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| 1 | Delayed gastric emptying is associated with pylorus-preserving but not classical Whipple pancreaticoduodenectomy:A review of the literature and critical reappraisal of the implicated pathomechanism显示文摘Pylorus-preserving pancreaticoduodenectomy (PPPD) is nowadays considered the treatment of choice for periampullary tumors, namely carcinoma of the head, neck, or uncinate process of the pancreas, the ampulla of Vater, distal common bile duct or carcinoma of the peri-Vaterian duodenum. Delayed gastric emptying (DGE) comprises one of the most troublesome complications of this procedure. A search of the literature using Pubmed/Medline was performed to identify clinical trials examining the incidence rate of DGE following standard Whipple pancreaticoduodenectomy (PD) vs PPPD. Additionally we performed a thorough in-depth analysis of the implicated pathomechanism underlying the occurrence of DGE after PPPD. In contrast to early studies, the majority of recently performed clinical trials demonstrated no significant association between the occurrence of DGE with either PD or PPPD. PD and PPPD procedures are equally effective operations regarding the postoperative occurrence of DGE. Further randomized trials are required to investigate the effi cacy of a recently reported (but not yet tested in large- scale studies) modifi cation, that is, PPPD with antecolic duodenojejunostomy. | Kosmas I Paraskevas Costas Avgerinos Costas Manes Dimitris Lytras Christos Dervenis | 2006 | World Journal of Gastroenterology2006，12，37： | 16 |
| 2 | How to identify which patients with asymptomatic carotid stenosis could benefit from endarterectomy or stenting显示文摘Offering routine carotid endarterectomy(CEA)or carotid artery stenting(CAS)to patients with asymptomatic carotid artery stenosis(ACS)is no longer considered as the optimal management of these patients.Equally suboptimal,however,is the policy of offering only best medical treatment(BMT)to all patients with ACS and not considering any of them for prophylactic CEA.In the last few years,there have been many studies aiming to identify reliable predictors of future cerebrovascular events that would allow the identification of patients with high-risk ACS and offer a prophylactic carotid intervention only to these patients to prevent them from becoming symptomatic.All patients with ACS should receive BMT.The present article will summarise the evidence suggesting ways to identify these high-risk asymptomatic individuals,namely:(1)microemboli detection on transcranial Doppler,(2)plaque echolucency on Duplex ultrasound,(3)progression in the severity of ACS,(4)silent embolic infarcts on brain CT/MRI,(5)reduced cerebrovascular reserve,(6)increased size of juxtaluminal hypoechoic area,(7)identification of intraplaque haemorrhage using MRI and(8)carotid ulceration.The evidence suggests that approximately 10%-15%of patents with asymptomatic stenosis might benefit from intervention;this will become more clear after publication of ongoing studies comparing stenting or endarterectomy with best medical therapy.In the meantime,no patient should be offered intervention unless there is evidence of high risk of ipsilateral stroke,from modalities such as those discussed here. | Kosmas I Paraskevas Frank J Veith J David Spence | 2018 | Stroke & Vascular Neurology2018，3，2： | 10 |
| 3 | Retinol-binding protein, acute phase reactants and Helicobacter pylori infection in patients with gastric adenocarcinoma显示文摘AIM: To determine the serum levels of c-reactive protein (CRP), transferrin (TRF), a2-macroglobulin (A2M),ceruloplasmin (CER), a1-acid glycoprotein (AAG), prealbumin (P-ALB) and retinol-binding protein (RBP) in gastric carcinoma patients and to explore their possible correlation with underlying Helicobacter pylori (H pylon)infection.METHODS: We measured the serum levels of CRP, TRF,A2M, CER, AAG, P-ALB, and RBP in 153 preoperative patients (93 males; mean age: 63.1±11.3 years) with non-cardia gastric adenocarcinoma and 19 healthy subjects.RESULTS: The levels of CRP, CER, RBP, andAAG in cancer patients were significantly higher than those in healthy controls (P<0.0001), while no difference was found regarding the TRF, P-ALB, and A2M levels. Cancer patients with H pylori infection had significantly lower RBP values compared to