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Black holes binaries coming from a distribution of primordial black holes might exhibit a large merger rate up to large redshifts. Using a phenomenological model for the merger rate, we show that changes in its slope, up to redshifts $z\sim 4$, are constrained by current limits on the amplitude of the stochastic gravitational wave background from LIGO/Virgo O3 run. This shows that the stochastic background constrains the merger rate for redshifts larger than the single event horizon of detection ($z\simeq 1$ for the same detector). Moreover, we show that for steep merger rates the shape of the stochastic gravitational wave signal at intermediate frequencies differs from the usual $2/3$ IR scaling. We discuss the implications of our model for future experiments in a wide range of frequencies, as the design LIGO/Virgo array, Einstein Telescope, LISA and PTA. Additionally, we show that i) the stochastic background and the present merger rate provide equally constraining bounds on the abundance of PBHs arising from a Gaussian distribution of inhomogeneities and ii) Degeneracies at the level of the stochastic background (i.e. different merger histories leading to a similar stochastic background) can be broken by considering the complementary direct observation of the merger rate from number counts by future detectors such as the Einstein Telescope., Comment: 29 pages, 7 figures

Σκοπός της διατριβής ήταν η μελέτη των περιορισμών των μαρτύρων κατά την απόδειξη των δικαιοπραξιών. Η διατριβή αποτελείται από τέσσερα μέρη. Στο πρώτο, οριοθετείται η έννοια του μάρτυρα, κατατάσσονται οι περιορισμοί σε υποκειμενικούς και αντικειμενικούς, παρουσιάζονται οι αντίστοιχες ρυθμίσεις αλλοδαπών δικαίων (ιδίως του γαλλικού) και παρουσιάζεται η διαχρονική πορεία του θεσμού στην ελληνική έννομη τάξη. Στο δεύτερο μέρος, αναλύονται οι κανόνες που απαγορεύουν την εμμάρτυρη απόδειξη της δικαιοπρακτικής δέσμευσης (απαγόρευση μαρτύρων λόγω έγγραφου τύπου, απαγόρευση μαρτύρων λόγω ποσού, απαγόρευση απόδειξης με μάρτυρες κατά του περιεχομένου εγγράφου, απαγόρευση απόδειξης με μάρτυρες πρόσθετων συμφώνων δικαιοπραξίας που καταρτίστηκε εγγράφως). Στο τρίτο μέρος, αναλύονται οι εξαιρέσεις των περιορισμών του εμμάρτυρου μέσου. Έτσι, μάρτυρες επιτρέπονται ελεύθερα όταν υπάρχει αρχή έγγραφης απόδειξης ή αδυναμία σύνταξης εγγράφου (φυσική ή ηθική) κατά τον κρίσιμο χρόνο κατάρτισης της δικαιοπραξίας ή τυχαία απώλεια του εγγράφου που είχε συνταχθεί, καθώς και όταν από την φύση της δικαιοπραξίας ή τις ειδικές συνθήκες κατάρτισης δικαιολογούνταν η μη σύνταξη εγγράφου. Η εμπορικότητα της διαφοράς συνιστά προνομιακά αντιμετωπιζόμενη εξαιρετική περίσταση. Στο τέταρτο μέρος παρουσιάζεται η επίδραση των περιορισμών των μαρτύρων στη χρήση των αποδεικτικών μέσων των δικαστικών τεκμηρίων, των ενόρκων βεβαιώσεων και της εξέτασης των διαδίκων. Ερευνάται η επίδραση των περιορισμών στη διαμόρφωση της φυσιογνωμίας της αποδεικτικής διαδικασίας, αλλά και η εφαρμογή τους στο πλαίσιο της ποινικής δίκης.

