Women in spine surgery: can we change the society?

BACKGROUND: Although the number of educated women and physicians, and especially neurosurgeons, is increasing worldwide, the educational opportunities, careers, and beliefs concerning female neurosurgeon's status and abilities are undermined. To date, reported studies have focused on the conditions of the work environment, work-life balance, and the academic career of female neurosurgeons. In this study, we aimed to report the patients' viewpoint and how they choose spine physicians. METHODS: We conducted an international survey based on 19 questions in four languages (Bulgarian, Greek, English, and German). The responses of 413 individuals, unrelated to the medical field (sex, 315 female and 115 male individuals; one individual did not answer the question regarding the gender), were obtained. Except for the question regarding the patient's preference for the physician sex, the survey aimed to examine the factors that might be contributing to this choice, including education, age, heard/read recommendations/advertisements, knowledge regarding the work of the neurosurgeons/orthopedists, and their difference regarding spine surgery. RESULTS: The majority of the participants responded that they prefer male surgeons to treat their spine. The results showed a significant correlation between the choice of a male spine surgeon and heard/read advertisements/recommendations and knowledge regarding the work of the neurosurgeon. Despite the fact that education was not related to physician selection, it was an indirect factor that led to the final choice. CONCLUSION: Women in surgery, mainly in neurosurgery, are being treated by society in an unequal way. Female surgeons are still discriminated because of their gender. The most patients prefer female physicians to talk to, but still believe that they are incapable to perform spine surgery. We cannot stop this until we change our mindset and perception of reality.

Oxidative stress and female infertility: the role of follicular fluid soluble receptor of advanced glycation end-products (sRAGE) in women with endometriosis.

Oxidative Stress (OS) relates to the pathophysiology of endometriosis by activation of the inflammation process in the ovary, abdomen, peritoneum and endometrium. Advanced Glycation end-products (AGEs) cause oxidative damage to the follicles of the ovary. This study aims to investigate the correlation of follicular fluid soluble receptor of AGEs (FF sRAGE) with fertility-related parameters in infertile women with endometriosis. From January 2012 to July 2015 twenty-four women diagnosed with mild to moderate endometriosis aged 28-38 years underwent assisted reproduction. sRAGE levels measured in FF were related to lifestyle factors, sociodemographic characteristics, gynaecological and obstetric parameters, hormonal status and fertilization. sRAGE was inversely associated with BMI (r = -0.503, p = 0.012). No significant association of sRAGE with age (p = 0.714) or alcohol consumption (p = 0.882) was found. Pearson's r correlation coefficient revealed that sRAGE was positively associated with serum AMH (r = 0.518, p = 0.009), FF AMH (r = 0.630, p = 0.001), number of follicles >15mm (r = 0.601, p = 0.002), total number of follicles aspirated (r = 0.698, p < 0.001), total number of MII oocytes obtained, (r = 0.757, p < 0.001) and the number of embryos with good embryo scoring (suitable for ET) (r = 0.522, p = 0.009). It seems that measurement of FF RAGE might be a useful predictive marker for IVF success in infertile women with endometriosis undergoing assisted reproduction.

Viral-induced inflammation can lead to adverse pregnancy outcomes.

INTRODUCTION: Parvoviruses are DNA viruses of small size. There have been a number of reports indicating the possible effects of B19 infections during pregnancy. These effects include spontaneous abortions, stillbirth, fetal damage, and quite often, fetal anemia with hydrops fetalis.

Differential apoptotic activity in trophoblast of spontaneous abortions and normal pregnancies.

