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Pancreatic involvement in celiac disease

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World Journal of Gastroenterology 2022年第24期28卷 2680-2688页

作者： Daniel Vasile Balaban Iulia Enache Marina Ciochina Alina Popp Mariana Jinga Department of Internal Medicine and Gastroenterology Carol Davila University of Medicine and PharmacyBucharest 020021Romania Dr.carol davila Central Military Emergency University Hospital Bucharest 020021Romania Department of Pediatrics Carol Davila University of Medicine and PharmacyBucharest 020021Romania National Institute for Mother and Child Health Bucharest 020021Romania

Celiac disease(CD)is well recognized as a systemic,chronic autoimmune disease mainly characterized by gluten-sensitive enteropathy in genetically predisposed individuals but with various extraintestinal features.One of the affected organs in CD is the pancreas,consisting of both endocrine and exocrine alterations.Over the last decades there has been increasing interest in the pancreatic changes in CD,and this has been reflected by a great number of publications looking at this extraintestinal involvement during the course of CD.While pancreatic endocrine changes in CD,focusing on type 1 diabetes mellitus,are well documented in the literature,the relationship with the exocrine pancreas has been less studied.This review summarizes currently available evidence with regard to pancreatic exocrine alterations in CD,focusing on risk of pancreatitis in CD patients,association with autoimmune pancreatitis,prevalence and outcomes of pancreatic exocrine insufficiency in newly diagnosed and gluten-free diet treated CD patients,and the link with cystic fibrosis.In addition,we discuss mechanisms behind the associated pancreatic exocrine impairment in CD and highlight the recommendations for clinical practice.

关键词： Pancreas Celiac disease Autoimmune Pancreatitis Cystic fibrosis Exocrine insufficiency

Minimally invasive surgery for gastro-oesophageal junction adenocarcinoma: Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1675-1690页

作者： Rodica Birla Petre Hoara Florin Achim Valeriu Dinca Diana Ciuc Silviu Constantinoiu Adrian Constantin Department of General Surgery Carol Davila UniversityBucharest 011172Romania Department of General Surgery Carol Davila University of Medicine and PharmacyBucharest 020021Romania Faculty of Medicine “Titu Maiorescu”UniversityBucharest 031593Romania

Minimally invasive surgery is increasingly indicated in the management of malignant disease.Although oesophagectomy is a difficult operation,with a long learning curve,there is actually a shift towards the laparoscopic/thoracoscopic/robotic approach,due to the advantages of visualization,surgeon comfort(robotic surgery)and the possibility of the whole team to see the operation as well as and the operating surgeon.Although currently there are still many controversial topics,about the surgical treatment of patients with gastro-oesophageal junction(GOJ)adenocarcinoma,such as the type of open or minimally invasive surgical approach,the type of oesophago-gastric resection,the type of lymph node dissection and others,the minimally invasive approach has proven to be a way to reduce postoperative complications of resection,especially by decreasing pulmonary complications.The implementation of new technologies allowed the widening of the range of indications for this type of surgical approach.The short-term and long-term results,as well as the benefits for the patient-reduced surgical trauma,quick and easy recovery-offer this type of surgical treatment the premises for future development.This article reviews the updates and perspectives on the minimally invasive approach for GOJ adenocarcinoma.

关键词： Gastro-oesophageal adenocarcinoma Minimally invasive oesophagectomy Laparoscopic gastrectomy Abdomino-mediastinal lymph node dissection Indocyanine green fluorescence imaging

Overview of dyslipidemia and metabolic syndrome in myeloproliferative neoplasms

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World Journal of Clinical Oncology 2024年第6期15卷 717-729页

