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Static visual representations (VRs) of chemical structures are necessary for an understanding of chemical bonding, a topic which continues to lead to learning difficulties and misconceptions for many students. The efficacy and problems associated with the use of VRs of chemical structures and chemical bonding in the form of electrostatic potential maps resulting from accurate quantum mechanical calculations are the subject of this study, which involved a sample of first year, second semester students, studying the elective course “Science Education” (N = 31). Students distinguished between nonpolar and polar covalent bonding, however, they encountered difficulties with concepts related to ionic bonding. Most students did not employ multistructural thinking (in the sense of the SOLO taxonomy), when providing explanations about the variation of bond polarity. Persistence of a covalent-ionic bond dichotomy was apparent, while for some, ions can be involved in both ionic and covalent bonding. Many students preferred to use their established high school knowledge. On a positive note, many students were clearly affected by the information provided by the colored VRs. Finally, the minimal experience of our students with these VRs leads us to believe that a more systematic and extensive coverage would be likely to produce improved outcomes.

The last three years have seen remarkable progress in comprehending predisposing factors and upgrading our treatment arsenal concerning hepatocellular carcinoma (HCC). Until recently, there were no means to withstand the progression of viral hepatitis-associated liver cirrhosis to HCC. A deeper understanding of the molecular mechanism of the disease, the use of biomarkers, and the follow-up, allowed us to realize that conventional chemotherapy failing to increase survival in patients with advanced HCC tends to be exiled from clinical practice. Multi-kinase inhibitors (TKIs) such as sorafenib, lenvatinib targeting mainly the vascular endothelial growth factor receptors 1–3 VEGFRs 1–3 provided until recently the standard of care for these patients, as first- or second-line treatment. Since May 2020, the atezolizumab plus bevacizumab combination (immunotherapy plus anti-VEGF) has become the new reference standard in first-line HCC treatment. Additionally, anti-programmed cell death protein 1 (anti-PD-1) immunotherapy can be used as a second-line treatment following first-line treatment’s failure. Phase III clinical trials have recently suggested the efficacy of novel anti-angiogenic factors such as cabozantinib and ramucirumab as a second-line treatment option. With considerations about toxicity arising, clinical trials are investigating combinations of the aforementioned targeted therapies with immunotherapy as first-line treatment. This paper aims to perform a systematic review describing the evolving treatment options for HCC over the last decades, ranging from neoadjuvant treatment to systemic therapy of advanced-stage HCC. With the landscape of HCC treatment shifting towards novel agents the forming of a new therapeutic algorithm for HCC seems to be imperative.

AIMS: Although the significance of upper-body posture in relation to piano performance has often been highlighted, the role of experience remains unclear. The aim of this study was to examine selected upper body posture parameters in adolescent piano students of different performance level (beginners vs advanced). METHODS: Thirteen (13) adolescent piano students (14.7±0.5 yrs; 7 beginners and 6 advanced) volunteered. They all performed two specific major scales (G-major and E-major) in five octaves in two predetermined different tempi (slow and fast). An upper body biomechanical model consisting of 27 reflective markers was applied on specific bony landmarks. A 10-T camera Vicon system running Nexus 2 was employed to capture upper body motion—-a) sway of the trunk in relation to the instrument, b) finger/hand sway over the keyboard, c) overall hand movement, and d) spinal angles—-at selected moments of four different performances. RESULTS: Beginners demonstrated more trunk sway than their advanced counterparts (p

Objective To investigate the impact of metabolic status on choroidal thickness (ChT) in healthy subjects, patients with obesity, and type 2 diabetes. Design and Methods Fasting blood glucose, insulin, insulin-like growth factor-1 (IGF-1), and ChT measured by optical coherence tomography were assessed in healthy normal-weight (n=17), obese participants (n=20), and obese participants with T2D (n=16). Results ChT increased in obese participants and obese participants with T2D as compared to healthy normal-weight participants (P0.975). Conclusion ChT is associated with metabolic characteristics, i. e., BMI and HOMA-IR. Due to the key role of choroidal function in retinal physiology, future studies are needed to evaluate whether metabolic traits, ChT, and potential metabolic eye complications are mechanistically linked.

