Sotiria General Hospital

The approval of programmed death-ligand 1 (PD-L1) inhibitors in the first line of treatment has transformed the therapeutic landscape of extensive-stage small cell lung cancer (ES-SCLC); real-world (rw) evidence of clinical benefit is currently limited. In this study, we investigated the rw efficacy of first-line chemoimmunotherapy and the role of potential biomarkers. We retrospectively assessed patients with SCLC receiving first-line chemoimmunotherapy at Sotiria Thoracic Diseases Hospital of Athens, Athens, Greece. Kaplan-Meier curves were used to calculate real-world progression-free survival (rwPFS) and real-world overall survival (rwOS). Cox proportional hazards regression analysis was utilized to identify associations between patient characteristics and outcomes. 188 patients were included. Median rwPFS was 6.5months (95% CI 5.8-7.1months) and median rwOS was 11.2months (95% CI 9.1-12.0months). rwOS was higher in the atezolizumab group compared with the durvalumab group (median, 12.0 vs 9.2months; hazard ratio [HR], 1.51; 95% CI 1.06-2.15; p = 0.02), similar results were observed for rwPFS (median, 6.5 vs. 6.0months, HR, 1.55; 95% CI 1.10-2.16; p = 0.01). In multivariate analysis, the difference between atezolizumab and durvalumab was not statistically significant, while lung, bone and liver metastases, ECOG PS, LDH and NLR were associated with an increased risk of death. Associations were utilized for the generation of a novel prognostic score with good discriminatory power (C-statistic: 0.73). Real-world efficacy of first-line chemoimmunotherapy in patients with ES-SCLC is comparable to randomized trials. The association between prognostic scores and survival outcomes in ES-SCLC should be explored in prospective studies.Query.

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).

Complications related to vascular closure devices (VCDs) remain relatively common after transcatheter aortic valve implantation (TAVI), while the optimal suture-based strategy remains a subject of debate. This systematic review and meta-analysis aim to evaluate the efficacy and safety of single versus double Perclose VCD in patients undergoing transfemoral TAVI. A literature search was conducted across PubMed, Scopus, and Cochrane databases to identify appropriate studies. The primary outcome was technical success; secondary outcomes included vascular and bleeding complications, bailout interventions, and all-cause mortality. Seven studies (3940 patients) fulfilled the inclusion criteria. Technical success was comparable between the two strategies (relative risk [RR]: .89; 95% confidence interval [CI]: .64-1.22), while the single Perclose strategy was associated with a lower risk of major vascular complications (RR: .61; 95% CI: .40-.92), major bleeding (RR: .28; 95% CI: .11-.73) and bailout surgical interventions (RR: .45; 95% CI: .24-.84). There were no differences in minor vascular complications and all-cause mortality. Stepwise closure with the upfront single Perclose strategy demonstrated comparable technical success and a more favorable safety profile regarding major vascular complications and bleeding compared with the double Perclose strategy. Additional randomized controlled trials are essential to validate these findings.

<title>Abstract</title> Mortality prediction in critically ill patients remains challenging due to poor cross-institutional performance and limited generalizability of machine learning models. This study addresses this, by systematically benchmarking and prospectively validating transfer learning frameworks. We trained our models on MIMIC-IV and validated them on a multicenter prospective cohort of 539 patients from three hospitals. We compared tree-based methods and modern deep learning architectures for tabular data. Results demonstrated that both Domain Adaptation (DA) and Inductive Transfer Learning (ITL) significantly enhanced model performance under realistic conditions where target-domain data are limited. DA consistently improved discrimination across all evaluated models, with LightGBM showing the most significant gains in Area Under the Receiver Operating Characteristic Curve (AUC) (p = 0.0010), and XGBoost yielding the largest improvements in Area Under the Precision-Recall Curve (AUPRC) (p = 0.0419). Among all evaluated models, Random Forest (RF) achieved the highest discriminative performance, achieving 90.7% AUC with DA and 81.3% AUPRC with ITL. Notably, the domain-adapted models significantly outperformed APACHE II (p = 0.0044) and SOFA (p = 0.0077). These findings suggest that transfer learning provides a robust and data-efficient pathway for improving model generalizability across heterogeneous populations, offering a pragmatic solution to the challenge of model degradation in clinical deployment.

