Showing papers by "Medical University of Varna published in 2018"

Buparlisib plus fulvestrant in postmenopausal women with hormone-receptor-positive, HER2-negative, advanced breast cancer progressing on or after mTOR inhibition (BELLE-3): a randomised, double-blind, placebo-controlled, phase 3 trial

Abstract: Summary Background Activation of the PI3K/AKT/mTOR pathway occurs frequently in breast cancer that is resistant to endocrine therapy. Approved mTOR inhibitors effectively inhibit cell growth and proliferation but elicit AKT phosphorylation via a feedback activation pathway, potentially leading to resistance to mTOR inhibitors. We evaluated the efficacy and safety of buparlisib plus fulvestrant in patients with advanced breast cancer who were pretreated with endocrine therapy and mTOR inhibitors. Methods BELLE-3 was a randomised, double-blind, placebo-controlled, multicentre, phase 3 study. Postmenopausal women aged 18 years or older with histologically or cytologically confirmed hormone-receptor-positive, HER2-negative, locally advanced or metastatic breast cancer, who had relapsed on or after endocrine therapy and mTOR inhibitors, were recruited from 200 trial centres in 22 countries. Eligible patients were randomly assigned (2:1) via interactive response technology (block size of six) to receive oral buparlisib (100 mg per day) or matching placebo starting on day 1 of cycle 1, plus intramuscular fulvestrant (500 mg) on days 1 and 15 of cycle 1 and on day 1 of subsequent 28-day cycles. Randomisation was stratified by visceral disease status. The primary endpoint was progression-free survival by local investigator assessment as per the Response Evaluation Criteria In Solid Tumors (RECIST) version 1.1 in the full analysis population (all randomised patients, by intention-to-treat). Safety was analysed in all patients who received at least one dose of treatment and at least one post-baseline safety assessment. This study is registered with ClinicalTrials.gov, number NCT01633060, and is ongoing but no longer enrolling patients. Findings Between Jan 15, 2013, and March 31, 2016, 432 patients were randomly assigned to the buparlisib (n=289) or placebo (n=143) groups. Median progression-free survival was significantly longer in the buparlisib versus placebo group (3·9 months [95% CI 2·8–4·2] vs 1·8 months [1·5–2·8]; hazard ratio [HR] 0·67, 95% CI 0·53–0·84, one-sided p=0·00030). The most frequent grade 3–4 adverse events in the buparlisib versus placebo group were elevated alanine aminotransferase (63 [22%] of 288 patients vs four [3%] of 140), elevated aspartate aminotransferase (51 [18%] vs four [3%]), hyperglycaemia (35 [12%] vs none), hypertension (16 [6%] vs six [4%]), and fatigue (ten [3%] vs two [1%]). Serious adverse events were reported in 64 (22%) of 288 patients in the buparlisib group versus 23 (16%) of 140 in the placebo group; the most frequent serious adverse events (affecting ≥2% of patients) were elevated aspartate aminotransferase (six [2%] vs none), dyspnoea (six [2%] vs one [1%]), and pleural effusion (six [2%] vs none). On-treatment deaths occurred in ten (3%) of 288 patients in the buparlisib group and in six (4%) of 140 in the placebo group; most deaths were due to metastatic breast cancer, and two were considered treatment-related (cardiac failure [n=1] in the buparlisib group and unknown reason [n=1] in the placebo group). Interpretation The safety profile of buparlisib plus fulvestrant does not support its further development in this setting. Nonetheless, the efficacy of buparlisib supports the rationale for the use of PI3K inhibitors plus endocrine therapy in patients with PIK3CA mutations. Funding Novartis Pharmaceuticals Corporation.

Cell biology of glioblastoma multiforme: from basic science to diagnosis and treatment.

Abstract: First described in the 1800s, glioblastoma multiforme (GBM), a class IV neoplasm with astrocytic differentiation, as per the revised 2016 World Health Organization classification of tumors of the central nervous system (CNS) is the most common malignant tumor of the CNS. GBM has an extremely wide set of alterations, both genetic and epigenetic, which yield a great number of mutation subgroups, some of which have an established role in independent patient survival and treatment response. All of those components not only represent a closed cycle but are also relevant to the tumor biological behavior and resistance to treatment as they form the pathobiological behavior and clinical course. The presence of different triggering mutations on the background of the presence of key mutations in the GBM stem cells (GBMsc) further separates GBM as primary arising de novo from neural stem cell precursors developing into GBMsc and secondary, by means of aggregated mutations. Some of the change in cellular biology in GBM can be observed via light microscope as they form the cellular and tissue hallmarks of the condition. Changes in genetic information, resulting in alteration, suppression and expression of genes compared to their physiological levels in healthy astrocytes lead to not only cellular, but also extracellular matrix reorganization. These changes result in a multiform number of micromorphological and purely immunological/biochemical forms. Therefore, in the twenty-first century the term multiforme, previously outcast from nomenclatures, has gained new popularity on the background of genotypic diversity in this neoplastic entry.

