Correlations between ecostifness of caudate lobe and the other lobes of the liver in children through elastography in real time, with implications in hepatic transplantation - ELASTOPEDCAUDAT


Final report - english - PDF file


      Pursued general objectives:


     The general objective of this project is to  make a strategy of development and operational support which assess and investigate the elasticity of the hepatic tissue in children with and without pathological affections( respectively the caudate lobe compared to the other lobes of the liver) in partnership with the team from State  University of Medicine and Pharmacy ”Nicolae Testemitanu”, Chisinau and to create and develop a common research base in the field of innovative techniques of ultrasonography in child with implications in hepatic transplantation. Thus, the Romanian infrastructure research works together, involves and interacts with Moldovean infrastructure and their users. This will optimize the function and development of the research infrastructures, will improve the services availables to researchers and will optimize the quality of medical servicies aimed to population.

      The study will generate operational and sustainable results at a national and UE level, first , by applying innovative methods that will reduce the  present  gap between Romania and the other UE countries, in medical field and also the medical superior  education,and secondly by improving the noninvasive methods of fast and efficient  diagnosis of hepatic pathology with implications in child’s hepatic transplantation.


The specific objectives  of the project are:

        Technique training in order to develop the research infrastructure which allows the comparative investigation of hepatic tissue elasticity on different lobes (respectively the caudate lobe with independent vascularization compared to the other lobe sof the liver) in children with and without pathological affections

        Define the criteria of qualitative and quantitative  investigation of hepatic tissue elasticity

        Determine the period of training and responsabilities for every researcher

        Precise and detailed definition of anamnastic data of studied children

        Dissemination of information obtained from research activities carried out under the ogoing internal contract of research

        Access the scientific database and form a common bibliographic base

        Accumulation of technical skills by researchers of the 2 teams in the quantitative and qualitative analyse of hepatic tissue elasticity in real time in child through ultrasonography together with SIEMENS Romania

        Documentation and perfecting actions of training, of how  the project progresses, the topic of the study, members, identification of local posibilities  of work at University of  Medicine and Pharmacy Chisinau

        Training in comparative exploration of the caudate lobe with the other lobes of the liver in child through elastography in real time, at UMF Tg. Mures, respectively at UMF Chișinău

        Investigate the particularities of hepatic parenchim elasticity on different lobes in children

        atudierea of imagisitc aspects  of the caudate lobe with the other lobes of the liver in child,  at University of Medicine and Pharmacy  Chisinau

        Training in comparative exploration of the caudate lobe with the other lobes of the liver in child through elastography in real time, at UMF Tg. Mures.

        Establish the strategy and management of the human resources with the specificity of further possibilities of colaboration in this field

         Using the innovative techniques to investigate and assess the children with hepatic sufferance, aiming the development of fast and innovative diagnosis.

        support in development of metodology and transferable facility, from medical education to international research, through common scientific projects which we want to fulfill in future.

         Thus, the theme proposed by this project, respectively hepatic elastography in real time is the latest method of diagnosis  which separates the healthy tissue from the patholological tissue, with direct implications in hepatic transplantation, being a „scientific emergency”.



The first objective: establish the protocol of examination of healthy children, but also for those with different pathological affections (hepatitis, hepatic steatosis, oncological affections), quantifying the degree of hepatic fibrosis:

-         Complete the study sheet of healthy children , but also for children.....

-         Clinical and lab assessment of the children

-         Ultrasound examination through virtual touch tissue imaging  method in order to obtain a diagram of the tissue stiffness

-         Examination through ARFI  methods in different hepatic segments and compare their values between them and on group of ages

-           Set the database. All the data obtained from the study sheets will be encoded in a dictionary of variables in order to information processing.

-        Statistical analyse of the data obtained. A descriptive statistical analyse and a comparative one will be made. The presentation of the results  will be made by using techniques of descriptive  statistics and also inferential statistics.

-       Draw the conclusions and results disemination. The results of the first study will be presented in an International congress (2011)  and published in extenso in a magazine of speciality,  ISI or CNCSIS, with factor of corresponding impact.

