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Liver transplantation in Wilson’s disease
Get PDFBackground. Wilson’s disease is a rare genetic disorder caused by excessive copper accumulation in
the body, particularly in the liver and brain. In severe cases, where the disease leads to liver failure,
liver transplantation may be required.
Objective. A review of the specialized literature to gain a better understanding of the indications for
liver transplantation in Wilson’s disease and its impact on patient health outcomes.
Material and Methods. A systematic search of scientific publications was conducted in major
databases, including PubMed, Web of Science, and Scopus.
Results. Liver transplantation from a living donor provides superior outcomes, with no reported
disease recurrence in these patients. Among patients with neurological manifestations, a 74.2%
reduction in symptoms was observed postoperatively. Survival rates at the interval of 1-10 years were
reported at 84% and 80%, respectively. While the mortality rate in the first post-transplantation year
is 16%, it decreases to 4% in the 1–10-year period. Liver transplantation immediately corrects the
copper metabolism defect, with serum ceruloplasmin levels normalizing within the first post-surgery
month. The only factor influencing survival rates was reported to be neurological status, with patients
presenting severe neurological symptoms having significantly lower survival rates. The high survival
rates may be attributed to the relatively young age at the time of transplantation, the low number of
comorbidities, and the absence of disease recurrence.
Conclusions. Liver transplantation in Wilson’s disease is associated with a high survival rate and a
74.2% improvement in neurological symptoms post-transplant. The 1-, 5-, and 10-year survival rates
were comparable, and perioperative care remains the primary determinant of long-term survival
Neural stem cell transplantation for neurodegenerative diseases
Get PDFBackground. Neurodegenerative diseases, including Alzheimer's disease, Parkinson's disease,
Huntington's disease, and amyotrophic lateral sclerosis, are severely disabling and ultimately fatal
conditions that affect millions of individuals worldwide. Stem cell transplantation is emerging as a
promising therapeutic approach due to its potential to facilitate multiple reparative processes within
the central nervous system, such as cell replacement and paracrine effects.
Objective of the study. To evaluate the potential of neural stem cell (NSC) transplantation as a
therapeutic approach for neurodegenerative diseases and identify the key mechanisms through which
NSCs exert their effects.
Material and Methods. This study represents a literature synthesis based on articles published in the
period 2020-2025, selected from the databases PubMed, NCBI, MPDI, Springer Ling, UpTodate.
Results. Studies have shown that neural stem cell transplantation can have a positive impact on
neurodegeneration through various mechanisms, including neurotrophic factor production, reduced
neuroinflammation, enhanced neuroplasticity, and cell replacement. To fully harness the potential of
NSCs, it is crucial to investigate their biological characteristics, such as subpopulation markers,
secretome, which is responsible for the regulation of intercellular communication, neuroprotection,
and immunomodulation, and ability to migrate and integrate into NSС neuronal networks. Recent
advances in gene editing and cellular engineering offer opportunities to enhance their therapeutic
effects.
Conclusion. Neural stem cell transplantation offers significant potential for treating neurodegenerative
diseases. It is necessary to standardize protocols, ensure control of secondary effects such as tumor
formation and immune rejection. Further research is needed to optimize cell sourcing, improve longterm outcomes, and minimize risks
Clinical-radiological features and oxidative stress in patients with community-acquired pneumonia and heart failure
No full textBackground and Objective: Diagnosing community-acquired pneumonia (CAP) in patients with chronic heart failure (CHF) can
be challenging. This study aimed to examine the clinical and paraclinical diagnostic characteristics, along with oxidative stress
(OS) markers, in individuals suffering from both CAP and CHF.
Methods: A total of 210 patients were enrolled and divided into two groups: group 1 (n = 105) – patients with CAP associated
with CHF and group 2 (n = 105) – patients with CAP without CHF.
Key Content and Findings: Worsening of dyspnoea was present in 98 (93.3%) patients in group 1, compared to group 2 – 73
(69.5%) patients, P < 0.0001. Bilateral extension of pneumonia was more frequent in group 1 compared to group 2: 63 (60.0%)
patients versus 57 (54.3%) patients, respectively, P = 0.515. The presence of pleural effusion was more common in group
1 compared to group 2: 41 (39.0%) patients versus 14 (13.3%) patients, P < 0.0001. The total antioxidant activity (AAT), by
CUPRAC method, had higher values in group 1 (6.70 ± 4.62) versus group 2 (4.99 ± 4.29), P = 0.006.
Conclusions: Bilateral extension of pneumonia, presence of pleural effusion, worsening of preexisting dyspnoea and the
elevation of total antioxidant activity values (CUPRAC method) are useful tools in the early diagnosis of CAP in patients with CHF.Introducere: Diagnosticul pneumoniei comunitare (PC) pe fundalul insuficienței cardiace cronice (ICC) poate fi dificil. Scopul
lucrării a fost de a analiza particularitățile clinice și paraclinice de diagnostic, precum și parametrii stresului oxidativ (SO), la
pacienții cu PC și ICC.
Metode: În studiu au fost incluși 210 de pacienți, divizați în 2 loturi: grupul 1 (n = 105) – pacienți cu PC asociată cu ICC și grupul
2 (n = 105) – pacienți cu PC fără ICC.
Rezultate: Agravarea dispneei fost prezentă la 98 (93.3%) pacienți din grupul 1, comparativ cu grupul 2, unde aceasta a fost
prezentă la 73 (69.5%) pacienți, P < 0,0001. Extinderea bilaterală a pneumoniei s-a întâlnit mai frecvent în grupul 1 comparativ
cu grupul 2: 63 (60.0%) pacienți versus 57 (54.3%) pacienți, respectiv, P = 0,515. Prezența revărsatului pleural a fost mai frecvent
întâlnită în lotul 1, comparativ cu lotul 2: 41 (39.0%) pacienți versus 14 (13.3%) pacienți, P < 0,0001. Activitatea antioxidantă
totală (AAT), prin metoda CUPRAC, a avut valori mai mari în grupul 1 (6,70 ± 4,62) versus grupul 2 (4,99 ± 4,29), P = 0,006.
