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APOE is one of the prominent genes involved in the increased risk of developing Alzheimer’s disease, but its effect on cognition in patients who are not yet diagnosed with dementia or mild cognitive impairment is relatively understudied. We aimed to examine the effect of ApoE4 on cognitive performance in unimpaired middle-aged and elderly persons.

When we think about our values, we think about what is important in our lives (security, independence, wisdom, success, goodness, pleasure). This article has as its starting point the assumption that happiness is the result of manifestation of human values. The first part deals with the concept of human values, and the second part is focused on the analysis of secondary sources (data obtained from the investigation conducted by the European Social Survey). Data was retrieved and processed by me in Excel, and SPSS. In order to test research hypotheses correlation was used. To support the argument we used a series of tables and representative images.

European Union and its Member States shall adjust some provisions of the development strategies aimed at increasing food production in sustainable ways, protecting natural resources and increase competitiveness of European agriculture on the world market. Romania faces imbalances in market conditions is not rationally use land particularly favorable to obtain a competitive agricultural supplies. Large annual variations in crop conditions in which the yields per hectare and per animal is about half the EU15 average does not provide the power necessary at affordable prices, especially for vulnerable population groups. Addressing structural and operational problems of the institutional system of agriculture in Romania's European integration process is an important way of overcoming the situations to which the elimination of disparities in economic development and social peace disturbed by high and rising prices of food, produced in quantities increasing imports. In the current international situation in which Romania difficulties in structural adjustment in agriculture and reduction of disparities compared to EU Member States, a national policy of granting real priorities for the sector is badly needed. These priorities cover both ways of achieving the overall objectives which fall within the strategic guidelines of the European Union and European integration meets the needs and solving specific national targets.

Common Agricultural Policy (CAP) is one of the first common policies adopted by the European Union. Its genesis was a reaction to food problems that followed the Second World War, and measures were adopted in the European Economic Community (EEC). The term "common policy" fairly reflects one of the defining features of the CAP, namely that, for about 90% of agricultural products, the decision not remain with the Member States but the European Union. CAP is not only one of the first common policies, but also among the most important. In its present form, agricultural policy is built around two pillars: the first - and original - is the common market organizations, common measures include regulating the operation of integrated markets for agricultural products, and the second, which has gained widespread in the last decade is that of rural development and includes structural measures targeting the harmonious development of rural areas, in some aspects: social, business diversity, quality products, protect the environment.

Abstract Background In order to establish a consistent method for brachial artery reactivity assessment, we analyzed commonly used approaches to the test and their effects on the magnitude and time-course of flow mediated dilation (FMD), and on test variability and repeatability. As a popular and noninvasive assessment of endothelial function, several different approaches have been employed to measure brachial artery reactivity with B-mode ultrasound. Despite some efforts, there remains a lack of defined normal values and large variability in measurement technique. Methods Twenty-six healthy volunteers underwent repeated brachial artery diameter measurements by B-mode ultrasound. Following baseline diameter recordings we assessed endothelium-dependent flow mediated dilation by inflating a blood pressure cuff either on the upper arm (proximal) or on the forearm (distal). Results Thirty-seven measures were performed using proximal occlusion and 25 with distal occlusion. Following proximal occlusion relative to distal occlusion, FMD was larger (16.2 ± 1.2% vs. 7.3 ± 0.9%, p < 0.0001) and elongated (107.2 s vs. 67.8 s, p = 0.0001). Measurement of the test repeatability showed that differences between the repeated measures were greater on average when the measurements were done using the proximal method as compared to the distal method (2.4%; 95% CI 0.5–4.3; p = 0.013). Conclusion These findings suggest that forearm compression holds statistical advantages over upper arm compression. Added to documented physiological and practical reasons, we propose that future studies should use forearm compression in the assessment of endothelial function.

