Background & Aims: To evaluate the predictive factors for recurrence of the disease and overall survival(OS) after achieving complete response (CR) in patients with hepatocellular carcinoma (HCC) treated withtransarterial chemoembolization (TACE).Methods: From January 2013 to December 2017, 168 treatment-naïve patients diagnosed with HCCunderwent TACE as a first-line therapy and the gathered data was retrospectively reviewed. We determined the predictive factors for complete response (CR), for recurrence after CR and for survival using the Cox proportional hazard model.Results: Median follow-up was 27.4 months (range 4-65 months). The mean patient age was 62.2±7.9 years. Eighty-three patients had an α-fetoprotein (AFP) level > 20ng/mL. The median maximal diameter of the tumors was 3.5 cm. Sixty-three patients (37.5%) achieved CR after TACE, and recurrence after CR was detected in 37 patients (58.7%). In multivariate analysis, tumor size (≤4.5 cm) and a single tumor were found to be predictive factors for CR, with hazard ratios (HRs) of 2.352 (p=0.022) and 3.964 (p<0.0001), respectively. After achieving CR the median time to recurrence was 12 months (range 6-24 months). Elevated serum AFP > 25 ng/mL and multiple tumors were demonstrated to have a significant relationship with recurrence after CR, with HRs of 1.650 (p=0.05) and 3.932 (p=0.038), respectively. Increased initial serum AFP > 22 ng/mL, tumorsize > 4.5 cm, outside Milan criteria, not receiving a liver transplant and presence of portal vein thrombosis (PVT) were correlated with poor survival.Conclusions: In patients treated with TACE as an initial therapy, tumor size (≤4.5 cm) and single tumor were predictive factors for CR. Multiple nodules and an elevated serum AFP > 25 ng/mL were predictive factors for recurrence after CR. Outside Milan criteria tumors, elevated AFP levels and the presence of PVT were significantly correlated with decreased survival.

Urosepsis is a very serious condition with a high mortality rate. The immune response is in the center of pathophysiology. The therapeutic management of these patients includes surgical treatment of the source of infection, antibiotic therapy and life support. The management of this pathology is multidisciplinary and requires good collaboration between the urology, intensive care, imaging and laboratory medicine departments. An imbalance of pro and anti-inflammatory cytokines produced during sepsis plays an important role in pathogenesis. The study of cytokines in sepsis has important implications for understanding pathophysiology and for development of other therapeutic solutions. If not treated adequately, urosepsis may lead to serious septic complications and organ sequelae, even to a lethal outcome.

Introducere: Răspunsul inflamator joacă un rol critic în carcinogeneză. Există scoruri recente bazate pe răspunsul inflamator sistemic, cum ar fi raportul neutrofile/limfocite (NLR), raportul trombocite/limfocite (PLR), raportul limfocite/monocite (LMR), despre care s-a arătat că au valoare prognostică la pacienţii cu cancer. Aceste scoruri permit identificarea pacienţilor care vor avea un răspuns slab la tratament şi o supravieţuire de scurtă durată. Scopul acestui studio este de a evalua rolul prognostic al NLR, PLR, LMR şi PNI în termeni de supravieţuire la distanţă pentru bolnavii cu cancer colorectal, operaţi în urgenţă. Material şi Metode: Am inclus în studiu 391 de pacienţi internaţi şi operaţi pentru cancer colorectal complicat în clinica Chirurgie II a Spitalului Clinic Judeţean de Urgenţă "Sf. Ap. Andrei" din Galaţi, în perioada 2008-2017. Am analizat factorii paraclinici de inflamaţie sistemică NLR, PLR, LMR şi PNI.Ca factori de prognostic, au fost analizate curbele de supravieţuire. Rezultate: La pacienţii din lot, valorile crescute ale NLR, precum şi ale PLR au dus la creşterea riscului de deces (HR=7,581, 95% CI=(6.358,9.039), p value=0.000000, respective HR=1.043, 95% CI=(1.039, 1.047), p value=0.000000), iar valorile crescute ale LMR şi PNI au condus la scăderea acestui risc (HR=0.069, 95%

Undescended ovary (UO) is an uncommon congenital condition characterized by the presence of the adnexa above the common iliac vessels, with an estimated incidence of 0.3-2%. Because of its rarity, it is usually presented as a case report. A thorough knowledge of the ovarian embryological development is essential for the clinician, who must be warned about the possibility of associated Müllerian and renal malformations. There may be asymptomatic patients, incidentally diagnosed during infertility evaluation, but when symptoms occur, these are unspecific and most often this disorder is misdiagnosed, the accurate diagnosis being established intraoperatory. The malignant potential of an UO is accepted, although no such cases were reported. The role of the UO in infertility is still unclear, despite evidence of its normal function. Complications are linked to the ovary (cyst formation, cyst ruptures or tumors) or to the undescended fallopian tube (ectopic pregnancies). The management should be conservative, but there is no consensus about whether it is necessary to excise the ipsilateral undescended tube. We included a short case presentation of an UO cystadenoma misdiagnosed as a renal cyst, which depicts all diagnostic and management dilemmas and inspired us to write this review. The present literature review includes all the cases reported from the early 20th century to the present, with updated data about epidemiology, pathophysiology, clinical and imaging diagnosis, treatment options and prognosis of this rare condition. This paper aims to establish some directions in the diagnosis and management of similar patients and to remind us that, no matter how advanced the imaging investigation techniques might be, a correct preoperative diagnosis may often be missed.

