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Varzaru B, Iacob RA, Bunduc S, Manea I, Sorop A, Spiridon A, Chelaru R, Croitoru A, Topala M, Becheanu G, Dumbrava M, Dima S, Popescu I, Gheorghe C. Prognostic Value of Circulating Cell-Free DNA Concentration and Neutrophil-to-Lymphocyte Ratio in Patients with Pancreatic Ductal Adenocarcinoma: A Prospective Cohort Study. Int J Mol Sci 2024; 25:2854. [PMID: 38474101 DOI: 10.3390/ijms25052854] [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: 12/29/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Circulating cell-free DNA (ccfDNA) quantity correlates with the clinical characteristics and prognosis of various cancer types. We investigated whether ccfDNA levels and the neutrophil-to-lymphocyte ratio (NLR) have prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC). Peripheral blood was collected from 82 patients with PDAC prior to any diagnostic procedure or the administration of chemotherapy. Plasma DNA was isolated, and ccfDNA concentration and NLR were determined. We found that ccfDNA levels were correlated with age and tumor burden. Moreover, higher values of NLR (≥3.31) were linked with worse overall survival (OS) (4 vs. 10 months; log rank p = 0.011), and an elevated ccfDNA concentration (≥25.79 ng/mL) was strongly associated with shorter OS (4 vs. 8 months; log rank p = 0.009). According to the results of the multivariable Cox regression analysis, the baseline concentration of ccfDNA was an independent prognostic factor for OS (HR 0.45, 95% CI 0.21-0.97, p = 0.041). Furthermore, the combination of ccfDNA levels with NLR greatly enhanced the prognostic accuracy of PDAC patients. Our study demonstrates that ccfDNA concentration and NLR are independent predictors of survival in PDAC. Subsequent studies should validate this combination as a prognostic indicator in PDAC patients and assess its utility for guiding therapeutic decisions.
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Affiliation(s)
- Bianca Varzaru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Razvan Andrei Iacob
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Stefania Bunduc
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Ioana Manea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andrei Sorop
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Andreea Spiridon
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Raluca Chelaru
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Adina Croitoru
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Mihaela Topala
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Gabriel Becheanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Mona Dumbrava
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Simona Dima
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Irinel Popescu
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, 022328 Bucharest, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, 022238 Bucharest, Romania
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Bunduc S, Varzaru B, Iacob RA, Sorop A, Manea I, Spiridon A, Chelaru R, Croitoru AE, Becheanu G, Dumbrava M, Dima S, Popescu I, Gheorghe C. Endoscopic ultrasound-guided fine-needle aspiration pancreatic adenocarcinoma samples yield adequate DNA for next-generation sequencing: A cohort analysis. World J Gastroenterol 2023; 29:2864-2874. [PMID: 37274073 PMCID: PMC10237110 DOI: 10.3748/wjg.v29.i18.2864] [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] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/14/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Genetic tests are increasingly performed for the management of unresectable pancreatic cancer. For genotyping aimed samples current guidelines recommend using core specimens, although based on moderate quality evidence. However, in clinical practice among the endoscopic ultrasound (EUS) guided tissue acquisition methods, fine needle aspiration (FNA) is the most widely performed.
AIM To assess the adequacy for next generation sequencing (NGS) of the DNA yielded from EUS-FNA pancreatic adenocarcinoma (PDAC) samples.
METHODS Between November 2018 and December 2021, 105 patients with PDAC confirmed by EUS-FNA were included in the study at our tertiary gastroenterology center. Either 22 gauge (G) or 19G FNA needles were used. One pass was dedicated to DNA extraction. DNA concentration and purity (A260/280, A260/230) were assessed by spectrophotometry. We assessed the differences in DNA parameters according to needle size and tumor characteristics (size, location) and the adequacy of the extracted DNA for NGS (defined as A260/280 ≥ 1.7, and DNA yield: ≥ 10 ng for amplicon based NGS, ≥ 50 ng for whole exome sequencing [WES], ≥ 100 ng for whole genome sequencing [WGS]) by analysis of variance and t-test respectively. Moreover, we compared DNA purity parameters across the different DNA yield categories.
