Optimizing the Functional Properties of Starch-Based Biodegradable Films.

A definitive screening design was used in order to evaluate the effects of starch, glycerol and montmorillonite (MMT) concentrations, as well as the drying temperature, drying tray type and starch species, on packaging film's functional properties. Optimization showed that in order to obtain films with the minimum possible thickness, the maximum elongation at break, the maximum tensile strength, as well as reduced water vapor permeability and low opacity, a combination of factors should be used as follows: 5.5% wt starch concentration, 30% wt glycerol concentration on a dry starch basis, 10.5% wt MMT concentration on a dry starch basis, 45 °C drying temperature, chickpea as the starch species and plexiglass as the drying tray type. Based on these results, starch films were prepared, and fresh minced meat was stored in them for 3 days. It was shown that the incorporation of MMT at 10.5% wt on a dry starch basis in the packaging films led to a decreased mesophilic and psychrotrophic bacteria growth factor compared to commercial packaging. When assessed for their biodegradability, the starch films disintegrated after 10 days of thermophilic incubation under simulated composting conditions. Finally, to prove their handling capability during industrial production, the starch films were rewound in a paper cylinder using an industrial-scale rewinding machine.

Immunotherapy and Chemotherapy Versus Sleep Disturbances for NSCLC Patients.

INTRODUCTION: Cancer patients are known to experience sleep disturbances that differ between disease stages and treatments. Regarding lung cancer patients and immunotherapy, information on their sleep disturbances has been recently acquired, but no comparison has been made between different treatment modalities. PATIENTS AND METHODS: We recruited 98 non-small cell lung cancer patients; 49 had programmed death-ligand 1 expression of ≥50% and received immunotherapy as first-line treatment and 49 had programmed death-ligand 1 expression in the range from 0-49 and received chemotherapy as first-line treatment. All patients were stage IV, but with no bone metastasis. Sleep disturbances were recorded through polysomnography and sleep questionnaires. RESULTS: For immunotherapy patients with PD-L1 expression ≥ 50%, the disease response was rapid and the sleep disturbances decreased rapidly. On the other hand, for chemotherapy patients, the sleep disturbances remained for all those patients that had partial response and stable disease. It was noticed that chemotherapy drugs induce severe adverse effects. DISCUSSION: In our study, it was observed that patients with complete response had reduced sleep disturbances in the case of immunotherapy patients. However, sleep disturbances continued for several patients in the chemotherapy group due to the adverse effects of chemotherapy drugs. IN CONCLUSION: Immunotherapy drugs on their own do not induce sleep disturbances and, through treatment response, alleviate sleep disturbances in lung cancer patients.

Non-Small-Cell Lung Cancer Immunotherapy and Sleep Characteristics: The Crossroad for Optimal Survival.

INTRODUCTION: Non-small-cell lung cancer is still diagnosed at an inoperable stage and systematic treatment is the only option. Immunotherapy is currently considered to be the tip of the arrow as the first-line treatment for patients with a programmed death-ligand 1 ≥ 50. Sleep is known to be an essential part of our everyday life. PATIENTS AND METHODS: We investigated, upon diagnosis and after nine months, 49 non-small-cell lung cancer patients undergoing immunotherapy treatment with nivolumab and pemprolisumab. A polysomnographic examination was conducted. Moreover, the patients completed the Epworth Sleepiness Scale (ESS), the Pittsburgh Sleep Quality Index (PSQI), the Fatigue Severity Scale (FSS) and the Medical Research Council (MRC) dyspnea scale. RESULTS: Tukey mean-difference plots, summary statistics, and the results of paired t-test of five questionnaire responses in accordance with the PD-L1 test across groups were examined. The results indicated that, upon diagnosis, patients had sleep disturbances which were not associated with brain metastases or their PD-L1 expression status. However, the PD-L1 status and disease control were strongly associated, since a PD-L1 ≥80 improved the disease status within the first 4 months. All data from the sleep questionnaires and polysomnography reports indicated that the majority of patients with a partial response and complete response had their initial sleep disturbances improved. There was no connection between nivolumab or pembrolisumab and sleep disturbances. CONCLUSION: Upon diagnosis, lung cancer patients have sleep disorders such as anxiety, early morning wakening, late sleep onset, prolonged nocturnal waking periods, daytime sleepiness, and unrefreshing sleep. However, these symptoms tend to improve very quickly for patients with a PD-L1 expression ≥80, because disease status improves also very quickly within the first 4 months of treatment.

Radial-EBUS: CryoBiopsy Versus Conventional Biopsy: Time-Sample and C-Arm.

