Καταγραφή Διαδρομής Πεζών: Ερευνητικές Προκλήσεις & Ανάπτυξη Mobile Εφαρμογής

Η τεχνολογική πρόοδος των τελευταίων ετών έχει καταστήσει τις συσκευές γεωγραφικού προσδιορισμού υπερβολικά προσιτές έως και αυτονόητες στα χέρια κάθε απλού πολίτη. Η καταγραφή διαδρομών με τη χρήση αυτών των συσκευών είναι μια διαδικασία εξαιρετικά χρήσιμη σε μεγάλο εύρος επιστημονικών κλάδων (από τη ζωολογία μέχρι την επιστήμη των συγκοινωνιολόγων) και αναμφισβήτητα έχει αποκτήσει πολλές εμπορικές εφαρμογές. Ωστόσο, η καταγραφή διαδρομών με συσκευές γεωγραφικού εντοπισμού δεν είναι απλή υπόθεση και παρουσιάζει αρκετές ερευνητικές και τεχνολογικές προκλήσεις. Στην παρούσα εργασία, επικεντρωνόμαστε στις διαδρομές πεζών οι οποίες παρουσιάζουν τις δικές τους ιδιαιτερότητες και ξεχωριστή κινητική συμπεριφορά. Παρουσιάζουμε τις βέλτιστες στρατηγικές περιορισμού των σφαλμάτων καταγραφής και τεχνικές εξομάλυνσης της διαδρομής όπως μελετήθηκαν από την βιβλιογραφία. Στην συνέχεια, προχωρούμε στην ανάπτυξη μίας mobile εφαρμογής καταγραφής διαδρομών ώστε να πραγματοποιήσουμε την δική μας πειραματική μελέτη των τεχνικών. Στα πλαίσια της ανάπτυξης, αναλύουμε και αιτιολογούμε τις κυριότερες σχεδιαστικές και τεχνικές αποφάσεις που λάβαμε και τελικά πραγματοποιούμε τις πειραματικές καταγραφές και παρουσιάζουμε τα αποτελέσματα και τα τελικά συμπεράσματα.Latest technological advancements have made geolocation devices easily accessible to the hands of every citizen. Route recording using these devices has been extremely helpful for a wide range of scientific fields (from zoology to transportation science) and it has been widely used in the industry. Nevertheless, route recording with geolocation devices is not a simple process and it introduces several research and technological challenges. In this study, we focus on routes by pedestrians and their own patterns and behavior. We present the best strategies for limiting errors in the recording and the best techniques for smoothing the resulting routes as they appear in scientific papers. In the next step, we develop our own mobile application for recording routes in order to proceed to our own experimental study of the best strategies and techniques. Along this journey, we analyze and justify the most critical technical decisions taken during the design and development of the application and we finally carry out our own experimental recordings, we present the results and draw our conclusions

Brace technology thematic series: the dynamic derotation brace

<p>Abstract</p> <p>Background</p> <p>The dynamic derotation brace (DDB) was designed in Greece in 1982, as a modification of the Boston brace. It is a custom-made, underarm spinal orthosis featuring aluminium blades set to produce derotating and anti-rotating effects on the thorax and trunk of patients with scoliosis. It is indicated for the non-operative correction of most curves, barring the very high thoracic ones, (when the apex vertebra is T5 or above). The purpose of this article is to familiarize physicians with the DDB, analyze the rationale behind its design, and present the published results of its application.</p> <p>Description & Principles</p> <p>The key feature of the DDB is the addition of the aluminium-made derotating blades posteriorly. These function as a force couple, which is added to the side forces exerted by the brace itself. Corrective forces are also directed through pads. One or more of previously proposed pathomechanical models of scoliosis may underline the corrective function of the DDB: it may act directly on the apical intervertebral disc, effecting correction through the Heuter-Volkman principle; the blades may produce an anti-rotatory element against the deforming "spiral composite muscle trunk rotator"; or it may alter the neuro-motor response by constantly providing new somatosensory input to the patient.</p> <p>Results</p> <p>Based on measurements of the Cobb and Perdriolle angles, up to 82% of patients remained stable or improved with the use of the DDB. Results have varied, though, depending on the type/location of the deformity. The overall results showed that 35% of the curves improved, 46% remained stable and 18% became worse, as assessed by measuring the Cobb angle. The DDB has also been shown to improve cosmesis (except for right thoracic curves) and leave several aspects of patient quality of life unaffected during use.</p> <p>Conclusion</p> <p>Conservative treatment of idiopathic scoliosis using the DDB has shown favorable results. Thoracic curves appear more resistant to both angular and rotatory correction. The published outcome data on the DDB support our belief that the incorporation of aluminium blades to other orthoses would likely improve their efficacy.</p

