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Aims: The overall aim of this study was to determine the impact of deprivation with regard to quality of life, demographics, joint-specific function, attendances for unscheduled care, opioid and antidepressant use, having surgery elsewhere, and waiting times for surgery on patients awaiting total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: Postal surveys were sent to 1,001 patients on the waiting list for THA or TKA in a single Northern Ireland NHS Trust, which consisted of the EuroQol five-dimension five-level questionnaire (EQ-5D-5L), visual analogue scores (EQ-VAS), and Oxford Hip and Knee Scores. Electronic records determined prescriptions since addition to the waiting list and out-of-hour GP and emergency department attendances. Deprivation quintiles were determined by the Northern Ireland Multiple Deprivation Measure 2017 using postcodes of home addresses. Results: Overall, 707 postal surveys were returned, of which 277 (39.2%) reported negative “worse than death” EQ-5D scores and 219 (21.9%) reported the consumption of strong opioids. Those from the least deprived quintile 5 had a significantly better EQ-5D index (median 0.223 (interquartile range (IQR) -0.080 to 0.503) compared to those in the most deprived quintiles 1 (median 0.049 (IQR -0.199 to 0.242), p = 0.004), 2 (median 0.076 (IQR -0.160 to 0.277; p = 0.010), and 3 (median 0.076 (IQR-0.153 to 0.301; p = 0.010). Opioid use was significantly greater in the most deprived quintile 1 compared to all other quintiles (45/146 (30.8%) vs 174/809 (21.5%); odds ratio 1.74 (95% confidence interval 1.18 to 2.57; p = 0.005). Conclusion: More deprived patients have worse health-related quality of life and greater opioid use while waiting for THA and TKA than more affluent patients. For patients awaiting surgery, more information and alternative treatment options should be available. Cite this article: Bone Jt Open 2024;5(5):444–451.

The most trivial example of self-assembly is the entropy-driven crystallization of hard spheres. Past works have established the similarities and differences in the phase behavior of monomers and chains made of hard spheres. Inspired by the difference in the melting points of the pure components, we study, through Monte Carlo simulations, the phase behavior of athermal mixtures composed of fully flexible polymers and individual monomers of uniform size. We analyze how the relative number fraction and the packing density affect crystallization and the established ordered morphologies. As a first result, a more precise determination of the melting point for freely jointed chains of tangent hard spheres is extracted. A synergetic effect is observed in the crystallization leading to synchronous crystallization of the two species. Structural analysis of the resulting ordered morphologies shows perfect mixing and thus no phase separation. Due to the constraints imposed by chain connectivity, the local environment of the individual spheres, as quantified by the Voronoi polyhedron, is systematically more spherical and more symmetric compared to that of spheres belonging to chains. In turn, the local environment of the ordered phase is more symmetric and more spherical compared to that of the initial random packing, demonstrating the entropic origins of the phase transition. In general, increasing the polymer content reduces the degree of crystallinity and increases the melting point to higher volume fractions. According to the present findings, relative concentration is another determining factor in controlling the phase behavior of hard colloidal mixtures based on polymers.

In clinical settings, standing height measurement is often difficult to perform due to patients’ inability to stand upright. Height prediction equations derived from measurements of the length of other body segments have been published; however, they are not readily applicable to all populations since ethnic differences affect the relationship between standing height and body segment length. This cross-sectional study aimed to examine the accuracy of height prediction using the Malnutrition Universal Screening Tool (MUST) height predictive equations among Greek patients and to develop new, nationally representative equations. The study population consisted of 1198 Greek adult outpatients able to stand upright without assistance and without medical conditions that affected their height. Standing height, ulna length, knee height and demi-span measurements were obtained from 599 males and 599 females. Patients were stratified into age groups of p < 0.001) in both sexes and all age categories. A strong correlation was observed between the measured and predicted standing height using ulna length (rho = 0.870, p < 0.001), knee height (rho = 0.923, p < 0.001) and demi-span length (rho = 0.906, p < 0.001). The average difference between the MUST indicative equations’ height predictions from alternative measurements and actual height was −3.04 (−3.32, −2.76), −1.21 (−1.43, −0.988) and 2.16 (1.92, 2.41), respectively. New height prediction equations for Greek patients were identified, with the predicted values closer to the measured standing heights than those predicted with the MUST indicative equations for height prediction from alternative measurements.

