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Introduction In patients with scleroderma the morphological remodeling and alteration of right ventricular (RV) function begins even before the setting of pulmonary artery hypertension (PAH). These alterations are associated with worse outcomes and high mortality. Purpose Early detection of RV dysfunction is possible using advanced imaging techniques and can lead to specific therapeutic measures before installation of PAH. Purpose of this study is to evaluate new indices, based on speckle tracking technology, for identification of subclinical RV systolic failure. Methods Twenty-five (25) scleroderma patients without any signs or symptoms of PAH and twenty-five (25) healthy subjects were included in the present study. Two-dimensional echocardiography (2DE) and two-dimensional speckle-tracking echocardiography (2DSTE) were performed. All the usual 2DE, Doppler and tissue Doppler imaging measurements were obtained for the evaluation of RV function. Moreover, TAPSE, maximum systolic myocardial velocity from TDI of lateral tricuspid valve annulus (SRV), auto RV global longitudinal strain (aRVGLS) and auto RV free wall longitudinal strain (aRVFWLS) by 2DSTE were measured. aRVGLS is a new index, with appropriate RV function echo logistics in new technology echo systems, independent from known manual measurements. Results In scleroderma patients significantly higher systolic pulmonary artery pressure was recorded, although it remained within normal limits in both groups. Scleroderma patients had significant decreased RV systolic function with significantly lower TAPSE and SRV. Both aRVGLS and aRVFWLS were also significantly lower in scleroderma patients compared to the control group. aRVGLS was the best predictor of early RV systolic impairment in patients with scleroderma. Conclusions Scleroderma is a severe systematic disease associated with high mortality rates. RV remodeling, dysfunction, and progressive pulmonary artery hypertension are among the most important internal organ manifestations of this disease. Early detection of RV dysfunction is possible by 2DSTE, and may be helpful to guide further therapy in these patients. Funding Acknowledgement Type of funding sources: None.

BackgroundPatients with active rheumatoid arthritis (RA) are at risk for poor functional outcomes, affecting quality of life (QoL). SF-36 is a validated instrument to measure health-related quality of life (HRQoL) in various domains of physical and mental health1, and has been validated in RA. Nevertheless, data on the impact of RA disease activity on SF-36 scores in Greek patients are lacking.ObjectivesTo compare SF-36 scores in Greek RA patients versus the general population and to assess the impact of disease activity on HRQoL.MethodsCross-sectional study in RA patients followed in the Department of Rheumatology, Asklepieio Voulas General Hospital (05-10/2021). Demographic characteristics, state of disease activity and current treatment for RA were recorded at most recent visit. All patients completed SF-36 questionnaires and were classified in three subgroups of DAS28-disease activity: i) Remission or Low disease activity (LDA), ii) Moderate disease activity (MDA), and iii) High disease activity (HDA). Data from the SF-36 validation study in the Greek general population with 1007 participants, were used as historical controls2. Descriptive statistics, one-way ANOVA and linear regression were used for statistical analyses.Results107 patients participated in the study (80,4% females, mean (SD) age 63.3 (12.1) years, 64.5% seropositive, 72% overweight or obese). One third (n=36) were active smokers and 63% (n=67) were receiving a biologic disease modifying antirheumatic drug (bDMARD).Patients with RA exhibited low scores in all SF-36 domains and reported significantly worse results compared to the general population (Figure 1).Figure 1.Physical component score (PCS) and Mental component score (MCS) of the SF-36 showed a negative correlation with DAS28 (β= -8.28, p= Table 1.SF-36 domain mean±SDRDA or LDA 51%MDA 37,2%HAD 11,7%p-valuePF48,43 ±34,2332,14 ±19,8320 ± 19,750.003RP34,9 ±43,6820,71 ± 32,920 ± 00.015BP51,2 ±30,4728,24 ± 24,4918,86 ± 23,54GH48,83 ±4541,57 ± 24,2532,27 ± 19,540.043VT49,48 ±22,2234,14 ± 18,5730,91 ± 15,940.001SF52,16 ±35,3340,36 ± 27,1328,41 ± 14,890.041RE39,01 ±44,6827,62 ± 40,8118,18 ± 34,520.246MH54,08 ±23,2447,57 ± 21,7540 ± 18,590.124ConclusionHRQoL assessed by SF-36 is dampened in RA patients, in both physical and mental component. Disease activity had a negative impact on both physical and mental components of HRQoL. Patients with remission or LDA showed better HRQoL outcomes, suggesting that the treat-to-target approach may also positively affect QoL.References[1]Ware, J. E., Jr, & Gandek, B. (1998) Journal of clinical epidemiology, 51(11), 903–912.[2]Pappa E et al. Qual Life Res. 2005 Jun;14(5):1433-8Disclosure of InterestsNone declared

