Feasibility of Transient Elastography with M and XL probes in real life

Abstract Aim: Reliable liver stiffness measurements (RLSM) using Transient Elastography (TE) with the standard M probe are difficult to obtain in overweight (BMI≥25kg/m 2 ) and obese (BMI>30kg/m 2 ) patients. The aim of our paper was to assess the feasibility of TE in daily practice using both M and XL probes. Material and method: We studied retrospectively 3235 patients with chronic liver disease assessed by TE first by the M probe (standard probe -transducer frequency 3.5 MHz), and if the measurements were unreliable, with the XL probe (transducer frequency 2.5 MHz). Reliable measurements were defined as the median of 10 valid measurements with a success rate ≥ 60% and an interquartile range < 30%. Results of liver elasticity were expressed in kiloPascals (kPa). Results: RLSM by M probe were obtained in 62.2% (2015/3235) patients, and by XL probe in 1011/1220 (80%) of patients with unreliable measurements by M probe; thus we obtained RLSM in 93.5% of 3235 cases. In overweight patients we obtained RLSM in 89.9% (1039/1156) cases: in 63.1

Gastrointestinal and Liver Complications in Patients with Diabetes Mellitus—A Review of the Literature

The number of diabetes mellitus patients has increased over the last few years in developing countries, along with obesity and sedentary lifestyle. Besides macroangiopathy and microangiopathy, damage to the nerve fibers of the peripheral nervous system is the most common chronic complication of diabetes. Digestive complications in diabetic patients represent a consequence of diabetic autonomic neuropathy involving the gastrointestinal tract, but unfortunately not always evaluated by diabetologists. Aside from the complications encountered in the digestive tract, patients with diabetes mellitus are prone to developing liver diseases. This review will describe the prevalence of these complications, the modality of diagnosis, and therapeutical solutions in order to reduce the risk of progression of these complications in diabetic subjects

Contrast-Enhanced Harmonic Endoscopic Ultrasound-Guided Fine-Needle Aspiration versus Standard Fine-Needle Aspiration in Pancreatic Masses: A Propensity Score Analysis

Background: Whether endoscopic ultrasound (EUS) contrast-enhanced fine-needle aspiration (CH-EUS-FNA) determines superior results in comparison to standard EUS-FNA in tissue acquisition of pancreatic masses remains unclear. The aim of this study was to compare these two techniques on a series of patients with solid pancreatic lesions. Methods: 362 patients underwent EUS-FNA (2008–2019), after the propensity score matching of two groups were compared; 103 treated with CH-EUS-FNA (group 1) and 103 with standard EUS-FNA (group 2). The primary outcome was the diagnostic accuracy. Secondary outcomes were sensitivity, specificity, and sample adequacy. Results: Diagnostic sensitivity was 87.6% in group 1 and 80% in group 2 (p = 0.18). The negative predictive value was 56% in group 1 and 41.5% in group 2 (p = 0.06). The specificity and positive predictive values were 100% for both groups. Diagnostic accuracy was 89.3% and 82.5%, respectively (p = 0.40). Sample adequacy was 94.1% in group 1 and 91.2% in group 2 (p = 0.42). The rate of adequate core histologic samples was 33% and 28.1%, respectively (p = 0.44), and the number of needle passes to obtain adequate samples were 2.4 ± 0.6 and 2.7 ± 0.8, respectively (p = 0.76). These findings were confirmed in subgroup analyses, conducted according to lesion size and contrast enhancement pattern. Conclusions: CH-EUS-FNA does not appear to be superior to standard EUS-FNA in patients with pancreatic masses

Comparative Study Regarding the Chemical Composition and Biological Activity of Pine (<i>Pinus nigra</i> and <i>P. sylvestris</i>) Bark Extracts

The bark resulted after the industrial processing of wood represents a byproduct of the forestry industry, used in many suboptimal ways, being considered a natural waste. Currently, it has been highlighted that the bark of different woody plants may be an important source of several bioactive compounds, with various beneficial biological functions. The aim of this study is to evaluate and compare the chemical composition and biological activities of two different pine species (Pinus nigra and Pinus sylvestris) bark extracts. Ultrasound (UAE) and microwave (MAE) assisted extractions were performed in order to obtain the extracts. The total polyphenol (TPC) and total tannin (TTC) contents of the extracts were assessed via the Folin–Ciocâlteu method. The volatile and polyphenolic compounds were identified and quantified via a GC/MS analysis and an UPLC-PDA analysis, respectively. The antioxidant activity (AOA) was evaluated using the DPPH and ABTS assays, while the antibacterial activity was assessed using the minimum inhibitory concentration (MIC) protocol. The results showed that the Pinus sylvestris bark extracts obtained by UAE had a higher TPC, TTC and AOA, while the Pinus nigra bark extracts obtained by MAE had higher volatile compounds content (mainly α-pinene and β-pinene). Moreover, the inhibition of the bacterial growth was more efficient in the case of Pinus sylvestris extracts, Gram-positive bacteria being the most affected, while Gram-negative strains presented a relative resistance to the tested extract concentrations. These results may indicate the potential use of the pine bark extracts as antioxidant or antibacterial agents

Genetic Predisposition to Primary Lactose Intolerance Does Not Influence Dairy Intake and Health-Related Quality of Life in Romanian Children: A Hospital-Based Cross-Sectional Study

