Blog Archive

Αλέξανδρος Γ. Σφακιανάκης

Tuesday, August 6, 2019

Medical Humanities

No One Who Loves Anyone


The Family Practice


The Right to Maim: Debility, Capacity, Disability by Jasbir K. Puar, Duke University Press, 2017


An Art-based Case Study: Reflections on End of Life from a Husband, Artist and Caregiver

Abstract

This study explores the reflective processes of Scottish artist, Norman Gilbert, as he created twenty-five drawings depicting his wife, Pat Gilbert, as she lay dying following an Alzheimer's-related stroke. Norman, ninety-one, had drawn Pat regularly over their sixty-five-year marriage. One week after Pat died, Norman was interviewed by a family friend to chronicle his reflections on the drawings. The drawings along with the interview transcript are analyzed qualitatively as a case study. Norman's Hospital Drawings of Pat transform what was initially a private experience into a shared comprehension of end of life and bereavement.



The Microbial Mother Meets the Independent Organ: Cultural Discourses of Reproductive Microbiomes

Abstract

The human microbiome is changing the way experts and non-experts think about germs and microorganisms. This essay is a gender analysis of contemporary discourses surrounding the human reproductive microbiome, specifically the vaginal microbiota and the penile microbiota. I first historically situate the human reproductive microbiome within the germ theory of disease. Then, I draw on Heather Paxson's Foucauldian and Latourian concept of microbiopolitics to argue that microbiopolitics is not only about how humans should live with microorganisms; but it also impacts how humans and microbes live together as gendered beings. I illustrate this gendering through two figures: the microbial mother and the independent organ.



Colonialist Pasts and Afrosurrealist Futures: Decolonizing Race and Doctorhood in Doctor Who

Abstract

Originally premiering in 1963, the BBC television series Doctor Who has long been criticized for essentializing colonial scenarios and failing to address issues of race and post-colonial realities. As a white male with the privilege to explore time and space, the titular Doctor stands in contrast to his human companion Martha Jones, a Black woman who represents the first and only main character in the show to be a medical professional of color. The relationship between the Doctor and Martha inherently demands an exploration of the meaning of doctorhood. In studying the ways in which these characters embody the idea of "doctor," we examine how race structures their approach to medicine, heroism, and colonialism. Whereas the Doctor personifies the figure of colonizer and post-colonial white savior, Martha emerges as a radical figure whose doctorhood potentially challenges and dismantles the colonial history of medicine. Through Afrofuturist and Afrosurrealist lenses, Martha represents a potentially subversive figure who offers a visionary medicine rooted in social justice.



The Beauty in Perfect Imperfection

Abstract

Modern technologies sanction a new plasticity of physical form. However, the increasing global popularity of aesthetic procedures (re)produces normative beauty ideals in terms of perfection and symmetry. These conditions limit the semblance of freedom by people to control their own bodies. Cultural emancipation may come from principles in Eastern philosophy. These reveal beauty in authenticity, including imperfection. Wabi-sabi acclaims beauty in common irregularity, while kintsugi celebrates beauty in visible signs of repair, like scars. These principles resist pressure to medicalize dissatisfaction with healthy bodies and invite multi-sited interventions to educate taste and aesthetic choices.



Bodies in Genres of Practice: Johann Ulrich Bilguer's Fight to Reduce Field Amputations

Abstract

This paper examines Johann Ulrich Bilguer's 1761 dissertation on the inutility of amputation practices, examining reasons for its influence despite its nonconformance to genre expectations. I argue that Bilguer's narratives of patient suffering, his rhetorical likening of surgeons to soldiers, and his attention to the horrific experiences of war surgeons all contribute to the dissertation's wide impact. Ultimately, the dissertation offers an example of affective rhetorics employed during the Enlightenment, demonstrating how bodies and environments—those "ambient rhetorics" made visible in a text—can contribute to an analysis of genre deviations and widen the scope of genre studies.



"No Country for Old Men": Huxley's Brave New World and the Value of Old Age

Abstract

This article inserts Aldous Huxley's Brave New World (1932) into a bioethical conversation about the value of old age and old people. Exploring literary treatments of bioethical questions can supplement conversations within bioethics proper, helping to reveal our existing assumptions and clear the way for more considered views; indeed, as Peter Swirski has argued, literary texts can serve as thought experiments that illuminate the ramifications of philosophical ideas. This essay examines the novel's representation of a society without old people in conjunction with ideas about aging and life narratives put forward by philosophers and bioethicists such as Ezekiel Emanuel, Gilbert Meilaender, and Alasdair MacIntyre. While critics, and Huxley himself, view the Brave New World as dystopian primarily because of its depiction of a totalitarian society where art, truth, and meaning are sacrificed to pleasure and distraction and where the ruled are programmed not to question the values of their rulers, the novel also makes clear that the excision of old age has significant political, moral, and emotional costs.



Women's Auto/Biography and Dissociative Identity Disorder: Implications for Mental Health Practice

Abstract

Dissociative Identity Disorder (DID) is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective experience of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority.



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Diabetologia

CD40-targeted peptide proposed for type 1 diabetes therapy lacks relevant binding affinity to its cognate receptor


CD40-targeted peptide proposed for type 1 diabetes therapy lacks relevant binding affinity to its cognate receptor. Reply to Pagni PP, Wolf A, Lo Conte M et al [letter]


Blood Mg 2+ is more closely associated with hyperglycaemia than with hypertriacylglycerolaemia: the PREVEND study


Up front


Endothelial or vascular smooth muscle cell-specific expression of human NOX5 exacerbates renal inflammation, fibrosis and albuminuria in the Akita mouse

Abstract

Aims/hypothesis

Excessive production of reactive oxygen species (ROS) plays a detrimental role in the progression of diabetic kidney disease (DKD). Renal oxidative stress activates proinflammatory cytokines, chemokines and profibrotic factors in DKD. Increased expression of the prooxidant enzyme NADPH oxidase (NOX) 5 in kidneys of diabetic individuals has been hypothesised to correlate with renal injury and progression of DKD. Since the gene encoding NOX5 is not expressed in the mouse genome, we examined the effect of inducible human NOX5 expression in renal cells, selectively in either endothelial cells or vascular smooth muscle cells (VSMCs)/mesangial cells in a model of insulin-deficient diabetes, the Akita mouse.

Methods

Renal structural injury, including glomerulosclerosis, mesangial expansion and extracellular matrix protein accumulation, as well as renal inflammation, ROS formation and albuminuria, were examined in the NOX5 transgenic Akita mouse model of DKD.

Results

Expression of NOX5 in either endothelial cells or VSMCs/mesangial cells in diabetic Akita mice was associated with increased renal inflammation (monocyte chemoattractant protein-1, NF-κB and toll-like receptor-4) and glomerulosclerosis, as well as upregulation of protein kinase C-α and increased expression of extracellular matrix genes (encoding collagen III, fibronectin and α-smooth muscle actin) and proteins (collagen IV), most likely mediated via enhanced renal ROS production. The effect of VSMC/mesangial cell-specific NOX5 expression resulted in more pronounced renal fibrosis in comparison with endothelial cell-specific NOX5 expression in diabetic mice. In addition, albuminuria was significantly increased in diabetic VEcad+NOX5+ mice (1192 ± 194 μg/24 h) when compared with diabetic VEcad+NOX5 mice (770 ± 98 μg/24 h). Furthermore, the regulatory components of NOX5 activation, including heat shock protein 90 and transient receptor potential cation channel subfamily C member 6, were upregulated only in the presence of both NOX5 and diabetes.

Conclusions/interpretation

The findings from this study highlight the importance of NOX5 in promoting diabetes-related renal injury and provide the rationale for the development of a selective NOX5 inhibitor for the prevention and/or treatment of DKD.



Biomarker panels associated with progression of renal disease in type 1 diabetes

Abstract

Aims/hypothesis

We aimed to identify a sparse panel of biomarkers for improving the prediction of renal disease progression in type 1 diabetes.

Methods

We considered 859 individuals recruited from the Scottish Diabetes Research Network Type 1 Bioresource (SDRNT1BIO) and 315 individuals from the Finnish Diabetic Nephropathy (FinnDiane) study. All had an entry eGFR between 30 and 75 ml min−1[1.73 m]−2, with those from FinnDiane being oversampled for albuminuria. A total of 297 circulating biomarkers (30 proteins, 121 metabolites, 146 tryptic peptides) were measured in non-fasting serum samples using the Luminex platform and LC electrospray tandem MS (LC-MS/MS). We investigated associations with final eGFR adjusted for baseline eGFR and with rapid progression (a loss of more than 3 ml min−1[1.73 m]−2 year−1) using linear and logistic regression models. Panels of biomarkers were identified using a penalised Bayesian approach, and their performance was evaluated through 10-fold cross-validation and compared with using clinical record data alone.

