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Background and aims: Anaemia is an important complication of inflammatory bowel disease [IBD]. The aim of this study was to determine the prevalence of anaemia and the practice of anaemia screening during the first year following diagnosis, in a European prospective population-based inception cohort.Methods: Newly diagnosed IBD patients were included and followed prospectively for 1 year in 29 European and one Australian centre. Clinical data including demographics, medical therapy, surgery and blood samples were collected. Anaemia was defined according to the World Health Organization criteria.Results: A total of 1871 patients (Crohn's disease [CD]: 686, 88%; ulcerative colitis [UC]: 1,021, 87%; IBD unclassified [IBDU] 164. 81%) were included in the study. The prevalence of anaemia was higher in CD than in UC patients and, overall, 49% of CD and 39% of UC patients experienced at least one instance of anaemia during the first 12 months after diagnosis. UC patients with more extensive disease and those from Eastern European countries, and CD patients with penetrating disease or colonic disease location, had higher risks of anaemia. CD and UC patients in need of none or only mild anti-inflammatory treatment had a lower risk of anaemia. In a significant proportion of patients, anaemia was not assessed until several months after diagnosis, and in almost half of all cases of anaemia a thorough work-up was not performed.Conclusions: Overall, 42% of patients had at least one instance of anaemia during the first year following diagnosis. Most patients were assessed for anaemia regularly; however, a full anaemia work-up was frequently neglected in this community setting.

Cost analysis in a prospective European population-based inception cohort : is there a cost-saving effect of biological therapy?

Background and aims: The aim of the present study was to validate the IBD (inflammatory bowel diseases) incidence reported in the 2010 ECCO-EpiCom (European Crohn's and Colitis Organization–Epidemiological Committee) inception cohort by including a second independent inception cohort from participating centers in 2011 and an Australian center to investigate whether there is a difference in the incidence of IBD between Eastern and Western European countries and Australia. Methods: Fourteen centers from 5 Eastern and 9 Western European countries and one center from Australia participated in the ECCO-EpiCom 2011 inception cohort. Patients' data regarding disease type, socio-demographic factors, extraintestinal manifestations and therapy were entered into the Web-based EpiCom database, www.ecco-epicom.eu. Results: A total of 711 adult patients were diagnosed during the inclusion year 2011, 178 (25%) from Eastern, 461 (65%) from Western Europe and 72 (10%) from Australia; 259 (37%) patients were diagnosed with Crohn's disease, 380 (53%) with ulcerative colitis and 72 (10%) with IBD unclassified. The mean annual incidence rate for IBD was 11.3/100,000 in Eastern Europe, 14.0/100,000 in Western Europe and 30.3/100,000 in Australia. Significantly more patients were diagnosed with complicated disease at diagnosis in Eastern Europe compared to Western Europe (43% vs. 27%, p = 0.02). Conclusion: Incidence rates, disease phenotype and initial treatment characteristics in the 2011 ECCO-EpiCom cohort were not significantly different from that reported in the 2010 cohort. * Abbreviations: : IBD : inflammatory bowel diseases CD : Crohn's disease UC : ulcerative colitis IBDU : inflammatory bowel disease unclassified ECCO : European Crohn's and Colitis Organization EpiCom : Epidemiological Committee IRR : incidence rate ratio CI : confidence interval EC-IBD : European Collaborative Study on Inflammatory Bowel Disease ACCESS : Asia-Pacific Crohn's and Colitis Epidemiology Study SE : standard error

