AbstractBackgroundElectrocardiographic non‐invasive risk factors (NIRFs) have an important role in the arrhythmic risk stratification of post‐myocardial infarction (post‐MI) patients with preserved or mildly reduced left ventricular ejection fraction (LVEF). However, their specific relation to left ventricular systolic function remains unclear. We aimed to evaluate the association between NIRFs and LVEF in the patients included in the PRESERVE‐EF trial.MethodsWe studied 575 post‐MI ischemia‐free patients with LVEF≥40% (mean age: 57.0 ± 10.4 years, 86.2% men). The following NIRFs were evaluated: premature ventricular complexes, non‐sustained ventricular tachycardia (NSVT), late potentials (LPs), prolonged QTc, increased T‐wave alternans, reduced heart rate variability, and abnormal deceleration capacity with abnormal turbulence.ResultsThere was a statistically significant relationship between LPs (Chi‐squared = 4.975; p < .05), nsVT (Chi‐squared = 5.749, p < .05), PVCs (r= −.136; p < .01), and the LVEF. The multivariate linear regression analysis showed that LPs (p = .001) and NSVT (p < .001) were significant predictors of the LVEF. The results of the multivariate logistic regression analysis indicated that LPs (OR: 1.76; 95% CI: 1.02–3.05; p = .004) and NSVT (OR: 2.44; 95% CI: 1.18–5.04; p = .001) were independent predictors of the mildly reduced LVEF: 40%–49% versus the preserved LVEF: ≥50%.ConclusionLate potentials and NSVT are independently related to reduced LVEF while they are independent predictors of mildly reduced LVEF versus the preserved LVEF. These findings may have important implications for the arrhythmic risk stratification of post‐MI patients with mildly reduced or preserved LVEF.

Although the impact of epilepsy on expressive language is heavily discussed, researched, and scientifically grounded, a limited volume of research points in the opposite direction. What about the causal relationship between disorder-related language activities and epileptic seizures? What are the possible diagnostic dilemmas that experts in the field of speech-language pathology, neurology, and related fields face? How far has research gone in investigating psychogenic nonepileptic seizures, the misdiagnosis of which can be a thorny issue for clinicians and a detrimental factor for the patients’ health? In order to address these questions, the study at hand focuses on a common, ever-intensified (by the COVID-19 pandemic) speech disorder—stuttering, and explores the pathophysiological and psychogenic background of the phenomenon. It also looks at the role of stuttering as a contributing factor to the appearance of epileptic seizures, in the hope of drawing attention to the complexity and importance of precise detection of stuttering-induced epilepsy, as a specific subcategory of language-induced epilepsy.

Introduction COVID-19 pandemic and lockdown has brought a serious impact on physical and mental health. Objectives The purpose of the present study was to estimate the impact of the first lockdown in Greece, on both quality of life and anxiety levels in different occupational groups. Methods A cross-sectional on- line survey was conducted from 20 th of April to 4 th of May 2020. A 24-item anonymous questionnaire was administered to collect basic demographic and socioeconomic data. The 5-item WHO Well-Being Index (WHO-5, 0-100%, cut-off 52%) and the Generalized Anxiety Disorder Assessment (GAD-7) tools were used to assess well-being and anxiety, respectively. Statistical analysis was performed with SPSS for Windows v.24.0 Statistical Package. Results A total of 575 participated in the study, 62.8% females, 48.5% aged between 40 to 59 years. 32.5% were employed in education sector, 32.5% in health sector and 20.3% as season workers in tourism sector. Males showed slightly higher levels of wellbeing (52.1 vs. 47.3, p=0.023) and lower levels of anxiety (7.1 vs. 8.2, p=0.023) compared to females. Factors associated with higher wellbeing and lower anxiety were higher education and income level, optimism, taking less protection measures, and being seasonal worker. Furthermore, participants with comorbidities and symptoms like headache, musculoskeletal pain, as well as feeling depressed or stressed revealed lower wellbeing and higher anxiety scores. Conclusions Our study revealed an overall poor wellbeing and mild to moderate levels of anxiety during the lockdown. Actions should be taken to address and to prevent its serious impact on mental health. Disclosure No significant relationships.

