Daniel Timofte

Oxidative Stress Implications in the Affective Disorders: Main Biomarkers, Animal Models Relevance, Genetic Perspectives, and Antioxidant Approaches

The correlation between the affective disorders and the almost ubiquitous pathological oxidative stress can be described in a multifactorial way, as an important mechanism of central nervous system impairment. Whether the obvious changes which occur in oxidative balance of the affective disorders are a part of the constitutive mechanism or a collateral effect yet remains as an interesting question. However it is now clear that oxidative stress is a component of these disorders, being characterized by different aspects in a disease-dependent manner. Still, there are a lot of controversies regarding the relevance of the oxidative stress status in most of the affective disorders and despite the fact that most of the studies are showing that the affective disorders development can be correlated to increased oxidative levels, there are various studies stating that oxidative stress is not linked with the mood changing tendencies. Thus, in this minireview we decided to describe the way in which oxidative stress is involved in the affective disorders development, by focusing on the main oxidative stress markers that could be used mechanistically and therapeutically in these deficiencies, the genetic perspectives, some antioxidant approaches, and the relevance of some animal models studies in this context.

Anaplastic Thyroid Carcinoma or Thyroid Metastasis fromCholangiocarcinoma? A Case Report

Anaplastic thyroid carcinoma presents as an extremely localy invasive neck mass while metastases in the thyroid are most commonly described as small, indolent, solitary nodules usually originating from kidney, breast, lungs and skin tumors. We report the case of a 74-year old male patient illustrating the difficulties of differential diagnosis between an anaplastic thyroid carcinoma and a thyroid metastasis of a peripheral cholangiocarcinoma in a cirrhotic patient diagnosed and operated for a locally advanced thyroid tumor. The history, clinical and imagistical features strongly pleaded for the diagnosis of anaplastic thyroid carcinoma presumably with liver metastases, also supported by the rapid recurrence following total thyroidectomy. Immunohistochemical tests showed a malignant carcinomatous proliferation with anaplastic prophile. Positive immunochemical staining for cytokeratin AE1/AE3, CK7 and negative CK20, AFP, CD15, CD30, CD5, TTF1 and thyroglobulin directed the possible diagnosis toward a secondary thyroid tumor from a peripheral cholangiocarcinoma. Immunohistochemical tests showed a malignant carcinomatous proliferation with anaplastic prophile. Positive immunochemical staining for cytokeratin AE1/AE3, CK7 and negative CK20, AFP, CD15, CD30, CD5, TTF1 and thyroglobulin directed the possible diagnosis toward a secondary thyroid tumor from a peripheral cholangiocarcinoma. A CT-guided percutaneous hepatic punction biopsy was planned but the patient presented an ischemic stroke with fatal outcome. In conclusion, in spite of surgical treatment the rapid recurrent thyroid cancer either primary or metastatic had a poor prognosis with fatal outcome mainly in the presence liver cirrhosis and cardio-vascular co-morbidities.

General issues encountered while diagnosing mild cognitive impairment in Romanian patients: Mild cognitive impairment in Romanian patients

Mild cognitive impairment (MCI) could be defined as a transition phase between normal aging and dementia. If one can imagine a scale of cognitive continuum, which has normal aging and dementia as benchmarks, MCI would be somewhere between the two, represented by cognitive disorders, which do not interfere significantly with one individual’s social or occupational functionality (Petersen et al., 1999). The main objective of this study is to validate Montreal Cognitive Assessment (MoCA) in Romanian language. MoCA is an instrument for screening cognitive function and has already been translated in 46 languages. MoCA has been validated by means of comparison, by placing the test in parallel with a similar one that has already been translated in Romania—mini-mental state examination (MMSE).

