Analysis of radiomic features derived from post-contrast T1-weighted images and apparent diffusion coefficient (ADC) maps for breast lesion evaluation: A retrospective study.

INTRODUCTION: Breast cancer is the most common malignancy among women, and its diagnosis relies on medical imaging and the invasive, uncomforted biopsy. Recent advances in quantitative imaging and specifically the application of radiomics has proved to be a very promising technique, facilitating both diagnosis and therapy. The purpose of this study is to assess radiomic features derived from post-contrast T1w Magnetic Resonance Imaging (MRI) sequences and Apparent Diffusion Coefficient (ADC) maps for the evaluation of breast pathologies. METHODS: MRI data from 52 women were retrospectively reviewed, involving 54 breast lesions, both malignant and benign. Diffusion Weighted Imaging (DWI) was applied as a standard MRΙ protocol, including dynamic contrast-enhanced (DCE) MRΙ in all cases. All patients were examined on a 1.5T MRI scanner, and 216 features were initially extracted from DCE-MRI images. Histological analysis of the breast lesions was performed, and a comparative analysis of the results was carried out to assess the accuracy of the method. RESULTS: Following surgery and histological analysis, 30 lesions were found to be malignant and 24 benign. Implementation of a Machine Learning (ML) classification algorithm with 5-fold cross-validation resulted in a sensitivity of 70%, specificity of 66%, Negative Predictive Value of 82% and overall accuracy of 67% in differentiating malignancy from benevolence. CONCLUSION: Texture analysis and ML methodology based on the first post-contrast dynamic sequences and ADC maps may be employed to differentiate between malignant and benign breast lesions, offering a promising new tool for diagnostic analysis. IMPLICATIONS FOR PRACTICE: The results of this study will enhance knowledge around application and performance of radiomics in breast MRI, thus helping MRI radiographers who use AI-enabled technologies to better delineate the pros and cons of these procedures.

Genotype-dependent regulation of vitamin E biosynthesis in olive fruits as revealed through metabolic and transcriptional profiles.

Vitamin E is a general term used to describe a group of eight lipophilic compounds known as tocochromanols. These vitamin E variants are chemically categorised into two classes formed by α-, ß-, γ- and δ- tocopherols and tocotrienols isoforms, respectively. The present study describes the concurrent regulation of genes and metabolites orchestrating vitamin E biosynthesis in olive drupes of five distinctive Greek olive cultivars. A combination of analytical, biochemical and molecular approaches was employed in order to carry out comparative analyses, including real-time RT-qPCR for gene expression levels and HPLC analysis of metabolite content. Findings indicated that tocochromanol levels and composition, oil content, gene expression levels as well as total antioxidant activity were highly dependent on cultivar and, to a lesser extent, on fruit developmental stage. Specifically, cultivars 'Kalokairida' and 'Lianolia Kerkyras' demonstrated the highest vitamin E content. The latter possessed high tocochromanol content combined with highest overall antioxidant activity in all developmental stages, concomitant with the up-regulation expression profile of HPPD. The genotypic imprint versus the temporal contribution to vitamin E levels, as well as the potential link to lipid peroxidation amelioration, are discussed.

Attitudes and behavior toward organ donation in Greece.

INTRODUCTION: During the two last decades remarkable progress has been made among transplantations in Greece. However, organ donation remains a controversial issue. PURPOSE: To explore and determine factors associated with differences in willingness to donate organs among Greeks. METHODS: We administered a survey to 2263 adults living in the region of Thessaloniki. We studied the incidence of registered donors, their awareness on the subject of brain death and organ donation, their willingness to donate and factors that influence donation of their own and their relatives organs, as well as their feelings about such a decision. RESULTS: The respondents knew the significance of brain death and organ donation; 3.8% were already registered to be donors. Nearly half of them (48.3%) wanted to become a donor and 49.1% would donate organs of their relatives; 55.7% were afraid of the procedure of organ removal to and 58.3% would feel guilt about gifting the organs of a relative. Women were more prone to become donors (odds ratio 1.95) and parents were more likely to be registered as donors (odds ratio 1.84). About 63.7% of Orthodox Christians wished to become donors. Professional and educational levels were not observed to influence attitudes. CONCLUSIONS: Despite knowledge and willingness regarding organ donation, only a small percentage of Greeks are actually registered to be donors.

