Changes in Smoking Habits in Greece During the Lockdown Measures Due to COVID-19.

INTRODUCTION: During lockdown, people are experiencing higher than usual levels of stress related to social isolation, employment, and finances that may result in lifestyle changes. Here, we aim to assess whether smoking habits changed during the lockdown measures due to coronavirus disease 2019 (COVID-19). METHODS: For the purpose of the survey, an online questionnaire was distributed from the tenth of April to the second of May 2020, among a Greek population, by using an online platform. RESULTS: Two hundred smokers/vapers participated in the present survey (62.5% women, 44% of 36-45 years, 29% of 16-55 years, 15.5% 26-35 years). The daily number of cigarettes smoked before the onset of the COVID-19 pandemic is 15.06 ± 9.84, while during the restrictive measures due to COVID-19, the daily number of cigarettes smoked is 14.52 ± 10.13 (p > 0.05). Vapers consumed an average of 0.54 ± 2.43 mL vapor per day before the COVID-19 pandemic and 0.61 ± 2.81 mL during lockdown. Males smoked more cigarettes per day before (16.31 ± 11.87) and during the lockdown (15.33 ± 12.17) versus females (14.30 ± 8.36) and 14.04 ± 8.70, respectively) (p > 0.05 for both genders). Before versus during the restrictive measures, subjects that were primary school graduates smoked more cigarettes per day (28.00 ± 9.09 and 27.50 ± 9.57, respectively), followed by subjects that were high school graduates (16.90 ± 9.33 and 15.97 ± 9.50, respectively), university graduates (14.17 ± 10.14 and 13.93 ± 10.66, respectively), postgraduates (12.96 ± 9.52 and 12.25 ± 9.90, respectively) and middle school graduates (12.89 ± 8.22 and 14.22 ± 7.93, respectively).The self-reported reason for the change in the mL vaporized and the cigarettes smoked are confinement at home (36.3%), stress about COVID-19 (34.09%), free time (20.45%), boredom (4.54%), stress about the work status (2.27%), and participation in online lucky games (2.27%). DISCUSSION: We did not observe significant differences in the daily consumption of smoke/vaping during the lockdown measures. More studies are needed to assess the long-term effects of the pandemic in smoking habits.

Investigation of the Level of Burnout in Health Care Professionals in COVID-19 Pandemic Conditions.

The coronavirus disease 2019 (COVID-19) pandemic has led to high levels of stress and anxiety for health care professionals. The purpose of this study was to investigate the burnout of health care professionals in COVID-19 pandemic conditions. Quantitative research was performed, and the Copenhagen Burnout Inventory was used to study burnout. The research sample consisted of 360 health care professionals. Health professionals have been found to have fairly high levels of personal burnout, work burnout, and burnout associated with patient interactions. It has also been found that women and health professionals working in department for patients with COVID-19 have significantly greater burnout. However, it was found that age, marital status, years of service, specialty, non-basic degree, and whether they or a first-degree relative had COVID-19 were not correlated to burnout. Given the very high level of burnout among health professionals, it is necessary to develop appropriate strategies to reduce burnout.

Obesity as a Risk Factor for Venous Thromboembolism Recurrence: A Systematic Review.

Background and Objectives: Venous thromboembolism (VTE) encompasses Deep Venous Thrombosis (DVT) and Pulmonary Embolism (PE). The duration of anticoagulant therapy following a VTE event partly relies on the risk of recurrent VTE which depends on the clinical setting where VTE occurred and the VTE risk factors present. Obesity is considered a minor risk factor and studies in the literature have provided conflicting results on whether obesity influences the development of recurrences. The aim of the present study is to assess the effect of obesity on VTE recurrence in patients that suffered from a previous VTE event. Materials and Methods: We conducted systematic research for English language studies in Medline, Scopus and ProQuest databases in order to identify publications that assess the risk of VTE recurrence in obesity. Inclusion criteria were: 1. Diagnosis of VTE, 2. Definition of obesity as a body mass index ≥30 kg/m2, 3. Report of the risk of obesity on VTE recurrence, 4. Adult human population. We did not include case reports, review studies or studies that assessed other forms of thrombosis and/or used other definitions of obesity. We used the Newcastle-Ottawa scale to address the quality of the studies. Results: Twenty studies were included in the analysis, of which 11 where prospective cohort studies, 6 were retrospective cohort studies, 1 was a cross-sectional study, and 2 were post-hoc analysis of randomized clinical trials. Obesity was significantly associated with recurrences in 9 studies and in 3 of them the association was significant only in females. Conclusions: There is heterogeneity between the studies both in their design and results, therefore the effect of obesity on VTE recurrence cannot be adequately estimated. Future randomized clinical studies with appropriately selected population are needed in order to streamline the effect of obesity on VTE recurrence.

