56 research outputs found
Treatment challenges in and outside a specialist network setting: Pancreatic neuroendocrine tumours
No full textPancreatic Neuroendocrine Neoplasms comprise a group of rare tumours with special biology, an often indolent behaviour and particular diagnostic and therapeutic requirements. The specialized biochemical tests and radiological investigations, the complexity of surgical options and the variety of medical treatments that require individual tailoring, mandate a multidisciplinary approach that can be optimally achieved through an organized network. The present study describes currents concepts in the management of these tumours as well as an insight into the challenges of delivering the pathway in and outside a Network
Μελέτη της έκφρασης των υποδοχέων των φυλετικών ορμονών στα παγκρεατικά νεοπλάσματα, και συσχέτισή της με κλινικοπαθολογικά δεδομένα
No full textΥπόβαθρο Η ανακάλυψη των δύο μορφών των οιστρογονικών υποδοχέων, κατέστησε απαραίτητη την επανεξέταση των ευρημάτων παλαιότερων μελετών και τον επανέλεγχο της έκφρασης των υποδοχέων σε όγκους που παλαιότερα θεωρούνταν αρνητικοί. Η μελέτη αυτή στόχευσε στην εκτίμηση της έκφρασης των δύο τύπων οιστρογονικών υποδοχέων ανάμεσα σε καλοήθεις και κακοήθεις παγκρεατικές βλάβες. Μέθοδος Διεξήχθη μελέτη αντιστοίχισης περιστατικών μεταξύ καλοηθών και καοηθών παγκρεατικών βλαβών σε ασθενείς με όμοια ηλικία, φύλο και μέγεθος όγκου. Η έκφραση του ER-α και ER-β αξιολογήθηκε με μεθόδους ανοσοϊστοχημείας και βαθμολογήθηκε με βάση δύο καθιερωμένα συστήματα βαθμολόγησης. Στατιστική ανάλυση πραγματοποιήθηκε μεταξύ των δύο υποομάδων καθώς και με άλλους ιστολογικούς παράγοντες κι ογκολογικά αποτελέσματα. Αποτελέσματα Δεκαέξι καλοήθεις βλάβες και 32 κακοήθεις βλάβες αναλύθηκαν. Ο ER-α ανιχνεύθηκε στο 31,25% των καλοηθών βλαβών και σε καμία κακοήθη βλάβη (p=0,003). Ο ER-β ανιχνεύθηκε στο 31,25% των καλοηθών βλαβών και στο 37,5% των κακοηθών βλαβών (p=0,757). Δεν ανευρέθηκε στατιστικά σημαντική διαφορά μεταξύ της έκφρασης του ER-β κι άλλων ιστολογικών ή κλινικών παραμέτρων. Συμπεράσματα Τα παγκρεατικά αδενοκαρκινώματα δεν εκφράζουν τον ER-α, γεγονός που μπορεί να εξηγεί γιατί παλαιότερες σχετικές κλινικές μελέτες απέτυχαν, αλλά εκφράζουν τον ER-β σε αξιοσημείωτο ποσοστό, γεγονός που υποστηρίζει την ανάγκη για περαιτέρω μελέτες στο πεδίο.Background The discovery of two forms of estrogen receptors, has mandated to reconsider findings of earlier studies and re-examine their expression in tumours that were previously thought negative. This study aimed to assess the expression of the two estrogen receptor types in benign and malignant pancreatic lesions. Methods A case-matched study was performed between benign and malignant pancreatic lesions of patients with similar age, gender and tumour size. ER-α and ER-β expression was assessed by immunohistochemistry and scored using two established scoring systems. Statistical analysis was performed between the two groups as well as with other histological factors and oncological outcomes. Results Sixteen benign lesions and 32 malignant lesions were analysed. ER-α was detected in 31,25% of benign tumours but in no malignant tumour (p=0,003). ER-β was positive in 31,25% of benign and 37,5% of malignant tumours (p=0,757). No statistically significant correlation was found between ER-β expression and other histological or clinical parameters. Conclusions Pancreatic adenocarcinomas do not express ER-α, which might explain failure of relevant earlier clinical trials, but do express ER-β at a considerable rate, which supports the need for further targeted studies
Study of the expression of sex hormones in pancreatic neoplasms, and correlation with clinical and pathological data
No full textBackground: The discovery of two forms of estrogen receptors, has mandated to reconsider findings of earlier studies and re-examine their expression in tumours that were previously thought negative. This study aimed to assess the expression of the two estrogen receptor types in benign and malignant pancreatic lesions. Methods: A case-matched study was performed between benign and malignant pancreatic lesions of patients with similar age, gender and tumour size. ER-α and ER-β expression was assessed by immunohistochemistry and scored using two established scoring systems. Statistical analysis was performed between the two groups as well as with other histological factors and oncological outcomes. Results: Sixteen benign lesions and 32 malignant lesions were analysed. ER-α was detected in 31,25% of benign tumours but in no malignant tumour (p=0,003). ER-β was positive in 31,25% of benign and 37,5% of malignant tumours (p=0,757). No statistically significant correlation was found between ER-β expression and other histological or clinical parameters. Conclusions: Pancreatic adenocarcinomas do not express ER-α, which might explain failure of relevant earlier clinical trials, but do express ER-β at a considerable rate, which supports the need for further targeted studies.