Radial probe endobronchial ultrasound assisted conventional transbronchial needle aspiration in the diagnosis of solitary peribronchial pulmonary lesion located in the segmental bronchi

Background: The diagnosis of peribronchial pulmonary lesions located in the tertiary bronchi, also known as segmental bronchi, as well as, the 4th order and 5th order segmental bronchi is very difficult. Histopathological specimens cannot be easily obtained by endobronchial biopsies (EBBX) due to the patent but small segmental bronchial lumen. The aim of the present study was to evaluate the diagnostic accuracy and safety of the novel technique with radial probe endobronchial ultrasound (R-EBUS) assisted conventional transbronchial needle aspiration (C-TBNA) in the diagnosis of solitary peribronchial pulmonary lesions located in segmental bronchi from 3th to 5th order. Methods: From December 2014 to December 2015, 16 patients with solitary peribronchial pulmonary lesions in the segmental bronchi from 3th to 5th order confirmed by computed tomography (CT) were enrolled. The lesions were located using radial probe endobronchial ultrasound (R-EBUS) to determine the sites of conventional transbronchial needle aspiration (C-TBNA), then, histopathological specimens were obtained using the technique of C-TBNA. The final pathological diagnosis was made based on the findings from the surgical specimens. Statistical analyses were performed for specimen results and complications. Results: On pathological evaluation, 14 of the 16 specimens were malignant, including 8 adenocarcinomas, 4 squamous cell carcinomas, and 2 small cell carcinomas, while 2 were non-malignant diseases. The diagnostic accuracy rate, sensitivity and missed diagnosis rates were 87.5%, 87.5% and 12.5%, respectively. When Combined the results of cytology with histologic samples obtained from C-TBNA the total diagnostic accuracy rate, sensitivity and missed diagnosis rate were 93.75%, 93.75% and 6.25%, respectively. There were 2 cases of bleeding complications \u3e5 mL after C-TBNA, and both were resolved with endobronchial management. Conclusions: The combination of R-EBUS with C-TBNA was advantageous and safe for the diagnosis of solitary peribronchial pulmonary lesions located in the segmental bronchi. However, possible bleeding complications should be anticipated with needle aspiration. Further verification of this combined application should be investigated in larger clinical trials

Cardiovascular disease, chronic kidney disease, and diabetes mortality burden of cardiometabolic risk factors from 1980 to 2010: A comparative risk assessment

Background: High blood pressure, blood glucose, serum cholesterol, and BMI are risk factors for cardiovascular diseases and some of these factors also increase the risk of chronic kidney disease and diabetes. We estimated mortality from cardiovascular diseases, chronic kidney disease, and diabetes that was attributable to these four cardiometabolic risk factors for all countries and regions from 1980 to 2010. Methods: We used data for exposure to risk factors by country, age group, and sex from pooled analyses of population-based health surveys. We obtained relative risks for the effects of risk factors on cause-specific mortality from meta-analyses of large prospective studies. We calculated the population attributable fractions for each risk factor alone, and for the combination of all risk factors, accounting for multicausality and for mediation of the effects of BMI by the other three risks. We calculated attributable deaths by multiplying the cause-specific population attributable fractions by the number of disease-specific deaths. We obtained cause-specific mortality from the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study. We propagated the uncertainties of all the inputs to the final estimates. Findings: In 2010, high blood pressure was the leading risk factor for deaths due to cardiovascular diseases, chronic kidney disease, and diabetes in every region, causing more than 40% of worldwide deaths from these diseases; high BMI and glucose were each responsible for about 15% of deaths, and high cholesterol for more than 10%. After accounting for multicausality, 63% (10·8 million deaths, 95% CI 10·1-11·5) of deaths from these diseases in 2010 were attributable to the combined effect of these four metabolic risk factors, compared with 67% (7·1 million deaths, 6·6-7·6) in 1980. The mortality burden of high BMI and glucose nearly doubled from 1980 to 2010. At the country level, age-standardised death rates from these diseases attributable to the combined effects of these four risk factors surpassed 925 deaths per 100 000 for men in Belarus, Kazakhstan, and Mongolia, but were less than 130 deaths per 100 000 for women and less than 200 for men in some high-income countries including Australia, Canada, France, Japan, the Netherlands, Singapore, South Korea, and Spain. Interpretation: The salient features of the cardiometabolic disease and risk factor epidemic at the beginning of the 21st century are high blood pressure and an increasing effect of obesity and diabetes. The mortality burden of cardiometabolic risk factors has shifted from high-income to low-income and middle-income countries. Lowering cardiometabolic risks through dietary, behavioural, and pharmacological interventions should be a part of the global response to non-communicable diseases. Funding: UK Medical Research Council, US National Institutes of Health. © 2014 Elsevier Ltd

