The Role of Ultrasound in Assessing Hand Joints and Tendons in Psoriatic Arthritis.

INTRODUCTION: Psoriatic arthritis (PsA) is an inflammatory arthritis, usually involving peripheral joints, associated with cutaneous psoriasis, in the absence of rheumatoid factor and anti-citrullinated protein antibodies. MATERIAL AND METHODS: The study included 28 patients diagnosed with psoriatic arthritis according to CASPAR criteria, presenting pain or swelling of the small joints of the hands and wrists, hospitalized in the Department of Rheumatology of the Emergency Clinical County Hospital of Craiova during 2016-2018. RESULTS: In the 28 patients, a total of 840 joints were examined clinically and by ultrasound. From the clinical point of view, out of the total, 32 joints were swollen while 59 joints were tender. Dactylitis was evidenced in 20/280 examined digits upon physical examination. MUS revealed the presence of synovial proliferation in 108/840 sites (12.85%), with grade 1 synovitis in 4 joints (3.7%), grade 2 in 94 joints (87.03%) and grade 3 in 10 joints (9.25%). Out of 280 examined fingers 5.71% presented dactylitis, the third digit being the most commonly targeted. Grade 2 tenosynovitis was found in 40 of the examined tendons, whereas 8 tendons presented with grade 3 tenosynovitis. The most frequently involved were the flexor tendons of the digits (38 out of 40 tendons with inflammatory changes), followed by the extensor carpi ulnaris and flexor carpi radialis tendons. CONCLUSIONS: Ultrasound has proven its utility in assessing joint and tendon inflammation to a higher extent that clinically expected. Thus, MUS examination of hand joints may aid the clinician in diagnosing PsA, in evaluating the prognosis and the course of treatment.

Hepatitis C Infection in Hemodialysis Patients.

Three centuries after the identification of hepatitis C virus (HCV), specialized literature has outlined the epidemiology, viral kinetics and clinical manifestations of this infection. A major cause of morbidity-mortality in patients with renal transplantation and in hemodialysis patients is HCV infection. In high seroprevalence countries, internal accounts are not uniform. The European trend is to decrease the incidence and prevalence of HCV in hemodialysis patients. In Europe, the prevalence of HCV infection among hemodialysis patients tends to be higher than that of the general population, but it is variable by region. Some studies indicate a decrease in incidence in parallel with prevalence in dialysis centers over the last 10 years, while others maintain a high incidence. In some countries, as is the case with Romania, both prevalence and incidence remain high, with the major route of transmission being nosocomial, probably due to limited resources for a rapidly growing dialyzed population. Some authors recommend more isolation measures to be taken in centers with high prevalence of infection.

Evaluation of Gastric Carcinomas Histological Patterns in Relation to Tumors Aggressiveness Parameters.

Gastric carcinomas are frequent tumors with variable growth patterns that may interfere with the evaluation of histopathological prognostic parameters of the lesions. In this study we analyzed the incidence and statistical relation of histological growth patterns depending on the prognostic parameters of gastric carcinomas for 95 cases. Pure forms were present in 82.2% of cases, from which more frequent subtypes were low grade tubular carcinomas and poorly cohesive with signet-ring cells carcinomas. Mixed forms were present in 17.8% of cases, with the highest incidence of tumors containing well differentiated tubular carcinoma and poorly differentiated papillary carcinoma areas. Analysis of the identified types and subtypes in relation to the histological prognostic parameters indicated significant differences regarding the tumor stage, the mixed subtypes being more frequent in advanced stages. Although mixed subtypes were more commonly associated with vascular and perineural invasion, the aspects were statistically insignificant. Together with tumor stage, the lymphovascular and/or perineural invasion should be taken into consideration as prognostic indicators in the postoperative management of gastric cancer.

Clinical and Ultrasound Assessment of Enthesis in Psoriatic Arthritis in a Romanian Cohort.

