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Exercise Intolerance and Excessive Chronotropic Response Due to Possible Autonomic Dysfunction Post COVID-19 Infection

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International Journal of Clinical Medicine 2023年第12期14卷 540-551页

作者： Stefanos Archontakis dimitrios venetsanos Nikias Milaras Eirini Beneki Panagiotis Dourvas Epameinondas Triantafyllou Konstantinos Sideris Konstantina Aggeli Petros Arsenos Athanasios Kordalis Konstantinos Gatzoulis Skevos Sideris Department of Cardiology Hippokration General Hospital Athens Greece First Cardiology Division Hippokration General Hospital Medical School University of Athens Athens Greece

Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.

关键词： COVID-19 Autonomic Neuropathy Exertional Intolerance Exaggerated Chronotropic Response POTS Dysautonomia

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Transjugular intrahepatic portosystemic shunt for recompensating decompensated cirrhosis?

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World Journal of Gastroenterology 2024年第20期30卷 2621-2623页

作者： dimitrios S Karagiannakis Academic Department of Gastroenterology and Hepatology Medical School of National and Kapodistrian University of AthensGeneral Hospital of Athens“Laiko”Athens 11527Greece

Transjugular intrahepatic portosystemic shunt(TIPS)is a medical procedure that has been used to manage variceal bleeding and ascites in patients with *** can prevent further decompensation and improve the survival of high-risk decompensated *** research indicates that TIPS could increase the possibility of recompensation of decompensated cirrhosis when it is combined with adequate suppression of the causative factor of liver ***,the results of the studies have been based on retrospective analysis,and further validation is required by conducting randomized controlled *** this context,we highlight the limitations of the current studies and emphasize the issues that must be addressed before TIPS can be recommended as a potential recompensating tool.

关键词： Decompensated cirrhosis Liver recompensation Baveno VII Transjugular intrahepatic portosystemic shunt

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Optimal Offering of Energy Storage in UK Day-Ahead Energy and Frequency Response Markets

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Journal of Modern Power Systems and Clean Energy 2024年第2期12卷 415-426页

作者： Makedon Karasavvidis Andreas Stratis dimitrios Papadaskalopoulos Goran Strbac Department of Electrical and Electronic Engineering Imperial College LondonLondonUK Statkraft UK Ltd. LondonUK Department of Electrical and Computer Engineering University of PatrasPatrasGreece IEEE

The offering strategy of energy storage in energy and frequency response(FR) markets needs to account for country-specific market regulations around FR products as well as FR utilization factors, which are highly uncertain. To this end, a novel optimal offering model is proposed for stand-alone price-taking storage participants, which accounts for recent FR market design developments in the UK, namely the trade of FR products in time blocks, and the mutual exclusivity among the multiple FR products. The model consists of a day-ahead stage, devising optimal offers under uncertainty, and a real-time stage, representing the storage operation after uncertainty is materialized. Furthermore, a concrete methodological framework is developed for comparing different approaches around the anticipation of uncertain FR utilization factors(deterministic one based on expected values, deterministic one based on worst-case values, stochastic one, and robust one), by providing four alternative formulations for the real-time stage of the proposed offering model, and carrying out an out-of-sample validation of the four model instances. Finally, case studies employing real data from UK energy and FR markets compare these four instances against achieved profits, FR delivery violations, and computational scalability.

关键词： Energy markets energy storage frequency response optimal offering robust optimization stochastic programming

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The effect of high-flow oxygen via tracheostomy on respiratory pattern and diaphragmatic function in patients with prolonged mechanical ventilation:A randomized,physiological,crossover study

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Journal of Intensive Medicine 2024年第2期4卷 202-208页

作者： Elena Lytra Stelios Kokkoris Ioannis Poularas dimitrios Filippiadis Demosthenes Cokkinos dimitrios Exarhos Spyros Zakynthinos Christina Routsi 1st Department of Intensive Care Medical SchoolNational and Kapodistrian University of AthensEvangelismos HospitalAthensGreece Radiology Department Evangelismos HospitalAthensGreece 2nd Radiology Department Medical SchoolNational and Kapodistrian University of AthensAttikon HospitalAthensGreece

