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Stiru O, Nayyerani R, Robu M, Geana RC, Dragulescu PR, Blibie OA, Bubenek-Turconi SI, Iliescu VA, Parasca C. Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature. J Pers Med 2024; 14:625. [PMID: 38929845 PMCID: PMC11204694 DOI: 10.3390/jpm14060625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Secondary aortoesophageal fistula (AEF) is defined as a communication between the aorta and the esophagus, occurring after aortic disease treatment or esophageal procedures, associating very high mortality rates with treatment and being fatal without it. Several treatment strategies have been described in the literature, combining open surgery or endovascular aortic repair with surgical or endoscopic management of the esophageal lesion. We present the case of a 53-year-old patient with a history of open aortic surgery for a giant descending thoracic aortic pseudoaneurysm complicated with secondary AEF, successfully managed using emergency transiliac TEVAR (thoracic endovascular aortic repair), extensive antibiotic therapy associated with nutritional replenishment, and rehabilitation therapy. Novel endovascular and endoscopic devices have been developed, offering less invasive treatment strategies with improved outcomes, especially for high risk surgical patients. This case highlights the importance of a multidisciplinary approach to personalized medicine to manage such complex situations.
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Affiliation(s)
- Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Reza Nayyerani
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Roxana Carmen Geana
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Petru Razvan Dragulescu
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Oana Andreea Blibie
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Serban-Ion Bubenek-Turconi
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- 1st Department of Cardiovascular Anesthesiology and Intensive Care, Prof. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
| | - Catalina Parasca
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (O.S.); (S.-I.B.-T.); (V.A.I.); (C.P.)
- Department of Cardiac Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania; (R.C.G.); (P.R.D.)
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Robu M, Radulescu B, Margarint IM, Robu C, Stiru O, Iosifescu A, Preda S, Cacoveanu M, Voica C, Iliescu VA, Moldovan H. Investigation of the Association between Bilateral Selective Anterograde Cerebral Perfusion and Postoperative Ischemic Stroke in Obese Patients with Emergency Surgery for Acute Type A Aortic Dissection. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:661. [PMID: 38674307 PMCID: PMC11052173 DOI: 10.3390/medicina60040661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/02/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Background and objectives: The relationship between cerebral perfusion and new postoperative ischemic stroke in obese patients is not well defined. The aim of this study was to investigate the association between selective bilateral anterograde cerebral perfusion and new postoperative ischemic stroke in obese patients with emergency surgery for acute type A aortic dissection. Materials and methods: A total of 292 patients with emergency surgery for acute type A aortic dissection were included in this study. Patients with hemorrhagic stroke or ischemic stroke with severe neurological dysfunction at admission that were not candidates for surgery; patients who died in the first 48 h after intensive care admission and patients with incomplete medical records were excluded. Results: The mean age was 59.42 ± 10.68 years and the mean Euroscore was 9.12 ± 1.63. Obesity was present in 76.4%, the incidence of new postoperative ischemic stroke was 27.5%, and the postoperative mortality rate was 26.7%. The mean cardiopulmonary bypass time was 206.81 ± 75.48 min, the aortic cross-clamp time was 118.2 ± 46.42 min, and 90% of cases required cerebral perfusion. The mean cerebral perfusion time was 30.8 ± 24.41 min. Obese patients had a higher frequency of in-hospital death (p = 0.009), smoking (p = 0.036), hypertension (p = 0.023), left common carotid artery dissection (p < 0.001), right common carotid artery dissection (p = 0.029), femoral artery cannulation (p = 0.026), aortic root replacement (p = 0.009), aortic valve replacement (p = 0.005) and early reintervention for bleeding (p = 0.004). Using logistic regression, selective bilateral anterograde cerebral perfusion over 40 min in obese patients was independently associated with new postoperative ischemic stroke (OR = 2.35; 95%CI = 1.36-4.86; p = 0.021). Conclusions: A patient-tailored strategy for cerebral perfusion should be considered in obese patients, considering the high atheromatous burden of the supra-aortic vessels in these patients and the potential risk of atheromatous embolization associated with this technique.
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Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Bogdan Radulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Irina Maria Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania
| | - Cornel Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Andrei Iosifescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Silvia Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | - Mihai Cacoveanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | - Cristian Voica
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania;
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
| | - Horatiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.R.); (C.R.); (O.S.); (A.I.); (S.P.); (M.C.); (V.A.I.); (H.M.)
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. Iliescu”, 022322 Bucharest, Romania
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania
- Academy of Romanian Scientists, 050711 Bucharest, Romania
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Robu M, Margarint IM, Robu C, Hanganu A, Radulescu B, Stiru O, Iosifescu A, Preda S, Cacoveanu M, Voica C, Iliescu VA, Moldovan H. Factors Associated with Newly Developed Postoperative Neurological Complications in Patients with Emergency Surgery for Acute Type A Aortic Dissection. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:27. [PMID: 38256288 PMCID: PMC10820683 DOI: 10.3390/medicina60010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/13/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. Materials and Methods: A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. Results: Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01-1.02; p < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43-5.14, p = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002-1.03; p = 0.027) were independently associated with newly developed postoperative NCs. Conclusions: Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.
