Search

Background: Prolonged repolarization duration is a significant total mortality (TM) predictor in post-myocardial infarction patients. Aim: We examined the clinical significance of QT interval that was extracted from a Short Resting Holter ECG (SRH ECG – 30-min duration) as a TM predictor in heart failure (HF) patients. Methods: One hundred forty-five HF patients (male = 84%, mean age = 64 ± 12 years, mean LVEF = 33 ± 10%) underwent an SRH ECG recording for 30 min. These high-resolution ECG signals were analyzed and the QT interval was calculated and corrected according to the Fridericia formula. After 42.1 months, 26 patients died. Results: Univariate analysis for Deceased and Living groups: QTc:455 ± 33 ms vs 441 ± 32 ms (p = 0.04), LVEF:32 ± 10% vs 34 ± 9% (p < 0.5), Mean Heart Rate: 73 ± 11 bpm vs 69 ± 12 bpm (p = 0.2), SDNN/HRV: 45 ± 42 ms vs 41 ± 29 ms (p = 0.4), QRS: 123 ± 26 ms vs 119 ± 29 ms (p = 0.5). Multivariate Cox regression analysis with model adjusted for QTc, Mean Heart Rate, LVEF, QRS, revealed that QTc-Fridericia interval was an independent TM predictor (H.R.:1.017, 95% C.I.: 1.003–1.030, p = 0.01). The cut-off point of 490 ms (90th percentile) in the same model presented HR: 2.9 for TM (95%C.I.: 1.066–7.882, p = 0.03). Kaplan Meier curves depicted a clear difference in survival between the two patients' groups (QTc Group≥490 ms vs QTc Group

Background: The role of adipose tissue (AT) in arterial inflammation in familial dyslipidaemias is poorly studied. We investigated the relationship between AT and arterial inflammation in patients with heterozygous familial hypercholesterolemia (heFH) and familial combined hyperlipidemia (FCH). Methods and Results: A total of 40 patients (20 heFH/20 FCH) and a subgroup of 20 of non-heFH/FCH patients were enrolled. Participants underwent blood sampling for serum adipokine measurements and Fluorine-18 fluorodeoxyglucose (18F-FDG) PET/CT imaging. Abdominal visceral (VAT) and subcutaneous (SAT) AT volumes and AT and abdominal aorta 18F-FDG uptake were quantified. FCH patients had increased VAT (pANOVA = 0.004) and SAT volumes (pANOVA = 0.003), lower VAT metabolic activity (pANOVA = 0.0047), and lower adiponectin levels (pANOVA = 0.007) compared to heFH or the control group. Log(Serum adiponectin) levels were correlated with aortic TBR (b = − 0.118, P = 0.038). In mediation analysis, VAT volume was the major determinant of circulating adiponectin, an effect partly mediated via VAT TBR. Clustering of the population of heFH/FCH by VAT volume/TBR and serum adiponectin identified two distinct patient clusters with significant differences in aortic TBR levels (2.11 ± 0.06 vs 1.89 ± 0.05, P= 0.012). Conclusions: VAT phenotype (increased VAT volume and/or high VAT TBR) and hypoadiponectinemia may account for the observed differences in arterial inflammation levels between heFH and FCH patients. © 2021, American Society of Nuclear Cardiology.

The percutaneous closure of ostium secundum atrial septal defects (ASD) is a well-established procedure. Currently available devices and delivery systems are designed to be used via the femoral venous route. However, an alternative approach needs to be considered in cases of congenital or acquired caval obstruction. We describe a successful transjugular closure of a moderate sized secundum ASD with the Cocoon Septal Occluder in a 37-year-old symptomatic woman with inferior vena cava (IVC) thrombosis, using a novel deployment technique to overcome difficulties, namely maintaining stable sheath position in the left atrium. Percutaneous closure of secundum ASDs via the transjugular approach is safe, feasible and effective and can be a reasonable alternative to surgical closure in patients with failed femoral venous access and not anatomically complex atrial septal defects. © 2020, Tech Science Press. All rights reserved.

