After 20 years: changing the clinical role of endoscopic retrograde cholangiopancreatography

Clinica Privată ”Sanatate EVP”, Spitalul Clinic Republican “Timofei Moșneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: De la începutul implementării pe scară largă în practica clinică, colangiopancreatografia endoscopică retrogradă (CPGER) a devenit o tehnică diagnostică valoroasă, deși unii si-au exprimat îndoieli cu privire la fezabilitatea și rolul acesteia. CPGER a primit un impuls prin dezvoltarea aplicațiilor sale curative, în special sfincterotomiei endoscopice (STE) la mijlocul anilor 1970 și stentării biliare (SB) puțin mai târziu. Scopul lucrării a fost de a estima evoluția și rolul actual al CPGER în patologia căilor biliare. Materiale si metode: În perioada 2011-2015, CPGER a fost efectuată la 410 pacienți cu manifestări clinice ale patologiei ducturilor biliare la Spitalul Clinic Republican. Femei au fost 249, bărbați - 161. Vârsta pacienților a variat de la 18 la 92 de ani, în medie 60,1±0,7 ani. Grupul de control a inclus 784 pacienți cărora li sa efectuat CPGER pentru patologia biliară în același spital la mijlocul anilor 1990. Rezultate: Comparația grupurilor istoric și curent a evidențiat o scădere statistic semnificativă în cazurile de coledocolitiază (63% vs 40,9% respectiv, p<0,01), stenoza benignă a papilei Vater (14% vs 8,8%, p<0,01), sporirea practic de trei ori a patologiei maligne a ducturilor biliare sau zonei periampulare (6,1% vs 15,7%, p<0,01). La 16,8% dintre pacienții din grupul istoric, CPGER nu a evidențiat nici o patologie biliară (p<0,01 cu date din grupul curent). Proporția CPGER curative cu STE, drenaj sau SB a crescut de la 83,1% în grupul istoric la 99,3% în grupul curent (p<0,01). Concluzii: În absența scanării cu rezonanță magnetică și computerizată, CPGER a reprezentat metoda diagnostică decisivă pentru patologia biliară 20 de ani în urmă. Scăderea proporției pacienților cu afecțiuni benigne (coledocolitiază, stricturile distale ale ductului biliar comun) trebuie explicată printr-o decizie mai precoce și mai ușoară în favoarea tratamentului chirurgical al litiazei biliare, datorită accesibilității crescute a colecistectomiei laparoscopice. Obstrucția biliară malignă este rezolvată din ce în ce mai frecvent prin metode minim-invazive, incluzând SB, asociate cu o reducere semnificativă a morbidității și mortalității.Introduction: Since the beginning of its widespread introduction into the clinical practice, endoscopic retrograde cholangiopancreatography (ERCP) has become a valuable diagnostic technique, although doubts were expressed about its feasibility and role. ERCP was given a boost by development of its therapeutic applications, notably biliary endoscopic sphincterotomy (EST) in the mid-1970s and biliary stenting (BS) a little later. Aim of the paper was to estimate the evolution and current role of ERCP in pathology of the bile ducts. Materials and methods: In the period of 2011-2015, ERCP were performed in 410 patients with clinical manifestations of bile ducts pathology at the Republican Clinical Hospital. Women were 249, men - 161. The age of patients ranged from 18 to 92 years, averaging 60.1±0.7 years. The control group was presented by 784 patients who had received ERCP in the same hospital in the mid-1990s, also for biliary pathology. Results: Comparison of the historical and current groups revealed a statistically significant decrease in cases of choledocholithiasis (63% vs 40.9% respectively, p<0.01), benign stenosis of papilla Vater (14% vs 8.8%, p<0.01), and almost threefold increase in malignant pathology of the biliary ducts or the periampular zone (6.1% vs 15.7%, p<0.01). In 16.8% of patients in the historical group, ERCP did not reveal any biliary pathology (p<0.01 with data in the current group). The proportion of therapeutic ERCP accompanied by EST, drainage or BS increased from 83.1% in the historical group to 99.3% in the current group (p<0.01). Conclusions: In absence of computed and magnetic resonance scans, ERCP was the decisive diagnostic method for biliary pathology 20 years ago. The decline in the proportion of patients with benign conditions (choledocholithiasis, distal common bile duct strictures) should be associated with an earlier and easier decision for surgical treatment of cholelithiasis, due to improved accessibility of laparoscopic cholecystectomy. Malignant biliary obstruction is increasingly resolved by mini-invasive methods, including BS, accompanied by significant reduction in morbidity and mortality

