a freshwater habitat.

Waterbirds depend on a dispersed network of wetlands for their annual life cycle during migration. Climate and land use changes raise new concerns about the sustainability of these habitat networks, as water scarcity triggers ecological and socioeconomic impacts threatening wetland availability and quality. During the migration period, birds can be present in large enough numbers to influence water quality themselves linking them and water management in efforts to conserve habitats for endangered populations. Despite this, the guidelines within laws do not properly account for the annual change of water quality due to natural factors such as the migration periods of birds. Principal component analysis and principal component regression was used to analyze the correlations between the presence of a multitude of migratory waterbird communities and water quality metrics based on a dataset collected over four years in the Dumbravița section of the Homoród stream in Transylvania. The results reveal a correlation between the presence and numbers of various bird species and the seasonal changes in water quality. Piscivorous birds tended to increase the phosphorus load, herbivorous waterbirds the nitrogen load, while benthivorous duck species influenced a variety of parameters. The established PCR water quality prediction model showed accurate prediction capabilities for the water quality index of the observed region. For the tested data set, the method provided an R2 value of 0.81 and a mean squared prediction error of 0.17.

Digital Twin for a Multifunctional Technology of Flexible Assembly on a Mechatronics Line with Integrated Robotic Systems and Mobile Visual Sensor-Challenges towards Industry 5.0.

A digital twin for a multifunctional technology for flexible manufacturing on an assembly, disassembly, and repair mechatronics line (A/D/RML), assisted by a complex autonomous system (CAS), is presented in the paper. The hardware architecture consists of the A/D/RML and a six-workstation (WS) mechatronics line (ML) connected to a flexible cell (FC) and equipped with a six-degree of freedom (DOF) industrial robotic manipulator (IRM). The CAS has in its structure two driving wheels and one free wheel (2DW/1FW)-wheeled mobile robot (WMR) equipped with a 7-DOF robotic manipulator (RM). On the end effector of the RM, a mobile visual servoing system (eye-in-hand MVSS) is mounted. The multifunctionality is provided by the three actions, assembly, disassembly, and repair, while the flexibility is due to the assembly of different products. After disassembly or repair, CAS picks up the disassembled components and transports them to the appropriate storage depots for reuse. Disassembling or repairing starts after assembling, and the final assembled product fails the quality test. The virtual world that serves as the digital counterpart consists of tasks assignment, planning and synchronization of A/D/RML with integrated robotic systems, IRM, and CAS. Additionally, the virtual world includes hybrid modeling with synchronized hybrid Petri nets (SHPN), simulation of the SHPN models, modeling of the MVSS, and simulation of the trajectory-tracking sliding-mode control (TTSMC) of the CAS. The real world, as counterpart of the digital twin, consists of communication, synchronization, and control of A/D/RML and CAS. In addition, the real world includes control of the MVSS, the inverse kinematic control (IKC) of the RM and graphic user interface (GUI) for monitoring and real-time control of the whole system. The "Digital twin" approach has been designed to meet all the requirements and attributes of Industry 4.0 and beyond towards Industry 5.0, the target being a closer collaboration between the human operator and the production line.

Antibiotic Resistance Patterns of Uropathogens Causing Urinary Tract Infections in Children with Congenital Anomalies of Kidney and Urinary Tract.

Background: Urinary tract infections (UTI) are common in children worldwide. Congenital anomalies of kidney and urinary tract (CAKUT) increase the risk of UTI and consequently antibiotic resistance. Antibiotic resistance represents an important public health issue worldwide. We aimed to evaluate the local trend in terms of bacterial uropathogen resistance in the western part of Romania in children with CAKUT and UTI. Methods: 252 children with CAKUT were admitted to our hospital over a five-year period. Of them, 91 developed at least one UTI episode, with a total number of 260 positive urine cultures. We collected data about age at diagnosis of CAKUT, sex, origin environment, type and side of CAKUT, number of UTIs, type of uropathogen, and uropathogens antibiotic resistance. Results: Distribution of uropathogens was Escherichia coli (38.84%), Klebsiella spp. (21.15%), Enterococcus spp. (15.76%), Proteus spp. (8.07%), Pseudomonas spp. (8.07%), Enterobacter spp. (2.3%), other Gram-negative bacteria (2.3%), and other Gram-positive bacteria (3.45%). High antibiotic resistance was detected for ampicillin, amoxicillin, and second-generation cephalosporins. Escherichia coli presented high resistance for cefepime and ceftriaxone. Pseudomonas spp. remained susceptible to amikacin, quinolones, and colistin. Vancomycin, teicoplanin, linezolid, and piperacillin/tazobactam remained effective in treating Gram-positive UTI. Conclusions: High antibiotic resistance was identified for frequently used antibiotics. Lower antibiotic resistance was observed for some broad-spectrum antibiotics. Understanding uropathogens' antibiotic resistance is important in creating treatment recommendations, based on international guidelines, local resistance patterns, and patient particularities.

