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Mechanisms of drug-induced proarrhythmia in clinical practice

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World Journal of Cardiology 2013年第6期5卷 175-185页

作者： Arkadia Konstantopoulou spyros tsikrikas Dimitrios Asvestas Panagiotis Korantzopoulos Konstantinos P Letsas Second Department of Cardiology Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of Athens Department of Cardiology University Hospital of Ioannina

Drug-induced proarrhythmia represents a great challenge for those involved in the development of novel pharmaceuticals and in the regulatory bodies for drug approval as well as for the prescribing *** understanding of the mechanisms that underlie druginduced proarrhythmia has grown dramatically over the last two decades.A growing number of cardiac and non-cardiac agents have been shown to alter cardiac repolarization predisposing to fatal cardiac arrhythmias such as ventricular tachycardia or ventricular fibrillation and sudden cardiac *** agents may induce the phenotype of long QT syndrome and less commonly of short QT syndrome and Brugada syndrome(BS).Although,genetic susceptibility underlie drug-induced proarrhythmia in certain cases,current data are limited regarding this *** present review surveys the current published literature on the mechanisms and the offending medical agents that predispose to drug-induced long QT syndrome,short QT syndrome and ***-induced proarrhythmia should be considered as a predictor of sudden cardiac death and should prompt critical re-evaluation of the risks and benefits of the suspicious *** of drug-induced proarrhythmia and family members require careful examination and possibly genetic testing for the presence of a *** physicians are advised to follow the lists of agents implicated in drug-induced proarrhythmia in order to minimize the risk of arrhythmia and sudden cardiac death.

关键词： Drugs Sudden cardiac death Long QT syndrome Short QT syndrome Brugada syndrome

The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris Ioannis Poularas Dimitrios Filippiadis Demosthenes Cokkinos Dimitrios Exarhos spyros Zakynthinos Christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical *** data exist on whether such effects are also present in HFOT through ***,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical *** A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical *** patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover *** the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle *** Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied *** were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(m

关键词： Diaphragm Diaphragm ultrasonography High-flow oxygen Prolonged mechanical ventilation Tracheostomy

Bacterial community in response to packaging conditions in farmed gilthead seabream

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Aquaculture and Fisheries 2023年第4期8卷 410-421页

作者： Apollon Thomas spyros J.Konteles Sotiris Ouzounis spyros Papatheodorou Aliki Tsakni Dimitra Houhoula Theofania Tsironi Department of Food Science and Technology Faculty of Food SciencesUniversity of West AtticaAthens11521Greece Medical Image and Signal Processing Laboratory Department of Biomedical EngineeringUniversity of West AtticaAthens11521Greece Laboratory of Food Process Engineering Department of Food Science and Human NutritionAgricultural University of AthensAthens11855Greece

The objective of this study was to evaluate the effect of modified atmosphere packaging(MAP)on fish skin,gills and intestines bacterial *** gilthead seabream was packed aerobically or under modified atmospheres(60%CO_(2),30%N_(2),10%O_(2))and stored isothermally at 0℃.Next Generation Sequencing(NGS)analysis was applied for the characterization of fish microbiome on fish skin,gills,and intestines initially(time of packaging,1 day after harvesting)and after 10 days of isothermal storage at 0℃.NGS results indicated statistically significant differences in families’richness and diversity in the tested fish tissues between aerobic and MAP packaging during storage at 0℃.The most persistent bacteria were Proteobacteria for both packaging *** fish skin microbiota,the initially prevailing families were Comamonadaceae,Enterobacteriaceae and Moraxellaceae while in the intestines Comamonadaceae,Anaplasmataceae,Bacillaceae and Enterobacteriaceae were the dominant *** the end of storage period,the fish microbiota was dominated by psychotropic and psychrophilic families(Pseudoalteromonadaceae,Psychromonadaceae,and Shewanellaceae),while families such as Comamonadaceae were persistent under MAP *** 8 days of fish storage at 0℃,МАРsamples exhibited higher sensory scorings than the respective aerobically stored fish,indicating better retention of fish freshness and fish quality attributes under *** on the results of the study,MAP modified significantly the microbiological status and extended the shelf life of *** was a powerful tool that provided a more complete assessment compared to a culture-based analysis.

关键词： Fish Preservation Next generation sequencing Modified atmosphere packaging Microbiome

Laparoscopic versus open appendectomy: Which way to go?

