Publications by authors named "Mihai Popescu"

74 Publications

Post-traumatic stress disorder is associated with alterations in evoked cortical activation during visual recognition of scenes.

Neuroimage Clin 2021 3;31:102752. Epub 2021 Jul 3.

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA. Electronic address:

We recorded magnetoencephalography data during a visual recognition task in participants with combat exposure (n = 40, age: 41.2 ± 7.2 years) to investigate the relationship between the evoked brain activity, behavioral performance, and the severity of their post-traumatic stress symptoms assessed using the PTSD Check List for DSM V version (PCL-5). In an initial study session, participants were presented with a series of images of outdoor scenes and were instructed to study the images for an upcoming recognition test. In a subsequent session, the original images were shown intermixed with novel images while participants performed the recognition task. PCL-5 scores were negatively correlated with discrimination performance and with the recognition accuracy for original images. During the recognition session, higher PCL-5 scores were associated with reduced relative power of the evoked response to original images from 100 ms to 300 ms following the image onset over a distributed brain network including the bilateral inferior frontal gyri, left middle frontal gyrus, left supramarginal gyrus, right precuneus and the bilateral superior temporal gyri. These findings indicate that the lower recognition performance in participants with higher PTSD symptom severity is associated with altered cortical activity in brain regions that are known to play a role in the elaboration on visual cues that supports recollection.
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http://dx.doi.org/10.1016/j.nicl.2021.102752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313740PMC
September 2021

Can SARS-CoV-2 Induce Uterine Vascular Anomalies and Poor Contractile Response?-A Case Report.

Medicina (Kaunas) 2021 Jun 29;57(7). Epub 2021 Jun 29.

Department of Obstetrics and Gynecology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.

We are reporting a case of a 36 year-old Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) positive hypertensive primigravida with postpartum uterine atony that required emergency subtotal hysterectomy at Saint John Hospital Bucur Maternity Bucharest. The maternity was designated as the Coronavirus Disease 2019 (COVID-19) Maternity for Bucharest and Ilfov County since March 2020. The patient was mildly symptomatic for SARS-CoV-2, infection confirmed with reverse transcription polymerase chain reaction (RT-PCR). The caesarean section was performed and a live male fetus was born, 2630 g and Apgar Score of 9 (the male fetus was negative for SARS-CoV-2). Postpartum hysterectomy with adnexal preservation was performed because of uterine atony. The postoperative evolution was favorable. The patient was discharged with her baby 10 days after birth. Given the limited resources, the placenta, the umbilical cord and the uterus were not tested for SARS-CoV-2. The pathology exam revealed that on the maternal side there were specific uterine atony lesions as well as endometrial and miometrial ischaemia. The placenta had nonspecific findings: chronic ischemic lesions with small villi, fibrin deposits in the materno-fetal interface. The peculiarity of the case is that we report the morphological findings of the placenta and uterus resulted from intrapartum uterine atonia in a patient with gestational arterial hypertension, premature birth and COVID-19. Further studies are required to characterize the pattern of such intricate conditions.
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http://dx.doi.org/10.3390/medicina57070670DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8303955PMC
June 2021

High perioperative lactate levels and decreased lactate clearance are associated with increased incidence of posthepatectomy liver failure.

Hepatobiliary Pancreat Dis Int 2021 Mar 21. Epub 2021 Mar 21.

"Carol Davila" University of Medicine and Pharmacy, Bucharest 020021, Romania; Department of Anesthesia and Intensive Care, Fundeni Clinical Institute, Bucharest 022328, Romania.

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http://dx.doi.org/10.1016/j.hbpd.2021.03.005DOI Listing
March 2021

Imaging of the Posttraumatic Knee in Pediatric Patients.

Curr Health Sci J 2020 Oct-Dec;46(4):390-395. Epub 2020 Dec 31.

Department of OtoRhinoLaringology, University of Medicine and Pharmacy of Craiova, Romania.

Owing to its continuous transformation, the musculoskeletal system of pediatric patients presents some unique features with respect to both anatomy and physiology. The lesional pattern of the knee in pediatric patients is both similar to and in many aspects different from the lesional pattern in adults with knee injuries. In the case of pediatric patients, meniscal, tendinous and ligamentous lesions occur most frequently as a consequence of traumatic episodes. The purpose of the present study is to emphasize the importance of MRI examinations in pediatric patients exhibiting symptoms of knee joint injury. The imaging assessment of the extent of the lesions, which can be either simple or complex alterations, can directly influence the clinical management of these cases by appreciating the growth potential of the specific segment of immature skeleton involved.
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http://dx.doi.org/10.12865/CHSJ.46.04.10DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948019PMC
December 2020

Haemoadsorption by CytoSorb® in patients with acute liver failure: A case series.

Int J Artif Organs 2021 Aug 10;44(8):560-564. Epub 2020 Dec 10.

Fundeni Clinical Institute, Department of General Surgery and Liver Transplantation, Bucharest, Romania.