INTRODUCTION: Diagnosis of lung nodules is still under investigation. We use computed tomography scans and positron emission tomography in order to identify their origin. PATIENTS AND METHODS: In our retrospective study, we included 248 patients with a single lung nodule or multiple lung nodules of size ≥1 cm. We used a radial-endobronchial ultrasound and a C-Arm. We used a 1.1 mm cryoprobe versus a 22G needle vs. forceps/brush. We compared the sample size of each biopsy method with the number of cell-block slices. RESULTS: Central lesions indifferent to the method provided the same mean number of cell-block slices (0.04933-0.02410). Cryobiopsies provide less sample size for peripheral lesions due to the higher incidence of pneumothorax (0.04700-0.02296). CONCLUSION: The larger the lesion ≥2 cm, and central, more cell-blocks are produced indifferent to the biopsy method (0.13386-0.02939). The time of the procedure was observed to be less when the C-Arm was used as an additional navigation tool (0.14854-0.00089).

Mediterranean Diet Adherence is Associated with Lower Prevalence of Functional Gastrointestinal Disorders in Children and Adolescents.

Dietary patterns may have a role in the prevention of functional gastrointestinal disorders (FGIDs). The current study aimed at examining the association between FGIDs and adherence to the Mediterranean diet (MD) among elementary school children (ESC), as well as high school students (HSS). In a prospective cohort study, data from 1116 subjects (387 ESC and 448 HSS) aged 6-18 years were collected. FGID identification was based on the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III (QPGS-RIII). Adherence to the MD was assessed using the KIDMED Index. Full data were available on 835/1116 questionnaires. Based on Rome III criteria, 184/835 participants (22%) were identified with FGID (122 (66%) with functional constipation (FC)). The prevalence of FGIDs (p = 0.001) was significantly higher in HSS (13-18 years). The KIDMED score in the cohort was 5.7 ± 2.5. Subjects with FGIDs demonstrated a lower KIDMED score compared to the non-FGID group, both in the cohort, as well as in the ESC and HSS subgroups (FGID vs. non-FGID: p = 0.001, p = 0.007, and p = 0.032, respectively). Multivariate analysis highlighted the KIDMED score as a significant predictor of FGIDs and FC after controlling for the age subgroups. We conclude that good adherence to the MD is associated to lower prevalence of FGIDs, while adolescents display a significantly higher prevalence of FGIDs compared to children.

Screening Olive Leaves from Unexploited Traditional Greek Cultivars for Their Phenolic Antioxidant Dynamic.

Quality characteristics of olive products significantly depend on cultivar (cv), among other factors. In this study, seven traditional, noncommercial Greek cultivars, along with the commercial Spanish Arbequina cv., were examined for the phenolic antioxidant dynamic of their leaves. Polar extracts (aqueous, methanol, and ethanol) were analyzed for Total Phenol (TP), Flavonoid (TFL), Hydroxycinnamic Acid Derivatives (THAD), Flavonol (TFLVN) contents, DPPH radical scavenging ability, and Ferric Reducing Capacity (FRAP). Selective characteristics of olive leaf methanol extracts for all cultivars were re-examined on a second sampling period. Olive leaf is considered a rich source of phenolic antioxidants total phenol content reaching 29.3 ± 1.3, 30.6 ± 0.4, and 27.0 ± 1.1 mg caffeic acid/g dry leaf for aqueous, methanol, and ethanol extracts, respectively) and all cultivars were considered of equal bioactive dynamic. TP data derived from Folin⁻Ciocalteu and another spectrophotometric assay employed presented a high correlation for all examined cases (R² = 71.5⁻86.9%). High correlation (R² = 0.92) was also found between TP and FRAP findings of aqueous extracts. Olive leaf is considered a promising source of phenolic antioxidants irrelevant to cultivar and therefore even cultivars less effective for oil or table olive production could be efficiently exploited for the bioactive dynamic of their leaves.

Roflumilast, a phosphodiesterase-4 inhibitor, induces phagocytic activity in Greek COPD patients.

BACKGROUND: A new approach to the treatment of COPD includes controlling inflammation because of its important role in exacerbation of the disease. Recently, roflumilast has been added as a therapeutic option for COPD. Roflumilast is an oral phosphodiesterase-4 inhibitor that targets inflammatory cells involved in triggering exacerbations of COPD. The objective of the current study was to evaluate roflumilast for its contribution to phagocytic activity in COPD patients. METHODS: Twenty-one patients diagnosed with COPD received roflumilast once daily for 6 months in combination with fluticasone (an inhaled corticosteroid), salmeterol (a long-acting ß2-agonist), and tiotropium (a long-acting muscarinic antagonist) or combinations of these agents. The main inclusion criterion was stable disease for at least the previous 30 days. Neutrophils and spirometric changes, ie, forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), were measured in the COPD patients at indicated time points. The first sample was taken before receiving roflumilast, the second 3 months later, and the third after 6 months. Examination of defective phagocytosis was done by flow cytometry using a FagoFlowEx(®) kit. The statistical analysis was performed using Statistica software. RESULTS: Our results indicate that phagocytic activity was increased after 3 and 6 months of treatment when compared with baseline (P<0.001). Similarly, FVC and FEV1 were also increased during the 6-month period, but only FVC differed significantly from baseline (P<0.001). CONCLUSION: Although the number of patients in this study was limited, our results indicate that roflumilast induces phagocytic activity, which improves lung function.

