General University Hospital of Patras

Objective: Nocturia, defined as waking from sleep to void, is a frequent lower urinary tract symptom associated with impaired sleep quality and reduced quality of life. This study aimed to evaluate the prevalence of nocturia episodes and their impact on sleep disturbance and health-related quality of life. Methods: A questionnaire-based cross-sectional study was conducted at the Urology Outpatient Clinic of the General Hospital of Eastern Achaia between November 2023 and May 2024. Participants reporting nocturia were assessed using the Nocturia Quality of Life (N-QOL) questionnaire, the Athens Insomnia Scale (AIS), and the EQ-5D questionnaire. Demographic data and comorbid conditions were also collected. Univariate analyses and multiple linear regression were applied to identify factors associated with nocturia-related outcomes. Results: A total of 89 participants (78 men and 11 women; mean age 68.9 years) were included. Most participants reported 2-3 nocturnal voids per night. The N-QOL score was significantly associated with the frequency of nocturia episodes (r = -0.55, p < 0.0001), and regression analysis confirmed this relationship (coefficient: -6.7; 95% CI: -10.4 to -3.1). Individuals scoring ≥ 8 on the OAB-V8 scale demonstrated significantly lower N-QOL performance. Conclusions: Increasing nocturia frequency is associated with impaired sleep, reduced vitality, and diminished quality of life, particularly among older adults. Nocturia should be recognized as a clinically relevant symptom requiring targeted evaluation and personalized management strategies.

In the original publication [...].

Giant AICA aneurysms are amenable to both microsurgery and endovascular treatment. AICA sacrifice may be safely attempted in distal aneurysms. Proximal thrombosed aneurysms which cannot be safely embolized or ones with significant mass effect may benefit from microsurgical occlusion and may require debulking.

Background Real-time methods are needed for intraprocedural detection of residual tumors and incomplete thermal ablation (TA) to allow immediate retreatment and tumor eradication. Purpose To validate a TA workflow for detecting and immediately ablating residual viable colorectal liver metastases (CLMs). Materials and Methods This prospective single-center trial enrolled participants who underwent PET/CT-guided microwave CLM ablation from November 2019 to February 2023. The minimal ablation margin (MM) was calculated in all directions. Biopsies were obtained from the ablation zone (AZ) center and margin, with rapid tissue assessment for viable tumor (VT) cells using imprint cytology and fluorescent viability staining. Immediate reablation was performed if any of the following criteria were met: MM less than 5 mm at contrast-enhanced CT, residual PET-avid tumor, and/or VT cells at rapid tissue assessment. Gray-model statistics quantified the MM and VT impact on local tumor progression subdistribution hazard amid the competing risk of death. Results Seventy-seven participants (median age, 56 years [IQR, 47-64.5 years]; 39 male participants) underwent ablation in 104 CLMs. Overall, 15 of 104 (14%) CLMs underwent immediate reablation per the criteria (12 of 15, VT; seven of 15, MM <5 mm; and four of 15, residual fluorodeoxyglucose avidity). After reablation, all 12 initially VT-positive AZs underwent repeat biopsies with negative findings. Five of seven MMs less than 5 mm in AZs increased to greater than 5 mm after reablation. All four CLMs that underwent reablation due to PET/CT findings had AZs positive for VT, and one had MM less than 5 mm. MM greater than 5 mm protected against local tumor progression (LTP) (subdistribution hazard ratio, 0.12; 95% CI: 0.05, 0.30; P < .001). There was no LTP for MMs greater than 10 mm. The cumulative LTP incidence at 1, 2, and 3 years for participants with biopsy-proven completely ablated CLMs with MM greater than 5 mm was 7%, 12%, and 12%, respectively. Conclusion MM remained a critical technical factor affecting tumor control; the proposed multimodal comprehensive AZ assessment enabled immediate onsite reablation of 14% of CLMs with initially insufficient ablation treatment and improved local tumor control after thermal ablation. ClinicalTrials.gov identifier: NCT04143516 © RSNA, 2026 Supplemental material is available for this article. See also the editorial by Georgiades in this issue.

