Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanizatio...Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanization phenomena. This continued urbanization increases profoundly all urban activities with transportation being the key driver in energy consumption. Theories for sustainable cities prerequisite are the integration of a number of acts in order to reduce energy consumption, with mobility being the first consideration among others. The aim of this paper is to critically explore implemented policies and plans as well as forthcoming strategic plans in terms of sustainable mobility as imposed in large scale regeneration plans in contemporary Athens. Research focuses on strategic interventions since the 1980s, such as the Athenian Daktylios （ring road for circulation management） and its later adjustments, the upcoming pedestrianization and unification of the commercial triangle and its subsequent tram line extension as well as the notable implementation of the metropolitan cycling network. Moreover, the discussion takes into consideration the implications of the Greek economic crisis in mobility choices, as aimless travels have been reduced to a minimum, several cars have been abandoned and cyclists seem to tentatively claim some space in the urban environment. What will likely be the next day in the Athenian historic centre？ Considering the transformations that are expected in the immediate future, this research paper explores their potential to enhance urban environment, reduce climate change impacts and amplify resilience.展开更多
AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 yea...AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg),the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P＜0.008 and P＜0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3 %). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities.Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.展开更多
Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the sta...Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the state of environment in the urban agglomeration of Athens (UAA) is examined. EO based indicators as used in the study, include land surface temperature, land use, land cover and aerosols distribution. The indicators are also related to the household density and population density, as extracted from census data, for the same area. Indicators are applied at the municipal scale and are also used to estimate an aggregate environmental indicator (AEI), at municipal scale, by integrating all indicators mentioned above in a GIS environment. It is found that the urban agglomeration of Athens is practically “dichotomized”, by being divided in a western and eastern area, with considerably different environmental conditions. Results are considered important for focused interventions supporting environmental urban planning, whereas they represent the high potential of EO based indicators to monitor and assess the state of the urban environment.展开更多
The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by ...The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.展开更多
N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory lo...N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory loss,behavioral abnormalities,and motor dysfunctions.Decades of research have significantly advanced our understanding of the pathophysiology underlying neurodegene rative diseases,including Alzheimer's disease(AD),Parkinson's disease,amyotrophic lateral sclerosis,and others.展开更多
This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） invol...This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.展开更多
BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are e...BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.展开更多
Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective to...Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.展开更多
This study investigates the mineralogy and mineral-chemistry of a newly discovered Au-Ag-Bi-Te mineralization at the Aydindere Fe-Cu skarn deposit,within the Pontides Tectonic Unit,northeastern Turkey.The mineralizati...This study investigates the mineralogy and mineral-chemistry of a newly discovered Au-Ag-Bi-Te mineralization at the Aydindere Fe-Cu skarn deposit,within the Pontides Tectonic Unit,northeastern Turkey.The mineralization is developed in the skarn zone at the contact between Upper Cretaceous andesite-pyroclastic rocks and a Paleocene–Eocene I-type granitoid.The principal ore minerals of the Aydindere Fe-Cu deposit are oxides(magnetite),sulfides(pyrite-chalcopyritegalena-sphalerite),tellurides/sulfotellurides(tetradymite,hessite),sulfosalts(wittichenite,emplectite,aikinite) and native gold-electrum.Skarn minerals include anhydrous phases(garnet) formed in a prograde stage and hydrous phases(amphibole,epidote,chlorite),which were formed in a retrograde stage in association with quartz,adularia,apatite and late calcite.Sulfides,tellurides and sulfosalts are introduced during the retrograde stage.The Au-Ag-Bi-Te mineralization was detected for the first time within the western ore body of the Aydindere deposit,and occurs in calcite-bearing sulfide bodies that cut magnetite-garnet-amphibole-epidote skarns with magnetite ores of different grade,including massive magnetite.Chlorite geothermometry indicates formation of the Au-Ag-BiTe mineralization at temperatures between 300 and 250 ℃,during the retrograde skarn evolution.Assuming the temperature is ~275 ℃,logfS_(2) =-10.5 to-13,logfO_(2) =-37 to-33,and logf Te2 values range from approximately-12 to-8.5 were estimated.The available mineralogical and geological data(presences of magnetite,oxidized-type tellurides/sulfotellurides,and andraditic garnets,and absence of pyrrhotite and arsenopyrite) suggest that Aydindere is an oxidized Au-bearing skarn deposit.The discovery of Au-Ag-Bi-Te mineralization at Aydindere increases its productivity and requires more detailed exploration in the deposit for precious(Au,Ag) and critical(Bi,Te) metals.展开更多
Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent nee...Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent need for new,accurate tools for early cancer detection,better prognostication and patient monitoring.Liquid biopsy(LB)is a modern and non-invasive technique comprising a diverse group of methodologies aiming to detect tumour biomarkers from body fluids.These biomarkers include circulating tumour cells,cell-free DNA,circulating tumour DNA,RNA and extracellular vesicles.The aim of this review is to explore the current and potential future applications of LB in CCA management,with a focus on diagnosis,prognostication and monitoring.We examine both its significant potential and the inevitable limitations associated with this technology.We conclude that LB holds considerable promise,but further research is necessary to fully integrate it into precision oncology for CCA.展开更多
Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligen...Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.展开更多
Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast cancer.It is considered as a mixed,biphasic neoplasm consisting...Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast cancer.It is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone.Although cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation.Despite recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative approach.Since CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented.Nevertheless,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone metastases.Thus,surgical removal of breast CS does not necessarily ensure patient’s long-term recovery.Moreover,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is limited.Nevertheless,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone.The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread.Clinical features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.展开更多
Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards f...Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards for early-stage HCC;however,advances in imaging and minimally invasive techniques have improved patient selection and outcomes.Additionally,the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC.This review highlights the efficacy of agents such as tyrosine kinase inhibitors,alongside emerging options like immune checkpoint inhibitors,which have shown promise in clinical trials.Furthermore,the role of locoregional therapies,including ablation in the setting of combined treatment,transar-terial chemoembolization and transarterial radioembolization with flow catheters,cone-beam computed tomo-graphy and 4D navigation guidance,is examined in the context of bridging therapies for patients awaiting surgical intervention.The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes.Future directions for HCC treatment are discussed,including the potential of novel biomarkers in prognosis and treatment response.This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates.展开更多
The significance of gut microbiota(GM)in human health is being increasingly researched.An imbalance in GM composition,known as dysbiosis,is linked to various and other health issues.In addition,antibiotics are the pri...The significance of gut microbiota(GM)in human health is being increasingly researched.An imbalance in GM composition,known as dysbiosis,is linked to various and other health issues.In addition,antibiotics are the primary and most significant factors leading to major changes in the composition and function of the GM,which may result in colonization by antimicrobial-resistant(AMR)pathogens.Therefore,alternative antibiotic strategies for combating AMR pathogens are urgently needed.This narrative review highlights current knowledge regarding various pertinent strategies for decolonizing bacterial pathogens from GM and emphasizes decolonization therapies’critical role in pediatric surgical disorders.Strategies such as decontamination of the digestive tract utilizing antibiotics,the use of probiotics,and particularly fecal microbiota transplantation have introduced new options for clinical treatment.These treatments show the potential to restore GM balance and have demonstrated advantages for intestinal disorders related to pediatric surgery,including inflammatory bowel disease,neonatal necrotizing enterocolitis,Hirschsprung-associated enterocolitis,and short bowel syndrome.Despite GM therapeutics,recent strategies are still in their developmental phase and exhibit challenges that need further research.Thus,potential future directions for GMtargeted decolonization therapies are under consideration.Innovative alternative strategies to combat AMR though GM modulation in disorders related to pediatric surgery appear to be promising and should continue to be prioritized for further research and development.展开更多
Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to blee...Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to bleeding.When both lesions coexist,the DVA’s altered venous pressure and flow can promote CM formation or rupture.Detecting a DVA abutting an otherwise unexplained intracerebral hemorrhage can therefore raise suspicion of an occult CM as a likely cause,a clue which may be invaluable for daily clinical practice.The main focus of this review is to acknowledge the hallmark imaging appearances of DVAs and CMs,as well as their coexistence,explore the clinical consequences of mixed lesions,and emphasize that recognizing their partnership is vital for an accurate,timely diagnosis and appropriately targeted management.展开更多
