Publications by authors named "Gabriel Constantinescu"

42 Publications

Assessment of Sleep among Patients with Chronic Liver Disease: Association with Quality of Life.

J Pers Med 2021 Dec 20;11(12). Epub 2021 Dec 20.

Department 5, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.

The present study aims to assess the sleep characteristics and health-related quality of life (HRQOL) among patients with chronic liver diseases (CLDs), as well as the relationship between them. We conducted a prospective cross-sectional study, over a period of eight months, on patients with CLDs. Sleep was assessed by subjective tools (self-reported validated questionnaires), semi-objective methods (actigraphy), and HRQOL by using the 36-Item Short Form Survey (SF-36) and Chronic Liver Disease Questionnaire (CLDQ). The results indicated that 48.21% of patients with CLDs had a mean Pittsburgh Sleep Quality Index (PSQI) score higher than five, suggestive of poor sleep; 39.29% of patients had a mean Epworth Sleepiness Scale (ESS) score ≥11, indicative of daytime sleepiness. Actigraphy monitoring showed that patients with cirrhosis had significantly more delayed bedtime hours and get-up hours, more awakenings, and more reduced sleep efficacy when compared to pre-cirrhotics. The CLDQ and SF-36 questionnaire scores were significantly lower in cirrhotics compared to pre-cirrhotics within each domain. Moreover, we identified significant correlations between the variables from each questionnaire, referring to HRQOL and sleep parameters. In conclusion, sleep disturbances are commonly encountered among patients with CLDs and are associated with impaired HRQOL. This is the first study in Romania that assesses sleep by actigraphy in a cohort of patients with different stages of CLD.
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http://dx.doi.org/10.3390/jpm11121387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8707501PMC
December 2021

Gastrointestinal Stromal Tumors-A Mini Review.

J Pers Med 2021 Jul 22;11(8). Epub 2021 Jul 22.

Clinical Emergency Hospital of Bucharest, Department of Internal Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. They are potentially malignant, and have an unpredictable evolution. The origin of these tumors is in the interstitial cells of Cajal, which are cells that are interposed between the intramural neurons and the smooth muscle cells of the digestive tract. GISTs are characterized by mutations in the gene c-Kit, but also other mutations, such as those of the platelet-derived growth factor receptor alpha. The most common locations of these tumors are the stomach and small intestine, although they can occur at any level of the digestive tract and occasionally in the omentum, mesentery and peritoneum. Most cases of GISTs are sporadic, and about 5% of cases are part of family genetic syndromes. The correct diagnosis of GIST is determined by histopathological examination and immunohistochemistry. According to histopathology, there are three main types of GISTs: spindle cell type, epithelioid type and mixed type. The therapeutic management of GIST includes surgery, endoscopic treatment and chemotherapy. The prognosis of patients with GIST varies depending on a number of factors, such as risk category, GIST stage, treatment applied and recurrence after treatment.
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http://dx.doi.org/10.3390/jpm11080694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8400825PMC
July 2021

Dysregulation of miRNAs Targeting the IGF-1R Pathway in Pancreatic Ductal Adenocarcinoma.

Cells 2021 07 22;10(8). Epub 2021 Jul 22.

Victor Babes National Institute of Pathology, 050096 Bucharest, Romania.

Background: Pancreatic ductal adenocarcinoma (PDAC), the most prevalent neoplastic lethal pancreatic disease, has a poor prognosis and an increasing incidence. The insulin-like growth factor-1 receptor (IGF-1R) signaling pathway is considered to be a contributing factor to the progression, metastasis, and therapy resistance of PDAC. Currently available treatment options for PDAC are limited, but microRNAs (miRNAs) may represent a new therapeutic strategy for targeting genes involved in the IGF-1R signaling pathway.

Method: We investigated the expression levels of 21 miRNAs involved in the IGF-1R signaling pathway in pancreatic tissue from 38 patients with PDAC and 11 controls (five patients with chronic pancreatitis and six patients with normal pancreatic tissue).

Results: We found 19 differentially expressed miRNAs between the PDAC cases and the controls. In particular, miR-100-5p, miR-145-5p, miR-29c-3p, miR-9-5p, and miR-195-5p were exclusively downregulated in PDAC tissue but not in chronic pancreatitis or normal pancreatic tissues; both control types presented similar levels. We also identified miR-29a-3p, miR-29b-3p, and miR-7-5p as downregulated miRNAs in PDAC tissues as compared with normal tissues but not with pancreatitis tissues.

Conclusions: We identified a panel of miRNAs that could represent putative therapeutic targets for the development of new miRNA-based therapies for PDAC.
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http://dx.doi.org/10.3390/cells10081856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8391367PMC
July 2021

Biliary Stenting for Malignant Biliary Obstruction Secondary to Pancreatic Cancer.

Curr Health Sci J 2020 Oct-Dec;46(4):323-328. Epub 2020 Dec 31.

Department of Gastroenterology, Bucharest Emergency Clinic Hospital, Bucharest, Romania.

Despite progresses made in oncology, pancreatic adenocarcinoma has a grim prognosis and commonly presents with rapidly advancing jaundice which requires endoscopic treatment.

Aim: Our objective was to show the perspective of a high ERCP volume dedicated Center on endoscopic stenting for malignant biliary obstruction consecutive to pancreatic cancer.

Methods: We conducted a retrospective study, between October 2017 and October 2020, and enrolled hospitalized patients within the Gastroenterology Department of the Clinical Emergency Hospital Bucharest, diagnosed with pancreatic cancer with secondary malignant biliary obstruction which underwent ERCP stenting.

