Exploring patterns of antibiotics during and after COVID-19 pandemic in wastewaters of northern Greece: Potential adverse effects on aquatic environment

Antibiotics, recognized as Emerging Contaminants (ECs), have raised concerns due to their pervasive presence in wastewater treatment plants (WWTPs) and subsequent release into aquatic environments, posing potential ecological risks and contributing to the development of antibiotic-resistant genes. The COVID-19 pandemic prompted an unprecedented surge in antibiotic consumption, necessitating a comprehensive assessment of its impact on antibiotic levels in wastewater. In this light, a four-year monitoring study (2020-2023) was conducted in a WWTP located in the Northern Greece (Thessaloniki), employing High-Resolution Mass Spectrometry (HRMS) technology to monitor twenty antibiotics, during distinct phases pre-, during, and post-COVID-19. Our findings revealed that macrolides and fluoroquinolones were among the most often detected categories during the sampling period. Among the compounds detected, azithromycin and clarithromycin showed the most significant increases during the pandemic, doubling their average concentrations. This establishes a clear correlation between the rise in their concentrations and the incidence of COVID-19 cases. A general downward trend after 2021 was attributed to the new restrictions posed in Greece during this year, regarding the liberal prescription of antibiotics. Seasonal variation revealed a minute augmentation of antibiotics' use during the months that infections are increased. Additionally, the study highlights the ecological risks associated with elevated antibiotic presence and emphasizes the need for continued monitoring and regulatory measures to mitigate potential ecological repercussions. These findings contribute to our understanding of the complex interplay between antibiotic consumption, environmental presence, and the COVID-19 pandemic's impact on antibiotic pollution in WWTPs.

An Unusual Manifestation of Brucella-Associated Uveitis in a Young Male Patient

This is a unique case of retinoschisis as an ocular manifestation of brucellosis. A 38-year-old male presented with recurrent episodes of bilateral eye redness, predominately in his left eye. His visual acuity was not affected, and he did not report any other symptoms. On slit lamp examination, binocular Koeppe nodules of the iris and cells in the left anterior chamber were observed. Fundoscopy followed by meticulous multimodal imaging confirmed left inferior retinoschisis. The patient was diagnosed with panuveitis, and a series of laboratory examinations revealed positive anti-IgM Brucella antibodies. Ocular brucellosis can cause variable, atypical, and serious presentations, hence, early diagnosis is paramount to avoid complications.

Central Serous Chorioretinopathy: An Update on the Current State of Management

Central serous chorioretinopathy (CSCR) is a relatively common retinal disorder that leads to central vision impairment, often with a high recurrence rate. The exact etiology and pathogenetic mechanisms have not been fully elucidated but are likely to be associated with hyperpermeability of the choroidal capillaries and failure of the retinal pigment epithelium (RPE), leading to serous detachment of the neurosensory retina. Multimodal imaging plays a critical role in the diagnostic approach and monitoring of CSCR. Fortunately, the natural course of the disease is usually self-limiting, with spontaneous resolution and total fluid reabsorption. However, some patients may exhibit recurrences or persistent subretinal fluid (chronic CSCR), leading to progressive and irreversible RPE atrophy or photoreceptor damage. Thus, to prevent permanent visual loss, individualized treatment should be considered. Recent developments in the diagnostic and therapeutic approach have contributed to better outcomes in patients with CSCR. More studies are required to improve our understanding of epidemiology, pathogenesis, diagnosis, and treatment, with a significant impact on the management of this challenging clinical entity. The purpose of this review is to summarize the current knowledge about the clinical features, diagnostic workup, and therapeutic approach of CSCR.

Local and regional air pollution characteristics in Cyprus: A long-term trace gases observations analysis

Observations of key gaseous trace pollutants, namely NO, NO_y, CO, SO₂ and O_3, performed at several curb, residential, industrial, background and free-troposphere sites were analyzed to assess the temporal and spatial variability of pollution in Cyprus. Notably, the analysis utilized one of the longest datasets of 17 years of measurements (2003-2019) in the East Mediterranean and the Middle East (EMME). This region is considered a regional hotspot of ozone and aerosol pollution. A trend analysis revealed that at several stations, a statistically significant decrease in primary pollutant concentration is recorded, most likely due to pollution control strategies. In contrast, at four stations, a statistically significant increase in ozone levels, ranging between 0.36 ppb_v y^-1 and 0.82 ppb_v y^-1_, has been observed, attributed to the above strategies targeting the reduction of nitrogen oxides (NO_x) but not that of Volatile Organic Compounds (VOCs). The NO and NO_y, and CO levels at the Agia Marina regional background station were two orders of magnitude and four times lower, respectively, than the ones of the urban centers. The latter denotes that local emissions are not negligible and control a large fraction of the observed interannual and diurnal variability. Speciation analysis showed that traffic and other local emissions are the sources of urban NO and NO_y. At the same time, 46 % of SO₂ and 40 % of CO, on average, originate from long-range regional transport. Lastly, a one-year analysis of tropospheric NO₂ vertical columns from the TROPOMI satellite instrument revealed a west-east low-to-high gradient over the island, with all major hotspots, including cities and powerplants, being visible from space. With the help of an unsupervised machine learning approach, it was found that these specific hotspots contribute overall around 10 % to the total NO₂ tropospheric columns.

The Role of Vessel Density as Measured by Optical Coherence Tomography Angiography in the Evaluation of Pseudoexfoliative Glaucoma: A Review of the Literature

INTRODUCTION

To review the existing literature about the optical coherence tomography angiography (OCTA) findings regarding peripapillary and macular vessel density (VD) in patients with pseudoexfoliative glaucoma (PXG).

METHODS

A comprehensive search of the PubMed database was conducted to include articles up to November 1, 2021, using an appropriate search algorithm. The retrieved articles were assessed for eligibility and filtered manually to exclude duplicates, while articles and book chapters cited in the reference lists of the eligible articles obtained by this method were reviewed so as not to miss any relevant studies.

