Athens Naval & Veterans Hospital

Background and Objectives: Tubal reanastomosis is an alternative option for women seeking fertility after sterilization. Thus, anastomosis healing quality and peri-tubal adhesions play a crucial role. TISSEEL® fibrin sealant may enhance tissue repair and reduce foreign-body reaction. We evaluated the effect of TISSEEL®, used alone or with sutures, on anastomotic healing and adhesion formation in a rat uterine horn model. Materials and Methods: Thirty female Wistar rats were randomized to Suture, TISSEEL®, or Suture + TISSEEL® groups (n = 10 each). After bilateral uterine horn transection, reanastomosis was performed with sutures alone, fibrin sealant alone, or combined sutures and sealant. On postoperative day 14, reanastomosis segments were collected for blinded histologic assessment and evaluation of modified Ehrlich-Hunt score parameters (inflammation, fibrosis, neovascularization and collagen production). Intra-abdominal adhesions were also macroscopically assessed. Results: Two animals died perioperatively and 56 uterine horns were included in the final analysis (Suture n = 18, TISSEEL®n = 18, Suture + TISSEEL®n = 20). The distribution of inflammation and fibrosis severity grades, as assessed by the modified Ehrlich-Hunt scoring system, did not differ significantly between the study groups (p = 0.208 and p = 0.652, respectively). In contrast, high-grade neovascularization (grades 3-4) was more common in TISSEEL® groups (77.8% TISSEEL®, 80.0% Suture + TISSEEL®, 33.3% Suture, p = 0.004), while increased collagen deposition was also more common in the TISSEEL® groups (p = 0.011), after binary analysis. Severe adhesions were more common in the Suture group (66.7% vs. 11.1% in the TISSEEL® group and 30.0% in the Suture + TISSEEL® group, p = 0.037). Conclusions: TISSEEL®, alone or as an adjunct to sutures, improves neovascularization and collagen production and is associated with milder adhesions without increased inflammation or fibrosis. The use of fibrin sealant TISSEEL® may be a useful tool in tubal reconstructive surgery.

Abstract Background Lipoprotein (a) is liver-generated lipoprotein which consists of LDL-particles attached apolipoprotein (a). Increased Lp(a) levels are implicated in the clinical course of atherosclerosis. Purpose We investigated whether participants with increased Lp(a) levels demonstrate altered arterial wall stiffness and thickness of endothelial glycocalyx. Methods we included participants from the primary prevention clinic of the Cardiology Department of our University Hospital. We performed propensity score matching for age, sex, diabetes, hypertension and smoking. We totally enrolled 90 participants of which a) n=30 participants had elevated Lp(a) levels as defined by Lp(a) >50mg/dl with the rest lipids within near optimal range b) n=30 participants with increased Total Cholesterol and non-HDL levels with normal Lp(a) and c) n=30 participants with lipid levels within reference range as controls. We measured at enrollment a) perfused boundary region (PBR) of the sublingual microvessels with a lumen diameter ranging from 4 to 25 μm, as a marker of endothelial glycocalyx integrity and b) carotid-femoral pulse wave velocity, Pulse Pressure (PP) and central systolic blood pressure (cSBP) as markers of arterial stiffness. Results We included participants aged 54±9 years, 43/90 (47.7%) were males. Participants with increased lipid levels had higher total cholesterol and non-HDL levels compared to Lp (a) and control group (p<0.05). The Lp (a) and the hyperlipidemia group showed similar PBR values and both groups higher than the control group (PBR 4-25: 2.28± 0.26 vs 2.26±0.25 vs 2.11±0.18; PBR 4-9: 1.25±0.17 vs 1.23±0.15 vs 1.15±0.10; PBR 10-19: 2.42±0.35 vs 2.47±0.33 vs 2.28±0.26; PBR 20-25: 3.07±0.52 vs 2.85±0.46 vs 2.60±0.36μm, respectively, p<0.05). The Lp (a) and the hyperlipidemia group demonstrated similar arterial stiffness and both groups greater than the control group (PWV: 11.96±2.41 vs 12.31±2.35 vs 9.98±2.29 m/sec; PP: 46.15±14.12 vs 48.27±14.52 vs 38.24±10.27mmHg; cSBP: 128.09±11.53 vs 130.27±11.72 vs 119.92±10.56 mmHg, respectively, p<0.05). Conclusion Participants with elevated Lp (a) levels present impaired arterial elasticity and glycocalyx integrity, similar to those with increased total cholesterol levels but normal Lp(a).

