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1. Video-assisted thoracoscopic versus open sleeve lobectomy for non-small cell lung cancer: A systematic review and meta-analysis from six comparative studies

Author

Georgios Geropoulos, Stepan M Esagian, Konstantinos Skarentzos, Ioannis A Ziogas, Ioannis Katsaros, Dimitrios Kosmidis, Georgios Tsoulfas, David Lawrence, and Nikolaos Panagiotopoulos

Subjects
Pulmonary and Respiratory Medicine, Lung Neoplasms, Treatment Outcome, Thoracic Surgery, Video-Assisted, Carcinoma, Non-Small-Cell Lung, Humans, Surgery, General Medicine, Pneumonectomy, Cardiology and Cardiovascular Medicine, Retrospective Studies
Abstract

Background Lung sleeve resection is indicated for centrally located lung tumors, especially for patients who cannot tolerate pneumonectomy. With video-assisted thoracoscopic surgery (VATS) being increasingly implemented for a wide variety of thoracic pathologies, this study aims to compare the intraoperative, postoperative, and long-term outcomes of VATS and open bronchial sleeve lobectomy for non-small cell lung cancer (NSCLC). Methods The MEDLINE (via PubMed), Cochrane Library, and Scopus databases were searched. Original clinical studies, comparing VATS and open sleeve lobectomy for NSCLC were included. Evidence was synthesized as odds ratios for categorical and weighted mean difference (WMD) for continuous variables. Results Our analysis included six studies with non-overlapping populations reporting on 655 patients undergoing bronchial sleeve lobectomy for NSCLC (229 VATS and 426 open). VATS sleeve lobectomy was associated with significantly longer operative time ((WMD): 45.85 min, 95% confidence interval (CI): 12.06 to 79.65, p = 0.01) but less intraoperative blood loss ((WMD): −34.57 mL, 95%CI: −58.35 to −10.78, p Conclusions The limitation of our study arises mainly due to the heterogeneity of the included studies. Nevertheless, VATS bronchial sleeve lung resection constitutes a feasible and safe alternative to the open sleeve lung resection surgery for the management of centrally located lung tumors.

Published
2022
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2. Prevalence and clinical outcomes of transthyretin amyloidosis: a systematic review and meta‐analysis

Author

Alexios S. Antonopoulos, Ioannis Panagiotopoulos, Alexandrina Kouroutzoglou, Georgios Koutsis, Pantelis Toskas, Georgios Lazaros, Konstantinos Toutouzas, Dimitris Tousoulis, Konstantinos Tsioufis, and Charalambos Vlachopoulos

Subjects
Heart Failure, Male, Amyloid Neuropathies, Familial, Prevalence, Humans, Cardiomyopathies, Cardiology and Cardiovascular Medicine
Abstract

Systematic evidence on the prevalence and clinical outcome of transthyretin amyloidosis (ATTR) is missing. We explored: (i) the prevalence of cardiac amyloidosis in various patient subgroups, (ii) survival estimates for ATTR subtypes, and (iii) the effects of novel therapeutics on the natural course of disease.A systematic review of literature published in MEDLINE before 31 December 2021 was performed for the prevalence of cardiac amyloidosis and all-cause mortality of ATTR patients. Extracted data included sample size, age, sex, and all-cause mortality at 1, 2, and 5 years. Subgroup analyses were performed for ATTR subtype, that is, wild-type ATTR (wtATTR) versus hereditary ATTR (hATTR), hATTR genotypes, and treatment subgroups. We identified a total of 62 studies (n = 277 882 individuals) reporting the prevalence of cardiac amyloidosis, which was high among patients with a hypertrophic cardiomyopathy phenotype, heart failure with preserved ejection fraction, and the elderly with aortic stenosis. Data on ATTR mortality were extracted from 95 studies (n = 18 238 ATTR patients). Patients with wtATTR were older (p = 7 × 10sup-10/sup) and more frequently male (p = 5 × 10sup-20/sup) versus hATTR. The 2-year survival of ATTR was 73.3% (95% confidence interval [CI] 70.9-75.7); for non-subtyped ATTR 70.4% (95% CI 66.9-73.9), for wtATTR 76.0% (95% CI 73.0-78.9]) and for hATTR 77.2% (95% CI 74.0-80.4); in meta-regression analysis, wtATTR was associated with higher survival after adjusting for confounders. There was an interaction between survival and hATTR genotypes (p = 10sup-15/sup, Val30Met having the lowest and Val122Ile/Thr60Ala the highest mortality). ATTR 2-year survival was higher on tafamidis/patisiran compared to natural disease course (79.9%, 95% CI 74.4-85.3 vs. 72.4%, 95% CI 69.8-74.9, p lt; 0.05).We report the prevalence of ATTR in various population subgroups and provide survival estimates for the natural course of disease and the effects of novel therapeutics. Important gaps in worldwide epidemiology research in ATTR were identified.

Published
2022
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3. Body composition and lung cancer-associated cachexia in TRACERx

Author

Al-Sawaf, Othman, Weiss, Jakob, Skrzypski, Marcin, Lam, Jie Min, Karasaki, Takahiro, Zambrana, Francisco, Kidd, Andrew C, Frankell, Alexander M, Watkins, Thomas BK, Martinez-Ruiz, Carlos, Puttick, Clare, Black, James RM, Huebner, Ariana, Al Bakir, Maise, Sokac, Mateo, Collins, Susie, Veeriah, Selvaraju, Magno, Neil, Naceur-Lombardelli, Cristina, Prymas, Paulina, Toncheva, Antonia, Ward, Sophia, Jayanth, Nick, Salgado, Roberto, Bridge, Christopher P, Christiani, David C, Mak, Raymond H, Bay, Camden, Rosenthal, Michael, Sattar, Naveed, Welsh, Paul, Liu, Ying, Perrimon, Norbert, Popuri, Karteek, Beg, Mirza Faisal, McGranahan, Nicholas, Hackshaw, Allan, Breen, Danna M, O'Rahilly, Stephen, Birkbak, Nicolai J, Aerts, Hugo JWL, Jamal-Hanjani, Mariam, Swanton, Charles, Lester, Jason F, Bajaj, Amrita, Nakas, Apostolos, Sodha-Ramdeen, Azmina, Ang, Keng, Tufail, Mohamad, Chowdhry, Mohammed Fiyaz, Scotland, Molly, Boyles, Rebecca, Rathinam, Sridhar, Wilson, Claire, Marrone, Domenic, Dulloo, Sean, Fennell, Dean A, Matharu, Gurdeep, Shaw, Jacqui A, Riley, Joan, Primrose, Lindsay, Boleti, Ekaterini, Cheyne, Heather, Khalil, Mohammed, Richardson, Shirley, Cruickshank, Tracey, Price, Gillian, Kerr, Keith M, Benafif, Sarah, Gilbert, Kayleigh, Naidu, Babu, Patel, Akshay J, Osman, Aya, Lacson, Christer, Langman, Gerald, Shackleford, Helen, Djearaman, Madava, Kadiri, Salma, Middleton, Gary, Leek, Angela, Hodgkinson, Jack Davies, Totten, Nicola, Montero, Angeles, Smith, Elaine, Fontaine, Eustace, Granato, Felice, Doran, Helen, Novasio, Juliette, Rammohan, Kendadai, Joseph, Leena, Bishop, Paul, Shah, Rajesh, Moss, Stuart, Joshi, Vijay, Crosbie, Philip, Gomes, Fabio, Brown, Kate, Carter, Mathew, Chaturvedi, Anshuman, Priest, Lynsey, Oliveira, Pedro, Lindsay, Colin R, Blackhall, Fiona H, Krebs, Matthew G, Summers, Yvonne, Clipson, Alexandra, Tugwood, Jonathan, Kerr, Alastair, Rothwell, Dominic G, Kilgour, Elaine, Dive, Caroline, Schwarz, Roland F, Kaufmann, Tom L, Wilson, Gareth A, Rosenthal, Rachel, Van Loo, Peter, Szallasi, Zoltan, Kisistok, Judit, Diossy, Miklos, Demeulemeester, Jonas, Bunkum, Abigail, Stewart, Aengus, Magness, Alastair, Rowan, Andrew, Karamani, Angeliki, Chain, Benny, Campbell, Brittany B, Castignani, Carla, Bailey, Chris, Abbosh, Christopher, Weeden, Clare E, Lee, Claudia, Richard, Corentin, Hiley, Crispin T, Moore, David A, Pearce, David R, Karagianni, Despoina, Biswas, Dhruva, Levi, Dina, Hoxha, Elena, Cadieux, Elizabeth Larose, Lim, Emilia L, Colliver, Emma, Nye, Emma, Gronroos, Eva, Galvez-Cancino, Felip, Athanasopoulou, Foteini, Gimeno-Valiente, Francisco, Kassiotis, George, Stavrou, Georgia, Mastrokalos, Gerasimos, Zhai, Haoran, Lowe, Helen L, Matos, Ignacio Garcia, Goldman, Jacki, Reading, James L, Herrero, Javier, Rane, Jayant K, Nicod, Jerome, Hartley, John A, Peggs, Karl S, Enfield, Katey SS, Selvaraju, Kayalvizhi, Thol, Kerstin, Litchfield, Kevin, Ng, Kevin W, Chen, Kezhong, Dijkstra, Krijn, Grigoriadis, Kristiana, Thakkar, Krupa, Ensell, Leah, Shah, Mansi, Duran, Marcos Vasquez, Litovchenko, Maria, Sunderland, Mariana Werner, Hill, Mark S, Dietzen, Michelle, Leung, Michelle, Escudero, Mickael, Angelova, Mihaela, Tanic, Miljana, Sivakumar, Monica, Kanu, Nnennaya, Chervova, Olga, Lucas, Olivia, Pich, Oriol, Hobson, Philip, Pawlik, Piotr, Stone, Richard Kevin, Bentham, Robert, Hynds, Robert E, Vendramin, Roberto, Saghafinia, Sadegh, Lopez, Saioa, Gamble, Samuel, Ung, Seng Kuong Anakin, Quezada, Sergio A, Vanloo, Sharon, Zaccaria, Simone, Hessey, Sonya, Boeing, Stefan, Beck, Stephan, Bola, Supreet Kaur, Denner, Tamara, Marafioti, Teresa, Mourikis, Thanos P, Spanswick, Victoria, Barbe, Vittorio, Lu, Wei-Ting, Hill, William, Liu, Wing Kin, Wu, Yin, Naito, Yutaka, Ramsden, Zoe, Veiga, Catarina, Royle, Gary, Collins-Fekete, Charles-Antoine, Fraioli, Francesco, Ashford, Paul, Clark, Tristan, Forster, Martin D, Lee, Siow Ming, Borg, Elaine, Falzon, Mary, Papadatos-Pastos, Dionysis, Wilson, James, Ahmad, Tanya, Procter, Alexander James, Ahmed, Asia, Taylor, Magali N, Nair, Arjun, Lawrence, David, Patrini, Davide, Navani, Neal, Thakrar, Ricky M, Janes, Sam M, Hoogenboom, Emilie Martinoni, Monk, Fleur, Holding, James W, Choudhary, Junaid, Bhakhri, Kunal, Scarci, Marco, Hayward, Martin, Panagiotopoulos, Nikolaos, Gorman, Pat, Khiroya, Reena, Stephens, Robert CM, Wong, Yien Ning Sophia, Bandula, Steve, Sharp, Abigail, Smith, Sean, Gower, Nicole, Dhanda, Harjot Kaur, Chan, Kitty, Pilotti, Camilla, Leslie, Rachel, Grapa, Anca, Zhang, Hanyun, AbdulJabbar, Khalid, Pan, Xiaoxi, Yuan, Yinyin, Chuter, David, MacKenzie, Mairead, Chee, Serena, Alzetani, Aiman, Cave, Judith, Scarlett, Lydia, Richards, Jennifer, Ingram, Papawadee, Austin, Silvia, Lim, Eric, De Sousa, Paulo, Jordan, Simon, Rice, Alexandra, Raubenheimer, Hilgardt, Bhayani, Harshil, Ambrose, Lyn, Devaraj, Anand, Chavan, Hema, Begum, Sofina, Buderi, Silviu, Kaniu, Daniel, Malima, Mpho, Booth, Sarah, Nicholson, Andrew G, Fernandes, Nadia, Shah, Pratibha, Proli, Chiara, Hewish, Madeleine, Danson, Sarah, Shackcloth, Michael J, Robinson, Lily, Russell, Peter, Blyth, Kevin G, Dick, Craig, Le Quesne, John, Kirk, Alan, Asif, Mo, Bilancia, Rocco, Kostoulas, Nikos, and Thomas, Mathew

Subjects
Male, Proteomics, Cachexia, Lung Neoplasms, Antigens, Neoplasm, Carcinoma, Non-Small-Cell Lung, Body Weight, Body Composition, Humans, Neoplasm Recurrence, Local, Muscle, Skeletal, Neoplasm Proteins
Abstract

Cancer-associated cachexia (CAC) is a major contributor to morbidity and mortality in individuals with non-small cell lung cancer. Key features of CAC include alterations in body composition and body weight. Here, we explore the association between body composition and body weight with survival and delineate potential biological processes and mediators that contribute to the development of CAC. Computed tomography-based body composition analysis of 651 individuals in the TRACERx (TRAcking non-small cell lung Cancer Evolution through therapy (Rx)) study suggested that individuals in the bottom 20th percentile of the distribution of skeletal muscle or adipose tissue area at the time of lung cancer diagnosis, had significantly shorter lung cancer-specific survival and overall survival. This finding was validated in 420 individuals in the independent Boston Lung Cancer Study. Individuals classified as having developed CAC according to one or more features at relapse encompassing loss of adipose or muscle tissue, or body mass index-adjusted weight loss were found to have distinct tumor genomic and transcriptomic profiles compared with individuals who did not develop such features. Primary non-small cell lung cancers from individuals who developed CAC were characterized by enrichment of inflammatory signaling and epithelial-mesenchymal transitional pathways, and differentially expressed genes upregulated in these tumors included cancer-testis antigen MAGEA6 and matrix metalloproteinases, such as ADAMTS3. In an exploratory proteomic analysis of circulating putative mediators of cachexia performed in a subset of 110 individuals from TRACERx, a significant association between circulating GDF15 and loss of body weight, skeletal muscle and adipose tissue was identified at relapse, supporting the potential therapeutic relevance of targeting GDF15 in the management of CAC. ispartof: NATURE MEDICINE vol:29 issue:4 ispartof: location:United States status: Published online

Published
2023

4. The evolution of non-small cell lung cancer metastases in TRACERx

Author

Al Bakir, Maise, Huebner, Ariana, Martinez-Ruiz, Carlos, Grigoriadis, Kristiana, Watkins, Thomas BK, Pich, Oriol, Moore, David A, Veeriah, Selvaraju, Ward, Sophia, Laycock, Joanne, Johnson, Diana, Rowan, Andrew, Razaq, Maryam, Akther, Mita, Naceur-Lombardelli, Cristina, Prymas, Paulina, Toncheva, Antonia, Hessey, Sonya, Dietzen, Michelle, Colliver, Emma, Frankell, Alexander, Bunkum, Abigail, Lim, Emilia L, Karasaki, Takahiro, Abbosh, Christopher, Hiley, Crispin T, Hill, Mark S, Cook, Daniel E, Wilson, Gareth A, Salgado, Roberto, Nye, Emma, Stone, Richard Kevin, Fennell, Dean A, Price, Gillian, Kerr, Keith M, Naidu, Babu, Middleton, Gary, Summers, Yvonne, Lindsay, Colin R, Blackhall, Fiona H, Cave, Judith, Blyth, Kevin G, Nair, Arjun, Ahmed, Asia, Taylor, Magali N, Procter, Alexander James, Falzon, Mary, Lawrence, David, Navani, Neal, Thakrar, Ricky M, Janes, Sam M, Papadatos-Pastos, Dionysis, Forster, Martin D, Lee, Siow Ming, Ahmad, Tanya, Quezada, Sergio, Peggs, Karl S, Van Loo, Peter, Dive, Caroline, Hackshaw, Allan, Birkbak, Nicolai J, Zaccaria, Simone, Jamal-Hanjani, Mariam, McGranahan, Nicholas, Swanton, Charles, Lester, Jason F, Bajaj, Amrita, Nakas, Apostolos, Sodha-Ramdeen, Azmina, Ang, Keng, Tufail, Mohamad, Chowdhry, Mohammed Fiyaz, Scotland, Molly, Boyles, Rebecca, Rathinam, Sridhar, Wilson, Claire, Marrone, Domenic, Dulloo, Sean, Matharu, Gurdeep, Shaw, Jacqui A, Riley, Joan, Primrose, Lindsay, Boleti, Ekaterini, Cheyne, Heather, Khalil, Mohammed, Richardson, Shirley, Cruickshank, Tracey, Benafif, Sarah, Gilbert, Kayleigh, Patel, Akshay J, Osman, Aya, Lacson, Christer, Langman, Gerald, Shackleford, Helen, Djearaman, Madava, Kadiri, Salma, Leek, Angela, Hodgkinson, Jack Davies, Totten, Nicola, Montero, Angeles, Smith, Elaine, Fontaine, Eustace, Granato, Felice, Doran, Helen, Novasio, Juliette, Rammohan, Kendadai, Joseph, Leena, Bishop, Paul, Shah, Rajesh, Moss, Stuart, Joshi, Vijay, Crosbie, Philip, Gomes, Fabio, Brown, Kate, Carter, Mathew, Chaturvedi, Anshuman, Priest, Lynsey, Oliveira, Pedro, Krebs, Matthew G, Clipson, Alexandra, Tugwood, Jonathan, Kerr, Alastair, Rothwell, Dominic G, Kilgour, Elaine, Aerts, Hugo JWL, Schwarz, Roland F, Kaufmann, Tom L, Rosenthal, Rachel, Szallasi, Zoltan, Kisistok, Judit, Sokac, Mateo, Diossy, Miklos, Demeulemeester, Jonas, Stewart, Aengus, Magness, Alastair, Karamani, Angeliki, Chain, Benny, Campbell, Brittany B, Castignani, Carla, Bailey, Chris, Puttick, Clare, Weeden, Clare E, Lee, Claudia, Richard, Corentin, Pearce, David R, Karagianni, Despoina, Biswas, Dhruva, Levi, Dina, Hoxha, Elena, Larose Cadieux, Elizabeth, Gronroos, Eva, Galvez-Cancino, Felip, Athanasopoulou, Foteini, Gimeno-Valiente, Francisco, Kassiotis, George, Stavrou, Georgia, Mastrokalos, Gerasimos, Zhai, Haoran, Lowe, Helen L, Matos, Ignacio, Goldman, Jacki, Reading, James L, Black, James RM, Herrero, Javier, Rane, Jayant K, Nicod, Jerome, Lam, Jie Min, Hartley, John A, Enfield, Katey SS, Selvaraju, Kayalvizhi, Thol, Kerstin, Litchfield, Kevin, Ng, Kevin W, Chen, Kezhong, Dijkstra, Krijn, Thakkar, Krupa, Ensell, Leah, Shah, Mansi, Vasquez, Marcos, Litovchenko, Maria, Werner Sunderland, Mariana, Leung, Michelle, Escudero, Mickael, Angelova, Mihaela, Tanic, Miljana, Sivakumar, Monica, Kanu, Nnennaya, Chervova, Olga, Lucas, Olivia, Al-Sawaf, Othman, Hobson, Philip, Pawlik, Piotr, Bentham, Robert, Hynds, Robert E, Vendramin, Roberto, Saghafinia, Sadegh, Lopez, Saioa, Gamble, Samuel, Ung, Seng Kuong Anakin, Vanloo, Sharon, Boeing, Stefan, Beck, Stephan, Bola, Supreet Kaur, Denner, Tamara, Marafioti, Teresa, Mourikis, Thanos P, Spanswick, Victoria, Barbe, Vittorio, Lu, Wei-Ting, Hill, William, Liu, Wing Kin, Wu, Yin, Naito, Yutaka, Ramsden, Zoe, Veiga, Catarina, Royle, Gary, Collins-Fekete, Charles-Antoine, Fraioli, Francesco, Ashford, Paul, Clark, Tristan, Borg, Elaine, Wilson, James, Patrini, Davide, Martinoni Hoogenboom, Emilie, Monk, Fleur, Holding, James W, Choudhary, Junaid, Bhakhri, Kunal, Scarci, Marco, Hayward, Martin, Panagiotopoulos, Nikolaos, Gorman, Pat, Khiroya, Reena, Stephens, Robert CM, Wong, Yien Ning Sophia, Bandula, Steve, Sharp, Abigail, Smith, Sean, Gower, Nicole, Dhanda, Harjot Kaur, Chan, Kitty, Pilotti, Camilla, Leslie, Rachel, Grapa, Anca, Zhang, Hanyun, AbdulJabbar, Khalid, Pan, Xiaoxi, Yuan, Yinyin, Chuter, David, MacKenzie, Mairead, Chee, Serena, Alzetani, Aiman, Scarlett, Lydia, Richards, Jennifer, Ingram, Papawadee, Austin, Silvia, Lim, Eric, De Sousa, Paulo, Jordan, Simon, Rice, Alexandra, Raubenheimer, Hilgardt, Bhayani, Harshil, Ambrose, Lyn, Devaraj, Anand, Chavan, Hema, Begum, Sofina, Buderi, Silviu, Kaniu, Daniel, Malima, Mpho, Booth, Sarah, Nicholson, Andrew G, Fernandes, Nadia, Shah, Pratibha, Proli, Chiara, Hewish, Madeleine, Danson, Sarah, Shackcloth, Michael J, Robinson, Lily, Russell, Peter, Dick, Craig, Le Quesne, John, Kirk, Alan, Asif, Mo, Bilancia, Rocco, Kostoulas, Nikos, and Thomas, Mathew