Aromatase Inhibitor-Associated Tendinopathy and Muscle Tendon Rupture: Report of Three Cases of This Exceedingly Rare Adverse Event

Aromatase inhibitors (AIs) are a commonly used antihormonal therapy in the treatment of breast cancer in postmenopausal women, specifically in the treatment of hormone receptor-positive breast cancer. AI-associated tendinopathy and muscle tendon rupture is exceedingly rare. Until now, only one case with AI-associated severe tendinopathy has been reported in the medical literature, and there are no recorded cases of AI-associated muscle tendon rapture. We report three cases of postmenopausal women with hormone receptor-positive breast cancer, who experienced tendinopathy or muscle tendon rupture under antihormonal treatment with letrozole. All of the three women were in the adjuvant setting, and the treatment of tendinopathy or tendon rupture consisted of AI discontinuation, initiation of corticosteroids, or surgical treatment. Diagnosis was made via MRI. Furthermore, in our cases, there were no signs of underlying systemic disease, there was no abnormal physical activity preceding the complaints, and there was no use of other drugs beside letrozole. AIs are one of the most commonly used drugs in antihormonal therapy for hormone receptor-positive breast cancer. In every case of a female patient with hormone receptor-positive breast cancer under treatment with AIs and arthralgia, an MRI should be performed in order to exclude the presence of tendinopathy or muscle tendon rupture

A Systematic Review of the Efficacy and Toxicity of Brachytherapy Boost Combined with External Beam Radiotherapy for Nonmetastatic Prostate Cancer

CONTEXT: The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain.OBJECTIVE: To perform a systematic review to determine the benefits and harms of EBRT-BT.EVIDENCE ACQUISITION: Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT ± androgen deprivation therapy (ADT) and/or radical prostatectomy (RP) ± postoperative radiotherapy (RP ± EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs).EVIDENCE SYNTHESIS: Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p &lt; 0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p = 0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p = 0.4). Fewer studies examined RP ± EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs.CONCLUSIONS: EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control.PATIENT SUMMARY: We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear.</p

A Systematic Review of the Efficacy and Toxicity of Brachytherapy Boost Combined with External Beam Radiotherapy for Nonmetastatic Prostate Cancer

CONTEXT: The optimum use of brachytherapy (BT) combined with external beam radiotherapy (EBRT) for localised/locally advanced prostate cancer (PCa) remains uncertain.OBJECTIVE: To perform a systematic review to determine the benefits and harms of EBRT-BT.EVIDENCE ACQUISITION: Ovid MEDLINE, Embase, and EBM Reviews-Cochrane Central Register of Controlled Trials databases were systematically searched for studies published between January 1, 2000 and June 7, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Eligible studies compared low- or high-dose-rate EBRT-BT against EBRT ± androgen deprivation therapy (ADT) and/or radical prostatectomy (RP) ± postoperative radiotherapy (RP ± EBRT). The main outcomes were biochemical progression-free survival (bPFS), severe late genitourinary (GU)/gastrointestinal toxicity, metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS), at/beyond 5 yr. Risk of bias was assessed and confounding assessment was performed. A meta-analysis was performed for randomised controlled trials (RCTs).EVIDENCE SYNTHESIS: Seventy-three studies were included (two RCTs, seven prospective studies, and 64 retrospective studies). Most studies included participants with intermediate-or high-risk PCa. Most studies, including both RCTs, used ADT with EBRT-BT. Generally, EBRT-BT was associated with improved bPFS compared with EBRT, but similar MFS, CSS, and OS. A meta-analysis of the two RCTs showed superior bPFS with EBRT-BT (estimated fixed-effect hazard ratio [HR] 0.54 [95% confidence interval {CI} 0.40-0.72], p &lt; 0.001), with absolute improvements in bPFS at 5-6 yr of 4.9-16%. However, no difference was seen for MFS (HR 0.84 [95% CI 0.53-1.28], p = 0.4) or OS (HR 0.87 [95% CI 0.63-1.19], p = 0.4). Fewer studies examined RP ± EBRT. There is an increased risk of severe late GU toxicity, especially with low-dose-rate EBRT-BT, with some evidence of increased prevalence of severe GU toxicity at 5-6 yr of 6.4-7% across the two RCTs.CONCLUSIONS: EBRT-BT can be considered for unfavourable intermediate/high-risk localised/locally advanced PCa in patients with good urinary function, although the strength of this recommendation based on the European Association of Urology guideline methodology is weak given that it is based on improvements in biochemical control.PATIENT SUMMARY: We found good evidence that radiotherapy combined with brachytherapy keeps prostate cancer controlled for longer, but it could lead to worse urinary side effects than radiotherapy without brachytherapy, and its impact on cancer spread and patient survival is less clear.</p

