Center In Greece Research Articles

Lipoprotein (a) and lipidemic parameters in PCSK-9 inhibitor patients. Experience from a specialized centre in Greece

Abstract Background Previous studies have reported an association between Proprotein Convertase Subtilsin-kexin type 9 (PCSK-9) inhibition and levels of lipoprotein a [Lp (a)], having a possible effect on the cardiovascular benefit achieved by their use. The purpose of this study was to investigate the effect of PCSK-9 inhibitor use in Lp (a) and other lipidemic parameter levels in the population of a specialized Lipids Clinic during a follow up period of 24 months. Methods We enrolled 143 (80 males, mean age 60 years old) patients who were on PSCK-9 inhibitor treatment from the outpatient lipid clinic of our hospital. Information were obtained regarding the presence of coronary artery disease (CAD) and CAD risk factors. CAD was present in 72 patients (63%), Familial Hypercholesterolaemia (FH) in 97 patients (85%) and 20 (18%) patients suffered from statin intolerance. Patients were on triple lipid lowering therapy (statin plus ezetimibe plus PCSK-9 inhibitors) except for those with statin intolerance who were either on dual therapy (ezetimibe plus PCSK-9 inhibitors, N=8) or single PCSK-9 inhibitors therapy (N=10). Lp (a) levels and lipid parameters such as Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglycerides (TG) were measured at baseline, 3 months, 12 months and 24 months of treatment. Additionally, patients were categorized according to baseline Lp (a) levels in two groups, Group 1 (<70mg/dl) (N=62), Group 2 (≥70 mg/dl) (N=26). A comparison of the response in lipid parameters between these two groups was performed. Results Mean value for Lp (a) in the whole population was 54mg/dl, 48mg/dl, 44mg/dl, and 45mg/dl at baseline, 3, 12 and 24 months, respectively. T test analysis revealed a significant reduction in Lp (a) levels after 12 months (P<0.05) There was also a significant reduction in LDL levels at all time points (165mg/dl to 78mg/dl, 85mg/dl, 78mg/dl respectively, P<0.05), a reduction in triglyceride levels at 3 and 12 months (125mg/dl to 110mg/dl, 108mg/dl respectively, P<0.05) and an increase in HDL levels after 12 months (50mg/dl to 53mg/dl, P<0.05). Moreover, in Group 1, the response in LDL levels was higher after 12 months of treatment with PCSK-9 inhibitors (158mg/dl to 69mg/dl, P<0.05) compared to Group 2 (155mg/dl to 86mg/dl), indicating that high levels of Lp (a) seem to define the response to treatment. Colclusions Besides the detrimental effect in LDL levels, PCSK-9 inhibition has an impact on HDL and TG levels. Lp (a) was also reduced indicating an additional important effect of this inhibition. While higher levels of Lp (a) seem to correlate with poorer response to treatment, our findings enhance the already known importance of Lp (a) as a prognostic factor.

Unveiling the Impact of Moderate and Severe Atopic Dermatitis: Insights on Burden, Clinical Characteristics, and Healthcare Resource Utilization in Adult Greek Patients from the APOLO Cross-Sectional Study.

