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Over the past decades, the comparative method has attracted the attention of the theorists, and studies based on this approach have increased in applied policy research. In their daily and strategically policy decisions, the decision makers from local, regional and national levels use more and more the comparative research methods, especially due to interlinked relationship and the need for bench learning and benchmarking practices. The comparative method allows the actors to analyse other experiences, and thus to take decisions more efficient. This is a normal, an inevitable situation, when the unit of analysis is a country, a field of matters or a process where researchers compare cases from empirical or theoretical point of view. The purpose of this paper is to provide a critical view on the capacity of comparative method to foster knowledge in policy studies. The intention is to see and to explore the utility of comparative method for policy studies and policy analysis, since a new approach “evidence-based policymaking” arise, emphasising the importance of using evidence from other political and policy systems.

Introduction Intravenous iron administration in patients treated by haemodialysis for end stage renal disease can exacerbate oxidative stress by increasing the level of free redox active iron. A way to reduce the impact of iron on oxidative stress in haemodialysis patients may be the administration of iron through arterial extracorporeal circuit. Objective The aim of our study was to compare the influence of iron route of administration (venous versus arterial extracorporeal circuit infusion) on antioxidant parameters in red blood cells of haemodialysis patients in order to clarify if arterial iron administration can have positive impacts related to iron induced oxidative stress. Method Twenty stable patients on regular haemodialysis treatment were selected for the study. They were investigated in a crossover design at 3 mid-week HD sessions, one week apart, without iron [HD basal] and with either IV infusion of 100mg iron sucrose over the first 20 minutes of HD session, via venous line [HDvenous], or the same solution infused on the arterial extracorporeal circulation [HDarterial]. Blood samples were drawn at 0 min, 40 min and 270 min. Erythrocytes superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) activity, non-protein thiol levels and total antioxidant capacity (TEAC) were analysed. Conclusion Haemodialysis significantly decreases the total antioxidant activity in erythrocytes. Iron supplementation, through venous or arterial extracorporeal route has no impact on the total antioxidant activity in red blood cells. Venous iron administration increases GPx activity in erythrocytes suggesting increased lipid peroxidation compared with arterial extracorporeal administration. [ABSTRACT FROM AUTHOR]

Aim: Our aim was to examine the impact of anger on students' self-rated oral health and oral health-related behaviors. Material and Methods: The present study sample consisted of 150 first year medical students. The questionnaire included information about socio-demographic factors, behavioral factors, self-reported oral health status and anger. Anger was evaluated with the 7-item subscale of The Coultauld Emotional Control Scale Results: Our study showed that the intensity of anger had a consistent association with self-reported flossing frequency. Conclusions: The results emphasize the significance of anger as a determinant of oral hygiene behaviour. [ABSTRACT FROM AUTHOR]

Background: Preterm birth, low birth weight, and infant catch-up growth seem associated with an increased risk of respiratory diseases in later life, but individual studies showed conflicting results., Objectives: We performed an individual participant data meta-analysis for 147,252 children of 31 birth cohort studies to determine the associations of birth and infant growth characteristics with the risks of preschool wheezing (1-4 years) and school-age asthma (5-10 years)., Methods: First, we performed an adjusted 1-stage random-effect meta-analysis to assess the combined associations of gestational age, birth weight, and infant weight gain with childhood asthma. Second, we performed an adjusted 2-stage random-effect meta-analysis to assess the associations of preterm birth (gestational age <37 weeks) and low birth weight (<2500 g) with childhood asthma outcomes., Results: Younger gestational age at birth and higher infant weight gain were independently associated with higher risks of preschool wheezing and school-age asthma (P < .05). The inverse associations of birth weight with childhood asthma were explained by gestational age at birth. Compared with term-born children with normal infant weight gain, we observed the highest risks of school-age asthma in children born preterm with high infant weight gain (odds ratio [OR], 4.47; 95% CI, 2.58-7.76). Preterm birth was positively associated with an increased risk of preschool wheezing (pooled odds ratio [pOR], 1.34; 95% CI, 1.25-1.43) and school-age asthma (pOR, 1.40; 95% CI, 1.18-1.67) independent of birth weight. Weaker effect estimates were observed for the associations of low birth weight adjusted for gestational age at birth with preschool wheezing (pOR, 1.10; 95% CI, 1.00-1.21) and school-age asthma (pOR, 1.13; 95% CI, 1.01-1.27)., Conclusion: Younger gestational age at birth and higher infant weight gain were associated with childhood asthma outcomes. The associations of lower birth weight with childhood asthma were largely explained by gestational age at birth., (Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Mosby, Inc. All rights reserved.)