Ultrasound sign found in progressive extrauterine pregnancy

Clinica Privată ”Sanatate EVP’’, Chișinău, Republica Moldova, Centrul Servicii Medicale, Policlinica de Ambulator, Tighina, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Ultrasonografia în sarcină ectopică progresivă este singura metodă neinvazivă în medicina mondială și modernă. Cercetarea dată a constat în determinarea semnelor ultrasonografice certe a sarcinei extrauterine. Material şi metodă: Au fost examinate 45 paciente cu suspecţie la sarcină extrauterină. In 36 cazuri s-a depistat sarcina extrauterină, din care 33 (91,7%), forma progresivă. Examinarea s-a efectuat cu dispozitivul SSD-500, ALOKA (Japonia), endocavitar cu senzor 5 MHz. Rezultate: Analiza retrospectivă a cazurilor clinice de sarcină extrauterină progresivă cu localizarea în trompele uterine (98%), a evidențiat unul și același semn ecografic, și anume: vizualizarea în afara uterului, a unei formațiuni echopozitive de formă rotundă sau ovală, de o densitate acustică medie, cu un centru anecogen sau hipoecogen, care reprezintă un ovul fecundat sau un făt, diametrul căruia corelează cu perioada de gestație prin amenoree. În regimul de cartografiere colorată, fluxul sanguin din această formațiune reprezintă fluxul excentric neînchis, ceea ce îl diferențiază de fluxul sanguin închis din regiunea corpului galben. Concluzii: Aceste semne au fost sistematizate într-un semn comun, denumit de autori, ca simptomul "Demeniuc-Pitel". Certificat de înregistrare a obiectelor dreptului de autor si drepturilor conexe (Seria 0 Nr.6291 din 04.03.2019).Introduction: The ultrasound in the progressive ectopic pregnancy is the only non-invasive method in modern global medicine. The following research publication consists in effective determination using extrauterine pregnancy ultrasound. Method and materials: 45 patients were examined with suspicion of extrauterine pregnancy. In 36 cases was determined the extrauterine pregnancy, from which 33 (91.7%) cases was a progressive pregnancy. The exams were performed using SSD-500, ALOKA (Japan), endocavitary, using 5 MHz sensor. Results: As a result of the analysis, within the progressive extra uterine pregnancy, predominantly found in fallopian tubes (98%), we succeeded in to unify the same echographic sign: the visualization outside the uterus of a echo positive formation of a round or oval form, that has a medium acoustic density, with a anecogen or hypoecogen center, that represents a fecundated ovule or fetus. Its diameter correlates with the gestation period through amenorrhea. In the color cartographic mode, the blood flow within this formation represents eccentric, unclosed flow, which differentiates it from the closed blood flow, from the yellow body zone. Conclusions: Hence, these signs were systemized within a common sign named by the authors as the "Demeniuc-Pitel" symptom. The registration certificate of the objects of the authors rights and related rights (Series 0 Nr.6291 from 04.03.2019)

Organization and history of endoscopy and ultrasonography in the Republic of Moldova

