POS1567-PARE ASSESSMENT OF ADHERENCE AMONG GREEK PATIENTS WITH RHEUMATIC DISEASES DURING THE COVID-19 ERA

Background

Patient’s (pts) adherence is a EULAR important recommendation for an optimal disease course and outcome. COVID-19 pandemic has globally challenged the issue of adherence. As relevant Greek data are lacking, the PanHellenic Federation “Rheumazein” (i.e., co-living with a Rheumatic Disease) conducted a survey among their members to assess adherence and a possible COVID-related negative impact.

Objectives

The main endpoint of the study aimed to capture the degree of pt adherence to treatment, either with conventional synthetic or/and biologic DMARDS (csDMARDS, bDMARDS). The secondary endpoints were: a. To record pts’–physicians’ interactive communication to assess the level of shared disease making (SDM). b. The emerged barriers to medication access during the pandemic and consequent restrictive measures. c. To record pt perceptions on the usefulness of mobile reminder applications towards an uninterrupted regimen.

Methods

A 29-item quantitative questionnaire was uploaded in the social media of the Federation and its associations, in order to register pts’ responses on the aforementioned sections. The questionnaire was accessible for a 58-day period (21/09/2021-17/11/2021).

Results

Participants’ characteristics: The responses of 303 adults with RD (M:F 63:240), aged (in yrs) 18-44: 35%, 45-54: 26%, >55: 38% respectively, were available for analysis. The RD types were RA 33%, AS 18%, PsA 13%, SLE 18%, Juvenile Arthritis 5% and Other RD 13%, respectively. Τhe education level was low/moderate 39%, high 30%, post-graduate 31%, respectively. Receivers of a monotherapy with either cs- or bDMARDS were 93(31%) and 83(27%), of a combined regimen cs+bDMARDs 114(38%) and off treatment 13 (4%). BDMARD receivers were mostly AS pts (93%) while the least, SLE pts (48%). The route of bDMARD administration (sc vs iv did not significantly differ (57% vs. 43%). Since diagnosis, the mean disease trajectory was 7.6 yrs, the mean time on medication 6.9 yrs, while the mean duration on the current regimen 3 yrs, respectively. Adherence: At least one skipped dose during the last trimester was reported, significantly more often by pts under csDMARDs than by those under bDMARDs, (60% vs. 40%, p<0.001) with a mean number of 2.7 vs. 1.8 skipped doses, respectively. Additionally, the main reasons of non-adherence under csDMARDs and bDMARDs significantly differed only in respect to pt responsibility (56% vs.19% p<0.001), but not for COVID-related reasons, namely fear either of getting infected, or due to a performed COVID vaccination (35% vs 42%), or due to physician recommendations (22% vs. 32%). Regarding the pt-physician interactive discussions on emerging new treatments, 90% of the pts reported this policy, but only 40% of them in a rather frequent to more frequent rate. In respect to satisfaction, 67% expressed a moderate to high satisfaction regarding the level of provided information, while the degree of their satisfaction was positively related with the frequency of these discussions. The main topics focused on the route and frequency of the medication, especially with bDMARD receivers. Of note, 80% of the bDMARD group participated in the SDM before commencing this therapy, but just 20% in the selection of the brand name. Only a minority of pts (17%) were aware of the existence of mobile applications, reminding the scheduled drug administration; however, they rated these programs as very useful (4.3 according to a 0-5 scale). Despite the difference source of supply of cs and bDMARDs on pt access to treatment, the impact of COVID-19 and consequent restrictive measures had not impaired it (1.5/5 and 1.7/5 by the above scale, respectively).

Conclusion

A significant percentage of pts skip scheduled DMARD administrations, especially those (60%) under csDMARDs. The relationship with the physician was considered relatively satisfactory. Most of the pts did not have any mobile phone reminder application regarding their dose. Finally, the COVID-19 pandemic appeared to have had little effect on pts’ access to both cs- and bDMARDs and consequently, adherence to their treatments.

