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An unclassified tibial plateau fracture： Reverse Schatzker type Ⅳ

Chinese Journal of Traumatology 2018年第4期21卷 211-215页

作者： Tien Yeoh efthymios iliopoulos Alex Trompeter St George's University Hospital NHS Trust London United Kingdom

The most commonly accepted system of classification for tibia plateau fractures is that of Schatzker. Increasingly, both high energy injuries and atypical osteoporotic fragility failures have led to more complex, unusual and previously undescribed fracture patterns being recognized. We present a case of a patient with a previously unreported pattern of tibia plateau fracture and knee dislocation. We highlight the challenges confronted and present the management and the outcomes of his injury. A 28-year old male motorcyclist was involved in a head on collision with a truck and was transferred by helicopter to our level I major trauma centre emergency department. His injuries were a circumferential degloving injury to his left leg and a right lateral tibial plateau fracture/knee dislocation. The pattern of the lateral tibial plateau fracture was unique and did not fit any recognised classification system. The patient received a spanning external fixator initially and after latency of 12 days for soft tissue resuscitation he underwent definite fixation through an antero-lateral approach to the proximal tibia with two cannulated 6.5 mm partially threaded screws and an additional lateral proximal tibia plate in buttress mode. A hinged knee brace was applied with unrestricted range of motion post-operatively and free weight bearing were permitted post operatively. At the 6 months follow up, the patient walks without aids and with no limp. Examination revealed a stable joint and full range of motion. Plain radiographs revealed that the fracture healed with good alignment and the fixation remained stable. High energy injuries can lead to more complicated fracture patterns, which challenge the orthopaedic surgeons in their management. It is crucial to understand the individual fracture pattern and the possible challenges that may occur. This study reports a lateral tibia plateau fracture/dislocation which perhaps is best described as a reverse Schatzker IV type fracture.

关键词： Knee Tibial plateau fractures Schatzker classification Lower limb trauma

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Chertsey Outcome Score for Trauma： Development and validation of a new unifying patient reported outcome measure for orthopaedic trauma

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Chinese Journal of Traumatology 2017年第6期20卷 329-332页

作者： efthymios iliopoulos Sujit Agarwal Arshad Khaleel The Rowley Bristow Unit Ashford and St Peter's Hospitals NHS Foundation Trust Chertsey United Kingdom

Purpose： Lately there is an increasing tendency of using Patient Reported Outcome Measures （PROMs） as a final indicator of the outcome of many surgical treatments in orthopaedics and in other medical specialties. Currently there are many outcome scores in orthopaedics and most of them are site specific. In the contrary there is a lack of trauma specific outcome scores. Methods： We have designed a new PROM especially for orthopaedic trauma patients, in order to measure in what extent the patients manage to return to their pre-injury state. This score uses as baseline the preinjury status of the patient and has the aim to determine the percentage of rehabilitation after treatment for any injury. Results： A total of 60 Chertsey Outcome Score for Trauma （COST） questionnaires were gathered in our outpatients department. The participants were 57% male （aged 46.81 years ± 18.5 years） and the questionnaires collected at mean 10 months post-injury. A Cronbach＇s Alpha value of 0.89 was identified for the whole construct. The three dimensions of the scale had good internal consistency as well （Cronbach＇s Alpha test values 0.74, 0.84 and 0.81 for symptoms, function and mental status respectively）. Strong/moderate correlation （Spearman＇s Rho test 0.43-0.65） was observed between the respective physical/mental dimensions of the COST and SF-12v2 questionnaires. Conclusion： There is a need among the orthopaedic trauma society for a specific PROM of trauma. COST is a useful and easy to use tool for every trauma surgeon.