non-infected ones (P<0.0001)and also higher values of CRP and AAG (P = 0.09 and P = 0.08, respectively).CONCLUSION: High serum levels of CRP, CER and AAG in cancer patients do not seem to be related to H pylori infection. Retinol-binding protein seems to discriminate between infected and non-infected patients with gastric carcinoma. Further studies are needed to explore if it is directly involved in the pathogenesis of the disease or is merely an epiphenomenon. | Nicolas Tsavaris Christos Kosmas Petros Kopterides Dimitrios Tsikalakis Hlias Skopelitis Fotini Sakelaridi Nikitas Papadoniou Michalis Tzivras Vasilios Balatsos Christos Koufos Athanasios Archimandritis | 2005 | World Journal of Gastroenterology2005，11，45： | 7 |
| 4 | Gastric neuroendocrine neoplasms type 1: A systematic review and meta-analysis显示文摘BACKGROUND To date, the histopathological parameters predicting the risk of lymph node (LN) metastases and local recurrence, associated mortality and appropriateness of endoscopic or surgical resection in patients with gastric neuroendocrine neoplasms type 1 (GNENs1) have not been fully elucidated. AIM To determine the rate of LN metastases and its impact in survival in patients with GNEN1 in relation to certain clinico-pathological parameters. METHODS The PubMed, EMBASE, Cochrane Library, Web of Science and Scopus databases were searched through January 2019. The quality of the included studies and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS) in accordance with the Cochrane guidelines. A random effects model and pooled odds ratios (OR) with 95%CI were applied for the quantitative meta-analysis. RESULTS We screened 2933 articles. Thirteen studies with 769 unique patients with GNEN1 were included. Overall, the rate of metastasis to locoregional LNs was 3.3%(25/769). The rate of LN metastases with a cut-off size of 10 mm was 15.3% for lesions > 10 mm (vs 0.8% for lesions < 10 mm) with a random-effects OR of 10.5 (95%CI: 1.4 -80.8;heterogeneity: P = 0.126;I2 = 47.5%). Invasion of the muscularis propria was identified as a predictor for LN metastases (OR: 17.2;95%CI: 1.8-161.1;heterogeneity: P = 0.165;I2 = 44.5%), whereas grade was not clearly associated with LN metastases (OR: 2;95%CI: 0.3-11.6;heterogeneity: P = 0.304;I2 = 17.4%). With regard to GNEN1 local recurrence, scarce data were available. The 5-year disease-specific survival for patients with and without LN metastases was 100% in most available studies irrespective of the type of intervention. Surgical resection was linked to a lower risk of recurrence (OR: 0.3;95%CI: 0.1-1.1;heterogeneity: P = 0.173;I2 = 31.9%). The reported complication rates of endoscopic and surgical intervention were 0.6 and 3.8%, respectively. CONCLUSION This meta-analysis confirms that tumor size ≥ 10 mm and invasion of the muscularis propria are linked to a higher risk of LN metastases in patients with GNEN1. Overall, the metastatic propensity of GNEN1 is low with favorable 5- year disease-specific survival rates reported;hence, no clear evidence of the prognostic value of LN positivity is available. Additionally, there is a lack of evidence supporting the prediction of local recurrence in GNEN1, even if surgery was more often a definitive treatment. | Apostolos V Tsolakis Athanasia Ragkousi Miroslav Vujasinovic Gregory Kaltsas Kosmas Daskalakis | 2019 | World Journal of Gastroenterology2019，25，35： | 6 |
| 5 | Albuminuria as a marker of arterial stiffness in chronic kidney disease patients显示文摘AIM:To access the association between albuminuria levels and arterial stiffness in non-diabetic patients with hypertension and chronic kidney disease(CKD) stages 1-2,treated with renin angiotensin blockade agents plus other hypertensive drugs when needed.METHODS:One hundred fifteen patients [median age 52 years(68% males)] were consequently enrolled in the study.For each patient,we recorded gender,age,body mass index(BMI),peripheral systolic blood pressure(p SBP),peripheral diastolic blood pressure,peripheral pulse pressure,central systolic blood pressure(c SBP),central diastolic blood pressure(c DBP),central pulse pressure(c PP),hematocrit,hemoglobin,hs CRP,total cholesterol triglycerides,high-density lipoprotein-C,low-density lipoprotein-C,calcium,phosphorus,parathormone,and albumin,as well as 24 h urine albumin excretion.According to 24-h urine albumin