404 General Military Hospital

ObjectiveTo determine whether the clinical phenotype of chemotherapy-induced neuropathic pain (CINP) varies based on the gender and age of patients.MethodsRetrospective, file-based analysis of cancer patients who received any conventional standard of care chemotherapy and were referred to assess the extent of painful chemotherapy-induced peripheral neurotoxicity (CIPN). A Propensity Score Matching Analysis (PSMA) was conducted to create balanced cohorts; accounting for variables that could impact the incidence and severity of CINP in CIPN patients. A total of 205 males and 295 females were initially included, and after PSMA, 191 patients of each gender were equally matched; totaling 382 patients. These patients were divided according to their age to those aged ≤65 years (group I, n=216) and patients aged ≥66 years (group II, n=166). CINP was assessed using the pain intensity numerical rating scale (PI-NRS) and the Douleur Neuropathique-4 questionnaire (DN4). The severity of CIPN was graded with Total Neuropathy Score-clinical (TNSc®). ResultsThe incidence of CINP was similar between males and females (27.2% vs. 27.7%; p = 1). The same applied for the DN4 scorings at CINP onset (median 7; p = 0.9). The severity of CINP at the end of chemotherapy, according to PI-NRS, was 7 (range:6–9) for males vs. 7 (range: 5–8) for females (p = 0.09), while at 3 months post-chemotherapy the PI-NRS scorings were comparable (p = 0.56). However, males tended towards higher rates of severe CINP (PI-NRS ≥ 7) [males: 59.5%, females: 40.5%; p = 0.1], compared to female patients, despite having lower CIPN severities, according to TNSc® scoring. No statistically significant differences were observed in the incidence (25% vs. 30.7%; p = 0.214) and severity (mean PI-NRS difference p = 0.584) of CINP between age groups. Older male patients presented a higher likelihood (OR: 1.08; 95CI: 1.01–1.16; p = 0.027) of severe pain (PI-NRS ≥ 7) at the end of chemotherapy, compared to their younger counterparts.ConclusionThere were no significant differences found between the occurrence and severity of CINP, based on gender or age. However, older men had more severe pain raters (PI-NRS), while scoring lower in TNSc® severities. Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-025-14579-x.

Abstract Background Anti-TNFa agents (anti-TNFs) are still the first line therapy for patients with Inflammatory Bowel Disease (IBD). We aimed to i) report IBD patients receiving anti-TNFs, who needed dose escalation because of secondary loss of response, and (ii) identify the rate and predictors of successful dose de-escalation. Methods Multicenter retrospective cohort study. Data were collected from consecutive patients with IBD followed up in referral centers in Greece and Turkey, who initially responded to the standard treatment scheme with anti-TNFs and subsequently received intensified regimens, because of secondary loss of response. Clinical response, steroid free clinical remission, biochemical response and/or mucosal healing were evaluated at 3 and 6 months after dose escalation. Adverse events were also recorded. Predictors for successful dose de-escalation were sought using multivariate analysis. Results A total of 1129 patients (Crohn’s disease = 743, ulcerative colitis = 386) were included in the analysis. Of those, 650 patients were receiving Infliximab (57.6%), 471 Adalimumab (41.7%) and 8 Golimumab (0.7%). The median (IQR) duration of treatment with anti-TNF before the need for dose escalation was 13.0 (6.0-36.0) months; precisely 12.0 (6.0-34.0), 14.0 (6.0-37.5) and 4.0 (1.7-5.0) months for Infliximab, Adalimumab and Golimumab, respectively. After a median (IQR) period of 16.0 (8.0-36.0) months, 283 (25.1%) patients were successfully de-escalated to the standard anti-TNF regimen, while 506 (44.8%) patients were switched to an agent with a different mode of action and 340 (30.1%) patients remained in the escalated anti-TNF dosage. The cumulative incidence rates of successful treatment de-escalation at 12, 36, 60 and 96 months were 8.4%, 30.1%, 48.5% and 57.9% respectively. No serious adverse events necessitating anti-TNF discontinuation were noted during the period of intensified treatment. Predictors of successful dose de-escalation were the concomitant use of steroids at the time of dose escalation and the anti-TNFa agent used (infliximab vs adalimumab or golimumab), whereas the presence of extra-intestinal manifestations, prior anti-TNF exposure (adalimumab use before the administration of infliximab and vice versa) and longer duration of anti-TNF administration before dose escalation influenced negatively the attempt of dose de-escalation. Conclusion In this multi-center cohort study, one fourth of patients with IBD necessitating intensified treatment with anti-TNFs, because of secondary loss of response, were successfully de-escalated to the standard anti-TNF dose, after a median (IQR) period of 16.0 (8.0-36.0) months.

