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A Connectivity-Based Legalization Scheme for Standard Cell Placement

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Circuits and Systems 2017年第8期8卷 191-201页

作者： Antonios N. Dadaliaris panagiotis oikonomou Maria G. Koziri Evangelia Nerantzaki Thanasis Loukopoulos Georgios I. Stamoulis Department of Computer Science University of Thessaly Lamia Greece Department of Electrical and Computer Engineering University of Thessaly Volos Greece Department of Computer Science and Biomedical Informatics University of Thessaly Lamia Greece

Standard cell placement algorithms have been at the forefront of academic research concerning the physical design stages of VLSI design flows. The penultimate step of a standard cell placement procedure is legalization. In this step the manufacturability of the design is directly settled, and the quality of the solution, in terms of wirelength, congestion, timing and power consumption is indirectly defined. Since the heavy lifting regarding processing is performed by global placers, fast legalization solutions are protruded in state-of-the-art design flows. In this paper we propose and evaluate a legalization scheme that surpasses in execution speed two of the most widely used legalizers, without not only corrupting the quality of the final solution in terms of interconnection wirelength but improving it in the process.

关键词： Legalization Standard Cell Placement Heuristics Interconnect Wirelength

Extracorporeal organ support for critically ill patients:Overcoming the past,achieving the maximum at present,and redefining the future

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World Journal of Critical Care Medicine 2024年第2期13卷 19-28页

作者： panagiotis Papamichalis Katerina G oikonomou Maria Xanthoudaki Asimina Valsamaki Apostolia-Lemonia Skoura Sophia K Papathanasiou Achilleas Chovas Intensive Care Unit General Hospital of LarissaLarissa 41221Greece Department of Transfusion Medicine University Hospital of LarissaLarissa 41110Greece Department of Internal Medicine General Hospital of LarissaLarissa 41221Greece

Extracorporeal organ support(ECOS)has made remarkable progress over the last few years.Renal replacement therapy,introduced a few decades ago,was the first available application of ECOS.The subsequent evolution of ECOS enabled the enhanced support to many other organs,including the heart[veno-arterial extracorporeal membrane oxygenation(ECMO),slow continuous ultrafiltration],the lungs(veno-venous ECMO,extracorporeal carbon dioxide removal),and the liver(blood purification techniques for the detoxification of liver toxins).Moreover,additional indications of these methods,including the suppression of excessive inflammatory response occurring in severe disorders such as sepsis,coronavirus disease 2019,pancreatitis,and trauma(blood purification techniques for the removal of exotoxins,endotoxins,or cytokines),have arisen.Multiple organ support therapy is crucial since a vast majority of critically ill patients present not with a single but with multiple organ failure(MOF),whereas,traditional therapeutic approaches(mechanical ventilation for acute respiratory failure,antibiotics for sepsis,and inotropes for cardiac dysfunction)have reached the maximum efficacy and cannot be improved further.However,several issues remain to be clarified,such as the complexity and cost of ECOS systems,standardization of indications,therapeutic protocols and initiation time,choice of the patients who will benefit most from these interventions,while evidence from randomized controlled trials supporting their use is still limited.Nevertheless,these methods are currently a part of routine clinical practice in intensive care units.This editorial presents the past,present,and future considerations,as well as perspectives regarding these therapies.Our better understanding of these methods,the pathophysiology of MOF,the crosstalk between native organs resulting in MOF,and the crosstalk between native organs and artificial organ support systems when applied sequentially or simultaneously,will lead to the multiplication of their effects and the mi

关键词： Kidney-liver replacement therapy Heart-lung support Blood purification Native–artificial organ crosstalk Multiple organ support therapy Extracorporeal organ support

Prevention,diagnostic evaluation,management and prognostic implications of liver disease in critically ill patients with COVID-19

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World Journal of Clinical Cases 2023年第3期11卷 514-527页

作者： Asimina Valsamaki Maria Xanthoudaki Katerina G oikonomou panagiotis J Vlachostergios AntoniosPapadogoulas Periklis Katsiafylloudis Ioanna Voulgaridi Apostolia-Lemonia Skoura Apostolos Komnos panagiotis Papamichalis Intensive Care Unit General Hospital of LarissaLarissa 41221Greece Division of Hematology and Medical Oncology Department of MedicineWeill Cornell MedicineNew YorkNY 10065United States Department of Microbiology General Hospital of LarissaLarissa 41221Greece Transfusion Medicine Department University Hospital of LarissaLarissa 41110Greece

Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2,broke out in December 2019 in Wuhan city of China and spread rapidly worldwide.Therefore,by March 2020,the World Health Organization declared the disease a global pandemic.Apart from the respiratory system,various other organs of the human body are also seriously affected by the virus.Liver injury in patients with a severe form of COVID-19 is estimated to be 14.8%-53.0%.Elevated levels of total bilirubin,aspartate aminotransferase and alanine aminotransferase and low levels of serum albumin and prealbumin are the main laboratory findings.Patients with pre-existing chronic liver disease and cirrhosis are much more prone to develop severe liver injury.This literature review presented the recent scientific findings regarding the pathophysiological mechanisms responsible for liver injury in critically ill patients with COVID-19,the various interactions between drugs used to treat the disease and the function of the liver and the specific tests providing the possibility of early diagnosis of severe liver injury in these patients.Moreover,it highlighted the burden that COVID-19 put on health systems worldwide and its effect on transplant programs and the care provided to critically ill patients in general and particularly to those with chronic liver disease.

关键词： Coronavirus disease 2019 Severe acute respiratory syndrome coronavirus 2 Liver disease Intensive care unit Liver unit Prealbumin

Diabetes mellitus and atrial fibrillation-from pathophysiology to treatment

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World Journal of Diabetes 2023年第5期14卷 512-527页

作者： Marianna Leopoulou panagiotis Theofilis Athanasios Kordalis Nikolaos Papageorgiou Marios Sagris Evangelos oikonomou Dimitris Tousoulis 1^(st)Cardiology Clinic ‘Hippokration’General HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece 3^(rd)Cardiology Clinic ‘Sotiria’Chest Diseases HospitalNational and Kapodistrian University of AthensSchool of MedicineAthens 11527Greece

Type 2 diabetes mellitus(T2DM)is a leading risk factor for cardiovascular complications around the globe and one of the most common medical conditions.Atrial fibrillation(AF)is the most common supraventricular arrhythmia,with a rapidly increasing prevalence.T2DM has been closely associated with the risk of AF development,identified as an independent risk factor.Regarding cardiovascular complications,both AF and T2DM have been linked with high mortality.The underlying pathophysiology has not been fully determined yet;however,it is multifactorial,including structural,electrical,and autonomic pathways.Novel therapies include pharmaceutical agents in sodium-glucose cotransporter-2 inhibitors,as well as antiarrhythmic strategies,such as cardioversion and ablation.Of interest,glucose-lowering therapies may affect the prevalence of AF.This review presents the current evidence regarding the connection between the two entities,the pathophysiological pathways that link them,and the therapeutic options that exist.

关键词： Atrial fibrillation Diabetes mellitus Pathophysiology Treatment

Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions

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World Journal of Clinical Cases 2023年第17期11卷 3932-3948页

作者： panagiotis Papamichalis Katerina G oikonomou Asimina Valsamaki Maria Xanthoudaki Periklis Katsiafylloudis Evangelia Papapostolou Apostolia-Lemonia Skoura Michail Papamichalis Marios Karvouniaris Antonios Koutras Eleni Vaitsi Smaragdi Sarchosi Antonios Papadogoulas Dimitrios Papadopoulos Intensive Care Unit General Hospital of LarissaLarissa 41221ThessalyGreece Department of Transfusion Medicine University Hospital of LarissaLarissa 41110ThessalyGreece Department of Cardiology University Hospital of LarissaLarissa 41110ThessalyGreece Intensive Care Unit AHEPA University HospitalThessaloniki 54636Greece 1^(st) Department of Obstetrics and Gynecology General Hospital of Athens“ALEXANDRA”National and Kapodistrian University of AthensAthens 11528Greece Department of Anesthesiology University Hospital of LarissaLarissa 41110ThessalyGreece