Endometrial thickness plays an important role in successful embryo implantation and normal pregnancy achievement.However,a thin endometrial layer(≤7 mm)may have a significant effect on microenvironment tolerance,whic...Endometrial thickness plays an important role in successful embryo implantation and normal pregnancy achievement.However,a thin endometrial layer(≤7 mm)may have a significant effect on microenvironment tolerance,which is further related to successful embryo implantation or conception,either naturally or after assisted reproductive technology.Moreover,this microenvironment tolerance shift induces hypoxic damage to endometrial epithelial cells(EECs),which results in altered signaling biomolecule secretion,including exosome content.In the context of endometrium regeneration,mesenchymal stromal cells(MSCs)and umbilical cord(UC)-derived stem cells have been applied in clinical trials with promising results.It has been recently shown that exosomes derived from hypoxic damaged EECs directly contribute to the increased migratory and regenerative abilities of UCs and MSCs.Specifically,microRNAs in exosomes secreted by the hypoxic damaged EECs,such as miR-214-5p and miR-21-5p,play a crucial role in the migratory capacity and differentiation ability of MSCs to EECs mediated through the signal transducer and activator of transcription 3(STAT3)signaling pathway.Taking into consideration the above information,UC-MSCs may be considered as a modern intervention for endometrial regeneration.展开更多
Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill pa...Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.展开更多
BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemothe...BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.展开更多
BACKGROUND The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To e...BACKGROUND The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.METHODS Magnetic resonance imaging scans from 80 patients(160 sides)were retrospectively analyzed,excluding cases with pathological processes affecting the TN.Using multiplanar reconstruction,the TN root was identified and its spatial relationship with the SCA was evaluated.RESULTS Eight distinct topographic patterns were identified.The SCA most commonly coursed superior(30.6%),lateral(18.8%),or superolateral(17.5%)to the TN.Medial configurations,although less frequent,were associated with the shortest artery-nerve distance(mean 1.85±1.28 mm)and significantly higher contact rates(P<0.001).Overall,SCA-TN contact was observed in 14.4%of sides,but only 20%of these patients reported ipsilateral facial numbness.Variations in SCA origin(basilar artery,posterior cerebral artery,or common origin)and duplication did not significantly influence the artery-nerve distance.CONCLUSION Although SCA-TN contact is relatively frequent,only particular medial and superior configurations seem to predispose individuals to symptomatic compression.These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia.Vascular contact alone should not serve as a diagnostic criterion;instead,geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.展开更多
BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in ...BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in a large,real-world clinical setting.METHODS Clinical,epidemiological,and procedural data collected from a prospectively maintained database were gathered over a 20-year period(2001-2021)from consecutive patients undergoing their first ERCP.Patients were grouped based on age:<80 years and≥80 years.RESULTS A total of 3147 patients were included in the study,with 70.3%<80 years old and 28.7%≥80 years.The most common indication for ERCP was biliary colic with or without elevated liver enzymes(39.6%).Periampullary diverticula were more frequently observed in elderly patients(P<0.001).Successful cannulation of the common bile duct was achieved in 96.1%of cases and did not differ significantly between age groups(P=0.148).Complete common bile duct clearance during the first ERCP was accomplished in 90.1%,and stone size was the only independent predictor of success.Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding(odds ratio[OR]=1.333;P=0.03 and OR=1.275;P=0.041,respectively).Overall,post-ERCP complications occurred in 6%of cases,with similar rates between elderly and younger patients.The most common complication was PEP.The incidences of clinical bleeding and PEP did not differ significantly between groups(P=0.290 and P=0.128,respectively).Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.CONCLUSION Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP,supporting the procedure’s safety and efficacy in this population.展开更多
文摘Athens, a metropolis characterized by agglutination and compactness, but at the same time facing numerous urban and transport issues, saw its population swell during the 20th century which led to extensive urbanization phenomena. This continued urbanization increases profoundly all urban activities with transportation being the key driver in energy consumption. Theories for sustainable cities prerequisite are the integration of a number of acts in order to reduce energy consumption, with mobility being the first consideration among others. The aim of this paper is to critically explore implemented policies and plans as well as forthcoming strategic plans in terms of sustainable mobility as imposed in large scale regeneration plans in contemporary Athens. Research focuses on strategic interventions since the 1980s, such as the Athenian Daktylios （ring road for circulation management） and its later adjustments, the upcoming pedestrianization and unification of the commercial triangle and its subsequent tram line extension as well as the notable implementation of the metropolitan cycling network. Moreover, the discussion takes into consideration the implications of the Greek economic crisis in mobility choices, as aimless travels have been reduced to a minimum, several cars have been abandoned and cyclists seem to tentatively claim some space in the urban environment. What will likely be the next day in the Athenian historic centre？ Considering the transformations that are expected in the immediate future, this research paper explores their potential to enhance urban environment, reduce climate change impacts and amplify resilience.
