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Katsiki N, Filippatos T, Vlachopoulos C, Panagiotakos D, Milionis H, Tselepis A, Garoufi A, Rallidis L, Richter D, Nomikos T, Kolovou G, Kypreos K, Chrysohoou C, Tziomalos K, Skoumas I, Koutagiar I, Attilakos A, Papagianni M, Boutari C, Kotsis V, Pitsavos C, Elisaf M, Tsioufis K, Liberopoulos E. Executive summary of the Hellenic Atherosclerosis Society guidelines for the diagnosis and treatment of dyslipidemias - 2023. Atheroscler Plus 2024; 55:74-92. [PMID: 38425675 PMCID: PMC10901915 DOI: 10.1016/j.athplu.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
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.
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Affiliation(s)
- N Katsiki
- Department of Nutritional Sciences and Dietetics, International Hellenic University, Thessaloniki, Greece
- School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Td Filippatos
- Department of Internal Medicine, School of Medicine, University of Crete, Crete, Greece
| | - C Vlachopoulos
- Cardiology Department, First Cardiology Clinic, Athens Medical School, Hippokration Hospital, Athens, Greece
| | - D Panagiotakos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | - H Milionis
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - A Tselepis
- Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - A Garoufi
- 2nd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L Rallidis
- 2nd Department of Cardiology, Medical School, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
| | - D Richter
- Head of Cardiac Department, Euroclinic Hospital, Athens, Greece
| | - T Nomikos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Athens, Greece
| | - G Kolovou
- Metropolitan Hospital, Cardiometabolic Center, Lipoprotein Apheresis and Lipid Disorders Clinic, Athens, Greece
| | - K Kypreos
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- University of Patras, School of Health Science, Department of Medicine, Pharmacology Laboratory, Patras, 26500, Greece
| | - C Chrysohoou
- 1st Cardiology Clinic National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - K Tziomalos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - I Skoumas
- 1st Department of Cardiology, National & Kapodistrian University of Athens, Athens, Greece
| | - I Koutagiar
- 1st Cardiology Department, Hygeia Hospital, Athens, Greece
| | - A Attilakos
- 3rd Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
| | - M Papagianni
- Third Department of Pediatrics, Aristotle University of Thessaloniki, School of Medicine, “Hippokrateion" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - C Boutari
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Kotsis
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University Thessaloniki, Greece
| | - C Pitsavos
- First Cardiology Clinic, School of Medicine, University of Athens, Greece
| | - M Elisaf
- Department of Internal Medicine, Faculty of Medicine, University Hospital of Ioannina, 45110, Ioannina, Greece
| | - K Tsioufis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Hippocration Hospital, Greece
| | - E Liberopoulos
- 1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
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Rizos C, Liamis G, Garoufi A, Skoumas I, Rallidis L, Kolovou G, Tziomalos K, Skalidis E, Kotsis V, Lambadiari V, Anagnostis P, Dima I, Kiouri E, Kolovou V, Polychronopoulos G, Zacharis E, Antza C, Liberopoulos E. One year follow-up of patients with familial hypercholesterolemia: Preliminary data from the HELLAS-FH registry. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rizos C, Skoumas I, Skalides E, Rallidis L, Tziomalos K, Sfikas G, Garoufi A, Anagnostis P, Kolovou G, Kotsis V, Doumas M, Bilianou E, Koutagiar I, Zacharis E, Kiouri E, Bantouvakis G, Agapakis D, Attilakos A, Antza C, Liberopoulos E. Implication of ESC/EAS 2019 dyslipidemia guidelines for PCSK9 inhibition in patients with familial hypercholesterolemia: An analysis from the Hellas-FH registry. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Antza C, Doundoulakis I, Akrivos E, Stabouli S, Kotsis V. Early vascular aging ambulatory score (EVAAS): Evaluation in an independent big data population. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Rizos C, Skoumas I, Skalides E, Rallidis L, Tziomalos K, Sfikas G, Garoufi A, Anagnostis P, Kolovou G, Kotsis V, Doumas M, Bilianou E, Koutagiar I, Zacharis E, Kiouri E, Bantouvakis G, Agapakis D, Attilakos A, Antza C, Koutsogianni AD, Liberopoulos E. Lipid profile and body mass index in patients with familial hypercholesterolemia: An analysis from the HELLAS-FH registry. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Anagnostis P, Rizos C, Skoumas I, Rallidis L, Tziomalos K, Skalides E, Kotsis V, Doumas M, Kolovou G, Sfikas G, Bilianou E, Koutagiar I, Kiouri E, Agapakis D, Zacharis E, Antza C, Koumaras C, Boutari C, Liamis G, Liberopoulos E. Prevalence of non-coronary heart disease in patients with familial hypercholesterolemia: An analysis from the HELLAS-FH. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rizos C, Elisaf M, Skoumas I, Rallidis L, Tziomalos K, Skalides E, Kotsis V, Garoufi A, Athyros V, Kolovou G, Sfikas G, Bilianou E, Koutagiar I, Kiouri E, Agapakis D, Zacharis E, Antza C, Attilakos A, Katsiki N, Liberopoulos E. Coexistence of cardiovascular risk factors in patients with familial hypercholesterolemia: Data from the HELLAS-FH registry. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rizos C, Liamis G, Skoumas I, Rallidis L, Tziomalos K, Skalides E, Kotsis V, Garoufi A, Athyros V, Kolovou G, Sfikas G, Bilianou E, Koutagiar I, Kiouri E, Agapakis D, Zacharis E, Antza C, Attilakos A, Katsiki N, Anagnostis P, Koumaras C, Liberopoulos E. Clinical characteristics of patients with familial hypercholesterolemia: Data from the HELLAS-FH registry. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rizos C, Liamis G, Skoumas I, Rallidis L, Tziomalos K, Skalides E, Kotsis V, Garoufi A, Athyros V, Kolovou G, Sfikas G, Bilianou E, Koutagiar I, Kiouri E, Agapakis D, Zacharis E, Antza C, Attilakos A, Katsiki N, Koumaras C, Liberopoulos E. Cholesterol levels of high-density lipoprotein (HDL-C), APOB/APOA1 ratio and cardiovascular risk in patients with familial hypercholesterolemia (FH): Data from the HELLAS-FH registry. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rizos C, Skoumas I, Rallidis L, Tziomalos K, Skalides E, Kotsis V, Garoufi A, Athyros V, Kolovou G, Sfikas G, Bilianou E, Koutagiar I, Kiouri E, Agapakis D, Zacharis E, Antza C, Attilakos A, Katsiki N, Anagnostis P, Elisaf M, Liberopoulos E. Latest European guidelines for dyslipidemias in the setting of familial hypercholesterolemia: Data from the hellas-fh registry. Atherosclerosis 2020. [DOI: 10.1016/j.atherosclerosis.2020.10.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Liberopoulos E, Rizos C, Garoufi A, Kolovou G, Athyros V, Skoumas I, Kotsis V, Rallidis L, Tziomalos K, Skalides E, Attilakos A, Katsiki N, Koutagiar I, Antza C, Elisaf M. P5324Children with familial hypercholesterolemia: lipid profile, treatment and evaluation of different formulas for calculating low-density lipoprotein cholesterol: an analysis from the HELLAS-FH registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
There is limited data on cardiometabolic characteristics and treatment of underage patients with familial hypercholesterolemia (FH). Accurate estimation of low-density lipoprotein cholesterol is essential to tailor hypolipidemic treatment.
Purpose
To report lipid profile and current treatment of underage patients with FH in Greece as recorded in the HELLAS-FH registry. Also, to compare the Friedewald with the Martin/Hopkins equation, (which provides a customized estimation of VLDL-C) and the Dahlen's formula [(which adjusts the LDL-C measurements for the amount of cholesterol in Lp(a)].