INTRODUCTION: Apoptosis is a key process during normal trophoblastic development and, consequently, the whole gestation. However, in trophoblastic differentiation in spontaneous abortions apoptosis has been hardly investigated. Therefore, the aim of the study was to investigate the correlation between apoptotic frequency in trophoblast and spontaneous abortion incidences. MATERIAL AND METHODS: A total of 72 trophoblastic tissue samples were immunohistochemically examined. 42 of 72 derived from first-trimester spontaneous abortions and the remaining 30 from elective terminations during the same trimester of pregnancy. TUNEL assay and M30 marker were used for apoptosis evaluation by immunohistochemistry. RESULTS: Comparative study of tissues from spontaneous abortions and elective pregnancy terminations demonstrated increased expression of both apoptotic markers in tissues derived from spontaneous abortions compared to normal pregnancies. In addition, statistical analysis correlated maternal age and gravidity with increased spontaneous abortion incidences. Moreover, both M30 and TUNEL staining were significantly correlated with maternal age and primigravidity in spontaneous abortion cases. CONCLUSIONS: Our data proved that elevated apoptotic activity during the first pregnancy trimester is clearly involved in spontaneous abortions. Moreover, two well-established apoptotic markers revealed high statistical significance in the evaluation of post-abortive tissues.

Influence of Social and Demographic Factors on the Montreal Cognitive Assessment (MoCA) Test in Rural Population of North-Eastern Greece.

The current study aims to investigate the influence of socio-demographic factors on the Montreal Cognitive Assessment (MoCA) test results in a Greek-speaking population consisting of a sample of healthy older adults, individuals with mild cognitive impairment (MCI), and dementia patients in rural areas. In addition, the current research focuses on determining optimal cut-off scores for the clinical diagnoses of MCI and dementia. The data originated from 283 participants in an ongoing registry of the Neurology Department of Alexandroupolis University Hospital, recruited in different rural districts of north-eastern Greece, across a broad range of educational and occupational categories. Total and sub-domain scores for the MoCA varied significantly, according to sex, age, and education, among the three study groups. The optimal cut-off points of 25/26 for the MoCA total score was determined to classify healthy subjects from individuals with MCI, 24 to discriminate healthy participants from demented, and 21/22 to discriminate subjects with MCI from dementia. Overall, the clinical use of the MoCA test can be supported by demographically adjusted standard scores in a Greek-speaking rural population. These findings serve to improve the diagnostic accuracy and utility of the MoCA test.

Association of the Modified Mediterranean Diet Score (mMDS) with Anthropometric and Biochemical Indices in US Career Firefighters.

The Mediterranean diet is associated with multiple health benefits, and the modified Mediterranean Diet Score (mMDS) has been previously validated as a measure of Mediterranean diet adherence. The aim of this study was to examine associations between the mMDS and anthropometric indices, blood pressure, and biochemical parameters in a sample of career firefighters. The participants were from Indiana Fire Departments, taking part in the "Feeding America's Bravest" study, a cluster-randomized controlled trial that aimed to assess the efficacy of a Mediterranean diet intervention. We measured Mediterranean diet adherence using the mMDS. Anthropometric, blood pressure, and biochemical measurements were also collected. Univariate and multivariate linear regression models were used. In unadjusted analyses, many expected favorable associations between the mMDS and cardiovascular disease risk factors were found among the 460 firefighters. After adjustment for age, gender, ethnicity, physical activity, and smoking, a unitary increase in the mMDS remained associated with a decrease of the total cholesterol/HDL ratio (ß-coefficient -0.028, p = 0.002) and an increase of HDL-cholesterol (ß-coefficient 0.254, p = 0.004). In conclusion, greater adherence to the Mediterranean diet was associated with markers of decreased cardiometabolic risk. The mMDS score is a valid instrument for measuring adherence to the Mediterranean diet and may have additional utility in research and clinical practice.

The results of a stepwise implementation of a fast-track program in total hip and knee replacement patients.

