Predictive factors of antiproliferative activity of octreotide LAR as first-line therapy for advanced neuroendocrine tumours

background: The antiproliferative activity of octreotide LAR in neuroendocrine tumours (NETs) has been demonstrated by small retrospective studies and confirmed by a prospective phase III trial (PROMID). However, there are limited data about the duration and predictors of response. The aim of our retrospective study was to determine the time to radiological progression (TTRP) of disease and the factors that were associated with better response. methods: A total of 254 treatment naïve patients with advanced NETs and positive somatostatin receptor scintigraphy were included. Mean follow-up period was 42 months. results: The location of primary was in the small bowel in 204, pancreas in 22, lungs in 14, rectum in 7 and unknown in 7 patients. Most tumours were well-differentiated, G1 (58%) and G2 (23%). The majority of patients commenced octreotide LAR due to functional symptoms (57%), radiological progression (10%) or in the presence of asymptomatic and stable disease on the basis of data from the PROMID trial (18.5%). Partial response occurred in 5%. For all patients, the median TTRP was 37 months (95% confidence interval, CI: 32–52 months). There was a statistically significant shorter TTRP in patients with pancreatic tumours, liver metastases and intermediate grade tumours. Extremely raised (>10 times the upper limit of normal) baseline chromogranin A levels were associated with an unfavourable outcome. In contrast, male sex, carcinoid heart disease and initiation of treatment in the presence of stable disease were predictive of a better response. Age, extra-hepatic metastases, presence of mesenteric desmoplasia, previous resection and functional status of the primary tumour did not affect response. conclusions: The duration of the antiproliferative effect of octreotide LAR seems to be longer than previously reported. This study has identified several predictors of response in a large cohort of patients with NETs on somatostatin analogue therapy