Temporal trends in pulmonary embolism prevalence in Greece during 2013-2017.

BACKGROUND: Pulmonary embolism (PE) epidemiological data about the disease prevalence in the general population are unclear. The present study aims to investigate the prevalence of PE in Greece and the associated temporal trends for the years 2013-2017. METHODS: Data on medical prescriptions for PE in the years 2013-2017 were provided by the Greek National Health Service Organization (EOPYY). Data on age, gender, specialty of the prescribing physician and prescription unit were provided as well. RESULTS: The total number of medical prescriptions for PE for the study period was 101,426. Of the total prescriptions, 51% were issued by the Public Sector and 48% by the Private Sector. In 2013 the prevalence of PE was 5.43 cases per 100,000 citizens and increased constantly until 2017 with 23.79 cases per 100,000 population. Prevalence was higher in all years studied in the age group of 70-80 years. For the year 2017, we observed 69.35 cases per 100,000 population for subjects 70-80 years, followed by the ages 80-90 (60.58/100,000) and 60-70 years (56.47 /100,000). Females displayed higher PE prevalence than males and higher increasing trend. CONCLUSION: PE prevalence has an increasing trend throughout the years 2013-2017 while prevalence in females is higher than males and displays a higher increasing trend. Our results may be used to appropriately organize nationwide health care campaigns aiming at the diagnosis, treatment and prevention of PE.

Level of Knowledge About COPD Among Patients and Caregivers.

Chronic obstructive pulmonary disease (COPD) represents a major health burden worldwide. COPD-specific education may positively affect the emotional distress associated with the disease and may contribute to the patients' poor health-related quality of life. Studies have shown that education regarding COPD is lacking among disease sufferers. The aim of our study was to evaluate the knowledge of COPD among patients and caregivers. We used the Bristol COPD Knowledge Questionnaire in hospitalized and nonhospitalized patients with COPD and other pulmonary diseases, their caregivers, and healthy volunteers. Mean total knowledge score of patients with COPD was 24.27 ± 8.44, of patients with other respiratory diseases 25.53 ± 7.93, of caregivers of patients with COPD 21.80 ± 5.32, of caregivers of patients with other pulmonary diseases 23.50 ± 8.79, and of healthy subjects 25.85 ± 9.27 (p = 0.071). Our data further indicate the lack of knowledge of COPD among patients and their carers and emphasize the need of education programs.

Time trends for pulmonary embolism incidence in Greece.

BACKGROUND: Pulmonary embolism (PE) is a disease with a significant impact on public health. However, international epidemiological data are unclear and show considerable heterogeneity. The present study aims to investigate the incidence of PE at the Greek population and the associated demographic characteristics of patients with PE. METHODS: Data on hospital admissions for PE between 1999 and 2012 were provided by the Hellenic Statistical Authority of Greece. Data on age, gender and days of hospitalization from 1999 to 2007 were provided as well. The total population in each region was derived from the 1991, 2001, 2011 Census of the national statistical service of Greece. RESULTS: The mean annual incidence of PE during the study period was 18.5 per 100.000 population. The annual incidence of PE showed an upward trend ranging from 14 (1999) to 30 (2012) per 100.000 population. In the years before and after the economic crisis faced by Greece we observed statistically significant differences of PE incidence for the two different periods (1999-2008 versus 2009-2012, 14.49 versus 23.06 respectively, p = 0.002). The available data revealed a female predominance (16.48 cases for females per 100.000 population versus 13.69 cases for males per 100.000 population, p = 0.031). Incidence rate increased with age with a higher incidence in the "80-89" age group. CONCLUSIONS: The incidence of PE appeared to increase in Greece, while it remains below the expected trend in an international context that may be attributed to Computed Tomography Pulmonary Angiography availability and/or PE awareness among clinicians.

