Colistin Effects on Emphysematous Lung in an LPS-Sepsis Model.

Emphysema is prevalent in various respiratory diseases like Chronic Obstructive Pulmonary Disease (COPD) and cystic fibrosis. Colistin and vasoconstrictive drugs are crucial for treating these patients when diagnosed with sepsis in the ICU. This study examines colistin impact in ether-induced emphysematous septic and non-septic animals, focusing on lung pathophysiology and inflammatory responses, including IL-1ß, TNF-α, AMPK, caspase-3, cyclin-D1, and colistin levels in lung tissue. All animals exhibited significant emphysematous changes, accentuated by LPS-induced septic conditions, validating the emphysema model and highlighting the exacerbating effect of sepsis on lung pathology. Colistin, alone or with vasoconstrictive drugs, stimulated immune responses through increased inflammatory cell infiltration and the presence of lymphocytes, indicating potential immunomodulatory effects. Vasoconstriction did not alter the effects of colistin or sepsis but correlated with increased colistin levels in the lungs of septic animals. These observations suggest a potential interplay between vasoconstrictive drugs and colistin distribution/metabolism, leading to enhanced local concentrations of colistin in the lung microenvironment. The findings suggest the need for further investigations to optimize colistin and vasoconstrictive drug delivery in critically ill patients with lung pathologies. Understanding these complexities may guide more effective management of inflammatory responses and lung pathologies in these critical conditions.

Critical-Illness: Combined Effects of Colistin and Vasoactive Drugs: A Pilot Study.

Colistin is often used as a last resort for treating multidrug-resistant infections, particularly in critically ill patients in intensive care units. Nonetheless, its side effects, including myopathy, require careful monitoring. Vasoconstrictive drugs are also used in intensive care to increase blood pressure and improve blood flow to vital organs, which can be compromised in critically ill patients. The exact mechanism of colistin-induced muscle toxicity is of significant interest due to its potential intensive-care clinical implications. Colistin alone or in combination with vasoconstrictive agents was administrated in non-septic and LPS-induced septic animals for 10 days. Histopathological evaluation of the gastrocnemius muscle and dot-blot protein tissue analysis were performed. Increased intramuscular area, de-organization of the muscle fibers and signs of myopathy were observed in colistin-treated animals. This effect was ameliorated in the presence of vasoconstrictive drugs. Administration of colistin to septic animals resulted in a decrease of AMPK and cyclin-D1 levels, while it had no effect on caspase 3 levels. Vasoconstrictive drugs' administration reversed the effects of colistin on AMPK and cyclin D1 levels. Colistin's effects on muscle depend on septic state and vasoconstriction presence, highlighting the need to consider these factors when administering it in critically ill patients.

Neurorehabilitation: Looking Back and Moving Forward, 1st Edition.

Rehabilitation is "a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment", according to the recent report from the World Health Organization (WHO), released in January 2023 [...].

Quality of Life and Family Support in Critically Ill Patients following ICU Discharge.

BACKGROUND: Following discharge from the intensive care unit (ICU), critically ill patients may present cognitive dysfunction and physical disability. OBJECTIVES: To investigate the quality of life (QoL) of patients following discharge from ICU, physical performance and lung function and to assess the role of support by family members and friends. METHODS: This prospective study was conducted in the University Hospital of Larissa Greece between 2020 and 2021. Patients hospitalized at the ICU for at least 48 h were included and assessed at hospital discharge, at 3 and at 12 months later. The research implements of the study were a dedicated questionnaire and the SF-36 health questionnaire for the appraisal of the QoL. Lung function changes were assessed by spirometry and physical performance by the 6-min walking test (6MWT). RESULTS: One hundred and forty-three participants were included in the study. The mean (SD) of the physical and mental health SF-36 scores at hospital discharge, 3 and 12 months were 27.32 (19.59), 40.97 (26.34) and 50.78 (28.26) (p < 0.0001) and 42.93 (17.00), 55.19 (23.04) and 62.24 (23.66), (p < 0.0001), respectively. The forced expiratory volume in one second and 6MWT significantly improved over 12 months. Patients who were supported by two or more family members or patients who were visited by their friends >3 times/week presented better scores in the physical and mental SF36 domains at 12 months. CONCLUSION: This study shows that the quality of life of Greek patients who were discharged from the ICU can be positively affected both by the support they receive from their family environment and friends.

Objective Measurements of Physical Function to Predict Survival in Patients with Metastatic Cancer.