RESULTS

There is consistency among the studies published so far that a significant decrease in peripapillary VD exists in eyes with PXG compared to controls, and macular VD has also been reported to be significantly lower in PXG eyes than controls. However, the existing literature remains controversial regarding OCTA findings in eyes with PXG compared to those with primary open-angle glaucoma (POAG). Several studies have found that peripapillary VD and macular VD were significantly lower in PXG than POAG, while other studies reported no significant difference.

CONCLUSIONS

Eyes with PXG were found to present decreased peripapillary and macular VD compared to control eyes, suggesting that a vascular component, including optic nerve hypoperfusion, may be implicated in the pathogenesis of PXG.

Assessment of a wide array of organic micropollutants of emerging concern in wastewater treatment plants in Greece: Occurrence, removals, mass loading and potential risks

Exploring the contamination profile of multi-class emerging contaminants (ECs) in wastewater is highly desirable. To this end, the occurrence, removal, mass loading and risks associated with a large panel of pharmaceuticals and personal care products, illicit drugs, perfluorinated compounds and organophosphate flame retardants in two wastewater treatment plants (WWTPs) in the region of Thessaloniki (Greece) after a survey is illustrated. Influent and effluent wastewaters were submitted to solid phase extraction on Oasis HLB cartridges, followed by ultra-high-performance liquid chromatography Orbitrap high-resolution mass spectrometry (UHPLC-Orbitrap MS). Influent concentrations in both WWTPs were notably higher than effluent, with caffeine, acetaminophen, irbesartan and valsartan being the most ubiquitous compounds, exhibiting elevated concentrations. Average effluent concentrations ranged from below the method quantification limits (<MQL) to remarkably high values (μg L^-1 scale), such as for caffeine, acetaminophen, diclofenac, irbesartan and valsartan, among others. Removal efficiencies ranged between -273% for lamotrigine and 100%, i.e., for the UV filter BP1. Notably, the polar compounds such as cytarabine, methotrexate and capecitabine were removed at a rate >80% in both WWTPs, allowing the correlation between logK_ow and removals. Interesting trends for the illicit drugs were revealed by means of mass loading estimation, as in the case of benzoylecgonine (71.6 mg/day/1000 inhabitants). Ecotoxicological risk assessment was evaluated for both single components and mixture, using three approaches: risk quotient (RQ), risk quotient considering frequency (RQ_f) and toxic units (TU). Irbesartan and telmisartan posed a high risk in all trophic levels, while fish was the most sensitive taxa for diclofenac. This work aspires to intensify the surveillance programs for the receiving water bodies, as well as to motivate the investigation of toxicity to non-target organisms.

Mineralocorticoid receptor signaling is implicated in carfilzomib-induced increase in blood pressure

Introduction

Carfilzomib (Cfz), an irreversible proteasome inhibitor, is a first line antineoplastic agent indicated for relapsed/refractory multiple myeloma, with its clinical use being hampered by cardiovascular adverse effects. Hypertension, is the most common cardiovascular side effect of Cfz, remaining of unknown pathogenicity.

Purpose

Considering that management of Cfz-related hypertension remains an unmet clinical need and that renal function plays a pivotal role in blood pressure regulation we sought to investigate the renal contribution in Cfz-induced hypertension.

Methods

We have previously established a translational model of Cfz-induced cardiomyopathy, based on clinically applicable dose regimens and we have concluded that two and four dose protocols successfully resemble the clinical observations in vivo. Herein, sixty C57Bl/6 male mice (12–14 weeks old) were randomized to: 1. Two doses Protocol: i. Control (N/S 0.9%), ii. Cfz (8mg/kg) for two consecutive days; and 2. Four doses Protocol: i. Control (N/S 0.9%), ii. Cfz (8mg/kg) for seven days intraperitoneally. Systolic (SBP) and diastolic blood pressure (DBP) were measured by tail cuffs; the latter protocol was repeated and urine collection was performed via metabolic cages studies. Renal samples were collected for histological, proteomic, metabolomic and molecular signaling analyses. Finally, eplerenone, a mineralocorticoid receptor (MR) blocker, was orally co-administered with Cfz to the mice daily (165 mg/kg) in the four doses protocol.

Results

Cfz increased SBP only in the four doses protocol (78.50±2.05 vs 68.20±0.73 in the Control group, **P&lt;0.01). Histological evaluation of the kidneys revealed a juxtaglomerular apparatus hyperplasia (JAH) in the same dose regimen. Proteomic analysis presented that metabolic and transport of small molecules pathways were differentially regulated in the Cfz treated murine kidneys. Metabolomic analysis revealed an increase in urea cycle metabolites (L-Alanine, L-Glutamine, glutamate, aspartate) and taurine content in the kidneys. Additionally, mice presented decreased diuresis without any differences in other metabolic parameters. In parallel an upregulation of β-ENaC expression and activation of MR/SGK-1 signaling in the kidneys was observed, indicating that Cfz activates MR signaling. Co-administration of eplerenone and Cfz, restored diuresis, decreased SBP and inhibited MR/SGK-1 signaling in the kidneys.

Conclusions

Activation of MR signaling by Cfz in the kidneys orchestrates renal water/salt retention and drives an increase in blood pressure in vivo. Histological and metabolomic analyses present that Cfz induces an acute kidney injury and a tonicity increase. Eplerenone reversed Cfz-induced blood pressure increase and restored diuresis by inhibiting MR/SGK-1 signaling. Therefore, MR blockade emerges as a potent therapeutic approach against Cfz-related cardiovascular adverse events.

Funding Acknowledgement

Type of funding sources: None.

Comparative study of the bioactive compounds of olive products on cardioprotection from ischemia-reperfusion injury in mice with metabolic syndrome

Background/Introduction

The main bioactive compounds of olive products, oleuropein (OL), hydroxytyrosol (HT), oleocanthal (OC) and oleanolic Acid (OA) exert multiple benefits in cardiovascular diseases. However, their potential cardioprotective effect after chronic administration at a nutritional dose has not been studied in metabolic syndrome (MS).

Purpose

We evaluated and compared possible cardioprotective effects of chronic oral treatment with OL, HT, OC and OA in a mouse model of diet-induced MS.

