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Immune signature of small bowel adenocarcinoma and the role of tumor microenvironment

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World Journal of Gastroenterology 2024年第8期30卷 794-798页

作者： Grigorios Christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Department of General Surgery University Hospital of LarissaLarissa 41110Greece

In this editorial we comment on the article published“Clinical significance of programmed cell death-ligand expression in small bowel adenocarcinoma is determined by the tumor microenvironment”.Small bowel adenocarcinoma(SBA)is a rare gastrointestinal neoplasm and despite the small intestine's significant surface area,SBA accounts for less than 3%of such *** detection is challenging and the reason arises from its asymptomatic nature,often leading to late-stage discovery and poor *** involves platinum-based chemotherapy with a 5-fluorouracil combination,but the lack of effective chemotherapy contributes to a generally poor *** are linked to genetic disorders and risk factors,including chronic inflammatory *** unique characteristics of the small bowel,such as rapid cell renewal and an active immune system,contributes to the rarity of these tumors as well as the high intratumoral infiltration of immune cells is associated with a favorable *** cell death-ligand 1(PD-L1)expression varies across different cancers,with potential discrepancies in its prognostic *** instability(MSI)in SBA is associated with a high tumor mutational burden,affecting the prognosis and response to *** presence of PD-L1 and programmed cell death 1,along with tumor-infiltrating lymphocytes,plays a crucial role in the complex microenvironment of SBA and contributes to a more favorable prognosis,especially in the context of high MSI *** tumor-infiltrating lymphocytes are identified as independent prognostic indicators and the association between MSI status and a favorable prognosis,emphasizes the importance of evaluating the immune status of tumors for treatment decisions.

关键词： Programmed cell death 1 Programmed cell death-ligand 1 Programmed death ligand Small bowel adenocarcinoma Tumor infiltrating lymphocytes Tumor microenvironment Microsatellite instability

Understanding autoimmune pancreatitis: Clinical features, management challenges, and association with malignancies

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World Journal of Gastroenterology 2024年第15期30卷 2091-2095页

作者： Grigorios Christodoulidis Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Department of General Surgery University Hospital of LarissaUniversity of ThessalyLarissa 41110Greece

In this editorial we comment on the article by Jaber et *** pancreatitis(AIP)represents a distinct form of pancreatitis,categorized into AIP-1 and AIP-2,characterized by obstructive jaundice,lymphoplasmacytic infiltrate,and ***-1,associated with elevated immunoglobulin G4(IgG4)levels,exhibits higher relapse rates,affecting older males,while AIP-2 is less common and linked to inflammatory bowel *** is considered a manifestation of IgG4-related systemic disease,sharing characteristic histological *** are the primary treatment,with emerging biomarkers like interferon alpha and *** poses an increased risk of various malignancies,and the assoc-iation with pancreatic cancer is *** is reserved for severe cases,necessitating careful evaluation due to diagnostic *** patients may have concurrent PanINs but display favorable long-term outcomes compared to pancreatic cancer *** diagnostic assessment,including biopsy and steroid response,is crucial for informed surgical decisions in AIP.

关键词： Autoimmune pancreatitis Immunoglobulin G4-related disease Pancreatic cancer Surgery

Double role of depression in gastric cancer:As a causative factor and as consequence

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World Journal of Gastroenterology 2024年第10期30卷 1266-1269页

作者： Grigorios Christodoulidis Koumarelas Konstantinos-Eleftherios Kouliou Marina-Nektaria Department of General Surgery University Hospital of LarissaLarissa 41110Greece

In this editorial we comment on the article“Hotspots and frontiers of the rela-tionship between gastric cancer and depression:A bibliometric study”.Gastric cancer(GC)is a common malignancy in the digestive system with increased mortality and morbidity rates *** treatments,such as gastrectomy,negatively impact patients'quality of life and beyond the physical strain,GC patients face psychological challenges,including anxiety and *** prevalence of depression can be as high as 57%,among gastrointestinal cancer *** to the advancements in treatment effectiveness and increased 5-year overall survival rates,attention has shifted to managing psychological ***,the significance of managing the depression doesn’t lie solely in the need for a better psychological *** leads to chronic stress acti-vating the sympathetic nervous system and the hypothalamus-pituitary-adrenal axis,leading release of catecholamines inducing tumor proliferation,migration,and metastasis,contributing to GC *** dysregulation of neurotrans-mitters and the involvement of various signaling pathways underscore the complex interplay between depression and *** strategies are required to address the psychological aspects of GC,including region-specific interventions and increased monitoring for *** the intricate relationship between depression and GC progression is essential for developing effective therapeutic strategies and improving overall outcomes for patients facing this complex *** this Editorial we delve into double role of depression in the pathogenesis of GC and as a complication of it.

