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Autoimmune polyglandular syndrome type 2 (APS2) is characterized by autoimmune adrenal insufficiency (AI) in conjunction with autoimmune thyroid disease (AITD) and/or type 1 diabetes mellitus (T1DM). The aim is to report an 11-year-old girl with concurrence of Addison disease, celiac disease and thyroid autoimmunity. She initially presented at the age of 5 with vomiting, dehydration, hyponatremia, hyperkalemia and low glucose. She recovered with intravenous hydration but the diagnosis was not established. She presented again at the age of 11 with hyperpigmentation, weakness and signs of impending adrenal crisis. Diagnosis of autoimmune AI was established together with celiac disease and thyroid autoimmunity. Thus, she met criteria for APS, being the third pediatric case report of APS2 with this combination. This case is notable for the atypical age of onset, given that APS2 is rare in the pediatric population. Furthermore, it depicts the insidious course of Addison disease with symptoms fluctuating for years before diagnosis. [ABSTRACT FROM AUTHOR]

This paper builds on the emerging literature concerning constrained rural entrepreneurship. We explore the context of rural Greece, examining the utility of farm diversification strategies used by farmers to respond to industry constraints. Adopting a multi-method approach, this qualitative study theorises the 'present realities' of Greek farming families. Through a multiple case study exploration of five family farms, which includes twenty-five in-depth semi-structured interviews with members of these farm families, we explore farmers' lived experiences in relation to their constrained institutional contexts. Our qualitative analysis, which identifies four original themes, leads to the theorisation of the exogenous and internal challenges within the sector that continue to constrain rural entrepreneurial potential. Findings highlight how farmers' diversification strategies are crucial in enabling farm family households to respond effectively to the sector's increasing challenges, ensuring business survival. These diversification strategies offer significant benefits to farmers, providing sufficient value-added activities that support rural retention within farm family households. Implications for practice and policy suggest a greater need for the development of entrepreneurial and strategic skill sets. Further research is needed to help establish a conducive—not constraining—environment that supports farm entrepreneurship strategies. • Constrained entrepreneurship in rural Greece. • Farm diversification as a strategic response to the increasing industry constraints. • Diversification can add sufficient value to the family farm business. • A greater need to understand the lived experiences of farmers via the farm family. • Policy attention is required to establish a conducive rural economy. [ABSTRACT FROM AUTHOR]

Seizures are common in children with acute lymphoblastic leukemia (ALL). As ALL survival rates are improving, the challenge to minimize treatment related side effects and late sequelae rises. Here, we studied the frequency, timing, etiology and risk factors of seizures in ALL patients. The study included children aged 1–17.9 years at diagnosis of B-cell-precursor and T cell ALL who were treated according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO) ALL2008 protocol between 2008 and 2015. Detailed patient data were acquired from the NOPHO ALL2008 registry and by review of medical records. Seizures occurred in 81/1464 (5.5%) patients. The cumulative incidence of seizures at one months was 1.7% (95% CI: 1.2–2.5) and at one year 5.3% (95% CI 4.2–6.5%). Patients aged 10–17.9 years, those with T cell immunophenotype, CNS involvement, or high-risk induction with dexamethasone had higher risk for seizures in univariable analyses. Only age remained a risk factor in multivariable analyses (the cumulative incidence of seizures for patients 10–17.9 years old at one year was 9.0% (95% CI: 6.2–12.9)). Of the 81 patients with seizures, 43 had posterior reversible encephalopathy syndrome (PRES), 15 had isolated seizures, nine had sinus venous thrombosis (SVT), three had stroke-like syndrome, and 11 had other neurotoxicities. Epilepsy diagnosis was reported in totally 11 ALL survivors at last follow up. Seizures are relatively common in ALL patients and occur most often in patients with PRES, SVT, or as an isolated symptom. Older children have higher risk of seizures. • Seizures were common in pediatric acute lymphoblastic leukemia (ALL) patients. • Posterior reversible encephalopathy syndrome (PRES) was the most common underlying cause of seizures in ALL. • Older age was an independent risk factor for seizures in pediatric ALL. • Epilepsy was common sequelae after seizures and it was most common in ALL patients having displayed PRES. [ABSTRACT FROM AUTHOR]