Results: We identified 269 patients which were admitted in our Clinic with a pancreatic lesion on computed tomography or magnetic resonance imaging and underwent EUS-FNA. 115 patients with proven pancreatic malignancy were selected and underwent ERCP stenting. 69 received plastic stents and 46 metal biliary stents, with the stent chosen based on patient's characteristics and availability at the time of the procedure. Per total 234 stents were used for relief of the cholestasis syndrome. The number of ERCP procedures was higher in the plastic stents group with a median of 1,8 whereas the SEMS had 1,5 range of procedures. Procedures were successful in 54 patients following plastic stents and 33 that underwent SEMS. At 30 days, overall mortality rate was of 5%.

Conclusions: Malignant obstruction secondary to pancreatic cancer is amenable by ERCP. However, choosing the right stents still varies. SEMS seem to be more efficient on a long term with fewer complications rates and further studies should be performed.
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http://dx.doi.org/10.12865/CHSJ.46.04.01DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948020PMC
December 2020

A plea for a unified approach to sedation in gastrointestinal endoscopy in Romania: results from a prospective multicentric trial.

Rom J Intern Med 2021 Sep 26;59(3):303-311. Epub 2021 Aug 26.

Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, Timișoara, Romania.

Adequate sedation is a prerequisite for quality endoscopic examination of the digestive tract. We aimed to evaluate the current practices and safety profile of sedation for gastrointestinal endoscopy in Romania and its impact on the technical success of the procedure and procedure-related adverse events. We conducted a prospective, multicentric, observational study including all patients undergoing digestive endoscopic procedures under various degrees of sedation. We collected data regarding the endoscopic procedure, type and degree of sedation, drug regimens, personnel in charge of sedation, and relevant patient related information. The main study outcome was the rate of sedation-related adverse events; secondary study outcomes included procedure-related adverse events and the impact of sedation on procedure success. 1,043 consecutive endoscopic procedures from eight Romanian endoscopy units were included in our study. Sedation regimens were highly variable between participating centers, with 566 (54%) of procedures being performed under sedation provided by an anaesthesiologist. Sedation-related adverse events occurred in 40 cases (3.8%), most of them were mild respiratory and cardiovascular events and all reversed spontaneously. On multivariate analysis, male gender, procedure type (endoscopic ultrasound and endoscopic retrograde cholangiopancreatography) and deep sedation were risk factors for complications. The endoscopy unit, ASA status, age and type of sedative did not influence the complication rate. In conclusion, sedation for endoscopic procedures is generally safe, despite a high variability in sedation practices between centers in Romania. Establishing a national guideline on sedation for gastrointestinal endoscopy will ensure consistent and safe practice for these procedures.
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http://dx.doi.org/10.2478/rjim-2021-0011DOI Listing
September 2021

Prospects for Electrical Performance Tuning in CaCoO Materials by Metallic Fe and Ni Particles Additions.

Materials (Basel) 2021 Feb 19;14(4). Epub 2021 Feb 19.

Department of Materials and Ceramics Engineering, CICECO-Aveiro Institute of Materials, University of Aveiro, 3810-193 Aveiro, Portugal.

This work further explores the possibilities for designing the high-temperature electrical performance of the thermoelectric CaCoO phase, by a composite approach involving separate metallic iron and nickel particles additions, and by employing two different sintering schemes, capable to promote the controlled interactions between the components, encouraged by our recent promising results obtained for similar cobalt additions. Iron and nickel were chosen because of their similarities with cobalt. The maximum power factor value of around 200 μWmK at 925 K was achieved for the composite with the nominal nickel content of 3% vol., processed via the two-step sintering cycle, which provides the highest densification from this work. The effectiveness of the proposed approach was shown to be strongly dependent on the processing conditions and added amounts of metallic particles. Although the conventional one-step approach results in Fe- and Ni-containing composites with the major content of the thermoelectric CaCoO phase, their electrical performance was found to be significantly lower than for the Co-containing analogue, due to the presence of less-conducting phases and excessive porosity. In contrast, the relatively high performance of the composite with a nominal nickel content of 3% vol. processed via a two-step approach is related to the specific microstructural features from this sample, including minimal porosity and the presence of the CaCoO phase, which partially compensate the complete decomposition of the CaCoO matrix. The obtained results demonstrate different pathways to tailor the phase composition of CaCoO-based materials, with a corresponding impact on the thermoelectric performance, and highlight the necessity of more controllable approaches for the phase composition tuning, including lower amounts and different morphologies of the dispersed metallic phases.
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http://dx.doi.org/10.3390/ma14040980DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922274PMC
February 2021

What is the Impact of the Proportion of Solid Necrotic Content on the Number of Necrosectomies during EUS-Guided Drainage using Lumen-Apposing Metallic Stents of Pancreatic Walled-off Necrosis ?

J Gastrointestin Liver Dis 2020 Dec 12;29(4):623-628. Epub 2020 Dec 12.

Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca; First Surgical Clinic, Cluj-Napoca, Romania.

Background And Aims: The fully-covered, lumen apposing metal stents are designed for one step placement, facilitating the direct endoscopic necrosectomy into the walled-off pancreatic necrosis. However, the prediction of the number of necrosectomy sessions in these patients is not known. This study evaluated the association between the proportion of solid necrotic material inside walled-off necrosis, as assessed during the endosonography placement of a lumen apposing metal stent, and the number of necrosectomies subsequently required.

Methods: Patients from three tertiary medical centers with symptomatic walled off pancreatic necrosis (pain, infection, gastric/biliary obstruction) at more than 4 weeks after onset of acute pancreatitis were retrospectively analysed. Proportion of solid necrotic debris was estimated during endosonography procedure of lumen apposing metal stents placement. Necrosectomy was performed when obstruction or inflammation occurred subsequently. Lumen apposing metal stents were removed after clearance of necrotic content.

