Iuliu Hațieganu University of Medicine and Pharmacy

We conducted a multicenter, observational, post-marketing, real-world cohort study in Romania that included all patients with MS (PwMS) who completed at least one cycle of CLD with at least three months of follow-up as of September 2024. Demographic variables and MS clinical characteristics regarding each patient were recorded. No Evidence of Disease Activity (NEDA-3) was assessed at one and two years after CLD initiation. The primary outcome was the proportion and characteristics of PwMS achieving NEDA-3 at 12 and 24 months after CLD initiation and the identification of predictors of failure in achieving NEDA-3. A total of 348 PwMS cases were included, of which CLD was the first DMT option in 129 (37.1%). At one year, 76.74% of the patients with complete available data fulfilled all criteria, achieving NEDA-3 status, with similar proportions between previously DMT-treated PwMS and naïve PwMS. In the univariate analysis, the onset of long-tract involvement, as compared to infratentorial (OR = 6.32, p = 0.01), and the number of Gd-enhancing lesions (OR = 1.12, p = 0.02), were significantly associated with increased odds of not achieving NEDA-3 at one year. In the multivariate model, long tracts (OR = 10.28, p = 0.006), higher baseline EDSS (OR = 1.39, p = 0.01), and longer disease duration (OR = 0.92, p = 0.04) were independent predictors. The initiation of CLD treatment was associated with achieving NEDA-3 at one year in >70% of cases. CLD demonstrated an improvement in MS control, irrespective of the patients' demographics, RMS history, or prior DMT exposure. CLD treatment has a favorable safety profile and a high level of patient adherence.

To provide an ESSKA-ESA formal Consensus to help general practitioners in their daily clinical decisions regarding the diagnosis and treatment of traumatic anterior shoulder instability (TASI) according to age and timing after injury. Part 1 is dedicated to the history-taking, physical examination and imaging studies. Patients were categorised into three age groups: adolescents (<20 years), young adults (20-40 years) and older adults (>40 years). Two clinical scenarios were addressed: first-time and recurrent dislocations. A formal consensus process was followed, including a steering group (15 experts from 9 countries), a rating group (18 experts from 18 countries) and a reader group (28 experts from 13 countries). The steering group formulated 35 clinical questions, 12 of which related to Part 1. Each question was answered with a statement and grade of recommendation (A-D), based on literature and expert opinion. The rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Consensus was reached with high agreement: median (range) 9 (8-9). One question received a grade A recommendation, nine were B, and two were C. Most debated topics included imaging to guide treatment decisions in first-time dislocations, assessment of glenoid bone loss, and soft tissue quality. Each age group presents unique diagnostic considerations: younger patients have higher recurrence risk and activity levels; older patients more often present with associated soft-tissue injuries. While physical exam findings were consistent across ages, associated injuries gain importance with age. The distinction between first-time and recurrent dislocations significantly impacts imaging needs. The ESSKA-ESA Consensus highlights that age and timing (first-time versus recurrent) influence the decision-making when managing TASI. All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. Level II.

Background/Objectives: This finite element analysis (FEA) assessed stress distribution in the tooth and dentin within an intact periodontium under 4 N of force and five orthodontic movements (intrusion, extrusion, rotation, tipping, and translation), using four failure criteria commonly used in numerical dental studies. Secondly, differences between brittle- and ductile-like failure criteria were found, and the most accurate criterion was determined. Additionally, movements more prone to inducing external orthodontic root resorption were assessed. Methods: Using nine 3D models of the second lower premolar, 180 numerical simulations were performed. The models were anatomically accurate based on CBCT scans. FEA employed the brittle-like Maximum Principal (MaxP), Minimum Principal (MinP), and ductile-like Von Mises (VM) and Tresca (T). Results: The results showed that tipping was less prone to external orthodontic root resorption than translation, extrusion, intrusion, and rotation, which showed areas of high stress concentration in the cervical third of the root. High-stress areas were visible only when the dentin-pulp-NVB components were separately analyzed, and not when the entire tooth structure was assessed. Only by correlating the qualitative with the quantitative results could the difference between brittle-like and ductile-like failure criteria be seen. Conclusions: In total, 4 N of applied orthodontic force can induce limited islands of external orthodontic root resorption (intrusion-extrusion on the vestibular side, rotation-translation on the lingual and distal-lingual sides). The ductile-like failure criteria maintained the accuracy of the results across all FEA simulations, while the brittle-like criteria showed various quantitative and qualitative inconsistencies.

