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This article analyses the literature regarding the value of computer-assisted systems in esogastroduodenoscopy-quality monitoring and the assessment of gastric lesions. Current data show promising results in upper-endoscopy quality control and a satisfactory detection accuracy of gastric premalignant and malignant lesions, similar or even exceeding that of experienced endoscopists. Moreover, artificial systems enable the decision for the best treatment strategies in gastric-cancer patient care, namely endoscopic vs surgical resection according to tumor depth. In so doing, unnecessary surgical interventions would be avoided whilst providing a better quality of life and prognosis for these patients. All these performance data have been revealed by numerous studies using different artificial intelligence (AI) algorithms in addition to white-light endoscopy or novel endoscopic techniques that are available in expert endoscopy centers. It is expected that ongoing clinical trials involving AI and the embedding of computer-assisted diagnosis systems into endoscopic devices will enable real-life implementation of AI endoscopic systems in the near future and at the same time will help to overcome the current limits of the computer-assisted systems leading to an improvement in performance. These benefits should lead to better diagnostic and treatment strategies for gastric-cancer patients. Furthermore, the incorporation of AI algorithms in endoscopic tools along with the development of large electronic databases containing endoscopic images might help in upper-endoscopy assistance and could be used for telemedicine purposes and second opinion for difficult cases.

Despite a decrease in gastric cancer incidence, the development of novel biologic agents and combined therapeutic strategies, the prognosis of gastric cancer remains poor. Recently, the introduction of modern immunotherapy, especially using immune checkpoint inhibitors, led to an improved prognosis in many cancers. The use of immunotherapy was also associated with manageable adverse event profiles and promising results in the treatment of patients with gastric cancer, especially in heavily pretreated patients. These data have led to an accelerated approval of some checkpoint inhibitors in this setting. Understanding the complex relationship between the host immune microenvironment and tumor and the immune escape phenomenon leading to cancer occurrence and progression will subsequently lead to the identification of prognostic immune markers. Furthermore, this understanding will result in the discovery of both new mechanisms for blocking tumor immunosuppressive signals and pathways to stimulate the local immune response by targeting and modulating different subsets of immune cells. Due to the molecular heterogeneity of gastric cancers associated with different clinico-biologic parameters, immune markers expression and prognosis, novel immunotherapy algorithms should be personalized and addressed to selected subsets of gastric tumors, which have been proven to elicit the best clinical responses. Future perspectives in the treatment of gastric cancer include tailored dual immunotherapies or a combination of immunotherapy with other targeted agents with synergistic antitumor effects.

In order to shape a representative economic model, meant to be used for the analysis of direct acquisitions conducted by the public institutions on the electronic platform called SEAP (Electronic System of Public Acquisitions) we need to make a series of calculations which can lead to the establishment of risk scores for this types of acquisitions or procurements and their ranking, This hierarchy shall provide the public institutions with valuable items of information for the awareness of direct acquisitions particularities.

In order to study the compatibility and convergence of accounting information between the Autonomous Region Vojvodina and the West Development Region of Romania and implicitly between Vojvodina and Hungarian counties of DKMT, it is necessary to study the compatibility and possible convergence between the Vojvodina Balance Sheet (Bilans Stanja) and the Romanian Abridged Balance Sheet. In order to reach the set goal we opted for the detailed presentation of the Bilans Stanja, with the highlighting of correspondences, indicators’ manner of calculation (when necessary) and the highlight of differences and complementarities.

BACKGROUND Nonvariceal upper digestive bleeding (NVUDB) represents a severe emergency condition and is associated with significant morbidity and mortality. Despite a decrease in the incidence due to the widespread use of potent therapy with proton pump inhibitors as well as the implementation of modern endoscopic techniques, the mortality rate associated with NVUDB is still high. AIM To identify the clinical, biological, and endoscopic parameters associated with a poor outcome in patients with NVUDB to allow the stratification of risk, which will lead to the implementation of the most accurate management. METHODS We performed a retrospective study including patients who were admitted to the Gastroenterology Department of Clinical Emergency County Hospital Timisoara, Romania, with a diagnosis of NVUDB between 1 January 2008 and 31 December 2016. All the data were collected from the patient’s records, including demographic data, medication history, hemodynamic status, paraclinical tests, and endoscopic features as well as the methods of hemostasis, rate of rebleeding, need for surgery and death; we also assessed the Rockall score of the patients, length of hospitalization and associated comorbidities. All these parameters were evaluated as potential risk factors associated with rebleeding and death in patients with NVUDB. RESULTS We included a batch of 1581 patients with NVUDB, including 523 (33%) females and 1058 (67%) males with a median age of 66 years. The main cause of NVUDB was peptic ulcer (73% of patients). More than one-third of the patients needed endoscopic treatment. Rebleeding rate was 7.72%; surgery due to failure of endoscopic hemostasis was needed in 3.22% of cases; the in-hospital mortality rate was 8.09%, and the bleeding-episode-related mortality rate was 2.97%. Although our predictive models for rebleeding and death had a low sensitivity, the specificity was very high, suggesting a better discriminative capacity for identifying patients with better outcomes. Our results showed that the Rockall score was associated with both rebleeding and death; comorbidities such as respiratory conditions, liver cirrhosis and sepsis increased significantly the risk of in-hospital mortality (OR of 3.29, 2.91 and 8.03). CONCLUSION Our study revealed that the Rockall score, need for endoscopic therapy, necessity of transfusion and sepsis were risk factors for rebleeding. Moreover, an increased Rockall score and the presence of comorbidities were predictive factors for in-hospital mortality.

Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.

In the gastroenterology field, the impact of artificial intelligence was investigated for the purposes of diagnostics, risk stratification of patients, improvement in quality of endoscopic procedures and early detection of neoplastic diseases, implementation of the best treatment strategy, and optimization of patient prognosis. Computer-assisted diagnostic systems to evaluate upper endoscopy images have recently emerged as a supporting tool in endoscopy due to the risks of misdiagnosis related to standard endoscopy and different expertise levels of endoscopists, time-consuming procedures, lack of availability of advanced procedures, increasing workloads, and development of endoscopic mass screening programs. Recent research has tended toward computerized, automatic, and real-time detection of lesions, which are approaches that offer utility in daily practice. Despite promising results, certain studies might overexaggerate the diagnostic accuracy of artificial systems, and several limitations remain to be overcome in the future. Therefore, additional multicenter randomized trials and the development of existent database platforms are needed to certify clinical implementation. This paper presents an overview of the literature and the current knowledge of the usefulness of different types of machine learning systems in the assessment of premalignant and malignant esophageal lesions via conventional and advanced endoscopic procedures. This study makes a presentation of the artificial intelligence terminology and refers also to the most prominent recent research on computer-assisted diagnosis of neoplasia on Barrett’s esophagus and early esophageal squamous cell carcinoma, and prediction of invasion depth in esophageal neoplasms. Furthermore, this review highlights the main directions of future doctor–computer collaborations in which machines are expected to improve the quality of medical action and routine clinical workflow, thus reducing the burden on physicians.

Background and Aims: The ECCO-EpiCom study investigates the differences in the incidence and therapeutic management of inflammatory bowel diseases [IBD] between Eastern and Western Europe. The aim of this study was to analyse the differences in the disease phenotype, medical therapy, surgery, and hospitalization rates in the ECCO-EpiCom 2011 inception cohort during the first year after diagnosis. Methods: Nine Western, five Eastern European centres and one Australian centre with 258 Crohn’s disease [CD], 380 ulcerative colitis [UC] and 71 IBD unclassified [IBDU] patients [female/male: 326/383; mean age at diagnosis: 40.9 years, SD: 17.3 years] participated. Patients’ data were registered and entered in the web-based ECCO-EpiCom database [www.epicom-ecco.eu]. Results: In CD, 36 [19%] Western Europe/Australian and 6 [9%] Eastern European patients received biological therapy [ p = 0.04], but the immunosuppressive [IS] use was equal and high in these regions [Eastern Europe vs Western Europe/Australia: 53% vs 45%; p = 0.27]. Surgery was performed in 17 [24%] CD patients in Eastern Europe and 13 [7%] in Western Europe/Australia [ p < 0.001, p LogRank = 0.001]. Of CD patients from Eastern Europe, 24 [34%] were hospitalized, and 39 [21%] from Western Europe/Australia, [ p = 0.02, p LogRank = 0.01]. In UC, exposure to biologicals and colectomy rates were low and hospitalization rates did not differ between these regions during the 1-year follow-up period [16% vs 16%; p = 0.93]. Conclusions: During the first year after diagnosis, surgery and hospitalization rates were significantly higher in CD patients in Eastern Europe compared with Western Europe/Australia, whereas significantly more CD patients were treated with biologicals in the Western Europe/Australian centres.

Aim and background: Dieulafoy lesion (DL) represents a rare, but important cause of major upper digestive bleeding, especially in elders. The aim of the study consists in identifying the clinico-biological and endoscopic features and the outcome of these patients. Methods: We retrospectively evaluated the patients admitted with non-variceal upper digestive bleeding (UDB) in the Department of Gastroenterology, of the Emergency County Hospital Timisoara, from 2003 to 2014. Out of the total number of cases we selected the patients with endoscopic diagnosis of Dieulafoy lesion. In these patients we analyzed the demographic, clinico-biological and endoscopic data, compared to the control group that encountered the rest of the patients with UDB. Results: Out of 2104 patients with non-variceal UDB, 31/2104 (1.5%) presented DL, 19/31(61.3%) male and 12/31(38.7%) female, mean age 63 ± 12.83. Diabetes mellitus was present in 35.5% cases. The mean value of hemoglobin was significantly lower in Dieulafoy group 7 ± 2.69 vs. 8 ± 3.28 in the control group, p=0.05, thus a significantly larger number of blood units per patient were needed in this group (p

