Pancreatic Pseudocyst

Pancreatic pseudocysts frequently occur in the context of acute or chronic pancreatitis and seldom appear as a post-surgical outcome or trauma. Complicated pancreatic pseudocysts represent extremely rare entities but still life-threatening situations, including infection, hemorrhage, rupture, pseudoaneurysms, pancreatic fistulas, obstructions, and splenic complications. Premature diagnosis, based on transabdominal ultrasonography or computed tomography, is crucial for the early therapeutic approach. Conservative treatment, surgical and endoscopic intervention consist the therapeutic options. Thus, management of the complicated pseudocysts demands a multidisciplinary team eligible to cope with complications that might even occur due to the intervention. Pancreatic pseudocysts represent a challenge for clinical doctors

Cushing's syndrome in pregnancy: a review of reported cases

Cushing’s syndrome (CS) causes hypogonadotropic hypogonadism and anovulatory infertility due to hypercortisolism, and it is very rare in pregnancy. CS in pregnancy is associated with important maternal-foetal morbidity and mortality, such as preeclampsia and premature delivery. A systematic search was conducted in the MEDLINE library to retrieve articles reporting cases of CS in pregnant women, during the period between 2010 and 2020.Thirty-five reported cases are presented focusing on the ability of diagnosis, treatment therapies, and foetal outcomes. Diagnosis of CS during pregnancy can be challenging and is often delayed, adrenal adenoma being the predominant cause. Both medical treatment and surgery aiming at restoring the cortisol balance reduce maternal and foetal complications

Association between smoking cessation and alterations in forced expiratory volume in one second (FEV1). A Follow-Up Study from a Greek Tobacco Cessation Clinic

Background: Cigarette smoking is the most important preventable cause of several diseases such as malignancies, pulmonary and cardiovascular diseases. Smoking cessation is now supported by both behavioral counseling and medical pharmacotherapy and is the only effective approach for slowing down an accelerated decline in forced expiratory volume in one second (FEV1). Our study aims to examine changes in forced expiratory volume in one second (FEV1) after smoking cessation for smokers attending our smoking cessation clinic their correlation to smokers’ demographic characteristics.Methods: 114 smokers (48 males and 66 females), with a mean age of 48.36±10.49 years, were enrolled. They were classified in 4 groups, according to their age; 60 years (Group D) and underwent Spirometry on the 1st day of visit, one month (2nd visit) and, 3 months later (3rd visit).Findings: Statistically significant increase in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was observed in smokers who quit smoking in Group Α, B and C (p<0.05). In addition, a statistically significant decrease in FEV1 values at the 2nd and 3rd visit compared to the 1st visit was noticed in smokers who continued smoking in Group B, C and D (p<0.05).Conclusion: Smoking cessation achieved through smoking cessation support led to the improvement of FEV1 values within 3 months. The greatest benefit was observed in smokers under the age of 60

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Investigational Drug Treatments for Triple-Negative Breast Cancer

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) and accounts for 10–20% of cases. Due to the lack of expression of several receptors, hormone therapy is largely ineffective for treatment purposes. Nevertheless, TNBC often responds very well to chemotherapy, which constitutes the most often recommended treatment. New beneficial targeted therapies are important to be investigated in order to achieve enhanced outcomes in patients with TNBC. This review will focus on recent therapeutic innovations for TNBC, focusing on various inhibitors such as phosphoinositide 3-kinase (PI3K) pathway inhibitors, poly-ADP-ribosyl polymerase (PARP) inhibitors, aurora kinase inhibitors, histone deacetylase inhibitors (HDACIs), and immune checkpoint inhibitors