Results

For final eGFR, 16 proteins and 30 metabolites or tryptic peptides showed significant association in SDRNT1BIO, and nine proteins and five metabolites or tryptic peptides in FinnDiane, beyond age, sex, diabetes duration, study day eGFR and length of follow-up (all at p < 10−4). The strongest associations were with CD27 antigen (CD27), kidney injury molecule 1 (KIM-1) and α1-microglobulin. Including the Luminex biomarkers on top of baseline covariates increased the r2 for prediction of final eGFR from 0.47 to 0.58 in SDRNT1BIO and from 0.33 to 0.48 in FinnDiane. At least 75% of the increment in r2 was attributable to CD27 and KIM-1. However, using the weighted average of historical eGFR gave similar performance to biomarkers. The LC-MS/MS platform performed less well.

Conclusions/interpretation

Among a large set of associated biomarkers, a sparse panel of just CD27 and KIM-1 contains most of the predictive information for eGFR progression. The increment in prediction beyond clinical data was modest but potentially useful for oversampling individuals with rapid disease progression into clinical trials, especially where there is little information on prior eGFR trajectories.



New insights into the mechanisms of diabetic complications: role of lipids and lipid metabolism

Abstract

Diabetes adversely affects multiple organs, including the kidney, eye and nerve, leading to diabetic kidney disease, diabetic retinopathy and diabetic neuropathy, respectively. In both type 1 and type 2 diabetes, tissue damage is organ specific and is secondary to a combination of multiple metabolic insults. Hyperglycaemia, dyslipidaemia and hypertension combine with the duration and type of diabetes to define the distinct pathophysiology underlying diabetic kidney disease, diabetic retinopathy and diabetic neuropathy. Only recently have the commonalities and differences in the metabolic basis of these tissue-specific complications, particularly those involving local and systemic lipids, been systematically examined. This review focuses on recent progress made using preclinical models and human-based approaches towards understanding how bioenergetics and metabolomic profiles contribute to diabetic kidney disease, diabetic retinopathy and diabetic neuropathy. This new understanding of the biology of complication-prone tissues highlights the need for organ-specific interventions in the treatment of diabetic complications.



Targeting gut microbiota and barrier function with prebiotics to alleviate autoimmune manifestations in NOD mice

Abstract

Aims/hypothesis

Adopting a diet containing indigestible fibre compounds such as prebiotics to fuel advantageous bacteria has proven beneficial for alleviating inflammation. The effect of the microbial changes on autoimmunity, however, remains unknown. We studied the effects of prebiotic xylooligosaccharides (XOS) on pancreatic islet and salivary gland inflammation in NOD mice and tested whether these were mediated by the gut microbiota.

Methods

Mother and offspring mice were fed an XOS-supplemented diet until diabetes onset or weaning and were compared with a control-fed group. Diabetes incidence was monitored, insulitis and sialadenitis were scored in histological sections from adult mice, and several metabolic and immune variables were analysed in mice before the development of diabetes. Gut barrier function was assessed using an in vivo FITC-dextran permeability test. The importance of XOS-mediated gut microbial changes were evaluated in antibiotic-treated mice fed either XOS or control diet or given a faecal microbiota transplant from test animals.

Results

Diabetes onset was delayed in the XOS-fed mice, which also had fewer cellular infiltrations in their pancreatic islets and salivary glands. Interestingly, insulitis was most reduced in the XOS-fed groups when the mice were also treated with an antibiotic cocktail. There was no difference in sialadenitis between the dietary groups treated with antibiotics; the mice were protected by microbiota depletion regardless of diet. Faecal microbiota transplantation was not able to transfer protection. No major differences in glucose–insulin regulation, glucagon-like peptide-1, or short-chain fatty acid production were related to the XOS diet. The XOS diet did, however, reduce gut permeability markers in the small and large intestine. This was accompanied by a more anti-inflammatory environment locally and systemically, dominated by a shift from M1 to M2 macrophages, a higher abundance of activated regulatory T cells, and lower levels of induction of natural killer T cells and cytotoxic T cells.

Conclusions/interpretation

Prebiotic XOS have microbiota-dependent effects on salivary gland inflammation and microbiota-independent effects on pancreatic islet pathology that are accompanied by an improved gut barrier that seems able to heighten control of intestinal diabetogenic antigens that have the potential to penetrate the mucosa to activate autoreactive immune responses.



Discovery of biomarkers for glycaemic deterioration before and after the onset of type 2 diabetes: descriptive characteristics of the epidemiological studies within the IMI DIRECT Consortium

Abstract

Aims/hypothesis

Here, we describe the characteristics of the Innovative Medicines Initiative (IMI) Diabetes Research on Patient Stratification (DIRECT) epidemiological cohorts at baseline and follow-up examinations (18, 36 and 48 months of follow-up).

Methods

From a sampling frame of 24,682 adults of European ancestry enrolled in population-based cohorts across Europe, participants at varying risk of glycaemic deterioration were identified using a risk prediction algorithm (based on age, BMI, waist circumference, use of antihypertensive medication, smoking status and parental history of type 2 diabetes) and enrolled into a prospective cohort study (n = 2127) (cohort 1, prediabetes risk). We also recruited people from clinical registries with type 2 diabetes diagnosed 6–24 months previously (n = 789) into a second cohort study (cohort 2, diabetes). Follow-up examinations took place at ~18 months (both cohorts) and at ~48 months (cohort 1) or ~36 months (cohort 2) after baseline examinations. The cohorts were studied in parallel using matched protocols across seven clinical centres in northern Europe.

Results

Using ADA 2011 glycaemic categories, 33% (n = 693) of cohort 1 (prediabetes risk) had normal glucose regulation and 67% (n = 1419) had impaired glucose regulation. Seventy-six per cent of participants in cohort 1 was male. Cohort 1 participants had the following characteristics (mean ± SD) at baseline: age 62 (6.2) years; BMI 27.9 (4.0) kg/m2; fasting glucose 5.7 (0.6) mmol/l; 2 h glucose 5.9 (1.6) mmol/l. At the final follow-up examination the participants' clinical characteristics were as follows: fasting glucose 6.0 (0.6) mmol/l; 2 h OGTT glucose 6.5 (2.0) mmol/l. In cohort 2 (diabetes), 66% (n = 517) were treated by lifestyle modification and 34% (n = 272) were treated with metformin plus lifestyle modification at enrolment. Fifty-eight per cent of participants in cohort 2 was male. Cohort 2 participants had the following characteristics at baseline: age 62 (8.1) years; BMI 30.5 (5.0) kg/m2; fasting glucose 7.2 (1.4) mmol/l; 2 h glucose 8.6 (2.8) mmol/l. At the final follow-up examination, the participants' clinical characteristics were as follows: fasting glucose 7.9 (2.0) mmol/l; 2 h mixed-meal tolerance test glucose 9.9 (3.4) mmol/l.

Conclusions/interpretation

The IMI DIRECT cohorts are intensely characterised, with a wide-variety of metabolically relevant measures assessed prospectively. We anticipate that the cohorts, made available through managed access, will provide a powerful resource for biomarker discovery, multivariate aetiological analyses and reclassification of patients for the prevention and treatment of type 2 diabetes.



The impact of GDF-15, a biomarker for metformin, on the risk of coronary artery disease, breast and colorectal cancer, and type 2 diabetes and metabolic traits: a Mendelian randomisation study

Abstract

Aims/hypothesis

Growth differentiation factor 15 (GDF-15), a suggested biomarker for metformin use, may explain the potential cardioprotective and anti-cancer properties of metformin. We conducted a Mendelian randomisation study to examine the role of GDF-15 in risk of coronary artery disease (CAD) and breast and colorectal cancer. Secondary analyses included examination of the association of GDF-15 with type 2 diabetes, glycaemic traits, BP, lipids and BMI.

Methods

We obtained SNPs strongly (p value <5 × 10−8) predicting GDF-15 from a genome-wide association study (GWAS) (n = 5440) and applied them to genetic studies of CAD (CARDIoGRAMplusC4D 1000 Genomes-based GWAS [n = 184,305]), type 2 diabetes (DIAGRAM [DIAbetes Genetics Replication And Meta-analysis; n = 898,130]), glycaemic traits (MAGIC [the Meta-Analyses of Glucose and Insulin-related traits Consortium; HbA1cn = 123,665; fasting glucose: n = 46,186]), BP, breast cancer and colorectal cancer (UK Biobank [n ≤ 401,447]), lipids (GLGC [Global Lipids Genetic Consortium; n ≤ 92,820]) and adiposity (GIANT [Genetic Investigation of ANthropometric Traits Consortium; n = 681,275]). Causal estimates were obtained using inverse variance weighting, taking into account correlations between SNPs. Sensitivity analyses included focusing on the lead SNP (rs888663) and validation for CAD in the UK Biobank and for breast cancer in the Breast Cancer Association Consortium.