INTRODUCTION: Spondyloarthritis (SpA) is a group of chronic inflammatory disorders which includes ankylosing spondylitis (SA), psoriatic arthritis (PsA), reactive arthritis (ReA), arthritis associated with inflammatory bowel disease (IBD) and undifferentiated spondyloarthritis (uSpA). The enthesis, the area of insertion of the tendon, ligament or joint capsule onto the bone, can be characterized as a central feature in PsA. MATERIAL AND METHODS: The study included a number of 28 patients, 18 females and 10 males, with PsA hospitalized during 2016-2018 in the Department of Rheumatology of the Emergency County Hospital of Craiova. All the patients were diagnosed with psoriatic arthritis according to CASPAR criteria and had a history of entheseal pain, mandatory criteria for inclusion in the study. All patients underwent clinical examination, laboratory tests and musculoskeletal ultrasonography (MSUS). RESULTS: The Belgrade Ultrasound Enthesitis Score (BUSES) was not significantly associated either with ESR (p=0.536) or CRP (p=0.965) values. Furthermore, the clinical evaluation through the LEEDS enthesitis index (LEI) showed no significant association with ESR (p=0.067) or CRP (p=0.206). Despite MSUS and clinical findings, there was no significant correlation between disease activity in psoriatic arthritis (DAPSA) and BUSES (p=0,549) or LEI (p=0,197). However, clinical and echographic scores (BUSES and LEI) were significantly associated (p=0.001). CONCLUSIONS: Our study proved a significant correlation between LEI and BUSES, although in literature the evidence is contrasting. This is probably due to the fact that the majority of the patients had high disease activity which made the clinical assessment similar to the US. Further studies on more numerous groups of patients have to be conducted in order to debate the inconsistencies related to clinical and US examinations in patients with PsA.

Noninvasive Fibrosis Assessment in Chronic Viral Hepatitis C associated with End Stage Renal Disease.

INTRODUCTION: HCV is considered the most encountered viral infection that affect patients after hemodialysis sessions. Even though liver biopsy is considered the golden standard for hepatic diagnosis, additional methods have been used for assessing liver fibrosis. Transient elastography (TE) has evolved as a reference method in some European countries and allows the physician to carry out a fibrosis evaluation in a noninvasive, low-cost and rapid method. Our objective was to assess the efficacy of TE in staging patients with HCV liver disease associated with ESRD, thus choosing the correct moment to perform the procedure. MATERIALS AND METHODS: We included 34 patients known with ESRD within the regional Nephrology Clinic of Olt County Hospital and also having positive hepatitis C viral liver marker. TE was performed before and hemodialysis and data was analyzed. RESULTS: The patients where we have encountered significant changes were especially within the F0 and F1 stage with a decrease of fibrosis after hemodialysis. Thus, 7 patients which had no fibrosis (F0) went from 4,14±0,98kPa to 3,54±0,84 (p<0,05) and 12 patients from the F1 stage went from 6,22±0,39kPa to 5,47±0,58kPa. The other stages had no significant changes with F2 changing after hemodialysis from 8.03±0,62kPa to 7, 76±0,6kPa. CONCLUSIONS: TE represents a valuable tool for stiffness assessment and should be taken into considerations as a major option for ESRD patients with liver disease. However, more patients should be enrolled to strengthen this theory and thus providing more reliable results.

Study of Histopatological Parameters of Gastric Carcinomas with Micropapillary Component.

Micropapillary carcinoma was recently identified as a carcinoma variant characterized by the presence of small clusters of tumor cells located in optically empty spaces. The study included a number of 14 cases represented by surgical excision specimens diagnosed with gastric carcinoma (tubular, papillary and signet-ring) which associated the micropapillary component in variable proportions. Regarding the low-grade tubular carcinomas, the micropapillary component represented less than 25% of the tumor, while in the high-grade tubular carcinomas and papillary carcinomas it represented 25-50%. Among signet-ring carcinomas, the micropapillary component had a percentage of over 50. The depth of invasion was frequently associated with T3 and T4 categories. Lymph nodes metastasis were found in ten cases and distant metastasis were present in three cases. Recognition of the micropapillary component associated with gastric carcinoma represents an aspect of great importance because it is frequently correlated with unfavorable prognosis parameters.

