1. The impact of ventilatory efficiency on reduced exercise capacity and recovery oxygen kinetics has not been addressed in cirrhotic patients. The aim of the present study was to investigate exercise performance and ventilatory efficiency in patients with mild and moderate liver cirrhosis (LC). 2. Nineteen male non-hypoxic patients with LC (age 51.3 +/- 9.1 years; body mass index (BMI) 25.6 +/- 3.6 kg/m(2)) classified by the Child-Pugh score as class A (n = 7) and class B (n = 12) and 19 age- and BMI-matched controls participated in the study. Subjects undertook maximal incremental exercise testing on a treadmill using the Bruce protocol. 3. Patients with LC showed a reduced diffusion capacity (D(L,CO)%) compared with controls (74.6 +/- 15.2 vs 95.6 +/- 12.9%, respectively; P < 0.001), but a comparable volume standardized diffusion coefficient (1.33 +/- 0.22 vs 1.45 +/- 0.18 mmol/min per kPa per L, respectively; P = 0.74). Patients with LC had a significantly lower exercise capacity compared with controls (VO(2 max) 23.8 +/- 3.8 vs 30.6 +/- 4.4 mL/min per kg, respectively; P < 0.001). Recovery oxygen kinetics were also impaired in LC patients compared with controls (104.6 +/- 19.3 vs 84.4 +/- 22.7 s, respectively; P = 0.012). The chronotropic index was significantly lower in the LC group compared with controls (0.67 +/- 0.19 vs 0.82 +/- 0.17, respectively; P = 0.030) and LC patients showed higher ventilatory equivalents (30.4 +/- 3.8 vs 26.3 +/- 2.3, respectively; P < 0.001) and lower oxygen uptake efficiency slope values (2187 +/- 445 vs 2745 +/- 473 mL/min per log(10)L, respectively; P < 0.001) compared with controls, which is indicative of decreased ventilatory efficiency. Patients with LC also had a higher standardized maximal exercise perception score (SMEPS) compared with controls (0.62 +/- 0.18 vs 0.46 +/- 0.15, respectively; P = 0.011). Moderate negative correlations were found between Child-Pugh score and VO(2 max)% (r = -0.496; P = 0.031). 4. In conclusion, patients with mild and moderate LC have reduced exercise capacity, which correlates with Child-Pugh score, as well as reduced chronotropic index and prolonged recovery oxygen uptake kinetics. The results suggest worsened ventilatory efficiency during exercise and cardiopulmonary reasons for the higher SMEPS in these patients.

Magnetic resonance imaging (MRI) of the breast has been increasingly used for the detailed evaluation of breast lesions. Diffusion-weighted imaging (DWI) gives additional information for the lesions based on tissue cellularity. The aim of our study was to evaluate the possibilities of DWI, apparent diffusion coefficient (ADC) value and ADC ratio (the ratio between the ADC of the lesion and the ADC of normal glandular tissue) to differentiate benign from malignant breast lesions. Materials and methods: Eighty-seven patients with solid breast lesions (52 malignant and 35 benign) were examined on a 1.5 T MR scanner before histopathological evaluation. ADC values and ADC ratios were calculated. Results: The ADC values in the group with malignant tumors were significantly lower (mean 0.88 ± 0.15 × 10−3 mm2/s) in comparison with the group with benign lesions (mean 1.52 ± 0.23 × 10−3 mm2/s). A significantly lower ADC ratio was observed in the patients with malignant tumors (mean 0.66 ± 0.13) versus the patients with benign lesions (mean 1.12 ± 0.23). The cut-off point of the ADC value for differentiating malignant from benign breast tumors was 1.11 × 10−3 mm2/s with a sensitivity of 94.23%, specificity of 94.29%, and diagnostic accuracy of 98%, and an ADC ratio of ≤0.87 with a sensitivity of 94.23%, specificity of 91.43%, and a diagnostic accuracy of 95%. Conclusion: According to the results from our study DWI, ADC values and ADC ratio proved to be valuable additional techniques with high sensitivity and specificity for distinguishing benign from malignant breast lesions.