Background and aims: The aim of the present study was to validate the IBD (inflammatory bowel diseases) incidence reported in the 2010 ECCO-EpiCom (European Crohn's and Colitis Organization–Epidemiological Committee) inception cohort by including a second independent inception cohort from participating centers in 2011 and an Australian center to investigate whether there is a difference in the incidence of IBD between Eastern and Western European countries and Australia. Methods: Fourteen centers from 5 Eastern and 9 Western European countries and one center from Australia participated in the ECCO-EpiCom 2011 inception cohort. Patients' data regarding disease type, socio-demographic factors, extraintestinal manifestations and therapy were entered into the Web-based EpiCom database, www.ecco-epicom.eu. Results: A total of 711 adult patients were diagnosed during the inclusion year 2011, 178 (25%) from Eastern, 461 (65%) from Western Europe and 72 (10%) from Australia; 259 (37%) patients were diagnosed with Crohn's disease, 380 (53%) with ulcerative colitis and 72 (10%) with IBD unclassified. The mean annual incidence rate for IBD was 11.3/100,000 in Eastern Europe, 14.0/100,000 in Western Europe and 30.3/100,000 in Australia. Significantly more patients were diagnosed with complicated disease at diagnosis in Eastern Europe compared to Western Europe (43% vs. 27%, p = 0.02). Conclusion: Incidence rates, disease phenotype and initial treatment characteristics in the 2011 ECCO-EpiCom cohort were not significantly different from that reported in the 2010 cohort. * Abbreviations: : IBD : inflammatory bowel diseases CD : Crohn's disease UC : ulcerative colitis IBDU : inflammatory bowel disease unclassified ECCO : European Crohn's and Colitis Organization EpiCom : Epidemiological Committee IRR : incidence rate ratio CI : confidence interval EC-IBD : European Collaborative Study on Inflammatory Bowel Disease ACCESS : Asia-Pacific Crohn's and Colitis Epidemiology Study SE : standard error

Background and Aims: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. Methods: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1. million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. Results: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p.

BACKGROUND & AIMS: Health-related quality of life (HRQoL) is impaired in patients with Inflammatory Bowel Disease (IBD). The aim was prospectively to assess and validate the pattern of HRQoL in an unselected, population-based inception cohort of IBD patients from Eastern and Western Europe.METHODS: The EpiCom inception cohort consists of 1560 IBD patients from 31 European centres covering a background population of approximately 10.1million. Patients answered the disease specific Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and generic Short Form 12 (SF-12) questionnaire at diagnosis and after one year of follow-up.RESULTS: In total, 1079 patients were included in this study. Crohn's disease (CD) patients mean SIBDQ scores improved from 45.3 to 55.3 in Eastern Europe and from 44.9 to 53.6 in Western Europe. SIBDQ scores for ulcerative colitis (UC) patients improved from 44.9 to 57.4 and from 48.8 to 55.7, respectively. UC patients needing surgery or biologicals had lower SIBDQ scores before and after compared to the rest, while biological therapy improved SIBDQ scores in CD. CD and UC patients in both regions improved all SF-12 scores. Only Eastern European UC patients achieved SF-12 summary scores equal to or above the normal population.CONCLUSION: Medical and surgical treatment improved HRQoL during the first year of disease. The majority of IBD patients in both Eastern and Western Europe reported a positive perception of disease-specific but not generic HRQoL. Biological therapy improved HRQoL in CD patients, while UC patients in need of surgery or biological therapy experienced lower perceptions of HRQoL than the rest.

BACKGROUND AND AIMS: The EpiCom study and inception cohort was initiated in 2010 in 31 centers from 14 Western and 8 Eastern European countries, covering a 10.1million person background population. Our aim was to investigate whether there is a difference between Eastern and Western Europe in health care and education of patients with inflammatory bowel disease (IBD).METHODS: A quality of care (QoC) questionnaire was developed in the EpiCom group consisting of 16 questions covering 5 items: time interval between the onset of symptoms and diagnosis, information, education, empathy and access to health care providers.RESULTS: Of 1,515 patients, 947 (217 east/730 west) answered the QoC questionnaire. Only 23% of all patients had knowledge about IBD before diagnosis. In Eastern Europe, significantly more patients searched out information about IBD themselves (77% vs. 68%, pCONCLUSION: Health care differed significantly between Eastern and Western Europe in all items, but satisfaction rates were high in both geographic regions. Because of the low awareness and the rising incidence of IBD, general information should be the focus of patient organizations and medical societies. In Western Europe IBD nurses play a very important role in reducing the burden of patient management.