Methods

We initially explored if OL, HT, OC, OA exert cardioprotection against ischemia-reperfusion (I/R) injury after chronic administration in healthy animals. The nutritional dose was selected as the equivalent to the estimated daily phenolic intake in humans following the Mediterranean diet. C57Bl6 mice were randomized into 5 groups and treated daily for 6 weeks as followed: i) DMSO 5%, ii) OL (20.6 mg/kg), iii) HT (5.9 mg/kg), iv) OC (11.6 mg/kg), v) OA (17.4 mg/kg). All animals were then subjected to I/R (30/120 min) and infarct size (IS) was determined. In a second cohort, C57Bl6 mice were fed with western diet for 14 weeks to induce MS. At 8th week, mice were randomized into 6 groups: i) Normal Saline (NS), ii) OL, iii) HT, iv) DMSO 5%, v) OC, vi) OA and treated daily with the assigned compound/vehicle for the last 6 weeks. At baseline, 8th and 14th week, body weight, mean arterial blood pressure (MAP) and fasting glucose levels were evaluated. Blood samples were collected at baseline and 14th week for the determination of the lipid profile and the mice were subjected to IR (30/120 min).

Results

OL, OC and OA reduced IS in healthy animals (p&lt;0.05 vs. DMSO). Similarly, the IS was significantly reduced in MS mice after OL (19.4±2,6% vs. NS 34.7±1.6%, p&lt;0.01), OC and OA (12.3±2.9% and 18.3±0.4% vs. DMSO 35.6±4.9%, p&lt;0.0001 and p&lt;0.001). HT failed to reduce the IS in both cohorts. Body weight, glucose, cholesterol and LDL levels were significantly elevated in the control groups, whereas MAP did not change. OL was the only compound that reduced fasting glucose and LDL levels, while OA reduced total cholesterol and LDL levels (p&lt;0.01). OC and HT did not alter the lipidemic parameters. None of the bioactive compounds affected the body weight, MPA and triglyceride levels.

Conclusion(s)

Chronic treatment with nutritional doses of OL, OC and OA reduce IS in mice with MS; OC displays the most potent cardioprotective effect. OL ameliorates hyperglycemia and decreases LDL, while OA lowers both total cholesterol and LDL. Investigation of the underlying mechanisms and combined treatment with these compounds could emerge novel molecular cardioprotective approaches explaining possible additive beneficial effects in patients with MS.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Operational Program “Competitiveness, Entrepreneurship and Innovation”, under the call “RESEARCH – CREATE – INNOVATE” (project code: 5048539).

Molecular Analysis of Dirofilaria repens Isolates from Eye-Care Patients in Greece

PURPOSE

Human ocular dirofilariasis is a zoonotic disease caused by several species of filarioid helminths of the genus Dirofilaria. The aim of this study was to further re-examine five preserved specimens previously isolated from patients with ocular dirofilariasis by molecular means.

METHODS

Four of the examined helminths had been stored in unbuffered formaldehyde solution for more than eight years; whereas, the fifth helminth was stored in ethanol buffer for more than two years. For the four specimens stored in formaldehyde, different methods of DNA recovery and amplification were applied and investigated for their efficiency in DNA extraction and PCR amplification. However, the DNA extraction and PCR amplification were successful only for the ethanol-preserved helminth.

RESULTS

The genetic identification of the ethanol-preserved specimen as Dirofilaria repens (D. repens) and its phylogenetic position based on the analysis of mitochondrial 12S ribosomal RNA, nuclear 18S ribosomal RNA and mitochondrial cytochrome c oxidase subunit one sequences are reported in the present paper. To our knowledge, these are the only deposited sequences related to D. repens that have been isolated in Greece.

CONCLUSIONS

Routine laboratory diagnosis is based on phenotypic characteristics of the helminthic parasites, but more accurate diagnosis requires molecular identification. Although the specimens preserved in formalin buffers may be a potential source for the enrichment of parasite genome databases, the DNA recovery of such samples is a challenging task.

SHERPA-city: A web application to assess the impact of traffic measures on NO2 pollution in cities

This paper presents SHERPA-City, a web application to assess the potential of traffic measures to abate NO₂ air pollution in cities. The application is developed by the Joint Research Centre. It is freely available (https://integrated-assessment.jrc.ec.europa.eu) and allows the user to perform a fast screening of possible NO₂ abatement measures addressing traffic in European cities. SHERPA-City results depend on the quality of the default input data. It is therefore important to stress that the SHERPA-City default traffic flows, emission factors, fleet composition, road network topology, NO₂ pollution from other sources and meteorological data are based on EU-wide datasets that may not always represent perfectly a particular local situation. This is why the SHERPA-City allows the default data to be substituted by local data, to better reflect local features. This tool must be considered as a first step in exploring options to abate NO₂ air pollution through transport measures. The final decisions should be based, wherever possible, on full-scale modelling studies incorporating local knowledge.

Dietary patterns and their association with cardio-metabolic outcomes in US firefighters

Background

Cardiovascular disease is prevalent among US firefighters. Obesity is known to be associated with an increased risk of CVD and it can be prevented by following a more Mediterranean style diet. The aim of this study was to identify the dietary patterns of US firefighters and assess how these patterns are associated with cardio-metabolic outcomes in the specific population.

Methods

Individuals were recruited from within a FEMA sponsored study from the Indiana Fire Department. IFD members with permanent station assigned were included. All participants underwent the Public Safety Medical examination, which includes occupational and medical history; a physical examination; routine laboratory tests; resting electrocardiograms; and maximal treadmill exercise testing. Participants self-reported their dietary habits.

Results

The mean BMI of the participants was 30.0 ± 4.5 kg/m2 and the percentage of body fat was 28.1 ± 6.1%. Using principal component analysis, two dietary patterns were identified, namely a Mediterranean style diet and an American Standard style diet. The Mediterranean style diet is positively associated with HDL cholesterol (β = 2.08, p = 0.001) even after adjusting for gender, BMI, VO2 max, max METS, age, and body fat percent. Triglycerides (β=-3.195, p = 0.585) and glucose (β=-0.079, p = 0.219) decreased with the Mediterranean style diet. The Standard American diet was also significantly associated with HDL cholesterol (β=-4.82, p = 0.002) and LDL cholesterol (β = 0.455, p = 0.014). In addition, body fat percentage increases significantly in the Standard American style diet (β = 1.778, p = 0.029), even after the adjustments.