Course and outcome of renal transplant recipients admitted to the intensive care unit: a 20-year study.

BACKGROUND: Renal transplantation represents the main treatment for end-stage renal disease. The goal of this study was to evaluate the course and outcome of renal transplant recipients admitted to the intensive care unit (ICU) and to analyze factors determining prognosis and mortality. METHODS: The demographic features, data admission characteristics, and ICU courses of all renal transplant recipients admitted to our ICU from 1992 to 2012 were evaluated to analyze factors for mortality. RESULTS: Eleven women and 50 men of mean age 45.5 ± 12.5 years were included in the study. Acute Physiology And Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores on ICU admission were 20 ± 5.7 and 8.5 ± 3.5, respectively. The main reasons for admission were as follows: sepsis (n = 27) or immediate postoperative complications (n = 16). Thirty-five patients during their ICU stay required hemodialysis and 34 needed catecholamines. The mortality rate was 42.6%. APACHE II Score, dialysis requirement, and sepsis as a reason for ICU admission were independently related to the mortality. CONCLUSIONS: The mortality rate was higher than that of the general ICU population (42.6% vs 30%). The main reason for ICU admission of renal transplant recipients was sepsis.

Infections related to renal transplantation requiring intensive care admission: a 20-year study.

INTRODUCTION: The aim of this study was to evaluate infection complications as the reason for intensive care unit (ICU) admission among transplant recipients. METHODS: We studied all renal transplant recipients with infectious complications admitted to our ICU from 1992 to 2012:44.3% of all renal transplant recipients admitted to ICU. The epidemiology and prognosis of infectious complications requiring ICU admission were evaluated with analysis of mortality factors. RESULTS: The 22 men and 5 women included in this study showed a mean age of 42.7 ± 12.3 years. The Acute Physiologic and Chronic Health Evaluation II and Seguential Organ Failure Assessment scores on ICU admission were 20 ± 4.6 and 8.6 ± 3.9, respectively. The main infections complications requiring ICU admission were cytomegalovirus pneumonia (n = 15) and aspergillus pneumonia (n = 4). Sixteen patients required hemodialysis and 14, catecholamine support upon ICU admission owing to septic shock. The mortality rate among study patients was 62.9%, versus 26.5% for noninfectious renal transplant recipients requiring ICU admissions. Catecholamine support at ICU admission was independently related to mortality. CONCLUSION: The mortality rate of renal transplant recipients admitted to ICU owing infection complications was higher than that of noninfected renal transplant patients. These data suggest that infections and septic shock in renal transplant recipients requiring ICU admission worsen their outcome significantly.

How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study.

Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients' rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.

Dieulafoy-like lesion of the colon presenting with massive lower gastrointestinal bleeding.

The Dieulafoys lesion is a rare cause of severe gastrointestinal hemorrhage. The lesion is usually located in the stomach, although it may occur anywhere in the gastrointestinal tract. It is characterized by severe bleeding from a minute submucosal arteriole that bleeds through a punctate erosion in an otherwise normal mucosa. We describe an elderly patient who presented with severe lower gastrointestinal bleeding caused by a colonic Dieulafoy-like lesion. This is the third report of colonic Dieulafoys lesion treated successfully with endoscopic hemoclipping. We review the pathophysiology, clinical presentation, diagnosis, and treatment of this rare disease.

Endoscopic snare resection of an intrapapillary pedunculated villous adenoma presenting as acute recurrent pancreatitis.

Tumors of the papillary region are an unusual and heterogeneous group of neoplasms that arise from the major papilla, the ampulla of Vater, and the peripapillary duodenum. Benign adenomas of the papilla of Vater are an increasingly recognized condition in those with familial adenomatous polyposis syndromes as well as sporadic cases. Papillary adenoma is a recognized but rare cause of acute pancreatitis. We describe a patient who presented with acute recurrent pancreatitis that was attributed to an intrapapillary pedunculated villous adenoma. Following diagnosis by endoscopic needle knife sphincterotomy and endoscopic retrograde cholangiopancreatography, endoscopic snare resection of the adenoma resulted in symptomatic improvement.