Assessing the treatment effect in metabolic syndrome without perceptible diabetes (ATTEMPT): a prospective-randomized study in middle aged men and women.

AIM: To assess the reduction in estimated cardiovascular disease (e-CVD) risk after multifactorial treatment for 6 months and follow this change during the next 3-years. PATIENTS-METHODS: This prospective, randomized, target driven study included 1,123 subjects (512/611 men/women, aged 45-65 years) with metabolic syndrome (MetS) without diabetes or CVD referred to specialist outpatient clinics. Patients were randomized to two treatment groups: group A with low density lipoprotein cholesterol (LDL-C) target of < 100 mg/dl and group B with a target of < 130 mg/dl. Atorvastatin was used in both groups on top of optimal multifactorial treatment, (quinapril, amlodipine, hydrochlorothiazide for hypertension, metformin for impaired fasting glucose, and orlistat for obesity). The e-CVD risk was calculated using the Framingham, the PROCAM and Reynold's equations. RESULTS: Reductions in e-CVD risk at 6 months were > 50%in all patients, but were superior in group A and in women. Reductions were even greater during the next 3-years and were mainly attributed to changes in lipid profile. Actual CVD events were 1 in group A and 13 in group B; p=0.0012. CONCLUSIONS: Attaining the treatment target of LDL-C < 100 mg/dl within multifactorial treatment of MetS by expert clinics, is achievable and beneficial even in patients without diabetes or known CVD. This induces a considerable e-CVD risk reduction in MetS patients. Actual CVD events were negligible, suggesting that e-CVD risk overestimates actual CVD risk in MetS, at least in patients achieving LDL-C < 100 mg/dl [ClinicalTrials.gov ID: NCT00416741].

Primary pleomorphic adenoma of the external ear canal. Report of a case and literature review.

INTRODUCTION: Primary neoplasms of the external ear canal are rare, and 5% of these tumors are of glandular origin. Ceruminal glands are modified sweat glands of the skin of the external auditory meatus that may give rise to (a) benign tumors such as ceruminous adenoma, pleomorphic adenoma, and syringocystadenoma papilliferum, and (b) malignant tumors such as ceruminous adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. An alternative theory holds that pleomorphic adenomas may well arise from ectopic salivary tissue present in the external ear canal. These tumors are very rare and usually have a benign course. In this report, we describe an unusual case of pleomorphic adenoma of the external auditory canal associated with chronic infection of the middle ear. CASE REPORT: A 60-year-old woman presented with exacerbation of left otalgia over a 6-month period. She had been affected with chronic otitis media and aural polyps for the last 13 years, for which she had received medical treatment only. A canal-filling aural polyp was noted on clinical examination. Subsequent biopsy and histologic examination revealed pleomorphic adenoma of the external ear canal, possibly with malignant elements. Magnetic resonance imaging showed no intracranial extension or any association with the adjacent parotid gland. The patient underwent modified radical mastoidectomy and complete resection of the tumor and the entire skin of the external auditory canal. Final histology and immunohistochemistry confirmed the absence of malignancy, and no recurrence has been reported 1 year postoperatively. CONCLUSIONS: Pleomorphic adenoma is an extremely rare tumor arising from the ceruminal glands of the external ear canal. Nonspecific presentation and difficult histologic diagnosis characterize this benign neoplasm. Wide local excision is the mainstay of treatment.

Synthesis and characterization of 3D CoPt nanostructures.

Cobalt platinum polypod-like nanostructures were synthesized by thermolytic reduction of Pt(acac)2 and Co(CH3COO)2 in oleylamine at 250 degrees C. The as-made CoPt nanopolypods are ferromagnetic, are soluble in nonpolar organic solvents, and reveal a coercive field of 525 and 1200 Oe at room temperature and 5 K, respectively.

HbO-Arab mutation originated in the Pomak population of Greek Thrace.

HbO-Arab emerged about 2,000 years on a rare haplotype, characteristic of the Greek Pomaks. Its frequency increased as a consequence of high genetic drift within this population, and it was dispersed throughout the Mediterranean basin and Middle East with minor variations of its haplotypic pattern.

Synthesis of CoPt nanoparticles by a modified polyol method: characterization and magnetic properties.

