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"Costea, Radu"
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Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery
by
Costea, Radu
,
Zarnescu, Eugenia Claudia
,
Zarnescu, Narcis Octavian
in
Alcohol
,
anastomotic fistula
,
anastomotic leakage
2021
Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.
Journal Article
The Evaluation of Restored Proximal Contact Areas with Four Direct Adherent Biomaterials: An In Vitro Study
by
Căminișteanu, Florentina
,
Marcov, Narcis
,
Ștețiu, Maria Antonia
in
adherent biomaterials
,
Analysis
,
Biological products
2025
The aim of this study was to compare the interproximal contact tightness of lateral teeth after restoring adjacent proximal walls with four types of direct adherent biomaterials. Distal and mesial boxes were prepared on 160 artificial right first and second upper molars. Each set of 40 pairs of boxes was restored using one bulk biomaterial: Equia Forte Fil HT (GC), Cention® Forte (IVOCLAR VIVADENT), Admira Fusion x-tra (VOCO), or 3MTMFiltekTM One Bulk Fill. The mean difference in the passing-through force varied from sound to restored surfaces immediately after application, as well as at 7 and 14 days after: Equia Forte Fil HT—4.07 ± 0.01, 4.08 ± 0.01, and 4.11 ± 0.01; Cention® Forte—3.30 ± 0.01, 3.50 ± 0.01, and 3.56 ± 0.01; Admira Fusion x-tra—4.10 ± 0.01, 4.13 ± 0.01, and 4.13 ± 0.01; 3MTMFiltekTM One Bulk Fill—4.08 ± 0.01, 4.09 ± 0.01, and 4.07 ± 0.01 (p < 0.05). The passing-through force of the restored contact areas showed significantly higher values when compared to those for the sound surfaces, and among them, all biomaterials presented similar values, except for Cention® Forte. The potential clinical relevance of this study relates to better knowing the most appropriate restorative material for large proximal caries on adjacent surfaces from the outset of the treatment protocol.
Journal Article
Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review
by
Dumitrascu, Ioana
,
Zarnescu, Eugenia Claudia
,
Zarnescu, Narcis Octavian
in
Abdomen
,
abdominal compartment syndrome
,
Acidosis
2022
Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.
Journal Article
Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy: Unicenter Analysis
by
Zarnescu, Eugenia Claudia
,
Zarnescu, Narcis Octavian
,
Costea, Radu
in
Body mass index
,
Care and treatment
,
Classification
2022
Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods: All consecutive patients with right colon cancer who underwent right colectomy in our department between 2016 and 2021 were retrospectively included in this study. The Clavien–Dindo grading system was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyses were used to investigate risk factors for postoperative severe complications. Results: Of the 144 patients, there were 69 males and 75 females, with a median age of 69 (IQR 60–78). Postoperative morbidity and mortality rates were 41.7% (60 patients) and 11.1% (16 patients), respectively. The anastomotic leak rate was 5.3% (7 patients). Severe postoperative complications (Clavien–Dindo grades III–V) were present in 20 patients (13.9%). Univariate analysis showed the following as risk factors for postoperative severe complications: Charlson score, lack of mechanical bowel preparation, level of preoperative proteins, blood transfusions, and degree of urgency (elective/emergency right colectomy). In the logistic binary regression, the Charlson score (OR = 1.931, 95% CI = 1.077–3.463, p = 0.025) and preoperative protein level (OR = 0.049, 95% CI = 0.006–0.433, p = 0.007) were found to be independent risk factors for postoperative severe complications. Conclusions: Severe complications after oncologic right colectomy are associated with a low preoperative protein level and a higher Charlson comorbidity index.
Journal Article
Nanofeatured Titanium Surfaces for Dental Implants: A Systematic Evaluation of Osseointegration
by
Căminișteanu, Florentina
,
Șerbănescu, Cristina Maria
,
Popescu, Mircea
in
Analysis
,
Animal experimentation
,
Animal models
2025
Background: Whether nanoengineered titanium surfaces confer superior implant stability beyond modern microrough controls remains uncertain. Methods: This systematic review followed PRISMA 2020 guidance: comprehensive multi-database searching with de-duplication; dual independent screening, full-text assessment, and standardized data extraction for predefined outcomes (implant stability quotient [ISQ], mechanical anchorage by removal/push-out/pull-out torque, and histologic bone-to-implant contact). Risk of bias was appraised with RoB 2 for randomized trials, ROBINS-I for non-randomized clinical studies, and CAMARADES (animal experimentation). The certainty of clinical evidence was summarized using GRADE. Results: Across animal models, nanoengineered surfaces consistently improved early osseointegration indices (higher removal torque and bone-to-implant contact at initial healing). In clinical comparative studies, nanoengineered implants showed modest, time-limited gains in early stability (ISQ) versus microrough titanium. By 3–6 months, between-group differences typically diminished, and no consistent advantages were demonstrated for survival or marginal bone outcomes at later follow-up. Methodologic heterogeneity (surface chemistries, timepoints, outcome definitions) and small clinical samples limited quantitative synthesis. Overall, risk-of-bias concerns ranged from some concerns to high in non-randomized studies; the certainty of clinical evidence was low. Conclusions: Nanofeatured titanium surfaces improve early osseointegration but do not demonstrate a consistent long-term advantage over modern microrough implants. Current evidence supports an early osseointegration benefit without clear long-term clinical advantage over contemporary microrough implants. Adequately powered, head-to-head trials with standardized stability endpoints and ≥12-month follow-up are needed to determine whether early gains translate into patient-important outcomes.
