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Background Lower driving pressure is associated with better outcomes in patients with acute respiratory distress syndrome (ARDS) based on observational studies. However, individual randomized controlled trials provided inconclusive evidence. We synthesized evidence from randomized controlled trials to examine whether implementation of driving pressure-limiting strategies is feasible and improves outcomes. Methods This meta-analysis was registered with PROSPERO (CRD420251141653). PubMed, Scopus, CENTRAL and references were searched for trials comparing driving pressure-limiting strategies on top of lung protective ventilation (“intervention” group) versus lung protective ventilation alone (“control” group) in ARDS. Outcomes were feasibility of intervention, all-cause mortality, ventilator-free days and length of intensive care unit (ICU) stay. Results Four trials, enrolling 431 patients and implementing heterogenous driving pressure-limiting strategies (namely, tidal volume reduction and/or positive end-expiratory pressure titration), were included. There were no statistically significant mean differences in post-randomization driving pressure (namely, − 2.17, − 2.09 and − 2.15 cmH 2 O on study day 1, 2 and 3, respectively) between groups. There was no statistically significant difference between “intervention” versus “control” group in terms of mortality [35.7% versus 39.0%; relative risk 0.63, 95% confidence interval (CI) 0.20 to 1.94, p  = 0.28] or ventilator-free days ( p  = 0.88). Driving pressure-limiting strategies were associated with shorter length of ICU stay (mean difference − 2.40 days, 95% CI − 3.31 to − 1.49, p  = 0.004). Conclusions When lung protective ventilation is already applied, further limitation of driving pressure may be hard to achieve. This inability to meaningfully limit driving pressure might explain the neutral effect of driving pressure-limiting strategies on outcomes, such as mortality and ventilator-free days.

Abstract Background and aims Ischemic stroke causes significant long-term residual deficits that are poorly modelled and understood. Here, we build on our previous concept of “chronic mouse stroke model” to study 6-months´ clinical and tissue changes in young and old mice. Methods Adult male C57BL/6N young (n=31, 3 months old) and old (n= 30, 14 months old) mice were subjected to 1 hour transient middle cerebral artery occlusion with filament (fMCAo), were optimally supported with the “mouse Stroke Unit” protocol to increase survival for long-term studies, and were followed behaviorally (the open-field, tail suspension, cylinder, Corner and the horizontal ladder-rung test) and clinically (temperature, body weight, detailed neurological status) up to 6 months. At 6 months, brains and spinal cords were cryosectioned and studied for local and remote atrophy and cellular changes. Results Old mice had significantly higher acute mortality versus young, primarily due to edema-related herniation. Survivors exhibited prolonged (>1 month) and age-dependent weight loss (p<0.05). Both age groups developed severe focal neurological deficits with partial spontaneous recovery but persistent sensorimotor impairments up to 6 months. Ιpsilesional hemispheric atrophy (approximately 30% in both groups) was accompanied by ventricular enlargement and remote atrophy of sensory cortex, corpus callosum and thalamus, associated with ultra-chronic, region- and age-dependent astrocytic and microglial activation in brain. Spinal cord architecture showed preserved neuronal populations with affected contralateral corticospinal tracts and corresponding chronic residual microglial activation. Conclusions Mice can translationally model core long-term ischemic stroke parameters, revealing multiple chronic targets for drug discovery and treatment in stroke. Conflict of interest CP, IM and AL were supported by Unipharma S.A. with Research Grants. NK: nothing to disclose, APav: nothing to disclose, NZ: nothing to disclose, MG: nothing to disclose, ES-P: nothing to disclose, CPet: nothing to disclose, NP:nothing to disclose, AKot: nothing to disclose, AC: nothing to disclose, AKok: nothing to disclose

Abstract Background and aims Data on the role of thyroid hormone (TH) signaling in stroke have been contradictory between studies. Here, we aim to study the acute effects after TH-agonist/-antagonist treatment in experimental stroke. Methods C57BL/6 mice (n=90) underwent transient focal middle cerebral artery occlusion (fMCAO) for 1 hour, followed clinically up to day 3. Animals were randomized blindly to groups receiving either T3 (at doses of 25 μg/kg or 200 μg/kg), Desethyl-amiodarone (DEA) or Desbutyl-dronedarone (DBD) (at doses 25mg/kg) at reperfusion and on day 1; Sobetirome at 1mg/kg at reperfusion and daily up to day 3; controls received the corresponding vehicle. Histopathological brain studies on cryosections included infarct and hemispheric edema volumetry, as well as astrocytosis and neuronal death using a novel developed FluoroJadeB method for histological detection of penumbra from core and healthy tissue. Results Acute high-dose of T3 did not improve brain edema, infarct volume or neuronal survival compared to controls (p>0.1). Low-dose T3 worsened penumbral neuronal survival (p=0.0086). TH-receptors’ antagonism with DEA induced a clinical worsening with corresponding increased infarct size and neuronal death at day 3 (p<0.05); DBD conferred no effects (p>0.1). TRβ agonism with Sobetirome did not show any clinical effect or penumbral neuronal benefit (p>0.1). Conclusions Acute post-ischemic TH-receptor activation with low- and high- T3 doses or sobetirome confers mixed effects that need further clarification. However, TH-receptors antagonism with DEA (the active metabolite of amiodaron) is detrimental for stroke and should probably be avoided, at least during the first 3 days post-ischemia. Conflict of interest APav and NZ were supported by Tsetis Foundation, CP, IM and AL were supported by Uni-pharma S.A. with Research Grants. AK: nothing to disclose, IT: nothing to disclose, VA: nothing to disclose, EK: nothing to disclose, APap: nothing to disclose, MG: nothing to disclose, APap: nothing to disclose

