Large Language Models in Oncology: Revolution or Cause for Concern?

The technological capability of artificial intelligence (AI) continues to advance with great strength. Recently, the release of large language models has taken the world by storm with concurrent excitement and concern. As a consequence of their impressive ability and versatility, their provide a potential opportunity for implementation in oncology. Areas of possible application include supporting clinical decision making, education, and contributing to cancer research. Despite the promises that these novel systems can offer, several limitations and barriers challenge their implementation. It is imperative that concerns, such as accountability, data inaccuracy, and data protection, are addressed prior to their integration in oncology. As the progression of artificial intelligence systems continues, new ethical and practical dilemmas will also be approached; thus, the evaluation of these limitations and concerns will be dynamic in nature. This review offers a comprehensive overview of the potential application of large language models in oncology, as well as concerns surrounding their implementation in cancer care.

Pseudomyxoma Peritonei: A Challenging Clinical Diagnosis. Case Report and Review of the Literature.

Background: Pseudomyxoma peritonei (PMP) is a clinical entity of subtle onset abdominal pain, ascites, and distention associated with characteristic imaging. In most cases, laparoscopic exploration will give the definitive diagnosis and histopathologic verification. However, usually there are difficulties in the diagnosis of this disease. Case Report: Herein, we present a case of a 51-year-old female who developed ascites over 5 months. An investigational laparotomy established the diagnosis of PMP, after the discovery of a mucinous, grey-brown tumor that was CK20 positive and CK7 negative. Subsequently, chemotherapy with oxaliplatin combined with 5-FU (FOLFOX4 regimen), was initiated and the patient survived for 30 months. We also present a comprehensive review of the English literature concerning the different symptoms and radiological findings of this rare entity. According to the literature review, 35 cases of PMP with different clinical and radiological findings have been described. In the majority of the cases, ultrasound, computed tomography or magnetic resonance imaging was orientating towards a proper diagnosis before a diagnostic laparotomy. Conclusion: The combination of a clinical picture with the characteristic imaging findings enables a prompt diagnosis of PMP, making prognosis more favorable.

Small Bowel Diverticulosis and COVID-19: Awareness Is the Key: A Case Series and Review of the Literature.

Small bowel non-Meckelian diverticulosis is a rare condition with only a few published cases despite being described over 200 years ago. In the midst of the COVID-19 pandemic, studies suggested that many patients may experience gastrointestinal manifestations. Intestinal symptoms could worsen the inflammation and infection associated with small bowel diverticulitis. Here we present three cases: one with inflammation and rupture in a COVID-19 patient and another as an asymptomatic detection. The third case involved recurrence after the first laparoscopic lavage approach. Furthermore, we provide a mini-review of the literature to emphasize the importance of considering this entity in the differential diagnosis of an acute abdomen. In the majority of cases involving small bowel diverticula, conservative management is the preferred approach. However, when complications arise, surgical intervention, including enteroctomy and primary anastomosis, may be necessary to achieve optimal outcomes.

Quality of life, distress and psychological adjustment in patients with colon cancer.

PURPOSE: The purpose of this study was to investigate the relationships between distress, psychological adjustment, and quality of life in patients with colon cancer. METHOD: This study employed a cross-sectional design and included 104 colon cancer patients treated at AHEPA Hospital, Thessaloniki, Greece. The assessment tools used encompassed the Distress Thermometer, MINI-MAC scale, and FACT-C to evaluate distress, psychological adjustment, and quality of life. Statistical analysis, conducted in SPSS software, encompassed correlation tests and linear regression to explore the interplay between these variables in colon cancer patients. RESULTS: Correlation tests revealed that patients' quality of life is positively correlated with a fighting spirit (r = 0.719, p < 0.001), cognitive avoidance (r = 0.634, p < 0.001), and fatalism (r = 0.518, p < 0.001), and negatively with helplessness and hopelessness (r = -0.756, p < 0.001), and anxious preoccupation (r = -0.679, p < 0.001). OLS regression findings verified these results partially for a significance level of 5% but indicated no statistically significant effect of cognitive avoidance and fatalism on quality of life, which was further found unaffected by total distress. CONCLUSIONS: The intricate links between quality of life, distress, and psychological adjustment in colon cancer patients call for deeper investigation. A personalized approach in psycho-oncology care is essential for comprehensive treatment. These findings highlight the significance of addressing the psychological and emotional needs of colon cancer patients, as observed in the study's results.