Aim: The aim of this study was to identify the incidence of and the risk factors for poor bowel preparation in elderly patients. Patients and methods: We enrolled 240 patients over 60 years of age, hospitalized in the Clinic of Gastroenterology, Kaspela University Hospital between October 2016 and May 2017 and scheduled them for colonoscopy. We recorded patients’ demographics data, clinical characteristics and the rate of bowel preparation. Factors associated with poor bowel preparation were identified by multivariate logistical regression analysis. Results: The rate of poor bowel preparation was 33.6%. Factors associated with poor bowel preparation were a history of abdominal surgery (OR, 2.617, CI, 1.324-5.174), chronic constipation (OR, 3.307; CI, 1.551-7.054), non-compliance with dietary instructions (OR, 2.239, CI, 1.122-4.471), noncompliance with polyethylene glycol (PEG) dosage (OR, 4.576, CI, 1.855-11.287), walking less than 30 min during preparation (OR, 2.474; CI, 1.261-4.855), interval between PEG ingestion and the onset of bowel activity (OR, 1.025, CI, 1.010-1.040), the latest stool that was not clear and watery (OR, 4.191; CI, 1.529-11.485). Conclusions: Elderly patients tend to have suboptimal preparation for colonoscopy. Walking less than 30 min. during the PEG ingestion period may be a surrogate for bowel preparation failure. Future studies should identify patients at risk for poor bowel preparation. Methods and interventions should be developed to improve outcomes.

Non-invasive, ultrasound-based methods for visualizing and measuring tissue elasticity are becoming more and more common in routine daily practice. An accurate diagnosis of malignant and benign tumors is essential for determining the appropriate treatment. Despite the wide use of imaging techniques, the investigation for assessing the elasticity of focal liver lesions and their differentiating is still continuing. Aim: To investigate the value of point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) for the differential diagnosis of benign and malignant focal liver lesions. Materials and Methods: A total of 125 adult patients were included from the Clinic of Gastroenterology of University Hospital Kaspela, Plovdiv city, Bulgaria, in the period from January 2021 to July 2022. Participants were divided into two groups—with benign (hemangiomas) and malignant focal liver lesions (hepatocellular carcinoma). The group with benign lesions included 63 patients and the group with malignant focal liver lesions (FLLs)—62 patients. Point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) integrated in the same ultrasound machine (Esaote MyLab™ 9Exp) were performed for each lesion. Results: Malignant FLLs have significantly higher stiffness in both pSWE (2.52–4.32 m/s, 90% CI: 2.37 to 2.68, 90% CI: 4.19 to 4.55) and 2d-SWE (2.52–4.43 m/s, 90% CI: 2.31 to 2.65, 90% CI: 4.27 to 4.61). Conclusion: 2D-SWE and pSWE could provide complementary data about FLLs. They enable us to conveniently and easily obtain accurate stiffness information of FLLs.

Introduction: A variety of imaging techniques exists for the diagnosis of pancreatic disorders. None of the broadly applied diagnostic methods utilizes elasticity as an indicator of tissue damage. A well-known fact is that both chronic pancreatitis (CP) and pancreatic ductal adenocarcinoma (PDA) are associated with the development of prominent fibrosis (increased tissue stiffness). Purpose: To prospectively assess the accuracy of point shear wave elastography (pSWE) in differentiating between benign and malignant pancreatic diseases, establish a cut-off value for the diagnosis of PDA, and evaluate the influence of certain variables on the obtained results. Materials and methods: The present study included 78 patients who were admitted at the Department of Gastroenterology at the university hospital “Kaspela” between December 2017 and August 2021 for diagnosis and/or treatment of pancreatic disorders. Based on the clinical criteria, diagnostic imaging, and histological findings, patients were divided into the CP and PDA group. The ultrasound based pSWE technique was applied and shear wave velocity (SWV) was measured. The depth of region of interest (ROI) and successful measurement rate were also recorded. Results: The mean ± SD SWV values established through pSWE were 1.75 ± 0.34 m/s and 2.93 ± 0.91 m/s for the CP and PDA, respectively. With a cut-off value of 2.09 m/s, we calculated the sensitivity (Se), specificity (Sp), and accuracy for differentiating between CP and PDA of 89.47%, 91.20%, and 88.60%, respectively. Of the examined variables, BMI and depth of ROI in the CP group and sex in the PDA group showed a statistically significant influence on the obtained results. Conclusions: pSWE may be utilized as a differential diagnostic modality in patients with suspected CP or PDA.