Dimensional accuracy and surfaceroughness of polymeric dental bridgesproduced by different 3D printingprocesses

Abstract: Purpose: To compare the dimensions accuracy and surface roughness of polymeric dental bridges produced by different 3D printers. Design/methodology/approach: Four-part dental bridges were manufactured by three printing systems working on the basis of digital light projection (DLP) stereolithography (SLA), laser-assisted SLA and fused deposition modeling (FDM). The materials used from SLA printers are liquid methacrylate photopolymer resins, while FDM printer use thin wire plastic polylactic acid. The accuracy of the external dimensions of dental bridges was evaluated and the surface roughness was measured. Findings: It was found that compared to the base model, the dimensions of the SLA printed bridges are bigger with 1.25%-6.21%, while the corresponding dimensions of the samples, made by FDM are smaller by 1.07%-4.71%, regardless the position of the object towards the substrate. The samples, produced by FDM, are characterized with the highest roughness. The average roughness deviation (Ra) values for DLP SLA and lase-assisted SLA are 2.40 μm and 2.97 μm, respectively. Research limitations/implications: For production of high quality polymeric dental constructions next research should be targeted to investigation of the polymerization degree, stresses and deformations. Practical implications: Our study shows that 3D printers, based on laser-assisted and DLP SLA, can be successfully used for manufacturing of polymeric dental bridges – temporary restorations or cast patterns, while FDM system is more suitable for training models. The results will help the dentists to make right choice of the most suitable 3D printer. Originality/value: One of the largest fixed partial dentures – four-part bridges, produced by three different commercial 3D printing systems, were investigated by comparative analysis. The paper will attract readers’ interest in the field of biomedical materials and application of new technologies in dentistry.

Microbial Preparations (Probiotics) for the Prevention of Clostridium difficile Infection in Adults and Children : An Individual Patient Data Meta-analysis of 6,851 Participants

Abstract: OBJECTIVETo determine whether probiotic prophylaxes reduce the odds of Clostridium difficile infection (CDI) in adults and children.DESIGNIndividual participant data (IPD) meta-analysis of randomized controlled trials (RCTs), adjusting for risk factors.METHODSWe searched 6 databases and 11 grey literature sources from inception to April 2016. We identified 32 RCTs (n=8,713); among them, 18 RCTs provided IPD (n=6,851 participants) comparing probiotic prophylaxis to placebo or no treatment (standard care). One reviewer prepared the IPD, and 2 reviewers extracted data, rated study quality, and graded evidence quality.RESULTSProbiotics reduced CDI odds in the unadjusted model (n=6,645; odds ratio [OR] 0.37; 95% confidence interval [CI], 0.25-0.55) and the adjusted model (n=5,074; OR, 0.35; 95% CI, 0.23-0.55). Using 2 or more antibiotics increased the odds of CDI (OR, 2.20; 95% CI, 1.11-4.37), whereas age, sex, hospitalization status, and high-risk antibiotic exposure did not. Adjusted subgroup analyses suggested that, compared to no probiotics, multispecies probiotics were more beneficial than single-species probiotics, as was using probiotics in clinical settings where the CDI risk is ≥5%. Of 18 studies, 14 reported adverse events. In 11 of these 14 studies, the adverse events were retained in the adjusted model. Odds for serious adverse events were similar for both groups in the unadjusted analyses (n=4,990; OR, 1.06; 95% CI, 0.89-1.26) and adjusted analyses (n=4,718; OR, 1.06; 95% CI, 0.89-1.28). Missing outcome data for CDI ranged from 0% to 25.8%. Our analyses were robust to a sensitivity analysis for missingness.CONCLUSIONSModerate quality (ie, certainty) evidence suggests that probiotic prophylaxis may be a useful and safe CDI prevention strategy, particularly among participants taking 2 or more antibiotics and in hospital settings where the risk of CDI is ≥5%.TRIAL REGISTRATIONPROSPERO 2015 identifier: CRD42015015701Infect Control Hosp Epidemiol 2018;771-781.