-      Development of normal parameters  of hepatic tissue elasticity on different lobes and group of  ages, determining the implications of hepatic tissue elasticity in child with hepatic transplantation

-          Compare the hepatic tissue elasticity before and after chemiotherapy treatment in children with malignant affections, quantifing the degree of fibrosis, which would  allow  immediate adoption of an adequate therapeutic behavior, with a significant costs reduction which derives from these and even hepatic biopsy replacement.


    Scientific and technique description of the results and degree of objectives achievement


Summary of the phase

        After having conducted the necessary technical preparation for the development of  research infrastructure which allow the comparative investigation  of hepatic tissue elasticity on different lobes (respectively the caudate lobe with independent vascularization compared to the other lobes of the liver)  in children with or without pathological affections. Thus, the Romanian team together with the team from Moldova took part in an elastography training, with emphasis on hepatic elastography, training made by (Târgu Mureș, april 2011).

-          The criteria of qualitative and quantitative  investigations of the hepatic tissue  elasticity have been established, and considering the anamnestic data of the children , the criteria of children inclusion in the study have been established:

§   I  group– healthy children with normal biological samples and normal conventional ultrasound – will constitute the witness group

§   II group – children with hepatopathies (chronic hepatitis, hepatic cirrhosis,hepatic steatosis, hepatomegaly, obesity, children with oncological affections)

-          Actually,  231  healthy children and with different hepatopathies have been examined (right lobe compared to the left lobe)



Results:

-          Elastography in real time (ARFI) is a useful method of evaluation of hepatic stiffness (hepatic tissue elasticity)

-          On a comparative study (the group of healthy children– witness, group with heatopathies, obese children and those with malignities) it has been noticed that the ALT values were statistically significantly  higher in the group of children with hepatopathies compared to the group of healthy children and  those with malignities (p < 0,05), with CI 95% of 72,05 ± 25,39 in children with hepatopathies,and the AST values were statistically higher in the group of children with hepatopathies compared to the healthy children and those with malignities (p < 0,05), with a  CI 95% of 60,98 ± 31,73 in children with hepatopatii.

-          Through  ARFI , SWV has been measured in every group and statistical correlations have been established. Thus, in the group of healthy children, the median values of  SWV were 1,18 ± 0,27 m/s (with minimum values of 0,13 m/s and maximum values of 1,67 m/s). The  SWV values in the 8th segment (hepatic right lobe) were 1,259 ± 0,30 m/s,and in the 1st segment (the left lobe) of 1,083 ± 0,289 m/s. Comparing these values, it is noticed that in normal conditions in the 1st lobe the SWV values are smaller than in 8th segment (p = 0,0216).

-          In the group of obese children the global values of SWV were 1,646 ± 0,49 m/s, statistically higher than in the witness group (p = 0,0022), which shows the fact that the hepatic fat infiltration would increase the SWV, which decreases the hepatic elasticity.

-          In obese children, the SWV  values at the level of the 8th segment were 1,961 ± 0,756 m/s, higher than at the level of 1st segment where the values were 1,215 ± 0,2998 m/s, which shows that the hepatic steatosis affects first the right lobe. In addition, the SWV values in the 8th segment  in the group of obese children is significantly higher than in the group of control (p < 0,0001).

-          In the group of children with hepatopathies  and those with malignities who got chemiotherapy treatment, the SWV  values were higher compared to the witness group 1,30 ± 0,22 m/s, respectively 1,35 ± 0,41 m/s, but without being statistically significant. (p > 0,05). Taking individually the SWV values for the 8th and 1st segments, significant differences have been noticed between the group of control and the one with hepatic affections, respectively with malignities ( SWV on the 1st segment in children with  hepatopathies and oncological affections was 1,338 ± 0,495 m/s besides 1,083 ± 0,289 m/s in the witness group, and on the 8th segment 1,319 ± 0,4596 m/s, besides 1,259 ± 0,30 m/sin the witness group). Only for the 1st segment we have noticed differences  statistically significant (p = < 0,05); SWV is much higher in children with liver disease, which shows that it is first affected in hepatic fibrosis (taking in some diseases the aspect of a ping-pong ball).

