The History of the Greek Refugee Hospital of the Interwar Period in a General Hospital of Nikaia "Agios Panteleimon".

The Asia Minor Catastrophe caused the uprooting of thousands of Greeks from Asia Minor and their arrival in Greece. Especially in the areas around Piraeus, there was a large settlement of refugee populations. During that period, a small hospital was created, the "American Women's Hospital," by an initiative of the "American Women's Union," with the aim of treating and caring for suffering refugees. Within a decade, the hospital expanded and became a general hospital. In 1934, after the departure of the "American Women's Service" from Greece, it was renamed "Refugee Hospital of Nea Kokkinia," and then a year later (1935), it was renamed again to "Protypo Laiko Iatreio" (Model Public Clinic). In 1939, the construction of a larger hospital in Nea Kokkinia began. During World War II, the hospital managed to respond to the difficult conditions of the period and was renamed "General Hospital of Piraeus, Saporta Warehouse Building." After the war, in 1953, it was renamed to General Hospital of Piraeus "Queen Frederika." In 1986, it was renamed to Regional General Hospital of Nikaia "Damon Vassileiou" in honor of the Professor of Medicine of the University of Athens Damon Vassileiou who was one of the greatest Greek doctors. In 2001, it was renamed again to its current name General Hospital of Nikaia "Agios Panteleimon," becoming one of the largest hospitals in the Balkans.

In Vitro and In Vivo Effects of Docetaxel and Dasatinib in Triple-Negative Breast Cancer: A Research Study.

Introduction Triple-negative breast cancer (TNBC) comprises a heterogeneous group of tumors with a single trait in common: an evident aggressive nature with higher rates of relapse and lower overall survival in the metastatic context when compared to other subtypes of breast cancer. To date, not a single targeted therapy has been approved for the treatment of TNBC, and cytotoxic chemotherapy remains the standard treatment. In the present experimental study, we examine the effects of the chemotherapeutic docetaxel and the bcr/abl kinase inhibitor dasatinib on TNBC cell lines (in vitro) and on TNBC tumor xenograft mouse models (in vivo). Materials and methods TNBC cell lines were cultivated and treated with various concentrations of docetaxel and dasatinib (5 nM to 100 nM). Cell death and apoptosis were studied by flow cytometry. TNBC cell lines were then injected in BALB/c athymic nude mice to express the tumor in vivo. Four groups of mice were created (group A: control; group B: DOC; group C: DAS; group D: DOC + DAS) and treated, respectively, with the drugs and their combination. Tumors were obtained, maintained in a 10% formaldehyde solution, embedded in paraffin, and sent for further histological evaluation (hematoxylin-eosin staining and immune-histochemical analysis) to assess the tumor growth inhibition. Results The cytotoxic effects of docetaxel seem statistically important, with little effect on apoptosis. The effect of dasatinib in vitro and vivo is statistically important, in terms of apoptosis and tumor reduction, with little adverse effects. Conclusions TNBC is a difficult-to-treat oncologic condition, even in an experimental setting. Promising results concerning the addition of targeted therapies (dasatinib) to the conventional cytotoxic ones (docetaxel) have been shown, awaiting further evaluation.

A Review of the Significance in Measuring Preoperative and Postoperative Carcinoembryonic Antigen (CEA) Values in Patients with Medullary Thyroid Carcinoma (MTC).

Background and Objectives: Medullary thyroid carcinoma (MTC) accounts for 1-2% of all thyroid malignancies, and it originates from parafollicular "C" cells. Carcinoembryonic antigen (CEA) is a tumor marker, mainly for gastrointestinal malignancies. There are references in literature where elevated CEA levels may be the first finding in MTC. The aim of this study is to determine the importance of measuring preoperative and postoperative CEA values in patients with MTC and to define the clinical significance of the correlation between CEA and the origin of C cells. Materials and Methods: The existing and relevant literature was reviewed by searching for articles and specific keywords in the scientific databases of PubMedCentraland Google Scholar (till December 2020). Results: CEA has found its place, especially at the preoperative level, in the diagnostic approach of MTC. Preoperative CEA values >30 ng/mL indicate extra-thyroid disease, while CEA values >100 ng/mL are associated with lymph node involvement and distant metastases. The increase in CEA values preoperatively is associated with larger size of primary tumor, presence of lymph nodes, distant metastases and a poorer prognosis. The clinical significance of CEA values for the surgeon is the optimal planning of surgical treatment. In the recent literature, C cells seem to originate from the endoderm of the primitive anterior gut at the ultimobranchial bodies' level. Conclusions: Although CEA is not a specific biomarker of the disease in MTC, itsmeasurement is useful in assessing the progression of the disease. The embryonic origin of C cells could explain the increased CEA values in MTC.