Helicobacter pylori is a major human pathogen whose population structure is similar to that of its host. Here, the authors show that H. pylori has repeatedly spread out of Africa recently, replacing deleterious variants that accumulated during the original out of Africa migrations more than 50,000 years ago.

Aims: Tranexamic acid (TXA) is now commonly used in major surgical operations including orthopaedics. The TRAC-24 randomized control trial (RCT) aimed to assess if an additional 24 hours of TXA postoperatively in primary total hip (THA) and total knee arthroplasty (TKA) reduced blood loss. Contrary to other orthopaedic studies to date, this trial included high-risk patients. This paper presents the results of a cost analysis undertaken alongside this RCT. Methods: TRAC-24 was a prospective RCT on patients undergoing TKA and THA. Three groups were included: Group 1 received 1 g intravenous (IV) TXA perioperatively and an additional 24-hour postoperative oral regime, Group 2 received only the perioperative dose, and Group 3 did not receive TXA. Cost analysis was performed out to day 90. Results: Group 1 was associated with the lowest mean total costs, followed by Group 2 and then Group 3. The differences between Groups 1 and 3 (-£797.77 (95% confidence interval -1,478.22 to -117.32) were statistically significant. Extended oral dosing reduced costs for patients undergoing THA but not TKA. The reduced costs in Groups 1 and 2 resulted from reduced length of stay, readmission rates, emergency department attendances, and blood transfusions. Conclusion: This study demonstrated significant cost savings when using TXA in primary THA or TKA. Extended oral dosing reduced costs further in THA but not TKA. Cite this article: Bone Jt Open 2022;3(7):536–542.

Abstract Sharing in embryology and function between the eye and brain has led to interest in whether assessments of the eye reflect brain changes seen in neurodegeneration. We aimed to examine the associations between measures of retinal layer thickness using optical coherence tomography (OCT) and multimodal measures of brain structure and function. Using a convenient sample of twins discordant for type 2 diabetes, we performed cognitive testing, structural brain MRI (tissue volumetry), diffusion tensor imaging (white matter microstructure), and arterial spin labelling (cerebral blood flow). OCT images were recorded and retinal thickness maps generated. We used mixed level modelling to examine the relationship between retinal layer thicknesses and brain measures. We enrolled 35 people (18 pairs, mean age 63.8 years, 63% female). Ganglion cell layer thickness was positively associated with memory, speed, gray matter volume, and altered mean diffusivity. Ganglion cell layer thickness was strongly positively associated with regional cerebral blood flow. We found only a limited number of associations between other retinal layer thickness and measures of brain structure or function. Ganglion cell layer thickness showed consistent associations with a range of brain measures suggesting it may have utility as a marker for future dementia risk.

Abstract Background Before the pandemic of coronavirus disease (COVID-19), rapidly improving acute respiratory distress syndrome (ARDS), mostly defined by early extubation, had been recognized as an increasingly prevalent subphenotype (making up 15–24% of all ARDS cases), associated with good prognosis (10% mortality in ARDSNet trials). We attempted to determine the prevalence and prognosis of rapidly improving ARDS and of persistent severe ARDS related to COVID-19. Methods We included consecutive patients with COVID-19 receiving invasive mechanical ventilation in three intensive care units (ICU) during the second pandemic wave in Greece. We defined rapidly improving ARDS as extubation or a partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO2:FiO2) greater than 300 on the first day following intubation. We defined persistent severe ARDS as PaO2:FiO2 of equal to or less than 100 on the second day following intubation. Results A total of 280 intubated patients met criteria of ARDS with a median PaO2:FiO2 of 125.0 (interquartile range 93.0–161.0) on day of intubation, and overall ICU-mortality of 52.5% (ranging from 24.3 to 66.9% across the three participating sites). Prevalence of rapidly improving ARDS was 3.9% (11 of 280 patients); no extubation occurred on the first day following intubation. ICU-mortality of patients with rapidly improving ARDS was 54.5%. This low prevalence and high mortality rate of rapidly improving ARDS were consistent across participating sites. Prevalence of persistent severe ARDS was 12.1% and corresponding mortality was 82.4%. Conclusions Rapidly improving ARDS was not prevalent and was not associated with good prognosis among patients with COVID-19. This is starkly different from what has been previously reported for patients with ARDS not related to COVID-19. Our results on both rapidly improving ARDS and persistent severe ARDS may contribute to our understanding of trajectory of ARDS and its association with prognosis in patients with COVID-19.