Background: Moderate to severe (M2S) atopic dermatitis (AD) is a chronic condition impacting individuals, society, and healthcare systems. Considering the changing M2S-AD treatment landscape, this study assesses the M2S-AD burden in patients reaching referral centers in Greece. Methods: This was a multicenter, cross-sectional study. Patients aged 12 years or older with clinically diagnosed M2S-AD were enrolled. Data collected included clinical practice assessments and the following validated patient-reported instruments: Dermatology Life Quality Index (DLQI); EuroQol-5 Dimensions-3 Level scale (EQ-5D-3L); Patient Oriented Eczema Measure (POEM); Peak Pruritus Numerical Rating Scale (PP-NRS); and Work Productivity and Activity Impairment: General Health (WPAI:GH). A pain frequency/intensity/cause questionnaire and a sleep disturbance scale were also used. Results: Outcomes of 184 adults (51.1% female) with M2S-AD based on the Eczema Area and Severity Index (EASI) are presented (n = 117 moderate; n = 67 severe). Among the patients, 14.8% were obese, 59.2% had allergic comorbidities, and 88.0% were receiving AD-specific therapy (systemic: 38.6%). The median age, disease duration, body surface area, and total EASI scores were 38.8 years, 11.8 years, 30.0%, and 16.9, respectively. The median DLQI score was 12.0, with 'symptoms/feelings' being the most affected domain. EQ-5D dimensions 'anxiety/depression' and 'pain/discomfort' were also affected (65.2% and 64.1% reporting problems, respectively). The median POEM score was 17.0. Pain, severe pruritus (PP-NRS ≥ 7), and sleep disturbance were reported by 80.4%, 62.0%, and 88.5%, respectively. The median WPAI:GH 'work productivity loss' and 'activity impairment' scores were 23.8% and 30.0%, respectively. Conclusions: Both moderate and severe AD patients reaching Greek specialized centers experience significant symptom burden and impairments in quality of life, sleep, work, and daily activities.

EP.05A.04 Risk Factors for the Development of Pulmonary Infection after Bronchoscopy in Patients with Lung Cancer - A Centre in Greece

EP.05A.04 Risk Factors for the Development of Pulmonary Infection after Bronchoscopy in Patients with Lung Cancer - A Centre in Greece

Pregnancy outcomes in Greek women with inflammatory bowel disease: a longitudinal national retrospective study.

Inflammatory bowel disease (IBD) commonly affects patients of reproductive age. The effect of disease activity on the outcome of pregnancy and its impact on neonatal health are areas of intense research. Α national retrospective study of pregnancies in women with IBD between 2010 and 2020 was carried out in 22 IBD reference centers in Greece. 223 pregnancies in 175 IBD patients [122 Crohn's disease (CD)] were included. Mean age at diagnosis was 26 years (12-44) with a mean duration of 7.4 (0-23). Pregnancy as a result of IVF occurred in 15 cases (6.7%). At the beginning of gestation, 165 patients (74%) were under treatment: 48 (29%) with anti-tumor necrosis factor alpha agents, 43 (26%) with azathioprine, 101 (61%) with 5-aminosalicylates, and 12 (7%) with steroids. Forty-nine cases (22%) of IBD flares were recorded: Two-thirds (n = 30) were in clinical remission at the onset of pregnancy, whereas treatment with corticosteroids was required in 22 (45%). Patients with ulcerative colitis were at greater risk for flare compared to those with CD (P < 0.001). All but two pregnancies (99.1%) resulted in an uncomplicated delivery. In 147 cases (67.1%), c-section was performed. Two late fetal deaths (0.9%) were reported, both in patients with persistently active disease. After delivery, 75 patients (34%) presented with a disease flare, associated with active disease at the beginning of pregnancy (P < 0.001). The majority of Greek patients with IBD have a favorable pregnancy outcome. Active inflammation during gestation and a diagnosis of ulcerative colitis are negatively associated with pregnancy outcomes.

Central versus peripheral VA ECMO for cardiogenic shock: an 8-year experience of a tertiary cardiac surgery center in Greece

BackgroundVenoarterial extracorporeal membrane oxygenation (VA ECMO) has emerged as an effective rescue therapy in patients with cardiogenic shock refractory to standard treatment protocols, and its use has been rising worldwide in the last decade. Although experience and availability are growing, outcomes remain poor. There is need for evidence to improve clinical practice and outcomes. MethodsWe retrospectively reviewed the medical records of all patients who were supported with VA ECMO for cardiogenic shock at our institution between January 2015 and January 2023. The study purpose was to compare outcomes between patients who were supported with central versus peripheral configuration. ResultsECMO was applied in 108 patients, 48 (44%) of whom received central configuration and 60 (56%) peripheral. Patients supported with central VA ECMO were more likely to be supported for post-cardiotomy shock (odds ratio [OR] 4.6 [95% confidence interval (CI) 2.03–10.41]), while patients in the peripheral group were predominantly treated for chronic heart failure decompensation (OR 9.4 [95% CI 1.16–76.3]). Central VA ECMO had lower survival rates during ECMO support (29.2% versus 51.7%, p = 0.018) and at discharge (8% versus 37%, p = 0.001). These patients were at high risk of complications, such as acute kidney injury (AKI) (OR 2.37 [95% CI 1.06–5.3], p = 0.034) and major bleeding (OR 3.08 [95% CI 1.36–6.94], p < 0.001). ConclusionsPatients on central VA ECMO were supported mainly for post-cardiotomy shock, presented with more complications such as major bleeding and AKI, and had worse survival to hospital discharge compared with patients on peripheral VA ECMO. Patient selection, timing of implementation, cannulation strategy, and configuration remain the main determinants of clinical outcome.