Concluzii: Extinderea bilaterală a pneumoniei, prezența revărsatului pleural, agravarea dispneei preexistente și elevarea
valorilor activității totale prin metoda CUPRAC, sunt instrumente utile de diagnostic precoce a pneumoniei comunitare la pacienții
cu insuficiență cardiacă cronică
Eficacitatea investigațiilor imagistice în diagnosticul anomaliilor congenitale ale ducturilor Mülleriene: 324.01 – Radiologie și imagistică medicală: Teză de doctor în științe medicale
No full textStructura tezei: Lucrarea conţine următoarele compartimente: introducere, 4 capitole, concluzii generale,
recomandări practice, bibliografie din 274 de surse, este expusă pe 128 de pagini. Teza conţine 17 tabele, 85 de figuri,
8 anexe. Rezultatele obținute sunt publicate în 20 lucrări științifice.
Cuvinte-cheie: anomaliile ducturilor Mülleriene (ADM), atrezia himenului (AH), septuri vaginale transverse
complete (SVTC), sindromul Herlyn-Werner-Wunderlich (HWW), sindromul Mayer-Rokitansky-Kűster-Hauser
(MRKH), uterul Robert (UR), uterul unicorn (UU), histerosalpingografia (HSG) ultrasonografia bi- și tridimensională
(USG 2D și 3D), Imagistica prin Rezonanța Magnetică (IRM), Tomografia computerizată (TC).
Domeniul de studiu: imagistica medicală.
Scopul cercetării: Optimizarea managementului imagistic în diagnosticul anomaliilor ducturilor Mülleriene prin
prisma evaluării particularităților anatomiei radiologice a patologiei malformative cu abordarea complexă a metodelor
radio-imagistice.
Obiectivele cercetării: Analiza aspectelor moderne în diagnosticarea pacientelor cu patologia malformativă ale
ducturilor Mülleriene după efectuarea histerosalpingografiei, ultrasonografiei (2D şi 3D), Imagisticii prin Rezonanța
Magnetică și Tomografiei Computerizate. Validarea semiologiei imagistice și radiologice în stratificarea anomaliilor
simetrice și asimetrice uterine. Elucidarea anatomiei radiologice ale malformațiilor uterine orfane. Evaluarea
particularităților imagistice ale anomaliilor obstructive ale vaginului (atrezia himenului, septul vaginal transversal
complet, sindromul Herlyn-Werner-Wunderlich), evaluarea anomaliilor renale asociate. Determinarea anatomiei
radiologice al malformațiilor congenitale asociate ale uterului şi vaginului (sindromul Mayer-Rokitansky-Kűster Hauser).
Noutatea și originalitatea științifică: Cercetarea este originală prin faptul realizării unei analize comparative a
metodelor imagistice inițiale și ultraperformante în diagnosticul ADM. În baza studiului a fost confirmată și
argumentată necesitatea metodelor imagistice ultraperformante (USG 3D și IRM) în diagnosticul precoce al
anomaliilor Mülleriene. Prin analiza particularităților clinico-imagistice au fost evidențiate și stabilite diferite categorii
ale patologiei malformative Mülleriene, dintre care prevalează anomaliile simetrice uterine. Au fost stabilite 3 cazuri
extrem de rar întâlnite - uterul septat asimetric (Uterul Robert). S-a dovedit că UU fără corn rudimentar se întâlnește
mai des decât uter unicorn cu corn uterin cavitar sau necavitar. Sinteza rezultatelor obținute a stabilit că dintre
anomaliile obstructive asociate cu hematocolpos prevalează paciente cu atrezia himenului (AH) în comparație cu
sindromul HWW sau SVTC. În toate cazurile observate AH a fost prezentată în forma izolată. În studiul pacientelor
cu SVTC s-a constatat că hematocolposul asociat cu hematometra a fost diagnosticat mai frecvent de cât cel izolat. A
fost stabilit faptul că septurile vaginale transversale joase se întâlnesc statistic mai frecvent, decât cele medii. În mai
multe cazuri prezentate, SVTC reprezintă o anomalie izolată. În cazul sindromului HWW a fost constatat faptul că
varianta sindromului HWW pe dreapta a fost diagnosticat mai frecvent decât cel din stânga. S-a evidențiat că ocluzia
completă a hemivaginului se observă mai frecvent decât obstrucția incompletă. În toate cazurile sindromului HWW a
fost stabilită agenezia renală din partea hematocolposului. S-a stabilit că agenezia uterină se întâlnește mai rar,
comparativ cu aplazia uterină. Prezența ambelor rudimente uterine în grupul pacientelor cu MRKH s-a depistat mai
des. Rudimente uterine necavitare s-au întâlnit mai frecvent, comparativ cu rudimente cavitare. În sindromul MRKH a
fost stabilit că localizarea pelvină a ovarelor a fost mai frecventă comparativ cu poziţia extrapelvină. În cadrul
studiului a fost depistat un caz extrem de rar a sindromului MRKH asociat cu disgerminom ovarian .
Problema științifică soluționată: constă în optimizarea diagnosticului imagistic al ADM cu evaluare comparativă a
diferitelor metode imagistice. S-au constatat particularitățile clinice şi imagistice ale ADM, au fost elucidate
posibilitățile şi eficacitatea aplicării metodelor radiologice şi optimizarea diagnosticului acestora. A fost confirmat
rolul investigațiilor tomografice și ultrasonografice folosind reconstrucții multiplanare (MPR) și imagini 3D. Studiul
realizat a constatat că posibilitatea metodelor diagnostice inițiale (HSG și USG 2D) este limitată, în majoritatea
cazurilor ADM este necesar de efectuat metodele imagistice ultraperformante (USG 3D și IRM).
