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Pisla D, Crisan N, Gherman B, Andras I, Tucan P, Radu C, Pusca A, Vaida C, Al Hajjar N. Safety Issues in the Development of an Innovative Medical Parallel Robot Used in Renal Single-Incision Laparoscopic Surgery. J Clin Med 2023; 12:4617. [PMID: 37510731 PMCID: PMC10380956 DOI: 10.3390/jcm12144617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
Robotic-assisted single-incision laparoscopic surgery (SILS) is becoming an increasingly widespread field worldwide due to the benefits it brings to both the patient and the surgeon. The goal of this study is to develop a secure robotic solution for SILS, focusing specifically on urology, by identifying and addressing various safety concerns from an early design stage. Starting with the medical tasks and protocols, the technical specifications of the robotic system as well as potential; hazards have been identified. By employing competitive engineering design methods such as Analytic Hierarchy Process (AHP), Risk assessment, and Failure Mode and Effects Analysis (FMEA), a safe design solution is proposed. A set of experiments is conducted to validate the proposed concept, and the results strongly support the development of the experimental model. The Finite Element Analysis (FEA) method is applied to validate the mechanical architecture within a set of simulations, demonstrating the compliance of the robotic system with the proposed technical specifications and its capability to safely perform SILS procedures.
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Affiliation(s)
- Doina Pisla
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Corina Radu
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Pusca
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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2
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Rus G, Andras I, Vaida C, Crisan N, Gherman B, Radu C, Tucan P, Iakab S, Hajjar NA, Pisla D. Artificial Intelligence-Based Hazard Detection in Robotic-Assisted Single-Incision Oncologic Surgery. Cancers (Basel) 2023; 15:3387. [PMID: 37444497 DOI: 10.3390/cancers15133387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
THE PROBLEM Single-incision surgery is a complex procedure in which any additional information automatically collected from the operating field can be of significance. While the use of robotic devices has greatly improved surgical outcomes, there are still many unresolved issues. One of the major surgical complications, with higher occurrence in cancer patients, is intraoperative hemorrhages, which if detected early, can be more efficiently controlled. AIM This paper proposes a hazard detection system which incorporates the advantages of both Artificial Intelligence (AI) and Augmented Reality (AR) agents, capable of identifying, in real-time, intraoperative bleedings, which are subsequently displayed on a Hololens 2 device. METHODS The authors explored the different techniques for real-time processing and determined, based on a critical analysis, that YOLOv5 is one of the most promising solutions. An innovative, real-time, bleeding detection system, developed using the YOLOv5 algorithm and the Hololens 2 device, was evaluated on different surgical procedures and tested in multiple configurations to obtain the optimal prediction time and accuracy. RESULTS The detection system was able to identify the bleeding occurrence in multiple surgical procedures with a high rate of accuracy. Once detected, the area of interest was marked with a bounding box and displayed on the Hololens 2 device. During the tests, the system was able to differentiate between bleeding occurrence and intraoperative irrigation; thus, reducing the risk of false-negative and false-positive results. CONCLUSION The current level of AI and AR technologies enables the development of real-time hazard detection systems as efficient assistance tools for surgeons, especially in high-risk interventions.
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Affiliation(s)
- Gabriela Rus
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Corina Radu
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Stefan Iakab
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
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3
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Covaciu F, Crisan N, Vaida C, Andras I, Pusca A, Gherman B, Radu C, Tucan P, Al Hajjar N, Pisla D. Integration of Virtual Reality in the Control System of an Innovative Medical Robot for Single-Incision Laparoscopic Surgery. Sensors (Basel) 2023; 23:5400. [PMID: 37420568 DOI: 10.3390/s23125400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 06/05/2023] [Indexed: 07/09/2023]
Abstract
In recent years, there has been an expansion in the development of simulators that use virtual reality (VR) as a learning tool. In surgery where robots are used, VR serves as a revolutionary technology to help medical doctors train in using these robotic systems and accumulate knowledge without risk. This article presents a study in which VR is used to create a simulator designed for robotically assisted single-uniport surgery. The control of the surgical robotic system is achieved using voice commands for laparoscopic camera positioning and via a user interface developed using the Visual Studio program that connects a wristband equipped with sensors attached to the user's hand for the manipulation of the active instruments. The software consists of the user interface and the VR application via the TCP/IP communication protocol. To study the evolution of the performance of this virtual system, 15 people were involved in the experimental evaluation of the VR simulator built for the robotic surgical system, having to complete a medically relevant task. The experimental data validated the initial solution, which will be further developed.
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Affiliation(s)
- Florin Covaciu
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nicolae Crisan
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Calin Vaida
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Iulia Andras
- Department of Urology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Alexandru Pusca
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Bogdan Gherman
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Corina Radu
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Paul Tucan
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Department of Surgery, "Iuliu Hatieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Doina Pisla
- Research Center for Industrial Robots Simulation and Testing-CESTER, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
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4
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Castellani C, Morillas Becerril L, Luisetto R, Radu C, Barison I, Fedrigo M, Giarraputo A, Virzì G, Tomaz Do Nascimento M, Simioni P, Papini E, Tavano R, Vescovo G, Mancin F, Angelini A. Optimization and Safety of Lipoic Acid F127@pla Nanoparticles as New Therapeutic Vector for Rna Delivery in Cardiovascular Diseases. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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5
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George Iosifescu A, Enache R, Marinică I, Radu C, Anton Iliescu V. “Treat-Repair-Treat”: Management of Left Main Coronary Compression by a Pulmonary Artery Aneurysm in a Patient with Atrial Septal Defect and Significant Pulmonary Hypertension. CONGENIT HEART DIS 2023. [DOI: 10.32604/chd.2023.026598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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6
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Gherman B, Hajjar NA, Tucan P, Radu C, Vaida C, Mois E, Burz A, Pisla D. Risk Assessment-Oriented Design of a Needle Insertion Robotic System for Non-Resectable Liver Tumors. Healthcare (Basel) 2022; 10:healthcare10020389. [PMID: 35207006 PMCID: PMC8872014 DOI: 10.3390/healthcare10020389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Medical robotics is a highly challenging and rewarding field of research, especially in the development of minimally invasive solutions for the treatment of the worldwide leading cause of death, cancer. The aim of the paper is to provide a design methodology for the development of a safe and efficient medical robotic system for the minimally invasive, percutaneous, targeted treatment of hepatocellular carcinoma, which can be extended with minimal modification for other types of abdominal cancers. Using as input a set of general medical requirements to comply with currently applicable standards, and a set of identified hazards and failure modes, specific methods, such as the Analytical Hierarchy Prioritization, Risk Analysis and fuzzy logic Failure Modes and Effect Analysis have been used within a stepwise approach to help in the development of a medical device targeting the insertion of multiple needles in brachytherapy procedures. The developed medical device, which is visually guided using CT scanning, has been tested for validation in a medical environment using a human-size ballistic gel liver, with promising results. These prove that the robotic system can be used for the proposed medical task, while the modular approach increases the chances of acceptance.
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Affiliation(s)
- Bogdan Gherman
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Nadim Al Hajjar
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Paul Tucan
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Corina Radu
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Calin Vaida
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Emil Mois
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Alin Burz
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Doina Pisla
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
- Correspondence:
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7
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Radu C, Fisher P, Mitrea D, Birlescu I, Marita T, Vancea F, Florian V, Tefas C, Badea R, Ștefănescu H, Nedevschi S, Pisla D, Hajjar NA. Integration of Real-Time Image Fusion in the Robotic-Assisted Treatment of Hepatocellular Carcinoma. Biology (Basel) 2020; 9:biology9110397. [PMID: 33198415 PMCID: PMC7697343 DOI: 10.3390/biology9110397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/23/2020] [Accepted: 11/11/2020] [Indexed: 12/19/2022]
Abstract
Simple Summary Hepatocellular carcinoma is one of the leading causes of cancer-related deaths worldwide. An image fusion system is developed for the robotic-assisted treatment of hepatocellular carcinoma, which is not only capable of imaging data interpretation and reconstruction, but also automatic tumor detection. The optimization and integration of the image fusion system within a novel robotic system has the potential to demonstrate the feasibility of the robotic-assisted targeted treatment of hepatocellular carcinoma by showing benefits such as precision, patients safety and procedure ergonomics. Abstract Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related deaths worldwide, with its mortality rate correlated with the tumor staging; i.e., early detection and treatment are important factors for the survival rate of patients. This paper presents the development of a novel visualization and detection system for HCC, which is a composing module of a robotic system for the targeted treatment of HCC. The system has two modules, one for the tumor visualization that uses image fusion (IF) between computerized tomography (CT) obtained preoperatively and real-time ultrasound (US), and the second module for HCC automatic detection from CT images. Convolutional neural networks (CNN) are used for the tumor segmentation which were trained using 152 contrast-enhanced CT images. Probabilistic maps are shown as well as 3D representation of HCC within the liver tissue. The development of the visualization and detection system represents a milestone in testing the feasibility of a novel robotic system in the targeted treatment of HCC. Further optimizations are planned for the tumor visualization and detection system with the aim of introducing more relevant functions and increase its accuracy.
