Background and Objectives: Pulmonary embolism (PE) incidence has been increasing in the last 10 years. Computed thoracic pulmonary angiography (CTPA) had a major role in PE diagnosis and prognosis. The main purpose of this study was as follows: the prognostic value of a CTPA parameter, pulmonary artery obstruction index (PAOI), in PE risk assessment and the predictive accuracy of biomarkers, D-dimer and cardiac Troponin T (c-TnT), in 7-day mortality. A second objective of the research was to investigate the relationship between imaging by PAOI and these biomarkers in different etiologies of PE. Materials and Methods: This study comprised 109 patients with PE, hospitalized and treated between February 2021 and August 2022. They had different etiologies of PE: deep vein thrombosis (DVT); persistent atrial fibrillation (AF); chronic obstructive pulmonary disease (COPD) exacerbation; COVID-19; and cancers. The investigations were as follows: clinical examination; D-dimer testing, as a mandatory method for PE suspicion (values ≥500 µg/L were highly suggestive for PE); c-TnT, as a marker of myocardial injury (values ≥14 ng/L were abnormal); CTPA, with right ventricle dysfunction (RVD) signs and PAOI. Treatments were according to PE risk: systemic thrombolysis in high-risk PE; low weight molecular heparins (LWMH) in high-risk PE, after systemic thrombolysis or from the beginning, when systemic thrombolysis was contraindicated; and direct oral anticoagulants (DOAC) in low- and intermediate-risk PE. Results: PAOI had a high predictive accuracy for high-risk PE (area under curve, AUC = 0.993). D-dimer and cTnT had a statistically significant relationship with 7-day mortality for the entire sample, p < 0.001, and for AF, p = 0.0036; COVID-19, p = 0.003; and cancer patients, p = 0.005. PAOI had statistical significance for 7-day mortality only in COVID-19, p = 0.045, and cancer patients, p = 0.038. The relationship PAOI–D-dimer and PAOI–c-TnT had very strong statistical correlation for the entire sample and for DVT, AF, COPD, and COVID-19 subgroups (Rho = 0.815–0.982). Conclusions: PAOI was an important tool for PE risk assessment. D-dimer and c-TnT were valuable predictors for 7-day mortality in PE. PAOI (imaging parameter for PE extent) and D-dimer (biomarker for PE severity) as well as PAOI and c-TnT (biomarker for myocardial injury) were strongly correlated for the entire PE sample and for DVT, AF, COPD, and COVID-19 patients.

Background and Objectives: Job strain is a psychological, physical, and behavioral stress that occurs at the workplace. Job strain is associated with more than double the normal risk of coronary artery disease (CAD). The main aim of this study was to determine the association between job strain and the following parameters: high-sensitivity C-reactive protein (hs-CRP), the albumin urine excretion rate (AUER), and secondary-level testing. Materials and Methods: This study was a descriptive cross-sectional study conducted on patients who underwent cardiological assessment between October 2023 and February 2024 at the Promedicanon Cardiology Center. This study comprised 210 participants, with two groups: 105 chronic coronary syndromes (CCS) patients and 105 no-CCS patients. The baseline characteristics collected were age, gender, education, rural/urban environment, traditional CAD risk factors, hs-CRP, and AUER. The secondary-level testing included an electrocardiogram (ECG), echocardiography, and enhanced contrast computed tomography (ECCT). Psychological questionnaires comprised the tertiary-level testing, including the PHQ-9 depression questionnaire, and the satisfaction with work scale (SWWS) for job strain (Likert score). Results: The baseline characteristics were all significantly different between the groups (p < 0.05) except for total cholesterol. The hs-CRP level had a mean value of 0.4837 ± 0.19082 in the CCS group; for the no-CCS group, the hs-CRP mean value was 0.2289 ± 0.11009; p-value < 0.001. The AUER had a mean value of 42.770 ± 12.8658 for the CCS group and 26.432 ± 9.7338 for the no-CCS group; p-value < 0.001. For the associations between secondary-level testing and job strain: p < 0.001 for ST depression, negative T-waves, and q-waves; p = 0.415 for atrial fibrillation (AF); p = 0.018 for wall motion studies; p = 0.005 for ECCT. The association between job strain and AF had no statistical significance. The contractility of left ventricle walls and coronary calcification score were associated with job strain, with statistical significance. The p-value was 0.013 for the relationship between depression and the ECCT; for the association between depression and CCS status, the p-value was 0.021. Depression is usually diagnosed in job strain. The association between depression, and coronary calcification, as well as depression and CCS status had statistical significance. Conclusions: Job strain increased the hs-CRP level and AUER in both the CCS and no-CCS patients. The primary and secondary prevention of CHD could also include interventions to reduce job strain.