Subcutaneous ticks: a first report in a golden jackal, and their absence in non-canid carnivores.

BACKGROUND: Ticks are hematophagous arthropods which normally attach to the surface of the host's skin. Their aberrant presence in the subcutaneous tissue of a few carnivores, predominantly foxes, has been reported. However, there have been no reports of this phenomenon in other carnivores such as mustelids or golden jackals. Our aim was to investigate the host spectrum for this aberrant localization of ticks. METHODS: Between 2015 and 2020, a total of 198 carcasses of 12 species of carnivore were examined by parasitological necropsy. When a subcutaneous tick was found, the nodule was removed, carefully dissected, and stored in ethanol. The morphological identification of the subcutaneous tick was carried out to species level. RESULTS: A single subcutaneous tick was found in one carcass, that of a golden jackal (Canis aureus). The tick was identified as a female Ixodes ricinus. All the other carcasses were negative for the presence of subcutaneous ticks. CONCLUSION: To our knowledge, this is the first report of a subcutaneous tick in a golden jackal. This finding broadens the host spectrum of subcutaneous ticks, and reinforces the idea that, among carnivores, this phenomenon only occurs in canids.

Supply-side and demand-side policies for biosimilars: an overview in 10 European member states.

OBJECTIVE: This study aimed to provide an overview of biosimilar policies in 10 EU MSs. Methods: Ten EU MS pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK) were selected. A comprehensive literature review was performed to identify supply-side and demand-side policies in place in the selected countries. Results: Supply-side policies for biosimilars commonly include price linkage, price re-evaluation, and tendering; the use of internal or external reference pricing varies between countries; health technology assessment is conducted in six countries. Regarding demand-side policies, pharmaceutical prescription budgets or quotas and monitoring of prescriptions (with potential financial incentives or penalties) are in place in eight and in seven countries respectively. Switching is generally allowed, but is solely the physician's responsibility. Automatic substitution is not recommended, or even forbidden, in most EU MSs. Prescription conditions or guidelines that apply to biosimilars are established in nearly all surveyed EU MSs. Conclusions: Important heterogeneity in policies on biosimilars was seen between (and even within) selected countries, which may partly explain variations in biosimilar uptake. Supply-side policies targeting price have been reported to limit biosimilar penetration in the long term, despite short-term savings, while demand-side policies are considered to positively impact uptake.

Key drivers for market penetration of biosimilars in Europe.

Background & Objectives: Potential drivers and barriers of biosimilar uptake were mainly analysed through qualitative approaches. The study objective was to conduct a quantitative analysis and identify drivers of biosimilar uptake of all available biosimilars in the European Union (EU). Methods: A three-step process was established to identify key drivers for the uptake of biosimilars in the top 10 EU member states (MS) pharmaceutical markets (Belgium, France, Germany, Greece, Hungary, Italy, Poland, Spain, Sweden, and the UK): (1) literature review to identify incentive policies in place to enhance biosimilars adoption; (2) assessment of biosimilar market dynamics based on database analysis; (3) regression model analysis on price using the following explicative variables: incentive policies; price difference between the biosimilar and the originator product; distribution channel; generic uptake and generic price cut; pharmaceutical expenditure per capita; and market competition. Results: At the study cut-off date, 20 biosimilars were available on the market. Incentive policies applied to biosimilars were found to be heterogeneous across countries, and uptakes of biosimilars were also very heterogeneous between different therapeutic classes and countries. Results from the model demonstrated that incentive policies and the date of first biosimilar market entry were correlated to biosimilar uptake. Pharmaceutical expenditure per capita and the highest generic uptake were inversely correlated with biosimilar uptake. Average generic price discount over originator and the number of biosimilars showed a trend toward statistical significance for correlation with biosimilar uptake, but did not reach the significance threshold. Biosimilar price discount over original biologic price, the number of analogues, and the distribution channel were not correlated with the biosimilar uptake. Conclusions: Understanding drivers of biosimilar uptake becomes a critical issue to inform policy decision-makers. This study showed that incentive policies to enhance uptake remain an important driver of biosimilar penetration, while biosimilar price discounts have no impact. Future research is warranted when the biosimilar market gains maturity.