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Affiliation(s)
- Corina Radu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Petra Fisher
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Delia Mitrea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Iosif Birlescu
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Tiberiu Marita
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Flaviu Vancea
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Vlad Florian
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Cristian Tefas
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Radu Badea
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
| | - Horia Ștefănescu
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
| | - Sergiu Nedevschi
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
| | - Doina Pisla
- Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania; (D.M.); (T.M.); (F.V.); (V.F.); (S.N.)
- Correspondence: (I.B.); (D.P.)
| | - Nadim Al Hajjar
- Regional Institute of Gastroenterology and Hepatology Prof. Dr. O.Fodor, 400162 Cluj-Napoca, Romania; (C.R.); (P.F.); (C.T.); (H.Ș.); (N.A.H.)
- Iuliu Hatieganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
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8
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Mezdari Z, Pini M, Czibik G, Ternacle J, Riant E, Radu C, Zhang Y, Clerc F, Adnot S, Derumeaux G, Sawaki D. Role of adipose tissue macrophages in the cross-talk between visceral adipose tissue and heart during high fat diet. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2020.03.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Wemmert C, Fourreau F, Radu C, Balan A, Gomart C, Fiore A, La Martire G, Decousser J, Lepeule R. Traitement médical des sternites post sternotomie : 21 jours suffisent ? Med Mal Infect 2020. [DOI: 10.1016/j.medmal.2020.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Crisan D, Grigorescu M, Crisan N, Craciun R, Lupsor M, Radu C, Grigorescu MD, Suciu A, Epure F, Avram L, Leach N. Association between PNPLA3[G]/I148M variant, steatosis and fibrosis stage in hepatitis C virus - genetic matters. J Physiol Pharmacol 2019; 70. [PMID: 31642820 DOI: 10.26402/jpp.2019.4.09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/28/2019] [Indexed: 11/03/2022]
Abstract
There is an established correlation between the PNPLA3 rs738409 C > G single nucleotide polymorphism (SNP) and hepatic steatosis and fibrosis in hepatitis C virus (HCV) infected patients. However not all data is convergent regarding the exact impact of this SNP on the pattern of disease progression in different clinical settings. In this study, we aimed to further bridge the knowledge gap on this topic by investigating the role of the G allele in promoting steatosis, fibrosis and disease progression in relation to other metabolic and anthropometric host factors. Two hundred and fifty consecutive patients, previously diagnosed with chronic hepatitis C (CHC) underwent liver biopsy. Histology was assessed using the Metavir scoring system. Transient elastography was used for follow-up. Ninety-eight patients were genotyped for PNPLA3 rs738409 and followed up for fibrosis progression. PNPLA3 rs738409[G] allele was significantly correlated with severe steatosis (P = 0.04), severe fibrosis at the time of enrollment (P = 0.0005) and fibrosis progression with an OR of 10.31 (95% CI 1.06 - 99.59, P = 0.04), after a mean follow-up time of 62.85 (95%CI: 52.21 - 76.15) months. Severe steatosis at the time of enrollment had an OR of 11.02 (95% CI 1.48 - 82.09, P = 0.01) for the association with fibrosis progression. The HOMA-IR index was also positively correlated with severe fibrosis (P = 0.03) and fibrosis progression on univariate analysis (P = 0.02). PNPLA3 rs738409[G] allele is a reliable predictor for steatosis and fibrosis in CHC. The presence of G allele, along with severe steatosis and insulin resistance are significant predictors for fibrosis progression.
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Affiliation(s)
- D Crisan
- Fifth Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Municipal Clinical Hospital, Cluj-Napoca, Romania
| | - M Grigorescu
- Third Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - N Crisan
- Municipal Clinical Hospital, Cluj-Napoca, Romania. .,Department of Surgical Specialties, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - R Craciun
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania.
| | - M Lupsor
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania.,Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - C Radu
- Third Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,"Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - M D Grigorescu
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - A Suciu
- "Prof. Dr. Octavian Fodor" Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Romania
| | - F Epure
- Department of Medical Imaging, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - L Avram
- Fifth Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Municipal Clinical Hospital, Cluj-Napoca, Romania
| | - N Leach
- Fourth Medical Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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11
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Flores A, Sandoval-Gonzalez S, Takahashi R, Krall A, Sathe L, Wei L, Radu C, Joly JH, Graham NA, Christofk HR, Lowry WE. Author Correction: Increased lactate dehydrogenase activity is dispensable in squamous carcinoma cells of origin. Nat Commun 2019; 10:1449. [PMID: 30914644 PMCID: PMC6435690 DOI: 10.1038/s41467-019-09435-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Flores
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA.,Broad Center for Regenerative Medicine, UCLA, Los Angeles, 90095, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA
| | - S Sandoval-Gonzalez
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA
| | - R Takahashi
- Division of Dermatology, David Geffen School of Medicine, UCLA, Los Angeles, 90095, CA, USA
| | - A Krall
- Department of Biological Chemistry, UCLA, Los Angeles, 90095, CA, USA
| | - L Sathe
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA
| | - L Wei
- Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA
| | - C Radu
- Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA
| | - J H Joly
- Department of Engineering, USC, Los Angeles, 90089, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA
| | - N A Graham
- Department of Engineering, USC, Los Angeles, 90089, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, 90089, CA, USA
| | - H R Christofk
- Department of Biological Chemistry, UCLA, Los Angeles, 90095, CA, USA. .,Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA. .,Molecular Biology Institute, UCLA, Los Angeles, 90095, CA, USA. .,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, 90095, CA, USA.
| | - W E Lowry
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA. .,Broad Center for Regenerative Medicine, UCLA, Los Angeles, 90095, CA, USA. .,Division of Dermatology, David Geffen School of Medicine, UCLA, Los Angeles, 90095, CA, USA. .,Molecular Biology Institute, UCLA, Los Angeles, 90095, CA, USA. .,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, 90095, CA, USA.
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12
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Flores A, Sandoval-Gonzalez S, Takahashi R, Krall A, Sathe L, Wei L, Radu C, Joly JH, Graham NA, Christofk HR, Lowry WE. Increased lactate dehydrogenase activity is dispensable in squamous carcinoma cells of origin. Nat Commun 2019; 10:91. [PMID: 30626875 PMCID: PMC6327029 DOI: 10.1038/s41467-018-07857-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 12/04/2018] [Indexed: 12/17/2022] Open
Abstract
Although numerous therapeutic strategies have attempted to target aerobic glycolysis to inhibit tumor progression, these approaches have not resulted in effective clinical outcomes. Murine squamous cell carcinoma (SCC) can be initiated by hair follicle stem cells (HFSCs). HFSCs utilize aerobic glycolysis, and the activity of lactate dehydrogenase (Ldh) is essential for HFSC activation. We sought to determine whether Ldh activity in SCC is critical for tumorigenesis or simply a marker of the cell type of origin. Genetic abrogation or induction of Ldh activity in HFSC-mediated tumorigenesis shows no effect on tumorigenesis as measured by number, time to formation, proliferation, volume, epithelial to mesenchymal transition, gene expression, or immune response. Ldha-null tumors show dramatically reduced levels of glycolytic metabolites by metabolomics, and significantly reduced glucose uptake by FDG-PET live animal imaging. These results suggest that squamous cancer cells of origin do not require increased glycolytic activity to generate cancers. Most tumours are characterized by increased aerobic glycolytic activity. Here the authors show that elevated aerobic glycolysis is not essential for cancer initiation by testing the effect of lactate dehydrogenase depletion on the ability of hair follicle stem cells (HFSCs) to form squamous cell carcinoma (SCC) in mouse genetic models.
