Could near focus endoscopy, narrow-band imaging, and acetic acid improve the visualization of microscopic features of stomach mucosa?

BACKGROUND: Conventional magnifying endoscopy with narrow-band imaging (NBI) observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules, subepithelial capillary network, and gastric pits. AIM: To evaluate the effectiveness of a new one-dual (near) focus, NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification. METHODS: During 2021 and 2022, 68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid (AA). The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa. At the time of the endoscopy, the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy (WLE), near focus (NF), NF-NBI, AA-NF, and AA-NF-NBI modes. RESULTS: The WLE, NF and NF-NBI endoscopic modes for all patients (204 images) were classified in the same order into three groups. Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order. According to all three observers who completed the work independently, NF magnification was significantly superior to WLE (P < 0.01), and the NF-NBI mode was significantly superior to NF magnification (P < 0.01). After applying AA, the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF (P < 0.01). Interobserver kappa values for WLE were 0.609, 0.704, and 0.598, respectively and were 0.600, 0.721, and 0.637, respectively, for NF magnification. For the NF-NBI mode, the values were 0.378, 0.471, and 0.553, respectively. For AA-NF, they were 0.453, 0.603, and 0.480, respectively, and for AA-NF-NBI, they were 0.643, 0.506, and 0.354, respectively. CONCLUSION: When investigating gastric mucosa in microscopic detail, NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules, subepithelial capillary network, and gastric pits among the five endoscopic modalities investigated in this study. AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.

Scientometrics and academia.

The social significance and quality of every human activity are proportional to its usefulness to the social community. Science belongs to the very top of the processes and events in the history of humankind that strongly influenced the development of society, which over time transformed it and contributed to the common good. Science produced new knowledge that made it possible for billions of people to rise out of poverty, develop industrialization and mass communication, eradicate many dangerous diseases for humankind, and enable humans to leave their footprints on the moon. Science is a human activity that produces new knowledge presented through innovations, patents, and publications, aimed at solving the problems facing humanity. Read more in the PDF.

Current trends in acute pancreatitis: Diagnostic and therapeutic challenges.

Acute pancreatitis (AP) is an inflammatory disease of the pancreas, which can progress to severe AP, with a high risk of death. It is one of the most complicated and clinically challenging of all disorders affecting the abdomen. The main causes of AP are gallstone migration and alcohol abuse. Other causes are uncommon, controversial and insufficiently explained. The disease is primarily characterized by inappropriate activation of trypsinogen, infiltration of inflammatory cells, and destruction of secretory cells. According to the revised Atlanta classification, severity of the disease is categorized into three levels: Mild, moderately severe and severe, depending upon organ failure and local as well as systemic complications. Various methods have been used for predicting the severity of AP and its outcome, such as clinical evaluation, imaging evaluation and testing of various biochemical markers. However, AP is a very complex disease and despite the fact that there are of several clinical, biochemical and imaging criteria for assessment of severity of AP, it is not an easy task to predict its subsequent course. Therefore, there are existing controversies regarding diagnostic and therapeutic modalities, their effectiveness and complications in the treatment of AP. The main reason being the fact, that the pathophysiologic mechanisms of AP have not been fully elucidated and need to be studied further. In this editorial article, we discuss the efficacy of the existing diagnostic and therapeutic modalities, complications and treatment failure in the management of AP.

Portal vein aneurysm-etiology, multimodal imaging and current management.

Portal vein aneurysm (PVA) is a rare vascular abnormality, representing 3% of all venous aneurysms in the human body, and is not well understood. It can be congenital or acquired, located mainly at the level of confluence, main trunk, branches and bifurcation. A PVA as an abnormality of the portal venous system was first reported in 1956 by Barzilai and Kleckner. A review from 2015 entitled "Portal vein aneurysm: What to know" considered fewer than 200 cases. In the last seven years, there has been an increase in the number of PVAs diagnosed thanks to routine abdominal imaging. The aim of this review is to provide a comprehensive update of PVA, including aetiology, epidemiology, and clinical assessment, along with an evaluation of advanced multimodal imaging features of aneurysm and management approaches.

