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We explored whether radiomic features from T1 maps by cardiac magnetic resonance (CMR) could enhance the diagnostic value of T1 mapping in distinguishing health from disease and classifying cardiac disease phenotypes. A total of 149 patients (n = 30 with no heart disease, n = 30 with LVH, n = 61 with hypertrophic cardiomyopathy (HCM) and n = 28 with cardiac amyloidosis) undergoing a CMR scan were included in this study. We extracted a total of 850 radiomic features and explored their value in disease classification. We applied principal component analysis and unsupervised clustering in exploratory analysis, and then machine learning for feature selection of the best radiomic features that maximized the diagnostic value for cardiac disease classification. The first three principal components of the T1 radiomics were distinctively correlated with cardiac disease type. Unsupervised hierarchical clustering of the population by myocardial T1 radiomics was significantly associated with myocardial disease type (chi 2  = 55.98, p < 0.0001). After feature selection, internal validation and external testing, a model of T1 radiomics had good diagnostic performance (AUC 0.753) for multinomial classification of disease phenotype (normal vs. LVH vs. HCM vs. cardiac amyloid). A subset of six radiomic features outperformed mean native T1 values for classification between myocardial health vs. disease and HCM phenocopies (AUC of T1 vs. radiomics model, for normal: 0.549 vs. 0.888; for LVH: 0.645 vs. 0.790; for HCM 0.541 vs. 0.638; and for cardiac amyloid 0.769 vs. 0.840). We show that myocardial texture assessed by native T1 maps is linked to features of cardiac disease. Myocardial radiomic phenotyping could enhance the diagnostic yield of T1 mapping for myocardial disease detection and classification.

Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, mostly affecting small-sized arteries and usually occurring in patients with an allergic background. Eosinophils seem to play a significant role in the pathogenesis of the disease and, therefore, biologics targeting interleukin 5 (IL5), a cytokine tightly linked to eosinophils, have emerged as a promising therapeutic tool. A systematic review of Medline was conducted from 2007 to 2022 to search for data regarding the use of anti-IL5 therapies in patients with EGPA. Ongoing or unpublished trials were also searched in ClinicalTrials.gov and the World Health Organization trials portal. The efficacy and safety of mepolizumab, an anti-IL5 monoclonal antibody (mAb), was confirmed by a randomized controlled trial (RCT), although a significant proportion of patients did not respond to this treatment. Other studies showed that both doses of 100 mg and 300 mg of mepolizumab are almost equally effective in EGPA. Benralizumab, an anti-IL5 receptor mAb has preliminary promising results and an RCT is planned to be conducted. Apart from their clinical efficacy in EGPA, anti-IL5 therapies may have steroid-sparing properties. Anti-IL5 therapies seem to be effective and safe in patients with refractory/relapsing EGPA and can be used as a steroid-sparing treatment. Nevertheless, more research is needed to clarify the pathophysiology of the disease; this may potentially lead to the identification of biomarkers to pinpoint patients most likely to respond to anti-IL5-blockade.

Spondyloarthropathies (SpA) are a family of inflammatory disorders that affect the spine and peripheral joints. The most common representatives are axial Spondylarthritis (axSpA) and Psoriatic Arthritis (PsA). Despite the fact that SpA are characterised by new bone formation, paradoxically, total Bone Mineral Density (BMD) may be decreased. An electronic search was conducted on Medline in order to explore the prevalence, risk factors and pathophysiology of Osteoporosis (OP) in SpA patients. The prevalence of OP globally is reported to be 18.3%. The prevalence of OP in Axial Spondylarthritis (axSpA) patients ranges from 11.7% to 34.4%, while in Psoriatic Arthritis (PsA) patients seems to be similar to the general population. Several factors have been proposed for the development of OP in SpA, such as corticosteroid use and physical inactivity. Moreover, systemic inflammation appears to participate in the pathophysiology of OP with inflammatory cytokines such as Tumour Necrosis Factor (TNF) and Interleukin (IL)-23/IL-17 potentially having a key role in the pathogenesis of bone loss. The current literature points to the direction that OP is an established comorbidity in axSpA. Local or/and systemic inflammation is possibly the main pathway contributing to bone loss in axSpA patients. However, it remains unclear whether OP is an established comorbidity in PsA patients, as it seems that OP is a treatment-associated adverse event.