Disclosure of Interests

None declared

Tailoring the Nonlinear Optical Response of Some Graphene Derivatives by Ultraviolet (UV) Irradiation

In the present work the impact of in situ photoreduction, by means of ultraviolet (UV) irradiation, on the nonlinear optical response (NLO) of some graphene oxide (GO), fluorographene (GF), hydrogenated fluorographene (GFH) and graphene (G) dispersions is studied. In situ UV photoreduction allowed for the extended modification of the degree of functionalization (i.e., oxidization, fluorination and hydrogenation), leading to the effective tuning of the corresponding sp²/sp³ hybridization ratios. The nonlinear optical properties of the studied samples prior to and after UV irradiation were determined by means of the Z-scan technique using visible (532 nm), 4 ns laser excitation, and were found to change significantly. More specifically, while GO's nonlinear optical response increases with irradiation time, GF and GFH present a monotonic decrease. The graphene dispersions' nonlinear optical response remains unaffected after prolonged UV irradiation for more than an hour. The present findings demonstrate that UV photoreduction can be an effective and simple strategy for tuning the nonlinear optical response of these graphene derivatives in a controllable way, resulting in derivatives with custom-made responses, thus more suitable for different photonic and optoelectronic applications.

Silicon Nanosheets: An Emerging 2D Photonic Material with a Large Transient Nonlinear Optical Response beyond Graphene

The present work reports on the transient nonlinear optical (NLO) responses of two different types of 2D silicon nanosheets (SiNSs), namely hydride-terminated silicon nanosheets (SiNS-H) and 1-dodecene-functionalized silicon nanosheets (SiNS-dodecene). The main motivation of this study was to extend the knowledge regarding the NLO properties of these Si-based materials, for which very few published studies exist so far. For that purpose, the NLO responses of SiNS-H and SiNS-dodecene were investigated experimentally in the nanosecond regime at 532 and 1064 nm using the Z-scan technique, while the obtained results were compared to those of certain recently studied graphene nanosheets. SiNS-dodecene was found to exhibit the largest third-order susceptibility χ(3) values at both excitation wavelengths, most probably ascribed to the presence of point defects, indicating the importance of chemical functionalization for the efficient enhancement and tailoring of the NLO properties of these emerging 2D Si-based materials. Most importantly, the results demonstrated that the present silicon nanosheets revealed comparable and even larger NLO responses than graphene nanosheets. Undoubtedly, SiNSs could be strong competitors of graphene for applications in 2D-material-based photonics and optoelectronics.

OP0317-PARE THE CONTEMPORARY WORK-RELATED BURDEN OF DISEASE FOR PEOPLE WITH RHEUMATIC DISEASES IN GREECE

Background:

EULAR recommendations emphasize the importance of suitable working conditions for people with Rheumatic diseases (RD). Thus, opportunities and choices at work need to be increased for people with rheumatic diseases. Conversely, the COVID-19 pandemic has challenged the working population and particularly those with chronic conditions, such as those with RD. However, there is still a lack of reliable data.

Objectives:

To depict contemporary real-life data regarding the work-related burden of disease among Greek patients with RD. To develop a White Paper with proposals to the State in order to facilitate people with rheumatic diseases to rejoin or be retained in the work force.

Methods:

A 24-item quantitative questionnaire was uploaded in the website and social media of REUMAZEIN to capture patients’ responses in respect to work life. The questionnaire was online accessible for a 45-day period (15/8-30/9/2020).

Results:

The responses of 503 adult people with RD (M/F/NA 94/408/1), were available for analysis. Their age was stratified in decades (18-20 0.6%,21-30 5.99%, 31-40 22.36%, 41-50 38.92%, 51-60 22.16% and over 60 9.58%); totally, 83.44% were in the “work-reproductive” period. The predominant RD types were RA 30.3%, SLE 22.8%, AS 20.2% and PsA 20.2%, respectively. Nearly 90% were on medication, namely 40% on biologics, 33% on methotrexate (as a monotherapy or combined therapy), 16.2% on steroids. A minority were either on alternative therapies (2.8%) or off medication (7.5%), respectively. Most of the people were still employed (72.9%) on a full-time schedule (57.7%) and 4.8% on a part-time one, due to their RD. The rest of them (27.1%) were out of work either due to RD (17%) or retirement (1.7%) or for unrelated to the RD reasons (8.4%). The main source of financial income was personal work (52.4%), followed by a family member support (31.1%), while 11% had either a state pension (8%) or a subsidy (3.2%). In respect to the daily house-keeping, half of them (59.3%) had a varying difficulty (mild 36.3%, severe 23%) and 0.8% considered themselves as “unable”. The diagnosis was mostly established (81%) prior to the work onset. Post-diagnosis, RD had not affected their working schedule in 47.2%, 17% continued to work with respective adaptations but 30% had quitted or resigned from their work 1-7 years later. RD was notified to the work environment by 85%. As for a compassionate work management, 46% reported no change, 28% an improved policy but 28% a worse one. The development of relative adaptations in the work setting (as chairs, devices, flexible schedule) were considered as favorite factors easing the work by 85%. 17% reported an employer’s knowledge on RD related working legislation, 43% the contrary and another 38.7% wished for a future employer’s awareness. Most of the participants (58.9%) had no personal information on this field but were eager to get it. The uneventful impact of RD on finding or keeping a job was registered by 77.4% and 66.9%, respectively. During COVID, most of the participants (53%) have not asked for an RD-related leave and only 24.2% chose to telework, a policy that raised mutual satisfaction in 19%. Of note, the working conditions have not mainly been altered (67%) after the end of the 1st quarantine.

Conclusion:

This study highlighted that although RD predominate in females, women are more willing to participate in such projects (F 90%). The financial income was mainly based on a personal or a family member work reimbursement (83%), while 11% depended on a state pension or subsidy. The majority has notified the RD to their work environment (85%) while another 85% considered as favorite factors easing the work, several adaptations in the work setting such as chairs, devices, flexible schedule etc. Interestingly, 60% of the participants were unaware of the beneficial legal work rights and nearly 70% of them believe that RD is an obstacle for employment or working maintenance. COVID has not dramatically impaired their work life although the use of teleworking should be strengthened.

Disclosure of Interests:

None declared.

Joint ESH excellence centers' national meeting on renal sympathetic denervation: A Greek experts' survey

OBJECTIVE

The efficacy of renal sympathetic denervation (RDN) has been affirmed by a number of recent clinical studies, despite controversies in this field over the last five years. Therefore, it is of paramount importance that hypertension experts debate the merits of RDN by revealing and expressing their personal beliefs and perspectives regarding this procedure.

METHODS

A cross-sectional survey was conducted among Greek leaders of the Hypertension Excellence Centers with the use of a closed-type questionnaire specifically designed to elicit information and evaluate the respondent's views and perspectives about RDN efficacy, safety and ideal target patient population.

RESULTS

A total of 36 participants completed the survey. Based on the results, RDN was considered efficient (91.7%) and safe (94.5%), while the overwhelming majority of the participants felt confident in the long-term efficacy (88.9%) of the intervention and that it lacks reliable predictors of blood pressure response (94.5%). Patients with resistant (91.7%), ultra-resistant (94.4%), and uncontrolled hypertension (80.6%) were suggested as ideal candidates for RDN. Establishing a close co-operation between interventionalists and hypertension experts was considered essential to ensure the efficacy (97.2%) as well as the safety (97.3%) of the procedure.

CONCLUSION

The vast majority of Greek hypertension experts surveyed were convinced of the efficacy and safety of RDN based on the preponderance of available scientific and clinical data. Identification of the ideal patient group remains controversial. Respondents generally agreed on the necessity of building close collaborative relationships between interventionalists and hypertension experts in order to improve RDN clinical outcome.