The association between force–time characteristics of isometric leg press (ILP) and counter-movement jump (CMJ) with vastus lateralis (VL) muscle architecture, was examined in 19 female athletes (aged 23.2 ± 5.4 years). Peak force (PF), average rate of force development (ARFD) and rate of force development (RFD) at different time epochs were calculated from the force–time curve, as well as CMJ jump height and power. Significant correlations were found between ILP-PF and CMJ power (r = 0.658, p < 0.01), while both variables were correlated with VL thickness and fascicle length (r = 0.471 to 0.648, p < 0.05). Significant correlations were also observed between ILP-RFD epochs and VL fascicle length (r = 0.565 to 0.646, p < 0.05) and between CMJ height with VL thickness (r = 0.523, p < 0.05). Furthermore, positive correlations were found between ILP and CMJ in ARFD (r = 0.625, p < 0.01) and RFD epochs (r = 0.464 to 0.566, p < 0.05). ILP-PF and muscle thickness accounted for 52.8% (p = 0.002) of the variance in CMJ power. These results suggest that isometric force time characteristics are associated with power generation during dynamic muscle actions. Furthermore, VL muscle thickness and fascicle length are associated with rapid force production in female athletes, irrespective of the type of muscle action. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.

Aim the study was the comparison of enhanced recovery after surgery (ERAS) versus conventional care (CON) protocols in patients undergoing pancreatoduodenectomy with regard to pain intensity, emotional response (optimism/sadness/stress), and stress biomarker levels (adrenocorticotropopic hormone, cortisol). We conducted a prospective two-group randomized controlled study with repeated measures in 85 patients with cancer pancreatoduodenectomy. In the ERAS group (N = 44), the ERAS protocol was followed, compared with the CON group (N = 41). We assessed pain with the numeric rating scale and a behavioral scale (Critical Care Pain Observation Tool), emotional responses (numeric rating scale), and serum adrenocorticotropopic hormone and cortisol levels at three time points: T1, admission day; T2, day of surgery; and T3, discharge day (ERAS) or the fifth day of stay (CON). Data were analyzed by linear mixed modeling to account for repeated measurements. We observed decreased postoperative pain in ERAS patients after adjusting for confounders (p =.002) and a trend for less complications. No significant associations with stress/emotional responses were noted. Only age, but not protocol, appeared to have a significant effect on adrenocorticotropopic hormone levels despite a significant interaction with time toward increased adrenocorticotropopic hormone levels in the ERAS group. In conclusion, despite its fast track nature, ERAS is not associated with increased stress in patients undergoing pancreatoduodenectomy and is associated with decreased pain. © 2020 Society of Gastroenterology Nurses and Associates.