Results: In 46 patients with successful lumen apposing metal stents placement, necrosectomy was performed in 39 patients (72.78%). Performance of 3 or more necrosectomies was significantly associated with more than 50% pancreatic necrosis (p=0.032), but not with walled-off pancreatic necrosis size or location. Necrotic infection during lumen apposing metal stents stenting was associated with hypoalbuminemia, but not with necrosectomy requirement. Clinical success after a median follow-up of 13.37 months was 87%.

Conclusions: Walled-off pancreatic necrosis with more than 50% solid necrotic content were associated with more necrosectomy procedures, requiering longer endoscopy time, intravenous sedations, and higher costs.
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http://dx.doi.org/10.15403/jgld-3128DOI Listing
December 2020

Acid suppression therapy, gastrointestinal bleeding and infection in acute pancreatitis - An international cohort study.

Pancreatology 2020 Oct 22;20(7):1323-1331. Epub 2020 Aug 22.

Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.

Background: Acid suppressing drugs (ASD) are generally used in acute pancreatitis (AP); however, large cohorts are not available to understand their efficiency and safety. Therefore, our aims were to evaluate the association between the administration of ASDs, the outcome of AP, the frequency of gastrointestinal (GI) bleeding and GI infection in patients with AP.

Methods: We initiated an international survey and performed retrospective data analysis on AP patients hospitalized between January 2013 and December 2018.

Results: Data of 17,422 adult patients with AP were collected from 59 centers of 23 countries. We found that 23.3% of patients received ASDs before and 86.6% during the course of AP. ASDs were prescribed to 57.6% of patients at discharge. ASD administration was associated with more severe AP and higher mortality. GI bleeding was reported in 4.7% of patients, and it was associated with pancreatitis severity, mortality and ASD therapy. Stool culture test was performed in 6.3% of the patients with 28.4% positive results. Clostridium difficile was the cause of GI infection in 60.5% of cases. Among the patients with GI infections, 28.9% received ASDs, whereas 24.1% were without any acid suppression treatment. GI infection was associated with more severe pancreatitis and higher mortality.

Conclusions: Although ASD therapy is widely used, it is unlikely to have beneficial effects either on the outcome of AP or on the prevention of GI bleeding during AP. Therefore, ASD therapy should be substantially decreased in the therapeutic management of AP.
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http://dx.doi.org/10.1016/j.pan.2020.08.009DOI Listing
October 2020

Delayed Management of Zollinger-Ellison Syndrome in a Noncompliant Patient.

Cureus 2020 Jun 6;12(6):e8471. Epub 2020 Jun 6.

Department of Gastroenterology and Hepatology, Carol Davila University of Medicine and Pharmacy, Floreasca Emergency Hospital, Bucharest, ROU.

We present a case of a 60-year-old male diagnosed with Zollinger-Ellison syndrome (ZES) after a protracted multicentric workup for chronic diarrhea and unexplained weight loss. ZES is intrinsically difficult to diagnose due to nonspecific symptoms, which are mimicked by other more frequent pathologies, such as peptic ulcer disease secondary to Helicobacter pylori or nonsteroidal anti-inflammatory drugs. The diagnostic challenge can be further complicated by patient noncompliance, resulting in delayed management and unnecessary health care. In our case report, the patient did not adhere to the care plan preceding endoscopy and failed to maintain communication with the treating doctor. As a result, crucial information was missing, and establishing the diagnosis of ZES took six months. Delay in appropriate management also contributed to poor disease course, heavy necrotic ulceration of the duodenum and proximal jejunum that was discovered on repeat endoscopy.
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http://dx.doi.org/10.7759/cureus.8471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336717PMC
June 2020

Anatomy of Major Duodenal Papilla Influences ERCP Outcomes and Complication Rates: A Single Center Prospective Study.

J Clin Med 2020 May 28;9(6). Epub 2020 May 28.

Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been one of the most intensely studied endoscopic procedures due to its overall high complication rates when compared to other digestive endoscopy procedures. The safety and outcome of such procedures have been linked to multiple procedure- or patient-related risk factors. The aim of our study is to evaluate whether the morphology of the major duodenal papilla influences the ERCP outcomes and complication rates.

Methods: A total of 322 patients with a native papilla have been included in the study over an eight month period. Morphology of the papilla has been classified into normal papilla and four anatomical variations (Type I-IV). All patients have been prospectively monitored over a 15 day period after ERCP. Procedural outcomes and complication rates have been registered.

Results: Morphology of the papilla influences both overall complication rates (95%CI, = 0.0066) and post-ERCP pancreatitis rates (95%CI, = 0.01001) in univariate analysis. Type IV papillae have proven to be independent risk factors for post-ERCP pancreatitis in multivariate analysis (OR = 12.176, 95%CI, = 0.005). Type I papillae have been significantly linked to difficult cannulation (AUC = 0.591, 95%CI, = 0.008); Conclusions: In the monitored cohort morphology of the major duodenal papilla has significantly influenced both ERCP outcomes and post-procedural complication rates.
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http://dx.doi.org/10.3390/jcm9061637DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356786PMC
May 2020

The ONETEP linear-scaling density functional theory program.

J Chem Phys 2020 May;152(17):174111

Chemistry and Chemical Biology, University of California Merced, Merced, California 95343, USA.