Systematic Review of Active Surveillance for Clinically Localised Prostate Cancer to Develop Recommendations Regarding Inclusion of Intermediate-risk Disease, Biopsy Characteristics at Inclusion and Monitoring, and Surveillance Repeat Biopsy Strategy

none38siContext: There is uncertainty regarding the most appropriate criteria for recruitment, monitoring, and reclassification in active surveillance (AS) protocols for localised prostate cancer (PCa). Objective: To perform a qualitative systematic review (SR) to issue recommendations regarding inclusion of intermediate-risk disease, biopsy characteristics at inclusion and monitoring, and repeat biopsy strategy. Evidence acquisition: A protocol-driven, Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-adhering SR incorporating AS protocols published from January 1990 to October 2020 was performed. The main outcomes were criteria for inclusion of intermediate-risk disease, monitoring, reclassification, and repeat biopsy strategies (per protocol and/or triggered). Clinical effectiveness data were not assessed. Evidence synthesis: Of the 17 011 articles identified, 333 studies incorporating 375 AS protocols, recruiting 264 852 patients, were included. Only a minority of protocols included the use of magnetic resonance imaging (MRI) for recruitment (n = 17), follow-up (n = 47), and reclassification (n = 26). More than 50% of protocols included patients with intermediate or high-risk disease, whilst 44.1% of protocols excluded low-risk patients with more than three positive cores, and 39% of protocols excluded patients with core involvement (CI) >50% per core. Of the protocols, ≥80% mandated a confirmatory transrectal ultrasound biopsy; 72% (n = 189) of protocols mandated per-protocol repeat biopsies, with 20% performing this annually and 25% every 2 yr. Only 27 protocols (10.3%) mandated triggered biopsies, with 74% of these protocols defining progression or changes on MRI as triggers for repeat biopsy. Conclusions: For AS protocols in which the use of MRI is not mandatory or absent, we recommend the following: (1) AS can be considered in patients with low-volume International Society of Urological Pathology (ISUP) grade 2 (three or fewer positive cores and cancer involvement ≤50% CI per core) or another single element of intermediate-risk disease, and patients with ISUP 3 should be excluded; (2) per-protocol confirmatory prostate biopsies should be performed within 2 yr, and per-protocol surveillance repeat biopsies should be performed at least once every 3 yr for the first 10 yr; and (3) for patients with low-volume, low-risk disease at recruitment, if repeat systematic biopsies reveal more than three positive cores or maximum CI >50% per core, they should be monitored closely for evidence of adverse features (eg, upgrading); patients with ISUP 2 disease with increased core positivity and/or CI to similar thresholds should be reclassified. Patient summary: We examined the literature to issue new recommendations on active surveillance (AS) for managing localised prostate cancer. The recommendations include setting criteria for including men with more aggressive disease (intermediate-risk disease), setting thresholds for close monitoring of men with low-risk but more extensive disease, and determining when to perform repeat biopsies (within 2 yr and 3 yearly thereafter).noneWillemse, Peter-Paul M; Davis, Niall F; Grivas, Nikolaos; Zattoni, Fabio; Lardas, Michael; Briers, Erik; Cumberbatch, Marcus G; De Santis, Maria; Dell'Oglio, Paolo; Donaldson, James F; Fossati, Nicola; Gandaglia, Giorgio; Gillessen, Silke; Grummet, Jeremy P; Henry, Ann M; Liew, Matthew; MacLennan, Steven; Mason, Malcolm D; Moris, Lisa; Plass, Karin; O'Hanlon, Shane; Omar, Muhammad Imran; Oprea-Lager, Daniela E; Pang, Karl H; Paterson, Catherine C; Ploussard, Guillaume; Rouvière, Olivier; Schoots, Ivo G; Tilki, Derya; van den Bergh, Roderick C N; Van den Broeck, Thomas; van der Kwast, Theodorus H; van der Poel, Henk G; Wiegel, Thomas; Yuan, Cathy Yuhong; Cornford, Philip; Mottet, Nicolas; Lam, Thomas B LWillemse, Peter-Paul M; Davis, Niall F; Grivas, Nikolaos; Zattoni, Fabio; Lardas, Michael; Briers, Erik; Cumberbatch, Marcus G; De Santis, Maria; Dell'Oglio, Paolo; Donaldson, James F; Fossati, Nicola; Gandaglia, Giorgio; Gillessen, Silke; Grummet, Jeremy P; Henry, Ann M; Liew, Matthew; Maclennan, Steven; Mason, Malcolm D; Moris, Lisa; Plass, Karin; O'Hanlon, Shane; Omar, Muhammad Imran; Oprea-Lager, Daniela E; Pang, Karl H; Paterson, Catherine C; Ploussard, Guillaume; Rouvière, Olivier; Schoots, Ivo G; Tilki, Derya; van den Bergh, Roderick C N; Van den Broeck, Thomas; van der Kwast, Theodorus H; van der Poel, Henk G; Wiegel, Thomas; Yuan, Cathy Yuhong; Cornford, Philip; Mottet, Nicolas; Lam, Thomas B