作者： Mihnea-Alexandru Găman Bahadar Singh Srichawla Yong-Feng Chen Poulami Roy Arkadeep Dhali Ahmed Nahian Muhammad Romail Manan Vincent Kipkorir Richard Christian Suteja Lakshmi Venkata Simhachalam Kutikuppala Amelia Maria Găman Camelia Cristina Diaconu Faculty of Medicine “Carol Davila”University of Medicine and PharmacyBucharest 050474Romania Department of Hematology Center of Hematolog Department of Cellular and Molecular Pathology Stefan S Nicolau Institute of VirologyRomanian AcademyBucharest 030304Romania Department of Neurology University of Massachusetts Chan Medical SchoolWorcesterMA 01655United States Department of Basic Medical Sciences School of Medicine of Taizhou UniversityTaizhou UniversityTaizhou 318000Zhejiang ProvinceChina Department of Medicine North Bengal Medical College and HospitalWest Bengal 734012India Academic Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation TrustSheffield S57AUUnited Kingdom Lecom at Seton Hill GreensburgPA 15601United States Faculty of Medicine Services HospitalLahore 54000Pakistan Department of Human Anatomy and Physiology University of NairobiNairobi 00100Kenya Faculty of Medicine Udayana UniversityDenpasarBali 80361Indonesia Department of General Surgery Dr.NTR University of Health SciencesVijayawada 520008Andhra PradeshIndia Department of Pathophysiology University of Medicine and Pharmacy of CraiovaCraiova 200349Romania Clinic of Hematology Filantropia City HospitalCraiova 200143Romania Department of Internal Medicine Faculty of Medicine“Carol Davila”University of Medicine and PharmacyBucharest 050474Romania Internal Medicine Clinic Clinical Emergency Hospital of BucharestBucharest 105402Romania

Myeloproliferative neoplasms(MPNs)occur due to the abnormal proliferation of one or more terminal myeloid cell lines in peripheral blood.Subjects suffering from MPNs display a high burden of cardiovascular risk factors,and thrombotic events are often the cause of death in this population of patients.Herein,we provide a brief overview of dyslipidemia and metabolic syndrome and their epidemiology in MPNs and examine the common molecular mechanisms between dyslipidemia,metabolic syndrome,and MPNs,with a special focus on cardio-vascular risk,atherosclerosis,and thrombotic events.Furthermore,we investigate the impact of dyslipidemia and metabolic syndrome on the occurrence and survival of thrombosis in MPN patients,as well as the management of dyslipidemia in MPNs,and the impact of MPN treatment on serum lipid concentrations,particularly as side/adverse effects reported in the context of clinical trials.

关键词： Polycythemia vera Essential thrombocythemia Myelofibrosis Cardiovascular disease Hypercholesterolemia Hypertriglyceridemia Obesity Diabetes Inflammation Oxidative stress

Pursuing meaningful end-points for stem cell therapy assessment in ischemic cardiac disease

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World Journal of Stem Cells 2017年第12期9卷 203-218页

作者： Maria Dorobantu Nicoleta-Monica Popa-Fotea Mihaela Popa Iulia Rusu Miruna Mihaela Micheu Department of Cardiology Clinical Emergency Hospital of Bucharest carol davila University of Medicine 'Carol Davila' University of Medicine and Pharmacy Bucharest

Despite optimal interventional and medical therapy, ischemic heart disease is still an important cause of morbidity and mortality worldwide. Although not included in standard of care rehabilitation, stem cell therapy(SCT) could be a solution for prompting cardiac regeneration. Multiple studies have been published from the beginning of SCT until now, but overall no unanimous conclusion could be drawn in part due to the lack of appropriate endpoints. In order to appreciate the impact of SCT, multiple markers from different categories should be considered: Structural, biological, functional, physiological, but also major adverse cardiac events or quality of life. Imaging end-points are among the most used-especially left ventricle ejection fraction(LVEF) measured through different methods. Other imaging parameters are infarct size, myocardial viability and perfusion. The impact of SCT on all of the aforementioned end-points is controversial and debatable. 2 D-echocardiography is widely exploited, but new approaches such as tissue Doppler, strain/strain rate or 3 D-echocardiography are more accurate, especially since the latter one is comparable with the MRI gold standard estimation of LVEF. Apart from the objective parameters, there are also patient-centered evaluations to reveal the benefits of SCT, such as quality of life and performance status, the most valuable from the patient point of view. Emerging parameters investigating molecular pathways such as non-coding RNAs or inflammation cytokines have a high potential as prognostic factors. Due to the disadvantages of current techniques, new imaging methods with labelled cells tracked along their lifetime seem promising, but until now only pre-clinical trials have been conducted in humans. Overall, SCT is characterized by high heterogeneity not only in preparation, administration and type of cells, but also in quantification of therapy effects.

