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Pancreatic exocrine and endocrine dysfunctions often come together in the course of pancreatic diseases as interdependent manifestations of the same organ. However, the mechanisms underlying the bidirectional connection of the exocrine and endocrine pancreas are not fully understood. In this review, we aimed to synthetize the current knowledge regarding the effects of several exocrine pancreatic pathologies on the homeostasis of β-cells, with a special interest in the predisposition toward diabetes mellitus (DM). We focused on the following pancreatic exocrine diseases: chronic pancreatitis, acute pancreatitis, cystic fibrosis, pancreatic cancer, pancreatic resections, and autoimmune pancreatitis. We discuss the pathophysiologic mechanisms behind the impact on β-cell function and evolution into DM, as well as the associated risk factors in progression to DM, and we describe the most relevant and statistically significant findings in the literature. An early and correct diagnosis of DM in the setting of pancreatic exocrine disorders is of paramount importance for anticipating the disease's course and its therapeutical needs. [ABSTRACT FROM AUTHOR]

Background and Objectives: Inflammatory bowel diseases (IBD) are chronic conditions with an unpredictable evolution that can have a negative impact on patients' quality of life (QoL). Even though patients in remission have a better QoL compared to patients with active disease, they still have a lower QoL compared to healthy people. The aim of this study is to identify the factors that are associated with a lower QoL in patients with IBD in clinical remission, in a tertiary IBD center in Romania. Materials and Methods: Ninety-seven adult patients with a current diagnosis of IBD for over 3 months who were in clinical remission were enrolled in this study. Pregnant women, patients with ostomy, perianal disease, extraintestinal manifestations or other significant comorbidities were excluded. Out of the 97 patients, 63.9% were men. The median age was 39 years (IQR 29–47), and the median disease duration was 5 years (IQR 2–10). Disease activity was assessed using the SCCAI score for ulcerative colitis and HBI score for Crohn's disease. Remission was defined for SCCAI score ≤ 1 and HBI score ≤ 4. The health-related quality of life (HR-QoL) was assessed using the IBDQ32 score. FACIT-Fatigue was used to evaluate the level of fatigue. Patients with symptoms of anxiety or depression were identified with the HADS score. Symptoms of anxiety were considered when HADS-A >7 points and symptoms of depression when HADS-D >7 points. Results: Sixty-five patients (67%) were diagnosed with CD and the remaining 32 (33%) with UC. Ninety-three patients (95.9%) were on biological therapy. The mean IBDQ score (total score) was 190.54 points (SD +/− 8.2). The mean FACIT Fatigue score was 42.5 (SD +/− 8.2), with 6.2% of patients suffering from severe fatigue (FACIT Fatigue < 30 points). A total of 33% of patients had symptoms of anxiety and 16.5% of depression. Exposure to more than one biologic therapy (p = 0.02), fatigue (p < 0.001) and symptoms of anxiety (p < 0.001) were associated with a lower HR-QoL in the multivariate analysis. Female patients, patients with Crohn's disease, patients with anemia and patients with symptoms of depression also had a lower HR-QoL, but this did not reach statistical significance in our study. Conclusions: Exposure to a higher number of biological agents (patients that switched multiple biologics), the presence of fatigue and symptoms of anxiety impair the HR-QoL of patients with IBD in clinical remission. Further studies should assess in a prospective manner whether early identification of these factors with prompt clinical interventions could lead to a better HR-QoL in these patients. [ABSTRACT FROM AUTHOR]

