Concomitant versus sequential therapy for the treatment of Helicobacter pylori infection: a Greek randomized prospective study

Objective: The objective of this study is to compare, in Greece, a region with >20% local resistance to clarithromycin, the efficacy rates of the concomitant versus the sequential H. pylori eradication therapy. Materials and methods: Our prospective randomized study included 364 patients with newly diagnosed H. pylori infection, randomized to receive a 10-day concomitant or 10-day sequential therapy. Treatment outcome was assessed by C¹³-urea breath test at least 4 weeks after therapy. Intention to treat (ITT) and per protocol (PP) analysis of the eradication rates were performed. Secondary end points included patient compliance and safety. Results: The concomitant therapy group achieved statistically significant higher eradication rates when compared with the sequential treatment group, both in the ITT and in the PP analysis (84.6% versus 70.9%, p?=?0.002, and 90.6% versus 78.1%, p?=?0.001, respectively), after adjusting for age, gender, smoking status, and the presence or not of ulcer and/or non-ulcer dyspepsia. Both groups displayed excellent compliance rates (99.5% for the concomitant therapy group and 96.2% for the sequential therapy group, p?=?0.067). Regarding treatment safety, major adverse events that led to the discontinuation of both regimens were few, with no statistical difference between the two groups (7.0% for the concomitant therapy group and 2.9% for the sequential therapy group). Conclusions: Concomitant therapy led to statistically significant higher eradication rates over sequential therapy. Both therapies showed excellent compliance and an acceptable safety profile. The 10-day quadruple concomitant scheme should be the adopted for first-line H. pylori eradication in Greece.     

Early osteoblastic activity on TiO2 thin films decorated with flower-like hierarchical Au structures

Titanium alloys are the most commonly used dental and orthopedic implant materials due to their proven biocompatibility and mechanical properties. The native oxide layer (TiO₂ layer) formed on such Ti-based implants acts as the self-protecting layer against possible ion release. Increasing the oxide layer thickness further on such TiO₂ implants even opens the triggering of the osseointegration process if the oxide layer is having a certain degree of roughness, preferably higher. This work reports a novel photocatalytic patterning of sputter deposited TiO₂ layers with flower-like Au structures to enhance the early osteoblastic activity. The prepared hierarchical Au structures, composed of micro- and nanoscale features on the top, lead to improved number of filopodia formation. This suggest that proposed Au–TiO₂ surface may foster the cell attachment and as well as cell proliferation.

Flower-like hierarchical Au structures, composed of micro- and nanoscale features, lead to higher number of filopodia formation on TiO₂ thin films.     

Clinicopathological differences and correlations between right and left colon cancer

BACKGROUND The differences in histopathology and molecular biology between right colon cancer(RCC)and left colon cancer(LCC)were first reported in the literature by Bufill in 1990.Since then,a large number of studies have confirmed their differences in epidemiology,clinical presentation,comorbidities and biological behaviours,which may be related to the difference in prognosis and overall survival(OS)between the two groups.AIM To investigate statistically significant differences between Greek patients with LCC and RCC.METHODS The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period.Clinical information,comorbidities,histopathologic characteristics and molecular biomarkers were collected from the patients’medical records retrospectively,while administered chemotherapy regimens,targeted agents,progression-free survival(PFS)periods with first-and second-line chemotherapy and OS were recorded retroactively and prospectively.Data analysis was performed with the SPSS statistical package.RESULTS Eighty-six males and 58 females participated in the study.One hundred(69.4%)patients had a primary lesion in the left colon,and 44(30.6%)patients had a primary lesion in the right colon.Patients with RCC were more likely to display anaemia than patients with LCC[odds ratio(OR)=3.09],while LCC patients were more likely to develop rectal bleeding(OR=3.37)and a feeling of incomplete evacuation(OR=2.78)than RCC patients.Considering comorbidities,RCC patients were more likely to suffer from diabetes(OR=3.31)and coronary artery disease(P=0.056)than LCC patients.The mucinous differentiation rate was higher in the right-sided group than in the left-sided group(OR=4.49),as was the number of infiltrated lymph nodes(P=0.039),while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients(OR=2.78).RAS wild-type patients who received anti-epidermal growth factor receptor(EGFR):Treatment experienced greater benefit(PFS:16.5 mo)than those who received anti-vascular endothelial growth factor treatment(PFS:13.7 mo)(P=0.05),while among RAS wild-type patients who received anti-EGFR treatment,LCC patients experienced greater benefit(PFS:15.8 mo)than the RCC subgroup(PFS:5.5 mo)in the first-line chemotherapy setting(P=0.034).BRAF-mutant patients had shorter PFS(9.3 mo)than BRAF wild-type patients(14.5 mo)(P=0.033).RCC patients showed a shorter tumour recurrence period(7.7 mo)than those with LCC(14.5 mo)(P<0.001),as well as shorter(OS)(58.4 mo for RCC patients;82.4 mo for LCC patients)(P=0.018).CONCLUSION RCC patients present more comorbidities,worse histological and molecular characteristics and a consequently higher probability of tumour recurrence,poor response to targeted therapy and shorter OS than LCC patients.     