Success Rate and Safety of Dental Implantology in Patients Treated With Antiresorptive Medication: A Systematic Review

There is no agreement of data on the subject of implant failure and the development of osteonecrosis in patients receiving antiresorptive agents. The purpose of this systematic review is to evaluate whether dental implants placed in patients on antiresorptive medication have an increased failure rate and whether the implant placement or the implant existence are risk factors for developing medication-related osteonecrosis of the jaw (MRONJ). An electronic search was conducted in PubMed/Medline, and all publications fulfilling the inclusion criteria were included. The search was completed by a hand research of the references cited in all electronic identified publications, resulting in 411 articles. Based on the inclusion criteria, 32 studies were included, with a total of 5221 patients, 12 751 implants, 618 cases of implants loss, and 136 cases of MRONJ analyzed. Because of the small number of studies, most of which were characterized by a low level of quality, it cannot be established that the use of antiresorptive medication affects dental implant survival rates. The risk of MRONJ as an early or late complication is also not well established. Therefore, successful dental implant procedures in patients receiving antiresorptive medication might be possible, but more studies need to be carried out in the future to verify this topic. Apart from intravenous antiresorptive drugs, which remain an absolute contraindication, the use of antiresorptive medication is not a contraindication to dental implantology, but it must be accompanied by careful treatment planning, informing patients about possible complications, and essential long follow-up periods.

Silicon Nanosheets versus Graphene Nanosheets: A Comparison of Their Nonlinear Optical Response

Silicene, the silicon analogue of graphene, represents a new class of two-dimensional (2D) materials, which shares some of the outstanding physical properties of graphene. Furthermore, it has the advantage of being compatible with the current Si-based technology. However, this 2D material is not stable and is quite prone to oxidation. The hydride-terminated silicene, called silicane, is a more stable form of 2D silicon, if functionalized via, for example, the hydrosilylation reaction. In this work, the third-order nonlinear optical (NLO) properties of two functionalized silicanes, namely hydride-terminated silicon nanosheets (SiNS-H) and 1-dodecene-functionalized silicon nanosheets (SiNS-dodecene), are accessed and compared to those of single-layer graphene, under 35 ps, 532 and 1064 nm excitation. The present results show that the functionalized silicanes exhibit comparable and even higher NLO response than that of single-layer graphene, making them strong competitors of graphene and very interesting candidates for future photonic and optoelectronic applications.

Outstanding Broadband (532 nm to 2.2 μm) and Very Efficient Optical Limiting Performance of Some Defect-Engineered Graphenes

Graphene derivatives and defect-engineered graphenes have attracted the interest of researchers owing to the excellent and tunable properties they exhibit. In this work the optical limiting performance of two defect-engineered boron- and nitrogen-doped reduced graphene oxides is investigated. Both graphenes are found to exhibit exceptional and broadband optical limiting action ranging from 532 to 2200 nm. Their optical limiting efficiency was found to be superior to that of all the other graphene derivatives studied to date, exhibiting a gradually decreasing optical limiting onset, reaching the record low value of ∼0.002 J cm^-2 at 2200 nm. The results demonstrate the potential of engineering the defects of such reduced graphene oxides, resulting in very broadband and efficient optical limiting graphene derivatives, showing a promising method to further tailor their optical and optoelectronic properties.

The effect of vitamin K2 supplementation on vascular calcification in haemodialysis patients: a 1-year follow-up randomized trial

PURPOSE

Vascular calcification (VC) is an independent risk factor for cardiovascular disease in hemodialysis patients while Matrix GLA protein (MGP) is one of the most potent inhibitors of VC and its activation is vitamin K dependent. The aim of this study is to investigate the role of oral vitamin K2 supplementation in the prevention of VC progression in haemodialysis patients.

METHODS

We conducted a prospective randomized interventional study in patients on hemodialysis. Patients were randomly assigned to either receiving orally 200 μgr of vitamin K2 (vitamin K2/MK-7, Solgar) every day for 1 year or no treatment. Uncarboxylated MGP (uc-MGP) concentrations were quantified using ELISA at randomization, at 3 and at 12 months. Aortic calcification was evaluated using Agatston score after an abdominal computed tomography scan that was performed at the beginning and at 12 months of follow-up.

RESULTS

There were 102 patients that were randomized. After 1 year of follow-up, 22 patients from the vitamin K2 group and 30 patients from the control group were included in the analysis. After 3 months of treatment, uc-MGP values remained unchanged in the vitK2 group but after 1 year were reduced by 47% (p = 0.005). Furthermore, uc-MGP at 1 year was increased by 12% in the control group. At 1 year, vitK2 group had significantly lower values of uc-MGP in comparison to controls (p = 0.03). Agatston score was increased significantly both in vitamin K2 and control group at 1 year with no difference between groups.