Methods
Underage patients with FH were evaluated. Lipid profile, current treatment regimen as well as LDL-C levels as assessed with different formulas were evaluated.
Results
A total of 191 children were included (51.0% boys, 11.0±3.5 years old). Children at baseline had mean LDL-C as calculated by the Friedewald equation (LDL-CF) 233±65 mg/dL and median Lp(a) 15.3 (IQR 8–51) mg/dL. A total of 59.2% of subjects were receiving hypolipidemic treatment, mainly statins (29.4%) and sterols/stanols (25.5%). Children on hypolipidemic therapy had mean LDL-CF 183±98 mg/dL with 22.1% achieving an LDL-C≤130 mg/dL. When LDL-C was calculated based on the Martin-Hopkins equation (LDL-CM/H) respective values were 180±58 mg/dL and 24.8%. When LDL-C was corrected for Lp(a) [= LDL-CM/H − (Lp(a) * 0.30)], LDL-C was 174±105 mg/dL with 33.3% of patients within the LDL-C target.
Conclusions
Nearly two-thirds of children were receiving some kind of hypolipidemic treatment at the time of registration. For those on treatment, LDL-C goal is achieved by one in five, which rises to 1 in 3 when LDL-C is corrected for Lp(a) levels.
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Affiliation(s)
- E Liberopoulos
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
| | - C Rizos
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
| | - A Garoufi
- General Children Hospital Pan. & Aglaia Kyriakou, 2nd Pediatrics Clinic, Athens, Greece
| | - G Kolovou
- Onassis Cardiac Surgery Center, Cardiology Clinic, Athens, Greece
| | - V Athyros
- Hippocration General Hospital of Thessaloniki, Department of Internal Medicine, Thessaloniki, Greece
| | - I Skoumas
- Hippokration General Hospital, Cardiology Clinic, Athens, Greece
| | - V Kotsis
- Hospital Papageorgiou, Department of Internal Medicine, Thessaloniki, Greece
| | - L Rallidis
- Attikon University Hospital, Department of Cardiology, Athens, Greece
| | - K Tziomalos
- Ahepa University Hospital, 1st Department of Propaedeutic Internal Medicine, Thessaloniki, Greece
| | - E Skalides
- University Hospital of Heraklion, Cardiology Clinic, Heraklion, Greece
| | - A Attilakos
- Attikon University Hospital, 3rd Pediatrics Clinic, Athens, Greece
| | - N Katsiki
- Hippocration General Hospital of Thessaloniki, Department of Internal Medicine, Thessaloniki, Greece
| | - I Koutagiar
- Hippokration General Hospital, Cardiology Clinic, Athens, Greece
| | - C Antza
- Hospital Papageorgiou, Department of Internal Medicine, Thessaloniki, Greece
| | - M Elisaf
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
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Liberopoulos E, Rizos C, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Athyros V, Skalides E, Kolovou G, Garoufi A, Koutagiar I, Papagianni M, Kiouri E, Antza C, Elisaf M. P5321The association of Lp(a) levels and cardiovascular disease in adult patients with familial hypercholesterolemia: analysis from the HELLAS-FH registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Familial hypercholesterolemia (FH) as well as elevated Lp(a) levels are both associated with increased cardiovascular disease (CVD) risk. There are limited data on the association of Lp(a) levels with CVD in FH Patients.
Purpose
To evaluate the association between Lp(a) levels and CVD in adult FH patients included in the HELLAS-FH registry in Greece.
Methods
Adult patients with FH and measured Lp(a) levels were included in this analysis. Demographics, CVD prevalence and lipid profile were evaluated.
Results
A total of 337 patients were evaluated (46% male, 48.3±15.4 years old). The median [IQR] of Lp(a) at baseline was 22.6 (9.7–56.2) mg/dL. Patients were categorized into 4 different groups according to the Lp(a) levels quartiles. There was no gender or age difference between the 4 groups. Moreover, all groups had similar smoking status, hypertension, body mass index and type 2 diabetes prevalence. There was no significant difference between groups regarding baseline and on treatment lipid profile. We observed a significant positive association between Lp(a) quartile and coronary artery disease (CAD) prevalence (p=0.004). Patients in the highest vs lowest quartile had greater CAD prevalence (21.7% vs 7%, p=0.006). No association was observed between Lp(a) quartile and the prevalence of cerebrovascular disease or peripheral artery disease.
