Zenker's peroral endoscopic myotomy for management of large Zenker's diverticulum.

BACKGROUND: Zenker's diverticulum peroral endoscopic myotomy (zPOEM) is a minimally invasive treatment strategy for Zenker's diverticulum, with excellent results for management of small-to-moderate Zenker's diverticulum. We evaluated its use in the management of large Zenker's diverticulum. METHODS: This was a retrospective multicenter cohort study across 11 international centers including adult patients with large Zenker's diverticulum ≥ 40 mm treated by zPOEM between March 2017 and March 2022. The primary outcome was clinical success (dysphagia score ≤ 1 without need for further intervention). Secondary outcomes included technical success (complete myotomy as intended), adverse events (AEs), and rate of recurrence. RESULTS: 83 patients (male 62.7 %, mean age 72.6 [SD 11.5] years) underwent zPOEM for treatment of large Zenker's diverticulum (median size 50 mm, interquartile range [IQR] 41-55 mm, range 40-80 mm). The zPOEM procedure was technically successful in 82 patients (98.8 %), with a mean procedure time of 48.7 (SD 23.2) minutes. Clinical success was achieved in 71 patients (85.5 %). Median (IQR) symptom scores improved significantly from baseline for dysphagia (2 2 3 vs. 0 [0-2]; P < 0.001), regurgitation (3 2 3 4 vs. 0 [0-0]; P < 0.001), and respiratory symptoms (2 [0-3] vs. 0 [0-0]; P < 0.001). Among patients achieving clinical success, only one recurrence (1.4 %) was recorded during a median follow-up of 12.2 months (IQR 3-28). Post-procedure AEs, all mild to moderate, occurred in four patients (4.8 %). CONCLUSION: This study demonstrated safe and effective use of zPOEM in the management of large Zenker's diverticulum.

Metabolomics as a Tool to Elucidate the Sensory, Nutritional and Safety Quality of Wheat Bread-A Review.

Wheat (Triticum aestivum) is one of the most extensively cultivated and used staple crops in human nutrition, while wheat bread is annually consumed in more than nine billion kilograms over the world. Consumers' purchase decisions on wheat bread are largely influenced by its nutritional and sensorial characteristics. In the last decades, metabolomics is considered an effective tool for elucidating the information on metabolites; however, the deep investigations on metabolites still remain a difficult and longtime action. This review gives emphasis on the achievements in wheat bread metabolomics by highlighting targeted and untargeted analyses used in this field. The metabolomics approaches are discussed in terms of quality, processing and safety of wheat and bread, while the molecular mechanisms involved in the sensorial and nutritional characteristics of wheat bread are pointed out. These aspects are of crucial importance in the context of new consumers' demands on healthy bakery products rich in bioactive compounds but, equally, with good sensorial acceptance. Moreover, metabolomics is a potential tool for assessing the changes in nutrient composition from breeding to processing, while monitoring and understanding the transformations of metabolites with bioactive properties, as well as the formation of compounds like toxins during wheat storage.

Fatty Acids, Volatile and Sensory Profile of Multigrain Biscuits Enriched with Spent Malt Rootles.

Spent malt rootlets, a by-product of the brewing industry, are a rich source of protein, essential amino acids, healthy fats, polyphenols and minerals, and could be a new promising type of raw material from the nutritional, economic, sensory, and technical perspectives. However, their specific aroma profile could limit their addition in baked products. The aim of this work was to study the effect of spent malt rootlets addition on volatile derivatives of enriched biscuits in relation to their sensory profile. For this purpose, spent malt rootlets and enriched biscuits (0-25% spent malt rootlets added) were analyzed by GC-MS techniques, in order to obtain their fatty acids methyl esters and volatile compounds profile, while for the sensory analysis a nine-point hedonic score test was used. The results of this study reveal the fatty acids and volatile profile of spent malt rootlets and of the enriched biscuits with spent malt rootlets pointing out the contribution of fatty acids to the generation of aroma compounds. The influence of different aroma compounds on the consumer's preferences was studied and the optimum level addition of spent malt rootlets in multigrain biscuits was found to be 15%.

Quality Characteristics and Volatile Profile of Macarons Modified with Walnut Oilcake By-product.