Discussion

Two dietary patterns were identified in US firefighters - a Mediterranean style diet and an American Standard diet. Mediterranean diet was protective whereas the American Standard diet had the opposite effect. This could help provide suitable recommendations that could improve the lives of US firefighters.

Key messages

Two diet patterns have been identified in US firefighters. The Mediterranean style diet seems to have a protective effect. The American Standard diet has a negative impact on cardio-metabolic outcomes as expected.

Association of MMP2-1306C/T Polymorphism with Ischemic Retinal Vein Occlusion

PURPOSE

To investigate the possible association of the matrix metalloproteinase 2 (MMP2)-1306C/T polymorphism with the risk of ischemic retinal vein occlusion (iRVO).

METHODS

A total of 69 patients with RVO were enrolled in this study (43 with non-iRVO and 26 with iRVO). All subjects were screened for hypertension, diabetes mellitus, hyperlipidemia, history of stroke, anticoagulant medication, smoking status and glaucoma. The genotyping of MMP2-1306C/T polymorphism was performed using PCR-RFLP-based methods.

RESULTS

MMP2-1306C/T T allele carriers (CT+TT) were statistically significant associated with a higher risk of iRVO compared to CC genotype in the overall RVO group (odds ratio = 3.91, p = 0.015, 95% confidence interval:1.30-11.79). Analysis, following stratification by age revealed that T allele carriers had a statistically significant increased risk of iRVO compared to C allele carriers only in RVO patients <75 years old.

CONCLUSION

Our results demonstrated that MMP2-1306C/T polymorphism is a likely predisposing factor for iRVO in patients <75 years old. This is the first study attempting association of a gene polymorphism with the prevalence of iRVO.

Genetic polymorphisms associated with the prevalence of retinal vein occlusion in a Greek population

PURPOSE

To investigate possible associations of single-nucleotide polymorphisms (SNPs) from five genes with branch retinal vein occlusion (BRVO) and central retinal vein occlusion (CRVO).

METHODS

A total of 69 patients with retinal vein occlusion-RVO (24 with BRVO and 45 with CRVO), and 82 controls, were enrolled in this study. All subjects were screened for hypertension, diabetes mellitus, hyperlipidemia, glaucoma, anticoagulant medication, smoking status and history of stroke. The genotyping of AGTR1-A1166C, adiponectin + 276 G/T, MMP2-1306C/T, Gpla/lla-C807T/G873A and VKORC1-G1639A polymorphisms was performed using restriction fragment length polymorphism or allele-specific polymerase chain reaction.

RESULTS

The percentage of the AGTR1-A1166C C allele carriers and Gpla/lla-C807T/G873A T/A carriers was significantly higher in the CRVO patients than in the controls (P = 0.00001 and P = 0.0004, respectively). At the multiple logistic regression analysis, the AGTR1-A1166C C allele carrier status and the Gpla/lla-C807T/G873A T/A allele carrier status were found to be associated with an increased risk of CRVO. Moreover, adiponectin + 276 G/T T allele carriers had a significantly increased risk of RVO in subjects ≥ 75 years old. There was no significant difference between the BRVO patients and controls concerning the genotype or the allele frequency distributions of these SNPs. The genotype distributions or allelic frequencies of the other evaluated polymorphisms did not significantly differ between the patients with RVO and the control subjects.

CONCLUSIONS

AGTR1 A1166C and Gpla/lla C807T/G873A polymorphisms are likely to be risk factors for CRVO. Adiponectin + 276 G/T SNP is likely to predispose to RVO in older subjects.

Vitrectomy Results for Diffuse Diabetic Macular Edema with and without Inner Limiting Membrane Removal

Purpose

To determine whether vitrectomy for diffuse diabetic macular edema with and without internal limiting membrane (ILM) peeling is equally effective in reducing edema.

METHODS

The authors retrospectively analyzed the surgical outcomes in 73 eyes of 52 patients with diffuse diabetic macular edema. Eighteen eyes (Group A) underwent three-port pars plana vitrectomy with posterior hyaloid membrane (PHM) removal, while 55 eyes (Group B) had pars plana vitrectomy with additional ILM peeling after PHM removal. RESULTS. Intraoperatively the posterior hyaloid was found to be attached to the macula in all eyes. In Group A, macular edema resolved completely in 8 eyes (44.4%) with improvement of visual acuity (VA). In Group B, VA improved in 38 eyes (69.1%) with complete resolution of edema. The results of this study indicated that vitrectomy effectively reduced macular edema but eyes with ILM peeling (Group B) presented better results than those without ILM peeling. Another important factor related to the outcome seems to be the level of glycosylated hemoglobin (HbA1c).

CONCLUSIONS

In eyes with diffuse diabetic macular edema vitrectomy seems to be effective, but additional ILM peeling presented better results.

Characterization of activating mutations of NOTCH3 in T-cell acute lymphoblastic leukemia and anti-leukemic activity of NOTCH3 inhibitory antibodies

Notch receptors have been implicated as oncogenic drivers in several cancers, the most notable example being NOTCH1 in T-cell acute lymphoblastic leukemia (T-ALL). To characterize the role of activated NOTCH3 in cancer, we generated an antibody that detects the neo-epitope created upon gamma-secretase cleavage of NOTCH3 to release its intracellular domain (ICD3), and sequenced the negative regulatory region (NRR) and PEST domain coding regions of NOTCH3 in a panel of cell lines. We also characterize NOTCH3 tumor-associated mutations that result in activation of signaling and report new inhibitory antibodies. We determined the structural basis for receptor inhibition by obtaining the first co-crystal structure of a NOTCH3 antibody with the NRR protein and defined two distinct epitopes for NRR antibodies. The antibodies exhibit potent anti-leukemic activity in cell lines and tumor xenografts harboring NOTCH3 activating mutations. Screening of primary T-ALL samples reveals that two of 40 tumors examined show active NOTCH3 signaling. We also identified evidence of NOTCH3 activation in 12 of 24 patient-derived orthotopic xenograft models, two of which exhibit activation of NOTCH3 without activation of NOTCH1. Our studies provide additional insights into NOTCH3 activation and offer a path forward for identification of cancers that are likely to respond to therapy with NOTCH3 selective inhibitory antibodies.

