Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023.

Atherosclerotic cardiovascular disease (ASCVD) remains the main cause of death worldwide, and thus its prevention, early diagnosis and treatment is of paramount importance. Dyslipidemia represents a major ASCVD risk factor that should be adequately managed at different clinical settings. 2023 guidelines of the Hellenic Atherosclerosis Society focus on the assessment of ASCVD risk, laboratory evaluation of dyslipidemias, new and emerging lipid-lowering drugs, as well as diagnosis and treatment of lipid disorders in women, the elderly and in patients with familial hypercholesterolemia, acute coronary syndromes, heart failure, stroke, chronic kidney disease, diabetes, autoimmune diseases, and non-alcoholic fatty liver disease. Statin intolerance is also discussed.

Exercise testing and adipokine levels for the evaluation of overweight and obesity in children.

BACKGROUND: Childhood obesity poses a global health threat. We investigated the association of the cardiopulmonary exercise testing indexes with adipokines levels and insulin resistance along with the beneficial effect of physical exercise on insulin resistance in children. MATERIAL AND METHODS: Thirty-two obese, 21 overweight, and 30 normal-weight children participated in the current study, with mean age 11.98 (±1.95), 10.91 (±1.72), and 11.35 (±2.21) years, respectively. All children were clinically healthy. The children and their parents provided data on physical activity, while spirometry and maximal cardiopulmonary exercise testing were performed for the functional evaluation of the respiratory status of the study population. RESULTS: Leptin levels were significantly lower in normal-weight children compared to the obese ones (p <0.001). Maximum quantity of oxygen (VO2max) differences were statistically significant between the three groups (p =0.025 for normal weight vs overweight, and p =0.001 for normal vs obese children). Leptin levels were inversely related to VO2max in obese children (p =0.009, r =-0.491). Homeostatic model assessment of insulin resistance (HOMA-IR) was statistically significantly lower among children that were more physically active (p =0.042). Leptin was significantly related to body mass index among obese children (r =-0.582, p <0.001). CONCLUSIONS: Leptin is significantly inversely related to VO2max in obese children. This study, however, allows further assumptions for adipokines and childhood obesity, along with the possible role of leptin as an additional obesity index in relation with cardiopulmonary function. HIPPOKRATIA 2017, 21(3): 124-129.

Anastrozole plus leuprorelin in early maturing girls with compromised growth: the "GAIL" study.

PURPOSE: Aromatase inhibitors have been used to increase predicted adult height (PAH) in boys but in girls only in McCune-Albright syndrome. We investigated whether anastrozole combined with leuprorelin for up to 2 years is safe and effective in improving PAH in girls with early puberty and compromised growth, compared to leuprorelin alone. METHODS: The "GAIL" study: girls treated with an aromatase inhibitor and an LHRH analogue, ISRCTN11469487, was a 7-year prospective phase IIa study with parallel design, performed at Athens Medical Center (C-A), and Attikon University Hospital, Athens, Greece (C-B). Forty girls, consecutively referred for early puberty (onset 7.5-9 years) with a PAH <-2 or >1.5 SD lower than their target height (TH), were included. Twenty started on leuprorelin sc/im 0.3 mg/kg/month plus anastrozole 1 mg/d p.o. (group-A, C-A) and 20 on leuprorelin (group-B, C-B) for 2 years or until the age of 10 years. Groups did not differ in age, height, BMI, bone age advancement (BAA), and distance of PAH from TH. Follow-up was at 6, 12, 18, and 24 m. RESULTS: Reduction in BAA was significantly higher in group-A compared to group-B already by 6 m. Despite the transiently significant decrease in height velocity in group-A, gain in PAH SD was almost double by 12 and 18 m vs group-B and reached the maximum of +1.21 ± 0.45 (7.51 cm) vs +0.31 ± 0.37 (1.92 cm, p = 0.001) in group-B at 24 m. Group-A had no clinical or biochemical hyperandrogenism, unchanged normal bone density, and lumbar spine X-rays. CONCLUSION: The co-administration of anastrozole with leuprorelin safely improves PAH in girls with compromised growth.

Isolation of methicillin-resistant Staphylococcus aureus from small ruminants and their meat at slaughter and retail level in Greece.

UNLABELLED: Methicillin-resistant Staphylococcus aureus (MRSA) presents major health risk for humans causing serious nosocomial and community-acquired infections. Asymptomatic food-producing animal carriers and their meat may represent potential reservoirs for human infections. The aim of this study was to investigate the prevalence of MRSA in small ruminants raised under free-range conditions and their meat at slaughter and retail level in Northern Greece. Staphylococcus aureus was isolated from 9·6% of the examined samples. All isolates were resistant at least to one antibiotic, whereas 59·3% of them were multidrug resistant (MDR) exhibiting resistance to three or more antibiotic classes. The higher resistance rates were observed against penicillin (100%), tetracycline (74%), clindamycin (59·3%) and erythromycin (51·9%). Resistance to cefoxitin was exhibited by 22·2% of the isolates, but only one isolate was found to carry the mecA gene and belonged to spa type t127. This is the first time this type of Staph. aureus is isolated in Greece from the surface of a small ruminant's carcass. The presence of multidrug resistant Staph. aureus, and especially MRSA, in small ruminants and their meat, represents a potential threat for the spread of this pathogen in the community. SIGNIFICANCE AND IMPACT OF THE STUDY: This study is the first report on methicillin-resistant Staphylococcus aureus in small ruminants and their meat at slaughter level in Greece, elucidating a possible vehicle food for transmission to humans. These results suggest that human or animal sources could be involved in meat contamination and thus sources of contamination require investigation to control the dispersion of MRSA in the community.