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Affiliation(s)
- A Flores
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA.,Broad Center for Regenerative Medicine, UCLA, Los Angeles, 90095, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA
| | - S Sandoval-Gonzalez
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA
| | - R Takahashi
- Division of Dermatology, David Geffen School of Medicine, UCLA, Los Angeles, 90095, CA, USA
| | - A Krall
- Department of Biological Chemistry, UCLA, Los Angeles, 90095, CA, USA
| | - L Sathe
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA
| | - L Wei
- Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA
| | - C Radu
- Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA
| | - J H Joly
- Department of Engineering, USC, Los Angeles, 90089, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA
| | - N A Graham
- Department of Engineering, USC, Los Angeles, 90089, CA, USA.,Mork Family Department of Chemical Engineering and Materials Science, University of Southern California, Los Angeles, 90089, CA, USA.,Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, 90089, CA, USA
| | - H R Christofk
- Department of Biological Chemistry, UCLA, Los Angeles, 90095, CA, USA. .,Department of Pharmacology, UCLA, Los Angeles, 90095, CA, USA. .,Molecular Biology Institute, UCLA, Los Angeles, 90095, CA, USA. .,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, 90095, CA, USA.
| | - W E Lowry
- Department of Molecular Cell and Developmental Biology, UCLA, Los Angeles, 90095, CA, USA. .,Broad Center for Regenerative Medicine, UCLA, Los Angeles, 90095, CA, USA. .,Division of Dermatology, David Geffen School of Medicine, UCLA, Los Angeles, 90095, CA, USA. .,Molecular Biology Institute, UCLA, Los Angeles, 90095, CA, USA. .,Jonsson Comprehensive Cancer Center, UCLA, Los Angeles, 90095, CA, USA.
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13
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Mezdari Z, Pini M, Czibik G, Ternacle J, Radu C, Zhang Y, Adnot S, Henegar C, Derumeaux GA, Sawaki D. P2536Role of adipose tissue macrophages in the cross-talk between visceral adipose tissue and heart during high fat diet. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Z Mezdari
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - M Pini
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - G Czibik
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - J Ternacle
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - C Radu
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - Y Zhang
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - S Adnot
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - C Henegar
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
| | - G A Derumeaux
- Inserm U886, University Claude Bernard Lyon 1, Lyon, France
| | - D Sawaki
- University Hospital Henri Mondor, DHU ATVB, APHP, UPEC, Creteil, France
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14
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Radu C, Stancu O, Sav R, Bugariu A, Suciu A, Grigoras C, Procopet B, Stefanescu H, Sparchez Z. Liver stiffness better predicts portal hypertension after HCV eradication. JGLD 2018; 27:204. [DOI: 10.15403/jgld.2014.1121.272.hcv] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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15
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Crisan D, Grigorescu MD, Radu C, Suciu A, Grigorescu M. Interferon-γ-inducible protein-10 in chronic hepatitis C: Correlations with insulin resistance, histological features & sustained virological response. Indian J Med Res 2018; 145:543-550. [PMID: 28862188 PMCID: PMC5663170 DOI: 10.4103/ijmr.ijmr_1410_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND & OBJECTIVES One of the multiple factors contributing to virological response in chronic hepatitis C (CHC) is interferon-gamma-inducible protein-10 (IP-10). Its level reflects the status of interferon-stimulated genes, which in turn is associated with virological response to antiviral therapy. The aim of this study was to evaluate the role of serum IP-10 levels on sustained virological response (SVR) and the association of this parameter with insulin resistance (IR) and liver histology. METHODS Two hundred and three consecutive biopsy proven CHC patients were included in the study. Serum levels of IP-10 were determined using ELISA method. IR was evaluated by homeostasis model assessment-IR (HOMA-IR). Histological features were assessed invasively by liver biopsy and noninvasively using FibroTest, ActiTest and SteatoTest. Predictive factors for SVR and their interrelations were assessed. RESULTS A cut-off value for IP-10 of 392 pg/ml was obtained to discriminate between responders and non-responders. SVR was obtained in 107 patients (52.70%). Area under the receiver operating characteristic curve for SVR was 0.875 with a sensitivity of 91.6 per cent, specificity 74.7 per cent, positive predictive value 80.3 per cent and negative predictive value 88.7 per cent. Higher values of IP-10 were associated with increasing stages of fibrosis (P<0.01) and higher grades of inflammation (P=0.02, P=0.07) assessed morphologically and noninvasively through FibroTest and ActiTest. Significant steatosis and IR were also associated with increased levels of IP-10 (P=0.01 and P=0.02). In multivariate analysis, IP-10 levels and fibrosis stages were independently associated with SVR. INTERPRETATION & CONCLUSIONS Our findings showed that the assessment of serum IP-10 level could be a predictive factor for SVR and it was associated with fibrosis, necroinflammatory activity, significant steatosis and IR in patients with chronic HCV infection.
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Affiliation(s)
- Dana Crisan
- Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor"; Department of Internal Medicine, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Mircea Dan Grigorescu
- Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor", Cluj-Napoca, Romania
| | - Corina Radu
- Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor"; Department of Internal Medicine, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Alina Suciu
- Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor"; Department of Internal Medicine, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
| | - Mircea Grigorescu
- Department of Hepatology, Regional Institute of Gastroenterology & Hepatology "Prof. Dr. Octavian Fodor"; Department of Internal Medicine, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine & Pharmacy, Cluj-Napoca, Romania
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16
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Khayath N, Radu C, Choual I, Jilani S, Vecellio L, Domis N, De Blay F. [Environmental exposure chambers (EEC): A novel tool for pathophysiological and pharmaceutical research]. Rev Mal Respir 2018; 35:390-402. [PMID: 29731373 DOI: 10.1016/j.rmr.2018.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 09/15/2017] [Indexed: 01/27/2023]
Abstract
Airborne allergic diseases (allergic asthma, rhinitis and conjunctivitis) have reached epidemic proportions and are a great burden for both society and individuals. Therefore we need to better understand the physiopathological mechanisms and to increase clinical research in these diseases. However, traditional outpatient studies are difficult and have number of limitations, in particular the variability of allergen exposure. Yet allergen provocation tests, especially bronchial challenges in asthma, are excellent tools to measure the efficiency of anti-allergic therapies. Environmental exposure chambers (EEC) allow the performance of controlled allergen provocation tests on a large scale with remarkable sensitivity, specificity and reproducibility. Moreover, they allow a precise collection of allergic symptoms, making them interesting tools for patho-physiological and clinical studies. During the last thirty years, they have assisted the study of anti-allergic therapies and provided data on their pharmacodynamic characteristics, particularly in allergic rhinitis. However, there are still no EEC tests centered on asthma. The EEC of Strasbourg (ALYATEC®) was developed to fulfill two objectives: to allow standardized allergenic and non-allergenic exposures with better control of the parameters than in other EEC and to offer a place to study asthma and anti-asthmatic therapies safely.
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Affiliation(s)
- N Khayath
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Fédération de médecine translationnelle, université de Strasbourg, BP426, 67091 Strasbourg, France
| | - C Radu
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Alyatec, Biocluster-des-Haras, 23, rue des Glacières, 67000 Strasbourg, France
| | - I Choual
- Alyatec, Biocluster-des-Haras, 23, rue des Glacières, 67000 Strasbourg, France
| | - S Jilani
- Alyatec, Biocluster-des-Haras, 23, rue des Glacières, 67000 Strasbourg, France
| | - L Vecellio
- Université François-Rabelais, 37020 Tours cedex, France
| | - N Domis
- Alyatec, Biocluster-des-Haras, 23, rue des Glacières, 67000 Strasbourg, France
| | - F De Blay
- Service de pneumologie, pôle de pathologie thoracique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; Fédération de médecine translationnelle, université de Strasbourg, BP426, 67091 Strasbourg, France.
