Agios Pavlos General Hospital

Abstract Background Identifying pathogenic/likely pathogenic variants in high-risk cancer genes is key to cancer risk management.Prophylactic surgeries like RRM and RRSO are guideline-recommended options. This study aims to provide real-world evidence on their clinical implementation. Methods Between 2020 and 2025, 203 women referred for genetic testing at Genekor Medical S.A., were detected with P/LP variants in cancer susceptibility genes, for which risk-reducing surgical options are either recommended or considered for discussion. Referring clinicians were invited to complete a questionnaire to assess whether prophylactic surgical options had been discussed, if the patients had agreed to undergo such procedures, and whether the surgeries have already been performed or postponed. Results Among the individuals referred for genetic testing, 168(83%) were referred following a cancer diagnosis, while 35(17%) were unaffected individuals referred due to a family history. 153 individuals (76%) harbored BRCA1/2, 31(15%) harbored PALB2, PTEN, TP53 and 19 (9%) harbored BRIP1,RAD51C, RAD51D P/LP variants. RRSO was discussed with 78/153 (51%) of BRCA1/2 carriers and agreed in 60/78 (77%) cases. Addition of hysterectomy to RRSO was discussed in 16/78 (21%) of cases and agreed in 10/16 (63%). RRM was discussed with 113/203 (56%) of patients and agreed in 73/113(65%). In PALB2, PTEN, TP53 carriers, RRM was discussed in 21/31 (68%) cases, and accepted in 9/21 (43%), while in 5 cases both RRM/RRSO were discussed with 3 women agreeing. Finally, for 19 BRIP1,RAD51C, RAD51D carriers, in 9 cases the physician discussed RRSO as an option, with the examinees agreeing in 7 of them and in 5 cases RRM was discussed with agreement to proceed in 2 of them. In all cases, 22 individuals although agreed to proceed with RRM and/or RRSO, decided to postpone the procedure. Conclusions This study highlights the high awareness and acceptance of surgical management demonstrating the adherence to the recommendations. Age under 35 years and receiving therapy at the time of genetic testing were significant factors in lowering risk reduction RRSO and hysterectomy performance rates. Stage IV cancer was the main reason for not discussing surgical intervention. Citation Format: K. Papazisis, M. Paraskeva, S. Giassas, M. Skondra, R. Iosifidou, C. Tolis, G. Kesisis, E. Zairi, V. Venizelos, C. Markopoulos, I. Natsiopoulos, E. Bleka, I. Xanthakis, A. Ananiadis, D. Matheos, D. Stefanou, A. Adamidis, A. Meintani, G. Kapetsis, D. Bouzarelou, E. Papadopoulou, G. Nasioulas. High-risk cancer susceptibility genes mutation carriers’ compliance with surgical risk reduction for breast and ovarian cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS3-05-05.

