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Background and Aims: The Diverticular Inflammation and Complication Assessment (DICA) endoscopic classification of diverticulosis and diverticular disease (DD) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement on this classification in an international endoscopists community setting. Methods: A total of 96 doctors (82.9% endoscopists) independently scored a set of DD endoscopic videos. The percentages of overall agreement on DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of interrater agreement. Results: Overall agreement in using DICA was 91.8% with a free-marginal kappa of 88% (95% CI 80-95). The overall agreement levels were: DICA 1, 85.2%; DICA 2, 96.5%; DICA 3, 99.5%. The free marginal κ was: DICA 1 = 0.753, DICA 2 = 0.958, DICA 3 = 0.919. The agreement about the main endoscopic items was 83.4% (k 67%) for diverticular extension, 62.6% (k 65%) for number of diverticula for each district, 86.8% (k 82%) for presence of inflammation, and 98.5 (k 98%) for presence of complications. Conclusions: The overall interrater agreement in this study ranges from good to very good. DICA score is a simple and reproducible endoscopic scoring system for diverticulosis and DD.

Important progress has been made in the management of Helicobacter pylori infection and in this fifth edition of the Maastricht Consensus Report, key aspects related to the clinical role of H. Pylori were re-evaluated in 2015. In the Maastricht V/Florence Consensus Conference, 43 experts from 24 countries examined new data related to H. pylori in five subdivided workshops: (1) Indications/ Associations, (2) Diagnosis, (3) Treatment, (4) Prevention/Public Health, (5) H. pylori and the Gastric Microbiota. The results of the individual workshops were presented to a final consensus voting that included all participants. Recommendations are provided on the basis of the best available evidence and relevance to the management of H. pylori infection in the various clinical scenarios.

Background/Aims: The aim of the study is detection and evaluation of the abdominal and gastrointestinal; infective foci using Tc-99m-ciprofloxacin (Laboratory for radioactive isotopes, Vinca). Methodology: In total 21 patients with clinical suspicion on abdominal or gastrointestinal infection were investigated. In all the patients, planar liver/spleen scintigraphy was performed. Ciprofloxacin chloride (3.5mg) was mixed with 555MBq of Tc-99m in 3mL of physiological solution and incubated for 20 min. After slow i.v. injection in a cubital vein, dynamic acquisition (1 f/min) was performed during the first 60 min in the position of interest, followed by static acquisition (500 000 imp) anterior and posterior view, abdomen and pelvis after 1 h and 4 h in all patients. When necessary, additional scintigrams were acquired after 24h. In all the patients with negative or equivocal findings of planar scintigraphy, emission computerized tomography (SPECT) was performed (60 positions, 6 degrees). Interpretation was made by three independent observers. Additional data were provided using clinical findings, ultrasonography, computed tomography and magnetic resonance imaging, laboratory analyses, and surgical or microbiological confirmation of infection. Results: There were eleven true-positive findings, seven true negative, two were false negative while one was false positive due to intestinal obstruction. Sensitivity was 79%, specificity 91%, positive predictive value 92%, negative predictive value 77% accuracy 84%. Conclusions: According to our results, scintigraphy with radiolabeled ciprofloxacin is a useful method for detection and assessment of exact localization of abdominal and gastrointestinal infections.