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

Mitochondrial physiology

As the knowledge base and importance of mitochondrial physiology to evolution, health and disease expands, the necessity for harmonizing the terminology concerning mitochondrial respiratory states and rates has become increasingly apparent. The chemiosmotic theory establishes the mechanism of energy transformation and coupling in oxidative phosphorylation. The unifying concept of the protonmotive force provides the framework for developing a consistent theoretical foundation of mitochondrial physiology and bioenergetics. We follow the latest SI guidelines and those of the International Union of Pure and Applied Chemistry (IUPAC) on terminology in physical chemistry, extended by considerations of open systems and thermodynamics of irreversible processes. The concept-driven constructive terminology incorporates the meaning of each quantity and aligns concepts and symbols with the nomenclature of classical bioenergetics. We endeavour to provide a balanced view of mitochondrial respiratory control and a critical discussion on reporting data of mitochondrial respiration in terms of metabolic flows and fluxes. Uniform standards for evaluation of respiratory states and rates will ultimately contribute to reproducibility between laboratories and thus support the development of data repositories of mitochondrial respiratory function in species, tissues, and cells. Clarity of concept and consistency of nomenclature facilitate effective transdisciplinary communication, education, and ultimately further discovery

In vitro and in vivo effects of the SRC tyrosine kinase inhibitor Dasatinib and the chemotherapeutic docetaxel in Triple- Negaitve Breast Cancer