Results

Using 5 SNPs, increased GDF-15 was associated with lower CAD (OR 0.93 per SD increase, 95% CI 0.87, 0.99) and breast cancer (OR 0.89 per SD increase, 95% CI 0.82, 0.96), with similar results from lead SNP analysis. However, the associations with CAD (OR 0.99 per SD increase, 95% CI 0.93, 1.04) and breast cancer (OR 0.97 per SD increase, 95% CI 0.94, 1.01) in the validation studies were not as apparent. GDF-15 was not associated with type 2 diabetes, glycaemic traits, CAD risk factors or colorectal cancer.

Conclusions/interpretation

There is no convincing evidence that GDF-15 reduces risk of CAD or breast or colorectal cancer. Whether the observed inverse association of metformin use with cancer risk is via other unexplored mechanistic pathways warrants further investigation.



Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Hellenic Journal of Surgery




Diffuse Large B-cell Lymphoma of the Ileum in a 41-year-old Greek Male with Undiagnosed HIV Infection Presenting with Iliac Fossa Pain

Abstract

Introduction

The incidence of lymphoma in patients with HIV infection is higher than in the general population.

Case report

Here, we present the case of a 41-year-old Greek male with recurrent episodes of fever for one year, who presented with the symptoms and signs of acute abdomen, right pelvic pain, anorexia and nausea starting 8 hours prior to admission. Laparotomy revealed complete obstruction of the terminal ileum and cecum due to a ruptured mass. A right colectomy with a latero-lateral ileotransverse anastomosis was performed. On histology, the mass proved to be an extranodal localization of diffuse large B-cell lymphoma (DLBCL) of the ileum. Based on the history and histopathological findings, HIV infection was suspected and testing proved positive. We hypothesize that although this patient had been suffering from intermittent fever for a year, he was never investigated thoroughly, and delay in the diagnosis and treatment of the HIV infection favored the development of lymphoma.

In conclusion

All patients with lymphoma should be investigated for underlying immunosuppression, especially in the case of extranodal localization of the disease.



Surgery at the End of Life. Is it Necessary?


Neoadjuvant Chemotherapy for Male Breast Cancer - "Pushing the Boundaries"

Abstract

Male breast cancer accounted for around 370 new cases in 2015 in the UK and about 20 cases per year are reported in Scotland. Most male breast cancers are sporadic and are associated with risk factors such as race, genetic predisposition, estrogen exposure and radiation exposure.

We report the case of a 67-year-old male with Grade III invasive ductal carcinoma and lymph node metastasis who underwent neoadjuvant chemotherapy prior to surgical treatment. In addition, we discuss the current rationale and evidence behind neoadjuvant chemotherapy for breast cancer, and the justification for providing this treatment in male breast cancer.

Due to the rarity of male breast cancer, it is difficult to determine its optimal management, but it would appear reasonable to extrapolate from studies on the management of female breast cancer.



Comparison of Open Versus Closed Lateral Internal Sphincterotomy in the Management of Chronic Anal Fissure

Abstract

Background

An anal fissure is a longitudinal split in the anoderm of the distal anal canal, extending from the anal verge proximally towards, but not beyond, the dentate line. Various surgical methods of treatment of chronic anal fissure (CAF) are available, including anal dilatation, fissure excision, fissure excision with sphincterotomy, open lateral anal internal sphincterotomy and closed lateral anal internal sphincterotomy.

Method

This prospective study compared the results and complications of the open and closed techniques of lateral internal anal sphincterotomy in patients with CAF.

Results

A total of 60 patients with CAF were enrolled in this study, of which 30 underwent open lateral sphincterotomy and 30 underwent closed lateral sphincterotomy. Post-operative complications (pain, bleeding, constipation, perianal abscess, incontinence) were compared between the two groups. Postoperative pain, bleeding, and constipation were significantly less in the group undergoing closed surgery (p > 0.05). Perianal abscess and incontinence did not occur in any study subject.

Conclusions

Closed lateral anal sphincterotomy is the treatment of choice for CAF. It can be performed effectively and safely, with a low rate of complications and a reduced cost burden.



Laparoscopic Repair of Lumbar Hernia: A Case Report and Mini Review

Abstract

Background

Lumbar hernias are quite rare, constituting 2% of all abdominal wall hernias, and they are usually secondary to trauma or previous surgery. Approximately 300 cases have been reported so far. There are two different types, depending on the location: superior lumbar or Grynfeltt's hernia and inferior or Petit's hernia. Abdominal computed tomography (CT) will provide accurate diagnosis. Laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic.

Methods

We describe the diagnosis and laparoscopic repair of a symptomatic right superior lumbar hernia in a female patient, with a review of the relevant literature. The patient provided her written consent for publication of the case and the photographs.

Case report

A 48-year-old female was referred to the surgical clinic with a symptomatic right sided abdominal hernia. Clinical examination revealed an abdominal wall defect in the right superior lumbar region. Abdominal CT confirmed a right Grynfeltt's hernia, containing ascending colon and fat, but with no signs of strangulation. She underwent laparoscopic lumbar hernia repair with mesh under general anaesthesia, with uneventful recovery.

Conclusion

Lumbar hernia is a rare abdominal wall defect, which is usually secondary to trauma or previous surgery. A thorough history and clinical examination, along with abdominal CT, will provide accurate confirmation of the diagnosis. CT should always be included in the investigation prior to surgery, even in uncomplicated cases. The relevant literature is limited, but confirms that laparoscopic repair with mesh is the treatment of choice, especially when the hernia is symptomatic.



Evaluation of Laparoscopic Total Extraperitoneal Repair of Inguinal Hernia Under Regional Anesthesia: A Prospective Case Series

Abstract

Introduction

This study evaluated the feasibility and safety of laparoscopic total extraperitoneal (TEP) inguinal hernioplasty under regional (spinal/epidural) anesthesia, on the basis of duration of surgery, conversion to general anesthesia (GA), intra-operative and post-operative complications, post-operative hospital stay, time taken to resume normal activity and recurrence.

Material and Methods

A prospective observational study was conducted from 1st November 2014 to 31st December 2015 on a series of 33 patients with direct or indirect inguinal hernia treated in the Department of General Surgery. All the patients underwent laparoscopic TEP hernia repair under regional anesthesia and the outcome was evaluated.

Results

The study included 33 patients, 32 male and 1 female. All the patients were operated on under regional anesthesia and the operative procedure performed was laparoscopic TEP. There was no conversion of the operative procedure from TEP to the transabdominal preperitoneal (TAPP) procedure or to open hernioplasty, but conversion of regional anesthesia to GA was needed in 5 cases, because of hypotension, shoulder tip pain, pneumoperitoneum, intraoperative straining and/or inadequate preperitoneal space. A sensory level achieved after regional anesthesia below T6 was found to be a significant reason for conversion to GA. The mean post-operative hospital stay was 3.9 ± 0.9 days (range 2–6 days). The mean time taken to resume normal activity was 13.3 ± 1.8 days (range 10–15 days).

Conclusion

TEP hernioplasty is a feasible and safe procedure which can be performed under regional anesthesia and on patients who are at high risk or unfit for GA as well as in patients with no other problems.



Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Cancer: Case Series and Literature Review

Abstract

Background

Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis, often misdiagnosed as gallbladder malignancy. The clinical and radiological features often mimic gallbladder carcinoma, and the association of this entity with carcinoma makes the treatment decision difficult.

Methods

An analysis of patients operated on between July 2017 and December 2018 with a preoperative diagnosis of gallbladder malignancy, which ultimately turned out to be XGC, was conducted, in an attempt to determine the clinical and radiological features which could facilitate the preoperative diagnosis of XGC.

Results

The study included 6 patients who underwent radical cholecystectomy with a preoperative diagnosis of gallbladder malignancy, which proved on histological examination to be XGC. All 6 patients presented with mild upper abdominal pain, discomfort, anorexia and weight loss. Three of them had been diagnosed with diabetes mellitus (DM) in the past. Contrast enhanced computed tomography (CECT) scan showed gallbladder wall thickening, liver infiltration and lymphadenopathy in all cases. The surgery performed was radical cholecystectomy alone in 3 cases, radical cholecystectomy with right hemicolectomy in 2, and radical cholecystectomy with right hemicolectomy along with a Whipple procedure in one case. The postoperative course was uneventful, only two patients developed superficial wound infection, with an average hospital stay of 8.1 days.

Conclusion

Differentiation of XGC from gallbladder carcinoma is difficult, and a definitive diagnosis necessitates histopathological examination. An accurate preoperative diagnosis requires an integrated review of the clinical and characteristic radiological features, the presence of which may help to avoid radical resection and avoidable morbidity in selected cases. Knowledge of the entity, a high degree of suspicion and involvement of an expert surgeon should provide the optimal management. An incorrect diagnosis may lead to inappropriate surgery - either over-treating it by performing a radical cholecystectomy for XGC or perfoming a simple laparoscopic cholecystectomy for a malignant lesion.