The aim of this article is to explore the implications of the delegation of powers from central bureaucracies to semi-autonomous agencies for public administration under policy conditionality. Focusing on Greece, we argue that agencification reforms that were introduced during the economic adjustment programs (2010–2018) have changed the role of the administrative apparatus in policy-making and implementation. Based on two exemplary case studies, tax administration and state assets management, the empirical findings illustrate the political dynamics that induced organizational transformation and show how policy conditionality has changed the domestic agencification pattern and has rebalanced the institutional, functional, and democratic dimensions of agencies. © The Author(s) 2020.

Lameness represents an intractable problem for the dairy industry. Complicated claw horn disruption lesions, interdigital hyperplasia, and interdigital phlegmon are important lameness causing foot lesions. Their aetiology is multifactorial, but infectious processes are likely implicated in disease pathogenesis. Our aim was to investigate the bacterial profiles of these lesions using 16S rRNA gene sequencing of samples obtained from 51 cattle across ten farms in the UK. In this study, interdigital hyperplasia, interdigital hyperplasia with signs of interdigital dermatitis, interdigital phlegmon, complicated sole ulcers, complicated toe ulcers lesions, and complicated white line lesions were investigated; corresponding healthy skin control samples were also analysed. All diseased tissues displayed reduced microbial richness and diversity (as described by Chao1, Shannon, and Simpson alpha-diversity indices) compared to their healthy skin control samples. Our results confirm the association of Treponema spp with some of these disorders. Other anaerobic bacteria including Fusobacterium spp., Fastidiosipila spp. and Porphyromonas spp. were implicated in the aetiology of all these lesions with the exception of interdigital hyperplasia. Complicated claw horn disruption lesions, and interdigital phlegmon were found to have similar bacterial profiles. Such sharing of bacterial genera suggests many of the infectious agents detected in these foot lesions are acting opportunistically; this finding could contribute towards future treatment and control strategies.

PurposeIn the current case series, we present our experience with the self-expanding CoreValve or Evolut R (Medtronic Inc.) in patients with severe symptomatic aortic valve stenosis and concomitant mitral valve prosthesis.MethodsTwelve patients with previous mitral valve prosthesis underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and/or aortic valve regurgitation. All patients underwent evaluation with an echocardiogram, computed tomography and coronary angiogram. After the index intervention and before discharge all patients underwent transthoracic echocardiography. All outcomes were defined according to the Valve Academic Research Consortium-2 criteria. Results Eleven patients underwent transcatheter aortic valve replacement for severe symptomatic aortic valve stenosis and one patient for severe aortic valve regurgitation. There was immediate improvement of patients' hemodynamic status; no cases of procedural death, stroke, myocardial infarction, or urgent cardiac surgery occurred. There was no 30-day mortality and all patients improved, with 91.6% in functional New York Heart Association class I-II. Conclusion The current study demonstrates that in patients with severe aortic valve stenosis or regurgitation and mitral valve prosthesis, the implantation of a self-expanding aortic valve via the transfemoral route is safe and feasible, with maintained long-term results. © 2019 Italian Federation of Cardiology - I.F.C. All rights reserved.

