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Carcinosarcoma of the breast:Facing the challenge of a rare nosologic entity

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World Journal of Clinical Cases 2025年第2期13卷 14-20页

作者： Aikaterini Mastoraki Maria Tsamopoulou Foivos-konstantinos Stamatis Alexios Strimpakos Ero Mouchtouri Christiana Panagi Evgenia Mela Sotiria Mastoraki Aristotelis Kechagias Dimitrios Schizas Department of Surgery National and Kapodistrian University of AthensLaikon General HospitalAthens 11527Greece Department of Surgery National and Kapodistrian University of AthensAthens 11527Greece Department of Medical Oncology Hygeia HospitalAthens 15123Greece Department of Radiology Henry Dunant Hospital CenterAthens 11526Greece Department of Surgery Athens Metropolitan HospitalAthens 15562Greece

Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast *** is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition *** cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic *** recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative *** CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always ***,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone ***,surgical removal of breast CS does not necessarily ensure patient’s long-term ***,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is ***,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment *** aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological *** features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.

关键词： Carcinosarcoma Breast Diagnostic approach Therapeutic management Prognostic parameters

Improving service regularity for high-frequency bus services with rescheduling and bus holding

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Journal of Traffic and Transportation Engineering(English Edition) 2021年第5期8卷 778-794页

作者： konstantinos Gkiotsalitis Centre for Transport Studies Department of Civil EngineeringUniversity of TwenteEnschedeThe Netherlands

In high-frequency bus services,maintaining the service regularity is a critical *** service regularity is directly related to the excessive waiting times(EWT) of passengers at bus *** a regular service,the EWT is minimized resulting in even headways between consecutive buses of the same *** this study,we propose the combined use of rescheduling and bus holding to improve passengers’ excessive waiting *** model the dynamic rescheduling and bus holding problem as an integer nonlinear program(INLP) and we prove its *** model considers the constraints of the original timetable e an issue that is usually neglected from most dynamic control *** the NP-hardness of our mathematical program,we introduce a problem-specific heuristic to explore efficiently the solution *** convergence rate of the proposed heuristic is tested against other solution methods,including simulated annealing with linear cooling,hill climbing and branch and bound with multi-start sequential quadratic *** addition,simulations with the use of actual operational data from a major bus operator in Asia Pacific demonstrate an up to 35% potential EWT improvement for a minor increase of 6% to the travel times of onboard passengers.

关键词： Traffic engineering Rescheduling Bus holding Dynamic control Combinatorial optimization Bus bunching

Spatiotemporal graph queries on geographic databases under a conceptual abstraction scale

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Geo-Spatial Information Science 2014年第2期17卷 110-118页

作者： Panagiotis PARTSINEVELOS konstantinos PAPADAKIS konstantinos MAKANTASIS Laboratory of Geodesy and Geomatics Engineering Department of Mineral Resources EngineeringTechnical University of CreteUniversity CampusChania 73100CreteGreece Department of Electronic and Computer Engineering Technical University of CreteUniversity CampusChania 73100CreteGreece Computer Vision and Decision Support Laboratory Production and Management DepartmentTechnical University of CreteUniversity CampusChania 73100CreteGreece

Visual queries assist non-expert users to extract information from spatial databases in an intuitive and natural approach,making Geographic information systems comprehensive and efficient for a wide range of applications.A common visual means of querying takes the form of drawings or graphs,under which many spatial ambiguity and translation errors *** this study,common query attributes extracted from user graphs such as spatial topology,size,cardinality,and proximity are regarded under a conceptual moderation ***,the system/user may concentrate on various conceptual combinations of ***,time is incorporated to support spatiotemporal queries for changing scenes and moving ***,relative,and absolute scaling is possible according to the data-set and application at *** theoretic approach is implemented under a prototype user interface system,called *** this prototype,a user may extract scene-based relations in an automatically inferred fashion,or include single object-oriented relations when all possible relations seem ***,a natural language description of the query is extracted upon which the user may select the desired query *** on a spatial database demonstrates the concepts of predefined draw objects,scaling relaxation,conceptual abstraction,and scene,object-and textual-oriented transitions that promote query expressiveness and restrain ambiguities.