-          Then correlations between global SVW and BM have been made, tricipital fold, medium perimeter of the arm (parameters which assessed the nutritional status) and transaminasis (ALT, AST)  for each group. There was no statistical significant correlation in the witness group, respectively in the group of children with hepatopathies. Significant statistical positive correlations have been made between  SWV and AST in the group of obese children, r = 0,69 și p = 0,02 (statistically significant  0,05), for ALT -  r = 0,25, p = 0,44 statistically insignificant)

-          Statistical significant correlations have been made between SWV and AST  in the group of children with malignant affections, after chemiotherapy (r =0,55 și p = 0,0004),  which show that the higher  the AST is,the higher is the degree of hepatic cirrhosis. So, after chemiotherapy, due to hepatic mobilization of the cytostatics, a hepatic fibrosis  I and II degree appear.

-          In addition, in children with oncological affections, the increased values of SWV at the level of caudate lobe were positively correlated with aspartate transaminase (AST), statistically significant (p=0.0001, r=0.598 Person correlation), and a statistically significant correlation between the 8th segment and AST (p = 0,29, r = 0,359 Person correlation). This shows the fact that once with an AST increase,after chemiotherapy, the degree of hepatic fibrosis increases, so SWV, ARFI  is a true parameter in the assessment of hepatotoxicity.



Conclusions:

-          Finally, in recent times there is an increased interest in finding a noninvasive method of hepatic affections assessment, the degree of hepatic fibrosis, as an alternative to hepatic biopsy.

-          In healthy children, with normal values of transaminasis LS (liver stiffness) was 1,18 ± 0,27 m/s (with minimum values of 0,13 m/s and maximum values of 1,67 m/s).

-          the SWV values in the 8th  segment (hepatic right lobe) were 1,259 ± 0,30 m/s, and in the 1 st segment (left lobe) of 1,083 ± 0,289 m/s. Comparing these values it is noticed that in normal conditions in the 1st segment the SWV values are smaller than in the 8th segment (p = 0,0216).

-          In the group of obese children the  SWV values were 1,646 ± 0,49 m/s, statistically  higher than in the witness group (p = 0,0022), which shows the fact that the hepatic stenosis is correlated  with high values of  SWV, data obtained on a small number of cases  and by other authors. These statements are only a few,the study groups are small and the hepatic parenchim behavior in obese child has not been studied yet.

-          In obese children,  the SWV  values at the level of the 8th segment were higher  than at the level of 1 st segment(1,961 ± 0,756 m/s versus 1,215 ± 0,2998 m/s), which shows the fact that the hepatic steatosis affects mainly  the right lobe. Moreover, the steatosis areas are usually located at the level of the hepatic hilum, prior to the bifurcation of the portal vein, in the plan of the biliary bladder. It has been also noticed that the  SWV values in the 8th segment in the gruop of obese children is significantly higher than in the control group (p < 0,0001).

-          In the group of children with  hepatopathies  and those with malignities who got a chemiotherapy treatment, aslo the SWV values obtained were higher compared to the witness group (1,18 ± 0,27 m/s  versus 1,30 ± 0,22 m/s, respectively 1,35 ± 0,41 m/s), were not statistically significant.

-          Taking individually the SWV values for the 8th and 1st segment , statistically significant differences have been noticed between the group of control and those with hepatic affections, respectively with malignities ( SWV on the 1st segment in children with hepatopathies and oncological affections were 1,338 ± 0,495 m/s besides 1,083 ± 0,289 m/sin the witness group, and on the 8th segment 1,319 ± 0,4596 m/s, besides 1,259 ± 0,30 m/s in the witness group). Only for the 1st segment were statistically significant differences (p = < 0,05);

-          No statistical significant correlation has been found in the witness group with the assessed paramenters (BMI; AST; ALT,  tricipital fold,, medium circumference of the arm), respectively in the group of children with hepatopathies. Positive correlations, statistically significant, have been made between SWV and AST  in the group of obese children, r = 0,69 și p = 0,02 (statistically significant at 0,05).

-          Statistically significant correlations have been noticed between SWV and AST in the group of children with malignant affections, after chemiotherapy (r =0,55 și p = 0,0004), which shows the fact that the higher is  the AST , the higher is the degree of hepatic fibrosis, correlations which have been established individually, on each segment. After chemiotherapy, due to hepatic metabolization of cytostatics, appears a hepatic fibrosis   I and II  degree(Sporea and colaborators). This fact shows that once with an AST increase, after chemiotherapy, the degree of hepatic fibrosis increases so in SWV, ARFI  is a true parameter of  hepatotoxicity assessment.

