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Στο πρώτο μέρος της διατριβής, υπολογίζεται ο ρυθμός παραγωγής βαρυτίνων, μέσω της θερμικής ιδιοενέργειας σε επίπεδο ενός-βρόχου. Επίσης, παρέχουμε μια εύχρηστη φόρμουλα για τον ρυθμό παραγωγής και τη θερμική αφθονία των βαρυτίνων, σε συνάρτηση με τη θερμοκρασία αναθέρμανσης του Σύμπαντος. Η αφθονία των βαρυτίνων συγκρίνεται με την παρατηρούμενη σκοτεινή ύλη. Στο δεύτερο μέρος της διατριβής θεωρούμε την τετραγωνική βαρύτητα σε Palatini φορμαλισμό υποθέτοντας την ύπαρξη βαθμωτών πεδίων συνδεδεμένων με τη βαρύτητα. Όταν τα βαθμωτά πεδία αναπτύξουν την αναμενόμενη τιμή του κενού τους η κλίμακα Planck δημιουργείται δυναμικά. Το αποτέλεσμα των τετραγωνικών όρων καμπυλότητας είναι η μείωση της τιμής του λόγου τανυστή-βαθμωτού r. Οι πληθωριστικές προβλέψεις όλων των υπό εξέταση μοντέλων διαπιστώνεται ότι συμφωνούν με τα τελευταία παρατηρητικά δεδομένα που έχουν τεθεί από τη συνεργασία Planck για ένα ευρύ φάσμα των εμπλεκόμενων παραμέτρων.

Sense of coherence and self-efficacy has been found to affect health-related quality of life in chronic diseases. However, research on respiratory diseases is limited. Here we report findings on quality of life (QoL) of COPD patients and the associations with coherence and self-efficacy. This study consists of the Greek national branch of the UNLOCK study, with a sample of 257 COPD patients. Coherence and self-efficacy are positively inter-correlated (Pearson rho = 0.590, p p p p p

Overt aseptic meningitis rarely complicates varicella-zoster virus (VZV) reactivation in young and immunocompetent adults. Many of the cases of VZV meningitis are associated with an exanthem. We describe an otherwise healthy 36-year-old adult who had aseptic meningitis without skin rash, caused by reactivation of varicella-zoster virus. Cerebrospinal fluid (CSF) analysis revealed lymphocytosis, increased total protein, and low glucose. Diagnosis was made by polymerase chain reaction in CSF. The present case highlights the fact that VZV should be considered as a cause of aseptic meningitis with hypoglycorrhachia in healthy and young individuals, even in the absence of an exanthem. Keywords: Varicella-zoster, Meningitis, Immunocompetent, Hypoglycorrhachia

Myocarditis is the inflammation of the heart muscle and it is caused by a wide range of infectious and non-infectious conditions. Non-typhoidalSalmonellainfection, a common foodborne illness worldwide, only rarely causes myocarditis. We describe a case of an immunocompetent adult withSalmonella entericaserovar Typhimurium myocarditis who had a favorable outcome due to early recognition of the causative factor and prompt initiation of appropriate treatment.

BACKGROUND: The present study aimed to validate a recently proposed algorithm for assistance titration during proportional assist ventilation with load-adjustable gain factors, based on a noninvasive estimation of maximum inspiratory pressure (peak Pmus) and inspiratory effort (pressure-time product [PTP] peak Pmus). METHODS: Retrospective analysis of the recordings obtained from 26 subjects ventilated on proportional assist ventilation with load-adjustable gain factors under different conditions, each considered as an experimental case. The estimated inspiratory output (peak Pmus) and effort (PTP-peak Pmus) were compared with the actual-determined by the measurement of transdiaphragmatic pressure- and the derived PTP. Validation of the algorithm was performed by assessing the accuracy of peak Pmus in predicting the actual inspiratory muscle effort and indicating the appropriate level of assist. RESULTS: In the 63 experimental cases analyzed, a limited agreement was observed between the estimated and the actual inspiratory muscle pressure (−11 to 10 cm H2O) and effort (−82 to 125 cm H2O × s/min). The sensitivity and specificity of peak Pmus to predict the range of the actual inspiratory effort was 81.2% and 58.1%, respectively. In 49% of experimental cases, the level of assist indicated by the algorithm differed from that indicated by the transdiaphragmatic pressure and PTP. CONCLUSIONS: The proposed algorithm had limited accuracy in estimating inspiratory muscle effort and with indicating the appropriate level of assist.

