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The synaptonemal complex (SC) keeps homologous chromosomes in close alignment during meiotic recombination. A hallmark of the SC is the presence of its constituent protein SYCP3 on the chromosome axis. During SC assembly, SYCP3 is deposited on both axes of the homologue pair, forming axial elements that fuse into the lateral element (LE) in the tripartite structure of the mature SC. We have used cryo-electron tomography and atomic force microscopy to study the mechanism of assembly and DNA binding of the SYCP3 fibre. We find that the three-dimensional architecture of the fibre is built on a highly irregular arrangement of SYCP3 molecules displaying very limited local geometry. Interaction between SYCP3 molecules is driven by the intrinsically disordered tails of the protein, with no contact between the helical cores, resulting in a flexible fibre assembly. We demonstrate that the SYCP3 fibre can engage in extensive interactions with DNA, indicative of an efficient mechanism for incorporation of DNA within the fibre. Our findings suggest that SYCP3 deposition on the chromosome axis might take place by polymerization into a fibre that is fastened to the chromosome surface via DNA binding.

I've often heard young students say, "Let me check on the internet," when they're unsure of an answer. It's also evident that traditional paper dictionaries are rarely used nowadays, with foreign language words being automatically translated online. While the internet provides quick access to information, the accuracy of these answers needs research on sources and may require deep reading of different materials. This raises questions about the internet's role as a learning tool and how it's shaping our learning habits. Conducted in February 2024, a survey among 35 Romanian high school students aged 15-19 serves as the basis for this paper, which seeks to delve into students' internet usage for learning, their platform preferences, and their perceptions of how internet usage affects their learning styles. In conclusion, the paper will underscore the evolving learning needs identified and suggest ways educators can adapt to maintain students' interest in learning, guiding them towards focused research topics that align with their passions and future career aspirations.

Introduction: Surgical and non-surgical facial procedures have gained immense popularity thanks to their aesthetic benefits. Understanding the vascularization of the face and assessing potential risks is crucial to ensure patient safety and optimal outcomes. This study aims to evaluate the utility of thermal scanning and Doppler ultrasonography in evaluating the vascular risk for facial procedures. Material and Methods: A cohort of 60 patients were included in this prospective study. Preoperative thermal scanning and Doppler ultrasonography were performed in order to visualize the facial vasculature and identify potential areas of risk. Results: For 30 patients, we performed preprocedural Doppler ultrasound imaging and thermal scanning at the injection site. Only 6.66% of them suffered vascular complications, whilst 23.33% among those who didn’t undergo ultrasound and thermoscanning suffered vascular injuries. The combined use of these tools proved to be valuable in assessing the vascular risk for facial procedures. The findings emphasize the importance of preoperative assessment to identify patients at risk for vascular complications. Conclusions: Thermal scanning and Doppler ultrasonography offer a comprehensive approach to assessing the vascular risk for facial procedures. By ensuring the identification of abnormal vascular patterns and altered blood flow dynamics, these techniques enhance patient safety and procedure planning.

In reconstructive surgery, flaps are the cornerstone for repairing tissue defects, but postoperative monitoring of their viability remains a challenge. Among the imagistic techniques for monitoring flaps, the thermal camera has demonstrated its value as an efficient indirect method that is easy to use and easy to integrate into clinical practice. This provides a narrow color spectrum image that is amenable to the development of an artificial neural network in the context of current technological progress. In the present study, we introduce a novel attention-enhanced recurrent residual U-Net (AER2U-Net) model that is able to accurately segment flaps on thermographic images. This model was trained on a uniquely generated database of thermographic images obtained by monitoring 40 patients who required flap surgery. We compared the proposed AER2U-Net with several state-of-the-art neural networks used for multi-modal segmentation of medical images, all of which are based on the U-Net architecture (U-Net, R2U-Net, AttU-Net). Experimental results demonstrate that our model (AER2U-Net) achieves significantly better performance on our unique dataset compared to these existing U-Net variants, showing an accuracy of 0.87. This deep learning-based algorithm offers a non-invasive and precise method to monitor flap vitality and detect postoperative complications early, with further refinement needed to enhance its clinical applicability and effectiveness.