-          SWV was correlated with fibrosis,hepatic steatosis and hepatic necroinflammatory activity.

-          The theoretical advantage of  ARFI is to implement  an additional soft on the ultrasound which allows an  LS assessment and also a 2D , Doppler classic examination. SWV can also be measured  not only  at the level of the right lobe, but also subcostal  and left lobe, which is known that it is the first affected in hepatopathies  and hepatic cirrhosis.Anyway it must be known that the most perfect measurements are in the superior right quadran, the SWV measurements in the left lobe can be influenced by the movements of the cord.. The small number of cases where we have noticed errors and where is requested another examination, it happened because of excessive movement of the tissue, child’s movement, crying, cardiac beats and so on) and because of marked improvement of the signal in obese children.

-          The difference of elasticity between the caudate lobe and the rest of the liver is very high in the healthy group,but the speeds are not significantly different in the group with neoplasias , maybe because of hepatic fibrosis secondary to chemiotherapy.

-          Our study is a preliminary one, on a limited number of cases (103 cases)  which worth to be extended on a higher number of cases, included in cases with hepatic ascitis, systemic infections, HIV and so on.

-          Thus, the  ARFI technique can assess the hepatic elasticity (LS) in children with chronic hepatitis affections,hepatic steatosis,in malignant affections, after chemiotherapy, being almost a certain method of hepatic fibrosis assesssment besides clinical and biochemical parameters, being able to replace a hepatic biopsy (invasive method). The  ARFI  technique, due to the benefits it has, being a repetable method,noninvasive and easily accepted by children and parents,it can be integrated in the future ultrasonographic  protocol.

-          Due to its own vascularization of caudate lobe, the assessment elasticity in real time of the caudate lobe has further implications pssible in hepatic transplantation

Other results:                                        

Comparing the global elasticity of the hepatic tissue it  is  noticed that the high values are found in the group with hepatic affections, the difference is statistically significant at CI of 95%, cu p = 0.0044. It is noticed that in obese children, SWV had values statistically higher that in the witness group (p = 0,0022), and in the groups of different hepatopathies  and oncologic patients, even if the  SWV values were higher than those seen in the witness group, we have not detected differences statistically significant. (p > 0,05).

-          Dissemination of information through the following papers within the project:



Papers published in extenso:

o   Cristina Oana Marginean, Maria Despina Baghiu, Carmen Duicu, Ana Maria Pitea, Claudiu Marginean  a case of Stevens Johnson syndrome in child  The Romanian Magazine of Pediatry - Ro J Pediatr. 2012, Vol. LXI, Nr. 2, p. 216-221, cathegory B+, cod CNCSIS: 767

o    Cristina Oana Marginean, Ana Maria Pitea, Baghiu Maria Despina, Klara Brinzaniuc, Claudiu Marginean.  Recent  aquisitions in the imagistic diagnosis of the digestive diseases in child. The Romanian magazine of Pediatry - Ro J Pediatr. 2012, Vol. LXI, Nr. 1, p. 57-68, cathegory B+, cod CNCSIS: 767

o    Marginean Oana, Baghiu Maria Despina, Brinzaniuc Klara, Marginean Claudiu, Chincesan Mihaela, Pitea Ana Maria. The Elastographyc Aspect of Liver in Pediatric Patients with Hepatopathies and Malignities versus Healthy Children. Acta Medica Marisiensis 2011, Vol. 57;(6): 628-633, B+, cod CNCSIS: 103

o    Cristina Oana Mărginean,  Klara Branzaniuc,  C. Mărginean, L.Azamfirei, Ana-Maria Pitea: Elastography, factor of progress in hepatic untrasound:, paper published in the magazine medical-surgical  of the society of doctors and naturalists Iași, 2010, vol 114, nr 3, p. 764-770

o    Oana Mărginean, Klara Brânzaniuc, C. Mărginean, L. Azamfirei, Ana Maria Pitea. Segmentary assessment of liver structure in child, through elastography in real time. Clujul Medical 2011,84,Supp.2 (2):34-39 cod. CNCSIS 253 (rev B+)