Background Frailty is a state of increased vulnerability that has a significant risk of unfavorable outcomes such as increased dependency and/or death, but little is known about frailty in people with chronic obstructive pulmonary disease (COPD). Method We aimed to determine the prevalence of frailty in COPD patients and to identify the associated risk factors. Two hundred fifty-seven COPD patients enrolled from primary care in Greece between 2015 and 2016. Physicians used structured interviews to collect cross-sectional data including demographics, medical history, symptoms and COPD Assessment Tool (CAT) or modified Medical Research Council Dyspnea scale (mMRC) score. Patients were classified into severity groups according to GOLD 2017 guidelines. Participants completed the The Frail Non-Disabled (FiND) questionnaire, exploring the frailty and disability domains. In the present analyses, frail patients with and without mobility disability were pooled and were compared to non-frail patients. Factors associated with frailty were analyzed using univariate and multivariate logistic regression. Results Mean (SD) age was 65 (12.3) with 79% males. The majority of patients suffered with frailty (82%) of which 76.8% had mobility disability. 84.2% were married/with partner and 55.4% retired. 55.6% were current smokers. Uncontrolled disease (≥10 CAT score) was reported in 91.1% and 37.2% of patients had ≥2 exacerbations in the past year. Dyspnea (38%) and cough (53.4%) were the main symptoms. Main comorbidities were hypertension (72.9%), hyperlipidaemia (24.6%) and diabetes (11%). Risk of frailty was significantly increased with age (OR; 95%CI: 1.05; 1.02–1.08), hypertension (2.25; 1.14–4.45), uncontrolled disease (≥10 CAT score 4.65; 1.86–11.63, ≥2 mMRC score 5.75 (2.79–11.85) or ≥ 2 exacerbations 1.73; 1.07–2.78), smoking cessation (ex compared to current smokers: 2.37; 1.10–5.28) and GOLD status (B&D compared to A&C groups: CAT-based 4.65; 1.86–11.63; mMRC-based: 5.75; 2.79–11.85). In multivariate regression smoking cessation and GOLD status remained significant. Gender, body mass index, occupational or marital status, symptoms and other comorbidities were not significant. Conclusions Frailty with mobility disability is common in COPD patients and severity of disease increases the risk. It is possible that frail patients are more likely to quit smoking perhaps because of their disability and uncontolled disease. Routine assessment of frailty in addition to COPD control may allow early interventions for preventing or delaying progression of frailty and improvement in COPD disease.

Activin-A, a member of the TGF-b superfamily, plays an important role in the regulation of asthmatic inflammation, airway remodeling and pulmonary fibrosis. Activin-A is elevated in the airway epithelium by cigarette smoke in animal models and COPD. We compared the levels of Activin-A in the sputum and serum of COPD, asthma and ACOS patients. Specimens from 32 COPD, 9 asthma and 13 ACOS patients were collected at the day of hospitalization following an exacerbation, the discharge day, 1 and 4 months after hospitalization. 10 COPD patients suffered from at least one exacerbation and repeated the study. AnshLabs Activin-A ELISA kit was used. Pairwise analyses showed that Activin-A levels rise significantly during exacerbation and subsequently decline after 4 months in COPD without exacerbation (p=0.01), asthma (p=0.016) or ACOS (p=0.004). In COPD patients with at least 1 exacerbation sputum Activin-A levels remain similar at all time points of the study. Conversely, Activin-A serum levels do not significantly decline following the acute exacerbation event, but rather increased during the baseline periods of 1 and 4 months in COPD and ACOS. Overall, Activin-A levels did not show significant differences among the disease groups at any time point of the study in either sputum or serum. However, the baseline levels of Activin-A in the sputum at the 4 months were significantly higher in the COPD patients with at least one exacerbation relative to COPD without exacerbation (p=0.03), asthma (p=0.01) or ACOS (p=0.005). Sputum levels of Activin-A increase during acute exacerbations in patients with chronic obstructive pneumonias and remain elevated in the serum even at baseline.