Role of golden jackals (Canis aureus) as natural reservoirs of Dirofilaria spp. in Romania.

BACKGROUND: Dirofilaria immitis and Dirofilaria repens are mosquito-transmitted zoonotic nematodes, causing heartworm disease and skin lesions, respectively, in carnivores. In Europe, the domestic dog is apparently the main definitive host, but patent infections occur also in other species of carnivores. The rapid spread of the golden jackals (Canis aureus) throughout Europe opens a question of involvement of this species in the sylvatic cycle of pathogens in the colonised territories, including Dirofilaria spp. METHODS: Between January 2014 and May 2015, 54 golden jackals from 18 localities in Romania were examined by full necropsy for the presence of adult filarioid nematodes and blood samples from all animals were screened for the presence of microfilariae of D. immitis, D. repens and Acanthocheilonema reconditum by multiplex PCR DNA amplification. RESULTS: Nematodes morphologically identified as D. immitis were found in 18.52% of the animals, originating from the southern part of Romania. No D. repens or A. reconditum were found at necropsy. The molecular prevalence in blood samples from the same animals was 9.26% for D. immitis and 1.85% for D. repens. All samples were negative by PCR for A. reconditum. CONCLUSION: The relatively high prevalence of Dirofilaria spp. infections in golden jackals from Romania together with the increasing density of the jackal populations highlight their potential role in the transmission of these zoonotic parasites and in the maintenance of natural disease foci.

Molecular detection of Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato genospecies in red foxes (Vulpes vulpes) from Romania.

BACKGROUND: Red foxes (Vulpes vulpes) are one of the most widespread wild carnivores in the world, being recognized to harbor and transmit a wide range of vector-borne diseases. Anaplasma phagocytophilum and Borrelia burgdorferi sensu lato are zoonotic tick-borne pathogens causing emerging diseases. Wild animals play an essential role in the transmission of diseases and pathogens maintenance in nature. Epidemiological studies regarding the prevalence of tick-borne pathogens in red foxes are of public health importance, as they may successfully act as a pathogen transmission interface between wildlife, domestic animals and humans. FINDINGS: This study included 14 counties from Romania. A total number of 353 red foxes (Vulpes vulpes) were examined. Heart tissue samples were collected during necropsy and stored at -20 °C. Genomic DNA extraction was performed and all samples were examined by polymerase chain reaction (PCR). Specific primers for A. phagocytophilum, A. platys, E. canis and Borrelia burgdorferi s.l. were used. Sequence analysis was performed (Macrogen Europe, Amsterdam) and obtained sequences are available at GenBank™. Out of the 353 samples, 9 (2.55 %; 95 % CI: 1.25-4.96 %) were positive for A. phagocytophilum. Positive animals originated from 5 counties. In total, 5 out of 353 heart tissue samples (1.42 %; 95 % CI: 0.52-3.47 %) collected from red foxes were positive for B. burgdorferi s.l. Red foxes originated from 4 counties. None of the samples were positive for A. platys or E. canis. No co-infection with A. phagocytophilum and B. burgdorferi s.l. was found. CONCLUSION: This first report of A. phagocytophilum and B. burgdorferi s.l. in red foxes from Romania suggests a limited role of foxes in the maintenance of the two related pathogens, but may represent a potential risk from a public health perspective.

Peripheral Nerve Regeneration - an Appraisal of the Current Treatment Options.

During the last decades significant progress was made in the understanding of the physiopathology of the peripheral nerve regeneration. Although the evolution of therapy is not as spectacular, a series of new treatment solutions were developed. The gold standard in therapy remains the use of autografts. We present the current concepts and therapeutic options available.

A Cloud Based Real-Time Collaborative Platform for eHealth.

For more than a decade, the eHealth initiative has been a government concern of many countries. In an Electronic Health Record (EHR) System, there is a need for sharing the data with a group of specialists simultaneously. Collaborative platforms alone are just a part of a solution, while a collaborative platform with parallel editing capabilities and with synchronized data streaming are stringently needed. In this paper, the design and implementation of a collaborative platform used in healthcare is introduced by describing the high level architecture and its implementation. A series of eHealth services are identified and usage examples in a healthcare environment are given.

Red foxes (Vulpes vulpes) in Romania are carriers of Toxoplasma gondii but not Neospora caninum.