Effect of Farming System and Season on Proximate Composition, Fatty Acid Profile, Antioxidant Activity, and Physicochemical Properties of Retail Cow Milk.

Consumers differentiate milk-quality characteristics in relation to the production system, but data on retail milk composition are limited. This study investigated how farming methods and seasons affect proximate composition, fatty acid profile, antioxidant activity, and physicochemical characteristics of commercial cow's milk. Milk samples, both conventional (n = 84, 7 manufacturers) and organic (n = 24, 2 manufacturers), were collected monthly over a year. Farming system did not significantly affect milk composition other than fat content, whereas seasonal effects were notable, impacting the contents of ash, protein, and added water. Fatty acid composition exhibited variations influenced by both production system and season. Compared to conventionally produced milk, organically produced milk exhibited higher levels of polyunsaturated fatty acids (4.54 vs. 3.88, p < 0.01) and a lower atherogenicity index (2.23 vs. 2.50, p < 0.05). The antioxidant activity showed that conventionally produced milk exhibited better radical-scavenging activity (DPPH) (14.54 vs. 12.30 µM TE/mL, p < 0.01). Seasonal variations were evident in both free radical-scavenging activity (DPPH), with values of 12.29 µM TE/mL in winter and 15.58 µM TE/mL in spring (p < 0.05), and ferric reducing-antioxidant power (FRAP), with levels of 21.81 µM TE/mL in autumn and 27.94 µM TE/mL in spring (p < 0.05). Season significantly affected (p < 0.001) milk pH, electrical conductivity, refractive index, and freezing-point depression. In conclusion, this study showed that the farming system has a limited impact on retail milk quality compared to the significant influence of season.

Renal Cell Cancer - Insights in Drug Resistance Mechanisms.

Renal cell carcinoma (RCC) is the prevalent form of kidney cancer in adults, with clear cell renal carcinoma (ccRCC) being the predominant subtype. While surgical resection remains the primary curative approach for localized RCC, a significant number of patients encounter disease relapse. The advent of targeted therapies, including tyrosine kinase inhibitors (TKI), mammalian target of rapamycin (mTOR) inhibitors, and immune checkpoint inhibitors, has revolutionized the treatment of metastatic RCC. However, despite therapeutic advancements, the emergence of resistance poses a significant challenge. Resistance mechanisms in RCC involve the disruption of hypoxia pathways, activation of the PI3K/AKT/mTOR pathway, and increased expression of alternate proangiogenic factors. Furthermore, the sequestration of TKI within lysosomes contributes to reduced drug effectiveness and development of resistance. Current research is focused on overcoming resistance by identifying predictive biomarkers for treatment efficacy, developing novel variations of existing therapies that target alternative signalling pathways, and exploring combination therapy approaches. The objective of this review article was to provide a comprehensive assessment of resistance mechanisms to systemic therapies and explore emerging treatment strategies for RCC.

Variations in Composition, Antioxidant Profile, and Physical Traits of Goat Milk within the Semi-Intensive Production System in Mountainous Areas during the Post-Weaning to End-of-Lactation Period.

Dairy products from mountain-origin milk are known for their superior composition and quality. This study aimed to examine changes in composition, nutritional quality, and antioxidant properties of milk from semi-intensively managed goats in mountainous regions during the post-weaning to end-of-lactation period. Bulk tank milk samples from 10 farms were collected bi-weekly in the period from March to September. The farms were situated in regions with an average altitude of 772.20 m above sea level. The results revealed significant variations in milk composition, with fluctuations in fat, protein, lactose, and total solids. Milk yield per doe showed seasonal differences, with the highest yield in April and the lowest in September. Fatty acid composition exhibited changes throughout the sampling period, with variations in polyunsaturated fatty acids. Nutritional indices, such as the atherogenicity index and thrombogenicity index, remained within the recommended values. Antioxidant properties, including total phenolic content, DPPH, FRAP, and ABTS, showed significant differences, with higher values toward the end of the study. Milk pH, electrical conductivity, brix value, and refractive index also exhibited variations, while density and freezing point remained relatively stable. The study provided valuable information that can be used to develop breeding and feeding plans to achieve uniform milk quality in mountainous regions.