Objectives We compared the long-term outcomes of percutaneous coronary intervention with second-generation drug-eluting stents (PCI-DES) and coronary artery bypass graft surgery (CABG) with the left internal mammary artery in stable angina patients with isolated single-vessel proximal left anterior descending artery (pLAD) disease. Background Long-term outcomes of second-generation PCI-DES and CABG in isolated pLAD lesions have not been extensively studied. Methods We included 631 PCI-DES patients and 379 CABG patients. Unadjusted and adjusted hazard ratios (HRs) were derived for major adverse cardiac events (MACEs), their components (cardiac death, nonfatal myocardial infarction [MI] not attributed to a non-target vessel, target-lesion revascularization), and patient-related outcome (PRO, composed of all-cause mortality, any MI, any revascularization). Results In the unadjusted and adjusted analyses, no significant difference was observed between the two groups at follow-up (mean:4.6 +/- 2.5 years) for MACEs (HR: 1.45, 95% CI: 0.92-2.28,p= .11; HR:1.43, 95% CI: 0.91-2.26,p= .13), PRO (HR: 1.18, 95%CI: 0.86-1.61,p= .30; HR: 1.18, 95% CI: 0.86-1.62,p= .31), cardiac death (HR: 0.97, 95% CI: 0.46-2.05,p= .93; HR: 0.79, 95% CI: 0.36-1.72,p= .56) and MI (HR: 1.43, 95% CI: 0.49-4.13,p= .51; HR: 1.57, 95% CI: 0.53-4.64,p= .42). Compared with CABG, PCI-DES had a borderline significantly greater risk of repeat revascularization (HR: 1.99, 95% CI: 1.00-3.94,p= .05; HR: 1.95, 95% CI: 0.98-3.9,p= .06). Angina recurred more often after PCI (p < .001), whereas more arrhythmias developed after CABG (p= .02). PCI-DES resulted in fewer in-hospital complications (p < .001) and shorter hospitalizations (p < .001). Conclusions The long-term clinical outcomes of second-generation PCI-DES and CABG in patients with stable angina and isolated pLAD disease were comparable.

The changing hormonal milieu during the menopausal transition may contribute to the development of memory disorders. We aimed to assess the association of sex hormones with memory function in a sample of Greek middle-aged women. This pilot study included 44 women with subjective memory complaints. Memory performance was evaluated using the Hopkins Verbal Learning Test (HVLT), the Brief Visuospatial Memory test (BVMT), and the verbal digits backwards test (VSPAN), to assess verbal, visuospatial, and working memory performance, respectively. Menopausal symptoms were assessed using the Green Climacteric Scale. VSPAN backwards scores were positively associated with log-transformed free androgen index (logFAI), in models adjusted for age, education, log-transformed free estrogen index (logFEI), hypertension, and the intensity of menopausal symptoms. BVMT total scores were predicted by logFAI (b-coefficient = 0.424, p value = 0.002), education, and combined climacteric symptomatology, in a model adjusted for age, logFEI, and hypertension. Women with circulating estradiol above the median value of 10 pg/mL had better total HTLV total scores compared to women with estradiol values below the median (HTLV total scores, estradiol ≤ 10 pg/mL vs. > 10 pg/mL: 24.2 ± 3.6 vs. 30.0 ± 7.9, p value = 0.007 unadjusted). This association was affected by education and remained independent of menopausal symptoms and testosterone levels, education, and hypertension (model R 2 = 22.3%; b-coefficient = 0.318, p value = 0.024). Endogenous total estradiol is associated with verbal episodic memory, while logFAI is associated with working memory performance and visuospatial episodic memory in this sample of postmenopausal women. These associations were not influenced by age, education, or menopausal symptoms. Larger studies are necessary to evaluate the significance of our findings.

The rate of merger events observed by LIGO/Virgo can be used in order to probe the fraction $f$ of dark mater in the form of Primordial Black Holes. Here, we consider the merger rate of PBH binaries, accounting for the effect of cosmological perturbations on their initial eccentricity $e$. The torque on the binaries receives significant contributions from a wide range of scales, that goes from the size of the horizon at the time when the binary forms, down to the co-moving size of the binary. In scenarios where PBH are formed from adiabatic perturbations, it is natural to expect an enhancement of the power spectrum $P_\Phi$ at small scales, where it is poorly constrained observationally. The effect can then be quite significant. For instance, a nearly flat spectrum with amplitude $P_\Phi \gtrsim 10^{-7}$ on scales smaller than $\sim 10 Mpc^{-1}$ gives a contribution $\langle j^2 \rangle \sim 10^3 P_\Phi$, where $j= (1-e^2)^{1/2}$ is the dimensionless angular momentum parameter of the binaries. This contribution can dominate over tidal torques from neighboring PBHs for any value of $f$. Current constraints allow for a power spectrum as large as $P_\Phi \sim 10^{-5}$ at the intermediate scales $10^3-10^5 Mpc^{-1}$, comparable to the co-moving size of the binaries at the time of formation. In particular, this can relax current bounds on the PBH abundance based on the observed LIGO/Virgo merger rate, allowing for a fraction $f\sim 10\%$ of dark matter in PBH of mass $\sim 30 M_\odot$. We investigate the differential merger rate $\Delta\Gamma(m_1,m_2)$, as a function of the masses of the binary components, and the corresponding ``universality" coefficient $\alpha = -(m_1+m_2)^2 \partial^2 \ln \Delta\Gamma/\partial m_1\partial m_2$, concluding that merger rates may provide valuable information on the spectrum of primordial cosmological perturbations at currently uncharted lengthscales., Comment: 38 pages, 12 figures

