Background and Aims: The nonpharmacological therapy in irritable bowel syndrome (IBS) is expanding rapidly. Practitioners and medical educators need to be aware of progress and changes in knowledge of this topic. The Romanian Society of Neurogastroenterology aimed to create guidelines based on best evidence on the use of nonpharmacological therapy in IBS. Methods: A group of experts was constituted. This was divided in eleven subgroups dedicated to eleven categories of nonpharmacological therapy. The subgroups searched the literature and formulated statements and recommendations. These were submitted to vote in order to obtain consensus. Results: The outcome of this activity is represented by the guidelines of the Romanian Society of Neurogastroenterology, presented in this paper. The recommendations are seen as complementary to the pharmacological therapy and are not intended to recommend avoiding pharmacological drugs. Conclusions: These guidelines were elaborated by a Delphi process and represent a useful tool for physicians managing patients with IBS.

Background/Objectives: Heart failure (HF) with reduced ejection fraction (EF) has, in more than 50% of cases, an ischemic etiology and continues to be associated with increased mortality and morbidity despite all the progress registered in the field of medical therapy and interventional revascularization. Myocardial revascularization is extensively used in clinical practice based on the traditional concept that it can improve myocardial function and outcome in ischemic HF. This review is aimed at presenting current knowledge regarding revascularization in patients with chronic ischemic HF and reduced EF. Methods: The impact of revascularization on symptomatology, left ventricle reverse remodeling, major adverse cardiac events (MACEs), and the role of complete revascularization and of percutaneous interventional revascularization in chronic total occlusion (PCI-CTO) were analyzed. The best therapeutic strategies, revascularization and/or optimal medical therapy (OMT), are debated in different categories of patients, in order to identify who will benefit more from revascularization strategies. Results: Based on the long-term results of the STICH trial incorporated in the guidelines with a class I-b recommendation, coronary artery bypass graft (CABG) remains the main modality of revascularization for prognostic improvement in ischemic HF with multivessel disease. But real-life patients are usually old with multiple comorbidities and high surgical risk. In this category, the Heart Team opinion is required to evaluate the probability of complete revascularization and to choose between percutaneous coronary intervention (PCI) and CABG according to clinical status and coronary anatomy. Conclusions: However, until further studies are available, the results of the REVIVED-BCIS2 trial encourage OMT over PCI in patients with ischemic cardiomyopathy. The available randomized controlled trials (RCTs) showed improved angina and quality of life in PCI-CTO versus OMT, but the effect on MACEs was not demonstrated.

Background: Discrepancies are frequently observed between liver steatosis grading assessed by conventional B-mode ultrasonography and vibration-controlled transient elastography (VCTE) with controlled attenuation parameter (CAP). This study aimed to identify factors associated with these differences and to evaluate whether the two imaging methods provide comparable steatosis classifications. Methods: We conducted a retrospective cross-sectional observational study including 130 hospitalized patients evaluated over a two-year period who underwent laboratory testing, abdominal ultrasonography, and transient elastography. The analyzed variables included demographic characteristics, nutritional status, comorbidities, and biochemical parameters such as alanine aminotransferase (ALAT), total cholesterol, triglycerides, gamma-glutamyl transferase (GGT), and the fibrosis-4 index (FIB-4). Patients were classified into two groups: concordant steatosis grading between the two methods (n = 61) and discordant results (n = 69). Results: Concordant steatosis grading was more frequently observed in patients with serum total cholesterol > 200 mg/dL (45.9%) and FIB-4 values between 1.45–3.25 (44.2%). A trend toward higher concordance was also observed in patients with elevated triglycerides. In contrast, viral liver disease was significantly associated with discordant results (26.2%). Higher fibrosis stages assessed by VCTE (F ≥ 2) and FIB-4 values > 3.25 showed a non-significant trend toward discordance. Conclusions: Several clinical and biochemical factors influence the agreement between ultrasound and VCTE-based CAP in the assessment of hepatic steatosis. Elevated cholesterol and intermediate FIB-4 values were associated with concordant results, whereas viral liver disease was associated with discordance between the two imaging modalities.

During routine evaluation of hospitalized patients, discrepancies were frequently observed between the degree of liver steatosis assessed by conventional B-mode ultrasonography and Vibration-Controlled Transient Elastography (VCTE) with Controlled Attenuation Parameter (CAP). This study aimed to identify the factors contributing to these differences and to determine whether both imaging methods should be expected to produce comparable steatosis classifications. We conducted an observational retrospective cross-sectional study including 130 patients admitted over a two-year period who underwent laboratory testing, abdominal ultrasonography, and transient elastography. Variables analyzed included age, sex, environment, nutritional status, comorbidities, biochemical parameters (ALAT, total cholesterol, triglycerides, GGT), calculated FIB-4 score. Patients were classified in two groups: 61 with concordant steatosis grades across both methods and 69 with discordant results. Concordant results were more common in individuals with serum total cholesterol >200 mg/dL (45.9%), and those with a Fib-4 score between 1.45–3.25 (44.2%). Additionally, a trend toward a stronger correlation was observed in patients with elevated triglycerides. Viral liver disease showed a significantly higher rate of discordant results (26.2%). Total serum cholesterol >200 mg/dL, and a FIB-4 score between 1.45–3.25 can be significantly associated with concordance in steatosis grading, while serum triglyceride levels showed a nonsignificant trend toward concordance. In contrast, viral hepatitis with concomitant steatosis can be associated with discordant findings between the two imaging modalities. Although not statistically significant, a value F ≥ 2 measured by VCTE measured fibrosis and a FIB-4 score >3.25 also showed a trend toward discordance, suggesting they may contribute to variability in steatosis assessment.