CONCLUSIONS

Oral administration of vitamin K2 in patients on haemodialysis reduced serum uc-MGP levels but did not have an effect in the progression of aortic calcification.

Thiophenol-Modified Fluorographene Derivatives for Nonlinear Optical Applications

The synthesis and characterization of two thiophenol-modified fluorographene derivatives, namely methoxythiophenol-and dimethylaminothiophenol-modified fluorographenes, are reported, while their third-order nonlinear optical response were thoroughly investigated under both visible (532 nm) and infrared (1064 nm) with 35 ps and 4 ns laser pulses. The graphene derivatives were obtained by partial nucleophilic substitution/reduction of fluorographene by the corresponding organic thiophenols, and were fully characterized by techniques including infrared/Raman spectroscopy, X-ray photoelectron spectroscopy, atomic force spectroscopy, and high-resolution transmission microscopy. This type of modification resulted in graphenic structures where the attached thiol groups, sp² domains, and the residual fluorine groups act as donors, π bridges, and acceptors, respectively. Both derivatives exhibited large nonlinear optical response compared to fluorographene, and have potential applications in optical limiting as an alternative to fullerenes.

Cultivar-Dependent Responses of Eggplant (Solanum melongena L.) to Simultaneous Verticillium dahliae Infection and Drought

Several studies regarding the imposition of stresses simultaneously in plants have shown that plant responses are different under individual and combined stress. Pathogen infection in combination with drought can act both additively and antagonistically, suggesting a tailored-made plant response to these stresses. The aforementioned combination of stresses can be considered as one of the most important factors affecting global crop production. In the present research we studied eggplant responses to simultaneous Verticillium dahliae infection and drought with respect to the application of the individual stresses alone and investigated the extent to which these responses were cultivar dependent. Two eggplant cultivars (Skoutari and EMI) with intermediate resistance to V. dahliae were subjected to combined stress for a 3-week period. Significant differences in plant growth, several physiological and biochemical parameters (photosynthesis rate, leaf gas exchanges, Malondialdehyde, Proline) and gene expression, were found between plants subjected to combined and individual stresses. Furthermore, plant growth and molecular (lipid peroxidation, hydrogen peroxide, gene expression levels) changes highlight a clear discrimination between the two cultivars in response to simultaneous V. dahliae infection and drought. Our results showed that combined stress affects significantly plants responses compared to the application of individual stresses alone and that these responses are cultivar dependent.

Experimental Study of the Structural Effect on the Nanosecond Nonlinear Optical Response of O-Doped Polycyclic Aromatic Hydrocarbons

The nonlinear optical response of some O-doped polycyclic aromatic hydrocarbons (PAHs) is systematically investigated in the present work aiming to understand the influence of structural effects on their nonlinear optical response. In that view, the third-order nonlinear optical properties of these PAHs were measured under 4 ns visible (532 nm) and infrared (1064 nm) laser excitation. The O-doped PAHs were found to exhibit large saturable absorption and negative sign nonlinear refraction under visible excitation, increasing both with the addition of naphthalene units and with the number of O atoms. Their nonlinear optical response was found to be negligible under infrared excitation. Similar measurements performed on thin films of these PAHs have shown that they maintain their large nonlinear optical response even in the solid state, confirming their high potential for optoelectronic and photonic applications.