Overt or subclinical thyroid dysfunction may affect the risk of fragility fractures. The aim of the present study was to assess the association of thyroid function and autoimmunity with vertebral fractures (VF) in a large sample of Greek postmenopausal women. This cross-sectional study recruited 335 euthyroid postmenopausal women, aged 35-79 years. Euthyroidism was verified by serum thyroid-stimulating hormone (TSH) within the laboratory reference range (0.4-4.5 μIU/mL). VFs were diagnosed by lumbar spine lateral radiographs, according to quantitative procedures. Serum free triiodothyronine (FT3), free thyroxine (FT4), TSH, as well as levels of anti-thyroglobulin (anti-TG) and thyroid peroxidase antibodies (anti-TPO) were compared according to the presence of VFs. Multivariate logistic regression showed that the presence of VFs was predicted independently by ln-TSH levels (OR = 0.290, p = 0.037) and positive anti-TG antibodies (OR = 3.308, p = 0.026) in models adjusted for age, menopausal age, and ln-HOMA-IR. Stepwise logistic regression analysis showed that the presence of VFs was predicted by menopausal age (OR = 1.120, p = 0.001), ln-TSH (OR = 0.312, p = 0.052), and thyroid autoimmunity (anti-TG and anti-TPO positive: OR = 6.637, p = 0.007) in a model that also included age and ln-HOMA-IR. Women with lower circulating TSH had higher risk of having a VF, independently of age, menopausal age, and insulin resistance. The presence of positive anti-TG/anti-TPO antibodies also indicated an elevated risk of fracture. Levels of thyroid hormones had no apparent effect on the risk of fracture. Further studies are necessary to establish the significance of our findings.

PURPOSE In a considerable percentage of individuals with a detectable alpha rhythm in their EEG, bursts of generalized hypersynchronous alpha activity (GHSAA) may occur, during alertness. The aim of this study was to examine whether appearance of GHSAA, which probably generates from transcortical circuitry, shows any correlation with demographic characteristics, underlying normal or abnormal pathophysiology, or substances in use. METHODS The authors retrospectively reviewed 441 EEG recordings performed in their laboratory during a 1-year period for presence of GHSAA, concomitantly collecting data that concerned symptoms, diagnosis, imaging, medication, and demographics. Recordings in mental states other than alertness were excluded from the sample. RESULTS Generalized hypersynchronous alpha activity was found in 22.95% of the study population. Its occurrence was diminished in male gender (P < 0.001), older age (Kendall tau, 0.16; P < 0.0001), and disorders involving structural abnormalities like brain lesions or neurodegeneration (P < 0.02). Dementia, Parkinson disease, and psychoses showed individually a trend towards lower GHSAA presence. CONCLUSIONS In the sample, the presence of GHSAA was commonly observed in the cohort of patients without abnormalities in their neuroimaging studies. Generalized hypersynchronous alpha activity is a finding of youth and requires a properly functioning cerebral cortex in order to emerge. Female preponderance may signify underlying trangender differences in alpha rhythm generators. These preliminary results indicate that the significance of GHSAA alterations deserves more thorough evaluation in larger groups of patients suffering from a variety of different neuropsychiatric disorders.

We evaluated possible associations between the severity of multiple sclerosis (MS) and levels of sex hormones as well as biochemical parameters in a sample of ambulatory patients.This cross-sectional study recruited 133 adults (52 men, 66 premenopausal and 15 postmenopausal women), with relapsing-remitting MS. Fasting venous blood samples were drawn for biochemical and hormonal evaluation. These parameters were tested for possible associations with MS severity, assessed using the Expanded Disability Status Scale (EDSS)-scores.Follicle-stimulating hormone correlated with mean EDSS scores (r = -0.369, p = 0.038) in the premenopausal subgroup. However, this association became non-significant in the age-adjusted multivariate analysis (p = 0.141; power = 67%, type α error 0.10). Free androgen exhibited a borderline negative effect on EDSS-scores in the subgroup of men (r = -0.367, p = 0.093), which was lost after adjusting for age and duration of disease (p = 0.192; statistical power = 93%, type α error 0.05). Levels of estradiol tended to affect disability status of postmenopausal women (normal-mild vs. severe impairment: 23.33 ± 11.73pg/mL vs. 14.74 ± 6.30pg/mL, p = 0.095). Levels of sex hormones or indices of glycemic metabolism did not differ between patients presenting with EDSS scores higher or lower than the median value.Sex hormones and indices of glucose metabolism exhibited only a middle effect on EDSS scoring, which was not independent from the presence of confounders like age and duration of MS. The present study highlights the need for additional research, in order to elucidate the role of sex hormones and insulin resistance in the course of MS.