BACKGROUND/OBJECTIVES: Physician-reported performance status (PS) constitutes the established method for stratifying oncologic patients in therapeutic decision-making. Objective measurements of physical function may further refine prognostication. SUBJECTS/METHODS: In this prospective observational study, 103 patients with metastatic cancer who were referred for systemic therapy initiation were evaluated. PS was evaluated using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) and five objective physical function measurements (handgrip strength [HGS], chair stand test [CST], timed up and go [TUG] test, 4-m gait speed [GS] test, and short physical performance battery [SPPB] test). Overall survival and treatment complications were recorded from the medical records. RESULTS: Patients with low PS according to ECOG-PS (hazard ratio [HR]: 3.80, 95% confidence interval [CI]: 1.84, 7.80), HGS (HR: 2.37, 95% CI: 1.24, 4.55), SPPB (HR: 3.43, 95% CI: 1.55, 7.57), GS (HR: 3.03, 95% CI: 1.44, 6.38), and TUG (HR: 5.16, 95% CI: 2.19, 12.14) had shorter overall survival after adjustment for sex, age, symptomatology, comorbidity, percentage of weight loss, and tumor localization. CONCLUSIONS: Among the studied objective physical function measurements, HGS, SPPB, GS, and TUG were independent predictors of survival in a sample of patients with metastatic cancer, with TUG showing the highest effect size.

EEG in Neurorehabilitation: A Bibliometric Analysis and Content Review.

BACKGROUND: There is increasing interest in the role of EEG in neurorehabilitation. We primarily aimed to identify the knowledge base through highly influential studies. Our secondary aims were to imprint the relevant thematic hotspots, research trends, and social networks within the scientific community. METHODS: We performed an electronic search in Scopus, looking for studies reporting on rehabilitation in patients with neurological disabilities. We used the most influential papers to outline the knowledge base and carried out a word co-occurrence analysis to identify the research hotspots. We also used depicted collaboration networks between universities, authors, and countries after analyzing the cocitations. The results were presented in summary tables, plots, and maps. Finally, a content review based on the top-20 most cited articles completed our study. RESULTS: Our current bibliometric study was based on 874 records from 420 sources. There was vivid research interest in EEG use for neurorehabilitation, with an annual growth rate as high as 14.3%. The most influential paper was the study titled "Brain-computer interfaces, a review" by L.F. Nicolas-Alfonso and J. Gomez-Gill, with 997 citations, followed by "Brain-computer interfaces in neurological rehabilitation" by J. Daly and J.R. Wolpaw (708 citations). The US, Italy, and Germany were among the most productive countries. The research hotspots shifted with time from the use of functional magnetic imaging to EEG-based brain-machine interface, motor imagery, and deep learning. CONCLUSIONS: EEG constitutes the most significant input in brain-computer interfaces (BCIs) and can be successfully used in the neurorehabilitation of patients with stroke symptoms, amyotrophic lateral sclerosis, and traumatic brain and spinal injuries. EEG-based BCI facilitates the training, communication, and control of wheelchair and exoskeletons. However, research is limited to specific scientific groups from developed countries. Evidence is expected to change with the broader availability of BCI and improvement in EEG-filtering algorithms.

Analysis of SOD2 rs4880 Genetic Variant in Patients with Alzheimer's Disease.

A few gene loci that contribute to Alzheimer's Disease (AD) onset have been identified. Few studies have been published about the relationship between SOD2 rs4880 single nucleotide variant and AD, revealing inconsistent results. Therefore, the aim of the current study is to further examine the role of the SOD2 rs4880 in AD. We performed a case-control study with a total of 641 subjects (320 patients with probable AD, and 321 healthy controls). The statistical analysis was performed assuming five genetic models. The threshold for statistical significance was set at 0.05. The results revealed no association between SOD2 rs4880 and AD in any of the assumed genetic models that were examined [log-additive OR = 0.95 (0.76-1.19), over-dominant OR = 1.15 (0.85-1.57), recessive OR = 0.85 (0.59-1.22), dominant OR = 1.03 (0.72-1.47), and co-dominant OR1 = 1.10 (0.75-1.60) and OR2 = 0.90 (0.58-1.40)]. Adjustment for sex and subgroup analyses based on sex did not reveal any statistically significant results either. Based on our findings, SOD2 rs4880 does not appear to play a determining role in the risk of developing AD. Larger studies are warranted to elucidate the connection between rs4880 and AD.

Hospital Agios Dimitrios: The General Public Hospital of Thessaloniki.