Chemoradiotherapy with and without deep regional hyperthermia for squamous cell carcinoma of the anus.

PURPOSE: To compare results after chemoradiotherapy with and without deep regional hyperthermia in patients with anal cancer. METHODS: Between 2000 and 2015, a total of 112 consecutive patients with UICC stage I-IV anal cancer received chemoradiotherapy with 5­fluororuracil and mitomycin C (CRT). In case of insufficient tumor response 4-6 weeks after chemoradiotherapy, patients received an interstitial pulsed-dose-rate brachytherapy boost. Additionally, 50/112 patients received hyperthermia treatments (HCRT). RESULTS: Median follow-up was 41 (2-165) months. After 5 years follow-up, overall (95.8 vs. 74.5%, P = 0.045), disease-free (89.1 vs. 70.4%, P = 0.027), local recurrence-free (97.7 vs. 78.7%, P = 0.006), and colostomy-free survival rates (87.7 vs. 69.0%, P = 0.016) were better for the HCRT group. Disease-specific, regional failure-free, and distant metastasis-free survival rates showed no significant differences. The adjusted hazard ratios for death were 0.25 (95% CI, 0.07 to 0.92; P = 0.036) and for local recurrence 0.14 (95% CI, 0.02 to 1.09; P = 0.06), respectively. Grades 3-4 early toxicities were comparable with the exception of hematotoxicity, which was higher in the HCRT group (66 vs. 43%, P = 0.032). Incidences of late side effects were similar with the exception of a higher telangiectasia rate in the HCRT group (38.0 vs. 16.1%, P = 0.009). CONCLUSION: Additional regional hyperthermia improved overall survival, local control, and colostomy rates. Its potential beneficial role has to be confirmed in a prospective randomized setting. Therefore, the HyCAN trial has already been established by our group and is currently recruiting patients (Clinicaltrials.gov identifier: NCT02369939).

Continuous or interrupted suture technique for hepaticojejunostomy? A national survey.

BACKGROUND: Hepaticojejunostomy is commonly used in hepato-bilio-pancreatic surgery and a crucial step in many surgical procedures, including pancreaticoduodenectomy. The most frequently used techniques are the interrupted suture and the continuous suture technique. Currently, there is no data available in regard to the utilization of these techniques. METHODS: In total, 102 hospitals in Germany were invited between September and November 2017 to participate in this survey. Using a paper-based questionnaire, data were collected on surgical technique and complication rates of hepaticojejunostomies. RESULTS: A total of 77 of the 102 addressed hospitals (76%) participated in the survey. On average, each hospital performed 71 hepaticojejunostomies per year - most often in the context of pancreaticoduodenectomy (71%). 24 (31%) hospitals exclusively use an interrupted suture technique, 7 (9%) hospitals solely a continuous suture technique, 3 (4%) hospitals perform a combination of continuous and interrupted suture technique and 43 (56%) hospitals decide on one of both techniques depending on intraoperative findings. According to the participants in this survey, the continuous suture technique is significantly faster than the interrupted suture technique in hepaticojejunostomy (p = 0,015). There were no significant differences in the overall complication rate (p = 0,902) and insufficiency rate (p = 1,000). CONCLUSIONS: In Germany, there is a heterogeneity in the technique used to create a hepaticojejunostomy. As our survey suggests that the use of continuous suture technique may offer an advantage in time without jeopardizing patient outcomes, the different techniques should be compared in a randomized controlled study.

Circulating leptin in non-alcoholic fatty liver disease: a systematic review and meta-analysis.