The aryl hydrocarbon receptor (AhR) is a heterodimeric transcriptional regulator with pleiotropic functions in xenobiotic metabolism and detoxification, vascular development and cancer. Herein, we report a previously undescribed role for the AhR signalling pathway in the pathogenesis of the wet, neovascular subtype of age-related macular degeneration (AMD), the leading cause of vision loss in the elderly in the Western world. Comparative analysis of gene expression profiles of aged AhR(-/-) and wild-type (wt) mice, using high-throughput RNA sequencing, revealed differential modulation of genes belonging to several AMD-related pathogenic pathways, including inflammation, angiogenesis and extracellular matrix regulation. To investigate AhR regulation of these pathways in wet AMD, we experimentally induced choroidal neovascular lesions in AhR(-/-) mice and found that they measured significantly larger in area and volume compared to age-matched wt mice. Furthermore, these lesions displayed a higher number of ionized calcium-binding adaptor molecule 1-positive (Iba1(+) ) microglial cells and a greater amount of collagen type IV deposition, events also seen in human wet AMD pathology specimens. Consistent with our in vivo observations, AhR knock-down was sufficient to increase choroidal endothelial cell migration and tube formation in vitro. Moreover, AhR knock-down caused an increase in collagen type IV production and secretion in both retinal pigment epithelial (RPE) and choroidal endothelial cell cultures, increased expression of angiogenic and inflammatory molecules, including vascular endothelial growth factor A (VEGFA) and chemokine (C-C motif) ligand 2 (CCL2) in RPE cells, and increased expression of secreted phosphoprotein 1 (SPP1) and transforming growth factor-β1 (TGFβ1) in choroidal endothelial cells. Collectively, our findings identify AhR as a regulator of multiple pathogenic pathways in experimentally induced choroidal neovascularization, findings that are consistent with a possible role of AhR in wet AMD. The data discussed in this paper have been deposited in NCBI's Gene Expression Omnibus; GEO Submission No. GSE56983, NCBI Tracking System No. 17021116.

1) Internal Medicine 2, University Hospital University of Medicine, Bucharest; 2) University of Medicine, Tg-Mures; 3) University of Medicine, Iasi, 4) Fundeni Clinical Institute; University of Medicine, Bucharest; 5) Faculty of General Medicine, Ovidius University, Constanta; 6) Research Center of Gastroenterology and Hepatology University of Medicine, Craiova; 7) University of Medicine, Timisoara; 8) Colentina Hospital University of Medicine, Bucharest; 9) University of Medicine and Pharmacy, Cluj-Napoca Romania

Background and Aims: The incidence of inflammatory bowel disease (IBD) is increasing in Eastern Europe possibly due to changes in environmental factors towards a more "westernised" standard of living. The aim of this study was to investigate differences in exposure to environmental factors prior to diagnosis in Eastern and Western European IBD patients. Methods: The EpiCom cohort is a population-based, prospective inception cohort of 1560 unselected IBD patients from 31 European countries covering a background population of 10.1. million. At the time of diagnosis patients were asked to complete an 87-item questionnaire concerning environmental factors. Results: A total of 1182 patients (76%) answered the questionnaire, 444 (38%) had Crohn's disease (CD), 627 (53%) ulcerative colitis (UC), and 111 (9%) IBD unclassified. No geographic differences regarding smoking status, caffeine intake, use of oral contraceptives, or number of first-degree relatives with IBD were found. Sugar intake was higher in CD and UC patients from Eastern Europe than in Western Europe while fibre intake was lower (p.

Purpose – The purpose of this paper is to discuss the relative popularity of Lean Six Sigma among the internet users comparing it to other problem solving methodologies. Design/methodology/approach – The comparisons between the Lean Six Sigma and other problem solving methodologies among the internet users were assessed by using open-source intelligence (OSINT) tools, such as Google Keyword tools provided by Google, it is possible to assess the problem solving techniques popularity used by the internet users with a confidence of 80 percent. Findings – It is found that the popularity of Lean Six Sigma among the internet users far exceeds that of other methodologies. Research limitations/implications – The paper is limited as it is written from the view of the author, based the conclusions on OSINT tools. Further research could be beneficial. Originality/value – This study is based on Google Keyword tools provided by Google as an OSINT tools as effective source of information.

Haemostatic powder is an effective solution commonly used in various open surgeries. However, there is no specific intra-abdominal delivery device for application of haemostatic powder at the bleeding site during minimally invasive surgery (MIS). In this study, design, construction and test of a novel powder delivery device were carried out. The device uses pressurized gas to deliver the haemostatic powder to the bleeding point. The effect of the gas pressure and the spraying distance on the geometry of the powder dispersion surface area was investigated and found to be significant. The findings indicate that the driving gas pressure range of 60–80 mmHg and the spraying distance range of 2–5 cm achieve the most concentrated powder dispersion surface area. Additionally, in vivo experiments confirmed the effectiveness of the device in live tissue.

