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The purpose of this study was to examine the potential effect of Chios Mastic Gum (CMG) consumption on bone mineral density (BMD) and strength of ovariectomized rats. CMG is a known resin used from ancient times for its beneficial biological properties. Thirty mature female Wistar rats were randomized into three equal groups: sham-operated (control), ovariectomized (OVX), and ovariectomized and administered CMG per os (OVX+CMG). BMD of the total tibia, proximal tibia, and the 6th lumbar vertebra were measured at baseline and at 3 and 6 months post ovariectomy. Bone strength was assessed with three-point-bending (3pb) of the right femur. At 3 and 6 months, BMD values of the OVX+ CMG group were significantly higher for the anatomical cites evaluated than those of the OVX group. Femoral thickness assessed via 3pb had intermediate values in the treated group compared to the other groups. Cytology of vaginal smears and uterine weight of the OVX+CMG group were consistent with estrogen depletion. Gastrocnemius muscle and intraperitoneal fat ratios to body weight (BW) of the OVX+CMG group did not significantly differ from the control group. Daily consumption CMG had a protective effect on BMD of the total and proximal tibia and the 6th lumbar vertebra of the rats, without causing undesirable effects on the vaginal epithelium and uterus. The 3pb results also demonstrated a favorable effect on the thickness of rat femurs. In addition, CMG was beneficial for both the muscular system and the intraperitoneal fat/BW ratio of the rats. Copyright © 2021 by The Korean Society of Food Science and Nutrition. All rights Reserved.

Background/Aim: Postsurgical hypoparathyroidism (PostHypo) is a common complication after total thyroidectomy. We studied the risk factors associated with PostHypo. Patients and Methods: The study included 109 women, (mean age: 50.7±10.75 years), who underwent total thyroidectomy for thyroid diseases. Results: Based on the development of biochemical hypocalcemia on the first postoperative day following total thyroidectomy, (cCa

Background/Aim: Ischemia and reperfusion injuries may produce deleterious effects on hepatic tissue after liver surgery and transplantation. The impact of ischemia-reperfusion injury (ΙRΙ) on the liver depends on its substrate, the percentage of liver ischemic tissue subjected to IRI and the ischemia time. The consequences of IRI are more evident in pathologic liver substrates, such as steatotic livers. This review is the result of an extended bibliographic PubMed search focused on the last 20 years. It highlights basic differences encountered during IRI in lean and steatotic livers based on studies using rodent experimental models. Conclusion: The main difference in cell death between lean and steatotic livers is the prevalence of apoptosis in the former and necrosis in the latter. There are also major changes in the effect of intracellular mediators, such as TNFα and IL-1β. Further experimental studies are needed in order to increase current knowledge of IRI effects and relevant mechanisms in both lean and steatotic livers, so that new preventive and therapeutic strategies maybe developed. © 2020 International Institute of Anticancer Research. All rights reserved.

Regeneration of large jaw bone defects still remains a clinical challenge. To avoid incomplete bone repair, bone grafts have been advocated to support the healing process. This study comparatively evaluated new bone formation among a synthetic graft substitute, a human bone derivative, and a bovine xenograft. Materials were placed in 3 out of the 4 bone cavities, while 1 deficit was left empty, serving as a control, in mono-cortical defects, surgically prepared in the porcine calvaria bone. Animals were randomized in 2 groups and euthanized at 8 and 12 weeks. Harvested tissue specimens were qualitatively evaluated by histology. New bone formation was quantitatively measured by histomorphometry. Maximum new bone formation was noticed in defects grafted with beta-tricalcium phosphate b-TCP compared to the other bone substitutes, at 8 and 12 weeks post-surgery. Bovine and human allograft induced less new bone formation compared to empty bone cavity. Histologic analysis revealed that b-TCP was absorbed and substituted significantly, while bovine and human allograft was maintained almost intact in close proximity with new bone. Based on our findings, higher new bone formation was detected in defects filled with b-TCP when compared to bovine and human graft substitutes. © 2020 by the authors. Licensee MDPI, Basel, Switzerland.

Bone deficits of the jaws are often attributed to accidents, surgical removal of benign lesions or malignant neoplasms, congenital abnormalities, periodontal inflammation, tooth abscess or extraction and finally jaw atrophy due to advanced age or general disease. These bone defects require rehabilitation for a variety of reasons, e.g. maintaining the normal anatomic outline, eliminating empty space, aesthetic restoration and placing dental implants. Today, several techniques have been developed to eliminate these bone deformities including bone grafting, guided bone regeneration, distraction osteogenesis, use of growth factors and stem cells. Bone grafts consist of materials of natural or synthetic origin, implanted into the bone defect site, documented to possess bone healing properties. Currently, a variety of bone restorative materials with different characteristics are available, possesing different properties. Despite years of effort the ‘perfect’ bone reconstruction material has not yet been developed, a further effort is required to make this objective feasible. The aim of this article is to provide a contemporary and comprehensive overview of the grafting materials that can be applied in dentoalveolar reconstruction, discussing their properties, advantages and disadvantages, enlightening the present and the future perspectives in the field of bone regeneration. © 2018 The Authors

Type 1 diabetes mellitus (T1DM) is a disorder that decimates pancreatic β-cells which produce insulin. Direct pancreatic islet transplantation cannot serve as a widespread therapeutic modality owing to the need for lifelong immunosuppression and donor shortage. Therefore, several encapsulation techniques have been developed to enclose the islets in semipermeable vehicles that will allow oxygen and nutrient input as well as insulin, other metabolites and waste output, while accomplishing immunoisolation. Although encapsulation technology continues to face significant obstacles, recent advances in material science, stem cell biology and immunology potentially serve as pathways to success. This review summarizes the accomplishments of the past 5 years. © 2019 The most-recently developed strategies for islet encapsulation are reviewed regarding type 1 diabetes mellitus treatment aiming at efficient insulin production and delivery. © 2019

