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Focus on alcoholic liver disease:From nosography to treatment

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World Journal of Gastroenterology 2014年第25期20卷 8040-8047页

作者： Letitia Adela Maria streba Cristin Constantin Vere costin teodor streba Marius Eugen Ciurea Internal Medicine-Medical Semiology University of Medicine and Pharmacy of Craiova 200639 Craiova Romania Research Center of Gastroenterology and Hepatology of Craiova University of Medicine and Pharmacy of Craiova200639 CraiovaRomania University of Medicine and Pharmacy of Craiova 200639 Craiova Romania

Abusive alcohol intake currently ranks as a major cause of liver disease, and is associated with significant mortality worldwide. Alcoholic liver disease(ALD) generically defines liver abnormalities ranging from liver steatosis to the end-stages of disease such as liver cirrhosis. Information regarding the precise incidence and prevalence of ALD is still limited by a lack of large population-based studies and by the absence of large systematic reviews of all epidemiological data available. However, existing collected data show an overall increase in the number of alcohol abusers and alcoholrelated liver disease. The burden exerted on medical systems worldwide is significant, with hospitalization and management costs rising constantly over the years. A great number of all cirrhosis-related deaths in Europe and a significant percentage worldwide areassociated with alcohol consumption. The main possible risk factors for ALD are the amount and duration of alcohol abuse, patterns of drinking and the type of alcoholic beverage consumed. However, ALD does not progress to cirrhosis in all patients, therefore a series of additional factors are implicated. Even though insufficiently studied, genetic factors are generally regarded as highly important, and the presence of comorbidities and dietary habits seem to play a role in disease onset and progression. This lack of clear pathophysiological data further translates in the absence of definite treatment for ALD and shall prove challenging in the coming years. In this article, we aimed to briefly review epidemiologic data on the burden of ALD, risk factors, clinical and nosographic as well as therapeutic aspects of this disease. Without attempting to be exhaustive, this short topic highlight emphasizes each point and may serve as a general guidance tool in the complicated literature related to ALD.

关键词： Alcoholic liver disease Epidemiology Risk factors Diagnosis Treatment

Contrast-enhanced ultrasonography parameters in neural network diagnosis of liver tumors

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World Journal of Gastroenterology 2012年第32期18卷 4427-4434页

作者： costin teodor streba Mihaela Ionescu Dan Ionut Gheonea Larisa Sandulescu Tudorel Ciurea Adrian Saftoiu Cristin Constantin Vere Ion Rogoveanu Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy of Craiova200349 CraiovaRomania Department of Bioinformatics and Statistics University of Medicine and Pharmacy Craiova200349 CraiovaRomania

AIM:To study the role of time-intensity curve(TIC) analysis parameters in a complex system of neural networks designed to classify liver ***:We prospectively included 112 patients with hepatocellular carcinoma(HCC)(n = 41),hypervascular(n = 20) and hypovascular(n = 12) liver metastases,hepatic hemangiomas(n = 16) or focal fatty changes(n = 23) who underwent contrast-enhanced ultrasonography in the Research Center of Gastroenterology and Hepatology,Craiova,*** recorded full length movies of all contrast uptake phases and post-processed them offline by selecting two areas of interest(one for the tumor and one for the healthy surrounding parenchyma) and consecutive TIC *** difference in maximum intensities,the time to reaching them and the aspect of the late/portal phase,as quantified by the neural network and a ratio between median intensities of the central and peripheral areas were analyzed by a feed forward back propagation multi-layer neural network which was trained to classify data into five distinct classes,corresponding to each type of liver ***:The neural network had 94.45% training accuracy(95% CI:89.31%-97.21%) and 87.12% testing accuracy(95% CI:86.83%-93.17%).The automatic classification process registered 93.2% sensitivity,89.7% specificity,94.42% positive predictive value and 87.57% negative predictive *** artificial neural networks(ANN) incorrectly classified as hemangyomas three HCC cases and two hypervascular metastases,while in turn misclassifying four liver hemangyomas as HCC(one case) and hypervascular metastases(three cases).Comparatively,human interpretation of TICs showed 94.1% sensitivity,90.7% specificity,95.11% positive predictive value and 88.89% negative predictive *** accuracy and specificity of the ANN diagnosis system was similar to that of human interpretation of the TICs(P = 0.225 and P = 0.451,respectively).Hepatocellular carcinoma cases showed contrast uptake during the arterial phase

关键词： Hepatocellular carcinoma Liver tumors Contrast enhanced ultrasound Time-intensity curve Artificial neural network Computer-aided diagnosis system

B2 adrenergic receptors and morphological changes of the enteric nervous system in colorectal adenocarcinoma

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World Journal of Gastroenterology 2017年第7期23卷 1250-1261页

作者： Raluca Niculina Ciurea Ion Rogoveanu Daniel Pirici Georgica-costinel Tartea costin teodor streba Cristina Florescu Bogdan Catalin Ileana Puiu Elena-Anca Tartea Cristin Constantin Vere Department of Pathology University of Medicine and Pharmacy of Craiova Department of Gastroenterology University of Medicine and Pharmacy of Craiova Department of Research Methodology University of Medicine and Pharmacy of Craiova Department of Internal Medicine University of Medicine and Pharmacy of Craiova Department of Cardiology University of Medicine and Pharmacy of Craiova Department of Physiology University of Medicine and Pharmacy of Craiova Department of Pediatrics University of Medicine and Pharmacy of Craiova