collection,patients were then classified as those with moderately increased albuminuria(formerly called macroalbuminuria)(≤ 300 mg/d) and those with severely increased albuminuria(formerly called macroaluminuria(> 300 mg/d).We considered aortic stiffness(AS) indices [carotid femoral pulse wave velocity(PWVc-f) and augmentation index(AIx)] as primary outcomes ofthe study.We explored potential correlations between severely increased albuminuria and AS indices using a multiple linear regression model.RESULTS:Fifty-eight patients were included in the moderately increased albuminuria group and 57 in the severely increased albuminuria.Blood pressure measurements of the study population were 138 ± 14/82 ± 1.3 mm Hg(systolic/diastolic).There were no significant differences in age,sex,and BP measurements between the two groups.Patients with severely increased albuminuria had higher PWV and AIx than patients with moderately increased albuminuria(P < 0.02,P < 0.004,respectively).In addition these patients exhibited higher BMI(P < 0.03),hs CRP(P < 0.001),and fibrinogen levels(P < 0.02) compared to patients with moderately increased albuminuria.In multivariate linear regression analysis,severely increased albuminuria(β = 1.038,P < 0.010) p SBP(β = 0.028,P < 0.034) and Ht(β = 0.171,P = 0.001) remained independent determinants of the increased PWVc-f.Similarly,severely increased albuminuria(β = 4.385,P < 0.012),c SBP(β = 0.242,P < 0.001),c PP(β = 0.147,P < 0.01) and Ht levels(β = 0.591,P < 0.013) remained independent determinants of increased AIx.CONCLUSION:These findings demonstrate an independent association between AS indices and severely increased albuminuria in non-diabetic,hypertensive patients with CKD stages 1-2 treated with renin angiotensin aldosterone system blockers. | Rigas G Kalaitzidis Despina P Karasavvidou Athina Tatsioni Kosmas Pappas Giorgos Katatsis Angelos Liontos Moses S Elisaf | 2015 | World Journal of Nephrology2015，4，3： | 5 |
| 6 | Clinicopathological differences and correlations between right and left colon cancer显示文摘BACKGROUND The differences in histopathology and molecular biology between right colon cancer(RCC)and left colon cancer(LCC)were first reported in the literature by Bufill in 1990.Since then,a large number of studies have confirmed their differences in epidemiology,clinical presentation,comorbidities and biological behaviours,which may be related to the difference in prognosis and overall survival(OS)between the two groups.AIM To investigate statistically significant differences between Greek patients with LCC and RCC.METHODS The present observational study included 144 patients diagnosed with colon cancer of any stage who received chemotherapy in a Greek tertiary oncology hospital during a 2.5-year period.Clinical information,comorbidities,histopathologic characteristics and molecular biomarkers were collected from the patients’medical records retrospectively,while administered chemotherapy regimens,targeted agents,progression-free survival(PFS)periods with first-and second-line chemotherapy and OS were recorded retroactively and prospectively.Data analysis was performed with the SPSS statistical package.RESULTS Eighty-six males and 58 females participated in the study.One hundred(69.4%)patients had a primary lesion in the left colon,and 44(30.6%)patients had a primary lesion in the right colon.Patients with RCC were more likely to display anaemia than patients with LCC[odds ratio(OR)=3.09],while LCC patients were more likely to develop rectal bleeding(OR=3.37)and a feeling of incomplete evacuation(OR=2.78)than RCC patients.Considering comorbidities,RCC patients were more likely to suffer from diabetes(OR=3.31)and coronary artery disease(P=0.056)than LCC patients.The mucinous differentiation rate was higher in the right-sided group than in the left-sided group(OR=4.49),as was the number of infiltrated lymph nodes(P=0.039),while the percentage of high-grade differentiation was higher in the group of patients with left-sided colon cancer than in RCC patients(OR=2.78).RAS wild-type patients who received anti-epidermal growth factor receptor(EGFR):Treatment experienced greater benefit(PFS:16.5 mo)than those who received anti-vascular endothelial growth factor treatment(PFS:13.7 mo)(P=0.05),while among RAS wild-type patients who received anti-EGFR treatment,LCC patients