Background Compared to conventional oxygen devices,high-flow oxygen treatment(HFOT)through the nasal cannulae has demonstrated clinical *** data exist on whether such effects are also present in HFOT through ***,we aimed to examine the short-term effects of HFOT through tracheostomy on diaphragmatic function and respiratory parameters in tracheostomized patients on prolonged mechanical *** A randomized,crossover,physiological study was conducted in our ICU between December 2020 and April 2021,in patients with tracheostomy and prolonged mechanical *** patients underwent a 30-min spontaneous breathing trial(SBT)and received oxygen either via T-piece or by HFOT through tracheostomy,followed by a washout period of 15-min breathing through the T-piece and receipt of 30-min oxygen with the other modality in a randomized crossover *** the start and end of each session,blood gasses,breathing frequency(f),and tidal volume(VT)via a Wright's spirometer were measured,along with diaphragm ultrasonography including diaphragm excursion and diaphragmatic thickening fraction,which expressed the inspiratory muscle *** Eleven patients were enrolled in whom 19 sessions were uneventfully completed;eight patients were studied twice on two different days with alternate sessions;and three patients were studied *** were randomly assigned to start the SBT with a T-piece(n=10 sessions)or with HFOT(n=9 sessions).With HFOT,VT and minute ventilation(VE)significantly increased during SBT(from[465±119]mL to[549±134]mL,P<0.001 and from[12.4±4.3]L/min to[13.1±4.2]L/min,P<0.05,respectively),but they did not change significantly during SBT with T-piece(from[495±132]mL to[461±123]mL and from[12.8±4.4]mL to[12.0±4.4]mL,respectively);f/VT decreased during HFOT(from[64±31]breaths/(min∙L)to[49±24]breaths/(min∙L),P<0.001),but it did not change significantly during SBT with T-piece(from[59±28]breaths/(min∙L)to[64±33]breaths/(m

关键词： Diaphragm Diaphragm ultrasonography High-flow oxygen Prolonged mechanical ventilation Tracheostomy

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Minimally invasive pelvic exenteration for primary or recurrent locally advanced rectal cancer:A glimpse into the future

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World Journal of Gastrointestinal Surgery 2024年第7期16卷 1960-1964页

作者： dimitrios Kehagias Charalampos Lampropoulos Ioannis Kehagias Department of General Surgery General University Hospital of PatrasPatras 26504Greece Intensive Care Unit Saint Andrew’s General HospitalPatras 26335Greece Division of Bariatric and Metabolic Surgery Department of SurgeryUniversity of PatrasPatras 26504Greece

Surgeons have grappled with the treatment of recurrent and T4b locally advanced rectal cancer(LARC)for many *** main objectives are to increase the overall survival and quality of life of the patients and to mitigate postoperative ***,pelvic exenteration(PE)with or without neoadjuvant treatment is a curative treatment when negative resection margins are *** traditional open approach has been favored by many ***,the technological advancements in minimally invasive surgery have radically changed the surgical *** studies have demonstrated promising results in postoperative complications and oncological outcomes after robotic or laparoscopic PE.A recent retrospective study entitled“Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review”was published in the World Journal of Gastrointestinal *** we read this article with great interest,we decided to delve into the latest data regarding the benefits and risks of minimally invasive PE for ***,the small number of suitable patients,limited surgeon experience,and steep learning curve are hindering the establishment of minimally invasive PE.

关键词： Locally advanced rectal cancer Pelvic exenteration Multivisceral resection Minimally invasive surgical procedures Robotic surgical procedures

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Downstaging strategies for unresectable hepatocellular carcinoma

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World Journal of Gastroenterology 2024年第20期30卷 2731-2733页

作者： Georgia Sofia Karachaliou Nikolaos Dimitrokallis dimitrios P Moris Division of Gastroenterology Department of MedicineDuke University Medical CenterDurhamNC 27710United States First Department of Surgery&Organ Transplant Unit Evangelismos General HospitalAthens 10676Greece Department of Surgery Duke University Medical CenterDurhamNC 27710United States

A significant number of patients with hepatocellular carcinoma(HCC)are usually diagnosed in advanced stages,that leads to inability to achieve *** options are focusing on downstaging a locally advanced *** is wellsupported in the literature that patients with HCC who undergo successful conversion therapy followed by curative-intent surgery may achieve a significant survival benefit compared to those who receive chemotherapy alone or those who are successfully downstaged with conversion therapy but not treated with *** artery infusion chemotherapy can be a potential downstaging strategy,since recent studies have demonstrated excellent outcomes in patients with colorectal liver metastatic disease as well as primary liver malignancies.