Background All human islets used in research and for the clinical treatment of diabetes are subject to ischemic damage during pancreas procurement, preservation, and islet isolation. A major factor influencing islet function is exposure of pancreata to cold ischemia during unavoidable windows of preservation by static cold storage (SCS). Improved preservation methods may prevent this functional deterioration. In the present study, we investigated whether pancreas preservation by gaseous oxygen perfusion (persufflation) better preserved islet function versus SCS. Methods Human pancreata were preserved by SCS or by persufflation in combination with SCS. Islets were subsequently isolated, and preparations in each group matched for SCS or total preservation time were compared using dynamic glucose-stimulated insulin secretion as a measure of β-cell function and RNA sequencing to elucidate transcriptomic changes. Results Persufflated pancreata had reduced SCS time, which resulted in islets with higher glucose-stimulated insulin secretion compared to islets from SCS only pancreata. RNA sequencing of islets from persufflated pancreata identified reduced inflammatory and greater metabolic gene expression, consistent with expectations of reducing cold ischemic exposure. Portions of these transcriptional responses were not associated with time spent in SCS and were attributable to pancreatic reoxygenation. Furthermore, persufflation extended the total preservation time by 50% without any detectable decline in islet function or viability. Conclusions These data demonstrate that pancreas preservation by persufflation rather than SCS before islet isolation reduces inflammatory responses and promotes metabolic pathways in human islets, which results in improved β cell function. © Wolters Kluwer Health, Inc. All rights reserved.

Background: The reported rate of incidental parathyroidectomy (IP) during total thyroidectomy varies between 6.4 and 31.1%. The aim of this study was to investigate the clinicopathological characteristics associated with IP. Materials and methods: This is a retrospective cohort study which included 2556 patients who underwent total thyroidectomy between 2002 and 2012 at a single tertiary institution. Demographics, clinicopathological risk factors, and postoperative calcium levels were compared between IP and control group. Results: Incidental parathyroidectomy occurred in 18.3% of patients. IP patients had higher risk of postoperative biochemical (40.3% vs 17.3%, p < 0.001) and symptomatic hypocalcemia (14.3% vs 7.3%, p < 0.001) than no-IP group. Multivariate analysis showed malignancy, tumor size >10 mm, thyroid capsule invasion, extrathyroidal extension, lymph node metastases and central neck dissection, operation time, RLN injury, thyroid gland dimensions were independent risk factors for IP. Conclusions: Our results indicate that patients with certain preoperative findings such as larger thyroid dimensions, diagnosis of malignancy and especially tumor >10 mm, extrathyroidal extension, and lymph node metastasis are at higher risk of IP and postoperative symptomatic hypocalcemia and these patients should be adequately informed and treated. Α meticulous intraoperative identification and the preservation of all parathyroid glands results in lower incidence of IP and postoperative hypocalcemia. © 2018

Background: Hepatic steatosis causes severe liver damage and has deleterious effects when associated with ischemia-reperfusion mechanisms. Ischemic preconditioning (IPC) protects lean liver against prolonged ischemia by improving micro-circulation and reducing lipid peroxidation. We investigated the effect of intermittent IPC on liver ischemia-reperfusion injury (IRI) and extensive hepatectomy in severe hepatic steatosis. Methods: Severe hepatic steatosis was performed by 12–14 weeks of choline-free diet in 108 Wistar rats. We induced 30-minute ischemia-reperfusion manipulations and extensive hepatectomy with or without prior IPC in steatotic livers and after 6 and 24 hours of reperfusion blood transaminases, and IL6, TNFα, NO and Lactate in blood and liver tissue were measured. Results: Steatotic rats subjected to hepatic ischemia-reperfusion alone after extensive hepatectomy, showed severe liver damage with significantly increased values of AST, ALT, TNFα and Lactate and significantly reduced IL6 and NO, while no one rat survived for more than 29 hours. On the contrary, steatotic rats subjected to intermittent IPC, 24 hours before ischemia-reperfusion, presented increased 30-day survival (67%), lower values of AST, ALT, TNFα and Lactate, and increased IL6 and NO levels. Simple and intermittent IPC manipulations, 1 hour before the IRI and extended hepatectomy, did not prolong survival more than 57 and 98 hours, respectively. Simple IPC, 24 hours before IRI and extended hepatectomy had the lowest possible survival (16.7%).Conclusions: Hepatic steatosis and IRI after major liver surgery largely affect morbidity and mortality. Intermittent IPC, 24 hours before IRI and extensive hepatectomy, presents higher 30-day survival and improved liver function parameters. © 2017, Copyright © 2017 Taylor & Francis Group, LLC.

Hepatic steatosis significantly increases morbidity and mortality associated with major liver surgery. Several rodent models of hepatic steatosis have been previously reported, which aimed to investigate the effect of various pharmaceutical agents and interventional procedures on the pathophysiology of steatotic liver. The aim of the present study was to investigate the time frame of severe hepatic steatosis in rats after they were fed a choline-free diet and any associated histopathological changes. The duration of feeding with a choline-free diet required to develop severe hepatic steatosis was investigated in Wistar rats. The severity of hepatic steatosis in liver specimens was evaluated at 8, 10, 12 and 14 weeks following the onset of the choline-free diet. Comparisons were made with rats receiving standardized laboratory food. Feeding rats for 12-13 weeks with a choline-free diet led to 66% fatty liver infiltration, which exceeded 68% after 14 weeks. Prior to 8 weeks, the fatty infiltration reached 43%, with a gradual increase revealing a stronger rate from 8-12 weeks and a gradual decline after 14 weeks. At 12-13 weeks the fatty infiltration was considered representative of severe hepatic steatosis. Macrovesicular fatty infiltration revealed a significant increase at a steady rate between 8 and 14 weeks, with evidence of the onset of lobular inflammation and steatohepatitis after 14 weeks of feeding with the choline-free diet. Microvesicular fatty infiltration demonstrated a lower growth rate between 8 and 12 weeks while maintaining a steady rate between 12 and 14 weeks. Mixed fatty infiltration maintained its steady rate of hepatic parenchyma from 8.8-9.5%. Rats fed with the standard laboratory diet did not demonstrate fatty infiltration >4.5%, so they did not develop hepatic steatosis. Developing an ideal model of hepatic steatosis is a particular challenge. The findings of the present study indicate that severe hepatic steatosis in rodents may lead to the development of steatohepatitis after feeding with a choline-free diet for at least 14 weeks. This model is of particular interest in experimental liver surgery and associated surgical maneuvers, and is easily reproducible. © 2018, Spandidos Publications. All rights reserved.

