Prognostic Significance of Solitary Lymphnode Metastasis and Micrometastasis in Gastric Cancer

Gastric cancer (GC) used to be one of the most common malignancies in the world and still is the second leading cause of malignancy-related death in the Far East. The most significant factors that were found to be associated with the clinical outcome in patients with non-metastatic (M0) gastric cancer is tumor's depth of invasion, the presence and the extend of lymphnode involvement, as well as the histological type according to Lauren (intestinal or diffuse). Although it is generally accepted that D2 gastrectomy is the procedure of choice to achieve adequate oncologic excision, there are quite many concerns for its use in patients with early gastric cancer (EGC), where No or N1 specimens are frequently reported. The last two decades, with the evolvement of cancer cell detection techniques, the attend of the medical community is focused on GC patients with solitary lymphnode metastasis (SLN) or micrometastasis (mM). There is a discussion whether SLN should be attributed as the “real” sentinel node (SN) and its projection on patients' survival. The aim of this study is to review the recent literature and attempt to clarify the clinical significance of SLN in gastric cancer

The effect of intra abdominal infection on the pharmacokinetics of tigecycline in plasma and tissues: experimental study on Wistar rats

The aim of the doctoral thesis was to investigate possible alterations in tissue penetration of antibiotics (tigecycline) in complicated Intra-Abdominal Infections (cIAI) in an experimental animal model. For this purpose 132 adult male Wistar rats were divided in 2 groups, infection group (IG) and control group (CG). A standard solution with fixed concentration (0,5 MacFarland) of selected strains of E. Coli (ATCC25922) and Acinetobacter baumanii were inoculated intraperitonally in IG rats causing cIAI. On day 7 after inoculation in IG, and in all animals in CG, tigecycline (TG) was infused intravenously in a 7mg/kg dose. Animals were sacrificed in time-related groups on specific time intervals (1/2 , 1, 2, 4, 6, 9, 12 and 24h after infusion respectively) and tissue samples from liver, kidney, large intestine, spleen, muscle as well as plasma were collected. The tissue samples were processed and measured by liquid chromatography-mass spectrometry system (LC-MS/MS). The results of the measurements were analyzed statistically, normality check was performed and time/concentration graphs were created. Tigecyline concentrations were higher in IG than CG in all time intervals in all tissues studied except spleen. Consequently the calculation of the Area Under the Curve concentration/time (AUC0-24) were higher in IG than CG rats, but statistical analysis revealed difference of statistical significance (p<0.05) in the two groups only for large intestine and liver. In the experimental animal model used, rats in cIAI group showed wider tissue penetration of tigecycline than control group, although not proven to be statistical significant for all tissues studied. The authors suggest that the relatively high dose of TG used, the dose-dependence of TG half-life in animals, as well as the long post antibiotic effect of the drug might have milden the differences in tissue penetration.