Background: In this study the organization of long-term anticoagulant treatment has been evaluated to estimate whether clinical practice is in accordance with current recommendations for optimal use and effective control of oral anticoagulant (OAC) treatment. Material and methods: Mixed (quantitative and qualitative), transversal, descriptive, selective study. Samples: quantitative study – 394 adult patients, eligible for anticoagulant treatment; qualitative study – 39 family doctors. Results: The rate of use of OAC treatment is 68%. The period from the diagnosis of the disease to the initiation of OAC treatment lasted one month or more in 59.1% of patients. 60.6% of patients do not have sufficient knowledge regarding the treatment of OAC. The high price is the most important barrier to direct oral anticoagulant administration (91.1%). Patients’ satisfaction with OAC treatment control is low, mainly for vitamin K antagonists (59.8%). 75.5% of respondents claim that OAC treatment control and management is poor. 40.3% do not perform safe therapeutic International Normalized Ratio control, and 54.7% are not in the optimal therapeutic range. Conclusions: The main barriers to adherence to OAC treatment: the burden of regular monitoring of blood parameters, perceived concern about complications, limited access to laboratory tests and specialist doctors, insufficient information about anticoagulation, and deficiencies in communication with medical staff. There is limited conviction, and uncertainty persists in the initiation and monitoring of OAC treatment by family doctors.

Background: Preterm birth remains a leading obstetrical complication because of the incomplete understanding of its multifaceted etiology. It is known that immune alterations toward a proinflammatory profile are observed in women with preterm birth, but therapeutic interventions are still lacking because of scarcity of evidence in the integration of maternal and placental interrelated compartments. Objective: To investigate value of Lactoferrin (LF) and Interleukine-6 (IL-6) in the preterm labor. Material and methods: The study comprised 65 women with spontaneous preterm labor and 65 women with term labor. Maternal plasma concentrations of Lactoferrin and Interleukine-6 were detected by standard test system Aeskulisa Lactoferrin and Best-Vector A-8768 for Interleukine-6 Ref 3307 which (GmbH & Co, Germany) gave an analytical sensitive of 1.0 U/ml for Lactoferrin and 0.131 pg/ml for Interleukine-6. Results: Plasma levels of Lactoferrin in women with preterm labor were lower (μmedian = 0.90 U/ml) (p<0.001) than in the control subjects (μmedian = 40.68 U/ml). Plasma levels of Interleukine-6 in the plasma in women with preterm were predictably higher (μmedian = 51.90 pg/ml) than that in the control subjects with term delivery (μmedian = 21.51 pg/ml) (p<0.001). Conclusions: The study findings suggest that plasma levels of Lactoferrin and Interleukine-6 in women with preterm labor may be considered as a promising early biomarker for preterm labor.

Background: The tissue engineering is the evolving science that combines cells, biomaterials and biochemical factors aimed at restoring, maintaining and substituting different types of tissue. An important role is played by the use of the stem cells in various fields of medicine, including ophthalmology, namely in cases of retinopathies and optic nerve atrophy. Conclusions: Current treatment of the optic nerve atrophy is based on the etiological causes or late complications. Considering the availability of advanced therapies, stem cell therapy offers a new approach in the treatment of the atrophy of the optic nerve. Being easy to harvest and cultivate, mesenchymal stem cells are most commonly used in regenerative medicine, they can be induced to differentiate into cartilage, tendons, adipose tissue and other cell lines. Mesenchymal stem cell harvesting has no ethical issues compared to embryonic stem cell harvesting. The major histocompatibility factor II is not expressed on the surface of mesenchymal stem cells, and this great advantage allows their use in autologous or allogenic form. Mesenchymal stem cells produce growth factors with paracrine action that are thought to activate endogenous repair mechanisms, due to these properties mesenchymal stem cells have been used in several clinical studies in optic nerve disorders where immunomodulatory and neuroprotective properties have been demonstrated. All of the properties mentioned above stand for the clinical use of mesenchymal stem cells in case of optic nerve atrophy.