Recent simulation studies have revealed a wealth of distinct crystal polymorphs encountered in the self-organization of polymer systems driven by entropy or free energy. The present analysis, based on the concept of self-avoiding random walks (SAWs) on crystal lattices, is useful to calculate upper bounds for the entropy difference of the crystals that are formed during polymer crystallization and thus to predict the thermodynamic stability of distinct polymorphs. Here, we compare two pairs of crystals sharing the same coordination number, ncoord: hexagonal close-packed (HCP) and face centered cubic (FCC), both having ncoord = 12 and the same packing density, and the less dense simple hexagonal (HEX) and body centered cubic (BCC) lattices, with ncoord = 8. In both cases, once a critical number of steps is reached, one of the crystals shows a higher number of SAWs compatible with its geometry. We explain the observed trends in terms of the bending and torsion angles as imposed by the geometric constraints of the crystal lattice.

Background: Achieving accurate and consistent acetabular component orientation remains a major challenge in total hip arthroplasty. Methods: We used a pelvic model to compare freehand techniques vs mechanical and anatomical alignment guides in achieving a target operative inclination (OI) and operative anteversion (OA). Thirty subjects comprising consultant orthopedic surgeons, orthopedic trainees, and nonsurgical staff positioned an acetabular component in a pelvic model using 3 different methods for guiding inclination and another 3 for guiding version. Results: Using either a standard mechanical alignment guide (MAG) or a spirit level MAG technique eliminated outliers from target OI, while the freehand method resulted in 46.7% of measurements outside the OI target range. The spirit level MAG technique significantly outperformed the standard MAG technique in median unsigned deviation from target OI (0.8° vs 2.1°, P < .001). Either method of referencing the transverse acetabular ligament for version yielded lower deviations from target OA than the freehand method and fewer outliers from the ±5° target range. Surgical experience was not a significant factor for accurately achieving target OI and OA. Conclusions: Even in an idealized in vitro model, a wide range of OI and OA is seen with the freehand technique of cup placement by subjects of all levels of surgical experience. Using either a standard MAG or a spirit level MAG reduces deviations in target OI, with the spirit level MAG method yielding the best accuracy. Using the transverse acetabular ligament to guide cup anteversion yields more accurate OA.

To date in Cyprus, there is no dedicated “Quality Improvement” body or Public Health authority. The long-awaited general healthcare system (known as GeSy or GHS) has been completed, mid-stream of the COVID-19 pandemic. A recently proposed resilience plan in response to the lessons learnt from the pandemic was put forward by the Government of the Republic of Cyprus to strengthen the capacity of the GHS and support public health defense. The negotiator of GeSy and Health Minister 2015–2018 also provided his view that the health system needs a holistic transformation of service provision. Recognizing failures and thinking from a syndemogenesis perspective how the envisioned patient-centric healthcare delivery can be achieved, we propose that the public health response could also be linked to a politico-economic one in shielding GeSy. We make such case for a syndemic strategy (simultaneous management of COVID-19 and pre-existing epidemics on the island) and the development of the five-district model where each main district hospital is to complement the activities of the GHS through developing: 1. A training Center for training and sharing of best practices for COVID-19 and other public emergencies. 2. A public health body. 3. A quality improvement institute. 4. A commissioning center on planning and streamlining healthcare services. 5. A clinical trial platform. The rationale is based on the management literature and use of existing resources and capabilities for transforming the GeSy and generating value.

