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Objectives: The coronavirus disease 2019 (COVID-19) outbreak, along with implementation of lockdown and strict public movement restrictions, in Greece has affected hospital visits and admissions. We aimed to investigate trends of cardiac disease admissions during the outbreak of the pandemic and possible associations with the applied restrictive measures. Study design: This is a retrospective observational study. Methods: Data for 4970 patients admitted via the cardiology emergency department (ED) across 3 large-volume urban hospitals in Athens and 2 regional/rural hospitals from February 3, 2020, up to April 12 were recorded. Data from the equivalent (for the COVID-19 outbreak) time period of 2019 and from the postlockdown time period were also collected. Results: A falling trend of cardiology ED visits and hospital admissions was observed starting from the week when the restrictive measures due to COVID-19 were implemented. Compared with the pre–COVID-19 outbreak time period, acute coronary syndrome (ACS) [145 (29/week) vs. 60 (12/week), −59%, P < 0.001], ST elevation myocardial infarction [46 (9.2/week) vs. 21 (4.2/week), −54%, P = 0.002], and non-ST elevation ACS [99 cases (19.8/week) vs. 39 (7.8/week), −60% P < 0.001] were reduced at the COVID-19 outbreak time period. Reductions were also noted for heart failure worsening and arrhythmias. The ED visits in the postlockdown period were significantly higher than in the COVID-19 outbreak time period (1511 vs 660; P < 0.05). Conclusion: Our data show significant drops in cardiology visits and admissions during the COVID-19 outbreak time period. Whether this results from restrictive measures or depicts a true reduction of cardiac disease cases warrants further investigation. © 2020 The Royal Society for Public Health

Chromium has been proven to be extremely phytotoxic. This study explored the impacts of increasing Cr(VI) exposure (up to 10 mg L−1 K2Cr2O7) on the growth and development of alfalfa plants and adaptation responses employed, in an environmentally relevant context. The threshold concentration of K2Cr2O7 in irrigation water beyond which stress responses are initiated is 1 mg L−1. Lower Cr(VI) exposure (0.5 mg L−1 K2Cr2O7) induced hormesis, evident through increased biomass and larger leaves, likely mediated by increased NO content (supported by elevated NR enzymatic activity and overexpression of NR and ndh genes). Elevated Cr(VI) exposure (5 and 10 mg L−1 K2Cr2O7) resulted in reduced biomass and smaller leaves, and lower levels of photosynthetic pigment (10 mg L−1 K2Cr2O7). Higher levels of lipid peroxidation, H2O2 and NO contents in these plants suggested nitro-oxidative stress. Stress responses included increased SOD and CAT enzymatic activities, further supported to some extent by MnSOD, FeSOD, Cu/ZnSOD and CAT transcripts levels. GST7 and GST17 gene expression patterns, as well as proline content, P5CS enzymatic activity and corresponding P5CS and P5CR gene expression levels emphasized the role of proline and GSTs in the adaptation responses. Results highlight the importance of managing Cr(VI) levels in irrigation water. © 2020 Elsevier Ltd

Pharmaceutically active compounds (PhACs) have been recently shown to exert phytotoxic effects. The present study explores the uptake, systemic translocation, and abiotic stress responses and detoxification mechanisms induced by the exposure of alfalfa plants grown in sand under greenhouse conditions to four common, individually applied PhACs (10μgL−1) (diclofenac, sulfamethoxazole, trimethoprim, 17a-ethinylestradiol) and their mixture. Stress physiology markers (lipid peroxidation, proline, H2O2 and NO content, antioxidant activity assays) and gene expression levels of key plant detoxification components (including glutathione S-transferases, GST7, GST17 superoxide dismutases, CuZnSOD, FeSOD proton pump, H+-ATP, and cytochrome c oxidase, CytcOx), were evaluated. PhACs were detected in significantly higher concentrations in roots compared with leaves. Stress related effects, manifested via membrane lipid peroxidation and oxidative burst, were local (roots) rather than systemic (leaves), and exacerbated when the tested PhACs were applied in mixture. Systemic accumulation of H2O2 in leaves suggests its involvement in signal transduction and detoxification responses. Increased antioxidant enzymatic activities, as well as upregulated transcript levels of GST7, GST17, H+-ATPase and CytcOx, propose their role in the detoxification of the selected PhACs in plants. The current findings provide novel biochemical and molecular evidence highlighting the studied PhACs as an emerging abiotic stress factor, and point the need for further research on wastewater flows under natural agricultural environments. •PhACs were detected in higher concentrations in roots compared with leaves.•Stress effects were local and exacerbated when PhACs were applied in mixture.•H2O2 may be involved in signal transduction and detoxification responses.•GSTs, H+-ATPase and CytcOx contribute to the detoxification of PhACs in plants.•Results render studied PhACs as an emerging abiotic stress factor. 557-558 652 664