Tics wax and wane regarding their severity, while their expression is affected by non-motor sensory or cognitive elements that are mostly known as “premonitory urges.” Since premonitory urges are often used in non-pharmacological interventions to decrease tic severity, it is of interest in the present study to examine whether premonitory urges can actually predict tic severity. Fifty-two children and adolescents diagnosed with tics and Tourette syndrome (29 children with provisional tic disorder, 16 children with chronic motor tic disorder, and 7 children with Tourette syndrome) were included in the study. Their age ranged between 6 and 15.7 years (mean age 9 years and 2 months). All participants completed the YGTSS (Yale Global Tic Severity Scale) in order to assess tic severity and the Premonitory Urge for Tics Scale (PUTS) to measure premonitory urges (PU). Regression analysis revealed that PU were present at a higher rate in older subjects (>12 years of age) than in younger children and with a higher level of tic severity. Although the presence of PU was associated with tic severity across the entire age range, there was a stronger association between PU and tic severity in older children. A better insight into the pathophysiology of premonitory urges could possibly lead to the identification of new therapeutic modalities targeting the sensory initiators of tics in future research.

Locked-in syndrome (LIS) is a neuropsychological condition, in which patients present with quadriplegia, lower cranial nerve paralysis, and mutism. Diagnosis of LIS is difficult because of the similarities with other related syndromes, but it is of crucial importance to establish precise and early diagnosis in order to make the appropriate decisions according to the intervention and treatment planning. Access to a multidisciplinary, specialized team provides opportunity for continued improvement. Individualized treatment improves long-term management. Assistive technology and advanced communication aids may help people with disabilities to regain more independence and take part in everyday life. Technological achievements, such as brain-computer interfaces (BCIs) may potentially be of significant practical value to patients with LIS. Advancements in medical care, rehabilitation, and communication technology have focused on leading LIS patients to live meaningful lives in the society with the involvement of their families.

Sarcopenic dysphagia is described as difficulty swallowing due to generalized sarcopenia of skeletal muscles and thus swallowing muscles.It is a recently recognized condition.It draws attention due to its important complications.The risk factors of dysphagia include age, history of clinical disease, and physical frailty, including reduced activities of daily living.It is a common syndrome among the elderly and demands multidisciplinary therapeutic interventions, including nutritional support and rehabilitation programs, which are non-invasive but effective methods, mandatory for the best outcome.The prevention, assessment, and intervention methods for sarcopenic dysphagia are very important.Recent studies demonstrate that new concepts in rehabilitation and nutritional support render promising results.

Ferrets are considered a popular small mammal pet, and like other companion animals they are reported to suffer from diseases affecting the neuromuscular system. There currently is a lack of comprehensive electrodiagnostic study regarding the appendicular nerves of ferrets. In this research investigation, 25 domestic ferrets were used for electromyography and motor nerve conduction studies of the tibial, fibular, ulnar, and radial nerves, including H reflexes of the tibial and ulnar nerves, as well as sensory conduction of the fibular nerve. Mean and standard deviations for motor and sensory nerve studies were established. The hypothesis that weight would be correlated with all distal and proximal compound muscle action potential latencies was tested and confirmed for the tibial, fibular, and radial nerves but not the ulnar nerve.

Investigations on the fluctuation in PM10 air pollution in Volos, a medium-sized industrialized port city in the Mediterranean, are presented for the 5-year period between 2009 and 2014. The levels detected have been examined in relation to legislatively set limits, sampling year, and day of the week. A PM10 spring sampling campaign has been performed in 2014 and metals and other elements in the PM10 mass have been quantified. Source origin has been attempted for the latter sampling campaign and human health risk has been assessed. Results show compliance with the mean annual value of 40g m(-3) of 2008/50/EC for the city; however, exceedances of the daily quality standard of 50g m(-3) were frequently recorded. Shifts in PM10 concentrations and in contributing sources have been recorded; nevertheless, longer duration data series are needed for safe deductions. Element measurements have enabled source identification for early summer of 2014, with Earth's crust minerals and anthropogenic sources being the main factors. Cumulative non-carcinogenic risk may exceed the threshold value of 1. Possible involvement of sea salt aerosol and desert dust long-range transport has also been assessed. These results may furnish databases on PM pollution of Greek cities as well as other Mediterranean urban centers with similar characteristics.