The free energy of crystallization of monomeric hard spheres as well as their thermodynamically stable polymorph have been known for several decades. In this work, we present semianalytical calculations of the free energy of crystallization of freely-jointed polymers of hard spheres as well as of the free energy difference between the hexagonal closed packed (HCP) and face-centered cubic (FCC) polymorphs. The phase transition (crystallization) is driven by an increase in translational entropy that is larger than the loss of conformational entropy of chains in the crystal with respect to chains in the initial amorphous phase. The conformational entropic advantage of the HCP polymer crystal over the FCC one is found to be ΔschHCP−FCC≈0.331×10−5k per monomer (expressed in terms of Boltzmann’s constant k). This slight conformational entropic advantage of the HCP crystal of chains is by far insufficient to compensate for the larger translational entropic advantage of the FCC crystal, which is predicted to be the stable one. The calculated overall thermodynamic advantage of the FCC over the HCP polymorph is supported by a recent Monte Carlo (MC) simulation on a very large system of 54 chains of 1000 hard sphere monomers. Semianalytical calculations using results from this MC simulation yield in addition a value of the total crystallization entropy for linear, fully flexible, athermal polymers of Δs≈0.93k per monomer.

Abstract During the first quarter of 2020 the world is experiencing a pandemic of Severe Acute Respiratory Syndrome‑Coronavirus‑2 (SARS‑CoV‑2), a novel beta coronavirus that is responsible for the 2019 novel coronavirus disease (COVID‐19). The COVID‐19 pandemic revealed that healthcare systems around the world were not prepared to deal with either the direct effects of the pandemic or with the indirect effects that are imposed on the health of patients with chronic disorders such as cancer patients. Some challenges and dilemmas currently faced during the pandemic include the management of cancer patients during the treatment and follow‐up phases, the assessment of the safety of treatments currently used for the management of SARS‑CoV‑2 for use in cancer patients, the development of psychoeducation and emotional support for cancer patients and the safe conduct of clinical trials involving participation of cancer patients. Evidence from the literature supports the need for the urgent development of a holistic contingency plan which will include clear guidelines for the protection and comprehensive care of cancer patients. The implementation of such a plan is expected to have many beneficial effects by mainly minimizing the increased morbidity and mortality of cancer patients that could result as an adverse consequence of the COVID‐19 or future pandemics.

Rapidly progressive osteoarthritis (RPO) is a rare condition which is poorly understood. Limited published literature is available. Reported here is a cohort of patients with RPO and acetabular bone loss who underwent primary THA. Risk factors, degree of acetabular bone loss and outcomes are presented. A typical case of RPO is described and investigations discussed. A retrospective audit was undertaken. 49 patients over an 18-year period were included. RPO patients were significantly older (P < 0.01) and had a lower BMI (P = 0.03). The mean acetabular bone loss in this cohort was 10.0 mm. Pathogenesis and risk factors for developing RPO remain unclear and future research is necessary. Repeat imaging in patients with deteriorating symptoms is important and urgent surgery is required maintain bone stock.

The local and global order in dense packings of linear, semi-flexible polymers of tangent hard spheres are studied by employing extensive Monte Carlo simulations at increasing volume fractions. The chain stiffness is controlled by a tunable harmonic potential for the bending angle, whose intensity dictates the rigidity of the polymer backbone as a function of the bending constant and equilibrium angle. The studied angles range between acute and obtuse ones, reaching the limit of rod-like polymers. We analyze how the packing density and chain stiffness affect the chains’ ability to self-organize at the local and global levels. The former corresponds to crystallinity, as quantified by the Characteristic Crystallographic Element (CCE) norm descriptor, while the latter is computed through the scalar orientational order parameter. In all cases, we identify the critical volume fraction for the phase transition and gauge the established crystal morphologies, developing a complete phase diagram as a function of packing density and equilibrium bending angle. A plethora of structures are obtained, ranging between random hexagonal closed packed morphologies of mixed character and almost perfect face centered cubic (FCC) and hexagonal close-packed (HCP) crystals at the level of monomers, and nematic mesophases, with prolate and oblate mesogens at the level of chains. For rod-like chains, a delay is observed between the establishment of the long-range nematic order and crystallization as a function of the packing density, while for right-angle chains, both transitions are synchronized. A comparison is also provided against the analogous packings of monomeric and fully flexible chains of hard spheres.