Sepsis is heterogeneous, and the optimal strategy for tailoring immunotherapy is uncertain. To investigate whether precision immunotherapy guided by the presence of macrophage activation-like syndrome or sepsis-induced immunoparalysis improves organ dysfunction by day 9. A randomized, double-blind, double-dummy, placebo-controlled clinical trial conducted in 6 countries. Patients with sepsis, defined by Sepsis-3, were included if they had community-acquired or hospital-acquired pneumonia or ventilator-associated pneumonia or bacteremia and sepsis and had displayed either macrophage activation-like syndrome (blood ferritin >4420 ng/mL) or sepsis-induced immunoparalysis (blood ferritin ≤4420 ng/mL and <5000 human leukocyte antigen DR receptors on CD45/CD14 monocytes). The first patient was enrolled August 5, 2021, and the last follow-up, April 29, 2024. Eligible patients were randomized to receive standard care and precision immunotherapy or standard care and placebo. Those in the precision immunotherapy group with macrophage activation-like syndrome received anakinra intravenously (IV) and placebo subcutaneously, and those with sepsis-induced immunoparalysis received subcutaneous recombinant human interferon gamma and IV placebo. Those in the placebo group received both IV and subcutaneous placebo. Treatment was administered for up to 15 days. The primary end point was a decrease of at least 1.4 points in the mean Sequential Organ Failure Assessment (SOFA) score from baseline by day 9. The SOFA score evaluates 6 organ systems, ranging from 0, no dysfunction, to 4, failure, and the total score ranges from 0, normal, to 24, most severe form of multiorgan failure. Key secondary outcomes included 28-day mortality. Of 672 patients assessed for eligibility, 281 were randomized and 276 were included in the primary analysis population (mean [SD] age, 70 [13] years; 93 females [33.7%]; median baseline SOFA score, 9 [IQR, 7-11]). The SOFA decrease end point was attained by 46 of 131 patients (35.1%) in the precision immunotherapy group and by 26 of 145 patients (17.9%) in the placebo group (difference, 17.2% [95% CI, 6.8% to 27.2%]; P = .002). Mortality at 28 days was not statistically significantly different between groups. A total of 1069 serious treatment-emergent adverse events (88.8%) were reported; increased incidence of anemia was noted in the anakinra group; and hemorrhage in the recombinant human interferon gamma group. Among patients with sepsis, precision immunotherapy targeting macrophage activation-like syndrome and sepsis-induced immunoparalysis improved organ dysfunction by day 9 compared with placebo. ClinicalTrials.gov Identifier: NCT04990232.

Abstract Background/Introduction Paravalvular leak is a complication of valve replacement with 1% to 3% of patients developing symptoms including heart failure or hemolysis. Purpose This study aims to evaluate the long-term outcomes in whom the primary indication for paravalvular leak closure was hemolysis. Methods We included patients from five Greek hospitals between February 2013 and March 2024. The primary endpoint was the assessment of short and long-term changes in hemolysis parameters, including lactate dehydrogenase, hemoglobin, and indirect bilirubin at 1, 6, 12, and 24 months post-procedure versus baseline values. Secondary endpoints included clinical success, defined as improved hemolysis with transfusion-free status for at least 6 months and survival analysis during the follow-up. Results The study included 42 patients who underwent transcatheter closure of paravalvular leak for hemolytic anemia, with a 15±9 month follow up. Mean age was 69.7±10.3 years and 69% were male. For the primary endpoint, the mean pre-procedural lactate dehydrogenase was 1196±592 IU/L. Although reductions at 1 month (891±1051 IU/L, p=0.221), 6 months (504±378 IU/L, p=0.060), and 12 months (569±312 IU/L, p=0.085) were not statistically significant, a remarkable decrease was observed at 24 months (479±364 IU/L, p=0.040). Hemoglobin levels did not significantly change from pre-procedural values (9.91±1.7 g/dl) at 1 month (10.85±4.3 g/dl, p=0.196), 6 months (10.98±1.91 g/dl, p=0.051), 12 months (10.98±2.19 g/dl, p=0.097) and 24 months (13.09±5.7 g/dl, p=0.065). Indirect bilirubin, with a baseline of 2.4±2.19 mg/dl, showed significant reductions at all time points: 1 month (1.50±1.9 mg/dl, p&amp;lt;0.001), 6 months (0.66±0.44 mg/dl, p=0.003) and 12 months (0.76±0.42 mg/dl, p=0.005). A more than 50% reduction in lactate dehydrogenase was achieved by 44.4% of patients at 1 month, 61.5% at 6 months, 66.7% at 12 months, and 81.3% at 24 months. Similarly, &amp;gt;50% reduction in indirect bilirubin was observed in 58.3% at 1 month, 62.5% at 6 months, and 80% at 12 months. For the secondary endpoints, the need for transfusions significantly decreased from 63.4% pre-procedure to 14.7% at 6 months (p&amp;lt;0.001). Clinical success was achieved in 85.3% of patients. The technical success was 88.1%. The rates of remaining moderate paravalvular leak were 88.1% pre procedurally versus 7.1% at discharge, p&amp;lt;0.001. During the follow-up period of 15±9 months, the survival rate was 66.7%, with 14 patient deaths. Conclusions Transcatheter paravalvular leak closure significantly reduced hemolysis indices (lactate dehydrogenase, indirect bilirubin) with sustained benefits over 24 months. While hemoglobin showed a non-significant increase, transfusion requirements markedly decreased, with most patients remaining transfusion-free for at least 6 months. Overall, transcatheter paravalvular leak closure appears to be an effective option for selected patients.