Evaluation scores of critically ill patients began to develop in the '70s, in an attempt to create a real model to allow the quantification of disease severity, outcomes, prognosis and mortality rate of hospitalized patients in ICU. Over time many such scores were developed, some of them have lost practical value, being no longer in use, others are important tools in assessing critically ill patients. There are basically four areas of application of these scores: research and clinical trials - for this purpose,scores serve as common, standardized tools of patient comparison, as a common language for researchers and clinicians, who may thus decide how the results of clinical research can influence their daily practice; administrative field - refers to the capital allocation depending on the disease severity, to cost-effectiveness analysis; performance assessment field: comparative performance assessment of ICU from year to year is important, as well as, individual performance assessment; assessment of individual prognosis and treatment protocols or decisions. There are four known validated prediction scores: APACHE (Acute Physiology and Chronic Health Evaluation), SAPS (Simplified Acute Physiology Score), MPM (Mortality Prediction Model) and SOFA (Sequential Organ Failure Assessment) score. A prediction score (severity score) represents a numerical value, composed of a variety of clinical parameters, quantifying the severity of the disease. This can be introduced into a mathematical equation, the result reflecting the probability of clinical course, usually the mortality rate. There is an obvious correlation between the severity of the prediction score,length of ICU stay and the complexity of physical therapy. This study aims to demonstrate the importance of starting prompt physical therapy in critically ill patients with high severity scores, significantly influencing individual recovery and prognosis. [ABSTRACT FROM AUTHOR]

Background : Androgenetic alopecia (AGA) and alopecia areata (AA) are the most common types of non-cicatricial alopecia. Both diseases have limited effective therapeutic options and affect patient quality of life. Pharmacogenetic tests can help predict the most appropriate treatment option by evaluating the single nucleotide polymorphisms (SNPs) corresponding to genes related to alopecia. The objective of the study was to evaluate and compare selected SNPs and genes in AA and AGA patients from Romania and Brazil. Materials and Methods : We performed a retrospective study regarding the associations between AA and AGA and 45 tag SNPs of 15 genes in 287 Romanian and 882 Brazilian patients. The DNA samples were collected from oral mucosa using a swab. The SNPs were determined by the qPCR technique. Each genetic test displays the subject's genotype of the selected gene and the prediction of a successful treatment (e.g., genotype AA of the GR-alpha gene is related to a predisposition to normal sensibility to topical glucocorticoid, and, therefore, glucocorticoids should be effective). Results : The GR-alpha , GPR44-2 , SULT1A1 , and CRABP2 genes were statistically significantly different in Brazil compared to Romania. The SULT1A1 activity that predicts the response to minoxidil treatment showed in our analysis that minoxidil is recommended in half of the cases of AGA and AA. Patients with AGA and a high expression of SRD5A1 or PTGFR -2 may benefit from Dutasteride or Latanoprost treatment, respectively. Most of the studied genes showed no differences between the two populations. Conclusions : The DNA analysis of the patients with alopecia may contribute to a successful treatment.

To better understand the potential of drug repurposing in COVID-19, we analyzed control strategies over essential host factors for SARS-CoV-2 infection. We constructed comprehensive directed protein-protein interaction (PPI) networks integrating the top-ranked host factors, the drug target proteins and directed PPI data. We analyzed the networks to identify drug targets and combinations thereof that offer efficient control over the host factors. We validated our findings against clinical studies data and bioinformatics studies. Our method offers a new insight into the molecular details of the disease and into potentially new therapy targets for it. Our approach for drug repurposing is significant beyond COVID-19 and may be applied also to other diseases., (© The Author(s) 2021. Published by Oxford University Press.)