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Abstract Olive oil production generates large volumes of wastewaters mostly in peri-Mediterranean countries with adverse impacts on the biota of the receiving aquatic systems. Few studies have however documented its toxicity on aquatic species, with an almost total lack of relative studies on fish. We assessed the acute and sub-chronic OMW toxicity, as well as the acute and sub-chronic behavioural, morphological and biochemical effects of OMW exposure on the mosquitofish Gambusia holbrooki. LC 50 values of the acute bioassays ranged from 7.31% (24 h) to 6.38% (96 h). Behavioural symptoms of toxicity included hypoactivity and a shift away from the water surface, coupled with a range of morphological alterations, such as skin damage, excessive mucus secretion, hemorrhages, fin rot and exophhalmia, with indications also of gill swelling and anemia. Biochemical assays showed that OMW toxicity resulted in induction of catalase (CAT) and inhibition of acetylcholinesterase (AChE) activities. The implications of our results at the level of environmental policy for the sustainable management of the olive mill industry, i.e. the effective restriction of untreated OMW disposal of in adjacent waterways, as well as the implementation of new technologies that reduce their impact (detoxification and/or revalorization of its residues) are discussed. Graphical abstract fx1 Highlights • The LC 50 of OMW to mosquitofish ranged from 7.31% at 24 h to 6.38% at 96 h. • Among OMW contents, phenols were the most important contributor to the mortalities. • Behavioural symptoms included hypoactivity, bottom-dwelling and loss of equilibrium. • Exposed fish exhibited exophthalmia and damage to the skin, fins, gills and kidneys. • Biochemical assays showed evidence of oxidative stress and neurotoxicity. [ABSTRACT FROM AUTHOR]

Abstract Marine litter represents a transboundary challenge since it originates from manifold sources and travels long distances. Reducing marine litter can involve measures to prevent, mitigate, and remove litter, as well as to change behaviour. So far, the effects of prevention policies have been ineffective, resulting in great amounts of litter at sea and suggesting that removal actions are needed. Between 2014 and 2016, 15 ports in five countries (Italy, Slovenia, Croatia, Montenegro and Greece) in the Adriatic-Ionian macroregion implemented Fishing for Litter (FFL) pilot projects. The FFL scheme is a clean-up activity that aims to remove marine litter from the seafloor: fishing vessels collect marine litter that is caught in their nets during fishing activities and dispose of it on the quayside. This study investigates the barriers to implementing the FFL scheme in the Adriatic-Ionian macroregion. We prioritized the strengths, weaknesses, opportunities, and threats (SWOT) of the pilot projects in each country and compared the Adriatic-Ionian experience with that of the FFL initiatives in progress in Scotland since 2005 to achieve a comparative description and benefit from the lessons learnt. The lack of a comprehensive, holistic approach to marine litter management and an ambiguous bureaucracy with unclear definitions of the responsibilities are the main factors hampering the implementation of the FFL scheme in the Adriatic-Ionian macroregion. However, the increasing number of directives and strategies to address marine litter and the extensive public interest and media coverage represent opportunities to institutionalize the scheme as an effective clean-up strategy in the region. Highlights • In the Fishing for Litter scheme fishermen land marine litter caught in the nets. • EU directives, international strategies and conventions promote Fishing for Litter. • The fishery sector can have a significant role in removing marine litter. • A specific overarching legislation to address marine litter is needed. • A Fishing for Litter coordinator at the national or regional level should be appointed. [ABSTRACT FROM AUTHOR]

