The noninvasive diagnosis of the malignant tumors is an important issue in research nowadays. Our purpose is to elaborate computerized, texture-based methods for performing computer-aided characterization and automatic diagnosis of these tumors, using only the information from ultrasound images. In this paper, we considered some of the most frequent abdominal malignant tumors: the hepatocellular carcinoma and the colonic tumors. We compared these structures with the benign tumors and with other visually similar diseases. Besides the textural features that proved in our previous research to be useful in the characterization and recognition of the malignant tumors, we improved our method by using the grey level cooccurrence matrix and the edge orientation cooccurrence matrix of superior order. As resulted from our experiments, the new textural features increased the malignant tumor classification performance, also revealing visual and physical properties of these structures that emphasized the complex, chaotic structure of the corresponding tissue.

Oral lichen planus (OLP) is a chronic inflammatory disease characterized by the occurrence of multiple, symmetrical lesions in the oral cavity. Hepatitis C virus (HCV) infection has been suggested as an etiological factor in OLP. The purpose of this review was to summarize the current literature regarding the treatment of OLP in patients with HCV infection. An electronic search of the PubMed database was conducted until January 2018, using the following keywords: OLP, HCV, corticosteroids, retinoids, immunomodulatory agents, surgical interventions, photochemotherapy, laser therapy, interferon, ribavirin, and direct-acting antivirals. We selected the articles focusing on the clinical features and treatment management of OLP in patients with/without HCV infection. Topical corticosteroids are considered the first-line treatment in OLP. Calcineurin inhibitors or retinoids can be beneficial for recalcitrant OLP lesions. Systemic therapy should be used in the case of extensive and refractory lesions that involve extraoral sites. Surgical intervention is recommended for isolated lesions. In patients with HCV, monotherapy with interferon (IFN)-α may either improve, aggravate or trigger OLP lesions, while combined IFN-α and ribavirin therapy does not significantly influence the progression of lesions. Direct-acting antiviral (DAA) therapy appears to be a promising approach in patients with HCV-related OLP, as it can improve symptoms of both liver disease and OLP, with fewer side effects. Nevertheless, for clinical utility of DAAs in OLP patients, further studies with larger sample sizes, adequate treatment duration, and long term follow-up are required.

For UC, time-intensity curves (TIC) volume parameters (AUC) correlated better with endoscopy (ρ=0.64) than the clinical score (ρ =0.62). Other parameters such as CRP and thickness showed significant but less strong correlation, while TIC flow parameters (RT, TTP and mTT) did not show a significant correlation. Results were similar for CD (ρ=0.64 for Imax vs ρ=0.58 for CDAI). The best predictor for endoscopic improvement in both UC and CD was ln(AUC), with a Wilcoxon Z score of 3.76 and 2.61, respectively. There was also a good correlation between the difference of its values and the difference in endoscopic scores before and after the treatment (rho is 0.68 in UC and 0.73 in CD).

Background and Aims: Achalasia is an esophageal motility disorder with many available therapies. Peroral endoscopic myotomy (POEM) is a therapeutic alternative to surgical myotomy, harboring significant potential short term advantages. Our aim was to analyze a single-series POEM’s learning curve, safety and efficiency over short, medium and long-terms in an East European Center. Methods: This observational, prospective study was carried out in the Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. Patients with symptomatic achalasia (Eckardt score>3) and pre-op evaluations consistent with the diagnosis of achalasia were included. All POEMs were performed by a highly skilled endoscopist. All patients were allowed to eat 48 hours after POEM. An esophagography was performed in all patients to exclude any leakage. The patients were asked to return for follow-up at established intervals: 1 month, 6 months, 12 months, and annually thereafter. Results: 136 patients were included with an average duration of symptomatology of 36.75 months. The procedure was technically successful in all patients, while a clinical success rate was achieved in 87.5% (n=119) of patients after one POEM session. The success rate was 92.64% after 6 months, 91.17% after one year, 88.9% after 2 years, and 87.5% after 3 years or more; 12.5% of patients required additional treatment. Eighteen patients (13.23%) presented major early complications. Gastroesophageal reflux disease was encountered in 16 patients immediately after POEM and in 22 patients at subsequent follow-ups. Conclusion: POEM is a safe and effective minimally invasive therapeutic option which can substitute surgical myotomy, having a high success rate and a low rate of adverse events in short, medium and long-term.