关键词： visual queries spatial topology spatiotemporal queries graph and sketch queries query by example

Supporting decision-making processes for selecting fire safety measures for road tunnels

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Journal of Traffic and Transportation Engineering(English Edition) 2022年第3期9卷 473-489页

作者： Panagiotis Ntzeremes konstantinos Kirytopoulos School of Mechanical Engineering National Technical University of AthensAthens 10682Greece

Selecting fires safety measures for road tunnels relies mainly on strict regulatory requirements. However, the choice should also be based on many different criteria and ranking of alternatives should take place. Existing methods exhibit lack in dealing rigorously with measures’ selection amongst different alternatives. This paper contributes to the body of knowledge by proposing a novel method, named EVADE, which aims to incorporate diverse stakeholders’ views and provide a meaningful ranking of *** do so, it estimates the tunnel level of safety taking into account only any standard measures existing. Subsequently, the performance of additional measures is ***, a list of the most significant criteria that are valuable to judge the appropriateness of selected measures is introduced. The relative importance amongst the decision criteria is calculated through the Analytic Hierarchy Process, based on the expert opinion. Sensitivity analysis through Monte Carlo simulation is embedded to allow for a meaningful prioritization of the decision criteria. Thus, the alternatives’ ranking comes as a distribution instead of a single number, providing the decision-maker richer information for selecting the most suitable measure(s) according to the specific tunnel situation. At last, a typical tunnel is examined to showcase the utilization of the method.

关键词： Road tunnel Critical infrastructure Decision-making Quantitative-risk-assessment

Effects of glucose-lowering agents on ischemic stroke

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World Journal of Diabetes 2017年第6期8卷 270-277页

作者： konstantinos Avgerinos konstantinos Tziomalos First Propedeutic Department of Internal Medicine Medical SchoolAristotle University of ThessalonikiAHEPA Hospital54636 ThessalonikiGreece

Diabetes mellitus(DM) is a major risk factor for cardiovascular events, including ischemic stroke. Moreover, ischemic stroke appears to be more severe in these patients and to be associated with less favorable outcomes. However, strict glycemic control does not appear to reduce the risk of ischemic stroke. On the other hand, newer glucose-lowering agents(glucagon-like peptide 1 receptor agonists and sodiumglucose cotransporter 2 inhibitors) reduced the risk of cardiovascular events in recent randomized, placebocontrolled trials. Semaglutide also reduced the risk of ischemic stroke. These benefits are independent of glucose lowering and might be due to the favorable effects of these agents on body weight and blood pressure. Pioglitazone also reduced the risk of recurrent stroke in patients with insulin resistance or type 2 DM but the unfavorable safety profile limits its use. In contrast, sulfonylureas and dipeptidyl peptidase 4 inhibitors have a neutral effect on cardiovascular morbidity and might be less attractive options in this high-risk population.

关键词： Antidiabetic treatment Ischemic stroke Cardiovascular events Glucose regulation Neuroprotection

Large solitary retroperitoneal echinococcal cyst:A rare case report

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World Journal of Gastroenterology 2007年第45期13卷 6101-6103页

作者： konstantinos Tepetes Gregory Christodoulidis Michael Spryridakis konstantinos Hatzitheofilou General Surgery Department University Hospital of Larissa Mezourlo Larissa Greece

Echinococcal disease remains a problem within some endemic areas. Echinococcal cysts usually involve the liver and lungs, but any other organ can potentially be involved. Extrahepatic localization is reported in 14%-19% of all cases of abdominal hydatid disease. We report the case of a large echinococcal cyst localized in the lower pelvis. A 28-year-old woman was admitted to a surgical ward with lower abdominal pain and discomfort lasting for a month. Ultrasonography and computed tomography scanning revealed a large retroperitoneal cystic mass (9 cm × 4 cm) in contact with the left ovary and left ureter. There were no cysts in any other location. Serological tests were positive for Echinococcus. The patient was operated on and the entire cyst was excised intact. Histopathological results confirmed the diagnosis of echinococcosis. Antihelminthics were administered postoperatively and the patient was discharged after 6 d, and is now being closely followed up. Total cystectomy when possible represents the treatment of choice for large extrahepatic echinococcal cysts.

关键词： Echinococcus cysts Ultrasonography Extrahepatic location Seropositivity Antihelminthics Total cystectomy

Evaluating the role of risk assessment for road tunnel fire safety: A comparative review within the EU

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Journal of Traffic and Transportation Engineering(English Edition) 2019年第3期6卷 282-296页

作者： Panagiotis Ntzeremes konstantinos Kirytopoulos School of Mechanical Engineering National Technical University of Athens Athens 15780 Greece School of Natural and Built Environments University of South Australia Adelaide South Australia 5001 Australia

Fire is the foremost critical event for road tunnels’ safety. Therefore, the European Commission introduced the Directive 2004/54/EC for enhancing tunnels’ safety since they constitute a key element of the Trans-European Road Network. The Directive has established a common ground for tunnels’ safety evaluation providing certain minimum requirements while introducing officially the use of risk assessment. Despite the signifi-cant progress, this paper illustrates that further efforts are needed. Through a comparative review of the risk assessment methods, questions about the level of harmonisation of the framework are raised. Moreover, considerable problems are highlighted, like the incorporation of the new trends emerging from the literature or the deficiencies on addressing significant issues of the analysis, such as the risk acceptance criteria and the behaviour of trapped-users. These problems can affect the risk assessment process causing both significant discrepancies and deficiencies at the estimated level of tunnels’ ***, thus, the deficiencies and limitations of the methods, this paper contributes to i) the discourse for initiating relevant studies to enhance tunnels’ fire safety in Europe and worldwide, and ii) the harmonisation of risk assessment methods.