Background and Aim : Use of glass fiber posts is of widespread acceptance in restoring root canal treated teeth, but studies concerning the most proper length of the post to provide the utmost fracture resistance are inadequate. The aim of this study was to evaluate the effect of glass fiber post length on fracture resistance of root canal treated central incisors . Materials and Methods : This experimental study was carried out on 40 maxillary central incisors in 4 groups of 10 each. RDT posts and cement was used in this experimental study with the lengths of 6, 8, 10, and 12 mm in the study groups. The samples were debrided and decoronated at the CEJ levels and endodontically treated using step-back technique. RDT drills were used for post space preparation. Then, the root canal walls were etched and the posts cemented in place. The composite cores were then prepared at the height of 5 mm and samples mounted 2mm down to their CEJ levels within acrylic blocks. An impression material (Impregum, 3M, ESPE) with a thickness of 0.2mm was used to simulate PDL around the samples. The samples were subjected to compressive forces at a 135-degree angle to their long axes using a Universal Testing Machine. Data pertaining to the fracture of the samples were analyzed using ANOVA and Tukey statistical tests . Results : The maximum resistance to fracture was recorded in 8-and 10-mm-long posts and the minimum was observed in the lengths of 6 and 12 mm. Statistical tests showed a significant difference between 8- and 10-mm-long posts with those having lengths of 6 and 12 mm in terms of fracture resistance. There was no significant difference between 8- and 10-mm-long posts as well as 6- and 12-mm-long ones. Conclusion: It can be concluded that the length of post is influential in the fracture resistance of the root so that the maximal resistance can be obtained in 8 to 10 mm of length and such lengths can be recommended for non-metal posts .

Background The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of—and expansion on—the 2014 analysis, which reported 80 million (95% CI 64–103) viraemic infections in 2013. Methods We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. Findings Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8–1·1) in 2015, corresponding to 71·1 million (62·5–79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). Interpretation The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. Funding John C Martin Foundation. © 2017 Elsevier Ltd

Aim and background: Dieulafoy lesion (DL) represents a rare, but important cause of major upper digestive bleeding, especially in elders. The aim of the study consists in identifying the clinico-biological and endoscopic features and the outcome of these patients. Methods: We retrospectively evaluated the patients admitted with non-variceal upper digestive bleeding (UDB) in the Department of Gastroenterology, of the Emergency County Hospital Timisoara, from 2003 to 2014. Out of the total number of cases we selected the patients with endoscopic diagnosis of Dieulafoy lesion. In these patients we analyzed the demographic, clinico-biological and endoscopic data, compared to the control group that encountered the rest of the patients with UDB. Results: Out of 2104 patients with non-variceal UDB, 31/2104 (1.5%) presented DL, 19/31(61.3%) male and 12/31(38.7%) female, mean age 63 ± 12.83. Diabetes mellitus was present in 35.5% cases. The mean value of hemoglobin was significantly lower in Dieulafoy group 7 ± 2.69 vs. 8 ± 3.28 in the control group, p=0.05, thus a significantly larger number of blood units per patient were needed in this group (p