Introduction: Despite its limitations, alpha-fetoprotein (AFP) is still the most common used serum marker for hepatocellular carcinoma (HCC). Alpha-fetoprotein-L3 (AFP-L3), protein induced by vitamin K absence (PIVKA-II) and Glypican-3 (GPC-3) have been proposed as complementary biomarkers but their role is still controversial. Aims and Methods: We prospectively included 101 patients with HCC and 52 control patients with liver cirrhosis with the aim to investigate the diagnostic performance of AFP, AFP-L3 PIVKA-II, and GPC-3 as single markers or in combination for HCC diagnosis. To compare the diagnostic value in distinguishing the presence of HCC from chronic nonmalignant liver disease, receiver operating characteristic (ROC) curves were constructed for each marker and for every combination of markers. Results: When all biomarkers were individually analyzed, AFP-L3 had the highest area under the curve (AUC) (0.84), followed by AFP (0.79), PIVKA-II (0.75) and GPC-3 (0.73) for HCC diagnosis. The best sensitivity (84.7%) was for AFP L3 at a cut-off >13.5ng/mL and the best specificity (93.9%) was for AFP at a cut-off >18.9 ng/mL. For combinations of two biomarkers, the AUC was highest (0.87) for AFP and AFP-L3. The combination of all four biomarkers resulted in a much better sensitivity (88.1%) and specificity (93.9%) than each of the markers individually (p = 0.01). Conclusion: AFP-L3 was the most useful single marker for HCC diagnosis, and the combination of AFP, AFP-L3 and PIVKA-II could maximize the diagnostic performance. Efforts to seek novel combination of biomarkers for HCC should be continued.

There was a significant decrease of AFP and DCP values after complete response in HCC patients treated with TACE. DCP is a more effective tumor marker in predicting response than AFP, with no benefit found in their combination.

Background: Postural skills are fundamental in motor activities, so far no evidence of a direct relationship has been found, it is therefore recommended to consider the following directions, the higher the level of sports competition, the better the body posture; or better athletes also have a better body posture. Around the age of 11-14 years, it is a period of aggressive development, if the rapid growth of the bone system is not associated and symmetrical with the development of soft tissues serious postural deficiencies may develop in table tennis players. Methods: We used the web camera – photographic method (38) related to the Sensor Medica software that allows the acquisition of images in order to detect postural deficiencies and we considered it necessary to have a clear image of the level of technical-tactical training of female juniors III using 5 tests specific to topspin attack in order to assess the influence of body posture on such tests. Eighteen female juniors III (the mean ± SD age, height and weight were 11.1 ± 0.2 years, 147.7 ± 2.6 cm, 39.0 ± 2.0 kg). Descriptive statistical analysis was performed on the procedures for establishing the normality of data distribution, Levene's Test for Equality of Variances, the t test for independent samples. The confidence interval was set at 95% (p < 0.05), Results and Conclusions: Since Sig. (2-tailed) or p < α = 0.001 and taking into account that the confidence interval limits for the difference between the sample mean and the reference value (95% CI for the mean difference) do not contain the zero value, it is accepted that there are statistically significant differences between the shoulder inclination for the female athletes in the sample studied and the reference value. We identified that at the level of alignment between anatomical landmarks, the percentage of deficiency of the entire lot of female juniors III in the case of shoulders is 100% and at the level of PSIS is 66%, which validates several studies that stated that in this period of aggressive growth correlated with repetitive unilateral executions specific to the topspin attack lead to postural deficiencies. In terms of the influence of body posture on the quality level, we identified that Group 1 – (without PSIS imbalance) has a higher average overall efficiency of the 5 tests (11.33) compared to Group 2 (8.58), even if from a statistical point of view these differences are not significant. Keywords: Body posture, Asimmetry, Topspin attack, Table tennis, Sensor Medica,

Introduction: Acute kidney injury (AKI) following liver transplantation (LT) is a frequent complication and is associated with increased morbidity and mortality. Aim: To investigate whether the levels of urinary KIM-1 and serum Cystatin C are able to predict early occurrence (within the first 48 hours) of the post-LT renal dysfunction. Methods: The study was conducted on 25 recipients transplanted in the Fundeni Clinical Institute between May 2016 and February 2017. Serum Cystatin C, urinary KIM-1 and serum creatinine were analysed before LT, as well as 4 and 24 hours after graft reperfusion. In defining renal failure, the criteria of The Acute Kidney Injury Network (AKIN) were used. All patients received the same renal sparing regimen of immunosuppression (basiliximab, mycophenolate mofetil and delayed tacrolimus). Results: Ten patients (40%) had early post-LT (<48h) renal dysfunction according to the AKIN classification. In the AKI group, there was a considerable increase of serum Cystatin C at 4 and 24 h after LT in comparison with baseline values (p=0.011), whereas in the group without AKI, the values of Cystatin C dropped (p=0.11). There were no significant differences between the KIM-1 values between the two groups. The single independent risk factor for early post-LT AKI occurrence was serum Cystatin C value 4 hours after hepatic reperfusion. The clinical utility of serum Cystatin C and urinary KIM-1 4 h after reperfusion, evaluated by AUROC, was good (0.79). However, the combination of the two biomarkers and the MELD plus score had a better performance, with an AUROC of 0.83, an 80% sensitivity and 80% specificity for distinguishing patients with early post-transplant AKI from those without AKI. Conclusion: Early renal dysfunction following LT is frequent (40%) despite using a renal sparing immunosuppression regimen. Combination of serum Cystatin C and urinary KIM-1, 4 hours after hepatic reperfusion and pre-LT MELD-plus score performed the best in screening the early post-LT renal dysfunction.