Subjects
Clonal Evolution, Cohort Studies, Evolution, Molecular, Lung Neoplasms, Carcinoma, Non-Small-Cell Lung, Disease Progression, Humans, Neoplasm Metastasis, Neoplasm Recurrence, Local, Clone Cells
Abstract

Metastatic disease is responsible for the majority of cancer-related deaths1. We report the longitudinal evolutionary analysis of 126 non-small cell lung cancer (NSCLC) tumours from 421 prospectively recruited patients in TRACERx who developed metastatic disease, compared with a control cohort of 144 non-metastatic tumours. In 25% of cases, metastases diverged early, before the last clonal sweep in the primary tumour, and early divergence was enriched for patients who were smokers at the time of initial diagnosis. Simulations suggested that early metastatic divergence more frequently occurred at smaller tumour diameters (less than 8 mm). Single-region primary tumour sampling resulted in 83% of late divergence cases being misclassified as early, highlighting the importance of extensive primary tumour sampling. Polyclonal dissemination, which was associated with extrathoracic disease recurrence, was found in 32% of cases. Primary lymph node disease contributed to metastatic relapse in less than 20% of cases, representing a hallmark of metastatic potential rather than a route to subsequent recurrences/disease progression. Metastasis-seeding subclones exhibited subclonal expansions within primary tumours, probably reflecting positive selection. Our findings highlight the importance of selection in metastatic clone evolution within untreated primary tumours, the distinction between monoclonal versus polyclonal seeding in dictating site of recurrence, the limitations of current radiological screening approaches for early diverging tumours and the need to develop strategies to target metastasis-seeding subclones before relapse. ispartof: NATURE vol:616 issue:7957 ispartof: location:England status: Published online

Published
2023

5. The evolution of lung cancer and impact of subclonal selection in TRACERx

Author

Frankell, Alexander M, Dietzen, Michelle, Al Bakir, Maise, Lim, Emilia L, Karasaki, Takahiro, Ward, Sophia, Veeriah, Selvaraju, Colliver, Emma, Huebner, Ariana, Bunkum, Abigail, Hill, Mark S, Grigoriadis, Kristiana, Moore, David A, Black, James RM, Liu, Wing Kin, Thol, Kerstin, Pich, Oriol, Watkins, Thomas BK, Naceur-Lombardelli, Cristina, Cook, Daniel E, Salgado, Roberto, Wilson, Gareth A, Bailey, Chris, Angelova, Mihaela, Bentham, Robert, Martinez-Ruiz, Carlos, Abbosh, Christopher, Nicholson, Andrew G, Le Quesne, John, Biswas, Dhruva, Rosenthal, Rachel, Puttick, Clare, Hessey, Sonya, Lee, Claudia, Prymas, Paulina, Toncheva, Antonia, Smith, Jon, Xing, Wei, Nicod, Jerome, Price, Gillian, Kerr, Keith M, Naidu, Babu, Middleton, Gary, Blyth, Kevin G, Fennell, Dean A, Forster, Martin D, Lee, Siow Ming, Falzon, Mary, Hewish, Madeleine, Shackcloth, Michael J, Lim, Eric, Benafif, Sarah, Russell, Peter, Boleti, Ekaterini, Krebs, Matthew G, Lester, Jason F, Papadatos-Pastos, Dionysis, Ahmad, Tanya, Thakrar, Ricky M, Lawrence, David, Navani, Neal, Janes, Sam M, Dive, Caroline, Blackhall, Fiona H, Summers, Yvonne, Cave, Judith, Marafioti, Teresa, Herrero, Javier, Quezada, Sergio A, Peggs, Karl S, Schwarz, Roland F, Van Loo, Peter, Miedema, Daniel M, Birkbak, Nicolai J, Hiley, Crispin T, Hackshaw, Allan, Zaccaria, Simone, Jamal-Hanjani, Mariam, McGranahan, Nicholas, Swanton, Charles, Bajaj, Amrita, Nakas, Apostolos, Sodha-Ramdeen, Azmina, Ang, Keng, Tufail, Mohamad, Chowdhry, Mohammed Fiyaz, Scotland, Molly, Boyles, Rebecca, Rathinam, Sridhar, Wilson, Claire, Marrone, Domenic, Dulloo, Sean, Matharu, Gurdeep, Shaw, Jacqui A, Riley, Joa, Primrose, Lindsay, Cheyne, Heather, Khalil, Mohammed, Richardson, Shirley, Cruickshank, Tracey, Gilbert, Kayleigh, Patel, Akshay J, Osman, Aya, Lacson, Christer, Langman, Gerald, Shackleford, Helen, Djearaman, Madava, Kadiri, Salma, Leek, Angela, Hodgkinson, Jack Davies, Totten, Nicola, Montero, Angeles, Smith, Elaine, Fontaine, Eustace, Granato, Felice, Doran, Helen, Novasio, Juliette, Rammohan, Kendadai, Joseph, Leena, Bishop, Paul, Shah, Rajesh, Moss, Stuart, Joshi, Vijay, Crosbie, Philip, Gomes, Fabio, Brown, Kate, Carter, Mathew, Chaturvedi, Anshuman, Priest, Lynsey, Oliveira, Pedro, Lindsay, Colin R, Clipson, Alexandra, Tugwood, Jonathan, Kerr, Alastair, Rothwell, Dominic G, Kilgour, Elaine, Aerts, Hugo JWL, Kaufmann, Tom L, Szallasi, Zoltan, Kisistok, Judit, Sokac, Mateo, Diossy, Miklos, Demeulemeester, Jonas, Stewart, Aengus, Magness, Alastair, Rowan, Andrew, Karamani, Angeliki, Chain, Benny, Campbell, Brittany B, Castignani, Carla, Weeden, Clare E, Richard, Corentin, Pearce, David R, Karagianni, Despoina, Levi, Dina, Hoxha, Elena, Larose Cadieux, Elizabeth, Nye, Emma, Gronroos, Eva, Galvez-Cancino, Felip, Athanasopoulou, Foteini, Gimeno-Valiente, Francisco, Kassiotis, George, Stavrou, Georgia, Mastrokalos, Gerasimos, Zhai, Haoran L, Lowe, Helen L, Matos, Ignacio, Goldman, Jacki, Reading, James L, Rane, Jayant K, Lam, Jie Min, Hartley, John A, Enfield, Katey SS, Selvaraju, Kayalvizhi, Litchfield, Kevin, Ng, Kevin W, Chen, Kezhong, Dijkstra, Krijn, Thakkar, Krupa, Ensell, Leah, Shah, Mansi, Vasquez, Marcos, Litovchenko, Maria, Werner Sunderland, Mariana, Leung, Michelle, Escudero, Mickael, Tanic, Miljana, Sivakumar, Monica, Kanu, Nnennaya, Chervova, Olga, Lucas, Olivia, Al-Sawaf, Othman, Hobson, Philip, Pawlik, Piotr, Stone, Richard Kevin, Hynds, Robert E, Vendramin, Roberto, Saghafinia, Sadegh, Lopez, Saioa, Gamble, Samuel, Ung, Seng Kuong Anakin, Vanloo, Sharon, Boeing, Stefan, Beck, Stephan, Bola, Supreet Kaur, Denner, Tamara, Mourikis, Thanos P, Spanswick, Victoria, Barbe, Vittorio, Lu, Wei-Ting, Hill, William, Wu, Yin, Naito, Yutaka, Ramsden, Zoe, Veiga, Catarina, Royle, Gary, Collins-Fekete, Charles-Antoine, Fraioli, Francesco, Ashford, Paul, Clark, Tristan, Borg, Elaine, Wilson, James, Procter, Alexander James, Ahmed, Asia, Taylor, Magali N, Nair, Arjun, Patrini, Davide, Martinoni Hoogenboom, Emilie, Monk, Fleur, Holding, James W, Choudhary, Junaid, Bhakhri, Kunal, Scarci, Marco, Hayward, Martin, Panagiotopoulos, Nikolaos, Gorman, Pat, Khiroya, Reena, Stephens, Robert CM, Wong, Yien Ning Sophia, Bandula, Steve, Sharp, Abigail, Smith, Sean, Gower, Nicole, Dhanda, Harjot Kaur, Chan, Kitty, Pilotti, Camilla, Leslie, Rachel, Grapa, Anca, Zhang, Hanyun, AbdulJabbar, Khalid, Pan, Xiaoxi, Yuan, Yinyin, Chuter, David, MacKenzie, Mairead, Chee, Serena, Alzetani, Aiman, Scarlett, Lydia, Richards, Jennifer, Ingram, Papawadee, Austin, Silvia, De Sousa, Paulo, Jordan, Simon, Rice, Alexandra, Raubenheimer, Hilgardt, Bhayani, Harshil, Ambrose, Lyn, Devaraj, Anand, Chavan, Hema, Begum, Sofina, Buderi, Silviu, Kaniu, Daniel, Malima, Mpho, Booth, Sarah, Fernandes, Nadia, Shah, Pratibha, Proli, Chiara, Danson, Sarah, Robinson, Lily, Dick, Craig, Kirk, Alan, Asif, Mo, Bilancia, Rocco, Kostoulas, Nikos, and Thomas, Mathew

Subjects
Lung Neoplasms, Treatment Outcome, DNA Copy Number Variations, Mutagenesis, Carcinoma, Non-Small-Cell Lung, Mutation, Smoking, Humans, Adenocarcinoma of Lung, Neoplasm Recurrence, Local, Phylogeny
Abstract

Lung cancer is the leading cause of cancer-associated mortality worldwide1. Here we analysed 1,644 tumour regions sampled at surgery or during follow-up from the first 421 patients with non-small cell lung cancer prospectively enrolled into the TRACERx study. This project aims to decipher lung cancer evolution and address the primary study endpoint: determining the relationship between intratumour heterogeneity and clinical outcome. In lung adenocarcinoma, mutations in 22 out of 40 common cancer genes were under significant subclonal selection, including classical tumour initiators such as TP53 and KRAS. We defined evolutionary dependencies between drivers, mutational processes and whole genome doubling (WGD) events. Despite patients having a history of smoking, 8% of lung adenocarcinomas lacked evidence of tobacco-induced mutagenesis. These tumours also had similar detection rates for EGFR mutations and for RET, ROS1, ALK and MET oncogenic isoforms compared with tumours in never-smokers, which suggests that they have a similar aetiology and pathogenesis. Large subclonal expansions were associated with positive subclonal selection. Patients with tumours harbouring recent subclonal expansions, on the terminus of a phylogenetic branch, had significantly shorter disease-free survival. Subclonal WGD was detected in 19% of tumours, and 10% of tumours harboured multiple subclonal WGDs in parallel. Subclonal, but not truncal, WGD was associated with shorter disease-free survival. Copy number heterogeneity was associated with extrathoracic relapse within 1 year after surgery. These data demonstrate the importance of clonal expansion, WGD and copy number instability in determining the timing and patterns of relapse in non-small cell lung cancer and provide a comprehensive clinical cancer evolutionary data resource. ispartof: NATURE vol:616 issue:7957 ispartof: location:England status: Published online

Published
2023

6. Albuminuria screening in children with type 1 diabetes prior to and during the COVID-19 pandemic

Author

Kristen, Favel, Cherry, Mammen, and Constadina, Panagiotopoulos

Subjects
Male, Clinical Research Article, Adolescent, COVID-19, Cohort Studies, Diabetes Mellitus, Type 1, Child, Preschool, Creatinine, Pediatrics, Perinatology and Child Health, Humans, Albuminuria, Female, Child, Pandemics
Abstract

Background Albuminuria is an important risk factor for adverse renal and cardiovascular outcomes in type 1 diabetes (T1D). We sought to describe: (1) adherence to albuminuria screening prior to and during the COVID-19 pandemic and (2) occurrence of abnormal urine albumin-creatinine ratio (ACR) tests in children with T1D. Methods This cohort study involved children aged 18 years or younger with T1D followed in the diabetes clinic at a pediatric tertiary center. Data was collected from 2016 to 2020. Adherence was defined by Diabetes Canada (DC) Guidelines for T1D in Children and Adolescents (2018). Results Of the 165 children who met DC criteria for screening; 88 (32%) were male and the median age at diagnosis was 5.8 years. Twenty-eight (17%) children had not completed a single ACR test, and 30 (18%) completed all eligible ACR tests. Test completion decreased from 66% in 2019 to 45% in 2020. Of the 345 ACR tests completed, 40 (11%) were abnormal (>2.5 mg/mmol) and 29 abnormal ACR tests (72%) were not repeated. Conclusion Adherence to albuminuria screening in this pediatric diabetes clinic is suboptimal with deterioration during the COVID-19 pandemic. Patient/physician and program-level strategies to improve adherence will play an important role in quality improvement. Impact Albuminuria screening is an important part of pediatric diabetes care.In our study, pediatric albuminuria screening adherence was suboptimal at 66% in 2019 and deteriorated during the pandemic to 45% in 2020.Program and patient-level adherence to clinical guidelines and barriers to accessing diabetes care during the pandemic merit further study.

Published
2022
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7. Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification

Author

Paraskevi Tseke, Michail Panagiotopoulos, and Lina Michala

Subjects
Septate, medicine.medical_specialty, Cervical insufficiency, Placental Retention, Pregnancy, Humans, Medicine, Rupture of membranes, Societies, Medical, Placental abruption, business.industry, Obstetrics, Uterus, Obstetrics and Gynecology, Odds ratio, Delivery, Obstetric, medicine.disease, Placenta previa, Europe, Pregnancy Complications, Fetal Malpresentation, Gynecology, Urogenital Abnormalities, Female, business
Abstract

OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.

Published
2021
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8. Estimating the burden of adult hospital admissions due to RSV and other respiratory pathogens in England

Author

Ashley Sharp, Andre Charlett, Richard Pebody, Nikolaos Panagiotopoulos, Mehdi Minaji, and Rachel Reeves

Subjects
Pulmonary and Respiratory Medicine, Pediatrics, medicine.medical_specialty, Epidemiology, respiratory syncytial virus, Psychological intervention, Disease, Respiratory Syncytial Virus Infections, burden of disease, Medicine, Humans, Respiratory system, Aged, Influenza-like illness, business.industry, Incidence (epidemiology), Public Health, Environmental and Occupational Health, Infant, Original Articles, respiratory, Hospitals, Respiratory pathogens, Hospitalization, hospital admission, Infectious Diseases, England, time series analysis, Respiratory Syncytial Virus, Human, Population study, Respiratory virus, Original Article, business
Abstract

Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus and an important cause of illness among infants, but the burden of RSV disease is not well described among the older population. The objective of this study was to estimate the age-specific incidence of hospital admission among over 65s due to respiratory illnesses attributable to RSV in England to inform optimal vaccine and therapeutic interventions. We used linear multiple regression to examine the effect of changes in weekly counts of respiratory pathogens on the weekly counts of respiratory hospital admissions. The study population was all patients aged 65 years or over admitted to English hospitals between 2nd August 2010 and 30th July 2017. RSV was estimated to account for a seasonal annual average of 71 (95% CI 52-90) respiratory admissions per 100,000 in adults age 65-74 and 251 (95% CI 186-316) admissions per 100,000 adults age 75+. Pneumococcus was the pathogen responsible for highest annual average respiratory admission with 448 (95% CI 310-587) admissions per 100,000 adults age 65-74 and 1010 (95%CI 527-1493) admissions per 100,000 adults aged 75+. This study shows that RSV continues to exert a significant burden of disease among older adults in England. These findings will support development of policy for the use of RSV therapeutics and vaccines in this age group.

Published
2021

9. Computed tomography angiography scoring systems and the role of skull defects in the confirmation of brain death

Author

Sofia Dimoulia, Nektarios Sioulas, Vasilios Panagiotopoulos, Petros Zampakis, Fotini Fligou, Maria Karachaliou, Christina Kalogeropoulou, Dimitrios Karnabatidis, and Diamanto Aretha

Subjects
Adult, Male, Clinical tests, medicine.medical_specialty, Brain Death, Tomography Scanners, X-Ray Computed, Adolescent, Computed Tomography Angiography, Science, Subgroup analysis, Sensitivity and Specificity, Article, Imaging, 03 medical and health sciences, Young Adult, 0302 clinical medicine, McNemar's test, medicine, Humans, In patient, Statistical analysis, Computed tomography angiography, Aged, Retrospective Studies, Multidisciplinary, medicine.diagnostic_test, business.industry, Skull, Angiography, Digital Subtraction, 030208 emergency & critical care medicine, Digital subtraction angiography, Middle Aged, Cerebral Angiography, medicine.anatomical_structure, Medicine, Female, Radiology, business, X-ray tomography, 030217 neurology & neurosurgery
Abstract

To assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

Published
2021

10. Use of the Modified Constraint Induced Movement Therapy Protocol to Improve Function of the Predominant Arm on a Patient With Incomplete Spinal Cord Injury

Author

Eleftheria, Antoniadou, Panagiota, Vassilopoulou, Katerina, Marini, Maria, Patouha, Spiros, Tsoukanelis, Evgenia, Panagea, and Elias, Panagiotopoulos

Subjects
Male, Treatment Outcome, Activities of Daily Living, Rehabilitation, Arm, Humans, Physical Therapy, Sports Therapy and Rehabilitation, Quadriplegia, Spinal Cord Injuries
Abstract

In this case study, an off label modified constraint induced movement therapy protocol was applied in a 28-year male patient with incomplete tetraplegia C5 American Spinal Cord Injury Association D as a facilitator to enhance predominant upper arm function and regain important activities of daily living. The patient was ambulatory for short distances with arm crutches but could not perform important activities of daily living because of the involvement of his right arm, autonomy, and function were impaired. A 10-wk protocol of modified constraint induced movement therapy was performed, with two daily sessions for 30 mins each, a sling was used to constrain the less affected arm, and exercises of the predominant hand were performed. Spasticity was managed with botulinum toxin injections. After 5 wks, the patient was able to use a spoon, perform intermittent catheterization, dress upper body, and use the right arm to feed himself. The protocol was concluded without further amelioration. The modified constraint induced movement therapy is also a valuable facilitator for incomplete tetraplegia.

Published
2021
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11. Ulvan-Based Nanofibrous Patches Enhance Wound Healing of Skin Trauma Resulting from Cryosurgical Treatment of Keloids

Author

Stefanos Kikionis, Marianna Koromvoki, Anna Tagka, Eleni Polichronaki, Alexandros Stratigos, Antonios Panagiotopoulos, Aikaterini Kyritsi, Vangelis Karalis, Andreas Vitsos, Michail Rallis, Efstathia Ioannou, and Vassilios Roussis

Subjects
Hemoglobins, Wound Healing, Polysaccharides, Keloid, Drug Discovery, Nanofibers, Pharmaceutical Science, Humans, Pharmacology, Toxicology and Pharmaceutics (miscellaneous), Skin Diseases, Antioxidants, ulvan, electrospun nanofibrous patches, keloids, cryosurgery, wound healing, Polyethylene Glycols
Abstract

Keloids are skin fibroproliferative disorders, resulting from abnormal healing of deep cutaneous injuries. Cryosurgery, the most common treatment for keloids, causes skin traumas. Even though the clinical practice of cryosurgery has increased, effective wound healing therapy is still lacking. In this investigation, nonwoven nanofibrous patches composed of ulvan, a marine sulfated polysaccharide exhibiting anti-inflammatory and antioxidant activities, and polyethylene oxide (PEO) were fabricated through electrospinning and characterized. Their wound healing efficacy on skin traumas resulting from cryosurgical treatment of keloids was clinically tested and evaluated in comparison to a reference product. Twenty-four volunteer patients undergoing cryosurgery as a treatment of keloids were selected to apply either the ulvan/PEO patch or the reference product for 21 days. The ulvan/PEO patch, 21 days after cryosurgery, showed significant wound healing, elimination of skin inflammation, restoration of biophysical parameters similar to normal values and significant decrease in haemoglobin concentration, skin texture and volume, while no discomfort or adverse reaction was observed. In contrast, the reference product showed inferior performance in all evaluated parameters. The designed ulvan/PEO patch represents the first wound dressing to effectively heal skin trauma after cryosurgical treatment of keloids.