关键词： Gastric cancer Depression Anxiety Chronic stress Pathogenesis of gastric cancer

Prognostic nutritional index in predicting survival of patients with gastric or gastroesophageal junction adenocarcinoma: A systematic review

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 514-526页

作者： Stylianos Fiflis Grigorios Christodoulidis Menelaos Papakonstantinou Alexandros Giakoustidis Stergos Koukias Paraskevi Roussos Marina Nektaria Kouliou Konstantinos Eleftherios Koumarelas Dimitrios Giakoustidis First Department of Surgery General Hospital PapageorgiouThessaloniki 56429Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

BACKGROUND Gastric cancer is the third most common cause of cancer related death *** with or without chemotherapy is the most common approach with curative intent;however,the prognosis is poor as mortality rates remain *** indexes have been proposed in the past few years in order to estimate the survival of patients undergoing *** preoperative nutritional status of gastric cancer patients has recently gained attention as a factor that could affect the postoperative course and various indexes have been *** aim of this systematic review was to assess the role of the prognostic nutritional index(PNI)in predicting the survival of patients with gastric or gastroesophageal adenocarcinoma who underwent gastrectomy with curative *** To investigate the role of PNI in predicting the survival of patients with gastric or gastroesophageal junction *** A thorough literature search of PubMed and the Cochrane library was performed for studies comparing the overall survival(OS)of patients with gastric or gastroesophageal cancer after surgical resection depending on the preoperative PNI *** PRISMA algorithm was used in the screening process and finally 16 studies were included in this systematic *** review protocol was registered in the International Prospective Register of Systematic Reviews(PRO) RESULTS Sixteen studies involving 14551 patients with gastric or esophagogastric junction adenocarcinoma undergoing open or laparoscopic or robotic gastrectomy with or without adjuvant chemotherapy were included in this systematic *** patients were divided into high-and low-PNI groups according to cut-off values that were set according to previous reports or by using receiver operating characteristic curve analysis in each individual *** 5-year OS of patients in the low-PNI groups ranged between 39%and 70.6%,while in the high-PNI groups,it ranged between 54.9%and 95.8%.In most of the included st

关键词： Prognostic nutritional index Gastric adenocarcinoma Gastroesophageal junction cancer Prognosis Overall survival

Latest updates on structure and recommendations of cardiac rehabilitation programs in chronic heart failure

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World Journal of Clinical Cases 2024年第8期12卷 1382-1387页

作者： Christos Kourek Alexandros Briasoulis Dimitrios E Magouliotis John Skoularigis Andrew Xanthopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece Department of Clinical Therapeutics Alexandra HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 11528Greece Department of Surgery University Hospital of LarissaLarissa 41110Greece of Cardiology University Hospital of LarissaLarissa 41110Greece

Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality *** rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF,recommended by both American and European guidelines.A CR program con-sists of a multispecialty group including physicians,nurses,physiotherapists,trainers,nutritionists,and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF *** activity,lifestyle,and psychological support are core components of a successful CR *** has been shown to be beneficial in all ejection fraction categories in HF and most patients,who are stable under medication,are capable of *** individualized exercise prescription should be developed on the basis of a baseline evaluation in all *** main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and *** is important to set the appropriate clinical outcomes from the beginning,in order to assess the effectiveness of a CR *** are still significant limitations that prevent patients from participating in these programs and need to be solved.A significant limitation is the generally low quality of research in CR and the presence of negative trials,such as the rehabilitation after myocardial infarction trial,where comprehensive rehabilitation following myocardial infraction had no important effect on mortality,morbidity,risk factors,or health-related quality of life or *** the present editorial,we present all the updated knowledge and recommendations in CR programs.

关键词： Cardiac rehabilitation Heart failure Outcomes Exercise protocols Prescription Future perspectives Limitations

Stent A pancreaticojejunostomy after pancreatoduodenectomy:Is it always necessary?