Σκοπός: Διαταραχές των γνωστικών λειτουργιών, συμπεριλαμβανομένης της διαδικασίας ταχείας λήψης απόφασης, έχουν περιγραφεί τόσο στη Σχιζοφρένεια όσο και στη Νόσο του Πάρκινσον. Και οι δύο διαταραχές χαρακτηρίζονται από μειωμένα επίπεδα ντοπαμίνης στον προμετωπιαίο φλοιό. Το ερώτημα που προκύπτει είναι το κατά πόσο τα κοινά ελλείμματα που εμφανίζονται στις δύο διαταραχές οφείλονται σε ένα κοινό νευροφυσιολογικό υπόστρωμα στο Κεντρικό Νευρικό Σύστημα (ΚΝΣ).Μέθοδος: 30 ασθενείς με Σχιζοφρένεια υπό φαρμακευτική αγωγή και 30 υγιείς μάρτυρες αυτών εξομοιωμένοι ως προς το φύλο και την ηλικία καθώς και 24 ασθενείς με Νόσο Πάρκινσον και 28 υγιείς μάρτυρες αυτών εξομοιωμένοι ως προς το φύλο και την ηλικία ολοκλήρωσαν ένα απλό έργο χωρικής προσοχής και λήψης απόφασης μεταξύ δύο επιλογών γνωστό ως “Eriksen Flanker Spatial Attention Τask” με ταυτόχρονη λειτουργική απεικόνιση μαγνητικού συντονισμού (functional Magnetic Resonance Imaging - fMRI). Οι συμπεριφορικοί δείκτες προς ανάλυση περιελάμβαναν την ακρίβεια, τον μέσο χρόνο αντίδρασης (μέσος Χ.Α), την τυπική απόκλιση του χρόνου αντίδρασης (τυπική απόκλιση Χ.Α) καθώς και τις τρεις παραμέτρους του μοντέλου ex-Gaussian (mu, sigma και tau) για τον Χ.Α.Συμπεριφορικά αποτελέσματα: Οι ασθενείς με Σχιζοφρένεια εμφάνισαν υψηλότερους χρόνους αντίδρασης (μέσος Χ.Α και παράμετρος mu) συγκριτικά με την ομάδα ελέγχου. H διαφορά αυτή παρατηρήθηκε ακόμη μεγαλύτερη για τους ασθενείς συγκριτικά με τους υγιείς μάρτυρες στις δύσκολες συγκριτικά με τις εύκολες δοκιμές του έργου επιβεβαιώνοντας την ύπαρξη ελλείμματος στη λειτουργία χωρικής προσοχής στη Σχιζοφρένεια. Επιπλέον, παρατηρήθηκε στατιστικά σημαντικά αυξημένη ενδο-ατομική διακύμανση (τυπική απόκλιση του Χ.Α και παράμετροι sigma και tau) για τους ασθενείς χωρίς στατιστικά σημαντική επίδραση του τύπου της δοκιμής στους δείκτες αυτούς. Σε αντίθεση με τη Σχιζοφρένεια, οι ασθενείς με Νόσο Πάρκινσον δεν παρουσίασαν στατιστικά σημαντικές διαφορές από την αντίστοιχη ομάδα ελέγχου σε κανέναν από τους υπό μελέτη συμπεριφορικούς δείκτες (ακρίβεια, μέσος Χ.Α, τυπική απόκλιση Χ.Α, παράμετροι mu, sigma και tau). Η απευθείας σύγκριση από τους υγιείς μάρτυρες με τη χρήση τιμών z (z-scores) επιβεβαίωσε τις στατιστικά σημαντικές διαφορές μεταξύ των ασθενών με Σχιζοφρένεια και Νόσο Πάρκινσον.Νευροαπεικονιστικά αποτελέσματα: Οι δύσκολες δοκιμές (επίδραση τύπου δοκιμής) οδήγησαν στην ενεργοποίηση μετωπιαίων και βρεγματικών -δεξιών κυρίως- φλοιωδών περιοχών στους ασθενείς με Πάρκινσον και στην αντίστοιχη ομάδα ελέγχου. Μια πιο εκτεταμένη αμφίπλευρη ενεργοποίηση μετωπιαίων και βρεγματικών περιοχών παρατηρήθηκε για τους ασθενείς με Σχιζοφρένεια και τους υγιείς μάρτυρες αυτών στις δύσκολες συγκριτικά με τις εύκολες δοκιμές (επίδραση τύπου δοκιμής). Ενδιαφέρον παρουσιάζει το γεγονός ότι οι ασθενείς με Σχιζοφρένεια ενεργοποίησαν λιγότερο κάποιες συγκεκριμένες φλοιώδεις περιοχές συγκριτικά με την ομάδα ελέγχου ανεξάρτητα από τον τύπο της δοκιμής (εύκολη ή δύσκολη). Δεν παρατηρήθηκαν αντίστοιχα ευρήματα διαφορών στην εγκεφαλική ενεργοποίηση των ασθενών με Πάρκινσον συγκριτικά με την αντίστοιχη ομάδα ελέγχου. Επιπλέον, η υπο-ενεργοποίηση ιδιαίτερα της περιοχής του ραχιαίου προμετωπιαίου φλοιού στους ασθενείς με Σχιζοφρένεια συγκριτικά με την ομάδα ελέγχου βρέθηκε να σχετίζεται με μεγαλύτερη διακύμανση στους Χ.Α (κυρίως με την παράμετρο tau). Δεν παρατηρήθηκε αντίστοιχη συσχέτιση μεταξύ συμπεριφορικών δεικτών και εγκεφαλικής ενεργοποίησης στους ασθενείς με Πάρκινσον. Η απευθείας σύγκριση των αποκλίσεων ενεργοποίησης από τους υγιείς μάρτυρες με τη χρήση τιμών z επιβεβαίωσε την ύπαρξη στατιστικά σημαντικών διαφορών στην ενεργοποίηση προμετωπιαίων και φλοιωδών εγκεφαλικών περιοχών μεταξύ των ασθενών με Σχιζοφρένεια και Νόσο Πάρκινσον. Συμπεράσματα: Τόσο τα συμπεριφορικά όσο και τα νευροαπεικονιστικά αποτελέσματα υποδηλώνουν αύξηση του Χ.Α και της ενδο-ατομικής μεταβλητότητας αυτού στη διαδικασία ταχείας λήψης απόφασης καθώς και σχετική με την αύξηση της ενδο-ατομικής μεταβλητότητας του Χ.Α υπο-ενεργοποίηση του προμετωπιαίου φλοιού στη Σχιζοφρένεια. Η αντίστοιχη λειτουργία στη Νόσο του Πάρκινσον φαίνεται γενικά άθεικτη. Τα ευρήματα αυτά δεν επιβεβαιώνουν την υπόθεση για ένα κοινό υπόστρωμα γνωστικών ελλειμμάτων και εγκεφαλικής δυσλειτουργίας στη Σχιζοφρένεια και τη Νόσο Πάρκινσον.