关键词： Road tunnel Safety Fire Risk assessment

Liver iron content determination by magnetic resonance imaging

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World Journal of Gastroenterology 2010年第13期16卷 1587-1597页

作者： konstantinos Tziomalos Vassilios Perifanis 1st Propedeutic Department of Internal Medicine Medical School Aristotle University of Thessaloniki AHEPA University Hospital Thalassemia Unit Hippokration Hospital

Accurate evaluation of iron overload is necessary to establish the diagnosis of hemochromatosis and guide chelation treatment in transfusion-dependent anemia. The liver is the primary site for iron storage in patients with hemochromatosis or transfusion-dependent anemia, therefore, liver iron concentration (LIC) accurately re? ects total body iron stores. In the past 20 years, magnetic resonance imaging (MRI) has emerged as a promising method for measuring LIC in a variety of diseases. We review the potential role of MRI in LIC determination in the most important disorders that are characterized by iron overload, that is, thalassemia major, other hemoglobinopathies, acquired anemia, and hemochromatosis. Most studies have been performed in thalassemia major and MRI is currently a widely accepted method for guiding chelation treatment in these patients. However, the lack of correlation between liver and cardiac iron stores suggests that both organs should be evaluated with MRI, since cardiac disease is the leading cause of death in this population. It is also unclear which MRI method is the most accurate since there are no large studies that have directly compared the different available techniques. The role of MRI in the era of genetic diagnosis of hemochromatosis is also debated, whereas data on the accuracy of the method in other hematological and liver diseases are rather limited. However, MRI is a fast, non-invasive and relatively accurate diagnostic tool for assessing LIC, and its use is expected to increase as the role of iron in the pathogenesis of liver disease becomes clearer.

关键词： Thalassemia major Iron overload Magnetic resonance imaging Liver Hemochromatosis Desferrioxamine Deferiprone Deferasirox Thalassemia inter media Myelodysplastic syndromes

Presentation and surgical management of xanthogranulomatous cholecystitis

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Hepatobiliary & Pancreatic Diseases International 2021年第2期20卷 117-127页

作者： Maximos Frountzas Dimitrios Schizas Efstathia Liatsou konstantinos P Economopoulos Christina Nikolaou konstantinos G Apostolou konstantinos G Toutouzas Evangelos Felekouras First Propaedeutic Department of Surgery Hippocration General HospitalNational and Kapodistrian University of AthensSchool of Medicine114 Vas.Sofias Ave.11527AthensGreece Laboratory of Experimental Surgery and Surgical Research National and Kapodistrian University of AthensSchool of Medicine15B Ag.Thoma Str.11527AthensGreece First Department of Surgery Laikon General HospitalNational and Kapodistrian University of AthensSchool of Medicine17 Ag.Thoma Str.11527AthensGreece Society of Junior Doctors Surgery Workgroup75 Mikras Asias Str.11527AthensGreece Department of Surgery Duke University Medical Center2301 Erwin RdDurhamNC 27707USA

Background:Xanthogranulomatous cholecystitis(XGC)is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical *** addition,distinguishing XGC from gallbladder cancer preoperatively is still a *** aim of the present systematic review was to outline the clinical presentation and surgical approach of *** sources:The present systematic review was designed using the PRISMA and AMSTAR *** searched MEDLINE,Scopus,***,EMBASE,Cochrane Central Register of Controlled Trials(CENTRAL)and Google Scholar databases from inception until June ***:The laparoscopic cholecystectomy rate(34%)was almost equal to the open cholecystectomy rate(47%)for *** important conversion rate(35%)was observed as *** XGC cases treated by surgery were associated with low mortality(0.3%),limited intraoperative blood loss(58-270 m L),low complication rates(2%–6%),along with extended operative time(82.6–120 minutes for laparoscopic and 59.6–240 minutes for open cholecystectomy)and hospital stay(3–9 days after laparoscopic and 8.3–18 days after open cholecystectomy).Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi *** addition,complex surgical procedures,like wedge hepatic resections and bile duct excision were required during operations for ***:XGC seemed to be a rare,benign inflammatory disease that presents similar features as gallbladder *** mortality and complication rates of XGC were low,despite the complex surgical procedures that might be required in some cases.

关键词： Xanthogranulomatous cholecystitis Surgical management Pathology Postoperative complications