Σκοπός της διατριβής ήταν να διερευνηθεί η επίδραση της (επιπλεγμένης) ενδοκοιλιακής λοίμωξης (ΕΕΛ) στην ιστική φαρμακοκινητική του αντιβιοτικού (τιγεκυκλίνη) σε πειραματικό μοντέλο με ζωικά πρότυπα. Για το σκοπό της μελέτης χρησιμοποιήθηκαν 132 ενήλικοι άρρενες επίμυες τύπου Wistar οι οποίοι χωρίστηκαν σε 2 ομάδες, την Ομάδα Λοίμωξης (ΟΛ) και την Ομάδα Ελέγχου (ΟΕ) . Προκειμένω να επιτευχθεί σταθερή και αναπαραγώγιμη ενδοκοιλιακή λοίμωξη (ΟΛ) χρησιμοποιήθηκαν ανακαλλιέργειες από συγκεκριμένα στελέχη E. Coli (ATCC25922) και Acinetobacter baumanii από τα οποία προέκυπτε πρότυπο διάλυμα 0,5 MacFarland και το οποίο εγχέονταν ενδοπεριτοναϊκά. Και στις 2 ομάδες χορηγήθηκε ενδοφλέβια τιγεκυκλίνη σε δόση 7mg/kg, στην ομάδα λοίμωξης αυτό διενεργούνταν την 7η ημέρα μετά τον ενοφθαλμισμό των μικροβίων. Τα ζωικά πρότυπα θυσιάζονταν σε συγκεκριμένα χρονικά στιγμιότυπα μετά την χορήγηση του φαρμάκου (1/2 , 1, 2, 4, 6, 9, 12 και 24 ώρες) και λήφθηκαν ιστοτεμάχια ήπατος, παχέος εντέρου, σπληνός, νεφρού, μυός, καθώς και πλάσμα. Από τα ιστικά δείγματα και μετά από κατάλληλη επεξεργασία λαμβάνονταν με έκλουση διαλύματα, στα οποία μετρήθηκαν οι ιστικές συγκεντρώσεις της τιγεκυκλίνης σε σύστημα Υγρής Χρωματογραφίας συζευγμένη με Φασματομετρία Μαζών (LC-MS/MS). Ακολούθησε στατιστική επεξεργασία των αποτελεσμάτων των μετρήσεων, έλεγχος κανονικότητας των τιμών, δημιουργία γραφημάτων συγκέντρωσης/χρόνου και υπολογισμός της επιφάνειας κάτω από την καμπύλη AUC0-24. Οι συγκεντρώσεις της τιγεκυκλίνης ήταν υψηλότερες στην ΟΛ σε σχέση με την ΟΕ σε όλα τα ιστικά δείγματα που μελετήθηκαν εκτός από τον σπλήνα, και για όλα τα χρονικά στιγμιότυπα. Κατ’ αναλογία οι επιφάνειες κάτω από την καμπύλη χρόνου-συγκέντρωσης (AUC0-24) ήταν υψηλότερες στην ΟΛ, ωστόσο η στατιστική επεξεργασία των αποτελεσμάτων έδειξε στατιστικά σημαντική διαφορά μόνο για το παχύ έντερο και τον σπλήνα. Στο πειραματικό μοντέλο που χρησιμοποιήθηκε, επιβεβαιώθηκε η αυξημένη ιστική διάχυση του υπό μελέτη αντιβιοτικού (τιγεκυκλίνη) στα πειραματόζωα με ΕΕΛ, αν και στατιστικά σημαντική διαφορά φάνηκε μόνο για δύο ιστούς. Η σχετικά μεγάλη δόση του φαρμάκου που χρησιμοποιήθηκε, ο δοσοεξαρτώμενος χρόνος ημίσειας ζωής της τιγεκυκλίνης στα ζωικά πρότυπα, καθώς και το μακρόχρονο μετά-αντιβιοτικό αποτέλεσμα του φαρμάκου, πιθανώς να «κάλυψαν» τυχόν μεγαλύτερες διαφορές

Surgical Significance of Berry&rsquo;s Posterolateral Ligament and Frequency of Recurrent Laryngeal Nerve Injury into the Last 2 cm of Its Caudal Extralaryngeal Part(P1) during Thyroidectomy