Unlabelled: The aim of this study is to emphasize the importance of knowing the predisposing factors of the occurrence of homolateral upper limb lymphedema after breast cancer surgery., Material and Methods: The study included 1104 patients with breast cancer, who were hospitalized in the IIIrd Surgical Clinic, lasi, between 2000 and 2010, for surgical treatment followed by oncological adjuvant therapy. The surgical intervention was conservative in 228 cases and modified radical mastectomy - Madden type - in 876 patients. Periodic clinical follow-ups were done every 3 months during the first postoperative year, every 6 months during the second year and annually thereafter., Results: Early lymphedema occurring in the first 14 postoperative days or between day 14 and day 21 was found in 8 patients. Late lymphedema, occurring up to 12 months or more after surgery, was diagnosed in 41 patients. Medium and severe lymphedema occurred at 42 patients. We evaluated the preexisting risk factors, the risk factors related to the type of surgery and those related to the cancer staging., Conclusions: It's ideal to identify predisposing factors of developing lymphedema related to breast cancer surgery before applying any type of treatment, There are therapeutic methods (general, drug therapy, physiotherapy) and methods related to the surgical act that influences the prophylaxis of lymphedema or have an amazing effect on already occurred lymphedema.

Unlabelled: It is well known that the diverticuli of the colon gets inflamed in 10-15% of cases, thus becoming clinical symptomatic as a diverticulitis, while in other 15% they will bleed, with the clinical aspect of an inferior digestive bleeding. Our study presents some clinical observations with diverticuli of the colon, that raised diagnostic and therapeutic problems., Material and Method: Between 2001-2010, 17 patients were admitted in the 3rd Surgery Clinic, University Hospital "St.Spiridon", Iasi, with asymptomatic diverticuli of the colon, that were put in evidence imagistically, intraoperative or on specimens after removal of the colon for other conditions;meanwhile, there were 15 patients admitted with complications of the diverticuli:5 patients had perforated diverticulitis (4-pericolic abscesses and one with peritonitis in the lower abdomen), 4 had rectal bleeding and the other 6 raised particular problems of diagnostic and treatment, being included in the present study., Results: Five out of six underwent operation. One patient refused the surgical treatment. Postoperative evolution was favorable in 4 out of the 5 operated patients., Conclusions: The complications of colonic diverticuli present on admission under clinical aspects that usually mimic a colonic cancer. In these situations the imagistic examinations do not offer enough details to elucidate the diagnosis. Our six particular observations strengthen the dictum of avoiding the "mirage" of the first lesion. The extent of the surgical procedure in the case of patients with colonic diverticuli admitted under the clinical aspect of a complication is sometimes disproportionate and encumbered of increased mortality and complication rate.

Purpose: To evaluate and compare the impact on quality of life of tamoxifen and aromatase inhibitors (AIN's) in adjuvant settings, at women with breast cancer., Methods: From a total of 441 patients with breast cancer with hormonal treatment, were selected 177 of patients with adjuvant hormonal treatment (95 with tamoxifen treatment and 82 with AIN's treatment). These patients have completed the EORTC QLQ C-30 and EORTC QLQ BR23 questionnaires after 1 month of treatment (baseline), at 2 year of treatment with tamoxifen versus aromatase inhibitors (exemestane, anastrazole, letrozole). Mean change score from baseline and 2 years of treatment were compared in the both arms (tamoxifen vs. AIN's)., Results: In both arms, after two years, a decreased QOL was observed as compared with the baseline. In the tamoxifen arm, global health status (GHS) and breast symptoms score (BRBS) were similar comparative with AIN's arm at baseline, with a similar status at 2 years measurement., Conclusions: The global health status (GHS) and breast symptoms score (BRBS) shows that there is no difference in the QOL at the women with breast cancer treated with tamoxifen, comparative with the women treated with AIN's. We conclude that AIN's did not have an adverse impact on overall QOL, comparative with tamoxifen, in adjuvant settings.

