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Simple Summary: Cholangiocarcinoma (CCA), a rare cancer that affects the bile ducts, is often diagnosed at a late stage, making treatment difficult and survival rates low. This research aims to improve the accuracy of diagnosing distal cholangiocarcinoma (dCCA) by using advanced artificial intelligence (AI) models to analyze endoscopic ultrasound (EUS) images. By developing a user-friendly tool, this study hopes to assist doctors in making quicker and more reliable diagnoses, potentially leading to better outcomes for patients with this challenging disease. Introduction: Cholangiocarcinoma (CCA) is a highly lethal malignancy originating in the bile ducts, often diagnosed late with poor prognosis. Differentiating benign from malignant biliary tumors remains challenging, necessitating advanced diagnostic techniques. Objective: This study aims to enhance the diagnostic accuracy of endoscopic ultrasound (EUS) for distal cholangiocarcinoma (dCCA) using advanced convolutional neural networks (CCNs) for the classification and segmentation of EUS images, specifically targeting dCCAs, the pancreas, and the bile duct. Materials and Methods: In this retrospective study, EUS images from patients diagnosed with dCCA via biopsy and an EUS-identified bile duct tumor were evaluated. A custom CNN was developed for classification, trained on 156 EUS images. To enhance the model's robustness, image augmentation techniques were applied, generating a total of 1248 images. For tumor and organ segmentation, the DeepLabv3+ network with ResNet50 architecture was utilized, employing Tversky loss to manage unbalanced classes. Performance evaluation included metrics such as accuracy, sensitivity, specificity, and Intersection over Union (IoU). These methods were implemented in collaboration with the ADAPTED Research Group at the Technical University of Cluj-Napoca. Results: The classification model achieved a high accuracy of 97.82%, with precision and specificity both at 100% and sensitivity at 94.44%. The segmentation models for the pancreas and bile duct demonstrated global accuracies of 84% and 90%, respectively, with robust IoU scores indicating good overlap between predicted and actual contours. The application performed better than the UNet model, particularly in generalization and boundary delineation. Conclusions: This study demonstrates the significant potential of AI in EUS imaging for dCCA, presenting a robust tool that enhances diagnostic accuracy and efficiency. The developed MATLAB application serves as a valuable aid for medical professionals, facilitating informed decision-making and improving patient outcomes in the diagnosis of cholangiocarcinoma and related pathologies. [ABSTRACT FROM AUTHOR]

Background: Cholangiocarcinoma (CCA) is a highly aggressive cancer of the bile ducts with a poor prognosis and limited diagnostic markers. This study aims to investigate the potential of miR-18a and miR-532 as biomarkers for CCA by exploring their correlations with clinical parameters and traditional tumor markers such as CA19.9, CEA, and AFP. Methods: This study involved a cohort of patients diagnosed with CCA. Serum levels of miR-18a and miR-532 were measured and analyzed in relation to various clinical parameters, including age, tumor markers, and histological features. Results: Serum levels of miR-18a and miR-532 were upregulated in patients with extrahepatic cholangiocarcinoma (eCCA) compared to healthy controls (p < 0.05). MiR-18a and miR-532 levels were correlated with each other (p = 0.011, Spearman's rho = 0.482) but showed no significant correlation with age or traditional tumor markers (CA19.9, CEA, AFP). No significant differences in miR-18a and miR-532 levels were observed concerning tumor localization or histological grading. For predicting tumor resectability, miR-532 at a cut-off point of 2.12 showed a sensitivity of 72.73%, specificity of 81.25%, and an AUC of 71.3%, while miR-18a, at a cut-off of 1.83, had a sensitivity of 63.64%, specificity of 75%, and an AUC of 59.7%. ROC curve analysis suggested moderate diagnostic potential for miR-18a and miR-532, with AUC values of 0.64 and 0.689, respectively. Conclusions: Although miR-18a and miR-532 showed significant upregulation in eCCA patients compared to healthy controls, they did not demonstrate significant associations with key clinical parameters, limiting their effectiveness as standalone diagnostic biomarkers. Further research involving larger, multi-center cohorts and additional molecular markers is necessary to validate these findings and explore the broader diagnostic potential of miRNAs in CCA. [ABSTRACT FROM AUTHOR]