The purpose of this article is to highlight the history of Hospital Agios Dimitrios, the General Hospital of Thessaloniki. During the early 20th century, many refugees settled in the Greek city of Thessaloniki. To address the growing public health needs of the city's inhabitants, the Greek government established a health agency to offer medical care and respond to infectious disease outbreaks and epidemics. This initiative resulted in the construction or renovation of various hospitals. The Hospital Agios Dimitrios in Thessaloniki was completed in 1903. Its innovative architecture includes kiosks and wards designed to provide better ventilation and prevent the transmission of infectious diseases.

Lack of an association between SCFD1 rs10139154 polymorphism and amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease. Through a genome­wide association study (GWAS), the Sec1 family domain­containing protein 1 (SCFD1) rs10139154 variant at 14q12 has emerged as a risk factor gene for ALS. Moreover, it has been reported to influence the age at onset (AAO) of patients with ALS. The aim of the present study was to assess the association of the SCFD1 rs10139154 polymorphism with the risk of developing ALS. For this purpose, 155 patients with sporadic ALS and 155 healthy controls were genotyped for the SCFD1 rs10139154. The effect of the SCFD1 rs10139154 polymorphism was then examined on the following parameters: i) The risk of developing ALS; ii) the AAO of ALS; iii) the site of ALS onset (patients with bulbar onset ALS vs. healthy controls; and patients with limb onset ALS vs. healthy controls); and iv) the AAO of ALS onset with subgroup analyses based on the site of onset (bulbar and limb, crude and adjusted for sex). The analysis of all the outcomes was performed assuming five genetic models. Crude and adjusted analyses were applied. The threshold for statistical significance was set at 0.05. The results revealed no association between SCFD1 rs10139154 and any of the examined phenotypes in any of the models examined. On the whole, based on the findings of the present study, SCFD1 rs10139154 does not appear to play a determining role in the risk of developing ALS.

The Individual Rehabilitation Project as the core of person-centered rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists Framework for Rehabilitation in Europe.

To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centered rehabilitation management scheme, in which rehabilitation is generally provided by a multiprofessional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are: 1) to introduce the IRP; and 2) to describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of the action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.

Therapeutic application of rTMS in neurodegenerative and movement disorders: A review.

Transcranial magnetic stimulation (TMS) is a non-invasive form of brain stimulation that makes use of the magnetic field generated when an electric current passes through a magnetic coil placed over the scalp. It can be applied as a single stimulus at a time, in pairs of stimuli, or repetitively in trains of stimuli (repetitive TMS, rTMS). RTMS can induce changes in brain activity, whose after-effects reflect the processes of long-term potentiation and long-term depression, as certain protocols, namely those using low frequencies (≤1 Hz) seem to suppress cortical excitability, while those using high frequencies (>1 Hz) seem to enhance it. It is a technique with very few and mostly mild side-effects, whose effects can persist for long time periods, and as such, it has been studied as a potential treatment option in a multitude of neurodegenerative diseases, including those affecting movement. Although rTMS has received approval as a treatment strategy of only a few aspects in movement disorders in the latest guidelines, its further use seems to also be promising in their context. In this review, we gathered the available literature on the therapeutic application of rTMS in movement disorders, namely Parkinson's disease, Amyotrophic Lateral Sclerosis, Huntington's disease, Dystonia, Tic disorders and Essential Tremor.

Myelin-associated oligodendrocyte basic protein rs616147 polymorphism as a risk factor for Parkinson's disease.

BACKGROUND: The rs616147 polymorphism of the myelin-associated oligodendrocyte basic protein (MOBP) gene locus has been associated with amyotrophic lateral sclerosis (ALS). ALS and Parkinson's disease (PD) are two common neurodegenerative disorders that share features regarding their etiology, pathophysiology, and genetic backgrounds. While the MOBP rs616147 polymorphism has been associated with ALS, little is known about its role in PD. OBJECTIVE: To assess the role of MOBP rs616147 on PD risk. METHODS: This case-control comparison study consists of 358 PD-affected cases and 358 controls from the Neurology Clinic of the University Hospital of Larissa, University of Thessaly, Faculty of Medicine, in Greece. The diagnosis of PD was made by a specialist neurologist according to the UK Parkinson's Disease Society Brain Bank's clinical criteria. All the participants were genotyped for the MOBP rs616147. Furthermore, in order to validate our results, we genotyped 327 patients with Alzheimer's disease (AD) for MOBP rs616147 and compared them with the control group. RESULTS: According to the univariate analysis, there was a significant association between rs616147 and PD in the dominant (OR [95% C.I.] = 0.70 [0.52-0.94], p = .018), the overdominant (OR [95% C.I.] = 0.68 [0.50-0.92], p = .011), and in the codominant (G/A VS G/G; OR [95% C.I.] = 0.66 [0.48-0.91], p = .035) modes of inheritance. In contrast, there was no association between the MOBP rs616147 polymorphism and AD. CONCLUSIONS: We provide preliminary results associating MOBP rs616147 genetic variant with PD.