Comparative Assessment of the Anticoagulant Activity of Rivaroxaban and Dabigatran in Patients With Nonvalvular Atrial Fibrillation: A Noninterventional Study

There is a shortage of data in everyday clinical practice about the anticoagulant effects caused by the new oral anticoagulants (NOAs). Our aim was to estimate the intensity of anticoagulant activity induced by rivaroxaban 20 mg qd and dabigatran 110 mg bid among patients with nonvalvular atrial fibrillation (NV-AF).We studied 20 patients with NV-AF treated with dabigatran, and 20 patients treated with rivaroxaban. We performed conventional coagulation tests, thrombin generation (TG) test, thromboelastometry (ROTEM), and epinephrine-induced light transmission aggregometry (LTA) in all 40 patients and 20 controls. Hemoclot Thrombin Inhibitors (HTI) and Factor Xa Direct Inhibitor (DiXaI) assay were used to measure dabigatran and rivaroxaban plasma levels, respectively.Measurements of all assays estimating anticoagulant activity across the 2 patient groups were similar, except for aPTT. Patients on dabigatran exhibited statistically significantly prolonged aPTT values (P < 0.001). In LTA, patients on dabigatran also showed decreased aggregation compared to those on rivaroxaban (P = 0.045). Regarding the TG test, there was no association between endogenous thrombin potential (ETP) and rivaroxaban plasma levels (P = 0.33) as opposed to dabigatran levels (P < 0.001), but significant correlations were observed between rivaroxaban plasma concentrations and kinetic parameters of TG assay (Tlag, P = 0.045; Tmax, P = 0.016; and Cmax, P = 0.003).Based on ROTEM and TG assays, the anticoagulant effects induced by the 2 drugs given in the specific dose regimens in real-world patients were comparable. Only platelet aggregation was found to be more affected by dabigatran as compared to rivaroxaban.

Arterial Stiffness Alterations and Inflammatory Response Following Endovascular Aortic Repair: Based on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA)

Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic aortic aneurysm repair (TEVAR) have been widely incorporated into clinical practice. However, changes in arterial stiffness and post-implantation syndrome after aortic endografting remain important issues under investigation. The aneurysm sac wall motion after successful EVAR and TEVAR reflects complex interactions between all the components of the excluded aneurysm, including true compliance of the aneurysm wall itself, intra-aneurysm sac pressure, remodeling of the thrombus, and mechanical characteristics of the endograft. Experimental and clinical studies have shown that aortic endografting results in increased arterial stiffness in animal models. It can be assumed that the alterations of aortic mechanical properties can have a direct impact on heart output. The long-term impact of these mechanical changes on cardiovascular outcomes and the potential effects of different endografts on hemodynamics are important issues under investigation. Post-implantation syndrome (PIS) is a systemic inflammatory response frequently observed after endovascular treatment of aortic pathologies. The main features of PIS include fever, leukocytosis, elevated C-reactive protein levels, and coagulation disturbances. Endograft design appears to influence this inflammatory response following aortic endografting; woven polyester endografts have been shown to be associated with greater inflammatory response compared to PTFE stent grafts. The purpose of this paper is to review the literature to elucidate arterial stiffness alterations and inflammatory response after EVAR and TEVAR and the impact of endograft design on aortic stiffness and the post-inflammatory response.

Laboratory assessment of the anticoagulant activity of dabigatran

BACKGROUND

Our aim was to identify laboratory assays in order to assess the anticoagulant effects of dabigatran etexilate (DE).

METHODS

Twenty patients with nonvalvular atrial fibrillation treated on DE (110 mg per os twice daily) and 20 on acenocoumarol were studied. Conventional coagulation tests, endogenous thrombin potential (ETP), thromboelastometry (ROTEM), epinephrine-induced light transmission aggregometry (LTA), and Hemoclot Thrombin Inhibitors (HTI) were performed in all patients.

RESULTS

In ROTEM analysis, the lysis index at 60 minutes was significantly lower in patients receiving DE (P = .011). In LTA, patients on DE showed decreased aggregation compared to those on acenocoumarol, marginally insignificant (P = .068). Regarding ETP, acenocoumarol affected thrombin generation more than dabigatran (area under the curve [AUC], P < .001), while statistically significant associations were detected between dabigatran levels, as determined by the HTI assay, and almost all parameters of ETP assay (AUC, P < .001).

CONCLUSION

The role of ETP in estimating anticoagulant activity of dabigatran possibly requires further research.