Aim: Steatotic liver is more susceptible to ischemia-reperfusion injury than is lean liver. Our aim was to investigate the ability of the severely steatotic rat liver to sustain ischemia. Materials and Methods: One hundred male Wistar rats aged 12-14 weeks were included. Fifty rats were given regular diet, while the rest were given a choline-free diet for 12-14 weeks to develop severe liver steatosis. Each group was divided into the following five subgroups: Shamoperated, and 5, 10, 15 and 20 minutes of continuous vascular inflow occlusion. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase levels were measured at 24 hours postoperatively and the animals were surveilled for 30 days. Results: Serum transaminase levels increased as the duration of ischemia increased in lean livers (p

Introduction: The purpose of this study was to evaluate the relationship between iodine intake and autoimmune thyroiditis in Chios, an island located in the North East Aegean Sea, in comparison to mainland regions in South Western Greece (SWG). Materials and methods: Urine iodine concentration (UIC), thyroid function (serum TSH, thyroid autoantibodies: anti-TPO and anti-Tg), and thyroid U/S were assessed in 200 subjects (150 females and 50 males) from Chios and 322 subjects (255 females and 67 males) from several mainland regions in SWG. All participants were recruited from outpatient clinics and were diagnosed as euthyroid. Results: Median UIC in Chios was significantly higher compared to SWG (136.1 vs. 104.5 μg/L, p < 0.001), indicating that both regions are iodine sufficient according to World Health Organization (WHO) criteria. The prevalence of thyroid autoimmunity was 66.5% in Chios and 27% in SWG, significantly higher in females (46.7%) than in males (26.5%). Furthermore, individuals with increased levels of thyroid autoantibodies either anti-TPO or anti-Tg (TAbs) showed increased median UIC levels compared to those / subjects / patients with normal levels (126.7 vs. 108.95 μg/L, p < 0.001). Serum TSH mean values (mIU/L) were greater in females (mean = 2.1 ± 1.41) compared to males (mean = 1.82 ± 1.26) (p = 0.04) and decreased with age. Conclusions: In conclusion, in the present study, we clearly indicate that increased thyroid autoimmunity is positively associated with increased iodine intake, as well as with the female gender. Moreover, iodine intake and thyroid autoimmunity appear to be significantly higher in a coastal region (Chios) than in mainland Greece (SWG). Additional environmental factors, apart from iodine, should be investigated in future studies. Mean TSH values were increased in females and decreased with age. The latter is probably due to the presence of autonomous goiter in older Greek populations, as a result of long-term status of iodine deficiency in the past. © 2018, Hellenic Endocrine Society.

Background: Papillary thyroid carcinoma (PTC) is the most common histological type of differentiated thyroid malignancy. Although the majority of PTC is located in the thyroid lobes, a small minority arise from the thyroid isthmus. The reported incidence of PTC arising in the thyroid isthmus ranges from 1% to 9.2%, probably reflecting variation in the study populations. Purpose: This review aimed to analyze the data about the optimal management of PTC arising in the isthmus. Data sources: We performed a systematic review of PubMed, MEDLINE, EMBASE, Scopus, and Cochrane Central Register of Controlled Trials to identify eligible studies analyzing surgical management strategies and published outcomes of isthmic PTC. Results: Most reports support that papillary thyroid carcinomas originating in the isthmus are more likely to have multiple foci, invasion of thyroid capsule and adjacent tissues with increased rate of central node involvement, compared to carcinomas located in other parts of the thyroid. Conclusions: The extent of the surgical resection, the role of prophylactic central neck dissection and the extent of central neck dissection in surgery for isthmic PTC remain highly controversial. However, total thyroidectomy and central node dissection may be an appropriate treatment for these patients. © 2017 Elsevier Inc.

Background: Parathyroid water-clear cell hyperplasia (WCCH) and water-clear cell adenoma (WCCA) are rare causes of primary hyperparathyroidism. The frequency of WCCH seems to be less than 1% of all primary hyperplasia. Case presentation: We report a 53-year-old woman with a large unilateral water clear cell parathyroid hyperplasia associated with primary hyperparathyroidism and severe osteoporosis. Ultrasonography showed a 5.4 cm multilobulated hypoechoic well defined mass localized in the lower half of the left thyroid lobe. Technetium sestamibi scanning showed a persistent very large area of increased activity possibly corresponding to a left inferior double parathyroid adenoma. At surgery, two large merged lobulated parathyroid glands were removed from the left superior and inferior aspects of the adjacent thyroid extending to the sub-clavicular area. Histopathology showed polygonal hyperplastic vacuolated cells with abundant water clear cytoplasm. The lesion had lack of capsule or rim of parathyroid tissue and immunohistochemistry was positive for PTH staining. These findings were consistent with diffused water clear cell hyperplasia. After parathyroidectomy, iPTH and calcium levels dropped immediately. Conclusion: The clinical presentation of the patients with water clear cells parathyroid content and hyperparathyroidism is indistinguishable from that of the more common causes of primary hyperparathyroidism of adenoma or hyperplasia and the diagnosis is made only on pathological examination. In conclusion, the distinction of water clear cell hyperplasia from water clear cell adenoma can be challenging in many cases, although clinically significant as far as treatment and follow-up. © 2017 The Author(s).