Immunohistochemical study of angiogenesis in benign prostatic hyperplasia, prostatic intraepithelial neoplasia and prostate cancer

PURPOSE: Vascular endothelial factor (VEGF) and its receptors (VEGFR-1, VEGFR-2) play a critical role in angiogenesis. Microvascular density (MVD) contributes to the quantification of angiogenesis. MVD is better evaluated with the newly proposed marker endoglin (CD105), a protein considered to have important prognostic value. Purpose of this study was to evaluate and compare angiogenesis in benign prostate hyperplasia (BPH), high grade prostatic intraepithelial neoplasia (HGPIN) and prostate cancer (Pca). Additionally, we investigated possible correlations between the expression of the angiogenic markers and specific pathological parameters of PCa. METHODS: The study was retrospective and included 39, 12 and 51 samples of BPH, HGPIN and PCa, respectively. In each sample, immuno-histochemical methods were applied in order to evaluate the expression of VEGF and its receptors. Additionally, MVD was assessed, using CD105 as angiogenic marker. In Pca samples, we recorded stage, differentiation, perineural invasion and adjuvant radiotherapy and theirs correlation with VEGF, VEGFR-1, VEGFR-2 and CD105. RESULTS: Evaluation of VEGF, VEGFR-1 and VEGFR-2 expression led to the conclusion that angiogenesis is significant higher in PCa compared to BPH (p=0,00, p=0,00 and p=0,00, respectively) and HGPIN (p=0,00, p=0,00 and p=0,04, respectively), while there was no statistically significant difference between BPH and HGPIN (p=1,000, p=0,981 and p=0,492, respectively). VEGFR-2 was the receptor with the strongest expression, while the expression of VEGFR-2 was associated with overexpression of VEGF (p=0,032) and VEGFR-1 (p=0,015). In BPH, expression of VEGFR-1 and VEGFR-2 was significantly correlated (p=0,032). MVD was significantly higher in PCa compared to BPH (p=0,000) and HGPIN (p=0,002), while there was no statistically significant difference between BPH and HGPIN (p=0,952). CD105 was strongly expressed primarily in intratumoral blood vessels while mesenchymal-inflammatory cells and normal vessels were always negative for CD105. Additionally, positive correlation was observed between VEGF overexpression and high MVD (p=0,052). VEGF and CD105 were also found to be significant prognostic markers of PCa. We observed correlation of these markers with adverse pathologic parameters such as poor differentiation (p=0,044 and p=0,038, respectively) and perineural invasion (p=0,002 and p=0,019, respectively) while overexpression of VEGF was associated with advanced pathological stage (p=0,047). CONCLUSIONS: In conclusion, angiogenesis was significantly higher in PCa compared to BPH and HGPIN, while there was no difference between BPH and HGPIN. Its role is crucial regarding survival and metastasis of tumor cells and it could play significant role as prognostic indicator in these patients. Pharmaceutical inhibition of angiogenesis will presumably be a valuable therapeutic option for PCa patients in the near future.