Migration policies versus public health - the ethics of Covid-19 related movement restrictions for asylum seekers in reception centers in Greece in 2020.

The emergency context of the Covid-19 pandemic necessitated the use of national and international public health measures of unprecedented scale to minimize mortality and morbidity, often in conflict with other principles and rights, such as the autonomy of individuals. Concerns have been voiced that for populations facing precarity, such as migrants, a disproportionate and unfair application of restrictive measures, deficient application of protective measures, and even enforcement of restrictive migration policies under the pretext of the pandemic has occurred. Various principles have been proposed as moral foundations of public health interventions. The author used two public health ethics frameworks to examine the ethical acceptability of movement restrictions on asylum seekers residing in refugee camps in Greece from March 2020 to October 2020. Most of the principles described in the frameworks for the ethical application of movement restrictions were not adhered to. Main concerns include that, measures were prolonged despite lack of evidence about their effectiveness to reduce morbidity and mortality, while posing severe and disproportionate burdens for this population. An ethically acceptable public health response to Covid-19 is incompatible with certain living conditions of refugees, asylum seekers, and migrants. The question of whether and if so the extent to which the discipline of public health inherently has the role of rectifying existing injustices and social inequalities when these can be convincingly related to health outcomes, is central to the design of public health interventions for these populations. The answer can exemplify the need to address moral and political determinants of health. It is essential for public health professionals to be aware of the moral theorizations that underpin their work, so as to ensure that their policies are aligned with those and to contribute to the debate that shapes these determinants.

SCN1A Channels a Wide Range of Epileptic Phenotypes: Report of Novel and Known Variants with Variable Presentations.

SCN1A, the gene encoding for the Nav1.1 channel, exhibits dominant interneuron-specific expression, whereby variants disrupting the channel's function affect the initiation and propagation of action potentials and neuronal excitability causing various types of epilepsy. Dravet syndrome (DS), the first described clinical presentation of SCN1A channelopathy, is characterized by severe myoclonic epilepsy in infancy (SMEI). Variants' characteristics and other genetic or epigenetic factors lead to extreme clinical heterogeneity, ranging from non-epileptic conditions to developmental and epileptic encephalopathy (DEE). This current study reports on findings from 343 patients referred by physicians in hospitals and tertiary care centers in Greece between 2017 and 2023. Positive family history for specific neurologic disorders was disclosed in 89 cases and the one common clinical feature was the onset of seizures, at a mean age of 17 months (range from birth to 15 years old). Most patients were specifically referred for SCN1A investigation (Sanger Sequencing and MLPA) and only five for next generation sequencing. Twenty-six SCN1A variants were detected, including nine novel causative variants (c.4567A>Τ, c.5564C>A, c.2176+2T>C, c.3646G>C, c.4331C>A, c.1130_1131delGAinsAC, c.1574_1580delCTGAGGA, c.4620A>G and c.5462A>C), and are herein presented, along with subsequent genotype-phenotype associations. The identification of novel variants complements SCN1A databases extending our expertise on genetic counseling and patient and family management including gene-based personalized interventions.

Measures during the COVID-19 pandemic in public primary health care in Greece: is there still a missing link to universal health coverage?