Published
2022
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12. Actinic Keratoses (AK): An Exploratory Questionnaire-Based Study of Patients’ Illness Perceptions

Author

Dimitrios Sgouros, Adamantia Milia-Argyti, Dimitrios K. Arvanitis, Eleni Polychronaki, Fiori Kousta, Antonios Panagiotopoulos, Sofia Theotokoglou, Anna Syrmali, Konstantinos Theodoropoulos, Alexander Stratigos, Dimitrios Rigopoulos, and Alexander Katoulis

Subjects
Keratosis, Actinic, Skin Neoplasms, Surveys and Questionnaires, Sunlight, Humans, Female, Sunscreening Agents, actinic keratosis, non-melanoma skin cancer, illness perception, awareness, prevention
Abstract

Background: Decreased illness perception among actinic keratoses (AK) patients is a major barrier to the effective management of AK. Objective: We aimed to investigate patients’ illness and treatment perceptions, their correlation to demographics and AK/skin cancer history, and secondarily the influence of these perspectives on treatment and sunscreen use. Materials and Methods: Participants completed questionnaires based on the Brief Illness Perception Questionnaire and statistical analysis was performed. Results: In total, 208 AK patients were enrolled. A large proportion were poorly aware of the disease (41.4%), with less than half (43%) being familiar with AK. Patients were aware of the chronic nature of the disease and its correlation to sunlight regardless of demographic characteristics. The level of education played a role in disease awareness (p = 0.006), and treatment plan perception (p = 0.002). The increase in sunscreen protection after AK diagnosis was higher in women (p = 0.009) and younger patients (p = 0.044). Patients’ concerns regarding treatment were mainly related to the duration (30%) and effectivity (25%). Dermatologists’ statements highlighting that AK are precancerous lesions (86.2%) influenced patients’ willingness for treatment. Conclusion: Improved awareness of AK is necessary to increase treatment seeking and compliance, regarding both treatment and sunscreen use. Dermatologists’ statements may have critical influence on patients’ decisions to receive treatment for AK.

Published
2022
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13. Migration and newborn screening: time to build on the European Asylum, Integration and Migration Fund?

Author

Christos Tsagkaris, Anna Eleftheriades, Dimitrios V. Moysidis, Andreas S. Papazoglou, Anna Loudovikou, Dimitrios Panagiotopoulos, Chrysi Christodoulaki, and Periklis Panagopoulos

Subjects
Male, Transients and Migrants, Refugees, Financial Management, Infant, Newborn, Obstetrics and Gynecology, COVID-19, Europe, Neonatal Screening, Reproductive Medicine, Humans, Pharmacology (medical), Female, Child
Abstract

The authors discuss the need for newborn screening in the context of the migration policy of the European Union, and particularly, the European Asylum, Migration and Integration Fund.The authors searched scholarly databases (Pubmed, Scopus, Google scholar) and grey literature (LexEuropa, Policy reports) to identify original peer-reviewed research examining the migration to the European Union and the provision of healthcare to infants born to refugees and immigrant mothers. Resources in language different from English, French, German and Greek were not taken into consideration.Every year, a large number of refugees and immigrants from sub-Saharan Africa and Middle East countries travel to and enter in Europe. It has been estimated that two thirds of those seeking asylum are women and children. Many of these children have been born on the way to Europe or in migrant camps. Essential newborns' health screening is not accessible in most cases. Congenital conditions such as hypothyroidism and phenylketonuria may remain untreated, and once these infants are diagnosed, the organic damage could be irreversible. Prolonged necessary hospitalisation might be out of consideration at a time when clinics and hospitals are overstrained with COVID-19 patients.It is essential to ensure that newborn screening will be performed in a timely and evidence-based manner as well as that the information will be communicated between hospitals and within countries' health networks. In order to achieve these goals interdisciplinary and international technical and logistical collaboration are required.

Published
2022

14. Lung Decortication With Argon Plasma Energy for the Treatment of Chronic Pleural Empyema

Author

Nikolaos Panagiotopoulos, Sofoklis Mitsos, David Lawrence, and Savvas Lampridis

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Plasma Gases, Fibrothorax, Plasma energy, Air leak, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Argon, Lung, Empyema, Pleural, 030219 obstetrics & reproductive medicine, business.industry, Pleural empyema, General Medicine, respiratory system, medicine.disease, respiratory tract diseases, Surgery, Dissection, surgical procedures, operative, Lung decortication, 030220 oncology & carcinogenesis, Hemostasis, Pleura, Cardiology and Cardiovascular Medicine, business, Energy source
Abstract

Lung decortication for the treatment of chronic pleural empyema remains a technically challenging procedure that is associated with bleeding and air leak. The recent advent of pure argon plasma has provided thoracic surgeons with an electrically neutral energy source for dissection and coagulation of pulmonary tissue with minimal depth of necrosis. In this article, we describe the technique of lung decortication with argon plasma energy (PlasmaJet, Plasma Surgical, Roswell, GA, USA) for the treatment of chronic pleural empyema. With appropriate application, the PlasmaJet can facilitate the removal of fibrous cortex with satisfactory hemostasis and aerostasis. Argon plasma energy can potentially be a useful adjunct in lung decortication. Controlled trials are needed to determine its role in the surgical management of advanced pleural empyema.

Published
2021
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15. An updated brief overview on post-traumatic headache and a systematic review of the non-pharmacological interventions for its management

Author

Elisa Mantovani, Pantelis Litsardopoulos, Dimos-Dimitrios Mitsikostas, Stefano Tamburin, Vasileios Panagiotopoulos, and Andreas A. Argyriou

Subjects
biofeedback, non-invasive brain stimulation, endocrine system, medicine.medical_specialty, cognitive-behavioral therapy, Traumatic brain injury, Migraine Disorders, medicine.medical_treatment, Biofeedback, Brain Injuries, Traumatic, Acupuncture, Whiplash, Humans, Medicine, post-concussion syndrome, Pharmacology (medical), therapeutic exercise, Non pharmacological interventions, Cognitive Behavioral Therapy, Post-concussion syndrome, business.industry, traumatic brain injury, General Neuroscience, Headache, medicine.disease, Cognitive behavioral therapy, non-pharmacological interventions, Physical therapy, Post-Traumatic Headache, Neurology (clinical), business, human activities, acupuncture, hormones, hormone substitutes, and hormone antagonists
Abstract

Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients.After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015-2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed.PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most.

Published
2021
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16. Treatment-related weight gain and metabolic complications in children with mental health disorders: potential role for lifestyle interventions

Author

Constadina Panagiotopoulos, Angela M. Devlin, and Alejandra M. Wiedeman

Subjects
Gerontology, Canada, Physiology, Endocrinology, Diabetes and Metabolism, Physical activity, MEDLINE, Type 2 diabetes, Weight Gain, 03 medical and health sciences, 0302 clinical medicine, Metabolic Diseases, Physiology (medical), Lifestyle intervention, Humans, Medicine, Child, Exercise, Life Style, Nutrition and Dietetics, business.industry, Mental Disorders, General Medicine, medicine.disease, Obesity, Mental health, Diet, 030227 psychiatry, medicine.symptom, Energy Intake, business, Weight gain, 030217 neurology & neurosurgery, Antipsychotic Agents
Abstract

Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children.Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.

Published
2021
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17. Second-Generation Antipsychotic Use in Pediatric Emergency Medicine

Author

Clare Lambert, Jana Davidson, Constadina Panagiotopoulos, and Ran D. Goldman

Subjects
medicine.medical_specialty, medicine.medical_treatment, Type 2 diabetes, Weight Gain, 03 medical and health sciences, 0302 clinical medicine, Pediatric emergency medicine, 030225 pediatrics, Diabetes mellitus, Humans, Medicine, Obesity, Medical prescription, Child, Antipsychotic, Pediatric Emergency Medicine, business.industry, 030208 emergency & critical care medicine, General Medicine, Emergency department, medicine.disease, Mental health, Diabetes Mellitus, Type 2, Pediatrics, Perinatology and Child Health, Emergency medicine, Emergency Medicine, business, Dyslipidemia, Antipsychotic Agents
Abstract

In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.

Published
2021
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18. Isolated lip dermatitis (atopic cheilitis), successfully treated with topical tacrolimus 0.03%

Author

Aikaterini Grigoraki, Eleni A Georgakopoulou, Antonios Panagiotopoulos, and Panagiota Loumou

Subjects
osseodensification, primary stability, medicine.medical_specialty, Administration, Topical, Esthetics, Dental, Tacrolimus, low density bone, Atopy, medicine, Humans, General Dentistry, UNESCO:CIENCIAS MÉDICAS, Retrospective Studies, rfa, Oral Medicine and Pathology, Clinical pathology, business.industry, Research, Atopic dermatitis, Topical tacrolimus, medicine.disease, Dermatology, Lip, body regions, stomatognathic diseases, Treatment Outcome, Cheilitis, Otorhinolaryngology, Concomitant, Surgery, business, Immunosuppressive Agents
Abstract

Background Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may also be an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflammatory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, have been used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lip conditions. Material and Methods We performed a retrospective clinical analysis of atopic cheilitis patients. Results Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips and were diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointment and responded completely. Conclusions These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis without concomitant dermal lesions appear in the literature. We are also showing and discussing yet another application of tacrolimus in a local atopic form of inflammation affecting the lips. Key words:Atopy, cheilitis, tacrolimus.

Published
2021
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19. A 3-miRNA Signature Enables Risk Stratification in Glioblastoma Multiforme Patients with Different Clinical Outcomes

Author

Vivi Bafiti, Sotiris Ouzounis, Constantina Chalikiopoulou, Eftychia Grigorakou, Ioanna Maria Grypari, Gregory Gregoriou, Andreas Theofanopoulos, Vasilios Panagiotopoulos, Evangelia Prodromidi, Dionisis Cavouras, Vasiliki Zolota, Dimitrios Kardamakis, and Theodora Katsila

Subjects
MicroRNAs, Brain Neoplasms, glioblastoma multiforme, 3-microRNA signature, risk stratification, machine learning, image classification, pattern recognition, Humans, Glioblastoma, Prognosis, Risk Assessment
Abstract

Malignant gliomas constitute a complex disease phenotype that demands optimum decision-making as they are highly heterogeneous. Such inter-individual variability also renders optimum patient stratification extremely difficult. microRNA (hsa-miR-20a, hsa-miR-21, hsa-miR-21) expression levels were determined by RT-qPCR, upon FFPE tissue sample collection of glioblastoma multiforme patients (n = 37). In silico validation was then performed through discriminant analysis. Immunohistochemistry images from biopsy material were utilized by a hybrid deep learning system to further cross validate the distinctive capability of patient risk groups. Our standard-of-care treated patient cohort demonstrates no age- or sex- dependence. The expression values of the 3-miRNA signature between the low- (OS > 12 months) and high-risk (OS < 12 months) groups yield a p-value of 12 months) vs. high-risk (OS < 12 months) glioblastoma multiforme patients. Our 3-microRNA signature (hsa-miR-20a, hsa-miR-21, hsa-miR-10a) may further empower glioblastoma multiforme prognostic evaluation in clinical practice and enrich drug repurposing pipelines.

Published
2022

20. Transmission dynamics of COVID-19 in household and community settings in the United Kingdom, January to March 2020

Author

Jamie Lopez Bernal, Nikolaos Panagiotopoulos, Chloe Byers, Tatiana Garcia Vilaplana, Nicki Boddington, Xu-Sheng Zhang, Andre Charlett, Suzanne Elgohari, Laura Coughlan, Rosie Whillock, Sophie Logan, Hikaru Bolt, Mary Sinnathamby, Louise Letley, Pauline MacDonald, Roberto Vivancos, Obaghe Edeghere, Charlotte Anderson, Karthik Paranthaman, Simon Cottrell, Jim McMenamin, Maria Zambon, Gavin Dabrera, Mary Ramsay, and Vanessa Saliba

Subjects
Family Characteristics, Adolescent, Epidemiology, SARS-CoV-2, Virology, Public Health, Environmental and Occupational Health, COVID-19, Humans, Pandemics, United Kingdom
Abstract

Background Households appear to be the highest risk setting for COVID-19 transmission. Large household transmission studies in the early stages of the pandemic in Asia reported secondary attack rates ranging from 5 to 30%. Aim We aimed to investigate the transmission dynamics of COVID-19 in household and community settings in the UK. Methods A prospective case-ascertained study design based on the World Health Organization FFX protocol was undertaken in the UK following the detection of the first case in late January 2020. Household contacts of cases were followed using enhanced surveillance forms to establish whether they developed symptoms of COVID-19, became confirmed cases and their outcomes. We estimated household secondary attack rates (SAR), serial intervals and individual and household basic reproduction numbers. The incubation period was estimated using known point source exposures that resulted in secondary cases. Results We included 233 households with two or more people with 472 contacts. The overall household SAR was 37% (95% CI: 31–43%) with a mean serial interval of 4.67 days, an R0 of 1.85 and a household reproduction number of 2.33. SAR were lower in larger households and highest when the primary case was younger than 18 years. We estimated a mean incubation period of around 4.5 days. Conclusions Rates of COVID-19 household transmission were high in the UK for ages above and under 18 years, emphasising the need for preventative measures in this setting. This study highlights the importance of the FFX protocol in providing early insights on transmission dynamics.

Published
2022

21. Epidemiological and clinical characteristics of early COVID-19 cases, United Kingdom of Great Britain and Northern Ireland

Author

Joseph Shingleton, Simon Cottrell, Gavin Dabrera, Suzanne Elgohari, Mary Ramsay, Emma Bennett, Nicola L Boddington, Roberto Vivancos, Obaghe Edeghere, Andre Charlett, Louise Letley, Vanessa Saliba, Rosie Whillock, Tatiana Garcia Vilaplana, Chloe Byers, Laura Coughlan, Pauline MacDonald, Maria Zambon, Mary Sinnathamby, Jim McMenamin, Nikolaos Panagiotopoulos, and Jamie Lopez Bernal

Subjects
Adult, Male, Pediatrics, medicine.medical_specialty, Adolescent, Coronavirus disease 2019 (COVID-19), 030231 tropical medicine, MEDLINE, Northern ireland, World health, Young Adult, 03 medical and health sciences, Age Distribution, 0302 clinical medicine, Epidemiology, medicine, Humans, Young adult, Child, Respiratory Tract Infections, Aged, Travel, Respiratory tract infections, SARS-CoV-2, business.industry, Research, Public health, Public Health, Environmental and Occupational Health, COVID-19, Infant, Middle Aged, United Kingdom, Dyspnea, Child, Preschool, Female, business
Abstract

To describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland.We implemented the World Health Organization's First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms.Approximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases.The study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.Décrire la manifestation clinique, l'évolution de la maladie et la propension à recourir aux services de santé des premières centaines de cas de maladie à coronavirus 2019 (COVID-19) au Royaume-Uni de Grande-Bretagne et d'Irlande du Nord.Nous avons appliqué leEnviron la moitié des cas de COVID-19 ont été importés (196 cas; 51,4%), la majorité s'étant récemment rendue en Italie (140 cas; 71,4%). Sur les 94 (24,7%) cas secondaires, presque tous ont signalé un contact rapproché avec un cas confirmé (93 cas; 98,9%), généralement au sein de leur foyer (37 cas; 39,8%). Au niveau de l'âge, la proportion d'enfants ayant contracté la COVID-19 était moindre. La plupart des cas avaient de la toux, de la fièvre et de la fatigue. La sensibilité et la spécificité des symptômes variaient en fonction de l'âge, présentant une relation non linéaire avec cet élément. Plus l'âge des cas de COVID-19 avançait, plus ils étaient susceptibles de développer de la fièvre, à l'exception de ceux touchés par d'autres infections respiratoires. Le risque d'essoufflement augmentait lui aussi avec l'âge chez une grande partie des cas de COVID-19.Cette étude a apporté un éclairage utile dans l'établissement d'une définition des cas. Elle a également fourni, pour diverses modélisations, des indications sur la charge que pourrait faire peser la COVID-19.Describir la presentación clínica, el curso de la enfermedad y el comportamiento de búsqueda de atención sanitaria de los primeros cientos de casos de la enfermedad del coronavirus de 2019 (COVID-19) en Reino Unido e Irlanda del Norte.Implementamos el protocolo de investigación de los primeros casos y contactos de la Organización Mundial de la Salud para la COVID-19. Profesionales expertos en el área de la salud pública recopilaron información sobre 381 casos virológicamente confirmados de COVID-19 entre el 31 de enero de 2020 y el 9 de abril de 2020. Realizamos un seguimiento activo de los casos para identificar la exposición a la infección, los síntomas y los resultados. También recogimos datos limitados sobre 752 personas sintomáticas que dieron negativo en los resultados de la COVID-19, como grupo de control para el análisis de la sensibilidad, la especificidad y el valor predictivo de los síntomas.Casi la mitad de los casos de COVID-19 fueron importados (196 casos; 51,4%), de los cuales la mayoría había hecho un viaje reciente a Italia (140 casos; 71,4%). De los 94 (24,7%) casos secundarios, casi todos informaron de un contacto cercano con un caso confirmado (93 casos; 98,9%), muchos de ellos a través del contacto con el hogar (37 casos; 39,8%). Por edad, una proporción menor de niños tenía COVID-19. La mayoría de los casos se presentaban con tos, fiebre y fatiga. La sensibilidad y especificidad de los síntomas variaba según la edad, con relaciones no lineales con la edad. Aunque la proporción de casos de COVID-19 con fiebre aumentaba con la edad, en el caso de los que tenían otras infecciones respiratorias la aparición de fiebre disminuía con la edad. La incidencia de la falta de aliento también aumentó con la edad en una mayor proporción de casos de COVID-19.El estudio ha aportado pruebas útiles para generar definiciones de casos y también ha servido de base a los estudios de modelización del probable coste de la COVID-19.الغرض وصف العرض السريري، ومسار المرض وسلوك البحث عن الرعاية الصحية لأول بضع مئات من حالات الإصابة بمرض فيروس كورونا 2019 (كوفيد 19) في المملكة المتحدة لبريطانيا العظمى وأيرلندا الشمالية. الطريقة قمنا بتنفيذ بروتوكول منظمة الصحة العالمية للتحقيق بخصوص الحالات الـ X القليلة الأولى للإصابة بكوفيد 19، والمخالطين لهم. وقام أخصائيو الصحة العامة المدربون بتجميع معلومات عن 381 حالة إصابة فيروسية مؤكدة بكوفيد 19 في الفترة من 31 يناير/كانون ثاني 2020 إلى 9 أبريل (نيسان) 2020. وتابعنا بدأب الحالات لتحديد التعرض للعدوى والأعراض والنتائج. كما قمنا بجمع بيانات محدودة عن 752 شخصاً يعانون من أعراض كوفيد 19، ولكن كانت نتيجة الاختبار سلبية، كمجموعة تحكم لتحليلات الحساسية، والنوعية، والقيمة التنبؤية للأعراض. النتائج تم استيراد نصف حالات الإصابة بكوفيد 19 تقريباً (196 حالة؛ 51.4%)، سافر معظمهم مؤخراً إلى إيطاليا (140 حالة؛ 71.4%). من بين 94 حالة ثانوية (24.7%)، أبلغت كل الحالات تقريباً عن مخالطة وثيقة مع حالة مؤكدة (93 حالة؛ 98.9%)، والعديد منها عن طريق الاتصال المنزلي (37 حالة؛ 39.8%). وبالنسبة للعمر، فقد أُصيبت نسبة أقل من الأطفال بكوفيد 19. وكانت معظم الحالات مصحوبة بسعال وحمى وإرهاق. تختلف حساسية ونوعية الأعراض تبعاً للعمر، مع علاقات غير خطية مع العمر. على الرغم من أن نسبة حالات الإصابة بكوفيد 19 المصحوبة بالحمى قد زادت مع تقدم العمر، إلا أنه بالنسبة للمصابين بأمراض الجهاز التنفسي، فإن الإصابة بالحمى انخفضت مع التقدم في العمر. كما زاد كذلك حدوث ضيق التنفس مع التقدم في العمر في نسبة أكبر من حالات الإصابة بكوفيد 19. الاستنتاج قدمت الدراسة أدلة مفيدة لوضع تعريفات الحالة، وأوضحت لدراسات النماذج العبء المحتمل لمرض كوفيد 19.旨在描述大不列颠及北爱尔兰联合王国最初数百个新型冠状病毒肺炎（新冠肺炎）病例的临床表现、病程及就医行为。.我们实施了世界卫生组织制定的少数最初新冠肺炎病例和接触者调查方案。经过培训的公共卫生专业人员收集了 2020 年 1 月 31 日至 2020 年 4 月 9 日期间通过病毒学方法确诊的 381 例新冠肺炎病例的相关信息。我们积极跟踪病例，以确定接触感染情况、症状和结果。我们还针对 752 名具有新冠肺炎症状但其检测结果为阴性的病例收集了有限的数据，并将其作为对照组，以分析症状的敏感性、特异性和预测价值。.约有一半的新冠肺炎病例属于境外输入病例（196 例；51.4%），且其中大多数病例近期曾前往意大利旅行（140 例；71.4%）。在 94 例 (24.7%) 二代病例中，几乎所有病例都报告称曾与确诊病例密切接触（93 例；98.9%），且许多病例是因家庭内部接触而导致感染（37 例；39.8%）。按年龄统计，患有新冠肺炎的儿童比例较低。大多数病例表现为咳嗽、发热和疲乏。症状的敏感性和特异性因年龄而异，并与年龄呈非线性关系。虽然其他呼吸道疾病感染病例的发热症状发生率随着年龄增长而降低，但新冠肺炎病例的发热症状发生比例却随年龄增长而增加。而且，大部分新冠肺炎病例的呼吸短促发生率也随年龄的增长而增加。.本研究为制定诊断标准提供了有用的证据，并为针对新冠肺炎潜在负担的模拟研究提供了素材。.Описать клинические признаки, течение болезни и обращение за медицинской помощью первых нескольких сотен случаев коронавирусного заболевания 2019 г. (COVID-19) в Соединенном Королевстве Великобритании и Северной Ирландии.Авторы внедрили протокол исследования первых случаев заболевания новой коронавирусной инфекцией 2019 г. (COVID-19) и контактов, разработанный Всемирной организацией здравоохранения. Квалифицированные специалисты в области общественного здравоохранения собрали информацию о 381 подтвержденном вирусологическим тестированием случае заболевания COVID-19 в период с 31 января по 9 апреля 2020 года. Авторы активно отслеживали данные случаи для определения контакта с инфекцией, изучения симптомов и исхода болезни. Были собраны ограниченные данные по 752 пациентам, имеющим клинические симптомы заболевания, но отрицательный результат теста на COVID-19, в качестве контрольной группы для анализа чувствительности, специфичности и прогностической ценности симптомов.Примерно половина случаев COVID-19 была завезена из-за границы (196 случаев; 51,4%), большинство из которых недавно путешествовали в Италию (140 случаев; 71,4%). Из 94 (24,7%) вторичных случаев заражения почти все сообщали о тесном контакте с лицами с подтвержденным случаями заболевания (93 случая; 98,9%), многие из которых проживали совместно с инфицированными (37 случаев; 39,8%). Вирус COVID-19 редко заражает детей. В большинстве случаев отмечались кашель, высокая температура и утомляемость. Чувствительность и специфичность симптомов варьировались в зависимости от возраста и находились в нелинейной зависимости от возраста. Несмотря на то что доля случаев COVID-19 с высокой температурой увеличивалась с возрастом, у людей с другими респираторными инфекциями частота наличия лихорадки с возрастом снижалась. Возникновение одышки также увеличивалось с возрастом для большинства случаев COVID-19.Исследование предоставило полезную информацию для определения случаев возникновения и послужило основой для модельных исследований вероятного бремени COVID-19.