Telangiectasia Detection in Wireless Capsule Endoscopy Using the Color Slicing Technique.

Wireless capsule endoscopy represents a color imaging technology in the field of medical endoscopy that is extensively used to detect lesions of the human digestive tract. It is the golden standard in evaluating small bowel lesions, offering a set of digital snapshots difficult to get using other investigation methods. Its major drawbacks are the time consumed for image analysis and the burden for the physicians that must spot and classify lesions within more than 55000 images. This paper carries out a study on the detection of telangiectasia in the small bowel, based on an adapted color slicing technique applied not only on unique frames, but on series of successive frames, performing a global analysis suitable on partial sequences or entire wireless capsule endoscopy movies. We have quantified the extracted features and determined a weighting algorithm to find telangiectasia lesions. For frames containing potential lesions, we have determined features not only for the global image, but also for the normal mucosa surrounding the lesion extracted from the image. This approach allows the physician to see variations of parameters within a frame or a sequence that contains lesions. Experimental results prove that the algorithm is effective in detecting telangiectasia patterns of different images, with an accuracy of 93.88%, reducing thus the time spent for the analysis of the images acquired by wireless capsule endoscopy.

Upper Gastrointestinal Bleeding - Initial Manifestation of Pancreatic Head Carcinoma.

Pancreatic head carcinomas are a rare cause of upper digestive bleeding and the diagnosis and the treatment of these pose particular problems. We selected 6 cases from a number of 283 patients who were hospitalized for surgery between January 2014 and December 2016 with signs of upper digestive bleeding with no varicose origin who were subsequently diagnosed with pancreatic head carcinomas. The diagnosis was established by endoscopic and surgical methods. The evolution of these patients was influenced by whether there was active digestive bleeding or history of digestive bleeding and the possibility of tumor resection. Four patients needed emergency surgery due to continuous bleeding or rebleeding. The resectability of the cephalo-pancreatic tumor was determined and then subsequently performed in two patients who had a favorable postoperative outcome, while in two patients the tumor resection was impossible. The other two patients with upper digestive haemorrhage responded favorable to drug therapy, and digestive endoscopy and CT explorations were negative. After a 5-month interval they presented with clinical signs of a pancreatic neoplasm with invasion into the common bile duct, unwanted weight loss, abdominal pain, and icterus of the sclera and skin. The surgical intervention resulted in the confirmation of locally advanced pancreatic head carcinomas and the performing of bilio-digestive derivations. Pancreatic head carcinomas may be associated with upper digestive tract haemorrhage due to duodenal or bile duct invasion. The clinical picture of these patients can vary from occult haemorrhage to severe upper digestive tract haemorrhage accompanied by hypovolemic shock.

The Role of Early Diagnosis of Hepatorenal Cystic (HRC) Syndrome in Children-Clinical Trial.

The hepatorenal cystic (HRC) syndrome is a heterogeneous group of severe monogenic conditions that may be detected before birth. Effective programme evaluation of children with HRC syndrome is a systematic way to identify the renal and urinary tract malformations which represent the most common cause of end-stage renal disease (ESRD). We conducted a study involving 50 patients, who were between 3 months and 16 years of age, with multiple admissions in the Nephrology Department of "Maria Sklodowska Curie" Children Emergency Hospital from Bucharest, during 6 years (April 14th 2010-October 24th 2016), to evaluate the HRC syndrome. The admission symptomatology was mainly represented by the nephrology evaluation which was essential in the management of children's polycystic kidney disease. For example, a premature infant (gestational age=32 weeks) with positive heredo-collateral history (mother and grandmother were diagnosed with polycystic kidney disease), was tested positive for cystic renal disease after the fetal morphology was performed. It was also done a genetic determination for the presence of PKD1 and PKD2 mutations which are specific to autosomal dominant polycystic kidney disease-ADPKD. However, the genetic test was negative and a postnatal nephrological evaluation was performed using renal ultrasound. The image revealed autosomal recessive polycystic kidney disease-ARPKD. This study emphasizes the importance of an early diagnosis (prenatal, neontal, postnatal) correlated with the admission symptoms and also with the genetic diagnosis (mutations of PKD1 and PKD2).