The PRICOV-19 study aimed to assess the organization of primary health care (PHC) during the COVID-19 pandemic in 37 European countries and Israel; and its impact on different dimensions of quality of care. In this paper, we described measures taken by public PHC centers in Greece. Additionally, we explored potential differences between rural and non-rural settings. The study population consisted of the 287 public PHC centers in Greece. A random sample of 100 PHC centers stratified by Health Region was created. The online questionnaire consisted of 53 items, covering six sections: general information on the PHC center, patient flow, infection prevention, information processing, communication to patients, collaboration, and collegiality. Seventy-eight PHC centers (78%) - 50 rural and 28 non-rural - responded to the survey. Certain measures were reported by few PHC centers. Specifically, the use of online messages about complaints that can be solved without a visit to the PHC center (21% rural; and 31% non-rural PHC centers), the use of video consultations with patients (12% rural; and 7% non-rural PHC centers), and the use of electronic medical records (EMRs) to systematically identify the list of patients with chronic conditions (5% rural; and 10% non-rural PHC centers) were scarcely reported. Very few PHC centers reported measures to support identifying and reaching out to vulnerable population, including patients that may have experienced domestic violence (8% rural; and 7% non-rural PHC centers), or financial problems (26% rural; and 7% non-rural PHC centers). Providing administrative documents to patients through postal mail (12% rural; and 21% non-rural PHC centers), or regular e-mail (11% rural; and 36% non-rural PHC centers), or through a secured server (8% rural; and 18% non-rural PHC centers) was rarely reported. Finally, providing information in multiple languages through a PHC website (12% rural PHC centers only), or an answering machine (6% rural PHC centers only), or leaflets (3% rural PHC centers only; and for leaflets specifically on COVID-19: 6% rural; and 8% non-rural PHC centers) were lacking in most PHC centers. Our study captured measures implemented by few PHC centers suggesting potential priority areas of future improvement.

Sensitivity Assessment of a Multiplex and Real-Time PCR Protocols for the Detection of Malaria in External Quality Control Samples in the Malaria Reference Center in Greece

Background: Accurate malaria diagnosis constitutes a challenging task, necessitating the need for the implementation of targeted and effective diagnostic tools. The purpose of the current study was to evaluate the effectiveness of two different molecular methodologies in terms of sensitivity for the detection of External Quality Assessment (EQA) Plasmodium samples. Methods: A total of 104 lyophilized blood samples from 14 different UK-NEQAS (National External Quality Assessment Site) (2016–2021) and eight WHO-NEQAS distributions (2017–2020) were analyzed. An in-house multiplex PCR protocol, followed by single target real-time PCR protocols for all five Plasmodium species, was implemented. Results: The multiplex PCR had a success rate of 10/16 and 20/28 for P. vivax and P. falciparum species, respectively. On the other hand, the respective results for real-time PCR had a success rate of 13/16 (P. vivax), 28/28 (P. falciparum), 5/8 (P. malariae), 8/10 (P. ovale), and 10/14 (P. knowlesi). Plasmodium falciparum samples displayed the highest sensitivity of detection, 0.02 parasites/μL. Plasmodium vivax samples displayed a 0.1 parasites/μL cutoff value, greater than the respective value for whole blood samples, while P. ovale species displayed a respective cutoff value of 0.05 parasites/μL. Due to the limited number of tested samples, data obtained for P. malariae and P. knowlesi species samples were inconclusive. Conclusions: Real-time PCR comprises a credible molecular methodology in terms of sensitivity assessment and detection of low parasitemia levels of Plasmodium sp. in EQA lyophilized blood samples.

The Effect of the COVID-19 Pandemic on Odontogenic Cervicofacial Infections in a Single Center in Greece.