Semnificația teoretică: a fost stabilită acuratețea de diagnostic a metodelor imagistice inițiale (HSG și USG 2D) și
metodelor ultraperformante diagnostice (USG 3D și IRM) în estimarea ADM. Au fost elucidate variantele radiologice
al anatomiei organelor bazinului mic în ADM în sindromul MRKH. A fost prezentat un caz extrem de rar a
sindromului MRKH cu disgerminom ovarian. În cadrul studiului efectuat au fost stabilite variantele anatomice al
sindromului Herlyn-Werner-Wunderlich (OHVIRA). Au fost stabilite caracteristicele radiologice ale septului vaginal
transversal complet, au fost constatate radiologic toate variantele anatomice a uterului septat (US). A fost confirmat
rolul imaginilor IRM în ponderație T1 și T2 pentru determinarea țesutului endometral și pentru determinarea
conţinutului hemoragic.
Valoarea aplicativă: în practica imagistică au fost implementate criteriile obligatorii de selecție pentru diagnostic
contemporan precoce al ADM. Studiul efectuat a permis de analizat diversele clase de anomalii ale uterului şi
vaginului, anomaliilor asociate concomitente.
Implementarea rezultatelor științifice: în baza acestui studiu a fost implementată metodologia diagnostică de
determinare a variantelor ADM în Departamentul diagnostic, secție medicină materno-fetală a IMSP Institutului
Mamei și Copilului, în Centrul Medical „MagnaMed”, în Centrul Medical „AnaMaria-Med” (or. Chișinău, Republica
Moldova).Структура диссертации: Диссертация содержит следующие разделы: введение, 4 главы, общие выводы,
практические рекомендации, библиография из 274 источников, изложена на 128 страницах. Диссертация
содержит 17 таблиц, 85 рисунков, 8 приложений. Полученные результаты опубликованы в 20 научных работах.
Ключевые слова: аномалии Мюллеровых протоков (АМП), атрезия девственной плевы (АДП), полные
поперечные перегородки влагалища (ПППВ), синдром Herlyn-Werner-Wunderlich (HWW), синдром Mayer Rokitansky-Küster-Hauser (MRKH), матка Robert (МR), однорогая матка (ОМ), гистеросальпингография (ГСГ),
двухмерная и трехмерная ультрасонография (УЗИ 2D и 3D), магнитно-резонансная томография (МРТ),
компьютерная томография (КТ).
Область исследования: методы диагностики в медицине.
Цель исследования: Комплексный подход в оптимизации использования радиовизуализирующих методов
исследования при диагностике аномалий Мюллеровых протоков путем оценки особенностей
рентгенологической анатомии пороков развития.
Задачи исследования: Анализ современных аспектов диагностики у пациенток с АМП после выполнения
различных методов визуализации (ГСГ, УЗИ 2D, 3D и МРТ). Оценка радиологической семиологии в
стратификации симметричных и асимметричных аномалий матки. Особенности радиологической анатомии
редких пороков развития матки. Оценка радиологических особенностей обструктивных аномалий влагалища
(атрезия девственной плевы, полная поперечная перегородка влагалища, синдром HWW), оценка
сопутствующих аномалий почек. Определение радиологической анатомии сочетанных аномалий матки и
влагалища (синдром MRKH).
Новизна и научная оригинальность: впервые был проведен сравнительный анализ первичных и
высокоэффективных методов визуализации в диагностике АМП. Подтверждена и аргументирована
необходимость использования высокопроизводительных радиологических методов (УЗИ 3D и МРТ) в ранней
диагностике аномалий Мюллеровых протоков. Путем анализа клинико-радиологических особенностей
выделены и установлены различные категории АМП, среди которых преобладают симметричные аномалии
матки. Среди АМП выявлено 3 редких случая аномалий матки – ассиметричная перегородка матки (матка
Robert). Установлено, что ОМ без рудиментарного рога встречалась чаще, чем ОМ с наличием кавитарного
или некавитарного рога. Обобщение результатов проведенного клинического исследования установило, что
среди обструктивных аномалий влагалища с наличием гематокольпоса, преобладают пациентки с атрезией
девственной плевы (АДП) по сравнению с синдромом HWW или ПППВ. Во всех наблюдаемых случаях АДП
была представлена в изолированной форме. При исследовании пациенток с ПППВ установлено, что
гематокольпос, ассоциированный с гематометрой, диагностируется чаще, чем изолированный. Доказано, что
дистальные поперечные перегородки влагалища статистически встречаются чаще, чем расположенные в
средней трети влагалища. В большинстве представленных случаев ПППВ представляет собой изолированную
аномалию развития. В случае синдрома HWW установлено, что правосторонний вариант HWW
диагностировался чаще, чем левосторонний. Было доказано, что полная окклюзия влагалища встречается
чаще, чем частичная. Во всех случаях синдрома HWW была установлена агенезия почки со стороны
гематокольпоса. Доказано, что агенезия матки встречается реже по сравнению с аплазией матки. Наличие
обоих рудиментов матки в группе пациенток с синдромом MRKH выявлялось чаще. Некавитарные рудименты
матки установлены чаше, чем кавитарные. При синдроме MRKH установлено, что тазовое расположение
яичников встречается чаще, чем внетазовое. В процессе исследования выявлен и установлен крайне редкий
случай синдрома MRKH с наличием дисгерминомы яичника.
Научная решенная проблема: заключалась в оптимизации методов лучевой диагностики АМП со
сравнительной оценкой различных методов визуализации. Установлены клинические и радиологические
особенности АМП, выяснены возможности и эффективность применения лучевых методов и оптимизации
диагностирования АМП. Подтверждена роль томографических и ультрасонографических методов
исследования с использованием мультипланарных реконструкций (МПР) и 3D-изображений. В результате
исследования установлено, что возможности первичных методов диагностики (ГСГ, УЗИ 2D) ограничены, в
большинстве случаев при наличии АМП необходимо выполнение высокоэффективных методов визуализации
(УЗИ 3D и МРТ).