BACKGROUND: Several reports have shown that enhanced recovery or fast-track (FT) regime introduction in patients undergoing total knee replacement (TKR) and total hip replacement (THR) results in significant reduction in length of stay (LOS) with no associated increase of complications or readmission rate. Despite that, FT programs for arthroplasty have has not been uniformly recognized or accepted by many orthopaedic surgeons and there is still no consensus on the best implementation process. The aim of this study was to report the results of a stepwise implementation of a FT regime in TKR and THR patients in a general orthopaedic department. MATERIAL AND METHODS: This was a retrospective study of prospectively collected data (from 2014 to 2017) concerning all consecutive unselected patients who underwent TKR or THR on Monday morning. At stage 1 the rehabilitation and physiotherapy component was changed, at stage 2 and 3 a patient's blood management program and a pain management program were prospectively recorded (i.e. respectively Patients' demographics, ASA classification, Charlson index, LOS, blood loss, transfusion rate, complications and 30 - day readmissions). RESULTS: Four hundred and thirty four patients underwent either TKR (n: 302) or THR (n:132) and were included in this study. A gradual reduction of mean LOS was found in THR patients from 5.7 days to 3.0 days and in TKR patients from 5.6 days to 3.4 days. Furthermore, no significant difference was found in complications or regarding the 30-day readmission rate at the different stages of implementation of the different FT components (i.e. at the final stage 96.7% of THR and 86.7% of TKR patients were discharged to home by the fourth post-operative day). CONCLUSION: The stepwise implementation of a FT program in an unelected population of THR and TKR patients was effective and safe, reducing the post-surgical recovery time and patients' LOS with no major complications and no increase of 30-day re-admissions.

Serum levels of NGAL and cystatin C as markers of early kidney dysfunction in patients with obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) has been recently proposed as an independent risk factor for chronic kidney disease. Cystatin C (Cyst C) and neutrophil gelatinase-associated lipocalin (NGAL) are novel biomarkers for the earlier detection of latent kidney disease. The aim of the study was to assess serum Cyst C and NGAL levels in otherwise healthy OSAS patients and to explore possible associations with sleep parameters. METHODS: Consecutive subjects (n = 96, 79.2% males), without known comorbidities, with symptoms suggestive of OSAS were included. All of them underwent polysomnography (PSG) and blood examination for the measurement of serum Cyst C and NGAL levels. RESULTS: Based on apnea-hypopnea index (AHI), subjects were classified into two groups: 32 controls and 64 OSAS patients, with no significant differences in terms of age (50.1 ± 11.7 vs 51 ± 12.2 years, p = 0.747) and BMI (33.9 ± 8.8 vs 35.9 ± 13.1 kg/m2, p = 0.449). Serum Cyst C and NGAL mean levels were higher in OSAS patients compared to those in controls (1155.2 ± 319.3 vs 966.8 ± 173 ng/ml, p = 0.001, and 43.7 ± 23.2 vs 35.6 ± 13.8 ng/ml, p = 0.035, respectively). After adjustment for age and BMI in OSAS patients, serum NGAL levels were associated with AHI (ß = 0.341, p = 0.015) and minimum oxyhemoglobin saturation during sleep (ß = - 0.275, p = 0.032), while serum Cyst C levels were associated with percentage of time with oxyhemoglobin saturation < 90% (ß = 0.270, p = 0.043), average (ß = - 0.308, p = 0.018), and minimum (ß = - 0.410, p = 0.001) oxyhemoglobin saturation during sleep. CONCLUSIONS: Higher risk for latent kidney disease in otherwise healthy OSAS patients is indicated. Sleep hypoxia seems to be a significant contributor in the pathogenetic process of renal dysfunction in OSAS.

Effect of Shift Work on Sleep, Health, and Quality of Life of Health-care Workers.

BACKGROUND: Shift work is associated with sleep disruption, impaired quality of life, and is a risk factor for several health conditions. Aim of this study was to investigate the impact of shift work on sleep and quality of life of health-care workers (HCW). SETTINGS: Tertiary University hospital in Greece. STUDY DESIGN: Cross-sectional study. MATERIALS AND METHODS: Included were HCW, working either in an irregular shift system or exclusively in morning shifts. All participants answered the WHO-5 Well-Being Index (WHO-5) and a questionnaire on demographics and medical history. Shift workers filled the Shift Work Disorders Screening Questionnaire (SWDSQ). STATISTICAL ANALYSIS: Descriptive statistics, Student's t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multivariate stepwise linear regression analysis were applied. RESULTS: Included were 312 employees (87.9% females), 194 working in irregular shift system and 118 in morning shifts. Most shift-workers (58.2%) were somehow or totally dissatisfied with their sleep quality. Regression analysis revealed the following independent determinants for sleep impairment: parenthood (P < 0.001), age 36-45 years (P < 0.001), >3 night shifts/week (P < 0.001), work >5 years in an irregular shift system (P < 0.001). Diabetes mellitus was the most common medical condition reported by shift workers (P = 0.008). Comparison between the two groups revealed a significantly impairment in WHO-5 total score, as well as in 4 of 5 of its items (P < 0.001). CONCLUSION: Shift-work impairs quality of life, whereas its duration and frequency, along with age and family status of employees can have adverse effects on sleep.