Overview of legislation on sewage sludge management in developed countries worldwide

The need to apply innovative technologies for maximizing the efficiency and minimizing the carbon footprint of sewage treatment plants has upgraded sewage sludge management to a highly sophisticated research and development sector. Sewage sludge cannot be regarded solely as 'waste'; it is a renewable resource for energy and material recovery. From this perspective, legislation on sewage sludge management tends to incorporate issues related to environmental protection, public health, climate change impacts and socio-economic benefits. This paper reviews the existing legislative frameworks and policies on sewage sludge management in various countries, highlighting the common ground as well as the different priorities in all cases studied. More specifically, the key features of legislation regarding sludge management in developed countries such as the USA, Japan, Australia, New Zealand and the European Union (EU27) are discussed.

Ultrasound evaluation of the distal migration of the long head of biceps tendon following tenotomy in patients undergoing arthroscopic repair of tears of the rotator cuff

This study evaluates the position of the long head of biceps tendon using ultrasound following simple tenotomy, in patients with arthroscopically repaired rotator cuff tears.

In total, 52 patients with a mean age of 60.7 years (45 to 75) underwent arthroscopic repair of the rotator cuff and simple tenotomy of the long head of biceps tendon. At two years post-operatively, ultrasound revealed that the tendon was inside the bicipital groove in 43 patients (82.7%) and outside in nine (17.3%); in six of these it was lying just outside the groove and in the remaining three (5.8%) it was in a remote position with a positive Popeye Sign. A dynamic ultrasound scan revealed that the tenotomised tendons had adhered to the surrounding tissues (autotenodesis).The initial condition of the tendon influenced its final position (p < 0.0005). The presence of a Popeye sign was statistically influenced by the pre-operative co-existence of supraspinatus and subscapularis tears (p < 0.0001).

It appears that the natural history of the tenotomised long head of biceps tendon is to tenodese itself inside or just outside the bicipital groove, while its pre-operative condition and coexistent subscapularis tears play a significant role in the occurrence of a Popeye sign.

Arthroscopic removal of impinging cement after unicompartmental knee arthroplasty

Complications following unicompartmental knee arthroplasty (UKA) include aseptic loosening, polyethylene wear, arthritis progression and periprothetic fractures. We report on a patient with a firmly fixed, sizeable cement extrusion into the posteromedial aspect of the knee after a UKA causing impingement and pain in full extension. Cement extrusion is an extremely rare but potentially disabling complication that may occur despite care to remove all cement following implantation of the prosthesis. Removing a cement fragment, especially when this is firmly fixed to difficult-to-visualise and access parts of the prosthesis, is challenging. We believe the patient we report is the first one where a firmly fixed, sizeable cement extrusion was removed arthroscopically from the posterior aspect of the knee. This was achieved via an anterolateral portal with trans-notch view, combined with a posteromedial portal used both for viewing and instrument insertion. Arthroscopic removal of the impinging cement with the technique described above is a safe and effective option for the treatment of this difficult albeit rare problem.

Contrast sensitivity in patients with Beta-thalassemia major and sickle cell disease under regular transfusions and treatment with desferrioxamine

Purpose:

Evaluation of contrast sensitivity in patients with beta-thalassemia major and sickle cell disease which undergo regular transfusions and chelation therapy with desferrioxamine (DFX).

Materials and Methods:

We studied contrast sensitivity in 48 eyes (24 patients) with beta-thalassemia major (group A) and in 42 eyes (21 patients) with sickle cell disease (group B), compared to 60 eyes of 30 healthy individuals (control group). Contrast sensitivity was measured using B-VAT II-SG Mentor Video Aquity Tester.

Results:

We found no statistically significant difference between group A and group B in any spatial frequency, while we found statistically significant differences between group B and control group in all spatial frequencies studied. Between group A and control group we found statistically significant differences in spatial frequencies of 2.3, and 6 cyc/deg.

Conclusion:

DFX causes retinal alterations that may explain reductions in contrast sensitivity function and justifies regular evaluations that may allow early detection of visual function deterioration.

[The psychopathology of bilingual children in a sample of a Community Mental Health Center]