Background and objectives: Laparoscopic cholecystectomy (LC) is the most commonly performed operation in general surgery in the Western World. Gallbladder surgery, although most of the time simple, always offers the possibility of unpleasant surprises. Despite progress, the incidence of common bile duct injury is 0.2-0.4%, causing devastating implications for the patient and the surgeon. This is mainly due to the failure to identify the normal anatomy properly. The literature review reveals a lack of structured knowledge in the surgical anatomy of cholecystectomy. The aim of this study was to develop a framework with a common anatomical language for safe laparoscopic and open cholecystectomy. Materials and Methods: The Hellenic Task Force group on the typology for Safe Laparoscopic Cholecystectomy performed a critical review of the literature on the laparoscopic anatomy of cholecystectomy. The results were compared with those of a clinical study of 279 patients undergoing LC for uncomplicated symptomatic gallstone disease. Results: Fourteen elements encountered during LC under the critical view of safety (CVS) approach were determined. The typical vascular-biliary pedicle with one cystic duct distributed laterally (or caudally) and one cystic artery medially (or cranially) lying at any point of the hepatocystic space was found in 66% of the cases studied. Anatomical schemata were formulated corresponding to the norm and four variations. Conclusions: The proposed cognitive anatomical schemata summarize simply what one can expect in terms of deviation from the norm. We believe that the synergy between the correct application of the CVS and the structured knowledge of the surgical anatomy in cholecystectomy helps the surgeon to handle non-typical structures safely and to complete the laparoscopic or open cholecystectomy without vascular-biliary injuries.

Senescence-resembling alterations on the lymphocytes of patients undergoing dialysis have been widely described. However, the pathophysiology behind these phenomena has not been clarified. In this study, we examined the impact of dialysis prescription on T and B lymphocytes, in patients undergoing dialysis.: T and B cell subsets were determined with flow cytometry in 36 patients undergoing hemodialysis and 26 patients undergoing hemodiafiltration, according to the expression of CD45RA, CCR7, CD31, CD28, CD57, and PD1 for T cells, and IgD and CD27 for B cells. The immune phenotype was associated with dialysis modality, hemofiltration volume, and mortality. Compared with hemodialysis, patients undergoing hemodiafiltration had a significantly decreased percentage of CD4+CD28-CD57- T cells [3.8 (2.4–5.3) vs. 2.1 (1.3–3.3)%, respectively, p = 0.002] and exhausted CD4+ T cells [14.1 (8.9–19.4) vs. 8.5 (6.8–11.7)%, respectively, p = 0.005]. Additionally, the hemofiltration volume was negatively correlated with CD8+ EMRA T cells (r = −0.46, p = 0.03). Finally, the increased exhausted CD4+ T cell percentage was associated with increased all-cause mortality in patients undergoing dialysis, independent of age. Hemodiafiltration, especially with high hemofiltration volume, may have beneficial effects on senescence-related immune phenotypes. Immune phenotypes may also be a predicting factor for mortality in patients undergoing dialysis.

Chronic pain is best understood as a disease process rather than a symptom. Underlying mechanisms for chronic pain are, nociceptive- tissue damage, neuropathic - sensory, nervous system damage, central heightened pain sensitivity in the central nervous system. Chronic pain has signicant cognitive, affective, and interpersonal components. Effective chronic pain management is focused on maximizing function and limiting disability, not just on reducing pain. Non-pharmacological pain management is method utilizes ways to alter thoughts and focus concentration to better manage and reduce pain. Hypnosis is an effective method for acute and chronic pain, but there are also a few limitations. It is only effective in patients with high hypnotic susceptibility. The anticipated analgesic effect is not achieved in low to moderately hypnotizable patients. The cognitive behavioral approach can be used in patients who do not practice self-hypnosis. There are cases where patients with chronic pain have psychological problems. These patients require psychodynamic therapy, which is not in the range of pain medicine. Hypnosis may be a helpful nondrug therapy to reduce pain in chronic conditions.