Published
2020
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22. Video-thoracoscopic left cardiac sympathetic denervation for long-QT syndrome

Author

Sofoklis Mitsos, David Lawrence, Davide Patrini, Nikolaos Panagiotopoulos, Achilleas Antonopoulos, Savvas Lampridis, and Christos Kakos

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, Tachycardia, medicine.medical_specialty, medicine.medical_treatment, Long QT syndrome, 030204 cardiovascular system & hematology, Sympathetic Denervation, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, Video assisted, 030212 general & internal medicine, Sympathectomy, Retrospective Studies, Cardiac channelopathy, Thoracic Surgery, Video-Assisted, business.industry, Heart, General Medicine, Middle Aged, medicine.disease, Long QT Syndrome, Treatment Outcome, Cardiothoracic surgery, Cardiology, Female, Surgery, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Background Congenital long-QT syndrome represents the most common cardiac channelopathy and manifests as potentially lethal ventricular arrhythmias. Prevention strategies include beta-blockade pharmacotherapy, implantable cardioverter-defibrillators, and left cardiac sympathetic denervation, which can increase the threshold for ventricular fibrillation. Herein, we report our experience with video-assisted thoracoscopic left cardiac sympathetic denervation. Methods We performed a retrospective review of the electronic medical records of all patients with congenital long-QT syndrome who underwent video-assisted thoracoscopic left cardiac sympathetic denervation at our institution. Results From September 2009 to May 2016, 6 patients with a mean age of 30.5 years (range 20–47 years) underwent video-assisted thoracoscopic left cardiac sympathetic denervation for medically refractory long-QT syndrome. All patients had an uneventful recovery and were discharged 1–3 days after the operation. At a median follow-up of 14 months (range 12–60 months), 4 patients had no cardiac events while 2 experienced 1 episode of arrhythmic syncope and 1 episode of appropriate implantable cardioverter-defibrillator shock. Following surgery, the mean annual cardiac events in the study cohort decreased from 2.13 to 0.33 ( p = 0.004) and the mean corrected QT interval reduced from 560 ms to 491 ms ( p = 0.006). Conclusions Video-assisted thoracoscopic left cardiac sympathetic denervation is a safe and effective therapy in patients with congenital long-QT syndrome who continue to suffer from recurrent life-threatening arrhythmias or frequent implantable cardioverter-defibrillator discharges despite maximum tolerated doses of beta blockers.

Published
2020
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23. Pectus excavatum and scoliosis: a review about the patient’s surgical management

Author

Sofoklis Mitsos, Eleftherios T. Beltsios, and Nikolaos Panagiotopoulos

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, General Medicine, Scoliosis, 030204 cardiovascular system & hematology, medicine.disease, Nuss procedure, Surgery, Cardiac surgery, 03 medical and health sciences, 0302 clinical medicine, Pectus excavatum, Acquired scoliosis, Cardiothoracic surgery, Funnel Chest, 030220 oncology & carcinogenesis, medicine, Humans, Orthopedic Procedures, Cardiology and Cardiovascular Medicine, business
Abstract

Although Nuss procedure is performed with satisfactory results, there has been a controversy in the literature regarding the effect of a Nuss procedure on the spine. This review article aims to perform an updated overview of the literature about the effect of pectus excavatum correction at the spine and the management of patients with both pectus excavatum and scoliosis. Although acquired scoliosis has been rarely reported after a Nuss procedure, studies show that the Nuss procedure can have a beneficial effect in mild coexisting scoliosis especially when it is performed during the adolescence. The management of cases presented with both pectus excavatum and scoliosis depends on the severity of pre-operative scoliosis and demands detailed evaluation of the spine pre and postoperatively. In the rare condition of post-operative scoliosis following a Nuss procedure, the removal of the metallic bar and conservative measures may have satisfactory results on the spine.

Published
2020
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24. Reliability of muscle thickness measurements in ultrasonography

Author

George Panayiotakis, Elias Panagiotopoulos, Zinon T. Kokkalis, Panagiotis Tsiganos, and Nikolaos Barotsis

Subjects
Adult, Male, Sarcopenia, 030506 rehabilitation, Intraclass correlation, Physical Therapy, Sports Therapy and Rehabilitation, Masseter muscle, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Healthy volunteers, Humans, Medicine, Muscle, Skeletal, Reliability (statistics), Ultrasonography, business.industry, Rehabilitation, Ultrasound, Reproducibility of Results, Repeatability, Geniohyoid, Healthy Volunteers, Female, 0305 other medical science, business, Nuclear medicine, 030217 neurology & neurosurgery
Abstract

This study aims to clarify some of the issues associated with the reliable measurement of muscle thickness on ultrasonographic images of the musculoskeletal system, namely the repeatability of measurements in different time frames, the effect of body side selection, and the effect of scan orientation. Ultrasound scans were performed on muscles associated with essential daily activities: geniohyoid, masseter, anterior arm muscles, rectus femoris, vastus intermedius, tibialis anterior, and gastrocnemius. Measurements of the muscle thickness were performed and repeated after 1, 6, and 24 h, on both dominant and nondominant side, using both transverse and longitudinal scans. Thirteen healthy volunteers (eight males and five females, mean age = 24 years, SD = 2.86, range = 19-29) were included. The intraclass correlation coefficient (ICC) was calculated between the baseline and the 1-, 6-, and 24-h interval, using a two-way mixed model of absolute agreement. The ICC ranged from 0.295 for the longitudinal scan of the left masseter muscle in the 6-h interval to 0.991 for the longitudinal scan of the nondominant anterior arm muscles in the 24-h interval. The results indicate that there is variable reliability of the measurements depending on the muscle, time frame, body side, and scan orientation. Consequently, the choice of these parameters can affect the validity of the measurements. Further investigation on a larger scale is required to establish the preferred parameters for each anatomical site.

Published
2020
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25. Child sexual abuse among medical school students: experiences and perceptions

Author

Theodoros Panagiotopoulos, Spiridon I Pantzios, Theodoros Nicoletos, Maria-Roza Panagiotou, Alexandra Soldatou, and Lina Michala

Subjects
Adult, Students, Medical, Urology, media_common.quotation_subject, education, 030232 urology & nephrology, Adult population, MEDLINE, 03 medical and health sciences, 0302 clinical medicine, Surveys and Questionnaires, Perception, Humans, Medicine, Child, Schools, Medical, media_common, 030219 obstetrics & reproductive medicine, business.industry, Mentally ill, Medical school, Child Abuse, Sexual, Sexual abuse, Child sexual abuse, Female, business, Clinical psychology
Abstract

Given that 5-25% of the adult population report child sexual abuse (CSA), most clinicians will care for victims. Data regarding CSA experiences among medical students are limited and the association of medical students' own history of CSA with relevant perceptions has not been previously examined. The aim of this study was to assess CSA perceptions and exposure of medical students, while exploring their associations. For this purpose, a link was created and made available on a site accessed solely by the Athens medical school undergraduates from February 20 to March 20 2019, comprising a 12-item questionnaire to assess the knowledge and past experience of CSA. This was based on a larger published questionnaire, which was translated and adapted. The questionnaire was then transcripted online, and after pilot testing, was disseminated using the Google documents® platform. Out of 261 responses, CSA was reported by 48 participants (18%), of which 39 were women. Thirty five reported contact CSA. Thirty seven victims (77%) reported previous disclosure of the event, but 18 of them were not protected post disclosure. CSA victims were less likely to agree with the perception that most perpetrators are mentally ill or disabled (p = 0.043), and more likely to strongly disagree with the statement that reputable families are protected from sexual abuse (p = 0.019). In agreement with existing data in general populations globally, about one in five medical students had exposure to CSA. In addition, a potential association of their own experiences with shaping perceptions regarding the identity of CSA perpetrators and affected families for medical students is highlighted.

Published
2020
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26. Increase of breast-feeding in the past decade in Greece, but still low uptake: cross-sectional studies in 2007 and 2017

Author

Zoi Iliodromiti, Chryssa Ekizoglou, Eleni Gaki, Takis Panagiotopoulos, Irini Zografaki, Eleni Nteka, Dimitris Papamichail, Ioanna Antoniadou, Theodora Stavrou, Spilios Zidropoulos, and Panagiota Mavrika

Subjects
Adult, Male, medicine.medical_specialty, Cross-sectional study, Mothers, Medicine (miscellaneous), Hospitals, Maternity, Pregnancy, Sampling design, Prevalence, medicine, Cluster Analysis, Humans, Nutrition and Dietetics, Data collection, Greece, business.industry, Public health, Infant, Newborn, Public Health, Environmental and Occupational Health, Infant, Breast Feeding, Cross-Sectional Studies, Telephone interview, Infant formula, Female, Cluster sampling, business, Breast feeding, Research Paper, Demography
Abstract

Objective:To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.Design:Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.Setting:Telephone interview with babies’ mothers or fathers.Participants:Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).Results:We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and Conclusions:We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

Published
2020
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27. Work and Training Conditions of German Residents in Radiology – Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society

Author

Jörg Barkhausen, Hinrich B. Winther, Michel Eisenblaetter, Friederike Koerber, Nikolaos Panagiotopoulos, T Oechtering, Johannes Wessling, Isabel Molwitz, Frank Anton, Corinna Storz, Matthias Raspe, Arnd Doerfler, Stefan O. Schönberg, Gerald Antoch, Stefan Lohwasser, Stephan Ellmann, Günter Layer, Martin Völker, Michael Wucherer, and Stefan Neumann

Subjects
Adult, Male, medicine.medical_specialty, Inservice Training, Workload, Job Satisfaction, 030218 nuclear medicine & medical imaging, German, 03 medical and health sciences, 0302 clinical medicine, Germany, Surveys and Questionnaires, medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, Curriculum, Societies, Medical, Motivation, Work-Life Balance, Work–life balance, Internship and Residency, Family life, language.human_language, Quality of Life, language, Female, Job satisfaction, Radiology, Psychology, Citation, Psychosocial
Abstract

Good training is the basis for high job satisfaction and high-quality patient care in radiology. The aim of this survey was to record the current state of working conditions for residents in radiology training in Germany and to focus on the aspects of training and psychosocial workload. The description of the actual state should help to identify possible problem areas and to develop improvement approaches. At the beginning of 2018, we sent an electronic questionnaire to the German Roentgen Society (DRG), the German Association of Chairmen in Academic Radiology (KLR), the Chief Physician Forum of the DRG (CAFRAD) and the Forum of Registered Radiologists (FUNRAD) with the request to forward it to radiology residents. With 63 questions, the questionnaire covered seven essential areas of medical working and training conditions. In order to ensure interdisciplinary comparability, most questions were identical to previous surveys among residents of other disciplines. 643 residents started the survey. 501 (78 %) questionnaires were fully processed and included in the final analysis. 65 % of respondents were satisfied with their current job situation. At the same time, shortcomings, especially with regard to the reconciliation of family and work as well as scientific and clinical work, became clear. Only 36 % of participants with children were satisfied with the compatibility of family and work at their workplace. Only 31 % of the researchers were satisfied with their research conditions. In addition, residents experienced a high psychosocial workload. Job satisfaction is high among radiology residents in direct comparison to other disciplines. However, based on this survey, adjustments to working conditions and training in radiology seem necessary to maintain the health of the physicians concerned, to encourage motivation for scientific work and to enhance development opportunities, especially for women, through a better compatibility of work and family life. The present survey identifies strategies and leadership tools that can help to achieve this. Residents in radiology training ... · have a relatively high job satisfaction.. · experience a high psychosocial workload.. · evaluate the compatibility of family and work as in need of improvement.. · are interested in research, but evaluate research conditions as insufficient.· Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology - Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 - 469.ZIEL: Eine qualitativ hochwertige Weiterbildung ist Grundlage für eine hohe Arbeitszufriedenheit und eine exzellente Patientenversorgung in der Radiologie. Ziel dieser Umfrage war es, den aktuellen Stand der Arbeitsbedingungen von Ärzten in der Weiterbildung Radiologie in Deutschland zu erfassen und einen Fokus auf die Teilaspekte Weiterbildung sowie psychosoziale Arbeitsbelastung zu legen. Die Beschreibung des Ist-Zustandes soll helfen, mögliche Problemfelder zu identifizieren und Verbesserungsansätze zu entwickeln. Anfang 2018 wurde ein elektronischer Fragebogen über die Deutsche Röntgengesellschaft (DRG) e. V., die Konferenz der Lehrstuhlinhaber für Radiologie (KLR), das Chefarztforum der DRG (CAFRAD) und das Forum Niedergelassener Radiologen (FUNRAD) an radiologische Weiterbildungsassistenten verschickt. Der Fragebogen deckte mit 63 Fragen 7 wesentliche Themenfelder ärztlicher Arbeits- und Weiterbildungsbedingungen ab. Um eine fächerübergreifende Vergleichbarkeit zu sichern, wurden Fragen von bisherigen Erhebungen unter Ärzten in Weiterbildung anderer Fachrichtungen übernommen. 643 Ärzte haben die Umfrage begonnen. 501 (78 %) Fragebögen wurden vollständig bearbeitet und in die endgültige Analyse einbezogen. 65 % der Befragten waren mit ihrer derzeitigen beruflichen Situation zufrieden. Gleichzeitig wurden Defizite besonders in Bezug auf die Vereinbarkeit von Familie und Beruf sowie die Möglichkeit zu wissenschaftlichem Arbeiten deutlich. Nur 36 % der Teilnehmer mit Kindern waren zufrieden mit der Vereinbarkeit von Familie und Beruf an ihrem Arbeitsplatz. Nur 31 % der wissenschaftlich Tätigen waren zufrieden mit ihren Forschungsbedingungen. Zudem war die psychosoziale Arbeitsbelastung unter den befragten Ärzten stark ausgeprägt. Die Arbeitszufriedenheit ist unter radiologischen Assistenzärzten im Vergleich zu anderen Fachrichtungen hoch. Dennoch scheinen auf Basis dieser Erhebung Anpassungen der Arbeits- und Weiterbildungsbedingungen in der Radiologie erforderlich, um die Gesundheit der betroffenen Ärzte zu erhalten, die Motivation für wissenschaftliches Arbeiten zu fördern und die Entwicklungsmöglichkeiten insbesondere von Frauen durch eine bessere Vereinbarkeit von Familie und Beruf aufzuwerten. Die vorliegende Umfrage zeigt Strategien und Führungsinstrumente auf, mit denen dies erreicht werden kann. Ärzte in radiologischer Weiterbildung ... · sind zufrieden mit ihrer beruflichen Situation.. · stehen unter hoher psychosozialer Arbeitsbelastung.. · bewerten die Vereinbarkeit von Familie und Beruf als verbesserungsbedürftig.. · sind an Forschung interessiert, bewerten die Forschungsbedingungen aber als unzureichend..· Oechtering TH, Panagiotopoulos N, Völker M et al. Work and Training Conditions of German Residents in Radiology – Results from a Nationwide Survey Conducted by the Young Radiology Forum in the German Roentgen Society. Fortschr Röntgenstr 2020; 192: 458 – 470.

Published
2020
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28. Hypocomplementemia is associated with more severe renal disease and worse renal outcomes in patients with ANCA-associated vasculitis: a retrospective cohort study

Author

Konstantinos Thomas, Harikleia Gakiopoulou, Athanasia Kapota, Emilia Hadziyannis, Panagiota Giannou, Aglaia Chalkia, Dimitrios Petras, Dimitrios Vassilopoulos, and Alexandros Panagiotopoulos

Subjects
Male, medicine.medical_specialty, 030232 urology & nephrology, Fluorescent Antibody Technique, Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis, Disease, 030204 cardiovascular system & hematology, Kidney, lcsh:RC870-923, Critical Care and Intensive Care Medicine, Gastroenterology, vasculitis, End stage renal disease, Pathogenesis, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Humans, Medicine, complement, cardiovascular diseases, Aged, Proportional Hazards Models, Retrospective Studies, end-stage renal disease, business.industry, Glomerulonephritis, Retrospective cohort study, Complement C3, General Medicine, Middle Aged, anca, Prognosis, lcsh:Diseases of the genitourinary system. Urology, medicine.disease, Complement system, medicine.anatomical_structure, Nephrology, Creatinine, Clinical Study, Disease Progression, Kidney Failure, Chronic, Female, business, Vasculitis, glomerulonephritis, Research Article
Abstract

The complement system has been recently proposed to play an important role in the pathogenesis of ANCA-associated vasculitis (AAV). This study evaluated the value of serum and kidney deposited C3 in predicting renal outcomes in AAV. This was a retrospective study of 47 patients with AAV, who were categorized according to their serum C3 levels as hypo- or normo-complementemic and to those with positive or negative kidney biopsy immunofluorescence (IF) for C3. Baseline characteristics as well as progression to end-stage renal disease (ESRD) between the 2 groups were compared. In total, 23% (11/47) were hypo-complementemic; these patients were older (74 vs. 65 years, p = 0.013), had higher creatinine levels (4.9 vs. 2.2 mg/dL, p = 0.006), were more often hemodialysis dependent (64% vs. 19%, p = 0.009) and progressed more often to ESRD (55% vs. 11%, p = 0.01) compared to normo-complementemic patients (n = 36). On multivariate analysis, serum creatinine at diagnosis (HR = 16.8, 95%CI: 1.354–208.62, p = 0.028) and low serum C3 (HR = 2.492; 95% CI: 1.537–11.567; p = 0.044) were independent predictors for ESRD. Among 25 patients with an available kidney biopsy, 56% had C3 deposition by IF and displayed more often a mixed histological pattern (72% vs. 27%, p = 0.033), low serum C3 levels (42% vs. 18%, p < 0.001) and serious infections during follow-up (57% vs. 18%, p = 0.047) compared to those with negative (n = 11) IF staining. Almost one of four patients with AAV has low C3 levels at diagnosis which is associated with more severe renal disease and worse renal outcomes (ESRD). This should be taken into account in therapeutic and monitoring strategies.

Published
2020
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29. Patient characteristics, treatment patterns and disease outcomes in patients with psoriatic arthritis followed in a combined Dermatology-Rheumatology clinic: a retrospective real-world study

Author

Kalliopi Klavdianou, Maria Stavropoulou, Pantelis Panagakis, Marina Papoutsaki, Alexandros Panagiotopoulos, Christos Koutsianas, Alexandros Stratigos, Dimitrios Rigopoulos, and Dimitrios Vassilopoulos

Subjects
Male, Biological Products, Rheumatology, Immunology, Arthritis, Psoriatic, Immunology and Allergy, Humans, Psoriasis, Female, Dermatology, Middle Aged, Retrospective Studies
Abstract

The aim of this study was to assess the patient characteristics, treatment patterns and disease outcomes in patients with psoriatic arthritis (PsA) referred to a combined Dermatology-Rheumatology (Derm-Rheum) Clinic. This was a retrospective study of patients seen in a combined Derm-Rheum Clinic (February 2018 to June 2020) in a Tertiary University Hospital. Consecutive patients with suspicious musculoskeletal symptoms or a known diagnosis of PsA referred to the Derm-Rheum Clinic were examined and followed simultaneously by experienced dermatologists and rheumatologists. Among 151 patients with psoriasis (PSO) with suspicious musculoskeletal complaints, 129 (85%) with a final diagnosis of PsA were included (56% females, mean age: 55 years, median disease duration: 14.2 years). In 62% of these patients (n = 94), PsA was diagnosed for the 1st time. At initial evaluation, 95% had peripheral arthritis, 45% nail involvement, 23% axial involvement, 12% enthesitis and 6% dactylitis with a median DAPSA and PASI scores of 20.5 and 1.6, respectively. 31% of the patients were not receiving any systemic treatment, 45% were on biologics, 29% on non-biologics and 10% on targeted synthetic agents (apremilast). At last visit (median interval time: 15 months), only 8% did not receive any systemic therapy (p 0.001 compared to 1st visit), 62% were on biologics (p = 0.009 compared to 1st visit), 46% on non-biologics (p = 0.01 compared to 1st visit) and 10% remained on apremilast. The median DAPSA and PASI scores decreased significantly to 5.3 and 0, respectively. In conclusion, about 2/3 of patients with PSO and musculoskeletal complaints referred to a combined Derm-Rheum Clinic were diagnosed for the 1st time with PsA. During follow-up, the percentage of PsA patients on systemic therapies significantly increased with major improvement of disease activity indices. These data emphasize the value of combined Derm-Rheum Clinics for earlier referral, diagnosis, and more effective treatment of PsA patients.

