Does COVID-19 Vaccination Warrant the Classical Principle " ofelein i mi vlaptin"?

The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic warrants an imperative necessity for effective and safe vaccination, to restrain Coronavirus disease 2019 (COVID-19) including transmissibility, morbidity, and mortality. In this regard, intensive medical and biological research leading to the development of an arsenal of vaccines, albeit incomplete preconditioned evaluation, due to emergency. The subsequent scientific gap raises some concerns in the medical community and the general public. More specifically, the accelerated vaccine development downgraded the value of necessary pre-clinical studies to elicit medium- and long-term beneficial or harmful consequences. Previous experience and pathophysiological background of coronaviruses' infections and vaccine technologies, combined with the global vaccines' application, underlined the obligation of a cautious and qualitative approach, to illuminate potential vaccination-related adverse events. Moreover, the high SARS-CoV-2 mutation potential and the already aggregated genetical alterations provoke a rational vagueness and uncertainty concerning vaccines' efficacy against dominant strains and the respective clinical immunity. This review critically summarizes existing evidence and queries regarding SARS-CoV-2 vaccines, to motivate scientists' and clinicians' interest for an optimal, individualized, and holistic management of this unprecedented pandemic

The role of perineural invasion in the prognosis and the treatment approach in patients with oral squamous cell carcinoma