Background: Ischemic colitis (IC) is a common type of ischemic insult, resulting from decreased arterial blood flow to the colon. This disease can be caused from either atherosclerotic occlusive vascular disease or non-occlusive disease. The aim of this study is to present the diagnostic methodology and management of this severe disease based on current literature. Methods: A literature search has been done including articles referring to modern diagnosis and management of IC. Results: IC is usually a transient disease, but it can also cause gangrene of the colon, requiring emergency surgical exploration. Diagnosis is troublesome and is based on imaging examinations, mainly computerized tomography, which in association with colonoscopy can delineate the distribution pattern and severity of disease. Conclusion: The majority of patients with mild disease have usually complete clinical recovery within a short period. The severe forms of the disease carry high morbidity and mortality rates and prompt surgical intervention is the only way to improve the associated severe prognosis. © Copyright © 2017 Misiakos, Tsapralis, Karatzas, Lidoriki, Schizas, Sfyroeras, Moulakakis, Konstantos and Machairas.

Background: Necrotizing fasciitis (NF) is a group of relatively rare infections, usually caused by two or more pathogens. It affects the skin and subcutaneous tissues of lower and upper limbs, perineal area (Fournier’s gangrene), and the abdominal wall. Early diagnosis and aggressive surgical management are of high significance for the management of this potentially lethal disease. Methods: We conducted a retrospective study in patients who presented, during the last decade, at four University Surgical Departments in the area of Athens, Greece, with an admission diagnosis of NF. Demographic, clinical, and laboratory data were gathered, and the preoperative and surgical treatment, as well as the postoperative treatment was analyzed for these patients. Results: A total of 62 patients were included in the study. The mean age of patients was 63.7 (47 male patients). Advanced age (over 65 years) (P < 0.01) and female sex (P = 0.04) correlated significantly with mortality. Perineum was the mostly infected site (46.8%), followed by the lower limbs (35.5%), the upper limbs, and the axillary region (8.1%). Diabetes mellitus was the most common coexisting disease (40.3%), followed by hypertension (25.8%) and obesity (17.7%). The most common symptom was local pain and tenderness (90.3%). Septic shock occurred in eight patients (12.9%) and strongly correlated with mortality (P < 0.01). Laboratory data were used to calculate the LRINEC score of every patient retrospectively; 26 patients (41.9%) had LRINEC score under 6, 20 patients (32.3%) had LRINEC score 6–8, and 16 patients (25.8%) had LRINEC score >9. Surgical debridement was performed in all patients (mean number of repeated debridement 4.8), and in 16 cases (25.8%) the infected limb was amputated. The mean length of hospital stay was 19.7 days, and the overall mortality rate of our series was 17.7%. Conclusion: Diagnosis of NF requires high suspect among clinicians, as its clinical image is non-specific. Laboratory tests can depict the severity of the disease; therefore, they must be carefully evaluated. Urgent surgical debridement is the mainstay of treatment in all patients; the need of repetitive surgical debridement is undisputed. © Copyright © 2017 Misiakos, Bagias, Papadopoulos, Danias, Patapis, Machairas, Karatzas, Arkadopoulos, Toutouzas, Alexakis, Konstantoulakis, Zografos, Smyrniotis, Kouraklis and Machairas.

IMPORTANCE Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection. OBJECTIVE To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy. DESIGN, SETTING, AND PARTICIPANTS This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece. Patients who had IONM during the procedure (n = 1481) were compared with patients who underwent surgery with nerve visualization alone (n = 1075). All patients underwent indirect laryngoscopy-fiberoptic nasopharyngoscopy both preoperatively and on day 2 after surgery to assess vocal cord motility. MAIN OUTCOMES AND MEASURES Use of IONM and incidence of RLN injury. RESULTS A total of 2556 patients (2028 women and 528 men [5112 RLNs at risk]; mean [SD] age, 51.35 [14.18] years; age range, 18-89 years) underwent total thyroidectomy. Univariate analysis showed that the use of IONM resulted in a significant reduction in RLN injury incidence (3.3%vs 0.7%) with a relative risk reduction of 2.6%(odds ratio [OR], 5.15; 95%CI, 3.12-8.49; number needed to treat, 19). Multivariate logistic regression showed that no use of IONM was an independent risk factor for RLN injury in patients who underwent total thyroidectomy (adjusted OR [AOR], 5.44; 95%CI, 3.26-9.09). Additional risk factors for RLN injury were operative time (AOR, 12.91; 95%CI, 6.66-25.06), maximum diameter greater than 45mmof right thyroid lobe (AOR, 4.91; 95%CI, 3.12-8.56) and left thyroid lobe (AOR, 2.24; 95%CI, 1.39-4.32), extrathyroid extension (AOR, 3.26; 95%CI, 1.62-6.59), incidental parathyroidectomy (AOR, 3.30; 95%CI, 2.13-5.09), and tumor size larger than 10mm(AOR, 3.24; 95%CI, 1.59-6.62). CONCLUSIONS AND RELEVANCE Our findings showed that the use of IONM decreased significantly both temporary and permanent RLN injuries. The technology of IONM is safe and reliable, and this technique is an important adjunct in nerve dissection and functional neural integrity. The routine use of IONM reduced pitfalls and provided guidance for our surgeons in difficult cases, reoperations, and high-risk patients. © Copyright 2016 American Medical Association. All rights reserved.