Published
2022

30. Addressing Concomitant Gradient Phase Errors in Time-Interleaved Chemical Shift-Encoded MRI Fat Fraction and R2* Mapping with a Pass-Specific Phase Fitting Method

Author

Nathan T. Roberts, Diego Hernando, Nikolaos Panagiotopoulos, and Scott B. Reeder

Subjects
Adipose Tissue, Liver, Phantoms, Imaging, Humans, Reproducibility of Results, Radiology, Nuclear Medicine and imaging, Protons, Magnetic Resonance Imaging, Article
Abstract

PURPOSE: Concomitant gradients induce phase errors that increase quadratically with distance from isocenter. This work proposes a complex-based fitting method that addresses concomitant gradient phase errors in chemical-shift-encoded (CSE) MRI estimation of proton density fat fraction (PDFF) and R2* through joint estimation of pass-specific phase terms. This method is applicable to time-interleaved multi-echo gradient-echo acquisitions (i.e., multi-pass acquisitions) and does not require prior knowledge of gradient waveforms, typically needed to address concomitant gradient phase errors. THEORY AND METHODS: A CSE-MRI spoiled gradient echo signal model, with pass-specific phase terms, is introduced for non-linear least squares estimation of PDFF and R2* in the presence of concomitant gradient phase errors. Cramér-Rao lower bound analysis was used to determine noise performance tradeoffs of the proposed fitting method, which was then validated in both phantom and in vivo experiments. RESULTS: The proposed fitting method removed PDFF and R2* estimation errors up to 12% and 10s(−1), respectively, at ±12cm off isocenter (S/I) in a water phantom. In healthy volunteers, PDFF and R2* bias was reduced by ~10% (12cm off-isocenter) and ~30s(−1) (16cm off-isocenter), respectively. An evaluation in 29 clinical liver datasets demonstrated reduced PDFF bias and variability (8.4% improvement in the coefficient of variation), even with the imaging volume centered at isocenter. CONCLUSION: Concomitant-gradient-induced phase errors in multi-pass CSE-MRI acquisitions can result in PDFF and R2* estimation biases away from isocenter. The proposed fitting method enables accurate PDFF and R2* quantification in the presence of concomitant gradient phase errors without knowledge of imaging gradient waveforms.

Published
2022

31. Clinical Applications of 4D Flow MRI in the Portal Venous System

Author

Thekla H. Oechtering, Grant S. Roberts, Nikolaos Panagiotopoulos, Oliver Wieben, Scott B. Reeder, and Alejandro Roldán-Alzate

Subjects
Imaging, Three-Dimensional, Portal Vein, Abdomen, Humans, Radiology, Nuclear Medicine and imaging, Child, Magnetic Resonance Imaging, Blood Flow Velocity
Abstract

Evaluation of the hemodynamics in the portal venous system plays an essential role in many hepatic pathologies. Changes in portal flow and vessel morphology are often indicative of disease.Routinely used imaging modalities, such as CT, ultrasound, invasive angiography, and MRI, often focus on either hemodynamics or anatomical imaging. In contrast, 4D flow MRI facilitiates a more comprehensive understanding of pathophysiological mechanisms by simultaneously and noninvasively acquiring time-resolved flow and anatomical information in a 3D imaging volume.Though promising, 4D flow MRI in the portal venous system is especially challenging due to small vessel calibers, slow flow velocities, and breathing motion. In this review article, we will discuss how to account for these challenges when planning and conducting 4D flow MRI acquisitions in the upper abdomen. We will address patient preparation, sequence acquisition, postprocessing, quality control, and analysis of 4D flow data.In the second part of this article, we will review potential clinical applications of 4D flow MRI in the portal venous system. The most promising area for clinical utilization is the diagnosis and grading of liver cirrhosis and its complications. Relevant parameters acquired by 4D flow MRI include the detection of reduced or reversed flow in the portal venous system, characterization of portosystemic collaterals, and impaired response to a meal challenge. In patients with cirrhosis, 4D flow MRI has the potential to address the major unmet need of noninvasive detection of gastroesophageal varices at high risk for bleeding. This could replace many unnecessary, purely diagnostic, and invasive esophagogastroduodenoscopy procedures, thereby improving patient compliance with follow-up. Moreover, 4D flow MRI offers unique insights and added value for surgical planning and follow-up of multiple hepatic interventions, including transjugular intrahepatic portosystemic shunts, liver transplantation, and hepatic disease in children. Lastly, we will discuss the path to clinical implementation and remaining challenges.

Published
2022

32. Design and synthesis of a novel non peptide CN-NFATc signaling inhibitor for tumor suppression in triple negative breast cancer

Author

Adrià Sánchez-Morales, Atilla Biçer, Vasilis Panagiotopoulos, Selma Crecente-Garcia, Cristina Benaiges, Sergi Bayod, José Luís Hernández, Félix Busqué, Minos-Timotheos Matsoukas, Mercè Pérez-Riba, and Ramon Alibés

Subjects
History, Polymers and Plastics, Druggability evaluation, NFAT signaling Inhibitor, Calcineurin Inhibitors, Triple Negative Breast Neoplasms, Industrial and Manufacturing Engineering, SAR exploration, Càncer de mama, Mice, Breast cancer, Drug Discovery, Animals, Humans, Triple negative breast cancer, Business and International Management, Proteïnes supressores de tumors, Pharmacology, Docking-based design, NFATC Transcription Factors, Calcineurin, Organic Chemistry, General Medicine, Tumor suppressor protein, Phosphoric Monoester Hydrolases, PxIxIT, Cyclosporine
Abstract

Altres ajuts: acords transformatius de la UAB The Ca2/calmodulin-mediated phosphatase activity of calcineurin (CN) integrates calcium-mediated signaling with gene expression programs involved in the control of essential cellular processes in health and disease, such as the immune response and the pathogenesis of cancer progression and metastasis. In addition, CN is the target of the immunosuppressive drugs cyclosporine A (CsA) and FK-506 which are the cornerstone of immunosuppressant therapy. Unfortunately, long-term administration of these drugs results in severe side effects. Herein, we describe the design, synthesis and evaluation of new synthetic compounds that are capable of inhibiting NFATc activity in a dose-dependent manner, without interfering on CN phosphatase activity. These compounds were designed using the structure-based pharmacophore model of a peptide-derived PxIxIT sequence binding to calcineurin A subunit. Moreover, these compounds inhibit NFATc-dependent cytokine gene expression, secretion and proliferation of human T CD4 cells. More importantly, compound 5a reduces tumor weight and shows a tendency to reduce tumor angiogenesis in an orthotopic immunocompetent mouse model of triple negative breast cancer, suggesting that 5a has tumor suppressor activity. These findings validate compound 5a as an agent with therapeutic activity against CN-NFATc and highlight its potential as a tool for drug development with therapeutic purposes.

Published
2022

33. Ambulatory blood pressure and carotid intima media thickness in children with type 1 diabetes

Author

Amanda M. Henderson, Constadina Panagiotopoulos, Janis M. Dionne, Angela M. Devlin, Kevin C. Harris, Sinead Glackin, and Nazrul Islam

Subjects
Male, medicine.medical_specialty, Ambulatory blood pressure, Adolescent, Endocrinology, Diabetes and Metabolism, Diastole, Blood Pressure, 030209 endocrinology & metabolism, Carotid Intima-Media Thickness, 03 medical and health sciences, 0302 clinical medicine, Diabetes mellitus, Internal medicine, Internal Medicine, medicine, Humans, 030212 general & internal medicine, Child, Subclinical infection, Type 1 diabetes, business.industry, Blood Pressure Monitoring, Ambulatory, medicine.disease, Confidence interval, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Blood pressure, Intima-media thickness, Case-Control Studies, Pediatrics, Perinatology and Child Health, Cardiology, Female, business
Abstract

Background/objective Blood pressure abnormalities may play an important role in macrovascular damage in type 1 diabetes. Little is known about blood pressure abnormalities and macrovascular damage in children with type 1 diabetes. Methods Children with type 1 diabetes (n = 57) for a short (3 months-2 years; n = 24) or long duration (≥5 years; n = 33) and a group of control children without diabetes (n = 29) completed 24-h ambulatory blood pressure monitoring (ABPM). Carotid intima media thickness (cIMT), a subclinical indicator of atherosclerosis, was assessed by carotid ultrasound. Results ABPM abnormalities were more prevalent (57% vs 24%, respectively), and daytime, nighttime and 24-h systolic, diastolic, and mean arterial blood pressure indices were higher in children with type 1 diabetes compared to control children. The odds estimate of an ABPM abnormality was 6.68 (95% confidence interval: 1.95, 22.9; P = .003) in children with type 1 diabetes compared to controls after adjusting for age, sex, and BMI standardized for age and sex (zBMI). An interaction between ABPM and zBMI on cIMT was observed. In children with type 1 diabetes and ABPM abnormalities, every 1 SD increase in zBMI was associated with a 0.030 mm increase in cIMT (95% confidence interval: 0.002, 0.041; P = .031). This was not observed in control children with ABPM abnormalities or in children with normal ABPM, regardless of type 1 diabetes status. Conclusions Children with type 1 diabetes have a high prevalence of ABPM abnormalities independent of disease duration and this is related to early indicators of cardiovascular damage.

Published
2019
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34. Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Author

Thomas M. Drake, Matthew J. Lee, Adele E. Sayers, John Abercrombie, Austin Acheson, Derek Alderson, Iain Anderson, Mike Bradburn, Michael Davies, Zaed Hamady, Daniel Hind, Marianne Hollyman, Sarah Hare, Ellen Lee, John Northover, Christopher Lewis, Paul J. Marriott, Nick Maynard, Malcolm McFall, Aravinth Muragananthan, David Murray, Pritam Singh, Gillian Tierney, Azmina Verjee, Ciaran Walsh, Jonathan RL. Wild, Timothy Wilson, S. Abbott, Y. Abdulaal, S. Afshar, M. Akhtar, D. Anderson, S. Appleton, D. Bandyopadhyay, G. Bashir, N. Behar, S. Bhandari, G. Branagan, R. Boulton, C. Borg, G. Bouras, J. Boyle, H. Brewer, L. Brown, C. Briggs, M. Cartmell, S. Chan, N. Chandratreya, P. Conaghan, J. Cornish, D. Cotton, P. Coyne, J. Crozier, T. Cook, P. Cunha, N. Curtis, A. Day, S. Dayal, R. Dennis, P. Dent, H. Dowson, R. Fallaize, S. Farag, M. El Farran, G. Faulkner, P. Giordano, T. Grey, V. Halahakoon, J. Hannay, A. Harikrishnan, S. Holtham, P. Hawkin, C. Hall, L. Hancock, J. Hartley, F. Howse, R. Kallam, G. Kakaniaris, S. Kelly, S. Lockwood, D. Leinhardt, B. Levy, R. Lal, T. Lazim, J. Lund, R. Lunevicius, P. Mathur, K. Maude, D. McArthur, B. McIlroy, A. Miles, S. Moug, M. Mondragon-Pritchard, D. Messenger, M. Mullan, A. Myers, K. Muhammad, C. Mason, J. Sarveswaran, V. Shatkar, B. Singh, B. Skelly, S. Subramonia, M. Swinscoe, B. Thava, C. Thorn, S. Panagiotopoulos, P. Patel, J. Phillips, I. Peristerakis, A. Qureshi, M. Saunders, P. Shah, A. Sheel, S. Siddiqui, P. Skaife, N. Smart, I. Smith, L. Stevenson, N. Stylianides, J. Steinke, B. Stubbs, R. Thompson, M. Varcada, D. Vimalachandran, I. Virlos, J. Watfah, N. Watson, M. Walker, N. Ventham, H. West, J. Wilson, S. Wijeyekoon, J. Ah-Chuen, T. Ahmed, F. Akram, E. Aldred, A. Ali, M. Aly, A. Amajuoyi, V. Amin, A. Andreou, A. Ansari, R. Ardley, F. Arshad, O. Ashour, A. Asour, F. Ayoub, H. Azeem, B. Azhar, C. Baillie, J. Barker, B. Barkham, R. Baron, J. Barrie, E. Barry-Yarrow, N. Battersby, G. Bazoua, C. Berger, S. Bhasin, S. Biggs, C. Bisset, N. Blencowe, A. Boddy, C. Boereboom, M. Bogdan, R. Bogle, P. Bohra, H. Bolkan, M. Boyer, J. Broadhurst, E. Brown, J. Brown, K. Burns, K. Butcher, C. Capper, T. Cash, J. Chapman, S. Chapman, A. Charalabopoulos, C. Cheek, S. Chok, W. Choong, J. Chowdhury, P. Coe, G. Conn, N. Cook, S. Cooper, C. Cox, R. Crook, G. Cuffolo, L. da Silva, B. Das, M. Davenport, J. Davies, T. Davies, S. Dean, G. Demetriou, F. Dengu, H. Dent, G. Di Benedetto, S. Dindyal, E. Donnelly, E. Douka, C. Downham, H. Edent, K. Edgerton, M. El-Sharif, O. Elamin, N. Elsaid, J. Evans, M. Evans, R. Ewe, A. Ewing, H. Ferguson, O. Fisher, J. Fletcher, A. Forouzanfar, A. Foster, R. Fox, N. Francis, V. Fretwell, D. Fung, E. Gammeri, J. Garnham, A. Geraghty, A. Gilbert, M. Gill, M. Gillespie, J. Glasbey, A. Golder, N. Green, E. Groundwater, T. Grove, H. Habib, J. Haddow, C. Halkias, A. Hampson, T. Hanna, R. Harries, K. Harvey, J. Hawkins, R. Healy, R. Heartshorne, S. Heller, L. Hendra, P. Herrod, N. Heywood, G. Hicks, P. Ng, C. Hope, P. Hopley, T. Hossain, S. Hossaini, T. Hubbard, A. Humphreys, H. Ikram, M. Ioannis, M. Iqbal, J. Jatania, P. Jenkinson, S. Jokhan, A. Jones, C. Jones, L. Jones, H. Joshi, K. Joshi, M. Joy, P. Jull, E. Kane, R. Kanitkar, S. Kauser, F. Kazmi, M. Kedrzycki, J. Kendall, T. Khan, G. King, A. Kisiel, C. Kitsis, I. Kolawole, S. Kosasih, A. Kosti, A. Kotb, A. Lau, G. Lafaurie, A. Lazzaro, R. Lefroy, H. Lennon, K. Leong, E. Lim, J. Lim, S. Lindley, D. Liu, P. Lloyd, D. Locker, C. Lowe, A. Lunt, S. Lutfi, A. Luther, S. Luwemba, P. Mahankali-Rao, D. Mai, S. Majid, A. Malik, N. Manu, R. Mapara, C. Martin, J. Martin, L. Massey, J. Mathias, S. McCain, S. McCluney, A. McNair, P. Mekhail, J. Merchant, L. Merker, S. Mir, P. Mistry, V. Miu, M. Moat, E. Mohamed, I. Mohamed, N. Moore, L. Moretti, H. Morris, T. Morrison, J. Moss, D. Mountford, R. Moynihan, D. Muldoon-Smith, J. Mulholland, E. Murgitroyd, K. Murugaiyan, I. Mykoniatis, G. Nana, T. Nash, A. Nassar, R. Newton, K. Nguyen, F. Nicholas, M. Noor, J. Nowers, C. Nugent, A. Nunn, J. O'Callaghan, R. O'Hara, A. O'Neill, J. Olivier, D. Osei-Bordom, L. Osgood, B. Panchasara, R. Parks, H. Patel, K. Pawelec, C. Payne, K. Pearson, G. Perin, B. Petronio, L. Phelan, C. Pisaneschi, J. Pitt, L. Ponchietti, A. Powell, A. Powell-Chandler, N. Pranesh, V. Proctor, N. Qureshi, M. Rahman, Z. Rai, S. Ramcharan, K. Rangarajan, M. Rashid, H. Reader, A. Rehman, S. Rehan, C. Rengifo, N. Richardson, A. Robinson, D. Robinson, B. Rossi, F. Rutherford, I. Sadien, T. Saghir, K. Sahnan, G. Salahia, B. Scott, K. Scott, A. Seager, S. Seal, E. Sezen, F. Shaban, M. Shahmohammadi, A. Shamsiddinova, S. Shankar, A. Sharpe, T. Shields, M. Shinkwin, J. Shurmer, A. Siddika, R. Simson, S. Singh, J. Sivaraj, A. Skinner, C. Smart, F. Smith, R. Smith, A. Sreedhar, E. Stewart-Parker, M. Stott, N. Symons, T. Taj, J. Tam, K. Tan, S. Tani, D. Tao, K. Thippeswamy, C. Thomas, E. Thompson, C. Thompson-Reil, F. Tongo, G. Toth, A. Turnbull, J. Turnbull, T. Wade, A. Wafi, K. Waite, N. Walker, T. Walker, U. Walsh, S. Wardle, R. Warner, J. Watt, J. Watts, J. Wayman, C. Weegenaar, M. West, M. Whyler, L. Whitehurst, M. Wiggans, G. Williams, R. Williams, A. Williamson, J. Williamson, A. Winter, L. Wolpert, J. Wong, G. van Boxel, E. Yeap, S. Zaman, B. Zappa, D. Zosimas, O. Anderson, A. Athem, M. Athersmith, T. Badenoch, S. Barker, S. Bellam, T. Boam, M. Boland, L. Blake, O. Brown, M. Butler, B. Byrne, L. Campbell, M. Chow, K. Da Costa, J. Cutting, M. Deputy, L. Devoto, P. Doody, N. Ekpete, M. Eljaafari, K. Exarchou, M. Faoury, E. Farinella, C. Gill, M. Goh, T. Gregoir, S. Growcott, S. Gunasekaran, G. Harris, R. Heard, B. Hobson, N. Iqbal, R. Jain, P. Kang, M. Khan, S. Korambayil, S. Kouris, K. Kshatriya, S. Kumar, K. Lee, S. Mahroof, K. Malik, K. Mann, S. Mansour, R. Martin, S. McKay, N. McKinley, D. McWhirter, K. Mellor, A. Mishra, K. Mockford, V. Morrison-Jones, C. Ng, R. Nunn, S. O'Neill, O. Oke, N. Obeid, R. Patel, S. Patel, K. Plunkett-Reed, M. Pouzi, S. Pywell, E. Richards, P. Sinclair, N. Slim, G. Spence, M. Swinkin, W. Tahir, K. Takacs, N. Tanner, M. Taylor, C. Valero, M. Venn, M. Venza, T. Yeong, and Nicola S. Fearnhead

Subjects
Male, medicine.medical_specialty, Colorectal cancer, 030230 surgery, Malignancy, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Internal medicine, Intestinal Neoplasms, Intestine, Small, Humans, Medicine, Prospective Studies, Aged, business.industry, Mortality rate, Hazard ratio, Cancer, General Medicine, medicine.disease, United Kingdom, Bowel obstruction, Oncology, Abdominal Neoplasms, 030220 oncology & carcinogenesis, Cohort, Female, Surgery, business, Intestinal Obstruction, Cohort study
Abstract

Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Published
2019
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35. Machine learning of native T1 mapping radiomics for classification of hypertrophic cardiomyopathy phenotypes

Author

Alexios S. Antonopoulos, Maria Boutsikou, Spyridon Simantiris, Andreas Angelopoulos, George Lazaros, Ioannis Panagiotopoulos, Evangelos Oikonomou, Mikela Kanoupaki, Dimitris Tousoulis, Raad H. Mohiaddin, Konstantinos Tsioufis, and Charalambos Vlachopoulos

Subjects
Adult, Male, Multidisciplinary, Myocardium, Science, Cardiology, Magnetic Resonance Imaging, Cine, Diagnostic markers, Amyloidosis, Cardiomyopathy, Hypertrophic, Middle Aged, Article, Machine Learning, Phenotype, cardiovascular system, Humans, Medicine, Female, cardiovascular diseases, Cardiomyopathies, Aged
Abstract

We explored whether radiomic features from T1 maps by cardiac magnetic resonance (CMR) could enhance the diagnostic value of T1 mapping in distinguishing health from disease and classifying cardiac disease phenotypes. A total of 149 patients (n = 30 with no heart disease, n = 30 with LVH, n = 61 with hypertrophic cardiomyopathy (HCM) and n = 28 with cardiac amyloidosis) undergoing a CMR scan were included in this study. We extracted a total of 850 radiomic features and explored their value in disease classification. We applied principal component analysis and unsupervised clustering in exploratory analysis, and then machine learning for feature selection of the best radiomic features that maximized the diagnostic value for cardiac disease classification. The first three principal components of the T1 radiomics were distinctively correlated with cardiac disease type. Unsupervised hierarchical clustering of the population by myocardial T1 radiomics was significantly associated with myocardial disease type (chi2 = 55.98, p

Published
2021
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36. Abdominal Applications of Quantitative 4D Flow MRI

Author

Nikolaos Panagiotopoulos, Grant S Roberts, T Oechtering, Scott B. Reeder, Oliver Wieben, and Alejandro Roldán-Alzate

Subjects
medicine.medical_specialty, Urology, Portal venous system, Hemodynamics, Computed tomography, Article, Imaging, Three-Dimensional, Abdomen, medicine, Humans, Radiology, Nuclear Medicine and imaging, Radiological and Ultrasound Technology, medicine.diagnostic_test, business.industry, Ultrasound, Gastroenterology, Magnetic resonance imaging, Magnetic Resonance Imaging, Review article, medicine.anatomical_structure, Angiography, Radiology, business, Blood Flow Velocity, Magnetic Resonance Angiography
Abstract

4D flow MRI is a quantitative MRI technique that allows the comprehensive assessment of time-resolved hemodynamics and vascular anatomy over a 3-dimensional imaging volume. It effectively combines several advantages of invasive and non-invasive imaging modalities like ultrasound, angiography, and computed tomography in a single MRI acquisition and provides an unprecedented characterization of velocity fields acquired non-invasively in vivo. Functional and morphological imaging of the abdominal vasculature is especially challenging due to its complex and variable anatomy with a wide range of vessel calibers and flow velocities and the need for large volumetric coverage. Despite these challenges, 4D flow MRI is a promising diagnostic and prognostic tool as many pathologies in the abdomen are associated with changes of either hemodynamics or morphology of arteries, veins, or the portal venous system. In this review article, we will discuss technical aspects of the implementation of abdominal 4D flow MRI ranging from patient preparation and acquisition protocol over post-processing and quality control to final data analysis. In recent years, the range of applications for 4D flow in the abdomen has increased profoundly. Therefore, we will review potential clinical applications and address their clinical importance, relevant quantitative and qualitative parameters, and unmet challenges.