Objective: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe. The reasons for these changes remain unknown. The aim of this study was to investigate whether an East-West gradient in the incidence of IBD in Europe exists. Design: A prospective, uniformly diagnosed, population based inception cohort of IBD patients in 31 centres from 14 Western and eight Eastern European countries covering a total background population of approximately 10.1 million people was created. One-third of the centres had previous experience with inception cohorts. Patients were entered into a low cost, web based epidemiological database, making participation possible regardless of socioeconomic status and prior experience. Results: 1515 patients aged 15 years or older were included, of whom 535 (35%) were diagnosed with Crohn's disease (CD), 813 (54%) with ulcerative colitis (UC) and 167 (11%) with IBD unclassified (IBDU). The overall incidence rate ratios in all Western European centres were 1.9 (95% CI 1.5 to 2.4) for CD and 2.1 (95% CI 1.8 to 2.6) for UC compared with Eastern European centres. The median crude annual incidence rates per 100 000 in 2010 for CD were 6.5 (range 0-10.7) in Western European centres and 3.1 (range 0.4-11.5) in Eastern European centres, for UC 10.8 (range 2.9-31.5) and 4.1 (range 2.4-10.3), respectively, and for IBDU 1.9 (range 0-39.4) and 0 (range 0-1.2), respectively. In Western Europe, 92% of CD, 78% of UC and 74% of IBDU patients had a colonoscopy performed as the diagnostic procedure compared with 90%, 100% and 96%, respectively, in Eastern Europe. 8% of CD and 1% of UC patients in both regions underwent surgery within the first 3 months of the onset of disease. 7% of CD patients and 3% of UC patients from Western Europe received biological treatment as rescue therapy. Of all European CD patients, 20% received only 5-aminosalicylates as induction therapy. Conclusions: An East-West gradient in IBD incidence exists in Europe. Among this inception cohort-including indolent and aggressive cases-international guidelines for diagnosis and initial treatment are not being followed uniformly by physicians.

Although incidence has declined in recent years, gastric cancer still represents the second most frequent cause of cancer-related mortality in the world [1]. The prognosis of stom‐ ach cancer is related to the stage of disease at the time of diagnosis, with a good progno‐ sis associated with early gastric cancer [2]. Therefore, it is essential an early diagnosis of gastric carcinoma, at present only about 10-20% of cancers being diagnosed in an early phase [3]. A great interest has arisen in recent years in the detection and management of premalignant conditions and early gastric cancer because of the high cure rate achieved treating these lesions, compared with advanced gastric cancer. The well known multistep cascade of carcinogenesis developed by Correa [4] is represented by superficial gastritis followed by atrophic gastritis, intestinal metaplasia and increasing grades of dysplasia, leading to gastric adenocarcinoma. Surveillance of the premalignant lesions could deter‐ mine an early detection of patients with disease progression, with the possibility of early therapeutic intervention and improved survival of these patients [5].

Despite a decrease in incidence over past decades, gastric cancer remains a major global health problem. In the more recent period, survival has shown only minor improvement, despite significant advances in diagnostic techniques, surgical and chemotherapeutic approaches, the development of novel therapeutic agents and treatment by multidisciplinary teams. Because multiple genetic mutations, epigenetic alterations, and aberrant molecular signalling pathways are involved in the development of gastric cancers, recent research has attempted to determine the molecular heterogeneity responsible for the processes of carcinogenesis, spread and metastasis. Currently, some novel agents targeting a part of these dysfunctional molecular signalling pathways have already been integrated into the standard treatment of gastric cancer, whereas others remain in phases of investigation within clinical trials. It is essential to identify the unique molecular patterns of tumours and specific biomarkers to develop treatments targeted to the individual tumour behaviour. This review analyses the global impact of gastric cancer, as well as the role of Helicobacter pylori infection and the efficacy of bacterial eradication in preventing gastric cancer development. Furthermore, the paper discusses the currently available targeted treatments and future directions of research using promising novel classes of molecular agents for advanced tumours.

Gastric cancer represents the second leading cause of cancer related death (after lung cancer) despite a global decline in both its incidence and mortality since the late half of the 20th century (Kelley & Duggan, 2003; Zheng et al., 2008). This type of cancer continues nowadays to be a major health problem due to the slow decrease in incidence in Asia and its high mortality in the western countries (Roukos et al., 2002). The overall prognosis is reserved, depending on the TNM stage in the moment of diagnosis and somewhat on its histological type (Lauren, 1965). Based on morphological characteristics focused on gland formation and histogenetic background, gastric adenocarcinomas are divided into intestinal and diffuse types using the Lauren classification system (Lauren, 1965), or as differentiated and undifferentiated using the Nakamura classification system (Nakamura et al., 1968). Intestinal-type adenocarcinoma is considered to be equivalent to differentiated adenocarcinoma and the diffuse-type to the undifferentiated adenocarcinoma. These different types of gastric carcinomas express particular biological behaviours. Helicobacter pylori infection leads to the development of chronic atrophic gastritis and intestinal metaplasia (Byrd et al., 1997). Usually the intestinal-type gastric carcinoma arises on the background of intestinal metaplasia (Stemmermann, 1994; Tahara, 1993), and, by contrary, the diffuse-type on the background of gastric mucosa without intestinal metaplasia (Nakamura et al., 1968). The diffuse-type, as classified according to the Lauren system (non-solid type of poorly differentiated adenocarcinoma and the signet-ring cell carcinoma according to a Japanese classification system) (Japanese Gastric Cancer Association, 1996), do not show glandular formation, can be further divided into two subtypes. In the first one, the tumor is predominantly composed of signet-ring cells (>50%) (signet-ring cell carcinomas) and in the other one, the adenocarcinoma contains few signetring cells (