Hepatocellular Carcinoma in Diabetic Patients - a Single Center Experience.

INTRODUCTION: Hepatocellular carcinoma (HCC) represents a major health concern worldwide; identifying risk factors and associated conditions that may lead to its development are therefore of utmost importance to the medical community. An association between diabetes mellitus (DM) and development of HCC on underlying liver conditions has been previously suggested. The aim of our study is to reveal possible significant statistical correlations between the two entities, which might warrant further study of the pathophysiological mechanisms behind this association. PATIENTS AND METHODS: We have prospectively included consecutive cirrhotic patients admitted to our medical clinic over a period of four years, between 2010 and 2014. Diagnostic was established using the EASL criteria. We have documented history of hyperglycemia and any changes of serum values in these patients, evaluating DM patients within the LC lot. From these patients we have selected all patients with imaging suggestive for HCC and established positive diagnosis on the criteria established in the latest EASL guidelines. We have used statistical tests to identify possible correlations between these pathologies. RESULTS: We have identified 2718 consecutive patients with LC and successfully included 2556. Of these, 164 also had HCC. A total of 371 patients had DM - 54 also had HCC while 317 remained cancer-free through our study period. We found positive correlations between the presence of DM and HCC. Subgroup analysis of the HCC cohort revealed a positive association between DM and liver cirrhosis and chronic hepatitis. We did not find positive relationships between DM and overall liver conditions, splenomegaly, hepatomegaly, other significant symptoms, substance abuse and main serum values. CONCLUSIONS: We have found several significant correlations between DM and underlying liver conditions in a HCC cohort. Our study, however, did not reveal other significant associations regarding these diseases. Further studies are required to determine the precise role this disease plays in the development and severity of liver diseases.

The Evaluation of Beta-2-Adrenoreceptors' Expression in Normal Peritumoral Tissue in Patients with Colorectal Adenocarcinoma.

INTRODUCTION: The aim of this study is to evaluate the expression of beta-2 adrenergic receptors in the normal peritumoral tissue at the colorectal level, just after the front tumor invasion, in patients with colorectal cancer. METHODS: In this study we analyzed normal peritumoral tissues belonging to 56 patients, who were diagnosed with colorectal adenocarcinoma. These tissues were fixed in paraformaldehyde and paraffinembedded. The immunohistochemical study was done on seriate slides following the hematoxylin and eosin staining, after diagnostic and grading. Correlations were made between beta-2-adrenoreceptors' expression in the normal peritumoral tissue and the clinical and histopathological parameters of the patients with colorectal cancer. RESULTS: There are positive correlations between the expression of beta-2-adrenoreceptors and feminine gender, age group under 50 years, tumor size under 5cm, tumor invasion T3-4 and tumor metastasis in regional lymph nodes N≥2. By analyzing the expression of beta-2-adrenoreceptors in peritumoral tissue depending on tumor grading one can notice that there are positive correlations between beta-2-adrenoreceptors' expression and poorly differentiated colorectal adenocarcinoma. CONCLUSIONS: Positive correlation between this type of receptors in normal glandular epithelium, in the vicinity of tumor invasion front of colorectal neoplasm, and certain clinicopathological features suggests the involvement of tumor microenvironment, which expresses them, in the pathogenesis of this neoplasm.

Superior digestive tract side effects after prolonged treatment with NSAIDs in patients with osteoarthritis.