AIMS/HYPOTHESIS: Clinical data regarding circulating leptin levels in patients with non-alcoholic fatty liver disease (NAFLD) are conflicting. The purpose of this meta-analysis was to compare leptin levels between the following groups: patients with biopsy-proven NAFLD vs controls; simple steatosis (SS) patients vs controls; non-alcoholic steatohepatitis (NASH) patients vs controls and NASH patients vs SS patients. METHODS: We performed a systematic search in PubMed, Scopus and the Cochrane Library. We analysed 33 studies, published between 1999 and 2014, including 2,612 individuals (775 controls and 1,837 NAFLD patients). RESULTS: Higher circulating leptin levels were observed in NAFLD patients vs controls (standardised mean difference [SMD] 0.640; 95% CI 0.422, 0.858), SS patients vs controls (SMD 0.358; 95% CI 0.043, 0.673), NASH patients vs controls (SMD 0.617; 95% CI 0.403, 0.832) and NASH patients vs SS patients (SMD 0.209; 95% CI 0.023, 0.395). These results remained essentially unchanged after excluding studies involving paediatric or adolescent populations and/or individuals undergoing bariatric surgery. There was moderate-to-severe heterogeneity among studies in all comparisons, but no significant publication bias was detected. Meta-regression analysis demonstrated that BMI was inversely associated with leptin SMD and accounted for 26.5% (p = 0.014) and 32.7% (p = 0.021) of the between-study variance in the comparison between NASH patients and controls and NAFLD patients and controls, respectively. However, when bariatric studies were excluded, BMI did not significantly explain the between-study variance. CONCLUSIONS/INTERPRETATION: Circulating leptin levels were higher in patients with NAFLD than in controls. Higher levels of circulating leptin were associated with increased severity of NAFLD, and the association remained significant after the exclusion of studies involving paediatric or adolescent populations and morbidly obese individuals subjected to bariatric surgery.

The effects of iloprost on colonic anastomotic healing in rats under obstructive ileus conditions.

BACKGROUND: The aim of this study was to investigate the effects of iloprost, on colonic anastomotic healing in rats, under obstructive ileus conditions. MATERIALS AND METHODS: Eighty male Albino rats were randomized into four groups of 20 animals each. They underwent colonic resection followed by an inverted anastomosis. The rats of group 1 (control) and group 2 (ileus) received 3 mL of saline 0.9% intraperitoneally and those of group 3 (iloprost), and group 4 (ileus + iloprost) iloprost (2 µg/kg of body weight), immediately postoperatively and daily until the day of sacrifice. Each group was further divided into two equal subgroups, depending on the day of sacrifice. The animals of subgroup "a" were sacrificed on the fourth postoperative day, whereas those of "b" on the eighth day. Macroscopic and histologic assessment was performed, whereas anastomotic bursting pressures and the tissue concentrations in hydroxyproline and collagenase I were evaluated. RESULTS: Means of bursting pressure, neoangiogenesis, fibroblast activity, and hydroxyproline concentration were significantly increased in group 4 compared with group 2. In addition, on the fourth postoperative day, the inflammatory cell infiltration and the collagenase I concentration were significantly decreased in group 4 compared with group 2. Moreover, on the eighth postoperative day, collagen deposition was significantly increased in group 4 compared with group 2. CONCLUSIONS: Iloprost after intraperitoneal administration reverses the negative effect of obstructive ileus. It promotes not only the angiogenic activity but also collagen formation, resulting in increased bursting pressures on the fourth and eighth postoperative days.

Understanding the Internal Conversion Efficiency of BiVO4/SnO2 Photoanodes for Solar Water Splitting: An Experimental and Computational Analysis.

This work aims to understand the spin-coating growth process of BiVO4 photoanodes from a photon absorption and conversion perspective. BiVO4 layers with thicknesses ranging from 7 to 48 nm and the role of a thin (<5 nm) SnO2 hole-blocking layer have been studied. The internal absorbed photon-to-current efficiency (APCE) is found to be nonconstant, following a specific dependence of the internal charge separation and extraction on the increasing thickness. This APCE variation with BiVO4 thickness is key for precise computational simulation of light propagation in BiVO4 based on the transfer matrix method. Results are used for accurate incident photon-to-current efficiency (IPCE) prediction and will help in computational modeling of BiVO4 and other metal oxide photoanodes. This establishes a method to obtain the sample's thickness by knowing its IPCE, accounting for the change in the internal APCE conversion. Moreover, an improvement in fill factor and photogenerated voltage is attributed to the intermediate SnO2 hole-blocking layer, which was shown to have a negligible optical effect but to enhance charge separation and extraction for the lower energetic wavelengths. A Mott-Schottky analysis was used to confirm a photovoltage shift of 90 mV of the flat-band potential.

Investigation of Health-Related Quality of Life, Anxiety and Satisfaction in Patients with Pulmonary Embolism.

