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Porto Alegre, Brazil

Kandarakis S.A.,National and Kapodistrian University of Athens | Piperi C.,National and Kapodistrian University of Athens | Moschonas D.P.,National and Kapodistrian University of Athens | Korkolopoulou P.,National and Kapodistrian University of Athens | And 2 more authors.
Experimental Eye Research | Year: 2015

Exogenous intake of glycotoxins present in western diet accelerates the accumulation of advanced glycation end products (AGEs) in multiple organs leading to potential tissue damage. Advanced ageing and diabetic conditions have been associated with AGEs deposition in multiple eye compartments including Bruch's membrane, optic nerve, lens and cornea. However, the impact of dietary AGEs in ocular physiology has not been extensively studied. The present study investigates the direct effects of a high AGE content diet in the ocular tissues of normal rats of different age. Two groups of baby (4 weeks of age) and adult (12 weeks of age) female Wistar rats (n=73) were allocated to high- or low-AGE diet for 3 months. Upon completion of experimental protocol, somatometric, hormonal and biochemical parameters were evaluated in all groups. Circulating and tissue AGE levels were estimated along with their signaling receptor (receptor for AGEs, RAGE) and vascular endothelial growth factor A (VEGF-A) expression in ocular tissues of the different subgroups. High AGE intake was associated with elevated serum AGEs (. p=0.0001), fructosamine (. p=0.0004) and CRP levels (. p=0.0001) compared to low AGE. High peripheral AGE levels were positively correlated with significant increased tissue immunoreactivity of AGEs and RAGE in retinal and uveal tissues as well as retinal VEGF-A expression. Up-regulation of RAGE and VEGF-A expression was observed in the ocular tissue of both baby and adult animals fed with high-AGE diet. Co-localization of AGEs and RAGE staining was observed mainly in the inner retinal layers and the retinal pigment epithelium (RPE) of all groups. VEGF-A expression was elevated in the RPE, the inner nuclear layer and the retinal ganglion cell layer of the animals exposed to high-AGE diet. In conclusion, dietary AGEs intake affects the physiology of ocular tissues by up-regulating RAGE and VEGF-A expression contributing to enhanced inflammatory responses and pathologic neovascularization in normal organisms independent of ageing. © 2015 Elsevier Ltd. Source

Triantafillidis J.K.,Saint Panteleimon General Hospital | Merikas E.,Saint Panteleimon General Hospital | Nikolakis D.,Saint Panteleimon General Hospital | Papalois A.E.,Experimental Research Center
World Journal of Gastroenterology | Year: 2013

Diagnostic and therapeutic endoscopy can successfully be performed by applying moderate (conscious) sedation. Moderate sedation, using midazolam and an opioid, is the standard method of sedation, although propofol is increasingly being used in many countries because the satisfaction of endoscopists with propofol sedation is greater compared with their satisfaction with conventional sedation. Moreover, the use of propofol is currently preferred for the endoscopic sedation of patients with advanced liver disease due to its short biologic half-life and, consequently, its low risk of inducing hepatic encephalopathy. In the future, propofol could become the preferred sedation agent, especially for routine colonoscopy. Midazolam is the benzodiazepine of choice because of its shorter duration of action and better pharmacokinetic profile compared with diazepam. Among opioids, pethidine and fentanyl are the most popular. A number of other substances have been tested in several clinical trials with promising results. Among them, newer opioids, such as remifentanil, enable a faster recovery. The controversy regarding the administration of sedation by an endoscopist or an experienced nurse, as well as the optimal staffing of endoscopy units, continues to be a matter of discussion. Safe sedation in special clinical circumstances, such as in the cases of obese, pregnant, and elderly individuals, as well as patients with chronic lung, renal or liver disease, requires modification of the dose of the drugs used for sedation. In the great majority of patients, sedation under the supervision of a properly trained endoscopist remains the standard practice worldwide. In this review, an overview of the current knowledge concerning sedation during digestive endoscopy will be provided based on the data in the current literature. © 2013 Baishideng. All rights reserved. Source

Triantafillidis J.K.,Inflammatory Bowel Disease Unit | Papalois A.E.,Experimental Research Center
Scandinavian Journal of Gastroenterology | Year: 2014