INTRODUCTION: Anti-inflammatory drugs (NSAIDs) represent one of the classes of drugs commonly recommended for patients with osteoarthritis. These drugs have side effects that sometimes affect the digestive tract. PATIENTS AND METHODS: 30 patients with either axial or peripheral osteoarthritis, hospitalized between January 2013 and January 2015 in the Rehabilitation Clinic of the Clinical Emergency County Hospital of Craiova, were followed. All the patients included had upper gastrointestinal endoscopy performed, excluding patients who had a history of gastritis, endoscopically demonstrated ulcer or those with a history of gastrointestinal dyspeptic phenomena. RESULTS: The endoscopic examination found acute erosive gastritis in eight cases, gastric ulcer (four cases) and duodenal ulcer (six cases). No serious complications were encountered. Four patients had no clinical manifestations with endoscopic expression. Lesions were mainly mild esophagitis (Grade I) and only in three cases, esophagitis grade II or III was found. Twelve patients (40%) had Helicobacter pylori infection and had endoscopic changes (gastric ulcer, duodenal ulcer, or gastric lesions). CONCLUSIONS: The adverse effects of NSAIDs in patients with osteoarthritis vary in severity. Patient age significantly influences the severity of injuries. We have not found significant differences in the incidence of COX2 selective and non-selective NSAID-induced lesions. Pathogenic interaction between the NSAID and Helicobacter Pylori infection is most often a synergistic effect in the development of gastritis or gastroduodenal ulcer.

Diabetes mellitus and renal involvement in chronic viral liver disease.

HYPOTHESIS: Chronic viral liver disease is often associated with other conditions. Diabetes mellitus (DM) is frequently reported in this context and may play a role in the progression of the liver disease to hepatocellular carcinoma (HCC). Renal disease is also an important extrahepatic manifestation of hepatitis viral infection and its presence is associated with poor prognosis and management issues. OBJECTIVES: Our study had multiple purposes: to determine the frequency of the association between chronic viral liver disease and diabetes mellitus, evaluate the potential of diabetes mellitus as a risk factor for HCC and assess an eventual renal involvement. METHODS AND RESULTS: We included in our study a number of 246 patients with chronic liver disease, from whom 136 were diagnosed with chronic viral hepatitis and 110 with viral liver cirrhosis. These patients were assessed by using a clinical examination and a series of tests, including serum transaminase levels, serum bilirubin, serum albumin, markers of cholestasis, fasting plasma glucose levels, serum creatinine, urea, albuminuria, Addis-Hamburger test, electrophoresis of urinary proteins, abdominal ultrasound and, in some cases, CT examination. We obtained the following results: diabetes mellitus is often associated with chronic liver disease of viral etiology, having been identified in 18.29% of the patients in our study. Age above 60 in patients with chronic hepatitis (p=0.013<0.05) and presence of hepatitis C virus were particularly correlated with the presence of diabetes mellitus. Renal disease was present in 13.4% of the patients with chronic liver disease and it was especially associated with liver cirrhosis and hepatitis C virus. The most common form of renal injury was glomerulonephritis. Acute kidney injury was diagnosed only in cirrhotic patients as hepatorenal syndrome, occurring in 7.27% of the subjects, while chronic kidney disease was identified only in two cases of chronic viral hepatitis. Four patients in our study were diagnosed with HCC and none of them presented diabetes mellitus. DISCUSSION: Our study revealed that there is a significant association between diabetes mellitus and chronic viral liver disease induced by hepatitis C virus. Glomerulonephritis was the most common type of renal disease in both hepatitis patients and in those with cirrhosis. Glomerular injury was strongly correlated with the presence of hepatitis C virus than with hepatitis B virus. A connection between diabetes mellitus and hepatocellular carcinoma could not be established.

Wireless Capsule Endoscopy in Correlation with Software Application in Gastrointestinal Diseases.