Background:Inflammation has recently been identified as a critical regulator of the pathophysiology and prognosis of acute coronary syndrome (ACS). The systemic immune–inflammation index (SII), derived from platelet, neutrophil, and lymphocyte counts, has gained attention as a potential marker for predicting adverse outcomes in cardiovascular diseases. However, the prognostic value of the SII, particularly in relation to gender differences, has not been extensively studied.Methods:Thus, we conducted a retrospective cohort study of 835 patients hospitalized for ACS at Hippokration Hospital, Thessaloniki, Greece, between 2017 and 2023. The SII was calculated using blood samples taken at admission. Logistic and Cox regression models were used to evaluate the relationship between the SII and all-cause mortality, with stratified analyses conducted according to gender. Receiver operating characteristic (ROC) analysis, Kaplan–Meier survival curves, and restricted cubic spline (RCS) modeling were also performed to assess the discriminative ability and non-linear associations of the SII with mortality.Results:A total of 835 patients were included, with a median follow-up of 25 months. An elevated SII was independently associated with increased long-term mortality, with patients in the highest SII quartile exhibiting a 2.3-fold higher risk of death compared to those in the lowest quartile (adjusted hazard ratio (aHR) = 2.31, 95% confidence interval (CI): 1.60–3.32; p < 0.001). The optimal cut-off value for the SII was identified as 1864.19. Gender-stratified analyses revealed a stronger prognostic value in women compared to men (area under the curve (AUC) = 0.70 vs 0.58; p = 0.018). The Kaplan–Meier and Cox regression analyses confirmed significantly worse survival for patients with SII levels above this threshold (p < 0.05). The RCS modeling demonstrated a non-linear relationship between the SII and mortality, with a marked increase in risk at higher levels of the SII, especially in women.Conclusions:The SII is a simple, easily accessible biomarker that independently predicts mortality in ACS patients, with notable gender-specific differences in the prognostic value of the SII. Nonetheless, incorporating SII into routine risk assessment could enhance risk stratification and improve personalized treatment strategies, particularly in settings with limited resources.

Background/Objectives: It is well established in the modern literature that newborns delivered from multiple gestations are more predisposed to low birthweight in comparison to their singleton equivalents. In this study, we sought to explore the potential of first-trimester biochemical (PAPP-A and free β-hCG) and biophysical indices (uterine artery Doppler) to predict low birthweight in one or both twins. Methods: This is a retrospective cohort analysis of 400 twin viable pregnancies presenting for routine first-trimester assessment in four fetal medicine centers between 2014 and 2025. The examination included the recording of maternal demographic characteristics and medical history, the assessment of markers of aneuploidy and the fetal anatomy, the measurement of mean arterial pressure, the assessment of uterine arteries and the measurement of serum concentration of PAPP-A and free β-hCG. The evaluated outcomes included BW ≤ 3rd centile and BW ≤ 10th centile in one or both twins based on local population birthweight reference charts. Results: The study cohort consisted of 400 twin pregnancies. BW ≤ 3rd centile in one or both twins was reported in 1.5 and 3.8% of cases, respectively, and there was no association of BW ≤ 3rd centile with any of the studied parameters. BW ≤ 10th centile in one or both twins was reported in 14.8 and 9.8% of the cases, respectively. PAPP-A MoM values were significantly lower in cases complicated by BW ≤ 10th centile in one and in both twins, remaining statistically significant even after the appropriate multiple logistic regression. PAPP-A MoM demonstrated statistically significant but low prognostic value for BW ≤ 10th centile in either one or both twins. Conclusions: Low PAPP-A levels were associated with BW ≤ 10th centile in one and both twins and its significant value as a risk marker was demonstrated. Higher PAPP-A MoM halves the risk of having at least one twin with low BW. Other maternal biophysical and biochemical indices did not seem to be predictive of low birthweight.