Background Hepatitis C virus (HCV) is a leading cause of liver-related morbidity and mortality worldwide. In the European Union (EU), treatment and cure of HCV with direct-acting antiviral therapies began in 2014. WHO targets are to achieve a 65% reduction in liver-related deaths, a 90% reduction of new viral hepatitis infections, and 90% of patients with viral hepatitis infections being diagnosed by 2030. This study assessed the prevalence of HCV in the EU and the level of intervention required to achieve WHO targets for HCV elimination. Methods We populated country Markov models for the 28 EU countries through a literature search of PubMed and Embase between Jan 1, 2000, and March 31, 2016, and a Delphi process to gain expert consensus and validate inputs. We aggregated country models to create a regional EU model. We used the EU model to forecast HCV disease progression (considering the effect of immigration) and developed a strategy to acehive WHO targets. We used weighted average sustained viral response rates and fibrosis restrictions to model the effect of current therapeutic guidelines. We used the EU model to forecast HCV disease progression (considering the effect of immigration) under current screening and therapeutic guidelines. Additionally, we back-calculated the total number of patients needing to be screened and treated to achieve WHO targets. Findings We estimated the number of viraemic HCV infections in 2015 to be 3 238 000 (95% uncertainty interval [UI] 2 106 000–3 795 000) of a total population of 509 868 000 in the EU, equating to a prevalence of viraemic HCV of 0·64% (95% UI 0·41–0·74). We estimated that 1 180 000 (95% UI 1 003 000–1 357 000) people were diagnosed with viraemia (36·4%), 150 000 (12 000–180 000) were treated (4·6% of the total infected population or 12·7% of the diagnosed population), 133 000 (106 000–160 000) were cured (4·1%), and 57 900 (43 900–67 300) were newly infected (1·8%) in 2015. Additionally, 30 400 (26 600–42 500) HCV-positive immigrants entered the EU. To achieve WHO targets, unrestricted treatment needs to increase from 150 000 patients in 2015 to 187 000 patients in 2025 and diagnosis needs to increase from 88 800 new cases annually in 2015 to 180 000 in 2025. Interpretation Given its advanced health-care infrastructure, the EU is uniquely poised to eliminate HCV; however, expansion of screening programmes is essential to increase treatment to achieve the WHO targets. A united effort, grounded in sound epidemiological evidence, will also be necessary. Funding Gilead Sciences. © 2017 Elsevier Ltd

Human capital and the effect it has on the economic growth of countries have been the focus point of economists in the past few decades. There has been a serious consideration over the uneven distribution of the two genders amongst the human capital and the effect this has on the economic growth. Experimental evidence from different countries reveals that Gender Inequality paralyses the economic functionality of the countries, deteriorates their ability to take advantage of their potentials, and finally, it slows down the economic growth and efficiency as well as the pace of the human development. The aim of the current research is to analyze the status of the Gender Inequality in Iran and to compare it with seven Middle Eastern countries and then to evaluate the Gender Gap trend and its impact on Global Competitiveness in Iran, utilizing the data from the Gender Gap Report and Global Competitiveness Report from 2006 to 2015. The data from the Gender Gap Report and the Global Competitiveness Report submitted in the World Economy Forum were also used to examine the link between Gender Gap and Iran’s Global Competitiveness. The results show that, despite some improvements in certain areas, the Gender Equality condition in the country is not acceptable compared with the other countries studied in the research between 2006 and 2015. Iran was ranked 141 in Economic Participation and opportunities, 106 in Educational Attainment, 99 in survival and health, and 137 in political achievements among 145 countries in 2015.

This paper is the first in a series of two publications relating to the European Crohn's and Colitis Organisation [ECCO] evidence-based consensus on the diagnosis and management of Crohn's disease and concerns the methodology of the consensus process, and the classification, diagnosis and medical management of active and quiescent Crohn's disease. Surgical management as well as special situations including management of perianal Crohn's disease of this ECCO Consensus are covered in a subsequent second paper [Gionchetti et al JCC 2016].

Congenital hypothyroidism is the most common preventable cause of mental retardation. It is important to know the cause of each patient's thyroid dysfunction to foresee the course of therapy and outcomes. Imaging methods, such as ultrasound and thyroid scan, help determine the anatomy and function of the thyroid gland. Although thyroid scan is considered superior in detecting ectopic thyroid tissue, ultrasound is able to detect the presence of thyroid tissue not otherwise visualized in 15% of patients.

Alteration of β-catenin expression is involved in the development and evolution of hepatocellular carcinoma (HCC); β-catenin is able to influence tumor cell proliferation. We analyzed the immunohistochemical (IHC) expression of β-catenin on a group of 32 patients diagnosed with HCC using the anti-β-catenin monoclonal antibody (clone E247). We correlated the expression of β-catenin with the proliferation index of Ki-67 (PI Ki-67), the mitotic index (MI) and other clinical and pathological features. We observed an altered β-catenin expression in 58.38% of all HCC cases. This expression was insignificantly correlated with tumor size (]5 cm) (p = 0.683), histological grade G1-G2 (p = 0.307), vascular invasion (p = 0.299) and advanced pT stage (p = 0.453); we obtained a significantly higher MI in HCC with altered β-catenin expression (p = 0.018), as compared to HCC without overexpression (1.66 � 1.37) (p = 0.038) and a PI Ki-67 of 22.49 � 20.1 and 28.24 � 18.2, respectively in tumors with altered β-catenin expression with insignificant differences compared to HCC without overexpression (25.95 � 15.2) (p = 0.682 and p = 0.731, respectively). According to the results we obtained, aberrant β-catenin expression in HCC was correlated with a high mitotic index, therefore playing an important role in tumor progression by stimulating tumor cell proliferation; non-nuclear β-catenin overexpression can have a pathological significance in HCC, especially in cases of HCC associated with hepatitis B virus (HBV) infection.