This review explores the advantages of ivabradine in the management of cardiac surgery patients, particularly highlighting its heart rate (HR)-reducing properties, its role in minimizing the impact of atrial fibrillation, and its contributions to improving left ventricular diastolic function, as well as reducing pain, stress, and anxiety. In parallel, studies provide evidence that ivabradine influences endothelial inflammatory responses through mechanisms such as biomechanical modulation. Unlike traditional beta-blockers that may induce hypotension, ivabradine selectively inhibits hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, allowing for effective HR reduction without compromising blood pressure stability. This characteristic is particularly beneficial for patients at risk of atrial fibrillation post-surgery, where HR control is crucial for cardiovascular stability. This is an area in which ivabradine appears to play a role prophylactically, possibly in combination with beta-blockers. Furthermore, ivabradine has been associated with enhanced diastolic parameters in left ventricular function, reflecting its potential to improve surgical outcomes in patients with compromised heart function. In addition to its cardiovascular benefits, it appears to alleviate psychological stress and anxiety, common in postoperative settings, by moderating the neuroendocrine response to stress, thereby reducing stress-induced hormone levels. Furthermore, it has notable analgesic properties, contributing to pain management through its action on HCN channels in both the peripheral and central nervous systems. Collectively, these findings indicate that ivabradine may serve as a valuable therapeutic agent in the perioperative care of cardiac surgery patients, addressing both physiological and psychological challenges during recovery.

Objective: Primary healthcare (PHC) physicians have a pivotal role in the diagnosis and management of hypertension. While guidelines suggest that blood pressure (BP) should be measured in each patient visit at the PHC unit (PHCU), the few studies conducted among PHC physicians report low daily average BP measurements in PHCUs. Data on PHC physicians’ practices concerning BP measurement in Greece are lacking. This study aimed to investigate the practices of PHC physicians regarding BP measurement in Greece.Design and method: A cross-sectional web-based survey was conducted on PHC physicians in Greece (in 7/7 Health Districts). The survey consisted of closed-type socio-demographic and practice questions towards BP measurements. Appropriate statistical analyses were conducted, according to the type of variable and the research question. Results: A total of 182 PHC physicians completed the questionnaires, 94.5% general practitioners and 4.5% internists, with a median of 25 (Q1, Q3- 18, 30) daily patient visits. 63.7% had >10 years of experience as consultants and 56% used an electronic BP monitor (Figure 1). PHC physicians declared that they measure BP in a median of 30% (Q1, Q3- 20, 50) of their patients. Regarding mentioned measurement frequency, only 13.2% measured BP in all patients and others measured BP only under certain conditions (Figure 2). Among those who measure BP, 23.6% measure it once, 44.5% measure it twice, and only 19.2% measure it three times. Physicians with work experience > 20 years measured BP in a higher proportion of their patients than those with fewer years of work experience (38.5 vs. 28.6, p=0.044). Moreover, the physicians who declared they measured BP in all patients were more likely to have decreased daily patient visits than those who did not (15 vs. 25.7, p=0.02). Conclusions: This is the first study in Greece investigating the practices among PHC physicians regarding BP measurements. Our findings underscore the need for targeted interventions to improve BP monitoring practices. Actions that promote the collaboration between PHC doctors and hypertension specialists would possibly increase the physicians’ awareness towards hypertension.