Squamous cell carcinoma of the oral cavity is considered one of the most aggressive cancers and among the leading causes of mortality and morbidity worldwide. Despite the advancement in multidisciplinary treatment approach, the 5-year overall survival (OS) remains relatively low, reflecting the difficulty in achieve adequate control of the disease. As the locoregional recurrence is the main pattern of treatment failure, the best chance of reaching higher survival rates is by maximizing primary oncologic control. In an attempt to enhance the effectiveness of the initial therapeutic intervention, in conjunction with clinical parameters (TNM status), various other ongologic histopathologic features have been analyzed to determine the most appropriate therapeutic approach. Among these features, perineural invasion (PNI) has been widely recognized as an oncologic feature, strongly associated with a more aggressive tumor behavior and a poorer prognosis. The main aim of the present study is to investigate the role of PNI on loco-regional recurrence, neck management, adequate surgical margins and postoperative adjuvant treatment decisions, in patients with oral carcinoma. The diagnostic significance of the PNI-associated clinical features and their role in guiding clinical treatment decision-making was also investigated.A total of 470 consecutive patients with primary squamous cell carcinoma, were included in this retrospective study. Data collected and analyzed included patient age, sex, tumor location, TNM stage, grade of differentiation, perineural invasion (PNI), lymphatic-vascular infiltration (LVIF), resection margins, lymph node involvement, extracapsular spread (ECS), loco-regional control, and treatment modalities. The mean follow-up period was 42.7 months (range: 24 to 96 months) and was considered to be sufficient enough for detection of local or regional recurrence. Perineural invasion (PNI) was not found to be an independent prognostic factor for local recurrence (p=1.000, OR: 0.972, 95%CI: 0.311-3.039). Perineural invasion was found to be an independent prognostic factor for cervical lymph node metastasis (p= 0.005, OR =3.967, 95%CI: 1.336-12.659). Patients with neck metastasis had 3.967 times more odds to have perineural involvement. Elective neck dissection was found to significantly reduce the risk of regional recurrence in cN0 patients with PNI-positive oral SCC (p=0.026, OR=0.025, 95%CI: 0.001- 0.645). Neck observation demonstrated as an independent predictor of regional recurrence (Chi-square=10.442, df=2, p=0.005).PNI-associated clinical features (e.g. pain, otalgia, sensory disturbances of the lower lip) were found to be a strong preoperative indicator for perineural dissemination of the primary lesion (68,2% vs. 31,8%, p<0.001). Symptomatic patients were found to be at a relative higher risk of treatment failure (39.8% vs. 55.9%). Perineural invasion was not found to significantly affect the extent of surgical resection margins. Postoperative adjuvant radiotherapy (RT) was found not to significantly alter the incidence of local (p=0.445, OR=3.387, 95%CI: 0.147-77.931) or regional recurrence (p=0.319, OR=4.741, 95%CI: 0.221-101.645) in patients with PNI-positive oral SCC. In conclusion, detection of PNI is a well-recognized adverse oncologic feature, affecting treatment decisions, and should be documented in regular pathological report for oral cancer patients. Although a prospective, randomized study would be valuable in establishing the prognostic impact of PNI and the effectiveness of different treatment modalities.Το καρκίνωμα από πλακώδες επιθήλιο της στοματικής κοιλότητας θεωρείται ένας από τους πιο επιθετικούς καρκίνους και μεταξύ των κυριότερων αιτιών θνησιμότητας και νοσηρότητας από νεοπλασματικά αίτια παγκοσμίως. Ωστόσο, παρά την αναμφίβολη πρόοδο στη θεραπευτική προσέγγιση των ασθενών αυτών, η 5ετής συνολική επιβίωση παραμένει σχετικά χαμηλή, αντικατοπτρίζοντας τη δυσκολία επίτευξης επαρκούς ογκολογικού ελέγχου της νόσου. Δεδομένου ότι η τοπικοπεριοχική υποτροπή αποτελεί την κύρια αιτία αποτυχίας της θεραπείας, σε μια προσπάθεια να ενισχυθεί η αποτελεσματικότητα της αρχικής θεραπευτικής παρέμβασης, σε συνδυασμό με τις κλινικές παραμέτρους, διάφοροι ιστοπαθολογικοί δυσμενείς προγνωστικοί παράγοντες έχουν κατά καιρούς διερευνηθεί, ως προς το ρόλο τους στην αντιμετώπιση των ασθενών με καρκίνωμα της στοματικής κοιλότητας. Μεταξύ αυτών, η περινευρική διήθηση αποτελεί έναν κοινά αποδεκτό δυσμενή προγνωστικό παράγοντα, ο οποίος συνδέεται στενά με επιθετική βιολογικά συμπεριφορά του όγκου και αυξημένα ποσοστά υποτροπής της νόσου. Ο κύριος στόχος της παρούσας μελέτης είναι η διερεύνηση του ρόλου της περινευρικής διήθηση στο θεραπευτικό σχεδιασμό και την πρόγνωση των ασθενών με καρκίνωμα στοματικής κοιλότητας. Συνολικά 470 ασθενείς με πρωτοπαθές καρκίνωμα από πλακώδες επιθήλιο της στοματικής κοιλότητας, συμπεριλήφθηκαν στην παρούσα κλινική μελέτη. Τα ιατρικά δεδομένα των ασθενών ελέγχθηκαν αναδρομικά με λεπτομέρεια. Η στατιστική επεξεργασία των δεδομένων αποκάλυψε ότι η περινευρική διήθηση δεν αποτελεί ανεξάρτητο προγνωστικό παράγοντα για τον κίνδυνο εμφάνισης τοπικής υποτροπής (p=1,000, OR: 0,972, 95%CI: 0,311-3,039), ενώ ο κίνδυνος ανάπτυξης περιοχικής υποτροπής ήταν μεγαλύτερος μεταξύ των PNI-θετικών ασθενών σε σχέση με τους PNI-αρνητικούς ασθενείς (12,8% vs. 2,5%; p =0,089). H περινευρική διήθηση βρέθηκε να είναι ανεξάρτητος προγνωστικός παράγοντας για την εμφάνιση τραχηλικών λεμφαδενικών μεταστάσεων (p=0,005,OR=3,967, 95%CI:1,336– 12,659). Οι ασθενείς με θετικό για περινευρική διήθηση καρκίνωμα στόματος είχαν 3.967 φορές μεγαλύτερο κίνδυνο να εμφανίσουν λεμφαδενικές μεταστάσεις. Ο προφυλακτικός (εκλεκτικός) τραχηλικός λεμφαδενικός καθαρισμός, βρέθηκε να μειώνει στατιστικώς σημαντικά τον κίνδυνο εμφάνισης περιοχικής υποτροπής (p=0,026, OR=0,025, 95%CI:0,001-0,645). Η μη εφαρμογή προφυλακτικού λεμφαδενικού καθαρισμού σε ασθενείς με θετικό για περινευρική διήθηση καρκίνωμα από πλακώδες επιθήλιο στόματος, βρέθηκε να είναι ανεξάρτητος προγνωστικός παράγοντας για την εμφάνιση περιοχικής υποτροπής (Chi-square=10,442, df=2, p=0,005). Ασθενείς με καρκίνωμα από πλακώδες επιθήλιο της στοματικής κοιλότητας, οι οποίοι εμφανίζουν προεγχειρητικά κλινικά σημεία ή συμπτώματα περινευρικής διήθησης (όπως άλγος, παραισθησία, υπαισθησία), βρίσκονται σε στατιστικά σημαντικό κίνδυνο ύπαρξης περινευρικής διασποράς του όγκου (p<0,001). Η περινευρική διήθηση δε βρέθηκε να επηρεάζει στατιστικώς σημαντικά τη 5-ετή συνολική επιβίωση (p=0,501) και τον κίνδυνο εμφάνισης τοπικής (p=0,491) ή περιοχικής (p=0,106) υποτροπής σε σχέση με το εύρος των χειρουργικών ορίων εκτομής. Η εφαρμογή συμπληρωματικής μεταγχειρητικής θεραπείας σε ασθενείς με περινευρική διήθηση, δε βρέθηκε να μειώνει στατιστικώς σημαντικά τον κίνδυνο εμφάνισης τοπικής (p=0,445, OR=3,387, 95%CI: 0,147–77,931) ή περιοχικής (p=0,319, OR=4,741, 95%CI:0,221–101,645) υποτροπής. Συμπερασματικά, η περινευρική διήθηση αποτελεί έναν ισχυρό δυσμενή ογκολογικό προγνωστικό παράγοντα για το καρκίνωμα από πλακώδες επιθήλιο της στοματικής κοιλότητας, ο οποίος παίζει σημαντικό ρόλο στη λήψη θεραπευτικών αποφάσεων. Η διενέργεια μιας πολυκλινικής, προοπτικής, τυχαιοποιημένης μελέτης με αντικείμενο την περινευρική διήθηση θα οδηγούσε σε πολύτιμα συμπεράσματα για την αντιμετώτων ασθενών με καρκίνωμα από πλακώδες επιθήλιο της στοματικής κοιλότητας