Total parenteral nutrition (TPN) represents a therapeutic modality that could save the life of a patient with inflammatory bowel disease (IBD) facing severe nutritional problems, by restoring the patient's impaired nutritional status. TPN does not compete with enteral nutrition (EN), the latter being the first choice for all patients having anatomically intact and functionally normal digestive tract. TPN allows bowel rest while supplying adequate calorific intake and essential nutrients, and removes antigenic mucosal stimuli. The value of TPN in malnourished patients with intestinal failure due to CD is beyond doubt. However, it is difficult to suggest TPN as a sole treatment for active CD. An increased rate of remission could not be expected by applying TPN. The utility of TPN is restricted to certain cases involving efforts to close enterocutaneous or other complicated fistulas in patients with fistulizing CD, the treatment of short bowel syndrome following extensive resections for CD, or when EN is impractical for other reasons. There are no advantages of TPN therapy over EN therapy regarding fistula healing. TPN has no influence on the surgical intervention rate and little benefit by bypassing the intestinal passage could be expected. Also TPN shows no advantage if the disease is chronically active. However, an optimal supply of nutrients improves bowel motility, intestinal permeability and nutritional status, and reduces inflammatory reactions. TPN might be associated with an increased risk of adverse events, although TPN undertaken by experienced teams does not cause more complications than does EN. © 2014 Informa Healthcare. Source

Karagianni V.T.,Saint Panteleimon General Hospital | Papalois A.E.,Experimental Research Center | Triantafillidis J.K.,Saint Panteleimon General Hospital
Indian Journal of Surgical Oncology | Year: 2012

Cachexia, malnutrition, significant weight loss, and reduction in food intake due to anorexia represent the most important pathophysiological consequences of pancreatic cancer. Pathophysiological consequences result also from pancreatectomy, the type and severity of which differ significantly and depend on the type of the operation performed. Nutritional intervention, either parenteral or enteral, needs to be seen as a method of support in pancreatic cancer patients aiming at the maintenance of the nutritional and functional status and the prevention or attenuation of cachexia. Oral nutrition could reduce complications while restoring quality of life. Enteral nutrition in the post-operative period could also reduce infective complications. The evidence for immune-enhanced feed in patients undergoing pancreaticoduodenectomy for pancreatic cancer is supported by the available clinical data. Nutritional support during the post-operative period on a cyclical basis is preferred because it is associated with low incidence of gastric stasis. Postoperative total parenteral nutrition is indicated only to those patients who are unable to be fed orally or enterally. Thus nutritional deficiency is a relatively widesoread and constant finding suggesting that we must optimise the nutritional status both before and after surgery. © 2012 Indian Association of Surgical Oncology. Source

Kaptchuk T.J.,Harvard University | Chen K.-J.,Chinese Academy of Sciences | Song J.,Experimental Research Center | Song J.,Chinese Academy of Sciences
Chinese Journal of Integrative Medicine | Year: 2010

In the West, hundreds of randomized controlled trials (RCTs) have been performed testing acupuncture. They include two types: those that compare acupuncture to other therapies, usual care or no treatment (pragmatic trials), and those that have placebo controls (efficacy trials). Acupuncture has generally performed well against other therapies or no treatment, but until recently, the evidence from placebo controlled trials has been considered equivocal or contradictory. A recent series of large RCTs, mostly performed in Germany and also in the US have included both pragmatic and placebo comparisons. The evidence poises a conundrum for the profession of acupuncture. This essay first describes the two types of RCTs used to examine acupuncture and examine the results of two recent large RCTs for chronic low back pain as representative examples of recent large studies. The essay then presents the most common Euro-American acupuncture professions' interpretation of these results. Western responses have included: (1) methodological weaknesses; (2) inappropriateness of placebo controls; (3) questions as to whether acupuncture placebo controls are "inert"; (4) rejection of evidence-based medicine epistemology; (5) discrepancy between acupuncture performed in RCTs with real world acupuncture; (6) enhanced placebo effects of acupuncture; and (7) needs to re-evaluate acupuncture theory. The authors do not necessarily agree with all of these responses; they are presented in an attempt to foster critical discussion. The paper also looks at recent neuroimaging experiments on acupuncture that may point to some worthwhile new avenues of investigation. Finally, the Euro-American health care policy consequences of these recent RCTs are discussed. © The Chinese Journal of Integrated Traditional and Western Medicine Press and Springer-Verlag Berlin Heidelberg 2010. Source

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