Published
2021

37. Natural polyphenols inhibit the dimerization of the sars-cov-2 main protease: The case of fortunellin and its structural analogs

Author

Marilena Kampa, George Sourvinos, Elias Castanas, Vangelis Daskalakis, Ioannis Karakasiliotis, Danai-Maria Kotzampasi, Athanasios A. Panagiotopoulos, Marios Dimitriou, and Stergios Pirintsos

Subjects
natural products, viruses, medicine.medical_treatment, Pharmaceutical Science, Context (language use), Antiviral Agents, Medical and Health Sciences, Article, metadynamics, Analytical Chemistry, chemistry.chemical_compound, QD241-441, Cleave, Chlorocebus aethiops, Drug Discovery, medicine, Animals, Humans, Protease Inhibitors, Glycosides, Physical and Theoretical Chemistry, Vero Cells, Coronavirus 3C Proteases, Flavonoids, Natural products, Protease, Metadynamic, Acacetin, SARS-CoV-2, Organic Chemistry, Polyphenols, COVID-19, Viral plaque, In vitro, COVID-19 Drug Treatment, Molecular Docking Simulation, Biochemistry, chemistry, Chemistry (miscellaneous), Polyphenol, Other Medical Sciences, Vero cell, Molecular Medicine, Molecular simulations, Protein Multimerization, molecular simulations
Abstract

3CL-Pro is the SARS-CoV-2 main protease (MPro). It acts as a homodimer to cleave the large polyprotein 1ab transcript into proteins that are necessary for viral growth and replication. 3CL-Pro has been one of the most studied SARS-CoV-2 proteins and a main target of therapeutics. A number of drug candidates have been reported, including natural products. Here, we employ elaborate computational methods to explore the dimerization of the 3CL-Pro protein, and we formulate a computational context to identify potential inhibitors of this process. We report that fortunellin (acacetin 7-O-neohesperidoside), a natural flavonoid O-glycoside, and its structural analogs are potent inhibitors of 3CL-Pro dimerization, inhibiting viral plaque formation in vitro. We thus propose a novel basis for the search of pharmaceuticals as well as dietary supplements in the fight against SARS-CoV-2 and COVID-19.

Published
2021

38. Glomerular Filtration Rate Abnormalities in Children With Type 1 Diabetes

Author

Kristen Favel, Mike Irvine, Rebecca Ronsley, Constadina Panagiotopoulos, and Cherry Mammen

Subjects
Male, Adolescent, Endocrinology, Diabetes and Metabolism, General Medicine, Endocrinology, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Creatinine, Internal Medicine, Humans, Female, Renal Insufficiency, Chronic, Child, Glomerular Filtration Rate
Abstract

Type 1 diabetes (T1D) increases the risk of chronic kidney disease (CKD) development. The primary objective of this study was to assess the prevalence of abnormalities in estimated glomerular filtration rate (eGFR) in children with T1D. As a secondary objective, we sought to explore the relationship between clinical characteristics and abnormalities in eGFR.This cross-sectional study involved children ≤18 years of age with T1D followed in the diabetes clinic at a pediatric tertiary care centre. Data were collected from health records between 2016 and 2020. Using the Bedside Schwartz, Chronic Kidney Disease in Children Under 25 (CKiD U25) and European Kidney Function Consortium (EKFC) equations, eGFR was categorized as CKD (60 mL/min/1.73 mOf the 420 participants, 225 were male (54%); the median age at diagnosis and duration of T1D were 6.1 and 4.8 years, respectively. The proportion of participants with mildly decreased eGFR was similar regardless of eGFR equation, with 11% to 14% of participants with an eGFR90 mL/min/1.73 mA notable proportion of children with T1D demonstrates eGFR abnormalities early in their T1D course. This finding along with evidence of lower eGFR in adolescence is concerning for long-term risk of CKD and warrants systematic serum creatinine monitoring at diagnosis and regular intervals thereafter in children with T1D.

Published
2021

39. Better outcomes of COVID-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases

Author

Kleopatra Deftereou, Stylianos Panopoulos, Nafsika Gerolymatou, Antonia Elezoglou, Paraskevi V. Voulgari, Stamatis-Nick C. Liossis, Petros P. Sfikakis, Charalampos Papagoras, Vasiliki-Kalliopi Bournia, Konstantinos Melissaropoulos, Maria Pappa, Maria G Tektonidou, Evrydiki Kravvariti, Gerasimos Evangelatos, Theodoros Dimitroulas, Theodora Simopoulou, Kalliopi Fragiadaki, Georgia Mparouta, Panagiotis Georgiou, Nikoleta Zioga, Nikolaos Kougkas, Dimitrios Vassilopoulos, Evangelia Zampeli, George E Fragoulis, Evangelia Kataxaki, Dimitrios P. Bogdanos, Eleni Kalavri, Alexandros Panagiotopoulos, Anastasios Karamanakos, Aikaterini Arida, and Christos Koutsianas

Subjects
medicine.medical_specialty, Oxygen supplementation, COVID-19 Vaccines, Coronavirus disease 2019 (COVID-19), business.industry, SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Mortality rate, Immunology, COVID-19, Disease, Treatment characteristics, General Biochemistry, Genetics and Molecular Biology, Rheumatology, Vaccination, Hospitalization, Internal medicine, Rheumatic Diseases, medicine, Immunology and Allergy, Humans, business
Abstract

ObjectiveΤo report outcomes of breakthrough COVID-19 in comparison with COVID-19 in unvaccinated patients with systemic rheumatic diseases (SRDs).MethodsPatients with SRD with COVID-19 (vaccinated and unvaccinated) were included by their rheumatologists in a registry operated by the Greek Rheumatology Society in a voluntarily basis. Type, date and doses of SARS-CoV-2 vaccines were recorded, and demographics, type of SRD, concurrent treatment, comorbidities and COVID-19 outcomes (hospitalisation, need for oxygen supplementation and death) were compared between vaccinated and unvaccinated patients.ResultsBetween 1 March 2020 and 31 August 2021, 195 patients with SRD with COVID-19 were included; 147 unvaccinated and 48 vaccinated with at least one dose of a SARS-CoV-2 vaccine (Pfizer n=38 or AstraZeneca n=10). Among vaccinated patients, 29 developed breakthrough COVID-19 >14 days after the second vaccine dose (fully vaccinated), while 19 between the first and ConclusionsVaccinated patients with SRD with breakthrough COVID-19 have better outcomes compared with unvaccinated counterparts with similar disease/treatment characteristics.