Tree canopy cover is an important forest inventory parameter and a critical component for the in-depth mapping of forest fuels. This research examines the potential of employing single-date Sentinel-2 multispectral imagery, combined with contextual spatial information, to classify areas based on their tree cover density using Random Forest classifiers. Three spatial information extraction methods are investigated for their capacity to acutely detect canopy cover: two based on Gray-Level Co-Occurrence Matrix (GLCM) features and one based on segment statistics. The research was carried out in three different biomes in Greece, in a total study area of 23,644 km2. Three tree cover classes were considered, namely, non-forest (cover < 15%), open forest (cover = 15%–70%), and closed forest (cover ≥ 70%), based on the requirements set for fuel mapping in Europe. Results indicate that the best approach identified delivers F1-scores ranging 70%–75% for all study areas, significantly improving results over the other alternatives. Overall, the synergistic use of spectral and spatial features derived from Sentinel-2 images highlights a promising approach for the generation of tree cover density information layers in Mediterranean regions, enabling the creation of additional information in support of the detailed mapping of forest fuels.

Wildland fuel distribution and characteristics are critical components for the development of a national integrated wildfire management strategy. This study presents a methodological framework for the mapping of fuels in Mediterranean ecosystems in the different levels of a new fuel hierarchical classification scheme, using a spectral–spatial approach based on Sentinel-2 timeseries and auxiliary thematic maps. Furthermore, in the context of this research, a novel approach is proposed for separating Mediterranean shrubland vegetation into three broad height categories, using Sentinel-2 images, landscape variables, and climatic data. Two areas in Greece, namely Attica and Euboea, with major wildfire events over the past 3 years were selected as the study areas. The mapping methodology was designed to consist of three complementary mapping processes, each for the identification of specific types of fuels (i.e., urban, agricultural, and vegetation). The results are validated in a two-step approach for different levels of the classification scheme. The results for the first level display an overall accuracy of 88% and kappa of 0.84, while for the second level, overall accuracy was 71.64% and kappa was 0.68. Our research demonstrates the capacity to map fuel types with promising accuracy at different depths, highlighting a viable method that can be potentially exploited for the large-scale fuel mapping of Mediterranean biomes at a national level.

Purpose Prostate cancer patients are a heterogeneous group as regards the aggressiveness of the disease. The relationship of steroid hormones with the aggressiveness of prostate cancer is unclear. It is known that the anti-Müllerian hormone (AMH) inhibits prostate cancer cell lines in vitro. The aim of this study is to investigate the relationship of AMH and steroid hormones with the aggressiveness of prostate cancer. Methods This was a prospective study of consecutive radical prostatectomy patients. We measured the following hormones: total testosterone, sex hormone-binding globulin, albumin, luteinizing hormone, follicle-stimulating hormone, estradiol, dehydroepiandrosterone sulfate, androstenedione, and AMH. The minimum follow-up after radical prostatectomy was 5 years. For the aggressiveness of prostate cancer, we considered the following three variables: post-operative Gleason score (GS) ≥ 8, TNM pΤ3 disease, and prostate-specific antigen (PSA) biochemical recurrence (BCR). Results In total, 91 patients were enrolled. The mean age and PSA were 64.8 years and 9.3 ng/dl, respectively. The median post-operative GS was 7. Low AMH blood levels were correlated with higher post-operative GS ( p  = 0.001), as well as with PSA BCR ( p  = 0.043). With pT3 disease, only albumin was (negatively) correlated ( p  = 0.008). ROC analysis showed that AMH is a good predictor of BCR (AUC 0.646, 95% CI 0.510–0.782, p  = 0.043); a cutoff value of 3.06 ng/dl had a positive prognostic value of 71.4% and a negative prognostic value of 63.3% for BCR. Cox regression analysis showed that AMH is a statistically significant and independent prognostic marker for BCR ( p  = 0.013). More precisely, for every 1 ng/ml of AMH rise, the probability for PSA BCR decreases by 20.8% (HR = 0.792). Moreover, in Kaplan–Meier analysis, disease-free survival is more probable in patients with AMΗ ≥ 3.06 ng/ml ( p  = 0.004). Conclusions Low AMH blood levels were correlated with aggressive prostate cancer in this radical prostatectomy cohort of patients. Therefore, AMH could be a prognostic biomarker for the aggressiveness of the disease.