This case report describes an uncommon overlap syndrome between ankylosing spondylitis (AS) and amyotrophic lateral sclerosis (ALS). Initially, the patient was diagnosed with AS, for which he received various specific treatments, including TNF-α inhibitors. After five years of treatment with TNF-α inhibitor etanercept, the patient was referred for a full neurological assessment after he reported balance disturbances, postural instability, muscle weakness, and other neurological symptoms that indicated the presence of a neurological disorder. After a thorough investigation, the patient was diagnosed with ALS. This case report aims to contribute to the limited literature by providing a detailed case study regarding the crosstalk between AS and ALS while also exploring the potential underlying mechanisms and the possible link between TNF-α inhibitors therapy and ALS. [ABSTRACT FROM AUTHOR]

Este cunoscut faptul că infecţia cu virus hepatitic C reprezintă un factor de risc pentru limfoamele non- Hodgkin cu celule B. Studiile referitoare la prevalenţa acesteia în limfoame raportează rezultate contradictorii, în funcţie de zona geografică. Limfocitoza monoclonală B este o condiţie asimptomatică care se poate transforma în limfom malign, caracterizată prin prezenţa unei populaţii clonale B circulante. Poate fi detectată prin citometrie în flux şi s-a demonstrat că prevalenţa ei la pacienţii cu virus hepatitic C este mai mare decât la populaţia generală. În literatură există doar câteva studii referitoare la prevalenţa limfocitozei monoclonale la pacienţii cu virus C iar în România nu a fost condus un asemenea studiu. Am efectuat un studiu prospectiv pe 50 de pacienţi cu virus hepatitic C internaţi la Institutul Regional de Gastroenterologie şi Hepatologie Prof.Dr.Octavian Fodor. Datele clinice şi de laborator au fost culese din foile de observaţie. Citometria în flux s-a efectuat în Laboratorul de Imunologie al Spitalului Judeţean de Urgenţă Cluj-Napoca. Am găsit o prevalenţă de 22% a limfocitozei monoclonale. Nu au existat diferenţe statistic semnificative între pacienţii cu şi fără limfocitoză monoclonală, cu excepţia numărului mai mic de leucocite (p=0.04) şi a ecogenicităţii hepatice mai mari (p=0.02) la cei cu monoclonalitate. Am întâlnit toate cele 3 subtipuri de limfocitoză monoclonală B. Prevalenţa ridicată la pacienţii cu virus hepatitic C susţine implicarea virusului în limfomageneză, dar sunt necesare alte studii pe viitor, care să analizeze rata de transformare în limfom la aceşti pacienţi.

Background: In order to pursue recovery, Quality of life (QoL) and general functioning in patients with schizophrenia are milestones that need to be addressed in the treatment of the disease. The major aim of the present study was to examine the relationship between QoL, functionality and symptoms, and clinical characteristics of the disease, and to identify whether the two domains of negative symptoms, avolition/apathy and diminished expression, are predictive factors for the quality of life and functionality in patients diagnosed with schizophrenia. In the present cross-sectional study, 87 patients diagnosed with schizophrenia completed a thorough battery of instruments evaluating: clinical symptoms, stigma, QoL, functionality, socio-demographic and clinical variables. Multiple regression analyses were performed to test the significance of predictor variables for QoL and functionality. Multiple regression analyses revealed that internalized stigma, depression, and excitement were significant predictors for the variability of QoL, and experiential deficit and cognitive symptoms were significant predictors of the variability of functioning. In patients with schizophrenia, functioning and quality of life are two related but different constructs. Even though they are strongly associated, they have different predictive factors. The clinical implication of these results is that both of these constructs should be assessed and that the strategies for improving them should be different. [ABSTRACT FROM AUTHOR]

Abstract Background The cavitating mesenteric lymph node syndrome (CMLNS) is a rare manifestation of celiac disease, with an estimated mortality rate of 50%. Specific infections and malignant lymphoma may complicate its clinical course and contribute to its poor prognosis. Diagnosing the underlying cause of CMLNS can be challenging. This is the first report on contrast enhanced ultrasound (CEUS) findings in enteropathy associated T-cell lymphoma (EATL) complicating CMLNS in a gluten-free compliant patient with persistent symptoms and poor outcome. Case presentation We present the case of a 51-year old Caucasian male patient, diagnosed with celiac disease and CMLNS. Despite his compliance to the gluten-free diet the symptoms persisted and we eventually considered the possible development of malignancy. No mucosal changes suggestive of lymphoma were identified with capsule endoscopy. Low attenuation mesenteric lymphadenopathy, without enlarged small bowel segments were seen on computed tomography. CEUS revealed arterial rim enhancement around the necrotic mesenteric lymph nodes, without venous wash-out. No malignant cells were identified on laparoscopic mesenteric lymph nodes biopsies. The patient died due to fulminant liver failure 14 months later; the histopathological examination revealed CD3/CD30-positive atypical T-cell lymphocytes in the liver, mesenteric tissue, spleen, gastric wall, kidney, lung and bone marrow samples; no malignant cells were present in the small bowel samples. Conclusions CEUS findings in EATL complicating CMLNS include arterial rim enhancement of the mesenteric tissue around the cavitating lymph nodes, without venous wash-out. This vascular pattern is not suggestive for neoangiogenesis, as arteriovenous shunts from malignant tissues are responsible for rapid venous wash-out of the contrast agent. CEUS failed to provide a diagnosis in this case.