ΣΚΟΠΟΣ: Στην διαδικασία της αγγειογένεσης ο αγγειακός ενδοθηλιακός παράγοντας (VEGF) και οι υποδοχείς του (VEGFR-1, VEGFR-2) κατέχουν κεντρικό ρόλο, ενώ η μικροαγγειακή πυκνότητα (MVD) όπως αυτή αξιολογείται με τη βοήθεια της ενδογλίνης (CD105) θεωρείται ότι έχει σπουδαία προγνωστική αξία. Σκοπός της παρούσας διατριβής ήταν η αξιολόγηση της αγγειογένεσης στην υπερπλασία, την υψηλόβαθμη προστατική ενδοεπιθηλιακή νεοπλασία (HGPIN) και το καρκίνωμα του προστάτη καθώς και η αναζήτηση πιθανής συσχέτισης μεταξύ των αγγειογενετικών δεικτών και συγκεκριμένων κλινικών και παθολογοανατομικών παραμέτρων του καρκίνου του προστάτη. ΜΕΘΟΔΟΛΟΓΙΑ: Η παρούσα μελέτη ήταν αναδρομική. Επιλέχθηκαν 39, 12 και 51 δείγματα υπερπλασίας, HGPIN και καρκινώματος, αντίστοιχα. Με τη βοήθεια ανοσοϊστοχημικών μεθόδων αξιολογήθηκε η έκφραση του VEGF και των υποδοχέων του (VEGFR-1, VEGFR-2). Επιπλέον προσδιορίστηκε η μικροαγγειακή πυκνότητα, χρησιμοποιώντας ως δείκτη την ενδογλίνη (CD105). Στα καρκινώματα μελετήθηκε η ύπαρξη πιθανής συσχέτισης μεταξύ των αγγειογενετικών δεικτών και παραμέτρων όπως το παθολογοανατομικό στάδιο, η διαφοροποίηση της νόσου, η παρουσία περινευρικής διήθησης και η εφαρμογή επικουρικής ακτινοθεραπείας. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η έκφραση των VEGF, VEGFR-1, VEGFR-2 και CD105 ήταν σημαντική υψηλότερη στο αδενοκαρκίνωμα του προστάτη σε σχέση με την καλοήθη υπερπλασία και την HGPIN ενώ δεν παρατηρήθηκε στατιστικά σημαντική διαφορά μεταξύ της υπερπλασίας και της HGPIN. Στο καρκίνωμα ο VEGFR-2 ήταν ο υποδοχέας που εκφράστηκε περισσότερο, ενώ η έκφραση του VEGFR-2 συνδέθηκε με υπερέκφραση τόσο του VEGF όσο και του VEGFR-1. Στην υπερπλασία η έκφραση του VEGFR-1 συνοδεύτηκε και από υπερέκφραση του VEGFR-2. Η ενδογλίνη βρέθηκε να εκφράζεται έντονα κυρίως από τα νεοπλασματικά νεοαγγεία ενώ τα μεσεγχυματικά και τα φλεγμονώδη κύτταρα καθώς και τα φυσιολογικά αγγεία ήταν πάντα αρνητικά ως προς αυτή. Καταγράφηκε συσχέτιση της υπερέκφρασης του VEGF και της υψηλής MVD. Παρατηρήθηκε επίσης θετική συσχέτιση των VEGF-CD105 με δυσμενείς παθολογοανατομικές παραμέτρους του καρκινώματος όπως η κακή διαφοροποίηση και η ύπαρξη περινευρικής διήθησης ενώ η υπερέκφραση του VEGF σχετίστηκε και με προχωρημένο στάδιο νεοπλασματικής νόσου. ΣΥΜΠΕΡΑΣΜΑΤΑ: Συμπερασματικά η αγγειογένεση είναι σημαντικά υψηλότερη στο καρκίνωμα συγκριτικά με την υπερπλασία και την HGPIN, ενώ δεν φαίνεται να διαφέρει μεταξύ των δύο τελευταίων. Πιθανόν η αγγειογένεση να αποτελέσει βασικό μέρος ενός νέου συστήματος σταδιοποίησης και πρόγνωσης του καρκίνου του προστάτη ενώ το μέλλον θα δείξει εάν η φαρμακευτική αναστολή της διαδικασίας αυτής θα μπορέσει να προστεθεί και να συνδυασθεί με τις ήδη υπάρχουσες θεραπευτικές επιλογές

Metastatic Cutaneous Squamous Cell Cancer with Peritoneal Carcinomatosis: A Case Report

Peritoneal involvement as a metastatic site of squamous cell skin cancer is exceptionally rare. The current work analyzes a 52-year old male with high-risk cutaneous squamous cell nose carcinoma (cSCC) that was initially treated with surgery and platinum-based concurrent chemoradiation. Five years later, he presented jaundice and hypercalcemia. Further imaging revealed diffused liver, peritoneal and paraaortic lymph node metastases without evidence of locoregional recurrence. The patient underwent liver biopsy, which confirmed the diagnosis. High-risk features for metastasizing can be considered the maximum clinical diameter, the anatomical subsite (localization of the primary tumor in the ear and retroauricular area, cheek and lip are considered to significantly increase the risk of distant metastasis), poor histological differentiation, perineural invasion and lesions with a thickness of more than 2.0 mm. Late relapse that involves only disseminated abdominal disease is very uncommon and may justify closer follow-up and more aggressive chemotherapy in high-risk patients