Abstract Objectives The aim of this study was to test the hypothesis that more intensive over standard anticoagulation administered during coronary angiography would significantly reduce rates of radial artery occlusion (RAO). Background RAO, although silent, remains a frequent and therefore worrisome complication following transradial coronary angiography. Anticoagulation is effective in reducing RAO, but the optimal heparin dose remains ill defined. Methods In this multicenter, randomized superiority trial, a high dose (100 IU/kg body weight administered in divided doses) and a standard dose (50 IU/kg body weight) of heparin during 5- or 6-F coronary angiography were compared. A total of 3,102 patients were randomized, of whom 1,836 patients not proceeding to percutaneous coronary intervention and without need for arterial access crossover entered the trial. Post-catheterization hemostasis did not follow a rigid protocol. Results A total of 102 early RAOs were found on ultrasonography (incidence 5.6%). In the high-dose heparin group, the rate of RAO was significantly lower compared with the standard-dose heparin group (27 [3.0%] vs. 75 [8.1%]; odds ratio: 0.35; 95% confidence interval: 0.22 to 0.55; p < 0.001), without compromising safety. The time to achieve hemostasis was similar between groups. To avoid 1 RAO, the number of patients needed to treat in the high-dose heparin group was approximately 20. These results were corroborated by our integrated database, showing an 80% reduction of forearm artery occlusions in high versus low heparin dose patients and our updated meta-analysis of randomized controlled trials demonstrating significant benefit of higher over lower anticoagulation intensity. Conclusions High compared with standard heparin dose significantly reduced the rate of RAO in patients undergoing coronary angiography. High-intensity anticoagulation should be considered in transradial diagnostic procedures. (High [100IU/Kg] Versus Standard [50IU/Kg] Heparin Dose for Prevention of Forearm Artery Occlusion; NCT02570243) Graphical abstract [ABSTRACT FROM AUTHOR]

Abstract This study provides the first evidence of nylon filament occurrence in the stomach of an economically important target shrimp species in the Mediterranean Sea, Plesionika narval (Fabricius, 1787). Samples were collected monthly from November 2014 to October 2015 from shallow (10–30 m) and deeper waters (150–170 m). The occurrence of plastics in the stomachs of the Narwal shrimp was 5.93% and identified as Nylon by FT-IR analysis. Higher percentages of ingested plastics were found in females from shallower depths and in males from deeper waters. The maximum number of plastics was recorded in January and March, possibly related to the higher feeding intensity of females prior to their reproduction period. A total of 10.3% of females and 4.8% of males with ingested plastics had almost empty stomachs. The presence of plastics in the stomach of P. narval is an evidence of passive ingestion which in this study related to fishing activities. Highlights • First record of plastic ingestion by the Plesionika narval (narwal shrimp) • Ingested plastics were related to fishing activities. • Nylon filament was the only polymer detected in the stomachs of the examined narwal shrimp. [ABSTRACT FROM AUTHOR]

Abstract Microplastic ingestion by marine organisms presents an emerging threat to marine ecosystems; microplastics in different marine species are currently reported worldwide. This study aims to assess microplastic ingestion in four, highly commercial, marine species from Greek waters in the Northern Ionian Sea (Mediterranean Sea). Microplastics were found in mussels (Mytilus galloprovincialis) and all three fish species (Sardina pilchardus , Pagellus erythrinus , Mullus barbatus) examined. The frequency of occurrence of ingested microplastics was 46.25% in mussels, while among fish species, S. pilchardus showed the highest frequency of microplastic ingestion (47.2%). Microplastic abundance ranged from 1.7–2 items/individual in mussels and from 1.5–1.9 items/individual in fish. The majority of ingested microplastics were fragments, while their color and size varied. Fourier Transform Infrared Spectroscopy (FT-IR) indicated polyethylene as the most common polymer type in mussels and fish. Results can be used to set baseline levels for the assessment of microplastic pollution in the Ionian Sea. Highlights • Microplastics were detected in commercial species from the Northern Ionian Sea. • Sardines and mussels presented the highest frequency of occurrence of ingested microplastics. • Polyethylene is the most common polymer detected in the species investigated. [ABSTRACT FROM AUTHOR]

This study presents data on the marine litter occurrence in the stomachs of fish species living in different marine habitats for the Adriatic and NE Ionian Sea macro-region. “Macro-litter” was examined in 614 specimens belonging to 11 species, while micro-litter in 230 specimens belonging to 7 species. The study highlights for the first time the presence of litter in the stomachs of the fish species Citharus linguatula . The occurrence of “macro-litter” in the guts of fish was <3% in both the NE Ionian and N Adriatic but reached 26% in the S Adriatic Sea. Micro-litter occurrence was 40 for the NE Ionian and increased to 87% in the N Adriatic (Slovenian Sea). The ingested “macro” and micro-litter differed among the areas. The marine habitat was found to affect the “macro”-litter ingestion but not the micro-litter. [ABSTRACT FROM AUTHOR]