Conclusions
Elevated Lp(a) levels have a positive correlation with CAD in patients with FH.
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Affiliation(s)
- E Liberopoulos
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
| | - C Rizos
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
| | - I Skoumas
- Hippokration General Hospital, Cardiology Clinic, Athens, Greece
| | - K Tziomalos
- Ahepa University Hospital, 1st Department of Propaedeutic Internal Medicine, Thessaloniki, Greece
| | - L Rallidis
- Attikon University Hospital, Department of Cardiology, Athens, Greece
| | - V Kotsis
- Hospital Papageorgiou, Department of Internal Medicine, Thessaloniki, Greece
| | - V Athyros
- Hippocration General Hospital of Thessaloniki, Department of Internal Medicine, Thessaloniki, Greece
| | - E Skalides
- University Hospital of Heraklion, Cardiology Clinic, Heraklion, Greece
| | - G Kolovou
- Onassis Cardiac Surgery Center, Cardiology Clinic, Athens, Greece
| | - A Garoufi
- General Children Hospital Pan. & Aglaia Kyriakou, 2nd Pediatrics Clinic, Athens, Greece
| | - I Koutagiar
- Hippokration General Hospital, Cardiology Clinic, Athens, Greece
| | - M Papagianni
- Ahepa University Hospital, 1st Department of Propaedeutic Internal Medicine, Thessaloniki, Greece
| | - E Kiouri
- Attikon University Hospital, Department of Cardiology, Athens, Greece
| | - C Antza
- Hospital Papageorgiou, Department of Internal Medicine, Thessaloniki, Greece
| | - M Elisaf
- University of Ioannina, Department of Internal Medicine, Ioannina, Greece
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Rizos C, Garoufi A, Elisaf M, Kolovou G, Athyros V, Skoumas I, Kotsis V, Rallidis L, Tziomalos K, Skalides E, Attilakos A, Katsiki N, Koutagiar I, Antza C, Kiouri E, Papagianni M, Loulakakis M, Liberopoulos E. Children With Familial Hypercholesterolemia: Cardiometabolic Profile Data From The Hellas-Fh Registry. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rizos C, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Athyros V, Skalides E, Kolovou G, Garoufi A, Koutagiar I, Papagianni M, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Liberopoulos E. Cardiovascular Disease And Lp(A) Levels In Adult Patients With Familial Hydrocholesterolemia. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rizos C, Elisaf M, Skoumas I, Tziomalos K, Rallidis L, Kotsis V, Athyros V, Skalides E, Kolovou G, Garoufi A, Florentin M, Koutagiar I, Papagianni M, Kiouri E, Antza C, Katsiki N, Zacharis E, Attilakos A, Liberopoulos E. Adults With Familial Hydrocholesterolemia: Latest Update On Cardiometabolic Profile From The Hellas-Fh Registry. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Antza C, Doundoulakis I, Natsis M, Sfikas G, Stabouli S, Kotsis V. Mdrd Versus Ckd-Epi Glomerular Filtration Rate: Which Can Be Better Correlated With Arterial Stiffness? Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Antza C, Doundoulakis I, Natsis M, Kotsis V. Treatment of Early Vascular Ageing. Curr Pharm Des 2018; 24:4385-4390. [PMID: 30514187 DOI: 10.2174/1381612825666181204120506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 11/22/2018] [Accepted: 11/29/2018] [Indexed: 11/22/2022]
Abstract
Artery disease can be identified from ankle-brachial index (peripheral artery disease), pulse wave velocity (arterial stiffness), carotid intima media thickness (atherosclerosis) and flow-mediated dilation (endothelial dysfunction). Arterial stiffness is a marker of cardiovascular disease associated with cardiovascular events. Increased vascular ageing is the acceleration of arterial stiffness inappropriate for the given chronological age. Treatment of early vascular ageing seems to be important if we target primary cardiovascular prevention. Known factors that postpone the progression of vascular ageing may include lifestyle interventions such as physical exercise, moderate alcohol consumption, reduced salt consumption and weight reduction, factors that may preserve the vessels healthier than what expected for the chronological age. Hypertension, diabetes mellitus, obstructive sleep apnea and dyslipidemia are factors accelerating vessels damage and should be treated and maintained over time well controlled. In the future, trials are needed in order to identify the best combination of treatment as well as to identify drugs targeting on the vessels ageing.
