Trepanation practices in Asclepieia: systematizing a neurosurgerical innovation.

As ancient Greeks started looking for deities that could fulfil the pragmatic needs of common people, local heroes started being mythologized and worshipped through cults. The most widespread such example was Asclepius, possibly a skilled war surgeon who followed military expeditions to Colchis and Troy. He was worshipped at religious temples called Asclepieia where certain specific medical and surgical techniques were followed. The most advanced must have been skull trepanation, most likely done as an acute operation to release intracranial pressure. The contemporary Hippocratic corpus provided extensive descriptions of the technique and archaeological evidence have shown that many patients survived the operation. Decompressive craniectomy techniques have been practiced for millennia but it is possible that they were first systematized as a neurosurgical innovation through the Ancient Greek religious cult followed in Asclepieia

Impact of Hepatitis B Exposure on Sustained Virological Response Rates of Highly Viremic Chronic Hepatitis C Patients

Aim. To evaluate the impact of hepatitis B core antibody (anti-HBc) seropositivity in sustained virological response (SVR) rates in treatment-naïve, chronic hepatitis C (CHC) patients with high pretreatment viral load (>800000 IU/mL). Methods. 185 consecutive CHC patients (14.4% cirrhotics, 70.2% prior intravenous drug users) treated with pegylated interferon-a2b plus ribavirin, for 24 or 48 weeks based on viral genotype, were retrospectively analyzed. SVR was confirmed by undetectable serum HCV-RNA six months after the end of treatment schedule. Results. Thirty percent of CHC/HBsAg-negative patients were anti-HBc-positive. Anti-HBc positivity was more prevalent in cirrhotic, compared to noncirrhotic patients (76.9% versus 19.5%, P < .05). Serum HBV-DNA was detected in the minority of anti-HBc-positive patients (1.97%). Overall, 62.1% of patients exhibited SVR, while 28.6% did not; 71.4% of non-SVRs were infected with genotype 1. In the univariate analysis, the anti-HBc positivity was negatively associated with treatment outcome (P = .065). In the multivariate model, only the advanced stage of liver disease (P = .015) and genotype-1 HCV infection (P = .003), but not anti-HBc-status (P = .726), proved to be independent predictors of non-SVR. Conclusion. Serum anti-HBc positivity does not affect the SVR rates in treatment-naïve CHC patients with high pretreatment viral load, receiving the currently approved combination treatment

Body donation for research and teaching purposes: the contribution of blood donation units in the progress of anatomical science

Background: Cadaver’s dissection has a fundamental role in teaching and understanding the anatomy. Postmortem body donation (PMBD) is an important source of cadavers and provides an opportunity to carry out research or educational activities in medicine and surgery. The objective of the current study is to determine the perspectives and attitudes toward PMBD among blood donors (BLD) and elderly people. These data are fundamental to highlight the PMBD extent and individual factors that might influence PMBD. Materials and methods: Six hundred and fifty questionnaires were distributed to 500 (327 male and 173 female, mean age 39.9 ± 9.6 years) blood donors (BLD) and 150 elderly people (62 males and 88 females, mean age 74 ± 9.4 years). A specially designed self-administered questionnaire covering demographic data, knowledge and attitude of the participants concerning body donation (BD) was used. Results: Concerning the perception of BD among BLD and elderly people, the most common reason for BD in both study groups was the contribution in research, while the commonest reason for hesitating about BD was the lack of information, following by personal reasons. The BLD were more likely to be interested in BD for contribution in research and personal reasons. Additionally, BLD were less likely than the elderly to hesitate about BD for religious and personal reasons and more likely to hesitate about BD for not being informed. BLD who were interested in BD for contribution in research were significantly older. Elderly people who hesitated about BD for personal reasons were significantly older. In the BLD group, those who responded that blood and body donation are the same were significantly younger, while in the elderly group — significantly older. The proportion of BLD who declared that blood and body donation is the same was significantly higher in more educated people. Conclusions: A need for well-organised and informative BD programmes is evident. Orientating the public towards this practice is of high moral and medical value, since with this important promotion the altruistic act of BD will expand globally.