o    Oana Marginean, Branzaniuc Klara, Marginean C., Pitea Ana Maria, Azamfirei Leonard, Ludmila Cerempei, Ludmila Bologa, Ninel Revenco. Elastography - New Imagistic Method for Assessment of Liver Structure in Children. International Conference on Nanotechnologies and Biomedical Engineering with related German-Moldovan Workshop on Novel Nanomaterials for Electronic, Photonic and Biomedical Applications, Chisinau, 6-8 iulie 2011, ICNBME PROCEEDINGS, Technical University of Moldova 2011, pag 387-390; ISBN 978-9975-66-239-0 (Rev B+, BDI)

o    Mărginean Oana, Klara Brânzaniuc, Mărginean Claudiu: Etical considerations in child’s obesity, The Romanian Magazine of bioetic; rev indexata ISI, paper which is going to be published.

o    Dr. Mărginean Cristina Oana1, Asist. Univ. Dr. Duicu Carmen2, Şef Lucr. Dr. Bănescu Claudia3, Prep Univ. Dr. Pitea Ana Maria, the disease of the urine which smells like sirop de arţar, paper accepted to be published in the Romanian Magazine of Pediatry, rev. B+



Papers  oral/poster  communicated in international congresses:

-          O. Marginean, A. Pitea, K. Brinzaniuc, C. Marginean. Real-time Elastography of Liver in Obese Children. Poster presentation Nr. A-423-0000-00066, International Conference on Nurtition and Growth Paris 2012

-          Oana Mărginean, Claudiu Mărginean "Corelations of Body Mass Index (BMI) with Leptin levels, Cholesterol and Triglycerides in Obese Children" volumul de rezumate al revistei Pediatric Research (p. 1086)

-           Oana Mărginean "Serum leptin levels according to gender in obese children" volumul de rezumate al revistei Pediatric Research (p. 1093)

-          Oana Mărginean, Brînzaniuc Klara, Mărginean C., Azamfirei L., Pitea Ana-Maria, Voidăzan S., Podeanu Daniela. Elastographic Assessment of Caudate Lobe Compared with the other Liver Lobes in Healthy and Liver Diseases Children. ESPR 2011, Newcastle, UK, October 14-17, 2011, poster, Pediatric Research. 70(5):813, November 2011, doi:10.1203/01. pdr. 0000403893.61640.b6

-          Oana Marginean, Klara Brînzaniuc, C. Mărginean, L. Azamfirei, Ana-Maria Pitea. Corelations between caudat and other liver lobes stiffness in children by real elastography, with implications in liver transplant. The 1st Global Congress for Consensus in Pediatrics & Child Health, CIP, 17-20 Febr. 2011, Paris, France, volum rezumate pagina 311

-          Oana Marginean, Carmen Duicu, Claudiu Marginean, Klara Branzaniuc, Leonard Azamfirei, Daniela Podeanu, Septimiu Voidazan. Comparative study of rigidity of the caudate lobe and of the eight segment of the liver in child through real-time elastography, with implications for liver transplantation. Vienna, Austria, 23-26 iunie 2011, Poster, Evidence based child health vol 6 Suppl 1, p. 99, July 2011

-          Marginean Oana, Branzaniuc Klara, Marginean C., Pitea Ana Maria, Azamfirei Leonard, Ludmila Cerempei, Ludmila Bologa, Ninel Revenco. Elastography - New Imagistic Method for Assessment of Liver Structure in Children. International Conference on Nanotechnologies and Biomedical Engineering with related German-Moldovan Workshop on Novel Nanomaterials for Electronic, Photonic and Biomedical Applications, Chisinau, 6-8 iulie 2011, ICNBME PROCEEDINGS, Technical University of Moldova 2011, pag 387-390; ISBN 978-9975-66-239-0

-          Oral communications within some national congresses:

-          Oana Mărginean: New methods in abdominal ultrasounds diagnosis  in children, paper communicated at the National Congress of Gastroenterology, Hepatology and Pediatric Nutrition, Galați sept 2010, paper published in the volume of  summaries of the congress

-          Oana Mărginean, Klara Brînzaniuc, C. Mărginean, L. Azamfirei, Ana-Maria Pitea, S. Voidăzan:  Comparative evaluation of stiffness of caudate lobe and the other lobes of the liver in children by real-time elastography,paper communicated at the Session of cadrelor didactice al UMF Tg. Mureș on 16-18 december 2010 and then published in summary in the UMF magazine.