We examined the contribution of demographics and cognitive background variables (processing speed, visuospatial skill, working memory, and interference control) on derived Trail Making Test (TMT) scores in a large sample of Greek healthy participants. We included 775 participants and administered the TMT (TMT-A and TMT-B) and the Wechsler Intelligence Adult Scale (WAIS). Direct (TMT-A & TMT-B time-to-completion) and derived [difference TMT-(B - A) & ratio TMT-(B/A)] scores were calculated. Demographics (age, age(2), education, and gender) and WAIS Full Intelligence Quotient significantly predicted the direct TMT-A (R(2) = 0.426) and TMT-B (R(2) = 0.593) scores and to a lesser extent, the derived TMT-(B - A) (R(2) = 0.343) and TMT-(B/A) (R(2) = 0.088) scores. In a subsample of 537 healthy participants who also completed the Stroop Neuropsychological Screening Test (SNST), demographics (age and education), WAIS Digit Symbol, Block Design, Arithmetic, and SNST accounted for 44.8% and 59.7% of the variance on TMT-A and TMT-B, and 32.5% and 9.6% of the variance on TMT-(B - A) and TMT-(B/A), respectively. We found minimal influence of Block Design and Arithmetic on TMT-(B - A) and an absence of significant influence of any cognitive variable on TMT-(B/A) score. Concluding, derived TMT scores are suggested as indices to detect impairment in cognitive flexibility across the adult life span, since they minimize the effect of demographics and other cognitive background variables.

Previous studies have showed that perceived stress (PS) in patients with multiple sclerosis (MS) constitutes an important factor for disease onset, relapse, symptomatology and psychological adjustment.The aim of this pilot cross-sectional study was to examine the role of self-esteem in PS, after controlling for sociodemographical characteristics, depression and personality in MS patients.Sixty-six relapsing-remitting MS patients (66.67% females, mean age of 40 ± 11.1 years old, mean duration of disease 133.6 ± 128.8 months) were studied. Perceived stress, self-esteem, depression and personality type were assessed using self-administered questionnaires. Hierarchical multivariate regression modelling was used.Higher education and depression and lower self-esteem were independently and significantly associated with increased PS, accounting for 40.5% of its variance. Univariate analyses revealed that low extroversion and openness and higher neurotism were associated with higher PS, although no significant after adjusting for other factors.Although our findings need further confirmation, psychological interventions targetting self-esteem are strongly encouraged.

1 Department of Oral and Maxillofacial Surgery, Dental School, University of Athens, Greece. Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece. Department of Neurology, School of Medicine, University of Ioannina, Greece. 4 Department of Neurology, “Eginition” Hospital, School of Medicine, University of Athens, Greece. Vascular Unit, Third Department of Surgery, “Attikon” Hospital, School of Medicine, University of Athens, Greece. 6 Second Department of Neurosurgery, “Attikon” Hospital, School of Medicine, University of Athens, Greece. 7 Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA. 8 International Clinical Research Center, St. Anne’s University Hospital in Brno, Brno, Czech Republic.

Background and objectives Clinicians commonly use verbal and nonverbal measures to test fluency in patients with epilepsy, either during routine cognitive assessment or as part of pre- and postsurgical evaluation. We hypothesized that patients with mesial temporal lobe epilepsy (TLE) with hippocampal sclerosis would perform worse than patients with lateral TLE in both verbal and design fluency. Methods We assessed semantic, phonemic, and nonverbal fluency in 49 patients with TLE: 31 with lateral TLE and 18 with mesial TLE plus hippocampal sclerosis. We also gave non-fluency cognitive measures: psychomotor speed, attentional set shifting, selective attention, abstract reasoning, verbal and visual episodic memory, and incidental memory. Results Patients with mesial TLE performed significantly worse on figural fluency than patients with lateral TLE. Even though group differences on verbal fluency measures were not significant, the patients with mesial TLE had a pattern of poorer performance. The patients with mesial TLE scored significantly worse on measures of selective attention, verbal episodic memory, and incidental memory. Conclusions Our study underlines differences in cognitive function between patients with mesial and lateral TLE, particularly in figural fluency. Although we cannot directly assess the role of the hippocampus in cognitive aspects of creative and divergent thinking related to figural fluency, the cognitive discrepancies between these two TLE groups could be ascribed to the mesial TLE hippocampal pathology shown in our study and addressed in the literature on hippocampal involvement in divergent thinking. Our findings could benefit cognitive rehabilitation programs tailored to the needs of patients with TLE.