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17
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Pini M, Czibik G, Sawaki D, Mercedes R, Ternacle J, Henegar C, Braud L, Mezdari Z, Radu C, Dubois-Randé J, Adnot S, Foresti R, Motterlini R, Derumeaux G. Exercise rescues obesity-induced adipose tissue premature aging and restores cardio-metabolic homeostasis. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2018.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Fard D, D’humières T, Bergoend E, Radu C, Deux J, Benhaiem N, Oliver L, Brault-Meslin O, Couetil J, Dubois-Randé J, Lim P, Ternacle J. A new modality for assessing aortic calcium score by 3D trans-esophageal echocardiography. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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De Blay F, Radu C, Choual I, Khayath N, Jilani S, Beck N, Smet S, Domis N. Validation clinique de la chambre d’exposition environnementale de Strasbourg (ALYATEC ® ) chez des patients asthmatiques allergiques aux acariens. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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20
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Crisan N, Andras I, Radu C, Andras D, Coman RT, Tucan P, Pisla D, Crisan D, Coman I. Prostate ultrasound: back in business! Med Ultrason 2017; 19:423-429. [PMID: 29197919 DOI: 10.11152/mu-1147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The use of grey scale prostate ultrasound decreased after the implementation of magnetic resonance imaging (MRI) for the diagnosis and evaluation of prostate cancer. The new developments, such as multiparametric ultrasound and MRI-ultrasound fusion technology, renewed the interest for this imaging method in the assessment of prostate cancer. The purpose of this paper was to review the current role of prostate ultrasound in the setting of these new applications. A thorough reevaluation of the selection criteria of the patients is required to assess which patients would benefit from multiparametric ultrasound, who wouldbenefit from multiparametric MRI or the combination of both to assist prostate biopsy in order to ensure the balance between overdiagnosis and underdiagnosis of prostate cancer.
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Affiliation(s)
- Nicolae Crisan
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Iulia Andras
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Corina Radu
- Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca.
| | - David Andras
- Oncologic Surgery Department, Ion Chiricuta Institute of Oncology, Cluj-Napoca.
| | - Radu-Tudor Coman
- Epidemiology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
| | - Paul Tucan
- CESTER (Research Center for Industrial Robots Simulation and Testing), Technical University, Cluj-Napoca.
| | - Doina Pisla
- CESTER (Research Center for Industrial Robots Simulation and Testing), Technical University, Cluj-Napoca.
| | - Dana Crisan
- Internal Medicine Department, 5th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca Internal Medicine Department, Clinical Municipal Hospital Cluj-Napoca.
| | - Ioan Coman
- Department of Urology, Clinical Municipal Hospital, Cluj-Napoca Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca.
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21
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Damy T, Galat A, Rouffiac S, Guendouz S, Kharoubi M, Ayad K, De Nadai N, Plante-Bordeneuve V, Lebras F, Amiot A, Radu C, Dubois-Rande J, Bodez D. P5845Prognosis of patients with cardiac amyloidosis referred in the French cardiac amyloidosis expert center. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T. Damy
- AP-HP - University Hospital Henri Mondor, Creteil, France
| | - A. Galat
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - S. Rouffiac
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - S. Guendouz
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - M. Kharoubi
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - K. Ayad
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - N. De Nadai
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | | | - F. Lebras
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - A. Amiot
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | - C. Radu
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
| | | | - D. Bodez
- GRC-Amyloid Research Institute - APHP - INSERM, Creteil, France
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22
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Crisan D, Radu C, Suciu A, Leach N, Stefanescu H, Avram L, Crisan N, Grigorescu M. Hepatitis C in nonobese nondiabetic patients: Insulin resistance and the metabolic syndrome make a difference. J Viral Hepat 2017; 24:86-87. [PMID: 27700001 DOI: 10.1111/jvh.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- D Crisan
- 5th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - C Radu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - A Suciu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - N Leach
- 4th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - H Stefanescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - L Avram
- Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - N Crisan
- Clinical Municipal Hospital, Cluj-Napoca, Romania.,Department of Surgery, Iuliu-Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - M Grigorescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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23
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Stefanescu H, Suciu A, Romanciuc F, Crisan D, Procopet B, Radu C, Tantau M, Socaciu C, Grigorescu M. Lyso-phosphatidylcholine: A potential metabolomic biomarker for alcoholic liver disease? Hepatology 2016; 64:678-9. [PMID: 27123871 DOI: 10.1002/hep.28630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/24/2015] [Accepted: 09/29/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Horia Stefanescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Alina Suciu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Florina Romanciuc
- RTD Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Dana Crisan
- 5th Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Bogdan Procopet
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.,3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corina Radu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.,3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Marcel Tantau
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Carmen Socaciu
- RTD Center for Applied Biotechnology BIODIATECH, SC Proplanta, Cluj-Napoca, Romania
| | - Mircea Grigorescu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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24
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Affiliation(s)
- C Radu
- Department of Chest Disease, University Hospital of Strasbourg, France
| | - C Barnig
- Department of Chest Disease, University Hospital of Strasbourg, France.,Federation of Translational Medicine, EA3072, University of Strasbourg, France
| | - F de Blay
- Department of Chest Disease, University Hospital of Strasbourg, France.,Federation of Translational Medicine, EA3072, University of Strasbourg, France
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25
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Kremer T, Cordts T, Hirche C, Hernekamp F, Radu C, Kneser U. [Reconstruction of Defects after Oncologic Resection and Radiation - Indications for Microsurgical Reconstruction]. HANDCHIR MIKROCHIR P 2015; 47:353-8. [PMID: 26676555 DOI: 10.1055/s-0041-108197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The surgical treatment of soft tissue sarcomas in the extremities frequently requires radiation therapy to achieve local tumour control. However, both adjuvant and neoadjuvant radiation are associated with significant morbidity caused by impaired wound healing, ulcers or osteonecrosis with subsequent fractures. This is due to altered local cell mediator levels, fibrosis occurring simultaneously with decreased cell division rates and diminished vascularity. This article describes a number of local conservative treatment options, all of which have limited success rates. In addition, it describes plastic surgical treatment options for radiation-induced local morbidity. Surgical reconstruction includes the full range of plastic reconstructive techniques. However, less complex options such as random pattern flaps or split thickness skin grafts are often associated with complications. Therefore, a large number of cases require free tissue transfer.
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Affiliation(s)
- T Kremer
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
| | - T Cordts
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
| | - C Hirche
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
| | - F Hernekamp
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
| | - C Radu
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
| | - U Kneser
- BG Unfallklinik Ludwigshafen und Ruprecht-Karls-Universität Heidelberg, Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, Klinik für Plastische Chirurgie, Ludwigshafen
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26
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Crisan D, Radu C, Suciu A, Grigorescu MD, Stefanescu H, Romanciuc F, Socaciu C, Grigorescu M. Metabolomics for genomics: the role of vitamin D in nonalcoholic fatty liver disease. J Gastrointestin Liver Dis 2015; 24:394-395. [PMID: 26405717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Dana Crisan
- Iuliu Hatieganu University of Medicine and Pharmacy; Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Corina Radu
- Iuliu Hatieganu University of Medicine and Pharmacy; Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romamia
| | - Alina Suciu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca,
| | | | - Horia Stefanescu
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florina Romanciuc
- Faculty of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca,Romania
| | - Carmen Socaciu
- Faculty of Food Science and Technology, University of Agricultural Sciences and Veterinary Medicine, Cluj-Napoca,Romania
| | - Mircea Grigorescu
- Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Stefanescu H, Radu C, Procopet B, Lupsor-Platon M, Habic A, Tantau M, Grigorescu M. Non-invasive ménage à trois for the prediction of high-risk varices: stepwise algorithm using lok score, liver and spleen stiffness. Liver Int 2015; 35:317-25. [PMID: 25228102 DOI: 10.1111/liv.12687] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/23/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS Liver stiffness (LS), spleen stiffness (SS) and serum markers have been proposed to non-invasively assess portal hypertension or oesophageal varices (EV) in cirrhotic patients. We aimed to evaluate the performance of a stepwise algorithm that combines Lok score with LS and SS for diagnosing high-risk EV (HREV) and to compare it with other already-validated non-invasive methods. METHODS We performed a cross-sectional study including 136 consecutive compensated cirrhotic patients with various aetiologies, divided into training (90) and validation (46) set. Endoscopy was performed within 6 months from inclusion for EV screening. Spleen diameter was assessed by ultrasonography. LS and SS were measured using Fibroscan. Lok score, platelet count/spleen diameter ratio, LSM-spleen diameter to platelet ratio score and oesophageal varices risk score (EVRS) were calculated and their diagnostic accuracy for HREV was assessed. The algorithm classified patients as having/not-having HREV. Its performance was tested and compared in both groups. RESULTS In the training set, all variables could select patients with HREV with moderate accuracy, the best being LSPS (AUROC = 0.818; 0.93 sensitivity; 0.63 specificity). EVRS, however, was the only independent predictor of HREV (OR = 1.521; P = 0.032). The algorithm correctly classified 69 (76.66%) patients in the training set (P < 0.0001) and 36 (78.26%) in the validation one. In the validation group, the algorithm performed slightly better than LSPS and EVRS, showing 100% sensitivity and negative predicted value. CONCLUSION The stepwise algorithm combining Lok score, LS and SS could be used to select patients at low risk of having HREV and who may benefit from more distanced endoscopic evaluation.