RESULTS Our cohort included 49% male patients, aged 67.02 ± 8.38 years. The 22G needle was used in 71% of the cases. The DNA parameters across our samples varied as follows: DNA yield: 1289 ng (inter quartile range: 534.75-3101), A260/280 = 1.85 (1.79-1.86), A260/230 = 2.2 (1.72-2.36). DNA yield was > 10 ng in all samples and > 100 ng in 93% of them (one sample < 50 ng). There were no significant differences in the concentration and A260/280 between samples by needle size. Needle size was the only independent predictor of A260/230 which was higher in the 22G samples (P = 0.038). NGS adequacy rate was 90% for 19G samples regardless of NGS type, and for 22G samples it reached 89% for WGS adequacy and 91% for WES and amplicon based NGS. Samples with DNA yield > 100 ng had significantly higher A260/280 (1.89 ± 0.32 vs 1.34 ± 0.42, P = 0.013). Tumor characteristics were not corelated with the DNA parameters.
CONCLUSION EUS-FNA PDAC samples yield DNA adequate for subsequent NGS. DNA amount was similar between 22G and 19G FNA needles. DNA purity parameters may vary indirectly with needle size.
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Affiliation(s)
- Stefania Bunduc
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Bianca Varzaru
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Razvan Andrei Iacob
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Andrei Sorop
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Ioana Manea
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Andreea Spiridon
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Raluca Chelaru
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Adina Emilia Croitoru
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Gabriel Becheanu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Mona Dumbrava
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Simona Dima
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Irinel Popescu
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
| | - Cristian Gheorghe
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest 020021, Romania
- Digestive Diseases and Liver Transplantation Center, Fundeni Clinical Institute, Bucharest 022328, Romania
- Center of Excellence in Translational Medicine, Fundeni Clinical Institute, Bucharest 022328, Romania
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Iacob S, Iacob R, Manea I, Uta M, Chiosa A, Dumbrava M, Becheanu G, Stoica L, Popa C, Brasoveanu V, Hrehoret D, Gheorghe C, Gheorghe L, Dima S, Popescu I. Host and immunosuppression-related factors influencing fibrosis occurrence post liver transplantation. Front Pharmacol 2022; 13:1042664. [PMID: 36330082 PMCID: PMC9622773 DOI: 10.3389/fphar.2022.1042664] [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: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Post liver transplantation (LT) fibrosis has a negative impact on graft function. Cytokine production in the host immune response after LT may contribute to the variable CYP3A-dependent immunosuppressive drug disposition, with subsequent impact on liver fibrogenesis, together with host-related factors. We aimed to investigate whether the cytochrome P4503A5*3 (CYP3A5*3) or TBX21 genotypes impact post-LT liver fibrogenesis. Furthermore, the impact of immunosuppressants on cellular apoptosis has been evaluated using human hepatocytes harvested from cirrhotic explanted livers. We have enrolled 98 LT recipients that were followed for occurrence of liver fibrosis for at least 12 months. There was a statistically significant higher trough level of TAC in patients with homozygous CC-TBX21 genotype (7.83 ± 2.84 ng/ml) vs. 5.66 ± 2.16 ng/ml in patients without this genotype (p = 0.009). The following variables were identified as risk factors for fibrosis ≥2: donor age (p = 0.02), neutrophil to lymphocyte ratio (p = 0.04) and TBX21 genotype CC (p = 0.009). In the cell culture model cytometry analysis has indicated the lowest apoptotic cells percentage in human cirrhotic hepatocytes cultures treated with mycophenolate mofetil (MMF) (5%) and TAC + MMF (2%) whereas the highest apoptosis percentage was registered for the TAC alone (11%). The gene expression results are concordant to cytometry study results, indicating the lowest apoptotic effect for MMF and MMF + TAC immunosuppressive regimens. The allele 1993C of the SNP rs4794067 may predispose to the development of late significant fibrosis of the liver graft. MMF-based regimens have a favourable anti-apoptotic profile in vitro, supporting its use in case of LT recipients at high risk for liver graft fibrosis.