BACKROUND: The term “triple-negative breast cancer” (TNBC) is used to identifythe approximately 15% of breast cancers that lack expression of estrogen receptor (ER)and progesterone receptor (PR) and do not show amplification of the human epidermalgrowth factor receptor 2 (HER2) gene. TNBCs are a heterogeneous group of tumorswith one common feature: a distinctly aggressive nature with higher rates of relapseand shorter overall survival in the metastatic setting compared to other subtypes ofbreast cancer. To date, not a single targeted therapy has been approved for the treatmentof TNBC, and cytotoxic chemotherapy remains the standard treatment. OBJECTIVE: The experimental study of the effects of the chemotherapeutic docetaxeland the bcr/abl kinase inhibitor dasatinib on triple- negative breast cancer cell lines (invitro) and on TNBC tumor xenograft mouse models (in vivo). MATERIALS AND METHODS: TNBC cell lines were cultivated and treated withvarious concentrations of docetaxel and dasatinib (5 nM to 100nM). Cell death andapoptosis were studied by flow cytometry. TNBC cell lines were then injected inBALB/c athymic nude mice to express the tumor in vivo. Four groups of mice werecreated (group A: Control, group B: DOC, group C: DAS, group D: DOC + DAS) andtreated respectively with the drugs and their combination. Tumors were obtained,maintained in formaldehyde solution of 10%, embedded in paraffin and sent for furtherhistological evaluation (hematoxylin- eosin staining and immune-histochemicalanalysis) to assess the tumor growth inhibition. RESULTS: The cytotoxic effects of docetaxel seem to be statistically important, withlittle effect on apoptosis. The effect of dasatinib in vitro and vivo is statisticallyimportant, in terms of apoptosis and tumor reduction, with little adverse effects. CONCLUSION: TNBC is a difficult to treat oncologic condition, even in theexperimental setting. Promising results concerning the addition of targeted therapies(dasatinib) to the conventional cytotoxic ones (docetaxel) have been shown, awaitingfurther evaluation.ΕΙΣΑΓΩΓΗ: Ο όρος «Τριπλά- Αρνητικός Καρκίνος του Μαστού (TNBC) αναφέρεταιστο περίπου 15% των καρκίνων του μαστού που στερούνται της έκφρασης τωνοιστρογονικών (ER) και προγεστερονικών υποδοχέων (PR) και δεν εμφανίζουνέκφραση του γονιδίου του υποδοχέα του ανθρώπινου επιδερμικού αυξητικούπαράγοντα 2 (HER2). Ο TNBC αποτελεί μια ετερογενή ομάδα όγκων με ένα κοινόχαρακτηριστικό: μια επιθετική φύση με υψηλότερα ποσοστά υποτροπής και βραχύτερησυνολική επιβίωση σε σύγκριση με άλλους υποτύπους καρκίνου του μαστού. Έως καισήμερα, δεν έχει εγκριθεί κάποια στοχευμένη θεραπεία για τον TNBC, με τηνκυτταροτοξική χημειοθεραπεία να αποτελεί τη βασική θεραπεία. ΣΚΟΠΟΣ: Η πειραματική μελέτη της επίδρασης του χημειοθεραπευτικού ντοσεταξέληκαι του αναστολέα κινασών bcr/abl δασατινίμπη σε κυτταρικές σειρές Τριπλά-Αρνητικού Καρκίνου του Μαστού (in vitro), καθώς και σε πειραματικά μοντέλαποντικών που προσβλήθηκαν από τον TNBC (in vivo). ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΙ: Κυτταρικές σειρές TNBC καλλιεργήθηκαν και χορηγήθηκανσε αυτές διάφορες συγκεντρωσεις ντοσεταξέλης και δασατινίμπης (από 5 nM έως100nM). Ο κυτταρικός θάνατος και η απόπτωση μελετήθηκαν με την τεχνική τηςκυτταρομετρίας ροής. Οι κυτταρικές σειρές TNBC εν συνεχεία ενοφθαλμίστηκαν σεBALB/c άτριχα αθυμικά ποντίκια για έκφραση του όγκου in vivo. Τα ζώα τουεργαστηρίου χωρίστηκαν σε τέσσερις ομάδες (group A: Control, group B: DOC, groupC: DAS, group D: DOC + DAS) και θεραπεύτηκαν αντίστοιχα με τους παραπάνωφαρμακευτικούς παράγοντες και τους συνδυασμούς τους. Οι όγκοι αφαιρέθηκαν,συντηρήθηκαν σε διάλυμα φορμαλδεΰδης 10%, τοποθετήθηκαν σε παραφφίνη καιστάλθηκαν για περαιτέρω ιστολογική αξιολόγηση (χρώση αιματοξυλίνης- εωσίνης καιανοσοϊστοχημική ανάλυση) για εκτίμηση της αναστολής εξέλιξης του όγκου. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η ντοσεταξέλη έχει σημαντική επίδραση στην αναστολήκυτταρικού πολλαπλασιασμού και την επαγωγή απόπτωσης in vitro, με τακυτταροτοξικά αποτελέσματά της να χρήζουν ιδιαίτερης προσοχής και σημασίας. Ηεπίδραση της δασατινίμπης in vitro κρίνεται στατιστικά σημαντική, στον τομέα τηςαπόπτωσης και της μείωσης (αναστολής κυτταρικού πολλαπλασιασμού) του όγκου, μεαποδεκτό προφίλ ανεπιθύμητων ενεργειών. Στην in vivo πειραματική διαδικασία, ησυνδυασμένη δράση των δύο παραγόντων φαίνεται πως έχει σημαντικό κλινικόόφελος, λαμβάνοντας ταυτόχρονα υπόψη το προφίλ τοξικότητας της ντοσεταξέλης. ΣΥΜΠΕΡΑΣΜΑΤΑ: Ο TNBC είναι μια δύσκολη στη θεραπεία ογκολογική οντότητα,ακόμα και σε πειραματικό επίπεδο. Παρατηρούνται ενθαρρυντικά αποτελέσματα πουαφορούν στην προσθήκη στοχευμένων θεραπειών (δασατινίμπη) στη συμβατικήκυτταροτοξική χημειοθεραπεία (ντοσεταξέλη), τόσο in vitro όσο και in vivo, τα οποίαχρήζουν περαιτέρω αξιολόγησης