Walnut oilcake is a low-cost by-product of the edible oil industry but at the same time it is a valuable source of dietary fiber, natural antioxidants, and polyunsaturated fatty acids. In the context of health-friendly confectionary food products and to reduce the production cost, the aim of this study was to investigate the effect of walnut oilcake by-product on the quality characteristics and volatile profile of modified macarons. For this purpose, GC-MS and ITEX/GC-MS techniques were used to obtain the fatty acids methyl esters and the volatile profiles; physicochemical analyzes were performed to determine the nutritional characteristics and a nine-point hedonic scale test was performed for the sensory characteristics. The substitution of almond flour with 0%, 10%, 25% and 50% walnut oilcake powder increased the fiber, total phenolic content, and antioxidant capacity. Hedonic scores of the macaron samples made with different percentage of walnut oilcake decreased to additions of over 10%. Moreover, this result is emphasized by Pearson's correlation parameters indicating as optimal addition for modified macarons, percentages up to 10% of walnut oilcake. This approach could reduce the costs related to the acquisition of the ingredients due to the oilcake price which is 3% of the almonds flour price.

Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients be Associated with the Presence of Variceal Hemorrhage?

Background and objectives: Variceal bleeding is a serious complication caused by portal hypertension, frequently encountered among cirrhotic patients. The purpose of this study was to determine whether the aspect of the collateral, porto-systemic circulation, as detected by CT are associated with the presence variceal hemorrhage (VH). Materials and Methods: 81 cirrhotic patients who underwent a contrast-enhanced CT examination were retrospectively included in the study. Patients were divided into two groups: Cirrhotic patients with variceal hemorrhage during the hospital admission concomitant, with the CT examination (n = 33) and group 2-cirrhotic patients, without any variceal hemorrhage in their medical history (n = 48). The diameter of the left gastric vein, the presence or absence and dimensions of oesophageal and gastric varices, paraumbilical veins and splenorenal shunts were the indicators assessed on CT. Results: The univariate analysis showed a significant association between the presence of upper GI bleeding and the diameters of paraoesophageal veins, paragastric veins and left gastric vein respectively, all of these CT parameters being higher in patients with variceal bleeding. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17-2.19), p = 0.003). We found an optimal cut-off value of 3 mm for the diameter of the left gastric vein useful to discriminate among patients with variceal hemorrhage from the ones without it, with a good diagnostic performance (AUC = 0.78, Se = 97%, Sp = 45.8%, PPV = 55.2%, NPV = 95.7%).Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition.

Endoscopic ultrasound-guided tissue acquisition for the diagnosis of focal liver lesion.

In patients with liver tumors, the histopathology examination can assist in diagnosis, staging, prognosis, and therapeutic management strategy. Endoscopic ultrasound (EUS)-guided tissue acquisition using fine needle aspiration (FNA) or more newly fine needle biopsy (FNB) is a well-developed technique in order to evaluate and differentiate the liver masses. The goal of the EUS-FNA or EUS-FNB is to provide an accurate sample for a histopathology examination. Therefore, malignant tumors such as hepatocarcinoma, cholangiocarcinoma and liver metastasis or benign tumors such as liver adenoma, focal hyperplastic nodular tumors and cystic lesions can be accurately diagnosed using EUS-guided tissue acquisition. EUS-FNB using 19 or 22 Ga needle provide longer samples and a higher diagnostic accuracy in patients with liver masses when compared with EUS-FNA. Few data are available on the diagnostic accuracy of EUS-FNB when compared with percutaneously, ultrasound, computer tomography or transjugulary-guided liver biopsies. This review will discuss the EUS-guided tissue acquisition options in patients with liver tumors and its efficacy and safety in providing accurate samples. The results of the last studies comparing EUS-guided liver biopsy with other conventional techniques are presented. The EUS-guided tissue acquisition using FNB can be a suitable technique in suspected liver lesions in order to provide an accurate histopathology diagnosis, especially for those who require endoscopy.

Nutritional composition, in vitro carbohydrates digestibility, textural and sensory characteristics of bread as affected by ancient wheat flour type and sourdough fermentation time.

This study aimed to investigate the effect of ancient wheat flour type and sourdough fermentation time on the nutritional, textural and sensorial properties of fiber-rich sourdough bread. The proximate composition, minerals, carbohydrates, organic acids, volatiles, total phenolic content, simulated gastrointestinal digestion, textural and sensorial characteristics were investigated. Bread's minerals, total phenolics, cellulose contents and radical scavenging activity variations clearly indicates an increasing trend with sourdoughs fermentation time. Compared to maltose and glucose, fructose was predominant in all bread samples. Sourdough fermentation time and wheat type had non-significant influence on fructose content from digested fraction. Excepting emmer bread, fermentation time increased in vitro digestibility values for tested samples. The crumb textural parameters (hardness, gumminess, chewiness, cohesiveness and springiness index) were positively influenced by fermentation time. The specific clustering of the analysed characteristics distinguished emmer bread from other samples in terms of volatile compounds, textural and overall acceptability, being preferred by panellists.