Corrected QT interval in cirrhosis: A systematic review and meta-analysis.

BACKGROUND: Corrected QT (QTc) interval is prolonged in patients with liver cirrhosis and has been proposed to correlate with the severity of the disease. However, the effects of sex, age, severity, and etiology of cirrhosis on QTc have not been elucidated. At the same time, the role of treatment, acute illness, and liver transplantation (Tx) remains largely unknown. AIM: To determine the mean QTc in patients with cirrhosis, assess whether QTc is prolonged in patients with cirrhosis, and investigate whether QTc is affected by factors such as sex, age, severity, etiology, treatment, acute illness, and liver Tx. METHODS: In the present systematic review and meta-analysis, the searching protocol "{[QTc] OR [QT interval] OR [QT-interval] OR [Q-T syndrome]} AND {[cirrhosis] OR [Child-Pugh] OR [MELD]}" was applied in PubMed, EMBASE, and Google Scholar databases to identify studies that reported QTc in patients with cirrhosis and published after 1998. Seventy-three studies were considered eligible. Data concerning first author, year of publication, type of study, method used, sample size, mean age, female ratio, alcoholic etiology of cirrhosis ratio, Child-Pugh A/B/C ratio, mean model for end-stage liver disease (MELD) score, treatment with ß-blockers, episode of acute gastrointestinal bleeding, formula for QT correction, mean pulse rate, QTc in patients with cirrhosis and controls, and QTc according to etiology of cirrhosis, sex, Child-Pugh stage, MELD score, and liver Tx status (pre-Tx/post-Tx) were retrieved. The Newcastle-Ottawa quality assessment scale appraised the quality of the eligible studies. Effect estimates, expressed as proportions or standardized mean differences, were combined using the random-effects, generic inverse variance method of DerSimonian and Laird. Subgroup, sensitivity analysis, and meta-regressions were applied to assess heterogeneity. The study has been registered in the PROSPERO database (CRD42023416595). RESULTS: QTc combined mean in patients with cirrhosis was 444.8 ms [95% confidence interval (CI): 440.4-449.2; P < 0.001 when compared with the upper normal limit of 440 ms], presenting high heterogeneity (I2 = 97.5%; 95%CI: 97.2%-97.8%); both Egger's and Begg's tests showed non-significance. QTc was elongated in patients with cirrhosis compared with controls (P < 0.001). QTc was longer in patients with Child-Pugh C cirrhosis when compared with Child-Pugh B and A (P < 0.001); Child-Pugh B patients presented longer QTc when compared with Child-Pugh A patients (P = 0.003). The MELD score was higher in patients with cirrhosis with QTc > 440 ms when compared with QTc ≤ 440 ms (P < 0.001). No correlation of QTc with age (P = 0.693), sex (P = 0.753), or etiology (P = 0.418) was detected. ß-blockers shortened QTc (P< 0.001). QTc was prolonged during acute gastrointestinal bleeding (P = 0.020). Tx tended to improve QTc (P < 0.001). No other sources of QTc heterogeneity were revealed. CONCLUSION: QTc is prolonged in cirrhosis independently of sex, age, and etiology but is correlated with severity and affected by ß-blockers and acute gastrointestinal bleeding. QTc is improved after liver Tx.

Comparison between upfront surgery and neoadjuvant chemotherapy in patients with locally advanced gastric cancer: A systematic review.