Upper Digestive Endoscopy Prior to Bariatric Surgery in Morbidly ObesePatients - A Retrospective Analysis

Aim: Obesity has become one of the world’s major public health problems. It is now accepted that bariatric surgery is a far better option than nonsurgical treatments for morbid obese patients. Routine upper gastrointestinal (GI) endoscopy as a complementary method for evaluation of bariatric patient’s status prior to surgery is still a matter of debate. Aim of the study was to evaluate the importance of routine upper GI endoscopy before bariatric surgery. Material and methods: A clinical retrospective study was carried out on a series of 77 patients referred for bariatric surgery between 2012 and 2015 in our surgical unit. We reviewed the medical records of all patients, endoscopy diagnosis, histopatological reports on gastric endoscopic biopsies and the colonisation with H. pylori. Result: The patients in our study had a median age of 39.25 years and a BMI (body mass index) ranging from 33.3 to 60.5 kg/m2 (median of 44.66 kg/m2). Upper GI endoscopy was performed in all patients before bariatric surgery, regardless of upper gastrointestinal simptomatology. Chronic gastritis was found on upper GI endoscopy prior to bariatric surgery in 36.3% of cases and Helicobacter pylori infection was identified in 26% of cases. 6.5% of the patients were diagnosed with hiatal hernia, a hyperplastic gastric polyp, a intragastric pancreatic tissue ectopy and a case of gastric cancer were also detected. Conclusion: Although preoperative endoscopy rarely diagnose pathological conditions that may change the surgical approach, we believe that, for a complete work-out of these patients, gastroenterology consultation and upper GI endoscopy should be mandatory prior to bariatric surgery.

Increased oxidative stress status in rat serum after five minutes treadmill exercise

Although it is accepted that an important correlation exists between the physical exercise and the oxidative stress status, the data regarding the levels of the main oxidative stress markers after physical training have been difficult to interpret and a subject of many controversies. There are also very few studies regarding the effects of short-time exercise on the oxidative stress status modifications. Thus, in the present report we were interested in studying the modifications of some oxidative stress markers (two antioxidant enzymes-superoxide dismutase and glutathione peroxidase, a lipid peroxidation parameter — malondyaldehide, the total antioxidant status and protein carbonyl levels), from the serum of rats that were subject to one bout of five minutes exercise on a treadmill, when compared to a control sedentary group. In this way, we observed a decrease of superoxide dismutase specific activity in the rats which performed the exercises. Still, no modifications of glutathione peroxidase specific activity were found between groups. In addition, increased levels of malondyaldehide and protein carbonyls were observed in the rats subjected to exercises. In conclusion, our data provides new evidence regarding the increase of the oxidative stress status, as a result of a 5-minutes bout of treadmill exercising in rats, expressed through a decrease in the SOD specific activity and the total antioxidant status and also an increase of the lipid peroxidation and protein oxidation processes.

Survival Prediction for Romanian Patients with Pancreatic Cancer

Pancreatic cancer is one of the most lethal malignancies worldwide and in some of the latest statistics ranks fourth in the total number of deaths related to cancer in patients of both genders. Currently, curative treatment is only possible in cases of resectable disease and during the initial stages. Still, although complete surgical resection is the only potential curative approach of this disease, it can only be performed in 10 to 20% of patients, since most individuals present with advanced disease upon diagnosis. Moreover, in the recent decades the development and improvement of surgical techniques have only improved postoperative mortality, without having any significant impact on the survival, with specialized pancreatic surgery centres reporting mortality below 5%. In this way, in the present study conducted on 188 patients from the “St. Spiridon” Clinical Emergency Hospital Iasi, we were interested in determining the survival rates in pancreatic cancer, as well as looking at the staging criteria for adenocarcinoma of the pancreas that follows the tumor/node/metastasis (TNM) system and the correlations between any of these stages and the overall survival. Weibull distribution was used to estimate the overall survival. Reduced survival in pancreatic cancer was found to be within the limits found in the published literature: 41.7% at 1 year, 8.7% at 3 years and 1.9% at 5 years. Still, no significant correlation was found between any of the disease stages and the overall survival.