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CONVENTIONALLY, UC IS RECOGNIZED AS A DISEASE WITH CONTINUOUS MUCOSAL INFLAMMATION THAT EXTENDS FROM THE RECTUM TO THE PROXIMAL PART OF THE COLON, BUT DURING THE LAST DECADE, A PARTICULAR PATTERN OF COLITIS THAT INVOLVES THE DISTAL COLON WITH A NORMAL APPEARANCE MUCOSA INTERPOSED AND A WELL DEFINED AREA OF INFLAMMATION AROUND THE APPENDIX HAS BEEN HIGHLIGHTED. WE USED A TERTIARY CARE CENTER EVIDENCES TO ANALYZE THE CHARACTERISTICS OF UC PATIENTS WITH PARP. WE EVALUATED 76 PATIENTS WHO WENT TO OUR CLINIC FOR INVESTIGATING CHRONIC DIARRHEA SYNDROME BETWEEN JANUARY 2018-DECEMBER 2020 AND FOR WHOM A DIAGNOSIS OF ULCERATIVE COLITIS WAS ESTABLISHED. ONLY 7 PATIENTS HAD ENDOSCOPICALLY ASPECT OF PARP (THIS HAPPENED DURING FOLLOW-UP ENDOSCOPY), ASPECT SUPPORTED ALSO BY THE HISTOLOGICAL DESCRIPTION (NANCY INDEX SCORE). DURING FOLLOW-UP, MOST PATIENTS WITH PARP KEPT THE SAME EXTENT OF LESIONS. CONCLUSIONS: WE CONFIRM THE PRESENCE OF PARP AS A "SKIP LESION" IN DISTAL UC, DIAGNOSTIC SUPPORTED ALSO BY THE HISTOPATHOLOGIST, AND EVEN THOUGH WE ARE CONFIDENT IN THE DIAGNOSIS OF ULCERATIVE COLITIS, ONE PATIENT HAD A CROHN'S DISEASE PHENOTYPE SWITCH DURING THE EVOLUTION. NONETHELESS, WE CANNOT CONCLUDE THAT PARP HAS A ROLE IN THE EXTENSION OF LESIONS, REMISSION OR RELAPSE OF DISEASE, GIVEN THE FACT THAT WE DO NOT HAVE A SUFFICIENT GROUP OF ELIGIBLE PATIENTS, FOR WHICH REASON DETAILED STUDIES ARE NEEDED. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) is among the most lethal cancers. Its poor prognosis is predominantly due to the fact that most patients remain asymptomatic until the disease reaches an advanced stage, alongside the lack of early markers and screening strategies. A better understanding of PDAC risk factors is essential for the identification of groups at high risk in the population. Genome-wide association studies (GWAS) have been a powerful tool for detecting genetic variants associated with complex traits, including pancreatic cancer. By exploiting functional and GWAS data, we investigated the associations between polymorphisms affecting gene function in the pancreas (expression quantitative trait loci, eQTLs) and PDAC risk. In a two-phase approach, we analysed 13 713 PDAC cases and 43 784 controls and identified a genome-wide significant association between the A allele of the rs2035875 polymorphism and increased PDAC risk (P = 7.14 × 10−10). This allele is known to be associated with increased expression in the pancreas of the keratin genes KRT8 and KRT18 , whose increased levels have been reported to correlate with various tumour cell characteristics. Additionally, the A allele of the rs789744 variant was associated with decreased risk of developing PDAC (P = 3.56 × 10–6). This single nucleotide polymorphism is situated in the SRGAP1 gene and the A allele is associated with higher expression of the gene, which in turn inactivates the cyclin-dependent protein 42 (CDC42) gene expression, thus decreasing the risk of PDAC. In conclusion, we present here a functional-based novel PDAC risk locus and an additional strong candidate supported by significant associations and plausible biological mechanisms. [ABSTRACT FROM AUTHOR]

International investors are now increasingly demanding the presentation of financial and non-financial information in order to understand how much the entity's performance can be affected by the way it handles environmental issues, human resources, anti-corruption, the relationship with the community as well as to understand the possible risks associated with the activity of an entity, risks that could be faced, precisely by detailing the non-financial information to be interpreted together with the financial one. It is increasingly imperative to draw up a framework report on nonfinancial reporting that links financial and non-financial performance, with the possibility of longterm prioritization of business plans with benefits to the entity as well as to its outer sphere. All rights reserved. [ABSTRACT FROM AUTHOR]