Schizophrenia is one of the most disabling disorders globally, with a significant impact on the professional, social and personal functioning of those affected. Mortality rates are estimated to be 2-2.5 times greater than in the general population attributable to not only suicide but also physical illnesses, such as cardiovascular, metabolic and infectious diseases. Patients with schizophrenia have increased needs for health services which vary according to the stage of the illness and the way the disorder affects the patient. A significant part of the costs of treating patients with schizophrenia is attributed to the health service costs, both to address the disorder itself and its wider effects. In 2015 the National Clinical Guidelines for the management of schizophrenia were formulated by a Working Group that was set up by the Greek Ministry of Health. In this article, a summary of the recommendations (as included in the National Clinical Guidelines) is presented, describing the role of primary care and community mental health services in the management of schizophrenia. The NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia was utilized as the main guide to develop the Greek National Guidelines . In addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA, 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists, 2005), as well as other relevant sources were also used. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. Special effort was made to adapt the international experience to the current Greek landscape with its constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. The proposals aim to contribute to the efficient implementation of the provision of community mental health services for patients suffering from psychotic disorders, focusing in particular on: (a) the role of primary health care services and the role of family physician in the treatment of schizophrenia; (b) the cooperation and coordination between mental health services and primary care services in order to ensure continuity of care (c) designing services that deliver evidence-based interventions,thus ensuring that a larger proportion of the population receives interventions with documented effectiveness in the treatment of schizophrenia, in the least restrictive environment. A particular emphasis is placed on services that are expected to reduce the need for hospitalization, such as crisis intervention services, community interventions aimed at maintaining and continuing the treatment of difficult patients who tend to be lost to follow up from services and early intervention services in psychosis.

The initiative for the development of national treatment guidelines, dates back to the '90s. In Greece, however, National Clinical Guidelines for the management of schizophrenia were first formulated in 2014 when a Working Group was set up for this purpose by the Greek Ministry of Health. The objective of this Working Group was to provide evidence-based recommendations covering the pharmacological and psychosocial treatment of schizophrenia as well as the development of appropriate treatment services. The Working Group utilized the NICE Guideline (National Institute of Clinical Excellence, 2010, 2014) for the management of Psychosis & Schizophrenia as the main guide to develop the Greek National Guidelines , and in addition the American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia (APA 2004), the Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of schizophrenia and related disorders (Royal Australian and New Zealand College of Psychiatrists 2005) , as well as other relevant sources. The Working Group also took into consideration the available Greek bibliography as well as the external evaluations of the Greek psychiatric reform programs. A special effort was made to adapt the international experience to the current Greek landscape with the constraints resulting from the uneven dispersion of mental health services, the lack of coordination between services, the incomplete sectorization of mental health services provided as part of the National Health System, the still underdeveloped Primary Care Health Service, and last but not least the difficult economic situation in Greece. After the preparation of the draft guidelines, a thorough consultation followed with the relevant stakeholders, including mental health professionals, user associations and representatives of the Greek Ombudsman. Additionally, the Hellenic Psychiatric Association established an Expert Committee in Spring 2016, that contributed with its observations to the final exercise. This article will be followed by two further publications (incorporating the Hellenic Psychiatric Association comments) which include: (1) the summary recommendations regarding the pharmacological, psychological and psychosocial interventions in the treatment of schizophrenia, and (2) the summary recommendations regarding: (a) the role of primary health care service and the role of the family physician in the treatment of schizophrenia (b) the summary recommendations regarding continuity of care and c) the summary recommendations regarding community interventions with documented effectiveness in the treatment of schizophrenia.

The use of reclaimed wastewater (RWW) for the irrigation of crops may result in the continuous exposure of the agricultural environment to antibiotics, antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs). In recent years, certain evidence indicate that antibiotics and resistance genes may become disseminated in agricultural soils as a result of the amendment with manure and biosolids and irrigation with RWW. Antibiotic residues and other contaminants may undergo sorption/desorption and transformation processes (both biotic and abiotic), and have the potential to affect the soil micro- biota. Antibiotics found in the soil pore water (bioavailable fraction) as a result of RWW irrigation may be taken up by crop plants, bioaccumulate within plant tissues and subsequently enter the food webs; potentially resulting in detrimental public health implications. It can be also hypothesized that ARGs can spread among soil and plant-associated bacteria, a fact that may have serious human health implications. The majority of studies dealing with these environmental and social challenges related with the use of RWW for irrigation were conducted under laboratory or using, somehow, controlled conditions. This critical review discusses the state of the art on the fate of antibiotics, ARB and ARGs in agricultural environment where RWW is applied for irrigation. The implications associated with the uptake of antibiotics by plants (uptake mechanisms) and the potential risks to public health are highlighted. Additionally, knowledge gaps as well as challenges and opportunities are addressed, with the aim of boostingfuture research towards an enhanced understanding of the fate and implications of these contaminants of emerging concern in the agricultural environment. These are key issues in a world where the increasing water scarcity and the continuous appeal of circular economy demand answers for a long- term safe use of RWW for irrigation.