文摘AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg),the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P＜0.008 and P＜0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3 %). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities.Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.
文摘Earth observation (EO) provides the opportunity for periodic and spatially detailed assessment of the state of the environment in urban areas. In this study, the potential of EO based indicators (EI) to assess the state of environment in the urban agglomeration of Athens (UAA) is examined. EO based indicators as used in the study, include land surface temperature, land use, land cover and aerosols distribution. The indicators are also related to the household density and population density, as extracted from census data, for the same area. Indicators are applied at the municipal scale and are also used to estimate an aggregate environmental indicator (AEI), at municipal scale, by integrating all indicators mentioned above in a GIS environment. It is found that the urban agglomeration of Athens is practically “dichotomized”, by being divided in a western and eastern area, with considerably different environmental conditions. Results are considered important for focused interventions supporting environmental urban planning, whereas they represent the high potential of EO based indicators to monitor and assess the state of the urban environment.
文摘The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.
基金supported by the National Institute on Aging(Nos.AG000723 and AG000578)(to VAB)the Fondation Sante(No.19656),Greece 2.0+1 种基金the National Recovery and Resilience Plan’s flagship program TAEDR-0535850the European Research Council(No.101077374-Synapto Mitophagy)(to KP)。
文摘N umerous neurological disorders negatively impact the nervous system,either through loss of neurons or by disrupting the normal functioning of neural networks.These impairments manifest as cognitive defects,memory loss,behavioral abnormalities,and motor dysfunctions.Decades of research have significantly advanced our understanding of the pathophysiology underlying neurodegene rative diseases,including Alzheimer's disease(AD),Parkinson's disease,amyotrophic lateral sclerosis,and others.
基金supported by the special fund for research grants of NTUA for PhD studies
文摘This study aims to divide traffic into meaningful clusters （regimes） and to investigate their impact on accident likelihood and accident severity. Furthermore, the likelihood of pow- ered-two-wheelers （PTWs） involvement in an accident is examined. To achieve the aims of the study, traffic and accident data during the period 2006-2011 from two major arterials in Athens were collected and processed. Firstly, a finite mixture cluster analysis was imple- mented to classify traffic into clusters. Afterwards, discriminant analysis was carried out in order to correctly assign new cases to the existing regimes by using a training and a testing set. Lastly, Bayesian logistic regression models were developed to investigate the impact of traffic regimes on accident likelihood and severity. The findings of this study suggest that urban traffic can be divided into different regimes by using average traffic occupancy and its standard deviation, measured by nearby upstream and downstream loop detectors. The results revealed potential hazardous traffic conditions, which are discussed in the paper. In general, high occupancy values increase accident likelihood, but tend to lead slight acci- dents, while PTWs are more likely to be involved in an accident, when traffic occupancy is high. Transitions from high to low occupancy also increase accident likelihood.
文摘BACKGROUND Pubic ramus fractures are generally considered fragility fractures in the elderly population,commonly deriving from a low-impact fall.Treatment is ordinarily conservative and hemodynamic complications are exceedingly infrequent.Notwithstanding,patients with copious comorbidities should be carefully monitored for potential vascular injury.CASE SUMMARY This case report presents the management of a 75-year-old male patient with a history of diabetes mellitus and arterial hypertension who was admitted to the emergency room with a superior pubic ramus fracture.The patient experienced a significant drop in hematocrit and hemoglobin levels post-admission,necessi-tating urgent intervention.A computed tomography angiography revealed active bleeding,leading to the embolization of the medial femoral branch.The patient was stabilized hemodynamically and was discharged after 15 days,with recom-mendations for home-based follow-up care.CONCLUSION This report denotes the various challenges and strategies in managing simple fractures that are treated conservatively,but need prompt monitoring for occult vascular injuries that can be fatal.