Cardiovascular effects of dipeptidyl peptidase-4 inhibitors.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are effective glucose-lowering agents that do not increase body weight and are associated with a low risk for hypoglycemia. Also, they appear to exert beneficial effects on other established cardiovascular risk factors, including dyslipidemia and hypertension. Moreover, DPP-4 inhibitors exert antiinflammatory and antioxidant actions, improve endothelial function and reduce urinary albumin excretion. In contrast to these favorable cardiovascular effects, three recent large, randomized, placebo-controlled trials in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease or multiple cardiovascular risk factors showed that DPP-4 inhibitors do not affect the risk of myocardial infarction or ischemic stroke and might increase the risk of heart failure. The findings of the former randomized studies highlight the limitations of surrogate markers and show that beneficial effects on cardiovascular risk factors do not necessarily translate into reductions in hard clinical endpoints. Ongoing trials will shed more light on the safety profile of DPP-4 inhibitors and will clarify whether they will improve the cardiovascular outcomes of patients with T2DM. Hippokratia 2015; 19 (3): 195-199.

Purification and biochemical characterization of a novel alkaline protease produced by Penicillium nalgiovense.

Penicillium nalgiovense PNA9 produces an extracellular protease during fermentation with characteristics of growth-associated product. Enzyme purification involved ammonium sulfate precipitation, dialysis, and ultrafiltration, resulting in 12.1-fold increase of specific activity (19.5 U/mg). The protein was isolated through a series of BN-PAGE and native PAGE runs. ESI-MS analysis confirmed the molecular mass of 45.2 kDa. N-Terminal sequencing (MGFLKLLKGSLATLAVVNAGKLLTANDGDE) revealed 93 % similarity to a Penicillium chrysogenum protease, identified as major allergen. The protease exhibits simple Michaelis-Menten kinetics and K m (1.152 mg/ml), V max (0.827 mg/ml/min), and k cat (3.2 × 10(2)) (1/s) values against azocasein show that it possesses high substrate affinity and catalytic efficiency. The protease is active within 10-45 °C, pH 4.0-10.0, and 0-3 M NaCl, while maximum activity was observed at 35 °C, pH 8.0, and 0.25 M NaCl. It is active against the muscle proteins actin and myosin and inactive against myoglobin. It is highly stable in the presence of non-ionic surfactants, hydrogen peroxide, BTNB, and EDTA. Activity was inhibited by SDS, Mn(2+) and Zn(2+), and by the serine protease inhibitor PMSF, indicating the serine protease nature of the enzyme. These properties make the novel protease a suitable candidate enzyme in meat ripening and other biotechnological applications.

Effects of the presence of the curing agent sodium nitrite, used in the production of fermented sausages, on bacteriocin production by Weissella paramesenteroides DX grown in meat simulation medium.

Weissellin A is a listericidal bacteriocin produced by the sausage-isolated strain of Weissella paramesenteroides DX. The response of the strain to various concentrations of the added curing agent NaNO2 (0.0025, 0.005 and 0.01g/L) was evaluated in bioreactor fermentations using a meat simulation medium. The presence of nitrite suppressed bacteriocin production - the effect being more pronounced with increasing concentrations. Weissellin A was produced as a growth-associated metabolite in the absence of nitrite or its presence in the low concentration of 0.005g/L under aerobic conditions. The suppressive effect of nitrite was apparent under conditions supporting increased specific production rates, e.g. 50% and 100% dissolved oxygen tension, but no effect was observed under anaerobic conditions. As the latter prevail in the microenvironment of fermented meat products, the absence of any influence of nitrite on bacteriocin production is an important finding that enlightens the role of this species of lactic acid bacteria in its common substrates.

Human cytomegalovirus-associated oral and maxillo-facial disease.

Human cytomegalovirus is a ubiquitous pathogen with protean clinical manifestations. After initial infection, the virus remains in a persistent state in the host. Immunity plays a pivotal role in counteracting its virulence, albeit intermittent virus shedding occurs in immunocompetent individuals. Should deficiencies in immunity occur, e.g., as a consequence of AIDS or iatrogenic immunosuppression, then virus replication and subsequent pathogenic manifestations ensue. In the oral and maxillo-facial region, the virus causes a wide variety of diseases, mainly atypical chronic ulcerations and sialadenitis. These morbidities are rarely reported and sometimes cause significant problems for clinicians.