Background: The constrained knee prosthesis has the basic indication in revision arthroplasty, but the latest literature reveals that it takes place also in primary total knee arthroplasty in cases of knee osteoarthritis associated with major deformities. Material and methods: Present study is based on the surgical treatment, using the constrained knee prosthesis in the primary total knee arthroplasty, during 2019-2021, of 28 patients with knee osteoarthritis associated with severe deformities in varus or valgus, in the Big Joint Replacement Department, Clinical Hospital of Traumatology and Orthopedics, Chisinau. Results: In this study, the following criteria were evaluated: the type of deformity – valgus (10 cases) and varus (18 cases); the degree of deformation – for varus knees was on average 300 , and for valgus knee – 250 ; bone attrition – 11 cases with bone defects where it was necessary to use augmentations; affected side – in 19 cases the right knee was affected and 9 cases the left one; the women/men ratio was 4/1; the mean age of the patients was 67.5 years; average duration of the intervention – 140 minutes; in 5 cases a lateral para-patellar approach was performed, of which 2 cases with tibial tuberosity osteotomy; complications – 1 case with intra-operative periprosthetic fracture and 2 cases with superficial infections of the operated joints. Conclusions: Osteoarthritis of the knee progresses rapidly, leading to severe deformities, significant bone defects and joint instability, which are indications to use the constrained prosthesis in the primary total knee arthroplasty, long-term follow-up is necessary to obtain the last conclusion, but from this study the constrained knee prosthesis like primary implant for special indication had promising results.

Background: Transurethral resection of the bladder is one of the essential methods in the diagnosis, treatment and management of non-muscularinvasive bladder cancer. The purpose of the procedure is to remove completely all visually detected tumors with a following establishment of a very precise histological diagnosis. The aim of the study is to compare the results of conventional transurethral endoscopic treatment and the En-bloc resection method using different types of energy sources in the treatment of bladder tumors. Material and methods: A total number of 88 patients underwent endourological interventions. Regarding the distribution, 23 patients had conventional transurethral resection, 22 – En-bloc monopolar resection, 21 – En-bloc bipolar resection and 22 – En-bloc with Thu:YAG laser. Clinical data, intraoperative and postoperative data and also the histopathological examination results were compared. Results: The compared groups were heterogeneous by age, sex, tumor characteristic (size, number, location). No significant differences were observed during the operations, comparing the intraoperative and postoperative complications of the studied groups. The detrusor musculature was detected in 74% of cases after conventional transurethral resection, in 91% of cases of En-bloc monopolar resection, in 95% of cases of En-bloc bipolar resection and in 96% of cases of En-bloc Thu:YAG laser. Conclusions: The En-bloc resection technique of non-muscular-invasive bladder tumors is a safe and effective method comparing with the conventional transurethral resection; it allows more favorable postoperative results and obtaining better quality tumor samples which allow establishing correct diagnosis of the disease.

Background: Frailty syndrome is one of the most important multifactorial medical syndromes, which is characterized by a decrease in functionality of many systems and organs. Material and methods: In order to establish the nutritional determinants that contribute to the onset of frailty syndrome, a study was performed on a group of 50 patients, aged ≥65 years with chronic pathologies and geriatric syndromes. All participants were examined according to clinical features (history, clinical examination), Mini Nutritional Assessment and of the Complex Geriatric Assessment, which included: the data of the frailty tools, age category, Vulnerable Elders Survey, Charlson Comorbidity Index, autonomy – Activity Daily Living, Instrumental Activity Daily Living, Tinetti scale, psychoaffective status – by memory test Mini-Mental State Examination and the Geriatric Scale of Depression in the context of nutrition in the elderly. A clustered analysis (k-means method) of nutritional status showed that the most relevant indicators that separated the clusters were: age category, gender, clinical scale of frailty, comorbidities and polymedication. Results: Frailty through the multidimensional aspects that it meets has an increased prevalence among the elderly with an unfavorable prognosis. Following the proposed study, it was revealed that insufficient nutrition and comorbidities can lead to the weakening of the institutionalized age. The results obtained by evaluating the bio-psycho-social aspects characterize the profile of the institutionalized elderly and can be used as a basis for the development of effective strategies aimed at reducing physical, cognitive and social frailty. Conclusions: The comparative evaluation between both groups of elderly people by gender, showed a normal nutritional status with a higher share in women in the group of 75-84 years, compared to older men, and malnutrition was practically manifested equally in both groups in the study (men/women)

Background: Multiple studies have found a relatively increased risk of placenta-mediated pregnancy complications in women with congenital thrombophilia, especially early recurrent pregnancy loss, fetal loss, early-onset preeclampsia, intrauterine growth restriction, and premature abruption of normally positioned placenta. However, the extent of the association and the absolute risk are very modest, but they significantly increase in pregnant women with severe obstetric complications. Conclusions: There is convincing evidence that deficiency of natural anticoagulants (antithrombin, protein C, protein S) is a risk factor for late fetal loss. Factor V Leiden G1691A gene mutation and prothrombin G20210A gene mutation are associated with a double risk for early and unexplained recurrent pregnancy loss and for non-recurrent late fetal loss. The association of congenital thrombophilia with preeclampsia is much more uncertain, being probably limited factor V Leiden G1691A gene mutation and more severe cases of preeclampsia. Fewer data are available on intrauterine growth restriction (IUGR) and premature abruption of the normally positioned placenta. There is insufficient evidence to suggest an association of other forms of congenital thrombophilia with adverse pregnancy outcomes. In addition, genetic and epidemiological research suggests that placenta-mediated pregnancy complications are of polygenic multifactorial etiology, with a risk determined by the interaction of multiple genetic variants and other risk factors.