The Rising Era of Immune Checkpoint Inhibitors in Myelodysplastic Syndromes.

Abstract: Myelodysplastic syndromes (MDS) are a heterogeneous group of diseases characterized by ineffective hematopoiesis and a wide spectrum of manifestations ranging from indolent and asymptomatic cytopenias to acute myeloid leukemia (AML). MDS result from genetic and epigenetic derangements in clonal cells and their surrounding microenvironments. Studies have shown associations between MDS and other autoimmune diseases. Several immune mechanisms have been identified in MDS, suggesting that immune dysregulation might be at least partially implicated in its pathogenesis. This has led to rigorous investigations on the role of immunomodulatory drugs as potential treatment options. Epigenetic modification via immune check point inhibition, while well established as a treatment method for advanced solid tumors, is a new approach being considered in hematologic malignancies including high risk MDS. Several trials are looking at the efficacy of these agents in MDS, as frontline therapy and in relapse, both as monotherapy and in combination with other drugs. In this review, we explore the utility of immune checkpoint inhibitors in MDS and current research evaluating their efficacy.

A review: Biological activity of myrtenal and some myrtenal-containing medicinal plant essential oils

Abstract: Introduction: Myrtenal, a component of many plants` essential oils, is a bicyclic monoterpenoid. Numerous effects of myrtenal in experimental animals have been found - bronchodilatory, anti-inflammatory, anti-aggregative and antihemolytic ( in vitro ), and antibacterial. Its other activities have been studied - antioxidant, antitumor, antihyperglycemic, vasodilating, heart rate reducing and hypotensive. Myrtenal is relatively little studied in the field of neuroscience. Aim : The aim of this article is to summarize the available information on the established biological activity of the monoterpenoid myrtenal. Materials and Methods : Scientific databases such as PubMed, ResearchGate, HMDB and others have been used to provide information on the published results of properties and activities of the test substance (myrtenal) over a period of 15 years (2003 - 2018). Results: Our research confirmed the available data for its central nervous system (CNS) activity - anxiolytic and potentiating the effects of the hypnotic drugs, as well as the antioxidant properties. We have evaluated the neuromodulatory activity of M in brain tissue manifested in elevated levels of major neurotransmitters in healthy rodents and those with neurodegenerative changes accompanied by improvement in the animals` memory. Conclusion : Significant protective effects of myrtenal on neurodegenerative processes were established. Probably they are related to its complex mechanisms, including neuromodulatory and antioxidant properties.

Nerve growth factor in brain diseases

Abstract: The nerve growth factor (NGF) belongs to a family of proteins termed neurotrophins, consisting of NGF, brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3), NT-4/5 and NT-6. Today, NGF is well recognized to mediate a large number of trophobiological actions resulting in neurotrophic, immunotrophic and/or metabotrophic effects. The pathobiology of neurodegenerative diseases, including Alzheimer disease, psychiatric disorders (e.g. depression and schizophrenia) and brain parasitic infections have in common the effect of altering the brain levels of neurotrophins and in particular NGF. The involvement of NGF and its TrkA receptor in these pathologies and the recent promising results of NGF therapies are presented and discussed.

Bending fracture of Co-Cr dental bridges, produced by additive technologies: experimental investigation

Abstract: The aim of this paper is to investigate the fracture during bending test of Co-Cr dental bridges, produced by additive technologies. Three groups of samples (four-part dental bridges from 1-st premolar to 2-nd molar) were produced by conventional casting with handmade wax patterns, casting with 3D printed patterns and selective laser melting (SLM). The bending test was done using Tira Test 2300 SE/50 kN machine and especially designed appliance, ensuring loading closest to the actual during masticatory process. The loadings until cracking and fracture were evaluated. The fractured surfaces were investigated by optical microscopy. It was established that the SLM dental bridges of Co212-f alloy are being destroyed in 9.255 kN loading, which is commensurable with that for cracking of the samples, cast from Biosil-F alloy – 9.820 kN in conventional casting and 10.171 kN in casting with 3D printed patterns. The destruction of the cast Co-Cr bridges consists of three stages – crack initiation in the most loaded area, its growth and final fracture, while the destruction of the SLM samples suddenly occurs because of a network of cracks in the entire volume. The destruction type of the Co-Cr bridges, produced by SLM and casting, is identical - ductile, but the way that fracture occurs is different due to their structure. The specific layered macrostructure, the fine microstructure with dendritic morphology, the phase composition – the presence of e-phase and the typical defects of the SLM Co-Cr alloy define the fracture mechanism during bending.