Background We investigated whether blood pressure lowering for secondary prevention is associated with a reduction in recurrent stroke risk and/or a higher risk of adverse events in very elderly compared with younger trial participants. Methods and Results This is a random effects meta‐analysis of randomized controlled trials of blood pressure lowering for secondary stroke prevention to evaluate age‐stratified (

Astronauts exhibit several pathophysiological changes due to a variety of stressors related to the space environment, including microgravity, space radiation, isolation, and confinement. Space motion sickness, bone and muscle mass loss, cardiovascular deconditioning and neuro-ocular syndrome are some of the spaceflight-induced effects on human health. Optimal nutrition is of the utmost importance, and—in combination with other measures, such as physical activity and pharmacological treatment—has a key role in mitigating many of the above conditions, including bone and muscle mass loss. Since the beginning of human space exploration, space food has not fully covered astronauts’ needs. They often suffer from menu fatigue and present unintentional weight loss, which leads to further alterations. The purpose of this review was to explore the role of nutrition in relation to the pathophysiological effects of spaceflight on the human body.

This study investigates the acquisition of grammatical gender in Heritage Greek as acquired by children (6–8 years of age) and adolescents (15–18 years) growing up in Adelaide, South Australia. The determiner elicitation task from Varlokosta (2005) was employed to assess the role of morphological and semantic cues when it comes to gender assignment for real and novel nouns. Ralli’s (1994) inflectional classes for Greek nouns and Anastasiadi-Symeonidi and Cheila-Markopoulou’s (2003) categories of prototypicality were employed in the analysis of the collected data. The performance of heritage speakers was compared to that of monolingual speakers from Greece (Varlokosta, 2011). The results indicate that–beyond age differences in the two groups–a formal phonological rule guides gender assignment in the production of heritage speakers which departs from initial expectations.

We present results on polymorphism and perfection, as observed in the spontaneous crystallization of freely jointed polymers of hard spheres, obtained in an unprecedentedly long Monte Carlo (MC) simulation on a system of 54 chains of 1000 monomers. Starting from a purely amorphous configuration, after an initial dominance of the hexagonal closed packed (HCP) polymorph and a transitory random hexagonal close packed (rHCP) morphology, the system crystallizes in a final, stable, face centered cubic (FCC) crystal of very high perfection. An analysis of chain conformational characteristics, of the spatial distribution of monomers and of the volume accessible to them shows that the phase transition is caused by an increase in translational entropy that is larger than the loss of conformational entropy of the chains in the crystal, compared to the amorphous state. In spite of the significant local re-arrangements, as reflected in the bending and torsion angle distributions, the average chain size remains unaltered during crystallization. Polymers in the crystal adopt ideal random walk statistics as their great length renders local conformational details, imposed by the geometry of the FCC crystal, irrelevant.

Human-Computer Interaction (HCI) and games set a new domain in understanding people’s motivations in gaming, behavioral implications of game play, game adaptation to player preferences and needs for increased engaging experiences in the context of HCI serious games (HCI-SGs). When the latter relate with people’s health status, they can become a part of their daily life as assistive health status monitoring/enhancement systems. Co-designing HCI-SGs can be seen as a combination of art and science that involves a meticulous collaborative process. The design elements in assistive HCI-SGs for Parkinson’s Disease (PD) patients, in particular, are explored in the present work. Within this context, the Game-Based Learning (GBL) design framework is adopted here and its main game-design parameters are explored for the Exergames, Dietarygames, Emotional games, Handwriting games, and Voice games design, drawn from the PD-related i-PROGNOSIS Personalized Game Suite (PGS) (www.i-prognosis.eu) holistic approach. Two main data sources were involved in the study. In particular, the first one includes qualitative data from semi-structured interviews, involving 10 PD patients and four clinicians in the co-creation process of the game design, whereas the second one relates with data from an online questionnaire addressed by 104 participants spanning the whole related spectrum, i.e., PD patients, physicians, software/game developers. Linear regression analysis was employed to identify an adapted GBL framework with the most significant game-design parameters, which efficiently predict the transferability of the PGS beneficial effect to real-life, addressing functional PD symptoms. The findings of this work can assist HCI-SG designers for designing PD-related HCI-SGs, as the most significant game-design factors were identified, in terms of adding value to the role of HCI-SGs in increasing PD patients’ quality of life, optimizing the interaction with personalized HCI-SGs and, hence, fostering a collaborative human-computer symbiosis.