Purpose\ud The objective of this paper is to undertake an in-depth exploration of how structural characteristics of on-farm demonstration events impact the effectiveness of the demonstration as perceived by participants.\ud \ud Methodology\ud An explanatory mixed-methods approach was used based on the responses to 356 post-demonstration questionnaires filled out by the attendees of 31 demonstration events held in 12 EU countries in 2018, together with the qualitative data from an observation tool, interviews and case study reports relating to the same 31 events. Factor analysis was employed to predict general effectiveness, complemented with a qualitative analysis of participants’ responses to improve the understanding of the quantitative results.\ud \ud Findings\ud Results indicate that peer-to-peer learning activities and good facilitation increase participants’ perception of the effectiveness of a demonstration event. Furthermore, characteristics such as the structure of the day, the suitability of the host farm, a trustworthy demonstrator, and group size add much to the effectiveness of a demo event. Group dynamics – including group connectedness and composition – have the potential to impact perceived effectiveness.\ud \ud Practical implications\ud The paper contains clear messages for practitioners when designing a demonstration event.\ud \ud Theoretical implications\ud Our results connect with theories on motivation and adult learning in the context of farmer learning during on-farm demonstration.\ud \ud Originality\ud The paper is based on a rich empirical dataset. It reveals that group size and learning methods are crucial to achieve effective learning outcomes during demonstration events.

The paper aims to examine interactions between demonstrations at programme level and Agricultural Advisory Services (AAS). It situates analysis of the demonstration programme activities within contemporary advisory contexts, asking: how do demonstration programmes interact with the AAS in which they are situated; and what role do demonstration programmes play in enhancing and contributing to the AAS?

Purpose: The paper focuses on exploring the influence of structural\ud and functional characteristics of demonstrations on their\ud effectiveness.\ud Design/Methodology: In the framework of AgriDemo-F2F project,\ud we analysed the responses to 345 post-demonstration\ud questionnaires filled out by the attendees of 31 demo events\ud held in 12 EU countries. Factor analysis was employed and on a\ud subsequent step a linear regression to predict general effectiveness.\ud Findings: Results indicate that the very first steps in the\ud organisation of on-farm demonstration are of critical importance\ud for the successful delivery of their objectives, particularly\ud decisions relating to relevance to farmers’ needs and the\ud structure of the event. Moreover, the paper offers first evidence\ud that when/if on-farm demonstrations are appropriately structured\ud and delivered they can meet their objectives regardless of the\ud status and strength of the corresponding AKIS.\ud Practical implications: Demonstration organisers should take\ud special care with regard to the relevance of the topic and the group\ud (demonstrator and attendees) as well as of the structure of the event.\ud Theoretical implications: The various elements influencing the\ud success of on-farm demonstrations are examined together and\ud ranked.\ud Originality/Value: The study generates important (theoretical and\ud practical) insights concerning the success of a widely used\ud technique of advisory/extension services, that is on-farm\ud demonstrations, based on a large data-set from demonstration\ud events through out Europe.