Backround We investigated the efficacy of thyroglobulin antibodies (TgAb) in detecting malignancy in indeterminate thyroid nodules and evaluated the possible association between TgAb and autoimmunity in papillary thyroid carcinoma (PTC). Methods This retrospective, nonrandomized study included 1,646 patients who had undergone preoperative fine-needle aspiration biopsy to evaluate their thyroid nodules, and then standard total thyroidectomy. Of 194 patients (11.8%) with indeterminate nodules, 61 (31.4%) had PTC and 133 (68.6%) had benign nodules at the final histologic examination. Results Univariate analysis showed that multifocality (P =.002), bilaterality (P =.003), lymph-node metastasis (P =.030), and capsule penetration (P =.003) were significantly associated with positive TgAb in patients with indeterminate cytology and histopathologic diagnosis of PTC. The multivariate analysis showed that TgAb positivity (P

Background Serum creatinine (S-Cr) is the most commonly used marker for the assessment of renal function in kidney transplantation (KTx). Cystatin-C (Cys-C) has been proposed as an alternative marker of renal function for the estimated glomerular filtration rate (eGFR), which seems to be more accurate than S-Cr. The aim of this study was to investigate the relationship between changes in S-Cr, Cys-C, and eGFR measurements in KT patients during the early post-transplantation (post-Tx) period. Methods Fifty consecutive patients, aged 15 to 70 years, were subjected to KT. Blood samples were collected at stable time-points on pre-Tx and post-Tx days 2, 6, and 14 and in the third month. Cys-C and S-Cr levels were measured, and GFR was estimated at all time-points using the Cockcroft-Gault and Le Bricon equations. Results S-Cr and Cys-C levels decreased significantly post-Tx in all time-point determinations compared with pre-Tx levels. Both markers showed a parallel decrease, reaching normal levels in the third month. Estimated GFR post-Tx by S-Cr and Cys-C exhibited a parallel progressive increase without significant difference between the calculations. Correlation between S-Cr and Cys-C in all time-point determinations was positive and of high significance using Pearson's correlation (r = 0.969, P

Backround: Appropriate surgical treatment of papillary thyroid carcinomas (PTC) located in the isthmus remains controversial. The aim of this study was to evaluate the clinicopathological characteristics of PTC of the isthmus compared to tumors located in the thyroid lobes, to identify differences between PTC and microcarcinomas of the isthmus, and to use these findings to establish total thyroidectomy as an appropriate surgical resection for treating these tumors. Methods: We retrospectively analyzed 2239 patients subjected to total thyroidectomy. PTC was diagnosed in 575 patients, of whom 521 had dominant malignant nodule located in thyroid lobes and 54 had a dominant carcinoma located in the isthmus. Patients with isthmic PTC were divided in Group A (n=27) with PTC >10mm and Group B (n=27) with microcarcinoma ≤10mm. Results: In univariate analysis, multifocality (p=0.019), lymph node metastasis (p10mm vs ≤10mm) in isthmus showed that multifocality, bilaterality, histological subtype and lymph node metastasis were not significantly different between the two groups. Conclusions: Our results suggest that PTCs located in the isthmus were more likely to be associated with multifocal disease, lymph node involvement and capsule invasion, than carcinomas in other thyroid regions. Therefore, total thyroidectomy could be considered as an appropriate surgical treatment for papillary carcinomas located in the isthmus regardless of size. © 2015 IJS Publishing Group Limited.

For thousands of years, Chios Gum Mastic (CGM), the resin produced by the trunk of Pistachia lentiscus var Chia, has been used for culinary and medicinal purposes and several therapeutic properties have been attributed to it. CGM has been used in traditional medicine of various nations in the eastern Mediterranean area. This survey was carried out to identify biological mechanisms that could explain traditional usage and recent pharmacological findings. We reviewed the related scientific literature available from the NCBI PUBMED database on CGM studies and on natural products showing peroxisome proliferator-Activated receptor (PPAR) agonist effects. We investigated whether CGM qualifies as a PPAR modulator. A large number of studies demonstrate that CGM has antioxidant, anti-inflammatory, hypolipidemic, and anticancer properties. Recently, the first evidence of CGM antidiabetic effect became known. CGM chemical composition has been extensively analyzed and the presence of several compounds, especially triterpenoids is well documented. Some of them, oleanonic acid, oleanolic acid, and gallic acid are considered to act as PPAR modulators. PPARs are nuclear receptors functioning as transcription factors and thereby controlling cellular functions at the level of gene expression. PPARs are involved in the pathways of significant diseases, such as metabolic syndrome, diabetes mellitus, dyslipidemia, inflammation, atheromatosis, and neoplasias, constituting a key target for pharmacological interventions. This article proposes that the synergistic action of some constituents of CGM on PPARs and more precisely on both PPARs isotypes-α and -γ, may be one of the major biological mechanisms via which CGM exerts its multiple effects. © Copyright 2015, Mary Ann Liebert, Inc. and Korean Society of Food Science and Nutrition 2015.

Purpose: Tissue damage in testicular torsion/detorsion is caused not only by the ischemia, but also by the ischemia/reperfusion injury after detorsion. Erythropoietin and sildenafil are considered to protect against ischemia/reperfusion injury. Here, we studied and compared their actions in testicular torsion/detorsion in adult rats. Methods: Twenty-two adult male Wistar Albino rats were divided into four groups. Rats in group A (n = 5) were sham operated. Rats in group B (n = 5), group C (n = 6) and group D (n = 6) underwent torsion of the right testis and detorsion after 90 min. No pharmaceutical intervention was performed in group B. Erythropoietin (1,000 IU/kg) and sildenafil (0.7 mg/kg) were injected intraperitoneally in groups C and D, respectively, after 60 min of torsion. All animals were killed 24 h after detorsion, and their right testis was extracted, placed into 10 % formalin solution and sent for histopathological examination. The histological changes in the testes were scored according to the four-point grading system proposed by Cosentino et al. Results: All rats in group A had normal testicular architecture (grade 1). The untreated group B had a mean grade of 3.81 (range 3.65-4). The treated groups C (mean grade 3.24; range 3.05-3.45) and D (2.69, range 2.4-2.9) presented statistically significant better results (lower grades) compared with the untreated group B. Group D had significantly better results (lower grades) than group C. Conclusions: The intraperitoneal injection of erythropoietin and sildenafil protects against ischemia/reperfusion injury after testicular torsion and detorsion. Sildenafil may have a stronger action than erythropoietin at the doses used in this study. © 2013 Springer Science+Business Media Dordrecht.