Published
2021

40. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Author

Nepogodiev, D., Matthews, J. H., Morley, G. L., Naumann, D. N., Ball, A., Chauhan, P., Bhanderi, S., Mohamed, I., Glasbey, J. C., Wilkin, R. J. W., Drake, T. M., Clements, J., Blencowe, N. S., Herrod, P. J. J., Pata, F., Frasson, M., Blanco-Colino, R., Soares, A. S., Nepogodiev D, Bhangu A., Matthews, Jh, Morley, Gl, Naumann, Dn, Ball, A, Chauhan, P, Bhanderi, S, Mohamed, I, Glasbey, Jc, Wilkin, R, Drake, Tm, Clements, J, Blencowe, Ns, Herrod, P, Pata, F, Frasson, M, Blanco-Colino, R, Soares, As, Bhangu, A, Nepogodiev, D, Jain, S, Amuthalingam, T, Tyler, R, Griffiths, Ea, Pinkney, Td, Gee, O, Morton, Dg, Beggs, A, Beral, D, Bowley, D, Cruickshank, N, Daniels, I, Griffiths, E, Hornby, St, Lund, Jn, Marriott, P, Singh, P, Smart, Nj, Speake, D, Thompson, C, Torkington, J, Torrance, A, Vohra, R, Warren, O, Winter, Dc, Pellino, G, Sgrò, A, Simioni, A, Farina, V, Podda, M, Di Saverio, S, Birindelli, A, Pasquali, S, Itsurg, Surg, Pt, Bolton, W, Bradshaw, Cj, Chean, Cs, Harris, G, Haddow, Jb, Jamieson, Nb, Mccain, S, Mason, J, Milgrom, D, Nana, Gr, Mohamed, Mn, Brien, Jo, Pearce, J, Rabie, M, Sahnan, K, Sarmah, P, Skerritt, C, Ghazanfar, Ma, Sreedharan, L, Kabwama, S, Gray, Rt, Kamande, Iw, Nazarian, S, Dar, Fa, Misky, At, Arunachalam, S, Twum-Barima, Cs, Mohamed, Im, Connor, Kl, Coe, Po, Kosti, A, Elshaer, M, Colvin, Da, Charalambous, Mp, Yeung, K, Merker, L, Morrison, T, Thaventhiran, Aj, Gilbert, Tm, Clements, Jm, Hicks, G, Afshar, S, Mckinley, Nc, Assaf, N, Hanna, T, Macinnes, E, Thavanesan, N, Dubois, As, Palani-Velu, Lk, Tezas, S, Yow, L, Radwan, Rw, Abdelrahman, M, Lee, Ka, Zarka, Za, Mcdowall, Na, Tan, Cy, Venn, Ml, Ashmore, Dl, Whitehorn, Se, Golder, Am, Reddy, A, Delimpalta, C, Kay, Oh, Shah, Sm, Eiben, I, Doyle, C, Tudyka, V, Issa, E, West, H, Brewer, Hk, Farrow, Ez, Taylor, Ns, Smart, Cj, Griffiths, Np, Halkias, C, Vitish-Sharma, P, Knight, Sr, Mowbray, Ng, Olivier, Jb, Lee, Kj, Clement, Kd, Chrastek, D, Panda, N, Connor, Mj, Fahmy, Se, Bryan, Es, Ngu, Ws, Adegbola, So, Vaughan, Em, Stupalkowska, W, Simmonds, L, Malik, A, Hussein, A, Karim, Mj, Singhal, T, Ormiston, R, Kung, V, Rabie, Ma, Park, Jh, Lal, N, Worku, D, D'Auria, M, Ang, A, Orizu, M, Gammeri, E, Clough, E, Choy, Ch, Lawday, S, Hann, Aj, Robinson, D, Wardle, Bg, Mcdonnell, D, Rutherford, Dg, Hickey, Lm, Garg, Ag, Rezvani, S, Bell, Cr, Mahmood, F, Rehman, S, Donaldson, G, Peleki, A, Pearce, L, Sharp, Ol, Singh, S, Thompson, Db, El-Tayar, O, Hollyman, M, Rupasinghe, Sn, Toomey, Db, Murray, Mp, Amtul, N, Mersh, Rj, Newton, Rc, Al-Khyatt, W, Stephens, Gf, Abbas, Sh, Iqbal, Mr, Brown, Ce, Renshaw, S, Hureibi, Ka, Pullabatla-Venkata, Up, Donohoe, No, Myatt, A, Egan, Rj, Rangarajan, K, Trail, M, Mckay, Sc, Engall, N, Jerome, E, Townsend, Dc, Patel, By, Pronin, S, Chandratreya, N, Choong, Jh, Mohamed, Tm, Hudson-Peacock, Nj, Manson, R, Hebbar, K, Mothe, Bs, Weegenaar, Cr, Saad, M, Bowman, Cr, Serventi, F, Fleres, F, Foppa, C, Pata, G, Baronio, G, Pertile, D, Lucchi, A, Sagnotta, A, Maretto, I, Campagnaro, T, Gatti, M, Gjoni, E, Roscio, F, Inama, M, Coccolini, F, Colombo, F, Avanzolini, A, Aresu, S, De-Manzoni-Garberini, A, Merlini, Da, Chessa, A, Tamini, N, Mulas, S, Cillara, N, Coletta, D, Atzeni, J, Erdas, E, Gallo, G, Francone, E, Di Gioia, P, Bianchi, Cl, Ferrara, F, Biancafarina, A, Scabini, S, Marano, L, Miegge, A, Sasia, D, Savino, G, Scatizzi, M, D'Amico, Fe, Arcuri, Ga, Gavagna, L, Salamone, G, Tatulli, F, Goldin, E, Matos, Ml, Caldeira, Ab, Romano, J, Pereira, J, Azevedo, J, Azevedo, Jm, Simoes, J, Silva, A, O'Leary, Dp, Kennedy, Nd, Quinn, Em, Zhang, Ay, Neary, Pm, De-Marchi, Ja, O'Connor, Br, Wijesundera, K, Foley, Nm, Wong, J, Tiedt, La, Bolger, Jc, Connelly, Tm, Ahmed, Os, Vigorita, V, García, V, Arredondo, J, Redondo, E, Sainz, B, Aldrey, I, Landaluce-Olavarria, A, Gómez, Aa, Cordoba, E, Sánchez-Fuentes, Mn, Cerdán-Santacruz, C, Beltran-De-Heredia, J, García, M, Veres, T, García-Novoa, A, Abellán, Am, García-Catalá, L, Ruiz-Marín, M, Menendez, P, Roldán-Ortiz, S, Navas-Cuéllar, Ja, Sabia, D, Gomez-Rosado, Jc, Navidad, Ms, Caula, C, Sanchez, Er, Espin-Basany, E, Fernández-Martínez, D, Bravo-Gutiérrez, Af, Payá-Llorente, C, Dujovne, P, Lima, F, Soria-Aledo, V, Gomez, Cj, Pascual-Miguelañez, I, Muinelo, M, Alvarez, Cm, Vargas-Pierola, Hj, Vallve-Bernal, M, Hidalgo-Rosas, Jm, Arenal-Vera, Jj, Sena-Ruiz, F, Sanchez-Guillen, L, Villarejo-Campos, P, Tallon-Aguilar, L, Garcea, A, Bennett, Jm, Whittaker, L, Gidwani, Al, Byrnes, Ck, Saunders, S, Shiwani, Mh, Ashraf, N, Venkatasubramaniam, Ak, Bevan, Ke, Mcarthur, D, Mustafa, Ak, Griffith, Jp, Blazeby, Jm, Charalabopoulos, A, Campbell, W, Reese, G, Warren, Oj, Peacock, M, Menzies, D, Jenner, D, Eardley, Nj, Yoong, S, Abulafi, M, Avalapati, H, Thompson, R, Nastro, P, Kochupapy, R, Stubbs, Bm, Mcintyre, R, Crozier, J, Patel, Pk, Pento, V, Beasley, Wd, Roxburgh, C, Youssef, H, Alexander, R, Denley, S, Di Franco, F, Quddus, A, Saha, A, Hunter, I, Hannay, J, Velchuru, Vr, Bond-Smith, G, Salama, Y, Bhargava, A, Panagiotopoulos, Sp, Watson, N, Garcea, G, Boddy, Ap, Dunning, Pg, Lloyd, G, Gurjar, Sv, Hill, J, Andrews, B, Singh, A, Ruzvidzo, F, Shingler, G, Mahon, D, Elgaddal, S, Payne, Cj, Shaikh, Ia, Dalmia, S, Nair, Ms, Finch, Jg, Chapple, Ks, Bawa, S, Watfah, J, Carden, Ca, Makhija, R, Rao, M, Sarveswaran, J, Vijay, V, Rekhraj, S, Knight, B, Siddiqui, Mn, Sebastian, Jf, Glen, P, Vakis, S, Ebied, H, Rajaram, R, Gray, J, Mcgrath, D, Faulkner, G, Gopalswamy, S, Varcada, M, Woodward, A, Williams, Gl, Szentpali, K, Ravindran, R, Bronder, C, Thaha, Ma, Rate, A, Shetty, Vd, Rao, V, Sajid, Ms, Clements, B, Patel, Rt, Mason, C, Branagan, G, Maude, K, Kaur, G, Lyons, A, Ainsworth, P, Hagger, R, Zadi, Az, Maslekar, Su, Kinross, J, Irukulla, S, Hawkins, W, Wheatstone, S, Magro, T, Bailey, S, Marshall, G, Mccullough, J, Marangoni, G, Leung, El, Borg, Cm, Gopinath, S, Kirkby-Bott, J, Yalamarthi, S, Mirza, S, Brett, M, Ramcharan, S, Pandey, V, Thava, B, Andreani, Sm, Sahay, Sj, Aravind, B, Downey, M, Nicol, D, Whitehouse, P, Sharma, A, Francis, N, Chitsabesan, P, Stewart, Dj, Norcia, Gg, Cucinotta, E, Cianchi, F, Romario, Uf, Taglietti, L, Capelli, P, Garulli, G, Parisi, A, Nitti, D, Guglielmi, A, Alonzo, A, Scandroglio, Is, Moretto, G, Ansaloni, L, Pietrabissa, A, Foschi, D, Vettoretto, N, Ercolani, G, Coppola, M, Colangelo, E, Morandi, E, Niolu, P, Pala, M, Coletti, M, Pisanu, A, Nicolosi, A, Sammarco, G, Berti, S, Soliani, P, Tonini, V, Stella, M, Ceccarelli, G, De Nisco, C, Castagnoli, G, De Nardi, P, Borghi, F, Agresta, F, Benevento, A, Cantafio, S, Cesari, Mc, Rubbini, M, Chetta, G, De Marchi, F, Nora, Mf, Sousa, Hs, Nascimento, Ca, Casimiro, C, Costa, Sd, Rosa, Mj, Carvalho, N, Correia, J, Gomes, Ap, Hill, Ad, Walsh, Tn, Aremu, Ma, Mulsow, J, El-Masry, S, Gillick, J, Garvin, J, Caldwell, M, Mehigan, B, Peirce, Cb, Cooke, F, Mealy, K, Ruano, A, Ais, G, Fueyo, J, Parajó, Ae, Bernal-Sprekelsen, Jc, Monzón-Abad, Ja, Blanco, F, Arroyo, A, Bazán-Hinojo, Mc, Ramos-Bernado, Mi, Lopez-Ruiz, Ja, Golda, T, Julià, D, Cuadrado, Mm, Gómez-Abril, Sa, Martinez, J, Aguayo, Jl, Millan, M, Alvarez-Gallego, M, Muinelo-Lorenzo, M, Parra, Jm, Muñoz-Muñoz, E, De Chaves-Rodríguez PG, Cánovas-Moreno, G, Rodriguez-Lopez, M, Segura-Sampedro, Jj, García-Granero, A, Redondo-Calvo, Fj, Dyson, S, Thakur, D, Swords, C, Siaw, O, Zelazek, M, Woo, R, Badran, A, Aruparayil, N, Christopoulos, P, Chambers, B, O'Neill, N, Long, Rh, Mccaughey, P, Wong, Ml, Mccain, Rs, Lennox-Warburton, Hc, Moore, C, Manektella, Km, Mcilwaine, S, Rupani, S, Simpson, Dj, Wauchope, J, Ng, M, Christian, L, Crone, A, Sacks, R, Symons, N, Lazzaro, A, Patil, Sd, Roomi, S, Silva, I, Hodgson, Jm, Ly, C, Froud, H, Patel, H, Cay, P, Karwal, Rs, Danquah-Boateng, D, Berry, B, Esmail, Hd, Maripi, H, Bilku, D, Mckelvie, Ma, Miller, K, Maina, A, Velho, R, Hasan, R, Clingan, R, Jah, S, Waite, K, Jones, A, Buckley-Jones, S, Lecky-Thompson, L, Saghir, N, Mansoor, S, Mistry, D, Brown, R, Wong, A, Gurung, S, Wensley, F, Fleming, Ta, Griggs, R, Haines, S, Bedoya, S, Beverstock, A, Johnson, J, Govind, G, Niaz, O, Dyal, A, Tokidis, E, Punj, S, Leusink, A, Rudland, I, Kelly, M, Morgan, R, Al-Musawi, S, Lek, C, Gilbert, A, Gosal, A, Mahoney, R, Parwaiz, I, Mitchard, Mj, Ribeiro, B, Merai, H, Dean, Ea, Khan, S, Baginski, A, Mann, C, Foers, W, Jones, L, Woodward, B, Mcwhirter, Dm, Thomas, At, Gilbert, Tg, Weatherburn, Lw, Pilkington, Jp, Cameron, Fc, Clements, Jd, Mccann, C, Davidson, S, Hackney, L, Clements, Js, Martin, A, Du, Dt, Shakoor, Z, Yen, Sk, Adnan, M, Ranathunga, S, Sana, S, Tay, Yh, Chin, My, Gillespie, M, Brown, Ag, Campbell, U, Chatzikonstantinou, M, Mahendran, B, Flack, T, Chowdhary, M, Lim, Jm, Whiteman, E, Shepherd, Ja, Pedder, A, Siggens, Kl, Lai, Cw, Morrison-Jones, V, Hayat, Z, Nehikhare, I, Macleod, C, Quinn, Hc, Brown, A, Neagle, G, Chok, Sm, Carrano, Fm, Abbassi, Oa, Divekar, Ga, Halmer, S, Adams, Re, Davies, Pl, Wong, Sy, Amarasinghe, R, Tague, Le, Jones, E, Singh, J, Boza, K, Kelly, Sd, Morrison, F, Chan, Wh, Wilson, Ej, Awokoya, Oo, Griffiths, Sn, Kirkham, En, Cotton, Ae, Adimonye, A, Leighton, Pa, Abdelrahman, A, Cartwright, H, Gates, Z, Miguras, M, Khan, K, Louw, C, Grove, T, Badenoch, T, Mckeon, J, Wood, Cs, Leitch, Rp, Sgardelis, P, Perera, Mi, Nagarajan, D, Malam, Y, Theodoropoulou, K, Rajagopal, S, Kaptanis, S, Popova, D, Olagbaiye, O, Tayeh, S, Rigby, S, Harris, Mp, Ren, Kz, Liaw, G, Zhou, S, White, F, Marshall, Cm, Mitchell, Jh, Anderson, Dj, Kanakala, V, Hollingsworth, A, Paramasevon, Kr, Milward, J, Ahmed, S, Fanibi, Bf, Ferguson, N, Dickson, Ea, Shaw, Av, Dixon, F, Morrish, S, Dandy, R, Fooks, P, Sharma, P, Islam, N, Tabain, V, Keegan, R, Ahel, J, Alhammali, T, Graveston, J, Balai, Ej, Rothnie, K, Pankin, Gp, Eiben, Ie, Jackson, Nj, Dhar, M, Nash, D, Dharamavaram, S, Seth, M, Chowdhury, F, Rezacova, M, Seneviratne, N, Turner, Ej, Currow, C, Isherwood, Jd, Hobson, Bm, Lui, Dh, Rodger, V, Ting, N, Photiou, D, Taze, D, Lodhia, S, Earnshaw, L, Kumar, K, Neale, A, Bastianpillai, J, Cipparrone, M, Barrie, A, Nash, Z, Anandan, L, Tailor, K, Vinnicombe, Z, Krivan, S, Kuo, R, Giorga, A, Habib, H, Malik, K, Bogdan, M, Mahon-Daly, Fp, Athersmith, Mj, Strange, Ja, Wheeler, C, Summerfield, L, Khaw, Ra, Ashour, O, Iosif, E, Fadel, M, Gopalakrishnan, K, Orme, N, Williams, S, Rashid, M, Sultana, A, Patel, N, Pearson, R, Yasin, T, Bevan, V, Al-Sarireh, B, Brown, M, Mohd, N, Howie, Ee, Poudevigne, M, Paget, C, Rallage, H, Chui, K, Fawzi, F, Layman, S, Okorocha, E, Jama, Gm, Orawiec, P, Kouli, O, Hassane, A, Kilkenny, J, Devine, Aa, Laurenson, M, Slezak, I, Barker, T, Lau, E, Limbada, M, O'Brien, J, Weaver, J, Hajibandeh, S, Shah, J, Mansour, Mm, Malik, Sn, Davis, S, Trew, F, Bandyopadhyay, Sk, Dart, K, Guru-Naidu, S, Callan, R, Nair, Mk, Alani, M, Sezen, E, Salim, S, Shurlock, J, Siddique, K, Forouzanfar, A, Brews, R, Acharya, A, Jain, A, Tozer, Pj, Warusavitarne, J, Emslie, Km, Collier-Wakefield, O, Sivaloganathan, P, Dobson, C, Elseedawy, M, Mcnally, L, Williams, M, Motiwala, Fh, Choi, S, Asmadi, Aa, Burnside, D, Everden, A, Suriyakumar, S, Sandu, L, Kent, Da, Bowen, J, Long, P, Khair, A, Shah, K, Phelan, L, Pierre, R, Dhari, Aa, Hoff, M, Nickson, S, Setshwaelo, T, Chalk, A, Parkola, Mj, Harlinska, A, Chan, T, Dudek, Jg, Rolph, R, Allen, M, Pollard, H, Gormely, R, Finlayson, H, Ljungqvist, G, Peponis, C, Rahman, M, Dhesi, S, Arshad, F, Faris, Ar, Sooriyamoorthy, T, Springate, El, Barnieh, W, Patel, As, Siddiqui, Za, Chishti, Ia, Ayube-Brown, J, Rabie, Mr, Blake, L, Yardimci, E, Nagendram, S, Neophytou, Gi, Henderson, L, Farhan-Alanie, M, Kong, Cy, Ghazala, R, Evans, J, Hussain, N, Kabir, M, Hraishawi, I, Cox, M, Bailey, Ja, Muhibullah, N, Yanni, F, Stevenson, R, Nair, A, Murphy, C, Mcgucken, O, Pandya, R, Bowerman, H, Lafaurie, G, Van Boxel GI, Shanmugarajah, K, Maragouthakis, D, Hanif, Z, Evans, Jd, Yoganathan, S, Richardson, Td, Cook, V, Clark, Gl, Rigney, B, O'Neill, E, Guliani, J, Chan, D, Harper, F, Sian, T, Boereboom, C, Blackwell, J, Hardy, E, Boyd-Carson, H, Couch, Dg, Barter, Ca, Thoukididou, Sn, Hatt, Jr, Jones, Cs, Dean, S, Rajaretnam, N, Masood, M, Thakral, N, Griffith, D, Doherty, C, Longshaw, A, Peprah, D, Mathew, G, Hook, A, Vance-Daniel, J, Ibrahim, Y, Walters, Kj, 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Samuel M., Docherty J.A., Cheah W.L., Ooi R., Nyeko-Lacek M., Marsh L., Prideaux A., Li C.H., Poacher A., Lee M., Muzaffar M., Kara A., Walsh E., Sunter H., Roth N., Roy C., Mcmorran D., Turnbull A., Layton G.R., Archer J.E., Yang P., Douka E., Amin V., Borghol K., Blackford O.D., Bond S., Baker B., Mohamed W.O., Williams R., Garnham J., Robb H.D., Allington J., Cloney L., Tamborska A., Kalia K., Fung E., Johnston Z., Lynch L., Christides A., Tan H.L., Cynthia G., Tsang B., Rossi C., Kaubrys M., Al-Khafaji N., Jenkins M., Peiris G.B., Gunning S., Nimako E., Pandya D., Hever P., Amayo A., Bull C., Clements C., Al-Sheikh M., Savioli F., Long M., Horsfield E., Robertson C., Ogboru S., Mcilwrath A.C., Bell J., Limb C., Obeid N., Rich J.E., Balasubramaniam A., Mashar R., Taylor M., Bruce J.S., Dennison G., Curtis N.J., Ezerska E., Ellis B., Wiggill S., Tee A., Ng S., Carder C., Abdelwahed A., Chandler S.B., Tinsley B.J., Finotti E., Occhioni G., Cossu F., Vulcano I., Viscosi F., Michelini M., Compagnoni B., Sepe C., Isolani S.M., Regina G., Alagna V., Martorelli G., Gabbianelli C., Moroni P., Zuin M., Conci S., Lazzari G., Costamagna D., Zurleni T.Z., Altomare M.A., Desiderio J., Di Cintio A., Gemini A., Trastulli S., Viviani E., Tomasoni M., Montori G., Harder G., Argenti F., Malabarba S., Checcacci P., Montanelli P., Guerra F., Skalamera I., Staderini F., Grandi S., Nelli T., Coratti F., Sorrentino L., Maffioli A., Cavallo D., Bondurri A., Groppo G., Curti R., Solaini L., Xidas A., Manias T., Delogu D., Vacca A., Solinas L., Corbellini C., Fiore L., Nigro A., Santurro L., Angrisani M., Sparta C., Lorettu A., Mura F.A., Ruggiu G.V., Pirari P.F., Pau R., Melis M., Piu F., Patti S., Deserra A., Angelieri D., Del Basso C., Rossi D., Iannone I., De Padua C., Giubilo C., Falaschi F., Cirillo B., Gordini L., Podda F., Sanna S., Saba A., Poillucci G., Pinna E., Messina A., Sena G., Cardona R., De Luca E., Sacco R., Vescio G., Ammendola M., Romano R., Bianco A., Bonfante P., D'Ambra L., Feleppa C., Gennai A., Lizzi V., Moggia E., Imperatore M., Bolzon S., Belvedere A., Amaducci E., Ripoli M.C., Segalini E., Cervellera M., Vaccari S., Eretta C.O., O'Neill R., Llewelyn O., Jones N., Clerici F., Ballabio M., Andolfi E., Angelini M., Fontani A., Miranda E., Scricciolo M., Provenza G., Pellicano G.A., Pulighe F., Argenio G., Melis A., Balestra F., Anania M., Cruccu A., Massaiu C., Murru M.L., Martino A., Luzzi A.P., La Valle G., Chillitupa C.Z., Bartoli A., Conti D., Spaziani A., Bellochi R., Listorti C., Salandini M.C., Carlucci M., Tenconi S.M., Cannavo M., Marano A., Giuffrida M.C., Cannata G., Pellegrino L., Giraudo G., Baraghini M., Garzi A., Giudicissi R., Zalla T., Romoli L., Vannucchi A., Giani I., Feroci F., Calussi M., Ribaudo M., Fiorot A., Stecca T., Nistri C., Fornasier C., Valiani S.V., Brunelli D.B., Evoli L.E., Giuliani N.G., Contine A.C., Renzi C.R., Feo C.V., Anania G., Carcoforo P., Aisoni F., Licari L., Tutino R., Cocorullo G., Silvestri V., De Marco P., Fontana T., Orlando G., Falco N., Baseggio M., Napetti S., Mella A., Rossi G.M., Chimetto A., Cosci M., Bonomo M., Scialandrone G., Chetta N., Carvalho L.C., Magalhaes J.S., Pereira A.M., Fernandes C., Fareleira A., Goncalves D., Pais M., Pereira A., Resende F.M., Correia D., Cardoso D., Tojal A., Santos S.C., Barbosa L., Louro H.C., Bairos F., Martins F.M., Messias F.M., Ferreira M.S., Borges F.C., Botelho P., Lima M., Valente P.M., Joao A.A., Guimaraes J.M., Rocha R., Nogueira S.T., Kabir U., Wong C., Rahmani L.S., Tan S., Chng S., Jasinski B., Cheng S.A., Mardhiah S., McGlynn K., Hannan E., Burke J., Haveliwala Z., O'Neill M., Boland M., Hayes C., Fox A., Zaborowski A., Mitru R.M., Mc-Dermott A., Coyle D., Stoica I., McMahon S.V., Laughlin D.M., Kannegieser-Bailey M., Murphy R., Muntean A., Shet S., Thomas L., De Freitas S., Quill S., Aljorfi A., Soh B., Law J.J., Hartnett J., Jansen T., Gilgan J., Jung J., Scanlon K., Szucs A., Ahern D.P., Redmond A.E., Edwards S.E., Manoharan P., Brennan S., Abdelgadir A.M., Mckevitt K.L., Zarog M.A., Ahmed G., Bukhari W., Ahad A., Paniagua M., Samartin C., Primo J.C., Garrido L., Lopez M., Rufo E., Trostchansky I., Rodriguez L., Infante H., Acosta A., Cremades P., Cidoncha A., Olmos V., Oliva I., Santamaria C., Cavero A., Calvo H., Suero C.A., Maderuelo V.M., Galvez P., Hernando A., Eguaras I., Recreo A.C., Garcia-Carrero M., Moreda R., De Andres U., Del Pozo E., Calvo M., Moratalla C.N., Ronda R.N., Contreras R.G., De Burgos C.B., Cortes G.V., Martinez C.C., Agudo A.R., Soriano J.T., Ramos X.H., Echazarreta E., Elia M., Hernaez A., Sanchez L., Vallejo-Bernad C., Oliver J.R., Sanchez-Rubio M., Kalviainen H.K., Genzor S., Gonzalez-Nicolas T., Puerta E., Laviano E., Gimenez T., Ferminan A., Muriel-Alvarez P., Sierra-Granon J.E., Escoll-Rufino J., Cuello-Guzman E., Mestres-Petit N., Merichal-Resina M., Pinillos-Somalo A., Gomez-Carmona Z., Vazquez-Fernandez A.P., Trujillo-Diaz J.J., Couso J.R., Fernandez M.D., Riera E., Espinosa J., Carral-Freire M., Martinez-Almeida R., Santarrufina-Martinez S., Sebastian-Tomas J.C., Gonzalvez-Guardiola P., Fernandez E.C., Mozo A.S., Stoyanov T.I., Santamaria P.C., Grimaldo E.G., Fernandez-Candela A., Curtis-Martinez C., Del-Valle-Ruiz S.R., Sanchez-Cifuentes A., Ramirez-Faraco M., Lopez A.F., Leon C., Kumar S., Fornell-Ariza M., Ayllon-Gamez S., Pena-Barturen C., Ojea-Ruiz-Yherla L., Saavedra-Chacon M., Perez-Calvo J., Gomez-Facundo H., Riba-Combatti L., Manas O.C., De-Soto-Cardenal B., De-La-Herranz-Guerrero P., Dominguez-Sanchez C., Gamero-Huaman J.C., Suarez-Cabrera A., Ramirez-Redondo A.A., Lara-Fernandez Y., Bascuas-Rodrigo B., Lopez-Duran B.L., Pigem A., Gil J., Salvador H., Planellas P., Farres R., Caballero A., Arnau M., Tapiolas I., Ridaura N., Roncero L.S., Collado-Roura F., Fijo L.M., Cormenzana O.B., Vinas N.L., Grifell M.S., Prats M.A., Torrado A.A., Sanz-Navarro S., Contreras-Saiz E., Solar-Garcia L., Moreno-Gijon M., Suarez-Sanchez A., Diaz-Vico T., Rodicio-Miravalles J.L., Garcia-Gutierrez C., Pila U., Melone S., Martin-Prieto L., Rojo J.A., Gonzalez M., Zorrilla L., Garcia-Marin J.A., Baeza-Murcia M., Pellicer-Franco E., Jimenez-Ballester M.A., Asensio-Gomez L., Gortazar-De-Las-Casas S., Guevara-Martinez J., Ramirez L., Verea S., Anguita F., Navarro G., Criado ADC., Lara M.C., Martinez E.T., Sanchez-Martinez A., Hernandez-Gimenez L., Galofre-Recasens M., Ferrer-Vilela I., Perez-Sanchez L.E., Esteves M.B., Menendez-Moreno A., Baz-Figueroa C., Rosat A., Hontoria M.S., Garcia N.A., Gracia-Roman R., Pascua-Sole M., Pino-Perez O., Garcia-Perez J.M., Pineno-Flores C., Ambrona-Zafra D., Sancho-Muriel J., Alvarez E., Jimenez-Rosellon R., Daga O., Alberca-Paramo A., Sanchez-Garcia S., Garcia-Santos E., Pareja-Ciuro F., Olivares-Oliver C., Navarro-Morales L., Tamayo-Lopez M.J., Tinoco-Gonzalez J., Garcia-Rivera C.O., Agua I.A., Moreno-Suero F., Pereira-Mosquera E., Zerpa C., Llacer E., Diaz A., Caro A., Feliu F., Franco M., Escuder J., Abellan M., Padilla E., Mambrilla-Herrero S., Plua-Muniz K.T., Bailon-Cuadrado M., Tejero-Pintor F.J., Choolani-Bhojwani E., Vila-Zarate C., Delgado-Plasencia L.J., Ponchietti L., Cousins L., Busuttil A., Baird C., Drye N., Brown O.D., Mansour S., Anderson O., Mahapatra R., Clements J.A., D'Souza N., Littlehales D.J., Tang A.M., Byrne B.E., Cunha P., Ogbuokiri C., Eiben P., Gravante G., Kho H., Dobbs S., Doulias T., Ng J., Wilson M., Venugopal R., Wolff J., Akhtar K., Walji H.D., Tognarelli J.M., Knight K.A., Ansari A., Hussaini S.A., Wright E., Brewer H., Rinkoff S., Harries R.L., Fairfield C.J., Abbott T., Jackson A., Wright H.L., Walters U., Carney K., Logan P.C., Mughal Z., Strachan E., Chasty B., Ma J., Mazzeo C., Badii B., Armellini A., Grassia M., Perin A., Ruzzenente A., Magnoli M., Depalma N., Longheu A., Papandrea M., Dova L., De Prizio M., Gusai G.P., Di Zitti L., Geretto P., Azabdaftari A., Chianese G., Elbetti C., Ruffolo C., Giaccari S., Devezas V., Ferreira J.S., Peixoto R., Alshafei A., Simo V., Jose H.S., Ugarte-Sierra B., Salva A.B., Gomez N., Marinello F., Medina-Arana V., Vega L., Ballester M.M., Espina B., Prieto-Nieto M.I., Rodriguez E.C., Padilla-Valverde D., and Duran-Munoz-Cruzado V.M.

Subjects
Adult, humanos, Decision Making, Risk Assessment, NO, apendicectomía, apendicitis, evaluación de riesgos, Appendectomy, Humans, hospital, General, collaborative, LS7_4, right iliac fossa, appendicitis, emergency service, Original Articles, adulto, Appendicitis, adult, appendectomy, humans, risk assessment, decision making, Lower GI, Original Article, appendicitis, prediction models, right iliac fossa pain, Emergency Service, Hospital, toma de decisión
Abstract

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P, Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making were identified by identifying UK adults at low risk of appendicitis. An online calculator is available (http://appy-risk.org). WCC, white cell count; CRP, C‐reactive protein; AIRS, Appendicitis Inflammatory Response Score; AAS, Adult Appendicitis Score. Important differences between men and women

Published
2019

41. p‐cymene impairs SARS‐CoV‐2 and Influenza A (H1N1) viral replication: In silico predicted interaction with SARS‐CoV‐2 nucleocapsid protein and H1N1 nucleoprotein

Author

Nikolaos Kesesidis, George Sourvinos, Marilena Kampa, Christos Lionis, Athanasios A. Panagiotopoulos, Elias Castanas, Vangelis Daskalakis, Melpomeni Tseliou, Danai-Maria Kotzampasi, Stergios Pirintsos, George Notas, and Ioannis Karakasiliotis

Subjects
Models, Molecular, Protein Conformation, viruses, Nuclear Localization Signals, importin A, rabies, Influenza A, Virus Replication, 030226 pharmacology & pharmacy, SARS‐CoV‐2, Madin Darby Canine Kidney Cells, 0302 clinical medicine, Influenza A Virus, H1N1 Subtype, Chlorocebus aethiops, General Pharmacology, Toxicology and Pharmaceutics, influenza A, nucleoprotein, Nucleocapsid protein, p‐cymene, virus diseases, Nucleocapsid Proteins, Biological Sciences, Protein Transport, p-cymene, Neurology, 030220 oncology & carcinogenesis, Ebola, Original Article, Natural Sciences, nucleocapsid protein, Rabies, In silico, Protein domain, Importin, RM1-950, Biology, Molecular Dynamics Simulation, Antiviral Agents, 03 medical and health sciences, Dogs, Protein Domains, Importin A, NLS, Animals, Humans, Vero Cells, Nucleoprotein, Cell Nucleus, SARS-CoV-2, RNA, Original Articles, Virology, Viral replication, Cymenes, Therapeutics. Pharmacology, Nuclear localization sequence
Abstract

Therapeutic regimens for the COVID‐19 pandemics remain unmet. In this line, repurposing of existing drugs against known or predicted SARS‐CoV‐2 protein actions have been advanced, while natural products have also been tested. Here, we propose that p‐cymene, a natural monoterpene, can act as a potential novel agent for the treatment of SARS‐CoV‐2‐induced COVID‐19 and other RNA‐virus‐induced diseases (influenza, rabies, Ebola). We show by extensive molecular simulations that SARS‐CoV‐2 C‐terminal structured domain contains a nuclear localization signal (NLS), like SARS‐CoV, on which p‐cymene binds with low micromolar affinity, impairing nuclear translocation of this protein and inhibiting viral replication, as verified by preliminary in vitro experiments. A similar mechanism may occur in other RNA‐viruses (influenza, rabies and Ebola), also verified in vitro for influenza, by interaction of p‐cymene with viral nucleoproteins, and structural modification of their NLS site, weakening its interaction with importin A. This common mechanism of action renders therefore p‐cymene as a possible antiviral, alone, or in combination with other agents, in a broad spectrum of RNA viruses, from SARS‐CoV‐2 to influenza A infections., Left panel: Docking of p‐cymene within the NLS sequence of N protein, shown in yellow. The ligand interacts preferentially with Arginine 262 and Threonine 265, in the center of the NLS sequence (aa 258–268), therefore impairing the interaction of N with importin‐α. Right panel: p‐cymene inhibits (black curve) and prevents (red curve) SARS‐CoV‐2 replication, in a dose‐dependent manner.