Internal Drainage of Infected Pancreatic Necrosis: A Fail-Safe Alternative to Percutaneous Catheter Drainage

Abstract

Introduction

Necrosectomy and external drainage has been the traditional surgical treatment for infected pancreatic necrosis (IPN) following acute pancreatitis. It is a highly invasive and high risk procedure in an already compromised individual and demands multiple trips to the operating room for subsequent debridement. Recent evidence suggests that minimally invasive procedures, including surgical video-assisted retroperitoneal debridement and percutaneous catheter drainage (PCD) can often "take the heat out of the fire" and thereby delay or even avoid surgery, but these procedures sometimes fail and surgical intervention needs to be undertaken. In order to avoid multiple surgical procedures we decided to drain the IPN internally into the stomach.

Aims and Objectives

To ascertain the efficacy and safety of open necrosectomy and internal drainage into the stomach as a feasible alternative in patients with IPN.

Materials and Methods

We conducted a prospective study of the results of open surgical necrosectomy and internal drainage performed on patients with IPN from March 2012 to February 2019. This was a record based qualitative study. The patients were initially managed in the intensive care unit (ICU) with goal-directed therapy and organ support where indicated. All patients with IPN requiring PCD or surgical intervention were included in this study.

Results

A total of 44 patients with acute necrotizing pancreatitis who underwent either PCD or surgical drainage were included in the study. Of the 44 patients, 16 (36.4%) were treated with open transgastric debridement and internal drainage into the stomach for IPN. The mean age of this subgroup of patients was 51.3 ± 11.1 years, the most common etiology of the pancreatitis was alcoholic, the mean acute physiology and chronic health (APACHE II) score of these patients was 15.9 ± 4.72, and the mean bedside index of severity in acute pancreatitis (BISAP) score was 4.92 ± 0.11. On contrast enhanced computed tomography (CECT) scan of the abdomen, 93.8% of the patients had >50% necrosis, with a mean CT severity index (CTSI) of 9.3 ± 0.7. The mean operating time was 137 ± 42.4 minutes, with a mean blood loss of 225.4 ± 50.5 ml. Two patients required reoperation because of persistence of necrosum and signs of collection on repeat CT, and there were two mortalities. None of the patients had any late complications related to the surgery and the procedure was successful in 91%.

Conclusion

Internal drainage into the stomach in IPN is a feasible and relatively safe procedure when indicated. It is more effective in avoiding repeated surgical procedures when compared to external drainage.



Transgastric and Reverse Sleeve Resection of Gastric Submucosal Tumors: Analysis of 7 Cases

Abstract

Background

Gastric submucosal tumors (SMTs) are tumors originating in the subepithelial layer of the stomach. Excision of the tumors in the esophagogastric junction and lesser curvature of the stomach by simple wedge resection is technically difficult and the risk of complications is high. Here, we present a series of cases of submucosal lesions located in the esophagogastric junction and lesser curvature which were successfully treated by reverse sleeve gastrectomy or combined endoscopic laparoscopic surgery (CELS).

Methods

Between January 2018 and February 2019, 7 patients with gastric SMTs in the esophagogastric junction or lesser curvature underwent surgery at the Turkiye Yuksek Ihtisas Training and Research Hospital. The patients were evaluated in terms of age, gender, additional disease, localization, symptoms, operation type, operation time, intraoperative complications, conversion requirement, pathology, negative surgical margin (R0) resection, tumor size, time of oral intake, post-operative complications and duration of hospitalization.

Results

The tumor was located in the cardia in three patients, in the lesser curvature in three and in the corpus posterior wall in one patient. In three of the cases, preoperative dysphagia was present, in one dyspepsia and in one upper gastrointestinal (GI) bleeding. Transgastric CELS was performed in 4 cases and laparoscopic reverse sleeve gastrectomy in three cases. One patient developed pneumonia postoperatively, but no other complications were observed. Histopathological examination showed leiomyoma in 3 cases and GI stromal tumor (GIST) in four. In all patients surgical margins were negative.

Conclusions

Transgastric CELS and reverse sleeve gastrectomy can be performed safely for gastric submucosal lesions located in the esophagogastric junction and lesser curvature.


Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182
6948891480

Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,


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Αλέξανδρος Γ. Σφακιανάκης
1h
Professionalism: An Archaeology Abstract For more than two decades, classes on "professionalism" have...
Professionalism: An ArchaeologyAbstractFor more than two decades, classes on "professionalism" have been the dominant platform for the non-technical socialization of medical students. It thus subsumes elements of previous foundation courses in bioethics and "medicine and society" in defining the appropriate relation between practitioners, patients, and society-at-large. Despite its importance, there is, however, no clear definition of what "professionalism" entails or the manner in which it serves...
Αλέξανδρος Γ. Σφακιανάκης
1h
Is Molecular Diagnosis Necessary for Children with Duchenne Muscular Dystrophy? Theme : Neonatology...
Is Molecular Diagnosis Necessary for Children with Duchenne Muscular Dystrophy?Theme : NeonatologyNews in BriefAwakening the Spirits and Addressing the Safety Concerns in ChildhoodFlexible Bronchoscopic Removal of Foreign Bodies from Airway of Children: Single Center Experience Over 12 YearsAbstractObjectiveTo report our experience of tracheobronchial foreign body removal in children using flexible bronchoscopy as the primary mode.MethodsHospital records of tracheobronchial foreign body extractions...
Αλέξανδρος Γ. Σφακιανάκης
1h
Imaging and Surgical Treatment of Primary Pulmonary Artery Sarcoma Abstract Primary pulmonary artery...
Imaging and Surgical Treatment of Primary Pulmonary Artery SarcomaAbstractPrimary pulmonary artery sarcoma is a rare tumor originating from the pulmonary artery tree. Given the low incidence, few centers have reported on more than a handful of cases. Because of its rarity it is also commonly misdiagnosed as pulmonary embolism. Multi-modality diagnostic imaging and recognition of specific imaging characteristics along with a high index of suspicion is required to make the correct diagnosis and expedite...
Αλέξανδρος Γ. Σφακιανάκης
1h
The pristine nature of river Ganges: its qualitative deterioration and suggestive restoration strategies...
The pristine nature of river Ganges: its qualitative deterioration and suggestive restoration strategiesAbstractThe river Ganges, the National Heritage, and the lifeline of millions of Indians, unfortunately, ranked the second most polluted rivers of the world in 2017. This review reveals the current trends of the water quality of the Ganges assessed around 36 stretches during 2012–2016, to indicate an improvement around 6 (16.7%), deterioration around 14 (38.9%), and non-significant changes around...
Αλέξανδρος Γ. Σφακιανάκης
1h
Introduction Vol. 2 Issue 2 International Journal of Community Well-Being Correction to: Economy Doesn't...
Introduction Vol. 2 Issue 2 International Journal of Community Well-BeingCorrection to: Economy Doesn't Buy Community Wellbeing: a Study of Factors Shaping Community Wellbeing in South KoreaThis paper was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2016S1A3A2924563).Correction to: Community Well-Being in Neighbourhoods: Achieving Community and Open-Minded Space through Engagement in NeighbourhoodsThis work was supported by the...
Αλέξανδρος Γ. Σφακιανάκης
1h
A Step in the Right Direction But We Must Resist Identity Politics Science Has Always Been Ideological,...
A Step in the Right Direction But We Must Resist Identity PoliticsScience Has Always Been Ideological, You Just Don't See ItPower and Privilege in the Field of Sexuality Research and BeyondSexual Science versus Progressive Advocacy: The Need for ResistanceAdvancing Our Scientific Understanding of Sexual HarassmentShades of Rind: Ought We Be Surprised?Sexual Harassment: "I Just Do Not Feel Safe"Are Healthy Parental Attachments and Resilience to Societal Objectification Basic to Women's Sexual Health?The...
Αλέξανδρος Γ. Σφακιανάκης
1h
A Multiscale Hierarchical Threshold-Based Completed Local Entropy Binary Pattern for Texture Classification...
A Multiscale Hierarchical Threshold-Based Completed Local Entropy Binary Pattern for Texture ClassificationAbstractOver the year, visual texture analysis has come to be recognized as one of the most important methods in the area of medical image analysis and understanding, face description and detection, and so on. The goal of texture descriptors is to capture the general characteristic of textures such as dependency as well as invariance properties. Among all the texture descriptors, the binary...
Αλέξανδρος Γ. Σφακιανάκης
1h
Journal of Cutaneous Pathology Early View Online Version of Record before inclusion in an issue ORIGINAL...
Journal of Cutaneous PathologyEarly ViewOnline Version of Record before inclusion in an issueORIGINAL ARTICLESVariable loss of CD30 expression by immunohistochemistry in recurrent cutaneous CD30+ lymphoid neoplasms treated with brentuximab vedotinAmrita Goyal, Sanjay Patel, Kavita Goyal, Elizabeth A. Morgan, Ruth K. ForemanVersion of Record online: 02 August 2019CASE REPORTSMalignant melanoma with metaplastic cartilaginous transdifferentiation: A case reportJuliett Berro, Nour Abdul Halim, Chirine...
Αλέξανδρος Γ. Σφακιανάκης
1h
Cellular & Molecular Immunology
RESEARCH HIGHLIGHTSAutophagy induced by STING, an unnoticed and primordial function of cGASJunjie Yang, Xiaoshan Tang, Kutty Selva Nandakumar & Kui Cheng Cellular & Molecular Immunology 2019 16 :683 - 684; May 29, 2019; 10.1038/s41423-019-0240-2Abstract | Full TextARTICLET cells from induced and spontaneous models of SLE recognize a common T cell epitope on β2-glycoprotein IDavid Salem, Rebecca Subang, Masataka Kuwana, Jerrold S. Levine & Joyce Rauch Cellular & Molecular Immunology...
Αλέξανδρος Γ. Σφακιανάκης
1h
Bullous pemphigoid with linear lesions and antibodies exclusively against the soluble ectodomain of...
Bullous pemphigoid with linear lesions and antibodies exclusively against the soluble ectodomain of BP180 (LAD‐1)Hamidreza Mahmoudi, Roja Toosi, Kambiz Kamyab, Detlef Zillikens, Enno Schmidt, Maryam DaneshpazhoohVersion of Record online: 28 July 2019
Αλέξανδρος Γ. Σφακιανάκης
1h
Chemical profiling and functional properties of dietary fibre rich inner and outer bracts of culinary...
Chemical profiling and functional properties of dietary fibre rich inner and outer bracts of culinary banana flowerAbstractThe present study endeavoured to evaluate the nutritional, phytochemical and functional properties of outer and inner bracts of culinary banana flower which is a by-product of banana production. Both outer and inner bracts were found to be rich in dietary fibre (61.13 and 66.22%, respectively) along with other chemical compositions including proximate, minerals, and antioxidant-rich...
Αλέξανδρος Γ. Σφακιανάκης
1h
Mediators of physical activity adoption and maintenance among breast cancer survivors Abstract The purpose...
Mediators of physical activity adoption and maintenance among breast cancer survivorsAbstractThe purpose of this study is to explore the mediators associated with physical activity (PA) within the adoption and maintenance phase of a PA intervention trial among breast cancer survivors. Overall, 192 breast cancer survivors (average age = 55.9 years) were randomized to an Intervention or Control group. Both groups received 8 calls in the first 3-months, 3 monthly calls, and then entered a no-contact...
Αλέξανδρος Γ. Σφακιανάκης
1h
Associations between Perceived Homophobia, Community Connectedness, and Having a Primary Care Provider...
Associations between Perceived Homophobia, Community Connectedness, and Having a Primary Care Provider among Gay and Bisexual MenAbstractAccording to the minority stress model and social evaluation theory, stigma increases negative health outcomes in sexual minorities, and those with greater connection to a community appraise their lives with respect to fellow community members. This study was a secondary analysis of data from the online 2010 Social Justice Sexuality Project and examined associations...
Αλέξανδρος Γ. Σφακιανάκης
1h
nternational Journal of Dermatology  Early View Online Version of Record before inclusion in an issue...
nternational Journal of Dermatology Early ViewOnline Version of Record before inclusion in an issueCorrespondenceAcquired macronychia with painful toe: osteoid osteomaSeung Hee Woo BSc, Keunyoung Hur MD, Je‐Ho Mun MD, PhDVersion of Record online: 01 August 2019ReportsDermoscopic features of lichen planopilaris in Northern Iran: a prospective observational studyHojat Eftekhari MD, Seyyede Zeinab Azimi MD, Rana Rafiei MD, Abbas Darjani MD, Narges Alizadeh MD, Elahe Rafiei MSc, Reyhaneh Ghadarjani MD, Kaveh...
Αλέξανδρος Γ. Σφακιανάκης
1h
During Cycling What Limits Maximum Mechanical Power Output at Cadences above 120 rpm? Purpose A key...
During Cycling What Limits Maximum Mechanical Power Output at Cadences above 120 rpm?Purpose A key determinant of muscle coordination and maximum power output during cycling is pedalling cadence. During cycling the neuromuscular system may select from numerous solutions that solve the task demands while producing the same result. For more challenging tasks fewer solutions will be available. Changes in the variability of individual muscle excitations (EMG) and multi-muscle coordination, quantified...
Αλέξανδρος Γ. Σφακιανάκης
1h
A Preliminary Study Evaluating the Safety and Efficacy of Bumetanide, an NKCC1 Inhibitor, in Patients...
A Preliminary Study Evaluating the Safety and Efficacy of Bumetanide, an NKCC1 Inhibitor, in Patients with Drug-Resistant EpilepsyThe correct name of the co-author should be ''Vajiheh Aghamollaii'', and not ''Vajihe Aghamollaii'' as given in the original publication of the article.Objective Derivation of the Morphology and Staging of Visual Field Loss Associated with Long-Term Vigabatrin TherapyAbstractBackgroundThe morphology and between-eye symmetry of the visual field loss associated with the...
Αλέξανδρος Γ. Σφακιανάκης
1h
Pembrolizumab for Locally Advanced or Metastatic Urothelial Cancer Where Cisplatin is Unsuitable: An...
Pembrolizumab for Locally Advanced or Metastatic Urothelial Cancer Where Cisplatin is Unsuitable: An Evidence Review Group Perspective of a NICE Single Technology AppraisalAbstractAs part of its Single Technology Appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer (Merck Sharp & Dohme) of pembrolizumab (Keytruda®) to submit evidence of its clinical and cost effectiveness for the treatment of locally advanced or metastatic urothelial cancer...
Αλέξανδρος Γ. Σφακιανάκης
1h
Let us 'bring back the forest' Detecting dynamic system regime boundaries with Fisher information:...
Let us 'bring back the forest'Detecting dynamic system regime boundaries with Fisher information: the case of ecosystemsAbstractThe direct measurement of the resilience (resistance to disturbances) of an ecosystem's current regime (or "alternative stable state") remains a key concern for managing human impacts on these ecosystems and their risk of collapse. Approaches which utilize statistics or information theory have demonstrated utility in identifying regime boundaries. Here, we use Fisher information...