Helicobacter pylori (Hp) management has undoubtedly resulted in a notable economic burden on healthcare systems globally, including Greece. Its cost has never been estimated so far, especially during the recent 10-year unprecedented financial crisis. Direct medical and procedural costs for one attempt “outpatient” Hp eradication treatment were estimated as the following: (I) first-line regimens: 10 and 14 days standard triple, 10 and 14 days sequential, 10 and 14 days concomitant non-bismuth quadruple, 14 days hybrid, (II) second-line salvage regimens: 10 and 14 days levofloxacin-containing triple regimens. Treatment costs using prototypes and/or generic drugs were calculated. Drug prices were collected and confirmed from two official online medical databases including all medicines approved by the Greek National Organization for Medicines. Regimens based on generics were more affordable than prototypes and those including pantoprazole yielded the lowest prices (mean: 27.84 €). Paradoxically, 10-day concomitant and 14-day hybrid regimens (currently providing good (90–94%) first-line eradication rates in Greece) cost the same (mean: 34.76 €). The expenditures for Hp eradication treatment regimens were estimated thoroughly for the first time in Greece. These data should be taken into account by Public Health policymakers both in Greece and the European Union, aiming for a better and less expensive therapeutic approach.

PurposeTeenage pregnancies have consistently been associated with preterm labor in a wide range of studies. Evidence regarding the incidence and potential complications of teenage pregnancies in Greece is at present scarce. The aim of this study was to evaluate the perinatal outcomes as well as the risk of perinatal and obstetric complications of teenage pregnancies.MethodsThis retrospective study was conducted at the Department of Obstetrics and Gynecology of the University Hospital of Patras, Greece, and all data recorded concerned the year 2019 (January–December). We retrospectively reviewed 643 cases of singleton pregnancies divided into two groups, as follows: Group A included women of average maternal age (AMA) (20–34 years old), and Group B included teenagers, defined as women less than 20 years old. Data regarding demographic and pregnancy characteristics as well as obstetric and neonatal complications were collected.ResultsTeenage pregnancies accounted for 6.7% of all deliveries. We detected significantly higher rates of preterm births (p = 0.025), primiparity (p < 0.001), and negative marital status (p < 0.001) in teenage mothers compared to pregnant women of AMA. There were no significant differences concerning other factors between the two groups.ConclusionsThe findings of the present study raise concern regarding the perinatal, obstetric, and social consequences of teenage pregnancies in Greece. Extended studies that will include further information on antenatal care and detailed socioeconomic factors (i.e., level of education, income, and ethnicity) are required to formulate reliable conclusions concerning teenage pregnancies and their effect on maternal and neonatal health.

The HYPEDIA study aimed at evaluating the implementation of the 2018 European guidelines for treating hypertension in primary care. A nationwide prospective non-interventional cross-sectional study was performed in consecutive untreated or treated hypertensives recruited mainly in primary care in Greece. Participants’ characteristics, office blood pressure (BP) (triplicate automated measurements, Microlife BPA3 PC) and treatment changes were recorded on a cloud platform. A total of 3,122 patients (mean age 64 ± 12.5 [SD] years, 52% males) were assessed by 181 doctors and 3 hospital centers. In 772 untreated hypertensives (25%), drug treatment was initiated in the majority, with monotherapy in 53.4%, two-drug combination in 36.3%, and three drugs in 10.3%. Angiotensin receptor blocker (ARB) monotherapy was initiated in 30%, ARB/calcium channel blocker (CCB) 20%, ARB/thiazide 8%, angiotensin converting enzyme inhibitor (ACEi)-based 19%. Of the combinations used, 97% were in single-pill. Among 977 treated hypertensives aged <65 years, 79% had BP ≥ 130/80 mmHg (systolic and/or diastolic), whereas among 1,373 aged ≥65 years, 66% had BP ≥ 140/80 mmHg. ARBs were used in 69% of treated hypertensives, CCBs 47%, ACEis 19%, diuretics 39%, beta-blockers 19%. Treatment modification was decided in 53% of treated hypertensives aged <65 years with BP ≥ 130/80 mmHg and in 62% of those ≥65 years with BP ≥ 140/80 mmHg. Renin-angiotensin system blocker-based therapy constitutes the basis of antihypertensive drug treatment in most patients in primary care, with wide use of single-pill combinations. In almost half of treated uncontrolled hypertensives, treatment was not intensified, suggesting suboptimal implementation of the guidelines and possible physician inertia.

A 68-year-old woman with a left renal artery aneurysm underwent successful endovascular repair with the use of a commercial type self-expanding stent-graft. Complete aneurysm exclusion was achieved after stent-graft expansion. A side branch vessel was occluded after stent-placement, resulting in a small upper lobe renal perfusion defect. There were no other complications. The aneurysm remained excluded and its greatest diameter has been reduced from 2.6 cm to 1.95 cm, 10 months after treatment. Renal function remained normal.