Теоретическая значимость: установлена диагностическая точность методов первичной визуализации (ГСГ,
УЗИ 2D) и высокоэффективных методов диагностики (УЗИ 3D и МРТ) при оценке АМП. Выявлены
радиологические варианты анатомии органов малого таза при синдроме MRKH. Представлен крайне редкий
случай синдрома MRKH с наличием дисгерминомы яичника. В ходе исследования были установлены
анатомические варианты синдрома HWW (OHVIRA). Определены радиологические характеристики полной
поперечной перегородки влагалища (ПППВ), радиологически оценены все анатомические варианты септатной
матки ((УЗИ 3D). Была подтверждена роль МРТ, T1 и T2 взвешенных изображений для визуализации
эндометрия и геморрагического содержимого.
Практическая значимость: для современной ранней диагностики АПМ в практику визуализации внедрены
обязательные радиологические критерии отбора пациенток. Проведенное исследование позволило
проанализировать различные классы аномалий матки и влагалища, сопутствующие ассоциированные
аномалии.
Внедрение научных результатов: на основе данного исследования методика диагностики вариантов АМП
внедрены в отделении радиологии Института матери и ребенка, в медицинском центре «MagnaMed», в
медицинском центре «AnaMaria-Med» (г. Кишинев, Республика Молдова).Thesis structure: The thesis contains the following sections: introduction, four chapters, general conclusions,
practical recommendations, bibliography of 274 sources, it is exposed on 128 pages. The thesis contains 17 charts, 85
figures and 8 appendices. The obtained results are published in 20 scientific papers.
Keywords: Müllerian ducts anomalies (MDA), imperforate hymen (IH), complete transverse vaginal septum (CTVS),
Herlyn-Werner-Wunderlich (HWW) syndrome, Mayer-Rokitansky-Kűster-Hauser (MRKH) syndrome, Robert's
uterus (RU), unicornuat uterus (UU), hysterosalpingography (HSG), two-dimensional and three-dimensional
ultrasonography (US 2D and U3D), magnetic resonance imaging (MRI), computed tomography (CT).
Field of study: 324.01 – Radiology & medical imaging.
The purpose of work: Optimization of imaging management in the diagnosis of Müllerian duct anomalies through
the evaluation of the particularities of the radiological anatomy of malformative pathology with the complex approach
of radio-imaging methods.
Study objectives: Review of modern aspects in the diagnosis of patients with malformative pathology of the
Müllerian ducts after hysterosalpingography, ultrasonography (2D and 3D), magnetic resonance imaging and
computed tomography. To validate imaging and radiological semiology in t he stratification of symmetric and
asymmetric uterine anomalies. To clarify the radiological anatomy of orphan uterine malformations. To evaluate the
imaging characteristics of obstructive vaginal anomalies (hymenal atresia, complete transverse vaginal septum,
Herlyn-Werner-Wunderlich syndrome), assessment of associated renal anomalies. Assessment of the radiological
anatomy of associated congenital malformations of the uterus and vagina (MRKH syndrome).
Research novelty and originality: The research is original in that it performs a comparative analysis of the initial and
ultra-performing imaging methods in the diagnosis of MDA. The necessity of using high -performance radiological
methods (3D ultrasound and MRI) in the early diagnosis of anomalies of the Müller ducts has been confirmed and
argued. By analyzing the clinical and radiological features, various categories of MDA have been identified and
established, among which symmetrical uterine anomalies predominate. Among MDA, 3 rare cases of uterine
abnormalities were identified – asymmetric uterine septum (Robert's uterus). It was found that UU without a
rudimentary horn was more common than UU with a cavitic or non-cavitic horn. Summarizing the results of the
conducted clinical study, it was found that among obstructive vaginal abnormalities with the presence of
hematocolpos, patients with imperforate hymen (IH) predominate compared with HWW syndrome or CTVS. In all
observed cases, IH was presented in an isolated form. In the study of patients with CTVS, it was found that
hematocolpos associated with a hematometra is diagnosed more often than isolated. It has been proven that distal
transverse vaginal septa are statistically more common than those located in the middle third of the vagina. In most of
the presented cases, CTVS is an isolated developmental anomaly. In the case of HWW syndrome, it was found that
the right-sided variant of HWW was diagnosed more often than the left-sided one. It has been proven that complete
vaginal occlusion is more common than partial occlusion. In all cases of HWW syndrome, renal agenesis was
established on the hematocolpos side. It has been proven that uterine agenesis is less common compared to uterine
aplasia. The presence of both uterine rudiments in the group of patients with MRKH syndrome was detected more
often. Non-cavitic uterine rudiments are more often established than cavitic ones. In MRKH syndrome, it was found
that the pelvic location of the ovaries is more common than the extrapelvic location. In the course of t he study, an
extremely rare case of MRKH syndrome with the presence of ovarian dysgerminoma was identified and established.
Solved scientific issue: The aim was to optimize the methods of radiologic diagnostics of MDA with a comparative
assessment of various imaging methods. The clinical and radiological features of MDA have been established, the
possibilities and effectiveness of using imaging methods and optimizing their diagnosis have been clarified. The role
of tomographic and ultrasonographic research methods using multiplanar reconstructions (MPR) and 3D images has
been confirmed. As a result of the study, it was found that the possibilities of primary diagnostic methods (HSG, US
2D) are limited, in most cases, in the presence of MDA, it is necess ary to perform highly effective imaging methods
(US 3D and MRI).
Theoretical significance: The diagnostic accuracy of initial imaging methods (HSG, 2D ultrasound) and high -
performance diagnostic methods (3D ultrasound and MRI) in estimating MDA was established. The radiological
variants of the anatomy of the pelvic organs in MRKH syndrome were elucidated. An extremely rare case of MRKH
syndrome with ovarian dysgerminoma was presented. The anatomical variants of the HWW syndrome (OHVIRA)
were determinated in the study. The radiological characteristics of the complete transverse vaginal septum (CTVS)
were established, all anatomical variants of the septate uterus were assessed radiologically. The role of MRI in T1W
and T2W images for determination of the endometrial tissue and for determination of hemorrhagic content was
confirmed.
