Elias Skopelitis

National and Kapodistrian University of Athens, Athínai, Attica, Greece

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Publications (31)41.99 Total impact

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    ABSTRACT: Mediterranean Kaposi's sarcoma (MKS), HIV-related KS (HIV-KS) and immunosuppression-associated KS (IS-KS), caused by human herpes virus 8 (HHV-8), share similar histological features. The aim of this study was to investigate differences in epidermal nerve fibers (ENFs) between the three KS types and controls. Skin biopsies from 23 HIV-KS, 16 MKS, 28 IS-KS patients and 18 controls, age-gender matched, were immunostained with PGP 9.5; ENFs in upper epidermal layer (EL) and penetrating the basement membrane were measured. The mean number of nerve fibers penetrating ENFs was significantly lower in HIV-KS (p < 0.001) compared to all other groups. MKS and IS-KS had comparable ENFs but lower than controls (p < 0.00 1). In the upper EL all groups had comparable ENFs and lower than controls. In conclusion, HIV-KS can be distinguished histologically from other types, by counting ENFs. Moreover, KS is associated with decreased ENFs, which may be a histological reflection of nerve damage. This is even more pronounced in HIV-KS patients and could be explained by a neurotoxic action of HHV-8, HIV, and their co-existence.
    No preview · Article · May 2013 · Archives for Dermatological Research
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    ABSTRACT: Objective: To identify changes in peripheral immune responses in patients with metastatic colorectal cancer (mCRC) treated with irinotecan/5-fluorouracil/leucovorin (IFL) alone or in combination with cetuximab (C-IFL). Methods: Peripheral blood mononuclear cells (PBMCs) collected from healthy donors (n = 20) and patients with mCRC receiving treatment with either IFL (n = 30) or C-IFL (n = 30) were tested for cytokine production upon polyclonal stimulation with anti-CD3 monoclonal antibody, T cell proliferation in the autologous mixed lymphocyte reaction (auto-MLR) and T regulatory cell (Treg) frequency. The respective results were evaluated over two treatment cycles and further assessed in relation to response to treatment. Results: PBMCs prior to treatment exhibited significantly lower production of IL-2, IFN-γ, IL-12 and IL-18 cytokines and lower auto-MLR responses, whereas Treg frequency, IL-4, IL-10 cytokines were increased compared to healthy donors. During treatment, IL-2, IFN-γ, IL-12, IL-18 and auto-MLR responses increased, while Treg frequency and IL-10 secretion decreased significantly compared to the baseline. Responders to treatment exhibited a significantly higher increase in IL-2, IFN-γ, IL-12 and IL-18 production and auto-MLR responses, and higher decrease in IL-4, IL-10 secretion and Treg frequency. Among all patient subgroups analysed, responders to C-IFL demonstrated significantly higher increase in auto-MLR responses, IL-12 and IL-18 secretion and higher decrease in Treg frequency. Conclusion: The disturbed immune parameters observed in patients with mCRC at presentation can be significantly improved during treatment with IFL and this effect can be potentiated by the addition of cetuximab. Monitoring of the peripheral immune system function could be used as surrogate marker in predicting treatment-related outcome.
    Full-text · Article · Feb 2013 · Oncology
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    ABSTRACT: Objectives: to investigate the predictive value of arterial stiffness (AS) estimation for long-term recurrences in patients with type 2 diabetes (DM2) following acute coronary event. Patients and methods: prospective observational study involving 119 DM2 patients without history of coronary heart disease admitted with ST-segment elevation myocardial infarction (STEMI). Medical history, anthropometrics, smoking, HbA1c, lipid profile, troponine-I levels, and left ventricular ejection fraction (LVEF) were recorded. Carotid-femoral pulse wave velocity (cf-PWV) was measured 1 month after discharge. Patients were followed up for 36 months or to reach an end-point: cardiovascular death, acute coronary event, angioplasty or hospitalization for acute heart failure. To facilitate analysis, patients were divided into two groups according to cf-PWV, using the accepted cut-off value of 12m/s. Results: overall, 34 patients had a recurrence. In Kaplan-Meier analysis patients with cf-PWV>12m/s had mean time-to-event 353±43 days compared to 505±115 days for patients with cf-PWV≤12m/s, log rank=0.0252. In multivariate analysis factors independently associated with recurrence were age (66.53±6.87 vs. 61.54±10.77 years, p=0.015), LVEF (41.66±8.21 vs. 47.58±8.11%, p=0.001) and cf-PWV (13.94±2.91 vs. 12.35±2.77m/s, p=0.008). Conclusions: AS estimation in patients with DM2 after STEMI discriminate patients at higher risk for 3-year recurrence, and maybe valuable for distinguishing patients likely to require a more rigorous therapeutic intervention.