Odontogenic cervicofacial infections are still an ongoing problem, requiring immediate hospital admittance and management. The aim of this studyis to reflect the number of patients with cervicofacial infections who were admitted during the coronavirus disease 2019 (COVID-19) pandemic period in a single, point of reference center in Northern Greeceas well as analyze the quantitative and qualitative parameters of patient characteristics and management data. This was a retrospective cohort study that included all the patients with cervicofacial infections who were admitted to our unit during the COVID-19 pandemic, specificallybetween 2020 and 2021. For comparative reasons, patients admitted with cervicofacial infections between 2019 and 2020 (pre-COVID period) were analyzed. In total, 341 patients fulfilled the criteria for this study. Specifically, the number of admitted patients was 151 in the pre-COVID era instead of 190 patients in the pandemic. The mean age of the patients was 45.3 years, with a slight male predominance (54.7% males to 45.3%). The mean duration of hospitalization was 2.5 days in the pre-COVID period instead of 3.42 days in the pandemic. Interestingly, in the pandemic, eight times more patients were admitted to the ICU post-operatively, in contrast to the pre-COVID period (23 vs 3 patients). Also in the COVID period, almost 54.9% of the patients presented with fever and 49.6% with trismus. Moreover, the submandibular space involvement was the most common space of infection in both COVID and pre-COVID groups with (58.9% and 49.7%) respectively.In one-third of all cases, a post-extraction infection of a third molar was the main cause of abscess. Cervicofacial infections during the COVID-19 pandemic appeared with more severe symptoms and resulted in an increased number of patients who needed admittance to the intensive care unit, in contrast to the pre-COVID era. Also, the mean length of stay was increased for a day at the same period. This study could be used as an example for further research, in case of similar pandemic situations in the future.

A national mental health cascade training programme for practitioners supporting unaccompanied minors in Greece.

Practitioners who support unaccompanied minors (UAMs) come from different professional backgrounds and often are not appropriately trained to address children's complex mental health needs. This gap informed a training programme across all accommodation centres in Greece. The aim of the Train-of-Trainer (ToT) national programme was to upskill trainers from 17 organisations to cascade knowledge. Training was interprofessional, trauma-informed and culturally sensitive. A pilot implementation involved 199 practitioners from all disciplines. A sub-sample of 33 practitioners, nine managers and six trainers shared their experiences in focus group discussions, which were analysed through a thematic framework. Participants found that the programme was useful in generating knowledge relevant to children's needs and their roles, addressing the emotional impact of trauma on staff, sharing learning across professional disciplines and being interactive, but systemic support should be put in place for benefits to be sustained. Train-of-Trainer is a resource-effective approach to upskill mixed staff groups across many organisations. This should involve caregivers and staff with limited educational opportunities, while accommodating for different professional needs. Training should be integrated to service budgets, specifications and structures.

Migration policies versus public health – the ethics of Covid-19 related movement restrictions for asylum seekers in reception centers in Greece in 2020

Background The emergency context of the Covid-19 pandemic necessitated the use of national and international public health measures of unprecedented scale to minimize mortality and morbidity, often in conflict with other principles and rights, such as the autonomy of individuals. Concerns have been voiced that for populations facing precarity, such as migrants, a disproportionate and unfair application of restrictive measures, deficient application of protective measures, and even enforcement of restrictive migration policies under the pretext of the pandemic has occurred. Methods Various principles have been proposed as moral foundations of public health interventions. The author used two public health ethics frameworks to examine the acceptability of movement restrictions on asylum seekers residing in refugee camps in Greece from March 2020 to October 2020. Results Most of the principles described in the frameworks for the ethical application of movement restrictions were not adhered to. Main concerns include that, measures were prolonged despite lack of evidence about their effectiveness to reduce morbidity and mortality, while posing severe and disproportionate burdens for this population. Conclusions An ethically acceptable public health response to Covid-19 is incompatible with certain living conditions of refugees, asylum seekers, and migrants. The question of whether and if so the extent to which the discipline of public health inherently has the role of rectifying existing injustices and social inequalities when these can be convincingly related to health outcomes, is central to the design of public health interventions for these populations. The answer can exemplify the need to address moral and political determinants of health. It is essential for public health professionals to be aware of the moral theorizations that underpin their work, so as to ensure that their policies are aligned with those and to contribute to the debate that shapes these determinants.