The characteristics of the cellular kinetic reflect the aggressiveness of the tumors and even their prognosis, many studies proving the correlation between the increased proliferation activity and a poor prognosis in a variety of neoplasms.The analysis of immunohistochemical expression of the Ki-67 antigen using the monoclonal antibody MIB1 in 61 patients with gastric cancer, the correlation with clinicopathological factors and the prognosis of the patients.We used the primary MIB1 antibody pre-diluted, using the LSAB technique, DAB visualization. The quantification of the reaction was performed by appreciating the marking index Ki-67 (MI Ki-67). Although all the lesions were positive, we noticed a marked intratumoral heterogeneity regarding the distribution of the Ki-67 score. The tumor cells were considered Ki-67 positive in the presence of brown nuclear staining of granular or diffuse type. The tumor invasion front has shown the most numerous Ki-67 positive cells.In the gastric carcinomas, we remarked various Ki-67 scores. For a proper grouping of the results, we classified gastric carcinomas into two categories: carcinomas with high MI Ki-67 (≥45%) and carcinomas with low MI Ki-67 (≤45%). We noticed an increased frequency of high MI Ki-67 carcinomas in elderly patients (p=0.03) and also in the tumors developed at cardia level and those extended in the entire stomach in the moment of diagnosis (p0.001). The histological forms associated to high Ki-67 values are represented by the anaplastic carcinoma (100% of cases) and papillary adenocarcinoma (60% of cases).We observed a close correlation between the degree of tumor differentiation and the Ki-67 score (p0.001). The results of our study do not reveal any correlation between the Lauren's Classification of gastric carcinomas, the lymphovascular invasion, the depth of tumor invasion, the TNM stage and the Ki-67 score (p0.05).In our study, immunohistochemical assessment of the tumor proliferation does not represent a prognostic factor, but seems to be useful in identifying of a group of patients with aggressive tumors, needing adjuvant postoperatory chemotherapy.

The purpose of this study was to identify the clinicopathological factors that influence the prognosis of patients having undergone surgery for gastric cancer. The analysis of the potential prognosis factors has included in this study parameters concerning the patient (sex, age), as well as parameters related with the tumor (histological type according to the WHO classification; degree of tumor differentiation; tumor location; stage of disease; pT and pM parameters according to the TNM classification of AJCC/UICC).From the total number of 265 patients (186 men and 79 women) diagnosed with gastric cancer in the period 1998-2002, 61 operated patients were selected. On this group, we performed a prospective study regarding the evolution and aggressiveness of gastric cancer, on a duration of 5 years. Survival time was calculated from the month of the surgical intervention until the month of death or confirmation of survival, and survival rate was represented by the percentage of survivals at the end of the observed interval (in years and months).The studied group consisted of 61 patients (43 men and 18 women), with ages between 30 and 80 (average age = 59.34 years). According to the maximum level of tumor invasion we identified: pTis - one case (1.6%); pT1 - four cases (6.6%); pT2 - nine cases (14.7%); pT3 - 17 cases (27.9%); most gastric cancers were included in the pT4 category (49.2%). We identified 43 gastric carcinomas with metastases in regional lymph nodes (70.5% of the cases). According to the number of lymph nodes involved: pN0 - 18 cases (29.5%); pN1 - 16 cases (26.2%); pN2 - 23 cases (37.7%); pN3 - four cases (6.6%). Distance synchronous metastases were present in 14 gastric carcinomas (pM1 - 23% of the cases), nine cases with hepatic metastases and five cases with distance peritoneal disseminations. Classification of gastric carcinomas: we identified one single case listed in the 0 stage, three cases in the IA stage, five cases in the IB stage, seven cases in the II stage, 11 cases in the IIIA stage, eight cases in the IIIB stage, and 26 cases in the IV stage. From the total of carcinomas, stage IV consisted of the greatest number of tumors, representing 42.6%. We generally remarked the increase of the number of cases in advanced stages.In the studied group, we noted a great number of gastric carcinomas diagnosed in stages T3 and T4 (77.1% of cases). Cardial tumor locations and gastric stump locations, as well as "signet-ring" cell and undifferentiated carcinomas prove to be aggressive, being diagnosed in advanced stages. 70.5% of gastric neoplasms presented lymph node metastases, most cases representing pN2 tumors (37.7%). 23% of neoplasms studied presented distance metastases at the time of diagnosis. We noted a significant correlation between the degree of tumor differentiation and the level of invasion, as well as the presence of distance and lymph node metastases. Survival at 5 years of patients included in the study was correlated significantly with the level of tumor invasion, the presence of lymph node and distance metastases, and the TNM stage.