Στόχος; Στόχος της διατριβής ήταν αρχικά να καταγραφεί και να μελετηθεί ο τρόπος παρουσίασης των χημικών δεσμών από πανεπιστημιακά βιβλία Γενικής Χημείας αλλά και εγχειρίδια Χημείας δευτεροβάθμιας εκπαίδευσης. Στη συνέχεια να παρουσιαστεί ο τρόπος σύνδεσης της γνώσης σε βιβλία Χημείας και οι δομές οργάνωσης της γνώσης που χρησιμοποιούνται. Έπειτα να καταγράψει σε τι βαθμό οι ερωτήσεις των πανεπιστημιακών εγχειριδίων Γενικής Χημείας, αξιολογούν διάφορα είδη γνώσεων και δεξιοτήτων συμπεριλαμβανομένης και της μεταγνώσης, ποιες νοητικές διεργασίες πρέπει να ακολουθήσει ο φοιτητής έτσι ώστε να απαντήσει και να συγκρίνει τα βιβλία αυτά ως προς τα είδη των ερωτήσεών τους και τον σκοπό που επιτυγχάνουν. Τέλος πραγματοποιήθηκε έρευνα και διδακτική παρέμβαση με σκοπό τον εντοπισμό δυσκολιών κατανόησης των μαθητών και φοιτητών στο κεφάλαιο του χημικού δεσμού. Μέθοδος;Στο πρώτο στάδιο η αξιολόγηση περιελάμβανε τα παρακάτω στάδια: α. Περιγραφή και μελέτη του τρόπου παρουσίασης του Χημικού δεσμού για κάθε βιβλίο ξεχωριστά και β. σύγκριση συνολικά όλων των βιβλίων μαζί, ως προς τον τρόπο παρουσίασης συγκεκριμένων χαρακτηριστικών. Στη συνέχεια πραγματοποιήθηκε αναγνώριση, ανάλυση και κατηγοριοποίηση βασικών στοιχείων αλλά και των συνδέσμων που σχετίζουν τα βασικά αυτά στοιχεία. Τέλος η οργάνωση της γνώσης των βιβλίων παρουσιάστηκε, χρησιμοποιώντας χάρτες εννοιών και ταξινομώντας την ποιοτικά με βάση εξωτερικά χαρακτηριστικά αναδεικνύοντας έτσι τις θεμελιώδεις διαφορές στις δομές της. Το εργαλείο αξιολόγησης των ερωτήσεων που χρησιμοποιήθηκε, κατέγραψε το είδος της γνώσης που απαιτούσε η ερώτηση αλλά και την νοητική διεργασία που έπρεπε να ακολουθήσει ο μαθητής έτσι ώστε να δώσει την απάντηση. Η ερευνητική διαδικασία πραγματοποιήθηκε σε δύο κύκλους. Στον α ΄ κύκλο, αφού οι εκπαιδευτικοί ολοκλήρωσαν την διδασκαλία τους, δόθηκαν ερωτηματολόγια τα οποία συμπληρώθηκαν από τους εκπαιδευόμενους. Στον β ΄ κύκλο, πραγματοποιήθηκε παρέμβαση σε δύο σχολεία της Δ.Ε. Κάθε σχολείο είχε μία ομάδα ελέγχου στην οποία διδάχτηκε το κεφάλαιο του χημικού δεσμού αποκλειστικά χρησιμοποιώντας το σχολικό βιβλίο και μία πειραματικά ομάδα, στην οποία ο χημικός δεσμός και τα είδη του διδάχτηκαν αποκλειστικά από πρότυπη διδακτική παρέμβαση, η οποία δόθηκε στους εκπαιδευτικούς. Στη συνέχεια, συμπληρώθηκαν τα ίδια ερωτηματολόγια με τον α ΄ κύκλο και από τις δύο ομάδες. Αποτελέσματα;Τα περισσότερα βιβλία μελετούν τον ιοντικό δεσμό πρώτο, αναφέρουν τους διαμοριακούς δεσμούς ως δυνάμεις και συνδέουν τις έννοιες ηλεκτραρνητικότητα, και πολικότητα με τον ομοιοπολικό δεσμό ενώ δυνάμεις Coulomb και κανόνα οκτάδας με τον ιοντικό δεσμό. Ενώ όλα τα βιβλία χρησιμοποίησαν τα ίδια βασικά στοιχεία, οι δομές οργάνωσης της γνώσης ήταν τελείως διαφορετικές και κυριάρχησαν οι σύνδεσμοι των περιγραφικών μοντέλων. Η πλειοψηφία των ερωτήσεων στα βιβλία αξιολογούσε δηλωτική γνώση βασικού επιπέδου, ενώ παρατηρήθηκε η πλήρης απουσία μεταγνωστικών και ομαδικών ερωτήσεων. Τέλος εντοπίστηκαν δυσκολίες στην κατανόηση βασικών χημικών εννοιών που χρησιμοποιούνται στην μελέτη του χημικού δεσμού, όπως είναι η ηλεκτραρνητικότητα, οι δομές Lewis, ο κανόνας της οκτάδας, οι δυνάμεις Coulomb, η πολικότητα κ.ά., από μαθητές α΄ τάξης λυκείου αλλά και πρωτοετείς φοιτητές. Η διδακτική παρέμβαση βελτίωσε αρκετά τον αριθμό των σωστών απαντήσεων αλλά και το επίπεδό τους με βάση τη μέθοδο Solo.

Background: Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) is associated with hypercholesterolemia and atherosclerotic disease while its inhibition reduces cardiovascular risk. There is some evidence that serum PCSK9 concentrations are higher in patients with acute coronary syndromes compared with those with stable coronary artery disease, which has been attributed to a proatherogenic and prothrombotic state. Objective: This case-control pilot study investigated potential associations of PCSK9 in patients with transient ischemic attack (TIA). Methods: A total of 20 patients with a first-ever atherosclerotic non-cardioembolic TIA and 20 controls of similar age and sex were enrolled. Clinical characteristics, metabolic parameters, including serum PCSK9 within 24 hours from the onset of TIA symptoms were recorded. Results: The serum PCSK9 concentration was higher in TIA patients vs. controls (mean values, 248 ng/mL vs. 196 ng/mL, p = 0.02). In patients with TIA, serum PCSK9 correlated with age (r=0.603, p=0.03), history of coronary artery disease (r=0.515, p=0.020) and ABCD2 score (Age, Blood pressure, Clinical features, symptom Duration, Diabetes – a future stroke prediction tool) (r=0.512, p=0.021). In multivariate analysis, serum PCSK9 was independently associated with higher odds of TIA (1.16 per 10 ng/mL increase, 95% CI 1.01-1.34, p=0.035). Conclusions: Our findings indicate that serum PCSK9 levels are independently associated with atherosclerotic TIA and the risk of future stroke. Further investigation is needed to confirm these findings or to assess the use of PCSK9 as a target for early treatment as well as for secondary stroke prevention.