Primary neuroendocrine tumors of the extrahepatic bile ducts are extremely rare - up to date, only 77 cases have been reported in the literature, which represents between 0.2-2% of all gastrointestinal carcinoid tumors. The paper focuses on the case of a woman patient, aged 37 years, admitted to the Clinic with the diagnosis of obstructive jaundice, unaccompanied by pain and where imaging indicates a tumor in the third average of the common bile duct (CBD). The surgery involved the excision of CBD, lymphadenectomy and restoring the biliodigestive continuity of Roux-en-Y hepaticojejunostomy. The histopathological and immunohistochemical examinations revealed the presence of a well-differentiated neuroendocrine tumor of CBD. Based on the case report and literature, we attempted to accurately identify and relate this type of tumor to other varieties encountered in the extrahepatic bile ducts, pointing out elements of a positive diagnosis, differential diagnosis, histopathology and immunohistochemistry, and referring to the therapeutic attitude, evolutionary methods and prognosis.

Neuroendocrine tumors (NETs) originate in the neuroendocrine cells of the neural crest (Kulchitsky cells). If neuroendocrine tumors arising in the digestive tract or lung may occasionally result in skin metastases, primary soft tissue or skin NETs are infrequent. The current paper presents the case of an elderly woman patient with neuroendocrine tumors arising de novo in the left upper thigh, accompanied by lymph nodes metastases in the left groin and in the left pelvic sidewall, in close vicinity of the iliac vessels. The diagnosis of NET was performed based on immunohistochemical tests. Such tumors show a slow growth and, generally, have a good prognosis. It is emphasized that complete surgical excision, in some cases associated with adjuvant external radiotherapy is the optimal therapeutic modality in dealing with such lesions.

This paper draws attention towards 3 cases with different pathologies all of which suggesting however both clinically and by imaging means as the most likely diagnosis advanced-stage epithelial ovarian cancer since all these three postmenopausal women had been admitted to the hospital with ascites, pelvic masses and deterioration of the physical wellbeing (fatigue, decreased appetite, weight loss, pallor). Findings during exploratory laparotomy on all these three pacients included ascites (hemorragic in one case) diffuse tumorous implants throughout the abdominal and pelvic peritoneal surfaces (in two cases) and the ovarian tumour. Postoperatively, the final histopathologic diagnoses consisted of primary peritoneal carcinoma (one pacient), peritoneal tuberculosis (TB, one pacient) and hepatic cirrosis with an incidental benign adnexial mass (one pacient). Moreover, nonmalignant ovarian tumours were certified in all three cases under current presentation. The differential diagnosis of the ovarian cancer and a tailored approach to treatment for each of these three pathologic entities will also be described in detail.

Objective: The paper analyses the incidence, diagnosis and treatment options available for stress urinary incontinence (SUI) in women with pelvic floor dysfunction admitted to Craiova's Surgery Clinic IV., Methods: This is a retrospective 10-year study comprising a surgical cohort of 420 patients with significant enough to alter quality of life SUI associated to ureterocele and cystocele and in 353 cases with rectocele too. The highest incidence of SUI was encountered between 50 and 59 years of age (range 39 - 81 years). In 21 of this case series the diagnosis of SUI was established soon after the surgical repair of the urethro-cystocele. The diagnosis of SUI was based on careful history and physical examination with emphasis on the gynecologic survey of the abdomen and pelvis but in the absence (for objective reasons) of urodynamic testing which is especially useful for SUI pathophysiological evaluation and thus surgery success rate prediction. All our 420 severe SUI associated with vaginal wall hernias underwent surgical treatment by either open Burch retropubic urethropexy or anterior colporraphy., Results: Among anterior colporraphy treated patients SUI persisted in 19.3% of the cases (33 patients). Complications of Burch urethropexy procedure (despite its high ability for cure) in our case series include: urinary retention, hemorrhage into the space of Retzius, intraoperative injury to the bladder and long-term postoperative incisional hernia. Moreover, 5 patients (2%) of the group who underwent Burch operation were readmitted with recurrent urinary incontinence between 2 and 6 months after the aforementioned surgical intervention despite its good anatomical results in all of these cases., Conclusions: SUI is a prevalent disorder of women that can be diagnosed easily with history and physical exam. If symptoms persist and severely affect quality of life, despite modern noninvasive treatments, several surgical procedures are now available.