Background. The shipment of human islets (IE) from processing centers to distant laboratories is beneficial for both research and clinical applications. The maintenance of islet viability and function in transit is critically important. Gas-permeable silicone rubber membrane (SRM) vessels reduce the risk of hypoxia-induced death or dysfunction during high-density islet culture or shipment. SRM vessels may offer additional advantages: they are cost-effective (fewer flasks, less labor needed), safer (lower contamination risk), and simpler (culture vessel can also be used for shipment). Method. IE were isolated from two manufacturing centers and shipped in 10-cm2 surface area SRM vessels in temperature- and pressure-controlled containers to a distant center after at least 2 days of culture (n = 6). Three conditions were examined: low density (LD), high density (HD), and a microcentrifuge tube negative control (NC). LD was designed to mimic the standard culture density for IE preparations (200 IE/cm2), while HD was designed to have a 20-fold higher tissue density, which would enable the culture of an entire human isolation in 1-3 vessels. Upon receipt, islets were assessed for viability (measured by oxygen consumption rate normalized to DNA content [OCR/DNA)]), quantity (measured by DNA), and, when possible, potency and function (measured by dynamic glucose-stimulated insulin secretion measurements and transplants in immunodeficient B6 Rag+/- mice). Postshipment OCR/DNA was not reduced in HD vs LD and was substantially reduced in the NC condition. HD islets exhibited normal function postshipment. Based on the data, we conclude that entire islet isolations (up to 400,000 IE) may be shipped using a single, larger SRM vessel with no negative effect on viability and ex vivo and in vivo function. © 2014 by Elsevier Inc. All rights reserved.

Background. Hashimoto thyroiditis (HT) is associated with an increased risk of developing papillary thyroid carcinoma (PTC). The relationship between thyroid autoimmunity and cancer remains controversial. The purpose of this study was to investigate whether the preoperative TgAb could be a potential predictor of PTC in patients with thyroid nodules and to assess whether there is an association of preoperative TgAb with lymph node metastases. Methods. This retrospective, nonrandomised study included 854 patients who underwent standard total thyroidectomy. Benign thyroid nodules were diagnosed in 447 patients, and 407 presented with malignant nodules. The examined parameters included the clinical characteristics, preoperative TSH and TgAb levels, and the histopathological characteristics of the tumour. Results. Tumour size >10 mm (p = 0.01), the presence of PTC (p < 0.001), elevated TSH levels (2.64 ± 1.28 μU/ml vs. 2.09 ± 0.98 μU/ml, p = 0.001), HT (p < 0.001), and lymph node metastasis (p = 0.005) were significantly associated with positive TgAb. Additionally, tumour size >10 mm (p < 0.001), preoperative TgAb positivity (p = 0.003), and elevated TSH levels (TSH > 3.4 μU/ml, p = 0.038) were independent risk factors for PTC based on the multivariate logistic regression analysis. Conclusions. This study showed that TgAb positivity was an independent risk factor for PTC. A positive correlation between TgAb and PTC in patients with indeterminate nodules was existed. Additionally, a positive correlation existed between TgAb and lymph node metastases in patients with PTC. Prospective studies with a larger number of patients and long-term follow-up are needed clarify the potential role of positive serum TgAb in the prediction of PTC. © 2014 Society of Surgical Oncology.

Chios mastic gum (MG), a resin produced from Pistacia lentiscus var. Chia, is reported to possess beneficial cardiovascular and hepatoprotective properties. This study investigated the effect of crude Chios MG on metabolic parameters in diabetic mice. Streptozotocin-induced diabetic 12-week-old male C57bl/6 mice were assigned to three groups: NC (n=9) control; LdM (n=9) animals receiving low dose mastic for 8 weeks (20 mg/kg body weight [BW]); and HdM (n=9) animals receiving high dose mastic (500 mg/kg BW) for the same period. Serum lipid and glucose levels were determined at baseline, at 4 and 8 weeks. Serum total protein, adiponectin, and resistin levels were also measured at the end of the experiment. Histopathological examination for liver, kidney, aorta, and heart lesions was performed. After 4 weeks, MG administration resulted in decreased serum glucose and triglyceride levels in both LdM and HdM, whereas BW levels were reduced in LdM group compared with controls. At the end of the experiment, LdM presented significantly lower serum glucose, cholesterol, low-density lipoprotein cholesterol, and triglyceride levels and improved high-density lipoprotein cholesterol levels compared with control group. HdM group had ameliorated serum triglyceride levels. Hepatic steatosis observed in control group was partially reversed in LdM and HdM groups. MG administered in low dosages improves glucose and lipid disturbances in diabetic mice while alleviating hepatic damage. © 2014, Mary Ann Liebert, Inc.