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Affiliation(s)
- C Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - I Doundoulakis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - M Natsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - V Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
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Abstract
Hypertensive disorders in pregnancy are a worldwide health problem for women and their infants complicating up to 10% of pregnancies and associated with increased maternal and neonatal morbidity and mortality. In Europe, 2.3-3% of pregnancies are complicated by preeclampsia. Gestational diabetes, obesity, no previous or multiple births, maternal age less than 20 or greater than 35years old and thrombophilia can be some of the possible factors related to increased risk for hypertension in pregnancy. Complications of hypertension during pregnancy affect both mothers and their infants. Ambulatory blood pressure monitoring helps to distinguish true hypertension from the white coat as pregnant women with office abnormal values may have normal out of office blood pressure. Imbalance between proangiogenic and antiangiogenic factors in placenta may lead to endothelial dysfunction, vasoconstriction, activation of the coagulation system, and hemolysis. Carotid intima-media thickness, pulse wave velocity, augmentation index, and arterial wall tension were found to be significantly increased in women with preeclampsia compared to normotensive pregnant women. Uterine artery Doppler and serum biomarkers can be used to evaluate the probability of hypertension and complications during pregnancy, but further research in the field is needed. Lately, micro ribonucleic acids have also been the focus of research as potential biomarkers.
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Affiliation(s)
- C Antza
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece
| | - R Cifkova
- Charles University in Prague, Center for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Prague, Czech Republic
| | - V Kotsis
- Hypertension Center, 3rd Department of Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Greece.
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Abstract
The human gut microbiota is being composed of more than one hundred trillion microbial cells, including aerobic and anaerobic species as well as gram-positive and negative species. Animal based evidence suggests that the change of normal gut microbiota is responsible for several clinical implications including blood pressure increase and kidney function reduction. Trimethylamine-N-Oxide, short-chain fatty acids and inflammatory factors are originated from the gut microbes and may induce changes in arteries, kidneys and blood pressure. Prebiotics and probiotics change the gut microbiota and may reduce high blood pressure and ameliorate chronic kidney disease suggesting a new treatment target in patients for the initial stages of hypertension concomitant with other life style changes such as increased physical exercise and weight reduction to reduce cardiovascular disease complications.
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Affiliation(s)
- C Antza
- Hypertension Center, 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece
| | - S Stabouli
- 1st Department of Pediatrics, Aristotle University, Thessaloniki, Greece
| | - V Kotsis
- Hypertension Center, 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece.