Converging data from humans and laboratory animals suggest that altering bloodborne amylin could potentially reduce cerebrovascular amylin deposits and Aβ pathology in Alzheimer’s disease brains.

Background and Objectives: Maternal–fetal gestational pathology is one of the biggest challenges in the field of health at this moment. The current study is designed to determine the effects of vitamin D on pregnancy, starting with the idea that impairment of vitamin D status is thought to be correlated with impairment of the newborn’s health. Materials and Methods: In this retrospective study, we tried to establish the link between vitamin D deficiency and maternal characteristics and also how it impacted the clinical status of the newborn. We analyzed a group of 260 patients: 130 pregnant women and 130 newborns, in whom vitamin D status was detected using the serum levels of 25-hydroxyvitamin D (25-(OH)D). Results: The results showed that vitamin D deficiency has a high incidence among pregnant women, as was presented in many important international studies. Our study also showed a positive, direct correlation between the mother’s and newborn’s vitamin D status. Conclusions: Taking into consideration that vitamin D deficiency has been correlated with many complications, both in maternal and newborn health, a serum level determination of 25-(OH)D is necessary in the first trimester of pregnancy, and after that, adequate supplementation is necessary in order to prevent any negative effects.

The recent introduction of immunotherapy and targeted therapy has substantially enriched the therapeutic landscape of metastatic melanoma. However, cerebral metastases remain unrelenting entities with atypical metabolic and genetic profiles compared to extracranial metastases, requiring combined approaches with local ablative treatment to alleviate symptoms, prevent recurrence and restore patients’ biological and psychological resources for fighting malignancy. This paper aims to provide the latest scientific evidence about the rationale and timing of treatment, emphasizing the complementary roles of surgery, radiotherapy, and systemic therapy in eradicating brain metastases, with a special focus on the distinct response of intracranial and extracranial disease, which are regarded as separate molecular entities. To illustrate the complexity of designing individualized therapeutic schemes, we report a case of delayed BRAF-mutant diagnosis, an aggressive forearm melanoma, in a presumed psychiatric patient whose symptoms were caused by cerebral melanoma metastases. The decision to administer molecularly targeted therapy was dictated by the urgency of diminishing the tumor burden for symptom control, due to potentially life-threatening complications caused by the flourishing of extracranial disease in locations rarely reported in living patients, further proving the necessity of multidisciplinary management.

Background: The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. Methods: We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. Results: Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). Conclusions: Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient’s quality of life.

Pain control is crucial in surgical patients, being an essential part of enhanced recovery after surgery protocols. Lidocaine, an amide local anesthetic, was primarily used as an antiarrhythmic. It has analgesic, antihyperalgesic and anti-inflammatory effects, with various actions on cardiovascular, respiratory, and digestive systems. Lidocaine has been shown to also have antithrombotic, antimicrobial, and antitumoral effects. Numerous studies have reported its safe profile and role in managing perioperative pain after breast cancer, abdominal, genitourinary, gynecologic, obstetric, orthopedic, cardiothoracic, spine, thyroid, and upper airway surgery. Lidocaine, as part of multimodal analgesia, also shows promising results in ambulatory surgery. Therefore, the use of intravenous lidocaine in the perioperative period is mainly associated with better pain control, reduced opioid use, diminished incidence of postoperative nausea, vomiting, and ileus, and exhibits antithrombotic effects.

Thumb carpometacarpal (CMC) joint dislocation is rare, and the treatment options may vary from conservatives’ strategies to open reduction and fixation. In face of pain and joint instability persistence, surgical intervention is required. We present the case of a 67-year-old male that was referred to our hospital with pain and edema of the left hand, after the failure of a conservative treatment. After initial refusal of open surgery, due to the persistent joint instability, open reduction of the CMC joint dislocation was performed, and stabilized using two percutaneous Kirschner wires after repairing the joint capsule and dorsoradial ligament. Immobilization was required for 4 weeks. After that, the Kirschner wires were removed. Along with physiotherapy, the follow-up showed no pain persistence nor CMC joint luxation reoccurrence while the joint recovered its mobility. Further studies are required in order to determine the optimal therapy for such cases and to provide standardized recommendations, taking into account that the restoration of thumb CMC joint mobility is one of the most important goals in hand surgery.