Background We analyzed the incidence and the clinicopathological characteristics of papillary thyroid microcarcinoma (PTMC) in a high prevalence region of goiter with the purpose to investigate differences between incidental and nonincidental PTMC. Methods A total of 2236 patients who underwent total thyroidectomy from 2001 to 2009 were reviewed retrospectively. Papillary carcinoma was diagnosed in 583 patients. Of these, 339 patients with PTMC were included in the study. Clinicopathological features were evaluated by univariate and multivariate analysis. Results The prevalence of incidental PTMC was 12% of all patients who underwent surgery for thyroid disease. Univariate analysis showed that bilaterality (p =.001), autoimmune thyroid disease (p =.049), size of tumor >5 mm (p

Background. Replacement of β-cells with the use of isolated islet allotransplantation (IT) is an emerging therapy for type 1 diabetics with hypoglycemia unawareness. The current standard protocol calls for a 36-72-hour culture period before IT. We examined 13 clinical islet preparations with ≥2 purity fractions to determine the effect of culture on viability. Methods. After standard islet isolation and purification, pure islet fractions were placed at 37°C with 5% CO2 for 12-24 hours and subsequently moved to 22°C, whereas less pure fractions were cultured at 22°C for the entire duration. Culture density was targeted at a range of 100-200 islet equivalents (IEQ)/cm2 adjusted for purity. Islets were assessed for purity (dithizone staining), quantity (pellet volume and DNA), and viability (oxygen consumption rate normalized to DNA content [OCR/DNA] and membrane integrity). Results. Results indicated that purity was overestimated, especially in less pure fractions. This was evidenced by significantly larger observed pellet sizes than expected and tissue amount as quantified with the use of a dsDNA assay when available. Less pure fractions showed significantly lower OCR/DNA and membrane integrity compared with pure. The difference in viability between the 2 purity fractions may be due to a variety of reasons, including hypoxia, nutrient deficiency, toxic metabolite accumulation, and/or proteolytic enzymes released by acinar tissue impurities that are not neutralized by human serum albumin in the culture media. Conclusions. Current clinical islet culture protocols should be examined further, especially for less pure fractions, to ensure the maintenance of viability before transplantation. Even though relatively small, the difference in viability is important because the amount of dead or dying tissue introduced into recipients may be dramatically increased, especially with less pure preparations. © 2014 by Elsevier Inc. All rights reserved.

Porcine islet xenotransplantation is a promising alternative to human islet allotransplantation. Porcine pancreas cooling needs to be optimized to reduce the warm ischemia time (WIT) following donation after cardiac death, which is associated with poorer islet isolation outcomes. This study examines the effect of four different cooling Methods on core porcine pancreas temperature (n = 24) and histopathology (n = 16). All Methods involved surface cooling with crushed ice and chilled irrigation. Method A, which is the standard for porcine pancreas procurement, used only surface cooling. Method B involved an intravascular flush with cold solution through the pancreas arterial system. Method C involved an intraductal infusion with cold solution through the major pancreatic duct, and Method D combined all three cooling Methods. Surface cooling alone (Method A) gradually decreased core pancreas temperature to

Porcine islet xenotransplantation is emerging as a potential alternative for allogeneic clinical islet transplantation. Optimization of porcine islet isolation in terms of yield and quality is critical for the success and cost-effectiveness of this approach. Incomplete pancreas distention and inhomogeneous enzyme distribution have been identified as key factors for limiting viable islet yield per porcine pancreas. The aim of this study was to explore the utility of magnetic resonance imaging (MRI) as a tool to investigate the homogeneity of enzyme delivery in porcine pancreata. Traditional and novel methods for enzyme delivery aimed at optimizing enzyme distribution were examined. Pancreata were procured from Landrace pigs via en bloc viscerectomy. The main pancreatic duct was then cannulated with an 18-g winged catheter and MRI performed at 1.5-T. Images were collected before and after ductal infusion of chilled MRI contrast agent (gadolinium) in physiological saline. Regions of the distal aspect of the splenic lobe and portions of the connecting lobe and bridge exhibited reduced delivery of solution when traditional methods of distention were utilized. Use of alternative methods of delivery (such as selective re-cannulation and distention of identified problem regions) resolved these issues, and MRI was successfully utilized as a guide and assessment tool for improved delivery. Current methods of porcine pancreas distention do not consistently deliver enzyme uniformly or adequately to all regions of the pancreas. Novel methods of enzyme delivery should be investigated and implemented for improved enzyme distribution. MRI serves as a valuable tool to visualize and evaluate the efficacy of current and prospective methods of pancreas distention and enzyme delivery. © 2014 John Wiley & Sons A/S Published by John Wiley & Sons Ltd.

Incidentally discovered pancreatic lesions that are asymptomatic have become much more common in recent years. It is important to characterize these lesions and to determine which patients can be safely observed and which should undergo an operation, as a substantial proportion of them might be malignant or premalignant. This review focus on the diagnostic approach and management of the different types of cystic and solid incidental pancreatic lesions based on appropriate clinical input, imaging screening and histological criteria. The task of developing guidelines to deal with an incidentally found pancreatic lesion, however, is much more complex and controversial than with other organs incidentalomas. In most series, pancreatic incidentalomas (PIs)2 cm and of cystic appearance are likely to be benign, whereas those2 cm are usually premalignant or malignant. Serous cystadenomas can reach very large size and are usually benign lesions. The presence of a solid mass or a mural nodule in a cystic lesion along with main pancreatic duct dilatation, thick septations and biliary obstruction are considered features suspicious of malignancy. Mucinous cystic neoplasms and intraductal papillary mucinous neoplasms are malignant or lesions of malignant potential and need surgical exploration. Solid lesions are much more likely to be premalignant or malignant and most of patients will undergo resection. The decision to operate rather than follow a solid lesion is a matter of tumor size and of clinical judgment based on the age and patient comorbidities. The present study should serve as a general guide and not applied as strict principles. Key words: cystic pancreatic incidentalomas, diagnostic approach, management, solid pancreatic incidentalomas.

