University Hospital of Heraklion

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Immunotherapy has significantly reshaped the management of malignant pleural mesothelioma (MPM), offering new therapeutic opportunities after decades in which platinum-pemetrexed chemotherapy represented the only systemic option. However, clinical benefit remains markedly heterogeneous, with outcomes strongly influenced by histologic subtype, patient characteristics, and real-world treatment conditions. Evidence from monotherapy trials has been inconsistent, whereas combination approaches-particularly nivolumab plus ipilimumab-have demonstrated improved survival compared with chemotherapy, mainly in non-epithelioid tumors. Nevertheless, real-world data consistently show lower efficacy and higher toxicity than registrational studies, especially among elderly and unselected populations. Recent translational work has highlighted the relevance of the tumor microenvironment and recurrent genomic alterations such as BAP1, NF2, and CDKN2A in shaping immune activity and potentially modulating response to immune checkpoint inhibitors. Transcriptomic signatures and circulating biomarkers-including soluble mesothelin-related peptide-have shown prognostic associations but no validated predictive value. Overall, current evidence suggests that sensitivity to immunotherapy in MPM arises from a complex interplay of genomic, immunologic, and clinical factors, and that no biomarker is yet suitable for guiding treatment decisions. Prospective studies integrating molecular and immune profiling will be essential to refine patient selection and advance toward a more rationally personalized use of immunotherapy.

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.

Growth factors play a significant role in the immunopathogenesis of liver diseases, especially liver cirrhosis and hepatocellular carcinoma (HCC). The somatostatin analog octreotide has been used as treatment in advanced HCC, based on its anti-neoplastic effects in vitro. Therefore, the effect of somatostatin and octreotide was studied on several growth factors in patients with HCC. Nineteen patients with advanced HCC were treated with octreotide and compared with thirty-seven patients with viral cirrhosis (19 decompensated) treated with intravenous somatostatin for severe bleeding from portal gastropathy. Five growth factors, namely Gastrin, Insulin-like growth factor 1 (IGF 1), Hepatocyte growth factor (HGF), Stem cell factor (SCF) and Vascular endothelial growth factor (VEGF) were measured in serum before and after treatment with specific commercially available ELISAs. Seventeen healthy individuals and nineteen patients with chronic viral hepatitis C (CAH) were used as pre-treatment controls. Eighteen patients with advanced Primary Biliary Cholangitis (stage III and IV) before and after Ursodeoxycholic acid (UDCA) treatment were also studied. Pre-treatment levels of Gastrin were significantly increased in HCC, cirrhosis and PBC but not in CAH. Levels were significantly reduced by octreotide or somatostatin but also by UDCA in PBC. By contrast, IGF1 showed a mirror image being significantly reduced in HCC, cirrhosis and PBC, but not in CAH. Post-treatment levels were reduced in all groups, but not in PBC. Levels of HGF were significantly increased in HCC and cirrhosis but not in CAH and PBC. They were further increased in HCC after treatment. SCF increased only in HCC and was reduced after octreotide but not after somatostatin treatment. VEGF was reduced in cirrhosis and CAH but not in PBC. It was not significantly increased in HCC, but it was reduced by octreotide and was increased after UDCA. In this retrospective observational study, somatostatin and its analog octreotide have a significant effect on several growth factors involved in HCC pathogenesis.

In this article a comparative statement regarding the frequency of GBA1 variants in the Cretan Parkinson's disease (PD) cohort versus the Greek mainland was overstated in wording.This issue concerns interpretation in the Abstract and Discussion section only.In the Abstract the statement was "The proportion of GBA1 in Crete is substantially higher than on the Greek mainland, highlighting the distinct genetic PD profile in this population and supporting targeted genetic testing and counseling." and should have read "The proportion of GBA1 in Crete highlights the distinct genetic PD profile in this population and supports targeted genetic testing and counseling." and in the Discussion section the statement was "This proportion is substantially higher than previous estimates of GBA1 frequency in the mainland Greek population (~4%), and more closely resembles reports of Greek familial PD cohorts (10.3%)." and should have read "This proportion is comparable to previous estimates of GBA1 frequency in the mainland Greek population".

BackgroundThe rapidly changing landscape of healthcare in the era of digital transformation brings an abundance of opportunities to improve quality of patient care; however, in parallel, it poses unique challenges to healthcare professionals, which mandate constant efforts to develop both digital competencies and a crucial set of transversal skills. In this context, to address existing unmet needs, the consortium of the H-PASS (Health Professionals and the DigitAl team SkillS advancement) European project has developed a blended learning-based educational programme.ObjectivesThe primary objective of the hereby presented preliminary analysis is to evaluate the degree of improvement in participants’ knowledge on key aspects of technologies currently incorporated in healthcare, after completion of the training’s first module.MethodsThe training courses are currently being delivered in 6 EU member stated, and are divided into 5 distinct educational modules; four primary and one secondary module, focused on virtual reality (VR) technology. A detailed description of the pilot training course conducted in Greece is provided in Figure 1.Before initiation and after completion of each educational module’s activities, all participants are invited to answer the same set of module-specific multiple choice questions. For the purposes of the present analysis, we comparatively evaluated the percentages of participants that answered Module 1-specific questions correctly, prior to- and after completion of all educational activities of the course’s first module.ResultsAs of 10/6/2025, thirty nine of the 75 in total healthcare professionals that have already been enrolled in the Greek pilot training, have completed Module 1 and answered both the pre- and the post-module six-question knowledge evaluation survey.Questions included, as well as percentages of trainees having provided the correct answers to each question prior to- and after completion of the first module, are outlined in Figure 2.For all 6 questions, a significant increase of the percentage of trainees that provided the correct answer was observed (9.7%-31,6%, mean value=18.6%).ConclusionsWhile the delivery of the H-PASS pilot training courses is still ongoing, our preliminary results suggest that appropriately designed, blended learning-based educational programs could be valuable in promoting key digital skills, which are sine qua non for healthcare professionals in the era of digital transformationFigure 1.Figure 2

