Acute Postoperative Changes in Body Composition and Muscle Function Among Patients with Pancreatic Cancer Undergoing Pancreaticoduodenectomy

Aim: To observe changes in the nutritional status of patients during the acute postoperativedays following pancreaticoduodenectomy and to evaluate their influence onpostoperative complications.Methods: Nutritional status was assessed in 72 patients on the preoperative day beforesurgery and postoperative days (PD) 3 and 8, included measurements of bodycomposition by bioimpedance impedance analysis, biochemical values and musclefunction by maximum handgrip strength (HGS). The presence of postoperative complicationswas collected over 30 post operative days. Changes at PD were calculatedfor all variables. Non-parametric statistics were used and results are given as median(25th–75th quartiles).Results : Significant changes occurred on PD 3 in body weight +2.3 (0.8–3.6) kg, totalbody water +2.8 (1.1–5.9) l, extracellular water +2.5 (1.2–3.7) l, intracellular water+1.1 (-0.4–1.9) l, phase angle -1.0 (-1.2 to -0.7)°, C-reactive protein +58.0 (36.0–100.8)mg/l, serum albumin -12 (-16.5 to -10.0) g/l, and HGS -4.8 (-7.3 to -3.0) kg. Higher butno significant changes were observed at PD 3 in patients with postoperative complications(n=28) compared to those without (n=44). The hospital stay was longer inpatients with complications (12.5 days, p=0.005).Conclusion: Changes in body composition, biochemical values and muscle functionwere observed during the first 8 PDs. Changes at PD 3 did not influence significantlythe outcomes, but trends in body fluids and phase angle were found among patientswith postoperative complications

Development of comprehensive earthquake loss scenarios for a Greek and a Turkish city - structural aspects

The paper presents a methodology for developing earthquake damage and loss scenarios for urban areas, as well as its application to two cities located in Mediterranean countries, Grevena (in Greece) and Düzce (in Turkey), that were struck by strong earthquakes in the recent past. After compiling the building inventory in each city, fragility curves were derived using a hybrid approach previously developed by the authors, and a series of seismic scenarios were derived based on microzonation studies that were specifically conducted for each city (see companion paper by Pitilakis et al.). The results obtained in terms of damage estimates, required restoration times and the associated costs are presented in a GIS environment. It is deemed that both the results obtained, and the overall methodology and tools developed, contribute towards the enhancement of seismic safety in the Mediterranean area (as well as other earthquake-prone regions), while they constitute a useful pre-earthquake decision-making tool for local authorities

Tailoring interfacial effect in multilayers with Dzyaloshinskii-Moriya interaction by helium ion irradiation

We show a method to control magnetic interfacial effects in multilayers with Dzyaloshinskii–Moriya interaction (DMI) using helium (He+) ion irradiation. We report results from SQUID magnetometry, ferromagnetic resonance as well as Brillouin light scattering results on multilayers with DMI as a function of irradiation fluence to study the effect of irradiation on the magnetic properties of the multilayers. Our results show clear evidence of the He+irradiation effects on the magnetic properties which is consistent with interface modification due to the effects of the He+ irradiation. This external degree of freedom offers promising perspectives to further improve the control of magnetic skyrmions in multilayers, that could push them towards integration in future technologies

Bullying behaviour in schools, socioeconomic position and psychiatric morbidity: a cross-sectional study in late adolescents in Greece

<p>Abstract</p> <p>Background</p> <p>Bullying is quite prevalent in the school setting and has been associated with the socioeconomic position and psychiatric morbidity of the pupils. The aim of the study was to investigate the association between bullying and socioeconomic status in a sample of Greek adolescents and to examine whether this is confounded by the presence of psychiatric morbidity, including sub-threshold forms of illness.</p> <p>Methods</p> <p>5,614 adolescents aged 16-18 years old and attending 25 senior high schools were screened and a stratified random sample of 2,427 were selected for a detailed interview. Psychiatric morbidity was assessed with a fully structured psychiatric interview, the revised Clinical Interview Schedule (CIS-R), while bullying was assessed with the revised Olweus bully/victim questionnaire. The following socio-economic variables were assessed: parental educational level and employment status, financial difficulties of the family and adolescents' school performance. The associations were investigated using multinomial logit models.</p> <p>Results</p> <p>26.4% of the pupils were involved in bullying-related behaviours at least once monthly either as victims, perpetrators or both, while more frequent involvement (at least once weekly) was reported by 4.1%. Psychiatric morbidity was associated with all types of bullying-related behaviours. No socioeconomic associations were reported for victimization. A lower school performance and unemployment of the father were significantly more likely among perpetrators, while economic inactivity of the mother was more likely in pupils who were both victims and perpetrators. These results were largely confirmed when we focused on high frequency behaviours only. In addition, being overweight increased the risk of frequent victimization.</p> <p>Conclusions</p> <p>The prevalence of bullying among Greek pupils is substantial. Perpetration was associated with some dimensions of adolescents' socioeconomic status, while victimization showed no socioeconomic associations. Our findings may add to the understanding of possible risk factors for bullying behaviours in adolescence.</p