Repetitive Transcranial Magnetic Stimulation in the Treatment of Alzheimer's Disease and Other Dementias.

Dementia is a debilitating impairment of cognitive functions that affects millions of people worldwide. There are several diseases belonging to the dementia spectrum, most prominently Alzheimer's disease (AD), vascular dementia (VD), Lewy body dementia (LBD) and frontotemporal dementia (FTD). Repetitive transcranial magnetic stimulation (rTMS) is a safe, non-invasive form of brain stimulation that utilizes a magnetic coil to generate an electrical field and induce numerous changes in the brain. It is considered efficacious for the treatment of various neuropsychiatric disorders. In this paper, we review the available studies involving rTMS in the treatment of these dementia types. The majority of studies have involved AD and shown beneficial effects, either as a standalone, or as an add-on to standard-of-care pharmacological treatment and cognitive training. The dorsolateral prefrontal cortex seems to hold a central position in the applied protocols, but several parameters still need to be defined. In addition, rTMS has shown potential in mild cognitive impairment as well. Regarding the remaining dementias, research is still at preliminary phases, and large, randomized studies are currently lacking.

The Anatomy in Greek Iatrosophia during the Ottoman domination era.

The knowledge of Anatomy during the Ottoman domination in Greece has not been widely studied. Medical knowledge of the time can be retrieved from folk and erudite books called Iatrosophia. The majority of these books focused on empirical diagnostics and therapeutics. However, a small quota of these Iatrosophia includes important information about anatomy. The interest in anatomy appears only after the Neohellenic Enlightenment (1750-1821) and has been associated to the scholarly background of the 1821 revolution against the Ottomans. At the same time, anatomy has been discussed by various authors in diverse contexts. All in all, it appears that a consensus on the importance of anatomy has been established among Greek scholars in the late 18th century, leading to the translation of current anatomical knowledge to the contemporary language and literature.

Transcranial magnetic stimulation (TMS) and repetitive TMS in multiple sclerosis.

Multiple sclerosis (MS) is the most well-known autoimmune disorder of the central nervous system, and constitutes a major cause of disability, especially in young individuals. A wide array of pharmacological treatments is available, but they have often been proven to be ineffective in ameliorating disease symptomatology or slowing disease progress. As such, non-invasive and non-pharmacological techniques have been gaining more ground. Transcranial magnetic stimulation (TMS) utilizes the electric field generated by a magnetic coil to stimulate neurons and has been applied, usually paired with electroencephalography, to study the underlying pathophysiology of MS, and in repetitive trains, in the form of repetitive transcranial magnetic stimulation (rTMS), to induce long-lasting changes in neuronal circuits. In this review, we present the available literature on the application of TMS and rTMS in the context of MS, with an emphasis on its therapeutic potential on various clinical aspects, while also naming the ongoing trials, whose results are anticipated in the future.

CD33 rs3865444 as a risk factor for Parkinson's disease.

BACKGROUND: Alzheimer's (AD) and Parkinson's diseases (PD) share a few elements of their clinical, pathological and genetic backgrounds. The CD33 rs3865444 has emerged as a strong genetic locus associated with AD through genome-wide association study (GWAS). However, little is known for its role in PD. OBJECTIVE: To assess the role of CD33 rs3865444 on PD risk. METHODS: We genotyped 358 patients with PD and 358 healthy controls for theCD33 rs3865444. Odds ratios (ORs) with the respective 95% confidence intervals (CIs)], were calculated with the SNPStats software, assuming five genetic models (co-dominant, dominant, recessive, over-dominant and log-additive), with the G allele as the reference allele. RESULTS: The CD33 rs3865444 was associated with decreased PD risk in the dominant [GG vs GT + TT; OR (95% CI) = 0.61 (0.45-0.82), p = 0.001], the over-dominant [GG + TT vs GT; OR (95% CI) = 0.65 (0.48-0.89), p = 0.0061], log-additive [OR (95% CI) = 0.67 (0.52-0.86), p = 0.0014], and co-dominant [with overall p = 0.0043, and OR (95% CI) = 0.62 (0.45-0.84) for the TG genotype compared to the GG], modes of inheritance. CONCLUSIONS: The CD33 rs3865444 is associated with decreased PD risk, and larger studies investigating the role of CD33 rs3865444 on PD are needed.