Aim: Changing the sequence of therapeutic options in stage II breast cancer: first, a core biopsy, followed by the evaluation of the tumoral markers, adaptation of the chemotherapy scheme and finally, surgical approach. Thus would be possible to improve the hope of life in some stage II breast cancer patients, in whom survival is poorer than in some stage III patients., Material and Method: 144 patients in stage II breast cancer were included in this study, over a period of 5 years (2000-2004). In all these patients the first therapeutic option was surgery (radically modified mastectomy type Madden), followed by systemic chemotherapy-FAC or FEC, 6 cycles, and finally Tamoxifen., Results: 34 out of them developed metastases in a period between 6 and 72 months, most of them in the first 26 months; 25 out of these 34 didn't have metastases in the axillary lymph nodes, and in 18 patients estrogen--and progesterone--receptors were highly positive. HER 2 neu was negative or low expressed in patients with metastases. CD 34 wasn't evaluate in the whole group., Conclusions: Early onset of metastases in the studied patients, in whom tumoral aggressiveness markers were not obvious, impose the evaluation of the angiogenesis markers and, when positive, chemotherapy as the first therapeutic option.

Unlabelled: The aim of this study is to point out the late diagnosis and initiation of treatment in male with breast cancer. At the same time, to show the importance of the correlation between different markers in assessing the prognostic, as well as the treatment for the patient., Material and Methods: Retrospective study on a group of 15 males with breast cancer, out of 1043 patients with the disease, in a period of 10 years. Eight patients were stage III of disease, 2 were stage II, one was stage I, and in other 3 cases the evaluation of the tumor and of the axillary lymph nodes was performed only by echography, considered stage II., Results: All patients underwent radically modified Madden mastectomy; 4 patients needed a partial resection of the great pectoralis muscle. Adjuvant chemotherapy was performed in 9 patients, and neoadjuvant chemotherapy in 2 cases. Three patients refused the chemotherapy, and one patient chose an alternative paramedical treatment. The treatment with Tamoxifen was done in 11 patients with high values of Progesterone and Estrogen Receptors (PR, ER). At the date of our study, 8 patients were alive, without clinical signs of disease (free of disease), while in 3 patients, alive, clinical signs of disease were detected (recurrence). Survival rate couldn't be evaluated in 4 patients., Conclusions: Breast cancer in male is usually discovered in locally advanced stages, although most of the patients are regularly screened for chronic hepatitis. Use of biological markers allows a more accurate evaluation of the aggressiveness of the tumor, as well as a more specific treatment for each patient. Modified radical mastectomy type Madden remains the preferred surgical approach. Surgical approach should be considered even in locally advanced cases, as well as in elder patients.

Purpose: The aim of the present study was to investigate whether self-consciousness, self-reported oral health status and oral-health-related behaviours were associated., Material and Methods: The present study sample consisted of 253 first year medical students in Romania. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status and three self-consciousness subscales (Private Self-Consciousness, Public Self-Consciousness, and Social Anxiety)., Results: Significant differences were found in Public Self-Consciousness and Social Anxiety according to several variables: anxiety, stress, depression and current non-treated caries. There were significant differences in Social Anxiety for the variables of gender, smoking, perceived dental health, self-reported gum bleeding and reason for dental visit (p < 0.05). A significant difference was found in Public Self-Consciousness for the reason for dental visits (p < 0.05). Total Self-Consciousness is correlated with anxiety, stress, depression, current non-treated caries, gingival bleeding and reason for dental visit. Oral health behaviours such as tooth brushing, flossing, mouth washing and last dental visit were not influenced by each of the self-consciousness subscales., Conclusions: The results suggest that self-consciousness might be a psychosocial risk marker that influences self-reported oral health status.