In vivo confocal microstructural analysis of corneas presenting Kayser-Fleischer rings in patients with Wilson's disease

Abstract: PURPOSE To evaluate microstructural differences between corneas with and without Kayser-Fleischer rings in age-matched subjects with Wilson's disease with neurological symptoms, using confocal laser scanning microscopy. METHODS The study included 12 subjects with Wilson's disease with neurological symptoms. Twelve corneas presented clinically with classic Kayser-Fleischer rings, visible on slit lamp examination; the other 12 served as controls. The subjects underwent a comprehensive clinical examination. Microstructural analysis using confocal laser scanning microscopy evaluated increased corneal thickness, decreased number of cells, increased debris or specific deposits, and unusual microstructures. RESULTS Clinically, the subjects with Kayser-Fleischer rings had similar corneal findings and normal intraocular pressure; two had typical sunflower cataracts and decreased visual acuity. The control eyes all presented normal visual acuity, intraocular pressure, and corneal appearance. The microstructural analysis demonstrated similar findings in all the affected corneas. Compared with the control corneas, there were fewer keratocytes in the anterior stroma (17.380 vs. 22.380/mm3). Round, "hollow" dark areas were observed between the keratocytes; these were universal and similar in appearance in all affected corneas and all cornea layers. In the peripheral posterior stroma, there were dust-like, bright, granular deposits that tended to increase in number and density toward Descemet's membrane, masking the peripheral endothelium. The control corneas presented a normal microstructure apart from dust-like granular deposits in the periphery. CONCLUSIONS In vivo confocal microscopy is a useful tool for evaluating the corneal microstructure when a Kayser-Fleischer ring is clinically present. The ring consists of granular, bright particles that increase in density toward Descemet's membrane, and is associated with a decreased number of keratocytes and peculiar dark, round areas in all stromal layers, probably a sign of corneal damage. When the ring is not visible in subjects with Wilson's disease, changes to the corneal microstructure are insignificant.

Association Between Serum CK-18 Levels and the Degree of Liver Damage in Fructose-Induced Metabolic Syndrome

Abstract: Background: The pathogenesis of nonalcoholic fatty liver disease as a component of metabolic syndrome (MetS) involves the activation of apoptosis in steatotic hepatocytes. Caspase-generate...

Wine as a medicine in ancient times

Abstract: The history of wine use as a medicine dates back to antiquity. However, it has been rediscovered and reliably confirmed by current medical research. It is believed that wine is among the first documented remedies known and used by humans dating back to a period before 5000 BC. Preserved to date evidence of the medical use of wine in ancient times is very limited and is related to the development of different cultures and ancient civilizations. The article chronicles the more important periods of the history of the use of wine for medical (healing and prophylactic) purposes. The first evidence dates back to the time of the Mesopotamian culture, when the world's oldest Sumerian Pharmacopoeia - clay tiles, some of which contain wine prescriptions for therapy, was created. The next important documentary evidence is found in the Sino-Tibetan Pharmacopoeia, the Egyptian Medical Papyri, the Bible, the Sacred Book of the Jews Talmud , and the ancient Indian medical texts of Ayurveda. In ancient Greece, the first evidence of the healing effects of wine is found in the two poems of Homer Iliad and Odyssey . With the development of medical knowledge at the time of Hippocrates, the therapeutic use of wine expanded. Hippocrates included wine in the diet of almost all diseases, especially during the recovery period. Afterwards, the principles of wine therapy continued to be topical, although they were the subject of a heated debate during the Greco-Roman period, Galen's era, and even the Byzantine era, when the influence of Arab medicine began to manifest itself more and more.