Unveiling the incidences and trends of the neglected zoonosis cystic echinococcosis in Europe: a systematic review from the MEmE project.

The neglected zoonosis cystic echinococcosis affects mainly pastoral and rural communities in both low-income and upper-middle-income countries. In Europe, it should be regarded as an orphan and rare disease. Although human cystic echinococcosis is a notifiable parasitic infectious disease in most European countries, in practice it is largely under-reported by national health systems. To fill this gap, we extracted data on the number, incidence, and trend of human cases in Europe through a systematic review approach, using both the scientific and grey literature and accounting for the period of publication from 1997 to 2021. The highest number of possible human cases at the national level was calculated from various data sources to generate a descriptive model of human cystic echinococcosis in Europe. We identified 64 745 human cystic echinococcosis cases from 40 European countries. The mean annual incidence from 1997 to 2020 throughout Europe was 0·64 cases per 100 000 people and in EU member states was 0·50 cases per 100 000 people. Based on incidence rates and trends detected in this study, the current epicentre of cystic echinococcosis in Europe is in the southeastern European countries, whereas historical endemic European Mediterranean countries have recorded a decrease in the number of cases over the time.

Percutaneous biliary drainage for obstructive jaundice in patients with inoperable, malignant biliary obstruction.

Aim of the study: Most of the malignancies leading to obstructive jaundice are diagnosed too late when they are already advanced and inoperable, with palliation being the only treatment option left. Due to progressing hyperbilirubinaemia with its consequent adverse effects, biliary drainage must be established even in advanced malignancies. This study aims to investigate and analyse factors that affect clinical outcomes of percutaneous trans-hepatic biliary drainage (PTBD) in patients with obstructive jaundice due to advanced inoperable malignancy, and identify potential predictors of patient survival. Study design: Observational retrospective cohort study. Material and methods: Baseline variables and clinical outcomes were evaluated in 108 consecutive patients treated with PTBD. The study's primary endpoints were significant bilirubin level decrease and survival rates. Secondary endpoints included periprocedural major and minor complication rates and catheter primary and secondary patency rates. Results: PTBD was technically successful and bile ducts were successfully drained in all 108 patients. Median serum bilirubin level, which was 282 (171-376) µmol/l before drainage, decreased significantly, to 80 (56-144) µmol/l, 15 days after stent placement (p < 0.001). Patient survival ranged from 3 to 597 days and the overall (median) survival time following PTBD was 168 days (90-302). The 1, 3, 6, 12 and 18-month survival rates were 96.3%, 75.9%, 48.1%, 8.3% and 1.9%, respectively. Multivariate analysis revealed that liver metastases and alkaline phosphatase were significantly associated with mortality. The overall complication rate was 9.3%. Conclusions: PTBD is a safe and effective method to relieve jaundice caused by advanced inoperable malignant disease. Careful patient selection is necessary when introducing PTBD in order to avoid invasive procedures in patients with a poor prognosis.

SCIENCE METRICS SYSTEMS AND ACADEMIC PROMOTION: BOSNIAN REALITY.

Societal importance and the quality of scientific research highly depend on the usefulness of the results of research for the societal and scientific community. The wish to allocate the funds to high-quali-ty research and to establish right criteria for scientific evaluation and academic career progression, make scientific criteria increasingly important to measure the quality of research and knowledge valorization. However, it is very difficult to apply the right criteria which can objectively assess scientific research. For many years, there has been a great interest in scientific ranking and evaluation of scientific journals, but also of sci-entific contribution of scientists. It is generally accepted that the IF (WoS) and the total number of citations of articles published in the journal, are the most relevant parameters of the journal's significance. However, the significance of a scientist and the value of their scientific production are much more complicated to evaluate and they cannot be directly reflected by the importance of the journals in which their articles are published. In this article, the authors describe and evaluate the most known scientific databases which are used in science. The majority of existing science metric systems, which evaluate the achievement of scientists are focused solely on the number of citations of their articles. For example, H-index, which is calculated as the lowest ranked ar-ticle which number of citations matches its ranking number, has considerable shortcoming because it does not take into account the individual contribution of each author and allows expanding author lists with authors whose contribution may be insignificant or none. Therefore, the authors propose Z-score, as a new science met-ric system, which takes into account the author's contribution to the scientific article and greatly remedy major discrepancies in evaluating scientific production of individual authors and institutions.