Aims. Contrast enhanced endoscopic ultrasound (CH-EUS) is superior to standard endoscopic ultrasound (EUS) for T staging of biliary duct tumors (BDT) but its role in guiding EUS-fine needle aspiration (EUS-FNA) is unknown. We compared the diagnostic performance of CH-EUS-fine needle aspiration (CH-EUS-FNA) and standard EUS-FNA in BTD and aimed to determine the factors influencing the Results. Methods. This randomized controlled study was conducted in a tertiary medical center and included jaundiced patients with BDT on CT scan. Patients were randomly assigned to EUS-FNA or to CH-EUSFNA group. Final diagnosis was based either on EUSFNA or surgical specimen results or endoscopic retrograde cholangiopancreatography (ERCP) or 12-month follow-up. Results. 61 patients were included in the study, 31 in EUS-FNA and 30 in CH-EUS-FNA group (mean age 74±11.04 years, mean tumor dimension 20.39±9.17mm). Most BDT were located in the distal bile duct (n= 40). Final diagnosis (based on: surgery in 9 cases, ERCP in 7, EUS-FNA in 41, follow-up in 4) were: cholangiocarcinoma (n=37), pancreatic ductal carcinoma (n=12), other malignancy (n=3), benign lesion (n=9). Diagnostic sensitivity, specificity and accuracy were 84%, 100% and 87% respectively in EUS-FNA and 82%, 100%, and 83% respectively in CH-EUS-FNA group (p=0.22). Plastic biliary stent placement or tumor location did not influence the results CH-EUS hyperenhancement with rapid washout was seen in 81.8% of cholangiocarcinoma cases. Conclusions. Most but not all of cholangiocarcinoma are hyperenhanced, but CHEUS-FNA had similar value with standard EUS-FNA in diagnosing bile duct tumors. [ABSTRACT FROM AUTHOR]

Background and aims. Anger is strongly associated with the coping style, personality, interpersonal conflicts and quality of life. Increased research is being focused on the negative impact of anger on irritable bowel syndrome (IBS). Certain psychological areas such as anger have not been investigated in Romanian patients. The present study aims to determine the basal differences in experiencing anger between IBS patients and controls. Method. We examined the State-Trait anger in 60 subjects with IBS and 45 controls. The socio-demographic data and the State-Trait Anger Inventory were administered in individual sessions. Results evidenced that the IBS group had high mean scores for trait anger. No significant differences between the groups were detected on state anger. Conclusion. Higher levels of trait anger characterize IBS patients when compared to controls and this may be associated with symptoms. These findings are discussed within the context of other data suggesting that trait anger contributes to development and evolution of IBS, perhaps through modulation of the colonic motor activity. [ABSTRACT FROM AUTHOR]

Background and aim. Anxiety is a negative emotional response that occurs in certaint situations viewed by the subject as being threatening. Colonoscopy is a situation that produces anticipatory anxiety and because of this reason, sometimes the subjects refuse to undergo it even if the procedure is recommended by the physician. Methods. We studied 108 subjects that had presented for colonoscopy in a colorectal cancer screening programme. We applied them the STAI-S and STAI-T questionnaires 3 weekes before and immediately before the procedure, in order to assess the levels of state and trait anxiety. Results. We took into study 108 subjects, 49 men (45,37%) and 59 (54,62%) females, mean age 59,26±12,45 years (23-83 years). Mean age was higher in females (62,52±11,17 years) than in males (55,34±12,89 years). Results at the STAI-S and STAI-T questionnaires showed a significantly higher level of anxiety immediately before the procedure compared to the levels 3 weeks before the procedure: state anxiety: t=17,24, p<0,0001 and trait anxiety: t=8,31, p<0,0001. Conclusions. The level of anxiety is significantly higher before colonoscopy, and this can be the reason why some subjects choose to avoid this procedure, even if it is recommended by the physician. [ABSTRACT FROM AUTHOR]