Background:The current goal of treatment in SLE is remission or low disease activity (LDA) and prevention of flares, achieved with the lowest possible dose of glucocorticoids. Nevertheless, in current clinical practice a significant number of patients still has active disease.1,2Objectives:To assess the current disease activity state of SLE patients during their most recent visit in two centers (Department of Rheumatology in “Asklepieio” Hospital and Rheumatology Unit in “Attikon” Hospital, both in Athens, Greece).Methods:Cross-sectional study of patients with a diagnosis of SLE for at least one year. Patients were divided into four groups: 1) Remission off-therapy: SLE Disease Activity Index (SLEDAI)=0 without prednisone or immunosuppressive drugs (IS), 2) Remission on-therapy: SLEDAI=0, prednisone dose ≤5mg/day and/or IS (conventional and biologic, maintenance phase), 3) LDA: SLEDAI ≤4, prednisone dose ≤7.5mg/day and/or IS (maintenance phase), 4) Active disease: SLEDAI >4 and/or prednisone dose >7.5mg/day and/or IS (induction phase).2 Hydroxychloroquine was allowed in all groups.Results:205 patients were included [95.1% female, mean (SD) age 48.4 (14.9) years and median disease duration (IQR) 6.2 (12.6) years]. A history of lupus nephritis and neuropsychiatric SLE was present in 16.6% and 17.1% of our patients, respectively, and 39% of patients had SLICC/ACR damage index (SDI) > 0. At last visit, remission off-therapy and remission on-therapy was present in 8.3% (n=17) and 15.1% (n=31) of our patients, respectively. Seventy-five patients (36.6%) had LDA, whereas 82 patients (40%) had active disease. More than 85% (86.3%) of patients were in treatment with hydroxychloroquine and 64.4% were receiving immunosuppressive drugs. Regarding glucocorticoids, 50.2% (n=103) were treated with prednisone dose ≤7.5mg/day and over 40% (42.4%, n=87) did not receive prednisone at all. A SLEDAI score 0 and 1-4 was achieved in 24.4% and 42.9% of patients, respectively, but only 3.9% had a SLEDAI > 8, indicative of high disease activity.Conclusion:Although the majority of our patients were treated with hydroxychloroquine and glucocorticoids in acceptable levels of daily dose, four out of ten patients in our practice have active disease during their last visit. Achieving treatment goals in SLE patients remains a challenge for future novel therapies.References:[1]Fanouriakis A, Kostopoulou M, Alunno A, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis 2019; 78: 736–745.[2]Ugarte-Gil MF, Wojdyla D, Pons-Estel GJ, et al. Remission and Low Disease Activity Status (LDAS) protect lupus patients from damage occurrence: data from a multiethnic, multinational Latin American Lupus Cohort (GLADEL). Ann Rheum Dis 2017; 76: 2071–2074.Disclosure of Interests:None declared

Hypereosinophilic syndrome is a rare entity that can develop secondary to overproduction of eosinophilopoietic cytokines or as idiopathic disease. Cardiac involvement, which occurs often, is divided into 3 stages, the latter of which is nonreversible and leads to severe heart failure. Early detection and treatment of the syndrome is essential. For this reason, genetic testing for the FIP1L1-PDGFRA fusion gene has recently been added to the diagnostic algorithm. Patients with this mutation are at increased risk for the development of cardiac involvement and typically respond to treatment with the tyrosine kinase inhibitor imatinib mesylate. © 2017 Canadian Cardiovascular Society

Background: Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols. Objectives: To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols. Method: A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT (n = 29) or CON (n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge. Results: ACTHT1 and ACTHT2 levels were positively correlated with self-reported stress levels (ρ =.43 and ρ =.45, respectively, p .05). Conclusions: Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress. © 2016, © The Author(s) 2016.