Objective Recent studies have shown that in carefully selected patients, conservative treatment alone can be an option in the management of spinal epidural abscess (SEA). The aim of this study was to identify prognostic factors of outcome in patients with spontaneous SEA treated conservatively. Patients and methods A retrospective cohort study of all patients with spontaneous SEA treated with antibiotics alone from January 2012 to December 2015 was conducted in a 1200-bed tertiary referral center. Demographic, clinical, microbiological, and radiological characteristics were analyzed. Failure of medical treatment was defined as the need for delayed surgical intervention, no neurological improvement or deterioration, death due to the infection, or relapse after hospital discharge. Results We identified 21 patients diagnosed with spontaneous SEA treated conservatively. Median age was 72 years and 10 patients were male. Eleven patients presented with radicular weakness and/or radicular sensory deficit, or incomplete cord injury. Inflammatory markers were markedly elevated in all patients. Thirteen patients were successfully treated with conservative treatment, while among 8 patients with treatment failure, 1 died due to the infection. Presence of serious neurological deficits and infection due to methicillin-resistant S. aureus (MRSA) were associated with failure of conservative treatment. Notably, neither the extension nor the location of the abscess on magnetic resonance imaging (MRI) was associated with failed medical management. Conclusions A significant proportion of patients with spontaneous SEA can respond to antibiotic treatment alone. However, in patients with infection due to MRSA or with severe neurological impairment, conservative management has an increased risk of failure.

A method of identifying the dominant hydrodynamic sea-intrusion mechanism of brackish karst springs is presented. A karst spring becomes brackish when tubes, which bring the freshwater to the spring (freshwater discharge), intersect other tubes that come from the sea and bring saltwater to the freshwater tubes (saltwater discharge) when the saltwater pressure at the intersection is higher than the freshwater pressure. There are two potential seawater intrusion mechanisms. The first one is the difference between the freshwater density and the seawater density, and the second is the venturi effect. Both mechanisms are present but it is a matter of great significance to know which mechanism dominates. In order to find out the dominant mechanism, the seawater discharge versus the freshwater discharge was charted using the MODKARST model, which estimates these discharges. The model determines how the freshwater discharge affects the saltwater discharge estimating thereby the dominant seawater intrusion mechanism. Application was made to the “Almiros” and “Makaria” springs in Greece.

Common sea bass ( Dicentrarchus labrax) of a Greek cage-culture origin, sampled in December and July, were stored in ice, and their sensory, microbiological and chemical spoilage patterns were studied as well as their seasonal differentiation. The sensory storage life was determined at 15 days of ice storage. The microbial population in the muscle reached levels of 105 at the acceptability limit. The ATP breakdown pattern showed a quick depletion of inosine-monophosphate (IMP) in the first 8–9 days of ice storage and slower depletion thereafter. Inosine (INO) and hypoxanthine (Hx) were formed at significant quantities. TVBN and TBA, as indicators of protein breakdown and lipid oxidation, respectively, showed low and delayed increase. A seasonal effect was observed with summer fish showing higher rates of K-value increase during early spoilage, while winter fish showed higher K-values, microbial populations and TVBN at late spoilage stages.