Wireless capsule endoscopy is one of the most recent investigation techniques of gastrointestinal pathology. Unlike conventional upper and lower endoscopy, it has the advantages of being a noninvasive and painless procedure. One of the capsule endoscopy disadvantages is represented by the necessary time to analyze the video frames obtained. Software applications proposed in this purpose could offer support in the images evaluation. Different algorithms have been described in the literature, but further research is needed to establish the practical value of computer vision tools in gastroenterology.

Particularities of Renal Manifestations in Chronic Viral Hepatitis.

INTRODUCTION: Chronic viral hepatitis represent major health problems worldwide, with an evolution that is sometimes marked by a series of extrahepatic manifestations. Among these, kidney disease may occur, either as glomerulonephritis, and/or renal dysfunction. MATERIAL AND METHODS: The purpose of this study was to achieve a complete assessment of the liver and kidney function in a series of patients diagnosed with chronic viral hepatitis, in order to identify a possible kidney disease in this context. 104 patients with chronic viral hepatitis B and C, aged between 25 and 80, were included in the study. These patients were assessed by a series of tests that allowed us to perform a complete evaluation of both liver and kidney function: liver cytolysis enzymes, serum bilirubin, markers of cholestasis, markers of viral infection, urinalysis, albuminuria, electrophoresis of urinary proteins, urea, creatinine, and abdominal ultrasound. RESULTS: Glomerular injury was a rare finding in patients with chronic hepatitis. Patients with chronic hepatitis B had glomerular disease in 5,88 % of cases, while 10 % of the patients with hepatitis C presented this type of renal disease. Acute kidney injury was not identified in our patient group. None of the patients in the hepatitis B study group presented chronic kidney disease. CKD was present in two patients with chronic hepatitis C that had no other associated conditions.

Current Role of Endoscopic Ultrasonography in Rectal Cancer Evaluation During Multidisciplinary Therapy.

We report the case of a patient presenting in the Gastroenterology Department with intermittent rectal bleeding during the past year. A diagnosis of a low rectal adenocarcinoma was based on colonoscopy examination with biopsies, and staging procedures included transrectal endoscopic ultrasonography and magnetic resonance imaging of the abdomen and pelvis (cT2N0M0). Consequently the patient was referred for pre-operative chemoradiotherapy, achieving a complete clinical response as documented by repeated EUS and MRI examinations. Transanal endoscopic microsurgery with pathological assessment of the resected specimen revealed residual adenocarcinoma, highlighting the limitations of current imaging methods, and the constant need of technological improvements.

Genetic Factors Involved in the Development and Progression of Nonalcoholic Fatty Liver Disease.

PURPOSE: The aim of our study was to identify the possible involvement of adiponutrine polymorphysm and of human leukocyte antigens (HLA) in the development of non-alcoholic fatty liver disease (NAFLD). MATERIAL AND METHODS: We included in this study a total of 138 subjects with non-invasive diagnosis of non-alcoholic hepatic steatosis. The patatin-like phospholipase domain containing protein 3 (PNPLA3) rs738409 (adiponutrine) polymorphism was genotyped by allelic discrimination TaqMan PCR assay (5' nuclease assay), using predesigned TaqMan SNP Genotyping Assays. Class I and II HLA antigens were determined by the polymerase chain reaction sequence specific oligonucleotide method (ADN-PCR-SSO). The results were compared with the same data from the control group subjects. RESULTS: For PNPLA 3 polymorphism we found [CC] genotype in 82 subjects (59,42%), [GC] genotype in 45 (32,61%) and [GG] genotype in 11 subjects (7,97%). The frequency of minor [G] risk allele was 0.25. We found class I and II HLA antigens HLA A24, HLA B15, HLA DR15, HLA DR16, HLA DQ3 and HLA DQ5 more frequent in subjects with hepatic steatosis without any other risk factor and HLA-A2, HLA-32, HLA B18, HLA B49 and HLA B53 in patients with obesity or metabolic syndrome. CONCLUSIONS: Our results are consistent with the literature and show an association of PNPLA3 rs738409 polymorphism with hepatic steatosis. Regarding histocompatibility antigens, we studied for the first time in our country the relationship between HLA and non-alcoholic fatty liver disease.