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Affiliation(s)
- Speranta Iacob
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Razvan Iacob
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Ioana Manea
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
| | - Mihaela Uta
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Andrei Chiosa
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Luminita Stoica
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Codruta Popa
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Brasoveanu
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Doina Hrehoret
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Liana Gheorghe
- Gastroenterology Department, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
| | - Simona Dima
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
- *Correspondence: Simona Dima,
| | - Irinel Popescu
- Center for Excellence in Translational Medicine, Bucharest, Romania
- Fundeni Clinical Institute, Bucharest, Romania
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Saizu AI, Bancila I, Becheanu G, Dumbrava M, Gheorghe C. An Unusual Etiology of Obstructive Jaundice in a Newly Diagnosed Celiac Disease Patient. J Gastrointestin Liver Dis 2021; 30:15. [PMID: 33723549 DOI: 10.15403/jgld-3343] [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] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/14/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Adrian Ionut Saizu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Ion Bancila
- Carol Davila University of Medicine and Pharmacy, Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Gabriel Becheanu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Mona Dumbrava
- Carol Davila University of Medicine and Pharmacy, Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Cristian Gheorghe
- Carol Davila University of Medicine and Pharmacy, Gastroenterology Department, Fundeni Clinical Institute, Bucharest, Romania.
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Cotruta B, Gheorghe C, Iacob R, Dumbrava M, Radu C, Bancila I, Becheanu G. The Orientation of Gastric Biopsy Samples Improves the Inter-observer Agreement of the OLGA Staging System. J Gastrointestin Liver Dis 2018; 26:351-356. [PMID: 29253048 DOI: 10.15403/jgld.2014.1121.264.olg] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Evaluation of severity and extension of gastric atrophy and intestinal metaplasia is recommended to identify subjects with a high risk for gastric cancer. The inter-observer agreement for the assessment of gastric atrophy is reported to be low. The aim of the study was to evaluate the inter-observer agreement for the assessment of severity and extension of gastric atrophy using oriented and unoriented gastric biopsy samples. Furthermore, the quality of biopsy specimens in oriented and unoriented samples was analyzed. METHODS A total of 35 subjects with dyspeptic symptoms addressed for gastrointestinal endoscopy that agreed to enter the study were prospectively enrolled. The OLGA/OLGIM gastric biopsies protocol was used. From each subject two sets of biopsies were obtained (four from the antrum, two oriented and two unoriented, two from the gastric incisure, one oriented and one unoriented, four from the gastric body, two oriented and two unoriented). The orientation of the biopsy samples was completed using nitrocellulose filters (Endokit®, BioOptica, Milan, Italy). The samples were blindly examined by two experienced pathologists. Inter-observer agreement was evaluated using kappa statistic for inter-rater agreement. The quality of histopathology specimens taking into account the identification of lamina propria was analyzed in oriented vs. unoriented samples. The samples with detectable lamina propria mucosae were defined as good quality specimens. Categorical data was analyzed using chi-square test and a two-sided p value <0.05 was considered statistically significant. RESULTS A total of 350 biopsy samples were analyzed (175 oriented / 175 unoriented). The kappa index values for oriented/unoriented OLGA 0/I/II/III and IV stages have been 0.62/0.13, 0.70/0.20, 0.61/0.06, 0.62/0.46, and 0.77/0.50, respectively. For OLGIM 0/I/II/III stages the kappa index values for oriented/unoriented samples were 0.83/0.83, 0.88/0.89, 0.70/0.88 and 0.83/1, respectively. No case of OLGIM IV stage was found in the present case series. Good quality histopathology specimens were described in 95.43% of the oriented biopsy samples, and in 89.14% of the unoriented biopsy samples, respectively (p=0.0275). CONCLUSION The orientation of gastric biopsies specimens improves the inter-observer agreement for the assessment of gastric atrophy.