THE CORRECT EXAMINATION, BY AN ANATOMOPATHOLOGIST WITH EXPERTISE IN INFLAMMATORY BOWEL DISEASES, OF BIOPSIES OR RESECTION PIECES IS OF OVERWHELMING IMPORTANCE FOR ESTABLISHING THE DEFINITE DIAGNOSIS, BUT ALSO CONSIDERING MANAGEMENT STRATEGIES AND SUBSEQUENT SURVEILLANCE OF THE PATIENT, GIVEN THE FACT THAT THERE IS A POSSIBILITY OF PROGRESSION OF DYSPASTIC LESIONS TO ADENOCARCINOMA, IN THE LONGSTANDING DISEASE. THE RISK OF COLORECTAL CANCER IS CUMULATIVE, ESPECIALLY IN ULCERATIVE COLITIS, AS THE YEARS PASS, SO BIOPSIES FROM SUSPICIOUS AREA SHOULD BE TAKEN, WHENEVER NEEDED. REGULAR ENDOSCOPIC FOLLOW-UP IS RECCOMENDED BY THE NTERNATIONAL GUIDELINES AND SHOULD BE TAILORED TO EACH INDIVIDUAL, TAKING INTO ACCOUNT THE RISK FACTORS, THE DETECTION OF DYSPALSIA BEING THE MOST IMPORTANT GOAL OF SURVEILLANCE COLONOSCOPY. EARLY IDENTIFICATION OF DYSPLASIA (MACROSCOPICALLY VISIBLE OR NOT) IS THE CORNERSTONE OF REDUCING THE RISK OF COLORECTAL CANCER. IN RECENT YEARS, SEVERAL NEW TYPES OF UNCONVENTIONAL DYSPLASIA HAVE BEEN RECOGNIZED, BUT EXACT MORPHOLOGIC CRITERIA ARE REQUIRED. OF ALL PATTERNS ENCOUNTERED, THE HYPERMUCINOUS DYSPLASIA HAS BEEN THE MOST COMMONLY DETECTED AND DESCRIBED. THE ASSOCIATION WITH CLASSIC DYSPLASIA OR EVEN COLORECTAL CANCER IS STILL NOT ENOUGH STUDIED SO FAR. [ABSTRACT FROM AUTHOR]

IN THE YEAR 1905 THE LEADERSHIP OF THE TOWN HALL FROM TÂRGU JIU TOWN CONTRACTED A LOAN OF 300 000 LEI FOR TO BUILD AN POWER STATION AND OTHER TOWN WORKINGS. IN MARCH 1906 THEY SIGNED AN AGREEMENT WITH AN AUSTRIAN FIRM CALLED VEREIGNITE ELEKTRICITATS ACTIENGESELLSCHAFT (HEREINAFTER REFERRED TO AS V.E.A.G.), BUT THE SPENDING FOR THE INTRODUCTION OF THE ELECTRIC ILLUMINATION OUTRAN THE SUM OF 217 246 GOLDEN FRANCS, STIPULATED IN CONTRACT. THIS MATTER AND THE ANALYSE MADE BY THE ENGINEER DELESCU REGARDING THE BAD QUALITY OF THE WORKINGS, CONVINCED THE CITY COUNCIL TO CALL IN JUDGE THE COMPANY V.E.A.G., BUT THE EXPERTS NAMED BY THE LAW-COURT GORJ ESTABLISHED THAT THE WORKINGS WERE GOOD AND IN ACCORD WITH THE CONTRACT. THEREFORE THE LEADERSHIP OF THE TOWN HALL LOST THE TRIAL AND WAS FORCED TO PAY THE DEBT SUMS, DAMAGES AND SPENDING IN TRIAL TO THE AUSTRIAN FIRM. IN THE YEAR 1912 THE COUNSELORS VOTED THE EXTENSION OF THE POWER STATION AND THE REPLACING THE WOOD WITH FUEL OIL AS FUEL. BY THIS THEY TRIED TO REDUCE THE SPENDING WITH THE ILLUMINATION, WHICH OUTRAN THE INCOMES BROUGHT BY THE SUBSCRIPTIONS TO ELECTRIC POWER. [ABSTRACT FROM AUTHOR]