Objective: the extent of thyroidectomy for papillary thyroid microcarcinoma (PtMc) is debatable. this study investigated the rate and predictive factors of bilateral versus unilateral PtMc with the objective of identifying those patients who may benefit from total thyroidec-tomy. design: between January 2001 and December 2008, 2019 patients who underwent total thyroidectomy were examined. A total of 319 patients diagnosed histopathologically as PtMc were included in the study. the predictive value of age at diagnosis, gender, tumor size, multifocality, lymph node metastasis, thyroid capsule invasion and nonincidental diagnosis using univariate and multivariate analyses were retrospectively analyzed. Results: Of the 319 patients with PtMc, 77 (24.1%) presented bilateral disease. In univariate analysis, size of tumor ≥5mm (p

Objectives: Metastatic tumors in the external auditory canal (EAC) are exceptionally rare. These metastases almost always occur in the latter stages of the disease process. Ten cases of metastatic tumors of the EAC have been reported in the literature. We report the first case of a metastatic bronchogenic adenocarcinoma that presented initially as an EAC mass. Methods: We present a case report and a literature review. Results: Although bronchogenic adenocarcinoma not uncommonly metastasizes to the temporal bone, metastasis to the EAC is extremely rare. We report the case of a 62-year-old woman who presented with a 6-week history of swelling in her right EAC and sudden onset of hearing loss. Physical examination revealed a small, polypoid, friable mass originating from the superior-posterior wall of the right EAC. Incision biopsy was performed, and the histopathologic examination of specimens revealed a moderately to poorly differentiated adenocarcinoma compatible with a bronchogenic origin. Conclusions: A patient with an aural mass presents a diagnostic dilemma. Metastatic tumors in the EAC are extremely rare, but they should be included in the differential diagnosis of a mass in this location. © 2013 Annals Publishing Company. All rights reserved.

Recently, initiatives have been undertaken to establish an islet transplantation program in Athens, Greece. A major hurdle is the high cost associated with the establishment and maintenance of a clinical-grade islet manufacturing center. A collaboration was established with the University Hospitals of Geneva, Switzerland, to enable remote islet cell manufacturing with an established and validated fully operational team. However, remote islet manufacturing requires shipment of the pancreas from the procurement to the islet manufacturing site (in this case from anywhere in Greece to Geneva) and then shipment of the islets from the manufacturing site to the transplant site (from Geneva to Athens). To address challenges related to cold ischemia time of the pancreas and shipment time of islets, a collaboration was initiated with the University of Arizona, Tucson, USA. An international workshop was held in Athens, December 2011, to mark the start of this collaborative project. Experts in the field presented in three main sessions: (i) islet transplantation: state-of-the-art and the "network approach"; (ii) technical aspects of clinical islet transplantation and outcomes; and (iii) islet manufacturing - from the donated pancreas to the islet product. This manuscript presents a summary of the workshop. © 2013 John Wiley & Sons A/S.

Background The aggressiveness of papillary thyroid carcinoma (PTC) was evaluated by comparing conventional PTC with papillary thyroid microcarcinoma (PTMC). Risk factors associated with differences in clinical and pathologic features were analyzed to provide appropriate surgical management. Methods A total of 539 patients with papillary carcinoma who underwent total thyroidectomy were retrospectively reviewed. The median follow-up period was 32 months. Results Of 539 patients, 311 (57.7%) had PTMC, and 228 (42.3%) had conventional PTC. No differences between patients with PTMC and those with PTC were observed in age, gender, and multifocality. PTMC was associated with less frequent bilaterality (P =.002), lymph node metastasis (P .05). Conclusions Incidental PTMC had significantly fewer aggressive tumor features. Nonincidental PTMC presented with aggressive characteristics similar to those of conventional PTC and should be treated likewise. The authors suggest routine total thyroidectomy followed by an adequate exploration of the central neck compartment as a safe treatment. © 2013 Elsevier Inc. All rights reserved.

Background There is debate concerning the clinical significance of papillary thyroid microcarcinoma (PTMC), and therefore, the rise in the incidence of PTMC creates management dilemmas. The purpose of this study was to analyse the clinicopathological characteristics of PTMC in an island region that has a high prevalence of goitre and to determine risk factors for the worst prognosis. Materials and methods Data from 1874 patients who underwent a total thyroidectomy between January 2002 and December 2008 were reviewed retrospectively. A total of 276 patients who were diagnosed with PTMC in a final pathology report were included in the study. A PTMC was defined as a papillary thyroid carcinoma with a diameter ≤10mm. Clinicopathological features were evaluated by both univariate and multivariate analyses. Results Of the 276 patients with PTMC, 219 patients (79·3%) were incidentally diagnosed. Two hundred and two patients had carcinomas of ≤5mm, and 74 patients presented with carcinomas that ranged in size from 0·6 to 1·0cm. Lymph node metastasis was diagnosed in 3·5% of patients with tumours ≤5mm, and 21·6% of patients presented tumours >5mm. Upon multivariate analysis, clinically suspected diagnosis, a tumour size >5mm and an age over 45years at diagnosis were independent risk factors for capsule invasion, while tumour multifocality, bilaterality, size of tumour >5mm and thyroid capsule invasion were independent risk factors for lymph node metastasis at diagnosis. Conclusions Patients presenting multifocal, bilateral PTMC with a maximum diameter >5mm and thyroid capsule invasion may have an increased risk of lymph node metastasis. These factors should be considered in the follow-up for these patients. © 2011 The Authors. European Journal of Clinical Investigation © 2011 Stichting European Society for Clinical Investigation Journal Foundation.

INTRODUCTION: Asymptomatic lesions of the pancreas, referred to as 'incidentalomas', have appeared with increased frequency in recent years. Giant incidentalomas have rarely been reported in the literature. PRESENTATION OF CASE: We report herein a rare case of a giant cystic pancreatic incidentaloma measuring 12.7 cm × 8 cm, which was found in an otherwise healthy male patient during a routine genitourinary imaging work-up. The patient underwent a distal pancreatectomy and splenectomy; the pathology report demonstrated a giant serous cystadenoma of the body and tail of the pancreas. DISCUSSION: The management of pancreatic incidentalomas is challenging. While solid lesions almost always warrant surgery, there is ongoing debate concerning the management of cystic lesions that are found incidentally in the pancreas and have no clinical manifestations. CONCLUSION: We report herein an interesting case of a voluminous incidental cystic pancreatic lesion. The appropriate approach and the decision whether to operate or not in such cases can be puzzling to the physician. © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.