BACKGROUND: Gastric cancer (GC) is a major health concern worldwide. Surgical resection and chemotherapy is the mainstay treatment for gastric carcinoma, however, the optimal approach remains unclear and should be different in each individual. Chemotherapy can be administered both pre- and postoperatively, but a multidisciplinary approach is preferred when possible. This is particularly relevant for locally advanced GC (LAGC), as neoadjuvant chemotherapy (NAT) could potentially lead to tumor downsizing thus allowing for a complete resection with curative intent. Even though the recent progress has been impressive, European and International guidelines are still controversial, thus attenuating the need for a more standardized approach in the management of locally advanced cancer. AIM: To investigate the effects of NAT on the overall survival (OS), the disease-free survival (DFS), the morbidity and the mortality of patients with LAGC in comparison to upfront surgery (US). METHODS: For this systematic review, a literature search was conducted between November and February 2023 in PubMed, Cochrane Library and clinicaltrials.gov for studies including patients with LAGC. Two independent reviewers conducted the research and extracted the data according to predetermined inclusion and exclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses was used to form the search strategy and the study protocol has been registered in the International Prospective Register of Systematic Reviews. RESULTS: Eighteen studies with 4839 patients with LAGC in total were included in our systematic review. Patients were separated into two groups; one receiving NAT before the gastrectomy (NAT group) and the other undergoing upfront surgery (US group). The OS ranged from 41.6% to 74.2% in the NAT group and from 30.9% to 74% in the US group. The DFS was also longer in the NAT group and reached up to 80% in certain patients. The complications related to the chemotherapy or the surgery ranged from 6.4% to 38.1% in the NAT group and from 5% to 40.5% in the US group. Even though in most of the studies the morbidity was lower in the NAT group, a general conclusion could not be drawn as it seems to depend on multiple factors. Finally, regarding the mortality, the reported rate was higher and up to 5.3% in the US group. CONCLUSION: NAT could be beneficial for patients with LAGC as it leads to better OS and DFS than the US approach with the same or even lower complication rates. However, patients with different clinicopathological features respond differently to chemotherapy, therefore currently the treatment plan should be individualized in order to achieve optimal results.

Omicron variant dominance and anti-SARS-CoV-2 vaccination are key determinants for a milder course of COVID-19 in patients with systemic autoimmune rheumatic diseases.

INTRODUCTION: This study aimed to determine whether the introduction of anti-SARS-CoV-2 vaccines and the dominance of the omicron variant had a significant impact on the outcome of COVID-19 in patients with systemic autoimmune rheumatic diseases (SAIRDs). METHODS: Using data entered to the Greek Rheumatology Society COVID-19 registry, we investigated the incidence of hospitalization and death due to COVID-19, during the successive periods of the pandemic according to the prevalent strain (wild-type, Alpha, Delta, Omicron) in vaccinated and unvaccinated patients. Variables independently associated with hospitalization and death were explored using multivariate regression analyses, while Kaplan-Meier curves were used to depict survival data. RESULTS: From August 2020 until June 30, 2022, 456 cases (70.2% females) of COVID-19 with a mean age (± SD) of 51.4 ± 14.0 years were reported. In unvaccinated patients, the proportions of hospitalization and death were 24.5% and 4%, compared to 12.5% and 0.8% in the vaccinated group (p < 0.001 for both comparisons). The rates of hospitalization for the wild-type, Alpha, Delta, and Omicron periods were 24.7%, 31.3%, 25.9%, and 8.1% respectively (p < 0.0001), while the case fatality rates were 2.7%, 4%, 7%, and 0%, respectively (p = 0.001). Using multivariable regression analysis, factors independently associated with hospitalization were infection by a non-Omicron variant, being non-vaccinated, exposure to rituximab, older age, and respiratory and cardiovascular disease. Independent predictors for death were contracting COVID-19 during the Alpha or Delta period, pulmonary disease, and older age, while being vaccinated was protective. CONCLUSIONS: In this 2-year analysis, the rates of hospitalization and death among patients with SAIRDs have declined significantly. Vaccination and the dominance of the Omicron variant appear to be the major determinants for this shift. Key points • During the late phase of the pandemic, the proportion of severe COVID-19 cases, defined as requiring hospitalization or resulting in death, in patients with systemic autoimmune rheumatic diseases has declined. • Anti-SARS-CoV-2 vaccination and the dominance of the Omicron strain are the key factors that have independently contributed to this shift.