Eosinophilic Fasciitis (EF) is a rare disease, originally proposed as \"diffuse fasciitis with eosinophilia\" by Shulman in 1974. Symptoms of EF include peripheral eosinophilia accompanied by symmetrical inflammation of the subcutaneous fascia and muscle, usually locating in the upper arms or thighs. There is no approved standard of care treatment. Taking into account that eosinophils may be pathogenetically involved in EF, we performed a review on Medline focusing on anti-Interleukin-5 (IL-5) therapies in EF. Only one case of a patient with EF has been reported who was successfully treated with reslizumab, an anti-IL-5 therapy. The patient had EF refractory to the commonly used immunosuppressive treatment but when reslizumab was added, the patient experienced remission of her symptoms. The exact aetiology of EF is still unclear, and many therapeutic approaches have been tested. Commonly used immunosuppressive agents, such as corticosteroids are not always effective and associate with significant side effects. Eosinophils seem to have a role in the pathogenesis of the disease; anti-eosinophilic therapies targeting IL-5/IL-5 Receptor could be an attractive alternative for the treatment of the disease.

This manuscript concerns the case of a patient hospitalized and diagnosed with Evans syndrome. She was hospitalized with signs of thrombocytopenia induced purpura, petechiae, ecchymosis and anemia. She was successfully treated with corticoids and blood transfusions. Our purpose is to explain her clinical presentation and the exams, we used in order to make the diagnosis of Evans syndrome, which requires great suspicion. Moreover, other diseases causing hemolytic anemia and thrombocytopenia must be excluded. We used laboratory tests (blood samples, Coombs examination and virologic test). Marrow examination took place twice. Evans syndrome is an autoimmune disease which is characterized by the coexistence of hemolytic anemia and immune-mediated thrombocytopenia. There is no typical clinical presentation. It´s etiology is unknown and its therapy is generally poor. Diagnosis of Evans syndrome is very difficult and requires the exclusion of other diseases causing anemia and thrombocytopenia.

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. The hallmark of HCM is myocardial fibrosis which contributes to heart failure, arrhythmias, and sudden cardiac death (SCD). Objective: To identify the factors implicated in heart failure symptoms and functional capacity of patients with HCM. Methods: In this cohort study, 43 patients with HCM were recruited. According to functional capacity and symptoms presentation, patients were categorized according to New York Heart Association (NYHA) classification, and echocardiographic measurements of left ventricle systolic and diastolic function were conducted. The echocardiographic assessment of right ventriculo–arterial coupling (RVAC) was made by calculating the tricuspid annular peak systolic tissue Doppler velocity (TASV)/estimated RV systolic pressure (RVSP) ratio. Results: Almost half (51%) of our study population present symptoms of heart failure and were categorized as the symptomatic group—NYHA 2 or higher. Maximum LVOT gradient, RVSP, and the ratio of E/e’ were higher in the symptomatic group compared with the asymptomatic group. TASV was lower in the symptomatic group compared with the asymptomatic group (11 ± 1 cm/s vs. 13 ± 2 cm/s, p = 0.04). However, there was no difference in other potentially influential factors, such as heart rate or systemic blood pressure. The SCD risk score does not differ between the two studied groups. The RVAC (estimated with the TASV/RVSP ratio) was lower in the symptomatic group compared with the asymptomatic group (0.32 ± 0.09 vs. 0.46 ± 0.11, p < 0.001). Conclusion: A low RVAC (as estimated with TASV/RVSP ratio) value could represent an echocardiographic marker of right ventricular–arterial uncoupling in patients with HCM and impaired functional status.

This manuscript concerns the case of a patient hospitalized and diagnosed with Evans syndrome. She was hospitalized with signs of thrombocytopenia induced purpura, petechiae, ecchymosis and anemia. She was successfully treated with corticoids and blood transfusions. Our purpose is to explain her clinical presentation and the exams, we used in order to make the diagnosis of Evans syndrome, which requires great suspicion. Moreover, other diseases causing hemolytic anemia and thrombocytopenia must be excluded. We used laboratory tests (blood samples, Coombs examination and virologic test). Bone marrow examination took place twice. Evans syndrome is an autoimmune disease which is characterized by the coexistence of hemolytic anemia and immune-mediated thrombocytopenia. There is no typical clinical presentation. Its etiology is unknown and its therapy is generally poor. Diagnosis of Evans syndrome is very difficult and requires the exclusion of other diseases causing anemia and thrombocytopenia.