Background and Objectives: Recurrent laryngeal nerve injury is one of the major complications of thyroidectomy, with the lateral thyroid ligament (Berry&rsquo;s ligament) being the most frequent site of nerve injury. Neuromonitoring during thyroidectomy revealed three possible anatomical regions of the recurrent laryngeal nerve P1, P2, and P3. P1 represents the recurrent laryngeal nerve&rsquo;s caudal extralaryngeal part and is primarily associated with Berry&rsquo;s ligament. The aim of this systematic review is to identify the anatomical region with the highest risk of injury of the recurrent laryngeal nerve (detected via neuromonitoring) during thyroidectomy and to demonstrate the significance of Berry&rsquo;s ligament as an anatomical structure for the perioperative recognition and protection of the nerve. Materials and Methods: This study conducts a systematic review of the literature and adheres to all PRISMA system criteria as well as recommendations for systematic anatomical reviews. Three search engines (PubMed, Scopus, Cochrane) were used, and 18 out of 464 studies from 2003&ndash;2018 were finally included in this meta-analysis. All statistical data analyses were performed via SPSS 25 and Microsoft Office XL software. Results: 9191 nerves at risk were identified. In 75% of cases, the recurrent laryngeal nerve is located superficially to the ligament. In 71% of reported cases, the injury occurred in the P1 area, while the P3 zone (below the location where the nerve crosses the inferior thyroid artery) had the lowest risk of injury. Data from P1, P2, and P3 do not present significant heterogeneity. Conclusions: Berry&rsquo;s ligament constitutes a reliable anatomical structure for recognizing and preserving recurrent laryngeal nerves. P1 is the anatomical area with the greatest risk of recurrent laryngeal nerve damage during thyroidectomy, compared to P2 and P3

A Unique Case of Appendiceal Intussusception (Inversion): A Case in Bloom

A 40-year-old female patient presented to a secondary facility with dull lower abdominal pain and a persistent low-grade fever. Her laboratory results showed elevated inflammation markers. A CT scan revealed two abscesses in the lesser pelvic region in direct contact with the apex of the appendix, the posterior wall of the uterus, and the right-side appendages. The patient responded well to intravenous antibiotics, and an MRI scan revealed the cause to be an appendiceal rupture. The patient was scheduled for an appendectomy. The procedure started laparoscopically but had to be converted to an open one with a midline infra-umbilical incision in order to protect the right appendages. A standard appendectomy was conducted, and the histology report revealed rupture of the appendix with concomitant wall inversion in the context of fibrous adhesions as well as obstruction due to a fecalith. Patient recovery and follow-up were excellent. Acute appendicitis, while frequently encountered in surgical practice, can present a diagnostic conundrum when it manifests in an atypical manner. This unique form of inversion appeared to confer a protective role against peritonitis, primarily through the mechanism of obstruction occurring centrally to the rupture. We suggest that this case should be included in current classifications as a partial inversion of the appendix after rupture and inflammation

Giant Echinococcosis of the Liver with Suppuration: A Case Report and Review of the Literature

Purpose: Cystic echinococcosis (CE) is a common, complex parasitic disease that constitutes a major public health concern. CE demonstrates high endemicity in areas where dogs are used for herding or where animal husbandry practices involve close contact with livestock. It can clinically manifest with a variety of signs and symptoms, such as cholangitis, jaundice, pancreatitis, external biliary fistula, inferior vena cava obstruction, portal hypertension, and superinfection. The latter can notably be related to suppuration, either by rupture or bacteremia. The aim of this study is to report our 76-year-old patient who presented with a primarily infected giant-suppurated hydatid cyst of the liver and its surgical management. Methods: In this case, the diagnosis was based primarily on clinical presentation, computed tomography (CT) scan, and magnetic resonance imaging (MRI) of the patient’s abdomen. The surgical procedure of choice was the partial retaining of the pericystic membrane and drainage of the cystic contents (partial pericystectomy). Results: The surgical management and meticulous long-term follow-up of our patient produced a positive outcome without any post-operative complications

Brain aging in major depressive disorder: results from the ENIGMA major depressive disorder working group.

