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New endoscopes and add-on devices to improve colonoscopy performance

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World Journal of Gastroenterology 2017年第21期23卷 3784-3796页

作者： paraskevas gkolfakis georgios tziatzios george d dimitriadis konstantinos triantafyllou hepatogastro--enterology unit second department of internal medicine propaedeutic research institute and diabetes center medical school national and kapodistrian university of athens attikon university general hospital

Colonoscopy is the gold standard for colorectal cancer prevention; however, it is still an imperfect modality. Precancerous lesions can be lost during screening examinations, thus increasing the risk of interval cancer. A variety of factors either patient-, or endoscopist dependent or even the procedure itself may contribute to loss of lesions. Sophisticated modalities including advanced technology endoscopes and add-on devices have been developed in an effort to eliminate colonoscopy's drawbacks and maximize its ability to detect potentially culprit polyps. Novel colonoscopes aim to widen the field of view. They incorporate more than one cameras enabling simultaneous image transmission. In that way the field of view can expand up to 330°. On the other hand a plethora of add-on devices attachable on the standard colonoscope promise to detect lesions in the proximal aspect of colonic folds either by offering a retrograde view of the lumen or by straightening the haustral folds during withdrawal. In this minireview we discuss how these recent advances affect colonoscopy performance by improving its quality indicators(cecal intubation rate, adenoma detection rate) and other metrics(polyp detection rate, adenomas per colonoscopy, polyp/adenoma miss rate) associated with examination's outcomes.

关键词： Colonoscopy Quality indicators Wide-angle view colonoscopes Add-on devices

Gene polymorphisms associated with functional dyspepsia

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World Journal of Gastroenterology 2015年第25期21卷 7672-7682页

作者： Anastasia Kourikou george P Karamanolis george d dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine and Research Institute Attikon University General Hospital Medical School Athens University Academic department of Gastro- enterology Laiko General Hospital

Functional dyspepsia(Fd) is a constellation of functional upper abdominal complaints with poorly elucidated pathophysiology. However, there is increasing evidence that susceptibility to Fd is influenced by hereditary factors. Genetic association studies in Fd have examined genotypes related to gastrointestinal motility or sensation, as well as those related to inflammation or immune response. G-protein b3 subunit gene polymorphisms were first reported as being associated with Fd. Thereafter, several gene polymorphisms including serotonin transporter promoter, interlukin-17 F, migration inhibitory factor, cholecystocynine-1 intron 1, cyclooxygenase-1, catechol-o-methyltransferase, transient receptor potential vanilloid 1 receptor, regulated upon activation normal T cell expressed and secreted, p22 PHOX, Toll like receptor 2, SCN10 A, Cd14 and adrenoreceptors have been investigated in relation to Fd; however, the results are contradictory. Several limitations underscore the value of current studies. Among others, inconsistencies in the definitions of Fd and controls, subject composition differences regarding Fd subtypes, inadequate samples, geographical and ethnical differences, as well as unadjusted environmental factors. Further well-designed studies are necessary to determine how targeted genes polymorphisms, influence the clinical manifestations and potentially the therapeutic response in Fd.

关键词： Functional dyspepsia Gene polymorphism Genetic susceptibility Pathophysiology

Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate

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World Journal of Clinical Cases 2015年第10期3卷 880-886页

作者： Ioannis S Papanikolaou Athanasios d Sioulas Nektarios Magdalinos Iosif Beintaris Lazaros-dimitrios Lazaridis dimitrios Polymeros Chrysoula Malli george d dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine and Research InstituteAttikon University General HospitalMedical SchoolAthens University Salamina General Private Cinic

AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHOdS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates ***: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P diminutive(P d 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P d in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.