Acute liver failure (ALF) is a life-threatening disease associated with multi-organ failure and increased mortality. Severe inflammation is now considered the main pathophysiological mechanism for organ dysfunction, thus rebalancing pro- and anti- inflammatory cytokines may improve liver function and outcome. The aim of this study was to assess the clinical effects of a haemoadsorption column on biochemical parameters in patients with ALF. We prospectively included 28 patients with ALF who were treated with three consecutive sessions of continuous venovenous haemofiltration in combination with CytoSorb. Our results show an improvement in liver functional tests and a decrease in Creactive protein. Thrombocytopenia remains one of the most important side effects of this treatment and careful consideration should be made before initiation of treatment.
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http://dx.doi.org/10.1177/0391398820981383DOI Listing
August 2021

Standard renal replacement therapy combined with hemoadsorption in the treatment of critically ill septic patients.

Ther Apher Dial 2021 Oct 12;25(5):663-670. Epub 2021 Jan 12.

Department of Anaesthesia and Critical Care, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

The aim of the study was to assess clinical and paraclinical effects of hemoadsorption on organ dysfunction, severity scores, and 28-day survival in septic patients. Fifty-five septic patients admitted to a general intensive care unit of a university hospital were included in the present study. Each patient underwent three consecutive 24-hour sessions of renal replacement therapy in combination with hemoadsorption. Clinical and paraclinical variables were measured after the treatment and severity scores were calculated. The use of hemoadsorption was associated with an increase in arterial partial pressure of oxygen/fraction of inspired oxygen ratio (P = .02), urine output (P = .01), and Glasgow Coma Score (P = .03) and a decrease in white blood cell count (P = .03), C-reactive protein (P = .01), procalcitonin (P = .01) levels, and platelet count (P = .01). The use of hemoadsorption was associated with an improvement in neurological and renal functions and a decrease in inflammatory markers. Acute respiratory distress syndrome improved significantly based on relevant improvements in one-third of the patients.
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http://dx.doi.org/10.1111/1744-9987.13612DOI Listing
October 2021

Isovolemic filter-based therapeutic plasma-exchange with fresh frozen plasma is associated with minimal thromboelastometric changes in noncoagulopathic patients.

Blood Coagul Fibrinolysis 2021 Apr;32(3):216-220

Department of Anaesthesia and Critical Care, 'Carol Davila' University of Medicine and Pharmacy.

The aim of this study was to assess the effects of isovolemic therapeutic plasma-exchange using fresh frozen plasma on coagulations parameters assessed by standard coagulation tests and rotational thromboelastometry in noncoagulopathic patients. Twenty patients who underwent isovolemic filter-based therapeutic plasma-exchange of approximately 1.5 plasma volume per session were included in the current study. Standard coagulation tests and rotational thromboelastometry (ExTEM, InTEM, FibTEM and ApTEM) were performed 30 min before and after the procedure. Isovolemic therapeutic plasma-exchange was associated with decreased fibrinogen levels (P = 0.01). Thromboelastometric assay demonstrated an increased clotting time in both ExTEM (P = 0.03) and InTEM (P = 0.01) and a decreased thrombodynamic potential index in ExTEM (P = 0.03). No significant difference in FibTEM maximum clot firmness was recorded (P = 0.41). Therapeutic plasma-exchange in noncoagulopathic patients is associated with minimal changes in thromboelastometric parameters, mainly by an increase in clotting time in both intrinsic and extrinsic pathways.
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http://dx.doi.org/10.1097/MBC.0000000000000976DOI Listing
April 2021

Gingival Recession in a Case of Anterior Crossbite with Angle Class I Relationship.

Curr Health Sci J 2020 Apr-Jun;46(2):190-192. Epub 2020 Jun 30.

Department of Periodontology, University of Medicine and Pharmacy of Craiova, Romania.

Anterior crossbite is one of the most common orthodontic problems encountered during the dental eruption. Usually, the anomaly becomes evident during mixed dentition, as a result of the disharmony between the dental, skeletal and functional components of the orthognathic system. As complications, the presence of the anterior dental cross bite can lead to the thinning of the vestibular alveolar process of the lower incisors and gingival recession. Periodontal changes could recede spontaneously if orthodontic treatment is applied early, in the presence of good oral hygiene. In this case, gingival recession decreased, but not completely receded after orthodontic treatment, although the patient had a good oral hygiene.
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http://dx.doi.org/10.12865/CHSJ.46.02.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445634PMC
June 2020

Visible-Light-Mediated Heterocycle Functionalization via Geometrically Interrupted [2+2] Cycloaddition.

Angew Chem Int Ed Engl 2020 Dec 8;59(51):23020-23024. Epub 2020 Oct 8.

Chemistry Research Laboratory, University of Oxford, 12 Mansfield Road, Oxford, OX1 3TA, UK.

The [2+2] photocycloaddition is the most valuable and intensively investigated photochemical process. Here we demonstrate that irradiation of N-acryloyl heterocycles with blue LED light (440 nm) in the presence of an Ir complex leads to efficient and high yielding fused γ-lactam formation across a range of substituted heterocycles. Quantum calculations show that the reaction proceeds via cyclization in the triplet excited state to yield a 1,4-diradical; intersystem crossing leads preferentially to the closed shell singlet zwitterion. This is geometrically restricted from undergoing recombination to yield a cyclobutane by the planarity of the amide substituent. A prototropic shift leads to the observed bicyclic products in what can be viewed as an interrupted [2+2] cycloaddition.
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http://dx.doi.org/10.1002/anie.202009704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891567PMC
December 2020

Isolated Meniscus Tears in Adolescent Patients Treated with Platelet-Rich Plasma Intra-articular Injections: 3-Month Clinical Outcome.

