A rare case of extrahepatic cholangiocarcinoma – a multidisciplinary approach

Department of Radiology and Medical Imaging, Department of Rheumatology, Departament of Gastroenterology, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Background: Bile duct carcinoma is an extremely aggressive and rare primary hepatobiliary malignancy affecting nearly 1-2/100,000 people in most countries in Europe. Biliary tract malignancies located in the distal third of the common bile duct (CBD) account for approximately 17-18% of all cholangiocarcinomas. This report aims to provide a step-by-step evaluation of a rare case of cholangiocarcinoma. Content: The current report focuses on a 65-year-old male patient who was presented to the emergency department with signs and symptoms suggestive for a biliary tract obstruction. An intense cooperation between multiple departments was required in order to perform a complete and accurate evaluation of the patient. Initially, the patient underwent an abdominal Ultrasonography (US), followed by an abdominal and pelvic Computed Tomography (CT), which revealed an intraductal tumor affecting the distal CBD. Furthermore, the patient underwent an endoscopic retrograde cholangiopancreatography (ERCP) in order to provide tissue samples and to perform a dilatation of the CBD in the affected area. The histopathology report confirmed the malignant nature of the lesion describing it as an adenocarcinoma. The surgeons performed a pancreaticoduodenectomy (Whipple procedure), managing to achieve negative tumor resection margins. However, the patient developed several complications that required multiple surgical reinterventions. Conclusions: This report presents a fully investigated less common type of cholangiocarcinoma, highlighting the principles of diagnosis and management as well as of a multidisciplinary approach in such patients

Quantitative evaluation of fatty liver using spectroscopic sequence – correlation between Magnetic Resonance Spectroscopy and histopathology

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: La stéatose hépatique entraîne l’accumulation des lipides dans les hépatocytes. La tomographie computerisée (CT) et l’échographie (US) peuvent évaluer qualitativement la graisse du foie. La technique d’imagerie la plus précise en termes de quantification de la stéatose hépatique est la Spectroscopie par Résonance Magnétique (MRS). L’objectif de l’étude était de valider le rôle de MRS 3T dans l’évaluation quantitative de la stéatose hépatique. Matériel et méthodes: Le foie de 33 patients a été évalué qualitativement par des tests de laboratoire et d’échographie. Tous les patients ont été étudiés avec une 3T haute résolution IRM, constituée de séquences en phase, déphasées et de séquences spécifiques pour la steatose en T1 pondérées, ainsi que des séquences en T2 pondérées et de séquences de spectroscopie. L’évaluation qualitative a été réalisée en utilisant la fraction de graisse calculée manuellement après l’analyse par spectroscopie. La stéatose a été classée 0 = jusqu’à 10%, grade 1 = 10-33%, grade 2 = 34-66%, grade 3 = ≥67%. La biopsie hépatique a été réalisée chez des patients opérés pour différentes pathologies. Résultats: Limitée par un petit nombre de patients et par les manoeuvres chirurgicales invasives de la biopsie hépatique, l’étude montre que cinq patients présentaient une stéatose classée en grade 0, treize – en grade 1, six – en grade 2 et un – en grade 3, offrant une bonne corrélation entre MRS et histopathologie. Conclusions: En dépit d’être une étude pilote, nous pouvons conclure que MRS est une technique non invasive efficace qui peut être extrêmement utile dans le diagnostic et la quantification de la stéatose hépatique.Background: Hepatic steatosis results in the accumulation of lipids within hepatocytes. Computed Tomography (CT) and Ultrasound (US) can qualitatively assess liver fat. The most accurate imaging technique in terms of quantifying hepatic steatosis is Magnetic Resonance Spectroscopy (MRS). The study aimed to validate the role of 3T MRS in quantitative assessment of liver steatosis. Material and methods: The liver of 33 patients was qualitatively assessed through lab and ultrasound tests. All patients were investigated with a 3T high resolution MRI consisting of T1 weighted sequences with in-phase, out-of-phase and fat specific phases and also T2 weighted and spectroscopy sequences. The qualitative assessment was carried out using the fat fraction calculated manually after spectroscopy computer analysis. The steatosis was graded as grade 0 = up to 10%, grade 1 = 10-33%, grade 2 = 34-66%, grade 3 = ≥ 67%. Liver biopsy was performed in patients who underwent surgery for different pathologies. Results: Limited by a small number of patients and surgical invasiveness of liver biopsy, the study shows that five patients had grade 0 steatosis, thirteen had grade 1, six patients – grade 2 and one patient – grade 3, offering a good correlation between MRS and histopathology. Conclusions: Despite being a pilot study, we can conclude that MRS is an effective noninvasive technique that can be extremely useful in diagnosing and quantifying hepatic steatosis