    No preview · Article · Dec 2012 · Diabetes research and clinical practice
  • I. Syrios · E. Skopelitis · N. Tsavaris
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    ABSTRACT: Most patients with gastric cancer present with locally advanced or metastatic disease on diagnosis, despite the availability of advanced imaging techniques. Gastrectomy in patients with stage II and III gastric carcinoma may contribute to a complete cure of the disease by total resection of the tumor and alleviation of overt metastatic or residual micrometastatic disease. Technically, this is achieved by allowing a 5cm resection disease-free margin. According to the "R" taxonomy, it is desirable to have a R0 stage post-gastrectomy. Generally, subtotal gastrectomy is more commonly used as it presents similar mortality and morbidity as total gastrectomy. The minimum number of lymph nodes required to be harvested during gastrectomy is 16, which usually allows a more accurate pathologic staging. The most appropriate method of lymph node resection, D1, D2, D3 or satellite node technique is a matter under extensive investigation in the literature. The implementation of splenectomy together with gastrectomy depends on the location of the tumor and the suspected spleen infiltration intraoperatively. Similarly, if pancreas is infiltrated, a partial pancreatectomy should be undertaken. In stage IV gastric carcinoma, gastrectomy serves only palliative purposes to alleviate symptoms, such as pain, hemorrhage, nausea and vomiting, dysphagia and obstruction; it might also reduce morbidity and hospitalizations. The most commonly types of operations used are bypasses, partial or sub-total gastrectomy and total gastrectomy. Clinical trials have shown that gastrectomy is more effective than the various bypasses in respect with duration of pain relief as well as survival. It is generally accepted that for patients in stage IV M0 gastric cancer, surgery should be offered before the initiation of chemo- or radiotherapy. For patients with unresectable disease at time of diagnosis and for those whose disease recurs after primary therapy, gastric cancer is incurable and therapy is palliative. This chapter will present the role of gastrectomy in advanced and/or metastatic gastric carcinoma and will specifically focus on a trial searching for potential prognostic factors of survival in such patients.
    No preview · Article · Aug 2012
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    ABSTRACT: OBJECTIVE: To investigate the underlying mechanisms of polyneuropathy induced by HIV infection or antiretroviral drugs. METHODS: We tested 100 HIV patients (59 with AIDS). Ninety-three patients received antiretroviral drugs. Forty-four were treated with neurotoxic compounds (ddI, ddC, d4T). Nerve conduction velocities and the sympathetic skin response (SSR) in palms and soles were measured in all patients. In skin biopsies (ankle and thigh), the intraepidermal nerve fiber density (IENFD) and the number of epidermal fibers without contact to the basal membrane (fragments) were quantified using PGP9.5 staining. RESULTS: Severity of the disease (CD4+count) correlated to conduction velocities of peroneal (p<0.01, Spearmans rank correlation), sural (p<0.01) and median nerves (p<0.05/p<0.001, sensory/motor). In contrast, the duration of neurotoxic treatment did not impair conduction velocities (p>0.3) but correlated to reduced IENFD in the ankle (r=-0.24, p<0.05). Despite their reduced IENFD, patients with long neurotoxic treatment had a high number of fragments irrespective of their CD4+count. CONCLUSIONS: Neurotoxic treatment appears to primarily impair thin fiber conduction, whereas HIV neuropathy is linked to large fiber impairment and reduction of fragments of nerve fibers. SIGNIFICANCE: These findings emphasize the differential pattern of polyneuropathy in HIV patients caused by the infection or induced by antiretroviral treatment.
    Full-text · Article · Jul 2012 · Clinical neurophysiology: official journal of the International Federation of Clinical Neurophysiology
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    Preview · Chapter · Mar 2012
  • N. Tsavaris · E. Skopelitis · P. Gouveris · C. Kosmas