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Stabouli S, Printza N, Dotis I, Papadimitriou E, Gidaris D, Antza C, Kotsis V, Zafeiriou D, Papachristou F. [PP.LB02.16] EXECUTIVE FUNCTION PERFORMANCE IN HYPERTENSIVE CHILDREN. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000492166.59774.72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Viigimaa M, Talvik A, Wojciechowska W, Kawecka-Jaszcz K, Toft I, Stergiou GS, Nasothimiou EG, Kotsis V, Agabiti Rosei E, Salvetti M, Dorobantu M, Martell-Claros N, Abad-Cardiel M, Hernández-Hernández R, Doménech M, Coca A. Identification of the hemodynamic modulators and hemodynamic status in uncontrolled hypertensive patients. Blood Press 2013; 22:362-70. [DOI: 10.3109/08037051.2013.782900] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kotsis V, Benson S, Bingel U, Forsting M, Schedlowski M, Gizewski ER, Elsenbruch S. Perceived treatment group affects behavioral and neural responses to visceral pain in a deceptive placebo study. Neurogastroenterol Motil 2012; 24:935-e462. [PMID: 22747652 DOI: 10.1111/j.1365-2982.2012.01968.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND To assess effects of perceived treatment (i.e. drug vs placebo) on behavioral and neural responses to rectal pain stimuli delivered in a deceptive placebo condition. METHODS This fMRI study analyzed the behavioral and neural responses during expectation-mediated placebo analgesia in a rectal pain model. In N = 36 healthy subjects, the blood oxygen level-dependent (BOLD) response during cued anticipation and painful stimulation was measured after participants were informed that they had a 50% chance of receiving either a potent analgesic drug or an inert substance (i.e., double-blind administration). In reality, all received placebo. We compared responses in subjects who retrospectively indicated that they received the drug and those who believed to have received placebo. KEY RESULTS 55.6% (N = 20) of subjects believed that they had received a placebo, whereas 36.1% (N = 13) believed that they had received a potent analgesic drug. Subjects who were uncertain (8.3%, N = 3) were excluded. Rectal pain-induced discomfort was significantly lower in the perceived drug treatment group (P < 0.05), along with significantly reduced activation of the insular, the posterior and anterior cingulate cortices during pain anticipation, and of the anterior cingulate cortex during pain (all P < 0.05 in regions-of-interest analyses). CONCLUSIONS & INFERENCES Perceived treatment constitutes an important aspect in placebo analgesia. A more refined understanding of individual treatment expectations and perceived treatment allocation has multiple implications for the design and interpretation of clinical trials and experimental studies on placebo and nocebo effects.
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Affiliation(s)
- V Kotsis
- Institute of Medical Psychology and Behavioral Immunobiology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
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Benson S, Kotsis V, Rosenberger C, Bingel U, Schedlowski M, Gizewski E, Elsenbruch S. S274 BEHAVIORAL AND NEURAL CORRELATES OF VISCERAL PAIN SENSITIVITY IN HEALTHY MALES AND FEMALES: DOES SEX MATTER? ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s1754-3207(11)70839-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Benson S, Kotsis V, Rosenberger C, Bingel U, Forsting M, Schedlowski M, Gizewski E, Elsenbruch S. Behavioural and neural correlates of visceral pain sensitivity in healthy men and women: Does sex matter? Eur J Pain 2011; 16:349-58. [DOI: 10.1002/j.1532-2149.2011.00027.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2011] [Indexed: 01/03/2023]
Affiliation(s)
- S. Benson
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital of Essen, University of Duisburg-Essen; Essen; Germany
| | - V. Kotsis
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital of Essen, University of Duisburg-Essen; Essen; Germany
| | - C. Rosenberger
- Institute of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg; Germany
| | - U. Bingel
- Neuroimage Nord; Department of Neurology; University Medical Center Hamburg-Eppendorf; Hamburg; Germany
| | - M. Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology; University Hospital of Essen, University of Duisburg-Essen; Essen; Germany
| | - M. Schedlowski
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital of Essen, University of Duisburg-Essen; Essen; Germany
| | - E.R. Gizewski
- Department of Neuroradiology; Centre for Radiology; University Clinic of Gießen and Marburg, Justus-Liebig-University Gießen; Gießen; Germany
| | - S. Elsenbruch
- Institute of Medical Psychology & Behavioral Immunobiology; University Hospital of Essen, University of Duisburg-Essen; Essen; Germany
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Kotsis V, Gamvrili L, Papakatsika S, Karafillis G, Goulopoulou S, Sion M. REPRODUCIBILITY OF NON-DIPPING STATUS IN ACUTE ISCHEMIC STROKE PATIENTS. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-00885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miyakis S, Giannakaki V, Moustakidis E, Trelopoulou A, Trakatelli C, Kotsis V, Sion M. Vaccination against 2009 pandemic H1N1 influenza among healthcare workers in a tertiary hospital: rates, reasoning, beliefs. J Hosp Infect 2011; 78:75-6. [PMID: 21411186 DOI: 10.1016/j.jhin.2010.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
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Trakatelli C, Kintiraki E, Koratzis J, Gamvrili L, Kotsis V, Sion M. Periodic fever as the only presenting symptom of multiple myeloma in a young man. J BIOL REG HOMEOS AG 2008; 22:263-265. [PMID: 19036229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We describe a 30-year-old male patient presenting with periodic fever. The patient underwent a series of laboratory tests, X-rays and CT scans. Quantitative immunoglobulin showed IgG 3210.00 mg/dl, IgA 20.00 mg/dl and IgM 27.70 mg/dl. Serum protein electrophoresis revealed a peak with a broad gamma band. Immunofixation revealed an immunoglobulin G -lambda monoclonal component. A bone marrow biopsy established the presence of multiple myeloma. To our knowledge, a periodic 24-hour-lasting fever as the only presenting symptom of multiple myeloma has never been reported.
