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Small airways in asthma:Pathophysiology,identification and management

Chinese Medical Journal Pulmonary and Critical Care Medicine 2023年第3期1卷 171-180页

作者： dimitrios Toumpanakis Omar S.Usmani National Heart and Lung Institute Imperial College LondonLondonSW36LYUnited Kingdom General State Hospital for Thoracic Diseases of Athens“Sotiria” Athens11527Greece

Background:The aim of this review is to summarize the current evidence regarding small airway disease in asthma,focusing on recent advances in small airway pathophysiology,assessment and therapeutic ***:A search in Medline was performed,using the keywords“small airways”,“asthma”,“oscillometry”,“nitrogen washout”and“imaging”.Our review was based on studies from adult asthmatic patients,although evidence from pediatric populations is also ***:In asthma,inflammation in small airways,increased mucus production and airway wall remodelling are the main pathogenetic mechanisms of small airway *** airway dysfunction is a key component of asthma pathophysiology,leading to increased small airway resistance and airway closure,with subsequent ventilation inhomogeneities,hyperresponsiveness and airflow *** tests of lung function,such as spirometry and body plethysmography are insensitive to detect small airway disease,providing only indirect *** discussed in our review,both functional and imaging techniques that are more specific for small airways,such as oscillometry and the multiple breath nitrogen washout have delineated the role of small airways in *** airways disease is prevalent across all asthma disease stages and especially in severe disease,correlating with important clinical outcomes,such as asthma control and exacerbation ***,markers of small airways dysfunction have been used to guide asthma treatment and monitor response to ***:Assessment of small airway disease provides unique information for asthma diagnosis and monitor-ing,with potential therapeutic implications.

关键词： Small airways Asthma Oscillometry Nitrogen washout

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High-Risk Congenital Coronary Abnormalities in Patients with Bicuspid Aortic Valve

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Congenital Heart Disease 2021年第2期16卷 141-146页

作者： Félix Collard dimitrios Buklas Pascale Maragnes Fabien Labombarda Department of Cardiology CHU de CaenCaen14000France Department of Heart Surgery CHU de CaenCaen14000France

Objective:Abnormal coronary artery origin(ACAO)from the opposite sinus with inter-arterial course of the ectopic proximal vessel is associated with the greatest potential for clinical manifestations,specifically sudden *** remain limited regarding the association between bicuspid aortic valve(BAV)and this potentially dangerous coronary variant reported in up to 0.6%in the general *** investigated the frequency of this high-risk ACAO with inter-arterial course in our surgical series of BAV *** and Results:We conducted a retrospective study to identify BAV patients with ACAO and inter-arterial course who underwent elective aortic valve/root surgery between 2010 and 2019 in our tertiary center.A total of 279 consecutive patients with BAV were *** these,four patients(1.4%)had ACAO with inter-arterial *** patients had abnormal right coronary artery arising from the theoretical opposite coronary sinus with intramural *** fourth patient presented an abnormal left coronary artery from a single coronary artery arising from the theoretical right coronary sinus with a long inter-arterial ***:Our results from a single-center experience support high-risk ACAOS may be more frequently diagnosed in BAV patients,especially in surgical series,justifying a careful preoperative assessment.

关键词： Congenital heart disease coronary artery bicuspid aortic valve

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“Oligometastatic pancreatic cancer”definition:The first step

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Hepatobiliary & Pancreatic Diseases International 2023年第6期22卷 645-647页

作者： Maximos Frountzas dimitrios Schizas Stylianos Kykalos Konstantinos G Toutouzas First Propaedeutic Department of Surgery Hippocration General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthensGreece First Department of Surgery Laikon General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthensGreece Second Department of Propaedeutic Surgery Laikon General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthensGreece

Pancreatic ductal adenocarcinoma(PDAC)is nowadays the fourth leading cause of cancer-related death worldwide,but according to recent estimations it will become the second leading cause of cancer-related deaths in the USA up to 2030,following lung *** implementation of neoadjuvant chemotherapy during recent years led to an increase of overall survival at 35 months in PDAC after R0 resection[1].However,pancreatic cancer has a particularity that makes it a real challenge for clinicians:only 20%of patients are diagnosed early enough to have a resectable pancreatic cancer,whereas 40%of patients present with locally advanced or non-resectable disease,while the rest present with distant metastases[2].Systemic chemotherapy plays the main role in metastatic PDAC treatment:polychemotherapy regimens such as FOLFIRINOX(folinic acid,5-fluorouracil,irinotecan and oxaliplatin)or combination of gemcitabine/nab-paclitaxel seemed to improve median overall survival from 6.8 to 11.1 months and 6.7 to 8.5 months,respectively[3].

关键词： chemotherapy metastatic cancer

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Data learning and expert judgment in a Bayesian belief network for aiding human reliability assessment in offshore decommissioning risk assessment

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Journal of Ocean Engineering and Science 2021年第2期6卷 170-184页

作者： Mei Ling Fam dimitrios Konovessis XuHong He Lin Seng Ong Lloyds Register Singapore 1 Fusionopolis Place09-11 GalaxisSingapore 138522Singapore Singapore Institute of Technology SIT@Dover 10 Dover Drive Singapore 138683Singapore Lloyd’s Register Consulting Landsvaegen 50A17263SundbybergSweden School of Mechanical and Aerospace Engineering Nanyang Technological University50 Nanyang AvenueSingapore 639798Singapore

Decommissioning of offshore facilities involve changing risk profiles at different decommissioning *** Belief Networks(BBN)are used as part of the proposed risk assessment method to capture the multiple interactions of a decommissioning *** BBN is structured from the data learning of an accident database and a modification of the BBN nodes to incorporate human reliability and barrier performance *** analysis covers one case study of one area of decommissioning operations by extrapolating well workover data to well plugging and *** analysis from well workover data,of a 5-node BBN provided insights on two different levels of severity of an accident,the’Accident’and’Incident’level,and on its respective profiles of the initiating events and the investigation-reported human *** initial results demonstrate that the data learnt from the database can be used to structure the BBN,give insights on how human reliability pertaining to well activities can be modelled,and that the relative frequencies from the count analysis can act as initial data input for the proposed *** is also proposed that the integrated treatment of various sources of information(database and expert judgement)through a BBN model can support the risk assessment of a dynamic situation such as offshore decommissioning.

关键词： Bayesian belief network Human reliability assessment Expert judgement Data learning

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Ocular stem cells:a narrative review of current clinical trials

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International Journal of Ophthalmology(English edition) 2022年第9期15卷 1529-1537页

作者： Konstadinos Sotiropulos dimitrios Kourkoutas Diamantis Almaliotis Katherine Ploumidou Vasileios Karampatakis Department of Ophthalmology 417 Army Shared Fund HospitalAthens 11521Greece Department of Ophthalmology 401 Army General Hospital of AthensAthens 11525Greece Laboratory of Experimental Ophthalmology School of MedicineAristotle University of ThessalonikiThessaloniki 54124Greece Department of Otolaryngology Children’s Hospital“Aglaia Kyriakou”Athens 11527Greece

·Stem cells are undifferentiated cells showcasing a remarkable capacity of self-replenishing and differentiating into mature *** ability to proliferate connotes that a designated stem cell source is capable of generating an unrestricted number of mature *** ever-increasing comprehension of position,activity,and function of ocular stem cells has led to rapid progress and incessant improvement of possible procedures and therapies.A narrative review was conducted to summarize the current evidence on clinical trials and respective literature,regarding current evolution in the field of ocular regenerative *** tried to ascertain the safety of experimental and clinical procedures,their effectiveness,and the ethical repercussion of their use.