关键词： Patient reported outcome measures Surveys and questionnaires Injury severity score

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Predicting factors for better outcomes of stable supination external rotation type 2 ankle fractures

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Chinese Journal of Traumatology 2022年第6期25卷 353-356页

作者： efthymios iliopoulos Jay James Watson Felicity Auld Richard Freeman Natasha Hossain Brighton&SussexUniversity Hospitals NHS TrustBrightonBN25BEUnited Kingdom

Purpose:Stable Weber B ankle fractures are treated by a walking boot for 6 weeks and bearing full weight through the boot as *** aim of the present study was to assess the outcome parameters of this treatment protocol,evaluate the efficacy of using the walking boot,and investigate any possible predicting factors that could affect the ***:All the patients with stable Weber B ankle fractures,treated in our hospital between January 2018 and December 2018,were prospectively included to the *** patients were evaluated clinically,and the patient-reported outcome measures data were collected at the 2 and 6 weeks *** square,Spearman’’s rho test,independent samples and paired samplet-tests were used for the monovariant ***:A total of 128 consecutive patients(aged 52.2±19.1 years)with supination external rotation type 2 fracture were finally included to the *** the 2 weeks follow-up,the reported outcome measures scores were in moderate levels,but improved significantly at the 6 weeks follow-up(p<0.0001).Multivariant analysis revealed that the ability to bear full weight without the boot at the 2 weeks after diagnosis was the only variable,which made statistically unique contribution to the foot and ankle disability index score at the 6 weeks(p=0.005).Conclusion:Conservative treatment using a walking boot with advice to bear full weight of stable ankle Weber B fractures can bring to good functional *** ability to bear full weight without the aid of the walking boot at 2 weeks after diagnosis was the only significant predicting factor for better outcomes at 6 weeks after diagnosis.

关键词： Ankle injury Weber B SER2 Ankle fracture rehabilitation

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Posterior shoulder fracture-dislocation:A systematic review of the literature and current aspects of management

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Chinese Journal of Traumatology 2021年第1期24卷 18-24页

作者： Georgios Paparoidamis efthymios iliopoulos AAli Narvani Ofer Levy Eleftherios Tsiridis loannis Polyzois The Rowley Bristow Unit Ashford&St Peter's HospitalsNHS Foundation TrustChertseySurreyUnited Kingdom Academic Orthopaedic Department Papageorgiou General HospitalFaculty of Health SciencesMedical SchoolAristotle University of Thessalonikiand CORE LabCIRI-AUThThessalonikiGreece Shoulder and Elbow Centre-Reading Shoulder Unit United Kingdom International Center for Arthroplasty&Robotic Orthopaedic Surgery(ICAROS) European Interbalkan Medical CenterThessalonikiGreece Surrey Orthopaedic Clinic United Kingdom

Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event;however,most orthopaedic surgeons may face the challenge of treating *** aim of this study is to review and summarise systematically the current principles of the management of this complex injury,and create a treatment *** Both PubMed and Scopus Databases were systematically searched for the terms“posterior shoulder fracture-dislocation”or“posterior glenohumeral fracture-dislocation”or“posterior glenoid fracture-dislocation”for articles written in English and published in the last *** A total of 900 articles were identified,of which 13 were retained for analysis.A total of 153 patients(161 shoulders)were *** patients were treated either with open reduction and internal fixation,modified McLaughlin procedure,allograft/autograft humeral head reconstruction or shoulder *** mean age was 40.15 *** mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45,whereas by bone graft was ***,the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure,*** The management of posterior shoulder fracture-dislocation may be challenging,and the best surgical option depends on many variables such as the chronicity of the injury,the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any.A treatment algorithm is proposed,based on the current literature in an effort to create a consensus for these *** the acute shoulder fracture-dislocations,an open reduction should be *** the chronic fracture/dislocations in the elderly low-demand patients,conservative treatment should be *** the rest of the patients,depending on the severity of the Hill-Sachs lesion different surgical options are available such as the

关键词： Treatment algorithm Shoulder injury Posterior dislocation Fracture-dislocation Shoulder dislocation

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Nucleic acid vaccines: A taboo broken and prospect for a hepatitis B virus cure

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World Journal of Gastroenterology 2021年第41期27卷 7005-7013页