The prognosis of the gastric cancer is generally reserved. The purpose of this study consists in the identification of the clinicopathological parameters that influence the prognosis of the patients that underwent surgery for gastric cancer.Out of a total amount of 265 patients (186 males and 79 females) clinically and histopathologically diagnosed with gastric cancer, 61 patients operated for this disease have been selected from the Surgical Departments of the Emergency County Hospital in Timisoara. A prospective study was conducted on this group, regarding the gastric cancer's evolution and aggressiveness, for a period of 5 years. The survival time was calculated starting with the month when the surgery took place, and up to the month of death or that of the survival confirmation, and the survival rate was represented by the percentage of survivals at the end of the tracked period (in years and months).The study group was formed of 61 patients (43 males and 18 females) of ages between 30 and 80 years (mean age = 59.34 years). Gastric cancer was encountered more frequently in males (70.5%) than in females (29.5%) (p0.001 ES). The amount of gastric cancer cases grows with age, the highest percent being observed in patients from the 51-70 years age group. However, the incidence is significantly lower after the age of 71 - 8.2% (p0.001 ES). Antral localization of the gastric cancer predominates in both males and females, for all the age groups (50.8%). The average 5 years survival rate, for the whole group has been of 16.4%. We remark the extremely low survival rate for the older patients. In our study, we have identified five early gastric carcinomas (8.2%), classified as being type I protrusive tumors of intestinal type and 56 advanced gastric carcinomas, 16 cases in females (28.6%) and 40 cases in males (71.4%). The average survival for the patients with advanced gastric cancers was of 13.9 months, significantly lower than the average survival value of the patients with early gastric cancers (57.2 months). According to Borrmann's classification, we have identified five type I carcinomas (8.9%), 20 type II carcinomas (35.7%), 22 type III carcinomas (39.3%), and nine type IV carcinomas (16.1%). We did not notice any significant differences between the survival values of the patients with tumors of types I, II and III (p0.05 NS), but the patients with diffuse infiltrative gastric cancers had an average survival of only 4.9 months after the surgery.The prognosis for gastric cancer is reserved, the 5 years average survival rate is of 16.4%. We have noticed a significantly decrease of survival rate with age (p = 0.024688 S). The 5 years survival is of 10.7% for patients with advanced cancers, significantly lower than the 5 years survival of 80% for patients with early gastric cancers (p0.001 ES).The ulcerative-infiltrative type of cancer is predominant (39.3%). The patients with diffuse infiltrative forms of gastric cancers survived for an average period of only 4.9 months after surgical intervention.

AIM: To compare the liver stiffness (LS) measurement by transient elastography (TE) to the liver biopsy (LB)-considered the “gold standard” in the evaluation of patients with chronic hepatitis C. METHODS: During a period of 12 mo, we evaluated 199 consecutive patients with chronic hepatitis due to hepatitis C virus (HCV), in which LB and LS assessments (by means of TE) were performed during the same session. RESULTS: Out of 199 patients, a valid measurement of the LS could not be obtained in 8. The mean value of LS in the cohort of 191 valid measurements was 8.45 ± 4.96 kPa, ranging from 2.3 to 38 kPa.The mean value of LS in patients with significant fibrosis at biopsy (161 patients with F ≥ 2 according to Metavir) was 9.02 ± 5.15 kPa, significantly higher than in patients with no or mild fibrosis (30 patients with F < 2 Metavir): 5.39 ± 1.81 kPa (P < 0.0001). For a cut-off value of 6.8 kPa, the LS had a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6% and a specificity of 93.3% for the presence of significant fibrosis (at least F2 Metavir), with a diagnostic performance of 77.3% (AUROC 0.773). Using this cut-off value, we reached the best discrimination between absence of fibrosis/mild fibrosis (F < 2 Metavir) and the presence of moderate to severe fibrosis (F ≥ 2 Metavir). CONCLUSION: In patients with chronic hepatitis due to HCV, a cut-off value of 6.8 kPa measured by TE can differentiate between significant fibrosis and absent or mild fibrosis, with a PPV of 98%, a NPV of 30.1%, a sensitivity of 59.6%, a specificity of 93.3%, and a diagnostic performance of 77.3%.

