Predictive tissue markers in testicular germ cell tumors: Immunohistochemical expression of MLH1 and REV-7 proteins.

PURPOSE: Testicular Germ Cell Tumors (TGCTs) are the most frequent solid malignancies in young adult men. Regardless of differences in their cell of origin, all TGCTs are considered highly curable malignancies. However, approximately 3-5% of all TGCTs do not respond to platinum-based chemotherapies. The purpose of our paper is to investigate whether immunohistochemical expression of MLH1 and REV-7 can be used as predictive tissue markers for TGCTs. MATERIAL AND METHODS: The main demographic and clinicopathological characteristics of 64 male patients with TGCTs who underwent orchiectomy from 2007 to 2022 were retrospectively obtained from two large Oncology Clinics in Greece. Both patients with chemosensitive and chemoresistant disease were included. Immunohistochemical staining for MLH1 and REV-7 proteins was applied in specimens of these patients. RESULTS: 31 seminomas and 33 non-seminomas were included. 48 patients had chemosensitive disease, while 16 had chemoresistant disease. 53 specimens showed preserved MLH1 expression, while 11 specimens had lost MLH1 expression. Expression of MLH1 was only significantly associated with patients' age. 16 specimens showed positive REV-7 expression, while 48 specimens were REV-7 negative. Interestingly, 50% of patients with chemoresistant disease and 16,7% of patients with chemosensitive disease were REV-7 positive. This difference was statistically significant. Moreover, REV-7 positivity was significantly associated with chemoresistance, various clinicopathological parameters and patients' prognosis and survival. CONCLUSION: Loss of MLH1 expression was only found to be significantly associated with lower patients' age. Positive immunohistochemical REV-7 expression was significantly associated with various clinicopathological parameters, while it was also associated with significantly lower survival and greater hazard. REV-7 positive percentages were significantly higher in patients with chemoresistant disease. Our findings imply that immunohistochemical staining for REV-7 could potentially be used as a predictive tissue marker for TGCT tumors. Moreover, targeting of REV-7 protein, could represent a potential therapeutic strategy for chemoresistant TGCT cases. The implementation of well-designed studies on a larger scale is of utmost importance, in order to draw safer conclusions. Additional studies are needed so as to draw safer conclusions.

Endocervical crypt involvement by high-grade cervical intraepithelial neoplasia and its association with high-grade histopathological recurrence after cervical excision in women with negative excision margins: a systematic review and meta-analysis.

BACKGROUND: There is a growing body of evidence suggesting that endocervical crypt involvement by high-grade cervical intraepithelial neoplasia (CIN) may represent a risk factor for disease recurrence after cervical treatment. OBJECTIVES: To provide a systematic review and meta-analysis on whether endocervical crypt involvement by high-grade CIN on the excised cervical specimen is associated with high-grade histopathological recurrence during the follow-up of women after cervical excisional treatment. SEARCH STRATEGY: We searched the Medline, Scopus, Central, and Clinical Trials.gov databases from inception till May 2023. SELECTION CRITERIA: Studies that reported on women with a single cervical treatment with any method of excision for CIN2 or CIN3 lesion, negative excision margins, and whose recurrence was defined histopathologically were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently evaluated study eligibility. We used the fixed effects model for meta-analysis. MAIN RESULTS: There were 4 eligible studies included in the present systematic review that evaluated 1088 women treated with either large loop excision of the transformation zone (LLETZ) or with cold knife conization (CKC). We found no significant association of endocervical crypt involvement by CIN2-3 with high-grade histopathological recurrence at follow-up after cervical excision (OR 1.93; 95% CI 0.51-3.35). The subgroup analysis of women with LLETZ cervical excision showed again no significant association with high-grade histopathological recurrence at follow-up (OR 2.00; 95% CI 0.26-3.74). CONCLUSION: Endocervical crypt involvement by high-grade CIN does not seem to be a risk factor for high-grade histopathological recurrence after cervical excision with negative excision margins.

Perceptions and attitudes of people with severe mental disorders towards smoking in Greece.

