Monadic NIP in Monotone Classes of Relational Structures

We prove that for any monotone class of finite relational structures, the first-order theory of the class is NIP in the sense of stability theory if, and only if, the collection of Gaifman graphs of structures in this class is nowhere dense. This generalises results previously known for graphs to relational structures and answers an open question posed by Adler and Adler (2014). The result is established by the application of Ramsey-theoretic techniques and shows that the property of being NIP is highly robust for monotone classes. We also show that the model-checking problem for first-order logic is intractable on any monotone class of structures that is not (monadically) NIP. This is a contribution towards the conjecture that the hereditary classes of structures admitting fixed-parameter tractable model-checking are precisely those that are monadically NIP

Evaluation of cardiotoxicity five years after 2D planned, non-simulated, radiation therapy for left breast cancer

Kyriaki Pistevou-Gompaki1, Apostolos Hatzitolios2, Nikos Eleftheriadis2, Evaggelos Boultoukas2, George Ntaios2, Ioannis Andronikidis2, Ioannis Tzitzikas11Department of Radiation Oncology; 2First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University, Thessaloniki, GreeceIntroduction: Radiation treatment has been associated with radiation induced cardiotoxicity, especially with older, long-outdated, techniques. Such complications include pericarditis, myocardial fibrosis, valvular injury, ischemic heart disease, and myocardial infarction.Aim: To assess the effect of outdated breast radiation therapy (RT) – using a diagnostic CT scanner in the absence of a CT simulator – on cardiac function in women with stage II left breast cancer.Patients and Methods: Sixty-two women under 65 with stage II left breast cancer who received post-operative RT using a diagnostic computed tomography scanner were studied between 1997 and 2001. Participants underwent a clinical interview, ECG, and echocardiography before and 6 months and 5 years after RT.Results: There was no serious cardiotoxicity at 6 months and 5 years after radiotherapy. A 23% increase in hypertensive patients, and a slight decrease (2.3%) in ejection fraction was observed after 5 years, with 3 patients (5%) developing abnormalities. Two patients presented abnormal electrocardiographic findings within 6 months of RT.Conclusion: Our study showed that RT for left breast cancer was not associated with significant alteration in heart morbidity or mortality within 5 years of treatment, despite the lack of a simulator.Keywords: radiotherapy, breast cancer, cardiotoxicity, acute myocardial infraction, ischemic heart diseas

First-Order Model Checking on Monadically Stable Graph Classes

A graph class $\mathscr{C}$ is called monadically stable if one cannot interpret, in first-order logic, arbitrary large linear orders in colored graphs from $\mathscr{C}$. We prove that the model checking problem for first-order logic is fixed-parameter tractable on every monadically stable graph class. This extends the results of [Grohe, Kreutzer, and Siebertz; J. ACM '17] for nowhere dense classes and of [Dreier, M\"ahlmann, and Siebertz; STOC '23] for structurally nowhere dense classes to all monadically stable classes. As a complementary hardness result, we prove that for every hereditary graph class $\mathscr{C}$ that is edge-stable (excludes some half-graph as a semi-induced subgraph) but not monadically stable, first-order model checking is $\mathrm{AW}[*]$-hard on $\mathscr{C}$, and $\mathrm{W}[1]$-hard when restricted to existential sentences. This confirms, in the special case of edge-stable classes, an on-going conjecture that the notion of monadic NIP delimits the tractability of first-order model checking on hereditary classes of graphs. For our tractability result, we first prove that monadically stable graph classes have almost linear neighborhood complexity. Using this, we construct sparse neighborhood covers for monadically stable classes, which provides the missing ingredient for the algorithm of [Dreier, M\"ahlmann, and Siebertz; STOC '23]. The key component of this construction is the usage of orders with low crossing number [Welzl; SoCG '88], a tool from the area of range queries. For our hardness result, we prove a new characterization of monadically stable graph classes in terms of forbidden induced subgraphs. We then use this characterization to show that in hereditary classes that are edge-stable but not monadically stable, one can effectively interpret the class of all graphs using only existential formulas.Comment: 55 pages, 13 figure

Phosphorus nutritional knowledge among dialysis health care providers and patients: a multicenter observational study

Background-aims Phosphorus nutritional knowledge level of hemodialysis patients and renal nurses has been found to be low, while respective knowledge of nephrologists has not been studied yet. There are equivocal results regarding the association of phosphorus nutritional knowledge level and serum phosphorus values. The aim of this study was to assess phosphorus nutritional knowledge of hemodialysis patients, nephrologists and renal nurses and seek potential interventions to improve patients’ adherence to phosphorus and overall nutritional guidelines. Methods This cross-sectional observational study was conducted on sixty eight hemodialysis patients, 19 renal nurses and 11 nephrologists who were recruited from 3 hemodialysis units in Greece. Phosphorus nutritional knowledge of the participants was assessed by a 25-item item questionnaire (CKDKAT–N) which included 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge. Results Nephrologists had higher CKDKAT–N total (19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2 ± 2.8, P < 0.01) and phosphorus knowledge scores (10.6 ± 2.7 vs 7.6 ± 2.2 and 7.3 ± 2.0, P < 0.01) compared to renal nurses and patients respectively. There were no differences in total and phosphorus knowledge scores between nurses and patients. Patients and nurses answered correctly significantly less questions regarding phosphorus compared with the rest of the questions (P < 0.01) while no such difference was found in nephrologists. Serum phosphorus was positively correlated with phosphorus knowledge score (r = 0.31, P = 0.02), and negatively correlated with patient age (r = −0.34, P < 0.05). None of the patients, 11% of the nurses and 27% of the nephrologists answered correctly all three questions regarding P, K and Na dietary recommendations (P < 0.01). Conclusions The study confirms that hemodialysis patients have low renal nutrition knowledge while higher nutritional phosphorus knowledge does not lead to lower serum phosphorus values. Alarmingly, renal nurses have been found to have a similar level of knowledge with hemodialysis patients, something that needs to be taken into account when training the new dialysis staff. Nephrologists have superior knowledge; however they are still lacking essential nutritional knowledge that could affect patients' and nurses’ overall understanding. Continuing education on nutrition of nephrologists and renal nurses could improve nutrition care of hemodialysis patients