BACKGROUND: Features of post-traumatic stress disorder and anxiety may be present in pulmonary embolism (PE) patients, along with impaired quality of life (QoL). We aim to evaluate health-related QoL, anxiety and satisfaction with life in patients with PE. METHODS: Patients with PE were enrolled during their follow-up. All participants completed the Short Form 36 (SF-36) questionnaire, the State-Trait Anxiety Inventory (STAI) X1 and X2 forms, and the Satisfaction with Life Scale (SWLS). RESULTS: 92 PE patients were included (mean age ± SD = 62.50 ± 15.33 years, 56.5% males). The median values of the SF-36 subscales were below the corresponding values of the Greek general population (besides the mental health (MH) subscale). Mean STAIX1 levels were 37.05 ± 11.17 and mean STAIX2 levels were 39.80 ± 10.47. Mean SWLS levels were 23.31 ± 6.58. According to multiple linear regression analysis, the MH and general health subscales were predictive of SWLS levels (F (10.76) = 10.576, p < 0.001, R2 = 0.581). The MH score (ß = -0.242, p < 0.01) and STAIX1 level (ß = 0.312, p < 0.001) (F (9.77) = 26.445, p < 0.001, R2 = 0.756) were predictive of STAIX2. CONCLUSIONS: Patients with PE exhibit slight satisfaction with life, borderline anxiety and impaired HRQoL.

Surgical and oncological outcome after extended lymph node dissection for carcinoma of the stomach and the esophagogastric junction: a retrospective analysis from an experienced single center.

Introduction: Gastric cancer remains the fourth leading cause of cancer-related death in Europe, while the proportion of adenocarcinomas of the esophagogastric junction has risen by more than one third over recent years. In 2018, 14,700 new cases of gastric cancer were estimated in Germany, while the 5-year relative survival rate is reported to be 33% for women and 30% for men; in the USA almost the same rate was reported, with 31% 5-year survival. Material and methods: Between 2001 and 2014, 590 patients with a diagnosis of gastric cancer underwent surgery in our institution, including 120 Siewert type II/III carcinomas of the esophagogastric junction. All patients underwent distal resection of the stomach, gastrectomy or total gastrectomy combined with transhiatal distal esophageal resection. All operations included D2-D3 lymph node dissection (LND). Data were recorded by the cancer registry of the department of surgery and analyzed retrospectively. Results: The patients were classified according to the TNM (UICC 2010) and Lauren classification. 29% of the patients underwent primary surgery and 31% received neoadjuvant therapy. The median number of harvested lymph nodes was 33 for patients diagnosed with gastric cancer, and 29 for esophagogastric adenocarcinomas, respectively. The anastomotic leak rate was 3%. In this study, the 5-year overall survival rate was 51% concerning gastric carcinomas, 44% for Siewert type II and 47% for Siewert III cancers of the esophagogastric junction. Conclusions: Increased survival with low complication rates were achieved after individualized and multimodal treatment concepts combined with consistently applied extended lymphadenectomy.

Fibroblast Growth Factor-21 as a Potential Therapeutic Target of Nonalcoholic Fatty Liver Disease.

Nonalcoholic fatty liver disease (NAFLD) is a highly prevalent disease without any approved treatment to-date despite intensive research efforts by researchers and pharmaceutical industry. Fibroblast growth factor (FGF)-21 has been gaining increasing attention as a possible contributing factor and thus therapeutic target for obesity-related metabolic disorders, including NAFLD, mainly due to its effects on lipid and carbohydrate metabolism. Most animal and human observational studies have shown higher FGF-21 concentrations in NAFLD than non-NAFLD, implying that FGF-21 may be increased to counteract hepatic steatosis and inflammation. However, although Mendelian Randomization studies have revealed that variations of FGF-21 levels within the physiological range may have effects in hyperlipidemia and possibly nonalcoholic steatohepatitis, they also indicate that FGF-21, in physiological concentrations, may fail to reverse NAFLD and may not be able to control obesity and other diseases, indicating a state of FGF-21 resistance or insensitivity that could not respond to administration of FGF-21 in supraphysiological concentrations. Interventional studies with FGF-21 analogs (eg, pegbelfermin, efruxifermin, BOS-580) in humans have provided some favorable results in Phase 1 and Phase 2 studies. However, the definite effect of FGF-21 on NAFLD may be clarified after the completion of the ongoing clinical trials with paired liver biopsies and histological endpoints. The aim of this review is to critically summarize experimental and clinical data of FGF-21 in NAFLD, in an attempt to highlight existing knowledge and areas of uncertainty, and subsequently, to focus on the potential therapeutic effects of FGF-21 and its analogs in NAFLD.