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Affiliation(s)
- Horia Stefanescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Procopet B, Farcau O, Balagel M, Crisan D, Stefanescu H, Pop A, Fischer P, Habic A, Radu C, Tantau M, Grigorescu M. The metabolic syndrome is not correlated with the short-term risk of decompensation in patients with cirrhosis. J Gastrointestin Liver Dis 2014; 23:397-403. [PMID: 25531998 DOI: 10.15403/jgld.2014.1121.234.msy] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Obesity proved to favor clinical decompensation in patients with cirrhosis. Our aim was to investigate if metabolic syndrome (MS) in cirrhotic patients represents a risk factor for decompensation. METHODS 704 cirrhotics, included in a MS prevalence study were considered for evaluation; 121 patients were excluded because they did not complete the follow-up and 303 because they were decompensated at the start of the study. The remaining 280 were followed-up for a median period of 28.1+/-18 months. Patients were censored at the end of follow-up or at occurrence of a liver related event (LRE). Liver related events were considered the following: decompensation (ascites, variceal bleeding, hepatorenal syndrome, jaundice, encephalopathy), hepatocellular carcinoma, portal vein thrombosis and infections. RESULTS All MS criteria except the abdominal circumference were significantly different between decompensated and compensated patients. HDL-cholesterol levels were lower in decompensated patients. Among the 280 patients who completed the follow-up, 85 (30%) presented LREs. Ascites was the most frequent event. In the univariate analysis of the MS criteria we found a trend to significance of an inverse correlation between MS and LREs. There was no significant difference between patients with or without MS regarding survival free of LREs, 76.7% and 66.5%, respectively. None of the MS criteria reached the level of significance in discriminating patients with and without LREs. CONCLUSIONS In short term, presence of MS was not a risk factor for LREs. In short term, liver function and lower nutritional status influenced the prognosis. In decompensated patients, the MS defining criteria are not applicable.
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Affiliation(s)
- Bogdan Procopet
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania;Hepatic Hemodynamic Laboratory, Liver Unit, IDIBAPS, Hospital Clinic, Barcelona, Spain.
| | - Oana Farcau
- Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Marius Balagel
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Dana Crisan
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Horia Stefanescu
- Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Andreea Pop
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Petra Fischer
- Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Alina Habic
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Corina Radu
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Marcel Tantau
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mircea Grigorescu
- Gastroenterology Department, Iuliu Hatieganu University of Medicine and Pharmacy; Gastroenterology Department, Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Radu C, Stefanescu H, Procopet B, Lupsor Platon M, Tantau M, Grigorescu M. Is spleen stiffness a predictor of clinical decompensation in cirrhotic patients? J Gastrointestin Liver Dis 2014; 23:223-224. [PMID: 24949619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Corina Radu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca;Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Horia Stefanescu
- Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Bogdan Procopet
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca;Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Monica Lupsor Platon
- Medical Imaging Department, Iuliu Hatieganu University of Medicine and Pharmacy,Cluj-Napoca, Romania
| | - Marcel Tantau
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca;Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Mircea Grigorescu
- 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca;Hepatology Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Bugiardini R, Badimon L, Manfrini O, Boytsov S, Bozidarka K, Daullxhiu I, Dilic M, Dorobantu M, Erglis A, Gafarov V, Gale CP, Goncalvesova E, Goudev A, Gustiene O, Hall A, Karpova I, Kedev S, Manak N, Milicic D, Ostojic M, Parkhomenko AN, Popovici M, Studenkan M, Toth K, Trninic D, Vasiljevic Z, Zakke I, Zaliunas R, Bugiardini R, Vaccarino V, Manfrini O, Badimon L, Manak N, Karpova I, Dilic M, Trninic D, Goudev A, Milicic D, Toth K, Daullxhiu I, Erglis A, Zakke I, Zaliunas R, Gustiene O, Kedev S, Popovici M, Knezevic B, Boytsov S, Gafarov V, Dorubantu M, Vasiljevic Z, Ojstoic M, Goncalvesova E, Studencan M, Parkhomenko AN, Hall A, Gale C, Karpova I, Manak N, Lovric M, Korac R, Mandic D, Vujovic V, Blagojevic M, Milekic J, Trendafilova E, Somleva D, Krivokapic L, Rajovic G, Sahmanovic O, Saranovic M, Radoman C, Tomic SC, Ljubic V, Velickovic M, Radojicic S, Arsenescu-Georfescu C, Garbea S, Radu C, Olinic D, Calin P, Chifor A, Babes K, lonescu DD, Craiu E, Petrescu H, Magda I, Luminita S, Benedek I, Marinescu S, Tiberiu N, Gheorghe G, Malaescu I, Trocan N, Doina D, Macarie C, Putnikovic B, Arandjelovic A, Nikolic NM, Zdravkovic M, Saric J, Radovanovic S, Matic I, Srbljak N, Davidovic G, Simovic S, Zivkovic S, Petkovic-Curic S, Studencan M, Parkhomenko AN. Perspectives: Rationale and design of the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) project. Eur Heart J Suppl 2014. [DOI: 10.1093/eurheartj/sut002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Capilna B, Radu C. The association of month of birth with allergic sensitization in pediatric patients with asthma in Mureş County, Romania. Clin Transl Allergy 2013. [PMCID: PMC3723735 DOI: 10.1186/2045-7022-3-s3-p165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Spiezia L, Visentin S, Radu C, Bon M, Woodhams B, Cosmi E, Simioni P. P-036 Changes in plasma levels of factor VIIa-antithrombin complex during normal pregnancy and in pre-eclampsia. Thromb Res 2013. [DOI: 10.1016/s0049-3848(13)70082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Crisan D, Radu C, Grigorescu MD, Lupsor M, Feier D, Grigorescu M. Prospective non-invasive follow-up of liver fibrosis in patients with chronic hepatitis C. J Gastrointestin Liver Dis 2012; 21:375-382. [PMID: 23256120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Non-invasive methods for the assessment of liver fibrosis are accurate in staging chronic liver diseases before treatment. AIM To prospectively assess liver fibrosis in chronic hepatitis C (CHC) in patients treated vs untreated, using non-invasive methods. METHOD 224 patients with CHC were included in the study: 179 received antiviral treatment for 48 weeks, and 45 patients received no antiviral therapy. All patients underwent liver biopsy at baseline and were also evaluated by simple biological scores (APRI, HAPRI, Forns, Bonacini, Lok) and transient elastography (TE). The progression of fibrosis was non-invasively assessed over a period of 72 weeks. RESULTS Fibrosis decreased significantly in patients who gained sustained virological response (SVR). A significant decrease of fibrosis was also observed in all treated patients, irrespective of SVR when using APRI, HAPRI and Bonacini scores (p=0.001, 0.009 and 0.02). Untreated patients yielded constant values of fibrosis or a slight increase in follow-up. Patients with Lok score and stiffness predictive for cirrhosis had a decreasing trend of fibrosis (p=0.03 for Lok and 0.05 for TE), but persisting in the cirrhosis domain. Of the non responders, those who gained biological response demonstrated improvement of fibrosis assessed by APRI and TE. CONCLUSION The prospective follow-up of liver fibrosis assessed by simple biological scores and TE in patients with CHC revealed a downstaging of fibrosis in treated patients and especially in those who gained SVR.