Despite its significant decline in the general population, smoking remains endemic and highly prevalent among people with mental disorders. The impact of smoking-attributable morbidity on life expectancy is significant since, in comparison to the general population, people with severe mental disorders have a 15-20-year reduction in life expectancy. A cross-sectional study was conducted among 1015 people with mental disorders through personal interviews. The questionnaire was designed to examine these patients' knowledge, perceptions, and attitudes towards smoking. Individuals were recruited from the mental health residential community services, the outpatient department, and the inpatient facilities of the Psychiatric Hospital of Attica. Statistical analysis was performed using SPSS 26.0. In the sample analyzed, the current-smoking prevalence stood at 68.4% (n=643), while 12.3% reported being former smokers. A staggering 86.3% smoked their first cigarette within 30 minutes of waking up, indicating a high level of dependence. Most of the former smokers (83.6%) reported that their main reason for quitting smoking was to improve their health, and the overwhelming majority (97.4%) had done so using no smoking cessation aid. Although slightly over half of the participants (53.7%) believed that health professionals adequately inform smokers about the harmful health effects of tobacco products, the information provided by health professionals on smoking cessation programs and tobacco harm reduction alternatives was considered sufficient by a mere 11.2%. Multiple logistic regression analysis demonstrated that outpatients tended to have a greater likelihood of being current smokers as compared to inpatients (OR=1.45), while users of mental health residential community services showed a significantly lower likelihood of being current smokers in comparison to inpatients (OR=0.49). Additionally, it was found that women had a lower likelihood of being current smokers compared to men (OR=0.51), while divorced/ widowed participants had a greater likelihood of being current smokers compared to single ones (OR=1.93). Finally, multiple regression analysis indicated that participants with psychotic disorders displayed a 2.39 times greater likelihood of being current smokers compared to those with mood disorders (OR=2.39). Understanding the knowledge, beliefs, and attitudes of people with mental disorders towards tobacco is an essential first step to confronting this neglected epidemic.

A standardized nutraceutical supplement contributes to pain relief, improves quality of life and regulates inflammation in knee osteoarthritis patients; A randomized clinical trial.

Osteoarthritis (OA) is a degenerative disease of the joints that affects greatly the elderly population and the health care systems and is on the increase due to aging and obesity. Interventions aim at palliative care and pharmaceutical therapies entail serious adverse events. Whereas polyphenols constitute a promising holistic approach in the arsenal of physicians, trials investigating biomarkers and questionnaires are scarce. As such, a randomized controlled trial (RCT) was conducted to evaluate the potency of a standardized polyphenolic supplement in the management of systemic inflammation, oxidative stress, pain and general quality of life (QoL) in patients with osteoarthritis. Sixty subjects were randomized to receive either a polyphenol supplement (curcuma phospholipid, rosemary extract, resveratrol, ascorbic acid), or an active comparator (ascorbic acid) twice, daily for 12 weeks. The group that received the polyphenols exhibited significantly lower symptoms of pain and improved physical function and QoL as it was depicted by validated questionnaires, compared to the control group. Furthermore, post intervention, inflammation was restrained in the polyphenol group. Since systemic inflammation promotes local inflammation, the decrease of pain herein might be attributed to the attenuation of systemic inflammation by the polyphenols.

Chios mastiha essential oil exhibits antihypertensive, hypolipidemic and anti-obesity effects in metabolically unhealthy adults - a randomized controlled trial.