Comparative study of plasma ghrelin levels in women with polycystic ovary syndrome, in hyperandrogenic women and in normal controls

BACKGROUND: Ghrelin is a novel peptide associated with energy balance, obesity, and perhaps gonadal function. The present study was designed in order: (i) to compare plasma ghrelin levels between women with PCOS, women who presented only with hyperandrogenaemia and healthy controls; and (ii) to investigate the relationship between circulating ghrelin and the heterogeneity of clinical and biochemical manifestations of PCOS. METHODS: Two hundred and fifty-nine women with PCOS, 25 women who had only hyperandrogenaemia and 46 controls, were studied. Women with PCOS were further divided, based on the presence of chronic anovulation, biochemical hyperandrogenaemia, clinical hyperandrogenism, and polycystic ovary morphology on ultrasound evaluation. In all women, the basal levels of gonadotrophins, androgens, 17-OH-progesterone, sex hormone-binding globulin, glucose, insulin and ghrelin were measured. RESULTS: Women with PCOS had lower ghrelin levels, compared to both women with hyperandrogenaemia and controls; women with hyperandrogenaemia had lower ghrelin levels, compared to controls, but not significantly so. While PCOS-associated hyperandrogenaemia was inversely related to ghrelin levels, anovulation and polycystic ovary morphology were associated with higher concentrations. Ghrelin levels were negatively correlated with 17-OH-progesterone levels. CONCLUSIONS: In PCOS, circulating ghrelin and androgens are inversely related and it is possible that this peptide is involved in steroidal synthesis and/or action. It is also likely that different clinical and biochemical manifestations of the syndrome are also associated with different ghrelin concentrations.     

The ophthalmic wound of Philip II of Macedonia (360-336 BCE)

The aim of this report is to present the ophthalmic wound of King Philip II of Macedonia, father of Alexander the Great. From a series of ancient literary and historical sources, a number of archaeological finds, and the paleopathological remains in the supposed tomb of Philip in Vergina, it can be deduced that the king was seriously wounded in his right eye during the siege of Methoni. The renowned physician Critobulos undertook the removal of the arrow that had injured the eye and the postoperative follow-up. He was already experienced and belonged to the official medical family of Asclepiades of Cos Island. It seems that an ugly scar remained in the area of Philip's right eye, possibly causing him psychological problems.     

T-cell-rich B-cell lymphoma. Analysis of clinical features, response to treatment, survival and comparison with diffuse large B-cell lymphoma.

OBJECTIVES: Clinical features, response to treatment and survival of T-cell-rich B-cell lymphoma (TCRBCL) patients were compared to those of a similar group of patients with diffuse large B-cell lymphoma (DLBCL). METHODS: Between 1992 and 1999, 10 patients with a diagnosis of TCRBCL were treated in our department. Over the same 7-year period, a group of 65 patients with DLBCL were diagnosed in the same department. Both groups of patients were treated with the same anthracycline-based chemotherapy. RESULTS: A significantly higher percentage of patients with TCRBCL presented with B-symptoms, elevated LDH, bone marrow infiltration and disseminated extranodal involvement compared to patients with DLBCL. TCRBCL patients responded poorly to combination chemotherapy, since only 3 of them achieved complete remission (33%) compared to 48 (75%) patients with DLBCL. All patients with TCRBCL who achieved complete response relapsed within the first 2 years while 65% of patients with DLBCL survive disease free for a median follow-up period of 4 years. The median overall survival for DLBCL patients has not been reached yet, while it was 18 months for TCRBCL patients. CONCLUSIONS: Although the number of patients in our study is small, it seems that patients with TCRBCL present with advanced disease, respond poorly to chemotherapy and display a short disease-free and overall survival compared to patients with DLBCL.     

Capsule endoscopy retention as a helpful tool in the management of a young patient with suspected small-bowel disease

Capsule endoscopy is an easy and painless procedure permitting visualization of the entire small-bowel during its normal peristalsis. However, important problems exist concerning capsule retention in patients at risk of small bowel obstruction. The present report describes a young patient who had recurrent episodes of overt gastrointestinal bleeding of obscure origin, 18 years after small bowel resection in infancy for ileal atresia. Capsule endoscopy was performed, resulting in capsule retention in the distal small bowel. However, this event contributed to patient management by clearly identifying the site of obstruction and can be used to guide surgical intervention, where an anastomotic ulcer is identified.     

Evaluation of capsule endoscopy in active, mild-to-moderate, overt, obscure GI bleeding

BACKGROUND: The role of capsule endoscopy (CE) in the diagnosis of active mild-to-moderate GI bleeding (GIB) immediately after a negative EGD and ileocolonoscopy has not been prospectively evaluated. OBJECTIVE: To estimate the diagnostic yield and clinical significance of CE in patients with acute, obscure, overt, mild-to-moderate GIB. DESIGN: A single-center prospective study. PATIENTS: During a 3-year period, 573 patients admitted to the hospital with acute mild-to-moderate GIB were included in this study. Among them, 37 patients (6.5%) with negative endoscopic findings, after urgent upper- and lower-GI endoscopies, underwent CE within the first 48 hours to identify the source of bleeding. RESULTS: CE revealed active bleeding in 34 patients and a diagnostic yield of 91.9%, including angiodysplasias in 18 patients, ulcers in 3 patients, and tumors in 2 patients. In the remaining 11 patients (32%), CE revealed the site of bleeding: distal duodenum in 1 case (9%), jejunum in 6 cases (54%), ileum in 2 cases (18%), and cecum in 2 cases (18%). From the 37 bleeders, 16 were managed conservatively, 14 endoscopically, and 7 surgically. During a 12-month follow-up period, bleeding recurrence was observed in 5 of 32 (15.6%). LIMITATIONS: This study had a limited number of patients. CONCLUSIONS: CE appeared to have a high diagnostic yield in patients with acute, mild-to-moderate, active hemorrhage of obscure origin when performed in the hospital after a negative standard endoscopic evaluation and has important clinical value in guiding medical management.