A comprehensive overview of radioguided surgery using gamma detection probe technology

The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology

A study of transcription factor E2F-1 in adenocarcinomas of gastroesophageal juction and in barrett's adenocarcinomas. The relation of E2F-1 with the kinetic parameters of growth and of apoptosis correlation with clinicopathological parameters

E2f-1 is a significant transcriptional factor, that receives signals from phase G1/S regulators and expresses various cellular functions, such as DNA formation and repair, mitosis and apoptosis. Its role in cellular proliferation and apoptosis has been studied in many experimental models and a few of these studies concerning human malignancies have been published, so far. The aim of this study is to investigate the role of E2F-1 in tumor growth, apoptosis and other clinical and pathological parameters of Barrett’s adenocarcinomas as well as in adenocarcinomas of the gastroesophageal junction. The relationship of E2F-1 and p53’s expression has also been studied. Method: The expression levels of E2F-1, p53, Ki-67 and caspase-3 were studied by immuno-istochemistry in 55 (fifty-five) cases of esophageal adenocarcinoma (18 cases of Barrett’s adenocarcinoma and 37 adenocarcinomas of the gastroesophageal junction). In order to ensure greater accuracy in the evaluation of apoptosis, TUNEL technique was performed in 20 of the samples. The outcomes were evaluated in unison as well as in relation to the clinical and pathological findings of the patients. Results: The mean percentage of E2F-1’s expression was 39.43% (±31.19%) in Barrett’s adenocarcinomas and 42% (±30.47%) in adenocarcinomas of the gastroesophageal junction. The expression rate of proliferation indicator Ki-67 was found to be 38.15% (±18.71) in Barrett’s adenocarcinomas and 38.93% (±16.32) in adenocarcinomas of the gastroesophageal junction. High expression of E2F-1 was associated with a low expression of Ki-67 (p=0.038) in all of the samples. Positive staining for p53 was observed in 50% of all Barrett’s adenocarcinomas and in 67.6% in adenocarcinomas of the gastroesophageal junction. Whenever E2F-1 was greatly expressed, so was p53, on both types of cancer. Caspase-3 was expressed in 1.025% (±0.3948) of all Barrett’s adenocarcinomas and in 0.9783% (±0.4635) of all gastroesophageal junction adenocarcinomas. The inversed relation between E2F-1 and Ki-67 was statistically significant (p=0.038) both in Barrett’s and gastroesophageal adenocarcinomas. The E2F-1 expression rates were also directly associated with the p53 expression rates. Moreover, E2F-1 high levels were inversely related with survival (p=0.08) in gastroesophageal junction adenocarcinomas. Finally, the lymph node infiltration was seriously associated with grim survival (p=0.07). Conclusions: E2F-1 expression is inversely related with cellular proliferation (Ki-67), it is directly related with p53 positive expression, it is not connected with caspase-3 expression (apoptosis), and tends to be related with lymph node infiltration and grim survival. E2F-1 seems to act as a tumor suppressor both in Barrett’s and gastroesophageal adenocarcinomas.Τα αδενοκαρκινώματα οισοφάγου Barrett και γαστροοισοφαγικής συμβολής παρουσιάζουν σημαντική αύξηση τα τελευταία τριάντα χρόνια. Στην ερμηνεία της καρκινογένεσης στον οισοφάγο Barrett φαίνεται να ισχύει η ακολουθία: φυσιολογικό επιθήλιο-μεταπλαστικό επιθήλιο-χαμηλόβαθμη δυσπλασία-υψηλόβαθμη δυσπλασία-αδενοκαρκίνωμα. Το παραπάνω πρότυπο δε φαίνεται να ισχύει στα αδενοκαρκινώματα της γαστροοισοφαγικής συμβολής. Διαταραχές στην λειτουργία πολλών γονιδίων που εμπλέκονται στην καρκινογένεση του οισοφάγου Barrett και της γαστροοισοφαγικής συμβολής έχουν καταγραφεί. Ο Ε2F-1 είναι ένας κορυφαίος μεταγραφικός παράγοντας που λαμβάνει σήματα από ρυθμιστές της G1/S φάσης και εκφράζει διαφορετικές κυτταρικές λειτουργίες όπως σύνθεση DNA, επιδιόρθωση DNA, μίτωση και απόπτωση. Ο ρόλος του στον κυτταρικό πολλαπλασιασμό και την απόπτωση έχει μελετηθεί σε πειραματικά μοντέλα και έχουν δημοσιευτεί σε περιορισμένο αριθμό μελέτες που αφορούν ανθρώπινες κακοήθειες. Σε μελέτη μη-μικροκυτταρικού καρκίνου του πνεύμονα η υπερέκφραση του Ε2F-1 συσχετίζεται με την αύξηση του όγκου υποδηλώνοντας «ογκογενετική» δράση. Σε μελέτη αδενοκαρκινώματος παχέος εντέρου η έκφραση του Ε2F-1 συσχετίζεται αντίστροφα με την αύξηση του όγκου και εκφράζεται σε περιοχές με αυξημένη απόπτωση. Σκοπός αυτής της ερευνητικής εργασίας είναι η διερεύνηση του ρόλου του μεταγραφικού παράγοντα Ε2F-1 σε σχέση με τις κινητικές παραμέτρους της αύξησης και της απόπτωσης και με τις κλινικοπαθολογικές παραμέτρους στα αδενοκαρκινώματα Barrett και γαστροοισοφαγικής συμβολής. Μελετήθηκε επίσης η σχέση με την έκφραση της p53. Τα αποτελέσματά τους συσχετίστηκαν τόσο μεταξύ τους, όσο και με τις κλινικοπαθολογικές παραμέτρους (διήθηση λεμφαδένων, στάδιο νόσου, επιβίωση). Μέθοδος: Εξετάστηκαν ανοσοϊστοχημικά τα επίπεδα έκφρασης των μορίων Ε2F-1, p53, Ki 67, κασπάση 3 σε μια σειρά πενήντα πέντε αδενοκαρκινωμάτων (δεκαοκτώ αδενοκαρκινωμάτων Barrett και τριάντα-επτά αδενοκαρκινωμάτων γαστροοισοφαγικής συμβολής). Για μεγαλύτερη ασφάλεια ως προς την εκτίμηση της απόπτωσης έγινε η τεχνική TUNEL σε είκοσι δείγματα. Οι όγκοι προέρχονταν από χειρουργημένους ασθενείς σταδίων ?, ??, ?, χωρίς να έχει προηγηθεί χημειοθεραπεία ή ακτινοθεραπεία. Τα ευρήματα συσχετίστηκαν μεταξύ τους και με κλινικοπαθολογικά δεδομένα των ασθενών. Αποτελέσματα: Ο μέσος όρος έκφρασης του E2F-1 στα αδενοκαρκινώματα Barrett ήταν 39.43% (±31.19%), ενώ στα αδενοκαρκινώματα γαστροοισοφαγικής συμβολής ο μέσος όρος της έκφρασης του E2F-1 ήταν 42% (±30.47%)..