Low-density lipoprotein cholesterol targets may not be achieved by statin monotherapy, especially in high-risk patients. Furthermore, in some patient subgroups, atherogenic dyslipidemia is observed. As a result, a combination of a statin with other hypolipidemic drugs may have additional benefits, especially in the form of a single tablet. The aim of this review is to present the novel fixed-dose drug combinations for the management of hyperlipidemia. Statins, ezetimibe, and fibrates have established their efficacy and safety in the treatment of hypercholesterolemia and hypertriglyceridemia. Clinical trials have shown that these hypolipidemic drug classes can be safely combined in order to augment the lipid-lowering efficacy. Furthermore, novel hypolipidemic drugs such as bembedoic acid and berberine have shown some promising initial results. The combination of different hypolipidemic regimens in a fixed-dose formulation can enhance the adherence to hypolipidemic treatment leading to improved outcomes. Moreover, complementary mechanisms of action of the combined hypolipidemic drugs may also provide additional benefits such as improvement in carbohydrate metabolism. As a result, fixed-dose combinations of hypolipidemic agents may provide an attractive option for the effective and safe management of hypercholesterolemia.

Administration of insulin degludec and liraglutide (IDegLira) correlates to fasting lipid profile changes of diabetic patients, while data concerning apoB-containing lipoprotein subclasses and HDL lipidome are scarce. We evaluated its effect on fasting lipid parameters, apolipoproteins, apoB-containing lipoprotein subclasses and HDL lipidome in patients with type 2 diabetes.Sixty three patients with HbA1c 7 % on oral glucose-lowering drugs received either IDegLira or insulin degludec for 3 months. Lipoprotein subfraction profile was determined through Lipoprint method, whereas HDL lipid composition viaCompared to insulin degludec, IDegLira administration resulted in significantly greater reduction of total and LDL-cholesterol. On the other hand, the effect of the two drugs on apolipoprotein-B-containing lipoprotein subfractions concentration was minimal and did not differ between the 2 interventions. IDegLira, but not insulin degludec, induced an atheroprotective shift in HDL's fatty acid composition and particle core depletion in triglycerides.IDegLira administration is accompanied by total and LDL-cholesterol reduction, while sdLDL concentration only reduced in patients experiencing triglyceride reduction. IDegLira induced compositional changes of HDL particles. These changes may contribute to the cardioprotective properties of liraglutide.

Aim: To compare the effect of fixed-dose combination of Insulin Degludec and Liraglutide (IDegLira) on anthropometric, carbohydrate metabolism and lipid parameters, as well as on apoB-containing lipoprotein subclasses and HDL lipidome, in patients with type 2 diabetes (T2DM) regarding changes in triglyceride (TG) levels. Methods: Seventy-two uncontrolled patients with T2DM on oral antidiabetics were randomized to receive IDegLira or Insulin Degludec (IDeg) for a 12-week treatment. In the present study, 42 patients receiving IDegLira were included. Twenty-one presented a decrease, while the remaining an increase in TG levels. ApoB-containing lipoprotein subclasses levels were measured by LDL-Lipoprint method, whereas HDL lipidomic analysis via 1H-NMR spectroscopy. Results: In patients experiencing a decrease in TG levels after IDegLira administration, a significant decrease in body weight and BMI, by 4.4kg and 1.59kg/m2 respectively, was observed. Fasting glucose, HbA1c and HbA1c Glycation Index noted a decrease by 35 mg/dl, 1.4% and 1.1 respectively (p=0.018, p=0.004, p=0.004). IDegLira administration in this subgroup resulted in a significant reduction of total (TC) and LDL cholesterol (LDLC) by 22.5mg/dl and 13.2mg/dl, respectively. Small-dense LDLC (sdLDLC) levels significantly correlated with changes in TG levels (r=0.496, p=0.02). Furthermore, IDegLira administration resulted in significant enrichment of HDL particle core in esterified cholesterol, depletion of TG content and an atheroprotective shift in fatty acid pattern of HDLs. The aforementioned changes were significantly greater than those observed in patients receiving IDegLira and did not experience a TG reduction. Conclusions: TG reduction as a result of IDegLira administration is accompanied by greater changes in anthropometric and carbohydrate metabolism parameters, TC, LDLC, sdLDLC and HDL lipidome. Disclosure E. Pappa: None. C. Kostara: None. A. Dimou: None. E. T. Bairaktari: None. V. Tsimihodimos: None.