The presence of inhalation injury has a negative impact on the evolution of burned patients, being associated with increased mortality. It occurs as a direct consequence of thermal action, or secondary to the presence of respiratory irritants or absorption of toxins, and actual therapeutic management is mainly supportive. Several clinical findings are relevant to raising suspicion and guiding further examinations, fiberoptic bronchoscopy being the gold standard of diagnosis and staging. In burned patients with inhalation injuries, various reports showed that nebulized heparin (5,000 or 10,000 units) with a 4-hour administration regimen leads to improved outcome, reduces the days of mechanical ventilation and consequently the length of hospital stay, reduces pulmonary complications and improves lung function, having a safe profile, with fewer side effects.

Hydrotherapy represents the use of water for medical purpose, being involved in burn wound care since the 17th century. Burn wound cleansing, performed daily, twice a day, or as needed, as part of standard care, should be scheduled by a burn surgeon and supervised by proper specialists. It can be performed by various methods, like shower, immersion, bedside irrigation or wiping. Due to the high risk of cross-contamination, immersion is no longer recommended. Tap water seems to be superior to saline solution in burn wound care, and adjuvants can be added, especially chlorhexidine, povidone-iodine, or special detergents. Disposable plastic sheets use during showering and the following of cleaning protocols for washing areas have decreased the risk of infection. Apart from the wound-cleansing role, hydrotherapy reduces itching and pain, improves wound healing, favours early mobilization and increases patients’ comfort. Controversy persists around the optimal method and appropriate solutions for cleaning burn injuries and clinical studies are further required to solve this matter. In the absence of standardized recommendations, most burn centers are guided by experience.

Limb amputation has a severe somatic and psychological impact, that can furthermore have complications, which lead to increased morbidity, mortality, hospitalization days, health care costs, delay prosthetic application, and social reintegration. Proper therapeutic management must be initiated in cases with amputation stump complications to ensure the best result. This paper aims to present the therapeutic management of a patient with sepsis after above–the–knee amputation, performed after acute limb ischemia. The patient presented in our clinic 10 days postoperatively with local infection, wound dehiscence, and sepsis.

The COVID-19 outbreak triggered a global crisis with long-term effects on people’s daily lives. It has altered surgical practice and education and imposed major changes in healthcare systems and resources. In order to analyze the impact the COVID-19 pandemic has had on Romanian Plastic Surgery residents, we carried out an anonymous questionnaire through Google forms. Survey items addressed aspects such as how the pandemic has affected their surgical practice, their exposure to the virus, and the protective measures that have been implemented to minimize risk. Among other results, our study found that nearly 1 in 5 respondents had contact with a coronavirus patient, that most of the patients were tested at admission, mostly using RT-PCR, and that various combinations of personal protective equipment had been used. Most participants also felt that their surgical training has been negatively affected, despite attendance at online courses and webinars. Although the pandemic has brought significant changes to the daily lives of residents and to the residency training, the Plastic Surgery community has been brought closer than ever and reminded that, through unified efforts, such obstacles can be overcome.

The periorbital region has a complex anatomy and the reconstruction process of this area requires a precise approach, in order to preserve vision and offer a good esthetic aspect. The pathological processes that occur in this area are diverse and include trauma, tumors, burns, radiation, infections and congenital anomalies. This paper presents the surgical experience of a plastic surgery department in choosing the proper surgery for reconstructing periorbital defects after tumors excision and the possible complications. The used methods were local advancement and rotational flaps associated with full thickness skin grafts in small defects. Regarding postoperative complications, ectropion developed in one patient that was corrected in another surgery. Periocular reconstruction surgery depends not only on the defect zone, thickness and general status of the patient but also on the surgeon’s experience. The main goal is to restore the periocular structures functions in order to achieve protection of eye surface and to preserve the visual acuity.

