The Digital Agenda for Europe 2020 has more objectives from increasing the participation of its citizens and consumers in the digital society to creating a fully interconnected society. These objectives can be supported through a high degree of digitization achieved at public administration level and an increased performance in delivering public services. Cloud computing is one of the ICT areas with a fast growth in the last years that presents a big promise for achieving the objectives of the Digital Agenda for Europe 2020. This paper aims to present what cloud computing is and how it can help the public administration to increase its performance. From Infrastructure as a Service continuing with Platform as a Service and moving up to Software as a Service each level of cloud computing is presented in here with its strong and weak points and how it is suitable for a given use case in public administration. The challenges and the risks of moving to cloud and the differences between public, private and hybrid cloud are also presented in the paper. The research done by the author is both theoretical and literature review and combines knowledge from different areas. An analysis and examples of cloud computing approach and implementation in several European Union countries are presented in this paper to facilitate the understanding of the subject. Cloud computing can help public administration to decrease costs, standardize services in different locations, integrate public resources and provide a higher transparency in the government act.
Constantin Borcia, Carmen Rădulescu, Radu Ciucă and Viorel Blendea
On ecosystems, the radioactive material can have several consequences: the mechanisms of self-regulation of biocoenosis are affected; the interactions and composition of flora and fauna in biocoenosis are modified etc., and on humans, radioactive material presents a major risk through external exposure and internal exposure to radiation. On the other hand, floods and droughts, among others, can have the effect that they can act as a support for radionuclides. The existence of risks of radioactive and chemical pollution on the lower course of the Danube, in the Black Sea Danube spill area as well as in the Black Sea coastal area, where a number of complex processes occur, determined the study of the radiochemical processes taking place in these areas. The paper addresses the following issues: radiation risk and nuclear risk, general hydrological characteristics, radioactivity of the Lower Danube water and coastal zone of the Black Sea, radioactivity of the Lower Danube sediments and coastal zone of the Black Sea, modeling of radiochemical processes.
Traian Ciobanu, Ioan Mihau Japie, Octavian Nutiu, Alexandru Papuc, Dragos Radulescu and Radu Radulescu
Periprosthetic joint infection is the most common reason for a failed TKA, with a septic TKA reported rate of 1 to 4% of primary TKA patients. Septic TKA has a various number of treatment options which include chronic-suppressive antibiotics, irrigation and debridement, single or staged revision arthroplasty. The goal is to eradicate the periprosthetic joint infection and reimplant a sterile and fully functional total knee prosthesis. In case the infection becomes uncontrollable, there is only one option to eradicate the infection: knee arthrodesis or above-knee amputation.
We report the case of a 63-year-old patient who in 2009 underwent TKA, the 1 year follow-up showed periprosthetic infection. At first stage, the prosthetic implants were removed and a solid cement spacer was shaped to occupy the remaining space. In 2011, after achieving complete clinical and biological remission of the infection, the cement spacer was removed and LCCK revision prosthesis was inserted.
In 2013 reinfection occurred leading to removal of the prosthetic implants and reinsertion of an antibiotic impregnated cement spacer.
Since the patient suffered significant bone loss and the local conditions were unfavorable, being prone to infection, there were 2 options to evaluate: knee arthrodesis or above knee amputation. We chose knee arthrodesis using Ilizarov external fixation technique.
Many surgical techniques are available to achieve knee arthrodesis: internal fixation with plates or intramedullary nails and external fixation. The Ilizarov method is a very effective technique that could be taken into consideration when knee arthrodesis is required.
Alexandru Papuc, Ioan Mihai Japie, Traian Ciobanu, Octavian Nutiu, Dragos Radulescu and Radu Radulescu
The GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.
The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).
We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.
The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.
Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.
Ioan Mihai Japie, Adrian Bădilă, Radu Rădulescu, Eduard Mitroi, Andra Bujdei, Adrian Dumitru, Răzvan Ene, Alexandru Papuc and Cătălin Cîrstoiu
Introduction. Chondrosarcoma is a malignant tumor of cartilaginous origin representing approximately 20-30% of all bone malignant tumors and occupying the second place in terms of their incidence. It usually affects adults between 40 and 60 years old, but can be encountered at older ages as well.
Materials and methods. We report the case of a 55-year-old male patient who presented to our department with 2 weeks-long right hip pain and partial loss of functionality in right limb. We performed X-rays, magnetic resonance imaging, computed tomography, bone scintigraphy, and angiography, which established the diagnosis of pelvic tumor. Biopsy of the tumor was performed by iliofemoral approach and its result showed moderately differentiated chondrosarcoma. Orthopaedic surgery was performed, with tumoral removal within oncological limits, pelvic reconstruction using acrylic bone cement impregnated with Vancomycin and total hip arthroplasty.
Results were assessed using the Musculoskeletal Tumor Rating Scale and a score of 23 out of 35 was obtained (the higher the better). Postoperative complications consisted in flap-skin necrosis that resolved within 2 months after surgery.
Conclusion. Bone defects repair using antibiotic impregnated cement drastically reduced the rate of postoperative infections, thus decreasing both morbidity and mortality. In spite of technological advancement, long-term prognosis remains reserved in chondrosarcoma, due to its specific aggressivity, resistance to chemo- and radiotherapy and high rate of recurrence.
Ioan Mihai Japie, Radu Rădulescu, Adrian Bădilă, Ecaterina-Maria Japie, Alexandru Papuc, Traian Ciobanu, Adrian Dumitru and Cătălin Cîrstoiu
Introduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.
Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.
Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.