Υπόβαθρο: Η ανακάλυψη των δύο μορφών των οιστρογονικών υποδοχέων, κατέστησε απαραίτητη την επανεξέταση των ευρημάτων παλαιότερων μελετών και τον επανέλεγχο της έκφρασης των υποδοχέων σε όγκους που παλαιότερα θεωρούνταν αρνητικοί. Η μελέτη αυτή στόχευσε στην εκτίμηση της έκφρασης των δύο τύπων οιστρογονικών υποδοχέων ανάμεσα σε καλοήθεις και κακοήθεις παγκρεατικές βλάβες. Μέθοδος: Διεξήχθη μελέτη αντιστοίχισης περιστατικών μεταξύ καλοηθών και καοηθών παγκρεατικών βλαβών σε ασθενείς με όμοια ηλικία, φύλο και μέγεθος όγκου. Η έκφραση του ER-α και ER-β αξιολογήθηκε με μεθόδους ανοσοϊστοχημείας και βαθμολογήθηκε με βάση δύο καθιερωμένα συστήματα βαθμολόγησης. Στατιστική ανάλυση πραγματοποιήθηκε μεταξύ των δύο υποομάδων καθώς και με άλλους ιστολογικούς παράγοντες κι ογκολογικά αποτελέσματα. Αποτελέσματα: Δεκαέξι καλοήθεις βλάβες και 32 κακοήθεις βλάβες αναλύθηκαν. Ο ER-α ανιχνεύθηκε στο 31,25% των καλοηθών βλαβών και σε καμία κακοήθη βλάβη (p=0,003). Ο ER-β ανιχνεύθηκε στο 31,25% των καλοηθών βλαβών και στο 37,5% των κακοηθών βλαβών (p=0,757). Δεν ανευρέθηκε στατιστικά σημαντική διαφορά μεταξύ της έκφρασης του ER-β κι άλλων ιστολογικών ή κλινικών παραμέτρων. Συμπεράσματα: Τα παγκρεατικά αδενοκαρκινώματα δεν εκφράζουν τον ER-α, γεγονός που μπορεί να εξηγεί γιατί παλαιότερες σχετικές κλινικές μελέτες απέτυχαν, αλλά εκφράζουν τον ER-β σε αξιοσημείωτο ποσοστό, γεγονός που υποστηρίζει την ανάγκη για περαιτέρω μελέτες στο πεδίο
Estrogen Receptor Expression in Pancreatic Adenocarcinoma Time to Reconsider Evidence
No full textPancreatic adenocarcinoma remains a chemotherapy-resistant and refractory malignancy with high mortality, unaffected by recent progress in anticancer treatment. Expression of estrogen receptors was detected almost 50 years ago, in both benign and malignant pancreatic cells. However, early preclinical studies in pancreatic cancer led to contradictory findings, and most clinical studies failed to demonstrate an effect with tamoxifen treatment. The identification of a second form of estrogen receptor seems to provide some explanation for these discrepancies. Predominantly expressed in malignant cells and structurally different from what was considered the only estrogen receptor, estrogen receptor beta was recognized as a negative prognostic factor and a possible therapeutic target in pancreatic ductal adenocarcinoma. Therefore, findings of research before the identification of estrogen receptor beta should be reconsidered, and further studies should be designed to reassess the expression and effect of this specific estrogen receptor type in pancreatic cancer
Estrogen Receptor Expression in Pancreatic Adenocarcinoma: Time to Reconsider Evidence
No full textPancreatic adenocarcinoma remains a chemotherapy-resistant and refractory malignancy with high mortality, unaffected by recent progress in anticancer treatment. Expression of estrogen receptors was detected almost 50 years ago, in both benign and malignant pancreatic cells. However, early preclinical studies in pancreatic cancer led to contradictory findings, and most clinical studies failed to demonstrate an effect with tamoxifen treatment. The identification of a second form of estrogen receptor seems to provide some explanation for these discrepancies. Predominantly expressed in malignant cells and structurally different from what was considered the only estrogen receptor, estrogen receptor β was recognized as a negative prognostic factor and a possible therapeutic target in pancreatic ductal adenocarcinoma. Therefore, findings of research before the identification of estrogen receptor β should be reconsidered, and further studies should be designed to reassess the expression and effect of this specific estrogen receptor type in pancreatic cancer
Overcoming geographical and socioeconomic limitations in colorectal cancer screening