Applicative value of the work. In the imaging practice, the mandatory selection criteria for early contemporary
diagnosis of MDA were implemented. The study made it possible to analyze the various classes of uterine and vaginal
anomalies, the associated concomitant anomalies.
Implementation of the scientific results: Based on this study, the diagnostic methodology for determining MDA
variants was implemented in the Radiology Department of the Mother and Child Institute, in the „MagnaMed”
Medical Center, in the „AnaMaria-Med” Medical Center (Chisinau, Republic of Moldova)
Artificial intelligence-based techniques for predicting outcomes in COVID-19 patients
Get PDFIntroduction. Currently, extensive research has shown that almost all published prediction models are poorly studied
and have significant limitations, leading to their predictive performance often being overestimated. Additionally, there is
still no universally accepted scoring system, primarily due to the need for adaptation to heterogeneous patient samples
(including patient numbers, clinical profiles, and risk factors) and/or ongoing differences in the organization of healthcare
systems across various countries.
Materials and methods. This is a narrative literature review. A bibliographic search was conducted in the PubMed, Hinari,
SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published between 2000
and 2024 were selected based on keyword combinations such as “artificial intelligence”, “prediction model”, “algorithm”,
“machine learning”, and “COVID-19”. Information on machine learning predictive models was selected and processed to
identify characteristics that can be used to predict diagnosis, severity, length of hospital stay, ICU admission, treatment,
vaccination, and mortality in COVID-19 patients. After processing the data according to the search criteria, 125 full-text
articles were identified. The final bibliography includes 52 relevant sources, which were considered representative of the
literature on this synthesis article topic.
Results. Artificial intelligence techniques are increasingly being used to predict outcomes in COVID-19 patients, particularly
in estimating mortality among individuals infected with SARS-CoV-2, which can rapidly and effectively support clinical
decision-making. According to the analysis of multiple studies, strong predictors of mortality in COVID-19 patients include
advanced age, male gender, comorbidities, reduced levels of calcium, albumin, red blood cells, and oxygen saturation, as
well as lymphopenia, elevated blood urea nitrogen, creatinine, lactate dehydrogenase, D-dimers, neutrophils, interleukin-6,
procalcitonin, bilirubin, ferritin, aspartate aminotransferase, and troponin.
Conclusions. Artificial intelligence techniques provide potential advantages over conventional assessment methods. The
information obtained from machine learning and deep learning algorithms, including easily accessible and interpretable
data, can assist healthcare workers in making accurate decisions for the appropriate and timely care of COVID- 19 patients.
This can improve patient outcomes, reduce the burden on healthcare systems, and ultimately decrease mortality rates
Особенности радиологических исследований брюшной полости и малого таза в плане лечения больных с новообразованиями
No full textStructura tezei: introducere, patru capitole, concluzii și recomandări, bibliografie
din 236 de surse, 16 anexe, 95 de pagini de text de bază (până la Bibliografie), 24
figuri, 12 tabele. Rezultatele obţinute sunt publicate în 7 lucrări ştiinţifice.
Cuvinte-cheie: neoplasme abdominale; neoplasme pelvine; stadializare; tomografie
computerizată, programe de postprocesare; principiile ALARA; doză de iradiere;
follow-up. Scopul lucrării: Evaluarea particularităților metodologiei de examinare
prin CT a pacienților cu neoplasme abdomino-pelvine pentru optimizarea
managementului clinico-imagistic. Obiectivele cercetării: 1. Eficientizarea
protocoalelor investigațiilor CT la pacienții cu neoplasme ale abdomenului și
pelvisului; 2. Optimizarea dozei de iradiere la pacienții cu neoplasme abdominale și
pelvine examinați prin tomografie computerizată; 3. Elaborarea unui ghid pentru
justificarea examinărilor radiologice prin CT, care permite desfăşurarea în siguranţă a
activităţilor radiologice și respectarea normelor cu privire la radioprotecție,
securitatea radiologică în practicile de radiologie de diagnostic; 4. Constituirea unui
algoritm de evaluare a actului medical calitativ în departamentul de radiologie.
Noutatea şi originalitatea ştiinţifică: În acest studiu a fost evaluată eficiența
protocoalelor investigațiilor CT la pacienții cu neoplasme ale abdomenului și
pelvisului. S-a optimizat doza de iradiere la pacienții cu neoplasme abdominale și
pelvine examinați prin tomografie computerizată. S-a efectuat o analiză comparativă
a parametrilor imagistici și investigațiilor radiologice efectuate în Republica Moldova
și o țară a Uniunii Europene (Italia). În cadrul studiului au fost introduse 2 servicii
noi în Catalogul tarifelor unice pentru serviciile medico-sanitare pentru investigarea
prin CT a pacienților cu tumori ale abdomenului și pelvisului. Au fost elaborate o
serie de metode pentru investigațiile repetate prin CT la pacienții cu patologii
oncologice ale abdomenului și pelvisului.
Semnificaţia teoretică: Rezultatele studiului au permis acumularea cunoștințelor
pentru a propune crearea unor instrumente pentru justificarea examinărilor
radiologice, desfăşurarea în siguranţă a activităţilor radiologice și respectarea
normelor cu privire la radioprotecție, securitatea radiologică în practicile de
radiologie de diagnostic. Au fost perfectate principiile pentru reducerea și
monitorizarea dozei de iradiere la pacienții cu patologii oncologice ale abdomenului
și pelvisului. A fost elaborat un Ghid pentru utilizarea examenelor imagistice în
managementul pacienților cu patologii oncologice ale abdomenului și pelvisului.
Valoarea aplicativă: Au fost acceptate 3 Certificate de inovator, cu câte 4 acte de
implementare la Catedra de Radiologie și imagistică, USMF „N. Testemiţanu”; Secția
de Radiologie a IMPS Centrul Republican de Diagnosticare Medicală; Departamentul
de Radiologie al Centrului Medical Euromed Diagnostic și Departamentul de
Radiologie al Centrului Medical MedExpert din Cahul.