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Affiliation(s)
- Dana Crisan
- Regional Institute of Gastroenterology and Hepatology "Prof.Dr.Octavian Fodor", "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Senzolo M, Rodriguez-Castro KI, Rossetto V, Radu C, Gavasso S, Carraro P, Zerbinati P, Sartori MT, Simioni P. Increased anticoagulant response to low-molecular-weight heparin in plasma from patients with advanced cirrhosis. J Thromb Haemost 2012; 10:1823-9. [PMID: 22712870 DOI: 10.1111/j.1538-7836.2012.04824.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Cirrhotic patients may present thrombotic complications that warrant anticoagulant therapy. However, the efficacy of low-molecular-weight heparin (LMWH) in this clinical setting is still unclear. AIMS/METHODS To evaluate the in vitro effect of LMWH on thrombin generation (TG) in cirrhotic patients at different stages of liver disease. Thirty cirrhotics (10 Child Pugh A, 10 Child Pugh B and 10 Child Pugh C), 10 subjects with inherited type 1 antithrombin (AT) defect and 10 healthy controls were studied. TG was determined at baseline and with anti-Xa levels after the addition of enoxaparin at 0.35 and 0.7 U anti-Xa mL. The endogenous thrombin potential (ETP) ratio at 0.35 and 0.7 U anti-Xa mL was obtained by dividing ETP with LMWH by ETP at baseline. RESULTS Mean AT levels in all cirrhotic subgroups and in patients with AT deficiency were significantly lower than in controls. The 0.35 ETP ratio was significantly lower in cirrhotic patients than in controls (0.26 ± 0.1 vs. 0.48 ± 0.1, P < 0.001) and the reduction paralleled the severity of liver disease, in spite of the concomitant decrease in AT and anti-Xa activity. AT-deficient subjects showed a significantly increased 0.35 ETP ratio compared with both cirrhotic patients and controls (0.69 ± 1 vs. 0.26 ± 0.1, P < 0.001, and vs. 0.48 ± 0.1, P = 0.04 respectively). LMWH at 0.7 U anti-Xa mL completely inhibited TG in 9/30 cirrhosis patients with more advanced liver disease (Child Pugh B and C), whereas complete TG abolition was seen in only 1/10 controls. CONCLUSIONS Cirrhotic patients show an increased response to LMWH, which correlates with the severity of liver disease, in spite of reduced AT and anti-Xa activity levels. Thrombin generation may be a useful tool to monitor the response to LMWH in cirrhotic patients.
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Affiliation(s)
- M Senzolo
- Multivisceral Transplant Unit, Department of Surgical and Gastroenterological Sciences. Padua University Hospital, Padua, Italy.
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Grigorescu M, Crisan D, Radu C, Grigorescu MD, Sparchez Z, Serban A. A novel pathophysiological-based panel of biomarkers for the diagnosis of nonalcoholic steatohepatitis. J Physiol Pharmacol 2012; 63:347-353. [PMID: 23070083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/17/2012] [Indexed: 06/01/2023]
Abstract
Non-invasive biochemical markers are useful to distinguish between nonalcoholic steatohepatitis (NASH) and simple steatosis. The aim of this study was to test the diagnostic value of a panel of biomarkers derived from the pathophysiological events involved in the development of NASH. A total of 79 patients: 20 not-NASH and 59 NASH were included in the study. Definitive NASH was defined according to Kleiner's classification. In all subjects, parameters of the metabolic syndrome, insulin resistance (HOMA-IR), adiponectin, interleukin-6 (IL-6) and total cytokeratin-18 (M65 antigen) were determined. Univariate and multivariate analysis were used to identify independent predictors of NASH. In multivariate analysis three markers were independently predictors of NASH: adiponectin, IL-6 and M65 levels. In decreasing order, the independent predictors of NASH (NAS≥5) were M65 with an AUROC of 0.791, IL-6 with an AUROC of 0.727 and adiponectin with an AUROC of 0.709. The combination of two biomarkers yelded an AUROC of 0.828 for M65 and IL-6, 0.841 for adiponectin and M65 and 0.852 for adiponectin and IL-6. The best value was obtained by triple combination: adiponectin, M65 and IL-6 with and AUROC of 0.903, Sp=85.7% (PPV=94.2%) and Se=84.5% (NPV=66.7%). In conclusion, a novel pathophysiological - based panel of biomarkers combining total CK-18, IL-6 and adiponectin may be useful to predict NASH.
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Affiliation(s)
- M Grigorescu
- Regional Institute of Gastroenterology and Hepatology, 3rd Medical Clinic, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Crisan D, Radu C, Lupsor M, Sparchez Z, Grigorescu MD, Grigorescu M. Two or more synchronous combination of noninvasive tests to increase accuracy of liver fibrosis assessement in chronic hepatitis C; results from a cohort of 446 patients. Hepat Mon 2012; 12:177-84. [PMID: 22550525 PMCID: PMC3339417 DOI: 10.5812/hepatmon.853] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 02/21/2012] [Accepted: 03/04/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND The prediction of fibrosis is an essential part of the assessment and management of patients with chronic liver disease. Non-invasive tests (NITs) have a number of advantages over the traditional standard of fibrosis assessment by liver biopsy, including safety, cost-effectiveness, and widespread accessibility. OBJECTIVES The aim of this study was to determine the accuracy of certain biomarkers and transient elastography (TE) alone or in combination to predict the stage of liver fibrosis in chronic hepatitis C (CHC). Also, we examined whether the combination of certain biomarkers and TE could increase the diagnostic accuracy of liver fibrosis assessment. PATIENTS AND METHOD A total of 446 patients who were previously diagnosed with CHC were included in the study. In the study group, 6 blood-based scores (APRI, Forns, Fib-4, Hepascore, FibroTest, and Fibrometer) were calculated, and TE was performed to validate the stage of fibrosis, compared with liver biopsy (LB) as the standard. RESULTS Significant fibrosis (F ≥ 2) was predicted with an AUROC of 0.727, 0.680, 0.714, 0.778, 0.688, 0.797, and 0.751 for the APRI, Forns, Fib-4, FibroTest, Hepascore, and Fibrometer scores and TE (Fibroscan), respectively. Severe fibrosis (F ≥ 3) was predicted, with AUROCs ranging between 0.705 and 0.811 for Hepascore and Fibrometer, respectively. Of the biomarkers, Fibrometer had the highest AUROC value in predicting both significant and severe fibrosis. The combination of APRI or FIB-4 with Fibrometer increased the diagnostic accuracy for significant fibrosis (from 69.07 to 82.27 for APRI, P = 0.001 and from 57.74 to 81.33, P = 0.001 for Fib-4). Combining APRI or Fib-4 with TE also increased the diagnostic accuracy (from 69.07 to 80.70%, P = 0.001 for APRI and from 57.74 to 81.33%, P = 0.001 for Fib-4) for significant fibrosis. The association that included Fibrotest was also reliable for the improvement of diagnostic accuracy. These combinations were more accurate or the assessment of severe fibrosis. CONCLUSIONS The synchronous association between a simple, inexpensive score and a complex but expensive score or TE increases the diagnostic accuracy of non-invasive methods for the assessment of liver fibrosis stage.