Dilemmas about instructions for administering drugs and indications for their use: is there negative effect of pharmaceutical industry?

Instructions for administering some drugs and indications for their use raise certain dilemmas and controversies questioning the appropriateness of the treatment in this way. In this article, some controversies regarding the prescribing of statins in patients whose blood cholesterol level is normal and the use of anticoagulants in the elderly patients without blood clots prior to the treatment are described. Also, it is discussed about some controversies regarding the use of the insulin analogues in the treatment of patients with diabetes mellitus.

Changes in Splenic Volume After the Treadmill Exercise at Specific Workloads in Elite Long-Distance Runners and Recreational Runners.

INTRODUCTION: Spleen acts as blood reservoir both in animals and human beings. Spleen contracts during the exercise and so augment the systemic circulation and helps body to maintain longer on high intensity exercise. Reviewing all available literature, the human spleen shows a decrease in volume, in range from 8% to 56%, depending on the work intensity. AIM: To evaluate the percentage of the decrease in splenic volume after the treadmill exercise at specific workloads: aerobic threshold intensity, anaerobic threshold intensity, submaximal intensity and maximal intensity. METHODS: This prospective study with repeated measurements included 16 healthy subjects, divided in two groups. First group consisted of 8 elite long-distance runners and second group of 8 recreational runners. First testing consisted of treadmill ergospirometry test. This data was crucial for the second testing where subjects were exercising on treadmill at specific workloads. Four specific workloads were determined: treadmill exercise at aerobic threshold intensity (1st workload), anaerobic threshold intensity (2nd workload), submaximal intensity (3rd workload) and maximal intensity (4th workload). Workloads were controlled by the speed of treadmill, for each subject individually regarding the ergospirometry test. Ultrasound measurement of spleen was done before and after each workload. RESULTS: Elite long-distance runners showed greater spleen contraction than recreational runners after four workloads. Spleen contraction was the biggest after the 3rd workload in elite long-distance runners. Smallest contraction was in group of recreational runners after the 1st workload. Statistically significant difference was not found between the groups, regarding the splenic volume after exercise at four specific workloads (p>0.05). CONCLUSION: Elite long-distance runners had greater decrease in splenic volume than recreational runners, after exercise at four specific workloads, without significant difference. Greatest decrease happened in elite long-distance runners, after exercise at submaximal intensity - 49% decrease in splenic volume.

Comparison of Conventional Ultrasound and Contrast Enhanced Magnetic Resonance (MR) Enterography in Evaluation Patients with Crohn's Disease.

INTRODUCTION: The small intestine is a challenging organ for clinical and radiological evaluation, and by introducing imaging radiological techniques, not significantly disturbing the comfort and safety of patients, it attempts to obtain adequate diagnosis and valuable information. AIM: The research was conducted with the aim of checking the comparability and potential of diagnostic modality of ultrasound and dynamic contrast enhanced MR Enterography (DCE-MR) in patients with Crohn's disease. METHODS: 55 patients were examined prospectively, and ultrasound examination of the abdomen was performed for all patients before the MR enterography. They were subsequently endoscopically examined or treated surgically, which was taken as a reference. Four parameters characterizing the disease itself were analyzed: bowel wall thickening, presence of abscess, fistula and lymphadenopathy. RESULTS: Comparing the accuracy of the results of ultrasound findings and findings of MR enterography, it was found that there is a significant difference in the results obtained. The study found that the sensitivity for MR enterography for bowel wall thickening was 97.8%, and the specificity was 70%, while the sensitivity for ultrasound for the bowel wall thickening was 51% and the specificity was 100%. In the diagnosis of abscess, there was no significant difference between the results obtained by ultrasound and magnetic resonance imaging (MRI) findings, while in fistula and lymphadenopathy there was a significant difference. CONCLUSION: Conventional ultrasound is a good orientation method in the initial evaluation of patients with Crohn's disease, while contrast enhanced MR enterography provides an excellent assessment for disease activity as well as the complications that accompany it.