Abstract Introduction Pre-eclampsia (PreE), presenting after the 20th week of gestation, leads to high blood pressure and proteinuria. If left untreated it may cause adverse outcomes due to cardiac impairment. Objective The current meta-analysis sought to investigate the association of PreE with cardiac structure and function. Methodology A systematic review was conducted in electronic databases to identify studies reporting the association of PreE with the structure and function of the heart in comparison with non-PreE women. Results Fourteen studies with 12,634 patients were included in the meta-analysis. Women with PreE were older (standardized mean difference (SMD) = 0.12, 95% confidence interval (CI) =0.04-0.20, p &amp;lt;0.003, I2 =1.29%), and with greater body mass index (SMD =0.46, 95% CI =0.39-0.52, p &amp;lt;0.001, I2 =0.05%) compared with non-PreE. The patients with PreE had more dilated left atrial (LA) volume in comparison to the non-PreE group (SMD =0.70, 95% CI =0.43-0.96, p &amp;lt;0.001, I2 =0%) and LA Volume Index (SMD =0.46, 95% CI =0.25-0.67, p &amp;lt;0.001, I2 =10.01%). Moreover, the left ventricular (LV) end-diastolic diameter (SMD =0.22, 95% CI =0.07-0.37, p =0.004, I2 =0%), the LV posterior wall thickness (SMD =1.42, 95% CI =1.12-1.73, p &amp;lt;0.001, I2 =0%), the interventricular septum thickness (SMD =0.83, 95% CI =0.68-0.98, p &amp;lt;0.001, I2 =0%) and the LV mass index (SMD =0.62, 95% CI =0.48-0.77, p &amp;lt;0.001, I2 =0.01%) were increased in PreE compared to the non-PreE women. Considering the cardiac function, there was no significant difference in the LV ejection fraction (SMD =0.03 , 95% CI =-0.21-0.27, p =0.798, I2 =0%) between the 2 groups. Conclusion Women with PreE have more pronounced cardiac remodelling and similar LV ejection fraction compared with their counterparts.

Simple SummaryExcess body weight greatly increases the risk of endometrial cancer and at the same time makes surgery harder, because access to the pelvis is more difficult. Robotic surgery is a minimally invasive technique that may overcome these challenges, but data in morbidly obese patients are still limited. We reviewed 54 women with early endometrial cancer who underwent a robotic hysterectomy with bilateral salpingo-oophorectomy, together with lymph nodes sampling. We compared results across body mass index groups, including women with severe obesity. Operating time, hospital stay, complication rates and sentinel lymph nodes detection rates were similar among all groups. These findings support robotic surgery as a safe, effective standard, even for morbidly obese patients.Background/Objectives: Obesity is a well-established risk factor for endometrial cancer and presents challenges for surgical management. Robotic-assisted surgery offers a minimally invasive approach with potential benefits for obese patients. This study sought to assess the impact of body mass index (BMI) on surgical performance and short-term outcomes in patients undergoing robotic surgery for early-stage endometrial cancer, focusing on follow-up and perioperative treatment. Methods: A retrospective analysis was conducted on 54 patients with early-stage endometrial cancer who underwent a robotic total hysterectomy, bilateral salpingo-oophorectomy, and indocyanine green sentinel lymph node biopsy between January 2021 and December 2024 at two tertiary centers. Patients were stratified by body mass index. Surgical variables, sentinel lymph node detection rates, peri- and postoperative complications, length of hospital stay, and short-term oncologic outcomes were assessed. Statistical comparisons were performed using ANOVA, chi-square tests, and Pearson’s correlation analysis. Results: The mean patient age was 59.7 years, with a mean BMI of 31.1 kg/m2. Bilateral sentinel lymph node detection was successful in 87% of cases, with no significant differences between BMI groups. Console time, hospital stay, and complication rates were comparable across BMI categories. Console time positively correlated with the number of lymph nodes removed (r = 0.302, p = 0.026), but not with BMI. At a mean follow-up of 24.4 months, no recurrences were observed. Conclusions: Robotic surgery for early-stage endometrial cancer is safe and effective regardless of BMI, including in patients with Class III obesity. BMI does not negatively impact surgical or short-term oncologic outcomes, supporting robotic surgery as an optimal approach in obese endometrial cancer patients.