The essential oil of the resinous exudate from Pistacia lentiscus of Chios namely Chios Mastiha Essential Oil (CMEO), is a natural volatile oil rich in monoterpenes α-pinene, ß-myrcene, ß-pinene. In the present randomized controlled trial, we investigated the effects of CMEO on individuals with abdominal obesity and metabolic abnormalities i.e., dyslipidemia, hypertension, insulin resistance. Eligible patients (N = 94) were randomly assigned to either the intervention group, receiving capsules containing 200 mg of CMEO daily for 3 months adjunct to current treatment for metabolic disorder(s), or the control group. Anthropometric measurements, blood markers, and quality of life (QoL) were assessed. Statistical analysis was performed on an intention-to-treat basis. A significant improvement in blood lipid profile, namely triglycerides (p = 0.026) and low-density lipoprotein (p = 0.05) of the CMEO group versus controls was observed. Systolic blood pressure (p = 0.05) and alanine aminotransferase (p = 0.022) significantly decreased only after CMEO intake. Alike, weight decreased only in CMEO (p = 0.02), while mean changes in % body fat (p = 0.005) and visceral fat (p = 0.045) were significantly different between groups post-intervention. Lower oxidized LDL (p = 0.044) and higher adiponectin (p = 0.007) were recorded in CMEO with significant different mean changes between groups post-intervention. QoL, as assessed by Short Form-12 questionnaire was improved in the CMEO compared to control (p = 0.041 for Physical Composite Score, p = 0.035 for Mental Composite Score). No adverse effects were reported. An anti-obesity effect of CMEO, probably attributed to modulation of inflammatory and antioxidant processes, is suggested. Conclusively, CMEO can be safe and effective in regulating metabolic abnormalities, adjunct to treatment. (ClinicalTrials.gov. The effect of Mastiha oil in Metabolic Syndrome, ID Number: NCT04785573).

Primary Health Care: Our Experience From an Urban Primary Health Care Center in Greece.

This observational study reported patient data derived from the emergency files of a primary health care (PHC) center in Greece, with the aim of providing potential solutions for a well-organized, well-structured, and effective social healthcare system. This series was conducted at a single urban PHC center in Greece between August 2017 and March 2020. A total of 83,592 patient visits were registered. The mean patient age was 42.5 years (range: three months to 93 years). Demographics, presenting complaints, and the need for patients who visited the healthcare center to be referred to tertiary hospitals were examined. Further perspectives and future strategies to strengthen the national PHC system were addressed. The most common reasons for visits were pathological (33.6%), followed by general surgery (21.2%) and orthopedics (18.1%). Pediatric conditions accounted for 12% of visits, cardiological conditions accounted for 8.6%, and dental problems accounted for 6.8%. The majority of the patients (n = 81,317, 97.3%) were managed within the health center, and only 2.7% of cases (n = 2275) needed to be referred to a secondary or tertiary healthcare structure. Reasons for patient referral included the severity or complexity of the patient's situation, lack of a specific medical specialty, and the unavailability of overnight laboratory tests. The PHC center remains the cornerstone of a high-quality healthcare system. A well-structured PHC unit can improve health outcomes and decongest secondary and tertiary health care.

Systematic review of sample size calculations and reporting in randomized controlled trials in ophthalmology over a 20-year period.

PURPOSE: Randomized Controlled Trials (RCTs) are considered the gold standard for the practice of evidence-based medicine. The purpose of this study is to systematically assess the reporting of sample size calculations in ophthalmology RCTs in 5 leading journals over a 20-year period. Reviewing sample size calculations in ophthalmology RCTs will shed light on the methodological quality of RCTs and, by extension, on the validity of published results. METHODS: The MEDLINE database was searched to identify full reports of RCTs in the journals Ophthalmology, JAMA Ophthalmology, American Journal of Ophthalmology, Investigative Ophthalmology and Visual Science, and British Journal of Ophthalmology between January and December of the years 2000, 2010 and 2020. Screening identified 559 articles out of which 289 met the inclusion criteria for this systematic review. Data regarding sample size calculation reporting and trial characteristics was extracted for each trial by independent investigators. RESULTS: In 2020, 77.9% of the RCTs reported sample size calculations as compared with 37% in 2000 (p < 0.001) and 60.7% in 2010 (p = 0.012). Studies reporting all necessary parameters for sample size recalculation increased significantly from 17.2% in 2000 to 39.3% in 2010 and 43.0% in 2020 (p < 0.001). Reporting of funding was greater in 2020 (98.8%) compared with 2010 (89.3%) and 2000 (53.1%). Registration in a clinical trials database occurred more frequently in 2020 (94.2%) compared to 2000 (1.2%; p < 0.001) and 2010 (68%; p < 0.001). In 2020, 38.4% of studies reported different sample sizes in the online registry from the published article. Overall, the most studied area in 2000 was glaucoma (29.6% of RCTs), whereas in 2010 and 2020, it was retina (40.2 and 37.2% of the RCTs, respectively). The number of patients enrolled in a study and the number of eyes studied was significantly greater in 2020 compared to 2000 and 2010 (p < 0.001). CONCLUSION: Sample size calculation reporting in ophthalmology RCTs has improved significantly between the years 2000 and 2020 and is comparable to other fields in medicine. However, reporting of certain parameters remains inconsistent with current publication guidelines.

