Ungureanu B.S.,University of Medicine and Pharmacy of Craiova
American Journal of Therapeutics | Year: 2017
BACKGROUND:: Obesity treatment options are of great interest worldwide with major developments in the past 20 years. From general surgery to natural orifice transluminal endoscopic surgery intervention nowadays, obesity surgical therapies have surely developed and are now offering a variety of possibilities. AREAS OF UNCERTAINTY:: Although surgery is the only proven approach for weight loss, a joint decision between the physician and patient is required before proceeding to such a procedure. With a lot of options available, the treatment should be individualized because the benefits of surgical intervention must be weighed against the surgical risks. DATA SOURCES:: Medline search to locate full-text articles and abstracts with obvious conclusions by using the keywords: obesity, surgical endoscopy, gastric bypass, bariatric surgery, and endoscopic surgery, alone and in various combinations. Additional relevant publications were also searched using the reference lists of the identified articles as a starting point. RESULTS:: Laparoscopic Roux-en-Y gastric bypass still is the most effective, less invasive, bariatric surgical intervention, although there are various complications encountered, such as postoperative hemorrhage (1.9%–4.4%), internal hernias, anastomotic strictures (2.9%–23%), marginal ulcerations (1%–16%), fistulas (1.5%–6%), weight gain, and nutritional deficiencies. However, the absence of parietal incisions, less pain, decreased risk of infection, and short hospital stay make room for endoscopic surgery as a possible valid option for obesity for both the doctorsʼ and the patientsʼ perspective. CONCLUSIONS:: The current tendency is to promote surgical treatment of obesity to a status of less invasive scars therefore promoting minimally invasive surgical techniques. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2012.2.3.2-2 | Award Amount: 7.87M | Year: 2013
Diabetes (DM) triples the risk of developing tuberculosis (TB). Consequently, the alarming growth of type 2 DM in TB endemic countries and among people originating from TB-endemic countries poses a serious threat to global TB control. This project addresses the scarce evidence for many of the recently advocated guidelines for care and control of TB and DM, as well as our lack of understanding of the mechanisms underlying the effect of DM on TB susceptibility and treatment outcome. We will use a comprehensive and integrated approach combining clinical, epidemiological and cutting edge expertise in laboratory sciences, bringing together a multi-disciplinary consortium linking field sites in Romania, Peru, South Africa and Indonesia, with leading laboratories in Germany, United Kingdom and the Netherlands. We will define the optimal and most cost-effective ways of screening TB patients for DM diabetes, and determine the prevalence of DM among TB patients and of TB in DM patients in the four countries. With regard to treatment, we will determine the level of DM management required during and after TB treatment, the safety and pharmacokinetics of metformin when combined with rifampicin, and the effect of hyperglycemia control on TB treatment outcome. To help establish the cellular basis and immunological pathways underlying the link between DM and TB we will provide new data on: gene expression data of TB patients with and without DM; ex vivo and in vitro Mycobacterium tuberculosis stimulation data of different cell types, including macrophage subsets and adipocytes in the presence of high glucose and insulin; data regarding the role of common and more rare genetic variants in the combined susceptibility to TB and type 2 DM; and relevant functional genomics experiments. In summary, this project is expected to have significant impact both in improving basic knowledge on the link between TB and DM, as well as on prevention, therapeutic management and prognosis of TB-DM.
Agency: European Commission | Branch: FP7 | Program: CP-CSA-Infra | Phase: INFRA-2011-1.1.5. | Award Amount: 10.83M | Year: 2012
ECRIN is a distributed ESFRI-roadmap pan-European infrastructure designed to support multinational clinical research, making Europe a single area for clinical studies, taking advantage of its population size to access patients. Servicing multinational trials started during its preparatory phase, and it now applies for an ERIC status by 2011. The ERIC budget will be restricted to core activities required to enable provision of services, and the ECRIN-IA project is designed to expand ECRIN partnerships and impact beyond this core activity. Networking activities will promote pan-European expansion, capacity building, and partnership with other world regions, and address the funding issue (WP2). ECRIN-IA will develop e-services, education material to train professionals and patients associations, and communication with users, patients, citizens and policymakers (WP3). It will support the structuring and connection to ECRIN of disease-, technology-, or product-oriented investigation networks and hubs focusing on specific areas: rare diseases (WP4), medical device (WP5), nutrition (WP6). Transnational access activities will support the cost of multinational extension of clinical trials on rare diseases, medical device and nutrition selected by the ECRIN scientific board (WP7). Joint research activities are designed to improve the efficiency of ECRIN services, through the development of tools for risk-adapted monitoring (WP8), and the upgrade of the VISTA data management tool (WP9). This project will build a consistent organisation for clinical research in Europe, with ECRIN developing generic tools and providing generic services to multinational studies, and supporting the construction of pan-European disease-oriented networks, that will in turn act as ECRIN users and provide the scientific content. Such organisation will improve Europes attractiveness for industry trials, boost its scientific competitiveness, and result in better healthcare for European citizens.