Leuconostoc citreum: A Promising Sourdough Fermenting Starter for Low-Sugar-Content Baked Goods.

This review highlights Leuconostoc citreum's promising possibilities as a proficient mannitol producer and its potential implications for sugar reduction, with a focus on its use in sourdough-based baked good products. Mannitol, a naturally occurring sugar alcohol, has gained popularity in food items due to its low calorie content and unique beneficial qualities. This study summarizes recent research findings and investigates the metabolic pathways and culture conditions that favor increased mannitol production by Leuconostoc citreum. Furthermore, it investigates the several applications of mannitol in baked goods, such as its function in increasing texture, flavor and shelf life while lowering the sugar content. Sourdough-based products provide an attractive niche for mannitol integration, as customer demand for healthier and reduced-sugar options increases.

Antibacterial and Phytochemical Screening of Artemisia Species.

Taking into account the increasing number of antibiotic-resistant bacteria, actual research focused on plant extracts is vital. The aim of our study was to investigate leaf and stem ethanolic extracts of Artemisia absinthium L. and Artemisia annua L. in order to explore their antioxidant and antibacterial activities. Total phenolic content (TPC) was evaluated spectrophotometrically. Antioxidant activity was evaluated by DPPH and ABTS. The antibacterial activity of wormwood extracts was assessed by minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) in Escherichia coli, Staphylococcus aureus, Listeria monocytogenes, and Salmonella enteritidis cultures, and by zone of inhibition in Klebsiella carbapenem-resistant enterobacteriaceae (CRE) and Escherichia coli extended-spectrum ß-lactamases cultures (ESBL). The Artemisia annua L. leaf extract (AnL) exhibited the highest TPC (518.09 mg/mL) and the highest expression of sinapic acid (285.69 ± 0.002 µg/mL). Nevertheless, the highest antioxidant capacity (1360.51 ± 0.04 µM Trolox/g DW by ABTS and 735.77 ± 0.02 µM Trolox/g DW by DPPH) was found in Artemisia absinthium L. leaf from the second year of vegetation (AbL2). AnL extract exhibited the lowest MIC and MBC for all tested bacteria and the maximal zone of inhibition for Klebsiella CRE and Escherichia coli ESBL. Our study revealed that AbL2 exhibited the best antioxidant potential, while AnL extract had the strongest antibacterial effect.

Effects of Botanical Ingredients Addition on the Bioactive Compounds and Quality of Non-Alcoholic and Craft Beer.

Special beers, known as artisanal, are progressively gaining consumer preference, opening up competition, and acquiring more space in the market. Considering that, exploration for new formulations is justified and plants represent a source of novel compounds with promising antioxidant activity for this beer segment. This paper aims to evaluate the current knowledge on the role of botanical ingredients on the final yield of bioactive compounds in special beer, and how these molecules generally affect the sensory profile. Furthermore, the estimated difficulties of implementation, taking into account the new processes and the relative cost, are discussed. The addition of plants to beer could serve the interests of both the industry and consumers, on one hand, by improving the functional properties and offering a unique flavor, and on the other hand by adding variety to the craft beer landscape. This paper provides guidance and future directions for the development of new products to boost the brewing industry. Brewing processes might affect the valuable compounds, especially the phenolic content. Consequently, future studies need to identify new methods for protecting the level of bioactive compounds in special beer and increasing the bio-accessibility, along with optimization of the sensory and technological properties.

Freeze-Dried Powder of Fermented Chili Paste-New Approach to Cured Salami Production.

Fermented chili powders were obtained through the freeze-drying of fermented chili pastes and used as a condiment, acidifier, antioxidant, colorant, and microbial starter carrier in fermented salami production. Fermented chili powders were examined regarding carbohydrates, organic acids, vitamin C, phenolic compounds, carotenoids, and aroma profile. High concentrations of lactic (10.57-12.20%) and acetic acids (3.39-4.10%) were recorded. Vitamin C content was identified in the range of 398-1107 mg/100 g, with maximum values for C. annuum cv. Cayenne chili powder. Phenolic compounds showed values between 302-771 mg/100 g. Total carotenoid content was identified between 544-2462 µg/g, with high concentrations of capsanthin esters. Aroma profile analysis evidenced specific compounds (1-hexanol, 2-hexanol, hexenal, E-2-hexenal) with sensory importance and a more complex spectrum for Capsicum chinense cultivar. Plant-specific lactic acid bacteria showed dominance both in fermented chili paste, chili powder, and salami. Lactic and acetic acids from the fermented chili powder reduced the pH of the filling immediately, having a stabilizing effect on the meat. Nor molds or pathogens were identified in outer limits. Based on these results, fermented chili powders could be used as starter carriers in the production of fermented meat products for exceptional sensory properties and food safety management.