Biomed Res Int 2020 21;2020:8282460. Epub 2020 May 21.

Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania.

Objectives: Meniscus repair is a challenge for a practitioner, as an injured meniscus can lead to osteoarthritic joint changes with a greatly disabling outcome. Platelet-rich plasma has been regarded as a promising therapy to help induce healing. The purpose of the study is to clinically assess the effectiveness of PRP treatment in adolescents with meniscal lesions.

Methods: This retrospective study analyzed 30 patients with meniscal tears, aged 12 to 17 years, who had documented MRI meniscal lesion and persistent knee pain. In order to evaluate the outcome, the Lysholm knee scoring scale and numerical rating scale were used before injection and 3 months after treatment.

Results: Patients had a mean age of 13.93 years, 70% girls and 30% boys. The most affected was the medial meniscus. The mean value before injection on the numerical rating scale (NRS) of pain was 7.73, after the treatment being of 2.0. After treatment, 76.7% of the patients had "excellent" and "good" outcomes, while before injection, just 3% of the patients had a "good" score.

Conclusions: Platelet-rich plasma treatment can be effective in improving the clinical outcomes of adolescent patients with meniscus tears, for whom conservative management and physical therapy have failed to achieve pain relief.
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http://dx.doi.org/10.1155/2020/8282460DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7273443PMC
March 2021

Logical Rules and a Preliminary Prototype for Translating Mortality Coding Rules from ICD-10 to ICD-11.

Stud Health Technol Inform 2020 Jun;270:297-301

Iris Institute, DIMDI, Germany.

Iris is a system for coding multiple causes of death in ICD-10 and for the selection of the underlying cause of death, based on a knowledge base composed by a large number of rules. With the adoption of ICD-11, those rules need translation to ICD-11. A pre-project has been carried out to evaluate feasibility of transition to ICD-11, which included the analysis of the logical meta-rules needed for rule translation and development of a prototype support system for the expert that will translate the coding rules.
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http://dx.doi.org/10.3233/SHTI200170DOI Listing
June 2020

Liver transplantation for acute-on-chronic liver failure.

Best Pract Res Clin Anaesthesiol 2020 Mar 16;34(1):25-33. Epub 2019 Dec 16.

University School of Medicine, Department of Anesthesia and Critical Care, Pisa, Italy.

Acute-on-chronic liver failure (AoCLF) represents a newly defined entity in patients with liver disease leading to multiple organ failures and increased mortality. To date, no universally accepted definition exists, and different academic societies developed guidelines on the early diagnosis and classification of AoCLF. Recently published trials focused on factors associated with a poor outcome and on the development of severity scores aimed to identify patients who may benefit for advanced monitoring and treatment. No specific therapies are demonstrated to improve survival, and liver transplantation (LT) remains the only treatment associated with improved outcome. Our review focuses on current evidence for early diagnosis and prognostication of disease in patients with AoCLF, as well of criteria for intensive care unit admission, indication, and futility markers of LT, as well as bridging therapy and optimal timing of surgery.
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http://dx.doi.org/10.1016/j.bpa.2019.12.001DOI Listing
March 2020

A Communication Infrastructure for the Health and Social Care Internet of Things: Proof-of-Concept Study.

JMIR Med Inform 2020 Feb 25;8(2):e14583. Epub 2020 Feb 25.

Cimtech Srl, Reana del Rojale, Italy.

Background: Increasing life expectancy and reducing birth rates indicate that the world population is becoming older, with many challenges related to quality of life for old and fragile people, as well as their informal caregivers. In the last few years, novel information and communication technology techniques generally known as the Internet of Things (IoT) have been developed, and they are centered around the provision of computation and communication capabilities to objects. The IoT may provide older people with devices that enable their functional independence in daily life by either extending their own capacity or facilitating the efforts of their caregivers. LoRa is a proprietary wireless transmission protocol optimized for long-range, low-power, low-data-rate applications. LoRaWAN is an open stack built upon LoRa.

Objective: This paper describes an infrastructure designed and experimentally developed to support IoT deployment in a health care setup, and the management of patients with Alzheimer's disease and dementia has been chosen for a proof-of-concept study. The peculiarity of the proposed approach is that it is based on the LoRaWAN protocol stack, which exploits unlicensed frequencies and allows for the use of very low-power radio devices, making it a rational choice for IoT communication.

Methods: A complete LoRaWAN-based infrastructure was designed, with features partly decided in agreement with caregivers, including outdoor patient tracking to control wandering; fall recognition; and capability of collecting data for further clinical studies. Further features suggested by caregivers were night motion surveillance and indoor tracking for large residential structures. Implementation involved a prototype node with tracking and fall recognition capabilities, a middle layer based on an existing network server, and a Web application for overall management of patients and caregivers. Tests were performed to investigate indoor and outdoor capabilities in a real-world setting and study the applicability of LoRaWAN in health and social care scenarios.

Results: Three experiments were carried out. One aimed to test the technical functionality of the infrastructure, another assessed indoor features, and the last assessed outdoor features. The only critical issue was fall recognition, because a slip was not always easy to recognize.