Journal Article
Comparative Cost-Effectiveness of Resin 3D Printing Protocols in Dental Prosthodontics: A Systematic Review
by
Ștețiu, Maria Antonia
,
Popescu, Mircea
,
Drăguș, Andi Ciprian
in
3-D printers
,
Bias
,
Clinical outcomes
2025
Objectives: This systematic review aimed to evaluate the cost, production time, clinical performance, and patient satisfaction of 3D printing workflows in prosthodontics compared to conventional and subtractive methods. Methods: Following PRISMA guidelines, a systematic search of electronic databases was performed to identify studies published between 2015 and 2025 that directly compared digital additive workflows with analogue or subtractive workflows. Studies were eligible if they included prosthodontic treatments such as dentures, crowns, or implant-supported prostheses and reported at least one relevant outcome. The primary outcomes were cost, time efficiency, clinical accuracy (e.g., marginal adaptation, fit), and patient satisfaction. Included studies were methodologically evaluated using MINORS scale and the risk of bias was assessed using ROBINS-I and RoB 2 tools. Results: Seven studies met the inclusion criteria. Overall, 3D printing workflows demonstrated reduced production time and cost in comparison to conventional or subtractive methods. Clinical outcomes were generally comparable or superior, particularly regarding adaptation and fit. Patient satisfaction was favourable in most studies, although reporting varied. Long-term follow-up was limited, which constrains the interpretation of sustained clinical performance. Conclusions: These findings suggest that 3D printing can serve as an efficient and cost-effective alternative in prosthodontic fabrication, with clinical results comparable to those already established. Further research is needed to assess long-term clinical performance and cost-effectiveness in various clinical scenarios.
Journal Article
Multimodal Prehabilitation in Major Abdominal Surgery—Rationale, Modalities, Results and Limitations
by
Vasilescu, Catalin
,
Jafal, Nader Mugurel
,
Minca, Dana Galieta
in
Abdomen - surgery
,
abdominal surgery
,
Colorectal cancer
2025
Recent evidence revealed that an adequate preoperative physiological reserve is crucial to overcome surgical stress response. Consequently, a new concept, called prehabilitation, emerged, aiming to improve the preoperative functional reserve of patients who will undergo major abdominal surgery. During the interval between diagnosis and surgery, a multimodal approach consisting of physical exercise and nutritional and psychological support could be employed to enhance physiologic reserve. Physical activity interventions aim to improve aerobic capacity, muscle strength and endurance. Nutritional support addressing malnutrition and sarcopenia also contributes to the achievement of the above-mentioned goals, particularly in patients undergoing cancer-related procedures. Psychological interventions targeting anxiety, depression and self-efficacy, as well as risk behavior modification (e.g., smoking cessation) seem to enhance recovery. However, there is a lack of standardization regarding these interventions, and the evidence about the impact of this multidisciplinary approach on the postoperative outcomes is still contradictory. This narrative review focuses on the physiological basis of surgical stress response and on the efficacy of prehabilitation, reflected mainly in the length of hospitalization and rates of postoperative complications. Multidisciplinary collaboration between surgeons, nutritionists, psychologists and physiotherapists was identified as the key to the success of prehabilitation programs. Synergizing prehabilitation and ERAS protocols significantly improves short-term surgical outcomes. Recent well-designed, randomized clinical trials revealed that this approach not only enhanced functional reserve, but also decreased the rates of postoperative complications and enhanced patient’s overall quality of life, emphasizing the importance of its implementation in routine, elective, surgical care.
Journal Article
Cervical Cancer Mortality in Romania: Trends, Regional and Rural–Urban Inequalities, and Policy Implications
by
Neacsu, Adrian
,
Bohiltea, Roxana Elena
,
Bacalbasa, Nicolae
in
Age groups
,
age-standardized mortality
,
Cellular biology
2021
Background and Objectives: Despite being largely preventable, cervical cancer mortality still remains an important public health problem globally, in Europe, and in Romania. The European Union member states are urged to implement systematic, population-based screenings for cervical cancer, but the programs developed by the countries remain very heterogeneous. This study aimed to investigate the differences in cervix cancer mortality between Romania and EU and within Romania over the last two decades and to reveal the major sources of inequalities and the policy implications. Materials and Methods: We analyzed the number of deaths and the mortality rates by cervical cancer, standardized using the direct method, over two decades (2001–2016 for the EU, and 2001–2019 for the national and sub-national analyses). Trends, mortality reduction over the years, and mortality differences at the beginning and end of the time interval have been calculated for the EU and Romania, at national and sub-national levels (rural–urban and regions). Results: Our results revealed differences in cervical cancer mortality between Romania and EU and within Romania (among regions and rural–urban areas). These differences used to be very high in the past and are still persisting. Conclusions: The country should revisit its national cervical cancer screening program, which has been implemented for many years, but with a very limited participation rate. Due to the similar problems existing in Central-Eastern Europe, targeted support from the EU for the members from this geographical area could contribute to the minimization of differences in cervical cancer mortality among the EU members.
