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The intention of the paper is to analyse the evolution of the effective tax rate of corporate income tax for the 2011-2016 period, calculated for the non-financial companies listed on the Bucharest Stock Exchange (Romanian: Bursa de Valori București - BVB). The first part of the paper presents the main causes for the divergence between the statutory and effective rate of the corporate income tax, based on the provisions of the Romanian Fiscal Code. The differences between the gross income and the taxable profit, which form the basis for calculating the income tax, are highlighted. The second part is devoted to the methodology for calculating the effective income tax rate and its analysis, based on data from the financial statements published in the post-crisis period by Romanian companies listed on BVB.

Background: In March 2020, many elective medical services were canceled in response to the coronavirus disease 2019 (COVID-19) pandemic. The daily case rate is now declining in many states and there is a need for guidance about the resumption of elective clinical services for patients with lung disease or sleep conditions.Methods: Volunteers were solicited from the Association of Pulmonary, Critical Care, and Sleep Division Directors and American Thoracic Society. Working groups developed plans by discussion and consensus for resuming elective services in pulmonary and sleep-medicine clinics, pulmonary function testing laboratories, bronchoscopy and procedure suites, polysomnography laboratories, and pulmonary rehabilitation facilities.Results: The community new case rate should be consistently low or have a downward trajectory for at least 14 days before resuming elective clinical services. In addition, institutions should have an operational strategy that consists of patient prioritization, screening, diagnostic testing, physical distancing, infection control, and follow-up surveillance. The goals are to protect patients and staff from exposure to the virus, account for limitations in staff, equipment, and space that are essential for the care of patients with COVID-19, and provide access to care for patients with acute and chronic conditions.Conclusions: Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a dynamic process and, therefore, it is likely that the prevalence of COVID-19 in the community will wax and wane. This will impact an institutions mitigation needs. Operating procedures should be frequently reassessed and modified as needed. The suggestions provided are those of the authors and do not represent official positions of the Association of Pulmonary, Critical Care, and Sleep Division Directors or the American Thoracic Society.

Obstructive sleep apnea (OSA) is highly prevalent in patients with asthma. Asthma, dose-dependently to its duration, promotes incident OSA, suggesting that asthma plays a role in OSA pathogenesis. We hypothesized that asthma-related inflammation alters breathing control mechanisms, specifically the carotid chemoreflex. Accordingly, we measured hypoxic ventilatory responses (HVR) in awake, unrestrained, ovalbumin (OVA)-sensitized Brown Norway rats and compared them with responses in sham-sensitized (SALINE) controls. To differentiate the role of allergic inflammation from bronchoconstriction, we repeated hypoxic ventilatory response (HVR) after administration of formoterol, a long-acting bronchodilator. Blood and bronchoalveolar lavage (BAL) fluid were collected for quantification of inflammatory cytokines. The rise in ventilatory equivalent for O2 evoked by acute exposure to hypoxia was augmented following sensitization by OVA, whereas it remained stable after SALINE. This augmentation was driven by increased breathing frequency with no change in tidal volume. Tachypneic hyperventilation in normoxia was also observed with OVA. Neither the increased HVR nor excessive normoxic ventilation was affected by formoterol, suggesting that they were not secondary to lung mechanical constraints. Higher levels of inflammatory cytokines were observed in BAL fluid and serum of OVA versus SALINE. In OVA, serum interleukin-5 levels significantly correlated with change from baseline in ventilatory responses to severe hypoxia (F I O 2 , 0.09). These observations are consistent with inflammation-induced enhancement of carotid chemoreflex function, i.e., increased controller gain, and they suggest a possible role for asthma-related allergic inflammation in the ventilatory instability known to promote upper airway collapse and sleep apnea in humans. NEW & NOTEWORTHY: Asthma is a risk factor for obstructive sleep apnea (OSA); however, the mechanisms are incompletely understood. In a rat model of allergic inflammation associated with asthma, we found that ventilation in normoxia and ventilatory responses to hypoxia were markedly enhanced and related with systemic inflammation. These alterations indicating carotid chemoreflex sensitization, known to promote ventilatory instability during sleep in humans, may contribute to the increased OSA risk in asthma. [ABSTRACT FROM AUTHOR]

Study objectiveObstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness.Study design16-week single-arm study.Participants18 (14 females, mean [ ± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV1 89 ± 8% predicted).InterventionsHigh dose (1,760 mcg/day) inhaled FP.Measurements(1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure-Pmax, in KPa) and endurance-time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot)-at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects.ResultsPcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved.ConclusionsIn this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined.