The reconstruction of the hip joint in patients suffering from developmental hip dysplasia (DDH) is a demanding procedure and presents many challenges to the reconstructive surgeon. Higher rates of mechanical complications are present in this group of patients. The results of cemented and uncemented implants used in DDH patients are very promising, according to recent outcomes. However, the surgeon has to be aware of several complications, in order to establish an uneventful surgical management of DDH. The specific article investigates the technical challenges and clinical results of total hip arthroplasty in patients with DDH.

Introduction Monitoring the progress of fracture healing is essential in order to establish the appropriate timing that ensures adequate bone strength for weight-bearing. In the present experimental study on a rat model of femoral fracture healing, the measurement of bone density and strength by peripheral quantitative computerized tomography (pQCT) was correlated with the modal damping factor (MDF) method. Methods Four groups of 12 male six-month-old Wistar rats each were anesthetized and submitted to baseline femoral pQCT and MDF scanning, followed by aseptic midshaft osteotomy of the right femur which was fixed by a locking intramedullary nail technique. The animals were left to recover and re-scanned following euthanasia of each group after six, eight, 10, and 12 weeks, respectively. The parameters measured by the pQCT method were total bone mineral density (BMD) and polar strength strain index (SSIp). Results Fracture healing progressed over time and at 12 weeks post-osteotomy there was no statistically significant difference between the osteotomized right and the control left femurs regarding MDF, BMD, and SSIp measurements. The highest correlations for the osteotomized femurs were observed between MDF and BMD (r = -0.647, P = 0.043), and between MDF and SSIp (r = -0.350, P = 0.321), at 10 weeks postoperatively. The high to moderate correlations between MDF and BMD, and between MDF and SSIp respectively, support the validity of MDF in assessing fracture healing. Conclusions Based on our findings in this fracture healing animal model, the results from the MDF method are reliable and correlate highly with the total BMD and moderately with the SSI polar values obtained by the pQCT method of bone quality measurement. Further studies are needed which may additionally support that the MDF method can be an attractive portable alternative to monitor fracture healing in the community.

Context Inhibitors of sodium-glucose cotransporters-2 have cardio- and renoprotective properties. However, the underlying mechanisms remain indeterminate. Objective To evaluate the effect of dapagliflozin on renal metabolism assessed by urine metabolome analysis in patients with type 2 diabetes. Design Prospective cohort study. Setting Outpatient diabetes clinic of a tertiary academic center. Patients Eighty patients with hemoglobin A1c > 7% on metformin monotherapy were prospectively enrolled. Intervention Fifty patients were treated with dapagliflozin for 3 months. To exclude that the changes observed in urine metabolome were merely the result of the improvement in glycemia, 30 patients treated with insulin degludec were used for comparison. Main Outcome Measure Changes in urine metabolic profile before and after the administration of dapagliflozin and insulin degludec were assessed by proton-nuclear magnetic resonance spectroscopy. Results In multivariate analysis urine metabolome was significantly altered by dapagliflozin (R2X = 0.819, R2Y = 0.627, Q2Y = 0.362, and coefficient of variation analysis of variance, P Conclusions Dapagliflozin significantly affects urine metabolome in patients with type 2 diabetes in a glucose lowering-independent way. Most of the observed changes can be considered beneficial and may contribute to the renoprotective properties of dapagliflozin.

Aim: Administration of fixed-dose combination of Insulin Degludec and Liraglutide (IDegLira) has been associated with changes in the lipid-profile of diabetic patients. We assessed the effect of IDegLira on serum apolipoproteins, apoB-containing lipoprotein subclasses and HDL lipidome in patients with type 2 diabetes mellitus (T2DM). Methods: Sixty uncontrolled patients with T2DM on oral antidiabetic drugs were included. Of them, thirty received IDegLira and the remaining Insulin Degludec(IDeg). Lipid and carbohydrate metabolism parameters were assessed before and following 3-month-treatment. ApoB-containing lipoprotein subclasses levels were measured by LDL-Lipoprint method, whereas HDL lipidomic analysis via 1H-NMR spectroscopy. Results: Administration of IDegLira resulted in a significant reduction of total (TC) and LDL cholesterol (LDLC) by 14.68mg/dl and 10.45mg/dl, respectively. ApoA1 and apoB decreased in patients treated with IDegLira. A non-significant change in small-dense LDLC (sdLDL-C) levels was observed that was significantly correlated with changes in TG levels (r=0.468, p=0.007). Furthermore, IDegLira administration resulted in significant enrichment of HDL particles’ core in esterified cholesterol and depletion of TGs content. IDegLira induced an atheroprotective shift in fatty acid pattern of HDLs characterized by a statistically significant lower content in saturated and higher in unsaturated fatty acids (linoleic acid, eicosapentaenoic and arachidonic acids and docosahexaenoic acid). No significant changes were observed in the IDeg group. Conclusions: Administration of IDegLira is accompanied by changes in HDL lipdome, a decrease in TC, LDLC, apoA1 and B, while the levels of sdLDL were only reduced in patients experiencing a decrease in TGs. The contribution of these changes to cardiovascular risk reduction after treatment with liraglutide in clinical trials cannot be excluded. Disclosure E. Pappa: None. C. Kostara: None. C. Tellis: None. A.D. Tselepis: None. E. Bairaktari: None. V. Tsimihodimos: None.