Implementarea rezultatelor ştiinţifice: Rezultatele actualului studiu sunt utilizate în
procesul științifico-didactic al Catedrei de radiologie și imagistică medicală a USMF
„N.Testemițanu”. Datele obținute au fost publicate în 7 lucrări științifice, editate în
țară și peste hotare.Thesis structure: introduction, four chapters, conclusions and recommendations,
bibliography from 236 sources, 16 appendices, 95 pages of basic text (up to
Bibliography), 24 figures, 12 tables, results are published in 7 scientific papers.
Keywords: oncology statistics; abdominal neoplasms; pelvic neoplasms; staging;
computed tomography, post-processing programs; ALARA principles; irradiation
dose; follow-up.
The aim of the study: To evaluate the particularities of CT radiological explorations
of patients with neoplasms of the intact abdomen for optimizing clinical-imaging
management.
Research objectives: To optimise CT investigation protocols in patients with
neoplasms of the abdomen and pelvis. Optimization of irradiation dose in patients
with abdominal and pelvic neoplasms examined by CT. To create a basic tool for the
justification of CT radiological examinations, enabling the safe conduct of
radiological activities and compliance with radiation protection, radiological safety in
diagnostic radiology practices. Standardisation of a tool for the evaluation of
qualitative medical practice in the radiology department.
Scientific novelty and originality: This is the first study in which a comparative
analysis of imaging parameters and radiological investigations performed in the
Republic of Moldova and a country of the European Union has been carried out. 2
new services have been introduced in the Single Tariff Catalogue for medical services
for CT investigation of patients with tumours of the abdomen and pelvis. A series of
concepts for repeat CT investigations in patients with oncological pathologies of the
abdomen and pelvis were developed.
Theoretical significance: The results of the study have allowed the accumulation of
sufficient knowledge to propose the creation of tools for the justification of
radiological examinations, the safe conduct of radiological activities and compliance
with radiation protection regulations, radiological safety in diagnostic radiology
practices. The principles for reducing and monitoring irradiation dose in patients with
oncological pathologies of the abdomen and pelvis have been perfected. Guidelines
for the use of imaging examinations in the management of patients with oncological
pathologies of the abdomen and pelvis were developed.
Applicative value: 3 Certificates of Innovator were received, with 4 acts of
implementation each at the Department of Radiology and Imaging, USMF “N.
Testemitanu"; Radiology Department of IMPS Republican Center for Medical
Diagnostics; Radiology Department of Euromed Diagnostic Medical Center and
Radiology Department of MedExpert Cahul Medical Center.
Implementation of scientific results: The results of the current study are used in the
scientific and didactic process of the Department of Radiology and Medical Imaging
of USMF “N. Testemitanu". The obtained data have been published in 7 scientific
papers, published in the country and abroad.Структура диссертации: введение, четыре главы, выводы и рекомендации,
библиография из 236 источников, 16 приложения, 95 страница основного текста (до
библиографии), 24 рисунка, 12 таблиц, результаты опубликованы в 7 научных работах.
Ключевые слова: онкологическая статистика; новообразования органов брюшной
полости; новообразования органов малого таза; стадирование; компьютерная
томография, программы постобработки; принципы ALARA; доза облучения;
наблюдение. Цель работы: Оценить особенности КТ-радиологических исследований
пациентов с новообразованиями брюшной полости для оптимизация клинико-радиологического менеджмента. Задачи исследования: Оптимизировать протоколы
КТ-исследований у пациентов с новообразованиями брюшной полости и таза.
Оптимизация дозы облучения у пациентов с новообразованиями брюшной полости и
малого таза, обследованных с помощью КТ. Создание базового инструмента для
обоснования КТ-радиологических исследований, позволяющего безопасно проводить
радиологическую деятельность и соблюдать радиационную защиту,
радиологическую безопасность в диагностической радиологической практике.
Стандартизация инструментария для оценки качества медицинской практики в
радиологическом отделении. Научная новизна и оригинальность: Впервые
проведен сравнительный анализ параметров визуализации и радиологических
исследований, выполняемых в Республике Молдова и стране Европейского союза. В
Единый тарифный каталог медицинских услуг введены 2 новые услуги по КТ-исследованию пациентов с опухолями брюшной полости и таза. Разработан ряд
концепций повторных КТ-исследований у пациентов с онкологической патологией
брюшной полости и малого таза. Теоретическая значимость: Результаты
исследования позволили накопить достаточный объем знаний, позволяющий
предложить создание инструментария для обоснования рентгенологических
исследований, безопасного проведения рентгенологической деятельности и
соблюдения правил радиационной защиты, обеспечения радиологической
безопасности в диагностической рентгенологической практике. Усовершенствованы
принципы снижения и контроля дозы облучения у пациентов с онкологической
патологией органов брюшной полости и малого таза. Разработаны рекомендации по
использованию визуализирующих исследований при ведении пациентов с
онкологической патологией органов брюшной полости и малого таза. Прикладное
значение: Получено 3 удостоверения инноватора, по которым составлено 4 акта
внедрения на кафедре радиологии “Н. Тестемицану"; в радиологическом отделении
Республиканского центра медицинской диагностики; в радиологическом отделении
диагностического медицинского центра "Евромед" и в радиологическом отделении
медицинского центра "МедЭксперт Кагул”. Внедрение научных результатов:
Результаты настоящего исследования используются в научно-дидактическом
процессе кафедры радиологии “Н. Тестемицану". Полученные данные опубликованы
в 7 научных работах, изданных в стране и за рубежом
Management of the professional training process through the application of simulation methods in university medical education: Abstract of the Phd Thesis in medical sciences: 331.03 - Social medicine and management
No full textRelevance and significance of the topic. In the context of increasing demands for training, limited patient interaction, and the prioritization of patient safety, a new concept has emerged in medical education, integrating advanced technologies and innovative teaching methods. Simulation-based medical training is an educational process that utilizes simulators, clinical scenarios, and specialized technologies to replicate real medical situations. Its purpose is to develop and evaluate theoretical, practical, and communication skills in a controlled, safe, and ethical environment, without risks to patients. Simulation in medical education has immense potential for widespread application throughout the education system, from undergraduate to postgraduate levels and continuing medical education. Recent developments, such as the right to clinical practice during the residency stage, have increased the focus on professional medical training at the university level. The benefits of clinical simulation are increasingly reported in specialized literature, and its integration into curricula requires careful planning [1–3].