Atomic force microscopy (AFM), a unique tool to investigate drug treatment of cancer cells, was used to analyze the anti-neoplastic activity of adriamycin by comparing DNA structures of non-treated and adriamycin-treated Ehrlich tumor cells. The non-treated cells exhibited a highly branched intact chromatin structure, related to the intensive DNA replication in cancer cells. Images from adriamycin-treated tumor cells showed that the DNA chains were broken and the chromatin structure had been destroyed. Possible explanations for these effects of adriamycin are considered: breakage of hydrogen bonding, oxidation and intercalation effects, as well as the poisoning of topoisomerase enzyme. DNA fractal and multifractal analyses performed in order to evaluate the degree of bond scission, showed that the treated DNA had become more fractal compared to non-treated DNA. DNA izolovana iz Erlihovih tumorskih ćelija je AFM mikroskopijom posmatrana prethodno tretirana adriamicinom i u netretiranom stanju, radi poređenja. AFM mikroskopija pruža mogućnost dobijanja direktne slike izgleda DNA strukture maligne ćelije koja nije tretirana lekom i iste strukture posle delovanja adrijamicina, što daje nove podatke o delovanju citostatika na malignu ćeliju. Netretirane ćelije (viđene AF Mmikroskopijom) su ispoljile netaknutu strukturu hromatina koja odgovara intenzivnoj DNA replikaciji u malignoj ćeliji. Maligne ćelije tretirane adriamicinom su pokazale da su DNA lanci pokidani tj. dalja replikacija je sprečena, što je jedan od osnova aktivnosti citostatika. Multifraktalna analiza AFM mikroskopskih slika tretirane i netretirane DNA je kvantitativno potvrdila zaključke dobijene mikroskopijom jer su grafici AFM slika uzoraka tretiranih adriamicinom pokazali fraktalniju strukturu od AFM slika netretiranih malignih ćelija kod kojih grafik ukazuje na potpuni gubitak fraktalnosti, što je znak prisutnog patološkog procesa u organizmu.

IUBMB 50th Anniversary Symposium, Jul 02-07, 2005, Budapest, Hungary

It is currently unclear whether intestinal metaplasia at the esophagogastric junction and in the distal esophagus represent a continuum of the same underlying disease process, i.e., gastroesophageal reflux, or constitute different entities with a diff e r e n t pathogenesis. Biopsies below the Z line might show specialized epithelium in some patients and the question is whether this is another form of short segment Barrett’s esophagus or whether it is related to a generalized atrophic process of the stomach. Data from recent studies regarding the expression of cytokeratin CK7 and CK20 in intestinal metaplasia (IM) found at the gastroesophageal junction are conflicting. Prompted by these data we undertook the present study: a) to evaluate the expression of CK7 and CK20 in IM of the gastric cardia and to compare the findings with those in patients with Barrett’s esophagus and IM of the gastric corpus and antrum mucosa; and b) to evaluate the immunophenotype of non-intestinalized cardiac mucosa and to compare it with that of normal gastric epithelium. We studied the expression of CK7 and CK20 on biopsy specimens from patients with long-seg m e n t B a r r e t t ’s esophagus (n=17) and surgical resection and biopsy specimens of gastric cardia (n=15), corpus (n=14) and antrum (n=22) from patients with histological evidence of IM. Eighty-four biopsy specimens from 42 patients (antrum n=15, corpus n=20, cardia n=7) without evidence of IM were studied as a control group. We observed an immunophenotype characterised by diffuse moderate to strong CK7 staining on the surface and crypt epithelium combined with strong CK20 staining on the surface and superficial part of the crypts in 94.1% (16/17) of the cases with long-se g m e n t Barrett’s esophagus, but in none of the 36 cases with IM in distal stomach (antrum and corpus). IM in the gastric cardia expressed the immunophenotype seen in IM of the gastric mucosa in 93.3% (14/15) of the cases. On the other hand, normal cardiac epithelium expressed patchy strong CK7 staining on the surface epithelium and on both, superficial and deep parts of the pits combined with patchy strong CK20 staining on the surf a c e epithelium and superficial pits, a feature permitting distinction of the normal cardiac epithelium from those of the normal gastric antrum and corpus epithelium. We conclude that the expression of cy t o keratins 7 and 20 can be used to distinguish the origin of IM of the gastroesophageal junction. The CK7/20 immunophenotype of IM in the gastric cardia closely resembles that of the IM in the gastric antrum and corpus and is different from IM in long-segment Barrett's esophagus. In contrast, the CK7/20 immunophenotype of the cardiac epithelium is different from that of the gastric antrum and corpus mucosa, suggesting that cardiac epithelium might not be a native normal g a s t r i c epithelium but one that is acquired as a consequence of longstanding inflammation. Changing pattern of CK7 and CK20 expression from normal to intestinalized epithelium suggests that IM arising from cardiac epithelium might have distinctive features.