Patient response after treatment of renal cell cancer (RCC) with systemic agents, which include various drug categories, is generally poor and unpredictable. In this context, the ideal drug administration includes tools to predict the sensitivity of the disease to therapy. The aim of this study was to systematically summarize the reports on the predictive value of the methylation status in the systemic therapy of RCC. Only original articles reporting on the association of promoter methylation with the response of patients or cell lines to systemic agents were included in this review. We applied PRISMA recommendations to the structure and methodology of this systematic review. Our literature search concluded with 31 articles conducted on RCC cell lines and patient tissues. The majority of the studies demonstrated a methylation-dependent response to systemic agents. This correlation suggests that the methylation pattern can be used as a predictive tool in the management of RCC with various classes of systemic agents. However, although methylation biomarkers show promise for predicting response, the evidence of such correlation is still weak. More studies on the gene methylation pattern in patients under systemic therapy and its correlation with different degrees of response are needed.

Objective: The Greek Society of Migraine and Headache Patients conducted its third in-line population web-based survey in 2023 to ascertain if the burden of the disease and the patients’ satisfaction with conventional and novel migraine therapies are changing compared to our previous findings from 2018 and 2020. Methods: The sampling process was based on a random call to participants to reply to a specific migraine-focused self-administered questionnaire, including 83 questions in Greek, which was distributed nationwide through the online research software SurveyMonkey. Results: We eventually enrolled 2565 patients, the majority of which were females. Our findings clearly demonstrate that migraine is still a burdensome condition. The degree of its impact on all aspects of productivity depends on the monthly frequency of migraine and the response rates to acute and prophylactic treatments. A total of 1029 (42.4%) of the patients had visited the emergency room mainly for unresponsiveness to acute treatments or aura-related symptoms. Triptans seem to be partly effective as acute therapies. OnabotulinumtoxinA seems to be effective for almost half of chronic migraine patients (43.9%) to report adequate satisfaction with this treatment (27.8% were “fairly happy”, 10.6% were “very happy”, and 5.5% were “extremely happy”). Due to their high rates of preventative effectiveness, most respondents treated with anti-CGRP Mabs expressed their optimism concerning their future while living with their migraine (88.25%), as well as towards further improvements in their quality of life (82.8%) status, mostly with fremanezumab. Conclusions: The patients recognize the usefulness of anti-CGRP Mabs in migraine prevention and consequently seem to be more optimistic than before about living with migraine. Considering the market change that is anticipated with the use of gepants and ditans, larger longitudinal population-based studies are warranted to further explore if the new era of migraine therapeutics might further lessen the burden of the disease.

Background: We primarily aimed to ascertain whether treatment with OnabotulinumtoxinA (BoNTA) might influence the extent of the interictal burden and cutaneous allodynia in patients with chronic migraine (CM). Methods: Seventy CM patients, who received three consecutive cycles of BoNTA, were studied. The interictal burden was assessed with the Migraine Interictal Burden Scale (MIBS-4), while cutaneous allodynia was examined with the Allodynia Symptom Checklist (ASC-12) together with PI-NRS VAS to obtain hair brushing scores, and then these were compared from baseline (T0) to the last efficacy evaluation follow-up (T1). Efficacy outcomes, mostly mean headache days (MHD) and “Headache Impact Test” scores, were also assessed between T0 and T1. Results: BONTA improved the interictal burden, with a decrease in MIBS-4 scoring by an average of −7 at T1, compared to baseline (p < 0.001). The percentage of patients with a moderate/severe interictal burden was substantially decreased. Likewise, BoNTA reduced the extent of cutaneous allodynia, with a significant reduction in both the ASC-12 (1 vs. 6; p < 0.001) and PI-NRS VAS (1 vs. 5; p < 0.001) to hair brushing median scores at T1, compared to baseline. Reduced MHD rates were significantly associated with a smaller interictal burden at T1. The efficacy of BoNTA, with a significant reduction in MHD and HIT-6 scores at T1 compared to T0, was re-confirmed. Conclusions: BoNTA resulted in a statistically significant reduction in the interictal burden and also improved cutaneous allodynia. The reduction in ictal burden was associated with the down-scaling of the interictal burden. Hence, BoNTA improved the full spectrum of migraine impairment by diminishing the clinical expression of central sensitization.