Developing an alternative curriculum for mathematics teaching in a detention faculty adopting an ethnomathematics perspective

In Greece, as more or less all over the world, the curriculum is a matter of central authority and teachers can only apply it in their classrooms, without any connection to the whole curriculum development process. Students’ population in prison schools, and especially young prisoners, often show school denial, poor performance, academic inadequacy, and failure, leading to low self-esteem (Mallett, 2014). Common barriers to participation are lack of motivation —often because of the absence of any means for meaning-making and identity formation in prison— and previous negative education experiences (Liebling, 2011) especially in secondary school when they frequently begin to truant. Working, as teacher, for long time in the secondary school of a youth detention center in Greece, I faced the challenge to reconsider the formal curriculum. Following an ethnomathematics perspective, an alternative curriculum is developing aiming to meet young prisoners’ needs and expectations as a matter of social justice, taking into consideration the need of techniques and strategies that can help to untangle and respond to above structures as part of ongoing research, policy, and practice. The young detainees following the official curriculum applied in the mainstream classes are faced with various problems, such as lack of appropriate schoolbooks, the need to motivate and successfully address educational, psychological and environmental difficulties, and the need for developing a framework for alternative teaching practices and materials based on a multicultural education with the teaching and learning of mathematics, as is the case in the field of ethnomathematics is dictated.

Patients' Intentions to Use Telemedicine for Ophthalmic Medical Care During the COVID-19 Pandemic.

Background This study aimed to examine the factors predicting participants' intention to use telemedicine during the COVID-19 pandemic. Interest in health information technologies (HITs) has increased due to COVID-19. Most studies have focused on the acceptance of HIT by physicians and nurses, while there is a lack of studies on patients' perception and acceptance of such systems in ophthalmology. Methodology In the first year of the COVID-19 pandemic, a survey comprising 19 items was conducted at an ophthalmic center in Greece. The participants included 77 patients diagnosed with various eye diseases. The survey aimed to evaluate variables related to the Technology Acceptance Model (TAM), such as perceived usefulness, perceived ease of use, facilitating conditions, and intention to use telemedicine. The statistical analyses included intercorrelations, internal consistency reliability tests, and multiple linear regression analysis to examine the predictors of intention to use telemedicine. Results The multiple linear regression analysis revealed that perceived usefulness and facilitating conditions emerged as significant predictors of eye patients' intentions to use HIT. Interestingly, while perceived ease of use did not exhibit a significant predictive relationship with use intentions, the influence of perceived usefulness and facilitating conditions within the healthcare context underscores the pivotal role of perceived utility and external support in shaping patients' willingness to engage with HIT for eye care. Conclusions Empirical data on patient acceptance offer a better understanding of the limiting factors and the variables that facilitate intentions to use services that may improve medical diagnoses, patient communication, and treatment adherence processes. Related interventions and communication efforts should highlight the benefits of HIT in ophthalmology and provide the appropriate support and means to facilitate its use during and after the pandemic.

Rapid and reliable testing for clinically actionable EGFR mutations in non-small cell lung cancer using the IdyllaTM platform: a real-world two-center experience in Greece

ABSTRACT Background Limited information exists on epidermal growth factor receptor (EGFR) molecular epidemiology in Greece. Next-generation sequencing (NGS) is the recommended method for EGFR genotyping in NSCLC. The Idylla Biocartis platform is a fully automated system for actionable EGFR mutation detection. Research design and methods We describe the prevalence of EGFR mutations in NSCLC patients in two high-volume clinical centers in Greece and compare key methods used for their determination. Eight hundred and fifty-seven FFPE samples from NSCLC patients were tested for EGFR mutations at University of Crete (UoC; n = 324) and at Evangelismos Hospital, Athens (Evangelismos; n = 503). Results The prevalence of EGFR mutations was 11.1% in the whole cohort (11.5% in non-squamous). The detection rate was 11.0% by NGS, 9.8% by Sanger and 11.3% by Idylla for the whole cohort (12.0% in non-squamous). The agreement between Idylla and Sanger was 93.2%. A targetable EGFR mutation was detected in 10.0% using tissue NGS alone, and in 16.0% using concurrent Idylla ctEGFR testing. Conclusion The frequency of EGFR mutations was as expected for a Caucasian population. The Idylla EGFR test performance is comparable to reference methods and with a shorter TAT. Adding a concurrent plasma Idylla test to tissue NGS testing increases the detection rate of EGFR mutations in NSCLC.