BackgroundHereditary angioedema (HAE) is a rare disease characterized by unpredictable, recurrent subcutaneous or submucosal swelling that negatively impacts patients’ health-related quality of life (HRQoL). Despite treatment goals aimed at achieving complete control of the disease and normalizing patients' lives, the disease remains poorly controlled for some patients.ObjectivesTo describe the demographic, clinical and treatment characteristics, as well as the HRQoL impairment of patients with sub-optimally controlled HAE type I/II per treating physician's judgment, focusing on understanding the factors influencing the burden of illness.MethodsA chart review was conducted at 32 HAE care centers across 18 European countries, Canada, and Israel between April 2022 and January 2023 in 214 patients aged ≥12 years with HAE type I/II sub-optimally controlled with on-demand treatment (ODT) and/or long-term prophylaxis (LTP). Patients receiving lanadelumab were excluded, as it was not yet widely available during the eligibility period. A cross-sectional survey at patient enrollment included the Angioedema Quality of Life (AE-QoL) and EQ-5D-5L questionnaires to assess the impact of HAE on HRQoL.ResultsPatients with uncontrolled HAE had a mean (standard deviation [SD]) of 9.9 (13) attacks per year, with a mean (SD) duration of 1.9 (1) days per attack. During the one-year observation period, 50.5% of patients were on ODT only, 36.0% used LTP and ODT concurrently, 6.5% used LTP without ODT, and 7.0% were untreated. Attenuated androgens (AA; stanozolol and danazol) in LTP were used by 24.7% of patients, while tranexamic acid (TA) and C1-esterase inhibitor (C1–INH) replacement products were used for LTP by 9.8% and 6.5%, respectively. The mean (SD) AE-QoL total score was 44.4 (24.0), indicating a moderate level of impairment, with women experiencing worse HRQoL (total score of 50.9 [SD 24] vs 37.3 [SD 23] in men) [where the minimal clinically important difference is 6 points] [1]. HRQoL worsened with increasing attack rates, from 41.4 (SD 24.0) among patients with one to 5 attacks/year, still indicating moderate impairment in HRQoL, to 73.0 (SD 27.0) for patients with >40 attacks/year.ConclusionsSuboptimal disease control in HAE was associated with the use of ODT only, as well as LTP mainly with AA/TA. It imposes a substantial burden on patients’ HRQoL, more particularly, but not exclusively, for those with frequent attacks and for women. The results suggest a need for improved HAE management.ClinicalTrial.gov study identifier NCT04957641.