No full textDespite colorectal cancer’s (CRC) high global incidence, residents of low- and middle- income countries, as well as low-income minorities in advanced economies have low screening rates. Observational studies demonstrate that in these groups higher incidence of CRC is observed, yet screening rates remain low for consistent reasons. Low income, low educational background, and lack of awareness in combination with inadequate social security of certain population groups impede access and compliance rates to CRC screening. On the other hand, despite the global availability of multiple screening approaches (colonoscopy, sigmoidoscopy, faecal occult blood test, faecal immunochemical test, computed tomography-colonography, etc.) with proven diagnostic validity, many low-income countries still lack established screening programs. The absence of screening guidelines in these countries along with the heterogeneity of guidelines in the rest of the world, demonstrate the need for global measures to tackle this issue comprehensively. An essential step forward is to develop a global approach that will link specific elements of screening with the incidence and available resources in each country, to ensure the achievement of at least a minimum screening program in low-income countries. Utilizing cheaper, cost-effective techniques, which can be carried out by less specialized healthcare providers, might not be equivalent to endoscopy for CRC screening but seems more realistic for areas with fewer resources. Awareness has been highlighted as the most pivotal element for the effective implementation of any screening program concerning CRC. Moreover, multiple studies have demonstrated that outreach strategies and community-based educational programs are associated with encouraging outcomes, yet a centrally coordinated expansion of these programs could provide more consistent results. Additionally, patient navigator programs, wherever implemented, have increased CRC screening and improved follow-up. Therefore, global coordination and patient education seem to be the main areas on which policy making needs to focus
Development and implementation of a virtual reality laparoscopic colorectal training curriculum
No full textBringing gut microbiota into the spotlight of clinical research and medical practice
No full textDespite the increasing scientific interest and expanding role of gut microbiota (GM) in human health, it is rarely reported in case reports and deployed in clinical practice. Proteins and metabolites produced by microbiota contribute to immune system development, energy homeostasis and digestion. Exo- and endogenous factors can alter its composition. Disturbance of microbiota, also known as dysbiosis, is associated with various pathological conditions. Specific bacterial taxa and related metabolites are involved in disease pathogenesis and therefore can serve as a diagnostic tool. GM could also be a useful prognostic factor by predicting future disease onset and preventing hospital-associated infections. Additionally, it can influence response to treatments, including those for cancers, by altering drug bioavailability. A thorough understanding of its function has permitted significant development in therapeutics, such as probiotics and fecal transplantation. Hence, GM should be considered as a ground-breaking biological parameter, and it is advisable to be investigated and reported in literature in a more consistent and systematic way
Validation of a Virtual Reality Endoscopy Platform in Providing a Training Solution for Barrett’s Esophagus
No full textVirtual reality (VR) offers an unrivalled immersive education opportunity to provide guaranteed pathology exposure, reproducible instruction and robust pathology recognition key performance indicators. Our novel VR platform aims to address the heterogenous and subjective nature of endoscopy education to tackle statistics such as the published missed cancer rate of 11.3% in upper gastrointestinal endoscopy (EGD). Quality of endoscopic assessment of Barrett’s esophagus (BE) is variable despite early neoplasia detection being vital to address the grave prognosis of esophageal adenocarcinoma. This is a pilot validation study for a novel prototype VR endoscopy training environment for Barrett’s esophagus
When the Going Gets Tough, the Tough Get Going: Improving the Disaster Preparedness of Health Care Providers: A Single Center’s 4-Year Experience
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