作者： efthymios P Tsounis Athanasia Mouzaki Christos Triantos Division of Gastroenterology Department of Internal MedicineUniversity of PatrasPatras 26504Greece Division of Hematology Department of Internal MedicineUniversity of PatrasPatras 26504Greece

Although a prophylactic vaccine is available,hepatitis B virus(HBV)remains a major cause of liver-related morbidity and *** treatment options are improving clinical outcomes in chronic hepatitis B;however,true functional cure is currently the exception rather than the *** acid vaccines are among the emerging immunotherapies that aim to restore weakened immune function in chronically infected *** vaccines in particular have shown promising results in vivo by reducing viral replication,breaking immune tolerance in a sustained manner,or even decimating the intranuclear covalently closed circular DNA reservoir,the hallmark of HBV *** DNA vaccines encoding surface antigens administered by conventional injection elicit HBVspecific T cell responses in humans,initial clinical trials failed to demonstrate additional therapeutic benefit when administered with nucleos(t)ide *** an attempt to improve vaccine immunogenicity,several techniques have been used,including codon/promoter optimization,coadministration of cytokine adjuvants,plasmids engineered to express multiple HBV epitopes,or combinations with other *** vaccine delivery by electroporation is among the most efficient strategies to enhance the production of plasmid-derived antigens to stimulate a potent cellular and humoral anti-HBV *** results suggest that DNA vaccination via electroporation efficiently invigorates both arms of adaptive immunity and suppresses serum HBV *** contrast,the study of mRNA-based vaccines is limited to a few in vitro experiments in this *** studies are needed to clarify the prospects of nucleic acid vaccines for HBV cure.

关键词： Chronic hepatitis B Therapeutic vaccination Nucleic acid vaccines DNA vaccines Electroporation Immunotherapy

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Using blockchain and semantic web technologies for the implementation of smart contracts between individuals and health insurance organizations

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Blockchain(Research and Applications) 2022年第2期3卷 1-14页

作者： efthymios Chondrogiannis Vassiliki Andronikou Efstathios Karanastasis Antonis Litke Theodora Varvarigou National Technical University of Athens 9 Heroon Politechniou Str15773AthensGreece

Blockchains and smart contracts are gaining momentum as enabling technologies for a wide set of applications where data distribution and sharing among decentralized infrastructures is *** this work,we present a distributed application developed using blockchain technologies that allows individuals and health insurance organizations to come into agreement during the implementation of the healthcare insurance policies in each *** this purpose,health standards and semantic web technologies were used for the formal expression of both the insured individual's data and contract ***,a fine-grained data access policy was applied for evaluating contract terms on the basis of relevant data captured in healthcare settings.A prototype was implemented involving the development of several different smart contracts for the Ethereum platform as well as the necessary visual environment for accessing *** developed system validates various features related to blockchain and smart contract features that are briefly discussed in this work,part of which can be mitigated or resolved through the use of a private permissioned *** application of well-established techniques for potential malfunctions of external services could also boost the security of the system and prevent it from potential attacks.

关键词： Blockchain Smart contracts Insurance organizations Health standards Semantic web

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Toward a new era of hepatitis B virus therapeutics:The pursuit of a functional cure

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World Journal of Gastroenterology 2021年第21期27卷 2727-2757页

作者： efthymios P Tsounis Evanthia Tourkochristou Athanasia Mouzaki Christos Triantos Division of Gastroenterology Department of Internal MedicineMedical SchoolUniversity of PatrasPatras 26504Greece Division of Hematology Department of Internal MedicineMedical SchoolUniversity of PatrasPatras 26504Greece