Outcomes of Combined Penetrating Keratoplasty and Limbal Stem Cell Transplantation: A Meta-Analysis on Simultaneous Versus Sequential Surgery.

PURPOSE: The objective of this study is to perform a systematic review and meta-analysis of the published studies on limbal stem cell transplantation (LSCT) combined with penetrating keratoplasty (PK) performed either simultaneously or sequentially. METHODS: An extensive search was conducted in the MEDLINE and Google Scholar databases. Prospective and retrospective trials and case series reporting on the outcomes of LSCT with PK were included. Primary outcomes were the stability of the ocular surface and the rejection and/or failure of the corneal graft. RESULTS: A total of 209 eyes from 13 studies were included in the simultaneous group and 489 eyes from 33 studies in the sequential group. Ocular surface stability was 88% [95% confidence interval (CI), 79%-96%] for sequential cases and 64% (95% CI, 43%-82%) for simultaneous cases ( P = 0.001). The graft failure rate was 15% (95% CI, 6%-26%) for sequential cases and 44% (95% CI, 31%-58%) for simultaneous cases ( P < 0.001). For cases performed sequentially, subgroup analysis revealed a stable ocular surface in 97% (95% CI, 91%-100%) of autograft cases and 63% (95% CI, 45%-80%) of allograft cases ( P < 0.001). The graft failure rate in sequential cases was 7% (95% CI, 0%-18%) for autografts and 34% (95% CI, 18%-52%) for allografts ( P < 0.001). CONCLUSIONS: Sequential LSCT followed by PK demonstrated superior results in terms of ocular surface stability and graft retention compared with simultaneous LSCT and PK. Limbal stem cells of autologous origin fare better than allogeneic ones in sequential cases.

Dietary Patterns and Nutritional Value in Non-Communicable Diseases.

Non-communicable diseases (NCDs) constitute the leading cause of mortality worldwide, with the four major contributors being cardiovascular diseases (CVDs), cancers, respiratory diseases, and diabetes [...].

Knowledge and Perceptions of Greek Students about Human Papilloma Virus, Vaccination and Cervical Cancer Screening.

INTRODUCTION: Human papillomavirus (HPV) is the main cause of cervical cancer; the level of HPV-related knowledge among young students remains however questionable. The purpose of the present study was to investigate knowledge pertaining to HPV, cervical cancer screening, and vaccination among students in the Nursing Department and Department of Social Work of the Hellenic Mediterranean University of Crete, Greece. METHODS: This was a questionnaire-based, cross-sectional study involving 371 first-year and third-year students of the two Departments. Multivariate linear and logistic regression analysis was performed to examine factors associated with knowledge related to HPV, cervical cancer screening, and HPV vaccination. RESULTS: Only 22.1% of students knew all the ways of HPV transmission and only 5.9% knew the whole spectrum of cancers that HPV could cause. The vaccination rate for HPV was 33.7%. The majority of students used the Internet as the main source of information (62.3%). Students' sociodemographic characteristics, including age, marital status, and Department of studies were associated with knowledge about HPV. CONCLUSIONS: The present study highlights knowledge gaps and indicates the need for thorough health education strategies on HPV, targeting families and young people.

Automated Analysis vs. Expert Reading in Nuclear Cardiology: Correlations with the Angiographic Score.

