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

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%)..

Standard and Variable Key Anatomical Structures for Safe Surgical Repair of Bochdalek Hernia: A Rare Case Series

Bochdalek hernia (BH) is a developmental defect in the posterolateral diaphragm, allowing herniation of abdominal contents into the thorax causing mechanical compression of the thoracic viscera. This type of hernia is rare in adults, usually asymptomatic and may be diagnosed incidentally in a routine chest X-ray. The aim of the present retrospective study was to highlight the standard and important anatomical structures that are crucial to safe surgical repair of BH during laparotomy and thoracotomy by the placement of mesh graft, along with a short review of the existing evidence. Records from 2005 to 2017 were reviewed to identify the patients with adult BH who underwent mesh repair through thoracotomy or laparotomy and evaluate the possible complications and results. Six patients were operated for adult BH with the above-mentioned techniques. Four underwent laparotomy and two were treated through thoracotomy. Mild fever was reported only in one patient. There was significant improvement in the symptoms of all patients and no recurrence was reported in the subsequent follow-up period. Surgical treatment is strongly indicated for both symptomatic and asymptomatic patients. Surgeons&apos; in-depth knowledge of the anatomy of the diaphragm will ensure better outcomes for the patients

Surgical anatomy of double pyramidal lobe on total thyroidectomy: a rare case report

Double pyramidal lobe is a scarce anatomical variation of the thyroid gland. Its presence impinges on the completeness of total and subtotal thyroidectomy and the postoperative treatment. Surgeons should be always aware of this variation in order to perform sufficient resection of the thyroid gland and minimize the possibility of recurrence of benign and malignant thyroidopathies

COVID-19 Vaccine Uptake among Healthcare Workers: A Systematic Review and Meta-Analysis

The vaccine-induced immunity of healthcare workers (HCWs) is crucial to controlling the COVID-19 pandemic. Therefore, we conducted a systematic review and meta-analysis to assess the COVID-19 vaccine uptake among HCWs worldwide and to identify predictors of vaccination. We searched Scopus, Web of Science, Medline, PubMed, ProQuest, CINAHL, and medRxiv up to 25 August 2022. We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We found 25 studies including 491,624 vaccinated HCWs, while the full sample included 555,561 HCWs. The overall proportion of vaccinated HCWs was 77.3%. Vaccine uptake for studies that were conducted in North America (85.6%) was higher than the proportion for studies that were conducted in Asia (79.5%), Europe (72.8%), and Africa (65.6%). The overall prevalence of COVID-19 vaccine uptake was 83.6% and 77.4% for physicians and nurses, respectively. Older age, white race, physicians&rsquo; profession, seasonal influenza vaccine, direct COVID-19 patient care, and confidence in COVID-19 vaccine safety and effectiveness were positive predictors of vaccine uptake, while history of SARS-CoV-2 infection was a negative predictor. Deep understanding of the factors that influence HCWs&rsquo; decisions to receive a COVID-19 vaccine is critical to implementing tailored communication strategies for HCWs who are at risk for not getting vaccinated

Liposarcoma of the pelvic fossa masquerading as hematoma: a rare case report and its surgical management

Liposarcomas constitute rare malignant tumors of the soft tissue,with wide anatomical distribution. The prompt diagnosis of a liposarcoma is extremely challenging since these tumors tend to remain asymptomatic, until they grow enough to displace adjacent anatomical structures. In the presented case, a 55-year-old Caucasian male proceeded to our institution complaining about irreducible swelling of the right iliac fossa and constant discomfort, over the course of a year. His medical history revealed injury of the right groin and pelvis a year ago. The diagnosis was ilioinguinal liposarcoma masquerading as hematoma, due to the previous injury.The patient underwent primary complete tumor resection, and the operation was uneventful.The essential diagnostic and surgical steps for the management of a liposarcoma,mimicking a hematoma are meticulously described

Laparoscopic abdominoperineal resection for the treatment of a mucinous adenocarcinoma associated with an anal fistula

Mucinous adenocarcinoma associated with an anal fistula is a rare oncologic entity which may pose diagnostic and therapeutic challenges for Surgeons and Medical Oncologists. Few reported cases without definite therapeutic guidelines exist. It represents 2-3% of all gastrointestinal malignancies and arises from chronic anal fistulas, ischiorectal or perianal abscesses. We report a case of perianal mucinous adenocarcinoma in a 65-year-old male initially surgically treated multiple times for a recurrent fistula in ano of 5 years duration. He presented with an ischiorectal and a perianal fistula. Incisional biopsy from fistulotomy revealed mucinous adenocarcinoma. Contrast enhanced computed tomography scan and magnetic resonance imaging showed a localized perianal growth of a tumor which was further evaluated with colonoscopy. With no evidence of metastasis, we performed a laparoscopic abdominoperineal resection (APR). Two years follow-up after APR and without adjuvant chemotherapy there is not any evidence of recurrence or distant metastasis

Anomalous anatomic trajectory of the superior thyroid artery encountered during thyroidectomy. A rare case report

Superior thyroid artery (STA), which is one of the primary arteries supplying to the thyroid gland, constitutes a severe consideration of both surgeons and interventional radiologists. Knowledge of the origin, the trajectory, the branching patterns and the anatomic aberrations of STA are of paramount clinical significance, due to its proximity to the external branch of the superior laryngeal nerve and the potentiality of accidental hemorrhage. The present manuscript reports for the first time the anomalous trajectory of the left STA, coursing superficially, through the left sternothyroid muscle and underlines the clinical significance of such aberrations