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Affiliation(s)
- Dana Crisan
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Corina Radu
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Monica Lupsor
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Zeno Sparchez
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mircea Dan Grigorescu
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mircea Grigorescu
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Corresponding author: Mircea Grigorescu, Third Medical Clinic, 19-21Croitorilor Street, 400162, Cluj-Napoca, Romania. Tel.: +40-741055464, Fax: +40-264432625, E-mail:
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Crisan D, Radu C, Lupsor M, Sparchez Z, Grigorescu MD, Grigorescu M. Two or more synchronous combination of noninvasive tests to increase accuracy of liver fibrosis assessement in chronic hepatitis C; results from a cohort of 446 patients. Hepat Mon 2012. [PMID: 22550525 DOI: 10.5812/hepatmon.5106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prediction of fibrosis is an essential part of the assessment and management of patients with chronic liver disease. Non-invasive tests (NITs) have a number of advantages over the traditional standard of fibrosis assessment by liver biopsy, including safety, cost-effectiveness, and widespread accessibility. OBJECTIVES The aim of this study was to determine the accuracy of certain biomarkers and transient elastography (TE) alone or in combination to predict the stage of liver fibrosis in chronic hepatitis C (CHC). Also, we examined whether the combination of certain biomarkers and TE could increase the diagnostic accuracy of liver fibrosis assessment. PATIENTS AND METHOD A total of 446 patients who were previously diagnosed with CHC were included in the study. In the study group, 6 blood-based scores (APRI, Forns, Fib-4, Hepascore, FibroTest, and Fibrometer) were calculated, and TE was performed to validate the stage of fibrosis, compared with liver biopsy (LB) as the standard. RESULTS Significant fibrosis (F ≥ 2) was predicted with an AUROC of 0.727, 0.680, 0.714, 0.778, 0.688, 0.797, and 0.751 for the APRI, Forns, Fib-4, FibroTest, Hepascore, and Fibrometer scores and TE (Fibroscan), respectively. Severe fibrosis (F ≥ 3) was predicted, with AUROCs ranging between 0.705 and 0.811 for Hepascore and Fibrometer, respectively. Of the biomarkers, Fibrometer had the highest AUROC value in predicting both significant and severe fibrosis. The combination of APRI or FIB-4 with Fibrometer increased the diagnostic accuracy for significant fibrosis (from 69.07 to 82.27 for APRI, P = 0.001 and from 57.74 to 81.33, P = 0.001 for Fib-4). Combining APRI or Fib-4 with TE also increased the diagnostic accuracy (from 69.07 to 80.70%, P = 0.001 for APRI and from 57.74 to 81.33%, P = 0.001 for Fib-4) for significant fibrosis. The association that included Fibrotest was also reliable for the improvement of diagnostic accuracy. These combinations were more accurate or the assessment of severe fibrosis. CONCLUSIONS The synchronous association between a simple, inexpensive score and a complex but expensive score or TE increases the diagnostic accuracy of non-invasive methods for the assessment of liver fibrosis stage.
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Affiliation(s)
- Dana Crisan
- Third Medical Clinic, Regional Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Spiezia L, Radu C, Bulato C, Tognin G, Gavasso S, Barillari G, Pradella P, De Angelis V, Simioni P. Platelet factor V levels in moderate to severe congenital factor V deficiency. Haemophilia 2011; 18:e53-5. [PMID: 22176589 DOI: 10.1111/j.1365-2516.2011.02717.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pisla D, Gherman B, Plitea N, Gyurka B, Vaida C, Vlad L, Graur F, Radu C, Suciu M, Szilaghi A, Stoica A. PARASURG hybrid parallel robot for minimally invasive surgery. Chirurgia (Bucur) 2011; 106:619-625. [PMID: 22165061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
This paper presents the parallel hybrid robot, PARASURG 9M, for robotically assisted surgery, a robot which was entirely designed and produced in Romania. It is a versatile robot, being composed of a positioning and orientation module, PARASURG 5M with five degrees of freedom, having the possibility of attaching at its end either a laparoscope or an active surgical instrument for cutting/grasping, PARASIM, with four degrees of freedom. Based on its mathematical modelling, the first low-cost experimental model of the surgical robot has been built. The robot is part of the surgical robotic system, PARAMIS, with three arms, one used as a laparoscope holder, and other two for manipulating active instruments. When it is used as a manipulator of the camera, the user has the possibility to give commands in a large area for the positioning of the laparoscope using different interfaces: joystick, microphone, keyboard & mouse and haptic device. If the active surgical instrument, PARASIM, is attached, the robot commands are given through a haptic device. The main features that make the PARASURG 9M surgical robot suited for minimally invasive surgery are: precision, the elimination of the natural tremor of the surgeon, direct control over a smooth, precise, stable view of the internal surgical field for the surgeon. It also eliminates the need of a second surgeon to be present for the entire procedure (in the case of using the robot as a camera holder). In addition, there is improvement of surgeon dexterity in the case of using the PARASIM active instrument and better ergonomics in using the robot (in the case of the classic laparoscopy, the surgeon must adopt a difficult position for a long period of time, while the robot never gets tired). Having a relatively easy to understand, intuitive commanding system, the surgeons can rapidly adapt to the use of the PARASURG 9M robot in surgical procedures.
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Affiliation(s)
- D Pisla
- Technical University of Cluj-Napoca, Romania
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Castoldi E, Duckers C, Radu C, Spiezia L, Rossetto V, Tagariello G, Rosing J, Simioni P. Homozygous F5 deep-intronic splicing mutation resulting in severe factor V deficiency and undetectable thrombin generation in platelet-rich plasma. J Thromb Haemost 2011; 9:959-68. [PMID: 21320286 DOI: 10.1111/j.1538-7836.2011.04237.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Coagulation factor (F) V deficiency is associated with a bleeding tendency of variable severity, but phenotype determinants are largely unknown. Recently, we have shown that three patients with undetectable plasma FV and mild bleeding symptoms had sufficient residual platelet FV to support thrombin generation in platelet-rich plasma (PRP). Therefore, we hypothesized that FV-deficient patients with severe bleeding manifestations may lack platelet FV. OBJECTIVES To characterize a FV-deficient patient with a severe bleeding diathesis. PATIENTS/METHODS We performed FV mutation screening and functional studies in a 31-year-old male (FV:C < 1%) with umbilical bleeding at birth, recurrent hemarthrosis and muscle hematomas, and a recent intracranial hemorrhage. RESULTS The proband was homozygous for a deep-intronic mutation (F5 IVS8 +268A→G) causing the inclusion of a pseudo-exon with an in-frame stop codon in the mature F5 mRNA. Although platelet FV antigen was detectable by immunoprecipitation followed by Western blotting, no FV activity could be demonstrated in the proband's plasma or platelets with a prothrombinase-based assay. Moreover, no thrombin generation was observed in PRP triggered with 1-50 pm tissue factor (even in the presence of platelet agonists), whereas an acquired FV inhibitor was excluded. Clot formation in the proband's whole blood, as assessed by thromboelastometry, was markedly delayed but not abolished. CONCLUSIONS This is the first report of a pathogenic deep-intronic mutation in the F5 gene. Our findings indicate that the minimal FV requirement for viability is extremely low and suggest that thrombin generation in PRP may predict bleeding tendency in patients with undetectable plasma FV.