Background and Objectives: The role of neoadjuvant or perioperative treatment in anatomically resectable pancreatic ductal adenocarcinoma (PDAC) remains intensely debated, in part because prior evidence syntheses have often pooled resectable and borderline-resectable disease. We aim to evaluate the efficacy and safety of neoadjuvant or perioperative treatment versus upfront surgery in trial-defined resectable PDAC using randomized evidence only. Materials and Methods: We performed a systematic review and meta-analysis of parallel-group randomized controlled trials comparing neoadjuvant therapy with upfront surgery in adults with resectable PDAC. PubMed, CENTRAL, Scopus, and Clarivate Web of Science were searched from inception until 30 November 2025. Mixed resectable- and borderline-resectable trials were included only when outcomes for the resectable subgroup were extractable. The primary outcome was overall survival (OS), analyzed on an intention-to-treat basis. Secondary outcomes included time-to-disease-event (TTDE) endpoints, resection rate, R0 resection, pathological node-negative (pN0) status, postoperative morbidity and mortality, and grade ≥3 adverse events. The review protocol was prospectively registered in PROSPERO (CRD420251243805). Results: Eight randomized controlled trials enrolling 1395 patients, including 1184 patients with resectable PDAC, met the eligibility criteria. Overall survival was available for six trials (seven comparisons totaling 1066 randomized patients) and was not significantly different between neoadjuvant treatment and upfront surgery (HR 0.80, 95% CI 0.59–1.08). TTDE was likewise not significantly different between strategies (HR 0.80, 95% CI 0.58–1.11). Neoadjuvant treatment reduced the likelihood of proceeding to resection (RR 0.90, 95% CI 0.85–0.95), while R0 resection and pN0 rates were numerically but not significantly higher among the resected patients. Postoperative morbidity and mortality were comparable between groups. Exploratory analyses suggested favorable survival estimates in trials with higher neoadjuvant treatment deliverability and completion. Conclusions: In trial-defined resectable PDAC, current randomized evidence does not demonstrate a universal survival advantage for neoadjuvant treatment over upfront surgery. Exploratory trial-level analyses suggested that higher neoadjuvant treatment deliverability and completion were associated with more favorable survival estimates. These findings support a selective, individualized rather than routine use of preoperative strategies in resectable PDAC.

Hepatocellular injury syndrome represents a pathological process with a broad etiological spectrum, including viral infections, autoimmune diseases, or intoxications. Clinicians must identify the potential cause using both anamnestic data and available paraclinical examinations. We present the case of a 55-year-old female patient, admitted to the Internal Medicine 1 Department at the Clinical County Emergency Hospital Bihor, Oradea, Romania. The patient exhibited nonspecific complaints and insignificant pathological antecedents, but from a biochemical perspective, substantial changes in liver transaminase levels were evident. To establish differential diagnoses, a series of biochemical and immunological tests were performed, along with a thorough medical history. It was concluded that the patient regularly consumes herbal infusions, specifically Laurus nobilis leaves, commonly known as Bay Laurel. Although this might be easily overlooked at first glance, a closer examination could explain the current clinical picture. In April 2024, a 55-year-old female patient with no history of liver pathology was admitted. She complained of asthenia fatigue, anorexia, mixed dyspeptic symptoms, diffuse abdominal pain, and a weight loss of 12 kg. The pathology had insidiously started approximately 3 months prior. On examination, the patient had altered general status, anorexia, and was overweight. Biochemically, the patient had elevated liver transaminase values (AST = 196 U/L and ALT = 357 U/L) that continued to rise during hospitalization, despite hepatoprotective treatment. Various paraclinical examinations were performed to exclude other potential causes of hepatic aggression, having excluded ordinary causes. Consequently, a liver biopsy was performed, and the histopathological examination leaned toward a toxic hepatitis etiology. Application of the updated RUCAM scale yielded a score of eight points (“probable” HILI—Herb-Induced Liver Injury). Clinical and biochemical improvement was observed after complete cessation of bay leaf tea consumption. This case highlights the potential hepatotoxicity of commonly used culinary herbs when consumed in large quantities or as concentrated infusions and emphasizes the importance of detailed anamnesis regarding herbal product use.