Metaxa Hospital

Gastric adenocarcinoma is a major cause of cancer mortality worldwide, and reliable biomarkers remain insufficient. This study investigates the immunohistochemical expression of progastrin (hPG) and annexin A2 (ANXA2) and the polarization of tumor-associated macrophages in gastric adenocarcinoma to explore their potential prognostic and biological significance. A retrospective analysis was conducted on formalin-fixed, paraffin-embedded tissue samples from 60 patients with gastric adenocarcinoma (primary tumors, lymph node metastases, and non-tumoral gastric mucosa) and gastric biopsies from 23 healthy controls. The expression of hPG and ANXA2 was quantified using the H-score, and the CD163/human leukocyte antigen-DR (HLA-DR) ratio was used to represent macrophage polarization (M2/M1). Statistical analyses included non-parametric tests, Spearman correlations, Kaplan-Meier survival curves, and Cox proportional-hazards models. ANXA2 expression was significantly elevated in cancer cells from primary tumors and lymph node metastases, compared with the non-tumoral gastric mucosa tissues and gastric mucosa tissues from healthy controls. ANXA2 expression increased with the tumor grade. High ANXA2 levels were associated with shorter overall and disease-free survival, but they did not have independent prognostic value. Although hPG expression correlated positively with ANXA2, it showed no significant prognostic association. The CD163/HLA-DR ratio increased with tumor progression and negatively correlated with ANXA2, but it did not influence survival outcomes. This study is the first to demonstrate the adverse prognostic impact of ANXA2 overexpression in gastric adenocarcinoma tissues from Caucasian patients. Our results suggest that ANXA2 might have utility as a prognostic biomarker and therapeutic target, if further large-scale studies validate and expand our findings.

Esophageal cancer (EC) is a highly aggressive gastrointestinal malignancy, with a notable increase in incidence over recent decades, representing a significant global health burden. The main histological subtypes are esophageal adenocarcinoma (EAC) and esophageal squamous cell carcinoma (ESCC), with the former being closely associated with gastroesophageal reflux disease, Barrett's esophagus, and obesity, and its incidence continues to increase in Western populations. The rising incidence of EC, combined with poor survival rates, underscores the need for new therapeutic approaches. A deeper understanding of the molecular basis of this prevalent malignancy may open new avenues for optimal therapeutic strategies, with immunotherapy now central in several clinical trials. Understanding the interplay between the tumor microenvironment (TME) and disease progression is pivotal for managing this malignancy, which remains highly challenging. This review highlights the role of the TME in EAC progression and drug resistance, and recent therapeutic advances.

Radiotherapy (RT) is an integral component of various multidisciplinary treatment approaches for pelvic malignancies, used both in the radical and adjuvant setting. Despite the improvement of radiotherapy modalities, pelvic radiotherapy often induces permanent erectile dysfunction (ED). However, post-treatment ED receives little medical attention, since patient follow-up focuses mainly on cancer recurrence surveillance. The present review aims to summarize the current treatment modalities against radiation-induced erectile dysfunction (RIED) for patients who have received pelvic radiotherapy. A literature review on emerging treatment strategies for RIED was conducted to summarize existing evidence. Research in medical literature was conducted through the PubMed Central databases, from 1996 up until June 2024, in the English language. All relevant clinical trials on RIED management were included. The efficacy of PDE5i was investigated by 12 research studies. The majority of studies revealed that PDE5i have a potentially positive effect on maintaining EF, mainly in the shortterm after pelvic RT. Despite penile prostheses' high efficacy, their role remains limited due to various factors. Regarding yoga, a randomised clinical trial demonstrated clinical effectiveness only during the first 4 weeks of the twice/week regimen of sessions. Treatment strategies for RIED range from oral medication to more invasive treatment modalities that present high efficacy. Penile prosthesis remains the most invasive, yet the most effective and definitive treatment. Stem cell therapy, platelet-rich plasma intracavernosal injections, and penile vibratory stimulation feature an efficient profile, but their beneficial role has not yet been established. Further randomized controlled trials are required to assess the effectiveness of these interventions. Establishing strategies for the needs of survivors with RIED should also be prioritized in the therapeutic management, because patients' quality of life can be substantially improved.

Sepsis is a life-threatening condition and a major cause of hospital mortality worldwide. This study investigated the diagnostic utility of monocyte mean volume (MONO MEAN-V), monocyte distribution width (MDW), monocyte mean conductivity (MONO MEAN-C), and monocyte standard deviation conductivity (MONO Sd-C) for sepsis, compared to conventional markers. A prospective cohort study was conducted in two centers, enrolling adult patients classified into three groups: sepsis, septic shock, and febrile. Blood was drawn from septic patients on days 1, 3, and 5 of admission. MDW and other inflammatory parameters were measured in all patients. Patients with sepsis or septic shock exhibited significantly elevated MONO MEAN-V, MDW, and MONO MEAN-C and lower MONO Sd-C compared to febrile patients. Among the biomarkers evaluated, MDW emerged as a reliable predictor of sepsis. A cut-off MDW value of 25.1 on day 1 demonstrated optimal diagnostic performance, with an area under the ROC curve of 0.84 (95% CI: 0.77-0.91), sensitivity of 75%, and specificity of 91.2%. MDW appears to be a cost-effective, rapid marker for sepsis detection, performing at least as effectively as existing biomarkers. Our findings corroborate other published studies, highlighting MDW's potential to enhance early sepsis recognition.

Sepsis is a life-threatening condition; it is a major cause of hospital mortality worldwide and it constitutes a global health problem. This research investigates the use of MDW as a predictor for septic patients. This was a double-center prospective cohort study of adult septic patients. Septic patients were identified and were categorized into two categories: those who improved and those who died. Blood was drawn from the patients three times, on the first, third, and fifth day of their admission to the hospital. MDW was evaluated as a biomarker to predict patient outcome. In addition, existing inflammatory markers were recorded in all patients. The MDW was able to predict patient's outcome. The average MDW was found to be significantly higher in patients who died in all records. For example, an MDW value of 28.4 on the first day of admission to the hospital was shown to be the best cut-off value in determining fatal outcomes; receiver operating characteristic (ROC) analysis revealed an area under the curve value of 0.71 (95% Confidence Interval-CI: 0.57-0.84) with a sensitivity of 64.7% and a specificity of 88.2%. In conclusion, MDW, in addition to being a marker that can quickly detect sepsis more effectively than other biomarkers, which is proven by numerous studies, could also be used as an indicator to predict patient outcome. This work is an attempt in that direction.

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.

The rectovaginal septum is a rare location for gastrointestinal stromal tumors (GIST) to occur. The aim of this study was to present a case of synchronous local recurrence of solitary liver metastasis originating from an extra gastrointestinal tumor (E-GIST) of the rectovaginal space.