Thoughts and views of one's internal self can be materialized via verbal symbols. Therefore literal people can use these verbal symbols as a means of recording their ideas and experiences in order for them to be passed on and read by others. Evidently the abovementioned mental operations can be reflected in speech and language. It is not yet known whether bilingualism is the sum of two monolingual situations or whether they coexist. The way each language is organized is also not known, neither are the psychological operations that may influence the organization of each language, memory and the relationship with each language. During childhood and adolescence, language is a very important tool via which one communicates, materializes emotional behavior and organizes oneself. Linguistic development and identity formation both follow a parallel and connected line in view of the internal psychological organization. However, in the bilingual person, this relationship is influenced both by the two different cultural stimuli and by the two different linguistic stimuli (i.e. language). However, in the case where children grow up in a bilingual environment there are some particularities and special issues affecting these children. Under such circumstances, the accomplishment of the feeling of coherence and stability of the self becomes an even more difficult task for the child. Nowadays, in Greek reality, the phenomenon of bilingualism tends to be associated with economic immigration. In the sample used, five fourths of children consist of children coming from families of economic immigrants. The composition of the student population in Greece is characterized by linguistic and cultural polymorphism. The presence and existence of a large number of immigrants has changed the setting in Greece in many regions of the country and in turn, the composition of the school population. Any public school allover in Greece consists, among others, of children coming from families of economic immigrants, including thus a random number of children speaking different languages. Without doubt, immigration affects the immigrating person as much as it affects the new group. Also, immigration adjustment and formation depends on the pre-existing characteristics of the immigrants as much as it does on the characteristics of the welcoming society. Research dealing with the issues of economic immigrants in Greece are limited and mainly come from schools. The focus of interest is aimed firstly on the psychopathology that can be linked to the phenomenon of immigration and secondly on the social consequences of the phenomenon. The formation of psychopathology is associated with immigration and the importance of psychological trauma and its consequences. However, the association between the creation of psychopathology, which is formulated in childhood/adolescence, and the bilingual environment together with identity formation, is not yet clear. The aim of this paper was to study the effect of the dual language environment on psychopathology formation among children and adolescents as it appears in everyday clinical practice and as it has been recorded at the Child and Adolescent Mental Health Unit of the Community Mental Health Centre of Byron and Kaissariani, Psychiatric Hospital, Athens University. Data deriving from the database of the Community Mental Health Centre were extracted from the files of 62 bilingual children, aged 0 to 18 years, who had visited the CMHC of Byron and Kaissariani in the period 2000 to 2005. The data selected concerned the sex, age, maternal language, diagnosis and the existence of economic immigration. Means deriving from the sample of bilingual children were compared to the means of the rest of the sample. (Pearson chi,2 Fishers exact test) Based on the results, four fifths of the sample was composed of children belonging to families of economic immigrants. The occurrence of Pervasive Developmental Disorders was triple among the sample of bilingual children compared to the sample of monolingual children. Among school-aged children the majority of diagnoses concerned Specific Language, Movement and Learning Disorders. On the contrary, during adolescence, there was a two-fold increase of psychiatric illness among bilingual adolescents compared to monolingual adolescents with conduct disorders being more prominent among males and mood disorders more prominent among females. Based on the extent and importance of the influence of the dual linguistic environment on children and adolescents as well as on the originality of the new situation in Greek society, further exploration of this area is believed to be necessary.

Scheuermann's disease: focus on weight and height role

The aim of this cross-sectional case-control study is the comparison of the weight and height between a group of children with Scheuermann's disease (SD) and a comparable group of healthy ones and also the correlation of them with the degree and the morphology of the kyphotic curve. Following a school-screening program of 10,057 school students, aged between 11 and 17 years old, 175 adolescents with Scheuermann's disease were diagnosed. The mean height and weight of 175 adolescents diagnosed to have SD compared with this of a group of normal children taken randomly from the group of 9,882 healthy children screened. The control group was comparable with the study group concerning age (p = 0.605) and sex. The weight, height and body mass index (BMI) were significantly lower in the healthy (control) group (p < 0.001). However, there was no correlation between weight (r = -0.019, p = 0.804), height (r = 0.053, p = 0.484) and BMI (r = -0.177, p = 0.019) with the magnitude of kyphotic curve. There was also no correlation between weight (r = -0.27, p = 0.722), height (r = -0.025, p = 0.744) and BMI (r = -0.038, p = 0.619) with Voutsinas index as well. Scheuermann's disease is probably a multifactorial skeletal deformity. Weight and height do not seem to affect the magnitude and morphology of the main kyphotic curve in SD. It seems probably that this observation is not part of the pathogenetic mechanism of SD but a result of its cascade. The increased weight and height of these patients may be the secondary result of other disturbances (i.e. hormonal), which may play more crucial role in Scheuermann's disease pathogenesis.

The role of the dorsal vertebral cortex in the stability of transpedicular screws. A biomechanical study in human cadaveric vertebrae

The aim of this biomechanical study was to investigate the role of the dorsal vertebral cortex in transpedicular screw fixation. Moss transpedicular screws were introduced into both pedicles of each vertebra in 25 human cadaver vertebrae. The dorsal vertebral cortex and subcortical bone corresponding to the entrance site of the screw were removed on one side and preserved on the other. Biomechanical testing showed that the mean peak pull-out strength for the inserted screws, following removal of the dorsal cortex, was 956.16 N. If the dorsal cortex was preserved, the mean peak pullout strength was 1295.64 N. The mean increase was 339.48 N (26.13%; p = 0.033). The bone mineral density correlated positively with peak pull-out strength. Preservation of the dorsal vertebral cortex at the site of insertion of the screw offers a significant increase in peak pull-out strength. This may result from engagement by the final screw threads in the denser bone of the dorsal cortex and the underlying subcortical area. Every effort should be made to preserve the dorsal vertebral cortex during insertion of transpedicular screws.

Neglected trans-scaphoid trans-styloid volar dislocation of the lunate

A rare case of radiocarpal dislocation is presented. The lunate and proximal pole of the scaphoid were displaced in a volar and proximal direction. The injury was missed initially and the patient was subsequently operated on six weeks later. Open reduction and internal fixation of the scaphoid was performed and this was followed by an uneventful postoperative period, with a satisfactory functional outcome at the eight-year follow-up, despite carpal instability non-dissociative-dorsal intercalated segmental instability configuration of the carpus.

We believe that although open reduction in neglected cases carries the potential risks of avascular necrosis and nonunion of the affected carpal bones, an attempt should be made to restore the anatomy of the carpus.

Does aprotinin reduce blood loss in total hip arthroplasty?

This prospective randomized study examined the effects of aprotinin during total hip arthroplasty (THA). Fifty patients who were enrolled in the study received aprotinin or normal saline. Mean intraoperative blood loss was reduced from 1496 mL in the control group to 1073 mL in the aprotinin group. The mean transfusion unit was 1.56 in the aprotinin group and 3.8 in the control group.

Fracture callus engulfing a peripheral nerve does not affect its function: an experimental study in rabbits

The fate of a peripheral nerve engulfed in fracture callus is not known. We investigated the impact of envelopment of the sciatic nerve by fracture callus using a New Zealand rabbit femoral fracture model. The sciatic nerve was mobilized and coiled around the ipsilateral femur, which was surgically fractured, shortened, and osteosynthesized. Bony union was achieved, and callus engulfed the sciatic nerve in all animals. Nerve function was evaluated clinically and by conduction studies preoperatively and postoperatively. Although the nerve function in terms of clinical evaluation, amplitude, motor latency, and spontaneous activity deteriorated immediately postoperatively, recovery was evident in the following weeks indicating that the detected nerve dysfunction was attributable to the surgical mobilization. In addition, histologic and quantitative histomorphometric analyses proved that in none of the animals did the callus compress the sciatic nerve whereas an impressive process of axonal regeneration took place despite callus maturation. Results of our study suggest that callus, engulfing a peripheral nerve, does not compress it and the nerve appears to be intact in an osseous canal. This results in preservation of the integrity and function of the nerve, which may have significant clinical applications.