Hepatitis B virus(HBV)infection,although preventable by vaccination,remains a global health problem and a major cause of chronic liver *** current treatment strategies suppress viral replication very efficiently,the optimal endpoint of hepatitis B surface antigen(HBsAg)clearance is rarely ***,the thorny problems of persistent chromatin-like covalently closed circular DNA and the presence of integrated HBV DNA in the host genome are ***,the scientific community has focused on developing innovative therapeutic approaches to achieve a functional cure of HBV,defined as undetectable HBV DNA and HBsAg loss over a limited treatment period.A deeper understanding of the HBV life cycle has led to the introduction of novel direct-acting antivirals that exert their function through multiple mechanisms,including inhibition of viral entry,transcriptional silencing,epigenetic manipulation,interference with capsid assembly,and disruption of HBsAg *** parallel,another category of new drugs aims to restore dysregulated immune function in chronic hepatitis B accompanied by lethargic cellular and humoral *** of innate immunity by pattern-recognition receptor agonists leads to upregulation of antiviral cytokine expression and appears to contribute to HBV *** checkpoint inhibitors and adoptive transfer of genetically engineered T cells are breakthrough technologies currently being explored that may elicit potent HBV-specific T-cell *** addition,several clinical trials are attempting to clarify the role of therapeutic vaccination in this ***,it is increasingly recognized that elimination of HBV requires a treatment regimen based on a combination of multiple *** review describes the rationale for progressive therapeutic interventions and discusses the latest findings in the field of HBV therapeutics.

关键词： Chronic hepatitis B Functional cure Direct-acting antivirals Gene silencing Immunotherapy Therapeutic vaccination

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Ultrasonography in differentiation between chronic viral hepatitis and compensated early stage cirrhosis

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World Journal of Gastroenterology 2008年第13期14卷 2072-2079页

作者： Panagiotis iliopoulos Marianna Vlychou Chrisoula Karatza Spyros D Yarmenitis Maria Repanti Ioannis Tsamis Kostantinos Tepetes Department of Radiology "Agios Andreas" General Hospital Patras Greece Department of Radiology University of Thessaly Greece Department of Hepatology-Gastroenterology University of Patras Greece Department of Radiology University of Crete Greece Department of Pathology "Agios Andreas" General Hospital Patras Greece Department of Surgery University of Thessaly Greece

AIM: To assess the value of gray scale (GS) and colour Doppler ultrasonography (CDU) in differentiating the progression of chronic viral hepatitis (CVH) and compensated liver cirrhosis (CIR). METHODS: Seventy-two patients and 32 normal individuals who were used as controls were studied. Forty-four patients suffered from CVH and 28 from CIR. All patients were underwent to liver biopsy. Multiple qualitative and quantitative variables were studied in liver, portal vein (PV), hepatic artery (HA) and spleen with GS and CDU. On the basis of the obtained CDU data, several known indexes were calculated. In addition, alternative indices [PV diameter (D)/time average mean velocity (VTAM), HA/PV VTAM ratio] were calculated and studied. RESULTS: ROC analysis showed that PV congestion index, PV D/VTAM and HA/PV VTAM indices had the best sensitivity and specificity in discriminating CVH from CIR. Stepwise discriminant analysis showed that 88.9% of the originally grouped cases could be correctly classified by the three qualitative and four quantitative variables selected as statistically significant predictors. Among the CVH patients who underwent to biopsy, statistically significant changes were found in those at fibrosis stage 5 compared to fibrosis stages 1-4. CONCLUSION: Simple GS and CDU parameters discri-minate CVH from CIR. The alternative Doppler indexes can accurately differentiate chronic virus hepatitis from cirrhosis. These indexes can be used in monitoring chronic virus hepatitis and avoiding unnecessary biopsies.