Association of SCN1A gene polymorphism with antiepileptic drug responsiveness in the population of Thrace, Greece.

INTRODUCTION: The aim was to examine the influence of the SCN1A gene polymorphism IVS5-91 rs3812718 G>A on the response to antiepileptic drugs (AEDs) in monotherapy or polytherapy. MATERIAL AND METHODS: Two hundred epilepsy patients and 200 healthy subjects were genotyped for SCN1A IVS5-91 rs3812718 G>A polymorphism using TaqMan assay. Patients were divided into drug-responsive and drug-resistant patients. The drug-responsive group was further studied, comparing monotherapy in maximum and minimum doses and monotherapy-responsive and -resistant groups. RESULTS: There were no statistically significant differences in the allelic frequencies and genotype distributions between patients and controls (p = 0.178). The distribution of SCN1A IVS5-91 rs3812718 G>A genotypes was similar between drug-responsive and drug-resistant patients (p = 0.463). The differences in genotype distributions (A/A or A/G vs. G/G) between monotherapy-responsive and -resistant groups were statistically significant (p = 0.021). Within the monotherapy-responsive group, patients with the A/A or A/G genotype needed higher dose AEDs than patients with the G/G genotype (p = 0.032). The relative risk for generalized epilepsy due to A-containing genotypes was of marginal statistical significance when compared with the G/G genotype (p = 0.05). CONCLUSIONS: Overall, our findings demonstrate an association of SCN1A IVS5-91 rs3812718 G>A polymorphism with AED responsiveness in monotherapy without evidence of an effect on drug-resistant epilepsy.

Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature.

INTRODUCTION: The literature is lacking information on the anatomy and the osseous dimensions of the thoracic intervertebral foramen (IVF). We describe the anatomy of the broader area, and we proceed with morphometric data of the vertebrae and the foramina. Depiction of these features is provided with imaging and illustrations. The purpose of this paper is to survey and present the anatomy of the foramen as a whole and provide baseline statistical data. MATERIALS AND METHODS: We review relevant literature, and we present data obtained from skeletal samples of known population and sex. One hundred and nineteen thoracic vertebrae of ten cadaveric spines from the prefecture of Eastern Macedonia and Thrace, Greece, were selected. Statistical analysis measuring the vertical height and the foraminal width of each vertebra was made in accordance with sex. RESULTS: No statistically important differences referring to the descriptive data of both sexes were found. However, statistically, important positive correlation between the vertebral height and the foraminal width was observed, especially for men. The components of the foramen including arteries and veins passing through or neighboring it, and the spinal nerves and roots are described and depicted. CONCLUSIONS: The osseous thoracic IVF reveals a glimpse of the in vivo structure and alterations of its width may be present in back pain and other degenerative diseases. Although it is crucial for surgeries and other interventional procedures of the thoracic spine, little is known about the precise anatomy and dimensions of this anatomical landmark.

A randomized comparative study of topical versus intravenous tranexamic acid administration in enhanced recovery after surgery (ERAS) total knee replacement.

BACKGROUND: The aim of this study was to compare the topical to IV tranexamic acid (TXA) administration of the same dose, given at the same time in patients who underwent TKR using an enhanced recovery after surgery (ERAS) regime. METHODS: Ninety patients were randomized in control group, and IV and topical application groups received 1 g TXA. RESULTS: Blood loss and transfusion requirements in control group were statistically higher compared to both TXA groups (p < 0.05). Length of stay was the same in all groups. CONCLUSIONS: TXA reduced significantly the blood loss and the need for transfusion in ERAS primary unilateral TKR.