Background and Objectives: Myocardial perfusion imaging (MPI) has an important role in the non-invasive investigation of coronary artery disease. The interpretation of MPI studies is mainly based on the visual evaluation of the reconstructed images, while automated quantitation methods may add useful data for each patient. However, little evidence is currently available regarding the actual incremental clinical diagnostic performance of automated MPI analysis. In the present study, we aimed to assess the correlation between automated measurements of Summed Stress Score (SSS), Summed Rest Score (SRS) and Summed Difference Score (SDS), with the corresponding expert reading values, using coronary angiography as the gold standard. Materials and Methods: The study was conducted at the Nuclear Medicine Laboratory of the University Hospital of Larissa, Larissa, Greece, οver an one-year period (January 2019-January 2020). 306 patients, with known or suspected coronary artery disease, were enrolled in the study. Each participant underwent a coronary angiography, prior to or after the scintigraphic study (within a three-month period). Either symptom-limited treadmill test, or pharmacologic testing using adenosine or regadenoson, was performed in all participants, and the scintigraphic studies were carried out using technetium 99m (99mTc) tetrofosmin (one-day stress/rest protocol). Coronary angiographies were scored according to a 4-point scoring system (angiographic score; O: normal study, 1: one-vessel disease, 2: two-vessel disease, 3: three-vessel disease). Moreover, automated measurements of SSS, SRS and SDS were derived by three widely available software packages (Emory Cardiac Toolbox, Myovation, Quantitative Perfusion SPECT). Results: Interclass Correlation Coefficients of SSS, SRS and SDS between expert reading and software packages were moderate to excellent. Visually defined SSS, SRS and SDS were significantly correlated with the corresponding results of all software packages. However, visually defined SSS, SRS and SDS were more strongly correlated with the angiographic score, indicating a better performance of expert reading when compared to automated analysis. Conclusions: Based on our results, visual evaluation continues to have a crucial role for the interpretation of MPI images. Software packages can provide automated measurements of several parameters, particularly contributing to the investigation of cases with ambiguous scintigraphic findings.

Ovarian cancer: 20-year experience with cytoreductive surgery and perioperative intraperitoneal chemotherapy.

PURPOSE: Complete cytoreduction has been established as the most significant factor of long-term survival in epithelial ovarian cancer. Perioperative intraperitoneal chemotherapy has been added in the treatment of ovarian cancer the last 20 years. The purpose of the study was to determine the outcome of women with ovarian cancer using the data of one surgical team. METHODS: Women with ovarian cancer treated from 2000 to 2019 by the same surgical team were enrolled in the study. The patients underwent cytoreductive surgery combined with perioperative intraperitoneal chemotherapy. Clinical and histopathological variables were correlated to hospital mortality, morbidity, survival and recurrences. RESULTS: The mean age of 350 women was 59.5+11.7 years. The hospital mortality and morbidity rate were 2.0% and 28.3%, respectively. Complete cytoreduction was possible in 60% of the cases. The overall 5- and 10-year survival rate was 47% and 39%, respectively. The prognostic variables of survival were the extent of peritoneal malignancy, the extent of previous surgery, the grade of differentiation, the use of adjuvant chemotherapy, the lymphadenectomy of the resected large bowel, and the postoperative morbidity. The recurrence rate was 45.7%. The extent of peritoneal carcinomatosis, the extent of previous surgery, and the grade of differentiation were the prognostic variables of recurrence. CONCLUSIONS: The limited extent of peritoneal carcinomatosis in women with well differentiated ovarian cancer that do not have history of previous surgery, who undergo standard pelvic peritonectomy procedure, and receive adjuvant chemotherapy are expected to be long-term survivors.

Quitting behaviours and cessation methods used in eight European Countries in 2018: findings from the EUREST-PLUS ITC Europe Surveys.

BACKGROUND: We examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain). METHODS: Cross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain-2018), the ITC Netherlands Survey (the Netherlands-late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England-2018). Logistic regression was used to examine associations between smokers' characteristics and recent quit attempts. RESULTS: Quit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56-84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult. CONCLUSIONS: Apart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts.