Endobiliary endoprosthesis without sphincterotomy for the treatment of biliary leakage.

Endoscopic retrograde cholangiopancreatography with biliary drainage is an effective therapeutic tool in the management of bile duct injuries associated with laparoscopic cholecystectomy. Placement of a stent or a nasobiliary drain in the common bile duct, or biliary sphincterotomy, is an effective treatment for bile leaks and obviates the need for otherwise complex biliary tract surgery. Although there are no controlled comparative trials, placement of a 7-, 8.5-, or 10-Fr biliary stent without sphincterotomy may cause the least morbidity and be the most comfortable nonoperative management option. We report a child who presented with a bile leak that occurred after laparoscopic cholecystectomy and was successfully treated with the placement of a biliary stent without sphincterotomy. To our knowledge, this is the second pediatric case of a bile leak successfully treated by endoprosthesis placement without sphincterotomy.

Double Dieulafoy-like lesion in the stomach.

Dieulafoy's lesion is an uncommon cause of major gastrointestinal bleeding and may be difficult to recognize. It consists of an arteriole that protrudes through a tiny mucosal defect usually within 6 cm of the gastroesophageal junction on the lesser curve of the stomach. Despite widespread awareness of this entity, it remains a diagnostic challenge for gastroenterologists because of its small size and hidden location. Emergency endoscopy is the most effective method of diagnosing the disease. We report a patient, with double Dieulafoy-like lesion, who was successfully treated endoscopically using hemostatic clip application. The characteristics of the Dieulafoy's lesion, its current diagnosis, and its treatment are discussed.

Successful treatment of duodenal bulb obstruction caused by a gallstone (Bouveret's syndrome) after endoscopic mechanical lithotripsy.

Because of acute symptoms in the upper abdomen, upper gastrointestinal endoscopy was performed in a 68-year-old man. A large perforated gallstone was embedded in the duodenum, causing complete obstruction of the duodenal bulb. The stone was crushed successfully by endoscopic mechanical lithotripsy. The patient was referred for surgery, and was discharged after a successful and uneventful cholecystectomy.

Sesquiterpene lactones from Centaurea thessala and Centaurea attica. Antifungal activity.

The aerial parts of Centaurea thessala ssp. drakiensis and C. attica ssp. attica afforded, in addition to several known sesquiterpene lactones, two new eudesmanolides, 4-epi-sonchucarpolide and its 8-(3-hydroxy-4-acetoxy-2-methylene-butanoyloxy) derivative and one new eudesmane derivative, named atticin. The in vitro antifungal activity of most compounds was tested against nine fungal species, using the micro-dilution method. All the compounds tested showed great antifungal activity.

Insulin sensitivity and antiandrogenic therapy in women with polycystic ovary syndrome.

Polycystic ovary (PCO) syndrome is strongly associated with insulin resistance and the accompanying adverse metabolic profile. To distinguish the mechanisms of this association, we determined the interactions of PCO with obesity and the influence of ameliorating direct androgenic actions via short-term treatment with the antiandrogen flutamide. Insulin sensitivity was determined by the hyperinsulinemic euglycemic clamp in groups of lean and obese PCO women and weight-matched controls. Compared with control values, insulin-mediated glucose utilization in PCO women was significantly lower in lean (1.96 +/- 0.17 v 1.24 +/- 0.10, P < .01) and obese (1.23 +/- 0.18 v 1.03 +/- 0.09 mmol/m2/min, P < .01) subjects. ANOVA indicated that the effects of obesity and androgenicity are independent and additive. In both lean and obese PCO women, treatment with flutamide for 1 or 3 months markedly improved the clinical and biochemical androgenic features, but did not significantly influence the overall insulin sensitivity. A large disparity between individuals in the response to treatment correlated significantly with a simultaneous reduction in plasma levels of dehydroepiandrosterone sulfate (DHEA-S). Thus in women, PCO and obesity exert synergistic effects on insulin resistance. The decreased insulin sensitivity is mediated via indirect androgenic actions or nonandrogenic mechanisms. In some individuals, a direct effect of androgens might have been masked by a decrease in DHEA-S levels.