关键词： Stem cell therapy Cardiac imaging techniques Ischemic cardiac disease Cardiac regeneration Endpoints

Occult hepatitis B—the result of the host immune response interaction with different genomic expressions of the virus

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World Journal of Clinical Cases 2022年第17期10卷 5518-5530页

作者： George Sebastian Gherlan Department of Infectious Diseases “Carol Davila”University of Medicine and PharmacyBucharest 030303Romania Department of Infectious Diseases “Dr.Victor Babes”Hospital of Infectious and Tropical DiseasesBucharest 030303Romania

With over 40 years of history,occult hepatitis B infection(OBI)continues to remain an important and challenging public health problem.Defined as the presence of replication-competent hepatitis B virus(HBV)DNA(i.e.,episomal HBV covalently closed circular DNA)in the liver and/or HBV DNA in the blood of people who test negative for hepatitis B surface antigen(HBsAg)in currently available assays,OBI is currently diagnosed using polymerase chain reaction(PCR)and real-time PCR assays.However,all efforts should be made to exclude a false negative HBsAg in order to completely follow the definition of OBI.In recent years,significant advances have been made in understanding the HBV lifecycle and the molecular mechanisms that lead to the persistence of the virus in the occult form.These factors are mainly related to the host immune system and,to a smaller proportion,to the virus.Both innate and adaptive immune responses are important in HBV infection management,and epigenetic changes driven by host mechanisms(acetylation,methylation,and microRNA implication)are added to such actions.Although greater genetic variability in the S gene of HBV isolated from OBIs was found compared with overt infection,the mechanisms of OBI are not mainly viral mutations.

关键词： Hepatitis B virus Occult hepatitis B Covalently closed circular DNA Epigenetic factors Immune factors MicroRNA

Laparoscopic vs open complete mesocolic excision with central vascular ligation for colon cancer: A systematic review and meta-analysis

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World Journal of Gastrointestinal Oncology 2017年第12期9卷 475-491页

作者： Ionut Negoi Sorin Hostiuc Ruxandra Irina Negoi Mircea Beuran Department of General Surgery Emergency Hospital of Bucharest Carol Davila University of Medicine and Pharmacy Bucharest National Institute of Legal Medicine Mina Minovici Carol Davila University of Medicine and Pharmacy Bucharest Department of Anatomy Carol Davila University of Medicine and Pharmacy Bucharest Emergency Hospital of Bucharest Carol Davila University of Medicine and Pharmacy Bucharest

AIM To compare the effectiveness of laparoscopic complete mesocolic excision(CME) with central vascular ligation(L-CME) with its open(O-CME) counterpart. METHODS We conducted an electronic search of the Pub Med/MEDLINE, Excerpta Medica Database, Web of Science Core Collection, Cochrane Center Register of Controlled Trails, Cochrane Database of Systematic Reviews, Sci ELO, and Korean Journal databases from their inception until May 2017. We considered randomized controlled trials(RCTs) and controlled clinical trials(CCTs) that included patients with colonic cancer comparing L-CME and O-CME. Primary outcomes included the quality of the resected specimen(lymph nodes retrieved, complete mesocolic plane excision, tumor to arterial high tie, resected mesocolon surface). Secondary outcomes included the three-year and five-year overall and disease-free survival rates, recurrence of the disease, surgical data, and postoperative morbidity and mortality. Two authors of the review screened the methodological quality of the eligible trials and independently extracted data from individualstudies.RESULTS A total of one RCT and eleven CCTs(four from Europe and seven from Asia) met the inclusion criteria for the current meta-analysis. These studies involved 1619 patients in L-CME and 1477 patients in O-CME. The L-CME was associated with the same quality of the resected specimen, with no differences regarding the retrieved lymphnodes(MD =-1.06, 95%CI:-3.65 to 1.53, P = 0.42), and tumor to high tie distance(MD = 14.26 cm, 95%CI:-4.30 to 32.82, P = 0.13); the surface of the resected mesocolon was higher in the L-CME group(MD = 11.75 cm2, 95%CI: 9.50 to 13.99, P < 0.001). The L-CME was associated with a lower rate of blood transfusions(OR = 0.45, 95%CI: 0.27 to 0.75, P = 0.002), faster recovery of gastrointestinal function, and less postoperative overall complication rate. The L-CME approach was associated with a statistical significant better three-year overall(OR = 2.02, 95%CI: 1.31 to 3.12, P = 0.001, I2 = 28%) and disease-free(OR

关键词：结肠癌完成 mesocolic 切除 D3 lymphadenectomy 中央脉管的结扎

Exploring the impact of rotavirus vaccination on antibiotic prescription and resistance:A comprehensive systematic review

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World Journal of Virology 2024年第2期13卷 115-122页