Background: Primary lactose intolerance (PLI) is characterized by the inability to digest lactose. Homozygotes for the lactase gene polymorphisms (CC or GG) are considered to be genetically predisposed to PLI. Still, symptoms may only be present later in life. The evidence supporting a link between PLI, dairy intake, and quality of life (QoL) is limited in children. Aim: This study investigates the link between LCT polymorphisms and suggestive symptoms and the influence of the genetic predisposition to PLI on dairy intake and QoL in Romanian children. Materials and methods: We recruited consecutive children evaluated in our ambulatory clinic. We asked all participants to complete a visual-analog symptoms scale, a dairy intake, and a QoL questionnaire. We used strip genotyping to identify genetic predisposition to PLI. Results: 51.7% of children had a CC genotype, and 34.5% also had a GG genotype. Most children reported no or mild symptoms. Dairy intake and QoL were similar across study groups. Conclusions: Our study shows that genetic predisposition does not necessarily assume the presence of specific symptoms. Genetic predisposition to PLI did not lead to dairy avoidance, nor did it negatively influence our children’s QoL

Dynamic Changes in Liver Stiffness in Patients with Chronic Hepatitis B Undergoing Antiviral Therapy

This is a retrospective single-center study that included 87 subjects. All subjects had chronic hepatitis B or HBV cirrhosis and underwent nucleos(t)ide analogs (NUC) treatment for more than one year. The study aimed to evaluate the dynamic changes in liver stiffness (LS) measured by transient elastography (TE) during a median interval of 64 months. Patients were assessed prior to starting therapy and followed up annually. Liver stiffness measurements (LSM) were performed annually, and ten valid LSMs were obtained in each session. Reliable LSMs were defined as the median value of 10 measurements with Interquartile range/median (IQR/M) &le; 30%. A significant decrease in liver stiffness values (p &lt; 0.001) was observed during follow-up. In patients with liver cirrhosis, the LSMs decreased significantly after only one year, 24.6 &plusmn; 4.3 kPa vs. 13.5 &plusmn; 4.2 kPa (p = 0.007), whereas the decrease in non-cirrhotic patients was not significant, 7.31 &plusmn; 3.62 vs. 6.80 &plusmn; 2.41 (p = 0.27). Liver stiffness decrease was more significant in patients with initially higher transaminases. Undetectable viral load was achieved in 73.5% of patients in year one, 82.7% in year two, and 90.8% in year three of treatment. In conclusion, our study reveals a decrease in liver stiffness by TE in patients with chronic hepatitis B when undergoing anti-HBV therapy in the first two years. It can be used as a method for follow-up in patients undergoing NUC therapy

Biological Activity of Bark Extracts from Northern Red Oak (Quercus rubra L.): An Antioxidant, Antimicrobial and Enzymatic Inhibitory Evaluation

The northern red oak (Quercus rubra L.) is an ornamental oak species native to eastern America, being an invasive species in Europe, with increasing coverage. The aim of this work was to evaluate the biological potential of red oak bark extracts. Aqueous and ethanolic preparations were obtained by two extraction methods: ultrasonic-assisted extraction (UAE) and microwave assisted extraction (MAE). The total phenolic and tannin contents were measured using spectrophotometric methods. The antioxidant activity was evaluated by two complementary methods (DPPH and ABTS). Antimicrobial potential was tested against five bacteria and three Candida species, and the effect on biofilm formation and synergism with gentamicin was also evaluated. Finally, enzyme inhibitory properties were assessed for &alpha;-glucosidase, tyrosinase, and acetylcholinesterase. The results indicated a higher phenolic content for the extracts obtained through MAE, while UAE bark extracts were rich in tannins. All the extracts exhibited antioxidant, anti-glucosidase, and anti-tyrosinase activity, while the antibacterial potential was mostly observed for the MAE extracts, especially against S. aureus, C. parapsilopsis, and C. krusei; inhibition of biofilm formation was observed only for MRSA. These findings show that the red oak bark might be an important source of bioactive compounds with antioxidant and antimicrobial properties

A Comparative Analysis of Polyphenol Content and Biological Potential of <i>Quercus petraea</i> Matt. and <i>Q. pubescens</i> Willd. Bark Extracts

Quercus wood (oak wood) is a valuable resource, which has led to the intense processing of oak trees by the forestry industry. As a result, large amounts of forestry by-products (bark and leaves) are left in the woods, considered valueless. Thus, the aim of this study was to evaluate and compare the phytochemical profile and potential biological activities of Q. petreaea Matt. and Q. pubescens Willd. bark extracts. The extracts were obtained by microwave (MAE) and ultrasound-assisted extraction (UAE) with water (100%) and ethanol:water (70:30). These extracts were then characterized in terms of the total polyphenolic and tannin contents using the Folin–Ciocâlteu method. Their antioxidant properties were determined by observing the neutralizing effects of the extracts against 1,1-diphenyl-2-picrylhydrazyl (DPPH) and 2,2′-azino-bis(3-ethylbenzothiazoline)-6-sulfonic acid (ABTS) radicals. The antimicrobial effect was tested on Gram-positive and Gram-negative bacterial strains and three fungi from the Candida genus. Cellular counts were measured to determine the cytotoxic effects of the extracts on HEK 293T cell lines. Moreover, spectrophotometrical assays were performed to assess the inhibitory effects of the extracts against the enzymatic activity of α-glucosidase, tyrosinase, and acetylcholinesterase. The MAE resulted in higher yields of polyphenolic compounds and tannins compared to the UAE bark extracts. All of the experimental variants exhibited free-radical-neutralizing properties, especially Q. petraea extracts. Q. petraea extracts also had a more efficient antibacterial effect, especially against Gram-positive bacteria and K. pneumoniae. Antifungal activity was highlighted against C. krusei. Cell counts indicated a cytotoxic effect of the tested extracts against HEK 293T cells. The tested extracts inhibited the activity of α-glucosidase, tyrosinase, and acetylcholinesterase, indicating the potential use of these extracts as antidiabetic, neuroprotective, and skin-protecting agents. These findings highlight the untapped therapeutic potential of the bioactive compounds found in the bark of Q. petraea and Q. pubescens