Scopul lucrării. Endoscopia și ultrasonografia sunt specialități relativ tinere, iar succesele medicinei contemporane sunt în mare măsură determinate cu apariția și dezvoltarea lor. Materiale şi metode. Această lucrare se bazează pe documentele păstrate și amintirile martorilor despre istoria dezvoltării endoscopiei și ultrasonografiei în Republica Moldova (RM), precum și pe date statistice privind starea actuală în domeniu. Rezultate. Primele examene endoscopice efectuate în RM includ bronhoscopia rigidă în Institutul de Ftiziopulmonologie în anul 1954, și fibrogastroscopia (FGS) în cadrul Institutului de Oncologie (1966) şi a Spitalului Clinic Republican (SCR) din 1976. Din 1979, în noul sediu al SCR Dr.V.Guţu este autorizat să deschidă un cabinet şi apoi o secţie de endoscopie, dotată cu FGS, fibrocolonoscopie, fibrobronhoscopie, laparoscopie diagnostică, urmată din 1983 şi de ultrasonografie (USG). Din acest moment începe formarea structurii naționale de endoscopie, inclusiv deschiderea cabinetelor și secțiilor de endoscopie și USG în Chișinău și raioanele RM, dotarea cu echipament și pregătirea personalului. Medicii au fost instruiţi la locul de muncă în secția de endoscopie a SCR, la ședințele ale Societății Științifice de Endoscopie, înființată în 1980, precum și la cursul de specializare și perfecționare în endoscopie și USG în cadrul USMF „Nicolae Testemițanu” (deschis în 1989). În prezent, în RM există o rețea largă de cabinete și secții de endoscopie, Societatea științifică „V.M.Guţu”, înregistrată în 2017, Comisia de specialitate „Endoscopie” şi Comisia de atestare profesională la Ministerul Sănătății, funcția de endoscopist în personalul spitalelor. Concluzii. În pofida succeselor obținute, endoscopia din RM are nevoie de măsuri ulterioare de dezvoltare, inclusiv extinderea rețelei de cabinete şi secţii, un sistem stabil pentru formarea tinerilor specialiști, dobândirea de către aceștia a diverselor competențe în domeniu și introducerea specialităţii „Endoscopie” în nomenclatorul de pregătire și educație a medicilor.Aim of study. Endoscopy and ultrasonography are relatively young specialties, and the successes of contemporary medicine are largely determined with their appearance and development. Materials and methods. This paper is based on preserved documents and witnesses' memories about the history of the development of endoscopy and ultrasonography in the Republic of Moldova (RM), as well as on statistical data regarding the current state in the field. Results. The first endoscopic examinations performed in RM include rigid bronchoscopy in the Institute of Phthisiopulmonology in 1954, and fibrogastroscopy (FGS) in the Institute of Oncology (1966) and the Republican Clinical Hospital (RCH) in 1976. Since 1979, in the new headquarters of RCH Dr. V.Guţu is authorized to open an office and then department of endoscopy, equipped with FGS, fibrocolonoscopy, fibrobronchoscopy, diagnostic laparoscopy, followed by ultrasonography (US) from 1983. From this moment, the formation of the national endoscopy structure begins, including the opening of endoscopy and USG offices and departments in Chisinau and districts of RM, the supplying of equipment and the training of personnel. The doctors were trained at the workplace within RCH department of endoscopy, at meetings of the Scientific Society of Endoscopy, established in 1980, as well as at the specialization course in endoscopy and US within the Nicolae Testemițanu University (opened in 1989). Currently, in the RM there is a wide network of endoscopy offices and departments, the V.M.Guţu scientific society, registered in 2017, the „Endoscopy” specialty commission and the professional attestation commission at the Ministry of Health, the position of endoscopist in hospital staff. Conclusions. Despite the successes achieved, endoscopy in the RM needs further development measures, including expansion of the offices and departments network, a stable system for the training of young specialists, their acquisition of various skills in the field and the introduction of the „Endoscopy” specialty in the nomenclature of training and education of physicians

Endoscopic stenting and sphincterotomy for obstructive jaundice caused by pancreatic head cancer