Shareable abstractAI and robotic bronchoscopy boost early lung cancer detection, dual-energy CT and cardiac MRI advance pulmonary vascular imaging, evidence-based standardised ultrasound training progresses. Innovation is reshaping respiratory medicine.https://bit.ly/454pPX3

Patients receiving moderately emetogenic chemotherapy (MEC) are commonly prescribed a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist (RA) and dexamethasone (DEX) as standard-of-care (SOC) antiemetic prophylaxis. However, in patients with an elevated risk of chemotherapy-induced nausea and vomiting (CINV) due to individual risk factors, prophylaxis with an neurokinin-1 (NK1) RA-containing regimen may optimise their antiemetic prevention. To address this unmet need for a more personalised antiemetic strategy, the MyRisk trial incorporated a predictive risk factor algorithm to select patients at increased risk of CINV who may benefit from enhanced antiemetic prophylaxis. MyRisk was a phase IV, randomised, open-label, multicentre, multinational trial. Adult patients scheduled to receive three cycles of MEC with a high-risk CINV score were randomly assigned to NEPA (a fixed combination of an NK1 RA, netupitant, and 5-HT3 RA, palonosetron) + DEX or SOC. The CINV risk score was calculated based on an algorithm that considered seven risk factors. The primary endpoint was complete response (CR: no emesis/no rescue medication) during the overall phase (0-120 h) across three consecutive cycles. Of 401 randomly allocated patients, 388 were included in the efficacy analysis. The most common cancers were colorectal and lung; oxaliplatin and carboplatin were the most common MECs. Patients randomly assigned to NEPA were significantly more likely to experience a CR compared with SOC (odds ratio 1.67, 95% confidence interval 1.12-2.49, P = 0.012). The NEPA group had a significantly higher probability of CR, no nausea, no emesis, and complete protection (81.0%, 63.7%, 95.4%, and 71.8%, respectively) compared with the SOC arm (71.8%, 54.9%, 86.7%, and 62.4%, respectively) across three cycles of chemotherapy. When individual risk factors are considered before MEC, a three-drug regimen including NEPA provides superior CINV prevention across multiple cycles compared with the standard two-drug approach. These findings underscore the value of personalised risk-adapted antiemetic strategies and have practice-changing potential for optimising antiemetic control.

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.