Diabetic foot ulcers usually appear in diabetic patients, being associated with neuropathy, peripheral arterial disease and infection. The treatment should be initialized after stabilizing the patients in terms of glycaemia, nutritional status and systemic infections. The local treatment is started with the surgical debridement and the defect is then closed by secondary intention or by using a skin graft or local flaps. A multidisciplinary approach and proper treatment prevent in some cases complications and avoid leg amputation, thus increasing the patient’s quality of life. Amputation might be an option to the treatment when necrosis or osteomyelitis are present. On a long term, complications can arise due to the modification of the normal tension forces of the leg, with new ulcerative lesions or stress fractures. The long-term goal is to prevent injury to the affected or contralateral leg by maintaining health and glucose blood levels within normal limits and to instruct patients to maintain a proper feet care.

Introduction. The number of implant-related complaints is constantly rising, a phenomenon probably accentuated by the extensive use of social media by patients. Material and method. A group of signs and symptoms considered to be caused by mammary implants is known as “Breast Implant Illness”. This paper analyzes the increased number of posts by patients on social media in which they describe their symptoms, their disappointment with the decision of using breast implants, and the beneficial effects of explantation. The case of a patient with breast implants who visited our clinic is reported here. The patient complained of two palpable masses, located in the left axilla and in the superolateral quadrant of the left breast. The pathophysiological mechanism by which lymphadenopathy occurred after a long period of time remains uncertain. Discussion. A review of the literature was conducted to identify the underlying causes of implant-related complaints, allowing evaluation of the presence of local complications, cancer with large anaplastic cells, and autoimmune diseases. The possibility of a somatization effect has also been considered. Conclusions. Plastic surgeons must remain the best source of information, taking on the role of educating the patient in order to better understand this condition.

Polyrheumatoid arthritis (PA) is a chronic systemic inflammatory condition of unknown origin and autoimmune pathogenesis. It affects several articulations, which become damaged and deformed; furthermore, multiple systemic manifestations are often encountered. Rheumatoid arthritis(RA) is an important risk factor for the occurrence of CKD and is mandatory that clinicians possess a good knowledge of the mechanisms determining renal impairment and means to prevent it.

The aim of this study is to evaluate the presence / absence of the correlation between pulse pressure (PP, determined by ambulatory blood pressure monitoring (ABPM)) and traditional and non-traditional cardiovascular (CV) risk factors: age, sex, blood glucose, proteinuria / microalbuminuria, uric acid, ESR, fibrinogen, total cholesterol, HDL – cholesterol), triglyceridemia, Hb, in renal and non-renal hypertensive patients. Material and method. The data were collected from the observation records of 412 hypertensive patients admitted during the period 2006-2012 to the Department of Nephrology and Internal Medicine 1 of the Bucharest Emergency University Hospital. It is a retrospective study. These data consist of blood and urine analysis, on the one hand, and parameters obtained by ABPM, on the other hand. The subjects were divided into two groups: hypertensive patients with and without CKD. The results of the study showed a positive correlation between the presence of CKD and mean 24-hour PP with a statistical effect (p

Following the increase in incidence and prevalence of the risk factors responsible for the occurence of renal impairment is the increase of patients suffering from chronic kidney disease (CKD). As the renal function declines and the end stage of the chronic kidney disease is reached, it is necessary to start one of the following methods for substituting the renal function: renal transplantation, hemodialysis or peritoneal dialysis. The treatment of choice for most patients is hemodialysis, both in Romania and abroad in the international medical centers. According to official data, the number of patients undergoing hemodialysis is constantly growing. Hemodialysis adequacy evaluation instruments must be familiar among clinicians in order to provide a treatment that meets the quality standards.

