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.

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.

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.

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.

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.

Intestinal microbiota and colorectal cancer: a new aspect of research.

Colon holds a complex microbial community, which is crucial for maintaining homeostasis and regulating metabolic functions, supporting the intestinal barrier and controlling immune responses. Previous studies have supported a link between intestinal microbiota and colorectal cancer (CRC). Based on these fndings, the present review analyzed the numerous interactions that occur between microbiota and CRC, starting from the role of intestinal microbiota in colonic homoeostasis. Intestinal microbiota is a cause of CRC and involves various mechanisms such as chronic inflammation, the production of genotoxins causing DNA impairment and/or the biosynthesis of toxic compounds. Moreover, basic metabolic factors such as short-chain fatty acids (SCFAs) and bile acids are included in CRC pathogenesis. Different pathogenic pathways have been reported among different CRC regions (proximal or distal). Variations in the microbial populations are reported between the CRC from these colonic sites, possibly reflecting the bacterial dysbiosis and bioflm distribution. Bowel preparation is essential prior to colonoscopy and surgery; there is, however, minor consensus on the effects of this procedure on intestinal microbiota, notably with regard to the long-term outcomes. With regard to the therapeutic strategy in CRC, the intestinal microbiota is further involved in the modulation of the host response to chemotherapeutic agents (5-fluorouracil and irinotecan) by the interference with drug efcacy and by adverse effects and associated toxicity. In addition, the newly emerged research on CRC immunotherapy reveals an important interplay between intestinal microbiota and the immune system, which includes the possibility of targeting microbiota for the enhancement of anticancer treatment. Additional studies will further clarify the interaction between microbiota and CRC, resulting in the development of alternative therapeutic strategies by manipulating microbiota composition.

A Historical Glance at the Arabo-Islamic Surgical Instruments During the Ages.

Arabo-Islamic physicians demonstrated exceptional skill and innovation in surgery, by having used the instruments introduced by ancient Greeks and Greco-Roman surgeons. In many cases they have manufactured their own innovative designs promoting further the success of the difficult surgical operations of their era. The surgical instruments and the surgeon's boxes, used to regularise the plethora of the metallic items, were decorated with fine designs, in order to depict the Arab civilisation. For the first time surgery became a separate medical art, while Arabo-Islamic medicine re-introduced ancient Greek and Byzantine surgery to the world.

Paul of Aegina (ca 625-690 ad), Reconstructing Male Gynecomastia.

Paul of Aegina thrived with his innovative operations, practically creating a kind of a new surgical school. He had deeply believed in human's body perfection introducing a series of cosmetic operations. Among them stood the male's breasts reconstruction in the case of pseudo-gynecomastia. His intervention was replicated by both the western Europeans and the Arabs.

Ammonius Lithotomos (3rd Century BC), the Alexandrian Innovative Surgeon Who Introduced Lithoclastic Cystotomy.

Alexandrian surgeon Ammonius Lithotomos, was the first to introduce lithoclastic cystotomy during the 3rd century BC in order to relieve a bladder's stone blockage. He had used a metallic hook or crotchet to remove the stone, which was named at the era "thrombus" of the urinary tract.

Greek Surgeon Pavlos Ioannou's Possible Influence on William Halsted's Famous Radical Mastectomy.

Pavlos Ioannou performed an innovative surgical operation for breast cancer in Vienna University Hospital in 1861. A few years later, after his return to Greece, an operation performed on his closest friend's child, which led to fatal complications, led him to retire from surgical practice. William Halsted travelled to Europe in order to master European surgery, including at Vienna University, and about 20 years later he published his famous method for radical mastectomy, which appears to be identical to Ioannou's operation. This article debates whether Halsted studied Ioannou's method in the archives of Vienna University (and was encouraged by Ioannou's retirement to develop this technique), whether he learned about it through his peers, or whether this was simply a historical coincidence.

Paul of Aegina (ca 625-690 AD), and his orthopaedic surgical reconstruction of the preternatural fingers.

Paul of Aegina lived in a era when the preservation of the ancient Greek tradition was for him almost a necessity. Eager to follow the dogma of "oρθoπo(ε)δώ" (orthopodo: pace with no malformation), he introduced a series of surgical operations of reconstructive-cosmetic-plastic-orthopaedic nature to confront any disfiguration of the human body. The aim of our study is to present the atmosphere of the era concerning the congenital malformations, describe briefly Paul's contribution on classic orthopaedics and present his views on the preternatural fingers. Our methodology mainly included the indexing of Paul's treatise, as published by the Sydenham Society during the nineteenth century, while references from the ancient Greek scholars were added to compose a better understanding of Paul's views. Inside his seven book treatise "Medical Compendium", he dedicated a separate chapter "On preternatural fingers, and on persons having six fingers", to introduce a detailed description of the extremities' additional digits and propose surgical treatment for their correction. He classified polydactylism according both to the presence of bones and to the anatomical origin of each additional finger. Paul marked the beginning of a new era for orthopaedics.

Hippocrates (ca 460-375 bc), Introducing Thoracotomy Combined With a Tracheal Intubation for the Parapneumonic Pleural Effusions and Empyema Thoracis.

