Survival in patients with stage IV noncardia gastric cancer - the influence of DNA ploidy and Helicobacter Pyloriinfection

BACKGROUND: Palliative surgery followed by postoperative chemotherapy is a challenging approach in the treatment of stage IV gastric cancer yet patients must be carefully selected on the basis of likely clinical benefit. METHODS: The records of 218 patients with histological diagnosis of gastric adenocarcinoma who underwent palliative surgery followed by postoperative chemotherapy were retrospectively reviewed. Twelve potential prognostic variables including tumour DNA index and serum IgG anti- Helicobacter pylori (HP) antibodies were evaluated for their influence on overall survival by multivariate analysis. RESULTS: The median survival was 13.25 months [95% Confidence Interval (CI) 12.00, 14.50]. Three factors were found to have an independent effect on survival: performance status (PS) [PS 60–70 vs. 90–100 Hazard Ratio (HR) 1.676; CI 1.171-2.398, p = 0.005], liver metastases (HR 1.745; CI 1.318-2.310, p < 0.001), and DNA Index as assessed by Image cytometry (2.2-3.6 vs. >3.6 HR 3.059; CI 2.185-4.283, p < 0.001 and <2.2 vs. >3.6 HR; 4.207 CI 2.751-6.433 <0.001). HP infection had no statistically significant effect on survival by either univariate or multivariate analysis. CONCLUSION: Poor pre-treatment PS, the presence of liver metastasis and high DNA Index were identified factors associated with adverse survival outcome in patients with Stage IV gastric cancer treated with palliative gastrectomy and postoperative chemotherapy. HP infection had no influence on survival of these patients

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6&nbsp;years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P &lt; 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100&nbsp;years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Durability of reinforced concrete beams under simultaneous flexural load