[Brown syndrome. General considerations. Case report]. / Sindromul Brown. Consideratii generale. Prezentare de caz clinic.

This is an overview of a few general aspects of Brown's syndrome followed by a case report of a three year old girl suffering from congenital Brown's syndrome, astigmatism and amblyopia, which was detected by an ophthalmological screening at her kindergarten. The main differential diagnosis is ipsilateral inferior oblique paresis/paralysis. Since this was a mild-degree syndrome, it didn't require surgery only optical treatement and follow-up.

The Impact of the COVID-19 Pandemic on Independent Creative Activities in Two Large Cities in Romania.

The COVID-19 pandemic has had both financial and activity-related effects on a number of areas of activity, among which those involving the creative industries have proved to be weak in their capacity to survive the halting of all events held in physical spaces. The long-term effects of the current health crisis are bringing about changes in cultural demand and offer and highlighting the need to adapt and to think of new ways of functioning. Taking its cue from this situation, the research underlying our article set out to investigate the ways in which Romania's independent creative sector is adapting. We achieved this by means of conducting 25 semi-structured interviews and undertaking case studies of two cities that are among the most effervescent from the point of view of cultural and creative industries, Timișoara and Cluj-Napoca. With the strengthening of this sector as the aim in view, the forms of early social resilience we identified are capable in the short term of taking action to ensure the survival of some of the spaces; in the medium term, through activating mechanisms that encourage entrepreneurial spirit, they will be able to adapt to any external shock.

Extrahepatic cholangiocarcinoma: Current status of endoscopic approach and additional therapies.

The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is poor. More than 50% of patients with jaundice are inoperable at the time of first diagnosis. Endoscopic treatment in patients with obstructive jaundice ensures bile duct drainage in preoperative or palliative settings. Relief of symptoms (pain, pruritus, jaundice) and improvement in quality of life are the aims of palliative therapy. Stent implantation by endoscopic retrograde cholangiopancreatography is generally preferred for long-term palliation. There is a vast variety of plastic and metal stents, covered or uncovered. The stent choice depends on the expected length of survival, quality of life, costs and physician expertise. This review will provide the framework for the endoscopic minimally invasive therapy in extrahepatic cholangiocarcinoma. Moreover, additional therapies, such as brachytherapy, photodynamic therapy, radiofrequency ablation, chemotherapy, molecular-targeted therapy and/or immunotherapy by the endoscopic approach, are the nonsurgical methods associated with survival improvement rate and/or local symptom palliation.

Textural and Sensory Features Changes of Gluten Free Muffins Based on Rice Sourdough Fermented with Lactobacillus spicheri DSM 15429.

Gluten free products available on the market have a low textural quality associated with high crumbly structure, low-flavor, aroma, poor mouthfeel, less appearance, in comparison with the conventional final baked products. The aim of this study was to assess the influence of rice sourdough fermented with Lactobacillus spicheri DSM 15429 strain on textural, volatile profile, and sensorial properties of gluten free muffins in order to obtain baked goods with improved quality characteristics. Lactobacillus spicheri is a novel strain isolated from industrial rice sourdough but unexploited for bakery products manufacturing. The results showed that Lactobacillus spicheri DSM 15429 was able to growth in the rice flour influencing the texture and the volatile profile of gluten free muffins as well as their sensory characteristics. Both, textural parameters and volatiles recorded significant differences comparing to muffins obtained with a spontaneously fermented rice sourdough. Hardness and cohesiveness decreased while springiness and resilience of gluten free muffins improved their values. The volatile profile of gluten free muffins was significantly improved by utilization of the rice sourdough fermented with Lactobacilus spicheri DSM 15429. 3-methylbutanal, 2-methylbutanal, acetophenone and limonene were the main volatile derivatives responsible for aroma and odor scores of sensory analysis.

Effect of Rice Flour Fermentation with Lactobacillus spicheri DSM 15429 on the Nutritional Features of Gluten-Free Muffins.