关键词： Unresectable hepatocellular carcinoma Hepatic arterial infusion chemotherapy Downstaging Hepatocellular carcinoma

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Latest updates on structure and recommendations of cardiac rehabilitation programs in chronic heart failure

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World Journal of Clinical Cases 2024年第8期12卷 1382-1387页

作者： Christos Kourek Alexandros Briasoulis dimitrios E Magouliotis John Skoularigis Andrew Xanthopoulos Medical School of Athens National and Kapodistrian University of AthensAthens 15772Greece Department of Clinical Therapeutics Alexandra HospitalFaculty of MedicineNational and Kapodistrian University of AthensAthens 11528Greece Department of Surgery University Hospital of LarissaLarissa 41110Greece of Cardiology University Hospital of LarissaLarissa 41110Greece

Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality *** rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF,recommended by both American and European guidelines.A CR program con-sists of a multispecialty group including physicians,nurses,physiotherapists,trainers,nutritionists,and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF *** activity,lifestyle,and psychological support are core components of a successful CR *** has been shown to be beneficial in all ejection fraction categories in HF and most patients,who are stable under medication,are capable of *** individualized exercise prescription should be developed on the basis of a baseline evaluation in all *** main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and *** is important to set the appropriate clinical outcomes from the beginning,in order to assess the effectiveness of a CR *** are still significant limitations that prevent patients from participating in these programs and need to be solved.A significant limitation is the generally low quality of research in CR and the presence of negative trials,such as the rehabilitation after myocardial infarction trial,where comprehensive rehabilitation following myocardial infraction had no important effect on mortality,morbidity,risk factors,or health-related quality of life or *** the present editorial,we present all the updated knowledge and recommendations in CR programs.

关键词： Cardiac rehabilitation Heart failure Outcomes Exercise protocols Prescription Future perspectives Limitations

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Height-diameter models for King Boris fir(Abies borisii regis Mattf.) and Scots pine(Pinus sylvestris L.) in Olympus and Pieria Mountains, Greece

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Journal of Mountain Science 2024年第5期21卷 1475-1490页

作者： dimitrios I.RAPTIS Dimitra PAPADOPOULOU Angeliki PSARRA Athanasios A.FALLIAS Aristides G.TSITSANIS Vassiliki KAZANA Renewable Natural Resource Management and Bioeconomy Laboratory Department of Forest and Natural Environment SciencesInternational Hellenic University66100 DramaGreece

In forest science and practice, the total tree height is one of the basic morphometric attributes at the tree level and it has been closely linked with important stand attributes. In the current research, sixteen nonlinear functions for height prediction were tested in terms of their fitting ability against samples of Abies borisii regis and Pinus sylvestris trees from mountainous forests in central Greece. The fitting procedure was based on generalized nonlinear weighted regression. At the final stage, a five-quantile nonlinear height-diameter model was developed for both species through a quantile regression approach, to estimate the entire conditional distribution of tree height, enabling the evaluation of the diameter impact at various quantiles and providing a comprehensive understanding of the proposed relationship across the distribution. The results clearly showed that employing the diameter as the sole independent variable, the 3-parameter Hossfeld function and the 2-parameter N?slund function managed to explain approximately 84.0% and 81.7% of the total height variance in the case of King Boris fir and Scots pine species, respectively. Furthermore, the models exhibited low levels of error in both cases(2.310m for the fir and 3.004m for the pine), yielding unbiased predictions for both fir(-0.002m) and pine(-0.004m). Notably, all the required assumptions for homogeneity and normality of the associated residuals were achieved through the weighting procedure, while the quantile regression approach provided additional insights into the height-diameter allometry of the specific species. The proposed models can turn into valuable tools for operational forest management planning, particularly for wood production and conservation of mountainous forest ecosystems.