Αdnexal cystic lymphangiomas in patients with massive leiomyomatous uterus: a not so uncommon finding on pelvic MRI.

PURPOSE: To investigate any association between the presence of an adnexal cystic lymphangioma (ACL) and an enlarged leiomyomatous uterus. METHODS: A retrospective observational study was conducted by two expert radiologists using a 10-year MRI database (2008-2018); 85 patients (mean age: 45.5 years ± 10.9) were considered eligible due to the presence of a single (n = 31) or multiple (n = 54) leiomyomas causing distortion of the uterine contour and uterine enlargement. The association of specific leiomyoma features (longest diameter (Dmax), location, number) and uterine volume with the presence of ACL was statistically tested. Diagnosis of ACL was based on typical imaging features (n = 14) and intraoperative/histological findings (n = 3). RESULTS: ACL (unilateral = 9, bilateral = 8) was recorded in 17/85 (20%) of patients; it was more frequently observed when the largest leiomyoma was located in the uterine fundus (33.3%). Patients with ACL had significantly more leiomyomas (median: 5 vs. 2, p = 0.043), greater Dmax of largest leiomyoma (median: 13.3 vs. 7.2 cm, p < 0.001), and larger uterine volumes (median: 676.7 vs. 223.1 cm3, p < 0.001) compared to patients without ACL. ROC curve analysis for a number of leiomyomas showed that the optimal cut-off for the prediction of ACL was the presence of 5 leiomyomas with 53.8% sensitivity and 84% specificity (AUC = 0.65, 95% CI 0.51-0.83, p = 0.049), Dmax of largest leiomyoma 9.1 cm with 76.5% sensitivity and 77.9% specificity (AUC = 0.83, 95% CI 0.73-0.94, p < 0.001), and uterine volume 311 cm3 with 71% sensitivity and 75% specificity (AUC = 0.79, 95% CI 0.66-0.92, p < 0.001). CONCLUSIONS: The presence of ACL is significantly associated with number of leiomyomas, Dmax of largest leiomyoma, and uterine volume; prospective evaluation of our results is needed to investigate its clinical significance.

Passive exposure of non-smokers to E-Cigarette aerosols: Sensory irritation, timing and association with volatile organic compounds.

AIM: The current study examined symptoms of irritation reported by non-smokers passively exposed to e-cigarette aerosols and their timing and association with the concentrations of volatile organic compounds (VOCs) produced. METHODS: 40 healthy non-smoking adults were exposed to e-cigarette aerosols for 30 min in a 35 m3 room. Second-hand e-cigarette aerosol (SHA) was produced by an experienced e-cigarette user using a standardized topography and two resistance settings (exposure 0.5 Ohm and 1.5 Ohm), in addition to a control session (no emissions). PM2.5 and PM1.0 were continuously measured over the duration of exposure, while Volatile Organic Compounds (VOCs) were recorded at 0, 15 and 30 min (t0, t15 and t30) of exposure. Each participant completed an irritation questionnaire at t0, t15, t30 of exposure and t60 (30 min post-exposure) on ocular, nasal, throat-respiratory symptoms of irritation and general complaints. Kruskal-Wallis H test for PM comparisons, repeated measures ANOVA for VOCs and Generalized Estimating Equations for symptoms of irritation and association with VOCs were used for statistical analysis. RESULTS: 20 males and 20 females, with a mean age of 24.6 years (SD = 4.3) and exhaled CO < 7 ppm participated. PM concentrations in both experimental sessions were higher than the Control (p < 0.001). The most commonly reported symptoms were burning, dryness, sore throat, cough, breathlessness and headache. During both experimental sessions, ocular, nasal, throat-respiratory symptoms and general complaints increased significantly (p < 0.05). Ocular and nasal symptoms returned to baseline by t60 (p > 0.05) while throat-respiratory symptoms were still significantly higher at t60 (p = 0.044). VOCs were significantly associated with reported nasal and throat-respiratory symptoms in both experimental sessions (p < 0.05). CONCLUSION: A 30-min exposure to SHA provoked symptoms of sensory irritation and general complaints that lasted up to 30 min after the exposure and were positively associated with the concentrations of the VOC mixture emitted.