Obesity is Linked with Inflammation-Evaluation of Subclinical Inflammatory Status in Obese Patients

Background: Obesity is one of the most important public health; it seems that inflammation is a pathogenic pathway between obesity and its associated comorbidities. The aim of the study was to evaluate the status of serum inflammatory markers in a group of obese patients hospitalized for bariatric surgery.Materials and methods: We performed a retrospective study on 64 obese patients successively hospitalised in our Surgical Unit between November 2014 and November 2016. All patients received a full evaluation including medical and personal history, complete clinical examination, and anthropometric measurements as well as general and special biological tests. The inflammatory status of each patient was evaluated by serum values of fibrinogen, CRP, Leptin and NLR and PLR scores. Insulin resistance was assesed by the homeostasis model assessment of insulin resistance index. We noted the presence of metabolic syndrome and its components and also the presence of obstructive sleep apnea syndrome.Results: 62.5% of patients had ≤45 years and the number of male patients was significantly lower (23.4%) than the number of females. The mean value of BMI was 45.06 ± 6.67 SD and the mean value of waist circumference was 133.39 cm ± 17.47 SD. The mean values of serum inflammatory markers (fibrinogen, CRP and leptin) were abnormally elevated. There was a directly proportional relationship between the increasing of waist circumference and serum fibrinogen (p=0.04) and CRP (p=0.003) variation. Elevated fibrinogen values corelated with MS, DM II and OSA. Increased leptin values corelated with BMI, HOMA IR and OSA.Conclusion: Elevated serum values of fibrinogen and CRP correlate especially with abdominal obesity, quantified by waist circumference, while increased pathological values of serum leptin correlates also with BMI. Of all inflammatory markers assesed in the study, elevated fibrinogen appear to be most sensitively related to the presence of MS, OSA and DM II.

Complex Systems with Self‐Elimination of Dissipation with Implication in Bio‐Structural Behavior Via Nondifferentiability

In the present chapter, we show that the use of the nondifferentiable mathematical procedures, developed in the Scale Relativity Theorywith constant arbitrary fractal dimension, simplifies very much the dynamics analyses in the case of complex systems. By applying such a procedure to various complex systems dynamics (biological structures, ablation or discharge plasmas, etc.), we are able to observe that it starts from a steady (oscillating state) and as the external factor is varied the system undergoes significant changes. The systems evolve asymptotically through various transition, toward a chaotic regime (like bifurcations or intermittencies), but never reaching it. Another important reveal from the study of the system’s dynamics was the presence of various steady states depending on the resolution scale atwhich the theoretical investigations are performed.

Giant retroperitoneal paraganglioma debuting with gestational hypertension

We present the case of a 26-year-old female patient with no significant personal or collateral history of diseases, first time pregnant, diagnosed with gestational hypertension, arising de novo in ...

Postoperative Biological and Physiological Gastrointestinal Changes afterWhipple Procedure

In the last years there was an increased interest towards the pancreatic cancer, especially considering its growing incidence (rapidly becoming the fifth cause of death by cancer in the developed countries), lack of any sustainable markers and/or risk factors and the chilling fact that almost 95% of the patients with this disorder are presenting to the hospital in the advanced and unresectable stages. Even more, although known and developed for almost 70 years, the surgical approach for the pancreatic cancer is a subject of debate because its efficacy and postoperative biological changes. It is known that the most common surgery in chronic pancreatitis and pancreatic cancer is represented by the Whipple pancreatico duodenectomy. Still, after an extended resection and reconstruction of the upper gastrointestinal tract, it seems that the digestive physiology can be disrupted. In this way, in the present mini-review we will describe some postoperative gastrointestinal biological and physiological changes after Whipple procedure, by mainly focusing on the gastrointestinal motility, bone demineralization, dumping and re-resection, as well as on the affected pancreatic function, postoperative weight loss and remnant pancreatic fibrosis and how the management of this related pathological aspects can be applied in these cases.