The diabetic foot syndrome is the most common cause of diabetic patients hospitalization, being a challenging complication of diabetes. This is a case report of a diabetic patient who presented a silent myocardial infarction after partial foot amputation. The patient presented normal troponin at admission, but after 21 days of hospitalization he acused a very slight pain in the chest and breathing difficulty. The troponin was 682 ng/l. He was transfered immediately in the intensive care unit for specific treatment. The evolution of the surgical intervention was favourable even under the poor general status. The patient fully recovered after 10 days and left the cardiology department in a good clinical condition. A silent myocardial infarction seems to occur with increased frequency in patients with diabetes, due to the cardiac autonomic dysfunction. It is highly important a quick diagnosis and a good management of the patient.

Objectives. Vulvar cancer is a rare gynecological malignancy, with an incidence of 1.5 per 100 000 women/year. The most common vulvar cancer is developed in squamous cells, the most encountered type of skin cells. Case report. We report a case of a 72-year-old female admitted in the Department of Plastic Surgery of Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu” with a 5/4.2 cm painful ulcerated tumoral mass located in the vulvar area. The lesion slowly increased in size over the past 12 months. The tumour was surgically removed with oncological safety margins and sent for histopathological evaluation. The histopathological examination revealed an ulcerated squamous carcinoma with lymphovascular and perineural invasion, but with negative margins. Postoperative results were favorable, and no local or general complications were observed. Conclusion. We highlight this case due to its unusual presentation in the clitoral area. Moreover, considering the potential for recurrence we point out the importance of the radical vulvectomy with regional lymphadenectomy and histopathological examination, in order to put a precise diagnosis and ensure the best possible treatment for the patient.

Objectives. Distal biceps tendon rupture affects the functional upperextremity movement, impairing supination and flexion strength. According to age, profession and additional risks treatment might be nonoperative or surgical. Methods. We describe the case of a 43 years old male patient who sustained an injury to his right distal biceps and was diagnosed with acute right distal biceps rupture. Surgical treatment was decided and biceps tendon was reinserted to the radius tuberosity using a combination of a cortical button fixation associated with an interference screw. Results. Postoperative functional result was favorable with no complications and with no movement limitation after one month. Conclusions. When possible, distal biceps tendon repair should be realized surgically because this permits restoring of the muscle strength to near normal levels with no loss of motion. Nerve complications are common; therefore the surgery should be realized by experienced upper extremity surgeons.

Background. Saliva is a complex biological fluid that has great potential as a diagnosis fluid for both oral and systemic diseases. At the same time, chronic hepatitis affects millions of people worldwide and can lead to liver cirrhosis and hepatocellular carcinoma. In this context, our research group aimed to evaluate the modifications produced in the saliva of patients with chronic hepatitis compared to healthy subjects. Material and method. The present work included 88 subjects that were divided into 4 groups, each consisting of 22 people. Saliva samples were collected for each participant to the study. Salivary levels of total protein (TP), IgA, IgG and aminotransferases AST (aspartate aminotransferase) and ALT (alanine amino-transferase) were determined. Results. Our results showed significantly increased salivary levels of TP, IgA, AST and ALT for patients with chronic viral hepatitis (CHV) and chronic alcoholic hepatitis (CAH) compared to controls. IgG salivary levels were also higher in patients with hepatitis versus controls, however while statistical significance could be found for patients with chronic hepatitis C (CHC) and CAH, this was not the case for the patients with chronic hepatitis B (CHB). Conclusions. The results of our study showed significantly increased salivary levels of the determined parameters in hepatitis patients compared to the healthy subjects, hence promoting the use of saliva as a diagnosis and monitoring fluid for chronic hepatitis.