Purpose Asthmatics have unique characteristics that may influence cardiovascular morbidity. We tested the association of lower airway caliber, obstructive sleep apnea (OSA), and other asthma-related factors, with systemic hypertension (HTN). Methods Asthma individuals at specialty clinics completed the Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ). Medical records were reviewed for diagnosed HTN, OSA and comorbidities, spirometry, and current medications. FEV.sub.1% predicted was categorized as [greater than or equal to]80 (reference), 70-79, 60-69, and Results Among 812 asthmatics (mean age ± standard deviation: 46 ± 14 years), HTN was diagnosed in 191 (24 %), OSA in 65 (8 %), and OSA or high OSA risk (combined OSA variable) in 239 (29 %). HTN was more prevalent in lower FEV.sub.1% categories (p < 0.0001), in subjects with OSA, and those with combined OSA variable (55 vs. 21 % and 46 vs. 14 %, respectively, both p < 0.0001). With adjustment for covariates, associations with HTN remained significant for some FEV.sub.1% categories (70-79 % odds ratio = 1.60 [95 % CI 0.90-2.87]; 60-69 % 2.73 [1.28-5.79]; Conclusions In this young population, worse lower airways obstruction and OSA were associated with HTN. In contrast, lower ICS doses attenuated likelihood for HTN. Adequate control of airway inflammation at appropriate ICS doses, and screening for OSA may reduce the burden of HTN in asthma., Author(s): Susan Ferguson[sup.1] [sup.2] , Mihai C. Teodorescu[sup.1] [sup.3] [sup.4] , Ronald E. Gangnon[sup.5] [sup.6] , Andrea G. Peterson[sup.2] , Flavia B. Consens[sup.7] , Ronald D. Chervin[sup.7] , Mihaela Teodorescu[sup.1] [...]

Background. Lung cancer represents the main cause of cancer-related mortality at a worldwide level and ranks second in global incidence statistics. The therapeutic management of non-small cell lung cancer (NSCLC) has been substantially modified by the development of immune checkpoint inhibitors (ICI), nivolumab, pembrolizumab, durvalumab and atezolizumab. In Romania, the reimbursement of healthcare costs for immune checkpoint inhibitors has started since late 2017. Aim of the study. The assessment of efficacy, safety profile, overall survival (OS) and progression-free survival (PFS) from real-world data for nivolumab as second-line therapy for advanced and metastatic NSCLC. Our real-world study was conducted between 1.01.2018 and 31.12.2020, right after the approval of nivolumab in Europe for metastatic NSCLC. Methodology. For data analysis, we used R programming language, version 3.6.2, the Excel application in Microsoft 365 for Enterprise pack. Results. We studied 34 participants from our lot. Nivolumab was administered from second line and beyond. The average age was 65.5 years old. The majority of patients had multiple comorbidities. The histopathology was represented by 56% non-squamous NSCLC, and 44% squamous NSCLC. The overall survival for nivolumab therapy was 72.3 weeks (18.07 months). The overall survival for non-smokers was 32.5 weeks (8.12 months) versus 93 weeks for smokers (23.25 months). The overall survival for women was 15.3 weeks (3.8 months) and for men this value could not be reached. The overall survival for squamous carcinoma was 72.3 weeks (18.1 months), and for non-squamous carcinoma, it was 93 weeks (23.25 months). Median PFS was 17.3 weeks (4.3 months). Conclusions. ICI with nivolumab administered from second line and beyond had a favorable safety profile and manageable adverse events, similar to those described in pivotal studies, making them a reasonable choice in pretreated, frail and elderly patients. Distinctively, our real-world data regarding OS and PFS did not show the same advantage magnitude as seenin CheckMate 017 and CheckMate 057 studies. [ABSTRACT FROM AUTHOR]

After 1989, the transition process, by means of whic h Romania went over from a planned economy to a market economy has involved a constant ly changing of the dynamics of industry, and hence, of the occupational profile of the popul ation in all areas of the country, regardless of population size and of the level of economic develo pment. The main processes that have led to changes in the industrial profile of the cities were economic restructuring and privatization, in most cases accompanied by de-industrialization and economic decline. The transition from a socialist economy to a market economy, involving a process of significant restructuring, is an ongoing continuous phenomenon.

Real-world data (RWD) and observational studies (OS) are increasingly important in current clinical research. In this article, we have summarized the definition of the two means of research, we have defined them, and we have shown how they can determine results that support the results of clinical randomized trials. We have also shown the fact that RWD and OS can partially or totally disprove controlled randomized clinical trials (CRCT). The latter remain the gold standard in research regarding the efficacy and safety of innovative drugs. We present the plan for conducting observational studies, which is based on a checklist recognized by a large community of researchers. We also present the types of observational studies that can be used in clinical research. Finally, we followed the results obtained in the clinical trials performed in non-small cell lung cancer (NSCLC). The analysis was done on the most important studies published online. The conclusions are in favor of using RWD and OS to verify the results published after CRCT. [ABSTRACT FROM AUTHOR]

This short review analyzes several studies published in the last three years entirely on the internet. We sought to extract the main clinical characteristics of cardiac toxicity and the main investigations necessary for diagnosis, which are currently not standardized. Finally, we presented the management of the main toxic cardiac manifestations induced by checkpoint inhibitors (ICI) in cancer immunotherapy. The main references were made to myocarditis, which is the most frequently reported toxicity. Essentially, the management of the cardiac toxicities of ICI is done by following the cardiological protocols to which corticotherapy is added in high doses. Considering the complexity of diagnosis and treatment, a new structure was developed within cardiology, namely cardio-oncology. [ABSTRACT FROM AUTHOR]