-          Oana Mărginean, Klara Brânzaniuc, C. Mărginean, L. Azamfirei, Ana Maria Pitea. Segmentary assessment of the liver structure in child, through elastography in real time. the XII th Congress of Romanian Society of Anatomy, Hotel Golden Tulip Ana Dome Cluj Napoca, 9-11 June 2011

-          Oana Mărginean, Claudiu Mărginean, Klara Brânzaniuc. Studiul hepato-toxicităţii la copiii cu malignităţi prin elastografie în timp real. A 14-a Conferinta a Societatii Romane de Ultrasonografie in Medicina si Biologie, ECOMURES 2011, Tg Mures, 10-12 iunie 2011, poster Medical Ultrasonography, vol 13 suppl 1 june 2011, p. 156

-          Oana Mărginean,  Baghiu Maria Despina, Branzaniuc Klara, Mărginean C., Chinceşan Mihaela, Pitea Ana Maria. The Elastographic Aspect of Liver in Pediatric Patients with Hepatopathies and Malignancies versus Healthy Children. the 4th Conference of  PHD and the first Conference of Postdoctoranzilor in Medicine and Pharmacy, UMF Tg Mures, 7-9 July 2011, oral communication, Acta Medica Marisiensis 2011; 57(3):36

-          Marginean Oana, Pitea Ana Maria. Recent Aquisitions in the imagistic diagnosis of child’s  digestive diseases. The National Congress of Pediatry, Bucharest, 28 september – 01 october 2011, oral communication, Volum rezumate ISSN 2247-9015; ISSN-L 2247-9025

-          Oana Marginean, Klara Branzaniuc, Claudiu Marginean, Ana Maria Pitea, Leonard Azamfirei.  ARFI  elastography (Acoustic Radiation Force Impulse)in the assessment of different segments of the child’s liver. The National Congress of Pediatry, Bucharest, 28 september – 01 october 2011, poster P72, Volum rezumate ISSN 2247-9015; ISSN-L 2247-9025 – The prize for the best poster  

-          Oana Mărginean:Elastography and ultrasound with contrast substance in child’s abdominal pathology, paper communicated at the Congress of Romanian Society of  Gastroenterology, Hepatology and Pediatric Nutrition, Poiana Brașov 3-6 october 2012.

-          Documentation and perfection of training actions,  the way the project develops, of the topic of study, members, identification of local working possibilities at the University of Medicine and Pharmacy. This has been realized through the visit at University of Medicine and Pharmacy in the period 1-7 March of Assos. Dr. Oana Mărginean, paper manager dr. Claudiu Mărginean, Dr.Pitea Anamaria  and working visit of Assos. Dr. Oana Mărginean and paper manager. Dr. Claudiu Mărginean at Chișinău, 20 – 27 sept 2011

-          Training in efastographic exploration and also the improvemnet of the elastographic methods of exploration of the patients with and without hepatic affection made at University of Medicine and Pharmacy Chisinau.This has been made through the visit of Assos. Dr. Oana Mărginean, paper manager dr. Claudiu Mărginean, Dr.Pitea Anamaria  in the period 20-26 march and working visit of Asso. Dr. Oana Mărginean and Dr Pitea Anamaria at Chișinău, 17 – 23 sept 2011

-          Training in comparative exploration of the caudate lobe  versus the other lobes of the liver in child through elastography in real time, at UMF Tg. Mures through the visit of the colaborators from  R .Moldova: Assos. Dr. Ludmila Bologa, Assos. Dr. Ludmila Cerempei și Prof. Dr. Nineli Revenco. The collaborators from Moldova Republic have learnt technical skills in the qualitative and quantitative analyse of the hepatic tissue elasticity  in real time in children through ultrasonography 1-10 april 2011 and 1-09 oct 2011.