This article presents the analysis of an empirical study that explored the political discourse of the Church of Greece (CoG) during a specific period of the Greek financial crisis, that is, from January 2015 to January 2019. The analysis is based on official texts of the CoG, reports in two daily newspapers, and the results of a quantitative content analysis. Through our analysis, we explore three main questions. The first focuses on the types of issues (‘agenda’) raised by the main representatives of the CoG; the second focuses on the framing used concerning these issues; and the third focuses on how the agenda and frames interact with regard to the CoG’s active (discursive) role as an ‘established church’ and/or a ‘public religion’. Our findings indicated that the CoG intervened in a considerable number of issues not strictly related to religion or the Greek financial crisis. Moreover, the main framing devices of the CoG’s discourse varied from identity to conflict frames, while its discourse reflected its self-understanding as both an established church and a public religion.

The recent COVID-19 pandemic, which resulted from SARS CoV-2 coronavirus infection, contributed toa rapid increasein hospital and intensive care unit (ICU) admissions [...]

Being the second most common neurodegenerative disease, Parkinson's disease (PD) can be symptomatically treated, although, unfortunately, it cannot be cured yet. Moreover, diagnosing and assessing PD patients is a complex process, requiring continuous monitoring. In this vein, the design, development, and validation of innovative assessment tools may be helpful in the management of patients with PD, in particular. Based on intelligent ICT interventions, the i-PROGNOSIS project intends to mitigate PD's specific symptoms, such as neurological movement disorders of gait, balance, coordination, and posture, already characterized in the early phase of the disease. From this perspective, an innovative iPrognosis motor assessment tool is presented here, taking into consideration the Unified Parkinson Disease Rating Scale (UPDRS) Part III motor skills testing items, for evaluating the motor skills status. The efficiency of the proposed Assessment Tests to reflect the motor skills status, similarly to the UPDRS Part III items, was validated via 27 participants (18 males; mean age = 62 years, SD = 10.36 years; range, 43–79 years) with early (n = 10) and moderate (n = 17) PD who performed the Assessment Tests. Features from the latter were then correlated with the corresponding clinically assessed UPDRS Part III items, and statistically significant negative correlations (range, −0.364 to −0.802) were identified between the median values of the Assessment Tests and the UPDRS Part III items. In this vein, the iPrognosis Assessment Tests were integrated within the personalized interventions of the i-PROGNOSIS project, providing alternative means of assessing their effect on the PD patient's motor skills enhancement. The promising results presented here elaborate on the concept of using ICT-based assessment means to achieve comparable outcomes with the clinical standards in motor skills assessment.

Aims: Type 2 diabetes (T2D) is associated with dementia, and abnormal blood pressure (BP), aortic stiffness, and haemodynamics. We aimed to study the contribution of such factors to brain structure and cognition, relative to the contribution of metabolic factors in T2D such as insulin resistance and adiposity, in older people with T2D. Methods: Cross-sectional sample with T2D in the Cognition and Diabetes in Older Tasmanians–Blood Pressure (CDOT-BP) study. Measurements included neuropsychological battery, brain MRI, and Mobil-o-Graph-derived (IEM, Germany) aortic BP and haemodynamics. We studied associations of exposure variables with outcomes using structural equation modelling for cognition, and simple linear regression for brain structure, using standardised coefficients to determine relative contribution of variables to the outcomes in combined regression models. Results: 202 participants (mean age 68.5 years, mean HbA1c = 6.42%). Augmentation index was associated with processing speed (p < 0.05). The contribution of augmentation index to processing speed (standardized β = −0.237) was greater than waist-hip ratio (β = −0.175) and use of oral glucose lowering medications and insulin (β = −0.126), but less than age (β = −0.431). Peripheral systolic BP, pulse wave velocity, and peripheral nocturnal systolic BP dipping were associated with measures of white matter integrity (fractional anisotropy and mean diffusivity, p < 0.05) but not with cortical thickness. Conclusion: BP, aortic stiffness and altered haemodynamics contribute to early cognitive change and loss of white matter integrity in T2D. The novel association between nocturnal BP dipping and white matter integrity deserves further investigation. Measuring white matter integrity may be useful to detect the effect of these vascular factors on the brain.