SWOT analysis of Eastern Medicine developments in Bulgaria

Abstract: Geographically, Bulgaria is situated in the heart of the Balkans, bridging Western European and Eastern (Asian) cultures. In this article, Eastern Medicine (EM) developments in Bulgaria are investigated. EM is a heterogeneous concept that comprises many curing methods (focused therapies), or complete medical therapeutic systems (like Traditional Chinese Medicine, Ayurveda, Tibetan medicine), which are native for Asia and applied worldwide. In order to explore the current status, needs and expectations in the field of EM in Bulgaria, we have carried out the classical SWOT analysis (Strengths, Weaknesses, Opportunities and Threats). Contrary to popular belief, SWOT analyses must follow strict guidelines in order to be a credible instrument of change. We therefore describe the theoretical backgrounds and rationale of such analysis before proceeding to its application to the Bulgarian EM situation. Our analysis reveals that there are both strengths and opportunities for the modern developments of EM in Bulgaria. They must, however, outweigh the weaknesses and threats to such a development. In our view, increased international collaboration, more awareness of the EM effectiveness and public health benefits shall enhance the chances of EM to be fluently integrated in the Bulgarian national health care system. The development of more outward-looking public health stakeholders could enhance the chances of the rapid establishment of modern schools for EM in the country.

Application of aesthetic crowns in children patients

Abstract: Неснемаемото коронково протезиране се приема за сигурен и успешен метод за възстановяване увредените млечни и постоянни зъби. Цел на изследването е да се проучи приложението на естетичните корони в ежедневната практика на лекарите по дентална медицина в България. Източник на информация беше специално разработена за целта анкетна карта. Обект на изследване са 767 лекари по дентална медицина от цялата страна. Резултатите са обработени статистически, като са използвани методите на вариационен, сравнителен и корелационен анализ. От изследваните дентални лекари само 10.70% (82 души) са посочили, че използват естетични корони при деца. Значима разлика в при-ложението на естетичното протезиране с корони има по отношение на наличието на специалност, вида на съзъбието и използвания материал. Предимство при възстановяването с естетични корони е подобряването не само на функционалната ефективност, но и на естетическите показатели и психоемоционалното състояние на децата.

Molecular Mechanisms of Melatonin Protection from Gastric Mucosal Apoptotic Injury in Experimental Burns

Abstract: Melatonin, a basic secretory pineal gland product, is a nontoxic, multifunctional molecule. It has antioxidant and anti-apoptotic activities and protects tissues from injury. The objective of the present study was to determine the molecular mechanism of melatonin anti-apoptotic effect on gastric injury in a rat burn model. We hypothesized that melatonin gastric protection may be related to the activation of transcription erythroid 2-related factor 2 (Nrf2). Using a 30% total body surface area (TBSA) rat burn model, melatonin (10 mg/kg, i.p.) was injected immediately and 12 h after thermal skin injury. Via light immunohistochemistry, we determined the tissue level of 4-hydroxy-2-nonenal (4-HNE) as a marker of lipid peroxidation, Bcl-2 and Bax as apoptosis-related proteins, and Nrf2. Results are presented as medians (interquartile range (IQR)). Thermal trauma in burned animals, compared with the controls, increased the expression of pro-apoptotic Bax protein (1.37 (0.94–1.47)), decreased anti-apoptotic Bcl-2 protein (1.16 (1.06–1.23), p < 0.001) in epithelial cells, and elevated Bax/Bcl-2 ratios (p < 0.05). Tissue 4-HNE and Nrf2 levels were increased following severe burns (1.55 (0.98–1.61) and 1.16 (1.01–1.25), p < 0.05, respectively). Melatonin significantly decreased 4-HNE (0.87 (0.74–0.96), p < 0.01) and upregulated Nrf2 (1.55 (1.52–1.65), p < 0.001) levels. It also augmented Bax (1.68 (1.5–1.8), p < 0.001) and Bcl-2 expressions (1.96 (1.89–2.01), p < 0.0001), but reduced Bax/Bcl-2 ratios (p < 0.05). Our results suggest that experimental thermal trauma induces oxidative gastric mucosal injury. Melatonin manifests a gastroprotective effect through Nrf2 activation, lipid peroxidation attenuation, and Bax/Bcl-2 ratio modification as well.