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Dokas S, Kotsis V, Milionis G, Lazaraki G, Sion M. Fatal upper gastrointestinal bleeding caused by a metal biliary stent despite stent shortening with APC. Endoscopy 2008; 40 Suppl 2:E135. [PMID: 18633879 DOI: 10.1055/s-2007-995713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- S Dokas
- Endoscopy Department, Papageorgiou General Hospital, Thessaloniki, Greece.
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Kotsis V, Stabouli S, Pitiriga V, Papamichael C, Toumanidis S, Zakopoulos N. Impact of gender on 24-h ambulatory blood pressure and target organ damage. J Hum Hypertens 2006; 20:658-65. [PMID: 16738688 DOI: 10.1038/sj.jhh.1002047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Differences between male and female subjects in mean 24 h blood pressure (BP) values and target organ damage such as left ventricular mass (LVMASS) and intima-media thickness (IMT) of carotid arteries were explained. The study population consisted of 1,445 subjects. All subjects underwent 24 h ambulatory BP monitoring, left ventricular echocardiography and measurement of IMT of carotid arteries. Men and women did not differ in age, body mass index (BMI) and clinic BP values. Mean 24 h systolic and diastolic BP were significantly higher in men compared to women. LVMASS corrected for body surface area or height(2.7), IMT of common (MCCA) and internal (MICA) carotid arteries were found to be significantly higher in men compared to women. Analysis of covariance showed that men had significantly higher LVMASS, MCCA and MICA than women, after adjustment for BMI, age, smoking status, mean 24 h systolic and diastolic BPs, fasting serum glucose, total cholesterol and triglycerides. These findings indicate that male sex could be an important predictor of higher mean 24 h BP and target organ damage for subjects of similar BMI and clinic BP values.
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Affiliation(s)
- V Kotsis
- Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodestrial University, Athens, Greece.