Background and aim. FOBT detects a high proportion of less advanced colorectal cancers (CRC) in asymptomatic patients. We aimed to assess the effectiveness of FOBT screening on CRC detection in Romania. Methods. We used Hemoccult II to assess the presence of occult blood in stools. This was a part of a national program for CRC prevention and the free administration of FOBT, together with basic information about CRC, were advertised in local media. Patients with positive FOBT were referred to colonoscopy, and so were those with negative results but who asked themselves for the procedure. Results. 1292 asymptomatic subjects provided stool specimens on FOBT cards. 141 had positive results (10.91%) and 123 of them underwent colonoscopy (18 refused). The findings at colonoscopy were: CRC 6 patients (4.87%) and colonic polyps 35 patients (28.45%). 97 patients with negative FOBT underwent colonoscopy and 1 of them had adenocarcinoma (2.29%) and 7 (7.21%) had polyps. The sensitivity, specificity, PPV and NPV of FOBT for detecting CRC and colonic polyps were as follows: 50%, 52%, 32% and 68% respectively. Conclusions. Our findings suggest that consideration should be given to a national program of FOBT screening in order to detect the early cases of CRC or colonic polyps. Unfortunately the population compliance to this kind of programs is still low in Romania. [ABSTRACT FROM AUTHOR]

Gastrointestinal disorders represent are conditions frequently seen in primary care, usually associated with a poor quality of life, entailing increased direct and indirect costs. Disorders of the digestive tract frequently coexist with psychological impairment. Even in early times scientists were concerned about the influence of the mind over body, and that there are many theories that explain the interaction between psychological factors and the physical status. At the present time the most comprehensive theory is the biopsychosocial model. There are four categories of factors that have to be addressed by the physician (or the integrated team that manages the patient): disease-related, therapeutic-regimen-related, individual factors and psychopathological comorbidities. In the following paper we discuss these factors and their importance in clinical management of gastrointestinal disorders. [ABSTRACT FROM AUTHOR]

Background & Aims: Radiofrequency ablation of unresectable pancreatic tumors represents a palliative method in selected patients. The lack of standardization of the technique used as well as the non-homogeneous immediate and long-term results from the reports in the literature made us evaluate in a pilot study the application of a standardized technique through a surgical approach, with the evaluation of the immediate and long-term results. Methods: Ten consecutive patients diagnosed with unresectable nonmetastatic pancreatic adenocarcinoma were referred for radio-frequency ablation by surgical approach. For that, a UniBlate (AngioDinamics®) internal cooled electrode was used, under intraoperative ultrasound guidance. We analysed the morbidity, mortality and survival associated with this procedure. The median follow-up period was 12 months. Results: Intraoperative ultrasound was essential for guiding the procedure. No mortality and no major postoperative complications after intraoperative tumoral ablations were noted. The median survival after the procedure was 7.5 months. Conclusions: Radiofrequency intraoperative ablation of unresectable pancreatic tumors is a feasible procedure, with low morbidity and mortality if standardized, being noninferior to palliative chemotherapy alone in regards with survival. A larger study is necessary to demonstrate the potential benefits in survival, the role of multidisciplinary selection being also mandatory. [ABSTRACT FROM AUTHOR]

Introduction. EUS guided gastroenteroanasomosis (EUS-GE) established itself as an effective and safe procedure to alleviate malignant gastric outlet obstruction (mGOO), but enteral stenting (ES) is often preferred in patients with short life expectancy and disseminated malignant disease. Our aim was to compare survival rates, technical and clinical success and complications between the two groups as our center has begun performing this novel technique, EUS-GE. Methods. The patients with mGOO treated by EUS-GE between March-2022 and March 2023 were included and then retrospectively matched 1:1 (primary disease & stage and Charson Comorbidity Index) with patients that underwent ES. Results. 5 EUS-GE and 20 ES patients were included. After matching, 5 patients per arm were analyzed with no significant differences within the matched parameters. The indication of the procedure was mGOO related to inoperable pancreatic cancer invading duodenum (n=8) and gastric antrum carcinoma obstructing the pylorus (n=2), with no/minimum ascites and hepatic metastasis (n=8). Technical success rate was 100% in both arms. Median survival was 4mos in the EUS-GE group and 5mos in the ES group. All patients in the EUS-GE group and 3/5 in the ES group were able to eat solid food (GOOSS score=3). Symptom recurrence after an initial improvement occurred in 1/5 in the EUS-GE group and 3/5 in the ES group. Significant complications (defined as II or higher on AGREE classifications) appeared in 1/5 cases in both groups. Conclusions. Initial experience with EUS-GE seems to be more efficient and longer lasting than ES for alleviating symptoms associated with malignant gastric outlet obstruction without increase in complication rates. The low survival rate in both groups was related to the advanced disease stage of the patients. [ABSTRACT FROM AUTHOR]