Insulin causes a transient induction of proliferation via activation of the PI3-kinase pathway in airway smooth muscle cells.

Insulin regulates glucose metabolism and activates cell growth. As the respiratory system is an alternative route for insulin administration in patients with diabetes mellitus, we studied the effect of insulin on rabbit tracheal airway smooth muscle (ASM) cell proliferation. We show that treatment of quiescent ASM cells with insulin for 24 h increased cell number compared to control cells. This increase was similar to the increase caused by the addition of fetal bovine serum (FBS). Moreover, in contrast to cells treated with FBS, exposure of ASM cells with insulin for longer periods (48 and 72 h) did not have any further influence on cell proliferation. In ASM cells, insulin activated the phosphatidylinositol 3-kinase (PI3 K) pathway, while FBS activated both PI3 K and the mitogen-activated protein kinase (MAPK) pathway. The PI3K pathway inhibitors LY294002 and wortmannin abolished the stimulation of cell proliferation by insulin, indicating a role for this pathway in the cellular response to insulin. These results show that while insulin has a mitogenic effect on ASM cells, prolonged insulin treatment does not lead to excessive ASM cell proliferation and suggest that the use of aerosolized insulin does not represent a potential hazard for airway remodeling.

Substrate inhibition kinetics of Saccharomyces cerevisiae in fed-batch cultures operated at constant glucose and maltose concentration levels.

Fed-batch culture is the mode of operation of choice in industrial baker's yeast fermentation. The particular mode of culture, operated at stable glucose and maltose concentration levels, was employed in this work in order to estimate important kinetic parameters in a process mostly described in the literature as batch or continuous culture. This way, the effects of a continuously falling sugar level during a batch process were avoided and therefore the effects of various (stable) sugar levels on growth kinetics were evaluated. Comparing the kinetics of growth and the inhibition by the substrate in cultures grown on glucose, which is the preferential sugar source for Saccharomyces cerevisiae, and maltose, the most common sugar source in industrial media for baker's yeast production, a milder inhibition effect by the substrate in maltose-grown cells was observed, as well as a higher yield coefficient. The observed sugar inhibition effect in glucostat cultures was taken into account in modeling substrate inhibition kinetics. The inhibition coefficient Ki increased with increasing sugar concentration levels, but it appeared to be unaffected by the type of substrate and almost equal for both substrates at elevated concentration levels.

Modeling growth, substrate consumption and product formation of Penicillium nalgiovense grown on meat simulation medium in submerged batch culture.

Penicillium nalgiovense is the most widely used starter mold for cured and fermented meat products. The development of a biomass film on the surface of these products prevents a large degree undesirable growth of various fungal contaminants and contributes to the ripening process with production of metabolites. This work presents an attempt to model the growth of P. nalgiovense and to relate it to substrate consumption and product release. Because of the extremely complex nature of the meat product fermentation, submerged culture was employed in a bioreactor system that enabled on-line monitoring, using a meat simulation medium, which contained peptones and lactate as carbon, nitrogen and energy sources. The unstructured model presented is based on a partial association of substrate assimilation and product formation with growth. Experimentally derived values for peptones and lactate were compared with model-derived values and their proportions corresponding to growth associated parts, used for biosynthesis, and non-growth associated parts, used for maintenance. The model was applied for the products ammonia, carbon dioxide and protons. Both peptones and lactate were used mainly for biosynthesis (85 and 80% of the total amounts provided, respectively). Assimilation of lactate and ammonia formation from amino acid metabolism resulted in a proton exchange, which was mainly growth associated. The contribution of the growth associated mechanism to the total proton exchange was estimated to be 75% while the contribution of the non-growth associated mechanism increased during the growth phase and reached a maximum of 25%. For carbon dioxide production, the contribution of a maintenance mechanism was evident at 40 h, while production was growth-associated and remained such even at the end of fermentation at 168 h when growth rate was very low. The partially growth associated model showed good agreement with the experimental data and allows accurate determination of the proportions of substrates or products related to biosynthesis and cell maintenance.

Comparative studies on extracellular protease secretion and glucoamylase production by free and immobilized Aspergillus niger cultures.

The effects of cell immobilization on the secretion of extracellular proteases and glucoamylase production by Aspergillus niger were investigated under a variety of immobilization techniques and culture conditions. Immobilization was achieved by means of cell attachment on metal surfaces or spore entrapment and subsequent growth on porous Celite beads. Free-suspension cultures were compared with immobilized mycelium under culture conditions that included growth in shake flasks and an airlift bioreactor. Cell attachment on metal surfaces minimized the secretion of proteases while enhancing glucoamylase production by the fungus. Growth on Celite beads in shake-flask cultures reduced the specific activity of the secreted proteases from 128 to 61 U g(-1), while glucoamylase specific activity increased from 205 to 350 U g(-1). The effect was more pronounced in bioreactor cultures. A reduction of six orders of magnitude in protease specific activities was observed when the fungus grew immobilized on a rolled metal screen, which served as the draft tube of an airlift bioreactor.