Postmortem magnetic resonance imaging (PMMRI) after fetal or perinatal death is now being adopted more widely in clinical settings as a non-invasive alternative or complementary approach to conventional autopsy. However, indications and imaging protocols vary significantly between centers and require standardization. Emerging advanced imaging techniques such as ultra-high-field MRI are very promising in smaller fetuses. In this article, we outline the current indications for PMMRI across different clinical scenarios and review consensus PMMRI protocols, together with a preview of future imaging possibilities enabled by 7-T MRI technology. We hope these recommendations will facilitate the standardization and implementation of perinatal PMMRI in clinical practice.

Medical oncology is a young specialty in Romania, where early-career oncologists face challenges related to training, mentorship, and research. This study explored their professional status and needs to inform workforce development. An online survey was conducted between February and April 2025 among physicians under 40 years of age who were members of the Romanian National Society of Medical Oncology (SNOMR). The questionnaire (60 items) covered demographics, employment, mentorship, research, and professional development. Descriptive analysis was performed. Of 456 eligible members, 169 responded (response rate: 37%). Most were residents based in oncology institutes or university hospitals. Job insecurity was common, with 57% on temporary contracts. Nearly all respondents (99%) had clinical duties, but only 21% engaged in research and 9% in teaching. Mentorship was inconsistently available (61% had a mentor), yet interest in structured programs was very high (88% for national and 87% for international initiatives). Research involvement was limited: 46% reported no activity, 85% lacked funding, and only 28% published in the past year. While over 80% expressed interest in fellowships or exchanges, only 16% had trained abroad. Most (85%) were ESMO members, but only half considered SNOMR support sufficient. Young oncologists in Romania are motivated but face significant barriers, including job instability, insufficient mentorship, and limited research opportunities. Expanding structured mentorship, ensuring protected research time, and strengthening international mobility are essential. Recent SNOMR initiatives represent important first steps toward addressing these gaps.

Vimentin expression as a prognostic marker in pancreatic cancer: a systematic review and meta-22 analysis 23 The authors apologize for this error and state that this does not change the scientific conclusions of 34 the article in any way. The original article has been updated.

IntroductionClonal hematopoiesis (CH) is a common age-related phenomenon associated with an increased risk of hematologic malignancies and cardiovascular disease. Its prognostic significance in patients with solid tumors remains unclear. The aim of this meta-analysis was to evaluate the association between CH and clinical outcomes, including overall survival (OS), progression-free survival (PFS), cardiovascular events, and all-cause mortality in patients with solid tumors.MethodsWe conducted a meta-analysis according to PRISMA guidelines, including 21 studies comprising 4845 patients with CH and 63557 patients without CH. Hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals were pooled using random-effects or fixed-effects models as appropriate, based on assessments of between-study heterogeneity.ResultsCH was not significantly associated with OS in patients with solid tumors (HR: 1.10, 95% CI: 0.92–1.32, p = 0.30). The pooled analysis using a random-effects model suggested a trend toward improved PFS in patients with CH compared with those without CH, although statistical significance was not reached (HR: 0.83, 95% CI: 0.67–1.02, p = 0.08). However, CH was associated with an increased mortality in patients with solid tumors, with nearly a twofold higher risk compared to those without CH (OR = 1.70, 95% CI: 1.34-2.16, p < 0.00001). Furthermore, CH was significantly associated with an increased risk of cardiovascular events (OR = 2.75, 95% CI: 1.38 to 5.47, p = 0.004).ConclusionOur meta-analysis indicated that CH mutations have a prognostic value and are associated with a clinically meaningful increased risk of overall mortality and cardiovascular events in patients with solid tumors.