Supracondylar femoral fractures in elderly patients treated with the dynamic condylar screw and the retrograde intramedullary nail: a comparative study of the two methods

INTRODUCTION

The objective of this study is to present the results of surgical management of supracondylar fractures of the femur (types A and C according to the AO/ASIF classification) in elderly patients with the use of two different methods of fixation: the mini open dynamic condylar screw fixation (DCS) and the closed retrograde intramedullary nailing (RIN).

MATERIALS AND METHODS

Eighty patients with supracondylar fractures of the femur were treated from January 1994 to June 2000 and 72 of them followed up completely. There were 25 (34%) men and 47 (65%) women with a median age of 73.2 years (range 60-88 years). In patients with the same type of fracture, the chosen method was random, one after the other (alternately). RIN was used in 35 patients, and DCS was used in 37. The mean operative time for the DCS fixation group was 145 min (range 115-180 min), whereas for the RIN group it was 92 min (range 76-110 min) (p<0.001) with an average estimated blood loss of 310 cc (range 120-450 cc) and 118 cc (range 90-165 cc), respectively (p<0.001). The mean follow-up was 28 months (range 18-42 months).

RESULTS

According to the criteria set by Schatzker and Lambert, excellent results were recorded in 18 (51%), good in 11 (31%), moderate in 3 (9%), poor in 3 (9%) patients with RIN and excellent in 19 (51%), good in 11 (30%), moderate in 4 (11%) and poor in 3 (8%) patients with DCS (p>0.05). The complications that occurred in the RIN group were 2 (6%) stiffness of the knee (mean flexion 80 degrees), 2 (6%) non-unions, 2 (6%) varus deformity and in the DCS group 2 (5%) haematomas, 4 (11%) stiffness of the knee (mean flexion 73 degrees) and 2 (5%) non-unions.

CONCLUSION

Although the two methods appear to have the same percentage of excellent results and same time to bony union, RIN is preferable to DCS in terms of less blood loss and shorter operating time.

Soleus accessorius, an anomalous muscle in a young athlete: case report and analysis of the literature

The soleus accessory muscle is a rare anatomical variation. It usually appears as a soft tissue mass and may be mistaken for a tumour or an inflammatory lesion. The differential diagnoses include ganglion, lipoma, haemangioma, synovioma, and sarcoma. This is a report of such a muscle mass in the leg of a young athlete with 16 years follow up. A review of the English literature on this subject is also presented.

A combined proximal and distal dislocation of two adjacent metatarsals: double floating metatarsal bones (second-third)

A rare foot injury consisting of an irreducible, closed combined distal and proximal articulation dislocation of two adjacent metatarsals (second and third), called a "double floating metatarsal," was encountered in a 29-year-old man. The anatomy, mechanism of injury, and sequence of the surgical procedure are presented and discussed.

Sizable pseudoaneurysm of the abdominal aorta after laparoscopic cholecystectomy: a report of a serious complication

After the first successful laparoscopic cholecystectomy in Europe by Phillipe Mouret, the method quickly became established all over the world. In the meantime, its advantages and complications have been identified. In rare cases, major vascular injuries occur as serious and deadly complications of laparoscopic surgery. We present the case of a patient with a sizable pseudoaneurysm of the abdominal aorta that was identified 5 months after the performance of a laparoscopic cholecystectomy at another hospital. Thereafter, we review the literature in search of some methods that can be used to avoid vascular injuries.

Free-electron-laser oscillator with a linear taper

We present experiments and simulations showing the behavior of a free-electron laser (FEL) with both positive and negative linear tapers along the wiggler. We show the power desynchronism curve widths, efficiency, exhaust electron energy spread, and wavelength dependence as a function of taper for 3- and 6-microm optical wavelengths and for resonators with 10% and 2% loss/pass. Simulations of the experiments, using a multimode analysis, are seen to be in general agreement with the experimental results, carried out at the IR Demo FEL at Thomas Jefferson National Accelerator Facility. We find that short-pulse effects are more effective than tapers in producing high efficiency with low exhaust energy spread, and the expected performance enhancement of FEL tapering is not achieved.

Dislocation of bipolar hemiarthroplasty following breakage of the polyethylene ring

Dislocation after bipolar hemiarthroplasty is rare. In classical dislocations of bipolar prosthesis, the prosthetic femoral head escapes from the natural acetabular cavity. Two cases of a bipolar hip prosthesis are presented in which the dislocation occurred between the cup and the metallic ball head 4 and 12 months postoperatively. The reason for the dislocation was fracturing of the edge of the polyethylene ring - either due to impingement at the full flexion position of the hip or to dislocating forces in extreme positions of the metallic ball head. To avoid this complication we recommend installation of the notch of the polyethylene ring be at the peripheral half of the acetabular cup.

Morphometric characteristics of the thoracic and lumbar pedicles in the Greek population

OBJECTIVES

To measure the dimensions of the pedicles of T1 to L5 in the Greek population.

METHODS

A total of 12 whole human cadaver spines were evaluated regarding pedicle dimensions (5 women and 7 men). The mean age at the time of death was 69,6 (range 62 to 84 years). The transverse and sagittal out side pedicle isthmus widths, the internal transverse diameter and cortex width were measured with electronic calipers both on the right and left pedicles. The data collected were statistically analyzed with the t-test.