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Affiliation(s)
- Bogdan Cotruta
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania.
| | - Razvan Iacob
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristina Radu
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Ion Bancila
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Gastroenterology and Hepatology Center, Fundeni Clinical Institute, Bucharest, Romania
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Bancila I, Becheanu G, Dumbrava M, Costache R, Gheorghe C. Brunner's gland hyperplasia - a rare cause of gastrointestinal bleeding. J Gastrointestin Liver Dis 2018; 27:9. [PMID: 29557409 DOI: 10.15403/jgld.2014.1121.271.brn] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ion Bancila
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Gabriel Becheanu
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania.
| | - Mona Dumbrava
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Roxana Costache
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
| | - Cristian Gheorghe
- Fundeni Clinical Institute, Gastroenterology Department, Bucharest, Romania
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Gheorghe C, Cotruta B, Becheanu G, Dumbrava M, Verban S. Giardia duodenalis associated with intestinal metaplasia of the stomach. J Gastrointestin Liver Dis 2017; 26:221. [PMID: 28922429 DOI: 10.15403/jgld.2014.1121.263.gia] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Cristian Gheorghe
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Bogdan Cotruta
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Gabriel Becheanu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefania Verban
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
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Bancila I, Popescu I, Herlea V, Becheanu G, Dumbrava M, Gheorghe C. Ménétrier's disease: a rare entity which mimicks gastric cancer. J Gastrointestin Liver Dis 2017; 25:137. [PMID: 27308642 DOI: 10.15403/jgld.2014.1121.252.men] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ion Bancila
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania.
| | - Irinel Popescu
- Department of Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Vlad Herlea
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Department of Pathology, Fundeni Clinical Institute, Bucharest, Romania
| | - Cristian Gheorghe
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, Bucharest, Romania
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Preda CM, Sandra I, Becheanu G, Dumbrava M, Manuc M, Diculescu M. Endoscopic aspect of a severe CMV colitis induced by azathioprine in a patient with ulcerative colitis. J Gastrointestin Liver Dis 2016; 25:429. [PMID: 27981297 DOI: 10.15403/jgld.2014.1121.254.eda] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Carmen M Preda
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Irina Sandra
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriel Becheanu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mona Dumbrava
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea Manuc
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
| | - Mircea Diculescu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
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Preda CM, Meianu C, Sandra I, Becheanu G, Dumbrava M, Manuc M, Diculescu M. Fecal Microbiota Transplantation in Recurrent NAP1/B1/027 Clostridium Difficile Infection (CDI) Resistant to Vancomycin and Metronidazole in a Patient with Ulcerative Colitis (UC): A Case Report. Rev Med Chir Soc Med Nat Iasi 2016; 120:563-567. [PMID: 30044904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Most of the studies showed that IBD patients inflammatory bowel diseases (IBD) with CDI have more of the whole range of short- and long-term worst outcomes than those without CDI. Initial infection with the BI/NAP1/027 epidemic clone was found to be a significant risk factor for relapse. However, current literature is suggesting increasingly that for patients with infections that fail to resolve with traditional antibiotic regimens, FMAT's average cure rate of >90%. We report a case of a 40-year-old man, diagnosed with ulcerative colitis (UC) in 2012 who presented in our clinic for 20 watery stools per day with mucus and blood, hypogastric pain, pyrexia and chills. Rectosigmoidoscopy and histopathological examination diagnosed a ctive lesions of ulcerative colitis with Clostridium difficile toxins A/B enzyme immunoassays (EIA) testing initially negative. The patient was non-responder at day 10 of intravenous (iv) corticotherapy and received induction therapy with Infliximab 5 mg/kg. EIA testing for Clostridium difficile was repeated at day 12 of hospitalization with positive results for toxins A/B, and associated oral therapy with Vancomycin and Metronidazole was initiated without clinical response in day 7, reasons for what intravenously therapy with Tigecycline was started with good response. Patient was discharged after 10 days of Tigecycline, but came back twice for two relapses of Clostridium difficile colitis treated successfully with Tigecycline, reasons for what fecal transplantation was performed in Matei Bals Institute, which induced remission of both CDI and UC.