To study the morphology of the enteric nervous system and the expression of beta-2 adrenergic (B2A) receptors in primary colorectal *** this study, we included forty-eight patients with primary colorectal cancer and nine patients for control tissue from the excision of a colonic segment for benign conditions. We determined the clinicopathological features and evaluated the immunohistochemical expression pattern of B2A receptors as well as the morphological changes of the enteric nervous system (ENS). In order to assess statistical differences, we used the student t-test for comparing the means of two groups and one-way analysis of variance with Bonferroni’s post hoc analysis for comparing the means of more than two groups. Correlations were assessed using the Pearson’s correlation ***2A receptors were significantly associated with tumor grading, tumor size, tumor invasion, lymph node metastasis (P 0.05). We observed, on one hand, a decrease of the relative area for both Auerbach and Meissner plexuses with the increase of the tumor grading, and on the other hand, an increase of the relative area of other nervous elements not in the Meissner plexus or in the Auerbach plexus with the tumor grading. For G1 tumors we found that epithelial B2A area showed an inverse correlation with the Auerbach plexus areas [r(14) = -0.531, P < 0.05], while for G2 tumors, epithelial B2A areas showed an indirect variation with both the Auerbach plexus areas [r(14) = -0.453, P < 0.05] and the Meissner areas [r(14) = -0.825, P < 0.01]. For G3 tumors, the inverse dependence increased for both Auerbach [r(14) = -0.587, P < 0.05] and Meissner [r(14) = -0.934, P < 0.05] ***2A receptors play an important role in colorectal carcinogenesis and can be utilized as prognostic factors. Furthermore, study of the ENS in colorectal cancer m

关键词： Beta-2 adrenergic receptors Enteric nervous system Colorectal adenocarcinoma Spectral unmixing immunohistochemistry Tumor grading

Nonalcoholic fatty liver disease, metabolic risk factors, and hepatocellular carcinoma: An open question

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World Journal of Gastroenterology 2015年第14期21卷 4103-4110页

作者： Letitia Adela Maria streba Cristin Constantin Vere Ion Rogoveanu costin teodor streba Internal Medicine Medical SemiologyUniversity of Medicine and Pharmacy of Craiova Research Center of Gastroenterology and Hepatology of Craiova University of Medicine and Pharmacy of Craiova Internal Medicine GastroenterologyUniversity of Medicine and Pharmacy of Craiova

Non-alcoholic liver disease(NAFLD) defines liver abnormalities ranging from simple steatosis to nonalcoholic steatohepatitis with or without cirrhosis development, occurring in the absence of significant alcohol consumption, use of teratogenic medication, or hereditary *** association between NAFLD and metabolic syndrome is well documented and widely ***, type 2 diabetes mellitus(T2DM), and dyslipidemia are the most common metabolic risk factors associated with *** the components of metabolic syndrome, current evidence strongly indicates obesity and diabetes as hepatocellular carcinoma(HCC) risk *** is also growing evidence that suggests an increased risk of HCC in NAFLD patients, even surpassing other etiologies in some high-income *** data demonstrate a parallel rise in prevalence of obesity, diabetes, NAFLD, and *** obesity and its related diseases have steadily afflicted larger populations, HCC incidence is expected to increase in the *** mechanisms that underlie NAFLD development and subsequent progression to nonalcoholic steatohepatitis and cirrhosis(insulin resistance and hyperinsulinemia, oxidative stress, hepatic stellate cell activation, cytokine/adipocytokine signaling pathways, and genetic and environmental factors) appear to play a significant role in the development of NAFLD-related ***, a comprehensive view of molecular mechanisms linking obesity, T2 DM, and NAFLD-related HCC, as well as the exact sequence of molecular events, is still not understood in its ***-quality data are still necessary, and efforts should continue towards better understanding the underlying carcinogenic mechanisms of NAFLD-related *** this paper, we aimed to centralize the most important links supporting these relationships, focusing on obesity, T2 DM, and NAFLD-related HCC, as well as point out the major gaps in knowledge regarding the underlying molecular mechanisms beh

关键词： Diabetes mellitus Hepatocellular carcinoma Metabol

Role of intrahepatic innervation in regulating the activity of liver cells

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World Journal of Hepatology 2014年第3期6卷 137-143页

作者： Letitia Adela Maria streba Cristin Constantin Vere Alin Gabriel Ionescu costin teodor streba Ion Rogoveanu University of Medicine and Pharmacy of Craiova Research Center of Gastroenterology and Hepatology University of Medicine and Pharmacy of Craiova

Liver innervation comprises sympathetic,parasympathetic and peptidergic nerve fibers,organized as either afferent or efferent nerves with different origins and *** anatomy and physiology have been studied in the past 30 years,with different results published over *** are the main cell population of the liver,making up almost 80%of the total liver *** interaction between hepatocytes and nerve fibers is accomplished through a wealth of neurotransmitters and signaling *** this short review,we have taken the task of condensing the most important data related to how the nervous system interacts with the liver and especially with the hepatocyte population,how it influences their metabolism and functions,and how different receptors and transmitters are involved in this complex process.

关键词： Liver innervations Hepatocytes Neurotransmitters Cellular receptors