Repulsive guidance molecule-a (RGMa) has emerged as a significant therapeutic target in a variety of neurological disorders, including neurodegenerative diseases and acute conditions. This review comprehensively examines the multifaceted role of RGMa in central nervous system (CNS) pathologies such as Alzheimer's disease, Parkinson's disease, amyotrophic lateral sclerosis, multiple sclerosis, neuromyelitis optica spectrum disorder, spinal cord injury, stroke, vascular dementia, auditory neuropathy, and epilepsy. The mechanisms through which RGMa contributes to neuroinflammation, neuronal degeneration, and impaired axonal regeneration are herein discussed. Evidence from preclinical studies associate RGMa overexpression with negative outcomes, such as increased neuroinflammation and synaptic loss, while RGMa inhibition, particularly the use of agents like elezanumab, has shown promise in enhancing neuronal survival and functional recovery. RGMa's responses concerning immunomodulation and neurogenesis highlight its potential as a therapeutic avenue. We emphasize RGMa's critical role in CNS pathology and its potential to pave the way for innovative treatment strategies in neurological disorders. While preclinical findings are encouraging so far, further clinical trials are needed to validate the safety and efficacy of RGMa-targeted therapies.

Introduction: We used CBCT application as one-stop-shop nodule orientated approach in regards to increase DY, reduce complication rate, reduce time on-table and economical costs with classical peripheral instruments including mini-cryoprobe (ERBE 1,1mm), rEBUS (Olympus) and standard RUFBs (Olympus Company) with at least 2mm working channel and 4,2mm outer diameter for the diagnosis of peripheral targets (iSPNs) in a prospective all-comers registry after detailed analysis of pre-interventional CT for vessel- and bronchus sign classes. Materials and Methods: From Jun 2017 until Nov 2019 in 90 all-comers patients between 16 and 95 years fit for bronchoscopy with 101 peripheral lesions in a daily routine scheme after informed consent about this prospective registry were included. For histological proven benign disease in any lesion patients had to adhere FU according radiological guidelines and further on by re-visits for at least 2 years after biopsy resulting into last visit in Feb 2022 without any drop-out. Present HRCT was mandatory to achieve one day before intervention. It had to be decided by the examiner mainly after analysis of the preset HRCT which of the 3 CBCT driven modalities were used for diagnostical approach: A) Pure endobronchial approach (CBCT, rEBUS, TBB), B) Pure transthoracical approach with a 21G core-biopsy needle (BIOPINCE needle) with CBCT only, or C) Combined approach as described below (CBCT, rEBUS, TTNA). As instruments were available common forceps and needles, EWC, curette and various RUFB (Olympus Company) mentioned in the materials section. A second CBCT was only allowed in the combined approach group to plan the 3D transthoracic approach in expiration whereas even a CBCT for tool-in-lesion control (TIL CBCT) was never allowed in all 3 groups. Results: In 100 lesions predefined modalities pure endobiopsy, pure TTNA and combined approaches were performed in 77, 9 and 14 lesions respectively without any pneumothorax or bleeding. In these 3 modalities we found confirmed (mostly specific) benign and malignant cases 47 and 30, 4 and 5, 2 and 12 respectively. Lesion sizes in the 3 different groups were (median, mean) 14 and 17,7mm (of those 41 invisible of 77 under XR (53%) in the pure endobiopsy group), 27 and 31mm (11% invisible under XR in the pure TTNA group), 18,5 and 23mm (35% invisible under XR in the combined group) respectively. In the 3 groups for the malignant cases 25 of 30, 5 of 5 and 12 of 12 were diagnosed correctly rendering a diagnostical yield of 42 in 47 malignant cases for the whole algorithm (89,4%) with sizes (mean, median) for the whole algorithm of 16 and 19,7mm respectively which is comparable to published data for robotic-assisted bronchoscopy yield. In regards to vessel sign analysis it has to be clearly stated that the significance level for outcome prediction is inferior to bronchus sign analysis. In multivariate analysis there was a clear tendency towards higher outcome prediction especially if a pulmonary artery branch leads into such target even when a bronchus sign is missing. For NY when comparing univariate analysis and partition model analysis at a set diameter of >11mm with significance (p=0,0052) the additional advantage of analysing a given vessel sign (especially pulmonary artery branches) seems to add on 19% of valuable outcome prediction. Conclusion: A nodule orientated approach in a manual CBCT-AF environment including typical instruments renders in experienced hands comparable results to robotic assisted bronchoscopy even without UTN bronchoscopes or other specialized, therefore expensive tools. In multivariate analysis only bronchus sign analysis revealed significant (p = 0,05) prediction of navigational yield outcome prediction whereas vessel sign analysis increases highly the odds ratio in favor of positive outcome prediction but without significance at the given level. In a partition model to erase outliers at a set iSPN diameter >11mm vessel sign analysis (especially pulmonary artery branches) renders a significant and ameliorated prediction of NY.