Lactobacillus Spicheri DSM 15429 strain was used to ferment rice flour, aiming at exploiting its influence on the amino-acids, minerals, lactic acid, total phenols, and antioxidant activity of the rice sourdough and gluten-free muffins. Gluten-free muffins were prepared by using 15% rice sourdough fermented with the above strain of lactic acid bacteria and compared with rice spontaneous fermentation. Methods like LC-MS (Liquid chromatography-mass spectrometry), AA (atomic absorption), HPLC (High-performance liquid chromatography), Folin-Ciocalteu, and 1,1-Diphenyl-2-picrylhydrazyl radical scavenging activity (DPPH) were used to fulfill the aim of the study. The addition of rice sourdough fermented with LAB was reflected in the chemical composition of the final baked good, improving its amount on bioactive compounds such as amino acids, mineral bioavailability, total phenols, and antioxidant activity. Total phenols and antioxidant activity increased their amount by 70.53% and 73.70%, respectively, meanwhile, lactic acid, minerals, and amino-acids increased their values at least twice. Thus, rice fermented with Lactobacilus spicheri DSM 15429 strain could be a tool to further increase the nutritional value of gluten-free baked products.

Flexible endoscopic treatment for Zenker's diverticulum - experience on 31 patients.

BACKGROUND AND AIMS: The aim of this study is to present the experience of our center over the last 8 years in a series of patients with Zenker's diverticulum (ZD), treated using an endoscopic, minimally invasive procedure. METHODS: We retrospectively included 31 patients with a previously established diagnosis of ZD based on endoscopic and oral contrast examinations. Patients' age, comorbidities, size of the diverticulum or previous endoscopic treatment were not considered exclusion criteria. A soft, flexible diverticuloscope to expose the septum and a dual knife for "cutting" the diverticular septum were used. We analyzed the short term efficacy based on symptomatic relief and occurrence of side effects, and long term efficiency at 6 and 12 months by clinical assessment, upper gastrointestinal endoscopy and oral contrast media passage. RESULTS: Patients had a mean age of 67 years (range 42-86); 55% of them were male. All patients reported symptom relief after the procedure. A decrease of more than 70% from the initial size of the diverticulum was noted. There were 3 cases (9.67%) of intraprocedural hemorrhage, endoscopically managed. No serious post-procedural complications and no mortality were reported. The mean procedural time was 21.87 minutes (range 15-25 minutes). Average hospitalization was 2.5 days. Five patients developed recurrence and needed a second session of endoscopic treatment for achieving complete myotomy. CONCLUSIONS: Endoscopic management for ZD was efficient and safe in our series of patients. A short hospitalization period was required.

Incidental findings during follow-up scans in oncological patients.

BACKGROUND AND AIM: To assess the prevalence of incidental findings during follow-up scans of patients with oncologic pathology. METHODS: 499 follow-up scans from different patients with cancer pathology were retrospectively analyzed. Findings which were not suspected by the clinician or known from previous scans were considered as incidental lesions. We excluded lesions that were already suspected by the clinician or were already recorded in the patient's history before the initial computed tomography (CT) scan. The CT scans were performed on two different machines ("Siemens Somatom Sensation, 64 slices, Erlangen, Germany" and "Siemens Somatom Emotion, 16 slices, Erlangen, Germany").Most of the patients had a native scan followed by a thoraco-abdominal-pelvic image acquisition after the injection of intravenous contrast media. RESULTS: 28% of the patients had unsuspected incidental findings. The prevalence of incidental findings was similar: 56.6% of them were found in men and 43.4% in female patients. In 6 cases (1.2%) the presence of unsuspected pulmonary embolism was discovered. From these cases, 5 (83.3%) had metastatic disease at the moment of the follow-up CT scan and 1 (16.6%) had metastasis-free disease. In 17 patients out of 499 (3.4%) we incidentally made an important discovery which either changed the cancer therapy or required immediate treatment. CONCLUSION: Incidental findings are not rare in oncological patients and the radiologist has to be aware of their presence in order not to overlook them and to correctly diagnose them.

Low-grade appendiceal mucinous neoplasm mimicking an adnexal mass.

We present a rare case of malignant epithelial neoplasm of the appendix, an uncommon disorder encountered in clinical practice, which poses a variety of diagnostic and therapeutic challenges. We report a particular case in which the appendix was abnormally located in the pelvis, mimicking an adnexal mass. Therefore, it was difficult to make the preoperative diagnosis on clinical examination, imaging studies and laboratory tests and we discovered the lesion during the diagnostic laparoscopy. No lymphadenopathy or mucinous ascites were found. The case was completely handled via the laparoscopic approach keeping the appendix intact during the operation. The frozen section, the detailed histopathology overview as well as multiple immunostaining with a complex panel of markers report diagnosed a low-grade appendiceal mucinous neoplasm (LAMN) with no invasion of the wall. No adjuvant therapy was considered needed. At a one-year follow-up oncological assessment, the patient was free of disease. In women with cystic mass in the right iliac fossa an appendiceal mucocele should be considered in the differential diagnosis. Laparoscopic appendectomy can represent an adequate operation for the appendiceal mucinous neoplasm if the histological report is clear and surgical precautionary measures are taken.