Η εφαρμογή μέτρων υγιεινής σε μια εκτροφή βοοειδών έχει σαν στόχο: α) τη διατήρηση της υγείας των ζώων, προστατεύοντας τα τόσο από νέους παθογόνους παράγοντες όσο και από εκείνους που υπάρχουν ήδη στην εκτροφή και β) την παραγωγή ασφαλών προϊόντων. Τα γενικά μέτρα υγιεινής βρίσκουν εφαρμογή ανεξάρτητα από τα συγκεκριμένα προβλήματα που αντιμετωπίζει κάθε εκτροφή. Οι 'ανοικτές' εκτροφές, τα ζώα των οποίων έρχονται σε επαφή με βοοειδή άλλων εκτροφών (αγορά ζώων για αναπαραγωγή, συμμετοχή σε εκθέσεις, κοινοί βοσκότοποι κ.λπ.), πρέπει να εφαρμόζουν αυστηρά μέτρα ελέγχου, όπως απομόνωση των εισερχόμενων ζώων, κλινικές και εργαστηριακές εξετάσεις, εμβολιασμοί κ.λπ. Συνεπώς, οι 'κλειστές' εκτροφές παρουσιάζουν σημαντικά υγειονομικά και διαχειριστικά πλεονεκτήματα. Επιπλέον, όλες οι εκτροφές πρέπει να εφαρμόζουν μέτρα ελέγχου-περιορισμοΰ των επισκεπτών και των οχημάτων τους και μέτρα ελέγχου-προστασιας των ζωοτροφών και του νεροΰ σε όλα τα επίπεδα. Η διατήρηση οποιουδήποτε ζώου (παραγωγικού ή συντροφιάς) στις εκτροφές πρέπει να αποφεύγεται και να αποτρέπεται η είσοδος άλλων ζώων, αδέσποτων ή μη. Η συστηματική καταπολέμηση των εντόμων και των τρωκτικών και η απομάκρυνση των άγριων πτηνών είναι απαραίτητη. Η ομαδοποίηση των ζώων ανάλογα με την ηλικία τους, η αποφυγή συστέγασης των νεαρών με τα μεγαλύτερα ζώα, η τήρηση των προδιαγραφών κατασκευής των βουστασιων σε συνδυασμό με τον σωστό αερισμό και τον συχνό καθαρισμό τους, η εφαρμογή όπου είναι δυνατόν του συστήματος all in - all out και οι κατάλληλες απολυμάνσεις είναι απαραίτητα για τον περιορισμό της διάδοσης των παθογόνων παραγόντων μέσα στην εκτροφή. Τα επικίνδυνα υλικά και τα φάρμακα πρέπει να φυλάσσονται σε χώρους ελεγχόμενης πρόσβασης. Η κατάλληλη διατροφή και η αποφυγή των καταπονήσεων ενισχύουν το ανοσοποιητικό σύστημα των ζώων, ενώ η επιλογή τους με τη χρήση ειδικών γενετικών δεικτών αυξάνει την ανθεκτικότητα τους. Τέλος, η σωστή διαχείριση των αποβλήτων κατά τον χειρισμό και την αποθήκευση τους μειώνει τον κίνδυνο μετάδοσης νοσημάτων. Τα προγράμματα ειδικών μέτρων υγιεινής στοχεύουν στην αντιμετώπιση των συγκεκριμένων υγειονομικών προβλημάτων που απασχολούν μια εκτροφή. Αυτά καταρτίζονται με βάση τη μεθοδολογία της «ανάλυσης κίνδυνων» {risk analysis), η οποία περιλαμβάνει την «εκτίμηση του κίνδυνου» {risk assessment), τη «διαχείριση του κίνδυνου » {risk management) και την «επικοινωνία του κίνδυνου» {risk communication). Στην ιεράρχηση των προβλημάτων, κτηνίατροι και κτηνοτρόφοι λαμβάνουν υπόψη την επίδραση τους στην παραγωγικότητα της εκτροφής, στη δημόσια υγεία και στην ευζωία των βοοειδών. Η ομαδοποίηση των υγειονομικών προβλημάτων με βάση κάποια κοινά τους χαρακτηριστικά επιτρέπει, με την ίδια ή με μικρή επιπλέον προσπάθεια, την ταυτόχρονη αντιμετώπιση τους. Εμπόδια στην εφαρμογή των μέτρων υγιεινής αποτελούν η έλλειψη της σχετικής νοοτροπίας από τους κτηνοτρόφους και ο πλημμελής σχεδιασμός, η άναρχη ανάπτυξη και η ανεπαρκής οργάνωση των ελληνικών εκτροφών. Ευθύνη, όμως, για την υστέρηση στον τομέα αυτό φέρει και ο κτηνιατρικός κλάδος λόγω ελλιπούς εκπαίδευσης και έλλειψης κινήτρων., The aim of implementing biosecurity measures on cattle farms is: a) to preserve a high health status of animals by protecting them from new and existing pathogens and b) to ensure the production of safe food. General biosecurity measures should be implemented in any farm regardless of any specific problem. In "open" herds, where cattle have contact with animals from different farms (purchase of breeding animals, participation in cattle shows, common pastures etc) more strict biosecurity measures (i.e., isolation of in-coming animals, clinical examinations, laboratory tests, vaccinations) should be implemented. Therefore, "closed" herds present significant advantages in terms of health management. Moreover, all farms must apply control-restriction measures for visitors and vehicles as well as control and protection measures for feedstuffs and water. Animals of other species (farm or companion animals) should not be kept on the farm, whereas the entry of stray and wild animals must be prevented. Planned control measures for insects, rodents and wild birds are imperative. Management practices, such as grouping according to the age of cattle, but avoiding mixing young with older animals, should be combined with high housing standards, including proper ventilation and frequent manure removal. The implementation of the "all-in, all-ouf principle, whenever possible, as well as proper disinfections, are necessary to eliminate the distribution of pathogens within the farm. Dangerous chemicals and veterinary products must be kept in designated areas. Appropriate nutrition and avoidance of stress will boost the immune system of cattle. On the other hand, genetic selection, based on specific genetic indexes, will increase disease resistance. Moreover, proper manure handling and storage reduces the danger of disease transmission. The aim of specific biosecurity programmes is to confront specific health hazards on farm. Such programmes are developed according to the risk analysis methodology, which comprises risk assessment, risk management and risk communication. Both veterinarians and farmers give priority to problems that are related with farm profitability, public health and animal welfare. Grouping health problems by some of their common characteristics, allows a simultaneous approach, without extra effort. Overall, the lack of professional attitude by farmers, the defective design and development, as well as the inadequate organization of Greek cattle farms, are the main obstacles in implementing biosecurity measures. But, part of the responsibility lies on the veterinary profession as well; lack of training and motivation is the most probable explanation.