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World Journal of Gastroenterology 2008年第31期14卷 4909-4914页

作者： Ioannis Kehagias Stavros Nikolaos Karamanakos spyros Panagiotopoulos Konstantinos Panagopoulos Fotis Kalfarentzos Department of Surgery School of Medicine University Hospital of Patras Rion University Hospital Patras 26500 Greece

AIM: To compare the outcome of laparoscopic versus open appendectomy. METHODS: Prospectively collected data from 293 consecutive patients with acute appendicitis were studied. These comprised of 165 patients who underwent conventional appendectomy and 128 patients treated laparoscopically. The two groups were compared with respect to operative time, length of hospital stay, postoperative pain, complication rate and cost. RESULTS: There were no statistical differences regarding patient characteristics between the two groups. Conversion to laparotomy was necessary in 2 patients (1.5%). Laparoscopic appendectomy was associated with a shorter hospital stay (2.2 d vs 3.1 d, P = 0.04), and lower incidence of wound infection (5.3% vs 12.8%, P = 0.03). However, in patients with complicated disease, intra-abdominal abscess formation was more common after laparoscopic appendectomy (5.3% vs 2.1%, P = 0.002). The operative time and analgesia requirements were similar in the two groups. The cost of treatment was higher by 370 € in the laparoscopic group. CONCLUSION: Laparoscopic appendectomy is as safe and effi cient as open appendectomy, provided surgical experience and equipment are available.

关键词： Laparoscopy Appendicitis Appendectomy Conventional appendectomy

Modern diagnostic approaches to cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2012年第4期11卷 349-359页

作者： Larisa E Vasilieva Stefanos I Papadhimitriou spyros P Dourakis Second Department of Internal Medicine University of Athens Medical SchoolHippokration General Hospital114 Vas Sofias AvenueAthens 11527Greece Molecular Cytogenetics Unit Haematology Laboratory"G.Genimatas" Regional General HospitalAthensGreece

BACKGROUND:Cholangiocarcinoma is a very aggressive tumor with poor ***,early diagnosis and surgical resection are of paramount *** diagnosis is difficult because access to the tumor is not *** is possible only for intrahepatic cholangiocarcinoma,which accounts for 10% of *** brush cytology from endoscopic retrograde cholangiopancreatography(ERCP) has a high specificity of 100% but unfortunately a low sensitivity of 30%.In this review we briefly describe new diagnostic techniques applicable to ERCP brush cytology specimens and targeting the genetic background of the disease,in particular fluorescence in situ hybridization(FISH) and digital image analysis(DIA).DATE SOURCES:The PubMed database up to 2011 was used for the retrieval of relevant *** search terms FISH,fluorescence in situ hybridization,DIA,digital image analysis and cholangiocarcinoma were *** original and review articles were ***:FISH identifies cells with chromosomal abnormalities,mainly numerical aberrations,using a mixture of fluorescencelabeled *** offers a higher sensitivity than routine cytology,retaining a high level of *** DIA criterion for malignancy is demonstration of *** technique increases the sensitivity to 40%,but the specificity remains *** data from application to other tumors suggest that combination of FISH and DIA may be of further ***:The new techniques offer a significantly enhanced diagnostic efficacy in the evaluation of ERCP brush *** from contributing to a more timely diagnosis,their wider application to cholangiocarcinoma may also facilitate the genetic study of the disease and add to our understanding of oncogenesis at the molecular level,with the prospect of identifying targets for novel therapeutic interventions.

关键词： cholangiocarcinoma fluorescence in situ hybridization digital image analysis

Walled-off pancreatic necrosis

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World Journal of Gastroenterology 2010年第14期16卷 1707-1712页

作者： Michael Stamatakos Charikleia Stefanaki Konstantinos Kontzoglou spyros Stergiopoulos Georgios Giannopoulos Michael Safioleas 4th Department of Surgery Medical School University of Athens Attikon Hospital Athens 12462 Greece 2nd Department of Propaedeutic Surgery Medical School University of Athens Laikon Hospital Athens 11527 Greece

Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encourag-ing results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.

关键词： Walled-off pancreatic necrosis Infected pseudocyst Severe pancreatitis Acute necrotizing pancreatitis Pancreas Inflammation Alcoholism

Prospective evaluation of laparoscopic Roux en Y gastric bypass in patients with clinically severe obesity

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World Journal of Gastroenterology 2008年第39期14卷 6024-6029页

作者： Kostantinos Vagenas spyros Panagiotopoulos Ioannis Kehagias Stavros Nikolaos Karamanakos Nancy Mead Fotis Kalfarentzos Department of Surgery University of Patras School of MedicineUniversity HospitalRion 26504Greece Nutrition Support and Morbid Obesity Clinic University of Patras School of MedicineUniversity HospitalRion 26504Greece