Popescu F.C.,University of Medicine and Pharmacy of Craiova
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie | Year: 2011
Pericytes and myofibroblasts are two types of connective cells that appear in large quantities in reparative processes. In order to evaluate their response and any relationships between them, we have inflicted third degree skin burns to seven groups of five common Wistar rats each from which we sampled granulation tissue at three days interval for histological and immunohistochemical studies. Alpha-SMA and CD34 antibodies revealed that granulation tissue myofibroblasts do not express CD34 and do not arise from pericytes. The parallel arrangement of myofibroblasts in relation to the burned wound surface suggests that their main function is mechanical traction on granulation tissue and wound edges.
Petrescu F.,University of Medicine and Pharmacy of Craiova
International journal of chronic obstructive pulmonary disease | Year: 2010
Tobacco smoking is the most important risk factor for chronic obstructive pulmonary disease (COPD) development. Inhaled cigarette smoke can induce tumor necrosis factor-alpha (TNF-alpha) production by alveolar macrophages, which in turn may enhance the production of metalloproteinases (MMPs). MMPs have been involved in mediating airway inflammation and lung destruction. We aimed to measure the TNF-alpha serum levels in healthy heavy smokers and healthy nonsmokers to determine the dose-response relationship based on the cigarette smoke exposure. We included in our study 43 healthy heavy smokers and 19 healthy nonsmokers (the control group). The smokers group was classified as less than one pack, one pack, and more than one pack per day. A clinical and paraclinical evaluation was performed in both groups, without any evidence of infection or COPD. The serum levels of TNF-alpha were assessed by ELISA. The TNF-alpha serum levels were significantly higher for the group of smokers compared to the group of nonsmokers (P < 0.004). We also noticed an increased TNF-alpha concentration in the serum of smokers with more than one pack per day compared with those with less than one pack per day (P < 0.03). There was a positive correlation between the serum level of TNF-alpha and tobacco smoke exposure. The high levels of TNF-alpha in the serum of smokers suggest an imbalance between the proinflammatory and anti-inflammatory factors as a result of tobacco smoke exposure. The concentration of TNF-alpha is elevated in the serum of healthy heavy smokers in a cigarette dose-dependent manner. We speculate that the serum level of TNF-alpha might be a useful biomarker for the selection of heavy smokers with a high risk of developing smoke induced pulmonary diseases.
Vere C.C.,University of Medicine and Pharmacy of Craiova
Chirurgia (Bucharest, Romania : 1990) | Year: 2012
Videocapsule endoscopy (VCE) can identify lesions in the small bowel which would otherwise be hard to detect. We have selected 53 patients with digestive symptoms in which upper and lower endoscopy had provided no findings. Patients were classified into three groups, based on their main indication for VCE exploration: group one--obscure gastrointestinal bleeding (OGIB); group two--unspecific abdominal symptoms; group 3--monitoring of a prior known pathology. We found that VCE has high predictive values, sensibility and specificity in the diagnosis of OGIB. VCE was also useful in the detection and extent evaluation of lesions in Crohn's and celiac disease. VCE is also able to detect tumors of the small bowel with sufficient accuracy, and can be used to monitor patients with hereditary pre-malignant diseases such as FAP. There were few light adverse effects and no major complications. We conclude that VCE is a safe and effective procedure for the detection of small bowel lesions.
Vreju F.,University of Medicine and Pharmacy of Craiova
Medical ultrasonography | Year: 2010
Osgood-Schlatter disease is a condition that is caused by traction of the muscle-tendon unit at tibial tuberosity, which affects adolescents who exercise. The predisposing factors include rapid growth and physical activity, particularly running and jumping. Osgood- Schlatter disease causes intermittent pain, which can be aggravated by running, cycling and climbing stairs. We present the case of a young boy, soccer player, which presented for pain at the level of the tibial tuberosity. Ultrasonography showed changes at the distal part of the patellar tendon and at the tibial tuberosity, consistent with Osgood-Schlatter disease.