Phyllodes tumors, also known as cystosarcoma phyllodes, represent a rare and complex category of fibroepithelial neoplasms that primarily affect the breast. These tumors are characterized by their unique histological architecture, which resembles leaf-like structures, as suggested by the etymology of the term “phyllodes,” derived from the Greek word “phyllodes,” meaning “leaf-like”. The World Health Organization (WHO) has classified these tumors into three distinct categories—benign, borderline, and malignant—based on various histopathological criteria, including cellular atypia, mitotic activity, and stromal overgrowth. With a peak incidence occurring between the ages of 40 and 52, these tumors primarily affect women and constitute 0.3% to 1% of all breast tumors. Imaging modalities currently employed (mammography, ultrasound, and MRI) play a crucial role in the initial assessment of breast masses. Histopathological characteristics, such as stromal cellularity and mitotic activity, and immunohistochemical markers, like Ki-67 and p53, are important in the diagnosis, categorization, treatment plans, and prognosis of breast phyllodes tumors. Surgical intervention, with the goal of achieving complete excision of the tumor along with adequate margins, is the primary treatment option. Adjuvant therapies, such as radiotherapy, may be considered but are still debatable. Understanding the nuances of these tumors is crucial for healthcare professionals, as they present unique challenges in both diagnosis and treatment.

Background and Objectives: Fibrillinopathies have different phenotypic expression: Marfan-like skeleton features, MLSF; mitral valve prolapse syndrome, MVPS; MASS phenotype, M = mitral valve prolapse, MVP, A = aortic root dilation, S = skeletal features, and the second S = (cutaneous) striae; Marfan Syndrome, MS. The study had the following main objectives: the correlation between disc displacement, DD (a major sign for temporomandibular joint dysfunction, TMDs) on magnetic resonance imaging, MRI, and aortic Z score (a major sign for aortic root dilation) on echocardiography; the predictive value of DD towards aortic Z score. DD had 2 types of severity: DD with reduction (the mild type, DDwR), and DD without reduction (the severe type, DDwoR). Materials and Methods: The type of fibrillinopathy was precised by clinical exam (systemic score), ophthalmic exam (for ectopia lentis), and echocardiography (aortic Z score, MVP). Medical treatment consisted of betablockers, BB (for patients with tachycardia), or angiotensin II receptor blockers, ARB. Surgical treatment was addressed to aortic root aneurysm, and severe mitral regurgitation, MR. DD benefited from dental conservatory treatment or surgical restoration. Results: DD-Z score had a powerful correlation in MASS (Rho = 0.787, p < 0.01), and in MS patients (Rho = 0.819, p < 0.01). For the entire sample, both DDwR-Z score and DDwoR-Z score had a moderate correlation (Rho = 0.469, and respectively 0.669). Furthermore, DD was an important predictor for Z score. DDwoR had a double power of prediction for the Z score compared with DDwR (B coefficient = 1.661 for DDwR and 3.281 for DDwoR). Conclusions: TMDs had a powerful correlation with aortic root dilation in MASS and MS patients from the sample. Likewise, TMDs was a major predictor for aortic root dilation, in the entire sample. In clinical practice, we can utilize an extracardiac finding, TMDs, obtained by a non-invasive technique, MRI, for cardiac severity stratification of fibrillinopathies.

Left iliac fossa (LIF) pain is a common reason for emergency department (ED) visits and can be caused by a wide range of conditions, from benign to life-threatening, timely and accurately diagnosis being crucial for appropriate management. This study aims to highlight the management of LIF pain and to outline the etiology and imaging findings in a real-world ED setting. Materials and methods: We conducted a retrospective study of 144 patients who presented with LIF pain at the ED of Sf. Spiridon County Clinical Emergency Hospital Iași between August 2022 and December 2024. Imaging studies and final diagnoses were analyzed to assess diagnostic pathways and imaging concordance. Results: The patients had a mean age of 53.9 years, with a slight female predominance (56.25%), the most frequent diagnoses being acute diverticulitis (25%). Computed tomography (CT) was performed in 105 cases (72.92%) and provided clarification in nearly a third of the patients who had previously undergone ultrasound (US) and didn’t have a final diagnosis. Overall, CT findings confirmed the ED’s initial diagnostic hypothesis in 75.24% cases. Conclusions: This study offers a detailed analysis of CT utility in a real-world emergency setting, confirming that CT plays an important role in the differential diagnosis of LIF pain in the ED, influencing management decisions and improving clinical outcomes. Our data support the implementation of standardized diagnostic algorithms for LIF pain in the ED, incorporating early CT in selected cases in order to ensure a patient-centered approach.

Obesity can conceal nutritional impairment and compromised muscle health in metabolic dysfunction-associated steatotic liver disease (MASLD). This critical narrative review examines the potential role of eating behaviors in nutritional impairment and muscle health in MASLD, focusing on adults with overweight or obesity while considering the limited findings in lean MASLD and, separately, pediatric evidence. Altered eating behaviors are associated with prevalent MASLD, but their contribution to malnutrition, myosteatosis, and sarcopenic obesity remains unproven. Nutritionally adverse dietary patterns and appetite loss may increase vulnerability, although evidence linking these factors to muscle outcomes derives predominantly from aging and general obesity populations. Total daily protein intake is better supported than specific meal-level distribution targets, while resistance exercise offers more consistent functional benefits than protein supplementation alone in the limited direct MASLD evidence. Restricting eating windows has not demonstrated additional hepatic benefit over usual care. Incretin-associated lean-mass loss does not by itself establish sarcopenia or disproportionate muscle harm and requires interpretation alongside muscle strength and function. Physical inactivity, socioeconomic circumstances, multimorbidity, and reverse causation complicate attribution to eating behavior. These findings support assessment beyond body mass index, integrating eating behaviors, nutritional risk, and muscle health. We propose an adult assessment framework; however, prospective studies are needed to validate it and clarify the independent contribution of eating behaviors to nutritional and muscle deterioration in MASLD.