Association of Lp-PLA2 with digital reactive hyperemia, coronary flow reserve, carotid atherosclerosis and arterial stiffness in coronary artery disease

BACKGROUND

Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has a powerful inflammatory and atherogenic action in the vascular wall and is an independent marker of poor prognosis in coronary artery disease (CAD). We investigate the association of Lp-PLA2 with markers of vascular dysfunction and atherosclerosis with proven prognostic value in CAD.

METHODS

In 111 patients with angiographically documented chronic CAD, we measured 1) carotid intima-media thickness (CIMT), 2) reactive hyperemia using fingertip peripheral arterial tonometry (RH-PAT), 3) coronary flow reserve (CFR), by Doppler echocardiography 4) pulse wave velocity (PWV) and 5) blood levels of Lp-PLA2.

RESULTS

Patients with Lp-PLA2 concentration >234.5 ng/ml (50th percentile) had higher CIMT (1.44 ± 0.07 vs. 1.06 ± 0.06 mm), PWV (11.0 ± 2.36 vs. 9.7 ± 2.38 m/s) and lower RH-PAT(1.24 ± 0.25 vs. 1.51 ± 0.53) and CFR (2.39 ± 0.75 vs. 2.9 ± 0.86) compared to those with lower Lp-PLA (p < 0.05 for all comparisons). Lp-PLA2 was positively associated with CIMT (regression coefficient b: 0.30 per unit of Lp-PLA2, p = 0.02), PWV (b:0.201, p = 0.04) and inversely with RHI-PAT (b: -0.371, p < 0.001) and CFR (b:-0.32, p = 0.002). In multivariate analysis, Lp-PLA2 was an independent determinant of RHI-PAT, CFR, CIMT and PWV in a model including age, sex, smoking, diabetes, dyslipidemia and hypertension (p < 0.05 for all vascular markers). Lp-PLA2, RHI-PAT and CFR were independent predictors of cardiac events during a 3-year follow-up.

CONCLUSIONS

Elevated Lp-PLA2 concentration is related with endothelial dysfunction, carotid atherosclerosis, impaired coronary flow reserve and increased arterial stiffness and adverse outcome in CAD patients. These findings suggest that the prognostic role of Lp-PLA2 in chronic CAD may be explained by a generalized detrimental effect of this lipase on endothelial function and arterial wall properties.

Inflammatory markers in coronary artery disease

Coronary artery disease (CAD) is one of the most common manifestations of atherosclerosis. Inflammation is considered one of the major processes that contribute to atherogenesis. Inflammation plays an important role not only on the initiation and progression of atherosclerosis but also on plaque rupture, an event that leads to acute vascular events. Various biomarkers express different pathways and pathophysiologic mechanisms of cardiovascular disease, and inflammatory biomarkers express different parts of the atherogenic process, regarding the initiation and progression of atherosclerosis or the destabilization of the atherosclerotic plaque. Therefore, inflammatory biomarkers may prove to be useful in the detection, staging, and prognosis of patients with CAD. Furthermore, the fact that inflammatory processes are essential steps in the course of the disease offers future therapeutic targets for the interruption of the atherogenic process or for the management of acute events.

Nasal packing aspiration in a patient with Alzheimer's disease: a rare complication

Nasal bleeding is a frequent problem for patients receiving anticoagulant agents. Most cases are successfully managed with anterior or posterior nasal packing. However, the complications of nasal packing should be always considered. We report the case of a 78-year-old man with Alzheimer’s disease who was treated for anterior epistaxis with anterior nasal packing using three pieces of antibiotic-soaked gauze. Two days later, the patient was admitted to the emergency department in respiratory distress. A chest x-ray demonstrated atelectasis of the right lung. During an examination of the nasal cavities, the nasal packing was removed, and one of the gauze pieces was missing. The patient underwent rigid bronchoscopy, and the missing gauze was found to be obstructing the right main bronchus. The patient’s respiratory function improved considerably after removal of the foreign body. It is assumed that gauze packs should be used with caution in patients with an impaired level of consciousness and neurodegenerative diseases.

Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients

AIMS

Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients.