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Affiliation(s)
- E Castoldi
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
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Rossetto V, Spiezia L, Dabrilli P, Radu C, Gavasso S, Simioni P. P.50 Effect of low dose LMWH “in vitro” addition on thrombin generation potential in healthy pregnant and non pregnant women. Thromb Res 2011. [DOI: 10.1016/s0049-3848(11)70105-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Radu C, Schachner M, Tränkle M, Germann G, Sauerbier M. Funktionelle Ergebnisse nach Handgelenksdenervation. HANDCHIR MIKROCHIR P 2010; 42:279-86. [DOI: 10.1055/s-0030-1249060] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Castoldi E, Maurissen LFA, Tormene D, Spiezia L, Gavasso S, Radu C, Hackeng TM, Rosing J, Simioni P. Similar hypercoagulable state and thrombosis risk in type I and type III protein S-deficient individuals from mixed type I/III families. Haematologica 2010:haematol.2009.021923. [DOI: 10.3324/haematol.2009.021923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Spiezia L, Radu C, Gavasso S, Rossetto V, Abalotti C, Fadin M, Dabrilli P, Woodhams B, Simioni P. PO-30 Procoagulant phospholipids in patients with venous thromboembolism and cancer. Thromb Res 2010. [DOI: 10.1016/s0049-3848(10)70080-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pettersson D, Cedermark B, Holm T, Radu C, Påhlman L, Glimelius B, Martling A. Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 2010. [PMID: 20155787 DOI: 10.1002/bjs.691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To address issues regarding the fractionation of radiotherapy (RT) and timing of surgery for rectal cancer, a multicentre trial has randomized patients to preoperative short-course RT with two different intervals to surgery, or long-course RT with delayed surgery. The present interim analysis assessed feasibility, compliance and complications after RT and surgery. METHODS Some 303 patients were randomized to either short-course RT (5 x 5 Gy) and surgery within 1 week (group 1), short-course RT and surgery after 4-8 weeks (group 2) or long-course RT (25 x 2 Gy) and surgery after 4-8 weeks (group 3). RESULTS Demographic data were similar between groups and there were few protocol violations (5.0-6 per cent). Eight patients (2.6 per cent) developed radiation-induced acute toxicity. There were no significant differences in postoperative complications between groups (46.6, 40.0 and 32 per cent in groups 1, 2 and 3 respectively; P = 0.164). Patients receiving short-course RT with surgery 11-17 days after the start of RT had the highest complication rate (24 of 37). CONCLUSION Compliance was acceptable and severe acute toxicity was low, irrespective of fractionation. Short-course RT with immediate surgery had a tendency towards more postoperative complications, but only if surgery was delayed beyond 10 days after the start of RT. REGISTRATION NUMBER NCT00904813 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Pettersson D, Cedermark B, Holm T, Radu C, Påhlman L, Glimelius B, Martling A. Interim analysis of the Stockholm III trial of preoperative radiotherapy regimens for rectal cancer. Br J Surg 2010; 97:580-7. [PMID: 20155787 DOI: 10.1002/bjs.6914] [Citation(s) in RCA: 194] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND To address issues regarding the fractionation of radiotherapy (RT) and timing of surgery for rectal cancer, a multicentre trial has randomized patients to preoperative short-course RT with two different intervals to surgery, or long-course RT with delayed surgery. The present interim analysis assessed feasibility, compliance and complications after RT and surgery. METHODS Some 303 patients were randomized to either short-course RT (5 x 5 Gy) and surgery within 1 week (group 1), short-course RT and surgery after 4-8 weeks (group 2) or long-course RT (25 x 2 Gy) and surgery after 4-8 weeks (group 3). RESULTS Demographic data were similar between groups and there were few protocol violations (5.0-6 per cent). Eight patients (2.6 per cent) developed radiation-induced acute toxicity. There were no significant differences in postoperative complications between groups (46.6, 40.0 and 32 per cent in groups 1, 2 and 3 respectively; P = 0.164). Patients receiving short-course RT with surgery 11-17 days after the start of RT had the highest complication rate (24 of 37). CONCLUSION Compliance was acceptable and severe acute toxicity was low, irrespective of fractionation. Short-course RT with immediate surgery had a tendency towards more postoperative complications, but only if surgery was delayed beyond 10 days after the start of RT. REGISTRATION NUMBER NCT00904813 (http://www.clinicaltrials.gov).
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Affiliation(s)
- D Pettersson
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Lupsor M, Badea R, Stefanescu H, Grigorescu M, Serban A, Radu C, Crişan D, Sparchez Z, Iancu S, Maniu A. Performance of unidimensional transient elastography in staging non-alcoholic steatohepatitis. J Gastrointestin Liver Dis 2010; 19:53-60. [PMID: 20361076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND/AIMS Transient elastography (TE) is a noninvasive method for predicting liver fibrosis, mainly validated in patients with viral hepatitis. Information is still limited concerning its performance in non-alcoholic steatohepatitis (NASH) patients. We aimed to assess the value of TE in the prediction of fibrosis stage in NASH as well as the factors determining the discordance between the TE-predicted and the biopsy-proven fibrosis stage in these patients. METHODS Liver biopsy and TE were performed on 72 consecutive NASH patients. Fibrosis, lobular inflammation, ballooning and steatosis were evaluated (Brunt system). RESULTS Liver stiffness (LS) values ranged from 2.80 to 16.90 kPa. In the univariate analysis, LS was correlated with fibrosis (r=0.661; p<0.0001), steatosis (r=0.435, p<0.0001), ballooning (r=0.385; p=0.001) and lobular inflammation (r=0.364; p=0.002). In multivariate analysis, only fibrosis significantly correlated with LS (p<0.0001). The median (and range) LS values (kPa) according to the fibrosis stages were: 4.90 (2.80-7.30) for F0; 6.15 (4.80-12.50) for F1; 6.90 (3.30-16.90) for F2 and 14.00 (10.70-14.10) for F3, with significant difference between stages, except for F1-F2 (p=0.249). Cut off values were calculated for predicting each fibrosis stage: 5.3 kPa (AUROC=0.879) for F1; 6.8 kPa (AUROC=0.789) for F2; and 10.4 kPa (AUROC=0.978) for F3. Patients with false-positive results had a significantly higher ALT level than those with concordant results (p=0.039). CONCLUSION In NASH patients, TE allows a reliable assessment and prediction of liver fibrosis, especially in advanced stages. Steatosis, ballooning and inflammation do not influence liver stiffness.
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Affiliation(s)
- Monica Lupsor
- Department of Medical Imaging, 3rd Medical Clinic, University of Medicine and Pharmacy, 19-21 Croitorilor Street, 400162 Cluj-Napoca, Romania.
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Acalovschi M, Buzas C, Radu C, Grigorescu M. Hepatitis C virus infection is a risk factor for gallstone disease: a prospective hospital-based study of patients with chronic viral C hepatitis. J Viral Hepat 2009; 16:860-6. [PMID: 19486279 DOI: 10.1111/j.1365-2893.2009.01141.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We evaluated the prevalence and the risk factors for gallstone disease in patients with chronic hepatitis C infection. We investigated 453 consecutively admitted patients with chronic infection with hepatitis C virus (HCV) (cirrhosis excluded) and 879 patients without liver disease (October 2006-April 2007). Gallstone disease was diagnosed if gallstones were present at ultrasonography or if there had been a previous cholecystectomy. Variables evaluated were age, gender, gallstone heredity, body mass index, waist circumference, parity, serum lipids, fatty liver, arterial hypertension, diabetes mellitus and metabolic syndrome (International Diabetes Federation criteria). Informed consent was obtained from all patients. We found that 88 of 453 (19%) patients with chronic HCV hepatitis (age 50.1 +/- 11.7 years) and 153 of 879 (17%) controls (age 60.6 +/- 12.6 years) had gallstone disease (GD). Abdominal obesity (OR = 2.108, 95% CI 1.287-3.452) and steatosis (OR = 3.699, 95% CI 2.277-6.008) were risk factors for GD in HCV patients. Gallstone heredity, dyslipidaemia, type 2 diabetes mellitus and metabolic syndrome increased the risk for GD in controls vs HCV patients. Our study shows that even HCV patients with chronic hepatitis but not cirrhosis have an increased prevalence of gallstones. Compared with controls, gallstones are present in HCV patients at a younger age and are associated with central obesity and liver steatosis, but not with gallstone heredity, dyslipidaemia, diabetes mellitus or metabolic syndrome. Although we could not establish a temporal relationship, the association between HCV infection and gall stone disease is real and appears to be causally linked, at least in predisposed individuals (obese and with liver steatosis).
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Affiliation(s)
- M Acalovschi
- 3rd Medical Clinic, University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Radu C. WE-D-210A-04: Novel PET Probes to Image the Immune System and Cancer - From Discovery to Clinical Applications. Med Phys 2009. [DOI: 10.1118/1.3182549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Campello E, Spiezia L, Castelli M, Rossetto V, Radu C, Tormene D, Simioni P. O5 Microparticles plasma levels in women with venous thromboembolism and cancer. Thromb Res 2009. [DOI: 10.1016/s0049-3848(09)70030-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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