Investment services and activities on the account of the investors shall be supplied under a contract drafted in accordance with Capital Market Laws. Intermediaries (investment firms) hold the market access monopoly to trading systems of the regulated market or multilateral trading systems. Contracting them is the only way for investors to have access (indirectly) to trading through market orders. The legal framework shaped by the contract regarding investment services and activities is the premise, the mandatory and preliminary condition for the sale or purchase offinancial instruments. The contract of investment services and activities is thus a sine qua non for trading on the capital market. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness and safety of biosimilar infliximab (CT-P13) in a real-life setting in adults with moderate-to-severe active Crohn's disease (CD) or ulcerative colitis (UC). Methods: This multi-centre, observational cohort study was conducted at medical centres in Romania, Czech Republic, and Bulgaria. Effectiveness was measured using the Crohn's Disease Activity Index (CDAI) for CD or partial Clinical Activity Index (pCAI) for UC. Quality-of-life (QoL) was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Safety was assessed according to treatment withdrawals and adverse events (AEs) monitoring. Analyses were performed in the safety population and were reported based on the observed case (OC) or last observation carried forward (LOCF) method. Results: Altogether, 85 patients with CD (n = 38) or UC (n = 47) received biosimilar infliximab for up to 30 weeks. Most patients (n = 68; 80.0%) had no prior exposure to infliximab. At the end of treatment, 65.8% (95% CI = 49.8–78.9) of CD patients and 55.3% (95% CI = 41.2–68.6) of UC patients showed a clinical response, and 47.4% (95% CI = 32.5–62.7) and 48.9% (95% CI = 35.3–62.8), respectively, were in remission. Statistically significant (p < 0.0001) improvements from baseline were observed in CDAI and pCAI scores (both LOCF). In the combined CD and UC population, SIBDQ was significantly improved (p < 0.0001) from baseline to end of treatment (OC). Two AEs (moderately severe infusion reactions) were judged by investigators to be definitely related to treatment, one of which led to treatment withdrawal. Conclusion: Results align with those of previous studies demonstrating the effectiveness and safety of biosimilar infliximab in CD and UC. [ABSTRACT FROM AUTHOR]

Percutaneous endoscopic gastrostomy with jejunal extension (PEG/J) was first described in 1998 and has become the standard technique for fixing the tube in place for levodopa carbidopa intestinal gel (LCIG) infusion. The Romanian Society of Digestive Endoscopy (RSDE) decided to create a consensus paper to meet the needs in medical training and practice. After reviewing the available published data and existing recommendations, a consensus process was carried out involving the leaders of opinion in this field. The resulting text and recommendations were approved, after reaching expert consensus, and reflects the views of the RSDE for the best practice of PEG/J tube placement. The pull through method ("pull technique") is the prevailing PEG-tube placement procedure in Romania. The procedure can be performed with intravenous sedation combined with local anesthesia. Although minor complications are common, serious complications are infrequent, and the tube insertion procedures have a good safety record. Redo procedures are sometimes necessary and clinicians should be aware of these situations. [ABSTRACT FROM AUTHOR]

Irrespective of typology and manifestation, control is the managerial tool through which the public enterprise benefits from efficient management of its own assets, debts and households, and at the same time it protects its public and private wealth. Moreover, control is the overall decision support, although the actions are individual. Between corporate governance, own financial control and relevant financial and accounting information a relationship of interconditionality is created so that the relevance of financial-accounting information enhances the quality of corporate management through economic and financial control and, in the context of substantiating its decisions and operationalising, the financial and accounting information relevant governance determines good governance that ensures both the protection and the harmonization of economic interests. [ABSTRACT FROM AUTHOR]

The sector of services is one of the broadest sectors in the modern economy, being constantly subject to the transformation of globalization, and tourism and public sector as integral parts of the sector, have a rather socio-economic impact on the development of a nation. In order to be able to identify rigorously the role of tourism and public alimentation in the national economy it is appreciated that it imprints on several plans such as: economic, social, cultural and political, the structure of the entities and the cultures of different countries. The accounting of the entities in tourism and public alimentation must be independent and capable of providing a complete picture of assets, equity and debt, and the management has a high contribution to valuing service activities. [ABSTRACT FROM AUTHOR]