Clinica Privată ”Sanatate EVP’’, IMSP Spitalul Clinic Republican “Timofei Mosneaga”, Chișinău, Republica Moldova, Al XIII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” și al III-lea Congres al Societății de Endoscopie, Chirurgie miniminvazivă și Ultrasonografie ”V.M.Guțu” din Republica MoldovaIntroducere: Deși doar tratamentul chirurgical oferă un potențial curativ pentru cancerul de cap pancreatic, procedeele paliative sunt din ce în ce mai utilizate, în special la pacienții cu adenocarcinom avansat la momentul diagnosticării și la cei vârstnici cu boli concomitente severe, care nu sunt potriviți pentru tratament chirurgical deschis. Scopul studiului a fost evaluarea aplicării colangiopancreatografiei endoscopice retrograde (ERCP), sfincterotomiei (STE) și stentării endoscopice (SE) pentru cancerul capului pancreatic cu ocluzie biliară și icter obstructiv. Material si metode: În perioada 2011-2015, ERCP a fost efectuată la 66 pacienți cu adenocarcinom al capului pancreatic tratați la Spitalul Clinic Republican. Bărbați – 35, femei - 31. Vârsta medie a pacienților 67,4±1,3 ani. Icterul obstructiv la spitalizare a fost diagnosticat la 61 (92,4%) pacienți. Ultrasonografia efectuată la 43 pacienți, tomografie computerizată - la 12. Rezultate: Procedeul endoscopic a avut caracter doar diagnostic la 7 (10,6%) pacienți și curativ - la 59 (89,4%). Din cele din urmă s-au efectuat: SE (38 de cazuri), suplimentată cu STE (28), restentare (11) și numai STE (10). Tratamentul chirurgical deschis a fost necesar mult mai rar în grupul endoscopiei curative în comparație cu cea diagnostică (16,9% vs 42,9%, respectiv, p<0,05). Trei pacienții au decedat: 2 (15,4%) - după intervenție chirurgicală și 1 (1,9%, p<0,05) - după STE şi SE. Concluzii: Procedeele endoscopice (SE și STE) pot fi utile în ameliorarea ocluziei biliare și a icterului obstructiv la pacienții cu cancer de cap pancreatic. Paliația endoscopică este foarte eficientă, cu morbiditate și mortalitate semnificativ mai reduse la pacienții vârstnici cu formă locală inoperabilă sau generalizată a cancerului de cap pancreatic.Background: Although only surgery offers curative potential for the cancer of pancreatic head, palliative procedures are increasingly used, especially in patients with advanced adenocarcinoma at the time of diagnosis and in elderly patients with severe concomitant diseases that are poor candidates for surgical treatment. Aim of the paper was to assess application of endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy (EST) and stenting (ES) for pancreatic head cancer with biliary occlusion and obstructive jaundice. Methods and materials: In 2011-2015, ERCP was performed in 66 patients with pancreatic head adenocarcinoma treated at the Republican Clinical Hospital. Men - 35, women - 31. Average patients age 67.4±1.3 years. On admission obstructive jaundice has been diagnosed in 61 (92.4%) patients. Ultrasonography performed in 43 patients, computed tomography – in 12. Results: Endoscopic intervention was diagnostic only in 7 (10.6%) patients, and curative - in 59 (89.4%). From them performed: ES (38 cases), supplemented by EST (28), restenting (11), and EST only (10). Open surgical treatment was necessary less frequently in the group of curative endoscopy in comparison with the diagnostic one (16.9% vs 42.9%, respectively, p<0.05). Three patients died: 2 (15.4%) - after surgery and 1 (1.9%, p<0.05) - after EST and ES. Conclusion: Endoscopic procedures (ES and EST) can be helpful in relieving biliary obstruction and obstructive jaundice in patients with pancreatic head cancer. Endoscopic palliation is highly effective, has a significantly lower morbidity and mortality in elderly patients with locally inoperable or generalized form of pancreatic head cancer

Ensuring the Sustainability of Russian Federation National Nuclear Material Accounting System

The Federal Nuclear Material Control and Accounting Information System (FIS) is the national information source on nuclear material accounting of the Russian Federation (RF). RF regulations mandated the creation of a national nuclear material accounting system to be managed by Federal Agency For Atomic Energy (Rosatom), and for the past decade, the FIS has been developed for all organizations required to report to Rosatom. The system represents a successful integration of U.S. financial support and consulting with Russian vision and technical expertise, creating a viable national nuclear material accounting system. This paper discusses crucial elements to ensure Sustainability of the FIS. A long-term plan for operation and maintenance of the information system is critical to a sustainable national accounting system. Plans undertaken throughout the FIS Project lifecycle have supported the necessary elements to ensure success. Through the next two years, long-term planning will be reevaluated and the successful elements and new initiatives will become part of an overall Operations Management Program. FIS resource needs will be managed through prioritization and ranking for each Program element, including: system operation; revising and implementing supporting regulations; establishing monitoring and control mechanisms to ensure validity of the data reported; maintaining and improving communication channels; and establishing regular FIS training. The results of a survey on improving FIS reporting, expected in June 2006, will be used in the prioritization and ranking process. Developing the Program and planning for long-term sustainability of the FIS will ensure a viable national nuclear material accounting system for the future