Clinically,it is highly challenging to promote recovery in patients with acute liver failure(ALF)and acute-on-chronic liver failure(ACLF).Despite recent advances in understanding the underlying mechanisms of ALF and ACLF,standard medical therapy remains the primary therapeutic approach.Liver transplantation(LT)is considered the last option,and in several cases,it is the only intervention that can be lifesaving.Unfortunately,this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant.Another option is to restore impaired liver function with artificial extracorporeal blood purification systems.The first such systems were developed at the end of the 20th century,providing solutions as bridging therapy,either for liver recovery or LT.They enhance the elimination of metabolites and substances that accumulate due to compromised liver function.In addition,they aid in clearance of molecules released during acute liver decompensation,which can initiate an excessive inflammatory response in these patients causing hepatic encephalopathy,multiple-organ failure,and other complications of liver failure.As compared to renal replacement therapies,we have been unsuccessful in using artificial extracorporeal blood purification systems to completely replace liver function despite the outstanding technological evolution of these systems.Extracting middle to high-molecular-weight and hydrophobic/protein-bound molecules remains extremely challenging.The majority of the currently available systems include a combination of methods that cleanse different ranges and types of molecules and toxins.Furthermore,conventional methods such as plasma exchange are being re-evaluated,and novel adsorption filters are increasingly being used for liver indications.These strategies are very promising for the treatment of liver failure.Nevertheless,the best method,system,or device has not been developed yet,and its probability of getting developed in the near future is also lo

关键词： Liver failure Transplantation Blood purification Liver replacement therapy Artificial extracorporeal systems Transplant-free survival

Role of genetic testing in cardiomyopathies:Αprimer for cardiologists

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World Journal of Cardiology 2022年第1期14卷 29-39页

作者： Georgia Vogiatzi George Lazaros Evangelos oikonomou Emilia Lazarou Emmanouil Vavuranakis Dimitris Tousoulis The Third Department of Cardiology Sotiria HospitalAthens 11527Greece The First Department of Cardiology Hippokration HospitalAthens 11526Greece The First Department of Cardiology Hippokration HospitalMedical School of National and Kapodistrian University of AthensAthens 11527Greece

Recent advances in cardiovascular genetics have transformed genetic testing into a valuable part of management of families with inherited cardiomyopathies.As novel mutations have been identified,understanding when to consider genetic testing has emerged as an important consideration in the management of these cases.Specific genetic testing has a paramount importance in the risk stratification of family members,in the prognosis of probands at higher risk of a serious phenotype expression,and finally in the identification of new mutations,all of which are discussed in this review.The indications for each type of cardiomyopathy are described,along with the limitations of genetic testing.Finally,the importance of public sharing of variants in large data sets is emphasized.The ultimate aim of this review is to present key messages about the genetic testing process in order to minimize potential harms and provide suggestions to specialized clinicians who act as a part of a multidisciplinary team in order to offer the best care to families with inherited cardiomyopathies.

关键词： Cardiomyopathy Genetic counselling Genetic testing Variant Hereditary

Gastroenterology and liver disease during COVID-19 and in anticipation of post-COVID-19 era: Current practice and future directions

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World Journal of Clinical Cases 2021年第19期9卷 4918-4938页

作者： Katerina G oikonomou panagiotis Papamichalis Tilemachos Zafeiridis Maria Xanthoudaki Evangelia Papapostolou Asimina Valsamaki Konstantinos Bouliaris Michail Papamichalis Marios Karvouniaris panagiotis J Vlachostergios Apostolia-Lemonia Skoura Apostolos Komnos Intensive Care Unit General Hospital of LarissaLarissa 41221ThessalyGreece Surgical Department General Hospital of LarissaLarissa 41221ThessalyGreece Department of Cardiology University Hospital of LarissaLarissa 41110ThessalyGreece Intensive Care Unit University Hospital of LarissaLarissa 41110ThessalyGreece Division of Hematology and Medical Oncology Department of MedicineWeill Cornell MedicineNew YorkNY 10065United States Transfusion Medicine Department University Hospital of LarissaLarissa 41110ThessalyGreece

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has emerged as a major threat to global public health.The virus causes the clinical syndrome known as coronavirus disease 2019(COVID-19),in which multiple organs can get affected.Apart from manifestations of the respiratory system,which predominate,its clinical presentation is frequently accompanied by symptoms of the gastrointestinal(GI)tract and liver abnormalities.The correlation of symptoms and abnormalities with disease severity is discussed,leading to ambiguous results from international literature.Moreover,the disease infects patients with coexisting liver and GI disorders affecting both their health status and the availability of healthcare services provided to them.The risk of transmission of the disease during aerosol-generating procedures has changed the diagnostic approach and follow-up algorithms for liver and GI diseases.For the safety of both doctors and patients,telemedicine and distant evaluation have become everyday practice,whereas several routines and emergency visits at outpatient and emergency departments have been postponed or delayed.Vaccination against SARS-CoV-2 is underway,providing hope to humanity and the expectation that the post-COVID-19 era is near.This review aims to update knowledge about the manifestations of COVID-19 related to liver and GI diseases and the effect of the pandemic on the diagnostic and therapeutic procedures for these diseases with a special focus on how current practices have changed and what changes will possibly remain in the future.