The complexity of the business environment, the more pronounced economic liberalization, increasing competition, rapid changes in technology, changes in demographics, ecological problems caused by pollution, resource depletion, not least the financial and economic crisis, are some elements imposing in a certain way another kind of leadership and governance of economic, public or private interest entities. A new system of governance based on principles and new relations among states, international organizations, civil societies, businesses and multinational companies is required for a better business management. The concept of corporate governance has ceaselessly been used more and more as a pathway to improvement and increase of economic and financial performance of state-owned or private economic entities. The context of the study can be found at a time when our country as part of the European Union must comply with steps taken at European level in terms of strengthening the state reforms concerning corporate governance, accounting, internal control and audit. [ABSTRACT FROM AUTHOR]

Background & Aims: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease. Methods: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus. Results: Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement. Conclusion: This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease. [ABSTRACT FROM AUTHOR]

PREVIOUS STUDIES HAVE SHOWN A VARIETY OF RISK FACTORS THAT MAY BE INVOLVED IN THE AETIOLOGY OF PANCREATIC NEOPLASIA. WE EXAMINED RISK FACTORS FOR PANCREATIC CANCER IN A CASE-CONTROL STUDY CONDUCTED IN FUNDENI CLINICAL INSTITUTE BETWEEN SEPTEMBER 2016 AND SEPTEMBER 2018, THAT INCLUDED 74 INCIDENT CASES AND 74 CONTROLS ADMITTED FOR NONNEOPLASTIC DISEASES, FREQUENCY-MATCHED TO CASES BY SEX AND AGE. LOGISTIC REGRESSION MODELS WERE USED FOR MULTIVARIATE OR SUCH AS SEX, AGE, DIABETES, VIRAL HEPATITIS, SMOKING AND ALCOHOL CONSUMPTION STATUS, AND OTHER PERSONAL AND FAMILIAL HISTORY. OUR FINDINGS SUPPORT PREVIOUS STUDIES INDICATING THAT DIABETES IS A RISK FACTOR FOR PANCREATIC CANCER (OR 4.8, P<0.05). CHOLECYSTECTOMY ALSO APPEARED TO BE A RISK FACTOR, SUBJECTS WITH A CHOLECYSTECTOMY AT LEAST 20 YEARS PRIOR TO THE DIAGNOSIS OF PANCREATIC CANCER EXPERIENCED AN INCREASED RISK, WHICH WAS MARGINALLY SIGNIFICANT. IN CONTRAST, SIGNIFICANT 2- FOLD (P<0.05) REDUCED RISK WAS ASSOCIATED WITH ALLERGIES. IN ADDITION, WE OBSERVED SIGNIFICANTLY INCREASED RISKS FOR SUBJECTS WHO SMOKED OR ARE CURRENTLY SMOKING. THIS STUDY DEMONSTRATES THE ROLE AS RISK FACTORS OF SOME ENVIRONMENTAL FACTORS, PERSONAL AND FAMILIAL HISTORY, BUT THESE ASSOCIATIONS, HOWEVER, MAY BE DUE TO CHANCE SINCE THE NUMBER OF INDIVIDUALS INCLUDED IN THE STUDY IS REDUCED. [ABSTRACT FROM AUTHOR]