The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.

We present Simu-D, a software suite for the simulation and successive identification of local structures of atomistic systems, based on polymers, under extreme conditions, in the bulk, on surfaces, and at interfaces. The protocol is built around various types of Monte Carlo algorithms, which include localized, chain-connectivity-altering, identity-exchange, and cluster-based moves. The approach focuses on alleviating one of the main disadvantages of Monte Carlo algorithms, which is the general applicability under a wide range of conditions. Present applications include polymer-based nanocomposites with nanofillers in the form of cylinders and spheres of varied concentration and size, extremely confined and maximally packed assemblies in two and three dimensions, and terminally grafted macromolecules. The main simulator is accompanied by a descriptor that identifies the similarity of computer-generated configurations with respect to reference crystals in two or three dimensions. The Simu-D simulator-descriptor can be an especially useful tool in the modeling studies of the entropy- and energy-driven phase transition, adsorption, and self-organization of polymer-based systems under a variety of conditions.

There is an ongoing need for new therapeutic modalities against SARS-CoV-2 infection. Mast cell histamine has been implicated in the pathophysiology of COVID-19 as a regulator of proinflammatory, fibrotic, and thrombogenic processes. Consequently, mast cell histamine and its receptors represent promising pharmacological targets. At the same time, nutritional modulation of immune system function has been proposed and is being investigated for the prevention of COVID-19 or as an adjunctive strategy combined with conventional therapy. Several studies indicate that several immunonutrients can regulate mast cell activity to reduce the de novo synthesis and/or release of histamine and other mediators that are considered to mediate, at least in part, the complex pathophysiology present in COVID-19. This review summarizes the effects on mast cell histamine of common immunonutrients that have been investigated for use in COVID-19.

Abstract Background In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population’ preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. Methods The ‘conjoint analysis’ technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. Results It was revealed that the “severity of the disease” and the “age of the patient” were the key prioritization criteria. Participants assigned the smallest relative value to the criterion “healthy lifestyle”. More precisely, participants older than 35 years old assigned higher relative importance to “age”, while younger participants to the “severity of the disease”. The “healthy lifestyle” criterion was assigned to the lowest relative importance to by all participants. Conclusion In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public’s participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the General System of Health Insurance.

We investigate, through Monte Carlo simulations, the heterogeneous crystallization of linear chains of tangent hard spheres under confinement in one dimension. Confinement is realized through flat, impenetrable, and parallel walls. A wide range of systems is studied with respect to their average chain lengths (N = 12 to 100) and packing densities (φ = 0.50 to 0.61). The local structure is quantified through the Characteristic Crystallographic Element (CCE) norm descriptor. Here, we split the phenomenon into the bulk crystallization, far from the walls, and the projected surface crystallization in layers adjacent to the confining surfaces. Once a critical volume fraction is met, the chains show a phase transition, starting from regions near the hard walls. The established crystal morphologies consist of alternating hexagonal close-packed or face-centered cubic layers with a stacking direction perpendicular to the confining walls. Crystal layer perfection is observed with an increasing concentration. As in the case of the unconstrained phase transition of athermal polymers at high densities, crystal nucleation and growth compete with the formation of sites of a fivefold local symmetry. While surface crystallites show perfection with a predominantly triangular character, the morphologies of square crystals or of a mixed type are also formed. The simulation results show that the rate of perfection of the surface crystallization is not significantly faster than that of the bulk crystallization.