Background: Pregnancy-Related Acute kidney injury (PRAKI) is a critical complication of pregnancy, defined by the sudden deterioration in renal function during gestation or within the initial six weeks postpartum. Pregnancy is thought to increase the risk of acute kidney injury (AKI) by 51%. This is linked to the anatomical alterations that occur during pregnancy and special conditions, such as preeclampsia/eclampsia. PRAKI's epidemiology and outcome vary between developed and developing nations. PRAKI is an uncommon entity in high-income countries; however, its incidence has recently increased. The aim of this systematic review is to evaluate the maternal and perinatal outcomes and risk factors affecting pregnancies affected by AKI. Methods: Comprehensive research was performed in PubMed/Medline, Scopus, and Google Scholar electronic databases from 2015 up to January 2025, using the terms AKI, PRAKI, sepsis, preeclampsia/eclampsia, liver enzymes, low platelet count (HELLP) syndrome, and pregnancy. After a thorough assessment, 25 full-text articles were obtained. Results: Our results revealed that preeclampsia, eclampsia, HELLP syndrome, and antepartum and postpartum hemorrhage predispose women to PRAKI. Other unusual factors, like disseminated intravascular coagulation (DIC) or hemolytic uremic syndrome (HUS), should not be underestimated. Furthermore, the latest published data showed unfavorable maternal and fetal outcomes in pregnancies affected by AKI compared to the general population. Conclusions: PRAKI constitutes a serious pregnancy complication that requires immediate treatment. The higher prevalence of PRAKI in developing countries (4-26%) versus wealthy nations (1.0-2.8%) has considerably indicated the impact of socioeconomic status and the accessibility of health services.

Background: Sarcomas are a rare and biologically diverse group of malignant tumors that originate from mesenchymal tissues. They are characterized by a broad range of histopathological subtypes, varying clinical courses, and differing responses to treatment. This study seeks to clarify the clinicopathological and molecular predictors of recurrence in leiomyosarcomas, carcinosarcomas, and endometrial stromal sarcomas to enhance our understanding, thereby improving clinical knowledge, consultation practices, and the overall benefit for patients. Methods: A literature search was conducted utilizing PubMed/MEDLINE, Embase, Cochrane Library, and Scopus to execute a comprehensive structured narrative review of articles published up to 31 March 2025. Results: We summarize existing evidence on the clinical, histological, and molecular predictors of recurrence and poor prognosis for leiomyosarcomas, carcinosarcomas, and endometrial stromal sarcomas. While the stage, grade, tumor size, and novel molecular biomarkers are crucial high-risk parameters that have been associated with recurrence, existing data demonstrate contradictory results, indicating the need for further research. Conclusions: Recent advancements in next-generation sequencing have facilitated the identification of women at increased risk of recurrence, poor disease-free survival, and overall adverse prognosis. Stratifying this risk requires a comprehensive understanding of the clinical, histological, and molecular risk factors involved. Understanding these underlying factors is essential for effectively addressing the initial consultation, guiding management, and-considering the novel treatment modalities-individualizing the care provided to the affected women.

Social cognition impairment is common in multiple sclerosis (MS) and could implicate the well-being of patients by promoting difficulties in social interactions. This study investigated the relationship between social cognition and quality of life (QoL) in patients with MS (PwMSs). In total, 100 PwMSs, enrolled as per distinct criteria, underwent neuropsychological assessment using validated questionnaires and scales. To assess QoL, Multiple Sclerosis Quality of Life-54 (MSQOL-54) questionnaires, both physical and mental, were utilized. The components of social cognition were evaluated using the Reading the Mind in the Eyes Test (RMET) and the Faux Pas task. The type of MS and years since diagnosis were also recorded. The RMET score (β = 0.336; p = 0.001) and years since diagnosis (β = -0.225; p = 0.017) emerged as significant predictors of physical QoL, whereas the Faux Pas score did not significantly predict MSQOL-54_PHYSICAL scores (p = 0.451). Both Faux Pas (β = 0.247; p = 0.015) and RMET scores (β = 0.221; p = 0.028) showed a positive association with MSQOL-54_MENTAL scores. The years since diagnosis did not significantly predict the mental component of QoL (p = 0.635). Social cognition deficits are crucial for the social functioning of patients with MS, inevitably affecting both physical and mental aspects of QoL.