The implementation of simulation at the Nicolae Testemițanu State University of Medicine and Pharmacy began in 2003 with the use of standardized patient methodology in university training. The establishment of the University Center for Simulation in Medical Training (CUSIM) facilitated the enhancement and diversification of simulation-based medical training methods across all levels of professional education. Recent changes in licensing regulations and new responsibilities assigned to medical trainees have made it essential to increase the complexity and utility of developing practical competencies for students, particularly in the final years of their studies [30 – 35]. The complementarity of medical simulation must be justified and strategically applied to meet the requirements of the national healthcare system in alignment with policies for training specialized human resources. [4, 12, 24, 25].
The goal of medical education is to develop the skills of physicians capable of providing a high level of care in safe conditions for patients. Identifying the optimal methods and necessary elements to achieve educational objectives remains an ongoing challenge [5, 13, 14]. Over the past two decades, simulation has significantly enhanced the concept of traditional medical training, with its use increasing exponentially. Drawing on experiences from fields such as aviation and astronautics, efforts have been made to refine effective methods for utilizing simulation in medical education [6, 15, 16].
Description of the field situation and identification of the research problem. Simulation-Based Medical Education (SBME) has become fundamental in training healthcare professionals, providing a dynamic and interactive learning environment that mirrors clinical realities without compromising patient safety. It allows learners to practice procedures, make decisions, and manage patient interactions in a controlled setting, thereby enhancing their clinical skills, critical thinking, and confidence before practicing in real-world scenarios [1, 17, 18, 26, 27]. The significance of SBME lies in bridging the gap between theory and practice, providing an essential platform for experiential learning, and thereby preparing competent and efficient healthcare providers [7, 19, 22, 23]. The complexity of modern healthcare systems and the need for high-quality care demand innovative educational approaches that adequately prepare students for the challenges of clinical practice [8, 9, 20, 21]. Simulation-based approaches are essential, providing an effective means of teaching clinical skills, improving decision-making, and enhancing professional competencies in a safe environment [10, 11, 34].
The formulated research hypothesis asserts that simulation sessions, implemented based on a rigorous methodology, can have a significant impact on clinical skills, student satisfaction, and the standardization of the educational process in higher medical education.
The research aims to identify optimal strategies for integrating simulation into national university programs by developing a procedural framework to implement simulation-based methods. The ultimate goal is to enhance the quality and effectiveness of medical education and to train graduates with transferable and generalizable professional competencies. Additionally, the research explores simulation techniques and methodologies, evaluating their merits and disadvantages while improving the understanding of simulation customization to meet specific needs based on available facilities and instructional objectives.
Research aim: The development and validation of an efficient methodology for the application of simulation in university medical education, aimed at enhancing teaching quality and strengthening the management of the professional training process.
General objectives of the thesis:
1. Development of the procedural framework by determining the need for and organizing simulation training at the university level.
2. Evaluation of students' acquisition of practical skills through the observational method, using checklists as an assessment tool.
3. Analysis of the impact of training on students' theoretical knowledge through the application of pre- and post-training testing procedures.
4. Determination of student satisfaction with the applied components of medical simulation training.
5. Development of recommendations for the comprehensive and efficient implementation of medical simulation training at the university level.
Scientific research methodology. The research focused on evaluating the effectiveness of simulation-based training in university medical education at the University Center for Medical Simulation of the Nicolae Testemițanu State University of Medicine and Pharmacy. The study, analytical and experimental in nature, involved students divided into groups based on the practical skills being trained. Due to certain limitations, a quasi-experimental design was employed to assess the impact on theoretical and practical skills. Data were collected using written tests, checklists, and questionnaires, employing historical, mathematical, and sociological methods. The analysis was performed using specialized software, which facilitated the application of statistical tests and the validation of the research hypothesis. The scientific novelty and originality of the results obtained. The research conducted at Nicolae Testemițanu State University of Medicine and Pharmacy introduced an innovative methodology for implementing simulation-based training in university medical education. This approach incorporated diverse simulation methods, such as standardized patients and integrated clinical scenarios, which had not been previously applied in a structured educational setting. The originality of the research lies in a comprehensive pre- and post-intervention evaluation system that measured theoretical knowledge, clinical competencies, student satisfaction, and adaptability to unexpected situations. The results demonstrated a significant improvement in student performance, validating the effectiveness of simulation and proposing it as a standard for national medical education. The study highlighted the importance of integrating advanced technologies into the curriculum and opened new avenues for adapting the methodology.
The important scientific problem addressed in the thesis. The research was initiated to address the need for improving the professional training of medical students in the context of increasing complexity in medical practice and heightened safety requirements. Traditional medical education, based on direct clinical experiences, was constrained by the availability of cases and posed risks to patients due to medical errors. Developing innovative training methods that enable the practice of clinical skills in a safe and controlled environment became essential.
The problem solved in this study was the creation and validation of an efficient simulation-based training methodology that enhanced students' clinical competencies and satisfaction. This methodology demonstrated a positive impact on both theoretical and practical performance, providing a framework for its integration into the university curriculum. The implementation of simulation contributed to training in a safe environment, supported the accreditation process, and highlighted the potential of this approach to transform medical education.
Theoretical significance. The research reveals a significant shift in the paradigm of medical education, highlighting the inadequacy of ad-hoc educational sessions in clinical settings for refining physicians' skills. In this context, the study emphasized the need for curriculum standardization and the adoption of a systematic approach that incorporates deliberate practices, structured exercises, and rigorous outcome evaluations grounded in continuous feedback.