FAS/FAS-ligand (FAS-L) complex is implicated in critical cell functions including programmed cell death (apoptosis) and immune response regulation. FAS and FAS-ligand are members of the tumor necrosis factor (TNF) superfamily. Their activation triggers the caspase-mediated apoptotic cataract. The aim of this study was to investigate the role of their altered co-expression in a series of laryngeal squamous cell carcinomas (LSCCs). A set of fifty (n=50) LSCC archival tissue sections was analyzed by performing a combination of immunohistochemistry (IHC) and digital image analysis (DIA) assays for determining the expression of FAS/FAS-L expression. A broad spectrum of FAS/FAS-L expression values were detected across the examined cases. A significant negative correlation was found between FAS and FAS-L overall expression (p<0.001) indicating that higher FAS expression is associated with lower FAS-L expression. Furthermore, the expression of FAS was highest in stage IV carcinomas, whereas FAS-L was higher in stage III tumors, however, the differences were not statistically significant (p=0.260, p=0.101, respectively). Concerning the size of the examined malignancies (max diameter), the FAS/FAS-L expression showed a statistically significant difference in both (p=0.001, p=0.011, respectively). According to their expression status, larger tumors tend to demonstrate higher levels of FAS protein, whereas smaller tumors exhibit overexpression of FAS-L. FAS/FAS-L apoptotic system deregulation is a relatively frequent event in LSCCs. Dysregulation of the system - due to altered FAS and FAS-L co-expression levels - negatively affects the normal apoptotic mechanism. Additionally, this abnormality is clearly observed in aggressive phenotypes (advanced stage, enlarged tumor volume).

Basosquamous carcinoma (BSC) is a rare, aggressive non-melanoma skin cancer that exhibits histopathological features of both basal and squamous cell carcinoma. Surgical excision remains the first-line treatment; however, standardized guidelines for its management and reconstruction are lacking. Central forehead defects pose reconstructive challenges due to limited tissue mobility, high tension, and both aesthetic and functional significance.An 88-year-old male presented with a 2.6 x 2.4 cm ulcerative lesion on the central forehead, histopathologically diagnosed as infiltrative BSC. Under local anesthesia, a wide surgical excision was performed, including a small periosteal segment. The resulting 4.6 x 4.4 cm defect was reconstructed using an O-to-H flap. Horizontal incisions were designed parallel to relaxed skin tension lines, Burrow’s triangles were excised, and vertical sutures converted the O-shaped defect into an H configuration. Meticulous hemostasis was achieved, and closure was completed with 5-0 nylon sutures. At the four-month follow-up, the patient demonstrated excellent functional and aesthetic outcomes. The scar healed well, sensory function was preserved, and there was no evidence of local recurrence.Local flap reconstruction, particularly H-plasty, provides reliable coverage for central forehead defects, with favorable aesthetic results and low donor-site morbidity. Careful dissection minimizes the risk of supratrochlear and supraorbital nerve injury.The O-to-H flap represents a simple and effective option for central forehead reconstruction following BSC excision, achieving optimal functional and cosmetic outcomes. Further studies are needed to establish standardized management and reconstructive strategies for BSC.

Background/Objectives: In an attempt to combine the benefits of the Holmium:YAG (Ho:YAG) laser and Thulium Fiber Laser (TFL), the "Magneto" mode lowers the peak power of the Ho:YAG laser, generating longer duration pulses. The purpose of this study is to compare the effect of the standard virtual basket (VB) Ho:YAG laser, Magneto Ho:YAG laser and TFL on soft tissue in an ex vivo model. Methods: Two renal units from a female pig were used for the current experiment. Sixteen distinct areas were defined. Each area included three parallel lines, which were made with the three different laser technologies. The VB Ho:YAG laser was used for the first line and the Ho:YAG laser in the "Magneto mode" was used to generate the second line, while the third line was performed with a TFL in short pulse mode. The same laser settings (1 J/10 Hz/10 W) and the same fiber diameter (200 μm) were used for all three laser incisions. The same surgeon performed all incisions with a standardized and repeatable technique, controlling hand speed and distance of laser fiber from kidney surface using the stabilization setup. Sections of the selected areas produced distinct paraffin blocks, each one containing three parallel laser lines. Two independent pathologists evaluated the incision depth, incision width, coagulation depth and carbonization effect of the three different lasers. Results: Although the incision depth and the carbonization effect were comparable between the three lasers, incision width and coagulation depth showed a statistically significant difference. Median incision width was 1.17 (1.04, 1.99) mm for the VB Ho:YAG laser, 1.05 (0.89, 1.50) mm for the Magneto Ho:YAG laser and 0.82 (0.65, 0.88) mm for the TFL (p = 0.001). The coagulation depth was 0.49 (0.41, 0.56) mm for the VB Ho:YAG laser, 0.51 (0.39, 0.59) mm for the Magneto Ho:YAG laser and 0.18 (0.17, 0.23) mm for the TFL (p < 0.001). During post hoc analysis for the three comparisons, the differences between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL were statistically significant for both parameters. Conclusions: Both the VB and Magneto Ho:YAG lasers produced laser incisions with statistically significant greater incision width and coagulation depth than the TFL on the ex vivo model. Overall, the Magneto Ho:YAG laser was associated with the greatest median coagulation depth. Post Hoc Man-Whitney tests for the three comparisons revealed statistically significant differences only between the VB Ho:YAG laser and TFL and between the Magneto Ho:YAG laser and TFL. This finding could potentially be translated into better haemostasis during endourological soft tissue surgery. The implementation of additional studies, both experimental and clinical ones, is of outmost importance to draw safer conclusions.