Although several studies have reported an association between malnutrition and the risk of severe complications after abdominal surgery, there have been no studies evaluating the use of Global Leadership Initiative on Malnutrition (GLIM) criteria for predicting postoperative pulmonary complications (PPCs) following major abdominal surgery in cancer patients. This study aimed to investigate the association among the diagnosis of malnutrition by GLIM criteria, PPCs risk and 90-day all-cause mortality rate following major abdominal surgery in cancer patients. We prospectively analyzed 218 patients (45% male, mean age 70.6 ± 11.2 years) with gastrointestinal cancer who underwent major abdominal surgery at our hospital between October 2018 and December 2019. Patients were assessed preoperatively using GLIM criteria of malnutrition, and 90-day all-cause mortality and PPCs were recorded. In total, 70 patients (32.1%) were identified as malnourished according to GLIM criteria, of whom 41.1% fulfilled the criteria for moderate and 12.6% for severe malnutrition. PPCs were detected in 48 of 218 patients (22%) who underwent major abdominal surgery. Univariate logistic regression analysis revealed that the diagnosis of malnutrition was significantly associated with the risk of PPCs. Furthermore, in multivariate model analysis adjusted for other clinical confounding factors, malnutrition remained an independent factor associated with the risk of PPCs (RR = 1.82; CI = 1.21–2.73) and 90-day all-cause mortality (RR = 1.97; CI = 1.28–2.63, for severely malnourished patients). In conclusion, preoperative presence of malnutrition, diagnosed by the use of GLIM criteria, is associated with the risk of PPCs and 90-day mortality rate in cancer patients undergoing major abdominal surgery.

Helicobacter pylori infection induces a plethora of DNA damages. Gastric epithelial cells, in order to maintain genomic integrity, require an integrous DNA damage repair (DDR) machinery, which, however, is reported to be modulated by the infection. CagA is a major H. pylori virulence factor, associated with increased risk for gastric carcinogenesis. Its pathogenic activity is partly regulated by phosphorylation on EPIYA motifs. Our aim was to identify effects of H. pylori infection and CagA on DDR, investigating the transcriptome of AGS cells, infected with wild-type, ΔCagA and EPIYA-phosphorylation-defective strains. Upon RNA-Seq-based transcriptomic analysis, we observed that a notable number of DDR genes were found deregulated during the infection, potentially resulting to base excision repair and mismatch repair compromise and an intricate deregulation of nucleotide excision repair, homologous recombination and non-homologous end-joining. Transcriptome observations were further investigated on the protein expression level, utilizing infections of AGS and GES-1 cells. We observed that CagA contributed to the downregulation of Nth Like DNA Glycosylase 1 (NTHL1), MutY DNA Glycosylase (MUTYH), Flap Structure-Specific Endonuclease 1 (FEN1), RAD51 Recombinase, DNA Polymerase Delta Catalytic Subunit (POLD1), and DNA Ligase 1 (LIG1) and, contrary to transcriptome results, Apurinic/Apyrimidinic Endodeoxyribonuclease 1 (APE1) upregulation. Our study accentuates the role of CagA as a significant contributor of H. pylori infection-mediated DDR modulation, potentially disrupting the balance between DNA damage and repair, thus favoring genomic instability and carcinogenesis.

In the present work, we revise and extend the Characteristic Crystallographic Element (CCE) norm, an algorithm used to simultaneously detect radial and orientational similarity of computer-generated structures with respect to specific reference crystals and local symmetries. Based on the identification of point group symmetry elements, the CCE descriptor is able to gauge local structure with high precision and finely distinguish between competing morphologies. As test cases we use computer-generated monomeric and polymer systems of spherical particles interacting with the hard-sphere and square-well attractive potentials. We demonstrate that the CCE norm is able to detect and differentiate, between others, among: hexagonal close packed (HCP), face centered cubic (FCC), hexagonal (HEX) and body centered cubic (BCC) crystals as well as non-crystallographic fivefold (FIV) local symmetry in bulk 3-D systems; triangular (TRI), square (SQU) and honeycomb (HON) crystals, as well as pentagonal (PEN) local symmetry in thin films of one-layer thickness (2-D systems). The descriptor is general and can be applied to identify the symmetry elements of any point group for arbitrary atomic or particulate system in two or three dimensions, in the bulk or under confinement.