文摘Accurate medical diagnosis,which involves identifying diseases based on patient symptoms,is often hindered by uncertainties in data interpretation and retrieval.Advanced fuzzy set theories have emerged as effective tools to address these challenges.In this paper,new mathematical approaches for handling uncertainty in medical diagnosis are introduced using q-rung orthopair fuzzy sets(q-ROFS)and interval-valued q-rung orthopair fuzzy sets(IVq-ROFS).Three aggregation operators are proposed in our methodologies:the q-ROF weighted averaging(q-ROFWA),the q-ROF weighted geometric(q-ROFWG),and the q-ROF weighted neutrality averaging(qROFWNA),which enhance decision-making under uncertainty.These operators are paired with ranking methods such as the similarity measure,score function,and inverse score function to improve the accuracy of disease identification.Additionally,the impact of varying q-rung values is explored through a sensitivity analysis,extending the analysis beyond the typical maximum value of 3.The Basic Uncertain Information(BUI)method is employed to simulate expert opinions,and aggregation operators are used to combine these opinions in a group decisionmaking context.Our results provide a comprehensive comparison of methodologies,highlighting their strengths and limitations in diagnosing diseases based on uncertain patient data.
文摘This study investigates the mineralogy and mineral-chemistry of a newly discovered Au-Ag-Bi-Te mineralization at the Aydindere Fe-Cu skarn deposit,within the Pontides Tectonic Unit,northeastern Turkey.The mineralization is developed in the skarn zone at the contact between Upper Cretaceous andesite-pyroclastic rocks and a Paleocene–Eocene I-type granitoid.The principal ore minerals of the Aydindere Fe-Cu deposit are oxides(magnetite),sulfides(pyrite-chalcopyritegalena-sphalerite),tellurides/sulfotellurides(tetradymite,hessite),sulfosalts(wittichenite,emplectite,aikinite) and native gold-electrum.Skarn minerals include anhydrous phases(garnet) formed in a prograde stage and hydrous phases(amphibole,epidote,chlorite),which were formed in a retrograde stage in association with quartz,adularia,apatite and late calcite.Sulfides,tellurides and sulfosalts are introduced during the retrograde stage.The Au-Ag-Bi-Te mineralization was detected for the first time within the western ore body of the Aydindere deposit,and occurs in calcite-bearing sulfide bodies that cut magnetite-garnet-amphibole-epidote skarns with magnetite ores of different grade,including massive magnetite.Chlorite geothermometry indicates formation of the Au-Ag-BiTe mineralization at temperatures between 300 and 250 ℃,during the retrograde skarn evolution.Assuming the temperature is ~275 ℃,logfS_(2) =-10.5 to-13,logfO_(2) =-37 to-33,and logf Te2 values range from approximately-12 to-8.5 were estimated.The available mineralogical and geological data(presences of magnetite,oxidized-type tellurides/sulfotellurides,and andraditic garnets,and absence of pyrrhotite and arsenopyrite) suggest that Aydindere is an oxidized Au-bearing skarn deposit.The discovery of Au-Ag-Bi-Te mineralization at Aydindere increases its productivity and requires more detailed exploration in the deposit for precious(Au,Ag) and critical(Bi,Te) metals.
文摘Cholangiocarcinoma(CCA)is a highly aggressive and heterogeneous malignancy arising from the epithelial cells of the biliary tract.The limitations of the current methods in the diagnosis of CCA highlight the urgent need for new,accurate tools for early cancer detection,better prognostication and patient monitoring.Liquid biopsy(LB)is a modern and non-invasive technique comprising a diverse group of methodologies aiming to detect tumour biomarkers from body fluids.These biomarkers include circulating tumour cells,cell-free DNA,circulating tumour DNA,RNA and extracellular vesicles.The aim of this review is to explore the current and potential future applications of LB in CCA management,with a focus on diagnosis,prognostication and monitoring.We examine both its significant potential and the inevitable limitations associated with this technology.We conclude that LB holds considerable promise,but further research is necessary to fully integrate it into precision oncology for CCA.