Background. Endoscopic ultrasound (EUS) in association with fine needle aspiration (FNA) it is considered to be the standard of pancreatic mass lesions diagnosis. Our aim was to determine which ultrasound features, including a particular hypoechoic rim aspect can predict a pancreatic neuroendocrine tumor (pNET) diagnosis. Methods. The EUS examinations performed for solid pancreatic lesions from 2015 to 2019 in a Tertiary Gastroenterology Center were evaluated in a prospective study. There were 175 cases analyzed, out of which pNET diagnosis was established by FNA in n= 19 (10.8%). Mean age of patients with pNETs was 56.1 ± 10.3 years, significantly lower than all cases in the study group and 52.7% of which were females. We studied the following EUS characteristics by univariate and multivariate analysis: well defined margins, hypoechoic EUS aspect, homogeneous pattern, the presence of internal vascularization, stiff elastographic appearance, the presence of multiple lesions, the internalization of large vessels, Wirsung duct dilation and the presence of a hypoechoic rim delimiting the interior margin of the lesion. Results. The following EUS features were significantly associated with EUS diagnosis of pNET: well defined margins (63.1% vs 35.7% p=0.02), homogeneous pattern (36.8% vs 16.9%, p=0.03), the presence of internal vascularisation (63.1% vs 24.3%, p=0.0004), blue on elastography (89.4% vs 64.2%, p=0.03) and the presence of a hypoechoic rim (47.3% vs 2.5%, P< 0.0001). In the multivariate logistic regression analysis only the presence of a hypoechoic rim was independently associated with the pNET diagnosis (p< 0.0001). Conclusions. EUS appearance can suggest the diagnosis of a pNET. The presence of a hypoechoic rim delimiting the interior margin of the lesion is an independent predictor of pNET diagnosis. [ABSTRACT FROM AUTHOR]

In this article the author talks about clinical insights for gastroenterology and hepatology providers during the COVID-19 Pandemic. topics discussed most patients infected with SARS-CoV-2 experienced a mild illness, patients developed severe lung injury or even multi-organ dysfunction, resulting in case fatality ratio, and the WHO declared COVID-19 a global pandemic on March 2020 Romanian Medical Scientific Societies started implementing infection control measures.

CANCER OF THE EXOCRINE PANCREAS IS A HIGHLY LETHAL MALIGNANCY. SURGICAL RESECTION IS THE ONLY POTENTIALLY CURATIVE TREATMENT. UNFORTUNATELY, BECAUSE OF THE LATE PRESENTATION, ONLY 15 TO 20 PERCENT OF PATIENTS ARE CANDIDATES FOR PANCREATECTOMY. THE AIM OF OUR STUDY WAS TO REVIEW THE RISK FACTORS, CLINICAL PRESENTATION, DIAGNOSTIC TOOLS AND THERAPEUTIC APPROACH OF PATIENTS WITH PANCREATIC CANCER, ADMITTED TO OUR CLINIC BETWEEN JANUARY 1ST AND DECEMBER 31ST OF 2016. WE ENROLLED TWO HUNDRED AND SIXTY EIGHT CONSECUTIVE PATIENTS. WE FOUND THAT MOST PATIENTS PRESENTED AT LEAST ONE RISK FACTOR FOR PANCREATIC NEOPLASIA, ESPECIALLY CIGARETTE SMOKING AND ALCOHOL DRINKING. MANY PATIENTS WERE DIAGNOSED IN ADVANCED STAGES OF THE DISEASE, WHEN THE TUMOR WAS LOCALLY INVASIVE OR HAD DISTANT METASTASES. THE MOST FREQUENT HISTOLOGICAL TYPE WAS ADENOCARCINOMA, FOLLOWED BY NEUROENDOCRINE TUMORS (13.36%). PATIENTS BENEFITED FROM SURGICAL, ONCOLOGICAL, AND/OR ENDOSCOPIC TREATMENT. THE MEDIAN SURVIVAL TIME WAS 8.83 MONTHS FOR ADENOCARCINOMA AND 66.34 MONTHS FOR NEUROENDOCRINE TUMORS. WE NOTED A LONGER MEDIAN SURVIVAL TIME FOR ADENOCACINOMA THAN THE EUROPEAN AVERAGE OF 4.6 MONTHS, PROBABLY DUE TO THE FACT THAN PATIENTS WERE DIAGNOSED AND TREATED BY A MULTIDISCIPLINARY TEAM, IN A TERTIARY CARE FACILITY. HOWEVER WE NEED TO DO A BETTER JOB IN IDENTIFYING HIGH RISK INDIVIDUALS AND THEN OFFERING THEM A PERSONALISED SCREENING PROGRAM, IN ORDER TO DIAGNOSE MORE PATIENTS IN POTENTIALLY CURATIVE STAGES. [ABSTRACT FROM AUTHOR]