We present an overview of the onetep program for linear-scaling density functional theory (DFT) calculations with large basis set (plane-wave) accuracy on parallel computers. The DFT energy is computed from the density matrix, which is constructed from spatially localized orbitals we call Non-orthogonal Generalized Wannier Functions (NGWFs), expressed in terms of periodic sinc (psinc) functions. During the calculation, both the density matrix and the NGWFs are optimized with localization constraints. By taking advantage of localization, onetep is able to perform calculations including thousands of atoms with computational effort, which scales linearly with the number or atoms. The code has a large and diverse range of capabilities, explored in this paper, including different boundary conditions, various exchange-correlation functionals (with and without exact exchange), finite electronic temperature methods for metallic systems, methods for strongly correlated systems, molecular dynamics, vibrational calculations, time-dependent DFT, electronic transport, core loss spectroscopy, implicit solvation, quantum mechanical (QM)/molecular mechanical and QM-in-QM embedding, density of states calculations, distributed multipole analysis, and methods for partitioning charges and interactions between fragments. Calculations with onetep provide unique insights into large and complex systems that require an accurate atomic-level description, ranging from biomolecular to chemical, to materials, and to physical problems, as we show with a small selection of illustrative examples. onetep has always aimed to be at the cutting edge of method and software developments, and it serves as a platform for developing new methods of electronic structure simulation. We therefore conclude by describing some of the challenges and directions for its future developments and applications.
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http://dx.doi.org/10.1063/5.0004445DOI Listing
May 2020

Redox-Promoted Tailoring of the High-Temperature Electrical Performance in CaCoO Thermoelectric Materials by Metallic Cobalt Addition.

Materials (Basel) 2020 Feb 27;13(5). Epub 2020 Feb 27.

CICECO-Aveiro Institute of Materials, Department of Materials and Ceramic Engineering, University of Aveiro, 3810-193 Aveiro, Portugal.

This paper reports a novel composite-based processing route for improving the electrical performance of CaCoO thermoelectric (TE) ceramics. The approach involves the addition of metallic Co, acting as a pore filler on oxidation, and considers two simple sintering schemes. The (1-x)CaCoO/xCo composites (x = 0%, 3%, 6% and 9% vol.) have been prepared through a modified Pechini method, followed by one- and two-stage sintering, to produce low-density (one-stage, 1ST) and high-density (two-stage, 2ST) ceramic samples. Their high-temperature TE properties, namely the electrical conductivity (σ), Seebeck coefficient (α) and power factor (PF), were investigated between 475 and 975 K, in air flow, and related to their respective phase composition, morphology and microstructure. For the 1ST case, the porous samples (56%-61% of ρ) reached maximum PF values of around 210 and 140 μWm·K for the 3% and 6% vol. Co-added samples, respectively, being around two and 1.3 times higher than those of the pure CaCoO matrix. Although 2ST sintering resulted in rather dense samples (80% of ρ), the efficiency of the proposed approach, in this case, was limited by the complex phase composition of the corresponding ceramics, impeding the electronic transport and resulting in an electrical performance below that measured for the CaCoO matrix (224 μWm·K at 975K).
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http://dx.doi.org/10.3390/ma13051060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7084518PMC
February 2020

Geographic Distribution, Phenotype and Epidemiological Tendency in Inflammatory Bowel Disease Patients in Romania.

Medicina (Kaunas) 2019 Oct 20;55(10). Epub 2019 Oct 20.

Department of Gastroenterology and Hepatology, "Carol Davila" University of Medicine and Pharmacy, Fundeni Clinical Institute, 020021 Bucharest, Romania.

The incidence of inflammatory bowel disease (IBD) over the past years in Romania has been on the rise, but epidemiologic data are lacking. The aim of this study was to define the characteristics of IBD, the trends and phenotype among IBD patients in Romania. We conducted a prospective study over a period of 12 years, from 2006 to 2017. All patients diagnosed with IBD on clinical, radiological, endoscopic and histological features were included. We divided the country into eight regions: west (W), north-east (NE), north-west (NW), south-east (SE), south-west (SW), south (S), central (C) and Bucharest-Ilfov (B), and data were analyzed accordingly. A total of 2724 patients were included in this database, but only 2248 were included in the final analysis, with all data available. Of the 2248 patients, 935 were Crohn's disease (CD), 1263 were ulcerative colitis (UC) and 50 were IBD-undetermined. In UC phenotypes we observed more frequent left-sided colitis (50.5%, < 0.0001), and in CD phenotype we observed more frequent colonic and ileo-colonic localization (37.8% and 37.6%, < 0.0001). The region with the most IBD cases was NE (25.1%) and with the least IBD cases was SW (4.9%). UC was found more frequently in NE (32%), while CD was found more frequently in Bucharest (28.6%). In Romania, ulcerative colitis is more frequent than CD. UC is predominant in the northern part of Romania, while CD has become predominant in the southern part of the country. IBD occurs more in the male population, and in urban and industrialized areas. There are differences between the regions in Romania regarding IBD phenotypes, gender distributions, age distribution, treatment, smoking status and complications.
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http://dx.doi.org/10.3390/medicina55100704DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6843626PMC
October 2019

Visualizing electrostatic gating effects in two-dimensional heterostructures.

Nature 2019 08 17;572(7768):220-223. Epub 2019 Jul 17.

Department of Physics, University of Warwick, Coventry, UK.