CoPt nanoparticles with an average size of 3 nm and narrow distribution were synthesized by chemical reduction of Co(CH(3)COO)(2) and Pt(acac)(2) by polyethyleneglycol-200. The as-prepared nanoparticles have a disordered fcc structure which transformed after thermal treatment to an ordered fct structure, which results in coercivity up to 6 kOe at room temperature and 9 kOe at 5 K because of the high magnetocrystalline anisotropy of the tetragonal structure [Formula: see text].

Evaluation of various therapeutic schemes in the treatment of tinnitus due to acute acoustic trauma.

OBJECTIVES: We evaluated the effectiveness of various pharmaceutical therapeutic schemes in the treatment of tinnitus due to acute acoustic trauma. PATIENTS AND METHODS: This prospective study included 108 military personnel (all males; mean age 22 years; range 18 to 31 years) with complaints of tinnitus due to acute acoustic trauma following firearm use. Involvement was in the left ear in 61 patients, the right ear in nine patients, and in both ears in 38 patients. The mean duration from trauma to treatment was 26 days (range 1 to 110 days). Before and after treatment, complaints of tinnitus were evaluated using a questionnaire and a visual analog scale. Treatment was carried out for 15 days in four randomized groups: oral administration of trimetazidine, prednisolone, and vitamin B complex; trimetazidine alone; prednisolone and vitamin B complex; and intravenous piracetam and prednisolone. Unresponsive patients were further treated with trimetazidine for a month. Evaluations were made 15 days and 45 days after the institution of treatment. RESULTS: Thirteen patients (12%) had complete remission and 28 patients (25.9%) showed significant improvement. Further treatment with trimetazidine was beneficial in only seven (9.5%) patients. No significant differences were found between the groups in terms of tinnitus remission and improvement in hearing (p>0.05). Initiation of treatment, especially within the first week following acoustic trauma was significantly linked with higher rates of tinnitus regression (p<0.05). The degree of hearing improvement after medication did not correlate with improvement in tinnitus. Intravenous treatment was not advantageous over oral treatment. CONCLUSION: A timely initiation of therapy, especially within the first week following acoustic trauma, increases the chance of improvement in tinnitus patients.

Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumor recurrence?

Pharyngocutaneous fistula is the most common complication (8.7 to 22%) in the immediate postoperative period following total laryngectomy. The study's objective was to determine the incidence of post-laryngectomy fistulas in patients operated on in our department to establish whether specific factors predispose to fistula formation and to determine whether fistulas and tumor recurrence are related. Between 1992 and 2001, 377 cases of laryngeal carcinoma were diagnosed, and the patients underwent total laryngectomy in our department. Of these patients, 291 had total laryngectomy as the primary management of their disease, while in 86 patients the operation treated recurrence of the disease. In 92 patients, total laryngectomy was combined with radical or eclectic neck dissection. The presence of early postoperative fistula was established in 49 of the 377 patients (13%) studied. The cancerous stage, exact localization of the tumor, degree of differentiation, previous irradiation, patient's age, performance or not of neck dissection or emergency tracheostomy and fitting of voice prostheses were all factors that, after statistical analysis, did not appear to significantly influence the incidence of postoperative fistulas. Factors that did show statistical significance were the histological infiltration of the tumor's surgical margins (11% negative vs. 38% with positive margins) and coexisting early complications. Fistula management was conservative in the majority of cases. The necessary closure period for a fistula varied between 5 and 81 days (mean: 29 days). Postoperative follow-up of all patients revealed that fistulas did not influence the incidence of tumor recurrence. The incidence of postoperative fistulas in our study was 13%. Incomplete excision of the tumor and coexisting complications were related, among other things, to a higher rate of fistula formation. The rate of tumor recurrence after total laryngectomy was not related to the presence of a fistula during the postoperative period.

Clays as a host matrix in the synthesis of organic macrocycles.

A new approach for the synthesis of amide macrocycles, based on the use of organo-clay derivatives as controlling template, is proposed as an alternative to the rotaxane method. Dications of p-xylylene diamine inserted in the clay interlayer space act as molding pillars around which neutral diamine molecules are erected via hydrogen bonding and pi-pi interactions to form supramolecular arrays. Condensation of diamines in the supramolecular arrays with diacetyl dichlorides yields various tetramide macrocycles in good yields. Shape, aromaticity and dimensions of the reactants are factors affecting the condensation reaction.

Organoclay Derivatives in the Synthesis of Macrocycles.

As an alternative to the rotaxane method, an organoclay can be used as a template for the efficient formation of macrocycles (ring in schematic representation) which are easily extracted from the clay interlayer space. The four-step synthesis involved preparation of a pillared clay from the dihydrochloride salt of p-xylylenediamine, insertion of neutral p-xylylenediamine into the pillared structure, reaction of the neutral p-xylylenediamine in the layers with isophthaloyl chloride and formation of the tetramide macrocycle, and extraction of the product from the clay.