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    ABSTRACT: Adenocarcinoma of the gallbladder is the sixth most common digestive system malignancy, diagnosed most frequently in the 6th - 7th decades of life, most prevalent in females. Environmental factors, such as carcinogens, infectious agents and diet might have a role in gallbladder tumorigenesis. There is a significant association between gallstones and gallbladder carcinoma. K-ras, p53 and p16 mutations, abnormal cyclin E, and Bc1-2 genes, and increased expression of angiogenesis factor (VEGF) have been implicated in pathogenesis. Resection of gallbladder carcinoma is curative between 10% - 30% of cases. The majority are not candidates for curative resection presenting with advanced or unresectable disease at the time of diagnosis. Survival can be improved by adjuvant radiation and/or chemo-therapy after resection of stage II, III, or IV tumors. Systemic 5-fluorouracil (5-FU)- based chemotherapy showed 12% response, 5-FU with doxorubicin 30%- 40% response, and Gemcitabine as a single agent similar response. Complete remission is rare. Cholangiocarcinomas are intrahepatic or extrahepatic, and are rare compared to hepatocellular carcinoma, comprising less than 10% of primary malignancies of the liver. The incidence of CC is rising worldwide, now being the second most common liver malignancy. Cholangiocarcinomas are diagnosed most frequently in the 5th-6th decades of life with a slight male preponderance. 10%-20% of cholangiocarcinomas occur in cirrhotic patients. Cholangiocarcinomas has also been related to parasitic infections (Opisthorchis sinensis and O. viverrini), polycystic liver disease, choledochal cysts, Caroli syndrome, sclerosing cholangitis, hepatolithiasis, and cholelithiasis. Serum tumor marker CA19-9 and CEA are frequently elevated. Mutations in the p53, K-ras, c-erbB-2, and Bcl-2 may promote tumorigenesis. The majority of intrahepatic cholangiocarcinomas present with large tumors and metastases at diagnosis. The median survival of patients with unresectable disease is 6 to 12 months. The most important factor affecting prognosis is resectability. Resection of a hilar cholangiocarcinoma is associated with better survival. Given the high percentage of unresectable hilar cholangiocarcinomas, adjuvant radiotherapy has been employed with Mitomycin-C, doxorubicin, and 5- fluorouracil. In our study, which aimed to evaluate the weekly gemcitabine administration as chemotherapy in patients with advanced biliary tract and gallbladder cancer, overall response rate was superior in patients with gallbladder cancer (ORR = 35.7%) compared with those patients with biliary duct cancer (ORR = 27.3%), with a significantly longer time to progression of 6.4 months (95% confidence interval (CI), 5.6-7.1 months) versus 3.6 months (95% CI, 2.9-4.3 months; p = 0.03) and a significantly better overall survival of 17.1 months (95% CI, 15.8-18.5 months) versus 11.4 months (95% CI, 10.2-12.6 months, p = 0.021). Toxicities were infrequent. So, weekly administration of gemcitabine provides a safe and effective chemotherapy regimen for patients with advanced cholangiocarcinoma, particularly of gallbladder.
    No preview · Article · Jan 2012
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    ABSTRACT: Background: CHARTER study provided a method for quantifying penetration of antiretroviral (ARV) drugs in the CNS, developing the CNS penetration-effectiveness (CPE) rank by algorithmically combining the individual drug rankings. CPE was associated with CSF viral load. Nevertheless, its association with neurocognitive disorders is ambivalent. The present study aimed to investigate whether the CPE rank might also associate with HIV-related distal sensory polyneuropathy (DSP) Methods: A total of 102 consecutive HIV patients of an outpatient clinic were submitted to clinical examination, electrophysiology, and intraepidermal nerve fiber density (IENFD) evaluation by skin biopsy for the presence of DSP. The HIV status, surrogate markers and antiretroviral history was recorded and the CPE rank of the current ARV regimen was calculated. Statistical analysis was executed using SPSS 15.0 Results: Almost 16% presented with symptomatic DSP and another 36% demonstrated subclinical DSP, recognized by means of electrophysiology and/or IENFD determination. IENFD was associated with more advanced HIV disease, lower nadir CD4 count, and exposure to NRTIs. Mean CPE rank was 1.52±0.77. The CPE rank did not differ in patients with or without DSP. Using the cutoff value of CPE = 2, the regimen was characterized as CNS effective or not effective. Patients under CNS effective regimen were older (41.9±11.6 vs. 38.9±8.3 years, p=0.014), had lower values of IENFD in the calf (3.36±1.75 vs. 6.02±2.47, p=0.02) and worse DSP in terms of conduction velocity, vibration threshold and tendon reflexes. IENFD correlated with the CPE rank values (r=0.22, p=0.039) Conclusion: ARV therapy with increased CNS effectiveness was associated with worse measures of small and large fiber neuropathy, such as IENFD, electrophysiology and clinical findigs, probably attributed to increased age, ARV toxicity, metabolic complications or compartmentalization of HIN in the nervous system
    No preview · Conference Paper · Oct 2011
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    Panagiotis Gouveris · Elias Skopelitis · Nicolas Tsavaris