The ability to directly monitor the states of electrons in modern field-effect devices-for example, imaging local changes in the electrical potential, Fermi level and band structure as a gate voltage is applied-could transform our understanding of the physics and function of a device. Here we show that micrometre-scale, angle-resolved photoemission spectroscopy (microARPES) applied to two-dimensional van der Waals heterostructures affords this ability. In two-terminal graphene devices, we observe a shift of the Fermi level across the Dirac point, with no detectable change in the dispersion, as a gate voltage is applied. In two-dimensional semiconductor devices, we see the conduction-band edge appear as electrons accumulate, thereby firmly establishing the energy and momentum of the edge. In the case of monolayer tungsten diselenide, we observe that the bandgap is renormalized downwards by several hundreds of millielectronvolts-approaching the exciton energy-as the electrostatic doping increases. Both optical spectroscopy and microARPES can be carried out on a single device, allowing definitive studies of the relationship between gate-controlled electronic and optical properties. The technique provides a powerful way to study not only fundamental semiconductor physics, but also intriguing phenomena such as topological transitions and many-body spectral reconstructions under electrical control.
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http://dx.doi.org/10.1038/s41586-019-1402-1DOI Listing
August 2019

Interrelations between elevated alpha-fetoprotein levels and tumor morphology of patients with hepatocellular carcinoma.

Rom J Morphol Embryol 2019 ;60(1):181-187

Trust Foundation Year 2, North West Anglia NHS Foundation Trust, Peterborough City Hospital, United Kingdom;

Background: Hepatocellular carcinoma (HCC) is one of the leading causes of cancer related deaths worldwide, while at the same time having a constant growth in incidence. A commonly used biomarker in managing liver cancer cases, alpha-fetoprotein (AFP) is losing clinical ground in favor of imaging studies and emerging biomarkers. The study aims to reassess potential prognosis indicators and risk factors for an elevated level of this glycoprotein by analyzing its relationship with macroscopic morphology tumor-related features.

Patients, Materials And Methods: One hundred and thirty-one newly diagnosed HCC patients had their clinical, tumor and liver disease features investigated in contrast to elevated AFP levels with 200 IU∕mL being used as preferred cut-off.

Results: Tumor size =5 cm [odds ratio (OR) 3.36, 95% confidence interval (CI): 1.29-8.74, p=0.013] is an independent tumor-related predictor of markedly elevated AFP values. Noteworthy connections with the type of tumor, multinodular appearance and portal vein thrombosis were also found through univariate analysis.

Conclusions: AFP could still be a reliable tool in diagnosis and prognosis of HCC patients especially in developing countries due to its relevant association with aspects of advanced tumor and liver disease, gender and a poor functional status.
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January 2020

Duodenoscope-Associated Infections beyond the Elevator Channel: Alternative Causes for Difficult Reprocessing.

Molecules 2019 Jun 25;24(12). Epub 2019 Jun 25.

Department of Gastroenterology, Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iași, Romania.

Objectives: Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP) procedures, but recently, numerous outbreaks of multidrug-resistant organisms (MDRO) infections have been reported which has led to extensive research for their possible causes. Consequently, the aim of this study is to search for possible duodenoscope surface damages that could provide an alternative and plausible source of infections.

Materials And Methods: In order to assess both outer and inner surfaces, a duodenoscope was dismantled and samples were taken from the outer resin polymer and from the air/water, elevator, and working (biopsy) channels that were characterized by FTIR, DSC, TGA, AFM, SEM techniques and the antimicrobial activity were tested.

Results: Alterations were noticed on both the coating and working channel polymers, with external alterations increasing progressively from the proximal sample to the distal sample near the tip of the scope. However, the results showed that the coating surface was still efficient against bacterial adhesion. Changes in surface texture and also morphological changes were shown.

Conclusions: The study describes the impact of routine procedural use and reprocessing cycles on the duodenoscope, showing that these may possibly make it susceptible to bacterial contamination and MDRO biofilm formation due to difficult reprocessing of the altered surfaces.
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http://dx.doi.org/10.3390/molecules24122343DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6631070PMC
June 2019

Malnutrition Prevalence in Newly Diagnosed Patients with Inflammatory Bowel Disease - Data from the National Romanian Database.

J Gastrointestin Liver Dis 2019 Jun 1;28:163-168. Epub 2019 Jun 1.

Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Department of Gastroenterology and Hepatology, Bucharest, Romania.

Background And Aims: Prevalence of malnutrition in inflammatory bowel diseases (IBD) varies between 16% and 75%. Data on the nutritional status at initial diagnosis of ulcerative colitis (UC) or Crohn's Disease (CD) are scarce. It is believed that more than 50% of IBD patients suffer significant weight loss prior to diagnosis. The aims of our study were to assess malnutrition in patients recently diagnosed with IBD and to determine its predictive factors.

Methods: We retrospectively included 625 IBD patients registered in the Romanian "IBD Prospect" database between January 2006 and July 2017. All patients were diagnosed within 6 months prior to registration. We defined malnutrition as weight loss of more than 5% of the initial weight during the 3 months prior to registration.

Results: There were 361 new cases of UC, 241 CD and 23 cases of unclassified IBD. There was a slight male predominance (M/F=1.2). Prevalence of overall malnutrition was 36.3%. It was significantly more frequent in CD than in UC patients (41.1% vs. 32.4%, p=0.031). In multivariate analysis, malnutrition in UC patients was associated with male gender (p=0.001), more severe disease (p<0.0001) and more extensive disease (p=0.027), while in CD it was associated with younger age (p=0.013) and more severe disease (p<0.0001).

Conclusions: About 1 in 3 newly diagnosed IBD patients presents with malnutrition at the time of diagnosis.
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http://dx.doi.org/10.15403/jgld-176DOI Listing
June 2019

EUS-Guided Transgastric Drainage of Intraabdominal Fluid Collections.