RESULTS

The widest transverse diameter was at the L5 level with a mean of 11,3mm (range 7,55-15,46mm). The narrowest transverse diameter was at the T5 level with a mean of 5,37mm (range 4,10-6,88mm). The widest sagittal diameter was at the T11 level with a mean of 17,23mm (range 14,84-19,57mm), while the narrowest one was at T1 level with a mean of 9,1mm (range 7,18-11,37mm). The maximum internal transverse diameter was at the L4 level with a mean of 8,26 mm (range 7,10-9,23mm) while the minimum was at the T5 level with a mean of 3,9mm (range 3,14-4,78mm). The maximum cortex width was at the L5 level with a mean of 2,55mm (range 2,15-3,02mm) and the minimum at the T5 level with a mean of 1,30mm (range 0,40-2,10mm).

CONCLUSIONS

From the statistic analysis of the above data it was found that regarding the internal diameter there was statistically significant difference between males and females especially at T3, T7, T8 and L3 levels (P<0,05), and almost in all levels regarding the cortex width. There was also statistically significant difference between right and left pedicles regarding the transverse and the sagittal widths (P<0,05). The narrowest pedicle was at the T5 level and the widest was at the L5.

Idiopathic scoliosis. Segmental fusion with transpedicular screws

The purpose of this study is to evaluate whether the surgical correction of the scoliotic curve with the use of segmental pedicle screw fixation system is effective. We studied 20 patients (19 girls, 1 boy) with a mean age of 14,6 years (range from 13 to 22). The spinal deformities were evaluated by Cobb method with anteroposterior and lateral bending radiographs. There were 13 right thoracic curves and 7 left thoracolumbar curves. The width of the pedicles was estimated in all patients by computerized tomography of the thoracic and lumbar spine. Posterior instrumentation (Moss-Miami transpedicular system) was used and additional thoracoplasty was performed in 2 patients. The transpedicular screws were placed between T2 and L5. Intraoperatively the image intensification was indispensable and the wake-up test was always conducted. All the patients were assessed both clinically and radiographically at 3,6,9,12 months and annually until now. The average follow-up was two years. There was an average correction of 73% of the primary curve (pre-op standing average 59 degrees (range from 42 degrees to 87 degrees), lateral bending average 33 degrees (range from 10 degrees to 75 degrees), post-op average 13 degrees (range from 6 to 30 degrees), at last examination average 14 degrees (range from 6 degrees to 33 degrees). Infection and neurological complications were not noted. No major complications were observed. Exact evaluation of the pedicles by CT scan is an essential prerequisite for transpedicular screw insertion. The correction of idiopathic curves with the use of segmental pedicle screw fixation system is a very effective method(correction > 70%) It seems that control of the three columns of the spine by the transpedicular screws offers sufficient apical translation and coronal realignment.

Surgical management of a congenital kyphotic deformity in an adolescent

This is a case of an adolescent with kyphoscoliosis due to congenital partially segmented vertebrae T12, L1, L2 who was treated operatively by a back-front-back, one stage operation. A 16 year old patient neurologically intact with a rounded gibbous in the lower thoracic region and a mild scoliotic element had no other congenital anomaly. His kyphotic deformity was 85 degrees measured with the Cobb method. Preoperatively, a CT and MRI scan of the spine was performed and a three-level anterolateral failure of segmentation in the thoracic spine was diagnosed without spinal dysraphism. The operation lasted 8 hours and the Moss-Miami anterior and posterior fixation systems were used for fusion from T10 to T4. It included initially posterior approach for transpendicular screw insertion, wedge resection of the posterior elemens followed by anterior approach (thoracotomy), osteotomy of the defected vertebrae, anterior correction and fusion T11 to L1 and final correction with rod placement posteriorly. The wake-up test was performed twice. The follow-up was 3 years. The postoperative correction of the kyphosis was 45% (42 degrees) and there was practically no loss of correction in the last follow-up. No complications were observed. Detailed preoperative assessment of the patients with congenital deformities is essential in order to establish the correct diagnosis and choose the proper treatment. Substantial kyphotic deformities require combined antero-posterior procedures.

Replacement of deficient acetabulum using Burch-Schneider cages. 22 patients followed for 2-10 years

The absence of good bone stock with massive acetabular deficiency has been a major problem in both revision hip arthroplasty and in primary arthroplasty for congenital dislocation of the hip (CDH). 22 patients (24 hips; 21 revision and 3 primary replacements: mean age 58 years) with substantial bone loss underwent acetabular reinforcement with Burch-Schneider cages. Classification of acetabular deficiency was made according to the AAOS system. The surgical procedure involved preparation of acetabulum, filling the defect with bone autografts, placement of the cage with its flanges, fixation with screws on the lateral wall only and placement of a cement and plastic cup. Radiographic loosening with breakage of the screws was observed in only 1 patient. After a mean follow-up of 8 (2-10) years, good stability was achieved in all patients and no mechanical failure was observed. Satisfactory results were observed in all but one of the cases, indicating that effective support of the acetabulum can be achieved using Burch-Schneider cages.

Effect on atrial natriuretic peptide by bracing in scoliosis. Boston brace removal studied in 10 cases

The immediate effect of Boston brace removal on plasma levels of atrial natriuretic peptide and arginine vasopressin was studied in 10 patients with idiopathic scoliosis ranging in age from 12 to 16 years. Blood samples were drawn via the antecubital vein in the supine position with the brace on and 10 min after brace removal. ANP and AVP plasma levels were measured by radioimmunoassay. Although no differences were found in the plasma concentrations of arginine vasopressin while on and after removal of the brace, atrial natriuretic peptide levels showed an approximately 80 percent increase 10 min after brace removal, presumably due to central volume redistribution. The changes of atrial natriuretic peptide plasma levels observed may be related to previously reported changes of the glomerular filtration rate and urinary sodium excretion following brace removal.

Retardation of Cd2+and Zn2+ discharge at the dropping mercury electrode by adsorbed phenyl substituted phosphonium cations

The effect of adsorbed propargyltriphenyl- and vinyltriphenylphosphonium cations on the discharge of Cd2+ and Zn2+ at dropping mercury electrode is studied by direct current polarographic measurements. Adsorption characteristics are determined by capacitance measurements. The size parameters of the activated complex and the surfactant particles are derived and an elucidation of the mechanism of the inhibited reaction is attempted.