    Full-text · Chapter · Aug 2011

  • No preview · Article · Jul 2011 · Neuroscience Letters

  • No preview · Article · Jun 2011 · Atherosclerosis Supplements
  • N. Diamantis · M. Zacharakis · I.D. Xynos · E. Skopelitis · N. Tsavaris
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    ABSTRACT: Introduction The aim of this study was to evaluate the predictive value of various factors on survival of patient with stage IIB-III and IV colorectal cancer (CRC). Patients and Methods The records of 541 patients with histologically confirmed CRC - UICC stage IV and 291 UICC stage IIB-III were retrospectively reviewed and a range of clinical and laboratory variables were analysed for their potential relationship with survival. Results For patients in stage IV the mean survival time was 12.8 months [95% confidence interval (CI) 12.0- 13.5]. Patients with worse PS had a hazard ratio (HR) of 2.6 for dying, those with increased CRP (>15 mg/dl) had a HR of 1.48, those with anemia (Hb <8.5 g%) had a HR of 1.58, those with weight loss of >10% of total body weight had a HR of 3.3, those with persistent anorexia 2.64, those with persistent fatigue 2.56, those with hypoalbuminemia 1.27, and those needed blood transfusions 2.0. Patients who received combination chemotherapy had a HR of 2.6, with dermatological complications of therapy associated with 1.26 times lower risk of death.Introduction The aim of this study was to evaluate the predictive value of various factors on survival of patient with stage IIB-III and IV colorectal cancer (CRC). Patients and Methods The records of 541 patients with histologically confirmed CRC - UICC stage IV and 291 UICC stage IIB-III were retrospectively reviewed and a range of clinical and laboratory variables were analysed for their potential relationship with survival. Results For patients in stage IV the mean survival time was 12.8 months [95% confidence interval (CI) 12.0- 13.5]. Patients with worse PS had a hazard ratio (HR) of 2.6 for dying, those with increased CRP (>15 mg/dl) had a HR of 1.48, those with anemia (Hb <8.5 g%) had a HR of 1.58, those with weight loss of >10% of total body weight had a HR of 3.3, those with persistent anorexia 2.64, those with persistent fatigue 2.56, those with hypoalbuminemia 1.27, and those needed blood transfusions 2.0. Patients who received combination chemotherapy had a HR of 2.6, with dermatological complications of therapy associated with 1.26 times lower risk of death. Conclusion Various prognostic parameters of survival and relapse of CRC patients, both clinical and biochemical, may augment selection of patients who might benefit from therapy, thus enabling clinicians to implement the appropriate management and construct the overall care strategy of such patients.
    No preview · Article · Jan 2011