Objectives: Our aim was to investigate whether body appreciation and self-criticism are associated with self-reported oral health status and oral-health-related behaviors were associated., Methods: The present study sample consisted of 178 first year medical students. The questionnaire included information about socio-demographic factors, behavioral variables, self-reported oral health status, self-criticism and body appreciation., Results: Significant differences were found on body appreciation and self-criticism scales according to several variables: gender, anxiety, stress, depression, smoking status, perceived dental health status, current extracted teeth, satisfaction by appearance of own teeth, self-reported gingival condition. When oral health behaviours were analysed we observed that toothbrushing frequency once a day or less was reported mainly in persons with low-levels of body appreciation (P < 0.01) and comparative self-criticism (P < 0.05). Moreover, individuals who visit their dentist mainly when treatment is needed or when in pain were compared with persons who visit their dentist mainly for check-up or for tooth cleaning and scaling; they showed lower levels of body appreciation (P = 0.005), as well as higher levels of comparative self-criticism (P < 0.05), internalized self-criticism (P < 0.05) and total self-criticism (P = 0.009). Multiple linear regression analyses revealed that anxiety in everyday life, body appreciation and comparative self-criticism scales were significantly positively associated with oral health status (r2 = 0.144; F = 3.436, P = 0.001), while body appreciation was related also to gingival health-related status (r2 = 0.087; F = 1.943, P = 0.057). When oral health behaviors were evaluated, it was shown that gender and body appreciation scale were positively associated with toothbrushing frequency (P < 0.0001)., Conclusions: The results suggest that there is an increased risk for impaired dental health status and behaviour among subjects with low levels of body appreciation and high levels of self-criticism.

Unlabelled: Although the "gold standard" in the multimodal treatment of liver primary and secondary tumors is the surgical ablation, the rate of resection, despite the last decades advances, remains still low (10 - 20%). In addition, the interest for non-surgical ablation therapies is increasing. Among them, regional or systemic chemotherapy, intra-arterial radiotherapy as well as locally targeted therapies--cryotherapy, alcohol instillation and radiofrequency (RF) are the most valuable options as alternative to the surgical approach., Material and Method: Between February 2005 - January 2007, 9 patients with liver metastases underwent open RF ablation of their secondaries in the III-rd Surgical Unit, "St. Spiridon" Hospital. An Elektrotom 106 HiTT Berchtold device with a 60W power generator and a 15 mm monopolar active electrode was used., Results: Destruction of the tumors was certified with intraoperative ultrasound examination. Pre- and postoperative CarcinoEmbryonic Antigen (CEA) together with imaging follow-up was carried out, in order to determine local or systemic recurrencies. Six patients died between 6 month - 4 years after the RF ablation. Median survival is 29.2 months., Conclusion: RF ablation is a challenge alternative in non-resectable liver tumors.

Introduction: The presence of Reed-Sternberg malignant cells is absolutely necessary for Hodgkin's lymphoma diagnostic, but it is not always sufficient because can be observed Reed-Sternberg-like cells in other malignant and benign diseases, too. The CD30 expression at Hodgkin and Reed-Sternberg level can give us supplementary information in differential diagnostic and can be used as progressive disease factor., Material and Methods: Our study was composed from 63 cases histopathological diagnosed with Hodgkin's lymphoma and hospitalized in Hematology Department of County Hospital Timişoara. CD30 expression was immunohistochemical semi-quantitative evaluated using clone BerH2 as primary antibody and APAAP-New Fuchsin as visualization system., Results and Discussions: The increasing of CD30 expression occurs in the same time with advanced stages and the disease progression (p =0.001). For I and II stages CD30 expression does not overcome (-/+) category while the III and IV stages, all the cases are situated in (+/-) and (+) categories. No connection can be noticed between histological type and CD30 expression (p < or = 1). We consider that using this staining, although less used in Romania, must be done in all Hodgkin's lymphoma and Hodgkin's lymphoma-like cases. We say that because the main cause of relapses is represented by inadequate clinical staging and diagnostic., Conclusions: In our study, the increasing of CD30 expression is associated with advanced disease stage. We recommend reinvestigating and restaging all cases that was included into an incipient stages and they have a CD30 expression situated in (+/-) and (+) intervals because some lymph nodes could be overlooked.

Unlabelled: The aim of this study is to present the difficulty of an accurate preoperative diagnostic for synchronous colonic cancers and to sustain the necessity of total colectomy. A retrospective study was carried out on 16 patients hospitalized in the IIIrd Surgical Unit, St. Spiridon Hospital, U.M.Ph. "Gr.T.Popa" Iasi between 1990-1999. The surgical procedures were: extensive colectomy with ileo-sigmoid anastomosis, segmentary colectomy, total colectomy with ileo-rectal anastomosis., Results: Perioperative mortality: zero; uneventfully recovery for all patients. A metachronous lesion 3 years after the first operation was detected in one patient; postoperatively, one patient developed occlussion 3 months after, requiring re-operation., Conclusions: 1. synchronous colonic cancers are closely related with a genetic instability of the colonic mucosa; 2. total colectomy is a safe manner to prevent metachronous lesions.