Subcutaneous and total fat at L4-L5 and subcutaneous, visceral and total fat at L3-L4 are important contributors of fasting and postprandial adiponectin levels.

OBJECTIVES: Insulin resistance and central obesity have been implicated in the pathogenesis of hypoadiponectinemia in obesity. The aim of this study is to evaluate circulating post-prandial adiponectin in relation to glucose and insulin metabolism, indexes of insulin resistance and sensitivity and, indexes of body fat accumulation and distribution in obese men. METHODS: Twenty-eight non-diabetic men underwent an OGTT followed by an oral fat load and were studied at baseline and for 5 h post-prandially for serum adiponectin, glucose and insulin. Insulin resistance was estimated by Homeostasis model assessment (HOMA) and insulin sensitivity by Matsuda index. Body fat accumulation and distribution were evaluated by anthropometric indexes and multiple slices MRI of the abdomen and hip. RESULTS: Adiponectin was negatively correlated to insulin levels. Fasting and area under the curve (AUC) adiponectin levels were negatively correlated to HOMA (both p < 0.01) and positively to Matsuda index (both p < 0.05). Negative correlations between fasting adiponectin and total fat (r = -0.408, p < 0.05), AUC adiponectin and subcutaneous, visceral and total fat (r = -0.375, -0.413 and -0.475 respectively, all p < 0.05) at L3-L4 were found, and negative correlations between fasting adiponectin and subcutaneous (r = -0.402, p < 0.05) and total fat (r = -0.491, p < 0.05) and between AUC adiponectin and subcutaneous and total fat (r = -0.506 and -0.547, respectively, both p < 0.01) were present at L4-L5. CONCLUSIONS: Circulating adiponectin is inversely correlated to both visceral and subcutaneous fat in non-diabetic men, implying that both compartments are important for adiponectin levels. The best correlation is found at measurement site L4-L5.

The Greek version of the Hand20 questionnaire: crosscultural translation, reliability and construct validity.

The English version of Hand20 questionnaire was translated into Greek and cultural adaptation was performed. The validity was assessed in 134 patients with a variety of upper limb disorders. A comparison of Hand20 and DASH was also performed. All patients completed EQ-5D, Hand20 and DASH questionnaire. Test-retest reliability was assessed in a subgroup of 37 patients. We assessed the convergent validity of Hand20 by correlating its scores to DASH and EQ-5D scores. We also compared the completeness of Hand20 and DASH. We found no statistically significant differences in Hand20 scores between the 1st and 2nd measurements as well as a strong correlation between Hand20 and the other two questionnaires. There were also better rates of response and fewer missing data even in elderly individuals.

Views and attitudes of teachers on the educational integration of students with autism spectrum disorders.

OBJECTIVES: To investigate the views and attitudes of Greek teachers on educational and vocational integration of students with autism spectrum disorders (ASD). METHODS: A statistically reliable sample of questionnaires distributed towards a diversified teacher population is evaluated. The mean values of teachers' responses are analyzed with respect to critical independent variables: previous relevant training; and/or experience. RESULTS: The majority of the sample had a positive view towards the educational and vocational integration of students with ASD. Nevertheless, teachers appear to be sceptical in assuming that these students can be efficiently treated in their classroom. The vast majority of teachers maintain that students with ASD can be trained in technical vocation. However, the absence of support services is highly ranked as the most serious constraint for vocational integration. CONCLUSION: Training and experience substantially influenced teachers' views and attitudes in a positive way towards the integration of students with ASD.

Time course changes of anti- and pro-apoptotic proteins in apigenin-induced genotoxicity.