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Affiliation(s)
- Mircea Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Irina Maria Margarint
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Department of Cardiac Surgery, Emergency Clinical Hospital for Children “Maria Skłodowska Curie”, 077120 Bucharest, Romania
| | - Cornel Robu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Andreea Hanganu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Neurology Department, Fundeni Clinical Institute, 022322 Bucharest, Romania
| | - Bogdan Radulescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Ovidiu Stiru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Andrei Iosifescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Silvia Preda
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Mihai Cacoveanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Cristian Voica
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Vlad Anton Iliescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Horațiu Moldovan
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.R.); (A.H.); (B.R.); (O.S.); (A.I.); (S.P.); (M.C.); (C.V.); (V.A.I.); (H.M.)
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
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Gheorghiță D, Antoniac I, Moldovan H, Antoniac A, Grosu E, Motelica L, Ficai A, Oprea O, Vasile E, Dițu LM, Raiciu AD. Influence of Lavender Essential Oil on the Physical and Antibacterial Properties of Chitosan Sponge for Hemostatic Applications. Int J Mol Sci 2023; 24:16312. [PMID: 38003499 PMCID: PMC10671502 DOI: 10.3390/ijms242216312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 10/30/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Uncontrollable bleeding continues to stand as the primary cause of fatalities globally following surgical procedures, traumatic incidents, disasters, and combat scenarios. The swift and efficient management of bleeding through the application of hemostatic agents has the potential to significantly reduce associated mortality rates. One significant drawback of currently available hemostatic products is their susceptibility to bacterial infections at the bleeding site. As this is a prevalent issue that can potentially delay or compromise the healing process, there is an urgent demand for hemostatic agents with antibacterial properties to enhance survival rates. To mitigate the risk of infection at the site of a lesion, we propose an alternative solution in the form of a chitosan-based sponge and antimicrobial agents such as silver nanoparticles (AgNPs) and lavender essential oil (LEO). The aim of this work is to provide a new type of hemostatic sponge with an antibacterial barrier against a wide range of Gram-positive and Gram-negative microorganisms: Staphylococcus epidermidis 2018 and Enterococcus faecalis VRE 2566 (Gram-positive strains) and Klebsiella pneumoniae ATCC 10031 and Escherichia coli ATCC 35218 (Gram-negative strains).
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Affiliation(s)
- Daniela Gheorghiță
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.G.); (I.A.); (E.G.)
| | - Iulian Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.G.); (I.A.); (E.G.)
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania; (A.F.); (O.O.)
| | - Horațiu Moldovan
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania; (A.F.); (O.O.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Emergency Clinical Hospital Bucharest, 014461 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.G.); (I.A.); (E.G.)
| | - Elena Grosu
- Faculty of Material Science and Engineering, National University of Science and Technology Politehnica Bucharest, 313 Splaiul Independentei, 060042 Bucharest, Romania; (D.G.); (I.A.); (E.G.)
| | - Ludmila Motelica
- National Research Center for Micro and Nanomaterials, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania;
- National Research Center for Food Safety, National University of Science and Technology Politehnica Bucharest, Splaiul Independentei 313, 060042 Bucharest, Romania
| | - Anton Ficai
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania; (A.F.); (O.O.)
- National Research Center for Micro and Nanomaterials, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania;
- National Research Center for Food Safety, National University of Science and Technology Politehnica Bucharest, Splaiul Independentei 313, 060042 Bucharest, Romania
- Faculty of Chemical Engineering and Biotechnologies, National University of Science and Technology Politehnica Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Ovidiu Oprea
- Academy of Romanian Scientists, 54 Splaiul Independentei, 050094 Bucharest, Romania; (A.F.); (O.O.)
- National Research Center for Micro and Nanomaterials, National University of Science and Technology Politehnica Bucharest, 060042 Bucharest, Romania;
- National Research Center for Food Safety, National University of Science and Technology Politehnica Bucharest, Splaiul Independentei 313, 060042 Bucharest, Romania
- Faculty of Chemical Engineering and Biotechnologies, National University of Science and Technology Politehnica Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Eugeniu Vasile
- Department of Oxide Materials Science and Engineering, National University of Science and Technology Politehnica Bucharest, 1–7 Gh. Polizu, 060042 Bucharest, Romania;
| | - Lia Mara Dițu
- Botanic and Microbiology Department, Faculty of Biology, University of Bucharest, 3, Aleea Portocalelor, 17 District 5, Grădina Botanică, 030018 București, Romania;
| | - Anca Daniela Raiciu
- Faculty of Pharmacy, Titu Maiorescu University, 22 Dambovnicului Street, 040441 Bucharest, Romania;
- S.C. Hofigal Import Export S.A., 2 Intrarea Serelor Street, 042124 Bucharest, Romania
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