Major depressive disorder (MDD) is associated with an increased risk of brain atrophy, aging-related diseases, and mortality. We examined potential advanced brain aging in adult MDD patients, and whether this process is associated with clinical characteristics in a large multicenter international dataset. We performed a mega-analysis by pooling brain measures derived from T1-weighted MRI scans from 19 samples worldwide. Healthy brain aging was estimated by predicting chronological age (18-75 years) from 7 subcortical volumes, 34 cortical thickness and 34 surface area, lateral ventricles and total intracranial volume measures separately in 952 male and 1236 female controls from the ENIGMA MDD working group. The learned model coefficients were applied to 927 male controls and 986 depressed males, and 1199 female controls and 1689 depressed females to obtain independent unbiased brain-based age predictions. The difference between predicted "brain age" and chronological age was calculated to indicate brain-predicted age difference (brain-PAD). On average, MDD patients showed a higher brain-PAD of +1.08 (SE 0.22) years (Cohen's d = 0.14, 95% CI: 0.08-0.20) compared with controls. However, this difference did not seem to be driven by specific clinical characteristics (recurrent status, remission status, antidepressant medication use, age of onset, or symptom severity). This highly powered collaborative effort showed subtle patterns of age-related structural brain abnormalities in MDD. Substantial within-group variance and overlap between groups were observed. Longitudinal studies of MDD and somatic health outcomes are needed to further assess the clinical value of these brain-PAD estimates

Brain Aging in Major Depressive Disorder: Results from the ENIGMA Major Depressive Disorder working group

Background: Major depressive disorder (MDD) is associated with an increased risk of brain atrophy, aging-related diseases, and mortality. We examined potential advanced brain aging in MDD patients, and whether this process is associated with clinical characteristics in a large multi-center international dataset. Methods: We performed a mega-analysis by pooling brain measures derived from T1-weighted MRI scans from 29 samples worldwide. Normative brain aging was estimated by predicting chronological age (10-75 years) from 7 subcortical volumes, 34 cortical thickness and 34 surface area, lateral ventricles and total intracranial volume measures separately in 1,147 male and 1,386 female controls from the ENIGMA MDD working group. The learned model parameters were applied to 1,089 male controls and 1,167 depressed males, and 1,326 female controls and 2,044 depressed females to obtain independent unbiased brain-based age predictions. The difference between predicted brain age and chronological age was calculated to indicate brain predicted age difference (brain-PAD). Findings: On average, MDD patients showed a higher brain-PAD of +0.90 (SE 0.21) years (Cohen's d=0.12, 95% CI 0.06-0.17) compared to controls. Relative to controls, first-episode and currently depressed patients showed higher brain-PAD (+1.2 [0.3] years), and the largest effect was observed in those with late-onset depression (+1.7 [0.7] years). In addition, higher brain-PAD was associated with higher self-reported depressive symptomatology (b=0.05, p=0.004). Interpretation: This highly powered collaborative effort showed subtle patterns of abnormal structural brain aging in MDD. Substantial within-group variance and overlap between groups were observed. Longitudinal studies of MDD and somatic health outcomes are needed to further assess the predictive value of these brain-PAD estimates

Delayed colorectal cancer care during covid-19 pandemic (decor-19). Global perspective from an international survey

Background The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer (CRC) care during the pandemic. Methods The impact of COVID-19 on preoperative assessment, elective surgery, and postoperative management of CRC patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in CRC care. Respondents were divided into two comparator groups: 1) ‘delay’ group: CRC care affected by the pandemic; 2) ‘no delay’ group: unaltered CRC practice. Results A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the ‘delay’ (745, 70.9%) and ‘no delay’ (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to COVID-19 units, units fully dedicated to COVID-19 care, personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology and prolonged chemoradiation therapy-to-surgery intervals. In the ‘delay’ group, 48.9% of respondents reported a change in the initial surgical plan and 26.3% reported a shift from elective to urgent operations. Recovery of CRC care was associated with the status of the outbreak. Practicing in COVID-free units, no change in operative slots and staff members not relocated to COVID-19 units were statistically associated with unaltered CRC care in the ‘no delay’ group, while the geographical distribution was not. Conclusions Global changes in diagnostic and therapeutic CRC practices were evident. Changes were associated with differences in health-care delivery systems, hospital’s preparedness, resources availability, and local COVID-19 prevalence rather than geographical factors. Strategic planning is required to optimize CRC care