Conclusions: The project allowed the identification of some advantages and restrictions of the LoRaWAN technology when applied to the health and social care sectors. Free installation allows the development of services that reach ranges comparable to those available with cellular telephony, but without running costs like telephony fees. However, there are technological limitations, which restrict the scenarios in which LoRaWAN is applicable, although there is room for many applications. We believe that setting up low-weight infrastructure and carefully determining whether applications can be concretely implemented within LoRaWAN limits might help in optimizing community care activities while not adding much burden and cost in information technology management.
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http://dx.doi.org/10.2196/14583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064948PMC
February 2020

Altered modulation of beta band oscillations during memory encoding is predictive of lower subsequent recognition performance in post-traumatic stress disorder.

Neuroimage Clin 2020 27;25:102154. Epub 2019 Dec 27.

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, United States; Behavioral Biology Branch, Walter Reed Army Institute of Research, 503 Robert Grant Ave, Silver Spring, MD 20910, United States. Electronic address:

We studied the relationship between electrophysiological markers of memory encoding, subsequent recognition performance, and severity of PTSD symptoms in service members with combat exposure (n = 40, age: 41.2 ± 7.2 years) and various levels of PTSD symptom severity assessed using the PTSD Check List for DSM V version (PCL-5). Brain activity was recorded using magnetoencephalography during a serial presentation of 86 images of outdoor scenes that were studied by participants for an upcoming recognition test. In a second session, the original images were shown intermixed with an equal number of novel images while participants performed the recognition task. Participants recognized 76.0% ± 12.1% of the original images and correctly categorized as novel 89.9% ± 7.0% of the novel images. A negative correlation was present between PCL-5 scores and discrimination performance (Spearman r = -0.38, p = 0.016). PCL-5 scores were also negatively correlated with the recognition accuracy for original images (r = -0.37, p = 0.02). Increases in theta and gamma power and decreases in alpha and beta power were observed over distributed brain networks during memory encoding. Higher PCL-5 scores were associated with less suppression of beta band power in bilateral ventral and medial temporal regions and in the left orbitofrontal cortex. These regions also showed positive correlations between the magnitude of suppression of beta power during encoding and subsequent recognition accuracy. These findings indicate that the lower recognition performance in participants with greater PTSD symptom severity may be due in part to ineffective encoding reflected in altered modulation of beta band oscillatory activity.
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http://dx.doi.org/10.1016/j.nicl.2019.102154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6965746PMC
December 2020

The combination of electroporation and electrolysis (E2) employing different electrode arrays for ablation of large tissue volumes.

PLoS One 2019 22;14(8):e0221393. Epub 2019 Aug 22.

Center of General Surgery and Liver Transplantation-Fundeni Clinical Institute, Bucharest, Romania.

Background: The combination of electroporation with electrolysis (E2) has previously been introduced as a novel tissue ablation technique. E2 allows the utilization of a wide parameter range and may therefore be a suitable technology for development of tissue-specific application protocols. Previous studies have implied that it is possible to achieve big lesions in liver in a very short time. The goal of this study was to test a variety of electrode configurations for the E2 application to ablate large tissue volumes.

Materials And Methods: 27 lesions were performed in healthy porcine liver of five female pigs. Four, two and bipolar electrode-arrays were used to deliver various E2 treatment protocols. Liver was harvested approx. 20h after treatment and examined with H&E and Masson's trichrome staining, and via TUNEL staining for selective specimen.

Results: All animals survived the treatments without complications. With four electrodes, a lesion of up to 35x35x35mm volume can be achieved in less than 30s. The prototype bipolar electrode created lesions of 50x18x18mm volume in less than 10s. Parameters for two-electrode ablations with large exposures encompassing large veins were found to be good in terms of vessel preservation, but not optimal to reliably close the gap between the electrodes.

Conclusion: This study demonstrates the ability to produce large lesions in liver within seconds at lower limits of the E2 parameter space at different electrode configurations. The applicability of E2 for single electrode ablations was demonstrated with bipolar electrodes. Parameters for large 4-electrode ablation volumes were found suitable, while parameters for two electrodes still need optimization. However, since the parameter space of E2 is large, it is possible that for all electrode geometries optimal waveforms and application protocols for specific tissues will emerge with continuing research.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221393PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6705851PMC
March 2020

Post-traumatic stress disorder is associated with altered modulation of prefrontal alpha band oscillations during working memory.

Clin Neurophysiol 2019 10 12;130(10):1869-1881. Epub 2019 Jul 12.

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA; Behavioral Biology Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA. Electronic address:

Objective: To investigate the relationship between the severity of PTSD symptoms, modulation of alpha band oscillations, and behavioral performance in a working memory task.

Methods: Magnetoencephalography data were recorded in 35 participants with combat exposure and various degrees of PTSD symptom severity while they performed a modified Sternberg working memory task: briefly presented sets of two or six letters had to be held in memory and participants indicated whether subsequent probe letters were present or absent from these sets.

Results: PTSD scores were positively correlated with the false positive rate in the high memory load condition. Higher rates of false recognition were associated with negative probes that were seen in recent previous trials (negative probe recency effect) or were physically similar with the list letters. The relative alpha band power in the left middle frontal gyrus was negatively correlated with both PTSD scores and false positive rates.

Conclusions: Reduced task specific modulation of alpha band oscillations in left middle frontal cortex may reflect alterations in the functions of pattern separation and suppression of memory traces for irrelevant or no longer relevant information in PTSD.