Εναλλακτικός Τουρισμός – Μελέτη Περίπτωσης μίας μορφής Εναλλακτικού Τουρισμού

Με την παρούσα διπλωματική εργασία θα γίνει προσπάθεια κατανόησης της έννοιας του εναλλακτικού τουρισμού, του θεσμικού πλαισίου και των θεωριών που σχετίζονται με αυτόν. Απώτερος σκοπός της εργασίας είναι η διερεύνηση όλων των παραγόντων που συνιστούν στη δημιουργία ενός πετυχημένου σχεδίου εναλλακτικού τουρισμού σε έναν τόπο, αφού το μεγαλύτερο διαχρονικό πρόβλημα του Ελληνικού Τουρισμού είναι η έντονη εποχικότητά του τους καλοκαιρινούς μήνες και μόνο. Θα καταγραφούν αρχικά τα πρότυπα που ίσχυαν και τα πρότυπα που θα πρέπει να καθιερωθούν ώστε η τουριστική ανάπτυξη να ακολουθεί τις αρχές της βιώσιμης και χωρίς αποκλεισμούς ανάπτυξης. Θα γίνει καταγραφή των κύριων χαρακτηριστικών του εναλλακτικού τουρισμού μέσω των μορφών του, όπως αυτές παρουσιάζονται και αναπτύσσονται στην Ελλάδα και τα μοντέλα ανάπτυξης των τουριστικών προορισμών. Τέλος θα εξεταστούν εναλλακτικές μορφές τουριστικής ανάπτυξης μέσω των clusters. Στη συνέχεια της εργασίας θα γίνει μελέτη της μορφής Εναλλακτικού Τουρισμού του Αγροτουρισμού, ως η μορφή τουρισμού η οποία θα δώσει ζωή στην ύπαιθρο, τη δυνατότητα της τουριστικής ανάπτυξης όλες τις εποχές του χρόνου, της οικονομικής ανάπτυξης των τοπικών κοινωνιών μέσα από τα πρότυπα της βιώσιμης ανάπτυξης αλλά και της προσέλκυσης πελατών οι οποίοι ενδιαφέρονται για την προστασία του φυσικού περιβάλλοντος, σέβονται την λαϊκή παράδοση και τον πολιτισμό και αναζητούν διαφορετικές μορφές διακοπών επιστρέφοντας στη φύση και την ύπαιθρο. Θα γίνει ανάλυση μέσα από διεθνής και τοπικές μορφές Αγροτουρισμού, ανάπτυξη των στόχων, το θεσμικό πλαίσιο και τις δυνατότητες χρηματοδότησης των αγροτουριστικών επιχειρήσεων. Θα αναπτυχθεί η μελέτη δύο αγροτουριστικών περιοχών για την κατάδειξη μέσω των συγκρίσεων των αποτελεσμάτων. Τέλος μέσω συμπερασμάτων θα αναδειχθεί ο Εναλλακτικός Τουρισμός και ειδικά ο Αγροτουρισμός ως η περίπτωση βιώσιμης τουριστικής ανάπτυξης που θα βοηθήσει την τοπική και συνολική οικονομία, τις τοπικές κοινωνίες, το φυσικό περιβάλλον, τη σωστή διαχείριση των φυσικών πόρων αλλά και τον πολιτισμό μας, να ξεπεράσουν την πολύ-επίπεδη κρίση που βιώνει η Ελλάδα τα τελευταία χρόνια.This diploma thesis will attempt to understand the concept of alternative tourism, the institutional framework and the theories related to it. The ultimate goal of the work is to investigate all the factors that constitute the creation of a successful alternative tourism project in a place. The biggest long-standing problem of Greek tourism is its intense seasonality in the summer months. It will initially record the standards in place and the standards that should be introduced to ensure that tourism development follows the principles of sustainable and inclusive growth. The main features of alternative tourism will be recorded through its forms as presented and developed in Greece and the patterns of development of tourist destinations and alternative forms of tourism development, through clusters, will be considered. Afterwards, the study will explore the form of Alternative Tourism, Agro tourism as a form of tourism that will give life to the countryside, the possibility of tourism development at all times of the year, the economic development of local societies through the standards of sustainable development but also attracting customers who are interested in protecting the natural environment, respecting folk tradition and culture and seeking different forms of holiday, returning back to the nature . Study of rural tourism areas abroad (mode of operation etc.) and local agro tourism areas of our country, indicating all patterns of agro tourism development (model agro tourist farms, model villages, agro tourism ways, happenings-events, local gastronomic pudding patterns etc) and the agro tourist institutional framework and funding opportunities for agri-businesses round Greece. The study of two agrotouristic areas will be developed for demonstration through comparisons, of results. Finally, through Alternative Tourism and especially Agro tourism as a case of sustainable tourism development that will help the local and global economy, the local communities, the natural environment, the proper management of the natural resources as well as our culture, will overcome the very flat crisis that Greece is experiencing in recent years

Mineralogical characterization of the intraseam layers of Lofoi lignite deposits in Florina basin (western Makedonia, northwest Greece)

The mineralogical composition of intraseam layers from Lofoi lignite deposits (northwest Greece) is the subject of the present study. The samples were examined by means of X-ray diffraction (XRD), thermo-gravimetric (TG/DTG) and differential thermal analysis (DTA), and Fourier transform infrared (FTIR) spectrometry. The clay minerals prevail in most samples, with illitemuscovite being the dominant phase, and kaolinite and chlorite being the other major clay components. No smectite was found. Quartz and feldspars, dominate in two cases. The studied materials are characterized as clays to clayey sands, showing significant similarities with the intraseam layers of the adjacent Achlada lignite deposits

Percutaneous Vertebroplasty in Adult Degenerative Scoliosis for Spine Support: Study for Pain Evaluation and Mobility Improvement

We evaluate the efficacy-safety of percutaneous vertebroplasty (PV) as primary treatment in adult degenerative scoliosis. During the last 4 years, PV was performed in 18 adult patients (68 vertebral bodies) with back pain due to degenerative scoliotic spine. Under anaesthesia and fluoroscopy, direct access to most deformed vertebral bodies was obtained by 13G needles, and PMMA for vertebroplasty was injected. Scoliosis’ inner arch was supported. Clinical evaluation included immediate and delayed studies of patient’s general condition and neurological status. An NVS scale helped assessing pain relief, life quality, and mobility improvement. Comparing patients’ scores prior to (mean value 8.06±1.3 NVS units), the morning after (mean value 3.11±1.2 NVS units), at 12 (mean value 1.67±1.5 NVS units), and 24 months after vertebroplasty (mean value 1.67±1.5 NVS units) treatment, patients presented a mean decrease of 6.39±1.6 NVS units on terms of life quality improvement and pain relief (P=0.000). Overall mobility improved in 18/18 (100%) patients. No complications were observed. During follow-up period (mean value 17.66 months), all patients underwent a mean of 1.3 sessions for facet joint and nerve root infiltrations. Percutaneous vertebroplasty in the inner arch seems to be an effective technique for supporting adult degenerative scoliotic spine