关键词： Generalized nonlinear weighted regression Monte Carlo cross-validation Mountainous ecosystems Quantile regression Central Greece

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Drawing lines in the sand: The growing threat of obesity in type 1 diabetes

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World Journal of Diabetes 2024年第5期15卷 823-827页

作者： Theocharis Koufakis dimitrios Patoulias Ioanna Zografou Nikolaos Papanas Djordje S Popovic Second Propedeutic Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Diabetes Centre Second Department of Internal MedicineDemocritus University of ThraceAlexandroupolis 68100Greece Clinic for Endocrinology Diabetes and Metabolic DisordersClinical Center of VojvodinaMedical FacultyUniversity of Novi SadNovi Sad 21000Serbia

In this editorial,we comment on the article by Zeng et al published in the recent issue of the World Journal of Diabetes in *** focus on the epidemiological,pathophysiological,and clinical interplay between obesity and type 1 diabetes mellitus(T1DM).Overweight and obesity represent a growing threat for modern societies and people with T1DM could not be an exception to this *** exogenous insulin administration,genetic and epigenetic factors,and psy-chosocial and behavioral parameters,along with the modern way of life that incorporates unhealthy eating patterns and physical inactivity,set the stage for the increasing obesity rates in *** our knowledge of the underlying mechanisms that lead to the development of obesity and hyperglycemia expands,it becomes clear that there are overlap zones in the pathophysiology of the two main types of *** regarding strict dividing lines between“autoimmune”and“metabolic”phenotypes increase the risk of trapping physicians into ineffective therapeutic approaches,instead of individualized diabetes *** this context,the use of adjuncts to insulin therapy that have the potential to alleviate cardiorenal risk and decrease body weight can reduce the burden of obesity in patients with T1DM.

关键词： Obesity Overweight Type 1 diabetes Metabolic syndrome

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Traumatic lumbar hernia: A systematic review of the literature

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Chinese Journal of Traumatology 2024年第1期27卷 53-57页

作者： Ioannis Tsouknidas Nikolaos Tasis Maria Ioanna Antonopoulou Vasileios Acheimastos dimitrios KManatakis Department of Surgery Stony Brook University HospitalStony BrookNew YorkUSA Department of Surgical Oncology St Savvas Cancer HospitalAthensGreece nd Department of Surgery Athens Naval and Veterans HospitalAthensGreece Department of Surgery Naval Hospital of CreteChaniaGreece

Purpose:Traumatic lumbar hernia(TLH)constitutes a protrusion of content through a defect in the posterior abdominal wall,as a result of *** rare entity has been described in limited number of ***:A systematic review of the literature was performed according to the meta-analysis of observational studies in epidemiology *** English literature from 1990 until 2021 was reviewed,using PubMed,EMBASE and Google Scholar bibliographic databases,to identify case reports and case series with patients that were diagnosed with *** each eligible study,demographics,clinical presentation,hernia characteristics,preoperative imaging investigations,operation details,and postoperative data were extracted for *** analysis was performed on SPSS,version ***:A total of 62 studies were included for review,with 164 patients with *** age was(42.6±14.3)years(47.6%males,31.1%females,gender not specified in 35 cases).Mean diameter of hernia neck was(6.3±3.1)cm,while the triangles of Petit and Grynfeltt were affected in 74.5%and 14.6%,*** diagnosed in the emergency setting account for 54.2%,with CT scan establishing diagnosis in all but one case(97.7%).A delayed diagnosis was made in 45.8%,at a mean 1 year following *** bulging(82.8%)and chronic back pain(34.3%)were the most frequent *** both delayed and acute group,open surgery(63.6%and 92.3%,respectively)was the preferred surgical *** complications were reported in 11.4%of acute and 15.0%of delayed *** recurrence was 7%.Conclusions:TLH is uncommon with 164 cases described since *** scan is the gold standard in *** surgery is generally the preferred approach,particularly in the emergency *** TLH can be treated either by primary suture repair or mesh,depending on the local conditions,whereas delayed cases usually require a mesh.

关键词： Lumbar hernia Petit Grynfeltt Traumatic lumbar hernia Trauma

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