The Hellenic emergency laparotomy study (HELAS): a prospective multicentre study on the outcomes of emergency laparotomy in Greece

Background Emergency laparotomy (EL) is accompanied by high post-operative morbidity and mortality which varies significantly between countries and populations. The aim of this study is to report outcomes of emergency laparotomy in Greece and to compare them with the results of the National Emergency Laparotomy Audit (NELA). Methods This is a multicentre prospective cohort study undertaken between 01.2019 and 05.2020 including consecutive patients subjected to EL in 11 Greek hospitals. EL was defined according to NELA criteria. Demographics, clinical variables, and post-operative outcomes were prospectively registered in an online database. Multivariable logistic regression analysis was used to identify independent predictors of post-operative mortality. Results There were 633 patients, 53.9% males, ASA class III/IV 43.6%, older than 65 years 58.6%. The most common operations were small bowel resection (20.5%), peptic ulcer repair (12.0%), adhesiolysis (11.8%) and Hartmann’s procedure (11.5%). 30-day post-operative mortality reached 16.3% and serious complications occurred in 10.9%. Factors associated with post-operative mortality were increasing age and ASA class, dependent functional status, ascites, severe sepsis, septic shock, and diabetes. HELAS cohort showed similarities with NELA patients in terms of demographics and preoperative risk. Post-operative utilisation of ICU was significantly lower in the Greek cohort (25.8% vs 56.8%) whereas 30-day post-operative mortality was significantly higher (16.3% vs 8.7%). Conclusion In this study, Greek patients experienced markedly worse mortality after emergency laparotomy compared with their British counterparts. This can be at least partly explained by underutilisation of critical care by surgical patients who are at high risk for death

Development and internal validation of a clinical prediction model for serious complications after emergency laparotomy

Purpose Emergency laparotomy (EL) is a common operation with high risk for postoperative complications, thereby requiring accurate risk stratification to manage vulnerable patients optimally. We developed and internally validated a predictive model of serious complications after EL. Methods Data for eleven carefully selected candidate predictors of 30-day postoperative complications (Clavien-Dindo grade >  = 3) were extracted from the HELAS cohort of EL patients in 11 centres in Greece and Cyprus. Logistic regression with Least Absolute Shrinkage and Selection Operator (LASSO) was applied for model development. Discrimination and calibration measures were estimated and clinical utility was explored with decision curve analysis (DCA). Reproducibility and heterogeneity were examined with Bootstrap-based internal validation and Internal–External Cross-Validation. The American College of Surgeons National Surgical Quality Improvement Program’s (ACS-NSQIP) model was applied to the same cohort to establish a benchmark for the new model. Results From data on 633 eligible patients (175 complication events), the SErious complications After Laparotomy (SEAL) model was developed with 6 predictors (preoperative albumin, blood urea nitrogen, American Society of Anaesthesiology score, sepsis or septic shock, dependent functional status, and ascites). SEAL had good discriminative ability (optimism-corrected c-statistic: 0.80, 95% confidence interval [CI] 0.79–0.81), calibration (optimism-corrected calibration slope: 1.01, 95% CI 0.99–1.03) and overall fit (scaled Brier score: 25.1%, 95% CI 24.1–26.1%). SEAL compared favourably with ACS-NSQIP in all metrics, including DCA across multiple risk thresholds. Conclusion SEAL is a simple and promising model for individualized risk predictions of serious complications after EL. Future external validations should appraise SEAL’s transportability across diverse settings