Introduction Molecular thyroid testing is increasingly being used to further stratify risk of malignancy in cytologically indeterminate thyroid nodules. We report our experience using three commercially available tests in a community hospital setting. Materials and methods All molecular test reports (Afirma, ThyroSeqV2, and ThyGENX/ThyraMIR) on thyroid nodules from Einstein Medical Center, Philadelphia, between April 2014 to March 2017 were compared with follow-up surgical results as part of a quality assurance exercise. Slides and records of disparities were reviewed. Results Ninety-five thyroid nodules with molecular testing were identified with surgical follow up available on 19. No benign Afirma results had surgical follow-up. All 7 suspicious Afirma results had surgery, with 3 being benign on follow-up. Ten ThyroseqV2 tested nodules had follow-up surgery and included 2 papillary carcinomas following a completely negative result and another papillary carcinoma following over expression of the NIS gene reported as likely benign. One case with a TP53 mutation was benign on follow-up total thyroidectomy. Follow-up on 1 NRAS point mutation by ThyGenX/ThyraMIR was confirmed malignant although the microRNA portion of the test was negative. Conclusions Quality assurance review refined our utilization practices as we better appreciated the limitations of molecular testing and use relative to other factors in managing indeterminate thyroid nodules. [ABSTRACT FROM AUTHOR]

The presently reported study provides first and preliminary information on the feeding strategy and diet of boarfish, Capros aper (Linnaeus, 1758), in the eastern Ionian Sea (central Mediterranean). The sampling was carried out using the oceanographic RV PHILIA at the mean depth of 165 m in October 2014. A total of 95 C. aper were studied. The total length of the fish ranged from 4.1 to 10.3 cm. From the total number of stomachs examined only 2.1% were empty. The fullness index (RI) did not differ between juvenile and adult individuals. Cumulative prey curve showed that the sample sizes were adequate to describe the diet of the species. Capros aper fed mainly on Crustacea, especially Copepoda, followed by Amphipoda, Malacostraca, and Tanaidacea. Prey abundance and prey frequency values did not differ between juvenile and adult individuals. The determined feeding strategy showed that the most important prey taxon (Copepoda) had been eaten by more than half of the fish, but their contribution to the gut contents of these fishes was low, indicating a generalized feeding strategy with a high within-phenotype contribution to the niche width for this prey. [ABSTRACT FROM AUTHOR]

Research studies on the effects of microlitter on marine biota have become more and more frequent the last few years. However, there is strong evidence that scientific results based on microlitter analyses can be biased by contamination from air transported fibres. This study demonstrates a low cost and easy to apply methodology to minimize the background contamination and thus to increase results validity. The contamination during the gastrointestinal content analysis of 400 fishes was tested for several sample processing steps of high risk airborne contamination (e.g. dissection, stereomicroscopic analysis, and chemical digestion treatment for microlitter extraction). It was demonstrated that, using our methodology based on hermetic enclosure devices, isolating the working areas during the various processing steps, airborne contamination reduced by 95.3%. The simplicity and low cost of this methodology provide the benefit that it could be applied not only to laboratory but also to field or on board work. [ABSTRACT FROM AUTHOR]

Background Acute inflammatory demyelinating polyneuropathy (AIDP), also known as Guillain-Barré syndrome, is an immune-mediated polyneuropathy usually triggered by infections or vaccinations. In childhood AIDP is commonly described after the first year of life. Here, we present a case of a newborn infant with AIDP manifestation directly after delivery. Case study A newborn girl with a healthy mother, without known exposure to immunomodulating factors, was admitted to the neuropediatric department due to ascending hypotonia, weakness, pain and areflexia in the lower extremities. The clinical presentation, laboratory and neurophysiological studies supported the diagnosis of AIDP. The infant showed first signs of clinical improvement following administration of intravenous immunoglobulin and her recovery was complete at one year. Conclusion AIDP should be considered as a differential diagnosis in ascending hypotonia also in the neonatal period. [ABSTRACT FROM AUTHOR]