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Arendt G, Nolting T, Husstedt I, Maschke M, Obermann M, Sopper S, Koutsilieri E, Riederer P, Kotsis V, ter Meulen V. Wann wird das HI-Virus für das menschliche Gehirn gefährlich? Akt Neurol 2006. [DOI: 10.1055/s-2006-953032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bouldin MJ, Sumrall CD, Kotsis V, Low AK, Ramsey LA. 391 GENDER INFLUENCES ON DIABETES DISEASE MANAGEMENT IN AN IMPOVERISHED PREDOMINANTLY AFRICAN-AMERICAN MISSISSIPPI POPULATION. J Investig Med 2005. [DOI: 10.2310/6650.2005.00006.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Manios E, Tsivgoulis G, Vemmos K, Spengos K, Spiliopoulou J, Kotsis V, Revela J, Zakopoulos N. ELEVATED BLOOD PRESSURE VALUES DURING THE SECOND DAY AFTER SYMPTOM PRESENTATION ARE ASSOCIATED WITH SUBSEQUENT BRAIN EDEMA FORMATION IN ACUTE STROKE PATIENTS. J Hypertens 2004. [DOI: 10.1097/00004872-200406002-00375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vemmos KN, Spengos K, Tsivgoulis G, Zakopoulos N, Manios E, Kotsis V, Daffertshofer M, Vassilopoulos D. Factors influencing acute blood pressure values in stroke subtypes. J Hum Hypertens 2004; 18:253-9. [PMID: 15037874 DOI: 10.1038/sj.jhh.1001662] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this prospective observational study was to determine the association of acute blood pressure values with independent factors (demographic, clinical characteristics, early complications) in stroke subgroups of different aetiology. We evaluated data of 346 first-ever acute (<24 h) stroke patients treated in our stroke unit. Casual and 24-h blood pressure (BP) values were measured. Stroke risk factors and stroke severity on admission were documented. Strokes were divided into subgroups of different aetiopathogenic mechanism. Patients were imaged with CT-scan on admission and 5 days later to determine the presence of brain oedema and haemorrhagic transformation. The relationship of different factors to 24-h BP values (24-h BP) was evaluated separately in each stroke subgroup. In large artery atherosclerotic stroke (n=59), history of hypertension and stroke severity correlated with higher 24-h BP respectively. In cardioembolic stroke (n=87), history of hypertension, stroke severity, haemorrhagic transformation and brain oedema were associated with higher 24-h BP, while heart failure with lower 24-h BP. History of hypertension and coronary artery disease was related to higher and lower 24-h BP, respectively, in lacunar stroke (n=75). In patients with infarct of undetermined (n=57) cause 24-h BP were mainly influenced by stroke severity and history of hypertension. An independent association between higher 24-h BP and history of hypertension and cerebral oedema was documented in intracerebral haemorrhage (n=68). In conclusion, different factors influence acute BP values in stroke subtypes of different aetiology. If the clinical significance of these observations is verified, a differentiated approach in acute BP management based on stroke aetiology may be considered.
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Affiliation(s)
- K N Vemmos
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, Athens, Greece.
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Protogerou V, Deliveliotis C, Protogerou A, Kotsis V, Karayiannis V, Zakopoulos N, Kostakopoulos A. Extracorporeal Shockwave Lithotripsy for Kidney Stones Reduces Blood Pressure: Use of 24-Hour Ambulatory Monitoring for Study of Blood-Pressure Changes Induced by SWL. J Endourol 2004; 18:17-22. [PMID: 15006047 DOI: 10.1089/089277904322836604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the effects of shockwave lithotripsy (SWL) on blood pressure with the use of 24-hour ambulatory blood-pressure monitoring (ABPM). PATIENTS AND METHODS We studied three groups of patients. Group I consisted of 60 patients with kidney stones treated with SWL. Group II was formed by 30 patients with stones in the lower third of the ureter treated in situ with SWL, and group III consisted of 30 patients with ureteral stones treated with ureteroscopy (URS). The ABPM measurements were performed before stone treatment, immediately after, and then every 3 months through 1 year. RESULTS There was no new onset of hypertension in any group. The prevalences of hypertension before stone treatment were 21 (35%), 12 (40%), and 9 (30%) for groups I, II, and III, respectively. One-year post treatment, the numbers of hypertensive patients found for groups I, II, and III were 15 (25%), 11 (33.3%), and 8 (22.2%), respectively. In group I, a statistically significant decrease in blood pressure values was noted 1 year post-treatment (p<0.05). This decrease was related (p<0.05) to the power (r=0.35), as well as to the product of the number and the power (r=0.25), of the shockwaves applied. CONCLUSION Extracorporeal lithotripsy for kidney stone may be responsible for a drop in blood pressure possibly caused by alteration in intrarenal metabolism.
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Affiliation(s)
- V Protogerou
- Urological Department, Athens Medical School, Sismanoglio Hospital, Athens, Greece
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