关键词： Colonoscopy Bowel preparation Polyp miss rate Polyp detection Colorectal cancer

Insulin action in muscle and adipose tissue in type 2 diabetes:The significance of blood flow

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World Journal of diabetes 2015年第4期6卷 626-633页

作者： Vaia Lambadiari Konstantinos Triantafyllou george d dimitriadis Second department of Internal Medicine Research Institute and Diabetes CentreAttikon University General HospitalAthens University Medical School

Under normal metabolic conditions insulin stimulates microvascular perfusion(capillary recruitment) of skeletal muscle and subcutaneous adipose tissue and thus increases blood flow mainly after meal ingestion or physical *** helps the delivery of insulinitself but also that of substrates and of other signalling molecules to multiple tissues beds and facilitates glucose disposal and lipid *** effect is impaired in insulin resistance and type 2 diabetes early in the development of metabolic dysregulation and reflects early-onset endothelial *** of insulin to increase muscle and adipose tissue blood flow results in decreased glucose *** fat depots,a blunted postprandial blood flow response will result in an insufficient suppression of lipolysis and an increased spill over of fatty acids in the circulation,leading to a more pronounced insulin resistant state in skeletal *** defect in blood flow response is apparent even in the prediabetic state,implying that it is a facet of insulin resistance and exists long before overt hyperglycaemia *** following review intends to summarize the contribution of blood flow impairment to the development of the atherogenic dysglycemia and dyslipidaemia.

关键词： Insulin resistance Muscle blood flow Glucoseuptake Adipose tissue blood flow diabetes

Virtual reality simulators for gastrointestinal endoscopy training

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World Journal of Gastrointestinal Endoscopy 2014年第1期6卷 6-12页

作者： Konstantinos Triantafyllou Lazaros dimitrios Lazaridis george d dimitriadis Hepatogastroenterology Unit Second Department of Internal Medicine and Research InstituteAttikon University General HospitalMedical SchoolAthens University

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.

关键词： Virtual endoscopic simulators GI Mentor Accutouch endoscopy simulator Olympus Endo TS-1 Endoscopy training

Academic hospital staff compliance with a fecal immunochemical test-based colorectal cancer screening program

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World Journal of Gastrointestinal Oncology 2016年第8期8卷 629-634页

作者： Georgia Vlachonikolou Paraskevas Gkolfakis Athanasios d Sioulas Ioannis S Papanikolaou Anastasia Melissaratou Giannis-Aimant Moustafa Eleni Xanthopoulou Gerasimos Tsilimidos Ioanna Tsironi Paraskevas Filippidis Chrysoula Malli george d dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine and Research Institute Attikon University General Hospital Medical School University of Athens

AIM: To measure the compliance of an Academic Hospital staff with a colorectal cancer(CRC) screening program using fecal immunochemical test(FIT).METHOdS: All employees of 'Attikon' University General Hospital aged over 50 years were thoroughly informed by a team of physicians and medical students about the study aims and they were invited to undergo CRC screening using two rounds of FIT(dyoniFOB~ Combo H, dyonMed SA, Athens, Greece). The tests were provided for free and subjects tested positive were subsequently referred for colonoscopy. One year after completing the two rounds, participants were asked to be re-screened by means of the same ***: Among our target population consisted of 211 employees, 59(27.9%) consented to participate, but only 41(19.4%) and 24(11.4%) completed the first and the second FIT round, respectively. Female gender was significantly associated with higher initial participation(P = 0.005) and test completion- first and second round-(P = 0.004 and P = 0.05) rates, respectively. Phy sician’s(13.5% vs 70.2%, P d test completion rates(7.5% vs 57.6%, P d 2.3% vs 34%, P d round) were significantly lower compared to those of the administrative/technical staff. Similarly, nurses participated(25.8% vs 70.2%, P = 0.0002) and completed the first test round(19.3% vs 57.6%, P = 0.004) in a significant lower rate than the administrative/technical staff. One test proved false positive. No participant repeated the test one year ***: despite the well-organized, guided and supervised provision of the service, the compliance of the Academic Hospital personnel with a FIT-based CRC screening program was suboptimal, especially among physicians.

关键词： Colorectal cancer Screening Academic hospital staff Fecal immunochemical test Compliance

Self-expandable metal stents for achalasia: Thinking out of the box!