Brain samples from 182 red foxes (Vulpes vulpes) from Romania were examined using a standard PCR technique. Results provide evidence of Toxoplasma gondii (11 foxes=6.0%) and Neospora caninum (1 fox=0.5%) DNA in red foxes from Romania. No coinfections were found.

P wave signal-averaged ECG in normal population and in patients with converted atrial fibrillation.

BACKGROUND: Signal-averaged electrocardiography of the P wave (P wave SAECG) is a noninvasive method for evaluating the risk of atrial fibrillation (AF). We aimed to study P wave SAECG parameters in a large number of apparently healthy subjects and to compare them with patients with converted AF. METHODS: We examined 591 individuals; P wave SAECG were recorded in 330 normal subjects, 31 patients with converted persistent AF and 57 patients with converted paroxysmal AF immediately after conversion, at 12 and 24 hours after conversion, then after 3 and 6 months. P wave SAECG were recorded using a commercially available machine aiming to obtain a noise level <1 µV. RESULTS: In the normal population the duration of the filtered P wave (PWD) was higher in men. P wave duration, RMS(40) and RMS(30) were significantly correlated with age. By comparing the normal population with patients with persistent AF converted to sinus rhythm we demonstrated significant differences in PWD and P wave integral. Patients with recurrent persistent AF had significantly higher PWD. The study of patients with paroxysmal AF, compared to the control group, showed significant increase of the same parameters: PWD and integral of the P wave. Patients with recurrent paroxysmal AF had higher PWD and lower RMS(40) , RMS(30) , RMS(20) . CONCLUSIONS: Filtered P wave duration was higher in men; PWD was weakly but significantly correlated with age. Patients with paroxysmal or persistent AF converted to sinus rhythm had significantly higher P wave duration and P wave integral.

The Romanian Acute Heart Failure Syndromes (RO-AHFS) registry.

AIMS: The objective of the RO-AHFS registry was to evaluate the epidemiology, clinical presentation, inpatient management, and hospital course in a population hospitalized for acute heart failure syndromes. METHODS: During a 12-month period, 13 Romanian medical centers enrolled all consecutive patients hospitalized with a primary diagnosis of AHFS. Patients were classified into the following 5 clinical profiles at admission: acute decompensated heart failure, cardiogenic shock, pulmonary edema, right heart failure, and hypertensive heart failure. Statistical significance was assessed using Fisher exact test or the χ(2) test for categorical variables and a 1-way analysis of variance for continuous variables. Independent predictors of in-hospital all-cause mortality (ACM) were identified using a multivariate logistic regression model. RESULTS: A total of 3,224 consecutive patients hospitalized with AHFS were enrolled. The cohort had a mean age of 69.2 ± 11.8 years and 56% were men. The mean left ventricular ejection fraction was 37.7% ± 12.5%. The percentage of patients treated with evidence-based heart failure therapies increased from admission to discharge, but even at discharge, only 56%, 66%, and 54% of patients were on a ß-blocker, an angiotensin-converting enzyme inhibitors or an angiotensin receptor blocker, and a mineralocorticoid receptor antagonist, respectively. In-hospital ACM was 7.7% with substantial variation between sites (4.1%-11.0%). Increasing age, inotrope therapy, the presence of life-threatening ventricular arrhythmias, and elevated baseline blood urea nitrogen were all found to be independent risk factors for in-hospital ACM, whereas elevated systolic blood pressure and baseline treatment with a ß-blocker had a protective effect. CONCLUSIONS: The RO-AHFS study found substantial variation both among sites and between Romania and other European countries. National and regional registries have important clinical implications for patient care and the design and conduct of global clinical trials.

Ventricular septal rupture after acute myocardial infarction.

Ventricular septal rupture is a rare complication of acute myocardial infarction with important hemodynamic consequences. Spontaneous closure is extremely rare. Without a rapid diagnosis and correction by surgical intervention, the short-term mortality of these patients is higher than 90%. We report the case of a patient with acute myocardial infarction and a ventricular septal rupture that was partially closed by the formation of a thrombus. Early diagnosis was obtained in the emergency room, based on clinical examination and transthoracic echocardiography.

Serum testosterone and short-term mortality in men with acute myocardial infarction.