BACKGROUND: Apigenin (4',5,7-trihydroxyflavone, AP), an active component of many medicinal Chinese herbs, exhibits anticancer properties in vitro and in vivo. This study aims to investigate the genotoxic, cytostatic, and cytotoxic effects of AP and time course changes in the levels of anti- and pro-apoptotic proteins involved in the DNA damage response in HepG2 cells. METHODS: The genotoxic potential of AP was determined by sister chromatid exchanges (SCEs) and chromosomal aberrations (CAs) analysis. The levels of cytostaticity and cytotoxicity were evaluated by the proliferation rate and mitotic indices, respectively. MTT was used to study cytotoxicity, while the induction of apoptosis and the expression of apoptosis-related proteins were determined by ELISA. RESULTS: At concentrations greater than 10 µM, AP decreased cell survival in a dose- (48 h: 10 vs. 20 µΜ, P < 0.001 and 20 vs. 50 µΜ, P = 0.005; 72 h: 10 vs. 20 µΜ, P < 0.001 and 20 vs. 50 µΜ, P = 0.001) and time-dependent manner (20 µΜ: 24 vs. 48 h, P < 0.001 and 48 vs. 72 h, P = 0.003; 50 µΜ: 24 vs. 48 h, P < 0.001 and 48 vs. 72 h, P < 0.001; 100 µΜ: 24 vs. 48 h, P < 0.001 and 48 vs. 72 h, P < 0.001). SCEs rates, cell proliferation, and mitotic divisions were also affected in a dose-dependent manner (P < 0.001). There was no change in the frequency of aberrant cells (1 µΜ ΑP: P = 0.554; 10 µM AP: P = 0.337; 20 µΜ AP: P = 0.239). Bcl-2 levels were reduced 3 h after AP administration (P = 0.003) and remained reduced throughout the 48 h observation period (6 h, P = 0.044; 12 h, P = 0.001; 24 h, P = 0.042; 48 h, P = 0.012). Bax and soluble Fas exhibited a transient upregulation 24 h after AP treatment. The Bax/Bcl-2 ratio was also increased at 12 h and remained increased throughout the 48 h observation period. CONCLUSION: AP exhibited dose-dependent genotoxic potential in HepG2 cells. The protein levels of sFas, Bcl-2, and Bax were affected by AP to promote cell survival and cell death, respectively.

Mild cognitive impairment: effect of education on the verbal and nonverbal tasks performance decline.

We sought to longitudinally evaluate the potential association of educational level with performance on verbal and nonverbal tasks in individuals with mild cognitive impairment (MCI). We evaluated patients with MCI, age >50 years, no medication intake, absent vascular risk factors, and no lesions on brain magnetic resonance imaging (MRI). Each patient underwent a clinical assessment packet and a series of neuropsychological tests of the language and constructional praxis subtests of Cambridge Cognitive Examination (CAMGOG) and the Boston naming test (BNT), at baseline, 6 months, and 12 months. Educational levels were defined taking into account the total years of education, the school level, and diplomas. MCI patients with low education level showed a stepwise reduction in scores of naming objects (NO; P = 0.009), definition (DF; P = 0.012), language (LT; P = 0.021), constructional praxis (CD; P = 0.022), confrontation naming skills (BXB; P = 0.033), phonemic help (BFB; P = 0.041), and BNT (P = 0.002). Analysis of covariance, controlling for baseline scores, showed that education was associated with NO score (P = 0.002), DF score (P = 0.005), LT (P = 0.008), CD score (P = 0.008), BXB score (44.36 ± 1.84, P = 0.0001), BFB (P = 0.022), and BNT (P = 0.004). Our findings indicate that education appeared to affect verbal and nonverbal task performance in MCI patients. Despite the fact that higher educated patients are more acquainted with the tasks, slower deterioration in consecutive follow-up examinations could be explained by the cognitive reserve theory. The potential association of this protective effect with delayed onset of symptoms deserves further investigation.

Association of ultrasonographic parameters with subclinical white-matter hyperintensities in hypertensive patients.