Extensive cutaneous metastases of pancreatic adenocarcinoma: a case report and review of the literature

Herein, we present the case of a patient with pancreatic cancer and nonumbilical cutaneous metastasis. Patients with pancreatic adenocarcinomas can develop extensive cutaneous metastases involving not only abdominal skin but also other unusual sites such as the scrotum

The depositional conditions and the palaeoenvironment of the Achlada xylite-dominated lignite in western Makedonia, Greece

The depositional palaeoenvironment of the Neogene Achlada lignite deposit (western Makedonia, Greece) was deciphered with respect to the evaluation of the macro-petrographic characteristics, and the data resulted from coal petrographic analyses. The total thickness of the studied lignite seam is similar to 26 m and consists of organic and inorganic alternations. The macro-petrographic observations suggest extremely high contributions of woody-originated tissue (xylite) from a single tree type, among the lignite layers, whereas, numerous in situ stems and trunks were observed. The results of the coal petrographic analysis indicate the dominance of huminite (883 vol.%), whereas liptinite and inertinite show much lower values (11.0 vol.% and 0.7 vol.% respectively). High contribution of mineral matter is also observed in many cases. Ulminite types A and B are the most abundant macerals, whereas the content of ulminite B is followed by the xylite content. Facies modeling using maceral composition and maceral indices suggested the alternation of forest swamp and reed-moor environments where peat accumulated under highly-saturated and intensely-anoxic conditions. A terrestrial origin with wet forest to piedmont plain depositional conditions was suggested by the Gelification Index (GI) and Tissue Preservation Index (TPI) plot. A cross-plot of the ground water index (GWI) vs. the vegetation index (VI) suggested swamps under mesotrophic and rheotrophic hydrogeological conditions, where the dominant source for the peat was woody vegetation and vegetation high in preservation potential. The overall macro and micro characteristics of the Achlada lignite suggest a depositional palaeoenvironment that includes three independent parts: a) the main channel of a meandering river system; b) the floodplain area; and c) the oxbow lake. The establishment of telmatic/limnotelmatic conditions in this palaeoenvironment resulted in the formation of the entire Achlada lignite deposit, whereas numerous flood episodes interrupted the peat accumulation and resulted in the deposition of clay-rich sediments. (C) 2015 Elsevier B.V. All rights reserved

A case of encapsulating peritoneal sclerosis in a patient with chronic schistosomiasis

Encapsulating peritoneal sclerosis (EPS) is a debilitating condition, mainly associated with long-term peritoneal dialysis, where up-regulation of intra-abdominal inflammatory pathways leads to a fibrocollagenous peritoneal membrane formation resembling a cocoon. EPS causes intestinal encapsulation leading to bowel obstruction and dilatation. Chronic schistosomiasis is characterized by dysregulation of pro-inflammatory and anti-inflammatory cytokines. EPS has never been reported before in patients with chronic schistosomiasis. We report the first, to our knowledge, case of a 57-year-old male originated from Burkina Faso with chronic intestinal and urogenital schistosomiasis and EPS. Although causality cannot be established solely by this case, we hypothesize that EPS may be the result of chronic inflammatory activation, due to immune dysregulation driven by chronic schistosomiasis. The potential pathogenetic linkage between these two conditions should be further explored. (C) 2021 The Author(s). Published by Elsevier Ltd

Intrapericardial Hernia after Transdiaphragmatic Approach of Intrathoracic IVC

Trauma and abdominal surgery that involves the diaphragm and pericardium rarely ends up in post-operative visceral herniation into the pericardial cavity. Urgent intervention is crucial to restore the cardiac output and prevent bowel strangulation. A case of a patient with intrapericardial hernia following nephrectomy for renal cell carcinoma and en block resection of an IVC neoplasmatic thrombus via transdiaphragmatic approach is presented