Background The aim was to assess the effects of periodontal disease in promoting liver fibrosis in a rat model of ligature‐induced periodontitis. Methods Twenty‐four Wistar rats were divided into four groups: control (CTRL), experimental periodontitis group at day 7 (PER7), at day 14 (PER14), at day 21 (PER21). Experimental periodontitis was induced by the placement of a silk ligature around mandibular incisors. The following parameters were assessed: gingival index, tooth mobility; liver status, and portal vein caliber by ultrasound examination; bone retraction, bone mineral density (BMD), bone volume/tissue volume (BV/TV) by micro‐CT analysis; aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT); oxidative stress (malondialdehyde [MDA], reduced glutathione/oxidative glutathione ratio [GSH/GSSG]), and matrix metalloproteinase‐8 (MMP‐8) levels; and histopathological evaluation of periodontal and liver tissues. Results Periodontal parameters showed the development of periodontitis in experimental groups. Micro‐CT results indicates an increase of bone retraction and BMD values and a decrease of BV/TV value in PER groups. Liver fibrosis could not be diagnosed with ultrasound examination in any of the groups. Elevated levels of ASAT and ALAT in PER groups compared with CTRL group were found. MDA have indicated elevated levels and a decrease of GSH/GSSG ratio in PER group compared with the CTRL group. Levels of MMP‐8 have indicated high values in PER21 compared with the other groups. Histological analysis of the periodontal and liver tissues sustains the link between periodontal and hepatic injury. Conclusion This study demonstrates a positive correlation between periodontal lesions and liver disease. Periodontitis may be an independent risk factor for liver fibrosis.

Colonoscopic detection and removal of polyps represent the most important prevention method for colorectal cancer. We aimed to investigate the diagnostic yield of narrow band imaging (NBI) colonoscopy for polyp detection compared with standard colonoscopy. In this prospective study, 505 patients that underwent total colonoscopy were randomized into two groups: 226 patients in NBI group and 279 in non-NBI group (standard colonoscopy). The primary endpoints were polyp detection rate (PDR) and adenoma detection rate (ADR) in both groups. Polyps detected with NBI technique were characterized according to the NBI International Colorectal Endoscopic (NICE) classification. The total number of polyps detected in NBI group was significantly higher compared with non-NBI group (325 polyps in 226 patients versus 189 polyps in 279 patients, respectively). PDR in NBI group was 55.3%, versus 43.3% in non-NBI group. ADR in NBI group was significantly higher compared with non-NBI group (35.3% versus 20%, respectively). The proportion of detected adenomas in the left-sided colon was significantly higher in NBI group (72.8% versus 61.06% in non-NBI group), which was related to an increased number of small adenomas detected in NBI group. Also, in NBI group, a significant number of flat adenomas were detected (28 versus 9 in non-NBI group). A total of 147 (45.2%) polyps were classified according to the NICE classification, and showed a good correlation with histological analysis. In conclusion, this study demonstrated increased PDR and ADR for NBI colonoscopy. A good correlation between the NICE classification and histological analysis was also observed.

Inflammatory bowel diseases (IBDs) are conditions that still pose significant problems. A third of the patients are either misdiagnosed or a proper diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) cannot be made. We need new biomarkers, so that we can offer patients the best treatment and keep the disease in an inactive state for as long as possible. Alterations in metabolic profiles have been incriminated in the pathophysiology of IBD. The aim of the present study was to identify molecules that could serve as biomarkers for a positive diagnosis of IBD as well as to discriminate UC from colonic CD. Twenty-two patients with active colonic IBD (UC = 17, CD = 5) and 24 age- and gender-matched healthy controls were enrolled. Plasma lipid and metabolic profiles were quantified using ultra-high performance liquid chromatography combined with mass spectrometry. Univariate and multivariate statistical tests were employed. Six lipid species and seven metabolites were significantly altered in IBD compared to healthy controls, with the majority belonging to glycerophospholipid, linoleic acid, and sphingolipid metabolisms. Five lipid species and only one metabolite were significantly increased in UC compared to CD. This preliminary study suggests that lipid and metabolic profiling of serum can become diagnostic tools for IBD. In addition, they can be used to differentiate between CD and UC.

Background: The identification of subtle small-bowel mucosal lesions by video capsule endoscopy (VCE) can be challenging. Virtual chromoendoscopy techniques, based on narrowing the bandwidth of conventional white light endoscopic imaging (WLI), were developed to improve the analysis of mucosal patterns. However, data on the already-implemented Flexible spectral Imaging (or Fujinon Intelligent) Color Enhancement (FICE) software application in VCE are limited. Materials and methods: An evaluation of 250 difficult-to-interpret small-bowel ulcerative and 50 artifact lesions selected from 64 VCE recordings was conducted by four experienced VCE readers in two steps: initially as WLI, then with the addition of all available virtual chromoendoscopy pre-sets (FICE 1, 2, and 3 and Blue mode). The readers labeled them as real or false ulcerative lesions and rated the usefulness of each of the pre-sets. Results: Between the first (WLI-only) and second (virtual chromoendoscopy-aided) readings, in terms of accuracy there was a global 16.5 % (95 % confidence interval [95 %CI] 13.6 – 19.4 %) improvement (P < 0.001), derived from a 22 % [95 %CI 18.9 – 25.1 %] improvement in the evaluation of true ulcerative images (P < 0.001) and an 11 % (95 %CI 4.1 – 17.7 %) decrease in the evaluation of false ulcerative ones (P = 0.003). The FICE 1 and 2 pre-sets were rated as most useful. Conclusion: The application of virtual chromoendoscopy for VCE is useful to better categorize difficult-to-interpret small-bowel mucosal ulcerative lesions. However, care must be taken, and individual images should be evaluated only as part of a sequence in a recording because the technology can also mistakenly guide to the incorrect interpretation of artifacts as ulcerative lesions.