Role of gadoxetic-acid enhanced 3T MRI and diffusion in liver nodules diagnosis

Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, Craiova, Romania, The IVth Congress of Radiology and Medical Imaging of the Republic of Moldova with international participation, Chisinau, May 31 – June 2, 2018Introduction: La capacité multiparamétrique et l’imagerie par résonance magnétique (IRM) 3T à haute résolution jouent un rôle clé dans la caractérisation non invasive des lésions hépatiques focales (LHF). Certaines LHF ont des caractéristiques atypiques. De nouvelles techniques telles que les séquences à diffusion pondérée et les agents de contraste spécifiques aux hépatocytes sont actuellement utilisées en pratique clinique pour améliorer la détection et la caractérisation des LHF. L’étude visait à valider un protocole d’imagerie hépatique de haute qualité en utilisant une IRM à haute résolution combinée à un milieu de contraste spécifique à la diffusion et à l’hépatocyte pour le diagnostic de la LHF. Matériel et méthodes: 110 patients hépatiques ont été étudiés en utilisant une IRM à haute résolution de 3T (Phillips Ingenia) en utilisant une bobine de matrice en phase de corps. Le protocole inclue les séquences Dixon-all T1, T2, SPAIR et de diffusion. L’IRM améliorée a supposé l’utilisation des séquences Dixon-T1 de l’acide gadoxétique (PRIMOVIST), y compris la phase hépatobiliaire à 20 minutes et 30 minutes. Résultats: 65 patients ont été diagnostiqués avec précision des lésions bénignes, y compris les hémangiomes, les kystes, l’hyperplasie nodulaire focale et les adénomes. Parmi 45 lésions malignes, nous avons trouvé des métastases, un carcinome hépatocellulaire (CHC) et une pseudotumeur inflammatoire. Les lésions ont été suivies ou une pathologie a été obtenue. Conclusions: L’IRM est capable de fournir des informations diagnostiques complètes et très précises, avec l’avantage supplémentaire de l’absence de rayonnements ionisants nocifs. Un protocole IRM de haute qualité pour le foie est également nécessaire pour établir un diagnostic correct.Background: The multiparametric ability and high-resolution 3T magnetic resonance imaging (MRI) plays a key role in non-invasive characterization of focal liver lesions (FLL). Some FLL have atypical features. New techniques such as diffusion-weighted sequences and hepatocyte-specific contrast agents are being currently used in clinical practice improving the detection and characterization of FLL. The study aimed to validate a high-quality hepatic imaging protocol using high-resolution MRI combined with diffusion and hepatocyte-specific contrast media for FLL diagnosis. Material and methods: 110 patients were liver investigated using a 3T high-resolution MRI (Phillips Ingenia) using body-phase array coil. The protocol included Dixon-all T1, T2, SPAIR and diffusion sequences. The enhanced MRI assumed the use of gadoxetic-acid (PRIMOVIST) Dixon-T1 sequences, including the hepatobiliary phase at 20 minutes and 30 minutes. Results: 65 patients were accurately diagnosed with benign lesions, including hemangiomas, cysts, focal nodular hyperplasia and adenomas. Among 45 malignant lesions we found metastasis, hepatocellular carcinoma (HCC) and one inflammatory pseudotumor. The lesions were followed-up or pathology was obtained. Conclusions: MRI is able to provide comprehensive and highly accurate diagnostic information, with the additional advantage of lack of harmful ionizing radiation. Also a high-quality liver MRI protocol is needed in order to establish a correct diagnosis

Increased risk of chikungunya infection in travellers to Thailand during ongoing outbreak in tourist areas : cases imported to Europe and the Middle East, early 2019

We report nine travellers with confirmed chikungunya virus infection, returning from tourist areas of Thailand to Sweden, Switzerland, the United Kingdom, Romania, Israel and France, diagnosed in January and February 2019. These sentinel tourists support the intensification of chikungunya virus circulation in Thailand and highlight the potential for importation to areas at risk of local transmission

Impact of Intermediate Hyperglycemia and Diabetes on Immune Dysfunction in Tuberculosis