Chirurgia (Bucur) 2018 Nov-Dec;113(6):799-808

Intraabdominal fluid collections can be a significant cause of morbi-mortality among patients with acute pancreatitis and those who underwent surgery, especially oncological ones. Nowadays, the treatment tends to be minimally invasive, so that the patient's recovery would be shorter and the quality of life higher. EUS (endoscopic ultrasound) has emerged in the last decade to fulfill that demand, alongside percutaneous and surgical drainage in the management of perigastric collections. Objectives: The main objective of this paper is to evaluate the efficacy of EUS guided drainage in terms of techincal and clinical success. Secondary objectives refer to the assessment of complete resolution of intraabdominal collection, presence of infection after drainage, overall survival. We conducted a prospective study by enrolling 31 patients who were diagnosed using EUS with perigastric intraabdominal fluid collections, from an overall of 788 EUS performed over a period of 2 years. We analyzed their evolution during 6 months after treatment, by regular examinations (ultrasound/endoscopic/computed tomography). All of them were in-patients of Bucharest Clinical Emergency Hospital, either in Endoscopy or in Surgery Departments. Data collected was processed in IBM SPSS Statistics 20. Overall mean age was 51 year and intraabdominal collections average was 109 mm (range 34 250 mm) and was correlated with the method of treatment (p 0.005). Patients underwent different methods for their intraabdominal collections: EUS drainage, CT (computed-tomography)- guided percutaneous drainage, surgical intervention, alone or combined when needed. Overall mortality was 9,3% and was mainly related to the severity of the case and sepsis. We conclude that endoscopic ultrasound can be the first choice for drainage of intraabdominal perigastric fluid collections because it is a safe and effective technique with 100 % technical success, and with over 80 % clinical success assures a better quality of life. For collections with a diameter larger than 127 mm, we can expect however the need of combined treatment, EUS and surgery.
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http://dx.doi.org/10.21614/chirurgia.113.6.799DOI Listing
July 2019

Endoscopic ultrasound-guided choledochoduodenostomy using a lumen apposing metal stent for acute cholangitis.

Turk J Gastroenterol 2018 07;29(4):511-514

Department of Gastroenterology, Clinical Emergency Hospital, Bucharest, Romania.

We present the case of a 51-year-old woman with a history of uterine cancer who presented to the emergency room with a clinical picture of acute cholangitis. An abdominal ultrasound and a computed tomography scan were performed, revealing a gigantic lymphadenopathy mass compressing the common bile duct and the duodenum. After failure to perform an endoscopic retrograde cholangiopancreatography (ERCP) due to a modified anatomy, we performed an endoscopic ultrasound-guided choledochoduodenostomy (EUS-CDS) and placed a Hot AXIOS 10Fr/10 mm stent with efficient biliary drainage. In addition, we inserted a duodenal uncoated 120/22 mm expandable metallic stent. EUS-CDS presents a valid alternative in patients with failed ERCP and should be considered as an important option for rapid biliary decompression in patients with acute cholangitis.
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http://dx.doi.org/10.5152/tjg.2018.18095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6284640PMC
July 2018

Ectopic pancreas mimicking gastrointestinal stromal tumor in the stomach fundus.

Endoscopy 2018 07 9;50(7):E186-E187. Epub 2018 May 9.

Department of Gastroenterology, Fundeni Clinical Institute, Bucharest, Romania.

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http://dx.doi.org/10.1055/a-0605-2996DOI Listing
July 2018

Endoscopic Treatment of Benign Esophageal Fistulas Using Fully-covered Metallic Esophageal Stents.

Chirurgia (Bucur) 2018 Jan-Feb;113(1):108-115

Non-malignant esophageal fistulas have a wide spectrum of clinical and pathological features and it`s important to learn to detect and treat them, due to significant morbidity, mortality and costs. The need for minimally invasive, efficient and also quick procedures is imperative. Esophageal stenting using fully-covered expandable stents has become an increasingly preferred option and addresses to fistulas which arise from 2-3 cm beyond Killian's mouth and up to the gastroesophageal junction. The long-term purpose of the procedure is closure of the fistula and thus healing. A second goal would be avoiding the complications generated by long-term wearing of the stent, such as gastrointestinal perforation and stenosis.

Objectives: This review focuses on the efficacy of fully-covered metallic stents in treating benign esophageal fistulas. To this effect, we performed a retrospective study on 21 patients admitted in our clinic between January 2014 and April 2017 for non-malignant esophageal fistulas. The selection criteria were the following: post-operative fistulas (gastric sleeve, fundoplication for transhiatal gastric hernia, even malignancies for which surgical tumor removal was performed), foreign body acquired fistulas, post-traumatic fistulas. Esophago-jejunal anastomotic fistulas were also included in the study (following complete gastrectomy). The efficacy of esophageal stenting was proven in 76% of the cases, resulting in fistula closure. The rest of the patients either didn't achieve fistula closure or couldn't tolerate the stent, calling for early removal of the prosthesis. Reintervention procedures such as stent repositioning or stent replacement (with higher diameter) were carried out in 42% of the cases. A percentage of 19% of the patients who achieved fistula closure developed esophageal stricture on stent-induced ulcers and needed recalibration stenting or esophageal Savary dilation. 22% of the cases needed surgical drainage for infected collections developed simultaneously. We recorded 2 deaths, unrelated to the stenting procedure. Patients who didn't acquire fistula closure were referred to thoracic surgery in good physical condition. Fully-covered metallic esophageal stents can be successfully used to treat benign esophageal fistulas. Follow-up of the patient in order to see if stent repositioning or replacement is needed is crucial. Special design esophageal stents are highly recommended and must not lack. Close cooperation with thoracic surgery is indispensable.
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http://dx.doi.org/10.21614/chirurgia.113.1.108DOI Listing
June 2018

Auspicious Management of a Acute Obstructive Left Colon Tumor in a 93-year-old Patient - Case Report and Literature Review.