Background: Pelvic ring fractures (PRFs) may influence the daily activities and quality of life of the injured. The aim of this retrospective study was to explore the functional outcomes and factors related to return to work (RTW) after PRF.Methods: During the years 2003-2012, 282 injured individuals aged 20-55 years on the date of the accident, were hospitalized and treated for PRFs in a large tertiary hospital in Athens, Greece. One hundred and three patients were traced and contacted; 77 who were on paid employment prior to the accident gave their informed consent to participate in the survey, which was conducted in early 2015 through telephone interviews. The questionnaire included variables related to injury, treatment and activities, and the Majeed pelvic score. Univariate and multiple regression analyses were used for statistical assessment.Results: Almost half of the injured (46.7%) fully RTW, and earning losses were reported to be 35% after PRF. The univariate analysis confirmed that RTW was significantly related to accident site (labor or not), the magnitude of the accident's force, concomitant injuries, duration of hospitalization, time to RTW, engagement to the same sport, Majeed score, and complications such as limp and pain as well as urologic and sexual complaints (p < 0.05 for all). On multiple logistic regression analysis, the accident sustained out of work (odds ratio: 6.472, 95% confidence interval: 1.626-25.769) and Majeed score (odds ratio: 3.749, 95% confidence interval: 2.092-6.720) were identified as independent predictive factors of full RTW.Conclusion: PRFs have severe socioeconomic consequences. Possible predictors of RTW should be taken into account for health management and policies. (C) 2016, Occupational Safety and Health Research Institute. Published by Elsevier.

Background: Tic and Tourette disorders are not just movement disorders. Non-motor elements either sensory or cognitive are frequently associated with the expression of tics, commonly referred to as 'premonitory urge'. Older children with tic disorder are able to describe their sensory sensitivity, but this may remain undetected and underestimated in toddlers and young children. Although an important element in the pathophysiology of tic disorder, sensory pathways have not been widely evaluated neither in the clinical nor in a research setting. Objective: To elucidate associated sensory symptoms in children presenting with tic disorder. Methods: We studied 81 children and adolescents with tics and Tourette syndrome, (N = 62 children with provisional tic disorder, Ν = 12 children with chronic motor tic disorder, Ν = 7 children with Tourette syndrome), aged 3,5 to 15,5 years. In order to assess their sensory symptoms, all subjects underwent evaluation through the following YGTSS (Yale Global Tic Severity Scale) for the assessment of tic severity, Premonitory Urge for Tics Scale (PUTS) for the assessment of premonitory urge and Sensory Profile (SPQ) for the assessment of sensory disorders. Additionally, sensory pathways were evaluated using sensory evoked potentials (SEPs). Results: A significant positive correlation was found between age and Total YGTSS score (rho = 0.335, p < 0.05), as well as a between age and PUTS (rho = 0.445, p < 0.05) and PUTS and Yale (rho = 0.482, p < 0.05). According the results of regression analysis, we conclude that PUTS can be used as a prediction of Yale with the aid of a specific mathematic formula. Yale = 1.389*PUTS + 4.836 No significant correlation was found in median nerve SEP cortical latencies between patients and age-matched controls. Conclusion: The evaluation of sensory symptoms in children with tic disorders could be of benefit in the design of individualized management and specific interventions and thus should be part of their routine assessment.

•LCM, PHT and TPM exert significant effects on peripheral nerve excitability.•PHT has a neurotoxic potential even at subtherapeutic levels.•TPM, at low concentrations, may exert a neuroprotective effect on the PNS.•LCM appears to increase the viability of peripheral nerves at therapeutic levels.•The possible antinociceptive potential of LCM warrants further study.