Expression of HIF-2a in clear-cell renal cell carcinoma independently predicts overall survival.

The purpose of this study is to evaluate the expression and the prognostic role of main factors, involved in the hypoxia pathway, in patients with clear-cell renal cell carcinoma (ccRCC). Immunohistochemical expression of Hypoxia inducible factors (HIF) HIF-1a, HIF-2a, prolyl hydroxylases PHD1, PHD2, PHD3, and factor inhibiting HIF (FIH) was assessed on a tissue microarray, containing tumour and corresponding normal kidney tissue from 66 patients underwent surgery for ccRCC. Expression levels were evaluated in relation to T stage, Fuhrman grade, cancer-specific, and overall survival (OS). Cytoplasmatic expression of HIF-2a was positively correlated with expression of HIF-1a (p = 0.011). HIF-1a expression was also positively correlated with PHD3 and FIH (p = 0.020 and p = 0.039). Expression of HIF-1a was associated with lower Fuhrman grade (p = 0.008), while HIF-2a overexpression with unfavourable grade (p = 0.026). PHD3 was significant downregulated (84.8%). Age, LDH, presence of necrosis, Fuhrman grade, T stage, and HIF-2a cytoplasmatic expression were significant associated with OS of patients in univariable analysis. In multivariable analysis, HIF-2a expression (p = 0.006) and T stage (p = 0.001) remained as the only independent predictors for overall survival. These results indicate that HIF-2a overexpression not only is inversely correlated with Fuhrman grade in ccRCC, but also represents a strong independent prognostic factor for a poor overall survival.

A study about neck pain on active population who visit Primary Health Centers.

BACKGROUND: Cervical pain is very common among population and several methods have been used until now in order to evaluate it. The main aim of this study is to estimate the prevalence of non-specific neck pain and the special features of it through its relation to demographic agents, habits and physiology parameters. Additionally, this study aims to select the most valid and objective methods for neck pain evaluation, which could also be useful in Primary Health Care and could give new prospectives. METHODS: This is a cross sectional study with a sample of 440 people 20-40 years old who visited the Public Centers in the County of Thessaloniki. The sample was chosen randomly. The subjects were separated in two groups (neck pain and no pain group). A questionnaire was distributed to the sample. The devices were an algometer which was used to estimate pain threshold and an electronic hand watch/smartphone which was used to evaluate pulse and skin humidity. RESULTS: The 38.6% of the samples seemed to suffer from neck pain but real neck pain was found only in the 21% of the sample. The disturbance in neck area because of stiffness and fatigue was found in 51% of the subjects and 25.9% of theme felt both pain and fatigue. The factors which were related to neck pain were female sex (p<0.001), age after 40 (p=0.007), marriage status (p=0.042), smocking (p=0.034), lack of physical exercise (p=0.01) and stress (p<0.001). Neck pain was strongly associated to pain pressure thresholds (PPT) (p<0.001). The PPT were lower in the group who suffered from neck pain. The agents which were not statistically associated with neck pain were the hardness of work (p=0,369), computer use (p=0.07), educational level (p=0.274), alcohol consumption (p=0.748), siesta (p=0.913), depression (p=0.086), heart rate (p=0.216) and skin humidity (p=0.141). There was no correlation between NRS and pain thresholds (p=0.947). The majority of people seemed to suffer from mild disability caused by neck pain (56.7%). Almost the half of the sample did not asked for professional help for their neck pain (48%) and seemed to be ignorant about the role of general practitioner at the management of their neck pain (44.1%). CONCLUSION: The examination of the patients showed that neck pain is often confused with stiffness and fatigue at the neck area. The NDI and HADS questionnaires could be easily used to evaluate respectively the disability and the psychological status of a person who suffers from neck pain. Algometry seems to enhance the objectiveness at the field of neck pain evaluation. The algometer showed high validity and reliability as a mean of neck pain evaluation under the condition that it is applied by a health professional with experience on its use. Neck pain is a complexed symptom and should be evaluated from an integrated point of view. These tools could probably be used in Primary Health Care as contemporary resources in the medical practice but more research is needed.