Gas discharge visualization – historical developments, research dynamics and innovative applications

Abstract: Gas discharge visualization (GDV) is a method for entire diagnosis, which is based on natural physical phenomena in human body. Since the invention of GVD, till present, there is an inscreased interest in its application in different areas of life. The most important use of GVD is in medicine. GVD has a possibility for quantitative measurement of human physical and psychological well-being. It is used in medicine, psychology and sport for diagnosis, prevention and monitoring. The purpose of this article is to summarize the dynamics of scientific interest in GDV application in medicine, psychology and sport and to present current concepts and techiques in the use of this device in alternative medicine. Matherial and methods: research of the publishing activity in application of GVD in medicine, psychology and sport during last 70 years. Results: We observed an increasement of the scientific intreset in GVD use in medicine, alternative medicine, psychology and sport with progression for each decade, from 1950 - till now. GVD is a focus of large number of clinical studies in three dimentions of medicine - prevention, diagnosis and treatment, with culmination of publishing activity in all of the fields during last year. Conclusion: Although GVD is not well known in our country, the results of our survey are in prove of the uniqueness of GVD as a device for diagnosis, prevention and monitoring of illness. The opportunity for application of this method in conventional medicine, alternative medicine, pshychology and sport, is a beginning of new perspectives for personalized healthcare.

Early and continued manual stimulation is required for long-term recovery after facial nerve injury.

Abstract: Introduction We previously have shown that manual stimulation (MS) of vibrissal muscles for 2 months after facial nerve injury in rats improves whisking and reduces motor end plate polyinnervation. Here, we seek to determine whether discontinuing or delaying MS after facial-facial anastomosis (FFA) leads to similar results. Methods Rats were subjected to FFA and received MS for (1) 4 months (early and continued), (2) the first but not the last 2 months (discontinued), or (3) the last 2 months (delayed). Intact animals and those not receiving MS (no MS) were also examined. Results Early and continued MS restored whisking amplitude to 43°, a value significantly higher compared with the discontinued, delayed, and no MS groups (32°, 24°, and 10°, respectively). Motor end plate polyinnervation occurred in all experimental groups but was significantly higher in the delayed group. Discussion Early and continued MS results in better recovery than when it is either discontinued or delayed. Muscle Nerve 57: 100-106, 2018.

Mаsseter muscle hypertrophy in dentistry

Abstract: Masseter hypertrophy (MH) is rare, asymptomatic condition with unexplained etiology. The main finding is unilateral or bilateral benign enlargement of masseter muscles, which results in a pronounced contour of the face and/or in the angle of the lower jaw, as well as the occurrence of asymmetry in unilateral hypertrophy. Surgical resection of the masseter was a conventional method in the past for asymmetric edema treatment above the shoulder and the angle of the lower jaw, after unsuccessful altering of the vertical dimension, dental aligners, tranquilizers, etc. An effective alternative is injecting locally small doses of botulin toxin type A in the masseter. The toxin prevents the release of acetylcholine, causing presynaptic neuromuscular blockage. This way the muscles could be selectively weakened and after local paralysis muscle atrophy is observed. This technique ensures predictable result and it is an alternative conservative method for treating this type facial asymmetry. Another conservative way for treating MH is radio frequency electrocoagulation. The presence of MH after dental treatment requires specialized intervention of specialists and application of contemporary non-invasive interventions with predictable results.

Lipid composition of raw and cooked Rapana venosa from the Black Sea

Abstract: Abstract Rapana venosa is an edible mollusc with nutritional and economic importance. There is limited information about its lipid composition. The aim of the present study is to provide information about lipid composition, fatty acid profiles, fat soluble vitamins and cholesterol content of raw and cooked Rapana venosa. Cooking did not affect the ratio of lipid classes, but fatty acids composition varied significantly. Considerable variations were observed in fatty acid distribution of total lipids and neutral lipids. Fatty acid groups of phospholipids remained unaffected by temperature treatment. The most abundant fatty acids in all lipid classes of raw and cooked specimens were palmitic acid (C16:0) and eicosapentaenoic acid (C20:5n-3). The sum of omega-3 polyunsaturated fatty acids (PUFA) was higher than omega-6 PUFA in all lipid fractions. The results of the present study showed that cooking process affected cholesterol, fat soluble vitamins and carotenoids content differently. Larger variations were observed for vitamin A, β-carotene and astaxanthin and to lesser for vitamin E. Cholesterol and vitamin D3 were also affected by the thermal stress. The present study revealed that Rapana venosa meat could be a good source of high quality nutritional lipids, which are well preserved even after culinary treatment

Conservative management of periapical lesions of endodontic origin - a review of the different techniques

Abstract: Introduction : Periapical lesions of endodontic origin are common pathological conditions affecting the periradicular tissues. Mainly responsible for the initiation and progression of apical periodontitis is the microbial infection of pulpal tissues. There are different conservative techniques that can be applied in order to establish a healing process of periapical lesions of endodontic origin. Materials and Methods : We have conducted a research that covers related articles and publications, in order to review the different conservative management treatment techniques for lesions affecting the periradicular tissues. Results: Different non-surgical management techniques have been described, namely: conservative root canal therapy, decompression technique, a method using calcium hydroxide, aspiration-irrigation technique, lesion sterilization and repair therapy, active non-surgical decompression technique, and the apexum procedure. Conclusion: All of the described management techniques present with advantages, disadvantages and specific indications that should be taken into consideration when managing the treatment plan of every specific clinical case.