Efficiency of an Online Intervention in the Knowledge Concerning COPD in Nursing Students.

Background: Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating respiratory disorder. Nurses play a major role in managing the disease. This study aimed to test the effect of a brief online intervention in increasing the knowledge of COPD in a sample of nursing students in Greece. Materials and Methods: The intervention entailed a combination of two ½ hour lectures focusing on the treatment and care of patients with COPD according to existing guidelines. Data were collected with a structured questionnaire specially designed for this study including questions regarding information on sociodemographic characteristics of the participants, and the Bristol COPD Knowledge Questionnaire (BCKQ) which is designed to assess the knowledge of 13 COPD-specific topics. The questionnaire was distributed three times and the one-way ANOVA test of repeated measures was applied to investigate the effect of the educational intervention by examining the periods before, immediately after, and one month after the intervention. Results: 125 nursing students participated in this study of which 13.6% were men (n=17) and 86.4% were women. According to the results of the repeated measures ANOVA test, there was a statistically significant improvement in gained knowledge about COPD. Conclusions: Short educational interventions can be effective in acquiring and cultivating nursing students concerning COPD. These short online tutorials seem to be cost-effective as they can be organized easily and with minimal financial resources.

Solitary Soft-Tissue Metastasis of a Pancreatic Adenocarcinoma 2 Years After Curative Resection: Report of a Rare Case and a Literature Review.

BACKGROUND Soft-tissue metastases from a primary carcinoma are rare lesions. They often are the first clinical manifestation of a previously unknown malignancy of an advanced stage, but may also be solitary in a setting of a recurrent disease. Generally, they are associated with poor prognosis and may be the source of diagnostic confusion both clinically and pathologically. The primary location of the malignancy is usually lung, breast, kidney, or colon. Soft-tissue metastases from a pancreatic adenocarcinoma are extremely rare. A few cases involving the skin have been described in the literature, and solitary metastasis to the deep soft-tissue (eg, subcutis and skeletal muscle) was reported less than 10 times. CASE REPORT We report the case of a 74-year-old woman who presented with late-onset (recurrent disease), solitary, subcutaneous metastasis in the posterior aspect of the left thigh, deriving from a pancreatic head adenocarcinoma, 2 years after initial treatment with R0 resection (pancreaticoduodenectomy) and adjuvant chemotherapy. We emphasize the rarity of this entity, review the literature, and discuss treatment options. CONCLUSIONS Solitary soft-tissue metastasis from a pancreatic adenocarcinoma after initial curative treatment is very rare. Although hematogenous spread from a pancreatic adenocarcinoma generally has a very poor prognosis, treatment should be individualized according to the patient's history, general condition, and symptoms and the clinical setting in relation to the primary disease.

Association between white matter lesions and Parkinson's disease: an impact on Postural/Gait difficulty phenotype and cognitive performance.

BACKGROUND: White matter hyperintensities (WMHs) may be observed on Magnetic Resonance Imaging (MRI) in patients with Parkinson disease with or without vascular risk factors. Whether WMHs may influence motor and non-motor aspects of Parkinson disease is a subject of debate. The aim of this study is to evaluate the impact of WMH severity on various aspects of Parkinson disease in combination to the estimation of the impact of cerebrovascular risk factors. MATERIALS AND METHODS: We included a cohort of patients with Parkinson's disease who underwent MRI examination. The Fazekas visual rating scale was used to assess the severity and location of WMHs, and patient clinical characteristics were correlated with MRI data. RESULTS: All vascular risk factors were associated with higher Fazekas score in both periventricular and deep white matter. Periventricular white matter hyperintensities (PWMHs) and deep white matter hyperintensities (DWMHs) were associated with lower scores in the ACE-R cognitive assessment scale (p < 0.001). Furthermore, PWMHs and DWMHs severity was associated with higher UPDRS motor score (p < 0.001), while the Postural Instability Gait Difficulty (PIGD) phenotype was correlated with higher burden of WMHs. CONCLUSIONS: Comorbid WMHs may contribute to multi-dimension dysfunction in patients with Parkinson disease and consequently the management of vascular risk factors may be crucial to maintain motor and non-motor functions in PD.