-          Training in comparative exploration of the caudate lobe versus the other lobes of the liver in child through elastography in real time, at UMF Tg. Mures  through the collaborators’s visit from Moldova Republic: Assos. Dr. Ludmila Bologa, Assos. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco. The collaborators from Moldova Republic have learnt technical skills in the qualitative and quantitative analyse of the hepatic tissue elasticity  in real time in children through ultrasonography 20-29 JUne 2012 and 11-19 oct 2011

-          Participation of Dr. Oana Mărginean at United European Gastroenterology Week, Barcelona, october 2010

-          Participation Dr. Mărginean Claudiu at the  20th World Congress on Ultrasound in Obstetrics and Gynecology 10-14 october 2010, Praga

-          Participation Dr. Oana Mărginean a the course entitled “Optimization of conventional ultrasound examination through agents of contarst and elastographic techniques”, Cluj Napoca 26-27 november 2010

-          Participation of Dr. Oana Mărginean at the Congress of Gastroenterology European society, hepatology and pediatric nutrition ESPGHAN , Istambul 9-12 June 2010,

-          Participation Dr. Oana Mărginean at the third Congress of the European Academy of Paediatric Societies 2010, Copenhagen, 22-26 octomber 2010 with 2 papers which were published in the volume of summaries of the magazine Pediatric Research Partitcipation of dr. Oana Mărginean at the intitled conference – the first Internation  Consens in pediatry 17-20 february 2011 Paris.

-          Participation Dr. Oana Mărginean at the European Congress of Paediatric societies, Viena June 2011, with 3 papers communicated in the volume of summaries

-          Participation Dr. Oana Mărginean and Dr. Mărginean Claudiu  at the third  Congress of the European Academy of Paediatric Societies 2010, New Castle, 14-17 october 2010  with 2 papers which were published in the volume of summaries of Pediatric Research

-          Participation Dr. Oana Mărginean and Dr. Mărginean Claudiu at United European Gastroenterology Week, Stockholm, 23-26 october 2011

-          Participation Dr. Oana Mărginean and Dr. Mărginean Claudiu at the Congress of Nutritional European Society ,Espen, Gotheburg, 2-6 sept 2011 – 2  communicated papers

-          Participarea Conf. Dr. Oana Mărginean și Dr. Mărginean Claudiu at the National conference of Ultrasonography 10-13 June 2011 Tg. Mureș, 2 communicated papers

-          Participation Assos. Dr. Oana Mărginean at the National Congress of Pediatry Bucharest 27 sept – 1 oct 2011.

-          Participation Assos. Dr. Oana Mărginean and Dr. Mărginean Claudiu at the National Conference of Ultrasonography, June 2012 Cluj Napoca, 1 communicated paper

-          Participation Dr. Oana Mărginean at United European Gastroenterology Week, Amsterdam, 20-24 october 2012

-          Participation Dr. Oana Mărginean at  International Conference on Nurtition and Growth Paris 2012

-          Participation Dr. Oana Mărginean at the Congress of Gastroenterology Romanian Society, Hepatology and Pediatric Nutrition,Poiana Brașov 3-6 october 2012.

-          Examination of 231 healthy and ill children:  clinical-paraclinical assessment, liver examination through standard ultrasound , ultrasound examination through the method virtual touch tissue imaging  in order to get a diagram of tissue stiffness, hepatic elasticity assesssment compared on the caudate lobe and on the other hepatic lobes.

-          The manager’s involvement in a  postdoctoral project which aims to enlarge the research in the field:  The research topic postdoctorat  quantitative and qualitative assessment of hepatic healthy and pathologic tissue elasticity in child, with implications in the oncologic diagnosis and transplantation of organs

-          Apply and submit the documents for an international project with the topic "Iowa Non-communicable Chronic Diseases Research Training Program in Romania",  topic:Child’s nutrition and metabolic diseases

-          Organize a School of advanced Studies (with international participation) in the period 24-28 september 2012, having the topic ”Modern nutritional aspects  of the healthy and ill child – nutrigenomic  role, project CNCS-UEFISCDI: PN-II-IDEI-SSA-2012-2-004:



Working visits during bilateral project:

-      Documentation and perfection of training actions, the way it takes place, the study topics, members, identifying the local work possibilities at University of Medicien and Pharmacy Chisinau and Tg. Mureș have been made through the following workind visits:

-          Working visits of the members of UMF Tg. Mureș at the University of Medicine and Pharmacy N Testemițeanu from Chișinău as following:

o    prof. Dr. Azamfirei Leonard and  Assos. Dr. Oana Mărginean -  1-6 september 2010

o    Assos. Dr. Oana Mărginean, paper manager dr. Claudiu Mărginean, Dr.Pitea Anamaria - 1-7 march 2011

o    Assos. Dr. Oana Mărginean and ppaer manager Dr. Claudiu Mărginean at Chișinău, 20 – 27 sept 2011

o    Assos. Dr. Oana Mărginean, paper manager dr. Claudiu Mărginean, Dr.Pitea Anamaria 20-26 march 2012

o    Assos. Dr. Oana Mărginean, Dr.Pitea Anamaria, 17-23 september 2012

-          Working visits and training in the comparative exploration of the caudate lobe versus  the other lobes of the liver in child through elastography in real time (technical skills in the child’s qualitative and quantitative analyse of the hepatic tissue elasticity in real time through ultrasonography), at UMF Tg. Mures through the colaborators visit from Moldova Republic as following:

o     Prof. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco –

o    Assos. Dr. Ludmila Bologa, Prof. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco1-10 april 2011

o    Assos. Dr. Ludmila Bologa, Prof. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco 01-09 oct 2011.

o    Assos. Dr. Ludmila Bologa, Prof. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco 20-29 june 2012.

o    Assos. Dr. Ludmila Bologa, Prof. Dr. Ludmila Cerempei and Prof. Dr. Nineli Revenco 11-19 oct 2012.

         


Opportunities for economic exploitation of the results and future comunications

- Make ultrasonographic and elastographic investigations on liver with involvements in child’s hepatic pathology, in transplantation, in accordance with international standards.

- Further dissiminuation of the results by participating to national and international scientific manifestations, by  publishing articles in magazines  with impact on different groups of specialists

- Create some partnerships, in order to form and keep motility, research and innovation of the medical practice at an international level.

- The results of the study will be used in a large area of medical fields (pediatry, internal medicine, surgery, radiology, anatomy and so on)

- Fast, effective and innovative diagnosis of child’s hepatic affections which have clear social and economic effects by decreasing the costs of hospitalization and faster proffesional and social reinsertion  of the patients with severe hepatic affections.

- New partnerships will be established through European programs with quality increase of scientific research

- Insusirea the investigation techniques of elastography in real time allows dissemination of these investigations  which can be applied and screening at the level of the organs (lymphatic ganglions, breasts, thyroid, ovary, uterus ans so on) with implications in other clinical disciplines, thus promoting the transfer of information and transdisciplinarity

- Strengthening the international recognition, members of consortium, and the consortium as awhole

- Competitive approach of other research programs UE (FP7) and also a quick integration in the European research area of both partners.



Contact

Dr. Mărginean Oana

Universitatea de Medicină și Farmacie Tg. Mureș, str. Gh. Marinescu nr. 38, Tg. Mureș, tel. 0265-215551 sau 0265-211518, email:  marginean.oana@gmail.com

     

 

The sheet of final indicators of the project

Note:    The final report of the bilateral project will be signed by the managers of the project of the cooperative partners, except the annex with the final indicators of the project, which is for external use.

For intermediary report (after each working visit) the signiture of the Romanian project manager is requested.

_____________________________________

a  the title of the project will be written as in the contract

b the first name and last name of the legal contractor (manager of project)

c  the first name and the last name of the project manager will be written

d the first name and the last name of the legal representative of the foreign partner will be written


Annex to the final Report - RF

FINAL INDICATORS OF THE PROJECT

Contract no 421/04.06.2010

I. Indicators


No. crt.

Indicators

UM

1.

Number of publications in magazines:

Co-editate international

-     Indexated ISI

-     Included in other database internationally recognized

No.

1  course  published

6 + 2 which are going to be published

2.

Articles published in books,atlasis, dictionaries and other products with scientific character published yearly (in the country and abroad)

NO.14 (7 in the country and 7 abroad)

3.

Participations to organized conferences, from which international 

NO.17 (9 international)

4.

Organized events, from which international


N0 1

5.

leaflets, brochures, posters  for dissemination of information

NO.

6.

Scientific communication projects

NO 1

7.

Prospective studies projects

NO.  2

8.

Proiecte / participanţi în proiecte internaţionale finanţate 

NO 1




APPROVED,

APPROVED,

Rector /CHAIRMAN

ECONOMIC MANAGER,

Prof. Dr. Azamfirei Leonard

……………………………………………………………………………

( first name, last name, signiture)

Ec. Munteanu Paraschiva

………………………………………………………..

(first name, last name, signiture)