作者： Lakshmi Venkata Simhachalam Kutikuppala Matei-Alexandru Cozma Gautam Maddineni Harshal Prakash Chorya Nayanika Tummala Swathi Godugu Jyothi Swaroop Chintala Mihnea-Alexandru Găman Department of General Surgery Dr NTR University of Health SciencesVijayawada 520008Andhra PradeshIndia Faculty of Medicine “Carol Davila”University of Medicine and PharmacyBucharest 050474Romania Department of Gastroenterology Colentina Clinical HospitalBucharest 020125Romania Department of Internal Medicine Florida State UniversityCape CoralFL 33909United States Department of Internal Medicine Baroda Medical CollegeVadodara 390001GujaratIndia Department of Internal Medicine GITAM Institute of Medical Sciences and Research(GIMSR)Visakhapatnam 530045Andhra PradeshIndia Department of Internal Medicine Zaporozhye State Medical UniversityZaporozhye 69000Ukraine Department of Anesthesiology Dr NTR University of Health SciencesVijayawada 520008Andhra PradeshIndia Department of Hematology Center of Hematology and Bone Marrow TransplantationFundeni Clinical InstituteBucharest 022328Romania

BACKGROUND Rotavirus is a highly contagious virus responsible for a significant burden of acute gastroenteritis,particularly among infants and young children worldwide,however,vaccination against this viral agent is available.Several studies have hypothesized that rotavirus vaccination has been linked to lower rates of antibiotic resistance.AIM To assess the relationship between rotavirus vaccination and antibiotic resistance.METHODS The present systematic review was tailored based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Several electronic databases(PubMed/MEDLINE,Scopus and Web of Science)were searched independently by two investigators in order to retrieve relevant publications published until April 2023 that investigated the aforementioned research question.RESULTS The comprehensive database search identified a total of 91 records.After the duplicates were removed(n=75),we screened the titles and abstracts of 16 potentially eligible publications.After the irrelevant records were excluded(n=5),we screened the full texts of 11 manuscripts.Finally,5 studies were entered into the qualitative and quantitative analysis.CONCLUSION In conclusion,all the studies support the idea that vaccinations can reduce the need for antibiotic prescriptions which could potentially contribute to mitigating antibiotic resistance.However,to fully comprehend the mechanisms of antibiotic resistance,enhance treatment guidelines,and consider diverse demographic situations,further research is necessary to use evidence-based strategies to fight antibiotic misuse and resistance.

关键词： Rotavirus Vaccination Gastroenteritis Antibiotics Antibiotic resistance Diarrhea Children

Prospective study of hepatitis B and D epidemiology and risk factors in Romania:A 10-year update

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World Journal of Hepatology 2024年第4期16卷 640-649页

作者： Speranta Iacob Liana Gheorghe Mirela Onica Laura Huiban Corina Silvia Pop Ciprian Brisc Roxana Sirli Carmen Ester Cristina Mihaela Brisc Sorina Diaconu Ion Rogoveanu Larisa Sandulescu Deiana Vuletici Anca Trifan Department of Gastroenterology Carol Davila University of Medicine and PharmacyBucharest 050474Romania Department of Gastroenterology and Hepatology Fundeni Clinical InstituteBucharest 022328Romania Department of Gastroenterology Grigore T Popa University of Medicine and PharmacyIasi 700115Romania Institute of Gastroenterology and Hepatology Saint Spiridon County HospitalIasi 700111Romania Department of Gastroenterology and Medical Oncology University Emergency Clinical HospitalBucharest 050098Romania Faculty of Medicine and Pharmacy University of OradeaOradea 410087Romania Department of Gastroenterology Emergency County HospitalOradea 410169Romania Center for Advanced Research in Gastroenterology and Hepatology Department of Gastroenterology and Hepatology“Victor Babeş”University of Medicine and PharmacyTimisoara 300041Romania Department of Gastroenterology and Hepatology TimişCounty Emergency Clinical Hospital"Pius Branzeu"Timisoara 300723Romania Department of Internal Medicine II and Gastroenterology University Emergency Clinical HospitalBucharest 050098Romania Department of Gastroenterology University of Medicine and PharmacyCraiova 200349Romania Department of Cardiology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Research Center of Gastroenterology and HepatologyUniversity of Medicine and PharmacyCraiova 200349Romania Department of Gastroenterology Emergency County HospitalCraiova 200642Romania Department of Gastroenterology Faculty of MedicineGrigore T Popa University of Medicine and PharmacyIasi 700115Romania