Young-onset dementias pose a major challenge to both clinicians and researchers. Cognitive decline may be accompanied by systemic features, leading to a diagnosis of "dementia plus" syndromes. Whipple disease is a rare systemic illness characterized by arthralgias, chronic diarrhea, weight loss, fever, and abdominal pain. Central nervous system involvement, including severe cognitive deterioration, may precede systemic manifestations, appear during the course of the disease, or even be the only symptom. We report a previously highly functional 48-year-old man whom we first suspected of having early-onset neurodegenerative dementia but then diagnosed with Whipple disease based on a detailed clinical and laboratory evaluation. Initial neuropsychological evaluation revealed marked impairment in the patient's fluid intelligence and severe cognitive deficits in his information processing speed, complex attention, memory, visuomotor and construction dexterities, problem solving, and executive functions. At neuropsychological follow-up 21 months later, his information processing speed had improved only slightly and deficits persisted in his other cognitive functions. Repeat brain magnetic resonance imaging at that time showed that he had responded to antibiotic treatment. Because Whipple disease can cause young-onset "dementia plus" syndromes that may leave patients with neurocognitive deficits even after apparently successful treatment, we recommend comprehensive neuropsychological assessment for early detection of residual and reversible cognitive processes and evaluation of treatment response.

Background In recent years, there has been increasing interest in the role of plasma homocysteine (Hcy) as a possible risk factor for several diseases of the central nervous system. The aim of this study was to determine the plasma levels of Hcy in a group of multiple sclerosis (MS) patients from a Greek population and the possible correlation with age, disability status, activity or duration of disease, sex, and treatment. Methods The MS group that was studied consisted of 46 patients and a total of 42 healthy individuals served as a control group. Plasma Hcy levels were determined by means of high-performance liquid chromatography coupled with fluorescence detection, after precolumn derivatization with 4-Fluoro-7-aminosulfonylbenzofurazan (ABD-F). Results Statistical analysis revealed that, in the MS patients, Hcy levels were not significantly different as compared to those in the controls. Men presented with higher Hcy levels than women in the MS group; however, age, disease subtype, disease duration, relapse rate, and Expanded Disability Status Scale score/Multiple Sclerosis Severity Score did not significantly affect Hcy levels in MS patients. Conclusion The preliminary data suggest that Hcy levels were not elevated in our sample of Greek MS patients, which does not support previous findings of a significant correlation between elevated serum Hcy levels and MS. Further studies to establish a possible association between MS and Hcy levels in the context of different ethnic groups with different habits are needed.

A hyperoperation on the pixels of a two-dimensional picture is introduced and studied. In this setup pictures are defined as a specific type of rectangular graphs and the picture hyperoperation is given by virtue of the notion of the path inside such a picture. Using this hyperoperation objects can naturally be defined inside pictures in an algebraic way and this concept can be utilized in order to formally represent and compare video content using algebraic semiotics.

Background: Utilization of antiepileptic drugs (AEDs) has long been associated with bone deleterious effects. Furthermore, the BsmI restriction fragment polymorphism of the vitamin D receptor (VDR) has been associated with reduced bone mineral density (BMD), mostly in postmenopausal women. This study evaluates the association between bone metabolism of patients with epilepsy and the BsmI VDR’s polymorphism in chronic users of AEDs. Methods: This study evaluated 73 long-term users of antiepileptic drug monotherapy, in a cross-sectional design. Fasting blood samples were obtained to estimate the circulating serum levels of calcium, magnesium, phosphorus, parathormone, 25hydroxyvitamin D as well as the VDR’s genotype. Bone mineral density at the lumbar spine was measured with Dual Energy X-Ray Absorptiometry. Results: Bone mineral density was significantly associated with the genotype of VDR (mean BMD: Bb genotype 1.056 ± 0.126 g/cm2; BB genotype 1.059 ± 0.113 g/cm2; bb genotype 1.179 ± 0.120 g/cm2; P

The case of a middle-aged man who had intraventricular hemorrhages secondary to Moyamoya disease (MMD), and initially, presented with psychiatric symptoms which did not respond to treatment is described. Neuropsychological assessment showed underlying significant cognitive deficits, mostly of complex attention and speed of information processing, visuospatial and constructional abilities, verbal and nonverbal memory, and executive functions. These deficits remained stable or slightly improved in follow-up assessments. Cognitive dysfunction should be suspected in case of psychiatric or psychiatric-related symptoms in MMD patients. This case study in Greece highlights the range of preserved and impaired cognitive functions in adult MMD by means of repeated neuropsychological evaluations in which a broad range of cognitive abilities were assessed.

Aim of the report was the study of the clinical features of neurosyphilis in the last 40 years (1965-2005). The investigation was based on the retrospective review of patients with neurosyphilis hospitalized in our hospital from 1965 to 2005 (period A: 1965-1984 and B: 1985-2005). Eighty one patients with neurosyphilis were studied. Typical forms represent 68.6% of cases of neurosyphilis in period A. In period B, 85.7% of the cases are presented with atypical clinical patterns. Typical forms of the disease were no longer common, while atypical and masked clinical patterns prevailed. Neuropsychiatric symptoms were the most common manifestations of the disease.