AIM: To evaluate and present our experience with laparoscopic Roux en Y gastric bypass (RYGB) in a selected patient population. METHODS: A cohort of 130 patients with a body mass index (BMI) between 35 and 50 kg/m2 were evaluated in relation to postoperative morbidity,weight loss and resolution of co-morbidities for a period of 4 years following laparoscopic RYGB. RESULTS: Early morbidity was 10.0%,including 1 patient with peritonitis who was admitted to Intensive Care Unit (ICU) and 1 conversion to open RYGB early in the series. There was no early or late mortality. Maximum weight loss was achieved at 12 mo postoperatively,with mean BMI 30 kg/m2,mean percentage of excess weight loss (EWL%) 66.4% and mean percentage of initial weight loss (IWL%) 34.3% throughout the follow-up period. The majority of preexisting comorbidities were resolved after weight loss and no major metabolic disturbances or nutritional deficiencies were observed. CONCLUSION: Laparoscopic RYGB appears to be a safe and effective procedure for patients with BMI 35-50 kg/m2 with results that are comparable to previously published data mostly from the USA but from Europe as well.

关键词： Laparoscopic gastric bypass Evaluation Obesity

Cholangiocarcinoma:A 7-year experience at a single center in Greece

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World Journal of Gastroenterology 2008年第40期14卷 6213-6217页

作者： Alexandra Alexopoulou Aspasia Soultati spyros P Dourakis Larissa Vasilieva Athanasios J Archimandritis 2nd Department of Medicine University of Athens Medical SchoolHippokration General Hospital

AIM： To evaluate survival rate and clinical outcome of cholangiocarcinoma. METHODS： The medical records of 34 patients with cholangiocarcinoma, seen at a single hospital between the years 1999-2006, were retrospectively reviewed. RESULTS： Thirty-four patients with a median age of 75 years were included. Seventeen （50%） had painless jaundice at presentation. Sixteen （47.1%） were perihilar, 15 （44.1%） extrahepatic and three （8.8%） intrahepatic. Endoscopic retrograde cholangiography （ERCP） and/or magnetic resonance cholangiography （MRCP） were used for the diagnosis. Pathologic confirmation was obtained in seven and positive cytological examination in three. Thirteen patients had co-morbidities （38.2%）. Four cases were managed with complete surgical resection. All the rest of the cases （30） were characterized as non-resectable due to advanced stage of the disease. Palliative biliary drainage was performed in 26/30 （86.6%）. The mean follow-up was 32 mo （95% CI, 20-43 too）. Overall median survival was 8.7 mo （95% CI, 2-16 mo）. The probability of 1-year, 2-year and 3-year survival was 46%, 20% and 7%, respectively. The survival was slightly longer in patients who underwent resection compared to those who did not, but this difference failed to reach statistical significance. Patients who underwent biliary drainage had an advantage in survival compared to those who did not （probability of survival 53% vs 0% at 1 year, respectively, P = 0.038）. CONCLUSION： Patients with cholangiocarcinoma were usually elderly with co-morbidities and/oradvanced disease at presentation. Even though a slight amelioration in survival with palliative biliary drainage was observed, patients had dismal outcome without resection of the tumor.

关键词： Cholangiocarcinoma Surgical resection Palliative biliary drainage Survival

Laparoscopic cholecystectomy: A report from a single center

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World Journal of Gastroenterology 2006年第24期12卷 3887-3890页

作者： Konstantinos Vagenas Stavros N Karamanakos Charalambos Spyropoulos spyros Panagiotopoulos Menelaos Karanikolas Michalis Stavropoulos Department of Surgery School of Medicine University of PatrasRion University Hospital26500 PatrasGreece Department of Anaesthesiology and Critical Care Medicine School of Medicine University of PatrasRion University Hospital26500 PatrasGreece

AIM： To review and evaluate our experience in laparoscopic cholecystectomy. METHODS： A retrospective analysis was performed on data collected during a 13-year period （1992-2005） from 1220 patients who underwent laparoscopic cholecystectomy. RESULTS： Mortality rate was 0%. The overall morbidity rate was 5.08% （n = 62）, with the most serious complications arising from injuries to the biliary tree and the cystic artery. In 23 （1.88%） cases, cholecystectomy could not be completed laparoscopically and the operation was converted to an open procedure. Though the patients were scheduled as day-surgery cases, the average duration of hospital stay was 2.29 d, as the complicated cases with prolonged hospital stay were included in the calculation. CONCLUSION： Laparoscopic cholecystectomy is a safe, minimally invasive technique with favorable results for the patient.

关键词： Laparoscopy Cholecystectomy Minimallyinvasive