Objectives. To investigate the correlations between the frequency of dental caries, assessed as cariogenic index, and a series of blood parameters in patients diagnosed with chronic hepatitis of alcoholic etiology. Materials and method. The study was conducted on a total of 25 patients diagnosed with chronic hepatitis of alcoholic etiology. The following blood parameters were determined: blood count (erythrocyte count, total hemoglobin, hematocrit, mean red blood cell volume, mean red blood cell hemoglobin, mean erythrocyte hemoglobin concentration), platelet count, white blood cell count (leukocyte count, neutrophils ratio, lymphocytes ratio, monocytes ratio, eosinophils ratio, basophils ratio) and glucose, urea and creatinine concentrations. Results. The mean values were: cariogenic index 1.8±0.96, erythrocytes 4.66±0.51x106/mm3, total hemoglobin concentration 14.67±1.26 g/dL, hematocrit 44.45±3.75%, mean erythrocyte volume 95.6±6.03 fL, mean erythrocyte hemoglobin 31.6±1.86 pg, mean erythrocyte hemoglobin concentration 33.01±1.02 g/dL, platelet count 2.7±0.61x105/mm3, leukocytes 8,812±2,065.66/mm3, neutrophils ratio 63.32±8.75%, lymphocytes ratio 26.32±8.48 %, monocytes ratio 7.99±2.02 %, eosinophils ratio 1.87±1.6%, basophils ratio 0.5±0.31%, glycemia 91.52±8.38 mg/dL, urea concentration 32.12±8.44 mg/dL and creatinine 0.92±0.19 mg/dL. Conclusions. We have been able to establish statistically significant correlations between the cariogenic index and total hemoglobin, hematocrit, mean erythrocyte hemoglobin concentration and glycemia.

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer surgery, who had been preoperatively evaluated using psychological tests. Of those patients, 18 had scores indicating significant symptoms of depression (moderate or severe symptoms, HDSR >17). Patients with high HDSR scores needed an 18.4% longer hospitalization than patients without symptoms of depression. They also had 35.4% more ambulatory visits in the month following discharge, and a higher incidence of postoperative complications. Conclusions. There seem to be both physiological and somatic determinants responsible for the need of prolonged medical care, but the mechanisms responsible for these effects remain unclear. Identifying high-risk patients could not only lower the postoperative morbidity, but also increase the therapeutic outcomes.

Obiective. Plăgile cronice au o perioadă îndelungată de vindecare, care este influenţată de numeroşi factori, printre care şi infecţiile. Ulcerele venoase reprezintă 80% din ulceraţiile de la nivelul membrului inferior, având un impact major asupra calităţii vieţii pacientului. Scopul acestui studiu a fost de a evalua prezenţa bacteriilor şi de a institui un tratament corespunzător în ulcerele venoase. Material şi metodă. Studiul a înrolat zece pacienţi cu ulcere venoase cronice prezenţi în secţia de Chirurgie plastică a Spitalului Clinic de Urgenţă „Prof. Dr. Agrippa Ionescu“ pe o perioadă de şase luni. Am evaluat cultura plăgilor şi am instituit un tratament corespunzător fiecărui caz în funcţie de antibiogramă. Rezultate. Ulcerele venoase ale membrului inferior au avut o evoluţie favorabilă după administrarea tratamentului antibiotic şi eliminarea infecţiei. S-a realizat, de asemenea, şi debridarea chirurgicală şi acoperirea plăgii cu o grefă de piele. Concluzii. Ulcerele venoase pot evolua pe o perioadă îndelungată (săptămâni sau chiar ani), fiind, de asemenea, asociate cu complicaţii severe precum celulită sau transformare malignă. Unul dintre principalii factori care împiedică vindecarea este infecţia, debridarea chirurgicală asociată cu administrarea sistemică de antibiotice având un rezultat favorabil în epitelizarea ulcerelor venoase.