Objective To document the prevalence of dieting and to compare body composition markers, dietary intakes and eating behaviours across dieting categories. Design Prospective, cross-sectional study. Setting Twenty-four randomly selected secondary public schools located in Attica, Greece. Subjects Anthropometric, medical and dietary information was obtained from 857 (54·9 % females) adolescents (mean age 13·4 (sd 0·9) years). Meal patterns, eating behaviours and eating style score, reflecting conditions around eating, were assessed. Adolescents were asked about their dieting involvement and were categorised as 'never dieters', 'current dieters' or 'past dieters'. Results Overall, 20·1 % of the adolescents were currently dieting and 15·2 % reported past dieting. Mean BMI and body fat percentage of never dieters were significantly lower than those of both groups of dieters (P < 0·001). Breakfast skipping (χ2 = 10·92, P = 0·004) and eating large quantities of food (χ2 = 7·18, P = 0·028) differed significantly across dieting groups in females. Significant differences in dinner skipping were observed in both males (χ2 = 10·55, P = 0·005) and females (χ2 = 20·91, P < 0·001). Female past dieters had significantly higher eating style scores than never dieters (P = 0·010) and current dieters (P = 0·042), indicating less well-structured feeding practices and food intake for reasons other than hunger. Conclusions The present study showed a high prevalence of dieting among adolescents. Current dieters and past dieters had higher BMI and body fat percentage than never dieters. Eating behaviours differed significantly depending on dieting involvement, especially in females; while an apparently healthier, ordered eating style adopted by dieters during the dieting period seemed not to be maintained in the long term. © The Authors 2013.

Background: Human papillomavirus (HPV) infection is a causative factor for cervical cancer. Early detection of high risk HPV types might help to identify women at high risk of cervical cancer. The aim of the present study was to examine the HPV prevalence and distribution in cervical smears in a sample of Greek women attending a gynecological outpatient clinic and to explore the determinants of the infection.Methods: A total of 225 women were studied. All women underwent a regular gynecological control. 35 HPV types were studied; 6, 11, 16, 18, 26, 31, 33, 35, 39, 40, 42, 43, 44, 45, 51, 52, 53, 54, 56, 58, 59, 61, 62, 66, 68, 70, 71, 72, 73, 81, 82, 83, 84, 85 and 89. Also, basic demographic information, sociodemographic characteristics and sexual behavior were recorded.Results: HPV was detected in 22.7% of the study population. The percentage of the newly diagnosed women with HPV infection was 17.3%. HPV-16 was the most common type detected (5.3%) followed by HPV-53 (4.9%). 66.2% of the study participants had a Pap test during the last year without any abnormalities. HPV infection was related positively with alcohol consumption (OR: 2.19, 95% CI: 1.04-4.63, P = 0.04) and number of sexual partners (OR: 2.16, 95% CI: 1.44-3.25, P < 0.001), and negatively with age (OR: 0.93, 95% CI: 0.87-0.99, P = 0.03), and monthly income (OR: 0.63, 95% CI: 0.44-0.89, P = 0.01).Conclusion: The prevalence of HPV in women attending an outpatient clinic is high. Number of sexual partners and alcohol consumption were the most significant risk factors for HPV infection, followed by young age and lower income. © 2010 Stamataki et al; licensee BioMed Central Ltd.

The effects of a unilateral, penetrating brain trauma on IGF-I, BDNF and NT-3 were studied immunocytochemicaly in the rat. BDNF and NT-3 were decreased in the peritraumatic area, but increased in the adjacent region, 4 and 12 h post-injury. One week following the trauma, BDNF remained low in the peritraumatic area, but was restored to normal levels in the adjacent, while no effect of injury on NT-3 levels was detected in either area. Injury resulted in an increase in IGF-I levels in the peritraumatic area, which was most pronounced 1 week following the trauma, indicating that IGF-I could participate in endogenous repair processes. We thus administered IGF-I immediately following the trauma and investigated its effects on injury-induced changes in neurotrophin levels. Administration of IGF-I partially reversed the injury-induced decrease in BDNF and NT-3 in the peritraumatic area observed 4 and 12 h post-injury, while at the same time-points, it completely cancelled the effects of injury in the adjacent region. One week after the trauma, BDNF levels were dramatically increased in both the peritraumatic and adjacent area, reaching levels even higher than those of the sham-operated animals, following IGF-I administration. Our results showing that IGF-I not only counteracts injury-induced changes in neurotrophins, but can also further increase their levels, indicate that this growth factor could mediate repair and/or protective processes, following brain trauma. © 2004 Elsevier Inc. All rights reserved.