Purpose: This study aims to investigate the relationship between hair zinc levels and nociception/ pain tolerance in reference to dietary preferences, smoking and/or alcohol consumption and exercise in young men, aged 19-40 years old. Methods: Hair samples were collected from 42 recruited healthy soldiers, aged 19-40 years old. All subjects were asked to complete a detailed questionnaire including demographic data, education status, dietary preferences, smoking and alcohol use, exercise or athletic habits and then were submitted to a stress test. Data were subjected to statistical analysis via the SPPS program. Results: Zinc levels and pain tolerance were found linearly and positively correlated (r=0.293, sig<0.05), higher levels of zinc were observed in athletes (t=-2.534, sig<0.05) and a significant positive relation was registered between hair zinc levels (rho=0.366, sig<0.05), pain tolerance (rho=0.291, sig<0.05) and frequency of athletic activity. Foods providing high zinc levels, to the consumers, such as red meat (r=0.324, sig<0.05), white meat (r=0.361, sig<0.05) and legumes (r=0.346, sig<0.05) revealed higher correlation scores to pain tolerance, whereas consumption of red meat (r= 0.447, sig<0.05) and legumes (r=0.355, sig<0.05) showed also higher hair zinc levels. Persons performing athletic activity consumed more often red meat, legumes and seafood and presented higher zinc levels (r=0.430, sig<0.05) and higher pain tolerance (r=0.428, sig<0.05). Finally a negative relation between hair zinc levels and age (rho=-0.337, sig<0.05) was registered. Conclusions: Zinc seems to modulate somatosensory function, nociception and pain tolerance in relation to a variety of lifestyle parameters.

We analyzed n-alkane contents and their stable carbon isotope composition, as well as the carbon and nitrogen isotope composition (δ13C, δ15N) of sediment organic matter and different tissues of Posidonia oceanica seagrass sampled in Alexandroupolis Gulf (A.G.), north-eastern Greece, during 2007–2011. n-Alkane contents in P. oceanica and in sediments showed similar temporal trends, but relative to bulk organic carbon content, n-alkanes were much more enriched in sediments compared to seagrass tissue. Individual n-alkanes in sediments had similar values than seagrass roots and rhizomes and were more depleted in 13C compared to seagrass leaves and sheaths, with δ13C values ranging from −35‰ to −28‰ and from −25‰ to −20‰, respectively. n-Alkane indexes such as the Carbon Preference Index, carbon number maximum, and n-alkane proxy 1 (C23+C25/C23+C25+C29+C31) indicate strong inputs of terrestrial organic matter, while the presence of unresolved complex mixtures suggests potential oil pollution in some sampled areas.

AIM:The additive EuroSCORE system for predicting operative mortality of cardiac patients tends to underestimate the mortality risk of high risk patients and concomitantly to overestimate that of low risk patients. We propose a modification of stratification groups aiming at improving its precision. We also tested its ability to predict the length of postoperative mechanical ventilation of our patients.METHODS:The high risk group of the EuroSCORE system (>6 points) was divided into three additional groups (group I: 0-2 points, group II: 3-5 points, group III: 6-8 points, group IV: 9-13 points, group V: >14 points) thus producing a 5 classes system. In a group of 301 cardiac surgery patients operated on in a low volume cardiac center, we calculated the expected mortality rate for each EuroSCORE class, the calibration of the modified scoring system, the ROC and the corresponding AUC values and the relative risk of each predisposing factor used by the original EuroSCORE sytem.RESULTS:The proposed modification increased the discrimination ability of EuroSCORE in predicting mortality (Hosmer-Lemeshow P=0.78, ROC size: 0.791) and marginally affected its accuracy in predicting length of postoperative mechanical ventilation (Hosmer-Lemeshow: 0.11, ROC size: 0.711). Combined operations of CABG and valve replacement were shown to exert a statistically significant effect on mortality (odds ratio 3.85, CI: 1.15-12.87, P=0.028).CONCLUSION:The proposed modification of additive EuroSCORE can presumably increase its discrimination ability in predicting mortality of cardiac patients handled in a low volume cardiac center. The need for prolonged mechanical ventilation could be predicted with acceptable accuracy, possibly providing support in resource management.

The concentrations of 22 polyaromatic hydrocarbons (PAH) in Posidonia oceanica seagrass, sediments, and seawater from the Alexandroupolis Gulf in the Aegean Sea, were investigated from 2007 to 2011. Temporal trends of total PAH contents in P. oceanica and sediments were similar. PAH levels in seawater, sediments, and seagrasses generally decreased with increasing distance from Alexandroupolis Port. Leaves and sheaths of P. oceanica had higher PAH levels than roots and rhizomes. P. oceanica accumulates PAHs and has good potential as a bioindicator of spatiotemporal pollution trends. PAH concentrations were also examined using in situ passive seawater sampling and were compared to results of passive sampling in the laboratory using local sediments and seawater. Levels of high molecular weight PAHs assessed using passive samplers confirmed the decreasing gradient of pollution away from Alexandroupolis Port. Passive sampling also proved useful for investigating sources of PAHs in P. oceanica meadows.