BackgroundThe COVID-19 pandemic accelerated the adoption of digital health technologies, especially for patients with chronic diseases such as acute coronary syndrome (ACS). However, the impact of this rapid digital transformation on digital health literacy (DHL) among ACS patients in Greece remains unclear, particularly in the post-pandemic era. To evaluate changes in digital health literacy and the use of digital health services among ACS patients in Heraklion, Crete, Greece, across pre-pandemic, pandemic, and post-pandemic periods.MethodsA retrospective cohort study was conducted involving adults (≥18 years) hospitalized for ACS in the two major hospitals of Heraklion, Crete, from January 2019 to June 2023. Patients were identified via electronic health records and contacted by telephone for additional information on digital health service use and DHL. DHL was assessed using an 8-item questionnaire, categorizing literacy as good, moderate, or poor. Data were analyzed by time period: pre-COVID-19 (2019), COVID-19 (2020–2022), and post-COVID-19 (2023). Statistical analyses included chi-square tests, ANOVA, and Bonferroni correction for multiple comparisons.ResultsA total of 1,177 ACS patients were included (pre-COVID: 252; COVID: 702; post-COVID: 223). Digital health literacy levels varied significantly across periods. The proportion of patients with good DHL peaked during the COVID period (57.1%), compared to pre-COVID (42.9%) and declined to zero post-COVID. Moderate DHL increased during COVID (54.4%) and remained elevated post-COVID (28.2%) compared to pre-COVID (17.4%). The percentage of patients with poor DHL peaked during COVID (61.9%) and decreased substantially post-COVID (14.9%), lower than pre-COVID (23.1%) (p<0.001). Use of electronic prescription services increased markedly during COVID (60.7% vs. 16.2% pre-COVID), but declined post-COVID (23.2%). Remote appointment booking (online/phone) increased during the pandemic, with partial reversion to in-person bookings post-pandemic.ConclusionsThe COVID-19 pandemic significantly accelerated digital health literacy and digital service utilization among ACS patients in Greece. However, sustaining these advances post-pandemic remains a challenge, with a notable decline in good DHL and digital service use after the pandemic. Targeted interventions are needed to maintain and further improve digital health literacy and equitable access to digital health services in this vulnerable population.

Abstract Background Renal and urological manifestations are established but insufficiently investigated extraintestinal manifestations of inflammatory bowel disease (IBD). The aim of this study was to determine their prevalence and to investigate associations with clinical factors. Methods This was a retrospective, observational study, conducted at a tertiary center in Greece. IBD patients with at least one year of follow-up and documented renal function and disease activity were included. Demographic, clinical, and laboratory data were retrieved. The primary outcome was the composite outcome of kidney injury [acute kidney injury (AKI) and/or chronic kidney disease (CKD)] during follow-up. Secondary outcomes were AKI, CKD, and urolithiasis. Associations with independent variables were examined using univariate logistic regression; a multivariable analysis was performed for the primary outcome. Results A total of 660 IBD patients were included in this study [379 (57.4%) male, 368 (56%) Crohn’s disease (CD), 292 (44%) Ulcerative Colitis (UC)] (Table 1). Kidney injury occurred in 54 patients (8.3%), AKI in 23 (3.5%), CKD in 35 (5.3%), and urolithiasis in 48 (7.3%). Independent risk factors for renal injury were IBD-related surgery [adjusted Odds Ratio (aOR) 2.69, 95% Confidence Interval (CI): 1.25–5.80, p = 0.012], male sex (aOR 2.14, 95% CI: 1.06–4.32, p = 0.034), Charlson Index (per 1-point increase, aOR 1.53, 95% CI: 1.26–1.86, p &amp;lt; 0.001) and arterial hypertension (aOR 2.43, 95% CI: 1.20–4.94, p = 0.014) (Table 2). Extensive UC also independently predicted renal injury (aOR 2.81, 95% CI: 1.11–7.73, p = 0.035). AKI was associated with older age at IBD onset and a higher number of IBD flares. All secondary outcomes correlated with hypertension and dyslipidemia. Conclusion Renal and urological complications are relatively common in IBD affecting 8.3% and 7.3% of patients respectively. IBD-related surgery, extensive UC, and comorbidities significantly increase the risk of renal injury. These findings underscore the need for regular renal monitoring in IBD patients.