BACKGROUND The global burden of hepatitis D virus(HDV)infection represents a major medical challenge and a public health crisis worldwide.However,there is a lack of accurate data on the epidemiology and risk factors for HDV.Hepatitis B virus(HBV)and HDV coinfection causes the most severe form of viral hepatitis,leading to a higher cumulative incidence of liver-related events compared with HBV monoinfection,including the need for liver transplantation and death.AIM To investigate the epidemiology,natural history,risk factors and clinical management of HBV and HDV coinfection in Romanian patients.METHODS This prospective study was conducted between January and July 2022 in six tertiary gastroenterology and hepatology referral centres in Romania.All consecutive adults admitted for any gastroenterology diagnosis who were HBV-positive were enrolled.Patients with acute hepatitis or incomplete data were excluded.Of the 25390 individuals who presented with any type of gastroenterology diagnosis during the study period,963 met the inclusion criteria.Testing for anti-HDV antibodies and HDV RNA was performed for all participants.Demographic and risk factor data were collected by investigators using medical charts and patient questionnaires.All data were stored in an anonymized online database during the study.RESULTS The prevalence of HBV was 3.8%;among these patients,the prevalence of HBV/HDV coinfection was 33.1%.The median age of the study population was 54.0 years,and it consisted of 55.1%men.A higher prevalence of HBV/HDV coinfection was observed in patients 50–69 years old.Patients with HBV/HDV coinfection were significantly older than those with HBV monoinfection(P=0.03).Multivariate multiple regression analysis identified female gender(P=0.0006),imprisonment(P<0.0001),older age at diagnosis(P=0.01)and sexual contact with persons with known viral hepatitis(P=0.0003)as significant risk factors for HDV.CONCLUSION This study shows that HDV infection among those with HBV remains endemic in Romania and updates our underst

关键词： Epidemiology Hepatitis B Hepatitis D Natural history Risk factors Romania

Clinical characteristics and outcomes in carbohydrate antigen 19-9 negative pancreatic cancer

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World Journal of Clinical Oncology 2022年第7期13卷 630-640页

作者： Daniel Vasile Balaban Flavius Stefan Marin George Manucu Andreea Zoican Marina Ciochina Victor Mina Cristina Patoni Catalina Vladut Sandica Bucurica Raluca Simona Costache Florentina Ionita-Radu Mariana Jinga Department of Gastroenterology Carol Davila University of Medicine and PharmacyDr.Carol Davila Central Military Emergency University HospitalBucharest 020021Romania Department of Gastroenterology and Digestive Oncology Hôpital CochinParis 75014France Department of Gastroenterology Carol Davila University of Medicine and PharmacyProf Dr.Agrippa Ionescu Clinical Emergency HospitalBucharest 020021Romania

BACKGROUND Pancreatic ductal adenocarcinoma(PDAC)is a leading cause of death from cancer worldwide.Tumor markers like carbohydrate antigen 19-9(CA 19-9)have been proven valuable as a diagnostic tool and a predictor for tumor staging and response to therapy.AIM To delineate the phenotype of normal CA 19-9 PDAC according to clinical features,disease staging and prognosis as compared with high CA 19-9 PDAC cases.METHODS We performed a retrospective single-center analysis of all PDAC cases admitted in our Gastroenterology department over a period of 30 mo that were diagnosed by endoscopic ultrasound-guided tissue acquisition.Patients were divided into two groups according to CA 19-9 levels over a threshold of 37 U/mL.We performed a comparison between the two groups with regard to demographic and clinical data,biomarkers,tumor staging and 6-mo survival.RESULTS Altogether 111 patients were recruited with 29 having documented normal CA 19-9(<37 U/mL).In the CA 19-9 negative group of patients,20.68%had elevated levels of both CEA and CA 125,13.79%for CA 125 only whilst 17.24%for CEA only.The two groups had similar demographic characteristics.Abdominal pain was more frequently reported in positive vs negative CA 19-9 PDAC cases(76.83%vs 55.17%),while smoking was slightly more prevalent in the latter group(28.04%vs 31.03%).Tumors over 2 cm were more frequently seen in the positive CA 19-9 group,reflecting a higher proportion of locally advanced and metastatic neoplasia(87.7%vs 79.3%).Sixmonth survival was higher for the negative CA 19-9 group(58.62%vs 47.56%).CONCLUSION Elevated CA 19-9 at diagnosis seems to be associated with a more pronounced symptomatology,high tumor burden and poor prognosis compared to negative CA 19-9 PDAC cases.CEA and CA 125 can be adjunctive useful markers for PDAC,especially in CA 19-9 negative cases.

关键词： Pancreatic cancer Carbohydrate antigen 19-9 Survival Lewis Outcome