文摘Machine learning(ML)is a type of artificial intelligence that assists computers in the acquisition of knowledge through data analysis,thus creating machines that can complete tasks otherwise requiring human intelligence.Among its various applications,it has proven groundbreaking in healthcare as well,both in clinical practice and research.In this editorial,we succinctly introduce ML applications and present a study,featured in the latest issue of the World Journal of Clinical Cases.The authors of this study conducted an analysis using both multiple linear regression(MLR)and ML methods to investigate the significant factors that may impact the estimated glomerular filtration rate in healthy women with and without non-alcoholic fatty liver disease(NAFLD).Their results implicated age as the most important determining factor in both groups,followed by lactic dehydrogenase,uric acid,forced expiratory volume in one second,and albumin.In addition,for the NAFLD-group,the 5th and 6th most important impact factors were thyroid-stimulating hormone and systolic blood pressure,as compared to plasma calcium and body fat for the NAFLD+group.However,the study's distinctive contribution lies in its adoption of ML methodologies,showcasing their superiority over traditional statistical approaches(herein MLR),thereby highlighting the potential of ML to represent an invaluable advanced adjunct tool in clinical practice and research.
文摘Carcinosarcoma(CS),also known as metaplastic breast carcinoma with mesenchymal differentiation,is one of the five distinct subtypes of metaplastic breast cancer.It is considered as a mixed,biphasic neoplasm consisting of a carcinomatous component combined with a malignant nonepithelial element of mesenchymal origin without an intermediate transition zone.Although cellular origin of this neoplasm remains controversial,most researchers declare that neoplastic cells derive from a cellular structure with potential biphasic differentiation.Despite recent research on the therapeutic strategies against CS neoplastic disorders,surgical resection appears the only potentially curative approach.Since CS metastasize by the lymphatic route,axillary assessment with sentinel lymph node biopsy and/or axillary lymph node dissection is always implemented.Nevertheless,the tumor also presents a hematogenous metastatic pattern including pleural,pulmonary,liver,brain and less commonly bone metastases.Thus,surgical removal of breast CS does not necessarily ensure patient’s long-term recovery.Moreover,alternative therapies,such as radio-and chemotherapy proved insufficient and 5-year survival rate is limited.Nevertheless,there is evidence that following surgery,the combination of radio and chemotherapy is associated with a better prognosis than either treatment alone.The aim of this review is to evaluate the results of surgical treatment for breast CS with special reference to the extent of its histological spread.Clinical features,histogenesis,morphological and immunochemical findings are discussed,while the role of current diagnostic and therapeutic management of this aggressive neoplasm is emphasized.
文摘Hepatocellular carcinoma(HCC)remains a leading cause of cancer-related mortality worldwide,necessitating innovative treatment strategies.Surgical resection and liver transplantation continue to be the gold standards for early-stage HCC;however,advances in imaging and minimally invasive techniques have improved patient selection and outcomes.Additionally,the emergence of targeted therapies and immunotherapy has transformed the treatment landscape for advanced HCC.This review highlights the efficacy of agents such as tyrosine kinase inhibitors,alongside emerging options like immune checkpoint inhibitors,which have shown promise in clinical trials.Furthermore,the role of locoregional therapies,including ablation in the setting of combined treatment,transar-terial chemoembolization and transarterial radioembolization with flow catheters,cone-beam computed tomo-graphy and 4D navigation guidance,is examined in the context of bridging therapies for patients awaiting surgical intervention.The integration of multidisciplinary care approaches and personalized treatment plans is crucial for optimizing outcomes.Future directions for HCC treatment are discussed,including the potential of novel biomarkers in prognosis and treatment response.This comprehensive overview aims to equip clinicians with the latest insights and foster collaborative efforts to improve HCC patient management and survival rates.