关键词： Liver cirrhosis Virus hepatitis Portal hypertension Doppler ultrasonography

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Scintigraphic detection of carcinoid tumors with a cost effectiveness analysis

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World Journal of Gastroenterology 2004年第24期10卷 3628-3633页

作者： DimitrisDimitroulopoulos DimitrisXynopoulos KlisthenisTsamakidis EmmanouelParaskevas Athanassios Zisimopoulos efthymios Andriotis Ekaterini Fotopoulou Nikiforos Apostolikas Marios Kontis Ioannis Paraskevas Gastroenterology Unit Agios Savvas Cancer HospitalAthensGreece Section of Nuclear Medicine Agios Savvas Cancer HospitalAthensGreece CT Department.Agios Savvas Cancer Hospital AthensGreece First Radiology-Oncology Department Agios Savvas Cancer HospitalAthensGreece Pathology Department Agios Savvas Cancer HospitalAthensGreece Economics and Statistics Department Agios Savvas Cancer HospitalAthensGreece City University London LondonUnited Kingdom

AIM: To evaluate the diagnostic sensitivity and accuracy and the cost-effectiveness of this technique in the detection of gastroenteropancreatic cardnoid tumors and their metastases in comparison with conventional imaging ***: Somatostatin receptor scintigraphy (SRS) was performed in 24 patients with confirmed carcinoids and 7 under investigation. The results were compared with those of conventional imaging methods (chest X-ray, upper abdominal ultrasound, chest CT, upper and lower abdominal CT). Also a cost-effectiveness analysis was performed comparing the cost in Euro of several combinations of SRS with conventional imaging ***: SRS visualized primary or metastatic sites in 71.0% of cases and 61.3% of conventional imagings. The diagnostic sensitivity of the method was higher in patients with suspected lesions (85.7% vs57.1%). SRS was less sensitive in the detection of metastatic sites (78.9% vs 84.2%). The undetectable lesions by SRS metastatic sites were all in the liver. Between several imaging combinations, the combinations of chest X-ray/upper abdominal CT/SRS and chest CT/upper abdominal CT/SRS showed the highest sensitivity (88.75%) in terms of the number of detected lesions. The combinations of chest X-ray/upper abdominal US/SRS and chest CT/upper abdominal ultrasound/SRS yielded also a quite similar sensitivity (82%). Compared to the cost of the four sensitive combinations the combination of chest X-ray/upper abdominal ultrasound/SRS presented the lower cost,1183.99 Euro vs 1251.75 Euro for chest CT/upper abdominal ultrasound/SRS, 1294.93 Euro for chest X/ray/upper abdominal CT/SRS and 1362.75 Euro for chest CT/upper abdominal CT/***: SRS imaging is a very sensitive method for the detection of gastroenteropancreatic carcinoids but is less sensitive than ultrasound and CT in the detection of liver metastases. Between several imaging combinations, the combination of chest X-ray/upper abdominal CT/SRS shows the highest s

关键词：良性肿瘤成本效力关系 CT 敏感性腹部

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An Evaluation of Routing Algorithms in Traffic Engineering and Quality of Service Provision of Network on Chips

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Engineering（科研） 2021年第1期13卷 1-17页

作者： efthymios N. Lallas School of Technology University of Thessaly Lamia Greece

Nowadays the number of cores that are integrated into NoC (Network on Chip) systems is steadily increasing, and real application traffic, running in such multi-core environments requires more and more bandwidth. In that sense, NoC architectures should be properly designed so as to provide efficient traffic engineering, as well as QoS support. Routing algorithm choice in conjunction with other parameters, such as network size and topology, traffic features (time and spatial distribution), as well as packet injection rate, packet size, and buffering capability, are all equivalently critical for designing a robust NoC architecture, on the grounds of traffic engineering and QoS provision. In this paper, a thorough numerical investigation is achieved by taking into consideration the criticality of selecting the proper routing algorithm, in conjunction with all the other aforementioned parameters. This is done via implementation of four routing evaluation traffic scenarios varying each parameter either individually, or as a set, thus exhausting all possible combinations, and making compact decisions on proper routing algorithm selection in NoC architectures. It has been shown that the simplicity of a deterministic routing algorithm such as XY, seems to be a reasonable choice, not only for random traffic patterns but also for non-uniform distributed traffic patterns, in terms of delay and throughput for 2D mesh NoC systems.

关键词： Network on Chip QoS Traffic Engineering XY DyAD Routing Algorithm Hotspot Traffic

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