The purpose of this investigation was to develop and physicochemically characterize two natural O/W cosmetic cream prototypes (LC1, LC2) containing 5% (w/w) of a Vaccinium vitis-idaea (lingonberry) fruit extract (LE) together with their corresponding blank formulations (LC1-BL, LC2-BL). The extract was obtained by hydroalcoholic maceration followed by solvent removal and was characterized for total phenolic, flavonoid, and monomeric anthocyanin content. Its antioxidant capacity was evaluated using DPPH, FRAP, CUPRAC, and ABTS assays. The phenolic profile was further explored by HPLC–DAD–ESI(+), enabling tentative identification of phenolic subclasses previously reported in the literature to be associated with antioxidant properties. The prepared creams were evaluated for qualitative organoleptic properties, pH, texture (hardness, adhesiveness, and spreadability), viscosity, and accelerated conditions of stability. All formulations were stable, and no phase separation occurred; however, the addition of the extract modified their color and odor and decreased the pH to values within the physiological skin pH range. An in-silico safety evaluation of the constituents (MoS and TTC) found a good toxicological profile at concentrations employed. Overall, the results support the feasibility of incorporating lingonberry fruit extract into O/W cosmetic cream systems and demonstrate that appropriate formulation design allows the development of stable products with defined physicochemical and mechanical characteristics.

Microvascular procedures demand exceptional precision and are prone to technical errors that compromise outcomes. Performance improves fastest when errors are identified, measured, and corrected early during training. Error-based learning has become an essential part of microsurgical training, highlighting the importance of identifying and learning from mistakes to improve performance. This review aimed to systematically search the literature on all microsurgical errors and categorize them by operative phases. A structured literature search was conducted across Medline, Embase, and Web of Science databases, following PRISMA guidelines. Two reviewers independently screened records and extracted data in duplicate. Articles were included if they evaluated microvascular anastomoses with vessels less than 2 mm in diameter, and if microsurgical errors were detailed along with their impact on outcomes, in particular on anastomotic patency. Given the heterogeneity of the data, a SWiM-style (Synthesis Without Meta-analysis) narrative synthesis was used. A total of 34 studies met the inclusion criteria. Errors were categorized as pre-operative, intra-operative, and post-operative. Intra-operative errors were the most frequently reported. Back-wall stitches, uneven lumens, and excessive suture tension were consistently associated with reduced patency. Several validated scoring tools (e.g., ALI, MARS10, OSATS) were identified as effective in quantifying errors and guiding feedback in training settings. Microvascular anastomosis errors span all phases of the microsurgical procedure and significantly affect anastomotic success. This review offers a structured taxonomy of errors and underscores the importance of error-based learning and assessment in microsurgical training. Standardized error classification may enhance training programs, accelerating the acquisition of microsurgical skills along the learning curve and improving clinical outcomes.

Cardiovascular–kidney–metabolic syndrome is a novel concept defined by the American Heart Association, highlighting the complex interactions between the cardiovascular system, kidney function and metabolic risk factors. Poor cardiovascular–kidney–metabolic health is increasingly prevalent worldwide, giving rise to a need to optimize early detection of cardiovascular dysfunction. Heart failure is one of the most prevalent forms of cardiovascular disease in patients with chronic kidney disease and metabolic risk factors, but screening and diagnostic strategies remain challenging. Current guidelines endorse the use of prediction scores, as well as a biomarker-based strategy in patients at increased risk. Despite evidence supporting the use of biomarkers such as natriuretic peptides, there are considerable limitations to their use in the setting of cardiovascular–kidney–metabolic syndrome. Moreover, there is mounting evidence supporting the use of other biomarkers reflecting underlying mechanisms leading to heart failure. The aim of this review is to assess current approaches to screening for and diagnosing heart failure in cardiovascular–kidney–metabolic syndrome, highlighting the strengths and pitfalls of gold-standard and emerging biomarkers, while also addressing gaps in evidence and future research directions. Validation of screening biomarkers and development of multimarker prediction scores could impact clinical practice and reduce the growing morbidity and mortality in cardiovascular–kidney–metabolic syndrome.