METHODS AND RESULTS

We studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S', E', A' mitral annulus velocities with TDI, as well as the E'/A' ratio and the E/E' ratio before and during adenosine infusion (ii) the %changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S', E', and A' in all patients and controls (P < 0.05). Compared with controls and patients with CFR ≥ 2.5, patients with CFR <2.5 showed a smaller increase in S' (28.6 vs. 30.0 vs. 11.1%, F for interaction = 14.592) and E' (33.3 vs. 33.3 vs.1.5%, F = 28.927) as well as a decrease in E'/A' (9.2 vs. 6.4% vs. -20.0%, F = 5.128) and an increase in E/E' (-6.1 vs. -1.6 vs. 30.5%. F = 12.780) after adenosine infusion (P < 0.05 for all comparisons). CFR was independently related to %changes of TDI parameters (regression coefficient b = 0.576 for S'; b = 0.517 for E'; b = 0.473 for E'/A'; b = -0.520 for E/E', respectively, P < 0.001). By the receiver operating curve, a CFR <2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70% (AUC >75%, P < 0.05).

CONCLUSION

An abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.

Atypical solitary fibrous tumor of the nose and maxillary sinus

BACKGROUND

Solitary fibrous tumor (SFT) belongs to a group of mesenchymal tumors, also known as benign fibrous mesotheliomas or submesothelial fibromas. SFTs of the sinonasal tract are extremely rare.

METHODS

We report a rare case of an atypical SFT of the sinonasal tract presenting with ipsilateral nasal obstruction and recurrent epistaxis. Endoscopy and imaging studies showed a well-circumscribed mass of the nose and the maxillary sinus. The patient underwent total endoscopic resection of the tumor.

RESULTS

Permanent histology and immunohistochemical studies revealed an atypical variant of SFT of the sinonasal tract, with negative surgical margins. The patient did not receive any adjuvant treatment. Postoperative monitoring was uneventful.

CONCLUSION

In general, these tumors are reported to follow an indolent course. SFTs adopt a biological behavior that cannot be determined as malignant. Total surgical resection of the tumor remains the gold-standard method of treatment.

Molecular pathways of lymphangiogenesis and lymph node metastasis in head and neck cancer

Metastasis to regional lymph nodes constitutes the main route toward progression and dissemination of head and neck carcinoma; at the same time it is the most significant adverse prognostic indicator for this disease. In recent years, significant focus has been given on the molecular mechanisms behind lymph node metastasis of head and neck cancer. The aim of this study is to assess the role of growth factor expression and function in association with lymph node metastasis and overall prognosis of head and neck cancer. Current literature, searching for experimental data regarding the molecular pathways of lymph node dissemination of head and neck cancer, is reviewed giving special emphasis on the expression and prognostic significance of specific growth factors. Members of the vascular endothelial growth factor (VEGF), mostly VEGF-C and VEGF-D, with their action through the receptors VEGFR-3 and VEGFR-2, constitute the most extensively studied growth factors associated with lymphangiogenesis so far. High expression of these as well as other molecules, including angiopoietins, insulin-like growth factor, and fibroblast growth factor, has been associated with lymph node metastasis and poor prognosis in head and neck squamous cell carcinoma. Numerous growth factors seem to play an important role regarding the lymph node metastatic potential of head and neck cancer. Further research is necessary in order to further clarify the molecular pathways and introduce novel therapeutic options.

Merging Controlled Vocabularies for More Efficient Subject-Based IR Systems

One of the most important tasks of a librarian is the assignment of appropriate subject(s) to a resource within a library’s collection. The subjects usually belong to a controlled vocabulary that is specifically designed for such a task. The most widely adopted controlled vocabulary across libraries around the world is the Library of Congress Subject Headings (LCSH). However, there seems to be a shifting from traditional LCSH to modern thesauri. In this paper, a methodology is proposed, capable of incorporating thesauri into existing LCSH-based Information Retrieval–IR systems. In order to achieve this, a mapping methodology is proposed capable of providing a common structure consisting of terms belonging to LCSH and/or a thesaurus. The structure is modeled as a Simple Knowledge Organization System (SKOS) ontology, which can be employed by appropriate subject-based IR systems. As a proof of concept, the proposed methodology is applied to the DSpace-based University of Piraeus digital library.