Specific neck pain algometric measurements and their relation to heart rate and skin humidity.

Cervical pain is very common in general population but only few methods have been used to evaluate it with objectiveness. There are only few studies which use algometer as a means of neck pain assessment. Studies have shown that algometer could be used in pain evaluation but more studies are necessary to support this. The main purpose of the study was the evaluation of algometer as a means of an objective measurement of pain threshold to people with non-specific neck pain. The study focused on the search of correlation between neck pain and pain pressure threshold (PPT) after recording the number of the minimum pain feeling in the sample with the pressure of the algometer at specific neck points. The study also aimed at searching the correlation of neck pain with heart rate and skin humidity. This is a part of a cross-sectional study which was held during a PhD study which assessed 185 randomly chosen people, 20-60 years old, who visited all the Public Centers in the County of Thessaloniki. The sample was separated in two groups according to the frequency of their neck pain, those who suffered frequently or almost every day from non-specific neck pain (neck pain group) and those with non-specific neck pain occasionally, rarely or never suffered from it (no pain group). Subjects were randomly chosen from people who visited the Public Centers for any reason. Neck pain was strongly associated with PPT (P<0.001). Heart rate (P=0.216) and skin humidity (P=0.14) were not significantly related to neck pain. According to the results the algometer seems to be a useful tool as a mean of neck pain evaluation and algometry seems to enhance the idea of pain quantification. However more evidence is needed and more studies should be conducted in order to strengthen our results. Latter studies should be designed with more accuracy focusing on details in order to establish algometry as an objective method of pain evaluation.

Sitagliptin reduces urinary microalbumin in experimental model of diabetic nephropathy.

OBJECTIVE: The term Diabetic kidney disease (DKD) refers to any disease of the kidney that is a result of long-term hyperglycemia caused either by diabetes mellitus type 1 (DT1) or type 2 (DT2). When DKD coexists with macro albuminuria or proteinuria the condition is called diabetic nephropathy. DKD is the primary cause of renal failure since it is responsible for the 44% of new cases presented in the U.S.A. in 2008. Sitagliptin is an inhibitor of the enzyme dipeptidyl peptidase and is used as a treatment for diabetes since 2006. Through the inhibition of the enzyme's action sitagliptin prevents the degradation of GLP-1 which is an endogenous peptide with significant hypoglycemic actions, particularly postprandial. The proven hypoglycemic actions of sitagliptin led the researchers to further study the possible effects sitagliptin may have on the complications of diabetes mellitus such as diabetic nephropathy. The purpose of the study is to examine the effect of sitagliptin on diabetic nephropathy using biochemical parameters for assessment. METHODS: 27db/db mice were used in total. They were about 4 weeks old. The mice were randomly divided into 3 groups each one consisting of 9 mice, the first 2 groups received sitagliptin treatment over a period of 32 weeks while the third did not receive any treatment. In the first group the mice received 200mg sitagliptin per Kg of body weight and in the second 10mg per Kg. At the end of the 32 weeks period the serum glucose, urea, creatinine, cholesterol, LDL, HDL, hsCRP and triglycerides as well as the urinary creatinine and microalbumin were measured in all 3 groups. RESULTS: The first group (received 200mg/kg) in comparison to the third group (control group) exhibited a reduction in the biochemical parameters measured: glucose -12.35% (P=0.16), urea -17.18% (P=0.61), creatinine -0.81% (P=0.95 ), cholesterol -19.28% (P=0,09), HDL -12,25% (P=0.26), LDL -31.2% (P=0.25), triglycerides -13,9% (P=0.37), hsCRP -49.8% (P=0.06), microalbumin -37.8% (P<0.0001). CONCLUSION: The administration of sitagliptin reduces in a statistically significant manner the urinary microalbumin. In addition, hsCRP was greatly reduced but the reduction did not reach the required significance level. The other biochemical data presented a reduction which could not be considered as statistically significant. However, it should be mentioned that the exact mechanisms by which sitagliptin achieves this reduction in the biochemical parameters measured, except for the glucose reduction, remain unclear. Although it is suggested that the reduction of glucotoxicity due to sitagliptin treatment is the main reason for those results, the effects of sitagliptin on inflammation, protection of the endothelium and reduction of arterial blood pressure might play a facilitating role.