Supplementary Data: Supplementary materials are available at Clinical Infectious Diseases online at https://academic.oup.com/cid/article/72/1/69/5857148#274319223 . Consisting of data provided by the authors to benefit the reader, the posted materials are not copyedited and are the sole responsibility of the authors, so questions or comments should be addressed to the corresponding author.Copyright © The Author(s) 2020. Background: People with diabetes have an increased risk of developing active tuberculosis (TB) and are more likely to have poor TB-treatment outcomes, which may impact on control of TB as the prevalence of diabetes is increasing worldwide. Blood transcriptomes are altered in patients with active TB relative to healthy individuals. The effects of diabetes and intermediate hyperglycemia (IH) on this transcriptomic signature were investigated to enhance understanding of immunological susceptibility in diabetes-TB comorbidity. Methods: Whole blood samples were collected from active TB patients with diabetes (glycated hemoglobin [HbA1c] ≥6.5%) or IH (HbA1c = 5.7% to <6.5%), TB-only patients, and healthy controls in 4 countries: South Africa, Romania, Indonesia, and Peru. Differential blood gene expression was determined by RNA-seq (n = 249). Results: Diabetes increased the magnitude of gene expression change in the host transcriptome in TB, notably showing an increase in genes associated with innate inflammatory and decrease in adaptive immune responses. Strikingly, patients with IH and TB exhibited blood transcriptomes much more similar to patients with diabetes-TB than to patients with only TB. Both diabetes-TB and IH-TB patients had a decreased type I interferon response relative to TB-only patients. Conclusions: Comorbidity in individuals with both TB and diabetes is associated with altered transcriptomes, with an expected enhanced inflammation in the presence of both conditions, but also reduced type I interferon responses in comorbid patients, suggesting an unexpected uncoupling of the TB transcriptome phenotype. These immunological dysfunctions are also present in individuals with IH, showing that altered immunity to TB may also be present in this group. The TB disease outcomes in individuals with IH diagnosed with TB should be investigated further.European Union’s Seventh Framework Programme (FP7 2007-2013 - Health) under grant agreement No 305279

Technological revolution, labor markets and income distribution in the knowledge economy

The concept of knowledge-based economy is a new model of economic development. In this article I am analyzing the defining elements of the knowledge economy in Europe and Romania, in terms of the technological revolution, the labor market and income distribution. In order to perform this analysis, I will use the following economic indicators: the scientific research spending, the number of patents and the Gini index. To effectively compare the economic indicators that define the knowledge economy in the EU and in our country, I will test a series of econometric equations that describe the correlations between the Gini indexes and the determinant factors of the technological progress. Due to the complexity of interactions there will be used autoregressive tools. The comparison of the different forms of econometric estimation will take into consideration the results of similar studies in the literature, respectively the specific conditions in Romania. There will be analyzed the implications of new technologies on labor market and the income dynamics in the Romanian economy. On the other hand, there will be taken into account the impact of the current global economic crisis on the economic indicators analyzed. The conclusions of the analysis will be reported to the requirements of the EU’s strategic programs, in particular the “Europe 2020”

Pushing XML queries inside relational databases

, Donald Kossmann z The`me 3-- Interaction homme-machine, images, donne&apos;es, connaissances Projet Caravel Rapport de recherche nr ^ 4112-- January 2001-- 41 page

The coin of morality

Looking for an idealization of the business environment, we notice that private businesses which have set ethic goals in business achieved a much higher profit growth rate than similar businesses that have not set business ethic codes. Of course, entrepreneurs decide their own interests and do not consider that the action of social responsibility has to be mechanical. In fact, if we consider a free-market capitalist system, the entrepreneur should have an ethical behavior in business or to choose a moral voluntary attitude. The present paper is looking to see if, in a material, rational and a no-matter-what profit oriented attitude world, a moral capitalism is possible to exist. By the more significant phenomena of globalization, entrepreneurs can be considered selfish people, performing immoral actions, with a predisposition of owning everything, without thinking at the old ideals. Nowadays, the entrepreneurs act only in the direction of getting the profit and very few of them have a moral motivation. The man in the modern capitalist world is looking only for his own interest in order to satisfy his desires and aspirations at a level as high as possible. A normal and natural thing, in fact. Therefore, no matter the role of the entrepreneur, there is the possibility to create cultural ways to solve ethical and social problems, and also methods that make moral capitalism principles to be functional, and, thus, a convergence between the free market and entrepreneurial ethics to be possible