The mechanisms by which COX-2 contributes to the carcinogenesis are not known until present. It seems that the COX-2 enzyme stimulates the cell proliferation, inhibits the apoptosis, increases the malignant cells' invasiveness and induces the angiogenesis by elaborating some angiogenic factors.In the present study, we intend to evaluate the immunohistochemical expression of COX-2 in gastric carcinomas, keeping track of the correlations between the clinicopathologic factors, the tumor angiogenesis (evaluated by microvascular density--MVD--determination and by VEGF expression) and the patients' survival. In addition, we have tracked the immunoreactions' positivation in the peritumoral mucosa with various lesions, with the purpose to establish the contribution of COX-2 to the gastric carcinogenesis during the pre-invasive stages. A prospective study was realized, regarding the evolution and aggressiveness of the gastric cancer, with a duration of five years, 61 patients operated of gastric cancer being included.The COX-2 immunoreactions have been significantly more frequent noticed in the gastric carcinomas included in the study (57.4%) and in the epithelial dysplasia areas adjacent to the carcinomas of intestinal type (35.5% of the cases), than in the normal peritumoral mucosa (4.9%) (p0.001 ES). The COX-2 immunoreactions have turned positive more frequently in gastric carcinomas of intestinal type (68.4%), in comparison to the carcinomas of diffuse type (29.4%) (p0.001 ES). The COX-2 expression is significantly correlated with the invasion level, the presence of the metastases in the regional lymph nodes and the pTNM stage, but without influencing the prognosis of the gastric cancer patients. The negative VEGF carcinomas have turned positive for COX-2 only for 19% of the cases. Different from those, the positive VEGF carcinomas have associated COX-2 immunoreactivity in 77.5% of the cases.The results obtained are suggestive for the predominant expression of COX-2 in the carcinomas of intestinal type and its precursory lesions. Our results show a tight correlation between the immunohistochemical expressions of COX-2 and VEGF in gastric carcinomas (r = 0.562, p0.001 ES) and also a MVD average value significantly higher in the positive COX-2 carcinomas, suggesting an intense angiogenesis activity in that group of tumors (p0.001 ES).

The angiogenesis, the process by which new blood vessels are formed, plays an essential role in the survival of the malignant cells, in the local expansion and tumor invasion, as well as in the appearance of distant metastases.We evaluated the relation between MVD, the VEGF expression, the clinicopathologic factors and the survival in patients with gastric cancer. A prospective study has been carried out, regarding the evolution and aggressiveness of the gastric cancer, with a duration of 5 years, 61 patients that underwent a surgery for gastric cancer being included in the study. The immunohistochemical reactions for CD34 and VEGF were performed for all gastric cancers cases included in the study group.MVD has shown in the gastric carcinomas an average value significantly higher in comparison to the normal mucosa (38.7 vs. 12.5, p0.001 ES). In the intestinal type we have noticed a much lower average MVD than the average MVD in the diffuse type of gastric carcinomas (36.8 vs. 41.6) (p=0.02478 S). The anaplastic carcinoma and the signet ring cell carcinoma are detaching themselves as histological forms associated to an intense neoangiogenesis activity. The neoangiogenesis activity is correlated with: the histologic grade, the lymphovascular invasion, the level of extend, the lymph node metastasizing, the distant metastasizing and the TNM stage. The positive immunoreactions for VEGF are significantly more frequent in the gastric carcinomas, in comparison to the normal gastric mucosa (65.6% vs. 6.5%, p0.001 ES). The immunoreactions to the VEGF protein were positive in 71.1% of the intestinal carcinomas, significantly more frequent in comparison to the diffuse type carcinomas (52.9%) (p=0.018178 S). Our results show a tight correlation between the histologic grade, the level of the tumor invasion and the VEGF expression.Our results prove the major correlation between the VEGF expression and the 5-year survival rate of the patients with gastric cancer, the survival rate for the carcinomas with VEGF +~++ being significantly lower than for the VEGF negative ones (12.5% vs. 23.8%) (p=0.027983 S). Our study proves a tight correlation between the VEGF expression and the MVD (p=0.03986 S), these factors playing an important role in the tumoral biologic conduct, in the progression and the prognostic.

Gastric cancer still represents a difficult problem in the field of oncology, in terms of morbidity and mortality. The local progression and systemic spread is significantly influenced by tumor angiogenesis and lymphangiogenesis. In spite of many studies on the topic, data about the significance of growth factors in gastric cancer is controversial.to investigate the immunohistochemical expression of VEGF and to evaluate the relationships with the tumors stage and grade.The immunohistochemical expression of VEGF was investigated on 80 patients with intestinal type gastric carcinoma. Specimens were fixed in buffer formalin, embedded in paraffin, and sections were stained with Hematoxylin-Eosin and immunohistochemistry was performed for VEGF (clone VG-1). Evaluation was performed using the VEGF score, based on the intensity of reaction and percent of positive cells.The reaction for VEGF was positive in 52 from 80 cases (70%). The final product of reaction was found in the cytoplasm of tumor cells, with granular pattern. Positive reaction was also found in eight from 28 cases with associated intestinal metaplasia, and in six from nine cases with gastric dysplasia. In the adjacent apparently normal mucosa, the reaction was positive in hyperplastic gastric pits and parietal cells. A strong correlation was found between VEGF expression and lymph node status and grade of the primary, but not with the stage of the tumor.The investigation of the immunohistochemical expression of VEGF in the intestinal type of gastric carcinoma showed positive reaction in 70% of the cases. It was demonstrated the expression of VEGF in intestinal metaplasia and gastric dysplasia, which could signify an early angiogenic switch during tumorigenesis.