Intestinal Microbiota in Colorectal Cancer Surgery.

The intestinal microbiota consists of numerous microbial species that collectively interact with the host, playing a crucial role in health and disease. Colorectal cancer is well-known to be related to dysbiotic alterations in intestinal microbiota. It is evident that the microbiota is significantly affected by colorectal surgery in combination with the various perioperative interventions, mainly mechanical bowel preparation and antibiotic prophylaxis. The altered postoperative composition of intestinal microbiota could lead to an enhanced virulence, proliferation of pathogens, and diminishment of beneficial microorganisms resulting in severe complications including anastomotic leakage and surgical site infections. Moreover, the intestinal microbiota could be utilized as a possible biomarker in predicting long-term outcomes after surgical CRC treatment. Understanding the underlying mechanisms of these interactions will further support the establishment of genomic mapping of intestinal microbiota in the management of patients undergoing CRC surgery.

Dimitrios Mavrokordatos Disproving the Hemostatic Myth of Aqua Binelli.

"Aqua Binelli" or "Aqua Balsamica Arterialis" was a hemostatic compound invented by the Italian Fedele Binelli in 1797. Its hemostatic properties were viewed as the solution to treating hemorrhage in cases of wounds and surgical operations. Those who opposed the compound were persuaded of its total lack of effectiveness, supporting the view that hemostasis could be achieved by exerting pressure on, stitching, and ligating a vessel. The publications of Karl Ferdinand von Gräfe, Professor at the University of Berlin and fervent advocate of Aqua Binelli, helped spread the use of the compound in Europe. In 1832, however, one of his students, a young Greek named Dimitrios Mavrokordatos, who became the first Professor of Anatomy and Physiology in the newly established University of Athens in 1837, published in Würzburg his dissertation titled Observations on the Potency of Aqua Binelli (Weitere Nachrichten über das Binellische Wasser), where a completely different picture emerged relating to those applications of the compound that von Gräfe considered successful. The case of Mavrokordatos' dissertation was a typical 19th-century scientific controversy between a young student and his teacher who enjoyed the support of his associates. Eventually, the myth of the hemostatic activity of Aqua Binelli was debunked.

Role of anabolic agents in colorectal carcinogenesis: Myths and realities (Review).

Colorectal cancer (CRC) is one of the four leading causes of cancer­related mortality worldwide. Even though over the past few decades the global scientific community has made tremendous efforts to understand this entity, many questions remain to be raised on this issue and even more to be answered. Epidemiological findings have unveiled numerous environmental and genetic risk factors, each one contributing to a certain degree to the final account of new CRC cases. Moreover, different trends have been revealed regarding the age of onset of CRC between the two sexes. That, in addition to newly introduced therapeutic approaches for various diseases based on androgens, anti­androgens and anabolic hormones has raised some concerns regarding their possible carcinogenic effects or their synergistic potential with other substances/risk factors, predisposing the individual to CRC. Notably, despite the intense research on experimental settings and population studies, the conclusions regarding the majority of anabolic substances are ambiguous. Some of these indicate the carcinogenic properties of testosterone, dihydrotestosterone (DHT), growth hormone and insulin­like growth factor (IGF) and others, demonstrating their neutral nature or even their protective one, as in the case of vitamin D. Thus, the synergistic nature of anabolic substances with other CRC risk factors (such as type 2 diabetes mellitus, metabolic syndrome and smoking) has emerged, suggesting a more holistic approach.

The Innovated "Closed Chest Drainage System" of William Smoult Playfair (1871).

During the 19th century, the addition of the water-seal system to a closed chest drain was a major turning point in the history of thoracic surgery. German physician Gotthard Bülau seems to have invented and used his own closed chest drainage device with a liquid-seal system in 1875, and published it in the year 1891. But, in 1871, British physician William Smoult Playfair seems to have thought of the subaqueous drainage and used such drainage to treat the thoracic empyema in children. The British physician stresses in his texts the effectiveness of his method of fully draining the thoracic empyemas while simultaneously preventing air from entering the pleural cavity. An appropriate honor must be attributed to Playfair, who used a subaqueous chest drainage system and appears to be the first to publish such a method.