The deterioration of the reliability of a concrete structure over time is the result of various mechanical, physical, chemical and biological processes, with the corrosion of reinforcement being the most serious problem of durability of reinforced concrete structures. For the past fifty years, the international scientific community has made tremendous efforts with laboratory research and experimental field studies to increase the corrosion resistance of concrete. The infestation of structures by the penetration of chlorides is a key problem in our country as it mainly concerns coastal structures that are affected by seawater. The subject of this dissertation was the study of methods of protection of reinforced concrete while investigating the influence of permanent bending load on the strength of a carrier. The compositions were prepared according to the latest concrete regulations and international standards and are as follows: conventional quality concrete C30/37, conventional concrete with corrosion inhibitor as an additive, conventional concrete with surface protection, fine aggregate concrete and self-compacting concrete. For the experimental part, 40 reinforced concrete beams of 5 different compositions were constructed and exposed to 2 different simulated environmental conditions at 3 different loading levels for a total period of 42 months. Their anti-corrosion behavior was determined by regular tests of the electrical resistance of concrete and the corrosion potential of the reinforced steel bars using copper sulfate as the reference electrode. In addition, their anti-corrosion behavior was determined by the following laboratory tests: water absorption test, water pressure permeability test, mercury penetration porosimetry, rapid chloride penetration test, accelerated carbonation test. The experimental results showed that the protection systems tested provide adequate protection to the reinforcement against corrosion compared to the reference specimens. Also, an inversely proportional relationship of the Water/Cement ratio of a composition with the ability to protect against corrosion was observed. Lower Water/Cement values (0.4 instead of 0.5) lead to better anti-corrosion behavior. Finally, it is observed that the corrosion rate of steel gradually increases with increase of the permanent load. The interaction of permanent loading with the corrosion of the reinforcement is a relationship that has not been thoroughly investigated as of this writing. This creates a need for further research so that the new reinforced concrete structures take all harmful factors into account and prove to be more durable over time.Η υποβάθμιση της αξιοπιστίας μιας κατασκευής από σκυρόδεμα με την πάροδο του χρόνου είναι αποτέλεσμα διαφόρων μηχανικών, φυσικών, χημικών και βιολογικών διεργασιών, με τη διάβρωση του οπλισμού να αποτελεί το σοβαρότερο πρόβλημα ανθεκτικότητας των κατασκευών οπλισμένου σκυροδέματος. Τα τελευταία πενήντα χρόνια, η διεθνής επιστημονική κοινότητα κατέβαλε τεράστιες προσπάθειες με εργαστηριακές έρευνες και πειραματικές μελέτες πεδίου με στόχο την αύξηση της αντίστασης του σκυροδέματος στη διάβρωση. Η προσβολή των κατασκευών από τη διείσδυση χλωριόντων αποτελεί καίριο πρόβλημα και στη χώρα μας καθώς αφορά κυρίως παραθαλάσσιες κατασκευές που προσβάλλονται από το θαλασσινό νερό. Αντικείμενο της παρούσας διατριβής αποτέλεσε η μελέτη των μεθόδων προστασίας του οπλισμένου σκυροδέματος με ταυτόχρονη διερεύνηση της επιρροής της μόνιμης καμπτικής φόρτισης στην ανθεκτικότητα ενός φορέα. Οι συνθέσεις παρασκευάσθηκαν σύμφωνα με τους πιο πρόσφατους κανονισμούς σκυροδέματος και τα διεθνή πρότυπα και έχουν ως εξής: συμβατικό σκυρόδεμα ποιότητας C30/37, συμβατικό σκυρόδεμα με αναστολέα διάβρωσης ως πρόσθετο, συμβατικό σκυρόδεμα με επιφανειακή στεγανοποιητική προστασία, γαρμπυλοσκυρόδεμα και αυτοσυμπυκνούμενο σκυρόδεμα. Για το βασικό πειραματικό μέρος κατασκευάστηκαν 40 δοκοί οπλισμένου σκυροδέματος 5 διαφορετικών συνθέσεων και εκτέθηκαν σε 2 διαφορετικές προσομοιωμένες περιβαλλοντικές συνθήκες σε 3 διαφορετικά επίπεδα φόρτισης για συνολική περίοδο 42 μηνών. Η συμπεριφορά τους κατά της διάβρωσης προσδιορίστηκε μέσω τακτικών μετρήσεων της ηλεκτρικής αντίστασης του σκυροδέματος και του δυναμικού διάβρωσης των ενισχυμένων χαλύβδινων ράβδων με χρήση θειικού χαλκού ως ηλεκτρόδιο αναφοράς. Επιπλέον, η συμπεριφορά τους κατά της διάβρωσης προσδιορίστηκε μέσω των ακόλουθων εργαστηριακών δοκιμών: δοκιμή υδατοαπορροφητικότητας, δοκιμή διαπερατότητας νερού υπό πίεση, ποροσιμετρία διείσδυσης υδραργύρου, δοκιμή ταχείας διείσδυσης σε χλωριόντα, δοκιμή επιταχυνόμενης ενανθράκωσης. Τα πειραματικά αποτελέσματα έδειξαν ότι τα συστήματα προστασίας που εξετάστηκαν παρέχουν ικανοποιητική προστασία στον οπλισμό έναντι της διάβρωσης σε σύγκριση με τα δοκίμια αναφοράς. Επίσης, παρατηρήθηκε μια αντιστρόφως ανάλογη σχέση του λόγου Ν/Τ μιας σύνθεσης με την ικανότητα για προστασία από διάβρωση. Μικρότερες τιμές λόγου Ν/Τ (0,4 αντί 0,5) οδηγούν σε καλύτερη αντιδιαβρωτική συμπεριφορά. Τέλος, παρατηρείται πως ο ρυθμός διάβρωσης του χάλυβα αυξάνεται σταδιακά με την αύξηση του μόνιμου φορτίου. Η αλληλεπίδραση της μόνιμης φόρτισης με την εξέλιξη της διάβρωσης είναι μια σχέση που δεν έχει ερευνηθεί σε βάθος έως τη συγγραφή του παρόντος. Δημιουργείται έτσι η ανάγκη να υπάρξει επιπλέον έρευνα σε αυτόν τον συσχετισμό προκειμένου οι νέες κατασκευές από οπλισμένο σκυρόδεμα να λαμβάνουν υπόψιν όλους τους ζημιογόνους παράγοντες και να είναι περισσότερο ανθεκτικές στο χρόνο