Abiotic stress conditions such as drought, salinity and extreme temperatures are an increasing problem in agriculture. Research efforts are aimed to develop strategies to make agriculture more resilient and to mitigate the stress effects on crop production. In this context, the use of root-associated microbial communities able to improve plant tolerance is attracting increasing attention. In this chapter, we will offer an overview of the researches on the use of soil beneficial microorganisms, focusing mainly on mycorrhizal fungi and biocontrol agents such as Trichoderma species, to improve plant tolerance to different abiotic stresses (e.g. water stress, salinity, extreme temperatures).

The improvement of plant growth and productivity under biotic and abiotic stress conditions, as well as the reduction of post-harvest losses, are of paramount significance for meeting the increasing global population demand for food. Hydrogen sulphide (H2S) has recently appeared as a key contributor towards this goal via its bioactive role in the regulation of plant defence responses. Here, we provide an up-to-date overview of recent literature concerning the biosynthesis and regulation of H2S within the plant cell, as well as its involvement in a series of plant physiological processes. More precisely, H2S is actively associated with growth and developmental processes, tolerance responses following exposure to stress factors in horticultural plants, as well as in post-harvest fruit physiology. The H2S-mediated enhancement of tolerance following exposure of plants to several abiotic stress factors is highlighted, with particular emphasis on the priming effects of H2S on anti-oxidant capacity, redox regulation, and signalling, as well as transcriptional regulation of cellular defence components. Moreover, H2S has been reported to be associated with seed germination, increased growth and organogenesis in roots, while at the same time it enhances post-harvest performance and anti-oxidant capacity of fruit. The present review proposes a role for H2S in the physiology of horticultural crops, further supporting the hypothesis that H2S acts as a key signal molecule in plants, possibly involved in cross-talk with other secondary messengers in plants.

The present paper presents a two stage research which aims to depict the motivations and cognitive structures of quality food consumers through the use of Means–End Chain (MEC) approach and laddering technique. Quality food entails both organic and local protected/traditional products. The first stage of the research involved a meta-analysis of published journal articles regarding the purported motivations and cognitive structures of consumers when purchasing quality food. The results show that the values and motivations identified by the various researches varied greatly, thus a thematic categorization followed in order to produce a useful conceptual framework for the analysis of quality food cognitive structures. In the second stage we validated the proposed conceptual framework through 50 laddering interviews. A discussion regarding the ability to organize the motivations and cognitive structures of various consumer groups in order to highlight and analyze shifts in consumer behaviour related to quality food, is provided.

Experimental models for studying transplantation have up to now been unable to isolate reperfusion injury with minimal surgical manipulation and without the interference of graft rejection. Six pigs were subjected to left hilum preparation only (control group), and eight pigs were subjected to left hilum preparation plus in situ cooling ischemia and reperfusion of the lung (experimental group). The hilum was dissected free from other tissues in both groups. Lung preservation was achieved by antegrade flush perfusion via the left pulmonary artery. Pulmonary veins were clamped at the left atrium and a vent was created. The left main bronchus was clamped. Lung temperature was maintained at 4°-8°C, while core temperature was kept at 388C. After 3 hrs of cold ischemia the clamps were removed and the lung was reperfused. Elevated pulmonary vascular resistance and local and systemic aspects of ischemia-reperfusion syndrome were consistently reproduced. This large-animal model of in situ unilateral lung cold ischemia with warm reperfusion proved to be very reliable in reproducing all aspects of ischemia-reperfusion injury. It excludes the interference of rejection and extensive surgical manipulation. We therefore propose its use in experimental studies investigating pharmaceutical or cooling modifications affecting lung ischemia-reperfusion outcomes. Copyright © 2006 by the Society for Experimental Biology and Medicine.

In experimental lung transplantation, the reduction of endogenous surfactant properties occurs after graft preservation and transplant reperfusion. The aim of this study was to evaluate the efficacy of donor lung pretreatment with exogenous surfactant on graft damage after ischemia and reperfusion. Fourteen (control group A, n = 8; study group B, n = 6) young female white pigs (mean weight 27 +/- 3.5 kg) were used in a newly developed autotransplantation model with in situ cold ischemia. In study group B, before thoracotomy, 1.5 ml/kg surfactant apoprotein-A-free surfactant was administrated into the left main bronchus via flexible bronchoscopy. Belzer UW solution was used for lung preservation. Cold ischemia was achieved for 3 hr with interlobar lung parenchyma temperature at 8 +/- 1.3degreesC, and central temperature maintained at 37.20 +/- 0.5degreesC. Animals were sacrificed after 3 hr of graft reperfusion. At the end of reperfusion, pulmonary vascular resistance index (was 447.80 dyn/sec.cm(5).m(2) (+/-66.8) in group A vs 249.51 in group B (P < 0.001) and serum nitric oxide was adequately preserved. The mean alveolar surface area estimated by computerized morphometry was 5280.84 (4991.1) mum(2) (group A) vs 3997.89 (3284.70) mum(2) (group B; P < 0.005). Histology revealed milder macrophage and lymphocyte infiltration in group B at the end of reperfusion. Pretreatment of donor lung with an surfactant apoprotein-A -free surfactant agent appears to be beneficial in terms of maintaining serum NO and reducing hemodynamic disturbances. Furthermore, alveolar histology and stereomorphology are better preserved.