Chirurgia (Bucur) 2017 Nov-Dec;112(6):734-746

We present the case of a 93-year-old patient with intestinal occlusion due to a descending colon tumor, with carcinomatous ascites and secondary liver and lung determinations. Considering the risks associated with a surgical act in such a patient and the impossibility of performing a curative intervention, a self-expanding metallic colonic stent was mounted. The post-intervention evolution was favorable, the patient being discharged 48 hours later. Left colon cancer is diagnosed in the occlusive phase in 8 to 26% of cases (1). It often requires an immediate surgical resolution due to the potential risk of death. Emergency surgery involves increased rates of morbidity and mortality (2). Thus, other ways of resolving these surgical emergencies have been developed. Colonic stents were first reported in the literature by Dohmoto (3). Initially, the use of stents was as the final method of palletising (4). Later, they were used as a bridge to minimally invasive programmed surgery (5).
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http://dx.doi.org/10.21614/chirurgia.112.6.734DOI Listing
April 2018

The CADMUS trial - Multi-parametric ultrasound targeted biopsies compared to multi-parametric MRI targeted biopsies in the diagnosis of clinically significant prostate cancer.

Contemp Clin Trials 2018 03 3;66:86-92. Epub 2017 Nov 3.

Division of Surgery, Department of Surgery and Cancer, Imperial College London, United Kingdom; Division of Surgery and Interventional Sciences, University College London, United Kingdom.

Objective: To compare the proportion of clinically significant prostate cancers (PCa) found in lesions detected by multiparametric MRI (mpMRI) with that found in lesions detected by multiparametric ultrasound (mpUSS), in men at risk.

Patients And Methods: CADMUS (Cancer Detection by Multiparametric Ultrasound of the prostate) is a prospective, multi-centre paired cohort diagnostic utility study with built-in randomisation of order of biopsies. The trial is registered ISRCTN38541912. All patients will undergo the index test under evaluation (mpUSS±biopsies), as well as the standard test (mpMRI±biopsies). Eligible men will be those at risk of harbouring prostate cancer usually recommended for prostate biopsy, either for the first time or as a repeat, who have not had any prior treatment for prostate cancer. Men in need of repeat biopsy will include those with prior negative results but ongoing suspicion, and those with an existing prostate cancer diagnosis but a need for accurate risk stratification. Both scans will be reported blind to the results of the other and the order in which the targeted biopsies derived from the two different imaging modalities are taken will be randomised. Comparison will be drawn between biopsy results of lesions detected by mpUSS with those lesions detected by mpMRI. Agreement over position between the two imaging modalities will be studied.

Discussion: CADMUS will provide level one evidence on the performance of mpUSS derived targeted biopsies in the identification of clinically significant prostate cancer in comparison to mpMRI targeted biopsies. Recruitment is underway and expected to complete in 2018.
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http://dx.doi.org/10.1016/j.cct.2017.10.011DOI Listing
March 2018

Cholecysto-cutaneous fistula in a patient with biliary lithiasis.

J Gastrointestin Liver Dis 2017 06;26(2):112

Fundeni Clinical Institute, Gastroenterology and Hepatology Department, Bucharest, Romania.

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http://dx.doi.org/10.15403/jgld.2014.1121.262.vstDOI Listing
June 2017

Determination of band offsets, hybridization, and exciton binding in 2D semiconductor heterostructures.

Sci Adv 2017 Feb 8;3(2):e1601832. Epub 2017 Feb 8.

Department of Physics, University of Washington, Seattle, WA 98195, USA.

Combining monolayers of different two-dimensional semiconductors into heterostructures creates new phenomena and device possibilities. Understanding and exploiting these phenomena hinge on knowing the electronic structure and the properties of interlayer excitations. We determine the key unknown parameters in MoSe/WSe heterobilayers by using rational device design and submicrometer angle-resolved photoemission spectroscopy (μ-ARPES) in combination with photoluminescence. We find that the bands in the K-point valleys are weakly hybridized, with a valence band offset of 300 meV, implying type II band alignment. We deduce that the binding energy of interlayer excitons is more than 200 meV, an order of magnitude higher than that in analogous GaAs structures. Hybridization strongly modifies the bands at Γ, but the valence band edge remains at the K points. We also find that the spectrum of a rotationally aligned heterobilayer reflects a mixture of commensurate and incommensurate domains. These results directly answer many outstanding questions about the electronic nature of MoSe/WSe heterobilayers and demonstrate a practical approach for high spectral resolution in ARPES of device-scale structures.
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http://dx.doi.org/10.1126/sciadv.1601832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298850PMC
February 2017

Retained Common Bile Duct Lithiasis at a Pacient with Periampullary Duodenal Diverticulum.

Chirurgia (Bucur) 2016 Nov-Dec;111(6):517-521

Periampullary duodenal diverticula are associated with the presence of common bile duct stones, being encountered more frequently with the increase of age. We present the case of a 76 years old female patient, who underwents emergency surgery for a perforated lithiasic gangrenous acute cholecystitis and for whom we perform a cholecystectomy and an external biliary drainage using a transcystic tube. Both preoperative and postoperative imaging and endoscopic examinations certify the presence of a periampullary duodenal diverticulum. Postoperative cholangiography performed on the transcystic tube raises the suspicion of retained common bile duct lithiasis. An endoscopic retrograde cholangiopancreatography is performed, initially failing to cannulate the common bile duct. A precut sphincterotomy fistula technnique is performed, using as reference a guide inserted on the transcystic tube, with the extraction of biliay sludge from the common bile duct, and with subsequently favorable development. Association between common bile duct lithiasis and a periampullary duodenal diverticulum may represent a therapeutic challenge because of the increased risk of failure of the endoscopic treatment.
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http://dx.doi.org/10.21614/chirurgia.111.6.517DOI Listing
June 2017

Treatment of Malignant Esophageal Fistulas: Fluoroscopic Placement of Esophageal SEMS, Endoscopically-assisted through Surgical Gastrostomy. A Case Report.