The study's aim was to analyze a series of colon cancer cases in which the mirage of the first (clinically most obvious) lesion (gallstones) along with its minimally invasive approach - that explored only the biliary disease - had contributed to the delay of large bowel malignancy' diagnosis and treatment. 1327 patients aged between 17 and 83 years and diagnosed with cholecystolithiasis were operated upon laparoscopically in the Department of General Surgery of Craiova CFR University Hospital from 2000 through 2004. Four out of these 1327 patients (0,3%) were readmitted with the diagnosis of colon carcinoma between 1 and 16 months after the laparoscopic cholecystectomy. Our retrospective study gives a full report on these 4 cases insisting upon the links between their clinical - laboratory evaluations and final diagnosis. Despite the low laparoscopic cholecystectomy overlooked colon cancer' incidence it seems reasonable to both improve the technique of peritoneal cavity exploration during this type of surgery and extend the preoperative evaluation whenever the slightest suspicion of associated pathology is raised especially in patients over 50 years of age.

The importance of urinary tract infections relies in their relatively high incidence, as well as in their numerous and complicated problems of diagnosis and treatment. Considering the high incidence of urinary infections we made a study in order to determine the antibiotic susceptibility of Enterobacteriaceae strains isolated from urocultures of ambulatory patients and to precise the resistance phenotypes of these strains. We studied enterobacteriaceae strains isolated from 1889 urocultures of ambulatory patients between January - December 2004. From 1889 urocultures 431 were positive, the most common strains were E. coli - 350 strains (81.21%). We observed a constant lowering of the sensitivity of E. coli strains to many antimicrobial agents which draws attention to on the importance of monitoring antibiotics prescriptions. We must draw a signal about the presence of some ESBL (beta-lactamase with extended spectrum) strains (1 E. coli strain and 3 Klebsiella pneumoniae strains), which are usually isolated in hospital, due to empiric, irrational and abusive usage of antibiotics, without doing the antibiograms.

The aims of this paper are both to highlight some dilemmas concerning the diagnosis of primary epithelial ovarian carcinoma mainly in its early stages and to underline the capricious responses of this type of malignancy to an otherwise well coded modern management. This study is based on the analysis of the records of 78 patients with ovarian carcinoma admitted for diagnosis and surgical treatment to the Department of General Surgery of Craiova C.F.R. Clinic from 1993 through 2003. The results of this analysis are difficult to interpret due to loss to follow up (in terms of response rates) of some of our 78 operated on ovarian carcinoma patients who went on with their platinum-based chemotherapy (following surgical cytoreduction) under the supervision of different Oncology Departments nationwide. Nevertheless, it is worth mentioning that most of this study patients (71.9%) presented with advanced-stage (III and IV) ovarian carcinoma which sometimes seemed quite confusing by its clinical polymorphism but its prognosis was very much related to both the degree of surgical cytoreduction accomplished and tumor sensitivity to chemotherapy. Finally, although this study does not allow us to draw firm conclusions it is an attempt to share out our current perception on the primary epithelial ovarian cancer management.

The study analyzed the prognostic significance of a group of three histologic markers belonging to intra- and peritumorous stroma as derived from a series of 66 patients with gastric adenocarcinoma operated upon in Craiova CFR General Surgery Clinic. To this end we attempted to uncover any possible correlation between the three stromal parameters represented by type of angiogenesis, peritumorous inflammatory infiltrate and desmoplastic reaction and both the depth of malignant invasion through the gastric wall and the histologic type of gastric cancer. The results of our investigation highlighted that type A2 angiogenesis is displayed mostly by gastric carcinomas with well-differentiated tubular and secretory structure (class 2 Goseky) whereas type A3, angiogenesis is mainly a feature of gastric cancer with a poorly-differentiated tubular morphology (classes 3 and 4 Goseky). Moreover there was no statistically significant correlation between the intensity of inflammatory infiltrate and both the Goseky classes and the depth of neoplastic spread. Finally a clearly desmoplastic reaction was encountered in less than 50% of our patient series and represented almost a characteristic of both poorly-differentiated tubular structured malignancies and serosa invading tumors.