Face masks have been adopted as an essential measure to prevent transmission and spread of the virus infection during the pandemic of Covid-19. The present study evaluates the potential microfibers transfer from face masks to other recipients and the potential cross-contamination of samples by microfibers released from masks worn during the analysis of microlitter ingestion by fish. Results indicated that masks could easily transfer endogenous (originated from the mask tissue itself) and exogenous microfibers (with a different origin than the mask tissue itself) to other recipients (adhesive tape and air in our experiment). Exogenous fibers may be carried from everywhere and potentially released everywhere. Microfibers are also released into the air, driven by the airflow generated by breathing, and can be transferred to blanks and samples. Microfiber contamination by facial masks increases the risk of samples cross-contamination and raises concerns about the results reliability of the microlitter analysis on marine biota. [Display omitted] • Face masks worn during laboratory analyses are sources of microfibers contamination. • Microfibers are released from masks into the air by breathing. • Risk of sample cross-contamination by face masks microfibers. • Masks raises concerns about the reliability of results in microplastics analysis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hyperthyroidism is a common disease in the elderly. Antithyroid medications such as methimazole are one of the few treatment options. Case summary: A 76-year-old white woman presented to the clinic with a 1-week history of fatigue, sleepiness, 7-pound weight loss, and tachycardia. Her blood work showed low levels of thyroid-stimulating hormone and high levels of free thyroxine. Due to persistence of her symptoms, she was hospitalized and started on methimazole 10 mg TID. Six weeks after receiving methimazole for the treatment of hyperthyroidism, she had severe jaundice and itching. Results of her liver function tests showed elevation of her alkaline phosphatase and liver transaminase levels, as well as hyperbilirubinemia, formed mainly of the conjugated fraction. Methimazole-induced cholestatic jaundice was diagnosed. Her symptoms gradually improved after discontinuation of the medication, and plasma bilirubin levels were near normal after 8 weeks without methimazole. Conclusions: We report here a probable association between methimazole use and severe cholestatic jaundice in an elderly hyperthyroid patient. The patient''s jaundice was reversed after drug discontinuation. (Am J Geriatr Pharmacother. 2007;5:236-240). [Copyright &y& Elsevier]

Summary: Background and aim: Postprandial glycaemia and lipaemia are known risk factors for atherosclerosis in type 2 diabetes. Coagulation activation in the postprandial state also contributes to acceleration of atherosclerosis. Nateglinide is effective in reducing postprandial glycaemia. Its effect on glycaemia may also be beneficial in postprandial lipaemia and coagulation. The aim of this study was to examine the potential effect of a single dose of nateglinide on postprandial triglyceridaemia, coagulation, and fibrinolysis in patients with type 2 diabetes. Methods and results: Ten subjects with type 2 diabetes, treated with diet alone were recruited in a crossover randomized study. In the morning, after a 12- to 14-h fast, each subject received a standard mixed meal (total energy 783kcal), preceded by one tablet of 120mg nateglinide or placebo. Venous blood samples were drawn prior to meal consumption and 6h afterwards for the measurement of plasma glucose, insulin, and C-peptide, lipids, coagulation, and fibrinolysis factors. As expected, there was a significant reduction in postprandial glycaemia after nateglinide administration compared to placebo (P &#60;0.001). Plasma insulin levels were significantly higher after nateglinide than after placebo (P =0.002). Nateglinide administration resulted in a lower overall postprandial reduction of tissue-plasminogen activator than placebo (−2.9±1.3 vs. −8.3±3.7ng/mlh, P =0.003). In addition, a significant reduction of postprandial plasminogen activator inhibitor-1 was observed in comparison with the baseline values after nateglinide (P =0.001), although the overall response was not significantly different after nateglinide and placebo (P =0.31). Plasma concentrations of C-peptide, lipids and the remaining coagulation parameters studied were not different between nateglinide and placebo. Conclusions: Acute nateglinide administration improves postprandial glycaemia and fibrinolytic activity in patients with type 2 diabetes. This combined effect, if confirmed by a long-treatment study, might reduce cardiovascular risk in type 2 diabetes. [Copyright &y& Elsevier]

Discusses the role of feminist Callirrhoe Parren in the inception of feminism in Greece in the nineteenth century. Actions taken by Parren to prove the ethnic and cultural continuity of women in modern Greek society; Factors that contributed to the control of the Greek society over independence and self-determination from the Ottoman Empire; Background on changing the concept of the role of women in the Greek society.