Favoring D2-Lymphadenectomy in Gastric Cancer

The role of extended lymphadenectomy in the surgical treatment of gastric cancer has been debated for many years. So far six prospective randomized trials and a number of meta-analyses comparing D1- to D2-lymphadenectomy in open surgery have been published with contradicting results. The possible oncologic benefit of radical lymphadenectomy has been blurred by a number of reasons. In most of the trials the strategies under comparison were made similar after protocol violations. Imperfect design of the trials could not exclude the influence of cofounding factors. Inappropriate endpoints could not detect evidently the difference between the two surgical strategies. On the other hand radical lymphadenectomy was characterized by increased morbidity and mortality. This was mostly caused by the addition of pancreatico-splenectomy in all D2-dissections, even when not indicated. A careful analysis of the available evidence indicates that D2-lymphadenectomy performed by adequately trained surgeons without resection of the pancreas and/or spleen, unless otherwise indicated, decreases Gastric Cancer Related Deaths and increases Disease Specific Survival. This evidence is not compelling but cannot be ignored. D2-lymphadendctomy is nowadays considered to be the standard of care for resectable gastric cancer

Yeast saccharomyces cerevisiag as an experimental model for the study of antineoplastic agents

ΣΤΗ ΔΙΑΤΡΙΒΗ ΑΥΤΗ ΜΕΛΕΤΗΘΗΚΕ Η ΕΠΙΔΡΑΣΗ ΤΩΝ ΑΝΤΙΝΕΟΠΛΑΣΜΑΤΙΚΩΝ ΠΑΡΑΓΟΝΤΩΝ ΕΠΙ ΤΟΥ S.CEREEVISIAE.ΠΡΟΣΔΙΟΡΙΣΘΗΚΑΝ ΟΙ MIC,MCC,EC50 ΚΑΙ ΟΙ ΚΑΜΠΥΛΕΣ ΕΠΙΒΙΩΣΗΣ ΜΕΤΑ ΤΗΝ ΕΚΘΕΣΗ ΜΙΑΣ ΣΕΙΡΑΣ ΣΤΕΛΕΧΩΝ ΣΕ ΔΙΑΦΟΡΟΥΣ ΠΑΡΑΓΟΝΤΕΣ.ΤΟ ΣΤΕΛΕΧΟΣ ATCC2366 ΕΠΙΛΕΧΘΗΚΕ ΓΙΑ ΠΕΡΑΙΤΕΡΩ ΜΕΛΕΤΗ.Η ΕΠΙΒΙΩΣΗ ΚΑΙ Η ΑΝΑΠΤΥΞΗ ΤΩΝ ΚΑΛΛΙΕΡΓΕΙΩΝ ΤΟΥ ΕΛΑΤΤΩΝΟΝΤΑΝ ΑΠΟ ΤΙΣ ΑΔΡΙΑΜΥΚΙΝΗ, 5-ΦΘΟΡΙΟΥΡΑΚΙΛΗ, ΚΑΙ CIS-ΠΛΑΤΙΝΗ ΑΝΑΛΟΓΑ ΜΕ ΤΗ ΔΙΑΡΚΕΙΑ ΤΗΣ ΕΠΙΔΡΑΣΗΣ ΤΟΥΣ ΑΛΛΑ ΟΧΙ ΤΗ ΣΥΓΚΕΝΤΡΩΣΗ ΤΟΥΣ.Η ΜΥΤΟΜΥΚΙΝΗ-C ΕΛΛΑΤΩΝΕ ΤΗΝ ΕΠΙΒΙΩΣΗ ΟΠΩΣ ΚΑΙ Η ΜΕΘΟΤΡΕΞΑΤΗ ΠΟΥ ΟΜΩΣ ΔΕΝ ΜΕΤΕΒΑΛΛΕ ΣΗΜΑΝΤΙΚΑ ΤΗΝ ΑΝΑΠΤΥΞΗ ΤΗΣ ΚΑΛΛΙΕΡΓΕΙΑΣ.ΣΤΟ ΑΠΛΟ ΜΙΚΡΟΣΚΟΠΙΟ Η ΜΟΡΦΟΛΟΓΙΑ ΤΩΝ ΚΥΤΤΑΡΩΝ ΔΕΝ ΕΠΗΡΕΑΣΤΗΚΕ ΑΠΟ ΤΗΝ ΑΔΡΙΑΜΥΚΙΝΗ ΚΑΙ ΤΗ ΦΘΟΡΙΟΟΥΡΑΚΙΛΗ, ΕΝΩ Η ΜΕΘΟΤΡΕΞΑΤΗ ΚΑΙ Η CIS-ΠΛΑΤΙΝΗ ΠΡΟΚΑΛΕΣΑΝ ΤΟ ΣΧΗΜΑΤΙΣΜΟ ΚΥΤΤΑΡΩΝ ''ΔΙΚΗΝ ΑΛΤΗΡΑ'' ΚΑΤΑ ΠΟΣΟΣΤΟ ΑΝΑΛΟΓΟ ΜΕ ΤΗ ΜΕΙΩΣΗ ΤΗΣ ΕΠΙΒΙΩΣΗΣ ΚΑΙ ΤΗΣ ΑΝΑΠΤΥΞΗΣ.Η ΤΑΧΕΙΑ ΚΥΤΤΑΡΟΚΤΟΝΟΣ ΔΡΑΣΗ ΤΗΣ ΑΔΡΙΑΜΥΚΙΝΗΣ ΗΤΑΝ ΜΕΓΑΛΥΤΕΡΗ ΣΕ ΚΥΤΤΑΡΑ ΕΚΤΟΣ ΚΥΤΤΑΡΙΚΟΥ ΚΥΚΛΟΥ ΚΑΙ ΑΠΟΔΟΘΗΚΕ ΕΝ ΜΕΡΕΙ ΣΤΗ ΓΕΝΕΣΗ ΕΛΕΥΘΕΡΩΝ ΡΙΖΩΝ ΠΟΥ ΠΙΘΑΝΟΤΑΤΑ ΔΕΣΜΕΥΕ Η ΔΙΠΥΡΙΔΑΜΟΛΗ ΑΥΞΟΝΑΝΤΑΣ ΤΗΝ ΕΠΙΒΙΩΣΗ.Η ΜΥΚΗΤΟΣΤΑΤΙΚΗ ΔΡΑΣΗ ΤΗΣ ΦΘΟΡΙΟΟΥΡΑΚΙΛΗΣ ΑΠΟΔΟΘΗΚΕ ΣΤΗ ΔΙΑΤΑΡΑΧΗ ΤΟΥ ΜΕΤΑΒΟΛΙΣΜΟΥ ΑΛΛΩΝ ΜΑΚΡΟΜΟΡΙΩΝ ΠΕΡΑΝ ΤΟΥ DNA, ΕΝΩ Η ΣΥΝΕΡΓΕΙΑ ΤΗΣ ΜΕ ΤΗ ΔΙΠΥΡΙΔΑΜΟΛΗ ΙΣΩΣ ΠΡΟΕΚΥΠΤΕ ΑΠΟ ΤΗΝ ΑΝΑΣΤΟΛΗ ΤΗΣ ΠΕΡΜΕΡΜΕΑΣΗΣ ΚΥΤΟΣΙΝΗΣ- ΠΟΥΡΙΝΩΝ.Η ΚΥΤΤΑΡΟΚΤΟΝΟΣ ΜΕΘΟΤΡΕΞΑΤΗ ΕΜΦΑΝΙΣΕ ΣΥΝΕΡΓΕΙΑ ΜΕ ΤΙΣ ΔΙΠΥΡΙΔΑΜΟΛΗ ΚΑΙ ΘΕΟΦΥΛΛΙΝΗ ΙΣΩΣ ΛΟΓΩ ΑΝΑΣΤΟΛΗΣ ΤΗΣ ΒΙΟΣΥΝΘΕΣΗΣ ΤΩΝ ΠΡΟΔΡΟΜΩΝ ΤΟΥ DNA.ΔΕΝ ΚΑΤΕΣΤΕΙ ΣΑΦΕΣ ΑΝ Η CIS-ΠΛΑΤΙΝΗ ΗΤΑΝ ΚΥΤΤΑΡΟΚΤΟΝΟΣ 'Η ΟΧΙ ΕΝΩ Η ΣΥΝΕΡΓΕΙΑ ΤΗΣ ΜΕ ΤΗ ΘΕΟΦΥΛΛΙΝΗ ΙΣΩΣ ΟΦΕΙΛΕΤΑΙ ΣΤΗ ΔΙΑΤΑΡΑΧΗ ΤΟΥ ΜΕΤΑΒΟΛΙΣΜΟΥ ΤΗΣ ΓΟΥΑΝΙΝΗΣ 'Η ΣΤΗΝ ΠΑΡΑΚΑΜΨΗ ΤΩΝ ΣΗΜΕΙΩΝ ΕΛΕΓΧΟΥ - ''CHECKPOINTS''.ΤΑ ΕΥΡ