Unlabelled: The aim of this paper is to sustain the palliative resection in neoplasm of the esophago-gastric junction, as a surgical approach that allows a better post-operative life comfort in comparison with simple gastrostomy. 62 observations with proximal neoplasm of the stomach (12.5%) were identified between January 1996-August 2001, representing 12.5% of the 496 patients with gastric neoplasm admitted in our unit in the same period. Out of these 62 cases, 55 (88.71%) underwent surgical procedures. Our attitude was aggressive in 25 cases. 40.32%, including the locally advanced lesions with palliative surgical indications (18 obs.). The other 30 patients underwent: 10 laparotomies, 5 gastrostomies and 15 jejunostomies. Local invasion to the neighboring organs imposed partial resection of the transverse colon--1 obs., of the transverse mesocolon--2 obs., and corporeo-caudal pancreatectomies--3 obs. The surgical approach was a left abdomino-thoracic incision, with total gastrectomy and distal esophagectomy, with N1 and N2 lymphadenectomy, splenectomy, and esojejunal intrathoracic anastomosis, with a Roux-en-Y loop, with or without jejunostomy (13 obs.). The immediate post-operative complications were 8 anastomotic leakage, one duodenal stump fistula, one occlusion due to a jejunostoma, and 13 extradigestive complications. There were 5 post-operative deaths., Conclusion: Neoplasm of the esophago-gastric junction is lately diagnosed, but whenever is possible, total gastrectomy with distal esophagectomy should be carried out.

The aim of this study is to justify an individual therapeutical attitude in breast cancer, related to diversity of breast tumors, aggressiveness grade and metastatic potential. Between January 2000--December 2001, 150 patients were admitted with breast cancer (stage II and III) and underwent surgery in our department. We selected 75 cases in our study. In 51 (68%) cases the first therapeutical method was surgery, in 15 (20%) cases surgery was performed after chemotherapy, in 2 (2.66%) cases after radiotherapy and after chemotherapy and radiotherapy in 7 (9.33%) cases. We evaluated several classical factors and new immunohistochemical markers with an important value for diagnosis, prognosis and therapy: oestrogen and progesterone receptors, c-erb B2, pS2 and p53 proteins, von Willebrand factor. Several factors had a predictive role regarding the response to chemotherapy. These predictive factors will improve the histopathological diagnosis. The oncoproteins and hormonal receptors also will evaluate with more accuracy the metastatic risk and will assure a better therapy decision.

Acute or chronic intestinal ischaemia can be the consequence of either intrinsic vascular disease, systemic disease, drugs or surgical procedures. In one quarter of the patients with intestinal ischaemia, no major vascular obstructions can be detected. Very rarely, the cause of ischaemia is splanchnic vasoconstriction due to cardiac arrhythmias or sepsis. The bowel becomes ischaemic as a result of underperfusion. The clinical picture resembles the one of occlusive intestinal ischaemia. From the pathological standpoint, the ischaemia is more intense on the antimesenteric border of the bowel an the lesions are more advanced in the mucosal than in the serosal layer. Often, the ischaemia involves other organs too: liver, spleen or gallbladder. The reconstructive vascular procedures are inefficient, the only therapeutical options remains the resection of the infarcted bowel, together with other organs involved in the ischaemia process. The mortality rate approaches 90%.

The method for determining glycosylate serum proteins is based on the ketoamines property (fructosamine) of reducing nitro-tetrazoline blue, in alkaline medium, to a coloured, photometric product. The technique is simple, rapid, reproducible and cheap. The method was used for investigation of 52 diabetics and 17 normal subjects. The normal values were between 1.50-2.70 mmol/l, uncertain between 2.70-3.00 mmol/l, and certainly pathological above 3.00 mmol/l. The level of serum fructosamines shows the glycemia variations for an average period of about two weeks, before determination. It is one of the valuable parameters for detecting and following the patients with diabetes mellitus, and has also a prognostic value in the evolution of the disease.