Objectives. Chronic wounds have a prolonged period of healing due to numerous factors, including infections. Venous ulcers represent almost 80% of the lower extremity ulcerations, having a great impact on the patient's quality of life. The objective of this study was to evaluate the presence of bacteria and the proper management in treating venous leg ulcers. Material and methods. The study enrolled ten patients with chronic venous leg ulcers hospitalized in the Plastic Surgery Department of the Emergency Clinical Hospital “Prof. Dr. Agrippa Ionescu”, during a period of six months. For each patient included in the study, we assessed the wounds culture and we started an antibiotic treatment, according to the antibiogram, which was completed by the surgical treatment of the wound. Outcomes. Venous leg ulcers had a favorable outcome after the administration of antibiotic therapy, surgical debridement of the wound and coverage with a skin graft. Conclusions. Venous ulcers may evolve over an extended period of time (weeks or years) and may also be associated with severe complications, such as cellulites or malignant transformation. Infections affect the healing process. Surgical debridement associated with systemic administration of antibiotics has a favorable outcome in the epithelialization of venous ulcers.

Platelet-rich plasma (PRP) is a blood-derived fraction containing high level of platelets, a high concentration of leukocytes and growth factors. PRP therapy has been growing as a viable treatment alternative for a number of clinical applications and has a potential benefit for use in wound healing. Nowadays platelet rich plasma is used in stimulating wound healing in skin and soft tissue ulcerations, accelerating wound healing in diabetic patients and facilitating bone proliferation in orthopedic and trauma surgery. It has also applications in maxillofacial surgery, spinal surgery, plastic and esthetic surgery, heart surgery and burns. This review of the literature shows a limited number of studies realized on humans that sustain PRP applications in orthopedic and plastic surgery. As the use of PRP increases, more properly structured clinical studies are necessary to confirm the results and to establish clearly the techniques of preparing, the conditions and the clinical indications of applying this therapy.

Introduction. The paramedian forehead flap is one of the best options for reconstruction of the median upper two-thirds of the face due to its vascularity, color, texture match and ability to resurface all or part of the reconstructed area. The forehead flap is the gold standard for nasal soft tissue reconstruction and the flap of choice for larger cutaneous nasal defects having a robust pedicle and large amount of tissue. Materials and Methods. We are reporting a clinical series of cutaneous tumors involving the nose, medial canthus, upper and lower eyelid through a retrospective review of 6 patients who underwent surgical excision of the lesion and primary reconstruction using a paramedian forehead flap. Results. The forehead flap was used for total nose reconstruction, eyelids and medial canthal reconstruction. All flaps survived completely and no tumor recurrence was seen in any of the patients. Cosmetic and functional results were favorable. Conclusions. The forehead flap continues to be one of the best options for nose reconstruction and for closure of surgical defects of the nose larger than 2 cm. Even though is not a gold standard, median forehead flap can be an advantageous technique in periorbital defects reconstruction.

(1) Background: The water content and the way of bonding in the food matrices, including bread, can be easily and simply evaluated by Karl Fischer titration (KFT). The goal was to identify the main KFT parameters that influence the similarity/dissimilarity of commercial bread products, using multivariate statistical analysis. (2) Methods: Various commercial bread samples were analyzed by volumetric KFT and the water content, parameters from titration process and KFT kinetics were used as input for principal component analysis (PCA). (3) Results: The KFT water content was in the range of 35.1–44.2% for core samples and 19.4–22.9% for shell samples. The storage and transportation conditions consistently influence the water content of bread. The type of water molecules can be evaluated by means of KFT water reaction rates. The mean water reaction rates up to 2 min are consistently higher for bread core samples, which indicates a high fraction of “surface” water. PCA reveals the similarity of core samples and various bread types, as well as dissimilarity between bread parts, mainly based on KFT kinetic parameters. (4) Conclusions: KFT kinetics can be a useful tool for a rapid and simple differentiations between various types of bread products.

Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16–28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85–4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8–12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.