Published
2021

42. Greater Arterial Stiffness in Children with or without Second-generation Antipsychotic Treatment for Mental Health Disorders: Rigidité Artérielle Plus Importante Chez Les Enfants Avec ou Sans Traitement Par Antipsychotiques de la Deuxième Génération Pour des Troubles de Santé Mentale

Author

Angela M. Devlin, Amanda M. Henderson, Nazrul Islam, Constadina Panagiotopoulos, and George G.S. Sandor

Subjects
Gynecology, medicine.medical_specialty, business.industry, Mental Disorders, 030204 cardiovascular system & hematology, Pulse Wave Analysis, medicine.disease, Carotid Intima-Media Thickness, female genital diseases and pregnancy complications, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Mental Health, Vascular Stiffness, medicine, Arterial stiffness, Humans, business, Child, Pulse wave velocity, 030217 neurology & neurosurgery, reproductive and urinary physiology, Antipsychotic Agents, Original Research
Abstract

Objective: Second-generation antipsychotics (SGAs) are used for a variety of mental disorders and are associated with cardiometabolic side effects in children. The objective of this study was to assess the cardiovascular health of children with mental disorders that are SGA-treated or SGA-naive. Methods: SGA-treated ( n = 47) or SGA-naive ( n = 37) children (aged 6 to 18 years) with mental disorders and control children ( n = 83, no mental disorder) underwent assessment for cardiac function and morphology by echocardiography, aortic pulse wave velocity (PWV), and carotid intima-media thickness (cIMT). Body mass index (BMI) z-scores, waist circumference z-scores, systolic and diastolic blood pressure (BP) percentiles for height and sex, and fasting plasma glucose, insulin, triglycerides, and cholesterol were also assessed. Differences between SGA-treated, SGA-naive, and control children were assessed by linear and log-linear regression models. Results: SGA-treated children had greater BMI z-scores and overweight/obesity (BMI ≥ 85th percentile for age and sex) and hypertension than SGA-naive and control children. The PWV geometric mean was 11.1% higher in SGA-treated (95%CI, 3.95 to 18.77) and 12.9% higher in SGA-naive children (95% CI, 5.60 to 20.59) compared to controls in models adjusted for age, sex, BMI, and systolic BP percentile. Left ventricular (LV) end-diastolic dimension/body surface area (BSA), LV end-systolic dimension/BSA, and LV ejection fraction were lower in SGA-treated and SGA-naive children compared to controls in models adjusted for sex and age. Conclusions: Children with mental disorders have greater arterial stiffness and altered cardiac structure/function than children with no mental health diagnosis. SGA treatment in children is not associated with alterations in cardiovascular structure/function.

Published
2021

43. Speaking Clearly for Older Adults With Normal Hearing: The Role of Speaking Rate

Author

Jean C. Krause and Athina Panagos Panagiotopoulos

Subjects
Male, Conversational speech, Linguistics and Language, Signal-To-Noise Ratio, Pronunciation, Intelligibility (communication), 01 natural sciences, Speech Acoustics, Language and Linguistics, 03 medical and health sciences, Speech and Hearing, 0302 clinical medicine, Hearing, 0103 physical sciences, Humans, Speech communication, 030223 otorhinolaryngology, 010301 acoustics, Aged, Speech Intelligibility, Age Factors, Middle Aged, Linguistics, Comprehension, Speaking style, Speech Perception, Female, Noise, Psychology
Abstract

Purpose Talkers typically use a slow speaking rate when producing clear speech, a speaking style that has been widely shown to improve intelligibility over conversational speech in difficult communication environments. With training, however, talkers can learn to produce a form of clear speech at normal speaking rates that provides young listeners with normal hearing much of the same intelligibility benefit. The purpose of this study was to determine if older listeners with normal hearing can also obtain an intelligibility benefit from clear speech at normal rates. Method Eight older listeners (55–68 years of age) with normal hearing were presented with nonsense sentences from 4 talkers in a background of speech-shaped noise (signal-to-noise ratio = 0 dB). Intelligibility (percent correct key words) was evaluated for conversational and clear speech produced at 2 speaking rates (normal and slow), for a total of 4 conditions: conv/normal, conv/slow, clear/normal, and clear/slow. Results As expected, the clear/slow speaking condition provided a large and robust intelligibility advantage (23 points) over conv/normal speech. The conv/slow condition provided almost as much benefit on average (21 points) but was highly variable across talkers. Notably, the clear/normal speaking condition provided the same size intelligibility advantage (14 points), previously reported for young listeners with normal hearing ( Krause & Braida, 2002 ), thus extending the benefit of clear speech at normal speaking rates to older normal-hearing listeners. Conclusions Applications based on clear/normal speech (e.g., signal processing approaches for hearing aids) have the potential to provide comparable intelligibility improvements to older and younger listeners alike.

Published
2019
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44. Muscle Type and Gender Recognition Utilising High-Level Textural Representation in Musculoskeletal Ultrasonography

Author

Panagiotis Tsiganos, Christos Theoharatos, Dimitrios Kastaniotis, George Panayiotakis, Sofoklis Katakis, Elias Panagiotopoulos, Spiros Fotopoulos, George Economou, and Nikolaos Barotsis

Subjects
Adult, Male, Acoustics and Ultrasonics, Computer science, Feature extraction, ComputingMethodologies_IMAGEPROCESSINGANDCOMPUTERVISION, Biophysics, 02 engineering and technology, Texture (music), Biceps, Field (computer science), 030218 nuclear medicine & medical imaging, Domain (software engineering), Young Adult, 03 medical and health sciences, Sex Factors, 0302 clinical medicine, Reference Values, Image Processing, Computer-Assisted, 0202 electrical engineering, electronic engineering, information engineering, Medical imaging, Feature (machine learning), Humans, Radiology, Nuclear Medicine and imaging, Muscle, Skeletal, Ultrasonography, Greece, Radiological and Ultrasound Technology, business.industry, Reproducibility of Results, Pattern recognition, Data set, Female, 020201 artificial intelligence & image processing, Artificial intelligence, business
Abstract

Human assistive technology and computer-aided diagnosis is an emerging field in the area of medical imaging. Following the recent advances in this domain, a study for integrating machine learning techniques in musculoskeletal ultrasonography images was conducted. The goal of this attempt was to investigate how feature extraction techniques, that capture higher-level information, perform in identifying human characteristics. The potential success of these techniques could lead to significant improvement of the current assessment methods—as the gray-scale image analysis—for distinguishing healthy and pathologic conditions, that are heavily dependent on the image-acquisition system. The contribution of this work is threefold. First, a new privately held data set of 74 healthy patients was presented. This data set included musculoskeletal ultrasound images from four muscles of the human body, namely the biceps brachii, tibialis anterior, gastrocnemius medialis and rectus femoris, recorded in the transverse and longitudinal plane. Second, two classification tasks were performed, namely, gender and muscle-type recognition, to assess the performance of the proposed method for successfully identifying differences in the texture of the examined muscle sections. Third, a novel method used with great success in the computer vision domain was presented, allowing the extraction of a high-level feature representation, by encoding the distribution of locally invariant texture descriptors. On the muscle-type recognition our method achieved an 87.07% classification rate, and on the task of gender recognition it surpassed state-of-the-art textural representations, reported in the literature in almost all the examined muscle sections.

Published
2019
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45. Burden of hospital admissions caused by respiratory syncytial virus (RSV) in infants in England: A data linkage modelling study

Author

Pia Hardelid, Mehdi Minaji, Rachel Reeves, Fiona Warburton, Nikolaos Panagiotopoulos, and Richard Pebody

Subjects
Male, 0301 basic medicine, Microbiology (medical), medicine.medical_specialty, viruses, 030106 microbiology, Information Storage and Retrieval, Respiratory Syncytial Virus Infections, Logistic regression, medicine.disease_cause, 03 medical and health sciences, 0302 clinical medicine, Cost of Illness, Risk Factors, Epidemiology, medicine, Humans, 030212 general & internal medicine, Data Linkage, Models, Statistical, Clinical Laboratory Techniques, business.industry, Birth Month, Infant, Newborn, Infant, medicine.disease, Hospitalization, Vaccination, Pneumonia, Logistic Models, Infectious Diseases, Respiratory syncytial virus (RSV), England, Bronchiolitis, Respiratory Syncytial Virus, Human, Emergency medicine, Female, business
Abstract

Current national estimates of respiratory syncytial virus (RSV)-associated hospital admissions are insufficiently detailed to determine optimal vaccination strategies for RSV. We employ novel methodology to estimate the burden of RSV-associated hospital admissions in infants in England, with detailed stratification by patient and clinical characteristics.We used linked, routinely collected laboratory and hospital data to identify laboratory-confirmed RSV-positive and RSV-negative respiratory hospital admissions in infants in England, then generate a predictive logistic regression model for RSV-associated admissions. We applied this model to all respiratory hospital admissions in infants in England, to estimate the national burden of RSV-associated admissions by calendar week, age in weeks and months, clinical risk group and birth month.We estimated an annual average of 20,359 (95% CI 19,236-22,028) RSV-associated admissions in infants in England from mid-2010 to mid-2012. These admissions accounted for 57,907 (95% CI 55,391-61,637) annual bed days. 55% of RSV-associated bed days and 45% of RSV-associated admissions were in infants3 months old. RSV-associated admissions peaked in infants aged 6 weeks, and those born September to November.We employed novel methodology using linked datasets to produce detailed estimates of RSV-associated admissions in infants. Our results provide essential baseline epidemiological data to inform future vaccine policy.

Published
2019
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46. Pseudoaneurysm of a segmental lumbar artery following a full-endoscopic transforaminal lumbar discectomy: a rare approach-related complication

Author

Umberto Agrillo, Konstantinos Panagiotopoulos, Roberto Gazzeri, and Antonio Bruni

Subjects
Adult, Male, medicine.medical_specialty, Abdominal pain, Percutaneous, medicine.medical_treatment, 030218 nuclear medicine & medical imaging, 03 medical and health sciences, Pseudoaneurysm, Postoperative Complications, 0302 clinical medicine, Lumbar, medicine.artery, medicine, Foramen, Humans, Diskectomy, Percutaneous, Endovascular coiling, Lumbar Vertebrae, medicine.diagnostic_test, business.industry, Endoscopy, Interventional radiology, medicine.disease, Surgery, Neurology (clinical), medicine.symptom, Tomography, X-Ray Computed, business, Aneurysm, False, Intervertebral Disc Displacement, 030217 neurology & neurosurgery, Lumbar arteries
Abstract

Full-endoscopic transforaminal lumbar discectomy is based on a puncture technique using a guide needle to reach the target area of the foramen via a percutaneous posterolateral/lateral approach. It may correlate with specific approach-related complications, as exiting nerve root injury. We report the first case of pseudoaneurysm of the lumbar segmental artery secondary to a transforaminal full-endoscopic surgery in the treatment of a lumbar herniated disc. A 39-year-old man underwent left L4-L5 full-endoscopic transforaminal lumbar discectomy for a herniated disc. Three hours after surgery, he experienced acute progressive abdominal pain. An abdomen CT scan showed contrast extravasation in the left paraspinal compartment at L4 vertebral body level. The selective left lumbar angiogram revealed a pseudoaneurysm of a side branch of the left lumbar segmental artery, which was treated by endovascular coiling. The patient made a rapid postoperative recovery without further complications and was discharged 4 days later. This report identifies a rare complication of transforaminal full-endoscopic surgery in the treatment of a herniated lumbar disc. To our knowledge this is the first case of pseudoaneurysm formation of the lumbar artery following a full-endoscopic transforaminal lumbar discectomy.

Published
2019
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47. Imiquimod 3.75% for field‐directed therapy of actinic keratosis: results of a prospective case‐series study in Greece

Author

Christina Antoniou, Alexander J. Stratigos, Vasiliki Chasapi, Vassiliki Tzanetakou, Angeliki Befon, and Antonios Panagiotopoulos

Subjects
Male, medicine.medical_specialty, Keratosis, Imiquimod, Dermatology, Administration, Cutaneous, Drug Administration Schedule, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Adjuvants, Immunologic, Report, medicine, Humans, Prospective Studies, Prospective cohort study, Aged, Skin, Subclinical infection, Aged, 80 and over, Greece, business.industry, Actinic keratosis, Middle Aged, medicine.disease, Keratosis, Actinic, Clinical trial, Treatment Outcome, Face, 030220 oncology & carcinogenesis, Cohort, Sunlight, Female, business, Reports, medicine.drug, Case series
Abstract

Background Imiquimod 3.75% is a field‐directed treatment for actinic keratosis that can detect and treat clinical and subclinical lesions across an entire sun‐exposed field. The detection of subclinical lesions is evidenced by an increase in lesions to the maximum lesion count during treatment (L max). We report clinical outcomes for the first 15 patients treated with imiquimod 3.75% in daily clinical practice in Greece. Methods Fifteen patients with actinic keratosis lesions were treated with imiquimod 3.75% in an outpatient setting in two 2‐week treatment cycles separated by a 2‐week treatment‐free interval. Actinic keratosis lesions were counted before treatment, at the end of the first treatment cycle (Week 2; L max), and 2 weeks after the second treatment cycle (Week 8). Local skin reactions (LSR) were also evaluated at Weeks 2 and 8. Results The median baseline actinic keratosis lesion count was 25, which increased to a median L max of 29 at Week 2 and decreased to a median of 5 at Week 8. The median percentage and absolute reduction in actinic keratosis lesions from L max to Week 8 were 87% and 23%, respectively. Most of the LSR were mild‐to‐moderate in intensity at Week 2 and had resolved by Week 8. Conclusion Imiquimod 3.75% effectively detected and cleared both the clinical and subclinical actinic keratosis lesions across the entire sun‐exposed field in this cohort of Greek patients. Treatment was well tolerated.

Published
2019
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48. Membrane androgen receptors (OXER1, GPRC6A AND ZIP9) in prostate and breast cancer: A comparative study of their expression

Author

Athanasios A. Panagiotopoulos, Maria Tzardi, George Notas, Efstathios N. Stathopoulos, Panayiotis A. Theodoropoulos, Eleni Moustou, Konstantina Kalyvianaki, Marilena Kampa, Panagiotis Malamos, Kostas Marias, Georgios S. Ioannidis, and Elias Castanas

Subjects
Male, G protein, medicine.drug_class, Clinical Biochemistry, Breast Neoplasms, 030209 endocrinology & metabolism, GPRC6A, Biology, Biochemistry, Receptors, G-Protein-Coupled, 03 medical and health sciences, Prostate cancer, 0302 clinical medicine, Endocrinology, Cell surface receptor, Cell Line, Tumor, medicine, Humans, Receptor, Cation Transport Proteins, Molecular Biology, G protein-coupled receptor, Pharmacology, Organic Chemistry, Prostatic Neoplasms, medicine.disease, Androgen, Immunohistochemistry, Gene Expression Regulation, Neoplastic, Androgen receptor, Receptors, Eicosanoid, 030220 oncology & carcinogenesis, Cancer research, Female
Abstract

Accumulating evidence during the last decades revealed that androgens exert membrane-initiated actions leading to the modulation of significant cellular processes, important for cancer cell growth and metastasis (including prostate and breast), that involve signaling via specific kinases. Collectively, many nonclassical, cell surface-initiated androgen actions are mediated by novel membrane androgen receptors (mARs), unrelated to nuclear androgen receptors. Recently, our group identified the G protein coupled oxo-eicosanoid receptor 1 (OXER1) (a receptor of the arachidonic acid metabolite, 5-oxoeicosatetraenoic acid, 5-oxoETE) as a novel mAR involved in the rapid effects of androgens. However, two other membrane proteins, G protein-coupled receptor family C group 6 member A (GPRC6A) and zinc transporter member 9 (ZIP9) have also been portrayed as mARs, related to the extranuclear action of androgens. In the present work, we present a comparative study of in silico pharmacology, gene expression and immunocytochemical data of the three receptors in various prostate and breast cancer cell lines. Furthermore, we analyzed the immunohistochemical expression of these receptors in human tumor and non-tumoral specimens and provide a pattern of expression and intracellular distribution.

Published
2019
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49. Retrieval of Distally Migrated Coil with Direct Aspiration Technique During Temporary Bridging Device Embolization of a Wide-Neck Supraophthalmic Aneurysm

Author

Lampros Messinis, Georgios Gatzounis, Petros Zampakis, Dimitrios Karnabatidis, and Vasileios Panagiotopoulos

Subjects
Adult, Carotid Artery Diseases, Male, Middle Cerebral Artery, medicine.medical_specialty, Bridging (networking), medicine.medical_treatment, Lumen (anatomy), 03 medical and health sciences, 0302 clinical medicine, Aneurysm, Foreign-Body Migration, Humans, Medicine, Embolization, Wide neck, business.industry, medicine.disease, Embolization, Therapeutic, Electromagnetic coil, 030220 oncology & carcinogenesis, Device Embolization, cardiovascular system, Surgery, Neurology (clinical), Radiology, business, Parent vessel, Carotid Artery, Internal, 030217 neurology & neurosurgery
Abstract

Background Dislodgement of coils during endovascular embolization of brain aneurysms is a potentially hazardous complication due to high risk for cerebral infarct and subsequent neurologic deficits or death. We describe a case of whole coil mesh dislodgement due to interaction between the coil loops and a temporary neck-bridging device struts and subsequent successful retrieval of a distally migrated coil into the left middle cerebral artery branch with direct aspiration technique. Case Description A 32-year-old man was referred to our hospital for treatment of an unruptured wide-neck supraophthalmic aneurysm of the left internal carotid artery. A temporary bridging-neck device was placed and expanded across the aneurysm neck in order to support coil deployment inside the aneurysm sac and avoid coil prolapse into the lumen of the parent vessel. Retrieval of the bridging-neck device after coil embolization resulted in whole coil mesh dislodgement due to interaction between the coil loops and the device struts and finally distal migration of a single coil into the left middle cerebral artery temporal branch. The coil was successfully retrieved using direct aspiration technique similar to thrombectomy in acute ischemic stroke. The patient did not have any neurologic deficit. Conclusions Our case indicates that first-line direct aspiration technique is an atraumatic and effective procedure for coil retrieval when dislodged even in distal cerebral vessels, minimizing the chance for additional retrieval technique-related risks. Interventionists should be aware of coil dislodgment as a potential temporary bridging-neck device related complication.

Published
2019
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50. Three Dimensional Glomerular Reconstruction: A Novel Approach to Evaluate Renal Microanatomy in Diabetic Kidney Disease

Author

Alison Skene, George Jerums, Sianna Panagiotopoulos, Richard J MacIsaac, Paul Crammer, Niloufar Torkamani, Michele V Clarke, Elif I Ekinci, and David A. Power

Subjects
Male, 0301 basic medicine, Correlation coefficient, Kidney Glomerulus, Renal function, lcsh:Medicine, Type 2 diabetes, Article, Transforming Growth Factor beta1, Mice, 03 medical and health sciences, Imaging, Three-Dimensional, 0302 clinical medicine, Microscopy, Electron, Transmission, Diabetes mellitus, Image Processing, Computer-Assisted, medicine, Albuminuria, Animals, Humans, Diabetic Nephropathies, lcsh:Science, Aged, Multidisciplinary, Diabetic kidney, business.industry, lcsh:R, Glomerular mesangium, Heart, Fibroblasts, Middle Aged, medicine.disease, Glomerular Mesangium, Mice, Inbred C57BL, 030104 developmental biology, Hyperglycemia, Female, lcsh:Q, Analysis of variance, medicine.symptom, business, 030217 neurology & neurosurgery, Glomerular Filtration Rate, Biomedical engineering
Abstract

Mesangial metrics reflect glomerular filtration surface area in diabetes. The point-sampled intercept (PSI) method is the conventional method to calculate these parameters. However, this is time consuming and subject to underestimation. We introduce a novel three-dimensional (3D) reconstruction method applicable to light microscopy to measure mesangial metrics. Transmission electron microscopy (TEM), PSI and our new 3D imaging methods were used to quantify mesangial metrics from 22 patients with type 2 diabetes, normo-, micro- and macroalbuminuria and an estimated glomerular filtration rate of 2. Repeated-measures ANOVA test was used to test the equality of the measurement means from the three methods and the degree of inter method variability. Repeated-measures and post-estimation ANOVA tests together with correlation coefficient measurements were used to compare the methods with TEM as reference. There was a statistically significant difference in mesangial volume measurements (F(2, 16) = 15.53, p = 0.0002). The PSI method underestimated measurements compared to TEM and 3D methods by 30% (p = 0.001) and 15%, respectively (p

Published
2019
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