Perioperative blood management is essential to minimize allogeneic blood transfusion in total knee replacement. The effect of preoperative administration of erythropoietin, intraoperative cell saver, tranexamic acid, and restrictive transfusion strategies on allogeneic transfusion is studied in total knee replacement. A retrospective comparative study of 106 patients who underwent total knee replacement in different time periods was performed. Group A (n 1 = 45) underwent restrictive strategies of transfusion between 2009 and 2010. Group B (n 2 = 24) includes patients where erythropoietin of either 10.000 IU or 20.000 IU was given preoperatively. Patients of Group C (n 3 = 21) underwent autologous washed erythrocytes transfusion through a cell saver. Lastly, in Group D (n 4 = 15) tranexamic acid dose of 1 gr IV was given intraoperatively. The preoperative and discharge hemoglobin together with total units of blood transfusion and creatinine levels was studied. Tranexamic acid noted the least units of blood transfusion (mean = 0.82 units/patient, p

Increased reaction time (RT) and variability of RT in fast decision tasks is observed in patients with schizophrenia and their first degree relatives. This study used modelling of the RT distribution with the aim of identifying novel candidate endophenotypes for schizophrenia. 20 patients with schizophrenia, 15 siblings of patients and 25 healthy controls performed an oddball task of varying working memory load. Increases in mean and standard deviation (SD) of RT were observed for both patients and siblings compared to controls and they were again independent of working memory load. Ex-Gaussian modelling of the RT distribution confirmed that parameters μ, σ and τ increased significantly in patients and siblings compared to controls. The Drift Diffusion Model was applied on RT distributions. A decrease in the diffusion drift rate (v) modeling the accumulation of evidence for reaching the decision to choose one stimulus over the other, was observed in patients and siblings compared to controls. The mean time of the non-decisional sensorimotor processes (t0) and it's variance (st0) was also increased in patients and siblings compared to controls. In conclusion modeling of the RT distribution revealed novel potential cognitive endophenotypes in the quest of heritable risk factors for schizophrenia.

Chemical bonding is a fundamental but complex topic, which has traditionally been associated with learning difficulties, misunderstandings, and misconceptions. This paper reviews some previous studies, concerning students’ conceptual difficulties and reports the findings from a research study with Greek students, which set out to examine their knowledge and understanding of a number of key concepts related to bonding. Three student samples were studied; one consisted of tenth-grade students from three public schools, the second contained first-year chemistry and biology students at the beginning of their university courses, and the third involved tenth-grade students from a prestigious private school. The students generally exhibited limited knowledge and possessed certain misconceptions, with the private school and the university students demonstrating better knowledge than the public school students. A quasi-experimental research design was employed using students from the private school, with some students used as a control group and others as a treatment group. The control group was taught using the standard Greek chemistry textbook, while the treatment group used enriched teaching material. It was found that while the two groups demonstrated similar performance for many bonding concepts, the treatment group did show superior knowledge with respect to a number of issues, such as the role of electrostatic interactions, electronegativity, and bond polarity.

The present case is unique in that the fracture of the posteromedial talar tubercule involved the tibiotalar rather than the subtalar joint as described in existing reports, which underlines the need for acute management by the Orthopaedic Surgeon, The present case is unique in that the fracture of the posteromedial talar tubercule involved the tibiotalar rather than the subtalar joint as described in existing reports, which underlines the need for acute management by the Orthopaedic Surgeon.

In a preceding publication (Tsaparlis, G., Pappa, E. T., & Byers, B. (2018). Teaching and learning chemical bonding: Research-based evidence for misconceptions and conceptual difficulties experienced by students in upper secondary schools and the effect of an enriched text. Chemistry Education Research and Practice, 19(4), 1253–1269), we reviewed previous studies on students’ misconceptions and conceptual difficulties with the topic of chemical bonding and tested the knowledge of tenth-grade Greek students on certain key aspects of bonding. In addition, we presented an enriched teaching text on this topic for the tenth grade and examined its effectiveness with regard to the same aspects of bonding. In the present study, we review earlier studies, which made proposals concerning the teaching of this topic, and provide some proposals of our own, based on the findings of our previous study. We recommend that a spiral curriculum spanning all three upper-secondary grades should be adopted. A learning progressions approach, employing lower and upper anchors of relevant scientific knowledge is considered, and a proposed list of potential core concepts, lever concepts, and stepping-stones are presented. Finally, the pros and cons of a modern qualitative quantum mechanical approach to bonding are considered.