Aortic valve stenosis (AS) is the most common valvular heart disease among elderly. Trans-catheter aortic valve implantation (TAVI) has become an established and effective alternative therapeutical procedure for inoperable and high-risk patients with symptomatic AS. The procedural success is greatly dependent on a thorough pre-TAVI imaging screening. This requires a comprehensive and multi-modality approach, in which multi-slice computed tomography (MSCT) is the cornerstone in the selection of eligible patients, in choosing the appropriate prosthesis and size, and in mapping the safest access route for the intervention. From our experience of more than 400 TAVI procedures and many more MSCTs for screening purposes, we provide clinical and technical details on the use of MSCT pre-TAVI and brief review of the knowledge so far. © 2017 Hellenic Society of Cardiology

Departing from the post-war Weberian-oriented bureaucratic model, the Greek administrative system has been subjected to several reform programmes with a view to its modernization. This article aims to explore the main shifts in the course of administrative change and relate this process with the broader theoretical developments in the field of public administration. It is argued that the Greek administration has been unable to follow and take advantage of a vigorously expanded constellation of ideal-types and hybrid models of state (re)organization. Transformations have diachronically produced weak results and failed to build a consistent conceptual and operational administrative paradigm. Even under the current economic contraction and the external conditionality pressure, there is no strong evidence of a paradigm shift in the administrative pattern but rather fragmented changes of limited ambit. Points for practitioners: Despite the fact that the Greek public administration has undergone a series of transformations, interestingly almost none of these reform efforts seem to have incorporated a particular administrative pattern. This article summarizes old and more recent theoretical developments on models of administrative reorganization, with a view to broadening practitioners’ choices in the process of state reform. © 2016, © The Author(s) 2016.

Purpose: To assess the efficacy of the BLADE technique (MR imaging with 'rotating blade-like k-space covering') to significantly reduce motion, truncation, flow and other artifacts in cervical spine compared to the conventional technique. Materials and methods: In eighty consecutive subjects, who had been routinely scanned for cervical spine examination, the following pairs of sequences were compared: a) T2 TSE SAG vs. T2 TSE SAG BLADE and b) T2 TIRM SAG vs. T2 TIRM SAG BLADE. A quantitative analysis was performed using the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) measures. A qualitative analysis was also performed by two radiologists, who graded seven image characteristics on a 5-point scale (0: non-visualization; 1: poor; 2: average; 3: good; 4: excellent). The observers also evaluated the presence of image artifacts (motion, truncation, flow, indentation). Results: In quantitative analysis, the CNR values of the CSF/SC between TIRM SAG and TIRM SAG BLADE were found to present statistically significant differences (p.

We report a case of transient complete atrioventricular block in a 38-year-old man, after intake of a mixture of herbs, intended to aid cigarette smoking cessation. Since all other causes of conduction disturbances were excluded, a side-effect of the herbal remedy was identified as the most likely diagnosis. Given that most patients are unaware of the potential risks of the intake of various herbs, we would urge that their usage be regulated. Europace