Popescu A.,University of Medicine and Pharmacy of Craiova |
Saftoiu A.,University of Medicine and Pharmacy of Craiova
Endoscopic Ultrasound | Year: 2014
Endoscopic ultrasound (EUS) is one of the best diagnostic methods for diseases of the digestive tract and surrounding organs. Whereas EUS-guided fine needle aspiration (FNA) has been very useful for providing histological confirmation for previously hard to reach lesions, elastography is aiming to obtain a "virtual biopsy" by assessing differences in elasticity between the normal and pathological - usually malignant - tissue. A question that arises is whether EUS-elastography has reached a stage where it might successfully supplant the use of EUS-FNA in some of its clinical indications. The main indications of EUS-guided FNA are listed in this article and published data on the usage of elastography in these settings is reviewed for each one. In some of the indications, a plethora of studies have been published, notably for the evaluation of solid pancreatic masses and lymph nodes, while in others there is little relevant data (submucosal masses, left liver lesions, left adrenal masses), or elastography simply is not suitable as a diagnostic means (cystic lesions). Our conclusion is that elastography is not yet ready to replace EUS-FNA in its indications, but should complement it in various settings, especially for the assessment of lymph nodes. It can only be considered an alternative on a case-by-case basis, in situations where FNA is regarded as a contraindication. Furthermore, it could be used in conjunction with other imaging techniques, such as contrast-enhanced EUS, in order to further improve the accuracy of non-invasive EUS assessment, possibly making the case for a more limited or targeted use of EUS-FNA in selected cases.
Saftoiu A.,University of Medicine and Pharmacy of Craiova
World Journal of Gastroenterology | Year: 2011
Endoscopic ultrasound (EUS) has recently evolved through technological improvement of equipment, with a major clinical impact in digestive and mediastinal diseases. State-of-the-art EUS equipment now includes realtime sono-elastography, which might be useful for a better characterization of lesions and increased accuracy of differential diagnosis (for e.g. lymph nodes or focal pancreatic lesions). Contrast-enhanced EUS imaging is also available, and is already being used for the differential diagnosis of focal pancreatic masses. The recent development of low mechanical index contrast harmonic EUS imaging offers hope for improved diagnosis, staging and monitoring of anti-angiogenic treatment. Tridimensional EUS (3D-EUS) techniques can be applied to enhance the spatial understanding of EUS anatomy, especially for improved staging of tumors, obtained through a better assessment of the relationship with major surrounding vessels. Despite the progress gained through all these imaging techniques, they cannot replace cytological or histological diagnosis. However, real-time optical histological diagnosis can be achieved through the use of single-fiber confocal laser endomicroscopy techniques placed under real-time EUS-guidance through a 22G needle. Last, but not least, EUS-assisted natural orifice transluminal endoscopic surgery (NOTES) procedures offer a whole new area of imaging applications, used either for combination of NOTES peritoneoscopy and intraperitoneal EUS, but also for access of retroperitoneal organs through posterior EUS guidance. © 2011 Baishideng. All rights reserved.
Gorunescu F.,University of Medicine and Pharmacy of Craiova |
Belciug S.,University of Craiova
Journal of Biomedical Informatics | Year: 2014
The purpose of this paper is twofold: first, to propose an evolutionary-based method for building a decision model and, second, to assess and validate the model's performance using five different real-world medical datasets (breast cancer and liver fibrosis) by comparing it with state-of-the-art machine learning techniques. The evolutionary-inspired approach has been used to develop the learning-based decision model in the following manner: the hybridization of algorithms has been considered as "crossover", while the development of new variants which can be thought of as "mutation". An appropriate hierarchy of the component algorithms was established based on a statistically built fitness measure. A synergetic decision-making process, based on a weighted voting system, involved the collaboration between the selected algorithms in making the final decision. Well-established statistical performance measures and comparison tests have been extensively used to design and implement the model. Finally, the proposed method has been tested on five medical datasets, out of which four publicly available, and contrasted with state-of-the-art techniques, showing its efficiency in supporting the medical decision-making process. © 2014 Elsevier Inc.