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Tugui L, Dumitru M, Iacob S, Gheorghe L, Preda C, Dinu I, Becheanu G, Dumbrava M, Nicolae I, Andrei A, Lupu A, Diculescu M. The efficacy of the Peginterferon treatment in chronic hepatitis HDV and compensate liver cirrhosis. Rev Med Chir Soc Med Nat Iasi 2014; 118:368-375. [PMID: 25076702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To evaluate the efficiency of the treatment with Peginterferon alfa 2a 180 mcg/week, 48 weeks in patients with chronic hepatitis or compensated liver cirrhosis HDV and predictive factors of response to treatment. MATERIAL AND METHODS Prospective study that enrolled 50 patients with chronic hepatitis or compensated cirrhosis HDV between the 1st of January 2011 - 3st of December 2011. The diagnosis of chronic HDV infection was made based on the presence of detectable anti HDV IgG antibodies and HDV-RNA. Patients were evaluated at baseline by CBC, liver function tests, HBV profile, HDV RNA, and by liver biopsy/Fibrotest for evaluating fibrosis and necroinflammatory activity. At 24 weeks CBC (count blood cells), liver function tests, quantitative HBsAg and at 48 and 72 weeks biochemical tests, HDV RNA, HBV DNA, quantitative HBsAg, were performed. Adverse reactions to the treatment were recorded. RESULTS SVR (sustained virologic response) was recorded in 12 patients (24%) and biochemical response in 28 patients (56%). SVR was correlated with low-grade fibrosis, age, the aminotransferase value and the value of HBsAg at the beginning of the treatment. In week 48 HDV RNA was undetectable in 20 patients (40%). The therapy was well tolerated, except two patients for whom the discontinuation of the treatment was decided for severe exacerbation of cytolysis, respectively hepatic decompensation. CONCLUSIONS In a representative group of patients, the treatment with Peginterferon once again proves its efficacy in treating chronic HDV.
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Stoicescu A, Becheanu G, Dumbrava M, Gheorghe C, Diculescu M. Microscopic colitis - a missed diagnosis in diarrhea-predominant irritable bowel syndrome. Maedica (Bucur) 2012; 7:3-9. [PMID: 23118812 PMCID: PMC3484793] [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] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Accepted: 02/27/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Clinical presentation in microscopic colitis (MC) is similar in many cases to that of diarrhea-predominent irritable bowel syndrome (IBS-D). The proper differential diagnosis requires total colonoscopy with multiple biopsies from normal-appearing mucosa and a detailed histopathological exam. Specific treatment may improve symptomatology. AIM To evaluate the prevalence of MC in patients with an initial diagnosis of IBS-D, to analyse demographic and clinical features of MC patients and to assess the efficacy of specific treatment. MATERIAL AND METHODS Our retrospective study analyzed patients diagnosed with microscopic colitis in clinic during a three-year period. Diagnosis was established on histological exams of the samples obtained during colonoscopy in patients previously thought to have IBS-D. We evaluated clinical manifestations, time lapsed from their onset to definitive diagnosis, the association of MC with autoimmune diseases or with prior medication and the efficacy of treatment with budesonide or mesalazine. RESULTS From 247 patients considered to have IBS-D, 15 patients (6.07%) had actually MC (13 lymphocytic colitis and 2 collagenous colitis). MC was associated with nonsteroidal antiinflammatory drugs (3 patients), Lansoprazole (2 patients) and autoimmune diseases (6 patients). Watery, non-bloody diarrhea was present in all patients with MC. Other frequent complaints were nocturnal diarrhea (11 patients), abdominal pain (8 patients), abdominal bloating and flatulence (8 patients) and slight weight loss (6 patients). The diagnostic samples were obtained from the right colon in 6 cases and from rectosigmoid or transverse colon in 9 patients. Treatment was initial symptomatic in all patients, but there were 5 patients that required mesalazine and/or Budesonide, with favourable outcome. CONCLUSIONS All the patients thought to have diarrhea-irritable bowel syndrome should be evaluated for microscopic colitis. Symptomatology is almost superimposable, but a few distinct features can be noticed. The proper and early diagnosis and the specific treatment may lead to significant clinical improvement in some difficult cases of the so-called "irritable bowel syndrome".