Abstract Background Mesalazine (msz) is commonly used alongside advanced therapies in ulcerative colitis (UC), but its precise effects on efficacy and safety are not fully defined. This meta-analysis indirectly evaluates the impact of concomitant msz use on clinical and endoscopic outcomes and safety profiles in adults with moderate-to-severe UC treated with approved biological agents and small molecules. Methods A meta-analysis of RCTs including approved biological agents (Adalimumab, Infliximab, Golimumab, Mirikizumab, Guselkumab, Ozanimod, Etrasimod, Ustekinumab) and small molecules (Tofacitinib, Upadacitinib) in UC patients reporting concomitant msz use was conducted through a search of four databases. Available data on clinical remission, endoscopic remission, mucosal healing and adverse events were extracted. Msz co-therapy prevalence was categorized using the median concomitant use across datasets as the baseline threshold. Studies were stratified into ‘High’ and ‘Low’ prevalence groups based on this median. Pooled proportions for each outcome and subgroup were estimated, with between-group differences tested by two-tailed z-tests. Separate analyses were performed for induction and maintenance phases, including only approved UC treatment doses. Meta-regression assessed correlations between concomitant mesalazine prevalence and treatment outcomes. Results 32 Phase II and III RCTs were included. No statistically significant differences were shown during the induction phase (Table1). In the maintenance phase, the subgroup with a higher prevalence of msz use showed significantly greater mucosal healing than the low-prevalence group (45.0%[95%CI,32.0%–58.0%] vs. 29.0%[95%CI,21.0%–39.0%]), with a borderline positive correlation in meta-regression (r = 0.503,p=0.067) (Figure1). Conversely, infection rates were significantly higher among patients with higher msz prevalence during maintenance therapy (23.0% [95%CI,0.9%–47.0%] vs. 0.1%[95%CI,0.0%–12.0%]), supported by a significant meta-regression correlation (r = 0.396,p=0.015). No difference was found in serious infection rates between the high and low prevalence groups (p &amp;gt; 0.05). No other efficacy nor safety outcomes showed significant differences between groups. Conclusion The concomitant use of msz and advanced therapies is associated with improved mucosal healing during maintenance therapy for UC, suggesting a potential synergistic effect in the long term. Future prospective studies incorporating histologic outcomes are warranted to elucidate the mechanistic contribution of msz in combination regimens. Conflict of interest: Rodríguez-Lago, Iago: Financial support for traveling and educational activities from or has served as an advisory board member for Abbvie, Adacyte, Alfasigma, Biogen, Chiesi, Faes Farma, Ferring, Fresenius Kabi, Galapagos, Johnson &amp; Johnson, Eli Lilly, Mirum Pharmaceuticals, Merck, Pfizer, Roche, Takeda, and Tillotts Pharma. Research support from AbbVie. Supported by a research grant from Gobierno Vasco-Eusko Jaurlaritza (Grant No 2020111061 and 2023222006). D’Amico, Ferdinando: Grant: ECCO fellowship grant 2020 ECCO grant 2021 Personal Fees: F D’Amico has served as a speaker for Abbvie, Alfasigma, Ferring, Lilly, Sandoz, Janssen, Fresenius Kabi, Galapagos, Giuliani, MSD, Pfizer, Takeda, Tillotts, and Omega Pharma he also served as an advisory board member for Abbvie, AnaptysBio, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, MSD, Takeda, and Nestlè. Bamias, Giorgos: Grants: Grants from Takeda, AbbVie, Mylan/Viatris/Biocon, Genesis Pharma, Ferring, Vianex, and Aenorasis Consulting Fees and Speaker Honoraria: AbbVie, Adacyte Therapeutics, Amgen, Bristol Myers Squibb, Faran, Ferring, Galenica, Genesis Pharma, J&amp;ampJ, Lilly, MSD, Mylan/Viatris/Biocon, Pfizer, Shattuck Labs, Takeda, Vianex Mrs. Miranda Azpiazu, Patricia: Employed at Faes Farma S.A Barreiro-de Acosta, Manuel: MBA has been speaker, consultant and advisory member for or has received research funding from MSD, AbbVie, Janssen, Kern Pharma, Celltrion, Takeda, Alphasigma, Lilly, Pfizer, Sandoz, Biocon, Abivax, Fresenius, Faes Farma, Ferring, Tillots, Chiesi, Adacyte, Diasorin, Oncostellae and SunRock.

Mental health nursing can be highly rewarding but at the same time overwhelmingly stressful or even traumatizing. Spirituality constitutes a central element of mental health nurses' resilience while personal trauma may be activated during exposure to beneficiaries' trauma. The aim of this study is to examine the impact of sociodemographic and work-related characteristics, spirituality, and history of trauma on compassion fatigue (CF) and compassion satisfaction among psychiatric nurses in Greece. A cross-sectional survey study with a total of 91 mental health nurses selected by convenience sampling and required to complete the Professional Quality of Life Scale (ProQOL-V), the FACIT-Spiritual Well-Being Scale-12 non-illness scale, and the Traumatic Life Events Questionnaire (TLEQ). More than a quarter (25.3%) of participants reported high compassion fatigue risk, while 76% expressed high to moderate potential for compassion satisfaction. Secondary traumatic stress (STS) as expected was found to correlate positively with traumatic life events and negatively with the spirituality dimension of meaning. Spiritual well-being, good physical health, high levels of cooperation, respect for teamwork and positive work climate were positively related to higher levels of compassion satisfaction. The findings of this study shed light on the significant prevalence of compassion fatigue and personal trauma history among nursing staff, highlighting the need for targeted interventions to improve the mental health of front-line health care nurses. Mental health care organizations must recognize the importance of fostering compassionate work environments that prioritize mental health professionals' spiritual and psychological well-being.