Simultaneous clinical resolution of focal segmental glomerulosclerosis associated with chronic lymphocytic leukaemia treated with fludarabine, cyclophosphamide and rituximab

<p>Abstract</p> <p>Background</p> <p>Although renal involvement in advanced haematological malignancies is common, glomerulonephritis associated with lymphoproliferative disorders is rare, and the related pathogenetic mechanisms are still poorly understood. We present a rare case of chronic lymphocytic leukaemia(CLL)-associated focal segmental glomerulosclerosis with nephrotic-range proteinuria.</p> <p>Case presentation</p> <p>A 53-year-old Caucasian man, previously healthy, with no history of hypertension, alcohol use or smoking presented with rapid weight gain, massive peripheral oedema, and hypertension. Laboratory findings included a white blood cell count of 49,800 cells/mm³with an absolute lymphocyte count of 47,000 cells/mm³, serum albumin of 2.3 g/dL, urea 65 mg/dL, and creatinine 1.5 mg/dL. A 24-hour urine collection contained 7.1 g protein and significant haematuria. A peripheral blood smear showed mature lymphocytosis and smudge cells. Diagnostic imaging showed mild paraaortic lymphadenopathy with no renal abnormalities. Bone marrow aspiration and trephine biopsy showed diffuse and focal infiltration with B-CLL lymphocytes. Percutaneous renal biopsy revealed total sclerosis in 3/21(14%) of the glomeruli and focal and segmental solidification and sclerosis in 4/21 (19%) glomeruli. A regimen of fludarabine, cyclophosphamide and rituximab was successful in inducing remission of the CLL and clinical resolution of the nephritic-range proteinuria.</p> <p>Conclusions</p> <p>A multidisciplinary approach to monitor both the malignancy and the glomerular lesions is crucial for the optimal management of paraneoplastic glomerulonephritis. Although chemotherapy with fludarabine, cyclophosphamide and rituximab successfully treated CLL-associated nephrotic syndrome in our patient, further studies are required to confirm efficacy in this setting.</p

Self-reported risk of obstructive sleep apnea syndrome, and awareness about it in the community of 4 insular complexes comprising 41 Greek Islands

Obstructive Sleep Apnea Syndrome (OSAS) is a chronic disease that significantly increases morbidity and mortality of the affected population. There is lack of data concerning the OSAS prevalence in the insular part of Greece. The purpose of this study was to investigate the self-reported prevalence of OSAS in 4 Greek insular complexes comprising 41 islands, and to assess the awareness of the population regarding OSAS and its diagnosis. Our study comprised 700 participants from 41 islands of the Ionian, Cyclades, Dodecanese and Northeast Aegean island complexes that were studied by means of questionnaires via a telephone randomized survey (responsiveness rate of 25.74%). Participants were assessed by the Berlin Questionnaire (BQ) for evaluation of OSA risk, by the Epworth Sleepiness Scale (ESS) for evaluation of excessive daytime sleepiness, and by 3 questions regarding the knowledge and diagnosis of OSAS. The percentage of participants at high risk according to BQ was 27.29% and the percentage of people who were at high risk according to ESS was 15.43%. A percentage of 6.29% of the population was at high risk for OSAS (high risk both in BQ and ESS). A high percentage of 73.43%, were aware of OSAS as a syndrome however a significantly less percentage (28.00%) was aware of how a diagnosis of OSAS is established. The community prevalence of OSAS in Greek islands in combination with the low-level awareness of the OSAS diagnostic methods highlights the need for development of health promotion programs aiming at increasing the detection of patients at risk while increasing the awareness of OSAS

Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned

Results of the first European Source Apportionment intercomparison for Receptor and Chemical Transport Models

In this study, the performance of the source apportionment model applications were evaluated by comparing the model results provided by 44 participants adopting a methodology based on performance indicators: z-scores and RMSEu, with pre-established acceptability criteria. Involving models based on completely different and independent input data, such as receptor models (RMs) and chemical transport models (CTMs), provided a unique opportunity to cross-validate them. In addition, comparing the modelled source chemical profiles, with those measured directly at the source contributed to corroborate the chemical profile of the tested model results. The most used RM was EPA- PMF5. RMs showed very good performance for the overall dataset (91% of z-scores accepted) and more difficulties are observed with SCE time series (72% of RMSEu accepted). Industry resulted the most problematic source for RMs due to the high variability among participants. Also the results obtained with CTMs were quite comparable to their ensemble reference using all models for the overall average (>92% of successful z-scores) while the comparability of the time series is more problematic (between 58% and 77% of the candidates’ RMSEu are accepted). In the CTM models a gap was observed between the sum of source contributions and the gravimetric PM10 mass likely due to PM underestimation in the base case. Interestingly, when only the tagged species CTM results were used in the reference, the differences between the two CTM approaches (brute force and tagged species) were evident. In this case the percentage of candidates passing the z-score and RMSEu tests were only 50% and 86%, respectively. CTMs showed good comparability with RMs for the overall dataset (83% of the z-scores accepted), more differences were observed when dealing with the time series of the single source categories. In this case the share of successful RMSEu was in the range 25% - 34%.JRC.C.5-Air and Climat