Medical practice in the ancient Asclepeion in Kos island.

Asclepius was called "a great doctor for every disease". Asclepius was born in Trikala, Thessaly, in the middle of Greece, where the first Asclepeion was established. Patients coming to the Asclepeia were first taking cleaning baths and then entered the main Asclepeion, where they were examined by priests-therapists and were accommodated in certain areas-rooms of the Asclepeion. Inscriptions found in marble plaques describe treatment of some diseases and the sum of money paid for every treatment. These were the first medical records and fees in ancient Greece. Patients were considered as a unique psychosomatic entity. Patients followed many instructions in order to relax and rest, submitted daily baths, exercises, massages, entertainment attending theatrical or poetic or athletic races, reading special books, promenades, special diets or were kept fasting and were instructed to take many kinds of medicine per os, suppositories, ointments, eye drops etc. The main diseases treated in the Asclepeia were: chronic neuropsychological disorders, skin diseases and chronic lung diseases. Other diseases gynaecological, ophthalmic and surgical were also treated. Today, like in the ancient Asclepeia, the psychology of patients is important and certain preparatory drugs are administered before the actual main treatment of surgery or of some psychic disorders. In Aalborg, Denmark, a large prototype medical university hospital, is scheduled to be built in an area of 350acres within the next 15 years. The psychosomatic dogma and principals of a "green building" will be well respected. The Asclepeion of the island of Kos, where as we know Hippocrates was born, was built on the 5th century B.C. and functioned till the 4th century A.D. and had three floors. The Asclepeion had many dedications, of which many parts of the human body in marble: an ear, a damaged penis and two breasts. Surgical tools were also found and are now exhibited in the Dion Museum. After the 4th century A.D. the Asclepeion was destructed and/or destroyed by religious groups, more earthquakes, conflagrations, the Saint John's Knights of Jerusalem and the Turks. Recent excavations in the area in order to find and restore the old Asclepeion started in 1902. Now Asclepeion is partly restored. In conclusion, it is suggested that Hippocratic medicine, as practiced in the Asclepeion of the island of Kos, using psychosomatic means of treatment in a green natural environment was effective for many diseases at that time but also inspired modern medicine and as an example a large university institution is now under constructions based on the above ideals.

Vascular endothelial growth factor (VEGF) in the pathogenesis of diabetic nephropathy of type 1 diabetes mellitus.

Diabetic nephropathy (DN) is a common complication of diabetes mellitus and is the primary cause of end-stage renal disease in the Western World. Vascular endothelial growth factor (VEGF) is implicated in the pathogenesis of DN of type 1 diabetes mellitus. VEGF is the main angiogenic factor and a potent mitogen for endothelial cells. It is mainly produced in kidney by podocytes and exerts its biological activities by binding to its receptors (VEGFRs). Alternative splicing of a single VEGF gene produces various isoforms and two families with anti- and pro-angiogenic properties. In normal glomeruli, VEGF isoforms are in tight regulation and act in a paracrine and an autocrine manner preserving the integrity of glomerular filtration barrier. Many mediators in diabetic milieu induce the expression of VEGF and possibly the VEGFxxx isoform in animal models of type 1 diabetes, however, in human kidney with developed DN, VEGF expression seems to be lower or absent. Inhibition of VEGF in experimental DN ameliorates structural and functional changes and proposes possible therapeutic targets. Further studies are required before these treatments can be used in diabetic patients at early stages of DN.