Meletius theMonk (c. 8th to 9th century AD) and the blood circulation: The true story of the first description of cardiovascular circulation accompanied by the discovery of the microcirculation inside the capillaries

[No abstract available

Meletius theMonk (c. 8th to 9th century AD) and the blood circulation: The true story of the first description of cardiovascular circulation accompanied by the discovery of the microcirculation inside the capillaries

[No abstract available

Evaluation of a clinical attachment in Primary Health Care as a component of undergraduate medical education

Introduction: It seems that there is a trend in undergraduate medical education towards including clinical attachments in primary health care (PHC) worldwide. The benefits of such initiatives are already well described. The aim of this study was to evaluate the effect of a clinical attachment in undergraduate medical students in a European country with an odd medical educational system that essentially lacks any kind of academic PHC departments. Methods: The study was undertaken during 2005-2007. A non-mandatory 1-week clinical attachment in PHC/general practice was organized in an urban PHC unit by general practitioners with educational experience in collaboration with the Department of Physiology of the local medical school. The participants were a prospective cohort of medical students in the 2nd year of undergraduate studies. All participating students sat a pre-defined clinical exam which consisted of multiple choice questions, mini case papers and an objective-structured clinical examination before and after the attachment. In addition, the students rated the whole process. Results: The response ratio was 77.06%. The mean score on objective structured clinical examination of participants increased from 30.70/100 to 62.28/100 (p &lt; 0.001). The students&apos; impression of the study was rather positive (4.39/5). Discussion: The educational intervention of including a clinical attachment in an undergraduate curriculum seems to have encouraging results, considering the peculiarity of inexistence of academic departments of PHC or General Practice in the national medical schools and the inexperience of students regarding similar concepts

Trepanation Practices in Asclepieia: Systematizing a Neurosurgical Innovation

Background As ancient Greeks started looking for deities that could fulfill the pragmatic needs of common people, local heroes started being mythologized and worshipped through cults. Methods The most widespread such example was Asclepius, possibly a skilled war surgeon who followed military expeditions to Colchis and Troy. Our study investigates the possibility of the early neurosurgery to have been started inside Asclepieia by Asclepius and his followers. Results Asclepius was worshipped at religious temples called Asclepieia where certain specific medical and surgical techniques were followed. The most advanced technique was skull trepanation, which was most likely done as an acute operation to release intracranial pressure. The contemporary Hippocratic corpus provided extensive descriptions of the technique, and archaeologic evidence has shown that many patients survived the operation. Conclusions Decompressive craniectomy techniques have been practiced for millennia but it is possible that they were first systematized as a neurosurgical innovation through the Ancient Greek religious cult followed in Asclepieia. © 2017 Elsevier Inc