Αλέξανδρος Γ. Σφακιανάκης
1h
Strengthening Quadriceps Muscles with Neuromuscular Electrical Stimulation Following Total Hip Replacement:...
Strengthening Quadriceps Muscles with Neuromuscular Electrical Stimulation Following Total Hip Replacement: a ReviewAbstractPurpose of ReviewFunctional recovery from total hip replacement can be suboptimal and deficits in quadriceps muscle strength may hinder the return to activities of daily living. Neuromuscular electrical stimulation (NMES) devices have long been used to preserve and restore skeletal muscle mass and function following periods of muscle atrophy due to immobilisation. Here, we evaluate...
Αλέξανδρος Γ. Σφακιανάκης
1h
Response-level processing during visual feature search: Effects of frontoparietal activation and adult...
Response-level processing during visual feature search: Effects of frontoparietal activation and adult ageAbstractPrevious research suggests that feature search performance is relatively resistant to age-related decline. However, little is known regarding the neural mechanisms underlying the age-related constancy of feature search. In this experiment, we used a diffusion decision model of reaction time (RT), and event-related functional magnetic resonance imaging (fMRI) to investigate age-related...
Αλέξανδρος Γ. Σφακιανάκης
1h
Serious clinical events in HIV-positive persons with chronic kidney disease (CKD) Objectives: Predictors...
Serious clinical events in HIV-positive persons with chronic kidney disease (CKD)Objectives: Predictors of chronic kidney disease (CKD) amongst HIV-positive persons are well established, but insights into the prognosis after CKD including the role of modifiable risk factors are limited. Design: Prospective cohort study Methods: D:A:D participants developing CKD (confirmed, >3 months apart, eGFR ≤ 60 mL/min/1.73 m2 or 25% eGFR decrease when eGFR ≤ 60) were followed to incident serious clinical...
Αλέξανδρος Γ. Σφακιανάκης
1h
Dermatologic Therapy Early View Online Version of Record before inclusion in an issue LETTERS TO...
Dermatologic TherapyEarly ViewOnline Version of Record before inclusion in an issueLETTERS TO THE EDITORBullous pemphigoid in a patient treated with nivolumabCarlos Cuenca‐Barrales, Beatriz Espadafor‐López, Antonio Martínez‐López, Bárbara Cancela‐Díez, Ricardo Ruiz‐Villaverdee13030 | Version of Record online: 01 August 2019REVIEW ARTICLESTiming of quality of life improvements in psoriatic patients treated with different systemic therapiesGiuseppe Pistone, Rosario Gurreri, Giovanna Tilotta, Paolo...
Αλέξανδρος Γ. Σφακιανάκης
1h
A Comparison of Intracochlear Pressures During Ipsilateral and Contralateral Stimulation With a Bone...
A Comparison of Intracochlear Pressures During Ipsilateral and Contralateral Stimulation With a Bone Conduction ImplantObjectives: To compare contralateral to ipsilateral stimulation with percutaneous and transcutaneous bone conduction implants. Background: Bone conduction implants (BCIs) effectively treat conductive and mixed hearing losses. In some cases, such as in single-sided deafness, the BCI is implanted contralateral to the remaining healthy ear in an attempt to restore some of the benefits...
Αλέξανδρος Γ. Σφακιανάκης
2h
Verbesserung von Tinnitusdistress, Lebensqualität und psychologischen Komorbiditäten durch Cochleaimplantation...
Verbesserung von Tinnitusdistress, Lebensqualität und psychologischen Komorbiditäten durch Cochleaimplantation einseitig ertaubter PatientenZusammenfassungHintergrundPatienten mit einseitiger Ertaubung (SSD) fehlt die Fähigkeit des Richtungshörens, und das Sprachverstehen im Störgeräusch ist eingeschränkt. Zudem liegt eine hohe Tinnitusprävalenz vor. Dies kann zu reduzierter Lebensqualität (HRQoL) und psychologischen Komorbiditäten führen. Ziel dieser Studie war die Untersuchung des Einflusses der...
Αλέξανδρος Γ. Σφακιανάκης
2h
Ultrasound Guided Sacroiliac Joint Injections No abstract available Clinical Findings and Electrodiagnostic...
Ultrasound Guided Sacroiliac Joint InjectionsNo abstract availableClinical Findings and Electrodiagnostic Testing in Ulnar Neuropathy at the Elbow and Differences According to Site and Type of Nerve DamageObjective To evaluate the clinical and electrodiagnostic testing (EDX) in ulnar neuropathy at the elbow (UNE) and differences according to site (humeroulnar arcade, HUA, vs. retroepicondylar groove, REG) and injury physiopathology (axonal vs. demyelinating), through prospective multicenter case-control...
Αλέξανδρος Γ. Σφακιανάκης
2h
Deutsche Zeitschrift für Akupunktur
DGfANPersonaliaAkupunktur ist etabliertPalliativmedizin und OnkologieNachruf auf Horst BeckeAkupunktur bei Veteranen mit dauerhaften Schlafstörungen nach milder traumatischer HirnschädigungDÄGfALeserbriefeAkupressur als begleitende Behandlung in der Onkologie und PalliativmedizinKomplexbehandlung einer Finalbegleitung
Αλέξανδρος Γ. Σφακιανάκης
2h
Genetics in Medicine
IN THIS ISSUEIn This IssueRoni Dengler Genetics in Medicine 2019 21 :1673 - 1673; August 01, 2019; 10.1038/s41436-019-0605-zAbstract | Full TextNEWSNewsRoni Dengler Genetics in Medicine 2019 21 :1674 - 1674; August 01, 2019; 10.1038/s41436-019-0604-0Abstract | Full TextSYSTEMATIC REVIEWCharacteristics and evaluation outcomes of genomics curricula for health professional students: a systematic literature reviewDivya Talwar, Wei-Ju Chen, Yu-Lyu Yeh, Margaret Foster, Salah Al-Shagrawi et al. Genetics...
Αλέξανδρος Γ. Σφακιανάκης
2h
Nephrology  A Summary of Recently Published Activity PERSPECTIVE Combating EPA Rollbacks — Health...
Nephrology A Summary of Recently Published ActivityPERSPECTIVECombating EPA Rollbacks — Health Care's Response to a Retreat on ClimateG. McCarthy and A. BernsteinN Engl J Med, July 24, 2019Implementation Science for the BedsideE.H. GengN Engl J Med 381:304, July 25, 2019ORIGINAL ARTICLERoxadustat for Anemia in Patients with Kidney Disease Not Receiving DialysisN. Chen and OthersN Engl J Med, July 24, 2019Roxadustat Treatment for Anemia in Patients Undergoing Long-Term DialysisN. Chen and OthersN...
Αλέξανδρος Γ. Σφακιανάκης
2h
Role of Metoprolol Succinate in the Treatment of Heart Failure and Atrial Fibrillation: A Systematic...
Role of Metoprolol Succinate in the Treatment of Heart Failure and Atrial Fibrillation: A Systematic ReviewBackground: Beta-blockers are one of the most important classes of cardiovascular agents and have been considered a cornerstone therapy in heart diseases, such as heart failure (HF) and atrial fibrillation (AF). Among different beta-blockers, metoprolol is a selective beta1-adrenergic antagonist, which has been extensively used since the 1970s. Areas of Uncertainty: Although current guidelines...
Αλέξανδρος Γ. Σφακιανάκης
2h
Neurology/Neurosurgery   A Summary of Recently Published Activity PERSPECTIVE Combating EPA Rollbacks...
Neurology/Neurosurgery  A Summary of Recently Published ActivityPERSPECTIVECombating EPA Rollbacks — Health Care's Response to a Retreat on ClimateG. McCarthy and A. BernsteinN Engl J Med, July 24, 2019ORIGINAL ARTICLERimegepant, an Oral Calcitonin Gene–Related Peptide Receptor Antagonist, for MigraineR.B. Lipton and OthersN Engl J Med 381:142, July 11, 2019Trial of Galcanezumab in Prevention of Episodic Cluster HeadacheP.J. Goadsby and OthersN Engl J Med 381:132, July 11, 2019Quick TakeBrief Report:...
Αλέξανδρος Γ. Σφακιανάκης
2h
 Molecular Testing for Flu Catching up, But Still Lagging Far Behind RIDTsPublished on Aug 05, 2019 Comparison...
 Molecular Testing for Flu Catching up, But Still Lagging Far Behind RIDTsPublished on Aug 05, 2019 Comparison of KRAS Liquid Biopsy Kits Confirms Differences at Low Mutant Allele FractionPublished on Aug 02, 2019 Twist Bioscience Touts Longer Oligos, NGS-Based GenotypingPublished on Aug 02, 2019 ETH Zurich Team Uses NMR for Multi-Omic Analysis of RNA Folding NetworkPublished on Aug 02, 2019Automated Genomic DNA Extraction from Large Volume Whole BloodIn this poster from Beckman Coulter learn about...
Αλέξανδρος Γ. Σφακιανάκης
2h
Otolaryngology–Head and Neck Surgery  View online OnlineFirst Alert Original ResearchPostoperative...
Otolaryngology–Head and Neck Surgery View onlineOnlineFirst AlertOriginal ResearchPostoperative Opioid Prescribing and Consumption Patterns after TonsillectomyStephanie Choo, Stephen Nogan, Laura MatrkaOtolaryngology–Head and Neck SurgeryJul 30, 2019 | OnlineFirstInvited ArticleContributions of Contemporary Human Temporal Bone Histopathology to Clinical OtologyDebara L. Tucci, Joni K. DohertyOtolaryngology–Head and Neck SurgeryJul 30, 2019 | OnlineFirstOriginal ResearchPattern of Intraoperative Parathyroid...
Αλέξανδρος Γ. Σφακιανάκης
2h
Ear, Nose & Throat Journal  View online OnlineFirst Alert OtherBilateral Vocal Fold Paralysis...
Ear, Nose & Throat Journal  View onlineOnlineFirst AlertOtherBilateral Vocal Fold Paralysis Secondary to Intrathyroidal Calcifications Following Remote Administration of Radioactive Iodine Therapy for Graves DiseaseAlexander D. Karabachev, Nathan C. Grohmann, Mirabelle SajiseviEar, Nose & Throat JournalAug 2, 2019 | OnlineFirstResearch ArticleThe Feasibility of Utilizing Smartphone Flashlights as an Alternative Endoscopic Light Source in Emergency SituationsJennifer Johanna Butler, Stephen...
Αλέξανδρος Γ. Σφακιανάκης
2h
Lessons Learned From the Opioid Epidemic  Joshua M. Sharfstein, MD; Yngvild Olsen, MD, MPH Relative...
Lessons Learned From the Opioid Epidemic Joshua M. Sharfstein, MD; Yngvild Olsen, MD, MPHRelative Value Units and the Measurement of Physician PerformanceMichael Nurok, MBChB, PhD; Bruce Gewertz, MDAudio Interview: Relative Value Units and the Measurement of Physician PerformanceAUDIOAudio InterviewRelative Value Units and the Measurement of Physician Performance
Αλέξανδρος Γ. Σφακιανάκης
2h
Remember 2 Things: Proper Emergency Care By Steve Whitehead  Steve Whitehead discusses two ways providers...
Remember 2 Things: Proper Emergency CareBy Steve Whitehead Steve Whitehead discusses two ways providers can be confident that they provided exceptional, authorized care to their patients
Αλέξανδρος Γ. Σφακιανάκης
2h
Understanding compartment syndrome by type By EMS1 Staff Compartment syndrome should be considered early...
Understanding compartment syndrome by typeBy EMS1 StaffCompartment syndrome should be considered early to prevent dire consequences for the patient.
Αλέξανδρος Γ. Σφακιανάκης
2h
Experimental Dermatology Interleukin‐17A affects extracellular vesicles release and cargo in human...
Experimental DermatologyInterleukin‐17A affects extracellular vesicles release and cargo in human keratinocytesGiorgio Mangino, Marco Iuliano, Silvia Carlomagno, Nicoletta Bernardini, Paolo Rosa, Maria Vincenza Chiantore, Nevena Skroza, Antonella Calogero, Concetta Potenza, Giovanna RomeoFirst Published: 02 August 2019Focus Theme Issue: ViewpointInteraction of peripheral nerves and mast cells, eosinophils, and basophils in the development of pruritusChisa Nakashima, Yoshihiro Ishida, Akihiko Kitoh, Atsushi...
Αλέξανδρος Γ. Σφακιανάκης
2h