Favoring D2-Lymphadenectomy in Gastric Cancer

The role of extended lymphadenectomy in the surgical treatment of gastric cancer has been debated for many years. So far six prospective randomized trials and a number of meta-analyses comparing D1- to D2-lymphadenectomy in open surgery have been published with contradicting results. The possible oncologic benefit of radical lymphadenectomy has been blurred by a number of reasons. In most of the trials the strategies under comparison were made similar after protocol violations. Imperfect design of the trials could not exclude the influence of cofounding factors. Inappropriate endpoints could not detect evidently the difference between the two surgical strategies. On the other hand radical lymphadenectomy was characterized by increased morbidity and mortality. This was mostly caused by the addition of pancreatico-splenectomy in all D2-dissections, even when not indicated. A careful analysis of the available evidence indicates that D2-lymphadenectomy performed by adequately trained surgeons without resection of the pancreas and/or spleen, unless otherwise indicated, decreases Gastric Cancer Related Deaths and increases Disease Specific Survival. This evidence is not compelling but cannot be ignored. D2-lymphadendctomy is nowadays considered to be the standard of care for resectable gastric cancer. © Copyright © 2018 Karavokyros and Michalinos

RESPONSE OF SACCHAROMYCES-CEREVISIAE STRAINS TO ANTINEOPLASTIC AGENTS

The effect of several antineoplastic agents on Saccharomyces cerevisiae strains has been investigated. Minimum inhibitory concentration (MIC), minimum cytotoxic concentration (MCC) and median effective concentration (EC(50)) were determined to identify strains with inherent sensitivity to the agents tested. Several strains proved to be sensitive to the antimetabolites 5-fluorouracil and methotrexate as well as to doxorubicin and cis-platine. On the contrary m-amsacrine, procarbazine, vinca alcaloids, melphalan and hydroxyurea were inactive at concentrations up to 400 mu g ml(-1). The strain ATCC 2366, the most relatively sensitive to the agents tested, was used for studying the effect of treatment duration and of drug concentration on cell survival. Methotrexate and cis-platine, which according to MIC and MCC tests seemed ineffective for this strain, reduced survival significantly after 6 h of treatment. A correlation of the shape of the survival curves with MIC and MCC values was attempted