The goal of the present study was the evaluation of the fatty acid (FA) profile of lipid fraction from dry common beans (Phaseolus vulgaris L.) (CBO) harvested from North-East (NE) and South-West (SW) of Romania and to protect against thermal and oxidative degradation of the contained omega-3 and omega-6 polyunsaturated fatty acid (PUFA) glycerides by β-cyclodextrin (β-CD) nanoencapsulation, using kneading method. The most abundant FAs in the CBO samples were PUFAs, according to gas chromatography-mass spectrometry (GC-MS) analysis. Linoleic acid (methyl ester) was the main constituent, having relative concentrations of 43.4 (±1.95) % and 35.23 (±0.68) % for the lipid fractions separated from the common beans harvested from the NE and SW of Romania, respectively. Higher relative concentrations were obtained for the omega-3 α-linolenic acid methyl ester at values of 13.13 (±0.59) % and 15.72 (±0.30) % for NE and SW Romanian samples, respectively. The omega-3/omega-6 ratio consistently exceeds the lower limit value of 0.2, from where the PUFA glyceride mixture is valuable for the human health. This value was 0.32 (±0.02) for the NE samples and significantly higher for the CBO-SW samples, 0.51 (±0.01). These highly hydrophobic mixtures especially consisting of PUFA triglycerides provide β-CD complexes having higher thermal and oxidative stability. Kneading method allowed obtaining β-CD/CBO powder-like complexes with higher recovery yields of >70%. Thermal analyses of complexes revealed a lower content of hydration water (3.3-5.8% up to 110°C in thermogravimetry (TG) analysis and 154-347 J/g endothermal effect in differential scanning calorimetry (DSC) analysis) in comparison with the β-CD hydrate (12.1% and 479.5-480 J/g, respectively). These findings support the molecular inclusion process of FA moieties into the β-CD cavity. Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) analysis reveals the formation of the β-CD/CBO inclusion complexes by restricting the vibration and bending of some bonds from the host and guest molecules. Moreover, powder X-ray diffractometry (PXRD) analysis confirm the formation of the host-guest complexes by modifying the diffractograms for β-CD/CBO complexes in comparison with the β-CD and β-CD + CBO physical mixtures. A significant reduction of the level of crystallinity from 93.3 (±5.3) % for β-CD to 60-60.9% for the corresponding β-CD/CBO complexes have been determined. The encapsulation efficiency (EE), the profile of FAs, as well as the controlled release of the encapsulated oil have also been evaluated. The EE was >40% in all cases, the highest value being obtained for β-CD/CBO-SW complex. The SFA content increased, while the unsaturated FA glycerides had lower relative concentrations in the encapsulated CBO samples. It can be emphasized that the main omega-3 FA (namely α-linolenic acid glycerides) had close concentrations in the encapsulated and raw CBOs (13.13 (±0.59) % and 14.04 (±1.54) % for non-encapsulated and encapsulated CBO-NE samples, 15.72 (±0.30) % and 12.41 (±1.95) % for the corresponding CBO-SW samples, respectively). The overall unsaturated FA content significantly decreased after complexation (from 19.03-19.16% for the raw CBOs to 17.3-17.7% for encapsulated oils in the case of MUFAs, and from 55.7-58.8% to 35.13-43.36% for PUFAs). On the other hand, the omega-3/omega-6 ratio increased by β-CD nanoencapsulation to 0.51 (±0.07) and 0.76 (0.26) for β-CD/CBO-NE and β-CD/CBO-SW complexes, respectively. As a conclusion, the lipid fractions of the Romanian common beans are good candidates for β-CD complexation and they can be protected against thermal and oxidative degradation in common beans based food products such as functional foods or food supplements using natural CDs.

Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients’ mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients’ quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.

Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. Material and methods: We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. Results: The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8−43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Conclusions: Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist.

This study presents the design of novel composites nanogels, based on poly(ethylene glycol) diacrylate and natural zeolite particles, that are able to act as materials with controlled drug delivery properties. Natural zeolite−nanogels composite, with varying zeolite contents, were obtained by an inverse mini-emulsion technique and loaded with 5-fluorouracil, a widely used chemotherapeutic drug. Herein, the possibility of adjusting final properties by means of modifying the preparation conditions was investigated. The prepared composite nanogels are characterized by dynamic light scattering (DLS), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR), and thermogravimetric analysis (TGA). In light of this tunable drug-loading capability, swelling behaviour, and cytotoxicity, these composite nanogels could be highly attractive as drug reservoirs.