Exosomes in the Diagnosis and Treatment of Renal Cell Cancer.

Renal cell carcinoma (RCC) is the most prevalent type of kidney cancer originating from renal tubular epithelial cells, with clear cell RCC comprising approximately 80% of cases. The primary treatment modalities for RCC are surgery and targeted therapy, albeit with suboptimal efficacies. Despite progress in RCC research, significant challenges persist, including advanced distant metastasis, delayed diagnosis, and drug resistance. Growing evidence suggests that extracellular vesicles (EVs) play a pivotal role in multiple aspects of RCC, including tumorigenesis, metastasis, immune evasion, and drug response. These membrane-bound vesicles are released into the extracellular environment by nearly all cell types and are capable of transferring various bioactive molecules, including RNA, DNA, proteins, and lipids, aiding intercellular communication. The molecular cargo carried by EVs renders them an attractive resource for biomarker identification, while their multifarious role in the RCC offers opportunities for diagnosis and targeted interventions, including EV-based therapies. As the most versatile type of EVs, exosomes have attracted much attention as nanocarriers of biologicals, with multi-range signaling effects. Despite the growing interest in exosomes, there is currently no widely accepted consensus on their subtypes and properties. The emerging heterogeneity of exosomes presents both methodological challenges and exciting opportunities for diagnostic and clinical interventions. This article reviews the characteristics and functions of exosomes, with a particular reference to the recent advances in their application to the diagnosis and treatment of RCC.

Gestational Renal Cell Cancer - An Update.

Gestational renal cell carcinoma (RCC) is an uncommon occurrence and presents a diagnostic and clinical challenge for healthcare providers. The manifestation of gestational RCC often lacks overt symptoms and can mimic physiological changes and disorders associated with pregnancy. Frequently, patients are asymptomatic, and the condition is detected during routine antenatal ultrasonography. However, the options for imaging modalities and treatment are limited due to the potential risks of harm to the developing fetus and interruption of pregnancy. Throughout the management of pregnant patients with RCC, both maternal and neonatal risks must be carefully considered, while respecting the patient's autonomy. Currently, there are no internationally or nationally recognized evidence-based guidelines for managing gestational RCC, highlighting the need for a multidisciplinary approach to treatment. Advances in surgical techniques have resulted in a shift from open surgeries to laparoscopic radical or partial nephrectomy procedures, with robotic-assisted approaches also gaining popularity. In cases of metastatic gestational RCC, termination of the pregnancy may be considered, and the appropriate treatment of RCC should be the priority. This article aims to provide a comprehensive review of the epidemiology, aetiology, clinical presentation, diagnosis, prognosis, and management of gestational RCC.

A Comprehensive Analysis on Nutritional and Antioxidant Characteristics of a Traditional Roasted Maize Flour (Furniko) of Pontic Greeks: Comparative Study to Related Flour Products.

Furniko flour (FF) is a traditional roasted flour derived from a maize landrace, commonly consumed by Greeks of Pontic origin in the northern regions of Greece. Despite its perceived nutritional benefits, there is a lack of scientific data to support and highlight its value. This study aimed to compare the nutritional, physicochemical, anti-nutritional, functional, and antioxidant characteristics of FF with those of traditional and non-traditional types of maize flour. Furniko flour (FF) presented the highest values for protein (10.86 ± 0.36 g/100 g), fat (5.05 ± 0.08 g/100 g), K (539.93 mg/100 g), Mg (126.38 mg/100 g), P (296.4 mg/100 g), Zn (2.44 mg/100 g), and total phenolic content (TPC) (156 mg GAE/100 g). However, FF exhibited lower levels of Fe (3.83 mg/100 g), carbohydrates (70.55 ± 0.24 g/100 g), and antioxidant activity (0.27 ± 0.02 µmol of TE/g) than other types of flour examined. Furniko's functional properties make it an excellent source for porridges, while its low content of antinutrients reduces the possibility of low bioavailability of Fe, Zn, Mg, and Ca. Due to its significant and functional characteristics, Furniko flour could be considered an important material in the food industry, especially in bakery goods and health-oriented foods like energy bars, breakfast cereals, and gluten-free pasta. More research is needed, however, to thoroughly investigate its dietary potential and compatibility with other components.