Practical applicability of the work. The effective implementation of the simulation component in various university-level study programs is essential. It aims to provide comprehensive and modern training for medical university students, facilitating their seamless integration into subsequent clinical activities during postgraduate residency. This is achieved by developing professional and communication skills, increasing self-confidence and decision-making abilities, and enhancing teamwork. Such an innovative methodology allows students to practice in controlled environments and receive constant feedback, significantly reducing medical errors. By applying this approach, graduates will be better prepared to face real clinical challenges, ultimately improving the quality of patient care. This will, in turn, enhance the overall quality of medical practice and increase patient safety, ensuring a higher educational standard and contributing to the general improvement of the healthcare system.
Priority scientific results submitted for defense: 1. A procedural framework for identifying needs and efficiently organizing simulation-based training in medical university education was developed and validated.
2. A significant improvement in students' practical competencies was demonstrated through the use of checklists developed as standardized assessment tools.
3. The positive impact of simulation-based training on theoretical knowledge was highlighted, as confirmed by the comparative analysis of pre-test and post-test results.
4. A high level of student satisfaction with the relevance and effectiveness of simulation-based training in medical education was determined.
5. Recommendations were formulated for the integrated, comprehensive, and efficient implementation of simulation-based training in the medical university curriculum.
Implementation of research results. As a result of the conducted research, the outcomes, including the procedural framework and developed evaluation tools, validated through innovation certificates, were applied within the University Center for Medical Simulation. These tools were utilized during the practical examination of the summer clinical internship, organized for 2nd- to 5th-year students from the Faculty of Medicine and Somatology, as well as for graduates of the Bachelor's program in General Nursing. The implementation of the Objective Structured Clinical Examination (OSCE), recommended by the World Federation for Medical Education and integrated into the University's Strategic Development Plan for 2021–2030, has strengthened the role of this evaluation method as a standard of excellence for assessing clinical competencies. Approval of scientific results. The results obtained during the research were presented and discussed at the following scientific forums: The Second Conference of Simulations Applied in Medicine (Târgu Mureș, Romania, 2017); Annual Scientific Conference - University Days (Chișinău, Republic of Moldova, 2019); International Scientific Conference: Health, Medicine, and Bioethics in Contemporary Society: Inter- and Multidisciplinary Studies (Chișinău, Republic of Moldova, 2019); Virtual Annual Meeting of the Society for Simulation in Europe (2021); Scientific-Practical Conference with International Participation "Medical Simulation - A Look into the Future" (implementation of innovative technologies in higher medical education in Ukraine), online (Chernivtsi, Ukraine, 2021); Annual Scientific Conference "Research in Biomedicine and Health: Quality, Excellence, and Performance" (Chișinău, Republic of Moldova, 2022); International Conference on Simulation and Virtual Reality in Medicine, MediSim III (Târgu Mureș, Romania, 2023); Annual Scientific Conference "Research in Biomedicine and Health: Quality, Excellence, and Performance" (Chișinău, Republic of Moldova, 2023); 5th Interdisciplinary PhD Forum with International Participation (Kyustendil, Bulgaria, 2024); 3rd Edition of the International Exhibition of Innovation and Technology Transfer EXCELLENT IDEA (Chișinău, Republic of Moldova, 2024).
Publications related to the thesis. The thesis materials were reflected in 13 publications, including 2 single-author works, 2 articles in international journals, 2 articles in national journals, 2 articles in the proceedings of international scientific conferences, 6 theses in the proceedings of national and international scientific conferences, and 1 poster presented at an international scientific forum.
Summary of the thesis sections. The paper is written on a total of 181 pages in electronic format, of which 130 pages represent the main text. The structure of the paper includes the introduction, four chapters, a synthesis of the obtained results, conclusions, practical recommendations, and 26 appendices. The iconographic material consists of 37 figures and 26 tables. The scientific foundation of the paper is based on 97 bibliographic sources.
The study received favorable approval from the Research Ethics Committee of the Nicolae Testemițanu State University of Medicine and Pharmacy (no. 51, 12.04.2018)
Addressing artificial intelligence gaps in transplant medecine: a machine learning solution
Get PDFIntroduction: Artificial intelligence (AI) shows promise in transplant medicine, particularly in organ
matching and rejection prediction. However, gaps remain in personalized immunosuppression,
including optimal drug dosing, patient-specific data integration, and clinical implementation. This
study identifies these gaps and proposes a machine learning model to optimize immunosuppressive
therapy.
Material and Methods: A systematic review was conducted using PubMed, Scopus, and Web of
Science from 2010 to 2024 with keywords: "Artificial Intelligence," "Transplant Medicine," "Rejection
Prediction," and "Patient Care Optimization." Studies discussing AI applications in rejection prediction
or patient care in organ transplantation were included. Data on study design, AI methods, outcomes,
and limitations were extracted. Findings show most AI models rely on static predictors and fail to adapt
to real-time changes like infections and inflammation. Multi-omics data, crucial for drug metabolism
and immune response, are rarely integrated, reducing accuracy. Generalizability is also limited, as most
models are trained on small, single-center datasets further reducing accuracy. To address these gaps,
we propose a machine learning model using longitudinal transplant data. It will integrate electronic
health records, pharmacokinetics, genomics, and biomarkers to predict individualized dosing.
Recurrent neural networks or transformer-based architectures will update recommendations based on
patient-specific responses. Model performance will be validated using real-world clinical data and
benchmarked against traditional dosing protocols.
Results: The review included 68 articles, with 14 meeting inclusion criteria. While AI has been applied
to organ matching and rejection prediction, no existing models provide real-time, patient-specific
immunosuppression adjustments, impacting patient outcomes. The proposed model aims to bridge this
gap, potentially reducing rejection rates and improving outcomes.
Conclusions: This study identifies deficiencies in AI-driven immunosuppression management,
particularly in real-time dose adjustments, multi-omics integration, and model generalizability. The
proposed machine learning framework seeks to create an adaptive, personalized dosing system to
enhance transplant outcomes and minimize rejection risks