Background: The purpose of the study was to diagnose possible chronic nonbacterial prostatitis (CNP) and chronic pelvic pain syndrome (CPPS) among patients, as well as differentiate between the inflammatory (category IIIA) or non-inflammatory (category IIIB) types in selecting and optimizing differential drug treatment of this category of patients. Material and methods: The study was conducted on 43 patients diagnosed with CNP/CPPS. The control group included 10 healthy men. Both the production of nitric oxides (NO) by phagocytes, as well as prostate secretion and ejaculate were determined according to the procedure described by Metelyskaya B.A., which was modified by Gudumac V, et al. Results: There was a 39.0% (p <0. 05) decrease in NO production by induced NO-synthase (iNOS), determined in the blood of 11 patients (from the main group – 2) with CNP/CPPS and a 115% (p <0.05) increase was determined in 32 patients (from the main group 1) if compared to the same indices in the control group. The prostatic secretion and ejaculate showed a higher macrophage iNOS activity by 80% (p <0.05) and 75% (p <0.05) if compared to the same parameters from the control group. The iNOS activity in prostatic fluid and split-ejaculate fractions from the main group – 2 did not differ from that of the control group. Conclusions: The assessment of NO production, prostate secretion and ejaculate allows to somewhat establish the main diagnosis of CNP and category III types (A – inflammatory and B – non-inflammatory prostatitis), which will significantly contribute to the optimization and selection of an appropriate differential treatment based on the drug action mechanisms

Background: The extracellular matrix plays an important role in the promoting the tissue regeneration and repair. Decellularization or removal of the cells from the complex mixture of the structural and functional proteins that constitute the extracellular matrix (ECM) can be done by the physical (agitation, sonication, freeze and thaw), chemical (alkaline orchids, ionic detergents, nonionic, tri-n-butyl phosphate (TBP), hypotonic or hypertonic treatments, chelating agents), and enzymatic methods (trypsin or protease inhibitors). However, complications associated with the use of the decellularized skin have been reported, which are widespread and poorly understood. In this synthesis have been included publications, identified by the Google Search engine, National Bibliometric Tool (NBT), Pub Med databases, Web of Science, Springer, Elsevier, Wiley Online Library, Science Direct and Biosience, Biotechnology and Biochemistry. The results of the decellularization were reported in terms of the number of cells remaining in the collagen fibers depending on the duration of exposure to chemical agents. Conclusions: The natural matrix is more widely used than synthetic material, because it has the natural structure and composition of the ECM, it naturally stimulates cell development and allows the incorporation of the growth factors and other proteins increasing cell proliferation.The assessment of the quality of decellularization techniques is done by evaluating the necrosis of the extracellulare matrix, the depletion of the collagen fibers and the remaining amount of genetic material.

<strong>Background: </strong>Hepatitis C is a disease with significant global impact. According to the World Health Organization there are 71 million people chronically infected with the hepatitis C virus. About 399.000 people die each year, mostly from cirrhosis and hepatocarcinoma. GT 1 and 3 are the most common causes of infection. Chronic HCV infection is accompanied by extrahepatic manifestations reported in up to 75% of patients, rapid development of hepatic fibrosis and accelerated time to cirrhosis and increased risk for liver failure, HCC and liver-related mortality. HCV therapy is one of the interventions necessary to reduce global burden of disease. Because of their high virological efficacy, ease of use, safety and tolerability, IFN-free, ribavirin-free, DAA-based regimens must be used in HCV-infected patients without cirrhosis or with compensated cirrhosis, including: treatment-naïve patients: never been treated for their HCV infection, treatment-experienced patients: previously treated with PEG-IFNa + RBV. From pangenotypic drugs or drug combinations for treatment HCV in Europe are recommended: sofosbuvir/velpatasvir, sofosbuvir/velpatasvir/voxilaprevir and glecaprevir/pibrentasvir. Genotype-specific drugs sofosbuvir/ledipasvir, ombitasvir/paritaprevir/ritonavir, or grazoprevir /elbasvir are recommended for (GT 1, 4, 5 and 6). <strong>Conclusions:</strong> The new direct-acting antiviral treatment regimens can be given to most patients with chronic hepatitis C virus infection, including those with liver cirrhosis, their have shown high efficacy, achieving sustained virologic response in over 90% of patients. DAA are well tolerated and have minimal side effects that do not require treatment discontinuation.