文摘The significance of gut microbiota(GM)in human health is being increasingly researched.An imbalance in GM composition,known as dysbiosis,is linked to various and other health issues.In addition,antibiotics are the primary and most significant factors leading to major changes in the composition and function of the GM,which may result in colonization by antimicrobial-resistant(AMR)pathogens.Therefore,alternative antibiotic strategies for combating AMR pathogens are urgently needed.This narrative review highlights current knowledge regarding various pertinent strategies for decolonizing bacterial pathogens from GM and emphasizes decolonization therapies’critical role in pediatric surgical disorders.Strategies such as decontamination of the digestive tract utilizing antibiotics,the use of probiotics,and particularly fecal microbiota transplantation have introduced new options for clinical treatment.These treatments show the potential to restore GM balance and have demonstrated advantages for intestinal disorders related to pediatric surgery,including inflammatory bowel disease,neonatal necrotizing enterocolitis,Hirschsprung-associated enterocolitis,and short bowel syndrome.Despite GM therapeutics,recent strategies are still in their developmental phase and exhibit challenges that need further research.Thus,potential future directions for GMtargeted decolonization therapies are under consideration.Innovative alternative strategies to combat AMR though GM modulation in disorders related to pediatric surgery appear to be promising and should continue to be prioritized for further research and development.
文摘Developmental venous anomalies(DVAs)are benign congenital veins that collect normal brain drainage into a single outlet.Cerebral cavernous malformations(CMs)are clusters of thin-walled capillary cavities prone to bleeding.When both lesions coexist,the DVA’s altered venous pressure and flow can promote CM formation or rupture.Detecting a DVA abutting an otherwise unexplained intracerebral hemorrhage can therefore raise suspicion of an occult CM as a likely cause,a clue which may be invaluable for daily clinical practice.The main focus of this review is to acknowledge the hallmark imaging appearances of DVAs and CMs,as well as their coexistence,explore the clinical consequences of mixed lesions,and emphasize that recognizing their partnership is vital for an accurate,timely diagnosis and appropriately targeted management.
文摘Endometrial thickness plays an important role in successful embryo implantation and normal pregnancy achievement.However,a thin endometrial layer(≤7 mm)may have a significant effect on microenvironment tolerance,which is further related to successful embryo implantation or conception,either naturally or after assisted reproductive technology.Moreover,this microenvironment tolerance shift induces hypoxic damage to endometrial epithelial cells(EECs),which results in altered signaling biomolecule secretion,including exosome content.In the context of endometrium regeneration,mesenchymal stromal cells(MSCs)and umbilical cord(UC)-derived stem cells have been applied in clinical trials with promising results.It has been recently shown that exosomes derived from hypoxic damaged EECs directly contribute to the increased migratory and regenerative abilities of UCs and MSCs.Specifically,microRNAs in exosomes secreted by the hypoxic damaged EECs,such as miR-214-5p and miR-21-5p,play a crucial role in the migratory capacity and differentiation ability of MSCs to EECs mediated through the signal transducer and activator of transcription 3(STAT3)signaling pathway.Taking into consideration the above information,UC-MSCs may be considered as a modern intervention for endometrial regeneration.
文摘Transgender individuals often undergo gender-affirming hormonal therapy(GAHT)to align their physical characteristics with their gender identity,which introduces unique challenges in the management of critically ill patients.In the setting of critical illness,the interactions between GAHT and the body's endocrine response are complex.GAHT can influence the hypothalamic-pituitary-adrenal axis,sex hormone levels,and metabolic parameters,potentially complicating the clinical picture.For example,estrogen therapy in transgender women increases the risk of venous thromboembolism,which is further exacerbated by the immobility and hypercoagulable state often present in critically ill patients.Testosterone therapy in transgender men can lead to erythrocytosis,increasing the risk of thromboembolic events during critical illness.The potential for drug interactions,particularly with medications used in the intensive care unit,also requires careful consideration.Monitoring hormone levels and adjusting GAHT in the acute setting are crucial,although evidence-based guidelines are lacking.The need for individualized care and vigilant monitoring of endocrine and metabolic parameters is paramount to improve outcomes in this vulnerable population.