关键词： stem cells cell-based therapies limbal stem cells h ESC-derived retinal pigment epithelium human induced pluripotent stem cells olfactory mucosa mesenchymal stem cells

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Mixed reality for visualization of orthopedic surgical anatomy

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World Journal of Orthopedics 2021年第10期12卷 727-731页

作者： dimitrios Chytas Vasileios S Nikolaou Department of Physiotherapy University of PeloponneseSparta 23100Greece 2^(nd)Department of Orthopedics National and Kapodistrian University of AthensAthens 15124Greece

In the modern era,preoperative planning is substantially facilitated by artificial reality technologies,which permit a better understanding of patient anatomy,thus increasing the safety and accuracy of surgical *** the field of orthopedic surgery,the increase in safety and accuracy improves treatment quality and orthopedic patient *** reality technologies,which include virtual reality(VR),augmented reality(AR),and mixed reality(MR),use digital images obtained from computed tomography or magnetic resonance *** replaces the user’s physical environment with one that is computer *** and MR have been defined as technologies that permit the fusing of the physical with the virtual environment,enabling the user to interact with both physical and virtual *** has been defined as a technology that,in contrast to AR,enables users to visualize the depth and perspective of the virtual *** aimed to shed light on the role that MR can play in the visualization of orthopedic surgical *** literature suggests that MR could be a valuable tool in orthopedic surgeon’s hands for visualization of the ***,we remark that confusion exists in the literature concerning the characteristics of ***,a more clear description of MR is needed in orthopedic research,so that the potential of this technology can be more deeply understood.

关键词： Orthopedic surgery Mixed reality Anatomy Augmented reality Threedimensional visualization technologies Artificial reality technologies

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Modelling of temperature and strain rate dependent behaviour of pearlitic steel in block braked railway wheels

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Railway Engineering Science 2021年第4期29卷 362-378页

作者： Ali Esmaeili Johan Ahlstrom Magnus Ekh dimitrios Nikas Tore Vernersson CHARMEC/Department of Industrial and Materials Science Chalmers University of TechnologyGothenburgSweden Now at Department of Engineering and Physics Karlstad UniversityKarlstadSweden CHARMEC/Department of Mechanics and Maritime Sciences Chalmers University of TechnologyGothenburgSweden

Block braked railway wheels are subjected to thermal and rolling contact *** thermal loading results in high temperatures and thermal stresses which cause slow time dependent processes such as creep,relaxation and static recovery of the wheel *** the same time,the rolling contact loading implies a very fast mechanical load *** paper is focused on material modeling of pearlitic steel for a wide range of loading rates at elevated *** starting point is a viscoplasticity model including nonlinear isotropic and kinematic *** Delobelle overstress function is employed to capture strain rate dependent response of the *** model also includes static recovery of the hardening to capture slower viscous(diffusion dominated)behaviour of the *** for the pearlitic wheel steel ER7 in terms of cyclic strain-controlled uniaxial tests with hold-time,uniaxial ratchetting tests including rapid cycles and biaxial cyclic tests with tension/compression and torsion are used to calibrate the material *** experiments were performed under isothermal conditions at different *** the ratchetting tests,higher loading rates are obtained and these have been used to calibrate the high strain rate response of the viscoplasticity *** paper is concluded with a numerical example of a block braked wheel where the importance of accounting for the viscoplasticity in modelling is highlighted.

关键词： Block braking High temperatures Pearlitic steel Railway wheels Viscoplasticity

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Surgical treatment outcome of painful traumatic neuroma of the infrapatellar branch of the saphenous nerve during total knee arthroplasty

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World Journal of Orthopedics 2021年第12期12卷 1008-1015页

作者： Byron Chalidis dimitrios Kitridis Panagiotis Givissis The First Orthopaedic Department Aristotle University of ThessalonikiSchool of MedicineThessaloniki 57010Greece