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Affiliation(s)
- Adriana Stoicescu
- Gastroenterology, Hepatology and Digestive Endoscopy Clinic, Emergency University Hospital Elias
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Becheanu G, Dumbrava M, Arbanas T, Diculescu M, Hoyeau-Idrissi N, Fléjou JF. Esophageal xanthoma--report of two new cases and review of the literature. J Gastrointestin Liver Dis 2011; 20:431-433. [PMID: 22187711] [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: 05/31/2023]
Abstract
BACKGROUND Esophageal xanthoma is a very rare lesion which can be incidentally discovered during endoscopy. Only eleven cases have been reported, including ours. CASE REPORTS We present two new cases of esophageal xanthoma localized in the lower esophagus in a 56-year-old woman and a 62-year-old man. Endoscopically, esophageal xanthoma appears as yellowish granular spots or a slightly elevated lesion. Microscopically, it consists of fat accumulation in foamy histiocytes beneath the squamous epithelium. CONCLUSIONS The clinical and pathological importance of these lesions and what they mean in patients is discussed, along with a review of the literature.
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Affiliation(s)
- Gabriel Becheanu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania.
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Gheorghe C, Cotruta B, Iacob R, Becheanu G, Dumbrava M, Gheorghe L. Endomicroscopy for assessing mucosal healing in patients with ulcerative colitis. J Gastrointestin Liver Dis 2011; 20:423-426. [PMID: 22187709] [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: 05/31/2023]
Abstract
The assessment of tissue healing has emerged as an important treatment goal in patients with inflammatory bowel disease. In patients with ulcerative colitis (UC), mucosal healing may represent the ultimate therapeutic goal due to the fact that the inflammation is limited to the mucosal layer. Mucosal and histological healing may indicate a subset of UC patients in long-term clinical, endoscopic and histological remission in whom immunomodulators, biologics, and even aminosalicylates may be withdrawn. Confocal laser endomicroscopy allows the assessment of residual cellular inflammation, crypt and vessel architecture distortion during ongoing endoscopy, and therefore permits a real-time evaluation of histological healing in patients with ulcerative proctitis. Images of conventional optical microscopy and confocal laser endomicroscopy in patients with ulcerative proctitis in remission are presented.
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Affiliation(s)
- Cristian Gheorghe
- Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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Becheanu G, Dumbrava M, Diculescu M. An atypical, strange area in an adenomatous polyp of the colon: an animal inclusion? INDIAN J PATHOL MICR 2011; 54:620-1. [PMID: 21934241 DOI: 10.4103/0377-4929.85119] [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] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Gabriel Becheanu
- Gastroenterology and Hepatology Clinic-Fundeni Clinical Institute, Bucharest, Romania.