Intergenic SNPs in Obstructive Sleep Apnea Syndrome: Revealing Metabolic, Oxidative Stress and Immune-Related Pathways.

There is strong evidence supporting the contribution of genetic factors to obstructive sleep apnea syndrome (OSAHS) susceptibility. In the current study we analyzed both in a clinical cohort and in silico, four single nucleotide polymorphisms SNPs, rs999944, rs75108997, rs35329661 and rs116133558 that have been associated with OSAHS. In 102 patients with OSAHS and 50 healthy volunteers, genetic testing of the above polymorphisms was performed. Polymorphism rs116133558 was invariant in our study population, whereas polymorphism rs35329661 was more than 95% invariant. Polymorphism rs999944 displayed significant (>5%) variance in our study population and was used in the binary logistic regression model. In silico analyses of the mechanism by which these three SNPs may affect the pathophysiology of OSAHS revealed a transcriptomic network of 274 genes. This network was involved in multiple cancer-associated gene signatures, as well as the adipogenesis pathway. This study, uncover a regulatory network in OSAHS using transcriptional targets of intergenic SNPs, and map their contributions in the pathophysiology of the syndrome on the interplay between adipocytokine signaling and cancer-related transcriptional dysregulation.

Healing of colonic anastomosis in rats under obstructive ileus conditions.

BACKGROUND: The anastomosis leak in colon resections is a crucial post-operative complication with significant morbidity and mortality.  Methods: Forty (40) Wistar rats were allocated in two groups. In SHAM group only anastomosis was performed. In ILEUS group anastomosis was performed following one day of ileus. Animals in both groups were subdivided in two groups according to the day they were sacrificed, 4th or 8th post-operative day. A number of variables between the groups were estimated. RESULTS: Body weight loss was higher following obstructive ileus on both days. Adhesion score in 4th and 8th post-operative day was higher in ILEUS1, ILEUS2 groups compared to SHAM1, SHAM2 groups respectively (p<0.001 for both). Neovascularization decreased following obstructive ileus compared to control on the 4th day (ILEUS1 vs. SHAM1, p=0.038). Bursting pressure was lower in ILEUS2 group than SHAM2 group (p<0.001). The number of fibroblasts decreased following obstructive ileus compared to control on the 4th and 8th day (ILEUS1 vs. SHAM1, p=0.001, ILEUS2 vs SHAM2, p=0.016). Hydroxyproline concentration was decreased in ILEUS2 group compared to SHAM2 group (p<0.001). CONCLUSIONS: The balance of collagenolysis and collagenogenesis plays a decisive role in the healing of anastomoses following bowel obstruction. Under those circumstances, anastomosis' bursting pressure is reduced owning to decreased neovascularization, reduced fibroblast presence and lower hydroxyproline concertation. In our study, local inflammation, neocollagen concentration and collagenase activity were not associated with this adverse effect. However, further research should delineate the mechanisms of healing of colonic anastomoses and identify those factors that can improve our outcomes.

Clinically Silent Small Vessel Disease of the Brain in Patients with Obstructive Sleep Apnea Hypopnea Syndrome.

Obstructive sleep apnea hypopnea syndrome (OSAHS) is associated with increased risk of cerebrovascular disease. The aim of the present study was to investigate the association between the presence of the small vessel disease (SVD) of the brain in patients with OSAHS. The study included 24 patients with moderate to severe OSAHS and 34 healthy volunteers. All the subjects underwent magnetic resonance imaging (MRI) of the brain, in order to sought periventricular white matter (PVWM), deep white matter (DWM) and brainstem SVD. Among patients with OSAHS, 79.1% had SVD (grade 1-3, Fazekas score) in DWM and 91.7% in PVWM while 22.4% had brainstem-white matter hyperintensities (B-WMH). Patients with OSAHS had a much higher degree of SVD in the DWM and PVWM compared to the control group (p < 0.001). The multivariate analysis showed an independent significant association of OSAHS with SVD (DWM and PVWM) (p = 0.033, OR 95% CI: 8.66 (1.19-63.08) and: p = 0.002, OR 95% CI: 104.98 (5.15-2141)). The same analysis showed a moderate association of OSAHS with B-WMH (p = 0.050, OR 15.07 (0.97-234.65)). Our study demonstrated an independent significant association of OSAHS with SVD and a moderate association of OSAHS with B-WMH.