The present article reviews data from biomechanical and clinical studies which indicate that rotational instability can cause failure of fixation due to the particular characteristics of the fracture, the mechanical properties of the chosen implant or flaws in surgical technique. Although radiographs give a similar impression in failure of fractures fixed with cephalomedullary nails, different mechanisms involving rotation of the femoral head may play a key role. The incidence of failure in pertrochanteric fracture fixation is decreasing as implants continue to evolve. It is possible that currently reported low failure rates do not apply equally to all subtypes of this diverse group of fractures. Since the introduction of sliding hip screws, “cut-out” due to varus collapse of the proximal fracture fragment has been the only reported mode of failure. Excessive rotation leading to eventual “cut-out” has not been adequately studied, and thus, available evidence is not sufficient to definitely prove this theoretical approach. As nailing is gradually overtaking extramedullary fixation as the treatment of choice, especially for comminuted pertrochanteric fractures which can be rotationally unstable, further research is warranted to improve our understanding of the pathogenetic mechanisms of failure.

Objectives To perform a comparative analysis on the impact of Type 2 Diabetes Mellitus (DM) on in-hospital hyperglycemia, length of stay (LOS) and survival of patients suffering from brain tumor who receive dexamethasone. Patients and Methods Patients with brain tumor hospitalized in a Neurosurgery department between 2011 and 2018, were studied. Data referring to medical history, clinical characteristics and in-hospital survival was collected and analyzed. Morning plasma glucose levels (PGL) were obtained for seven consecutive days after the start of dexamethasone. Results Fifty-six patients were identified. Of them, 21 (37.5%) were diabetic. During dexamethasone administration, a difference in morning PGL values during different days was noted (p = 0.003). No difference in glucose levels among different glucocorticoid doses was seen. DM was associated with higher average PGL (aMPGL), calculated as the mean of morning PGL values for the last six days (p = 0.001) and with higher rates of persistent hyperglycemia (p = 0.002). The change of aMPGL from the morning PGL value of day one did not differ between the two cohorts (p = 0.729). DM neither affected LOS nor in-hospital survival (p = 0.745 & p = 0.438, respectively). Conclusion Although morning glucose values were higher in diabetic, compared to non-diabetic patients, their change from day one was similar between the two cohorts. LOS and in-hospital survival were not affected by DM.

The aim of the article is to present the medium-term results of surgical treatment of Schatzker's IV, V, and VI tibial plateau fractures, in a retrospective study of 22 patients at a level-1 trauma center. Twenty-two of 34 patients with Schatzker's IV–VI fractures completed follow-up at a mean of 56 months (range: 7–103 months). Patients' mean age was 47.6 years (range: 18–76 years). Open reduction and internal fixation were performed in 16 patients, while external fixators were used in the remaining six patents. Patients were assessed radiologically for the presence of arthritis using the Kellgren–Lawrence scale. Functional outcomes were measured using the Lysholm's knee score, knee injury, and osteoarthritis outcome score (KOOS). Quality of life was also assessed postoperatively using the EuroQol-5D (EQ-5D) form and EQ-VAS (visual analogue scale) score. There were no postoperative infections and no fracture went on to nonunion. Absence of arthritic change was noted in only 6.3% of cases. The average KOOS score was 80 and the average Lysholm's score was 84.91. Regarding the postoperative quality of life, mobility was impaired in 45.5%, self-care in 27.3%, and usual activities in 36.3% of patients. Pain or discomfort was reported in 77.2% and anxiety or depression in 40.9% of cases. The mean VAS score was 77.8. Eighty percent of patients had returned to their previous activities at the time of last follow-up. Although complex tibial plateau fractures are associated with a high rate of complications and can have a severe impact on the injured knee, most patients had quite satisfactory results during their medium-term clinical evaluation, in our study. It is a Level IV case series study.

Increased reaction time intra-subject variability (RT-ISV) in fast decision tasks has been confirmed in patients with schizophrenia and has been hypothesized to result from a deficit in the control of attention. Here, an attentional task and functional brain imaging were used to probe the neural correlates of increased RT-ISV in schizophrenia.Thirty patients and 30 age and sex matched controls performed the Eriksen flanker spatial attention task with concurrent measurement of brain activity using functional magnetic resonance imaging (fMRI). The behavioral measures included accuracy, mean, standard deviation of RT (RTSD), coefficient of variation of RT (RTCV) and ex-Gaussian model of RT distribution parameters (mu, sigma and tau).Larger mean RT and Ex-Gaussian mu was observed for patients compared to controls. The group difference was larger for incongruent (attentionally demanding) versus congruent trials confirming a deficit in the control of spatial attention for patients. Significant increase in RT-ISV measures (RTSD, sigma and tau) for patients compared to controls was observed and was not modulated by trial congruency. Attention modulation (congruency effect) resulted in activation of bilateral frontal and parietal areas that was not different between patients and controls. Right middle frontal, right superior temporal and bilateral cingulate areas were more active in controls compared to patients independent of congruency. Activation in ROIs extracted from attention (congruency) and group related areas correlated with RT-ISV measures (especially RTCV and tau). Hypo-activation of the right middle frontal area correlated with increased tau specifically in patients.Hypo-activity of the right prefrontal cortex predicted increased RT-ISV in schizophrenia. This effect was unrelated to the effects of spatial attention and might be linked to a deficit in the inhibitory control of action for these patients. Keywords: fMRI, Attention, Prefrontal cortex, Reaction time, Intra-subject variability, Psychosis