We evaluated cross-sectionally the associations of depression and anxiety with age, sex, duration of illness, educational level, degree of disability and treatment with interferon-beta in outpatients with relapsing-remitting multiple sclerosis (RRMS) during a clinically stable phase of their illness.The depression status scored on the Beck Depression Inventory (BDI), the symptoms of anxiety assessed using the State Trait Anxiety Inventory (STAI) and the level of disability measured by the Expanded Disability Status Scale (EDSS) were quantified in 86 consecutive RRMS patients.Linear regression analyses indicated that EDSS was independently (P0.001) associated with BDI and STAI and accounted for 15.7% and 18.5% of the variance in BDI and STAI respectively. The former association retained its statistical significance in multiple regression models adjusting for demographic and clinical characteristics.Disability status is an independent but moderate determinant of depression and anxiety in MS patients.

Serum folate and vitamin B12 levels were measured in 67 consecutive Parkinson’s disease patients treated either with levodopa + dopa decarboxylase inhibitor (DDC-i) plus catechol-O-methyltransferase inhibitors (COMT-i) or only with levodopa + DDC-i. The data were compared to 67 age-matched controls. Our findings show that levodopa-treated Parkinson’s disease patients have low folate (p < 0.0007) and vitamin B12 levels (p < 0.0003). They also demonstrate that the addition of a COMT-i to levodopa + DDC-i treatment causes lower serum vitamin B12 (p < 0.03) and folate levels (p < 0.005) than levodopa + DDC-i treatment alone. We suggest supplementary treatment with vitamin B12 and folic acid in these situations.

Heart failure (HF) is known to be a major risk factor for first-ever ischemic stroke (IS), and is associated with greater stroke severity and higher rates of early mortality and residual disability. There are limited data regarding the association of HF with stroke recurrence. We sought to evaluate the relationship between HF and recurrent IS using a comprehensive meta-analytical approach. We performed a systematic literature review according to PRISMA guidelines to identify all prospective study protocols (randomized clinical trials or observational cohorts) that reported rates of IS recurrence in patients with concomitant HF. We pooled independently the reported corresponding risk ratios (RRs) and hazard ratios (HRs) from each study protocol using the random effects model. Heterogeneity across included studies was evaluated using Cochran Q and I(2) statistics. Our literature search identified 7 eligible studies including 9173 IS patients (18.2% with HF). The reported mean follow-up period in the included studies ranged from 7days to 5years. The pooled estimate of RRs and HRs for recurrent IS was 1.96 (95% CI: 1.49-2.60; p

Enzyme-inducing antiepileptic drugs AEDs have adverse effects on bone mineral density (BMD), whereas studies on levetiracetam (LEV), a nonenzyme-inducing agent, have showed conflicting results. The aim of this study was to further elucidate the role of LEV in bone health. A sample of forty-six patients with epilepsy (mean age: 35.7 years, range: 20.2-64.2 years, 39.1% males) on LEV monotherapy for at least one year (range: 1.5-14.5 years, median 5.5 years) underwent femoral neck (FN) and lumbar spine (LS) BMD measurements. The T- and Z-scores were calculated. Results showed that 15.2% of the patients were identified with osteopenia and none with osteoporosis. Pearson's correlations revealed a negative but not significant association of LEV duration with bone-related measurements (range of rhos: from -0.004 to -0.23), except for LS T-scores. In terms of FN BMD measurements, Z-scores, and T-scores, longer LEV therapy duration had adverse but not significant effects on bone health after adjusting for age and gender. With regard to LS BMD measurements, Z-scores, and T-scores, men taking LEV for at least 5.5 years had better, although not significant, bone health compared with men with shorter LEV exposure, after adjusting for age. The opposite was found in women, although differences did not reach significance. These preliminary results are indicative of a differential effect of LEV therapy duration in men and women, which could presumably account for the incongruity of the already published studies. Also, LS assessments were more sensitive to these gender differences. Future larger studies should validate these results.