Significance: The lower amplitude of prefrontal alpha band oscillations may represent an important physiological basis for core PTSD symptoms and can provide a target for interventions to augment response to treatment.
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http://dx.doi.org/10.1016/j.clinph.2019.06.227DOI Listing
October 2019

Factors affecting the decision to undergo abortion in Romania: Experiences at our clinic.

J Eval Clin Pract 2020 Apr 31;26(2):484-488. Epub 2019 Jul 31.

Department of Obstetrics and Ginecology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania.

Rationale, Aims, And Objectives: It is estimated that 25% of pregnancies worldwide end in induced abortion. In Romania, the abortion situation shows a specific pattern. Following the fall of the communist regime, first-trimester abortions were legalized, and between 1990 and 1992, the country's abortion rate was the highest in the world, with 182 abortions per 1000 women of reproductive age. However, there are currently no statistically reliable data, as some abortions are not reported. The purpose of this study was to identify the main circumstances that determine the choice to undergo abortion with all related potential risks, rather than using contraception.

Method: We conducted a prospective type 1 cohort study based on a Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement that included women who presented at Bucur Maternity, Saint John Hospital, Bucharest, for abortion during the first trimester, between July and December 2018. The patients were asked to complete a 21-item questionnaire based on psychosocial data.

Results: The study included 119 patients, with a mean age of 29.57 years. Their educational level was average (ie, 51.3%, 4.2%, and 8.4% had completed high school, elementary school, and college or university, respectively). Most women were married (46.2%), and 47.9% were unemployed. The main reason for deciding to undergo an abortion was poverty (P = .014), and guilt was correlated with this decision (P = .004).

Conclusion: The profiles of the women who chose to undergo an abortion as a family planning method were as follows: in the third decade of life, resident of urban areas, married, unemployed, and with a low family income. The main reasons for abortion were financial status, advanced maternal age, incompatibility of pregnancy with future plans, and the desire to postpone conception.
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http://dx.doi.org/10.1111/jep.13250DOI Listing
April 2020

Continuous Noninvasive Hemoglobin Monitoring Reflects the Development of Acute Hemodilution After Consecutive Fluid Challenges.

Anesth Analg 2020 03;130(3):696-703

Department of Anesthesiology and Critical Care, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel.

Background: Consecutive fluid challenges (FCs) are frequently administered to maximize the stroke volume (SV) as part of a goal-directed therapy (GDT) strategy. However, fluid administration may also cause acute hemodilution that might lead to an actual paradoxical decrease in oxygen delivery (DO2). The aim of this study was to examine whether continuous noninvasive hemoglobin (SpHb) monitoring can be used to detect the development of acute hemodilution after graded fluid administration.

Methods: In 40 patients who underwent major vascular or gastrointestinal surgery, an FC, consisting of 250 mL colloid solution, was administered. When the SV increased by ≥10%, the FC was repeated up to a maximum of 3 times. Laboratory-measured hemoglobin concentrations (BHb), SpHb, SV, cardiac output (CO), and DO2 values were recorded after each FC.

Results: All 40 patients received the first FC, 32 patients received the second FC, and 20 patients received the third FC (total of 750 mL). Out of the 92 administered FCs, only 55 (60%) caused an increase in SV ≥10% ("responders"). The first and the second FCs were associated with a significant increase in the mean CO and DO2, while the mean SpHb and BHb decreased significantly. However, the third and last FC was associated with no statistical difference in CO and SV, a further significant decrease in mean SpHb and BHb, and a significant decrease in DO2 in these patients. Compared to their baseline values (T0), BHb and SpHb decreased by a mean of 5.3% ± 4.9% and 4.4% ± 5.2%, respectively, after the first FC (T1; n = 40), by 9.7% ± 8.4% and 7.9% ± 6.9% after the second FC (T2; n = 32), and by 14.5% ± 6.2% and 14.6% ± 5.7% after the third FC (T3; n = 20). Concordance rates between the changes in SpHb and in BHb after the administration of 250, 500, and 750 mL colloids were 83%, 90%, and 100%, respectively.

Conclusions: Fluid loading aimed at increasing the SV and the DO2 as part of GDT strategy is associated with acute significant decreases in both BHb and SpHb concentrations. When the administration of an FC is not followed by a significant increase (≥10%) in the SV, the DO2 decreases significantly due to the development of acute hemodilution. Continuous noninvasive monitoring of SpHb does not reflect accurately absolute BHb values, but may be reliably used to detect the development of acute hemodilution especially after the administration of at least 500 mL of colloids.
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http://dx.doi.org/10.1213/ANE.0000000000004323DOI Listing
March 2020

Remember the Romanian pioneers: Alexandru Obregia (1860-1937) - first in vivo suboccipital puncture.