Intussusception of the appendix in adult represents an uncommon entity. We report a 54-year old woman who underwent an appendectomy 24 years previously and who was hospitalized for changes in bowel habits and periumbilical and epigastric pain. A sessile polypoid tumor of cecum was discovered during colonoscopy, which was removed. Histopathological examination showed that it was the case of an inverted appendiceal stump. Authors present reviews of the literature concerning clinical features, associated conditions, diagnosis, classification and therapy of this extremely rare condition.

Hepatic histological features described in hepatitis C virus (HCV) infection include bile duct damage, lymphoid follicles and/or aggregates in portal tracts, large- and small-droplet fat, Mallory body-like material in hepatocytes, liver cell dysplasia and multinucleation, and activation of sinusoidal inflammatory cells. We have examined the frequency of these lesions in 189 liver biopsy specimens, to distinguish HCV from hepatitis B infection. We have analyzed a set of three features of tures more likely to be seen in HCV than in HBV infection: lymphoid follicles and/or aggregates (68%/20%), bile duct damage (44%/22%) and large-droplet fat (77%/64%). A fourth lesion, Mallory body-like material, was seen more frequently in HCV than HBV (25%/5%). These four histological lesions are useful pathological parameters in the diagnosis of liver disease caused by HCV.

Growth of solid tumors, including gastric cancer, and the formation of metastasis depend on the induction of new blood vessels; in tumors, angiogenesis is uncontrolled and immature. This is a complex process, depending on a great variety of angiogenic factors, one of the most important being the vascular endothelial growth factor. In order to suppress the tumor development and the occurrence of metastasis, clinical trials have been developed with angiogenesis inhibitors, many of them with encouraging results. Further research is needed in regard to the idea of combined antiangiogenic therapy with conventional chemotherapy, or even immune or genetic therapies, in order to increase treatment efficiency and to suppress side effects.

Hepatic steatosis (including microvesicular and macrovesicular fat) is a significant histologic feature associated to the chronic hepatitis C (HCV). The purpose of this paper was to analyze the incidence of hepatocyte steatosis in patients with HCV and the potential role of some the known variables as risk factors possibly involved in the occurrence of steatosis: age, sex, obesity, biological parameters, diabetes mellitus, degree of necroinflammation (NI) and stage of fibrosis. 96 of 125 (76.8%) patients had hepatic steatosis (mild 76%, moderate and severe 24%); in comparison with patients without steatosis, those with HCV and steatosis were more frequently women (males/females: 1/1.9) of older age (49.97 vs. 47.7 years), with a greater ICM (index of corporal mass) (26.55 sqm vs. 23.52 sqm), with raised glycemic values (13 of the 14 patients with HCV and diabetes mellitus had steatosis), an average value of serum ALT significantly raised (95.38 U/l vs. 78.96 U/l), and an average score of NI activity significantly higher (9.39 vs. 6.75).

A management system or integrated management system implemented in a food processing unit is a useful tool that provides important information upon technological and managerial processes. This paper drowns information related to ISO 9001, ISO 22000 and ISO 17025 applicability in a food processing unit. Law 150/2004 is the first legal regulation that obliges the food processor to develop a preventive system in order to assure safety of food. A statistical analyze has been made in Cluj to mark the influence of the legislation and international standards upon the quality and safety of the food products. The period taken in consideration is from 2005 – 2008 and follows two directions: strategic program of the territorial authority for food safety and self-control program of the food processor. The study scores the most relevant etiological agents that could cause foodborne illnesses, and their appearance in food products. A relationship has been associated between legal regulations, the years taken in consideration and the preponderant health risk (microbiological, chemical and physical risks).

Due to it’s high, best quality protein content, soybean is one of the few sources of vegetal origin that provides all eight essential amino-acids, being an important source of folic acid, vitamins B3, B6, E, magnesium, potassium, iron, copper and phosphorus. It contains quality lipids as well (polinonsaturated fatty acids) and it causes a drop of the “bad” cholesterol level from the body (LDL-cholesterol decreases with 12.9%). Good cholesterol level increases on an average with 9% and the triglycerid concentration from the blood drops, with approximately 10.5%.[2] The present paper points out the influences soybean fiber enrichment has on biscuits in the technological processing and also on the qualitative content of amino-acids. To achieve this, thin layer chromatography was used from biscuits samples with different soybean fiber enrichments and a witness sample of soybean fiber. Another studied aspect was the influence of extraction solvents (ethylic alcohol, isopropyl alcohol, ammonium hydroxide) upon the amino-acids spots resolution. The experiment ascertained that the rheological properties of the soybean fiber enriched dough were improved, the amino acid quantity grew exponentially with the growth of fiber content in the biscuits and the most efficient solvent was isopropyl alcohol.