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience.

The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team's clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.

Hepatitis E Virus (HEV) Infection in Hemodialysis Patients: A Multicenter Epidemiological Cohort Study in North-Eastern Greece.

Hepatitis E virus (HEV), a common cause of viral hepatitis in developing countries, is mainly transmitted via the fecal-oral route, but also may be a prevalent hospital-transmitted agent among patients on regular hemodialysis due to parenteral transmission. Previous epidemiological studies among hemodialysis patients in Greece, using different diagnostic techniques, gave conflicting results. Τhe present study aimed to measure the exposure rate of hemodialysis patients of north-eastern Greece to HEV by estimating the overall seroprevalence, and to identify potential risk factors. Serum samples from all patients attending the hemodialysis centers of north-eastern Greece (n = 6) were tested for the presence of anti-HEV IgG antibodies using a modern and sensitive ELISA (Enzyme-linked Immunosorbent Assay) technique (Wantai). In total, 42 out of 405 hemodialysis patients were positive for anti-HEV IgG (10.4%), while all samples were negative for HEV RNA when tested using nested RT-PCR. HEV seropositivity among hemodialysis patients was significantly associated with area of residence and contact with specific animals (pork, deer). No association was found with religion, gender distribution and hemodialysis duration. This study showed an increased seroprevalence of HEV among hemodialysis patients in Greece. Agricultural or livestock occupation and place of residence seem to be independent factors that increase the risk of HEV infection. In conclusion, HEV infection calls for the regular screening of hemodialysis patients regardless of the hemodialysis duration or clinical symptoms.

Trocar-site hernia repair after laparoscopic surgery: a case report study.

Tracer site hernias (TSHs) are extremely uncommon. There have been only a few cases reported in the literature. Here we report a case of TSH after umbilicus laparoscopic hernia repair procedure. Diagnosis was based on patient symptoms and computed tomography. Patient underwent exploratory laparoscopy followed by laparoscopic hernia repair with mesh. We also provide a mini review of the literature in order to highlight that although rare, this pathology should be included in the differential diagnosis of acute abdomen.

Diagnostic work-up and advancement in the diagnosis of gastroenteropancreatic neuroendocrine neoplasms.

Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms ranging from well-differentiated, slowly growing tumors to poorly differentiated carcinomas. These tumors are generally characterized by indolent course and quite often absence of specific symptoms, thus eluding diagnosis until at an advanced stage. This underscores the importance of establishing a prompt and accurate diagnosis. The gold-standard remains histopathology. This should contain neuroendocrine-specific markers, such as chromogranin A; and also, an estimate of the proliferation by Ki-67 (or MIB-1), which is pivotal for treatment selection and prognostication. Initial work-up involves assessment of serum Chromogranin A and in selected patients gut peptide hormones. More recently, the measurement of multiple NEN-related transcripts, or the detection of circulating tumor cells enhanced our current diagnostic armamentarium and appears to supersede historical serum markers, such as Chromogranin A. Standard imaging procedures include cross-sectional imaging, either computed tomography or magnetic resonance, and are combined with somatostatin receptor scintigraphy. In particular, the advent of 111In-DTPA-octreotide and more recently PET/CT and 68Ga-DOTA-Octreotate scans revolutionized the diagnostic landscape of NENs. Likewise, FDG PET represents an invaluable asset in the management of high-grade neuroendocrine carcinomas. Lastly, endoscopy, either conventional, or more advanced modalities such as endoscopic ultrasound, capsule endoscopy and enteroscopy, are essential for the diagnosis and staging of gastroenteropancreatic neuroendocrine neoplasms and are routinely integrated in clinical practice. The complexity and variability of NENs necessitate the deep understanding of the current diagnostic strategies, which in turn assists in offering optimal patient-tailored treatment. The current review article presents the diagnostic work-up of GEP-NENs and all the recent advances in the field.