Rom J Morphol Embryol 2019 ;60(1):333-336

Department of Neurosurgery, Faculty of Medicine and Pharmacy, University of Oradea, Department of Neurosurgery, Bihor Emergency County Hospital, Oradea, Romania;

In a time when doctors had limited knowledge about neuroanatomy and were focused primarily on clinical data, paraclinical investigations were overlooked even though they offered much needed information about the patients. Prof. Dr. Alexandru Obregia (1860-1937) is one of the forgotten pioneers of cerebrospinal fluid (CSF) investigation techniques. He envisioned, performed, and wrote about the very first in vivo suboccipital puncture, in 1908. The invention of this investigation technique was a considerable step forward in understanding the CSF and was Prof. Alexandru Obregia's most important scientific work. This, in turn, inspired Thoma Ionescu (1860-1926) to create the general rachianesthesia technique, in 1919, which allowed surgeons to perform a new range of procedures safely. The universal medical literature bears witness that this procedure was performed in other countries only after five years by Antonio & Bramman and after 11 years by Wegeforth, Ayer & Errik, thus confirming without a doubt Prof. Alexandru Obregia's priority in this historical finding.
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December 2019

Microscopic aspects of junction between dental hard tissues and composite material depending on composite insertion: layering versus bulk-fill.

Rom J Morphol Embryol 2019 ;60(1):133-138

Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Romania; Department of Dental Fixed Prosthetics-Occlusology, University of Medicine and Pharmacy of Craiova, Romania;

Polymerization stresses in adhesive structure could determine an adhesive or cohesive failure and interfacial gaps forming. Some clinical procedures - as light curing composite resin layering in 2-3 mm increments (especially for dental fills) or using dental reconfiguring clear acetate crowns - are sat up to combat (in some way) the polymerization shrinkage. This study approaches the manner how clinical dental adhesive application could influence the hard dental tissues-composite materials interface. The sample studied consisted of 12 upper bicuspids, extracted for orthodontic reasons. In our study, we chose the adhesion technique in "two steps". We prepared enamel and dentine areas, and then filled them with light-polymerization composite. After that, the teeth were subject of microscopic investigations, at 100× and 200× magnification. As conclusion of our study, we sustain that light curing composite resin applying clinical technique (by layering or with acetate crown) might influence a good dental restoration clinical performance.
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January 2020

Clinical effects of hemoadsorption with CytoSorb in patients with severe acute pancreatitis: A case series.

Int J Artif Organs 2019 Apr 14;42(4):190-193. Epub 2019 Jan 14.

3 "Dan Setlacec" Center of Gastrointestinal Disease and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.

Hemoadsorption using CytoSorb has recently gained attention as a new therapy aimed at modulating the inflammatory response syndrome in critically ill patients. The aim of our study was to assess the clinical effects of CytoSorb in patients with severe acute pancreatitis. We prospectively included 12 patients admitted to the intensive care unit for severe acute pancreatitis. After inclusion, continuous venovenous hemodiafiltration in conjunction with CytoSorb was applied. Clinical data, number of organ dysfunctions, paraclinical data, and vasopressor support were collected before and after the treatment. The use of CytoSorb was associated with a decrease in C-reactive protein from 242 (30, 300) to 180 (20, 252) mg/L (p = 0.04) and procalcitonin from 2.21 (0.01, 15.02) to 1.10 (0.01, 3.79) ng/mL (p = 0.02). The median vasopressor support was 0.1 (0, 0.9) mg/h at the beginning of the treatment and it was discontinued in all cases after the treatment. In conclusion, the use of CytoSorb in patients with severe acute pancreatitis was associated with improved hemodynamics and decreased inflammatory markers.
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http://dx.doi.org/10.1177/0391398818823762DOI Listing
April 2019

Effects of Fibrinogen Levels and Platelet Counts on Viscoelastic Testing in Cirrhotic Patients.

J Crit Care Med (Targu Mures) 2018 Jul 1;4(3):90-95. Epub 2018 Jul 1.

Department of Anesthesiology & Pain, Medicine, University of Washington Medical Center, Seattle WA, USA.

Introduction: Cirrhotic patients have been considered for decades to have a pro-haemorrhagic pattern and were treated as such based on the results from standard coagulation tests. The aim of our study was to determine the effects of platelet count and fibrinogen levels on rotational thromboelastometry (ROTEM) parameters.

Methods: We prospectively included 176 patients with End-Stage Liver Disease (ESLD) admitted to our Intensive Care Unit prior to liver transplantation. Collected data consisted of severity scores, liver, renal and standard coagulation tests, fibrinogen levels, platelet counts and ROTEM parameters. Four ROTEM assays were performed (ExTEM, InTEM, ApTEM and FibTEM) and the following parameters included: CT - clotting time, CFT - clot formation time, MCF - maximum clot firmness, ML - maximum lysis, alpha angle, TPI - thrombin potential index, MaxV - maximum velocity of clot formation (MaxV), MaxVt - time to MaxV, MCE - maximum clot elasticity and AUC - area under the curve.

Results: Statistical analysis demonstrated a linear correlation between platelet counts and ExTEM TPI (R2 linear =0.494), ExTEM MaxV (R2 linear =0.253), ExTEM MCE (R2 linear = 0.351) and ExTEM MCF (R2 cubic = 0.498). Fibrinogen levels correlated linearly with ExTEM MCF (R2 linear = 0.426), ExTEM TPI (R2 linear = 0.544), ExTEM MaxV (R2 linear = 0.332), ExTEM MCE (R2 linear = 0.395) and non-linearly with ExTEM CFT (R2 cubic = 0.475).

Conclusion: Fibrinogen levels and platelet counts had an important effect on both standard and derived ROTEM parameters. Further analysis is required in order to determine clinically oriented cut-off values below which severe coagulopathy would develop.
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http://dx.doi.org/10.2478/jccm-2018-0012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6294986PMC
July 2018

Morphological changes of gums in occlusal trauma.