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    ABSTRACT: The aim of this study is to determine the cardiovascular disease (CVD) risk profile of a large UK HIV cohort and how highly active antiretroviral therapy (HAART) affects this. It is a cross-sectional study within a large inner city hospital and neighbouring district hospital. A total of 1021 HIV positive outpatients representative of the complete cohort and 990 who had no previous CVD were included in CVD risk analysis. We recorded demographics, HAART history and CVD risk factors. CVD and coronary heart disease (CHD) risks were calculated using the Framingham (1991) algorithm adjusted for family history. The non-CVD cohort (n = 990) was 74% men, 51% Caucasian and 73.1% were on HAART. Mean age was 41 +/- 9 years, systolic blood pressure 120 +/- 14 mmHg, total cholesterol 4.70 +/- 1.05 mmol/l, high-density lipoprotein-C 1.32 +/- 0.48 mmol/l and 37% smoked. Median CVD risk was 4 (0-56) % in men and 1.4 (0-37) % in women; CHD risks were 3.5 (0-36) % and 0.6 (0-16) %. CVD risk was > 20% in 6% of men and 1% of women and > 10% in 12% of men and 4% of women. CVD risk was higher in Caucasians than other ethnicities; the risk factor contributing most was raised cholesterol. For patients on their first HAART, increased CHD risk (26.2% vs. 6.5%; odds ratio 4.03, p < 0.001) was strongly related to the duration of therapy. Conclusions: Modifiable risk factors, especially cholesterol, and also duration of HAART, were key determinants of CVD risk. Regular CHD and/or CVD risk assessment should be performed on patients with HIV, especially during HAART therapy. The effect of different HAART regimens on CHD risk should be considered when selecting therapy.
    Full-text · Article · Aug 2010 · International Journal of Clinical Practice
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    ABSTRACT: Oxidized low-density lipoprotein (oxLDL) is a pivotal factor of the atheromatous process. Statins reduce atheromatosis and cardiovascular risk. The aim of the present study was to investigate the effect of statin therapy on circulating oxLDL and the possible impact of such effect on stenosis due to carotid artery atheromatosis. A total of 100 patients (76 males, median age 68 years) with carotid atheromatosis were enrolled. Those with stenosis >70% (n=50) were pre-treated with carotid angioplasty, whereas those with <70% were treated conservatively. Both groups were given low-dose atrorvastatin, tittered to maintain LDL cholesterol <100 mg/dL. Anthropometrics, complete lipid profile, and oxLDL were obtained in 1, 3, 6 and 12 months. Stenosis was evaluated by ultrasonography at baseline and 12 months. Lipid profile significantly improved at 12 months and oxLDL fell from 62.26+/-22.03 mg/dL at baseline to 44.49+/-21.75 mg/dL at 12 months (P<0.001). In the invasively pretreated group no restenosis was noticed; in the conservatively treated group a significant reduction of stenosis was demonstrated (47.6+/-13.2% vs 37.7+/-15.7%, P<0.001). The decrease of oxLDL correlated with the reduction of stenosis (r=0.17, P=0.018). In multivariate analysis, oxLDL was an independent risk factor for re-stenosis (hazard ratio=4.319, P<0.001). A marked reduction of oxLDL was shown in patients with carotid atheromatosis treated with low-dose atorvastatin. Moreover, oxLDL could be a measure of the degree of stenosis in such patients.
    No preview · Article · Aug 2010 · International angiology: a journal of the International Union of Angiology