Refugee Children’s Career Aspirations at a Hospitality Center in Greece

A child-centered approach to education paves the way to discover a child’s personal dreams, aspirations, experiences, abilities, and interests. In child-centered educational contexts, students are encouraged to express and discover themselves. This is particularly relevant for refugee children who have suffered trauma, change, and repeated schooling interruptions that may negatively affect the future-oriented thinking that forms their career ambitions. The purpose of this study is to identify the aspirations of refugee children through a small-scale study conducted at a Refugee Hospitality Centre in the outskirts of Athens, Greece. Twenty-one (N) refugee teenagers were interviewed and participated upon their parents and teachers’ consent, through a semi-structured interview about their career preferences as well as their academic aspirations and intentions, as well as their chosen destination countries. The motives behind their choices were discussed and differentiations with gender, country of origin, and school attendance were examined. Finally, suggestions are made to support refugee students to explore possibilities about their career orientations and values in order to be included effectively within society and fulfill their aspirations.

City Branding and Video Production

Today, branding directly affects the growth process for countries, regions, and urban centers. Particularly, a successful branding process, including the framework design and establishment of regulation tools, is necessary and quite important to be able to succeed on recognize and furthermore to enhance the catch-up process, enforce competitiveness level and development. The socio-economic implications from a successful branding are more apparent using some of the main socio-economic variables, such as public investment, employability, and socio-economic regional growth. In this context, the urban and semi-urban centers must clearly define their position in the market through branding and marketing policy. This text attempts to examine the contemporary role of branding and furthermore to examine and analyze the results in the process of development for semi-urban centers in Greece.

Carbon sequestration and soil nitrogen enrichment in Robinia pseudoacacia L. post-mining restoration plantations

Robinia pseudoacacia L. (black locust) has been extensively used for restoring degraded lands, following anthropogenic interventions like coal mining. Here we have addressed the contribution of black locust restoration plantations, established on overburden post-mining material, to carbon storage and to soil nitrogen enrichment at the largest lignite center in Greece. Carbon stocks and fluxes in all pools of the ecosystem, as well as the foliar nitrogen resorption efficiency and soil N stocks were quantified and the effect of plantations’ age was tested. The young age of the plantations (4–24 years) resulted in a relatively low total ecosystem C stock (56.7 t ha−1), which was partitioned among the different pools in the following order: above-ground biomass (50%) &amp;gt; black locust-derived SOC (24%) &amp;gt; coarse roots (14%) &amp;gt; deadwood (6%) &amp;gt; forest floor (5%) &amp;gt; fine roots (less than 1%). Litterfall started early in the growing season and together with fine roots that had a turnover rate of 0.62 yr−1, fueled soil organic carbon. SOC accrual, referring to the accumulation of SOC derived by black locust, declined with age. However, further SOC accumulation is expected, based on the potential SOC storage capacity of soil at the area. C stocks in above- and below-ground biomass increased linearly with age. The same response was observed for soil N stock and NRE, indicating that despite the N2-fixing capacity of black locust, there was still a poor pedospheric N supply and a need for efficient N cycling. Overall, the studied restoration plantations have a considerable contribution to C and N accumulation at the degraded post-mining sites. These positive effects are expected to further increase at least until the plantations reach maturity.