Introduction: The aim of this work is to analyze the various gastric carcinoma classification systems, trying, at the same time, to establish connections between the anatomopathologic evolutionary and prognostic aspects. CASE MATERIAL AND METHODS: The study was performed on a series of 66 patients who undergone excision surgery for gastric carcinoma. The study material are 31 cases of gastric cancer diagnosed in Clinical Hospital CFR Craiova, and another 35 cases diagnosed at the "I.V. Babeş" Pathology and Medical Genetics Institute in Bucharest. The excised pieces underwent anatomopathological investigation using histopathological, histochemical and immunohistochemical methods., Results: From the macroscopic point of view, the most common tumor pattern was Bormann 2 ulcerovegetative, targeting patients over 60 years of age. In what the invasion level is concerned, most carcinomas were sanctioned at the time when the tumor was invading the serous fluid (pT3) or even the perigastric tissue (pT4). The microscopic criteria was approached by us using Goseky's method, the most common being Goseky stages 2 and 4, in equal rations. The distribution of cases depending on the OMS differentiation degree, shows a preeminence of low differentiated carcinomas (G3)., Conclusions: The abundance of classification methods in gastric cancer shows the complexity of the matter but none of the classifications is perfect.

Nosocomial urinary tract infection is the most common type of sepsis in the post-surgical patient. This paper presents our experience with 218 nosocomial urinary infections (34.93% of our postoperative infections) which complicated the postoperative course of 1002 (21.75%) urethral catheterized patients out of a total of 5950 (3.6%) operated on and under study individuals. Thus we found that urethral catheterization is the most important risk factor for post-surgery urinary infections. Moreover, in our series the postoperative urinary tract sepsis bacteriology is dominated (> 95% of cases) by aerobic gram-negative bacilli that mainly reside in the bowel and also commonly colonize the perineum. Furthermore, we demonstrated that post-surgical urinary infections did not influence directly death rate but they had a significant bearing on care costs. Finally we consider the prevention of postoperative nosocomial urinary tract sepsis as an essential principle of this condition management.

This article is a plea for the implementation of early-stage breast cancer conservative therapy into as many surgical clinics as possible. The aforementioned statement relies mainly on published papers and data (the protocol included) provided to us by Instituti Clinici di Perfezionamento di Milano experts in breast cancer conservative therapy and to a lesser extent on our not too numerous results (30 cases) obtained over the past 2 years since we applied the Milano protocol on a regular basis. Thus we support the view that the breast-conserving treatment is suitable for clinical stage I or II carcinoma whose tumors are 3 cm or less in greatest diameter, provided axillary lymphadenectomy is associated for prognostic and future management guidance reasons, but not for cure. Breast-limited postoperative radiation treatment is foremost aimed at local recurrences rate reduction without significantly influencing survival rate. Postoperative chemotherapy, indicated for node-positive patients and/or primary tumors over 1 cm in greatest, diameter, has been proved to contribute to long-term survival rate. However, both the small sample size and the short period of observation of our study prevented us from drawing firm conclusions directly.

The study of IgG, IgM and IgA immunoglobulins in the pleural exsudate and in the serum of 34 patients with pleurisy of various etiologies shows an increase in the level of serum immunoglobulins as compared with the level in the exsudate. The only immunoglobulin fraction showing variations in relation with the etiology of the disease in the IgG fraction, which is increased in inflammatory exsudates, in contrast with those found in pulmonary cancers. Recovery without sequellae of pleurisy supposes the presence (in situ) of an increased amount of IgG. These observations are supported by a good statistical-mathematical correlation (p less than 0,01 and 0,001).