Τα Δημόσια Νοσοκομεία της χώρας προβαίνουν στη προμήθεια αναλώσιμων υλικών και εξοπλισμού που είναι απαραίτητος για την ορθή λειτουργία τους αλλά και τη σύμπλευση με τις σύγχρονες ιατρικές επιταγές. Αυτές οι προμήθειες οδηγούν σε κακοδιαχείριση των ήδη περιορισμένων οικονομικών πόρων. Στην παρούσα εργασία συγκρίθηκε ο βαθμός συμμόρφωσης των ελληνικών δημόσιων νοσοκομείων με τον ευρωπαϊκό μέσο όρο όσον αφορά δείκτες που προάγουν τη διαφάνεια, τον υγιή ανταγωνισμό μεταξύ των προμηθευτών αλλά και το αποτέλεσμα στην λειτουργία ενός νοσοκομείου. Για το σκοπό αυτό, πραγματοποίθηκε μία έρευνα στην οποία συμμετείχαν 44 νοσοκομεία, όλων των διαθέσιμων τύπων νοσοκομείων, όπως πανεπιστημιακά, ειδικά, γενικά ή κέντρα υγείας. Το ερωτηματολόγιο μοιράστηκε στα τμήματα προμηθειών τους, αποτελούταν από 18 ερωτήσεις οι οποίες θα μας δώσουν σαφή εικόνα για τη κατάσταση των προμηθειών στο ελληνικό σύστημα υγείας. Πηγή έμπνευσης και πληροφοριών για το ερωτηματολόγιο μας αποτέλεσε η διδακτορική διατριβή του Θεοδώρου Α. Κοματά, «Η ΠΟΛΙΤΙΚΗ ΠΡΟΜΗΘΕΙΩΝΣΤΑ ΕΛΛΗΝΙΚΑ ΝΟΣΟΚΟΜΕΙΑ», (2016). Τα ευρήματα της έρευνας, μας οδήγησαν στο συμπέρασμα πως παρά τις εξαγγελίες και τις δράσεις που ανακοινώθηκαν τα τελευταία χρόνια, δυστυχώς οι καθυστερήσεις, η γραφειοκρατία και η έλλειψη συντονισμένων δράσεων, οδηγεί σε μη αποτελεσματική αξιοποίηση των ήδη περιορισμένων πόρων των ελληνικών δημόσιων νοσοκομείων

The CryoGrid community model is a flexible toolbox for simulating the ground thermal regime and the ice–water balance for permafrost and glaciers, extending a well-established suite of permafrost models (CryoGrid 1, 2, and 3). The CryoGrid community model can accommodate a wide variety of application scenarios, which is achieved by fully modular structures through object-oriented programming. Different model components, characterized by their process representations and parameterizations, are realized as classes (i.e., objects) in CryoGrid. Standardized communication protocols between these classes ensure that they can be stacked vertically. For example, the CryoGrid community model features several classes with different complexity for the seasonal snow cover, which can be flexibly combined with a range of classes representing subsurface materials, each with their own set of process representations (e.g., soil with and without water balance, glacier ice).We present the CryoGrid architecture as well as the model physics and defining equations for the different model classes, focusing on one-dimensional model configurations which can also interact with external heat and water reservoirs. We illustrate the wide variety of simulation capabilities for a site on Svalbard, with point-scale permafrost simulations using, e.g., different soil freezing characteristics, drainage regimes, and snow representations, as well as simulations for glacier mass balance and a shallow water body. The CryoGrid community model is not intended as a static model framework but aims to provide developers with a flexible platform for efficient model development. In this study, we document both basic and advanced model functionalities to provide a baseline for the future development of novel cryosphere models.

PurposeThis study uses a critically acclaimed digital game as an instructional tool to explore the role of emotional design elements on psychological flow and perceived learning.Design/methodology/approachThe authors employ transportation theory to generate a set of antecedents of psychological flow and the theory of flow to connect the gaming experience to positive learning outcomes. The authors investigate the subjective learning experience of players with the use of a psychometric survey, and the authors employ structural equation modelling (SEM) to unearth the direct as well as the indirect effects amongst narrative, aesthetics, flow and learning outcomes.FindingsThe findings of this study demonstrate that narrative and aesthetics in serious games positively influence the perceived learning by facilitating a state of psychological flow.Research limitations/implicationsThis study contributes to better understanding and theorizing the role of narrative and aesthetics on learning outcomes in the context of serious games.Practical implicationsThe findings of this study bear valuable implications for the design of serious games as they highlight the importance of elements often disregarded as not directly related to the learning process and are typically absent from the design of serious games.Originality/valuePrior studies have identified aesthetics and narratives as design elements that contribute to the perceived enjoyment of a game; this study empirically investigates the role of narratives and aesthetics in enhancing perceived learning through psychological flow.