Loss of dorsolateral nigral hyperintensity (DNH) in iron-sensitive sequences of Magnetic Resonance Imaging (MRI), also described as "swallow tail sign" (STS) loss, has shown promising diagnostic value in Parkinson's Disease (PD) and Atypical Parkinsonian Syndromes (APS). To conduct a bibliometric analysis on substantia nigra MRI and a systematic review on the clinical utility of STS visual assessment on Susceptibility-Weighted Imaging in various clinical entities. VOSviewer's keyword co-occurrence network was employed using Web of Science (WOS). Complying with the PRISMA statement, we searched MEDLINE, WOS, SCOPUS, ProQuest and Google Scholar for peer-reviewed studies conducted in vivo, excluding quantitative imaging techniques. DNH is a relatively novel parameter in substantia nigra MRI literature. Our SWI-focused review included 42 studies (3281 patients). Diagnostic accuracy of STS loss for PD/APS differentiation from controls and for Lewy Body Dementia differentiation from other dementias was 47.8-98.5% and 76-90%, respectively, with poorer capacity, however, in delineating PD from APS. STS evaluation in idiopathic REM sleep behavior disorder, a sign of prodromal PD, was typically concordant with nuclear scans, identifying subjects with high conversion risk. Iron deposition can affect STS in Multiple Sclerosis and STS loss in Amyotrophic Lateral Sclerosis is linked with multisystem degeneration, with poorer prognosis. In healthy individuals iron-induced microvessel changes are suspected for false positive results. STS assessment exhibits potential in different settings, with a possibly intermediate role in the diagnostic work-up of various conditions. Its clinical utility should be explored further, through standardized MRI protocols on larger cohorts.

The term "gossypiboma" or "textiloma" is used to describe a mass of retained cotton matrix and the surrounding inflammatory response inside a body cavity following surgical intervention. The precise incidence of this phenomenon is uncertain, as cases are frequently underreported due to concerns related to medical malpractice. This rare complication poses a diagnostic dilemma due to the non-specific clinical and radiological features, which can result in significant morbidity and mortality. While diagnosis of this condition has been reported through various imaging modalities such as abdominal ultrasound and computed tomography, there are instances where cases do not present with typical findings, which can make it tough to make a preoperative diagnosis. The differential diagnosis from submucosal tumors of the gastrointestinal tract becomes challenging, particularly when the tumors are in contact with the gastrointestinal tract. It is possible that patients may be incorrectly informed that masses may be malignant, which could result in unnecessary extirpative surgery. In some cases, the diagnosis is discovered postoperatively. This case report presents a case of a 42-year-old woman who was initially suspected of having a gastrointestinal stromal tumor based on radiological findings. However, the patient was ultimately diagnosed with a gossypiboma following surgical intervention. A gross examination of the surgical specimen revealed that a gauze left over from a cesarean section performed nearly 20 years ago was the source of the gossypiboma. It is therefore evident that meticulous counting of surgical instruments and materials is crucial for patient safety and optimal outcomes.