Both central (CNS) and peripheral nervous system (PNS) complications are frequent and varied in connective tissue diseases. A systematic review was conducted between 1989 and 2014 in the databases Medline, Scopus, and Cochrane Library using the search terms, peripheral and central nervous complications and immunological profiles, to identify studies in specific connective tissue disorders such as rheumatoid arthritis, systemic lupus erythematosus, and primary Sjögren’s syndrome. A total of 675 references were identified, of which 118 were selected for detailed analysis and 22 were included in the final review with a total of 2338 participants. Our search focused only on studies upon connective tissue disorders such as rheumatoid arthritis, systemic lupus erythematosus, and primary Sjögren’s syndrome associated with seroimmunological data. The reported prevalence of CNS involvement ranges from 9 to 92% across the reported studies. However, the association between CNS and PNS manifestations and seroimmunological profiles remains controversial. Τo date, no laboratory test has been shown as pathognomonic neither for CNS nor for PNS involvement.

Objective Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic ischemic stroke or transient ischemic attack has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods We performed a systematic literature review to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD, or both compared to the gold standard of TEE. Results Our literature search identified 35 eligible studies including 3,067 patients. The pooled sensitivity and specificity for TCD was 96.1% (95% confidence interval [CI] = 93.0–97.8%) and 92.4% (95% CI = 85.5–96.1%), whereas the respective measures for TTE were 45.1% (95% CI = 30.8–60.3%) and 99.6% (95% CI = 96.5–99.9%). TTE was superior in terms of higher positive likelihood ratio values (LR+ = 106.61, 95% CI = 15.09–753.30 for TTE vs LR+ = 12.62, 95% CI = 6.52–24.43 for TCD; p = 0.043), whereas TCD demonstrated lower negative likelihood values (LR− = 0.04, 95% CI = 0.02–0.08) compared to TTE (LR− = 0.55, 95% CI = 0.42–0.72; p < 0.001). Finally, the area under the summary receiver operating curve (AUC) was significantly greater (p < 0.001) in TCD (AUC = 0.98, 95% CI = 0.97–0.99) compared to TTE studies (AUC = 0.86, 95% CI = 0.82–0.89). Interpretation TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE. Ann Neurol 2016;79:625–635

ObjectiveWe aimed to evaluate the association between thyroid hormones and indices of obesity in a sample of euthyroid postmenopausal women.DesignCross-sectional study.MethodsSerum levels of TSH, free triiodothyronine (FT3), and free thyroxine (FT4) as well as BMI and waist:hip ratio (WHR) were evaluated in 194 healthy euthyroid postmenopausal women. Ultrasonography was used to assess abdominal fat layers (subcutaneous fat (SF), preperitoneal fat (PF), and SF:PF ratio). Indices of adiposity were defined as high vs low depending on the median value of the assessed parameters.ResultsAfter multivariate adjustment for traditional risk factors, lower FT4levels and a higher FT3:FT4ratio predicted higher SF mass (FT4, Exp(β)=0.035,P=0.020 and FT3:FT4, Exp(β)=2.374,P=0.018), whereas higher FT3predicted higher PF mass (Exp(β)=2.815,P=0.032). Women with FT3:FT4above the highest quartile had a significantly higher SF mass as compared to women in the lowest quartile (1.81±0.62 cm vs 1.54±0.46 cm,P=0.027). BMI had a positive independent association with TSH (Exp(β)=1.829,P=0.018). Finally, FT3was significantly associated with SF mass among women with higher BMI (FT3,β=0.259,P=0.040) and women with higher WHR (β=0.309,P=0.020) but not among women with lower BMI or WHR values.ConclusionThyroid hormone levels, and in particular FT3, were independently associated with SF and PF in euthyroid postmenopausal women, and this association was mainly evident in women with higher BMIs. On the other hand, among traditional indices of adiposity, only TSH was positively associated with BMI. Larger prospective studies are needed to evaluate the significance of the present findings.

This pilot study aimed to investigate the expression of estrogen (ER) and progesterone receptors (PR), as well as their subtypes [alpha (ERα), beta (ERβ)], in the ovaries of postmenopausal women with benign or malignant endometrial pathology. Twenty postmenopausal women (age 66.2 ± 7.4 years) were included, diagnosed with benign (n = 10) or malignant [(serous/papillary (n = 4), endometrioid (n = 6)] endometrial lesions. Higher ERβ and PR ovarian expressions were observed comparing women with endometrioid versus non-endometrioid endometrial carcinoma (p = 0.022 and p = 0.029, respectively). Age, age at menarche and presence of hypertension were negatively associated with ERs and PR expression. The expression of ERα and ERβ was inversely correlated with menopausal age, which was not verified for PR. No significant association was observed between ERs or PR expression and benign or malignant endometrial pathology. Higher expression of ERβ and PR in the postmenopausal ovary is associated with the presence of a less aggressive type of endometrial cancer, comparing women with endometrioid versus non-endometrioid lesions. The expression pattern of ovarian receptors did not differ regarding the development of benign or malignant endometrial lesions. Larger observational studies are necessary to confirm the significance of our findings.