Natural disease course of inflammatory bowel disease unclassified in a prospective European population-based inception cohort-the Epi-IBD cohort

Article type: original Article Background: Multiple variables influencing the sustained virologic response (SVR) in chronic hepatitis C have been evaluated. one of them is genetic polymorphism near the IL28B gene. Objectives: The aim of this study was to evaluate the influence of IL28B genotypes on SVR rates in a group of patients with chronic hepatitis C from the western part of Romania. Patients and Methods: A retrospective study was performed in 107 consecutive patients, previously treated with standard-of-care medication for chronic hepatitis C, identified from the databases of 2 centers. Patient demographics, viral load before treatment and at 12, 24, and 72 weeks from the treatment start, and IL28B genotype were evaluated. Results: Among the 107 patents in the study group, 54 patients had SVR (50.5%), and 62 (57.9%) showed a complete early virologic response (ceVR). The SVR rates according to IL28B genotype were as follows: 73.1% in patients with genotype C/C, 40.9% in those with genotype C/T, and 57.1% in those with genotype T/T (i.e., 73.1% among patients with the C/C genotype vs. 43.7% among those with non-C/C genotypes; P = 0.0126). The ceVR rates were 80.8% in patients with the C/C genotype vs. 51.2% in those with non-C/C genotypes (P = 0.011). Conclusions: In our cohort of 107 Caucasian HCV patients, the SVR rate was 50.5% with standard-of-care treatment. The SVR rate was directly related to the IL28B genotype: 73.1% in the C/C genotype vs. 43.7% in non-C/C genotypes (P = 0.0126).

BACKGROUND AND AIM Decisions on public health issues are dependent on reliable epidemiological data. A comprehensive review of the literature was used to gather country-specific data on risk factors, prevalence, number of diagnosed individuals and genotype distribution of the hepatitis C virus (HCV) infection in selected European countries, Canada and Israel. METHODOLOGY Data references were identified through indexed journals and non-indexed sources. In this work, 13,000 articles were reviewed and 860 were selected based on their relevance. RESULTS Differences in prevalence were explained by local and regional variances in transmission routes or different public health measures. The lowest HCV prevalence (â?¤ 0.5%) estimates were from northern European countries and the highest (â?¥ 3%) were from Romania and rural areas in Greece, Italy and Russia. The main risk for HCV transmission in countries with well-established HCV screening programmes and lower HCV prevalence was injection drug use, which was associated with younger age at the time of infection and a higher infection rate among males. In other regions, contaminated glass syringes and nosocomial infections continue to play an important role in new infections. Immigration from endemic countries was another factor impacting the total number of infections and the genotype distribution. Approximately 70% of cases in Israel, 37% in Germany and 33% in Switzerland were not born in the country. In summary, HCV epidemiology shows a high variability across Europe, Canada and Israel. CONCLUSION Despite the eradication of transmission by blood products, HCV infection continues to be one of the leading blood-borne infections in the region.

Over the past few years, the Persian and English translations of Quran have been studied from different standpointsThroughout the centuries, Muslim and non-Muslim translators have been very concerned to convey the meaning ofthe Quran into languages other than Arabic. The holy Quran is a divine book and its translation into other languagesmust be done meticulously. In this regard, Persian and English translation of one of the surahs of this magnificentbook was selected to be compared. the present study has gone through the investigation of the Persian translation ofone of the surahs of this holy book “Yasin” by Dr. Elahi Ghomshei (1361) and its English translation by threefamous translators Yusuf Ali (2000), Pickthall (1930) and Sarwar (2011) to see discrepancies. Also, this study triesto find out the unit of translation and classify different kinds of Vinay and Darbelnet’s procedures used by theEnglish translators.