Effect of ramipril alone compared to ramipril with eplerenone on diabetic nephropathy in streptozocin-induced diabetic rats.

BACKGROUND/AIMS: We studied the effect of the combined treatment with an angiotensin-converting enzyme (ACE) inhibitor (ramipril) and eplerenone compared with ramipril alone in streptozocin-induced diabetic rats. METHODS: Wistar rats were divided into 4 groups: nondiabetic controls, streptozocin-treated diabetic rats (50 mg/kg), diabetic rats receiving ramipril (1 mg/kg) and diabetic rats treated with the combination of ramipril (1 mg/kg) and eplerenone (100 mg/kg) for 8 weeks. Our model produced early-stage diabetic nephropathy. RESULTS: The diabetic rats developed polyuria, proteinuria, hyperfiltration (assessed by creatinine clearance) and histopathological evidence of renal injury including glomerular hypertrophy and mesangial expansion. Ramipril reduced proteinuria but its combination with eplerenone did not produce any greater benefit. Both treatment approaches prevented glomerular hypertrophy. Addition of eplerenone to ramipril prevented glomerular hyperfiltration. CONCLUSION: Whether eplerenone should be used in addition to an ACE inhibitor or an angiotensin receptor blocker at an early stage of diabetic nephropathy remains questionable.

Nanotechnology and radiopharmaceuticals: diagnostic and therapeutic approaches.

Nanotechnology is a novel but rapidly advancing domain of Therapeutics. Nanoscale-diameter particles such as liposomes and dendrimers may be conscribed for the effective and safe administration of several drugs. The main advantages of nanosystem-mediated drug delivery are the following; i) sufficient absorption, ii) delayed metabolism and excretion, iii) longer half-life, iv) ability to cross several anatomical barriers, v) enhanced accumulation in specific target-tissues (e.g. malignant tumors), vi) lower toxicity of the drug. During the last years there is a growing interest around the potential contribution of Nanotechnology in the development of Nuclear Medicine and vice versa. Radioactive agents called radiopharmaceuticals are already used in several medical procedures. Exploiting their ability to accumulate selectively on specific organ-targets, radiopharmaceuticals serve in diagnostic applications, such as scintiscan, PET scan and in therapy of several diseases (e.g. thyroid cancer). The use of nanosystems may further ameliorate the properties of radiopharmaceuticals regarding their targeting ability and their unique pharmacokinetic properties. On the other hand radionuclides may serve in experimental studies for the pharmacological evaluation of nanosystems. Nevertheless further research is required in order to confirm the effectiveness and safety of nanosystem-mediated radiopharmaceutical applications.

A validated SIM GC/MS method for the simultaneous determination of dextromethorphan and its metabolites dextrorphan, 3-methoxymorphinan and 3-hydroxymorphinan in biological matrices and its application to in vitro CYP2D6 and CYP3A4 inhibition study.

Dextromethorphan is used as a probe drug for assessing CYP2D6 and CYP3A4 activity in vivo and in vitro. A SIM GC/MS method without derivatization for the simultaneous determination of dextromethorphan and its metabolites, dextrorphan, 3-methoxymorphinan and 3-hydroxymorphinan, in human plasma, urine and in vitro incubation matrix was developed and validated. Calibration curves indicated good linearity with a coefficient of variation (r) better than 0.995. The lower limit of quantitation was found to be 10 ng/mL for all analytes in all matrices. Intra-day and inter-day precision for dextromethorphan and its metabolites was better than 9.02 and 9.91%, respectively and accuracy ranged between 91.76 and 106.27%. Recovery for dextromethorphan, its metabolites and internal standard levallorphan was greater than 72.68%. The method has been successfully applied for the in vitro inhibition of metabolism of dextromethorphan by CYP2D6 and CYP3A4 using known inhibitors of CYPs such as quinidine and verapamil.