Vaccination Rate for COVID-19 in a Primary Healthcare Center in Greece

The novel coronavirus SARS-CoV-2 has been the contributing factor to the COVID-19 disease pandemic, since early 2020. It first appeared in December 2019 and since then rapidly spread worldwide. The severe symptoms of COVID-19 disease, especially in the population groups with higher risk of infection or disease complications, along with the increased mortality rates determined the need for adequate protection and prevention measures to be taken. From the beginning of the pandemic, efforts have been made to develop and produce vaccines that could stop the spread of the disease. The vaccination in most countries was performed in phases, with priority to population groups with a higher risk of infection or disease complications, such as the elderly and patients with chronic diseases, and to population groups with a high risk of professional exposure. This study presented data from the vaccination program, implemented at a primary healthcare center in Greece, that served as a vaccination center during the pandemic. Relying on the results, both the attendance rate and the vaccination rate were very high, which proves that the necessity of the vaccine is well established and that vaccination hesitancy is mitigated among the population served at the Nikea Health Center.

Easix Indices Predict CRS and Overall Survival in Adult CAR-T Cell Recipients

Background: Immunotherapy with Chimeric Antigen Receptor T cells (CAR-Τ) is worldwide commercially available for refractory B cell malignancies, with continuously expanding indications.Given that cytokine release syndrome (CRS) and neurotoxicity (ICANS) are encountered in many CAR-T recipients both in trials and real-world setting, novel predictive and prognostic markers are highly needed. Aim: To this end, we hypothesized that EASIX (Endothelial Activation and Stress Index) and the most recently described modified EASIX (mEASIX) would be associated with severe CRS, ICANS and/or Overall Survival (OS) in the real-world setting. Methods: We collected data from consecutive adult patients (pts) from six transplant centers in Greece. Tisagenlecleucel and axicabtagene ciloleucel were administered since 2020, and brexucabtagene autoleucel since 2022. All pts received lymphodepleting therapy before CAR-T cell infusion with combination of cyclophosphamide and fludarabine. For patient monitoring as well as for prophylaxis and treatment of side effects, the EBMT and MD Anderson guidelines were adopted. EASIX (lactate dehydrogenase [LDH; U/L] x creatinine [mg/dL]/platelet [PLT] count; 10 9/L]) and mEASIX (which replaces creatinine with CRP [mg/dL]) were calculated before lymphodepletion (baseline), at day of infusion (0), and day 14 (14). The following variables were analyzed: age, gender, disease type and phase, product type, time from collection to product arrival and to infusion, progression-free (PFS) and overall survival (OS), laboratory markers at pre-specified time-points (LDH, creatinine, platelets, ferritin, CRP). Data cut-off date was end of June 2023, with at least 1 month of follow-up post infusion. Multivariate models were not performed due to multicollinearity issues. Results: Ninety pts, aged 49 (18-75) years, received commercial CAR-T cell products (33 tisagenlecleucel, 37 axicabtagene ciloleucel, 11 brexucabtagene autoleucel) for refractory/relapsed DLBCL (56), PMBCL (5), TFL (8), B-ALL (10), or MCL (11) after a median of 3 (1-9) previous lines of treatment including autologous (n=13) or allogeneic (n=7) transplantation. Severe (grade 3-4) CRS and ICANS were noted in 21% and 39%, respectively. Severe CRS was associated with mEASIXbaseline (p=0.025), and CRPbaseline (p=0.001), EASIX14 and m-EASIX14 (p&amp;lt;0.001). Both mEASIXbaseline and m-EASIX14 were able to predict severe CRS in ROC curve (AUC=0.768, p=0.032 and AUC=0.712, p=0.027). Severe ICANS did not correlate with EASIX indices, except for a trend towards statistically significant association with EASIX14 (p=0.054). On the other hand, severe ICANS was associated with increased LDH at baseline (p=0.001). With a median follow-up of 6.6 (1-42) months, 1-year PFS and OS were 33.2% and 62.5% respectively. Baseline values of ferritin and LDH, CRP values at all time-points, EASIX14 and mEASIX14 were associated with OS. Both EASIX indices predicted death in ROC curves. Similarly, EASIX14 was associated with PFS. Conclusions: This multicenter study, based on real-world experience with CAR-T cell therapy, confirms the predictive value of EASIX and mEASIX not only for life-threatening complications but also for survival outcomes. The implementation of EASIX may therefore aid in the selection of patients who are candidates for interventions to mitigate untoward sequelae of CAR-T therapy.