The effect of prenatal maternal physical activity and lifestyle in perinatal outcome: results from a Greek study.

BACKGROUND: Several maternal characteristics, including lifestyle, have been associated with perinatal outcomes and birth anthropometric characteristics of the offspring. This study aimed to identify whether physical activity (PA) and other lifestyle parameters of the mother are associated with the pregnancy outcomes or with the infant's birth anthropometric characteristics. METHODS: Participants were recruited in Mitera Maternity Hospital, Athens, Greece. Socio-demographic, medical history and anthropometric assessment took place. PA during pregnancy was assessed with the Pregnancy Physical Activity Questionnaire. Dietary assessment was conducted with the Food Frequency Questionnaire and adherence to the Mediterranean diet was evaluated with the MedDiet score. Birth weight and gestational age data were also collected. RESULTS: Sedentary-intensity activity scores increased with increased educational level, while moderate-intensity activity scores decreased with increased educational level. Pregnant women who delivered large for gestational age infants had lower sports activity score. Higher vigorous and sports activity score was demonstrated in cases with a vaginal delivery compared with caesarean section. PA score was significantly and positively correlated with several nutrient intakes and PA was higher in women with a healthier nutritional pattern. Increased MedDiet scores were found in mothers with increased educational level. CONCLUSIONS: Overall, PA was higher in women with a healthier nutritional pattern. An increased vs. a low activity level during pregnancy is positively associated with vaginal delivery and with the size of the offspring.

Longitudinal changes of right ventricular deformation mechanics during trastuzumab therapy in breast cancer patients.

BACKGROUND: Trastuzumab improves dramatically the prognosis of HER2-positive breast cancer patients, but it may lead to cardiotoxicity with left ventricular (LV) systolic dysfunction. Its effects on right ventricular (RV) function have not however been elucidated. We sought to assess LV and RV deformation mechanics during treatment with trastuzumab in breast cancer patients. METHODS AND RESULTS: We studied 101 consecutive women (mean age 54.3 ± 11.4 years) receiving trastuzumab for 12 months; 62 of them (61.4%) had previously received anthracyclines and 26 (25.7%) were receiving taxanes concurrently with trastuzumab. Comprehensive two-dimensional echocardiography with speckle tracking imaging of LV and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) analyses were performed at baseline and every 3 months up to treatment completion. Cardiotoxicity was defined as a decrease of baseline LV ejection fraction > 10 percentage units to a value < 50%. At 3 months, only LV GLS was significantly reduced (-19.5 ± 2.7 to -18.7 ± 2.8, P = 0.0410), while at 6 months, LV GLS, RV GLS and RV FWLS had significantly declined reaching their lowest values (-17.9 ± 6.1, P = 0.002, -19.6 ± 5.2, P = 0.003 and -19.7 ± 5.6, P = 0.004, respectively). Ten women (9.9%) developed cardiotoxicity. A RV GLS percent change of -14.8% predicted cardiotoxicity with 66.7% sensitivity and 70.8% specificity (area under the curve 0.68, 95% confidence interval 0.54-0.81), classifying correctly 90% of women with cardiotoxicity. This cut-off is quite similar to the 15% change of LV GLS previously suggested as predictive of cardiotoxicity. CONCLUSIONS: Deformation mechanics of both the left and right ventricle follow similar temporal pattern and degree of impairment during trastuzumab therapy, confirming the global and uniform effect of trastuzumab on myocardial function.

Plasma free amino acid profile in quiescent Inflammatory Bowel Disease patients orally administered with Mastiha (Pistacia lentiscus); a randomised clinical trial.