J Gastrointestin Liver Dis 2016 Jun;25(2):249-52

Radiology Department, Clinical Emergency Hospital Bucharest, Romania.

Progressive esophageal carcinoma can infiltrate the surrounding tissues with subsequent development of a fistula, most commonly between the esophagus and the respiratory tract. The endoscopic placement of covered self-expanding metallic stents (SEMS) is the treatment of choice for malignant esophageal fistulas and should be performed immediately, as a fistula formation represents a potential life-threatening complication. We report the case of a 64-year-old male diagnosed with esophageal carcinoma, who had a 20Fr surgical gastrostomy tube inserted before chemo- and radiotherapy and was referred to our department for complete dysphagia, cough after swallowing and fever. The attempt to insert a SEMS using the classic endoscopic procedure failed. Then, a fully covered stent was inserted, as the 0.035" guide wire was passed through stenosis retrogradely by using an Olympus Exera II GIF-N180 (4.9 mm in diameter endoscope) via surgical gastrostomy, with a good outcome for the patient. The retrograde approach via gastrostomy under endoscopic/fluoroscopic guidance with the placement of a fully covered SEMS proved to be the technique of choice, in a patient with malignant esophageal fistula in whom other methods of treatment were not feasible.
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http://dx.doi.org/10.15403/jgld.2014.1121.252.mlgDOI Listing
June 2016

Multipurpose Black-Phosphorus/hBN Heterostructures.

Nano Lett 2016 Apr 1;16(4):2586-94. Epub 2016 Apr 1.

Department of Physics, University of Warwick , Coventry CV4 7AL, United Kingdom.

Black phosphorus (BP) has recently emerged as a promising semiconducting two-dimensional material. However, its viability is threatened by its instability in ambient conditions and by the significant decrease of its band gap in multilayers. We show that one could solve all the aforementioned problems by interfacing BP with hexagonal boron nitride (hBN). To this end, we simulate large, rotated hBN/BP interfaces using linear-scaling density functional theory. We predict that hBN-encapsulation preserves the main electronic properties of the BP monolayer, while hBN spacers can be used to counteract the band gap reduction in stacked BP. Finally, we propose a model for a tunneling field effect transistor (TFET) based on hBN-spaced BP bilayers. Such BP TFETs would sustain both low-power and fast-switching operations, including negative differential resistance behavior with peak-to-valley ratios of the same order of magnitude as those encountered in transition metal dichalcogenide TFETs.
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http://dx.doi.org/10.1021/acs.nanolett.6b00154DOI Listing
April 2016

Diagnostic Delay in Romanian Patients with Inflammatory Bowel Disease: Risk Factors and Impact on the Disease Course and Need for Surgery.

J Crohns Colitis 2016 Mar 20;10(3):306-14. Epub 2015 Nov 20.

Carol Davila University of Medicine and Pharmacy, Fundeni Clinical Institute, Digestive and Liver Disease, Bucuresti, Romania.

Background: The epidemiology of inflammatory bowel disease [IBD] in Eastern Europe is poorly understood, particularly with regard to diagnostic delay. Here we investigated the factors leading to delayed diagnosis and the effect of the delay on several disease progression and outcome measures.

Methods: A total of 1196 IBD cases [682 ulcerative colitis [UC], 478 Crohn's disease [CD], 36 indeterminate colitis] from the Romanian national registry IBDPROSPECT were reviewed. Standard clinical and demographic factors were evaluated as predictors of a long diagnostic delay in both CD and UC. Diagnostic delay was subsequently evaluated as a potential risk factor for bowel stenoses, bowel fistulas, perianal fistulas, perianal surgery, and intestinal surgery in CD patients.

Results: The median diagnostic delay was significantly longer in CD [5 months] than in UC [1 month] patients [p < 0.001]. Compared with 5 months for UC patients, 75% of CD patients were diagnosed within 18 months of symptom onset. In CD patients, extra-ileal location was a protective factor (odds ratio [OR], 0.5; p = 0.03), whereas being an active smoker [OR, 2.09; p = 0.01] and symptom onset during summer [OR, 3.35; p < 0.001] were independent risk factors for a long diagnostic delay [> 18 months]. In UC patients, an age > 40 years was a protective factor [OR, 0.68; p = 0.04] for a long delay. Regarding outcomes, a long diagnostic delay in CD patients positively correlated with bowel stenoses [OR, 3.38; p < 0.01] and any IBD-related surgery [OR, 1.95; p = 0.03] and had a positive trend for intestinal fistulas [OR, 2.64; p = 0.08] and perianal fistulas [OR, 2.9; p = 0.07]. Disease duration since diagnosis positively correlated with bowel stenoses [OR, 1.04; p = 0.04], any IBD-related surgery [OR, 1.04; p = 0.02], and intestinal surgery [OR, 1.07; p < 0.01].

Conclusions: A long diagnostic delay in IBD correlates with an increased frequency of bowel stenoses and need for IBD-related surgery.
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http://dx.doi.org/10.1093/ecco-jcc/jjv215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4957477PMC
March 2016

Endoscopic resection of a giant colonic lipoma causing severe anemia.

J Gastrointestin Liver Dis 2015 Jun;24(2):142

Gastroenterology Department, Clinical Emergency Hospital,Bucharest, Romania.

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http://dx.doi.org/10.15403/jgld.2014.1121.242.endrDOI Listing
June 2015
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