Rom J Morphol Embryol 2018 ;59(3):787-802

Department of Occlusology and Fixed Prosthetics, University of Medicine and Pharmacy of Craiova, Romania;

Aim: Occlusal trauma causes major modifications of the coverage periodontium, which in turn reflect on the dental unit. The aim of the present study is to evaluate some of the morphological modifications occurred in the marginal periodontium surrounding teeth affected by occlusal trauma.

Materials And Methods: Fragments of marginal periodontium coming from 51 patients with occlusal trauma were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE), Masson's trichrome and anti-CD34 antibody immunostaining, in order to highlight the epithelial and connective tissue changes of gingival mucosa. A set of epithelial and connective tissue morphological parameters were assessed individually and based on three topographical criteria concerning the affected tooth.

Results: The epithelium and especially its superficial compartment presented changes depending on the tooth type and the dental arch. Epithelial thickness had the tendency to decrease as the fibrosis in both corium compartments and vascular density in the deep corium compartment were increasing. Leukoplakia present around the affected teeth but not always was related with the tooth type and was more obvious as the superficial compartment of the epithelium was thicker and as fibrosis was more reduced in the papillary compartment of the corium. Vascular density reduced when fibrosis process increased in the corium.

Conclusions: Lesions determined by occlusal trauma and their topography can and are influencing locally the different structures of the surrounding periodontium.
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December 2018

Quantitative assessment of morphological changes of dental pulp components of teeth affected by occlusal trauma.

Rom J Morphol Embryol 2018 ;59(3):729-740

Department of Occlusology and Fixed Prosthetics, University of Medicine and Pharmacy of Craiova, Romania;

Aim: In the general economy of the stomatognathic system functionality, the occlusal function has an important role, meaning both the dental-dental reports and the dynamic reports interarch-interarch. Because of the interrelationships and inter-dependency that govern the functioning of the biological systems, a pathological change affecting a component of the stomatognathic system produces impaired functioning of the others. The aim of the present study is to assess the morphological changes occurred in the dental pulp components of teeth affected by occlusal trauma.

Materials And Methods: Fragments of dental pulp coming from 45 patients with occlusal trauma were processed using classical histological techniques (formalin fixation and paraffin embedment) and stained with Hematoxylin-Eosin (HE), Masson's trichrome and anti-CD34 antibody immunostaining, in order to highlight the peripheral zone and central connective tissue of dental pulp morphological changes. A set of parameters namely thickness of peripheral zone components, calcifications, fibrosis and vascular density in the dental pulp were assessed individually and based on three topographical criteria namely the affected tooth, the position on the dental arches and the position according to sagittal plane.

Results: There was no correlation between morphological changes of dental pulp and the topography of teeth with occlusal trauma. The size of the peripheral area of the dental pulp and that of its components evolved in the same sense, whether it was growth or decrease. Decrease of the peripheral area was associated with the increase of collagen fibers density, calcium deposits and density of the capillary network. The direct correlation between the amount of collagen fibers and vascular density seems somewhat paradoxical but it can be explained by the reemergence of chronic inflammatory events located in the dental pulp.

Conclusions: It seems that dental pulp morphological changes are not influenced by the teeth with occlusal trauma topography. With one exception (the components of peripheral zone), most of the correlations between the dental pulp morphological changes were only suggested but not validated statistically, which requires further studies on larger groups together with the introduction of inflammatory cell population studies.
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December 2018

Rotational thromboelastometry (ROTEM) 24 hours post liver transplantation predicts early allograft dysfunction.

Rom J Anaesth Intensive Care 2018 Oct;25(2):117-122

Fundeni Clinical Institute, "Dan Setlacec" Center for General Surgery and Liver Transplantation, Bucharest, Romania.

Early allograft dysfunction (EAD) represents one of the most common and serious complications after liver transplantation (LT).

Methods: One hundred sixty-four patients who underwent LT were prospectively included in the present study. Patient demographics, intraoperative blood loss and transfusion were recorded at the time of LT. Lactate levels were recorded during surgery and daily for the first 3 postoperative days. Standard and derived rotational thromboelastometry (ROTEM) parameters were recorded 24 hours after LT. EAD was diagnosed according to Nanashima criteria and post anaesthesia care unit length of stay was recorded.

Results: Forty-seven patients (28.6%) developed EAD. Intraoperative blood loss (p = 0.01), packed red blood cells (p = 0.04) and fresh frozen plasma (p = 0.01) transfusion represented intraoperative risk factors for EAD. Lactate levels were significantly higher in patients with EAD at all time points. Patients with EAD demonstrated an increased clot formation time and decreased maximum clot firmness in both intrinsically (p < 0.01) and extrinsically (p < 0.01) activated assay, a decreased thrombin potential index (p < 0.01), area under the curve (p < 0.01) and clot elasticity (p < 0.01) on ROTEM assay.

Conclusion: Our results show that both standard and derived ROTEM parameters may indicate early signs of graft failure and can aid in the diagnosis of EAD.
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http://dx.doi.org/10.21454/rjaic.7518.252.tmsDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6211610PMC
October 2018

Neurosurgical rare disease: solitary plasmacytoma of the skull - case report and literature review.