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World Journal of Methodology 2024年第3期14卷 23-29页

作者： Dimitrios Symeonidis Dimitris Zacharoulis Georgios Tzovaras Labrini Kissa Athina A Samara Eleana Petsa Konstantinos Tepetes Department of Surgery University Hospital of LarissaLarissa 41110Greece Department of General Surgery University Hospital of LarissaLarissa 41110Greece

The establishment of a postoperative pancreatic fistula(POPF)is considered the most common and,concomitantly,the most serious complication associated with pancreaticoduodenectomy(PD).The search for either technical modifications of the operative technique or pharmaceutical interventions that could possibly aid in decreasing the incidence of this often-devastating complication appears *** stenting of the pancreatic duct,with the use of either internal or external stents,has been evaluated in this *** theory,it is an approach that could eliminate many pathophysiological factors responsible for the occurrence of a *** purpose of the present study was to review the current data regarding the role of pancreatic duct stenting on the incidence of POPF,after PD,by using PubMed and Reference Citation *** general,previous studies seem to highlight the superiority of external stents over their internal counterparts in regard to the incidence of POPF;this is at the cost,however,of increased morbidity associated mainly with the stent ***,the use of an internal stent is a less invasive approach with acceptable results and is definitely deprived of the drawbacks arising through the complete diversion of pancreatic juice from the gastrointestinal *** in mind the scarcity of high-quality data on the subject,an approach of reserving stent placement for the high-risk for POPF patients and individualizing the selection between the use of an internal or an external stent according to the distinct characteristics of each individual case scenario appears appropriate.

关键词： Pancreaticoduodenectomy Postoperative pancreatic fistula Pancreatic stent Pancreaticojejunostomy

Extracorporeal organ support for critically ill patients:Overcoming the past,achieving the maximum at present,and redefining the future

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World Journal of Critical Care Medicine 2024年第2期13卷 19-28页

作者： Panagiotis Papamichalis Katerina G Oikonomou Maria Xanthoudaki Asimina Valsamaki Apostolia-Lemonia Skoura Sophia K Papathanasiou Achilleas Chovas Intensive Care Unit General Hospital of LarissaLarissa 41221Greece Department of Transfusion Medicine University Hospital of LarissaLarissa 41110Greece Department of Internal Medicine General Hospital of LarissaLarissa 41221Greece

Extracorporeal organ support(ECOS)has made remarkable progress over the last few *** replacement therapy,introduced a few decades ago,was the first available application of *** subsequent evolution of ECOS enabled the enhanced support to many other organs,including the heart[veno-arterial extracorporeal membrane oxygenation(ECMO),slow continuous ultrafiltration],the lungs(veno-venous ECMO,extracorporeal carbon dioxide removal),and the liver(blood purification techniques for the detoxification of liver toxins).Moreover,additional indications of these methods,including the suppression of excessive inflammatory response occurring in severe disorders such as sepsis,coronavirus disease 2019,pancreatitis,and trauma(blood purification techniques for the removal of exotoxins,endotoxins,or cytokines),have *** organ support therapy is crucial since a vast majority of critically ill patients present not with a single but with multiple organ failure(MOF),whereas,traditional therapeutic approaches(mechanical ventilation for acute respiratory failure,antibiotics for sepsis,and inotropes for cardiac dysfunction)have reached the maximum efficacy and cannot be improved ***,several issues remain to be clarified,such as the complexity and cost of ECOS systems,standardization of indications,therapeutic protocols and initiation time,choice of the patients who will benefit most from these interventions,while evidence from randomized controlled trials supporting their use is still ***,these methods are currently a part of routine clinical practice in intensive care *** editorial presents the past,present,and future considerations,as well as perspectives regarding these *** better understanding of these methods,the pathophysiology of MOF,the crosstalk between native organs resulting in MOF,and the crosstalk between native organs and artificial organ support systems when applied sequentially or simultaneously,will lead t

关键词： Kidney-liver replacement therapy Heart-lung support Blood purification Native–artificial organ crosstalk Multiple organ support therapy Extracorporeal organ support

Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance

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Journal of Intensive Medicine 2024年第3期4卷 355-361页

作者： Vasiliki Tsolaki Kyriaki Parisi George E.Zakynthinos Efrosini Gerovasileiou Nikitas Karavidas Vassileios Vazgiourakis Epaminondas Zakynthinos Demosthenes Makris Intensive Care Unit University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece Third Cardiology Clinic University of AthensSotiria HospitalAthensGreece Respiratory Department University Hospital of LarissaUniversity of Thessaly Faculty of MedicineLarissaGreece