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World Journal of Gastrointestinal Endoscopy 2015年第1期7卷 45-52页

作者： Athanasios d Sioulas Chrysoula Malli george d dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine and Research InstituteAttikon University General HospitalMedical SchoolAthens University12462 HaidariGreece

Achalasia is a primary motor disorder of the esophagus diagnosed manometrically in the clinical setting of dysphagia to both solids and liquids. Currently established treatment options include pneumatic dilation, laparoscopic Heller myotomy, botulinum toxin injection performed endoscopically, oral agents that relax the lower esophageal sphincter and esophagectomy for refractory, end-stage disease. despite their effectiveness, a significant proportion of patients eventually relapses and needs retreatment. In this setting, several new techniques are under investigation promising future enrichment of our therapeutic armamentarium for achalasic patients. Among them, peroral endoscopic myotomy and selfexpandable metal stents placed across the gastroesophageal junction represent the most encouraging modalities, as initial studies assessing their efficacy and safety indicate. This review highlights the role of selfexpandable metal stents in the management of patients with achalasia. Their possible position in the therapeutic algorithm of achalasia along with established and novel techniques is also assessed. Finally, the need for large prospective randomized trials is underlined in order to elucidate the numerous relevant issues.

关键词： Achalasia Self-expandable metal stents dysphagia Endoscopy Treatment

Gut microbiota and non-alcoholic fatty liver disease

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Hepatobiliary & Pancreatic diseases International 2015年第6期14卷 572-581页

作者： Paraskevas Gkolfakis george dimitriadis Konstantinos Triantafyllou Hepatogastroenterology Unit Second Department of Internal Medicine and Research InstituteAttikon University General HospitalMedical SchoolAthens University

BACKGROUNd： Non-alcoholic fatty liver disease （NAFLd） is a common disorder with poorly understood pathogenesis. Beyond environmental and genetic factors, cumulative data support the causative role of gut microbiota... 详细信息

关键词： non-alcoholic fatty liver disease non-alcoholic steatohepatitis gut microbiota 16S r RNA sequencing archaea

Treating amyotrophic lateral sclerosis with allogeneic Schwann cell-derived exosomal vesicles: a case report

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Neural Regeneration Research 2025年第4期20卷 1207-1216页

作者： Pascal J.Goldschmidt-Clermont Aisha Khan george Jimsheleishvili Patricia Graham Adriana Brooks Risset Silvera Alexander J.P.Goldschmidt damien d.Pearse W.dalton dietrich Allan d.Levi James d.Guest Miller School of Medicine University of MiamiMiamiFLUSA Stem Cell Institute Miller School of MedicineUniversity of MiamiMiamiFLUSA The Miami Project to Cure Paralysis Miller School of MedicineUniversity of MiamiMiamiFLUSA Alzady International LLC MiamiFLUSA Neurological Surgery Miller School of MedicineUniversity of MiamiMiamiFLUSA

Schwann cells are essential for the maintenance and function of motor neurons,axonal networks,and the neuromuscular *** amyotrophic lateral sclerosis,where motor neuron function is progressively lost,Schwann cell function may also be ***,important signaling and potential trophic activities of Schwann cell-derived exosomal vesicles have been *** case report describes the treatment of a patient with advanced amyotrophic lateral sclerosis using serial intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles,marking,to our knowledge,the first instance of such *** 81-year-old male patient presented with a 1.5-year history of rapidly progressive amyotrophic lateral *** initial diagnosis,the patient underwent a combination of generic riluzole,sodium phenylbutyrate for the treatment of amyotrophic lateral sclerosis,and *** patient volunteered to participate in an FdA-approved single-patient expanded access treatment and received weekly intravenous infusions of allogeneic Schwann cell-derived exosomal vesicles to potentially restore impaired Schwann cell and motor neuron *** confirmed that cultured Schwann cells obtained from the amyotrophic lateral sclerosis patient via sural nerve biopsy appeared impaired(senescent)and that exposure of the patient’s Schwann cells to allogeneic Schwann cell-derived exosomal vesicles,cultured expanded from a cadaver donor improved their growth capacity in *** a period of observation lasting 10 weeks,during which amyotrophic lateral sclerosis Functional Rating Scale-Revised and pulmonary function were regularly monitored,the patient received weekly consecutive infusions of 1.54×1012(×2),and then consecutive infusions of 7.5×1012(×6)allogeneic Schwann cell-derived exosomal vesicles diluted in 40 mL of dulbecco’s phosphate-buffered *** of the infusions were associated with adverse events such as infusion reactions(allergic or otherwise)or

关键词： allogeneic amyotrophic lateral sclerosis exosomes infusion neuromuscular junction Schwann cell