关键词： COVID-19 SARS-CoV-2 Liver disease Gastroenterology practice Endoscopy

α2-Heremans-schmid glycoprotein(fetuin A)downregulation and its utility in inflammatory bowel disease

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World Journal of Gastroenterology 2017年第3期23卷 437-446页

作者： Anastassios C Manolakis Gregory Christodoulidis Andreas N Kapsoritakis panagiotis Georgoulias Elisavet K Tiaka Kostas oikonomou Varvara J Spyros P Potamianos Department of Gastroenterology University of ThessalySchool of Medicine41110 LarissaGreece Department of Surgery University of ThessalySchool of Medicine41110 LarissaGreece Laboratory of Nuclear Medicine University of ThessalySchool of Medicine41110 LarissaGreece

AIM To investigate the impact of inflammatory bowel disease (IBD) on α2-Heremans-Schmid Glycoprotein(AHSG/fetuin A) and potential associations with disease and patient characteristics.METHODS AHSG serum levels were determined in treatment-na?ve newly-diagnosed patients, 96 with ulcerative colitis(UC), 84 with Crohn's disease (CD), 62 with diarrheapredominant or mixed irritable bowel syndrome (IBS, D- and M- types) and 180 healthy controls (HC), by an enzyme linked immunosorbent assay (ELISA).All patients were followed for a minimum period of 3 years at the Gastroenterology Department of the University Hospital of Larissa, Greece. C-reactive protein(CRP), anti-glycan antibodies, anti-Saccharomyces cerevisiae mannan antibodies Ig G, anti-mannobioside carbohydrate antibodies Ig G, anti-laminariobioside carbohydrate antibodies Ig G and anti-chitobioside carbohydrate antibodies Ig A were also determined via immunonephelometry and ELISA, respectively.RESULTS The mean ± SE of serum AHSG, following adjustment for confounders, was 0.32 ± 0.02 g/L in IBD, 0.32 ± 0.03 g/L in CD and 0.34 ± 0.03 g/L in UC patients, significantly lower than in IBS patients(0.7 ± 0.018 g/L) and HC (0.71 ± 0.02 g/L) (P < 0.0001, in all cases). AHSG levels were comparable between the CD and UC groups. Based on AHSG levels IBD patients could be distinguished from HC with about 90% sensitivity and specificity. Further adjusted analysis verified the inverse association between AHSG and penetrating, as well as stricturing CD (partial correlation coefficient: -0.45 and -0.33, respectively) (P < 0.05). After adjusting for confounding factors, inverse correlations between AHSG and CRP and the need for anti-TNFα therapy or surgery, were found (partial correlation coefficients:-0.31,-0.33,-0.41, respectively, P < 0.05, in all cases). Finally, IBD individuals who were seropositive, for at least one marker, had AHSG levels falling within the two lower quartiles (OR = 2.86, 95%CI: 1.5-5.44, P < 0.001) while those with at least two serological markers pos

关键词： Inflammatory bowel disease Irritable bowel syndrome Fetuin A

Fecal DNA testing for colorectal cancer screening:molecular targets and perspectives

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World Journal of Gastrointestinal Oncology 2015年第10期7卷 178-183页

作者： Amaninder Dhaliwal panagiotis J Vlachostergios Katerina G oikonomou Yitzchak Moshenyat Department of Medicine NYU Lutheran Medical Center Division of Gastroenterology NYU Lutheran Medical Center

The early detection of colorectal cancer with effective screening is essential for reduction of cancer-specific mortality. The addition of fecal DNA testing in the armamentarium of screening methods already in clinical use launches a new era in the noninvasive part of colorectal cancer screening and emanates from a large number of previous and ongoing clinical investigations and technological advancements. In this review, we discuss the molecular rational and most important genetic alterations hallmarking the early colorectal carcinogenesis process. Also, representative DNA targets-markers and key aspects of their testing at the clinical level in comparison or/and association with other screening methods are described. Finally, a critical view of the strengths and limitations of fecal DNA tests is provided, along with anticipated barriers and suggestions for further exploitation of their use.

关键词： Colorectal cancer Screening Fecal DNA Cologuard^(■) Adenoma