Significance of diffusion weighted imaging (DWI) as an improving factor in contrast enhanced magnetic resonance imaging (MRI) enterography in evaluation of patients with Crohn's disease.

Aim To determine capabilities and potential of contrast enhanced magnetic resonance imaging (MRI) enterography in order to establish the diagnosis and to evaluate severity and activity of intestinal inflammation. Methods Fifty-five patients with suspicion for presence of Crohn's disease were evaluated. All patients underwent contrast enhanced MRI enterography and diffusion weighted imaging (DWI), and subsequently endoscopic examination or surgical treatment. Four parameters were analysed: thickening of the bowel wall, and presence of abscess, fistula and lymphadenopathy. Results Comparing results of DWI and contrast enhanced MRI enterography a significant difference between results given through diffusion and histopathological test was found, e.g. a significant difference between results obtained through diffusion and MRI enterography was found. MRI enterography sensitiveness for bowel wall thickening was 97.7% and specificity 70%, whilst DWI sensitivity for bowel wall thickening was 84% and specificity 100%. The diagnostics of abscess and fistula showed no significant difference between DWI and MRI, while in lymphadenopathy significant difference between contrast enhanced MRI enterography and DWI was found. Conclusion Contrast enhanced MRI enterography in combination with DWI allows for excellent evaluation of disease activity, but also problems or complications following it. The examination can be repeated, controlled, and it can contribute to monitoring of patients with this disease.

Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis.

AIM: The assessment of the severity of acute pancreatitis (AP) is important for proper management of the disease and for its prognosis. The aim was to correlate clinical, biochemical, and imaging diagnostic parameters and evaluate their prognostic values in the early assessment of severity of AP. MATERIALS AND METHODS: We prospectively studied 128 consecutive patients with AP. The predictors were clinical, biochemical, and imaging diagnostic parameters. The outcome measure was the occurrence of complications. Abdominal sonogram, contrast-enhanced computer tomography, and pancreatitis-specific clinical and laboratory findings were done. RESULTS: According to the Atlanta classification, 84 patients (65.6%) had mild and 44 (34.4%) had severe AP. The severity markers were significantly different between the mild and the severe groups (p < 0.001). Leukocyte count, serum albumin level, C-reactive protein (CRP), Ranson, acute physiology and chronic health evaluation II (APACHE II), and Glasgow score were the factors associated with radiological severity grade. Leukocyte count, CRP, Ranson score, APACHE II, and Glasgow score were the factors associated with the number and appearance of acute fluid collections (AFCs). A significant association was found between the number of AFCs and the occurrence of complications [odds ratio 4.4; 95% confidence interval 2.5-7.6]. Hospital stay was significantly longer in the group with severe disease as compared with the group with mild disease (p < 0.001). CONCLUSION: Clinical, biochemical, and imaging diagnostic parameters are related to the clinical course of AP and they can predict its severity. This allows us to determine the severity of the disease and to target the patients with high scores for close monitoring and more aggressive intervention.How to cite this article: Zerem D, Zerem O, Zerem E. Role of Clinical, Biochemical, and Imaging Parameters in predicting the Severity of Acute Pancreatitis. Euroasian J Hepato-Gastroenterol 2017;7(1):1-5.