Urinary incontinence in general is a major cause of quality of life impairment, morbidity and hospitalization. Its onset is strongly linked to the menopause. Our study aimed to elucidate the possible relationship between endogenous circulating estrogens and the onset and development of stress urinary incontinence (SUI).One hundred and thirty eight peri- and postmenopausal women with SUI were matched 1:1 with continent women based on age and BMI. Morning fasting blood samples were drawn from all subjects for assessment of estradiol (E2), FSH, LH, Testosterone, Δ4-Androstendione (Δ4Α), DHEAS, prolactin, SBHG as well as a biochemical profile (glucose, insulin, triglycerides, cholesterol, HDL, LDL, ApoA1, ApoB). Hormone and biochemical parameters were compared between continent and incontinent women.Incontinent women had significantly lower serum estradiol levels compared to those in the control group (17.30 ± 8.16 vs. 24.22 ± 8.99, P 0.001). Furthermore, the same association was observed for serum Δ4Α (146.07 ± 52.63 vs. 159.99 ± 42.62, P = 0.017). These associations remained significant after controlling for age, menopausal age, BMI, and number of deliveries.These results may indicate that within the postmenopausal range, endogenous sex hormones may be associated with the presence of SUI in women not on menopausal hormone therapy. Neurourol. Urodynam. 36:121-125, 2017. © 2015 Wiley Periodicals, Inc.

We investigated the effects of add-on lamotrigine treatment on plasma glutamate (Glu) levels, in 29 epileptic patients. Plasma Glu levels were determined by high-performance liquid chromatography at baseline and at 1 and 3 months post-treatment. In patients with a seizure reduction ofor = 66% a decrease of Glu at month 1 was noted, followed by return to baseline levels at month 3. In the remaining patients a gradual increase of Glu was noted throughout the 3 months of the study. The above findings indicate that an excellent clinical response to add-on lamotrigine may be characterized by a statistically significant, yet transient decrease of plasma Glu levels, while increasing Glu levels may accompany a response that is moderate at best. The combination of lamotrigine with valproate was more frequent in patients with excellent clinical response and tended to result in glutamate decrease.

Interleukin-15 (IL-15) is a novel proinflammatory cytokine having similar biological activities to IL-2 which is implicated in the pathogenesis of multiple sclerosis. It is produced by activated blood monocytes, macrophages and glial cells. There is little information about the involvement of IL-15 in the development of multiple sclerosis (MS). The objective of our study was to measure IL-15 serum and cerebrospinal fluid (CSF) levels in MS patients and to correlate serum and CSF IL-15 concentrations with clinical parameters of the disease. CSF IL-15/Serum IL-15 ratio (c/s IL-15 ratio) was introduced to assess the origin of elevated IL-15 levels. Materials and methods: We measured serum and CSF IL-15 levels in 52 patients with MS and 36 age and gender matched patients with inflammatory (IND) and non-inflammatory neurological diseases (NIND) studied as control groups. IL-15 levels were correlated with clinical parameters as duration, disability, MRI activity and clinical subtypes of the disease. Results: MS patients were found to have significantly higher serum IL-15 levels compared with IND (p=0.00016) and NIND patients (p=0.00045). Elevated levels of IL-15 were also found in CSF samples from MS patients compared with patients with IND (p=0.00034) and NIND (p=0.0003). Among MS subgroups there were no statistically different IL-15 serum and CSF concentrations. No significant correlation of serum and CSF IL-15 concentrations with MRI activity, disability assessed by EDSS score and duration of the disease were also found. C/S IL-15 ratio was found lower in MS patients compared with IND (p=0.01) and not significantly different compared with NIND patients (p=0.14) suggesting that systemic activation might be the source of high CSF IL-15 levels in MS patients. Conclusions: Our findings suggest a possible role of IL-15 in the immunopathogenetic mechanisms of MS. D 2005 Elsevier B.V. All rights reserved.

Objective: To describe a case of limbic encephalitis which initially presented as viral limbic encephalitis and during the clinical evaluation a renal carcinoma was diagnosed. Case report: Patient with history of peripheral paresis of right facial nerve, 1 month after symptoms appearance and treatment, developed fever, vomiting, grand mal seizure, decreased level of consciousness, confusion, hallucinations and agitation. The patient initially presented a clinical picture of viral LE. which confirmed by CSF. MRI brain showed areas with pathological intensity signal in the region of limbic system unilateral. During the clinical evaluation a renal carcinoma was discovered and a nephrectomy has been performed. Conclusions: Although PLE typically presents as a chronic or subacute disease, it may be fulminant and clinically indistinguishable from an acute HSVE. This association pose the problem of a possible relation between this two syndromes and the correct diagnosis is very important, because there are effective treatments.