文摘BACKGROUND Cardiovascular diseases and cancer are leading causes of morbidity and mortality.Patients with malignancies are at increased risk for cardiovascular complications including acute coronary syndromes,chemotherapy or radiation therapy related complications and cardiac metastasis.CASE SUMMARY We present a case of a 47-year-old female with metastatic cancer on immuno-therapy presented with anterior ST elevation myocardial infarction followed by emergent percutaneous coronary intervention in the left anterior descending artery.Echocardiography after 72 hours showed thickening of inferior wall and cardiac magnetic resonance depicted inflammation and necrosis attributable to either cardiac metastasis or immunotherapy induced myocarditis.Biopsy was not performed because of treatment with antiplatelet drugs and a definite diagnosis was achieved after probationary administration of high-dose intravenous methyl-prednisolone that led to recovery.CONCLUSION In patients with malignancy,chemotherapy-induced cardiovascular complications and cardiac metastasis are common concerns and may coexist with common acute cardiovascular diseases including acute coronary syndromes.In such cases clinical suspicion aided by multimodality imaging is crucial for the diagnosis.A multidisciplinary team approach is required for prompt initiation of the appro-priate treatment.
文摘BACKGROUND The trigeminal nerve(TN)is frequently implicated in neurovascular conflicts,most commonly with the superior cerebellar artery(SCA),its predominant arterial counterpart in the cerebellopontine angle.AIM To examine the relationship between the SCA and TN utilizing high-resolution magnetic resonance imaging and evaluated whether particular anatomical configurations predispose to clinically significant contact.METHODS Magnetic resonance imaging scans from 80 patients(160 sides)were retrospectively analyzed,excluding cases with pathological processes affecting the TN.Using multiplanar reconstruction,the TN root was identified and its spatial relationship with the SCA was evaluated.RESULTS Eight distinct topographic patterns were identified.The SCA most commonly coursed superior(30.6%),lateral(18.8%),or superolateral(17.5%)to the TN.Medial configurations,although less frequent,were associated with the shortest artery-nerve distance(mean 1.85±1.28 mm)and significantly higher contact rates(P<0.001).Overall,SCA-TN contact was observed in 14.4%of sides,but only 20%of these patients reported ipsilateral facial numbness.Variations in SCA origin(basilar artery,posterior cerebral artery,or common origin)and duplication did not significantly influence the artery-nerve distance.CONCLUSION Although SCA-TN contact is relatively frequent,only particular medial and superior configurations seem to predispose individuals to symptomatic compression.These observations are consistent with cadaveric and surgical evidence highlighting the significance of root entry zone contact in trigeminal neuralgia.Vascular contact alone should not serve as a diagnostic criterion;instead,geometric configuration and related nerve alterations must also be incorporated into preoperative assessment.
文摘BACKGROUND Data suggest that elderly patients may have a lower risk of complications after endoscopic retrograde cholangiopancreatography(ERCP),especially post-ERCP pancreatitis(PEP).AIM To validate these findings in a large,real-world clinical setting.METHODS Clinical,epidemiological,and procedural data collected from a prospectively maintained database were gathered over a 20-year period(2001-2021)from consecutive patients undergoing their first ERCP.Patients were grouped based on age:<80 years and≥80 years.RESULTS A total of 3147 patients were included in the study,with 70.3%<80 years old and 28.7%≥80 years.The most common indication for ERCP was biliary colic with or without elevated liver enzymes(39.6%).Periampullary diverticula were more frequently observed in elderly patients(P<0.001).Successful cannulation of the common bile duct was achieved in 96.1%of cases and did not differ significantly between age groups(P=0.148).Complete common bile duct clearance during the first ERCP was accomplished in 90.1%,and stone size was the only independent predictor of success.Use of antiplatelet or anticoagulant therapy was independently associated with intraprocedural bleeding(odds ratio[OR]=1.333;P=0.03 and OR=1.275;P=0.041,respectively).Overall,post-ERCP complications occurred in 6%of cases,with similar rates between elderly and younger patients.The most common complication was PEP.The incidences of clinical bleeding and PEP did not differ significantly between groups(P=0.290 and P=0.128,respectively).Clinical bleeding was independently associated with anticoagulant use and intraprocedural bleeding.CONCLUSION Our findings highlight that elderly patients do not experience higher complication rates or lower success rates with ERCP,supporting the procedure’s safety and efficacy in this population.