Hippocrates was the first physician to describe in accuracy pleural effusion and pneumonia. To treat empyema thoracis he had introduced a combined method of tracheal intubation with a simultaneously thoracotomy. The surgical incision was used for the pus to be progressively drainaged. If the patient was too weak to eat, he had suggested for nutritional mixtures to be administered through an oral-gastric tube. Thus Hippocrates composed in his operating theatre, an icon similar to modern surgical operations.

Aretaeus of Cappadocia (ca 1st-3rd century AD): views on hepatic cancer.

Aretaeus lived in an era when cancer was known to be a fatal disease. He had understood both liver's capacity to regenerate, and its vital role for the body's homeostasis, and proposed the treatment to confront hepatic cancer. Although human's anatomy was well studied, especially in the Alexandrian School, and a plethora of surgical instruments and techniques were available, he had suggested a more holistic-palliative approach for hepatic cancer by applying a suitable dietetic regime, pain killers and psychological support.

Hippocrates (ca 460-370 BC) on nasal cancer.

The prevalence of cancer in antiquity is rather an unknown scientific field. Nevertheless, During the 5th century BC, Hippocrates and his followers, studied thoroughly this fatal disease and proposed surgical techniques and palliative drugs to confront and treat the malignant tumors caused by the black bile (the 4 humors theory). Inside Corpus Hippocraticum, nasal cancer was mentioned, alongside with its treatment. Local surgical excision, cautherization, drugs to relief the pain and face possible metastases combined with a possible pessary technique and endotracheal intubation, have been employed by the physicians of the era.

The Forgotten Asclepieion of Peparithos and the Islander Worshippers of the Snake God.

The ancient Asclepieion of the island of Peparithos, modern Skopelos, had been build in an ideal position, one kilometer from the ancient city of Peparithos. The angry north Aegean Sea brought in the surface its north wall at the beginning of the 60s decade. The monument was identified as an Asclepieion from one partially saved ceramic inscription "ASCL…" (Greek: ΑΣΚΛ…). The sanctuary was surrounded by covered walkway (Greek: στοά) and it is dated at the early years of the fourth century BC. It is possible that god Apollo and goddess Artemis were worshiped in parallel. The monument reflects the culture of Peparitheans and the importance given toward the holistic treatment for the patients.

Hippocrates on Pediatric Dermatology.

Hippocrates of Kos is well known in medicine, but his contributions to pediatric dermatology have not previously been examined. A systematic study of Corpus Hippocraticum was undertaken to document references of clinical and historical importance of pediatric dermatology. In Corpus Hippocraticum, a variety of skin diseases are described, along with proposed treatments. Hippocrates rejected the theory of the punishment of the Greek gods and supported the concept that dermatologic diseases resulted from a loss of balance in the body humors. Many of the terms that Hippocrates and his pupils used are still being used today. Moreover, he probably provided one of the first descriptions of skin findings in smallpox, Henoch-Schönlein purpura (also known as anaphylactoid purpura, purpura rheumatica, allergic purpura), and meningococcal septicemia.

Daniel Mollière (1848-1890): the French anatomist-surgeon who introduced Robin's pioneering osteoclast for the genu valgum observed in adolescents.

Inside the pages of the French medical treatises of the 19th century a forgotten osteoclast apparatus for the genu valgum observed in adolescents remained hidden waiting to be unearthed. It was Victor Robin's osteoclast, which has been used by the supreme French anatomist and surgeon Daniel Mollière. With the purpose to share a significant heritage on orthopaedics, a thorough research of the literature of the era was conducted. Our study resulted in the illumination of both Mollière's prolific figure and osteoclast's impact on orthopaedic surgery at that time. Having in mind Mollière's perseverance towards surgical apparatuses, his antiseptic measures inside his operating theatre, his published treatises, his surgical skills, we may effortlessly conclude that he stands among Lyon's best surgeons with an important contribution to orthopaedics.

Nicholas J. Giannestras (1908-1978): a distinguished orthopaedic surgeon, his work, life and times.

The purpose of our study was to summarize all the knowledge concerning the innovative pioneer in the field of orthopaedic surgery, Nicholas J. Giannestras (1908-1978). A thorough study of texts, medical books and reports, in the field of history of medicine, together with a review of the available literature in PubMed, was undertaken. Giannestras left his mark in the history of orthopaedics with his clinical work and his publications, mainly his treatise "Foot Disorders: Medical and Surgical Management" (1973), while his name lingers in Greece with the introduction of spine fusion with the use of metallic implants. He was an eminent university clinical professor of orthopaedics who had harmonically combined academic writing, teaching and clinical research in every field of orthopaedic surgery.

Uterine cancer in the writings of ancient Greek physicians.

In this article, we present the views on uterine cancer of the ancient Greek physicians. We emphasize on uterine's cancer aetiology according to the dominant in antiquity humoural theory, on its surgical treatment suggested by Soranus of Ephesus, and in the vivid description provided by Aretaeus of Cappadocia. During that period, uterine cancer was considered as an incurable and painful malignancy and its approach was mainly palliative.

The physician who first applied radiotherapy, Victor Despeignes, on 1896.

François-Victor Despeignes, a French physician with significant contribution in public hygiene, was the first who had applied the irradiation treatment against malignant tumours. During 1866 he had performed to a 52 years old male patient X-rays treatment for epigastric tumour, paving the way for a new treatment era.