BACKGROUND:Idiopathic epilepsies and epileptic syndromes predominate childhood and adolescence epilepsy. The aim of the present study was to investigate the clinical course and outcome of idiopathic childhood epilepsy and identify variables determining both early and long-term prognosis.METHODS:We followed 303 children with newly diagnosed idiopathic epilepsy aged 1-14 years old, both prospectively and retrospectively. Outcome was defined at one, 2 and 4 years of follow-up, as well as at the end of the study period for all patients. Based on the data collected, patients were classified in four patterns of clinical course: "excellent", "improving", "relapsing" and "poor". Variables defined at intake and after the initial year of treatment were analyzed for their prognostic relevance towards the clinical course and outcome of the patients.RESULTS:The mean age at seizure onset was 6.7 years and the mean duration of follow-up was 8.3 years (range 2,0-22,0,SD 4,24). During the initial year of treatment, 70,3% of patients were seizure-free. The course of epilepsy was "excellent" in 53,1% of the subjects, "improving" in 22,8%, "relapsing" in 22,1% whereas only 6 children with idiopathic epilepsy (2%) had a "poor" clinical course exhibiting drug-resistance. After multivariate analysis, variables predictive of a poor initial response to therapy were early seizure onset, multiple seizure types and history of status epilepticus. At the end of follow-up, early response to treatment was of significant positive predictive value, while the presence of multiple seizure types and the history of migraine had a negative impact on prognosis.CONCLUSIONS:In the vast majority of children, the long-term prognosis of idiopathic epilepsy is favorable. More than half of the patients attain seizure freedom immediately and their clinical course is considered "excellent". About one fifth exhibit either an improving or a fluctuating course. Early seizure onset, multiple seizure types and status epilepticus are predictive of an initial poor response to treatment in children with idiopathic epilepsy. Initial non-response to treatment, multiple seizure types and history of migraine are determinants of a less favorable final outcome after long-term follow-up.

Background Diabetes constitutes a risk factor for stroke that also aggravates stroke prognosis. Several prognostic models have been developed for the evaluation of neurologic status, severity, short-term functional outcome and mortality of stroke patients. IScore is a novel tool recently developed in order to predict mortality rates within 30 days and 1 year after ischemic stroke and diabetes is not included in the scoring scale of IScore. The aim of the present study was to evaluate and compare IScore validity in ischemic stroke patients with and without diabetes. Methods This prospective study included 312 consecutive Caucasian patients with type 2 diabetes and 222 Caucasian patients without diabetes admitted for ischemic stroke in a tertiary Greek hospital. Thirty-day and 1-year IScores were individually calculated for each patient and actual mortality was monitored at the same time intervals. IScore’s predictive ability and calibration was evaluated and compared for ischemic stroke patients with and without diabetes. The performance of IScore for predicting 30 and 1-year mortality between patients with and without diabetes was assessed by determining the calibration and discrimination of the score. The area under the receiver operating characteristic curve was used to evaluate the discriminative ability of IScore for patients with and without diabetes, whereas the calibration of IScore was assessed by the Hosmer–Lemeshow goodness-of fit statistic. Results Baseline population characteristics and mortality rates did not differ significantly for both cohorts. IScore values were significantly higher for patients with diabetes at 30 days and 1 year after ischemic stroke and patients with diabetes presented more frequently with lacunar strokes. Based on ROC curves analysis IScore’s predictive ability for 30 day mortality was excellent, without statistically significant difference, for both cohorts. Predictive ability for 1 year mortality was also excellent for both groups with significantly better ability for patients with diabetes especially at high score values. Calibration of the model was good for both groups of patients. Conclusions IScore accurately predicts mortality in acute ischemic stroke Caucasian patients with and without diabetes with higher efficacy in predicting 1 year mortality in patients with diabetes especially with high scores.