Journal Article
Assessing the Genotoxic Impact of Ni-Cr Alloys in Dental Prosthodontics: A Preliminary Comparative Analysis with and Without Beryllium
by
Caministeanu, Florentina
,
Burlibasa, Mihai
,
Popa, Andrei Sabin
in
Alloys
,
Beryllium
,
Biomedical materials
2025
Objective: This study aims to evaluate cell proliferation capacity and micronuclei incidence in the presence of nickel–chromium (Ni-Cr)-based dental alloys, with and without the addition of beryllium (Be). The use of these alloys in dental prosthetics is widespread; however, the potential risks associated with their genotoxicity and cytotoxicity require further investigation. The study seeks to provide insight into the safety of these materials and their long-term impact on the health of both patients and dental professionals. Methods: The study was conducted through a comparative analysis of genotoxicity and cytotoxicity using human lymphocyte cultures exposed to two types of Ni-Cr-based dental alloys, one containing beryllium and the other without beryllium. The evaluations were performed according to the OECD Test No. 487 guideline, employing the micronucleus assay and cell proliferation assay. Lymphocytes were exposed to three different alloy concentrations (5 mg/mL, 10 mg/mL, and 20 mg/mL), and the effects on genetic material were analyzed microscopically. Descriptive statistics (mean, standard deviation, and variance) were calculated, and one-way ANOVA was used to assess statistical significance between groups, with a significance threshold of p < 0.05. Results: A significant increase in cytotoxicity and micronuclei incidence was observed in the samples containing beryllium compared to those without beryllium. Statistical analysis revealed significant differences (p < 0.001) between the test and control groups and between different concentrations. Additionally, a direct proportional relationship was noted between alloy concentration and the intensity of genotoxic effects. Microscopic analysis confirmed genetic material damage, indicating a potentially increased risk associated with the use of this type of dental material. Conclusions: The data obtained suggest that Ni-Cr-based dental alloys containing beryllium may present a significant risk of genotoxicity and cytotoxicity. Therefore, the selection of materials used in dental prosthetics should be based on solid scientific evidence, and the use of these alloys should be approached with caution. The study highlights the need for further research to better understand the long-term impact of these materials on human health.
Journal Article
Cumulative Antibiogram: A Rapid Method to Hinder Transmission of Resistant Bacteria to Oral Cavity of Newborn Babies
by
Burlibasa, Mihai
,
Pîrvu, Daniela Aurelia
,
Manolescu, Loredana Sabina Cornelia
in
Antibiotic resistance
,
antibiotic susceptibility testing
,
Antibiotics
2023
Background: A rapid bacterial diagnostic is needed more and more in the treatment of patients, because of the emergence of antibiotic resistance. The cumulative antibiogram, an annual report that monitors antimicrobial resistance trends in health care facilities, may provide a profile of empirical therapy useful in diverse emergency situations, such as transmission of resistant bacteria to oral cavity of newborn babies. We aimed to draw a profile of antibiotic resistance encountered. Methods: We assessed the antibiotic resistance (ABR) profile in childbearing women and newborn babies in Ploiesti Obstetrics and Gynecology Hospital by the disk diffusion method characterizing the multidrug-resistant organisms after isolation and identification by phenotypic tests. Extended-spectrum β-lactamase (ESBL)-producing Enterobacterales (ESBL-E), Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant Group B Streptococcus (VR-GBS) were detected. Results: The prevalence of antibiotic resistance was 11.32% (53/468), while the prevalence of the ESBL-E, MRSA, VRE and VR-GBS strains was 8.34% (39/468). Within the bacteria isolated from fifty-three childbearing women, the prevalence of ESBL-E, MRSA, VRE and VR-GBS was 22.64% (12/53), 32.08% (17/53), 11.32% (6/53) and 7.55% (4/53). In the whole studied group, the prevalence was 2.56% (12/468), 3.63% (17/468), 1.28% (6/468) and 0.86% (4/468). Resistant bacteria were detected at birth in the oral cavity of the newborn babies in all cases. Maternal and neonatal isolates shared similar characteristics. Conclusions: Cumulative antibiogram is useful in case of empiric treatment needed in diverse emergencies, such as transmission of resistant bacteria to oral cavity of newborn babies.
Journal Article