Giant nonfunctioning adrenal tumors: two case reports and review of the literature

Abstract Background There are an estimated 1–2 cases per million per year of adrenocortical carcinoma in the USA. It represents a rare and aggressive malignancy; it is the second most aggressive endocrine malignant disease after anaplastic thyroid carcinoma. Non-secretory adrenal masses are diagnosed late due to a mass effect or metastatic disease or found incidentally (adrenal incidentalomas). Case presentation The first case report describes a 39-year-old Greek woman who presented to our department with complaints of repeated symptoms of flatulence and epigastric discomfort over a few months. The second case report is about a 67-year-old Greek woman who presented to our department after being evaluated for fatigue, mass effect, and epigastric discomfort. Both of them were diagnosed as having a nonfunctioning adrenocortical carcinoma and underwent open adrenalectomy. Conclusions Approximately 60% of patients with adrenocortical carcinoma present with symptoms and signs of hormonal secretion. Our cases’ adrenocortical carcinomas were not functional. Hormone secretion is not a discriminating feature between benign and malignant adrenocortical masses. The silent clinical nature of nonfunctioning adrenocortical carcinoma results in late diagnosis, while the majority of patients present with locally advanced and/or metastatic disease. Adrenocortical carcinoma is a rare endocrine tumor with a poor prognosis that can be diagnostically challenging and demands high clinical suspicion. The work-up for adrenal masses must include determination of whether the mass is functioning or nonfunctioning and whether it is benign or malignant

Correction to: Giant nonfunctioning adrenal tumors: two case reports and review of the literature

In the publication of this article [1], there is an error in the Family Name and Given Name of the authors since these were interchanged

Propensity Matched Outcomes of Minimally Invasive Mitral Surgery: Does a Heart-Team Approach Eliminate Female Gender as an Independent Risk Factor?

Background: There is increasing evidence that female gender is an independent risk factor for cardiac surgery. Minimally invasive mitral surgery (MIV) has proven to have excellent long-term results, but little is known about gender-dependent outcomes. The aim of our study was to analyze our heart team's decision-based MIV-specialized cohort. Methods: In-hospital and follow-up data were retrospectively collected. The cohort was divided into gender groups and propensity-matched groups. Results: Between 22 July 2013 and 31 December 2022, 302 consecutive patients underwent MIV. Before matching, the total cohort showed that women were older, had a higher EuroSCORE II, were more symptomatic, and had more complex valve pathology and tricuspid regurgitation resulting in more valve replacements and tricuspid repairs. Intensive and hospital stays were longer. In-hospital deaths (n = 3, all women) were comparable, with more atrial fibrillation in women. The median follow-up time was 3.44 (0.008–8.9) years. The ejection fraction, NYHA, and recurrent regurgitation were low and comparable and atrial fibrillation more frequent in women. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.9 and p = 0.2). Propensity matching compared 101 well-balanced pairs; women still had fewer resections and more atrial fibrillation. During the follow-up, women had a better ejection fraction. The calculated 5-year survival and freedom from re-intervention were comparable (p = 0.3 and p = 0.3). Conclusions: Despite women being older and sicker, with more complex valve pathology and subsequent replacement, early and mid-term mortality and the need for reoperation were low and comparable before and after propensity matching, which might be the result of the MIV setting combined with our patient-tailored decision-making. We believe that a multidisciplinary heart team approach is crucial to optimize patient outcomes in MIV, and it might also reduce the widely reported increased surgical risk in female patients. Further studies are needed to prove our findings

Symptomatic colonic lipomas: Report of two cases and a review of the literature

Colonic lipomas are the second most common benign tumor of the colon. During a systematic literature search, a lack of review is observed. This study reports two cases of colonic lipomas and also tries to review the clinical and pathologic features of the reported symptomatic lipomas