Update on Diagnosis and Treatment of Uveitic Glaucoma

Glaucoma is a common and potentially blinding complication of uveitis. Many mechanisms are involved alone or in combination in the pathogenesis of uveitic glaucoma (UG). In terms of diagnostic evaluation, the effects of inflammatory activity in the retinal nerve fiber layer may be a source of bias in the interpretation of optical coherence tomography measurements. For the successful treatment of UG, the control of intraocular inflammation specific to the cause or anti-inflammatory treatment, combined with IOP management, is mandatory. The early institution of specific treatment improves the prognosis of UG associated with CMV. The young age of UG patients along with increased failure rates of glaucoma surgery in this group of patients warrants a stepwise approach. Conservative and conjunctival sparing surgical approaches should be adopted. Minimally invasive surgical approaches were proved to be effective and are increasingly being used in the management of UG along with the traditionally used techniques of trabeculectomy or tubes. This review aims to summarize the progress that recently occurred in the diagnosis and treatment of UG

Subconjunctival orbital fat prolapse and thyroid associated orbitopathy: a clinical association

Background: Thyroid associated orbitopathy (TAO) comprises a spectrum of well-recognized clinical signs including exophthalmos, eyelid retraction, soft tissue swelling, ocular misalignment, keratopathy as well as a number of less common manifestations. Subconjunctival fat prolapse is a rare clinical condition occurring typically spontaneously in elderly patients with a mean age of 65-72 years. We describe subconjunctival prolapse of orbital fat as an uncommon clinical association of TAO. Materials and methods: Observational study of six patients presenting with a subconjunctival protrusion under the lateral canthus in a series of 198 consecutive cases with TAO examined at a tertiary care referral center. Results: A superotemporally located yellowish, very soft, freely mobile subconjunctival protrusion developed unilaterally in two and bilaterally in four patients with TAO (incidence 3.03%). It was one of the presenting manifestations of TAO in four of ten eyes studied and incited the diagnostic work-up for TAO in two of six patients in this series. Magnetic resonance imaging of the orbit indicated fat density in continuity with intraorbital fat in the area of protrusion. A male to female preponderance of 4: 2 and an advanced mean age at onset of TAO is noteworthy for these six patients compared to the pool of 192 patients (64.8 versus 51.8 years, respectively, P=0.003) not bearing this sign. Conclusion: Subconjunctival orbital fat prolapse, a clinically impressive age-related ocular lesion, may occasionally predominate amid other clinical manifestations of TAO. It is a nonspecific sign developing most commonly among patients with a relatively advanced age at presentation. Awareness of this association may alert to the diagnosis of thyroid orbitopathy and reassure the patient and physician as to the benign character of the lesion

Elucidating Carfilzomib’s Induced Cardiotoxicity in an In Vivo Model of Aging: Prophylactic Potential of Metformin

Background: Carfilzomib is a first-line proteasome inhibitor indicated for relapsed/refractory multiple myeloma (MM), with its clinical use being hampered by cardiotoxic phenomena. We have previously established a translational model of carfilzomib cardiotoxicity in young adult mice, in which metformin emerged as a prophylactic therapy. Considering that MM is an elderly disease and that age is an independent risk factor for cardiotoxicity, herein, we sought to validate carfilzomib’s cardiotoxicity in an in vivo model of aging. Methods: Aged mice underwent the translational two- and four-dose protocols without and with metformin. Mice underwent echocardiography and were subsequently sacrificed for molecular analyses in the blood and cardiac tissue. Results: Carfilzomib decreased proteasomal activity both in PBMCs and myocardium in both protocols. Carfilzomib induced mild cardiotoxicity after two doses and more pronounced cardiomyopathy in the four-dose protocol, while metformin maintained cardiac function. Carfilzomib led to an increased Bip expression and decreased AMPKα phosphorylation, while metformin coadministration partially decreased Bip expression and induced AMPKα phosphorylation, leading to enhanced myocardial LC3B-dependent autophagy. Conclusion: Carfilzomib induced cardiotoxicity in aged mice, an effect significantly reversed by metformin. The latter possesses translational importance as it further supports the clinical use of metformin as a potent prophylactic therapy

Autonomous robots, drones and repeaters for fast, reliable, low-cost RFID inventorying & localization

Summarization: This paper presents our latest results of our prototype robots and drones, aiming continuous inventorying and accurate real-time 3D localization of RFID tagged items. We have designed and constructed two ground robots, capable of autonomous inventorying in unknown regions, exploiting state-of-the-art methods from the field of robotics and RF-localization. Furthermore, we present our prototype drone, also capable of 3D inventorying and localization. In addition, we demonstrate the performance of our prototype RFID repeater, which also boosts the read-range of traditional RFID technology. The results of measurements campaigns conducted in different environments for the above prototypes are presented herein.Παρουσιάστηκε στο: 2021 6th International Conference on Smart and Sustainable Technologie