BACKGROUND: Natural products have been studied regarding their effectiveness on Inflammatory Bowel Disease (IBD). HYPOTHESIS/PURPOSE: To examine the effects of Mastiha (Pistacia lentiscus var. Chia) on clinical course and amino acid (AA) profile of patients in remission. STUDY DESIGN: This is a randomised, double-blind, placebo-controlled clinical trial. METHODS: Patients (n = 68) were randomly allocated to Mastiha (2.8  g/day) or placebo adjunct to stable medication. Free AAs were identified applying Gas Chromatography-Mass Spectrometry in plasma. Medical-dietary history, Inflammatory Bowel Disease Questionnaire, Harvey-Bradshaw Index, Partial Mayo Score, biochemical, faecal and blood inflammatory markers were assessed. Primary endpoint was the clinical relapse rate at 6 months. Secondary endpoints included variations in free AAs, inflammatory biomarkers and quality of life. Statistical significance was set at 0.05. RESULTS: Concerning AAs and biochemical data, alanine (p = 0.006), valine (p = 0.047), proline (p = 0.022), glutamine (p < 0.001) and tyrosine (p = 0.043) along with total cholesterol (p = 0.032) and LDL cholesterol (p = 0.045) increased only in placebo group compared with baseline and the change between the study groups was significantly different. Inflammatory markers had not a significantly different change between the two groups, even serum IL-6, faecal calprotectin and faecal lactoferrin increased only in the placebo group. Although Mastiha was not proven superior to placebo in remission rate (17.6% vs. 23.5%, p = 0.549), attenuation in increase of free AAs levels in verum group is reported. CONCLUSION: Mastiha inhibited an increase in plasma free AAs seen in patients with quiescent IBD. Since change of AAs is considered an early prognostic marker of disease activity, this indicates a potential role of Mastiha in remission maintenance.

Corrigendum: Patterns of tobacco use, quit attempts, readiness to quit and self-efficacy among smokers with anxiety or depression: Findings among six countries of the EUREST-PLUS ITC Europe Surveys.

[This corrects the article DOI: 10.18332/tid/98965.].

Antioxidative Efficacy of a Pistacia Lentiscus Supplement and Its Effect on the Plasma Amino Acid Profile in Inflammatory Bowel Disease: A Randomised, Double-Blind, Placebo-Controlled Trial.

Oxidative stress is present in patients with Inflammatory Bowel Disease (IBD), and natural supplements with antioxidant properties have been investigated as a non-pharmacological approach. The objective of the present study was to assess the effects of a natural Pistacia lentiscus (PL) supplement on oxidative stress biomarkers and to characterise the plasma-free amino acid (AA) profiles of patients with active IBD (Crohn's disease (CD) N = 40, ulcerative colitis (UC) N = 20). The activity was determined according to 5 ≤ Harvey Bradshaw Index ≤ 16 or 2 ≤ Partial Mayo Score ≤ 6. This is a randomised, double-blind, placebo-controlled clinical trial. IBD patients (N = 60) were randomly allocated to PL (2.8 g/day) or to placebo for 3 months being under no treatment (N = 21) or under stable medical treatment (mesalamine N = 24, azathioprine N = 14, and corticosteroids N = 23) that was either single medication (N = 22) or combined medication (N = 17). Plasma oxidised, low-density lipoprotein (oxLDL), total serum oxidisability, and serum uric acid were evaluated at baseline and follow-up. OxLDL/LDL and oxLDL/High-Density Lipoprotein (HDL) ratios were calculated. The plasma-free AA profile was determined by applying a gas chromatography/mass spectrometry analysis. oxLDL (p = 0.031), oxLDL/HDL (p = 0.020), and oxLDL/LDL (p = 0.005) decreased significantly in the intervention group. The mean change differed significantly in CD between groups for oxLDL/LDL (p = 0.01), and, in the total sample, both oxLDL/LDL (p = 0.015) and oxLDL/HDL (p = 0.044) differed significantly. Several changes were reported in AA levels. PL ameliorated a decrease in plasma-free AAs seen in patients with UC taking placebo. In conclusion, this intervention resulted in favourable changes in oxidative stress biomarkers in active IBD.