Black Sea fish and shellfish as essential source of vitamin B12

Abstract: Background: Vitamins are very important for the human body because they are necessary for many biological absorption processes of other nutrients, for cells and tissues growth and repair. Because of this, there are many recommendations on daily vitamins intake, approved by the different country and world food organizations. Usually under the term "vitamin B 12 " is understood only cyanocobalamin, but actually this name is general and covers all potentially biologically active "cobalamins"- a group of cobalt-containing compounds. Animal foods, as different meat, milk, eggs, fish and shellfish are considered as the main dietary sources of this vitamin. They contain different forms (methylcobalamin and deoxyadenosylcobalamin) of vitamin B 12 in different amounts. There is limited information in the scientific literature about the vitamin B 12 content in black sea fish and shellfish. The aims of the present work were to determine and compare vitamin B 12 contents as well as relative daily intake of vitamins in different fish and shellfish species from Black Sea waters. Methods: Vitamin B 12 was analysed spectrophotometrically. The method for quantitative analysis includes extraction from the edible tissue and enzymatic hydrolysis to release the cobalt ions. Results: The quantities of vitamin B 12 found in the edible tissue of the analysed samples ranged from 0.63 μg.100 g -1 ww to 21.5 μg.100 g -1 ww. Conclusions: The observed results confirm that all fish and molluscs samples deliver significant quantities of the water-soluble vitamin B 12 .

Comparison of fatty acids, cholesterol, fat soluble vitamins and carotenoids content of skin and edible tissue of farmed African catfish (Clarias gariepinus, Burchell 1822)

Abstract: Abstract African catfish (Clarias gariepinus) is new species for the Bulgarian market. It is a valuable source of biologically active components that play an important role in human diet, but there is lack of information for the quality of its dietary lipids. This study focuses on the assessment of skin and edible tissue lipid quality of farmed African catfish based on lipid content and detailed fatty acids, fat-soluble vitamins, cholesterol and carotenoids composition. Fatty acid composition was determined by gas chromatography with mass spectrometer (GC/MS) after lipid extraction. Vitamins A, D3 and E, beta-carotene, astaxanthin and cholesterol were analyzed simultaneously using high performance liquid chromatography (HPLC) with ultraviolet and fluorescence detectors. Lipids, cholesterol, astaxanthin and monounsaturated fatty acids (MUFA) were significantly higher in skin, whereas vitamin A and E, polyunsaturated fatty acids (PUFA) were higher in muscle tissue. Vitamin D3 showed comparable amounts in both tissues. Eicosapentaenoic acid (C20:5n3) and docosahexaenoic acid (C22:6n3) which are important indicators for fish lipids quality presented significantly high amounts. A portion of 100 g filet without skin contains approximately 600 mg. Results confirmed that African catfish meat - with or without the skin, can be valuable and preferable source of biologically active lipids.

Halotherapy - benefits and risks

Abstract: Salt has been used for millennia in different parts of the world by different cultures because of its health benefits and therapeutic effect. Halotherapy is a dry salt therapy that is provided in environments, with special equipment called a halogenerator. In the last decades halotherapy has gained the trust of more and more people around the world and has been spreading quickly in many countries. The positive results from the therapy last for more than a year. The possibility to combine it with other physical therapy methods, as well as with pharmacological therapy, makes halotherapy a treatment of choice in mild and moderate forms of bronchial asthma, chronic obstructive bronchitis, post-pneumonia states and various other respiratory and skin diseases. The insignificant side effects, together with the conduction of this treatment in a cosy environment, have a beneficial effect on the psycho-emotional state of adult patients and children. The aim of the article is to reveal the benefits of halotherapy as an alternative method for treating pulmonary and skin diseases and some other conditions. Technology and application method are mentioned as well as main therapeutic factors, the positive effects, contraindications for its application and some side reactions that may occur during treatment.