Do Neti Pots Really Work?Nasal irrigation may be a good way to relieve your stuffy nose. Here's how...
Do Neti Pots Really Work?Nasal irrigation may be a good way to relieve your stuffy nose. Here's how it works.Read More  
Αλέξανδρος Γ. Σφακιανάκης
2h
Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender Patients Emily...
Fertility Preservation Outcomes in Adolescent and Young Adult Feminizing Transgender PatientsEmily P. Barnard, Cherie Priya Dhar, Stephanie S. Rothenberg, Marie N. Menke, Selma F. Witchel, Gerald T. Montano, Kyle E. Orwig and Hanna Valli-PulaskiAdvancing the Agenda in Pediatric Mental Health EducationCori Green, John T. Walkup, Susan Bostwick and William TrochimCommentaryFertility Preservation Outcomes and Considerations in Transgender and Gender-Diverse YouthJason Rafferty
Αλέξανδρος Γ. Σφακιανάκης
2h
The State of Resting State Networks Functional MRI (fMRI) is currently used for pre-surgical planning,...
The State of Resting State NetworksFunctional MRI (fMRI) is currently used for pre-surgical planning, but is often limited to information on the motor and language systems. Resting state fMRI can provide more information on multiple other networks to the neurosurgeon and neuroradiologist; however, currently, these networks are not well known among clinicians. The purpose of this manuscript is to provide an introduction to these networks for the clinician and to discuss how they could be used in the...
Αλέξανδρος Γ. Σφακιανάκης
2h
Comparison of outcomes after human leukocyte antigen-matched and haploidentical hematopoietic stem-cell...
Comparison of outcomes after human leukocyte antigen-matched and haploidentical hematopoietic stem-cell transplantation for multiple myelomaBackground: Allogeneic stem-cell transplantation (SCT) is a well-established immunotherapeutic strategy for multiple myeloma (MM) with a potent and often sustained graft-vs.-myeloma effect. This multicenter investigation aimed to analyze the complications and survival of haploidentical SCT in patients with MM, and compare the main outcomes with matched-related...
Αλέξανδρος Γ. Σφακιανάκης
2h
Early Mechanical Hearing Devices    Sarli, Cathy C.; Uchanski, Rosalie M. PhD The Hearing Journal: August...
Early Mechanical Hearing Devices   Sarli, Cathy C.; Uchanski, Rosalie M. PhDThe Hearing Journal: August 2019 - Volume 72 - Issue 8 - p 8,9doi: 10.1097/01.HJ.0000579564.45174.32Hearing Aids DevelopmentOver the years, hearing devices have taken many shapes and forms. The first article of this series, published in The Hearing Journal's April 2019 issue, discussed the earliest of these mechanical devices—the "cupped" human hand, which provides an acoustic gain of up to 7 to 17 dB, benefiting listeners...
Αλέξανδρος Γ. Σφακιανάκης
2h
The Hearing Journal's August issue  Are You Compensated Fairly? Salary Survey Results...
The Hearing Journal's August issue Are You Compensated Fairly? Salary Survey Results RevealedBy Gordon GlantzThe Hearing Journal's salary survey looks into current trends and pressing issues affecting the career satisfaction and advancement of today's audiology professionals, including the gender pay gap, mentorship in the industry, among others. Read more.AuD Externships: Building, Managing Successful ExperiencesBy Sharon Van Hyfte, AuD, CCC-AThe tried-and-true externship guidelines observed by...
Αλέξανδρος Γ. Σφακιανάκης
2h
Navel to Knees With Chlorhexidine Gluconate: Preventing Catheter-Associated Urinary Tract Infections...
Navel to Knees With Chlorhexidine Gluconate: Preventing Catheter-Associated Urinary Tract InfectionsUrinary tract infections are the most common type of health care–associated infection, and greater than 75% of them are attributed to an indwelling urinary catheter. A catheter-associated urinary infection may lead to a longer hospital length of stay by as many as 4 days. A new patient care standard requiring twice-daily chlorhexidine cleansing from umbilicus to knees was implemented on all patients...
Αλέξανδρος Γ. Σφακιανάκης
2h
Effects of monoamine uptake inhibitors on pain-related depression of nesting in mice Pain is a significant...
Effects of monoamine uptake inhibitors on pain-related depression of nesting in micePain is a significant public health problem, and assessment of pain-related impairment of behavior is a key clinical indicator and treatment target. Similar to opioids and NSAIDs, dopamine (DA) transporter inhibitors block pain-related depression of intracranial self-stimulation (ICSS) in rats. The primary goal of the present study was to determine if the effects of monoamine uptake inhibitors on pain-related depression...
Αλέξανδρος Γ. Σφακιανάκης
2h
Endocrine Disruption and Reproductive Health from a Clinical Perspective A. Clinical aspects of endocrine disruption in humans B. Clinical dimorphism of EDCs on male and female reproduction C. Experimental and clinical evidence of EDCs and potential mechanisms III. Clinical and Translational Impacts of EDCs on Female Reproduction A. Introduction to female reproductive development and function B. Polycystic ovarian syndrome (PCOS) C. Premature ovarian failure, decreased ovarian reserve, aneuploidy, and granulosa steroidogenesis D. Reproductive tract anomalies E. Uterine leiomyomas F. Endometriosis IV. Endocrine Disruptors, Mammary Gland Development, and Breast Cancer A. Windows of vulnerability to carcinogenic agents and "natural" risk factors B. Theories of carcinogenesis C. Susceptibility of the breast during puberty and adulthood D. Susceptibility of the mammary gland during the perinatal period E. Perinatal exposure to environmentally relevant levels of endocrine disruptors V. Male Reproductive and Developmental Health: The Human Evidence A. Introduction to male reproductive health B. Male reproductive function and development C. Semen quality: temporal trends and EDC exposure D. Male urogenital tract malformations E. Testicular germ cell cancer F. Conclusions VI. Prostate Cancer A. Introduction to prostate cancer B. Evidence and mechanisms for EDC effects on the prostate VII. Neuroendocrine Targets of EDCs A. Endocrine disruption of reproductive neuroendocrine systems B. Hypothalamic-pituitary-adrenal (HPA) effects of EDCs C. Thyroid, metabolism, and growth D. Hormonal targets of neuroendocrine disruption VIII. Thyroid Disruption A. Introduction to thyroid systems B. Environmental chemicals impacting thyroid function C. Environmental chemicals impacting thyroid hormone transport, metabolism, and clearance D. Environmental chemicals impacting the thyroid hormone receptor IX. Environmental Chemicals, Obesity, and Metabolism A. Introduction to EDCs and the obesity epidemic B. Environmental estrogens and obesity C. Peroxisome proliferator-activated receptor (PPAR) γ and organotins D. Phytoestrogens E. Endocrine disruptors, diabetes, and glucose homeostasis F. Endocrine disruptors and cardiovascular systems G. Estrogenic EDCs and cardioprotection H. Advanced glycation end-products (AGEs)
Endocr Rev. 2009 Jun; 30(4): 293–342.doi: 10.1210/er.2009-0002PMCID: PMC2726844PMID: 19502515Endocrine-Disrupting Chemicals: An Endocrine Society Scientific StatementEvanthia Diamanti-Kandarakis, Jean-Pierre Bourguignon, Linda C. Giudice, Russ Hauser, Gail S. Prins, Ana M. Soto, R. Thomas Zoeller, and Andrea C. GoreAuthor information Article notes Copyright and License information DisclaimerEndocrine Section of First Department of Medicine (E.D.-K.), Laiko Hospital, Medical School University of Athens,...
Αλέξανδρος Γ. Σφακιανάκης
2h
The Heterogeneous Landscape of Head & Neck Squamous Cell Carcinomas, Head & Neck Squamous Cell...
The Heterogeneous Landscape of Head & Neck Squamous Cell Carcinomas,Head & Neck Squamous Cell CarcinomasHead and neck squamous cell carcinomas can be highly aggressive tumors in some cases, while other prognoses can be very good. The tumors present in different anatomical regions of the upper airways and digestive tract, and they present with very different mutation profiles, molecular characteristics, and immune landscapes, as well as prognoses.Recognizing that differences in these head...
Αλέξανδρος Γ. Σφακιανάκης
2h
Oncology
The Heterogeneous Landscape of Head & Neck Squamous Cell CarcinomasNo abstract availableFinding a Cure for Children With CNS NeuroblastomaNo abstract availableEHR Tool Finds Pediatric Leukemia Patients for Clinical StudiesNo abstract availableIn Search of an Immunotherapy Innovation for Ovarian CancerNo abstract availableChildhood Leukemia Cannot Hide From Immune SystemNo abstract availableUpToDate®No abstract availableEnzalutamide Improved Survival in Metastatic Prostate CancerNo abstract availableOlaparib...
Αλέξανδρος Γ. Σφακιανάκης
2h
Surgical Laparoscopy Endoscopy & Percutaneous Techniques
Endoscopic Transgastric Versus Surgical Approach for Infected Necrotizing Pancreatitis: A Systematic Review and Meta-AnalysisSurgical approach (SA) is the standard treatment for infected necrotizing pancreatitis (INP) and endoscopic transgastric approach (ETA) is a promising alternative treatment. This systematic review and meta-analysis aimed to compare the effectiveness and safety of ETA versus SA in INP. Several databases were systematically searched for eligible studies that compared ETA with...
Αλέξανδρος Γ. Σφακιανάκης
2h
Endoscopic Transgastric Versus Surgical Approach for Infected Necrotizing Pancreatitis: A Systematic...
Endoscopic Transgastric Versus Surgical Approach for Infected Necrotizing Pancreatitis: A Systematic Review and Meta-AnalysisSurgical approach (SA) is the standard treatment for infected necrotizing pancreatitis (INP) and endoscopic transgastric approach (ETA) is a promising alternative treatment. This systematic review and meta-analysis aimed to compare the effectiveness and safety of ETA versus SA in INP. Several databases were systematically searched for eligible studies that compared ETA with...
Αλέξανδρος Γ. Σφακιανάκης
2h
Offline beats online: transcranial direct current stimulation timing influences on working memory The...
Offline beats online: transcranial direct current stimulation timing influences on working memoryThe n-back task is an established measure of an individual's working memory. In this task, participants have to continuously update their working memory to react to a stimulus correctly. For the verbal n-back task in particular, the left dorsolateral prefrontal cortex (lDLPFC) plays a key role in working memory updating and a higher activation of the lDLPFC has been linked to an increase in performance....
Αλέξανδρος Γ. Σφακιανάκης
2h
Gastroenterology & Hepatology
Norfloxacin, ciprofloxacin, trimethoprim–sulfamethoxazole, and rifaximin for the prevention of spontaneous bacterial peritonitis: a network meta-analysisFor the prevention of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites, prophylactic antibiotics are recommended as a standard regimen. This study aimed to assess the efficacy of norfloxacin (N), ciprofloxacin (C), trimethoprim–sulfamethoxazole (T-S), and rifaximin (R) in the prevention of SBP. We searched the electronic...
Αλέξανδρος Γ. Σφακιανάκης
2h
Norfloxacin, ciprofloxacin, trimethoprim–sulfamethoxazole, and rifaximin for the prevention of spontaneous...
Norfloxacin, ciprofloxacin, trimethoprim–sulfamethoxazole, and rifaximin for the prevention of spontaneous bacterial peritonitis: a network meta-analysisFor the prevention of spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites, prophylactic antibiotics are recommended as a standard regimen. This study aimed to assess the efficacy of norfloxacin (N), ciprofloxacin (C), trimethoprim–sulfamethoxazole (T-S), and rifaximin (R) in the prevention of SBP. We searched the electronic...
Αλέξανδρος Γ. Σφακιανάκης
2h
Epidemiology
Sponsorship by Big Oil, Like the Tobacco Industry, Should be Banned by the Research CommunityNo abstract availableFine Particulate Air Pollution and Birthweight: Differences in Associations Along the Birthweight DistributionBackground: Maternal exposure to fine particulate air pollution (PM2.5) during pregnancy is associated with lower newborn birthweight, which is a risk factor for chronic disease. Existing studies typically report the average association related with PM2.5 increase, which does...
Αλέξανδρος Γ. Σφακιανάκης
2h
Gadolinium-Based MRI Contrast Agents Induce Mitochondrial Toxicity and Cell Death in Human Neurons,...
Gadolinium-Based MRI Contrast Agents Induce Mitochondrial Toxicity and Cell Death in Human Neurons, and Toxicity Increases With Reduced Kinetic Stability of the AgentObjectives This preclinical study was devised to investigate potential cellular toxicity in human neurons induced by gadolinium-based contrast agents (GBCAs) used for contrast-enhanced magnetic resonance imaging (MRI). Neurons modeling a subset of those in the basal ganglia were tested, because the basal ganglia region is 1 of 2 brain...
Αλέξανδρος Γ. Σφακιανάκης
2h
Sponsorship by Big Oil, Like the Tobacco Industry, Should be Banned by the Research Community No abstract...
Sponsorship by Big Oil, Like the Tobacco Industry, Should be Banned by the Research CommunityNo abstract availableFine Particulate Air Pollution and Birthweight: Differences in Associations Along the Birthweight DistributionBackground: Maternal exposure to fine particulate air pollution (PM2.5) during pregnancy is associated with lower newborn birthweight, which is a risk factor for chronic disease. Existing studies typically report the average association related with PM2.5 increase, which does...
Αλέξανδρος Γ. Σφακιανάκης
2h
Infectious Disease  A Summary of Recently Published Activity PERSPECTIVE Health Care Autonomy...
Infectious Disease A Summary of Recently Published ActivityPERSPECTIVEHealth Care Autonomy of Women Living with HIVR.R. Redfield and OthersN Engl J Med, July 24, 2019Imaging an Outbreak — Ultrasound in an Ebola Treatment UnitP.C. HenwoodN Engl J Med 381:6, July 4, 2019ORIGINAL ARTICLEDolutegravir plus Two Different Prodrugs of Tenofovir to Treat HIVW.D.F. Venter and OthersN Engl J Med, July 24, 2019Dolutegravir-Based or Low-Dose Efavirenz–Based Regimen for the Treatment of HIV-1The NAMSAL ANRS 12313...
Αλέξανδρος Γ. Σφακιανάκης
2h