BACKGROUND Development of infrapatellar saphenous neuroma(ISN)is a well-recognized reason for knee pain following total knee arthroplasty(TKA).So far,very few studies have addressed the development of painful ISN after TKA and its impact on functional outcome and patient *** To present the results of surgical treatment for ISN after primary TKA,the level of pain relief,and the improvement of knee motion and *** Fifteen patients(13 women,2 men)with persistent medial pain for more than six months after primary TKA,due to osteoarthritis,underwent surgical excision of *** diagnosis was confirmed with the presence of Tinel’s sign along the course of the infrapatellar branch of the saphenous nerve and with pain relief after selective nerve block using local *** loosening,malalignment,instability and infection were excluded systematically in all patients as a source of *** relief in terms of visual analog scale(VAS),active knee range of motion(ROM),and the Knee Society Score(KSS)for pain and function were evaluated preoperatively and at least six months *** The mean patients’age was 71.3±5.4 years *** mean interval between TKA and neuroma excision was 10 mo(range,6 to 14 mo),while the mean follow-up was 8 mo(range:6 to 11 mo).All 15 patients experienced almost complete immediate pain relief and resolution of allodynia and hyperesthesia after *** on the VAS scale improved from 8.6±1.3 preoperatively to 0.8±0.9 at the final follow-up(P=0.001).KSS pain and function scores were improved from 49.3±5.9 and 62.7±12.8 before surgery to 91.8±4.2 and 75.3±11.3 after surgery,respectively(P=0.001 and P=0.015).Active knee ROM was also increased postoperatively from 96±4 to 105±6 degrees(P=0.001).There were no complications and no further operations *** ISN should be considered a potential cause of persistent pain following *** excision not only provides immediate pain relief an

关键词： Total knee arthroplasty Infrapatellar branch of saphenous nerve Neuroma Neurogenic pain Knee osteoarthritis

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Tibial tubercle osteotomy in revision total knee arthroplasty: A systematic review

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World Journal of Orthopedics 2020年第6期11卷 294-303页

作者： Byron Chalidis dimitrios Kitridis Panagiotis Givissis 1^st Orthopaedic Department Aristotle University of ThessalonikiGeorge Papanikolaou HospitalThessaloniki 55210Greece

BACKGROUND Tibial tubercle osteotomy(TTO) is a well-established surgical technique to deal with a stiff knee in revision total knee arthroplasty(RTKA). However, several reports have described potential osteotomy-related complications such as nonunion, tibial tubercle migration and fragmentation, and metalware related *** To evaluate the literature and estimate the efficiency of TTO in RTKA in terms of osteotomy union, knee mobility and *** MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were investigated for completed studies until February 2020. The principle outcome of the study was the incidence of union of the osteotomy. Secondary outcomes were the knee range of motion as well as the TTO-related and overall procedure complication *** Fifteen clinical studies with a total of 593 TTOs were included. The TTO union rate was 98.1%. Proximal migration and anterior knee pain were the most common TTO-related complications accounting for 6.9% and 6.4% of all cases,respectively. However, only 2.2% of cases suffering from anterior knee pain needed hardware removal. Knee flexion was improved from 82.9° preoperatively to 100.1° postoperatively and total knee range of motion was increased from 73.4° before surgery to 97° after surgery. Stiffness requiring manipulation under anesthesia was recorded in 4.6% of cases. No major complications were *** The current systematic review supports the use of TTO in RTKA, as it is associated with high union rate, significant improvement in knee motion and low osteotomy-related complication risk that rarely leads to secondary tibial tubercle procedures.

关键词： Tibial tubercle osteotomy Knee flexion Extension lag Union Revision total knee arthroplasty Stiff knee

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Antithrombotic therapy in TAVI

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Journal of Geriatric Cardiology 2018年第1期15卷 66-75页

作者： Manolis Vavuranakis Konstantinos Kalogeras Angelos Michail Kolokathis dimitrios Vrachatis Nikolaos Magkoutis Gerasimos Siasos Euaggelos Oikonomou Maria Kariori Theodoros Papaioannou Maria Lavda Carmen Moldovan Ourania Katsarou dimitrios Tousoulis The First Department of Cardiology Hippokration Hospital Medical School National & Kapodistrian University of Athens Ilioupoli Greece

Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.

关键词： Antiplatelets Antithrombotic Bleeding Stroke Transcatheter aortic valve implantation

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