Histone deacetylase inhibitors in pancreatic cancer

Introduction: Acetylation and deacetylation of histones are important mechanisms of epigenetic transcriptional regulation, which are regulated by histone acetyltransferases (HAT) and histone deacetylases (HDAC), respectively. These enzymes regulate the expression of genes controlling cell proliferation, differentiation and apoptosis. Enhanced activity of HDAC results in suppression of cell proliferation, migration and metastasis and induction of cell cycle arrest and apoptosis. We tried to assess the expression of HDAC-1, -2, -4 and -6 in pancreatic cancer. Patients and methods: Formalin-fixed, paraffin-embedded tissue specimens were obtained from 70 patients with pancreatic adenocarcinoma who underwent surgical resection without previous treatment. We assessed the expression of HDAC-1, -2, -4 and -6 by estimating the immunohistochemical staining for these proteins using polyclonal and monoclonal IgG antibodies against them. The results were associated with patients’ clinicopathological parameters and survival. Results: The distribution of HDAC-1 and HDAC-2 was nuclear and of HDAC-4 and HDAC-6 cytoplasmic. Expression of HDAC-1, -2, -4 and -6 was detected in 64.3%, 74.2%, 69.1% and 63.1% of malignant tissues, respectively, whereas no expression was found in non-neoplastic tissues. High levels of HDAC-1, -2, -4 and -6 were detected in 40%, 50%, 48.6% and 44.3% of cases, respectively. High HDAC-1 expression was associated with increased proliferation of malignant cells, but also with longer survival. Increased HDAC-4 levels were related to the absence of distant metastases. High HDAC-6 expression was associated with earlier stages of disease and longer survival. Conclusions: Elevated HDAC expression is associated with favorable clinicopathological parameters and better prognosis. These findings implicate a role of HDAC in the biological mechanisms of pancreatic cancer, rendering them potential therapeutic targets for this malignant disease in the future. More studies are needed towards this direction.Εισαγωγή: Η ακετυλίωση και αποακετυλίωση των ιστονών αποτελούν σημαντικούς μηχανισμούς της επιγενετικής μεταγραφικής ρύθμισης, οι οποίοι ρυθμίζονται από τις ακετυλοτρανσφεράσες (HAT) και τις αποακετυλάσες (HDAC) των ιστονών, αντίστοιχα. Αυτά τα ένζυμα ρυθμίζουν την έκφραση γονιδίων που ελέγχουν τον κυτταρικό πολλαπλασιασμό, τη διαφοροποίηση και την απόπτωση. Αυξημένη δραστηριότητα των HDAC οδηγεί στην καταπίεση της μεταγραφής γονιδίων που σχετίζονται με τη διαφοροποίηση και την αρνητική ρύθμιση του κυτταρικού πολλαπλασιασμού, της κυτταρικής μετανάστευσης και της μετάστασης. Στην παρούσα μελέτη, εκτιμήθηκε η έκφραση των HDAC-1, -2, -4 και -6 σε καρκίνο του παγκρέατος. Ασθενείς και μέθοδοι: Δείγματα ιστών που ελήφθησαν από 70 ασθενείς με αδενοκαρκίνωμα παγκρέατος οι οποίοι υπεβλήθησαν σε χειρουργική εκτομή χωρίς προηγούμενη αντικαρκινική αγωγή, μονιμοποιήθηκαν με διάλυμα φορμόλης και εγκλείσθηκαν σε παραφίνη. Εκτιμήσαμε την έκφραση των HDAC-1, -2, -4 και -6 με αξιολόγηση της ανοσοϊστοχημικής χρώσης για αυτές τις πρωτεΐνες χρησιμοποιώντας πολυκλωνικά και μονοκλωνικά αντισώματα IgG έναντι αυτών. Τα αποτελέσματα συσχετίσθηκαν με κλινικο-εργαστηριακές παραμέτρους και την επιβίωση των ασθενών. Αποτελέσματα: Η κατανομή των HDAC-1 και HDAC-2 ήταν στον πυρήνα ενώ των HDAC-4 και HDAC-6 στο κυτταρόπλασμα. Έκφραση των HDAC-1, -2, -4 και -6 ανευρέθη στο 64,3%, 74,2%, 69,1% και 63,1% των κακοηθών ιστών, αντίστοιχα, ενώ δεν παρατηρήθηκε σε μη νεοπλασματικούς ιστούς. Υψηλά επίπεδα HDAC-1, -2, -4 και -6 ανιχνεύθηκαν σε 40%, 50%, 48,6% και 44,3% των περιπτώσεων, αντιστοίχως. Υψηλά επίπεδα έκφρασης της HDAC-1 συσχετίσθηκαν με αυξημένο πολλαπλασιασμό των κακοήθων κυττάρων αλλά και με μεγαλύτερη επιβίωση. Αυξημένη έκφραση της HDAC-4 σχετίζεται με την απουσία απομακρυσμένων μεταστάσεων. Υψηλή έκφραση της HDAC-6 συσχετίστηκε με πρώιμα στάδια της νόσου και μεγαλύτερης διάρκειας επιβίωση. Συμπεράσματα: Αυξημένη έκφραση των HDAC συσχετίσθηκε με ευνοϊκές κλινικο-εργαστηριακές παραμέτρους και καλύτερη πρόγνωση. Αυτά τα ευρήματα αποδίδουν στους HDAC ένα ρόλο στους βιολογικούς μηχανισμούς του καρκίνου του παγκρέατος, καθιστώντας τους πιθανούς θεραπευτικούς στόχους για αυτή την κακοήθη ασθένεια στο μέλλον. Ωστόσο, απαιτούνται περισσότερες μελέτες προς αυτή την κατεύθυνση

BRCA 1, 2 mutation and earlier menopause. Could BRCA 1, 2 be used as predictor of menopause?

Many studies have shown that BRCA mutation is not only related to cancer but also to ovarian aging. Studies in both human and mice oocytes have shown that Double-strand breaks (DSBs) accumulate with age. Genome-wide association studies (GWAS) have found 44 genetic loci that are related to variations when a female is about to have menopause. BRCA1 is involved in these 44 loci that are associated with the age of menopause. This review has gathered all results of literature search about the association between BRCA genes and early menopause. The majority of the articles found that women with BRCA mutation have earlier menopause compared to non-carriers. In conclusion, in the near future BRCA1,2 genes could be used as predictive biomarkers of menopause

Cone beam computed tomography imaging as a diagnostic tool in determining root fracture in endodontically treated teeth

Introduction: Vertical root fractures (VRFs) of endodontically treated teeth are serious complications that are associated with a poor survival prognosis. The diagnosis of VRFs is difficult, because the clinical signs and symptoms are often obscure and periapical radiographs (PAs) provide limited diagnostic information. Recently, Cone Beam Computed Tomography (CBCT) has been used to address complicated cases of VRFs with an inconclusive diagnosis. Aim: To determine the clinical diagnostic accuracy of CBCT in detecting VRFs in complex failing cases of endodontically treated teeth, as an adjunct to PAs. Materials and Methods: Evaluating the diagnostic accuracy of CBCT in a series of clinical cases of suspected VRFs, presented via clinical photographs, PAs, and CBCT images. Results: CBCT imaging significantly aided the differential diagnosis in most cases. Conclusions: CBCT imaging provides a 3D image and information in many cases of VRF that 2-dimensional PAs fail to generate. The slice thickness and interslice interval of the CBCT image influence the perception of the normal anatomy and pathoses