Background Sepsis is a life-threatening organ dysfunction,and septic cardiomyopathy(SCM)may complicate the course of the *** with multidrug-resistant(MDR)pathogens has been linked with worse *** study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant *** This retrospective study included patients with sepsis/septic shock,hospitalized,and intubated in the intensive care unit of the university hospital of larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection *** patients were divided into two groups:non-MDR-SCM group and MDR-SCM *** cardiac function was compared between the two *** A total of 62 patients were included in the ***-four patients comprised the MDR-SCM and 18 the non-MDR-SCM ***-six patients(41.9%)presented with left ventricular(LV)systolic dysfunction,and≤35%right ventricular fractional area change(RVFAC)was present in 56.4%.LV systolic function was more severely impaired in the non-MDR-SCM group(left ventricular ejection fraction,35.8%±4.9%vs.45.6%±2.4%,P=0.049;LV outflow tract velocity time integral,[10.1±1.4]cm vs.[15.3±0.74]cm,P=0.001;LV-Strain,–9.02%±0.9%vs.–14.02%±0.7%,P=0.001).The MDR-SCM group presented with more severe right ventricular(RV)dilatation(right ventricular end-diastolic area/left ventricular end-diastolic area,0.81±0.03 vs.0.7±0.05,P=0.042)and worse RV systolic function(RVFAC,32.3%±1.9%vs.39.6%±2.7%,P=0.035;tricuspid annular plane systolic excursion,[15.9±0.9]mm vs.[18.1±0.9]mm,P=0.165;systolic tissue Doppler velocity measured at the lateral tricuspid annulus,[9.9±0.5]cm/s vs.[13.1±0.8]cm/s,P=0.002;RV-strain,–11.1%±0.7%vs.–15.1%±0.9%,P=0.002).Conclusion SCM related to MDR infection presents with RV systolic dysfunction predominance,while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.

关键词： Septic cardiomyopathy Multidrug-resistant pathogen Left ventricular failure Right ventricular dysfunction Left/right ventricular longitudinal strain Ventriculoarterial Coupling

Hypoxia-inducible factor 1alpha and vascular endothelial growth factor in Glioblastoma Multiforme:a systematic review going beyond pathologic implications

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Oncology Research 2024年第8期32卷 1239-1256页

作者： DIMITRA P.VAGELI PANAGIOTIS G.DOUKAS KERASIA GOUPOU ANTONIOS D.BENOS KYRIAKI ASTARA KONSTANTINA ZACHAROULI SOTIRIS SOTIRIOU MARIA IOANNOU Department of Surgery Yale UniversityNew HavenCT 06510USA Department of Pathology Faculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissa41500Greece Department of Medicine Rutgers/Saint Peter’s University HospitalNew BrunswickNJ 08901USA Department of Neurology Army Share Fund Hospital(NIMTS)Athens11521Greece Laboratory of Embryology Faculty of MedicineSchool of Health SciencesUniversity of ThessalyLarissa41500Greece

Glioblastoma multiforme(GBM)is an aggressive primary brain tumor characterized by extensive heterogeneity and vascular *** conditions in the tissue microenvironment are considered a pivotal player leading tumor ***,hypoxia is known to activate inducible factors,such as hypoxia-inducible factor 1alpha(HIF-1α),which in turn can stimulate tumor neo-angiogenesis through activation of various downward mediators,such as the vascular endothelial growth factor(VEGF).Here,we aimed to explore the role of HIF-1α/VEGF immunophenotypes alone and in combination with other prognostic markers or clinical and image analysis data,as potential biomarkers of GBM prognosis and treatment *** performed a systematic review(Medline/Embase,and Pubmed database search was completed by 16th of April 2024 by two independent teams;PRISMA 2020).We evaluated methods of immunoassays,cell viability,or animal or patient survival methods of the retrieved studies to assess unbiased *** used inclusion criteria,such as the evaluation of GBM prognosis based on HIF-1α/VEGF expression,other biomarkers or clinical and imaging manifestations in GBM related to HIF-1α/VEGF expression,application of immunoassays for protein expression,and evaluation of the effectiveness of GBM therapeutic strategies based on HIF-1α/VEGF *** used exclusion criteria,such as data not reporting both HIF-1αand VEGF or *** included 50 studies investigating in total 1319 GBM human specimens,18 different cell lines or GBM-derived stem cells,and 6 different animal models,to identify the association of HIF-1α/VEGF immunophenotypes,and with other prognostic factors,clinical and macroscopic data in GBM prognosis and therapeutic *** found that increased HIF-1α/VEGF expression in GBM correlates with oncogenic factors,such as miR-210-3p,Oct4,AKT,COX-2,PDGF-C,PLDO3,M2 polarization,or ALK,leading to unfavorable *** HIF-1α/VEGF expression correlates with F

关键词： Glioblastoma multiforme(GBM) Astrocytoma Grade III Astrocytoma Grade IV Hypoxia-inducible factor 1alpha(HIF-1α) Vascular endothelial growth factor(VEGF)