Background and Purpose. Cerebral white matter hyperintensities (WMHs) are regarded as typical MRI expressions of small-vessel disease (SVD) and are common in hypertensive patients. Hypertension induces pathologic changes in macrocirculation and in microcirculation. Changes in microcirculation may lead to SVD of brain and consequently to hypertensive end-organ damage. This damage is regarded the result of interactions between the macrovascular and microvascular levels. We sought to investigate the association of cerebral WMHs with ultrasonographic parameters of cerebral macrocirculation evaluated by carotid duplex ultrasound (CDU) and transcranial doppler (TCD). Subjects and Methods. The study was prospective, cross-sectional and consecutive and included hypertensive patients with brain MRI with WMHs. Patients underwent CDU and TCD. The clinical variables recorded were demographic characteristics (age, gender, race) and vascular risk factors (hypertension, diabetic mellitus, hypercholesterolemia, current smoking, and body mass index). Excluded from the study were patients with history of clinical stroke (including lacunar stroke and hemorrhagic) or transient ischemic attack (either hemispheric or ocular), hemodynamically significant (>50%) extra- or intracranial stenosis, potential sources of cardioembolism, and absent transtemporal windows. WMHs were quantified with the use of a semiquantitative visual rating method. Ultrasound parameters investigated were (1) common carotid artery (CCA) diameter and intima-media thickness, (2) blood flow velocity in the CCA and internal carotid artery (ICA), and (3) blood flow velocity and pulsatility index of middle cerebral artery (MCA). Results. A total of 52 patients fulfilled the study inclusion criteria (mean age 71.4 ± 4.5 years, 54% men, median WMH-score: 20). The only two ultrasound parameters that were independently associated with WMH score in multivariate linear regression models adjusting for demographic characteristics and vascular risk factors were increased mean common carotid artery (CCA) diameter (beta = 0.784, SE = 0.272, P = 0.006, R(2) = 23.9%) and increased middle cerebral artery pulsatility index (MCA-PI; beta = 0.262, SE = 0.110, P = 0.025, R(2) = 9.0%). Among all ultrasound parameters the highest AUC (areas under the receiver operating characteristic curve) were documented for MCA-PI (AUC = 0.82, 95% CI = 0.68-0.95, P < 0.001) and mean CCA diameter (AUC = 0.80, 95% CI = 0.67-0.92, P < 0.001). Conclusions. Our study showed that in hypertensive individuals with brain SVD the extent of structural changes in cerebral microcirculation as reflected by WMHs burden is associated with the following ultrasound parameters of cerebral macrocirculation: CCA diameter and MCA-PI.

Blood transfusion and cytokines' changes in total knee replacement.

INTRODUCTION: The aim of this prospective comparative study was to evaluate the serum levels of different cytokines and the frequency of adverse reactions and wound infections in patients who underwent total knee replacement (TKR) and were not transfused or received either allogeneic blood transfusion or postoperative auto-transfusion (PAT) with unwashed shed blood. MATERIALS AND METHODS: A total of 248 patients were categorized into three groups; in Group 0 (n 85) patients received no blood transfusion, in Group 1 (n 92) patients received PAT and in Group 2 (n 71) patients received allogeneic blood transfusion. Patient's demographic and clinical data including age, gender, body mass index, preoperative haemoglobin value, adverse reactions and complications were documented. The serum levels of IL-1b, IL-6, IL-8, IL-10 and TNF were measured preoperatively, and on the first, third and fifth postoperative day. A statistical analysis of the results was performed. RESULTS: A significant elevation of cytokine values were observed during the first five postoperative days in patients who received blood transfusion after TKR. Adverse reactions (chills and pyrexia) were also more common in patients who received blood transfusion, whereas superficial infections were more common in patients who received allogeneic blood transfusion. CONCLUSION: The immunological status-as expressed by the measured cytokine levels-is altered in patients receiving blood transfusion compared to patients receiving no blood transfusion during the first five postoperative days. PAT is preferable to allogeneic blood transfusion in terms of the rate of adverse reactions and superficial wound infections.

Teachers' perceptions regarding the management of children with autism spectrum disorders.

This study examines Greek teachers' perceptions related to the nature and management of autistic children. To investigate these issues, a statistically reliable number of questionnaires (n = 228) was distributed to a diversified teacher population. The questionnaire responses were analyzed statistically to identify the explanatory power of critical independent variables. The research findings support that teachers' specialized training and working experience are critical inputs to improve teachers' perceptions and efficient serving of autistic children. A cumulative joint effect of teachers' previous specialized education and working experience working with autistic children was also indicated. This could be supportive of teachers upgrading their active leading role in team working with specialized scientific staff, parents and institutions on autistic children.