BACKGROUND: A significant and independent association between testosterone levels and coronary events in men and women has not been confirmed in large prospective studies, although some reports have shown that endogenous testosterone concentrations in men are inversely related to cardiovascular and general mortality. METHODS: We aimed to assess the relationship between serum testosterone level and short-time (30-day) mortality in men with acute myocardial infarction. RESULTS: We included 126 consecutive male patients admitted with acute myocardial infarction. The mean age was 62 +/- 13 years. We determined, at admission, serum free testosterone (T) level (using a chemoluminiscence assay), high sensitivity C-reactive protein, N-terminal pro-B-type natriuretic peptide, and glycated hemoglobin level. We analyzed the 30-day mortality. CONCLUSIONS: The mean level of serum T was 4.1 +/- 2.9 ng/mL. All non-survivors had T level < or = 3 ng/mL. A low level of T was independently related to total short-term mortality.

Antihypertensive efficacy of perindopril 5-10 mg/day in primary health care: an open-label, prospective, observational study.

BACKGROUND AND OBJECTIVES: Optimal control of hypertension reduces the risk of long-term cardiovascular complications, and current guidelines recommend blood pressure (BP) targets of <140/90 mmHg for patients. Despite this, the BP of many patients with hypertension in primary health care remains poorly controlled. The ACE inhibitor perindopril has proven BP-lowering efficacy as well as protective effects against cardiovascular events among patients with additional cardiovascular risk factors. The PREFER study assessed the antihypertensive efficacy and safety of perindopril 5-10 mg/day among hypertensive patients who were unresponsive to treatment with other ACE-inhibitor-based regimens. METHODS: The PREFER study was an open-label, prospective, observational study conducted in primary health-care centres throughout Romania. Patients selected for the study (n = 824; mean + or - SD age 60.3 + or - 9.8 years) had uncontrolled hypertension (i.e. seated BP > or =140/90 mmHg, or > or = 130/80 mmHg in patients with diabetes mellitus or at high cardiovascular risk) despite receiving ACE inhibitors either alone or in free combination with other antihypertensive classes. At study entry, current ACE inhibitor treatment was replaced by perindopril 5 mg/day. Patients were followed up monthly for 3 months and the dosage of perindopril could be increased to 10 mg/day in cases of failure to achieve BP control. No other change in antihypertensive therapy was permitted. RESULTS: Replacing the previous ACE inhibitor with perindopril 5-10 mg/day resulted in decreases of 26.2 mmHg (from 162.6 + or - 15.6 to 136.4 + or - 14.6 mmHg [p < 0.001]) in systolic BP and of 12.6 mmHg (from 96.9 + or - 17.2 to 84.3 + or - 12.8 mmHg [p < 0.001]) in diastolic BP. Mean pulse pressure (PP) was reduced by 13.6 mmHg (from 65.7 to 52.1 mmHg) with greater decreases seen in patients aged >70 years or with isolated systolic hypertension. BP control was achieved in 48.1% of the previously uncontrolled population. Antihypertensive efficacy was observed across patient subgroups regardless of the severity of hypertension at baseline and number of cardiovascular risk factors. Patient compliance with treatment was high throughout the study. CONCLUSIONS: Perindopril 5-10 mg/day lowers BP and PP and improves BP control among hypertensive patients who were previously unresponsive to other ACE inhibitor-based regimens.

Temperature requirements for altering the morphology of osteoarthritic and nonarthritic articular cartilage: in vitro thermal alteration of articular cartilage.

BACKGROUND: Radiofrequency and laser thermal chondroplasty procedures are performed to debride and smooth fibrillated, articular cartilage. HYPOTHESIS: Temperature requirements necessary to achieve morphological change will be lower in fibrillated arthritic cartilage as compared with nonarthritic articular cartilage. STUDY DESIGN: Controlled laboratory study. METHODS: A thermal cell-culture chamber was mounted on a stereoscopic microscope and coordinated with a custom temperature-control program. Nonarthritic and osteoarthritic articular cartilage specimens were sectioned into full-thickness slices. The articular sections were exposed to temperatures incrementally from 37 masculine C to 75 masculine C. Real-time, digital capture microscopy was used to visualize and analyze the morphological changes undergone by the articular cartilage specimens. RESULTS: Arthritic articular cartilage displayed morphological change at 56.5 +/- 1.7 masculine C. Loss of fibrillation was the initial morphological change visualized. Continued thermal exposure caused a shrinkage effect of the entire tissue section that was similar to the change seen in nonarthritic sections. Nonarthritic cartilage displayed morphological change at 60.9 +/- 1.9 masculine C. CONCLUSIONS: Consistent characteristic morphological changes were found at distinct temperatures in osteoarthritic and nonarthritic articular cartilage. CLINICAL RELEVANCE: This information begins to establish the thermal parameters required for morphological change of osteoarthritic articular cartilage.