In cases of early onset, severe obesity, especially when in the presence of additional clinical manifestations, genetic investigation to exclude syndromic or monogenic obesity is indicated. ROHHAD syndrome is one of the rarest syndromes associated with obesity. Genetic analysis has not to date identified responsible genes; therefore, its diagnosis is based on clinical criteria. Monogenic obesity is mainly caused by variants in genes involved in the leptin-melanocortin pathway, the satiety pathway. We present a patient with severe obesity from the age of 3 years, endocrinopathies (central diabetes insipidus, central hypothyroidism, precocious puberty, and growth hormone deficiency), hypoventilation, cold extremities, psychomotor retardation, behavioral disorders, strabismus, fatty liver infiltration, and syndromic facial features. Based on the clinical features, ROHHAD syndrome was diagnosed. The patient underwent genetic testing of 80 genes involved in the leptin-melanocortin pathway. He was found to be heterozygous in the PLXNA3 gene for a sequence variant designated c.3640 C > T, which is predicted to result in the amino acid substitution p.Arg1214Trp. This variant has not been reported in the literature and is of unknown clinical significance. The patient was also heterozygous in the PCSK1 gene for a sequence variant designated c.661 A > G, which is predicted to result in the amino acid substitution p.Asn221Asp and is classified as a risk factor for obesity. We present the first reported patient with ROHHAD syndrome and variants in two genes involved in the leptin-melanocortin pathway. The possibility of the coexistence of two rare types of obesity, syndromic and monogenic, makes this case particularly exceptional and raises questions about the potential association between the two entities.

Visceral leishmaniasis (VL) is an endemic zoonotic disease in southern Europe with increasing clinical relevance among immunocompromised populations; however, detailed clinical data remain scarce. This retrospective multicentre cohort study analysed patients with confirmed VL treated at seven hospitals in Greece over a 26-year period. Clinical, treatment, and outcome data were collected with a minimum follow-up of 18 months to assess cure, treatment failure, relapse, and mortality. A total of 144 patients were enrolled (59% male; mean age 41.8 years, range 0.1-84 years), most of whom were Greek nationals (85%) and resided in rural areas (61%). Fever was the primary reason for hospital admission in 95% of patients. At diagnosis, 42 patients (29%) were immunocompromised. These patients were significantly older than immunocompetent individuals and more likely to present with diarrhoea and arthralgia, whereas hepatomegaly was less frequent. Liposomal amphotericin B was administered to 90% of patients. Treatment failure occurred in 14 patients (10%) and was significantly associated with immunosuppression and leukaemia. Relapse within 18 months occurred in 5.5% of patients. Overall mortality was relatively low (7 patients, 5%), with one death directly attributable to VL. This study demonstrates that VL remains endemic in Greece, affects patients across all age groups, and is primarily autochthonous. Immunosuppression is associated with distinct clinical features and poorer treatment outcomes in VL, underscoring the need for heightened clinical vigilance, combined diagnostic approaches, and extended follow-up in vulnerable populations.

Background: The role of cognitive load theory (CLT) in understanding effective pedagogy has received increased attention in the fields of education and psychology in recent years. A considerable amount of literature has been published on the CLT construct as foundational guidance for instructional design by focusing on managing cognitive load in working memory to enhance learning outcomes. However, recent neuroscientific findings and practical critiques suggest that CLT’s emphasis on content-focused instruction and cognitive efficiency may overlook the complexity of human learning. Methods: This conceptual paper synthesises evidence from cognitive science, developmental psychology, neuroscience, health sciences and educational research to examine the scope conditions and limitations of CLT when applied as a general framework for K–12 learning. One of the major theoretical issues identified is the lack of consideration for the broad set of interpersonal and self-management skills, creating potential limitations for real-world educational contexts, where social-emotional and self-regulatory abilities are as crucial as cognitive competencies. Results: As a result of the critique, this paper introduces the Neurodevelopmental Informed Holistic Learning and Development Framework as a neuroscience-informed construct that integrates cognitive, emotional, and interpersonal dimensions essential for effective learning. Conclusions: In recognising the limitations of CLT, the paper offers practitioners contemporary, neurodevelopmentally informed insights that extend beyond cognitive efficiency alone and better reflect the multidimensional nature of real-world learning.