A genome scan for quantitative trait loci affecting the Salmonella carrier-state in the chicken

Selection for increased resistance to Salmonella colonisation and excretion could reduce the risk of foodborne Salmonella infection. In order to identify potential loci affecting resistance, differences in resistance were identified between the N and 61 inbred lines and two QTL research performed. In an F2 cross, the animals were inoculated at one week of age with Salmonella enteritidis and cloacal swabs were carried out 4 and 5 wk post inoculation (thereafter called CSW4F2 and CSW4F2) and caecal contamination (CAECF2) was assessed 1 week later. The animals from the (N × 61) × N backcross were inoculated at six weeks of age with Salmonella typhimurium and cloacal swabs were studied from wk 1 to 4 (thereafter called CSW1BC to CSW4BC). A total of 33 F2 and 46 backcross progeny were selectively genotyped for 103 and 135 microsatellite markers respectively. The analysis used least-squares-based and non-parametric interval mapping. Two genome-wise significant QTL were observed on Chromosome 1 for CSW2BC and on Chromosome 2 for CSW4F2, and four suggestive QTL for CSW5F2 on Chromosome 2, for CSW5F2 and CSW2BC on chromosome 5 and for CAECF2 on chromosome 16. These results suggest new regions of interest and the putative role of SAL1

Expanding Duplication of Free Fatty Acid Receptor-2 (GPR43) Genes in the Chicken Genome

International audienceFree fatty acid receptors (FFAR) belong to a family of five G-protein coupled receptors that are involved in the regulation of lipidmetabolism, so that their loss of function increases the risk of obesity. The aim of this study was to determine the expansion of genesencoding paralogs of FFAR2 in the chicken, considered as amodel organism for developmental biology and biomedical research. Byestimating the gene copy number using quantitative polymerase chain reaction, genomic DNA resequencing, and RNA sequencingdata, we showed the existence of 23 ±1.5 genes encoding FFAR2 paralogs in the chicken genome. The FFAR2 paralogs shared anidentity from 87.2%up to 99%. Extensive gene conversion was responsible for this high degree of sequence similarities betweenthese genes, and this concerned especially the four amino acids known to be critical for ligand binding. Moreover, elevated nonsynonymous/synonymous substitutionratios onsomeamino acids withinor inclose-vicinity of the ligand-bindinggroove suggest thatpositive selectionmay have reduced the effective rate of gene conversion in this region, thus contributing to diversify the function ofsome FFAR2 paralogs. All the FFAR2 paralogs were located on a microchromosome in a same linkage group. FFAR2 genes wereexpressed in different tissues and cells such as spleen, peripheral blood mononuclear cells, abdominal adipose tissue, intestine, andlung, with the highest rate of expression in testis. Further investigations are needed to determine whether these chicken-specificevents along evolution are the consequence of domestication and may play a role in regulating lipid metabolism in this species

Cryptic patterning of avian skin confers a developmental facility for loss of neck feathering