Stress in romanian first year nursing students.

OBJECTIVE: This study aims to analyze the stress of the students from the nursing department within the Medical Midwife and Nurse School from our University. SUBJECTS AND METHODS: For this purpose a questionnaire, comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. RESULTS: The result analysis revealed no significant differences as far as the genders of the subjects were concerned. In the same way, the prior academic background or the student experience did not influence the level of stress. The social and economic factors seem to be involved in choosing a career and thus influence the academic stress. For this purpose, a questionnaire comprising the factors the students consider important for their academic preparation during the first year, was elaborated and applied to 100 students. We used the Students t-test to determine differences between groups and considered p<0.05 as significant. CONCLUSIONS: The stress equally affects the nursing department students, regardless of their gender or prior studies. Social and economic factors play a role in adapting to a new academic environment, having higher expectations and requirements.

Histopathological and immunohistochemical study of hepatic stellate cells in patients with viral C chronic liver disease.

OBJECTIVE: Our aim was to establish a correlation between hepatic stellate cells (HSCs) activity within different areas of hepatic tissue and the degree of liver fibrosis, necroinflammation, and steatosis in patients with viral C chronic liver disease. PATIENTS AND METHODS: We prospectively included 41 liver biopsies from patients with chronic hepatitis C or liver cirrhosis, prior to antiviral treatment. Our control group consisted of seven tissue samples, obtained from 10 to 38 weeks old embryos. We assessed the alpha-smooth muscle actin (α-SMA) expression using immunohistochemistry and a semi-quantitative scoring method. RESULTS: We found a strong correlation (p<0.0001) between the number of activated HSCs and the stage of fibrosis in all examined areas. Necroinflammatory activity was significantly correlated (p<0.05) with the number of activated HSCs in perivenular area (p=0.014) and intermediate area (p=0.018), and strongly correlated (p<0.0001) in periportal and portal tracts and fibrous septa areas. We found no correlation between the degree of steatosis and the number of activated HSCs in the perivenular area (p=0.25), intermediate area (p=0.166) and in the periportal area (p=0.154); however, in the portal tracts and fibrous septa area we observed a significant correlation (p=0.022). CONCLUSIONS: The analysis of HSCs activity within specified areas of liver tissue may lead to new perspectives in early diagnosis of liver fibrosis and in the development of future antifibrinogenic therapies.

Association between liver histology, carotid ultrasonography and retinal vascular changes in patients with nonalcoholic fatty liver disease (NAFLD).

INTRODUCTION: The prevalence of nonalcoholic fatty liver disease (NAFLD) is increasing all over the world. NAFLD has been demonstrated to be associated with carotid artery atherosclerosis, evaluated using the intima-media thickness (IMT). In this article, we focused on the association between NAFLD, carotid parameters such as: intima-media thickness (IMT), pulsatility index (PI) and resistivity index (RI) as markers of subclinical atherosclerosis and the presence of retinal vascular disorders. PATIENTS AND METHODS: We compared carotid IMT, pulsatility and resistivity index evaluated by ultrasonography, in 10 patients with histological-proven NAFLD and retinal vascular changes (retinophotographies). RESULTS: The degree of hepatic steatosis, necroinflammation and fibrosis in NAFLD patients was strongly associated with the value of carotid IMT and also with PI and RI. Moreover, there seems to be a connection between the degree of NAFDL and the retinal vascular changes in patients with carotid atherosclerosis. CONCLUSIONS: These results suggest that the severity of liver histopathological lesions among NAFLD patients is strongly associated with carotid parameters: IMT, IP, IR and also with retinal vascular changes. Further controlled studies are needed to confirm the results.