experienced greater benefit(PFS:15.8 mo)than the RCC subgroup(PFS:5.5 mo)in the first-line chemotherapy setting(P=0.034).BRAF-mutant patients had shorter PFS(9.3 mo)than BRAF wild-type patients(14.5 mo)(P=0.033).RCC patients showed a shorter tumour recurrence period(7.7 mo)than those with LCC(14.5 mo)(P<0.001),as well as shorter(OS)(58.4 mo for RCC patients;82.4 mo for LCC patients)(P=0.018).CONCLUSION RCC patients present more comorbidities,worse histological and molecular characteristics and a consequently higher probability of tumour recurrence,poor response to targeted therapy and shorter OS than LCC patients. | Ioannis Kalantzis Afroditi Nonni Kitty Pavlakis Eumorphia-Maria Delicha Konstantinos Miltiadou Christos Kosmas Nikolaos Ziras Konstantinos Gkoumas Harikleia Gakiopoulou | 2020 | World Journal of Clinical Cases2020，8，8： | 4 |
| 7 | Aerobic vs anaerobic exercise training effects on the cardiovascular system显示文摘Physical exercise is one of the most effective methods to help prevent cardiovascular(CV) disease and to promote CV health. Aerobic and anaerobic exercises are two types of exercise that differ based on the intensity, interval and types of muscle fibers incorporated. In this article, we aim to further elaborate on these two categories of physical exercise and to help decipher which provides the most effective means of promoting CV health. | Harsh Patel Hassan Alkhawam Raef Madanieh Niel Shah Constantine E Kosmas Timothy J Vittorio | 2017 | World Journal of Cardiology2017，9，2： | 2 |
| 8 | Incidence of community‐acquired pneumonia in children caused by Mycoplasma pneumoniae: Serological results of a prospective, population‐based study in primary health care显示文摘 | MattiKorppi TarjaHeiskanen‐Kosma MarjaanaKleemola | 2004 | Respirology2004，，1： | 2 |
| 9 | Weekly Gemcitabine for the Treatment of Biliary Tract and Gallbladder Cancer显示文摘 | Nikolas Tsavaris Christos Kosmas Panagiotis Gouveris Kostadinos Gennatas Aris Polyzos Despina Mouratidou Heracles Tsipras Helias Margaris George Papastratis Evanthia Tzima Nikitas Papadoniou Gavrilos Karatzas Efstathios Papalambros | 2004 | Investigational New Drugs2004，，2： | 2 |
| 10 | Nuclear expression of Snaill in borderline and malignant epithelial ovarian tumours is associated with tumour progression显示文摘 | Tubkanen H Soini Y Kosma VM | 2009 | BMC Cancer2009，9，： | 1 |
| 11 | Simulated annealing for optimal ship routing显示文摘 | KOSMAS O T VIACHOS D S | 2008 | Computers and Operations Research2008，35，3： | 1 |
| 12 | 显示文摘 | Kosmas C Tsavaris N Vadiaka M | 2001 | Cancer2001，92，11： | 1 |
| 13 | Apoptosis in breast cancer as related histopathological characteristics and prognosis显示文摘 | Lipponen P Aaltomaa S Kosma V A | 1994 | European Journal of Cancer1994，30，14： | 1 |
| 14 | Low-dose HCG may improve pregnancy rates and lower OHSS in antagonist cydes:ameta- analysis 显示文摘 | KOSMAS IP ZIKOPOULOS K GEORGLOU L | 2009 | Reproductive BioMedicine Online2009，19，5： | 1 |
| 15 | Hyaluronan in human tumors:pathobiological and prognostic messages from cellassociated and stromal hyaluronan显示文摘 | Tammi R H Kultti A Kosma V M | 2008 | Semin Cancer Biol2008，18，： | 1 |
| 16 | Apoptosis in breast cancer as related to histopathologieal characteristics and prognosis显示文摘 | LIPPONEN P ALTOMAA S KOSMA VM | 1994 | Fur J Cancer1994，14，： | 1 |
| 17 | Classroom furniture dimensions and anthropometric measures in primary school显示文摘 | GEORGIA P KOSMAS C ANTHOULA P | 2004 | Applied Ergonomics2004，35，2： | 1 |
| 18 | Contribution of Psychological Factors in Dropping out from Chronic Obstructive Pulmonary Disease Rehabilitation Programs显示文摘 | Athanasios Tselebis Epaminondas Kosmas Dionisios Bratis Argiro Pachi Ioannis Ilias Maria Harikiopoulou Elpida Theodorakopoulou Konstantinos Velentzas Silvia Dumitru Georgios Moussas Nikolaos Siafakas Nikolaos Tzanakis Mitja Lainscak | 2014 | BioMed Research International2014，，： | 1 |
| 19 | Hypersensitivity reactions to carboplatin administration are common but not always severe : a 10-year experience 显示文摘 | Polyzos A Tsavaris N Kosmas C | 2001 | Oncology2001，61，2： | 1 |
| 20 | Expression of CD44 standard and variant-v6 proteins in transitional cell bladder tumors and their relation to prognosis during a long-term follow-up显示文摘 | Lipponen P Aaltoma S Kosma V M | 1998 | J Pathol1998，186，20： | 1 |
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