Vertebrate skin is characterized by its patterned array of appendages, whether feathers, hairs, or scales. In avian skin the distribution of feathers occurs on two distinct spatial levels. Grouping of feathers within discrete tracts, with bare skin lying between the tracts, is termed the macropattern, while the smaller scale periodic spacing between individual feathers is referred to as the micropattern. The degree of integration between the patterning mechanisms that operate on these two scales during development and the mechanisms underlying the remarkable evolvability of skin macropatterns are unknown. A striking example of macropattern variation is the convergent loss of neck feathering in multiple species, a trait associated with heat tolerance in both wild and domestic birds. In chicken, a mutation called Naked neck is characterized by a reduction of body feathering and completely bare neck. Here we perform genetic fine mapping of the causative region and identify a large insertion associated with the Naked neck trait. A strong candidate gene in the critical interval, BMP12/GDF7, displays markedly elevated expression in Naked neck embryonic skin due to a cis-regulatory effect of the causative mutation. BMP family members inhibit embryonic feather formation by acting in a reaction-diffusion mechanism, and we find that selective production of retinoic acid by neck skin potentiates BMP signaling, making neck skin more sensitive than body skin to suppression of feather development. This selective production of retinoic acid by neck skin constitutes a cryptic pattern as its effects on feathering are not revealed until gross BMP levels are altered. This developmental modularity of neck and body skin allows simple quantitative changes in BMP levels to produce a sparsely feathered or bare neck while maintaining robust feather patterning on the body. © 2011 Mou et al

Mapping main, epistatic and sex-specific QTL for body composition in a chicken population divergently selected for low or high growth rate

<p>Abstract</p> <p>Background</p> <p>Delineating the genetic basis of body composition is important to agriculture and medicine. In addition, the incorporation of gene-gene interactions in the statistical model provides further insight into the genetic factors that underlie body composition traits. We used Bayesian model selection to comprehensively map main, epistatic and sex-specific QTL in an F₂reciprocal intercross between two chicken lines divergently selected for high or low growth rate.</p> <p>Results</p> <p>We identified 17 QTL with main effects across 13 chromosomes and several sex-specific and sex-antagonistic QTL for breast meat yield, thigh + drumstick yield and abdominal fatness. Different sets of QTL were found for both breast muscles [<it>Pectoralis (P) major </it>and <it>P. minor</it>], which suggests that they could be controlled by different regulatory mechanisms. Significant interactions of QTL by sex allowed detection of sex-specific and sex-antagonistic QTL for body composition and abdominal fat. We found several female-specific <it>P. major </it>QTL and sex-antagonistic <it>P. minor </it>and abdominal fatness QTL. Also, several QTL on different chromosomes interact with each other to affect body composition and abdominal fatness.</p> <p>Conclusions</p> <p>The detection of main effects, epistasis and sex-dimorphic QTL suggest complex genetic regulation of somatic growth. An understanding of such regulatory mechanisms is key to mapping specific genes that underlie QTL controlling somatic growth in an avian model.</p

Seroprevalence of Toxoplasma gondii and Neospora spp. Infections in Arab Horses, Southwest of Iran

Background: Because of the economic importance of the Arab race horses and also the role of Toxoplasma gondii and Neospora spp. in abortion and reproductive failure of these animals, we decided to perform this study. Objectives: We designed this study to investigate the seroprevalence of anti-Toxoplasma gondii and anti-Neospora spp. antibodies in Arab horses from 12 cities of Khuzestan province in southwest of Iran. Materials and Methods: From October 2009 to March 2011, a total of 235 blood samples were collected from jugular veins of Arab horses of different ages and genders from 12 cities of Khuzestan province. All the sera were tested for anti-Toxoplasma antibodies using the modified agglutination test (MAT) and the existence of anti-Neospora antibodies were tested using N-MAT for Neospora spp. Results: According to the MAT results, antibodies to T. gondii were found in 114 (48.5%) of 235 sera with titers of 1:20 in 84, 1:40 in 19, 1:80 in four, 1:160 in four, and 1:320 in three horses. According to the N-MAT results, antibodies to Neospora spp. were found in 47 (20%) of 235 sera with titers of 1:40 in 39, 1:80 in five, and 1:160 in three horses. We did not observe any statistically significant differences regarding age groups and genders between seropositive and seronegative horses for Neospora spp. using chi-square (chi(2)) test, but it seemed that anti-Toxoplasma antibodies were more prevalent in older horses ( >= 10 years old). Conclusions: The results indicated that Arab horses are exposed to these parasites in southwest of Iran. Further research is required to determine the genomic structures of these parasites in Arab horses in southwest of Iran