Coronary Artery Disease
Beneficial effect of ticagrelor on microvascular perfusion in patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary interventionBackground Ticagrelor significantly reduced the incidence of death, myocardial infarction, and stent thrombosis in patients with ST-segment elevation myocardial infarction (STEMI) intended for reperfusion with a primary percutaneous coronary intervention (pPCI). However, the effects of this drug on microvascular perfusion in...
Αλέξανδρος Γ. Σφακιανάκης
2h
Association between lactic acid sting test scores, self‐assessed sensitive skin scores and biophysical...
Association between lactic acid sting test scores, self‐assessed sensitive skin scores and biophysical properties in Chinese femalesD.‐M. Ding, Y. Tu, M.‐Q. Man, W.‐J. Wu, F.‐Y. Lu, X. Li, Y. Li, J.‐T. Yang, Y.‐M. Jin, C.‐Y. Yang, L. HeVersion of Record online: 31 July 2019Renewable sources: Applications in personal care formulations  Fotini Μellou, Athanasia Varvaresou, Spyridon PapageorgiouFirst Published: 01 August 2019
Αλέξανδρος Γ. Σφακιανάκης
2h
Beneficial effect of ticagrelor on microvascular perfusion in patients with ST-segment elevation myocardial...
Beneficial effect of ticagrelor on microvascular perfusion in patients with ST-segment elevation myocardial infarction undergoing a primary percutaneous coronary interventionBackground Ticagrelor significantly reduced the incidence of death, myocardial infarction, and stent thrombosis in patients with ST-segment elevation myocardial infarction (STEMI) intended for reperfusion with a primary percutaneous coronary intervention (pPCI). However, the effects of this drug on microvascular perfusion in...
Αλέξανδρος Γ. Σφακιανάκης
2h
The antibody response in HIV-1-infected donors Purpose of review Although the goal of preventive HIV...
The antibody response in HIV-1-infected donorsPurpose of review Although the goal of preventive HIV vaccine design is primarily the induction of broadly neutralizing antibodies (bNAbs), recent evidence suggests that a protective response will also benefit from Fc effector functions. Here, we provide an update on the antibody response to HIV infection, including both Fab and Fc-mediated antibody responses. We also highlight recent studies showing the interplay between these functions, focusing primarily...
Αλέξανδρος Γ. Σφακιανάκης
2h