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Gheorghe L, Iacob S, Iacob R, Dumbrava M, Becheanu G, Herlea V, Gheorghe C, Lupescu I, Popescu I. Real time elastography - a non-invasive diagnostic method of small hepatocellular carcinoma in cirrhosis. J Gastrointestin Liver Dis 2009; 18:439-446. [PMID: 20076816] [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: 05/28/2023]
Abstract
BACKGROUND Small nodules (under 3 cm) detected on ultrasound (US) in cirrhotics represent the most challenging category for noninvasive diagnosis of hepatocellular carcinoma (HCC). AIM To evaluate real-time sonoelastography as a noninvasive tool for the diagnosis of small HCC nodules in cirrhotic patients. METHODS 42 cirrhotic patients with 58 nodules (1-3 cm) were evaluated with real-time elastography (Hitachi EUB-6500); the mean intensity of colors red, blue, green were measured using a semi-quantitative method. Analysis of histograms for each color of the sonoelastography images was performed for quantifying the elasticity of nodule tissue in comparison with the cirrhotic liver tissue. AUROC curves were constructed to define the best cut-off points to distinguish malignant features of the nodules. Univariate and multivariate logistic regression analysis was performed. RESULTS 595 sonoelastography images from 42 patients (25 men; 17 women) were analyzed. The mean age was 56.4 +/- 0.7 years and 69% patients were in Child-Pugh class A, 19% class B, 11% class C. For the mean intensity of green color AUROC=0.81, a cut-off value under 108.7 being diagnostic for HCC with a Sp=91.1%, Se=50%, PPV=92.1%, NPV=47.1%. Mean intensity of blue color proved to be an excellent diagnostic tool for HCC (AUROC=0.94); for a cut-off value greater than 128.9, Sp=92.2%, Se=78.9%, PPV=95.4%, NPV=68%. Independent predictive factors of HCC for a small nodule in cirrhotic patients were: blue color over 128.9 at sonoelastography and hypervascular appearance at Doppler US. CONCLUSIONS US elastography is a promising method for the non-invasive diagnosis of early HCC. Blue color at elastography and hypervascular aspects are independent predictors of HCC.
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Affiliation(s)
- Liana Gheorghe
- Fundeni Clinical Institute of Digestive Diseases, Liver Transplantation, Bucharest, Romania.
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Gheorghe C, Iacob R, Dumbrava M, Becheanu G, Ionescu M. Confocal laser endomicroscopy and ultrasound endoscopy during the same endoscopic session for diagnosis and staging of gastric neoplastic lesions. Chirurgia (Bucur) 2009; 104:17-24. [PMID: 19388564] [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: 05/27/2023]
Abstract
INTRODUCTION Confocal LASER endomicroscopy (CLE) is a newly developed endoscopic technique which allows subsurface in vivo histological assessment during ongoing endoscopy and targeted biopsies. Ultrasound endoscopy (EUS) is a useful tool in staging upper GI malignant lesions. We describe for the first time the use of both techniques during the same endoscopic session, in a pilot study, in order to increase the diagnostic yield of histological assessment and provide the staging of the gastric neoplastic lesions thus decreasing the time to therapeutic decision. AIMS & METHODS CLE has been performed with the Pentax EG-3870CIK confocal endomicroscope after a 5 ml intravenous 10% fluorescein injection; EUS has been performed subsequently, during the same endoscopic Propofol sedation session, using a standard radial EUS-scope. RESULTS Eleven patients have been investigated, 4 females, 7 males, mean age 59.7 +/- 12.3 years. The indication of CLE/EUS exploration was the presence of a gastric polypoid lesion in 37% of cases, atypical gastric ulcer in 27% of patients, gastric lymphoma 18%, suspicion of gastric cancer recurrence after resection 9% and infiltrating type gastric cancer 9%. Histological assessment after targeted biopsy has established the diagnosis of gastric adenocarcinoma in 55% of cases, gastric lymphoma in 18% of cases, gastric adenoma, gastric GIST and gastric foveolar hyperplasia in 9% of cases respectively. CLE has allowed targeted biopsies in 81.8% of cases. In 2 patients - one case with suspected recurrent gastric cancer after surgery and one case of gastric lymphoma, CLE has indicated normal gastric mucosa. The EUS evaluation has shown TO lesion in two cases, T1 in 3 cases, T2 in 3 cases, T3 in one case. The EUS evaluation showed in one gastric lymphoma patient a lesion interesting the mucosa and submucosa with regional adenopathy and a submucosal lesion with regional adenopathy in the other gastric lymphoma case. The therapeutic decision was surgery in 73% of cases, chemotherapy and follow-up in 18% of cases and follow-up in 9% of cases. No complications were registered during the CLE/EUS explorations. CONCLUSION CLE and EUS can be successfully associated during the same endoscopic session, for upper GI neoplastic lesions allowing targeted biopsies for histological assessment and disease staging for optimal therapeutic decision.
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Affiliation(s)
- C Gheorghe
- University of Medicine and Pharmacy Carol Davila, Bucharest.
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