Rom J Morphol Embryol 2018 ;59(1):367-373

Department of Medical Assistance and Kinetotherapy, Faculty of Sciences, University of Pitesti, Department of Neurosurgery, Emergency Hospital of Arges County, Pitesti, Romania; Research Center for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, Romania;

Solitary extranevraxial plasmacytoma (SEP), as a clinical entity without signs of systemic myelomatosis, is extremely rare; it is difficult to find literature on the issue of patient management and proper course of action in the presence of associated pathology. The authors present a rare case of plasmacytoma of the skull vault associated with severe cardiac pathology, which made surgery extremely difficult and possible only through temporization of the interventions, as presented. We discuss our findings and opportunities for treatment in this case, which seemed unapproachable at presentation, in connection with the associated cardiac pathology. The case was followed-up for eight years with no recurrences.
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October 2018

Neurosurgery in Romania in the centenary of the Great Union (1918-2018).

Rom J Morphol Embryol 2018 ;59(4):1299-1303

Department of Neurosurgery, "Victor Papilian" Faculty of Medicine, "Lucian Blaga" University of Sibiu, Romania;

Neurosurgery is one of the newest medical specialties in the world, having less than 100 years since its definition as a stand-alone surgical specialty by Harvey Cushing (1869-1939). Its emergence required several special prerequisites, which were met only in the mid-19th century: knowledge of neuroanatomy, function of nervous centers and main cortical area topography, standard asepsis-antisepsis rules, neuroimaging, safe and longer general anesthesia, hemostasis and coagulation techniques and of course knowledgeable, skillful and bold surgeons. The emergence of neurosurgery in Romania has a profound bivalent origin: French and American. The first Romanian neurosurgical center was founded by Alexandru Moruzzi, in 1933, in Iaşi. He was a direct student of the first French neurosurgeon Thierry de Martel, in Paris. The other neurosurgical center in Romania was founded by Dumitru Bagdasar, in 1935, in Bucharest. He studied directly under the first neurosurgeon in the world: Harvey Cushing (Boston, USA). Considering their success and international recognition against tremendous odds, the founding fathers of Romanian neurosurgery represent an example of intelligence, skill, courage and dedication for all future neurosurgeons.
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April 2019

Long disease-free survival following total sternal resection and reconstruction of the sternum with acrylic cement for unique massive sternal metastasis after operated breast cancer.

Rom J Morphol Embryol 2018 ;59(4):1225-1232

Department of Extreme Conditions Medicine, University of Medicine and Pharmacy of Craiova, Romania;

Unique sternal metastasis is an uncommon finding in the follow-up of operated breast cancer. We present a case of massive sternal metastasis occurred few years after radical resection of a right mammary cancer, that we solved by total sternal resection and reconstruction of sternum with acrylic cement and Vicryl mesh. The patient is disease-free five years after the operation.
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April 2019

Synthesis of Triarylamines via Sequential C-N Bond Formation.

J Org Chem 2017 11 7;82(22):11933-11938. Epub 2017 Sep 7.

School of Chemistry, University of Manchester , Oxford Rd, Manchester M13 9PL, U.K.

A one-pot domino N-arylation protocol is described using diaryliodonium reagents under copper catalysis. The reaction uses both aryl groups of the diaryliodonium reagent to generate triarylamines starting from simple anilines, representing an atom-economical preparation of an important class of organic material building blocks.
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http://dx.doi.org/10.1021/acs.joc.7b01778DOI Listing
November 2017

Activation of dominant hemisphere association cortex during naming as a function of cognitive performance in mild traumatic brain injury: Insights into mechanisms of lexical access.

Neuroimage Clin 2017 23;15:741-752. Epub 2017 Jun 23.

National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA.

Patients with a history of mild traumatic brain injury (mTBI) and objective cognitive deficits frequently experience word finding difficulties in normal conversation. We sought to improve our understanding of this phenomenon by determining if the scores on standardized cognitive testing are correlated with measures of brain activity evoked in a word retrieval task (confrontational picture naming). The study participants ( = 57) were military service members with a history of mTBI. The General Memory Index (GMI) determined after administration of the Rivermead Behavioral Memory Test, Third Edition, was used to assign subjects to three groups: low cognitive performance (Group 1: GMI ≤ 87,  = 18), intermediate cognitive performance (Group 2: 88 ≤ GMI ≤ 99,  = 18), and high cognitive performance (Group 3: GMI ≥ 100,  = 21). Magnetoencephalography data were recorded while participants named eighty pictures of common objects. Group differences in evoked cortical activity were observed relatively early (within 200 ms from picture onset) over a distributed network of left hemisphere cortical regions including the , the and , the and posterior part of the , and the and . Differences were also present in bilateral and , and in the . All differences reflected a lower amplitude of the evoked responses for Group 1 relative to Groups 2 and 3. These findings may indicate weak afferent inputs and an extended cortical network including association cortex of the dominant hemisphere in patients with low cognitive performance. The association between word finding difficulties and low cognitive performance may therefore be the result of a diffuse pathophysiological process affecting distributed neuronal networks serving a wide range of cognitive processes. These findings also provide support for a parallel processing model of lexical access.
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http://dx.doi.org/10.1016/j.nicl.2017.06.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491489PMC
April 2018
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