  • No preview · Article · Jul 2010

  • No preview · Article · Jun 2010 · Atherosclerosis Supplements

  • No preview · Article · Jun 2010 · Atherosclerosis Supplements

  • No preview · Article · Jun 2010 · Atherosclerosis Supplements
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    ABSTRACT: Arterial stiffness (AS) is a risk marker of atherosclerosis and coronary artery disease, yet its association with metabolic syndrome (MS) in diabetic patients is not established. The aim of this study was to investigate possible association of MS or its components with AS in diabetic population and to identify the MS definition which better correlates with AS. Overall, 98 type-2 diabetic men, mean age 64+/-10 years, were classified into groups according to the presence of MS, using the National Cholesterol Educational Program-Adult Treatment Panel III (NCEP-ATPIII) and International Diabetes Federation (IDF) definition. AS was estimated using carotid-femoral pulse wave velocity (PWV). For between-group comparisons and correlations between MS and it's components with AS, t-test and Pearson's correlation coefficient were employed, respectively. For multivariable analysis a linear regression model was used. PWV in those with (72.5%) and without NCEP-ATPIII MS was 13.4+/-2.9 vs 12+/-3.2 m/s (P=NS) and in those with (79.6%) and without IDF MS 13.6+/-2.8 vs 11+/-3.2 m/s (P=0.036). AS positively correlated with IDF MS (r=0.332, P=0.036), increased blood pressure (r=0.324, P=0.037), and the combination of increased waist circumference according to IDF with hypertension (r=0.380, P=0.013); no correlation with NCEP-ATPIII MS was detected. In multivariable analysis, age, hypertension, and IDF MS were independently associated with AS (beta=2.52, P=0.039). IDF MS is independently associated with increased AS in diabetic men. Additionally, abdominal obesity, hypertension and older age were likely to be associated with increased AS. PWV measurement may be indicated in such patients.
    No preview · Article · Dec 2009 · International angiology: a journal of the International Union of Angiology
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    ABSTRACT: Most patients with pancreatic adenocarcinoma are diagnosed with locally advanced (unresectable) or metastatic disease. The aim of this study was to investigate possible prognostic factors of survival in such patients. Two hundred and fifteen patients were studied retrospectively. Twenty-four potential prognostic variables (demographics, clinical parameters, biochemical markers, treatment modality) were examined. Mean survival was 29.0 weeks. 21.9% survived more than 36 weeks. On multivariate analysis, 10 factors had an independent effect on survival: tumour localisation, metastasis, performance status, jaundice, weight loss, C reactive protein, CEA, CA 19-9, palliative surgery and chemotherapy. Patients managed only with palliative care had a hazard ratio of 8.94 versus those offered a combination of palliative surgery and chemotherapy. Many factors could be used as predictors of survival in patients with advanced or metastatic pancreatic cancer. Chemotherapy and palliative surgery are associated with increased survival, and should be offered to all eligible patients.
    Preview · Article · Jan 2008 · Anticancer research

Publication Stats

194 Citations
41.99 Total Impact Points

Institutions

  • 2007-2013
    • National and Kapodistrian University of Athens
      • Division of Pathophysiology
      Athínai, Attica, Greece
    • Κωνσταντοπούλειο νοσοκομείο Νέας Ιωνίας (Η Αγία Όλγα)
      Athínai, Attica, Greece
  • 2005-2012
    • Laiko Hospital
      • Department of Radiology
      Athínai, Attica, Greece
  • 2010
    • General Hospital of Nikaia, Piraeus "Agios Panteleimon ''
      Le Pirée, Attica, Greece
  • 2008
    • Harokopion University of Athens
      Athínai, Attica, Greece