Background. Primary sclerosing cholangitis (PSC) is a chronic, progressive cholestatic disease that is associated with inflammatory bowel disease (IBD) in approximately 70-75% of cases. Most cases of IBD are represented by ulcerative colitis (UC) (80%). Existing data are from the literature, but the profile of this rare disease in association with inflammatory bowel disease in Romania is less studied. Aims. The clinic-demographic profile in patients diagnosed with sclerosing cholangitis. Methods. We performed a retrospective analysis of patients diagnosed with PSC between Jan 2018 to Oct 2022 in a tertiary medical center. The diagnosis was based on both typical aspect on MRI (paucity of biliary ducts with dilatations and stenosis) and hepatic biopsy. All patients had colonoscopy with ileal intubation with biopsy for excluding the association of inflammatory bowel diseases. Results. From 14 patients diagnosed with PSC there were 11 patients included, mean age was 46, male: female ratio being 3:2. UC was identified in 89% of cases, as pancolitis in 4 (36%) patients. Only one patient was diagnosed with ileo-colonic Crohn's disease (CD). The clinical presentation included obstructive jaundice in 5 (45%) patients, liver cirrhosis in 3 (27%) patients (Child-Pugh B in all cases) and cholangiocarcinoma in one (9%) patient. The MRCP aspect showed a dominant stricture in 5 (45%) patients, located in the hilum in 2 (18%) cases. Perinuclear anti-neutrophil cytoplasmic antibodies (pANCA) were not suggestive for diagnosis, were identified in only 9% of cases. ERCP with stenting was performed in case of dominant strictures with cholangitis in 5 (45%) patients, with secondary lithiasis in 2 (18%) cases. Conclusions. The association of PSC-inflammatory bowel disease is a rare disease, with involvement of ulcerative colitis in most of the patients and mild symptoms. [ABSTRACT FROM AUTHOR]

Background. In patients with cirrhosis, the gold standard for assessment of portal hypertension is the measurement of the hepatic venous pressure gradient (HVPG), a minimally invasive radiological technique that determines indirectly the porto systemic pressure gradient (PPG). However, the technique is available only in referral centres and requires special expertise. Recently, EUS-guided techniques for the measurement of the PPG (EUSPPGm) by directly puncturing the portal vein and the hepatic vein, have shown promising results in terms of feasibility and safety. Nevertheless, the equipment for this procedure uses special devises that require a high purchase cost, and the pressure results are difficult to interpret. The aim of our study was to evaluate the feasibility and safety of EUS-PPGm using a 22 G FNA in a cohort of patients with cirrhosis undergoing TIPS placement for the indication of recurrent variceal bleeding or refractory ascites. Methodology. The patients were included prospectively. Patients with complete portal vein thrombosis were excluded. The EUS-PPGm was performed under general anesthesia, prior to TIPS procedure, by experienced endosonographers, using a linear echoendoscope and a 22-G FNA transgastrically, close to the cardia. After checking the intravascular position of FNA by injecting saline, the pressures were recorded using the same hemodynamic unit as the HVPG, XperFlex Cardio (Philips). The systemic pressure was measured at the level of the median SHV and the portal pressure was measured at the level of the portal trunk. Feasibility was defined as successful PPGm in each patient. Safety was based on adverse events captured during the perioperative period and in a the postprocedural interview. Results. The study included 7 patients (5 male and 2 female), mean age 57 years, mean platelets count 104/mm3, range [52-172]. The indication for TIPS was refractory ascites in 5 patients and variceal bleeding in the other 2 patients. In two patients, the direct puncture of the SHV was not feasible due to poor visualization of portal vein in an obese patient and narrow SHV in a patient with advanced cirrhosis. The mean PPG-EUS was 12.2 mmHg SD 2.68 and mean PPG-TIPS was 15 mmHg, SD 3.317. There were no intraprocedural or post procedural complications recorded. Conclusion. EUS-PPGm using a 22-G FNA is feasible and appears safe. Given the availability of EUS, EUS-PPGm may represent a promising breakthrough for procuring indispensable information in the management of patients with liver disease. [ABSTRACT FROM AUTHOR]