Is a cooperation between Eastern and Western Medicine possible in Bulgaria

Abstract: INTRODUCTION : Bulgarian patients are increasingly looking for Eastern (traditional) medicine (EM) in addition to their basic treatment. In order to avoid a conflict between the methods of Eastern and Western medicine (WM) in Bulgarian conditions, it is necessary to determine the possibilities for their joint application. AIM: The purpose of the article is to explore and present the opportunities for cooperation between Eastern and Western medicine in Bulgarian conditions. MATERIALS AND METHODS: A review and content analysis of bibliographic sources, relevant scientific articles and Bulgarian legislation normative acts were performed. RESULTS AND DISCUSSION: Western medicine affects the symptom, focuses the treatment on individual organs and systems, provides fast results, but the treatment has its side effects. Eastern medicine treats the individual in his entirety, mostly without side effects, cures the root cause, but the results are obtained through a prolonged treatment. Disadvantages of both types of medicine: the Alternative medicine is inable to deal with diseases that arise in people from the West due to contaminated environment, noise factors, impact of chemical agents, etc.; In Western medicine there are cases of sustained and irreversible health effects caused by iatrogenesis. In recent decades in Europe and around the world, the practicing of Eastern medicine techniques has been implemented as part of the prophylaxis and as a complementary therapy next to drug treatment. CONCLUSION: Bulgarian legislation regulates the training and practicing of some methods that are part of the Alternative medicine ("unconventional methods"). The Eastern medicine methods have their place in the prophylaxis and treatment of the Bulgarian patient. A cooperation between Eastern and Western medicine is possible in Bulgarian conditions.

Equipment For Object Photography In The Dental Technician’s Laboratory, Characteristics And Prices For 2018

Abstract: В началото на XIX век фотографията за първи път се прилага в медицината. Техническото й развитие я прави приложима в много сфери. Предметната фотография намира приложение в зъботехническата лаборатория, когато за нуждите на зъботехника се снимат изработени протезни конструкции, восъчен моделаж, ортодонтски апарати или апаратура. Снимките служат за прецизна документация, за комуникация с дентален кабинет, за архив или за реклама. Цел на това проучване е да предложим оптимално оборудване на основна и допълнителна фотографска техника, на добра цена. След проучване на литературни източници и експертно мнение на професионален фотограф, предлагаме конфигурации, покриващи минималните изисквания за постигане на качествени резултати. Чрез сравнителна характеристика на подбрани марки фотографска техника и тяхната относителна стойност в цени, отнесени към 2018 г., установихме, че не е задължително да се оборудва скъпоструващо фотографско студио, за да се получат добри резултати. Препоръчваме ползването на цифровата фотография като средство за подобряване на ефективността в комуникацията и в работата. Препоръчваме след набавянето на подходяща техника, да се надградят знания, относно настройки на фотоапарата, разполагане на светлинни източници, кадровка, протоколи на снимане на предметна фотография чрез допълнителни фотографски курсове.

Possibilities for more accurate prediction of thermal injury severity and determination of its impact on the body using the Abbreviated Burn Severity Index

Abstract: INTRODUCTION: During the last decades, the chances of survival in burn patients have been progressively increasing, but the issue of prognosis of death after such injuries is still of great ethical, social, medical, and forensic interest. AIM: The purpose of our study was to examine and confirm the accuracy of the ABSI (Abbreviated Burn Severity Index) system in predicting the risk of death in thermal trauma by comparing its values with the actual risk reported. MATERIALS AND METHODS: In order to achieve this purpose, the medical records of burn patients admitted to the Clinic of Thermal Trauma, Plastic, Reconstructive and Aesthetic Surgery at the Naval Hospital of Varna for a five-year period (2011-2015) were studied and the death cases were analyzed. The mortality rate predicted by ABSI was compared to the actual death rate reported in the medical records. RESULTS: There was a significant difference in the mean values of ABSI in survivors and deceased: 4.65 and 11, respectively. All with an ABSI value less than 3 survived. For ABSI values up to 10, a slightly lower mortality was reported than the predicted. For the values ≥11 they matched. Despite these discrepancies, we believe that ABSI is suitable for calculating the risk of death in thermal trauma, especially in more severe burns, where the threat to life is higher. CONCLUSION: Three groups were differentiated with a sharp increase in the percentage of actually reported mortality. Their respective ABSI values can be taken as a reference for forensic medical practitioners in the classification of bodily injuries due to burns.